SURGEON  GENERAL'S OFFICE
   LIBRARY.
Section
W.D.S.G.O.
No.
zf/ttt
S—613 

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MEDICAL
JURISPRUDENCE.
BY
         ALFRED S. TAYLOR, M.D., F.R.S..
HON. M.D. UNIV. ST. ANDREWS; LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; ME.MUER
       OF THE ROYAL COLLEGE OF SURGEONS, AND LECTURER ON MEDICAL
           JURISPRUDENCE AND CHEMISTRY IN GUY's HOSPITAL.    \
Quo difficilius, hoc praclarius.
£jltrit Imnunib frnm \\t ^TnnrtJj  Itnntmc; dSiitinn.
EDITED, WITH ADDITIONS,
BY
      EDWARD HARTSHORNE, M.D.
ONE OF THE SURGEONS OF WILLS' HOSPITAL, ETC., ETC.
wft
X.
         PHILADELPHIA:
BLANCHARD  AND  LEA
             1853. 
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600
 I8Z2
        Entered according to Act of Congress, in the year 1853, by
                     BLANCHARD & LEA,
In the Clerk's Office of the District Court for the Eastern District of Pennsylvania.
WM. 9. YOUNG, PRINTER. 
PREFACE.
   In the preparation of the Fourth Edition of this work, the
 author has found it necessary to revise the whole of the chap-
 ters.  Numerous additions and alterations have been made, and
 many important cases of  recent occurrence have  been intro-
 duced.
   Under Poisoning,  the additions include a notice of the new
 enactments affecting  medical evidence, and of the recent deci-
 sions regarding the administration of poison,—some new facts
 and cases illustrative of the action of arsenic, opium, strychnia,
 the  salts of lead, antimony, and other poisons,—as well as im-
 provements in the application of chemical tests for the detec-
 tion of poisons:—under Wounds, the changes produced by the
 new statutes,—cases of peculiar and severe suicidal wounds,—
 struggling and power of exertion in wounds of the heart,—pro-
 cesses for the detection of blood-stains, and  their distinction
 from vegetable dyes,—the examination of weapons and pro-
 jectiles,—additional facts  regarding burns on the  living and
 dead bodies:  under Child-murder,  medical evidence derivable
 from an examination  of the umbilical cord, with references to
 many new cases. ■ Additions have been made under Abortion,
 on the action  of oil of savin:—under Legitimacy, on the dura-
 tion  of pregnancy,—proofs from the development of offspring,
 —plural and  twin births: — under Rape, fallacies attending
 evidence from the examination of females: under the various
 forms of death from Asphyxia,—additional facts regarding the
 examination of the bodies of persons who have died by drown-
 ing, hanging, strangulation, and suffocation,—facts and cases
 illustrating the means of distinguishing homicidal from suicidal
strangulation—under Insanity, some additions on the applica-
tion of Restraint,—decisions in recent cases, showing the  lia-
bility of medical practitioners,—the testimonial capacity of the 
IV
PREFACE.
Insane, with remarks and cases illustrative of Homicidal Mania
and the Plea of Insanity.
  The author has reason to believe that this small volume has
already found a wide circulation, not only among members of
his own profession, but among gentlemen practising at the bar.
To many of these he has to express his obligations for sugges-
tions which he has received, as well as for numerous important
facts which they have kindly communicated to him.  In order
to meet the wishes of those members of the bar who make the
book a kind of Circuit companion, a glossary containing some
professional terms used in the volume has been added.
  To make the work complete, the  author  proposes with the
least possible delay to publish a treatise on a much larger scale,
and printed in larger type. This new and enlarged volume will
embrace not only  many facts  and  cases to which it has been
impossible to give more than a brief reference in the small work
now published, but also some subjects of great  interest in me-
dical jurisprudence, for a notice of which it has not hitherto
been possible to  find room.  The new subjects  thus proposed
to be introduced, are the various modes of Death,—Sudden
Death,—the Signs of Death,—the changes in  the dead body,
including Putrefaction,—determination of the period of death,
—the disinterment of bodies,—examination of bones in refe-
rence to sex, age, stature, race, period of interment, and other
circumstances,—Age  and Personal Identity, — Presumption
of Survivorship,—Life Insurance,—and Feigned and Disqua-
lifying Diseases.
  The author cannot close this notice  without thanking the
members of the  Legal and Medical professions for the very
great encouragement which they have hitherto extended  to
his labours in the science of Medical Jurisprudence.
Guy's Hospital, June, 1852. 
PREFACE
TO THE THIRD AMERICAN EDITION
  The great popularity of Dr. Taylor's Medical Jurisprudence
is abundantly proved by the rapid disposal of several editions.
This  already wide circulation,  and the author's long estab-
lished reputation, render it  unnecessary to dwell  upon the
merits of his manual as  a standard  authority to members of
the legal and medical professions.
  It will be seen by the author's preface and the body of the work
that many advantageous changes have been made, and a large
amount of important matter  added,  in such a manner  as very
slightly to augment the volume, while they have materially
enhanced  its value.  In this way, we think, the author has
succeeded in producing a book which, however  incomplete it
may appear to  one of his great learning and rigorous exact-
ness,  will nevertheless, for practical availability  as a means
of constant  reference,  go very far to lessen, at least  in  this
country, the demand for a voluminous and costly treatise, such
as he  anticipates preparing at a future day.
  The last English edition is brought so fully up to the level
of its date, and so short  a period has since elapsed, that the
duties of  the present  editor have been comparatively light.
He has tftken care to incorporate in  his own notes such of the
additions of his predecessor, the late Dr. R. E. Griffith, as had
not been used by Dr. Taylor, or as it seemed on other accounts
desirable to retain.  He has endeavoured, also, whilst avoiding
any increase  of bulk as much as possible, to  present all the im-
portant facts and cases that have  recently occurred within his
knowledge, especially in this country;  and  he  trusts  that he
has thus  added  somewhat  to  the usefulness of  this  reprint
among his countrymen, if not to its interest generally as the
latest publication on the subject. 
vi        preface  to the  American edition.

  The  additions are, as usual,  inclosed  within brackets, and
are marked with the letter H.   The Glossary which has been
appended by the author for the benefit of members of the bar,
although brief, has not been interfered with, because the Ame-
rican editor did not feel at liberty either  to alter or to leave it
out.  It would be better for readers of every kind—legal, me-
dical, and  general—who are in need  of  explanations, to look
at once to  such a dictionary as Dunglison's Medical Lexicon,
a book which no  criminal lawyer or careful  general  reader
should ever be without, rather than to the best glossary that
could be given at  the end  of any work  on Medical Jurispru-
dence.
                                                     E. H.

   453 AValnut St., Philadelphia, \
         May, 1853.        /
                         ERRATA.

  Page 431, sixth line from top, the words, "i. e. usual in the female, we suppose," should
be enclosed within brackets.
  Page 462, fourth line from bottom, for "Brownsegnard" read Brown-S&quard.
  Page 466, first line of second paragraph, same as  above; and on second line of same
paragraph omit the word "no." 
TABLE   OF  CONTENTS.
POISONING.
                                CHAPTER I.
Definition of the term Poison—Meaning of the words Deadly Poison—Legal Defini-
  tion—Mechanical Irritants —Influence of Habit and Idiosyncrasy  on  Poisons-
  Classification of Poisons—Special Characters of Irritants, Narcotics, and Narcotico-
  Irntants
                                CHAPTER II.
Evidence of Poisoning in the Living Subject—Symptoms occur suddenly—Modifying
  Conditions—Action of Poisons increased or diminished by Disease—Symptoms con-
  nected with Food or Medicine—Sudden Death from Natural Causes mistaken for
  Poisoning—Several persons attacked simultaneously—Evidence from the Detec-
  tion of Poison in Food     .      .     .      .      .      .      .       .41

                               CHAPTER III.
On the Evidence of Poisoning in the Dead Body—Period at which Poisons prove fatal
  —Chronic Poisoning—Post-mortem Appearances produced by the different Classes
  of Poisons—Redness of the Mucous Membrane mistaken for Inflammation—Ulcera-
  tion and Corrosion—Softening—Perforations of the Stomach from  Poison and Dis-
  ease  ••......:..  46

                               CHAPTER IV.

Rules to be observed in investigating a Case of Poisoning—with respect to the Pa-
  tient while Living—the Inspection of the body—the Exhumation of Bodies—Dis-
  posal of the Viscera.  Identity of Substances.  Preservation of Articles for Ana-
  lysis.  On the Use of Notes—When allowed to be used in Evidence—Medico-legal
  Reports      •....:.                     52
                           IRRITANT  POISONS.

                                CHAPTER V.
Division of Irritant Poisons.  Sulphuric Acid or Oil of Vitriol.  Symptoms caused
  by this Poison in the Concentrated and Diluted State—Post-mortem Appearances.
  Quantity of Acid required to destroy Life—Fatal Doses—Period at which Death
  takes place—Treatment—Chemical Analysis—Mode of Detecting the Poison in Pure
  and Mixed Liquids—Its Detection in Articles of Clothing—Poisoning by Sulphate
  of Indigo    ..........   59

                                CHAPTER VI.
Poisoning by Nitric Acid or Aqua Fortis.  Action of the Concentrated and Diluted
  Acids—Post-mortem Appearances—Quantity required to Destroy Life—Period at
  which Death takes place.  Processes for Detecting the Poison in Pure and Organic
  Liquids.  Poisoning by Muriatic Acid      .      .       .      .      .      .63

                               CHAPTER VII.
Poisoning by the Vegetable Acids.  Oxalic Acid—Symptoms and Effects—Post-mor-
  tem Appearances—Fatal Doses —Recovery from  Large Doses—Period at which
  Death takes place—Treatment—Chemical Analysis—Tests for Oxalic Acid in Pure
  and Mixed Liquids—Binoxalate of Potash.   Tartaric Acid.  Acetic Acid. Vinegar   67 
vm
CONTENTS.
                               CHAPTER VIII.
Poisoning by the Alkalies.—Potash, Soda, and  their Carbonates—Symptoms—Fatal
  Effects of the Carbonates of Potash—Post-mortem Appearances—Treatment—Am-
  monia and Sesquicarbonate of Ammonia (Sal Volatile)—Chemical Analysis—Tests
  for Potash and Soda—Tests for Ammonia  .      .      .      •       .      .71

                                CHAPTER IX.
Metallic Irritant Poisons.  Arsenic—Arsenious Acid—Taste—Solubility in various
  Liquids — Symptoms — Chronic  Poisoning—Anomalous  Cases—Post-mortem Ap-
  pearances—Quantity required to  Destroy Life.—Period at which Death takes place
  —Treatment—Chemical Analysis—Tests in the Solid State—in Solution—Marsh's
  Process—Reinsch's Process—Arsenic in Organic Liquids—Absorbed Arsenic—Its
  Presence in the Soil of Cemeteries—Sulphurets of Arsenic and other Compounds  .  74

                                CHAPTER  X.
Corrosive Sublimate—Taste and Solubility—Symptoms—Its Effects compared With
  those of Arsenic—Slow or Chronic Poisoning—Salivation from Small Doses of Mer-
  curial Medicines—From other Causes—Post-mortem  Appearances—Quantity re-
  quired to Destroy Life—Period at which Death takes place—Fatal Dose—Treat-
  ment—Chemical Analysis in Powder and Solution—Process  in Organic Liquids—
  Calomel—White and Red Precipitates—Sulphurets of Mercury    .       .      .94

                               CHAPTER XL

On Poisoning  by Lead—Sugar of Lead—Symptoms—Chronic Poisoning by Sugar of
  Lead—Post-mortem Appearances—Treatment—Quantity required to Destroy  Life
  —Chemical Analysis — Lead  in Organic Mixtures—Carbonate or White Lead—
  Painter's Colic—Oxides—Litharge and Red  Lead—Accidents from the Glazing of
  Pottery      .       .      .       .      .      .      .      .       .      .104

                               CHAPTER XII.

Copper—Blue Vitriol.   Symptoms.  Post-mortem  Appearances—Treatment.  Poi-
  soning by Verdigris—Subchloride of Copper—Carbonate—Scheele's Green.  Che-
  mical Analysis—Tests—Special  Characters of the  Salts.—Copper in Organic Li-
  quids—In Articles of Food  .      .      .      .      .      .       .       .110

                               CHAPTER XIII.

Tartarized Antimony—Symptoms—Recovery from  Large  Doses—Post-mortem Ap-
  pearances— Treatment—Chemical Analysis — Tests.   Antimony in Organic Li-
  quids.  Chloride of Antimony—Analysis.  Poisoning by Sulphate and Chloride of
  Zinc. Carbonate of Zinc.  Preparations of Tin — Silver—Gold—Iron—Bismuth
  and Chrome—Bichromate of Potash  ....... 114


                       VEGETABLE IRRITANTS.

                               CHAPTER XIV.

General Remarks—Mode of Action of Vegetable Irritants.  Aloes. Colocynth. Gam-
  boge.  Jalap.  Scammony.   Savin.   Croton  Oil.  Castor Seeds.   Oil of Turpen-
  tine.  Oil of Tar.   Mouldy bread   ....... 123


                          ANIMAL  IRRITANTS.

                                CHAPTER XV.  _

Cantharides or Spanish Fly—Symptoms  and effects—Analysis.  Poisonous Food-
  Fish—Mussels—Salmon—Cheese—Sausages—Diseased Flesh of Animals  .       . 12s


                          NARCOTIC POISONS.

                               CHAPTER XVI.

Narcotic Poisons—Opium—Symptoms—Period of Commencement—Post-mortem Ap- 
CONTENTS.
IX
  pearances—Quantity required to destroy Life—Death from  Small, and Recovery
  from Large Doses—Its Action on Infants—Period at which Death takes place—
  Poisoning  by Poppies — Godfrey's  Cordial—Dalby's  Carminative — Paregoric
  Elixir—Dover's Powder—Morphia and  its Salts—Black Drop—Sedative Solution
  —Tests for Morphia and Meconic Acid—Process for Detecting Opium in Organic
  Mixtures    ..........  134

                               CHAPTER XVII.

Prussic Acid—Differences in  Strength—Taste and Odour—Conditions under which
  the Odour may and may not be Detected—Symptoms produced by Small and Large
  Doses—Period at which the  Symptoms commence—Power of Volition and Locomo-
  tion—Post-mortem Appearances—Quantity required to  destroy Life—Fatal Dose
  —Period at which Death takes place—Tests for the Acid—Vapour-Tests—Process
  for Organic Mixtures.  Bitter Almonds.  Noyau.   Cyanide of Potassium .      .  142

                               CHAPTER XVIII.

Narcotic Poisons continued.—Hyoscyamus Niger.  Lactuca Virosa and Sativa—Let-
  tuce-Opium—Solanum Dulcamara and Nigrum—Camphor—Symptoms—Alcohol—
  Symptoms—Treatment—Analysis—Action of Ether as a Liquid—Symptoms and
  Appearances—Chloroform— Symptoms and Appearances  .....  152
                   NARCOTICO-IRRITANT  POISONS.

                               CHAPTER XIX.
General Remarks—Nux Vomica—Strychnia—Colchicum—White Hellebore—Digita-
  lis—Conium Maculatum—Datura Stramonium—Aconite—Deadly Nightshade—To-
  bacco—Cocculus Indicus—Laburnum—Mushrooms—Yew ....  157


                                  WOUNDS.

                               CHAPTER XX.
Various Surgical Definitions of a Wound—Injury to the Skin—Legal Definition—An
  Abrasion of the  Cuticle not  a Wound—Implies Immediate and not Remote Lacera-
  tion  of the Skin — Is a Dislocation a Wound?—Wounds Dangerous to Life—the
  Danger imminent—Wounds producing grievous bodily harm.  Intent of the Accused
  a question for the Jury      .      .     .      .      .      .      .      .169

                               CHAPTER XXI.
Examination of Wounds in the Dead Body—All the cavities should be inspected—
  Acquittals from the neglect of this Rule—Characters of a Wound inflicted during
  Life—Of a Wound made after Death—Experiments on Amputated Limbs—Caution
  in Medical  Opinions—Wounds  or Injuries unattended by Hemorrhage.  Ecchy-
  mosis from Natural causes—In the Dead Body—Lividity—Vibices—Effects of Pu-
  trefaction—Is Ecchymosis a necessary result of Violence  .      .      .        173

                               CHAPTER XXII.

Evidence of the Use of a Weapon—Characters of Wounds caused by Weapons.—In-
  cised, Punctured, Lacerated, and  Contused Wounds—Stabs and Cuts—What are
  Weapons ?—Examination of the Dress    ......  185

                               CHAPTER XXIII.

Wounds indicative of Homicide, Suicide, or Accident—Evidence from the Situation
  of a Wound—Suicidal Wounds in  unusual Situations—Evidence  from Nature and
  Extent—Shape—Evidence from the Direction of a Wound—Wounds inflicted by the
  Right or Left Hand—Accidental  and Homicidal Stabs—Evidence from the presence
  of several Wounds—The use of several Weapons—Two or more Mortal Wounds—
  Wounds produced simultaneously or at different times     ....  189

                               CHAPTER XXIV.

Evidence from Circumstances — Medical Questions—Value of Circumstantial  Evi-
  dence—The Position of the  Body—Of the Weapon—The Weapon or other  Articles 
X
CONTENTS.
  found in the Hand of the Deceased—Evidence  from Blood on Weapons—Marks
  of Blood on the Person or in the Apartment—Position of the Person when mor-
  tally Wounded—Evidence from Wounds on the Deceased—No Blood on the As-
  sailant— Fallacy  respecting Marks  of  Blood.   Arterial distinguished from Ve-
  nous Blood—Evidence from the Form and Direction of Spots of Blood .       • 197


                                CHAPTER XXV.
Distinction of Suicidal from Accidental Wounds—Important in Cases of Life-Insurance
  —-Wounds on the Throat—Facts indicative of Suicide, Homicide, or Accident—Im-
  puted or Self-Inflicted Wounds—Motives for their production—Characters of Imputed
  Wounds—Rules for detecting False Charges of Murder    .       .      •       .204


                               CHAPTER XXVI.
The Cause of Death in Wounds—Caution in assigning  too many causes—Wounds
  directly or indirectly fatal—Death from hemorrhage—Loss of Blood required to
  prove fatal — Modified by Age and other  circumstances—Fatal Wounds of small
  Arteries—Internal Hemorrhage—Death from Mechanical Injury to a Vital Organ
  —Death from Shock—Blows on the Abdomen—Flagellation—Death from a multi-
  plicity of Injuries without any mortal Wound—Subtle Distinctions  respecting the
  Mortality of Wounds       .      .      .       .      .       .      .       .208

                              CHAPTER XXVII.
Chemical Examination of Blood-stains—Action of the Tests on Organic and Inorganic
  Red  Colouring Matters—Stains of Blood on Linen and other Stuffs—Date of the
  Stains—'Evidence from the Detection of Fibrin—Insoluble Stains resembling Blood
  —Red Paint mistaken for Blood—Soluble Stains of Fruits, Flowers, Roots and Ex-
  tracts— Removal  of Blood-stains from Articles of Clothing—Stains of Blood on
  Weapons—Citrate of Iron Mistaken for Blood—Distinction of Stains from Iron-rust
  —Colour from Red Dyes—Blood of Man and Animals—Evidence from the Odour—
  —Microscopical Evidence—Form and Size of the Red Globules in Mammalia and
  other Classes .........        . 214

                              CHAPTER XXVIII.
Death of Wounded Persons from Natural Causes—Distinction  between Real and Ap-
  parent Cause — Death from Wounds or Latent Disease—Accelerating Causes—
  Which of two wounds caused death?—Death following slight Personal injuries    . 224


                               CHAPTER XXIX.
Wounds indirectly fatal—-Death from Wounds after long  periods—Secondary  Causes
  of Death—The Cause is unavoidable—The Cause avoidable by Good Medical Treat-
  ment—Comparative Skill in Treatment—Cause avoidable but for Imprudence on
  the part of the Wounded Person—Abnormal or Unhealthy State of Body—Accele-
  ration of Death      .       .      .      .      .       .       .      .       .227

                               CHAPTER XXX.
Wounds indirectly fatal.  Tetanus following Wounds—Causes of—Death from Surgi-
  cal Operations—Primary and Secondary Causes of Death—Unskilfulness in Opera-
  tions—Necessity for the Operation—Erysipelas following Operations.    .        . 231


                               CHAPTER XXXI.

Cicatrization of Wounds—Evidence from Cicatrices—Changes in an Incised Wound—
  Is a Cicatrix always a Consequence of a wound?  Are cicatrices, when once formed,
  indelible?—Characters of Cicatrices—Medical Evidence  respecting the period at
  which a Wound was  inflicted—Changes in Contusions—How  long did the Deceased
  survive the Wound? ......... 234


                               CHAPTER XXXII.
Acts indicative of Volition and Locomotion—Injuries to the Head not immediately
  fatal—Wounds of the Heart  not immediately fatal—Wounds of the Carotid Arteries
  —Locomotion after Ruptures of the Diaphragm and Bladder—Summary  .       .237 
CONTENTS.
XI
                               CHAPTER XXXIII.

Wounds as they affect Different Parts of the Body—Wounds of the Head—Of the Scalp
  —Concussion—How distinguished from Intoxication—Extravasation of Blood—Feat
  of—As a result of Violence, Disease, or Mental  Excitement—Wounds of the Face
  —Of the  Orbit—Of the Nose—Deformity as a consequence of Wounds of the Face
  —Injuries to the  Spine—Fractures of the Vertebrae—Death from Injuries to the
  Spinal Marrow     ......... 242

                               CHAPTER XXXIV.
Wounds of the Chest—Of the Lungs—Ruptures from Accident— Wounds and Ruptures
  of the Heart—Wounds of the Aorta and Venae Cavae—Wounds and Ruptures of the
  Diaphragm—Direction of Wounds of the Chest—Wounds of the Abdomen—Death
  from Blows on the Cavity—Ruptures of the Liver, Gall-Bladder, Spleen, Kidneys,
  Intestines, Stomach, and Urinary Bladder—Medico-legal Questions connected with
  Ruptured Bladder—Wounds of the Genital Organs—Mutilation    .     .      . 248


                               CHAPTER XXXV.

Fractures—Produced by a Blow with a Weapon or by a Fall—Occur in the  Aged—
  Brittleness of the  Bones—Fractures caused by slight Muscular Exertion—In the
  Living and Dead Body—Has a Bone ever been Fractured?—Questions of Survivor-
  ship—Dislocations from Violence or Natural Causes—Diagnosis—Actions for Ma-
  lapraxis     .......... 258

                               CHAPTER XXXVI.
Gun-Shot Wounds—Their Danger—On the Living and Dead Body—Was  the Piece
  fired near or from a distance?—Evidence from several Wounds—Deflection of Balls
  —Accidental, Suicidal, or Homicidal Wounds—Position of the Wounded Person when
  Shot—Wounds from Small Shot—Wounds from Wadding and Gunpowder—Identity
  from the  Slash of Powder—Examination of the Piece            •»               262


                              CHAPTER XXXVII.

Burns and  Scalds—Circumstances which render them dangerous to Life—Did the
  Burning take place before or after Death?—Experiments on the  Dead  Body—Vesi-
  cation and Line of Redness—Presence of Several Burns—Summary.   Accident,
  Homicide, or Suicide—Human  or Spontaneous Combustion—Burns by  Corrosive
  Liquids—Spontaneous Ignition of Organic and Mineral Substances  .      .       .271
                                INFANTICIDE.

                              CHAPTER XXXVIII.
 Nature of the Crime—The same Evidence required as in other cases of Murder—Proof
   of Life Demanded—Body of the Child not discovered—Medical Evidence at In-
   quests—Age or Maturity  of the Child—Viability not required to be proved—^Cha-
   racters from the Sixth to the Ninth Month—Signs of Maturity—Abnormal Devia-
   tions—Position of the Umbilical Opening—General Conclusions—Rules for Inspect-
   ing the Body .......... 281

                               CHAPTER XXXIX.
 On the Proofs of a Child having lived at its Birth—Evidence of Life before Respira-
   tion—Signs of Putrefaction in Utero—Evidence from Marks of Violence—Summary
  —Evidence of Life after  Respiration—Inspection of the Body—Colour, Volume,
  Consistency, and Absolute Weight of the  Lungs—Static Test—Weight increased
  by Respiration—Test of  Ploucquet — Blood in the  Pulmonary Vessels—Relative
   Proportion  of Fat in the  Lungs—Specific gravity of the Lungs—General Conclu-
   sions ........... 287

                                 CHAPTER XL.
Mode of Employing the Hydrostatic Test—Incorrect Inferences—Sinking of the Lungs
  from Disease or Atelectasis—Life with partial Distention of the Lungs—Life with
  perfect Atelectasis or entire Absence of Air from the  Lungs—Hydrostatic Test 
xu
CONTENTS.
  not applicable to such cases—Erroneous  Medical Inference from  Sinking  of the
  Lungs—Floating of the Lungs from Emphysema and Putrefaction—Effects of Pu-
  trefaction in Air—General Conclusions respecting the Hydrostatic Test   .       . 2!>/

                                 CHAPTER XLI.
Floating of the Lungs from Artificial  Inflation.  Inflation distinguished from perfect
  Respiration^not distinguishable  from imperfect  Respiration — Doubtful Cases—
  Results of Compression—Improper  Objections to  the Hydrostatic Test—Summary
  —Respiration before Birth—Vagitus Uterinus—Respiration a Sign of Life, not  of
  Live Birth—The Killing of Children which Breathe during Birth not Child murder.
  General Conclusions ......... 30.j

                                CHAPTER XLII.
On the Proofs of a Child having been born alive—Evidence from Respiration—Evi-
  dence from Marks of Violence—Evidence from Natural Changes  in the Umbilical
  Vessels, the  Foramen Ovale, and Ductus Arteriosus—Closure of the Foramen and
  Duct before  Birth—Evidence from the Discovery of Food in the Alimentary Canal
  —Detection of Live Birth by the Application of Chemical Tests to the Contents  of
  the Stomach—Defective Evidence.—General Conclusions  .      .       .       . 31G

                               CHAPTER XLIII.
Rules for determining the period of Survivance in Children that have been born alive.
  Appearances indicative of a Child  having  lived twenty-four hours—From two  to
  three days—From three  to four days—From four to six days—From six to twelve
  days—Uncertainty of Medical Evidence.—On the Period which has elapsed since
  the Death of the Child—Process of Putrefaction in the Bodies of New-born Child-
  ren—General Conclusions  .      .       .      .       .      .       .       . 321

                               CHAPTER XLIV.
Causes of Death in New-born Children—Proportion  of Children born  Deal—Natural
  Causes of Death—A Protracted Delivery—Debility—Hemorrhage—Laceration  of
  the Cord—Compression  of the Cord—Malformation — Destruction of Monstrous
  Births Illegal.—General Conclusions       .      .       .       .       .       . 32 o

                                 CHAPTER XLV.

Violent Causes of Death—Forms of Violent  Death unattended by Marks of External
  Violence—Suffocation—Drowning—In the Soil of Privies—Power of  Locomotion
  and Exertion in Females after Delivery—Death of the Child from Cold and Expo-
  sure—Starvation—Immaturity in Cases of Abortion—Wounds, Evidence from,  in
  New-born Children—Fractures of the Skull, Spontaneous and Criminal.—Death of
  the Child from Delivery in the Erect  Posture—Accidental Injuries in Utero—De-
  ficient  Ossification—Twisting of the Neck—Violence in Self-delivery.—General
  Conclusions .......... 330

                                CHAPTER XLVI.

Death of the Child from Strangulation—Deceptive Appearances on the Body—Strangu-
  lation by the Umbilical Cord—Diagnosis—Accidental  Marks resembling those°of
  Strangulation—Constriction before and after Death—Before and after Respiration
  —Constriction before and after entire Birth—Before and after the severance of the
  Umbilical Cord—Constriction without Ecchymosis—Examination of the Mother—
  Summary of Medical Evidence—Death of the Child after Birth from Wounds during
  Delivery.—General Conclusions    ......       * 341
                                PREGNANCY.

                               CHAPTER  XLVII.
Pregnancy in its Legal relations—Cases of rare occurrence—Signs of Pregnancy__Sup-
  pression of the Menses—Prominence of the Abdomen—Changes in the Breasts__
  Quickening—Uncertainty  of the period  at which it occurs—Sounds of the Fcetal
  Heart—Kiestein in the Urine—Changes in the Os and Cervix Uteri—Feigned Preg-
  nancy—De Ventre Inspiciendo—Plea of Pregnancy in bar of execution—The Jury
  of Matrons and their Mistakes—Concealment of Pregnancy a Crime in the Scotch
  Law—Pregnancy in the Dead—Pregnancy in a state of Unconsciousness  . 
CONTENTS.
Xlil
                                DELIVERY.

                              CHAPTER XLVIII.

Delivery in its Legal Relations—Delivery in the Living—Concealed Delivery, Abor-
  tion in the early Stages of Pregnancy—The Signs speedily disappear—Early Exa-
  minations—Signs of recent Delivery in advanced Pregnancy—Evidence from the
  Skin of the Abdomen—The organs of Generation—The Presence of the Lochia—
  Signs of Delivery at a remote period—Feigned Delivery—Delivery in a state of Un-
  consciousness—Circumstances under which this may occur—Natural  and  Morbid
  Sleep—Admission of the Plea in cases of alleged Child-murder—Signs of Delivery
  in the Dead—Appearances of the Internal Organs in cases of recent Delivery—
  Their rapid obliteration—True and  False Corpora Lutea—Fallacies to which they
  give rise—Examination of the Ovum or Embryo—Its Characters from the First to
  the Sixth Month—Abortion of Moles and Hydatids.—Medico-Legal Cases .       . 363


                       CONCEALMENT  OF  BIRTH.

                               CHAPTER  XLIX.
Medical Evidence required in reference to Delivery—Concealment of the Birth of a
  Child—Definition of the Crime—Females acquitted of Infanticide found guilty of
  Concealment—Medical Evidence from the Remains of the Body—Analysis of Bones
  —The Child must be dead—Concealment of the Ovum or Embryo—Not necessary
  to prove when the Child died       ....... 375


                          CRIMINAL  ABORTION.

                                CHAPTER L.
General Remarks on  the Crime of Abortion—Abortion from Natural  Causes—Its
  Frequency—Criminal Causes—Local Violence—Abortion by Mechanical Means—
  From Venesection—Medicinal Substances—Popular Abortives—S;gns of Abortion
  in the Female—Specific Abortives—Abortion not  always a result of Poisoning—
  Local Applications—Feigned Abortion—Legal Relations—Meaning of the  word
  Noxious as applied  to Drugs—On Inducing Premature Labour—Medical Responsi-
  bility—Proof of Pregnancy not necessary—Abortion of Monsters—Extra-uterine
  Conceptions—Abortion of Moles and Hydatids     .      .      .      .       .377


                          BIRTH.  INHERITANCE.

                                CHAPTER  LI.
Evidence of Live Birth in Civil Cases—Legal Rights of the Foetus in Utero—Differ-
  ences between Entire and Partial Birth—Case—Signs of Live Birth independent of
  Respiration or Crying—Conflicting Medical Evidence in the Case of Fistiv. Palmer
  —Motion  of a Lip a Proof of Live Birth—Vagitus Uterinus—Possessio Fratris—
  Tenancy by Courtesy —Csesarean Extraction  of Children—Legal Birth—Post-mor-
  tem Births—Date of Birth—Minority and Majority—Medical Evidence in  relation
  to Plural Births—Monsters—What  constitutes a Monster in Law—Deprivation of
  Legal rights—Double Monsters—Christina Ritta—The Siamese Twins    .      . 387


                                LEGITIMACY.

                                CHAPTER LII.

Legal Presumption of  Legitimacy—Date of Conception not regarded—Difference be-
  tween the English and  Scotch Law—Children born after Death—Natural Period of
  Gestation—Duration from one Intercourse—Premature Birth—Short Periods of Ges-
  tation—Viability—Earliest Period  at which  a Child may be  born Living—Fama
  Clamosa—Evidence from the State of the Offspring—Can fully-developed Children
  be born prematurely ?—Protracted  Births—Long  Periods of Gestation—Cases—
  Longest Periods yet known—The Sex  of the Child  has  no influence—Period not
  fixed by Law—Gardner Peerage Case—Evidence from the State of the Child—Le-
  gal Decisions—Mistakes in the Mode of Computation      .... 397 
xiv
CONTENTS.
                                PATERNITY.

                               CHAPTER  LIII.
Disputed Paternity—Evidence from Likeness—Douglas Peerage Case—Parental Like-
  ness—Affiliation—Posthumous Children—Superfcetation in relation to Legitimacy-
  Circumstances under which it is supposed  to occur—Superconception—Suppositi-
  tious Children—Relation of the Subject to Feigned Delivery and Legitimacy    .41*


                           HERMAPHRODITISM.

                               CHAPTER  LIV.
Sexual Malformation—Hermaphroditism—Androgynus—Androgyna—Distinction of
  Sex—Mistakes in the Sex of Children—Rules for Diagnosis—Cases—Causes of Sex-
  ual Deformity in  the Foetus—Legal Relations—Cases in which the Determination
  of the Sex is necessary—Imputation of Hermaphroditism—The Rights of Electors
  dependent on a normal condition of the Sexual Organs—Concealed Sex   .      . 425


                        IMPOTENCY.  STERILITY.

                                CHAPTER  LV.

Impotency—Definition—Physical Causes—Procreative Power in the Male—Puberty
  — Age of Virility—Loss of Virile Power by Age—Diseases of the Testis—Powers
  of Crypsorchidesand Monorchides—Supernumerary Testes—Arrested Development
  —Moral Causes—Sterility—Causes of—Procreative Power in the Female—Puberty
  —Earliest and latest Ages for Child-bearing—Female Precocity—Menstrual Cli-
  macteric—Age for Cessation—Remediable Causes  of Sterility—Legal Relations of
  the Subject—Contested Legitimacy and Divorce   ..... 434


                                   RAPE.

                               CHAPTER  LVI.
Nature of the Crime—Sources of Medical Evidence—Rape on Children—Legal Com-
  pletion—Proofs of  Penetration—Absence of  Marks  of Violence—Purulent Dis-
  charges from the Vagina—Evidence from  Gonorrhoea and Syphilis—From Marks of
  Violence—Rape on Young Females after Puberty—Defloration—Signs of Virginity
  —Proofs of  Intercourse—Rape on  the Married—Rape under the  influence of Nar-
  cotics—On Idiots—Microscopical Evidence—Legal Relations—Sodomy   .       .417
                        ASPHYXIA.  DROWNING.

                               CHAPTER LVII.

Drowning—Cause of Death—Death not caused by Apoplexy—Asphyxia—Mixed Cases
  —Death from Secondary Causes—Period at which Death takes place—Period for
  Resuscitation—Cases of Recovery—Treatment—Post-mortem Appearances—Ri-
  gidity and Spasm in the Drowned—External and Internal Appearances—Was Death
  caused by Drowning ?—Substances grasped in the Hands—Water in the Stomach—
  Mucous Froth in the Trachea  and  Lungs—Water in the Lungs—Destruction of
  Post-mortem Appearances—Specific Gravity of the Human Body living and dead—
  Survivorship of the Drowned—Summary of Medical Evidence—Marks of Violence
  on the Drowned—Accidental Fractures—Was the Drowning the result of Homicide,
  Suicide, or Accident?—Drowning in  Shallow Water—by Partial Immersion of the
  Body.       .......... 460


                                HANGING.

                              CHAPTER LVIII.

Cause of Death—Rapidity of Death—Death from the Secondary Effects—Treatment
  —Period at which Death takes place—Post-mortem Appearances—Mark of the Cord 
CONTENTS.
XV
or Ligature—Unecchymosed Marks—Other Appearances—Was  Death caused by
Hanging ?—Hanging post-mortem—Summary of Medical Evidence—Circumstantial
Evidence—Marks of Violence on the Hanged—Was the Hanging the result of Acci-
dent, Suicide, or Homicide?—Homicidal Hanging—Injury to the Cervical  Vertebras
—The Position of the Body—The Limbs secured—Power of Self-suspension      . 487
                            STRANGULATION.

                               CHAPTER LIX.

Cause of Death—Post-mortem Appearances—Was Death caused by Strangulation, or
  was the Constriction applied  to the Neck after Death ?—Casper's Experiments on
  Post-mortem Strangulation—Marks of Violence—Accidental, Homicidal, and Sui-
  cidal Strangulation—Cases  ........ 508
                              SUFFOCATION.

                               CHAPTER LX.

Suffocation from Mechanical Causes—Various Forms of—Cases—Cause of Death—
  Post-mortem Appearances—Evidence of Death by Suffocation—Accidental, Suicidal,
  and Homicidal Suffocation—Medical and Physical Evidence of the Cause of Death
  —Cases—Smothering       .       .      .       .      .      .      .       .519

                               CHAPTER  LXI.
Gaseous Poisons—Mode  of  Action—Asphyxiating and Poisonous  Gases—Cause of
  Death mistaken—Carbonic Acid—Symptoms—Appearances—Mode of Action—Ab-
  sorption—Treatment—Analysis—Charcoal Vapour—Its Effects—Products of Burn-
  ing Wood—Coal and Coke Vapour—Sulphurous Acid—Vapour of Lime and Brick-
  Kilns—Confined Air—Effect of Carbonic Acid on Combustion—Its Diffusion—Coal
  Gas—Carburetted Hydrogen—Carbonic Oxide      ..... 525

                              CHAPTER  LXII.

Sulphuretted Hydrogen  Gas—Its  Poisonous Properties—Symptoms—Post-mortem
  Appearances—Effluvia of Drains and Sewers—Analysis—Me"phitic Vapours—Exha-
  lations of the Dead  ......... 537
                  LIGHTNING.  COLD.  STARVATION.

                              CHAPTER LXIII.

Lightning—Effects of the Electric Fluid—Cause of Death—Post-mortem Appearances
  —Cases—Legal  Relations—Cold—An occasional Cause of Death—Symptoms—
  Circumstances which accelerate Death—Post-mortem Appearances—Case of Mur-
  der by Cold—Starvation—A Rare Cause of Death—Symptoms—Post-mortem Ap-
  pearances—Summary of Medical Evidence—Legal Relations      .      .       .542
                                INSANITY.

                              CHAPTER  LXIV.

Legal Definitions—Lunacy—Non Compos Mentis—Unsoundness of Mind—Varieties
  of Insanity—Mania—Hallucinations—Illusion—Delusion — Mania distinguished
  from Delirium—Monomania—Known from Eccentricity—Moral Insanity—Demen-
  tia—Idiocy—Imbecility—Post-mortem Appearances—Hereditary Transmission—
  Feigned Insanity—Mode of Detection     ...... 551

                               CHAPTER LXV.

Medico-legal Questions in relation to the  Insane—Imposition of Restraint—Illegal
  Imposition of Restraint—Violence of Temper—Certificates of  Insanity—Rules for
  the Discharge of Lunatics   .       .      •      •      .       .       .      . 55? 
XVI
CONTENTS.
                               CHAPTER  LXVI.

Testimonial Capacity of Lunatics—Interdiction—Commissions of Lunacy—Examina-
  tion of Alleged Lunatics—Medical and Legal Tests of Competency—Lucid Inter-
  vals  ........... 5fi4

                               CHAPTER LXVII.
Responsibility in Civil Cases—Insanity as  an Impediment to Marriage—Deeds and
  Contracts—Wills made by the Insane—Testamentary  Capacity—Test of Capacity
  —Delusion in the Deed—Eccentricity in Wills—Wills in Senile Dementia—Wills
  in Extremis—Restriction of Medical Opinions      .      .      .       •       .569

                              CHAPTER LXVIII.
The Plea of Insanity—Homicidal Monomania—Moral Insanity—Causes—Symptoms
  —Legal  Tests—Medical  Tests—Motive for Crime—Confession—Accomplices—
  Delusion in the Act—Summary—Test of Irresponsibility—Cases in  Illustration—
  Summary of Medical Evidence      ....... 574

                               CHAPTER  LXIX.
Suicidal Mania—Suicide not necessarily indicative of Insanity—Suicide a Felony—
  In relation  to Life-Insurance—Hereditary Taint—Puerperal Mania—Pyromania—
  Kleptomania—Drunkenness—Civil and Criminal Responsibility of Drunkards—Illu-
  sion— Restraint—Interdiction—Delirium Tremens—Somnambulism—Civil and
  criminal Liabilities of the  Deaf and Dumb.        ...              . 590

Glossary      .......... 603
Index
.  609 
MEDICAL   JURISPRUDENCE.
POISONING.
                             CHAPTER I.

DEFINITION OF THE TERM POISON—MEANING OF THE WORDS DEADLY POISON—LEGAL DEFI-
  NITION--MECHANICAL IRRITANTS--INFLUENCE OF HABIT AND IDIOSYNCRASY ON POISONS
  —CLASSIFICATION OF POISONS—SPECIAL CHARACTERS  OF IRRITANTS, NARCOTICS, AND
  NARCOTICO-IRR1TANTS.

  Definition.—A poison is commonly defined to be a  substance, which, when
administered in small quantity, is  capable of acting deleteriously on the body.
It is obvious that this definition is too restricted for the purposes of medical juris-
prudence.  It would, if admitted,  exclude numerous substances, the poisonous
properties of which cannot be disputed; as, for example, the salts of lead, copper,
tin, zinc, and antimony, which are only poisonous when administered in very
large doses.   Nitre, it  is well  known, exerts a poisonous action only in large,
while arsenic is poisonous in small doses; but in a medico-legal  view, whether a
person die from  the effects  of an ounce of nitre, or five grains of arsenic, is a
matter of little importance.   Each substance must be regarded as a poison, dif-
fering from  the other only in its degree  of activity, and perhaps in  its mode of
operation.  The result is the same; death is caused by the substance taken, and
the quantity required to kill  cannot, therefore, be made a ground for distinguishing
a poisonous from a non-poisonous substance.  If, then, a medical witness be asked,
"What is a poison?" he must beware of adopting this common definition, or of
confining the term poison to those  substances only that operate in small doses.
  The fact that a poison has been commonly regarded as a substance which pro-
duces serious effects when taken in small quantity,  has induced many who have
adopted this  arbitrary view to assert that certain substances which have actually
been known to cause death, are not poisons; and this doctrine has been apparently
strengthened by the fact, that were not  some such  distinction adopted, it would
be difficult to separate the class of poisons from bodies which are reputed inert.
In answer to this view, it is,  perhaps, sufficient to show that there  is  no good
reason for assuming this as the distinguishing character of a poison;  for it is im-
possible, even among substances universally admitted to be poisonous, to make
any division  according to.the effects produced by the quantity taken.  In relation
to the quantity required to operate fatally, the difference is not so great between
cream of  tartar and oxalic acid as between oxalic acid and strychnia.
  Deadly Poison.—There is another point of view in which this question may
require to be considered, namely, What is to be understood by a deadly poison?
       3 
34
MEANING OF THE WORDS DEADLY POISON.
In  most indictments for poisoning, it is customary to describe every poison as
deadly,—a form of expression decidedly bad, and calculated to give rise to tech-
nical objections.   The  substance  administered might, with  equal propriety, be
described as poisonous, or of a destructive nature: but those who draw up indict-
ments are but little informed  on such matters, and they can never  speak of a
poison without describing it as deadly.  This term can be applied with propriety
only to those poisons which  may prove speedily fatal in small doses,—e.  g.,
prussic acid, arsenic, aconitina, and nicotina;  and although  it has been used in
indictments in reference to such substances as blue and green vitriol,  or common
sal  volatile,  this has arisen from an unnecessarily strict adherence  to old legal
forms.  In a case (Reg. v. Hay don, Somerset Spring Assizes,) in which "spirit
of hartshorn" was thus described as a "deadly poison," and an objection was
taken to the validity of the indictment, the learned judge (Earle J.) held that the
word deadly was not essential: it was mere surplusage.  (Law Times, April 12,
1845.)  This decision is in accordance with common sense.
  In legal medicine, it is difficult to give such a definition of a poison as shall be
entirely free from objection.   Perhaps the most comprehensive  definition which
can be suggested is this:—"A poison is a substance which, when taken internally,
is capable of destroying life without acting  mechanically on  the system."   But
it is well known that some substances act as poisons by absorption when applied
to the  skin of a wounded surface; while  others again, as the poison  of the viper,
and of rabies, may have their fatal effects limited to those cases in which they
are introduced by a wound: and a third class may destroy life  merely by their
chemical effects upon the parts with which they come in contact, without  neces-
sarily poisoning the blood by absorption; e. g. sulphuric acid.  These facts show
that it is very difficult to comprise in a few words an accurate  description of what
should be understood by the term  " poison."
  Legal definition.—In reference to the medical definition of a poison, it is ne-
cessary to observe that the law never regards the manner in which the substance
administered acts.  If it be capable of destroying life, or of  injuring the health
of an individual, it is of little consequence, so far as the responsibility of a prisoner
is concerned, whether its action on the body be of a mechanical or chemical nature.
Thus a substance which simply acts mechanically on the stomach, may, if wil-
fully administered with intent to  injure, involve a person in a criminal charge,
as much  as if he had administered arsenic or any of the ordinary poisons.   It is,
then, necessary that we should consider what the law  strictly means  by the act
of poisoning.   If the substance criminally administered destroy life, whatever
may be its nature or mode of operation, the accused is tried on a charge of murder
or manslaughter, and the whole duty of the medical  witness consists in showing
that the substance taken was the certain cause of death.  If, however, death be
not a consequence, then the accused is tried under a particular statute for the
attempt to murder by poison.  (1 Vict. c. 85, sec.  2.)  The words of this statute
are very general, and embrace  all kinds of substances, whether they be popularly
or professionally regarded as poisons or not.   Thus it is laid down that—
  "Whosoever shall administer, or cause to be taken by any  person, any poison,
or other destructive thing, with intent to commit murder, shall be guilty of felony,
and, being convicted thereof, shall suffer death."
  Whether the administering be followed by death or bodily injury dangerous to
life, it is still a capital felony, provided the intent have been  to commit murder.
The same administering with  intent, &c, although  no bodily injury be effected
is felony, punishable by transportation for life, for fifteen years, or imprisonment
for  any term, not exceeding three years.   [In all the states of our Union wilful
but unsuccessful attempts to destroy life by poison are ranked among the higher
crimes; and in the Revised  Statutes of New York it is now provided that similar
attempts shall be punished by ten years' imprisonment in a state prison.  Revised
Statutes, ii. 665.   The following  also are treated as offences in the same enact- 
MEDICAL AND LEGAL DEFINITIONS OF A POISON.
35
 ments: "Mingling poison with any food, drink, or medicine, with intent to kill
 or injure any human being; wilfully poisoning any spring, well, or  reservoir of
 water; and administering, or exposing any poisonous substance so that it should
 be taken by any horse, cattle,  or sheep."   Ibid. 666, 689.  "If any physician,
 while in a state of intoxication, shall, without a design to effect death, administer
 any poison, drug, or medicine, or do any other act to another person, which shall
 produce the death of such  other, he shall be  deemed guilty of manslaughter."
 Ibid. 662.  ^ "If, under the same circumstances, a physician, or any other person,
 prescribes either of the above,  and life is endangered, it is declared a  misdemean-
 or."   Ibid.  694.  Vide Beck's Med. Jurisp. ii. 373.   A stringent  act for the
 regulation of the sale of poisons, and resembling the present British  law, is now
 in force in the state of Ohio, but we are informed that  its  provisions are not
 regarded. H.]   From the words of the  statute it appears that the law requires,
 in order to constitute the crime of poisoning, that the substance should be  admi-
 nistered to, or be taken by, an individual.  Several deaths have been caused of
 late years by the external application of arsenic and corrosive sublimate to ulcer-
 ated and diseased surfaces.   Supposing  that poison is thus applied intentionally,
 and great bodily injury is  done to the individual, it might be a question whether
 the crime could  be  punished under these sections of the  statute.  Lord Camp-
 bell's act (14 and 15 Vict. c. 19,) appears to provide for this description of offence,
 although the application or administration is herein limited to chloroform, lauda-
 num, or other  stupifying drug.  The external application of arsenic  in a way to
 produce personal injury would, no doubt, be considered an act of administration.
   [In a  former  edition Dr. Griffith observes, "As the laws of most, if not all,
 the states, use  the word poison, without defining it, a medical witness is  liable
 to be called upon to  declare whether certain  substances are, or are  not, to  be
 considered as poisons: in some instances, as may be seen,  this is extremely diffi-
 cult.  Were our  laws so  modified as to define the crime of poisoning to be the
 administration of any destructive article with an intent to kill,  there would  be
 but little ambiguity; but, as the statutes now stand, it is almost impossible to
 decide what are to be regarded as poisons:  thus, whilst a death by the adminis-
 tration of one of the mineral acids is, without hesitation, considered as "by poison,"
 it is extremely doubtful whether  a murder by pouring boiling water into the
 mouth would be so ruled,  and yet the injuries causing death are essentially the
 same in both instances, each acting as  a mechanical irritant.  So also, when a
 person throws sulphuric acid on another, and death is  the result, is  it to  be re-
 garded as a case of death by poison? The substance employed is admitted  to
 be a poison, when given internally;  would it be so, when applied  externally?
 The definition of a poison, in the text, is a modification of that given by Duver-
 gie {[Med. Leg.  ii. 430,) and, though better than that of most authors, is deficient
 in not including poisons acting externally.  Now, it is well known that many of
 the admitted poisons are capable of inducing death when applied to the surface
 as, for instance, arsenic, strychnia, &c.   The following will include  almost all
 cases that can occur:  'A poison is a substance  which, when taken internally,  or
 applied to the surface of the body, is capable of destroying life, without  acting
 in a purely mechanical manner.'  Mr. Taylor (Poison*, 18) objects to this defi-
 nition, as not sufficiently precise, but it is certainly as much so  as the nature of
 the case will admit."
   The foregoing  note of Dr. Gr. is retained without alteration, although we are
disposed to admit the force of Mr. T.'s objection above acknowledged.  "Can it
be said," he justly asks, (he. cit.j "that boiling water, or oil, or melted, lead
when applied to the surface of the body, destroy life by exercising a mechanical
action ?  If not, then these liquids are poisonous.   If, however, this kind of ac-
tion be regarded as mechanical, then the mineral  acids and alkalies  must also
be considered by their effects to act mechanically whether applied to the skin or
the mucous membrane of the stomach."   We must remember too that even if 
36          STATUTE ON POISONING.—MECHANICAL IRRITANTS.

the law described the act of poisoning to be the administration, no matter how,
or by what  passage  into the human  organization, of "a destructive article" or
"thing," it  would still leave us to determine in each case  the  reality of  the de-
structiveness required in the "thing"  proved to have been employed.   In short,
no single form of words would seem to comprise enough to relieve us of the doubt
in many cases that must now and then occur.—H.]
   It will be perceived that the words  of the statute leave the question <<what is
a poison" to depend upon the medical evidence adduced.  In a trial which took
place lately  at the Chelmsford Assizes, a woman was charged with administering
white precipitate to her husband with intent to kill.  She was acquitted on the
ground that there was no evidence to show that white precipitate was either a
poison or a destructive thing.   It is, however, placed beyond doubt that this
substance is not only capable of producing noxious effects, but of destroying
human life; hence, this acquittal was based on a pure mistake.  White precipi-
tate is not  by any  means so poisonous as corrosive  sublimate, but it is un-
doubtedly a mercurial poison.   White hellebore has been pronounced not to be
a poison under similar circumstances; and, in fact, unless the medical evidence
received by  a court when this question is raised, is very closely investigated, the
greatest mistakes  may arise, owing, perhaps, to want of experience or want of
reflection on the part of those to whom the question is put.
   The quantity of a poisonous substance found in an article of food does not af-
fect the culpability of a person indicted  for  administering it.   In the  case of
Hartley (C.C.C. May 12, 1850) in which  an  attempt was made to administer
sulphuric acid mixed with coffee, Mr.  Justice Cresswell stated—if poison be ad-
ministered with intent to murder, it is not  necessary there should be enough in
the article administered to cause death.  If any poison be there, and the intent
be proved, the crime of attempting to administer poison is complete.   In the case
of Reg. v. Southgate (Chelmsford Lent Assizes, 1849,) Baron Parke  said in reply
to an objection taken, it was quite  immaterial  to define or prove in what  vehicle
a poison was given, or whether it was administered in a solid or liquid form.
   This question, "What is a poison," may present  itself under another aspect.
In The Queen v. Cluderay (Exchequer Chamber, January 19,1849,) the prisoner
was indicted for administering poison  with  intent to murder.   He was proved to
have  administered to a child, nine weeks old,  two berries in  the husk of Coc-
colus Indicus, and the berries passed through the  body  of the child without
doing any injury.   It was  submitted  for the prisoner, that being in  the husk,
they could not be considered a poison.  The point was reserved by Mr. Justice
Williams, who  tried the case at York.  It  was now contended  for the prisoner,
that although the kernel of this nut was poison, still, having been  given in the
husk, which was hard of digestion, it  could not be considered  an administering
of poison  within the statute 1 Vict.  c. 85.  The Chief-Justice said the Court
was of opinion that where a man administered something that was  poison, with
intent to murder, but in such a way that it did not act, he was guilty.   Convic-
tion affirmed.  This is the only reasonable view to take of such an  objection.
The seed contains the poison, but the  husk is inert: nevertheless the berry must
be regarded  as a poison.
   Mechanical Irritants.—Such, however, is the present state of the law of Eng-
land in respect to attempts at poisoning when death does not take place.  While
the words of the statute render  it unnecessary for a medical witness, in  such
cases, to give judicially a very close definition  of a "poison," they impose upon
him a difficulty which he must be prepared to meet.   The substance administered
may not be  a poison in the medical signification of the term, and it may  not  be
popularly considered  as such; yet when taken it may be destructive to life.  We
have examples of substances of this description in iron filings, powdered glass
sponge, pins and needles, and such like bodies, all of which have been adminis-
tered  with  the wilful design of  injuring, and  have on various occasions given 
INFLUENCE OF HABIT ON POISONS.
37
rise to criminal charges.   In cases of this kind, the legal guilt of a prisoner may
often depend on the meaning assigned by a medical witness to the words destruc-
tive thing.   Thus, to  take an example, liquid mercury might be poured down
the throat of a young infant, with the deliberate attempt to destroy it.   A ques-
tion of a purely medical nature will then arise whether mercury be "a  destruc-
tive thing"  or not; and the conviction of the prisoner will probably depend on
the answer  returned  by the witnesses.   Should a difference of opinion exist,—
an occurrence by no means unusual in medical evidence, the prisoner  will, ac-
cording to the humane principle of our law, receive the benefit of the doubt.
  Among the singular methods resorted to for the purpose of  destroying the
lives of infants and children, that of causing them to swallow pins or needles in
their food is one which claims the attention of medical jurists.   This mode of
attempting  murder has been brought to light by the evidence given on several
criminal trials, which have taken place of late years in England and on  the con-
tinent. In cases of this kind, death is commonly to be referred to inflammation;
and a  practitioner can have no hesitation in designating these bodies, when ex-
hibited to young children, as "destructive things."   They are at all times likely
to lead to serious  injury if not to  death; nor is it any answer to this view to
assert, that they have been often swallowed with  impunity.   We know that
active poisons are sometimes taken without causing death; but this does not alter
our opinion, that they are substances destructive to life, and  likely to  give  rise
to the most serious consequences.
   Influence of Habit  on Poisons.—Habit, it is well known, diminishes the effect
of certain poisons:—thus it is that opium, when frequently taken by a person,
loses its effect after a time, and requires to be administered in a much larger dose.
Indeed, confirmed opium-eaters have been enabled to take, at once, a quantity of
the drug which would have infallibly killed them, had they commenced with it
in the first instance.  Even infants and young children, who are  well known to
be especially susceptible  of the effects of opium,  and  are liable to be poisoned by
very small doses, may, by the influence of habit, be brought to take the drug in
very large quantities.   This is well illustrated by a statement made by Mr. Grain-
ger, in the Report of the Children's Employment Commission.  It appears that
the system  of drugging children with opium in the Factory districts commences
as soon after birth as possible; and the dose is gradually increased until the child
takes  from  fifteen to  twenty drops of laudanum at once!   This has the effect of
throwing it into a lethargic stupor.  Healthy children of the same age would be
killed by a dose of five drops.  Dr. Christison has remarked that this influence
of habit is chiefly confined to poisons derived from the organic kingdom;  and I
quite agree  with him  in thinking that the stories related of arsenic-eaters, and
corrosive sublimate-eaters, are not to be. credited.  There is no proof  that  any
human being has ever accustomed himself, by habit, to take these substances in
doses  that would prove poisonous to the generality of  adults.   I have only met
with one fact which appears adverse to this opinion.   M. Flandin states that he
gave to animals doses of arsenious  acid in powder, commencing with l-65th of a
grain mixed with their food; and  that in nine months, by progressive increase,
they bore a dose of upwards of fifteen grains of arsenious acid, in powder, in
twenty-four hours,  without  their appetite or health becoming affected!   (Traite
des Poisons, i. 737.)   This is contrary to all experience in the medicinal  use of
arsenic in the human  subject; for, as it will be seen hereafter (see Arsenic,) a
very slight increase of a medicinal  dose has often been  attended with such alarm-
ing symptoms as to render a discontinuance of the medicine absolutely necessary
to the  safety of the person.  The only form in which I have known the question
of habit to be raised  in medical jurisprudence is this: whether, while  the more
prominent effects of a poison are thereby diminished, the insidious or latent ef-
fects on the constitution are at the same time counteracted.   The answer is of
some importance in relation to the subject of life-insurance:—for the concealment 
38
INFLUENCE OF IDIOSYNCRASY.
of the practice of opium-eating by an insured party has already given rise to an
action in which medical evidence on this subject was rendered necessary.   As a
general principle, we must admit that habit cannot altogether counteract these.
insidious effects of poisons; but that the practice of taking them is liable to give
rise to disease or impair the constitution.
   [The practice of drugging infants with preparations of opium is only too com-
mon in this country, although there is no evidence of its having been carried to
the frightful extent described in the manufacturing towns of England.  We have
heard of as much as a tea-spoonful  of laudanum having been given, without  ap-
parently serious effects, to a child under five years of age, and of other fabulously
large quantities being given with supposed impunity by mothers and nurses in
the rural districts and the suburbs of our city.   The tinctures employed on these
occasions were doubtless  materially diluted, as they are very apt to be at the
low price for which they are generally sold by the country and suburban shop keep-
ers, and, therefore, do not afford a fair criterion of the1 tolerance of the narcotic
in the  different cases.  The frequent dilution and want at least of uniformity of
strength of the laudanum and  paregoric used reminds us of a source of fatal  ac-
cident arising from the administration of a preparation of officinal strength where
an inferior article had been habitually indulged in.   An instance of this  kind
was brought to our notice some  years ago in a neighbouring city.  An old wo-
man who had  accustomed herself to tablespoonful drams of the spurious lauda-
num for sale in her immediate vicinity, was so unfortunate as to meet with some
of her favourite liquor that had been  prepared by a respectable apothecary; and
upon taking the usual amount was thrown into a coma that soon ended with her
life.
   In relation  to the  "arsenic-eaters"  whose existence is so entirely discredited
by Mr.  Taylor, we cannot help thinking that the evidence of their reality is un-
happily too strong to be resisted on merely theoretical grounds.   (See Am. Journ.
Med.  Sci., July, 1852, 270; also, L'Officine of Dorvault, who cites the Gazette
Medicate de Vienne.j  We refer to it especially in order to call attention to the
fact that within the last ten years the  consumption of arsenic and opium, or the
demand for them, among wholesale druggists, on the part of country dealers,
has remarkably increased in Philadelphia.  We are not aware that this increased
demand exists in other large cities of  the Union, or is confined to the merchants
of any particular part or parts  of the country, or that it comes from any one class
of our countrymen; nor have we been able to discover to what uses, other than the
ordinary applications, the arsenious  acid, thus distributed throughout the land,
is professed to be applied.   The whole inquiry, however, is now in  the hands of
a committee of the American Pharmaceutical Association, (see Am. Jour. Pharm.
for Jan. 1853, 87,) whose researches will  doubtless enable  them  to  throw a
great  deal  of  important  light upon the subject; and, at all  events, to furnish
the necessary  data  which our sources of information have not  enabled us to
reach.   The object of this committee is to bring about a much needed reform
in the sale of  poisons generally.  We sincerely hope they will make it a per-
manent and speedy one.—H.]
  Influence of Idiosyncrasy.—Idiosyncrasy differs from habit:—it does not, like
this last, diminish the effect of a poison; for it is not commonly found that any
particular state of the body is a safeguard  against the effects  of these  powerful
agents.   Some constitutions are observed to be much more affected than others
by certain  poisons:—Thus opium, arsenic, and mercury, are substances of this
description,  and this difference in their effects is ascribed to idiosyncrasy.   Dr.
Christison mentions  a remarkable instance, in which a gentleman unaccustomed
to the  use of opium,  took nearly an ounce of good laudanum without any effect.
(On Poisoning, 33.)   This form of idiosyncrasy is very rare.  Certain substances
generally reputed harmless, and,  indeed, used as articles of food, are  observed
to affect some  persons like poisons.  This is the case with pork, certain kinds of 
         DIFFERENCE BETWEEN CORROSIVE AND IRRITANT POISONS.       39

shell-fish, and mushrooms.  There may be nothing poisonous in the food itself;
but it acts  as a poison in particular constitutions:—whether from its being in
these cases a poison per se, or rendered so during the process of digestion, it is
difficult to say.  The subject of idiosyncrasy is of great importance in a medico-
legal view, when symptoms resembling those of poisoning follow a meal consist-
ing of  a particular kind of food.  In  such a case, without  a knowledge of this
peculiar condition, we might hastily attribute to poison effects which were really
due to  another cause.  It would appear that in some instances idiosyncrasy may
be acquired—i. e. a person who at one period of his life had been in the  habit
of partaking of a particular  kind of food, may find at another period that it will
disagree with him.   When pork has been disused as an article of diet for many
years, it cannot always be  resumed by individuals with  impunity.   When the
powers  of life have become enfeebled by age, the susceptibility of the system to
poisons is  increased; thus aged persons may be killed by comparatively small
doses of arsenic and opium.  Cases of acquired  idiosyncrasy are very rare; it
appears to be, if we may so  apply the term, a congenital condition.
   Classification of Poisons.—Poisons may  be  divided into three classes,
according to their mode of action on the system; namely, Irritants, Narcotics,
and  Narcotico-Irritants.   This classification  is a modification of that origi-
nally proposed by Orfila, and is almost universally adopted by toxicologists.
   Irritants.—The irritants  are possessed of these common characters.   When
taken in ordinary doses,  they occasion speedily violent vomiting and purging.
These  symptoms are either accompanied or followed by an intense pain in  the
abdomen.  The peculiar effects of the poison are manifested chiefly  on the sto-
mach and  intestines, which, as their name implies, they irritate and inflame.
Many Substances belonging to this class of poisons possess corrosive  properties;
such as the strong mineral acids, caustic  alkalies, bromine, corrosive  sublimate,
and  others.   These, in the act of swallowing, are commonly accompanied by an
acrid or burning  taste, extending from the mouth down  the oesophagus to  the
stomach.   Some irritants do not possess any corrosive action,—of which we have
examples in arsenic, the poisonous salts of barytes, carbonate  of lead, canthari-
des, &c, and these are often called pure irritants.  They  exert no  destructive
chemical action on the tissiles with which they come in contact; they simply irri-
tate them.
   Difference between Corrosive and Irritant Poisons.   There is this difference
between Corrosive and Irritant  poisons.  Under the  action of corrosive
poisons, the symptoms are commonly manifested immediately, because mere con-
tact  produces disorganization of a part, usually indicated by some well marked
symptoms.  In the action of the purely irritant poisons, the symptoms are gene-
rally more  slowly manifested, rarely showing themselves until at least half an
hour has elapsed from the time of swallowing the substance.  Of course, there
are exceptions to this remark; for sometimes irritants act speedily, though seldom
with the rapidity of corrosive poisons.  It is important, in  a  practical view, to
distinguish whether, in an unknown  case, the poison which a person, requiring
immediate  treatment, may have swallowed, be irritant or corrosive.  This may
be commonly determined by the answer to the question, as to the time at which
the symptoms appeared after the suspected poison was taken.   In this way we
may often  easily distinguish between a case of  poisoning from  arsenic and one
from corrosive sublimate.  There is also  another point which may be noticed.
As the corrosion is due to a  decided chemical action, so the examination of  the
mouth  and  fauces may enable us in some cases  to determine  the nature of  the
poison  swallowed.
   It has been already stated that there are many irritant poisons which have no
corrosive properties,  and, therefore, never act as corrosives;  but it must  be re-
membered  that every corrosive may act as an irritant.   Thus the action of cor-
rosive sublimate is that of an irritant  poison,  as, while it destroys some parts of 
40                NARCOTICS AND NARCOTICO-IRRITANTS.
 the coats of the  stomach and  intestines, it irritates and inflames others.  So
 again, most corrosive poisons may lose their corrosive properties by dilution with
 water, and then they act simply as  irritants.   This is the case with the mineral
 acids, and bromine.   In some instances, it is not easy to say whether an irritant
 poison possesses corrosive properties or not.  Thus oxalic acid acts immediately,
 and blanches and softens the mucous membrane of  the mouth and fauces, but I
 have never  met with any decided marks of what could be called  chemical cor-
 rosion produced by it in the stomach or viscera.  Irritant poisons, for the most
 part, belong to the  mineral kingdom;  and they may be divided  into the non-
 metallic and metallic irritants.  There are a few derived from the animal and
 vegetable kingdom; but these are not very often employed criminally.   Some of
 the gases likewise belong to the class of  irritant poisons.
   Narcotic  Poisons.—Narcotic  poisons have their operation confined to the brain
 and spinal marrow.  Either immediately or some time after the poison has been
 swallowed, the patient suffers  from cephalalgia, vertigo, paralysis, coma, and
 in some instances tetanus.   They have no acrid burning taste like the corrosive
 irritants;  and they very rarely  give rise to vomiting or diarrhoea.  When these
 symptoms follow the ingestion  of the poison into the stomach, the  effect may be
 generally ascribed either to the quantity in which  the  poison has been taken,
 and the mechanical effect on the stomach thereby produced, or to the poison be-
 ing combined with some  irritating substance, such  as alcohol.   The  pure nar-
 cotics are not found to irritate or inflame the viscera.
   Notwithstanding the well defined boundary thus apparently existing between
 these two classes of poisons, it  must not be supposed that each  class  of bodies
 will always act in the manner indicated.   Some irritants have been observed to
 affect the  brain or the spinal marrow remotely.   This is the case with ox#ic acid
 and arsenic.  Both of these common poisons have in some instances  given rise
 to symptoms closely resembling those of narcotic poisoning; namely, coma, para-
 lysis, and tetanic convulsions.   In a case of poisoning by arsenic which occurred
 to Dr. Morehead, of Bombay,  the  symptoms  of narcotism were so strongly
 marked that it  was believed at  first that the man had taken a narcotic.  (Med.
 Gaz. vol.  xliii.  p. 1055.)  I have met with one case of poisoning  by  arsenic in
 which there was paralysis of the extremities, with ad entire absence of purging,
 during the eight days which the deceased survived.   On the other hand, in the
 chapter on opium, a case of poisoning by a large dose of this drug will be found
 related, in which there was an  absence  of the usual symptoms of cerebral dis-
 turbance,  and the presence of others resembling those  of irritant poisoning—
 namely, pain and vomiting.   Thus, then, we must not allow ourselves to be de-
 ceived by the idea that the symptoms are always clearly indicative of the  kind
 of poison taken.  The narcotic poisons are few in number, and belong to the
 vegetable  kingdom.  Some of the poisonous gases possess a narcotic action.
   Narcotico-irritants.—Poisons belonging to this class have, as the name implies,
 a compound action.  They are  chiefly(derived from the vegetable kingdom.  At
 variable periods after they have been swallowed they give rise to vomiting and
 purging like  irritants;  and sooner or later  produce  stupor, coma, paralysis and
 convulsions, owing to their effect on the brain and spinal marrow.   They possess
 the property, like irritants,  of  irritating and inflaming the alimentary canal.
 As familiar  examples we may point  to nux vomica, monkshood, and  poisonous
 mushrooms.   This class of poisons is very  numerous, embracing a large variety
 of well known vegetable substances;  but they rarely form a subject of difficulty
 to a medical practitioner.  The  fact of the symptoms occurring after  a meal  at
 which some  of  the suspicious vegetables may have been eaten, coupled with the
nature of  the symptoms themselves, will commonly indicate  the class to which
the poison belongs.   Some narcotico-irritants have a hot acrid taste, such as the
aconite or monkshood;  others, an intensely bitter taste, as nux  vomica and its
alkaloid, strychnia. 
EVIDENCE OF POISONING IN THE LIVING.                41
                              CHAPTER  II.

 EVIDENCE  OF POISONING IN THE LIVING SUBJECT—SYMPTOMS OCCUR SUDDENLY—MODI-
   FYING CONDITIONS—ACTION OF POISONS INCREASED OR DIMINISHED BY DISEASE--SYMP-
   TOMS CONNECTED WITH  FOOD OR MEDICINE--SUDDEN DEATH FROM  NATURAL CAUSES
   MISTAKEN FOR POISONING--SEVERAL PERSONS ATTACKED SIMULTANEOUSLY'--EVIDENCE
   FROM THE DETECTION OF POISON IN  FOOD.

   We shall next proceed to consider the evidence of poisoning in the living subject.
 To the practitioner the diagnosis of  a case  of poisoning is of very great impor-
 tance, as  by mistaking the symptoms  produced by a poison for those  arising
 from natural disease, he  may omit to employ  the remedial measures which have
 been found  efficacious in counteracting its effects, and thus lead to the certain
 death of  the patient.  To a medical jurist a correct knowledge of the symptoms
 furnishes the chief evidence  of poisoning,  in those cases in  which persons are
 charged with the criminal administration of  poison with intent to  murder, but
 from the  effects of  which the patient ultimately recovers.   The  symptoms pro-
 duced during life  constitute also an important part of the  evidence, in those
 instances  in  which the poison proves fatal.   At present, however, we will sup-
 pose the case to have been, that poison has  been taken and the patient survives.
 Most toxicological writers have laid  down  certain characters whereby it is said
 symptoms of poisoning may be distinguished from those of disease.
   1.  In poisoning, the symptoms appear suddenly, while the individual is in
 health.—It is the common  character of most poisons, when  taken in the large
 doses  in  which they are usually administered with criminal intent, to produce
 serious symptoms either immediately or within a very short period after they have
 been swallowed.  Their operation, under such  circumstances, cannot be suspended,
 and then  manifest itself  after an indefinite interval; although this was formerly
 a matter of universal belief, and gave rise to many absurd accounts of what was
 termed slow poisoning.
   The symptoms of poisoning by prussic acid, oxalic acid, or strychnia, appear im-
 mediately, or within a very few minutes after the poison has been swallowed.  In one
 case, however, where the  dose of prussic acid was small, and insufficient to produce
 death, the poison was supposed by the patient not to have begun to act until
 after the lapse of fifteen  minutes.  (Ed. Med. and Surg. Journ. lix. 72.)  The
 symptoms caused  by arsenic and other irritants, and, indeed,  by  all poisons
 generally, are commonly manifested in from half an hour to an hour.  It is
 rare that the appearance  of symptoms is protracted for two hours, except under
 certain peculiar states of  the system.  It is said that some narcotico-irritant poi-
 sons, such as the poisonous  mushrooms, may remain  in  the stomach twelve or
 twenty-four hours without giving rise to symptoms;  and this is also affirmed to be
 the case with some animal irritants, such as decayed meat; but with regard to the
 first point, it has been shown by Dr. Peddie that mushrooms may produce symp-
 toms in half an hour; and a case has fallen  under my own observation, where the
 symptoms from noxious  food came  on within as short a time  after the meal
 as is commonly observed  in irritant poisoning by mineral  substances.  In cases
 of poisoning by phosphorus, the  symptoms do  not commonly begin until after
the lapse of many hours.
   Modifying conditions.   Influence  of disease.—A diseased  state of the body
 may render a person comparatively unsusceptible of the action of some poisons,
 while in othatinstances it may increase their action,  and render them fatal in small
 doses.  In dysentery and tetanus, a person will take, without being materially
affected, a quantity of opium sufficient to kill an adult in average health.  Mania, 
42
SUDDEN OCCURRENCE OF SYMPTOMS.
cholera, hysteria, and delirium tremens, are also diseases in which large doses of
opium may be borne with comparative impunity.  In a case of hemiplegia, a
woman,  Eet. 29,  took, for six days, three  grains  of  strychnia  daily  without
injurious consequences—the dose having been gradually raised (Gaz. Med. Mai,
1845;) while  one grain of strychnia is commonly regarded as a fatal dose to a
healthy person.   In a case of tetanus, Dupuytren gave as  much as  two ounces
of opium at a dose (60  grammes,) without serious consequences.   (Flandin,
Traite des Poisons, i. 231.)   It has also been remarked that persons affected
with tetanus are not easily  salivated  by mercury.   (Colles' Lectures, i. 77.)
The effect of certain diseases of  the nervous system as well as of habit, either
in retarding the appearance of symptoms, or  in blunting the operation of a poi-
son, it is not  difficult to  appreciate; and they are cases which can present no
practical difficulty to a medical jurist.   On the other hand, in certain  diseased
states of the system, there is an increased susceptibility of  the action of poison.
Thus, in those persons who have a disposition to apoplexy, a small dose of opium
may act more  quickly and prove fatal.   In a person labouring under inflamma-
tion of the stomach or bowels, there would be an increased susceptibility of the
action  of arsenic or other  irritants.   One  of the most remarkable  instances of
the influence of  disease in increasing the operation of poison, is perhaps seen
in cases of diseased kidney (granular degeneration,) in which very small doses
of mercury have been observed to produce severe salivation, leading to exhaus-
tion and death.   A knowledge of this fact is of importance in  reference to
charges of malapraxis, when death has arisen  from  ordinary doses of calomel
administered to persons labouring under this  disease.
   Symptoms appear  during a state of health.—Symptoms of poisoning often
manifest themselves in a person while in a state of perfect health, without any
apparent cause.   This rule is, of course, open to numerous exceptions, because
the person on whose  life  the attempt is made  may be actually labouring under
disease; and, under these circumstances, the symptoms of poisoning are so obscure
as  often to disarm all suspicion.   When  poison is exhibited  in medicine, a
practitioner is  very liable to be deceived, especially if the disease under which the
party is labouring be of an acute nature, and attended by symptoms of disorder
in the alimentary canal.  Several cases of poisoning have occurred  within the
last few years, where arsenic was criminally substituted for medicine, and given
to the  parties while laboring under a disorder of the bowels.   We are, however,
justified in saying with respect to this character  of poisoning, that, when in a pre-
viously healthy person, violent vomiting and purging occur suddenly, and without
any assignable cause, such as disease or indiscretion in diet, to account for them,
there is strong reason to suspect that irritant poison has been taken.  When the
person is already labouring  under disease,  we must  be  especially watchful, on
the occurrence of any sudden change in the character or violence of the symptoms,
unless such change can be easily accounted for on common or well-known me-
dical principles.   In most cases of criminal poisoning, we meet  with alarming
symptoms without any obvious or sufficient natural cause to explain them.  The
practitioner will  of course  be aware  that there are certain diseases which are
liable  to occur suddenly  in healthy people, the exact cause of which  may not
at first sight be apparent; therefore this  criterion  is only one out of many on
which a medical opinion should be founded.
   2. In poisoning, the symptoms appear soon  after a meal, or soon  after some
hind of food  or medicine has been taken.—This is by far the most important
character of poisoning in  the living body.    It has been already observed that
most poisons begin to operate within about  an hour after they have  been'swal-
lowed; and although there are a few exceptions to this remark, yet they occur under
circumstances  easily to be appreciated by a practitioner.   Thus, th^a  it follows
that, supposing the symptoms under which a person is labouring to depend on
poison, the substance has most probably been swallowed either in food or medi- 
THEIR CONNEXION WITH FOOD OR MEDICINE.
43
cine, from half an hour to an hour previously.   It must be observed, however,
that cases of poisoning may occur without the poison being introduced by the
mouth.  Oil of vitriol has  been thrown up the  rectum in the form of enema,
and caused death:  the external  application of arsenic, corrosive sublimate, and
cantharides, has destroyed life.   In one case arsenic  was introduced  into the
vagina of a female, and she died in five days under all the symptoms of arsenical
poisoning.  (Schneider, Ann.  der Ges. Staatsarzneikunde, i. 229.)  Such cases
are rare,  but  nevertheless the certainty that they have occurred where  their
occurrence could hardly have been  anticipated, shows  that in a suspicious case
a practitioner  should not deny the fact of poisoning, merely because it is proved
that the patient could not have taken the poison in the usual way—by deglutition.
Again, persons  may be destroyed by the vapours of ether, chloroform, prussic
acid, or other  powerful volatile poisons, introduced into the system through the
lungs.  Such  a mode of suicide, or  murder, might disarm suspicion, from the
fact of no noxious material being found in the stomach.  An act of Parliament
has been recently passed,  which  makes it felony to administer, or even attempt
to administer, poisons in this manner (14 and 15  Vict. c. 19, sec. 111.)
   Let us  suppose, however, the circumstances to have been such that these secret
means of destruction could not have been resorted to, and that the poison is one
of  those most commonly selected by a murderer,  such as arsenic, oxalic acid, or
corrosive sublimate, then we may expect that this character of poisoning will be
made evident  to us, and that something must have been swallowed by the pa-
tient  shortly before the alarming symptoms appeared.  By observations atten-
tively  made, it may be in  our power to connect the appearance of the symptoms
with the use of a particular article of food, and thus indirectly lead to the detec-
tion of the criminal.   Supposing that many hours have passed since food or me-
dicine was taken by the patient, without any effect ensuing,—it becomes very
probable  that the symptoms are due to  some other cause, and not to  poison.
The time  of the occurrence of the symptoms in relation to a particular meal, is
then a fact of especial importance in forming an opinion when poisoning is sus-
pected.
   Among numerous  cases which might be adduced  in support of  this view, I
select  the following, which was  communicated by Mr. George/ of  Bath, to the
Provincial Journal, (January 24th, 1849.)   The patient, a girl aet. 16, was preg-
nant:  she complained of a painful swelling of the  leg.   On the day of her death
she made a hearty dinner  of beef, vegetables, and porter, with the family at one
o'clock, and remained in the same room where she had partaken of that meal until
three o'clock.  On quitting the apartment, she began to groan, complained  of agony
at the  pit of the stomach, and became faint: there was vomiting, and in three-
quarters of an hour she died.  On inspection, there was an inflamed appearance
both of the duodenum and stomach.  A careful analysis of  the viscera, as well
as of the matter vomited, revealed no poison; and the fact that no symptoms had
occurred during a period of two hours after  the meal,  strongly corroborated the
conclusion that the deceased had died from natural causes.
   When symptoms resembling those of poisoning speedily follow the ingestion
of food or medicine, there is, however, always great room for suspicion;  but cau-
tion should be observed in drawing inferences, since the most extraordinary coin-
cidences sometimes present themselves.  In the celebrated case of Sir Tlieodosius
Boughton, who was poisoned by his brother-in-law, Donellan, in 1781, the fact
of alarming symptoms coming on in  two minutes after the deceased had swallowed
what was  supposed to be a simple medicinal  draught, was a most important fact
in the evidence against the prisoner.   There is no doubt that laurel water had
been substituted for the medicine by the prisoner.  I may here remark, that the
practice of substituting poisonous mixtures for medicinal draughts or powders, is
by no  means unusual; although it might be supposed to indicate a degree of
refinement and knowledge not  commonly to be found among the lower classes of
criminals.   Medical  practitioners are thus apt to  be imposed  upon,  and the fol- 
44
SEVERAL PERSONS ATTACKED SIMULTANEOUSLY.
lowing case, related by one of our present judges, will serve as a caution.  An
apothecary prepared a draught, into which another person put poison, intending
thereby to destroy the life of the patient for whom the medicine was prescribed.
The patient, not liking the taste of the draught, and thinking there was some-
thing suspicious about it, sent it back to the apothecary, who, knowing the in-
gredients of which he* had composed it, and wishing to prove to his patient that
he had done nothing wrong, drank it  himself, and died.  He was thus the un-
conscious  agent of his own death;  and although the draught was intended for
another, the party who poisoned  it was held  guilty of murder.  This case con-
tains a serious warning to medical witnesses.   It is not very unusual, on  trials
for poisoning, when the poison is conveyed through medicine, to find a medical
witness offering to swallow his own draught in a court of law, in order to furnish
to the court and jury a convincing practical illustration  of the innocence of the
medicine!  I need hardly observe  that an exhibition of this kind is never re-
quired of a medical witness.   The court will receive his deposition, without com-
pelling him to swallow his own medicine, even supposing it to have been secretly
poisoned.   If any doubt be raised of the innocent properties of a draught, a che-
mical analysis of its contents will be far more satisfactory, and attended with no
kind of risk to the practitioner.
   On the other hand, the occurrence of symptoms resembling those produced by
poison, soon after food or medicine has been taken, may be a pure coincidence.
In such a case, poison is always suspected by the vulgar; and it will be  the duty
of a medical jurist to guard against the encouragement of such a suspicion, until
he has strong grounds to believe it to be well founded.   No "public retraction or
apology can ever make amends for the injury which may in this way be inflicted
on the reputation of another; for they who hear the accusation may never hear
the defence.  In all such cases, a practitioner may entertain a suspicion, but he
should always avoid expressing it, or giving  it publicity.  When death is not a
consequence, it is difficult to clear up such cases, except  by the aid of a  chemical
analysis; but this, as we  know, is not always  applicable.  If death ensues, the
real cause is usually apparent, and a suspicion of poisoning is thus often  removed
by a post-mortem examination.
   3. In poisoning, when  several partake at the same time of the same food or
medicine (mixed with poison) all suffer from similar symptoms.—This character
of poisoning cannot always be procured;  but it furnishes good evidence of the
fact when it exists.  Thus, supposing after a meal made by several persons from
the same dish, only one suffers, the suspicion of poisoning is considerably weak-
ened.  The poisoned article of food may be detected by observing whether  they who
suffer under any symptoms  of poisoning have partaken of  one particular solid
or liquid  in common.   In a case  of accidental poisoning  at a  dinner-party, a
friend of mine observed that those  who suffered had taken  port-wine only: the
contents of the bottle were  examined,  and found to be a saturated solution of
arsenic in wine.   In general, considerable reliance may be placed upon  this cha-
racter, because it is very improbable that any common cause of disease should
suddenly attack, with violent and alarming symptoms, many healthy persons at
the same time, and within a short period after having partaken of food  together.
We must beware of supposing that, in those cases in which poison is really present,
all will be attacked with precisely similar  symptoms;  because, as we have seen
there are many circumstances which may modify their nature and progress.  In
general, that person who has partaken most freely of the poisoned dish will suffer
most severely, but even this does not always follow.   There is a well-known case
recorded by Bonnet, where, among several persons who partook of a dish poisoned
with arsenic, they who had eaten little  and did not  vomit, speedily died •  while
others who had partaken  largely of the dish, and had in consequence  vomited
freely, recovered.
   It was just now remarked that  there  is no disease  likely to  attack several 
DETECTION OF POISON IN THE FOOD.
45
healthy persons at the same time, and in the same manner.   This is undoubtedly
true, as a general principle, but the following case will show that mistakes may
occasionally arise even under these circumstances.  It occurred in London, during
the prevalence of the malignant cholera in the year 1832.   Four of the members
of a family living in a state of great domestic unhappiness, sat down to dinner
in apparently good health:  some time after the meal, the  father, mother, and
daughter, were suddenly seized with violent vomiting and purging.  The stools
were tinged with blood, while the blueness of the skin, observed in cases of ma-
lignant cholera, was wanting.   Two of the parties died.  The son, who was known
to have born ill-will against his father and mother,  and  who suffered no symp-
toms on this occasion, was accused of having poisoned them.  A  strict investi-
gation took place before the coroner; but it was clearly  shown by the  medical
attendant that the  deceased persons had really died of the malignant  cholera,
and there was no reason whatever to suspect that any poison had been adminis-
tered to them.   In this instance, it will be perceived that symptoms resembling
those of irritant poison appeared suddenly in several individuals in perfect health,
and shortly after a  meal. We hereby learn that the utility of  any rules for in-
vestigating cases of poisoning depends entirely on the  judgment and discretion
with which they are applied to particular cases.
   It is well to bear in  mind, in conducting these inquiries, that symptoms re-
sembling those produced by irritant poison  may be sometimes due to the descrip-
tion of food, which may have  been  taken at the meal.   Besides flesh  rendered
unwholesome from  disease and decay, there are certain kinds of  shell-fish, as well
as pork, bacon, sausages, cheese, and bread, which, under certain circumstances,
may give rise to formidable symptoms, and  even death.  In such a case, all the
foregoing characters of  poisoning are brought out; and, indeed, the case may be
regarded as one of  poisoning by an animal or vegetable irritant.  The diagnosis
is difficult;  and great ambiguity frequently arises, from  the fact that not more
than one or two individuals may be affected, who have frequently before partaken
of the  same kind of food without any particular inconvenience.
   4. The discovery of poison in the food  taken, or in the matters vomited.—One
of the best proofs of poisoning in the living subject is the detection of poison by
chemical, or if of a vegetable nature, by  microscopical  analysis, either in the
food taken by the person labouring under its effects, or in the matters vomited.
The evidence is of  course more satisfactory when the poison is detected in the
matters vomited, than in the food;  because this will show that the  poison has
really been taken, and will readily account for the symptoms.   If the vomited
matters have been thrown away, we must then examine  the  food  of which the
patient may have partaken.   Should the results in both  cases  be  negative, the
probability is, that  the symptoms may have been due to disease.
   In investigating a case of poisoning in the living subject, a medical  jurist must
remember that poisoning is sometimes feigned, and at others  imputed.  It is
very easy for an artful person  to put poison into  food,  as well as to introduce it
into the matters vomited or discharged from the bowels, and to accuse another of
having administered it.   There are few of these accusers who go  so far as to
swallow poison under such circumstances, there being a great dread of poisonous
substances among the lower orders; and it will be at once  apparent,  that it would
require a person well versed in toxicology to feign a series of symptoms which
would impose upon a practitioner at  all acquainted with the subject.   In short,
the difficulty reduces itself to this':—What inference can we draw from the chemi-
cal detection of poison in food?  All that a medical man can do,  is to say whether
poison be present or not in a particular article of  food:—he must leave it to the
authorities of the law to develope the alleged attempt at administration:—but if
the poison have been actually administered, then we should  expect  to find the
usual symptoms.  The  absence  of these symptoms would be a  very  strong fact
against the alleged administration.   With regard to the detection of poison in the 
46
EVIDENCE OF POISONING IN THE DEAD BODY.
matters vomited from the stomach, this affords no decisive proof that it has been
swallowed, except under two circumstances:—1. When-the accuser really labours
under the usual symptoms of poisoning, in which case there can be no feigning,
and the question of imputation is a matter to be established by general evidence.
2. When the matters are actually vomited into a clean vessel  in the presence of
the medical  attendant himself, or of some  person on whose testimony perfect re-
liance can be placed.
                              CHAPTER III.

ON THE EVIDENCE  OF  POISONING IN THE DEAD BODY—PERIOD AT WHICH POISONS PROVE
  FATAL--CHRONIC POISONING—POST-MORTEM APPEARANCES PRODUCED BY THE DIFFERENT
  CLASSES OF POISONS--REDNESS OF THE MUCOUS MEMBRANE MISTAKEN FOR INFLAMMATION
  --ULCERATION AND  CORROSION--SOFTENING--PERFORATIONS OF  THE STOMACH FROM
  POISON AND DISEASE.

  Supposing that the person is dead, and we are required to determine whether
the case be one of poisoning or not, we must, in the first instance, endeavour to
ascertain all the particulars  which have been  discussed  in the  last chapter, as
indicative of poisoning in the living subject.  Should the deceased have died from
poison, the circumstances of the attack, and the symptoms preceding death, ought
to correspond with the characters already described; and in these investigations
it is well to bear  in  mind the  following rule:—There is  no one  symptom or
pathological condition which is peculiar to poisoning; but at the same time there
is no disease which presents all those characters which are met with in a special
case of poisoning.   [Dr. G.  reminds us that the evidence of medical men is fre-
quently required to determine whether the deceased came to his death by poison,
or from some other cause.   (See 1 McNally,  329-335.)  When  this evidence
is given,  the facts on which the opinion is grounded must be stated.   (Dickerson
v. Barker, 9 Mass. Rep.  245.)—H.]   The additional evidence to be derived
from the death of the person may be considered under the following heads:—
  1.  The time at which death takes place after the first occurrence of symptejms.
—This question it is necessary to examine, because the more common poisons,
when taken in fatal doses, generally produce their fatal  effects within certain
periods of time.   By an attention to this point, we may, in  some  instances, be
enabled to negative a charge of poisoning, and in others to form an opinion of
the kind of poison which has been taken.   In a court of law, a medical practi-
tioner is often required to state the usual period of time within which poisons
prove fatal.   It is to be observed that not only do poisons differ from each other
in this respect, but  the same substance, according to the form or quantity in
which it has been taken, will differ in the rapidity of its action.  A large dose
of prussic acid, i.  e. from half an ounce to an ounce, may destroy life in less than
two minutes.  In ordinary cases of poisoning by this substance a person dies, /. e.
all signs of life have commonly ceased, in from  ten to twenty minutes:__if he
survive half an hour, there is some hope of recovery.   In the cases of the seven
Parisian  epileptics, accidentally poisoned by this acid, the first died in about
twenty minutes, the seventh survived three quarters of an hour.__(See  post
Prussic Acid.)   Oxalic acid, one of the most energetic of the common poisons'
when taken in a dose of from half an ounce to an ounce, may destroy life in from
ten minutes to an hour: if the poison be not perfectly dissolved when swallowed
it is a longer time in proving fatal.  The strong mineral acids, in poisonous doses'
destroy life in about eighteen or twenty-four hours.   Arsenic, under the  form
of arsenious acid  (white arsenic,) operates fatally in from eighteen hours to three 
ACUTE AND CHRONIC POISONING.
47
or four days.  It has, however, in more than one instance, killed a person in two
hours, although this is by no means common.   Opium, either as a solid or under
the form of laudanum, commonly proves fatal in from six to twelve hours; but
it has been known, in several instances, to destroy life in less than  three hours:
they who survive the effects of this poison for twelve hours are considered to
have a fair chance of recovery.  This must be understood to be  merely a state-
ment of the average results, as  nearly, perhaps, as we are warranted in giving an
opinion; but the  medical jurist will of course be aware that the fatal period may
be protracted or shortened, according  to all those circumstances which have been
elsewhere stated to affect the action of poisons.
  There are various forms which this question may assume in a court of law:—
the death of a party, alleged to have taken poison, may have occurred too rapidly  %
or too slowly to justify a suspicion of poisoning.  The following case may serve
as an illustration:—A woman of the name of Russell was tried and convicted at
the Lewes Summer Assizes, in 1826, for the murder of her husband, by poisoning
him with arsenic.  The  poison was  detected in the stomach;  but the fact of
poisoning was disputed by some medical witnesses,  for this among other reasons
—that the deceased had died three hours after the only meal at which the poison
could have been administered to him.   The authority of Sir A. Cooper and others,
was cited to show, that,  according to their experience, they had  never known a
case to prove fatal in less than seven  hours.  This  may have been; but, at the
same time, there  was sufficient authority on the other side, to establish that some
cases of arsenical poisoning had actually proved fatal in three or four hours.   So
far as this objection was concerned, the prisoner was very properly  convicted.
   On the medical question raised at this trial, I may observe, that within the
last few years, two distinct cases have occurred where the individuals died cer-
tainly within two hours  after taking  arsenic; and  several instances have been
reported since the trial,  in which  death  took  place  in from three to four hours
after the administration  of this poison.  It seems extraordinary in  the present
day, that any attempt should have been made by a professional man to negative
a charge of criminal poisoning upon  so weak  a ground  as this; but we  must
remember that this opinion was expressed many years ago, when the  subject of
toxicology was but little understood.   It is quite obvious that there is nothing,
so far as we know, to  prevent arsenic from destroying life in an  hour. A  case
will be  hereafter  related, in which death took place from  arsenic most probably
in half  an hour.   These matters can only be settled by a careful observation of
numerous cases, and not by any a priori reasoning, or  reference to  individual
experience.
   In all instances of sudden death, there is generally a strong tendency on  the
part of the vulgar to suspect poisoning.   They never can be brought to consider,
that persons may die a natural death  suddenly, as well as slowly; or, as we shall
presently see, that death may really take place slowly, as in cases of disease, and
yet be due to poison.  This prejudice continually gives rise to the most unfounded
suspicions  of poisoning.  One of the means  recommended for distinguishing
narcotic poisoning from apoplexy or disease of the heart, is  the difference in the
rapidity with which death takes place.   Thus,  apoplexy or disease  of  the  heart
may prove fatal either instantly or within an hour.   The  only  common poison
likely to operate with such fatal rapidity is prussic  acid.   Poisoning  by opium
is commonly protracted for five or  six hours.   This poison has never been known
to destroy life instantaneously, or in a few minutes.   Thus, then, it may happen,
that death will occur with such rapidity as  to render it impossible  under  the
circumstances to  attribute it to narcotic poison.
   Chronic poisoning.—When a poison destroys life rapidly, it is called a case of
acute poisoning, to distinguish it from the chronic form, /. e. where death  takes
place slowly.   Chronic poisoning is not a subject which  often requires medico-
legal investigation.  Most poisons, when their effects are not rapidly manifested, 
48                     POST-MORTEM EXAMINATIONS.
owing either to the smallness of the dose or to timely treatment, are capable of
slowly undermining  the powers of life, and killing the patient  by producing
emaciation and exhaustion.   This  is sometimes observed in the action of arsenic
and corrosive sublimate, but it has been remarked also in cases of poisoning by
the mineral acids and caustic alkalies.  Death is here an indirect consequence:—
in poisoning by the acids or alkalies, either stricture of the oesophagus is induced,
or the lining membrane of the stomach is destroyed and the process of digestion
impaired,—a condition which leads to emaciation and death.  The time at which
these indirect effects may prove fatal, is of course  liable to vary.   A person has
been known to  die from a stricture of the oesophagus, brought on by sulphuric
acid, eleven months after the poison was  swallowed;  and there is no reason  to
doubt that instances may occur of  a still more protracted nature.   In these cases
of chronic poisoning there is considerable difficulty in assigning death exclusively
to the original action  of the poison, since the  habits of life of the party, a ten-
dency to disease,  and other circumstances, may have concurred to accelerate  or
produce a fatal result.  To connect a stricture of the oesophagus with the  act of
poisoning by a  mineral acid, it is necessary to show that there was no tendency
to this disease before the acid was  administered:—that the  symptoms appeared
soon after the first effects of the poison went off:—that these symptoms continued
to become  aggravated until the time of  death:—and that there was  no  other
cause, to which death could  with  any probability be referred.   These  remarks
apply equally to the indirectly fatal effects of any poison,—such, for instance,  as
the salivation occasionally induced  by corrosive sublimate, when the acute symp-
toms of poisoning by  this substance have passed away.  It has been stated, that
chronic poisoning is not a subject commonly requiring a  criminal  investigation.
Two cases have, however, come before our tribunals, in which the facts connected
with this form of poisoning, were of some importance.  I allude to those of Miss
Blandy, tried at Oxford, in 1752, for the murder  of her father by arsenic; and
of a woman named Butterfleld, tried at Croyden, in 1775, for the murder of a
Mr.  Scawen, by administering corrosive sublimate.   In most  cases, murderers
destroy life by administering  poison in very large doses; but in  the instances
referred to, small doses were given at intervals,—a fact which led to great medical
doubt of the real  cause of the symptoms before death.  It is, however, very rare
to hear of this form of criminal poisoning.
   2. Evidence from post-mortem appearances.—One of the chief means  of deter-
mining whether a person has  died  from  poison, is  an examination of the  body
after death.  In relation to external  appearances, there  are none indicative  of
poisoning upon which we can safely rely.  It was formerly supposed  that the
bodies of persons who were poisoned putrefied more readily than those of others
who had died from natural disease; and evidence for or against poisoning, was at
one time  derived  from the external appearance of the body.  This  is now known
to be an error:  the bodies of persons poisoned are not more rapidly decomposed,
ccetcris paribus, than those of  others who have died a sudden and violent death
from any other cause  whatever.
   Irritant  poisons act chiefly upon the stomach and  intestines, which they irri-
tate, inflame, and corrode.  We may likewise meet with  all  the consequences of
inflammation, such as ulceration,  perforation,  and gangrene.   Sometimes the
coats of the viscera are thickened, at other times thinned and  softened by the
action of an irritant.                                                 '
   Narcotic poisons do  not commonly leave any well  marked *post-mortem ap-
pearances.  The stomach  and intestines  present no unnatural changes.  There
is greater or less fulness of the cerebral vessels;  but even this is often so  slight
as to escape notice, unless attention be particularly directed to the brain.   Ex-
travasation of blood is rarely found.
   The Narcotico-irritants affect either the brain or the alimentary canal and com-
monly both, according to their peculiar mode of action. 
REDNESS AS AN EFFECT OF IRRITANT POISONS.
49
   It is important to bear in mind, that both Irritants and Narcotics may destroy
 life without leaving  any appreciable changes in the body.   To such  cases as
 these, the remarks about to be  made do not apply.  The proofs of poisoning
 must, then, be procured entirely from other sources.  Any evidence  derivable
 from the appearances in the body of a person poisoned, will be imperfect unless
 we are able to distinguish them from those analogous changes often met with as
 the results of ordinary disease.   These are confined to the mucous membrane of
 the stomach and bowels.  They are redness, ulceration, softening, and perfora-
 tion.  Each of these conditions  may depend upon disease, as well as upon the
 action of irritant poisons.
   Redness.—It is a main character of the irritants  to produce redness of the
 mucous  membrane of the stomach and small intestines.  This redness, when first
 seen, is usually of a deep crimson colour, becoming brighter by exposure to air.
 It may be diffused over the whole mucous membrane:—at other times it is seen
 in patches, dots,  or lines (striae,) spread  irregularly over the surface  of  the  sto-
 mach.   It  is sometimes met with  at the smaller, but  more  commonly at the
 larger extremity of this organ; and again, we occasionally find that the rugae or
 prominences only of  the mucous membrane present this red or inflamed appear-
 ance.   Redness of the mucous membrane may, however, be due to  gastritis or
 gastro-enteritis; and in order to assign the true cause of the inflammation, it will
 be Jiecessary to have an account of the symptoms preceding death, or some che-
 mical proof of the existence of irritant poison in the contents  of the  stomach or
 the tissues of the body.
   In the healthy state, the mucous membrane of the stomach is pale and white,
 or nearly so, except during digestion, when it becomes slightly reddened; and some
 observers have remarked that a slight redness has often remained in the stomachs
 of those who have died during the performance of the digestive process.   When
 in contact with the spleen  or liver, after death,  the stomach  is apt to acquire a
 deep livid colour from the transudation of blood; and it is well known that the
 bowels acquire a somewhat similar  colour from the gravitation of blood, which
 always takes place after death.   None of these appearances are likely to be  mis-
 taken for the action of an irritant poison.
   There is an important class of cases in which redness of the mucous membrane
 of the stomach is found after death, not dependent on the  action of poison or on
 any assignable cause.  These cases, owing to their being so little known, and
 involved in much obscurity, deserve great attention from the medical jurist, since'
 the  appearances closely resemble  those produced by irritant poison.   A person
 may die without suffering from any symptoms of disordered stomach; but, on an
 inspection of the body, a general  redness of the mucous membrane of this organ
 will be found, not distinguishable from the redness which is so commonly seen
 in arsenical poisoning.  Several cases of  this kind have occurred at Guy's Hos-
 pital ; and drawings have been made of the appearance presented by the stomach,
 and are now preserved in the museum collection.
  The redness of  the stomach, in cases of poisoning, is so speedily  altered by
 putrefaction, when circumstances  are favourable  to this process, as to render it
 impossible for a witness to speak with any certainty upon its cause.  Putrefactive
 infiltration from  the blood contained  in  the adjacent viscera and muscles,  will
 give a reddish-coloured appearance to a stomach otherwise in a healthy condition.
 Great dispute has arisen respecting  the length of time during which redness of
 the  stomach produced by an irritant, will be recognisable and easily distinguish-
 able from putrefactive changes.    It is, perhaps, sufficient to say, that no certain
 rule can be laid down on the subject:  it must be left to the knowledge and di-
 rection of the witness.  I have distinctly seen the well  marked appearances of
inflammation produced by arsenic  in the stomach  and duodenum, in an exhumed
body twenty-eight  days  after  interment  (Reg.  v. Jennings, Berks  Lent Ass.
 1845;)  and in another instance, referred to me by Mr. Lewis, the coroner for
       4 
50
ULCERATION AND SOFTENING OF THE STOMACH.
Essex, in August, 1846, the reddened state of the mucous membrane, in a case
of arsenical poisoning, was plainly perceptible, on removing a layer of arsenic,
nineteen  months after interment.  (See, on this question,  a  case  of suspected
poisonino-, by Orfila, Annales d'Hyg. 1839, i.  127.)   If, however, there be the
least doubt respecting the origin of the discoloration, it would be unsafe to rely
upon the appearance as evidence of poisoning,  unless poison were detected.
   Ulceration.—In irritant poisoning, the stomach is occasionally found ulcerated;
but this is, comparatively speaking, a rare occurrence.   In such cases the mucous
membrane is removed in small distinct circular patches, under the edges of which
the poison (arsenic) is often found lodged.   Ulceration of the stomach is perhaps
a more common result of disease, than of the action of poison.  As a consequence
of disease, it is very insidious, going  on often for weeks together, without giving
any indications of its existence, except perhaps slight  gastric disturbance, with
occasional nausea, vomiting, and loss of appetite.  In this case the ulceration is
commonly seen in small circumscribed patches.  It is worthy  of remark, as one
means of diagnosis, that  ulceration  has never been known  to take place from
arsenic or any irritant poison, until symptoms  indicative of  irritant poisoning
have occurred.   In ulceration from disease, the  mucous membrane is commonly
only reddened in the neighbourhood of the ulcer.   In ulceration from poison, the
redness is generally diffused over other parts of the stomach, as well as over the
duodenum and small intestines.  A  case, however, occurred in Guy's Hospital,
some years ago, in which, with a small circular patch  of ulceration near the car-
diac opening, the whole mucous membrane was red and injected:—but this sin-
gular  condition  of  the stomach, so closely resembling the effects of an irritant
poison, was  unaccompanied by any marked  symptoms of irritation during life.
The history of a  case previous to death, will thus  commonly enable us to deter-
mine  to  what cause the  ulceration found may be  due.  Care must be taken to
distinguish ulceration from corrosion.  Ulceration is a vital process: the substance
of a part is removed by the absorbents as a simple  result of inflammation.   Cor-
rosion, on the other hand, is a chemical action;—the  parts are removed by the
immediate contact of the poison: they are decomposed: their  vitality is destroyed,
and they combine with the corrosive matter itself.  Ulceration requires  time for
its establishment, while corrosion is either an instantaneous or a very rapid effect.
   Softening.—The coats of the stomach are not unfrequently found so soft as
to yield and break down under very  slight pressure;  and this may be the result
either of poisoning, of some spontaneous morbid change in its structure during life,
or of the solvent action  of the  gastric juice after death.    As this condition in
the stomach, when caused by poison, is commonly  produced by those substances
only which  possess  corrosive  properties, it  follows that in such cases  traces of
their action  will be  perceived in the  mouth, fauces, and oesophagus.   In soften-
ing from disease, the change will be confined to the stomach  alone, and it is com-
monly found only at the  cardiac extremity of the organ.   When  softening  is
really caused by an  irritant poison, it is generally attended by other striking and
unambiguous marks of its operation.   Softening is not to  be regarded as a com-
mon character of poisoning: it is only an occasional appearance.  I have met
with a case,  in which the  coats of the stomach  were  considerably hardened by
sulphuric acid.   Softening can never be inferred to have proceeded from poison,
unless other well marked changes are present, or unless the poison be discovered
in the softened parts.   The  stomachs of infants  have been  frequently  found
softened from natural causes:—such  cases could not be mistaken for poisoning
since the history during life,—the want of other appearances indicative of poison-
ing, and  the total absence of poison  from the viscera, would prevent such a sus-
picion from  being entertained.
  Perforation.—The stomach may become perforated either as a result of poison-
ing or disease.                                                       4
  Perforation from poisoning.— This may occur in two ways:—-1. By corrosion • 
PERFORATION OF THE STOMACH FROM DISEASE.
51
2. By ulceration.  The perforation by corrosion is by  far the most common
variety of perforation  from poisoning.   It is occasionally witnessed where  the
strong mineral acids have been taken, especially sulphuric acid:—the stomach, in
such  cases, is blackened and  extensively destroyed,—the aperture  is large, the
edges are rough  and irregular, and the  coats are easily lacerated.   The  poison
escapes  into  the abdomen,  and may be readily detected by chemical  analysis.
The perforation from ulceration caused by irritant poison (arsenic,)  is but little
known.   There  are, so far as I know, only three instances on record.   In a great
number of poisoned subjects examined during many years past at Guy's Hospital,
not a single case has occurred.  It must, then, be looked  upon as a very rare ap-
pearance in cases of irritant poisoning.
   Perforation from disease.—This is by no means an unusual occurrence.  Many
cases of  this description will be found reported elsewhere.  (Guy's Hosp. Rep.
No. 8.)  It  is invariably fatal when it proceeds so far  that the contents of the
stomach escape  into the abdomen;  but sometimes the stomach becomes glued to
the pancreas during the ulcerative process, and then the individual may recover.
Several specimens of  this kind of adhesion have been met with in post-mortem
inspections.   The symptoms  from  perforation commonly attack the individual
suddenly, apparently  while enjoying  perfect health.  Hence these cases may be
easily mistaken  for those of irritant poisoning.  The principal facts observed with
regard to this formidable disease are the following:—1. It often attacks young
females from eighteen to twenty-three years of age.   2. The preceding illness is
extremely slight, sometimes there is merely loss of appetite or capricious appetite,
with  uneasiness after eating.  3. The attack commences with a sudden and most
severe pain in the abdomen, generally soon after a meal.   In irritant poisoning,
the pain usually comes on gradually,  and slowly increases in  severity.  4. Vo-
miting,  if it exist at  all,  is commonly slight, and is chiefly confined to what is
swallowed.   There is  no purging:—the bowels are generally constipated.  In
irritant poisoning, the  vomiting is usually severe, and purging seldom absent.   5.
The person dies commonly in from eighteen to thirty-six hours:—this is also the
average period of death in the most common form of irritant poisoning, i. e. by
arsenic;—but in no case yet recorded has arsenic caused perforation of the sto-
mach, within twenty-four hours; and it appears probable that a considerable time
must elapse before such an effect could be produced by this or any irritant.   6.
In perforation  from disease,  the  symptoms and death are clearly  referrible to
peritonitis.   7.  In the perforation from  disease, the aperture is commonly of  an
oval or  rounded form, about  half an inch in diameter, situated in  or  near  the
lesser curvature of the stomach, and the edges are  smooth.  The outer margin
of the aperture is often blackened, and the aperture  itself is funnel-shaped from
within outwards, i. e.  the  mucous  coat  is the  most removed, and the  outer  or
peritoneal coat,  the least.  The coats of the stomach, round the edge of the aper-
ture,  are usually thickened for some distance; and when cut, they have almost a
cartilaginous hardness.   These characters of the aperture will not alone indicate
whether it be the result of poisoning or disease; but the absence of  poison from
the stomach, with the  want of other  characteristic  marks of irritant poisoning,
would enable us to say that disease was the cause.  Besides, the history of  the
case during  life would  materially assist us in our diagnosis.  The great risk in
all these cases is, that  the effects of disease may be mistaken for those of poison-
ing ;  for we are not likely  to  mistake a perforation caused by irritant poison for
the result of disease.   Notwithstanding the  well marked  differences above de-
scribed, it is  very common to meet with cases of imputed poisoning where death
has really occurred from  peritonitis  following  perforation.  Within  a  recent
period I  have had to examine several cases of this kind: one of them will be found
elsewhere recorded (Guy's Hosp. Reports, Oct. 1850,  page 226.)  In another
the body was exhumed after several months' burial, and the stomach was found
perforated from  disease in the usual situation. 
52           RULES TO BE OBSERVED IN CASES OF POISONING.

   Spontaneous or Gelatinized Perforation.—The stomach is occasionally subject
to a spontaneous change, by which its coats become softened and give way, gene-
rally at the cardiac extremity.   As the extravasation of the contents of the organ
in such a case never gives rise to peritoneal inflammation, and no symptoms occur
prior to death to indicate the existence of so extensive a destruction of parts, it is
presumed to be a post-mortem change, and the  stomach is supposed to undergo
a process of solution soon after death.  It is commonly attributed to the solvent
action  of the gastric juice,—the spleen,  diaphragm,  and  other viscera  being
sometimes softened.   (For some remarks on this subject, by Dr.  Budd, see Med.
Gaz. vol. xxxix. p. 895.)  In January, 1845,1  met with  an instance of this
perforation in a child between two and three years of age.  It was seized  with
convulsions, became insensible, and died twenty-three hours afterwards.   After
death,  the cardiac  end of the stomach was found destroyed to the extent of three
inches, and the edges were softened and blackened.  There was no food in the
stomach, nor had  any thing passed into the organ for thirty-two hours before
death!   It was therefore impossible to ascribe  death to the perforation, or the
perforation to poison.   (For a full account of this case, see Med. Gaz. vol. xxxvi.
p. 32.)   The inspection of the body,  with the general history of the case, will
commonly suffice to remove any doubt in forming an opinion as to whether the
extensive destruction commonly met  with has  or has not arisen  from poison.
Thus, in a post-mortem perforation, the aperture is always situated in that part
of the stomach which lies to the left of the cardia, is very large,  of an irregular
form, and ragged and pulpy at the edges, which have the appearance  of  being
scraped.  The mucous membrane of the stomach is  not found  inflamed.  There
is occasionally slight redness,  with dark brown or almost black lines (striae) in
and near the  dissolved coats, which have an acid reaction.  It  can only be con-
founded with perforation by the action of corrosives; but the well marked symp-
toms during life, and the detection of the poison after  death, together with the
changes in the fauces and oesophagus, will at once indicate the perforation produced
by corrosive poison.  A case of extensive perforation of the stomach, as the result
of the action of the gastric fluids, has been recently reported by Dr. Barnes.   (See
Med. Gazette, vol.  xli. p. 293.)
                             CHAPTER IV.

RULES TO BE OBSERVED IN INVESTIGATING A CASE OF POISONING—WITH RESPECT TO THE
  PATIENT WHILE LIVING--THE INSPECTION OF THE BODY--THE EXHUMATION OF BODIES
  --DISPOSAL OF THE VISCERA.  IDENTITY OF SUBSTANCES.  PRESERVATION OF ARTICLES
  FOR ANALYSIS.  ON THE USE OF NOTES—WHEN ALLOWED TO BE USED IN EVIDENCE—
  —MEDICO-LEGAL REPORTS.


  When a  practitioner is called to a case of poisoning, it is above all things
necessary that he  should know to  what points he ought to give his  attention.
It is very proper that every effort should be made by him  to save life when the
individual is living: but while engaged in one duty, it is  also in his power to
perform another, supposing the case to be one of  suspected criminal poisoning__
namely, to note down many circumstances which may tend to detect the perpe-
trator of the crime.   There  is no  person  so well fitted  to  observe these points
as a medical man;  but it unfortunately happens, that many facts important as
evidence, are often overlooked.   The necessity for observing and recording them
is not perhaps generally known.  A medical man need not make himself officious
on such occasions,  but he would  be sadly unmindful of his  duty as a member of 
CIRCUMSTANTIAL EVIDENCE.
53
society, if he did not aid the course of justice by extending his scientific know-
ledge to the detection of crime.  It is much to the credit of the medical profession,
that the crime of murder by poisoning—a form  of death from which no caution
or,  foresight  can  protect  an  individual, is so frequently brought  to light,
by the announcement of suspicious facts of a medical nature to  magistrates and
coroners;  and on several occasions the highest compliments have been passed by
judges on medical  practitioners who have been thus indirectly the  means of
bringing an atrocious criminal to the bar of justice.
  The  following appear to me to  be the principal points which  demand the
attention of a medical jurist in all cases  of  suspected poisoning:—1.  With re-
spect to

                                Symptoms.
  1.  The time of their occurrence,—their nature.  2.  The exact period at which
they were observed to take place after a meal, or after food or medicine had been
taken.  3. The order of their occurrence.   4. Whether there was any remission
or  intermission in  their progress,  or whether they  continued to become  more
and more aggravated until death.   5. Whether the patient had laboured under
any previous illness.   6.  Whether the symptoms were observed to recur  more
violently after a particular meal, or after any particular kind of food or medicine.
7. Whether the patient has vomited:—the vomited matters, if any, (especially
those first ejected,) to be procured:—their odour, colour, acid or alkaline reaction
noted,—as well as their quantity.  8.  If none be procurable, and the vomiting
have  taken place on the dress, furniture, or floor of a room,—then a portion of
the clothing, sheet, or carpet, may be cut out and reserved for analysis;—if the
vomiting have occurred on a deal floor,  a portion of  the wood may be scraped or
cut out;—or if on a stone pavement,  then a clean piece of rag or sponge soaked
in distilled water, may be used to remove any traces of the substance.  [Some
years since, an animal was  poisoned by arsenic.   None  of the poison could be
detected in the stomach, but  it was easily found  in a portion of deal  floor,
rendered humid by the liquid matters which the animal had vomited during the
night.]  The vessel  in  which vomited matters have  been contained  will often
furnish valuable evidence, since heavy mineral poisons fall to the bottom, or adhere
to the sides of the vessel.   [Whether the patient  experienced  any sensation of
acridity or burning in the throat or mouth, previous to the occurrence  of vomit-
ing.  Dr. Griffith notes this inquiry as  especially important, where  the poison is
supposed to be one of the irritants.—H.]  9. Endeavour to ascertain the probable
nature of the food or medicine last taken, and the exact time at which it was taken.
10. Ascertain the nature of all the different articles of food used at  a meal.  11.
Any suspected articles of food, as well as the vomited matter, to be as soon as
possible sealed up  in a clean  glass vessel, labelled, and  reserved  for  analysis.
12. Note down, in their own words, all  explanations voluntarily made by parties
present, or who are supposed to be concerned in the suspected poisoning.   13.
Whether more than one person partook of the food or medicine:—if so, whether
all  these persons were affected, and how?   14. Whether the same kind of food
or  medicine had  been taken before by the patient or other persons without ill
effects following.  In the event of the death of the patient, it will be  necessary for
the practitioner to note down—15.  The exact time of death, and thus determine
how long a period the person has survived after having been first attacked with
the suspicious symptoms.   16. Observe the attitude and position  of  the body.
17. Observe the state  of the dress.   18. Observe all surrounding objects.  Any
bottles, paper-packets, weapons, or spilled liquids lying about, should be collected
and preserved.  19.  Collect any vomited matters near the deceased.   Observe
whether vomiting has taken place in  the recumbent position or not.  If the
person  has vomited  in the erect  or sitting  posture, the front of the dress will
commonly be found covered with the vomited matters. 
54
RULES FOR THE EXAMINATION OF THE BODY.
                         Inspection of the Body.
   20. Note the external appearances of the body, whether the surface be livid
 or pallid.  21. Note the state of the countenance.  22. Note all marks of violence
 on the person or discomposure of the dress,—marks of blood, &c.  23. Observe
 the presence or absence of warmth or coldness in the legs, arms, abdomen, mouth,
 or axilla?.  24. The presence of rigidity or  cadaverous  spasm in the body.   To
 give any value to the two last-mentioned characters, it is necessary for the prac-
 titioner to observe the nature of the floor on which the body is lying, whether this
 be clothed or naked, young or old, fat or emaciated.  All these conditions create
 a  difference in  respect to the  cooling  of the  body' and the  access of rigidity.
 25. If found dead—When was the deceased last seen living, or known to have
 been  alive?   26. Note all circumstances leading to  a suspicion of suicide or mur-
 der.  27. The time after death at which the inspection  is made.  28. Observe
 the state of the abdominal viscera.   If the  stomach and intestines be found in-
 flamed, the seat of inflammation should be exactly specified; also all marks of
 softening, ulceration, effusion of blood, corrosion, or perforation.   The stomach
 should be removed and placed in a separate vessel, a ligature being applied  at
 the cardiac and pyloric ends.  29. The contents of the stomach should be collected
 in a clean graduated vessel:—notice a the quantity, b the odour tried by several
 persons, c the colour, d acid or alkaline reaction; e presence of blood, mucus or
 bile;  /presence of undigested food: and here it may be as well to observe, that
 the presence of farinaceous  matters  (bread) would be indicated  by the addition
 of iodine water, if the contents were not alkaline—of fat, by heat; g other special
 characters.  30. The contents of the duodenum should  be separately collected,
 ligatures being applied to it.  31. Observe the state of the large intestines, espe-
 cially the rectum, and note the condition of their  contents.  The discovery of
 hardened faeces in the rectum would  prove that purging had not existed recently
 before death.   In one case which I had lately  to examine, this became a ques-
 tion of considerable importance.  32. The state of the larynx, fauces, and oeso-
 phagus,—whether there be in these  parts any foreign  substances, or  marks  of
 inflammation or corrosion.   This is  of  essential importance, as it throws light
 upon  the question,  whether  the  poison  swallowed was irritant or corrosive, and
 whether it had or had not a local chemical action.   33. The state of the thoracic
 viscera:—all morbid changes noted.   34. The  state of the brain.   35. The con-
 dition of the genital organs should  be  examined, as, in  the  female, poison has
 been  sometimes introduced into the system by  the vagina.
   Such are the points to which, in the greater number of cases of suspected
 poisoning, a medical jurist should attend.   By means of these  data, noted  ac-
 cording to the particular case to which  they are adapted, he will  in general  be
 enabled, without difficulty, to determine the  probable  time of death, and  the
 actual means by which death was brought about.   He  may thereby have it  in
 his power also to point out the dish or article  of food which  had  contained  the
 poison, if the case be one of poisoning; and to throw light  upon any disputed
 question of suicide or murder in relation to the deceased.   Many cases of poisoning
 are rendered obscure, owing to these points  not having  been attended to in  the
 first instance.
   I have not considered it necessary to enter into any details respecting the mode
 of performing an inspection.  This the practitioner will have acquired during his
 study of anatomy: and the only essential points, in addition to those mentioned,
 are—1. To examine all the important organs for marks of natural disease*  and
2.  To note down any unusual pathological appearances, or abnormal deviations*
 although they may at the time  appear to have no  bearing on the  question of
poisoning.  It  is useful to  bear in  mind  on  these occasions, that the body is
 inspected, not merely to show that the individual has died from poison  but to
prove that he has not died from any  natural cause  of disease.   Medical practi- 
              OF the identity of substances FOR ANALYSIS.            55

tioners commonly give their attention exclusively to the first point;  while lawyers,
who defend accused parties, very properly direct a most searching examination to
the last mentioned point, i.  e.  the  healthy or unhealthy state of those  organs
which are essential to life, and with which  the poison has not  probably come in
contact.   The most usual causes of sudden death commonly have their seat in
the brain, the heart and its great vessels, and in the lungs.   Marks of effusion
of blood, congestion, inflammation,  suppuration, or a diseased condition of the
valves of the heart, should be sought for and  accurately noted, whatever may be
the condition of the abdominal viscera.  It has  also been recommended that an
examination of the spinal marrow should be  made.   If  the cause of death be
very obscure after the general examination  of the body, there may be some reason
for inspecting the condition of this  organ.
   Exhumation of bodies.—Sometimes the  inspection of a body is required to be
made long after interment.  So long as the  coffin remains  entire, there may be
the expectation of discovering certain kinds of mineral poison  in the organs; but
decomposition may have advanced so far as to destroy all pathological evidence.
The inspection is in such cases commonly confined to the abdominal viscera.   The
stomach is often found so thinned and collapsed, that the anterior and posterior
walls appear  to form only one coat.   This  organ should be removed, with the
duodenum, and ligatures applied to each.  The liver and the  spleen should  also
be removed, in order that  they may, if necessary, be separately analyzed.   If
poison be not found  in one or more of these viscera, it is not likely that it will
be discovered in the body.  It has been recommended  that  a portion of earth
immediately above and  below the  coffin should be removed  for analysis,  as it
may contain arsenic: but this appears to me to be an unnecessary piece of refine-
ment, in those cases where the coffin is entire, or where  the abdominal parietes
still cover the viscera.  When decomposition has so far advanced as to  have led
to a mixture of the earth with the viscera, and the poison is found  in very minute
quantity in the tissues only, the case may be regarded as doubtful.  In giving a
positive opinion upon such hyperchemical  views, it might be fairly objected that
traces of arsenic always exist in the iron and brass nails and ornaments which
are used in a coffin; and this arsenic is just as likely to furnish a valid objection
to medico-legal  researches as that which is said to be a constituent of all soils in
which oxide of .iron abounds!   The body of a deceased person, when exhumed,
should be identified by some friend or  relative, in  the presence of the medical
examiner.  In  one case of murder by poison the evidence  almost failed, owing
to this precaution not having been  taken.
   It is important that the viscera taken from a body which  has been  long in the
grave should be sealed up immediately.  They  should not  be allowed to  come
in contact with  any metal, nor with any surface except that  of clean glass, porce-
lain, or wood.  It  has  been recommended  that they should be  washed  with
chloride of lime, or placed in alcohol;  but this  is decidedly  improper: the use
of any preservative chemical liquid would not only embarrass the future analysis,
but would render a special examination of an unused portion of the liquid neces-
sary—the identity of which would have to be unequivocally  established.   Pre-
servation from air in clean glass vessels, with well fitted corks, covered with skin,
or, what is still better, sheet-caoutchouc, is all that is required in practice.

                         Identity of Substances.
   It is necessary to observe, that all legal authorities rigorously insist upon proof
bein"- adduced of the identity of the vomited matters or other  liquids  taken from
 the body of a deceased person, when poisoning is  suspected.  Supposing  that
 during the post-mortem  examination the stomach and viscera  are removed from
 the body, they, should never be placed on any surface, or in any vessel, until we
 have first ascertained that the surface or vessel is perfectly clean.    If this  point
 be not attended to, it will be in the power  of counsel to  raise  a doubt in the 
56
PRESERVING ARTICLES FOR ANALYSIS.
minds-of the  jury, whether  the  poisonous substance might not have ocen acci-
dentally present in the vessel used.   This may be regarded as a  very remote
presumption;  but, nevertheless, it is upon technical objections of this kind, that
acquittals follow,  in  spite of the strongest  presumptions of guilt.   This is a
question for which every medical witness  should be prepared, whether  he  be
giving his evidence at a coroner's inquest, or in a court of law.   31 any  might
feel disposed to regard matters of this kind as involving unnecessary nicety and
care;  but if they be neglected, it is possible that a case may be at once stopped:
so that any care subsequently bestowed upon the chemical analysis by the prac-
titioner will have  been thrown away.  Evidence of the presence of poison  in
the contents of a stomach was once rejected at a trial  for murder, because they
had been hastily thrown into a jar borrowed from  a neighbouring grocer's shop;
and it could not be satisfactorily proved that the jar was clean and entirely free
from traces  of poison (in which the grocer  dealt) when used for this purpose.
When the life of a human being is at stake, as in a charge of murder by poisoning,
the slightest doubt is always very properly interpreted in favour of the accused.
  Not only must clean vessels be used for receiving any liquid destined for sub-
sequent chemical analysis, but care must be taken by the practitioner that the
identity of a substance is preserved, or the most correct analysis afterwards  made,
will be inadmissible as evidence.   The suspected substance, when once placed in
his hands, should never be let out of  his  sight or custody.  It should  be kept
sealed under his private seal, and locked  up, while in  his possession, in a  closet
to which no other  person has a key.  If he has once let it out of his hands, and
allowed it to pass through the hands of several other persons, then he complicates
the evidence for the prosecution, by rendering it indispensable for these parties
to state under what circumstances it was placed while  in their possession.   The
exposure of a suspected substance on a  table, or in a closet or room, to which
many have access, may be fatal to its  identity;  for the chemical  evidence,  so
important in a criminal investigation, will probably be altogether rejected by the
court.   A few years ago, a case was tried on the Norfolk circuit, in which the
analysis of the matters vomited by a person poisoned by arsenic, was not admitted
as evidence against the prisoner, because the practitioner had left  them in the
keeping  of two  ignorant women;  and these women had allowed the vessel con-
taining the suspected liquid (which was proved to  contain arsenic) to be exposed
in a room open to the access of many persons.   In another ease, tried at the Old
Bailey Sessions in 1835, the analysis  of some suspected liquids was  not allowed
in evidence,  because the practitioner, who lived in the country, and was unwilling
to take upon himself  the responsibility of analyzing them, had sent them  up  to
town  by a carrier, to be examined by a London chemist.   If closely sealed by a
private  seal, and this be observed by the receiver to be unbroken, before  he
proceeds to the analysis—this mode of transmission will not probably be objected
to.   When any article (e. g. a stomach or. other viscus) is reserved for analysis,
care should  be taken to attach immediately to it, or the vessel containing it, a
parchment or wooden label upon which is plainly written in ink, the name  of the
deceased and  the  date  of removal, including  the "day of the week  and month.
This is especially necessary when there are two or more articles  for analysis.   I
have known the greatest inconvenience to result from the neglect of this simple
precaution.
  Preserving  articles for analysis.—In removing viscera or liquids from the
body, and reserving  them for analysis, it is necessary to observe certain precau-
tions.   A clean vessel with a wide mouth should be selected:  it should be only
sufficiently large to hold the viscus or liquid (the less  air remaining in it the
better;)  it should be  secured by a closely fitting cork, covered with fine skin  or
bladder.   Another piece of skin should then be tied over the mouth  or for this
sheet-caoutchouc may be substituted with advantage.   It should then be covered
with tin-foil, and lastly with white leather. ' In this way any loss by evaporation 
MEDICO-LEGAL REPORTS.
57
or decomposition is prevented, and the viscera may be preserved (in a cool place)
for some time.   If the mouth of the vessel be too wide for a cork, the other ar-
ticles cannot be dispensed with.  Paper only should not be used: I have known
the post-mortem appearances of the viscera of an  infant, suspected to have died
from poison, entirely destroyed by drying, from the evaporation which took place
through the  layers of paper with which the vessel in which they were contained
was covered.  The practitioner should bear in mind that all these matters are
likely to come  out in  evidence;  and whatever is worth doing at all, is worth
doing well.   For  reasons already stated no antiseptic  should be used.   The ad-
dition of alum or  alcohol to the viscera may seriously  embarrass the analysis.
   On the use of Notes.—If has  already been recommended as  a  rule in  these
criminal investigations, that a practitioner should make notes of what he observes
in regard to  symptoms, post-mortem  appearances,  and the  results of a chemical
analysis.  From the common forms of law in this country,  an individual charged
with the crime of  poisoning may remain  imprisoned,  if at a distance  from the
metropolis, for some months before he is  brought to trial.  It is  obvious, how-
ever clear the circumstances may at the time appear to the practitioner, that it
will require more than ordinary powers of memory  to retain, for so long a period,
a distinct recollection of all the facts of the case.  If he be  unprovided with
notes, and his  memory be defective, then  the case will turn  in  favour of the
prisoner, for he will be  the party to  benefit by the neglect of the witness.  In
adopting the plan  here recommended, such a result may be easily prevented.  It
may be remarked, that the law relative to the admissibility of notes or memo-
randa in evidence  is very strict, and is rigorously insisted on by the judges.  In
order to render such notes, or memoranda admissible, it is indispensably neces-
sary that they should be taken on the spot at the time the observations are made,
or as soon afterwards as practicable.
   Medico-legal Reports.—One of the  duties of the medical  jurist is to draw up a
report of the results of his examination: 1, in regard to  symptoms: 2, in regard to
the post-mortem appearances; and, 3,  in  regard  to the results of an analysis.
With respect to the first two divisions of the report, I must refer the reader to
the rules for investigating cases of  poisoning.  I need hardly observe that the
time at which the person was first seen, and the circumstances under which the
attendance of the practitioner was required, as well as the period of death, should
be  particularly stated.  The hour, the day of the week,  and the  day of the
month,  should  be invariably mentioned.   Some medical witnesses merely state
the day of the week, without that of the month, or vice  versa. . At  a  trial this
creates  great confusion, by rendering a reference  to almanacs necessary.  The
words yesterday, next day,  &c. should never be used.   The facts  which it will
be necessary to enter in the report are specially stated  under the heads of  in-
vestigation (see p. 53.)  If these facts be  not observed  in the order  there  set
down, their value  as evidence of the cause  of death,  or of the criminality of par-
ticular parties,  will be entirely lost.   In drawing up a report of symptoms and
post-mortem  appearances, the facts should be  in  the first instance plainly and
concisely stated seriatim, in language easily intelligible to  non-professional per-
sons.   A reporter  is not called upon  to display his erudition, but  to make him-
self understood.  If technical terms are employed, their meaning should be stated
in parentheses.   When a subject is thoroughly understood, there can be no diffi-
culty in rendering  it in simple language; and when it is not well understood the
practitioner  is  not in a position to make a report.   Magistrates,  coroners, and
barristers, are very acute, and easily detect ignorance, even when it appears under
the mask of  erudition.
  In recording facts, a reporter should not encumber his statements with opinions
and inferences.   His conclusions should be reserved until the end  of the report.
The language in which conclusions are expressed  should be  precise and clear.
It must be  remembered that  these are to form a concise summary of the whole 
58
MEDICO-LEGAL REPORTS.
report, upon which the judgment of a magistrate or the decision of a coroner's
jury will be ultimately based.   They should be most strictly kept to the matters
which are the subject of inquiry.  Thus, they commonly refer to the following
questions.  What was the cause of death?   What are the medical circumstances
which lead you to suppose that death was caused by poison?   What are the cir-
cumstances which lead you to suppose that death was not caused by natural disease?
Answers to one or all of these questions comprise, in general, all that the reporter
is required to introduce into the conclusions of his report.
  The reporter must remember, that  his conclusions are to be based only upon
medical  facts,—not upon moral circumstances, unless he be especially required
to express his opinion with regard to them, when they are of a medico-moral
nature.  Further, they must be based only on what he has himself seen  or ob-
served.   Any information derived from  others should  not  be made the basis of
an opinion in a medico-legal report.   It is scarcely necessary  to remark,  that a
conclusion based upon mere probabilities is of no  value as evidence.
  In drawing  up a report on the results of a chemical analysis, the  following
rules may be borne in  mind.   A liquid or solid is reserved for analysis.   1.
When, and of whom, or how received?  2.  In what state was it received—se-
cured in  any way, or exposed?   3. If more than one substance received, each to
be separately and distinctly labelled; appearance  of the vessel, its capacity,  and
the quantity of  liquid (by measure) or solid (by weight) contained therein.   4.
Where and when did you proceed to make the analysis", and where was the sub-
stance kept during the intermediate period?   5.  Did any one assist you,  or did
you make the analysis yourself?  6.  Physical characters of the  substance.   7.
Processes and tests employed for determining whether it contained poison.  All
the steps of these processes need not be described;—a general  outline  of the
analysis will suffice.  The magistrate may thus satisfy himself by  an appeal to
others (if necessary) to say whether the analysis has or has not  been properly
made.  8.  Supposing  the substance to  contain  poison,—is this in a pure state,
or mixed with any other body?  9. The strength of the poison, if an acid, or  if it
be in solution:  in all cases, the quantity of poison present.   10.  Supposing no
poison to be contained in it, what was the nature of the substance?  Did it contain
any thing likely to injure health or destroy life?  11. Could the supposed poison-
ous substances exist naturally or be produced within  the body?   12.  What
quantity of the poison discovered would  suffice to  destroy life, and how far is the
dose likely to be modified by age or disease ?
  There are few reports in which answers to most of these questions, although
not formally put, will not be required: and unless the whole of them be borne in
mind by the operator at the time  an analysis is undertaken, those which are
omitted can never receive an answer,  however important to the ends of justice
that answer may ultimately become.
  The results of analysis in the shape  of sublimates or precipitates should be
preserved as evidence, distinctly labelled to correspond with the report, in small
glass tubes hermetically sealed.   In  this way they may be produced  for  exami-
nation at the inquest or trial. 
SYMPTOMS PRODUCED BY OIL OF VITRIOL,
59
IRRITANT  POISONS.
                               CHAPTER  V.

 DIVISION OF IRRITANT POISONS.  SULPHURIC ACID, OR OIL OF VITRIOL.   SYMPTOMS CAUSED
   BY' THIS POISON IN THE CONCENTRATED AND DILUTED STATE--POST-MORTEM APPEARANCES.
   QUANTITY OF ACID REQUIRED TO DESTROY LIFE--FATAL DOSES—PERIOD AT WHICH DEATH
   TAKES PLACE--TREATMENT--CHEMICAL ANALYSIS--MODE  OF DETECTING THE POISON IN
   PURE AND MIXED LIQUIDS--ITS DETECTION IN ARTICLES OF CLOTHING--POISONING BY
   SULPHATE OF INDIGO.

   General Remarks.—Irritant poisons may be divided into four groups—the
 non-metallic—the metalloids—the metallic—and those of an organic nature, i. e.
 derived from the vegetable and  animal kingdoms.   The non-metallic  irritants
 comprise the mineral acids, oxalic acid, the alkalies, and their salts.   According
 to strict chemical views, the alkalies and their salts should be placed  among the
 metallic irritants; but it will be, in many respects, convenient to consider them
 in the same group with the acids.   Besides, although they certainly have  me-
 tallic bases, the demonstration of the existence of the metal is never required at
 the  hands of a  medical jurist, as  in the case of the  true metallic irritants.
 Among the mineral acids, we shall first speak of poisoning by sulphuric acid.

                    Sulphuric Acid, or Oil of Vitriol.
   Symptoms.—When this  poison is swallowed in a concentrated form, the symp-
 toms produced come on immediately or during the act of  swallowing.   There is
 violent burning  pain, extending through the fauces and oesophagus  to the sto-
 mach—the pain is often so severe that the body is bent.   There is an escape of
 gaseous  and frothy  matter, followed by retching  and vomiting, the latter ac-
 companied by the discharge of shreds of tough mucus and of a liquid of a dark
 coffee-ground colour, mixed with blood.   The mouth is excoriated,  the  lining
 membrane and surface of the tongue white, or resembling soaked parchment—in
 one instance the appearance of the mouth was as if  it had  been smeared with
 white paint: after a time, the membrane acquires a gray or brownish colour; the
 cavity  is filled with a thick viscid substance consisting of saliva, mucus, and the
 membrane of the mouth :—this renders speaking  and swallowing very difficult.
 If the  poison has been administered by a spoon, or the phial containing it has
been passed to the back of the fauces, the mouth may escape the chemical action
 of the  acid.  A medical witness must bear this circumstance in  mind, when he
is called to examine an infant suspected to have been  poisoned by sulphuric acid.
 Around the lips and  on the neck may be found spots of a brown colour from the
action  of the acid on the skin.   There is extreme difficulty of breathing,  owing
to the  swelling and  excoriation  of the fauces and larynx, and the  countenance
 has from this cause a blueish or  livid appearance;—the least motion of the ab-
 dominal muscles is attended with increase of pain.   These symptoms have been 
60
POST-MORTEM APPEARANCES.
sometimes mistaken for those of disease.   (Henke, Zeitschrift der £\ A. 1843,
ii. 284.)   The stomach is so irritable that whatever is swallowed is immediately
ejected, and the vomiting is commonly violent and incessant.   In an interesting
case communicated to the Medical Gazette by my friend, Dr. Geoghegan, of
Dublin, the patient vomited for three or four hours.  This symptom then ceased,
and did not recur, although she did not die until thirty-four hours after the poison
had been swallowed.   (Med. Gaz., vol. xlviii. p. 328.)   The matters first vomited
generally contain the poison: they are acid, and if they fall on a limestone pave-
ment there is effervescence, if on coloured  articles of dress, the colour  is some-
times altered to a red or yellow  (if logwood,) or the colour is discharged and the
texture of the stuff destroyed:—on a black cloth dress, the spots produced by the
concentrated acid are brown, and remain moist for a considerable  time.   An at-
tention to these circumstances may often lead  to a suspicion of the real  cause of
the symptoms, when the facts are concealed.   After a time  there is great ex-
haustion, accompanied by general weakness:—the pulse  becomes quick, small,
and feeble;  the skin  cold, mottled,  and covered  with  a clammy  sweat.  There
is generally great thirst, with obstinate constipation of the bowels:—should any
evacuations  take place, they are commonly either of  a dark brown or leaden
colour,—in some instances almost black, arising from the admixture of altered
blood.   There are sometimes convulsive motions  of the muscles, especially of
those of the face and lips.   The countenance,  if not livid from obstructed respi-
ration, is pale, expressive of great anxiety, and of the most  dreadful suffering.
The intellectual faculties are quite clear, and death usually takes place  very sud-
denly,  in from eighteen to twenty-four hours after the  poison has been taken.
  Post-mortem appearances.—It  has been remarked that these  are not always
to be found in the  stomach; they may be  confined to the region  of the fauces
and larynx.  In an inspection of the body, the whole  course  of  the alimentary
canal,  from the  mouth downwards, ought to be examined;  since in recent or
acute cases, it is in  the oesophagus and fauces that we generally obtain strong evi-
dence of the action of a corrosive poison.   The discovery of  the  usual marks of
corrosion in these parts  is always highly corroborative  of the signs of poisoning
found in the stomach.   During the  inspection, the  examiner must not omit to
notice  any spots on the skin produced by the action of the acid:—these  are com-
monly of a dark brown colour, and are situated about the mouth,  lips, and neck.
The appearances met with in the body will vary, according to whether death has
taken place rapidly or slowly.   Supposing the case, to have  proved fatal very
rapidty, the membrane lining the mouth will be found white, softened, and cor-
roded; but this appearance may  be absent.   The mucous membrane of the fauces
and oesophagus will commonly be found corroded,  having sometimes a  brownish
or ash-gray colour.   The corroded membrane of the oesophagus  is  occasionally
disposed in longitudinal folds, portions of it being partly detached.   The stomach,
if not perforated, is collapsed and contracted.  On laying it open, the  contents
are commonly found of a dark brown or black colour, and of a tarry  consistency,
being formed in great part of mucus and  altered  blood.   The contents may or
may not be acid, according to the time the patient has survived, and the  treat-
ment which has been adopted.   On removing them, the stomach may be  seen
traversed by black lines, or the whole of the mucous membrane may be corrugated,
and stained, of a dark brown or black colour.  This blackness  is not removed by
washing.   On stretching the stomach, traces of inflammation  may  be found
between the folds, indicated by a deep crimson-red colour.   On removing the
blackened membrane, the red colour indicative of inflammation may be also seen
in the parts beneath.  Both the dark colour and marks of inflammation are
sometimes partial,  being confined to insulated  portions  of the mucous membrane.
When the stomach is perforated, the  coats are  softened, and the  edge of the
aperture is commonly black and irregular.  In removing the 'stomach, the aper-
ture is apt to be made larger by the mere weight of the organ.  The contents do 
SULPHURIC ACID.  FATAL DOSE.
61
not always'escape;  but when this happens, the surrounding viscera are attacked
by the poison.   [According to Dr. Griffiths, perforation of the stomach has been
found to take place in about one-third of the cases of death from this poison.
H.]   In a case which occurred at Guy's Hospital, the  spleen, the liver, and the
coats of the aorta, were found blackened and corroded by the acid, which had
escaped through the perforation.  When the person has survived for eighteen or
twenty hours, traces of corrosive and inflammatory action may be  found in the
small intestines.  In one case the mucous membrane of the ileum was corroded.
The  interior of the larynx, as well as of the bronchial tubes,  has also presented
marks of the local action of the acid.   The  acid has thus destroyed life without
reaching the stomach.   A  remarkable instance in which the poison penetrated
into  and destroyed both lungs has been reported by Dr. Gull.  (See Med. Gaz.
vol.  six. p. 1102.)
  It is important for the medical witness to bear in mind that the condition of
the fauces and oesophagus above described, is not constantly met with.   Strange
as it may appear, cases  are recorded in which, notwithstanding the introduction of
the  poison into the  stomach, the oesophagus has escaped its chemical action.
   When the acid has been taken in a diluted  state, the marks of  inflammation
on the mucous membrane are more decided, and the charring is not so consider-
able.  Nevertheless, the acid, unless too much diluted, acts  upon  and  darkens
the  blood in the vessels, as well as that contained in the stomach, although it
may not blacken the mucous membrane or the contents.
   Quantify required to destroy life.—The dangerous effects of this poison appear
to arise rather from its degree of concentration, than from the absolute quantity
taken.  The quantity  actually required to  prove fatal must depend on  many
circumstances.   If  the stomach  be  full when it is swallowed, the  action of the
acid may be spent on the food and not on the stomach; and a larger  quantity
might thus be taken, than  would suffice to destroy life if the  organ were empty.
The smallest quantity which is described as having proved fatal was in the fol-
lowing case.   Half a tea-spoonful of concentrated sulphuric acid was given to a
child about a year old  by mistake for castor-oil.   The usual symptoms came on,
with great disturbance of the respiratory functions; and the child died in twenty-
four hours.   The quantity here taken could not have exceeded  forty drops.
(Med. Gaz. vol. xxix. p. 147.)  It is, however, doubtful whether this small quan-
tity  would have proved fatal  to an  adult.  The smallest  fatal dose which Dr.
Christison states he has found recorded was one drachm; it was taken, by mis-
take, by a stout young man, and killed him in seven days.   (Op. cit. 162.)
   Period at which death takes place.—It has  been already stated  that the ave-
rage period at which death takes  place in cases of  acute poisoning  by sulphuric
acid, is from eighteen to twenty-four hours.   When the stomach  is perforated
by the acid, it commonly proves more speedily fatal.   In one instance, reported
by Dr. Sinclair, a child about four years old died in four hours—the stomach was
perforated.  When  the poison acts upon the larynx, death may be a still more
speedy consequence from suffocation; and, owing to this, it appears  to be more
rapidly fatal to children than adults.  Dr. Craigie mentions a case in which three
ounces of concentrated sulphuric acid destroyed life in  three  hours and a half;
but the shortest case on record is, perhaps, that mentioned by Remer in Hufe-
land's Journal.   In this instance death took place in two hours.   A case is re-
ported by Mr. Watson, in which a woman swallowed two ounces of  the strong
acid.   She died in half an hour,  but it appears that a quarter of an hour before
death she had made a deep wound in her throat, which gave rise to great hemor-
rhage.  The stomach was  found very extensively perforated:—but it is highly
probable that the wound accelerated death in this case.
  On the other hand, there are numerous instances reported, in which the poison
proved fatal, from secondary causes, at periods varying  from one week to several
months. 
62
SULPHURIC ACID.   CHEMICAL ANALYSIS.
   Chemical analysis.—This acid may be met with either concentrated or diluted;
and a medical  jurist may have to examine it under three conditions:   1.  In its
simple state.   2.  When mixed with organic matters, as with  liquid articles of
food, or in the contents of the  stomach.   3.  On  solid organic substances, as
where the acid has been thrown or spilled on articles of dress or clothing.
   In the simple state.—If concentrated', it possesses these properties:   1. A. piece
of wood or other organic matter plunged  into  it, is immediately  carbonized or
charred.   2. When boiled with wood,  copper-cuttings, or mercury, it evolves
fumes of sulphurous acid;  this is immediately known by the odour, as well as by
the acid vapour first rendering blue, and then bleaching starch-paper dipped in
a solution of iodic acid.  3. When mixed with an equal bulk of water, great heat
is evolved (nearly 200° F.  in a cold vessel.)
   The diluted acid.   For the acid in a  diluted state, but  one  test need  be ap-
plied:—a solution of a salt of barytes,'—the Nitrate of barytes, or the  Chloride
of barium.  Having  ascertained, by test-paper, that  the  liquid is acid, we add
to a portion of it. a few drops of nitric acid, and then a  solution of nitrate of
barytes.   If sulphuric acid be present, a dense white precipitate of sulphate of
barytes will fall down—which is insoluble in all acids and alkalies.  If this pre-
cipitate be collected, dried and heated to redness in  a small platina crucible with
five or six parts of charcoal powder, it will, if a sulphate, be converted to sulphu-
ret of barium.   To prove this, we add  to the calcined residue diluted  muriatic
acid, at the same time suspending over it a slip of filtering  paper moistened with
a solution  of acetate of lead, or, what is  exceedingly convenient,  we place  the
residue on a slip of glazed card, (coated  with  carbonate of  lead,) scraped and
wetted on the surface.   (The card  should be first tested for lead;  because some
kinds of glazed cards are made without lead.)   If the original  precipitate was a
sulphate, the gas now evolved will be sulphuretted hydrogen, known by its  odour,
and by its turning the salt of lead or staining the card of  a brown colour.   In-
stead of charcoal, we  may  use an  equal bulk  of cyanide  of potassium as  the
reducing agent, and the experiment may then be performed in a small reduction
tube over a spirit lamp.   On breaking  the  tube and placing  the powder on a
glazed card (containing lead) previously wetted, the stain  of sulphuret of lead
will be perceived;-—or the calcined residue may be dissolved in water and tested.
The smallest visible quantity of sulphate  of barytes thus admits of easy detec-
tion.
  In liquids containing organic  matter.—If the sulphuric acid be mixed with
such liquids as porter,  coffee, or tea, the  process for  its detection is substantially
the same, the liquid being rendered clear by filtration previously to adding  the
test.  The sulphate of barytes, if mixed  with organic matter,  may be purified by
boiling  it  in strong nitric acid;  but this is  not commonly necessary, as the re-
duction of the precipitate  may be equally well performed with the impure, as
with the pure sulphate.  Some liquids generally contain sulphuric acid  or a sul-
phate, such as vinegar  and porter, but  the  acid is  in  very minute proportion;
therefore, if there be  an abundant precipitate,  there  can  be no doubt caeteris
paribus, that free sulphuric acid has been added to them.   Should the liquid be
thick and viscid like gruel,  it may be diluted with water, and then boiled with
the addition of a little  acetic acid.   For  the action of the test, it is not necessarv
that the liquid  should  be absolutely clear,  provided  it be not so thick  as to in-
terfere mechanically with the  precipitation of  the sulphate of  barytes.    So far
with regard to articles  administered, or of which the administration has  been at-
tempted.   The same rules apply to the examination of matters vomited and  of
the contents of the stomach,—care being  taken to separate the insoluble  parts by
filtration, before adding the test.
  On solid organic sidjstanccs.—It sometimes happens in cases of poisoning that
sulphuric acid is spilled upon articles of clothing, such as cloth or linen and here
a medical jurist may succeed in detecting it,  when every other source of chemi- 
POISONING BY NITRIC ACID OR AQUA FORTIS.
63
cal evidence fails.  Again, sulphuric acid is often used for the purpose of seriously
injuring a party, as by throwing it on the person,—an offence which, when ac-
companied with bodily injury, renders the offender liable to a severe punishment.
On such occasions, proof of the nature of the corrosive liquid is required; and
this is easily obtained by a chemical examination  of a part of the dress.   The
process  of analysis is very simple.   The piece of cloth should be digested in a
small quantity of distilled- water at a gentle heat, whereby a brownish-coloured
liquid is commonly obtained on filtration.  If sulphuric acid be present,  the
liquid will  have a strong acid  reaction, and produce the usual effects with the
barytic  test.

                           Sulphate of Indigo.
   Several cases of accidental poisoning by this substance have occurred.  As the
compound is nothing more than a  solution of indigo in common sulphuric acid,
the symptoms and  post-mortem appearances are the same  as those which have
been described for  the latter substance.   This kind of poisoning may be sus-
pected, when, with  these symptoms, the membrane  of  the mouth has a  blue
colour.   The  vomited matters, as well as the  faeces,  are at first of a  deep blue
tint; afterwards green;  and it was observed in two instances that  the urine had
a blue tinge.
   It is  proper to notice, that as indigo is one of the substances now directed by
the statute  to be mixed with arsenic when sold in small quantities, the detection
of this colouring principle in the mouth and vomited matters will not necessarily
show that it has been taken in the form of sulphate.
                             [CHAPTER  VI.

 POISONING BY NITRIC ACID OR AQUA FORTIS.   ACTION OF THE CONCENTRATED AND DILUTEB
  ACIDS--POST-MORTE.M APPEARANCES—QUANTITY REQUIRED TO DESTROY LIFE--PERIOD AT
  WHICH DEATH TAKES PLACE.  PROCESSES FOR DETECTING THE POISON IN PURE AND OR-
  GANIC LIQUIDS.  POISONING BY MURIATIC ACID.

   General Remarks.—Nitric acid is popularly known under the name of Aqua
fortis, or fled spirit of nitre.   According  to Tartra, it seems to have  been first
used as a poison about the middle  of the fifteenth century.   Although it is per-
haps much more used in the arts than oil of vitriol, cases of  poisoning by it are
by no means common.
  Symptoms.—When the acid is in a concentrated state, the symptoms, on the
whole, bear a close analogy to those produced by sulphuric acid.  They come on
immediately, and the swallowing of the acid  is accompanied by the most intense
burning pain in the fauces and oesophagus, extending  downwards to the stomach:
—there are gaseous eructations, from the chemical action of the poison,—swell-
ing of the abdomen, violent vomiting of liquid or solid  matters, mixed with altered
blood of a dark  brown colour, and shreds of mucus, having a strong acid reaction.
The  abdomen is generally exquisitely tender:  but, in one well marked case of
poisoning by this acid,  the pain was chiefly confined to the fauces:  probably the
poison  had not reached the stomach.  The  mucous membrane  of  the mouth i«
commonly soft and white, after a time becoming yellow, or even brown; the teeth
are also white, and the enamel is partially destroyed  by the chemical action of
the acid.   There is great  difficulty of speaking, as well as  of deglutition, the
mouth being filled with viscid  mucus: the power of swallowing is sometimes en-
tirely lost.  On opening  the mouth, the tongue may be found swollen and of a 
64
NITRIC ACID.   SYMPTOMS AND APPEARANCES.
citron colour;' the tonsils are also swollen and enlarged.  The difficulty of respi-
ration is occasionally such  as to render tracheotomy indispensable, especially in
young subjects.   (See case by Mr. Arnott, Med. Gaz.  xii. 220.)   As the symp-
toms progress, the pulse becomes small, frequent, and irregular;  the surface of
the body extremely cold, and there are frequent rigours.  The administration of
remedies, even the deglutition of the smallest  quantity of liquid, increases the
severity of the pain, occasions vomiting, and  gives rise to a feeling of laceration
or corrosion.  (Tartra, 144.)   There is obstinate  constipation.   Death takes
place in from eighteen to twenty-four hours, and is sometimes  preceded  by a
kind of stupor from which the patient is easily roused.  The intellectual faculties
commonly remain clear until the last.  In one instance, the patient was insensi-
ble,  but she ultimately recovered.   Death may be  occasioned by this acid in
consequence of its action on the larynx, as in the case of sulphuric  acid.  Should
the patient survive the first effects of the poison, the mucous membrane of the
fauces and oesophagus may be discharged, either in irregular  masses, or in the
form of a complete cylinder of the oesophageal lining.   There is great irritability
of the stomach,  with frequent vomiting and ultimate destruction of the powers
of digestion: the patient becomes slowly emaciated, and dies from starvation or
exhaustion.
  Post-mortem appearances.  Supposing death to have taken place rapidly, the
following appearances will be met with.  The skin  of the mouth  and lips will
present  various shades of colour from an orange yellow to a brown; it appears
like the skin after a blister or burn, and is easily detached from subjacent parts.
Yellow spots produced by the spilling of the  acid may be found about the hands
and neck.  A yellow frothy liquid escapes from  the nose and mouth, and the
abdomen is often much distended.  The membrane lining the mouth is some-
times white,  at  others of a citron colour;  the teeth are white,  but present a
yellowish colour about the  coronae.    The pharynx and larynx  are much in-
flamed; the latter sometimes oedematous.  The lining membrane of the oesophagus
is softened, and of a yellow or brown colour, easily detached, often in long folds.
The  trachea  is more  vascular than  usual, and the lungs are congested.   The
most strongly marked  changes  are, however, seen in  the stomach.   When not
perforated, this organ may be found distended with  gas—its mucous membrane
partially inflamed with patches  of a yellow, brown, or green colour, or it  may
be even black.   This green colour is due to the action of the acid  on the colomv
ing matter of the bile; but it must be remembered that a morbid state of the
bile itself often gives this appearance to the mucous  membrane in  many cases of
death from natural disease.  There is occasionally inflammation of the peritoneum,
and the stomach is glued to the surrounding organs.   Its coats are often so much
softened, as to break  down under the slightest pressure.   In the duodenum
similar changes are found; but in some cases the small intestines have presented
no other appearance than that of slight vascularity.  It might be supposed that the
stomach would be in general perforated by this very corrosive substance; but
this is far from being the case.   Tartra only met with two instances, and in one
of these, the individual survived twenty, and in the other thirty hours.  In giving
this poison to rabbits, I have not  found the stomach perforated, although the acid
had evidently reached that organ, from its coats being stained of a  deep yellow
colour.   In these experiments the non-perforation  appeared to be  due to the
protective influence of  the food with which  the stomach was distended.  In the
very few cases there are reported in English journals, it would appear  that the
stomach has not  been  perforated: the poison  had been swallowed  soon after a
meal, and its parietes had thus escaped the  corrosive action of the  acid.
   Quantity required to destroy  life.—The  smallest  quantity of this acid which
I find reported to have destroyed life, is about two drachms.   It was in the case
of a boy aged thirteen: he died in about thirty-six hours.   But less than this
even one drachm, would doubtless suffice  to kill a child; and, under certain 
TESTS FOR NITRIC ACID.
65
circumstances, an adult;  for the fatal result depends  on the extent of the mis-
chief produced by this corrosive poison in the larynx, oesophagus, and stomach.
What is the largest dose of concentrated acid, from the effects of which a person
has recovered, it is difficult to say; since, in most of the cases of recovery men-
tioned by authors, the quantity of the poison taken was unknown.
   Period at which death takes place.—Sobernheim relates  a case  of poisoning
by nitric acid, which proved fatal in one hour and three quarters.   ( Op. cit. 402.)
This I believe to be the most rapidly fatal  case on record, where the acid acted
as a poison.   The usual well marked effects were  found in the oesophagus, sto-
mach, and duodenum.  In young infants, however, life may be destroyed by this
poison in a few minutes, should it happen to affect the larynx.  The longest case
is, perhaps, that recorded by Tartra, where a woman perished from exhaustion,
produced by the secondary effects of the poison, eight months after having swal-
lowed it.
   Treatment.—It should be the same  as  that recommended  in  poisoning by
sulphuric acid.
   Chemical Analysis—In the simple state.—This acid may be met with either
concentrated  or diluted.   The  concentrated acid varies in  colour  from a deep
orange red to a light straw yellow.   It may be recognised:  1.  By evolving acid
fumes when exposed.  2. By its staining  organic matter yellow or brown, the
colour being  heightened  and turned of a  reddish tint by contact with caustic
alkalies.   3.  When mixed with  a few copper cuttings, it is rapidly decomposed,
a deep red acid vapour is given off, and  a greenish-coloured solution of nitrate
of copper  is  formed.   Tin  or mercury may be substituted for copper in  this
experiment.
   In the diluted state.—This acid is not precipitated like the sulphuric by any
common reagent, since all its alkaline combinations are soluble in water.—1. The
liquid has a highly acid reaction, and on boiling  it with some copper-turnings,
red fumes of nitrous acid vapour are given off, unless the proportion of water be
very great.  At the same time, the liquid acquires a blue colour.—2.  A streak
made on white paper with the diluted acid, does not carbonize it when heated;
but a scarcely visible yellow stain is  left.—3. The liquid is neither precipitated
by nitrate of barytes nor  by nitrate of silver.  These  last two experiments give
merely negative results—they serve to show that the sulphuric and muriatic acids
are absent.
   In order to detect nitric acid, the liquid should be carefully neutralized  by
potash, and then evaporated slowly to  obtain crystals.  If the liquid contain
nitric acid, these crystals  will possess the following characters:—1.  They appear
in the form of lengthened fluted prisms, which neither effloresce  nor deliquesce
on exposure.   One  drop of the solution  evaporated spontaneously on glass will
suffice to yield distinct  and well formed  crystals.   This character distinguishes
the nitrate of potash from a very large  number  of salts.—2. When moistened
with strong sulphuric acid, the powdered crystals slowly evolve a colourless acid
vapour.  By this test, the nitrate is known from every other deflagrating salt.—
3. A portion of the powdered crystals  should be placed in a small tube and
mixed with their bulk of fine copper filings.   The mass  is then to be moistened
with water, and a few  drops of strong sulphuric  acid added.   Either with  or
without the application  of a gentle heat, a decomposition immediately ensues, by
which red fumes of nitrous acid are evolved, recognisable by their colour, odour,
and acid reaction.—1. We add to the  crystals a  small piece of gold-leaf and
muriatic acid;  then boil for a few minutes.   The  gold will either wholly or en-
tirely disappear if nitric acid or a nitrate be present.  Its partial solution will be
indicated by the addition of chloride of tin to the liquid after boiling.
   In  liquids containing organic matter.—Nitric  acid may be administered  in
such liquids as tea, vinegar, or porter.   In  this case, besides the acid reaction,
there will be the peculiar smell produced by the acid, when mixed with substances
       5 
66
MURIATIC ACID.
 of an organic nature.   The application of the usual tests is here counteracted:—
 thus, unless the  quantity of nitric acid in  the liquid be  very considerable, the
 orange-red fumes of nitrous acid are not evolved on boiling the liquid with cop-
 per-cuttings.   If the liquid be viscid, this viscidity must be destroyed by dilution
 with water:—and in all cases, if any solid or insoluble substances be present, as
 in the matters vomited or contents of the stomach, it must be filtered, in order to
 separate the insoluble portions.   This operation is commonly very slow.   If we
 succeed  in  procuring a clear acid liquid, the  colour may be disregarded.   We
 should then carefully neutralize it with a weak solution  of carbonate  of  potash.
 (Should the liquid  thus procured not be  acid, we may  then boil the  organic
 substance itself with carbonate of potash.)  If the liquid be very acid and highly
 coloured, a portion may be boiled with animal charcoal previously washed with
 muriatic acid, as some  organic colouring matters are partly or wholly removed
 by this agent.   The liquid may then be concentrated to a small bulk by evapo-
 ration.  • As a trial-test we may dip in a slip of bibulous paper, dry it, and  observe
 whether it burns with deflagration.   This commonly answers, unless the quantity
 of nitric acid  present be very small, or unless the  nitrate of potash formed be
 mixed with a large portion of some other salt.  A few drops of the liquid may
 be crystallized on a piece of glass by slow evaporation; and the resulting crystals
 examined for all  those properties which have been described as characteristic of
 the compound of potash with nitric acid.  The crystals obtained may be coloured
 and  impure.   This  circumstance does not at all interfere with the action of the
 most important test for nitric acid, namely,  that by copper-filings  and  sulphuric
 acid.  The  crystals, may, however, if necessary, be purified  by  washing them
 with ether or alcohol.   These liquids do not dissolve the  nitrate of  potash, but
 will  often serve to remove from  it the organic matters by which  it is  coloured.
 This process, according to my observation, is, when carefully carried out, effectual
 in detecting nitric acid in organic liquids.   When the nitric acid, or the nitrate
 to which it has been converted, is mixed with common salt, the copper-test cannot
 be employed.   The gold test will in such a case furnish the best evidence.  Mu-
 riatic acid may be added to the dried residue, with a small portion of  gold-leaf,
 and  the mixture boiled.  If nitric acid or a nitrate be present, even in a  minute
 proportion, some portion of the  gold will be  dissolved—a  fact demonstrable by
 the addition of chloride of tin.
   Nitric acid may be detected in stains on clothing, if recent, by  simply  boiling
 the stained portion in water, with or without the addition of a small  quantity of
 carbonate of potash.    The carbonate must be used when an acid liquid is not
 obtained by boiling the stained cloth in distilled water.

                              Muriatic Acid.
   This acid is but seldom taken as a poison.    In the few cases which have been
 hitherto  observed, the  symptoms and appearances  have been similar to those
 caused by nitric acid.   I have elsewhere related a recent case of poisoning by
this  acid (Guy's Hosp.  Reports, Oct.  1850,  p.  211;) and for another, in which
 a man recovered after swallowing one ounce, see Lancet, July 27, 1850, p.  113;
also  for  a case of recovery from a similar  dose, see Medical Gazette, Dec. 2b,
1849.   [For another case of recovery from the effects of an ounce, see  Boston
 Med. and Surg. Journ. xv. 270.] 
SYMPTOMS PRODUCED BY OXALIC ACID.
67.
                             CHAPTER VH.

POISONING BY THE VEGETABLE ACIDS.  OXALIC ACID—SYMPTOMS AND EFFECTS—POST-MORTEM
  APPEARANCES--FATAL DOSES--RECOVERY FROM LARGE DOSES--PERIOD AT WHICH DEATH
  TAKES PLACE--TREATMENT--CHEMICAL ANALYSIS--TESTS FOR OXALIC ACID IN PURE AND
  MIXED LIQUIDS—BINOXALATE OF POTASH—TARTARIC ACID—ACETIC ACID—VINEGAR.

                               Oxalic Acid.
   Symptoms.—In many instances of poisoning by oxalic acid, death has taken
place so rapidly that the individual has not been seen alive by a medical practi-
tioner.   If the poison be taken in  a large dose, %. e. from half an ounce to an
ounce of the crystals, dissolved in water, a hot burning acid taste is experienced
in the act of swallowing, with a sense of constriction or suffocation, and vomiting
occurs either immediately, or within a few minutes.  Should the poison be di-
luted, there is merely a sensation of strong acidity, and vomiting only occurs after
a quarter of an hour or twenty minutes.   In some cases there has been little or
no vomiting; while in others this symptom has been incessant until death.  In
a case in which the poison was much diluted, vomiting did not occur for  seven
hours.   (Christison, 221.)  The vomited matters are highly acid, and have  a
greenish brown or almost black colour: they consist chiefly of mucus and altered
blood.  In one instance, reported by my friend, Dr. Geoghegan, they were colour-
less.  (Med. Gaz. xxxvii. 792.)  In another interesting case,  reported by Mr.
Deane in  the Provincial Journal,  fluid blood  of a bright arterial colour was
vomited  after some  hours.   (June  25th, 1851, p. 344.)  There is great pain
and  tenderness in the epigastrium, with a burning sensation in the stomach, fol-
lowed by cold clammy perspirations, and convulsions.   In a case which occurred
at Guy's Hospital, in May, 1842, where about two ounces of the poison had  been
swallowed, there was no pain.  Urgent vomiting and collapse were the  chief
symptoms.   There is in general an entire prostration of strength, so that if the
individual be in the  erect position, he falls:  there is likewise  unconsciousness of
surrounding objects, and a kind of stupor, from which,however, the patient may
be without difficulty roused.   Owing to the severity of  the  pain, the legs are
sometimes drawn up towards the abdomen.  The pulse is  small, irregular, and
scarcely perceptible;  there is a sensation of numbness in the extremities, and the
respiration, shortly before death, becomes spasmodic.   The inspirations are deep,
and  a long interval elapses  between  them.   Such  are the symptoms commonly
observed in a rapidly fatal case.
   Should the patient survive the first effects of the poison, the  following symp-
toms appear: there is  soreness of the mouth, constriction and burning pain in
the  throat, with painful deglutition,—tenderness  in the  abdomen, with irrita-
bility of the stomach, so that there  is frequent vomiting, accompanied by, diar-
rhoea.   The tongue becomes swollen, and there is great thirst.   The patient may
slowly recover from these symptoms.  In a case related by Mr. Edwards to the
Westminster Medical Society, the patient, a female, lost her voice for eight days.
In former editions of this work, I have treated it  as doubtful whether the loss
of voice in this case depended on the action of the poison.   A  case has, however,
been reported by Mr. T. W. Bradley, from which it may be inferred that loss of
voice may result from the direct effect of oxalic acid on the nervous system.  A
man swallowed a quarter of an ounce of the acid,  and suffered from  the usual
symptoms in  a severe form.   In about nine hours, his voice, although naturally
deep, had become  low and feeble.  This weakness of voice remained for  more
than a month, and its natural strength had  not returned even after the lapse of
nine weeks.  During the first month there was  numbness, with tingling of the 
68
OXALIC ACID.  FATAL DOSE.
legs.   (Med. Times, Sept. 14, 1850, p. 292.)   The occurrence of this sensation
of numbness, and  its persistence for so' long  a period after recovery from the
symptoms of irritation, clearly point to a remote effect on the nervous system.
Spasmodic twitchings of the muscles of  the face and extremities have also been
observed in some instances.   (See Lancet, March 22,1851, page 329.)
   Post-mortem appearances.—The lining membrane of the  mouth, fauces, and
oesophagus, is commonly white, although it is often coated with a portion of the
brown mucous matter discharged from the stomach.   This latter organ contains
a  dark-brown mucous liquid, often  acid, and  having almost a gelatinous  con-
sistency.  On removing the contents, the mucous membrane will be seen  pale
and softened, without always presenting marks of inflammation or abrasion, if
death have taken place rapidly.  This membrane is soft and brittle, easily raised
by the scalpel, and presents much the appearance which we might  suppose  it
would assume, after having been for  some time boiled in water.   The small ves-
sels are seen ramifying over the surface, filled with dark-coloured blood, apparently
solidified within  them.  The lining membrane of the oesophagus presents much
the same characters.   It is pale, and  appears as if it had been boiled in water,  or
digested in alcohol: it has been found strongly raised  in longitudinal folds, inter-
rupted by patches where the membrane has become abraded.  With respect  to
the intestines, the  upper portion of the canal maybe  found inflamed; but unless
the case be protracted, the appearances  in these viscera are not very strongly
marked.   In a recent case of poisoning by this acid, where two ounces had been
taken, and death was rapid, the coats of the stomach presented almost the black-
ened appearance produced by sulphuric  acid, owing to the colour of the altered
blood spread over them.   It is worthy of remark that the glairy contents of the
stomach  do not always indicate strong acidity until after they have been boiled  in
water.
   Oxalic acid does not appear to have a strong corrosive action on the stomach,
like that possessed  by the mineral acids.  It is,  therefore, rare to hear of the coats
of the organ  being perforated by it.   In many experiments on animals, and  in
some  few observations on the human subject, I have  found nothing  to bear out
the view that  perforation is a common effect of the action of this poison.   The
acid undoubtedly renders the mucous coat soft and  brittle,  and it dissolves by
long contact animal matter, which possesses the properties of gelatine.
   In  protracted cases, the oesophagus, stomach, and intestines have been found
more  or  less  inflamed.  In  several instances there have been scarcely any per-
ceptible morbid appearances produced.  [Death may ensue from oxalic acid, and
yet no evidence  of its action on the alimentary canal  be perceptible on a post-
mortem examination: the  case of a girl is cited, in the  last edition, whose death
took place in thirty minutes after she had taken an ounce of the poison.   (Lon-
don Med. Repos. iii. 380.)—H.]
   Quantity required to destroy life.—A smaller dose than half an ounce of the
crystallized acid has not,  so  far as I am aware, been known to prove fatal; al-
though, from the  serious effects which have followed  doses less than this, it  is
probable that a smaller quantity might destroy life when medical treatment was
not resorted to.  Two cases have occurred at Guy's Hospital, where, in each, half
an ounce of oxalic  acid had been swallowed.   Active treatment was adopted, and
both patients recovered.   When the  dose is upwards of half an ounce, death is
commonly the result; but one of my pupils informed me of a case where a man
recovered, after  having taken one ounce of crystallized oxalic acid;  and Dr.
Brush, of Dublin,  has communicated to the  Lancet a case in which  recovery
took place perfectly after a similar dose  of the poison had  been taken.  (See
also  case by Mr. Allison, in  the same journal, Nov. 2, 1850, p. 502.)   The
acid was in this instance  taken by mistake for Epsom salts.
   It may be proper to state that this poison is retailed to the public at the rate 
OXALIC ACID.  CHEMICAL ANALYSIS.  TESTS.
69,
©f from a quarter to half an ounce for twopence, and one ounce for fourpence or
sixpence.
   Period at which death taJces place.—Equal quantities of this  poison do not
always destroy life within the same period of time.   In two cases, in which about
two ounces of the acid were respectively taken, one man died in twenty minutes,
—the other in three-quarters of an hour.   Dr. Christison mentions an instance,
where an ounce killed  a girl in thirty minutes; and  another where  the  same
quantity destroyed, life in ten minutes.   Dr. Ogilvy, of Coventry, has reported a
ease of poisoning by oxalic acid, in which it  is probable that death took  place
within three minutes after  the poison had been swallowed.  The sister of the de-
ceased had been absent from the room about that period, and on her return found
her dying.  The quantity of poison taken could not be determined.  When the
dose of oxalic acid is half an ounce and upwards, death commonly takes place in
an hour.  There are, it must be admitted, numerous exceptions to this rapidity
of action.  Dr. Christison reports two cases, which did not prove fatal for thir-
teen hours; and in an instance that occurred to Mr. Fraser, in which only half
an ounce was taken, the individual died from the  secondary effects, in a state of
perfect exhaustion, twenty-three days after taking the  poison.
   Chemical analysis.   In the simple state.-—This acid may be met with either
as a solid, or  in  solution in water.   Solid oxalic  acid: It is seen more or less
perfectly crystallized in four-sided  prisms, in which  respect it differs from all
other acids, mineral and vegetable.  The crystals are unchangeable in air.   They
are soluble in water, forming a strongly acid solution.
   Tests.—1. Nitrate of silver.  When added to a  solution of oxalic acid, it pro-
duces an abundant white precipitate of oxalate of silver.   A solution containing
so small a quantity of oxalic acid as not to redden litmus paper, is affected by
this test; but when the  quantity of poison is small, it would be always advisable
to concentrate the liquid by evaporation before applying it.  The oxalate of silver
is identified by the following properties:  1. It is completely dissolved by cold
nitric acid.   If collected on a filter, thoroughly dried, and heated on thin platina
foil, it is entirely dissipated in a white vapour with a slight detonation.   When
the oxalate is in  very small quantity, this detonation may be observed in detached
particles on burning the filter previously well dried.   2.  Sulphate of lime.  A
solution of  oxalic acid  is precipitated white by lime water  and all the salts of
lime.   Lime water is itself objectionable as a test, because it is precipitated white
by several other  acids.  The salt of lime, which,  as a test, is open to the least
objection, is the  sulphate.   As this is not a very soluble  salt, its solution  must
be added in rather large quantity to the suspected poisonous liquid.   A fine white
precipitate of oxalate of lime is slowly formed.  This precipitate should possess
the following properties:—1. It ought to be immediately soluble in nitric acid.
2. It ought not to be dissolved by the tartaric, acetic, or any vegetable acid.
   In liquids containing organic matter.—The process is the same, whether it be
applied to liquids in which the poison is administered, or to the matters vomited,
or, lastly, to the contents  of the stomach.   This poison readily combines with
albumen  and gelatine, and it is not liable to  be decomposed or precipitated by
these or any other organic principles: it is, therefore,  commonly found in solu-
tion in the liquid portion, which will then have a  greater or less acid reaction.
Should the liquid be very acid, we must filter it to separate any insoluble matters:
should it not be very acid, the whole may be boiled, if necessary, with distilled
water, before filtration is performed.   On no account are the tests for oxalic acid
to be employed in liquids containing organic  matter,  since nitrate of silver is
easily precipitated  by such matters, although none of the poison be present.
Should the acid liquid be  highly coloured, it may be first  boiled for some time
with well washed animal charcoal.  After this it may be filtered and concentrated
by evaporation.   To the filtered liquid, acetate  of lead  should  be added  until
there is no further precipitation; and the white precipitate formed collected and 
70
SALT OF SORREL.  TARTARIC ACID.
washed.   If any oxalic acid were present in the liquid, it will exist in this pre-
cipitate under the form of oxalate of lead.   The following plan  may be adopted
for separating oxalic acid from the oxalate of lead:—Diffuse the precipitate in
water, and pass into the liquid for about two hours, a current  of sulphuretted
hydrogen gas, taking  care that the gas comes in  contact with  every portion of
the precipitate.   Black sulphuret of lead will be precipitated; and with it com-
monly the greater part of the organic matter  which may have been mixed with
the oxalate of lead.  Filter, to separate the sulphurpt of lead; the filtered liquid
may be clear  and highly acid.   Concentrate  by evaporation; the sulphuretted
hydrogen dissolved in  the liquid is  thereby expelled, and oxalic acid may be ulti-
mately obtained crystallized by evaporation on a piece of plate  glass.   If there
were no oxalic acid present  in the precipitate, no crystals will be  procured on
evaporation.   If crystals be obtained,  then they must be dissolved in water, and
tested in the manner above directed.

              Binoxalate of  Potash, or Salt of  Sorrel.
   Symptoms and effects.—The poisonous effects of this salt entirely depend  on
the oxalic acid which it contains.   It is said to be much used for the purpose of
bleaching straw and removing ink-stains—being sold under the name of essential
salt of lemons.   The  smallest quantity retailed to the public is a quarter of  an
ounce, and for this three-half-pence are charged. Its poisonous properties are not
commonly known, or no doubt it would be frequently substituted for oxalic acid.
Three cases of poisoning by this substance have occurred within a recent period:
two of these proved fatal, while in the other the patient recovered.
   In the case of recovery, a young lady, aged twenty, swallowed an ounce of the
salt dissolved  in warm  water.   She was not seen by any one for an hour and a
half: she was  then found on the floor,  faint and exhausted, having previously vo-
mited considerably.  There was great depression,  the skin cold  and clammy, the
pulse feeble, and there was a scalding sensation in the throat and  stomach.  There
were also continued rigors.   Proper medical treatment was adopted, and she re-
covered in two days,—still suffering from debility and great irritation of the sto-
mach.  During the state of depression, it was remarked  that  the  conjunctivae
were much injected, and the pupils dilated.  There was also great dimness of vi-
sion.   (Med.  Gaz., vol. xxvii. p. 480.)
   This salt destroys life almost as readily as oxalic acid itself; and in the symp-
toms which it produces it closely resembles that  poison.   In one case, half an
ounce killed an adult in so short a  time as eight minutes;  but probably the fatal
effects in this  instance  were  accelerated by the debilitated state of the person who
took it.  In another case reported by M. Chevallier, death took place in ten mi-
nutes.  (Ann. d'Hyg., 1850, vol. i. p. 162.)
   Chemical Analysis.—Its  solution  might be readily mistaken for oxalic acid:
for, 1st, it has an acid reaction; and, 2d, it is precipitated by nitrate of silver and
sulphate of lime, like oxalic acid: but with respect to the latter test, the precipita-
tion, although more slowly produced, is much more copious.  It is distinguished
from  oxalic acid—1. By its crystalline form, which, as seen in  a few drops eva-
porated on glass, is plumose; and 2. By heating a  portion on platina foil.  While
oxalic acid is volatile,  the binoxalate leaves an ash, which, when sufficiently cal-
cined, is alkaline, and  it may be proved to contain potash by its dissolving in di-
lute nitric acid, with effervescence, and forming nitrate of potash.

                              Tartaric  Acid.
   Symptoms  and Appearances.—Tartaric acid has been hitherto considered not
to possess any poisonous properties;  but one case has occurred in which there
was no doubt  that it acted as an  irritant, and destroyed life.  The case referred
to was the subject of  a trial for manslaughter at  the Central  Criminal Court 
SYMPTOMS CAUSED BY POTASH AND SODA.
71
(Reg. v. Watkins) in January, 1845.   The accused  gave the  deceased, a man
aged twenty-four, by mistake, one ounce of tartaric acid instead of aperient salts.
The deceased swallowed the whole dissolved in half a pint of warm water at a
dose: he immediately exclaimed that he was poisoned: he complained of having
a burning sensation in his throat and  stomach, as though he had drunk oil of
vitriol, and that he could compare it to nothing but being all on  fire.  Soda and
magnesia were administered with diluent drinks.  Vomiting set in, and continued
until death, which took place nine days afterwards.  On  inspection, nearly the
whole of the alimentary canal was found highly inflamed.  The accused admitted
that he had made a mistake, and tartaric acid was found in the  dregs of the cup.
The jury acquitted the prisoner.   Another case of poisoning by this acid, with a
report of the results of analysis, has been recently published by M. Devergie.—
(Ann. d'Hyg., 1851, ii. 432.)

                              Acetic Acid.
   This  acid has been generally excluded from the class of poisons.  Common vi-
negar, which contains only five per cent, of acetic acid, has often  been taken
in  large doses without injurious  consequences.   From  the experiments per-
formed  by Orfila on dogs, and from one case which he reports as having occurred
in the human subject, acetic acid, when concentrated, appears to exert an irritant
action on the  body.   (Annales d'Hygiene, 1831, ii. 159; also  Toxicologic, ii.
198.)   This is not more than we might have expected, seeing that  the concen-
trated acid is highly corrosive.   In the case referred to, the deceased, a young
female aged nineteen, was found dying on the highway.   She suffered from con-
vulsions, and complained of pain in the stomach, and died in a very short time.
On inspection, the stomach was found neither softened nor corroded, but its mu-
cous membrane near  the pylorus was almost black.  The mucous  glands were
prominent, and the vessels were filled with black coagulated blood.
   Vinegar, which may be regarded as an organic mixture containing but a very
small proportion of acetic acid, (five per cent.) may be examined by distilling a
portion, and testing the distilled liquid for  the acid.  Vinegar, as it exists  in
commerce, always contains  traces of  sulphuric acid.  In general it is easily re-
cognised by its odour.  Pelletan observed in the  case  of a young child that
the abuse of vinegar led to a thinning of the mucous membranes  of the stomach;
and Landerer remarked that the milk of a wet-nurse who had  been  in the habit
of taking large quantities of the Vinegar of  Roses, became thin, very acid, and
deficient in casein and oil.   The infant which she was suckling gradually wasted
and died, and the woman herself suffered severely.   (Heller's Archiv. 1847, 2
H. s. 185.)
                            CHAPTER VIII.

POISONING BY THE ALKALIES.--POTASH, SODA, AND THEIR  CARBONATES--SYMPTOMS—
  FATAL EFFECTS OF  THE CARBONATE OF POTASH--POST-MORTEM APPEARANCES--TREAT-
  MENT--AMMONIA  AND  SESQUICARBONATE  OF AMMONIA  (SAL VOLATILE)—CHEMICAL
  ANALY'SIS—TESTS FOR POTASH AND SODA--TESTS  FOR  AMMONIA.

                           Potash and  Soda.

  Symptoms.—The symptoms  produced by potash and soda, when taken in a
strong dose, are so similar that  one description will serve for both.   It must be
observed that cases of alkaline poisoning are  extremely rare, and  have been, I
believe, hitherto the result of accident.   The most common form in which these
poisons are met with, is in the state of pearlash (carbonate of potash) and soap- 
72
QUANTITY REQUIRED TO DESTROY LIFE.
 lees (carbonate of soda.)  The patient experiences, during the act of swallowing,
 an acrid caustic taste, owing  to  the  alkaline liquid, if sufficiently concentrated,
 excoriating the mucous membrane.   There is a sensation of burning heat in the
 throat, extending down the oesophagus to the epigastrium.   Vomiting is not al-
 ways observed; but when it does occur, the vomited matters are sometimes mixed
 with blood of a dark brown colour, and detached portions of mucous membrane;
 this effect depending on the degree of causticity in the liquid  swallowed.  The
 surface is cold and clammy: there is  diarrhoea, with severe pain in the abdomen,
 resembling colic.   The pulse is quick and feeble.   In the course of a short time,
 the lips, tongue, and fauces, become  swollen, soft, and red.
   Post-Mortem Appearances.—In recent cases there are strong marks of the local
 action of the poison on the mucous membrane of the mouth, fauces, and oesopha-
 gus.  This membrane has been found softened, detached, and inflamed in patches
 of a deep chocolate colour; sometimes almost black.  The  same appearance has
 been met with in the mucous membrane of the larynx and trachea.  The stomach
 has had its mucous  surface eroded in patches, and there has been partial inflam-
 mation.
   Period of Death.—The most rapidly fatal case which  I have found reported
 is that of a boy who died in three hours after swallowing three ounces of a strong
 solution of carbonate of potash.  In  another case, which occurred at Yarmouth,
 in 1835, a child, aged three years,  took a small quantity of pearlash, which had
 deliquesced, and died in twenty-four hours.  Death was caused, in this instance,
 by the inflammation induced in the larynx causing an obstruction to the  process
 of respiration.  In this respect, the caustic alkalies may destroy life like the mi-
 neral  acids.   But death may be  a slow result of these poisons.   Thus in an in-
 stance which  was communicated  to  me, a lady swallowed, by mistake, one ounce
 and a half of the common solution  of potash of  the shops, which contains about
 five  per cent,  of caustic alkali.   She recovered from the first symptoms of irrita-
 tion, but died seven weeks afterwards, from  pure exhaustion, becoming  greatly
 emaciated before her death.  Orfila refers to two cases of poisoning by carbonate
 of potash, in each  of which half an  ounce of this substance was taken by mistake
 for aperient salts.  The patients,  two young men, recovered  from the first effects,
 but ultimately died;  the one three  months, and the other four months after the
 poison had been taken.  The secondary fatal effects appear to be due to diarrhoea,
 great irritability of the stomach,  loss  of the functions of this organ from  the de-
 struction of the lining membrane,  and stricture of the oesophagus,'—either of
 which causes  may prove fatal  at almost any period.  A fatal case of  stricture,
 produced by soap-lees after the lapse of two years and three months, is reported
 by Dr. Basham. (Lancet, March  2,  1850.)   The constant use of the alkalies or
 their carbonates appears to be productive of latent mischief; yet the quantity
 which may be sometimes taken in divided doses without destroying life is enor-
 mous.   Dr. Tunstall, of Bath, relates  the case of a man who, for eighteen years,
 had been in the habit of taking bicarbonate of soda to remove dyspepsia.  It is
 stated  that for sixteen years he took  two ounces of the bicarbonate daily!  The
 man died suddenly, and on examining the stomach it was  found to be greatly
 distended and extensively diseased,—conditions which were referred by Dr. Tun-
 stall to the action of the  carbonate  of soda.  (Med. Times, Nov. 30  1850 n
 564.)                                                            y      >v
   Quantity required to destroy life.—The quantity of any of these alkaline poi-
 sons, required to destroy life, is unknown.
   Chemical analysis.—Caustic Potash and Soda are  known from  their re-
 spective  carbonates by giving a brown precipitate with a solution of nitrate of
 silver.   The carbonates, on the other hand, yield a whitish-yellow precipitate.
 Causticpotash is known from caustic soda  by the following characters:__1  Its
solution,  when not too much diluted  with water, is precipitated of a canary-yellow
colour, by bichlcride  of platina.   2.  It is precipitated in granular white crystals 
POISONING BY SAL VOLATILE.
73
 on adding the alkaline liquid gradually to a strong solution of tartaric acid, and
 occasionally stirring the mixture, or by digesting in it a large crystal of tartaric
 acid.  Caustic soda is not precipitated by either of these tests, which will serve
 equally to distinguish the salts of potash from those of soda, if we except the bi-
 noxalate and bitartrate of potash, which, from being but little soluble in water,
 are not precipitated.  3.  If we neutralize the two alkalies by diluted nitric acid,
 and crystallize  the liquid on a  slip of glass, should  the alkali be potash, the
 crystals will have  the  form of long slender fluted prisms; if soda, of rhombic
 plates.
   In liquids containing organic matter.—Such liquids are frothy; they possess
 an alkaline  reaction, a peculiar  alkaline odour, and  are unctuous  to the feel.
 The organic liquid may be evaporated to dryness, then heated to char the animal
 and vegetable matter, and the alkali will be recovered from it in the state of car-
 bonate, by digesting the residuary ash in distilled water.


                Ammonia.   Sesquicarbonate of Ammonia.
   The vapour of strong ammonia is poisonous.  It may destroy life by producing
 violent inflammation of the larynx,  or by causing pneumonia.   It is often most
 injudiciously employed to rouse persons from  a fit.   A case is on record, of an
 epileptic having died, under  all the symptoms of croup, two days after  the ap-
 plication of strong ammonia, in this way, to the nostrils.  A  very singular case
 of recovery from the poisonous effects of this vapour, by Dr.  Sanchard, will be
 found reported in the Annales d'Hygiene (Janvier, 1841.)  The solutions of am-
 monia and its sesquicarbonate, produce symptoms similar to those described in
 speaking of potash.  The only difference observed is, that the sense of heat and
 burning pain in the throat, fauces, and stomach, is much greater.   Cases of this
 form of poisoning are rare.   Dr. Sanchard relates an instance which occurred in
 France, where a boy, only six years  old, poisoned his younger sister by pouring
 several teaspoonfuls of  strong solution of ammonia down her throat.   A case is
 likewise reported where a strong dose of the solution  killed a man in four mi-
 nutes. (Christison, 167.)  Another case is referred to in the Journal de Phar-
 macie (Oct. 1846, p.  285,) in which from one to two drachms  of  ammonia, un-
 knowingly administered, caused death.  There was violent vomiting, with bloody
 stools; and, on inspection, blood was found effused in the intestines.  There was
 also a remarkably fluid state of the blood in the body.   In another instance, a
 man walked into a druggist's shop, and asked  for a small quantity of ammonia
 to take some spots out of his clothes.  The druggist poured about a teaspoonful
 and a half into a glass.   The man suddenly swallowed it, and fell instantly to
 the ground.   He soon  afterwards died, complaining  of the most excruciating
 pain.  (Journal de Chimie Medicale, 1845, 531.)
   Sesquicarbonate of ammonia.—The solution of this salt (sal volatile) is pro-
 bably more active as a poison than is commonly supposed.   The following case
 occurred to my knowledge in 1832.   A man, in a fit of passion, swallowed about
 five fluid-drachms of a solution of sal volatile.  In ten  minutes, he was seized
 with stupor and insensibility; but, upon the application of stimulant remedies,
 he recovered.  He suffered, for some  time afterwards, from severe irritation about
 the fauces and oesophagus.  Mr. Iliff, jun., reports  the case of a little boy, aged
two years, who swallowed about half an ounce of a strong solution of spirits of
hartshorn, and in spite of some rather severe symptoms, recovered in a few days.
(Lancet, Dec. 1, 1849.)   These poisons are  not often used by persons who are
intent upon  suicide or  murder, but there is  one instance on record in which a
man was tried for the murder of a child by administering to it spirits of harts-
horn.  (Regina v. Ilaydon, Somerset Spring Assizes,  1845.)   Of the action of
the other salts of ammonia on man, nothing is known.
   The subjoined case lately occurred  in the practice of Mr. Procter, of York.  On 
74
POISONING BY ARSENIC.
the 30th of May, 1852, a woman gave by mistake to her infant, four weeks old, a
teaspoonful of hartshorn of the shops.  The child soon afterwards breathed with
difficulty—the skin was universally red—the pulse weak and feeble, and a frothy
mucus issued from the mouth.  The child became more and more depressed, and
died thirty-six hours after taking the ammonia.  There was no vomiting or diar-
rhoea, and the mouth and fauces presented no excoriation: there was, however,
slightly increased redness of the  lining membrane.   A post-mortem  examination
was not made.   The strength of the hartshorn used was found by -Mr. Procter to
amount to about nine per cent.
   Chemical analysis.—The  three caustic alkalies, potash, soda, and ammonia,
are known from the solutions of the alkaline earths by the fact that they are not
precipitated by a solution of carbonate of potash. They all three possess a power-
ful alkaline reaction  on test paper, which, in the case of ammonia, is easily dissi-
pated by heat.  Ammonia is immediately known from potash and soda by its
odour and volatility.   The Sesquicarbonate of Ammonia may be known from
other salts by its alkaline reaction, its odour, and its entire volatility  as a solid:—
from pure ammonia—1, by its effervescing on being added to an acid; 2, by its
yielding an abundant white precipitate with a solution of chloride of calcium;—
from the carbonates of potash and soda, among other properties,—1, by its giving
no precipitate with a solution of the sulphate of magnesia; 2, from the rich violet
blue solution which it forms when added in  excess to the sulphate of copper; 3,
by its odour and volatility.
                             CHAPTER IX.

METALLIC IRRITANT POISONS.  ARSENIC—ARSENIOUS ACID—TASTE—SOLUBILITY IN VARIOUS
  LIQUIDS—SYMPTOMS--CHRONIC POISONING--ANOMALOUS CASES--POST-MORTEM APPEAR-
  ANCES--QUANTITY REQUIRED TO DESTROY LIFE--PERIOD AT WHICH DEATH TAKES PLACE
  --TREATMENT.   CHEMICAL ANALYSIS--TESTS IN  THE SOLID STATE--IN SOLUTION—
  MARSH'S PROCESS—REINSCH's PROCESS--ARSENIC IN ORGANIC LIQUIDS--ABSORBED ARSENIC
  —ITS PRESENCE  IN THE SOIL OF CEMETERIES—SULPHURETS OF ARSENIC AND OTHER
  COMPOUNDS.

                       Arsenic.  Arsenious Acid.

   General remarks.—The term White Arsenic is commonly applied to the
arsenious acid of chemists.  Arsenic acid is another compound which is highly
poisonous, but has never, so far as I know, been used for the purposes of suicide
or murder.  Yellow Arsenic, or orpiment, is the sulphuret  of chemists.   This
is also poisonous,  apparently because it contains a large portion of arsenious acid
uncombined with  sulphur.  This often amounts  to from fifteen to twenty per
cent, of its weight.  Orpiment has been, on several recent  occasions, criminally
used as a poison.   White arsenic, or arsenious  acid, is, however, that preparation
which chiefly requires the attention of a medical jurist.   In the years  1837-8,
there were one hundred and eighty-five cases of poisoning by this substance, the
greater number of which were the result of suicide and murder.
   Taste of arsenious acid.—White arsenic is commonly  seen under the form of
a white powder, or in opaque masses resembling enamel. It is called an acid from
its power of combining with alkalies, but it possesses a very feeble acid reaction
when dissolved in water.  It is often described as having an acrid taste  but this
does not appear to be correct:  a small quantity of it has certainly no appreciable
taste, a  fact which may be  established by direct experiment, and might be in-
ferred from its very sparing solubility.  It would appear from numerous cases 
SYMPTOMS OF POISONING BY ARSENIC.
75
on record, that it has been unconsciously taken in fatal quantities, in all descrip-
tions of food, without exciting the least sensation on the tongue.  Most of those
persons who have been  criminally or accidentally poisoned by arsenic have not
been aware of any taste  in taking the poisoned substance.   In other cases where
the powder has been taken in  large  quantity it is described as  having had a
roughish taste.
   Solubility of  arsenic.—The solubility of this substance in liquids is a frequent
question on trials.  The action of water is materially influenced by circumstances.
I have found by numerous experiments (Guy's Hospital Reports, No. 4, p. 81,)
that hot water in cooling from 212° on the poison in powder, dissolves about the
400th part of its weight.   This is in the proportion of nearly one  grain  and a
quarter of white arsenic to about one fluid-ounce of water.   Water boiled for an
hour on the poison and allowed to cool, holds dissolved  the 40th part of its
weight, or about twelve grains in one ounce.  Cold water  allowed to stand for
many hours on the poison, does not  dissolve more than from the 1000th to the
500th  part of its weight;  i. e.  one-half grain to one grain of arsenic to nearly
one fluid-ounce  of water.   The  presence of organic matter in a liquid renders
the poison much less soluble.
   [There seems to be a great want of agreement as to the solubility of arsenic in
water.   This  is  attributed in part to the different solubilities of the two  kinds of
arsenious acid, to the convertibility of the one into the other, and to the simul-
taneous occurrence of the two in one solution.   Guibourt asserts that the opake
acid dissolves in water more quickly  and abundantly than the vitreous; while
Bussy  and some others  assert the contrary.  Bussy finds that the same quantity
of  water, which at 12°  or 13° will take up  36 or 38 parts of the former, will
not dissolve more than  12 or 14 of the latter.  By long boiling with water, the
opake  acid is converted into the transparent variety—that is to say, it  acquires
the solubility  of the latter.   On the  other hand, by the continued action  of water
and of  a low temperature, the vitreous acid  is rendered opake—that is  to say,
the solution,  after awhile, becomes weaker,  retaining only the proportion of
acid which corresponds to the solubility of the opake.  Comminution diminishes
the solubility of the  opake  and increases that of the vitreous  acid.   (Compt.
rend. 24, 774;  Liebig and Kopp's Jahresbericht,  1847-8, 422;  see  Gmelin,
Hand-Book, iv. 258.)   Regnault says  (Cours de Chimie, i.  320) that mechanical
division transforms the vitreous into  the opake variety;  so that after having
reduced the former to a very fine powder we find its solubility no  greater than
that of the latter.   Dr. J. K. Mitchell and  Mr. Durand, of Philadelphia, show,
by their experiments, that the power of the  solvent is influenced by the fineness
of  the  powder, the time the fluid is  in  contact with the  arsenic, and even the
shape of the vessel in which the solution  is made.   They state  that 1000 parts
of temperate water will take up  12 to 16 of the acid of either variety, whilst the
same proportion of boiling water will dissolve 148, and retain, on  cooling, from
25 to 40, according to the time the boiling fluid is in contact with the  arsenic.
-H']
   Weight of Arsenic.—A medical witness is often asked the weight of  common
or  familiar  measures  of arsenic  in powder.   I have  found a teaspoonful of
powdered arsenic to weigh  150 grains,—a tablespoonful to weigh 530 grains,—
and a pinch, or the quantity taken up between the finger and thumb of an adult,
to weigh 17 grains.   These weights are here  given as the results of actual ex-
periment : but they are of course liable to some variation.
   Symptoms.—These will  vary according to  the form and dose  in which the
poison  has been administered.   The time at  which they come on  is generally
in from half an  hour  to an hour after the poison has been swallowed.   This is
the average period.  I  have known them to appear in a quarter of an hour.
Dr. Christison mentions one instance in which the symptoms  began in eight
minutes;  but in the case of Lofthouse, tried  at the York Lent Assizes, 1835, 
76
SYMPTOMS CAUSED BY ARSENIC.
the symptoms were proved to have attacked the diseased, while he was in the act
of eating the cake in which the poison was administered.   On  the other hand,
in an instance communicated to me by Mr. Todd, where one drachm had been
taken  on an empty stomach,  no symptoms appeared for two  hours;  in one
reported by Orfila, the symptoms did not show themselves for  five hours; and
in another that occurred to Dr. Lachese, in which a large dose was taken, the
symptoms  did  not  come on for seven  hours.   (Ann.  d'Hyg.  1837, i. 344.)
There  may be every variety between these extremes.  In one case their  appear-
ance was protracted for ten hours—the maximum period yet known.   A very
remarkable instance occurred to M. Tonnelier, in which the poison was taken by
a young female at eleven o'clock in the morning, and no well marked symptoms
occurred for eight hours: there  was then violent vomiting.  After death, a cyst,
formed of mucous membrane and containing arsenic, was found in the stomach:
the poison having thus become  sheathed over!  (Flandin, i. 535).   See  on this
question the case of Reg. v.  Foster, Bury Lent Assizes, 1847.  In an interesting
case communicated by Mr. Clegg to the Medical Times [Oct 21,1848,] symptoms
of violent irritation did not show themselves until twenty-three hours after the
poison had been taken, and  within about half an hour of the death of the patient.
The girl was once sick shortly after having taken the poison, but the first symptoms
were those of narcotism.   The  girl was  a confirmed opium-eater,* and this habit
may in some measure have influenced the operation of the  poison.   A case has
been recently communicated to the Medical Gazette by Dr. W. Burke Ryan,
from which it app'ears  that the active symptoms of irritation which commonly
attend arsenical poisoning, may not appear until after the lapse of nine hours
from the time at which the  poison has been swallowed.   With  the exception of
a case recorded  in my work  On  Poisons [page 317] in which  the interval was
ten hours, this is the longest period of protraction on record.  In other instances
there  have been long intermissions.  In all cases  in which arsenic enters the
system from without, as by its application to the skin  and to ulcerated  or dis-
eased surfaces, the symptoms are rarely manifested until after the lapse of several
hours.
   Their nature.—The  individual first experiences faintness, depression, nausea,
and sickness, with an intense burning pain in the region of the stomach, increased
by pressure.  The pain in  the abdomen becomes  more and more severe;  and
there  is  violent vomiting of a  brown turbid matter, mixed with mucus, and
sometimes  streaked with blood.   These symptoms  are followed by purging,
which  is more or less violent; and this is accompanied by severe cramps in the
calves of the legs.   The matters discharged from the stomach and bowels  have
had in some instances a yellowish colour, as it was supposed, from  a  partial
conversion of the poison to  sulphuret, but more probably from  an admixture of
bile.   The vomited matters are  in some cases coloured by blood,—and the mix-
ture of blood with bile has often given to them an olive green or brown  colour.
In other cases, they may consist of a large quantity of mucus ejected in  a flaky
state, and having a milky-white  appearance, as if from  the admixture of white
arsenic.  The colour of the  vomited matters has been hitherto much relied on as
an aid to diagnosis; but it is necessary to direct the attention of practitioners to
the probable effect of the new law on the sale of arsenic (14 Vic. cap. 13, sec. 3)
in completely changing the  appearance of the matters vomited  by a person la-
bouring under the effects of this poison.   The sale of white arsenic in any quan-
tity less than ten pounds is prohibited, unless it be mixed with l-16th part of
its weight of soot, or l-32d  part of its weight of  indigo.  The vomited matters
may therefore be blue or black,—or the admixture of bile may  render them of
a deep green colour.  In a case  of arsenical poisoning recently communicated to
me by Dr. Maclagan, the blue  vomiting at first  completely puzzled those who
were called to render assistance.   As soot and indigo are both insoluble in water
these substances will be slowly deposited from the vomited matters by subsidence'
and the colour given by blood or bile may then become perceptible.-           ' 
arsenic,   chronic poisoning.
77
  The vomiting is in general violent and incessant, and excited by any substance
taken into  the stomach.   There is tenesmus (straining), and the discharges by
the bowels are frequently tinged with blood.   There is a  sense of constriction,
with a feeling of burning heat in the throat, commonly accompanied by the most
intense thirst.   The  pulse  is small, very frequent,  and irregular; sometimes
wholly imperceptible.   The  skin is cold and clammy in the stage of collapse; at
other times it is very hot.   The respiration is  painful from the tender state of
the abdominal parietes.  Before death, coma sometimes supervenes, with para-
lysis, tetanic convulsions, or  spasms  in the muscles of the extremities.   In one
instance trismus (lock-jaw)  appeared in three-quarters of an hour.   (Orfila, i.
449.)   Such is the ordinary character of  the symptoms in an acute case of ar-
senical poisoning, i. e. where from half an ounce to an ounce of the poison has
been  taken.
   Chronic poisoning.—Should the person recover from the first effects, and the
case be protracted, or should the dose have been small and frequently administered,
there will be an inflammation of the conjunctivae, with suffusion of the eyes, and
intolerance of light,—a condition which is, however, often  present with the early
symptoms above described.   In  a case reported by Mr. Jeffreys, an adult female
died in three hours after taking arsenic in a pudding  served at dinner.  There
was no vomiting  or  diarrhoea.  In  two hours she was in a state  of  complete
collapse, and at this time it  was  noticed that the conjunctivae (the membranes of
the  eyes)  were  red.   (Med. Times,  Aug. 30, 1851,  p.  229.)  There  is also
irritation of the skin, accompanied by a vesicular eruption, which has been called
eczema arsenicale.  Sometimes  this  has assumed the form of nettle-rash, or  of
the eruption attending scarlet  fever, for which disease arsenical  poisoning has
been mistaken.   Local paralysis, and other symptoms  of nervous disorder, are
also very common consequences.   Exfoliation of the cuticle  and skin of the
tongue, with the falling off  of the hair, has likewise been witnessed.   (Case  of
the  Turners, 1815, Marshall, 119.)  Salivation has been  observed to  follow,
especially when small doses of the poison have been given for a length of time,
(Med. Gaz. xvi. 790.)  Strangury and jaundice  have been  noticed among the
secondary  symptoms.  (Marshall on Arsenic, 44, 111.)  A well marked case of
slow poisoning by arsenic is  recorded by Flandin.  (Traite des Poisons ou Toxi-
cologic, Tom. i. p. 510.)  It illustrates a  not unfrequent form of secret murder,
and it is well calculated to inspire caution  in making a diagnosis from symptoms.
A woman  put daily into the soup of her fellow servant a very small quantity of
arsenious acid  in powder.   Shortly after dinner, this person was seized with
vomiting, which led to the rejection  of the food and poison before the latter had
caused any serious mischief.   As this practice was continued for about six weeks,
the stomach became exceedingly irritable;  there was pain  in the bowels, and the
woman became much emaciated.   There was also spitting of blood, with such a
degree of nervous irritability, that a  current of air falling upon  her caused  an
attack of spasms and  convulsions.   When the patient found that she could not
bear any thing on her stomach,  she left the place and passed two months in the
country.   Her health became gradually re-established there, and she returned to
resume her usual  occupations.   The prisoner,  however, renewed her attempts;
and, to make sure of destroying life, gave her one morning,  in coffee, a strong dose
of arsenious acid in powder:  violent vomiting ensued, and the poison was expelled
with  the food taken at breakfast.  Arsenic was detected in the vomited  matter,
and the explanation of the cause of the long previous illness then became clear.
Under proper treatment the  patient recovered.  I believe this mode of poisoning
to be more frequent in this country than is commonly supposed: and it behooves
practitioners to be exceedingly guarded in their diagnosis, for the usual characters
of arsenical poisoning are completely masked.   They might be  easily referred
to chronic inflammation, or  ulceration of the stomach leading to perforation.   I
have lately had to examine a case of this kind, where the  death of a person had 
78
PERIOD FOR INFLAMMATION AND ULCERATION.
been caused by his housekeeper under somewhat similar circumstances.   The
crime was not discovered until after the lapse of two years; and from the small
dose given, and repeated vomiting during  life, no arsenic could be detected  in
the body.  There are many anomalous cases on record, in which the symptoms
have diverged so much from the ordinary course as to embarrass medical practi-
tioners.  For some of these, I must refer to  a paper by Dr. Ogston, Med. Gaz.
vol. xlvii. p. 181; also to my work On Poisons, p. 320.
   Post-mortem appearances.—The  striking  changes produced  by arsenic are
generally confined to the  stomach and intestines.   They  are  commonly well
marked in proportion to the largeness of the dose and the length of time which the
individual has survived after taking the poison.  Our attention  must be first di-
rected  to the stomach.   Arsenic seems to have a specific effect on this organ; for,
however the poison  may  have  entered into the system—whether through  a
wounded or ulcerated surface, or by the  act of  deglutition—the  stomach has
been found inflamed.  Inflammation  of this organ cannot, then,  be  always consi-
dered to depend on the local irritant  action of the poison on the  stomach.
   The mucous  membrane  of the stomach, which is often covered with a layer  of
mucus, mixed with blood, and with scattered white pasty-looking patches of arse-
nious acid, is commonly found red and inflamed: the colour, which is sometimes  of
a dull or brownish red, becomes brighter on exposure to the air: at other times
it  is of a deep crimson hue, interspersed with black-looking lines or dots of al-
tered blood.  The redness is usually  most strongly marked at the greater extre-
mity;  in one case it may be found spread over the whole mucous surface, giving
to it the  appearance  of red velvet,  in  another it will  be  chiefly  seen on the
prominences of the rugae.   Blood of a dark  colour is effused in various  parts
between the rugae, or beneath the lining membrane,—an appearance which has
been mistaken for gangrene.  [On this point see the case of The Queen against
Dore  and  Spry, C.  C. C, August 28, 1848; also Med. Gaz., Nov. 24, 1848.]
The stomach often contains a mucous liquid of a dark colour tinged with blood.
The coats are sometimes thickened in patches, being raised  up into a sort  of
fungous-like tumour, with  arsenic imbedded in' them; at other times they have
been found thinned.   The mucous membrane is rarely ulcerated, and still more
rarely gangrenous.  Perforation of the coats is  so uncommon  a  result of arseni-
cal poisoning, that there are only three instances on record.  The mucous glands
of the stomach have been found enlarged; but this is by no means  an  unusual mor-
bid appearance  from any cause of local irritation, without reference  to poisoning.
Various morbid appearances are said  to have been met with in the  lungs, heart,
brain, and urinary organs;  but they do not appear to be characteristic of arseni-
cal poisoning.   It is undoubtedly to  the stomach  and intestines that a medical
jurist must look for  the  basis  of medical evidence in regard  to  post-mortem
appearances.
   Period required for inflammation.—A witness is  often asked in a  court  of
law how long a time  is required, after the  taking of arsenic, for the production
of these well marked appearances in the stomach,  especially of inflammation  of
the mucous membrane.  In three cases communicated to me  by Mr. Foster,  of
Huntingdon, death occurred in one,  a  child, at the  end of two hours; in the
second, an adult, at the end of three hours and a half; and in the third, after the
lapse of about six hours.  In each of these the stomach was found highly in-
flamed, and, in  the one that proved fatal in two hours, the mucous membrane
had a vermilion hue.  This last I believe  to be  the  shortest period  at which
inflammation of the stomach from the effects of arsenic has been met with.
   Period required for ulceration.—Another  question put to  a  witness may be
this,—What period of time is required for ulceration  of the mucous membrane
to take place, as an effect of this poison?   If arsenic has destroyed  life with un-
usual rapidity, and the stomach is found ulcerated, an attempt may be made  to
refer this ulceration to some other cause.  Such an attempt was made in the case 
ABSENCE OF INFLAMMATION.  FATAL DOSE.
79
of Rhymes, which was the subject of a criminal trial in 1841.  (Guy's Hospital
Reports, Oct. 1841, p. 283.)  I found ulceration of the mucous membrane, which
had been completely removed in patches, although the deceased had survived the
effects of the poison only ten hours.   The deposition of the arsenic in and around
the ulcers, as well as the appearance of recent inflammation about them, left no
doubt that they had been produced by the poison, and were not owing to previous
disease, as it was attempted to be urged in defence.   Dr. Christison mentions a
case observed by Mr. Hewson, where many eroded spots existed on  the stomach,
although the person died from the effects of arsenic in five hours.   (On Poisons,
p. 340.)
   Absence of inflammation.—Are the stomach and  intestines always found  in-
flamed in cases of poisoning by arsenic?  The answer must  be decidedly in the
negative.  At the  trial of M-Cracken, at the Derby Autumn Assizes, in 1832,
for killing his wife with arsenic, the fact of poisoning was clearly established, and
a large quantity of  arsenic was found in the stomach of the deceased; but there
was no appearance of inflammation, either in that organ or in the  intestines.   In
a late number of Rust's Magazine, I find the two following cases.  A servant-girl
had some arsenic administered to her in chocolate.  She was seized with nausea
and violent pain in the stomach, and died the same evening.   On inspection,
there was no remarkable vascularity or inflammation of the stomach;—but arsenic
was found in  the duodenum.   A man was taken ill with vomiting and violent
pains in  the abdomen after partaking of some soup, and he died from symptoms
of poisoning.   On  inspection the mucous  surface of the stomach  presented no
morbid change, with the exception of slight redness about the cardia.   Arsenic
was found in the contents of the intestines.
   In  a few rare instances, the  mouth, pharynx, and oesophagus, have been found
inflamed, but  in  general there are no post-mortem changes  in this part of the
alimentary canal to attract particular attention.  The mucous membrane of the
small intestines may be found inflamed throughout, but commonly the inflamma-
tory redness is confined to  the duodenum, especially to that  part joining the
pylorus.   Of the large intestines, the rectum appears  to be the most prone to in-
flammation.  The heart, brain, and lungs, present no appearances which can be
considered characteristic of arsenical poisoning.   The same remark applies to the
liver, spleen, and kidneys, although these, like  the other soft organs, may be-
come receptacles of  the absorbed poison.  It is worthy of remark in relation to
the known antiseptic properties of arsenic, that the parts especially affected  by
this poison, (the stomach and intestines,) occasionally present the  well marked
characters of irritant poisoning for a long time after death.  In two cases (Ches-
ham) referred to me by Mr. Lewis, coroner for Essex, a deep red inflammatory
appearance of the mucous membrane immediately below a layer of  sulphuret of
arsenic was well marked, although the bodies had been buried nineteen months.
In a case which occurred in March, 1848, the stomach was also well preserved;
and it retained an inflammatory redness after the lapse of tivelve months.  Ab-
sorbed arsenic does  not, however, appear to prevent the  decomposition of the
body.  For a very admirable summary of the  post-mortem appearances  caused
by arsenic, I must refer the reader to  a paper by my friend Dr. Geoghegan (See
Medical Gazette, vol. xlvi. pages 171 and 218.)
   Quantity required to destroy life.—This is an important medico-legal question.
According to a case quoted by Dr. Christison,  the smallest fatal dose on record,
in an  adult, is stated to  have been  thirty grains of the  powdered white arsenic:
the man  died in six days.   But undoubtedly a much smaller quantity than this
would kill.  Dr. Lachese states that a-dose of from one to two grains may act
fatally in a few days:—this, however, is a speculative statement.   (Ann. d'Hyg.
1837, i. 334.)   It is highly probable that this dose would prove fatal to a child,
or to weak and debilitated persons.   The smallest fatal dose hitherto recorded,
was observed in a case communicated  by Dr. Castle, of Leeds, to  the Provincial 
"80
ARSENIC.   PERIOD OF DEATH.
 Journal (June 28, 1848, page 347.)   A woman took half an ounce of Fowler's
 solution, (Arsenite of Potash) in unknown doses, during a period of  five days.
 She then died:  and on examination the stomach and  intestines were  found  in-
 flamed.  Death took place by syncope, (mortal fainting) and there was an  ab-
 sence of vomiting and diarrhoea.   The quantity of arsenic  which here  destroyed
 life could  not  have been  more than two grains.   In another case—two grains
 and a half of arsenic, contained in two ounces of Fly-water, killed a robust healthy
 girl, aged nineteen, in thirty-six hours.  (See Med. Gaz., vol. xxxix. p. 116.)
 Hence a medical witness will be justified  in  stating that  under  circumstances
 favourable to its operation, the fatal dose of this poison in  an adult  is  from two
 to three grains.
   Period at which death takes place.—Some  remarks on the important bearing
 which an answer to this question may have in  a case of arsenical poisoning, have
 been elsewhere made (ante, p. 46.)   From the numerous well observed cases
 which are now on record it would appear that large doses  of arsenic commonly
 prove fatal in from eighteen hours to  three days.   Probably, the average time
 at which death takes place is twenty-four hours; but the poison may destroy life
 within a much shorter period than  this.  There are now many authentic cases
 reported, in which death has occurred in from three to six hours.   In 1845 I met
 with a well marked case of death from arsenic in  five hours, and  in another,
 which occurred in April, 1849, death took place in two and a half hours.  (Guy's
 Hospital Reports, Oct. 1850, 183.   See also Ann. d'Hyg.  1837, i. 339.)  It is
 singular that a few years since, observations were so limited that it was thought
 to be impossible that arsenic could destroy  life in a shorter period of time than
 seven hours!  (See ante, p. 46, Russell's case;) and this rapidity of death was
 actually  considered as a medical fact, which in some measure tended to negative
 the  allegation of death from arsenic!   One of the most rapidly  fatal case's  on
 record I  believe to be that  which occurred to Mr. Foster, of Huntingdon.  This
 gentleman satisfactorily ascertained that the  subject, a child under three years
 of age, died within two hours from the effects of arsenic.  The quantity taken
 could not  be determined;  but the time at which death takes place  is by no
 means dependent on the quantity of poison taken.  Dr. Borland, who  formerly
 attended my lectures, communicated to  me a  case, in which death probably oc-
 curred in less than two hours.   An interesting case has been published by Dr.
 Dymock.   A girl, aged twenty, took two ounces of powdered arsenic,  and died
 in less than  two hours and a half afterwards.  There were no comatose symp-
 toms;—the girl was sensible to the last, and  she had vomited violently.  The
 mucous membrane of the stomach was covered with bright patches of  a scarlet
 colour.   (Ed. Med. and Surg. Journ. April, 1843.)  In some instances  death
 does not occur until long after  the average period.  In one case, in which an
 adult swallowed about half an  ounce, death  did not take place for  fifty hours,
 and  it is remarkable that there was an entire absence of pain (Med.  Gaz. vol.
 xlviii. page 446.)  In the case of the Duke de Praslin, one large dose was taken,
 but death did not occur until the sixth day.  (Ann. d'Hyg. 1847,  ii. 367.)  In
 October,  1847,  a man who had swallowed 220 grains of arsenic, was  admitted
 into Guy's Hospital.   He died on the seventh day.  It is obvious that  a patient
 who recovers from the first effects of this poison may still  die from exhaustion
 or other  secondary causes, many days or weeks after having  taken it.  In the
 case of Reg. v. Ml Cormick, Liverpool Winter Assizes, the child died, as it ap-
peared, from  one dose of arsenic after the lapse of twelve days.   (Med. Gaz.
xxxiii. 434.)   The child partially recovered from the first effects.   In  the case
of The Queen Y.Gilmour (Edinburgh, Jan. 1844,) the deceased died  after thirteen
days.  In one instance, arsenic was applied externally to the head, and the per-
son did not die until the twentieth day.   The longest duration of a case of poison-
ing by arsenic which I have met with is reported by Belloc.   A woman, aged
56, employed a solution of arsenic in water to  cure the itch, which had resisted 
ARSENIC.   REDUCTION TO THE METALLIC STATE.             81
the usual remedies.  The skin became covered with an erysipelatous eruption,
and the itch was cured, but she experienced severe suffering.   Her health gra-
dually failed, and she died after the lapse of two  years, having suffered during
the whole of this period from  a  general tremor of the limbs.   (Cours de Med.
Leg. 121.)
   Chemical analysis.—Arsenic as a solid.  In the simple state, White arsenic
may be  identified by the following  properties:—1. A small  quantity  of the
powder, placed on  platina foil, is entirely volatilized at a gentle heat (370°) in
a white vapour.  Should there be any residue, it is impurity; sometimes  plaster
of Paris or chalk is found mixed with it.  The quantity of fixed impurity present
may in this way be easily determined.   If a small portion of the white powder
be very gently heated in a glass tube  of narrow  bore, it will be sublimed without
melting, and form a ring of minute octahedral crystals, remarkable for" their lustre
and brilliancy.  It will be observed in  these experiments, that white arsenic in
vapour possesses no odour.  2. On  boiling a small  quantity of the powder in
distilled water, it is not dissolved, but it partly floats in a sort of film, or becomes
aggregated in small lumps at the bottom of the vessel.  It requires long boiling,
in order that it should become dissolved and equally diffused through water.  3.
When the powder is  treated with a solution of  hydrosulphuret of ammonia in a
watch-glass, there is no change of colour, as there is with most metallic poisons:
on heating the mixture, the white powder is dissolved;  and on continuing the
heat until the  ammonia is expelled, a rich  yellow or orange-red film is left (ses-
quisulphuret of arsenic,) which is soluble  in all  alkalies, and  insoluble in mu-
riatic acid.
   Reduction-process.—When a small portion of the powder, i. e. from one-fourth
to one-twentieth part of a grain,  is heated with some reducing  agent containing
carbon (and the best for this purpose is a flux  obtained by incinerating  acetate
 of soda in a close vessel) in a glass tube about three inches long and one-eighth
 of an inch in diameter, it is decomposed: a ring  of metallic arsenic of an iron-
 gray colour is  sublimed and deposited in a cool part of the tube.  At the same
 time there is a perceptible odour, resembling that of garlic, which is  possessed
 by metallic arsenic only while passing from a state of  vapour to arsenious acid.
 This odour was at one time  looked upon as peculiar to arsenic, but no reliance
 is now placed on it as a matter of medical evidence—it is a mere accessary result.
 In this experiment of reduction, there are commonly two rings deposited in the
 tube:—the upper ring has a brown colour, and appears to be a mixture of finely
 divided metallic arsenic and arsenious acid.   In order to determine the weight
 of the sublimate, the glass tube should  be filed off closely on each  side of the me-
 tallic ring, and weighed; the sublimate may then be driven off by heat, and the
piece of glass again weighed:—the difference or loss represents the weight of the
sublimate.  These sublimates are remarkably  light, and  require to be weighed
in a delicate balance.  I found, in one experiment, a  large  sublimate to weigh
 no more than *08 grains.  By heating gently the piece of tube, reduced to pow-
 der, in another tube of larger diameter, the metallic arsenic, during volatilization,
forms octahedral  crystals of arsenious acid, which may be  dissolved  in a few
drops of water, and  tested by the liquid reagents.  The metallic sublimate, or
the crystals produced from it, may be subjected  to the following process, in order
to determine their real nature -.—Break the glass on which the sublimate is de-
posited into fragments, and digest these in a few drops of strong nitric acid.   The
sublimate, if due to arsenic,  is converted to arsenic  acid.  The acid solution
should be evaporated to dryness; the  white uncrystalline residue dissolved in a
 few drops of distilled water, and  a solution of nitrate of silver added.  A brick-
 red precipitate indicates arsenic acid, and thereby proves that the sublimate was
 of an arsenical nature.
    Objections to the Reduction-process.—I.  The glass itself may acquire  a black
metallic lustre by heat from the reduction of the  oxide of lead contained in it.
        6 
82
TESTS FOR ARSENIC IN SOLUTION.
This is always the case when the tube is held too much in the body of the spirit-
lamp flame instead of over  the point.   This metallic stain differs in appearance
from arsenic; it is fixed, while the arsenical sublimate is volatile  by heat, and
convertible to white  octahedral crystals of arsenious acid.  2.  Charcoal may
give a dark colour to the tube, but it is not  advisable to employ this substance
unless the quantity of arsenious acid'is very minute; besides the stain of char-
coal is fixed,  and has no metallic lustre like  that of arsenic.  3. Arsenic is said
to be contained in glass, and it was supposed that it might be sublimed by heat:
this, however, is impossible; arsenic is  sometimes used in the manufacture of
glass, but it is entirely volatilized during the process.   (See Ann. d'Hyg. 1834,
i. 224;  also  Galtier, Toxicologic, i.  297.)  I have  frequently examined  large
quantities of the glass tubing employed by  chemists in a finely powdered  state,
without finding the slightest trace of arsenic.  4. Cadmium is a metal which is
said to form  a metallic sublimate  like arsenic.   The oxide of cadmium may be
reduced by a similar process, but the metallic sublimate is wholly different from
that of  arsenic: it has  a tin-like lustre, and is generally fringed with  a brown
margin  of reproduced oxide.   There is no odour of garlic during the reduction
of oxide of cadmium; and, on heating the metallic ring, it is not wholly volati-
lized like arsenic, but converted to a ring of brown oxide.   5.  Mercury forms a
sublimate, but in white silvery globules, quite distinct from the dark iron-gray
lustre of arsenic.   Neither antimony nor zinc can be volatilized from any of their
preparations in a metallic state, by the heat of a spirit lamp.  The process of reduc-
tion, with the most simple precautions, is, therefore, when thus applied, conclu-
sive of the nature of the substance under examination.   It is advisable, although
not absolutely necessary, that we  should apply the three foregoing tests to the
white powder, before  attempting to extract the metal  from it.
   Arsenic in solution in water; Liquid  tests.—The solution is clear, colourless,
possesses scarcely any perceptible  taste, and has a very faint acid reaction.  In
this state, we should first evaporate slowly  a few drops on  a glass plate,  when
a confused crystalline crust will be obtained.  On examining this  crust with a
common lens, it will be found to consist of numerous minute octahedral crystals,
presenting triangular surfaces by reflected  light.  By this simple experiment,
arsenic is distinguished from every other metallic poison.   Under a good achro-
matic microscope, it is  easy to determine the form of a crystal which  has only
the 1-4000th of an inch in diameter.
   1. On adding to the solution Ammonio-nitrate of silver, a rich yellow precipi-
tate of arsenite of  silver falls  down;—rapidly changing in colour, under expo-
sure to daylight, to a greenish brown hue.   The test is made by adding to a very
strong solution of nitrate of silver a weak  solution of  ammonia, continuing  to
add the latter, until the brown oxide of silver, at first  thrown down, is almost re-
dissolved.   The yellow precipitate is soluble in nitric, tartaric, citric, and acetic
acids, as well as in caustic ammonia.  It is  not dissolved by potash or soda.
   2. On adding to the solution of arsenic  Ammonio-sulphate of copper, a rich
green precipitate is formed, the tint of which varies according to the proportion
of arsenic present,  and the quantity of the test added: hence, if the quantity of
arsenic be small, no green precipitate at first appears; the liquid simply acquiring
a blue colour from the test.   In less than an hour, if arsenic be present, a bright
green deposit is formed, which  may be easily separated  from the blue liquid by
filtration.  This test  is made by adding ammonia to a weak solution of sulphate
of  copper, until the bluish white  precipitate, at first  produced, is nearly re-dis-
solved : it should not be used in large quantity if concentrated, as it possesses a
deep violet blue colour, which  completely obscures or  conceals the green precipi-
tate formed.   The precipiljated arsenite of copper is soluble in  all acids  mineral
and vegetable, and in ammonia, but not  in potash or  soda.   When dried and
collected, it possesses this characteristic property: by very slowly heating a few
grains in a tube of small bore, arsenious acid is sublimed in a ring  of minute re-
splendent octahedral crystals, oxide of copper being left as a residue. 
ARSENIC.   MARSH'S PROCESS
83
   3.  Sulphuretted hydrogen gas.—The  hydrosulphuret of ammonia gives no
precipitate in a solution of arsenic until an acid has been added, whereby arsenic
is known from most metallic poisons.   On adding an  acid (acetic or dilute hy-
drochloric,) a rich golden yellow-coloured precipitate is thrown down (orpiment
or sulphuret of arsenic.)  It is better, however, to employ in  medico-legal ana-
lyses, a current of washed sulphuretted hydrogen  gas, which  is easily procured
by adding sulphuret of iron to one part of strong sulphuric acid  and three parts
of water in a long-necked bottle.  The arsenical liquid should be slightly acidu-
lated with acetic or very diluted muriatic acid, before the gas  is passed into it;
at least care should  be taken  that it is not alkaline.   The yellow compound  is
immediately produced if  arsenic be present, and may  be collected after  boiling
the liquid sufficiently to drive off any surplus gas.   The precipitation is likewise
facilitated by adding to the liquid a solution of muriate of ammonia.  This yellow
precipitate is known to be sulphuret of arsenic by  the  following properties:—1.
It is insoluble in water, alcohol, and ether, as well as in all acids, mineral (mu-
riatic) and vegetable; but. it is decomposed  by strong nitric and nitro-muriatic
acids.   2.  It is  immediately  dissolved by  caustic potash, soda, or ammonia;
forming, if no organic matter be present, a colourless solution.   3.  When dried
and heated with  three  parts of soda-flux, or, what is  better, an equal part  of
cyanide of potassium, it  furnishes a metallic sublimate of arsenic.   This last
experiment requires a little  care, as some sulphur is  apt  to  be sublimed, and
obscure the results.   If fine pulverulent silver  be used as the reducing  agent,
and the heat gently applied, the arsenic may be evolved at once from the sulphu-
ret, in a ring of octahedral crystals of arsenious  acid.   4.  The arsenical nature
of the  yellow precipitate may be also  conclusively proved  by  heating  it with a
mixture of  one part nitric and two parts hydrochloric  acid, and  evaporating  to
dryness.  A residue of arsenic acid is  thus obtained, which, when dissolved  in
a few drops of distilled water, and tested by nitrate or ammonio-nitrate of silver,
yields a brick-red precipitate of arseniate of silver.   Unless two or more of these
properties are proved to be possessed by the yellow precipitate formed by sulphu-
retted hydrogen in an unknown liquid, it cannot be a compound of arsenic;  and
it would not be safe as a general rule to receive evidence on the point.   On the
other  hand, when  these  properties (especially 3  and  4) are possessed by the
precipitate, it must be arsenic, and can be no other substance.
   Objections.—Many objections have been taken on criminal trials to the medical
evidence, founded on the application of these tests individually; but it may be
safely  averred that  there is no substance except arsenic  which will give the
reactions with the three.  It is customary for toxicologists to lay down the rule,
that the objection urged against one test for arsenic is removed by the application
of the  other tests.  In a criminal case in which I was  required to give evidence
(Reg.  v. Jennings, Berks Lent Ass. 1845,) it was  ingeniously suggested in the
defence, that there might perchance be such a mixture of substances not containing
arsenic, as  to affect all the  tests like  arsenic when separately  applied.  This,
however, is clearly a chemical impossibility, for it would require  the mixture  of
substances incompatible with each other.   But a mere  change  of colour, or even
the production of  a coloured precipitate on adding a test to an unknown liquid,
furnishes no evidence, unless the properties of the precipitate be those of an arse-
nical compound.  Again, no conceivable  mixture  of substances would produce
a metallic ring resembling that of arsenic, so as to deceive an analyst experienced
in such matters; and far less  a ring, possessing  those properties of an arsenical
sublimate, which it would be easy for one who may have had i>ut little experience,
to determine by simple chemical processes.
   Marsh's process.   Hydrogen test.—The action  of  this  test depends on  the
decomposition of arsenious acid and its  soluble compounds, by hydrogen evolved
in the  nascent state from the action of diluted sulphuric acid  on zinc.   The
apparatus is of the most simple kind, and is so well known as to need no descrip- 
Q4                     ARSENIC.   REINSCH'S PROCESS.
tion.   The arsenic may be introduced into the short leg of the tube in the state
of powder; but it is far better to dissolve it in water, by boiling, either with or
without the addition of a few  drops  of caustic potash.  The metallic arsenic
combines with the hydrogen, forming arsenuretted hydrogen gas, which possesses
the following properties:—1.  It burns with a bluish-white flame, and thick white
smoke (arsenious acid.)   2.  A  cold plate of glass or white porcelain held in the
flame near the point, receives a dark stain from the deposit of arsenic upon  it.
This stain is composed in the  centre of pure metallic  arsenic, which  may be
sometimes raised up in a distinctly bright leaf of  metal,—immediately on  the
outside of this, is an opake black ring (suboxide or hydruret of arsenic,) which,
when viewed by transmitted light,  is of a clear hair-brown colour at the extreme
edge:—if the quantity of arsenic be Very small, the metallic lustre  and opacity
may be wanting, and the whole stain will  have a brown colour  by transmitted
light.   On  the  outside  of this black ring is a thin wide film of a milk-white
appearance, which is nothing more than arsenious acid reproduced by combustion.
3. A white saucer or a slip of card or paper moistened with ammonio-nitrate of
silver, held about an inch above the point of the flame, will be found,  if arsenic
be  present, to be coloured yellow, from the reproduced arsenious acid being
absorbed, and forming yellow arsenite of silver, easily soluble in  acetic acid and
ammonia.   4. Nitrate of silver on paper is immediately blackened and reduced
by  the unignited gas.   Unless the gas possess these properties, there is  no certain
evidence of the presence of arsenic in the liquid examined.
,  Objections to Marsh's process.—Other substances  will combine with  hydrogen,
and when  the gas is burnt, a deposit will be formed  on glass  which  may be
mistaken for arsenic.  The only objection of any practical force is that founded
on  the presence  of antimony.   There are these differences between the arsenical
and antimonial deposits:  the deposit of  antimony has rarely the  bright metallic
lustre which that of arsenic commonly presents; by transmitted  light it is of a
smoky black, while  that of arsenic is of a hair brown  colour.  Although  the
antimonial is very similar in colour to the arsenical  flame, yet the third property
is entirely wanting.   If the ammonio-nitrate of silver be held over the antimonial
flame, the silver is reduced; no yellow arsenite is formed, as in the case of arsenic.
This last criterion distinguishes the arsenical flame from that produced by all the
other bodies above mentioned.   The arsenical deposit may be further distinguished
by  dissolving it in nitric acid, evaporating to dryness,  and adding nitrate of sil-
ver.  A brick-red precipitate is formed if the stain  have been caused by arsenic.
   Arsenic is sometimes contained  as an impurity  in zinc and sulphuric acid:
hence the purity of  the materials employed must be determined before any reli-
ance can be placed on the results.
   Reinsch's process.—In the application of this ingenious process, the liquid sus-
pected to contain arsenic, or the solid dissolved in distilled water, is boiled with
about one-sixth to one-eighth part of pure muriatic acid, and a small slip of bright
copper foil or copper gauze is then introduced.  If arsenic  be present,  even in
small quantity, the  copper acquires either immediately or within a  few minutes
a dark iron-gray coating from the deposit of that metal.  This is apt to scale off,
if the arsenic be in  large quantity, or if the liquid  be long boiled.   We remove
the slip of copper, wash it in water, dry it, and gradually heat it in a reduction-
tube, when arsenious acid will be sublimed in minute octahedral crystals: if these
should not be apparent from one piece of copper, several may be successively in-
troduced.   A large surface of copper may be in this way at once covered__the
gray deposit scraped off, and the powder gently heated in a reduction-tube.  This
test succeeds perfectly  with powdered  arsenic, the arsenites  arsenic acid  the
arseniates, and orpiment; but, as it has been shown by Dr. Rainey its operation
is not so delicate or certain with arsenic acid and the arseniates as with the other
compounds of arsenic.  This process will  even separate the arsenic from  the
arsenite of copper, and from common lead-shot.  When the quantity  of arsenic 
ARSENIC IN LIQUIDS CONTAINING ORGANIC MATTER.           85
is small, the polished copper merely acquires* a faint violet or bluish tint, and
the deposit is materially affected by the quantity of water present, or, in other
words, the degree of dilution.  But one great advantage is, that we are not obliged
to dilute the liquid in the experiment, and there is no material loss of arsenic, as
in the hydrogen  process:—the whole may be removed and collected by the in-
troduction of successive portions of copper.   This process is extremely delicate,
the results are very speedily obtained, and are highly satisfactory.   One caution
is to be observed, i. e. not to remove the copper from the liquid too soon.  When
the arsenic is in minute quantity, and the liquid much diluted, the deposit does
not take  place sometimes for  half  an  hour.   If the copper be  kept in for an
hour or longer, it may acquire a dingy tarnish from the action of the acid only.
This  is known by its want  of metallic lustre, and  its being easily removed by
friction, as well as by its yielding no crystalline sublimate when heated.
   Objections to Rcinsch's process.—Certain objections have been urged to this
test.   Thus arsenic may be  present in the muriatic acid: this is at once answered
by boiling the copper in a portion  of  the muriatic acid before adding  the  sus-
pected liquid.   This should always be a preliminary experiment.   A more im-
portant objection is, that other metals are liable to be deposited on copper under
similar circumstances.  Thus, this is the case  with Antimony, whether in  the
state of chloride or of tartar-emetic; and it  is not always possible  to distinguish,
by the appearance, the antimonial from the  arsenical deposit.   Should the quan-
tity of antimony be small, the deposit is of a violet tint; if large, of an iron-gray
colour, exactly like arsenic.  There is one  answer  to these objections,  namely,
that from  the arsenical deposit, octahedral crystals of arsenious acid may be pro-
cured by slowly heating either the slip of copper, or the gray deposit scraped from
it, in a reduction-tube.  If this  experiment be carefully performed, a ring of
white arsenious acid  will be easily obtained: this may be boiled in a few drops
of water,  and tested with the ammonio-nitrate of silver and sulphuretted hydro-
gen.   When the sublimates are  too small for such a solution and subdivision,
they may be converted to arsenic acid, by digestion  in nitric acid, by the process
already described (ante, page 83,) and the residue tested for arsenic acid by ni-
trate of silver.   Such a corroboration is  necessary,  because the crystalline form
of arsenious acid is not always distinguishable by the eye;  and  the antimonial
deposit gives a white  amorphous sublimate, which, however, is quite insoluble in
water.  Care must be taken not to mistake minute  spherules of water or muri-
atic acid for detached crystals of arsenious acid,  and here the microscope will be
found of great service.  The  facility of applying  Reinsch's  process renders it
necessary that the experimentalist should be guarded in his inferences.  It is not
merely by the production of a deposit on copper, that he judges of the presence
of arsenic, but by the conversion of this  deposit to  arsenious acid, demonstrable
by its crystalline  form or  its chemical properties.   If a  deposit take place on
copper, and arsenious acid cannot be obtained by heating it, then  the evidence
of its having been caused by arsenic is defective.  Owing to the neglect of these
corroborative results,  antimony and other  substances have been mistaken for
arsenic.
   Arsenic in liquids  containing  organic matter.—Arsenious acid, when in a
state of solution, is not liable to be precipitated by any animal or vegetable prin-
ciples, although all such substances render it less soluble in water.   It has been
recently announced that it enters into combination with albumen, but this  is a
point of no practical  importance in reference to the present subject of  inquiry.
The liquid for analysis should  be filtered through  muslin, cotton, or paper, in
order to separate any insoluble matters: these should be well pressed and  drained.
Should the liquid  be coloured, this is of little moment, provided it be clear.  If
viscid, it should be diluted with water and boiled with a small quantity of mu-
riatic acid; on standing, a deposit may take place, and this should  be separated
by a filter.  As a trial-test, we may now boil in a portion of the liquid,  strongly 
86
ARSENIC.   PROCESS IN ORGANIC LIQUIDS.
acidulated with pure muriatic acid, a slip of bright copper, or introduce a piece
of fine copper-wire highly polished.   In a few seconds, if arsenic be present, the
copper will acquire a gray metallic coating.   If, after half an hour, the copper
remain unchanged, the arsenic, if present, must be in extremely minute propor-
tion; if, on the other hand, the copper be covered by a gray deposit, it should
be dried and heated in a reduction-tube in the way already described, in order to
obtain from it octahedral crystals of arsenious acid, the nature of which must be
subsequently demonstrated  by the special mode of examination already pointed
out.  From several such slips of copper, or  copper-gauze, i. e. very finely woven
copper-wire, a quantity of metallic arsenic may be procured, sufficient,  on recon-
version to arsenious acid, to allow of a solution in water  being made, to which
all the liquid tests may be applied.  If the  quantity thus procured be small, the
arsenious acid may be converted to arsenic acid by nitric acid (see p. 83.)^  Un-
less  a brick-red precipitate result,  under due precautions, on the  addition of
nitrate of silver, we cannot be certain that the sublimate was owing to arsenic.
One obstacle to the use of the gauze is, that oily and other kinds of animal mat-
ter, not easily removable by washing in water, may adhere to it.  Digestion in
ether and alcohol, slightly warmed, will free it from these substances, which are
apt to become sublimed  by heat, and obscure the  arsenic:—but it should  be
again washed in water and dried  before heat is applied to it.   When, however,
much oily matter is present, it is better  to  boil the organic substance with mu-
riatic acid, and filter the liquid through a wet filter before introducing the cop-
per-gauze.   In this way the fat and solid organic  impurities  may be separated.
An even coating of arsenic was by this  process obtained  on copper-gauze from
the decomposed tissue of  the stomach of a person whose  body had been buried
nearly two years.   As the gauze,  from its  extreme  fineness, is remarkably hy-
grometric, it requires to be thoroughly dried in a vapour-bath before it is submitted
to heat in a reduction-tube.   Should there be any doubt whether the sublimate
be caused by spherules  of liquid or particles of arsenic, the tube itself should be
kept some time in a vapour-bath.   Water is dissipated at 212°.  Arsenious acid
requires a heat of nearly 370° for  its sublimation.  In order  to avoid the possi-
bility of a mistake, when the  sublimate is very minute, and of a doubtful cha-
racter, it will be advisable to examine it with a good microscope, under a power
of one hundred and forty diameters.   If arsenic, it will present itself in minute
detached angular crystals, having  triangular surfaces, and more or less of an oc-
tahedral form.   Globules of water, or of hydrochloric acid,  present themselves
in rounded or oblong spots, transparent in the centre^ and dark at the circumfe-
rence.  They may thus be seen among, and easily distinguished from, the crys-
tals of arsenic, in ordinary sublimates.   In a fine sublimate, derived from some
hay in the  stomach of a horse that had been killed by arsenic, I counted twenty-
eight distinct crystals of arsenic, in a space the 1-200th of an inch square.  The
greater number of these crystals  had a diameter of the l-2000th of an inch;
some were distinctly recognised which had a diameter of less than l-4000th of
an inch.  In general the  octahedra are truncated.
  Another process for procuring evidence of the presence of this poison  in
liquids, consists in precipitating the arsenious acid in the state of sulphuret, and
in decomposing this compound by an  alkaline flux to obtain metallic arsenic, or
by nitroinuriatic acid, to obtain arsenic acid.  Sulphuretted hydrogen gas should
be passed into the suspected liquid, previously filtered and acidulated with mu-
riatic or acetic acid.   When  all  further precipitation  has  ceased, the  liquid
should be filtered, the precipitate  collected, dissolved in ammonia,  and repreci-
pitated by  an acid.  By digesting it in water, alcohol, and muriatic  acid succes-
sively, it may be deprived of any organic matter combined with it, sufficiently
to allow of its reduction by soda-flux or metallic silver  in  the way described.
The sulphuret  has sometimes a dark brown  colour from adhering organic matter;
it is then better to transform it to  arsenic  acid  by boiling it in nitro-muriatic 
ARSENIC.   CONTENTS OF THE STOMACH.
87
acid, and slowly evaporating the acid liquid to dryness: during this process, the
organic matter is entirely destroyed, and a dry residue of arsenic acid is obtained
and rendered fit for testing, by digesting it in distilled water; or the  sulphuret
may be deflagrated with nitre, and arseniate of  potash  then procured.  In this
case the surplus nitric acid should be driven off by sulphuric acid.   An abun-
dant deposit of metallic arsenic may be obtained in either case by boiling the
liquid with  muriatic acid and copper-gauze.  In this way it is  easy to  analyze
wine, coffee, tea, milk,  porter, brandy, and similar liquids, for arsenic.  This
corroborative test is necessary, since I have known an instance in which a large
quantity of orange-peel had been eaten and had caused death, and  the contents
of the stomach acquired a yellow colour  from sulphuretted hydrogen gas, like
that produced by arsenic.   There was no deposit, and the yellow colour did not
disappear on adding ammonia.
   The contents of the stomach are often mixed with lumps of arsenic which may
be separated by throwing those portions that do not pass through a filter into  a
large glass  of distilled water, and after giving  to it a circular motion, suddenly
pouring off the supernatant liquid, when the heavy portions containing arsenic
will be found at the bottom.  The lumps left in the contents may be easily re-
moved, dried on filtering paper, and  tested.   If the arsenic has been taken in
fine powder, there will be no lumps, but it will probably be deposited in masses,
mixed with mucus and blood, on the coats of the organ, chiefly in those parts
where it is much inflamed and ulcerated.   The  arsenic in this  state looks like
moistened plaster of Paris, but it is of a darker colour, and when  examined by
a lens it is crystalline.  It may be removed on  a spatula, spread  in masses on
filtering paper, and slowly dried.   As  it dries, the granules will detach them-
selves from the mass, and they may be then easily tested  either by the Reduc-
tion or by  Reinsch's process; i. e.  by boiling the suspected particles, or even
the stained portions  of paper on which the organic matter  has become dried,
with muriatic acid and  copper-gauze.  Mucus, blood, or even a  layer of the mu-
cous membrane of the  stomach, may be thus readily tested.  This is in general
the only method which it is now necessary to employ.   By the use of numerous
tests  and processes, a witness only exposes his evidence most  unnecessarily to
many ingenious objections.  It is sufficient, after having obtained a metallic de-
posit on copper, to procure from it crystals of arsenious acid, and to demonstrate
that they are really this  substance, by dissolving them in water, and applying
the liquid tests, or in nitric acid, and applying to the evaporated residue either
the nitrate or the ammonio-nitrate of silver.  It is necessary to remark in refe-
rence to the application of the last-mentioned process,  that there  should be no
free acid present, because the arseniate of silver is very soluble in acids.   The
ammonio-nitrate of silver may  be sometimes, therefore, advantageously substi-
tuted for the simple nitrate.
   In forming a judgment of the quantity of arsenic procured by Reinsch's pro-
cess, it may be stated that only three-fifths  of the arsenious acid  employed  are
obtained in  crystals by  heating the copper.   My friend, Dr. Geoghegan,  of Dub-
lin, has lately published some very interesting observations on this subject, for
an account of which I must refer the reader to his paper in the Dublin Quarterly
Journal for February, 1851.  He has found that while the whole of the arsenic
is deposited, but little more than one half  can be re-obtained by sublimation in
the crystalline state.
   Since  the publication of the previous edition of this work, Dr. Maclagan of
Edinburgh, and Dr. Rainey of Glasgow, have added many valuable facts regarding
the application of Reinsch's process in the detection of arsenic when mixed with
organic matters.  Dr. Rainey finds that l-1000th of a grain of arsenious acid will
give a full steel colour to  one square inch of copper-surface, and he properly ad-
vises the analyst not to waste the arsenic, (when present in small  quantity) by
spreading it in a thin film over too large a surface of copper.  (See Proceedings 
88
PROCESSES FOR ABSORBED ARSENIC.
of Glasgow Phil. Soc, December, 1849.)   For Dr. Maclagan's practical remarks
on the same subject, I must refer the reader to the Edinburgh Journal of Medi-
cal Science for 1848-9.
  A plan which I have lately found convenient for  preliminary testing is to in-
troduce a loop of fine and highly polished copper-wire into the boiling acid liquid:
—the two ends of the wire resting on the  edges of the basin or glass vessel, as a
support, and for the convenience of occasional examination.   So soon as a closely
adhering steel-coloured deposit appears on the copper the loop of wire is removed,
and small pieces of finely-woven copper-gauze, containing 16000 apertures to the
square inch, and therefore presenting  a comparatively large surface for deposit,
are successively introduced until they cease to be coated.  From one or more of
these pieces, crystals  are obtained, and their nature proved by  the processes
above described.
   When arsenic is discovered in the stomach mixed with food, it does not neces-
sarily follow that it has been  administered in  that particular  article of  food.
Should the person have partaken of food, such as milk or gruel, subsequently to
the swallowing of arsenic, these fluids will necessarily acquire an  arsenical im-
pregnation from the poison contained in the stomach.  The patients may have
taken the arsenic in one kind of food, when another  and an innocent description
of food might thus inadvertently be pronounced  to have been the vehicle.
  It is unnecessary in this place to enter into a comparison of the two processes
above noticed, in respect to their relative powers of enabling the analyst to detect
minute quantities of arsenic.   It may be conceded that  Marsh's process will de-
tect a smaller  quantity of arsenic  than the process of  Reinsch, but the latter,
when the quantity of liquid is small, will  detect  the  l-150th part  of a grain of
the poison, and this is itself a point of delicacy in analysis, which, when the
issues of life and death are involved, might almost suffice to justify a reasonable
distrust  of the  resources of science.   It would  require considerable courage to
go beyond this, and it  appears to me that in a criminal case it would not be safe
to depose to the presence of arsenic from Marsh's process alone, when the quan-
tity of poison was too small to admit of separation or detection by the process of
Reinsch.  When the  point of detection by Reinsch's process has been passed,
then we increase the chance of fallacy to which  Marsh's process is always ex-
posed, by the fact that such minute traces of arsenic may have existed in some
portion of the zinc or sulphuric acid employed.   It was this over-reliance on the
extreme delicacy of the test in degrees of research where the process admitted of
no corroboration whatever, that led to the  great error committed by Orfila of as-
serting  that arsenic was  a natural constituent of the human body!  [Several
papers on the detection of arsenic, when mixed with the contents of the stomach,
have appeared in this country, and may be consulted with  advantage; as  Am.
Journ. Med. Sci. ix. 524; xvi. 240.   Phil. Journ. Pharm. vi. 94,  190.  Trans.
Mar.  Acad. vol. i. pt, 1.    Hays' Amer. Med. Cycloped., art. Arsenic.  Philad.
Med.  Ex., 1851, vol. vii.  153.]
  Detection of absorbed acid in the  tissues.—When arsenic cannot be detected
in the contents of the viscera, it is necessary to adopt some method of extracting
from  the blood,  secretions, muscles, or viscera of the deceased, that  portion of
the poison which has been absorbed.   In most cases of acute poisoning, arsenic
will be found, but in variable quantities, in  every one of the soft structures of
the body—more abundantly in the  viscera of the abdomen than elsewhere.
  The processes commonly employed for the discovery of arsenic  in the tissues
are those of MM. Danger and Flandin, and of Reinsch.
  1. MM. Danger and Flandin carbonize the animal matter by boiling it to dry-
ness in a small quantity  of strong  sulphuric acid, equal to about one-third the
weight of the dried organic matter.   They  digest the  resulting carbonaceous ash
in nitro-muriatic acid, and after driving off the acid by a moderate heat treat
the residue with distilled water.  This, if arsenic be present in the viscera yields
arsenic acid,—a compound the nature of which may be easily demonstrated (page 
^PROCESSES FOR ABSORBED ARSENIC.                   89
83.)  In pursuing this process, I obtained, from seven ounces of the liver of a
man poisoned by arsenic, about a dozen minute sublimates, as well as the action
of the vapour of the flame on ammonio-nitrate of silver.   M. Blondlot has lately
advised that the carbonization should not be carried to dryness, as  it occasions
a loss of arsenic; but when the liquid is of a pasty consistency,  he passes into it
a current of chlorine;  the  liquid  is then filtered, and introduced into Marsh's
apparatus, where it produces but little froth.   (Comptes  Rendus, 1845, ii. 32.)
There can be no doubt that by the use of nitro-muriatic instead of nitric acid, a
portion  of the arsenic is volatilized as chloride.
  2.  The process of Reinsch  is, however, more easily applied than  that of M.
Flandin:  it is simply this.   The soft organs (and for this purpose the liver is
preferable) are to be cut into very small pieces, and boiled in a mixture of one
part of  pure muriatic acid and eight of water, for two hours, or until the whole
of the organic matter becomes a soft magma.   The liquid may then be strained,
and the residue pressed.   If the quantity be large, it may be  concentrated by
evaporation.   The copper-gauze, foil, or  fine wire, should be next introduced,
the  acid  liquid boiled, and half an  hour or an hour allowed  for the deposit,
if necessary.   Should a deposit be formed, its  nature must be positively de-
termined in the way already described (p. 86.)  I have  had occasion to apply
this process to the detection of absorbed arsenic in the tissues in numerous cases
of arsenical poisoning, with the most  satisfactory results.   A witness, in making
use of it, must always be prepared to meet with the following objection—namely
whether a deposit resembling  that of arsenic  may not be formed on the surface
of copper by long boiling with animal matter (free from  poison) and muriatic
acid.  Having tried on  several occasions  the liquid contents of the human sto-
mach, the viscera, and even common muscle (beef,) as well as various articles
of food, in order to determine this point,—the result has been, that except when
arsenic  was added, or when there was a very strong suspicion of its presence, no
metallic deposit was formed on the  copper.   The metal  came out of the vessel
untarnished, or there was  only a slight superficial discoloration (from oxide or
subchloride) easily removed by friction.  It would be wrong, however, to'say,
whatever suspicions  may  exist, that arsenic  was present in any case,  unless
arsenious acid be obtained from the deposit.   The analyst should remember that
the liver, spleen, and kidneys, are the organs best fitted for yielding arsenic under
these circumstances.   I have found  arsenic, by  Reinsch's process, in the liver,
after sixteen months' interment.  (Case of Reg. v. Southgate, Chelmsford Lent
Assizes, 1849.)  The urine also contains this poison in the living and dead body.
   In reference to the detection of absorbed arsenic,—as this substance is much
used in skin and other diseases, its discovery does  not necessarily establish the
cause of death, or an act of criminal administration.
   If the patient has died with arsenic in  the body, there  is scarcely any limit to
the period at which it may be detected.   In the cases of  two children examined
by Mr.  Herapath, in July, 1849,  the poison was discovered in the remains of
the dead bodies after eight years' interment; and in a remarkable instance which
occurred to Dr. Webster, of Boston, it was discovered in  the remains of a body,
after fourteen years' burial in a tomb.  It has been  sought for, and not  found,
at much shorter periods  after death, where there  was very strong  suspicion that
the poison had been taken: but it is highly probable that in these cases there was
little or no arsenic in the bodies at the time of interment.   The longer a person
has survived, the less probable is it, cceteris paribus, that arsenic will be  found.
   In those cases where arsenic is found in a solid state after  long interment, it
is generally under the form of sulphuret or yellow arsenic, the white arsenic
being thus changed in colour, during the process of putrefaction.  This change
of colour, however,  is not always met with, even in bodies which have  been
buried for a year, or longer.  (See Guy's Hosp.  Reports, Oct. 1850, p. 206.)
Care must be taken not to confound stains produced by bile with those caused
by sulphuret of arsenic. 
90
ARSENIC IN SOLIDS.
  The medical practitioner should be aware that a crystalline substance resem-
bling arsenic is very often produced in the dead stomach at variable periods after
interment.   These  crystals are  ammonio-phosphate of magnesia derived  from
putrefaction.  I have  met with them in several  instances within the last few
years.   They have been mistaken for arsenic, and their  occurrence has in  some
instances led to unjust suspicions and accusations.  (See Guy's  Hosp. Reports,
Oct. 1850, p. 222.)  An analysis will of course remove any doubt.
  For many important facts  connected with  the  quantity of absorbed arsenic
deposited  in the tissues, as well as the relative proportion found in  different
organs, and in the same organ at different periods after the taking of the poison,
I must refer the reader to the valuable paper of Dr. Geoghegan, whose remarks
on this subject are deserving of the highest praise.
  Arsenic  in the soil of cemeteries.—It appears from the researches of several
toxicologists, that the soil of graveyards often contains a compound of arsenic,
generally in an insoluble  form.   In eight trials on different soils, Orfila found
three of them arsenical.   He used about six pounds of earth in  the experiment.
As  there was no sign of  arsenic, except when an acid was used,  he inferred that
it existed in the state of arsenite or arseniate of lime.  The researches of Flandin
have corroborated this  result; and, in one instance, this experimentalist estimated
that the quantity of arsenic, in an insoluble form, in about a pound of earth, did
not exceed the twentieth part of a grain!   Admitting the existence of arsenic as
a natural constituent of certain soils, it becomes important to determine how far
it may affect the chemical evidence of the presence of this poison in the remains
of bodies which have undergone exhumation.   If the coffin be cracked or entirely
destroyed,  so that the earth has become intermixed with the remains, and that
which surrounds the coffin yields traces of arsenic, it is  evident that no reliance
could be placed upon the inference that the arsenic existed in the human  body,
unless the  poison found in the  remains was in a soluble  form and  in  extremely
large proportion.  The reader will  find cases in which  doubts  based upon the
origin of the arsenic detected in the  decomposed dead body, led  to the abandon-
ment of chemical evidence.  (Flandin, Trait e des Poisons, 674, 683.)  A diffi-
culty of this kind  cannot, however, when proper precautions  are taken, often
present itself in  practice.   A body buried in  a coffin is rarely so far decomposed
as to become covered by the soil from the disintegration of the coffin in a period
shorter than from seven  to ten years; and until such a  complete disintegration
has taken  place, it is not easy to perceive how the presence of an insoluble arse-
nical compound, as a natural constituent of the  soil, can present any objection to
the results of an analysis.   In the examination  of these soils, it has been  ascer-
tained that no arsenical compound soluble in water has existed in  them; therefore,
if distilled water should  yield, on boiling the  remains, a solution of arsenic, the
presumption is that it  could not have been derived from the soil.  It has been
supposed that the arsenic may have been carried by percolation from  the soil
into the body; but  in this case, as Flandin has observed, the exterior of the body
would contain more than the interior: while  in a case of arsenical poisoning
(except when dependent on local application) the liver and stomach would yield
more than the skin.   (See Galtier,  i. 368; Flandin, i. 429, 741.)*
   Arsenic in solids.—Arsenic  may  exist in solid articles of food, such as  bread,
pills, and powders:—in  ointments, and certain candles;—or matters vomited by
a person poisoned, may sometimes be imbibed by articles of clothing or furniture.
In all these cases we should  simply boil the solid matter, with the  addition of
muriatic acid and copper; or if we wish to separate the whole of the  poison,  we
may proceed,  as in the case of organic liquids, by using a current of sulphuretted
hydrogen gas.   A cat was poisoned by half a drachm of arsenic—the animal died
in about nine hours.  No trace of poison was found in the body; but a  small
part of the floor of the room, where the cat had vomited, was scraped off  boiled
in water,  and yielded on analysis clear evidence of the presence of arsenic. 
ARSENITE OF POTASH.   FLY POWDER.                 91
                           Arsenite of Potash.
   The compounds formed by arsenious acid in the alkalies are all poisonous,
 Those of potash, soda, and ammonia, are soluble in water, and,  therefore, act
 with more energy.  The Arsenite of Potash is  the  only preparation which
 here requires notice.   It is used in medicine, and is  well known under the name
 of Fowler's Mineral Solution, or Tasteless Ague  Drop.  It is made by
 boiling arsenious acid with carbonate of potash, the latter being in slight excess,
 and it is  coloured with compound  tincture  of lavender.  In the preparation of
 the London  Pharmacopoeia, there are four grains of arsenious acid, in a fluid-
 ounce (or eight fluid-drachms) of the solution.  Its real strength may be affected
 by any impurities in the arsenious acid employed.  The  preparation used in
 Scotland is of the  same  strength;  but that of the  Dublin  College is one-ninth
 weaker.   The action of this liquid as a poison, in large  doses, is in all  respects
 analogous to that of arsenious acid.
   According to Mr. Bullock,  the pharmacopceial preparation is not a true arse-
 nite of potash, but a  solution of arsenious  acid, in  carbonate of potash, with  a
 minute trace  of the arsenite.   (Lancet, Dec. 21, p.  674.)   This  uncertainty of
 composition  may possibly account for the variable effects produced  by the pre-
 paration.  In a former page I have related  the case  of a female who was killed
 by half an ounce, in  divided  doses, in  five  days, (see ante, page 79) while Mr.
 Hunt, who has largely employed arsenic in the treatment of skin-disease, states
 that where the susceptibility is not great, a dose of two drachms of the solution
 (= one grain of arsenic) can be borne about as well in one dose as in twenty.  He
 quotes a case in which a patient took two drachms of  this  solution, in twenty-four
 hours, by mistake.  It cured the ague  for which it was prescribed, and had no
 detrimental effect.  (Med. Times, September 14,1850, page 270.)   It is difficult
 to explain such anomalies by varying susceptibility only: they are more probably
 due to the uncertainty of composition in the preparation employed.
   The ordinary chemical processes for arsenic are sufficient for its detection in
 this solution.
                    Metallic Arsenic.  Fly-Powder.
   It is generally considered that metallic arsenic is  not poisonous;  but,  as it is
 very easily oxidized,  it  speedily acquires poisonous properties.   According to
 Berzelius, the metal is  slowly converted, by exposure to air, to  a pulverulent
 suboxide of a  black or brownish-black colour.   This is commonly called Fly-
 Powder, a name also  applied  to the  arsenical cobalt ores  reduced to powder.
 Thus, what is called the Tunaberg ore, a mixture of cobalt, arsenic, iron, and
 sulphur, is largely used on the  continent under the name of Fly-Powder: and, as
 it comes within the reach of children, it frequently gives rise to accidents.  A
 few years ago,  Dr. Schobbens was called to a man who had taken some by mis-
 take for a purgative.   He was  soon attacked with the usual symptoms of poison-
 ing by arsenic.  He swallowed a large  quantity of milk, which occasioned im-
 mediate vomiting.  As fifteen hours had elapsed before a medical man saw him,
 no treatment was of any avail, and  he died from  the effects  of the poison.   In
 another case, a child, aged four years, swallowed a portion of fly-powder.  The
 hydrated sesquioxide of iron was given every half hour, and the child recovered
 the next  day.  (Monthly Jour. Med. Science, Sept.  1846, p. 228.)   The exact
 quantity taken in these cases is not known; but there is no doubt that the poison
 is  but  little inferior to arsenious acid  in activity;  and the symptoms  and post-
 mortem appearances from a fatal dose would be similar.   This substance is not
 much known in England.   A woman was convicted in France for poisoning her
 husband with it in 1844.   (Briand, Man. Comp. de  Med. Leg. 452.)  It owes
 its poisonous properties to arsenious acid, of which, with the  metal, it appears to
 be a mechanical mixture.
   Fly-Water is a name applied to solutions of various arsenical compounds in
water.   One mixture of this kind is formed by dissolving one part of the arse- 
92
arsenic acid,  arseniates.  orpiment.
niate of soda and two parts of sugar in twenty parts of water.   Paper soaked in
this solution, and dried, is used for poisoning flies; and, perhaps, this is the safest
form in which arsenic can be used for such a purpose.
  A case of poisoning by fly-water, in which two grains and a half of arsenious
acid destroyed the life of an adult in thirty-six hours, will be found reported in
the Medical Gazette (vol. xxxix. page 116.)

                              Arsenic Acid.
  This is an artificial product almost entirely confined to the chemical laboratory.
Orfila states that it is a more powerful poison than arsenious  acid, but he does
not adduce any case in support of this opinion.  Dr. Christison does not mention
it, and I have not been able to find any case of poisoning by it  in  the human
subject.  Dr. Glover ascertained  that four grains of  the acid, dissolved in two
drachms of water  and introduced into the stomach of a  stout rabbit, killed the
animal in four hours, with the symptoms of irritant poisoning, and an affection
of the nervous system.   (Ed.  Med.  and Surg. Jour. vol. lviii. page 121.)
  Analysis—Arsenic acid is a white uncrystalline deliquescent solid.  1. It is
not entirely volatilized on  platina foil,  by the flame of a lamp.   2. It is very
soluble in water, forming a highly acid solution.   3. It is precipitated of a brick-
red colour  by nitrate or  the ammonio-nitrate of silver.   In these characters it
differs  from  arsenious acid.   4.  It yields readily  an arsenical sublimate with
charcoal.   5.  It yields deposits with copper and muriatic acid, or  in Marsh's ap-
paratus.  But Dr. Rainey has shown that Reinsch's process does not act so deli-
cately with the arsenic as with arsenious acid.   The arsenic may, however, be con-
verted  to  arsenious  acid by a current of sulphurous acid gas.   Arsenic acid is
also  precipitated, although slowly and of a pale  yellow colour, by sulphuretted
hydrogen gas.   In these properties, it resembles arsenious acid.

                          Arseniate of Potash.
  The arseniates of potash and soda must be regarded as active poisons, although
there are but few instances on record, in which life has been destroyed by them.
Dr. Christison states that, in the course of his reading, he has met with only two
reported cases of poisoning by arseniate of potash, (Op. cit. 284.)

                         Sulphurets of Arsenic.
  There are several kinds met with in commerce.—Orpiment or Yellow Ar-
senic, and Realgar or Red Arsenic.   They are very poisonous  in consequence
of their containing  a large proportion of free arsenious acid; this sometimes
amounts to as much as from 30 to 70 per cent, of their weight.  They are not often
used as poisons. , Orpiment has, however, given  occasion to several criminal
trials in England.
   Symptoms (did appearances.—The sulphurets of arsenic produce symptoms
and appearances after death similar to those caused by arsenious acid; but the
dose required to destroy life must vary according to the proportion of  arsenious
acid  with which the sulphuret happens to be mixed.  This is not a common form
of criminal poisoning; the intense colour of the poison would lead to suspicion.
It was with orpiment that Mrs. Smith was poisoned at Bristol in 1835.   (Med.
Quart. Rev. July, 1835,  p. 390.)   Its colour might cause it to be mistaken for
mustard.   Orpiment has been known to cause  death by external application as
a depilatory (see Annales d'Hygiene, 1834, i. 459;) a result which might be ex-
pected from the quantity of arsenious acid with which it is mixed.   There is a
form of depilatory used,  which consists of one part of orpiment,  twelve parts of
quick-lime, and ten  parts of starch, made into soft paste with water (Pereira  i.
218,) the use of which must be always attended with danger.
  Analysis.—The powdered sulphurets yield a solution of arsenious acid on boil-
ing them in water acidulated with muriatic acid.   They readily give the well
known sublimates of metallic  arsenic, both with soda-flux, silver,  and the hydro- 
arsenuretted hydrogen.
93
gen apparatus.   They also yield a deposit of arsenic when boiled with copper and
muriatic acid.  Orpiment is insoluble in muriatic acid, but it is readily dissolved
by caustic potash.   Organic mixtures.—The sulphuret being insoluble in water,
it is in general easily separated mechanically by allowing the matters mixed with
it, to become dry upon  bibulous paper.  If the sulphuret cannot be separated
mechanically, the  organic matter  suspected  to contain it should be dried and
boiled with nitric acid to dryness.  The arsenic of the sulphuret will be found,
as arsenic acid, soluble in water.  Another impure sulphuret, sold as King's yel-
low, is composed, according to Dr. Christison, of sulphuret of arsenic, lime and
sulphur.  It is highly poisonous, and is extensively sold as a pigment.   A case
of alleged  poisoning  by this substance is reported in the Edinburgh Monthly
Journal (Sept. 1846.)   The sulphuret of arsenic is easily separated  fr«m the
mixture by digestion in solution of ammonia.

                        Arsenuretted Hydrogen.
   Symptoms and effects.—This is a gaseous poison of arsenic,  producing, when
respired in small quantity, very serious effects upon the system.  It has already
occasioned death in at least three instances.  The gas is an artificial product, and
is formed in a chemical laboratory in various ways,—one method has been already
described in speaking  of Marsh's process; and its highly poisonous properties
render it necessary that caution should be used in the employment  of this mode
of testing.  The gas is most effectually decomposed, and prevented from diffusing
itself,T$y passing  it into a solution of nitrate of  silver.    This form of  gaseous
arsenical poisoning  has been  hitherto purely accidental.  Gehlen, a  German
chemist, was killed by accidentally breathing a small quantity.  He suspected
that the gas was escaping from some part  of the apparatus which he was using,
and applied his nose  for the purpose of detecting it:  although  he respired but a
very small quantity, he was seized in about half an hour afterwards with vomit-
ing, shivering, and great prostration of strength.   He died on the ninth day.
The most complete history of this kind of poisoning has been  published by Dr.
 O'Reilly, of Dublin.   He has been kind enough to forward me  the particulars of
 the subjoined case.
   A gentleman, for the sake of experiment, wished to respire about  one hundred
 and fifty cubic inches of hydrogen gas.  It unfortunately happened that the sul-
 phuric acid,  which he used for making the hydrogen, was largely contaminated
 with arsenic; and immediately after respiring the gas, he was seized with giddi-
ness and fainting, constant vomiting of a greenish-coloured matter, and dull pain
in the epigastrium.   There was also complete suppression of urine.   He died in
about six days.  On dissection, the liver and kidneys were found of a deep indigo
colour,—the mucous membrane of the stomach was easily separated; and  there
were two distinct patches of inflammation in the greater curvature.   There was
a quantity of reddish-coloured fluid effused in the chest, and it is an interesting
fact, that Dr. O'Reilly, on examining about ten ounces of this fluid, was enabled,
by the use of  Marsh's  process,  to detect arsenic in it. From experiments  made
on the sulphuric acid, it is supposed that the deceased must have inhaled a quan-
tity of arsenic equivalent to about twelve grains of arsenious acid.
   Analysis.—The chemical properties of this gas have been already described.
 (See Marsh's Process,  ante, p. 84.)   [An abstract of interesting cases of
poisoning  by arsenic and its compounds, tried in  this and other countries, will
be found in  Beck.   (Elem. Med. Jur. ii. 535, to 551.)    Also in  Lee's edition
 of Guy's Forensic Medicine, 607.  In the case of Mina, a fact  given in evidence
 by several of the medical witnesses has not  been elsewhere noticed;  that  when
 the stomach  of Mr. Chapman was opened there arose a peculiar  smell, resembling
 that of pickled herring.  In reference to this, Dr. J. K. Mitchell states that a
 stomach which he placed in some Fowler's Solution, for two  or three months,
 acquired the same odour.   Dr. Griffith tried a similar experiment,  using a solu-
 tion of arsenious acid, with the same result.—H.] 
94            mercurial poisoning,  corrosive sublimate.
                               CHAPTER X.

CORROSIVE  SUBLIMATE—TASTE AND  SOLUBILITY—SYMPTOMS—ITS EFFECTS  COMPARED
   WITH THOSE  OF  ARSENIC--SLOW OR CHRONIC POISONING--SALIVATION FROM  SMALL
   DOSES OF MERCURIAL  MEDICINES--FROM OTHER CAUSES--POST-MORTEM APPEARANCES
   --QUANTITY REQUIRED TO DESTROY  LIFE--PERIOD AT WHICH  DEATH TAKES PLACE—
   FATAL DOSE--TREATMENT--CHEMICAL ANALYSIS IN POWDER AND SOLUTION--PROCESS IN
   ORGANIC  LIQUIDS--CALOMEL--WHITE AND RED PRECIPITATES--SULPHURETS OF MER-
   CURY.*

                          Corrosive Sublimate.
   This substance  is usually known under the chemical name of Bichloride op
Mercury ; but according to some distinguished authorities, it is a Chloride.   To
prevent any confusion from scientific chemical nomenclature, the old and popular
name of Corrosive Sublimate is here used.  It is not often taken as a poison.
In the Coroner's report for  1837-8, there were about fifteen cases of mercurial
poisoning, in twelve of which corrosive sublimate was the  poison taken.   It is
commonly seen under the  form of  very heavy crystalline masses, or of a white
powder.                                                               ,
   Taste and solubility.—The taste  of corrosive sublimate is powerfully aflstere
and metallic, so that no poisonous quantity of it can be easily swallowed without
the individual  becoming immediately aware of it.   It is very soluble in water,
hot or cold, and speedily sinks in it, in which properties it differs strikingly from
arsenic.   I have found by experiment that one hundred grains of a cold saturated
solution hold dissolved at a maximum, ten grains of corrosive sublimate; and it
is stated by most chemists that two parts  of boiling water (212°) will dissolve
one part of the poison.  It is also readily dissolved by alcohol and ether; the last
body takes up one-third of its weight and has the property of abstracting it from its
aqueous solution,—a principle which is sometimes resorted  to for separating the
poison when dissolved in  organic liquids.   It is soluble without change in nitric
and muriatic acids, and it is a fact  of some medico-legal importance, that com-
mon salt renders it more  soluble in  water.
   Symptoms.—The  symptoms  produced by corrosive sublimate generally come
on immediately or  within a few minutes after the poison has been  swallowed.
In the first  place,  there is perceived a  strong metallic taste in the mouth, often
described as a coppery taste; and there is, during the act of swallowing, a sense of
constriction almost amounting to suffocation, with burning heat in the throat, ex-
tending downwards to the stomach.   In a few minutes violent pain is felt in the
abdomen,  especially in  the region of the stomach, which is increased by pressure.
Pain in the abdomen is, however, sometimes wholly absent.  There is nausea, with
frequent vomiting  of long stringy masses of white mucus, mixed with blood; and
this is accompanied by profuse diarrhoea.   The countenance is sometimes swollen
and flushed, in other cases it has been  pale and anxious.   The pulse  is small
frequent, and irregular, becoming scarcely perceptible as the symptoms  become
aggravated. The tongue is white and shrivelled,—the skin is cold and clammy,
the respiration difficult; and death is commonly preceded by syncope convulsions
or general insensibility.  The internal  parts of the mouth,  when  examined  are
swollen, and sometimes present the  appearance as if the cavity had been washed
with a solution of nitrate  of silver: the  lips are often  swollen.  Suppression
of urine has also been frequently noticed among the symptoms.   It existed in a
well-marked case of poisoning by this substance at Guy's Hospital:__the patient
lived four days, but did not pass any urine during the whole of this time,  f G. H R
April, 1844, p. 24.)  This symptom was observed in an interesting case reported 
CORROSIVE SUBLIMATE.  PERIOD FOR SALIVATION.           95
by Dr.  Wegeler  (Casper's Wochenschrift, Jan. 10, 1846, p. 30,) in which a
youth, act. 17, swallowed three drachms of the poison, and died on the sixth day.
During  the last three days, no urine was secreted.  This case was otherwise re-
markable from the fact that no pain was experienced on pressure of the abdomen,
and that the pulse underwent no change until shortly before death.  In another
case,  reported by Dr. Herapath, in which a scruple of corrosive sublimate in
solution was swallowed,  suppression of urine and ptyalism came on on the third
day, and the patient died on the ninth day.  (Lancet, Dec. 13 and 27,1845, pp.
650, 698.)  In a case  observed by Mr. Morris, the quantity of urine  secreted
was  small, and it produced a scalding  pain  when voided.    (Prov. Med. Jour.
Nov.  18, 1843, p. 126.)  In this instance there was no purging.
  Its effects compared with those of arsenic.—This poison differs from  arsenic:
1, in having a well marked taste; 2, in producing violent symptoms within a few
minutes;  and 3,  in the fact of the evacuations  being  more frequently mixed
with blood.  The symptoms produced by corrosive sublimate, in the first instance,
resemble  those of cholera: if the individual should survive several days, they
are more like those of dysentery,—tenesmus, and mucous discharges mixed with
blood being very  frequently observed.
   Slow or chronic poisoning.—The symptoms are much modified when the poison
is given in small  doses at certain intervals for some days or weeks.   There  are
colicky  pains, with nausea, vomiting, general uneasiness, and depression.   The
salivary glands become  inflamed and painful; the tongue and gums are red and
swollen, sometimes ulcerated, and  there is fetor of the breath.  A deep blue
line,  like  that observed in poisoning by lead, is sometimes found around the edges
of the gums.  The patient experiences difficulty of swallowing and breathing.  The
constitutional effects are indicated by cardialgia, diarrhoea, dyspnoea, haemoptysis,
cough, general tremor of the limbs, and paralysis, with slow fever and emacia-
tion, under which the patient sinks.
   Salivation.—One of the most marked effects of slow or chronic poisoning by
mercurial preparations is salivation or  ptyalism, indicated  by an increased flow
of saliva.   This is by no means a necessary symptom in cases of acute poisoning
by corrosive sublimate,  but it not unfrequently shows itself  about the second or
third day.  In some instances the patient dies too rapidly for this effect to follow,
but even  when he survives some days, salivation is not always observed.  In a
case related by Dr. Venables, in which two drachms of the poison had been taken,
and the woman survived for the long period of eight days, this symptom did not
exist.  In another case reported by Mr. Wood  (Ed. Med. and  Surg. Joiir. Ii.
141,) in which half a teaspoonful of the  poison was taken, salivation was pro-
fuse in  the course of a few hours.   In a case which occurred at Guy's Hospital,
in February, 1843, where two drachms had been taken, salivation commenced in
four hours; but this is by no means the earliest  period.   Dr. Percy relates an in-
teresting case of poisoning by corrosive sublimate, in which the saliva was flowing
profusely an hour and a half after the woman had taken a dose of thirty grains.
(See Med. Gaz. 1843, i. 942.)   In these early cases, it is  alleged that fetor of
the breath is absent, but most practitioners will look chiefly to the production of
salivation as a symptom.   The local  action of the poison  is, in some  of these
cases, sufficient to account for the abundant flow of saliva independently of the
influence  of the absorbed mercury on the salivary organs.   In Mr. Morris' case
in which half a drachm of the poison in powder was placed  by the female on her
tongue, the saliva flowed abundantly from the  mouth, and  the  lips were much
swollen.   (Prov.  Med.  Jour. Nov. 18, 1843, p. 127.)   This was undoubtedly
due to the local irritant action of the poison.
   In the chronic  form of poisoning, when the dose has been small and frequently
repeated,  we may generally expect to meet with salivation, accompanied by fetor
of the breath, and sponginess and  ulceration of the gums.   Should the person
survive some time, this  symptom is more  commonly met with than not; but in 
96
SALIVATION EXCITED BY MORBID CAUSES.
looking for it as an indication of mercurial poisoning, a medical jurist must re-
member that some persons are wholly unsusceptible of this condition.   On the
other hand, there are cases in which the salivary glands are most easily excited,
so that the usual innocent doses of mercurial medicines have been  known to pro-
duce  salivation  to such a degree as to cause  death.   Facts  of  this kind are  of
some importance, since charges of malapraxis may be easily raised in respect to
them.   Dr. Christison mentions a case in which two grains of calomel destroyed
life by the severe salivation induced, as well as by ulceration of  the throat.   An-
other was mentioned to me by a pupil, in 1839, in which five grains of calomel
killed an adult by producing fatal  salivation.  From some cases related  by Mr.
Samuel, of Newark, it appears that two  grains of calomel, divided  into  three
powders, were given in the proportion of one powder daily (two-thirds of a grain)
to a little boy aged eight.   This small dose produced the most violent salivation,
sloughing,  and exfoliation, from which he was some weeks in recovering.  In
another instance, a little girl, aged five, took  daily for three  days three grains  of
mercury and chalk powder.   Her mouth was  severely affected, sloughing ensued,
and she died  in eight days.  In a third  case of recent occurrence, a boy, aged
eleven years, took  three doses of this powder—one of six grains on the 14th, a
similar dose on the 17th, and four grains on the 20th, making altogether sixteen
grains.   The most profuse  salivation followed; sloughing commenced in both
cheeks, and rapidly extended through them.   The boy died in  four days.  Pre-
viously to the exhibition of the mercury he had recovered from an attack of fever.
(Lancet, Dec. 20, 1851, p. 579.)   In a fourth case, three  grains of blue pill
given twice a day for three days, making eighteen grains, were ordered for a girl
aged nineteen, who complained of a slight pain in  her abdomen.   Severe saliva-
tion supervened, the teeth separated, and she  died in twelve days.  With respect
to the effects  of corrosive sublimate, Dr. Christison  states  that three grains  of
this substance in three doses caused violent salivation.  (Op. cit. 408.)  When
this state results from the use of  mild mercurial medicines in small doses, the
severe effects may be in general referred to idiosyncrasy.   A person may dfe
under these circumstances,  either from  simple exhaustion  or from  extensive
sloughing of the fauces, with exfoliation of the bones.   When an individual has
recovered from the first effects of acute poisoning by corrosive sublimate, he may
die at almost any period from these secondary consequences.  It is generally ad-
mitted by  toxicologists that salivation may be intermittent—i. e. that  it may
cease and reappear without more mercurial poison or any mercurial preparation
being given in  the interim, although such cases are rare.   [Although evidence
is in favour of these  intermittent  salivations, and they certainly  do  sometimes
appear to take place, still the fact is not so generally admitted as might be sup-
posed from the text.  Dr.  Christison, who  admits  their rare occurrence, ob-
serves, on this point (323,1st Am. ed.:) "Granting the ptyalism to be in every
instance mercurial, it would require much better evidence than any practitioner
could procure to determine the fact that mercury had not been  given during the
supposed interval."—H.]
   Profuse  salivation from mercury dependent on morbid causes.—In addition
to the facts already detailed, respecting death from excessive  salivation under the
use of small doses of calomel, there  are certain morbid conditions of the  body
which appear to have the effect of  increasing the action of this medicine on the
salivary glands.  This kind  of acquired  idiosyncrasy exists especially in that
form of disease called granular degeneration of the kidney, which is characterized
in  its early stage by albuminuria.   On this subject  Dr. Craige says  the  great
objection to the employment of any preparation  of quicksilver for the cure of
renal dropsy consists in the  fact, that the  use of the mineral is known to render
the urine albuminous, to increase the inflammatory state of the system and to
induce the disease, the effects of which it is  expected to remove.   Another evil
is, that in persons  labouring under symptoms of  granular  kidney a very  small
quantity of mercury induces ptyalism, and renders the mouth tender and most 
CANCRUM ORIS.   POST MORTEM APPEARANCES.
97
painful.   (Practice of Physic, ii. 1148.)   This he considers to depend much on
the fact, that patients of this description have in general, if not always, been
subjected  previously to  the full influence  of  the mineral  in repeated courses.
For these reasons, in his view, mercury should never be exhibited without the
previous full trial of other remedies, as even assiduous watching will not always
succeed in preventing bad effects.   Dr. Christison informs me  that he has re-
peatedly observed that mercurial action (salivation) is in these cases brought on
by unusually small doses of the compounds of mercury, or  unusually soon; and
the action, under these circumstances, has been very violent, although not uncon-
trollable.   [Salivation may be also caused by a variety of metallic preparations,
and even by vegetable products, but in general is not accompanied by the pecu-
liar fetor of the breath, and peculiar discoloration of the gums so constantly at-
tendant on mercurial salivation.—H.]
   Cane rum oris.—Corrosive sublimate, as well as other mercurial preparations,
is liable to produce gangrene of the mouth and fauces,—a state which may equally
occur from spontaneous causes: death is commonly the  result.  In a case of this
kind, supposing any mercurial preparation to have  been given  medicinally, it
may become a serious question whether death actually resulted from  the mercury
acting as a poison, or  from natural disease.   Several fatal cases have occurred
within the last few years, among children; and the subject has become a matter
of inquiry before  coroners.   Although salivation and  its consequences are not
common among young children, as an effect of mercurial preparations, yet it is
clear, from the cases already cited (p. 96,) that small closes of mercury may have
a most violent effect upon them, and render the suspicion of poisoning probable.
Of two children, whose deaths became the subject of investigation under these
circumstances, one was affected with whooping-cough, and the other with measles.
Powders  containing calomel were prescribed  in both cases,—gangrene of the
mouth supervened, and the children died.   There was some reason to believe,
from the  evidence, that the mercury had really produced the effect attributed to
 it, at least in one  of the cases.   It is proper to remark, that this  kind of disease,
 gangrene of the mouth, has been observed to occur in children to whom no calo-
 mel, or any mercurial preparation whatever, had been given:—the subjects have
 been chiefly young infants, badly fed and clothed, and generally labouring under,
 or recovering from, fever, small-pox, measles, or whooping-cough.   It  is, how-
 ever, far  more common as a consequence of measles than of other diseases, and
 it is always connected with a depressed state of the vital  powers.  Many cases
 of this kind are reported by Dr. Hennis Green (see Lancet, Dec. 1839.)  The
disease is often  vulgarly called canker of the mouth.
    Post-mortem  appearances.—These, as in the case of arsenic, are chiefly con-
fined to the alimentary canal.  Corrosive sublimate, however, affects both the
mouth and fauces; the mucous membrane is softened,  of a white or bluish gray
colour, and sometimes inflamed; that lining the oesophagus is similarly affected,
and partially corroded and softened.   The mucous membrane of the stomach is
more or less inflamed, sometimes in patches;  and there are masses of black ex-
travasatod blood  found  beneath it.   Occasionally the whole cavity has a slate-
gray colour from the partial decomposition of the poison by the membrane itself;
beneath this, the mucous coat  may be found  reddened.   This gray tint  of the
mucous membrane has been  considered by some to be indicative of the action of
the poison on the living mucous membrane; but it is not always present.   A case
occurred at Guy's Hospital, in which the mucous membrane was simply inflamed,
and very much resembled the condition presented in  eases of arsenical poisoning.
 The coats of the  stomach are sometimes corroded, and  so much softened that
 they cannot be removed from the body without laceration.   Similar appearances
 have been met with in the small and large intestines, especially the caecum.  In
a case reported by Dr. Herapath, in which a scruple  was  taken, and death  oc-
 cuired on the ninth day, the muccus membrane of the stomach was softened, but
        7 
98
FATAL DOSE.  ANALYSIS.
 there were no well marked appearances of the action of the poison in this organ.
 The caecum had been the seat of the most violent inflammation, the whole sur-
 face being of a deep black-red colour, and there were patches of sloughing in the
 coats.   (Lancet, Dec. 27, 1845, p. 700.)  Perforation of the stomach  is very
 rare as an effect of this poison: there is, I believe, only one case  on record.
 Certain morbid changes have been found in the urinary and circulating  organs,
 and Mr. Swan states that he has found the ganglia and branches of the sympa-
 thetic  inflamed; but these changes are not by any means characteristic of this
 variety of poisoning.   Appearances in the alimentary canal, like those just de-
 scribed, have been seen, not only  where the case has terminated fatally in a few
 hours, but where it has been protracted for  six, eight, and even  eleven days.
 (Chaussier, Recueil des Memoires, 363.)
   Quantity required to destroy life.—This is a question which  it is somewhat
 difficult to answer with any degree of certainty, since it is only by accident that
 the quantity taken can be ascertained, and the fatal effects must  vary according
 to many circumstances.   A child, aged three years, died in  twenty-three days
 from the effects of twelve grains of corrosive sublimate.   The smallest dose which
 is reported to have destroyed life was three grains.  This was also in the case of
 a child, and the quantity was accurately determined from the fact of its having
 been made up by mistake for three grains of calomel, which  the physician in-
 tended to  order.   (This case is  referred to in the Lancet,  1845, p. 297.)  A
 very loose and imperfect report either of the same or of a similar case is given
 in the Ann. d'Hyg., 1835, i. 225.  It is stated that three  children lost their
 lives.  It is  probable  that, under favourable circumstances, from three  to five
 grains, or even less, would destroy an adult.  Persons have been known to reco-
 ver who have taken very large doses, when remedies were timely administered,
 or vomiting was produced.   I have elsewhere reported a case in which a female
 who had swallowed nineteen grains recovered in a few days without a bad symp-
 tom.  (Guy's Hosp. Reports, Oct. 1850, p. 213.)  A  most interesting case of
 recovery after forty grains had been taken in whiskey under  circumstances fa-
 vourable to its fatal operation—i. e.  on an empty stomach,  is recorded by Dr.
 Andrews.  (Cormack's Journal,  February, 1845, 102.)  The  patient  was  a
 woman of sixty-five.  The smallest dose required to destroy an adult, under ordi-
 nary circumstances,  cannot,  therefore, be determined  at present from  any re-
 ported facts.   Judging from the effects produced by small quantities used medi-
 cinally, possibly the average fatal dose may not differ widely from that of arsenic,
 i. e. two to three grains.  [A medical friend of ours has lately seen a man  in this
 city  swallow about five grains of  corrosive sublimate, and was informed by the
 apothecary at whose shop he witnessed the act, that the  individual in question
 was in the habit of taking the same  quantity every day.—H.]
  Period at which death takes place.—In an acute case, an individual commonly
dies  in from one to five days; but death may take place much sooner or much
 later than this.   A person has been  known to die from the effects of this poison
 in eleven hours (Christison, 402:) and in one instance of a child two years old,
 by whom twelve grains had  been  taken, death probably occurred in six  hours.
 (Niemann's Taschenbuch, 451.)   A case is reported in which a child aged seven,
 was killed in three hours by eighteen grains of corrosive sublimate.  The shortest
 fatal case on record was communicated to me by Mr. Welch.  The quantity of
 poison taken was not ascertained,  but the man died in less  than half an hour.
 (On Poisons, p. 404.)
   Chemical analysis.—In the solid state.—We will first suppose that the poison
 is in the solid  state, and in the form of a white powder.   1.  A small  quantity
 heated on thin platina foil is entirely volatilized at a moderate heat__Ccare should
 be taken in performing this experiment)—in this property corrosive sublimate re-
 sembles arsenic, but differs from it in all other respects.   2.  It is very soluble in
 water: if the water be warmed, the powder will be dissolved instantly.  3. A small 
CORROSIVE SUBLIMATE.   TESTS.
m
quantity of the powder  dropped into a white saucer, containing a solution of
iodide of potassium, is turned of a bright scarlet colour.  4. Dropped into potash
in a similar way it is turned of a yellow colour.   5. Into a solution of hydrosul-
phuret of ammonia, it is turned black.  6. When a few grains are rubbed on a
clean surface  of copper, with a mixture of one part of muriatic acid, and  two
parts of water, a bright silvery stain is produced, which is entirely volatilized by
heat.  If zinc or tin-foil be used instead of copper, the surface acquires a silvery
lustre, and the metal becomes remarkably brittle.  7. When mixed with three
or four parts of calcined carbonate of soda, and heated in a small tube similar to
that employed in the analysis of arsenic,  the metal is  reduced; and a ring of
bright globules of mercury is  formed, while common salt  remains in the tube.
For the success of this experiment the materials must be quite dry, and the tube
at first gently heated;  any undecomposed corrosive sublimate that may be sub-
limed should be driven higher up, before  finally applying a strong heat, so that
the ring of mercury may not be obscured by it.   This last experiment is conclu-
sive of the nature of the substance; because mercury, being the only liquid me-
tal, is the only metal which sublimes in globules.   If the end of the reduction-
tube, containing the fused chloride of sodium, left as a  residue  by the  decompo-
sition, be filed off, reduced to powder,  and boiled with a little diluted nitric acid,
a solution is obtained in which, on the addition of nitrate of silver, chlorine may
be proved  to  exist.   The analysis is then  complete.  The properties mentioned
under 1, 2, and 5,  are possessed in common by other bodies; but the other cha-
racters are peculiar to the  per salts of mercury;  and when  the results agree, they
render it absolutely certain that the powder must be a persalt of that metal.  The
action of the nitrate of silver  upon the solution of the residue, will prove that the
persalt must have been a chloride.  There are, therefore, no objections to this mode
of analysis.
   In solution in water.—Corrosive sublimate is very soluble in  water, forming a
 clear solution, which, when concentrated, has a  faintly acid reaction  and  a
 strong metallic taste.   A few drops of the solution may be first gently evapo-
 rated on a slip of glass,  and then set aside to  crystallize.  If it be corrosive sub-
 limate, it  forms slender opake silky prisms, sometimes of  considerable length,
 and intersecting each other.  When a weak  solution of  iodide of potassium is
 dropped on them, they acquire a bright scarlet colour, and chloride of potassium
 is formed.  These  characters, which  may be obtained from the minutest crystal
 and only one drop of solution,  prove that the body dissolved in water is corro-
 sive sublimate: it is thus distinguished from  every other mineral poison, and all
 other substances whatever.
    Tests.—1.  Potash.  On  adding a small  quantity of caustic potash to the solu-
 tion, a reddish-coloured precipitate falls,  becoming yellow  by  the addition of a
 larger quantity of alkali.  This precipitate, when washed, dried, and heated in a
 reduction-tube, yields a well defined ring of metallic mercury.  The filtered liquid
 will be found, on  being  tested with nitrate of  silver,  to  contain chloride of
 potassium, thus proving that the mercury was combined with chlorine, and that
 the compound was soluble in water.   2.  Prof'/chloride of tin.-—On adding  this
 test  in rather large quantity to the  solution, a white precipitate at  first falls
 down, (calomel,) becoming speedily of a slate-gray colour, and  afterwards almost
 black.   On warming the liquid, it soon becomes clear, while a  heavy precipitate,
 in great part formed of pure metallic mercury, falls to the bottom of  the vessel.
 The mercury may be collected by pouring the liquid on  a  filter, and  afterwards
 drying the filter;  or its  presence may be easily demonstrated by pouring the
 water carefully from the precipitate, and forcing down upon this a slip of bibulous
 paper;—the paper absorbs the water from the mercury, and the pressure condenses
 the metal into one or  more well defined globules.  3.  Sulphuretted hydrogen
 gas.—This gives at first a precipitate, partly black and partly white (chlorosul-
 phuret,) becoming  entirely black when the current of gas has been allowed  to 
100
CORROSIVE SUBLIMATE IN ORGANIC LIQUIDS.
pass in for some time.  Hydrosulphuret of ammonia gives a similar precipitate
in the solution;—thus clearly distinguishing corrosive  sublimate from arsenic.
The test acts equally in  an acid solution of the salt.  The precipitated black
sulphuret of mercury, dried and heated with carbonate of soda or metallic silver,
easily furnishes a  ring of pure metallic mercury.  4. Precipitation by metals.—'
If we acidulate the liquid with a few drops of diluted muriatic acid, and introduce
a slip.of bright copper, or what  is better, fine copper-gauze, it is soon coated with
metallic  mercury, having more or less of a silvery lustre, especially on friction.
On heating the copper in a reduction-tube, the mercury may be obtained in well
defined globules.   5. The galvanic  test.—There are  various ways  in  which
galvanism  may be applied  to the detection of mercury in corrosive sublimate.
Dr. Wollaston, on  one  occasion, employed an iron key and a guinea:  he placed
a drop of the suspected solution on a surface of gold, and touched it and the gold
with the key:—the mercury was deposited on the gold in a bright silvery stain.
The following is a ready method of  producing the metal:—Place a few drops of
the solution on a  clean surface  of copper and slightly acidulate it with muriatic
acid; then touch the copper through the solution with a slip of zinc-foil.  Wher-
ever the copper is touched by the zinc the mercury is deposited, and on washing
the surface with diluted muriatic acid or ammonia a silvery stain  is left,  which
is immediately dissipated by the heat  of a spirit-lamp.   The experiment may be
modified by twisting a slip of zinc round a slip of bright copper, or copper-gauze,
and introducing them into the liquid; any change of  colour or tarnish is very
apparent on the copper.   Mercury is  deposited on both metals.   A surface of
gold with zinc is,  perhaps, more delicate than a surface of copper as a test of the
presence of mercury.   Applied  in a way to be presently explained, it will detect
the metal when nearly every other method fails.   Other tests have been proposed;
but I omit  all  notice of  them,  because the foregoing are, in my opinion, quite
sufficient  for  every  practical  purpose.  [Value of these tests, according  to
Devergie:—Potash 7000; Proto-chloride of  tin, 80,000;  Sulph-hyd. 60,000;
galvanic test, 80,000.]
  In  liquids containing organic matter.—The same process of analysis will apply
to the vomited matters and contents of the stomach.   Masses of corrosive sublimate
may be sometimes locked up in  thick viscid mucus; and in such cases, the coarse
powder, being heavy, may be sometimes separated by simply agitating the viscid
liquid in water, and then  decanting it suddenly.  This poison is decomposed and
precipitated by many organic principles,  such as albumen, fibrin, mucous mem-
brane,—also by gluten, tannic acid, and other vegetable substances.   Thus, then,
we  cannot always expect to  find  it in a state of solution.   We must filter in order
to  separate  the liquid from the solid portion; and  our first object will be to
determine whether any of the  poison  is  held  in solution.   For  this purpose a
portion of it may  be  shaken with one-third of  its volume of ether, and after a
time  the ethereal  liquid decanted and allowed  to  evaporate spontaneously in a
watch-glass, or other convenient glass  vessel.   If corrosive sublimate be present
in large quantity, white prismatic crystals will appear, which are rendered scarlet
when touched with a solution of iodide of potassium.   The other properties of
the poison may also be brought  out by dissolving the crystalline residue in water,
filtering  the solution through  a wet filter, and. applying the appropriate tests.
The quantity of corrosive sublimate may be too small for this method of separa-
tion ;  then we  may acidulate the liquid with about one-tenth part of its volume
of muriatic  acid, and  introduce a slip of copper-gauze, at the same time warming
the liquid.   If the poison be present, even in minute quantity, the gauze speedily
acquires a silvery gray colour, from a deposit of mercury.'  It should be well
washed in water, in alcohol or ether, again in water, and then dried.   On heating
it in a reduction tube, a ring of fine metallic globules will appear  in a detached
form, and having  a silvery white lustre.* There is no angularity, transparency
or crystalline character about this sublimate, as in the case of arsenic__a fact
speedily made evident under the microscope. 
CALOMEL.
101
   In order to remove any doubt, the ring of glass *on which the sublimate is
deposited may be broken  up and warmed in a wide tube with a few  drops of
nitro-muriatic acid.   On  evaporating  to  dryness at a very low temperature
(corrosive  sublimate  being volatile,)  a residue  having a prismatic crystalline
character remains.  These are crystals of corrosive sublimate re-formed from the
globules of  metallic  mercury.   When touched  with  a solution  of iodide of
potassium, they acquire a scarlet colour.   In very fine sublimates this, or some
corroborative experiments  on their nature,  are indispensably necessary.
   The galvanic gold test may be thus  applied:—Cut a  slip of fine gold-foil, of
about one inch in length and  one-eighth of an inch in width; it should be just
large enough to enter into a small  reduction-tube.  We then twist round this,
in a spiral form,  a slip of  finely laminated  zinc;  acidulate the  suspected liquid
with a few drops of diluted muriatic acid, and suspend the  gold and zinc by a
thread in the midst of it.  Several such pieces may be at once suspended in the
liquid.   According to the quantity of mercury present, the gold will be coated
with a gray-coloured deposit,  either immediately or in the course of a few hours.
If at the  end of ten  or twelve  hours the gold retain its  bright  yellow colour,
there is probably no  mercury present in  a dissolved  form,  or the quantity is
exceedingly minute.  Supposing the gold to have lost its colour, owing to its
having become completely coated, we should remove it and dip it in ether, and
afterwards in distilled water, to wash off  any corrosive sublimate and organic
matter adhering to it: it should then  be dried in air without being  allowed to
touch any  surface, and  introduced into a reduction-tube.  The zinc  may be in
part dissolved;  but as mercury is also deposited on this metal, whereby it is
commonly rendered  quite  brittle, it may be introduced with the gold into  the
tube.  On applying heat, a fine sublimate  will soon appear in the cool part of
the tube, which,  if not perceptible  to the eye, may be easily  seen, by the aid of
a common lens, to consist  of minute globules of mercury.   Fine wires of gold
and zinc may be substituted for the foil.
   Let us suppose that the filtered liquid contains no  trace of a mercurial salt;
we must now direct our attention to the analysis of the insoluble matters separated
by filtration.  These  may be boiled  in distilled water;  the  liquor  filtered and
tried by agitating it with  one-third of its volume of ether.   It will be found,
when the analysis has not been  long delayed, that most of the compounds which
corrosive sublimate forms  with organic matter, yield  commonly sufficient poison
for detection by boiling  them  in water.   Should water fail in extracting  the
poison,  the substance may be brought to dryness and heated with nitromuriatic
acid until all the organic matter is decomposed, and the surplus acid expelled.
The residue may then be digested in water  and tested for mercury by the aid of
copper-gauze or of gold and zinc.  I have  separated mercury from the liver by
simply  boiling it with  muriatic acid,  as in Reinsch's process for arsenic, and
plunging into the liquid slips of copper-gauze.
   A person may die from the effects of corrosive sublimate, and. no mercury may
be found in the tissues.  A ease of this kind occurred to me  some years since at
Guy's Hospital;  and  another, in which the deceased died in fifteen days from a
large dose of corrosive sublimate  in whiskey, has been reported by Dr. Geoghegan.
On this occasion, although the local effects of the poison on the throat,  stomach,
and bowels were of an intense kind, the viscera, on careful analysis, yielded no
trace  of mercury: it  had  been  entirely eliminated.  (See Med. Gaz. vol. xlvi.
p. 253.)
                                 Calomel.
   This substance, now called chloride of mercury, although commonly  regarded
as a mild medicine, is capable of destroying life, even  in comparatively small
doses.   Several  cases have been already referred  to,  where excessive salivation,
gangrene of  the  salivary organs, and death, have followed from  the medicinal 
102
WHITE PRECIPITATE.   RED PRECIPITATE.
dose of a few grains.  There is a case reported in the Med. Gaz. (xviii. 484,) in
which  a boy, aged fourteen, was killed in about three weeks by a dose of only six
grains of calomel.  It is singular that in this case neither the teeth nor the salivary
glands were affected; still, considering the effects of calomel in other instances,
it seems most probable that the ulceration and gangrene of the face which fol-
lowed were due to it.   Pereira mentions the case of a lady who was killed by a
dose of twenty grains  of calomel: she had previously taken  a moderate dose
without a sufficient effect being produced.   Sobernheim  states that a  girl, aged
eleven, took in twenty-four hours eight grains of calomel, for an attack of croup,
and died in eight days from inflammation and ulceration of the mouth and fauces.
In another instance, which occurred to Lesser, fifteen grains of calomel produced
similar effects, with excessive salivation; and this patient also died in eight days.
Meckel relates that twelve grains have destroyed life.   (Lehrbuch der Ger. Med.
267.)  Two cases of death from calomel, in children, are recorded in the Regis-
tration returns for 1840.
  There  are many other fatal cases  on record, and the facts seem to leave no
doubt that calomel may,  in large doses, act as an irritant  poison.   It was sup-
posed that these effects might be  ascribed to this compound being adulterated
with corrosive sublimate;  but this supposition is not well founded.   It has been
further supposed that calomel  might be converted into  corrosive sublimate, by
the free  muriatic acid contained in the gastric secretions;  but the very minute
proportion in which this acid exists in the gastric  juice, according to Dr. Prout,
renders this explanation improbable.

         White Precipitate.   Ammonio-Chloride of Mercury.
  This is an irritant compound, although  little is known concerning its effects.
In January, 1840, a young woman who had swallowed this substance was received
into St. Thomas's Hospital.   She had mixed it and taken it in water,—but the
quantity swallowed could not be ascertained.  The stomach-pump was employed,
mucilaginous drinks and olive oil were administered; and in the course of a few
days she  perfectly recovered.   The  symptoms under which she  suffered were
those Of gastric-irritation.  Judging  from this case, white precipitate does not
appear to be a very active preparation; yet still it must be regarded as a poison.
One instance of death from salivation produced by this compound is recorded in
the Registration  returns  for 1840, in a child, aged seven; and within the last
two years there have been several attempts at murder by the  administration of
this substance.   It is much used by  the poor as a  popular external remedy for
the ringworm.

              Red Precipitate.   Red Oxide of Mercury.
  This substance is poisonous, but instances of poisoning by it are very rare.
The following case occurred at Guy's Hospital in 1833.   A woman aged twenty-
two, who had swallowed a quantity of red precipitate, was brought in, labouring
under  the following symptoms:—The surface was cold and clammy, there was
stupor  approaching  to  narcotism,—frothy discharge  from  the mouth, and oc-
casional vomiting:—the vomited matters contained some red powder, which was
proved to  be red precipitate.  There was considerable pain in the abdomen in-
creased by pressure; and  there were cramps in the lower extremities   On the
following day the fauces and mouth became painful, and the woman complained
of a coppery taste.  The treatment consisted  in the use of the stomach-pump,
and the free administration of albumen with gluten.   She  left the hospital four
days afterwards, still under the influence of mercury.  The quantity of oxide
here taken was not  ascertained.  Sobernheim  relates a case where a man  aged
twenty-six, swallowed an ounce of red precipitate.  He was  speedily attacked
with pain in the abdomen, nausea, purging, cramps, and general weakness   The
vomited matters consisted of masses of mucus  containing red precipitate.   He 
         cinnabar,  bicyanide of mercury,  turbith mineral.      103

continued to get worse, and died in less than forty-eight hours after taking the
poison.  On inspection the mucous  membrane was found eroded and inflamed
in patches, small particles of the poison being imbedded in it.   The duodenum
was in a similar state, and there was a large quantity of red precipitate in the
contents of  this viscus, as well as in  the stomach.  (Op. cit. 250.)  [Alison
relates a case in which a woman swallowed about thirty-five  grains:—an emetic
was immediately given, and the stomach-pump was used.  A burning pain con-
tinued for some time after the evacuation of the stomach, but was relieved by
bleeding, and the patient gradually recovered.   (Lancet N. S. 19, 401.)—H.]
   A common opinion exists among the vulgar, that this compound is possessed
of very active  poisonous properties;  hence it is sometimes  administered with
criminal design.

          Cinnabar.  Vermilion.   Persulphuret of Mercury.
   The term Cinnabar is applied to a dark and heavy compound of sulphur and
mercury, while Vermilion is the same substance reduced to  a fine powder.   It
is well known as a red pigment, and is often employed in colouring confectionary,
wafers, &c.   I  have not  been able to find any instance  of its having acted as a
poison on man.   Orfila believes that it is not poisonous.  It has, however, proved
fatal to  animals in the proportion of from thirty to seventy grains, even  when
applied externally to a wound.   Cinnabar is  sometimes used for giving  a red
colour to ointments, e. g. the sulphur ointment.  In  such cases the quantity is
very small,  and can do no injury even if swallowed.
   Dr. Sutro has published  a  short abstract of a case in which the vapour  of
 Vermilion  applied  externally produced severe symptoms.   A woman, by the
advice of a  quack,  applied this vapour to a cancerous breast.   She employed
three drachms  of vermilion, covering herself with  a  sheet so that the vapour
should  only reach the body externally.  After three fumigations, she suffered
from severe salivation and violent fever, which continued for four weeks.  The
right arm became  oedematous.  (Med. Times, Sept. 27, 1845, p. 17.)   ["A
patient in the surgical ward of the Louisville Hospital, labouring under a  vene-
real ulcer of the palate, was directed to use mercurial fumigations, which he did
in the manner  and  to the degree usually practised  in the ward;  but  it proved
fatal to  him in less than half an hour."   (Beck,  ii. 596, from West. Jour,  of
Med. & Surg.,  1840, 84.)—H.]

                         Bicyanide of Mercury.
   This is a  substance which is but very little known,  except  to chemists, yet  it
is an active poison, and has caused  death  in one instance.   In April, 1823,
a  person who had  swallowed twenty grains  of this  compound (thirteen  deci-
grammes) was immediately seized with all the symptoms of poisoning by corrosive
sublimate, and died  in nine days.  There was continued vomiting, with excessive
salivation, ulceration of the mouth and fauces, suppression of urine, purging, and
lastly, convulsions of the extremities.   On inspection, the mucous membrane  of
the  stomach and intestinal canal was  extensively inflamed.    (Orfila, i.  583.)
Dr. Christison quotes a case in which ten grains destroyed life within the  same
period of time.   (On Poisons, p. 427.)   As a poison, the bicyanide is probably
not much inferior in activity to the bichloride of mercury.

      Turbith Mineral.   Subsulphate of Peroxide of Mercury.
   Fatal cases of poisoning by this compound  are by no means common.   It  is
undoubtedly, although very insoluble, a strong irritant poison, and is capable  of
causing death in a comparatively small dose.   A well marked instance of its fatal
operation was communicated to the Pathological Society by Mr. Ward, in March,
1847.   A boy,  act. 16, swallowed one drachm of this preparation on the night  of
February 19th.   It produced a burning sensation in the mouth and throat, and 
 104               poisoning by lead,   sugar of lead.

 vomiting in ten minutes.   In about an hour there was paleness with anxiety of
 countenance, coldness of surface, constant sickness, sense of heat and constriction
 in the throat, and burning pain in the stomach with cramps.  The irritability of
 the stomach continued in spite of treatment, and after two days  there was saliva-
 tion with mercurial fetor.  The gums acquired a deep  bluish tint  and began
 to ulcerate.  The patient died in about a week after he had taken the poison,
 without convulsions, and without suffering at any period from symptoms of cere-
 bral disturbance.   The principal  post-mortem appearances were—inflammation
 of the oesophagus, its mucous membrane at the lower part peeling off; the inner
 surface of the stomach near the cardia and pylorus was  covered with petechial
 spots; the small intestines were contracted, the inner coat reddened, and petechial
 spots were found, but chiefly in the large intestines.   The parotid and  submax-
 illary glands were swollen.   Mercury was detected in the intestines.  (See Med.
 Gaz. xxxix. 474.)  From this account it will  be perceived that turbith mineral
 has an action  somewhat  similar to corrosive sublimate, although it is certainly
 much less active.

                          Nitrates of Mercury.
  These are corrosive poisons which  are used for several purposes in the arte.
 They are solid white salts, easily dissolved by water, especially if there be a litfle
 excess of acid present.  The acid pernitrate has already caused death in  an  in-
 teresting case reported  by Mr. Bigsley in  the Medical Gazette (vi. 329.)  A
 butcher's boy dissolved some mercury in strong nitric  acid, and  swallowed about
 a teaspoonful of the solution.  Soon afterwards he suffered the most excruciating
 pain in the pharynx, oesophagus, and stomach:—there was great anxiety, with
 cold skin, small pulse, colic, and  purging.   He became  gradually weaker, and
 died in about two hours and a half.  On inspection, the fauces, oesophagus, and
 stomach were found corroded and inflamed.  Although he survived so  short a
 time,  the mucous membrane of the stomach was of a deep red  colour.   I have
 elsewhere related a singular case in which the application of the pernitrate of
mercury  to the throat as  an escharotic caused  immediate death  by asphyxia.
 (See Guy's Hosp. Reports, Oct. 1850, 206.)
  The acid nitrate of mercury has often been employed by accoucheurs as a local
application in diseases of the neck of the  uterus.  In one instance in which it
was thus used,  the ordinary symptoms of mercurial poisoning showed  them-
selves, and the patient appears to have  suffered severely.   (Med. Gaz. vol. xlv.
p. 1025.)
                             CHAPTER  XL

ON POISONING  BY LEAD--SUGAR OF LEAD--SYMPTOMS--CHRONIC POISONING BY SUGAR OF
  LEAD--rOST-MORTEM  APPEARANCES--TREATMENT--QUANTITY  REQUIRED TO DESTROY
  LIFE—CHEMICAL ANALYSIS—LEAD IN ORGANIC MIXTURES--CARBONATE OR WHITE LEAD
  --PAINTER'S COLIC--OXIDES--LITHARGE AND RED LEAD--ACCIDENTS FROM THE GLAZING
  OF POTTERY.

                       Sugar of Lead.   Acetate.

  This is  more frequently taken as a  poison than any of the other  salts  al-
though  cases of acute poisoning by lead in  any form are very uncommon. ' In
the Coroner's report for 1837-8 there is not a single instance.   The substance is
commonly met with in solid heavy crystalline  masses,' white,  or of a brownish-
white colour: it much  resembles loaf-sugar  in appearance, and has often been 
symptoms caused by sugar of lead.
105
 mistaken for it.   It has also a sweet taste, which is succeeded by an astringent
 or metallic taste.   It is very soluble in water.   Four parts of water at 60° will
 dissolve one part;  and it is much more soluble at a boiling temperature.
    Symptoms.—Acetate of lead is by no means an  active poison, although it is
 popularly considered to possess a very virulent action.   In medical practice it
 has often been given in considerable doses without  any  serious  effects resulting.
 Dr. Christison states that he has given  it in divided  doses to  the amount of
 eighteen  grains daily for  eight or ten days without remarking any. unpleasant
 symptom whatever, except once or  twice slight  colic.  (Op. cit. 555.)  When,
 however, the quantity  taken has  been  from one to two  ounces, the  following
 'symptoms have been observed:—A burning pricking sensation  in  the throat,
 with dryness and  thirst:—vomiting supervenes;  there is uneasiness in the epi-
 gastrium, which is sometimes followed by violent colic.   The abdomen is tense,
 and the parietes have been occasionally drawn in.  The pain is relieved by pres-
 sure, and has intermissions.  There is in general constipation of the bowels.  If
 any fasces be passed, they are commonly of a very dark colour, indicative of the
 conversion of lead  to sulphuret.  The skin is cold, and there is great prostration
 of strength.  When the case is protracted, the  patient has been observed to suf-
 fer from cramp in the calves of the legs, pain in the insides of the thighs, numb-
 ness and sometimes paralysis of the extremities.   The  affection of the nervous
 system is otherwise indicated by giddiness, torpor, and  even  coma.   A well
 marked blue line has been observed round the margin of the gums, where they
 join the teeth.
   Since the publication of the former edition of this work, a remarkable series
 of cases of  poisoning by acetate of lead has been  reported by Mr. Bancks, of
 Stourbridge.   (Lancet, May 5, 1849, p. 478.)   By some accident, about thirty
 pounds of this substance were mixed at  a miller's with eighty sacks of flour, and
 the whole was made into  bread by the bakers and supplied as usual  to  their
 customers.   It seems that no fewer than five hundred persons were attacked with
 symptoms of  poisoning after partaking of this bread.  In a few days they com-
 plained of a sense of constriction in the throat and the pit of the stomach, violent
 crampy pains  round  the navel, rigidity of the abdominal muscles,  a  dragging
 pain in the  loins, and cramp, with  paralysis of the lower  extremities.  There was
 obstinate constipation, and the urine was scanty and of  a deep red colour.  The
 pulse generally was slow and feeble; the countenance anxious and sunken, fre-
 quently of a peculiar livid hue; tongue flabby; gums marked by a deep blue
 line.   The  surface was cool, and  there was a general arrest of the secretions.
 Sickness was not a uniform symptom, and even when it existed at first, it speedily
 subsided.   The mental  faculties were undisturbed.   Not one of the cases proved
 fatal, but among the more aggravated there was great prostration, with collapse,
 livid countenance,  universal cramps,  numbness, and other alarming  symptoms.
 After apparent convalescence, some of the symptoms returned in a more aggra-
 vated form without any  obvious cause, and for a long time the patients  were out
 of health.   Inflammation  was not observed. Purgative medicines were found
 most effectual in the treatment.  The quantity of acetate of lead taken by each
person could not be determined, as,  on  analysis, the samples were found to be
 very unequally impregnated with the poison.  [See  Beck, ii. 659, for an analo-
gous instance in which near one hundred persons were almost  simultaneously
affected with lead colic,  three fatally, and several seriously, many also  suffering
paralytic symptoms. These effects were traced to  the use of sugar obtained from
 a particular  mercantile establishment, and imported  from Barbadoes.   Chemical
 investigation demonstrated the presence of lead,  which was supposed to have been
 derived from leaden reservoirs employed in reducing the syrup  from which the
 sugar was made.—H.]
   Even when the patient recovers  from the first symptoms, the secondary effects
often last  for a considerable time.   In two cases which occurred to Mr. Gorringe,
two girls swallowed an ounce of the acetate of lead by mistake.   Soon afterwards 
106
CHEMICAL analysis.
they felt a burning pain in the mouth, throat, and stomach, and in a quarter of
an hour they vomited freely: in half an hour there was severe pain in the bowels,
with diarrhoea.  Under treatment  recovery took place.   (Prov. Med. Journ.
April,  1846.)  Although nearly a year  had elapsed, they both  suffered from
severe  pain in the epigastrium, which was tender on pressure.  Nothing could
be retained on the stomach; and there was a choking sensation in the throat,
with other constitutional symptoms.   Paralysis and other symptoms of nervous
disorder, are, however, by no  means necessary consequences.   A girl  who had
swallowed sixty grains of acetate of lead,  and suffered severely from the primary
symptoms, recovered, and left the hospital in about three weeks without any
paralysis or other disorder affecting  the muscular system.    (Lancet, April 4,
1846, p. 384.)   This lead-palsy appears  to be a more common consequence  of
small doses frequently repeated.
  Post-mortem appearances.—In one. acute case related by Dr. Kerchhoffs, the
mucous membrane of the stomach was found abraded in several places,  especially
near the pylorus; and most of the  abdominal viscera were in a  state of high
inflammation.  A trial for murder by this substance took place at the Central
Criminal Court, in November, 1844, (Reg. v. Edwards,) but the details are  so
imperfectly reported as to  throw no light upon the subject.    The stomach and
intestines are stated  to have been found inflamed, and there were dark spots on
the former.   In animals, according to Dr. Mitscherlich, when  the dose is large,
the mucous coat of the stomach is  attacked and corroded: this change appears
to be purely chemical, and takes place in all the organs of the body with which
the salt of lead comes in contact.   If given in a small dose, it  is decomposed by
the gastric secretions, and exerts no corrosive power on the mucous membrane.
When the acetate of lead was given in a state of albuminate  dissolved by acetic
acid, death took place with great rapidity; but on inspection, the stomach was
not found to be corroded.   This corrosive action belongs to the neutral salt, and
is not manifested when the dose is  small, or when the poison  is combined with
an acid.
  Quantity required to destroy life.—Nothing is accurately known concerning
the fatal dose of sugar of lead.   The facts already detailed show that it may be
taken in comparatively large quantities without producing serious effects.  Thirty
and forty grains have been given daily, in divided doses, without injury.   The
following additional cases, in some of which recovery  took place under very
disadvantageous circumstances, prove that the acetate of lead is far from being a
virulent poison:—Dr. Iliff met with an instance where an ounce was  swallowed
in solution.  The symptoms were pains in the abdomen resembling colic, vomiting,
rigidity, and numbness.  It was three hours before any remedies were used, and
five hours before the stomach-pump was employed;  but the person recovered.
In the  second case, also, an  ounce was  swallowed: sulphate  of  magnesia was
freely exhibited, and the stomach-pump  was  used.  On the following morning
there was slight excoriation of the gums,  which were white, with a sensation  of
heat in the  throat:  the bowels  were relaxed, probably from  the  effect  of the
medicine.  The  day following there were pains in the calves of the  legs and
thighs, with restlessness and thirst.   In a week the woman perfectly recovered.
  Chemical analysis.  Acetate of lead as a solid.—1. If a portion of the powder
be heated in a small reduction tube, it melts, then becomes solid; again melts,
acquiring a dark colour, and gives off vapours of acetic acid;  a black mass is left
in the tube, consisting of carbon and reduced metallic lead.  There is no subli-
mate formed.  2. It is very soluble in water, even when cold;  common water is
turned milky by it,  from the presence of carbonic  acid  and  sulphates.   3. A
small portion of the powder dropped into  a saucer, containing a solution of iodide
of potassium, acquires a fine yellow colour.   4. When dropped into caustic potash,
it remains white;—5. Into hydro-sulphuret of ammonia, it is turned black  in
which respect it resembles the white salts of some other metals.  6.  When the 
goulard's extract,   symptoms and effects.            107
powder is boiled in a tube with diluted sulphuric acid, acetic acid, known by its
odour and volatility, escapes.   All these properties, taken together, prove that
the salt is acetate of lead.
  Acetate of lead  in solution.—If acetate of lead be presented in a state of
solution, or if  the  solid salt be  dissolved in water for the purpose  of  making
further examination, we should note the following points.   1. A small quantity,
slowly evaporated on a slip of glass, will give white and opake prismatic crys-
tals, which are turned yellow by iodide of potassium, and black by hydro-sulphu-
ret  of ammonia.   The solution  is  said to be  neutral; but  I have found the
common acetate of lead to have at the same  time both  an acid and an alkaline
re-action, i. e. reddening litmus-paper, and turning rose-paper green, a  circum-
stance which might create some  embarrassment in an  analysis.   2.   Caustic
potash., added to the solution  much diluted with water, throws down a white
precipitate, which is easily soluble in an excess of the alkali.  3. Diluted sulphuric
acid produces an abundant white precipitate, insoluble in nitric acid, but  soluble
in muriatic acid and in a large excess of caustic potash.  4. It is precipitated of
a bright yellow colour  by the Iodide of potassium; the yellow iodide of  lead is
soluble in caustic potash, forming  a colourless solution.   It is also dissolved by
concentrated muriatic  acid.  5.  Hydrosulphuret  of ammonia, or sulphuretted
hydrogen gas, produces a deep black precipitate, even when less than the 100,000th
part of the salt  is dissolved.  6.  Place  a few drops of  the solution on clean
platina-foil,—acidulate  it with  acetic acid, then apply, through the solution, to
the surface of the platina, a thin polished slip of zinc :—bright crystals of metal-
lic lead are instantly deposited on the zinc: in this way a small quantity  of lead
may be detected.
  Lead in organic mixtures.—The acetate of lead is precipitated by many organic
principles, especially by albumen and tannin.  Thus, we  may have to  analyze
either  an organic  liquid containing lead, or a solid precipitate consisting of
mucous  membrane, intimately united to  oxide of lead.  The liquid must be
filtered and examined by a trial test, i. e. either by adding  to a portion sulphuric
acid, or  by exposing bibulous paper dipped into the suspected liquid, to a  free
current of sulphuretted hydrogen gas.  If the paper be not stained brown, there
is no perceptible quantity of lead dissolved;—if it be stained brown, we dilute
the liquid if necessary in order to destroy  its  viscidity, and pass into it a  current
of sulphuretted hydrogen until  all action has  ceased.  The black  sulphuret of
lead should be collected on a filter, washed and dried, then boiled for a quarter
of an  hour in a mixture  of one part of nitric acid, diluted with four parts of
water.   This has the effect of transforming it, at  least in part, to nitrate  of lead
soluble in water.   This liquid, when filtered,  may be evaporated to dryness, and
the residue dissolved in water, or it may be at once cautiously neutralized by
potash or ammonia (free from lead) and the tests added.    If the quantity be too
small for the application of all  the tests, we  may add sulphuric acid; should a
white precipitate be formed, soluble in potash, and this alkaline solution be again
turned black by hydro-sulphuret of ammonia, this is sufficient evidence of the
presence of  lead.   Should there be no lead  dissolved, we must decompose  the
solid and insoluble matters in nitric acid  slightly diluted, at a  boiling tempera-
ture, filter, and test the filtered liquid, previously neutralized; or we may evapo-
rate  to dryness, destroy the organic  matter  by nitric  acid, and redissolve the
residue in water for testing.

               Goulard's Extract.  Subacetate of Lead.
  Symptoms and  Effects.—This substance has caused  death in at least  four
instances,—one in France and three in England.   The symptoms produced  are
similar to those described in speaking of the former compound.
  Goulard  Water is nothing more than a mixture of  one drachm and a half
of this solution to a pint of water. 
108
CHRONIC POISONING,
                           Carbonate of Lead.
  Symptoms.—A very interesting case of poisoning  by the carbonate  of  lead
was reported,  in October, 1844,  to  the  Westminster Medical Society, by Dr.
Snow.   A child aged five years ate a portion not so large as a marble, ground up
with oil.  For three days he merely suffered from pain  in  the  abdomen  and
costiveness.   On the third night,  the child became rapidly worse,  and there was
vomiting.  He died ninety hours after taking the  poison, having passed some
very offensive  motions of a greenish-black  colour (probably from sulphuret  of
lead) before he died.  The mucous membrane of the stomach was much inflamed,
and of a dark-red colour throughout.   Poison could not be detected in the  con-
tents or tissues of the stomach or in  the matter vomited.   It is remarkable that
in this case  so  small a quantity should have proved fatal without exciting any
marked symptoms of irritation in the first instance.   There are many fatal cases
of poisoning by the carbonate of  lead in the human subject, but it has in these
instances proved insidiously fatal  by  inducing  Colica pictonum.  They are to be
regarded as cases of  chronic poisoning.
  Colica Pictonum.—Painter's Colic may be considered to be a chronic form of
poisoning by carbonate  of lead, indicated by violent pain in the bowels, consti-
pation, and paralysis.  Among white lead manufacturers,  the carbonate finds its
way into the system, either  through the skin or through the  lungs, or both to-
gether;—it becomes diffused in a fine powder through the atmosphere, and  thus
enters into the lungs.  It has been remarked in France,  that  in manufactories,
where the powder was ground dry, not only have the labourers suffered, but also
horses, dogs, and  even  rats, have died from its effects.   Since the practice has
arisen of grinding the carbonate in water, cases of colica pictonum have not been
so numerous.
   Symptoms.—The diagnostic symptoms of chronic poisoning by lead are well
marked.  There is first pain, with  a  sense of sinking commonly in or about
the region of the umbilicus.  Next  to pain there is  obstinate constipation, re-
traction of the abdominal parietes, loss of appetite, thirst, fetid odour of the breath,
and general emaciation.  The skin  acquires  a yellowish or earthy colour, and
the patient  experiences a saccharine, styptic, or astringent taste  in the  mouth.
A symptom of a peculiar nature has been pointed out by Dr. Burton and others
(Med. Gaz. xxv. 687,) namely, a  blueness of the edges of  the gums, where these
join the bodies of the  teeth: the teeth are of a brownish colour.   Dr.  Chowne
states that from inquiry and observation, he considers that the presence or ab-
sence of this blue line is not connected with the administration or non-adminis-
tration of lead.  (Lancet, Oct. 26, 1844.)  It has, however, been so  frequently
observed, that most  pathologists  now regard it as a well marked pathognomonic
symptom.   A similar blue mark  around the edges of the gums has been  noticed
in other cases of poisoning—as by mercurial preparations (ante, p. 95;) and it is
possible that in an advanced stage of chronic poisoning by lead it may be absent,
(see a case by Mr. Fletcher, Med. Times, Feb. 14, 1846, p. 395:)—as where, for
example, the  individual has ceased to expose himself to emanations of  lead.
Many -facts  tend  to show that it  is an early symptom.  This disease often  kills
the patient; and after death the large and small intestines are found contracted,
—especially the colon.
   For a remarkably interesting series of cases of chronic poisoning  by lead, I
must refer  the reader  to a paper, by Dr. de Mussy, published in the  Dublin
Quarterly Journal, for  May,  1849; also Medical  Gazette, vol. xliv.  page  260.
These cases occurred at Claremont, in  the members of the Royal  Family of
France.  The effects were traced to  the use of very pure  water, which had
acquired an impregnation  of lead from contact with that  metal,  in  the propor-
tion of one grain to the imperial gallon.   Thirteen out  of thirty-eight  persons
were affected, and to such a degree, that the nails of the toes and  finders  ao- 
OXIDES of lead.
109
quired a bluish discoloration.  The children of the family did not suffer.  [For
two very interesting papers on lead poisoning from spring and cistern water, beer,
gin, rum, mineral water, &c. &c, see Fenner's Southern Med. Rep. i. 182—189,
and ii. 247—2*0.—H.]
  Analysis.—Carbonate of lead is a solid white powder, insoluble in water, and
immediately blackened by sulphuretted hydrogen  or hydro-sulphuret of ammo-
nia.   1. When heated on platina, it leaves a residue of yellow or orange-coloured
oxide of lead, soluble in nitric acid.   2.  The carbonate is easily dissolved, with
effervescence, by diluted nitric acid—a fact which shows that it contains carbonic
acid.   The oxide of lead,  combined with nitric acid, may be readily detected by
the tests already mentioned.  This salt of lead is sometimes contained in very
small proportions in loaf-sugar,  owing to the moulds in which the loaf is set to
crystallize being painted  with white lead, and a portion being thus mechanically
taken up.  This is a dangerous  process, and ought to be prohibited.

                             Oxides of Lead.
   The  yellow oxide (massicot,)  and the brown oxide (peroxide,) are but little
known except to  chemists.  Litharge and minium or Red lead are, however,
much employed in the arts, and have sometimes given rise to accidental poison-
ing.  In October, 1849, a woman who had  swallowed two and a quarter ounces
of the red oxide of lead,  was admitted into Guy's Hospital.   No symptoms ap-
peared for nine hours.   There was then colicky pain  with urgent vomiting, fol-
lowed  by headache and general  tenderness of the  abdomen.   She  entirely reco-
vered in about twelve days (Guy's Hosp. Reports,  October, 1850, 209.)
   Liquids used for culinary or dietetic purposes, especially if they contain a free
acid, are  liable to become sometimes impregnated with oxide of lead, derived
from the glaze of the vessel in which they are kept, and to form poisonous salts.
If vinegar be used, acetate of lead may result.  Litharge-glaze rs also easily dis-
solved by alkaline or fatty substances.  The eating of dripping, or the fat of meat,
baked in a newly glazed vessel,  has  been thus known  to give rise to slight at-
tacks of colic; while the  symptoms were referred by the party to some substance
mixed with the food.  A case in which the whole of the members  of  a family
were thus  poisoned, will be found in the Lancet (July 4,1846, p. 27.)   Another
case of a similar kind will be found reported in the Medical Gazette  (vol. xlvii.
page 659.)  When articles of this kind are impregnated with oxide of  lead, the
fact is immediately known by their  being  turned of a brown colour by hydro-
sulphuret of ammonia.   All newly glazed vessels yield traces of lead, more or
less, on boiling in  them  acetic acid or caustic potash.  In this way, the poison-
ous nature of the glaze may be tested,—the oxide  of lead being dissolved by the
acid or the alkali.   Litharge was formerly much used to remove the acidity of
sour wine, and to convey  a sweet taste.   Acetate of lead, or some other vegetable
salt of the metal, is  in  these cases formed; and  the  use of  such wine may be
productive of alarming symptoms.   Many years since, a fatal epidemic colic pre-
vailed  in Paris owing to this cause:—the adulteration  was discovered by Four-
croy, and  it was immediately suppressed.  Such  wine is known by its being
blackened by hydrosulphuret of ammonia.  [More recently a similar prevalence
of this disease  in  Paris  was produced by the use of  cider similarly poisoned.
(Bull, de Therap. xlii. 122, from Brit. For. Rev. x. 262.)  An interesting instance
of slow lead poisoning at sea, on a voyage from Calcutta, owing to the use of claret
wine that had been sophisticated with litharge, was related to us by one of the suf-
ferers.   He was a cabin passenger, and only escaped with his life by leaving  the
 vessel before the voyage was completed.   The master of the ship and one of his
 officers were fatally diseased before the source of the mischief was discovered.—H.]
 Snuff has been adulterated with red lead:  in  one instance this mixture is sup-
 posed to have caused death, and in another, it gave rise to serious symptoms.
 (Med. Gaz. xxxii. 138; also Ann. d'Hyg. 1831, ii. 197.) 
110
SULPHATE OF COPPER.
                             CHAPTER XII.

COPPER--BLUE VITRIOL.  SYMPTOMS. POST-MORTEM APPEARANCES--TREATMENT.  POISON-
  ING BY VERDIGRIS--SUBCHLORIDE OF COPPER--CARBONATE--SCHEELE's GREEN.  CHEMI-
  CAL ANALYSIS—TESTS--SPECIAL CHARACTERS OF THE SALTS.  COPPER IN ORGANIC LIQUIDS
  --IN ARTICLES OF FOOD.

  All the salts of copper are poisonous.  The  two most commonly known are
the Sulphate or blue vitriol, and the Subacetate or verdigris.   These
substances have been frequently taken and administered in large  doses for the
purposes of suicide and  in attempts at murder.   In the latter case the attempt
has been immediately discovered, owing  to the very strong metallic taste pos-
sessed by the salt.   This would in general render it impossible that the poison
should be taken unknowingly.  With the exception of these salts, poisoning  by
copper is usually the accidental result of  the common employment of this metal
for culinary purposes.

                          Sulphate of Copper.
   Symptoms.—Sulphate of copper has been frequently given for the purpose of
procuring abortion.  In  doses of half an  ounce and  upwards, it  acts as a power-
ful irritant on adults, and a much smaller quantity would suffice to destroy  in-
fants  or children.   The salt speedily induces vomiting of the most violent kind:
this sometimes expels the poison from the  stomach, and the person recovers. The
vomited matters are remarkable for being generally of a blue or green colour; and
broken crystals bf blue vitriol have been discovered in them, when the poison
was taken in a loosely  pulverulent state.  If the green colour of  the vomited
liquids be owing to altered bile, it will not acquire a blue tint on  adding to a por-
tion of the liquid a strong solution of ammonia; but if it be caused by a salt of
copper, this change of colour will serve to indicate the fact.  There is headache,
pain in the abdomen, with diarrhoea; the pain is of a colicky character; and in
aggravated cases there are spasms of  the extremities, and convulsions.  Dr. Per-
cival met with a case where the most violent convulsions were produced in a young
female by two drachms of the sulphate of copper.   Paralysis, insensibility, and
even tetanus, have preceded death, when the poison was administered to animals.
Among the symptoms casually met  with in the  human subject, may be  men-
tioned jaundice.  This has been observed to attend poisoning  by the sulphate,
as well as by Scheele's green.   The medicinal dose of sulphate  of copper as an
emetic, is from  five to fifteen grains, and as a tonic from one  to three or four
grains.
   There are but few instances in which this poison  has proved fatal in the  hu-
man subject. In 1836,  a girl, sixteen months old, put some pieces of Blue stone
(sulphate of copper) which were given her  to play with, into her mouth.  In a
quarter of an hour, the child vomited a bluish-green coloured matter, with pieces
of sulphate of copper in it; the skin was alternately cold and hot, but there was
neither diarrhoea nor convulsions.  The child died in four hours and was insen-
sible  before death.   (Med. Gaz. xviii. p. 742.)   The coroner and jury did  not
consider it necessary that an inspection should be made; and yet in  the event of
murder being committed by the administration of this substance  it would be
somewhat unreasonably expected  that medical  witnesses  should  be fully ac-
quainted with the post-mortem appearances produced by it!
   Post-mortem appearances.—In poisoning by  the  salts of copper,  the  mucous
membrane of the stomach and intestines has been found more or less thickened
and inflamed in the few  fatal cases which have been hitherto examined: the mem 
          verdigris,   subchloride and carbonate of copper.        Ill

brane has been also found eroded and softened in poisoning by verdigris.   The
■ esophagus has presented  an inflammatory appearance.  In  a case of poisoning
by Verdigris, quoted by Orfila, the stomach was inflamed and  thickened, espe-
cially towards the pylorus, the orifice of which, from the general thickening,
was almost obliterated.  The small intestines were throughout inflamed, and per-
foration had taken place,  so that part of the green liquid was  effused  into the
abdomen.  The large intestines were distended in some parts and contracted in
others, and the rectum was ulcerated on its inner surface.  (Toxicologic, i. 623.)
The lining membrane of the alimentary canal is often throughout of a deep green
colour, owfng to the small particles of verdigris adhering to it.  It has been said
that this is an uncertain character of poisoning by copper; since a morbid state
of the bile often gives a similar colour to the mucous membrane of the stomach
and duodenum.  This objection cannot apply, when the green colour is found in
the oesophagus, and throughout the intestines; and, under any circumstances, the
evidence, from the presence of a green colour would amount to nothing,  in the
judgment of a prudent witness, unless copper were freely detected in the parts
so coloured.  It is well to remember, that the green stain, if due to copper, would
be turned blue by ammonia.   In death from arsenite of copper, the inflamma-
tory appearances would probably be more strongly marked.

                   Verdigris.   Subacetate of Copper.
   This salt produces symptoms somewhat similar to those caused by the sulphate.
There is a strong styptic metallic taste, with a sense of constriction in the throat,
followed by  severe colicky pains,—vomiting of a green-coloured liquid, diarrhoea,
and  tenesmus.  In a case reported  by Phyl, a woman who  took two  ounces of
verdigris died in three days: in addition to the symptoms above described, there
were  convulsions and paralysis before death.  Niemann relates that a female,
aged twenty-four, swallowed half an ounce of verdigris, and died under symptoms
of violent gastric irritation in sixty hours.  (Taschenbuch, 458.)   In consequence
of the great uncertainty  of its  operation, subacetate of copper is not  employed
internally.
                         Subchloride of Copper.
   This is a  rich green compound known as Oxychloride or Brunswick green.
It is formed when common salt has been used in a copper vessel, and  has  thus
given rise to accidental poisoning.  It is also used as a pigment.

                          Carbonate of Copper.
   A case of poisoning by this substance has been reported by M. Desgrange, of
Bordeaux.  A man died in about six hours, as it was supposed, from the effects
of an  unknown quantity of this poison  which he had taken.  When  first seen
he was comatose;  he had sustained some violence from a fall, and there was
great coldness of the extremities.  There was neither vomiting, purging, nor
pain in the  abdomen on  pressure.  On  inspection, the oesophagus and stomach
were  covered  with a green-coloured substance.   The larger extremity  of the
stomach was vascular, and the mucous membrane of the intestine,  as well as the
liquid contained  in them, was green.   Carbonate  of copper was  found  in the
stomach, and  traces of the metal existed in the urine—none was found  in the
blood.   (Med. Gaz. xxxi. 495.)  It is remarkable that in this  case there should
have been neither vomiting nor diarrhoea.   The poison seems to have acted more
like a narcotic than an irritant.

                           Arsenite of Copper.
   This compound,  which is known  under the  name of Scheele's,—Emerald
or Mineral Green, contains about half its weight of arsenic.  It is extensively
used  as a pigment in the arts; it is also improperly employed  to give a green
colour to wafers and articles of confectionary. 
112                  TESTS FOR SOLUTIONS OF COPPER.
   Symptoms and Effects.—A child, aged three years, swallowed a small capsule
of Scheele's  green, used by his father as a pigment.   In half an hour he com-
plained of violent colic : there was frequent vomiting, with diarrhoea, cold sweats,
intense thirst, and  retraction of the parietes of the abdomen.  The mouth and
fauces were stained of a deep green colour.  Hydrated sesquioxide of  iron was
given: in about an  hour  the vomiting and  diarrhoea ceased, and soon afterwards
the thirst and pain in the abdomen abated.   The next morning  the child was
well.   In another case, a child, a year old, ate several pieces of a cake of arsenite
of copper, used for colours.   There was immediate vomiting, the liquid containing
green-coloured particles of the arsenite, but there were no other urgent symptoms.
White of egg with sugared water was given to it.   After a short time the child
became pale, and complained of  pain in the abdomen; the pulse was frequent,
the skin  cold, and there was great depression.  Copious diarrhoea followed, soon
after which the child  recovered.  (Galtier, i. 636.)
   In  the cases  of  two  children  poisoned  by confectionary  coloured with this
substance, the chief symptom was incessant vomiting  of a light  green-coloured
liquid, resembling bile diluted with water.   Mr. Bulley, of Reading, who reports
these  cases (Medical Times, April 28, 1849,  page 507,) describes the symptoms
as very severe, although the  quantity of poison swallowed was small.   Under
the use of an emetic of ipecacuanha the children recovered.   A case was com-
municated to me in  July 1849, by Mr. J. B.  Hicks, in which a child, aged
seven years, ate a slice of cake with part of a green ornament on it.   There was
severe pain with  thirst, burning sensation in the throat, with constant vomiting,
but no purging.  The child recovered in three  days.   The  green pigment was
found to be pure arsenite of  copper mixed with sugar.   (Guy's Hosp.  Reports,
Oct. 1850, p. 218.  See also Med. Gaz. vol. xliii. p. 304.)  In  a  case  which
was the  subject of a  criminal trial, this deadly compound was proved  to have
caused the death of a gentleman by reason of its having been employed to give
a  rich green colour to  some  confectionary served  at  a  public dinner.   It was
ignorantly used to give a colour to some blanc-mange :—the party who employed
it  considering that emerald or mineral green was nothing more than an extract
of spinach !  It  led to death under the  usual  symptoms, and the parties were
convicted of  manslaughter and sentenced to imprisonment.   (Reg. v. Franklin
and Randall, Northampton Summer Assizes, 1848.)  Most of the colours used
for confectionary are  of a poisonous nature: the pink colour given by cochineal
or madder is the  only one which can be regarded as innocent.   [A case  occurred
under our observation some years ago. in which a boy five years old  died, with
all the symptoms of poisoning by copper, just two years after having swallowed
a brass button: see Beck ii. 609, 610, for other like cases.—H.]
   ■Chemical analysis  of the Salts of Copper.—The salts of copper are generally
known by their colour: whether in the solid state or in solution, they are either
blue or green.   The salts of  one other metal are  also of a green colour, namely
nickel; but there are striking chemical differences between the salts of this metal
and those of copper.  There are three very soluble salts of copper; two  of these
are blue, the sulphate and nitrate,—and one green, the chloride.   The  solutions
of the cupreous salts have  generally an acid reaction.   The salt should be dis-
solved in water, diluted,  and the  following tests may then be applied.
   Tests.—1.  Solution of ammonia: _this gives, in a solution  of copper,  a bluish-
white precipitate, which is soluble in an excess of the test, forming a deep violet-
blue solution.  2. Ferrocyanide  of potassium, a rich  claret-red precipitate:—if
the quantity of  copper be small,  the liquid acquires merely  a light-red colour;
if large the precipitate is of a red-brown colour, and of a gelatinous consistency.
The ferrocyanide of  potassium will act  on the  violet-blue  solution produced
by ammonia, provided it be much diluted, or an acid  added (sulphuric) to neu-
tralize the ammonia.  One portion of liquid may thus be tried by the two test--.
3. Sulphuretted  hydrogen  gas, or hydro-sulphuret of ammonia  gives a  deep 
COPPER IN ARTICLES OF FOOD.
113
 chocolate-brown precipitate, even in an acid solution; or if the copper be in small
 proportion, merely a light-brown colour.  4. A slip of Polished Iron (a common
 needle) suspended by a thread in the liquid, is  speedily coated witlna layer of
 copper, even when the salt is in very small proportion.  When much diluted, a
 drop of diluted sulphuric acid may be added.  If  the  needle be left for some
 days in  the liquid, the iron will  be  slowly removed, and a hollow cylinder of
 metallic copper will remain.  This may be dissolved in diluted nitric acid, and
 tested with the foregoing  tests;  or the needle coated with copper, may be im-
 mersed in ammonia and exposed to air.   The liquid then becomes slowly blue.
 Half a grain of sulphate of copper dissolved in sixteen ounces of water, may be
 thus easily detected.   It was long since proposed  by Orfila  to substitute Phos-
 phorus for polished iron.   This substance most effectually separates metallic
 copper from its salts, even when they are dissolved in organic liquids.  5. The
 Galvanic test.   If a few drops of  the copper solution be placed on platina-foil,
 slightly acidulated with a diluted acid, and the platina be then touched through
 the solution with a thin slip of zinc, metallic copper, of its well known red colour,
 is immediately deposited on the  platina.   When  the quantity of copper is small
 there is merely a  brown stain; but a blue liquid  is  formed by pouring on it am-
 monia, and exposing it to  air.
    Copper in organic liquids.—The oxide of copper is  liable to be precipitated
 by certain organic principles, as albumen, fibrin and  mucous  membrane: but
 some of these organic compounds  are easily dissolved  by acids  or  even  by an
 excess of the solution of cupreous salt.   A portion at least of the salt of copper
 is, therefore, commonly held dissolved.  In  such  cases, there is  one peculiar
 character possessed by these liquids, i. e.  they have a decidedly  green  colour
 even when the copper-salt is in a far less than poisonous proportion.
   Separation by iron.—AVe first filter the liquid, and save the insoluble portions
 for a separate operation.   We may use as a trial-test either  a needle, zinc with
 platina, or add to  a portion, oxalic acid: the last gives a bluish-white precipitate
 only when the copper is in a moderately large quantity, and the liquid  is not
 very acid.   If the needle be not coated with copper  in the course of a few  hours,
 it is certain that there is no detectable quantity of the poison present in the liquid.
   Separation as  a  sulphuret.—If the copper salt be present in large quantity,
 any of the trial-tests will indicate it immediately.   AVe now destroy the viscidity
 of the liquid by diluting it if necessary, and pass into it a current of sulphuretted
 hydrogen gas in  order  to  precipitate all  the copper  in the  state of sulphuret.
 The black sulphuret may be collected, washed, dried, and then boiled in equal
 parts of nitric acid and  water for a quarter of an hour.  Nitrate and sulphate
 of copper are produced and dissolved,—a fact indicated by the liquid acquiring
 a rich blue colour; and some sulphur is at the same time  separated.  This liquid,
 when filtered, will give the usual reactions with the tests for  copper.
   Separation by  platina.—I have also found the following  a very expeditious
 and simple method of obtaining  copper from organic liquids.   Having filtered
 the liquid, let a portion of it be placed in a clean  platina capsule or crucible.
 A few drops of diluted sulphuric acid  may be added, and a slip of zinc foil intro-
duced.  AYherever the platina is touched by the zinc, metallic copper is deposited;
and after having in this way coated the platina capsule, the surplus liquid may-
be poured off and  the capsule well washed out.  The copper is then dissolved in
diluted nitric acid, and the tests  may be applied after the excess of acid has been
driven off by heat.   This is, perhaps, the most expeditious and certain method of
detecting  a salt of copper  in an organic liquid.   It is, however, less delicate
than the Iron-test.
   Copper in articles of food.—The Medico-legal history of poisoning by copper
would be incomplete without some remarks on the action of certain articles of
food on this  metal when used for culinary purposes.  This is a not unfrequent
form of accidental  poisoning.  The symptoms rarely appear until after  the lapse
       8 
114
POTSONINC, BY TARTARIZED ANTIMONY.
of three or four hours.  There is commonly nausea, with  colicky pains and
cramps in the  limbs.   It results from the experiments of Falconer and others,
that metallic copper undergoes no change by contact with water, unless air be
present, when a hydrated carbonate will be formed mixed with peroxide.  If the
water  contain  any acid, such as vinegar,  or common salt, or  if there be oily or
fatty matter in contact with the metal, then the copper is more rapidly  oxidized,
and the liquid or fat acquires a green colour.   If the copper  vessel be  kept per-
fectly clean, and the food prepared in it be allowed to cool in other vessels, there
is not much risk of its acquiring a poisonous impregnation: nevertheless, no acid,
saline, fatty, or oily liquid should be  prepared as an article of food in a copper
vessel.   (See Ann. D'Hyg. 1832, i. 102.)  Under the influence of heat and air,
a portion of copper becomes  dissolved, and  the oily or other liquid acquires a
green colour.   The preparation of fruits, such as preserves, in copper vessels, is
necessarily attended with some risk; for on cooling, a green crust is apt to form
on the copper, just above the surface where the air and acid liquid meet. Some
liquids while boiling appear  to be but little liable to this impregnation:—thus,
coffee, beer, milk, or tea, has been boiled  for two hours together, in a  clean
copper vessel, without any portion of the metal being taken up by either of the
liquids.   (See  Falconer, on  the Poison  of  Copper, 65.  London, 1774; also
Orfila, i. 611.)   Accidents of this kind are usually prevented by lining the cop-
per vessel with tin; but in very large boilers this plan is not always adopted—
cleanliness alone is trusted to, and  this is a sufficient  preventive when  properly
observed.
  It has been stated that an impure alloy used by some of the lower  grade of
dentists has been so largely composed  of  copper, as  to affect the health of those
who have used the plates for the support  of artificial teeth.   The acid and salts
in the  saliva would facilitate  the production of a poisonous salt of copper.
  In the making  of preserved fruits  and vegetable pickles, the salts of copper
(blue vitriol) are sometimes used for the purpose of giving a rich  green colour.
Many of the green pickles sold in shops are thus impregnated with  the vegetable
salts of this metal, to which  they owe  their bright  grass-green colour. If the
fruit or pickle  be placed in  a solution of ammonia, and copper be present, the
substance is speedily turned blue.  The iron test is, however,  more delicate.  A
bright needle immersed in the pickle, or plunged into the solid, will be speedily
coated with copper.  The quantity of  copper contained in such articles may not
be sufficient to cause fatal effects, but  serious symptoms of  gastric irritation are
sometimes produced, and in very young subjects these may assume an  alarming
character.  (See Falconer, 87.)
                             CHAPTER Xni.

TARTARIZED ANTIMONY--SYMPTOMS--RECOVERY  FROM LARGE DOSES—POST-MORTEM AP-
  PEARANCES--TREATMENT—CHEMICAL ANALYSIS--TESTS. ANTIMONY IN ORGANIC LIQUIDS.
  CHLORIDE OF ANTIMONY--ANALYSIS.  POISONING BY SULPHATE AND CHLORIDE OF ZINC1—
  CARBONATE  OF  ZINC.  PREPARATIONS OF  TIN--SILVER--GOLD—IRON--BISMUTH AND
  CHROME--BICHROMATE OF POTASH.

     Tartarized Antimony.  Tartar Emetic.  Stibiated Tartar.

   Symptoms and effects.—This substance, which is seen in the form of a white
powder, or in crystals, is  by no means so poisonous as it is often described to
be.  Forty grains have  been given to an  adult in twenty-four  hours without
causing serious mischief.  When taken in  a poisonous dose,  a strong  metallic 
TARTAR EMETIC.   SYMPTOMS.
115
 taste is perceived in the mouth during  the act of swallowing.   There is violent
 burning pain in the epigastric region, followed by nausea, incessant vomiting,
 profuse diarrhoea and syncope.   The pulse is small and rapid, sometimes imper-
 ceptible;  the .skin cold, and covered with a clammy perspiration;  and the respi-
 ration painful.   Death is preceded by vertigo, insensibility, great prostration of
 strength, and violent spasms of  the muscles of the extremities.  Among the
 symptoms there  has been  observed great heat and  constriction  in  the throat,
 with difficulty of swallowing.   The quantity actually required  to destroy life is
 unknown.   It will probably depend in some degree on whether active vomiting
 and purging have been  excited or not;  for these symptoms have not been  pre-
 sent in all  cases.  Doses  of twenty, twenty-seven, and even sixty grains have
 been taken  without destroying life, although  alarming symptoms of irritation
 followed.   In one case related by Orfila, a man, aged fifty, took forty grains of
 tartar emetic, and died in about four days.   This was  the  only one  out of five
 cases of poisoning by this substance which proved fatal.  (Orfila, i. 447.)   Dr.
 Beck mentions a case in which fifteen grains of tartar emetic, in solution, killed
 a child in a few weeks: vomiting and purging ensued, followed by convulsions
 and death.  This case proves that a patient is not always saved by vomiting and
 purging:—the fatal effects on  such an occasion are probably due to rapid absorp-
 tion.  (See  also Medical Gazette, vol. xliv. p. 334.)   Dr. Pollock has recorded
 a case in  which an adult was killed in  ten hours by a dose of one drachm, in
 spite of  early and  violent vomiting.  (Med. Gaz. vol. xlv. p. 801.)   In  two
 cases observed  by Mr. Hartley,  which  will be  presently described, ten grains
 killed each child in a few hours.   This, I believe, is the  smallest fatal dose on
 record.   In  a case recently reported by Mr. Freer, of Stourbridge, a man, aetat.
 28, swallowed hoo drachms of tartar emetic  by mistake for Epsom  salts, and
 recovered from its effects.   An hour after the poison  had  been  taken, he was
 found in the following  state:—his pulse imperceptible; tongue  dry and red;
 countenance cold and livid, bathed with clammy perspiration,  and indicative of
 great suffering; violent pain at the epigastrium and over  the whole of the abdo-
 men, with constant spasmodic contraction of all the muscles, particularly of the
 abdomen and upper  extremities.  The  fingers were  firmly contracted, and the
 muscles quite rigid.   He vomited  only once, about half an hour after  he  had
 swallowed the poison, and after this he had constant involuntary aqueous stools.
 An emetic of mustard  and salt was given to him,  and  this  produced  violent
 vomiting of  bilious matter.   Green tea,  brandy, and decoction of oak-bark were
 freely given.  The  cramps, vomitings,  and  aqueous  stools  continued  for six
 hours.  The symptoms then became mitigated, and he  gradually recovered, suf-
 fering chiefly from profuse night perspirations.  (Lancet,  May 22d, 1847, 535.)
 This case is remarkable for the anomalous character of the symptoms, as, in the
 absence of active vomiting, an emetic was actually required to be given,—also
 for the recovery of the individual after a very large dose of the poison.
   Dr. Gleaves, U. S., has related, in the Western Journal of Medicine and Sur-
 gery, the following singular case of recovery:—A young  man swallowed, by
 mistake, a tablespoonful of  tartar emetic.  In an hour  after, he was speechless,
 pulseless,  and apparently dying.   Although he drank freely of cold water, and
 irritated his fauces repeatedly with his finger, no vomiting had occurred.  During
 the first three hours he vomited only two or three times, and the matter ejected
 was chiefly the warm water taken to favour vomiting.  After the lapse of two
 hours there was the most violent purging.  In seven hours this ceased, and there
 was great thirst, with a sense of burning pain in the fauces, oesophagus, sto-
 mach, and bowels.  There was also great irritability of  the stomach, and the
 vomited matters were  tinged with blood.  On the following  day the  vomiting
continued, but  the purging was  arrested.   The  fauces were covered with pus-
tules: there was pain  in passing the urine, which was copious.   On the third
day, the whole of  the  body was covered with  genuine tartar emetic  pustules. 
116
CHEMICAL analysis.
 These  began to heal, and the patient  to recover, in about two weeks.   (Med.
 Times, Jan. 24, 1846, p. 127.)   This is the only case of poisoning by tartar
 emetic in which pustular eruptions have been observed.  It is otherwise remark-
 able for  recovery from so large a dose, considering that but little of the poison
 could have been expelled in the first instance by vomiting.
   Post-mortem appearances.—The following cases, reported by Mr. Hartly, show
 the nature  of the post-mortem appearances  likely to be found in the body:—.
 Two children, a boy aged five years, and a girl aged three years, each swallowed
 a powder containing ten grains of tartar emetic mixed with a little  sugar.  It
 was stated  that, in twenty minutes after taking  the  powders, they were  seized
 with violent vomiting and purging, and great prostration of  strength, followed
 by convulsions and  tetanic spasms:  there was also great thirst.  The boy died
 in eight hours, and the girl in twelve or thirteen hours after swallowing the dose.
 The bodies were inspected between four and five days after death.  In that of
 the boy there was effusion of serum in the right pleura; the  lower  lobe of the
 right lung posteriorly was redder than natural, and the peritoneum was injected
 from recent inflammation.   The  mucous membrane of the duodenum was in-
 flamed, and covered with a whitish yellow viscid  secretion;  this was observed
 throughout the intestinal canal, although the colour was of a deeper yellow in
 the colon and rectum: there was no ulceration.   The peritoneal coat of the sto-
 mach was inflamed.  The mucous membrane of this organ was much inflamed,
 especially about the larger curvature  and at the cardiac orifice: there was no
 ulceration.   The contents, (about two ounces and a half of a dark grumous fluid,
 having a slightly acid reaction,) were very adherent to it; and in one  place there
 was a patch of lymph.   The tests used did not indicate the presence of antimony.
 AArith regard  to other appearances, the tongue was covered with a white fur,
 and appeared soddened;  the fauces were not  inflamed; the trachea and oesopha-
 gus  had a  natural appearance.   On opening the cranium, the dura mater was
 found very vascular; the longitudinal sinus contained a coagulum of lymph, and
 but very little blood.  The vessels of the surface of the brain were  very much
 injected with dark blood, the whole surface having a deep purple colour.   Every
 portion  of the brain, when cut, presented many bloody points.   The cerebellum
 and  medulla oblongata were also*extremely vascular;  there was no  effusion in
 the ventricles or at the base of the brain.   In the body of the girl, the morbid
 appearances were similar;  there were  also patches resembling the  eruption of
 scarlatina on the arms, legs, and neck.  The  arachnoid membrane  was  more
 opake than  usual;  and on the mucous membrane of the stomach, where the in-
 flammation  was greatest, were two or  three  white  spots, each about the size of
 a split pea, which appeared to be  the  commencement of ulceration.  (Lancet,
 April 25, 1846, 460.)  In animals poisoned  by this substance, it is common to
 find general inflammation of the alimentary canal.
   Chemical analysis.   Tartar emetic as a solid.—In the state of powder.—1.
 Tartar emetic is easily dissolved  by water,—it is taken up by  fourteen parts of
 cold and two of boiling water;  the solution  has  a faint acid  reaction, and an
 acrid caustic taste; it becomes decomposed  by long keeping.   It is insoluble in
 alcohol.    2.  The powder dropped into hydrosulphuret of ammonia, is turned of
 a deep reddish brown colour, and is thereby known from other poisonous metallic
 salts.   3.  When heated  in a reduction-tube, it becomes charred, but does not
melt before charring, like the acetate of lead.  The metal is  partially reduced
by the carbon of the  vegetable acid, and the decomposed mass has a grayish-blue
lustre.  I have not found that a metallic sublimate is produced  in this  experi-
ment  by the heat of a spirit-lamp.  4. When boiled with muriatic acid and
metallic copper, a  gray deposit of antimony  takes  place on that metal.  The
colour of the deposit is violet, if  the quantity be very small.
   Tartar emetic in solution.—1. On slowly evaporating  a small quantity on a
slip of glass, it will  crystallize in tetrahedra.   If obtained  from a very diluted 
ANTIMONY IN ORGANIC LIQUIDS.
117
solution, this crystallization resembles that of arsenic.   2.  Diluted nitric  acid
added to the solution, throws down a white precipitate (subnitrate of antimony:)
the other two mineral acids act in the same way; but, as they precipitate nume-
rous other metallic solutions, there are objections to them which do not hold with
respect  to nitric acid.   The white precipitate thus formed possesses the remark-
able property of being easily and  entirely redissolved  by a solution of tartaric
acid:—it is also soluble in a large excess of nitric  acid, so  that  if much of the
test be added at once, no precipitate is produced.  3. Ferro-cyanide of potassium
does not precipitate the solution, whereby tartar emetic is known from most other
metallic poisons,  4. Hydrosulphuret of ammonia or sulphuretted hydrogen gas
produces in the solution a reddish orange-coloured precipitate, differing in colour
from every other metallic sulphuret.
   The foregoing tests, it will be observed, merely indicate the presence of oxide
of antimony,—but this is in reality the poison which  we  have to seek,—the
cream of tartar with which it  is combined being merely the vehicle; and in a
case of poisoning, this  is  no more the object of medico-legal research than if it
were the vehicle for the administration of arsenic or corrosive sublimate.   It is,
besides, well known that tartar emetic is the only salt of the oxide  of antimony
in a soluble form which is  likely to be met with in medicine or chemistry.  Should
it be required to prove the presence of cream of tartar, this may be done by filter-
ing a solution from which the oxide of antimony has been  entirely precipitated
by sulphuretted hydrogen gas.  On evaporating this solution, the cream of tartar
may be obtained.
   In liquids containing organic matter.—Tartar emetic is precipitated by tannic
acid in  all its forms, but not readily by albumen or mucous membrane; there-
fore it may be  found partly dissolved in the liquids of the stomach, provided no
antidote has been administered.  The liquid must be filtered, and then strongly
acidulated with tartaric acid.   A current of sulphuretted hydrogen gas  is now
passed into it, until there is no further precipitation.  The sulphuret is collected,
washed, and dried.  If it be the sulphuret of antimony, it  will have an orange-
red or brown colour, and will, when  dried, be dissolved by a small quantity of
boiling muriatic acid (forming sesquichloride of antimony) with the evolution of
sulphuretted hydrogen.  The boiling should be continued  for several minutes.
On adding  this solution to a large quantity of water, a dense white precipitate
of oxychloride of antimony (powder of  Algaroth or Algarotti, Mercurius  Vita)
will fall down.    This is characteristic of antimony.   If it be objected that nitrate
of bismuth undergoes a similar change when dropped into water, hydrosulphuret
of ammonia will easily enable  us to distinguish the two metals;  the antimonial
precipitate is turned of an orange-red by that solution, while the bismuthic pre-
cipitate is turned of a deep black.
   A medical jurist must remember that the discovery of  tartar emetic  in the
contents of a  stomach is by no means a proof of its having been taken or ad-
ministered as a poison; since it is frequently prescribed as a medicine, and often
taken as such by persons of their own accord.   We could only  infer that it ex-
isted as a poison, or had caused death, when the quantity present was very large,
and there were corresponding appearances of irritation in the alimentary canal.
Still less would the discovery of it in a medicinal mixture, unless in a very large
proportion, be evidence of an intent to poison.
   In Ike tissues.—Orfila has successfully applied Marsh's process for arsenic to
the detection of antimony in the tissues.   (For the details of this process I must
refer to my work On Poisons, p.  490.)  Reinsch's process also serves to sepa-
rate antimony from the soft parts when they are boiled for some time in muri-
atic acid and water.  The copper acquires a violet-blue or steel-gray colour (re-
sembling arsenic,) according to the proportion present.   This separation of anti-
mony from  the tissues does not necessarily indicate that it  has been criminally
administered or  has caused death.  In a recent case of suspected  death from 
lis
preparations of zinc.
 poison, a deposit on copper, evidently of an antimonial nature, was obtained by
 boiling part of the liver in hydrochloric acid and water.   The boy had died from
 natural causes;  and, on inquiry, it was found that a dose of antimonial  powder
 had been given to him shortly before death.

   Chloride of Antimony.  Sesquichloride or Butter of Antimony.
   Symptoms and appearances.—The following case was communicated tome by
 Mr. Henry Pearson:—In 1836, a boy, aged 12, swallowed by mistake for ginger
 beer four or five drachms of a solution of butter of antimony.  In half an hour
 he was seized with vomiting, which continued at intervals for two hours.   There
 was faintness, with general weakness, and  great prostration  of  strength.   Re-
 medial means were adopted, and the  next day the chief symptoms were heat and
 uneasiness in the mouth and throat,  with pain in swallowing.  There were nu-
 merous abrasions on the mucous membrane of the  mouth and fauces; and there
 was slight fever, from which he quite recovered in about eight days.  Another
 case of recovery from a  dose of an  ounce  is reported  in the Lancet, Feb. 26,
 1848,  p. 230.
   The only fatal case which I have met  with was  communicated to me  by Mr.
 Mann, of Bartholomew  Close.  An army surgeon swallowed, for the purpose of
 suicide, from two to three ounces by measure of chloride of antimony.  About
 an hour afterwards he was seen by Mr. Mann.  There  was  entire prostration of
 strength,  with coldness of skin, and incessant attempts to vomit.   The most ex-
 cruciating griping  pains were felt in the  abdomen; and there  was a frequent
 desire  to evacuate the bowels, but nothing  was passed.   In the course of a few
 hours  reaction took place, the pain subsided, and the pulse rose to 120.  There
 was now a strong disposition to sleep, so that he appeared as if labouring under
 the effects of a narcotic poison.   In this state he continued until he died,—ten
 hours  and a half after he had swallowed the poison.  On inspection, the interior
 of the  alimentary canal,  from the mouth downwards to the jejunum, presented a
 black appearance, as if the  parts had been charred.  In general, there  was no
 mucous membrane remaining, either on the stomach or elsewhere;  only a floc-
 culent substance, which could be easily scraped off with the back of the scalpel,
 leaving the submucous tissue and the peritoneal coat.   All these parts were so
 soft that they were easily torn by the fingers.
   Chemical analysis.—If any portion of the  chloride be left in the  vessel, it
 may be tested by adding a few drops to a large  quantity of water, when the
 whitish-yellow oxychloride  of antimony  will be precipitated: the supernatant
 liquid  will contain muriatic acid, which may be detected by nitrate of silver.  It
 has been  already observed, that the  only objection to  this  mode of testing is,
 that the salts of bismuth are also decomposed by water; but the precipitate in
 this  case is insoluble in tartaric acid,  and is  blackened by hydrosulphuret of am-
 monia; while in the case of antimony it is  soluble in that acid, and is changed
 to an orange-red by the hydrosulphuret.

 Preparations of Zinc.—Sulphate of Zinc.  White Vitriol or AVhite
                                Copperas.
   Symptoms^ and appearances.—The symptoms produced  by an over-dose of
 sulphate of zinc are pain in the abdomen and violent vomiting, coming on almost
immediately, and diarrhoea.  After death, the stomach has been found inflamed.
The  sulphate appears to act as a pure irritant; it has no corrosive properties.
   Chemical analysis.—The pure  sulphate  is seen  in  white prismatic crystals
closely resembling in  appearance sulphate  of magnesia  and oxalic  acid* from
oxalic acid it is distinguished by remaining  fixed when heated on  platina foil__
from the  sulphate of magnesia, by tests applied to its solution.   It is  readily
dissolved by water, this fluid taking up about one-third of its weight at common 
CHLORIDE OF ZINC
119
temperatures.   Analysis of the  solution.—The solution in water has a slightly
acid reaction.   The  following tests may be  used for the detection  of oxide  of
zinc:—1. Ammonia gives a white precipitate, soluble in an excess of the alkali.
2. Sesquicarbonate of ammonia, a white precipitate, also soluble in a large ex-
cess of the test.  3. Ferrocyanide of potassium, a white precipitate.  4.  Sul-
phuretted hydrogen and hydrosulphuret of ammonia, a milky white precipitate,
provided  the solution be pure and  neutral, or nearly so.  If the  solution  be
very acid, sulphuretted hydrogen produces no effect whatever.
   In organic mixtures.—If the sulphate of zinc be dissolved, we may pass into
the solution a current of sulphuretted hydrogen gas; the presence of zinc is im-
mediately indicated by a milky-white froth—the sulphuret may be collected, and
decomposed by boiling  it with muriatic acid.   The solution may be then tested
for zinc.

                            Chloride of  Zinc.

   Since the publication of the previous edition of this work, the attention of the
 profession has been  directed to the subject of poisoning by Chloride of zinc  by
 Dr. Stratton and others.   The chloride of zinc is sold to the public as a disin-
 fectant under the name  of  "Sir W. Burnett's fluid."  This is a highly concen-
 trated solution of the impure chloride of the metal:  it has been taken by acci-
 dent in several cases, and in one instance was supposed to have been criminally
 administered as a poison.
   Symptoms.—In one of the cases reported by Dr.  Stratton, about two ounces
 of a solution containing only twelve grains of the chloride were swallowed.  The
 patient immediately felt pain and nausea; vomiting followed, and she recovered,
 but suffered from some indisposition for three weeks.   In a second  case, a wine-
 glassful,  equivalent  to at least two hundred grains of solid chloride, was swal-
 lowed.   The man instantly experienced burning pain in the gullet,  burning and
 griping pain in the stomach, great nausea, and coldness.   Vomiting came on in
 two minutes; the legs were drawn up to the body; there were cold  perspiration,
 and other signs of collapse.  The man perfectly recovered in sixteen days.   (Ed.
 Med. and Surg. Journal,  Oct.  1848, p. 335; and British American Journal,
 Dec. 1848, p. 201.)  Other cases show that the concentrated liquid has a strong
 corrosive action locally, destroying the membrane of  the mouth, fauces, gullet,
 and stomach.   There has been frothing of the mouth, general lividity, with cold-
 ness of the surface.  In one case, in which only a mouthful of the fluid had been
 swallowed, with immediate burning heat in the stomach, the patient experienced
 giddiness and loss of sight: vomiting and purging came on, and the former symp-
 tom continued for a week.  There was so much irritability of the stomach for a
 period  of three weeks, that the woman became greatly reduced.   Among the
 early symptoms was loss of voice, which did not return  for five weeks.   (Med.
 Times, Oct.  11, 1851,  p. 382; and Nov. 8, 1851, p. 497.)
   Post-mortem appearances.—Out of five cases of poisoning  by this  substance
 within the last  four years, only one has proved fatal:  this  was in the case of au
 infant  aged  fifteen  months.  The lining membrane of  the  mouth and fauces
 was white and opake.   The stomach was hard and leathery, containing a liquid
 like curds and whey.   Its inner surface was corrugated, opake,  and tinged of a
 dark leaden hue.   The lungs  and kidneys were congested.  The fluid  of  the
 stomach  was  found to contain  chloride of  zinc.  (Med. Times, July 13, 1850,
 r-47.)
   These facts show that the concentrated solution of  chloride of zinc is  both a
 corrosive and an irritant poison, exerting also a powerful  action on the nervous
 system.  It may destroy life by producing  stricture of the oesophagus, or by its
 chemical action on the lining  membrane of the  stomach, leading  to a  loss of
 power of digestion, emaciation, and exhaustion.
    Analysis.—The chlorine may be discovered by nitrate of silver—the zinc by 
120
preparations of iron.
the tests above described.   (See Sulphate.)   All the samples which I have ex-
amined contained iron.

                     Carbonate of Zinc (Calamine.)
   This compound  does not appear to have any poisonous action; and it would
probably require to be given in large quantity to  produce any effect.   Carbonate
of zinc is the white substance which is formed on the metal when long exposed
to air and moisture.   Its effects may become a subject of investigation as a mat-
ter of medical police;  since zinc is now much used for roofing,  and also in the
manufacture of water-pipes and cisterns.   (See Ann. d'Hyg. 1837, 281, ii. 352.)

                          Preparations of Tin.
   The only preparations of this metal which require  to be  noticed as poisons are
the Chlorides, or Muriates, a  mixture of which  is extensively used  in the arts
under the name of Dyer's spirit.   The  salts  may exist in the form of whitish-
yellow crystals;  but more commonly they are met with in a strongly acid solu-
tion in water.  They are irritant poisons; but so seldom used as  such that only
one death occurred from them in  England and  Wales during a period of two
years.
                         Preparations of Silver.
   Nitrate of Silver.    Lunar Caustic.   Lapis Infemails.—This  substance,
which is commonly met with in small sticks of a white or dark  gray colour, is
readily soluble in distilled water; in common  water it  forms a milky solution.
It acts as a powerful corrosive, destroying all  the organic  tissues with which it
comes in contact.  There  are at least two cases on record in which it has proved
fatal in the human subject:—one of these occurred  in 1837-8, but the particu-
lars are unknown.   The symptoms  come on immediately, and the whitish flaky
matter vomited is rendered dark by exposure to light.  Dark coloured spots on
the skin will also indicate  the nature of  the poison.

                         Preparations of Gold.
   Tcrchloride.—This is the only preparation of gold which requires notice.   It
is a powerful  irritant poison, acting locally like the nitrate of silver.  Nothing
is known of its effects on the human subject;  but in administering it to animals,
Orfila  has found extensive  inflammation, and even ulceration of the  mucous
membrane of  the stomach.  (Toxicologie, ii. 30.)   The metal  is absorbed and
carried into  the tissues, but its poisonous action is wholly independent of  absorp-
tion.
                         Preparations of Iron.
   Sulphate  of Iron.   Copperas.   Green Vitriol.—This compound has been se-
veral  times  administered with malicious intention.   One death from this sub-
stance took place in 1837-8.   It cannot, however, be a very active preparation;
for a girl who swallowed an ounce of it recovered, although she suffered for some
hours from violent pain, vomiting and purging.  (Christison on Poisons, 506.)
   Green vitriol or copperas is sometimes  given as  an abortive.  A suspicious case
is reported,  in which a woman far  advanced  in  pregnancy, but  enjoying good
health, was  suddenly seized about  midnight  with vomiting and purging and
died in about fourteen hours.  The body was  disinterred,  and  iron found in
large quantity in the viscera.   The  symptoms are not always of this violent kind.
In a case which occurred to M. Chevallier, a husband gave a large dose of sul-
phate of iron to his wife.   There was neither colic  nor vomiting.  The  woman
lost her appetite, and she had a clayey complexion, but she ultimately recovered.
   Muriate of Iron.  Tincture of sesquichloride of Iron.—This is an acid solution
of peroxide of iron  with alcohol, of a red colour,  much  used in medicine.  Dr.
Christison relates an instance where a man, by mistake, swallowed an ounce and
a half of this liquid: the symptoms were somewhat like those produced by muri- 
preparations of chrome.
121
atic acid.  He at first rallied, but died in about five weeks.  The stomach was
found partially inflamed, and thickened towards the pylorus.   This salt has been
of late much used for criminal purposes in  France.  (See Med. Gaz. vol. xlvii.
p. 307;  also Ann. d'Hyg. 1850, i. p. 180, 416—and 1851, i. p.  155, ii. 337.)
A case was reported to the AArestminster Medical Society, in November, 1842, in
which a girl, aged fifteen, five  months advanced  in pregnancy,  swallowed an
ounce of the  tincture of muriate of iron in four doses in one day, for the purpose
of inducing  abortion.   Great irritation of  the whole urinary system followed;
but  this was speedily removed, and she recovered.  Another case of recovery
from a large  dose of this preparation has been recently reported by Mr. Amyot.
A healthy married female swallowed, by mistake for an aperient draught, one
ounce and a  half of. the tincture of muriate of iron.  She immediately ejected a
portion, and  violent retching continued for some time.   There was great swell-
ing of the glottis, with cough, and difficulty of swallowing.   These symptoms
were followed by heat and dryness of the throat, with a pricking sensation along
the course of the  oesophagus and stomach; and in the afternoon  a quantity of
dark grumous blood was vomited.   The motions were black, owing doubtless to
the action of sulphur upon the metal.   In  about a month the patient was per-
fectly restored to  health.  (Provincial  Journal, April  7 and 21, 1847, 180.)
Another case of recovery from  a large dose has been  reported  by Sir James
Murray.   The patient, aet.  72, swallowed by mistake three ounces of the tincture
in a concentrated state.  The tongue soon became swollen; a ropy mucus flowed
from the mouth and nose; there was croupy respiration, with a sense of impend-
ing  suffocation.  The  pulse was feeble, the skin cold and clammy, and the face
swollen and livid.   A  castor oil mixture brought away inky evacuations, and the
patient rapidly recovered.  (Dub. Med. Press, Feb. 21, 1849.)
   Chemical analysis.—The muriatic acid may be  detected by nitrate of silver
and nitric acid, while the peroxide  of iron is immediately indicated by a preci-
pitate of Prussian  blue on adding a solution of Ferrocyanide of potassium.

                       Preparations of  Bismuth.
   Subnitrate of Bismuth.   Pearl-white.   Magistery of Bismuth.—This sub-
stance, in a dose of two  drachms, caused the death of an adult in nine days.
There was burning pain in the throat, with vomiting and diarrhoea, coldness of
the surface, and spasms of the extremities,—also a strong metallic taste in the
mouth.   On inspection, the fauces, larynx, and oesophagus were found inflamed;
and there was inflammatory redness in the stomach and throughout the intestinal
canal.  (Sobernheim, 335.)  In a case mentioned by Dr. Traill, a man took by
mistake  six  drachms of the subnitrate, in divided doses, in three days.   He
suffered from vomiting and pain in the abdomen and throat, but finally recovered.
(Outlines,  115.)  These cases are  sufficient  to prove  that  a  substance  very
slightly soluble in  water, may exert a powerfully poisonous action on the  human
system.
                        Preparations of Chrome.
  Bichromate of Potash.—Well observed instances of  poisoning  by this com-
pound, which is now extensively used in the arts, are  rare;  and,  therefore, the
details of the following case, communicated to the Medical Gazette (xxxiii.  734)
by Mr. Wilson of Leeds, are of great practical interest:—A man, aged sixty-four,
was found dead  in  his bed, twelve hours after he  had  gone  to rest.  He  had
been heard to snore loudly during the night, but this had occasioned no alarm
to his relatives.  When discovered, he was lying on his  left  side,  his lower ex-
tremities being a little drawn up to his body: his countenance was pale, placid,
and composed; eyes and mouth closed; pupils dilated; no discharge from any of
the outlets of the  body; no marks of vomiting or diarrhoea, nor any stain  upon
his  hands  or person,  or  upon the bed-linen or  furniture.   The surface was 
122                     preparations of chrome.

moderately warm.   Some dye-stuff, in the form of a black powder, was found in
his pocket.  On inspection, the brain and its membranes were healthy and na-
tural; there was neither congestion nor effusion in any part.   The thoracic viscera
were equally healthy, as well as those of the abdomen, with the exception of the
liver, which contained several hydatids.   A pint of a turbid inky-looking fluid
was found in the stomach.   The mucous membrane was red and very vascular,
particularly at the union of the cardiac extremity with the oesophagus: this was
ascribed to the known intemperate habits of the deceased.   In the absence of any
obvious cause for death, poison was suspected; and on analyzing the contents of
the stomach, they were found to contain bichromate of potash.  The dye-powder
taken from the man's pocket consisted of this salt mixed with cream of tartar
and sand.  It is remarkable that in this case there was neither  vomiting nor
purging.   The salt does not appear to have operated so much by its  irritant
properties as by its indirect effects on the nervous system.   This, however, is by
no means an unusual occurrence, even with irritants far more powerful than the
bichromate of potash.   A  case has been recently communicated to me  by Mr.
Bishop, of Kirk stall, in  which  a boy recovered from the effects of a dose of this
salt only after the lapse  of  four months.  The first symptoms were pain, vomit-
ing, dilated and fixed pupils, cramps in the legs, and insensibility.  His recovery
was due to early and active treatment.   A  report  of this case will be found in
Guy's  Hosp. Reports, Oct.  1850, p. 214.
   There  can be no doubt that this salt is a very active poison.   Mr. West has
recently published a case from which it appears  that a medical man, who had
inadvertently tasted a solution of bichromate of potash, suffered from very severe
symptoms, resembling those of Asiatic cholera.  (Provincial Journal, Dec. 24,
1851, p.  700.)
   [Several fatal cases from this poison have occurred in this country, especially
at Baltimore, where this salt is manufactured on a large scale.   They all appear
to have been the result  of accident.—H,] 
GENERAL REMARKS ON VEGETABLE IRRITANTS.           123
VEGETABLE  IRRITANTS.
                            CHAPTER XIV.

GENERAL REMARKS.—MODE OF ACTION OF VEGETABLE IRRITANTS.  ALOES.  COLOCYNTH.
  GAMBOGE.  JALAP.  SCAMMONY.  SAVIN.   CROTON OIL.   CASTOR SEEDS.  OIL  OF TUR-
  PENTINE.  OIL OF TAR.  MOULDY BREAD.

  General Remarks.—The poisonous  substances of an irritant nature which
belong to the vegetable kingdom are  very numerous as a class;  but it will here
be necessary to notice only those which  have either caused  death, or have given
rise to accidental poisoning.

         Aloes.   Colocynth.  Gamboge.  Jalap.  Scammony.
  These different  substances, which  are used in small doses as  medicines,  are
liable, when taken in large quantities, to give rise to vomiting, purging, and
other symptoms of irritation.  Colocynth has occasioned death in several  in-
stances: in one case a  teaspoonful and a half of colocynth powder destroyed
life; and one drachm of gamboge, a medicine much used by quacks, has proved
fatal to man.  (Traill's Outlines, 150.)   Aloes  and colocynth mixed are said
to be the  basis of a certain quack medicine  sold under the  name of Morison's
Pills.  These have proved fatal in many instances from the exhaustion produced
by excessive purging, owing to the  large quantity of these pills taken in  fre-
quently repeated doses.   Our knowledge of the symptoms and post-mortem  ap-
pearances  produced by these  irritants  is, indeed, chiefly derived from the cases
which have proved fatal under this  pernicious treatment.    In the seventeenth
volume of the Medical Gazette will be found four cases of this  description.  The
most prominent symptom is excessive diarrhoea, with the discharge of large quan-
tities of mucus; 'the individual becomes emaciated, and slowly sinks.  In some
instances the symptoms are those of  inflammation and ulceration of the bowels.
In 1836, a man was convicted of having  caused the  death  of a person  by  the
administration of these pills: in this  instance the death of the deceased was
clearly due to the medicine; and on  inspection, the stomach  was found inflamed
and ulcerated; the mucous membrane of the small  intestines was inflamed and
softened, and there was the appearance of  effused lymph upon it.  An ingenious
attempt was made  in the defence to  draw  a statement from the medical witness
that the good effects of some medicines invariably increased in  proportion to the
quantities taken.   This anti-hoiiueopathic proposition was,  however, very pro-
perly rejected.  The same remarks apply to Holloway's Pills, although these are
of a more innocent description.  The principal ingredient in them is aloes.  In
all oases it must be remembered that these drastic purgatives may cause serious
symptoms or even death when administered to infants, or to  persons debilitated
by age or  disease;  and it is not necessary that the dose should  be very large for 
 124                 EFFECTS OF SAVIN AND CROTON OIL.

 fatal effects to follow.   The question here will be, whether the medicine caused
 death, or whether it simply accelerated it.
   Hiera picra appears to be a popular aloetic compound, and one death is recorded
 to have been produced by this in 1837-8.  In another instance death was caused
 by taking aloes in nitric acid, in which case the mineral acid was most probably
 the destructive agent.   A singular case occurred in Germany a few years since,
 wherein  a medico-legal  question was raised respecting the poisonous properties
 of aloes.   A woman, aged forty-three,  not labouring under any apparent dis-
 ease, swallowed two drachms of powdered aloes in coffee.   Violent diarrhoea su-
 pervened, and she died  the following morning, twelve hours after having taken
 the medicine.   On inspection, the  stomach was found partially, and the small
 intestines extensively, inflamed.  There were no other particular appearances to
 account for death, and this was referred to the effect of the aloes.

                       Savin.  (Juniperus Sabina.)
   This is a well known plant, the  leaves or tops  of which contain  an irritant
 poison in the form of an acrid volatile  oil of a remarkable  odour.   They exert
 an irritant action, both  in the state of infusion and powder. They yield by dis-
 tillation a light yellow oil, on which the irritant properties of the plant  depend.
 The powder is sometimes used in medicine in a dose of from five to twenty grains.
 The substance is not often taken as a poison for the specific purpose  of  destroy-
 ing life;  but this is occasionally an indirect result of its use, as a popular means
 of procuring abortion.  In this way it appears to have proved fatal in one case
 in 1837-8.  From the little that is known of its effects, it  acts by producing vio-
 lent pain in the abdomen, vomiting, and strangury.   After death, the  oesopha-
 gus, stomach and viscera, with the kidneys, have been found either much in-
 flamed or congested.   It has no action as an abortive, except  like other irri-
 tants, by causing  a violent shock to the system, under which the  uterus may
 expel its contents.   Such a result can never be obtained without placing in jeo-
 pardy the life of the woman;  and where abortion follows, she  generally falls a
 victim.   On the  other  hand, the female may be  killed  by the poison  without
 abortion  ensuing.   In  May, 1845, I met with a case in which death had been
 caused by savin-powder,—abortion  having first taken  place.   Eight ounces of
green liquid were found  in the stomach, which, with the oesophagus and the small
intestines, was highly inflamed.  The poison was easily identified by placing some
 of the minute portions of the leaves found in the stomach under a powerful mi-
croscope.  (Med. Gaz. xxxvi. 646.)  [Several cases are on  record in this  country
 of the fatal use of oil of tansy (tanacetum vulgare) for the purpose of producing
abortion.   In one instance a teaspoonful of this oil was  taken  by mistake, in-
 stead of the essence, as  an emmenagogue, by a girl who was ignorant of its poi-
 sonous effects.  She immediately complained of vertigo, and became insensible in
about ten minutes.  Convulsions supervened directly, with frothing at the mouth,
 labour in breathing, irregular pulse, and death in one hour after taking  the oil.
 Am. Jour. Med. Sci., July, 1852, 279.—H.]

                               Croton Oil.
  This is an oil extracted from the seeds of the croton tiglium.   It is a powerful
drastic purgative, producing, in a large dose, severe purging, collapse, and death.
 A case occurred in Paris in 1839, where a man swallowed by mistake two drachms
 and a half of croton oil.    In three-quarters of an hour the surface was cold and
clammy,  the pulse imperceptible, respiration  difficult, and the extremities and
face were as blue as in  the collapsed stage of cholera.   In an  hour and a half
purging set in; the stools were passed involuntarily, and the abdomen was very
 sensitive to  the touch.   The patient complained of a burning pain in the course
 of the oesophagus.   He  died in four hours after swallowing the poison.   There
 was no marked change in the mucous membrane of the stomach! 
CASTOR OIL SEEDS.   THE ELDER.
125
   In June, 1850,1 was consulted in a case in which it was supposed that this
 liquid had been employed for the purpose of destroying life; and although arsenic
 was found in the stomach, it became a question to determine what was the fatal
 dose of this oil.  In this instance, sixty drops had been  sold, mixed with two
 ounces of linseed oil.   This is considered  a proper dose for cattle.  In man, a
 dose of from fifteen to twenty drops of the pure oil, might give rise to excessive
 purging, and thus cause  death  by exhaustion.   The cases recorded of  its fatal
 operation are very few, and do not enable us to solve this question from observed
 facts.  According to Landsberg, as quoted by Christison, (Dispensatory, p. 382)
 thirty drops of the oil  have killed  a dog, and Dr. Christison has known four
 grains  of the oil to produce an  alarming degree of purging.   It is  frequently
 adulterated with Castor oil and other substances, and these adulterations must of
 course  influence the dose required  to  act fatally.  In  a  recent volume of the
 Medical Gazette, there is a report of a case in which a woman died from the ef-
 fects of an embrocation containing croton oil—with other drugs.  A teaspoon-
 ful was incautiously given to her; she immediately complained of a hot burning
 sensation in her throat.   She was an aged person, and died in convulsions in
 three days.  (Med. Gaz.  vol. xliii. page 41.)

                               Castor Seeds.
   Of castor oil  itself nothing need  be said.   It is not commonly known that
 the  seeds from which this  oil is extracted contain in the  embryo a very active
 poison, and  that  a few of  them are  sufficient to produce  violent  purging and
 death.   The following is an instance of poisoning by these seeds,—the only one
 with which I have met.   The deceased, aged eighteen, was the sister of a gentle-
 man who was at the time attending my lectures at Guy's Hospital.
   The  deceased, it appears, ate about twenty castor-oil seeds; one of her sisters
 ate four or five, and another two.   This was on a Wednesday evening.   In the
 night they were all  taken ill.   About five hours after the  seeds were eaten, the
 deceased felt faint and  sick; vomiting and  purging  came on, and continued
 through  the night.   On  the following morning, she appeared  like one affected
 with malignant cholera.   The  skin  was cold and dark-coloured,  the  features
 contracted, and the breath cold;  the  pulse was small  and wiry; there was  rest-
 lessness, thirst, pain in the  abdomen, and she lay in a sort of drowsy, half con-
 scious  state.   Whatever  liquid was  taken was  immediately  rejected,  and the
 matters passed by stool consisted chiefly of a serous fluid, with blood.   She died
 in five days without rallying; the two other sisters recovered.   On inspection, a
 very large portion of the mucous membrane of the stomach was found abraded
 and softened in the course of the great curvature.   There was general vascularity
 of the organ, and the abraded portion presented the appearance of a granulating
 surface  of a pale rose colour; it was covered by a considerable quantity of slimy
 mucus.   The small intestines were inflamed, and the inner surface of them was
 abraded.  The effects produced  on the  sisters  who recovered bear out the state-
 ment of Dr. Christison, that two or three of the seeds will operate as a violent
 cathartic.  [AVe  have  known the castor-bean, as  it is called in  this country, to
 be eaten freely with impunity, and  in  other cases to produce the most  violent
 and even  fatal  emeto-catharsis.   The oil itself is sometimes a  powerful irritant.
 Devergie notices  two cases where death followed in  three hours after the ad»
 ministration of an ounce of this oil.—H.]

                    The Elder.   (Sambucus nigra.)
  Dr. Christison states that the leaves and flowers of the common elder act as an
irritant  poison,  having caused in a boy severe inflammation  of the bowels, which
lasted for eight days.  (Ed. Med. and Surg. Jour, xxxiii. 73.)  The berries of
this tree do not appear to possess, in the  ripe state, any noxious properties.  The 
126
NOXIOUS EFFECTS OF MOULDY BREAD.
 following case of poisoning by the expressed juice of the roots, is reported in the
 Med. Gaz. xxxv. 96.
   A weakly woman, fifty-four years of age, who had been sick all day, and thrown
 up a quantity of greenish matter, which she regarded as bile, was persuaded
 by her husband to take two tablespoonfuls of the juice of the  fresh elder root,
 which he himself had  dug up, shaved down,  and pressed.   The woman  soon
 after complained of severe pain in the abdomen.   She was ordered some infusion
 of senna, but did not take  it,  as  the bowels began almost immediately to act
 copiously.   Next day the symptoms were those of enteritis, which proved fatal.

                            Oil of Turpentine.
   The few cases in which this liquid has produced any noxious symptoms,  have
 occurred among children.  From these it appears to have  rather the effects of a
 narcotic  than an irritant poison.  In a dose of three drachms it produced intoxi-
 cation.   A dose of a tablespoonful caused in a child aged eighteen months, symp-
 toms bearing a strong resemblance to those occasioned by  an overdose of  opium,
 although they were not so rapidly manifested.   (See case by Mr. Johnson, Med.
 Times, Oct. 11,  1851, page 380.)   In three hours there was complete insensibi-
 lity; stertorous  breathing, strongly contracted  pupils, rapid and weak pulse,—
 coldness of surface, pallor of the countenance,'—general relaxation of the mus-
 cles, with occasional convulsive movements.   In  no instance  yet recorded has
 this oil caused death.   A case of recovery in an infant that had swallowed  four
 ounces,  is recorded in another work.  (On Poisons, 528.)

                                Oil of  Tar.
   This is a powerful vegetable irritant.   In 1832, about ten drachms of it caused
 the death of a gentleman, to whom it had been sent by mistake for a black draught.
 The party who sent it was tried for manslaughter, but acquitted.

                              Mouldy  Bread.
   There is a  common article of food, namely, bread, upon the noxious  effects of
 which some observations have been lately made by toxicologists. In the Ann.ol'Hy-
 giene, 1843, pp. 35 and 347, will be found communications on  this subject from MM.
 Guerard, Chevallier," and Gaultier de Claubry.   The changes which take place in
 the decomposition of flour and bread, and the production of  various  kinds of
 mouldiness, are here investigated, together with the effects of such bread upon the
 animal system.   It would appear that in some parts of France the peasantry ma-
 nifest no repugnance to the eating of mouldy bread, and that in many instances
 the practice appears to be attended with no ill effects.   The nature of the mould
 produced, however, is subject to great variation, and it is not improbable, as M.
 Chevallier suggests, that in some cases a poisonous principle  is actually deve-
 loped.   In two  instances of children, who had partaken of mouldy rye-bread,
 symptoms resembling those of irritant poisoning supervened.  The countenance
 was red and swollen; the tongue dry; the pulse  quick; there were violent  colics,
 with pain in the head, and intense thirst.  Vomiting and purging  supervened
 with a state of collapse, but the children eventually recovered.  These symptoms
 were ascribed to the production of "mucor  mucedo" in the bread.   In 1829,
 alarming effects having followed from the use of a certain kind of bread  in Paris,
 M. Barruel was called upon to determine  whether any irritant poison had  or had
 not become accidentally intermixed with it.  The bread was simply in a mouldy
 state; there was no trace of poison.  It is unnecessary to enter further into  this
 subject;  the  facts adduced, together with experiments performed  on animals,
show that bread, in a state of mouldiness, may not only produce symptoms of
poisoning, but actually cause death;  and  as it is  impossible to distinguish  the
noxious from  the innoxious kind of mould, the use of all bread in such  a  condi-
tion should be avoided. 
                   NOXIOUS EFFECTS OF MOULDY BREAD.                 127

  Even fresh bread may occasionally seriously affect the body. The brown bread
of London has been known to produce vertigo, lethargy, and other unpleasant
symptoms, indicative of an affection of the brain and nervous system.   This has
i-ni ascribed, with some probability, to the "lolium temulentum"  (darnel) be-
coming accidentally mixed with the corn.   In one instance in which Darnel seeds
were mixed  in the proportion of one tenth  part with rye, the persons partaking
of the bread suffered from vertigo, headache, nausea, vomiting,  deafness, and
cramps.   (Med. Gaz., xlv. 872.)  Rye-bread is not much used  in this country,
but the accidental presence of the ergot might here, in some cases, account for the
symptoms which have been observed.  (See Ann. d'Hyg. 1834, ii. 179; 1835, ii.
240;  1843, i.  41, 347; Henke, Zeitschrift der S. A. 1842, ii. 185; 1844, i. 286,
ii. 215.)
  Other vegetable irritants might  be enumerated, but these are  the principal
which have  given rise to medico-legal inquiries.   The treatment of  such cases
must depend on the nature of the symptoms; the main object should always be
to remove the poison either from the stomach or bowels, with as  little delay as
possible.  The nature of the poison is  commonly apparent from the circum-
stances ; for these cases,  if we except the substance Savin,  which  is  sometimes
criminally administered, are generally the result of accident.   These vegetable
poisons are beyond the reach of chemical processes: they are  only to be recognised
 ■ither by their physical properties,  or by the botanical characters of the berries,
seeds, or leaves. 
1*28                 POISONING BY ANIMAL IRRITANTS.
ANIMAL   IRRITANTS.
                              CHAPTER XV.

 CANTHARIDES OR SPANISH FLY—SYMPTOMS  AND EFFECTS—ANALYSIS.   POISONOUS FOOD—
   FISH—MUSSELS—SALMON—CHEESE—SAUSAGES--DISEASED FLESH OF ANIMALS.

                     Cantharides.   (Spanish Fly.)
   Symptoms and effects.—This poison has been frequently administered, either
 in the state of powder or tincture, for the purpose of exciting aphrodisiac propen-
 sities, or of procuring  abortion.  When taken in powder, in the dose of one or
 two drachms, it gives rise to the following symptoms :—A burning  sensation in
 the throat, with great difficulty of swallowing—violent pain in the abdomen, with
 nausea, and vomiting of bloody mucus; there is also great  thirst and dryness of
 the fauces, but in a few cases observed by Mr. Maxwell, salivation was a promi-
 nent symptom.  As the case proceeds, pain is commonly experienced in the loins,
 and there is incessant desire to void urine, but only a small quantity of blood or
 bloody urine is passed at each effort.  The abdominal pain becomes of  the most
 violent griping kind.   Diarrhoea supervenes,  but this is not always  observed;—
 the matters discharged from  the bowels  are mixed with blood and mucus, and
 there is often tenesmus, (straining.)   In these, as well as in the vomited liquids,
 shining green particles may be commonly seen on examination,  whereby the  na-
 ture of the poison taken is at  once indicated.  After a time, there is often severe
 priapism,  and  the genital organs are swollen  and inflamed both  in the male and
 female.  In one  instance, observed by Dr. Pereira, abortion was induced, pro-
 bably owing to the  excitement of the uterus, from the severe  affection of  the
 bladder; for there is no proof that this substance acts directly  on the uterus to
 induce abortion.  AVith respect to the aphrodisiac propensities caused by cantha-
 rides, these can seldom be excited in either sex, except when the substance is ad-
 ministered in a dose which would seriously endanger life.  When the case proves
 fatal, death is usually preceded by syncope, vertigo, and convulsions.  The tinc-
 ture of cantharides produces similar symptoms: they are, however, more speedily
 induced, and the burning sensation and constriction of the throat and stomach
 are more strongly marked: it  is often so severe as to render it impossible for  the
 individual to swallow; and the act of swallowing gives rise to the most excruci-
 ating pain  in the throat and abdomen.
  Post-mortem  appearances.—In one well-marked case of poisoning by this sub-
 stance, the whole  of  the alimentary canal, from the mouth downwards  was in a
 state of inflammation, as well as the ureters, kidneys, and internal organs of gene-
ration.  The mouth  and tongue seemed to be deprived of their mucous mem-
brane.  In another instance, where an ounce  of the tincture was swallowed and
death did not occur for fourteen days, the mucous membrane of  the stomach was
not inflamed, but it  was pulpy, and easily detached.   The  kidneys were how- 
CANTHARIDES.   fatal dose.
129
ever, inflamed.  The brain has been found congested, and ulceration of the blad-
der is said to have been met with. There are very few fatal cases reported, in which
the appearances have been accurately noted; indeed, the greater number of those
who  have  taken this poison  have recovered.   In a case  which occurred  to
Mr. Saunders, death  took  place  in about  twenty-four hours.  The deceased
must have  taken the greater part of half an ounce of cantharides in powder.
This was followed by the usual symptoms.   On  inspection, the vessels of the
brain were filled with dark-coloured blood, and the  ventricles were  distended
with serum.   Both lungs were highly engorged with dark-coloured blood.   The
gullet was partially inflamed, and there were patches of inflammation on the mu-
cous coat of the stomach, which had become detached in several  places.   The
same inflammatory appearance existed in  the small  intestines, in the folds  of
which the powder of cantharides was  abundantly seen.   The vessels were dis-
tended, and the liver was engorged with dark blood.   The gall-bladder was much
distended with bile,  and none of this secretion appeared- to have passed into the
bowels.  The spleen and kidneys were highly congested:  the  ureters were in-
flamed;  the bladder contracted and empty, and its internal surface pale.   The
glittering of the particles of cantharides in the viscera  during this  inspection
by candlelight was  very remarkable.   (Medical Times, Feb. 3, 1849, p.  287.)
Cantharides have no local action of a chemical nature.  The poison is a pure ir-
ritant, and the effects observed are entirely due to irritation  and inflammation.
   The quantity of this'poison required to  produce serious effects, or  to destroy
life, has been a frequent subject of  medico-legal inquiry.   Dr. Thomson repre-
sents the medicinal dose of the powder to  be  from one to three grains.   On a
late criminal  investigation,  one medical  witness stated that one grain was the
maximum  dose, but  this is an under-statement; according to Thomson it is three
grains.   The  dose of the London Pharmacopceial  tincture  is from ten minims
gradually increased to one fluid-drachm,—of the powder, from one to two grains.
(Pereira, Mat. Med.  ii. 1846.)  Doses above  this, whether of  the  powder or of
the tincture, are likely to be injurious, and to give rise to symptoms of poison-
ing.  On a trial which took place at Aberdeen, in 1825, it appeared that a drachm
of the powder had been administered: severe symptoms followed, but  the person
recovered.   Dr. Dyce, the medical witness, said  he had given ten grains of the
powder at a dose as  a medicine.  In three cases, observed by Mr. Maxwell, a
drachm of the powder mixed with six ounces of rum, was taken by each person;
they were robust, healthy negroes,—they suffered severely, but  recovered in
about ten days: in these cases, irritation of the urinary  organs did not appear until
after themen had been bled.  The smallest quant ityoi powder which has been known
to destroy life was in the case of a young female, quoted by Orfila,—the quantity
taken was estimated  at twenty-four grains in two "doses.   She died in four  days;
but as abortion preceded death, it is difficult to say how far this may have been
concerned in accelerating that event.  Her intellect was clear until the last.  In
one  instance a man  recovered after having taken twenty grains of the powder,
(Ed. Med. and Surg. Journ. Oct. 1844;) and in another, after having taken two
drachms.   (Med. Gaz. xlii. 873.)
   An ounce of the tincture has been known to destroy life.  It was taken by a
boy, aged seventeen, and he died in fourteen days.  This, I believe, is the small-
est dose of the tincture which has killed.  In the following instance a similar
dose produced only serious symptoms.  A woman, aged twenty-nine,  swallowed
an ounce of tincture of cantharides.   Some time afterwards, there was severe pain
in the abdomen, increased by pressure: it became swollen and tympanitic.   She
passed in the night a pint and a half of urine unmixed  with blood.  In two days,
the pulse became feeble and scarcely perceptible:—there  was delirium, with se-
vere pain in the region of the  kidneys and  bladder: the  urine was continually
drawn off by a catheter.   It was more than a fortnight before she was convales-
cent.   (Med. Gaz. xxix. 63.)  Four  drachms, and even six drachms have  been
       9 
130
CHEMICAL ANALYSIS.
 taken;  and although the  usual symptoms followed, the parties did well.   The
 last case was the subject of a trial at the Central Criminal Court, in September,
 1836.  Six drachms of the tincture were administered to a girl, aged seventeen:
 the medical witness was required to  say whether half an ounce was sufficient to
 kill, as also what proportion of cantharides was contained in an  ounce of the
 tincture:  he said, five grains.  One ounce of the tincture, (P. L.) is equivalent
 to six grains of the powder;'  but considering that the principle cantharidine is
 the substance  on which the poisonous properties depend, it is very likely that
 the tincture varies in  strength according to its mode of preparation.  A case
 is quoted  by Pereira,  from Dr. Hosack (Mat. Med. ii.  1842,) in which  it is
 said six ounces of the tincture were  taken by a man without causing dangerous
 symptoms!  This must have  been  an extraordinarily weak preparation; and
 probably the insects from which the tincture was made  contained little  or no
 cantharidine.   The same writer mentions a case within his own  knowledge, in
 which one ounce of the tincture caused serious symptoms.
   Chemical Analysis.—Cantharidine is the vesicating, and at the  same time
 the poisonous principle of  the insect.  It is a white solid crystallizable  sub-
 stance,  insoluble in  water;  but soluble  in ether, alcohol, the oils and caustic
 alkalies.   Although water does not dissolve it in its pure state, it takes it up with
 other principles from the  powdered  insect; and thus an infusion of cantharides
 is poisonous.  It is very volatile, and produces serious effects in the state of va-
 pour.   There are no  chemical characters by which  this principle can be safely
 identified, if we except its vesicating properties.   Orfila has applied reagents to
 detect cantharidine in  the tincture;  but without  success.   It has been recom-
 mended to digest the suspected solid, or the liquid contents of the stomach eva-
 porated to an extract, in  successive  quantities of ether,—to concentrate  these
 ethereal solutions by slow evaporation, and then  observe  whether the concen-
 trated liquid produces vesication or not; the medical  jurist being expected in
 such cases to make  himself the  subject of experiment.   In this way, Barruel
 discovered cantharides in  some chocolate.   (Ann. d'Hyg.  1835, i. 455.)  This
 mode of testiag is somewhat uncertain, unless the  quantity of poison be large;
 and the affirmative  evidence  which it yields is better than the  negative;  since
 we can  hardly infer the absence of the poison when we obtain no result.   There
 is, however, no other mode  of discovering cantharidine in solution, whether as
 tincture or infusion,  than this.   The difficulty of extracting this  principle may
 be conceived, when  it is stated that, according to Thierry's experiments, which
 are the most perfect, the quantity of cantharidine contained in the poison is
 only about the 250th part  of the weight of the fly,  so  that it would  require
 nearly half an ounce  of the  powder to yield one grain of cantharidine.   The
 quantity required to  produce vesication  is unknown, but it is extremely small.
 Cantharides are most  commonly taken in powder, and then we may easily recog-
 nise  the poison by its physical characters. If the insect be  entire, or only
coarsely powdered, there can  be no doubt of its nature.   However finely reduced,
 the powder is observed to present, by reflected light, small golden-green or cop-
 per-coloured  scales.   These  are perceptible to the  eye, and are very  distinct
 under a common lens, or by the aid  of the microscope.   It has  been recom-
mended to separate  the particles  of cantharides,  by suspending  the liquid or
 other contents of the stomach  in warm water, when the  insoluble powder will
 subside, and they may be collected and dried for examination.   In an elaborate
 essay on this subject (Ann. d'Hyg. Oct. 1842,) M. Poumet recommends  that
 the suspected liquids, mixed  with alcohol, should be spread  on  sheets of o-lass
and allowed to evaporate spontaneously to dryness.  The shining scales wilAhen
b3 seen, on examining, by reflected light, either one or both surfaces of the glass.
 This experiment answers very  well.   He has also  found  that the particles ad-
 hering to the mucous membrane of the stomach or intestines  might be easily de-
 tected by inflating the  viscus,  and allowing it to  become dry in the distended 
NOXIOUS EFFECTS OF ANIMAL FOOD.
181
state, taking care to attach to  it a heavy weight, so that during the process of
drying all the folds of the  mucous  membrane may disappear.  On cutting the
dried membrane, and opening it on a flat surface, the shining scales are percep-
tible.  Physical evidence of this  kind would not be of much avail for medico-
legal purposes, unless there were concomitant evidence from symptoms and post-
mortem appearances.  In trials for administering, the analysis might be confined
to the article administered;  and the physical test is then applicable, since the
powder is commonly given  in very  large quantity.  There are many insects be-
sides cantharides, which have wings of a golden  green  colour, and are not poi-
sonous , yet such insects are not likely to be found in the state of powder in the
human stomach.   M. Poumet states that there are some cantharides which con-
tain no cantharidine.
   The evidence of the presence of cantharides, or of their having been taken, is
necessary to support a criminal  charge; for, however unambiguous the symptoms
produced by this poison may appear to be in its peculiar effects upon the genera-
tive and urinary apparatus, the  medical  jurist should be aware  that similar
symptoms may proceed from disease.   An important case of this kind has been
reported by Dr. Hastings.   (Med. Gaz. xii. 431.)   A young lady was suddenly
seized with  vomiting, thirst, pain in the loins, strangury and considerable dis-
charge of blood from the urethra: the generative organs were swollen and pain-
ful.  She died in four days.  She was governess  in a family, and there was some
suspicion  that she had been poisoned by cantharides.   The  stomach and the
kidneys were  found inflamed, and  the bladder also: this contained about two
ounces of blood.   There was no trace  of poison; and, indeed, it was  pretty cer-
tain, from the general evidence, that none could  have been taken.
   Particles  of cantharides may be detected in the viscera long after interment.
Orfila has detected them after a period of nine months, so that they do not seem
to be affected  by the decomposition of the body.   [Several species of Lytta, pos-
sessing all the properties of cantharides, are to be found in this country.  An ac-
count of them may be found in the  Phila. Journ. of Pharm.   776.—H.]

                             Poisonous Food.
   Certain kinds of animal  food  are found to produce, occasionally, symptoms
resembling  those of irritant poisoning.   In some cases  this poisonous effect ap-
pears to be due to idiosyncrasy; for only  one  person out of several may be
affected.   These cases are of some importance to the medical jurist, since they
are  very likely to give rise to unfounded charges of criminal  poisoning.  In
the absence  of any demonstrable  poison, we must test the question of idiosyn-
crasy by observing whether more than one person  is affected, and whether the
same kind of food, given  to animals, produces symptoms  of poisoning.  If,
with this latter condition, several  persons be affected simultaneously, we cannot
refer the effects to idiosyncrasy;  they are most probably due to  the presence of
an animal poison.   Among the articles of food which have given  rise to symp-
toms of poisoning,  may be mentioned,—
   Poisonous Fish.   Mussels.   Salmon.—Of all the varieties of  shell-fish, none
have so frequently given rise to accidents as the common mussel.  The symp-
toms which  it produces are, uneasiness and sense of weight in the stomach, sen-
sation of numbness in the extremities, heat  and constriction  in the mouth and
throat;  thirst, rigors, difficulty of  breathing, cramps in the  legs,  swelling and
inflammation of the eyelids, with a profuse secretion of tears, and heat and itch-
ing of the skin, followed by an eruption resembling nettle-rash.  The symptoms
are  sometimes accompanied by vomiting, colic, and purging.  They may occur
within ten minutes or a quarter of an hour; but their appearance has been de-
layed for  twenty-four hours.  There  is generally great debility.   These symp-
toms have proceeded from  the eating of not more than ten  or twelve mussels.
Two cases, reported  by Christison, proved fatal, the one in three, and the other 
132
NOXIOUS EFFECTS OF ANIMAL FOOD.
in about seven hours.  In general, however, especially where there is free vomit-
ing, the patients recover.  In the inspection of the two above-named fatal cases,
no appearance was found to account for death.  The treatment consists in the
free exhibition of emetics.  A case in which two mussels produced in a boy aged
ten, very alarming symptoms, followed by an eruption resembling scarlatina and
nettle-rash, will be found elsewhere reported.  (Guy's Hosp. Reports, Oct. 1850,
213.)
   The poisonous action of mussels can neither  be referred to putrefaction nor
disease;  nor in  all cases to idiosyncrasy, since  sometimes those mussels only
have been poisonous which have been taken from a particular  spot: all  persons
who partook of them suffered, and a dog was killed to which some of them were
given.   From a case which occurred to M. Bouchardat, it would  appear that
copper is sometimes present, and may be the cause of the poisonous effects. Two
women were poisoned by mussels, and he  found on  analysis sufficient copper in
the  fish to  account  for the symptoms  of irritation from  which they suffered.
(Ann.  d'Hyg. 1837, i. 358.)  Copper is not, however, present in all cases, and
it is therefore probable that there is in some, if not in  all  instances, an animal
poison present in the fish.  Oysters and  Periwinkles have occasionally given rise
to similar symptoms.   Salmon, sold in the state of pickled salmon, or even
Herrings salted, may also act as irritants:  this may be due  to the fish being par-
tially decayed before it is used.   In 1834, two persons at  Maidstone lost their
lives from eating salmon of this description.
   Cheese.  Sausages.—These articles of food have frequently given rise to symp-
toms of poisoning in Germany, but there is, I believe, no instance of their having
proved fatal in England.   The symptoms produced by cheese have been those of
irritant poisoning.  The nature of the poison is unknown.  In some cases the
irritant property is undoubtedly due to a putrefied state  of  the curd.  Again, it
has been supposed that the poison is occasionally derived from certain vegetables
on which the cows feed.   The symptoms caused  by the sausage-poison are very
slow in appearing,—sometimes two, three, or four, days elapse before they mani-
fest themselves:  they partake of the narcotico-irritant character. This poison is
of a very formidable kind.   In the Medical Gazette for Nov. 1842, there is an
account of the cases of three persons, who had died from  the effects of liver-
sausages, which had been made from an  apparently healthy pig, slaughtered only
a week before.  The inspection threw no light on the cause of death.  The poi-
sonous effect is supposed to depend on a partial decomposition of the fatty parts
of the  sausages.   It is said, that when extremely putrefied, they possess no poi-
sonous properties!
   Pork.  Bacon.—These common articles of food occasionally give rise to symp-
toms so closely resembling those  of irritant poisoning, as to be easily mistaken
for them.  In some cases, the effect appears to be due to idiosyncrasy;  but in
others it can only be explained by supposing the food to have a directly poison-
ous action.  The noxious effects  of pork  have been particularly shown  by the
cases published by Dr. MacDivitt.   (Ed. Med. and Surg. Jour. Oct. 1836.)
   There is no doubt that epizootic disease may be a frequent cause of rendering
animal food  poisonous.   Partial decay  may also render unwholesome and inju-
rious the flesh of  the most healthy animal.  What the  nature of the poison is,
We are  quite unable to determine.   Liebig imagines  that it is owing to the pro-
duction of a fermenting  principle, and  that it operates fatally by producing a
kind of fermentation in the animal body.    It has been said that the symptoms
of irritant poisoning produced by animal  food, seldom appear  until five or six
hours after the meal.  This may  be generally true, but in  certain  instances it
has undoubtedly happened that the symptoms came on in from a quarter  to half
an hour after the noxious food was taken.
  Much of the game and butcher's meat sold to the poor in  this metropolis is in
a state of decay, and quite unfit for human food.   In January, 1851 the family 
FLESH OF DISEASED ANIMALS.
133
of a surgeon near London were all affected with symptoms resembling irritant
poisoning, after  having partaken of a  hare which had been stewed in a clean
earthen vessel.   The surgeon informed me that on the second day, his wife was
seized  with  vomiting and purging, giddiness, heat in the throat, and general
numbness, with semi-inflamed eyes.   Other members of the family vomited, and
in the course of a few days the symptoms disappeared.  I examined the vomited
matter, and  found it to consist of portions of the hare, partially digested, but in
a state of putrefaction, so that there was abundant evidence of sulphuretted hy-
drogen  in the liquid.   There was no mineral  poison of any kind, although the
symptoms, it will be observed, were rather like those occasioned by arsenic.  It
had been remarked  by the family, that a silver  spoon which had been used in
serving out  this unwholesome food, was turned of a brown colour, no doubt from
the chemical action of sulphuretted hydrogen; and this may be taken as a good
domestic test of the putrefied condition of such food.   Nature generally applies
an appropriate remedy, in the fact that the food itself produces copious vomiting
and purging.
   Cases of  this kind must be distinguished from those in which poisoned game
is sold to the public.   The game may be quite free from putrefaction, but noxious.
from the poisoned grain which may have caused death.  It is a very common
practice to steep grain in a solution of arsenic previous to sowing, and pheasants,
partridges, and other birds, may be accidentally  destroyed by eating the  grain.
In some instances, grouse and other game are maliciously destroyed by corn sa-
turated with arsenic being laid in the localities where the birds abound.   There
is no law to prevent the  sale of the poisoned game by poulterers, and there is no
precaution which can be  taken, except by observing whether the birds have been
shot.   (See the work On Poisons, p.  164;  also on this  subject, a letter by Dr.
Fuller, Med. Gaz. xlii. 1036.)
   [The most frequent cases of poisoning from animal substances in the United
States, have occurred from the pheasant.  (Tetrao umbellus.)   This bird, during
the winter season, has sometimes caused dangerous symptoms  in persons who
have eaten it.  These have generally been attributed  to the  fact of the bird
having fed upon the leaves and buds of the Laurel (Kalmia,) and  many facts
have been adduced which are considered as corroborating this  opinion, the most
 striking of  which is the occurrence of the leaves of  the plant in the crops of the
 birds.  Notwithstanding this almost universal belief, Dr. Griffith, from whom we
quote,  is by no  means satisfied with this explanation, but is inclined to attribute
it to some change in the flesh analogous to that  noticed above as taking place in
other meats, since the symptoms are almost identical, and these cases are rare,
whilst nearly all these birds feed on the  laurel, when the ground is covered with
snow, and other food cannot be readily obtained.
   AVe have known cases also of serious irritation of the kidneys and bladder,
from eating game which had been rendered poisonous by feeding on the potato
fly, a species of Lytta.
   But by far the most interesting subject connected with animal poisons in this
country is that of "milk sickness," as it is termed, a disease with symptoms re-
sembling those caused by the animal poisons, which has been not unfrequent and
oftentimes fatal, in some of the western States, and is  almost universally attri-
buted to poison communicated to the milk from  some noxious plant eaten by the
cow.  It is also stated that the flesh of  the animal becomes equally deleterious
with the milk.  The accounts of this  disease, as Dr. Griffith justly says, are by
no means satisfactory, nor has it been shown that any plants fed on by the cow
are capable of thus  rendering  the secretions  and flesh of the  animal so highly
noxious.   From all the evidence on the subject, he considers it more probable
 that it is rather attributable to some peculiar disease of the cattle, more especially
 ks it  is known that murrain will thus render the flesh of animals poisonous  to
M<an.   Sec  Am. Med.  Recorder, vi. 257; Am. Journ. Med. Science, 1841; New
 York Journ. Med. 1843; also Taylor on Poisons, 441, 456.—II.] 
1U
EFFECTS OF NARCOTIC POISONS.
NARCOTIC  POISONS.
                             CHAPTER XVI.

narcotic poisons—opium—symptoms — period of commencement—post-mortem ap-
  pearances--quantity required to destroy life--death from small, and recovery
  from large doses--its action on infants--period at which death takes place—
  poisoning by poppies--godfrey's cordial--daley's carminative--paregoric elixir
  —Dover's powder—morphia and its salts—black drop—sedative solution—tests
  for morphia and  meconic acid—process for detecting opium in organic mixtures.

                                  Opium.
   Symptoms.—The symptoms which manifest themselves when a large dose of
opium or its tincture has  been taken, are in general of a uniform character.
They consist in giddiness,  drowsiness, strong tendency to sleep,  stupor, suc-
ceeded by perfect insensibility, the person lying motionless, with the eyes closed
as if in a sound sleep.   In  this stage  he may be easily roused by a loud noise,
and  made to answer  a question;  but he speedily relapses  into stupor.   In a
later stage, when coma has supervened with stertorous breathing, it will be diffi-
cult, if  not impossible, to rouse him.   The  pulse is at first  small, quick, and
irregular, the respiration hurried, and the skin warm and bathed in perspiration
—sometimes  livid: but when the individual becomes comatose, the  breathing is
slow and stertorous: the  pulse slow and full.   The skin is occasionally cold and
pallid.  The  pupils are  sometimes contracted, at others dilated.   From cases
which I have been able to collect, contraction of the pupils is much more fre-
quent than dilatation.  In  a case referred to me in 1846, one pupil was con-
tracted  and the other dilated.  They are commonly insensible to light.   The
expression of the countenance is placid, pale, and ghastly: the eyes are heavy,
and the lips are livid.  Sometimes there is vomiting,  or even  diarrhoea;  and if
vomiting takes place freely before stupor sets in, there is great hope of recovery.
This symptom is chiefly observed when a large  dose  of  opium has been taken;
and it may then be, perhaps, ascribed to the mechanical effect of the poison on
the stomach.   The odour  of  opium is occasionally perceptible in  the breath.
Nausea and vomiting, with headache, loss of appetite  and lassitude, often follow
on recovery.   The muscles of the limbs feel flabby and relaxed, the lower jaw
drops, the pulse becomes feeble and imperceptible, the sphincters are in a  state
of relaxation, the  temperature of the body is low, there is a loud mucous rattle
in breathing, and convulsions  are  sometimes observed before death: these are
more commonly met with in children than in  adults.  One of the marked effects
of this poison is to suspend all the secretions  except that of the skin.  During
the lethargic state, the skin, although  cold, is often  copiously bathed in perspi-
ration.   It is a question yet to be determined, whether this may not be the
medium by which the poison is principally eliminated. 
OPIUM,   post-mortem appearances.
135
   These symptoms usually commence in from half an hour to an hour after the
 poison has been swallowed.   Sometimes they come  on in a few minutes, espe-
 cially in children; and at others their appearance is  protracted for a long period.
 In a case reported by Dr. Skae, the  individual was  found  totally insensible in
 fifteen minutes.  As  we might expect, from the facts connected with the absorp-
 tion  of  poisons, when  the  drug is taken  in  the  solid state, the symptoms are
 commonly more slow in appearing, than when it is dissolved in alcohol.
   Post-mortem appearances.—In a case which proved fatal  in fifteen hours, ex-
 amined  at Guy's Hospital a few years since, the vessels of the  head were found
 unusually turgid throughout.   On the  surface of the anterior part of  the  left
 hemisphere there "was an ecchymosis,  apparently produced by the  effusion  of a
 few drops of blood.  There were numerous bloody points on the cut surface of
 the brain:—there was  no  serum collected in the ventricles.  The stomach was
 quite healthy.   Fluidity of the blood is mentioned  as a common appearance in
 cases of poisoning by opium.  There is also  engorgement  of the lungs; most
 frequently, according to Dr. Christison, in those cases which have been preceded
 by convulsions.  (Op.  cit. 732.)  Among the external appearances  there is
 often great lividity of the skin.  This  may be taken as a general statement of
 the post-mortem appearances in poisoning by opium.  Extravasation of blood
 on the brain is rarely seen;—serous effusion in the ventricles, or between  the
 membranes, is  much more common.   The stomach is so seldom found otherwise
 than in a healthy state, that the inflammatory redness said to have been occa-
 sionally met with, may be regarded as probably due to accidental causes.   When
 tincture of opium has been taken and retained on  the stomach, increased vascu-
 larity in the mucous membrane may occasionally be produced by the  alcohol
 alone.
   In a case of poisoning by a large dose of tincture of opium, Dr. Sharkey found
 the following appearances twelve hours  after death:—The body warm and rigid;
 the stomach healthy, containing a quantity of  a  gruel-like fluid, without  any
 smell of opium.  The  intestinal canal and all the  other viscera were healthy.
 The veins of the scalp, as well as  of the  dura mater and sinuses, were gorged
 with  blood; but there was no effusion in any part  of the  brain.  The contents
 of the stomach yielded  no trace  of morphia or  meconic acid, but there  was no
 doubt that death had been caused by  opium, taken the previous night.   (Med.
 Gaz.  xxxvii. 235.)
   This description of the appearances  refers to the action of large doses on adults.
 In a  case which  I  had to  investigate a few years since, a  child aged fourteen
 months was killed in  eighteen hours,  from  the  effects of a  dose of infusion of
 opium, equivalent to from three to five grains of the  powder.  The inspection of
 the body was made about twenty-four hours after death.  It was not emaciated;
 and, externally, there  were no  particular appearances, excepting a few livid spots
 on the skin of the abdomen, back, and genitals, as also on the upper part of the
 thighs, sides, and back of the neck.   The eyelids were open; the eyes sunk into
 the orbits, and  their transparency gone: the child,  it seems, had died with its
 eyes prominent and open.  The pupils appeared contracted, but the condition of
 the iris was not particularly noticed during life.   The viscera of the chest were
 perfectly  healthy; there was  no mark  of  effusion,  or of any organic disease.
 The right cavities of the heart were congested, and the lining membrane of the
 organ was observed to  be somewhat  opalescent.   The viscera of the abdomen
 were also healthy, except the kidneys, the cortical structure of which had under-
 gone some change from  disease, although to a very slight  extent.  It had  evi-
 dently had no influence on the illness  and death  of the child.  The peritoneum
 presented, in some  parts, patches of  a  milky whiteness; but there was  no  ap-
pearance of  inflammation or effusion.  The stomach  was perfectly healthy;  the
mucous membrane was raised into numerous rugae, but there was no trace of in-
flammation or disease in any part.  The cavity of the organ  contained about a 
136
ACTION on infants.
teaspoonful of a white viscid liquid, apparently consisting of milk and mucus in
a semi-digested state.   There was no farinaceous or any other food present, and
no smell of opium; nor was the slightest trace of  morphia or meconic acid de-
tected in it on analysis, although the child had not vomited, but had remained
throughout in a state  of insensibility.   The intestines were found quite healthy.
On opening the duodenum and jejunum a small quantity of liquid, similar to
that contained  in the stomach, was observed: this was  also collected and set
aside for analysis.   In the cranium, the blood-vessels  of the brain were found
much congested;  but  there was no effusion or extravasation of .blood or serum.
In all other respects,  the brain presented its usual  healthy characters.
   From this  account  of the post-mortem appearances it will be  seen that  there
is nothing  but turgescence of the vessels of the brain, which can be looked upon
as indicative  of poisoning by opium, and even this is not always present.  This
condition of the brain, however, if it exist, can furnish no evidence of poisoning,
when taken alone, since it is so frequently found, as a result  of morbid causes,
in otherwise healthy subjects.   The occasionally anomalous nature of the symp-
toms and  post-mortem  appearances  in  poisoning  by opium, is well  shown in a
case communicated to me in November, 1850, by "Mr. AAralter Clegg, formerly a
pupil of mine, and now Deputy Coroner  for the County of Lincoln.  A man,
aet. 56,  in good health, swallowed by mistake in two pills from twenty-eight to
thirty grains of  the  opium of  commerce.   This  was at three  o'clock in  the
morning, and he died rather suddenly at one o'clock in the day—i. e. ten  hours
after taking the drug.   In about an hour he began to moan; there was twitching
of the head and arms, and copious perspiration, with alteration of speech; but
he retained his senses, was a little drowsy at intervals, and vomited occasionally.
He dressed himself as usual in the morning, and complained of severe pain in
his stomach.   He was seen by a medical man about two hours before his death:
there was no coma,contraction of the pupils, nor any other symptom of poisoning
by opium.   Even the vomited liquid had no  smell of the drug.  He walked in
a trembling way.   As it was not supposed that he could have swallowed opium,
no emetic was given.   After death, there was no turgescence of the vessels of
the brain, or  of its membranes, but there was  such congestion at the greater end
of the stomach as to lead to the supposition that irritant poison had been  taken.
No irritant poison was found, but there were distinct indications of opium.   The
poison appears in this case to have produced  no effect on the  brain, but to have
exerted  its influence chiefly on the nerves connected with speech and motion.
   Quantify required  to destroy life.—The medicinal dose of opium, in extract.
or poicder, for a healthy adult, varies from half a grain to two grains.  Five
grains would be a very full dose.  The medicinal dose of the tincture  is from ten
minims  to one  drachm,—as an average, from thirty to forty  minims.   The
smallest dose  of solid  opium which has been known to prove  fatal  to an adult,
was in a case reported by Dr. Sharkey, of Jersey.   A man, aged 32, died very
speedily in a convulsive fit, after having taken two pills, each containing  about
one  grain  and  a quarter of extract of opium.   This quantity is equivalent to
four grains of crude opium.  (Med. Gaz. xxxvii. 236.)   The smallest fatal dose
of the tincture in an adult, which I have found recorded, is two drachms.   The
case is reported by Dr. Skae.  (Kd. Med. and Surg. Journ. July, 1840.)   The
patient  was a robust man, aged fifty-six;—he  swallowed the tincture at  ten in
the  evening, and died under the usual  symptoms the following morning;  the
case thus lasting only twelve hours.  The quantity actually swallowed, however,
appears to  be involved in some doubt; for it is subsequently stated (p.'l60) that
half an ounce of laudanum may have been taken.   Very large doses  of the tinc-
ture have frequently been  taken without proving  fatal.  I have elsewhere re-
corded  a case in which  five ounces of laudanum were taken  without producing
sleep, and  the patient recovered. (Guy's Hosp. Reports, Oct. 1850, p. 220.)
   Action of  opium on infants.—As connected with this subject, it is important 
OPIUM.   PERIOD OF DEATH.
137,
for a medical jurist to bear in mind, that infants and young persons  are  liable
to be killed by very small doses of opium:  they appear to be peculiarly suscep-
tible of the effects of this poison.  Dr. Ramisch, of Prague, met with an instance
of a child four months old, that was  nearly killed by the administration of one
grain of Dover's powder, containing only the tenth part of a grain of opium:—
the child suffered from stupor and other alarming symptoms.  The following case
occurred in June, 1832.  Four grains  of Dover's powder (containing less than
half a  grain of opium) were given to a  child four years and a half old.  It soon
became comatose, and died in seven hours.  Death was referred to inflammation
of the  throat, and the jury returned the usual unmeaning verdict of "Died by
the visitation of  God;" but there was  no doubt  from the evidence, that  death
was caused by the opiate medicine.   Dr. Kelso also met  with an instance where
a child, nine months old, was killed  in nine hours by four drops (minims?) of
laudanum, equal to only one-fifth part  of a grain of opium: it was much con-
vulsed before death.   A case is referred to in a late number of the Medical Ga-
zette, in which two drops (minims?) of laudanum, equal to the tenth part of a
grain of opium, killed an infant.  The  following is a  more recent illustration of
the fatal effects of a similar dose.  A nurse gave to an infant, five days old, two
dmp>s (minims?) of laudanum, about three o'clock in the morning.   Five  hours
afterwards, the child was found by the  medical attendant in a state of complete
narcotism. It was revived by a cold bath, but a relapse came on, and it died the
same evening, about eighteen hours after the poison had been given to  it.  On
inspection, the brain  and abdominal viscera were found  in  a perfectly healthy
state, and there was no smell of opium in the stomach. (Prov. Med. Journ. Oct.
28, 1846, p. 519.)  The fatal dose here, as  in the former case, was equal to the
tenth  part of a grain of opium, and  to only an infinitesimal dose of morphia!
In some instances infants have been found to have an astonishing power of re-
covery.  Dr. Guy met with a case  in which an infant of six months recovered
after having had administered to it ten  grains of Dover's powder, = one grain
of opium  (Lancet, June 8,  1850;) and Mr. Tubbs  has  informed  me, that in a
case which occurred in January, 1852,  aninfant of nine months recovered under
treatment from a dose of two teaspoonfuls of laudanum, given by mistake.  This
quantity left by  evaporation four grains of an impure extract of  opium.
   Period at which death takes place.—It has been remarked, that most cases of
poisoning by opium  prove fatal in from about six to twelve  hours.  They who
recover from the stupor, and survive longer than this period, generally do well;
but from  some cases  which have occurred, it  would seem that there may be a
partial recovery,  or a remission of the symptoms, and afterwards a relapse.  The
symptoms, however, generally progress steadily to a fatal termination, or the
stupor  suddenly disappears, vomiting ensues, and  the individual recovers.  Seve-
ral instances are  recorded of this poison having destroyed life in from  seven to
nine hours.   One has occurred within my knowledge in  which an adult died in
five hours after taking the drug prescribed for him by a  quack.   Dr. Christison
met with a case which could not have lasted above five, and another is mentioned
by him which lasted  only three hours.  Dr. Beck quotes a case which proved
fatal in two hours and a half.   (Beck,  Med. Jur. 873.)   The most rapid case of
death yet  reported was that of a soldier who was accidentally poisoned, in Sep-
tember, 1846, in the Hospital of Val-de-Grace.  It appears  that he swallowed
by mistake about an ounce of laudanum, and died in convulsions in three-quar-
ters of an hour afterwards.  (Journal de Medecine, Oct. 1846, p. 475.)   For a
similar case, see  Med. Gaz. xlv. 743.   It is  possible that the  drug may even kill
with greater rapidity than this; but as  a medico-legal fact, we are at present en-
titled to state, that it has destroyed life  within the short period above mentioned.
On the other hand, the  cases are sometimes much protracted.  There  are seve-
ral instances of  death in fifteen or seventeen hours.   I have  known  one case
fatal in twenty-two hours, and among those  collected  by Dr. Christison, the
longest lasted twenty-four hours.  (Op. cit. 712.) 
 138       poppies.  Godfrey's cordial,  dalby's carminative.

                          Poisoning by Poppies.
   The heads of the white poppy, grown in this country, have a narcotic action.
 They yield an inspissated extract called English opium, which, according to Mr.
 Hennell, contains five per cent, of morphia.  The white poppy-heads, therefore,
 yield to water, in the form of decoction, a poisonous substance capable of act-
 ing deleteriously on children.   Many cases of poisoning have occurred from the
 injudicious use of Syrup of poppies, which  is nothing  more than a sweetened
 decoction of the poppy-heads.   This syrup is  said to contain one grain of extract
 (opium) to one ounce (Thomson.)  The common  dose of it for  an infant three
 or four months old, is half a drachm; for adults, two to four drachms.  (Pereira,
 ii. 1769.)  There is some  reason to  believe that what is often sold by many drug-
 gists for syrup of poppies as a soothing or cordial medicine for  children, is no-
 thing more than a mixture of  tincture or infusion of opium with simple syrup:
 it is, therefore, a preparation of very variable strength.  This may account for
 what appears to many persons  inexplicable, namely, that an infant may be de-
 stroyed by a very small dose.  In January, 1841, a child six months old is said
 to have died  from the effects of less than  half a teaspoonful of syrup of poppies
 bought at a retail druggist's.   The narcotic  symptoms were fully developed in
 three quarters of an hour.  The syrup in this case probably contained  tincture
 of opium.   Seven children are reported to have lost their lives by this syrup in
 1837-8.  In one of these cases, a teaspoonful and a half was given.  Stupor came
 on  in half an hour, and the child  died the following  day.   A teaspoonful  has
 been known to prove fatal to a healthy child.   (Pereira, ii. 1769.)

                           Godfrey's Cordial.
  This is chiefly a mixture of infusion of sassafras, treacle, and tincture of opium.
 The quantity of tincture of opium,  according to Dr. Paris,  is about one drachm
 to six ounces of the mixture, or half a grain of  opium  to one ounce; but it is
 very probable that, like the so-called syrup of poppies,  its strength is subject to
 great variation.  A case has been reported, in which half a tea-spoonful, = l-32nd
 part of a grain of opium, was alleged to have  caused the death of an infant.  In
 1837-8, twelve children were admitted to have been killed by this mixture alone.
 The explanation of this is, that the medicine  is given in  large doses by very ig-
 norant persons.  [The U.  S. Pharm. directs rather more than one grain of opium
 to the fluid ounce.]

                         Dalby's Carminative.
  This is a compound of several essential oils and aromatic tinctures in pepper-
 mint water, with carbonate of  magnesia and  tincture of opium.  According to
 Dr. Paris, there  are five minims of the  tincture, or one quarter of  a grain of
 opium, to rather more than two ounces of this mixture, or the one-eighth of a
grain to  an ounce.   The  formula commonly given is—carbonate of magnesia
two scruples, oil of peppermint one  minim, of nutmegs two minims,  of  aniseed
three minims, tincture of opium five minims, spirit of  pennyroyal and tincture
of assafcetida of each fifteen minims, tincture of castor and compound tincture of
cardamoms of each thirty  minims, and of peppermint water two ounces.   Ac-
 cording to this formula, tincture of opium forms  the 1-211th part by measure,
 or one teaspoonful would  contain the  l-64th part of a grain of opium.  Like
most of these quack-preparations, it probably varies in strength:  An infant is
reported  to have been destroyed by forty drops of this nostrum—a quantity  ac-
 cording to  the strength assigned, equivalent  to more than two minims of  the
tincture,  or one-tenth of a grain, of opium.  Accidents  frequently occur from
its use, partly owing to ignorance, and partly to gross carelessness on  the part of
mothers and nurses. 
paregoric,  black drop.                     139
         Paregoric Elixir.   Compound Tincture of Camphor.
  This is a medicinal preparation of alcohol, opium, benzoic acid, oil of aniseed,
and camphor.   Opium is the active ingredient, and of this, the tincture contains
rather less than one grain in every half ounce (nine grains to five ounces.)
  In one case of poisoning by this tincture, a child aged seven months was killed
by a tea-spoonful given in two "doses at an interval of a day;  i. e. by a quantity
equal to one quarter of a grain of opium.  (Pharmaceutical Journal, April, 1845.)

                Dover's Powder.   (Pulv. Ipecac. Comp.)
  This is a preparation of opium, the effects of which on young children have
been already adverted  to.   The proportion of opium is one-tenth part, or  one
grain in every ten grains of the powder.  A child has been killed by four
grains;  therefore by a quantity containing about two-fifths of a grain of opium;
but Dr. Guy has reported a case in which an infant of six  months recovered,
under active treatment, from a dose of ten grains.  (Lancet,  June 8, 1850.)

                         Morphia and its Salts.
   Morphia and its saline combinations must be  regarded as active poisons.  The
pure alkaloid is known from its  salts by its great insolubility in water; and owing
to this property some have regarded it as less poisonous.   The acid secretions of
the stomach would, however, dissolve it in sufficient quantity to produce very
speedily dangerous effects.   The two principal salts of morphia are the muriate
and the acetate.
   Symptoms.—They generally commence  in from five to twenty minutes after
the dose of poison  has been swallowed; and they very closely resemble those
observed in  poisoning by opium.   As a summary, it may be  stated that they
consist in dimness of sight, weakness and  relaxation of the muscular system,
tendency to sleep, stupor, loss of consciousness, coma, stertorous respiration, and
more commonly than in poisoning by opium, there are convulsions.  According
to Orfila, in nineteen-twentieths of  all cases, the pupils will  be found strongly
contracted, a statement which I believe to be correct: the few exceptional cases
were those  in which the dose was excessive, and the symptoms were unusually
violent.  The  state of the pupils gave rise to great difference of opinion among
the medical witnesses on the trial  of Dr. Castaign.  (Orfila, ii.  185;  On Poi-
sons, 615.)  The condition of the  pulse varies greatly.  In some cases, there
is great irritability with itching of the skin, and irritability of the bladder with
difficulty of passing urine.   Vomiting and diarrhoea have been met with in those
instances in which the  dose was large.
  Post-mortem appearances.—The only post-mortem appearance which can be
referred to the action  of morphia, is fulness of the cerebral vessels, with occa-
sionally serous effusion.  These poisons have no local irritant action, and they,
therefore, leave no marks of their operation in the stomach and bowels.

                              Black  Drop.
  This is a preparation of opium, in which the morphia is combined with acetic
acid, and very little meconic acid is present.  In the Black  drop, according to
Pereira, verjuice, the juice of the wild crab, is employed as a  menstruum instead
of vinegar.  The Black drop is considered to have, from three to four times  the
strength  of  the  tincture of opium.   The formula for this preparation will be
found in Dr. Neligan's work, On Medicines, &c, p. 235. According to this, it
is a compound of half  a pound of opium to three pints of the expressed juice
of the wild crab.
  It resembles the Acetum  Opii, and has more than twice the strength of lauda-
num.   [The Black drop of the U. S. Pharm. contains about  one grain  of opium
to from six and a half  to seven minims.] 
140
SEDATIVE SOLUTION.
                            Sedative Solution.
   This is an aqueous solution of opium with a little spirit and less meconic acid
 than the common tincture.   (Pereira, ii. 1772.)  It is considered to have three
 times the strength of tincture of opium; but there is so great a difference of opi-
 nion on this point, that Dr..Neligan represents it as being only of about the same
 strength as laudanum.  (Medicines, &c, 236.)  He states that it is composed of
 three ounces of extract of opium, six drachms of spirit, and as much distilled
 water  as will make up two pints.  It appears to be an energetic preparation.
 Mr. Streeter stated at the Westminster Medical Society, Dec. 1838, that he had
 known one drachm and a half of it prove fatal to a lunatic; and twenty minims
 of the solution destroyed the life of an old woman.  A medical gentleman, lying
 dangerously ill from an attack of dysentery, took, by mistake, about seven drachms
 of Battley's Solution.  Within  five minutes, salt and water, with mustard, were
 administered, and twenty-four grains of sulphate of zinc.   Vomiting  ensued:
 the  emetic was  repeated, and with the  same effect; the fluid evacuated at  the
 second vomiting  having  the usual smell of  opium.  Half a drachm of ipeca-
 cuanha was afterwards given, to complete  the  emptying of the stomach. Not-
 withstanding this repeated vomiting, symptoms  of narcotism  presented them-
 selves speedily,  with contraction of the pupil, and very great drowsiness—ren-
 dering it necessary to  remove him from bed  in  his very debilitated  state, and
 keep him constantly moving, until about 9 P. M. (seventeen hours,) when vomit-
 ing  came on spontaneously, and he was put to bed, and  allowed to sleep.  The
 original disease  afterwards resumed its course (complicated by an attack of gas-
 tritis,) and at length terminated favourably; but the patient had no recollection
 whatever of what occurred for twenty-four hours after the administration of the
 emetics;  and it appeared to his  medical attendants that  an excited state of the
 mind remained  for some days  afterwards.  (Prov. Journ., Jan. 28, 1846, 42.)
 The recent melancholy death of Dr. Badeley, of Chelmsford, from  a dose of this
 solution taken  medicinally, furnishes an additional proof of the dangerous un-
 certainty in the strength of  this preparation.
   Chemical analysis.   Opium.—There are no means of detecting opium itself,
 either in  the solid or liquid state, except by its smell and other physical proper-
 ties, or by exhibiting a portion of the suspected  substance to  animals, and ob-
 serving the effects produced.  The smell is said to be peculiar,  but a similar smell
 is possessed by  lactucarium, which contains neither meconic  acid nor morphia.
 The odour is a good concomitant test of  the presence of  the drug, whether it be
 in a free state, or dissolved in alcohol or water, but it is not perceptible when the
 solution is much diluted.   I found  that half a grain of powdered opium, dis-
 solved in half an ounce of water,  lost its characteristic  smell  by a short expo-
 sure.   The odour is decidedly volatile, and passes off when an opiate liquid is
 heated; it  also  escapes slowly at common temperatures.   Again, it may be easily
 concealed by other odours, or the drug may undergo some change in the stomach
 during life which may destroy the odour.  The analysis in cases of poisoning by
 opium is therefore limited to the detection of morphia and meconic acid.
   Morphia.—Morphia is known by the following properties:—1.  It crystallizes
 in fine prisms, which are white and perfect, according to their degree of purity.
 2. When heated on platina, the crystals melt, become dark-coloured, and burn
 like a resin with  a yellow smoky flame, leaving a carbonaceous residue.   If this
 experiment be performed in a small reduction-tube, it will  be found by employ-
 ing test-paper, or a mixture of arsenious  acid and nitrate of silver, that ammonia
 is one of the products of decomposition.  3.  It is scarcely soluble in cold water,
. requiring 1000 parts to dissolve it; it is soluble in one hundred parts of boiling
 water, and the  hot solution has a faint alkaline reaction.   By its insolubility in
 water it is readily known from its salts.   It is not very soluble in ether  thus
 differing from narcotina; but it is dissolved by forty parts of cold, and rather 
TESTS FOR MORPHIA.
141
less than this quantity of boiling alcohol.  It is soluble in oils and in the -caustic
alkalies (potash.)  4.  It is easily dissolved by a very small quantity of all diluted
acids, mineral and vegetable.   5.  It has a bitter taste.
   Tests.—In order to apply the chemical tests for morphia, the alkaloid may be
dissolved in a few drops of a diluted acid, either the acetic or muriatic.   If the
muriate or the acetate of  morphia be  presented for analysis, it may be  at  once
dissolved in a small quantity of boiling  water.  The best tests for this  alkaloid
are the following:  1.  Nitric acid.  This, when added to  a moderately strong
solution of a salt of morphia, produces slowly a deep orange-red colour.   If added
to the crystals of morphia or  its salts,  deutoxide of nitrogen is  evolved:—the
morphia becomes entirely dissolved, and the solution acquires instantly the  deep
red colour  above described,—becoming,  however, lighter by standing.   In order
that the effect should follow, the solution of morphia must not be too much di-
luted, and  the acid must be added in  pretty large quantity.  The colour is ren-
dered much lighter by boiling; therefore the test should never be added  to a hot
solution.   2. Permuriate of iron  (sesquichloride,) or colourless persulphate.
Either  of these  solutions when saturated and neutralized (by a small quantity of
potash if necessary,) produces an inky-blue colour in a solution of morphia.  If
the quantity of  morphia be small, or the test have a deep red or yellow  tint, the
colour is greenish.   The blue colour  is entirely destroyed by acids,—it is also
destroyed by heat: thus the iron-test should never be employed with a very acid
or a very hot solution  of a salt of morphia.    It should be  observed that the
blue  given by the test in a solution of morphia, is  entirely destroyed by nitric
acid and replaced by the orange-red colour, so that the nitric acid will act  through
the iron-test, but not vice versa. ' In  this way two tests may be applied to one
quantity of liquid.  3. Iodic acid.   Morphia  in the  solid state or in  solution
decomposes this acid, taking  part  of  its oxygen, and' setting free  iodine.   In
order to make this  evident, the iodic acid should be first mixed with starch; and
a part of this mixture only, added to the  suspected solution,—part being reserved
to allow of a comparison.  If the iodic acid be added to the solution of morphia
without starch,  the liquid becomes brown and smells of iodine.   AVhen the
quantity is very small, there is only a  reddish or purple tint slowly produced:—
when large, the dark-blue iodide of farina is  formed in a few seconds.   This
colour being destroyed by heat, the test must not be added to a hot solution.
This test succeeds equally well with morphia or its salts when unmixed  with or-
ganic matter; but the analyst must remember, that the blue iodide of farina forms
a colourless combination with a large quantity of starch:  hence but  little of this
substance should be used, if the quantity of morphia be small.  4.  Sulphuric
acid  and chromate of potash.  AVhen  strong sulphuric acid is poured  on  pure
morphia in a solid state, there is either no effect, or the alkaloid acquires a  light
pinkish colour.    On adding to this a drop of chromate of potash, it immediately
becomes green (from oxide of chrome,)  and it  retains this colour for some time.
Other alkaloids  are not thus affected.  Narcotina is  turned of a  bright yellow
by sulphuric acid; therefore, although it  becomes green with chromate of potash,
it could not be mistaken for morphia; besides, the green rapidly passes to a dingy
brown colour.
  Mconic  acid.—This is a solid crystalline acid, seen commmonly in scaly  crys-
tals of a reddish colour.  It  is  combined with morphia in opium, of which,  ac-
cording to  Mulder, it forms on an  average six per cent.  (Brande,  1200;)  and
it serves to render that alkaloid soluble in water and other menstrua.
   Tests.—Many tests  have  been proposed for meconic acid; there  is only one
upon which any reliance can be placed,  namely, the Permuriate or Persulphate
of iron.  This test gives, even in a very diluted solution of meconic acid, a  deep
red colour; and it is owing to the presence of this acid that the salt of iron causes
a deep red  colour in tincture and infusion of opium, as well  as in all liquids con-
taining traces of meconate of  morphia, the effects of the iron-test with morphia 
142
POISONING BY PRUSSIC ACID.
being counteracted by the presence of meconic acid.  The red colour of the me-
conate of iron is not easily destroyed by diluted mineral  acids, by a solution of
corrosive  sublimate, nor by  chloride of gold, but  it is by sulphurous acid and
chloride of tin.   In liquids  containing tannic acid, e. g. tea or beer, the action
of this test is obscured.
   Detection of opium in organic mixtures.—Opium itself may be regarded as an
organic solid, containing the poisonous salt which we wish to extract.   It is not
often that, in fatal cases of poisoning by opium or its tincture, even when these
are taken in large  quantity and death is speedy, we can succeed in detecting
meconate of  morphia in the  stomach.   It  is probably  removed by vomiting, di-
gestion, or absorption.   If the matter be solid, it should be cut into small slices;
if liquid, evaporated to an extract; and in either case, digested with distilled water
and a small quantity of acetic acid for one or two hours at a gentle heat.  The
aqueous solution  should be  filtered, some acetic acid added, and then acetate of
lead, until there is no further precipitation.   The liquid  should be boiled and
filtered:  meconate of lead is  left on the filter, while any morphia passes through
under the form of acetate.  The surplus acetate of lead contained in the solution
should now be precipitated by a current of sulphuretted hydrogen—the sulphuret
of lead separated by filtration, and the liquid evaporated at a very gentle heat to
an extract, so that  any sulphuretted hydrogen may be entirely expelled.  On
treating this extract with alcohol, the acetate of morphia may be dissolved out
and tested.   The meconate of lead left on  the filter may be decomposed by boil-
ing it with a small quantity  of diluted sulphuric acid; and in the filtered liquid,
neutralized if necessary by an alkali, the meconic acid is  easily detected by the
iron-test.   This analysis requires care as well' as  some  practice in the operator,
in order that the morphia should be obtained in a sufficiently pure state for the
application of the tests.   Before resorting to this process, it is advisable to em-
ploy trial tests on the original liquid, in order to determine whether any meconic
acid or morphia be present or not.  The smell of opium may be entirely absent.
The best trial tests are nitric acid and the permuriate of iron.   These will give
in the infusion or liquid, if it contain opium, the changes  already indicated.   In
testing for meconic acid, it is advisable to dilute  the organic liquid, if coloured,
with a sufficient quantity of water to render the production of a change of colour
by the test perceptible.   In  respect to this method of detecting the meconate of
morphia in a suspected  liquid, it is proper to observe, that nitric acid will indi-
cate the presence of morphia, and permuriate of iron the presence of meconic
acid, in infusions containing so small a quantity of opium as not to be precipitated
by the acetate of lead.
                             CHAPTER  XVII.

PRUSSIC ACID—DIFFERENCES IN STRENGTH—TASTE AND ODOUR—CONDITIONS UNDER WHICH
  THE ODOUR MAY AND MAY NOT BE DETECTED—SYMPTOMS PRODUCED BY SMALL AND LARGE
  DOSES--PERIOD AT WHICH  THE SYMPTOMS COMMENCE--POWER OF VOLITION AND LOCO-
  MOTION--POST-MORTEM APPEARANCES—QUANTITY REQUIRED TO DESTROY LIFE__FATAL
  DOSE--PERIOD AT WHICH DEATH TAKES PLACE--TESTS FOR THE ACID--VAPOUR-TESTS—
  PROCESS FOR ORGANIC MIXTURES.  BITTER ALMONDS.  NOYAU.  CYANIDE  OF  POTASSIUM.

   General remarks.—HYDROCYANIC, or Prussic Acid, owing to its rapid and
unerring effects when taken even in comparatively small doses, is one of the most
formidable poisons with which we  are  acquainted.   As it is sold in shops  it
varies  considerably in strength.   I have found different  specimens  to contain
from 1-3 to 65 per cent, of the strong acid; but two varieties are now commonly 
SYMPTOMS OF POISONING BY PRUSSIC ACID.
143
met with—1.  The prussic acid of the London Pharmacopoeia, containing about
two per cent.   (Phillips.)  2. Scheele's acid, containing  from four to five per
cent.   In a case of poisoning which I had to investigate in July, 1847, the acid
which was sold  for Scheele's was found to contain only two per cent.!  (Med.
Gaz. xl. 171.)   In another instance there was the same deficiency of strength.
In  short, there is no certainty respecting the strength of any two specimens sold
as  Scheele's acid,—a subject which requires  the very serious consideration of
medical practitioners who prescribe it.
   Taste and odour.—The evidence derivable from the taste and  odour of this
poison is,  in some instances, of importance.  The  taste is described by Dr. Chris-
tison  as pungent; some state that it is hot, others that it is bitter.   (Pereira.)
When the common acid is  taken mixed with organic liquids, the taste is not
likely to be very perceptible unless the dose be exceedingly large.
   AVith regard to the odour, Dr.  Christison states that when  diffused, it has  a
distant  resemblance to that of  bitter almonds; but it is accompanied  with a pe-
culiar impression of acridity on the nostrils and  back of the throat.   (Op. cit.
752.)   Orfila also  says that it is similar to that of bitter almonds:—this is, in-
deed, the common  impression.   There  is, however, a difference between  these
odours; but the difference is not perceptible to the  senses of all, and the only prac-
tical  point  requiring  notice is, that the diluted  odour of bitter almonds would
probably be pronounced by many to indicate the  presence of prussic acid, espe-
cially if there existed any suspicion of violent death.   Even experienced medical
men have to my knowledge been  deceived on  this point.   There are some who
are unable to perceive the odour of prussic acid when it exists  in large propor-
tion, whether  mixed with water or other liquids;  while others, again, are pecu-
liarly susceptible of it.   With  some, it does not affect the olfactory nerves at all,
but produces  merely a  sense of constriction in the fauces.   These facts appear
to  me to explain why, on the post-mortem examination of a body,  some persons
may perceive  the odour while  others may not.   When many have to form  a
judgment on  this subject, it is much more common to find disagreement than
unanimity.  Again, the odour may be  completely concealed by other odours.
In  a case  communicated to  me in May,  1850, by Mr. Rake, of Newark, a  man
swallowed a large dose of prussic  acid, and was afterwards observed walking and
smoking  his pipe.  He was found dead in a privy very shortly afterwards; but
although the body was  still warm, the smell of tobacco-smoke overpowered and
concealed that of prussic acid.   On opening the body, the smell of the acid was
at once perceptible.
   Symptoms.—The time at which the symptoms of poisoning commence in the
human subject is liable  to  great variation from  circumstances  not well under-
stood.   When a large dose has been taken, as from half an ounce to an ounce of
the diluted acid, the symptoms may commence in the act of swallowing, or within
a few seconds.   It is  rare that their appearance is delayed beyond one or two
minutes.  When the patient has been seen at this period, he has been perfectly
insensible, the eyes fixed and  glistening, the pupils  dilated and unaffected by
light, the  limbs flaccid,  the skin cold and covered with  a clammy  perspiration;
—there is convulsive respiration at long  intervals, and the patient  appears dead
in the intermediate time; the pulse is imperceptible, and involuntary evacuations
are occasionally  passed.   The respiration is slow,  deep, gasping, and sometimes
heaving or sobbing.  The following case was communicated to me by my friend
Mr. French: it presents a fair  example of the effects of this  poison  in a large
and fatal dose.   A medical man swallowed seven drachms of the common prussic
acid.   He survived about four or five  minutes,  but was quite insensible when
discovered, i. e. about two minutes after he  had taken the poison.   He was
found lying on the floor, senseless,—there were no convulsions of the limbs or
trunk, but a faint flickering motion was observed  about the muscles of the  lips.
The process of respiration appeared to  cease entirely for some  seconds: it was 
144
PRUSSIC ACID.   SYMPTOMS.
 then performed in convulsive fits, and the act of expiration was remarkably deep,
 and lasted for a very long time.  The deceased, swallowed the poison while as-
 cending the stairs; his body was found on the landing.   The bottle had rolled
 some distance from him, and the stopper was lying in another direction.  Simon
 mentions a case in which an ounce was taken, and the symptoms were precisely
 similar.   There, was, besides, coldness of the hands and feet, and no pulse could
 be felt.   In such cases, i. e. when the dose is large, the breath commonly exhales
 a strong odour of the acid.  Convulsions of the limbs and trunk, with spasmodic
 closure of the jaws, are usually met with among the symptoms;  the finger-nails
 have been found of a livid colour, and the hands firmly clenched.
   AVhen a small dose (/'. e. about thirty minims of a weak acid) has been taken,
 the individual has first experienced weight and pain in the head, with confusion
 of intellect, giddiness, nausea, a quick pulse, and loss of muscular power: these
 symptoms are sometimes slow in appearing.   Aromiting has been occasionally ob-
 served, but it is more common to find foaming at the mouth, with suffusion or a
 bloated appearance of the face, and prominence of the  eyes.   If death result,
 this is preceded by tetanic  spasms, opisthotonos, and  involuntary  evacuations.
 Vomiting is sometimes the precursor of recovery.   (See case, Med. Gaz. xxxvi.
 103.)   For an account of the symptoms produced by comparatively small doses,
 see cases by Mr. Hicks (Med. Gaz. xxxv. 893,) by  Mr. Pooley (ib. p. 859,) and
 one which occurred to Mr. Bishop, reported by Mr. Nunneley, (Prov. Med. and
 Surg. Jour. Aug.  13, 1845, p.  517.)   The last case was remarkable in several
 particulars: the individual swallowed, it was supposed, forty minims of an acid
 (at three and a quarter per cent.,) and was able to give an account of his symp-
 toms.   He was conscious for some time after he had taken it, and he recollected
 experiencing the sensation of his jaws becoming gradually stiff and tight.  It is
 not improbable, as Mr. Nunneley has suggested, that this poison may act more
 on the nerves of motion than of sensation, and that consciousness and sensibility
 may be retained by a person who has taken it, when, from  the powerlessness of
 the muscles, he  is  unable  to  indicate  their  existence.  (Prov. Trans. N. S.
 iii. 74.)
   Period at which the symptoms commence.   Power of volition and  locomotion.
 —One of the most marked effects of prussic  acid is to produce insensibility, and
 loss of muscular power, much  more  speedily than any other poison.  In some
 instances, there may be loss of  consciousness  in a few seconds; in others, certain
 acts indicative of volition and locomotion may be performed, although requiring
 for their performance several minutes.   This is one of the most important ques-
 tions connected with death  by prussic acid.   In treating of this  subject, Dr.
 Lonsdale says  that a drachm of Scheele's acid would  affect an  ordinary adult
 within the minute;  and if the  dose  were three or four drachms, it would exert
 its influence within ten or fifteen seconds.  AVhen the  acid is stronger and the
 quantity larger, we are pretty  certain of its  immediate  action,  and the conse-
 quent annihilation of the sensorial functions.   (Ed. Med. and Sur. Jour. Ii. 50.)
 Mr. Nunneley found that in  some instances the action of the poison was so ex-
 peditious as to prevent the least exhibition of voluntary motion;  but in the ma-
jority of dogs, about  twenty seconds elapsed  before  any symptoms were mani-
fested.   (Prov. Trans. N. S.  iii.  p. 75.)   Dr. Gerecke gave a tea-spoonful of con-
centrated prussic acid to a doe;  symptoms were instantaneously produced, and in
three seconds the  animal was dead.   (Casper's AVochenschrift, 26  Sept. 1846,
615.)  In the Leicester case, Mr. Macaulay found that  a dog was killed in three
seconds; and Dr. A. Thomson  has observed that a dog has been killed in two
seconds.   Dr. Christison  ascertained that a quantity of poison, equivalent to two
scruples of medicinal acid, did  not begin to act on  a rabbit for twenty seconds,
and certainly, for so small an animal,  two scruples  are as large a dose as five
drachms given to  a grown-up  girl.   (Op. cit. 757.)  These very different  re-
sults appear to me  to show clearly that experiments on animals cannot enable us 
POST-MORTEM APPEARANCES.
145
 to give a satisfactory solution of this question.   AArc should rather trust to the
 few observations made on the human subject, as well  as  to analogy from other
 sources,—as, for example, to the fact of survivorship after the infliction of what
 are commonly  regarded as instantaneously mortal wounds.
   Post-mortem appearances.—The body often exhales the odour of prussic acid
 when seen soon after death; but if it has remained exposed for some time before
 it is seen, and especially if it has been exposed to the open air or in a shower of
 rain, the odour may not be perceptible: again,  as in a case already related, the
 odour may be concealed by tobacco smoke, or other powerful odours.   In a case
 in which a person poisoned himself with two ounces of the acid, and his body
 was examined twenty-eight hours after death, the vapour of prussic acid which
 escaped on opening the stomach, was so powerful that  the inspectors were seized
 with dizziness, and obliged to quit the room hastily.  This may serve as a cau-
 tion in  conducting an examination.   In cases of suicide  or accident, the vessel
 out of which the poison has been taken will commonly be found near; but there
 is nothing to preclude the possibility of a person throwing it from him in the
 last act of life, or even concealing it, if the appearance of the symptoms should
 be delayed.  Owing  to the great volatility of the poison, the vessel may, if left
 uncorked, not retain  the odour when found.  Putrefaction is said to be accele-
 rated in these cases;  but  from what I have been  able to collect, there seems to
 be no ground for this opinion, any more than in the case of poisoning by opium.
 (See case by  Mr. Nunneley, Prov.  Med. Jour.  July 30, 1845.)  Orfila  has
 shown that in most instances of sudden death, from whatever cause, putrefaction
 is, caieris jxiribus, accelerated; and  the fact that in one or two instances of death
 from prussic acid, the bodies have speedily putrefied, has  improperly led to this
 condition being set down as one of the characters of poisoning by the acid.
   The post-mortem appearances are very slight.   Externally, the body is com-
 monly livid,  or the skin is tinged of a violet colour; the nails are  blue, the fiDgers
 clenched, and the toes contracted;  the jaws firmly closed, with foam about the
 mouth,  the face often pallid, but sometimes bloated and  swollen, and the e}res
 have been observed to be  wide  open, fixed, glassy, very prominent and glisten-
 ing1, and the  pupils dilated: but this condition of the eyes exists in other kinds
 of death.  Internally, the venous system is gorged with dark-coloured blood; the
 stomach and  alimentary canal are in their natural state; but in several instances
 they have been found more or less reddened.  The mucous membrane of the sto-
 mach of a dog  which died  in a few minutes from a  dose of three drachms of
 Scheele's acid,  was intensely reddened  throughout, presenting the appearances
 met with in  cases of arsenical poisoning.   In a  large number  of experiments
 upon dogs, Mr. Nunneley  found that there was  generally a congested condi-
 tion of  the mucous membrane of the stomach:  if  empty at the time the  poison
 was  taken, the organ was found  much contracted,  and of a brick-red colour.
 This appearance of congestion was observed on the mucous membrane of the
 vagina,  the rectum, and conjunctiva, when the acid was applied to these parts.
 ^Prov. Trans. N. S. iii. p.  79.)   The same redness was noticed in the case of the
 Parisian epileptics. (On Poisons, 667.)  Dr. Geoghegan, of Dublin, has commu-
 nicated  to me the particulars of a case in which this redness of the stomach was
 well marked.   In April, 1847,  a  healthy man, act. 30, swallowed a large dose
 of prussic acid.   He was soon afterwards found dead in his bed.   The body was
inspected  five hours afterwards: rigidity had commenced, but there was some
warmth.  The face was pale, the eyes half closed, nit presenting  any remarkable
brilliancy or  prominence, nor was there much  dilatation of the pupils.   The
mouth was closed, and no froth issued from it.  The abdomen was the only cavity
examined.  The muscles were red, and gave out, on section, a good deal of fluid
blood, which  had a strong odour of prussic acid; the odour of the  poison was also
perceptible in the peritoneal cavity.  About eight ounces of a thick farinaceous
mass were found in the stomach: the odour of prussic acid was very perceptible
       10 
146                    PRUSSIC ACID.  FATAL DOSE.
in this organ, but it was mixed with that of rancid food.   The  mucous  mem-
brane had every where, except  at the splenic end and posterior wall, a vivid in-
flammatory redness of  a well marked character, and it was lined with a layer of
viscid mucus to a considerable extent.   The coats  were not thickened, but the
submucous coat presented ramified vascularity;  the peritoneal coat was also de-
cidedly red.   The posterior wall, at  the  splenic end, was of a chocolate colour,
with scattered petechia?; the great venous trunks stood out in relief as dark blue
lines.  The mucous membrane, even when  washed three  times  in water, gave
out a strong odour of prussic acid.   In a case which I examined  in May,  1850,
in which death had been caused by a large dose of the acid, there was also a ge-
neral redness of the stomach.   Hence an irritant action may be fairly assigned to
this poison.
   Quantity required to destroy life.—This is a very important question:  and it
is made somewhat perplexing by the fact, that beyond a certain  dose,  the weak
and the strong acid appear to act with equal rapidity.  (Christison, 658.)  The
smallest dose which is reported to have caused death was in a case which occurred
to Mr. Hicks.   (Med. Gaz.  xxxv.  896.)  The female, a healthy adult, died in
twenty minutes from a dose equivalent to  nine-tenths of a grain of anhydrous
prussic acid.  This was equivalent to forty-nine grains of  the London Pharma-
c ipoeial acid;  and taking Scheele's  acid  at four per cent.  (Pereira,) to  about
twenty-five grains of Scheele.   In an interesting case reported by Mr. T. Taylor,
(Med. Gaz. xxxvi. 104,)  a stout healthy man swallowed this  dose, i. e. nine-
tenths of a grain, by mistake, and  remained insensible for four hours, when he
vomited, and  began to recover.  The vomited matters had no odour of the poi-
son, showing  that if not concealed  by other odours, the whole of the acid must
have  been here absorbed.   He had a very narrow escape of his life.  Dr.  Banks
has published a  case in which a female recovered after swallowing thirty drops
of prussic acid, (Ed. Med.  and Sur. Jour, xlviii. p. 44;)  but the  interest of this
case is lost, owing to the strength of the acid not having been determined.
   Recoveries from large doses.—The largest dose from which  an adult has reco-
vered was probably in a case which occurred to  Mr. Bishop, reported by Mr.
Nunneley. (Prov. Med. Jour. Aug. 13,  1845, p. 517.)  The  person swallowed,
it was supposed, forty minims of an acid at  three and a quarter per cent. Taking
the minim as equal to the grain, although  it may be a little more or less, ac-
cording to circumstances, this is equivalent to about one grain and one-third of
anhydrous acid.   The man was for a short time conscious, got into  bed after
taking the poison, and spoke.   He felt his  jaw become stiff, and then remained
insensible until roused by the cold affusion.   The fact of recovery having token
place on this  occasion, must not lead us to  suppose that such  a large dose could
be commonly taken with impunity.   If we refer to the chapters on arsenic and
 corrosive sublimate, we shall find that persons have recovered from doses of these
 poisons, much larger than those which  have proved fatal  in  other cases. The
 same circumstance is observed in  respect to all other poisons.   Judging  by the
 effects produced in Dr. Geoghegan's case from  0*66 grain  of  anhydrous acid,—
 from the fact that death took place in Mr. Hicks' case from  nine-tenths of a
 grain, and that, in another instance, a strong  adult had a narrow escape of his
 life from the  same dose, we shall not be wrong in assuming that a quantity of
 Scheele's acid (at five per cent.) above twenty grains (i. e. one grain of anhydrous
 acid,) or an equivalent portion of any other acid, would  commonly suffice to de-
 stroy the life of an adult.   This I believe  to  be  the nearest approach we can
 make to the smallest fatal dose.
    There appears to be no  strict relation between grains,  minims, and  drops.  I
 have found by experiment, that sixty minims (or one drachm) of the same prus-
 sic acid,  at two per cent.,  measured in three different measures, weighed  respec-
 tively 61, 62-5, and 64 grains (On Poisons, p. 673,) while sixty minims dropped
 from an eight  ounce bottle of the acid at two  per  cent, were equivalent  to
 42 drops,—and the same measure of an acid at four per cent, was equivalent to 
PRUSSIC ACID.   CHEMICAL ANALYSIS.
147
40 drops.  The volume and weight of drops vary according to the nature of the
liquid, the size of the bottle, the width of the lip of the bottle, and the angle of
inclination.  Hence it is a most uncertain mode of measuring, and in this edi-
tion I have substituted •• grains" for  "drops."
  Period at which death takes place.—When the dose is two drachms and up-
wards, we  may probably take the  average period for  death  at  from two to ten
minutes.  In Mr.  Hicks's case,  forty-nine grains of the Pharmacopoeial acid de-
stroyed life in twenty minutes.   It is only where the dose is just in a fatal pro-
portion, that we find the individual to survive from  half an hour to  an hour.
In this respect, death by prussic acid is like death by lightning:—the person in
general either dies speedily or recovers altogether.  According to Dr. Lonsdale,
death has occurred in the human subject as early as  the second, and as  late as
the forty-fifth minute.   But although death does not commonly ensue until  after
the lapse of a  few minutes, insensibility, and consequently a want of power to
perform  acts of volition and locomotion, may come on sometimes in a few se-
conds.  The time at which this loss of power is supposed to take place  has fre-
quently become an important medico-legal question; and on the  answer to  it,
the hypothesis of  suicide or murder in a particular case, may rest.
   Chemical analysis.—Prussic  acid  is limpid like water; it possesses  a  faint
acid reaction, and its vapour has a  peculiar odour, which, when the acid is con-
centrated, although not at  first perceptible, is sufficient to produce giddiness, in-
sensibility, and other alarming symptoms.   The tests which are best adapted for
the detection  of this poison, either in liquid or vapour, are equally applicable
whether the acid be concentrated or  diluted, and, so far as the detection of the
vapour is concerned, whether it be pure or mixed up with organic matter.
   Tests in the simple state.—The  tests are three in number:—the Silver, the
Iron,  and the Sulphur tests.  1. Nitrate of Silver.—This yields, with  prussic
acid, a dense white precipitate, speedily subsiding in heavy clots  to the  bottom
of the vessel, and  leaving the liquid almost clear.  The precipitate is identified
as cyanide of silver by the following properties:—a.  It is insoluble in cold nitric-
acid;  but  when drained of water, and a sufficient  quantity of strong  acid is
added, it is easily dissolved on boiling,   b. It evolves prussic acid when digested
in muriatic acid.  c.  The precipitate, when well dried and heated in a small re-
duction-tube, yields cyanogen gas, which may  be burnt at the  mouth  with a
rose-red flame  and blue halo.   This is a well marked  character, and at  once
identifies the acid which yielded the  precipitate  as prussic acid.  By this pro-
perty, the cyanide is eminently  distinguished from all the other salts of silver.
  In  the employment of the silver-test for the  detection of the vapour of the
poison, we  place a few drops of the silver solution in a watch-glass, and invert it
over another watch-glass containing the suspeeted poisonous liquid.  Cyanide of
silver, indicated by the formation of  an opake white film in the solution, is im-
mediately produced, if the acid be only in  a moderate  state of concentration.
One drop of the pharmacopoeial  acid (containing less than the l-50th of a grain)
produces speedily a visible effect.  When the prussic  acid is- much diluted, a few
minutes are required;  and the opake film begins to show itself  at the  edges of
the silver solution.  In this case the action- may be accelerated by the  heat of
the hand.
  2.  The Iron-Test.—The object of the application of this test is the production
of Prussian Blue.  We add  to a small quantity of  the suspected  poisonous
liquid a few drops of potash and of a  solution of green sulphate of iron.  A
dirty green or brownish precipitate falls:  on shaking this for a few minutes, and
then adding diluted muriatic or sulphuric acid, the  liquid becomes blue; and
Prussian blue, of its well  known colour, unaffected  by diluted  aeids, subsides.
If the prussic acid be in very small quantity, the liquid is at first yellow,  from
the salt of iron formed; it then becomes green, but the precipitate ultimately
subsides so as to appear of a blue  colour  in  the mass.   The same result is ob- 
148            DETECTION OF PRUSSIC ACID IN ORGANIC LIQUIDS.
tained by adding the solution of the iron-salt to the potash-solution of the cya-
nide of silver;  and thus, in this way, the two tests may be applied to only one
portion of the poison.
  The iron-test may be employed for the detection of the vapour of prussic acid,
by the same method as that described in speaking of the silver-test.   For this
purpose we place a few drops of  caustic potash in a small white saucer, and in-
vert it over the suspected liquid.  After a few minutes a  drop of solution of
green sulphate of iron may be added, and then  a drop of diluted muriatic acid,
—Prussian blue appears.   The recently precipitated mixed  oxides  of iron with
potash may be  placed in the upper vessel with the same results.   The silver and
the iron-tests may be in this way easily conjoined  in  testing the same quantity
of poison.  If  the precipitated cyanide of silver, obtained by the addition of ni-
trate of silver to the suspected liquid, be moistened with  strong muriatic acid,
and the vapour collected in a watch-glass or saucer, on the plan just described,
Prussian blue will be procured, and thus strongly corroborate the action  of the
silver-test.
  3.  The Sulphur-Test.—Baron Liebig has proposed the following process for
detecting prussic  acid  as  a liquid.   (Oesterreichische Med. Wochenschrift, 27
Marz, 1847,  396.)  If a  small  quantity of hydrosulphuret of ammonia (con-
taining a little excess  of sulphur) be  added to a  few drops of the solution of
prussic acid,  and the mixture be gently warmed, it becomes  colourless, and, on
evaporation, leaves sulphocyanate of ammonia—the sulphocyanic acid being in-
dicated by the intense  blood-red colour produced on adding to the residue  a solu-
tion of a persalt  of iron:  this colour  immediately disappears on adding  one or
two drops of a solution of corrosive sublimate.   This test is very  delicate, and
it therefore requires some care, in its application:  thus, if the boiling and  evapo-
ration be not carried far enough, the persalt of iron will be precipitated black by
the undecomposed hydrosulphuret of ammonia; and, if the  heat be carried too
far, the sulphocyanate of  ammonia may itself undergo decomposition, and be
lost.   It will be perceived, too, that it requires  a longer time for its application
than either the silver or the iron-test.
  The great utility of the sulphur-test, however, is in its application  to the de-
tection of the minutest portion of prussic acid when in the state of vapour.  In
this respect it surpasses any other process yet discovered.   In order to apply it,
we  place  the  diluted  prussic acid in  a watch-glass, and  invert over it another
watch-glass, holding in its centre one drop  of the hydrosulphuret  of ammonia.
No change apparently takes place in the hydrosulphuret;  but if the watch-glass
be removed after the lapse of  from half a  minute to ten minutes, according to
the quantity and  strength of  prussic  acid present, sulphocyanate  of ammonia
will be obtained on gently heating the drop of  hydrosulphuret and evaporating
it to dryness.   With an acid  of from three to five per cent, the action is com-
pleted in ten seconds.   The addition of one drop of  persulphate of iron  to the
dried residue, brings out the blood-red  colour instantly, which is intense in pro-
portion to the quantity of  sulphocyanate present.  Such  is  the simple method
of employing the test.   When the prussic acid is excessively diluted, the warmth
of the  hand may serve to expedite the evolution of the vapour.
  In  detecting the vapour, the sulphur-test acts, cccteris paribus,  more rapidly
and more delicately than the silver-test; but the two may be usefully employed
together in corroboration of each other.  If a suspected liquid, placed in a  watch-
glass, produce  a  film  on a drop of nitrate of  silver, the reaction will be very
speedy with  the hydrosulphuret.  The silver-test acts visibly,  and therefore
serves to guide us: the sulphur-test  acts  invisibly;  for there is  no  apparent
change unless  the glass be left so long that the ammonia  is  spontaneously eva-
porated, and  the sulphur oxidated or deposited.
  Prussic Acid in Organic Liquids.   Detection by vapour without distillation.
—The organic liquid may be placed in a wide-mouthed bottle, to which a  watch- 
POISONING BY OIL OF BITTER ALMONDS.
149
glass has been previously fitted as a cover.  The capacity of the bottle may be
such as to allow the surface of the liquid to be within one or two inches of the
concave surface of the watch-glass.   The  solution of Nitrate of silver is then
used as a trial-test in the way already described.  If the l-200th of a grain of
prussic acid be present, and not too largely diluted, it will be detected (at a tem-
perature of  60°) by the drop of nitrate  of  silver being converted into an opake
white film of cyanide of silver, the chemical change commencing at the margin.
We  may then substitute for the nitrate of silver the hydrosulphuret of ammonia,
and  proceed in the way above described.  By this  process I have detected prus-
sic acid in the stomach of a person poisoned by it, as late as twelve days after
death.  After the stomach had been exposed for a few days, all traces of the
poison had disappeared.
   Detection by distillation.—This process was originally suggested by Lassaigne.
The organic liquid should be distilled  in a water bath, at 212°, and about one-
sixth or one-eighth of the contents of  the retort collected in a receiver kept cool
by water.   The tests may now be applied to the distilled liquid.   If the trial-
tests indicate  that the quantity of poison is small, a solution of nitrate of silver
or caustic potash may be  placed in the receiver, to fix the acid as it distils over;
Prussian blue may then be procured in the  way described, or  the vapour may be
at once absorbed by hydrosulphuret of ammonia in the receiver, and the  liquid
evaporated to obtain sulphocyanate.   Prussic acid has been found in the stomach
by distillation, so late as seven days  after death, although  the odour could not
be perceived  before distillation.   Mr. AVest states that he was able to  detect
prussic acid, on distillation, by the odour, and  the  silver and  iron-tests, twenty-
three days after death;  although no  pains had been taken to insure its preserva-
tion, and not more  than four-tenths  of a  grain of anhydrous acid could have
originally existed in the contents of the stomach.   (Prov. Med. Jour., July 23,
1845.)
   Detection of prussic acid in the  tissues.—The poison may be easily detected in
the blood, secretions, or any of the soft organs, by placing the vapour in a bottle,
and  collecting it in  the way already described.  This will be found  to be far
more convenient and satisfactory than the process by distillation.  In  the case
of a dog poisoned by prussic acid,  Mr.  Hicks  brought me the stomach after it
had  been exposed twenty-four hours, and thoroughly washed  under a current of
water, and yet the poison was readily detected by placing the  whole organ in a
bottle, and  absorbing the vapour  by  nitrate of silver.  This shows how  com-
pletely the  animal tissues are  penetrated by prussic acid, and  how firmly it  is
retained by  them.  The poison has been thus discovered in the blood and in the
serous exhalation of the chest.

                         Oil of  Bitter Almonds.
   Symptoms and effects.—A man, aged forty-eight, swallowed two  drachms of
the ethereal oil  of bitter  almonds.   In a few minutes afterwards, he was found
by his servant with his  features spasmodically contracted, his eyes fixed, staring,
and  turned upwards.  The chest was expanded convulsively and hurriedly.   In
twenty minutes  he was insensible, the pupils  immovable,  the  breathing slow
and  stertorous,—the breath  having a  strong odour of bitter  almonds, and the
pulse feeble.  He died half an hour after he had taken the poison.  On inspec-
tion, the whole of the body, and the blood which escaped, smelt strongly of bitter
almonds; the teeth were fixed, the  lips pale, fingers contracted, and  the  nails
blue.  The  mucous membrane of the stomach  and intestines presented an in-
flammatory  redness, and there was turgescence  of  the brain.   The blood, bile,
and  the muscles, had a  deep violet colour.  (Ed. Med. and Sur. Jour. xxii. 232.)
The  following case occurred to Mt.  Chavasse,  of Birmingham.   A  druggist
swallowed by mistake half an ounce  of "almond flavour."   In half a minute he
fell down in a state of syncope;  his  face  being deadly pale, and  his pulse im- 
150
POISONING BY OIL OF BITTER ALMONDS.
perceptible.  After a few minutes he came to himself, and vomited some undi-
gested food mixed with bile and strongly impregnated with  the  odour of bitter
almonds.   Delirium, with slight convulsions, came on; he then became sensible,
and conversed upon his condition; but  again gradually relapsed into delirium,
his eyes being prominent and brilliant.   In a few minutes he again became sen-
sible, and  slowly  recovered from the effects of the poison.   The quantity of
"almond flavour" which he had taken was estimated  to contain about half a
drachm of the essential oil.   I cannot avoid remarking,  that we  have  here
another instance of the disgraceful state of medical police in this country, in the
fact that a deadly poison like  this is allowed to be sold  by druggists for the
purpose of giving flavour to  pastry and liqueurs!   In the above case, thirty
drops of the essential oil were taken without destroying life, although  the patient
had a very narrow escape.   Dr. Bull, of Hereford, has communicated to me a
case  in which less than twenty drops (seventeen) destroyed the life of a woman,
aged forty-nine, in half an hour.  For  a case of poisoning  by this oil, reported
by Mr. Iliff, jun., see Lancet, Dec. 1, 1849, page 575.
   Is the vapour of this oil sufficient to produce fatal effects?  This question was
raised in the subjoined case, which occurred in London, in 1838.   The deceased,
the wife of a publican, had been clearing out a closet, which contained, among
other liquors, a bottle  of the essential oil of bitter almonds.   She was suddenly
heard to call  out.  A servant  found her pale and  faint, and she complained of
sickness.   There was  a  strong  odour in the room, and deceased  said that the
corks of some of the bottles had come out, and the smell had made her feel sick.
She was removed to bed, but  died  before  any medical assistance could be ob-
tained.  There was no motive for the deceased committing suicide, and it was a
subject of inquiry, whether the vapour alone might not have caused death.   This
question was set at rest by an inspection of the  body.   Some of the  poison was
found in the  stomach,  and there was a very strong odour  of bitter almonds in
the contents.  It was, therefore, clear that the deceased must have swallowed a
portion of the poison;  whether from motives of  curiosity or not, it is impossible
to say. The medical  witness in answer to a question, properly stated that less
than a teaspoonful might cause the death of an adult.   The vapour may produce
vertigo and stupor; but  unless  long respired, it would not be likely to cause
fatal effects.   In 1837-38, there were four cases of poisoning by this oil.   This
poison is sold to the public, in quantities of not  less than a quarter of an ounce,
at the rate of five shillings per ounce.   The liquid called Almond flavour, spirit
of almonds, or essence of peach-kernels, contains half a drachm of the essential
oil to one ounce of spirit.  It is sold in quantities of not less than a quarter of
an ounce, at the rate of one shilling per ounce.   The chief use of this liquid is
for the purpose of flavouring  confectionary.  Serious  symptoms have in some
instances been produced  by it; and  as  cooks and confectioners who  use it are
not aware that they are administering prussic acid to their customers, it is pos-
sible that accidents may arise from this  practice.  A flavour is at all times dearly
purchased if it depends on even a small dose of poison.  Within a recent period,
a liquid has been sold  for flavouring confectionary under the name of Essence of
Jargonelle  Pear.   It is a noxious artificial compound made by distilling oil of
grain, or fusel oil, with acetate of potash and sulphuric acid.   In the Pharma-
ceutical Journal for November, 1851 (page 214) it is stated that a child which
had on two occasions eaten confectionary flavoured with about one drop of the
essence of pear, became partially comatose,  with livid lips and feeble pulse.  The
symptoms  resembling poisoning, observed in children, may very commonly be
referred to the eating of confectionary which is coloured or flavoured with various
kinds of poison.
   Another artificial fruit-essence has been still more recently brought  into notice
—namely,  the "Essence of Ripstone Pippin,"  or  "oil of apples."   It is pro-
cured from a mixture of bichromate of  potash, sulphuric acid, and amylic alco- 
NOYAU.  LAUREL-WATER.  CYANIDE OF POTASSIUM.         151
hol (Chemical  Record,  Jan. 17,  1852, page 44)—all substances of a noxious
nature.   There will thus be for  the  younger portion of the public a choice of
confectionary coloured green with arsenic or flavoured with essential oil of almonds
(containing prussic acid,) or the artificial essences of apples and pears, the effects
of which still remain to be determined.

                        Noyau.   Cherry Ratafia.
   These liqueurs, which have the smell of bitter almonds, are considered to be
poisonous when taken in large doses.  The quantity of prussic acid present in
them is liable to vary;  it may be  separated by distillation *at a gentle heat, and
then  tested.   I have found that an ounce and a half  of good noyau, having a
strong odour and flavour, when  distilled two-thirds, yielded  scarcely a trace of
prussic  acid either by the silver or iron test.   It had  been kept some time in a
well closed bottle.  An equal quantity of cherry ratafia, similarly treated, gave
me no ponderable quantity of Prussian blue.

                Laurel-water.  Cherry Laurel-water.
   This  is a very weak solution of prussic acid, containing only about one-fourth
of a grain per cent, of the strong acid, but it is stated to be more poisonous than
this quantity of acid would indicate.  (Pereira, ii. 1542.)  In some specimens
which I procured by distilling the bruised tops and the fine shoots of the laurel
with water, the odour was powerful;  but  the proportion of prussic acid present
was considerably less than this.    It is a limpid colourless liquid, possessing a
strong odour of bitter almonds,  and producing, in large doses, the usual effects
of poisoning by prussic acid.  Cherry laurel oil.—By distillation, the leaves
of the plant yield  also an essential oil, resembling that of the bitter almond, but
much weaker, as it contains on  an average less than three per cent, of prussic
acid.  According  to Christison,  almost every part of the plant is  poisonous, but
especially the leaves, flowers, and kernels; the pulp of the cherry is not poisonous.
Articles of food are often flavoured with the leaves, but accidents are  said to have
arisen from this practice.  [Dr.  Griffith notes that  accidents have  happened
from eating the fruit of the  wild cherry (Cerasus Virginianus and C. Serotinus,)
owing to the hydrocyanic acid present in these berries.  From the experiments
of Mr. Procter (Amer. Jour. Pharm.  iii. 191,)  it  appears  to exist in some
quantity more especially in the kernels.   Dr. Beck cites  the case of a child to
whom the  fruit proved highly deleterious, and several  other analogous instances
have been  reported from time to time.—H.]

                          Cyanide  of Potassium.
   Symptoms and effects.—This is a poisonous  salt, now much used in the art
of electro-gilding and plating.   It is a solid, sometimes seen crystallized, at others
in the form of a white chalky-looking  powder.   It is without odour until put into
water, when it is freely dissolved, forming an alkaline solution, from which prus-
sic acid is abundantly evolved.  It acquires a strong smell in a damp atmosphere,
and becomes dark-coloured.  The cyanide of potassium is used on the continent
as a  medicine, and a few years since it occasioned the death of a person  at St.
Malo, under the following circumstances.  A  physician prescribed  for the de-
ceased rather more than one drachm of the cyanide in two ounces and a half of
orange  flower  water and syrup;  and of this mixture three spoonfuls  were to be
taken daily.   It seems that table-spoonfuls were taken, and the patient died in
three-quarters of an hour after the first dose.  None of the poison was found in
the stomach;  but a portion of the mixture from which the dose had been taken
was examined  and found to contain cyanide of potassium.  A criminal proce-
dure was instituted against  the physician, and he was fined and imprisoned.  M.
Malaguti,  who gave evidence on the occasion,  stated that a dog was  killed in a 
152
poisoning by henbane.
few minutes after taking less than three grains of the cyanide in solution; and
that the largest medicinal dose of this substance to a human being was five-sixths
of a grain.  (Lancet,'Jan. 1S43.)  The mixture in  the  above  case contained
about three grains of the cyanide in one drachm; therefore, had  tea-spoonfuls
been taken by the deceased, he would have taken quite sufficient to destroy life.
The medicine had evidently been prescribed  by a person totally ignorant of its
poisonous properties.   Another case occurred at Breslau, in which a man, aged
thirty, died in a quarter of an hour under all the symptoms of poisoning by prus-
sic acid, after taking a dose of a mixture containing fifteen grains of cyanide of
potassium, which had been prescribed for him by his medical attendant.  (Henke,
Zeitschrift der S. A., 1843, 7.  See also Ann. d'Hyg., 1843, i. 404.)
  Cases of poisoning by this agent have been rather frequent of late years.  The
cyanide of potassium  is  much  used as a solvent for  silver, and is largely em-
ployed by coiners for covering base metal.  In most of the cases the poison has
proved so rapidly fatal, that the persons have died before  they were seen by a
medical practitioner.  The symptoms have  not therefore been observed;  but so
far as we can form a judgment, they are identical with those produced by prussic
acid.  (See Med. Times,  Oct. 12,  1850, p. 390; also Nov. 9,  1850, p. 482;  and
July 12, 1851, p. 41.)
                            CHAPTER XVIII.

NARCOTIC POISONS  CONTINUED.--HYOSCYAMUS  NIGER.  LACTUCA  VIROSA  AND SATIVA—
  LETTUCE-OPIUM--SOLANUM DULCAMAR4 AND NIGRUM--CAMPHOR--SYMPTOMS—ALCOHOL
  --SYMPTOMS--TREATMENT--ANALYSIS--ACTION OF ETHER AS A LIQUID--SYMPTOMS AND
  APPEARANCES—CHLOROFORM--SYMPTOMS AND APPEARANCES.

                           Hyoscyamus Niger.
  All  the  parts of this plant, which  is commonly known under the name of
Henbane, are poisonous.  The seeds  produce the  most powerful effects, then
the roots, and lastly the leaves.  The vapour evolved from the fresh-cut leaves
has been known to produce vertigo, stupor, and syncope. In small or medicinal
doses, henbane has a narcotic action; but when taken  in large doses, it produces
those effects usually assigned to the narcotico-irritant class.
   Symptoms and aj>]>earanees.—The best summary of these is given by AVibmer,
(Arzneimittel, Art.  Hyoscyamus Niger.)  AVhen the dose is not sufficient to
destroy  life, the  symptoms are,—general excitement, fulness of the pulse, flush-
ing of the face, weight in the head, giddiness, loss of  power and tremulous mo-
tion of  the  limbs, somnolency, dilatation  of  the  pupils, double vision, nausea,
and  vomiting.   After  a time these symptoms pass off, leaving the individual
merely languid.   AArhen a large quantity of the root or leaves has been eaten,—
an accident which has occurred from the plant having been mistaken for other
vegetables,—then other and more serious effects are  manifested.   In addition to
the above symptoms in an aggravated form, there will be loss or incoherency of
speech,  delirium, confusion of  thought, insensibility, coma, and,  sometimes, a
state resembling insanity (see Med. Gaz. vol. xlvii. p.  640;) the pupils are dilated,
and insensible to light; there is coldness of the surface, cold perspiration, loss of
power in the legs, alternating with tetanic rigidity and convulsive  movements of
the muscles; the pulse small, frequent, and irregular; the respiration deep  and
laborious.  Occasionally there is nausea, with vomiting and diarrhoea.   Death
takes place in  a few hours or  days, according to the severity of the symptoms. 
LACTUCA.  SOLANUM.   CAMPHOR.
153
The special effect of this poisonous plant is manifested in its tendency to produce
a general paralysis  of the nervous system.
   There are other varieties of hyoscyamus which are also poisonous.

                                 Lactuca.
   The two species of lettuce known under the names of  Lactuca Sattva and
Virosa (strong-scented lettuce) contain a principle which is possessed of feeble
narcotic properties.   Orfila has found that the extract prepared by evaporation
at a low temperature acts upon the brain and nervous system of animals, although
very large doses were required for  the production of narcotic effects.   There is
no record of these  plants  having exerted a poisonous action in the human sub-
ject.  The inspissated juice of the lettuce is well known under the name of lac-
tucarium or lettuce-ojjium.

                                 SOLANUM.
   There are two species of this plant—the Solanum Dulcamara, Bitter-sweet
or  Woody-nightshade, which has a  purple flower and bears red berries; and the
Solanum Nigrum, or Garden-nightshade, with a white flower and black be'rries.
Dunal gave to dogs four ounces of the aqueous  extract, and, in another experi-
ment l!S0 ripe berries of the Dulcamara, without any ill  effects resulting.   On
the other hand, Floyer states that thirty of the  berries  killed a dog in  three
hours.  (AVibmer,  op. cit. Solanum.)  These  differences may perhaps be re-
conciled by supposing that the active principle Solania, on which  the poisonous
properties of both species depend, varies in proportion at different seasons of the
year.   In one instance, a decoction of the Dulcamara  is said to have produced
in a man dimness of sight, vertigo, and trembling of the limbs—symptoms which
soon disappeared under  slight treatment.  (For a case of poisoning by the de-
coction, see Med. Gaz. xlvi. 548.)  Orfila found that the extract of Solanum ni-
grum had a very feeble effect as a poison; and the fatal cases reported to have
been caused by it are perhaps properly referrible to belladonna, for which it may
have been mistaken.  The single death from Dulcamara reported  in the Regis-
tration returns for 1840 may have  been due to a mistake of this kind.

                                Camphor.
   In the  few cases  of poisoning by camphor which have been observed and re-
corded,  its effects were somewhat different, although both in man and animals
they were referrible to an impression on the brain and nervous system.
   Symptoms and effects.—The  following case  is reported by Mr. Hallett,  of
Axminster:—A woman swallowed in the morning about  a scruple of camphor
dissolved in rectified spirits of wine and mixed with tincture of myrrh.  In half
an hour she was suddenly seized with languor, giddiness, occasional loss of sight,
delirium,  numbness, tingling and coldness of the  extremities, so that she could
hardly walk.   The  pulse was quick and respiration difficult, but she suffered no
pain in any part.   On the administration of  an emetic, she vomited a  yellowish
liquid, smelling strongly of camphor.  In the evening the symptoms were much
diminished, but she had slight convulsive fits during the  night.  The next day
she was convalescent; the dyspnoea, however, continued more or less for several
weeks.  The dose did not probably exceed twenty grains:—this is the smallest
dose of  camphor which  appears to have been attended with  serious symptoms.
In a case which occurred to AVendt, of Breslau, eight scruples were  swallowed by
a drunkard, dissolved in spirit.  The symptoms were vertigo, dimness of sight, deli-
rium, and burning pain in the stomach.  There was no vomiting: the man recovered.
In  another, reported by Mr. Stokes, a woman swallowed half an ounce of cam-
phor dissolved in oil.  In two hours she was delirious;  her face  pale; pupils
dilated;  hands and feet cold;  pulse 120.  There was no pain, vomiting (except
as the results of emetics,) or purging.  She  recovered in a few hours.  (Med. 
154
ALCOHOL.  SYMPTOMS.   APPEARANCES.
Times, June 10, 184S, p. 88.)  These and other cases show that  camphor can-
not be regarded as a very active poison.  (AVibmer, op. cit. iii. 212.) In Orfila's
experiments on animals, the mucous membrane of the stomach was found in-
flamed (ii. 493.)
  In a series of cases reported by Dr. Schaaf, the symptoms caused by camphor
were those of a narcotico-irritant poison.   A woman  gave a tablespoonful (180
grains) of powdered camphor to three of her children as a vermifuge.  Two of
the children were respectively of the ages of three and five years,  the third was
an infant aged eighteen months.  The first symptoms were pallor of the face, with a
fixed and stupid look.   Delirium followed, with a sense of burning in the throat,
and great thirst.   Vomiting, purging, and convulsions supervened, and  in one
child the convulsions were most violent.   The two elder children,  after suffering
thus for  three hours, fell into a comatose sleep, and on awaking the  symptoms
passed off.  The infant died in seven hours, not having manifested any return of
consciousness from the first occurrence of convulsions.  (Med. Gaz. vol. xlvii. p.
219.)  The severity of the symptoms is fully explained by the enormous dose
administered to these  young subjects.  In  a  dose of one drachm given in  a
clyster, camphor produced alarming symptoms.   (Med. Gaz. xlviii. 552.)

                                Alcohol.
   Symptoms.—A large quantity of spirit has been known to destroy life  speed-
ily, although such a case is rare.  Orfila mentions an instance in  which  a man
died immediately from the effects of a large dose of brandy.   (Op. cit. ii. 528.)
In general, the symptoms come on in the course of a few minutes.   There is
confusion of thought, with inability to stand or walk, a tottering  gait, and ver-
tigo, followed by coma.   Should the individual recover from this state, vomiting
and sickness supervene.  This form of poisoning presents some singular anoma-
lies:—thus the insensibility may come on suddenly after a certain period. Dr.
Christison met with a case where the individual fell suddenly into a deep  stupor
some time after he had swallowed sixteen ounces of whiskey: there were none of
the usual premonitory symptoms.   In another instance a  person will apparently
recover from the first effects, then suddenly become insensible, and  die convulsed.
Convulsions are, however, by no means a necessary attendant upon poisoning by
alcohol.  Orfila makes  their absence a  ground of diagnosis  between poisoning
by alcohol and opium (Op.  cit. ii. 530,)—and Dr. Ogston only observed them
twice out of many cases:  the subjects in these two instances were young.  In
poisoning by alcohol, the supervention of the symptoms is not commonly so rapid
as to prevent an individual from performing locomotion or certain acts of volition.
The more concentrated the alcohol, the  more rapidly are the symptoms induced,
and they are then more severe  in their character.   Diluted alcohol generally
produces the stage of  excitement  before stupor, while in  the action of concen-
trated alcohol there may be profound coma in a few  minutes.   This appears to
indicate an action  by sympathy on the nervous system, as the diluted alcohol  is
in a condition most favourable to absorption.   Alcohol may act as a poison by
its vapour.  If  the concentrated  vapour be  respired, it will produce the usual
effects of intoxication.  It is generally known that persons who  have been for
the first time employed in bottling spirits are easily intoxicated by the alcoholic
vapour.  There is a case on record in which a child two years of age was thrown
into an apoplectic  stupor by the alooholic vapour of Eau de Cologne.   In this
way a child might be destroyed, and* no trace  of the poison be found  in the
stomach.
   Post-mortem appearances.—In respect to post-mortem appearances, the stomach
has been found  inflamed—the mucous membrane having been in one case of  a
bright red, and in another of a dark red-brown colour.  When death has taken
place rapidly, there will be  a strong odour of spirits  in the contents; but this
may not be perceived if many hours have elapsed before the inspection is made. 
ether,   chloroform.                      155
The brain is found congested, and in some instances there is effusion of blood or
serum beneath the membranes.   In a case observed by Dr. Ge'oghegan, in which
a pint of spirits had been taken, and proved fatal in eight hours, black  extrava-
sation was found on the  mucous membrane of the stomach; but no  trace of
alcohol could be detected in the contents.   [Dub. Med. Press, i.  293.]

                                  Ether.
   Symptoms and  appearances.—The effects produced on the system by the ad-
ministration of Sulphuric or any other form of ether, are  not unlike those  oc-
casioned  by alcohol.  Orfila found that about half an ounce of sulphuric ether
administered to a dog caused, in a few minutes,  a disposition to vomit.  This
was followed by vertigo, and, in ten minutes, by an entire loss of power in the
muscles.   Respiration was painful  and hurried, but there were no convulsions.
After a slight abatement  in the symptoms, the dog fell into a state of insensi-
bility, and died in three  hours.  The whole of the mucous membrane  of the
stomach  was of a blackish-red  colour, and, with the other coats, intensely in-
flamed.   There was  slight inflammation in the duodenum; but the rest of the
alimentary canal was in a healthy condition.  The heart contained black blood
partly coagulated: the lungs were gorged with fluid blood.   (Op. cit. ii. 531.)
   Very little is known concerning the action of large doses of liquid ether taken
into the stomach.  It has, in moderate doses, a hot burning taste, and produces,
during swallowing, a sense of constriction in the throat.   It causes, like alcohol,
great excitement and exhilaration, with, subsequently, intoxication; but persons
may become  habituated to it;  and  thus, after a time, it  may be taken in very
large quantities with comparative impunity.  The  medicinal dose is from half a
drachm to two drachms.   Dr. Buchanan has known seven drachms  of  it taken
at once:  it produced, at the pit of the stomach, a most uneasy sensation of heat
and  pain, which only the callous stomach  of a dram drinker could  withstand.
(Med. Gaz. xxxix. 715.)   In 1845, a young man was brought before one of the
London Police-magistrates in a stupefied state: to  those present he appeared to
be intoxicated.  It was proved in evidence that he was in the habit of  taking
ether, and that he was then labouring under its effects.  It appeared that he fre-
quented the shops of druggists, and swallowed this liquid in large doses.  There is
no instance reported of ether having caused death when taken in the liquid form:
but it has never been swallowed at once in the same excessive doses as alcohol.  It
does not  admit of dilution with water to the same degree  as alcohol,  and. there-
fore it acts, caterisparibus, as a more violent local irritant.   It requires ten parts
of water  to dissolve one of ether: hence, unless, as Dr. Buchanan has remarked,
the water be in very large proportion,  it does not  render the ether palatable to
most persons.  It is at present impossible to give any precise opinion respecting
the smallest quantity of this liquid which would  destroy the life of an adult.
Hoffman's Liquor is a mixture of alcohol and ether.
   Ether  vapour.—'The vapour of ether, when respired, may act as  a  narcotic
poison.   Several cases in  which it has  thus proved fatal, when  it has been ad-
ministered for the purpose of producing insensibility during surgical operations,
are recorded, and for an account of  these, as well as of poisoning by the vapour
generally, I must refer to the separate work On Poisons,  (Am. Ed. 590.)

                               Chloroform.
   This liquid, when taken in a  large dose, appears  to affect the system like alco-
hol;  but  as a liquid it cannot be regarded as an active poison.  I have elsewhere
recorded  a case communicated to  me by Mr. Jackson of  Sheffield,  in which a
man swallowed four ounces of chloroform.   He was able to walk for a consider-
able  distance after taking  this dose,  but he subsequently fell into a state of coma
—the pupils were dilated, the breathing  stertorous, the skin cold, the pulse im- 
156
SYMPTOMS.   post-mortem appearances.
perceptible, and  there were  general  convulsions.  He recovered in five days.
(Med. Gaz. vol. xlvii. p. 675.)
   Chloroform vapour.  SymqWoms.—The symptoms which the vapour of chloro-
form  produces  are very similar to those produced by the vapour of ether;  but
the individual passes much more rapidly into a state of insensibility with sterto-
rous breathing.   From being at first excited, he becomes motionless—the pupils
widely dilated—the sphincters lose their contractile power,—the face is pale, the
lips congested,  the breathing becomes slow, the surface cold, and the pulse gra-
dually sinks.  There is an entire loss of sensibility.   The Sinking  of the pulse
in some cases is so rapid as to expose the patient to death by syncope (see case
Med. Gaz. xl. 1036.)  In some  instances violent convulsions  have supervened,
even  where the dose has been only from half a drachm to a drachm.  These ef-
fects  may be occasionally due to idiosyncrasy, or to latent organic disease.  The
fatal  effects of the vapour are likely to be manifested when it is breathed rapidly
and  unmixed with  air.'  There is no doubt  that in a concentrated state it is a
powerful narcotic poison.   It is absorbed into the blood,  which it darkens, as in
asphyxia, and circulates throughout the system.   The blood, however, is directly
poisoned by it.
   Post-mortem appearances.—In an interesting case reported by Dr. Meggison,
a girl, aet. 15, had the vapour administered to her on a warm cloth.   The quan-
tity of chloroform used was  about one  drachm.  In  about half a minute,  she
became insensible—the lips  were  suddenly blanched, and it Was observed that
one arm was  rigid.   The respiration was quick,  but there was no stertor.  The
patient suddenly  spluttered at the mouth, as if in an epileptic fit.  Attempts
were  made to revive her, but she was dead in  from two to three minutes after
commencing  the  inhalation.   On  inspection, the pulmonary  tissue was found
greatly congested.  There was a bloody froth  in the bronchi, mixed  with mucus:
—the epiglottis was  reddened.   The  brain and  its membranes were more con-
gested than usual, and the ventricles contained  more than the usual quantity of
6erum.  The abdominal viscera were also highly congested.   (Med. Gaz. xli.
250-254.)  These appearances correspond to those observed by Dr. Glover, and
Mr. AVakley,  jun., in its action on animals.  There can be no doubt that chloro-
form  was really the cause of death.   In another case of poisoning in the human
subject, fully reported by Dr. Jamieson, in which the quantity inhaled was pro-
bably three or  four  drachms, the appearances of general congestion were very
pimilar (Med. Gaz. xli. p. 318:)  it was remarked that the  mass of  blood was
darker than  natural, and  that it was fluid and  unusually thin.  The  muscles
were also darker than ordinary.
   The vapour of  chloroform  being more volatile than that of  ether, would  not
be so readily detected in the body by the smell.  In Dr. Jamieson's case,  the
blood had no odour, but the bloody fluids yielded on distillation a small quantity
©f a volatile liquid, which had a strong chloroform smell.  A process  for detect-
ing chloroform in the tissues has been suggested, but as it rather detects chlorine,
hydrochloric  acid or a chloride, and not chloroform, I do not here describe it.
It appears  to me  to be unsatisfactory.
   In  consequence of the power  possessed by this vapour of rendering persona
insensible and incapable of offering resistance in assaults with intent  to commit
rape  and other felonies, the using of it for such a purpose  has been made a felony
by a recent act of Parliament (14 and 15 Vict. ch. 19, s. 3 ) 
narcotico-irritants.   nux vomica.
157
NARCOTICO-IRRITANT  POISONS.
                            CHAPTER  XIX.

GENERAL REMARKS—NUX VOMICA—STRYCHNIA—COLCHICUM—WHITE HELLEBORE—DIGI-
  TALIS—CONIUM MACULATUM--DATURA STRAMONIUM—ACONITE--DEADLY NIGHTSHADE--
  TOBACCO—COCCULUS INDICUS—LABURNUM—MUSHROOMS—YEW.

  The Narcotico-irritant poisons are derived from the vegetable kingdom.  Their
effects on the body are of a mixed character, since both the brain and alimentary
canal are liable to be affected by them.
  In order to prove fatal, they require to be exhibited commonly in large doses.
The symptoms in most cases appear in about an hour; but sometimes they may
be delayed for many hours.   This has  been especially noticed with regard to
poisonous mushrooms.  The  symptoms commonly observed are vertigo, coma,
delirium, paralysis, and convulsions;  such, at least, are the effects resulting from
Monkshood (Aconite) and deadly Nightshade (Belladonna.)   These poisons have
in general a strong and well marked taste, so that they cannot be criminally ad-
ministered without suspicion being excited, or without detection.   Murder by
monkshood has been accomplished by the criminal substitution  of the leaves of
this plant for other vegetables at a meal.
  The strychnos tribe, including Nux Vomica, has a specific action on the spinal
marrow, producing tetanus and convulsions, but rarely coma or delirium. Squills
and  foxglove (Digitalis)  produce  symptoms of narcotism,  i. e. they affect the
brain; but  these symptoms  are commonly preceded by vomiting, with violent
pain in the stomach  and bowels, indicative  of an irritant action.
  Thus, then, there is great variety in  the effects produced by this class of poisons,
and the same may be said of the post-mortem appearances in the bodies of those
who have been killed by them.  In some instances the stomach and intestines
are  inflamed; in others not.  AAhen the person has died under symptoms of
narcotism, traces of cerebral congestion are occasionally found; but cases of fatal
poisoning by these vegetable  substances are so rare, that we have yet much to
learn respecting the morbid changes which they produce.

                              Nux Vomica.
  Cases of poisoning by nux  vomica are not unfrequent.  In 1837-8, there were
three fatal cases  marked  in  the coroner's return, and one case  of poisoning by
strychnia.   The poisonous properties of nux vomica are due to the presence of
Strychnia ;  the symptoms of the two forms of poisoning are alike, but of course
much more severe when produced by the pure alkaloid, strychnia.   Nux vomica
is usually taken in the form of powder.
  Symptoms. — The powder  has  an  intensely bitter taste, which  is very  per-
sistent,  and  is with difficulty concealed by other substances.   In from five to
twenty minutes after it has been swallowed, the patient is  suddenly seized with
tetanic spasms, affecting the  whole of the muscular system, the body becoming 
158
NUX vomica,   chemical analysis.:
rigid, the limbs stretched out, and  the  jaws so fixed that considerable difficulty
is experienced in introducing any thing into the mouth.  The muscles of the
chest are also fixed by spasmodic contraction, and the body sometimes  assumes
the state of opisthotonos:  the  intellect is clear.  This  spasmodic state ceases,
but, after a short interval, reappears, and the chest is so fixed as to give a sense
of impending suffocation.   After several such  attacks,  increasing in severity,
the patient dies asphyxiated.   Drowsiness and a feeling of general illness  have
sometimes preceded the attack; vomiting, pain in the abdomen, and other symp-
toms of irritation, have been occasionally witnessed where the case was protracted;
but in general, death takes place long before such symptoms are manifested.
  Post-mortem  appearances.—In a well marked case  of poisoning by this sub-
stance at  University College Hospital in 1839, the only appearances met  with
were general turgescence of the brain and its vessels.   A quantity of the  pow-
der was found in the stomach, to the mucous membrane of which it adhered very
tenaciously; there was  injection, with many ecchymosed points at the cardiac ex-
tremity.   The brain, as well as the  spinal  marrow,  has been found softened.
The spasmodic condition of the  body has been observed to continue after death,
and to pass into the  state of cadaverous rigidity.
  Fatal dose.—According to Christison, the smallest dose yet recorded is three
grains of  the alcoholic extract; but it  is not stated to how much of the powder
this would correspond.   Two cases occurred in London, in 1889, in each of which
fifty grains of the powder (equal to about one-fourth of a grain of strychnia,)
proved fatal.   In one of these cases, death took place in an hour;—the druggist
who sold the poison said that he did not  think that a dose of fifty grains was suffi-
cient to cause death! but a smaller quantity has been known to destroy life.  In
a case reported  by Hoffmann, and  quoted  by Christison, (901,) also by Traill,
(Outlines, 137,) thirty grains of the powder given in two doses of fifteen grains
each, proved fatal.   The poison  was given by mistake to a patient labouring un-
der quartan fever.   This  is, I  believe, the smallest fatal dose  recorded.   In
the third edition of this work it was stated, on the authority of Dr. Traill, that
fifteen grains had proved fatal;  but Dr. Traill informs  me that the dose was
twice given, thus making thirty grains.  This question became of some impor-
tance in the case of Reg. v. Wren, (Winchester Spring Ass. 1851.)   The priso-
ner was convicted of an attempt to administer this poison in milk: the quantity
separated from the milk amounted to forty-seven grains.   The intense bitterness
which the nux vomica  gave to the milk led  to detection, and this would, in ge-
neral, be a bar to the criminal administration of this poison or of strychnia, ex-
cept in the form of pills.   Death usually occurs in from one to two hours: but
Dr. Christison mentions a case where a  man died in fifteen minutes after taking
a dose. (898.)   This is probably the shortest period.  There are several instances
of recovery on record.   Mr. Iliff has reported a case in which a female recovered
after taking two drachms of the  poison.  (Lancet, Dec. 15, 1849.)
  Chemical analysis.—Nux vomica is  well known as a flat round kernel, less
than an inch  in diameter, with radiating fibres, slightly raised in the centre.  It
is of a light brown colour, and covered with a fine silky down.  It is very hard,
brittle, tough, and difficult to pulverize.  The powder is  of a gray brown colour
like that  of liquorice: it is sometimes met with in a coarsely rasped state: it has
an intensely bitter taste.  It yields to water and alcohol, strychnia, brucia, \<s<i-
suric or strychnic acid, and some common vegetable principles.   Heated on pia-
tina-foil,  it burns with  a  smoky flame.   Nitric acid turns it of a dark orange-red
colour, which is  destroyed by protochloride of tin.  In one case of poisoning by
this  substance, (Reg. v.  Wren,) I found a quantity of guaiacum powder mixed
with the nux vomica.  This so  completely changed the action of nitric aeid as in
the first instance to create some difficulty in identifying the substance.  The ana-
lyst must be prepared for these  adulterations.
  The aqueous infusion is  similarly changed by nitric acid, and it is freely pre- 
strychnia and its salts,   recovery.
159
cipitated by tincture of galls.  The quantity of strychnia contained in the pow-
der has not been very accurately determined.   It probably amounts to 0'5 grain
or one-half grain per cent.   If this be the case, the strychnia is more energetic
when contained in the nut, than when separated.

                        Strychnia and its Salts.
   The symptoms produced by strychnia closely resemble those described in speak-
ing of nux vomica.  The following case is reported in the Lancet, (Jan. 7,1838.)
A young man, aged seventeen, swallowed forty grains of strychnia.   The symp-
toms came on in about-a quarter of an hour; lock-jaw and spasmodic contraction
of all  the  muscles speedily set in, the whole body becoming as  stiff as a board;
the lower extremities were  extended and stiff, and the soles of the feet concave.
The skin became livid, the eye-balls prominent, and  the pupils  dilated and in-
sensible; the patient lay for a few minutes without consciousness, and in a state
of universal tetanus.   A remission occurred, but the symptoms became  aggra-
vated, and the patient died asphyxiated from the spasm of the chest, in about
an hour and a half after taking the poison.  On inspection, twenty hours after
death, the body was very rigid.   There was effusion in the spinal sheath, and
the.upper part of the spinal marrow was softened; the brain was congested, but
the alimentary canal was in its normal state.
   The quantity of strychnia required to destroy life is very small.  The smallest
fatal dose was in the case of Dr. Warner, who  died  from the effects of half a
grain of sulphate of strychnia in about fourteen minutes.   In a case communi-
cated to the  Lancet (Aug.  31, 1850, p. 259) by Mr. Bennett, one grain and a
half, taken by mistake, destroyed the life  of a healthy young female in an hour
and a half.  It is remarkable that no symptoms appeared  for  an hour.   They
first consisted in spasmodic twitchings of  the limbs, with general  tremors.
When  seen  at this time there  were paroxysms, in which the limbs were rigid,
and the jaw was completely fixed, the whole  body  stiffened, and  straightened;
and in one of these fits the girl died.  It was remarked  that during the fit the
pupils were dilated, but after it had passed off they  became contracted.   When
this poison proves fatal, it generally destroys life within two hours.  In  a case
which occurred in October, 1848, nine grains of strychnia were dispensed  in  a
mixture by mistake, in place of salicine.   A part only of the mixture was taken,
and the patient died in less than two hours.   (See Med. Gaz. vol. xlii. p. 797.)
There is one case reported in  which  a person is stated to have recovered from a
dose of seven grains.  (Med.  Gaz. xli. 305.)
   Recovery from a large dose of strychnia.—I am indebted to Mr. J. C. Forster
for the subjoined account  of  a  case showing the effects produced by a grain of
strychnia  on an adult.  It occurred in May, 1852.  S. J., act. 52, a dissolute
 hypochondriac,  with  a  constitution and intellect considerably damaged, was
under Mr. Forster's care for indolent ulcers on both legs, and on account of dys-
 peptic symptoms, from which he also suffered.  He  ordered him. one-twelfth of
 a grain of strychnia, to be taken three times a day.  For convenience and accu-
racy in dispensing, an acid solution of strychnia is kept at the Surrey Dispensary,
 in the proportion of  one  grain to an ounce of water, and this patient had one
ounce and a half of that solution given to him, a teaspoonful of which contained
the dose required.   From  inattention to both verbal and printed instructions, on
 his return home  he took rather  more than an ounce  of the  medicine, which  he
 had not swallowed above ten minutes when he became violently convulsed.   On
discovering his mistake he immediately took copious draughts of cold water, but
 the convulsions increasing in severity his friends became alarmed, and  he was
 taken to a hospital, where, being refused admittance, he was again brought to
 the Dispensary.   An hour and a half had now elapsed since the poison was taken,
 during the whole of which time his attendant stated he had been violently con-
 vulsed.   When  Mr. Hills first saw him  he  had  lock-jaw, with  the upper and 
160
COLCHICUM.  WrHITE  HELLEBORE.  VERATRIA.
lower extremities completely rigid, and paroxysms of opisthotonos and  empros-
thotonos occurring alternately.  A paroxysm now took place every six minutes,
each one lasting about two minutes, and during the emprosthotonic condition he
uttered a violent shriek.  He had half a drachm of sulphate of zinc given imme-
diately,  and was sent home and placed in a warm bed.   Mr. Forster saw the pa-
tient with Mr. Hills about four hours after the poison had been taken, and found
that he had been slightly emetized by the zinc, and had also been most violently
purged.  The tetanic rigidity still continued; the paroxysms  were, however,
less frequent;  the patient could only lie on his back, and the slightest exertion
brought on the convulsive attacks.  The bladder also seemed to  participate in
the general contraction  of the voluntary muscles, and expelled small quantities
of urine as  fast apparently as it flowed into  that organ; the pupils were natural;
the pulse small and irritable; and the whole frame was evidently much exhausted
and enfeebled.   He was now ordered frictions over the spine by means  of  soap
liniment, which afforded him great relief, and half a drachm of the compound
spirit of sulphuric  ether in camphor mixture to be taken internally every four
hours.   During the night he continued to  have involuntary twitchings of the
limbs, which lasted also through the following  day; on  the  second night  they
became  more severe, but were of only a few hours' duration, and then  entirely
left him.  He has since returned to his work in his usual health.
   Although strychnia is a poison  which has been hitherto considered to be be-
yond the reach of the common class of criminals, it has of late  been employed
for poisoning vermin and game in  certain  districts.  It may thus find its way
into the hands of persons  as a  substitute  for arsenic.   A trial for murder by
strychnia administered  in pills took place in 1851 in Canada.   Suspicion was
excited from the nature of the symptoms and the rapidity of death.  There was
no direct proof of the administration, and the jury acquitted the prisoner.   For
the details  of this interesting case, see British American Journal, July, 1851;
and Med. Gaz. vol.  xlviii. p. 517.   (Case of Azenath Smith.)


 Colchicum.   (Meadow  Saffron.)   Colchicina.   White Hellebore.
                                Veratria.

   The roots and seeds of these plants, and the leaves and flowers of colchicum,
exert a violent action on the human subject, chiefly manifested by symptoms of
irritation in the alimentary canal.   AVith a  burning pain in the throat and  oeso-
phagus,  there have been violent vomiting and purging, and death in the course
of some  hours.   After death, the stomach has been found inflamed, but not  in
all instances.   In November, 1839, a gentleman swallowed by mistake one ounce
and a half of  wine of colchicum.   He was  immediately  seized with severe  pain
in the abdomen: other symptoms  of irritation  came on, and  he  died in seven
hours.   No post-mortem examination was required by  the coroner!   In  another
instance in which an ounce  was  taken, death  occurred in  thirty-nine  hours.
(Schneider's Annalen, i. 232.)  In a well marked case of poisoning by the  wine
of colchicum,  reported by Mr. Faraday, two  ounces were taken.  The symptoms
did not  come on for an hour and a half; there was then copious vomiting  of a
yellow fluid, severe pain with great  tenderness in the  abdomen, tenesmus, and
thirst.   The patient died in forty-eight hours, without  manifesting any sign  of
cerebral disturbance.  The chief  morbid appearance was a patch of redness  in
the mucous membrane of the stomach, near the cartliao orifice;  the intestines
were slightly inflamed.   In another c*:s;, where an ounce and a half of the  tinc-
ture was taken, and death ensued  in forty-eight hours, no morbid appearances
were found.  A man, aged fifty-two, took a decoction,  made with a table-spoon-
ful of colchicum seeds to a pint and a  half of water.   He was seized with vo-
miting and purging, continuing  incessantly until death, which took  place  in
about thirty-six hours.   The only appearance of note was that the stomach had 
FOXGLOVE.   HEMLOCK.
161
a violet or purple hue.   In one instance a person recovered after swallowing an
ounce of the tincture.   There were cramps in the limbs and twitchings in  the
tendons.  (L'Union  Med. Aug. 24, 1848.)   An  interesting case of poisoning
by the medicinal administration  of  colchicum has been communicated to me by
Mr. Mann, of Bartholomew Close.  Three  and a half drachms of the wine of
colchicum were  taken  in divided  doses, and caused  death on the fourth day.
There was no inflammation of the mucous membrane, but simply extravasation
of blood in the mucous follicles.
   A decoction of Hellebore is a popular remedy for worms in some parts of the
country.  When thus administered to children, it has in several instances caused
convulsions  and death.    It is in all cases a  dangerous  substance in the hands of
the ignorant.

                  Digitalis.   (Foxglove.)  Digitalia.
   This plant, whether in the form of powder, extract, tincture, or infusion,  is a
poison, acting both on the brain and alimentary canal.   The  leaves  appear to
have the most powerful effect.  One of the best marked cases of poisoning by
this plant became the subject of a criminal trial at the Old Bailey in  Oct. 1826.
A quack was indicted for the manslaughter of a boy under the following circum-
stances :—He prescribed for a trivial complaint six ounces of a strong decoction
of digitalis.   The boy was soon attacked with vomiting, purging, and severe pain
in the abdomen.   After some time, he became lethargic, and slept for several
hours;  in the night he was seized  with  convulsions.   The pupils were dilated
and insensible, the pulse slow, small, and irregular;  coma followed, and the  boy
died twenty-two hours after the taking of the poison.   On inspection, the mem-
branes  of the brain were found much injected, and  the mucous lining of  the
stomach was partially inflamed.  The prisoner was acquitted of the charge, be-
cause he had only given his advice on the application  of the friends  of the de-
ceased!  (Ed. Med. and Surg. Jour, xxvii. 223.)  For cases  of recovery from
a strong dose of the infusion, see Med. Gaz. xxxiv. 659; and L'Union Medic-ale,
24 Aofit, 184S.   On the other hand, a  case in which an  infusion of  the root
proved fatal will  be found  in the  Lancet,  July  14,  1849, p. 31.  Accidents
sometimes occur from the medicinal use of  the tincture.  In a late number of
the Medical Gazette is the account  of a case where,  from a dose of the  tincture
too frequently repeated, the  person was attacked with restlessness,  thirst, in-
flamed  conjunctivas, and other serious symptoms.   The medicinal dose of the
infusion is from half an ounce to one ounce,—of the tincture,  from ten minims
to forty,—of the powder, from half a grain  to one grain and a half.

               Conium  Maculatum.  (Common Hemlock.)
   The leaves and roots of this plant, in common with those of the Cicuta, Virosa
(Water  Hemlock,) JEthusa  Gynapium (Fool's  Parsley), (Euanihe  Crocata
{_Hemlock AVater-dropwort), have frequently given rise to accidents. The  symp-
toms which they produce are  dimness of sight, vertigo, delirium, swelling with
pain in the  abdomen, vomiting, and diarrhoea.   Convulsions are  sometimes  ob-
served.  Death commonly takes place rapidly, and the post-mortem appearances
are slight, sometimes amounting merely  to congestion of the brain, with  slight
inflammatory redness of the stomach  and  bowels.  The (Enanthe crocata  ap-
pears to be the most  fatal among  these plants.   In February, 1834, four con-
victs  at AVoolwich lost their lives by  eating the roots of this  vegetable, which
they had mistaken for parsnips.   One  died in less than an hour.   (For an ac-
count of these cases, see  Med. Gaz.  May, 1844.)   On  inspection, their stomachs
were found  completely  filled with slices of the root.   Ten others who -had also
partaken of the root suffered severely,  but recovered.  This is one of the most
virulent of  English vegetable poisons.   It  is found growing abundantly in the 
162
datura stramonium.
South of Ireland.  Dr. Pickells has collected thirty  cases of death from  the
eating of the  root,—the quantity taken in one instance did not exceed the top
of the finger in size.   The symptoms were insensibility, tetanus, delirium, and
insanity.  Dr. Christison states that he has not found  this plant, as it grows in
Scotland, to be poisonous; but  it is an active poison as it grows in England,
Wales, and Ireland.   The following is a case of poisoning by the yEthusa cyna-
pium, reported in a late number of the Medicinisches Jahrbuch.  A woman
gave  two of her children some soup  in which she had boiled the root of this
plant, mistaking it for parsley.   They were both  seized with severe pain in the
abdomen, and the next morning one of  them, a boy aged eight years, was in a
state  of  perfect unconsciousness, and  his jaws were spasmodically fixed.   The
abdomen was swollen;  there was  vomiting of bloody  mucus, with obstinate
diarrhoea,—the extremities were cold, and the whole body was convulsed.   He
died in twenty-four hours.  The only appearances met with were redness of the
lining membrane of the oesophagus and  trachea, with slight vascular congestion
of the stomach  and duodenum.  For a very interesting case of  poisoning by
Conium, by Dr. Bennett, I must refer  the reader to the Ed. Med. and  Surg.
Journal, July, 1845, p. 169.   (See also, On Poisons, 752.)   And  the  reader
will find  some important remarks on its active principle, Conia or Conicine, by
Orfila, in the Annales d'Hygiene, 1851, ii. 224.
   It is rare that the question of poisoning  by hemlock comes before a judicial
tribunal.  One case of this kind was, however, submitted to me in 1848.  (Reg.
v. Bowyer, Ipswich Summer Ass. 1848.)  In this instance a  child died  in an
hour after swallowing part of a  tea-cupful of a decoction of hemlock, alleged to
have  been administered by the mother.   The woman was acquitted for want of
proof.  There were no morbid appearances in the stomach,  nor  any trace of
hemlock leaves in the stomach or bowels.

            Datura Stramonium.   (Thornapple.)  Daturia.
   The following case, reported by Mr. Mash of Northampton, may be taken as
an example of the effects produced by this plant, all the parts  of which,  but
especially the seeds and fruit, are poisonous. A woman, aged thirty-six, took two
tea-cupfuls of infusion of stramonium, by mistake for senna-tea.   In about ten
minutes  she was seized with dimness of sight, giddiness, and  fainting.  In two
hours she was quite insensible, the pupils were fixed and dilated; all the muscles
of the body convulsed, the countenance flushed, and  the pulse full and slow.
The stomach-pump was applied, and in the course of a few hours she recovered,
suffering, however, from indistinctness of vision and vertigo.   (Med. Gaz. viii.
605.)  The seeds of this plant have been known to produce furious delirium;
and a case is mentioned by Sauvages of an old man of sixty, who, after taking
this poison, became intoxicated, maniacal, and lost the power of speech.  He
remained in a lethargic state for five hours.  Several fatal cases are reported, one
of which terminated in six hours.  Dr. Thomson relates  the case of a child, aged
two years, who swallowed sixteen grains of the seeds.   Maniacal delirium super-
vened; the symptoms resembled those of hydrophobia, and death  took place in
twenty-four hours.  This plant has been used by robbers for the purpose of stu-
pifying those whom they intend to attack.  A very interesting medico-legal case
of poisoning by thornapple will be found reported in Henke's Zeitschrift der 8.
A. 1837, i. H.; and another in the Lancet, April, 1845, 47.   Dr. Zechmeister
has reported the case of a boy, aged five years, from which it would appear that
the vapour of the full-blown flowers is capable  of giving rise to well marked
symptoms of poisoning.  (Oesterreich. Med. AVochenschr. 19 Juli, 1845.)   Other
cases of poisoning by stramonium will be found in the Prov.  Journal  Dec  24,
1851, p. 699; and Lancet, May 31, 1851, 599. 
poisoning by monkshood.
163
    ACONITUM NAPELLUS.   (MONKSHOOD.   WOLFSBANE.  BLUE-ROCKET.)
                                ACONITINA.
   Two deaths are recorded to have taken place from this poisonous plant in 1837-
 8.   The root, seeds, and leaves, contain a  most active poison, Aconitina,  to
 which the properties of the plant are due.   These parts of the plant possess a
 hot acrid taste, and give rise to a burning sensation in the fauces, numbness and
 tingling in the limbs, swelling and pain in the abdomen, vomiting and diarrhoea,
 accompanied by vertigo, delirium, dimness of sight, and other symptoms indica-
 tive of cerebral affection.  In 1842, a lady, residing in Lambeth, was poisoned
 by her having eaten the root in mistake for horse-radish with some roast beef.  It
 is.not likely that, under these circumstances, much could have  been eaten; but
 very shortly after dinner slight vomiting came on, with severe pain in the abdo-
 men.  Emetics and the stomach  pump were used, but she died  in three hours.
   In the hospital at Bordeaux, jive grains of fresh extract of aconite w^re given
 to three patients.  One of them  died in  three hours.  In a quarter of an hour
 after taking the poison, the patients had tremors of the muscles, and a pricking
 sensation over their bodies; severe vomiting followed. They became quite uncon-
 scious; and on recovering their senses there was confusion of sight, with intense
 headache;  the skin was cold and  clammy, the pulse slow and irregular, and the
 respiration short and hurried.   Two of the patients recovered.   (Med. Chir.
 llev. Oct. 1839, 544.)   One drachm of the  root is said to have proved  fatal;
 but it is probable that less than this would suffice to kill an adult.   There ap-
 pears to  be considerable uncertainty in the operation of this poison under the
 form of tincture.  In a case which occurred to M. Devay (Cormack's Edinburgh
 Journal, April, 1844,) a man recovered in three days after having taken upwards
 of  ten drachms of the tincture  (only infused for a day;) while the late Dr. Male
 of Birmingham is reported to have died from  the effects of not more than eighty
 drops taken in ten doses, over a period  of four days,—the largest quantity taken
 at  once being ten drops.  (Prov. Med. and Surg. Journ. August 20,1845, p.
 535; also Med. Gaz. xxxvi. 861.)  Dr. Pereira  informs me that he has known
 general numbness produced  in hysterical females by a dose of ov\j five minims
 of  a  carefully prepared tincture.   Dr. Topham  has  recently communicated to
 the Lancet an interesting account  of  the  symptoms produced by only fifteen
 minims of the tincture of the  root of aconite.   Immediately after taking the
 poison in a mixture into which  it was put by mistake, the patient (a woman aged
 twenty-seven) felt a sensation  of numbness  in  the  tongue,  with  difficulty of
 swallowing.  There were convulsive twitchings of the muscles of the face, and
 she lost  the power of walking.  There  was complete unconsciousness,  which
 continued for two hours, when she began to recover.  The pupils were observed
 to be slightly contracted.  The intensity of the  symptoms varied at  intervals,
 and came on in paroxysms.   They indicated great disorder of the nervous system.
 The next day she had numbness in both arms, but she rapidly and perfectly
 recovered.   (Lancet, July 19, 1K51, p. 56.)  [A case  recently occurred in the
 neighbourhood of Philadelphia, in which death rapidly ensued from the adminis-
 tration by mistake of a  tablespoonful of the saturated tincture.   The victim in
 this instance had been  confined to bed for some days by neuralgic  disease, for
 which the  tincture  had been externally applied.   Another case is reported by
 Dr. MoCready of New York, in which a tablespoonful of the saturated tincture
 was swallowed by a healthy Irish woman aet. 25.   An emetic was taken about an
 hour after the poison, and a pint of thick  fluid, consisting chiefly of partially di-
 gested food,  ejected.  Presence of  the tincture therein not ascertained.   She
 complained  of numbness and tingling of tongue  and  whole surface of  body.
 Pulse 120, soft, feeble and varying  in  force.   No nausea except  from emetic,
 head  perfectly  clear,  and pupils dilated.  (Am. Journ. Med. Sci.  Jan.  1852,
268.)—H.]
  The alkaloidal base of this plant, Aconitina,  is a mos,t  formidable poison, 
164
DEADLY NIGHTSHADE.  TOBACCO.
 exceeding all others in its effects; according to Dr. Pereira, it is strongly retained
 in the vegetable tissues  after their compression.   Hence the uncertainty of the
 strength of the preparations of aconite.
   Although there are few poisons so deadly as aconitina,—for even experiments
 on it require to be  made  with the greatest  caution,—a singular instance is re-
 corded by Dr. G. Bird, in which a gentleman recovered after having taken two
 grains and a half.   (Med. Gaz. vol. xli. p. 30.)  In this case, however, there
 appears to have been early and copious vomiting, so that the greater part of the
 poison had probably been discharged.   Enough had been absorbed, however, to
 produce most serious symptoms.   There was collapse, coldness of surface, cold
 perspiration, heart's action scarcely perceptible, and constant spasmodic vomiting
 of a very violent kind.

        Atropa Belladonna.   (Deadly Nightshade.)  Atropia.
   This plant is poisonous in  its root, leaves, and berries.   Children have fre-
 quently suffered severely from eating the shining black berries of the belladonna.
 The symptoms observed  have  been heat and dryness of the throat and fauces,—
 vertigo, double vision, with delirium, convulsions, sopor, and lethargy; sometimes
 nausea and vomiting.  The pupils are much dilated, and the eyes are insensible
 to light.   On inspection, the  vessels of the  brain have been found turgid with
 dark-coloured blood.  Several deaths from the effects of the berries occurred in
 this  metropolis  in the autumn of 1846.  Dr. Scharf has  published a case of
 poisoning by the root of belladonna infused in four ounces of water and injected
 as a clyster.  In a very short time the patient fell into a state of complete narcotism,
 and  died in five hours.   (Casper's AVochenschrift, February, 1845.)  Mr. Iliff,
 Jun., gives an account of the effects produced on himself by a dose of nine  grains of
 the extract of belladonna, for which I must  refer to the Lancet (Dec.  1, 1849,
 p. 756.   See also Med. Times, Aug. 30, p. 234.)  In the Medical Gazette (vol.
 xlii. p. 589,) will be found the report of an inquest in a case of alleged poisoning
 by belladonna, involving many interesting points regarding this poison.   The
 extract of  belladonna is no doubt subject to great variation in strength,  and this
 may explain certain  exceptional cases  in  which persons  have recovered after
 having  taken large doses of this compound.   Mr. Edwards has reported a very
 interesting case  in which a female, get.  34, recovered after  having swallowed a
 drachm of the extract by mistake.   (Lancet, May 24, 1851, p. 568.)
  The alkaloidal principle of this plant, Atropine, [Atropia] is a powerful poison.
 In November, 1850, Mr. Sells, of Guildford, forwarded  to me for examination
 the stomach of a young man  who had poisoned himself  by taking two grains of
 atropine.   He took the dose on going to bed.  He was heard to snore heavily
 through the night, and was found dead about seven o'clock in the morning, lying
 on his right side, the surface livid, the limbs rigid and  contracted, and with
 a little brown matter issuing  from the mouth.   The pupils were much dilated.
 The  mucous membrane of the  stomach presented a diffused redness which might
 have arisen from some brandy which he had  swallowed.   No trace of the poison
 could be detected in  the stomach or its contents.  [An instance of the poisonous
 effects of a solution  of atropia (5 centigr. in thirty grammes—nearly one grain
in an ounce—of water acidulated with acetic  acid) applied to the conjunctiva in
 a case of double cataract, is reported  in  the Abeille Medicale (25 Jan. 1853,
 29) to have occurred in the service of M. Chassaignac at  the Hospital St. Anto-
ine, Paris.   Half an hour after the instillation of three or four drops in each eye
the patient was attacked with violent symptoms of poisoning by belladonna  which
did not entirely  subside until three or four days had elapsed.—H.]

                    NlCOTIANA TABACUM.   (TOBACCO.)
  This plant, according to late researches, contains a poisonous volatile alkaloidal
principle, nkotina, which forms from two to seven per cent, of tobacco.   It is a 
LOBELIA inflata.   COCCULUS INDICUS.               165
colourless oleaginous liquid of a powerful tobacco odour, hot acrid taste, and solu-
ble in alcohol, water, and ether.  It has a strong alkaline reaction.  A remarkable
case  of poisoning by nicotina will be found  in  the Annales d'Hygiene, 1851,
p. 167: I allude to  that of the  (hunt Bocarme, who was tried  and executed  in
Belgium for the murder of his brother-in-law.  Tobacco has proved fatal, when
used improperly or by mistake, in the form  of  an injection, but  very little  is
known concerning the few cases in which it has destroyed life.   The symptoms
have been nausea, vomiting, vertigo, convulsions, and coma, followed by death
in a  few hours.  In one case it  destroyed life in three-quarters of an hour.   One
of the best observed cases of poisoning by tobacco has been reported by Mr. Eade.
A girl, aet. 18, injected as a clyster a decoction made  by boiling three drachms
of common shag tobacco in a pint of water.   In half an hour she complained of
faintness and feeling sick, and in another half hour she became quite collapsed,
with cold sweats, vomited, was  slightly  convulsed, and died  in  an hour and a
half from the time at which she injected  the clyster.   On  inspection, the heart
was  found very flaccid; there were  three drachms of fluid black  blood in the
ventricles.   The stomach contained food, but had no unusual appearance.   The
intestines presented no trace of inflammation or redness in  any part, and  there
was  no smell of tobacco (thirty-six hours  after death) either in  the intestines  or
in any part of the body.  The head was not examined.  (Med. Gaz.  xliv. p. 823.)
These facts tend to show that tobacco is  rather a narcotic than a narcotico-irritant
poison.
                            Lobelia  Inflata.
   The powdered leaves of Indian tobacco (Lobelia Inflata) contain an  acrid
principle which is capable of producing narcotico-irritant effects.  As a poison
it is but little known in this country.  Wibmer relates that in one  instance  it
produced at first violent vomiting in the person for whom it was prescribed; but
the medicine was repeated until it was no longer ejected from the stomach.   The
patient suffered severe pain, and speedily died: stupor and convulsions having
preceded death.  The powdered leaves and seeds are much employed by quacks
in the United States;  and accidents occasionally arise from the  substance being
prescribed in excessive doses.  When administered in doses of from ten to twenty
grains, lobelia  acts  as an emetic; but in larger quantity it acts deleteriously.   It
would also appear that even ordinary medicinal doses affect some individuals  with
great severity; owing, probably,  to idiosyncrasy.
   A case has recently occurred, in which a man  lost his life by swallowing one
drachm of the powdered leaves, prescribed by a quack.  This person was seen by
a medical practitioner soon after he had taken the poison; he was evidently suf-
fering great pain,  but  he was quite unconscious,—the pulse small, the pupils
strongly contracted and insensible to light.   He had vomited the greater part of
the poison.   He suffered from spasmodic twitchings of the face, sank into a  state
of complete insensibility, and died in about thirty-six hours.   On  inspection,
some fluid was found  in  the stomach,  but  none of the powder.  The  mucous
membrane was intensely inflamed, and the vessels of the brain were strongly con-
gested.   (Pharm. Times, May 1, 1847, p. 182.)
   Since the third edition  of this work appeared, there have  been  several  trials
for manslaughter in this country as a result of the administration  of the leaves
of the Lobelia Inflata by ignorant quacks.  The medical evidence given on these
trials shows  that it is a most  noxious  drug.   (See Medical Gazette, vol. xliv.,
pp. 383 and 433, also vol. xlvi. p. 384, and  for some valuable  remarks on the
action of the poison see a paper by Mr. Curtis and Dr. Pearson, Med. Gaz., vol.
xlvi. p. 285,  and vol. xlvii. p. 160.)

                            Cocculus Indicus.
   This is the fruit  or berry of  the  Menispermum Cocculus, imported from the
East Indies.   It contains from  one to two per cent, of  a poisonous alkaloid 
166
CYTISUS LABURNUM.
(Picrotoxia,) which resides in the substance of the berry or kernel, and not in
the husk.   The  seeds give rise to vomiting and griping pains, and a decoction
of them produces stupor and  intoxication.  There is, so far as I am aware, only
one well authenticated instance of this  substance having proved fatal to  man.
(See Traill's Outlines, 146.)   London porter and ale are considered, and in some
instances with propriety, to owe their  intoxicating  properties ta a decoction or
extract of these berries,—a fraud not readily susceptible of detection.  [A simi-
lar use of it is attributed to some brewers in this country.  A well authenticated
case of poisoning from the external application of a strong decoction of the berries
is reported by Dr. Wm. B. Thompson, in the Phila. Med. Exam., April, 1852,227.
—H.]  Cocculus indicus is also  used by robbers to intoxicate their victims, and
to this form of intoxication the term hocussing is applied.   This substance  is
applied to  no useful purpose whatever, either in medicine or the arts; and, un-
der a proper system of medical police, its importation would be strictly prohibited.
For some account of the properties of picrotoxia, see a paper by Dr. Glover, Lan-
cet, Jan. 11, 1851, p. 47.

                            Cytisus Laburnum.
   The bark and seeds of the common  laburnum contain an active poison called
 Cytisine.   Dr. Traill met with two cases of poisoning  by the seeds, and an in-
teresting case has been reported by Dr. Christison, (Ed. Med. and S. J. Oct.,
1843,) which was the subject of a trial at Inverness.  . A youth, with the inten-
tion of merely producing vomiting  in  one of his fellow-servants, a female, put
some  dry  laburnum-bark into the  broth which was being  prepared for their
dinner.  The cook, who remarked "a strong peculiar taste" in the  broth, soon
became very ill, and in five  minutes was attacked with violent vomiting.   The
account of the symptoms is imperfect;  for the cause of them was not even sus-
pected until  six  months afterwards.   The vomiting continued thirty-six hours;
was accompanied by shivering,—pain in the abdomen, especially in the stomach,
—and great feebleness, with  severe purging.   These symptoms continued, more
or less, for a period  of eight  months;  and she fell off in flesh and  strength.  At
this period she was seen by  a physician, who had been called on by the law-au-
thorities to investigate  the case.  She was then suffering from gastro-intestinal
irritation,  vomiting after food, pain in  the abdomen increased by pressure, diar-
rhoea, tenesmus, and bloody  stools, with other serious  symptoms.   The medical
 opinion was, that she was  then in a highly dangerous state.  The woman did
not recover until the following April.   There was no doubt, from the investiga-
tion made by Dr. Ross  and Dr. Christison, that her protracted illness was really
 due to the effects of the laburnum-bark.
    Mr. Rake, a former pupil,  has communicated to me the subjoined recent cases
 of poisoning by laburnum pods and berries, which occurred  in September, 1851.
 Two children, the one aged two, and the other three years, had been seen playing
 together, and on returning home they appeared unwell, and soon  after vomited.
 They  had  been seen with  laburnum pods in their hands, and some berries with
 portions of the enclosing pods were mixed with the vomited matter.  Both chil-
 dren were pallid and  exhausted, with a slow and  somewhat feeble pulse.  The
 pupils were natural.  An emetic was given, but no more seeds were ejected: the
 pulse  increased in volume  and frequency, and the next day the children had re-
 covered their usual health.
    Mr. Barber, of Stamford,  communicated to me in June, 1848, the particulars
 of a case which show that  even  the flowers of this plant are highly noxious.  A
 child between three and four years of age ate twelve laburnum flowers, and in about
 fifteen minutes  it complained of sickness and severe pain in the stomach.  The
 child  vomited a quantity of mucus mixed with the yellow petals of  the laburnum.
 An emetic was  given:  this cleared the stomach, and the child recovered.   There
 was no purging.  (Guy's  Hosp. Reports, Oct. 1850, p. 219.)  A case in which
 a child suffered from symptoms of a nervous kind by  reason of its having eaten 
POISONING BY MUSHROOMS.  YEW.
167
laburnum flowers, is described by Mr. North in the Medical and Physical Journal,
vol. lxii. page 86.
                          Fungi.  Mushrooms.
  Poisoning by mushrooms is  by no means unusual as the result of accident.
In 1837-8 there were four fatal cases of this description.  There do not appear
to be any satisfactory rules for distinguishing the mushrooms which are whole-
some from  those which are poisonous.   The best test  is that assigned by Dr.
Christison—namely, that the poisonous vegetable has an astringent styptic taste;
and perhaps also a disagreeable but certainly a pungent odour.  The narcotic
poisonous principle is called Fungin, but its nature and properties are but imper-
fectly known.   These fungi act sometimes  as narcotics, at others as irritants.
[It has been recently ascertained by M. Gerard, that the mushroom may be de-
prived of its noxious property by prolonged maceration in acidulated water, (Am.
Jour. Med. Sci., Jan. 1853, 261.)—H.]  It is  difficult  to generalize where ob-
servations are so limited;  but it would appear from the reports of several cases
which I have collected, that when the narcotic symptoms are excited, they come
on soon after the meal at which the mushrooms  have  been eaten, and  they are
manifested by giddiness, dimness of sight, and debility.  Dr. Peddie has related
three cases of  poisoning  by mushrooms,  in which the poison acted  as a pure
narcotic: there was  no pain  in  the abdomen, nor irritation in the alimentary
canal (Ed.  31. and S. J. xlix. 200.)  The  narcotic  symptoms began in half an
hour with giddiness and stupor.   The first effect with one patient was, that every
object appeared to him  to be of a  blue colour.  The  three  patients  recovered,
two of them rapidly.  When the drowsiness passes off, there are generally nausea
and vomiting.   If the symptoms do not occur until many hours after the meal,
they partake more of the characters of irritation;—indicated by pain and swelling
of the abdomen, vomiting and  purging.   Several cases, in which the symptoms
did not appear until after the lapse of fourteen hours, are reported in the Medical
Gazette, (vol. xxv. p. 110.)   In some instances the symptoms of poisoning have
not commenced until after the lapse of thirty hours; and in these, narcotism fol-
lowed the  symptoms of  irritation.  It might be supposed that these different
effects were due to different properties in  the mushrooms; but the same fungi
have acted on members of the same family, in one case like irritants, and in an-
other like narcotics.  In some persons, even the edible mushrooms will produce
disorder of the stomach and bowels by the effect of idiosyncrasy.  In most  of
these cases recovery takes place, especially if vomiting be induced: in the few
instances which have proved fatal, there has been more or less inflammation in the
stomach and  bowels, with turgescence of  the vessels of the  brain.  Reports  of
recent cases of death from mushrooms will be found in the Medical Gazette, vol.
xlvi. p. 307, and xlvii. p. 673.   Even Catsup, a liquor made from mushrooms,
has  been known to produce serious effects.   (Dub. Med. Press, Sept. 24, 1845,
p. 195.)
                                  Yew.
   It has long been known that the berries and leaves of  the yew-tree (Taxus
BACCATA)  are  poisonous  to  cattle;—they act very energetically, and produce
death in a  few hours, sometimes without vomiting or purging.   It is  stated by
Dr. Percival, that a table-spoonful of the fresh leaves was administered to three
children of five, four, and three years of age, as a vermifuge.   Yawning and
listlessness soon succeeded;  the eldest vomited a little, and complained of pain
in the abdomen, but the other two suffered no pain.  They all died within a few
hours of each other. An  interesting  case of poisoning by the berries of this
tree was published a few years  since by Mr. Hurt, of Mansfield.  A child, aged
three years and a half, ate a quantity of yew-berries about eleven o'clock.  In
an hour afterwards the child appeared  ill,  but did not complain of any pain.  It
vomited part of its  dinner, mixed with some of the  berries.   A medical  man 
168
YEW.
was sent for, but the child died in convulsions before he arrived.  On inspection,
the stomach was found tilled with mucus and the half-digested pulp of the berries
and seeds.   There were patches  of redness in the mucous membrane, and this
was so much softened that it could be detached with the slightest friction.   The
small intestines were also inflamed.
  The symptoms produced by yew-leaves and berries are pretty uniform in cha-
racter: convulsions, insensibility, coma, dilated pupils, pale countenance,  small
pulse, and cold extremities, are the most prominent.  Vomiting and purging are
also observed among the symptoms.  In two cases of recent occurrence, the sub-
ject of one—a girl, about five years of age, died in a comatose state  in four hours
after  she  had eaten the berries, and of the other, a boy, aged four years, died
nineteen days after taking the berries, obviously from severe inflammation of the
bowels (see Prov. Journal, Nov.  29,1848, 662, and Dec. 27, p. 708.)
  There is a vulgar but erroneous notion that the yew-leaves are not poisonous
when fresh, and that in any case  they act only mechanically.  A case related
above shows the fallacy of the opinion, and the other cases prove that there is a
specific poison in the yew, since  it  exists in the berries.  If cattle  recover from
the primary effects on the nervous system,  they are liable to die  after several
days, from inflammation of  the bowels.  I lately examined the viscera of an ox
which had obviously died from the effects of yew-leaves.  In some parts of the
intestines gangrene had taken place.
   [Many other plants indigenous to the U. S. are possessed of narcotico-acrid pro-
perties: none of them with the exception of Cicuta maeulata require notice.   The
cicuta is exceedingly active and  prompt in  its operation.  Many cases of death
are recorded, in almost every instance from  eating the root  in  mistake.   The
symptoms  are analogous to those  caused by other articles of the  class, except
that pain and  convulsions are sometimes wanting.
  The following list given in the previous American edition includes most of our
native poisonous plants, in addition to those already noticed, and is  mainly taken
from Dr. Beck, (ii. 883.)

   Sanguinaria  canadensis.— Vid. Tully, Med. Rec, xiii.  1.  Barton, Veg. Mat.
                                    Med. i. 31.
                                 Rafinesque, Med. Flor. i. 160.
                                 Phil. Journ. Pharm. vi. 285.
                                  Short, Transylvania Journ. i. 422.
                                 Torrey & Gray, Flora.  N. America, i. 252.
                                 Amer. Journ. Pharm. i. 180.
                                 Boston Med. & Surg. Journ. vii. 117.
                                 Bigelow, 31 ed. Botany, i. 137.
                                 Barton, Veg. Mat. Med. ii. 80.
                                 Boston Med. & Surg. Journ. vii. 136.
                                 Barton, Veg. Mat.  Med. i. 128. Am.  Jour.
                                    Pharm. i. 1.
                                  Barton,  Veg. Mat.  Med. ii. 14. Jour. Phil.
                                    Col. Pharm. iii. 273.
                                  Amer. Journ. Med. Sci. xii.  76.
                                  Caldwell, Med. Theses, i.  128.
                                 Barton, Areg. Mat. Med.
                                  Amer. Journ. Pharm.
                                 Amer. Journ. Med. Science.—H.]
Dirca palustris.
Robinia pseudo-acacia.
JEscxdus ohioensis.
jEsculus pavia.
Media azederach.
Gelsemium nitidum.
Kalmia latifolia.
Spigelia marilandica.
Helonias erythrospcrma.
Symploca rjms fatida,

Podophyllum peltatum.

Euphorbia corollata.
Rhus radicans, &c.
Phytolacca decandra.
Actsea alba et rubra.
Apocynum a ndrossemifoilum. 
wounds,  surgical definitions.                 169
WOUNDS.
                             CHAPTER  XX.

VARIOUS SURGICAL DEFINITIONS OF A WOUND--INJURY TO THE SKIN--LEGAL DEFINITION—
  AN ABRASION OF THE CUTICLE NOT A WOUND--IMPLIES IMMEDIATE  AND  NOT REMOTE
  LACERATION OF THE SKIN--IS A DISLOCATION A WOUND?--WOUNDS DANGEROUS TO LIFE
  --THE  DANGER IMMINENT--WOUNDS PRODUCING GRIEVOUS BODILY HARM.  INTENT OF
  THE ACCUSED A QUESTION FOR THE JURY.

  When a person is the subject of a wound or external injury, from the effects
of which he ultimately recovers, a medical witness is often rigorously examined
with respect to  the precise nature of the injury, and how far it involved a risk
of life.   The answers to these questions may have an important influence on the
defence of a prisoner, when the crime is charged  under particular forms of in-
dictment.
  Definition  of a wound.—It may, I think,  be safely asserted, that we shall look
in vain  for any consistent definition  of  a  wound, in works on  medicine and
Burgery.   A  wound is, perhaps, most commonly defined to be, a  "recent solution
of continuity in the  soft parts, suddenly occasioned by external causes."  Yet
they who adopt this view do  not regard as wounds  ruptures of the liver or
spleen, burns by heated  bodies, or simple dislocations and fractures;  although
all of these injuries are comprehended in the literal signification of such a defini-
tion.   The following definitions of a wound  have  been  furnished to me by three
eminent  surgeons of  this metropolis:—
  "A solution  of continuity from violence of any  naturally continuous parts."
  "An external breach  of continuity directly occasioned by violence."
  "An injury to an  organic texture by mechanical or other violence."
  Owing to the unsettled meaning of the  word wound, it has happened on more
than one occasion, that  medical witnesses have differed in their evidence; and
some difficulty has arisen in the prosecution of criminal charges.   It has been
asserted,  that in order to constitute a wound, the  skin  should always be broken
or injured; and this, as we shall see presently, is the  interpretation commonly
put upon the term by our  judges.  But those  who have  adopted this view do
not regard burns, produced either by heated metals, or corrosive  liquids, as
wounds;  although there seems  to be no good reason why, under the above defi-
nition, they should be excluded.   Technical difficulties of  this kind, which only
lead to the  embarrassment of witnesses and to the acquittal of prisoners charged
with serious offences, might be avoided if the medical witnesses of England were
allowed to adopt the comprehensive definition sanctioned by the legal tribunals
of certain States on  the Continent, namely, that "a wound includes every de-
scription  of personal injury, arising from whatever cause, applied externally."
It may appear  contrary to propriety to designate a contusion  or fracture  as a
wound; but the common definitions will be found, on examination, to be equally
inconsistent, and to be attended, in legal medicine, by evil results, inasmuch as 
170
LEGAL definition of a wound.
they lead to acquittals, not upon the merits of the case, but upon the most trivial
pretences.  This could not happen if the above comprehensive signification were
generally followed.   It appears to  me, that  in  a case of this kind we should
rather regard the wants of justice than the rules of surgery.   If medico-legal
cases fail from differences respecting the meaning of scientific terms among sur-
gical  writers, it is time  that  some fixed  rule should  be adopted.   While the
science of surgery cannot possibly suffer by such an innovation, the administra-
tion of the law will be rendered  much more efficient.   It is probable that the
new Statute, the 14 and  15 Vict. ch. 100, will supply  a remedy for some of the
evils which have hitherto arisen from a misdescription  of personal injuries in in-
dictments.
   Legal definition.—It cannot be denied that an alteration in the use of medical
terms must, in order to  be attended with any good effects, receive the support
of our legal authorities.  This, probably, would not be long withheld, if good
reasons for the change were afforded by medical witnesses.  The present rule ap-
pears to be, that no  injury constitutes a wound in law, unless  the continuity of
the skin  be broken;  so that in a case where blows were inflicted with a hammer
or iron-instrument sufficient  to break  the collar-bone, and violently bruise but
not break the skin, it was held not to be a wounding within the statute.   (Arch-
bold.)  The Act 1 Aric. c. 85, has in some measure provided for the punishment
of persons guilty of inflicting such severe injuries, but still it has left the legal
signification of the word wound unsettled.   The 14 and 15 Vic. ch. 100, is still
more precise, but avoids the definition of  a  wound.   From several recent deci-
sions, it appears that an abrasion of the cuticle only, is not to be understood as
a breaking of the continuity of the skin,—the cutis or  true skin must participate
in  the injury,  and probably the cellular membrane beneath.   A man was tried
at the Central Criminal Court in  August, 1838, on a charge of cutting and
wounding the prosecutor.  The prisoner struck  the prosecutor a severe blow on
the temple with a heavy stone-bottle, which was thereby broken to pieces.  The
prosecutor fell  senseless, and it was a  long  time before he recovered from the
effects of the violence.   The medical witnesses in this case underwent a rigorous
cross-examination by the prisoner's counsel, respecting the meaning of the word
"wound."   They said that there had been a separation of the cuticle or  outer
skin of the temple, although there was no absolute wound in the usual accepta-
tion of the word.   They further deposed that the prosecutor  had lost the sight
of his left eye, and the  hearing  of  his left ear; and he was for a considerable
time  in a state of great  danger, from which he  had scarcely recovered.  The
prisoner's counsel contended that the injuries were not such as to constitute cut-
ting and wounding in law.   The judge said, in order  that a wound, in contem-
plation of  law, should have been inflicted, it was necessary that the whole skin,
and not the mere cuticle, should have been separated and divided;  and as  the
evidence did not show distinctly that  there was such a wound, those counts of
the indictment could not be sustained.  The prisoner  was found guilty of an as-
sault.
   It is also to be inferred that for the production of a wound, the continuity of
the skin must  be broken at the time of the infliction of the violence, and as a di-
rect effect of it.  Thus, if from a severe contusion, sloughing should take place,
this would not constitute a wound, notwithstanding the very  extensive destruc-
tion of the skin and soft parts, as an indirect  result  of the violence.   So, if a
bone of the leg be broken by a blow,  and the skin lacerated, and a  compound
fracture produced by the assaulted party falling, it is doubtful whether this would
be a wounding in a  legal sense.  Again, if an assault be committed with a heated
 solid, such as a red-hot poker, although the whole skin might here be  destroyed,
it is doubtful whether such an injury would constitute a wound in law.  In short,
 this subject, whether we regard  it in  a medical or legal aspect, is in a very un-
 settled state, but in the mean time a legal remedy is provided by Lord Campbell's
 Act, 14 and 15 Vict., chap. 19, s. 4. 
on wounds dangerous to life.
171
  A case was decided in the Queen's Bench in Nov. 1847, which shows that in
a civil action, our judges are not disposed to put too close a restriction upon the
meaning of medical  terms.  The question here was, whether a dislocation was
or was not a  wound.   An action was brought against a medical practitioner for
negligence in the  treatment of a dislocation of  the arm, and a verdict was re-
turned for the plaintiff.   An application was made to the court of Queen's Bench
for a rule  to show cause why there should not  be a new trial, on the ground of a
misdirection of the learned Chief Baron, who tried the case.   The declaration al-
leged that the plaintiff had employed the defendant, who was a surgeon, for the
treatment and cure of certain wounds, fractures, bruises, complaints, and disor-
ders—but the evidence showed that the defendant had been employed to cure the
plaintiff of a dislocated arm.   At  the close of the plaintiff's case, it was  sub-
mitted to the learned Chief Baron  that there was no word  in  the declaration
which was applicable to the case;  but  this objection was overruled.  A disloca-
tion, it was argued, was neither a wound, bruise, nor fracture;  and  the words,
" complaint and disorder," were not at  all applicable to a surgical case, but to in-
ternal complaints which required to be treated  medically.   Lord Denman, in de-
livering the judgment of the court, said, "It is rather strange that the pleader
should have omitted  the most appropriate word;" but we think the Chief Baron
was quite.right.  Rule refused.
  To constitute  a wound—Should the breach of continuity be external, or does it
apply to the mouth and fauces as  well  as the skin ?  This question arose  at  the
Norwich Summer  Assizes, 1849, in the case of a man named Bolton, charged
with maliciously wounding a mare.  He had thrust forcibly down the throat of
the animal a stone, which had torn  the fauces and oesophagus.   It was objected
that the injury  was not a wounding within the statute, the parts injured being
internal, and there being no proof of external blow or violence.  The judge who
tried the case was  of opinion that it fell within the statute.   Blood flowed from
the broken skin, or membrane, lining  the throat, and the stone was forced  into
the flesh; and it had been held that the injury need not be external to bring the
case within the  statute.  The prisoner was convicted.
   [In the United States the same rule has been pursued as in  England, viz., that
no injury to  the person is a wound where the skin is not broken; hence  a  frac-
ture of a bone without a solution of continuity of the skin is not, legally speak-
ing, a wound.   In France, three words are employed as almost synonymous—
wounds, blows,  or violence to the body, and hence either one includes all possi-
ble injuries that can result from external causes.—H.]
   Wounds dangerous to life.—A medical witness is  often asked whether a wound
was or was not dangerous to life.   In reference to persons  charged with  an at-
tempt to murder or maim, a written medical opinion, or a deposition, may be de-
manded of a surgeon by a magistrate,  in order to justify the  detention  of priso-
ners.  The  law has  not defined the meaning of the words, "dangerous to life,"
or stated to what kind of wound the term dangerous should be applied.   This is
a point which is left entirely to the professional knowledge of the witness.   It is
not sufficient on these occasions  that the witness should make a naked declara-
tion of  the wound being dangerous to life; he must, if  called upon, state to the
court satisfactory reasons for this  opinion; and these reasons  are  rigorously in-
quired into by the counsel for the defence.  As a general principle, it would not
be proper to  consider those wounds  dangerous  to life in  which the danger is not
imminent. A wound of a great blood-vessel, of any of the viscera, or a compound
fracture with depression of the bones of the head, must in all instances be regarded
as bodily injuries dangerous to life;  because in such cases the danger is imminent.
Unless  timely assistance be rendered, these injuries will most  probably prove
fatal, and, indeed, they often destroy life in spite of the best  surgical treatment.
AVhen,  however, the danger is remote, as in a puncture or laceration of the hand
or foot, which may be  followed by  tetanus, or in  laceration of the scalp, which 
172
wounds causing grievous bodily harm.
may be followed by erysipelas, or in penetrating wounds of the orbit, which may
be attended by fatal inflammation of the brain or its membranes, the case is
somewhat different.  Such injuries as these are not" directly dangerous to life,—
they are only liable to be attended with danger  in certain cases;  and therefore
the medical opinion must  be qualified.  The law, on these occasions, appears to
contemplate the direct, and not the future or  possible occurrence of danger: if
the last view were adopted, it is clear that the  most trivial lacerations and punc-
tures might be pronounced dangerous to life; since tetanus or erysipelas  proving
fatal, has  been an occasional consequence of very slight injuries.   A difference
of opinion will often exist among medical witnesses as to whether a particular
wound was or was not dangerous to life.   Unanimity can only be expected when
the judgment and experience of the witnesses are equal.   The rules for  forming
an opinion in these cases will, perhaps, be best deduced from the results of the ob-
servations of good surgical authorities in relation to injuries of different  parts of
the body.   These will form a subject for examination hereafter.
   Wounds causing grievous bodily harm.—If  the witness admit that the wound
was not dangerous to life, then he may be required to state whether it was such
as to have been capable of producing "grievous bodily harm."   This question
is sometimes put, although the most usual practice is to leave it as an inference
to be drawn by the jury from the professional  description of the injury.   These
words have a vague signification; but it would perhaps be difficult to substitute
for them others less open to objection.   They evidently refer to a  minor  descrip-
tion of offence, and are applied commonly to those injuries which,  while they are
not actually  dangerous  to life, may  be  attended with  considerable personal in-
convenience, or be in some way detrimental to the health  of the wounded party.
It is always a question for a jury, whether the  intent of the prisoner, in inflicting
a wound,  was or was not to produce grievous bodily harm.  Sometimes  the na-
ture or the situation  of  the wound, as well as  the kind of weapon used, will at
once explain the  intent: so far  the  medical witness may assist  the Court, by
giving a  plain description of the injury, as well  as  of  the  consequences with
which  it is usually attended.  It may so happen, that the wound itself is not of
a very serious nature, and yet the intention of  the prisoner may have been to do
grievous bodily harm to the wounded party; or, as in the following case, the in-
jury may be  really serious, and yet  the prisoner may not have intended to do
grievous bodily harm.  A  man was indicted  for feloniously wounding a girl,
with intent to do grievous bodily harm.  He kicked her in the lower part of her
abdomen,—the surgeon described the injury as of the most serious character, and
said that  at one time he considered the life of the prosecutrix in danger.   She
was still suffering, and would probably feel the effects of the injury for the rest
of her life.   The judge, in summing up the case, told the jury that the  material
question for them to consider was the intent of the prisoner.   It was not because
serious injury was the result of  the  prisoner's act, that  they were therefore to
infer his intention was  to do that injury; and they were  to  judge, from all the
circumstances, whether, at the time he kicked  the prosecutrix, he  intended to do
her grievous bodily harm, as was imputed to him by the indictment, or  whether
he was merely guilty of a common assault.  He was found  guilty of a  common
assault.   (Reg. v. Haynes, Central Criminal  Court,  September,  1847.)   In
cases of  this description, the intent with which the wound was inflicted must be
made  out by evidence  of a non-medical kind.  (See also  the  case of Reg. v.
Maslin, Devizes Summer Assizes, 1838.)
   These  are the principal  medico-legal questions connected with wounds when
the wounded person is  seen while living.  AVe will suppose, however,  that the
wounded person is found  dead, and an examination of the body is required to be
made.  The most difficult part of the duty of a medical jurist now  commences.
 Among the numerous questions which here present themselves, we will  first pro-
ceed to  inquire whether  the wound was inflicted on the body before  or after
death. 
medico-legal examination of wounds.             173
                            CHAPTER XXI.

EXAMINATION OF WOUNDS  IN THE DEAD BODY--ALL THE CAVITIES SHOULD BE INSPECTED--
  ACQUITTALS FROM THE  NEGLECT  OF THIS RULE--CHARACTERS OF A WOUND INFLICTED
  DURING LIFE—OF A WOUND MADE AFTER DEATH--EXPERIMENTS ON AMPUTATED LIMBS--
  CAUTION IN MEDICAL OPINIONS--WOUNDS OR INJURIES UNATTENDED  BY  HEMORRHAGE—
  ECCHYM0SIS FROM VIOLENCE--EVIDENCE FROM ECCHTMOSIS--ECCHTMOSIS FROM NATURAL
  CAUSES--IN THE DEAD BODY--LIVIDITY--VIBICES--EFFECTS OF PUTREFACTION—IS ECCHY-
  MOSIS A NECESSARY RESULT OF VIOLENCE?

  Examination of wounds.—In examining a wound on a dead body, it is  pro-
per to observe its situation, extent, length, breadth, depth,  and direction:—
whether  there be about it effused blood, either liquid or coagulated, and whether
there be  ecchymosis in  the skin.  It should also be ascertained whether the sur-
rounding parts be swollen,—whether adhesive  matter  or pus  be effused,—-the
edges of the wound gangrenous, or any foreign substances  present in  it.   The
wound may be best examined by gently introducing into it a bougie, and carrying
on the dissection around  this instrument, avoiding as much as possible any in-
terference with the external  appearances.   The preservation of the external form
will allow of a comparison  being made at any future time between the edges of
a wound and a weapon found on a suspected person.   Of all these points notes
should be taken, either on the spot  or immediately afterwards.   In  the dissec-
tion, every  muscle, vessel, nerve, or organ involved in the injury should be traced
and described.   This will enable a witness to answer many subordinate questions
that may unexpectedly arise during the  inquiry.  One other point should be
especially attended to.   A medical practitioner has frequently contented himself
by confining his dissection to the injured part, thinking that on the  trial of an
accused party the questions  of counsel would be limited to the  situation and ex-
tent of the wound only:  but this is a serious mistake.  If the cause of  death be
at all obscure, on no account should the inspection be  abandoned until all  the
organs and cavities  of the  body have  been closely  examined: since it may be
affirmed  that a natural  cause of death might have existed in that organ  or cavity
which the medical witness had  neglected to examine.   It rests with  the practi-
tioner to disprove the probability thus urged by counsel, but he is now  destitute
of facts  to reason from: legal ingenuity will triumph, the witness will be dis-
comfited, and the prisoner, of whose guilt there may be, morally speaking, but
little doubt, will have the benefit of his inattention, and be acquitted by the jury.
  In  making an inspection of the body, the state of the stomach  should not be
overlooked.   Death may have been apparently caused by violence, and yet really
be due to poison.  AVildberg was called upon to examine the body of a girl,  who
died while  her  father was chastising her for stealing.  It was supposed by all
that the girl had died from the  effects of the violence.  On  the arms, shoulders,
and back, many marks  of violent treatment were found; and under some of them
blood was extravasated  in large quantity.   The injuries, although severe, did not,
however, appear sufficient to account for the sudden  death.   He therefore  pro-
ceeded to examine the  cavities,  and on opening the  stomach, he  found it very
much inflamed, and lined with a white powder, which was proved to be arsenic.
It turned out that on the theft being detected, the girl had taken arsenic for fear
of her father's anger:  she vomited during the flogging, and died in slight  con-
vulsions.  Upon this, AVildberg imputed death to the arsenic, and the man was
exculpated.   The cause of death may be easily assigned in  such cases when the
circumstances are known: but it is evident that without great care in conducting
post-mortem examinations, the apparent may be sometimes mistaken for the  real
cause.  (For some interesting  cases and  good  practical suggestions on this sub- 
174
CHARACTERS OF A WOUND MADE AFTER DEATH.
ject, see Belloc, Cours. de Med. Leg. 148.)  Even when there may be no sus-
picion of poisoning, it will be necessary to observe the state of the stomach and
its contents—/. e. to determine whether it contain food, the nature of the food,
and the degree to which it may have undergone digestion.  In the case of Reg.
v. Spicer (Berks Lent Assizes, 1846,) the falsehood of one part of the prisoner's
defence was made evident by the  examination  of the stomach.   The deceased
was found dead at the foot of a stair.  The prisoner stated that after he and his
wdfe had had their dinner, he heard a fall.  The woman had died instantaneously,
and the fall was heard by neighbours at or about the dinner hour.  Mr. Hooper,
the medical witness, found the stomach quite empty;  there was no trace of food.
It was therefore clear that this part  of the prisoner's story was untrue, as, had
the deceased died immediately after dinner, some portion of undigested food
would have been found in the organ.
   Characters of a wound  inflicted during life.—If we  find about the wound
marks of gangrene, the effusion of adhesive or purulent matter, or if the edges
be swollen and enlarged, and cicatrization has commenced, it is not only certain
that the  injury must  have  been inflicted before death, but that the individual
must have lived some time after it was inflicted.  Marks of this description will
not, however, be  commonly  found when death has taken place within  ten or
twelve hours from the receipt of the  injury.  A wound which proves fatal within
this  period  of  time will present throughout much the same characters.   Thus
supposing it to have been incised, there will be traces of more or less hemor-
rhage, having chiefly an arterial character, and the blood will be coagulated where
it has fallen on surrounding bodies: the edges of the wound are everted, and the
cellular tissue around is deeply reddened by effused blood.  Coagula are found
adhering to the wound, provided it has not been interfered with.   The principal
characters of a wound inflicted during life are, then, the following:—1. Eversion
of the edges, owing to vital elasticity of the skin.   2. Abundant hemorrhage,
often  of  an arterial character, with general sanguineous infiltration of the sur-
rounding parts.  3.  The presence of  coagula.   The wound may not  have in-
volved any vessel, and there may be no appearance  of hemorrhage,—still the
edges will be everted, and the muscles and skin retracted.  By an observation
of this kind made on the body of a new-born child  (Case of Elphick, March,
1848,) Mr. Prince was enabled to state that the child  was living when it was in-
flicted—an opinion afterwards confirmed by the confession of the mother.
   Characters of a wound made after death.—If the wound  on the dead body
be not made until twelve or fourteen hours have elapsed from the time of death,
it cannot be easily mistaken for one produced during  life.   Either no blood is
effused, or it is of a venous  character—i. e., it  may have  proceeded  from some
divided vein.  The blood is commonly liquid, and does  not coagulate as  it falls
on surrounding bodies, like that poured  out of a vital wound.  The edges are
soft, yielding, and destitute of elasticity;  they are therefore in close approxima-
tion.   The cellular tissue around is either not infiltrated with blood, or only to
a very partial extent.   There are no coagula within the wound.   In experiment-
ing upon amputated  limbs, I have found these characters possessed by a post-
mortem wound, even when  it had  been produced  not later than  two or three
hours after death, although they are best seen when the wound is not made until
after the body has lost all its animal heat.  In wounds on the dead subject, di-
vided arteries have no marks of blood about them: in the living subject the fatal
hemorrhage  commonly proceeds from  these vessels: hence, in a wound on the
living, it will be found that the surrounding vessels are empty.  The chief cha-
racters of a  post-mortem wound are, therefore,—1.  Absence of copious hemor-
rhage.  2. If there be hemorrhage, it is exclusively venous.  3.  The edges of
the wound are close, not everted.  4. There is no sanguineous infiltration in the
cellular tissue.   5. There is an absence of coagula.   But  it may happen  that a
wound has been  inflicted soon after the breath has left the body, and while it 
WOUNDS ON THE DEAD BODY.
175
was yet warm.  The distinction  between a wound then  made  and one made
during life is not so well marked as in wounds inflicted at a later period  after
death.   Observations of this kind on the human subject must of course be purely
accidental; and  there are many obstacles to the performance of experiments on
the recently dead.   I, therefore,  selected  limbs immediately after amputation;
and there is no reason to suppose that the results obtained in these cases would
differ very widely from those derived from  experiments made on the entire body.
   Wounds on the dead body.—In the first experiment, an incised wound, about
three inches in length, was made in the upper part of the calf of the leg two minutes
after its separation from  the  body,  by which the gastrocnemii  muscles, and the
fascia covering the deep-seated layer of  the leg, were divided.   At the moment
that the wound was  made, the skin retracted considerably, causing a protrusion
of the adipose substance beneath: the quantity of blood which escaped was small,
—the cellular membrane, by its  sudden protrusion forwards, seeming mechani-
cally to prevent its exit.   The wound was examined  after the lapse of twenty-
four hours: the edges were red, bloody, and  everted; the skin was not in the
least degree tumefied, but merely somewhat flaccid.   On separating the edges, a
small quantity of fluid blood escaped, but no coagula were seen adhering to the
muscles.   At the bottom of the wound, however, and in close contact with the
fascia, was a small quantity of coagulated blood; but the coagula were so loose
as readily to break down under the  finger.  In the second experiment, ten mi-
nutes after the separation of the member  from the body, an incision of similar
extent was made on  the outer side of  the  leg, penetrating through  the peronei
into the flexor longus pollicis of the deep-seated layer of muscles.   In this case
the skin  appeared to have  already lost its elasticity^ for  the edges of the wound
became but very slightly everted, and scarcely any blood escaped from it.  On
examining the  leg twenty-four hours afterwards, the edges of the incision were
pale and perfectly collapsed, presenting none of the characters of a wound  in-
flicted during life.   Still, at the bottom of the wound, and inclosed by the divided
muscular fibres, there were some coagula of blood; but these were certainly fewer
than in the former experiment.   A portion of liquid blood had evidently escaped,
owing to the leg having been moved.  Other experiments were performed at  a
still later period after the removal of the limbs; and it was found that in propor-
tion to the length of time suffered to elapse before the production of the wound,
so were the appearances less distinctly marked: that is to  say, the less likely
are they to be confounded  with similar injuries inflicted upon the  living  body.
Wluu the incised wound was not made until two or three hours after the removal
of the limb, although a small quantity  of liquid blood  was effused, no coagula
were found.
   It is necessary to remember that, when  an incised wound is the cause of death,
the person dies  either  immediately, in which case there is a most abundant  he-
morrhage from  the wounded organ  or some large vessel,—or he dies after some
time, in  which case,  as the wound continues  to bleed during the time that he
survives, the longer  he lives the more copious will be the effusion of blood.  In
a wound  inflicted after death, and while the body is warm, nothing of this kind
is observed.   Unless the weapon injure one of the large veins, the hemorrhage
is always slight, so that the quantify of blood lost may assist us in determining
whether the wound was  made during life or after death.   AVhen the  body has
been moved, and all  marks of blood effaced by washing,  rules of this kind cannot
serve a  medical witness:—the time at which the wound was actually inflicted
must then be deduced from other circumstances.  In the case of Grccnacre, who
was tried in 1837  for the murder and mutilation of a female, this formed  a ma-
terial part of the medical evidence.   The  head of the deceased had been severed
from the body, and the question was, whether the severance had taken  place
during life or after death.   The prisoner  alleged in his  defence that it was after
death; but the medical evidence went to establish that the head must have been 
176
ECCHYMOSIS FROM VIOLENCE.
 cut off while the woman was living, but probably after she had  been rendered
 insensible by a blow on that part, the marks of which were plainly visible.   This
 medical opinion  was founded on  two circumstances.  The muscles of the  neck
 were retracted, and the head was  completely drained of its blood, showing that
 a most copious and abundant flow must have ensued at the time of separation;
 and therefore indicating that the circulation was probably going on at that time.
 On cutting off a  head after death, a small quantity of blood may escape from the
 jugular veins; but this soon ceases, and the quantity lost  is insufficient to affect
 materially the contents of the cerebral vessels.   The chief medical witness, Mr.
 Girdwood, expressed himself with very proper caution, by stating, in answer to
 a question from  the judge, that all the wounds in the neck  must have been in-
 flicted during life or very shortly  after death, while the body still  preserved its
 warmth.   The circumstantial evidence tended to show that the deceased was first
 stunned,  and that her head was cut off while she was in a  state of stupor.
   In any case in which the vital or post-mortem origin of a wound is doubtful,
 it will be proper to adopt the same cautious mode of expressing a medical opinion;
 since it must be  remembered there are no decisive characters  by which wounds
 of the kind referred to can be distinguished;  and a medical witness is as likely
 to be wrong as right in selecting either hypothesis.  It is a considerable step in
 evidence, when we are able to assert, that a particular wound, found on a dead
 body, must have  been inflicted either during life or immediately after death;  for
 it can scarcely be supposed, that in a case calling for criminal investigation, any
 one but a murderer would think of inflicting a wound upon a body immediately
 after death,  which would  assuredly have produced fatal  effects had the same
 person received it while living.   So soon as such an opinion can be safely expressed
 by a witness, circumstantial evidence will often make up for that which may be,
 medically speaking, a matter of  uncertainty.
   Wounds or injuries unattended by hemorrhage.—The copious effusion of blood
 has been  set down as a well marked character of a  severe wTound received during
 life; but  this  observation applies chiefly to incised wounds,—cuts, and  stabs.
 Lacerated and contused wounds of  a very severe kind are not always accompanied
 by much  hemorrhage,  even when a large blood-vessel happens to be implicated.
 It is well known, that a whole member  has been torn from the trunk, and that
 little blood has been  lost; but  in such  cases, coagula are commonly found ad-
 hering  to the  separated parts,—a character which  indicates either a vital or a
 very recent post-mortem  origin.   AVhen a lacerated or contused wound involves
 a highly vascular part, although no large blood-vessel may be implicated, it is
 liable to cause death by copious hemorrhage.  In a case tried at the Liverpool
 AVinter Assizes, 1847 (Reg.  v. Cawley,) the prisoner was  charged with having
 caused  the death of his wife by  kicking her in the lower part of the abdomen.
 Copiou shemorrhage followed, and  in spite of medical assistance the woman died
 very shortly afterwards, evidently from the exhaustion produced  by the hemor-
 rhage.  It was stated in  evidence  that there was no external laceration but the
 post-mortem  examination  showed  that a contused wound (of the oenitals) had
 been produced internally,  and had given rise  to  fatal  hemorrhage.   There is
 nothing at all remarkable in such a result, considering the great vascularity of
these parts in the female.
   Contusions and contused wounds are commonly accompanied by a discolor-
ation of the surrounding skin, to which the term ecchymosis  is applied.
   Ecchymosis from violence.—The subject of ecchymosis is of considerable im-
portance in legal  medicine, since it has often given rise to  numerous difficulties
and complicated questions.  It consists essentially in the extravasation or effusion
of blood from ruptured vessels into the surrounding cellular  texture.  An ecchy-
mosis is in general superficial, affecting only the layers of the skin, and showing
itself externally, either immediately or in the course of a short time in the form
of a deep  blue, or livid red patch.   According to Dr. Chowne, the former colour 
                CHANGES OF COLOUR IN ECCHYMOSED SPOTS.             177

is met with in the ecchymosis slowly produced; while that which is the immedi-
ate result of violence is red or livid red.   In some instances, the ecchymosis is
deep-seated,—the blood being effused among the muscles and beneath the fascia:
its extent cannot then  be so readily determined by  the external discoloration,
for this is commonly slight, and it appears only after the lapse of some hours,
or even two or three days.  Sometimes the ecchymosis shows itself not over the
immediate seat of  injury or around it, but at some distance from it.   This is a
matter of some importance to the medical jurist, since he might be led to sup-
pose that the violence had been applied to the discoloured portion of skin, whereas
the extravasation may have been produced by what some have called contre-coup,
or counter-stroke.   Dr.  Chowne met with  an instance where a young man re-
ceived a severe bruise on the inner side of the ankle.  In two days,  ecchymosis
appeared around the outer ankle.   The term contre-coup is, however, inappropri-
ate; since the blood will diffuse itself where it meets with the least resistance, and
the layers of  the skin in the part struck may become so condensed by the blow,
that the blood is diffused in the cellular membrane of the adjoining parts.  Mr.
Syme met with a case where a compound fracture  of the tibia, about one-third
down, was produced by the wheel of a carriage passing over the leg of a woman.
There was no ecchymosis around  the seat of injury; but  after some days, the
skin of the knee and lower part of the thigh became ecchymosed.   (Ed. Med.
and Surg. Jour. October, 1836.)   It  is proper to  mention,  that  ecchymosis
may sometimes proceed from causes irrespective of the direct application  of vio-
lence to the skin.   Strong muscular exertion,—the act of  vomiting, and many
other conditions, may give rise  to a rupture of the minute vessels, and to an ef-
fusion of blood in parts which have been stretched or compressed.  I have known
it to have been produced to a great extent  around  the knee without any blow,
from the stretching of the ligamentum patellae, in an  individual who was trying
to save himself from suddenly falling forwards with  his knee bent  under him.
Such cases are  commonly recognised by there being no mark of mechanical in-
jury about the part:—the skin is  smooth and unabraded.
  It is of importance to know that violence inflicted  on a living body may not
show itself under the  form of ecchymosis until after death.   A case of this
kind was communicated to me by Mr. J. Steavenson. A man received from be-
hind several kicks on the lower part of the abdomen,  which caused a rupture of
the bladder, and death  by peritonitis.   He  died in about thirty-five  hours: but
there was no  ecchymosis in the seat of the blows, i. e. the  pubic and lumbar
regions, until after death.   Dr.  Hinze met  with a case of suicidal  hanging, in
which it was observed that ecchymosis appeared in the course  of the cord  only
after death.  [See Hanging, post.]  It has been  remarked by Devergie  that
ecchymoses are often concealed on the bodies of the drowned, when first removed
from water, owing to the sodden state of the skin;  and they  may become ap-
parent only after the body has been exposed for some  days.
  A medical jurist must guard against the error of supposing that when a blow
has been inflicted on a living person, it is necessary that the individual who is
maltreated should survive for a certain period in order that ecchymosis should be
produced.   Among numerous  instances proving the  contrary,  the case of the
Duchess of Praslin (August, 1847) may be mentioned.  This lady was assassi-
nated by her husband, having been attacked while asleep in bed.  The number
of wounds on her person (thirty)  showed that there had been a mortal struggle,
which, however, could not have  lasted more than half an hour.   Yet, on inspec-
tion, there were the marks of numerous ecchymoses, which had resulted from the
violent use of a bruising instrument.   (Ann. d'Hyg.  1847, ii. 377.)
  Changes of colour.—The changes which  sometimes take  place in  the colour
of an  ecchymosed spot are worthy of the attention  of a medical jurist, since
they will serve to aid him in giving an opinion as to the probable time at which
a contusion has been inflicted.   After a certain period, commonly in eighteen or
       12 
178
CONTUSIONS ON THE DEAD.
twenty-four hours, the blue or livid margin of the spot  is observed to become
lighter; it acquires  a violet tint, and  before its  final disappearance  it passes
successively through shades of a green, yellow, and lemon colour.  During this
time, the  spot becomes much increased in extent, but the central portion of the
ecchymosis is always darker than the circumference.   These changes have  been
referred by Chaussier and others to the gradual dilution of the serous portion of
the extravasated blood by the fluid of the cellular membrane, and its  slow and
uniform dispersion throughout the cells.   The colour is finally entirely removed
by the absorption of the extravasated blood.   The extent and situation of the
ecchymosis, the degree of violence by which it has been produced, as well as the
age and state of health  of the person, are so many circumstances which  may
influence the progress of these phenomena.  Thus an ecchymosis is longer in
disappearing in the old than in the young.  Mr. Watson, of Edinburgh, found
extravasated blood in an  ecchymosis in an old person, five weeks after the receipt
of the injury.  Where the cellular membrane is dense, the  ecchymosis, caeteris
paribus, is not so rapidly formed; nor, when formed, do  the above changes take
place in it so speedily as where the blood is effused into a loose portion of mem-
brane like that surrounding the eye or existing in  the scrotum.   In some instances
an ecchymosis has been observed to disappear without undergoing these changes of
colour at its margin.   On examining an ecchymosed portion of skin which has
suffered from a severe contusion, we find that the discoloration affects more or
less the whole substance  of the true skin as well as the  cellular membrane be-
neath : it  is necessary to  remember this in forming our diagnosis.
  Evidence from the form of an ecchymosis.—It not unfrequently happens that
the ecchymosis produced by a contusion will assume a form  indicative  of the
means by which the violence was offered.  In hanging, the impression caused by
the cord on the neck is  sometimes ecchymosed, and indicates its course  with
precision;—so also in strangulation, when the fingers have been violently applied
to the fore part of the neck, the indentations  produced may serve to point out
the manner in which life was destroyed.  A case is mentioned by Starkie, which
shows that the form of an ecchymosis may occasionally furnish very strong pre-
sumptive  evidence against an  accused  party.   In an attempt at murder, the
prosecutor, in his own defence, struck the assassin  violently in the face with the
key of the house-door,—this being the only weapon near at hand.  The  ecchy-
mosis which followed this contusion corresponded in the impression produced on
the face to the wards of the key; and it was chiefly through this very singular
and unexpected source of evidence  that  the assassin was afterwards identified
and brought to trial.  (Law of Evidence, vol. i.  art. Circ. Ev.)
   Contusions on the dead.—For our knowledge of the effects of contusions on the
recently dead subject, we are chiefly indebted to Dr. Christison. This gentleman
found that blows inflicted two hours after death will give rise to appearances on
the skin similar to those  which result from blows inflicted recently before death.
The  livid discoloration thus produced generally arose from an effusion of the
thinnest possible layer of the fluid part of the blood on the outer surface of the
true  skin, but sometimes also from an effusion of blood into a perceptible stratum
of the true skin itself.  He likewise found that dark fluid blood might even be
effused into the subcutaneous cellular tissue in the seat of the discolorations, so
as to blacken or redden the membranous partitions of the adipose cells; but this
last effusion was never extensive.  From this,(then, it follows, that by trusting to
external  appearance only, contusions made soon after death may be easily con-
founded with those which  have been produced  by violence  immediately before
death.
  If  a contusion has been caused some time before death, there will be swelling
of the part, and probably also certain changes of colour in the ecchymosed patch,
in either of which cases  there will commonly be  no difficulty in forming a  diag-
nosis.  Although ecchymosis, or an appearance analogous to it, may be  produced 
            DIAGNOSIS OF CONTUSIONS ON THE DEAD AND LIVING.        179

after death,  the  changes in colour are then met with  only under very peculiar
circumstances,  to  be presently mentioned.   If the blood found beneath  the
ecchymosed  spot be in the state of coagulum,  this will afford  a remote pre-
sumption of its having been effused during life, although, in fact, it only proves
that the effusion must have taken place before death, or very soon after it; and
the experiments related, in speaking of incised wounds, show that the blood ef-
fused from a wound ten minutes after death, may be found in a coagulated state.
Again, the circumstance of the blood effused under a contused wound being liquid,
is not to be  considered as a proof that the effusion did not take place during life;
for sometimes, as in death from a sudden and violent shock of the nervous sys-
tem, or in cases of rupture of the heart, the effused blood may not  coagulate after
death.  Blood effused into the  spinal canal during life is often fluid; and it is
well known  that the blood may be found coagulated in  some parts of the body,
while it remains uncoagulated in others.  There is reason to believe that  the
blood coagulates more slowly in the dead body than in  a vessel into which it has
been drawn  during life or after death.   The blood may remain fluid in the dead
body from four to  eight, and, according to Donne, twelve hours  after death.—
(Cours de Microscopie, 52.)  It rarely begins to coagulate until  after the lapse
of four hours; but if drawn from a blood-vessel and exposed to air, it would pro-
bably coagulate  in a few minutes after its removal.
  In general, those contusions which  have been produced during life, and in
which the effused blood remains liquid, may be recognised by the extent of the
effusion.  If,  under  the  ecchymosed  part, we find  a  large quantity of liquid
blood, and the seat of the injury is  so situated that the  blood could not have
become infiltrated  into it,  and at  the same time there  is no ruptured vein from
which it might have flowed, we may confidently pronounce that the effusion must
have preceded death.   In a dead body, a contusion would cause but little extra-
vasation, unless  a vein of very large size were torn through.   The sign which is
most satisfactory as a criterion, in the opinion of Dr. Christison, is, however, the
following:—In a contusion inflicted during life, the ecchymosed portion of cutis
is generally dark and much discoloured by the infiltration of blood throughout
its whole  thickness;  the skin at the same time is increased in firmness and tena-
city.  This  is not, however, a uniform consequence of a contusion during life;
for a blow may cause extensive extravasation beneath the skin without affecting
the cutis  in the manner  stated.   The state of  the skin here described cannot,
however, be produced by a contusion on a dead subject; although it is question-
able whether it might not be produced if the contusion were inflicted a few mi-
nutes after death.  As it is, the value of this sign is somewhat circumscribed,—it
is not always produced on the living: it might be possibly produced on the recently
dead; so that when  it does not exist, we must look for other diagnostic marks;
and  when it does exist, we ought to  satisfy ourselves that  the  contusion was
not inflicted recently after death.
  The period at which such injuries cease to resemble each other has not been
fixed with any degree of precision; but, as in the case of incised wounds, it would
seem that there is  little danger of confounding them, when the contusion has not
been inflicted on the dead subject until after the disappearance of animal heat,
and the commencement of cadaverous rigidity!   Dr. Christison found that some-
times the appearance of contusions could hardly be produced on the dead body
two hours after death; at others they might be slightly caused after three hours
and a quarter;  but this period is very near the  extreme  limit.   Whenever the
warmth of the body and  the laxity of the muscles are  not considerable  at  the
time  the  blow  is  inflicted, the appearance of vital contusions cannot be very
clearly produced.  It is probably, therefore, only on the trunk that, even in the
most favourable state of the body,—namely, when the blood remains altogether
liquid, any material mark resembling what may be termed a vital contusion, can
be produced so late as two hours after death.  (Ed.  Med. and Surg. Jour. No. 99, 
180        ECCHYMOSIS FROM NATURAL CAUSES IN  THE LIVING.

p. 247, et seq.)   Notwithstanding these very satisfactory results, it will be seen,
that from the moment of death until after the lapse of two hours, contusions may
be followed by appearances on the dead body, almost identical with those observed
on the living.   The earliest period after death in which an experiment was tried
on the human subject, was one hour and three-quarters:  in this case the  simila-
rity was so strong, that we may infer, if the experiments had been  performed
within half an hour, or even one hour after dissolution, it would have been very
difficult to say whether the blow producing the  discoloration had  been inflicted
on the body before or after death.  Dr. Christison's experiments lead to the con-
clusion that severe blows  inflicted on  a recently dead body, produce  no greater
degree of ecchymosis or cutaneous discoloration than slight blows inflicted  be-
fore death.  Assuming that the great extent of an ecchymosis would in all cases
serve as a criterion that the violence producing  it had been inflicted during life,
it must be remembered that the importance of these facts, in relation to medical
evidence, is not affected by the  extent of the discoloration.   It may  be just as
necessary to have a positive opinion on the origin of a slight, as on the origin of
an extensive bruise.  Trivial ecchymoses, as in cases of strangulation, if they can
be certainly pronounced vital, may make all the difference between the acquittal
or  conviction  of a person  charged with murder.   Again, slight ecchymosis on
the bodies of the drowned may excite a suspicion of strangulation and subsequent
immersion of the body in water.  This question is quite irrespective of the extent
of the ecchymosis,—the great point for the medical witness to consider is whether
it occurred during life or after death.  Cases in which a mistake  might easily
have arisen will be related in speaking of marks of violence in the drowned.
  The practical inference,  then, is, that  these post-mortem discolorations are
liable to be mistaken for marks of violence to the living body.  An instance has
been communicated to me, on respectable authority, in which, for the sake of ex-
periment, blows with a stick were inflicted on the recently dead body of a female,
while still warm.  The body was afterwards accidentally seen by non-professional
persons, who were not aware of the performance of these experiments, and so
strong was the impression, from the  appearances, that the  deceased  had been
maltreated during life, that a judicial inquiry was actually instituted, when the
circumstances were  satisfactorily explained.  The  fact,  therefore, that  severe
blows after death resemble slight blows during life, is, in  a practical view, unim-
portant.   It does not aid our diagnosis, nor prevent serious mistakes from occur-
ring.
  Ecchymosis from natural causes in the living.—There are certain conditions of
the body in which ecchymosed marks are found  on the skin, and which a witness
must be careful not to confound with the ecchymosis arising from violence. First,
with regard to the living body,—in very aged persons, it is not unusual to find
the legs and feet covered with livid patches, sometimes of considerable uniformity
of  colour, at  others  very much mottled.   These  discolorations, which, after
death, might be mistaken for ecchymosis from violence, arise from the languor of
the capillary circulation in such subjects:  the blood with difficulty finds its way
through  the venous capillaries, and the marks are  commonly observed on the
lower parts of the body, because they are far removed from the centre of circu-
lation, and the blood has to rise contrary to the  law of gravity.  This is the con-
dition which has been denominated, by Andral, asthenic  hyperemia.   (Andral,
Anat. Pathol,  t. i. p. 40.)   Similar discolorations are sometimes met with  on the
bodies of those who have died from scurvy, typhus, and other adynamic diseases.
In  persons severely affected with scurvy, it is well  known  that the slightest pres-
sure on any part of the skin will suffice to produce a spot resembling the ecchy-
mosis of violence, and arising like it from a rupture of minute cutaneous vessels;
but the extravasation of blood, which causes the discoloration, is commonly con-
fined to the superficial layers of the true skin.   These spots, under  certain states
of  the system, occur spontaneously, and often cover the body to a  great extent: 
ECCHYMOSIS IN THE DEAD BODY.  LIVIDITY.
181
when small, they take the name of petechia ;  but when extensive, in which case
they bear a very close resemblance to the ecchymosis of violence, they constitute
the chief pathognomonic character of the disease termed purpura.  To all these
effusions of blood in the living  body, the  term Sugillation (from sugillatio, a
black mark) has been applied.  Some medical  jurists have attempted to draw
a distinction between ecchymosis and sugillation:  thus it is said:—ecchymosis
proceeds from external, sugillation from internal causes,—ecchymosis is confined
to the marks which occur in the living body,  sugillation to those which occur in
the dead;—in ecchymosis the vessels are ruptured, in sugillation there is mere con-
gestion;—again, some have considered that ecchymosis and sugillation might take
place both in the living and in the dead.   From this statement, it appears im-
possible to give a consistent definition of the  meaning of either of these terms;
but it is altogether unnecessary to make the attempt, for the error, after all, con-
sists in the  introduction of a superfluity of words to express a simple  condition
of the body, depending on different causes.   AArhy, according to the view taken
by Chaussier, an ecchymosis should not also be called a sugillation, it is difficult
to say:  for so far as we are bound by a comparison of the definitions above given
with the usual  applications of these words, the terms are equally appropriate.  I
would advise a medical jurist to  avoid the use of the term sugillation, if by em-
ploying it he considers  that he  is speaking of a condition essentially different
from ecchymosis.  The most important point to attend to is to distinguish these
ecchymoses in the living body arising from infirmity or disease, from those which
have  their origin from violence.  In regard to the  spots on the legs of old per-
sons, the appearance of the subject, and their general extent, enveloping, as they
often do, the whole circumference of the  leg,  must suffice to establish a correct
diagnosis.   In  distinguishing the spots of purpura, a difficulty may sometimes
exist; but here also the  appearance of the  subject, the general diffusion of the
spots over the whole of the body, and their simultaneous existence on the mucous
membrane of the fauces and alimentary canal, cannot fail to point out that they
originate from  some other cause than violence.   In the living, these spots have
been  observed to undergo the same changes of colour as the true ecchymosis of
violence.   It  has been alleged, on the  authority of Zacchias, one of the early
writers on medical jurisprudence, that a diagnosis is obtained in these cases after
death by a dissection of the part.  According to this authority, in what is termed
sugillation, i. e. the ecchymosis of disease, the  blood is stated to  be fluid, while in
the ecchymosis of violence it is described as being in a thick and concrete state.
In the remarks  already made respecting contusions, facts have been mentioned
which show that such a mode of distinction is  inadmissible;  neither the  state
of the blood nor its situation will alone suffice to determine the question.   Al-
though  it has been usual to describe the ecchymosis of disease as being due to a
superficial extravasation on the true skin, yet  certain cases recorded by patholo-
gists prove that in purpura  the discoloration  may  occasionally extend through
the whole substance of the integuments to the adipose tissue beneath.
  Ecchymosis in the  dead body.   Lividity.—Ecchymosis  may present itself in
various  forms on the  skin of  a dead subject.  The first form, when it occurs, is
almost an immediate consequence of death, but  it is not fully developed  until
the body has cooled.   It is commonly called  Cadaverous lividity.   It presents
itself in diffused patches of very great extent, sometimes covering the whole of
the fore part of  the chest and abdomen, at other times the lateral regions of the
back.  The upper or lower extremities, either on their internal or external  sur-
faces, or on their whole  circumference, are often thus completely ecchymosed.
The colour is sometimes purple, at others  livid, and often mottled in interspaces,
but it is commonly well defined in its extent by the whiteness of the surrounding
skin.   This form of  ecchymosis is almost invariably seen on the bodies of those
who die suddenly or by a violent death, as well as in individuals who perish from
apoplexy, or who'are hanged or suffocated.  AArhen the skin is divided, the colour 
 182          CHANGES OF COLOUR IN POST-MORTEM ECCHYMOSIS.

 is found to bo confined to the upper surface of the cutis, and never to extend
 through it.  This  discoloration  is ascribed  to the congestion which takes place
 in the capillary system, at the moment of death, in subjects that are full of blood.
 It is rarely seen in the bodies of those who  have died from profuse hemorrhage
 —the skin is in these cases  commonly pallid.  The circumstances under which
 it occurs, and the characters above described, distinguish it from the ecchymosis
 of violence.  Its existence on the dead  body must  be regarded as a sign of the
 vigour and activity of the circulation at the moment  of death, and generally as
 a mark of death having taken place suddenly.   It  might seem improper to call
 this, which has been described as a mere capillary congestion, "ecchymosis," this
 word signifying effusion; but the term sugillation has been so vaguely employed
 by different writers, that I think the former preferable to the latter, in  spite of
 the apparent  inconsistency of its application to every variety of cutaneous dis-
 coloration.   (See Henke, Zeitschrift der S. A., 1844, i. 199.)
   Vibices.—Sometimes,  instead of  seeing this cadaverous lividity diffused in
 large patches  over the skin,  it will be disposed in stripes which traverse  and in-
 tersect each other in all directions, and often cover the whole of the body.  These
 marks, which vary from a scarlet to a dark red or livid hue, have been supposed
 to resemble those  produced on the skin in  the act of scourging or flagellation.
 On this account they have been called by some writers vibices.  Sometimes the
 body is completely covered with them,—they are often of considerable  length,
 and pass in a  very symmetrical hut occasionally tortuous course; they are chiefly
 observed about the sides, the upper part of the shoulders, and back.  In meet-
 ing with  this  appearance for the  first  time  on a subject, an individual, unac-
 quainted with  its nature, might look upon it as a strong proof of violent treat-
 ment during life, especially in a case of  suspected violence;  but the practitioner
 will distinguish it readily, by the uninjured state of the cuticle and  the  superfi-
 cial nature of  the  discoloration, from those marks of violence which it  is con-
 sidered to resemble.  In  general, it appears to be produced by the wrapping of
 a body in a sheet or other covering soon after death, and allowing it to cool while
 thus wrapped up :  even if a subject be  allowed to cool merely with  the  clothes
 covering it, these peculiar marks will often be seen.  In many cases they exist
 only on the back, and here they are to be ascribed  to the pressure produced by
 the irregularities or folds in the sheet on which the body has been lying.  The
 capillaries, it is to be observed, are  always congested  in or near those parts of
 the skin which are  exposed to the least pressure.  A few years since I saw a well-
 marked case of vibices, in which the suspicion was so strong  that violence had
 been used to the deceased, that a coroner's inquest took place.  The  fore part of
 the body was covered with the stripes, which were of a  red and livid colour: they
 seemed to correspond exactly to the folds of a sheet drawn tightly across the
 chest; and  it  was subsequently ascertained that  the  body of the deceased had
 been treated in this way after death.   The blood was superficially diffused, and
 the cuticle uninjured.  The circumstance above mentioned at once satisfactorily
 explained the  cause of the appearance.   These vibices, like  the cadaverous livi-
 dity already described, are commonly seen in plethoric subjects; they also indi-
 cate great vigour of circulation at the moment of death.
  But lividity sometimes presents itself in a more deceptive form than in either
 of the instances just mentioned; as in the following case.   A  man, aged thirty-
three, died suddenly from disease of the heart.   Eighteen hours after death the
body was examined, and the skin was then found to  be covered in different parts
with patches of ecchymosis, varying in size from small spots to  others of se-
veral inches in diameter.   These patches were evidently due to simple lividity,
although they closely simulated marks  of violence  produced  during life.  On
cutting into them,  the layers of  the cutis as well as. the cellular  tissue beneath
were throughout reddened by a congestion of blood.   There was no decided ex-
travasation, but small rounded semi-coagulated masses oozed out from the cells 
            ECCHYMOSIS NOT^A NECESSARY RESULT OF VIOLENCE.         183

on slight pressure.  There was another extraordinary, and, so far as I know, a
perfectly unexampled circumstance, in which these patches of lividity resembled
the ecchymosis of violence produced during life.   Around many of  them there
was a wide border or ring of straw colour, with various shades of green, precisely
similar to those witnessed in the disappearance of an ecchymosis from the living
subject.  By all medical jurists it has been hitherto laid down as a positive rule,
that these rings of colour, when not depending on putrefaction, are peculiar to
the ecchymosis of the living body, and are never seen in  the ecchymosis taking
place spontaneously after death.  The occurrence  of this case shows with what
caution general rules should be framed for medico-legal practice.  Had the body
of this person been found lying dead exposed on a high road, and it was proved
that another man had been quarrelling  with him, it is easy to  imagine that  a
very unfavourable medical opinion might have been  expressed against the party
accused of the violence.  This kind of  ecchymosis could only have been distin-
guished from that of violence during life, by the unruffled state of the skin, and
the very slight extravasation of blood compared with the extent of the ecchymosed
surface.  It is worthy of note, also, that the principal seat of the ecchymosis was
in those parts which were recumbent or depending.  The formation of the coloured
zones around some of the patches of lividity, was  fully explained by the fact of
the man having laboured under anasarca.  The serum effused in the cells here
acted upon and diluted the blood as it became extravasated;  and diffused it around,
much in the same way as the serous exhalation of the cellular membrane acts on
the blood effused in the living body.   A wax model of this remarkable appear-
ance is preserved in the Museum of Guy's Hospital, and is well worthy of in-
spection.
   Effects of putrefaction.—Another form of ecchymosis  observed in the dead
body is that which occurs some time after death.   This appears to proceed from
an infiltration of blood into the depending parts of the body, and to be a result
of incipient putrefaction.   Those engaged in post-mortem inspections are well
aware that the skin of the back, especially that covering the loins and buttocks,
often presents irregular discolorations resembling ecchymosis.   The skin of the
occiput is a well known seat of this form of ecchymosis.   On  cutting into the
skin of any of these parts, the whole of the cutis is found to be more or less dis-
coloured, and the adipose tissue is filled with a sanguineous serum which readily
escapes.  In proportion as putrefaction advances,  the discoloration  becomes
greater, passing from a dark red to a green colour.   The general characters  of
this species of ecchymosis are so well marked, that it cannot easily be confounded
with the ecchymosis of violence.  The parts of the body in which it is known  to
occur, as well  as the state of the body, are circumstances which distinguish it
from all the other  forms described.  This variety of ecchymosis is also termed
sugillation by some medical jurists.  (On the subject of Ecchymosis, see Ann.
d'Hyg.  1843, ii. 388.)
   Is ecchymosis a necessary resxdt of violence?—This is a most important medico-
legal  question, and one which  has often created great  difficulty  to medical
witnesses.  It has been repeatedly asserted in Courts of law, that no severe blow
could have been inflicted on a deceased person in consequence of the absence of
ecchymosis from the part struck; but we shall see that this assertion is entirely
opposed to well ascertained facts.   However true the  general principle may be,
that severe contusions are commonly followed by ecchymosis, it  is open  to nu-
merous  exceptions; and unless these be known to the practitioner, his evidence
may mislead the Court.  The presence of ecchymosis is commonly presumptive
evidence of the infliction of violence: but its absence does not negative this pre-
sumption.
   It was long since remarked by Portal, that the spleen had been found ruptured
from blows or falls, without any ecchymosis or abrasion of the skin appearing in
the region struck.   This has been more recently observed  in respect  to ruptures 
184
INJURIES UNATTENDED BY ECCHYMOSIS.
 of the stomach, intestines, and urinary bladder, from violence directly applied to
 the abdomen.  Portal supposed that the mechanical impulse was simply trans-
 ferred through the supple parietes of the abdominal cavity to the viscera behind,
 as in the striking of a  bladder filled with water.  AVhether this be the true ex-
 planation or not, it is quite certain that the small vessels of the skin often escape
 rupture from a blow, so that their contents are not extravasated.  A case is re-
 ported by Henke, in which a labouring man died some hours after fighting with
 another; and on inspection  of the  body, the peritoneum  was found extensively
 inflamed, owing to an extravasation of the  contents of the jejunum, which had
 been ruptured to a considerable extent.   There was, however, no ecchymosis or
 mark on the skin externally, and the medical inspectors were inclined to affirm,
 contrary in  this case to direct  evidence, that no blow could have been struck;
 but others were appealed  to,  who at once admitted that the laceration of the in-
 testine might have been caused by a blow,  even  although  there was  no appear-
 ance  of violence externally.   Mr. Watson states that a girl aged nine received
 a  smart blow upon the abdomen from a stone.   She immediately complained of
 great pain;  collapse ensued,  and she died in twenty-one hours.   On inspection
 there was no mark of injury externally; but the ileum was found ruptured, its
 contents extravasated, and the peritoneum extensively inflamed.   (On Homicide,
 187.)   Dr.  Williamson, of Leith, met with a case where a man  received a kick
 on the abdomen from a horse:—he  died in thirty hours from peritonitis.   The
 ileum was found to  have been torn  completely across in its lower third.  There
 was not the  slightest trace of ecchymosis externally;  and this fact is the more
 remarkable,  since the blow was here struck by a somewhat angular  or  pointed
 body—the hoof of a horse.   (Med. Gaz. May, 1840.)
   Many cases might be adduced in support of the proposition that ecchymosis
 is  not a necessary or constant result of a severe contusion; but those  already re-
 lated sufficiently establish the fact.   This medico-legal question was raised on a
 trial before the Justiciary  Court of Glasgow, in January, 1837.  A woman was
 found dead in her house, and her husband was accused of having murdered her.
 There was no mark of violence  externally;  but on opening the abdomen, the
 liver was found extensively lacerated, and there was no doubt that this was the
 cause of death.   A medical witness asserted that, as there was no appearance of
 injury externally, the rupture could not have been caused  by a fall or a blow.-
 He attributed the absence of marks  of  ecchymosis to the rupture having been
 occasioned by the forcible  pressure of some heavy rounded smooth body on the
 abdomen.   The prisoner was  acquitted on a verdict of not  proven.  The liver is
 seldom ruptured except  from  violence directly applied; and it is observed  that
 the rupture is more commonly caused by the sudden than by the slow application
 of violence.   The explanation given by the witness would neither account for
 the rupture  nor for the absence of ecchymosis;  for these conditions are  more
 commonly met with under directly opposite circumstances.  At the same time,
 in  cases where the facts  are imperfectly known, a surgeon must not be too ready
 to  assume,  in the absence of ecchymosis or abrasion,  that violence has been
 directly applied, and caused the rupture  of  an internal organ.  The liver may
 have been ruptured in the above case either by a blow or a fall,—the absence of
ecchymosis in the skin of the  abdomen is not incompatible with either view. 
CHARACTERS OF WOUNDS PRODUCED BY WEAPONS.          185
                            CHAPTER XXII.

 EVIDENCE OF  THE USE OF A WEAPON--CHARACTERS OF WOUNDS CAUSED BY WEAPONS.--
   INCISED, PUNCTURED, LACERATED, AND CONTUSED  WOUNDS--STABS AND CUTS--WHAT
   ARE WEAPONS?—EXAMINATION OF THE DRESS.

   Evidence of the use of a weapon.—It sometimes happens on criminal investi-
 gations, that a weapon is presented to a medical witness;  and he is required to
 say, whether a wound, found on the  body of a person, was produced by it.  On
 the certainty of a weapon having been used, it is not uncommon for prisoners,
 even when found guilty upon  the  clearest evidence, to declare that no weapon
 was employed by them, but that the  wound  had been occasioned by accidental
 circumstances.  A witness should remember, that he is seldom in a position to
 swear that a  particular weapon  produced at  a trial must have been used by the
 prisoner:—he is only justified in saying, that the wound was caused either by it,
 or by one similar to it.   In reference to this subject, Schworer  relates  the  fol-
 lowing case.   A man was stabbed by another in the face, and a knife, with the
 blade entire,  was brought forward  as circumstantial evidence against him,—the
 surgeon having declared that the wound must  have  been caused by this  knife.
 The wounded person recovered;  but  a year afterwards an abscess formed in  the
 face, and the broken point of the real weapon  was discharged from it.   The
 wound could not therefore have been produced by the knife which  was  brought
 forward as evidence against the prisoner at the trial.  (Lehre von dem  Kinder-
 morde.)  Although the criminality of the act is not lessened  or impugned by an
 occurrence of this kind, it is advisable that such mistakes should be avoided by
 the use of proper  caution on the part of a witness.   (On this question, see  the
 case of Rcnaud, by Dr. Boys de  Loury,  Ann. d'Hyg. 1839, xi. 170.   As to
 what is a weapon,  see Henke, Zeitschrift der S. A. 1844, i. 67.)
   Characters of wounds produced by weapons.—Let us  now suppose  that no
 weapon is discovered; and that the opinion of a witness is to be founded only on
 an examination of the wound.   It is right for him to know that on all criminal
 trials, considerable importance  is attached by the law to  the fact of a wound
 having been caused by the use of a weapon;  since this often implies malice, and
 in most cases a greater desire to injure the party assailed, than the mere  employ-
 ment of manual force.   Some wounds at once indicate that they must have been
 produced by weapons.   This is the case with cuts or stabs.
   Incised wounds.—In incised wounds, the sharpness of the instrument may be
 inferred by the cleanness and regularity with which the edges are cut:  in stabs,
 also, the form  and depth of the wound will often indicate the kind of weapon
 employed.  Stabs  sometimes have the characters of incised punctures, one or
 both extremities of the wound being cleanly cut, according to whether the weapon
 was single or  double-edged.   Dupuytren has  remarked, that such stabs, owing to
 the elasticity  of the skin, are apparently smaller than the weapon—a point to be
 remembered in instituting a comparison between the size of the wound  and the
 instrument.   A lateral motion of the  weapon  may, however, cause a considerable
 enlargement of the wound.  (See case, Ann. d'Hyg. 1847, i. 400.)  When  a
 stab has traversed the body, the entrance-aperture is commonly larger than  the
 aperture of exit; and its edges, contrary to what might be supposed, are  some-
times everted, owing to the  rapid withdrawal of the instrument.   That  facts of
this kind should be available as evidence, it is necessary that the body should be
seen soon after the infliction of a wound, and before there has been any inter-
ference with it.
   Punctured  wounds.—It is important to notice whether the edges of a punctured 
186
WOUNDS PRODUCED BY GLASS OR WEAPONS.
wound be lacerated and irregular, or incised; because it may be  alleged in the
defence, that the wound was produced by a fall on  some substance capable of
producing an injury somewhat resembling it.   In a case that  occurred to  Mr.
Watson, a deeply penetrating wound on the genital organs of the deceased, which
had evidently caused the woman's death, was ascribed by the prisoners charged
with the murder, to her having fallen on some broken glass; but it was proved
that the edges of the wound were bounded every where by clean incisions, which
rendered this defence inconsistent, if not impossible.  I have  known  a similar
defence made on two other occasions, where the cases came  to  trial.  In one, a
man struck the prosecutor, and knocked him against a window.  On examina-
tion, there were three  deep cuts on the face of the  prosecutor, but no weapon
had been seen in the hands of the prisoner.   He was charged  with cutting  and
stabbing.   The surgeon deposed that the wounds appeared to have been inflicted
with a knife or a razor blade, and not by broken glass.  If the  wounds had been
made by glass,  particles of that substance would probably have been found in
them; but there were none.  The prisoner was  acquitted, the  infliction of the
wounds by a weapon not being considered to have been made  out.  In another
case that occurred in August, 1841, the prosecutor was knocked down, and his
throat was found severely  cut;  but there was no proof that a weapon  had been
used.  In  the  defence it  was urged  that the wound had been produced by a
broken pane  of glass;  but the surgeon described it as a clean cut, five inches in
length, and one inch  in depth, laying bare the carotid  artery.  He considered
that it must have been done by a razor or knife; and that it was a cut made by
one stroke of the instrument.   In the case of Reg. v. Ankers (Warwick Lent
Assizes, 1845,) a clean cut, as  from a penknife, about two inches long, and one
deep, was proved to have existed on the person of the prosecutor, who had fallen
during a quarrel with the  prisoner.   Some broken crockery was  lying  near the
spot, and it was alleged in the defence that a fall upon this had caused the wound.
This allegation was quite inconsistent with the clean and even  appearance of the
wound, and the prisoner,  in whose possession a penknife had been found, was
convicted.
   In  general, wounds made by glass or crockery are characterized by their great
irregularity and the unevenness of their edges.   Cases of this kind show that as
it is not always possible to know when this sort of defence may be raised, a me-
dical witness should never fail to make a minute examination of a wound which
is  suspected to  have been criminally inflicted.   A trial for murder took place at
the AArorcester Summer Assizes, in 1838, in which it appeared in evidence  that
the deceased  had died from a small punctured wound in the  thorax.   It was five
inches and a  half deep, and it had completely traversed the right ventricle of the
heart, and led to death by hemorrhage.   The wound was supposed to have been
produced by  a small skewer, which  was found near the spot: but in the defence
it  was alleged that the deceased had fallen over a tub, and that  the wound  had
been caused  by a  projecting nail.   This allegation, however, was negatived by
the surgeon, from the fact  of its being a clean cut wound.   Had it been produced
in the manner alleged  by the prisoners, the fact would have been indicated by
an irregularity of margin.   In the case of Bryant (Taunton Lent Assizes, 1849,)
which involved a charge of maliciously stabbing the prosecutor, the defence was
that,  as many flints were lying about in the road, and the assault took place in
the dark, the wound might have been inflicted accidentally during a fall.   The
medical witness could  not say that the wounds have been positively caused  by  a
weapon: they might have been produced by  the flints.  The prisoner was ac-
quitted.   A  careful examination made at the time of the injury, would most.pro-
bably have enabled the witness to give a positive opinion, instead of leaving the
case open to  doubt.  A puncture made by a flint during  a fall is  not likely to
resemble a stab with a knife.   The wound would present some marks of lacera-
tion and  great irregularity.  As the wound was under  the ear, it was by no 
STABBING AND CUTTING.
187
means probable from  the  situation, that it could have  been thus caused acci-
dentally.
   Lacerated and contused wounds.—Lacerated wounds do not in general present
more difficulty with regard to their origin than those which are incised or punc-
tured.  The means which  produced  the laceration are commonly well indicated
by the appearance of the wound.  These injuries are generally the result of ac-
cident;  they are, however, frequently met with on the bodies  of new-born chil-
dren, in which  case they  may  give rise to charges  of  infanticide.   Contused
wounds and severe contusions present much greater difficulty to a medical jurist.
It is not often in his power to say whether a contused wound  has resulted from
the use of  a weapon, from a blow of the fist, or from the deceased having acci-
dentally fallen against some  hard surface.  This question  is frequently put to
medical witnesses, on those trials for man-slaughter which  arise out  of  the
pugilistic  combats of half-drunken  men.   One of the combatants is generally
killed, either by a blow on the head, by a fall, or by both kinds of violence com-
bined.  The skull may or may not be fractured; and the  person may die of con-
cussion, inflammation of the brain, or from extravasation of blood.  The general
defence is,  that the deceased struck his head against some hard substance in fall-
ing on the  ground; and the surgeon  is asked whether the particular appearances
might not be explained on the supposition of a fall.   This, in general, he admits
to be possible, and the prisoner  is acquitted.  A medical witness is rarely in a
position to swear with certainty, that a contused wound of the head must have
been  produced by a weapon,  and not by a fall.  Some circumstances, however,
may occasionally enable him  to form an opinion on this point.   If there be  con-
tused wounds on several parts of the  head, with copious effusion of blood beneath
the skin, the presumption is that a weapon must have  been used.   If the marks
of violence be on the vertex,  it is highly probable that they have been caused by
a  weapon, since  this is not commonly a part which can be injured  by a  fall.
According  to the medical evidence given  on this question, an indictment may or
may not be sustained.  A case is reported in which a prisoner was indicted for
striking the deceased, and fracturing his skull with a piece of brick.   The evi-
dence showed that the prisoner struck with his fist, and that the deceased in  con-
sequence fell upon the piece of brick, which caused the fracture and led to death.
The judges held that this was a fatal variation.   (Law Times,  Mar. 21, 1846,
501.)  Technicalities of this kind will probably be set aside in future cases under
the new statute, 14 and 15 Vict. c. 100.
   AVe may be often in doubt whether, in respect to lacerated or contused wounds,
a weapon- has been used or not.   Contused wounds on bony surfaces, as on the
cranium, have somewhat the appearance of incised wounds, the skin being some-
times evenly separated; still, when  the wound is recent, a careful examination
will generally enable a witness to surmount  the difficulty.  If some time have
elapsed before the wound is examined, there will necessarily be great caution re-
quired in forming an opinion.  In some instances an accurate observation of the
form  of the wound, and a comparison of it with the supposed weapon, will justify
a medical witness in giving a strong  opinion on the point.   The depth and na-
ture of  the wound may be  such that no accidental fall will  reasonably account
for its production.   A case of considerable importance in reference to this medico-
legal question was tried at the late Cornish Assizes; for  a report of which I must
refer the reader to the Medical Gazette, xlviii. p. 729.  (Reg. v. Teague, Corn-
wall Summer Assizes, 1851.)
   Stabs and cuts.—It has already been  remarked, that  the law in some cases
attaches great importance to the  clear proof of the use of a weapon; and a medi-
cal man has therefore  a  serious responsibility thrown  upon him  when, in  the
absence of a weapon, he is called  upon to say, from an examination of the wound,
whether one has been used or not.  The statute on wounding makes no reference
to the means by which wounds are inflicted;  but  the  words have been hitherto 
188
WOUNDS PRODUCED BY ARTICLES OF DRESS.
held by the judges to imply, in all cases, the use of some weapon or instrument.
The following are the provisions of the law.   "AVhosoever shall stab, cut, or
wound any person, or shall, by any means whatsoever, cause to any person any
bodily injury dangerous to life, with intent in any of the cases aforesaid to com-
mit murder, shall be guilty of felony."  (1 Vict. c. 85, s. 2.)  The word stab
has been held to import a wound from a pointed instrument; the word cut, from
an instrument having an edge; and the word wound comprises incised, punctured,
lacerated, contused, and gun-shot wounds; thus  including all stabs and cuts, and
rendering the separate use of these words in the statute wholly unnecessary.  All
medical men know that stabs and cuts are varieties of wounds; and it is difficult
to understand why these terms should have been retained, and the other varieties
of wounding, as  " incise, puncture, lacerate, and contuse," omitted.  It was for-
merly held that an indictment for cutting would not be supported if the medical
evidence proved  that the alleged cut was a stab, and vice versa;  and further, in
an indictment for cutting and stabbing,  it was not considered sufficient to prove
that it was a contused or lacerated wound.
   Some doubt has also arisen regarding the meaning of the term weapon.  Thus,
the teeth, the hands or feet uncovered,  have  been held by  the majority of the
judges not to be  weapons; and injuries produced by them, however severe, have
not been hitherto treated as wounds within the  meaning of the statute.  Parties
have been tried on charges of biting off fingers and noses, and the medical evi-
dence has shown that great disfigurement and  mischief had been done to the
prosecutor; but  in these cases the degree of injury produced—the division of the
cutis—was not so much regarded  as the actual  method by which it was accom-
plished.   From a trial which took place at the  Nottingham  Assizes in 1832, it
appears, however, that artificial arms and legs were not exempted under the statute.
In this case alluded to, a strenuous effort was made by the prisoner's counsel to
show that the wooden arm with which the assault was committed had become,
by long use, part of the body of the prisoner,  and that, bike the natural arm,
it ought not be considered a weapon in law!   The objection  was overruled.
   Since the former edition of this work was published, a great improvement has
taken place in this part of our criminal law,  whereby much  trouble is  saved to
counsel and  medical witnesses.   The  technicalities which arose  out of the
necessity of strictly defining the nature  of a wound, and whether it had or had
not been caused  by a weapon, are now in great  part removed by the 14 and 15
Vict., chap. 19,  sec. 4.   It is herein provided that punishment shall follow the
conviction of a person who has inflicted grievous bodily harm, whether with or
without any weapon or  instrument, or who has  maliciously cut,  stabbed, or
wounded any person.  A man has been  recently committed  for trial under this
statute, for biting off part of the nose of another.   The old objection that the
teeth were not weapons, cannot here be raised in defence.  The 14 and 15 Vict.,
chap. 100, is also adapted to meet those cases in  which trivial technical objections
are raised to the  description of wounds in an indictment and of the circumstances
under which they have been inflicted.
   Examination  of the dress.—The use of a weapon on these  occasions may be
sometimes inferred from the dress having been cut;  although it is quite possible
that a contused wound may be inflicted by a bludgeon through the dress, without
tearing or injuring it.   A wound may be indirectly produced by a weapon, and
medical witnesses have been often questioned on this point.   Thus the prosecutor
may at the time have worn about his person some  article of dress which received the
blow, and this may have caused the wound.   On a trial for  maliciously wound-
ing, which took place at the Reading  Spring  Assizes in 1837, it appeared in
evidence, that the prisoner, while poaching, assaulted the game-keeper by inflict-
ing  on his  head severe blows with  a gun.   At the time  of the assault, the
prosecutor wore a, strong felt hat, which, it was contended  in the defence, had
caused the wounds that formed the subject of the charge.  The medical witness 
EVIDENCE FROM THE SITUATION OF A WOUND.            189
admitted that the wounds might have been produced either  by the hat  or gun.
The prisoner was convicted;  but the judge intimated a doubt whether this could
be considered a "wounding by a weapon," within the statute.  In another case,
a blow was  struck  with a bludgeon  at  the head of the prosecutor, who wore
spectacles.  Wounds were produced, which, it was argued in the defence, had
resulted from the glass of the spectacles.  The prisoner was acquitted.  Every case
of this kind must be determined according to the circumstances accompanying it.
One fact appears to me to be well established from the foregoing statements, name-
ly, that a medical practitioner should  always make a minute and careful examina-
tion of wounds which are likely to become the subject of criminal charges.  In
performing his duties as a surgeon, he is bound, so far as he consistently can, to
notice their characters as a medical jurist.
                            CHAPTER XXIIL

WOUNDS  INDICATIVE OF HOMICIDE, SUICIDE, OR ACCIDENT-—EVIDENCE FROM THE SITUA-
  TION OF A  WOUND—"SUICIDAL WOUNDS IN UNUSUAL  SITUATIONS—EVIDENCE  FROM
  NATURE  AND  EXTENT—SHAPE—'EVIDENCE  FROM  THE  DIRECTION  OF A  WOUND-
  WOUNDS  INFLICTED BY  THE RIGHT OR LEFT HAND--ACCIDENTAL AND HOMICIDAL
  STABS--EVIDENCE FROM THE PRESENCE OF  SEVERAL WOUNDS--THE USE OF SEVERAL
  WEAPONS--TWO OR MORE MORTAL WOUNDS--WOUNDS PRODUCED SIMULTANEOUSLY OR AT
  DIFFERENT TIMES.

   Wounds indicative of homicide, suicide,  or  acc?'c?enf.-"^Supposing  that the
wound which is found on a dead body is proved to have been caused before death,
it will next be proper to  inquire whether it was  the result of suicide, homicide,
or accident.   It might at first sight be  considered,  that the determination of a
question of this nature was wholly out of the province of a medical jurist.   In
some  instances it may be so, and the settlement  of it  is then properly left to the
legal  authorities; but in  a very large number of cases it is so closely dependent
for its elucidation on medical facts and opinions, that juries could never arrive at
a satisfactory decision without medical evidence.  Let us suppose, then, that a
medical jurist is consulted in a doubtful case.—-What are the points to which he
must  direct his attention ?   These are, with regard to the wound, its situation,
its nature and extent, and its direction.
   Evidence from the situation of a wound.—It is a general principle in which
most medical jurists agree,  that wounds inflicted by  a suicide  are usually con-
fined  to the  anterior or lateral parts of the  body.   The throat and chest are
commonly selected, where  cutting  instruments  are employed; while the chest,
especially  in the region of the heart, the mouth, the orbit and the temples, are
the spots generally chosen for the perpetration of suicide  by fire-arms.   But  it
is obvious, that any of these parts may be also selected by a murderer, with the
especial design of simulating a suicidal  attempt; therefore the mere situation of
a wound does not suffice to establish the fact of suicide.   Dr. Smith considers,
in reference to pistol-wounds, that if the weapon has been  introduced into the
deceased's mouth, and there discharged, we may almost take it for granted that
"it has not been done by another" (For.  Med. p. 302;) but this  inference has
been rather too hastily drawn, because it is quite within the range of possibility,
that a cool and calculating  assassin may purposely resort to this method of de-
stroying his victim, in order to conceal his crime.   In suicidal wounds from fire-
arms, a  discoloration  by powder  of the fingers  of  the hand which  discharged
the weapon is sometimes observed; this has also been looked upon as  a source
of evidence  of suicide under doubtful  circumstances, but  a similar objection, 
190        EVIDENCE FROM THE EXTENT AND SHAPE OF WOUNDS.

although not with equal force, might be made to its admission.   Some  have re-
garded it as fully established in legal medicine, that when wounds exist at the
posterior part of the body, it is a positive proof that they have not been self-
inflicted.   This situation is certainly very unusual in cases of suicide; but, as
Orfila observes, it is not the situation,  so  much  as the direction of a wound,
which here furnishes  evidence against the presumption of suicide.  A wound,
traversing  the body from behind to before in a direct line, is not very  likely to
have  resulted from a suicidal attempt; at least, it must be obvious that  it would
require more preparation and contrivance on the part of a self-murderer, so to
arrange matters, that such a wound should be produced, than we can  conceive
him to possess at the moment of attempting his life.   Besides, his object is to
destroy himself as quickly and  as  surely as circumstances will permit; he is,
therefore, not likely to adopt complicated and uncertain means for carrying this
design into execution.   Nevertheless, we must not always expect to find suicidal
wounds in  what a surgeon would pronounce to be, the most appropriate  situation
to produce instant destruction.   A want of knowledge,  or a want of resolution
on the part of the suicide, or the accidental slipping of the hand, will often  cause
a wound in a part where we might least  expect to find it.
   AVounds which result from accident or suicide are generally in exposed  parts
of  the body.   An incised wound in a concealed, or not easily  accessible part is
presumptive of murder: because this kind of injury could have resulted only from
the deliberate use of a  weapon.   Suicidal wounds are, however, sometimes found
in  the most unusual situations.   In December, 1842, a surgeon destroyed  him-
self by cutting through the brachial artery and the principal veins of his left arm
with  a penknife; and in another instance which occurred in 1839, a young man
committed suicide by dividing the arteries of  the fore arm on both sides.  It is
very  rare that we find  suicidal stabs in the abdomen or throat, but an  instance
occurred a few years since, where a woman destroyed herself  by a stab in the
lower part  of the abdomen; and several similar cases are recorded by medico-legal
writers.  In an attempt at suicide, which fell under my own observation, a stab
was inflicted by a carving-knife on the fore-part of the neck, traversing the  parts
from  the trachea to the spinal column.   In regard to situation, it has  been re-
marked, that  there is  no wound which  a suicide is  capable of inflicting  upon
himself, which may not be produced by a murderer; but there are many wounds
inflicted  by a murderer, which,  from their  situation and other circumstances, a
suicide would be incapable of producing on his own person.  AAre cannot always
obtain certainty in a question of this kind; the facts will often  allow us  to speak
only with different degrees of probability.  A remarkable instance of the singular
situation selected for suicidal wounds, is  reported  in the Medical Gazette, vol.
xlv. p. 439.
   The situation of a wound sometimes serves to show whether it be of an acci-
dental nature or not,—a point often  insisted on  in the defence.  Accidental
wounds generally exist on those parts of the body which are exposed.   Some
wounds, however, forbid the supposition of accident, even when  exposed; as  deep-
ly incised wounds of the throat, and gun-shot wounds of the mouth and  temples.
(For  the report of a case in which an accidental wound on  the head by an axe
closely simulated a homicidal'wound, see Casper's Wochenschrift, May 24,1845.)
   Evidence from the nature and extent of a wound.—Generally speaking, the
wound met with on the body of a suicide, where fire-arms  have not been  used,
is incised or punctured.  Contused wounds are  rarely seen in cases of suicide,
because in  producing them there is not that certainty of speedily destroying life
to which a self-murderer commonly looks.  There are,  of  course, exceptions to
this remark;  as where, for  instance, a man  precipitates himself from  any con-
siderable height, and  becomes wounded  by the fall.   Circumstantial  evidence
will however rarely fail to clear up a case of this description.  Greater difficulties
may  exist  when life is destroyed  by a contused  wound,  voluntarily  inflicted. 
SUICIDAL  WOUNDS BY MANIACS.
191
A case is related by a medico-legal writer in  which a man first attempted to
destroy himself by running with his head against a wall;  and not having suc-
ceeded in this attempt, he struck himself repeatedly  on the forehead  with a
cleaver.  By this he produced such violent injury to the  brain, that death soon
followed.  The man was seen to commit the crime, by several witnesses: had this
not been  the case, the nature of the wound was such as to have excited suspicion
that it had been inflicted by another, and that  the man had been murdered.
  A close attention to the shape of wounds made  by  cutting instruments will
sometimes lead to the development of  cases rendered doubtful  from the circum-
stances under which the dead  body of  a wounded person is found.  A few years
since, the body of a respectable farmer was found lying on a high road in one of
the midland  counties.  The  throat was severely cut, and he had evidently died
from the considerable hemorrhage which had taken place.  A bloody knife was
discovered at some distance from the  body, and this, together with the circum-
stance of the pockets of the deceased having  been rifled, led  to a suspicion of
murder.  The suspicion was confirmed when the wound in the throat was examined
by  a surgeon.  It was cut, not as is usual in suicides, by carrying the cutting in-
strument from  before  backwards, but as the throats of sheep are cut, when
slaughtered by a butcher.  The knife had been passed in deeply under and  be-
low the ear, and had been brought out by a semi-circular sweep in front, all  the
great vessels  of the neck, with the oesophagus  and  trachea, having been  divided
from behind forwards.  The nature of this wound  rendered it  at once improba-
ble that  it could have been self-inflicted; and it further served to detect the mur-
derer, who was soon after discovered.  The prisoner, who was proved to have
been a butcher, was subsequently tried and executed for the crime.
   It is necessary to bear in mind, that maniacs, when they commit suicide, often
inflict upon themselves wounds of a very extraordinary nature,—such as would,
at first view, lead to a suspicion that  they had been produced  by the hand of a
murderer;  and,  therefore, the rules which are here laid down  to distinguish ho-
micidal  from suicidal wounds, must be very guardedly applied to the cases of
those individuals who are known to have laboured  under insanity.  Perhaps  one
of  the most remarkable cases of this kind is that recorded by Mr. Tarleton.   A
gentleman was found lying in a state of insensibility in the kitchen of his house,
with a cleaver by his side.  On examining the head, upwards of thirty wounds
were found over the posterior portion of the occipital bone.  The wounds, many
of  which were superficial, had a horizontal direction from behind forwards.  One,
however, had removed a portion of the skull from the middle  of the lambdoidal
 suture, so that the brain had escaped.  This person, who was a lunatic, died four
 days afterwards, but recovered so far  as to admit that he had produced the wounds
 on himself, of which, from other circumstances, there could have been no doubt.
 This was a most unusual way of committing  suicide.  Had  the deceased been
 found dead on a public highway, thus wounded, it is probable that a strong sus-
 picion of murder would have arisen.   In 1850, a  case occurred at Guy's Hos-
 pital, in which a person in a fit of delirium tore away  the whole of the  abdomi-
 nal muscles from the lower and fore-part of the abdomen.  Had the body of this
 individual been found dead with such an unusual and serious personal injury, it
 is  not improbable that it would have been pronounced homicidal and not suici-
 dal.   In this point of view, a case which has recently occurred to Dr. AV. Burke
 Ryan is also of great interest.  The  suicide here contrived to cut his throat ex-
 actly between the  os hyoides and the larynx, having previously made  two dis-
 tinct cuts  on the thyroid  cartilage.   The wound was of a most extensive kind,
 reaching backwards through  the pharynx to the cervical vertebrae, one of which
 had  been  touched by the razor.  The carotids and jugulars had escaped, but
 some of the larger branches were divided.  The man survived  about seven hours.
 (Med. Times, Jan. 17, 1852, page 73.)   Cases of  this kind should be borne in 
192
EVIDENCE FROM THE DIRECTION OF WOUNDS.
mind, when we are called upon to speak to the possibility of certain wounds found
on a dead body having been self-inflicted.  (Med. Gaz. xxiv. 276.)
  The extent of a wound, by which we are to  understand the number and im-
portance of the parts injured, must in these cases be always taken into considera-
tion.   It has been somewhat hastily laid down as a rule, that an extensive  wound
of the throat, involving all the vessels and soft  parts of the neck to the vertebral
column,  could  not be inflicted by a suicide.   Although,  in  general, suicidal
wounds of this part of the body do not reach far back, or involve the vessels of
more than one side, yet we find occasionally that all the soft parts are completely
divided to the vertebrae.   These are cases in which,  perhaps, with a firm hand,
there is a most determined purpose  of self-destruction.  In a case  of suicide, ob-
served by Marc, the weapon had divided all the muscles of the neck, the larynx,
and oesophagus,—had opened  the jugular veins, and  both carotid  arteries,—and
had even grazed the anterior vertebral ligament.   A  wound so extensive as this
is certainly rarely seen in cases of suicide; but there is no ground for the asser-
tion, that these extensive wounds in the throat are at all  incompatible with self-
destruction.
  Incised wounds in the throat are generally set down as presumptive of suicide;
but murderers sometimes wound this part for the more effectual concealment of
the crime.   Circumstances connected with the  form and direction of  the wound
often, in such cases, lead to detection; for, unless the person attacked be asleep
or intoxicated, resistance is offered,—-evidence of which may be obtained  by the
presence of great irregularity  in the wound, or the marks of other  wounds on the
deceased.  In some instances, however, it  is extremely difficult to say whether
the wound be homicidal or suicidal,—the medical facts being equally explicable
on either hypothesis.  (See case by Marc, Ann. d'Hyg., 1830, ii. 408:—another
by Devergie, ib. 414; and a third by M. Ollivier, Ann. d'Hyg., 1836, i. 394.)
  The nature or the extent of a wound or of other injuries on  the person, will
sometimes allow us to distinguish, very positively, accident from homicide.  These
personal injuries may be such that they could not possibly have  had a suicidal
or accidental origin.  In a case that occurred at  Manchester, in October, 1836,
it was shown by the medical evidence that  seven ribs  were fractured on one side
of the thorax of the deceased, and  five on  the  other.   The person charged with
murder alleged in defence, that he had merely struck  the deceased a slight blow,
and that the ribs had become broken subsequently by an accidental fall.  The
medical witness, however, satisfied  the Court, that the fall, as  described by the
prisoner, was inadequate to the production of such extensive violence; and that
even had the deceased fallen on one side, this would not account for the fracture
of the ribs on the other.  AVhen, therefore, we find in a  dead body  severe inju-
ries referred to a fall, we should search the whole of the body carefully for marks
of violence.  The insides of the arms or thighs might present marks of injury,
which could not possibly be  explained on  the  supposition of an accidental fall.
Severe contusions on both sides of the body, or anteriorly and posteriorly, com-
monly indicate homicidal violence.
  Evidence from the direction of a wound.—The direction of a wound has been
considered by some to afford presumptive evidence sufficiently strong to guide a
medical jurist in this inquiry.  It has been remarked, that in most suicidal wounds
which affect the throat, the direction of the cut is commonly from left to right, either
transversely or passing obliquely from above downwards: in suicidal stabs and
punctured wounds, the direction is commonly from right to left, and from above
downwards.  In left-handed persons, the direction would, of course, be precisely
the reverse.  Suicidal wounds are, however, subject to such variation in  extent
and direction,  that it is scarcely possible  to generalize with respect to  them.
Nevertheless, an attention to these minutiae may sometimes be of real assistance
to the  inquirer, especially when the body has not been moved from  its position.
It is recommended that the instrument with which the wound has been inflicted, 
ACCIDENTAL STABS.
193
should be placed in either hand of the deceased, and the extremity moved to-
wards the wounded part, so that it may be clearly seen whether or not the direc-
tion of the wound could correspond to it in any position.  It might happen that
neither arm would reach the wounded part, so as to inflict a wound of the  par-
ticular direction observed: this may be the case in wounds situated on the back.
It is obvious that if a murderer makes an incised wound in the throat from be-
hind, the direction will be the same as that commonly observed in cases  of sui-
cide.   (See on this  point the case of Reg. v. Dalmas, Cent. Crim. Court, May,
1844.)   Again, if the person  attacked be powerless, the wound may be  delibe-
rately made, so as to simulate a suicidal act; indeed, murderers would  seldom
attack the throat, but with the design of simulating an act of suicide.  A homi-
cidal  stab may also  take the  same direction as one which is suicidal; but this
would be confined to those cases where the  murderer was placed behind or aside.
If in  front of the person whom he attacks, the direction would probably be from
left to right; but in suicide, where the right hand is commonly used, it is the
reverse.  All oblique wounds, passing from above  downwards, are common to
homicide and suicide; but those which take an oblique course from  below up-
wards, are  generally indicative of homicide; it is at least extremely rare, that a
suicide, unless  a lunatic, thus  uses a weapon.  Homicidal incisions, especially in
the throat, are  often prolonged below and behind the skin forming the angles of
the wound,  deeply into the soft parts.  Those which are suicidal  rarely  possess
this character;  they terminate gradually in a sharp angle, and the skin itself is
the furthest point wounded,—the weapon is not carried either behind, below, or
beneath  it.   Exceptions to these characters may exist;  but in  a dark and intri-
cate subject of this nature, we have only these limited rules to guide us.  The
instrument with which the wound is supposed to have been inflicted should' be
adapted  to the edges of the incision; its sharpness may be  compared with  the
cleanness and evenness of the cut, and its length with the depth of the incision
or stab.  It is no uncommon occurrence for  a murderer to substitute some  instru-
ment, belonging to the  deceased or another person, for that which he has em-
ployed.
   Wounds inflicted by the right or left hand.—Some  remarks have been made
about the direction of a cut or a stab, varying according to whether the right or
the left hand has been used by a suicide.  It is important for a medical jurist
to be aware, that there are many persons who are ambidextrous, i. e. who have
equal facility in the  use of the right or the left hand.   This may not be gene-
rally  known to the  friends of the  deceased;  and such persons are often pro-
nounced, even by those who have associated with them, to have been right-handed.
A want of attention to this point is said to have been one of the circumstances
which led to a suspicion of murder in the case of Sellis.   (Wills' Circ. Evidence,
97.)  He was found dead on his bed with the throat cut,—the razor was  dis-
covered on the  left side of the bed; whereas it was generally supposed and as-
serted that he was a right-handed man.  The truth was, he was ambidextrous,—
equally expert in the use of the razor with his  left and right hand; and thus the
apparently  suspicious circumstance of the razor being found on his left side was
at once explained away.
  Accidental stabs.—Severe incisions on vital  parts do not often happen by ac-
cident; but  severe punctures and stabs affecting vital organs, have frequently an
accidental origin.  These  stabs arise generally from falls, while the individual
is in the  act of running,  with  a pointed instrument in  his hand or his pocket.
There is  one character which,  when thus produced, they are commonly observed
to possess, namely, that their direction is from below upwards.   In this way, the
truth  of the defence may be sometimes tested, as where a prisoner alleges that
the deceased threw himself, or fell upon the weapon.   Homicidal stabs may be
likewise  directed from below upwards; but this is somewhat rare,  and not pro-
bable, unless an individual be stabbed by an oblique blow, while in  the  recum-
       13 
194        EVIDENCE FROM THE PRESENCE OF SEVERAL WOUNDS.

bent posture.  Rules of this kind may appear to be susceptible of but little prac-
tical application; yet cases occasionally present -themselves, wherein a close at-
tention to the situation and direction of wounds may materially assist a medical
jurist in forming an opinion.  In a case of alleged murder, which was tried in
1843 at the Central Criminal Court, the surgeon deposed that he  found, on ex-
amining the body of the deceased, a stab on the left side of the chest, near the
armpit, about six inches in depth.   It had .wounded the right lung, and had
penetrated obliquely into the right  auricle of the  heart, passing from  left to
right.  He contended, very properly, that, considering the situation and direc-
tion of the wound, it was very improbable that the deceased could  have inflicted
it upon himself.  The fact that there  may be some  instances in which rules of
this kind will not be applicable, must not deter us from endeavouring to make a
cautious application of them in doubtful cases.
  Evidence from the presence of several wounds.—In suicides, commonly, one
wound only is seen, namely, that which has destroyed life; and  the presence of
several wounds on a body, or the marks of several attempts around the principal
wound, have been considered to furnish presumptive evidence of murder.   But
it need hardly be observed that any inferences of this kind must be very cau-
tiously drawn, since not only may a murderer destroy his victim by one wound,
but a suicide may inflict many, or leave the marks of several attempts, before he
succeeds in his purpose.   A  case is reported  in which a gentleman, labouring
under mania, attempted to destroy himself.   Besides many wounds on the fore-
arm, neck, and face, which disfigured him, there were twenty-two in front of his
chest.  One of these had traversed the heart, producing death after some hours,
by causing extravasation of blood.   (Lancet, July,  1839.)  In incisions  on the
throat, from ignorance of the situation of vital parts or  from tremulousness, a
suicide often produces one or more incisions of greater or less extent near  that
which destroyed him.  This is especially the case when the instrument happens
to lodge in the first instance on the cartilages of the larynx.   The same remark
applies to  suicidal stabs, when the point of the weapon, in being directed against
the chest,  comes in  the first instance in contact with the  ribs.   With respect to
the throat, many cases might  be cited where two, three, and even six or more
incisions, have been made  in  this part by suicides before they have destroyed
themselves.  A very remarkable case  is  related by Dr. Handyside (Ed. Med.
and Surg. Jour. Jan. 1838,) in which  a gentleman  who had studied medicine
destroyed  himself by inflicting  several wounds on his  throat.  Incisions were
found on each side, just below the angle of the jaw and in the hollow behind it.
They were irregular in form, and bore  the character of deep stabs.  The only
important vessel divided was the internal jugular vein on  the right  side;  but,
nevertheless, a large quantity of blood was lost, and this,  no doubt, as it is stated
by Dr. Cormack, was the real cause of death.   This case is in  many points of
view singular; for such wounds have never before, so far as I know, been found
in cases of suicide.   It would appear that the deceased  was ambidextrous, and
that the wounds on each side of the neck were inflicted by the hand  of  the op-
posite side.   The following case, which occurred in London  in 1839, is some-
what similar:—A lady who had been for several days in a desponding state, was
found one morning  dead  in her bed, in a sitting posture.   On examination, two
very deep and extensive wounds, which had divided the  principal blood-vessels,
were perceived on the right side of the neck.  There were two penknives on the
bed, covered with blood.   From the situation and other characters of the wounds,
it was inferred that they must have been inflicted with the left  hand; although
-nothing satisfactory could be ascertained on this point.   The husband and son
slept in the adjoining room.  There was no doubt that this was a case of suicide,
although it is singular that two deep wounds should have been found thus in-
flicted by two different weapons on the right side of the neck, in the case of a
person who was not known to be left-handed. 
            OF SEVERAL WOUNDS, WHICH WAS FIRST RECEIVED.          195

   TJie use of several weapons.—In general, suicides, when  foiled  in a first at-
tempt, continue to use the  same weapon; but sometimes, after having  made a
severe incision in the throat, they will shoot themselves, or adopt other methods
of self-destruction.   These cases can only appear complicated to those who are
unacquainted with  the  facts relative to  self-murder.  Neither *he presence of
several wounds by the same kind of weapon, nor of different wounds by different
weapons, can be considered, of themselves, to furnish any proof of the act being
homicidal.   One  instance has been already related,  in which a lunatic,  in com-
mitting suicide, inflicted thirty  wounds upon his head.  In a  case  of murder,
when many  wounds are found on a dead body, it may happen that the situation
or direction  of some will be incompatible with the idea of a suicidal origin.
   Two or more mortal  wounds.—When we find several wounds on the  body of
a  suicide, it generally happens that one only bears about it a mortal character,
namely, that which has caused death.   On this account, it has been  asserted by
some medical jurists, that when  two mortal wounds are found upon a body, and
particularly if one of them be of  a stunning or stupifying tendency (i. e. affecting
the head,) they must be considered incompatible with suicide.   An inference of
this kind can be applied to those cases  only in which the two wounds,  existing
on different parts of the body, were likely to prove immediately fatal.  It must,
however,  be borne in mind that all suicides do  not immediately perish  from
wounds which are  commonly termed mortal; on the contrary, they have often
the  power to perform acts of volition and locomotion, which might  by  some be
deemed wholly incompatible with their condition.   It is very difficult to say
whether one wound is likely to  destroy life so rapidly as to render it impossible
for an individual to have inflicted another upon himself.   There are  no rules by
which, in  unknown cases,  the  instantaneous mortality of  wounds  can be
accurately determined,—a  fact which will be apparent hereafter, from a  descrip-
tion of cases of wounds of the head, heart, and throat.
   It is not  possible to say, from mere discovery of marks of contusion or injury
on the head, that the deceased must have necessarily  laboured under insensibility
or concussion, and  have therefore been afterwards  unable  to  inflict any other
wound upon himself.  Injuries  of the head are attended with the most  singular
anomalies in this respect.  One individual will be rendered insensible and power-
less by a  blow which may leave scarcely any appreciable marks, while  another
will be able to walk and exert himself  when the  skull has been fractured and
depressed, and even when  a portion of the brain has been lost: in short the ap-
pearances may be  such as to induce many surgeons to express an opinion that
death must have taken place instantaneously.   It is quite right that a  medical
jurist should be fully prepared for the occurrence of such anomalous cases;  but a
strong suspicion of homicide may fairly exist, when, besides marks  of great in-
jury to the  head, a severe cut or stab is found on the body.  A man is not likely
to cut or stab himself after having sustained such severe violence to the head;
but it is quite possible that he may have the power of precipitating himself from an
elevated spot, and  thereby of producing great injury to the head, after having
previously attempted to cut his  throat or to stab himself.
    Wounds produced simxdtaneously or at different times.—When several wounds
are found on a dead  body, the  question is frequently asked,— Which was first
received?   If one  be what is commonly called mortal, and the others not, it is
probable that the latter were first inflicted.  This remark applied both  to  cases
of homicide and suicide; but it is apparent that where, in a murderous assault,
a person has been  attacked by several individuals at once, the wounds may have
been simultaneously produced.   This is, however, a question to which  it is not
easy to give a general answer.   Each case must be decided from the special cir-
cumstances attending it; and in most  instances, unless some direct evidence be
afforded, a medical opinion can be little more  than conjectural.  I here refer to
it, because  it is a question almost always put in a Court of law; and a witness 
 196         OF SEVERAL WOUNDS, WHICH^WAS FIRST RECEIVED.

 should at least prepare himself for  it, by a proper examination of the medical
 circumstances of the case.
   The case of Reg. v. Spicer (Berks Lent Assizes, 1846) affords an illustration
 of the importance of examining wounds minutely, as well as the locality where
 a dead body is found.  The  prisoner was charged  with the murder of his wife,
 and the evidence against him was chiefly circumstantial.  The deceased was found
 dead  at the foot of a stair, as if she had  accidentally fallen.   The parietal bone
 was fractured, and the fracture had extended to the base of the skull.  The
 brain was lacerated, and there was great effusion of blood.   The second vertebra
 of the neck was fractured, and "the spinal marrow torn through.  These injuries
 were  quite sufficient to account for death; and had they existed alone, there
 might have been no reason to charge the husband with the murder.  But there
 was a wound on each temple, partly lacerated and partly bruised, and a  branch
 of the right temporal artery had been divided; the injury having been inflicted,
 apparently, with a pointed blunt instrument.  There were marks of blood on the
 wall at the top of the staircase, and a pointed stone, covered with blood, was found
 near the body.  It was therefore obvious, as the deceased had fallen on the ver-
 tex, that the injuries to the two temples  laterally, could not have been acciden-
 tally produced, for there was no projecting  body against which she could have
 fallen  in her  descent;  and when the force of  the fall had been spent  on the
 vertex, her body  could not  have rolled  over, so as to produce mixed punctures
 and lacerated wounds on both sides of the head.   All the facts tended to show
 that a murderous assault had been made upon her  at the top of the stair, and
 that she had been  pitched headlong backwards.   The injuries received previous
 to the fall might have stunned her, and might not have sufficed  to account  for
 death; but their nature and situation furnished strong proof that they could not
 have arisen from any cause operating simultaneously, and that they were neither
 of accidental nor suicidal  origin.  The prisoner was  convicted and executed.
 (Med. Gaz. xxxvii. 610.)
   If several wounds  have been inflicted through the dress, an examination of
 this may sometimes suffice to show which was first received.   A man, in strug-
gling with an assailant, received three stabs with  a knife—two on the left elbow,
and the third in the back.   The latter was at about the level of the eighth rib;
—it was vertical to the chest, and had clean edges.   The lower margin was  ob-
tuse—the upper acute; hence it was evident that the cutting edge of the weapon
had been directed upwards.  It had  traversed the  left lung and the heart, and
had caused immediate death.  It was obvious, on examination, that this  mortal
wound had been first received, and the stabs at the elbow inflicted subsequently.
These  two stabs, which were  slight, had  divided  the cloth  coat and shirt, and
had only grazed  the skin, so that no blood had been effused.   But the edges of
the cuts in the cloth coat and shirt were stained with blood;  hence it was evident
that they must have been produced  by a weapon already rendered bloody by a
previous wound.   The fact was of some importance in the case, and the correct-
ness of the  medical opinion was confirmed by the evidence at the judicial inquiry.
(See Ann.  d'Hygiene, 1847, i. p. 461.) 
VALUE OF EVIDENCE FROM CIRCUMSTANCES.
197
                            CHAPTER  XXIV.

EVIDENCE FROM CIRCUMSTANCES—MEDICAL QUESTIONS—VALUE OF CIRCUMSTANTIAL EVI-
  DENCE--THE POSITION OF THE BODY--OF THE WEAPON--THE WEAPON  OR OTHER ARTI-
  CLES FOUND IN THE HAND OF THE DECEASED--EVIDENCE FROM BLOOD ON WEAPONS--
  MARKS OF  BLOOD ON  THE PERSON OR IN THE APARTMENT--POSITION OF THE PERSON
  WHEN MORTALLY WOUNDED--EVIDENCE  FROM WOUNDS ON THE DECEASED—NO BLOOD
  ON THE ASSAILANT—FALLACY RESPECTING MARKS OF BLOOD.  ARTERIAL DISTINGUISHED
  FROM VENOUS BLOOD—EVIDENCE FROM THE FORM AND DIRECTION OF SPOTS OF BLOOD.

  Evidence from circumstances.—In pursuing the examination of the  question
respecting the homicidal or suicidal origin of wounds, the attention of the reader
may be called to  the force of  evidence which  is  sometimes derived from the cir-
cumstances  under which the body of a person, dead from wounds, is discovered.
It may be said that this is a subject wholly foreign to the duties of a medical
jurist, but I cannot agree to this statement: there are very few in  the profession,
who, when summoned to aid justice, by their  science, in the detection of crime,
do not seek for circumstances by which to support the medical evidence  required
of them.  A practitioner would certainly be wrong  to  base his professional opi-
nion exclusively on circumstantial proofs:  but it is scarcely possible for him to
avoid drawing an inference from these, as they fall  under his observation, for or
against the  prisoner.  His evidence may be of  itself  weak, and insufficient to
support the charge against an  accused  party:  in such  a case, if  any suspicious
circumstances have come to his knowledge, he may be often unconsciously in-
duced to attach greater  importance  to the medical  facts than  he  is  justified in
doing; in short, he may, through a feeling of prejudice, which it is not always
easy to avoid, give an undue force and value to  the medical evidence.   But if a
proper degree of  caution be used in drawing inferences from the circumstantial
proofs, and  they are not allowed to create a prejudice in his mind against a pri-
soner,  a practitioner is,  I think, bound to  observe and record them; for, being
commonly the first person called to the deceased, many facts, capable of throwing
an important light on the case, would remain unnoticed or  unknown, but for his
attention to them.  The position of a dead body,—the distance at which a knife
or pistol is found,—the direction of the instrument,—whether situated to the
right or left of the deceased,—the marks  of blood about the person, clothes, or
furniture of the apartment, are all circumstances which must assist materially in
developing the real nature of a case, and in giving force to a medical opinion.
Many of these circumstances can fall under the  notice of him only who is first
called to the deceased; and, indeed, if observed  by another, no advantage could
be taken of them without the assistance of a medical man.
  Among the  questions which present themselves on these  occasions are the
following:—Is the position of a wounded body that which  a  suicide could have
assumed?    Is the distance of  the fatal weapon from the body such as to render
it improbable that it could have been placed there by the deceased?—In answer-
ing either of these questions, it is necessary to take into consideration the extent
of the wound, and the period at which it probably proved fatal.   Again, it may
be inquired: Has the deceased bled in more places than one?   Are  the streams
of blood all  connected?   Are there  any marks of blood on his person or clothes,
which he could not well have produced himself?—These are questions, the an-
swers to which may materially affect the case of  an accused party; and the prac-
titioner, in  noticing and recording  the circumstances involved in  them, ought
therefore to  exercise due caution  and  deliberation.   "The consideration of the
nature of circumstantial evidence," observes Starkie, "and of the principles on 
198
THE POSITION OF THE BODY AND THE WEAPON.
which it is founded, merits  the  most profound attention.  It is essential to the
well being at least, if not to the very existence of civil society, that it should be
understood, that  the secrecy with which  crimes  are  committed will not insure
impunity to the offender.   At the  same time it is to be emphatically remarked,
that, in no case, and upon no principle, can the policy of preventing crime and
protecting society, warrant any inference which  is not founded on  the most full
and certain conviction of the truth of the fact, independently of the  nature of the
offence and of all extrinsic considerations whatever.   Circumstantial evidence is
allowed to prevail to the conviction of an offender, not because it is necessary
and politic that it should be resorted to, but because it is in its own nature ca-
pable of producing the highest degree of moral certainty in its application.  For-
tunately for the interests of society,  crimes, especially those of great enormity
and violence, can rarely be  committed,  without  affording vestiges by which the
offender may be traced and ascertained.   The very measures which he adopts for
his security not unfrequently turn out to be the most cogent arguments of guilt.
On the other hand, it is to be recollected, that this is a species of evidence which
requires the utmost degree of caution and vigilance in its application;  and, in
acting  upon it, the just and humane rule, impressed by Lord Hale, cannot be
too often repeated:—"tutius semper est errare in acquietando quam in puniendo,
ex parte misericordiae quam ex parte justitiae."   (Arol. i. p. 480.)  Evidence is
direct when a fact is proved by witnesses, and circumstantial when  the fact is at
once proved by circumstances.   More commonly the  evidence is presumptive, i.
e. founded on an inference from circumstances.
   There are many cases on  record in which  an  observance of slight and unex-
pected circumstances by medical men has led to the detection  of offenders.   In
the Life of Sir Astley Cooper, it is mentioned, that when called to see Mr. Blight,
of Deptford, who had been  mortally wounded by a pistol-shot in the year 1806,
he inferred, from an examination of the localities, that the shot must have been
fired by a left-handed man.   The only left-handed man near the premises at the
time was a Mr. Patch, a particular friend of the  deceased's, who was not in the
least suspected.  This man  was afterwards tried and convicted of the crime:—
and  he  made a full confession of his  guilt before execution.   The  rules for in-
vestigating a case of poisoning (see ante, p. 53) may be equally observed in many
cases of death from violence.   Among the circumstances to which a medical
witness should specially direct  his attention on these occasions are the follow-
ing:—
   The position of the body.—The body may be found  in  a position which the
deceased could not have assumed on  the  supposition of the wound or injury
having been accidental or  suicidal.  The  position  of a dead wounded body is
often only compatible with homicidal interference, either at the  time of death,
or immediately afterwards.  In order to determine the probable time of death,
we should always notice whether there be any warmth about the body,—whether
it be rigid, or in  a state of decomposition, and to what degree this may have ad-
vanced.   In the case of a female who was found dead in her apartment with her
throat cut, in November, 1847, it was ascertained that when first discovered, the
body was so warm as to render  it highly probable that the crime must have been
committed within an hour.   This observation tended to prove the innocence of
a party who was suspected of the murder, because it was known that he had been
absent from the. house for at least five hours.
   The position of the weapon.—If a person has died from an accidental or self-
inflicted wound, likely to cause death either immediately or within a few minutes,
the weapon is commonly found  either near the body or within a short distance.
If found near,  it is proper to notice on  which side of the body it is lyin<** if at
a short distance,  we must consider whether it might not have fallen to the spot,
or been thrown or placed there by the deceased.   If there has been any inter-
ference with the body, all evidence from  the relative position of it and the weapon 
WEAPONS GRASPED BY SUICIDES.
199
will be inadmissible.   In a  case which was  referred to  me some time since, a
woman had evidently died from a severe incision on the throat, which was homi-
cidally inflicted; the weapon, a razor, was found under the left shoulder, a most
unusual situation, but which, it appears, it had taken owing to the body having
been turned  over before it was seen by the  surgeon who was first called.   We
must remember  that it is quite compatible with suicide that a weapon may be
found at some distance, or in a concealed  situation;  but it is  much more fre-
quently either grasped in the hand, or lying by the side of the deceased.
  In one instance, it is stated the deceased was discovered in bed with his throat
cut, and the razor lying closed or shut by his side.   It appears  very improbable
that any person  committing suicide, after dividing one or both carotids and the
jugular veins, should have power to close  or shut the razor: and there is fair
ground to suspect interference when a  razor is thus found closed.  There is,
bowever, one circumstance in relation to a weapon strongly confirmatory of sui-
cide.   If the instrument be  found still  firmly grasped in the  hand of the de-
ceased, no better circumstantial evidence of suicide can, perhaps, be offered.  It
is so common to find knives,  razors, and  pistols grasped in the hands of suicides,
that it is quite unnecessary to produce cases illustrative of this statement.   The
grasping of  a weapon appears to be owing to muscular  spasm persisting after
death, and manifesting itself under the form  of what has been called cadaverous
spasm—a condition quite distinct from  rigidity, although often running into it.
It does not seem possible that any murderer could imitate this state, since the
relaxed hands of a dead person cannot be made to grasp or retain a weapon, like
the hand which  has firmly held it by powerful muscular contraction at the last
moment of life.  In this respect the case of Reg. v. Saville, Nottingham Summer
Assizes, 1844, is of great interest to the medical jurist.  A woman was found
dead with her throat cut, and there was  a  razor loose in her hand.  There was
no blood upon the hand which held the razor, and this, together with the fact of
its being quite loose, rendered it certain  that it must have been placed there by
the prisoner after having cut his wife's throat.  The  deceased may be found with
some other article grasped in the hand.   (See case, Ann. d'Hyg. 1829, i. 464.)
It may be her own or the prisoner's hair torn off in the struggle for life; and on
this point a question of identity may be easily raised. (Reg. v.  Ellison, Bodmin
Summer Assizes, 1845.)  In a case which occurred to Dr. Marc, a woman was
found assassinated in her house, and when the body was discovered, a small
snuff-box was still held firmly in one hand.   This proved that the murder must
have taken place very suddenly, and without any resistance on the part of the
deceased.  (Ann. d'Hyg. 1829, i. 465.)
   If the weapon cannot be discovered, or if  it be found  concealed in  a distant
place, this is strongly presumptive of homicide, provided the wound be of such
a nature as to prove speedily fatal.  In the case  of Lord  William Russell, no
weapon could be discovered;  and although the wound in  the throat bore some
of the characters of a suicidal incision, this fact alone was sufficient to show that
it must have been the act of a murderer.  AVith respect to the weapon being
found at a distance from the body, other circumstances should be taken into con-
sideration before any opinion is expressed.  We may observe whether the wea-
pon, if it be a sharp cutting instrument like a razor, has been recently notched;
for this might show that a degree of force or violence has been used, not easily
reconcileable with the suicidal use of the instrument.  The well known case of
the Earl of Essex, who was found dead in the Tower in July, 1683, gave rise to a
doubt on this point.  The deceased was discovered with his throat cut, and a razor
lying  near him.  This razor was found  to be much notched on the edge, while
the throat was smoothly and evenly cut  from one side to the  other, and to the
vertebral column.  Some considered this to have been an act of suicide, others of
murder.  Those medical witnesses who supported the view of suicide were asked
to explain how  it was that  such an even wound could have been produced by a 
200
MARKS OF BLOOD ON THE PERSON.
notched razor.  They attempted to account for this by asserting that the deceased
had probably drawn the razor backwards and forwards across the neck-bone; for-
getting that before this could have been done by the deceased, all the great ves-
sels of the neck must have been divided.
   Blood on weapons.—It does not always happen  that the weapon with which a
wound has been produced is covered with blood.   It has been remarked, that in
the case of stabs, the knife is frequently without any stains of blood upon it; or
there is only a slight  film, which, on drying,  gives to the surface  a yellowish-
brown colour.   The explanation of this appears to be, that the weapon, in being
withdrawn, is sometimes cleanly wiped against the edges of the wound in the in-
teguments.
   When a weapon is bloody, particular attention should be given to the manner
in which the blood is diffused over it.   In cases of imputed wounds, or in the at-
tempted concealment of murder, it is not unusual for the criminal  to besmear
with blood a knife or other weapon which has probably not been used.   A case
of this kind occurred to the late Dr. Marc.  A young man alleged that he had
received a cut on the forehead by a blow from a cutlass, which he produced.   It
was remarked that the weapon was smeared with blood on both surfaces; but the
layers were thicker towards the handle  than at the point.  The wound  on  the
forehead was a clean incision; and a cap which the complainant wore had been
eut through.   It was obvious,  therefore, that the blood on the weapon could not
have proceeded from this cut;  for it would have been wiped, or only left in thin
strise, and more towards  the point than the handle, by the act of drawing it
through the clothes in producing the wound.  There was no doubt that the blood
had been intentionally applied to the blade.   (Ann. d'Hyg. 1829,  p. 263.)
   Hair on  Weapons.—In some  instances, no blood may exist on the weapon,
but a few hairs may be found adhering  to it if the weapon be of a bruising kind.
The main question will be, in such a case,  whether the hair is that of a hu.: an
being or of an animal.   See in reference to this question the case of The Queen
v. Teague,  Cornwall Summer Assizes, 1851, (Med. Gaz. vol. xlviii.  p. 729.)
   Foreign substances in wounds.—In gun-shot wounds, the examination of wad-
ding or paper found  in the wound or near the deceased, has in more than one
instance led to the identity of  the person who had committed  the  crime.  His
hand-writing was traced on the paper used as wadding, or it has been found to
have been part of a printed page,  of which the remainder  has been discovered in
his possession.  Foreign substances may be sometimes discovered in contused
or lacerated wounds; and  these may throw an important light on the circum-
stances under which the crime was perpetrated.  In the  case of The  Queen v.
Hazell (Taunton Lent Assizes, 1848,) the body of the deceased was found in a
well.   AVhen examined, there were  on the head several severe wounds quite
sufficient to account for  death.  There was much blood on the clothes and  face,
and in the blood were sticking a  quantity of  hay-seeds, which  led the medical
witness to consider that the wounds must have been inflicted  in a stable or in
some  place where there  was hay.   On examining a neighbouring stable, the spot
where the murder was committed was rendered evident by the discovery of marks
of blood.
   Marks of blood.—It is proper to notice all marks of blood on the  person or in
the apartment, and to  observe where the greatest quantity of blood has  been
effused: this is generally found in the spot where  the deceased has died.  The
deceased may have bled in more places  than one;  if so, it becomes important to
notice whether  there be any communications  in blood between  these different
places.   Blood  on distant clothes or furniture will  show whether  the deceased
has moved about, and whether he has struggled much after receiving the wound.
Acts of locomotion  in a wounded person  who has died  from  hemorrhage, are
generally indicated by tracks of blood.   We must observe likewise, whether, if
the wound  be in the  throat, blood has flowed down in front of the clothes or 
MARKS OF BLOOD ON THE PERSON  AND DRESS.
201
person; for this will sometimes show whether the wound was inflicted when the
individual was standing, sitting, or lying down.  If the throat be cut while  a
person is lying down, it is obvious that the blood will be found chiefly on either
side of the  neck, and not extending down the front of the  body.  Few suicides
cut the throat while in^the recumbent posture, and the course which the blood
has taken may,  therefore, be sometimes rendered subservient to the distinction
of a homicidal  from a suicidal wound.   The position in which the body  was,
when the wound was inflicted,  is a frequent  question on inquests and criminal
trials.   In  the case of Lord William Russell, the throat had evidently been cut
while the deceased was lying in bed; the blood was effused on each side of the
neck only.   There was also found a wound on the  thumb of the right hand of
the deceased, which must have been inflicted at the time the hand was put up to
defend the throat.   Recent wounds on the back  of  one  or both hands, when
found in persons who have died from wounds in the throat, are,  caeteris paribus,
strongly  presumptive of homicide.   There may, however, be no marks of wounds
on the back of  the  hands, if the  individual was attacked  unexpectedly—if he
was intoxicated or rendered powerless, or several had combined to attack  him,
while he was pinioned and held by an accomplice.
  If the deceased has been wounded with his clothes on, we should notice
whether any part of his dress has or has not been cut or injured over the situa-
tion of the wound.   When, together with the wound in the  throat, we  find the
cravat and  the shirt, or part of the dress, cut through, this is, all other  circum-
stances being equal, presumptive of homicide; for it is not usual that a suicide,
unless labouring under confirmed insanity, would allow any mechanical obstacles
of this kind to remain in the way of a weapon.  In one case  of a homicidal wound
in the throat, inflicted in the recumbent posture, the cravat of the deceased had
been lifted  up, and  afterwards  allowed to drop over the wound in  order to  con-
ceal it.
  Marks of blood on the person of the deceased  require special  observation.
Very often the impression of a hand, or of some of the fingers, will be found on
the skin  in a situation where it would have  been improbable or impossible for
the deceased to  have produced  it, even supposing that one  or both of his hands
were covered with blood.   In  one  case of murder there was found the  bloody
impression  of a left hand upon the left hand of the deceased,  in such a  situation
that  it was quite impossible the deceased himself could have made the mark!
In other cases it may be important to state whether the inside or outside of the
hand, or  whether one or both hands, be marked with blood.  Marks of blood on
the  dress of  the  wounded person may often furnish  important circumstantial
evidence.   If there be several  stabs or  cuts on the body involving the dress, it
should be observed whether the edge of one or more  of them be stained  with
blood, as if from the wiping of a weapon, and whether the stain be on the outside
or inside of the  article of dress.   In simulated personal  injuries, the stain of
blood may be, through inadvertence, applied to the outside of the dress—a fact
which might, in some instances, lead to the  detection of the imposture.   (See
case by Dr. Bayard, Ann. d'Hyg. 1847, ii. 219.)  In judging  from marks of
blood in the apartment, we must take care that we are not  unconsciously misled
by the accidental diffusion of this  liquid by persons  going  in  and out.  The
following case, which will show  the necessity of extreme  caution, occurred in
France.  A young man was found dead in the bed-chamber  with three wounds
on the front of his neck.   The physician who was first called to see the deceased
had,  unknowingly, stamped in  the blood with which the floor was covered, and
had  then walked into an adjoining  room, passing and repassing several times;
he had thus left a number of bloody foot-prints on the floor.   No notice of this
was  taken  at the time; but on  the following day, when  the examination was
resumed, the  circumstance of  the  foot-prints was particularly attended to, and
excited  a suspicion that the young man had been  murdered.  The suspected 
202           ARTERIAL DISTINGUISHED FROM VENOUS BLOOD.
person was arrested, and would have undergone a trial on the charge of murder,
had not M. Marc been called in to examine all  the particulars of the case.  A
similar circumstance occurred in the case of Eliza Grimwood, who was murdered
at Lambeth in June, 1838.
   Arterial distinguished from venous  blood.—It is not  possible to distinguish
arterial from venous blood by any physical or chemical characters, when it has
been  for some days effused, and  has fallen upon  articles of dress or furniture;
but this, in medico-legal practice, is not often a subject of much importance,
since  there are few cases of severe wounds, either in the throat or other parts of
the body, in which the two kinds of blood do not  escape simultaneously.   The
most  striking and apparent difference between them, when recently effused, is
the colour; the arterial being of a bright scarlet,  while the venous is of a dark
red hue;  but it is well known that the latter, when exposed to air  for a short
time, acquires a florid red or arterial colour;  and the two kinds  of blood, when
dried, cannot be distinguished chemically by any known  criterion.   If the coat
or other stuff, covered with blood, were of a dark colour, the liquid would be
absorbed, and lose its physical characters.   Arterial blood  contains more fibrin
than  venous, and coagulates more firmly.   Even the microscope shows no appre-
ciable difference in the blood-corpuscles; and chemistry does not enable  us to
apply any test so as to make a satisfactory distinction between  them.   In this
deficiency of microscopical and chemical evidence, an attempt has been made to
establish a distinction by noticing the physical appearances of the  blood-stains.
Thus, it is alleged, the  arterial blood will be indicated by its being sprinkled
over  surfaces upon which it has fallen, while the venous blood is always poured
out in a  full stream.   In most wounds which prove fatal  by hemorrhage, the
blood is  poured  out simultaneously from  arteries and  veins.   The sprinkled
appearance of the blood, when it exists, will, caeteris paribus, create a very strong
presumption that it was poured out from a living body; for after the heart has
ceased to act, the arteries lose the power of throwing out the blood in jets.  This
mode of distinguishing arterial from venous  blood was adduced as evidence in
the case of Sell-is, who destroyed himself after  having attempted to  assassinate
the Duke of Cumberland.   There was the appearance of sprinkled blood on the
coat-sleeve of Sellis, and the temporal artery of the Duke had been wounded in
the struggle.   Sir Everard Home thence inferred that  Sellis had attacked the
Duke, and wounded the artery, which had led to  the sprinkling of  the sleeve.
(Will's Circ. Ev. 98.)   This method  of distinguishing the two  kinds of  blood,
therefore, may be occasionally  available for  practical  purposes;  but  it must be
remembered that accident may lead to the sprinkling of blood from a small vein
which has been wounded, while blood may be poured out in considerable quantity
from an artery, especially if large; and if it fall on one spot at a short distance,
it may produce a soaked appearance.   The  sprinkling  may be expected only
 when the*wounded artery is small, and the blood is effused at a  distance.  This
 is a fact which a  medical jurist should not overlook, although, for the reasons
 stated, too great a reliance must not be placed on it.   The spots  of blood,  if
 thrown out from a living blood-vessel, very speedily consolidate; and the fibrin,
 with the greater  portion of the  colouring matter, is found of a deep red colour
 at the lower part of the spot, the upper portion being of a  pale red.   The lower
 and thicker part  has commonly a shining lustre,  as if gummed, when the spot
 is recent, and when it  has  been effused  upon a  non-absorbent surface.  This
 glazed appearance is probably  given by the evaporation of  the aqueous, and the
 rapid desiccation of the albuminous portions.  AVhen the blood falls upon porous
 articles of clothing, as linen, or cotton, it is absorbed, and  produces a dull stain.
 In dark-coloured articles of dress, it is difficult  by day-light  to perceive these
 stains.   The part appears stiffened, and there is a dull red brown colour, which
 is more perceptible when seen by the reflection of the light of a candle.   Stains
 of tobacco, or of the juices of  certain vegetables,  may present somewhat the 
EVIDENCE FROM A POST-MORTEM EXAMINATION.          203
appearance of those of blood.   The distinction between them will, however, be
rendered immediately apparent by the application of the microscope and  of the
chemical processes to be hereafter mentioned.   (See Blood-stains.)
  In  trusting to the coagulation  of the blood as evidence of its  escape from a
living vessel, it must be remembered, that there are certain diseases, as  scurvy
and typhus, in which, owing to morbid causes, the blood does not  readily coagu-
late;  while, again, some  hours elapse before it coagulates in the healthy body
after death.   Hence blood which has escaped from a recently dead body, although
it would not be found diffused as if by spirting, might, in so far  as coagulation
is concerned, assume the appearance of having been effused from a living body.
On this fact, Donne has founded a process for determining whether a person he
really dead.  (Cours de Microscopie, 54.)
  When spots of blood are found upon articles of dress or furniture, their form
and direction may sometimes serve to give us an indication of the position of the
wounded person with respect  to them.   Thus, when the form of a spot  is oval
and elongated, the presumption is  that the person was  placed obliquely with re-
spect to the stained furniture, during the hemorrhage.  (Ann. d'Hyg. 1840,397.)
The impetus with which the blood is thrown out will be in some measure indi-
cated by the degree of obliquity and length of the spot.  This is in general wide
and  rounded at the upper  part, but  narrow and pointed below.  The  case of
Spicer (ante, page 196,) furnishes some interesting suggestions  on the impor-
tance of the evidence occasionally derived from examination of the form  and
direction taken by spots of blood.   At the top of the stair, and at the height of
four or five feet above the level, several spots of blood were observed upon the
brick-wall.  These were  rendered  very evident by the wall  having been white-
washed.   The spots took an oblique direction from above  downwards, were  of a
pale red colour at the upper part, but dark red below, terminating  in a point con-
sisting of the fibrin and the greater part of the red colouring matter. Their form
and regularity proved that they had proceeded from a small artery, and that 'the
wounded individual could not  have been very distant from the wall, while their
shining lustre rendered  it probable that they  were of recent origin, and their
well defined termination in a firm coagulum, showed that they had proceeded
from a living blood-vessel.  The deceased had died from fracture of the skull
and vertebral column by a fall from the top-stair; one branch of  the right tem-
poral artery was found divided, and this wound could not have been produced by
the fall.  It was therefore evident that a murderous assault had been made upon
her at the top of the stair: this had led to the  spirting  of the arterial blood on
the brick.  The  height at which the spots existed, and their appearance,  proved
that the jet of blood had been from above downwards; thereby rendering it pro-
bable that the deceased was standing up, or that her head  was raised at the time
the wound was inflicted.   Further, as the brick with the spots was on the left
hand in the descent, and the wounded artery was on the  right side, it is proba-
ble that the deceased was face to face with her  assailant in the act of ascending
the stairs, and that she was killed by being precipitated backwards to the bottom.
The position in  which the body was found in the cellar corroborated this view.
(See Med. Gaz. xxxvii. 612.)
  Inspection.—In examining a dead body, it is proper that attention should be
paid  to the state of the mouth and throat.  Assassins who  make their attack
during sleep, sometimes endeavour to close the mouth, or to compress the throat,
so as to prevent an alarm from  being  given.  In  the case of the Duchess of
Praslin, there were the marks of finger-nails around the mouth.   In another in-
stance ecchymosed impressions, as if produced  by a hand, were found upon the
throat of the deceased.  The hands of the deceased should always be examined;
many cuts, excoriations, or incisions, found upon them, especially if on the dorsal
surface, will indicate that there has been a mortal struggle  with the assailant.  In
the inspection, the examination of the stomach should not  be' omitted.  The 
204
homicidal and accidental wounds.
presence or absence of food, mucus, or blood, may furnish evidence of conside-
rable  importance in the elucidation of the case.  Thus, in the stomach of the
Duchess of Praslin, a quantity of bloody froth was discovered.  This rendered
it certain that she had lived sufficiently long to swallow a quantity of saliva mixed
with blood, and  that probably she  had made some attempts to give an alarm.
The fact that several days have elapsed since death, will not prevent the discovery
of food in the stomach, provided it has been taken within one or two hours be-
fore death;  since the digestion of food does not appear to go on  to any percep-
tible extent after death.  I have thus discovered food  in the stomach  twenty-
eight days after  interment.  This question connected with the digested or undi-
gested state of the food found in the stomach, very frequently arises on criminal
trials.
                            CHAPTER XXV.

DISTINCTION OF SUICIDAL FROM ACCIDENTAL WOUNDS--IMPORTANT IN CASES OF LIFE-INSU-
  RANCE--WOUNDS ON  THE THROAT--FACTS INDICATIVE OF SUICIDE,  HOMICIDE, OR ACCI-
  DENT--IMPUTED OR SELF-INFLICTED WOUNDS--MOTIVES FOR THEIR  PRODUCTION—CHA-
  RACTERS OF IMPUTED WOUNDS--RULES FOR DETECTING FALSE CHARGES OF MURDER.

   Suicidal wounds.—It is not often that any difficulty is experienced in distin-
guishing a suicidal from an accidental wound.  When the wound has really been
suicidally inflicted,  there are generally to be found about it very clear indications
of design; and the  whole of the circumstances are seldom reconcileable with the
supposition of accident.  But if the position of the deceased with respect to sur-
rounding objects have been disturbed, if the weapon has been removed, and the
body transported to a distance, then it will not always be easy to distinguish a
wound accidentally received, from one inflicted by a suicide  or a murderer.  The
evidence of  those who find the body can alone clear up the  case; and the medi-
cal witness may be  required to state how far this evidence is consistent with the
situation, extent, and direction of the wound by which the deceased has fallen.
It is unnecessary to dwell further on this subject, since the observations made in
the preceding pages will suggest to the practitioner the course which he has to
pursue.  Circumstantial evidence is commonly sufficient to show whether a wound
has  been accidentally received or not;  but as an accidental wound may some-
times resemble one of homicidal or suicidal  origin, so it follows that it is not
always possible for  a medical jurist to decide the question  peremptorily from a
mere inspection  of  the wound.   Homicide is  only liable to  be confounded with
accident  in relation to contusions and contused wounds.   In cuts and  stabs, the
evidence of  design  will be in general too apparent to allow of any doubt being
entertained respecting the real origin  of the injury.  It would not be difficult to
produce many instances where murderers, in their defence, have alleged that the
wounds observed in  the bodies of  their victims were of accidental origin, and
the allegations have been clearly refuted by medical  evidence.  A witness must
be prepared, therefore, in all cases where  death has  taken place  in secrecy, and
the nature of  the wound is such as to render its  origin doubtful, to be closely
examined by counsel for a prisoner  charged with felonious homicide, as to whe-
ther the wound might not have been accidental. Our law requires that it should
be rendered evident to a jury, before such a charge can be sustained, that the
fatal wound could not have been accidental or suicidal.   Hence this preliminary
question  is deserving  of serious attention from a medical jurist.
  The death of  a party from wounds  has hitherto been considered as a subject
connected with a criminal charge; but an investigation of the circumstances under 
IMPUTED OR SELF-INFLICTED WOUNDS.
205
which  death ensues, is occasionally rendered necessary when the deceased has
effected an insurance upon his life.   A policy of life-insurance is in some cases
rendered void by the act of self-destruction; and therefore an individual bent on
suicide might, for the sake of his family, take precautions to conceal the manner
in which he intended to destroy himself.  His body might be found wounded
in a way which  would render  it uncertain whether he had been wounded acci-
dentally, whether he had been murdered, or  whether  he had fallen by his own
hand.   In a disputed case, it is incumbent on the office to prove the act of sui-
cide (felo de se,) while the  relatives of the deceased would attempt to  show the
contrary.   Such litigation must, of course, call  forth a most deep and searching
investigation into all the circumstances connected  with the death of an insured
party, and the whole case would, in some instances at least, rest almost exclusively
on medical evidence.   (Med. Gaz. xxxvi.  826.)  Numerous cases have  of late
years occurred in England, which will illustrate the importance of attending to
the precise characters of wounds, and the circumstances under which the body of
a wounded person is found.  The following may serve as an illustration:—
   Wounds of the throat.   Suicide or homicide?—In the year 1837, the late
Mr. Docld, of Chichester, consulted me on the  following case:—He was called
to examine the body of a woman, who was found dead with her throat cut.   The
deceased,  when seen by him, was lying on her  back,  and the razor with which
the wound was inflicted, was found under the left shoulder.  On inquiry, it was
ascertained that when first  seen, she was lying on her face, and the body had
been turned round  on the back.  Blood had evidently run down the fore-part
of her person, rendering it  probable that  she had been wounded while in the
erect position.   The incision in the throat was deep, and extended obliquelytfrom
the right  side of the  chin to within about an inch of the left  collar-bone.  It
had divided the wind-pipe, the gullet, all the muscles of that side of the fore-part
of the neck,—the carotid artery, jugular vein,  and the muscles on  the fore-part
of the spine, penetrating even  into the bodies of the cervical vertebra.   The in-
cision was double,—one superficial,  close under  the  chin, and the other, the
deeper one, appeared to be continued from this.   The  deepest part of the right
end of the incision was nearly three inches in a direct line behind the right angle
of the wound, so that it extended at  that  part  behind and beneath the  sound
skin.   The cut was four and a half inches long, and two and a half deep.   The
main question was,  whether this could have  been a suicidal wound, inflicted by
a razor, the only weapon found near  the body.  Considering its characters, Mr.
Dodd inferred that it must have been inflicted by another person, and not  by the
deceased upon herself.  The deceased was right-handed, which would have added
to the difficulty  of supposing the wound to have been suicidal.  The inference
drawn was precisely that which the medical circumstances appear to me to justify.
   Imputed or self-inflicted wounds.—The question whether a wound was or was
not self-inflicted, may refer  to the living as well as to the dead.   Thus  a man
may produce wounds upon himself for the purpose of simulating a homicidal as-
sault, which, for  various motives, he may allege to have been committed upon
him.  AArith the motives for the self-infliction of wounds, a medical jurist is not
concerned,—it is of the fact only that he can take cognizance.   From the cases
that have  yet occurred, it would appear that the object has been to extort money,
to conceal murder, robbery, or some other crime, and to turn away suspicion
from the wounded party.   One of the most remarkable cases of this kind which
have occurred in England, was that of Bolam,  who was tried for the murder of
a man named Millie at the Newcastle Autumn Assizes, 1839.   It is impossible
to enter into all  the particulars of this singular  trial; but it may suffice to state,
that the prisoner Bolam was found lying in an apartment, which had been fired
by himself or some incendiary, and near him  was the body of the deceased, who
had evidently been killed by violence,—the skull having been  extensively frac-
tured  by a poker lying near.  The prisoner, when  found, was either insensible 
206
CHARACTERS OF SELF-INFLICTED WOUNDS.
  or pretended to be so.  He stated that he had been suddenly attacked by a man,
  and knocked down by a blow on the right temple.   After attempting to escape,
  he was again knocked down.   He then felt a knife at  his throat, but admitted
  that he did not put  up his hands to protect it.   His hands were not cut.  He
  said he remembered receiving some blows on his body, but he became insensible,
  and recollected nothing more.   On examining his throat, there was a wound an
  inch and a half in length on the left side of the neck, a quarter of an inch below
  the jaw.  It  had penetrated  merely through the true  skin, and was of  incon-
  siderable extent.  A small quantity of blood, which had flowed down on the in-
  side of his cravat, had escaped from this.   There were many cuts on his coat at
  the back and sides, through his waistcoat, shirt, and flannel shirt; but there were
  no corresponding  cuts or stabs, nor, indeed, any mark of injury upon the skin.
  The question was, whether these wounds had  been inflicted by the unknown
  person who was alleged to have fired the premises and murdered the deceased,
  or whether the prisoner  had inflicted them  on himself,  in order to divert atten-
  tion and conceal the crime which he was accused of having committed.   No mo-
  tive for  the imputed crime was discovered,  and he  had borne a very good cha-
  racter; but nevertheless, the medical facts relative to the probable self-infliction
  of the wounds were so strong, that he was convicted of  manslaughter.   There
  can hardly be a medical doubt that the prisoner produced the wounds upon him-
  self, in order  to remove any suspicion that he had caused the death of the de-
  ceased.   They were superficial, involved no important organs, and bore  the cha-
k  racters which those wounds only would have, that had not been produced with a
  suicidal intention.
    Soon  after Bolam's case,  one somewhat  similar occurred in this  metropolis.
  The steward of a club-house was found one morning in bed wounded,  and the
  cash-box of the club was missing.  Circumstances led the police to suspect that
  no one  could have broken into the house;  but the man himself was considered
  so trustworthy, that no suspicion was entertained of his having been concerned
  in the robbery.   The surgeon who examined him found the wounds on his per-
  son of a very trivial character, and there was but little doubt, from what  subse-
  quently transpired, that he had produced  them on himself for the purpose of
  averting suspicion.
    It is not always easy to trace the motive for the production of these injuries;
  and when a reasonable motive is not  immediately discovered, persons  are very
  apt to be misled and to credit the story.  Individuals who have been convicted
  of thus imputing violence to others have frequently borne a respectable character
  until the occurrence, and this has contributed to disarm suspicion.  When a per-
  son intending to commit suicide fails in the attempt, he has sometimes,  under a
  sense of shame, attributed the infliction of a wound in his throat to another; but
  facts of this kind may be without difficulty cleared up by circumstantial evidence.
  Imputed wounds, if we except the case of an attempt at suicide, where'the injury
  is commonly severe, are generally of a superficial character,—consisting of cuts
  or incisions not extending below the cutis:—deep stabs are seldom  resorted to
  where the purpose is not suicide, but merely to conceal other crimes.  Further,
  these wounds are  in front of the person,  and may be on the right or left side,
  according to whether the person be right or left-handed.   They have also been
  generally numerous, and scattered wide apart: sometimes  they have had a com-
  plete parallelism, unlike those which must have  been inflicted by an adversary
  during a mortal conflict with a weapon.  The hands are seldom wounded, although
  in the resistance to  real homicidal attempts these parts  commonly  suffer most
  severely.  The  injuries are not usually situated over those parts of the  body in
  which wounds  are by common repute  considered mortal, and there is in general
  an entire want of correspondence between' the situation of the wounds on the per-
  son, and the cuts or other marks on the dress.   This is an important fact  which
  requires the attention of the practitioner.   In an interesting case which  occurred 
CHARACTERS OF SELF-INFLICTED WOUNDS.
207
to Marc, a young man alleged that he had received a sword-cut in the forehead
from some assassins who  had escaped.   He was allowed to  relate the whole of
the  particulars, and they formed  a very romantic and  improbable  story.   He
stated that he wore at the time a handkerchief round his head, a cotton cap, and
a common cap with an elastic front, which he  alleged had  been cut through.
There was a longitudinal  wound, quite superficial, and about an inch  long, at the
upper and right part of the frontal bone, passing downwards from left to right.
The cut in the felt of the cap, which was very soft, passed obliquely from right
to left, and was about three  inches in length.   The cut was not so clean or regular
as if it had been produced by a sword:  there was very little blood upon the cap,
and only on the edge of the incision.  The silk  handkerchief was cut out in  an
irregular manner.  When the party was requested to  place  the  cap and other
articles upon his head in  the position in which they were when he was attacked,
it was found to be utterly impossible to adjust them,—the incisions could not be
made to correspond, and the cap could not be worn over the folded handkerchief.
This rendered it certain that the wound had not been  inflicted in the manner
described.   Besides, a blow of a sword which would have  divided the felt and
silk handkerchief, would  at the same time have produced a much deeper wound
on the forehead than that which was found.  Another instructive case is reported
by Dr. Bayard, in which the falsehood of a charge was demonstrated by the want
of correspondence between the cuts in the clothes and those found on the person.
(Ann. d'Hyg. 1847, ii. 222.)
  It has been contended  that no rules can be laid down for the detection of such
cases: each  must be decided by the facts which accompany it.  Nevertheless, the
details of the cases above mentioned will serve to direct the inquiries  of the prac-
titioner.
  The facts which he must endeavour to ascertain are the following:—1. The
relative positions of the assailant and the assailed person at the time of the alleged
attack.   2.  The situation,  direction, and depfih of the wound or wounds.  3.
The situation or direction of marks of blood or wounds on the person or dress of
either, or of both, the assailant and assailed.  4. The  marks of blood, and the
quantity effused at the spot where the mortal struggle is alleged  to  have taken
place.
  The importance of these  inquiries cannot be  over-estimated.  A strong sus-
picion was raised against the late  Duke of Cumberland, in the year 1810, in re-
ference to the death of Sellis, when a proper examination  of the wounds would
probably have shown that they could not have been self-inflicted.
  It is worthy of remark, that imputed wounds are generally cuts or stabs.   They
are seldom of the contused  kind:  the impostor cannot, in reference to contusions,
so easily calculate upon the amount of mischief which is likely to ensue.
  Pistol-shot wounds are sometimes voluntarily inflicted for the purpose of im-
puting murder or extorting  charity.  A man  intending  to  commit suicide by
fire-arms, and failing in the attempt, may, out of shame, in order to conceal his
act, attribute the wound  to the hand of some assassin.   In examining such im-
puted wounds, they will not be found (except in cases of attempted suicide) to
involve vital parts; and they will possess all the characters of near-wounds pro-
duced by gunpowder, wadding, or a  bullet.   (See  Gun-shot Wounds.)  The
skin around will be extensively lacerated and bruised:  there will be much ecchy-
mosis, and the hand holding the weapon, as well as the  dress and the wounded
skin, may be blackened or burnt  by the exploded gunpowder.   A pistol-shot
wound from an assassin may be produced from a distance, while  an imputed
wound which is produced  by a person on himself must always partake of the
characters of a near-wound.  If the weapon have been charged with gun-cotton,
there will be no marks of blackening on the person or  dress, but there may be
marks of burning. 
208
THE CAUSE OF DEATH IN WOUNDS.
                            CHAPTER XXVI.

THE CAUSE OF DEATH IN WOUNDS.—CAUTION ON ASSIGNING TOO MANY CAUSES—WOUNDS
  DIRECTLY OR INDIRECTLY FATAL—DEATH FROM HEMORRHAGE—LOSS  OF BLOOD REQUIRED
  TO PROVE FATAL—MODIFIED BY AGE AND OTHER CIRCUMSTANCES—FATAL WOUNDS OF
  SMALL ARTERIES--INTERNAL HEMORRHAGE--DEATH FROM MECHANICAL INJURY TO A VITAL
  ORGAN--DEATH FROM SHOCK--BLOWS ON THE ABDOMEN--FLAGELLATION--DEATH FROM A
  MULTIPLICITY OF INJURIES WITHOUT ANY MORTAL WOUND—SUBTLE DISTINCTIONS RESPECT-
  ING THE MORTALITY OF WOUNDS.

   Cause of death.—It is important for a medical witness to bear in mind that
in all cases of wounds criminally inflicted, the cause of death must be certain.
No man is ever convicted upon mere medical probability.  In general, there  is
only one real cause of death, although other circumstances may have assisted in
bringing about a fatal result.   Thus a person cannot die of disease in the bowels
and a stab in the chest  at the same time, nor of apoplexy from disease and com-
pression of the spinal marrow at the same instant.   Hence it is our duty,  when
several apparent causes for death exist, to determine which was the real cause;
and in stating it  to the Court, to be prepared to offer our reasons for this opinion.
In most cases of local injury, when a person dies speedily, there will be no great
trouble  in settling whether disease  or the  injury was  the  cause.   A difficulty
may, however, exist when a person has recovered from the first effects of a wound,
and has subsequently died.   Besides,  there may be cases in which the cause of
death, in spite of the most careful deliberation,  will be still  obscure; or some-
times it may happen that the death of a party appears to be as much dependent
on bodily disease as on an injury proved to  have been received at the  time he
was labouring under disease.   How is an opinion to be  expressed in such a case?
The course which I apprehend a medical witness ought to pursue, provided he
has duly deliberated on the circumstances  before  he appears  in Court, and his
mind is equally balanced between  the two causes, is to state at once his doubt to
the jury without  circumlocution, and not allow it  to be extracted from him in
cross-examination.   It  is the hesitating to assign a satisfactory cause, or the as-
signing of many  causes for death, that gives such advantage to a prisoner's case,
even when the general evidence  is entirely against him.  Occasionally  many
causes of death  are assigned by a witness, among which some have a tendency
to exculpate and  others to inculpate the prisoner in a greater  or less degree, and
it is left to the jury to select from the number one upon which to found a ver-
dict!   In a case  of this kind an acquittal is commonly  obtained.
   Wounds  directly or indirectly fatal.—A wound may cause death  either di-
rectly or indirectly.   A wound operates as  a direct cause of death when the per-
son dies immediately, or very soon after its infliction; and there is no other cause
internally or externally, to account for death.  In wounds which cause death in-
directly, it is assumed that the deceased survives  for a certain period, and that
the wound  is followed by inflammation, suppuration,  gangrene, tetanus, erysi-
pelas, or some other mortal disease, which is a direct and not  an unusual conse-
quence  of the injury.   Under this  head  may be  also  arranged all those cases
which prove fatal by reason of surgical operations rendered imperatively  neces-
sary for the treatment of the injury,—presuming that these operations have been
performed with ordinary skill and care.   We shall for  the present consider only
the direct causes of death in cases of wounds.   These are three in number:—1
Hemorrhage.   2. Great mechanical injury done  to an organ important to life.
3.  Shock, or concussion, whereby the functions of one or more vital  organs are
arrested, sometimes with  but very slight  injury to the  part struck  or wounded. 
DEATH FROM HEMORRHAGE.
209
from either of these  causes, a wounded person may die either  immediately or
within a very few minutes.
  1. Death from hemorrhage.—Loss of blood operates by producing fatal syncope.
A quantity of blood, however insufficient to cause syncope, may readily destroy
life by disturbing the functions of the organ or part into which it is effused.  Thus
a small quantity poured out in or upon  the  substance of the brain, may kill by
inducing fatal compression; and again, if in a  case of wounded throat,  blood
should flow into the trachea, it may cause death by asphyxia—i. e. by stopping
the respiratory process.   In both of these cases it is obvious that the blood acts
mechanically; and in respect to the last, a medical man may,  unless circumspec-
tion be used, involve himself in  a charge of malapraxis.  If he allow the wound
to remain open, the wounded person may die through hemorrhage,—if he close
it too soon, he may die through  suffocation; and, in  either case,  the counsel for
the prisoner will not fail  to  take advantage  of  a  plausible objection of this
kind.  In wounds of  the chest,  involving the heart and lungs, death is very fre-
quently due not so much to the  actual quantity of blood effused, as to the pres-
sure which it produces upon these organs.  A  few ounces effused in  the bag of
the pericardium  will entirely arrest the action of the heart.
  The absolute quantity  of blood required to be lost in order to prove fatal must
of course vary according to numerous circumstances.  The young,  the aged—they
who are labouring under infirmity or disease, will perish  sooner from hemor-
rhage than others who are  healthy and vigorous.   Females, cseteris paribus, are
more speedily destroyed  by hemorrhage than  males.  Infants are liable  to die
from hemorrhage resulting from  very slight wounds.   An infant has been known
to bleed to death from the bite of a single leech, or from the simple operation of
lancing the gums.   Even the healthy and vigorous, when their vital powers have
been depressed  by maltreatment or by  brutal violence, will sink under the loss
of a comparatively small  quantity of blood.  (See Watson on Homicide, p. 90.)
A medical jurist must not forget that some individuals have a predisposition to
hemorrhage; and this condition  is often hereditary.  The slightest wound  of
puncture,—the bite of a leech  or the extraction of a tooth, will be attended with
an  effusion of blood which cannot be  arrested, and which will slowly lead  to
death by exhaustion.  Cases have been  frequently recorded in our medical jour-
nals of fatal hemorrhage  following the extraction of  teeth, when there had been
previously nothing to indicate  the probable occurrence of death from so trivial a
cause.   (For striking instances of this remarkable tendency to hemorrhage in a
family, see Brit, and For. Med. Rev. xvii. 247; also  Med. Gaz. May, 1842.)  In
the thirty-ninth volume of the latter journal, p. 86, a case is reported by Mr.
Druitt, in which a very unusual  degree of hemorrhage followed a  compound frac-
ture of the leg.   Such cases are  without difficulty detected, since a surgeon may
always infer from the part injured and the extent of the injury, whether the he-
morrhage is likely  to be copious  or not.   When a  person bleeds to death from
what would, under common circumstances, be a simple wound, the admission of
this fact may in certain cases lessen the  responsibility of an accused party.
  [For a  large  number of American and other cases of this kind, see Beck's
Med. Jur. ii. 295, 296, 297.—H.]
  A sudden loss of blood has a much more serious influence than the same  quan-
tity lost slowly.  A person may  fall into a mortal syncope from a quantity of
blood lost in a few seconds, which he would have been able to bear without sink-
ing had it escaped slowly.  This is the reason why the wound  of an artery proves
so much more  rapidly fatal than  that  of a vein.  Death speedily follows the
wound of a large artery like the  carotid; but it takes place with equal certainty,
although more slowly, from wounds of smaller arteries.   In a case where one of
the  intercostal arteries was  wounded by a small shot, hemorrhage caused  death
in thirty-eight hours.  The hemorrhage  which  follows the division of the smaller
branches of the  external  carotid, is often sufficient to destroy life unless timely
       14 
210            WOUNDS PRODUCING INTERNAL HEMORRHAGE.

assistance be rendered.  A case was tried at the Berkshire Spring Assizes, 1832,
in which it was proved that the prisoner had killed his wife by stabbing her in
the leg:  the anterior tibial artery was  divided, and she died from hemorrhage
half an hour afterwards.   Wounds of arteries, even smaller than these, might in
some subjects prove fatal, if no assistance were at hand. Mr. Watson mentions a
case where the internal mammary artery on the left side was divided by a stab in
the chest. The woman died on the ninth day, and four pounds of blood were found
effused on that side.   In another case, where an intercostal artery was divided,
six pounds of blood were effused.  (Op. cit. 101.)  In both of these cases, as in
most wounds of the chest, the blood not only affected the system by its loss, but
by its compressing the lungs  and impeding respiration.  AArounds of large veins,
such as the  jugular, may, from the quantity of blood suddenly effused, speedily
destroy life.  If the wound be in a very vascular part,  although no vessel of any
importance be divided, the person may die from hemorrhage.  It is difficult to say
what quantity of blood should be lost in order that a wound may prove fatal by
hemorrhage.  The whole quantity contained in the body of an adult is calculated
at about  one fifth of its weight—i. e. about thirty pounds;  of this, one-fourth is
considered to be arterial, and the remaining three-fourths venous blood.  Accord-
ing to Mr. Watson, the loss of from five to eight pounds is sufficient to prove fatal
in adults.   But while this may be near the truth, many persons will die from
a much smaller quantity; the rapidity with which the effusion takes place having
a  very considerable influence.   It has been found, by experiment,  that  a dog
cannot bear the loss of more blood than is equivalent  to one-twelfth  part of the
weight of its body.
   Interned  hemorrhage.—Hemorrhage may prove  fatal, although  the blood
does not escape from the body.  In incised wounds, the flow externally is commonly
abundant; but in punctured  and gun-shot wounds, the effusion may take place
internally, and rapidly cause  death.  In severe  contusions or contused wounds,
involving highly vascular parts, the effusion may go on to an extent to prove fatal,
either in the cavities of the body or throughout the cellular membrane and parts
adjacent.  Many pounds of blood may in this way  become slowly or rapidly
extravasated.  The means of ascertaining whether a person has died  from he-
morrhage are these:—Unless the wound be  situated in a very vascular part, we
shall find the vessel or vessels from which the  blood  has issued divided,—the
neighbouring vessels empty, and the body more or lessj)allid; although this last
condition is of course liable to be met with in certain cases of disease, as also under
copious venesection,—points easily determined by an  examination.  The blood
will commonly be found more or less clotted  or coagulated on those surfaces on
which it has fallen. If, with these signs, there is an absence of disease likely to prove
rapidly fatal, and no other probable cause of death be apparent, it may be fairly
referred to hemorrhage.  This opinion may, however, be materially modified by
the fact of the body not being seen on the spot where the  fatal wound was actu-
ally inflicted,—by the wound having been  sponged,—the blood removed by
washing, and all traces of hemorrhage destroyed.  Under these circumstances,
the case  must in a great measure be made out by presumptive proof:  and here
a medical witness may have an important duty thrown upon him, namely, that
of examining articles of dress or furniture for marks or stains of blood.
   It must  not be supposed that all the blood met with around a wounded dead
body was actually effused during life.  As soon as the heart's action ceases, the
arteries pour out no more; but the blood, so long as it remains liquid, i.  e. from
four to eight or ten hours, and the warmth of the body is retained, continues to
drain from the divided veins  and smaller vessels.  The quantity thus lost, how-
ever^ is not very considerable, unless the veins implicated be large.  A question
relative to the degree of this post-mortem hemorrhage has very frequently been
put in a  Court of law.
   II. Death from  great  mechanical injury done to a vital organ.—AAre have 
         WOUNDS.   SHOCK FROM MANY INJURIES.  FLAGELLATION.      211

instances of this becoming a direct cause of death in the crushing of the heart,
lungs or brain, by any heavy body passing over or falling on the cavities.  This
severe mechanical injury is sometimes accompanied by a considerable effusion of
blood, so that the person really dies from hemorrhage; but in  other instances
the quantity of blood lost is inconsiderable, and the fatal effect may be referred to
shock.
   III. Death from shock.—This is sometimes a direct cause of death under the
infliction of external violence; and in this case life  is destroyed without the in-
jury being to all appearance sufficient  to  account for so speedily fatal a result.
There is no medical doubt that a person may die from what is termed shock, without
any marks of severe injury being discovered after death.   AAre  have examples of
this mode of death in accidents from lightning, or from severe burns or scalds, in
which the local injury is often far from sufficient to explain the rapidly fatal con-
sequences.  As instances of this form  of death  from violence  may be also cited
those cases in which a person has been suddenly killed by a blow upon the upper
part of  the abdomen or epigastrium, which is supposed to operate by producing
a  fatal impression on the cardiac plexus.   Whether this be or be not the true
explanation, the fact itself is undisputed;  it is certain that a person may die from
so simple a cause without any appearance being produced externally or internally
to account for death.   On the  skin, there may be some  marks of abrasion or
ecchymosis;  but, as it has been elsewhere stated, these are neither constant nor
necessary accompaniments of a blow.  An account of the post-mortem appearances
in a case  of this kind,  by Mr. AVood, will be found in the Med. Gaz. vol. xliv. p.
213.   Convictions for manslaughter have taken place, where death has been pro-
duced under these circumstances.  Concussion of the brain,  unattended by
mechanical lesion, is another example  of  this kind of death.   A man receives a
severe blow on the head;  he falls dead on  the  spot, or becomes senseless  and
dies in  a few hours.   On inspection there may  be merely the mark of a bruise
 on the scalp; in  the brain, there may be no rupture of vessels or laceration of
 structure, and all the organs of  the body are found healthy.   Thus, then, there
 may  be no sign of a mortal injury; and there is apparently no cause  to account
 for death.  This can only be referred to the shock or violent  impression which
 the nervous system has sustained from the blow,—an impression which the vital
powers are wholly unable to counteract or resist.  A medical witness must give
 his evidence with caution in such cases, since it is the custom to rely in the de-
 fence upon the absence of any visible mortal  wound to account for death,—a
 principle which, if  once unrestrictedly admitted as correct, would leave a large
 number of deaths, undoubtedly occurring from violence, wholly unexplained.  A
 trial  took place at the  Liverpool Autumn Assizes, 1837, wherein several persons
 were charged with manslaughter of the deceased, by kicking him  behind the
 right ear.   The medical witness deposed that there was in this spot the mark of
 a severe contusion,  but there was no injury whatever to the brain, and the body
 was otherwise healthy.  He very properly ascribed  death to  the violent shock
 given to the nervous system, and the Court admitted that the cause of death
 was satisfactorily made out.  The party who  inflicted the wound was convicted.
   There is another form of shock which is of some importance in medical juris-
prudence.  A person  may have received many injuries, as by blows or  stripes,
 not one of which, taken  alone, could, in medical language, be termed mortal;
and yet he may die directly from the  effects of  the violence, either on the  spot
or very soon afterwards.  Death is commonly referred to exhaustion, but this is
only  another mode of expression; the exhaustion is itself dependent on a fatal
influence or  impression produced on the  nervous system.  A prize-fighter after
having, during many rounds, sustained numerous blows on the body, may, either
at or after the fight, sink and die exhausted.  His  body may present marks of
bruises, or even lacerated wounds, but there may be no  internal changes to ac-
count for death.  In common language,  there is not a single injury which can
be termed mortal;  and yet, supposing him to have had good  health previously 
212
DEATH FROM A MULTIPLICITY OF INJURIES.
to the fight, and that all marks of disease indicative of sudden death arc absent,
it is impossible to do otherwise than  refer his death to the direct effect of the
violence.  A case of a somewhat  similar kind, we have  in the military punish-
ment of flagellation, which is occasionally followed  by death, either as a direct
consequence of shock, or from indirect causes, such as inflammation and its con-
sequences.  In a case which occurred at Hounslow (July, 1846,) it was considered
that the inflammation of the heart and pleura, of which the man had died, had
arisen from the disorganized condition of the back, produced by flogging.
   It is a well-ascertained medical fact, that a multiplicity of injuries, each com-
paratively slight, are as capable of operating fatally as any single wound,  whereby
some blood-vessel or organ important  to life is directly affected.  Age, sex, con-
stitution,  and the previous  state of health or disease, may accelerate or retard
the fatal consequences.   In the case of Governor Wall, the judge told the jury
that the long  continuance and severity of  pain (in flagellation) may be produc-
tive of as fatal consequences, as if instruments or weapons of a destructive kind
were used.   On a trial for murder, which took  place in Germany a few years
since, it was proved that the deceased  had been attacked with sticks, and that he
had been afterwards flogged on the back with willow-switches.  He died  in about
an hour.  On inspection, there was no mortal wound, nor  any lesion to a vital
organ; there were simply the marks of lacerations and bruises on  the skin, ap-
parently not sufficient to account  for death; but this was nevertheless very pro-
perly referred to the violence.  (Henke, Zeitschrift der S. A. 1836.) The case
of the Duchess of Praslin, who was murdered by her husband in Paris in August,
1847, furnishes  an additional proof of the fatal effects produced by numerous
injuries.   On an inspection of the body, it was found that on the head, neck,
and both of the hands, there were no fewer  than thirty distinct wounds, some
contused, and others incised and punctured. There were also the  marks of many
bruises, and the impressions produced by the nails of the murderer's hand over
the mouth.   For the  most part, these injuries were slight, and not  one could be
said to be necessarily mortal.  The most serious wound was situated on the right
side of the neck; but even here the carotid artery and internal jugular vein had
escaped injury.  Death was referred to the hemorrhage which had taken place
from the numerous wounds during the struggle with the assassin.  (Ann. d'Hyg.
1847, ii. 377.)  From these considerations, it  is obviously absurd to expect that
in every case of death from violence or maltreatment, there must be some specific
and well defined mortal lesion to account for that event. When the circumstances
accompanying death are unknown, a medical opinion should always be expressed
with caution;  but if we are  informed that the deceased was in ordinary health
and vigour previous to the infliction of the violence, and there is no morbid cause
to account for his sudden illness  and  death, there is no reason why we should
hesitate in  referring death to the effects of a multiplicity of injuries.  Among
non-professional persons, a strong prejudice exists that no person can  die from
violence unless there be some distinct  mortal injury actually inflicted on his per-
son.  By  this we are  to understand a visible mechanical injury to some  organ or
blood-vessel important to life;  but this is obviously a very erroneous notion, since
death may take place from the disturbance of the functions  of an organ without
this being necessarily accompanied by a perceptible alteration of structure. The
prevalence of this popular error often leads, to a severe cross-examination  of medi-
cal witnesses.  Among the questions  put, we sometimes find  the  following:—
Would you  have said, from the wounds or bruises alone, that  they were likely
to have occasioned death ?  Now, in answer to this, it may be observed, that we
cannot always judge of the probability of death ensuing from the appearance of
external violence alone.  Because these appearances were slight, it would be wrong
to infer  in every case that they were  not sufficient to cause death.  A man may
die from a blow on the epigastrium, and  how can this fact be determined by an
examination of the body? Then it may be  inquired, Were the wounds or bruises
mortal?  In the vulgar sense of the word,  i. e. by producing severe hemorrhage 
             WOUNDS ABSOLUTELY AND CONDITIONALLY MORTAL.         213

 or a destruction of parts, they might not be so; but in a professional view, they
 may have  acted  mortally by producing a shock to the nervous system.  Or  it
 may be inquired, which of the several wounds or  bruises found on the body of
 the deceased was mortal?  The answer to which may be: Not one individually,
 but all contributed to occasion death by exhaustion.
   It must likewise be remembered, that in all cases where a person has sustained
 a number of injuries, the loss of a much smaller quantity of blood than in other
 instances, will suffice to destroy life.  It is sometimes a very difficult question to
 decide on the relative  degree  of mortality of wounds, and  on the share which
 they have had respectively in causing death.   By a wound being  of itself mortal,
 we are to understand that it is capable of causing death directly  or indirectly, in
 spite of the best medical assistance.   It is presumed that the body is healthy, and
 that no cause has intervened to bring about or even accelerate a fatal result.
 The circumstance of a person labouring  under disease when wounded in a vital
 part, will not, of course, throw any doubt upon the fact of  such a wound being
 necessarily mortal, and of its having caused  death.  If there  should be more
 wounds than one, it is easy to say, from the nature of the parts  involved, which
 was likely to have led to a fatal  result.  In order to determine,  on medical
 grounds, whether a wound was or was not mortal, we may propose to ourselves
 this question: AVould the deceased have been likely to die at the same time, and
 under the same circumstances, had he not  received the wound?   There can ob-
 viously be no general rule for determining the mortal nature of wounds.   Each
 case must be judged by the circumstances which attend it.   In some parts of the
 Continent, the law requires that a medical witness should draw a distinction be-
 tween a wound which is absolutely and one which is conditionally mortal.   An
 absolutely mortal wound is defined to be that where, the best medical assistance
 being at hand, being sent for, or actually rendered, the fatal event could not be
 averted.   AVounds of the heart, aorta, and internal carotid arteries, are of this
 nature.   A conditionally mortal wound is one where, had medical assistance been
 at hand, been sent for, or timely rendered, the patient would, in all probabihty,
 have recovered.   AVounds of the brachial, radial, and ulnar arteries may be taken
 as instances.  The  responsibility of the  assailant  is made to vary according to
 which of these classes the wound may be referred by the medical  witnesses; and,
 as it is easy to suppose,  there is seldom any agreement on the subject.   Our
 criminal law is entirely free from such subtleties.   The effect of  the wound, and
 the intent with which it  was inflicted, are looked to: its anatomical relations,
 which must depend on pure accident, are never  interpreted in the prisoner's fa-
 vour.  Some extenuation might, perhaps, be occasionally admitted when a wound
 proves mortal through an indirect cause, as inflammation or fever, and medical
 advice  was obtainable,  but not obtained until every hope of recovery had disap-
 peared.  It would appear, however, from the case  of The Queen v. Tlwmas and
 others  (Gloucester Aut. Ass. 1841,) that the mere neglect to call in medical as-
 sistance is not allowed to be a mitigatory circumstance in the event of death en-
 suing.   The deceased died from the effects of a severe injury to the head inflicted
 by the prisoners, but had had no medical assistance.  The judge  said it was pos-
 sible that "if he had had medical advice, he might not have died; but whoever
 did a wrongful act must take the whole consequences of it.  It never could make
 any difference whether the party injured  had or had not  the means or the mind
 to apply for medical advice."   The prisoners were convicted.   According to Lord
 Hale, if a  man be wounded, and the wound,  although not in itself mortal, turn
 to a gangrene or fever  for want of proper applications, or from neglect, and the
man die of gangrene or fever, this is homicide in the aggressor; for though the
fever or gangrene be the immediate cause  of death, yet the wound being  the
cause of the gangrene or fever, is held the cause of death, causa causati.  These
nice questions relative  to  the shades of responsibility for personal injuries, oc-
casionally arise in those cases where individuals have been  wounded at sea en
board of a ship in which there was no surgeon. 
214                   EXAMINATION OF BLOOD-STAINS.
                            CHAPTER XXVII.

CHEMICAL EXAMINATION OF BLOOD-STAINS—ACTION OF THE TESTS  ON ORGANIC AND INOR-
  GANIC RED COLOURING MATTERS--STAINS OF BLOOD ON LINEN AND OTHER STUFFS—DATE
  OF THE STAINS--EVIDENCE FROM THE DETECTION OF FIBRIN—INSOLUBLE  STAINS RE-
  SEMBLING BLOOD--RED PAINT MISTAKEN FOR BLOOD--SOLUBLE STAINS OF FRUITS, FLOW-
  ERS, ROOTS, AND EXTRACTS—REMOVAL OF BLOOD-STAINS FROM ARTICLES OF CLOTHING—
  STAINS OF BLOOD ON WEAPONS--CITRATE  OF IRON MISTAKEN FOR BLOOD--DISTINCTION
  OF STAINS FROM IRON-RUST--COLOUR FROM RED DYES--BLOOD OF MAN AND ANIMALS—
  EVIDENCE FROM THE ODOUR--MICROSCOPICAL EVIDENCE--FORM  AND SIZE OF THE  RED
  GLOBULES IN MAMMALIA AND OTHER CLASSES.

  Examination of blood-stains.—It might appear at first sight a very easy matter
to say whether certain suspected spots  or stains on articles of clothing, furniture,
or weapons, were or were not due to  blood;  but in practice, great difficulty is
often experienced in answering the question.  If the stains be recent, most per-
sons may be competent to form an opinion; but the physical characters of blood
are soon changed, even when the stuff is white  and otherwise favourable to an
examination.   Again, when the  stains, whether recent or of old standing, are
upon dark-dyed woollen stuffs, as blue, black, or brown cloth, or when they ap-
pear in the form of detached spots or thin films on a rusty weapon, no one but a
professional man should be allowed to give an opinion.  It is, however, by no
means unusual to find questions put to policemen respecting the nature  of sus-
pected stains!—a practice obviously unjust to the accused, and fraught with con-
siderable danger.
   Chemical analysis.—There is  no direct chemical process by which blood  can
be  identified,  but we  presumptively  establish  its  nature  by determining  the
presence and properties of the red colouring matter or hcvmatosine.  The micro-
scope may be most usefully employed  in these medico-legal investigations, when
chemistry fails to aid the practitioner;  the value of this branch of evidence will
be presently considered.   The chemical properties of the red colouring matter of
blood are as follow:—1.  The colouring matter of blood readily  combines with
distilled xcater, forming, if recent, a rich red solution.  2. The red colour of this
solution is neither turned of a crimson nor of a  green tint by a few drops of a
solution of ammonia: if the ammonia be very concentrated, or added in large
quantity, the red liquid acquires a brownish tint.   3.  The liquid  when boiled is
coagulated,—the red colour is entirely destroyed, and a muddy brown flocculent
precipitate  is formed,—the  quantity of which will depend on the quantity of
colouring matter and albumen present.  4.  The  coagulum  produced by boiling,
when collected  on a filter and dried, forms a black resinous-looking mass, quite
insoluble in water, but readily soluble in boiling caustic potash, forming a green-
coloured solution.  This is not an important criterion.  5. To the above tests
some have united the action of strong  nitric acid, which coagulates the  red co-
louring matter, turning it of a dirty brown hue.   M. Boutigny has  suggested
the application of these tests, by taking advantage of the spheroidal state of li-
quids on red-hot metals (Ann. d'Hyg. 1844, ii.  217.)   Such are the chemical
properties of blood, whether derived  from  the body of man, or  from any red-
blooded animal.
   Objections to the  tests.—It will now be proper to mention the action of the
tests upon other red colouring matters, extracted from the animal or vegetable
kingdom.  Some of these are turned green by ammonia, as  the colouring matter
of the rose,—others crimson, as the red colouring matters of cochineal logwood,
and lac.  None of these red colours are coagulated or destroyed by boiling.  In
these respects, therefore, the colouring matter of the blood is eminently distin- 
BLOOD-STAINED LINEN.  ANALYSIS.
215
guished from them.   M. Raspail has  objected that a mixture of madder and
albumen possesses all the characters assigned to blood.  Having for some years
past performed numerous experiments on this subject, by making artificial mix-
tures of human serum or animal  albumen, with the red colouring matters of
cochineal, lac, and madder, and neutralizing the effects of the alkali contained in
the serum by the addition of a small quantity of acetic acid, I feel justified in
stating that in no respect whatever, except in regard to colour, can such mixtures
be confounded with  blood.   The objection is, therefore, more theoretical than
practical.  These red liquids may easily deceive those who trust to a red colour
alone; and  herein we see the absolute necessity for placing the investigation of
such subjects in the  hands of professional persons only.   It may be observed of
all such artificial mixtures, that they are changed by ammonia  to a crimson or a
green tint (sometimes passing through a blue,) and that under no circumstances
is the red colour destroyed by boiling the solution in water.  The albumen of
serum, if in sufficient quantity, becomes coagulated,  but the coagulum still re-
tains the red colouring matter locked up within it.   In the case of blood, the
effect of heat is widely different.  Those vegetable  colouring principles which
are  not  affected by ammonia (kino and catechu) are readily known  by the ap-
plication of heat.  The colour is not coagulated and destroyed like the red colour
of blood.   (See Guy's Hosp. Reports, October, 1S51.)  It was  formerly sup-
posed by some chemists that the blood owed its colour to the presence  of sulpho-
cyanate of iron.   When this mineral compound is mixed with albumen or serum
in water, in a certain  proportion, the resemblance to  a solution of the colouring
matter of blood  is so great, that from appearance only, it would be impossible to
distinguish them.    The effects of  the application of heat are, however, widely
different.   A coagulum is formed in the albuminous  solution of the  sulphocya-
nate of iron, but the red colour is not destroyed by boiling.  It becomes only of
a somewhat lighter  tint.
   Stains of blood on linen and other stuffs.—Supposing the stuff to be white or
 nearly colourless,  the  spot of blood, if recent, is of  a deep red colour; but it
 becomes of  a reddish brown, or of a  deep brown by keeping.  The change of colour
 to a reddish brown I have found to take place in warm weather in less than twenty-
 four hours.  After  a period of five  or six days, it  is scarcely possible to determine
 the date of the stain even conjecturally.  In a large  stain of blood on linen, no
 change took place during a period  of five years:—it  had a  brown colour at the
 end of six weeks,  which it retained for the long period mentioned.  Indeed, it
 is extremely difficult in any case, after the lapse of  a week, to give  an opinion
 as to the actual date of a stain.  Upon coloured stuffs it is of  course impossible
 to trace  these physical changes in  stains of blood,—on red-dyed stuffs the stain
 of blood appears simply darker from the first, and in all cases the fibre of the
 stuff is more or less stiffened.  Attention should be paid to the side of the stuff,
 if an article of dress, which  has first received the stain: sometimes both sides
 (if it be an apron or a stocking)  are  stained.  The evidence derived from an
 observation of this kind may be occasionally of importance.
   Analysis.—In order to determine whether the stain be due to blood, we cut a
 slip of the stained part of the linen, and suspend it by a  thread in,a small test-
, tube containing a small quantity of distilled water.   After a few minutes, or a
 few seconds, should the stain be recent,  a red  liquid  will  be seen  falling in fine
 dark threads, and collecting at the bottom of the test-tube, giving a red colour
 to  the  lower stratum of water; and a dark  red-brown colour, if it be of old
 standing.   The separation may not take place in  less than an hour, if the
 stuff be" thick and  coarse, or not  readily pervious to water.  AVhen the  stain
 is  on silk  it is speedily  separated.  Several slips  of the stuff may be  thus
 successively treated, until a liquid, sufficiently deep in colour for testing, is pro-
 cured.   If the quantity of coloured liquid thus obtained be small, the supernatant
 clear water may be  carefully poured off;  but it is better to use a small tube and
 a small  quantity of  water.  The liquid may then be tried by weak ammonia, and 
216
ANALYSIS.  DETECTION OF FIBRIN.
by the application of heat.  If ammonia produce any effect upon the solution of
blood, it is simply to brighten, it,—this alkali never  changes the red colour to
green or crimson..  When the stain is of  old  standing, the solution in water is
more slowly obtained, and does not present the bright red colour of blood.   The
action of ammonia may also be obscure, although it never gives to the liquid a
green or crimson tint.  The action of heat is in such cases certain and effectual:
if the coloured  solution be in such small quantity that there is no  coagulum
obtained by heat, it is impossible to give a decided opinion, from the application
of chemical tests, that the stain is due to blood.   In May, 1838, a piece of linen
was  examined in which there were  two  faint spots of  blood, each about one
quarter of an inch in diameter.  A reddish-coloured liquid was procured, but no
coagulum could  be  obtained  on boiling.  In these  ambiguous cases we  must
resort to the use of the  microscope.  AVhen the quantity of blood effused is
moderately large, it may be easily  detected by  the  above process—even after
the lapse of a great length of time.   I have thus detected the blood of the human
subject,  and of the bullock, on cotton, linen, and flannel, after the lapse of three
years.  If the stuff be dyed, we should proceed to examine it in the same way.
Thus, then, in testing for blood,  we rely upon—1, the  ready solubility of the
hsematosine (or red colouring  matter) in water;  2, the negative action of ammo-
nia; and 3, the positive effect of heat in entirely coagulating and destroying the
red colouring matter.
   Objections.—It may, however, be objected, that red stains  closely resembling
blood are occasionally found on linen and other stuffs.  It is  to be remarked of
all such  stains, that they are  either entirely insoluble in cold water or they are
soluble.   If insoluble, they  cannot by any possibility be mistaken for blood.  It
is very true, that if the linen  or stuff which is stained with blood be heated to a
high temperature, the colouring matter may, by its having become coagulated,
be rendered  insoluble in  water:—but it  is not  probable that medical evidence
will be thus defeated, except by those who have  made a  profound study of the
difficulties of medical jurisprudence.  In the case of a body found wounded and
burnt, it would be proper to allow for such a  change, and the  chemical evidence
would fail.  If the blood-stain be mixed with  oil or grease, this will interfere
with the action of water.  If the stain be on a plaster-wall or on wood, we must
scrape or cut out a portion,  and digest it in a small quantity of water in a tube
or watch-glass.   It will be proper here to examine well,  in  the first instance, an
unstained portion of the plaster or wood.
   Detection of fibrin.—In  this process for examining blood-stains, it has not
been thought necessary to refer to the properties  of fibrin.  Fibrin forms about
l-500th part  of human blood:  it exists in the  blood of all warm-blooded animals:
the other animal  liquids  in  which it  is found are the chyle and lymph.   It is
the chief constituent of muscular fibre.  AArhen the blood is in sufficient quantity,
a pale film of fibrin may be  left upon the stained substance, after the  colouring
matter has been removed by digestion in water.   Small quantities of fibrin are
not easily identified by its chemical properties.  Animal fibrin so closely resem-
bles coagulated albumen and gluten, that  it cannot be  distinguished from  them
by chemical tests.  Hence, unless evidence  of the presence of red  colouring
matter be obtained, the presence, of fibrin cannot be relied on; and if this evi-
dence be obtained, the demonstration of its properties is  unnecessary;  for  there
is no red colouring  matter which,  under due  precautions, can be  mistaken  for
that  of blood.   Evidence on this  subject was tendered  in  the case of Reg. v.
Reed (York Winter Assizes,  1847,) but it was not well  received by the Court.
It has been supposed  that the  demonstration of the presence of fibrin in a blood-
stain would enable us to say whether the blood had been effused from the living
or dead body; but, admitting that the existence of fibrin  in a small  quantity of
dried blood upon an article of dress could be  indisputably established, the fact
would not enable us to give a  conclusive answer to the important question above 
INSOLUBLE STAINS.   SOLUBLE STAINS.
217
suggested.   If the quantity of blood examined be  comparatively great, and no
fibrin can be procured from it after complete digestion in cold water, it is probable
that this blood has not come from a living body, and that it is merely a mixture
of red colouring matter and serum, like that found  in the vessels of the dead
body after perfect  coagulation.   But the experimentalist must bear in mind that
small stains of blood will commonly leave  no perceptible traces of fibrin.  On
the other hand, if  fibrin were clearly obtained, it would be by no means proved
that the blood yielding it had issued from a living body.    Until the blood has
coagulated, it retains fibrin; and coagulation seldom commences in the dead body
until after the lapse of four hours;  although, if drawn, it speedily consolidates.
Hence the dress of a person sprinkled with blood  from  a recently dead body,
would yield all the characters of stains which had been produced by the effusion
of blood from a wound inflicted on the living  body.  (See, on the subject of
blood-stains, Ann.  d'Hyg. 1829, 267, 548; 1830, 433;  1831, 467; 1833, 226,
ii. 160;  1834, 205; 1835, ii. 349;  1839,  i. 219; 1840, i. 387; also  Henke's
Zeitschrift der S. A. 1844, ii. 273.   See also for a  full account of this subject,
Guy's Hosp. Reports, Oct. 1851.)
   Insoluble  stains.—Among what may be classed  as insoluble  stains are—1,
certain red dyes, as madder, which, when fixed by a mordant, is  not readily affected
by ammonia.  2.  Iron-moulds.   These are of a reddish-brown colour, sometimes
of a bright red,—they are quite insoluble in water, but are easily  dissolved by
diluted  muriatic acid, and on adding ferrocyanide of potassium to  the  muriatic
solution, the presence of iron will be at once apparent.   Care should be taken
that the muriatic  acid used  for  this purpose contains no iron.  The stained
article of dress should also be proved  to be  free from any iron-dye, or a blood-
stain might be erroneously pronounced to be due to iron.   Some years since, a
man was found drowned in the Seine, at Paris,  under suspicious circumstances.
The body had evidently lain a long time in  the water.  On examining  the shirt
of the deceased,  a  number of red-brown stains were observed on the collar and
body,—resulting, as it  was  supposed, from spots of blood, which  had become
changed by time. On a chemical examination, however, they were found to be iron-
moulds  produced by the corrosion of a steel-chain which the deceased had worn
round his neck!  3.  Red paint.   Stains made with red paint have been mistaken
for blood.  In March, 1840, a person was murdered at Islington.  An individual
was arrested on suspicion, and in his possession was found a  sack,  having upon
it many red stains, which were supposed to  be dried and coagulated blood.  They
were examined by  Professor Graham, who found that they had been caused by
red paint, containing peroxide of iron;  and the sack was proved to have been
worn as an apron by a youth who was an apprentice to a paper-stainer.  It had
been sent to the accused party a few days before, as a wrapper to a parcel.   The
accused was immediately discharged.  Stains of this kind may be easily known
by digesting them  in diluted muriatic acid,  and applying to the solution the tests
for iron. Like those produced by iron-moulds, they are perfectly insoluble in water,
and therefore cannot be confounded with blood-stains.   The  same  may be  said
of spots of the ammonio-nitrate of silver changed by light,  which I have known
to be mistaken for  old stains of blood.   The stuff on which  the spots  of blood
are found may be itself stained  with a red dye or colour, or it may be dyed with
iron: in this case it will be necessary to test by the same process a piece of the
coloured or stained portion,  in order to  furnish negative  evidence  that the  sus-
pected stains are due to  blood.   In  Spicers case (ante, p. 196,) an apron which
the prisoner wore was found with stains of blood upon it; but the greater part was
covered  with dark-red stains, which turned out  to be owing  to a  logwood dye
that the prisoner had used in his business.   (Med. Gaz. xxxvii. 013.)
   Soluble stains.—Among the soluble stains resembling those of blood are the
spots produced by  juices of the  mulberry, currant, and other  red fruits.  These
are commonly recognised by dropping on them a solution of ammonia, when the 
218
ATTEMPTS TO REMOVE BLOOD-STAINS.
spot is turned either of a bluish or olive-green or crimson colour.   This crimson
colour, in very diluted solutions, is sometimes only slowly developed on the ad-
dition of ammonia or potash.  A spot of blood thus treated undergoes no change
from the alkali.   Further, if a piece of the stained stuff be suspended in water,
the coloured liquid, if any be  obtained, is  easily known from blood by its ac-
quiring a green or crimson tint on the addition of ammonia, and by the red colour
not being coagulated or destroyed when the liquid is  boiled.  Independently of
the fruits mentioned, there are many vegetable juices that will produce  stains of
a red or red-brown colour, which might be  mistaken for blood.  In the follow-
ing case, the red petals of flowers gave rise to an error only removed by a proper
examination.  A farmer's lad was arrested upon a charge of murder.  The blue
blouse and trowsers which he wore had on them numerous brown and red stains
resembling blood, and apparently produced by the wiping of bloody fingers. The
stained articles were subjected to a chemical examination, and it was found that
the colour was caused by some vegetable juice.   The accused, when interrogated
on  the  subject, stated, that the day before  his  arrest he had  collected a large
quantity of red  poppies, which had become bruised by his trampling on them,
and that he had carried them home in his  blouse.   The apparently suspicious
circumstance was thus explained  away.  Bayard, Man. Prat, de Med. Leg. 271.
Several varieties of sonchus, according to this writer, produce stains which might
be mistaken for blood.
  In some red stuffs, the dye is often so bad, that water will dissolve out a por-
tion of the colour; but in this case the action of ammonia and heat will serve rea-
dily to distinguish the stains from blood.   If minute spots be scattered on articles
of furniture, these  may be  examined by cutting out the stained portions, and
treating them in the way just mentioned.  It is said that blood-stains, when mi-
nute  and scattered, are more readily recognised and identified by the light of a
candle than in the light of day.   I do not know that much reliance can be placed
on this statement.  The brown stains appear to acquire a redder tint.
  The soluble red or brown stains given by woods or roots,  such as Logwood,
Brazil-xvood, or Madder-root, are changed to a  crimson colour by ammonia.—
They also generally contain tannic acid, and acquire a  dark olive-green colour
W,hen a persalt of iron is added to the liquid.  Red-brown extracts, such as Kino
and Catechu, are not affected by ammonia;  but  the colour given to water is dif-
ferent from  that of blood, and the addition of  a persalt of  iron reveals the pre-
sence of tannic acid.  For a further account of the differences between red dyes
and blood, see Guy's IJospital Reports, October, 1851.
  Removal of blood-stains.—It is not unfrequent that an attempt is made by a
murderer to wash out blood-stains, so that the colour is lost, and no chemical evi-
dence can be obtained.  It is a common notion that certain  chemical agents will
remove or destroy these stains;  but this is not the case,—the  colour may be al-
tered, but it is not discharged or bleached.   Chlorine, a most  powerful discolo-
rizing agent, turns the colouring  matter of blood of a green-brown colour.  Hy-
pochlorous acid has a similar effect.  This acid has been recommended as useful
by its bleaching properties for distinguishing the stain of blood  from all other
stains, except those produced by iron-rust.   Orfila has, however, shown that this
is not fitted for such a purpose, and that there are no better methods of testing
than those above described.  (Ann. d'Hyg. 1845, ii. 112.)   I have found that
nothing removes a blood-stain so effectually  as simple maceration in cold water;
although, when  the stain  is old, the  process is  sometimes slow.  On an impor-
tant trial for murder, at the Shrewsbury Lent Assizes, 1841, (The Queen against
Misters,) this question as to the power of certain reagents in discharging stains
of blood, was raised.  Alum was traced to the possession of the prisoner; it was
found dissolved in a vessel in his bed-room,  and  it was supposed that he had re-
moved some blood-stains from his shirt  by the  use of this salt.  Two medical
witnesses deposed that they had  made experiments, and had found that  alum 
BLOOD-STAINS ON WEAPONS.
219
would take the stains of blood out of linen:—according to one, sooner than soap
and water.  The results of my experiments  do not correspond with these.   I
have not found that alum  extracts stains of blood so  readily as common water,
and when alum is added  to a solution of hgematosine  in water,  so far from the
colour being discharged,  it is slowly converted to a deep greenish-brown liquid.
In one experiment,  a slip of linen, having upon it a deep stain of dried blood of
old standing, was left in a solution of alum for twenty-four hours; but not a par-
ticle of the red colouring matter had been extracted, although it was changed in
colour.   The prisoner's guilt did not rest on this point alone,—that was made
sufficiently evident from  other circumstances; but there have been few cases tried
in England where the facts connected with the analysis of blood-stains were so
closely examined, or of such great importance, as in this.   In a  case to be pre-
sently related, I was consulted as to whether the alkali contained in yellow soap
would alter or remove blood-stains.  The effect of this substance,  as well as of
potash, soda, and their carbonates, is to change the red colour of blood to a deep
greenish-brown, like many other reagents,—but they do not exert on it any dis-
charging or bleaching power.  Combined with friction, blood-stains may of course
be easily effaced by any cold alkaline or soapy liquid.
   Examination of  weapons.—Before the coagulum is removed  from a weapon
it should  be  examined carefully by the microscope.   Hairs  or fibres, or other
substances, may be  found imbedded in the solidified blood  either on the edge or
on the blade; and evidence of this kind may occasionally be of great importance.
In the case of  Reg. v. Harrington, Essex  Lent Assizes, 1852, a razor was pro-
duced in evidence, with which it was alleged the throat of the deceased had .been
cut.   I examined the edge microscopically, and separated some small fibres from
a coagulum of blood, which under  a high magnifying power turned out to be
cotton fibres.  It was proved at the trial that the assassin, in cutting  the throat
of the deceased while lying asleep, had cut through one of the strings of her cot-
ton nightcap.   This was a strong circumstance to  show that  the razor produced
was the weapon with which the fatal wound had been inflicted.
   Stains of blood on weapons.—AVhen recent, and on a  polished instrument,
stains of blood are  easily recognised;  but when of old standing, or on a rusty
piece of metal, it is  a matter of some difficulty to distinguish them from the stains
produced by rust or other causes.  If the stain of blood be large, a portion will
readily peel off on drying.   This may be placed in a watch-glass of  distilled wa-
ter, filtered to separate any oxide of iron, and then tested.  If the water by sim-
ple maceration do not acquire a red or red-brown  colour, the stain is not due to
blood.   Sometimes  the stain appears on a dagger or knife  either in the form of
a thin yellowish or  reddish film, or in striae, and is so  superficial that it cannot
be mechanically detached.   AVe should then pour  a stratum of water on a piece
of plate-glass, and lay the stained part of the weapon upon  the surface.   The
water slowly dissolves any portion of  the  colouring matter  of  blood, and this
may be examined in the  way recommended.  If the weapon  have been exposed
to heat, this mode of testing will fail.
   Objections.—There is often a remarkable  resemblance  to the  stains of blood
on metal produced by the oxide or certain vegetable salts of iron.   If the juice
or pulp of lemon or orange be spread upon a steel blade, and remain exposed to
air for a few days, the resemblance to blood produced by the formation of citrate
of iron is occasionally so strong, that I have known well informed  surgeons to
be completely deceived:—they have pronounced the spurious stain  to be blood,
while the real  blood-stain  on a similar weapon was pronounced to be artificial.
This difficulty of distinguishing  such  stains by the eye is  well illustrated  by a
case  which occurred in Paris a few years since.  A man was  accused  of having
murdered his uncle, to whose property  he was heir.  A knife was found in his
possession, having upon  it dark-coloured stains,  pronounced by those who saw
them to be stains of blood.  M. Barruel, and another medical  jurist, were re- 
 220             RED COLOURS MISTAKEN FOR BLOOD-STAINS.

 quired  to determine  the nature  of these stains, and the examination was made
 before a magistrate in the presence of the accused.  They were clearly proved,
 by these and other experiments, to be spots produced by the citrate of iron.   It
 appeared on inquiry, that the knife had been used by some person a short time
 previously, for the purpose of cutting a lemon; and not having been wiped before
 it was put aside, a simple chemical action had gone on between the acid and the
 metal, which had given rise to the appearance.   This case  certainly shows that
 physical characters alone cannot be trusted to in the examination of these sus-
 pected stains.   Stains of the citrate of iron may be thus  known.   The substance
 is soluble in water, forming,  when filtered, a yellowish-brown  solution, totally
 different from the red colour of blood under the same circumstances.   The solu-
 tion undergoes no change of colour on the addition of ammonia.   It is unchanged
 in colour, but may be partially coagulated at a boiling temperature; and it is at
 once identified as  a salt of iron,  by giving a blue colour with the ferrocyanide,
 and a deep red with sulphocyanide of potassium.  I have also  observed, that
 spots of the citrate of iron on knives, for they are not found on other weapons,
 are often soft and deliquescent, while those of blood are commonly dry and brittle.
   It might be supposed to be a very simple matter to distinguish by sight a stain
 of blood on a weapon from a mark produced by iron-rust: but this is not the
 case.  AVhen suspicion exists, it  is astonishing how readily mistakes are made;
 and marks are pronounced to  be due to blood, which, under other circumstances,
 would have passed  unnoticed.  One source of difficulty is this:  the iron-rust is
 often mixed up with articles  of food on an old knife, or even with  blood itself.
 AVe must here pursue the same mode of examination as if the stain were of blood;
 we macerate the weapon  or a portion of the coloured deposit in a small quantity
 of distilled water, and filter the liquid.  If the stain be  due to iron-rust, this  is
 separated by filtration, and the liquid comes through colourless.   The absence  of
 blood is thereby demonstrated: for I need not here consider the objection, that
 the weapon may have been exposed to heat, and thus have  rendered the blood-
 stain insoluble in water.   If we now digest the brown  undissolved residue left
 on the filter, in diluted muriatic acid free from iron, we  shall obtain a yellowish
 solution, which will give with the ferrocyanide and sulphocyanide of potassium
 the proper reactions for iron.  It  has  been recommended to  put muriatic acid
 on the stain as it exists on the weapon, and then to test the liquid, as  the red
 spot of rust is  soon  removed by the acid; but the objection to this is, that a spot
 containing blood may be thereby pronounced to be one of rust only, since muri-
 atic  acid, in all cases, dissolves a portion of the iron,  and the solution would
 therefore give  the characters of an iron-stain with  the  tests.   In all old blood-
 stains, when the weapon  is rusty, blood and oxide of iron are intermixed.  The
 blood may be easily separated by digesting the  compound in distilled water and
 filtering: this  is dissolved, and  passes through, while the rust is  left on the
 filter.
   The following case was referred  to me for examination a few years since.   A
 man was suspected  of murder, and some stains existed on his shirt,  which were
 supposed to have been produced by blood.  Around the collar and upper part
 of the shirt, there was a large and somewhat  deep pinkish-red stain, in some re-
 spects resembling washed blood.   This I considered as a very unusual situation
 for blood to be found  sprinkled; and upon trying the stained linen by the pro-
 cesses mentioned, the colour entirely resisted separation by water, and was turned
 of a slight crimson  tint by ammonia.   The stain was thus shown not to be due
 to blood.  On inquiry, it was ascertained that the man had worn round his neck
a common red handkerchief during a wet night, and while  taking violent  exer-
cise!   The stain was thus accounted  for.  There  were, however,  some other
marks on the shirt which required examination,  as there  was a very strong sus-
picion against  this man.   These were on the sleeves, at those parts which would
be likely to receive stains of blood if  they had  been rolled or turned up at the 
VARIETIES OF ELOOD.
221
wrists; and it was clearly ascertained, that the murderer, in this case, had washed
his hands, using a quantity of yellow soap.   These stains were of a brownish
colour, without any shade of red; they were faint in parts and diffused, convey-
ing the impression that an attempt had been made to wash them out.  So far as
external characters were concerned, it was difficult to say whether they had been
produced by blood or not.  On examining those parts of the shirt corresponding
to the armpits, stains precisely similar were there seen, evidently resulting from
cutaneous perspiration, since the suspicion of blood being poured out on this
part of the shirt under  the circumstances, could not be entertained.   Slips of
linen from the stained portions of the sleeves were digested in water.  In twenty-
four hours the stains were entirely removed;  and the lower stratum of water in
each tube had acquired a straw-yellow colour.   There was not the  least shade of
a red or brown tint;  and the solution was wholly unlike that produced by blood
under any circumstances.   The solution was unaffected by ammonia, as  well as
by a heat of 212°; but it gave a faint opalescence on the addition  of nitric acid.
These results not only indicated the absence of blood, but showed that the stains
were due to cutaneous  perspiration, acting on a dirty skin, and through a dirty
dress.  The stains on the part corresponding to the axillae could not be ascribed
to blood;  and from the similarity in physical and chemical properties, it was im-
possible to attribute those on the sleeves to any sanguineous effusion.   It so
happened, however, that a large pocket-knife, with numerous dark-red stains on
the blade  and between the layers of  the handle, was found  upon this man, and
this was  also  sent for examination.   Several  persons who  saw the knife pro-
neunced  a strong opinion that the marks were due to blood.  The stains were
composed of some soft viscid matter, which gave out ammonia when heated, and
left a residue of  peroxide of iron. On digesting the matter in water no portion
was dissolved; and it was, therefore,  evident that they were  due, not to blood,
but to a mixture of some animal matter, probably food, with  iron-rust.  These
results were somewhat in the  man's  favour,—at least, they removed what was
considered to be a strong circumstantial proof of his guilt.  He was subsequently
tried for the murder, and acquitted on an alibi, established by the  evidence  for
the prosecution.
   Conclusions.—From the foregoing remarks,  we may justly infer  that the che-
mical analysis of suspected spots or stains on weapons and  clothing is by no
means a trivial or unimportant duty.   If  we cannot always  obtain from these
experiments affirmative evidence, they often  furnish good negative proof, and
thus tend  to  remove unjust suspicions against accused parties.   There  is one
circumstance, however, of which a medical jurist is entitled to complain, namely,
that evidence should be received on matters of this kind from non-professional
persons, or that any confidence should be placed in an opinion derived from phy-
sical characters only.   On the occasion of the  murder of Eliza  Grimwood, in
June, 1838, committed, as it was, under circumstances of the greatest mystery,
and  the perpetrator of which  has not yet been discovered, the examination of
suspected marks resembling blood became rather an important part of the inquiry,
but it was most improperly conducted.   The finger-plates of the door of the room,
in which the  murder was  perpetrated, presented some  dark  stains, supposed to
have been produced by the bloody hand of the murderer in the act of escaping.
The  only test to which these  were submitted was, that the magistrate  before
whom the case was heard tried to rub off some of the stains with a piece of
blotting-paper, but did not succeed; and he expressed his opinion, that if they
were blood-stains they had been wiped!  It is easy to perceive to what  evil re-
sults superficial examinations of this kind may lead.
   Varieties of blood.—The means of distinguishing arterial  from  venous blood,
available to the medical jurist, have been elsewhere described (see  ante, p. 202.)
There is no method known by which the blood of a man  can be  distinguished
from that of a woman, or the blood of a child from that of an adult.  The blood 
 222                         ILEMATALLOSCOPY.

 of the child at birth contains less fibrin, and forms a thinner and softer coagulum
 than that of the adult.   The medico-legal question has arisen on more than one
 occasion, whether there were any means  of distinguishing menstrual blood from
 that  of the body generally.   This liquid  contains fibrin, red colouring matter,
 and the other constituents of blood.  The  only differences noticed are of  an ac-
 cidental kind:—1st, that it is acid, owing to its admixture with vaginal mucus;
 and 2d, that under the microscope it is mixed up with epithelial scales, which it
 has derived from its passage through the vagina.   (Donne, Cours  de Micro-
 scopic, 139.)   A case occurred recently in France, which induced the Minister
 of Justice to refer the consideration o.f this question to the Academy of Medicine.
 The reporters, MM. Adelon, Moreau, and Le  Canu, came to the conclusion, that,
 in the present state of science, there were no means of distinguishing menstrual
 blood from that which might be met with  in a case of infanticide or abortion.
 (Ann. d'Hyg. 1846, i. 181.)
   Blood of man and animals.—Test by odour.—AArhen marks of blood have
 been detected on the dress of an accused person, it is by no means unusual to
 find these marks referred to his having been engaged in killing a pig or a  sheep,
 or handling fish or dead  game.  Of course every allowance must be made for a
 statement  like this, which can  only be  proved or disproved by circumstances;
 but an important question here arises, namely, whether we possess any means of
.distinguishing the blood of a human being  from that of an animal.  M. Barruel,
 and  other French  medical jurists, state, that  by mixing fresh  blood with one-
 third or one-half of its bulk of strong sulphuric acid, and agitating the mixture
 with a glass rod, a peculiar odour is evolved, which differs in the blood of map
 and animals, and also in the blood of the two sexes.  This odour, it is said, re-
 sembles that  of the cutaneous  exhalation of the animal, the blood of which  is
 made the  subject  of experiment.   They have hereby pretended to determine,
 whether any given  specimen of blood belonged to a man, a woman, a horse,  sheep,
 or fish.  Others assert that they have been  enabled by this  process to identify
 the blood  of  frogs and  fleas!   (See Devergie, Med. Leg. ii. 907.)  Now it  is
 certain, that an excess of strong sulphuric acid does give rise to a particular odour
 when mixed with blood, probably owing to its decomposing some of the animal
 principles of this liquid;  it is also possible that some persons may discover a dif-
 ference in  the odour, if not according to the sex, at least according to the animal,
 —but even this point is far from being  established;  and if it were admitted,
 there is probably not one individual among a thousand whose sense of smelling
 would be so acute as to allow him to state, with undeniable certainty,  from what
 animal the unknown blood had really been taken.  Any evidence short  of this
 would not be  received in an English Court of law;  for it is considered better not
 to decide at all, than to  decide on principles  which are exposed  to unavoidable
 fallacy.   Besides, it must be remembered,  that in general the operator has not
 before him the blood, but merely a very  diluted solution of the colouring  matter
 mixed with a small quantity of serum.   (For additional remarks on this subject,
 see paper in Guy's Hospital Reports, Oct.  1851.)
   Hcematalloscopy.—Within a recent period,  M. Taddei, of Florence, has sug-
 gested another process for distinguishing human from animal blood, and the va-
 rieties of animal blood from each other.   He calls this process hsematalloscopy
 (atpa a%%ot,ov oxorttw.)   It is of the most complex kind, and essentially depends
 on varying degrees of fluidiflability of blood in different animals.  By the addi-
 tion  of an artificially prepared compound, mixed with sulphuric acid, he allege?
 that he has been able to distinguish human from animal blood, and to fix mea-
 surable degrees of fluidiflability so as to allow an opinion to be expressed.   Even
 if the complexity of the process were not a sufficient objection to its employment,
 the results, as he describes them, are so vague and unsatisfactory as to render it
 wholly inapplicable to practical purposes.   An  account of the process  will  be
 found in [the Second  Part (Chiinie Medicale) of] Briand's Manuel Complct  de
 Medecine  Legale,  1846,  745.   [See also same, 5th ed., 1852, 795.—H.J 
MICROSCOPICAL EVIDENCE.
223
  Detection of blood by the microscope.—The red corpuscles which characterize
the blo6d of the mammalia appear to resist the ordinary changes of putrefaction.
A dog was strangled in September, 1851.   A portion of blood was taken soon
after death from the vena cava.  About a drachm of the serum containing some
of the red colouring matter was kept in a corked phial, and examined at inter-
vals during a period of nine months.  In June, 1852, the corpuscles were again
examined, and it was found that although the blood was dark-coloured and highly
offensive, the corpuscles still  retained their perfect  shape and size without any
apparent alteration.
  Microscopical evidence.—The microscope  has been of late years employed not
only to distinguish blood from other coloured liquids, but for drawing a distinc-
tion between the blood of different classes of animals.  The red colouring matter
of blood  consists of globules or particles floating in a clear  liquid: they are in the
human subject about the 1-3500th of an inch in diameter, but they vary somewhat
in size in the same blood.  If, then, globules be clearly detected, there can be no
doubt that the liquid is blood:  but it appears to me that it would be unsafe to rely
upon  microscopical observation only, except  where the individual has been much
habituated to examine blood by this instrument.  In preparing the stain for the
microscope, water  must not be used, as this  alters the form of the  globules, and
ultimately destroys them.  Albumen or serum, free from globules,—a  solution
of white  sugar of sufficient density to prevent endosmosis (1.03,) or a solution of
sulphate  of soda of similar density, should be employed for the maceration of the
clot, coagulum, or stained portion of stuff;  and when the liquid has acquired a
red tinge by contact, a drop of the  coloured liquid may be  placed between two
plates of glass, and examined.  A portion of the stuff, or,  what  is better, if it
can be obtained, a  small portion of dried blood detached from it, should be placed
on a clean glass slide, and covered with a few drops of a solution of white sugar.
[A lump of white sugar dissolved in a wine-glassful of water will give a liquid
of  sufficient density.]   In about half an hour or an hour, the red-brown liquid,
having a thin piece  of  microscopic glass placed  over it, may be examined by a
power of about 250 diameters.  Globules more or less spherical in form, and of
a very faint reddish colour by daylight, may be then seen floating in the liquid.
These are the blood-globules or  corpuscles,  and they are immediately recognised
by their  peculiar characters.   By this process I lately obtained clear evidence of
their existence in  and separation from a minute fragment of dried blood which
had been kept in a dried state for a period of three years.  Hence there is scarcely
any limit to the period at which the microscope  may be made available for this"'
species of evidence.
   The microscope does not. enable us to distinguish with certainty animal from
human blood—i. e. the globules in the class mammalia are so similar to each other
in form and size, that it would be impossible to say whether the blood was that of
a sheep,  bullock, or human being.  The red globules vary in size: thus, in the
human subject the average size is l-3500th of an inch; but they are found both
larger and smaller in the same individual,  and they are of the same size in the
embryo  and foetus as in the adult.   In the blood of a human adult I have found
the globules to vary from a maximum size of l-2000th of an inch to a minimum
size of l-5000th of an inch, thus comprising the sizes of nearly all the mammalia.
In the elephant, they appear to have the maximum size among mammalia, being,
on an average, 1-2745th of an inch in diameter.   In all animals with red blood
they  have a disc-like or flattened form.   In the mammalia,  excepting the camel
tribe, these discs have a circular outline; in this tribe, and in birds, fishes, and
reptiles,  they have the  form of  a lengthened ellipse, or oval.  In the three last-
mentioned classes of animals, the globules have a central nucleus, which  gives
them an apparent prominence in the centre.  The blood-globules of all the mam-
malia, including the camel tribe, have  no  central nucleus, and the globule ap-
pears depressed.   The globules in reptiles are, comparatively speaking, very large; 
224       DEATH OF WOUNDED PERSONS FROM NATURAL CAUSES.

thus, in the frog, the largest diameter is not less than the  1-1100th of an inch.
If water, or any liquid of less specific gravity than serum, be employed in these
experiments, the flattened discs of the mammalia, and the elliptical discs of birds,
fishes, and reptiles, become spherical, and a distinction can no longer be drawn.
(For further information on this subject, see Donne, Cours de Microscopic; Ba-
yard, Man. Pratique de Med. Leg. 270;  and Hassall's Microscopical Anatomy,
66,118: also Guy's Hosp. Reports, Oct. 1851.)  [See also Briand, Man. Compl.
de Med. Leg. 5th Ed., 1852, 803.—H.]
   The microscope, therefore, in the  hands of a competent observer, may show
that a liquid is blood, and also whether the blood be derived from the class mam-
malia, or from a bird, fish, or reptile.  It has  been alleged that the microscopi-
cal detection of fibrin with the blood-globules would indicate that the blood came
from a living person by its possessing a coagulating power; but the blood would
present exactly the same appearance if drawn from the body many hours after
death.  (Donne, op. cit.  52.)  Nevertheless, where the blood remains liquid, as
in the dead body, the form of the globules undergoes a rapid change,  especially
in certain morbid states.   Donne has  observed that even prior to death they
sometimes become shrivelled, mis-shapen, and irregular in outline.  (Op. cit. 77.)
There is no doubt, however, that, so  long as an unbroken clot or coagulum can
be procured from the stained article  of dress, there may be a reasonable  expec-
tation of demonstrating by the microscope whether the stain be or  be not owing
to blood.   The value of the  instrument for this purpose  has  been fully made
known by Dr. Carl Schmidt.  ("Die Diagnostik verd'achtiger Flecke in  Crimi-
nalfallen," Leipzig, 1848.  See, also, a paper by Dr. Butler Lane, Med. Times,
Dec. 21, 1850.)
                           CHAPTER XXVIII.

DEATH OF WOUNDED PERSONS FROM NATURAL CAUSES—DISTINCTION BETWEEN REAL AND
  APPARENT CAUSE--DEATH FROM WOUNDS OR LATENT DISEASE--ACCELERATING CAUSES.
  --WHICH OF TWO WOUNDS CAUSED DEATH?--DEATH FOLLOWING SLIGHT PERSONAL IN-
  JURIES.

  Death of wounded persons from natural causes.—It is by no means unusual
for individuals who have  received a wound, or sustained some personal injury,
to die from latent natural causes; and as, in the minds of non-professional per-
sons, death may appear to be a direct result of the injury, the  case can only be
cleared up by the assistance of a medical practitioner.   Such a coincidence has
been witnessed in many instances of attempted suicide.  A man has inflicted a
severe wound on himself while labouring under disease; or some morbid change,
tending to destroy life, has occurred subsequently to the infliction of a wound,
and death  has followed.  Without a careful examination of the body, it is im-
possible to refer death to the  real  cause.   The importance of  an accurate dis-
crimination in a case where a wound or  personal injuries have  been caused by
another, must be obvious on the least reflection; a hasty opinion may involve an
accused party in a charge of manslaughter; and,  although a barrister might be
able to show on  the trial  that death  was probably  attributable not to the wound,
but to coexisting disease, yet  it must be  remembered, that  the evidence of a
surgeon before  a coroner, in remote parts of this  country, may be the means of
causing the accused to remain incarcerated for a period of five, six, or  seven
months  previously to the trial.  This is in itself a punishment, independently
of the loss of character, to which an  accused party must be in the mean time ex-
posed. 
WHICH OF TWO WOUNDS CAUSED DEATH.
225
   In Guy's Hospital Reports, Oct. 1850, p. 230, will be found two cases com-
 municated to me  by Mr. Procter of York, in which death from natural causes
 was wrongly assigned to violence.   In a very instructive case, reported by Dr.
 Berncastle (Lancet, Feb. 15, 1845, 185,) the deceased, a boy, died, from inter-
 nal strangulation of the intestine from morbid causes, after wrestling with another
 boy, who might, but for the inspection, have been erroneously charged with having
 caused his death.   For a similar  case,  see Medical Gazette, xxxvii. 702.  An in-
 stance is related by Dr. Neumann, in which the question was, however, doubtful.
 (See Casper's Wochenschrift, May 24,1845.)
   Death from wounds or latent disease.—It must be borne in mind by a practi-
 tioner, that numerous causes of death  may be lurking within  the system at the
 time that a wound is criminally inflicted, and a close attention to the symptoms
 and post-mortem  appearances  can  alone  assist him in  the  difficult position in
 which he may be placed, should the accused party be subsequently brought to
 trial.  A man may be severely wounded, and yet death may take place from rup-
 ture of the heart,  the bursting of an aneurism, from apoplexy, phthisis, or other
 morbid causes which it is here unnecessary to specify.   (Cormack's Ed. Journal,
 May 1846, 343.)   If death can be clearly traced to any of these diseases by an
 experienced surgeon, the prisoner cannot be charged with manslaughter; for the
 medical witness may give his opinion that death  must have taken place about the
 same time and under the same circumstances, whether the wound had been  in-
 flicted or not.  On these occasions, however, one  of the following questions would
 probably arise:—Was the death of  the party accelerated by the wound, or was
 the disease under which he was labouring so aggravated by the wound as to pro-
 duce a more speedily fatal termination ?  The answer to either  of these  questions
 must depend on the circumstances of the case, and the witness's ability to draw
 a proper conclusion«from these circumstances.   The maliciously accelerating of
 the death of  another already labouring under disease is criminal;  for what acce-
 lerates, causes.  Lord Hale, in  remarking upon the necessity of proving that the
 act of the prisoner caused the death of  the party, says:—-"It is  necessary that
 the  death  should  have been  occasioned by some corporeal injury done to the
 party by force, or by poison, or by some mechanical means which occasion death;
 for although a person may, in foro  conscientiw, be as guilty of murder by work-
 ing on the passions or fears of another, and as certainly  occasion  death by such
 means, as if he had used a sword or pistol for the purpose, he is not the object
 of temporal punishment."  (I. 247.)   Several  acquittals have taken  place of
 late years, where the deaths of parties have been occasioned by terror or  dread
 of impending danger, produced by acts of violence on the part of the prisoners;
 not, however, giving rise to bodily injury in the deceased. Conformably to Lord
 Hale's view, the Criminal Law Commissioners, in their report  on  the subject of
 homicide, state:—"Art. 1. The law takes no cognizance of homicide unless death
 result from bodily injury occasioned by some act or unlawful omission, as con-
 tradistinguished from death occasioned by an influence on the mind, or by any
 disease arising from such influence.   Art. 2. The  terms 'unlawful omission' com-
 prehend  every case where any one  being under  legal  obligation to supply food,
 clothing, or other  aid and support, or  to do any other act, or make any other
 provision for the sustentation of life, is guilty of any breach of such duty."
   Under the new statute (14 and 15 Vict. cap.  100,) the necessity for tracing
 death to some corporeal injury appears to be practically  abolished.   According
 to the fourth section, in any future  indictment for murder or manslaughter, it
 shall not be necessary to set forth the manner in which or the means by which
 the death of the deceased was caused.
   Which of two wounds caused death?—It is  possible that a  man may receive
 (wo wounds on provocation, at different  times, and from different  individuals,
and die after the receipt of the  second: in such a case, the course of justice may
require that a medical witness should state which wound was the cause of death.
       15 
226           DEATH FOLLOWING SLIGHT PERSONAL INJURIES.
 Let us take the following illustration:—A man receives during a quarrel a gun-
 shot wound in the shoulder.   He is going on well, with a prospect of recovery,
 when in another quarrel he receives a severe  penetrating wound in  the chest or
 abdomen from  another  person, and after lingering under the effects  of these
 wounds for a longer or shorter period, he dies.  If the gun-shot wound  were
 clearly shown to have been the cause of death, the second prisoner could  not be
 convicted of manslaughter; or if the stab were evidently the cause of death, the
 first prisoner would be acquitted on a  similar charge.   It  might be  possible for
 a surgeon to decide the question summarily, as where, for instance,  death speedily
 follows the second wound, and, on  inspection of the body, the heart or a large
 vessel is discovered to have  been penetrated; or, on the other hand, extensive
 sloughing, sufficient to account for death, might take place from the gun-shot
 wound, and  on inspection, the stab might be found to be of a slight nature, and
 not involving any vital parts.  In  either of these cases, all would depend upon
 the science and skill of the medical practitioner,—his evidence would be so im-
 portant that no correct decision could be come to without it; he would be, in
 fact, called upon substantially to distinguish the guilty from the innocent.   On
 some occasions, death may appear to be equally a consequence of  either or both
 of the wounds; in which case, probably, both parties would be liable to a charge
 of manslaughter.  (See Ann. d'Hyg. 1835, ii. 432.)   The second wound, which
 is here supposed to have been the act of another, may be inflicted by the wounded
 party on himself, in an attempt at suicide, or it may have  an accidental origin.
 The witness would then have to determine whether the wounded party died from
 the wound inflicted by himself, or from that which he had previously received.
   It may happen that the wounded person has  taken poison, and actually died
 from the effects of this, and not from the injuries or maltreatment.   A case  of
 this kind has been already related.   Again, the wounded person may have been
 the subject of further ill treatment, and the question will be put as to which  of
 the two causes his death was really due.  It is to be observed of these cases, that
 the supervening disease, the poison, or the subsequent ill treatment, should be
 of such a nature as to account for sudden or  rapid death; since it would  be no
 answer to  a charge of death from violence, to say that there were marks of
 chronic disease in the  body, unless it were  of such a nature as to account for the
 sudden destruction of life under the  symptoms which actually preceded death.
 In  the medical jurisprudence of wounds, there is probably no question which so
 frequently presents itself as this: it is admitted that the violence was inflicted,
 but it is  asserted that  death was due to some other cause; and the onus of proof
 lies on the medical evidence.   Among numerous  cases which have occurred in
 England during the last  twelve years, I find that the latent causes of death in
 wounded persons have been  chiefly inflammation of  the thoracic or abdominal
 viscera, apoplexy, diseases of the heart and large blood-vessels, phthisis, ruptures
 of the stomach and bowels from disease, internal strangulation, and the rupture
 of deep-seated abscesses.   In some of these cases the person was in a good state
 of health up  to the time of the violence, and in others there was a slight indis-
 position.   The history is nearly the same in all:—it was only by careful conduct
 on the part of the medical witnesses that the true cause of death was ascertained.
 It is obvious that questions of malapraxis and life insurance, giving rise to  civil
 actions, may have a very close relation to this subject.
  Death following slight personal injuries.—An imputation has  often been
 thrown on the masters of schools, where  boys have  died  soon after they have
 been chastised.   In  such cases there has been  commonly some unhealthy state
 of the body to explain this result.  When the disease which gives rise to doubt
 is seated in  a part which is remote from that which sustained the violence, all
 that is required is, that the post-mortem examination  of the body should be con-
 ducted with ordinary care.  If the disease should  happen to be in the  part in-
jured, the case becomes much more perplexing.  The difficulty can then be re- 
WOUNDS INDIRECTLY FATAL.
moved only by attentively considering the  ordinary consequences  of  such in-
juries.  The violence may have been  too  slight to account for the diseased ap-
pearance; and the disease itself, although situated in  the  part injured, may be
regarded as a most unusual consequence of such an injury.
                           CHAPTER XXIX.

WOUNDS INDIRECTLY FATAL — DEATH  FROM WOUNDS AFTER LONG PERIODS—SECONDARY
  CAUSES OF DEATH—THE CAUSE IS UNAVOIDABLE—THE CAUSE AVOIDABLE BY GOOD MEDI-
  CAL TREATMENT--COMPARATIVE SKILL IN TREATMENT—CAUSE AVOIDABLE BUT FOR IM-
  PRUDENCE ON THE PART OF THE WOUNDED PERSON—ABNORMAL OR UNHEALTHY STATE
  OF BODY—ACCELERATION OF DEATH.

   Wounds indirectly fatal.—Certain  kinds of  injuries are not immediately fol-
lowed by serious consequences, but the individual  may perish after a longer or
shorter period of time, and  his death may be as much a consequence of the in-
jury as if it had taken place on the spot.   The aggressor, however, is just as re-
sponsible as if the deceased had been directly killed  by his violence, provided the
fatal result can be  traced to  the usual and  probable consequences of the injury.
Wounds of the head are especially liable  to cause death insidiously,—the person
may in the first instance recover, he may appear to be  going on well, when, with-
out any apparent cause, he will suddenly expire.  It is scarcely necessary to ob-
serve, that in general a post-mortem examination of  the body will suffice to de-
termine whether death is to  be ascribed to the wound  or not.   In severe injuries
affecting the spinal marrow, death is not an immediate consequence, unless that
part of the organ which is above the origin of  the  phrenic nerves be wounded.
Injuries affecting the lower  portion of the spinal column do not commonly prove
fatal until after some time;  but the symptoms  manifested by  the patient during
life, as well as the appearances observed in the body after death, will sufficiently
connect the injury with that event.   Death may follow a wound,  and be a con-
sequence of that wound, at almost any period after  its infliction.  It is neces-
sary, however, in order to maintain a charge of homicide against  an individual,
that death should'be strictly and clearly traceable to  the injury, and  not  be de-
pendent on any other cause.  A doubt on this point  must, of course, lead to an
acquittal.
   Death from wounds after long periods.—Many cases might be quoted, in il-
lustration of the length of time which may elapse before death takes place from
certain kinds of injuries,—the  injured party having ultimately fallen a victim to
their indirect consequences.  One of the most striking instances of this kind is
that related by Sir A. Cooper,  of a gentleman of Yarmouth,  who died from the
effects of an injury to the head received about two years previously.   In  this
case, the  connexion of death with the wound was clearly made  out by the  con-
tinuance of the symptoms of cerebral disturbance during the long period which
he survived.
   There is a singular rule in our law relative to the period at which an individual
dies from a wound—namely, that a party shall not be adjudged guilty of homi-
cide unless  death  take place within a year and a day after the infliction of  a
wound.   (Archbold, 345.)   In practice, the existence of this  rule is of little im-
portance, but in principle it is erroneous.  Most wounds leading to death gene-
rally destroy life within two or three months after their infliction:—sometimes
the person does not die for five or six months,  and, in more rare instances, death
does not ensue  until after the lapse of twelve months, or even  several years. 
 228           UNAVOIDABLE AND AVOIDABLE CAUSES OF DEATH.

 These protracted cases occur especially in respect to injuries of the head.   Strict
 justice demands  that the responsibility of a person who  has inflicted a wound
 should depend upon this having really caused death, and not upon the period at
 which death takes place; for this must be a purely accidental circumstance.
   Secondary causes of death.—An individual who recovers from the immediate
 effects of a wound may die from fever, inflammation or  its  consequences, ery-
 sipelas, tetanus, or gangrene;  or an operation required during the treatment of
 the wound may prove fatal.  These are what may be called secondary causes of
 death, or secondary consequences of the wound.   The power of  deciding on the
 responsibility of an accused person for  an event which depends only in an in-
 direct manner on the injury originally inflicted by him, rests of  course with the
 authorities of the law.  But it is impossible that they can decide on so difficult
 and nice a question without satisfactory medical evidence; and on the other hand,
 it is right that a medical witness should understand the importance of the duty
 here  required of him.  Fever or  erysipelas may follow many kinds of  serious
 wounds, and in some few instances be distinctly traceable to them; but in  others,
 the constitution of the patient may be so broken up by dissipated habits as  to
 render a wound  fatal which in a healthy subject  might  have run through its
 course mildly and  have healed.  When the fever or erysipelas  is readily to be
 traced to the wound, and there is no other apparent cause of aggravation to which
 either of these disordered states of the body could be attributed, they can scarcely
 be regarded by the medical practitioner as very unexpected  or  unusual conse-
 quences  of such injuries, especially when extensive, or when seated  in certain
 parts of the body, as the scalp.   If death takes place under these circumstances,
 the prisoner would be  held as much responsible for the result as if the  wound
 had proved directly mortal.   This principle has been frequently admitted  by our
 law, and, indeed, were  it otherwise, many reckless offenders would escape,-and
 many lives would be sacrificed with impunity.   It is, however, difficult  to lay
 down general rules upon a subject which is liable to vary in its relations in every
 case; but when a wound is not serious, and the secondary cause  of death is evi-
 dently due to constitutional peculiarities from acquired habits of dissipation, the
 ends of justice are probably fully answered by an  acquittal;  in  fact, such cases
 do not often pass beyond a  coroner's inquest.
   These secondary causes of death may be arranged under the following heads:—
   1.  The cause is unavoidable.—Of this kind are  tetanus, following laceration
 of tendinous  and nervous  structure,—erysipelas following lacerated wounds of
 the scalp,—peritoneal inflammation following rupture of the bladder or intestines,
 with extravasation of their contents,—strangulation of the intestines, as phrenic
 hernia following rupture of the diaphragm, and others of the like nature.  Here,
 supposing proper medical  treatment and  regimen  to have been pursued, the
 secondary cause of  death was unavoidable, and the fatal result certain.
   2.  The cause avoidable by good medical treatment.—There  are, it  is obvious,
 many kinds of wounds which, if properly treated in the first instance, may be
 healed, and the patient recover; but when improperly treated, they may prove
 fatal.   In the latter case, it will be a question for the witness to determine, how
 far the treatment aggravated the effects of the violence, and from his answer to
 this, the jury may have to decide on the degree of  criminality which attaches to
 the prisoner.  Let us suppose, for instance, that an ignorant person has removed a
 clot of bloody which sealed up the extremity of a vessel, in  consequence of which
 fatal hemorrhage has  ensued,—or that he has produced, death by unnecessarily
 interfering with  a  penetrating wound  of the thorax or abdomen,—it  would
 scarcely be just to hold the aggressor responsible, since, but for the ignorance
 and unskilfulness of his attendant, the wounded  party might  have recovered
 from the effects of the wound.   When death is really traceable to the negligence
 or unskilfulness of the person who is called to attend  on a wounded party, this
circumstance ought to be, and commonly is, admitted in mitigation, supposing 
WOUNDS.   COMPARATIVE SKILL IN TREATMENT.           229
that the wound  was not originally of a mortal nature.   Lord  Hale observes:
"It is sufficient to constitute murder, that the party dies of the wound given by
the prisoner, although  the wound  was not originally mortal, but became  so in
consequence of negligence or unskilful treatment;  but it  is otherwise where
death arises not from the wound, but from unskilful applications or operations
used for the purpose of curing it." (I. 428.)  The medical jurist will perceive
that a very nice distinction is here drawn by  this great judge, between death as
it results from a wound rendered mortal by improper treatment, and death as it
results from the improper treatment, irrespective of the wound.   In the majority
of cases such a distinction could scarcely be established, except upon conjectural
grounds, and in no case, probably, would there be any accordance in the opinions
of medical witnesses.  In slight and unimportant wounds, it might not be diffi-
cult to distinguish the effects resulting from bad treatment from those connected
with the wound, but there can be but few cases of severe injury to the person,
wherein a distinction of this nature could be safely made;  and the probability is,
that no conviction for  murder would  now take place, if the medical evidence
showed that the injury was not originally mortal, but only became so by unskil-
ful or improper treatment.   In such a case,  it would be  impossible to ascribe
death to the wound,  or to its usual or probable consequences,—and without this
it  is not easy to perceive on what principle an aggressor could be made responsi-
ble for the result.
   3.  Comparative skill in treatment.—If the death be owing to the wound, it
signifies not that under more favourable  circumstances, and with more skilful
treatment, the fatal  result might  have been averted.  As a proof of this, the
following case, reported by Alison, may be quoted:—The prisoner was one of the
party of smugglers who fired at an officer of excise.  The wounded man was
carried to the nearest  village, where  he was attended by the  surgeon of the
country, who was not deficient  in attention, but a great collection of matter
having formed in the leg, fever ensued, and the patient died at the end of three
weeks.  In defence,  it was urged that,  by skilful treatment, the man might have
recovered, but the Court held that it was incumbent to prove that death arose ex
malo regimine.  The true distinction  in all such cases is, that if the death was
evidently occasioned by grossly erroneous medical treatment, the original author of
the violence  will  not  be  answerable;  but if it arise from  the  want merely of
the higher skill which can only be commanded in great towns, he will be respon-
sible, because he has wilfully exposed the deceased to a risk  from which he has
practically no means of escaping.   (150.)  In the  case of Macewan (Perth Sept.
Circ. 1830,) the prisoner was indicted  for the manslaughter of a boy, by striking
him a blow on the shoulder, which dislocated the arm.  Two days afterthe blow,
an ignorant bone-setter was consulted, and owing to his manipulations, inflamma-
tion took place, and  the boy being of  a sickly and scrofulous habit, this proved
fatal. Under the direction of Lord Meadowbank the prisoner was acquitted.  In
charging the grand jury in reference to Mr. Scion's case, (Winchester Aut. Ass.
1845,) Mr. Baron Piatt is  reported  to have observed, that if a man  inflicted
a wound likely to  produce death,  and  the wounded party should fall  into the
hands of an unskilful  practitioner, whereby  death was hastened, the aggressor
would still be responsible for the result.  If the wound  had not been likely to
produce death, but by unskilful treatment death ensued,  then that would not be
murder.
   It will be obvious that a serious responsibility is thrown on practitioners who
undertake the management of a case of criminal wounding.  Any deviation from
common practice should therefore be made with the greatest caution, since novel-
ties in practice will,  in  the event  of death, form one of the best grounds of de-
fence in the hands of a prisoner's counsel.  On these occasions,  every point con-
nected with the surgical treatment will be rigorously inquired into.   In the case
of a severe lacerated wound to the hand or foot, followed by fatal tetanus, it may 
230          WOUNDS.  ABNORMAL OR UNHEALTHY CONDITIONS.
be said that the wounded person would not have died, had amputation been per-
formed.  In this instance, however, a practitioner may justify himself by show-
ing either  that  the  injury was too  slight to require amputation, or that the
health or other circumstances connected with the deceased, would not allow of its
being performed with any fair hope of success.   On the other hand, if the prac-
titioner performed amputation, and the patient died, then it would be urged that
the operation was unjustifiable and had caused death.   Here the surgeon is bound
to show that  the  operation was necessary according to the  ordinary rules of
treatment.   The treatment  of  severe incised wounds of the  throat, where the
trachea is involved, sometimes places a practitioner in a very embarrassing posi-
tion.   If the wound be left open, death may take place from  hemorrhage; if it
be prematurely closed, the blood may be effused into the trachea, and cause death
by suffocation.
   4.  The cause avoidable but for imprudence or neglect on the part of the wounded
person.—A man who has been severely wounded in a quarrel may obstinately re-
fuse medical assistance, or he may insist upon taking exercise, or using an improper
diet,  contrary to the advice of his  medical  attendant, or, by other imprudent
practices, he may thwart the best conceived plans for  his recovery.
   The neglect to call in a medical practitioner,  or the refusal to receive medical
advice, will not, however, according to the decision in the case of Reg. v. Thomas,
(Gloucester Aut. Assizes, 1841,) be considered a mitigatory circumstance in fa-
vour of the prisoner, even although  the  wound was susceptible of being cured.
A man may receive a lacerated wound of  an extremity, which is followed by te-
tanus or gangrene, and thus prove fatal: he may have  declined receiving medical
advice, or have obstinately refused amputation, although proposed by his medical
attendant;  but this  would not be  received as a  mitigatory circumstance  on the
part of a prisoner, because the wounded party is not compelled to call for medical
assistance,  or to submit to an operation, and the medical witness could not always
be in a condition to swear that the operation would have positively saved his
life; he can merely affirm that it might have afforded the deceased a chance of
recovery.   In the case of The  Queen v. Hulme,  (Liverpool Aut. Assizes, 1843,)
it was proved  that the deceased  had died from tetanus, caused by an injury to a
finger some time before.  Amputation was advised by the surgeon, but  the de-
ceased would not consent to the operation.  The prisoner was convicted of man-
slaughter, and sentenced to the severest  punishment prescribed by the law for
that crime.
   5.  The cause avoidable but for  an abnormal or unhealthy state of the body of
the wounded person.—AVounds  which are  comparatively slight sometimes prove
indirectly fatal, owing to the person  being in  an unhealthy state at the time of
their infliction.   In bad  constitutions, compound fractures  or slight wounds,
which in a  healthy subject would have a favourable termination, are followed by
gangrene, fever, or erysipelas, proving fatal.   Here the responsibility of an as-
sailant for  the death may become reduced, so that although found guilty of man-
slaughter,  a mild punishment  might be inflicted.   The consequence  may be,
medically speaking, unusual or  unexpected, and, but for circumstances wholly
independent of the act of the  accused, would  not have been likely to  destroy
life.  In general, in the absence of malice, this  appears to be  the point to which
the law closely looks, in order to  make out the responsibility of the accused—
namely, that the fatal  secondary cause must  be something not unusual or unex-
pected as a consequence of the particular  injury; and  the medico-legal  question
presents itself under this form: AVould  the  same amount of injury have been
likely to cause death in a person of ordinary health and vigour ?  Men who have
suddenly changed their habits of living, and have passed from a full diet to ab-
stemiousness,  are unable to bear up against comparatively slight injuries, and
often sink  from the  secondary consequences.   So a  man otherwise  healthy la-
bouring under hernia,  may receive a blow in the groin, attended with rupture of
the intestine,  gangrene, and death,—another with calculus in the kidney may be 
                    WOUNDS.  ACCELERATION OF DEATH.                231

struck in the loins, and die in consequence of the calculus perforating the renal
vessels, and causing fatal hemorrhage, or from subsequent inflammation.
  Acceleration of death.—It must be evident that there exist numerous other
internal diseases, such as aneurism, and various morbid  affections of the heart
and brain, which are liable to be rendered fatal by slight external violence.  Now,
the law, as applied to these cases, is thus stated by Lord Hale:—" It is sufficient
to prove that the death of the party was accelerated by the malicious act of the
prisoner, although the former laboured under a mortal disease at the time of the
act."   (I. 428.)   In those cases where a  slight degree of violence has been
followed by fatal consequences, it is for a  jury to decide, under  all the circum-
stances of the case, upon the actual and specific intention of the prisoner at the
time of the act which occasioned  death.  And, according to  Starkie, "it seems
that in general, notwithstanding any facts which tend to excuse or alleviate the
act of the prisoner, if it be proved that he  was actuated by prepense and delibe-
rate malice, and that the particular occasion and circumstances upon which he
relies were sought for and  taken advantage of merely with a  view to qualify
actual malice, in pursuance of a pre-conceived scheme of destruction, the offence
will amount to murder."  In most of these cases there is an absence of intention
to destroy life; but  the nature of the wound, as well as  the means by which it
was inflicted, Will often suffice to develope  the  intention of the prisoner.  An
accurate description  of the injury, if slight,  may afford strong evidence in favour
of a prisoner, since the law does not so much regard the  means used by him to
perpetrate the violence, as the actual intention  to  kill,  or to do great  bodily
harm.  Serious injury, causing death  by secondary  consequences, will admit of
no exculpation when the prisoner was aware, or ought to have been aware, of
the condition of the party whom  he  struck.   Thus, if a  person  notoriously ill,
or a woman while pregnant, be violently maltreated, and death ensue  from a
secondary cause, the assailant would be held responsible; because he ought to
have known that violence of any kind to persons so situated must be attended
with dangerous consequences.  So, if the person maltreated be an infant, or a
decrepit old man, or one labouring under a mortal disease, it is notorious that a
comparatively slight degree of violence will destroy life in these cases;  and the
prisoner would properly be held responsible.  A wound  which accelerates death
causes death, and may therefore render the  aggressor responsible for murder or
manslaughter, according to  the circumstances.   The  Commissioners lately ap-
pointed to define the criminal law on the subject of homicide thus express them-
selves:—"Art. 3.  It is homicide, although the effect of the injury be merely to
accelerate  the death of one labouring under some previous injury or infirmity, or
although, if timely remedies or skilful treatment had been applied, death might
have  been  prevented."  This is  conformable to  the decisions of our  judges.
According to Lord Hale, if a man have a disease which in all  likelihood would
terminate  his life in  a short time, and another give him a wound or hurt which
hastens his death, this is such a killing as constitutes murder.   (Archbold, 345.)
                            CHAPTER XXX.

WOUNDS INDIRECTLY FATAL.  TETANUS FOLLOWING WOUNDS—CAUSES OF—DEATH FROM
  SURGICAL OPERATIONS--PRIMARY AND SECONDARY CAUSES OF DEATH--UNSKILFULNESS IN
  OPERATIONS--NECESSITY FOR THE OPERATION--ERYSIPELAS FOLLOWING OPERATIONS.

   Tetanus following wounds.—This disease frequently presents  itself as a se-
condary fatal consequence of wounds,—more especially of those which are lace-
rated or contused, and affect nervous or tendinous  structures.   It has  often
occurred as a result of very slight bruises  or lacerations, when the injury was so 
232
WOUNDS INDIRECTLY FATAL.
superficial as to excite no alarm;  and it is a disease which gives no warning of
its appearance.   Dr. Brady met with a case in which a man slipped in walking,
and fell flat on his back.  He was stunned, but able to walk home.   He appa-
rently recovered from  the  simple accident, but  on the following day he was
attacked with tetanus, and died in seventy hours.   (Lancet, May 15,1847, 516.)
In the case of Reg. v. Butcher (AArarwick Lent Assizes, 1848,) it was proved by
the medical evidence that  the deceased had received a blow on the nose, which
caused severe hemorrhage.   In spite of good surgical  treatment, the man was
attacked with tetanus on the fifteenth day, under which he sank.  On inspection,
it was found that one of the small bones of the nose had been broken, and this
had given rise to the fatal attack.   Tetanus may come on spontaneously, i. e.
independently of the existence of any wound on the body.   Many cases  have
been  brought into the London  hospitals, where the only  cause of this disease
appeared to be exposure to cold or wet,—or, in  some instances, exposure to a
current of air.   (Lancet, Dec. 14, 1844, 351.)   Dr. Watson  met with  a case
in which tetanus  appeared in a very severe form in a man  who had received no
wound, but who had been simply exposed to cold and wet.   (Cormack's Monthly
Journal, Dec. 1845, 902.)   It has sometimes come on without  any apparent
cause.  It is scarcely possible to distinguish, by the symptoms,  tetanus  from
wounds from that which occurs spontaneously as a result of natural causes.  In
endeavouring to connect its appearance with a particular wound or personal injury,
it will be  proper  to observe—1, whether there were  any symptoms indicative of
it before the maltreatment;—2, whether any probable cause could have intervened
to produce  it, between  the  time of its appearance and the time  at  which the
violence was inflicted;—3, whether the deceased ever rallied from the effects of
the violence.  The time at which tetanus usually makes its appearance, when it
is the result of a  wound, is from about the third to the sixth day.
  Death from surgical operations.—In the treatment of wounds, surgical opera-
tions  are occasionally resorted to, and a wounded  person may  die  either  during
the performance  of the operation, or  from its after-consequences.  . A question
then arises, whether the party who inflicted the wound can be held responsible
for the fatal result.   The law regards a surgical operation as part  of the treat-
ment, and if undertaken bond fide, and performed with reasonable  skill, the ag-
gressor will be held responsible, whatever may be the result.   The necessity of
the operation, and the mode of performing it, will be left to the operator's judg-
ment.   As the defence may turn upon the operation having been performed un-
necessarily and in a bungling and unskilful manner, it will be right for a prac-
titioner, if possible, to defer it until he  has had the advice and assistance of other
practitioners.  According  to Lord Hale, if death takes place  from an unskilful
operation, performed for the cure of a wound, and not from the wound,  the re-
sponsibility of the prisoner  ceases; but this eminent lawyer does  not appear to
have contemplated  that death  might take place  as a  consequence of the most
skilful operation required for the  treatment of a wound, and yet be wholly  inde-
pendent of the wound itself.
  Should an operation be unnecessarily or unskilfully performed,  the responsi-
bility of an aggressor would, it is presumed, cease, if the death of a wounded
party could be clearly ascribed to it.  Thus, if in carelessly bleeding a wounded
person, the brachial artery should be laid open (see Ann. d'Hyg. 1834, ii. 445,)
or if in performing amputation, a large artery be improperly secured, so that the
patient in either case die from hemorrhage, the prisoner could not be  equitably
held responsible; because it would be punishing him for an event  depending on
the unskilfulness of the medical practitioner.   From an  obiter dictum of Mr.
Baron Piatt (p. 229) it would appear that the prisoner will be held responsible,
if the original wound were likely  to produce death, although unskilfully treated.
Supposing the bleeding or amputation  to  be performed with  ordinary care and
skill,—and yet, in the one case phlebitis, and in the other  tetanus, gangrene, or
fever, should destroy life, the prisoner will be liable for the consequences.   The 
ERYSIPELAS FOLLOWING WOUNDS.
233
practice of the law is strictly consistent with justice.   Should the operation be
considered to be absolutely required for the treatment of a wound, which accord-
ing to all probability would prove mortal without it,—should it be performed
with ordinary skill, and still death ensue as a direct or indirect consequence, it
is only just that the prisoner  should be  held responsible for the result.  It is
presumed in these cases, that were the patient left to  himself, he would, in all
probability, die from the effects of the wound.  If, therefore, a surgeon, knowing
that an operation would give a chance of saving life on such an occasion, did not
perform it, it might be contended in the defence, that the deceased had died, not
from the wound, but from the incompetency and neglect of his  medical attendant.
Hence it follows, that if during this very necessary treatment, unforeseen, though
not unusual causes, cut short life, no exculpation should be admissible, if it went
to attack the best-directed efforts made  for the preservation  of life.   (See Ann.
d'Hyg. 1835, i. 231.)
   Erysipelas following operations.—AArhen a wounded  person is taken to a hos-
pital in which gangrene or erysipelas is  diffusing itself by infectious propagation,
and he is attacked by one of these diseases before or after the  performance of an
operation, and dies, a prisoner may be  held  responsible for the fatal result.   It
might be contended, that the transportation of the wounded man to such a locality
was not absolutely necessary to the preservation of his life;  and that he would
not then  have  died,  but for the accidental presence of an  infectious  disease.
Cases  of  this kind cannot be easily decided by general rules; but the question
has already been raised before a legal tribunal, in a trial which took  place at the
Maidstone Lent Assizes,  1839.  (The Queen against Connell  and others.)   The
deceased was assaulted by a number of soldiers, and received  two blows on the
head with a stick.  The wound was not of any great extent, and the deceased
did not appear  to suffer much from  it.   Two days afterwards, he was attacked
by erysipelas in the head and face, and he died in about a week.'   On inspection,
there was no appearance of disease.   The surgeon referred death to erysipelas,
which was prevalent in  the hospital at the time the deceased was  brought in.
The man  would probably have recovered but for the attack of erysipelas, and he
did not  think  that  he would  have been attacked by that disease  but for the
wound.  Erysipelas was an infectious disease, and a  common consequence  of
wounds of the head.   Under this  evidence the prisoners were  convicted.
   Questions relative to responsibility in death following operations would come
more  frequently before Courts of law, were it not that the cases are stopped  in
the Coroners' courts by a verdict of accidental death.   (See Med. Gaz. xix. 157.)
It unfortunately happens that on these  occasions there is great difference of opi-
nion among medical witnesses respecting the connexion of the disease with the
death, or, indeed, the necessity for the operation itself.  The evidence of opinion
in favour of the prosecution is sometimes exactly  balanced by that urged in the
defence;  and under these circumstances, the only alternative  left to the Court,
is to discharge  the accused.  Differences of  opinion upon these subjects among
eminent  members of the profession tend to convey to the public the impression
that there are no fixed principles upon which medical  opinions are  based;  and,
consequently, that it would be dangerous to act upon them.   Thus it  is that we
are accustomed to hear of a medical prosecution and a medical defence, as if the
whole duty of a medical  jurist consisted in his making the best of a  case, on the
side for which he happens to be engaged,—adopting the legal rule for suppress-
ing those points which  are  against him, and  giving  an undue  prominence  to
others which may be in his favour.   This is an unfortunate condition of things,
for which at present there appears  to be no other remedy than that of appointing
a Medical board of competent persons to whom such questions might be referred,
in the same way as questions relative to navigation are  referred by the Admiralty
Courts to a board formed of members of the Trinity House,—professionally ac-
quainted with the matters m litigation.  [See "Thoughts on .Malpractice," by
William  AV. Wood, M.D., Am. Journ. Med. Sci.  Oct.  1849.—II.] 
234                     CICATRIZATION OF WOUNDS.
                            CHAPTER XXXI.

CICATRIZATION OF WOUNDS—EVIDENCE FROM CICATRICES—CHANGES IN AN INCISED
  WOUND—IS A CICATRIX ALWAYS A CONSEQUENCE OF  A WOUND?--ARE CICATRICES,
  WHEN ONCE FORMED, INDELIBLE?—CHARACTERS OF CICATRICES--MEDICAL EVIDENCE
  RESPECTING THE PERIOD AT WHICH A WOUND WAS INFLICTED—CHANGES IN CONTUSIONS
  --HOW LONG DID THE DECEASED SURVIVE THE WOUND?

   Cicatrization of wounds.—The period of time at which a particular wound
was inflicted may become a medico-legal question, both in relation to the living
and dead.   The identity of a person, and the correctness of a statement made by
an accused party, may be sometimes determined by an examination of the wound
or its cicatrix.   So, if a dead body be found with marks of violence upon it, and
evidence adduced that the deceased  was maltreated at some particular period
before his death, it will be necessary for a practitioner to state whether, from
the appearance of the injuries, they could or could not have been inflicted at or
about the time.  A case was tried at the Taunton Spring Assizes, 1841 (The,
Queen against Raynon,) wherein evidence of this  kind served to disprove the
statement made by the accused.  He was charged with maliciously cutting and
wounding the prosecutrix.  There was a cut upon his thumb, which he accounted
for by saying it was from an accident that had occurred three weeks before.  The
medical witness declared, on examining it, that it could not have been done more
than two or three days, which  brought the period of its infliction to about the
time of the murderous assault.  This and other circumstances led to his convic-
tion.
   An incised  wound inflicted on the  living body gradually heals by adhesion
when no circumstances interfere to prevent the union of the edges.  For  eight
or ten hours the edges remain bloody,—they then begin to swell, showing the
access of inflammation.   If the parts be not kept well  in contact, a secretion of
a serous liquid  is poured out for about thirty-six or  forty-eight  hours.  On the
third day this secretion acquires a  purulent character.   On the fourth and fifth
days, suppuration is  fully established, and  it lasts  five, six, or eight days.  A
fibrous layer, which is at first soft and easily broken down, then makes its ap-
pearance between the edges:—this causes them gradually to unite, and  thus is
produced what is termed a cicatrix.   Cicatrization is complete about the twelfth
or fifteenth  day, when the wound is  simple, of little depth, and only affecting
parts endowed with great vitality.   The length of time required for these changes
to ensue will depend—1. On the situation of the wound,—wounds on the lower
extremities  are longer in healing than those on the upper part of the body.  If
a wound be situated near a joint, so that the edges are  continually separated by
the motion  of parts, cicatrization is retarded.   2.  On the extent.   Wounds in-
volving many and different structures are longer in healing than  those simply
affecting the skin and muscles.  3. On the age and health of the wounded party;
—the process of cicatrization is slow in those who are diseased or infirm.   In an
incised wound, the cicatrix is generally straight and regular; but it is semilunar
if the cut be oblique.  It is soft, red, and tender, if cicatrization be recent: it is
hard, white, and firm, if of long standing.  On compressing the skin around an
old cicatrix, its situation and  form are well marked by the blood not entering
into it on removing the pressure.   It has been said that the cicatrices of incised
wounds are linear, but that is not always the case; in general, they are more or
less elliptical, being wider in the centre than at the two ends,—this appears to
be due principally to the elasticity of the skin and the convexity of the subjacent
parts: thus it is well known that in every wound on the living body the edges 
CHARACTERS OF CICATRICES.
235
are much separated in the centre, and this physical condition influences the pro-
cess of cicatrization.   When the wound is  in  a hollow surface, or over a part
where  the skin is not stretched, as in the armpit or groin, then the cicatrix may
be linear or of equal width throughout.   If there were any loss of substance in
an incised wound, or if the wound were lacerated or contused, the cicatrix would
be irregular, and the healing would proceed by granulation.  The process might
here occupy five, six, or eight weeks, according to circumstances.   When healed,
the cicatrix would be white, and have a puckered appearance; the surface of the
skin would be uneven.   (See an essay on  this subject by Dr. Kriigelstein,
Henke's Zeitschrift der S. A. 1844, ii. 75.)
   Is a cicatrix always a consequence of a wound?—If we here use the term
wound in the sense in which it is commonly employed in jurisprudence,—i. e.
where  the  breach of continuity affects the layers of the true skin, a cicatrix is
always produced in the process of healing.   In even cuts made by a very  sharp
instrument, especially if they be in the direction of the fibres of subjacent mus-
cles, and the parts be kept in close apposition, the cicatrices are  even, linear, and
sometimes  so small as to be scarcely perceptible.  If, besides, the skin be white,
they may be easily  overlooked.  AVounds of this kind  are  not,  however, com-
monly the  subject of  a medico-legal inquiry.  If, then, on examining a part,
where  at some previous time a stab or a cut  is alleged to have been received, we
find no mark or cicatrix, it is fair to assume  that the allegation is false, and that
no wound has been inflicted, making due allowance for the fact that mere abra-
sions of  the cuticle, or very slight  punctures and  incisions, often heal without
leaving any well marked cicatrices.
   Is a cicatrix, when once formed, ever removed, or so altered by time as to be no
longer recognisable?—This  is rather an important  question, which sometimes
presents itself  to a medical  jurist both  in civil and criminal proceedings.   They
who have given close attention to this subject agree in considering that cicatrices,
when they are once  so produced in  the cutis as to be easily perceptible, are in-
delible :—they undergo no sensible alteration in their form or other external cha-
racters.  The tissue of which a cicatrix  is formed is different from that of the
skin;  it is harder and less vascular,  and is destitute of rete mucosum, so that its
whiteness,  which is particularly remarkable on the cicatrized skin of a negro, is
retained through life.  If any cicatrices were easily obliterated, it would be those
which  are even and regular,—the results of incised wounds by sharp instruments;
but from my own observation, I can  undertake to say that cicatrices of this kind
have certainly retained their characters unchanged in one instance for twenty, and
in  another for twenty-five years.  According to the observations of Dupuytren
and Delpech, the substance of a cicatrix is not converted into true skin—it never
acquires a rete mucosum.  In the cicatrices of lacerated and contused wounds,
the form of the weapon with which  the wound was inflicted is sometimes indi-
cated.   It  is not, however, easy to distinguish  the cicatrix of a stab from that
produced by a pistol-bullet fired from a distance.  In both cases the edges may
be rounded and irregular, unless the stab has been produced by a broad-bladed
weapon.
   Characters of cicatrices.—It is important to observe that all cicatrices are of
smaller size than the original wound; for there is a contraction of the skin during
the process of healing.  This is especially observed with  regard to the cicatrix
of  a stab.   The recent wound, as  it has been  elsewhere stated, is apparently
smaller than the weapon; and the resulting  cicatrix is always smaller  than the
wound.  Hence it is difficult to judge of the size of the weapon from an exami-
nation of the cicatrix. In gun-shot wounds, if the projectile has been fired from
a distance, the cicatrix is of less diameter than the  ball:—it represents a disk
depressed in the centre, and attached to the parts  beneath; while the skin is
in a state of tension from the centre  to the circumference.  If the bullet has been
fired near the body, the cicatrix is large, deep, and very irregular.  If the pro- 
236
HOW LONG DID THE DECEASED SURVIVE?
jectile has made two apertures, the aperture of exit is known by the greater size
and irregularity of the cicatrix.
   When was the wound inflicted?—When an individual is not seen until  after
death, and there are recent wounds  on his body, a medical jurist may be re-
quired to state at what period  they were probably inflicted.  It may be taken as
a general rule that there are no appreciable changes in any wound until eight,
ten, or twelve hours have elapsed from the time of its infliction;  then we  have
the various phenomena of inflammation, followed by adhesion, suppuration, or
gangrene, during any of which stages the wounded person may die.   Some re-
marks have already been made on the time at which adhesion  and suppuration
become established in wounds; and with respect to gangrene it may be observed,
that the deceased must have survived at least fifty hours, in order that this pro-
cess should be set up:—in old persons it may take place earlier.
   In  examining a dead body, we must  take care not to confound the effects of
putrefaction in a wound with those of gangrene.  Putrefaction always commences
sooner in parts which are wounded than those which are uninjured; but the gene-
ral appearance of the body will show whether the changes in the wound are or
are not due to putrefaction.  The collapse  of the eye will indicate the existence
of this process;  but the presence of  warmth or rigidity of the members will show
that death may have been too  recent for putrefaction to have become established.
The time at which a severe contusion has been  produced may be commonly de-
termined  by noting  the changes of colour which take place around it.   It is
rarely until after the lapse of  twenty-four or thirty-six hours that these changes
of colour  appear.  (See Ecchymosis, ante, p. 177.)  The livid circumference
passes into a green  circle, which  is gradually diffused into a wide straw-yellow
band, bounding the ecchymosis on  every side, if it be in a free or loose part of
the skin.   In four, five, or six days, the dark livid colour slowly disappears  from
the circumference to  the centre, while  the coloured bands spread more widely
around. A central dark spot may be perceived  after ten days or a fortnight, and
in a very extensive ecchymosis it is some  weeks  before all traces of it are  lost.
The rapidity of these changes will be modified by circumstances elsewhere stated.
Observations of this kind often lead to useful results when proper caution has
been taken.  The appearances presented by a contusion inflicted recently before
death, and of another inflicted some days before, are of course different; and by
an appreciation of this difference, a  person  charged with murder may or may not
be connected with one or the other period of infliction, or with both.  In a case
of alleged  manslaughter, in which I was consulted some years  since, there  were
found on the person of the deceased, the wife of a mechanic, the marks of severe
bruises; some of them, in the immediate neighbourhood of each other, had the
rings of colour peculiar to a disappearing ecchymosis, while others had not.  The
man alleged in his- defence that he had only struck his wife once, a few hours be-
fore her death, whereas the above medical facts proved not only that the deceased
had been struck more than once, but that some of the blows must have been in-
flicted probably  several  days before  her death.   These inferences were corrobo-
rated  by the evidence of an apprentice who had witnessed the assaults.
  Such is  an outline of the facts which may occasionally enable us to say how
long before death particular injuries have been received;  or to assign a probable
period for  their  infliction on  the living.   By their aid we may have it in our
power to determine whether two wounds found  on a dead body were or were not
inflicted at or about the same time.  The law in these cases seldom requires a
very precise medical opinion;  indeed, it would be scarcely possible to give this
under any  circumstances.  If  a medical witness can only state about  what time
the injury was inflicted, circumstantial evidence will make up for the want of
great  medical precision  or accuracy  on the  point.
  How  long did the deceased survive?—This question, it will  be perceived, is
indirectly connected with the  preceding, although sometimes  put with an en- 
             INJURIES TO THE HEAD NOT IMMEDIATELY FATAL.          237

tirely different object.   Supposing the wound not to have been such as to prove
rapidly fatal, the length of time which a person has survived its infliction  may
be determined by noting whether it has undergone any changes towards healing,
and in what degree.   As a wound remains in the same state for about eight or
ten hours after its  production, it is not possible to say within this period  how
long the person may have survived.   Then it has been supposed that a medical
opinion  might be formed  from the nature of the injury, and the parts which
it  has involved.   Thus, a wound may have involved  large blood-vessels, or or-
gans important to life:  in this case it is pretty  certain that the individual must
have died speedily.  Let  us, however, bear in  mind  that these so-pronounced
rapidly mortal wounds do not  often prove fatal for  some  hours  or days—a fact
which has been much overlooked  by surgeons, although of considerable import-
ance in relation to  the medical jurisprudence of wounds.
                           CHAPTER  XXXII.

 ACTS INDICATIVE OF VOLITION AND LOCOMOTION—INJURIES TO THE HEAD NOT IMMEDIATELY
  FATAL--WOUNDS OF THE HEART NOT IMMEDIATELY FATAL--WOUNDS OF THE CAROTID
  ARTERIES--LOCOMOTION AFTER RUPTURES OF THE DIAPHRAGM AND BLADDER--SUMMARY.

  Acts indicative  of volition and locomotion-—In cases of death from wounds
 criminally inflicted, it  is often a matter  of serious  inquiry, whether a person
 could have  performed  certain actions, or have moved  after receiving an injury
 which is commonly regarded as necessarily mortal,  and likely  to  destroy life
 speedily.  In respect to wounds of a less grave description, if we except those
 affecting the members directly,  which will be hereafter examined, the power of
 willing and moving in the person who  has  received them cannot be disputed.
 The best way of treating this  subject will be, perhaps, to select a  few cases of
 severe injuries to important parts or organs, which are  usually considered to de-
 stroy life speedily.   The question relative to the power of exercising volition
 and locomotion  has been chiefly confined to those cases in  which there were in-
 juries to  the head, wounds of the heart, the large blood-vessels, the diaphragm,
 and bladder.
  Injuries  to the head not  immediately fatal.—The following case occurred a
 few years since  in  the Norfolk and Norwich Hospital:—A boy, owing to the
 bursting  of  a gun, had the breech-pin lodged in his forehead.  He got out of a
 cart, in which he had been brought four or five miles,  and walked into the hos-
 pital without assistance.  The pin was firmly impacted in the frontal bone about
 the situation of the longitudinal sinus.  On its removal, a portion of brain came
 away, with several pieces  of bone, and the aperture in the cranium was nearly  an
 inch in diameter.  Symptoms of coma then came on, and the boy died in forty-
 eight hours.   The brain was found to  be  considerably injured.   (Med. Gaz.
 xviii. 458.)   Mr. Watson mentions  a  similar case.  During a quarrel between
 father and son,  the latter  threw a poker  at the former with such violence that
 the  head of the poker stuck fast  in his forehead, and was with some difficulty
 withdrawn.  The father asked those who were near him to withdraw the weapon,
 and  he was  afterwards able to walk to the infirmary.  He died from inflamma-
tion  of the  brain.   (On  Homicide, 62.)  A case occurred to Dr.  AVallace,  of
Dublin, in which a man fell from a scaffold on the summit of his head.   He was
stunned by the fall, but on reaching the hospital, dismounted from the car which
conveyed him, and walked up stairs with very little assistance.  He died in three 
238          WOUNDS OF THE HEART NOT IMMEDIATELY FATAL.
days, but he remained perfectly rational, and was enabled to get up and go to the
water-closet the day before his death.  On inspection, there was only a slight abra-
sion on the vertex, but the skull was found split into two nearly equal halves from
the frontal bone backwards, through the sagittal suture to the foramen magnum.
The longitudinal  sinus was  laid open  throughout.   In both hemispheres there
was a large quantity of effused blood in a  semi-coagulated state; and more than
two ounces were found at the base of the  skull.   (Lancet,  April, 1836.)  Sup-
posing this person to have been  found dead with such extensive  injuries,  the
medical opinion would probably have been that he was not likely to have lived
or moved  afterwards; and yet the power of volition and  locomotion remained
with him for two entire days!
   It is easy to conceive many cases in  which a question of this kind will be of
material importance.   For instance, a man may fall from a height, and produce
a severe compound fracture  of the skull.  He may, nevertheless,  be able to rise
and walk  some distance before he falls  dead.   Under these circumstances there
might be a strong disposition to assert  that the deceased must have been mur-
dered:—the  injuries  being  such that  they could not have  been produced by
himself, there being at the same time no weapon near, and no height from which
it might be supposed that he had fallen.
   [According to Dr. F.  D. Lente, in his statistics of fractures  of the.skull
during  twelve years  in the  New York Hospital (New York Journ. Med., Jan.
1852, and Am. Journ. Med. Sci. April, 1852, 578,) in not one of  106 fatal cases
"did death follow the receipt of the injury, until after the lapse of some hours, even
 in the most desperate cases;  nor does it appear to be possible for an ordinary blow
upon the head, producing fracture of the skull, to cause immediate death."   He
subsequently reminds us that, in a recent criminal trial of great interest, "it was
much discussed whether a blow upon the head with an ordinary weapon capable
of inflicting death could produce this result instantaneously.   Many eminent
surgeons were examined, and the general  impression was that the thing was ex-
ceedingly improbable, if not impossible, and  the  question was  thus decided."
Prof. F. II. Hamilton, of Buffalo, is stated by Dr. Beck to have arrived at a similar
result in his account of thirty-three cases  of fractured cranium, twelve of which
Were fatal.   (Am. Journ. Med. Sci. Jan. 1853, 254.)   See also Am.  Journ.
Med. Sci.  April, 1852, 579, for two remarkable cases of long survival after injury
of the head.  We might add many others, some  of  which occurred under  our
eyes at  the Pennsylvania Hospital, Philadelphia.   Still, rare as immediate death
must certainly be in consequence of wounds or other injuries by violence upon
the head,  we are not disposed to admit  their impossibility as by any means estab-
lished, although we are unable to recall a single instance in contradiction to the
negative assertion.—H.]
    Wounds of the heart not immediately fatal.—Wounds of the heart were
formerly considered to be immediately  fatal to life, but this only applies to those
wounds by which the cavities  of the organ are extensively laid open.   Persons
who have sustained wounds of the heart have frequently lived sufficiently long
to exercise the powers of  volition and locomotion.   Mr. Watson met with a case
where a man who.had been stabbed in the  right ventricle ran eighteen yards after
having  received the wound.   He then fell, but was not  again able to rise; he
died in  six hours.  On dissection, it was found that a punctured  wound had ex-
tended into the right ventricle in an obliquely transverse  direction, dividing in
its course the coronary artery.  The pericardium  was nearly filled with blood,
and about four pounds  were extravasated on the left side  of tho thorax.  (On
Homicide, 9S.)  One of the most remarkable instances  of the  preservation of
volition and locomotion after a severe wound of  the heart will be found reported
in the Medical Gazette (xiv. 344.)  In this case the patient, a boy, survived five
weeks,  and employed himself during that period in various  occupations.   After
death a mass of wood was found lodged in the substance of the heart.   Had this 
LOCOMOTION AFTER RUPTURE OF THE BLADDER.          239
boy been found  dead with such an injury it is most probable  the opinion would
have been that his death was instantaneous.
  [Cases in which persons have taken a few steps after fatal wounds of the heart
or large vessels, are not very rare.—Beck (Med. Jurispr. ii. 329—332,)  cites
numerous examples, and  among others, that of Dr. Randall, noted in the last
Am. ed. of this work, in which the patient, a negro boy, lived sixty-seven days,
and at one time walked about, after being shot in the chest with a fowling piece,
and was then found to have received three shot in the right ventricle and two in
the right auricle.—H.]
  In these cases, little or no blood probably escapes from the heart in the first
instance, but it may afterwards continue to ooze gently, or suddenly burst out in fa-
tal quantity. It must not, therefore, be supposed, when a person is found dead with
a wound of the heart, attended with abundant hemorrhage, either  that the flow
of blood took  place in an instant, or that the person died immediately and was
utterly  incapable of exercising  any voluntary power.   Only one  circumstance
will justify a supposition of this kind—namely, where the cavities of the organ,
more especially the auricles, are  largely laid open.
   Wounds of the carotid arteries not immediately fatal.—Questions relative  to
the power of locomotion perhaps more frequently occur with respect to wOunds
of the  great blood-vessels of the neck than of the heart,—suicide and murder
being more  commonly perpetrated  by this means.   There are several cases on
record  which show that wounds involving the  common carotid artery and its
branches, as well as the internal jugular vein, do not prevent the individual from
running for a certain distance.
  There is, however, one circumstance which requires notice in relation to severe
wounds in the throat—namely, that although the individual may have the power
of locomotion, he may not be able  to use his voice so as to call for assistance.  It
sometimes  excites surprise at an  inquest, how  a murder may in this way be
committed without  persons in an adjoining room hearing any noise;—but the
fact is well known medically, that  when the trachea is divided, as it generally is
on these occasions, the voice is lost.
  Locomotion after ruptures of  the diaphragm.—A rupture  of the diaphragm
has been considered sufficient to  deprive  a person of the power of locomotion:—
but there appears to be no good ground  for this  opinion.   The general effect of
such an injury may be  to incapacitate a person; but the question is put  to a
medical jurist as to the possibility of a wounded party being able to move or
walk after the injury,—and this, as a general rule, must  be admitted.
  Locomotion after ruptures of  the bladder.—In ruptures  of the  bladder, at-
tended with extravasation of urine, the  same  question as to the existence of a
power of locomotion has arisen.   By the answer to this we may sometimes de-
termine whether the rupture was the result of homicide or accident.  The following
cases will show that this power does exist in some instances, although the general
result is perhaps  to  incapacitate the individual from  moving:—A man, aged
thirty-one, while intoxicated, received a  blow on the lower part of his abdomen.
He was sobered by the accident, and walked home, a distance of a quarter of a mile,
although suffering the greatest agony.   When seen in the evening, twelve ounces
of bloody urine were drawn off  by the  catheter, and he  complained of having
felt cold immediately after he had received the blow.  He  died four days after the
accident.  On inspection, there was no mark of bruise or  ecchymosis on any part
of the abdomen.  The bladder was ruptured in its upper and posterior portion for
about an inch. (Lancet, May 14, 1842.) The second case was related to me by
a pupil.  A gentleman who had been compelled to retain his urine fell acciden-
tally in  descending a staircase, with the  lower part of  his abdomen against the
edge of one of  the  steps.  The sense  of fulness in his bladder immediately
ceased, and he walked to a friend's house to dinner.  The nature of the accident
was mentioned to a surgeon  there  present,  who  immediately  suspected that the 
240
STRUGGLING IN WOUNDS OF THE CHEST.
bladder must have been ruptured.   The case terminated fatally in twenty-four
hours.   A case is reported by Mr. Ilird, in which a man walked the distance of
two miles after having sustained a rupture of the bladder; and in another which
occurred in January, 1852, communicated to me by Mr. Rake of Newark, the man
who sustained the injury in a scuffle was able to walk a mile between two and three
hours after  the occurrence.   (Lancet, Oct. 31, 1846, 480.)   Thus, then, from
these various instances, it is  evident that locomotion and muscular exertion may
take place after an accident of this description.
   Summary.—Under survivance from many severe accidents or personal injuries,
this power of moving, if not  exerted to a large extent, may take place in4a small
degree, and this may become  occasionally an important question in legal medicine.
Thus it must not be lost sight of, when we are drawing inferences as to the re-
lative position of a murderer and a murdered person from the situation in which
the body of the deceased is  found.   A dead  man, with a  mortal  injury to the
head or heart, may be found lying on his  face,  when he actually fell upon hia
back, but still had had sufficient power to turn over before death; or he may have
fallen on his face, and have  afterwards moved, so that the body may be lying on
the back.   A slight motion  of this kind is  very easily executed,—it does not al-
ways depend on volition. Individuals  suffering under severe concussion have
been frequently known  to perform acts unconsciously and automatically.
   The cases related may perhaps  be considered  rare, and as exceptions to  the
general rule.   The medical jurist must bear in mind, however, that he is not re-
quired to state in  how many, out of a given number of individuals similarly
wounded, this power of performing acts indicative of volition and locomotion may
remain, but simply whether the performance of  these acts be or be not possible.
It is on this point only that the law requires information.   The hypothesis of
guilt, when  we are compelled to judge from circumstances  in an unknown case,
can only be  received by the  exclusion of every other possible explanation of the
facts.   As a matter of surgical prognosis or treatment, such cases, from their
rare occurrence, may have little influence; but in legal medicine the question is
widely different.   Medical facts, however rare, here admit of a very important
and unexpected application.
   Although, in cases of severe wounds, we may allow it to be  possible that per-
sons should  survive for  a sufficiently long period to perform ordinary acts of vo-
lition and locomotion, yet the presence of a mortal wound, especially when of a
nature to be accompanied by great  hemorrhage, must prevent all struggling or
violent  exertion on  the part of the wounded person,—such exertion we must
consider to be quite incompatible with the condition of the wounded person.  In
this way a medical jurist may occasionally be able to determine whether a mortal
wound found on the deceased has been inflicted for the purpose of murder or in
self-defence, as the following case, reported by Mr. Watson, will show:—A man
was tried at the Lancaster Assizes in 1834, for the murder of a woman at Liver-
pool, by stabbing her in the chest.   Prisoner and  the  deceased, with two other
females, were  quarrelling in the passage of a house.   A struggle ensued between
the prisoner and deceased, which one of the witnesses said lasted for ten minutes.
AVhen the prisoner had reached the door, he pulled out a knife and stabbed the
deceased in  the chest.  She fell, and died almost  immediately.   The prisoner
alleged that he was attacked by several persons, and that he stabbed the woman
in self-defence.  The judge  said, if the blow had been struck with premeditation
before the struggle, the crime would be murder;—if during the struggle, it would
be manslaughter.  The medical evidence  showed that the blow could not have
been struck  before the struggle, because it was of a speedily mortal nature; and
the deceased would not then have been able, as it was deposed to by the witness,
to struggle and exert her strength with  the prisoner for ten minutes afterwards.
This being the case, it followed that in all medical  probability the deceased had
received the blow towards the conclusion of the quarrel;  and therefore it might 
STRUGGLING UNDER FATAL WOUNDS.                 241
have been inflicted while the prisoner was attempting to defend himself.   The
jury returned a verdict of manslaughter.
   Struggling under fatal wounds.—A case involving this important medico-legal
question was tried at the Gloucester Lent Assizes, 1849 (Reg. v. Hobbs.)   The
prisoner was indicted for the wilful murder of a man with whom  he had been
drinking and quarrelling.  It appears that in the  early part  of the quarrel  the
deceased threw the prisoner down and struck him  unfairly.   The  deceased was
told by the landlord of the inn to go home.   He replied, "Very well," and then
leaving the  prisoner went  through the entrance arch of the inn  up the yard,
which was his usual way of going home.  About  seven minutes afterwards, the
prisoner, who had complained to the landlord of the maltreatment  which he had
undergone, returned into the inn-yard, and was seen on entering it to pull down
his waistcoat and button his coat.  A witness advised him to go home, and he
left the spot.  A short time afterwards the  deceased was found  at the  back of
the yard, lying on his face, and quite dead.   On examining the body it was
found that the deceased had been stabbed in two places, one of the stabs having
penetrated  the ventricle of the heart.  On apprehending the prisoner, a large
clasp  knife was found in his pocket stained with blood.  The prisoner admitted
that he had  stabbed the deceased, but  said it was  during the  quarrel, and that
he used the knife in self-defence while they had him on the  ground.   This was
the defence.  For the  prosecution it was argued that the deceased had been
stabbed by the prisoner subsequently to the quarrel—that he had gone through
the gate into  the  yard to meet  the  deceased, had there stabbed him, and had
caused his instant death.   The medical witness  who was called  stated  at first,
that from such a wound death must have  been  instantaneous.  In cross-exami-
nation, however, he admitted that the deceased might have lived some time after
he had been stabbed, and on this evidence the  prisoner was convicted  of man-
slaughter, and sentenced to six months' imprisonment.
   The medical facts  of this case are rather imperfectly reported: hence it is
difficult to give a decided opinion respecting the time at which the  deceased was
stabbed in the heart.   It  is true  that the Duke de Berry survived a punctured
wound of one of the ventricles for the long period  of eight hours: but every case
must  be judged by the special circumstances accompanying it.  The  size of the
stab in the ventricle is not stated; nor is  it in  evidence whether any blood was
found on the spot where the deceased was struggling with the prisoner.  That
the deceased should have struggled with the prisoner for one minute  after being
stabbed in the ventricle of the heart, is contrary to all medical probability.   It
is also irreconcilable  with  the existence of such a  wound, that  the deceased
should have spoken to the landlord—that he should not have called the attention
of the latter to the fact of his having been stabbed by the  prisoner while strug-
gling  with him,—that he should have been stabbed in the heart without knowing
it, or  without being aware of his condition,—that he  should have been  able
thereafter to walk away through  the inn-yard to the house,  and survive seven
minutes while thus walking; and yet all these circumstances must have happened,
in order that the defence, and the verdict based upon it, should be true.  Taking
the facts as  reported, it is, it appears to  me, impossible to arrive  at any  other
conclusion than that the deceased was stabbed by the prisoner subsequently to
the quarrel, while he was walking through the inn-yard.  The only circumstances
for the defence were  the prisoner's statement, and that, in some  rare cases,
wounds of the heart do not prove immediately fatal.
16 
242                       WOUNDS OF THE HEAD.
                           CHAPTER XXXIII.

WOUNDS AS THEY AFFECT DIFFERENT  PARTS OF  THE BODY—WOUNDS OF THE HEAD—
  OF THE SCALP--CONCUSSION--HOW  DISTINGUISHED FROM INTOXICATION--EXTRAVASA-
  TION OF BLOOD--SEAT OF--AS A RESULT OF VIOLENCE, DISEASE, OR MENTAL EXCITE-
  MENT—WOUNDS OF  THE FACE—OF THE ORBIT—OF THE NOSE—DEFORMITY AS A CON-
  SEQUENCE  OF WOUNDS  OF  THE FACE—INJURIES TO  THE SPINE—FRACTURES OF  THE
  VERTEBRA—DEATH FROM INJURIES TO THE SPINAL MARROW.

  The danger of wounds, and their influence in causing death, are the two prin-
cipal points to which the attention of a medical jurist must be directed.

                           WOUNDS OF THE HEAD.
  Incised wounds affecting  the scalp rarely produce any serious effects; but this
will, of course, depend on their extent.  When the  wound is contused, and ac-
companied by much laceration of the integuments, it is highly dangerous, in con-
sequence of the tendency which the inflammatory process has to assume an ery-
sipelatous character.  The results of these wounds are, however, often such as to
set all general rules of prognosis  at defiance.  Slight punctured wounds will
sometimes terminate fatally in consequence  of inflammation being set up in  the
tendon of the occipito-frontalis, followed by extensive  suppuration beneath; while,
on the other hand, a man will recover from a lacerated wound by which the greater
part of the integuments may have been stripped from the bone.  There are  two
sources of danger in wounds of the scalp: 1. The access of erysipelatous inflamma-
tion.  2. Inflammation of the occipito-frontalis tendon, followed or not by the pro-
cess of suppuration.  Either of these secondary effects  may operate fatally in slight
or severe wounds.   Neither can  be  regarded  in the  light of an unusual  conse-
quence of a severe wound of the scalp; but when one or other follows a very
slight injury, there is reason to suspect that  the patient may have been constitu-
tionally predisposed; and if fatal effects follow, the influence of the predisposition
might  be considered as a mitigatory circumstance.   Bad treatment may likewise
lead to a fatal result from a wound not regarded as serious in the first instance;
l)ut the question,—how far the responsibility of the  aggressor would be affected
by a circumstance of this nature has been considered in another place, (ante, p.
229.)  Wounds of the head are  dangerous in proportion as they affect the brain;
and it is rare that a severe contused wound is  unaccompanied by some injury to
this organ.  There is, however, a difficulty with which the practitioner has here to
contend—namely,  that it is scarcely possible to predict, from the external appear-
ance of the wound, the degree of mischief which has been produced internally.
These injuries, as it is well  known, are very capricious in their after-effects; the
slightest contusions  may be attended with fatal consequences, while fractures,
accompanied by great depression  of bone, and an absolute loss of substance of the   *
brain, are sometimes followed by perfect recovery.  (Cormack's Jour., Sept. 1845,
653;  Med. Gaz. xxxix. 40;  and  Phil.  Med. Exam. Nov. 1845, 696.)  Another
difficulty in the way of forming a correct prognosis consists  in the fact, that an
individual may recover from the first effects of an injury,  but after a short time
he will suddenly die; and on  examination of the  body, the greater part  of the
brain will be found destroyed by the suppurative process, although no symptoms
of mischief may have manifested themselves until within a few hours of death.
   Concussion.—The common effect of a violent contusion on  the head is to pro-
duce concussion or extravasation of blood, or both.  In concussion, the symptoms
come on at once, and the patient, if  severely affected,  sometimes dies without any
tendency to reaction manifesting itself.   But the period at  which death takes 
                  INJURIES OF THE nEAD.   CONCUSSION.                243

place is liable to vary: a man may die on the spot, or he may linger in a state
of insensibility several days, and in either case after death, no particular morbid
change may be discovered; there may be simply abrasion.  In  the case of Reg.
v. Burgess, (Liverpool Lent Assizes, 1845,) the deceased fell and died on  the
spot, and there was no lesion externally or internally. The state of insensibility
observed in concussion is sometimes only apparent.   Mr. Guthrie relates the fol-
lowing singular case:—A gentleman who had met with an accident on board of
a vessel at sea, while lying apparently deprived of sense and motion, heard a dis-
cussion between  a relative and another person, who supposed he was dying, as to
how they should dispose of his body, and he was conscious of his utter inability
to make any movement indicating that he was alive and understood their conversa-
tion.   Fortunately they resolved to convey him to the  port to which the  vessel
was bound.
  Inflammation  may  follow  the primary shock  from  concussion—suppuration
will take place, and the patient may die after the lapse of some weeks, or even
months. It is important, in a medico-legal point of view, to notice that an indi-
vidual may move about  and  occupy  himself, while  apparently convalescent, for
a week or  ten days  after recovery from the first shock, and then suddenly be
seized with fatal symptoms and die.  This apparent recovery leads to the com-
mon supposition, that death must have been produced by some intervening cause,
and not by violence to the head,—a point generally urged in the defence of such
cases.   When the inflammation that follows concussion is of a chronic character,
the person may suffer from pain in the head and vomiting, and die after the lapse
of weeks, months, or even years.   A case is mentioned by Hoffbauer, where the
person died from the effects of concussion of the brain, as the result of an injury
received eleven years before.   (Ueber die Kopfverletzungen, 1842, 57.)  Con-
cussion may sometimes take place as a consequence of a violent fall on the feet,
in which case the head receives a  shock through the medium  of the spinal co-
lumn.   The skull may be extensively fractured, and the brain may be even
shattered by such a fall.   This was the  cause of death in the Duke of  Orleans.
(Med. Gaz. xxxvi. p.  368.)
   Concussion distinguished from  intoxication.—The symptoms under which a
wounded person  is labouring may be sometimes attributed to intoxication, and a
medical witness may be asked what difference exists between this state  and that
of concussion.  The history of the case will, in general, suffice to establish a  dis-
tinction, but this cannot always be obtained.  It is commonly said that the odour
of  the breath will detect intoxication;  but it is obvious that  a man may meet
with concussion  after having drunk liquor insufficient to cause intoxication, er
concussion  might  take place while he is intoxicated,—a combination which  fre-
quently occurs.  Under  such circumstances we must wait for  time to develope
the real nature of the case; but concussion may be so slight, as sometimes closely
to resemble intoxication; and in the  absence of all marks of violence to  the head
and the existence of a spirituous odour in the breath, the medical examiner might
be easily deceived.   If there be no perceptible odour in the breath, the presump-
tion is that the symptoms are not due to intoxication.  On the  other hand, in-
toxication may be so great as to  give rise to the apprehension of fatal conse-
quences, and the co-existence of a mark of violence on the head might lead to
error in the formation of an opinion.   AVhat is the line of conduct to be pursued
on  such occasions?  The examiner should weigh all the  circumstances, and if
there be one cause for the symptoms more probable than another, he should adopt
it:—if there be any doubt, this should be stated to the court.
  It is to be feared that medical witnesses  are not sufficiently careful on these
occasions, in determining whether  there be any signs of intoxication about the
injured person.   Subsequent proceedings may render this a most important part
of the inquiry.   In November, 1851, the house-surgeon of a  London hospital
was severely reprimanded by a magistrate, in consequence of an omission to in- 
244         EXTRAVASATION OF BLOOD FROM BLOWS AND FALLS.

quire a id satisfy himself whether, in addition to the results of violence, a police-
man who was brought to the hospital was or was not intoxicated when admitted.
The fact was of importance in this way: the injuries to the head might have arisen
from a fall, and a drunken man might readily meet with such injuries from ac-
cident.  A person was charged with an assault on the policeman, but upon very
suspicious evidence;  and in fact, could intoxication have been proved or rendered
probable, there would have  been no ground for the charge.  The medical man
had already certified that the patient was  not intoxicated, but when  pressed in
cross-examination could  not say whether he was or was not.  The case was im-
mediately dismissed.  There can be no excuse for not  making an inquiry into
the precise condition of an injured person, and arriving at the best judgment of
which the case admits.
  A state of intoxication often renders it difficult to form an accurate diagnosis
in cases of alleged criminal wounding.  Some instructive cases in reference to
this  complication of wounds have  been published by  M. Tardieu.   (See Med.
Gaz. xliv. p. 347.)   [The question of intoxication is too often lost sight of at the
proper time by the surgical  attendant, in  its relations with the cause of the  in-
jury.—In a case that was tried in Philadelphia not long since, a worthless plain-
tiff succeeded in recovering heavy damages of a rail-road company, on account of
injuries from  an  accident which there is strong reason to believe was due to his
intoxication.   The company suffered, however, for want of sufficient evidence of
this fact.—H.]
  Extravasation of blood.—A blow on the head may destroy life by  causing an
extravasation of blood on the surface or in  the substance of the brain.   In pugi-
listic combats, when a person is thus struck, he commonly falls, and  death may
take place in a few minutes.   On inspection, blood may be found effused either
at the base or in the ventricles of the brain, and  the question  may arise—Did
the injury which caused death arise from a blow or a fall?  Two cases of this
description are reported by Dr. Wharrie.   The men were knocked down by blows
with the fist, and they were taken up dead.   (Cormack's Monthly Jour. Feb.,
1846, 117.)   It is not  easy to give an answer to this question, nor is its rele-
vancy in a legal view apparent, for as it was  presumed  the blow was the cause
of the fall, it is fair  to infer that the assailant should be  responsible for the  ef-
fects of either or both.   A heavy blow on the head might cause fatal extravasa-
tion  of blood; but in these instances the  extravasation  more commonly arises
from the violent concussion which the injured person sustains by the fall.  A medi-
cal witness will therefore in general be compelled to admit that the fatal effusion
might have taken place either from the blow or the fall.
  This subject has very important applications in  legal medicine, for  this is one
of the most common causes of death in injuries to the head, and there are generally
many cases of this  description tried  at the assizes.  Extravasation  may occur
from violence, with  or  without fracture, and it may take place without there
being any external  marks of injury to the head.   In the case of  The  Queen v.
Phelps  and others (Gloucester Aut. Ass.,  1841,)  it was proved that there was
great effusion of blood, and even laceration  of the brain, in the deceased, without
any corresponding external  injuries.   See also, at the  same assizes,  the case of
The  Queen v.  Thomas.   The late Dr. Griffiths, the American editor of this work,
mentions a case which was the subject of a trial at Massachusetts, in which an
individual received a blow from a small stone, and died in ten minutes.   On
examination there was no external bruise or fracture of  the bones: the ventricle?
were filled with coagulated  blood, and all the vessels were gorged with blood.
It is remarkable that the skull was in this instance unusually thin (p. 287, Am.
ed.)   The chief source of the effusion in violence  to the head arises from a rup-
ture  of  the meningeal artery, and  this may occur from the mere shock or con-
cussion, with or without a fracture  of its bony canal.   The blood thus effused
acts  by compressing the brain: this compression does not always cause death 
               EXTRAVASATION OF BLOOD FROM EXCITEMENT.           245

unless the blood be in large quantity, or unless  it be effused in or around the
medulla oblongata.  Thus the hemispheres will  bear a degree of compression
which, if it affected that portion of the base of the brain from which the spinal
marrow proceeds, would  instantly destroy life.  The most fatal effusions, there-
fore, are those which take place in a fracture of the base of the skull, whereby
one or both lateral sinuses are commonly  ruptured.
  In cases of injuries to  the head proving fatal by extravasation of blood on the
brain, an individual may recover from the first effects of the violence,  and appa-
rently be going on well, when he will  suddenly become worse, and die.   Extra-
vasation takes place slowly at first,—it may be arrested by the  effects of stupor
from concussion, by a portion of the blood  coagulating around the ruptured
orifices of the vessels, or  by some  other  mechanical impediment  to its  escape;
but  after a longer or shorter period, especially if the individual  be excited  or
disturbed, the hemorrhage will recur and  destroy life by producing compression.
How many hours or days, after an accident, are required in order that such  an
increased effusion should take place, it is  impossible to say;  but in severe cases,
fatal extravasation is observed to follow the injury within a very short time.   Sir
Astley Cooper relates the case of a gentleman who was  thrown out of a  chaise,
and fell upon his head with such  violence as to stun him in the first instance.
After a short time he recovered his senses, and felt so much better,  that  he
entered the chaise again, and was driven to his father's  house by a companion.
He attempted to pass off the accident as  of a trivial nature, but he soon began
to feel heavy and drowsy, so that  he was obliged to go to bed.   His  symptoms
became more alarming, and he died in about an hour, as it afterwards appeared,
from extravasation of blood on the brain.
   Extravasation from disease or violence.   Diagnosis.—Blood may be found
extravasated in  various situations within the interior of the cranium; and  the
cause of the extravasation may be either disease or violence.   The  skill of a
medical jurist is often required to determine which of these causes is the more
probable, as where, for instance, a pugilist has died after having received severe
injuries to the head, and his adversary is tried on a charge of manslaughter.   On
these occasions it is often urged in the defence, that the  fatal hemorrhage might
have arisen either from  a diseased state of the vessels  of the  brain, or, if  the
evidence render it probable that the blow was the cause, that the effects of the blow
were aggravated by a diseased state of  the vessels, or  by the excitement  into
which the deceased was thrown, either from the effects of intoxication or  passion.
When the  brain is not lacerated by violence, the blood  is effused either on  the
surface of the hemispheres,—between the membranes,—or at the base.  It is not
always seen under the spot where the blow was inflicted, but often by counter-
stroke on the surface of the brain, directly opposite to it;—a case which a medical
witness has frequently been required to explain on trials, and which depends  on
the  same  cause  as fracture by counter-stroke, to be hereafter spoken of.  (See
case by Dr. Haworth, Med.  Gaz.  xxxvi.  368.)   Effusions of blood from a dis-
eased state of the vessels more  commonly take place in the  substance of  the
brain, but they sometimes occur on the surface of the organ from mere excitement
or over-exertion of the muscular powers.
   Extravasation from excitement.—When engaged in the investigation of a case
of this kind, it is always a fair matter of  inquiry whether the violence, upon  the
evidence, was not of itself sufficiently great to account for the  extravasation  of
blood without the supposition of co-existing disease  or  excitement.  Admitting
that the rupture of a blood-vessel, and the extensive extravasation of blood  on
the  brain, may  take place from  simple  excitement and passion, yet this is  an
event comparatively rare, at  least in the young and healthy,  while nothing is
more common than that  these results should  follow violent  injuries to the head
whatever the age or condition of the person.   A medical witness should remem-
ber  that on these occasions, if  he  is  unable to say positively whether the extra- 
216
WOUNDS OF THE FACE.
vasation was due to the excitement or the blows, he will satisfy the Court if he
only state clearly that which is, in his  own  mind, the more  probable  cause of
death; and by weighing all the circumstances of the case exactly beforehand, he
will rarely fail to find that one cause  was more probable than the other.  Thus,
if a man, incited by passion and intoxication, is struck on the head, and the blow
is very slight—such as an unaffected person would probably have sustained with-
out injury—yet in this case insensibility and death follow, and, on  examination,
a quantity of  blood is found extravasated in  the  substance of the brain, can it
be a matter of doubt with the practitioner that the extravasation was chiefly due
to the excitement under which the deceased was labouring?  To take a converse
instance:  a man engaged in a personal  conflict with another, is struck most vio-
lently on  the head, or falls with great force on that part of the body; on inspec-
tion, it is  found that death has arisen from extravasation of blood on the surface
of the brain, and it would be no unexpected consequence of the violence inflicted
that a similar appearance should be met with in an individual 'calm and unex-
cited,—Can the practitioner  hesitate to say, under these circumstances, that the
blow would satisfactorily account for the extravasation, without reference to any
coexisting causes of excitement: these may be allowed to have their influence in
giving an increased tendency to cerebral hemorrhage, or in aggravating the con-
sequences of the blow, but no further.

                           WOUNDS OF THE FACE.
   AVounds of the face are important on several accounts.  AArhen of any extent,
they  are  usually followed by great  deformity;  and  when  they penetrate the
cavities in which the organs of the senses are situated, they often prove fatal by
involving the brain and its membranes, or by giving rise to inflammation in this
organ.  AVounds of the eye-brows are not always of so simple a nature  as might
at first sight be  supposed.  Besides being attended by deformity when they heal,
they are liable to give rise, during the process of healing, to serious disorders of
the neighbouring parts.   Amaurosis  and neuralgia are recorded among the  se-
condary and not unusual consequences of such wounds, when the supra-orbitar
nerve has become at  all implicated.  Under certain conditions of the system,
there may be inflammation of the parts  within the orbit, extending  by contiguity
to the membranes of  the brain, and proving fatal by leading to the formation of
matter within that organ.  Amaurosis  in the right eye has been known to occur
from a contused wound, not of a very violent nature, to the right eye-brow.  Dr.
AArallace, of New York, has reported two cases of amaurosis following blows over
the infra-orbitar nerve.  (Med. Gaz. xxxi. 931.)   Wounds  apparently confined
to the external parts  of the face, frequently conceal  deep-seated  mischief.  A
sharp  instrument penetrating  the eyelid, and passing upwards with any force,
will produce fracture  of the orbitar plate of the frontal bone, which is known to
be extremely thin, and even injure the  brain beyond.
   Wounds of the orbit.—Sir Astley Cooper relates, that  a girl, while playing
with a pair of scissors, accidentally fell, and the point of the scissors passed up-
wards under the upper eyelid.   It was  found difficult to extract them; the eye
became inflamed, but for some days after the accident the child was in  the habit
of walking a considerable distance daily to receive medical advice.  In about ten
days she suffered violent pain, with symptoms of inflammation of the brain, under
which she died.  On inspecting the body, it was found that the orbitar plate of
the frontal bone had been fractured, the dura mater torn, and the  anterior lobe
of the brain lacerated.  (For a similar case, see Med. Gaz. xli. 553.)  In several
instances  in this country, trials for murder have taken place, in which death has
been caused by a penetrating wound of the orbit, leading to fracture of the orbitar
plate and injuring the brain.
   Wounds of the nose.—These wounds are,  generally speaking, of a simple na-
ture, rarely giving rise to serious symptoms, but they are almost always attended 
                      FRACTURES OF THE VERTEBRAE.                   247

with great deformity.   If the injury be  contused and, at the same time, exten-
sive, a loss of the faculty of smelling will  probably result.  A penetrating wound
of the nose, produced by passing a sharp-pointed instrument up the nostril, may
destroy life by perforating the cribriform  plate of the ethmoid bone and injuring
the brain.  Such a wound, it is obvious, might be produced without leaving any
external marks of injury.   Dr. Corkindale, of Glasgow, met with a case in which
a man died in nine weeks from the effects of a wound of the nose, whereby the
nasal bones were fractured.   On  inspection, there was copious inflammatory ef-
fusion at the  surface of the brain, particularly at the part corresponding to the
seat of the violence.   An injury to the bones  of the nose may prove fatal by
giving rise to an attack of tetanus.  A case of this kind has been elsewhere re-
lated.
  Deformity as a  consequence of wounds  of the face.—AArounds of the face, when
at all extensive, are always followed in healing by greater or less deformity.   The
medical witness may perhaps find  these questions put to him in relation to them.
Is the wound likely to  be attended with deformity?   Could such a wound of the
face heal without deformity? or could the deformity, if it exist, have been pro-
duced by any other cause than the wound?   These  questions are of more im-
portance  than may at first sight appear.   Thus a person may allege that he was
severely wounded  in the face, when the-medical witness, on examination, may
find no trace  of such  a wound as  that  described.   Again, a person may seek
damages  from another  in a civil action, by alleging that  a particular  deformity
was produced by a wound, when  the medical witness may be  able to trace its
origin to disease, or to  some accidental cause.

                          INJURIES TO  THE SPINE.
   Injuries to the spine and spinal marrow seldom require medico-legal investiga-
tion; but this  organ is liable to concussion  from blows, to  compression from
fracture of the vertebrae, or the effusion  of blood, with all the secondary conse-
quences attending  such accidents.  Concussion of the  spinal marrow  commonly
produces paralysis; but the symptoms may be of a still more alarming kind; and
after death no traces  of  mechanical injury may be  discovered.   Blows on the
spine unattended with fracture or dislocation, may, according to the observations
of Sir B. Brodie, be followed by inflammation and softening of the spinal marrow.
A slight  injury has been known to cause death by giving rise to inflammation
of the spinal marrow.   (See Henke's Zeitschrift der  S. A. 1840, ii. 407.)   This
organ is also  liable to compression from very slight causes.
   Fractures of the vertebrce.—These fractures are generally attended by displace-
ment and compression  of  the spinal marrow.  They are the more rapidly fatal,
in proportion as the injury is high up  in the  vertebral column.  The whole of
the body becomes  paralyzed below the seat of  injury, by the compression of the
spinal marrow.  If the seat of compression be above the fourth cervical vertebra,
death is commonly immediate: asphyxia results from  paralysis of the phrenic
nerves. •  In falls  on the vertex  from a  height, it sometimes happens not only
that the skull is extensively fractured, but that the dentiform  process of the se-
cond vertebra is broken off, owing to the head  being  doubled under the body.
This might really  be the cause of death.   From a case related by Mr. Phillips,
it would  appear that this accident is not always attended by fatal compression
of the spinal  marrow.   (E. M. & S. J., Jan. 1838.)   In a second case the indi-
vidual survived fifteen months (ib. Oct. 1845, p.  527;) and in a third, where
the fracture was caused by the patient turning in bed while his head was pressed
on the pillow, death did not take  place for sixteen months.   (Copland, Diet. Pr.
Med., Paralysis.)   On several criminal trials, this  injury has been  proved to
have been the cause of death; and in a  memorable case, tried at Glasgow some
years since (The King  against Reid,) it  became a material question, how far an
injury of this kind might  result from disease.  It may happen that caries of the 
248
WOUNDS OF THE CHEST.
bone or disease of the transverse ligament will cause a separation of the denti-
form process from the second cervical vertebra.   The state of the bone  should,
therefore, be closely examined.  In Reid's case  an acquittal took place, partly
because the  deceased had laboured under disease of the spine, and the exact
state of the parts had not been noticed.  Disease of the ligaments may also  lead
to a separation, followed by slow or rapid death, according to the degree  of pres-
sure.
   Injuries to the spine and its contents are generally the result of falls or blows
either on the head or the lower part of the column.  The  secondary consequences
of these injuries are  sometimes very insidious, so as to disarm suspicion,  and
death may take place quite unexpectedly some weeks after the accident.   Spicula
of bone separated by fractures may remain adherent for some time;  and by a
sudden turn  of the head, be forced off and destroy life by penetrating the spinal
marrow, at a long period after the  infliction of the injury.  This has been known
to happen in fractures  involving the margin of the foramen magnum, and in
such cases death is immediate.  The  spinal marrow has been  in  some instances
wounded in its upper part by  sharp-pointed instruments  introduced between the
vertebrae.   Death is an instantaneous result when the wound is above  the third
cervical vertebra:—there is no part of the spine where a weapon can so readily
penetrate  as  this, especially if the  neck, be slightly bent forward.   The external
wound thus  made may be  very small, and  if produced  with  any obliquity by
drawing aside the integuments, it  might be easily overlooked, or it might be set
down as superficial.   For a medico-legal account of a case in which death occurred
from a stab in the back of the neck, causing a division of the spinal marrow, see
Henke, Zeitschrift der S. A. 1839, H. ii. 1836.
                           CHAPTER  XXXIV.

WOUNDS OF THE CHEST--OF THE LUNGS--RUPTURES FROM  ACCIDENT--WOUNDS AND RUP-
  TURES OF THE HEART--WOUNDS OF THE AORTA AND VEN.2E  C&VJE--WOUNDS AND RUP-
  TURES OF THE DIAPHRAGM--DIRECTION OF WOUNDS OF THE CHEST--WOUNDS OF THE
  ABDOMEN--DEATH  FROM  BLOWS ON THE  CAVITY--RUPTURES OF THE LIVER, GALL-
  BLADDER, SPLEEN, KIDNEYS,  INTESTINES, STOMACH,  AND URINARY BLADDER--MEDICO-
  LEGAL QUESTIONS CONNECTED WITH RUPTURED BLADDER--WOUNDS OF THE  GENITAL
  ORGANS--MUTILATION.


                          WOUNDS OF THE CHEST.

  Wounds of the chest have been divided into  those which are  confined to the
parietes, and those which  penetrate the cavity.   This division is important, so
far as it relates to the prognosis of such injuries.  Incised or punctured  wounds
of the parietes of the chest are rarely followed by dangerous consequences.  The
hemorrhage is  not  very considerable, and is generally  arrested without much
difficulty.   They heal either by adhesion or suppuration, and unless their effects
be aggravated  by incidental circumstances, the prognosis is  very favourable.
Contusions or contused wounds of the thoracic parietes are, however, far more
dangerous, and the danger is always in a ratio to the degree of violence used.
Such injuries, when  severe,  are ordinarily accompanied by  fractures of the  ribs
or sternum,—by a rupture  of the viscera within the cavity, including  the dia-
phragm,—by profuse hemorrhage,—or, as an after-effect, by inflammation of the
organs, with or without suppuration.   Fractures of the  ribs are  dangerous for
several reasons: the bones may be splintered and driven inwards, thereby wound-
ing the lungs and causing hemorrhage, or leading to inflammation of the pleura 
WOUNDS OF THE HEART.
249
or lungs.   In fractures of the upper ribs, the prognosis is less favourable than
in those of the lower,  because commonly a much greater degree of violence is
required to produce the fracture.  A simple fracture of the sternum, without
displacement of the bone, is rarely attended with danger, unless the concussion
has at the same time produced mischief internally, which will be known  by the
symptoms.  When, however, the bone is depressed as well as fractured, the vis-
cera behind may be mortally injured.   In a case of depressed  fracture  of  the
sternum, recorded by M. Sanson, the  individual died after the lapse of thirteen
days; and on inspection, it was found that the fractured portion of bone had
produced a transverse wound of the heart about an inch in length.  The cavities
of the organ had not been penetrated, but the piece of bone was exactly adapted
to the depression produced by it on the parietes.   (Devergie, Med. Leg.  vol. ii.
p. 243.)  A witness will frequently be required to take into consideration  the
effects of contusions on the thorax, with or without fracture, in cases  of death
from pugilistic combats, which  of late years have given rise to numerous trials
on charges of manslaughter.  Wounds penetrating into the cavity of the  thorax
are generally dangerous, even when slight, in consequence  of the numerous ac-
cidents  with  which they  are liable to  be complicated.   In  these wounds,  the
lungs are most commonly injured; but, according to the direction of the weapon,
—the heart, or the great vessels connected with it, as well as the oesophagus or
thoracic duct,  may share in the mischief.
   Wounds of the lungs.—The immediate cause of danger from wounds of these
organs is the consecpient hemorrhage, which is profuse in proportion to the depth
of the wound and  the size of the vessels wounded.   Should the weapon divide
any  of  the trunks of the  pulmonary veins, the individual may speedily sink.
The degree of hemorrhage cannot be judged of by the quantity of blood which
escapes  from the wound; for it may go on internally, and collect within the cavity
of the pleura, impeding the respiratory process.   This is especially to be  appre-
hended  when the external orifice is small and oblique, and one of the intercostal
arteries  has been  touched by the weapon.  A wound of the lung is  generally
known,  among other symptoms, by the frothiness and florid colour of  the blood
which issues  from the  orifice, as well as by the expectoration of blood.  The
lungs may sustain  serious  injury from a blow or fall, and yet there may be no
external marks of violence or symptoms indicative of danger for some hours.   A
young man, while  riding, fell from his horse on his left arm.  He complained of
no pain for five hours, but in twelve hours he was  seized with an alarming flow
of blood from the mouth.   He died in the course of a few days.  After death
there was  no mark of injury to the chest, but the right lung was ruptured pos-
teriorly  throughout its length, and much blood had become extravasated.  (Lancet,
November, 1842.)   During the convalescence of an individual who has survived
the first effects  of a penetrating wound of the chest, the surgeon should observe
whether death, when it  occurs, may not have been caused by any imprudence on
the part of a patient, or by abuse of regimen or other misconduct; for circum-
stances  of this nature may be occasionally regarded as mitigatory on the trial of
an aggressor.    It is very properly recommended that,  in all cases where a party
is progressing  to recovery, a relaxation of the antiphlogistic regimen should be
made with great circumspection.  Too much nourishment, too frequent talking,
or any exertion, are circumstances that may cause a renewal of the hemorrhage
and extravasation.   A case is related, in which a soldier died instantly from  in-
ternal hemorrhage, brought on by throwing a bowl at some nine-pins, two months
after he  had been apparently cured of a wound of the lungs.
   Wounds of the heart.—AArounds of the heart are among the most fatal  of pe-
netrating wounds of the chest.  It was  formerly considered that all wounds of
this organ were necessarily and instantly mortal.   Undoubtedly, when either of
the cavities is laid  open to a large extent, the  hemorrhage  is so profuse,  on the
withdrawal of the weapon, that death must be immediate.   But when the wound 
250                       WOUNDS OF THE HEART.

is small and penetrates into the cavities of the organ obliquely, life may be pro-
longed for a considerable period; and cases are on record in which it is probable
that such wounds would have healed, and the patients have finally recovered, but
for the supervention of other diseases which destroyed life.  Dupuytren has re-
ported the  case of a man who  received  a stab on the left side of the chest, on
November 5th, 1831.  He was brought to  the  H6tel Dieu, but the symptoms
under which he laboured did not  lead  to the  suspicion that he  had received a
wound of the heart.   The man died on the 13th, of cerebral  disease.  On in-
spection of his body, it was found that the left ventricle was wounded about the
middle and  a little to 'the right; its cavity having been penetrated in a transverse
direction.   The wound was three lines and a half across, and one line from above
downwards.   The external fibres of the organ were most separated; the opening
diminished gradually, so that the internal fibres were in contact and closed the
wound.  A boy,  in pulling a knife from a companion with the point towards
him, accidentally stabbed himself in the chest.   A small quantity of florid red
blood escaped—he vomited and  fell to the ground.  He died  in eight  days.
The left ventricle had been perforated, and one pound and a half  of blood was
effused in the chest.   This case shows that  the  fatal hemorrhage is  not always
immediate.   (Med.  Gaz.  ii. 721.)  In another  instance recorded by  Baron
Dupuytren, five or  six wounds were  made by means of a saddler's  needle,—
most of them penetrating into the right ventricle of the  organ.   This man died
of cerebral disease, twenty-five  days after the wounds  could  have been possibly
inflicted; for the needle  was taken from him twenty-five  days before his death,
without any suspicion being entertained of  his having wounded himself with it.
The external cicatrix was visible on an inspection of the body.   The quantity of
blood found in the chest amounted to about three  ounces, and this appeared to
have proceeded from the substance of the heart.   (Med. Gaz. vol. xiii. p. 662.)
For cases in illustration  of the position that wounds of the heart are not instan-
taneously mortal, see Med. Gaz. ii. 721.
   In the opinion of Baron Dupuytren, these injuries are not necessarily fatal,
although I believe, with one exception, there is no case on record in which a per-
son has recovered from a penetrating  wound of the cavities of the heart.   (Ed.
M. and S.  J., Oct. 1844, 557;  also Ann. d'Hyg., 1846, i. 212.)  There are few,
probably, who will be inclined to consider them curable; a remote possibility of
simple wounds  healing,  and of  the patient recovering,  may be admitted; but
until some  clear  instances of recovery from penetrating wounds of the cavities
are reported, the majority of practitioners will continue  to look upon them as
fatal.  From a series of cases collected  by MM. Ollivier  and Sanson, it appears
 that out of twenty-nine  instances of .penetrating wounds of the  heart, only two
 proved fatal within  forty-eight hours.   In the  others, death took place at the
 varying periods of from four to twenty-eight days after the receipt of the wound.
 (Devergie,  Med. Leg. vol. ii. p. 246.)   These differences in the time at which
 death occurs, as well  as the fact  that wounds of the heart do not instantly de-
 stroy life,  have been ascribed to  the peculiar disposition of the muscular fibres
 of the organ, and to the manner in which they are penetrated by a weapon.  Thus,
 as a general principle, it is stated that wounds which are parallel  to the axis of
 the heart are, caeteris paribus, less rapidly fatal than those which are transverse
 to its axis.   In a wound which divides  the fibres transversely, the opening will
 be larger,  and the hemorrhage greater, than in one which  is parallel to these
 fibres; and as the heart is composed of different layers,  of which the fibres pass
 in different directions, so in a penetrating wound of its  cavities, while one set
 tends to separate the edges, another tends to bring them together, and thereby to
 restrain the flow of blood.  It is this action of  the fibres which  renders wounds
 of the ventricles less rapidly fatal  than those of the auricles, all other circum-
 stances being equal;  but a man has been known to survive a laceration  of the
 left auricle  eleven hours.  In the 17th vol. of the Medical Gazette, page 82, a 
         DEATH FROM THE ENTRANCE OF AIR INTO WOUNDED VEINS.     251

case is reported in which a person is stated to have recovered from a punctured
wound of the heart; and Dr. Trugien met with a case in which a man who had
been stabbed in th« left ventricle survived jive days.   The wound in the heart
had partly cicatrized.  (See Med.  Gaz. vol. xlvii. p. 42.)  [For  cases, see Beck,
he. cit at.—H.]
   Ruptures of the heart.—The heart is liable to be ruptured either from disease
or accident.  In the latter case, the organ generally gives way towards the basis,
and through one of the cavities on the right side.  (For cases, see Med.-Chir.
Rev. xxxi. 532.)  Dr. Hope asserts that in ruptures from natural causes, it is the
left side of the heart, and particularly the left ventricle, in which the lesion is
most frequently found.   The symptoms are  sudden pain, collapse,  cramps, cold
extremities, and rapid death.  According to the circumstances under which they
occur, cases of rupture  from disease may excite a suspicion of  death from vio-
lence.   Sometimes the substance of the heart appears to have undergone a fatty
degeneration.  Dr. Quam met with a case in which, under  this diseased  condi-
tion, the left ventricle had  become ruptured during slight  muscular exertion.
(Med.  Gaz. xxxviii.  774 and 857.)  In other instances there has been no appa-
rent alteration of  structure.   Dr. Stroud reported to the Med.-Chir. Society a
case of  this kind, which occurred in a young man aged twenty-nine.  The de-
ceased died in ten hours after his first seizure: on inspection there was a small
aperture in the right auricle near the vena cava.  This did not appear to be con-
nected with any morbid condition of the heart.  (Med. Gaz. xxvi. 518; Lancet,
Nov. 1843.)  As  a  medico-legal  subject, it is  worthy of note  that  when this
alarming accident proceeds from blows or falls, it is not  always accompanied by
marks of external violence,—or any fracture or other injury to the  exterior of
the chest.
   It is  proper to state, that the natural causes of rupture of the heart are vio-
lent mental emotions, such as anger, fright, terror, paroxysms of passion, sudden
or excessive muscular efforts, or violent physical exertions  in constrained posi-
tions.   The heart,  like any other muscle, may also give way from its own power-
ful contraction.  The left auricle of the heart has been ruptured  as a mere result
of great physical exertion.  (See case, Med. Gaz. vol. xlviii. p. 1063.) Rupture
of the heart from any of these causes is, however, a very rare occurrence.   (Med.-
Chir. Rev., Oct. 1847, 460.)
   Wounds of arteries and veins.—Wounds of the large  arterial  and venous
trunks  around the heart must be considered  as decidedly mortal: death is gene-
rally instantaneous from the profuse hemorrhage which attends them.  Dr. Heil,
of Bamberg, has related a case which  he considers to prove that a person may
recover  from a penetrating wound of the ascending aorta. (Henke's Zeitschrift,
1837, ii. 459.) With  regard to these fatal  extravasations of blood within the
chest, as well as in the other great cavities, it  may be proper to mention  that,
from whatever vessel or vessels the blood may have  issued,  it is not  commonly
found coagulated to any extent.   The  greater part of it  generally preserves the
liquid state;  and it is rare that  so much as one-half of  the  quantity effused is
met with in the form of coagulum.  These extravasations of blood in the chest
may be  sometimes traced to wounds of the  intercostal,  the  internal  mammary
arteries, or of the vena azygos.
  AArounds of the carotid arteries have been considered in speaking of wounds of
the throat.    Of wounds of the other blood-vessels, whether arteries or veins, it is
unnecessary to make any further remark.  Death is generally owing to hemor-
rhage, and  the bleeding from  a  comparatively small vessel may prove fatal, ac-
cording  to its situation and the state of the individual.  [See Am. Cyc. Med. and
Surg., Art. Aorta,  ii. 185.—H.]
  Death from the entrance of air into wounded veins.—In the wounds of veins,
there is  a peculiar cause of death which requires notice, namely, the entrance of
air  by the open mouth of  the divided vessel.   Accidents of  this kind are  by no 
252
WOUNDS OF THE DIAPHRAGM.
means common.   The following case occurred to Dr. Willis, of Barnes, in March,
1848:—A man was labouring under  chronic laryngitis, and it  was considered
proper to introduce a seton at the fore part of the  neck.   The skin was raised,
and the seton-needle was passed horizontally through the skin, about two inches
and a half above the breast-bone, and not at all near the jugular vein or any other
important blood-vessel.   At the instant of its entrance, there was a momentary
hissing  sound,—the man became pale,—his features were set,—he fainted, and
he subsequently became rigid and convulsed.  The man did not recover his con-
sciousness, was attacked with lock-jaw, and died in  seven hours.   From the me-
dical evidence given at the inquest, it was obvious that death had not arisen from
hemorrhage, but  from the air penetrating through a small vein which had been
accidentally divided.  A verdict was  returned accordingly.  After the inquest,
the body was inspected, and it was then found that the jugular veins and the large
vessels of the neck were uninjured.  The right auricle and pulmonary artery
were distended  with frothy blood, and the lungs were emphysematous.  (Med.
Gaz. xli. page 608.)   For another case of sudden death from this cause, see Med.
Gaz. xliii. 1098.  See also a paper by Mr. Lane, vol. xlv. page 926.
  It has been long known that air injected into the jugular vein would destroy
life by interfering with the functions of the heart.  The exact nature of the ac-
cident, as it occurs in operations, is not well understood.  (Ferguson's Surgery,
444.)   According to some, the air rushes into the cavity of the vessel owing to
atmospheric pressure during the expansion of the heart, while others believe it
to be  dependent on the act of inspiration.   It is difficult to account for the en-
trance of  air by atmospheric pressure, unless the cut orifice of the vein be kept
open, or unless its coats be morbidly thickened,  so that it does not readily close
when divided:  nevertheless, death may thus occur without the slightest imputa-
tion on  the operator.  Dr.  Cormack has shown that in some alleged cases of this
kind, death was probably due to  hemorrhage.  When the hemorrhage is slight,
and the hissing sound is  heard  at the time of the  incision, it may fairly be as-
cribed to the entrance of air.  This opinion would be confirmed by the discovery
of a frothy state of the blood in the right cavities of the heart.
   Wounds of the diaphragm.—This muscular septum is liable to be wounded either
by weapons  which penetrate the cavity of the thorax or abdomen, or by the ribs
when fractured by violent blows or falls; but, under any circumstances, wounds
of this muscle are not likely to occur without implicating  the important organs
that are in  contact with  it.  It  is scarcely possible, therefore, to  estimate the
danger of these injuries  abstractedly, as the prognosis must materially depend
on the concomitant mischief to the adjoining viscera.  Slight penetrating wounds
of the diaphragm may heal, like those of other muscular parts; and cases of this
kind are on  record.  There is, however, especially when the wound is of a lace-
rated kind, a consecutive source of mischief which no remedial means can avert;
namely, that after the wound has, to  all appearance, healed, the life of a person
may be cut short by the strangulation of a portion of the  stomach or viscera in
the half-cicatrized aperture.  An instance reported by Dr. Smith affords an illus-
tration  of this.   A sharp-pointed weapon had  penetrated  the  diaphragm, not-
withstanding which the patient apparently made a rapid and perfect recovery.—
At the end of about three months, however, the man died from a strangulated hernia
of the stomach, which had passed through the wound of the diaphragm into the
thorax.    (For. Med. p. 279.)  In a case  of this description, when death occurs
at a very  considerable period after the infliction  of a wound, the witness will pro-
bably be asked,—AVhether the wound was the cause of death?   Or whether there
were  any  other circumstances which would  have caused or facilitated the  pro-
duction of a hernia?   The degree of culpability of an aggressor may materially de-
pend  upon the answers  returned to  these questions.   Phrenic hernia, as it is
termed, is not by any means an unusual  or  unexpected fatal consequence of a
wound of the diaphragm; and therefore it would appear, at first sight, that death, at 
WOUNDS OF THE PARIETES OF THE ABDOMEN.
253
whatever period this event may occur, should be referred to the original wound.
But the  question is of a very delicate nature; as it is possible that a slight blow
on the stomach, received subsequently to  the wound, or  even any violent  exer-
tion on the part of the deceased, might tend to produce strangulation.  [Accord-
ing  to Guthrie, wounds of the  diaphragm never close;  so that the liability to
strangulation always persists after such injuries.—H.]
  Ruptures of the diaphragm.—The most serious injuries to the diaphragm are
unquestionably those which are produced by violent contusions, or falls on the
abdomen, while the stomach and viscera are distended.   In these cases the mus-
cular fibres are commonly found ruptured to  a greater or  less  extent: the he-
morrhage is not very considerable, rarely exceeding two, three, or four ounces.
A uniform result of these ruptures, when extensive, is a protrusion of the stomach
into the  chest, with sometimes a rupture of the coats of that organ and extrava-
sation of its contents.  Severe  lacerations of the diaphragm are  more readily-
produced during the act of inspiration, than during expiration,—the fibres of the
muscle being then stretched, and  receiving,  while  in  this state of tension, the
whole of the force.  According to Devergie,  the rupture most frequently takes
place in  the central tendinous structure, where it is united with the left muscu-
lar portion above the crura.   He  has remarked  that it  is observed more com-
monly on the left side than on the right.  (Op.  cit. ii. p. 250.)   It has been
supposed that death was an immediate consequence of  this accident; but this
view is not supported by facts.    In the case of extensive rupture of the diaphragm
above referred to, where the stomach and colon were found in the chest, the per-
son lived nine months after the  only accident which could have produced it, and
then died from another cause.   Besides the stomach, it sometimes happens that
the liver, spleen, or intestines passes through the opening, and, like it, these organs
are liable to become strangulated: the lungs are, at the same time, so compressed
that respiration is stopped, and asphyxia is often an immediate result.
  Direction of wounds in the chest.—In judging of the direction taken by wounds
which traverse the antero-posterior axis of the chest, it is necessary to remember
the great difference that exists in the level of the  same  rib anteriorly and pos-
teriorly.   This must be especially attended to, when we are called  upon to state
the direction of a traversing wound from the  description of it given by another.
The point here referred to had an important  bearing in the case of a fatal gun-
shot  wound which was the  subject of  a criminal charge  some years since.
(Henke's Zeitschrift, 1836.)

                        WOUNDS OF THE ABDOMEN.
   Wounds of the Parietes.—Incised  and Punctured wounds, which affect the
parietes  of the abdomen, without  penetrating the cavity, are not  quite of  so
simple a  nature as might at first sight be imagined.   The danger is immediate, if
the epigastric artery be wounded; for a fatal hemorrhage will, in some instances,
take place from a wound of this small vessel.   Contusions are  attended generally
with far  more serious effects on  the cavity of "the abdomen, than on the thorax.
This arises  from  the abdominal parietes  having less  power to resist external
shocks.  In the first place, death may be  the immediate  result of a blow in the
upper and central portion; no particular morbid changes will  be apparent on in-
spection,  and the violence may have been  so slight, as not to have produced any
ecchymosed mark on the skin.   Death has been ascribed in these cases to  a fatal
shock transmitted to the system, through a violent  impression  produced on the
solar plexus.   In a case of manslaughter tried at the Cent. Crim. Court, in Aug.,
1841 (The  Queen against S.aye?-s,) death  had been caused in this way during a
pugilistic combat.   The man received a blow  in the stomach, and fell dead.   As
there were no marks of external injury, the surgeon thought the man had died
of apoplexy.  The prisoner was acquitted.  Blows on  the abdomen, when they
do not destroy life by shock, may cause death by inducing  peritoneal inflamma- 
254
RUPTURE OF THE SPLEEN.
tion.   Among many instructive cases of this kind, is one recorded by Dr. Allen,
in which fatal peritonitis followed a very slight amount of violence to the abdo-
men.  (See Lancet, Jan 5, 1850, p. 29.)
   Ruptures of the liver.—Violence to the abdomen  may also prove  fatal by
causing a rupture of the viscera with extravasation of blood; and,  as it has been
elsewhere stated, these serious injuries may occur without being attended by any
marks of external violence.   Of all the internal organs,  the liver and spleen are
the most exposed to rupture, owing to their very compact structure, which pre-
vents them from yielding to a shock, like the hollow viscera.   Ruptures of the
liver may occur from falls or blows; but this organ may be ruptured  merely by
a sudden action of the abdominal muscles.   An accident of this kind happened
to an individual who  was  endeavouring to avoid a fall from his horse.  (Male's
Jur. Med. 119.)  A  fall on the feet from an elevated spot may also determine
laceration of this organ.   (Ann.  d'Hyg.  1846, i. 133.)   Ruptures of the liver
are generally seen on the convex surface, seldom extending through the whole
substance of the organ, but consisting of fissures, varying from one to two inches
in depth.   Their usual direction is from  before  backwards, with a slight obli-
quity; they rarely intersect the liver transversely.  The  lacerated edges are not
much  separated, while  the surfaces present a  granular  appearance.  But little
blood is met with in  the laceration; it is commonly  found extravasated in the
lower part of the cavity of the peritoneum, or in the hollow of the pelvis, and is
only in part coagulated.   Ruptures of the liver, unless  they run far backwards
and involve the  vena cava, are not in general attended with  any considerable
effusion of blood; but the  hemorrhage, should  this vessel be implicated, is  suf-
ficient to  cause  the instant destruction of life.  Under  other  circumstances, a
person may survive some hours.   Rupture of this  organ may  take  place from
violence applied to the chest, and there may be no marks of injury over the region
of the  liver.   (See case, Med. Times, Aug. 30, 1851,  p.  234.  For other cases,
see Med. Gaz. xlvii. 156.)   [Superficial wounds of the liver are much less fatal
than the deep-seated,  especially if these latter involve either of the portal vessels
or the  duct.  In fact, wounds of the liver, cceteris paribus, do  not appear to be
as fatal as ruptures of this organ.  For several cases  where patients have sur-
vived  serious  wounds, see North Amer. Arch. i. 385,  and Amer. Med. Intell. i.
191.   Amer.  Cyclop. Med. and Surg.—art., Wounds  of the Abdomen.—H.]
   Wounds of the gall-bladder.—Wounds and  ruptures  of the  gall-bladder are
necessarily attended with the extravasation of bile.  This irritant fluid finds its
way into the cavity of the  peritoneum, and the individual dies from peritonitis.
A fatal case of this description occurred to Dr.  Maclachlan.  An old man while
getting out of bed fell with great violence on  the floor.    He died from peritonitis
in forty-eight  hours.   The gall-bladder was ruptured, and a large calculus  was
found impacted in the cystic duct.  (Med.  Gaz. xxxvii. 968.)
   Ruptures of the spleen.—Ruptures of the spleen may  occur either from violence
or disease, and it would appear from the following case, reported by Mr. Heddle,
(Med.  Chir. Rev., Oct. 1839,) that a very slight degree of violence is sufficient to
rupture this organ, while there may be no marks  of  injury externally.  A mid-
dle-aged man was observed fighting with a boy  about fourteen years of age, who
in stature scarcely reached to his waist.  When  the fight had terminated, the
boy ran away:  the deceased was observed to become  very weak and faint,  and
he complained of uneasiness in his left side.   He expired a few minutes after-
wards.  On inspection,  no  mark of violence could be detected;  but the cavity of
the abdomen contained a  large quantity of blood.  The  spleen was found en-
larged, and so softened that its structure was broken down by the slightest pres-
sure.   There was a laceration  across its surface,  about half an inch in  depth,
from which  the  fatal hemorrhage had  proceeded.   A case of  spontaneous rup-
ture of the spleen, which was enlarged and in a diseased condition, is reported in
the Medical Gazette, (June; 1842.)  It is  highly probable that when the liver 
RUPTURES OF THE STOMACH AND BLADDER.
255
 and spleen are ruptured from slight causes, the structure of these organs will be
 found in a diseased condition—a circumstance which may in some cases  be re-
 garded as  mitigatory of the act of the assailant.   (See also Medical Gazette,
 xxxv. 942.)                                      v                        '
   Ruptures of the kidneys.—The kidneys are occasionally ruptured  from vio-
 lence; but this appears to be a rare accident.   Two cases were reported by Mr
 Stanley to the Med. Chir. Soc. (Lancet, Nov. 1843.)   In one the individual re-
 covered—in the other, death did not take place for a considerable time.
   Ruptures and wounds of the intestines.—Ruptures of the intestines sometimes
 take place  from disease, and in a case of rupture alleged to have been produced
 by violence, we must always take  this possible objection  into account.   The
 ruptured part should be carefully examined, in order to see whether there be any
 signs of ulceration about.  If not, and there be clear evidence of violence having
 been used, it is impossible to admit this speculative objection.  If with the proof
 of violence there should also be a  diseased condition of the bowel,  we may be
 required to say whether this did not  create  a greater  liability to rupture,—a
 point which must be admitted.   (For interesting medico-legal cases of ruptured
 intestines, see Watson on Homicide, 159; also, Henke, Zeitschrift der S. A. 1836,
 Erg. xxii. and Brit, and For. Rev., iv.  519.)                                 '
   Punctured wounds which  merely touch  the bowels without  laying open the
 cavity, are liable to cause death by peritonitis.  These injuries to the intestines
 sometimes destroy life by shock; there is but little blood effused, and the wounded
 person dies before  peritonitis can  be  set  up.   Severe wounds to  the intestines
 may, however, be inflicted almost  without the consciousness of the individual,
 and the  wounded person may be able to walk a considerable distance.  (Med.
 Gaz. xlvi. page 24.)
   Wounds and ruptures of  the stomach.—Wounds  and ruptures of the stomach
 may cause death by shock:  ruptures commonly give  rise to the most excruci-
 ating  pain, which of itself is sufficient to  bring about rapid dissolution.   It is
 proper to state, however, that the stomach may become ruptured  from sponta-
 neous causes, as in  ulceration produced by disease;  but sometimes there  is no
 morbid cause to explain the result.  In April, 1828, a man, aged thirty-four,
 was brought into St. Bartholomew's Hospital^ complaining of severe  pain in the
 abdomen.  Ten hours afterwards he was seized with violent vomiting; the pain
 ceased, the vomiting also ceased; and he died in five hours more.  The posterior
 surface of the stomach was found lacerated  to the extent of three inches, and the
 contents of the organ had escaped through the aperture; the mucous membrane
 was reddened, but there was no thickening, ulceration, or any apparent disease
 of the stomach.  (Med. Gaz. ii. 182: see also Dub.  Med. Jour., May, 1845; and
 Ed.  Med. and Sur.  Jour., Oct. 1845, p. 522.)   Penetrating wounds of the sto-
 mach generally prove rapidly mortal; they seldom form a subject of medico-legal
 examination; but a  singular case was tried at the Norwich Assizes in 1832, where
 a man was  charged with the murder of his wife, by throwing at her a red-hot
 poker.  The weapon completely perforated her stomach, and  she died in six
 hours.  It  might be questioned whether this was a wound in the common sense
 of the  term; it was an injury compounded of a burn, puncture, and laceration.
   Ruptures of the bladder.—This injury, which has on several occasions of late
 years given rise to some medico-legal discussion, is frequently the result of blows
 on the lower part of the abdomen.  The principal questions to be answered are:
 AAras the rupture the result of wilful violence or of an accidental fall ? or, Did it
 proceed from  spontaneous causes, as from  over-distention ?   The spot in which
 rupture commonly takes place is in  the upper and posterior part, where the organ
is covered by the peritoneum.  The aperture is sometimes large, at others small;
but the effect is, that  the urine becomes  extravasated, and  death takes  place
through peritoneal inflammation.   It is commonly stated that these  ruptures,
when attended with the  extravasation of urine into the peritoneal cavity, are uni- 
256
RUPTURES OF THE BLADDER.
fornily fatal.   If the rupture occurs in the under part of the bladder, or the urine
finds its way  into the cellular tissue, the prognosis is not so unfavourable.   Mr.
Syme has lately reported a case of recovery under these circumstances.  (Sur-
gical Contributions, 332.)
  The usual  period at which death occurs from this accident is in from three to
seven days, but Mr.  Ellis met with a  case where  the  person did not die until
the fifteenth day.  There is another circumstance of medico-legal importance in
respect to these ruptures; namely, that when produced  by a blow, they are rarely
accompanied  by the slightest mark of ecchymosis, or of injury to the skin.   Thus,
then, there are no means of distinguishing, by an external examination, whether
the rupture was really due to violence or to spontaneous causes.  They who are
unacquainted with this fact might be disposed to refer  the  rupture to disease,
on the supposition that violence would be indicated by the usual characters ex-
ternally; but there are numerous cases on record which  show that this view is
erroneous.
  As an attempt may be made, in cases in which death  has resulted from  this
injury, to refer rupture of the organ to natural causes,  it may be observed  that
this is a very unusual occurrence; a rupture is almost always the result of  vio-
lence directly applied to the part, while the organ is  in a distended state.   A
spontaneous rupture may, however, occur,—1.  AVhen  there is  paralysis, with a
want of power to expel the urine; 2, when the bladder is ulcerated or otherwise
diseased;  3,  when there is an obstruction  in the urethra from stricture  or other
causes.   These causes of spontaneous rupture  are easily recognisable by ascer-
taining the previous  condition of the deceased, or examining  the  bladder  and
urethra after death.   If a man were in good health prior to being struck,—if he
suddenly felt intense pain, could not pass his urine afterwards, and died from an
attack of peritonitis in five or six days; if after death,  the  bladder was  found
lacerated, but this organ and the urethra were otherwise  in a healthy condition,
there can be  no doubt that the blow was  the  sole  cause of rupture  and death.
In such a case, to attribute the rupture to spontaneous  causes, would be equal to
denying all kind  of causation.  As to the  absence of all marks of violence exter-
nally, this would only be a difficulty to  those who had not previously made
themselves acquainted with the facts attending this accident.   Nevertheless, the
medical witness must be prepared to hear the  same line  of defence  continually
urged: it is of course the object of a counsel to make  the best of a case for  the
prisoner, and his  dutyvconsists in seeing him judged according to law, and  not
condemned contrary  to law.   AVith  medical  facts, opinions, and doctrines he
does not concern  himself, so long as they do not serve  his purpose.
   Can the bladder be ruptured by an  accidental fall,  and if so, by what kind
of fall?—The following case, reported by Mr. Syme,  shows that this accident
may readily occur.   A woman, aged twenty-six, fell forwards over  the edge of
a tub, and fainted immediately.  On recovering herself, she complained of in-
tense pain in the  abdomen, with inability to  pass the  urine.  Peritonitis came
on, and she died in a week.  On inspection, a small aperture was found in  the
upper part of the bladder; the peritoneum was extensively inflamed from  the
urine which had become effused.  The ruptured surfaces had become partly glued
together.   (Ed. Med. and Surg. Jour., Oct.  1836.)  Rupture of the bladder
may take  place from  an accidental fall,  and  cause death without necessarily
laying open the peritoneal cavity.  Two interesting cases of this kind have been
reported by Mr. Wells.  (Med. Gaz. xxxvi. p.  621.)   The patients were sailors,
who fell from their hammocks while in a state of intoxication.   The usual symp-
toms followed,—one  died in five, and the  other in eight days, from  peritonitis;
and after death it was clearly found, in one instance at least, that the bladder
had been ruptured in the usual situation, but the peritoneum was entire, although
in a state of intense inflammation.  A more recent case of this kind  which was
the subject of  a trial (Reg. v. Dixon, Durham Lent Assizes, 1846,) has been 
WOUNDS OF THE GENITAL ORGANS.
257
communicated to me by Mr. Steavenson.   The prisoner  kicked the deceased in
the pubic region from behind.   The  man died from peritonitis in thirty-five
hours.  On inspection, the bladder was found ruptured near its neck for about
half an inch, immediately above and to  the left of the prostate gland.   The urine
had become extravasated into the cellular  tissue of the scrotum:  but although
there was extensive inflammation, the  peritoneum was not lacerated.   On the
other hand, a remarkable case is reported  by Mr. Bower, in which a man died
on the sixth day from rupture of the  bladder; and after death, although the
peritoneum was lacerated, and the cavity of the abdomen was  filled with dark-
coloured urine, there was no sign  of peritoneal inflammation!   (Lancet, Dec. 19,
1846, 660.)
  This accident  is liable to occur in females during parturition,  owing to the
pressure of the child's head, an occurrence which may fix a charge  of malapraxis
on the medical attendant.   He is expected to know the  probability of such an
accident occurring, and to guard against it, if necessary,  by the frequent use of
the catheter.  A surgeon was a few years since tried on  a  charge  of this kind.
(Reg. v. Balsoner, Liverpool Lent Assizes, 1838.)   It is important to remember,
that although  rupture  of  the bladder  is commonly attended at the time  with
intense  pain, sickness, and prostration of strength, yet individuals may occasion-
ally retain the power of exerting and moving themselves  after the accident.  In
punctured and incised wounds of the bladder, the urine is immediately extrava-
sated; but in gun-shot wounds, the extravasation does not commonly take place
until the sloughs have separated.   Thus, life may be protracted longer in cases
of gun-shot, than under other wounds  of the bladder.   Barzellotti relates the
case of a medical student, shot through the bladder in a duel, who did  not die
until the twentieth day, from the  peritonitis which supervened on the extravasa-
tion.   (Questioni di Med. Leg. t. iii. 174.)   One instance of a person recovering
from  a gun-shot  wound perforating the bladder  is  reported by Mr. Douglas in
the Ed. Med. and Sur. Jour. vol. xiii.
   For the discovery of extravasated liquids or blood, in wounds and other in-
juries to the abdominal viscera, we must look to the cavity of the pelvis, as it ia
here that, for obvious reasons, such liquids have a tendency to collect.
   Wounds of the Genital Organs.—Wounds of these organs do not often require
the attention of  a medical  jurist: such wonnds, whether in the male or female,
may, however, prove fatal to life by excessive hemorrhage.   Self-castration or
mutilation is not unfrequent among male lunatics and idiots.  An inquest was
held some time since in London, upon an  idiot, who had  bled to death from a
wound of this description.   AArhen  timely  assistance is  rendered,  a fatal result
may  be  averted.   Incised, lacerated, or even contused  wounds  of the female
genitals may prove fatal by hemorrhage, not from the wound involving any large
vessel, but from  the  great vascularity of the parts.  Two females were  in this
way murdered in Edinburgh some years since.  The wounds were inflicted by
razors, and the women bled  to death.  (See  cases by Watson, p. 104.)   This
crime appears to have been at one time frequent in Scotland.  When deeply in-
cised  wounds are inflicted on the  genital organs of either sex, the fact of  their
existence in such a situation at once proves wilful  and deliberate malice on the
part of the assailant.   Accident is wholly out of the question, and  suicide is im-
probable, except in cases of confirmed idiocy and lunacy.   Such wounds require
to be carefully examined;  for the proof of the kind of wound, when fatal, may
be tantamount to the proof of murder.   (For a case in which such a wound was
homicidally inflicted  upon  a male, see Ann. d'Hyg. 1848, i. 443, and  for an-
other, which led to a trial for the murder of a female, see  Med. Gaz. xliv.  page
813.)
  Contused wounds on the female genitals  proves sometimes fatal by the lacera-
tion of parts leading to fatal hemorrhage.   Several trials  for manslaughter  have
recently taken place, in which this was proved to have been the cause of death,
       17 
258
FRACTURES FROM VIOLENCE.
(See the case of Reg v. Cawley, Liverpool Winter Assizes, 1847.) _ The only cir-
cumstance requiring notice is, that the hemorrhage may destroy life although no
large blood-vessel be implicated in the injury.  A case in which a contused wound
of the clitoris has thus proved fatal, has been communicated to the Lancet by Mr.
Gutteridge.   (Oct. 31,1846, 478.)  A woman, aet. 36, received a kick from her
husband in the lower  part of the abdomen while she was in a stooping posture.
She was seen by Mr. Gutteridge in about three-quarters of an hour, and she had
then lost from three to four pounds of blood.  She was then sinking, and expired
in a  few minutes after his arrival.  On inspection, there was no  injury to the
uterus or vagina;  but the wound was seen at the edge of the vulva, extending
from the pubis along the ramus of that bone.  It was about an inch long and
three-quarters of an inch  deep.  The left clus clitoridis was crushed throughout
its length, so as to exhibit its cavernous structure.  From this the fatal hemor-
rhage had proceeded.  The heart and great vessels contained no blood.   The hemor-
rhage from such injuries is always likely to be  more profuse when the female is
pregnant.  A case of recovery from  a contused wound to the genitals in a preg-
nant female, aet. 40, is reported by Dr. M'Clintock.   It is stated that there was
profuse hemorrhage from  a laceration involving the urinary passage, but under
early treatment the woman did well.  (Medical Times, May 15,1847, 233.)  It is
well known that  some females are subject to frequent discharges of blood from
the genital organs from natural causes.   When the hemorrhage immediately fol-
lows a blow, and a female has not been subject to such a discharge, the  fair pre-
sumption is that violence was the cause: but when the flow of blood appears only
a long time after the  alleged violence, of which no traces can be seen, it is most
probably due to natural causes.   An interesting case of this kind has been com-
municated to me by Mr. Proctor, of York.   There was no difficulty in giving an
opinion that the flow  of blood was not due to violence.
                           CHAPTER  XXXV.

FRACTURES—PRODUCED BY A BLOW WITH A WEAPON OR BY A FALL--OCCUR IN THE AGED—
  BRITTLENESS OF THE BONES--FRACTURES CAUSED BY SLIGHT MUSCULAR EXERTION—IN
  THE LIVING AND DEAD BODY--HAS A BONE EVER BEEN FRACTURED?--QUESTIONS OF SUR-
  VIVORSHIP—DISLOCATIONS  FROM VIOLENCE OR NATURAL CAUSES—DIAGNOSIS—ACTIONS
  FOR MALAPRAXIS.

                               FRACTURES.
  Fractures of the bones  have some important bearings in relation to medical
jurisprudence.   They may result from falls, blows,  or the spontaneous action of
muscles.
   Causes.—Questions are sometimes put as to whether a particular fracture was
caused by an accidental fall or a blow; and if  by a  blow, whether  by  the use of
a weapon or not.  It is obvious that the answers must  be regulated by the cir-
cumstances of each case.   In examining a fracture, it is  important  to determine,
if possible, whether a weapon  has  or has not been used, and  this may be some-
times known by the state of the parts.   It  is a common  defence  on these oc-
casions, to attribute the fracture to an accidental fall.  Fractures more readily
occur from equal degrees of force in the old, than in the young; and in  the young
rather than in the adult; because,  it is at  the adult  period of life that the bones
possess their maximum degree of firmness and solidity.   The bones of aged per-
sons are sometimes very brittle, and slight violence will then produce fracture.
This has been regarded  as an extenuating circumstance, when the fracture was
followed by death.   Certain diseases, such as  syphilis, arthritis, cancer, scurvy, 
FRACTURES IN THE LIVING AND DEAD BODY.
259
and rachitis, render bones more fragile;  but they are sometimes more preter-
naturally brittle in apparently healthy persons, and this  brittleness appears to
be hereditary.   (Dub. Hosp. Gaz. Feb. 1846, 189.)   In  such cases, a defence
might fairly rest upon an abnormal condition of the bones, provided the violence
producing the fracture was slight.   Two trials have lately  taken place where this
fragility of the bones became a subject of discussion.  But the fracture may be
attributed to spontaneous causes, even supposing there are no well marked signs
of disease.  Thus bones have  been fractured  by moderate muscular  exertion.
The olecranon,  os  calcis, and patella, are particularly exposed to this  accident.
The long bones are very seldom the subject of an accident of this kind; but the
os humeri in a  healthy man has  been broken, by the  simple muscular exertion
of throwing a cricket-ball.   (Medical Gazette, xvi. 659.)   Mr. May reports the
case of a young lady, who fractured the neck of the scapula by suddenly throw-
ing a necklace round her neck.    (Med. Gaz., Oct., 1842.)   It is probable that in
these instances, if there were an opportunity of examining the bone, it  would be
found to have undergone some  chemical change in  its composition, which had
rendered it brittle.  An interesting case of spontaneous fracture of the femur was
brought into Guy's Hospital in December, 1846.  A healthy man, set. 33, of tem-
perate habits, was in the act of placing one leg over the other to look at the sole of
his foot, when he heard something give way, and the right leg immediately hung
down.   On examination, it was found that the right os femoris had been trans-
versely fractured at the junction of its middle with the lower third.   This case is
remarkable, inasmuch as spontaneous  fractures of the thigh bones are very rare,
—as the  man  had not suffered from  any of those diseases which cause preter-
natural fragility, and the fracture was  not caused  by violent muscular exertion.
The actual condition of the bone  was of course unknown;  but it healed readily,
and the man left the hospital at the usual period.  In fractures arising from this
cause there will be no abrasion  of the skin, or any appearance to indicate that a
blow has been  struck, while the marks of a  blow would,  of course, remove  all
idea of the fracture having had a spontaneous origin.  Fractures are not danger-
ous to life, unless, when of a compound nature,  they occur in old persons, or in
those who are debilitated by disease or dissipated habits.   They may then cause
death by  inducing irritative fever, erysipelas,  gangrene, tetanus, or  delirium
tremens.
   In the living or dead body.—It is not always easy to say whether a  fracture
has been produced before or after death.  A fracture produced shortly after death,
while the body  is warm, and another produced shortly before death, will present
much the  same  characters, except, perhaps, that in the former case there would
be less blood effused.  One caused ten or twelve hours before death would  be
indicated by a copious effusion of blood into the surrounding parts, and between
the fractured edges  of the bones,  as  well as laceration  of the muscles; or if
for a longer period before  death, there may be the marks of inflammation.  Frac-
tures caused several hours after death are not accompanied by an effusion of blood.
A medical witness may be asked, how long  did the deceased survive after re-
ceiving  the fracture?   This is a question which can be  decided only by an
examination of the fractured part.  Unless the  individual has survived eighteen
or twenty-four  hours, there  are commonly no appreciable changes.  After this
time, lymph is poured out from the surrounding structures.  This slowly becomes
hard from the deposition of phosphate of lime, and forms what is called "callus."
In the process of time, this acquires all the hardness of the original bone.   The
death of a person may take place during these changes, and a  medical man may then
have to state the period at which the fracture probably happened, in order to con-
nect the violence with  the act  of a particular person.   Unfortunately we have
no satisfactory data, if we except the extreme stages of this process, upon which
to ground an opinion.   AAre can say whether a person lived for a long or short time
after receiving  a fracture, but  to specify the exact time is clearly impossible; 
260
EVIDENCE OF THE EXISTENCE OF FRACTURES.
since this process of restoration in bone varies according to age, constitution,
and  many other circumstances.  In young subjects, bones will unite rapidly, in
the  old slowly; in the diseased and unhealthy, the process is  very slow, and
sometimes does not take place at all.   According to Villerme, the callus assumes
a cartilaginous  structure in from  sixteen to twenty-five days; and it becomes
ossified in a  period varying from three weeks to  three months.  It requires,
however, a period of from six to eight months, for the callus to acquire all  the
hardness, firmness, and power of resisting shocks possessed by the original bone.
A force applied to a recently united bone will break it through the callus or
bond of union, while  after  the period stated, the bone will  break as readily
through any  other part.  It is generally assumed,  that  the period required for
the union of a  simple fracture is, in  the thigh-bone, six weeks; in  the tibia,
five weeks; in  the os  humeri, four weeks;  and in the  ulna and radius, three
weeks; in the ribs, about the same period; but cases have been  known where
the ribs had  not perfectly united  in two months, and in some fractures of the
other bones, union had not taken place in four months.
   Has a bone ever been fractured? This question is sometimes put in reference
to the living subject.   It is well known that a bone seldom unites so evenly, but
that the point of ossific union is indicated by a node or projection. Some bones
are  so exposed as to  be well  placed for this examination,  as the radius, the
clavicle, and  tibia,—these being but little covered by skin; in others the detec-
tion is difficult.  It is impossible for us to say when the fracture took place; it
may have been for  six months or six  years, since,  after the former period, the
bone undergoes no perceptible change.  These facts are of importance in rela-
tion to the dead as well as  to  the living; since they will enable  us to answer
questions  respecting the identity of skeletons found under  suspicious circum-
stances : and here medical evidence may take a wider range, for a fracture in any
bone may be discovered, if not by external examination, at least by sawing the
bone through the suspected  broken part, when, should the suspicion be correct,
the  bony  shell will be found thicker  and less regular  in the situation of the
united fracture than in the  normal state.  So, in such cases, it will be easy to
say whether a fracture is recent or of old standing.   In the case of Clarke, who
Was  murdered many years since by Eugene Aram, the traces of the fracture and
indentation of  the temporal bone were plainly distinguished  on the exhumation
of the skeleton of the  deceased, thirteen years after the perpetration of the mur-
der.   The manner in which the murder was committed was confessed  by an ac-
complice, and the medical evidence corroborated this confession.  An instance of
the utility of this kind of knowledge came  out on  the  trial of a gentleman in
India, in 1833, for the murder of a native, Meer Khan.  There was  some  rea-
son to suppose that the prisoner had  been falsely accused of causing the death
of the native.   Two witnesses  deposed that a  few hours before the death of the
deceased, the prisoner had struck him several blows on the chest, and had broken
his ribs. The alleged murder having taken place  some months previously to the
trial, a skeleton was produced as being that of the  deceased,  by one of the  per-
sons who had assisted in  burying the body.   On examining the ribs,  the medi-
cal witness found that only  one rib was broken, and the  fractured portions were
united by a firm osseous callus.  He, therefore, declared, that the fracture could
not'have been caused a few hours before death;  but that it must have existed
for a period of at least eight or twelve days.   Hence the account given by the
witnesses was rendered improbable; for the prisoner had used no violence to the
deceased, except just before his death:  the fracture, therefore, must have taken
place from another cause some  time previously.   The witness much understated
the  period at which the fracture  probably occurred; for ossification only com-
mences in the cartilage about the sixth day; and the specks of  bony matter  con-
tinue to increase from  the eighth to the twelfth day, but the union  is soft, and
some weeks elapse before the callus becomes perfectly firm and hard. 
DISLOCATIONS.
261
   Locomotion.—With respect to the power of locomotion after a fracture, it may
be observed, that when the injury is in the arm or in the ribs, unless many of
them be broken, an individual may move about, although unfitted for great exer-
tion.   Fractures of the leg incapacitate a person from moving  except to very
short distances.  See case by Syme, Ed. Med. and Surg. Journ., Oct. 1836.  (The
reader will find additional information on this subject in the Ann. d'Hvff. 1839,
ii. 241; and 1844, ii. 146.)

                               DISLOCATIONS.
   Dislocations are not very frequent in the old or in those persons whose bones
are brittle.   They rarely form a subject for medico-legal  investigation.  A wit-
ness is liable to be asked, what  degree of force, and  acting in which direction,
would produce a dislocation,—a question not  difficult  to answer.   They are not
dangerous to life, unless of a compound nature, when death may take place from
secondary causes.  A dislocation which has occurred in the living body would be
known after death by the  laceration of the soft parts in the neighbourhood of
the joint, and by the copious effusion and coagulation  of blood.  For a good ac-
count of the post-mortem  appearances four  days after a dislocation of the  hu-
merus, see Med. Gaz. xxxi. 266.  If of old standing, a  dislocation would be iden-
tified by the cicatrices in surrounding structures.   Dislocations may occur from
natural causes, as  from disease and destruction of the  ligaments in a joint, also   ,
from  violent muscular spasm  during an epileptic convulsion.   Dr. Dymock met
with an instance of dislocation of the humerus forwards during  puerperal con-
vulsions.   (Ed. Med. and  Surg. Journ., April, 1843; see  also  Lancet, April,
1845, 440.)  Locomotion may exist except when the injury is" in the lower ex-
tremity, and even  then it has been  observed, that for some time  after a disloca-
tion of the hip-joint, considerable power over  the limb remains;  it is only after
a few hours that it becomes fixed in  one position.   Exertion with the dislocated
member is in all cases out of the question.
   Diagnosis—malapraxis.—There are certain fractures of an obscure kind which
closely resemble dislocations.   This has been  pointed  out by Sir A. Cooper, in
relation to fractures in  the anatomical neck of the os humerL  (Guy's Hosp.
Rep. ix. 272.)  This accident might be easily mistaken for a dislocation of  the
shoulder.  (Med. Gaz. xxxvi. p. 38.)  In attempting to reduce the bone, the head
continually falls back into  the axilla.  In such a case  an action for malapraxis
might be brought  against a surgeon, and  heavy damages recovered.   It could
only be by a dissection of the part  after  death that the real nature of the  case
would be ascertained.   It is requisite, therefore, that  great caution should be
used in the diagnosis.   The same observations apply to fractures  of the neck of
the thigh-bone, although with less force, because this  is a much  more common
accident.  It is well known that fractures and dislocations, when cured, are often
attended either with some slight deformity of the limb, or with some impairment
of its functions.  This result is occasionally inevitable under the best treatment;
but it is commonly set down as a sign of unskilfulness  in the medical attendant.
Actions for malapraxis  are instituted, and  in  spite of good evidence in his fa-
vour,  the surgeon  is sometimes heavily fined for  a result which could not be
avoided.   There is often great injustice in these proceedings, and the mischief
can only be  remedied  by referring the facts to a medical tribunal, which alone
should be competent to decide whether or not unskilfulness had really been shown
in  the management of a case. 
262
GUN-SHOT WOUNDS.
                          CHAPTER XXXVI.

GUN-SHOT WOUNDS--THEIR DANGER--ON THE LIVING AND DEAD BODY—WAS THE PIECE FIRED
  NEAR OR FROM A DISTANCE?--EVIDENCE FROM  SEVERAL WOUNDS--THE PROJECTILE NOT
  DISCOVERED--DEFLECTION OF BALLS--ACCIDENTAL, SUICIDAL, OR HOMICIDAL WOUNDS—
  POSITION OF THE WOUNDED PERSON WHEN  SHOT--WOUNDS FROM SMALL SHOT—WOUNDS
  FROM WADDING AND GUNPOWDER--IDENTITY FROM THE FLASH OF POWDER--EXAMINATION
  OF THE PIECE.

  Gun-shot wounds are of the contused kind, but they differ from other wounds
in the fact that the vitality of the parts struck by the projectile is destroyed,
and this leads ultimately to a process of sloughing.   The legal definition of a
wound applies here as in other cases, so that, in order to constitute a gun-shot
wound within the meaning of the act, the cutis, or true skin, must  be injured.
In the case of The Queen against  Mortlock (Cambridge Lent Assizes, 1843,) the
surgeon deposed that there was a circular wound on the skin, by which it had
been deprived of its cuticle, but the true skin was not penetrated.  The bullet
had struck  obliquely at a very  considerable  angle:  had it  been otherwise, it
must have entered the abdomen.   The judge said that, as the true skin was not
penetrated, there was no wounding within the  meaning of the statute.
   Their danger.—The  medico-legal questions which arise  out of gun-shot
wounds, are much the same as those which have been examined in  relation to
other wounds.  They are very dangerous to life, more  especially when they pe-
netrate  or traverse any of the great cavities of the body.  Death may take place
directly from hemorrhage or shock; although immediate or copious  hemorrhage
is not a common character  of these injuries.  Death from shock is  occasionally
witnessed.  In the case of  the policeman Daly, who was killed by a  pistol-bullet
in Hornsey  AVood, May, 1842, it was found, on inspection, that the bullet had
traversed the distended  stomach at the cardiac end from behind forwards. The
two apertures were about the size of a shilling, and the edges black.    There was
but little blood effused, and the  other viscera were uninjured.  The deceased
died a  few  seconds after receiving  the wound, obviously from a shock to the
nervous system.  (Lancet, May,  1842.)  Indirectly, these wounds are attended
with much danger; sloughing generally takes  place uniformly throughout the
whole of the perforation, and inflammation or fatal  hemorrhage may cut short
life.  If the individual survive the first effects, he may die at almost any period
from suppurative fever, erysipelas, gangrene, or from  the  results of operations
absolutely required for his  treatment.   Gun-shot wounds may  thus  destroy life
after very long periods of time.   Marshal Maison, one of Napoleon's generals,
died in Paris in 1840, it is said from the effects  of  a gun-shot wound received
forty years before.  In gun-shot  wounds of a severe kind, the first symptoms do
not always indicate the degree of mischief.   Thus in  the case of Mr. Drummond,
who was shot by M'Naughten, in January, 1843, the symptoms were in the first
instance so slight, that the bullet was supposed not to have penetrated the cavity
of the  abdomen, but to have coursed round the skin.   Death took place in a few
days, and it Avas then found that the bullet had completely traversed the abdomen,
perforating  the diaphragm.  Army surgeons  have  also  remarked  that  slight
wounds of  the parietes are  often insidiously attended with  deep-seated injury.
Death might in such a case be improperly ascribed to mismanagement, when it
may have been really due  to the  wound.  (See cases by Mr.  Alcock, Med. Gaz.
xxiv. 850.)   It is not easy to mistake a gun-shot wound from any other injury.
If the circumstances under which it is produced do not satisfactorily account for
its origin, a simple examination will suffice to show its true nature.   Sometimes
the projectile or part of the dress is found lodged in the wound. 
              WAS THE PIECE FIRED NEAR OR AT A DISTANCE?          263

   On the living and dead body.—A medical witness may be asked, whether the
wound was inflicted before or after death.   It  is by  no means  easy  to  answer
this question, unless the  bullet has  injured some vessel, when  the effusion of
blood, and  the  formation  of coagula, will indicate that the person was living
when it was received.  In a gun-shot wound on the dead, no blood is effused,
unless the bullet happens to strike a vein.
   Was the piece fired near or from a distance?—A gun-shot wound produced
by the muzzle of the piece being placed near to the surface of the body, ha3 the
following characters:—There may be two apertures, the one of entrance and the
other of exit; but it sometimes happens that the bullet lodges and does not pass
out.   The edges of the aperture of entrance are torn and lacerated, and appear
blackened,  as if they had been burnt; this arises from the heat and flame of the
gunpowder at the moment of  explosion.   The  skin is often ecchymosed, and is
much blackened by the powder:—the clothes  covering the body are blackened
by the discharge, and sometimes ignited by the flame.   If the muzzle of the
piece was not in immediate contact with the part struck, the wound is rounded;
but if there has been direct contact, the skin, besides being  burnt, is torn and
much lacerated.  The hemorrhage is usually slight, and when this occurs  it is
more commonly observed from the orifice of exit,  than from that of entrance.
It should be remarked, that the  aperture of entrance is  round, only when the
bullet strikes point-blank or nearly so.   If  it should  strike obliquely, the orifice
will  have more or less of an oval or valvular form, and in this way we  may some-
times determine the relative position of the  assailant with respect to the wounded
party.   Supposing the bullet to have been fired from a moderate distance, but
so near as to have had sufficient momentum to traverse the body, then the ap-
pearance of the wound will be different.   The  orifice  of entrance will  be well de-
fined, round or oval, according to  the circumstances,—the skin slightly depressed,
—the edges presenting a faint bruised appearance, but the surrounding parts are
neither blackened or burnt, nor do they present any marks of hemorrhage.   In
all cases the orifice of exit is large,  irregular,  the  edges somewhat everted, and
the skin lacerated, but free from all marks  of  blackness or burning:  it is gene-
rally three or four times as  large as the entrance-aperture.   This is denied by
Dr. Malle (Ann. d'Hyg.  1840, i. 458,) but  it appears  to me upon insufficient
grounds.   The orifice of  entrance is, however, always large and irregular, when
the bullet strikes near the extremity of its range.   Under common circumstances,
the  entrance-aperture has generally the appearance  of being smaller than the
projectile, owing to  the  elasticity of the living  skin.  (Ann. d'Hyg. 1839, ii.
319.)  It is the same with the aperture in the dress, when this  is formed of an
elastic material:—according to  Dupuytren, the hole in  the  dress  is  always
smaller than that made by the bullet in  the integuments.  These points should
be remembered in fitting projectiles  to wounds which they are supposed  to have
produced.   [Dr. Griffith reminds us that the appearance of a wound from a rifle
ball  is  very different from that caused by a musket or pistol ball.   From the
spiral groove in the barrel of the American rifle, and the tightness with which
the ball fits, this latter also assumes a spiral motion in its progress, and hence
makes  a ragged hole, much larger than itself, and much more frequently shatters
a bone than is deflected by it.—H.]   Useful evidence may be sometimes obtained
by a careful examination of the  projectile,  the identity of which should be pre-
served by the medical witness.   AVhen the projectile cannot be found, and there
are no marks of burning,  or other signs of  a near wound on the skin, we  must
be cautious in making a diagnosis.   Mr. AArard has  reported a case  in which a
perforating wound of the skull closely resembled  a bullet wound.   (Med. Gaz.
xliv. 767.)
  The question whether a piece was fired near  to or at a distance from the
wounded party, may become of material importance on a charge of homicide, or
of alleged  suicide.   Two persons may quarrel, one having a loaded weapon in 
264           WAS THE PIECE FIRED NEAR OR AT A DISTANCE?
 his hand, which he may allege to have been accidentally discharged, and to have
 killed the deceased.  If the allegation be true, we ought to find on  the body the
 marks of a near-wound: if, however, it were such that it had been produced from
 a distance, and therefore after the quarrel, the medical proof of this fact  might
 imply malice, and  involve the accused in a  charge of murder.  The following
 case occurred in Ireland in 1834:—A tithe-collector was tried for the murder of
 a man, by shooting him.   It appeared in evidence, that the prisoner, while on
 duty, was attacked by the deceased and two of his sons, and he drew a  pistol to
 intimidate them.   He was dragged off his horse by these parties, and during the
 scuffle, it is supposed, the pistol accidentally  went off, and inflicted  a wound on
 the deceased, of which he died shortly afterwards.  The sons of  the deceased
 swore that the prisoner, when at some distance, took a deliberate aim, and fired
 the pistol at their father; and a priest came forward  to  depose that such was
 the dying declaration of the deceased.  From some subsequent suspicion of the
 truth of this story, the body, which had not been  properly inspected in the first
 instance, was ordered to be disinterred.   It was carefully examined by a surgeon,
 who was enabled to swear positively that  the pistol must have been fired close
 to the body of the deceased, and not  at a distance; since there were the marks
 of powder and burning on the wrist.   Hence it clearly followed, that the pistol
 had been discharged  during  the scuffle, either by accident or in  self-defence.
 The prisoner was  acquitted,  and  the parties who had appeared  as witnesses
 against him were indicted and convicted of perjury.  In the case of Mr. Pearce,
 a surgeon who was tried at the Central Criminal Court, in 1840,  for shooting at
 his wife, and was found insane, it appeared from the medical evidence that the
 pistol had been fired so near to the  person of the prosecutrix, that her dress was
 burnt and the skin blistered.   Mr. Marshall relates that when stationed at Ceylon
 with troops, a man, who had  but recently joined the  regiment, was placed as
 sentry in a position where  he  was occasionally fired at by the  enemy from the
 surrounding  jungle.   The man was one day found severely wounded;  the calf
 of his leg was greatly torn; the whole charge of a musket haying passed through
 it.  He attributed the wound  to a  shot  from the enemy, but from the skin of
 the leg  being completely blackened by charcoal, it is  clear  that it must  have
 arisen from the discharge of his own musket.   He  had  inflicted  this  wound upon
 himself, in order to obtain a discharge from the regiment.  These examples, then,
 show that both the dress and skin of a person who has received a gun-shot wound
 should be closely examined.  The result may be, that the statement  given of the
 mode in which the  wound was received will be entirely disproved.  The case of
 M. Peytel, tried  in  France, in  September, 1839, presents many points of great
 interest in relation to the medical jurisprudence of gun-shot wounds.  This gen-
 tleman was travelling in a carriage,  in company with his wife, and  attended by
 a man-servant.  The wife and the  man-servant were found  dead on the road,
 and the account given by M. Peytel  was, that  the servant had discharged a pistol
 into the carriage and shot his wife,  and he had afterwards  pursued and killed
 him.   The facts, however, were  so suspicious against M. Peytel,  that he was
 charged with the double murder.   From an examination of the  body of the wife,
 it appeared that  there were two pistol wounds in the face which  had most pro-
 bably been produced by two separate pistols.   The prisoner alleged that  about
 nine o'clock at night, when it was dark, he desired the servant  to get down in
order to relieve the horses.   Two minutes afterwards, some man, whom he found
to be the servant, approached the carriage-door, discharged a pistol  at him, and
 wounded his wife;  but the evidence showed that two weapons  must have  been
used,  or at least two different discharges made by a person sitting  very near to
the deceased, so  that the muzzles must have  almost touched her face,  the eye-
lashes and skin having been much burnt by the powder.  These  facts, together
with other strong circumstances against  him, led to  the prisoner's conviction.
The late Dr. Ollivier, who appeared in the prisoner's favour, considered  that the 
DEFLECTION OF BALLS.
265
 deceased might have been shot by the servant, and that the two wounds might
 have been produced by one pistol loaded with two bullets; also,  that the marks
 of burning about the face of the deceased might be attributed to the wadding,
 and therefore  they afforded no proof that the muzzle  of the  pistol had, at the
 time of its discharge, been close to her person.   He also contended that the de-
 ceased had not died from the wounds.  Notwithstanding these ingenious medico-
 legal arguments, there can be no doubt that the prisoner was very properly con-
 victed.   (See Ann. d'Hyg. 1839, ii. 339;  1842, i. 368.)
   It has been said that when a  bullet is fired near, it commonly traverses; and
 therefore it has been rather hastily assumed, that where there is  only one exter-
 nal wound, and the bullet has  lodged, this is a  proof  that the  piece has been
 fired from a distance.  This interference is, however, erroneous.   A bullet may
 be fired closed  to a person, and yet not traverse the body, either  from its impul-
 sive force not being sufficiently great, or from its meeting a great resistance in the
 body.  Many cases might be cited to show, that in the near wounds produced by
 suicides  and murderers, the bullets  have  not  always traversed  the body.  In
 suicide, where  the piece is discharged into the mouth, the projectile often lodges
 in some part of the cranium.
   Evidence from severed wounds.—When several wounds are found  on a body,—
 can  we  determine whether they were produced  by one or several  different dis-
 charges?   This question was raised in Peytel's case, as there were two wounds
 on the deceased, and  the prisoner alleged that the servant had  fired but one pis-
 tol.   M. Ollivier thought this might be explained by supposing  that there had
 been two bullets in the pistol:—it was, however, affirmed by some military officers
 and other witnesses, that  these wounds had been produced by separate pistols, a
 fact which overthrew the  defence of the prisoner.  (Ann. d'Hyg. 1842, i.  368.)
 It is proper to remark that one ball may produce several wounds on  the body:
 there will be only one orifice of entrance, but owing to the ball occasionally  split-
 ting within the body, and dividing itself into three or four pieces, there may be
 several orifices of exit.  The splitting of balls has repeatedly occurred where the
 projectile in its course has encountered an angular surface, or a projecting ridge
 of bone.   Dupuytren met with  an instance, where a ball,' after having struck
 the ridge of the tibia, divided itself into two parts, which traversed the calf of
 that leg, and penetrated into the calf of the opposite leg.  Thus no less than five
 wounds were produced in one instance by a  single ball; three of entrance  and
 two of exit. Had this man been found dead, and nothing known concerning him,
 this  singular circumstance would probably have  given  rise to  considerable em-
 barrassment.  After a careful examination, a surgeon might have been  induced
 to declare that  this person must have received at least three distinct  shots.  A
 similar effect was observed in another case, where the bullet struck the parietal
 bone and divided itself  into two portions:—one passed out superficially through
 the integuments, the other penetrated into the brain, and lodged on the tentorium.
 This fact  shows that  the  discovery of an exit-aperture does not always  prove
 that the whole of a projectile has passed out,—a matter  which may influence the
 prognosis.
  Deflection of balls.—When a  ball traverses the body, it sometimes happens
 that  the two apertures are opposite to each other, although it may not have taken a
 rectilinear course between them, but have been variously deflected by the subjacent
 soft parts.  This deflection of a  ball from a rectilinear  course  is especially met
 with in those cases where  it happens to strike obliquely a curved surface, and it
 is found that when the ball enters and does not pass out, its course is often ex-
 tremely circuitous, so that it is not always easy to say in what  part of the  body
it may be found.   In 1830, I saw, at the Hotel-Dieu, a boy who  had received a
gun-shot wound in the upper part of the abdomen: the entrance-orifice was very
plainly situated there, but there was an opening at the back, nearly diametrically
opposite,  out of which the ball had  passed,  so that it conveyed  the impression 
266
WOUNDS.   SUICIDAL AND ACCIDENTAL.
that the ball had completely traversed the abdominal cavity.  There was no sign
of collapse or depression, nor any indication of serious injury; and Dupuytren
gave an opinion, which was afterwards verified,—that the ball had not penetrated,
but had been  deflected beneath  the  skin, and had taken  a circuitous course
through the cellular membrane to the back.   Many similar  facts are recorded.
The same deflection may occur even when the piece is discharged close to the body,
as in cases of  suicide.   Mr. Abernethy was once called to  examine a man, who
had shot himself, as it was supposed, through the head.  He found two openings
in the  scalp, nearly opposite to each other: it was soon perceived, on examination,
that the ball  had not penetrated the bone, but had followed the curve of the
exterior of the skull to its point of exit.   The deflection of projectiles may occur
not merely when  they come in contact with  bone, but when they meet skin,
muscles, tendons,  and fasciae,—the ball then  takes its course in  the spaces be-
tween  these different structures.  A ball which entered at the  ankle has  been
known to make its exit at the knee;  and another, which entered at the back of
the left shoulder,  passed down on the inside of the scapula, and was found below
the right ear.   This deflection of balls by such slight obstacles has been ascribed
partly to the obliquity with which they strike, and partly to the rotatory motion
on its  axis which  every spherical projectile is  considered to have.  It does not
appear to be much connected with the degree  of velocity, for the  same deviation
has been found to occurwhen the bullet was fired near or at a distance.
   If we can at any time discover two fixed points where the ball has touched a
building, without being reflected, it will be easy to determine the situation from
which the piece was discharged.  A singular  example of this kind is stated by
Mr. Watson to  have occurred at Ayr in 1831.   Several shots had been mali-
ciously fired into a church.  Some of the  bullets traversed a window, making
holes in the glass, and stuck against a wall on the  other side of  the church,—a
fact plainly indicated by the marks  which they left.   A straight line carried
from these two points reached a window on the opposite side of the street, from
which it was  afterwards ascertained the bullets had been fired.
   Survivorship.—A witness may be  asked—When  was the gun-shot wound
inflicted, and  how long had the wounded party survived after receiving it?  A
gun-shot wound undergoes no change for eight or  ten hours after its  infliction.
Our judgment may be assisted by observing what parts are involved,  although
we cannot always infer, from the quantity of blood found near, that the hemor-
rhage  was an  immediate consequence  of the wound, or that the  whole  of the
blood  was effused at once.   We cannot, then, always affirm that the  deceased
could  not have moved or exerted himself in some degree, after receiving it.   The
exertion thus made subsequently to his being wounded may have actually caused
the fatal hemorrhage.
   Accidental, Suicidal, or Homicidal wounds.—AVhen it is doubtful whether
the wound was the result  of accident, suicide, or homicide, the point may be
 often settled by paying attention to its  situation and direction.   Suicidal gun-
 shot wounds are  almost always directed to  a  vital part—to the  heart  or to the
 brain:—they possess those  characters which belong to wounds inflicted near  to
 the body: the skin is blackened or burnt, the wound  wide  and  lacerated,—the
 hand which discharged the weapon often blackened,—and sometimes still grasping
 the pistol.  The ball may or may not have traversed, as this will depend on the
 momentum which it derives from the charge, and the resistance which it experi-
 ences.  (See the case of The  Queen v.  Thomas,  Brecon Lent  Assizes, 1845.)
 The situation in  this instance  negatived the supposition of suicide.   Suicidal
 gun-shot wounds are seldom situated at the posterior surface of the body; there-
 fore the  determination of the point of entrance, if the ball has traversed, is of
 some  importance.  The direction  of these wounds is probably of less moment
 than their situation, because the projectile  is liable to be deflected in  the body.
 In a duel which occurred in Paris, in 1827, one of the parties, a  tall  man, was 
WOUNDS FROM SMALL SHOT.
267
killed by a ball which was found to have entered below the  right shoulder, and
to have taken a direction downwards.   In  consequence of this, it was thought
that he had  been shot unfairly  by his antagonist, who was short in stature.
Breschet and  others explained the suspicious  course  of the wound, by saying
that the ball  had  struck the under part of the clavicle, and had  thence probably
been deflected downwards.
   Accidental wounds also bear the characters of near wounds:—they may touch
vital parts, but if the body be not disturbed, the presence or absence of design
in the infliction of the wound is commonly made apparent by the relative position
of the body and the weapon.   They frequently arise from persons drawing the
charges of  guns or pistols with the muzzles pointed towards them, and they are
then situated in  front:—at other times  they are produced by persons pulling
towards them through a hedge, or dragging after them, a loaded gun.   In the
latter case the wound is  behind, and strongly resembles a  homicidal wound,
although the  circumstances under which the  body is found  generally suffice to
explain the matter.   In the following case of attempted suicide, the characters
of the wound somewhat resembled those which are commonly imputed to homi-
cide.   In  March, 1844, a  man was  brought to  Guy's Hospital, with a large
ragged gun-shot wound on  the right  side of  the head, behind the angle of the
jaw, and between it and the ear.  No slugs  or bullets could be found;  the di-
rection was from behind forwards, and from  above  downwards.   According to
this man's statement, the pistol missed fire  three times, but he succeeded in dis-
charging it into his mouth at the fourth attempt.  He  lost a large  quantity of
blood, but after some time  he walked  to a  table at  the distance of five yards,
reloaded the pistol, and discharged it  at the back of his head in the situation
described.  Thus, then, there were in  this case two wounds, one homicidal in its
characters; and a power of locomotion after the  first wound, in spite of conside-
rable hemorrhage.  A gun-shot wound in the mouth or temple would seldom be
set down to accident, and yet attempts are occasionally made to ascribe to  such
wounds an accidental origin.  The admission  of a near wound in the temple
occurring from accident, must depend entirely upon  the circumstances proved.
(See the case of Reg. v. Tottenham, Norwich  Lent Assizes, 1845.)
   Position of the wounded person when shot.—Did the deceased receive the shot
while standing, falling, or lying down ? AVas the piece, when discharged, pointed
from the shoulder?   These questions can only be answered  by reference to the
particular circumstances of the case.   In  general, when a  person is shot while
standing, and the piece is pointed  from the shoulder, the wound is more or less
transverse; but due allowance must be made for the deflection of balls after pe-
netration.   (The  Queen v.  Magarity,  Central Criminal Court, July, 1841.)
   AVas the deceased  shot while running away, or when approaching the person
who fired?—This question is answered by observing, in the case of a traversing
wound, in which  alone any difficulty  can arise,  whether the entrance-orifice be
situated in  front or behind.   A trial took place  at the Kent Assizes, some years
since, in which this question was material.
   Wounds from small shot.—Death is sometimes occasioned by small shot, and
here several medico-legal questions present themselves.   Small shot may act in
two ways:—1, it  either strikes without spreading, in which case the discharge
is always near the person, and its action is  much more  dangerous than that of a
single ball, because it produces extensive  lacerations;  or, 2d, it strikes after it
has spread, and here the discharge must have been distant, and comparatively
little mischief is done.   Dr. Lachese  ascertained, by many experiments, that in
order to produce,  with small-shot, a regular round  opening like  that resulting
from a bullet, the discharge should not take place at a distance greater than ten
or twelve inches  from the  surface of  the  body.  AA^hen the distance was  from
twelve to eighteen inches, the opening made was irregular, and the borders were
much lacerated; at thirty-six inches, a central opening was entirely lost, and the 
268
WOUNDS FROM WADDING AND GUNPOWDER.
surface of the body was covered by shot.   The effect after this was found to de-
pend on the distance, the  goodness of the gun, and  the strength of the charge
(Ann. d'Hyg.  ISoO,  386;) but the shot is in general much scattered  over the
surface of the body.   In this way, we  may form  an opinion of the distance at
which the piece was fired.   In the case of The Queen v. Chapman (Oxford Lent
Assizes, 1839,) it was proved  that the  deceased had been killed  by small  shot
fired from a gun; that the discharge must have taken place very near, as the shot
had not been scattered, and the point of the gun must have been below ib.3 level
of the wound, as the  direction was rather upwards.   Two medical witnesses were
examined, and both agreed that the gun, when fired, could not have been pointed
from the shoulder, judging from the direction of the wound.  A similar question
was raised, and it was decided that the  discharge of the gun took place accident-
ally during a struggle, in the case of Reg. v. Hull (Oxford Summer Ass. 1846.)
The case of The Queen v. Ken drew (York AVinter Assizes, 1844,) is in this re-
spect of some medico-legal importance.  The medical evidence was pery satis-
factory.  It was shown to be highly improbable that deceased could have shot
himself with small shot from a gun, as the  shot were scattered, and there was
no round opening.  It can seldom happen that a circular wound will  be made
by small shot without the dress being singed or  burnt.   A wound of this de-
scription must not, however, be mistaken for one produced by a bullet.
   Small shot are rarely observed to traverse the body entirely, unless discharged
so near as to make a clean round opening; but a single pellet reaching the body
may destroy life.   Two cases have already been mentioned;  one where a young
man was killed by a single pellet wounding the fifth intercostal artery; the  other,
where a girl was killed by a pellet traversing the orbitar plate and wounding the
brain.   Such minute wounds might be easily overlooked in an examination of
the body.   Small shot, even when wounding only the skin of the back very su-
perficially, has been known to  cause death by tetanus.
   Wounds from wadding  and gunpowder.—It matters not with what the piece
is charged,—it is  capable, when fired  near, of producing a wound which may
prove fatal.   Thus, a piece loaded with wadding, or even gunpowder only, may
cause death.  In all these cases, an impulsive force is given by the explosion, and
the substance  becomes a dangerous projectile.  The lighter the  projectile, the
shorter the distance-to which it is carried; but when discharged near to the body,
it may produce a fatal penetrating wound.   A portion of the dress of the indi-
vidual may be carried into the wound, and lead to death from hemorrhage; or if
the wounded person  recover from the first effects,  he may  subsequently sink
under an attack of tetanus or erysipelas.  It is unfortunate that so much igno-
rance prevails  on this point; for fatal  accidents are  continually occurring from
persons discharging guns at others  in sport,—an act which they think' they may
perform without danger, because they are not loaded with  ball  or shot.  In the
case  of The Queen v.  Race (Bury Lent Assizes, March, 1840,) it was proved that
the prisoner had killed the deceased by discharging at him, within a few  feet, a
gun loaded with powder and paper-wadding.  This was done out of a joke at a
fair.   The deceased fell, and died in a few minutes:  it was found that the chest
was penetrated, and that the wadding had wounded the left auricle of the heart.
   It has been  observed that persons, in attempting to commit  suicide, have oc-
casionally forgotten to put a bullet into the pistol: nevertheless, the discharge of
a piece into the mouth has sufficed, from the  effect of the wadding only, to pro-
duce a considerable destruction of parts, and to cause serious hemorrhage.   Fatal
accidents have frequently taken place from the discharge of wadding from cannon
during reviews.  It is not easy to say at what distance a weapon thus charged
with wadding  and powder would cease to produce mischief, since this must de-
pend on the impulsive force given by the powder, and on the size of the piece. Dr.
Lachese has ascertained, by experiment, that a piece charged  with gunpowder
is capable of producing a  penetrating wound  somewhat resemblino- that  caused 
IDENTITY FROM THE FLASH OF POWDER.
269
by small shot, when the piece is  large, strongly charged, and  fired within six
inches of the surface of the body.  (A un. d'Hyg. 1836, 386.)   This arises from
a portion of the powder always escaping combustion at the time of discharge, and
each grain then acts like a pellet of small shot.   Under any circumstances, a dis-
charge of powder only contuses the skin, producing ecchymosis, and often lace-
rating it, if  the piece be fired near.  The dress  is burnt and the skin scorched
from the globe of flame formed by the combustion of the powder:  many particles
of gunpowder may be  actually driven into- the true skin.  All  the substances
here spoken of are considered  to be projectiles;  the weapons are held in law to
be loaded arms, so long as they are capable of producing  bodily injury at the
distance from which the piece  containing them is discharged.   It  may therefore
become a question as to the distance at which these light projectiles cease to  be
harmless.  The answer must be governed by circumstances; but it will in all cases
materially depend on the strength of the charge.   In the case of Reg. v.  Collier,
(Abingdon Lent Assizes, 1844,) the prisoner was charged with firing a gun loaded
with small shot at the prosecutor, with intent to do grievous bodily harm.   It
appeared that the gun  was  deliberately pointed  at the prosecutor, who was then
at a distance of from seventy to eighty yards from the prisoner.  The shot, which
was very small, had marked the clothes, but had not penetrated the skin or inflicted
any wound.   The defence was, that from the slight injury done, the prisoner merely
intended to frighten the prosecutor, and  not to do him any bodily harm.  He was
found guilty of a common assault.  The question was here a delicate one, for had the
  rosecutor been a few yards nearer, and the pellets touched an exposed part of the
  ody, the result might  have been serious.  One pellet has destroyed life, (ante, p.
208.) A case has recently occurred in the United States, involving the question, as
to the distance at which a pistol, not loaded with ball, would suffice to produce a se-
rious wound. A boy, in play, discharged a pistol  at a companion, producing on the
fleshy part of the left hip a wound  one inch in diameter and four inches in depth.
The integuments were destroyed, and the muscles presented a blackened lacerated
mass.  There was no ball in the pistol;  but it  is not certain whether there was
wadding.  Death took  place from tetanus on the seventh day; and, on examina-
tion, no wadding was found in the wound.   There were, however, grains of gun-
powder, with which the wound was blackened throughout its whole extent.  At
the inquest the witnesses differed respecting the distance at which  the pistol was
held at the time the wound was inflicted.   Some said one  foot,  others two  or
three yards.   The deceased stated his belief that the pistol almost touched him,
and, judging by the state of the wounded parts,  this was probably the truth.  Dr.
Swift believed tlfat the wound  had  been produced by gunpowder only, without
wadding.  He performed some experiments with the pistol used by the prisoner,
but loaded with gunpowder and wadding, in order to determine the effects of dis-
charges at different distances. At twelve inches distance from a body, he found that
the clothes were lacerated and  the skin abraded, but the wadding did not  pene-
trate : at six inches, the clothes were lacerated, and the wadding penetrated to the
depth of half an inch;  at two inches the wound produced, which was two inches
deep, was ragged and blackened; at one-and-a-half inches from the chest, the wad-
ding passed into the cavity between the ribs, and in a second experiment it carried
away a transverse portion of a rib.  (Med. Gaz. xl. 734.)   These  results  con-
firm those obtained by  Dr. Lachese.
  Identity from the flash of powder.—Among the singular questions which have
arisen out of this subject is the  following: Whether a person who fires a gun or pis-
tol at another during a dark night, can be identified by means of the  light produced
in the discharge?   This question was first referred to the class  of Physical Sci-
ences  in France, in 1809, and  they answered it  in the negative.  A  case tending
to show that their decision  was erroneous was subsequently reported by Fodere.
A woman positively swore that she saw  the face of a person who fired at  another
during the night, surrounded by a kind  of glory, and that she was thereby ena- 
270              CHEMICAL EXAMINATION OF FIRE-ARMS.

bled to identify the prisoner.   This statement was confirmed by the deposition
of the wounded party.  Desgranges, of Lyons, performed many experiments on
this subject, and he concluded  that on a very dark night, and  away from every
source of light, a person who had fired the gun might be identified within a mo-
derate distance.  If the flash were very strong, the smoke very dense, and the
distance  great, the person firing the piece could not be identified.   The question
was raised in this country, in the case of The  Queen v. White, at  the Croydon
Autumn Assizes, 1839.   A gentleman was  shot at while  driving home in his
gig during a dark night: he was wounded in the elbow.   AVhen he observed the
flash  of the gun, he saw that it was levelled towards  him, and the light of the
flash  enabled him to recognise at once the features of the accused:—in cross-ex-
amination he said he  was  quite sure he could see him, and that he was not mis-
taken as to  his identity.   The accused was skilfully defended, and he was ac-
quitted.   Evidence of this kind has, however, been received in an English Court
of Law.   A case is quoted by Paris and  Fonblanque, (Rex. v. Haines,) in which
some police-officers were shot at by a highwayman during a dark night.  One of
the officers stated that he could distinctly see, from the flash of the pistol, that
the robber rode a dark-brown horse of a very remarkable shape in the head and
shoulders; and that he had since identified the horse in a stable in London.  He
also perceived, by the same flash  of light, that the person had on a rough brown
great coat.  This evidence was considered to be satisfactory.
   From  the information  which I have been able to collect on this point it ap-
pears  to me there can be no doubt, that  an assailant may be thus occasionally
identified.   It is widely different, however,  in respect to the following case re-
ferred to by Miiller, in his Physiology;  namely, where a man declared that he
recognised a robber through the light produced by a blow on his eye in the dark!
As Miiller observes, this is a clear impossibility;  because the flashes  thus per-
ceived are unattended with the emission of light, and therefore can never be
visible to any other person than the subject of them, nor is it possible that they
can ever make any other objects visible.   [For some remarks on this  subject by
Dr. Schilbach, see Henke's Zeitschrift der S. A. 1842, i. 197.]  Dr. Kriigelstein
has lately opposed the inference deduced by  Miiller, and has supported his views
by cases, which, however, do not  appear to me  to be satisfactory.    (Henke's
Zeitschrift der S. A. 1845, iii. 172.)
   Chemical examination of fire-arms.—An attempt has been made by French
medical jurists to determine for how long a period a gun or a pistol  lying near
a dead body may have been discharged;  but it is out of our power to lay down
any precise rules on such a subject.   All  that we  can say is,  a quantity of
sulphuret of potassium, mixed  with charcoal, is  left adhering about  the barrel
of the piece, when recently discharged;  and this  is indicated by its forming a
strong alkaline solution with water,—evolving an odour of  sulphuretted hydro-
gen, and giving a deep brown precipitate with a solution of acetate of lead.  After
some hours or days, according  to  the degree of exposure to air  and  moisture,
the saline residue becomes converted to sulphate of potash, forming  a neutral
solution with water, and giving a white precipitate with acetate of lead.  If the
piece has been discharged for a considerable time, oxide of iron with traces of
sulphate  may be found.  (See Ann. d'Hyg.  1834, 458; 1S39,197; 1842, 368.)
This  subject has recently excited some  attention on  certain trials which have
taken  place in France in  reference to the death of M. Dujarrier.  It was con-
sidered here of some importance to determine whether, by the mere discharge of
powder, such a deposit of  charcoal or  powder took place  at the mouth of the
pistol, as to soil the finger when introduced three  hours after the alleged dis-
charge.  M. Boutigny  conducted  the  investigation, and found  in his experi-
ments that the finger was not blackened under the  circumstances.    He con-
siders  that sulphate and carbonate of potash are formed, and that  the charcoal
is entirely consumed.  The facts proved at the  trial were, however, adverse 
BURNS AND SCALDS.
271
to the view thus taken;  and it  really appears that this  most elaborate inquiry,
involving physics,  chemistry, and  mathematics, might have been spared, on the
simple ground that the result produced by a discharge of powder in the way sup-
posed must depend on the quantity of powder employed (its perfect or imperfect
combustion,) and  the proportion of charcoal contained in it!  The elements for
solving such a strange pyrotechnic question must therefore in most, if not in all
cases, be wanting.   (Ann. d'Hygiene, 1848, i. 392.)
  Examination of fire-arms and projectiles.—In the case of Rush, who was tried
and convicted of the murder of Mr. Jermy, by a remarkable train of circumstan-
tial evidence (Norwich Lent Assizes, 1849,) it was  proved that  the  projectiles
removed from  the body of the deceased consisted  of irregular  pieces of lead
(slugs.)  Similar masses were taken from the body of the son, who was killed at
the same time.   They were described by the medical witness  as  being angular,
and quite unlike the shot used in killing game.  Each piece weighed from eleven
to thirteen grains,  and there were fifteen pieces in  all.  As the learned judge re-
marked, this demonstrated that the two acts of murder  were  committed by the
same person,  or by this person acting in concert with others. -
  The chemical analysis of the projectile  may be  occasionally necessary.  A
common bullet  is entirely formed of lead.  Cast bullets are very commonly found
to have a void space in  the interior when cut through the centre, owing to the
exterior cooling more rapidly than the interior, and the greater bulk of the metal
when in the liquid state.  In large bullets this cavity is frequently of the size of
a barleycorn.   Bullets obtained by compression have no such space,  and are of
very great specific gravity.  Small shot consist of lead with a minute fractional
proportion of arsenic (g^th part.)  If the arsenic  be in large  proportion the
shot is lenticular—if absent, or in small proportion, pyriform (Ure.)   In the
case of Rush, type metal was found in the house.  This consists of lead with
one-fourth part antimony, the latter being left by digestion in  nitric acid.  It
was, therefore,  considered advisable to examine the  slugs chemically, and they
were found to consist chiefly of  lead, and to contain  no antimony.  Fortunately
the evidence here sought for was not necessary for conviction.
                          CHAPTER XXXVII.

 BURNS AND SCALDS—CIRCUMSTANCES WHICH RENDER THEM DANGEROUS TO LIFE—DID THE
  BURNING TAKE PLACE BEFORE OR AFTER DEATH'?--EXPERIMENTS ON THE DEAD BODY--
  VESICATION AND LINE OF REDNESS--PRESENCE OF SEVERAL BURNS--SUMMARY.  ACCI-
  DENT, HOMICIDE, OR SUICIDE--HUMAN  OR SPONTANEOUS COMBUSTION--BURNS BY CORRO-
  SIVE LIQUIDS--SPONTANEOUS IGNITION  OF ORGANIC AND MINERAL SUBSTANCES.

                            BURNS AND SCALDS.
  A Burn is an injury produced by  the application of a heated substance to the
 surface of the body; while a Scald results from the application of a liquid,  at or
 near its boiling point, under the same circumstances.   There seems to be no real
 distinction between a burn and a scald as to the effects produced on the body:—
 the injury resulting from boiling mercury or melted lead might  take either ap-
 pellation.   Nevertheless, as a matter of medical evidence, it may be important
 to state whether the injury found on a body was caused by such a liquid as boil-
ing water, or by a heated solid.  If  the former, the injury might be ascribed to
accident; if the latter, to criminal design.   A scald  produced by boiling water
would be indicated  by a sodden  state of the  skin,  and there would be no loss of
sul istance.   In a burn by a heated solid, the parts may be more or less destroyed,
or even charred: the cuticle may be found blackened, dry, almost of a horny con- 
272
VARIOUS DEGREES OF BURNS.
sistency, and presenting a shrivelled appearance.   This means of diagnosis would
only apply to scalds from water.  A scald from melted lead could not be distin-
guished from a burn produced by a solid heated to the same temperature.
  Action of melted metals.—A singular case in which an attempt on  life  was
made by pouring a melted metal into the  ear, occurred to M. Boys de Loury.
The mother of  an idiot, aged twenty-five, wishing to get rid of him, adopted the
plan of pouring melted pewter into his right ear while he was lying asleep.  Great
pain and  violent inflammation  followed, but the young  man recovered. » The
mother then alleged that he had himself poured the melted metal into his ear.  At
a judicial  investigation, M. Boys de Loury was required to say whether such an
act was likely to occasion death, and if so, how it happened that the party  had
in this instance recovered.   The alloy was formed of seven parts of tin and three
of lead, and the melting point of  such an alloy would be  about 340°.   M. De
Loury stated that such an act might  lead to  death by causing inflammation  and
caries of the internal  ear extending to the brain.  The recovery of the youth was
owing to  the mischief which followed having  been comparatively  slight.  In
performing some experiments on the dead body, he found that it was difficult to
fill the ear-passage with such an alloy, in consequence of the sudden expansion of
the air caused by the high temperature.   (Ann. d'Hyg. 1847, ii. 424.)
   Some of the oils boil at 500°, and produce, by contact  with the  skin, burns
as severe as those caused by  melted metals.
   Various degrees  of burns.—Dupuytren has divided burns into  six  degrees,
which are commonly  recognised by medical jurists.
   1.  The heat  produces a simple  inflammation  of the  skin without vesication.
The skin is very red,  but the redness disappears on pressure : there is slight  and
superficial swelling, with severe pain, relieved by the contact of cold substances.
The inflammation subsides after a few hours, and the  skin resumes its  natural
condition;—or it may continue for several days, and the cuticle then peels off.
   2.  There is  a severe  inflammation of  the  skin, and the  cuticle is raised into
blisters containing a yellow-coloured serum.   This kind of injury is generally
the result of the action of boiling liquids.   The blisters are  commonly formed
immediately; and others are produced during a period of twenty-four hours, or
those which are already formed become enlarged.   Suppuration takes place if
the cuticle be removed, and the individual survive for a period sufficiently long.
As the cutis or true skin is not destroyed by this  degree  of  burn, there is no
mark or cicatrix to indicate its past existence.
   3.  The superficial part of the cutis is destroyed. The burn appears in the form
of yellow or brown patches, insensible  when gently touched, but giving pain
when strongly pressed.   An  inflammatory redness, accompanied by vesication, is
perceived  in the healthy portion  of skin around  the eschars.  A white  and
shining cicatrix, without contraction  of  parts, remains  after healing.   This de-
gree of injury is commonly observed in burns from gunpowder, and  the part
which was the  seat of the burn is frequently  stained black, when the particles of
gunpowder have not been removed soon after the accident.
   4.  The skin  is disorganized as far as the subcutaneous cellular tissue.  There
are firm and thick eschars, which  are quite insensible.   If the burn has arisen
from a boiling liquid, the eschars are soft and of a yellowish  colour; if from  a
red-hot solid, they  are firm, hard, of a brown  colour—sometimes' black.   The
skin around appears  shrivelled and puckered up towards the eschar,  which is
depressed below the cutaneous surface.   The surrounding integuments present a
high  degree of inflammation, and vesications appear.   From  the fourth to the
sixth day, the  eschar falls off, leaving an ulcerated  surface which heals slowly,
and is always indicated by a cicatrix.
   5.  In the fifth degree, the whole of the  layers of the skin, the cellular mem-
brane, and a portion of the muscles beneath, are converted into an eschar.  The
appearances are similar to those of the fourth degree, but in a more aggravated
form. 
         DID THE BURNING TAKE PLACE BEFORE OR AFTER DEATH ?       273

  6. The burnt part is completely carbonized.  If the individual survives, the
most violent inflammation is set up in the subjacent tissues and organs.
  Danger to  life.—Neither a burn  nor a scald appears to be considered  as a
wound in law, but in the statute of wounding, they are included among bodily in-
juries dangerous to life.  (1 Vic. 85, sec. ii.)  Burns and scalds are dangerous
to life  in  proportion to the extent of surface which they cover, as well as the
depth to which they extend.   The extent of surface involved in a superficial burn
is of greater moment than  the entire destruction of a small part  of the body
through an intensely heated solid.  When the burn is extensive, death may ensue
either from the intensity of the pain produced, or from a sympathetic shock to the
nervous system.  Death takes place rapidly from burns in children and nervous
females; but in adults and old persons, there  is a better chance  of recovery.
When  death  has been caused by intense pain, no  post-mortem changes  have
been detected;  but under other circumstances, it has been found, on inspection,
that there were patches of redness on the bronchial mucous membrane, as well as
on that of the alimentary canal. The brain has been found gorged, and  the ven-
tricles have contained an abundance of serosity.  The serous liquids of the pericar-
dium and pleura have also been in larger quantity than natural.  In short, besides
congestion, there is generally abundant serous effusion in one of the three great cavi-
ties, especially in the cranium. This arises from the sudden reflux of blood into the
interior.   (See cases by Mr. Long, Med. Gaz. xxv. 743;  also by Mr. Erichsen,
xxxi.  551.)  If the person survive the first effects, he may die from inflamma-
tion, suppuration, gangrene, irritation, fever, or he may be worn out by exhaus-
tion.   In this respect, burns of the 4th, 5th, and  6th degrees are especially
dangerous to  life;  and it would be unsafe to give an early prognosis, as inflam-
mation of deep-seated viscera only appears after seven days.
  Stupor from burns.—In some instances, especially in children, stupor and in-
sensibility have supervened, owing to a sympathy with the brain; and these symp-
toms have been followed by coma and death.  If, under these circumstances,
opium  has been given to the patient  as a sedative, the stupor resulting from the
burn may be attributed to  the effects of the drug;  and should the person  die,
the practitioner may find himself involved in a charge of malapraxis.  It may-
be alleged, as in the following case related by Mr. Abernethy, that the person  was
poisoned by opium.  A medical man was charged with the  manslaughter of a
child by giving to  it an overdose of opium, when it was labouring under the ef-
fects of a severe scald.  Mr. Abernethy stated in his evidence, which was given
in favour of  the practitioner, that he  thought the exhibition of  opium very
proper;—that the quantity given, eight drops of tincture of opium immediately
after the accident,  and ten drops two hours afterwards, was not an  overdose for
a child (the age is not stated.) The circumstance of the child continuing to sleep
until it died, after the exhibition of the opium, was no proof that it had been poi-
soned.   This  sleep was nothing more than  the torpor into which  it had been
plunged by the accident.  The surgeon was acquitted.  Notwithstanding the fa-
vourable opinion expressed of this plan of treatment, it would be advisable to
avoid  the use of opium on these occasions,  in respect to infants  and young
children.  Life is readily destroyed  in young subjects by the smallest doses of
this drug; and there are no satisfactory means of distinguishing the comatose
symptoms produced by a burn or scald, from those produced by an overdose of
opium.
  Did the burning take place before  or after death?  Vesication.—The  produc-
tion of vesication or of blisters containing serum,  is commonly regarded as an
essential character of a burn which has been produced during life.   Vesication
is especially seen in scalds, or in those cases in which the skin has been burnt by
flame or by the ignition of the clothes, provided the cuticle be not destroyed.  It
is not so commonly observed in burns produced by intensely heated solids.  In
vesication, the  cuticle  becomes raised from the true  skin beneath, and is con-
       18 
274               BURNS DURING LIFE AND AFTER DEATH.
verted into one or more blisters containing serum, while the skin around is of a
deep-red colour.  It is very uncertain as to the time-at which it appears; it may
be produced in a few minutes, or sometimes not for several hours:  thus, death
may take place before vesication occurs; and the non-discovery of  this condition
does not warrant the opinion that the burn could not have taken place during
life.   If the cuticle be removed from a vesicated  part of the living  body, the
skin beneath will become intensely reddened; but if the cuticle be  stripped off
in a dead subject, the skin will become hard, dry, and of a horny-yellow colour;
it does not acquire  the intense scarlet injection which is acquired by the living
skin under the same circumstances.
  When vesication  is met with, is this certain evidence that the burn was vital,
i. e. that it took place during life? This question is of some importance in legal
medicine.   The following are, I believe, the facts which have been  hitherto as-
certained.  When boiling-water is poured upon the dead body ten minutes after
death, the skin is simply ruffled and  shrivelled;  but the cuticle does not become
raised into a blister.  (Christison.)  At a longer period than ten minutes, the
same effects have been observed while the body  retained its warmth.  What the
effect would be within a shorter period than ten minutes after death, it is not pos-
sible to say; nor is it likely that any experiments can be easily performed to de-
termine this point.  It is not probable,  however,  that vesication would  follow
after active life (indicated by the continuance of the functions of respiration and
circulation) had ceased, except under circumstances to be presently stated. Dr.
Christison, on one occasion, had an opportunity of trying the experiment on the
same subject before and after death; this was in the case of a young man who
had  poisoned himself with opium.   While he was lying in a hopeless state of
coma, four hours before death,  a hot iron was held  on  the outside  of the hip-
joint; and half an  hour after death, a red-hot poker was applied to three  places
on the inside of the arm.  Vesication followed the  burns in both instances; but
those caused during life contained serum, and those formed after death, air. In
another experiment, a cauterizing iron produced no blisters on a leg, half an hour
after amputation; but vesications, containing air, were formed, when in another
case the iron was applied ten minutes after amputation.  On  the whole, Dr.
Christison  thinks that a vesication containing serum, indicates a vital, and one
containing air, a post-mortem burn.  I have performed many experiments on
the bodies of infants eighteen and twenty hours after death, both with boiling
water and heated solids; but in no case have I observed any kind of vesication
to follow at that period.   The skin became shrivelled, and was partly  destroyed
by the heat, but there were no blisters produced.  (See case by M. Ollivier, Ann.
d'Hyg.  1843, i. 383.)  It has been ascertained, that under certain morbid states
of the body, blisters containing serum may be produced in the dead subject, even
twenty-four hours after death.   M. Leuret observed,  that this took place  in an
anasarcous subject, in the vicinity of which a heated brazier had been placed.
The cuticle became hardened, then raised and blistered; and the  blister con-
tained an abundance of reddish-coloured  serum.  In repeating this  experiment
on other dead bodies not infiltrated,  it was observed that no vesications contain-
ing serum were produced.  (Ann. d'Hyg. 1835, ii. 387.)   M. Champouillon has
recently repeated the experiments of M. Leuret on  anasarcous bodies, and  he
finds that blisters may be produced in these cases at almost any period after death.
Thus, they occurred when heat was  applied to  the anasarcous subject recently
dead,—to another when in a state of cadaverous rigidity, and  to a third when
putrefaction  had commenced.   The blisters do not  appear immediately,—the
time which he found requisite for their production varied from two to  six hours.
The serum effused beneath the raised cuticle was rarely tinged with blood.  (Ann.
d'Hyg.  1846, i. 421.)   These experiments only  confirm  the results obtained by
M. Leuret;  they add nothing to our knowledge  of  the subject.   The conclusion
to be drawn from them is, that in the  examination of burns on  the  body of a 
            EVIDENCE FROM VESICATION AND A LINE OF REDNESS.        275

person affected with anasarca, it is  necessary to be cautious in expressing an
opinion.   In such cases it would not be possible, from the  existence of mere
vesication, to say whether the burn took place before or after death.
  Dr. AVright, of Birmingham, has  lately published the results of some experi-
ments on post-mortem burning, from which  he infers that the production of a
serous blister in a dead  body is not dependent  on the presence of serum in the
cellular tissue (anasarca,) but upon the amount of (latent) organic life remaining
in the body.   He states that he has  produced a serous blister post mortem more
than a dozen times,—twice within half an hour, and once within fifteen minutes
after death; and in amputated limbs  he has produced them in from half a minute
to four minutes and a half after amputation.  The only favourable opportunity
which occurred to him  for producing, post mortem, a serous blister, was in the
person of a female thirty years of age, who died suffocated from acute  congestion
of the lungs.  She was slightly anasarcous.   Three hours and a half after death,
when the body was quite warm, and the joints flexible, a spirit-lamp-flame was
applied to the lower and back part of the left leg.  After the lapse of an hour,
blisters had arisen filled with serum of a pale straw colour; one contained  two
and the other three drachms.
  Ten and fifteen hours after death,  when the body had become  cold and rigid,
the flame produced only gaseous blisters.   (Pathological Researches on Vital and
Post-mortem Burning,  1850.)  These results are not  in  accordance  with those
obtained by Dr. Christison and M. Champouillon.
  A line of redness.—In burns produced by red-hot solids, other effects  besides
vesication follow.   The  edge  of the skin immediately around  the part burnt is
commonly of a dead white; and close to this, is a deep red line, gradually shaded
off into the surrounding skin, which  is reddened.  The diffused redness is remo-
vable by pressure, and disappears with life; the red line here referred to, however,
is not removable by pressure, and is  persistent after death.   This line of redness
is not always met with in severe burns; and  when the individual survives one or
two days, its production appears to depend upon a power of reaction in the sys-
tem.  Thus, then, its absence furnishes no proof of the burn having a post-mortem
origin; for it is not a necessary accompaniment of a vital burn.   Dr.  Christison
has endeavoured to determine by experiment whether this line of redness could
be produced by applying a heated solid to a  dead subject.   He found  that when
the person had been dead only ten minutes, no such effect  was produced.  In
repeating his experiments on dead subjects many hours after death, I have found
that no line of redness ever presented itself,  so that its discovery in a  dead body
burnt, would appear to indicate either that the burning took place during life,
or within ten minutes after death,—most probably the former.   M. Champouillon
takes exception to the inference derivable from these experiments.  He says that
he has caused the production  of  a line of redness by the application of heat to
the dead body, and that it is a uniform accompaniment of the formation of blisters
in the dead.   He admits that it is in this case a mere capillary infiltration, quite
superficial, and surrounding the margin of the blister, while in the red line pro-
duced during life, the tissues  of the skin are deeply injected, and it is  evidently
the result of  vital reaction.   (See Ann. d'Hyg. i. 422.)  It would appear that
he has only remarked this condition  in dead anasarcous bodies, in which vesica-
tions had been produced, and it is obvious from the  description, that he is refer-
ring to a slight congestion of the vessels, occasioned probably  by the  stagnation
of the fluid portion of the blood in the  superficial capillaries.   It  is altogether
distinct from the line of redness described by Dr. Christison as  a frequent con-
sequence of severe burns.   In the case of- Mr.  Westwood, who was murdered in
June, 1839, the fact of certain burns found on the body having been produced
during life, was determined by  Mr.  J. G. French, from an observance  of this
sign.   The deceased was found  dead with  his  skull extensively fractured, his
throat cut, and his body burnt in various places.   Mr. French, who gave evidence 
276
WOUNDS CAUSED BY THE ACTION OF FIRE.
 on this occasion, remarked, that the burns were surrounded by a line of redness;
 —that they were probably produced about the same time as  the  other  injuries,
 but certainly while there was some vital action in the system.  AVhen, however,
 vesication and a line of redness are  absent, we have no  medical data on  which
 to found an opinion as to whether the burn was  caused before or after  death.
 Dr. AArright considers that in a low state of vitality  a line of redness might not
 be produced by a severe burn on the living body, and that more certain reliance
 may be placed on the red marks found beneath the blisters  and crusts of vital
 burns.   These latter have been well marked when he has found the line of red-
 ness itself indistinct.   (Op. cit. page  25.)  These remarks of Dr. Wright were
 chiefly made in reference to a remarkable case of alleged matricide at Bridgnorth.
 (Reg. v. Newton, Shrewsbury Lent and Summer Assizes, 1849.)
   When several burns are found on a  dead body, it  may be  a question whether
 they were all produced at the  same  time.   This is a point which  can  be deter-
 mined only by observing whether  any of them present signs of gangrenous se-
 paration :—of suppuration,—granulation, or other changes that take place in a
 living body after accidents of this kind.   The witness may be asked, how long
 did the deceased survive the burn ?  A person may die in a few minutes or live
 some hours after receiving a  most extensive burn; and yet there will  be no
 change  in  the part burnt, to indicate when death actually  took place.   There
 may have been no  time for inflammation  or  its consequences to become estab-
 lished.   Suppuration generally follows vesication; and in severe cases it may oc-
 cur on the second or third day; but often not until a later period.   In regard to
 gangrene, this takes place, when the vitality of a part burned  is destroyed.  The
 time of its occurrence  is uncertain, but it sometimes very speedily follows the
 accident.
   After a murder has  been perpetrated, it is  not  uncommon for a murderer to
 attempt to dispose of the body by burning  it.   This was remarked in the case of
 Mr. Paas, (King v. Cook,) likewise  in the  case of The  Queen v.  Good, and  in
 another case at Leeds, (Jan. 1843,)  where a mutilated body  was found floating
 in a river with marks of burning about it.  In general, the  body is not burnt
 until all signs of life have disappeared; we shall therefore meet, in such cases,
 with nothing but the charring of  dead flesh, so that no difficulty can exist  in
 forming an opinion.  When the burning is partial, and has probably taken place
 from a wilful ignition of the clothes,  at or about the time of death, some cau-
 tion is required in expressing an opinion, since marks of vesication and a line of
 redness  are not always present in vital  burns.   It is by no means unusual, how-
 ever, to find it stated in evidence,  that blisters are a constant accompaniment of
 a burn in the living body!   In  the case of The Queen v. Taylor, (York Lent As-
 sizes, 1842,) the deceased was found dead with marks of  strangulation on her
 neck, and her clothes were much burnt from  her waist to the knees.  She was
 lying across the hearth,—the  body was  much burnt, as well as the upper and
 lower extremities and the neck: in the opinion of the medical witness, the burn
 on the neck could not  have been produced by the fire extending from the other
 parts of the body.  In cross-examination he stated that the burns must have oc-
 curred after death;  they could not have  taken place before, nor at the time of
 death, because there was no vesication, and he had never seen a burn on a living
 person which was not followed by blistering!   The prisoner  was convicted, the
 counsel having failed to prove or render it probable that death was caused as al-
 leged by accidental burning.
   Wounds caused by fire.—On the discovery of wounds on a  body burnt by fire,
it is necessary they should  be closely examined, in order that a witness may be
 enabled to say whether  they have been caused by cutting or  other instruments,
before death by burning, or whether  they are  not  simple mechanical results of
the effect of fire on the  skin.  Mr. T. B. Curling, of the London Hospital, has
 communicated to me a case which will  show the importance of this inquiry.   A 
INJURIES BY FIRE SIMULATING WOUNDS.               277
little boy, two years  of age, was brought to the London Hospital, Nov. 11th,
1840, so severely burnt on the face, neck, abdomen and extremities, that he sur-
vived the accident only three  quarters of an hour.   It appeared that the  step-
mother, who had charge of the child, left him at home locked up in a room where
there was a fire, while she went out.  Some of the neighbours, shortly afterwards
hearing screams proceeding from the room, broke open the door, and discovered
the child enveloped in flames, and its clothes on fire.  The flames were imme-
diately extinguished,  and the  little boy was  brought to the hospital.  Suspicion
of unfair treatment having been excited by the appearance of wounds about the
knees, which were observed as soon as the child was admitted, and by the reported
neglect  and ill usage of the child by the stepmother, the  coroner directed an
inspection to be made.  The body was plump and well formed.  The skin in the
burnt parts was denuded of cuticle and converted into a deep yellowish or blackish
dry mass, which was very tense, hard, and easily  torn.  There were gaping wounds
on both knees.  On the right side, a fissure on the skin commenced about the
middle of the thigh, and proceeded for two  inches and three quarters to the in-
side of the patella, where it became somewhat jagged, and making a sudden turn
inwards passed to the extent of two inches  towards the  back of the joint.   A
transverse laceration of the skin, three-quarters of an inch in length, was observed
on the front of the left thigh a little above the knee; and  another, which was
also transverse and measured an inch and a half, was situated below, on the inner
side of the joint.  These fissures in the charred skin were all about three lines
in width and two in depth, and exposed the adipose tissue beneath, which appeared
white, and free from all appearance of extravasation of blood.   The  edges  of
these fissures were not uneven, but they did not present the clean  and smooth
appearance usually observed in incised  wounds.  The vessels on the surface of
the brain were very turgid, and the cortical structure appeared remarkably dark-
coloured.  The lungs  were congested, but the heart,contained very little blood.
The mucous membrane of the stomach presented a slight pinkish hue,  but that
of the intestinal canal was nearly white.   The follicles throughout the whole of
the intestines  were all highly developed and very prominent.   The mesenteric
glands were enlarged.   The alimentary canal contained a good deal of undigested
food. The liver was in every respect natural.   From the absence of any trace
of effusion of  blood, the sound condition  of the exposed adipose tissue, its  ex-
emption from the action of the fire, and the  irregular character and appearance
of the fissures, Mr.  Curling concluded that they were not the result of wounds
inflicted before the occurrence of the burn: he considered them to have been
occasioned by the influence of heat, which had  forcibly corrugated the skin and
completely destroyed  its  elasticity, and  the superficial layer of adipose tissue
being closely adherent to the cutaneous tissue, necessarily gave way at the same
time.  In several places some small vessels containing blood were observed run-
ning across the fissures; these, being more tenacious than the adipose tissue, had
not yielded with it.   This appearance alone was sufficient  to negative the sup-
position of the infliction of the wounds by cutting instruments.  The production
of the fissures might have been aided by the child's struggles immediately after
the occurrence of the burn, but  it did  not appear that they were at all violent.
The conclusion at which Mr. Curling arrived was quite justified by the facts; and
the case is calculated to throw an important  light on the accidental origin of fis-
sures or wounds of the skin in cases of death from  burns.
  Summary.—The conclusions which, it appears to me, we may draw from the
foregoing statements, are: 1, that, as a general  rule, when we discover marks of
vesication, with serous effusion or a line of redness, or both, about a burnt part
of the body, we are justified in saying that the burn has occurred during life; 2,
that when these appearances are not met with, it by no means follows  that  the
burn was not vital; the affirmative evidence derived from such appearances being
much stronger than the negative. 
 278                HUMAN OR SPONTANEOUS COMBUSTION.

   Cause of death.—AArhether a burn or a scald was or was  not  sufficient to ac-
 count for death, must be determined by the extent, depth, and  situation  of the
 injury: but even when the burn has clearly been caused during  life, the body
 should be carefully examined for other  marks of violence, as blows about the
 head, wounds, marks  of strangulation, and internally  for hemorrhage, disease,
 or poisoning.   It must  be remembered,  that in burns which are rapidly fatal,
 the serous liquid found in  the cavities has commonly a  red  colour, and the mu-
 cous  membranes are also reddened.
   The subject of scalding scarcely  requires  a  separate notice.  A scald from
 boiling water would, when  recent, be indicated by vesication  and the sodden state
 of the skin.  The living structures are not charred or disorganized as by the ap-
 plication of a red-hot solid.  At the Liverpool Summer Assizes, 1847, a woman
 was convicted of throwing boiling water over her husband,  with intent to maim
 him.   (Reg. v. King.)  In  another case (Reg. v. Blewitt, AVorcester Summer
 Assizes, 1847,) the prisoner was convicted of the  manslaughter of  his wife by
 pouring over her the contents of a kettle of boiling water.   These are the only
 recent instances of criminal scalding which are reported.

                    HUMAN OR SPONTANEOUS COMBUSTION.
   Supposing  that  a dead  body is found burnt, and there  is no other  cause of
 death about it, it may be said that the burning was neither the result of accident
 nor of homicide,  but that it was the effect of spontaneous or human combustion.
 There are  two opinions concerning this so-called spontaneous destruction of the
 human body.   On  the one hand, it is alleged that the combustion may take place
 from internal causes,—in other words, that the  process is literally spontaneous:
 on the other hand,  it is contended that the contact of  a substance in a state of
 ignition is necessary for the production of the phenomenon,—so that, according
 to this view, the human body merely becomes preternaturally combustible.   The
 hypothesis of those who advocate  spontaneous  combustion is, it appears to me,
 perfectly untenable.   So far as I have been enabled to examine this subject,
 there is not a  single well authenticated instance  of such an event occurring:—in
 the cases reported which are worthy of any credit, a  candle, or some other ignited
 body, has been at hand, and  the accidental ignition  of the clothes was highly
 probable, if not absolutely  certain.   It is  in vain that they who  adopt this hypo-
 thesis appeal to the electrical state of the atmosphere or of the individual, coupled
 with the impregnation of the system with the inflammable principles of alcohol,
 as conditions sufficiently explanatory of their views,—such explanations may be
 reserved until the occurrence of this spontaneous combustion  from internal causes
 is placed beyond  all dispute.   [For a full description of the  phenomena which
 are said to accompany this  condition, see Casper's Wochenschrift,  1841, Nos. 8,
 9, 10; also, Henke's Zeitschrift der S. A. 1842, ii. 228; 1843, ii. 39.]
  AVe have, then, only to consider how far the views of those who  allow that the
 body may acquire preternaturally combustible properties' are  consistently borne
 out by facts.  It is generally admitted that the human body is highly difficult
 of combustion; and, therefore, if in any case the degree to which it is consumed
 by fire is great in  proportion to the small quantity  of combustible  matter  de-
 stroyed about the person, it is  not  unreasonable to refer this to  its possessing
 greater combustible properties.   This is precisely the species  of evidence which
 is furnished by the  alleged cases of spontaneous  combustion:  the body has been
 found almost entirely consumed, and the clothes and  other articles of furniture
surrounding it but little injured.  A similar remark was made  by Dr. Duncan,
 respecting  two cases in which the two husbands were tried  for  the murder of
 their wives: in both it was the opinion of this physician, that the bodies of the
 deceased were preternaturally combustible.
  AVithout attempting to offer any explanation of the fact,  there  appears to be
sufficient evidence on  record to bear out the view that the  human body may, 
BURNS BY CORROSIVE LIQUIDS.                   279
under certain circumstances, acquire increased  combustible  properties.  At the
same time, the medical jurist will perceive that this admission does not involve
any difficulty in the judicial determination of a question of murder by burning,
since it is contended that the combustion of the body cannot take place except
by contact with ignited substances.  But whether the ignition of the clothes of
a deceased person took place accidentally, or by the  criminal act of an accused
party, is a totally different question,—it is one in which a medical jurist is no
more concerned than a non-professional witness,—this  is, in fact, a point which
can be cleared up only by general or circumstantial evidence.  If it be admitted
that the body of one person will burn more rapidly and completely than that of
another, this will be no ground  of exculpation to a prisoner who is proved to
have wilfully set fire to the clothes of that person.  It may be urged in defence,
that the prisoner  might not have intended to destroy the deceased;  and that,
although he ignited the clothes, he did it  without any malicious intention;  and
that death would not have  been caused by his act, but for the preternatural com-
bustibility of the body of the deceased!  The intention which a person may have
had in setting fire  to the clothes of another, when he could not possibly know to
what degree the burning would extend, is,  of course, a question for a jury, to be
decided from the  circumstances.   The relation of this subject of  the alleged
spontaneous combustion of the body to  medical jurisprudence, appears therefore
to have been  much exaggerated.  The only credible part  of the doctrine can
never present any  sort of difficulty to  a medical jurist.  In the case of Stauff,
tried and convicted of the murder of  the Countess of Goerlitz, the theory of
alleged spontaneous combustion of the  human body was completely refuted by
Liebig and other eminent chemists (see Med. Gaz. xlvi. 899.)

                       BURNS BY CORROSIVE LIQUIDS.
  Among the  cases in which medical evidence  is sometimes required, are those
of throwing sulphuric acid  or other corrosive liquids on  the person.   This crime
has been especially prevalent of late years, and until the recent alteration  in the
criminal law there  was no  adequate punishment for it.  On one occasion, the
prisoner escaped the charge of felony, because it could not be considered, in  law,
that sulphuric acid was capable of producing a wound—the man  having been in-
dicted for wounding!   This case clearly showed a strong necessity for some legal
definition of a wound,  as well as the uncertainty of medical opinions;  for while
one surgeon considered that the injury produced was a wound, another  thought
that it was not.  The judges decided that it was not a wound within the meaning
of the  statute.   (The  King v. Murrow,  Liverpool  Aut. Assizes, 1835.)   The
Act 1 Vic. c. 85, s. v. while it punishes the offence, omits all reference to  a  defi-
nition of the word wound.  The nature  of the liquid thrown is merely defined in
general terms to be "any corrosive fluid or other destructive matter"—a point
which will require to be settled by medical evidence.   In common language, and
according to the statute, the injury thus produced is called a burn;  but it is
wholly different in its origin, as well as in  its progress.   I do not know  that
there has been a single instance in which such  an injury has directly destroyed
life;  but great deformity and actual blindness have resulted.  A medical man is
sometimes required to  distinguish these injuries from burns and  scalds:-—this
may be easily done in the first instance, by the appearance of the part  injured,
as well as by the description of the first symptoms.  The stain is brown when
sulphuric acid has  been used, and yellow when  nitric or muriatic acid has been
employed.   The eschar is soft, and not  dry, as  in a burn from  a heated  solid.
The skin touched by a concentrated acid is destroyed and sloughs away, leaving
a suppurating and  granulating surface.  The period of recovery  will depend on
the extent of the injury.   Although a person may not die from the direct effects
of the acid, yet in certain irritable constitutions the inflammation which follows in
deep-seated parts might prove fatal.  In infants, or delicate nervous females, an 
280
INJURIES BY CORROSIVE LIQUIDS.
extensive injury thus produced may readily destroy life.  In the case  of Mis*
Cashin, for whom an escharotic liniment was prescribed by a quack, there was
no doubt that death was caused by the great local mischief produced by the ap-
plication.   The nature of the acid may be determined by applying wetted linen
to the part when the injury is recent, and examining the  liquid thus absorbed.
In  general, however, evidence is readily obtained by  examining the spots  or
stains left on articles of clothing or furniture.   Sulphuric acid is most commonly
used;  but in a case which occurred at Guy's  Hospital, nitric acid had been
thrown at the individual, and had led to the destruction of the sight of one eye.
The caustic alkalies  might also  be  used under  these circumstances, as well  as
numerous other liquids, on which the only medical opinion required would be,
whether the liquid employed should or should not be considered as corrosive or
destructive matter.  To constitute a felony, it is necessary that the person should
have sustained, from the act of throwing, some grievous bodily harm.
  The mineral acids are sometimes used in other ways for the destruction of life.
In  June, 1833, a man poured a quantity of strong nitric acid into the ear of his
wife while she was lying asleep.   She awoke suddenly with a violent pain  in the
ear, which continued for three days, whereby she became weak and exhausted.
Soon afterwards there was copious hemorrhage, and   a  portion  of membrane
escaped.   She  lost the use of her right arm, and became completely deaf.   Sup-
puration took place  from the ear, and blood escaped daily.  She gradually sank
and died, six weeks  after the injury,  the right half of the body being convulsed
before death.   On inspection, a portion of the external  ear was wanting, and the
ear-passage was much wider than natural.   The brain,  near the petrous portion
of the temporal bone, was softened, and the bone itself carious.  The injury had
led to death indirectly by producing disease of the  brain.   (Medical Gazette,
xvii. 89.) 
INFANTICIDE.   NATURE OF THE CRIME.
281
INFANTICIDE.
                          CHAPTER XXXVIII.

NATURE OF THE CRIME--THE SAME EVIDENCE REQUIRED AS IN OTHER CASES OF MUR-
  DER—PROOF OF  LIFE  DEMANDED--BODY OF THE  CHILD  NOT  DISCOVERED--MEDICAL
  EVIDENCE AT INQUESTS--AGE OR MATURITY OF THE CHILD--VIABILITY NOT REQUIRED
  TO BE PROVED--CHARACTERS FROM THE SIXTH  TO  THE NINTH  MONTH--SIGNS OF MA-
  TURITY--ABNORMAL DEVIATIONS--POSITION OF THE UMBILICAL  OPENING--GENERAL
  CONCLUSIONS--RULES FOR INSPECTING THE BODY.

  Nature of the crime.—By infanticide we are to understand, in medical juris-
prudence, the murder of a new-born child.   The English law, however, does not
regard child-murder as a specific crime; it is  treated like any other case of mur-
der, and is tried by those rules of evidence which are  admitted in cases of felo-
nious homicide.   In saying that infanticide is the term applied to the murder of
a new-born child, it is not thereby implied that the wilful killing should take place
within any particular period after birth.  Provided the child be actually born and
its body entirely in the world, it matters not whether it  has been destroyed within
a few minutes, or not until several days after its  birth.  In the greater number
of cases  of infanticide, however, we find  that the  murder  is commonly perpe-
trated within a few hours after the birth of the child.   Although the law of Eng-
land treats a case of infanticide as one of ordinary murder,  yet there is a parti-
cular difference in the medical evidence required to establish the murder of a new-
born child.  It is well known that in the course of nature, many children  come
into the world dead, and that others die from various causes soon after birth.—
In the latter, the signs of their having lived are frequently indistinct.  Hence,
to provide against the danger of erroneous accusations, the law humanely pre-
sumes that every new-born child  has been born dead, until  the contrary appear
from medical or other evidence.  The onus of proof is thereby thrown on the
prosecution; and no evidence imputing murder can  be received unless it be made
certain by medical or other facts, that  the child survived its birth, and was actu-
ally living when the violence was offered to it.  Hence there is a most difficult
duty cast upon a medical witness on these occasions.
  [In the United States, the laws of the various states  do not differ greatly from
each other; and by all of them, as by that of England,  proof of the murder must
be furnished to constitute the  crime of infanticide.  In Pennsylvania,  sec. xviii.
of Act of 22d April, 1794, provides that the "concealment of the death of any
such child shall not be conclusive evidence to convict  the party indicted for the
murder of her child, unless the circumstances attending it be such as shall satisfy
the  mind of the jury that she  did wilfully and maliciously destroy and take away
the  life of such child."   The concealment of the birth of a bastard child, whether
it was born alive or dead, is punishable by fine or imprisonment.   A conviction
for a second offence is punishable by imprisonment for life. 
282
MATURITY OF THE CHILD.
   In most of the other states, this crime is in like manner punishable by fine or
imprisonment, or both.
   In Louisiana, the penal code recognises infanticide as a specific crime, of the
same grade as murder.  See last Am. ed. of this work by Dr. G.—II.]
   Body of the child not discovered.—In cases of child-murder, medical evidence
is commonly founded upon an examination of the body of the child; but it must
be borne in mind, that a woman may be found guilty of the crime although the
body of the child  be  not discovered:—it may have been destroyed  by burning,
or otherwise disposed of, and a medical witness  may have only a few calcined
bones to examine.  (Ann. d'Hyg. 1845, ii. 129.)  In these cases of the non-pro-
duction of the body, good legal evidence of the murder would,  however, be de-
manded ;  and this evidence should* be such as would satisfactorily establish a
matter of fact before a jury.   The production of the body of a child is therefore
no more necessary to  conviction than in any other case of murder.   A woman
has been tried within the last few years for the murder of her child, the body of
which was never discovered.
   [This  seems to us  very unwarrantable practice.  According to Roscoe's Cri-
minal Evidence, (4th American edition, Sharswood, 693,) "The corpus delicti,
that a murder had been  committed by some one is essentially necessary to be
proved, and Lord  Hale advises that in no case should a  prisoner be  convicted,
when the dead body has not been  found—when the fact of the murder depends
upon the fact of disappearance."  Ante, p. 18.   (Tyner  v. The State, 5 Hum-
phreys, 383.)
   "A girl was indicted for the murder of her child,  aged sixteen days.  She was
proceeding from Bristol to Llandago, and she was seen near Tintern with a child
in her arms at six o'clock in the evening: she arrived at Llandago between eight
and  nine without  the child.   The body of a child  was afterwards found in the
Wye, near Tintern, which appeared not  to be the  child of the prisoner.  Lord
Abinger,  C. B.,  held  that the  prisoner must be acquitted, and that she could not
[694] by law either be  called upon to account for  her child, or to say where it
was, unless there was evidence to show that the child was actually dead."  Hop-
kins' case, 8 C. &  P. 591, also Id. xxxiv. 540.—H.]
   Medical evidence at inquests.—In most instances, however, the  body of the
child is  found,—an inquest is  held, and medical  evidence  is  demanded.  In
giving evidence  at a coroner's inquest on a case of infanticide, as much  care
should be taken  by a  practitioner as if he were delivering it before a judge at the
assizes.   Some witnesses are disposed to treat an inquest with indifference, and
to be careless in their evidence, thinking probably that, should the case come to
trial, they could prepare themselves and amend any statements which from sub-
sequent reflection might appear to  have been hastily made before a coroner.  But
it ought  to be known that the depositions taken by this officer are at the trial
placed in the hands of the judge as well as of the  prisoner's counsel; and should
a witness deviate in his evidence at the  assizes from that which he gave at the
inquest,—or should he attempt to  amend or explain any of the  statements  then
made, so that they might,  by the ingenuity of a  barrister,  be represented as
having a new bearing on the prisoner's case, he would expose himself not merely
to a  severe cross-examination,  but probably to the censure of the Court.   If me-
dical men were to reflect that in delivering their opinions before a  coroner and
jury, they are, in  many instances, virtually delivering them  before  a Superior
Court, it is certain that many  unfortunate exposures would be easily avoided.

                UTERINE AGE OR MATURITY OF THE CHILD.
   One of the first questions which a witness has to consider in a case of alleged
child-murder, is  that which relates  to the age or probable degree of maturity which
the deceased child may have attained in utero.  The reason for making this in-
quiry is, that the  chances of natural death, in all new-born children, are great 
PROOF OF VIABILITY NOT NECESSARY.
283
in proportion to their immaturity;  and that, supposing them to have  survived
birth, the signs of their having respired are commonly very obscure.  It is found
that the greater number of children which are the subjects of these investigations
have reached the eighth or ninth month of gestation; yet charges of murder might
be extended to the wilful destruction of children at the seventh month or under,
provided the evidence of life after birth was clear  and satisfactory.
   Proof of viability not required.—The English law does not  act  on the  prin-
ciple that a child, in order to become the subject of a charge of murder, should
be born viable, i. e. with  a  capacity to live.  It is  observed by Mr. Chitty, al-
though no authority is quoted for  the statement,  that "the object of the law is
to prevent injuries to infants having capacity to maintain a separate existence;"
and he further suggests that such a capacity should be proved, in order to com-
plete the offence of infanticide.   (Med. Jur. i.  411.)  This argument, carried to
its full extent, would render it no  offence to put  to death all persons afflicted
with any mortal disease.  I have been unable to find, in the numerous reported
trials for infanticide, any ground for this extraordinary doctrine.   The capacity
of a child continuing to live has never been put as  a medical question  in a case
of alleged child-murder; and it is pretty certain, that if a want of capacity to
live were actually proved, this would not  render the party destroying it  irrespon-
sible for the offence.  Children may be born alive  at the sixth or seventh month;
but because they are much less likely to survive than those born at the eighth or
ninth  month, this is not  a  sufficient  ground of exculpation to any person  who
wilfully destroys them.  The real  question, as we shall presently see,  does not
refer to the period of gestation at which a child may be born, but to the fact of
its being living and  entirely born when the murderous violence is offered  to it.
The French law, although it requires in some cases proof of viability in relation
to the  rights of inheritance, demands only proof of life after birth in reference to
a charge of infanticide.   (Briand, Man. Complet de Med. Leg. 201.)
   Although the doctrine of viability is not recognised in English jurisprudence,
yet in  a case which occurred in  October,  1836, a  coroner refused to hold an in-
quest on the body of a child, because it had not reached an age (seven months,)
at which children are commonly born  alive!  In  this case there was probably
no harm  done; but when we consider—1st, the great difficulty of determining on
the exact  age of a child from the  characters found on its body;  and  2d, that
many children born under the seventh  month have not only been born alive, but
have lived to adult age, the acting  on a principle of this kind would be  likely to
give rise  to dangerous abuses.  It  is impossible to admit that children are to be
destroyed with impunity because  they happen to  be born under the seventh
month, or that a child should be assumed to have been born dead, and any in-
quiry into the cause of death dispensed with,  unless it  can be  medically esta-
blished that it has passed the seventh month of gestation.
   According to one  medico-legal authority—if it  can be  proved that the  child
which  is  the  subject  of  investigation has not attained this  age (the seventh
month,) no charge of infanticide can  or  ought to be entertained.   Are we  to
understand by this, that children proved to have been born living  before the
seventh month, may be wilfully destroyed, and the law take no cognizance  of
the matter?  If this be not the meaning,  the statement amounts to  nothing,
because whether the child have reached the  seventh, eighth, or ninth month, life
and live birth must still be proved, before the question of murder can be enter-
tained.  I have known an instance of a child born  between the sixth and seventh
months living a fortnight;  and many similar cases  are recorded.  On  the doc-
trine above laid down, the deliberate destruction of such children, although actually
living, ought not to  be considered or treated as murder!   It  is satisfactory to
know that such a principle as this is not recognised  by the law of England.  In
the case of Reg. v.  West (Nottingham Lent Assizes, 1848,) a midwife was tried
on a charge of causing the death  of a child  under  the seventh month of uterine 
284          CHARACTERS FROM THE SIXTH TO THE NINTO MONTH.

life (in the perpetration of abortion,) not by any direct violence applied to  its
body, but merely by leading to its premature birth.  This case proves, therefore,
that a charge of infanticide may be  fairly entertained with respect to children
under the seventh month.   The female in this instance was alleged to have been
between the fifth and sixth month of pregnancy.  The proof of this did not,
however, prevent an indictment for murder, or a full investigation of the facts
of the case.   AVe also learn from it, contrary to the  suggestion of Mr.  Chitty,
(supra) that the viability of a child is not  by the  English law required to  be
proved on an indictment for child-murder.   This child was certainly from mere
immaturity incapable of maintaining a separate  existence, and it was, therefore,
not viable; but the judge who tried the case, in answer to an objection taken  by
prisoner's counsel, said that if the child was proved to have died under  the cir-
cumstances alleged for the prosecution, it would be murder.
   Characters from the sixth to the ninth month.—The following are the  charac-
ters  whereby we may judge of  the uterine age of a child from the sixth to the
ninth month of gestation, a period which may be considered to comprise all cases
of child-murder.   Between the sixth and seventh:—The child measures, from the
vertex to the sole of the foot, from ten to twelve inches, and weighs from one to
three pounds.  The head is large in proportion to  the trunk,—the  eyelids are
adherent, and the pupils are closed by the membranes pupillares.  The  skin is
of a  reddish colour, and the nails are slightly formed;—the hair loses the silvery
lustre which it previously possessed, and becomes darker.   Ossification proceeds
rapidly in the sternum, and in the bones of the tarsus.   The  brain continues
smooth on its surface:—there  is no appearance of convolutions.  In the male
the testicles will be found in the abdominal cavity,  lying upon the psoae muscles
immediately below the kidneys.  Between the seventh and the eighth month:—
The child now measures between  thirteen  and fourteen  inches in length, and
weighs from three to four pounds.   The skin is thick,  of a more decidedly fibrous
structure, and covered with a white unctuous matter, which now for the first time
appears.   Fat is deposited in the cellular tissue, whereby the body becomes
round and plump:—the skin, previously to this, is of a reddish colour, and com-
monly more or less shrivelled.   The nails, which are somewhat firm, do not quite
reach to  the extremities of the fingers.   The  hair  becomes long,  thick,  and  co-
loured.   Ossification advances throughout the skeleton.    Valvulae conniventes
appear in the small intestines, and meconium is found occupying the caecum and
colon.  The testicles in the male are considered about this  period to  commence
their descent, or rather, the child's head being downwards, their ascent  towards
the scrotum.  The time at which these organs change their situation is probably
subject to variation.  According to J. Hunter, the testicles are situated in the
abdomen at the seventh, and in the scrotum at the ninth month.   Burns  believes
that at the eighth month they will commonly be found  in the inguinal canals.
The observation of the position of these organs in a new-born male child is of
considerable importance in relation to maturity, and it may have an influence on
questions of legitimacy as well as of child-murder.  Mr. Curling thus describes
their change of position:—At different periods between the fifth and sixth months
of foetal existence, or sometimes later, the testicle begins to move from its situation
near the kidney towards the abdominal ring, which it usually reaches about  the
seventh month. During the eighth month it generally traverses the inguinal canal,
and by the end of the ninth arrives at the bottom of the scrotum, in which situa-
tion it is commonly found at birth.   (Diseases of the Testis, 32.)   Its  absence
from the scrotum does not necessarily indicate that the child is immature, because
the organ sometimes does not reach the scrotum until after birth.
   Between  the eighth and ninth month, the child is from fifteen  to sixteen inches
in length, and weighs from four to five pounds.  The eyelids are no longer ad-
herent, and  the membranas pupillares will  have disappeared.   The quantity of
fat deposited beneath the skin is increased,  and the hair  and nails are well deve- 
SIGNS OF MATURITY IN THE CHILD.
285
loped.   The surface of the brain is grooved or fissured, but presents no regular
convolutions;  and the  cineritious matter is not yet  apparent.  The meconium
occupies almost entirely the large intestines, and the gall-bladder contains some
traces of a liquid resembling bile.  The testicles in the male may be found occu-
pying some part of the inguinal canal, or they may be in the scrotum.   The left
testicle is sometimes^in the scrotum, while the right is situated about the external
ring.
   Signs of maturity.—At  the ninth month the average length of the body is
about eighteen inches, and its weight about  six  pounds, or between  that and
seven pounds: the male child is generally rather longer, and weighs rather more
than the female.   Extraordinary deviations in length and weight are occasionally
met with.  Mr. Owens,  of Ludlow, has reported a case in which the child  at
delivery measured twenty-four inches, and weighed seventeen pounds  twelve
ounces.  (Lancet, December, 1838.)  In a case which I had to examine in June,
1842, the child, a male, measured twenty-two inches, and weighed twelve pounds
and a  half.   [According to Dewees  the average weight of  the mature  foetus  in
the United States is rather over seven pounds.—Vide Beck, i. 337.—H.]  (For
some practical remarks on this subject, by Dr. Ellsasser, see Henke's Zeitschrift,
1841, ii. 235.)  At the full period, the head of the child is large, and forms
nearly one-fourth of the whole length of the body.  The cellular  tissue is filled
with fat, so as to give considerable plumpness to the whole form, while the limbs
are firm, hard, and rounded.  The skin is pale.  The hair is thick, long, and
somewhat abundant.   The  nails  are fully developed, and reach to the ends  of
the fingers;—an appearance, however, which may be sometimes simulated  in
a premature child, by the shrinking of the skin after death.  The testicles  in
the male are generally within the scrotum.  Ossification will be found to have
advanced considerably throughout the skeleton.  (See, in relation to the progress
of ossification, some remarks  by M. Ollivier, Ann.  d'Hyg. 1842, 343.)  The
surface of the brain presents convolutions, and the cineritious matter  begins  to
show itself.   The internal organs, principally those of the chest, undergo  very
marked changes, if the act of respiration have been performed by the child before,
during, or after its birth.
   The relative position of the point at which the umbilical cord is inserted into
the abdomen, has been considered by some medical jurists to  furnish evidence
of the degree of maturity.   Chaussier thought that in the mature child, at the
ninth month, the point of insertion of the cord exactly corresponded to the centre
 of the length of its body.   Later observations, however, have shown that this is
not quite correct.   Out of five hundred children examined by M.  Moreau, at the
 Maternite, in Paris, the umbilical aperture corresponded to the  centre of the
body in four only.  In the majority of these cases, the point  of insertion was
 eight or nine lines below the centre: among many.cases of mature  children which
 I have had an opportunity of examining, the umbilical aperture  has  generally
 been situated from a quarter to half an inch below the centre of the body.   (Guy's
 Hosp. Rep., April, 1842.)  M. Moreau found, on the other hand, that in some
 children, born about the sixth or eighth  month, the cord  was inserted at the
middle point of the  length.  (Lane. Fran<j. 1837.)   On  the whole, it will  be
 perceived that no value can be attached to the situation of the umbilical opening,
 as a sign of maturity or immaturity.
   The characters which  have been here described as belonging to a child at the
 different stages of gestation, must be regarded as an average  statement.  They
 are, it is well known,  open to numerous  exceptions; for  some children at the
ninth  month are but little  more developed than others at the seventh;  although
 the converse of this proposition is not true—i. e. we do not find that children of
the seventh month have undergone such premature development as to be mistaken
 for children  at the ninth month.   Twins are generally less developed than single
 children;—the average weight of a twin child is not more  than five pounds, and 
286
INFANTICIDE.  INSPECTION OF THE BODY.
very often below this.   The safest rule to follow, in endeavouring to determine
the uterine age of a child, is to rely upon a majority of the characters which  it
presents.  That child only can be regarded as mature, which presents the greater
number of the characters already described, and which are met with in children
at or about the ninth month of gestation.
   If the age of the child has been determined;—whether it be under or over the
seventh month, the  s'ame rules  for a  further  investigation will be demanded.
Should the child be under the seventh month, the medical presumption will be,
that it was born dead;  but if it has arrived at its full period, then the presump-
tion is, that it was born alive.

   Conclusions.—The following may be taken as a summary of the principal facts
upon which  our opinion respecting  the uterine age of the child may be based:—
   1. At six months.—Length,  from nine  to  ten  inches; weight,  one to  two
pounds; eyelids agglutinated; pupils closed by membranse pupillares;  testicles
not apparent in the male.
   2. At seven months.—Length, from thirteen to fourteen inches; weight, three
to four pounds;  eyelids not adherent;  membranae pupillares disappearing; nails
imperfectly  developed; testicles not apparent in the male.
   3. At eight months.—Length, from fourteen to  sixteen  inches; weight, from
four to five pounds;  membranae  pupillares absent; nails perfectly developed, and
reaching to  the ends of the fingers; testicles in the inguinal canal.
   4. At nine months.—Length, from sixteen to twenty-one inches; weight, from
five to nine  pounds;  membranae pupillares absent; head well covered with fine
hair;  testicles in the scrotum; skin pale; features perfect—these and the body
are well developed, even when the length and weight of the child are much  less
than those above assigned.
   5. The point of insertion of the umbilical cord, with respect to the length of
the body, affords no  certain evidence of the degree of maturity.
   Inspection of the body.—The questions which a medical  jurist  has to solve, in
examining the body  of a new-born child, are—
   1. To determine its  age, or the stage of uterine  life which  it has reached;—
2. Whether it has lived to breathe;—3. Whether it has been born  alive;—4. The
period of time which has elapsed since its death;—5.  The cause of  death, whe-
ther violent or natural.
   Hence, before commencing  the inspection—
   1. The length (measured from the vertex to the sole of the foot) and weight
of the body should be  taken;—2.  The presence or absence of external foetal pe-
culiarities noticed;—3. Any peculiar marks or indications of deformity, whereby
identity may be sometimes established;—1. All marks of  violence in the shape
of wounds,  bruises,  or lacerations, and  the kind of instrument or weapon by
which  they  were probably produced;—5. Whether the umbilical cord has been
cut and tied, or lacerated; the appearance of the divided vessels,  and the length
of that portion which is still attached to the body of the child;—6. The presence
or absence of vernix caseosa  about the  groins, arm-pits, or neck—the presence
of this substance proves that the child has  not been washed or  attended to;—
7. It will be necessary to state whether  there  be  about the  body any marks of
putrefaction, indicated by the  separation of the cuticle, change of colour in the
skin, or offensive odour.  It is obvious, that unless these circumstances be noticed
before  the inspection is commenced, they may be entirely lost as evidence.  Notes
should be made on the spot, and the original  retained, even if copies .be  subse-
quently made. 
EVIDENCE OF LIFE BEFORE RESPIRATION.                287
                           CHAPTER  XXXIX.

ON THE PROOFS OF A CHILD HAVING LIVED AT ITS BIRTH—EVIDENCE OF LIFE BEFORE RES-
  PIRATION--SIGNS OF PUTREFACTION IN UTERO—EVIDENCE FROM MARKS OF VIOLENCE--
  SUMMARY--EVIDENCE OF LIFE AFTER RESPIRATION--INSPECTION OF THE BODY--COLOUR,
  VOLUME, CONSISTENCY AND ABSOLUTE WEIGHT OF THE  LUNGS--STATIC TEST--WEIGHT
  INCREASED BY RESPIRATION--TEST OF PLOUCQUET--BLOOD IN THE PULMONARY VESSELS--
  RELATIVE PROPORTION OF FAT IN THE LUNGS—SPECIFIC GRAVITY OF THE LUNGS—GENE-
  RAL CONCLUSIONS.

   On the proofs of a child having lived at its  birth.—The question  whether a
child was or was not born alive, is of the greatest importance in a case of alleged
child murder; and it is unfortunately one which, in  respect to the proofs upon
which medical evidence is commonly founded, has given rise to considerable con-
troversy.  When it is stated that in most cases of alleged infanticide which end
in acquittals in spite of the  strongest moral presumptions of guilt,  the proof
fails on this point only, it  must be obvious that this question specially claims
the attention of a medical  jurist.   The medical evidence  of a child having been
alive, when violence was offered to it at its birth or afterwards, may be divided
into two parts: 1, that which is obtainable before the act of respiration is per-
formed;  and  2, that which is obtainable afterwards.  At present it will be proper
to confine our attention to  the question, whether the child was alive when it was
maltreated,—the fact of its having been born alive will  be  a matter  for future
consideration.  These two questions have been frequently but improperly asso-
ciated, thus rendering the subject confused; but it must be so obvious as scarcely
to require stating, that violence of  a murderous kind may be offered to  a living
child before it is entirely born; and that owing to this violence it may come into
the world dead.

                  EVIDENCE OF LIFE BEFORE RESPIRATION.
   It was formerly supposed, that if the lungs contained  no air, the child  could
not have respired, and that it must have been born dead.  But neither of these
views is correct:—children have been known  to respire faintly, and continue in
existence many hours, without visibly distending the cells of the lungs with air,—
the absence of  air from the lungs,  therefore, furnishes no proof either that res-
piration  has  not been performed, or that the child has not lived.   (G. H. Rep.,
April,  1842.)  That  our law authorities will  admit  evidence  of life in a child
before the establishment of respiration, is clear from the decision of Judge Parke,
in the case of Rex v. Brain, in which he said that a child might be born alive,
and not breathe for some time after its birth, (Archbold, Crim. Plead. 367,) as
also from the charge of Mr. Justice Coltman, in the case of Rex v. Sellis (Norf.
Spr. Circ. 1837.)   In this instance it was alleged that  the prisoner had mur-
dered her child by cutting off its  head.   The judge told the jury, that if  the
child were alive at the time of the  act, it was not necessary, in order  to consti-
tute murder,  that it should have breathed.  In fact, it would appear that respi-
ration is regarded as only one proof of life;  and the law will, therefore, receive
any other kind of evidence which may satisfactorily show that the child has lived,
and make up for the  proof commonly derived from the state of the  lungs.   It
will be first incumbent on a medical practitioner to prove that the child  under
examination  has recently died, or  in  other words, that there are good grounds
for believing it to have been recently  living.   Hence, if  the body be highly pu-
trefied, either from the child having died in the uterus some time before  birth,
or from its having been born and its body not discovered until putrefaction had 
288        INFANTICIDE.   EVIDENCE FROM MARKS OF VIOLENCE.

far advanced, both internally and externally, the case is utterly hopeless.  The
medical witness will in general be compelled  to abandon the investigation, be-
cause the body can furnish no evidence whatever of life after birth.  The exa-
mination of the thoracic organs would throw no light on the case, for here we
are assuming that the lungs are in their foetal  condition.
   Signs of putrefaction in utero.—The phenomena of putrefaction in air require
no notice in  this  place; but the changes which ensue when a child dies and is
retained within the  uterus, may be briefly adverted to,  because they may some-
times form a subject for judicial inquiry.   According to Devergie, when a child
dies in utero, putrefaction takes place as rapidly as in the open air.  (Med. Leg. i.
526;) but this  is extremely doubtful.  In an advanced state of uterine putrefac-
tion, the body  of the child is so flaccid, that when placed  on a table it  becomes
almost flattened by the mere gravitation of its parts.  The skin is of a reddish-
brown colour,  not green as in a  putrefied body exposed to  air.  The cuticle
covering the  feet and hands is  white, and sometimes raised in blisters,—the cel-
lular membrane is filled with a reddish-coloured serum,  the bones are moveable,
and readily detached from the  soft parts.  In  the opinion of Devergie, the prin-
cipal difference between uterine  and atmospheric putrefaction in the body of a
new-born child, is seen in the colour assumed by the skin:—but it must be re-
membered, that should the  child  remain exposed to the air after its expulsion,
the skin-may acquire the colour observed in  cases of atmospheric putrefaction.
The changes which have just  been described  are such as  we may expect to find
when the child has  been retained in utero eight or ten days  after its death.
When it has remained for some weeks  in the uterine cavity, the body has oc-
casionally been found saponified, or even encrusted with phosphate of lime.   If
in any case we  are able to state distinctly that the body of a child has undergone
uterine, and  not atmospheric, putrefaction, it is clear that it could not have come
into the world  alive.  Under ordinary putrefaction in  air, the  child may have
been really brought into the world living, and the  process  may have destroyed
every proof of  that fact.
   Let us suppose that the child died in utero from forty-eight to twenty-four hours
before it was born: if it be soon afterwards examined, there will be no marks of
putrefaction  about it, and the appearances will closely  resemble those met with
in the body of a child which has been born alive and died without respiring;  or
of one which may not  have been born alive,  but have died in the act of birth.
It will be impossible to say, in  such a case, whether the child came into the world
living or dead.
   Evidence from marks of violence.—It has been proposed to seek for evidence
of life, under  these  circumstances, by  observing the  characters presented by
marks of violence on the body.   In general, when children are murdered, the
amount of violence inflicted is considerably greater than  that which is required
to destroy them, whereby satisfactory proofs  of the crime  are  occasionally ob-
tained.   On the  other hand,  the  body of a  still-born child, dead from natural
causes,  is often covered with lividities  and ecchymoses;—the foetal blood does
not coagulate with the same firmness as in the adult: hence the evidence de-
rivable from the extent, situation,  and characters of marks  of violence, is gene-
rally of too vague and uncertain a kind to allow of the expression of a medical
opinion  that the child was certainly living when the violence was offered to it.
The characters which have  been already described  as  peculiar to wounds  and
contusions inflicted during  life, may be  met  with  in  a child whether it have
breathed, or  died without respiring.  So, again, these characters are open to the
exceptions there  pointed out; for they will  be equally present, supposing the
wounds  to have been inflicted immediately after the cessation of respiration or
circulation in the child, or after  the cessation  of circulation only,—if the act of
respiration have not been performed.  Marks  of violence on the body of a child
which had died in utero twenty-four or forty-eight hours  before it was born, would 
SUMMARY OF MEDICAL EVIDENCE.
289
 not present the characters of injuries inflicted on the living.   There would be no
 ecchymosis and no effused coagula of blood.   These marks, when they exist, al-
 though they may establish that the child was either living or but recently dead
 at  the  time they were inflicted, can never show that the child was born alive.
 Injuries met with on the bodies of children alleged to have been born dead ought,
 however, to be of such a  nature as to be readily explicable on the supposition of
 their having  arisen from accident.  If, from  their nature,  extent, or situation,
 they be such as to evince a wilful design to injure, it is a fair ground  for a jury,
 —not for a medical witness, to  inquire why these extensive wounds, or other
 marks of violence, were inflicted on a child, if, as it  is alleged, it was really born
 dead.  It must be confessed that in such a case there would be a strong moral pre-
 sumption of murder, although medical proof of life, or actually live birth, might
 totally fail.
   Summary—As  a  summary of these remarks, it  may be observed, that
 although physiologically a child  may live for a certain  period after its birth
 without respiring,—and legally its destruction  during this period would amount
 to a murder, yet there are at present no satisfactory medical  data to enable a
 witness to express a positive opinion on this point.   If other evidence were ad-
 duced of a child having lived and been destroyed, under these circumstances,—
 as where, for example,  a woman causes herself to be delivered  in  a water-bath,
 or an accomplice covers the mouth of an infant in the aet of birth, or immedi-
 ately after it is born,—a medical witness would be justified in asserting that the
 absence of the signs of respiration in the lungs was no proof that the child had
 been born dead.   Indeed, it is apparent that the process could not be established,
 owing to the criminal means actually employed to prevent it.  Whether  a jury
 would convict upon such  evidence is doubtful;  but  this is of no importance to
 the witness:—his statements ought always to be made according to correct and
 well ascertained principles, and not for the purpose of procuring either the con-
 viction or acquittal of parties accused of offences against the laws.   In general,
 those cases in which questions relative to life before respiration might arise, are
 stopped in the Coroner's court,—the usual practice being, where the signs of re-
 spiration are absent or imperfect, to pronounce that the child was born  dead.   If
 the lungs sank in water, the presence of marks of violence on the body would be
 considered as furnishing no evidence;—for the  sinking of the  lungs  would be
 taken as positive evidence of still-birth, an  inference upon which some remarks
 will be made in speaking of the hydrostatic test.   The following case was the
 subject  of a criminal charge at Havre, in 1828:—A woman was delivered  of
 twins.   So soon as the  first child was born, but not  before it had breathed, she
 killed it by fracturing  its skull with a wooden shoe.  In a few minutes after-
 wards the second child was born, but scarcely had its head presented,  when she
 seized it and fractured  its skull in the same manner.  This double crime was
 soon discovered.   On an examination of the bodies of both children, the same
 degree of violence was found, presenting in each case precisely similar characters.
 There could be no doubt, from the appearance  of the injuries, that they must
 have been inflicted on both children at a time when the circulation was  going on.
 In one child, however, it was  proved that respiration had taken place; in the
 other that it had not.   In the latter case many practitioners  would at once have
 affirmed that the child had not lived, because there was no proof .that it had  re-
 spired; and they would have  proceeded to draw the inference that this  could not
 have been  a case of infanticide.   Dr. Bellot, however, declared that, although
 the child had not breathed, he had no doubt that it had been  born alive, and that
it would have  lived to respire, but  for the violence inflicted.  This opinion was
chiefly founded upon the similarity in the characters presented by the marks of
violence  in the two cases.   (Annales d'Hygiene,  1832, ii.  199.)   See further
remarks upon  this  subject, by M. Ollivier, Ann. d'Hyg. 1843,  i. 149; also  by
M. Devergie, op. cit. 1837, i.  400..
       19 
290               EVIDENCE OF LIFE AFTER RESPIRATION.
   The great question involved in this, and in all similar oases, is the following:
—Does the law regard the prevention of respiration as murder?   There cannot
be the slightest medical doubt that  living children are often thus destroyed in
the act of birth: they die, not from the actual infliction of violence, but because,
either through accident or design, the performance of that act which is necessary
to maintain existence when the child is born, is prevented.   Such a case has not
yet been decided, although, from the dicta of the judges, it would probably in-
volve a charge of murder.   In a case recently published by Dr. Wharrie, a preg-
nant woman, thinking she was about to have a motion, sat on an earthe» pitcher,
two feet in depth, which happened to be full of water.  She was there delivered
of a child,  which fell into the water, and was thus  prevented from breathing.
The child was full-grown, and its body was free  from putrescency.  It weighed
six pounds, and measured twenty inches.   There were no external marks of vio-
lence, and the cord had been tied.   The lungs weighed two and a  half ounces;
they were of  a  liver colour, contained no air, and sank in water.   The medical
opinion was, that from the size and general appearance of the child, and the state
of the parts discovered on dissection, it was mature,—that it had never breathed,
and life might have been  either wilfully or accidentally destroyed.   The exa-
miners wisely declined giving the usual opinion from the sinking of the lungs;
i. e. that the child  had been born dead.  The woman was not prosecuted, pro-
bably on the assumption that  the death of the child might have been accidental.
As Dr. AVharrie truly observes, there was no medical proof that the  child was
born alive;  although there was a strong moral presumption that life was extin-
guished after birth.   (Ed. Monthly Jour., Oct. 1845, p. 796.)
   Dr. Bayard mentions a case, in which a female, under somewhat similar cir-
cumstances, was convicted of the murder of her infant, and sentenced to the gal-
leys for five years.   In this case there was not the slightest evidence of respira-
tion, but the woman admitted that she fractured the skull of the child, with the
intention of destroying it, thinking that she perceived  a motion in its  legs after
it was born.   (Ann. d'Hyg. 1847,  i.  455.)  One physician thought that the
child was living when the blows were  inflicted;  two others, that it was dead.
In Dr. Bayard's opinion, the absence of the  signs of respiration must be taken
as a negative circumstance in favour of the accused.

                   EVIDENCE OF LIFE AFTER RESPIRATION.
   There  is no doubt that the proof  of  the  act  of respiration furnishes the best
and strongest evidence of a child having lived at or about the time it was born.
It does not, however, show that a child has  been born alive.   The physical
changes in the organs of a child, which result from the establishment of this pro-
cess, take place in the lungs immediately, but in  the  heart  and its appendages
more slowly.  It is, therefore, chiefly to the lungs that  a  medical witness looks
for the proofs of respiration.   Sometimes, however, these organs  are  found in
their foetal condition, or nearly so;—for although a child may have survived its
birth for'many hours, there may be no evidence of the fact from the state of the
lungs.   To  such cases, the remarks now about to be  made cannot, of course,
apply:—the proofs of life must be sought for elsewhere, and if none can  be found,
the case is beyond the reach of medical evidence.   But it  is obvious that the oc-
casional occurrence of cases of this description can present no objection to our
constantly seeking for proofs of life in  the lungs,  any more than the fact of poi-
son not being always discovered in  a poisoned subject, would be a bar to our
seeking for the proofs of  poison in  every unknown case which  presented itself.
It is the more necessary to insist upon  this point, because some have  held, that
as we cannot always derive proofs of life from an examination  of the lungs of
new-born children, we should abandon  all evidence of this description,  and leave
the case in its original obscurity.  The very  object of medical jurisprudence is,
to endeavour to remove  these difficulties, and to show, in every  department of 
INSPECTION OF THE BODY.
291
 the science, the degree to which we may safely trust the medical proofs of crime,
 however insufficient, inconsistent, or contradictory they may at first sight appear.
   Examination of the lungs.—-Some have pretended that the fact of respiration
 having been performed, would be indicated  by the external configuration of the
 chest.   Thus  it is said, before respiration  the chest is flattened, while after that
 process  it is  arched anteriorly.  The diameters of the cavity have also been
 measured, and  certain comparisons instituted, (Daniel,) but these  experiments
 have been attended with no practical result, and have long been abandoned by
 medical jurists.  Admitting  that such a visible change of form is occasionally
 produced by respiration, it is obvious  that  in these  cases, experiments on the
 lungs may  be readily made;  and on the  results of these, and not upon minute
 changes in  the capacity of  the chest, would a medical opinion be based.   The
 cavity of the chest may be conveniently laid open by carrying  incisions from
 below the clavicles downwards on each side from about half the length of the ribs
 backwards.   The diaphragm may be separated from the cartilages without open-
 ing the abdomen; the ribs  sawn or cut through, and  the flap formed by the an-
 terior parietes of the chest, turned upwards.   If the child have not respired, the
 following appearances will be seen.   The  thymus gland, as large as the heart,
 occupies the upper and middle portions of the cavity;—the heart in its pericar-
 dium is situated in the lower and middle portion, and is rather inclined to the
 left side.  The lungs are placed quite in the back part of the chest, so as often
 to give the  impression that they are wanting.   In  some instances, they project
 slightly forwards by their anterior margins, but in no  instance, unless congested,
 infiltrated, or otherwise diseased, do they cover  and conceal the pericardium.   The
 thymus gland is sometimes of a pale fawn—at others of a deep  livid colour: but
 there is no perceptible difference in this  organ in  new-born children, before or
 after the performance of respiration.  On the other hand, when the child has
 fully respired, the most striking differences will be observed in the colour and
 prominence of the lungs.   They are of a light red hue, project forwards—appear
 to fill the cavity of the chest, and cover, and in great part conceal by their ante-
 rior margins, the bag of the pericardium.   AVe may meet with  every variety in
 the appearances between these two extremes;  for the process of respiration  often
 requires a considerable  time in order that it should be fully established,  espe-
 cially in those children which are of a weakly constitution  or prematurely born.
 Hence the lungs will be found to occupy their respective cavities to a greater or
 less extent, and to cover the pericardium more or less, not according to the length
 of time which a child has lived, but according to the perfection with which the
 process of respiration has  been performed.   It will  be  seen hereafter, that
 although, as a general rule, the  lungs become more perfectly filled- with air in
 proportion to the time which a child survives its birth, yet this is  open to nume-
 rous exceptions.  It will next be necessary to give particular attention to certain
 other physical characters presented by the lungs.
   1. Colour of the lungs.—The  colour of the lungs  before respiration is  of  a
 bluish red,  or deep violet,  but  it is subject to slight variation.    Some 'medical
 jurists have compared it to the colour of the spleen.   It is important to remark,
 that a very short exposure to air will materially alter the colour,  so that it should
 be observed  and recorded immediately on opening the chest.  After respiration,
 the lungs acquire a light red hue, in proportion to the degree in which the pro-
 cess  has been performed.  If imperfectly established, they will be  mottled, gene-
 rally about the anterior surfaces and margins, the patches of light red being in-
 termixed with the livid foetal hue, and being slightly raised, as if  by distention,
 above the general surface of the organs.  The light  red tint changes, after  a
 short exposure to air, to a bright scarlet.  This change in the colour of the lungs
 is  not a necessary, nor is it an invariable consequence  of a child  having lived
after its birth.   I have known a child to live twenty-four hours  respiring feebly,
and on examining the body, the colour  of the  lungs was identical with  that of 
292         CONSISTENCY AND ABSOLUTE WEIGHT OF TnE LUNGS.

the organs in the foetal state.   The change of colour is then a usual, but by no
means a necessary consequence of the enjoyment of life:—so that the retention
of the foetal colour does not furnish positive evidence of still-birth.  Again, the
circumstance of the lungs having a light red colour is not an infallible criterion
of the child having lived and breathed;  for the artificial introduction of air by a
tracheal tube, or otherwise, in  the attempt to resuscitate a still-born child, is  at-
tended with the same physical  change.   In the course of numerous experiments,
purposely made, I have found  no appreciable difference.  Bernt says, that arti-
ficial inflation will not produce a scarlet red tint in the organs, and therefore
that this is a criterion of respiration.   (Ed. Med. and Surg. Jour. xxvi. 367.)
I have not only observed this tint to be absent in respiration, but have actually
produced it by artificial inflation in a dead child.
   2.  Volume of the lungs.—The difference in the relative situation of the lungs
before and after respiration, has been already described.  This difference depends
entirely upon the  increased volume or  dilatation of the organs, arising from
the  introduction of air.   Before respiration, the lungs are in general scarcely
visible, unless forcibly drawn forwards in the chest.  AVhen respiration has been
perfectly accomplished, the volume is so much increased that the bag of the pe-
ricardium is almost concealed by them.   Respiration must, however, have been
very perfectly performed in order that this condition should exist to the full ex-
tent described;  but I have known the lungs to acquire a considerable volume in
a healthy and vigorous child in only two or three respirations.   The child was
destroyed by craniotomy, and died before it was entirely delivered.  In other in-
stances a child may live for one or two days, and the volume of the  organs  be
but little altered.   Schmitt has  remarked that the lungs have sometimes a con-
siderable volume before respiration.  I have met with this in more than one in-
stance; but this condition will  probably be found in general to depend on disease.
As the altered volume of the healthy lungs depends on the introduction of air,
the effect is the same, whether  the air be derived from respiration, from artificial
inflation, or generated by putrefaction.   Other circumstances must therefore  be
considered before we draw any inference from this physical change.
   3.  Consistency of the lungs.—The lungs,  before respiration, fed like the liver,
or any of the other soft organs of the  body.  They are firm under the finger,
but their substance may be lacerated  by violent compression.   After respiration
has been fully  performed,  there is a distinct sensation  of what is termed crepi-
tus on compressing them, i. e., air  is felt within  them.   This  condition of the
organs must, of course, depend on the degree to which respiration has been car-
ried.   The lungs of children that have lived for a considerable time after birth
will  sometimes give no  feeling  of crepitation under the finger.   Generally speak-
ing,  lungs of this kind present the other foetal characters:—thus they are small
and of a livid colour.   There are, however, cases in which  the  organs may have
the light red colour of respiration, and be actually much dilated  in appearance,
yet no feeling of crepitus will be perceptible on pressure.  This character, there-
fore, is by no means a necessary accompaniment of the other two.  Crepitation
furnishes  presumptive  evidence  of respiration;  but  it may be equally met with
in lungs that are putrefied, or which have received air by artificial inflation.  The
characters here described are seldom found  in the lungs of children  that have
been born prematurely, although these children may have lived some time  after
birth.   They depend on respiration, and in  the exceptional cases referred to this
process is only  very slowly established.
   4. Absolute weight of the lungs.  The static test.—It is generally admitted  by
medical jurists  that the weight of the lungs before respiration  is less than that
which they have after the establishment of the process.  From this an inference
has been drawn that the absolute weight of the lungs in an unknown case, com-
pared with certain averages, will aid the inquirer in  ascertaining whether respi-
ration has or has not been performed.   In order to determine the weight of the 
             WEIGHT OF TnE LUNGS INCREASED BY RESPIRATION.         293

lungs, these organs should be  carefully separated by dissection from the heart
rind thymus gland, and removed, with the trachea and bronchi attached.   Pre-
viously to their removal, ligatures should  be placed on the pulmonary vessels, so
that no blood may escape from the lungs.   They should now be weighed, and the
weight accurately noted in grains.  In  taking this weight, it does not appear ne-
cessary to make any distinction founded on the  sex of the child, or on the diffe-
rence of weight in the two lungs; the only exception would be, perhaps, in re-
lation to twin children imperfectly developed.   The average weight before respi-
ration,  derived from nine cases, was found to be 649 grains.  According to Dr.
Traill, the weight varies from 430 to 600  grains.  It is of importance, in taking
the weight of these organs, to be certain  that the child is at or near maturity, and
that it is of or about the average size and weight: owing to a neglect of this  rule,
it is  highly probable that comparisons have been made  of the absolute weight
of the lungs  in different children, which  a full statement of the facts would not
have justified.  If it be immature or unusually large, the lungs will weigh either
less or more than the average.   The average weight of the lungs after respira-
tion, derived from three cases, was i'27 grains; but in making an estimate of this
kind much will depend upon the degree to which  respiration  has been  carried.
In three cases, in which the children  lived half  an  hour, six hours, and  twenty-
four hours respectively, the process had been so imperfectly performed that the
lungs varied but little in weight from the average before respiration.   (G. H.
Rep. No. V.)  The truth is, we cannot  compare  the lungs of children, as  to
weight, according to the time which  they may have  survived birth,  but rather
according to. the degree to which the lungs have  been penetrated by air.   In one
instance of alleged infanticide,  where the child was  probably killed  soon after
birth, the lungs weighed 1000 grains.   In another instance, where the child had
certainly lived eight or nine days, the lungs weighed only 861 grains.   In the
first case, respiration had been  perfectly performed;  in the  second, imperfectly.
Hence,  to say that the lungs weigh so  much after respiration,  amounts to no-
thing, unless we can estimate by a sight of  the organs its degree; and any cal-
culation founded upon such dissimilar cases must  unavoidably lead to error.
This increase of weight after birth is commonly  ascribed to the altered course  of
the blood under the establishment of the  respiratory process, as well as to the
fact that more blood circulates through  the  lungs after than before respiration.
Practically, this view is confirmed by the contraction of the ductus  arteriosus,
and the simultaneous enlargement of the two pulmonary arteries; changes which
have been occasionally observed when the child has survived its  birth for only a
very short period.   As these  normal changes in the duet depend on the esta-
blishment of  respiration, so we cannot expect to find them when the process has
been imperfectly performed, although the  child may have lived several days.
   Weight of  the lungs increased by respiration.—It appears to me that  the
general opinion on this  subject is correct, namely, that  the  healthy lungs  of
mature new-born children become heavier after respiration, and according to its
degree; and where a deviation  from  this rule  is observed, it may probably be
explained by the circumstance that the lungs of an immature have been compared
with those of  a mature child, the lungs of an undeveloped twin with those  of
one not a twin, or the lungs of one which had breathed imperfectly, with those
of another in which respiration had  become well established.   In this  respect
the extensive tables drawn up by Lecieux are liable to lead to  erroneous infer-
ences relative  to the effect of respiration  on the absolute  weight of  the lungs.
The weights  of the organs are noted, but the degree to  which  respiration  had
been performed is so loosely stated, as to allow of no fair inference of the effect
of this process upon the weight.   The time which the children survived is stated;
but this, as it  is very well known, furnishes no criterion  of the degree to which
respiration has been carried.   Again, we are not informed whether due care was
taken to ascertain  if the  lungs  were  healthy or diseased.   (Considerations sur 
294
VARIABLE WEIGHT OF THE LUNGS.
 l'lnfanticide, Paris, 1819.)  The following table of the weight of the lungs, in
 four cases, will show how much the organs  are liable  to  vary in weight  after
 birth,  according to the  degree of respiration.

       Case 1.           Case 2.             Case 3.             Case 4.
     Born dead       Lived six hours.  Lived twenty-four hours.  Lived nine  days.
  Weight, 687 grs.       774 grs.             675 grs.             861 grs.

   Relying upon  a table of this kind only, without comparing the other characters
 of the lungs  with the weight, it might be  inferred that the organs would weigh
 less in a child which had survived its birth twenty-four hours, than in another
 which had been born dead, and that there would  be very little difference in the
 weight, whether the  child lived  six hours or nine days;  but when it is stated,
 that in case 3 the lungs had every foetal character possessed by those in case 1,
 and that in case 4 respiration had been obviously very imperfectly performed,—
 the difficulty is removed.  Such cases should rather be compared with the lungs
 in the foetal  than in the  respired state.   They merely show what is very \*611
 known to, and admitted by,  all medical jurists, that there are  some instances in
 which the fact of respiration cannot be determined by the application of the static,
 or any other test, to the lungs.   But this is certainly no valid reason why evi-
 dence  from this source is to be rejected in all other cases.  It may be fairly granted
 that the weight of the lungs of some children which have outlived delivery,  may
 not come up to the weight assigned  to those  of children that have breathed; be-
 cause,  as we  have seen,  children may survive birth many hours without the pro-
 cess of respiration being properly established.  On the other hand, as in Chaussier's
 observations, the lungs of the still-born may be sometimes as  heavy  as those  of
 children who have respired;  but since such lungs would contain no traces of air,
 the weight above the average in these cases could not be assigned to  respiration.
 Among such subjects, whatever  might be the weight of  the lungs,  if the  facts
 were unknown, it would be impossible  to say whether the children were  born
 living  or dead.  (See Ed. M. and S.  J., xxvi. 375.)  Increased weight, therefore,
 is only one among several circumstances to which a medical jurist should attend.
  AAre  must not fall into the error of supposing that the lungs increase in weight
 according to  the length of  time which a child survives its birth;  it is within the
 limits  of a few days, according  to the  degree of perfection with which a  child
 respires: hence we may meet with cases of children being born alive, surviving some
 hours  or days, and yet after death the lungs  will retain the foetal weight.   This
 is the  case in immature subjects, in  most twin children, and in those which are
 mature but weakly.   Among many instances that have come to my  knowledge,
 no difficulty of this sort, however, has occurred.  The signs of respiration  have
 been sufficiently well developed to justify a medical opinion, although the  child
 had probably not survived its birth above a few hours, or even minutes.  (G.H.
 Rep. April, 1842.)  The cases of imperfect respiration, above alluded to, rarely go
beyond a coroner's inquest,for want of clear evidence of life.  There maybe a differ-
ence of opinion as to the relative number of  instances of perfect and imperfect
 respiration in new-born children;  but a case is never likely to proceed to trial,
 unless the signs of this process are well marked;  and thus many charged  with
murder must escape, through the want of sufficient medical evidence  to establish
the fact of respiration and life.
  It is scarcely necessary to observe, that the air which the lungs receive by res-
piration cannot add to their absolute weight.   This  is because they are in the
condition  of  a bladder which weighs the same, whether it be  filled with air  or
empty. The increase of weight is solely due  to the additional quantity of blood,
which, owing to the altered course of the circulation, permeates their structure.
Hence it follows that when the lungs are distended with air, either from artificial
i lflation or from putrefaction, the foetal weight will remain unaltered;  and by this
mean*, it  is contended, we may distinguish lungs that have respired  from  those 
INFANTICIDE.   TEST OF PLOUCQUET.
295
 which have been  artificially inflated.  Orfila states that  the foetal lungs weigh
 more before they are artificially inflated, than afterwards,—a circumstance which
 may depend upon the fact that the impulse employed in inflation may have forced
 out a portion of blood or other liquid. In carefully performing this experiment,
 I have found  that there was not even the  least fractional difference;  but that
 the inflated lungs weighed precisely the same as in the uninflated state.  From
 what has already  been said, it follows that great weight of the lungs can obvi-
 ously furnish no proof of respiration, unless this be accompanied by the other
 physical changes indicative of that process,—as, for example, great increase in
 volume from the presence of air and crepitation.   If the lungs  be very heavy,
 and at the same time  contain little or no air, it is certain that  the increase of
 weight must depend upon disease or other causes,—not upon respiration.  In one
 case which I had to examine, the lungs were large, and weighed upwards of 1200
 grains.  They contained no air:  when divided into thirty pieces not one portion
 floated, nor could  any air be seen on the closest examination.   It was therefore
 dearly impossible to ascribe  a weight so much  above the  average to the  effects
 of respiration.   It must not be forgotten that all the physical  characters pre-
 sented by lungs that have respired are liable to certain fallacies; but, as  in the
 evidence derived from  tests used in poisoning, these may be removed, or the force
 of the objection diminished, by not basing an opinion on one or  two 'conditions
 only.  AAre must take the whole combined; for it would  be as wrong  to regard
 great weight in the  lungs taken alone as an absolute proof of respiration, as it
 would be to draw the same inference from a mere change in the colour, volume,
 or consistency of the organs.   This is the view also taken by Professor Orfila.
 (Med. Leg. 1848, ii. 229.)
   5.  Test of Ploucquet.—This so-called test for determining whether or not the
 act of respiration has taken place, was proposed many years since by M. Plouc-
 quet.   It is founded  on a comparison of  the absolute weight of the lungs with
 the weight of the body of a child. Admitting that the lungs increased in weight
 from the establishment of the respiratory process, it was supposed that a like dif-
 ference would take place in the relative weight of these organs to the body; and
 that the ratios thus procured, compared with certain averages, would enable a me-
 dical  jurist to determine, in  an unknown case, whether or  not a child had res-
 pired.
  Ploucquet conceived that the average ratio of  the weight of the lungs  to the
 body in children which had  not breathed was 1 :70; and in  those which had
 breathed, 2 :70 or 1:35.  Subsequent researches, however, made by Chaussier
 and others, have shown that these numbers cannot be considered to represent the
 true averages.   The most serious objection to the employment of this test, in
 cases of infanticide, is, that the  lungs and  the body are liable to vary in  their
 relative weights, in children of the same age; and, ct fortiori, this variation must
 exist to a greater extent among children which have reached different ages.  There
 may be various degrees of development in the  body of a  child, without any ne-
 cessity existing for a corresponding development taking place in the lungs.  It
 is unnecessary  to enter into speculations  relative  to the causes:  experience has
 shown that such variations really exist;  and all  that a  medical jurist has  to
 consider, is whether the differences can be reduced within limits which may make
 the test available  in practice.  M. Devergie states, from  his  experiments, that
 Ploucquet's test affords no  satisfactory results, when applied  to the  bodies of
 children which  have not reached the eighth month of gestation.   According to
 him, the ratio is for the eighth  month:—Before respiration, 1: 63.  After respi-
 ration, 1:37.   Ninth month:—Before  respiration, 1:60.  After respiration,
 i : 45.  The ratio, he observes, becomes higher after respiration, in proportion to
the perfection with which the process has been carried on.  (Medecine Legale,
i. 556. See also Ann. d'Hyg. 1S35, i. 485; Med. Gaz., Nov. 1842, p. 208.)  The
facts which have been collected by different observers appear to me to show that 
 296          INFANTICIDE.   SPECIFIC GRAVITY OF THE LUNGS.

 Ploucquet's test is not fitted to determine, in'an unknown case, whether a child
 has breathed or not.
   6. Blood in the pidmonary vessels.—It has been asserted that if blood be found
 in the pulmonary vessels of  a  new-born child, we are justified in assuming that
 respiration has taken place.  On the other hand, the absence of blood from these
 vessels has been considered to prove that a child has not respired.   This assertion
 must have originated in a want of  correct  observation.  The pulmonary vessels
 contain blood, both  in the child which has, and in  that which has not respired.
 It is possible that  the vessels may contain more after respiration than before;
 but in most cases of infanticide it would be difficult to found any distinction on
 a point of this nature.   In  examining the  bodies of children which have died
 without  respiring, and  those of others which have  lived and respired for some
 time  after birth,  no perceptible difference was found in the quantity of blood
 existing in these vessels in the two cases.  The fact is, the excess of blood after
 the establishment of respiration is distributed throughout the minute capillary
 system of the lungs: it does not remain in the larger trunks.  The state of the
 pulmonary vessels, therefore, furnishes no evidence of respiration or the contrary.
 The same observation will apply to the presence of blood in the substance of the
 lungs.   It is said  that on cutting through lungs that have breathed the incisions
 are followed by a  copious flow  of blood; but this, it is alleged, does not happen
 with lungs  that have not breathed.   In performing this experiment on several
 occasions, I have  not been  able to perceive any well marked difference.  The
 blood in the new-born child may be found coagulated or not, and there is no dif-
 ference in this condition, whether it be born living or dead.
   7. Relative proportion of fat in the lungs.—In July, 1847, a memoir was pre-
 sented to the Academy of Sciences by M. Guillot, in which the author proposed
 to determine the question of respiration by the relative proportion of fat contained
 in the lungs  before and after  birth.   According  to M. Guillot, the quantity of
 fat contained in the  pulmonary tissue is always greater before than after respira-
 tion, and begins to diminish from the moment that the act of breathing commences.
 Before respiration, the  dried lungs yield from ten to eighteen per cent, of fat:
 after respiration, not more than six per cent.  The process followed by  M. Guillot
 is  to dry the organs  at a high temperature, so as to expel all the water,—reduce
 them to powder, and digest this powder in ether.  (Comptes Rendus, Juillet 12,
 1847, 77.)  It  need hardly be observed that  this  process could not be made
 available  in practice.   Admitting the facts as  stated,  the difference between six
 and ten per cent, may disappear by further observations.   A want  of chemical
 accuracy might  lead to  serious mistakes.  The process,  however, is open to this
 objection:—if respiration have been fully performed, this will be sufficiently evi-
 dent from the state of the lungs; and if imperfectly performed, as the change is
 alleged to depend  on the respiratory act, the result  of an analysis cannot tend
 to  remove the difficulty.
  8. The specific gravity of the lungs.—The specific gravity of the lungs is greater
before than after respiration; for although the  organs  become absolutely heavier
by the establishment of the  process,  this is owing, not to the air, but to the ad-
ditional quantity of blood received into them.   The air thus received so increases
the volume of the organs, as to more than counteract the additional weight de-
rived  from the  blood, and thus  apparently  to diminish their  specific  gravity.
Under these circumstances the organs readily float on water.   From several ex-
periments, I have found that the specific gravity of the lungs before respiration,
 i. e. in the foetal condition, varies from 1-04 to 1*05. They are about one-twentieth
part heavier than  their  bulk  of water.  After respiration, the specific gravity of
the lungs with the air contained in them, I found  in one experiment to be 0*94;
 i. e. the organs were  about one-seventeenth part lighter than their bulk of water.
 Thus it is that a very small quantity of air will render these organs buoyant in
 water; and  an alteration in  the volume of the  lungs sufficient for this purpose 
                MODE OF EMPLOYING THE HYDROSTATIC TEST.            297

would  not be perceptible  to  the eye.  It will be  understood that the specific
gravity of the substance of the lungs is unchanged; the organs are rendered only
apparently lighter by the air contained in their cells, on the same principle as a
distended bladder.  Hence it follows, that the same apparent diminution of specific
gravity will take place whether the air be derived from respiration, artificial in-
flation, or putrefaction.   It is on this property of the  lungs that the application
of what is termed the hydrostatic  test or the docimasia pulmonaris, is  founded,
—a subject which may  be appropriately considered in  another chapter.
   Conclusions.—The general conclusions which may be drawn from the contents
of this chapter are:—
  1. That a child may be born alive and be  criminally destroyed before it has
breathed.
  2. That the presence of any marks of putrefaction in utero proves that the
child must have  come into the world dead.
  3. That  the characters accompanying certain marks  of violence may  occa-
sionally show that the child was living when the violence was applied to it.
  4. That there are no certain  medical signs, by which a child which has not
breathed can be  proved  to have been living when it was maltreated.
  5. That a new-born child may be destroyed by the  prevention of respiration
during delivery.
  6. That the proof of respiration shows that  the child has breathed, not that it
has been born alive.
  7. That by taking together the colour, volume, consistency, absolute weight
and buoyancy of  the lungs, we may be able to draw an inference as to  whether
the child has or has not respired.
  8. That the lungs increase in weight according to the degree to which respiration
is established, and not necessarily according to the  period which the child has
survived  birth.
  9. That no reliance can be placed upon the  test of Ploucquet, or the propor-
tionate weight of the lungs to the body.
  10.  That no reliance can be placed upon the relative quantity of blood in the
pulmonary vessels, or the relative proportion of fat contained in the pulmonary
tissue, as evidence of respiration having been  performed.
                              CHAPTER XL.

 MODE OF EMPLOYING THE HYDROSTATIC TEST--INCORRECT INFERENCES--SINKING OF THE
  LUNGS FROM DISEASE OR ATELECTASIS--LIFE WITH PARTIAL DISTENTION OF THE LUNGS
  —LIFE WITH  PERFECT ATELECTASIS OR ENTIRE  ABSENCE OF AIR FROM THE LUNGS
  —HVDROPTATIC TEST  NOT APPLICABLE TO SUCH  CASES--ERRONEOUS  MEDICAL INFER-
  ENCE FROM SINKING  OF  THE LUNGS--FLOATING  OF THE LUNGS  FROM EMPHYSEMA
  AND  PUTREFACTION--EFFECTS OF PUTREFACTION IN AIR--GENERAL CONCLUSIONS  RE-
  SPECTING THE HYDROSTATIC TEST.

  Mode of employing  the hydrostatic test.—The hydrostatic test has been long
known, and various opinions have been entertained relative to  its efficiency and
value.   Many of the objections that have been urged to its use  appear to have
arisen from a mistaken view of the  evidence which it is  capable of furnishing.
The  term "test" is  decidedly improper, since there are  cases  in which  it does
not enable us to decide whether a new-born child has come into the world living
or dead.   It is, however, for the sake of  convenience, here retained.   AVhen the
hydrostatic test is properly applied, and with a full knowledge  of the exceptions 
298           SINKING OF THE LUNGS FROM VARIOUS CAUSES.

to which it is exposed, it may afford in many cases good evidence whether a child
has or has not respired.   The mode of performing the experiment is extremely
simple.  Having removed the lungs from the chest, they should be placed, still
connected by the trachea and bronchi, upon the surface of distilled or river water.
If they sink, it should be noted whether the sinking takes place rapidly or slowly.
If they both sink, the two lungs should be tried separately; for it is sometimes
found that one, commonly the right, will float while  the other will sink.  Sup-
posing that both lungs sink, it will then be proper to divide each  into twelve or
fifteen pieces, and place these pieces separately on water.  If, after this, they all
sink, the  inference is, that though  the child  may have lived and  survived its
birth, there is no evidence of its having respired.   On the other hand, the organs
when placed on water may float:  it should then be  noticed whether they float
high above the surface, or at or below the level of the water; sometimes they
indifferently float or sink.   These differences will lead to a conclusion respecting
the degree to which respiration  has taken place.   It will now be proper to sepa-
rate the lungs, and determine whether the buoyancy be due to one or both.  Each
lung should  be divided, as before, and each piece separately tried.  If all  the
pieces float, even after firm compression, we have good evidence, cceteris paribus,
that respiration has been very perfectly performed.   Should any of the divided
portions sink in water either before or after compression, our opinion may be
modified accordingly.  Some have recommended that the lungs should be placed
on water with the heart and thymus gland attached; but there appears to be no good
reason for this, since it is as easy to form an opinion of the degree of buoyancy
possessed by the lungs, from the readiness with which they float, as by observing
whether or not they have the power of supporting these two organs.
   Incorrect inferences.—Such, then, is the method of employing the hydrostatic
test in cases  of infanticide.  With regard to its use in medical jurisprudence, it
should be observed that the floating of the lungs in water is not, as it is often
incorrectly represented to be, a proof that the child  has been born alive; nor is
the fact of their sinking in  water any proof that the child was born dead.  The
floating under the limitations to be now described, proves only  that the child has
breathed; the sinking, either that it has not breathed, or breathed but imperfectly.
The fact of a child having been born living or  dead, has, strictly speaking, no
relation to the  employment of the hydrostatic test.   There are, indeed, cases of
infanticide which may be readily established without resorting to this test: all
that the law  requires is proof of a child having been born living,—whether this
proof be furnished by the state of the lungs through the hydrostatic test, or in any
other way, is of no moment.   The signs of life are commonly sought for in the
lungs, because  it is in these organs that the changes  produced by a  new state of
existence are first perceived;  but this examination may be dispensed with,  when
the woman confesses that the child was born  alive—when others have seen it
manifest life  by motion or otherwise  after its  birth;  or lastly, in cases, where,
without being seen, it has been heard to cry.   The crying of a child has been
admitted as evidence of live birth on several trials for infanticide; although, from
what will be  hereafter said, it is possible that a child may be heard to cry, and die
before its body is entirely born.   Among the objections which have  been urged
to the employment of the hydrostatic test, we have first to consider  those which
concern the sinking of the lungs in water.

           SINKING OF THE LUNGS FROM DISEASE OR ATELECTASIS.
  It is said that the hydrostatic test cannot show whether a child  has or has not
survived its birth,  because the lungs of children that  have lived for a considera-
ble period have been observed to sink entirely in water.   In some instances this
may depend  on disease, tending  to consolidate  the  air cells, as hepatization or
scirrhus;  in  others, on oedema or congestion; but these cases can create no diffi-
culty, since the reason for the lungs sinking in water would be  at once obvious 
LIFE WITH PARTIAL DISTENTION OF TnE LUNGS.           299
on examination.   The hepatized portion of lung may be known by the firmness
with which it resists cutting with a knife, as also by the fact that it is impossible
to distend it artificially with air.  On the other  hand, there are cases  in which
the lungs appear healthy and unaffected; all that we can perceive is, that  they
retain  their foetal condition.   This is a very different state to that of hepatization,
because the lungs may, in this case, be made to receive air by artificial  inflation.
It is remarkable that  life  should continue for  many hours, and  sometimes  even
for days, under  such a condition;  but the occasional existence  of this state of
organs in a living child is  placed  beyond all dispute;—the explanation of the
causes upon which it depends—how it is that a child may live and breathe for
hours  or days, and no signs of respiration are discovered in its body after death,
is involved in great difficulty.  The researches of Dr. E. Jorg, of Leipzig, have,
however, thrown some light upon the subject; and these may probably lead the
way to other discoveries in this obscure department of physiology.  Some of Dr.
Jorg's views are peculiar.   He considers that the act of parturition, as well as
the duration of the process, has a material influence upon the system of a child;
and that these conditions serve to prepare it for the efforts which it has to make
in performing respiration.  (Die Fotuslunge, Grimma, 1835.)   Supposing the
first inspirations made by a child to be, from any cause, feeble or imperfect,  then
the organs will become only partially distended;  the remaining portions will pre-
serve their foetal condition. Dr. Jorg considers this as a positively diseased state
of the lungs in  the new-born child, and he has  given to it the  name of atelec-
tasis;  ctTeXta "incomplete;"  ocrae-n; "expansion."   It may proceed from va-
rious  causes.  He considers that children which are  born after a very  easy and
rapid  delivery are subject to  it; and thus it may be found in a  mature, as  well
as in an  immature child.  Any cause which much weakens the  vital  powers of
a child before its actual birth, may give rise to the occurrence of this  imperfect
dilatation of the lungs.  In this way it may be  due to long-continued pressure
on the head during delivery, or to hemorrhage from the cord.  All the  causes of
asphyxia in a new-born  child will, when operating  only in a very slight degree,
also produce this atelectasic condition. AVhen only a part of the  lungs  becomes,
in the first instance, distended, the  child may not  afterwards acquire  sufficient
strength to fill the remaining portions; it may  thus live  on for some  hours or
clays,  respiring at intervals, and becoming occasionally convulsed, in which state
it will probably sink exhausted and die.   Jorg has remarked that those portions
of the lung which are not speedily distended  by air,  afterwards become consoli-
dated or hepatized, so that all traces of their vesicular structure are lost.   The
length of time which the child survives will depend upon  the degree  to which
its lungs have become dilated.  This condition of the lungs is sometimes to be
clearly traced to  the diversion of the blood supplied to the  lungs, by reason of
the ductus arteriosus or foramen ovale remaining open after birth.
  Life with partial distention of the lungs.—It  is  not necessary that the whole
of the lungs should  have received air, in order that a child should  continue to
live even for some months after its birth.   A few years ago, I met with the fol-
lowing case, which will serve to  illustrate this statement.  A  child,  aged six
months,  had been, it was supposed, destroyed by suffocation.   Upon opening
the thorax, the viscera were found healthy; but the  whole of the  inferior  lobe
of the right lung was, so far as regarded colour, density, and structure,  precisely
like the lungs of the foetus,—no air having ever penetrated into it.  It had be-
come developed in size, but its vesicular structure was perfectly destroyed.  When
the whole of  the  lung was placed in water, it floated;  but when the inferior lobe
was separated, it immediately sank to the bottom of the vessel.  I have  no doubt
that this was a case of  atelectasis, such  as it is described  by Jiirg.   The  lobe
had not received  air in the first instance, and had become afterwards consolidated
or hepatized, so that it could not be  inflated.  Dr. Albert met with a case where
a  child died thirty-six hours after its birth, having been attacked by convulsions 
300
LIFE WITH UNEXPANDED LUNGS.
at intervals during that time.   On  inspection the whole of the right and the
lower lobe of the left lung were found to  be in  their foetal  condition, and they
immediately sank when immersed in water.  There was no diseased appearance
in the organs, and  the undistcnded portions were easily filled by blowing air
into them.  (Henke's Zeitschrift, 1837, ii. 422.)  M. Depaul found that in many
cases where children had died suddenly after breathing for several hours or days,
there was no other morbid appearance to be perceived than an  unexpanded con-
dition of a large portion of the lungs.  (Med. Gaz. xxxix. 283.)
   Life with perfect  atelectasis, or entire absence of air from the  lungs.—It is
quite  necessary for a medical jurist to be aware, that this  state  of  the  lungs,
which  is here  called atelectasis, is  by no means unfrequent  among new-born
children, although  attention has been only of late years drawn to the subject.
AArhen no portion of air  is found in the lungs of a child,  there  is no test by
which such a case can be  distinguished from one where the  child  has come into
the world dead.  These cases of atelectasis are ordinarily set down as exceptions
to a very general rule;  but I cannot help thinking, that they are more common
than some medical jurists are  inclined to admit.  In examining  the body of a
child, the history of which is unknown, it is therefore proper that the possible
occurrence  of these cases  should  be well borne in mind.  It appears to me'not
improbable, that  many such come yearly before coroners in this country; and
that they are dismissed as  cases of still-born children, notwithstanding  that marks
of violence arc  often found upon  the bodies.  If, as it has been  already observed,
the lungs sink  in water, the fact  is commonly regarded as  sufficient evidence of
still-birth.  This is assuredly putting the most humane interpretation on the cir-
cumstances, and so far the result is not  to be objected to;  but we should take
care, in carrying out this  principle, that we do not throw obstacles in the way of
judicial inquiry, and lead to the concealment of crime.  Professor  Bernt met
with an instance  in which a seven-months child died two hours after  birth; and
when its lungs  were divided and  placed in water, every fragment sank.  Remer
has reported another, in which the lungs sank in water, both entire, as well as
when divided,  although  the child had  survived its birth  at least four days.
(Henke, Lehrbuch  der G. M. p. 374.)  In this case, the navel-string separated
naturally before death.   Orfila found, in  a child which had lived eleven hours,
every portion of the lungs, when divided, to sink on immersion.  In three other
cases, in which the subjects  survived  birth four, six, and ten  hours, the lungs
also  sank when divided;  two  of these were mature children.  (Med. Leg.  i.
375.)  Other instances are recorded by Daniel, Schenk, and Osiander.  Metzger
supposed that premature children alone were likely to present this  anomaly; i. e.
of continuing to live after birth without leaving any clear signs of respiration in
their  lungs.  Perhaps the greater number of these cases have occurred among
immature children; but  recent observations  satisfactorily prove  that perfectly
mature children may also be the subjects  of  this singular condition.
   I may add to these instances, two which have occurred under my  own obser-
vation.   In one, the case of a  mature male  child, the  lungs sank in water, al-
though the child had survived  its birth for a period of six hours.  In the other,
the case of a female twin, the child survived twenty-four hours, and after death,
the lungs were  divided into thirty pieces, but not a single piece floated; showing,
therefore, that  although life had been thus protracted, not one-thirtieth part  of
the structure of the lungs had received from respiration sufficient air  to render it
buoyant, (Guy's  Hospital Reports, No. v. p. 355.)  In the latter instance, no
particular remark was made during life respecting the respiration of the child.
These cases show most clearly  that buoyancy of the lungs is  not a necessary con-
sequence of a child having lived and breathed for some time after birth.  Pro-
bably, had  this been  a  ease  calling for medico-legal inquiry,  the lungs would
have been cut to pieces; the sinking of the divided pieces in  water, either before
or after compression, would have been set down a3 negativing the  act of respira- 
SINKING OF TnE LUNGS IN WATER.
301
  tion, and, unless  other  strong evidence were  forthcoming, the fact of the child
  having survived its birth.  Here, again, we perceive the necessity of not hastily
  assuming that a child has been born dead, because its lungs sink in water.—
  There may be no good medical evidence of such a child having lived  after birth,
  but assuredly the mere  sinking does not warrant the common dictum, that the
  child was necessarily dead when born:  it would be as reasonable to  pronounce,
  in a question of poisoning, that  the fact of an  individual having died from poison
  was negatived by the non-discovery of a poisonous substance in the stomach of
  the deceased.
     Hydrostatic test not applicable to such cases.—It must be  apparent, on reflec-
  tion, that cases of this  description are  beyond  the reach of the hydrostatic as
  well as of all other tests applied to the respiratory organs;  because the lungs do
  not receive and retain a  perceptible quantity of air, although the subjects may
  have lived some hours.   The hydrostatic test  is no more capable of showing that
  such subjects as these had lived, than it is of indicating from what cause they
  have died.  Facts of this kind  demonstrate  that passive existence may be for
  some time continued under a state of the respiratory process  not to be discovered
  after death.   In the opinion of  some, these cases form a serious objection to the
  hydrostatic test;  but it is difficult to understand how they can affect its general
  application,—or  why, because  signs of respiration do not always exist in the
  lungs of children which have lived,  we are not to rely upon them when they are
  actually found.   Poison is not always discoverable after death in the stomach of
  a person who has taken it; but this does not prevent a medical jurist from search-
  ing for it, and, under proper precautions, relying upon its discovery,  as evidence
  of poisoning in another  case.   These singular instances prove that we are greatly
  in want of some sign to indicate life after birth, when  the marks of  respiration
i  are absent.  Until we discover  this, we must, of course, make the  best use of
  that knowledge which lies at our disposal; taking care to apply it to those cases
  alone to  which experience shows it to be adapted.  In the mean time, the com-
  mon inference that a child has been born dead because its lungs sink in water,
  is never likely to implicate an innocent party; it can only operate by sometimes
  leading to the liberation of the guilty.
     Erroneous medical evidence from sinking of the lungs.—From the cases already
  reported, it is a fair subject of consideration whether a great error is not committed
  by those medical practitioners who  pronounce all children  to have been  born
  dead, merely because the lungs  contain no air and readily sink when placed on
  water.   This, it is true, is the common  opinion, but it is not warranted by ob-
  servation.  AVe are only entitled to say, in all  such cases, that there is no evidence
  of a child having breathed or lived.   Many might be  disposed to consider it an
  unnecessary degree of refinement,  to hesitate  to express an opinion that a  child
  was born dead when its lungs sank entirely in water, because certain cases have
  occurred wherein these  characters  have been possessed by lungs taken from the
  bodies of children that have survived their birth many hours.  To those inclined
  to'adopt this view, I would say, the answer to such a question is of far greater
  importance in a medico-legal, than  in  a medical light.  In the latter case, no
  responsibility can be attached to the expression of the opinion commonly adopted:
  in the former case, however, when the question refers  to child-murder, a serious
  responsibility attaches to a practitioner; and he can only guard himself from
  unpleasant consequences, by basing his evidence on carefully  observed  facts.
  If a child can live for six or twenty-four hours, without its lungs receiving suffi-
  cient air to allow even one-thirtieth part of their substance to float, it is clear that
  such a child may be the subject of a murderous assault; and if a medical practi-
  tioner, losing sight of this fact, proceed to declare, from the lungs sinking in
  water, that the child must have been born dead, his assertion may afterwards be
  contradicted, either by circumstances, by the  testimony of eye-witnesses,  or by
  the confession  of the woman  herself.  He will  be required, perhaps, to  revise 
302
SINKING OF THE LUNGS IN WATER.
his opinion; and he will then find, that the fact of the lungs sinking in water is
rather a want of evidence of life after birth, than a positive proof of a child
having been born dead.  It cannot be denied that the sinking of the lungs is a
presumption in favour of still-birth, but it is  nothing more;—it  is not, as it is
often set down,  a direct  or positive proof of the child  having been born dead.
There are many cases reported which show that this is not an unnecessary caution.
Meckel relates two instances where the lungs sank in water, but the women
respectively confessed that they had destroyed  their children: according to the
general rule,  these children  must have been born  dead, and  no murder could
have been committed! (Gerichtl. Med. 365.)   For other examples of a similar
kind, I must refer to the following journals: Ann. d'Hyg. 1837, i. 437;  also,
1841,429;  Henke's  Zeitschrift, 1840, xxvii.  Erg.  H.;  Brit,  and For. Med.
Rev.  Jan. 1842, p. 250.  The cases  there reported appear to me to convey a
serious warning to medical witnesses,  on the danger of expressing an opinion
not strictly warranted by the facts, and which  must be in such cases merely
speculative.   A case of some interest in this point of view has been communicated
to the Medical  Gazette, by Dr. Davies, of Hertford.   In  November,  1847, he
was required to examine the  body of a child found under suspicious circumstances.
It was in a pasteboard box,  of small size, with the lid turned inside out, and on
the top there was a quantity of mould.   The body was found buried in  a garden.
It turned out on inquiry that there had not been exactly a concealment of birth
on the part of the mother, who was an unmarried woman.  The  body was thir-
teen inches long from crown to sole; eyelids  were  adherent; testicles (it was a
male child) had not descended; it weighed one pound  and three-quarters.  It
was ascertained that it had been  buried a fortnight, which accounted in some
degree for the lightness of its weight in proportion to its length,  and for a slight
peeling off of the cuticle from some parts of the arms: the body looked otherwise
healthy.   The age was probably about seven months.  On examining the lungs,
they were found to be quite firm, like the liver; they sank in  water both ivholly
and in parts.   The right lung was of a dark brown  mahogany  colour, but  the
upper lobe of the left was of rather a lighter colour than any other part of the
lungs.  However, this lobe  sank immediately upon being put  in water.   The
evidence at the inquest proved that the child was not. only born  alive, but that
it had lived ten  minutes at  least, and  perhaps longer, after birth.  It  appeared
that an elderly woman, living close by, was sent for, and when she arrived  she
found the child, with the placenta attached to it, in the close-stool.  She noticed
that the child moved  its arms;  she therefore took it up with  the placenta, and
wrapped  it in flannel.   It continued to move its limbs for ten minutes, according
to her account, but it uttered no cry.  When the child ceased to move, she divided
the cord  seven inches from the  body, and tied  it into a knot.   (Med.- Gaz. xl,
1022.)
   It has been recommended that medical jurists should consider as dead  every
child that has not breathed; %. e., whose lungs sink in water; but they  who give
this advice at the same time admit that children may come into the world living
without breathing;  and the law holds, under the decisions of its expounders, that
respiration is only  one, and not the exclusive proof of life.   In order to establish
life or even live birth, respiration need not always be proved,  either  in civil or
criminal  cases.  (Fish v. Palmer, 1806.  See post, Birth.)  A medical jurist
would therefore  be  no more justified in  asserting that all  such children were
necessarily born dead, than that they were born living: and in  stating what is
the plain and obvious truth, it is not possible that he  can ever be the means of
involving an  innocent person.   It is certain, however, in departing  from the
truth, and stating what is contrary to well known facts, that when the lungs of a
child sink in water, it is  safe and just to consider such child as having been born
dead, he is incurring the risk of exculpating a really guilty person; for it cannot
be too strongly borne  in mind, that a woman is not charged with  murder, merely 
FLOATING OF THE LUNGS FROM PUTREFACTION.
303
 because the lungs of a child float or sink in water, but because there are upon
 its body marks of violent injuries  apparently sufficient to account for the death
 of a newborn child, or very strong moral presumptions of her guilt.   (See Ann.
 d'Hyg. 1836, ii. 362.)                                    &      v

      BUOYANCY OF THE LUNGS FROM OTHER CAUSES THAN RESPIRATION.
   Another series of objections has been urged to the hydrostatic  test, based on
 the fact that the lungs may receive air and acquire buoyancy from other  causes
 than respiration.   These causes are two: putrefaction and artificial inflation.
 It was supposed that the  lungs of a still-born child might become emphysematous
 from a compression of the sides of the thorax during delivery;  but it is difficult
 to understand how in this way air should be extricated  from these organs any
 more than it would be from the liver under  similar circumstances.   The  truth
 probably is, that what has been described as emphysema of the lungs in still-born
 children was nothing more than partial or imperfect respiration performed during
 delivery.  In examining  the bodies of  many still-born children,  I have never
 met with  any appearance resembling what has been described as a state of em-
 physema,  independently of respiration  and  putrefaction.  It  may be proper,
 however,  to state, that according to some observers, emphysema of the lungs may
 be produced under  the  following circumstances:—The  thorax of the  child is
 compressed  in passing the outlet,—the lungs within are thereby compressed; and
 if this compressing force be suddenly removed, as by the thorax escaping, the
 elasticity  of the parietes will cause the chest to expand, and  air, it is presumed,
 will enter as  a necessary consequence.   The simultaneous compression of the
 abdomen  might aid in the  entrance of the air.  (Lancet, May 20, 1837; also,
 June 17,1837.)   It is contended that not only may respiration take place during
 birth, but that even the lungs of the dead foetus may become thus mechanically
 inflated, and simulate respiration.
   This opinion appears to be founded on an erroneous view of the  condition of
 the thoracic viscera in the chest.   The lungs are as dense as the liver before air
 has entered  into them.  If they be compressed they may become  elongated, but
 when that pressure is removed, they will, if the child be  dead, simply return to
 their original foetal condition.   To suppose that they would expand and receive
 air, is to suppose that the reaction of the thoracic parietes is greater than the
 force with which they have  been compressed.   But what is to carry the thorax
 of a a dead child beyond the point at which equilibrium is  restored?  Besides,
 this would not suffice to distend the  air-cells, which are yet coiled  up as it were
 and condensed. . If this view were correct, scarcely a child would be born  without
 having air in its lungs.  In  experimenting on this subject, I have never observed
 the least  portion of air to enter:—the air-cells of  the  lungs do  not therefore
 appear to  be in  the condition of spiral springs, which this hypothesis would re-
 present.
   Floating of the lungs from putrefaction.—The lungs of a still-born child, when
 allowed to remain in the thorax, are  slow in undergoing putrefaction; but never-
 theless, they may sooner or later  acquire sufficient air  to render them buoyant
 in water.  This form of gaseous putrefaction may even take place in  the  lungs
 of a child  which has died  in utero.   One instance of the kind is recorded by Dr.
 Albert, (Henke's Zeitschrift, 1837, ii. 379,) in which the child was cut out of
 the uterus in a putrefied  state, and its lungs floated when placed  on water.  It
 has been also alleged, that the formation of air may  take place in the lungs from
 putrefaction, without this being indicated  by  change in colour, smell, or  other
 properties  of the organs; but admitting that this occurs, it can create no difficulty
 in the investigation.
   AVhen the lungs are putrefied, this will be determined,  in  general, by putre-
faction having extended throughout all the soft parts of the body.   The organs,
according  to the degree of putrefaction, will be found soft, of a dark green or 
304
GENERAL CONCLUSIONS.
brown colour, and of a highly offensive odour; the serous membrane covering
the surface will be raised in large visible bladders, from which the air may be
forced out  by very moderate compression.   It  has  been remarked, that under
the same conditions, gaseous putrefaction  takes place  as rapidly  in  the  liver,
heart, and  thymus gland of a new-born child, as in the lungs.   AVe should there-
fore examine the general condition of the body: the distention of the lungs with
gas from  putrefaction cannot  be  easily overlooked or  mistaken for the air of
respiration.  The answer to any objection founded on the putrefied state of these
organs,  must at  once suggest itself.   It is  impossible that any well informed
medical witness can  expect to obtain satisfactory evidence from experiments on
the lungs of such subjects.   He  should at once abandon the case, and declare
that in regard to the question of  respiration, medical evidence cannot establish
either the affirmative or the negative.   The fact of his not being able to  give the
evidence required, cannot be imputed as a matter of blame to  him; because this
is due to circumstances over which he has no control.   In a case of poisoning,
the post-mortem appearances in the viscera may be  entirely destroyed by putre-
faction ; but no practitioner would think of looking for proofs where the circum-
stances rendered it utterly impossible for him to obtain them.
   A case may possibly occur, wherein the characters presented by the lungs will
be such as to create  some doubt whether the buoyancy of the organs  be due to
putrefaction or respiration,  or,  what is not unusual,  whether the putrefied lungs
may not also have  undergone the changes of respiration.  The  facts  may be
apparently explicable on either assumption.  Even  here  a proper  investigation
may serve  to remove all doubt.   (See case by Dr.  Francis, Med.  Gaz. xxxvii.
460.)   It has been recommended  on these occasions that the witness should lean
to the side of the prisoner,—in other words,  he  should give an opinion, that the
child suspected to have been murdered had not respired.  This advice is equal
to recommending a witness  to take upon himself the duty of a jury, and virtually
to acquit a prisoner  upon a  doubt existing in his  own  mind, in respect to only
one portion of the evidence  adduced against  her.   The  evil effects of following
this kind of  advice  are well shown  by a case reported in Henke's Zeitschrift,
(1843, i. 102, Erg.  H.) where an opinion was  improperly given by  a  medical
witness, that the child, the  whole of  the organs  of whose body were in an  ad-
vanced state of putrefaction, was born dead; and the prisoner afterwards confessed
that it had been born living!   This shows  that it is always better  to leave a
doubtful case as we find it, than to express a positive opinion on one side or the
other, when  this opinion can  never amount to more than a conjecture.  If a
witness were simply to assure the jury, that medical evidence could not  solve
the question whether the child had lived,—if he were to assert what is really the
fact, that his experiments would not allow  him to  say whether the child had or
had not respired,—it is certain that no innocent person would ever be convicted
or a guilty person acquitted, upon his  evidence.   It is for a jury only to judge
of guilt from all the circumstances laid before them; but it is assuredly not for
a medical witness to prevent all further investigation, and put an end to the case,
by leaning to the side of the accused when there is really a doubt upon his mind.
It is his duty to state that doubt,  and  leave the decision of guilt or innocence in
the hands of the  Court.

   Conclusions.—The general conclusions which may be drawn from the contents
of this  chapter respecting the  application of the hydrostatic test in cases of in-
fanticide, are the following:—
   1.  That the hydrostatic  test can only show whether a child has or  has  not
breathed,—it does not enable  us to determine whether a child has been born
living or dead.
   2.  That the lungs of children which have  lived after birth  may  sink in water
owing to their not having received air, or to their being in a diseased condition. 
           FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION.        305

  3. That a child may live for a considerable period when only a portion of the
lungs has been penetrated  by air.
  4. That a child may survive  birth, even for twenty-four hours, when no part
of its lungs has been penetrated by air.
  5. Hence the sinking of the lungs (whether whole or divided) in water, is not
a proof that a child  has been born dead.
  6. That the lungs of children which have not breathed and have been born
dead, may float in water from putrefaction or artificial inflation.
  7. That the lungs as situated in the chest undergo putrefaction very slowly,—
that if but slightly putrefied, the air may be easily forced  out by compression,
and if much putrefied, either the case must be abandoned, or other sources of
evidence sought for.
                             CHAPTER  XLI.

         F
FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION.  INFLATION DISTINGUISHED FROM
  PERFECT RESPIRATION--NOT DISTINGUISHABLE  FROM IMPERFECT RESPIRATION—DOUBT-
  FUL CASES--RESULTS OF COMPRESSION--IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST
  —SUMMARY--RESPIRATION BEFORE BIRTH--VAGITUS UTERINUS--RESPIRATION A SIGN OF
  LIFE, NOT OF LIVE BIRTH--THE KILLING OF CHILDREN WHICH BREATHE DURING BIRTH
  NOT CHILD-MURDER. GENERAL CONCLUSIONS.

  Floating of the lungs from artificial inflation.—It has been alleged that the
lungs of a  still-born child may be made to assume, by artificial inflation, all the
characters assigned to those which have undergone respiration.   Thus, it is said,
a child  may not have  breathed, and yet the application of the hydrostatic test
would  lead to the  inference that it had.   It will be seen that the force of the
objection goes to attack directly the inference derived  from the presence of air
in the lungs.  This objection can, it appears to me, be admitted only under one
form, namely, as it applies  to lungs which have been inflated while lying in the
cavity of the chest.  Any experiments performed on inflation after their removal
from this cavity, can have no practical bearing;  since in a case of infanticide we
have to consider only the degree to which the lungs may be inflated by a person
who is endeavouring to resuscitate a still-born child.  The difficulty of inflating
the  lungs of a new-born child is too well known  to require to be here adverted
to;  the greater the violence used, the less likely is the air to pass into these or-
gans, but it rather finds its way  through the oesophagus into the bowels.   Dr.
Albert, a late writer on the subject, denies that the organs while lying in the
chest can be so filled with air, either by the mouth or by means of a tube, as to
be rendered buoyant in water.  In performing this experiment several times, he
never found a trace of air in the  air-cells;  and he contends that medical jurists
have begun at the wrong end (den Gaul von hinten aufgezaumt,) in endeavouring
to seek for  answers to an objection, before they had ascertained that such an  ob-
jection could  have, practically speaking, any  valid existence.   (Henke,  Zeit-
schrift, 1S37, ii. 390.)   M. Depaul has still more recently found that it required
great force  to inflate the lungs, and  that their  resiliency was sufficient to expel
the  greater part  of the air.   (Med. Gaz. xxxix. 283.)
  Having had several opportunities of examining the lungs of children in which
inflation had been resorted to, not for the express  purpose  of creating an objec-
tion to  the hydrostatic test, but with the bond fide intention  of resuscitating
them, I may here state the results.  In some of these instances a tube had been
used, and in others the mouth. • In the first case it was found, on inspection, that
only about  one-thirteenth part of the structure of the lungs had received air.  In
       20 
306      ARTIFICIAL INFLATION DISTINGUISHED FROM RESPIRATION.

the second, no part of the  lungs had received a trace of air, although inflation
had been repeatedly resorted to; the air had passed entirely into the abdomen.
In a third, attempts were made for upwards of half an hour to inflate the organs;
but on examination, not a particle of air was found to have penetrated into them.
In a fourth, no air had entered the lungs, and in a fifth, although a small portion
had  penetrated  into  the organs, it was  readily forced out by compression.  In
repeatedly performing experiments on dead children, the results  have been very
similar; the lungs, after several attempts, were found  to have received only a
small quantity of air.  Thus, then, it would appear, that the lungs of a new-born
child may be inflated in sitUe, although with some difficulty, and that the quantity
of air which they receive under these circumstances is inconsiderable.   If the
efforts at inflation be continued for some time in the dead body, and the tube be
violently introduced into the larynx  or trachea, or if the organs be inflated, after
removal from the thorax, with the express intention of causing them to resemble
respired lungs, the case is different:  but this is not the way in which  the objec-
tion  can possibly occur in a case of  infanticide,—a circumstance which  appears
to have been strangely overlooked by some  of those who  have examined this
alleged objection to the hydrostatic test.   It  is not likely that a woman, if able
to perform the experiment at all, would be capable of doing more than a practised
accoucheur; and the  probability is, that  she would, in general, altogether fail in
the attempt.  One case is recorded,  where a woman  recently delivered is stated
to have succeeded in artificially inflating the  lungs of her child (Meckel, Lehrb.
der G. M. 368:—see also  Ed. Med. and Surg. Jour. xxvi.  374;) and another,
in which this defence was urged on the part of the female, is reported by Dr. von
Siebold, of Gottingen (Henke's Zeitschrift der S. A., iii.  1845.)  The child, in
this  instance, was found with its head cut off, and the lungs contained air.  The
inconsistency of the woman's  statement as to the mode in which  she inflated the
lungs was clearly proved, and the examiners did not  hesitate to give a decided
opinion that the air found in the lungs had been derived from the act of respira -
tion, and  not from artificial inflation.  The whole  case  shows clearly that when
a theoretical objection of this  kind comes to be tested practically, it ceases to
present any difficulty.
  But let it be admitted that the lungs are artificially inflated; in this case, they
would resemble, by their partial distention with air, and other physical characters,
those of  children which  had  imperfectly breathed.   Like them, they may float
on water; but on cutting them into pieces, some of these would be found to sink.
If the pieces be firmly compressed either by means of a folded cloth or between
the fingers, they will  lose their air and sink; so that in fact there are no physical
means of distinguishing artificially inflated lungs from those that have imperfectly
breathed.    Experiment has repeatedly shown that where the respiration has been
very feeble, and  no artificial  inflation resorted to, the air may be forced out of
the lungs by moderate compression, and the  portion so compressed will  sink in
water.  If the compression  be performed under water, bubbles of air may be seen
to rise through the liquid.  The results I have found to be exactly the same with
lungs inflated artificially as they were lying in the chest.  (See Guy's  Hospital
Reports, No. V., and for some remarks  on  this subject by Dr. Christison, see
Ed.  Med. and Surg. Jour. xxvi.  74.)
   Artificial inflation distinguished from perfect respiration.—If respiration has
been perfectly established, and the lungs are  well filled with air,  it is impossible
so to expel this air by compressing the divided portions of the organs, as to cause
them to sink in water.  It has been  asserted  that it is equally impossible to force
the air out  of lungs that have been artificially inflated;  but  it is highly probable
that in these cases the lungs have been inflated to a  maximum degree when re-
moved from the thorax, a case in which much difficulty is certainly experienced
in expelling the air;  but this is not the form in which  the objection can ever
present itself in a case of infanticide.  If the lungs be inflated in the ordinary 
         ARTIFICIAL INFLATION DISTINGUISHED FROM RESPIRATION.     307

way, -/. e., while  lying within the thorax, there is never, according to my obser-
vation, any great difficulty in causing them to lose their air by compression,—a
result  which  has been repeatedly demonstrated to the  medico-legal classes of
Guy's Hospital.   Although no reliance can be placed on the effects of compres-
sion in cases of imperfect respiration, yet it appears to me that when, with great
weight of the lungs, there is great buoyancy in water, the fact of their not losing
the air contained in them, and not sinking  after very firm compression, ought to
be considered as a good corroborative proof of the child having breathed.   It has
been just stated that compression will not  extricate  air  from lungs which have
fully respired.  By this, it is not to be understood that the experiment  of com-
pression  can only be practically applied, to distinguish respiration in those cases
in which a child has lived for a considerable time after its birth.   I have found
it to succeed,  even where a child had lived  to make no more than one or two re-
spirations,  and had died before it was actually born.   In this case, it was found
necessary, in  order  to effect delivery, to destroy the child while the head was
presenting. # It lived, however, a sufficient  time after the protrusion of its head,
with the greater part of the  brain destroyed, to cry loudly for an instant.  The
general appearance of the body showed  that it had attained to the full period of
gestation.   On opening the thorax, the lungs Were seen  projecting slightly for-
wards over the sides of the pericardium.  They were of  a light-red colour, but
not crepitant under the finger.   They had the external physical characters which
these organs are known to acquire on the first establishment of respiration; but
the absence of crepitation proved that the process could not have been perfectly
performed.   The colour of the external  surface was throughout  uniform, a cir-
cumstance  which  I  have never witnessed in lungs that had been artificially in-
flated, except where the inflation had been carried to its fullest extent out of the
body.  Then, however, there is, commonly, distinct crepitation.  When removed
and placed on water, these organs floated freely; and on being  separated, both
appeared equally buoyant.  Each lung was next divided into sixteen pieces,and
every piece floated.  In dividing them, it was observed that the colour was uni-
form throughout their substance; there was no sense of crepitus under the knife;
nor could the cells, in which the air was diffused, be seen.  The pieces were then
subjected to very forcible compression, for a considerable  time, in a folded cloth.
The cloth was ruptured by the force employed; yet on removing the pieces, and
placing them on water, they all continued to float.   A portion of air had, un-
doubtedly,  been forced out, but not sufficient to deprive any of them of their
buoyancy.   By this we learn, that in some instances two or three respirations
only may suffice to stamp upon the lungs characters whereby they may be easily
distinguished  from those organs that have undergone  artificial inflation.   The
compression was carried to the furthest possible limit consistently with the pre-
servation of the organic structure of the  lungs.
   It must not be supposed, that, in all children which have lived but a second
or two to respire, similar results will be obtained.  The respiration of an instant
may distend the lungs of one child, as much as respiration, continued for several
hours,  would those of another.   The time which a child has  survived its birth
does not  allow us to predict to what degree  its lungs will  be  found distended on
inspection,  or what the results of experiments on these organs will be.  A child
may have very feebly respired, and died either in a few minutes or hours, or not
until many days  have elapsed  after its birth.  There is, of  course, no definite
boundary between the perfect and imperfect distention of the lungs, but by the
latter condition we may understand that state of the healthy organ's' in which
they contain only sufficient air to render them buoyant in water; and from the
slight difference in their specific gravity and that of water, a very small quantity
will suffice  for this.  In these cases, moreover, the colour, volume, and consis-
tency, are scarcely changed from the foetal condition.  The  admission that  air
may be compressed out of feebly respired lungs  by the same  means as  out of 
308
INFANTICIDE.  STATE OF THE LUNGS.
those which have been submitted to artificial inflation, may appear to render com-
pression useless, as a diagnostic sign of artificial inflation;  but we must not for-
get, that other corroborative sources of evidence may be forthcoming.  The ex-
periment of compression will, I believe, when properly applied, enable us to dis-
tinguish cases of complete respiration from those  of artificial inflation of the
lungs in sitii;  and, if for this circumstance alone, it ought to be regarded as an
adjunct occasionally useful in these investigations.
   Artificial inflation not distinguishable from  imperfect respiration.—It must,
however, be admitted, that there are no means of distinguishing feeble respiration
from  artificial inflation.   The physical characters of the lungs will be unaltered;
and compression will, in either condition, destroy their buoyancy.   In a case of
this kind, I apprehend the only course left open to a medical witness is, to state
to the jury, that the evidence derived  from experiments on the lungs left it un-
certain whether the child in question had respired, or had had its lungs artificially
inflated.  The jury will then  know how to return their verdict;  for it must be
remembered, they have always circumstances to guide their judgment, as well as
medical opinions; and it is upon the whole, and not upon a part of the evidence
laid before them, that their verdict is founded.   It is singular that this occasional
difficulty of distinguishing artificial inflation from respiration, should  have been
represented as a serious  objection to the employment of the hydrostatic test.
Even admitting, in the very few instances in which such a defence on the part
of a prisoner is possible, that a practitioner is unable to distinguish the one con-
dition from another, this becomes purely a point for the consideration of a jury;
it cannot affect the general application of the hydrostatic test.  Examples of this
sort of difficulty are by no means uncommon in the  practice of medical jurispru-
dence.  Many instances might be adduced of medical evidence becoming doubtful
from circumstances wholly independent of the  skill  of the practitioner, and over
which he has no possible control.   In the determination of any single point in
a case of child-murder, whether it relate to live  birth or the actual cause of death,
a doubt may arise; the question relative to the respiration of the child is not ex-
empted from this rule;  but it would be the height  of inconsistency to contend,
that,  because  certain means of investigation will not always enable us  to express
a positive opinion, we should  never have recourse to them.   I presume  that, in
the present day, no practitioner would  trust to  the floating of the lungs as a sign
of breathing,  before he had ascertained that the air  contained in them could not
be expelled by compression.  The charge against an accused party is not likely,
therefore, to be sustained by medical  evidence  of the  respiration  of  the child,
unless the child have actually respired; but it  is possible, that, owing to a want
of evidence  to characterize feeble respiration, a really guilty person may escape
upon the bare assumption that the lungs might have been artificially inflated.
The mischief  to be apprehended is  not, then, as it  has been  often alleged, that
the employment of this pulmonary test may lead to the condemnation of an in-
nocent,  but rather to the acquittal of a guilty  person.  This  is certainly an un-
fortunate result; but it is one for which medical science is not yet in a condition
to provide an  adequate remedy.
   In  reference to this objection, there "are, it appears to me, only two cases which
might give  rise to  some doubt on  the source of the air contained  in  the  lungs
of a new-born child:—
   Doubtful cases.—1.  In the case of a child that has not breathed, the lungs may
be disproportionately heavy, weighing  nine hundred to one thousand grains, and
they may have been artificially inflated in the attempt to resuscitate it.  Unless,
in this case, the air were expelled by compression, an inference might be hastily
drawn, that the child had probably  breathed.   The error could only be removed
by circumstantial evidence; which, however, is  generally sufficient to remove a
speculative objection of this kind.  But unless the  foetal lungs were highly con-
gested, diseased, or of extraordinary size, it is not likely  that they would weigh 
RESULTS OF COMPRESSION.
309
 so much as is here supposed.   This kind of doubtful case might always be sus-
 pected to exist where, with considerable absolute weight, the lungs contained very
 little air.  Let us, however, consider what would be its practical bearing on the
 question of child-murder, supposing the case not to be cleared up by any of the
 methods  above  suggested.   1st, The fact  of respiration would not  be clearly
 proved, because the great absolute  weight of the lungs, without their structure
 being permeated with air, amounts to  nothing.  2dly. Although  the proof of
 respiration might not be made out,  this would not show that the child was born
 dead; for we know that a child may live many hours, and yet no evidence of life
 may be derived from an  examination of the lungs.  3dly. Admitting that there
 was proof of the child having  lived  after birth, whether there were evidence of
 respiration or not, the eause of death would have still to be made out;  and unless
 this be clearly traeed to the wilful and malicious conduct of the prisoner—proofs
 of which are not likely to be derived from the body of a child whose lungs she has
 innocently inflated—she must be acquitted. Thus, then,  it is difficult to understand
 how, in the  hands of one who has attended to the subject of infanticide—and no
 others ought to be allowed to give medical evidence—this objection, on the ground
 of inflation, can lead to any difficulty whatever in practice.  Such a case as that
 which I  have here supposed, actually occurred to  me  in June,  1842.   A male
 child, weighing upwards  of twelve pounds, died during delivery in a difficult la-
 bour.   It gave  no signs of life when born, and there  was  no  pulsation in the
 cord.   Its lungs were artificially inflated in the  attempt to resuscitate it.  The
 organs weighed nine hundred and ninety-four grains.   They were slightly crepi-
 tant and floated on water, but gentle pressure by the fingers caused them to sink.
 It was clear that the increased weight depended on  their great  size, and not on
 any change produced by respiration.  They contained but a  very small quantity
 of air, which was most easily expelled by pressure.  In another case, which I
 examined in June, 1847, the child  was born  dead.  The body was well deve-
 loped, and the lungs weighed 784 grains.   These organs were  inflated in situ.
 On moderate compression, when divided, they immediately sank  in water.
   2.  AVe will now take the converse  objection.  A child may live and breathe,
 and its lungs weigh much under the average of respired lungs, i e. about seven hun-
 dred grains.  In a case like this, unless the air resist expulsion by compression, an
 opposite mistake might be made, and we should pronounce a child that  had really
 breathed and survived birth to have been still-born, and had  its lungs artificially
 inflated.   This might  happen in numerous  cases of imperfect respiration after
 birth, did we not know that the sinking of the lungs, whether containing air or
 not, and whether this air be expelled by  compression or not, does not necessarily
 prove that the child was born dead.   It can only show, under the  most favourable
 circumstances, that  it has either not respired,  or  respired  imperfectly.   The
 sinking  of the lungs may take place in  a child that has survived birth and has
 really been murdered;  but, in such a case, there might  be no proofs of life; and
 therefore a person actually guilty of a  crime  would be discharged for want  of
 sufficient medical evidence to convict.  This, however, could  no more justify the
 entire abandonment of medical evidence in such cases,  than  it could of general
 evidence;  because  this, like evidence which  is purely medical, is but  too often
 insufficient to bring home guilt to the really guilty.   The objection,  therefore,
 on the ground of artificial inflation, when closely examined,  is more speculative
 than real.  Admitting, as some  contend, that there is   no positive  criterion  to
 distinguish this condition from respiration, it is difficult to conceive a case in which
 the objection could be sustained; and if sustained, it  never could  lead, in the
 hands of proper witnesses, to the inculpation of the innocent:—unfortunately for
 society, it would only add another  loop-hole to  the many which, through, the
necessary forms of law, now exist, for the escape of the  guilty.
   Results of compression.—It is proper to observe, that the results  obtained by
submitting the lungs to compression in cases of respiration and artificial inflation, 
 310          IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST.

 have been  very different in the hands of experimentalists equally competent.
 Some have been  able to force out the  air in both instances,—others in neither
 case.  These discrepancies may depend either  upon  the different degrees of
 pressure employed, or  upon the actual degree of distention of the lungs.  The
 fact of their existence shows, at least, that the lung-tests cannot be safely trusted
 in  the hands of persons who have  not been used to such investigations.  It
 appears  to me that there has been a great deal of misplaced  discussion on this
 subject.   One case should at least be adduced, where a woman charged  with
 child-murder has been or can be hypothetically exposed to any risk of conviction
 from the admission that air cannot  by compression be forced  out of artificially
 inflated,  or that it can be expelled from respired lungs. • I am not aware that
 there is  a single instance in our law records, of such an objection being raised
 upon any but merely hypothetical grounds, in opposition to all  the circumstances
 of the case.   It might be imagined, however, from the discussions among medical
 jurists, as to the necessity  for certain and  infallible  means  of  distinguishing
 artificial inflation from  respiration,—that every woman  tried for child-murder
 had made the praiseworthy attempt to restore  a still-born child, although cir-
 cumstances may show that she had cut its throat, severed its head,  or strangled
 it, while circulation was going on!   (See case, Prov.  Med. Journal, April 23,
 1845.)   If compression be trusted to as a criterion, without a proper regard to
 other facts,  a practitioner not used to such cases may undoubtedly be easily led
 into error; but he may be equally deceived if he trust what has been proposed
 as a substitute for compression—i. e., a mere physical inspection of the lungs.
   Improper  objections to the hydrostatic test.   Summary.—In concluding these
 remarks  upon  the objections to the hydrostatic test, it may  be  observed that
 medical practitioners have differed much at different times in their ideas of what
 it was fitted to prove.   About fifty years ago, it would seem that this test was
 regarded by some as capable of furnishing evidence of murder!  Thus we find
 Dr. Hunter asking the question,  " How far may we conclude that the child was
 born alive, and probably murdered by  its mother, if the lungs swim in water?"
 Later authorities,  and, indeed, many  in the  present  day, assert that the  test is
 capable of proving whether a child has been born alive or not!  From what has
 already been stated, as well  as from  the most simple  reflection on the circum-
 stances accompanying the birth of children, I think it must be evident that the
 hydrostatic test is no more capable of showing that a child has been born alive
 or dead,  than it is of proving whether it has been murdered, or died from natural
 causes.   The majority of those who have made experiments on this subject  have
 only pretended to  show, by the use of this and other tests, whether or not a child
 has breathed:—they merely serve to furnish  in  many cases good proof of life
 from  the state of the lungs, and slight reflection will render it apparent that in
 no case are they susceptible of doing more.   Even  here, the utility is much re-
 stricted by numerous counteracting circumstances,  a knowledge of  which is es-
 sential to him who wishes to make a practical application of the facts connected
 with  them.   (See Ed. Med. and Surg. Jour.  xxvi. 365.)  If asked  to state  in
 what  cases the pulmonary tests are capable of assisting a medical  jurist, the an-
 swer, it appears to  me, would be:—1st. They will clearly show  that the  new-
 born child has  lived, when, during its  life, it has fully and perfectly resqnred.
 Cases of  this description form a certain number of those which come before our
 courts of law.  To them, the most serious objections are not applicable; and the
few which might be made to the medical  inferences are not difficult to answer.
2dly.  They will allow a witness to say, that the lungs must have either received
air by respiration, or by artificial inflation.  These are the cases in which a child
has died soon  after birth, and where the  respiratory changes  are but very im-
perfectly manifested in the lungs.   They probably form the  large  majority of
those  that fall under the jurisdiction of the criminal law.  It might be considered,
that the qualification in the inference here drawn would neutralize its force; but 
CASES IN WHICH THE TEST IS AVAILABLE.              311
 it  must be  remembered, that there are few instances of actual  and deliberate
 child-murder, wherein artificial inflation could beeome even a possible defence for
 an accused party.   So unusual is this kind of defence, that among the numerous
 trials for infanticide which have  taken place in  this country for many years past,
 I have not  been able to meet with a single instance in which it was alleged, as
 an objection to the evidence derived from the  buoyancy of the lungs, that  the
 prisoner had inflated  them in order to  resuscitate her child.  The reason is  ob-
 vious: had  such a defence been attempted, the whole of the circumstantial evi-
 dence would at once have set  it aside.   When, in  the  suspected  murder of an
 adult, a medical man swears that a fatal wound was such that the deceased might
 have inflicted it on himself, or that the  prisoner might have produced it, he is
 placing the jury in a very similar position to that in which he places them in a
 case of child-murder, when he says that the child  might have breathed, or  its
 lungs might have  been artificially inflated.   How would a jury decide in the two
 cases?  Assuredly, by connecting certain facts with which a medical witness has
 no  concern, but which may, in  their opinion, satisfactorily supply the place of
 what is defective in his evidence.   It is not for him to calculate the probabilities
 of respiration, or of artificial inflation; but it is for them to consider whether an
 accused party was or was not likely to  have resorted to an experiment  of this
 nature.   It  has been suggested that some person might inflate the lungs of a
 dead child,  in  order  to raise a charge  of murder  against  its  mother; but this
 suggestion presupposes a profound knowledge of the difficulties of medical juris-
 prudence; and, even  then, the question of murder does not happen to depend
 merely on the presence of air in  the lungs.   Such a case is very unlikely to pre-
 sent itself;  indeed, its occurrence is no  more probable than that in poisoning it
 should be considered a good defence, that some person might  have introduced
 the poison  into the stomach  after death.   The circumstances of the case will
 commonly furnish a sufficient answer to such hypothetical views.
   The hydrostatic test ought not, therefore, to be lightly condemned, or rejected
 upon a speculative objection, which, in nine-tenths of the cases of child-murder,
 could not possibly  exist.   Let it  be granted to the fullest extent, that a  conscien-
 tious medical jurist cannot always draw  a positive distinction between respiration
 and artificial inflation, still the  jury may be in a situation  to relieve him from
 the difficulty.   In short, it would be as reasonable to contend that all murderers
 should be acquitted because homicidal are  not always to be distinguished from
 suicidal wounds, as to argue that all cases of  infanticide should be abandoned
 because these two conditions are not to be known from each other by any certain
 medical signs.   If juries do frequently dismiss  such cases, it is, I apprehend, to
 be ascribed rather to their great unwillingness to become the means of adminis-
 tering severe laws, than  to their want  of power to balance and  decide on the
 probabilities laid before them.  If the pulmonary tests were wholly set aside, it
 is easy to conceive  what would be the consequences.  Thus, let us suppose that
 a new-born child is found, under suspicious circumstances, with its throat cut;
 we  are called upon to  say, that it is impossible for medical  evidence to establish
 whether the child  had lived or not, and therefore we are to decline  making  an
 inspection of its body.  But this would be the same as  declaring  that child-
 murder could never be proved against an accused party, and that new-born chil-
 dren might henceforth be destroyed with impunity!   It appears to me, that con-
 duct of this  kind, on the part of a medical witness, would be wholly  unwarrant-
able; for we may sometimes acquire, by an inspection, as  great a certainty  of
respiration having  been performed, and therefore of a child having lived, as  of
any other fact of a medico-legal  nature.  Cases of  poisoning often give rise  to
greater difficulties to a medical jurist; as where, for example, he attempts to found
his opinion of the cause of death on symptoms or post-mortem appearances.   But
we will put the question in this  light.  In the body of a healthy full-grown child,
which  has but recently died, we find the lungs filling the cavity of the chest,  of 
 312          RESPIRATION A SIGN OF LIFE, NOT OF LIVE BIRTH.

 a light-red colour, spongy, crepitant beneath the finger, weighing at least two
 ounces, and when divided into numerous pieces, each piece floating on water, even
 after violent compression.   Is it possible in such a case to doubt that respiration
 has been performed?  If there be no certainty here, it appears to me that medi-
 cal experience is but little fitted in any case to guide us in our inquiries.   It
 would be difficult to point out an instance in which an affirmative medical opinion
 would be more surely warranted by the data upon which it was founded.
   Respiration before birth.—It has been already stated that the pulmonary tests
 are only fitted to prove whether the child has or has not lived to respire.  Neither
 the hydrostatic nor any other test can positively show that  the child was entirely
 born alive  when the act of respiration was performed.  As this is a subject which
 generally gives rise to some discussion in cases of child-murder, I shall here make
 a few remarks on it:—1st,  Respiration  may be  performed while the child is in
 the uterus, after the rupture of  the  membranes; the mouth of the child being
 at the os uteri.  This is what is termed vagitus uterinus; its occurrence, although
 extremely  rare,  seems to me to rest upon undisputed  authority.  2dly, A child
 may breathe while its head is in the  vagina, either during a presentation of the
 head or the breach.   This has been  termed vagitus vaginalis.  It is not very
 common, but it must be set down as  a possible occurrence.  3dly, A child may
 breathe whilst its head is  protruding from the outlet: in this position, respiration
 may be as completely set up in a few moments by its crying, as we find it in some
 children that  have actually been born, and have survived their birth for several
 hours.  This is  the most  usual form of respiration before birth.  In the vagitus
 uterinus or vaginalis, the lungs receive but a very small quantity of air;  in res-
 piration after protrusion of the head, the lungs  may be sometimes found mode-
 rately well filled; although never, perhaps, possessing all the characteristic pro-
 perties of those  which have fully respired.   The well  known occurrence of res-
 piration under either of these three conditions strikingly displays the fallacy of
 making that process, as some have done, the certain criterion of uterine life.   A
 child may  breathe  in  the uterus or vagina, or with its head at the outlet, and
 die before its body is born: the discovery of its having respired would not, there-
 fore, be any sort of proof of its having enjoyed what has been termed "extra-
uterine life."  (For a well marked case of this kind, see Med. Gaz. xxxviii. 394,
 and another communicated to me by Dr. Crothers, of Coy, will be found in Guy's
 Hospital Reports, Oct. 1850, p. 231.)  The death of a child which has respired
in the uterus or vagina  from natural causes before its entire birth, is  a pos-
 sible occurrence; but its death from natural causes  before birth, after it has
breathed by the protrusion of its  head from the outlet,  is, I believe, a very un-
usual event.  All that we can say is—it  may take place; but its death, under
these circumstances, would be the  exception to a very general rule.  Oberkamp,
in four successive deliveries of the same female, observed that the children breathed
before delivery, but  died  before they were  born.   A  case of this  kind also oc-
 curred at Diemerbroek.   (See Meckel, Lehrbuch der G. M. p. 367; Beck's Med.
Jur. 277; also, Ed. Med.  and Surg. Jour.  xxvi. 374.)   The cases reported by
Beck, of which there are  three, lose much of their value from the fact that  the
 lungs were not examined.
  Respiration a sign of life, not of live birth.—The hydrostatic test is only ca-
pable of determining that respiration has taken place: it cannot show whether
that process was established during  birth, or afterwards.   The fact of a child
 having the power of breathing before it is  entirely born, does not therefore con-
stitute the  smallest objection to its employment; although,  upon this ground, we
find the use of it, in any  case, denounced by many eminent men of the medical
and legal professions.  Thus, Archbold says, "Very little confidence is placed in
this test as to the lungs floating, particularly if  the child were  dead any length
of time before the experiment was made."  (Criminal Pleading, 367.)  Matthews
speaksof the test as being "quite exploded."  (Digest, 251.)  And Jervis makes 
RESPIRATION A SIGN OF LIFE, NOT OF LIVE BIRTH.          313
 the same remark.  (On Coroners, 127.)  It is obvious that most members of the
 law who have treated this subject, have adopted, without sufficient examination,
 the statements of Dr. AVilliam Hunter.   This author observes: "A  child will
 commonly breathe as soon as  its mouth is born  or protruded from the mother;
 and, in that case, may lose its life before its body be born, especially when there
 happens to be a considerable interval between what we may call the birth of  the
 child's head and the protrusion of its body.  And if this may happen where  the
 best assistance is at hand, it is still more likely to happen when there is none—
 that is, where the woman is delivered by herself."  (On the Uncertainty of  the
 Signs of Murder in the case of Bastard Children, p.  33.)  Dr. Hunter here  ex-
 poses, in plain language, the fallacy of trusting to signs of  respiration alone, as
 evidence of a child having been born alive.  The truth of his remarks is, in  the
 present day, generally admitted; and if, among medico-legal writers, we find some
 still treating  of respiration as a certain proof of  live  birth, it is from their  not
 having sufficiently considered the probability of a child breathing, and dying  be-
 fore its body  is entirely extruded.   But we may ask, How does the admission of
 these  views  affect  a  case of deliberate child-murder?  A living and breathing
 child may be wilfully destroyed before its body is entirely born, as well as after-
 wards; and if the law of England does not contemplate the wilful destruction of
 a living and  breathing child, before  its  entire birth, as  a crime, this omission
 cannot be imputed as a fault to the medical  jurist; nor can it at all diminish the
 real value of  the hydrostatic  test as furnishing indisputable evidence  of life.
 Most persons  might consider  the  crime of murder sufficiently made out, when
 the medical evidence showed that the child had lived, and that it was living when
 criminally destroyed.   If, however, this do not constitute  infanticide in law, and
 evidence be further insisted on, to set forth where the child was  actually living
 when murdered—whether half protruding from the vagina,  or altogether exter-
 nal to the body of the mother;  then is the fact  of respiration before birth  an
 objection rather against the principles of the law, than against the tests used to
 determine  the presence of life.   In a case tried a few years since, in which a
 child had been found with a ligature firmly tied around its neck, the medical evi-
 dence showed, clearly, that it had breathed; and the whole of the appearances in
 its body were  such as to leave no medical doubt that it had died by strangulation.
 The judge, in charging the jury, said, "If they were of opinion that the prisoner
 had strangled her child before it was wholly born, she must be acquitted of  the
 murder!"  The prisoner was acquitted.   However we may regard the question
 of the utility  of pulmonary tests, wre cannot but look upon that law as but very
 imperfectly adapted to its purposes, which makes the proof of murder to rest, not
 upon the actual and wilful destruction of a living child, but upon the precise mo-
 ment which a murderer  may select for the  accomplishment  of the crime.  Im-
 punity is thus  held out to all offenders, who destroy living children in the act of
 birth;  but there is an additional evil,  accompanying  the  operation of this legal
 rule, which seriously affects the medical evidence given on these occasions.   It
 would seem, from cases to be presently related, that the  law will assume, until the
 contrary appear from  other  circumstances,  that  the  respiration of  a child, if
 proved by the best evidence, was  carried on before it was entirely born.   Let the
 witness, then,  in a case of alleged  infanticide, ever so  clearly establish the fact
 of respiration,  and  therefore of life, at the  time the violence was used, this evi-
 dence is not sufficient.  He is asked whether he will depose that the child had
 breathed after its body was entirely in the world.   Unless he can make this de-
 position—which,  for obvious reasons, he can rarely be in a  condition to  do—it
 will be presumed that, although the child had breathed, it came into the world
 dead.  In this  way, we perceive, a shield is  effectually thrown around those who
may have been really guilty of destroying their children immediately after birth.
Under  any moral consideration of  the circumstances,  I think it impossible  to
admit, that a woman who kills her child in the act of birth is less guilty of niur- 
314
BIRTH OF THE CHILD MUST BE COMPLETE.
der than she who chooses the moment of its entire expulsion to destroy it;—any
such distinction, carried to its full  extent, must virtually go to the  entire abro-
gation of the  law.   It is  quite necessary that medical witnesses should  know
what they are required to prove on  these occasions; and the following cases will,
perhaps, serve to place this matter  in a clear light.
   The killing of children which breathe during birth, not child-murder.—In the
case of Rex v. Poulton, good medical evidence was given to show that the child
was living when the violence Was offered to it.  Of three medical witnesses, who
were called, the first said, in  answer to questions  put to him: It frequently hap-
pens that the child is born  as far as the head  is  concerned, and breathes, but
death takes place before the whole delivery is complete.  My opinion in this case
is, that the child had breathed, but I cannot take upon myself to say, that it was
wholly born alive.   The second said that death might have occurred when the
child was partly born, if no  medical man was present to assist in the delivery,
The third witness said,—It is  impossible to state when the child respired; but
there is no doubt, from the condition of the lungs, when they were examined, that
the child had  breathed:  children may breathe during birth.  (Chitty, Med. Jur.
412.)  The evidence  here  given shows that the witnesses were intelligent men;
and that they had duly reflected upon what the hydrostatic test is really capable
of proving.   The judge held that  this medical  evidence was not sufficient:—
"Something more was required than to show that a child  had respired in the
progress of its birth;  it must  be proved that the whole body of the  child was
brought into  the world."   (See Matthew's Digest, Supp. 25; also, Archbold,
Crim.  Plead.  367.)  In the case of Rex v. Simpson, tried at Winchester, in
March, 1835, Baron  Gurney would not  allow  the case  to proceed  against a
prisoner,  so soon  as the  medical witness stated that the lungs of a child might
become distended by  the act of respiration during  birth.   In Rex v. Brain,  it
was held  that  the child must be wholly in the world in a  living state to be the
subject of murder; and in that of Rex v. Sellis (Norfolk Spring Circuit, 1837,)
Mr. Justice Coltman held,  that to justify a conviction for child-murder, the jury
must be satisfied that the entire body of the child was actually in the world in a
living state, when the violence was  offered to it.   But Mr. Baron Parke has pro-
nounced a more decided opinion on  this point, than any of the other judges.  In
relation to an important case of infanticide, tried at the Herts Lent Assizes, 1841,
(see Guy's Hospital Reports, April, 1842,) he thus charged the grand jury: " With
respect to all these  cases (of infanticide,) there is a degree of doubt  whether the
infant  has been born alive.  The law requires that this should be clearly proved,
and that the whole  body of the child should have come from the body of the pa-
rent.   If it should appear that death was caused during delivery, then you will
not find a true bill!"   On a more  recent occasion (Reg. v.  Christopher, Dorset
Lent Assizes,  1845,) Mr. Justice Erie drew a distinction between medical (phy-
siological) and legal life. The medical evidence clearly established that the child
had respired.  It was  found with its head nearly severed from the  body.  Mr.
Justice Erie told the  jury, that before they returned a verdict of Guilty, they
must be satisfied the child  was completely born, that it had an existence distinct
and independent from the mother, and  that it was murdered by her.   It was
possible  the child  might have  respired without  being completely born into the
world,  and although this might  medically be a live child, it was not one legally.
In law, the birth of the child must be complete.  The jury acquitted the prisoner.
(Prov. Med. Jour. April 23,  1845.)
  From these decisions it will be seen, that it is not sufficient for a  medical wit-
ness to declare, from the state of the lungs, that  the child was alive at or about
the time  of its birth: according to the present  view of our judges, it is indis-
pensably necassary  for him to prove that the child was born alive, or that it was
living after its body had entirely come into the world. 
             CONCLUSIONS ON THE USE OF THE HYDROSTATIC TEST.        315

    Conclusions.—The general conclusions respecting the employment of the hy-
 drostatic test,  to be drawn from the contents of this chapter, are—
    1. That the artificial inflation of the lungs of a child  born dead will  cause
 them to float in water.
    2. That while lying in the chest, the foetal lungs are not easily inflated, and
 that the difficulty of inflating them is great in proportion as the child  is imma-
 ture.
    3. That lungs artificially inflated in situ resemble those organs in which res-
 piration has been only imperfectly established.
    4. That in cases of inflation in situ, hitherto tried, the air  may be so far  ex-
 pelled from the divided portions of lung by firm compression, as to cause them
 to sink.
    5. That the same  result occurs with lungs in which  respiration has  been im-
 perfectly established.
    6. That when lungs have undergone perfect respiration the air cannot be  ex-
 pelled by compression of the divided parts, so as to cause them to sink.
    7. That the artificial inflation of foetal lungs causes  no  alteration of weight,
 and  as the weight increases in proportion to the degree of  respiration,  so  in
 healthy lungs, with great buoyancy, there should be great weight if the air have
 been derived from  respiration.
    8. That while respiration increases the absolute weight of the lungs, it dimi-
 nishes their specific weight by leading  to  the  distention of  the  pulmonary cells
 with air.
    9. That when the  lungs are very heavy, and contain but little air, it cannot
 with certainty be  inferred  that respiration  has  been  established.  The  facts,
 cseteris paribus, may be explained by supposing that the lungs have been  artifi-
 cially inflated.
    10. That we should  base our judgment of a child  having breathed,  upon
 great weight and great  buoyancy of the lungs combined,—that the one condi-
 tion without the other is open to the objection, that the air may not have been
 derived from respiration.
   11. That experiments on fcetal lungs, artificially inflated with air after removal
 from the chest, have no practical bearing on this  inquiry.
   12. That the floating of the lungs in water proves, caeteris paribus, that a child
 has breathed either at, during, or after birth;  it does not prove that the child was
 born alive, or that  it  has died a violent death.
   13. That the sinking of the lungs as a result  of the expulsion of air  from
 them by compression, does not  prove that  the child was born  dead.  It merely
 proves that the air  contained in them was derived either from  artificial inflation,
 or from the imperfect establishment of the respiratory process.
   14. That the hydrostatic test is not applicable to determine the fact of respira-
 tion or  non-respiration in all cases of  infanticide;  but  that with ordinary pre-
 cautions, it may be safely employed in  the majority of such cases.
   15. That a child may breathe before, during, or after birth, but the hydrostatic
 test will not enable us to say, in the greater number of  cases, at which of  these
 periods the act of respiration was performed.
   16. That respiration is a sign of life, and not necessarily  of live birth.
   17. That according to the present state of the law, the killing of a child which
 breathes during birth is not murder.
   18. Hence medical evidence is required to  show whether the child  breathed
 after it was entirely born; and whether  the act of violence which caused its death
 was applied to it while so breathing.
  These conclusions are here, for the sake of clearness,  expressed with brevity.
Some of them  may appear to require  qualification; but for the circumstances
which qualify them, the reader is referred to the contents of the chapter. 
316
EVIDENCE OF LIVE BIRTH FROM RESPIRATION.
                             CHAPTER XLII.

ON THE PROOFS OF A CHILD HAVING BEEN BORN ALIVE—EVIDENCE FROM  RESPIRATION
  --EVIDENCE  FROM MARKS OF  VIOLENCE--EVIDENCE FROM NATURAL CHANGES IN THE
  UMBILICAL VESSELS, THE FORAMEN OVALE, AND DUCTUS ARTERIOSUS—CLOSURE OF THE
  FORAMEN  AND DUCT  BEFORE BIRTH—EVIDENCE FROM THE DISCOVERY  OF FOOD IN
  THE ALIMENTARY CANAL—DETECTION OF LIVE  BIRTH  BY THE APPLICATION  OF CHEMI-
  CAL  TESTS  TO THE  CONTENTS OF  THE STOMACH--DEFECTIVE EVIDENCE--GENERAL
  CONCLUSIONS.

  The great question on a trial for child murder is,  whether the child has been
born alive, and in  order to answer this, it is necessary to consider what are the
proofs of live birth which are available to the medical witness.
  Evidence from respiration.—As a general rule there will be no  perceptible
difference in the state of  the lungs, whether the act of respiration be performed
by the child during parturition  or after it is born, provided its death speedily
follows its birth.   But should we find that this process had been perfectly estab-
lished, i. e.  that the lungs present all those conditions which have been described
as characteristic of full and perfect respiration, there is great reason  to presume,
that the process,  even if  it commenced during birth, must have continued after
the child was entirely born.   This presumption becomes still stronger,  when the
child is immature; for generally speaking, such  children must be born and con-
tinue to respire for many hours after birth, in order that their lungs should pre-
sent the characters of complete respiration.   The process is seldom so established
before birth as to give to  these organs the feeling of  crepitation under  pressure:
the existence of this character should, therefore, be sought for.   A witness who
relied upon  it as a conclusive proof of respiration after birth, might be asked by
counsel, whether it were not possible for some children to remain so long at the
outlet with the head protruding, as to render the lungs crepitant from frequent
respiration before entire  birth.   Admitting the bare possibility of this occur-
rence, he should endeavour to ascertain whether there were any probable causes
thus to protract delivery, while  the head of the child was in this position;  as
also what natural cause could have produced its death when its head was protruding,
and when respiration had been so freely performed as  to give crepitation to the lungs.
The presence of the usual scalp-tumour might throw some light upon the case.
If it did not prove live birth, it might indicate protracted delivery, and  show that
the child had been recently living.
  Evidence from marks of violence.—If  marks  of violence apparently inflicted
about the same time  be found on different  and  remote parts of the body, and
these marks bear the characters of  those produced  during life, it is rendered pro-
bable that the whole of the body of the child was  in the world, when they were
caused.  Marks of severe violence on one part, as the head or breech, would not
always justify such a presumption, because it might  be fairly objected that they
had been unintentionally produced by the woman in her attempts at self-delivery,
and yet the  child not have been born alive.   It  would be for a witness to form
an opinion from the circumstances accompanying the particular case, whether they
had been thus occasioned.   From this it will be seen that in making a post-mortem
examination, it is  proper that every mark of injury on the body of a child should
be noted down. In March, 1848,1 was consulted by Mr. Prince, a former pupil,
in reference to a  very interesting case in which the presumption of  live birth
rested mainly on the degree of respiration, and the position and nature of certain
marks of violence found on the child's body.   The child, which  was said to have
been born dead, was exhumed two days after burial, and eleven days after birth, 
INFANTICIDE.  EVIDENCE OF LIVE BIRTH.              317
and the body examined by Mr. Prince.  It was full  grown, and not putrefied;
the skin pale, and free from  lividity.   There was a clean cut on the right arm,
dividing the fascia and  muscles, as if made by a sharp instrument.   The edges
were much retracted, and the whole of the wound was  of a florid red colour; but
there was  no swelling or other marks of inflammation.  There was a large vesicle
(like the vesication of a burn) on the scrotum, containing three drachms of yellow-
coloured serum.   On the right leg the muscles and fascia were exposed for nearly
the whole length; the  surface  of the wound was  of a deep scarlet colour, and
the margin widely inflamed.  It had the  appearance as if fire had been applied
to the  leg, although there was no sign of charring.   These facts tended to show
that the child was living when the injuries were inflicted, and their nature and
situation rendered it impossible that they could have arisen from any accident
during delivery.  The state  of the lungs was somewhat remarkable,—the left
floated freely in water, and there was distinct crepitation in it; the right sank in
water,—no portion of it when divided was observed  to float.   From the very
buoyant and crepitant state of  the left lung, there was reason to presume that if
respiration had commenced during birth, it had continued afterwards.  Mr. Prince
therefore inferred that the child had been born alive:—this inference was corro-
borated by the appearance of the marks of violence.  It is probable that the child
did not live long after birth.   The air could not have  been derived  from  putre-
faction or artificial inflation; therefore  the  only question here was, whether the
child had breathed after its body was wholly in the world.  The facts above
mentioned justified the inference drawn by Mr. Prince.  From a confession subse-
quently made by the female, it appeared that the child had been born alive, and
had cried, but owing to the injuries inflicted on it, it did not survive birth longer
than a quarter of an hour.
   Although  it is a rare  circumstance that one lung  should become thus fully
distended with air, while the  other receives none, cases  of this kind are on record.
Chaussier met with the left lung much more distended than the right in the
bodies of children which had survived birth some hours.   (Capuron, Med. Leg.
des Accouchemens, 411.)  The general opinion is, that the  right lung receives
air more readily than the left, owing to the size and direction of the right bron-
chus.
   Evidence from certain changes in the body.—In a child which has been born
alive, or which has survived  its birth, that portion of the umbilical cord which is
contiguous to the abdomen undergoes certain changes:—thus it becomes slowly
corrugated, and  separates with or without cicatrization.   The umbilical vessels
become at the same time gradually closed.   According to Billard, the oblitera-
tion of these vessels is  effected  in a peculiar way.   The caliber diminishes as a
result of the concentric enlargement of the coats, so that while the vessel retains
its apparent  size, its cavity  becomes  gradually blocked  up.   A quill would re-
present the form of the vessel in the  foetal  state, and  a tobacco-pipe in the ob-
literated state.   It is only by cutting through the vessel that the degree  of ob-
literation  can be determined.
   The state of the umbilical cord has often furnished good evidence of live birth,
when the  other  circumstances  of the  case were inadequate to furnish decisive
proof.  In the following case, for the particulars of which I am  indebted to Mr.
French, it might have  been  suspected, but for the state of the cord, that the
child had  been still-born, and that its lungs had been  artificially inflated.   The
body of the child had been exhumed  soon after burial, in consequence of  some
suspicion respecting the cause of death.   It weighed nearly five pounds, and was
eighteen inches long; the opening for the navel was exactly in the centre of the
body.  The hair on the scalp was about an  inch  in length, and plentiful; the
nails reached to  the extremities of the fingers and toes.   There was no mark of
violence about it.  The navel-string had separated  by the natural process, but
the skin around was not quite  healed.  The tendon of the tibialis  anticus was 
318         EVIDENCE FROM THE STATE OF THE FCETAL VESSELS.

prominent, and apparently contracted at the instep.   The left testicle alone had
descended into the scrotum,—the right was still in  the inguinal canal.   This
rendered it probable that the child had not quite reached maturity.   It was by
this peculiarity of the instep that the child was identified.  In the first instance
a different child had been brought from the same  burial-ground, but rejected,
from  the absence of this appearance of the  foot.   On  opening the chest, the
lungs were observed to be situated posteriorly, and not filling the cavity.  They
weighed together 861  grains—the right weighing 430, and the  left 431 grains.
The  heart, thymus,  and lungs, were placed together in water, but they imme-
diately sank to the bottom.   The lungs, when separated  from the other organs,
floated, but with a very slight degree of buoyancy.   Indeed, this was established
by the fact that they sank  with the  heart and thymus attached.   The  lungs
were cut into twenty-two pieces—three from the apex sank; the remaining nine-
teen pieces floated, nor were they made to  sink on pressure.   The foramen ovale
was but slightly open  and contracted, as well as the  ductus arteriosus, to about
one-half of the fcetal  diameter.   The  bladder was perfectly empty,—the intes-
tines contained  only mucus.  The conclusions at  the inquest were:—1. That
the child had been born alive, and had lived certainly not less than  three days,
and probably longer.—2. That  respiration during that  time had been but im-
perfectly established.—3. That in all  probability it had died a natural death.
The conclusions were well warranted by the medical facts.  Experiments on the
lungs were here not absolutely necessary, owing to  the state of the umbilical
cord.   It might have  been objected to any inference from the condition of these
organs, that the facts were explicable  on  the supposition of their having been
artificially inflated.  This case,  therefore, furnishes  another proof of the ease
with which a speculative objection, on  this  ground, may be set aside.   It was
subsequently proved that the child had lived eight days after birth.
   These changes in  the umbilical cord, when found, clearly prove  that a child
has survived its birth, whatever may be the results of experiments on the lungs;
but the difficulty is,  that they require  some days for their development, and in
practice it is often necessary to procure  some sign of survivance  for only a
few minutes, or  at farthest of &few hours.  The same remark applies to the ex-
foliation of the cuticle in a new-born child: such a condition of the skin can very
rarely be found  in cases of infanticide.   The  absence of  meconium from the in-
testines, and of  urine from  the bladder, are  not proofs of live  birth, for these
may be discharged during birth, and yet the child not be born alive.
   Evidence from changes in the heart and fcetal vessels.  Docimasia circulationis,
—It has been supposed that the state of the foramen ovale, ductus arteriosus, and
canalis venosus,  would aid a  medical jurist in forming an  opinion whether a child
had survived its birth.   In general, as a result of the  establishment of respira-
tion, it is found that the communication between the auricles of the heart by the
foramen ovale becomes closed; and that the two vessels, after gradually contract-
ing, become obliterated or are converted into fibrous cords.  Whatever may be
the results of experiments on the lungs, it  has therefore been contended, that the
closure of the foramen and vessels would  infallibly indicate  that the child had
breathed.  This  inference, however, has  been too hastily  drawn.   Recent re-
searches have shown, that there are some most serious objections to any conclusions
based on the state of the foetal vessels.  The entire  closure of these parts, as a
natural process,  always takes place slowly,  and sometimes it is not complete even
many years after birth.  Thus, then, in the generality of cases of infanticide, in
which necessarily the  child survives but for a very short period, no  evidence of
the fact will be procurable by an examination of the heart and fcetal vessels.
   Ductus arteriosus.—Prof.  Bernt, of Vienna, who has made many observations
on this subject, has come to  the  following  conclusions respecting the period re-
quired for the closure  of the  ductus arteriosus in children which  have lived after
birth:—1. If the child has lived only a few seconds, the aortal  end of  the duct 
           EVIDENCE FROM THE CLOSURE OF THE ARTERIAL DUCT.        319

appears contracted, and the vessel, instead of being cylindrical throughout, ac-
quires the form of a truncated cone.—2. If the child has lived for several hours,
or a whole day, the duct becomes again cylindrical, although shortened and  con-
tracted in diameter.  Its size is about equal  to a goose's quill: it is, therefore,
much smaller than its root, and about as  large as either of the two branches of
the pulmonary artery, which have, in the mean time, become increased in size.
—3. If the child has lived for several days or a whole week, the duct contracts
to the diameter of a few lines,—about equal to a crow-quill, while the two branches
of the pulmonary artery are equal in  size to a goose's quill.—4.  The duct is met
with perfectly closed, and quite impervious, at a  much later period; i. e. after
the lapse of a very uncertain number of weeks or even months.  Among the ex-
ceptional conditions, Bernt remarks, that the contraction may be  first observed
at the cardiac instead of the  aortal end.  In one instance of a still-born child,
which was  resuscitated  and breathed feebly for a short  time, and  in which the
thymus gland was absent, the  duct was found of the size of a crow-quill, as in
children which  have lived several days.   He also  states, on  the  authority of
Joseph Schallgruber, that the duct is sometimes entirely absent.  (Das verfahren
bey der gerichtlich-medicinischen Ausmittelung  Zweifelhafter Todesarten  der
Neugebornen, von  Joseph  Bernt, S.  67,  Wien,  1826;  also, Systematisches
Handbuch  der gerichtlichen Arzneikunde, S. 275, Vierte Auflage, Wien, 1834.)
—I have here given the conclusions of Professor Bernt, in  order to show  that
the natural closure  of the duct is a  very slow process; but  the conclusions are
open to many more exceptions  than  those admitted by the writer.  Neither in
his works, nor in those of other authorities on medical jurisprudence, is any case
recorded which shows that the duct can become quite impervious from  natural
causes in a child which has  lived only a few hours.
   Although the closure may take place as a result of the establishment of respi-
ration, it is obvious that the time of its occurrence after  birth is so uncertain as
to render any evidence derived from the non-closure altogether fallacious.  I have
examined the bodies of several children which have survived birth  for some
hours, and have not been able  to discover any perceptible  alteration in the dia-
meter of the duct either at its aortal or cardiac end.   In other cases partial  con-
traction has been apparent.   As the closure depends on  a diversion of blood
through the lungs,  so it follows, that when respiration is feeble or imperfect, the
duct will be found either of its natural potency,  or, if closed, the closure must
be regarded as an abnormal deviation.   In the case of a child which died at the
age of ten weeks, the ductus arteriosus was found to be freely open.   (Med. Gaz.
xl. 994.)   The  researches of Dr. Norman Chevers  have shown that there are
numerous abnormal conditions which may give rise to non-occlusion of the duct.
 (Med. Gaz. xxxv.  187, and xxxviii. 961: see also, Orfila, Med. Leg. 1848, ii.
212.)   From the numerous facts collected by Dr.  Chevers, it would appear  that
the duct is liable to become  contracted and  even obliterated, before birth, and
before the child has breathed.  In these cases there has been, in  general, some
abnormal condition of the heart or its vessels; but  this, even if it exist, might
be overlooked in a hasty examination:  hence the contracted or closed condition
of the duct cannot be taken as an absolute proof that the child has been born
alive or survived its birth.  In  January, 1847, Dr. Chevers presented to  the
London Pathological Society the case of a child  born between the  seventh and
eighth month, in which this vessel was almost closed, being scarcely one-twelfth
of an inch in diameter,  and capable of admitting only the shank of a large pin.
The tissues of the duct had altogether an appearance  of  having undergone a
gradual process of contraction,  and its  state proved that its  closure commenced
previously  to birth.  In fact,  the child survived only fifteen  minutes; while,
according to Bernt's rule, the medical  inference might have  been that the child
had lived a week.  It  is important to remark, that in this  case the heart and
lungs were normal.  (Med. Gaz. xxxix. 205.) 
320          INFANTICIDE.  CLOSURE OF THE ARTERIAL DUCT.

  The value of these facts, in a medico-legal view, will be apparent from a case
recently tried in Scotland, in which the proof of live birth rested chiefly upon a
closed condition of the arterial duct.   (Reg.  v. Frith, Ayr Circ. Court of Justi-
ciary, Oct. 1846.)  The body of a child was found concealed in a bag, and buried
just below the surface of the ground.   The prisoner, who it was proved had been
delivered of a child about three weeks before, was charged with the murder.   The
circumstances against her were  chiefly  of a presumptive kind, and the  most
material medical question was, whether the  deceased  child had  come into the
world alive.  AVhen found, the body was slightly putrefied.   The following is a
detailed account of the  appearances, from the report of the  examiners:—"On
inspecting the body externally, we found it in a state of  putrefaction, with des-
quamation of the cuticle.  It weighed five  pounds, and was twenty inches in
length.  Its mouth  and nostrils were stuffed with flax.   The umbilicus was in
the centre of the body,  the cord cut close to the abdomen, and  left without a
ligature.  The scalp was covered  with  hair, and the nails were full grown.
There was an extensive ecchymosis all over  the fore  part of the  neck, and an
effusion of blood on the exterior  aspect of the  trachea.  The heart and lungs
weighed one ounce:  the latter organs were collapsed.   The right lung was con-
siderably decomposed, and sank when put in water:  the left was of a red colour,
firm in texture, and  floated on the surface when immersed in  a vessel filled with
water; but  on pressure  there was no crepitation.  The right side of the  heart
was filled with coagulated blood, the  foramen ovale  being partly open, and the
ductus arteriosus impervious.  The liver was large, and  of  a leaden hue, the
ductus venosus almost obliterated,'and the meconium found in abundance in the
lower bowels.  The reporters were of opinion, from the perfect conformation of
the child's body, and the  above  mentioned appearances, that it had life at birth.
The appearances  met with they considered quite sufficient to account for death."
   The circumstantial evidence  established that not more than five hours could
have elapsed from the birth of the child to the time at which its body was buried
in the spot where it was subsequently found; and that, admitting it to have been
born alive, there was the  strongest reason to believe that it did  not survive its
birth ten minutes.  The results of experiments on the lungs were insufficient to
show that the child had been born alive.   The organs were light,  and not crepi-
tant; the right lung was  decomposed, and yet it sank in water, while the left
was firm,  and floated.  The principal medical fact, then,  in favour of live birth,
was that the arterial duct was  impervious;  and it became a question, on the
examination of the medical witnesses, whether this vessel could have been  natu-
rally closed within so short a period after birth, as that which was proved in this
instance.   Two  of them  stated  that, in  their opinion, the child  had been born
alive, but they had known of no instance in which the arterial duct had become
so speedily closed after  birth.   In the defence, one medical witness deposed that,
from an impervious duct, he should infer a  survivance of at least twenty-four
hours, and the other  of four or five days.   The prisoner was acquitted, on a ver-
dict of Not proven.   (Med.  Gaz. xxxviii. 897; and  Ed. Monthly Jour.  Nov.
1846, 385.)
   So far as I am aware,  there is no  instance on record of the arterial duct be-
coming impervious within the period of five  or six hours after birth, as a result
of free and perfect respiration in a healthy child; and therefore it is in the highest
degree probable,  that its impervious state, in this instance, was not the result of
a natural process, but of some abnormal condition existing previously to birth,—
a conclusion warranted  by a case reported by Dr. Chevers.  The  facts that res-
piration had been most  imperfectly performed, and that the child  had been pro-
bably destroyed within  a  few minutes after its birth, are also strongly adverse to
the view taken by some of the witnesses at the trial,  that the occlusion  of the
duct was the result of the usual changes.   Hence its  condition could not safely
be regarded as furnishing clear evidence of live birth.   The only fact bearing on 
                THE CANALIS VENOSUS AND FORAMEN OVALE.            321

this, was the deposition of one witness, that he  slept in the  next room  to  the
prisoner, and heard what he thought was the cry of a child at the supposed period
of her delivery.
  Admitting that this abnormal  state of the duct, i. e. its closure previous to
birth is in general accompanied by malformation of the heart, or great vessels
connected with  it, yet a case already  related proves that this is by  no means
a necessary accompaniment.  Hence considering the very serious responsibility
attached to  a medical opinion in  a  case  of child-murder, the better rule  will
be to place no  confidence on a  contracted  condition of this duct as evidence
of live birth.   It can only have any importance as evidence, when the death of
the child speedily follows its birth; and these are precisely  the cases in which a
serious fallacy is likely to arise, for the contraction or closure may be really con-
genital, and yet pronounced normal.   If a child has  lived for a period of two or
three days (the time at which the duct naturally becomes contracted or closed,)
then evidence of live birth from its condition may not be required: the fact of
survivance may be sufficiently apparent from other circumstances.  Hence  this
species of evidence is liable to prove fallacious in the only instance in which  it is
required.
   Caned is venosus.—There is not, so far as I know, any instance of the obliteration
of this vessel previous to birth.   When respiration is fully established, it  col-
lapses, and becomes slowly converted, in a very variable period of time, to a liga-
mentous cord or band which is quite impervious.  There is no  doubt that in those
cases where it is stated to have become obliterated in children which could have
Burvived birth only a few minutes or hours, the  collapse of  the coats has been
mistaken for an obliteration of the canal.  It is  probably not  until the second or
third day after birth that its closure begins, although nothing certain is known
as to the period at which it is complete.  The condition of this vessel, therefore,
can  throw no light upon those cases of live birth in which evidence of the fact is
most urgently demanded.
   Foramen ovale.—This aperture in general becomes closed  after the establish-
ment of respiration; but I have found  it repeatedly open in children which  had
survived birth several hours; and, as it will  be  hereafter stated, the period of its
closure is as variable as in the case of the ductus arteriosus.  Hence  it is  not
capable of supplying, with certainty, evidence of live birth, in those instances in
which  this  evidence is required.   According  to Billard, the foramen becomes
closed between the second and third days; but there are numerous  cases in which
it is found not closed at much later  periods after birth.  Dr. Handyside states
that it is more or less open in one case  out of eight.   In 1838, two subjects were
examined at Guy's Hospital, one  aged fifty, the other eleven years, and in both
the foramen was found open.  There is, however, another serious fallacy, which
has  been  only recently brought to light: the closure of the foramen  ovale has
been known to  occur as an abnormal condition previously to birth  and the  per-
formance of respiration.   One case is mentioned by Capuron (Med. Leg. des  Ac-
eouchemens, p. 337,) and another, of a very instructive kind, is reported in the
Medical  Gazette (vol.  xxxviii.  1076.)   Other instances of this abnormal con-
dition  are  adverted to by Dr. Chevers (Med.  Gaz. xxxviii. 967,) and it would
:'.ppear, that in these the arterial duct remained open, in order to allow of the
circulation of blood not only before, but subsequently to respiration.   The child-
ren  rarely survive birth  longer than from twenty to  thirty hours.   Dr. Chevers
justly observes, that "cases of this  description  are of the highest importance in
a medico-legal point of view, as  they fully disprove the opinion  maintained by
many anatomists, that obliteration of  the foramen ovale must be received  as  a
certain evidence that respiration has been established.  It is assuredly impossible
to deny that in the heart of  a child  which has  died within the uterus, and has
been expelled in a putrid condition, the foramen ovale may be found completely
and  permanently closed.   In such cases as these, it would, however, probably be
       21 
322
EVIDENCE FROM FOOD IN TnE STOMACH.
always possible to determine, by an examination of the heart and its appendages,
that the closure of the foramen had occurred at some period or other antecedent
to birth."  It would, therefore, be unsafe in practice to rely upon the closure of
this aperture as proof of live birth, without other good evidence; and in no case
can its patency be regarded as a proof that a child has come into the world dead.
   As a general rule, these peculiar foetal vessels are rarely obliterated by a nor-
mal process  before  the  eighth or  tenth day after  birth.   The obliteration, ac-
cording to Bernt and Orfila, takes place in the following order:—1. The umbilical
arteries.—2.  The canalis venosus.—3. The ductus  arteriosus, and 4. The fora-
men ovale.   (Orfila, Med. Leg. 1848, ii. 210.)
   The result of this inquiry respecting Professor Bernt's docimasia circulationis
is essentially negative; it either proves nothing, or it may lead the medical wit-
ness into a fatal error.   It has been the more necessary to point out the serious
fallacies to which it  is  liable, because  hitherto medical jurists have been disposed
to  place great reliance  upon it, in cases where evidence  from the  state of  the
lungs was wanting.   The necessity of these facts being known is shown by the
case which occurred at  Ayr (ante, p. 320,).in which great reliance  appears to
have been placed upon  the following statement by Dr. Beck:—"If, therefore,
the ductus arteriosus be found cylindrical in its shape, and not contracted towards
the aorta, and if it equal in size the trunk of the pulmonary artery, the inference
would be, that the child was not born alive.  On the other hand, if the ductus
arteriosus be contracted  towards the aortal end, and if its size be much less than
the trunk of the pulmonary artery, the inference would be, that the child had
been born alive."   (Beck's Med. Jur. 5th edit. p. 251.)  From a consideration
of the preceding facts, it will be seen that such inferences would be quite erro-
neous, and might seriously mislead a Court of Law.
   Evidence from the state  of the alimentary canal.—Good evidence of live birth
may be sometimes derived from the discovery of certain liquids or solids in  the
stomach and intestines, such as blood, milk, or farinaceous or saccharine articles
of food;  for it is not likely that these substances would be  introduced or swal-
lowed during parturition, nor is it at  all probable that they should find their way
into the stomach or intestines of a  child which was really born dead.   In  the
case of a new-born child, Dr. Geoghegan discovered, by the application of iodine
water, the  presence of farinaceous food in the stomach;  hence the question of
live birth was clearly settled in the affirmative.   In a still more recent case, Dr.
Francis,  of Manchester,  employed this mode of testing, with satisfactory results,
even where the investigation was beset  with many unusual difficulties.  He was
required by  the coroner to examine the body of a  new-born child found under
suspicious circumstances.  The examination of the lungs  left no doubt that res-
piration  had taken place; and the fact that the child had been born alive, was
fully established by the discovery in the stomach of a small quantity of farina-
ceous food.   On digesting a fragment of the pulp found  in this organ with dis-
tilled water,  and adding a  drop of  a weak solution  of iodine, an intense indigo-
blue colour appeared immediately.   The application of this  chemical test, there-
fore, removed any doubts which might  have been entertained on the question of
live birth.   (Med. Gaz.  xxxvii. p.  460.)
   Sugar.   In one case  which I had  lately to examine, the presence of sugar was
easily detected in the contents of the stomach by the application of Trommer's
test.   In order to apply this test, a few drops of a very weak solution of sulphate
of copper should be added to a portion of the concentrated aqueous extract of
the contents  of the stomach.  An excess of a solution of  caustic potash is then
added, and the liquid boiled.   If  sugar be present, the sub-oxide  of copper is
immediately  precipitated of a reddish-brown colour.   With white sugar the same
decomposition is effected, but more slowly.   If starch be present, black oxide of
copper may be thrown down, but there is no reduction.    The production of the
red oxide proves that some  saccharine substance is present. 
DEFECTIVE EVIDENCE.
323
   Mdk   This liquid, or its principle, casein, forms a rich violet-blue solution
 with a tew drops of a solution  of sulphate  of copper, and an excess of caustic
 potash.  Ine red sub-oxide will be thrown down  on boiling if sufficient laetine
 (sugar of milk) be present.   Casein, or the curd of milk, acts in the same way.
 The decomposition takes place more slowly and is less perfect than with sugar!
   Albumen forms a deep violet-blue solution with potash and sulphate of copper,
 but the red sub-oxide is not precipitated on boiling.  Either there is no effect
 or if the caustic potash be in large quantity, the black oxide falls down.  An in-
 stance is related by Dr. Doring, where a spoonful of coagulated blood was found
 in the stomach  of a new-born child.  The inner surface of the oesophagus and
 trachea was also covered with blood.  Dr. Doring inferred from these facts, that
 the child had been born alive;  for the blood, in his opinion, must have  entered
 the stomach by swallowing, after the birth of the  child, and while it was probably
 te  -c^l ?Ce m a P°o1 of blood-  (See on this subJect  Henke's Zeitschrift
 1842, n. 219.)                                                              '
   In forming a judgment in a doubtful case, a question may arise whether any
 and what kind of food naturally exists in the stomach of  a foetus born dead
 ihis curious subject has  been recently examined with great ability by Dr George
 Robinson, of Newcastle-upon-Tyne, and I am indebted to that gentleman for the
 subjoined conclusions.  His observations were made on  the stomachs  of  two
 human foetuses, and on those of the calf, lamb, and rabbit.    His conclusions are:
 —1.  lhat  the  stomach of the foetus, during the latter period of its uterine ex-
 istence, invariably contains a peculiar substance, differing from the liquor amnii
 and generally of a nutritious nature.  2. That in its physical and chemical pro-
 perties,  this substance varies very much in  different animals,  being in no two
 species precisely similar.   3. That in each foetal animal the contents of the sto-
 mach  vary much at different periods; in the  earlier stages  of its development
 consisting chiefly of liquor  amnii, to which the  other peculiar matters are gra-
 dually added.  4.  That  the liquor amnii  continues to be swallowed by the
 foetus  up to the time  of  birth; and consequently after the formation of those
 matters, and their appearance in the stomach.   5.  That the mixture of this more
 solid and nutritious substance with the liquor amnii, constitutes the material sub-
 mitted to the process of chymification in the foetal  intestines.  He considers the
 contents of the alimentary canal to be chiefly derived from the salivary secretion.
 It is his opinion that there is no gastric juice  secreted until respiration is esta-
 blished.  The medical jurist will perceive, therefore, that the discovery of fari-
 naceous food, milk, or sugar in the stomach, will furnish evidence of. live birth •
 since substances of this kind are never found  in the foetal stomach.
   Defective evidence.—The  slightest  consideration will  show that the signs of
 live birth above  described are weak, and of purely accidental  occurrence.  If the
 child  be destroyed during birth or within a  few  minutes afterwards, there will
 be no medical evidence to indicate the period at which its destruction took place.
 The external and internal appearances presented by the body would be the same
 in the  two cases.  It is most probable  that in the greater number of instances of
 child-murder, the child is actually destroyed during birth, or immediately after-
 wards;  and,  therefore, the characters above described can rarely  be  available in
 practice.  If any exception be made, it is with  respect to  the nature, situation
 and extent of marks of violence; but the presence  of these depends on mere ac-
 cident.   Hence, then, we come to the conclusion, that although medical evidence
 can often show, from the state of the lungs, that a child has really lived it can
 very rarely be in  a condition to prove in a case of infanticide that its life certainly
 continued after its birth.   AVe could only venture  upon this inference when the
 signs of respiration were  full and  complete,  or food was found in the stomach.
 AVhy the destruction  of a child should  be treated  in the one case as a venial
offence, and in the other as a capital crime, is one  of those anomalies in our cri-
minal jurisprudence for which it is  impossible to account.  The inference which 
o24             INFANTICIDE.  SURVIVANCE OF THE CHILD.

we may draw from these observations is, that if positive proof of entire live birth
be in all cases rigorously demanded of  medical witnesses on trials for child-mur-
der, it is scarcely possible, when the prisoner is ably defended,  that any convic-
tion for the crime can take place.  The only exception would  be, where  a con-
fession was made by the accused, or the murder was actually perpetrated  before
eye-witnesses.   The numerous acquittals that take place on trials for this crime,
in face of the strongest medical evidence, bear out the correctness of this opinion.
The child is proved to have lived and breathed, but the  medical evidence fails to
show that  the living and breathing took place or continued after entire delivery.
[For some judicious remarks on this defective state of the law,  see Prov. Journ.,
April 2, 1851, p. 182.]
   Conclusions.—The general conclusions which  may be drawn from the facts
contained in this chapter,  on the question whether a child has or  has not been
born alive, are as follow:—
   1. That  if the lungs be fully and  perfectly distended with air by the act of
respiration, this affords a strong presumption that  the child has been born alive,
since respiration during birth is in general only partial and imperfect.
   2. That  the presence of  marks of severe violence on various parts of the body,
if possessing vital characters, renders it probable that the child  was entirely born
alive when the violence was inflicted.
   3.  That certain changes in the umbilical vessels, and the separation by a vital
process and cicatrization of the umbilical cord, as well as a  general exfoliation or
desquamation of the cuticle, indicate live birth.
   4.  That the  absence  of  meconium from the intestines, and of urine from  the
bladder, are  not proofs that a  child has been entirely  born alive, since these
liquids may be discharged  during the act of birth.
   5. That the open or contracted state of the  foramen ovale or ductus arteriosus,
furnishes no evidence of a child having  been born alive.  These  parts may  be-
come closed and contracted before birth, and therefore in a child born dead;  or
they may remain open after birth in a child born living, even after the establish-
ment of respiration.
   6. That  the presence  of farinaceous or other^food in the stomach proves that a
child has been  entirely born  alive.
   7. That  irrespective of the above conclusions, there is no certain medical sign
which indicates that a child, which may have died at or about the time of birth,
has been entirely born alive.
                            CHAPTER XLIII.

RULES FOR DETERMINING THE PERIOD OF SURVIVANCE IN CHILDREN THAT HAVE BEEN BORN
  ALIVE.  APPEARANCES INDICATIVE OF A CHILD HAVING LIVED TWENTY-FOUR HOURS—FROM
  TWO TO THREE DATS—FROM THREE TO FOUR DAYS—FROM FOUR TO  SIX DAYS—FROM SIX
  TO TWELVE DAYS.  UNCERTAINTY OF MEDICAL EVIDENCE.  ON THE PERIOD WHICH HAS
  ELAPSED SINCE THE DEATH OF THE CHILD.  PROCESS  OF PUTREFACTION IN THE BODIES OF
  NEW-BORN CHILDREN.  GENERAL CONCLUSIONS.


  If we suppose it to have been clearly established, that the child not only lived
but was actually born alive, it  may be a question whether it lived  for a certain
number of hours or days after it was born.  The answer to  this question may be
necessary in order to connect the deceased child with the supposed mother.  It
has been remarked that scarcely any appreciable changes take place  in the body
of a living child, until after the lapse  of  twenty-four hours; and  these changes 
                PUTREFACTION IN THE NEW-BORN CHILD.               325

may be considerably affected by its degree of maturity, healthiness, and vigour.
The following may be taken as a summary of the appearance of a child which
has survived its birth for different  periods:—
  1. After twenty-four hours.—The skin is firm and pale,  or less red than soon
after birth.   The  umbilical  cord  becomes somewhat shrivelled, although it re-
mains soft and bluish-coloured, from the point where it is secured by a ligature,
to its insertion in the skin of the  abdomen.  The meconium is discharged;  but
a green-coloured mucus is found  on the surface  of the large intestines.  The
lungs may be more or less distended with air, although in a case of survivorship
for  a period longer than this, no trace of air was found in  them.  "With regard
to the state of the lungs, it  should be remembered, that when these organs  are
fully and  perfectly distended, the  inference is that  the child has probably sur-
vived many  hours;  but the converse of  this proposition is not always true.
Several cases, already reported, show that where the lungs contain a  very small
quantity of  air, it does not  follow that  the child must have died immediately
after it  was born.
  2. From the second to the third  day.—The skin has a yellowish tinge,—the
cuticle sometimes  appears cracked, a change which precedes exfoliation or des-
quamation.   (Devergie, i. 519.)   The umbilical cord  becomes brown  and  dry
between the ligature and the abdomen.
  3. From the third to the fourth  day.—The skin  is more yellow, and there is
evident exfoliation of the cuticle on the chest and abdomen.   The umbilical cord
is of a  brownish-red colour, flattened, semi-transparent, and twisted.   The skin
in contact with the dried portion presents a ring of vascularity or redness;—but
Dr. Geoghegan met with this appearance in two cases of still-born children,  and
I have  also seen it in four cases where the children were  born dead.  (G.  H.
Rep. April,  1S42.)  The colon is  free from any traces of green mucosity.
  4. From the fourth to the sixth day.—The cuticle in various parts of the body
is found separating in the form of  minute scales or of a fine powder.   The um-
bilical cord separates from the abdomen  usually about the  fifth day, but some-
times not  until the eighth or the  tenth.   The membranous coverings become
first detached, then the arteries, and afterwards the vein.  If the umbilical aper-
ture is cicatrized and healed, it is probable that  the child  has lived from three
weeks to a month  after birth.  The ductus arteriosus  may be found  contracted
both in length and diameter: the foramen ovale may be also partly closed.
  5. From the sixth to the twelfth  day.—The cuticle will be found desquamating
on  the  extremities.   If the umbilical  cord was small, cicatrization  will have
taken place before the tenth day after birth.  If large, a sero-purulent discharge
will sometimes continue for  twenty-five or thirty days.   The ductus arteriosus is
said to become entirely closed during this period;  but this statement is open to
exceptions which have been elsewhere pointed out.   It need hardly be observed
that the body rapidly increases in  weight when the child has enjoyed active ex-
istence.
  On the  whole, it will be seen that the signs of survivorship  for short periods
after birth are not very distinct.  There is commonly no difficulty in determining
the fact after the second day.  The changes stated to take place in the umbilical
cord durin"- the first twenty-four hours, may be observed in the dead as well as
in the livino-  child; and the other changes occur with much  uncertainty as  to the
period.  These are, however, I believe, the principal facts upon which a medical
opinion on such a  subject  can be  based, and it  is in  some  respects fortunate,
that great precision  in  assigning  the time of survivorship is not demanded of
medical witnesses.
  Putrefaction in  the new-born child.—A practitioner may be  further  required
to state 'how long a period has elapsed since the death of the child.  The answer
to the previous question was derived from the  changes which take place  in the
body of a child during life, while, in relation to  the present inquiry,  we must 
326              CAUSES OF DEATH IN NEW-BORN CHILDREN.

look to those which occur in the body after  death ;—in other words, to the dif-
ferent stages of putrefaction.  From the observations of Orfila, it would appear
that the body of an infant putrefies more rapidly than that of an adult.  (Traite
des Exhumations.)  In forming a judgment on this point,  due allowance must
be made for  the  influence of temperature, humidity, and the free access of air.
If the body has been sunk in water, putrefaction takes place more slowly than
usual, and the process  is slower in running  than in stagnant water.  When the
body is floating on the surface of water, so as to be at the same time exposed to
air, then putrefaction  takes place very rapidly;—and this  also happens when
the body,  after removal from water, has been exposed to the air for some time.
Putrefaction is also retarded when  the  deceased  child has  been  buried  in the
ground in a box or coffin, unless the process had already commenced prior to in-
terment.   AVhen the body has been cut up  and mangled before being thus dis-
posed of, putrefaction takes place with  much greater  rapidity.   (The Queen v.
Railton, Stafford Winter Assizes, 1844.)

   Conclusions.—The general conclusions respecting survivorship are:—
   1. That the period  for which a new-born  child has survived birth cannot be
determined by any certain sign for the first  twenty-four hours.
   2. That after this period, an  inference may be drawn from certain changes
which take place progressively in the skin and umbilical cord externally, and in
the viscera  on  inspection;—that  these changes allow only of an approximate
opinion within the first five or six days.
   3. That the contraction of the foramen  ovale and ductus  arteriosus takes
place from natural changes at such uncertain intervals, as to  render it difficult
to assign a period  of survivorship from the state of these parts.
   4. That the period which has elapsed since the child died,  after it was born,
can only be determined by observing the degree of putrefaction  in the body com-
pared with temperature, locality,  and other  conditions to which it has been ex-
posed.
                            CHAPTER XLIV.

CAUSES OF DEATH IN NEW-BORN CHILDREN--PROPORTION OF CHILDREN BORN DEAD—NATU-
  RAL CAUSES OF DEATH--A PROTRACTED DELIVERY--DEBILITY--HEMORRHAGE—LACERA-
  TION OF THE CORD--COMPRESSION OF THE CORD--MALFORMATION--DESTRUCTION OF
  MONSTROUS BIRTHS ILLEGAL--DEATH FROM CONGENITAL DISEASE.  GENERAL CONCLU-
  SIONS.

   Causes of death in new-born children.—The next important question in a case
of infanticide, and that upon which the charge of murder essentially rests, is,—
what was the cause of death?  1. It is admitted that a child may die during
birth or afterwards.  2. In either of these cases it  may die from natural or vio-
lent causes.  The violent causes may have originated in accident or in criminal de-
sign.   The last case only involves the corpus delicti of child-murder.   If death
has clearly proceeded from  natural causes, it is of no importance to settle whether
the cause operated during or after birth:—all charge of criminality is thenceforth
at an end.
  Proportion of children born  dead.—It is well  known  that of  children which
are born  under  usual circumstances, a  great number die  from  natural causes
either during birth or  soon afterwards;  and in every case  of infanticide, death
will be presumed to have arisen from some cause of this kind, until the contrary
appear from the  evidence.  This throws the onus of proof entirely on the prose-
cution.   Many children die before performing the aet of respiration; and thus a 
PROTRACTED DELIVERY.  DEBILITY.
327
large number come  into the world still-born or dead.  The proportion of still-
born among legitimate children, as it is derived from statistical tables extending
over a series of years, and embracing not less than eight millions of births, varies
from one in eighteen to one in twenty of all births.  (B. and F. Med. Rev. No.
vii. 234.)   Dr. Lever found, out of three thousand births, that one in eighteen
was born dead.  In  immature and illegitimate children, the proportionate mor-
tality is much greater,—probably about one in eight or ten.  In Gottingen the
deaths were found to amount to one in seven, and in Berlin to one in ten.   (Ed.
Med. and  Sur. Jour, xxxvi. 172.)  Males are more frequently born dead than
females, in the ratio of 140 :100,—while the males to females born, has only a
ratio of 106 :100.   (Dr. Simpson, Ed. Med. and Sur. Jour., Oct., 1844, 395.)
The preponderance of still-births among males is  ascribed to the large size of the
head, and the  injury thus likely to be inflicted on the brain during  parturition.
Still-births are much more frequent  in first than in after  pregnancies.   These
facts  should be  borne in mind, when we are estimating  the  probability of the
cause of death being natural.  Should respiration be established by the protrusion
of the child's head from  the outlet, or the birth of its body,  the chances of death
from natural causes  are considerably  diminished.   Nevertheless,  as Dr. Hunter
long ago suggested, a child  may breathe and die.   Thus, according  to this au-
thor,—"If the child makes but one gasp and instantly dies, the lungs will swim
in water,,as readily as if it  had breathed longer and had then been strangled."
In  general, it would require more than one gasp to cause the  lungs to swim
readily in water; but waiving this point, the real question is,—if the child breathed
after birth, what could have caused  its death ?  The number of gasps which a
child may make, or which may be required for the lungs to swim in  water, is of
no  moment:—the point to consider is, whether its death was due  to causes of an
accidental or criminal nature.  So again observes Dr. Hunter: "AAre frequently
see children born, who from circumstances in their constitution or in the nature
of  the labour, are but barely alive, and after breathing a minute or two, or an
hour or two, die, in spite of all our attention.   And why may not this misfortune
happen to a woman who is brought to bed  by herself V   (Op. cit.)  The sub-
stance of this  remark is, that many children may die naturally after birth;  and
in  Dr. Hunter's time, these cases were not perhaps sufficiently attended to.   In
the present day, however,  the case is different:—a  charge of child-murder is
seldom raised except in those instances where there are the  most  obvious marks
of severe and mortal injuries on the body of a child; and unless it be intended
to defend  and justify the practice of infanticide, it must be  admitted that the
discovery of violence of  this kind on the body of a new-born infant, renders a
full inquiry into the circumstances necessary.  Among the natural causes of the
death of a child, may be enumerated the following:—
  1. A protracted delivery.—The death of a child may proceed, in this case, from
injury suffered by the head during the violent contractions of the uterus, or from
an interruption to the circulation in the umbilical cord before respiration is estab-
lished.  A child, especially if feeble and delicate, may die from exhaustion under
these circumstances.   This cause of death may be suspected, when  a sero-san-
guinolent tumour is found on the head of a child, and the head itself is deformed
or elongated:—internally by the congested  state of the cerebral vessels.   The
existence of deformity in the pelvis of the woman might corroborate this  view;
but in primiparous females (among whom  charges of child-murder chiefly lie,)
with well formed pelves, delivery is frequently protracted.   It is presumed that
there are no marks of violence on the body  of the child, excepting those which
may have arisen  accidentally in attempts at  self-delivery.
  2. Debility.—A child  may be born prematurely or at the full period, and not
survive its birth, owing to a natural feebleness of system.   This is especially ob-
served with immature children;  and it is the condition more especially dwelt on
by Dr. Hunter.   Such children may continue in  existence for  several  hours, 
328
HEMORRHAGE.   MALFORMATION.
feebly respiring, and then die from mere weakness.   These cases may lie recog-
nised by the appearance of a general want of development in the body.
  3. Hemorrhage.   Laceration of the cord.—A child may die from hemorrhage,
owing to a premature separation of the placenta or an accidental rupture of the
umbilical cord.  In  the  latter  case it is said  the loss of blood is not likely to
prove fatal, if respiration has been established; but an instance is reported where
a child died from hemorrhage even under these circumstances.   (Henke's Zeit-
schrift,  1839, Erg. H. 200; also 1840, i. 347, and ii. 105.  Ann. d'Hyg. 1831,
ii. 128.)  Hemorrhage  from the cord has in  some cases  taken place at various
periods  after  birth, and has led to the death of the  child.  (Ed. Month. Jour.
July, 1847, 70.)   Death from hemorrhage may be commonly recognised by the
blanched appearance of the body, and a want of blood in the internal organs, but
there are several cases on record where the cord has been  ruptured close to  the
abdomen, without causing the death  of the child.   It was formerly a  debated
question whether  in the event of the umbilical cord being left untied after cutting
or laceration, such a degree of hemorrhage could in  any instance occur as would
prove fatal to a child.   The case just now referred  to renders it unnecessary to
discuss  this question.  Hemorrhage is more likely to prove fatal, when the cord
is divided by a sharp instrument, than when it is lacerated;  and its dangerous
effects on the child are likely to be great in proportion as the  division is made
near to  the umbilicus.  It has been improperly described as a case of infanticide
by  omission, where  a self-delivered woman neglects  to apply a ligature to the
cord under these circumstances; because it is said she ought to know the neces-
sity for  this in order to prevent the child dying from hemorrhage.  Such a view
assumes not only malice against the accused, but that in the midst of her distress
and pain she  must necessarily possess the knowledge and  bodily capacity of an
accoucheur, a doctrine wholly repugnant to the common  feelings of humanity.
This question was, however,  actually raised in the case of The Queen v. Dash}
Aug. 1842.  There was no doubt in  this instance that the child had breathed,
and that its death had been caused by hemorrhage from the lacerated umbilical
cord.   The medical witness properly admitted, that the  cord might have been
torn through by the mere weight of the child  during labour;  and the jury ac-
quitted  the prisoner on the ground that she might have been  ignorant of the
necessity or not have had the power to tie the  cord.   The  cord, especially when
short, may become accidentally ruptured during delivery.   A  case of this kind
is reported by Mr. Mackie.  (Med. Times, July 24, 1847, p. 433.)  The child
was born  alive, after a very strong pain, and on examination it was  found  that
the cord was  torn through at about an inch from the abdomen.
  4.  Compression of the cord.—AVhen  a  child is born by the  feet or buttocks,
the cord may be so compressed under strong uterine contraction, that the circu-
lation between  the mother and  child will  be  arrested, and the latter'will die.
The same fatal compression may follow, when  during delivery the cord becomes
twisted  round the neck.  A child has been known to die under these circum-
stances before parturition, the cord having become twisted round  its neck in utero.
(Med. Gaz. Oct. 1840, 122.)   Other cases from this cause, during delivery, will
be found in the same journal.   (Vol. xix. 232, 933.)  On these occasions, the
child is sometimes described to have died from strangulation;  but it is evident
that before the establishment of respiration, such a form of expression is improper.
There are few or  no appearances  indicative of the cause  of death.   There may
be lividity about the  head and face,  and  cerebral congestion  internally: it is,
however, proper to state, that the brain of a child is always more congested than
that of  an adult.
   5. Malformation.—There may be a deficiency of some vital organ, which would
at once  account for the child dying either during delivery  or soon after its birth.
Two cases are reported, in one of which the child died from an absolute deficiency
of the oesophagus,—the pharynx terminating  in a cul-de-sac: in the other, the 
CONCLUSIONS.
329
 duodenum was obliterated for more than an inch, and had occasioned the child's
 death.   (Med. Gaz. xxvi. 542.)  In a third, recorded by Mr. Fairbairn, a child
 was suffocated by the retraction of the base of the tongue owing to defect of the
 fraenum.   (North. Jour. Med. March, 1846, p. 278.)  The  varieties of malfor-
 mation are very numerous, but there can be no difficulty in determining whether
 it be such as to account for death.  Individuals are not allowed to destroy these
 monstrous births; and the presence of all marks of violence in such cases should
 be regarded with suspicion.  It is the more  necessary to make this statement,
 as there is an idea among the vulgar,  that it is not illegal to destroy a monstrous
 birth.  Mr. Pooley, of Cirencester, informs me that the  following case occurred
 some years since in his practice:—A  lady was delivered of a most hideous'dice-
 phalous monster.   In his absence, and at the  earnest solicitations of the friends,
 the nurse destroyed  it.   The  question was—AVas this  woman guilty of child-
 murder?   The only case in reference to this point which  is recorded by medico-
 legal writers, is that of two women who were tried at the  York Assizes in 1812,
 for drowning a  child which was born with  some malformation of the cranium,
 in consequence  of which  it was likely that it  could  not survive many hours.
 There did not appear to have been any concealment on the part of the  prisoners,
 who were not aware of the illegality of the act.  (Paris and Fonblanque,  Med.
 Jur. i.  228.)  The absence  of malicious intention would probably lead to an
 acquittal  on the charge of murder; but such an act would doubtless amount to
 manslaughter.   The degree of monstrosity or the viability of the offspring cannot
 be received as extenuating circumstances: as to the first, if a liberty of judging
 what was monstrous and what not, were conceded to any ignorant nurse, children
 simply  deformed might be put to death on  this pretence:—as to the second, it
 is held  in law that whoever accelerates death causes it,—hence the fact that the
 offspring is not likely to live more than a few  hours, does not justify the act of
 one who prematurely destroys it.
   6.  Congenital disease.—It has been elsewhere stated, that a child may be born
 labouring under such a degree of congenital disease as to render it incapable of
 living.  The discovery of  any of the fcetal organs merely in a morbid condition,
 amounts to nothing, unless  the disease has advanced to a degree which would
 be sufficient  to  account for  death.  There  are, doubtless, many obscure affec-
 tions, particularly of  the brain, which are liable to  destroy the life of a child
 without leaving  any well marked post-mortem changes.  According to Dr. Bur-
 gess, apoplexy and asphyxia  are very common causes  of death among new-born
 children.   (Med. Gaz. xxvi. 492; Henke's Zeitschrift der S. A. 1S43, p. 67.)
 Probably  diseases of the lungs are of the greatest importance in a medico-legal
 view; because, by directly  affecting the organs of respiration they render it im-
 possible for a child to live  or to survive its birth for a long period.   These  dis-
 eases in The fcetal state are principally congestion, hepatization, tubercles, scirrhus,
 and oedema,—the existence of any of which, it is not difficult to discover.  They
 render the structure of the lungs heavier than water, and thus prevent the  or-
 gans from acquiring that buoyancy which in their healthy state they are known
 to have.  It is not common to find the lungs diseased throughout:—a portion
 may be  sufficiently healthy to allow of a partial performance of respiration.  The
 lungs may not be found diseased, but  simply in  that state which has been else-
 where described under the name of atelectasis.  The causes upon  which this
 condition of the lungs depends are not well understood.  The non-establishment
 of respiration sometimes arises from the mouth and fauces of the child being filled
 with mucus.  An enlargement of the  thyroid gland has occasionally led to the
 death of a new-born child by suffocation.  (Ed. Month. Jour. July,  1847, 64.)

   Conclusions.—The following conclusions  may be drawn from  the  preceding
remarks:—
   1. That a large number  of illegitimate  children, especially when immature,
are born dead from natural causes. 
330
VIOLENT CAUSES OF DEATH.
  2. That a child may die from exhaustion, as the result of a protracted labour.
  3. That if the child be prematurely born, or if it be small and weak, even at
the natural period, it may die from mere debility, or want of power in the con-
stitution to commence or continue the act of respiration.
  4. A child may die from hemorrhage, owing to accidental rupture of the cord
during delivery.   It may even die from this cause after it has breathed.
  5. That fatal hemorrhage is more likely to occur when the cord has been cut
close to the abdomen, than when it has been lacerated, or cut at a distance from
the navel.
  6. That the division of the cord, whether by rupture or incision, without liga-
ture, is by no means necessarily fatal to a healthy mature child.
  7. That a child may die from  accidental  compression of  the cord during de-
livery,—the circulation between the mother and child being thereby arrested be-
fore respiration has commenced.
  8. That death may speedily follow birth, from some  malformation or defect
of important organs.
  9. That the child may die from congenital disease, affecting the organs of res-
piration  or the air-passages.
                             CHAPTER XLV.

VIOLENT CAUSES OF DEATH.--FORMS OF VIOLENT DEATH UNATTENDED BY MARKS OF EXTER-
  NAL VIOLENCE--SUFFOCATION—DROWNING--IN THE SOIL OF PRIVIES--POWER OF LOCOMO-
  TION AND EXERTION IN FEMALES AFTER DELIVERY.--DEATH OF THE CHILD FROM COLD AND
  EXPOSURE--STARVATION--IMMATURITY IN CASES OF ABORTION.--WOUNDS, EVIDENCE FROM,
  IN NEW-BORN CHILDREN--FRACTURES OF THE SKULL SPONTANEOUS AND CRIMINAL.--DEATH
  OF THE CHILD FROM DELIVERY IN THE ERECT POSTURE--ACCIDENTAL INJURIES IN UTERO—
  DEFICIENT OSSIFICATION--TWISTING OF THE NECK.--VIOLENCE IN SELF-DELIVERY.—GENE-
  RAL CONCLUSIONS.

   Violent causes of death.—In this chapter we  shall  have  to consider all those
modes of death which are totally independent of the  existence of congenital
disease or other natural causes.  It is proper for the medical jurist to remember
that there are certain forms of child-murder  which are not necessarily attended
with any appearance indicative of violence,—these are, suffocation, drowning,
exposure to cold, and starvation.
  1. Suffocation.—This is a very common cause of death in new-born ^children.
A wet cloth may be  placed over the child's  mouth, or  thrust into that cavity
during birth  or afterwards, and before or after the  performance of respiration.
To the latter case only, could the term  suffocation be  strictly applied.  A child
may be  thus destroyed by being allowed to remain closely compressed under the
bed-clothes  after delivery,  or by its head being thrust into straw, feathers, and
such like substances.   The post-mortem appearances are seldom sufficient to ex-
cite a suspicion of the cause of death unless  undue violence has been employed.
There is commonly merely lividity about the head and  face, and slight congestion
in the lungs.  A careful examination of the mouth and fauces should be made,
as foreign substances are sometimes  found in this  situation, affording circum-
stantial  evidence of the mode in which suffocation has taken place.   Thus wood,
straw, feathers, dust,  or a  hard plug of linen, may be, and in some cases have
been found blocking up the mouth and fauces.  Again, a child may be suffocated
by having its head held over mephitic vapour, as the  exhalations of a privy or
of burning sulphur;  and it may be here necessary to  remind the medical jurist
that  other highly poisonous vapours may be used by a criminal without leaving 
INFANTICIDE.   DEATH FROM SUFFOCATION.
331
 any trace upon the body, except, possibly, that which may depend  upon their
 peculiar odour.   There are few of these cases of suffocation in which a medical
 opinion of the cause of death could be given, unless some circumstantial evidence
 were produced, and the witness were allowed  to say whether the alleged facts
 were sufficient  to account for death.  (Annales d'Hyg. 1832, i. 621.)
   On the other hand,  if it be even clearly proved that death has been caused by
 suffocation, it must be remembered that a child may be accidentally suffocated, and
 the crime of murder falsely imputed.   Dr. Hunter, who was well aware of the
 risk to which a female might be thus exposed, observes, in relation to this point,
 —"AVhen a  woman is delivered by herself, a strong child may be born perfectly
 alive, and die in a very few minutes for want of breath, either by being on its
 face in a pool formed by the natural discharges or upon wet clothes;—or by the
 wet things over it collapsing and excluding air, or drawn close to its mouth and
 nose by the  suction of breathing.    An unhappy woman  delivered  by her-
 self, distracted  in her mind and exhausted in her body, will not have strength or
 recollection  enough to fly instantly to the relief of her child."   (Op. cit. 35.)
 It may be added that a primiparous female may faint or become wholly uncon-
 scious of her situation; or if conscious,  she may be ignorant of the necessity of
 removing the child, and thus it maybe suffocated without her having been intention-
 ally accessory to its death.  In such cases,  however, there should be no marks of
 violence on the body, or they should be of such a nature and in such a situation as
 to be readily explicable on the supposition of an accidental origin.  An infant is very
 easily destroyed by suffocation.   If the mouth  and nostrils be kept covered for
 a very few minutes,  by being closely wrapped in clothes, asphyxia may come on
 without this being indicated by convulsions or any other marked symptoms.  A
 suspicion of murder may arise in such cases; but the absence of marks of violence,
 with an explanation  of the circumstances, will rarely allow the case to be carried
 beyond  an inquest.   Sometimes the body is found maltreated, with marks of
 strangulation about  it,—concealed in  a  feather-bed or privy;—or cut  up and
 burnt.  This kind of violence may probably excite a suspicion of murder, and
 lead to  the belief that the allegation  of death from accidental suffocation is a
 mere pretence.   This,  however, is purely a question for the jury, and not for a
 medical witness.   Unless the case be of a very glaring nature, the violence is
 considered to have been employed for the purpose rather of concealing the birth
 of the child than destroying it.  In the present day, these cases of death from
 accidental suffocation, when properly investigated, can never implicate an inno-
 cent woman in a charge of murder, although the facts may show in many instances
 that the death of the child was really due to great imprudence, neglect or indif-
 ference.
   The following case,  (The Queen v. Mortiboys,) tried in 1841, will show that
 even when the  evidence is very strong against a person, the  circumstances will
 be favourably interpreted.   In this instance, it was proved that the body of the
 child was discovered in a box  containing wool; it was  lying  on its  abdomen,
 with its face  raised  and its mouth open.  A red worsted comforter  had been
 passed twice round the neck, and was  tied a second time in a single  knot over
 the chin.  In the mouth, which was  open, was found a small quantity of fine
 flocks of wool.  The  medical evidence showed that the child had been born alive,
 the left lung being  fully inflated.  The brain  was congested.  There  was  no
 mark produced  by the ligature on the neck,  either externally or internally. Death
 was referred to  obstructed respiration (suffocation,) caused partly by the ligature
 and  partly by the wool in the  mouth,—but the latter was considered to  be the
 more active cause.   In the defence it was urged that the ligature could not have
produced strangulation, because the comforter was tied upon the chin,—that the
medical  evidence showed the wool in the mouth to have been the immediate cause
of death,—this was probably taken into the mouth by the child itself in  the in-
stinctive action  of breathing, and not put there by the prisoner for the purpose 
332
INFANTICIDE.   DEATH FROM DROWNING.
of suffocation.   The child had probably been placed carelessly on a quantity of
wool, into which it  had sunk by its own weight, and this  had caused its death.
It is reported that the judge joined in this view, and in charging the jury said,
that had the prisoner intended to choke the child with the  wool, she would have
inserted enough to fill its mouth.  The prisoner was acquitted.   In  this ca.se, ad-
mitting that the evidence did not bear out the charge of murder, still it is pretty
clear that death was caused by the child being placed on its face, with a ligature
round the neck, in a closed box filled with wool.   Admitting  the facts to have
been as represented, there appears to have been something more than an accident;
for the prisoner must have known that a new-born infant  was not  likely to live
under such circumstances, and had the  child been a week or a  month old, she
would probably have been convicted of manslaughter  or murder.  A very inte-
resting  case  of alleged infanticide,  by suffocation, has been reported by Dr.
Easton.   (Cormack's Journal, Feb. 1845.)   There is no doubt that the child in
this case was suffocated by a quantity of mud being forced into  its mouth and
fauces.  Its presence in the oesophagus was incompatible with its having entered
by gravitation.  In the case of Mackintyre (Glasgow Aut. Circ. 1829,) several
small pieces of straw were found in the stomach of the child, of the same kind as
those which were in the bed where  the birth took place.
   2. Drowning.—The fact of drowning cannot  be verified  by any appearances
on  the body of a child which has not breathed.   Thus, if  a woman caused her-
self to be delivered in a bath, and  the child were forcibly retained  under water
(a case which is said to have occurred,)  it would of course die; but no evidence
of the mode of death would be found in the body.  [For a case in which a child
was thus destroyed, probably, however, through accidental  circumstances, see
Cormack's Ed. Journal, Oct., 1845, p. 796.]   After respiration, the signs of
drowning will  be the same as those met with in the adult.  (See post, Drown-
ing.)   The main question  for a witness to decide, will be  whether  the child was
put into the water living or dead.   Infanticide by drowning is by no means com-
mon :—the child is generally suffocated, strangled, or destroyed in other ways,
and its  body is then thrown into water,  in order to conceal  the  real manner of
its death.  The fact of the dead body of an infant being  found in water, must
not allow the witness to be thrown off his guard, although a verdict of "found
drowned " is so commonly  returned in these cases.   The body  should be care-
fully inspected, in order to determine what was really the cause of death.  All
marks of violence on the bodies of children that have died by drowning, should
be  such as to have resulted from accidental causes.  It is  not necessary that the
whole of the body should be submerged,  in order that a child should be destroyed
by drowning: the mere immersion  of the head in water will suffice to produce
all the usual effects.  A case occurred in London, in 1842, where a woman at-
tempted to destroy her child by immersing its head only in a bucket of water.
The child was discovered, and resuscitated.
   New-born children may be drowned or suffocated by being thrown into mud,
or into  the soil of a privy.   Sometimes the child is destroyed in other ways, and
its body is thus disposed of for the purposes of concealment.   Should there be  a
large quantity of liquid  present, the  phenomena are those of drowning.  This
liquid abounding in hydrosulphuret of ammonia may then be found, if the child
were thrown in living, in the air-passages and the stomach.  On these occasions,
the defence may be,—1, that the child was born dead, and  that  the body was
thrown in for concealment; but the medical evidence may show that the child
had breathed and  had probably been born living.  2.  It. may be alleged that
the child breathed for a few moments after birth, but  then died, and that the fe-
male thus attempted  to conceal the  body.  A medical witness  may be here
asked, whether a woman could have had power to convey the body to the place,
—a point which must, as a general rule, be conceded.   3. It is most commonly
urged, that the woman being compelled to go to the privy, was there  delivered 
          THE PAINS OF LABOUR MISTAKEN FOR OTHER SENSATIONS.     333

unconsciously, and that the child dropped from her, and was either suffocated or
prevented from breathing.   All these circumstances may readily occur, but on
the other hand the explanation may be inconsistent with medical facts.  Thus
the head or the limbs of the child may be  found to have been  separated or di-
vided by some cutting instrument,—or a cord or other ligature  may be found
tightly bound around its neck, or there may be a tightly fitting plug in the
fauces.   Then, again, the body may be  entire, but  the  umbilical cord may be
cleanly cut.  This would tend  to set aside the  explanation of the child having
accidentally dropped  from the  female;  because in such an  accident the cord
should be found ruqUured.   The practitioner should make a careful examination
of the divided ends of the cord by the aid of a lens, or a rupture may be mis-
taken for a section with  a sharp instrument.  Mr. Higginson, of Liverpool, has
lately published a case of some interest in this point of view.   The child fell
from the mother, and the cord broke spontaneously.   "The  torn ends were
nearly as sharp-edged and flat as if cut."  (Med. Gaz. vol. xlviii. p. 985.)  This
case goes to prove that a careless or hasty examination of the ends of  the cord
may lead to a very serious mistake.   Sometimes the mark of a previous cut may
be found on the cord near one of its divided ends,—the first cut with  scissors
not having effectually divided it.  In a case tried at Lewes Lent Assizes, 1852,
 Mr. Gardner proved, in  reference to the body of a child which  had been found
in a privy, that the cord had  been ineffectually cut in one spot previous to its
complete division.  The cord had also been pulled out after this cut, so as to
elongate the vessels; hence they projected from one part of the sheath at one cut
portion,  while they were  retracted  in  the other.  This accurate  observation
 showed not only that the cord had  not been ruptured by the child  accidentally
 falling from the mother, but it served to establish  the identity  of the placenta,
 which was found concealed at a distance from the body.  In an interesting case
 which occurred to Dr. AVharrie, where the child fell from a female while sitting
 over a large jug containing water, and  in which it was  evident there had been
 no respiration, the  cord was found  secured.  The child was  removed from the
 vessel, dead; therefore, the ligature  must have been applied after death.   AVhen
 the cord is found lacerated, this will be casteris paribus in favour of the woman's
 statement  as to the mode in which her delivery occurred.  (For a case involving
 this question, see Med. Gaz. x. 374.)
    Circumstantial evidence.—AVhether, in any instance, the drowning of a child
 was accidental or criminal, must be  a question for  a jury to determine  from all
 the facts laid before them.   The situation in which the body of an infant is
 found, may plainly contradict  the supposition of accident.  On the other hand,
 a child may be accidentally drowned by its mouth  falling into a pool of the dis-
 charges during delivery, although this would be rather a case of suffocation.  The
 stomach of the  child  should always be examined  on  these  occasions, as mud,
 sticks, straws, weeds, or  other substances, may be found, indicating, according to
 circumstances, that the child had been put into the water living, and that it had
 been drowned in a particular pond or vessel.
   Accidental delivery.  The pains  of labour mistaken for other sensations.—In
 cases like that  reported by Dr. Wharrie, where a  female, under the impression
 that she was about to have a motion, sat over a large water-jug and was delivered
 of a child, it is proper to make full allowance for a mistake which may be com-
 patible with innocence.   A  woman is often unable to distinguish the  sense of
 fulness,  produced by the descent of the child, from the feeling which leads her
 to suppose that  she is  about to have an evacuation; and thus it is dangerous,
 when a labour has advanced, to allow a female to yield to this feeling;  for there
 is nothing more probable than that the child will be suddenly born.   Mr. Rankin,
 of Carluke, has reported two cases of this description,  where there could not be
 the slightest suspicion  of criminality.   In one, a primipara, the child was ac-
 tually born under these circumstances;  but its life was fortunately saved.—had 
334
INFANTICIDE.  COLD.
there been no other convenience than a privy, it must have been inevitably lost.
In the second, although a case of third  pregnancy, the female was equally de-
ceived by her sensations.  (Ed. Month. Jour. Jan. 1846, p. 11.)   It is true that
this  alleged mistaken  sensation forms a  very frequent and specious defence on
charges of child-murder; but still a medical jurist is bound to admit that an ac-
cident which occurs to females  of the middle  class, may also occur to the  poor
without necessarily implying guilt.
  Power of exertion in recently delivered females.—On these occasions, a witness
will  often find himself questioned respecting the strength or capability for exer-
tion, evinced by the lower class of women, shortly after child-birth.  Alison re-
marks, that  many respectable medical practitioners, judging only from what they
have observed among  the higher ranks, are liable  to be led  into an erroneous
opinion, which may be  injurious to an accused party.   He mentions a case, where
a woman charged with  child-murder walked a distance of twenty-eight miles in a
single day, with her child on  her back, two or three days after  her  delivery.
(Case of Anderson, Aberdeen Spring Cir. 1829.)   Instances have even occurred
in which women have  walked six and eight miles on the very day of their de-
livery, without sensible  inconvenience.   (Criminal Law,  161.)  In  one case
(Smith,  Ayr Spr.  Circ. 1824,)  the woman was  engaged in reaping,—retired to
a little distance, effected her delivery by  herself, and went  on with her work for
the remainder of the  day, appearing only a little  paler  and  thinner!  In  the
case of Macdougal (Aberdeen Spring Circ. 1823,) the prisoner, who was sleeping
in bed with two servants, rose,  was delivered, and returned to bed without any
of them being conscious of what had occurred.   Cases like  the last have often
presented themselves in the  English Courts.
  3.  Cold.—A new-born child may be  easily destroyed by simply exposing it
uncovered, or but slightly covered, in a cold atmosphere.   In a case of this kind,
there may be no marks of violence on the body, or these may be slight and evi-
dently of accidental origin.  In death from cold, the only appearance occasionally
met  with  has been congestion of theb rain with or without serous effusion in the
ventricles.  (See Cold.)  The evidence, in these cases, must be purely circum-
stantial.   The  medical witness  may have to consider, how far the  situation in
which the body was found,—the kind of exposure and the temperature of the
air, would suffice to account  for death from the alleged cause.   There is no doubt
that a new-born child  is easily affected  by a low temperature, and that warm
clothing is required for the preservation of its  life.   An inspection of  the body
should never be omitted on  these occasions, because it may turn out that there
was  some latent cause of natural death which would at once  do away with the
charge of murder.   Admitting that the child died from cold, it becomes necessary
to inquire whether the prisoner exposed  it with the malicious intention that it
should thus perish.  Unless wilful  malice  be  made out,  the  accused cannot be
convicted of infanticide.  In general, females do  not expose their children for
the purpose of destroying them, but for the purpose of abandoning them: hence
it is rare to  hear of convictions for  child-murder, where cold was the cause of
death,  although some medical jurists have called this infanticide  by omission, an
offence which does not appear to be recognised by the English Law.   In the case
of The Queen v.  Walters (Oxford Autumn Assizes, 1841,)  it was proved that
the  prisoner, while travelling in a  wagon, had suddenly left it,  and that she
was  delivered of a child, which was  afterwards  found dead and  exposed on the
road.  There was no doubt  that the child had  been born alive; for it was heard
to cry after it was abandoned by its mother, who appeared to have carried it some
distance after it was born.   The child had died from exposure to  cold.  The
woman was convicted of manslaughter, and sentenced to ten years' transportation.
(For other medico-legal cases of death from cold, see Henke's Zeitschrift, 1836;
also, 1840, i. 168, Erg. H.)  In the case of Reg. v. Waters (Exchequer Chamber,
Jan. 1849)  the judges held  on  appeal that the count which charged the prisoner 
DEATH OF THE CHILD FROM COLD AND STARVATION.         335
with causing the death of her child by throwing it on a dust-heap, and leaving
it exposed, was good, and the conviction was affirmed.
  4.  Starvation.—A. new-born child kept  long without food will die, and no
evidence of the fact may be derivable from an examination of the body.   There
may be no marks of violence externally, nor any pathological changes internally
to account for death.   This is a rare form of committing murder? unless  as  it
may be accidentally combined with exposure  to cold.  In  order  to convict the
mother, it is necessary to  show that the child was wilfully kept without  food,
with the criminal design of destroying it.   Mere neglect or imprudence will not
make the case infanticide.   The only appearance likely to be found on examina-
tion 01 the body, would be complete emptiness of the alimentary canal.   AVithout
corroborative circumstantial evidence, this would not suffice to establish the cause
of death:  a medical witness could  only form a probable conjecture on the point
In a suspected case of this kind, the contents  of the stomach should  be tested for
farinaceous and other kinds of food.
  5. Immaturity in cases of abortion.—From a recent case (Reg  v West  Not-
tingham Lent Assizes, 1848,) it would appear, that  if, by the perpetration  of
abortion, or the criminal inducement of premature labour, a child be born  at so
early a  period of uterine life that it dies  merely from immaturity,  the party
causing the abortion, or leading to the premature birth, maybe tried on a charge
of murder.  A midwife was  alleged to have perpetrated abortion  on a  female
who was between the fifth and sixth months of pregnancy.  The child was  born
living, but died five hours after its  birth.  There was no violence offered to it*
and its death appeared to be due entirely to its  immaturity.  The prisoner was
acquitted, apparently on the ground that abortion might have arisen from other
causes.
   Among those cases of violent death which leave on the body of the child certain
 marks or appearances indicative of the cause, may be mentioned wounds stran-
 gulation, and poisoning.
   6. Wounds.—Probably this is one of the most frequent causes of death in
 cases of infanticide.  Wounds may, however, be found on the body of a child
 which has died from some other cause.   The principal questions which a medical
 witness  has  to  answer are:—1, Whether the wounds were inflicted during or
 after birth, or, to adopt the legal view of the matter, before or  after the body of
 the  child was entirely in the world in a living state;  for, according to the deci-
 sions of our judges, a child is not considered living in law, at least its destruction
 does not appear to be murder, until its body is entirely born.  In most cases it
 will be utterly impossible for a medical witness to return any answer to a question
 put  in this form.  All  that medical evidence can  pretend to show, is whether
 the child was living or not when the wounds were  produced;—for whether  the
 whole of its  body was or was  not  in the world at  this time,  they will possess
 precisely the  same characters.   In  a few cases only, a conjectural opinion may
 be formed from the nature, extent,  and situation of these injuries.—2,  The wit-
 ness will be required to state, whether the wounds were inflicted before or after
 death.—3, AArhether they were sufficient to account for death.   4, Whether they
 originated in  accident or criminal design.  The  child may have been destroyed
 by burning, and evidence must then be sought  for by an  examination of  the
 state of the skin.   All these questions have  been fully considered in treating  the
 subject of Wounds; and they therefore do not require any further notice in this
 place.
  A case of infanticide was tried at  the Buckingham Summer  Assizes, 1840
 (The Queen  v. Wood,)  in which the main question was, whether  five severe
wounds  found on the  head of a child were  inflicted  before or after death, and
accidentally or criminally.   The mother confessed that the child was born alive,
and had cried, but that it had died in five minutes after its birth.  Its body was
buried, and it was assumed that the wounds might have been accidentally inflicted 
336
FRACTURE OF THE SKULL.
after death by a spade, which had been used for that purpose.  The medical
witness attributed death to  the wounds, which, in his opinion, could not have
been accidentally produced,  but very properly admitted, in cross-examination,
that the wounds would have  presented the same appearances had  they been in-
flicted  immediately  after death, while the blood was in  a  fluid state.  Answers
to questions of this kind can of course be given only in those cases where the
body is examined soon after the infliction of the wounds.   It would be extremely
hazardous to pronounce an opinion when the child has been long dead.  In the
case of The  Queen v. Taylor (York Lent  Assizes, 1843,) the child had been
dead about a year, and when its body  was  found  in  a garret, it was  so much
dried up, that the  medical witnesses were unable, with  certainty, to state the
sex.  The left arm had been removed from the body, and on the throat was  a
cut extending from ear to ear, which was considered to have been made by some
sharp instrument, and which, from the  retraction of the edges of the wound, the
witnesses thought must  have been produced during  life, or  immediately after
death.   The prisoner was acquitted.   In this case there do not appear to have
been any good medical reasons for the opinion expressed respecting the time at
which  the wound had been caused.   Certainly, the retraction of the  edges could
furnish no evidence in a wound "produced a year before, and in a subject so dried
up as to render the recognition of the sex difficult.  This may have been a case
of child-murder, but  there was no medical proof of it: it was not even proved
that the child  had come into the world  living.  Incised wounds found on the
bodies of children may be referred to the use  of a knife or scissors by the pri-
soner,  in attempting to sever  the navel-string, and therefore be due  to accident.   >
This point should not be forgotten, for a wound even of a severe kind might be
thus accidentally inflicted.  In such cases we should  always expect to find the
navel-string cut, and not lacerated.  The end of it may, for the purpose of exami-
nation, be stretched out on a piece of white card.  In  the case of  The Queen v.
 Wales, (Central  Criminal Court, Sep.  1839,) it was  proved  that there  was  a
wound on the right side of the neck of the child, not involving any important
vessels, although it had caused death.   The medical witness allowed that it might
have been accidentally inflicted in the way suggested, and  the prisoner was ac-
quitted.  As this question may be unexpectedly put at a trial, a witness should
prepare himself for it by a careful examination of the wound and of the umbilical
cord.    This will in general suffice to show whether an incised wound has been
produced accidentally in the  manner alleged, or by criminal design.
   Slight marks of external violence should not be overlooked:—minute punctures
or incisions  externally may correspond to  deep-seated injury of vital organs.
The spinal marrow is said to have been wounded by needles  or stilettos intro-
duced  between the vertebras,  the skin having  been drawn down before the wound
was inflicted, in order to give it a valvular character, and  to render it apparently
superficial.   The brain is  also said to  have  been wounded by similar weapons,
through the cribriform plate  of the ethmoid bone or the fontanelles.
   Fractures of the skull.—The only injuries which require to be specially con-
sidered in relation to infanticide, are fractures of the skull; and here the question
to which we may restrict our examination  is, whether the fracture arose from
accident or criminal violence.  Although it has been a matter of frequent observa-
tion, that great violence may be done to the head of a child during parturition,
without necessarily giving rise to fracture, yet it is placed* beyond all doubt that
this injury may occur by  the expulsive efforts of the uterus  forcing  the head
of a child against the bones of the pelvis.  Even the violent compression which
the head sometimes experiences in passing the os uteri, may suffice for the pro-
duction of fracture.  (See Ed. M. and S. J., xxvi. 75.)   Until within the last
few years, it had been generally supposed that fractures of the cranium in new-
born children were always indicative of criminal violence; but the cases collected
by Dr. Schworer of Freiburg, and others, have established the certainty of their 
DELIVERY IN THE ERECT POSTURE.
337
 accidental occurrence.   These accidental fractures, it is to be observed, are gene-
 rally slight:  they commonly amount merely to fissures  in the bones, beginning
 at the sutures, and  extending downwards fgr about an  inch or less into the
 body of the bone.
   The following case occurred to Dr.  Schwb'rer, while performing his duties at
 the Obstetric Institution:—The  child was  still-born:  he  received it into  his
 hands at birth, so that  the head could have sustained no outward violence.  On
 inspection, the  skin  over the  vertex  was found swollen;  and on removing it,
 there  was a  large extravasation of blood beneath, especially  over the right
 parietal bone.   The bone was fractured or fissured in two  places.  Blood in  a
 half-coagulated state  was found beneath the fissures, between the bone and  the
 dura mater, as also between this and the tunica arachnoides.  (Beit,  zur Lehr.
 v. d. Kindermord. Freiburg, 1836.)   Here, then, were  all the signs indicative
 of external violence;  and possibly, had this woman been delivered in secret, and
 the body of the child found in a concealed place, she might have been charged
 with the murder.   A second case is reported  in  Casper's Wochenschrift (Oct.
 1840,) where about  half a drachm of  blood was  extravasated on the right pa-
 rietal bone, which was compressed in the centre, and presented a radiated fracture.
 Coagula were found on  the dura mater.   (See also B. and F. Med.  Rev. xxi. 254,
 and vii. 333.)  In a third  case, where there was deformity of the  pelvis, the
 child was born dead,  and there were two fissures, about an inch long, in the left
 parietal  bone; and both parietal bones  were  considerably flattened.   (Casper's
 Wochenschrift, Sept. 1837.)   [See B. and F. Med. Rev. April, 1852, and Am.
 Jour. M. S., July, 1852, for three additional cases from Casper's Wochenschrift,
 1851.—II.]
   Dr. AAfest  has reported the following case of spontaneous fracture of the left
 parietal bone, during a  natural but tedious labour, in which the  head was five
 hours in the pelvic cavity, although the pelvis was well formed. There were
 three  fissures in the bone;  one  running into the  sagittal  suture, one  to the
 anterior inferior angle,  and  the other  to the middle of  the anterior edge  of the
 bone.   The child was  still-born.   Much blood was effused  beneath  the  scalp,
 but none under the skull.  (Med. Gaz.  xxxix. 288.)
   In respect to these  accidental fractures and extravasations, it may be remarked
 that they are in general recognised by their very slight extent.  [The  frontal
 and parietal bones are the only ones which Dr.  AVeber (On the Strength  of the
 Skull) has seen  fissured and fractured by the act of parturition. ( Vide Am. Jour.
 Med. Sci. Jan. 1853, 254.)—H.]  In cases of murder by violence to the  head,
 the injuries are commonly much more severe: the  bones are driven in,—the
 brain protrudes, and the scalp is  extensively lacerated.   Such severe  injuries as
 these cannot arise accidentally, from the action of the uterus during parturition.
 In these cases, however, it may be  fairly urged, that the woman was unexpectedly
 seized with labour, that the child was expelled suddenly by the violent efforts of
 the uterus, and that  the  injuries might have  arisen from its  head coming  in
 contact with some  hard surface—as a floor or pavement.   It must be admitted,
 that a woman may be  thus suddenly and unexpectedly delivered while  in the
 erect posture, although this is not common among primiparous females; and that
 injuries may be  thus produced on  the head of a child.
   Delivery in the erect posture.—An interesting case of  sudden delivery in the
 erect posture  in a primiparous female, without injury to the child, is reported
 by Dr. AAr. Burke Ryan, in the Lancet, June 21, 1845,  p. 707. ^  The umbilical
 cord was in this instance ruptured at the distance of about two inches from the
 navel.   In another case, also of a primiparous female, sudden delivery took place
 while the woman was  in the act  of sitting  down.  The child was forcibly ex-
 pelled,  and fell with its  head  on the floor of the room.  It was taken up dead,
 the cord being still attached  to  it and the placenta, which  came away shortly
after the birth of the child.  (Med. Gaz. xxxvii. 808.)   It would appear from
       22 
338                 DELIVERY IN THE ERECT POSTURE.

cases collected by Dr. Klein, that fractures  of  the  cranium under these circum-
stances are of very rare occurrence.   Out of one hundred and eighty-three cases
reported by him, in which the women were rapidly delivered while sitting, stand-
ing, or inclined on the knees,—the child falling on  the  ground or floor, there
was only one instance in which the child was killed; and there was not a single
case in whi(?h the bones of the cranium were fissured or fractured, so far as could
be  ascertained by external examination.   (Devergie,  i. 631; Briand,  271.)
Chaussier performed some  experiments on the  bodies  of still-born children,
allowing them to fall with their heads downwards on a paved floor, from a height
of eighteen inches; and he  found that out of fifteen cases one or other of the
parietal bones was fractured in twelve.   Although these results are conflicting,
yet Klein's observations appear more to the purpose; because  they were  made
under  circumstances in which  the question would really arise  in a case of in-
fanticide.  They are strikingly supported by the following case, which occurred
to Mr. Blacklock.   (Lancet, July 26, 1845.)  A married woman was suddenly
delivered while standing:—the child fell to the floor, but sustained no injury.
The umbilical cord was ruptured close to the umbilicus.   (See, also, Dr. Ryan's
case, supra.)  A case analogous to these, also in a primipara, is reported in the
Gazette Medicale,  26 Juin, 1847.   A woman,  aet.  27, was  delivered of a child
while in  the act of walking to the  hospital, at the distance of a mile.   She stated
that she  had lost a large quantity of blood.   ■ The child, which she brought in
her apron, was mature and living: the umbilical cord had been ruptured close to
the abdomen.   (See also another case by Dr. Pickford,  Med. Gaz. vol. xlii. p.
731.)  These observations would  lead  to the  inference that such accidents are
not very likely to occur, yet  we cannot deny the possibility of  their occurrence;
therefore a barrister  is  fully justified in endeavouring upon this ground to ex-
culpate a person charged with child-murder.  A medical  witness would  find no
difficulty in determining the  probability of this explanation of  the origin of the
fractures, if he were made acquainted with  all the facts connected with the de-
livery.  But the acquisition  of this knowledge  must be accidental; and it will in
general be out of his power to obtain it.   Sometimes the fractures will be accom-
panied by incisions, punctures, or  lacerations of the scalp or face:—in this case,
although the origin  of the  fractures might be accounted for by the alleged fall
during parturition, the  cause of the  other  injuries would still remain to be ex-
plained.  (See the case of The Queen v. Reeve, Cent. Crim. Court, Feb. 1839.
The Queen v. Stevens, Bodmin Lent Ass. 1845.)   The medico-legal importance
of this subject will be apparent from the evidence given in a case tried before
the Criminal Court of New  York, in November, 1834.   (Med. Gaz. xriii. 44.)
One of the medical witnesses positively denied that  the  bones of the cranium
could be  fractured by the action of the uterus during parturition!  It appeared
highly probable that the fracture had been here occasioned by the accidental fall
of the child during delivery—and the prisoner  was acquitted.   Dr. Wharrie has
published an interesting case, also the subject of a criminal charge, in which it
is probable that a fracture of the cranium of a  child was produced by the expul-
sive action  of the uterus.  The body of the child had  been found secretly buried.
It was fully developed,  but had evidently not  breathed.   The  navel-string had
been cut and tied; six inches of it still remained attached to the body.  On the
left side of the cranium, near the vertex, there was a small extravasation of blood;
and on removing this, a fissure half an inch in length was found in the edge of
the left parietal bone, close to the  line of the sagittal suture, and near the pos-
terior fontanelle.   On shaving  off the hair,  there was no discoloration,  nor any
mark on the skin indicative of a blow.   There  was no evidence to show that any
violence had been used to the child at its birth, and from the description of the
fissure it was a fajr presumption  that it had  arisen during  delivery from the
muscular contractions of the uterus.  (Cormack's Monthly Jour., Nov. 1845, p.
847.) 
DEFECTIVE OSSIFICATION SIMULATING VIOLENCE.           339
  Length of the umbilical cord.—It  has been recommended on these occasions,
that we should  observe the length of the umbilical cord, and notice whether it
be cut or lacerated, as these facts may, it is presumed, throw some light on the
question.  But a medical witness can seldom procure the cord for examination,
although it will generally be in his power to ascertain whether it was cut or lace-
rated, by examining the portion which is attached to the body of the child.   The
cord varies in length,—the average being from eighteen to twenty inches: but
it  has been  met with so short  as six  inches (Lancet, June 13, 1846, p. 660,)
and even five inches.   (Lancet, July 11, 1846, 49.)   In a twin case which oc-
curred to Mr. Stedman, of Guildford, the cord was only four inches long. (Lan-
cet, Aug. 28, 1K41.)   On the other  hand, in one instance, where it was found
twice  twisted round the child's neck,  it was fifty-three inches long. Dr. Churchill
found, out of three  hundred and ninety-one cases, that the shortest cord was
twelve inches, and the longest fifty-four inches in length.   In a case reported by
Mr. Wood, it was  sixty-one inches long, and coiled twice round the abdomen of
the child (Med. Gaz. xlv. 263.)   As the whole of the cord can rarely be obtained,
it is unnecessary to discuss the question, whether it were long enough to admit
of the falling of the child without  rupture.  It has been remarked, that when
the cord is ruptured from accidental causes  during delivery, the rupture  takes
place  either very near its placental or umbilical end.  In twenty-one of the cases
observed by Klein, it was found to have been forcibly torn out of the abdomen;
but it may be torn or lacerated at any part of its length, although the rupture is
commonly observed to occur near one or the other extremity.   It does  not ap-
pear how the examination of the cord can throw any light  upon the origin of
these fractures  of the cranium.
   Injuries accidentally sustained in  utero.—A practitioner must remember that
if at an advanced stage of pregnancy, a female should accidentally fall, the child
may sustain injury by a blow through  the abdominal parietes.   This is not to
be  strained  into a specious defence for violence which has obviously occurred
subsequently to birth, but the fact itself is of sufficient importance to merit at-
tention, as the  following case will show:—A pregnant woman, within five days
of the ordinary term  of gestation, fell while running,  so that her abdomen struck
sharply against an angular  stone.   There was an immediate loss of blood, and
the motion of the child  ceased.  Four days after the accident parturition came
on.   Dr. Stanelli  found the  head of the child much enlarged, and in a putrid
state.  The  female died in an  hour.   On  examining the child, the skull was
found almost crushed, the parietal having become separated from the temporal
bones as if by  external violence.   The marks of  injury  were entirely limited to
the head.   (Gazette  des Hopitaux, Nov. 7, 1846, p.  523.)
   In  accidents  of this kind it is most probable that the child would be born dead.
There might also be marks of violence on the abdomen of the mother.  Some
observers have  described cases in which the limbs of the foetus in utero have be-
come  deeply indented or spontaneously amputated, by the twisting of the umbi-
lical cord around them.   (Dublin Hospital Gazette, Jan. 1846, 153.)   It is not
possible that these accidental injuries could ever be mistaken  for violence in-
flicted on the body of the child after  its birth.
   Defective ossification simulating violence.—In reference to injuries of the bones
of the head in a new-born child, it may be proper to mention the particulars of
a case referred  to me by Mr. Lord, of Hampstead, in 1847.  The dead body of
a new-born child, wrapped up in brown paper and a towel, was found in a pond.,
Mr. Lord examined it  for the inquest,  The head was  very much decomposed,
and the scalp was extensively lacerated and  destroyed over the  parietal bones,
which readily separated.   The brain  was reduced  to a sanious pulp.  The umbi-
lical cord, which had not been tied, was cut  obliquely at about six inches from
the umbilicus.  The lungs, which were very crepitant, readily floated  on water,
and bore up the heart,   The body was generally bloodless.   The point  of diffi- 
840
VIOLENCE IN SELF-DELIVERY.  CONCLUSIONS.
culty which the case presented consisted in the presence of two apertures on one
pirietal bone.   These apertures were small and  rounded, and it was at first
doubtful whether they had not  been wilfully produced by  some perforating in-
strument applied to the cranium.  It was remarked that one aperture was situated
near the temporal ridge, and in this situation the scalp was  entire and uninjured.
The other was situated in that part of the bone which corresponded to the lace-
rated portion of scalp.   It was ascertained that no violence  had been used in the
removal of the body from the water.  The  bone  was macerated, and carefully
examined by the aid of  a lens.  It was then perceived that the apertures were
quite regular at the edges, which were remarkably thin, evidently passing into a
membranous condition.  The internal table was also deficient, so  that from the
interior the bone was bevelled off gradually from each aperture.   This examina-
tion left no doubt that  the  holes  in the bone were not due to any mechanical
violence applied during life, but to deficient ossification.   These spaces had been
membranous, and the membrane destroyed by decomposition.   The putrefaction
of the scalp, and  its separation, might have been accelerated by a bruised condi-
tion of these parts during a difficult labour.
   Twisting of the neck.—Children are sometimes destroyed in  the  act of birth
by the neck being forcibly twisted, whereby a displacement of the  cervical ver-
tebrae, with injury to the spinal marrow, may occur and destroy life.  Such in-
juries are immediately discovered by an examination.  It should be remembered,
however, that the neck of a child is very short, and that it  always possesses con-
siderable mobility.
   Violence in self-delivery.—When the  marks of violence found on the head,
neck, and body of a child, cannot be easily referred  to an accidental fall, it is
very common to ascribe them to the efforts made by the woman in her attempts
at self-delivery, and without any intention on her part of destroying life.   The
rules to guide a medical opinion in such a case must depend upon the nature,
situation and extent of the injuries; and each case must be therefore decided by
the circumstances attending it.   (The Queen v. Horder, Abingdon Summer Ass.
1840.)  This should be contrasted  with two other cases (The Queen v.  Trilloe,
Hereford Summer Ass. 1842; Queen v.  Turner, AArorcester AATinter Ass. 1843.)
In the first two cases, the children were admitted  to have been living:—in the
one violence was  chiefly confined to the head, and  the prisoner was acquitted,—
in the other the  marks of violence were upon the neck, and the prisoner was
convicted.   These cases show the uncertainty attendant on a plea of this kind.—
(See also  two other instances, B.  and F. Med. Rev. viii.  521.)   Sanguineous
tumours simulating  fractures  are sometimes found  on the heads  of new-born
children.   These depend on natural causes, and must not be  confounded with
marks of violence.   (Med. Gaz. xxxvi. 1082.)  They may be known by the un-
ruffled state of the skin.   A medical witness, however, must be prepared  to al-
low that a woman, at the time of her delivery, may from pain and anxiety be-
come deprived of all judgment, and may destroy her offspring without being con-
scious of what she is doing.  It is  therefore a sound  principle of law that mere
appearances of violence on a child's body are not per se sufficient, unless there
be some evidence to  show that the violence was knowingly and intentionally in-
flicted, or the appearances are of such a kind as of themselves to indicate inten-
tional murder.  (Alison.)  The  benefit  of a doubt will always be given in fa-
vour of  the accused.   See Puerperal Mania, post.

   Conclusions.—The conclusions to be derived from the contents of this chapter
are:—
   1. That a new-born child may die from violent  causes, arising from accident.
   2. That some forms of violent  death are  not necessarily attended with  exter-
nal signs indicative of violence.
   3. That a child may be accidentally suffocated during delivery. 
DEATH FROM STRANGULATION.
341
  4. That the marks of death from drowning are not apparent, except in child-
ren which have breathed.
  5. That the state of the umbilical cord may often furnish important evidence.
  6. That some  females, recently delivered, may have  strength to exert them-
selves and walk great distances.
  7. That a new-born child may speedily die from exposure to cold and privation
of food.
  8. That slight fractures of the bones of the cranium may arise from the action
of the uterus on the head  of the child during delivery.
  9. That females may be  unexpectedly delivered while in the  erect posture:
the umbilical cord is, under  these circumstances, sometimes ruptured, and the
child may sustain injury by  the fall.
  10. That the violence found on the body of a child may be sometimes referred
to attempts innocently made  by the female to aid delivery.
                            CHAPTER XLVI.

 DEATH OF THE CHILD FROM STRANGULATION--DECEPTIVE APPEARANCES ON THE BODY.--
  STRANGULATION BY THE UMBILICAL CORD--DIAGNOSIS.--ACCIDENTAL MARKS RESEMBLING
  THOSE OF STRANGULATION—CONSTRICTION  BEFORE AND  AFTER DEATH--BEFORE  AND
  AFTER RESPIRATION--CONSTRICTION  BEFORE AND AFTER  ENTIRE BIRTH--BEFORE AND
  AFTER THE SEVERANCE OF THE UMBILICAL CORD.--CONSTRICTION WITHOUT ECCHYMOSIS--
  EXAMINATION OF THE MOTHER--SUMMARY OF MEDICAL EVIDENCE--DEATH OF THE CHILD
  AFTER BIRTH FROM WOUNDS DURING  DELIVERY.  GENERAL CONCLUSIONS.

  Among the forms of violent death, which are almost always attended with ap-
 pearances indicative of criminal design, are the following:—
  7. Strangulation.—The destruction of a new-born child by strangulation is not
 an unfrequent form of child-murder;  and here a medical jurist has to encounter
 the difficulty, that the strangulation may have been accidentally produced by the
 twisting of the umbilical cord round the neck during delivery.  AVe must not
 hastily conclude, from the red and swollen appearance of the head and face of a
 child, when found dead, that it has been destroyed by strangulation.  There is no
 doubt that errors were formerly made with respect to this appearance; for Dr.
 Hunter observes,—"When  a child's head or face looks swollen,  and is  very
 red or black, the vulgar, because hanged  people look so, are apt to conclude that
 it must have been strangled.  But those who are in the  practice of  midwifery
 know that there is nothing more common, in natural  births, and that the swell-
 ing and deep colour go gradually off if  the  child live  but a  few  days.   This
 appearance is  particularly observable in  those cases where the navel string hap-
 pens to gird the child's neck,  and  where its head happens to be born some  time
 before  its body."—(Op. cit. 27.)  Strangulation by the  umbilical  cord can of
 course  refer to those cases only in which the  cord becomes firmly twisted round
 the neck after  the respiratory process is established, and this is rather a rare
 occurrence; because death more commonly takes place  by compression of the cord
 under these circumstances, and by  the consequent arrest of circulation before the
 act  of breathing is performed.  The appearance of ecchymosis on the scalp, as
 well as  lividity of the face, is  very common in  new-born children  when the
 labour  has been tedious and  difficult; and,  therefore,  unless  there were some
 marks  of injury about the neck,  this would  not justify any suspicion of death
 from strangulation.  The only internal appearance met with in death from  this
cause is  a  congested state of the  cerebral vessels. 
 342              STRANGULATION by the umbilical cord.

   Strangulation by the umbilical cord.—It  has been  supposed  that the stran-
 gulation produced by the wilful application of any constricting force to the neck,
 would be known from the  accidental strangulation caused by the cord, by the
 fact that in the former case there would be a livid or ecchymosed mark or depres-
 sion on the neck.   But it  may be objected to this view, that such a mark, al-
 though, from the  great violence used, a common, is not  a constant accompani-
 ment of homicidal strangulation.   On the other hand, although  it was formerly
 a disputed question, it is now certain that the umbilical cord may itself produce,
 in some instances, a livid or ecchymosed depression.  Among various cases which
 might be quoted in support of this view, is the following, reported by Mr. Foster.
 In  April, 1846,  he was summoned to attend  a lady in labour with her first child.
 Owing to the size  of the head, the labour was of a lingering kind, and the child
 came into  the world  dead.   The umbilical  cord was  found coiled three  times
 round the neck, passing under the right armpit; and upon removing it, three
 parallel discoloured depressions were distinctly evident.   These  extended com-
 pletely round the neck, and corresponded to the course taken by the umbilical
 cord.   The child appeared as if it had been strangled.   (Med. Gaz. xxxvii. 485.)
 Had this child been born secretly, this state of the neck  might  have created a
 strong suspicion of homicidal  violence.   Strangulation  after birth  could not,
 however, have been alleged, because there would have  been no proof of respira-
 tion.   AArhen a blue mark is  found on the  neck of a  child whose lungs retain
 their  foetal characters, it is fair to presume, c-eteris paribus, that it has been oc-
 casioned accidentally by  the twisting of the umbilical  cord during delivery.
 Mr. Price has communicated  to the same journal the account of a case in which
 the cord was so tightly twisted around the neck  of a child, that he was compelled
 to divide it before delivery could be accomplished.  There was in this case a deep
 groove formed on the neck, and it conveyed  the impression to himself and a me-
 dical  friend, that,  in  the absence  of any knowledge  of the facts, they would
 have been prepared to say that the child had been wilfully strangled by a rope.
 (Med. Gaz. xxxviii. 40.)   In this instance  the cord was very short.  A diag-
 nosis  might have been formed, as in the preceding case, by examining the state
 of the lungs.   Dr. Mutter met with  a case  in  which  the child was born dead,
 and the cord was tightly twisted round its neck,—when  removed, the neck ex-
 hibited a livid circle of  a finger's breadth, smooth, and shining;  but on cutting
 into this mark, no subcutaneous ecchymosis was found.   (North. Jour. Med. Jan.,
 1845, p. 190.)
  From two of these cases, it will be perceived that by trusting to ecchymosis in
 the mark as an absolute means of distinction between  constriction produced by
 criminal means,  and that which results from the umbilical cord, a serious error
may be committed.  As in the following case (reported  in the Annales d'Hyg.
 1841, i. 127,) a female  charged with the  murder of her child by strangulation,
may be unjustly condemned.   The child had fully and perfectly respired:—the
lungs weighed one thousand  grains, and when  divided, every portion floated on
water, even after firm compression.   There was a mark on the neck, which was
superficially ecchymosed in a  part of its course.  From an investigation of the
facts,  this appeared to have been a case in which  the  mark was  produced acci-
dentally by the umbilical cord, during attempts at self-delivery on the part of
the woman.  She was, nevertheless,  convicted, and  condemned to a  severe
punishment.   The case  establishes three points: 1, that partial ecchymosis may
be produced on the neck by the umbilical cord  becoming  twisted around it; 2,
that this may strangle a child after it has breathed at the outlet,—the cord was
twenty-four inches long; 3, that a child's lungs may in a few seconds become
sufficiently distended with air to give satisfactory evidence of respiration with the
pulmonary tests.   In the same journal, p. 428, will be found the report of ano-
ther case, suggesting many important reflections in regard to  the medical juris-
 prudence of infanticide.  In  this instance the umbilical  cord and membranes 
4*
                ACCIDENTAL MARKS RESEMBLING STRANGULATION.         343

   were actually used by the female as a means of strangulation: the child had not
   breathed, but was  thereby prevented from respiring.   There was  superficial
   ecchymosis on  each side of the neck  over the sterno-cleido-mastoidei muscles.
   The defence was, that the child was born with the cord around its neck, and that
   it was, from this circumstance, accidentally strangled;  but the medical evidence
   tended to show that the cord had been violently stretched and used as a means
   of strangulation.   The child had not breathed, and the witnesses considered it to
   have been born dead, owing to the violence used by the woman.  The cause of
   death here was certainly not strangulation,  but  arrested circulation.  In the
   mean time, the case proves that ecchymosis may be the result of the constriction
   produced by the cord.  (For additional remarks  on  this  subject, see Henke's
   Zeitschrift, 1837, iv. 352; also Ed. M. and  S. J.,  Oct., 1838,  p. 282.)  A case
   occurred to  Mr. M'Cann,  in  September, 1838, in which the  umbilical cord,
   which was of its full length, had been used  as the means of  strangulation.   It
   was twisted once round the neck, passed under the left arm over the  shoulders,
   and round the neck again, forming a noose or knot,  which, pressing upon the
   throat, muSfc  have caused strangulation, as the tongue  was protruded,  and there
   were other clear indications of the child having been strangled.   The hydrostatic
   test applied to the lungs proved that respiration  had been performed.
      Diagnosis.—When the mark is deep, much ecchymosed, and there is extra-
   vasation  of blood beneath, with ruffling or laceration of the skin, it is impossible
   to attribute this to the effect of the umbilical cord.   The  lividity produced by
   the cord  in the cases hitherto observed, has been only slight and partial, and un-
   accompanied  by laceration of the  skin, or injury to deep-seated parts.   (For a
   very instructive case by Dr. Scott, in reference to this  point, see Ed. M. and S.
   J. xxvi. 62.)   On the other hand, in homicidal strangulation, much more vio-
   lence being used than is necessary for destroying life, we should commonly ex-
   pect to find great ecchymosis and extensive injury to the surrounding  soft parts.
   On some occasions,  all difficulty is removed by the discovery of the rope, tape,
   or ligature round the  neck;  or, if this be not found, the proofs of some ligature
   having been used will be discovered in the indentations  or irregularly ecchymosed
   spots left on the skin, the  depressed portions of skin being generally white, and
   the raised edges livid.
      Marks on the neck may be produced by the umbilical cord without necessarily
»   destroying the child's life: two cases of this kind are  reported by Prof. Busch:
   (Br. and  For. Med. Rev. x. 579;) or the child may be  destroyed without ecchy-
   mosis being a necessary consequence of the constriction produced by it.  (See
   case by Dr. Hanff, Henke's Zeitschrift, 1836, Erg. H.)   There is much less risk
   of strangulation from twisting of the cord than  is commonly believed.  Out of
   one  hundred  and ninety cases, Dr. Churchill  found the cord round the neck in
   fifty-two  children.   The shortest cord so disposed was eighteen inches long, and
   it occurred twice in  seventy-five cases.
     Accidental marks resembling those of strangulation.—In the fore part of the
   neck of a child, a mark of depression is sometimes  accidentally produced by for-
   cibly bending the head forwards on the chest, especially when this has been done
   repeatedly and recently after death.  It may occur also as an accident during
   labour.   Such a mark must not be mistaken for the effect of homicidal violence.
   It has been a question whether, independently of  the constriction produced by
   the cord,  the cervix uteri might not cause, during its contractions, an ecchymosed
   mark on the neck.  I am not aware that there is any case reported which bears
   out this view;  and it seems highly improbable that any such result should follow.
   The mark on  the neck is sometimes such as not to be explained by an accidental
   constriction produced by the umbilical  cord.  The ecchymosis  may be in de-
   tached spots or  patches,—situated in  the fore part of the neck, and evidently
   not arising from the employment of any ligature.   These marks may depend on
   the forcible application of the fingers to the fore  part  of the neck of the child, 
344              CONSTRICTION BEFORE AND AFTER DEATH.

and the indentations have been known to correspond,—a fact which has at once
led to a suspicion of the mode of death.  It may be alleged in defence, that such
marks  might have been accidentally caused in two  ways: 1. By the  forcible
pressure produced by the child's hand during labour, an explanation which is
highly improbable, if respiration has  been performed:—although a  child has
been known to  breathe  in breech-presentations, while the head was still in the
vagina.  2. They will be more commonly referred to the violent  attempt made
by a woman at self-delivery, during a paroxysm of pain.   This explanation  is
admissible, so long as it is confined to injuries probably received during labour;
but supposing the marks to have been certainly produced after birth, it  will not
of course apply.   The following case (The Queen v. Ancliffe,  Nottingham Lent
Assizes, 1842) is in this  respect worthy of attention; for  it appears to me  to
show that a defence of this kind may be sometimes strained:—The evidence
proved that the prisoner was delivered of a child, under much suffering, on a
stone floor, and in the presence  of another woman,—a witness.   The child was
born alive, and was heard to cry several times.   The  witness left it in charge  of
its  mother, and on returning shortly  afterwards, she found it dead, with black
marks  upon its throat.   The female midwife, who  separated the child from the
mother, deposed that it gave a sort of  half cry;—she thought it was dead when
she first saw it, and the marks on the neck were not more than a woman might
have caused in  attempting to deliver herself.  The medical evidence showed that
there were many ecchymosed  marks upon the throat of the  child;  and on the
right side of the neck, blood was extravasated.   The marks might have been pro-
duced  by the fingers:—death had been caused by pressure on the windpipe.  The
judge  left it to the jury to say,  whether the marks of violence might not have
been unconsciously inflicted by the prisoner during  labour.  The jury returned
a verdict of acquittal.   (See also a case by Bellot,  Ann. d'Hyg. 1832, ii. 205.)
Among marks simulating violence, which are sometimes found on the necks  of
new-born children, Mr.  Harvey has pointed out one of a very singular kind.   In
February, 1846, he was present at a  delivery at which  the child was  expelled
rather  suddenly; and after making two or three convulsive gasps, it died. _ AVhilst
endeavouring to restore  animation, he observed a bright red mark extending com-
pletely across the  upper and fore part of the neck, from one angle of the lower
jaw to the other, exactly as 1 hough it had  been produced by strangulation with
a cord, except  that the  mark was not continued round to the back of the neck.
It was of a vivid red  colour, and not like a bruise or ecchymosis: it had very
much  the  appearance  of a  recent  excoriation.   It was  most clearly defined in
front, where it  was about a quarter of an inch in breadth, and  it became diffused
at the  sides.   The face  was  not swollen, and there was no fulness of the veins.
(Med.  Gaz. xxxvii. p. 379.)  The diagnosis here would have been based upon
the colour of the mark—the unabraded  state of the epidermis, and the absence
of congestion of the face and venous system.  Nevertheless, the case is of great
importance, and the facts should be  borne  in mind in the examination of the
body of a new-born child alleged to have been strangled.
   An  interesting case, which was  the subject of a coroner's inquest, has been
published  by Mr. Rose in the same journal (xxxvii. 530,) in which  red mark3
on each side of the nose of a new-born  child were  mistaken for the effects of
violence applied to the nostrils during an attempt at suffocation.  Mr. Rose exa-
mined them closely, and considered that they were nam, and had nothing to do
with the death of the infant!
   Constriction before and after death—before and after respiration.—A medical
witness is sometimes asked  to state, on these occasions, whether the  ligature or
the fingers had been applied to the  neck of the child, before or after  death,—or
before or after  it had breathed.  It is proper to observe, that so far as the exter-
nal marks of  strangulation are concerned, there is no difference in the appear-
ances,  whether the constriction take place during  life or immediately after death, 
               CONSTRICTION BEFORE OR AFTER ENTIRE BIRTH.           345

 while the body is warm.   Casper's experiments  render it highly probable, that
 when the constricting force is  applied to the neck of a dead child  at any time
 within an hour after death, the marks cannot with certainty be distinguished by
 any appearance from those made on a living body.  (AVochenschrift, Jan. 1837.)
 With regard  to the second point, it may be stated, that whether the child has
 breathed  or not, provided it be living, the marks of violence present precisely
 the same characters.  The following case is related by Casper:—The body of a
 new-born child was found concealed  in a cellar, and the mother was charged with
 having murdered it.  She confessed that she heard the child cry at the birth, but
 that it soon died.   In about an hour afterwards,  she tied tightly  round  its neck
 a band made of a few straws, which she had hastily twisted together for that pur-
 pose, in order, as she alleged, "to prevent it from awaking."  On the fifth day,
 the body was  examined: the child was mature, well formed, and had evidently
 breathed.   The examiners referred death to strangulation: the woman was con-
 victed, and  sentenced to be  imprisoned for life.  An appeal was made  against
 this sentence, and Casper's opinion was called for on the propriety of  the medical
 inference of strangulation during life, from the mark on the neck.  The wit-
 nesses had  stated "that  each  straw in the  band had produced a well defined
 depression, which was whiter than the surrounding skin, while the little folds or
 elevations between the straws were  red;—and on cutting into  these reddened
 portions, slight ecchymosis was found beneath."  Casper gave his opinion, that
 the slight ecchymosis observed might have resulted from the application of the
 straw-band soon after death,—while the body was warm;  and the circumstantial
 evidence allowed that the ligature might have been applied at some time within
 an  hour  after  death.   Hence he declared that there was a want of  proof that
 this child had died from  strangulation.  In consequence of this opinion the
 punishment was mitigated.  It is impossible to deny the correctness of the in-
 ference  drawn by Casper, since the mark was undoubtedly  such that it might
 have been produced either before or  recently after  death. AArhich of these two
 suppositions was the more probable, and whether it was more likely that a liga-
 ture should  be put round a child's neck an  hour after death  to prevent it from
 awaking (!), or before death for the  alleged  purpose of destroying it, it was of
 course for a jury, and not for a medical witness to decide.  If there was  nothing
 more in the prisoner's favour than her own  statement as to the time when  she
 applied the  ligature,  and  her object in applying  it,  it is certain that a very hu-
 mane interpretation was  put upon  the  facts.  If  the  Court entirely believed
 Casper's opinion, the  woman should  have been altogether acquitted, instead of
 having the punishment  merely mitigated.  It can be no crime, however absurd
 and unaccountable it may appear, for a person  to place a ligature  round the
 neck of  a child after death, to give the appearance of strangulation.  AVhen such
 an  extraordinary plea as this is raised, it is a fair matter of inquiry for a jury,
 to consider the motives of human conduct, and to  judge of such a  defence on
 the principles  of common sense.   If carried too  far, no one who was not seen
 by  others to perpetrate  the act, could be convicted of homicidal strangulation.
 In  the case of The Queen v.  Wren, tried at the AAlnchester Lent  Ass. 1840, the
 medical evidence went to  show that  the child had breathed, and was born alive.
 There was a piece of tape tied round its neck very tightly, and fastened behind,
 and there was a discoloration of the skin  beneath.  The  tongue was  livid
 and swollen, and blood was extravasated beneath the  scalp.   The medical wit-
 ness admitted  that the mark on the neck might have been produced after death;
 and as, he could not positively say that the child had been destroyed  by strangu-
 lation, the prisoner was acquitted.  (See also  The Queen v. Hylaud, Cent. Crirn.
 Court, Aug.  1844.)
  Constriction before  or after entire birth.—Judging from what has occurred on
several recent  trials,  a  medical witness  must prepare himself for another  ;.nd
more difficult question.  Let us suppose it to be admitted as proved, that the 
346           CONSTRICTION BEFORE OR AFTER ENTIRE BIRTH.
ligature was applied to the neck of a child while it was  living, and after it had
breathed;—it still remains  to  be determined, whether it was applied before or
after the legal birth  of the  child, or, as some judges have  laid down the rule,
before or after  an independent circulation has  been established  in the child's
body.   In the case of R. v. Enoch, Judge Parke held "that there must be an
independent circulation in the child before it can be accounted alive."  (Arch-
bold,  367.)  By an "independent circulation," we can only understand  that
condition in which respiration is established,  and the blood no longer passes from
the mother to the child.   Thus, this state would be proved by a cessation of pul-
sation in the cord, and the crying or audible  respiration of the child.  It will be
seen that this is tantamount to insisting  upon  absolute proof of  respiration, as
evidence of life, and, therefore, entirely conflicts with the opinions of many other
judges, who have held that  proof of respiration is not necessary on a charge of
murder, because a child might be born alive  and not breathe for some time after
its birth.  (R. v. Brain, Archbold, 367.)   On  the other hand, if  the presence
of an independent circulation  be the test of a child being legally alive at the
time of the violence, the  entire birth of  its  body is certainly not necessary for
this;  because,  as it is well known, respiration  may be  established, and conse-
quently an independent circulation  acquired, before the body of  the child is en-
tirely  born.   Here, again,  this judgment is opposed to the  opinions of most
judges, who have repeatedly held that whether  a child has breathed or  not, en-
tire live birth must be proved.   One of the  most common judicial objections to
the hydrostatic test is, that a child may breathe, i. e.  substantially acquire an
independent circulation, but die before its body is born.   In this state of uncer-
tainty, it is difficult to say what  medical  evidence is required to prove.  If an
independent circulation alone is sufficient, it  cannot be always necessary to prove
entire live birth; but if proof of  entire live birth be sufficient, then it cannot be
always necessary to show that the child had  acquired an independent circulation
when the violence was offered to it!   In a celebrated case of tenancy by courtesy,
(Fish v. Palmer, 1806, post, Birth,) the judges  of that time  held that the
quivering or spasmodic motion of  a lip  after birth without  respiration,  inde-
pendent circulation, or any  other sign of vitality, was sufficient to  show that that
child was born alive—and that it had thereby acquired civil rights which it could
transmit to others,—its heirs.   Why is the  proof of an  independent circulation
in a child to be demanded of medical witnesses  in a case involving a question of
its murder, when, in respect to its acquisition of civil rights, such a proof is not
called for?   If the question were fairly considered  by all the judges, probably
proof of an independent circulation in this sense would not be required; at any
rate it could not be consistently demanded,  in the face  of  other  decisions, that
proof of respiration was not absolutely necessary to  constitute live birth in law,
even in cases of child-murder.   The last case in which  this question was raised
was on the Oxford  Spring Circuit, 1841, (The  Queen  v.  Wright.)  The child
was found concealed in a  garden; its throat was completely cut, and there was a
stab under the left arm.   Baron Gurney  is  reported to  have  stopped  the case,
because there was no proof that the child had had "an  independent existence"
when the wounds were inflicted.   It is worthy of remark, that one form of mur-
der may be the actual prevention of the establishment of an  independent circu-
lation or existence in the child, as where  the cord is designedly tied  before the
commencement of the respiratory process.  It has been suggested that ignorance
of this point, among midwives, may be a  cause of numerous still-births.   In the
mean time one fact is obvious, that  whether the means of strangulation, if that be
the form of murder, be applied to the neck of a living  child before the entire
birth of its body or  afterwards,—before the  establishment of an independent cir-
culation (i. e.  the act of respiration) or afterwards,—the appearances will be
the same; and from these it will be impossible  to  say, when the strangulation
was accomplished. 
INFANTICIDE.  DEATH BY STRANGULATION.
347
   Cor, strict ion before or after severance of the  umbilical cord.—There is still
another novel form which  this question has  taken.   The witness may perhaps
be asked, whether the strangulation occurred  before or after the  umbilical cord
was severed.  It would appear that the severance of the cord has  been regarded
in law as a test of an independent  circulation being established in the child:—
but this is obviously an error depending on the want  of proper information re-
specting the phenomena which accompany birth.   Respiration, and therefore an
independent circulation, may exist  before the  cord is divided; and its  severance,
which is never likely to take place  until after entire birth, cannot consequently
be considered  as a boundary between a child which is  really born  alive, and one
which is  born dead.   A premature severance, as it was just now stated, might
positively endanger the life of the  child, instead of giving to it an independent
existence.   A healthy and vigorous child may continue to live and breathe in-
dependently of the mother, before the division of the cord, and the time at which
the severance  is made depends on mere accident.  Hence the marks of strangu-
lation on the  neck of a living and breathing child must  be the  same, whether
the cord be divided or not.  The object of putting such a question is not appa-
rent,  unless it is intended  to be implied that  no child  is legally born alive until
the accoucheur or the woman herself chooses to sever the cord.  It would there-
fore follow, on this doctrine, that to strangle a living child  (entirely born) with
the umbilical  cord, provided this be not lacerated in the attempt, would not con-
stitute infanticide!  If this inference  be incorrect, it  is impossible to see what
can have been the object of asking a medical witness  such  a question on these
occasions.   A case  in which the  cord was actually used  as the means of de-
struction has been already given.   (See ante,  p. 342.)
   The following cases will illustrate the difficulties which a witness may have to
encounter when it is alleged that the child has been destroyed by strangulation.
The first is that of Rex v.  Crutchley,  (Monmouth Lent Assizes, 1837.)  In this
case the body of the child was discovered by a medical man  (one of the  witnesses)
under the bed of the prisoner, who had  been secretly delivered.   There was a
riband tied in a knot so tightly round its neck as to have prevented respiration.
The child had evidently been dead some hours, and the prisoner  alleged that it
was born  dead.  On inspection, the face was  found swollen and the  lips livid:
the lungs contained air, and were  of a florid colour;  they were  crepitant and
floated on water, so as to leave no doubt that  the child had breathed.   The ves-
sels of the brain were gorged; the other viscera perfectly healthy.  He  attributed
death to  strangulation;—he thought that the ligature had been placed  round the
neck before the umbilical cord, which had not been tied, was secured;  but  the
reason for this opinion is not stated.   He considered  that the child  had been
born wholly alive; but admitted that the ligature would have produced the same
appearance  on the neck, had it  been applied before  the  complete birth of the
child.  Another witness, however, stated that he thought the ligature might have
been placed round the neck before  the entire  body of  the child was born.   The
defence was, that the ligature had  been used by the  woman for the purpose of
assisting  herself in the labour; and that the medical evidence allowed, whether
this was  the  motive or  not,  that it had  been applied before the  child was
actually born.   The  judge desired the jury  to consider,  whether the prisoner
wilfully killed the child,—if so, whether the killing occurred before or after the
entire birth of its body,—and lastly, whether  the killing took place while it was
still attached to the body of its mother.  Unless the  child was destroyed after
entire birth, the prisoner would be  entitled to an acquittal:—if destroyed, while
still attached to the body of its mother, the point would be reserved for the con-
sideration of the judges.   The prisoner was acquitted.  There can be no doubt
that, provided  a child be born entirely in a living state, the destruction of it would
be murder, whether the cord were severed or not.
  In the case  of The Queen v. Byron, (Chester Aut. Ass. 1838,) the dead body 
348
CONSTRICTION WITHOUT ECCHYMOSIS.
of the child was found with a piece of rag tied  round its  neck, which in the
opinion of the medical witness had caused death by strangulation; but on cross-
examination by the judge, he admitted that the appearances might be explained
by supposing that the prisoner had produced them in attempting to deliver herself.
In the case of The Queen v. Mitigate, (Central Criminal Court, Nov., 1842,) the
child was discovered dead, and  on examination the face was livid, the tongue
protruded, and the hands were clenched.  Around  the neck was a ligature which
had been passed round four times, and was tied tightly.   The vessels of the brain
were turgid, the lungs partially inflated, and the general  appearance of the body
was healthy.  The medical witness thought that the child had been born alive,
and had died from the effects of the ligature on the neck.  The judge  told the
jury they must  be  satisfied  that the child was completely born at the time the
ligature was put round the neck.   The prisoner was acquitted.   In another case,
The  Queen v.  Webster, (AVorcester Lent Ass., 1839,) the following facts were de-
posed  to by the  surgeon:—The child was full-grown, and was born alive: this
was  inferred from  the lungs being completely inflated.   A ligature was found
round the neck—it had been passed round twice—was very tight,  and fastened
in a  knot:  it  had caused two deep indentations.   The vessels of the  scalp and
brain  were  turgid with  blood, but there were no marks  of external violence.
Death was caused by strangulation.   The judge left it to the jury to say, whether
they were satisfied that the child was wholly born into the world alive;  and if so,
whether the prisoner had knowingly and wilfully  destroyed it after it was born.
The  prisoner was acquitted.
   Constriction without ecchymosis.—It  may be an important question whether,
in these instances, the absence of any mark of discoloration  of the skin by the
ligature should be taken as evidence of the means of constriction not having been
applied during life.  AVhat we are entitled to say from  observed facts  is, that
ecchymosis from the ligature is not a  necessary consequence  of  constriction,
either in a  living or dead child; although we might expect that there would  be
few cases of child-murder  in which, when,  strangulation was resorted to, there
would not be some ecchymosed mark or discoloration, chiefly on the presumption
that  great force is suddenly applied.   Besides, it is not improbable that a slighter
force would cause ecchymosis on the skin of a new-born infant  than would  be
required to produce such an effect on that of the adult.  When there is no mark
from  the ligature, an attempt may be made to show that death could  not have
been caused by strangulation, as in the following case, (The Queen v. Hagg,)
which was tried at the Carlisle Summer Assizes, in  1841:—The medical evidence
was to this effect.  The deceased child was discovered with a tape tied tightly round
its neck.  It was full-grown and healthy, and had been born alive, as respiration
had been fully established.   The lungs filled the chest, floated on water, and cre-
pitated when pressed.  From the livid appearance  of the face and neck, the con-
gested state of the brain, and extravasation of blood on the surface, combined with
the ligature round the neck, the witnesses were of opinion  that the child had
died  from  strangulation.  On cross-examination, they  said that  a child may
breathe when partially born.   The floating of the  lungs in water is of  itself  an
uncertain test, if the body is at all decomposed.   AVith  other tests it  affords a
proof of a child having been born alive.  One witness said the ligature had pro-
duced no mark of discoloration on  the neck, while  others said it was perceptible.
The  inference is, that the mark could  not have  been very apparent, or there
would have been no discrepancy on this point.  It was  very ingeniously urged
in the defence, that the child could not  have died from strangulation, because a
tape  tied so tightly round a child's neck as to cause death  in  this way, would
necessarily leave a discoloration of which no person could have any doubt.  The
prisoners were convicted.  Had the  defence been, as in the former cases, that
there was no proof whether the ligature had been applied before or after entire
birth,  or the establishment of an  independent existence in the child,  the result 
POISONING.   CONCLUSIONS.   SUMMARY.
349
 might have been different.  From  the cross-examination it will be seen in what
 way the objections to the hydrostatic test are ingeniously made to affect medical
 evidence.   An.answer to a general question is rendered applicable to a particu-
 lar case^  A witness admits on a trial that the lungs may float from putrefaction
 or artificial  inflation; in short, from  other causes than respiration.  If this  an-
 swer  be not qualified, an impression  is immediately conveyed to the court, and
 not always  removed by a re-examination, that  some of those causes may have
 given rise to the floating of the lungs in this particular instance,—when in fact
 there may have been not the least trace of putrefaction, nor the least ground for
 suspecting that artificial inflation had been practised.   As  contrasts to this case
 see report of a case which occurred to Mr. Coales (G. H. Rep., 1842;)  and  an-
 other by Dr. Scott (Ed. Med. and Surg. J., xxvi. 62.)
    Poisoning.—This is placed among the  probable means of perpetrating child-
 murder, but we rarely hear of new-born children being thus destroyed*?  The
 earliest age at  which I have known a trial to take place, for  the murder of a child
 by poison, was two months.  (R. v. South, Norf. Aut. Circ. 1834.)  A quantity
 of arsenic  was  given  to an infant, and it died in three hours and a quarter after
 the administration of the poison.   At this age, the  case can scarcely be called
 one of infanticide, in its  medico-legal signification; because all that it would be
 necessary to prove would be the cause  of death,—the question of life or live birth
 would not require to be entered into.   If, in a case of child-murder, death from
 poison should be suspected, it must be sought for in the usual way.
    Examination of the mother.—The duties of a medical witness, as they relate
 to the mother of the child, generally the accused party, are  slight.   All that  he
 is required to do is to show, by an examination made under an order from proper
 authority,  whether or not she had been recently delivered of a child, and to state
 the probable period at which  the delivery took  place.   (See post, Delivery.)
 This examination may be  necessary in order  to  connect her delivery with  the
 period which may have  elapsed since the birth and death of the child.   Unless the
 examination of the female be made within twelve or fifteen  days, no satisfactory
 evidence of  delivery can  in general be obtained.  It has  happened,  on more
 than one occasion, that medical  men have  assumed to  themselves the right  of
 enforcing an examination of  a  suspected female, and, by threats or otherwise
 have compelled her to undergo this.   Such a course of conduct is in the highest
 degree indecent and improper:—if a female willingly consent to the examination
 or an order be  obtained  from a  magistrate  or  other official person, the case is
 different.   In taking this authority upon himself, a medical practitioner is forcibly
 compelling an accused party to produce positive proof of  her guilt,—a principle
 which is entirely opposed to the spirit of English jurisprudence.

    Conclusions.—The following conclusions may be drawn from  the preceding
 remarks:—
   1. That congestion of the face and head, in a  new-born  child, is not a  proof
 of death from strangulation.
   2.  That strangulation can only take place in children which have breathed.
   3.  That a  child may be strangled during birth by the accidental twisting  of
 the umbilical cord round its neck.
   4.  That  the umbilical cord may produce a livid or ecchymosed depression  on
 the neck, like any other ligature.
   5.  That  marks on the neck, arising from accidental causes, may resemble those
 which  arise from strangulation.
   6. That  the effect of constriction on the  neck, either by the umbilical cord  or
any other ligature, is the same if the child be living, whether it has or has not
breathed.
  7. That the effect is the same whether the child has been partially or entirely
born. 
350          INFANTICIDE.   SUMMARY of MEDICAL EVIDENCE.
  8. That the effect of  a ligature on  the neck of a living  child is the same,
whether the umbilical cord has or has not bfeen severed.
  9. That a new-born  child  may die  from strangulation, without  this being
necessarily indicated by ecchymosis on  the  neck.   This depends on  the nature
of the ligature, and the amount of force used.

  Summary.   Frequent acquittals, in  spite of medical evidence of criminality.
—From the foregoing considerations it  will be seen, that the two great points to
be established by medical evidence, in a case of child-murder, are,—1st, that the
child was entirely born living when the alleged violence was  applied to it;  and,
2d, that its death was due to that violence, and to no other cause xchatever.   The
leniency with which such cases are regarded by the law, and the extreme rigour
with which the medical  evidence of live-birth, as well as of the cause of death,
is treated, must show that they who consider that the use of the hydrostatic test
can ever lead  to the conviction of an innocent woman, have taken a very limited
and incorrect  view of the subject.  The question of murder rests here, as in all
other cases, upon clear and undoubted  proof of the cause of death;—and more
than this, it must be shown  that the  violence was  criminal, and not  by any
possibility accidental.  Then it should  be proved that this violence, if criminal,
must have been applied to the body of  a child at a  particular period—i. e. after
entire birth; a case which, from what has already been stated, can rarely admit
of clear medical proof.    If strangulation, for example, be rendered probable from
the facts, the  woman cannot be convicted,  unless proof be afforded, 1st, that the
child was strangled after its entire body was born;—and, 2d, that she could not
possibly have  produced the marks of strangulation  in her convulsive or half-con-
scious attempts at self-delivery.   Medical evidence  can  rarely be in a condition
to establish either of these  points, and the assumptions will therefore be, as in
the numerous cases already reported,  in favour of the prisoner.   A serious ques-
tion will probably here suggest itself, from the  number of impossible proofs, so
to term them, which the law requires in these cases, namely—How can a con-
viction for child-murder  ever take place where there are no eye-witnesses to the
crime?   The  answer is, that these difficulties may not be raised in the prisoner's
favour; but this of course is a matter of accident.  On most charges of infanti-
cide, if the counsel for the defence insisted upon distinct medical  proof of the
child having been entirely born alive  when the violence was offered to it; or that
respiration, if clearly established by evidence, took  place, not during labour, but
after complete birth, or after the  child had acquired an  independent circulation;
—neither of  these proofs could be  possibly afforded; and the case, so far as
medical evidence was concerned, would fall to the ground.  That this is not an
exaggerated view of the subject, will be evident from the following case, tried
at the Lancaster Lent Assizes, 1846 (Reg.  v. Hacking.)   A female servant was
charged with, the murder of her infant  child.   The evidence went to prove that
she had attempted to conceal her pregnancy.   It was ascertained  that she  had
been delivered of  a child, and the medical evidence was to the effect, that its
throat had  been cut by some thin-bladed sharp instrument—a portion of the
gullet and wind-pipe having been cut away.  The  prisoner stated that the child
was born dead, and confessed that she  had, as she believed, cut its throat with a
pen-knife, which she had afterwards wiped and put away.   The weapon  was
found in her pocket.  The medical witness deposed, that the child had certainly
breathed, and  he was inclined to think it probable that it had been born alive.   He
admitted  that a child may breathe when partially born, and die before it is wholly
born; also, that the appearance of the  wound,  whether inflicted  before or imme-
diately after death, would be very similar; and it was impossible, from the exa-
mination of it, to say whether the child had been partially or wholly born at the
time of its infliction.   The counsel for  the  prisoner contended that no evidence
had been adduced which could  satisfy  the  jury that the  child  had  been fully 
              INFANTICIDE.   SUMMARY OF MEDICAL EVIDENCE.          351

born alive ;—a circumstance without which the charge must fall to the ground.
The jury acquitted the prisoner of the murder.  (Med. Gaz. xxxvii. 382.)
  In examining this case, it may be observed, that such a wound with a pen-
knife was hardly likely to have been  inflicted on  the child by any accident, or
for the purpose of aiding its expulsion during delivery.  As the child had breathed,
it is absurd to suppose that the woman waited until it had died from some other
cause, of  which there was no  appearance; and  that after death, without any
conceivable motive, she cut out a portion of its throat.  So far as the report goes,
the acquittal appears to have depended on the allegation that the child was de-
stroyed  before  it was wholly born; and  although it had breathed, there was a
want of evidence to show that this breathing had continued after it was entirely
in the world.   (See  also  another case in the same vol. p. 1007; and Prov. Med.
Journ. April 2, 1851, p. 182.)
  The frequent acquittals which take place on charges of child-murder, in spite
of strong evidence of criminality, most probably depend  on the  fact, that there
are many extenuating circumstances in the prisoner's favour.   She may be young,
unfortunate, friendless, and perhaps tempted by a seducer, or by utter destitution,
to the perpetration of the crime.   According to the present state of our law, the
jury have no alternative  but to convict her of a capital offence, or acquit her of
the charge of murder, and find her guilty of the concealment of birth, the extreme
punishment for which is two years'  imprisonment.  This  is substantially the
punishment at present inflicted for the crime of infanticide in this  country; for
it is not to be concealed that, medically speaking, these technical points relative
to "live birth," to "entire birth," or to an "independent circulation in the child,"
or lastly,  " concealed birth," are only so many ingenious  means for evading con-
victions on the capital charge.  Whatever doubt may exist according to the forms
and principles of law, there can be no doubt, medically, that living children are
often criminally destroyed, and that the law, from the severity of the punishment
attached in all cases to  the  crime, cannot reach the perpetrators.   In most of
these cases the punishment of death would be as much too severe, as the punish-
ment of two years' imprisonment for "concealed birth"  is too slight; and with
a full contemplation of this difficulty, the Civil Code of France (Art. 319) wisely
permits the court, on proof of  extenuating  circumstances, to mitigate the pu-
nishment.   Some  such provision is required in  our law;  and the unnecessary
perplexities which are now thrown on medical evidence, as well as the conflicting
opinions on what is live birth and what is not, would then disappear.   A change
of this kind might undoubtedly be  made, without prejudice to the accused, or
interference with the course of justice.
   It is  a question which it would be here out of place to discuss, whether a ver-
dict of manslaughter might not be proper on many of these  occasions; for to say
that the whole offence consists  in concealing the birth  of  a still-born child, is
virtually to disbelieve and reject the  clear and satisfactory medical evidence often
adduced.   A verdict of manslaughter would not,  however,  cover those numerous
cases where it is assumed that the child only lived to respire during  the act of
birth, and not afterwards.   Dr. Christison, in commenting upon  the frequent
acquittals on the capital  charge, and convictions  only on a minor offence, which
cannot always be proved, attributes it to a feeling sometimes entertained  in the
present day, that the killing of a new-born  child, when perpetrated under the
impulse of injured honour and the fear  of disgrace, should not be classed with
the other varieties of murder.   (See Ed. M. and S. J., xxvi. 76.)  There can,
I think, be no doubt that this is the true explanation.   (See also case by Mr.
Coales,  G. H. Rep., April, 1S42.)
   It may be mentioned,  in concluding this subject, as the  point has given rise
to a trial for malapraxis, that if injuries should be criminally inflicted on  a child
during birth, and the child be born alive and afterwards die from the injuries so
caused, the case would -be murder  or  manslaughter, according  to the circum- 
352         INFANTICIDE.  SUMMARY OF MEDICAL EVIDENCE.

stances.   The following instance  is reported by Chitty (Med. Jur. 416; also
Archbold, 345:)—A man  of the  name of Senior, who, it  appears, was an un-
licensed medical practitioner, was tried, in 1832, for the manslaughter of an in-
fant, by injuries inflicted on it  at  its birth.  The prisoner practised midwifery,
and was called on to attend the prosecutrix, who was taken in labour.  The evi-
dence showed that when the head of the child presented, the prisoner, by some
mismanagement, fractured, and otherwise so injured the cranium, that it died
immediately after it was born.   It was argued in defence, that as the child was
not born (in ventre sa mere) at the time  the wounds and injuries were inflicted,
the prisoner  could  not be guilty  of manslaughter.   The judge, however,  held
that as the child was born alive and died, the case might be one of manslaughter.
This opinion was  afterwards confirmed by the other judges, and  the prisoner was
convicted and sentenced to imprisonment.   From the decision in this case, it
will be seen that the law makes the question  of criminality  to depend upon the
period at which the injuries prove fatal, and not  upon the  time  at which  they
are inflicted on the  body of a child.   The decision  appears to depend on  this
principle of the criminal law, that the person killed must be a reasonable creature
in being* and under the king's peace:—therefore  to  kill  a  child in its mother's
Womb is no murder.  (Archbold, 345.)  The child, unless born alive, does not
come  under the  description  above given.  Admitting the wisdom  of adopting
some  fixed rule  of this kind in a legal view, it is undoubtedly proper that the
lives of children in the act  of birth should be protected;—at any rate, that their
destruction should not be treated, as it now appears to be; with perfect impunity.
  If a child be born alive, as a result of criminal abortion, and die, not from any
violence applied to its body, but as an  effect of its being immature,  this will be
sufficient to render the party causing the  abortion indictable for murder.
  It is difficult to determine the number of cases of infanticide which take place
annually in this  country;  but  in  France, where criminal  statistics  are more
closely attended to, there were, in 1838, one hundred and twenty-nine cases;
and in 1841, one hundred and forty-seven cases.   (See Annales d'Hygiene, Oct,
1840.)  [According to newspaper  reports, child-murder has been for some time
past alarmingly increasing among the working classes in England.  A desire to
escape the expense  of supporting their offspring, and to obtain the fee to which
they thus  become entitled as members of burial clubs, are said to be  the motives
by which the wretched parents are induced to commit the crime.—H.] 
PREGNANCY.   LEGAL RELATIONS.
353
PREGNANCY.
                           CHAPTER XLVII.

 PREGNANCY IN ITS LEGAL RELATIONS—CASES  OF RARE OCCURRENCE—SIGNS OF PREGNANCY
  —SUPPRESSION OF THE MENSES--PROMINENCE OF THE ABDOMEN--CHANGES IN THE BREASTS
  —QUICKENINd--UNCERTAINTY OF THE PERIOD AT WHICH IT OCCURS--SOUNDS OF THE FffiTAL
  HEART--KIESTEIN IN  THE URINE--CHANGES IN THE OS AND CERVIX  UTERI--FEIGNED
  PREGNANCY--DE VENTRE INSPICIENDO--PLEA OF PREGNANCY IN BAR OF EXECUTION--THE
  JURY OF MATRONS AND THEIR MISTAKES--CONCEALMENT  OF  PREGNANCY  A CRIME IN THE
  SCOTCH LAW—PREGNANCY IN THE DEAD—PREGNANCY IN  A STATE OF UNCONSCIOUSNESS.

  Pregnancy.  Legal Relations.—The  subject of  pregnancy, in so far  as the
 proofs of this condition in the living female are concerned, very rarely demands
 the attention of a medical jurist.   Some  exception has been taken to this opinion;
 but having now for a considerable period collected some hundreds  of cases, which
 have been the subject of inquisition or  trial in England and Wales, I find that
 there are but very few in the whole collection, in which the  signs of pregnancy
 became a matter of evidence;  and in some of these, the fact  of pregnancy was
 actually referred to the decision  of a jury of women, and not to a medical man!
 In relation to medical practice or to midwifery, the  subject is  undoubtedly one,
 the importance of which cannot be overrated; but this is entirely foreign to the
 object of this work, which is solely that of examining medical subjects in their
 strictly legal relations.  The remarks here made are therefore  brief;  and for ad-
 ditional information on the subject, I must refer the  reader to an excellent article
 by Dr. Montgomery, in the Cyclopaedia of Practical Medicine, and to the standard
 works on Midwifery.  If we except the  very few instances in which a magistrate
 requires  an opinion from a medical man respecting the pregnancy of a pauper
 female brought before him, there are only two cases in the English law in which
 pregnancy requires  to be verified;  and these  so seldom present themselves, that
 the questions connected with  the pregnant state rather belong to  the science,
 than the  practice of medical jurisprudence.

                           SIGNS OF PREGNANCY.
  Suppression of the menses.—It is well known  that in the greater number of
 healthy females, so  soon as conception has taken place, this secretion is arrested.
 But there are certain abnormal conditions, which must not be  overlooked.  There
 are some cases recorded which show that women, in whom the menses have  never
 appeared, may become pregnant.   This, however, is allowed by all accoucheurs
 to be rare;  and when  it occurs, which we may readily learn  from  the account of
 the female, it will be proper to search for other signs in order  to  determine  the
 question  of pregnancy.  Irregularity as  to the period at which the secretion takes
 place is very common among females.  This irregularity may depend either upon
 the age of the party, or upon disease, either  of which causes it will not be diffi-
cult to recognise.   It  is well known that there are numerous disorders of the 
354
A CHANGE IN THE BREASTS.
uterus under which, irrespective of pregnancy, the menses may become suppressed.
The absence of the menstrual  discharge as a consequence of pregnancy is gene-
rally  indicated by the good health which a female enjoys;—and although  dis-
ease may coincide with pregnancy, yet an acute practitioner will be able to esti-
mate  from the symptoms to what cause  the suppression is  due.   On  the other
hand, a  discharge perfectly analogous to the menstrual, sometimes  manifests
itself, not merely for several periods in a pregnant woman, but during  the whole
course of pregnancy.  (Dr. Murphy's  Obstetric Report, 1844, p. 9; also, Henke,
Zeitschrift der S. A., 1844,  265.)  Mr. Whitehead has  collected seven well
marked cases of menstruation  during pregnancy.  (On Abortion, 218.)  These
facts show that we must be cautious in our diagnosis, and not declare, that, be-
cause a discharge continues, pregnancy cannot possibly exist, or that because it
is suppressed,  the female must be pregnant.
  Feigned menstruation.—The menses  may be really suppressed; but if there
be any strong  motive for the concealment of her condition, the female may feign
menstruation.   Dr. Montgomery detected a case of this kind by an examination
of the areolae  of the breasts.   The woman had stained her linen with blood, in
order to make it  appear that the menses continued; but she subsequently ad-
mitted that this was an imposition.  It has been stated that there are differences
between menstrual and ordinary blood, but there are no certain chemical means
of distinguishing them.   (See  Blood-stains, ante, p. 222.)
  Prominence of the abdomen.—A gradual and progressive enlargement of this
cavity is one  of the most well marked  consequences of pregnancy.   The skin
becomes stretched, and the navel almost obliterated.   The enlargement in general
begins to be obvious about the third month, although there are some females of
peculiar organization, in whom the enlargement may  not become perceptible
until  the fifth  or sixth month,  or even later:  still  it may be detected on exami-
nation.   In fact, this sign  can never be absent in pregnancy, although it may
not be so apparent in some females as in others.  The objection which exists to
it is, that numerous morbid causes may give rise to prominence of the abdomen.
This is undoubtedly the fact,—as we have occasion to witness in ascites, ovarian
dropsy,  or in amenorrhcea,—diseases which, in several instances,  have been mis-
taken for pregnancy by eminent practitioners.   On the other hand, instances are
not wanting, in which, owing to the persistence of menstruation, and the absence
of quickening, the gravid uterus has been actually tapped, by mistake, for an
ovarian tumour; the operation being speedily followed by the birth  of a full-
grown child! (See Whitehead  on Abortion, p. 186;) but the history of the case
will in general enable a practitioner to form a diagnosis.  (An interesting case
of amenorrhcea strongly simulating pregnancy, is reported by Dr. Riittel, Henke,
Zeitschrift, 1844, 240.)  The  enlargement may be owing to disease when it has
been observed  by the female for a time longer than the whole period of gestation:
it may have been accompanied by a generally diseased condition  of the system,
and an absence of the other symptoms of pregnancy.  The most  embarrassing
cases  are unquestionably those in which abdominal  disease coexists with preg-
nancy.   Here time alone can solve the question, and the medical jurist should
give the benefit of his doubt to the side of chastity j mercy, and humanity.  (On
an important case in which an abdominal tumour was mistaken for pregnancy,
see  Lancet,  Oct. 16, 1847,  p.  408.)   AVhile  the abdomen  enlarges from preg-
nancy, the margins of the abdominal muscles become more clearly defined.  The
umbilicus is less depressed, and gradually acquires the level of the surrounding
skin.   As pregnancy advances,  it becomes  more prominent,  and  in the  last
month it assumes the character of a tumour, instead of a depression.   (White-
head, loc. cit.  209.)
  A change in  the breasts.—These organs in the pregnant female become full
and prominent, and the areolae  around the nipples  undergo changes which Dr.
Montgomery,  and others, regard as highly characteristic of the  pregnant state. 
PREGNANCY.   QUICKENING.
355
  LnTrifcZZ Painfn the^reasts' and,even in «ome rare instances the secre-
  tin of milk, may arise from other causes than pregnancy   Severe uterine irritn
   ion may cause the breasts to become pd^JUa^hJ^^^^

  and with regard to the secretion of milk m non-pregnant females, the few rare cases

  not well be mistaken for the pregnant cond tion.   (See Henke, Zeitschrift der
  b. A., 1844  269£   The  areola  is generally observed,  during  pregnancy  to
  become considerably darker in colour, and larger in diameter.   M^rf which
  the areola is formed becomes soft, moist, and slightly tumid.  The little glaJdS
  follicles  about it are  prominent, and often  bedewed with a  secretion--arnon^
  these changes, that of colour has been the most attended to.  They are comTon*?
  well marked in from the second to  the fourth month of pregnancyf-th3

  the glandular follicles does not always  exist in  pregnancy, and the areola  mav
  become large and dark-coloured from other causes; L^neXXeTe^n^e
  only to be looked upon as corroborative.  In females of dark complexion the
  areolae dark, irrespective of pregnancy; and in some cases of advanced pregnancy
  $32 tSfn  m T °la areueiltirely abse»t-  (Edin. Month. Journ., March,
  1848, 693.)  Dr. Montgomery has recently described, as a sign of pregnancy, the
  existence of a brown line extending from the pubes to the umbilicus? especially
  in  females of dark complexion, and a dark-coloured  but not raised areola  of
  about a quarter of an inch m breadth, around the umbilicus
    Quickening.—The  signs above given are  applicable to the early as well as  to
  the late stages of utero-gestation:  but that which  we have here to consider  is
  one which is rarely manifested until about the fourth or fifth month. Quickenine
  is the name applied to peculiar sensations  experienced by a female  about  this
  stage of pregnancy    The symptoms are popularly ascribed to the first perception
  ot the motions of the foetus, which occur when the uterus begins to rise out  of
  the pelvis; and to this  change of position the sensation  is perhaps really due
  Ihe motions of the fcetus  are perceptible to the mother  before they are made
  evident by an  external examination.   The term  is derived from the old Saxon
  word "quick," signifying living, as, at the time when medicine was in its infancy
  it was considered that the foetus only received vitality when the mother experi-
  enced the sensation of its motions!  On the occurrence of quickening  there  is
  generally great disturbance of  the system;  indicated by syncope, nausea, and
  other distressing  symptoms.  After a short time  the  female recovers; and  if
  sickness has hitherto attended the pregnant state, it  has been frequently observed
 to disappear when the  period of quickening is past.
   No evidence but that of the female can satisfactorily establish the fact of
 quickening, and this it  is important to bear in mind;  since, in some cases in
 which pregnancy becomes an object of medico-legal interest, proof of quickenin-
 is demanded by the law.    The discovery of  the motions of the child by an ex*
 ammer is really a proof that the usual period of quickening is past, but their non-
 discovery, at the time of examination, is no proof whatever that the woman has
 not quickened; since the motions are by no means constant, and may be acci-
 dentally suspended even at several successive examinations.  Besides, cases every
 now and then occur, in  which well formed, healthy females do not experience the
 sensation  of quickening  during the whole course of pregnancy; and, what is of
 more importance, the motions of the child may be at no time perceptible to the
 examiner.  The uncertainty of quickening, as  a  sign of pregnancy, is too well
 known to require more than adverting to.  Females have been known to mistake
 other sensations for it, and  in the  end it has  been proved that they were not
pregnant.   A woman may also declare that she has felt quickening when she has
not; and unless the motions of the child be perceived by the examiner at the time
how is he  to disprove her statement?   Quickening,  then, (so far as it concerns 
356
sounds of the fcetal heart.
the statement of  the female) cannot be relied on as a proof of pregnancy;  but
if the motions of the child can be felt by the examiner through the abdominal pa-
rietes, this is clear evidence, not only of the woman being pregnant, but of  her
having passed the period of  quickening.  AVe may next  consider the period of
pregnancy at which this symptom ordinarily occurs.  Our law seems to infer, that
it is a constant, uniform, and well marked distinction of the pregnant state; and
in some instances insists upon proof accordingly.  Taking the general experience
of accoucheurs, quickening happens from  the tenth to the twenty-fifth week of
pregnancy; but the greater number of instances occur between the twelfth and
sixteenth week;—or between the  fourteenth  and eighteenth week after  the last
menstruation.  It is a popular opinion that quickening takes place exactly at the
end of four calendar months and a half; but it mostly occurs two or three weeks
earlier than  this period.   Many  females estimate that they are four  months
advanced in pregnancy when they quicken; but this mode of calculation  is open
to numerous fallacies.   Dr. Rodrique knew a lady who invariably quickened at
two months, and went full seven  months after, with all  her children,—five  in
number.   (Amer. Journ. Med. Sci., Oct.  1845, p. 339.)
   From these observations, it will be seen that an examiner may sometimes de-
tect the motions of the child about the third or fourth month,—at others not
until the fifth or sixth;—and in other instances not  at  all, throughout preg-
nancy.   Even in those cases in which the motions of the child have indisputa-
bly existed, they are not always to be perceived:  hence several examinations
should be resorted to, before an  opinion  is expressed from their absence.   In
making these examinations,  the diagnosis is  often facilitated by previously im-
mersing the hand in cold water, and then suddenly applying it to the abdomen.
When the motions of the child are distinctly perceived through the parietes of
the  abdomen, they constitute a certain sign of pregnancy;  but their non-disco-
very at a particular time is no proof that the female is not pregnant. The
jury of matrons probably trust to this sign: hence their verdicts commonly turn
out to be erroneous.
   Sounds of the fcetal heart.—Another sign  is that which is derived from aus-
cultation.  By the  application of the ear, or  a stethoscope,  to the abdomen, at
about the fifth month of pregnancy, rarely earlier, the pulsations of the foetal
heart may be recognised and counted.  These  pulsations are not synchronous
with those in the arteries of the mother;  they are  much more rapid, and thus
it is impossible to mistake them.   Their frequency, according to Dr. Hope, is in
an inverse ratio to the  stage of gestation,  being 160 at the fifth, and 120 at the
ninth month. This sign, when present, (like  the motions of the child,) not only
establishes the fact of pregnancy beyond all dispute, but shows that the child is
living.  The sound of the foetal heart is, however, not always perceptible: when
the child is dead, of course it will  not be  met with: but its absence is no proof
of the death of the child, because  the hearing of the pulsations by an examiner
will depend  very much upon the  position of the  body, the quantity of liquor
amnii, and other  circumstances.   Thus it may be distinctly heard at  one time,
and  not at another.  It may be absent for a week or fortnight; and then will
reappear;—so that, although its  presence  affords the  strongest affirmative evi-
dence, its absence furnishes very uncertain negative evidence; and several exa^
ruinations must  be made in  the latter case, before an opinion is drawn.  The
earliest time  at which the pulsations may  be  heard has been stated to be about
the fifth  month; but they will be best heard between the sixth and eighth.  The
reason why the sound is not always perceived, is owing not only to changes  in
the position of the child, but to the vibrations having to traverse the liquor amnii
and the  soft parietes of the  abdomen.  The point of the  abdomen where  the
sound can be best heard  is in the centre of a line drawn from the umbilicus to
the anterior inferior spinous process of the ilium on either  side—perhaps most
commonly on the right.  When clearly detected, it is the most unequivocal sign 
CHANGES IN THE OS AND CERVIX UTERI.
357
 of the pregnant state.   Besides the sound of the foetal  heart, auscultation has
 led to the discovery of what is called the placental murmur.  This sound is more
 likely to create fallacy than that of the foetal heart.
    Kiestein in the urine.—A substance called Kteste in  has  been found in the
 urine of pregnant females.  It appears as a fatty iridescent pellicle on the sur-
 face of  the urine about twenty-four hours after it has been voided.   There are
 various opinions concerning the nature  of this substance, some regarding it as a
 mixture of casein  and oil with earthy phosphates, (Dr. Bird, Gr. H. Rep., April,
 1840, p. 26,) and others as a modification of albumen (L'Heritier, Chimie Patho-
 logique, 483.)  From the late researches of Dr. Moller, its presence in the urine
 is subject to so much uncertainty, that  it is wholly unfitted to serve in medical
 jurisprudence as a diagnostic character of pregnancy  (Casper's Wochenschrift,
 ii. 1845, S. 21.) Dr.  Mickschick has arrived at the same conclusion (Med. Gaz.,
 xxxix. 264.)  Mr. Kane  obtained kiestein in equally great quantity from the
 urine of a virgin aged fourteen, and that of a woman  who had nursed for  two
 months  (Whitehead on Abortion, 231.)  Dr. Golding, however, entertains a high
 opinion of its value as a sign of pregnancy in its earlier  stages when the other
 signs are obscure.  According to this gentleman, it is present in the urine at all
 periods of pregnancy—it is identical with milk in a crude form, and is to be re-
 garded  as a secretion of the  mammary glands (Obstetric Record, 3,  45.)   Dr.
 Rees has detected  in it  milk-globules, and considers it to be caseous matter al-
 tered by passing through the kidney (Anal, of Blood and Urine, 217.)
   In reference to the  above signs, it may be observed, that if the motions of the
 child or sounds of the heart be perceptible, no other evidence of pregnancy need
 be sought for.   The mere suppression of the menses, prominence of the abdomen
 and  fulness  of  the mammas, cannot alone establish the fact; but, unless  the
 morbid causes of these abnormal states of the system be clearly and satisfactorily
 obvious  to the examiner, it  is a fair presumption that the female is  pregnant.
 In every case where a doubt exists, we  should require sufficient time for a clear
 diagnosis.
    Changes in the os and cervix uteri.—The signs  hitherto mentioned are chiefly
 relied on in medical practice; but it must be remembered  that no case  can possi-
 bly occur in civil or criminal jurisprudence, in which it will not be in  the power
 of a medical witness to make an examination of the female.  He may  then form
 a safe diagnosis from the changes which  take place in the cervix uteri, and from
 the sensation imparted to the finger by the presence of a rounded body (like the
 fcetus) floating in a liquid, when an impulse is given to the uterus from below.
 Up  to the fifth  or  sixth month of pregnancy, the  neck of the uterus may be
 commonly felt projecting into the  vagina; it  is of its usual  length,  hard and
 firm,—after that period the uterus  rises into the  pelvis, and  the neck becomes
 spread out,  shorter and softer, the aperture  increasing  in size and  becoming
 rounder.  Towards the end of gestation, the neck of the uterus appears  to be
 lost, becoming like  a thin membrane, and sometimes no aperture can be felt.
   A well marked test of pregnancy is the motion perceptible to the finger on
 giving a sudden impulse  to the neck of the uterus.  Capuron  calls this  the
 touchstone in the diagnosis of the pregnant state:—without it, he considers the
 medical jurist may  be easily deceived.   To this passive motion of the  child,  the
 name of ballottement is given.   It cannot be easily determined before the fifth or
 sixth  month; but after the latter period, especially as pregnancy becomes  ad-
 vanced, it is always available.   In the  French schools, the method of applying
 the toucher and  ballottement to  pregnant females is  systematically taught, and
 by a little practice it may be easily acquired.
  As  most of these signs  refer to an advanced stage,  a witness may be asked
what are  the unequivocal indications of pregnancy before the fifth or sixth month?
The answer to this question is of little moment to  the medical jurist, since he is
rarely required to give an opinion under these circumstances.  In all legal cases, 
358
FEIGNED PREGNANCY.
when pregnancy is  alleged  or  suspected, it is the practice  for  the  judge or
magistrate, on a representation being made by the medical witness, to postpone
the decision one, two, or three months, according to the time required for obtain-
ing certain evidence.  This  evidence will  consist in plainly distinguishing a
rounded body floating freely in  the uterus, as well  as the  niotions of a foetus.
The most experienced men agree, that before the sixth month, the changes in the
cervix and os uteri  are of themselves too uncertain to enable an examiner to
form a safe diagnosis; and a fortiori it is impossible to trust  to external signs.
Mr. Whitehead dissents from this view, and considers that a specular examination
of the mouth" of the  uterus is not only more satisfactory than any  other mode of
exploration, but that it will  enable a person  to  determine with certainty the
existence of pregnancy during its earlier stages—from a few days after conception
to the middle or end of the fourth month, when auscultation first becomes avail-
able.   In the fourth week the  labia of the os at the centre of  their margins
become permanently separated to the extent  of  one or two  lines;  and  the os
tincse itself, which was before a mere chink with parallel boundaries, forms an
elliptical, or sometimes  rounded  aperture, which is  occupied by a deposit of
transparent, gelatinous mucus.  At six or eight weeks it becomes  decidedly oval
or irregularly circular, with a puckered or indented boundary, having  a relaxed
and lobulated character.   The whole  circumference of the cervix is  enlarged,
and, the commissures or angles of the os tineas are obliterated.   The os continues
of this  irregular form throughout the whole period of gestation;  but from the
period of  quickening to the  end of the seventh month the progressive changes
are not  so marked as to form a  guide  for determining the period  of pregnancy.
(On Abortion, 204.)  This  condition of the os uteri must not be  confounded
with its menstrual state in the early stages, nor with a diseased state in the latter
stage of gestation.
   Feigned pregnancy.—Pregnancy is sometimes  feigned or  simulated for the
purpose of extorting charity, of obtaining a settlement in a parish, or of compel-
ling marriage; but it is scarcely necessary to observe, that the imposture may be
easily detected  by a  well informed  practitioner, since  the woman  always  feigns
an advanced stage of pregnancy.  Although she may state that she has some of
the symptoms depending upon pregnancy (and, unless  she has  already borne
children, she will not be able to resist a cross-examination even respecting these,)
yet it is not possible for her  to  simulate without detection a prominence  of the
abdomen  or  the state of  the  mammas.   If she submit to an examination, the
imposition must be detected:  if she do not, the inference will be  that she is an
impostress.   Pregnancy may be feigned by a female in order to avoid being sent
by a magistrate's order to a distant parish, or to escape the punishment of hard
labour, to which she  may have been sentenced.   If in the latter case the slightest
doubt should exist whether the female be really pregnant or not,  an affirmative
opinion  should be given, at  least for  a time,  since very great and irreparable
mischief might result by taking  an opposite course.
  In civil cases  of feigned pregnancy, an examination should always be insisted
on, or the reputation of a practitioner may suffer by his giving a hasty opinion
on the subject.   In  this respect the case of Devonald  v. Hope, Q.  B., December,
1838, is of some interest.   A medical man having  given opinion that a  female
patient was pregnant, subsequently brought an action against her  for medical
attendance.   It  turned out, however, that she  was not pregnant,  and that there
were no satisfactory medical grounds upon which his opinion was based. The plain-
tiff complained of having been deceived by the female as to her condition; but it
is obviously in  the  power of every medical man to prevent such  a deception
being practised  on  him.   An external examination only, will not suffice either
to affirm or negative the allegation of  pregnancy, except where it  is stated to be
far advanced.  For a singular case in which, on a charge of assault, evidence of
this kind was tendered, see Med. Gaz. xxxvi. p. 1083, 1169.   On the fallacy of 
PLEA OF PREGNANCY IN BAR OF EXECUTION.            359
the signs of pregnancy, and the simulation of this state, see a paper by M. Tar-
dieu, Ann. d'Hyg., 1845, ii. p. 429; also 1846, i. 83.
   De ventre inspiciendo.—One of the cases in the English law, in which preg-
nancy requires to be verified, is of a civil nature.   It is in relation to the Chan-
cery writ "de ventre inspiciendo."   A woman may assert that she is pregnant
at the time of her husband's death, and  the heir  at law may sue out a writ to
require some proof of her alleged pregnancy, as his right to the estate of which
the husband died possessed may  be materially affected by the result.   Until
within a recent period, the decision of the question  of pregnancy was left to
twelve matrons and twelve respectable men, according to the strict terms of  the
ancient writ; but in one of the most recent cases, it was considered advisable
to depart from this absurd custom, and  to  place the decision in the hands of
medical practitioners.
   In May, 1835,  a  gentleman named Fox  died, leaving a widow, to whom he
had not been married more than  six weeks.  By his will, made some months
before his death, he left the great bulk of his property to the use of Ann Bake-
well, spinster, for the term of  her natural life, so long as she  remained sole and
unmarried; and after her decease or marriage, to one John Marston.   Soon after
the making of the will, this Ann Bakewell  became the wife, and  subsequently
the widow of Mr. Fox.   Notwithstanding that she had married the testator him-
self, the plaintiff  Marston claimed the property from the widow, on the ground
of her having infringed the terms of the will by her marriage with the  testator!
She pleaded pregnancy, and in August, 1835, the writ  "de ventre  inspiciendo"
was sued out of chancery by Marston.  Some discussion took place in court as
to whether the writ should be  issued in its original indelicate  form or not; i. e.,
whether the female should undergo examination by the sheriff, assisted by twelve
matrons and twelve respectable men!  The widow petitioned  the  court not to
issue the writ; and put in an affidavit from her ordinary medical attendant, to
the effect that she was pregnant and too weak to undergo the proposed examina-
tion.  Ultimately  it was decided that two matrons, with a medical man on each
side, should visit  Mrs. Fox once a fortnight  until her delivery.   There was no
doubt of her pregnancy, and she was delivered at the due time, to the great dis-
appointment  of the residuary legatee.   (See Med. Gaz. xvi. 697; xvii.  191.)
The nature of this judicial examination will  be understood by quoting the terms
of the writ addressed to the sheriff.  "In propria persona tua accedas ad prasfatam
R. et earn coram  prasfatis videri et diligenter examinari et tractari facias  per
ubera et ventrem omnibus modis quibus melius certiorari poteris utrum impreg-
nata sit neene."   (Register Brevium.)  There can of  course  be no difficulty in
forming an  opinion  in such a case, provided the pregnancy be at all advanced.
It is, however, not a little singular, that in  the present  day any attempt should
be made to apply the feudal customs of a rude and barbarous age to the deter-
mination of questions which belong to an exclusively advanced state of medical
science.
   Plea of pregnancy in bar of execution.—The second case in which pregnancy
requires to be verified in  English law, is  in  relation to  criminal jurisprudence.
AVhen a woman is  capitally convicted, she may plead pregnancy in bar of execu-
tion.  The judge will then direct a jury of twelve married women, "de circum-
stantibus," to be impannelled,  and sworn to try, in  the words of the law, "whe-
ther the prisoner be with child of a quick child or not."   If they find her quick
with child, she is respited; otherwise the sentence will take effect.  In admitting
the humanity of the principle by which a  pregnant woman is respited until after
delivery, there are  two serious objections to the  practice of  the  common law,
whereby it is made to fall far short of what,  in a civilized country, society  has a
right to expect from it:  these  are, 1, that the question of pregnancy is allowed
to  be determined  by a  jury of ignorant women accidentally present in Court;
and 2d, that the respite is made to depend,  not upon proof of pregnancy, but 
360
PLEA OF PREGNANCY IN BAR OF EXECUTION.
upon the fact of the woman having quickened!   This sign of the pregnant state
has been known to occur so early as the third, and so late as the sixth month:
some females have even reached the seventh month without observing it: hence,
the infliction of capital punishment, under these circumstances, becomes a matter
of accident.   Quickening is a sign not easily established, except by extorting a
confession from the female;  and  this is the  only possible way in which, in a
doubtful case, the question could be  determined by a jury of  matrons.  They
commonly trust to feeling the motions of the child externally, but this at par-
ticular times is a purely accidental circumstance.   It must be obvious, on the least
reflection, that the means resorted to by the  English law to determine such a
question are bad, and quite unfitted for the present  state of society.  Several
modern cases show that a jury of matrons may be very easily deceived with re-
spect to this sign of pregnancy.  In the case of Rex v. Wright, the prisoner was
found guilty of  the murder of her husband by poison.  She  pleaded pregnancy
in bar of execution.   The judge impannelled a jury of matrons; and they, after
a form of examination had been gone through,  brought in a verdict of not quick
with  child.   The woman would have been executed, had not several medical
practitioners of  Norwich represented to the judge that the method taken to de-
termine pregnancy and quickening, was so unsatisfactory, that no reliance should
be placed upon it.   The prisoner was then examined by some medical men, and
was found to have passed the usual period of quickening!  The  judge respited
the prisoner, and the correctness of the medical opinion was confirmed by the
female being delivered, within four months afterwards, of a healthy full-grown
child.  (See  Med.  Gaz. xii.  22, 585;  Rex v. Wright, Norwich Lent Assizes,
1832.)   In a case tried in March, 1838, a woman was convicted of murder, and
pleaded pregnancy.   A medical opinion was here required.  The pregnancy, if
it existed, had  so little advanced, that  the practitioner was unable to give a
satisfactory report; and the  judge respited the  prisoner  for a month, in order
that the witness might have full opportunity to ascertain the fact.   Still the jury
of matrons  is occasionally resorted to.  Thus in the ease of Reg. v. Westwood,
(Stafford AVinter Assizes, 1843,) the  matrons were summoned  to  examine a fe-
male capitally convicted, and they negatived the plea!  It is  not a little remark-
able that, although in  so many cases the  matrons have given a wrong verdict,
and that in no  instance can they give a right one except as a matter of pure
conjecture,  the practice still continues.   Thus this antiquated system was again
revived  at  the  Central Criminal court, in 1847.   (Reg. v. Hunt,  September,
1847.)  This woman was convicted of murder: she pleaded  pregnancy, and the
matrons were impannelled and directed to use  "their best skill" to determine
whether the prisoner "was big with a quick child or not."   It was left to their
 option  to have the assistance of a surgeon.  In half an hour they returned  a
verdict "that she had not a living child within her."  The law was directed to
 take  its course, and the woman would  have  been executed, but  for  the inter-
 ference of the Secretary of State.  He directed that the prisoner should be ex-
 amined by competent medical men, who ascertained that she was really pregnant,
 and  had passed that stage  at which quickening is  most commonly perceived.
 She was therefore respited, and the error in the verdict of the matrons was clearly
 proved by the birth of a child on the 28th December!
    It is unnecessary in the present day  to discuss the question, whether, until
 the period of quickening, the child be or be not "pars viscerum  matris.''   The
 vulgar opinion  is, that the foetus  only receives life when the woman quickens:
 but the law should not base its decisions in reference to capital punishment upon
 vulgar opinions.  As ovum, embryo  and foetus, the contents of the uterus are  as
 much endowed with special and independent vitality in the earlier as  in the later
 periods of gestation.  It is, then, absurd to fix upon an accidental and uncertain
 symptom, occasionally felt by the pregnant female, as the point at which clemency
 may be shown.  The bare proof of pregnancy, as in the  law of France (Art. 
CONCEALMENT OF PREGNANCY.
361
 xxvii. of the Penal Code) should be sufficient  to  authorize a suspension of the
 sentence.   The doctrine of quickening has  been abandoned in relation to the
 law of criminal abortion;  and there is still greater reason for its immediate abo-
 lition in reference to pregnant females capitally convicted.
   This change would, however, be attended with but little benefit if the decision
 of the question  of pregnancy were still to remain  in the hands of "matrons."
 The record of their mistakes sufficiently establishes the  correctness  of this view:
 for if they are unable to recognise  the pregnant state  at the fifth month, they
 cannot fail to be mistaken in their verdicts at  earlier periods.   It  is, moreover,
 an extraordinary circumstance, that when married women advanced  in pregnancy
 are themselves continually deceived, and are obliged to consult  medical men re-
 specting their condition, they should be specially selected by the law  as the per-
 sons best qualified to pronounce an opinion upon the pregnancy of a female, in
 a case involving the  infliction of capital punishment.   It would be  considered
 inhuman to execute knowingly  a pregnant  woman, but the imputation of in-
 humanity is not the  less  deserved  by a law  which virtually leaves  the issue in
 the hands of ignorant and incompetent persons.   The Americans  are certainly
 in advance of us in their legislation on this  subject.   Thus by the revised sta-
 tutes of New York, when pregnancy is pleaded in bar of execution,  it is enacted
 that the sheriff shall summon a jury of six physicians, and shall give notice to
 the district attorney, who shall have power to subpoena witnesses.
   These are, I  believe, the only two cases in which pregnancy has any direct
 relation to  medical jurisprudence; and  it is remarkable, that  with  respect to
 them, the law of England has expressly provided that they should be  left to the
 decision of  non-medical persons!   The following conclusions may  therefore be
 drawn:—-1.  That the cases in which the  signs of pregnancy  become a subject of
 legal  inquiry in England are exceedingly rare:—2. That  there is no case in
 English law, in which the medical man will not have an opportunity of performing
 an examination per vaginam:—3.  That a  medical opinion is never required by
 English law-authorities, until the pregnancy  is so far advanced as to render its
 detection  certain.   Hence discussions concerning areolae, the condition of the
 breasts, the presence of kiestein in the urine, &c, are really unimportant to the
 medical jurist.   By these remarks I do not intend to undervalue the importance
 of an accurate knowledge of the signs of pregnancy to a medical  practitioner.
 Cases which may never come before a Court of Law will be referred to him, and
 the serious moral injury which he may inflict on an innocent female by an inac-
 curate diagnosis  should make him scrupulously cautious in expressing an opinion.
 On this subject the reader may profitably consult a paper by Dr. Nelson (Lancet,
 November 22, 1851, p. 485.)
   Concealment of pregnancy.—According  to the law of Scotland, proof of preg-
 nancy is required, in charges of concealed  pregnancy, under the 49th Geo. III.
 c. xiv.  This has rendered it necessary to  establish this condition by the more
 common and outward signs, derived from the  appearance of the woman's person,
 — i. e. by the areola? around the nipples, the presence  of milk  in  the  breasts,
 &c.; but the Scotch juries wisely appear to  place  so little  confidence in these
 signs, that in the only two cases quoted by Alison, (Smith, 1761; Ferguson,
 1809,) they  acquitted the females.   (Criminal Law of Scotland, 154.)  These
 casual and uncertain  signs of pregnancy may be, however, of more importance
 in Scotch than in English practice.   Dr.  Seller, formerly the editor  of a respect-
 able Scotch  journal, who did me the favour to  notice  the  first edition of this
 work, appears to have entirely forgotten that there are any differences between
 the laws of  Scotland  and England in this  respect; for he  expresses perfect
astonishment at the statement made by me, that (the signs of) pregnancy rarely
demanded the attention of a medical jurist.  The facts  above mentioned appear
to me to establish the correctness  of this statement with respect to England; and
that so eminent a writer on the Criminal Law of Scotland as  Alison, was obliged 
362                      PREGNANCY IN THE DEAD.
 in 1832, to go back seventy years for a case in illustration, does not favour the
 view that questions connected with  this subject are  either frequently raised,  or,
 when raised, create much difficulty in that country.
    Pregnancy in a state of unconsciousness.—It was formerly a question whether
 a woman could become pregnant without her knowledge.   This may undoubtedly
 happen, where intercourse has taken place during profound sleep (lethargy,) or
 where a female has been thrown into this  state by narcotic  drugs.  But it is
 very difficult to admit that  any woman should  remain pregnant up to  the time
 of her delivery, without being conscious of her condition, if the  intercourse took
 place during the waking state.  A woman endowed  with ordinary intellect could
 not avoid suspecting her condition after the fourth or fifth month; and this alone
 would be sufficient to induce her to  seek advice, whereby the fact would become
 known to her.  When a woman is  impregnated in a lethargic  state, it is very
 unlikely that she  should go beyond the sixth month without being fully aware
 of her pregnancy,  as a female with  innocent  motives would  undoubtedly make
 some communication  to her friends.  Capuron mentions a case of this kind,
 where the fact of pregnancy was first ascertained at the end of the fourth month,
 by the female having complained to one of her sisters of a strange sensation which
 she experienced in the lower part of her abdomen.  (Med. Leg. des Accouche-
 mens, 86.)   In a  case related by Mr. Skey, a young female who had intercourse
 knowingly, was supposed  not to have been  aware of her pregnancy until the
 seventh month; but  there is some reason to believe that the woman was guilty
 of deception.  (Med. Gaz.  xxxix. p. 212.)   It is quite possible that women who
 are living in connubial intercourse may become pregnant without being conscious
 of it.   Dr. Ruttel mentions the case of a female, set. 41, who had been married
 upwards of sixteen years, and who while  returning from a neighbouring village
 was suddenly delivered of  her first child, when she had only a few days before
 been complaining  that she  was  not likely to have any children.   The child was
 born living and mature.   (Henke, Zeitschrift der S. A. 1844, 264.)  Many of
 these cases of alleged unconsciousness of intercourse and  pregnancy are,  however,
 quite unworthy of belief.
    Pregnancy in the dead.—I am not aware of any case  in law,  wherein the fact
 of pregnancy requires to be verified after the death  of a female.  The discovery
 of an embryo or foetus in the uterus would of course at once  solve the question,
 when the necessity for an examination occurred.   If the woman had obviously
 been pregnant, and the child was no longer in the womb, then several medico-
 legal questions may arise in reference to delivery.
    [The main question of pregnancy in a female just dead, or found dead, may
 often be important as collateral evidence, and for other reasons.   An interesting
 case, in which the inquiry  was  made long after death, is quoted by Dr. Beck in
•*■ the Am. Jour. Med. Sci. July, 1852, 269, from Casper in the Med. Times, Nov.,
 1851.  It is related by Casper "in exemplification of a  point he has frequently
 illustrated, viz., the much longer exemption which the uterus obtains from putre-
 faction  compared  to  other  organs."  A young woman  was missed, and  it was
 suspected that she was pregnant, and that her lover had made way with her.
 Nine months afterwards her body was found in a privy, having been macerated
 during that period in feces and urine.  Notwithstanding the horrible condition
 the soft parts generally had been reduced to, Dr. Casper, convinced that he could
 recognise the foetal bones  if there were any, searched for the uterus, and found
 it of a  light red colour, firm in texture, and of the normal size and form inter-
 nally and externally  of a non-pregnant organ.  Thus if the investigation threw
 no light  upon the cause of death, it at least wiped away an undeserved stain
 upon the poor girl's reputation.  We are not  told how the corpse was identi-
 fied.—II.] 
DELIVERY IN ITS LEGAL RELATIONS.
363
DELIVERY.
                           CHAPTER XLVIII.

DELIVERY IN ITS LEGAL RELATIONS--DELIVERY IN THE LIVING—CONCEALED DELIVERY--
  ABORTION IN THE  EARLY STAGES OF PREGNANCY—THE SIGNS SPEEDILY DISAPPEAR--
  EARLV EXAMINATIONS—SIGNS OF  RECENT DELIVERY  IN ADVANCED PREGNANCY--EVI-
  DENCE FROM THE  SKIN OF THE ABDOMEN--THE ORGANS OF  GENERATION--THE  PRE-
  SENCE OF THE LOCHIA—SIGNS OF DELIVERY AT A REMOTE PERIOD--FEIGNED DELIVERY
  —DELIVERY IN A STATE OF UNCONSCIOUSNESS--CIRCUMSTANCES UNDER WHICH THIS MAY
  OCCUR--NATURAL AND  MORBID SLEEP--ADMISSION OF  THE PLEA IN CASES OF ALLEGED
  CHILD-MURDER--SIGNS  OF DELIVERY IN THE DEAD--APPEARANCES OF THE INTERNAL
  ORGANS IN CASES OF RECENT DELIVERY--THEIR RAPID 6BLITERATION—TRUE AND FALSE
  CORPORA LUTEA--FALLACIES TO WHICH THEY GIVE RISE--EXAMINATION OF THE OVUM OR
  EMBRYO—ITS CHARACTERS FROM THE FIRST TO THE SIXTH MONTH--ABORTION OF MOLES
  AND HYDATIDS.   MEDICO-LEGAL CASES.

  Legal relations.—Delivery is a subject which  much more frequently requires
medico-legal intervention than pregnancy.  It will  be sufficient to state, that the
concealment of birth,—the crimes of abortion and  infanticide, with  questions
relative to  supposititious children, are closely  dependent on the proof of partu-
rition.   This subject will admit of being considered under two heads:—1. As it
relates to delivery in the living;—2. As it relates  to delivery in  the  dead.   In
undertaking the investigation, we ought, if possible, to ascertain, either from the
female herself or from those around her, whether there was reason  to suspect
that she bad been pregnant.   If we can acquire any knowledge on this point, it
will materially facilitate our inquiry; but this is not  always possible.  It has
generally happened, that previous pregnancy has been so concealed, that few who
saw the woman suspected her condition: then again,  as the admission of her de-
livery by a living female may be the strongest proof  of her criminality, she will
perhaps resolutely deny it; and a medical practitioner has no right to  extort this
admission  from her.   From this it  will be  seen, that a medical witness must
often be prepared to prove the fact of delivery against the subject of the crimi-
nal charge.
  Delivery in the  living.  Concealed delivery.—The  signs  of delivery in the
living female will vary materially, according to the time at which that event has
taken place.   In common language, if the contents of the uterus be expelled
before the  sixth month, the woman is said to miscarry, or to have an abortion:
if after the sixth month,  she is said to have a premature labour.   The law  does
not admit  any such distinction: the expulsion of  the ovum, foetus, or child by
criminal violence, at any period of utero-gestation, is regarded as a miscarriage or
abortion.  It will therefore be proper, in treating this subject, to commence with
the earliest period at which the contents of the uterus  may be expelled, and to
make no artificial distinction between the signs of abortion and delivery.  It has
been well observed, that the sign's of delivery are indistinct in proportion to the 
364              EARLY ABORTIONS.   SIGNS OF DELIVERY.
 immaturity of the  ovum.  Thus, when it takes place  at  the  second or third
 month, there are scarcely any proofs which can be derived from an examination
 of the female.   All the ordinary signs of delivery at the full period will be ab-
 sent,—the development of the embryo not having been sufficient to cause any
 prominence in  the abdomen, or to give rise to those changes in the system which
 take place previously to  the  birth of a mature  child; e. g. enlargement of the
 mammae, and dilatation of the os uteri.  Abortion at this period (the second or
 third month,) is generally accompanied by a loss of  blood, which may manifest
 itself by its effects on the body.  This, however, can only give  rise to a suspi-
 cion.  At a  later  period of gestation there may be a discharge resembling  the
 lochia, and the os uteri may be found enlarged and soft; but from the small size
 of the foetus,  the outlet will present no  positive evidence of  delivery.   The
 quantity of blood lost may be greater, and may have a more decided effect on
 the system.  Of course, if the  ovum or foetus be found, then the presumption
 of abortion  is strongly  supported;  but those females Who designedly conceal
 their condition will commonly take effectual means to prevent the examiner from
 obtaining evidence of this kind.
   These remarks  relative to the state of the female apply to  an examination
 made recently after the abortion.  If any delay take place (and this is a very com-
 mon occurrence,) even the ambiguous signs which have been mentioned speedily
 disappear; so that after a period, which is  short in proportion to the earliness of
 the expulsion, no trace whatever will be discovered.   Dr. Montgomery met with
 a case, in which abortion took place with considerable hemorrhage at the  close
 of the second month.  Twenty-four hours afterwards, the os and cervix  uteri
 were almost completely restored to their natural state.  The vagina and exter-
 nal parts were  hardly, if at all  dilated, and  very little relaxed; the breasts ex-
 hibited,  very imperfectly, the appearances  which accompany pregnancy, the or-
 dinary sympathetic symptoms of which had been almost entirely absent.  (Cyc.
 Pr. Med. 504;  Devergie, i. 682.) In such a case as  this,—and for  such cases
 the medical jurist must be prepared, scarcely a presumption could have been en-
 tertained of the fact of delivery.  After twenty-four or  thirty-six hours, in the
 greater number of cases of  early abortion, we  may expect to find, from a personal
 examination of the female, no proofs whatever of this event.
   In order to determine the signs of a "miscarriage," as it is termed by our law,
 at an advanced period  of gestation, it will be necessary to describe those which
 are considered to be characteristic of delivery at the full  period.   There will be,
 in these  cases, only a difference in degree; the signs being  more numerous and
 more clearly marked in proportion to the  lateness of the period at which the
 contents of the uterus are expelled.   The  signs of delivery may be enumerated
 in the following order:
   Signs of recent delivery in the living.—The female is weak, the countenance
 pale; the eyes surrounded  by livid areolae, and there is an appearance of general
 indisposition.   Any severe illness may,  however, give  rise to similar symptoms.
 Their sudden occurrence from a  state of previous good  health, especially when
 pregnancy is known or suspected, will create a strong suspicion.  The breasts are
 full, especially about the third or fourth day; the nipples are turgid, and the
 areolae around them  present all the characters of  advanced pregnancy.
   1. The skin of the abdomen is relaxed, sometimes thrown into folds; the cuticle
 interrupted by light-coloured broken streaks, passing especially from  the groins
 and pubes towards the umbilicus; and  the navel is more or less stretched raid
 altered.  The round form of the enlarged and  semi-contracted  uterus may be
felt at the lower part of the abdomen, generally lying towards one or the other
 side.  The apparent size of this organ will depend upon the degree to which it
 has contracted,  and therefore greatly upon the time at which the examination is
made.   Dr. Montgomery has pointed  out the existence of a dark line, extending
 from the pubes to the umbilicus, with a dark  areola around the latter, in cases of 
DELIVERY AT A REMOTE PERIOD.
365
recent delivery; but he has found this line to exist independently of pregnancy
and delivery,—in one case in a girl aged ten, and in another instance, in a lady,
labouring under ovarian tumours.
  2. The organs of generation will be found externally swollen, contused, or
even lacerated, with coagula of blood about them.  The outlet is much dilated;
the os uteri is considerably open, and its margin completely relaxed.
  3. The presence of the lochia.  This is a discharge, first of a sero-sanguineous
liquid, but which  afterwards  appears as a  brown or green-coloured serum.  It
commences soon after delivery, and continues from a week to  a fortnight, or even
longer.   The lochial discharge has so peculiar an odour, that some have regarded
this alone as furnishing very strong evidence of recent delivery.
  The signs which  have been here enumerated are found only when no delay has
taken place in making the examination, and the woman has been recently delivered.
In some strong and vigorous females, the  body resumes its natural state within
a few days, and the traces of parturition may have either wholly disappeared, or
have become so ambiguous as to furnish no satisfactory evidence.  In others, again,
evidence of delivery will be obtainable for a fortnight or three weeks afterwards.
In most cases, however, it is difficult, if not impossible, to  say, after the lapse of
eight or ten days, that delivery has certainly taken place, the signs having com-
monly by that time disappeared.  In all cases, the earlier the  period at which the
examination is made, the  more satisfactory  will be the evidence obtained.  Dr.
Montgomery once  examined a female five days  after delivery at the full time,
and he was particularly struck with the degree to which the parts had become
restored to their natural condition, especially the os and cervix uteri, which hardly
differed from their natural unimpregnated form.  (Cyc. Pr. Med., loc. cit.)

   Signs of delivery at a  remote period.—A question may arise, whether it be
in the power of  a medical practitioner to determine  the period at which the de-
livery  took place, i. e., how long  a time has elapsed.  This becomes necessary
where, in cases of  concealed birth,  abortion, or infanticide (some time after sus-
pected parturition,) a child is found, and it is required to determine,  whether
the time which has elapsed since the birth  of the child, either dead or living,
correspond with the supposed  delivery of a  suspected female.   An opinion may
be given,  within eight or ten days after delivery, from  the state of the  breasts,
of the lochia and of the os uteri; but it becomes difficult after the sixth day; and
where the tenth or  twelfth day has passed, it becomes still more difficult.  After
two or three months, it may be regarded as impossible to assign  the period of
delivery with any degree of precision.  (See Devergie, Med. Leg. i. 446.)
  Again in a case of pretended delivery,  contested  legitimacy, or disputed chastity
(Frazer v. Bagley, see post, Defloration,) the medical jurist may be required
to say, whether a female has, at any antecedent period of her life, been delivered.
This question,  it must be remarked, can be raised only in respect to delivery at the
full period, since there is no doubt that abortion in the early  stage of pregnancy
may take place, and leave no traces of such an event discoverable in after  life.
Indeed, a few days or weeks are sometimes sufficient to obliterate all evidence of the
fact.  AVith respect to delivery at the full term, certain signs have been mentioned,
which by  some are considered  indelible.  These  are the shining streaks on the
skin of the abdomen, a brown  mark reaching  from the umbilicus to the pubes,
and the state of the os uteri, which is said never to close so effectually as in the
virgin.  In regard to the  appearance of the skin of the abdomen, it may be re-
marked, that any morbid causes giving rise to  the distention of the cavity,—as
ovarian  enlargement, or ascites,—will produce the same effect;—so, also, to a
certain extent, will  extreme emaciation from a state of obesity.  Then, again,
these marks on the skin are not always persistent throughout life.   Besides, a
woman may be, according to  the  statements of good observers, not only once,
but repeatedly delivered, without having these marks produced. 
366
CASES OF UNCONSCIOUS DELIVERY.
   AVith regard to the state of the os uteri, it is liable to vary in different females,
and to be  affected  by disease,—so that a certain  judgment  cannot always be
formed from its condition.  In a female who has not borne children, the mouth
of the uterus is in the form of a slit, the angles being bent down, and giving to
it the appearance of the os tincse.   Mr. Whitehead has observed, that in a woman
who has borne children, the mouth becomes elongated, and loses the slight bend
at each of its extremities; the labia are thickened, and more nearly of equal size;
the commissures are less clearly defined, and the whole cervix is enlarged, and
not so compact in texture.   (On Abortion, p. 195.)   It must be remembered,
however, that  the  condition of the os uteri, even  in  the virgin, varies at each
menstrual  period.  Should there be occlusion of  the vagina, or  the hymen be
found imperforate,  this will at once negative a previous delivery;  but the latter
condition will not negative a previous pregnancy, since a woman may have been
impregnated and have had an abortion in the early stage of pregnancy, without
the necessary destruction of the hymen.   This sort  of negative evidence  will
sometimes  be of great value.  There is a total want of good affirmative evidence
of delivery at a remote period, in the living;  so that even a conjectural opinion
should be expressed only with caution.  It is extremely rare,  however, that any
decision  on this subject is required in medical jurisprudence.   It might  be de-
manded, in a question of infanticide, where a woman was accused of having de-
stroyed her alleged  offspring some months or years before; or in cases of contested
legitimacy, where a female is accused of having substituted a child of which she
pretends she has been delivered at  some remote period of time.
   Feigned delivery.—Delivery has often  been feigned by females, for the pur-
pose of extorting charity, compelling marriage, or disinheriting parties who have
claims to an estate, and in other cases without any assignable motive.   Of course,
an  imposition of this kind could not be sustained before a  medical practitioner;
and detection  is rendered easy,  because it is recent, and not remote delivery
which is assumed.   The  latter would, if pretended, be generally  cleared  up by
an  examination,  as well as by circumstantial evidence.   (See  case, Med. Gaz.
xix. 231; also another by Capuron, Med. Leg. des Accouchemens, 110.)
   Can a female  be delivered unconsciously?—Another important question, rela-
tive to delivery in the living female, is whether a woman can  be delivered with-
out being conscious of it.  The signs of delivery may be discovered by the prac-
titioner;  the offspring may also be found.   The female may admit the fact of her
delivery, but allege that she was totally unconscious of it.  The only medico-legal
case, in which this  plea is occasionally raised, is .in infanticide; and as the pos-
sibility of the occurrence may be questioned, the practitioner must be provided
with a knowledge of those facts which medico-legal  writers have accumulated re-
specting  it.   There is no doubt that a female may be  delivered unconsciously, if
she be labouring under coma, apoplexy, asphyxia, or syncope; or if labouring
under the effects of narcotic poisons, the vapours of chloroform and ether, or in-
toxicating liquors.  It is said, also, that delivery has  taken place spontaneously,
while a female was in the act of  dying.   This, however, has no bearing on the
present question.   It is in those cases where a female, after her recovery, pleads
unconsciousness of delivery, that  medical practitioners are  chiefly  consulted.
Besides the cases enumerated, hysteria, when  accompanied by loss of sense and
motion, has been mentioned as a state in which parturition is liable to occur un-
consciously.   AVe need not be surprised at delivery taking place under these
circumstances, when  we  consider that  the contractile power  of  the uterus is
altogether independent of volition; but it is difficult to believe, unless the morbid
states already mentioned  are accompanied  by the  most profound lethargy and
entire loss of sensation, that the contractions of this organ, in its efforts to expel
the child, should not suffice at once to rouse  the individual into  consciousness.
AA7e ought particularly to expect this in primiparous females;  i. e. in those who
have never borne children.  At the same time it must be remembered, that par- 
CASES OF UNCONSCIOUS DELIVERY.
367
turition with some females especially where the pelvis is wide and the child small,
takes place with such rapidity and ease, as scarcely to be accompanied by pain.
  It has been observed, that when a woman has frequently borne children, deli-
very sometimes takes place without effort, and without any consciousness on her
part.   On  other occasions, the female  may lie in a  kind of torpor or  stupor,
and have no recollection of her delivery.  Mr. King has described the  case of
a woman, aged thirty-six, the mother of nine  children.   She received his assis-
tance in her tenth labour: when  summoned, she was  lying calmly and placidly
in bed, and was perfectly insensible.   He found that the child had been expelled
with the placenta.  The woman did not recover her sensibility for ten  or twelve
hours, and then stated that she had no recollection of the birth of the child, or
of any circumstances connected with  that event.  She suffered no pain or un-
easiness.   Another case is  mentioned by this gentleman, in which  sensation
appeared to be entirely paralyzed during labour.   (Med. Times, May 15, 1847,
234.)  It is beyond doubt, that profound lethargy occasionally makes its appear-
ance  about the  time  of delivery.   Dr. Schulze met with a  case in which the
female remained in a state of sleep for  three days, and was delivered while in
this unconscious condition: on awaking she had no recollection of having suffered
any pain during delivery.  (Ann. d'Hyg. 1845, i. 216; Med. Gaz. xxxvi. 40.)
   The results obtained by the use of the vapours of chloroform and ether, show
that the expulsive efforts of the uterus are as energetic in the unconscious, as in
the conscious state.   It may appear extraordinary, however, that a primiparous
female, unless rendered unconscious by narcotic substances, should be delivered
without  suffering pain: nevertheless, a case  of this kind is recorded  by Dr.
AVharrie.  The woman's age was twenty-one:  she had been in labour about six
hours:  she complained of no pain, and the  child was born without effort or
consciousness.   The  child was healthy  but small, weighing  rather more than
four  pounds (Cormack's Journal, Jan. 1846,  12.)   Notwithstanding  this case,
it is  in the highest degree improbable that any primiparous female  should be
delivered, during  ordinary sleep, without being roused and brought to a sense
of her condition.
   Dr. Montgomery relates the case of a lady, the mother of several children,
who, on one  occasion,  was  unconsciously delivered  during  sleep.   (Cyc. Pr.
 Med.   See also case in B. and F. Med. Rev., No. ix. p. 256.)
   There is another condition in which a woman may state that her delivery took
place unconsciously;'and this, from its being  one of the most  common species
of defence set  up by a female charged with child-murder, must here  claim our
attention.   Thus she will allege, that while suffering from pain, she felt a strong
desire to pass  a stool:  that  she  went to the water-closet for  that purpose, and
was there  delivered without  knowing any thing of the occurrence, until it was
too late to save the child.  This kind of desire is a  very constant symptom of
the parturient state;  and, as it has been elsewhere remarked, it is often difficult
in private practice to restrain a woman from yielding to the feeling, when it
certainly would be attended with hazard to the child.   We must therefore admit,
that an accident of this kind is quite within the range of probability; although
here, as in every other  instance where unconscious delivery is pleaded, the
medical witness ought to inform  himself of all the particulars which  are stated
to have attended delivery, before he gives an answer specially applicable to the
case.  As  a general truth, it cannot be denied that delivery may take place,
under these circumstances, without the woman being conscious of it:  but before
we make the admission in regard to any particular instance, we ought to have a
full statement of the facts from the female herself.   It is thus  that we shall
avoid the risk of seeing a premature medical opinion set aside by the subsequent
production of circumstantial evidence.  Besides, it has been very properly ob-
served, that after an accident of this kind, a  woman cannot be ignorant of her
having been delivered. 
368
SIGNS OF DELIVERY IN THE DEAD.
  Females who have raised this  plea in cases of child-murder, have often been
known to maintain that they were unconscious of their pregnancy;  and thus have
attempted  to excuse themselves for not having prepared the articles  necessary
for child-birth.  It is possible^that a female may not be aware of her pregnancy
in the earlier stage; but it is scarcely credible that  she should remain ignorant
of it in the later period of gestation, or up to the time of her delivery.  It is at
least to be presumed that  she must have some reason to suspect her condition;
and if only a suspicion existed in the mind of a woman who did not contemplate
the destruction of  her future offspring, there would assuredly be  many circum-
stances forthcoming, which would vindicate her innocence.
  Signs of delivery in the dead.—It will now be  proper to  examine the signs
of delivery which are derivable from a post-mortem examiriation of  the body.
Occasionally,  we may obtain some account of the female during  life, by which
our labour will be  much facilitated: but, on the other hand, every fact may be
studiously concealed from us, and  then we may be required to prove not only
the  delivery,  but  the previous  pregnancy.   These investigations relative  to
pregnancy and delivery in the  dead body, are almost  exclusively confined  to
cases of  criminal abortion, where the contents of the uterus have  been expelled
at the sacrifice of the life of the woman.  Death commonly ensues in these cases
within two or three days after delivery; and then satisfactory proofs are obtain-
able  on an examination of the body;  but  if the female has survived three  or
four weeks, it will  be  as  difficult to determine delivery in  the dead,  as in the
living subject.  This  remark applies  to delivery at the full period;  for if the
uterus have expelled its contents in the first months of pregnancy, the traces of
this expulsion will have generally disappeared in the course  of a few days.
  According to Burns, the following may be taken as the chief appearances when
the body is examined soon after  delivery at  the full period.  The uterus is like
a large flattened pouch from nine to twelve  inches  long, its  mouth being wide
open.  The cavity contains coagula of blood or a sanguineous fluid; and its sur-
face is covered with the remains  of a decidua.   In the part to which the placenta
has  been attached, the substance of the organ appears exposed, presenting se-
veral large semilunar  or valvular openings.   This portion of the  uterus is of a
very dark  colour, so as to have given rise to a suspicion that the organ was gan-
grenous.   The vessels are extremely large and numerous.  The Fallopian tubes,
round ligaments, and ovaria, are  so vascular (full  of blood) that they have a
purple colour.  The spot whence the ovum  has escaped is more vascular than
the rest of the ovarian surface.   Obstetric writers differ greatly in their, state-
ments respecting the size of the uterus  at different periods after parturition; and
these differences may  be explained, partly by the fact that  the uterus contracts
more rapidly in some females than in others, and partly, perhaps, by the circum-
stance of the  birth having been, in some instances, premature.   According to
Dr.  Montgomery, after delivery at the full period, and under perfect contraction
of the uterus, if the body be  examined within a  day or two, it  will be found
seven inches long and four broad.   Its parietes on making a section will be from
an inch to an inch and a half in  thickness, and will  present the orifices of a great
number  of large vessels.   At the  end of a week the organ is between five and
six inches, and at the end of a fortnight about five inches in length:—the density
of the parietes has during this  period increased,  but their thickness or  sub-
stance has considerably diminished.  The inner surface is still bloody, and covered
partially with  a pulpy substance resembling the decidua.  The  orbicular direc-
tion of the fibres around the internal orifices of the tubes, is at this  time very
distinct.   In  about a  month the  uterus will have  become fully contracted;  but
the  os uteri rarely, if ever, closes so completely as in the virgin state.   In a case
examined  by  Dr. Barnes, where  a primiparous female, aged  36, died from puer-
peral fever on the sixth day after delivery, the following appearances were  met
with in the uterus.   The internal surface was blackened and congested, especially 
         EVIDENCE AFFORDED BY THE PRESENCE OF CORPORA LUTEA.      369

 in those parts to which the placenta had been attached.   There was the appear-
 ance of suppurative action in this part.   The substance of the uterus appeared
 healthy: there was  no pus in  the sinuses.   The  os  uteri showed considerable
 ecchymosis.   The vagina was healthy;  the iliac veins contained nothing but
 loosely coagulated blood.  There was in the left ovary a small, well  marked
 corpus luteum, having a central cavity.  (Med.  Gaz. xli. 294.)
   From this statement of the  appearances, it will be seen that there  must be
 considerable difficulty in determining the period  prior to death at which partu-
 rition  took place.   The difficulty is increased when the female has been prema-
 turely delivered, or if death has not taken place until some time  after delivery.
 Our opinion may be  then  in  some  degree  strengthened by searching for those
 signs which  have  been described as characteristic of parturition in the living.
 These, if present, will always furnish strong corroborative evidence, not only of
 the fact of delivery,  but of the period at  which it had probably occurred.
   Evidence  afforded by the presence of corpora lutea.—The condition  of the
 ovaries has been considered to furnish very strong evidence in the dead body,
 not so much of delivery as of previous pregnancy.  These organs, as it has been
 already stated, when examined soon after delivery, are  found of a deep purple
 colour, owing to their extreme vascularity.   If the female has really been preg-
 nant, we may expect to find on one  or the other of these bodies, the appearance
 which is denominated a corpus luteum.   The accounts given by obstetric writers
 of the characters of corpora lutea, and the evidence which they are capable of
 furnishing in legal medicine, are very conflicting.  Dr. Montgomery states, that
 in the true corpus luteum the ovary presents a protuberance with a distinct ci-
 catrix on some part whence the ovum has escaped.  The  protuberant part will
 be found on  section to have an oval form, and to be of a dull yellow colour.  It
 is very vascular, and in  texture resembles the  section of a kidney.   In the
 centre of this section there will be either a cavity or a radiated white  cicatrix,
 according to the period at which the examination is made.   The cavity remains
 for about three or  four months after conception,  and is surrounded by  a strong
 white cyst:—as  gestation advances, the opposite  sides approximate, and a radi-
 ated white  cicatrix results.  The size and vascularity of the  corpus luteum are
 considerably diminished by the time gestation is completed; and in about five or
 six months afterwards, i. e. fourteen months after its  first  formation,  it disap-
 pears altogether from the ovary, so that  the corpus luteum of one conception is
 never to be found  with  that of another, unless a premature expulsion of the con-
 tents of the uterus has taken place.   (Cyc.  Pr. Med., Pregnancy, 496;  see also
 Edinb. Monthly Journal, Jan., 1845, p. 58.)  The presence of a corpus luteum,
 as it is here described, does not prove that a woman has borne a child.   In the
 opinion of  some obstetric authorities, it establishes that conception  has taken
 place;  but the embryo may have been converted into a mole or a blighted foetus,
 and expelled at an early period.  It was  formerly supposed that one true corpus
 luteum only was met with in pregnancy with one child; but among other facts
 which  show that such an inference  is erroneous,  is a singular case reported  by
 Dr. Renaud to the Manchester  Pathological Society.  He examined the body of
 a female who died in the seventh month  of her pregnancy, and from whose
 uterus he extracted a foetus.  There were no traces of a blighted ovum.  The
 ovary,  however, presented two distinct and well  marked corpora lutea.    (Med.
 Gaz. xxxix. 599.)   Had the ovary alone been examined, it  might have been
 supposed that this  female had had twins.
  The characters of what has been hitherto denominated the false corpus luteum
have been thus described:—1.  There is no  prominence  or  enlargement of the
ovary generally,  at the part where it is  situated.   2. The .external cicatrix is
wanting.  3. There are often  several in both  ovaries.  4.  The  texture is not
glandular, nor can  it be injected.   5. AArhen laid open by section, it has neither
a central cavity,  nor  the cicatrix which results from its  closure.   Dr. Patterson
       24 
370
TRUE AND FALSE CORPORA LUTEA.
has published some remarks on this subject, with medico-legal cases and plates.
(Ed. Med. and Sur. Jour. liii. p. 49.)  According to this gentleman, the false are to
be distinguished from the true corpora lutea by the following signs.   They have in
general an irregular form, and want either the central cavity lined with a distinct
membrane or  the puckered cicatrix.  They have  no concentric radii, and are
frequently numerous in both ovaries.   He relates the following case in order to
show that the presence  or absence of a true corpus luteum may be sometimes
important in a question of disputed identity in the dead.  Four medical students
were charged with having disinterred the body  of a lady;  but the body was so
disfigured that the deceased could not be identified  by her relatives.   In one of
the ovaries a true corpus  luteum was reported to have been found; a discovery
which, if true, proved that it could not be the body of that lady,  since she was
a virgin, and advanced in life.   On the trial the medical evidence was very con-
flicting;  one half of the witnesses maintained that the body which was found in
the ovary was a true corpus luteum, while the others contended that it was  not!
   Since  the first  appearance  of this work, there have been many  contributions
to our knowledge on this subject.  In opposition to the views of Dr. Montgomery
and Dr.  Patterson, Dr.  Knox, an experienced anatomist, asserts that there is no
distinctive character whereby what has been called  the true, can be known from
the false corpus luteum, the only difference being that  the latter is smaller.
What have been  called corpora lutea  may be  formed in virgin animals, inde-
pendently of intercourse; and the time of their disappearance from the ovary
varies from three months to an almost indefinite period.   (Med. Gaz., Dec. 22,
1843.)  That there is considerable difficulty in  distinguishing the  true from the
false corpora lutea, is proved by reference to a case reported in the Medical Ga-
zette (xxxiv. 623,) in which two experienced observers differed.  Dr. Lee thought
that the preparation which was the subject  of examination was not a corpus lu-
teum, while Mr. Wharton Jones thought that it was,—founding his decision on
a microscopical examination.  This difference of opinion shows that a diagnosis
is by no means so simple a matter as some writers assert.   Mr. W. Jones agrees
with Dr. Knox an considering  that  a  corpus luteum may occur in the ovaries,
independently of coitus;  and the existence  of one in this organ would therefore
afford no proof whatever of  coitus having taken place.   The discovery of the
ovum in the uterus, in process of development, could alone, in the  present  state
of our knowledge, warrant an affirmative opinion on this point in a court of law;
and this I believe to be the safest view of this much-contested question.   On the
other hand, the absence  of a corpus luteum from the ovary would not warrant
the opinion that coitus had not taken place.
   These views regarding the evidence derivable from the presence of  corpora
lutea, have received considerable support from  the researches of  Professor Bis-
 choff.   (Med. Gaz. xxxv. 443, et seq.)  The experimental investigations of this
 gentleman  appear to show that  the extrusion of an ovum, or the production of a
 corpus luteum, is by no means necessarily connected with  coitus:—that the ova
 undergo a  periodical  maturation, about the time  of menstruation, and escape
 whether there be coitus or not;—therefore that fecundation is only likely  to occur
 when intercourse is had about this period.   This is also the opinion of Racibor-
 ski: indeed, some  physiologists now regard menstruation  as the  alternative of
 conception (see Dub. Quart. Jour., May, 1846,  p. 426,) and consider that there
 is no period so favourable to  conception, as that which immediately follows the
 cessation of the menses.   In this respect the Koran  appears to conflict with the
 laws of  physiology, since  it is laid down by Mahomet that females  are impure for
 eight days  before,  and eight  days after menstruation.   (Rostan, Cours d'Hyg.
 ii. 438.)  It is not a little singular that this comprises the period at which, ac-
 cording to modern theories,  conception commonly takes  place.  Women may
 eonceive during the flow  of the menses; it  is also well ascertained that a woman
 who has never menstruated  may conceive, and that conception may take place 
PRODUCTION OF CORPORA LUTEA.
371
one or two days before the period of menstruation.  Raciborski has met with
several instances in illustration of these views.   (Advances in Physiology, Baly
and Kirkes, p.  59.)   In  the  theory above given, we  have an explanation why
corpora lutea, or  bodies  closely resembling them, are so often found in virgin
animals, and it would also account for  those differences of opinion  among  ex-
perienced  men,  which almost invariably occur when it becomes a debated ques-
tion whether a corpus luteum be true or false.  The theory would further  ex-
plain cases like  the following, reported by Mr. Elkington:—A woman aged forty-
two, who had not borne a child for seven years, died from diseased lungs.   On
the right ovary were two corpora lutea; and the Fallopian tube on that side was
larger and more vascular than on the  other.   The deceased expected to men-
struate the  day she  died, or  at least one  day  later.   (Prov. Med. Jour., Feb.
1845, 104.)  Dr. Ritchie, of Glasgow, has lately examined this subject, and  has
arrived at results which tend  to confirm the views of Professor Bischoff and Mr.
AV. Jones.  He calls the bodies corpora menstrualia vel periodica.   They may,
in his opinion, be formed independently of pregnancy, and may possibly assume
all the characters of what are called  corpora lutea, by some reflex excitement in
the uterine organs.   According to this gentleman, there are no fewer than eight
varieties, which are liable to have their characters intermixed.  (Med. Gaz. xxxvi.
985, 1058.)  A recent case,  in which a well marked corpus luteum was found
coinciding with menstruation in a female who had been executed, is reported by
Dr. Michel.  (Med. Gaz. xliv. 307.)
   A very full account of  the general  and microscopical characters of the true and
false corpora lutea, by Dr. Renaud, will be found in the Edinburgh Monthly
Journal, August, 1845, p. 589; and an excellent summary of the present state
of physiological knowledge on this  subject  is  given by Brs. Baly and Kirkes.
(Recent Advances in Physiology, 1848, p. 46.)   These gentlemen conclude from
their researches, that cases can seldom occur where the mere presence of a corpus
luteum can be taken as a proof of previous impregnation; and they consider  the
following rules  to be deducible from  the facts which they have collected.   1.  A
corpus luteum in its early stage (that is, a large vesicle filled with  coagulated
blood, having a ruptured orifice,  and a thin layer of yellow matter within its
walls) affords no proof of impregnation having taken place.—2. From the pre-
sence of a corpus  luteum, the opening of which is closed, and the cavity reduced
or obliterated, only a stellate cicatrix remaining, also no conclusion as to preg-
nancy having existed can be drawn, if the corpus luteum  be of small size,  not
containing as much yellow substance as would form a mass the size of a small
pea.—3.  A similar corpus luteum of larger size than  a common pea, would be
strong presumptive evidence,  not only of impregnation having taken place, but
of pregnancy having existed  during  several weeks at least; and the evidence
would approximate more  and  more to complete proof, in proportion as the size of
the corpus luteum was greater. (Op. cit. p. 57.)
   From this statement, it will be perceived that the difference is only relative
and arbitrary, chiefly depending on the size; and, as in pregnancy, corpora lutea
are found  of very variable size, while in menstruation they may, under great  ex-
citement, attain a large size, it is  obvious that  no safe inference can be drawn
from their presence, irrespective of other signs of impregnation.   The terms true
and false,  therefore, are inappropriate;  and the most serious mistakes may arise
by a reception of  evidence on this point.  The  law requires  absolute certainty,
not mere probability or presumption; and in the present state of physiology, the
proof falls short of what  is necessary to guide the verdict of a jury.  At a trial
for attempted abortion,  Reg.  v. Goodall, (Nott's Lent Assizes, 1846,) on  ex-
amining the body of the  female on whom the attempt was alleged to have been
made, it was found that  she  was not  pregnant;  but on inspecting the ovary, a
corpus  luteum was  there discovered.   This was described as false, apparently
because there was no proof of impregnation.   Had an embryo been found in tie 
372
EXAMINATION OF THE EMBRYO.  MOLES.
 uterus, or had there been proof of its expulsion, it would probably have been de-
 scribed as true.   Dr. Meigs very justly says, that corpora lutea may vary in size,
 but in all cases they are real.   Physiologically speaking, they do not admit of a
 division into true and false.   (Females, and their Diseases, 1848, p. 43.)
   From these considerations,  therefore, it appears  to  me, we can  only come to
 the conclusion expressed in former  editions of this work, that medical evidence
 respecting the nature of a corpus luteum in an unknown case, if received in a
 Court of Law at all, should be received with the greatest caution, and only from
 a witness of great experience.  The old doctrine on this  subject, that the pre-
 sence of such a body on the ovary affords certain and undeniable evidence of im-
 pregnation, may  be regarded  as  completely subverted.   [For a most complete
 and splendidly illustrated monograph on corpora lutea,  see Dalton's prize essay,
 published by the Am. Med. Assoc, 1852.—H.]
   Characters of the ovum or embryo to the sixth month.—Hitherto the examina-
 tion has been confined to the female; but it is now necessary to describe the
 characters of the ovum or embryo at the early stages  of pregnancy, since, when
 this can be  procured, good medical evidence may be derived from an examination
 of  it.   If the ovum be expelled within a month after conception, it is scarcely
 possible to detect it, owing to its small size and its being enveloped in  coagula
 of  blood.   Burns examined three uteri, within the first month, where no expul-
 sion had taken place, but even under these favourable circumstances he failed in
 discovering the-ovum.   At first the ovum contains no visible embryo; but it ap-
 pears merely to consist of vesicular membranous coverings.   According to this
 writer, when first distinctly seen through its membranes, it is of an oblong form
 and about a line (the twelfth of an inch) in length.  At the sixth week, it is
 slightly curved, resembling, as it floats, a split pea.   In the seventh week, it is
 equal in size to a small bee; and by the end of the second month, it is bent, and
 as long as a kidney bean.   After this, development goes on rapidly: the features
 are in part well marked, and the extremities are gradually formed.   At the third
 month, the foetus weighs from one to two ounces:—when  stretched  out it mea-
 sures  about three inches, and  the genital organs, although the sex is not distin-
 guishable, are large in proportion to the rest of the body.  The membranes are
 larger than  a goose's egg.  At the  fourth  month the foetus  is from five to six
 inches long, and weighs from two to three ounces; at the fifth month it measures
 from  six to  seven  inches, and weighs from five to seven ounces;  at the sixth
 month, its length is from eight to ten inches, and its weight about a pound.
 (For the characters of the child beyond this  period, see ante, p. 284.)  The great
 difficulty will consist in determining the nature of the  supposed ovum or embryo
 between the second  and third month.   In making the examination, it should be
 placed in water, and all coagula gently washed away or  removed by some blunt
 instrument.   Alcohol may be  used  as a substitute for water, after the blood has
 been removed.  If the embryo cannot be found, the decidua and chorion may be
 recognised;—the former, by its forming the  outer  investment with its  smooth
 internal and rough external or uterine surface; the latter,  by the villous appear-
 ance of that portion of it which would have become the placenta.  Between the
 third  and fourth month, the foetus may be commonly identified without much
 difficulty.
  Moles.—The substance expelled from the womb may have been what is termed
 a mole—a morbid production of a fleshy or of a bloody structure, appearing like
 a blighted ovum or  placenta.   It  has  been said  that  a mole is never formed  in
the virgin uterus, but that  its presence always indicates previous  sexual inter-
 course : this  point,  however, is far from settled.  The term mole is also applied
by some to coagula  of blood, polypi, or hydatids.   In one case reported, a mole
and an ovum were expelled  together,—a  fact which shows  that they may co-
exist.   The symptoms accompanying a mole strongly resemble those of  preg-
nancy :—and the appearances produced by its expulsion  are not to be distin- 
                            DELIVERY.  HYDATIDS.                      873

  guished from those attending the abortion of a foetus at an early period of gesta-
  tion.   The only means of diagnosis would  be derived from  an examination of
  the expelled matters.   The local injury produced by the expulsion of these bodies
  on the organs of generation, is by no means so great as that  caused by delivery
  at the full period.
    Hydatids.—The signs of pregnancy and delivery may be present in a female;
  and yet these may be owing to the existence of hydatids  in the womb.  It was
  formerly a  question, whether conception or previous impregnation was or was
  not necessary to their formation.  Dr. Koch, of Heiligenbeil, has reported a case
  where they were probably produced  independently of sexual  intercourse.  A
  healthy strong woman, 32  years of age, had been married nine years, and had
  borne four children without difficulty.  At this time she was living apart from
  her husband, so that according to the declaration of both there could have been
  no intercourse.   The menstrual function ceased after the weaning of the last
  child, and the patient observed  that her abdomen became enlarged as if she were
  again pregnant.   After three months' suffering, during which she was continually
  upbraided by her husband in consequence of her condition, pains came on, and
  a hydatid mole (a cyst of hydatids) about the size of two fists was extruded.  The
  hydatids were collected in a grape-like cluster, and the  cysts varied in size from
  a hemp-seed to that of a  walnut.   (Wildberg, Jahrbuch der  gesammten S. A.,
  1837, 1 Heft, 145.)  In a case communicated by Mr. Hunter to the Lancet,
  hydatids co-existed with pregnancy, and the mass came away on the birth of the
  child.   (April 18, 1846, 430.)   When the mass is expelled,  it is found to con-
  sist of a group of vesicles or cysts of various sizes: but  sometimes, when this
  disease follows intercourse, the cysts  are found mixed with  the  remains  of a
  blighted ovum or a coagulum of blood.   Unless the expelled matters be produced,
  it would be very difficult to say, from an examination during life or after death,
  whether the uterus had contained an embryo or hydatids.  These morbid growths
  may even be enclosed in an investing membrane similar to  the decidua, and
  there may be the  remains of a corpus luteum in the ovary; but it is not likely,
  when  carefully examined in water, that they can be mistaken for an ovum or
  embryo.  An interesting case of the conversion of an ovum into hydatids will be
  found in the Med. Gaz. xlvi. 454.
   In examining the bodies of those who have died while  labouring under uterine
 hydatids, it has been found that occasionally the whole of a blighted  ovum  is
 converted into them;  but  sometimes only a part is thus converted.  The cysts
 vary in number:  there  may be  only one large cyst, and it is said this condition
 is more frequently met with when hydatids are combined with pregnancy or with
 a mole, than when alone.  The hydatid cysts  appear to be connected with the
 inner surface of the  uterus, by the unchanged portion of the ovum or placenta;
 and thus, upon their removal, we might expect to find the uterine surface more
 or less similar to that of the gravid state, according to the degree of change which
 may have taken place in the ovum.  Burns observes, that the relative magnitude
 of the vessels in the two states has not been ascertained;  few opportunities being
 afforded of examining the state of the organ in this disease.  According to Ma-
 dame Boivin, the hydatids are sometimes surrounded by an investing membrane
 similar to the decidua.   In a case which occurred to Mr. Brown, the  symptoms
 caused by uterine hydatids were  mistaken by the female (a married woman who
 had had children)  for those of true pregnancy.   The catamenia  had  ceased for
 about four months, the breasts were enlarged—there was a darting pain through
 them, with soreness of the nipples, and morning sickness.  In about  a month
 flooding took place,  and  the hydatids  came away.   (Obstetric  Record, i. 21.)
 These facts may have an important bearing on medico-legal practice, and in this
respect, the following case, reported by Dr. Chowne to the AVestminster Medical
 Society, Nov., 1843, will be found of interest:—A woman was seized with pains,
resembling those of labour, and  a mass of uterine hydatids was expelled, which 
871
HYDATIDS.  MEDICAL EVIDENCE.
were supposed to have been in the uterus about five months.  AVhen the woman
was examined, thirty-six hours afterwards, there were all the signs of recent de-
livery about her.   The parts of generation presented the usual appearances met
with on the expulsion of a foetus: the breasts were enlarged, the areolae  elevated,
of a brown colour, the follicles  prominent, and the organs evidently contained
milk.  The occurrence of this case led Dr. Chowne to think that had  the body
of an infant been found murdered and concealed in the house where this woman
lived, it would probably have been pronounced to be her child.   A medical man
might have strengthened the suspicion of criminality by declaring that there were
all the signs of delivery  about her.  It may be observed, however, that in such
a  case, the woman would probably state that no child, but some tumour, had
come away from her;  and a medical man would not be justified in swearing, that
the appearances  of delivery absolutely indicated, under  all circumstances, that
the woman must have been delivered of a child.   On the contrary, it is a well
known medical fact, that similar appearances might arise from the expulsion of a
mole or hydatids.  Circumstantial evidence would  be  against her, only on  the
assumption that some person had wilfully concealed or made away with the sub-
stantial proof of her innocence, i. e.  the group of hydatids which had  been  ex-
pelled.   Mr. Pearson  has  more recently communicated to the Medical Times
(Dec. 30,1848,) a case in which, after the expulsion of a mass of hydatids, there
were all the appearances which are usually observed after delivery.
   Some of the questions which  have been here considered, were raised on  the
trial of Angus, for the murder of Miss Burns, at the  Lancaster Assizes, 1808.
It was alleged that the  deceased was  pregnant,—that the  prisoner had admi-
nistered  corrosive sublimate to  her for the  purpose of inducing abortion, and
that this had caused  her death.  A question was raised  at the trial relative to
the appearances presented by the uterus as  indicative of recent delivery.  On
examining this organ, it was found to be considerably enlarged, and on its inner
surface was a mark, about four inches in diameter, plainly discernible,  to which
the placenta had been apparently attached.  The os uteri was  much dilated.
Indeed, the appearances  were described to be such as might have been  expected
to be found two hours after the  birth of a full-grown child.  The evidence  re-
specting previous pregnancy was conflicting; and the prisoner was acquitted,be-
cause the death of the deceased could not be distinctly traced to any criminal
act on his part.  The ovaries were not examined until  after  the trial, when a
body which was considered to be a  true corpus luteum was found on one  of them;
and some eminent authorities agreed that it indicated an advanced state of preg-
nancy.  (See Paris and  Fonblanque, Med. Jur. ii. 179.)  One medical witness
appeared for the prisoner;  and he contended that the state of the uterus did  not
justify the medical inference that there had been recent delivery.  He assumed
that the appearances might have been due to the expulsion of a group of hydatids.
On the whole, the medical defence, so to term it, appears to have been more in-
genious than sound;  and to  have  rested upon  assumptions, which, if generally
admitted, would effectually do away with all medical evidence in cases of criminal
abortion.   The contents of the uterus were not produced,—a fact which left  the
case in mystery. 
CONCEALMENT OF BIRTH.                      375
CONCEALMENT  OF  BIRTH.
                            CHAPTER XLIX.

 MEDICAL EVIDENCE REQUIRED IN REFERENCE TO DELIVERY--CONCEALMENT OF THE BIRTH
  OF A CHILD--DEFINITION OF THE CRIME--FEMALES ACQUITTED OF INFANTICIDE FOUND
  GUILTY OF CONCEALMENT--MEDICAL EVIDENCE FROM THE REMAINS OF THE BODY--ANA-
  LYSIS OF BONES--THE CHILD  MUST BE DEAD—CONCEALMENT OF THE OVUM OR EMBRYO
  —NOT NECESSARY TO PROVE WHEN THE CHILD DIED.

   Concealment of birth.—Medical evidence respecting delivery is required in two
 cases:  1, where the  birth of the child is wilfully concealed; and 2, where the
 contents of the uterus have been prematurely expelled by criminal means.  The
 concealment of  pregnancy is  no offence in the English law; but the concealment
 of delivery or of the birth of a child, is a misdemeanor by the 9 th Geo. IV. c.
 xxxi. sec. 14, the words of which are to the following effect:—
   "Be it enacted, that if any woman shall be delivered of a child, and shall, by
 secret  burying, or otherwise disposing of the dead body of the said child, en-
 deavour to conceal the birth thereof, every such offender shall be guilty of a mis-
 demeanor;  and being convicted thereof, shall be liable to be  imprisoned with or
 without hard labour in the common gaol or house of correction for any term not
 exceeding two years; and it  shall not be necessary to prove, whether the child
 died before, at,  or after its birth."
   This is the offence of which those females who are charged with infanticide
 are most commonly convicted, while the Scotch law punishes females for the con-
 cealment of pregnancy.  (Alison's Criminal Law, 153.)  The medical evidence
 on trials for this offence is exclusively derived from an examination of the mo-
 ther; and thus, much will depend upon the  time at which this is made.  With
 respect to the child, its body need not even be produced, provided there be satis-
 factory evidence of its death.   In the case of The Queen v. Varney, (Oxford Lent
 Assizes, 1*37,) it was proved that the prisoner had  been pregnant, and subse-
 quently delivered of  a child.   Its body had been burnt, and  only a few remains
 of the bones  of a human foetus were found in the ashes of a grate.  The priso-
 ner was convicted of the offence.  In a case like this, where an attempt has been
 made to destroy the body of  a child by burning, it will, of course, be necessary
 to have good  evidence that the bones are those of a human foetus or child. They
 may retain their shape whether burnt in a close fire or in the open air: in the
 latter case alone they will be white.   A small fragment only of  either end of
 any well  marked bone, will suffice for identification.   If burnt to a complete ash
 or powder, it will then  be difficult to identify them.   Orfila  was  consulted in a
 case of this kind, where a woman had burnt her child in an  oven, and its ashes
 had become mixed with those of wood.  He suggested, that on  calcining the
residue with potash, the ashes of a human foetus might be known by their yield-
ing cyanide of  potassium, owing to the nitrogen which would  remain  in and
about them.  The ashes of wood do not yield the cyanide under similar circum- 
376           CONCEALMENT OF BIRTH.  ANALYSIS OF BONES.
 stances.  (Ann. d'Hyg. 1845, ii. 129.)  The conclusions at which Orfila has ar-
 rived might, it appears to me, lead to a serious error;—the presence of a flannel
 dress, of  an old hat, shoe, or any nitrogenous substance, would, on incineration,
 give rise  to precisely similar results.  When  the form of a bone cannot be re-
 cognised, all that medical evidence  can, as it appears to me, accomplish, is  this:
 —The  detection of a large quantity of phosphate of lime in the ash, would in-
 dicate that bones were present,  and thus distinguish the  ash of bone from the
 ashes of  other substances.  Still the bones might have belonged to an animal,
 and not to a human foetus.  There are  no means of distinguishing the ash of
 human, from that of animal bone.
   According to the statute the child  must be dead—the  concealment of the
 birth of a living child not being any offence, unless  it  should happen to die be-
 fore its birth was made known.  In the case of The Queen'v. Woodman, (Kings-
 ton Lent Ass. 1845,) the woman  was acquitted because  the child was living
 when concealed.   Mr. Chitty says, that to constitute the offence, the child  must
 have advanced to the end of the seventh month (Med. Jur. 412;) but it is  to be
 presumed that the concealment of the birth of a dead child at  the sixth or
 under the seventh  month, would be as much an infringement of  the statute as
 if it  were more advanced.   The  concealment of the aborted but undeveloped
 ovum—a monster, i. e. of a child without human shape, a mole or other morbid
 growth, would not probably be considered a contravention  of  the statute.   Mr.
 Lane communicated to the Medical  Times (Aug., 1845) a case in which a charge
 of concealed birth was dismissed by the magistrates of Surrey, because the con-
 cealment referred  to  a child born  at the eighth month in its membranes.   The
 woman  stated that she did not consider it to be a child!  If this view be correct,
 the main  object of  the statute (i. e. to prevent secret delivery, so  often leading
 to murder) may be effectually  evaded.  The case  being  entirely new, should
 have been sent to trial, and the decision left to the proper interpreters of the law.
 A magisterial decision can furnish no precedent on a question of this kind.
  It will  be perceived, that it is  not material here, as it is in  a case of alleged
infanticide, to prove when the  child died,—whether before, during, or after its
birth;  and thus those subtleties and  technicalities which have been elsewhere
pointed  out in cases of infanticide, are avoided.   In regard to proof of conceal-
ment  and what constitutes it, these are essentially legal points:—but a medical
 practitioner may sometimes benefit  an accused party,  if he can prove that the
 female had made application to him  on the subject of her pregnancy and delivery.
 The law is especially lenient under such circumstances.   Questions connected
 with concealment of birth do not fall under the jurisdiction of a coroner:—the
 medical evidence is  therefore required by a magistrate.   Medical witnesses were,
 until lately, exposed to much trouble and inconvenience in  giving their evidence
 on these occasions (see Med. Gaz. xix. p. 287;) but the defect has been remedied
 by a recent statute.  (1 Vic. c.  xliv.)   [Concealment  of the birth  and death of
 a bastard child is a penal offence at common law in the United States;  and spe-
 cial statutes,  in most of the states, have rendered it a grave misdemeanor, pu-
 nishable with  fines and  imprisonment, according to the respective enactments. 
CRIMINAL ABORTION.  GENERAL REMARKS.
377
CRIMINAL  ABORTION.
                               CHAPTER  L.

 GENERAL REMARKS ON THE CRIME OF ABORTION—ABORTION FROM NATURAL CAUSES—ITS
   FREQUENCY.  CRIMINAL CAUSES—LOCAL VIOLENCE—ABORTION BY MECHANICAL MEANS
   —FROM VENESECTION—MEDICINAL SUBSTANCES—POPULAR ABORTIVES—SIGNS OF ABOR-
   TION IN THE FEMALE—SPECIFIC ABORTIVES--ABORTION NOT A RESULT OF POISONING--
   LOCAL  APPLICATIONS.  FEIGNED ABORTION--LEGAL  RELATIONS—MEANING  OF THE
   WORD  NOXIOUS AS APPLIED TO DRUGS--ON  INDUCING PREMATURE LABOUR—MEDICAL
   RESPONSIBILITY—PROOF OF PREGNANCY NOT NECESSARY—ABORTION OF MONSTERS—
   EXTRA-UTERINE CONCEPTIONS--ABORTION OF MOLES AND HYDATIDS.

   General remarks.—By abortion is commonly understood, in  medicine, the
 expulsion of thacontents of the uterus before the sixth month of gestation.   If
 the  expulsion take place between the sixth and ninth month, the woman is said
 to have a premature  labour.  The law makes no distinction  of this kind, but
 the  term abortion  is applied to the expulsion of the foetus at any period of p>reg-
 nancy, and in this sense it is synonymous  with the popular term miscarriage.
 Criminal abortion is rarely attempted before the third month:—it is  perhaps most
 common between the fourth  and fifth month, because then  a  female begins for
 the  first time to acquire a certainty of her pregnancy.   The causes of abortion
 may be either natural or violent.  The latter  only fall under the cognizance of
 the  law;—but a medical witness should be well acquainted with the causes which
 are called natural, in contradistinction to others which depend on the application
 of violence.  These natural causes are so frequent, that according to Mr. AVhite-
 head's observation,—of 2000 pregnancies,  one in seven terminated in abortion.
 These causes are commonly ascribable to peculiarities in the female system,—to
 the presence of uterine or other diseases, or to some moral shock sustained  by
 the woman during pregnancy.   Any diseases  which  strongly affect the uterus or
 general system of the female, may give rise to  abortion.   An attack of small-pox
 has been known to produce it; and it has  been suggested by Mr. Acton, that
 the presence of constitutional syphilis in the father is  not only a cause of infection
 in the offspring, but of repeated abortion in the female.  (Med. Gaz. xxxvi. p.
 164.)  These facts deserve attention, when it  is proved  that a woman has really
 aborted, and an attempt is unjustly made to fix an alleged act of criminality on
 another.   For further information on the numerous natural and accidental causes
 which may give rise to abortion, the reader may consult the work of 31 r.  AAThite-
 head (On Abortion and Sterility, p. 252.)   In considering the operation of these
 causes, it is proper to bear in mind that during pregnancy the uterus is subject
 to a natural periodical excitement, corresponding to what would have been the
 menstrual periods dating from the last cessation.  Hence  comparatively trivial
 causes operating at these periods, may lead to  an expulsion of the foetus.
  The violent causes of abortion may be of an accidental or criminal nature.  In
general, the distinction will  not be difficult:—the  kind of violence and  the 
378      NATURAL CAUSES OF ABORTION.   MEDICINAL SUBSTANCES.

adequacy of the alleged cause to produce abortion, will commonly clear up the
case.
   Criminal causes.   Local violence.—These  causes  are  either mechanical, or
they depend on the use of irritating medicinal substances.   They operate with
greater certainty in proportion to the advanced state of the pregnancy.  Among
the mechanical causes, may be  mentioned undue  exercise, the violent agitation
of the body, as  by riding or driving over a rough pavement, in which case no
marks of violence would be apparent.  Any physical  shock, sustained by the
body, may operate indirectly on the uterus.   Blows or violent  pressure on the
abdomen are sometimes resorted to; but in these cases the marks of violence will
be perceptible.   Instruments have been devised for the purpose of piercing the
membranes, destroying the child, and thereby leading to its expulsion.   Devergie
speaks of such instruments being well known in England, and of English mid-
wives deriving a living from the practice of this crime, a statement which it need
hardly be said is founded in error (i. 285.)  Although  mechanical means are
more effectual  in  producing abortion, than medicinal substances, yet from the
fact of such attempts being made by ignorant persons, the woman generally dies
from hysteritis, peritonitis, or  other serious  after consequences.  A case was
tried in the North of England some years since, in which the evidence  showed
that the prisoner had attempted to produce abortion in the deceased, by thrusting
wooden skewers into the  substance of the uterus.  Inflammation and gangrene
took place, and  the woman died.  The prisoner was  convicted and executed for
murder.   (For  a  similar case by Mr. M'Pherson, see Med. Gaz. xxxvi. 102.
See also a case in the same journal, vol. xlv. page 693.)   This kind  of injury
to the uterus always implies the interference of some other person in the per-
petration of the crime.   These mechanical means can seldom be  applied to the
uterus, without  leaving marks of violence on that organ,  as well as on the body
of the child.   If the mother die, a result which generally  takes place, an inspec-
tion will  at once  settle the point.   (Ann. d'Hyg.  1834,  191;  1838, i.  425;
1839, ii. 109.)  If the mother survive and the child  be expelled, then marks of
violence will be found on its body.   These marks may not  be sufficient to account
for its death;  but this is not here the question.   If it can be proved that they
have not resulted from accidental causes subsequently to delivery, then their
presence will furnish strong corroborative evidence of the actual means by which
abortion was attempted.   It is said that abortion has been in some instances
accomplished by frequent venesection.  This  effect may follow from the violent
shock produced  by the loss of a large quantity of blood.   An examination of the
veins of the arms would show whether any such attempt had been made.
   Medicinal substances.   These are perhaps more  frequently resorted to  for
inducing criminal abortion than other means; but they rarely answer the intended
purpose, and when this result is obtained, it is  generally at the expense of  the
life  of the mother.   Mineral  poisons have  been ignorantly employed  for this
nefarious object; as arsenic, corrosive sublimate, sulphate of copper, and other
irritants.   Croton  oil, gamboge, aloes (Henke, Zeitschrift,  1844, ii.  203,)
elaterium, and other drastic purgatives, have also been used for a similar purpose.
Purgatives which produce much straining,—powerful emetics or diuretics, will
readily excite abortion in the advanced stages of pregnancy;  but these violent
medicines fail in their effect at the earlier stages.   The substances just mentioned
exert an indirect action on the uterus by producing  a shock to the general sys-
tem :—but it is said there is a certain class of bodies called emmenagogues, which.
have a specific  action on the uterus itself.  Among  these, the  Ergot of rye, or
 Secale comutum, is particularly mentioned.   This substance has been found, in
many instances, to bring on violent action of the uterus at an advanced stage of
gestation, or when efforts at parturition had  already  commenced.  There is,
however, considerable difference of opinion respecting its emmenagogue properties.
 According to Dr. Lee, it has no effect, at least in the early stages of gestation, 
                 CRIMINAL ABORTION.   SPECIFIC ABORTIVES.            379

 although given  in  very large doses.  (Med. Gaz. xxv. 10;  see also Ed. Med.
 and Surg. Jour. liii. 27.)   Dr. Kluge, of Berlin, found that its properties varied
 according to whether it was  gathered before or after harvest:—in  the former
 case, it had an energetic  action, while in the latter it was powerless.   The
 properties of the secale are  not at all known to the vulgar; and this may account
 for the fact of our rarely hearing of cases where it has been criminally adminis-
 tered to  pregnant  females.  Dr. Beatty  states  that  when used in  obstetric
 practice it is liable, by absorption into the system of the mother, which may take
 place within two hours, to endanger the life of the child.   (Dub. Med.  Jour.
 May, 1844,  202.)   This question was actually  referred by the French Govern-
 ment to the Academy of Medicine in 1845, as there was reason to think that
 under its employment children were frequently born dead.   (Ann. d'Hyg.  1846,
 i. 204.   See also Med. Gaz.  xlvi., p. 680.)  In  confirmation of Dr. Beatty's
 statement, Drs. M-Clintock and  Hardy report, that out of thirty cases in which
 it was administered, twenty children were born dead.   CPractical Observations,
 95.)  .                                              V
   Among substances which have acquired popular repute as abortives, are savin,
 rue, iron-filings,  squills, black hellebore, and cantharides.   None of  them have
 any influence on the uterus, except in affecting  it indirectly by their  irritant ac-
 tion on the system.   (For  an account of the poisonous properties of savin, see
 ante, p. 124.)   In the coroner's return for 1837-8, there were four cases of the
 administration of savin and other drugs with the view of procuring abortion.
 In three of these cases, the mother died undelivered;  in the fourth, the  child
 perished.
   Specific abortives.   Ergot.—On trials for criminal abortion perpetrated or at-
 tempted, a medical witness must  be prepared for a close examination on the spe-
 cific emmenagogue properties  of the drug administered.   A very instructive case
 which occurred a few years  since (Reg. v. Colder,  Exeter Lent Assizes, 1844,)
 has been ably reported, with  comments, by Dr. Shapter (Prov. Med. Journal,
 April 10, 1844.)  It was alleged in this case, that savin, cantharides, and ergot,
 had been  respectively given by the prisoner, a medical  man, for the  purpose of
 procuring miscarriage.   The  prosecutrix was a woman of notoriously bad cha-
 racter, and the prisoner was acquitted.  There were three medical witnesses, who
 agreed that savin and cantharides were only likely to occasion abortion indirectly,
 i. e. by powerfully affecting the system—the view commonly entertained by pro-
 fessional men.   Some difference of opinion existed  with  regard to  Ergot.   Dr.
 Shapter stated in bis evidence, that he did not think the ergot would act unless
 the natural action of the uterus had  commenced,—a statement supported by a
 number of authorities.  Subsequently to the trial, he collected the observations
 of many obstetric writers, and so far modified his opinion  as  to admit that the
 ergot might  occasionally exert a  specific action on the uterus, in cases of ad-
 vanced pregnancy, where uterine action had not already commenced.   His sum-
 mary on this subject is one  of the best which has been  published.   Dr. Rams-
 botham  has reported three cases,  from which it would appear that the ergot may
 in some instances exert a direct action on the impregnated uterus.  In these in-
 stances, the females were  in or about  the  eighth month of pregnancy.  (Med.
 Gaz. xiv. 434.)   Dr. J. H.  Davis also believes  that it  is  a specific excitant of
 uterine action, and points out the cases in which, in his opinion, it may be safely
 employed.  (Lancet, Oct. 11, 1845, 393.)   Mr. AVhitehead, who has had con-
 siderable experience on this  subject,  has found that its action  is very uncertain.
 In a case under his care, where,  in a woman with  deformed  pelvis, it was con-
 sidered advisable  to procure  abortion  in  the fifth month of pregnacy, the  ergot
 alone was  employed,  and at  first with the  desired effect.   It was given in  three
successive pregnancies; and  in each instance labour-pains came on after eight or
ton doses had been administered,  and expulsion  was effected by the end of th e
third day.  It was perseveringly  tried in a fourth pregnancy in the same indivi- 
380                 ABORTION.   SAVIN.   OIL OF SAVIN.
dual, and failed completely.   (On Abortion, 254.)   It  also failed  in  a  recent
case in the hands of Dr. Oldham.   (Med. Gaz. vol. xliv., p. 49.)  Nevertheless,
the balance  of  evidence is now decidedly in favour of its specific action.; and,
according to Dr. Griffiths, this is so well known to the inhabitants of the United
States, that it  is in very frequent use  as a popular abortive.   Perhaps the dif-
ferences which have been observed  in  its action  may depend on the period at
which it has been administered to a pregnant woman.  Admitting that the uterus
is subject to periodical excitement,  corresponding to  the  menstrual periods, it
is probable  that the action of the ergot may be more powerfully abortive at these
than at other times.  The reader will find a large  collection of cases, illustrating
the properties of this drug, in Wibmer, (Arzneimittel und Gifte, ii. 80.   Sphace-
lia Segetum.)   Ergot has been supposed to exert a prejudicial  action on foetal
life, even when given with innocent intention.  For some remarks on this subject
by M. Danyau, see Med. Gaz. xlvi. p. 680.
   Savin.   Oil of Savin.—There appears to  be  less  doubt about the action of
savin.  In  a case which I was required to investigate  in 1845, various questions
were put as to whether this substance, which had been taken in  the state of pow-
dered leaves, and had caused the death of a woman, exerted any specific  action
on the uterus to induce labour.  The reply was  given, that, in large doses, it
acted only indirectly as an abortive  by its irritant properties.   (See Med. Gaz.
xxxvi. p. 646.)  It is proper to remember, that  the infusion  is more powerful
than the decoction; since the poison, being a volatile oil, is dissipated by long
boiling.   Savin is, however, most commonly taken  or administered in the form
of powder.  In a case tried at the Cornwall Lent Assizes, 1852 (Reg. v. Pascoe,)
the  accused, a medical man, was convicted  and sentenced to transportation for
administering oil of savin to a female with intent to procure miscarriage.  The
proof of intent rested partly on medical and partly on moral circumstances.  It
appeared that the  prisoner had given fourteen drops of the oil, in  three doses,
daily—a quantity  which, according to the medical evidence at the trial, was
greater than should have been  prescribed for any lawful purpose.   The medici-
nal  dose, as an emmenagogue, on  the authority of Christison, is from two to five
minims, and, according to Pereira, from two to six  drops.  The quantity given
by the prisoner, although a full dose, was not, therefore, greater than these au-
thorities recommend; and his criminality appears  to me to  have rested  not so
much on the dose given, as on  the question whether he knew, or as  a medical
man had reason to  suspect, that the female  for whom  he prescribed it was preg-
nant.  No medical authority would recommend  oil of  savin in  full doses for
pregnant females;  and with regard  to  the existence  or non-existence of preg-
nancy in a special  case, medical men  are reasonably presumed to have better
means of satisfying themselves than non-professional persons.   The prisoner's
innocence, therefore, rested on the presumption that he  implicitly believed what
a young woman told him regarding her  condition,—that he had no  reason to
suspect her pregnancy, and therefore did  not  hesitate to select and prescribe a
medicine which is  very rarely used  by practitioners,  and certainly has an evil
reputation.   If the prosecutrix  is  to be believed,  she  told the prisoner that she
had disease of the heart and liver, and that nothing  more was the matter with
her.  It is  absurd to suppose that oil of savin  should be prescribed for such a
disease as this.  The  prisoner, on the hypothesis of innocence, must have in-
tended the medicine to act on the uterus, and must have inferred the existence
of an obstruction of menstruation from natural causes irrespective of pregnancy.
The jury do not appear to have given him credit  for  such ignorance of his pro-
fession, and this probably led to his conviction.   At  the same time it is impos-
sible to subscribe to the  unqualified statement of one of the  medical witnesses
for the  prosecution,—that no  person of competent knowledge would prescribe
oil of savin in  such quantities except for abortion.   Every competent man would
undoubtedly satisfy himself that a young female,  whose menses were obstructed,
was not pregnant, before he prescribed  full doses of this oil three times a day, or 
SIGNS OF ABORTION.
381
he would  fairly lay himself open to a  suspicion of criminality.   If pregnancy
were only suspected, this would be sufficient to deter a practitioner of common
prudence from prescribing in any dose a drug which may exert a serious action
on the system.   (A report of the case of Mr. Pascoe will be found in the Med.
Times and Gazette, April 17,  1852, p. 404.)
  The oil of savin is obtained by the distillation of the tops in the proportion of
about three per cent.   It has a yellowish colour, and the peculiar terebinthinate
odour of the plant, by which  alone it may be recognised.  [We  have already
spoken, ante 124, of the oil of tansy as a popular abortive in the U. S.   A
very interesting report  of a  case of poisoning from this cause is  given  by Dr.
John C. Dalton, Jr., in the Am. Jour.  Med. Sci., Jan., 1852, 136.   Patient, a
healthy-looking girl about 21  years old, took f. gj. and f. Jiij. of oil of tansy,
about six hours after a hearty dinner.   She was found insensible and in convul-
sions soon after she must have taken the drug.  Death ensued at the end of three
hours and a half altogether.  A strong odour of tansy was observed in the breath
before death, and in the peritoneal  cavity, stomach, and interior of the heart at
the  autopsy.  The uterus  contained a  well formed foetus about  four months'
old, which did not either in itself or  its membranes present any evidence of having
been disturbed.   Dr. D. refers  to another fatal case of similar character, (Am.
Jour. Med. Sci. May, 1835,) in which a woman, but a few weeks pregnant, took
f. ^ss. of the oil and didfnot entirely lose her consciousness until three-quarters of
 an hour had elapsed, although she  was  convulsed at intervals before  that time.
 She died without abortion within two hours after taking the poison.—H.]
   It is  remarkable, that the action  of the most powerful mineral irritant poisons
 has sometimes no effect on the gravid uterus.  In July, 1845, a case was referred
 to me for examination by Mr. T. Carter, of Newbury, in which a female, aged
 twenty-two  years, who  had passed the fifth month of  pregnancy, took a large
 dose of arsenic, and died in  less than  seven hours, having suffered from severe
 vomiting and purging  during that time:  yet abortion did not take place!   In
 reference to the medicinal use of mercury, it may be proper to state, that Dr.
 Salomon has reported two cases, in which premature delivery appeared to follow
 the mercurialization of the system.  (Casper's Wochenschrift, June, 1845; Med.
 Gaz. xxxvi. p. 658.)
   Local  applications.—In  a case  which  occurred  recently in  France, it  was
 proved  that abortion had been caused by the injection of some corrosive and ir-
 ritating substance into the vagina.  The female genitals, as well as  the abdominal
 viscera, were found in a high state of inflammation.  (Med. Gaz. xxxvii. 171.)
 This is a very unusual mode of perpetrating the crime;  and it is one which could
 hardly  escape detection.  An analysis of the tissues might be required, to deter-
 mine the nature of the  substance used.
   Signs  of abortion.—These have been already fully considered in a previous
 chapter.  (See Delivery, ante, pp. 363 and 368.)  The examination may ex-
 tend to the female living or dead.  In  the former case, there will be some  diffi-
 culty if the abortion have occurred  at an early period of gestation,  and some  days
 have elapsed before the examination is made.   In the latter case the diagnosis
 is more easy, although  not  always free from difficulty.   One fact here requires
 to be especially noticed.  It is now believed by many physiologists, that men-
 struation is a state, in  some measure,  vicarious to conception; and the  appear-
 ances presented by the generative organs during the menstrual period, are some-
 what similar to those which are observed after conception in its early stage.  Mr.
 Whitehead  remarks, that in persons who have died while the menses were  flow-
 ing, the uterine walls have been found  thickened  and spongy, and the mucous
 lining more or less turgid and suffused.   The cervix and labia of the uterus were
 tumid,  the orifice patulous, and the vaginal membrane and clitoris involved in
 the increased action.   One of  the  ovaries was found larger and more congested
 than ordinary,  presenting evidences of the recent escape of an ovum.  (On Abor- 
/
382              CRIMINAL ABORTION.  LEGAL RELATIONS.

tion, 196.)   Unless these facts be attended to, the examiner  may form a very
erroneous opinion respecting the chastity of a deceased female.
   Feigned abortion.—For various motives, into the consideration of which it is
unnecessary to enter, a woman may charge another with having attempted or per-
petrated the crime of abortion.  Such a charge is not common, because, if untrue,
its falsity is easily demonstrated.  A young woman, admitted  into Guy's Hos-
pital, in April, 1846, charged a policeman, who, according to her statement, had
had forcible intercourse with her, with having given her some substance to pro-
duce  abortion, and with having subsequently effected this  mechanically.  She
was not examined until nearly  two months after the alleged perpetration of the
crime, when  Dr.  Lever found that there was no reason to believe she had ever
been pregnant.   This was a case  of feigned abortion.  When charges of this
serious kind  are brought forward, they are always open to the greatest suspicion,
unless made  immediately after the alleged attempt, as it is then  only that an ex-
amination can determine whether they be true or false.  If so long delayed as
in this instance,  without any satisfactory reason, the presumption  is that they
are false.
   Legal relations.—The English law relative to criminal abortion  is laid down
in the statute 1 Vict. c. lxxxv. s. 6.  By it,  capital punishment, which formerly
depended on whether the female had quickened or not, is abolished. The words
of  the statute are as follow:
   "Whosoever, with the intent to procure the miscarriage  of any woman, shall
unlawfully administer to her, or cause to be taken by her,  any poison  or other
noxious thing, or shall unlawfully use any instrument or other means whatsoever,
with the like intent, shall be guilty of felony, and being convicted thereof, shall
be liable, at the discretion of the Court, to be  transported beyond the seas for the
term of his or her natural life,  or for any term, not less than fifteen years, or to
be imprisoned for any term not exceeding three years."
   It is considered doubtful, whether, under this statute, a woman could be tried
for abortion attempted on herself.   The consent, or even the solicitation of the
female for the perpetration of the crime, does  not excuse the offender. The crime
would never be attempted without the consent of the woman; and, therefore,  to
admit this as  sufficient defence, would be equal to an entire abrogation of the
law.  The  means must have been used with the intent to procure the miscarriage
of a woman,—a point which will be sufficiently established  by  a plain  medical
statement of the means  employed.  Supposing that a drug has been used, the
witness will have to state whether it be "a poison, or other  noxious thing;" for
this must be  proved, in order that the prisoner should be convicted of the crime.
I must refer the reader to what has been said elsewhere (ante,  p. 34,)  in order
that he may be able to judge how far the substance administered would fall under
the description above  given.   Whether the substance administered  would or
would  not  have the effect intended, i. e. of  inducing abortion, is perfectly im-
material.   Some  uncertainty may exist as to the  strict  meaning  of the word
noxious:—all will allow that the word implies something injurious to the system;
but a difference of opinion may arise among witnesses with respect to its appli-
cation  to the  substance under discussion,—as, for example, with respect to rue
or savin.  A substance must be regarded as injurious to the system, or noxious,
either according to the form, quantity, or frequency with which it is administered.
Savin  and  rue are irritant; and become noxious when given in large doses,  or
in small doses frequently repeated.  (Ann. d'Hyg. 1838, ii. 180.)  Aloes and
castor-oil are  innocent when  taken in small doses; but they acquire noxious  or
injurious properties when  administered frequently, or in large quantity, to  a
pregnant female.   To  confine the term noxious, therefore, to  what is  strictly
speaking a poison, would be giving  a latitude to attempts at criminal abortion,
which  would  render  the law inoperative.    (See  the case  of  Reg. v.  Stroud,
Abingdon Summer Ass. 1846.)  The quantity of the substance taken at once 
       ON INDUCING PREMATURE LABOUR.   MEDICAL RESPONSIBILITY.    383

does not affect the question, provided the dose be frequently repeated.  A case
in which I was consulted by Mr. Reynolds (a former pupil,) was  tried at the
Exeter Winter Assizes, 1844.  Two powders, weighing each one drachm,  were
prescribed by the prisoner,—one  consisted of colocynth, the other of gamboge,
and with them was half an ounce of  a liquid (balsam of copaiba.)   They  were
to be mixed together, and a fourth part to be taken four mornings following.  Mr.
Reynolds said, in answer to the question whether such a mixture was noxious or
injurious,  that each dose would be an active  purgative, and might thereby  tend
to produce abortion.   One dose would not be productive of mischief in a healthy
country woman, but its frequent repetition might lead to serious consequences.
In an interesting trial, which took place at the Norwich Lent Assizes, 1846 (Reg.
v. Whisker,) it was proved that the prisoner had caused to be taken, by the pro-
secutrix, a quantity of white hellebore, in powder, for the purpose of procuring
abortion.  One medical witness said, he considered hellebore to be noxious to the
system, but he knew of no case in which  it had produced death; and under these
circumstances he did not consider himself justified in calling it a poison.  Another
medical witness  declared that in his opinion it belonged to the class of poisons.
The judge, in  summing up, told the jury that that  was to be regarded as a poi-
sonous drug which, in common parlance, was generally understood and taken to
be such; and he thought the evidence sufficiently strong to bring hellebore with-
in the meaning of the statute.  The jury found the  prisoner guilty, alleging that
in their belief white hellebore was a  poison.   (Med.   Gaz.  xxxvii. 830.)
The only circumstance calling for remark in  this case is, that any doubt should
have been entertained by a medical practitioner respecting the poisonous proper-
ties  of  white hellebore.   It  is a powerful vegetable irritant, and has caused
death in several instances; yet on this occasion it appears to have been admitted
to be noxious, but not poisonous.
   In reference  to the proof of this crime, it  is not  required, under  the circum-
stances, that  any specific  injury should have been done  to  the woman, or  that
abortion should have followed, in order to complete  the offence.  There is every
reason to believe that this crime is very frequent; but its perpetration is  secret.
Applications are continually made to druggists, by the lower class of people, for
drugs for this purpose: the applicants appear to have no idea of  the criminality
of the act.  (See, in reference to the frequency of this crime, a paper in the Med.
Gaz. xlvi.  p. 487.)
   [In many of the States no statute law exists on the subject of  criminal abor-
tion,  whilst in others severe  enactments have been passed.   Thus in  New
York, any person  who shall  wilfully  produce abortion, except to preserve the
life of the mother, and advised by two physicians to such effect, and the result
be the death of mother or child, shall be deemed guilty of manslaughter in the
second degree.  The enactment also goes on  to recite, that  whosoever shall ad-
minister any substance or employ any means to procure abortion, except in the
cases  just alluded to, is liable to fine or imprisonment, or both.   In Ohio,  Mis-
souri, and Connecticut, somewhat similar laws exist.  Vide note by Dr. G. 2d  Am.
Ed. of this work.—H.]
   On inducing premature labour.  Medical responsibility.—It may be proper to
offer here a few remarks upon the practice of  inducing premature labour, which
is adopted by some members  of the profession, in cases in which there happens
to be  great deformity of the female  pelvis.  This practice has been condemned
as immoral and illegal; but it is impossible to admit that there can be any im-
morality in performing an operation  to  give  a chance of saving the life  of a
woman, when by neglecting  to perform it, it  is almost certain that both herself
and the child will perish.   The question respecting its illegality cannot be en-
tertained;  for the means are administered or. applied with the bona fide hope of
benefiting the female,  and not with any criminal design.  It  is true that the law
makes no exception in favour of medical men who  adopt this practice, nor  does 
384
IS PROOF OF PREGNANCY NECESSARY?
it in the statute of wounding make any exceptions in favour of surgical opera-
tions; but what is performed without evil intention, would not be held unlawful.
The necessity for the practice ought to be apparent;—thus, for instance, it should
be shown that delivery was not likely to take place naturally, without seriously
endangering the life of  the woman.   It is questionable whether, under any cir-
cumstances, it would be  justifiable to bring on premature expulsion, merely for
the purpose of attempting  to save the  life of the  child, since the operation is
necessarily accompanied with risk to the life of the mother.   The grounds upon
which  many eminent authorities have  objected  to this practice  are:—1. That
there are few cases in which parturition, if left to itself, might not take place at
the full period.—2. The toleration of the practice  might lead to  great criminal
abuse.—3. It is attended with danger to the mother and child.   It is undoubt-
edly true, that parturition will sometimes take place safely at the full time, even
when the deformity of the pelvis  is apparently so great as to lead many ac-
coucheurs to suppose natural delivery to be utterly  impossible.  Dr. Lilburn
has reported the case of a female who laboured under great deformity of the
pelvis, but who  was  twice delivered in  safety, and the  child survived.   (Med.
Gaz. xix. 933.) It is therefore, not improbable that many cases of the kind  are
prematurely treated, which, if left to themselves, would probably do well with-
out interference.  Hence a cautious selection should be made;  because the ope-
ration is necessarily attended with some risk,—it does not ensure safety to the
woman and child.  All that we can say is, that according to  general professional
experience,  it  places her in a better position than she would be in, if the case
were left to itself.   It appears to  me  that before a practitioner resolves upon
performing  an operation of this kind, he should hold a consultation with others;
and before it is performed, he should feel well assured that delivery cannot take
place without greater risk to the life of the mother, than  the operation itself
would create.   These rules may  not be observed in practice; but the nonobser-
vance of them is necessarily attended with some responsibility to a practitioner.
In the event of the death of the mother or child, he exposes himself to a prose-
cution for a criminal offence, from the imputation of which, even an acquittal
will not always clear himjin the eyes of the public.  If the child were born alive,
and died merely as a result of its immaturity, this might give rise to a charge of
murder.   Within  a recent period several practitioners have been  tried upon
charges of criminal abortion,—whether justly or unjustly it is not necessary to
consider; but one fact was  clear, they neglected  to adopt those  simple measures
of prudence, the observance of which would have  been at once an answer to a
criminal charge.  Because one practitioner may have frequently and successfully
induced  premature labour without observing these rules, and  without any im-
putation on his  character, this cannot shield another who  is less fortunate.   A
charge  is only likely to arise where  a man has been unfortunate; and the re-
sponsibility of  one operator cannot be measured by the success of others.  For
a case  in which a surgeon was transported for seven years, on conviction of this
act criminally perpetrated, see Alison's Criminal Law, 628.
   A case of some  interest  occurred at Portsmouth, in which a female died from
hemorrhage, which took place during an  attempt to  induce premature labour.
A small aperture was discovered  after death in the left common iliac artery, and
more than  a pound of blood had been effused.   This was ascribed to a thin-
ning of  the coats of the artery, and not to a puncture of the vessel during  the
operation.  (See Lancet, July 22, 1848, p. 107.)  For some judicious remarks
on  the  induction of premature  labour, by Dr. Radford, see  Med. Gaz. xlvii. p.
583.
   Is proof of pregnancy necessary ?—A female may imagine that she is pregnant,
when she is labouring under ovarian dropsy, or other uterine or abdominal disease.
Under this mistaken view, an attempt may be made by another, also deceived as
to her condition, to procure abortion;  and  the proof of the corpus delicti  will 
ABORTION.  ATTEMPTS ON NON-PREGNANT FEMALES.        385
here rest with the medical evidence.   The pregnancy of the female is not alluded
to in the recent  statute;—the words being,—"procure the  miscarriage of any
woman."   These might at  first sight appear to include the state of pregnancy;
but the term "miscarriage" has a much more extensive meaning than this in a
popular sense.  The question in reference  to the necessity of the proof of preg-
nancy has  been hitherto  variously decided  by our judges.   A case was tried on
the Midland Circuit, July,  1838, where a medical practitioner was charged with
this crime.   Chief Justice Tindal held, that without positive proof of the woman's
pregnancy, which, however, was distinctly alleged in the indictment, a conviction
could not take place.   In this instance, the woman herself denied her pregnancy,
and there was no evidence  in  support of it.  The judge  directed an acquittal.
On the Spring Circuit of the same year, a man was tried at Lincoln, on a charge
of administering a certain noxious drug to a female, with the intent to procure a
miscarriage.  The jury stated  their opinion that  the girl was not pregnant when
she took the  drug.   In  this case the prisoner was discharged.  More recently,
in the case of Reg. v. Haynes (Cent. Crim.  Court, 1843,) the prisoner was found
guilty of administering a drug with intent to procure abortion, when the woman
was clearly proved, by the dissection of her body, not to have been pregnant.
  The question whether the state of pregnancy be or be not an essential condition
in reference to charges of criminal abortion, has, however, been decided in the
negative, on a conference of the  judges, in the  case of The Queen v. Goodall
(Notts Lent Ass. 1846.)  The deceased, believing herself to be pregnant, applied
to the prisoner to procure abortion by puncturing the membranes.   Some instru-
ment was used for this purpose;  and deceased, who had laboured under chronic
cough, died, as it was alleged, from the maltreatment of the prisoner.   The body
was "inspected, and it was clearly proved that  deceased was not pregnant.  The
defence was—a want of proof that the prisoner believed deceased to hava  been
pregnant, and therefore that the mechanical operation alleged to have bean per-
formed, might have been resorted to for the purpose of relieving her from  other
symptoms under which she was suffering.   The most important point urged in
the defence, however, was, that the crime of abortion was not complete without
pregnancy; and  therefore the prisoner could not  be convicted under the statute.
A verdict of guilty  was rendered, but Coltman, J. on this occasion reserved the
question for the consideration of the judges.  At the following Assizes, Coleridge,
J. delivered judgment.   The judges held that the conviction was right.  (Med.
Gaz. xxxvii.  831.)
  It is,  therefore, established by this decision, that a person believing a female
to be pregnant, and perpetrating  on her an act which would  amount to an at-
tempt at abortion if the female were really pregnant, may be equally  convicted
under the statute.   Hence the words "procure the miscarriage of any woman"
do not necessarily imply proof of pregnancy, nor can the term "miscarriage " be
considered to  apply only to a woman in the pregnant condition.  It is remarkable
that the same questions arose under the old statute, 43  Geo. III. c. 58, in which
the words "being with child" were used; yet even here Lawrence, J. held that
pregnancy was not necessary to be proved, and that the crime of abortion would
be complete although the woman was not  pregnant.   (Rex v. Phillips, Paris,
Med. Jur. iii. p.  88.)
  An attempt made on non-pregnant females should certainly be  treated  as a
crime, and  punished accordingly; but, medically  speaking, abortion presupposes
pregnancy; and  if a woman be not pregnant, the carrying out of the intent by
the prisoner is a physical impossibility;  yet, as the law is  now  expounded, a
person may be convicted of attempting to  procure miscarriage in a female who
cannot miscarry.
  It would appear that according to the law of France proof of pregnancy is not
essential.   Dr. Bayard relates a case in which a woman was convicted, in 1846,
of an attempt to produce  abortion in a female who was  subsequently proved not
      25 
386
ABORTION OF MOLES AND HYDATIDS.
to be pregnant, but to be labouring under ovarian disease.   The  prisoner was
sentenced to eight years' imprisonment.   (Ann. d'Hyg. 1847, i. 466.)
  Abortion of monsters.—Would the law apply if the  child were dead in the
uterus, or if it were a monster without human shape?   The symptoms indicative
of the death of the child in utero  have  been elsewhere stated.   The  death of
the  child subsequently to the attempted abortion, might perhaps be  adduced
as corroborative evidence of the crime; but even if it were dead at the time of
the attempt, a conviction would follow.  (Reg. v.  Goodall, supra.)  It cannot
be doubted  that the expulsion of  a dead child would come under the popular
signification of a miscarriage;  and if the words were strictly interpreted,  a
prisoner might be convicted  whether the child were  living or dead;  for it has
been already said, that it is not necessary that any abortion should have taken
place.   With respect to  monsters, the question actually arose in a case tried at
Drome, in France, in 1841.   (Gaz. Med. Juillet, 1841; also Brit, and For. Rev.
xxiv. 563.)  A girl was accused of procuring abortion.   The  aborted foetus, of
about the sixth month, was acephalous, and there was no vertebral canal for the
spinal marrow.   Other organs were also deficient or  imperfectly formed.  The
medical witnesses declared that it had never breathed, and that its life had ceased
with gestation.   On the upper part of the body was  a wound, which had  been
produced by a pointed instrument, probably just before it was expelled.  This
they thought  had caused  death.   The counsel for the prisoner  contended
that this could not be regarded  as a case of criminal abortion, owing to the
monstrosity of the offspring; and  the jury acquitted her.  As in this country
proof of pregnancy is no longer required, monstrosity would make no difference
in the crime.
   Extra-uterine  conceptions.—Would the law apply to cases of  extra-uterine
pregnancy?  There can  be  no doubt that the crime of abortion would apply to
cases of this description; and a  person would be equally amenable for the at-
tempt, whether the foetus were in the uterus or in  the Fallopian tube.  The
symptoms of extra-uterine pregnancy,  especially of the tubal kind, are very simi-
lar to those of ordinary pregnancy: they are  not to be distinguished from  them
in the early stages (see Med. Gaz.  xxxvi. 103.)
   Abortion of moles and hydatids.—The use of the word miscarriage in the sta-
tute, without any explanation of the meaning assigned to it, might, but for the
decision in  the case of Reg. v. Goodall, have created some  difficulty on  trials for
abortion.  In a popular sense (and  here a popular appears to have been purposely
selected in preference to a professional  term,) miscarriage signifies the violent
expulsion, not merely of a child, but of moles, hydatids, and other diseased growths,
or even of coagula of blood.  In these last mentioned cases,  the woman is not
actually pregnant, although she and the prisoner may imagine that she  is.   The
recent  decision in the case of Reg. v. Goodall, shows that it is unnecessary to
 speculate on this subject.  Whether the uterus contain these morbid growths, or
whether it be in  the virgin state, the party accused may still be convicted  of an
 attempt to procure abortion. 
LIVE BIRTH IN CIVIL CASES.
387
BIRTH.   INHERITANCE.
                              CHAPTER LI.

EVIDENCE  OF LIVE BIRTH IN CIVIL CASES—LEGAL RIGHTS OF THE FCETUS IN UTERO—DIF-
  FERENCES BETWEEN ENTIRE AND PARTIAL BIRTH--CASE.--SIGNS OF LIVE BIRTH INDEPEN-
  DENT OF RESPIRATION OR CRYING.--CONFLICTING MEDICAL EVIDENCE IN THE CASE OF FISH
  V. PALMER.—MOTION OF A LIP A PROOF OF LIVE BIRTH.—VAGITUS UTERINUS.—POSSESSIO
  FRATRIS--TENANCY BY COURTESY.--CESAREAN EXTRACTION OF CHILDREN--LEGAL BIRTH.
  —POST-MORTEM BIRTHS.--DATE OF  BIRTH--MINORITY AND MAJORITY.--MEDICAL EVI-
  DENCE IN RELATION TO PLURAL BIRTHS.--MONSTERS--WHAT CONSTITUTES A MONSTER IN
  LAW—DEPRIVATION OF LEGAL RIGHTS—DOUBLE MONSTERS—CHRISTINA RITTA—THE SIA-
  MESE TWINS.

  Live birth in civil cases.—The  law of England  has  not defined the meaning
of the term birth, in reference to civil jurisprudence; but if we are to be guided
by the numerous decisions which have been made on trials for infanticide, it must
be regarded  as signifying "the entire delivery of  a  child," with or without its
separation from the body of the  mother (ante, p. 351.  See also Chitty, Med.
Jur. 412.)   So long as  an  infant remains in the uterus, it is said in  law to be
"in ventre sa  mere;" but it is legally supposed to be born for many purposes.
(Blackstone's Comm. i. 130.)  A child in  the womb may have  a legacy or an
estate made over to it,—it may have a guardian assigned to it; but none of these
conditions can take effect unless the child  be born alive.   So the foetus may be
made  an executor; but an infant cannot act as  such until it has attained the age
of seventeen years!  The most important medico-legal questions  connected with
this subject are those which arise in contested suits relative to succession, or the
inheritance of property.   A child which is born alive,  or has come entirely into
the world in a living state, may by the English law inherit and transmit property
to its  heirs, even although its death has immediately, and  perhaps from morbid
causes necessarily followed its birth.  Should the child be  born dead, whether it
died in utero or during the act of  birth, it does not acquire any civil rights; for
it is not regarded as a life in being, unless it manifests signs of life after it is
entirely born.  Some have considered that partial birth,  provided the child be
living, should suffice to confer the same rights on  the offspring as the proof of
entire birth.   The following case has been adduced by Dr.  Locock in support of
this view, although the question here was rather in reference to  the actual date
of birth, than to the acquisition of  civil rights therefrom:—the principle is, how-
ever, the same.  On a Saturday  evening, a lady was  in  labour with her first
child.   The  head  and one  arm were born two or three minutes  before a neigh-
bouring clock struck twelve.  There was a cessation of pain for several minutes,
during which time the child cried and  breathed freely.  The rest of the body
was not expelled until full five minutes  after the same clock had struck twelve.
Was this child born on  the  Saturday or on the  Sunday?  Certainly the birth
was not completed until the Sunday:—the child was still partly  within the mo-
ther;  the circulation was still kept up  through the umbilical vessels: "but," 
388
PARTIAL BIRTH AND ENTIRE BIRTH.
 continues Dr. Locock, "I gave my opinion that the child was born on the Satur-
 day.  I considered that the child had then commenced an independent existence.
 The foetal life had then to all intents and purposes ceased; and  respiration—a
 function  incompatible  with the  condition of a foetus—had  commenced.  The
 umbilical cord will, it is true, go on pulsating for many minutes after an infant
 has been brought completely into the world crying and kicking, unless it be com-
 pressed artificially; and yet no one  will say that the child in such a case is not
 born until we choose to take the trouble to tie the navel string.  The child would
 not have been damaged if it had remained for hours, or even days, with merely
 its head and arms extruded:  it could have been fed in this situation."   (Med.
 Gaz. xii.  636.)   However reasonable this view may appear, a medical jurist must
 shape his evidence according to what the law demands.  It  has been elsewhere
 stated (Infanticide, ante, p. 351,) that our judges have distinctly laid down
 the law,  that no Child can be considered to be born until the whole of its body
 has come entirely into the world.  This is in relation to criminal jurisprudence,
 in which  case, if in any, the rule  should be relaxed; because its relaxation would
 tend to punish the wilful destruction of living infants partially born.  This child
 could not, therefore, have been born on the Saturday, because the law does not
 regard partial birth as entire birth; and respiration and birth are not synonymous
 terms.   Supposing this child to have died before its body was entirely extruded,
 it could not be said, even medically, that it was born alive; and certainly it could
 not be considered, according to the present state of the law, to have acquired the
 rights of a child born living.   The reasonableness of the opinion that  partial
 birth should suffice for all the legal  purposes of entire birth, is an entirely dis-
 tinct question, and one over which  a medical witness has  no sort of  control.
 Whatever apparent injustice may be done by adhering to this rule in  respect to
 the civil rights of persons, there is no doubt that the evil is really of great mag-
 nitude in relation to criminal jurisprudence; for it would appear from the present
 state of the criminal law, that partially-born children, although alive and healthy,
 may be wilfully  destroyed with impunity.
   On the other  hand, some difficulty might arise from  civil cases, if the bare
 extrusion of a part of the body sufficed for all the legal purposes of entire birth.
 It might  become a casuistical question, as to how much of the body should be
 in the world, in  order to constitute legal birth; for there is no reason why, in a
 medical view, the extrusion of the head and  shoulders  should constitute birth
 any more than the extrusion of a hand or a foot.   If it be  said that the act of
 respiration should be combined with partial  extrusion, this would be unjust; be-
 cause a child is alive,—its heart is evidently pulsating, and its blood circulating,
 as freely before the act of respiration as afterwards.   Besides, it is admitted that
 children  may be born alive and live for some time without respiring; and this
 want of respiration is no objection to these children  being considered living in
 law.  A case will be related  presently where a child was legally pronounced to
 have been born alive, although it had certainly not respired.   If, then, proof of
 respiration were not demanded in cases of entire, it could scarcely be required in
 cases of partial birth.  In the event of partial being treated as synonymous with
 entire birth, there would be no end  to litigation; and medical opinions would
 vary in every case.  It is doubtful whether, under such circumstances, the law
 could be administered with any degree of certainty or impartiality.   Admitting,
 then, that a child must  be entirely born, in  order that  it should  acquire civil
 rights, it  will next be necessary to examine the medical proofs required to show
 that it has been born alive.   The question here is different from that of live birth
 in reference to child-murder.  We must presume that a'practitioner is present at
 a delivery, in which a child is born in a doubtful state, or where its death speedily
follows its birth.   The civil rights of the child and its  heirs will depend upon
the careful observation made by the practitioner of the circumstances attending
the delivery.  In some instances,  a medical witness will  be required to form an
opinion from facts proved by non-professional persons. 
SIGNS OF LIVE BIRTH IN CIVIL CASES.
389
   Signs of live birth independently of respiration or crying.—The visible respi-
 ration of a child after its birth, or as it may be manifested by its crying, is an un-
 doubted sign of its having been  born alive: but, as it  has  just been stated, a
 child may acquire its civil rights, although it may be neither seen to breathe nor
 heard to cry.  The pulsation of a child's heart, or even the spasmodic twitching
 of any of the muscles of the body, is regarded as a satisfactory proof of live birth.
 The latter  sign has been judicially  so pronounced,—a  fortiori, therefore, the
 motion of a limb will be considered good evidence, in an English court of law, of
 life after birth.   It is to be observed,  that the length of time during which these
 signs of life continue after the child is born, is wholly immaterial;—all that is
 required to be established is, that they were  positively manifested.   A child
 which survives  entire birth for a single instant acquires the same civil rights as
 if it had continued to live  for a month or longer.  These facts will be better un-
 derstood from the following case (Fish v. Palmer,) which was tried in the Court
 of Exchequer, in the year 1806:—The wife of the plaintiff, Fish,  who was pos-
 sessed of landed estate in  her own right,  died about ten years previously to the
 trial, after having given birth to a child which was supposed at the time to have
 been born dead.   In consequence of the plaintiff's not having had a living child
 (as  it was assumed) by his marriage, the estate  of the  wife  was claimed and
 taken  by the defendant, Palmer, her heir at law, the husband  being obliged to
 surrender it under these circumstances. . From information derived many years
 subsequently from some women, who were  present  at  the delivery of  the wife,
 the plaintiff was led to think that the child had  not been born dead, and that
 the estate had been improperly surrendered.  The action was  therefore brought
 to contest the possession, ten years after the  death of  his wife; and it lay with
 the plaintiff to prove his allegation—that the child had been born living.  Dr.
 Lyon, the accoucheur who attended the plaintiff's wife, had died some time be-
 fore the trial; but it was proved that he  had declared  the child to  have been
 living  an hour before it was born, that he had directed a warm bath to be pre-
 pared, and when the child was born, gave it to the nurse to place in the bath.
 The child neither cried nor moved after its birth, nor did it manifest any signs
 of active existence;  but the two women who placed  the child in the bath, swore
 that, when it was  immersed, there appeared, twice, a twitching and tremulous
 motion of the lips.   They informed the accoucheur of this, and he directed them
 to blow into its  throat; but it did not  exhibit any further evidence of life.  The
 principal question on the trial was:—Whether this tremulous motion of the lips was
 sufficient evidence of the child having been born alive?  The  medical witnesses
 differed.  Dr. Babington and Dr. Haighton gave their opinion that had the vital
 principle been extinct, there could have been no muscular motion in any part of
 the body:—therefore the child had, in their opinion, been born alive  or mani-
 fested  life after its entire birth.   Dr, Denman gave  a contrary opinion: he con-
 tended that the child had not been born alive, and attempted to draw a distinction
 between uterine and extra-uterine life.  He  attributed the motions of the lips
 after birth, to the  remains of uterine life.   The jury, however, under the direc-
 tion  of the  Court,  did  not adopt  this view of the case:—they pronounced the
 child to have been born living; and by their verdict, the plaintiff recovered the
 estate of which he had been for ten years deprived.
   From  the result  of this  case, it would appear that the law does not recognise
 the distinction attempted to be drawn  by Dr. Denman, between what he  called
uterine and extra-uterine life.   A distinction  of this kind appears to be purely
artificial;—respiration is commonly set down as a mark of extra-uterine life: but
a child may breathe and die  before it is born, or it may be  entirely born and
manifest indubitable signs of life,  without respiring.   Respiration, therefore, is
properly regarded by the English law  as only one  sign  of  life,;—the proof of the
possession of active and vigorous life  is  not absolutely required.  It cannot be
admitted physiologically that any tremulous  motion in the muscles  could ever 
390
VAGITUS UTERINUS.
take place spontaneously in a really dead body; and the spasmodic motion of the
lips differs only in degree from the active motion of a leg or an arm.   If a cer-
tain  quantity of life, so  to  term it, were required  to  be  proved, instead of the
bare fact of its presence or absence, the most subtle distinctions would be con-
tinually drawn: thus it might be contended that unless a certain degree  of res-
piration had taken  place, it should  be assumed, contrary to well  known facts,
that the child had been born dead.   In this respect it appears to me that the law
of Scotland must operate unjustly.  The law of that country, in respect to tenancy,
declares that a child cannot be born alive unless it has breathed; it therefore re-
quires exclusive evidence of respiration.   (Ed. Med. and  Surg. Jour. xxvi. 369.)
It would be  as reasonable  to  demand, for exclusive proof of life, the motion of
one of the extremities, as to insist  upon exclusive proof  of respiration; for this
so varies in degree, that  a child may breathe and survive its birth many hours,
scarcely receiving any air into its lungs (ante, p. 294.)   AArould this be better
evidence of live birth, than the distinct motion of a limb ?  Non-professional
persons might be easily deceived as to the fact of respiration in these feeble sub-
jects, and a post-mortem examination would not always remove the doubt; but
no one is likely to be deceived about the motion of an arm or a leg.   The power
by which a limb is moved is the same as that by which  the  intercostal  muscles
are moved in the act of respiration.  Besides, it is forgotten  by those who would
thus restrict the proof of life, that such a restriction would be attended with great
injustice; for morally speaking, the  right of a husband to  enjoy for life the estate
of a  wife, should not be made to depend upon the mere accident of a child being
born, or of its having survived its birth for a few moments. It has been objected
to this view of the case, that the motion described may  have been the mere re-
mains of muscular irritability, and not a sign of actual life.  I am unable to per-
ceive the force of this  objection.   Irritability,  as manifested by  spontaneous
motion, is not a property of dead matter; and the remains of irritability must,
physiologically speaking, be regarded as the remains of life or of a vital power in
the muscles.   Could any witness have sworn that a child whose lips twice mani-
fested a tremulous motion after its  birth, was  born dead?  It appears to me that
he would not have been justified in so doing.   He would be compelled to admit
that such spontaneous contractions are not observed in bodies really dead, and
that they are the certain indications of some vital power still remaining.  The
English law recognises no intermediate state between life  and death; and it does
not require a certain amount of active life to be manifested, but merely satisfac-
tory proof  that there are some signs of vitality in  the  child's body after it has
been brought entirely into the world.  (For a case by M. Marc, somewhat similar,
but in which the medical opinions were opposed to these views, see Ann. d'Hyg.
1838, i. 98.)
  On these occasions the mere warmth of the body of a child at its birth would
not be evidence of life:—the slightest trace of vital action,  in its common and
true  physiological  acceptation, would, however, without doubt, be deemed by our
law a sufficient proof of the child having been born alive.

   Vagitus -uterinus.—Let us suppose that the evidence of a  child having  been
born alive  is stated to be that it was heard to cry:—it may  be a question  for a
medical witness, in cross-examination, whether this is to be taken as an absolute
proof of live  birth.    The answer  must be in the negative, because a child may
cry before its body is entirely born:—or it may be what is called vagitus uterinus,
—a uterine cry after the rupture of the membranes.   (See ante, Infanticide.)
As in all cases of  this description, there must be eye-witnesses, whether profes-
sional  or not, the evidence cannot  rest solely upon the mere medical  possibility
of the occurrence  of such a cry before birth;  and proof will be required of the
crying of the child after it was born.
  There are two cases in which the determination of the momentary existence of 
TENANCY BY COURTESY.   CESAREAN OPERATION.          391
children after birth becomes of importance in a legal point of view.   These are
cases involving the questions of  Possessio Fratris and Tenancy by the Courtesy.

  Possessio fratris.—In the event of a  man twice married dying  intestate, and
leaving a daughter by each marriage, his estate would be equally shared by the
daughters of the two marriages: but if  we suppose that there is a  son of the se-
cond marriage, born in a doubtful state, the legal effects of this child momentarily
surviving birth, manifested by some slight sign of life, would be to disinherit the
daughter of  the first marriage  entirely, and transfer the  whole of the  estate to
the daughter of the second marriage, she being sister to the male heir, while the
daughter of the first marriage is  only of half blood.  The determination of this
point, which does not often occur, must rest essentially upon medical evidence,
when there is a want of clear proof of life after birth.  (See Amos, Med. Gaz. i.
738.)

   Tenancy by courtesy.—This signifies, according to Blackstone, (Com.  ii. 426,)
a tenant by the Courts of England.  The nature of this tenancy has been already
explained.   (See the case of Fish v. Palmer, ante, p. 389.)   If a married wo-
man, possessed of fee  simple estate, die, the  estate passes from the husband to
her  heir at law, unless there has been a child born living of the marriage, in
which case the husband acquires a life-interest  in  the property.  The  only de-
fence of this singular custom is, that it is of great antiquity.   An unsuccessful
attempt was made a few years since to substitute for it the reasonable provision,
that the marriage should entitle the husband to a right, which he can now only
acquire by the fulfilment of certain accidental conditions.   Incurable sterility, a
protracted labour, deformity in the pelvis of the wife, or the necessary  perform-
ance of craniotomy on a healthy, well formed child, may, under this custom, lead
to an aversion of the inheritance.   The tenancy, in contested cases, is generally
established or disproved by medical evidence;  and  the following are the condi-
tions which the law requires  in order that the  right should exist.  1. The  child
must be born alive.  A case has  been already related wherein the tremulous
motion of a lip was held to be a  sufficient proof of live birth.   2. The child must
be born while the mother is living.  From this it would appear that if  a living
child were removed fromjthe outlet after the  death of the mother, or extracted
by the Cassarean operation from the uterus, the  husband would  not  become en-
titled to enjoy his wife's estate;  although the child may survive its  removal or
extraction, and succeed to the estate on attaining its majority.  How such a case
would be decided in the present day it is difficult to determine: but one  instance
is quoted by most medico-legal writers from Lord Coke, where, about three cen-
turies since, the case was decided against the husband, in consequence of the
child having been removed from the uterus by the Cesarean section after the
death of the.wife.   (For a very  singular case involving this question in France,
see Ann. d'Hyg. 1838, 98.)

   Cesarean  Operation.—The Cassarean operation has rarely been performed in
England, except when  the female was actually dying or dead.   Dr. Goodman, of
Manchester, has collected and published, from the table  of  Dr. Merriman and
other sources, an account of  thirty-eight of these operations performed in  this
country since 1737.  It appears that out of this number only three mothers have
recovered, the children, with one exception in the three cases, having died.   In
eighteen cases the  children  were  extracted living.  (Obstetric Record, No. 4,
1848, p. 3.)  Dr.  Goodman  himself performed this operation successfully  on a
female in November, 1845.   The child was extracted alive, and the woman per-
fectly recovered  from the operation.   (Med. Gaz.  xxxvi. 1392.)  The practice
on the continent has been to  undertake it while the woman was living,  and the
result has shown that it may thus  be performed successfully both with regard to 
392
LEGAL RELATIONS OF THE CESAREAN OPERATION.
  mother and child.   (See Med. Gaz. xix. 829, 878;  Cormack's Monthly Journal,
  July, 1845, p. 541-543.)   For a case in which this operation was successfully
  performed three times on the same person, see Brit, and For. Med. Rev., July,
  1836, 270.  Important legal consequences may hereafter  ensue from  the more
  general adoption of this practice in England  in respect to deformed females.
  Thus, supposing in any case the child were removed alive while the mother was
  living, both of them dying  shortly afterwards,—AArould the husband  become a
  tenant by the courtesy?   The law says  the  child  must be born; and some
  lawyers would find ground for arguing whether extraction by the Caesarean ope-
  ration should  be regarded as "legal birth."  "Ulud autem valde  controversum
  est inter jurisconsultos, an is qui editus est execto matris ventre reputetur partus
  naturalis et legitimus et successionis capax."   (Caranza.)   According to Fon-
  blanque, the  question  is now settled in the affirmative—a child  extracted  is a
  child born.  (Med. Jur. i.  226.)   Our ancient law-authorities do  not appear to
  have contemplated that the operation would ever be undertaken  on a living fe-
  male.  The words of Lord Coke, which are considered to express the state of the
  law, are:—"If a woman seized  of lands  in fee taketh husband, and by him is
  bigge with childe, and in her travell dyeth, and the  child is ripped  out  of  her
  body alive, yet shall he not  be tenant by the curtesie, because the  child was not
 born during the marriage, nor in the life of the wife, but in the meantime  her
 land descended."  According to Mr. Hobler, the Cassarean  operation  does  not
 divert the course of descent, nor divest the husband of  the  life-estate,  provided
 that the child  be born alive, and the mother was living when the child was born.
 (Obstetric Record, iii. 66.)    Birth  and extraction  by the Caesarean operation
 are, therefore,  treated as similar conditions.
   As a  proof  that this operation is not always necessary where circumstances
 may appear to call  for it, the following  case,  mentioned by Sir  B. Brodie as
 having occurred in a  French hospital, is of some interest.  It is that of  a woman
 whose pelvis was considered  to be too narrow for the egress of the child.   As
 she was  at the full  term of gestation, the  Caesarean section was proposed, but
 before the  operators  were ready  to  commence, the  child was  expelled by the
 natural efforts of the uterus, or, as Sir B. Brodie expressed  it, the child preferred
 coming into the world by the old road!  (Lancet, Dec. 1843.)
   This, however, is  not the only case of  the kind  on record.   There  is great
 reason to believe that continental practitioners are too officious in suggesting the
 performance of this operation, and that it is often undertaken to the serious risk
 of the life of the female, when the case, if  left  to nature, would have done well.
 A case  occurred in  Scotland  in  1847, in which the Caesarean operation was
 considered by several practitioners of experience to be the only means by which
 delivery  could  be accomplished.   Fortunately for the female,  the labour was
 somewhat rapid, and  she was delivered of a dead child, weighing about three
 pounds, before  the arrival of those who had considered that the operation would
 be  required.  (Ed. Monthly Journ. July, 1847, p.  30.)  The fact is,  on these
 occasions, nature  often adapts  means to ends in a most unexpected manner.   An
 interesting case of the performance of this operation  on a living female has been
 reported  by Mr. Skey.   Here sufficient time was allowed for the  advancement
 of the labour, and it was evident to all that delivery  could not take  place by the
 outlet; that embryotomy could not be performed; and that unless the operation
 was  resorted to, the female would infallibly sink from exhaustion.  The child
 was^ extracted,  but the mother died  in  about  thirty-six hours.  (Med. Gaz.
 xxxix. 212.)
  It has been a question among medical jurists as to the period of gestation at
 which the operation should be performed.  This would of course depend on the
 earliest period  at which a child might be born  capable of living.   In reference
 to tenancy by courtesy, the  child might be extracted alive as early as  the fifth
month; but it would not be likely to survive unless it was at or about the seventh 
DATE OF BIRTH.  MINORITY AND MAJORITY.
393
 month.   Some have alleged, that unless performed immediately after the death
 of the mother, the child would not be extracted living.  The condition  of the
 foetus in utero is, however, peculiar, and quite distinct from that of a child living
 by the act of respiration.   It is possible, therefore, that there may be a limited
 survivorship, and that the operation may be performed so late as an hour after
 the death of the  mother with the possibility of extracting a living child.   There
 are incredible accounts  of  children having  been extracted  living many hours
 after the death of the mother.   Dr. Kergaradec states that this happened in the
 case of the  Princess Pauline  of Schwartzenburgh, who, while pregnant,  was
 burnt to death at the ball given on the occasion of the marriage of the Empress
 Maria Louisa in 1810.  The  body was not  examined until the following  clay,
 and the foetus was  then  found  living!  (Ann.  d'Hyg. 1S46, i. 454.)
   3. The child must be born capable of inheriting; therefore if it be a monster
 the husband does not acquire the  right of tenancy.   There are some other legal
 conditions which must also  be fulfilled, but I have here confined myself to what
 may become matter for medical evidence.
   Admitting that  there are legal ways by which the obnoxious parts  of  this
 custom may  be set  aside during the life of the mother, it is hardly just that the
 knowledge of the necessity for  these precautions should be left to be  acquired by
 accident.   It would be  better  to  abolish tenancy by courtesy altogether, than
 to allow the  succession of the husband to rest upon a casualty of this kind.
   Post-mortem births.—That a child may be born after the death of the mother,
 and survive its birth, is proved  by the  following case.   A woman died  during
 labour.  The accoucheur, who was summoned, found the head of the child  pre-
 senting,  but too  high up in the pelvis to allow of the application of the forceps.
 He immediately introduced his hand into the uterus; and a  quarter of an hour
 after the death of  the mother, and twenty hours after the rupture of the mem-
 branes, he extracted a male infant in a state of apparent death.   The child, which
 was well formed, was  speedily resuscitated  by the  application  of the ordinary
 means.  (Berlin.  Medicin. Zeit. July, 1836.)  Had this case occurred in England,
 it would  probably have been decided, according to  the old precedent, that  the
 husband  could not become a tenant by the courtesy, because by the death of
 the  mother the marriage was dissolved, and the land descended before the child
 was born.  Another case of the birth of a living child  after the death of  the
 female, will be found in  the Med.  Gaz.  vol. xlvi. p. 713.
   Date of birth.—Medical evidence has occasionally been demanded in courts of
 law respecting the actual date  of  birth of individuals, in cases where a period
 of a few clays, hours, or even minutes, was required to prove the attainment of
 a majority,—and therefore a legal responsibility for the performance of civil con-
 tracts into which the parties had entered, either knowingly or ignorantly, when
 minors.  Some such cases have been decided by the evidence of the accoucheur
 himself,—others, when the accoucheur was dead,  by the  production of his case-
 books; and it is  worthy of  notice that the  strictness and punctuality of some
 medical practitioners in  making written memoranda of  the  cases attended by
 them, have in more than one instance led  to a satisfactory settlement of such
 suits, and the avoidance of further litigation.   The proof of the date of birth is
 also of considerable importance in cases of contested legitimacy.
   Minority and Majority.—The word minor is synonymous with that of infant,
 and  is applied in  law to any one under the age of twenty-one years.   The  age of
 a person may render him incompetent to the performance of civil duties.  Minors
 are frequently called upon to act  as witnesses in civil and criminal cases.   In
 rapes committed upon young females, it is especially important to notice whether
 the prosecutrix be or be not competent to give  evidence.   The law has fixed no
 age for testimonial competency; and I have never  heard of  the  question being
 referred to a medical practitioner.   The child is always orally examined  by the
court; and it is soon rendered  apparent whether the  witness possesses a proper
knowledge of the  nature and obligations of an oath.  If not, his testimony is not 
394
PLURAL BIRTHS.
received, or in a case of rape the trial is postponed and the child is placed under
instruction, to appear again at the following sessions or assizes.   The competency
of a child as a witness, therefore, does not depend on age, but upon its under-
standing.
  According to the principles of  our law, a  male at 12 may take the oath of
allegiance; at 14 he is considered to be at years of discretion,  and becomes then
responsible for his actions; at 21  he attains majority, and is at his own disposal,
and may alienate his lands, goods, and chattels by deed or will.   It is only when
this age has been attained that an individual can be sworn to serve  on a jury.
The period at which a male is considered to have attained full age varies in some
countries:  thus, in the kingdom of Naples it  is fixed at eighteen years; in Hol-
land at 25; but generally throughout the states of Europe the law prescribes 21
years, the same as the  common law of England.
   A  person is completely of age after the  first instant  of the  day before the
twenty-first anniversary of his birth-day, although forty-seven hours and fifty-nine
minutes short of the complete number of days counting by hours; and this mode
of  calculating age and  time is applicable to  all the other ages before and after
twenty-one.   This is on the principle that part of a day is equal to the whole of
a day in a legal point of view.   The following case in reference to this question
was decided by appeal in the House of Lords in February, 1775.   An estate was
bequeathed to a Thomas Sansom so soon  as he  should arrive  at the  age of 21.
He was born between  the hours of 5 and  6 on  the morning of the 16th August,
1725, and died about 11 in the forenoon on the 15th August,  1746.   The ques-
tion was, whether he had, at the time of his  death, arrived- at  the full age.  In
the Court of Chancery it had been so decided; but it was urged that more than
sixteen hours were wanting to  complete the term.   This plea  was overruled by
their Lordships, and the decree confirmed, because the deceased was living on
the day which would have completed the  period.  A  few minutes or hours may
thus  determine the  attainment of majority, and with  this, the responsibility of
minors for civil contracts.
   Plural births.—This has been regarded as a  subject appertaining  to medical
jurisprudence; but I am not aware that there is any case on record in which the
evidence of a medical man has been called for respecting it.  It is a simple ques-
tion  of primogeniture, which has been generally settled by the aid of depositions
or  declarations of old  relations or servants present at the birth.  AVomen'may
have two, three, four,  or five children at a birth.   Twins are comparatively fre-
quent, but triplets and quadruplets are very rare.   According to Dr.  Riittel, out
of  574,293 births in Prussia in 1840, there were 6381 cases of twins, 72 triplets,
and one  of quadruplets.   This writer knew an  instance in which a woman had
six children at a  birth.   (Henke, Zeitsch. 1844, 266; and Med. Gaz. xxxvi.
607.)  Mr.  Guthrie states, that in the Museum of the Royal College of Surgeons
"there is a large bottle containing five young ladies and  gentlemen,  all brought
forth at one birth,  and destroyed by an accident," and that  he was for many
years acquainted with a gentleman whose mother  produced twenty-eight living
children in the first twelve years of her married life.  (Lancet, Feb. 15, 1851,
p.  176.)   Mr. Russell met with a case in 1849, in which there were five children
at  a birth.   They were all males, and all born dead.  The largest was six inches,
and the smallest five  inches long.   They were prematurely born.   There was
one placenta of the  ordinary size, with five umbilical cords attached to it around
its centre.   (Lancet, Feb.  3,  1849.)  The  only circumstance with respect  to
these plural births which it  has  been recommended  that  an  accoucheur should
attend to, is the order of their  occurrence.   The first born child, according  to
the ancient principle of the common law of  this country, succeeds to the inheri-
tance.  In cases of twin or triplet males, a practitioner would find himself much
embarrassed to express an opinion as to which was first born after the lapse of a
certain period, unless  there were some personal peculiarity or deformity which
would at once stamp the  identity. 
TERATOLOGY.   MONSTERS.
395
    There is one case in which the law has interfered to prevent the inheritance
  of offspring, and this is in relation to monstrous births.

                                  MONSTERS.
    The connexion of teratology with medical jurisprudence  has been most ably
  investigated by M. St. Hilaire.   Although questions connected with these beings
  do not often occur, yet  it is proper that a medical witness should be acquainted
  with certain facts respecting them.  The law of England has given no precise
  definition of what is intended by a monster.   According to  Lord Coke, it is a
  being " which hath not the shape  of mankind: such a being cannot be heir to or
  inherit  land, although brought forth within marriage."  A mere deformity in
  any part of the body, such as supernumerary fingers or toes, twisted or deformed
  limbs, will not constitute a monster in law,  so far as"the succession  to property
  is concerned, provided the being still have "human shape."   Even  a supernu-
  merary leg would not probably be allowed to avert an inheritance!  The  trisceles
  monster, in which the third leg was a fusion of two legs, was lately exhibited in
  London.  (See Med. Gaz. xxxvii. 619.)  From  Lord  Coke's  description, it is
  obvious that the law will be guided in its decision by the description  of the mon-
  strous birth given by a medical witness.   It would not rest with  the witness to
  say whether the being was or was  not a monster—the Court would  draw its in-
  ference from the description given by him.  Various classifications of monsters
  have been made, but these are of no assistance whatever to a medical jurist, be-
  cause each case must be decided by the peculiarities attending it; and his duty
  will not be to state the class and order of the monster, but simply in what re-
  spect it differs from the healthy organized being.   In consequence of the want
  of a sufficient number of precedents on the subject, it is difficult to say what de-
  gree of monstrosity would be required in law in order to cut off the  civil rights
  of the being.   There are acephalous, dicephalous,  and disomatous monsters:
  others again, like the Siamese twins,  have two bodies united by a mere  band of
  integument.  AVould an acephalous monster be considered as devoid of human
  shape ?  AVould  a  disomatous monster be allowed to inherit as one ?—to marry
  as one?—or how would legal punishment be inflicted in the event of one of the
  bodies infringing the laws?  Such are the singular questions which have been
  propounded by medical jurists in relation to these beings; and there is obviously
  ample room for the exercise of much legal ingenuity in respect to these questions.
  According to St. Hilaire, the rule which has been  followed in all countries re-
 specting these monstrosities, is to consider every  monster with  two  equally de-
 veloped heads,  whether it be disomatous or not, as two  beings;  and  every mon-
 ster with a single head, under the same  circumstances, as  a single being.  He
 ascribes the origin of this rule to the performance of the rite  of baptism in all
 Christian countries upon each head, when the monster was  dicephalous.  This
 view certainly appears rational, when we consider  that with two heads there are
 two moral individualities; while with  a  single head, there is only one will and
 one moral individuality.   But  it is doubtful how far this doctrine would be re-
 ceived by jurists and legislators.   The question whether, in a dicephalo-disoma-
 tous monster, the two beings should be bound by the act of one,  either  in civil
 or  criminal jurisprudence, is a  matter which, if these  monstrosities were more
 frequent, would give rise to serious difficulties.  Such a question  is  not purely
 speculative,  because it might easily have been raised in respect  to the Siamese
 twins during their stay in this country; and  according  to  St. Hilaire, a case of
 this kind was actually decided in Paris in  the  seventeenth century, in relation
 to a double-headed monster.  This author relates that the double monster killed
 a man by stabbing him with a knife.   The being was condemned  to  death, but
 was not executed on  account of the innocence of one of its component halves!
 (Ann. d'Hyg. 1837, i. 331.)  According to the same authority, compound mon-
strosity is not transmissible by generation.   The reader will find an  account of
the most  remarkable  monsters born  during the present century in a paper by Dr. 
396
MODERN CASES OF MONSTROSITY.
Riittel (Henke, Zeitschrift der S. A. 1844, 229.)  Among them is mentioned a
tricephalous monster born living  in Paris in  1830.   Each head was baptized
under  a  separate name.   Monsters, especially  the dicephalous, are either born
dead or  die very soon after birth;  yet within a recent period two have been
known to live;  the  one, Christina  Ritta, for nine months,—the other, the Sia-
mese twins, for many years.  The  latter may be still living.
   Christina Ritta  was born in Sardinia in 1829.   This  monster was  double
from the head to the pelvis; the two vertebral columns being distinct as far as
the os  coccygis.   The left bust was christened by  the name of Christina,  the
right by  that of Ritta.   The monster was brought to Paris, where it died about
nine months after its birth. An excellent model of it may be seen in the museum
of Guy's Hospital,  together with  some good specimens  of the dicephalous and
disomatous varieties.  In the further description of it, it may be observed, that
below the pelvis  the monster is single.   There are  two heads resting on two
necks; and the union or  fusion of  the  two busts is effected  laterally towards the
middle portion of the chest, so that the two  corresponding breasts are almost
blended.   The  abdomen, as well as the pelvis, evidently  formed by the junction
of two primitive pelves, is single.  In the chest there  were found two distinct
sets of lungs and two hearts;  but  these were inclosed in a single pericardium.
During life, the pulsations of these organs were so  uniform that there was con-
sidered to- be only a single heart.   There was only one diaphragm,—a fact which
accounted for the simultaneous death of both bodies;  one only having been pre-
viously indisposed.
   The Siamese Twins may be regarded, from the age which they have attained,
and the probability  of their continuing to live, as forming the most remarkable
monster of modern times.   Many professional men must have had an opportunity
of seeing them  when exhibited in London in 1831.   They  had distinct volitions,
and would converse  at the same time on different subjects: their movements were
simultaneous, so as to appear like  those of a single being.  In short, they could
be regarded in no other light than  as two distinct beings united by a narrow band.
This band of union was,  however,  so intimate as to render it probable that they
had only one peritoneal cavity between them.   When either coughed, the band
swelled up in its whole length: this formed an insurmountable obstacle to their
separation.  It would, however, have been impossible, in  relation to civil and
criminal  jurisprudence, to have made both responsible for the acts of one, since
they occasionally differed in opinion!
   For  an account of a  case of a  monocephalic disomatous monster, which  was
born alive, but died  soon after  birth, see Ed.  Med. Jour.  lv. 76; and  at page
435 of the  same volume is an account of a dicephalous monster born at Man-
chester in 1840.
   Malpositions, transpositions, or  defects  of the internal  organs  of any of the
cavities,  do not form monstrous births  within the meaning  of the  English law.
The legal question relates only to  external shape, not to  internal  conformation.
It is well known that many internally malformed persons  live to a great age;  and
it is not until after death that malpositions and defects of this kind are discovered.
In French  jurisprudence the  case  appears to be different: if the malposition or
defect were such as to become a cause  of death  soon after birth, the child would
be pronounced not "viable,"  and  therefore incapable  of acquiring civil rights.
Some medical jurists have discussed  the question of "viability" in new-born
children, i. e. their  healthy organization with a capacity to continue  to  live, as
if it were part of  the jurisprudence of  this country; but I  am not aware of any
facts which bear out this view.  The English law does not regard internal mon-
strosity;  and the case of Fish v. Palmer shows clearly, that the simple question
in English jurisprudence  is, not  whether  a child  be or be not  "viable," but
whether  it has manifested the least sign of life after it was entirely born.   The
French law is much more complex, and throws a much greater degree of respon-
sibility on French medical jurists.    (See Viability, post.) 
LEGITIMACY.
397
LEGITIMACY.
                             CHAPTER LII.

LEGAL PRESUMPTION OF LEGITIMACY—DATE OF CONCEPTION  NOT  REGARDED—DIFFERENCE
  BETWEEN THE ENGLISH AND SCOTCH LAW.--CHILDREN BORN AFTER DEATH.--NATURAL
  PERIOD OF GESTATION--DURATION FROM ONE  INTERCOURSE.--PREMATURE BIRTH--SHORT
  PERIODS OF GESTATION.--VIABILITY--EARLIEST PERIOD AT WHICH A CHILD MAY BE BORN
  LIVING.--FAMA CLAMOSA--EVIDENCE FROM THE STATE OF THE  OFFSPRING.--CAN FULLY
  DEVELOPED  CHILDREN BE BORN PREMATURELY?--PROTRACTED  BIRTHS.--LONG PERIODS
  OF GESTATION--CASES--LONGEST PERIODS YET KNOWN--THE SEX OF THE CHILD  HAS  NO
  INFLUENCE—PERIOD NOT FIXED BY LAW.--GARDNER PEERAGE CASE—EVIDENCE  FROM THE
  STATE OF THE CHILD--LEGAL DECISIONS--MISTAKES IN THE MODE OF COMPUTATION.

  Legal presumption of legitimacy.—Every child born in  lawful matrimony is
considered by the English law to be the .child of the husband, unless the contrary
be made clearly to  appear by medical  or  moral evidence, or by both combined.
It is only in reference to  medical evidence that  the subject of legitimacy can
here be considered;  but it is extremely rare to find a case of this kind determined
by medical evidence alone.  There are generally circumstances which show that
the child whose legitimacy is  disputed, is the offspring of adultery, while the
medical facts may be perfectly reconcilable with the supposition that the claimant
is the child of the husband.  These cases, therefore, have been repeatedly decided
from moral evidence alone,—the medical evidence respecting the period  of ges-
tation or physical capacity in the parties, leaving the  matter in doubt.  The law
which formerly prevailed in this country was to the  effect, that if a child were
born during marriage,—the husband  being within the four seas  of the realm
(intra quatuor maria,) and no physical impossibility being proved, the child was
legitimate.   Access was  presumed, unless he  could  prove that he was  "extra
quatuor maria" for above nine  months  previously  to birth.   (Blackstone, i.
456.)   But  the present  state of the English law on the  subject appears to be
this.   A child born during marriage is deemed illegitimate, when by good me-
dical or other evidence it is proved that it was impossible for the husband to  be
the father,—whether from his being under the age of  puberty, from his labouring
under physical incapacity from age or natural infirmity,—or from the length of
time which may have elapsed since he could have had intercourse, whether from
absence or death.   With proof of non-access or immorality on the part of the
mother, so important on these occasions, a medical witness is not in the least con-
cerned.  In  the case of voluntary separation of husband and wife, which the law
does not recognise, the children born are the children  of the husband unless non-
access can be clearly proved.   In January, 1849, a woman applied to  a Police
Magistrate for a summons against a man to show cause why he  refused  to con-
tribute to support a child of which she declared him to be the father.   It appeared
that she parted  voluntarily from her husband, and had lived three years with the
adulterer, and during the last year this child was born.  The magistrate declined
granting the summons, as she had no claim upon  the adulterer.   There was  op- 
398           LEGITIMACY.  NATURAL PERIOD OF GESTATION.
portunity of access on the part of the husband, and he alone was liable in law for
the maintenance of the child.  In some instances, the law assumes without me-
dical evidence that the offspring is illegitimate, as where the husband and wife
have been legally divorced "a vinculo matrimonii."  AAThen children are born
where the divorce is "a mensd et thoro"  they are presumed to be  illegitimate
until the contrary appear.   There is a peculiar difference in relation to legitimacy
between the laws of England and Scotland.   A child born of parents in Scotland
before marriage, is rendered legitimate by their subsequent marriage.  In Eng-
land the offspring is illegitimate, whether the parents marry or not after its birth;
and under the Poor Law Act, 4 and 5 Will. IV., if a man marry a single woman
having  a child or children living, of whom he is not the father, he is bound to
maintain them, as if they were his own and born after marriage.  At the same
time the children are not legitimated by the marriage.   In the  case of Birtwistle
v. Vardell, decided on  appeal by the House  of Lords in August, 1840, it was
held that a child thus legitimated by the law of Scotland could not be allowed
to succeed to his father as heir to real estate in England.  The Scotch rule ap-
pears to be more consistent with natural justice;  since, according to the English
practice, it is inflicting  confiscation  on  the  offspring for a  fault in the parents,
which they had  done all in their power  to amend.   (See also  the cases Mvnro
v. Munro, Dalhousie v. M'Douall,  on  appeal to the  House of Lords,  March,
1840.)   In the  case of Munro v. Munro, the child was born during the residence
of its father, a Scotchman, in  England, but this was  not considered to invalidate
the application of the principle of Scotch law.  These suits are chiefly instituted
in respect to the right  of succession to property or claims for peerages;  and me-
dical evidence is then frequently required to clear up the case.   From what has
been already said, the English law does not regard the date of conception, which
cannot be fixed,  but the date of birth, which can be fixed.   Medical evidence may
relate—1, to the actual length of the period of gestation:—this may be in a given
case so  short or  so long, as to render it impossible that the husband could be the
father.   2. There may be physical incapacity in the husband—he  may be too
old or too young—or he may  labour under some physical defect rendering it im-
possible that he  should be the father.  3. There  may be sterility or incapacity
in the female, rendering it impossible that the child  should be the offspring of a
particular woman:—in other words it may be a supposititious child.  (See Sup-
posititious Children.)
   Children born after death.—It appears that a child  born after the death of
the mother, provided she be  lawfully married, is legitimate, although the mar-
riage is dissolved by the death.  This is not a mere hypothetical question.  Two
cases have already been given (ante, p. 393)  in which  there was a post-mortem
birth of a living child, and the facts are of especial interest in relation to tenancy
by the  courtesy. Whether the birth take  place by the aid of art through the
outlet, or by eventration as in the Caesarean section, the husband,  if the wife be
at the  time dead, cannot claim the estate; but the child thus  born out of mar-
riage is legitimate, and if it live, may, on attaining its majority, take the estate
of which the mother was seized.  (See ante,  Ccesarean  Operation, p. 391.)  The
fact that the English law disregards the place or date of conception might, there-
fore, give rise to a singular question. A child may  have been  conceived before
the marriage  of the parents, and be brought into  the  world  by the Caesarean
operation after the death of the mother.  Hence it would neither be begotten nor
born in wedlock, and yet, according to the principle of the English law, it would
be the legitimate offspring of the marriage!
   Natural period of gestation.  Duration from one intercourse.—The first point
to be considered is—what is the natural period of gestation,  and whether this
be  fixed or variable.  According to  the testimony of  the most experienced ac-
coucheurs, the average  duration  of  gestation in the  human female is comprised
between the thirty-eighth and fortieth weeks  after conception.   Numerous facts 
             DURATION OF PREGNANCY FROM ONE INTERCOURSE.         399

show that the greater number of children are naturally born between these two
periods.  Out of  186 accurately observed cases reported by Dr. Murphy, the
greater number of deliveries took place on the 285th day.  (Obstetric Report,
1844.)  The cause of this variation  may be,  that the common mode of calcula-
tion by reference to the suppression of the menstrual discharge, even in a healthy
female, must lead to a possible error of two, three, or  even four weeks, since
there is no sign whereby, in the majority of women, the actual period of con-
ception can be determined; although the late researches of Bischoff tend to show
that it may be at  or about the time of menstruation, and  not at an intermediate
period.   (Med. Gaz. xxxv. 443, et seq.; Baly and Kirke's Recent Advances in
Physiology, 1848, 46.)  It is, however, proper to remark, that  recent observa-
tions by accurate  observers are adverse to the correctness  of this view.  Dr. Old-
ham met with a case in which impregnation  took  place  twelve days after men-
struation; and he states that he has known it to occur at the respective times of
ten days, twelve days, and even twenty-one days after the monthly periods; and
he knows of no facts to disprove the opinion that the human female is suscepti-
ble of impregnation at any time between her monthly periods.  (Med. Gaz. xliv.
p. 48.)  In the  same volume, at page 930, Mr. Kesteven has reviewed the theory
of Bischoff at some length, and to his remarks I must refer the reader.
  On the other hand, accidental and  isolated cases have  already proved that a
great  difference naturally exists among females with respect to  the period of
gestation; and  it is probable that in no two is it necessarily the  same.   Thus,
when there has been only one intercourse,  the duration of pregnancy may be
easily calculated without reference to any changes in the female constitution: for
thereby the date of conception would be accurately fixed.  Observations of this
kind have shown  that females have differed from each other; and in several in-
stances they have exceeded or fallen short of the period of forty weeks, which has
been usually set down as the limit of natural gestation.   In  three cases of this
kind known to Dr. Rigby, labour came on in 260, 264,  and  276 days.   (Med.
Times, March 14, 1846, 471.)  In  three other instances of recent  occurrence,
privately communicated to me by Dr. S. W. J. Merriman, labour commenced at
281, 283, and 286 days respectively after one intercourse; and  in a case which
occurred to  Dr. Reid, the labour did not commence until after the lapse of 293
days from a single intercourse.   (Lancet, July 20, 1850, p. 79.)  In a case by
Mr. Skey, reported in a former  edition  of this work, the period alleged was 293
days; but the woman subsequently confessed that there had been several inter-
courses.   Dr. Reid's table, above referred to, will  be found the most complete.
 Hence it will be perceived that in well observed cases, where  there could be  no
motive  for  misstatement, and in which the  characters of the females, some of
whom were married and had already borne children, were beyond the  reach of
 suspicion, a difference of not less than thirty-three days has been observed to
 occur,—i. e. between the earliest case recorded by Dr. Rigby, and the latest re-
ported by Dr. Reid.  This is worthy of remark, because  in a case to be related
hereafter (Luscombe v. Prettyjohn, post, p. 415,) the judge held that 299 days,
only six days longer than in Dr. Reid's case, was an impossible period for human
gestation!   Dr. Macilwain, U. S., has  reported a case of gestation, which must
have  extended to 296 or at least to 293  days.  (Amer. Jour. Med. Sci., July,
 1848.)   In the same journal for July, 1845, page 241, there  is recorded the
case of a woman,  a primipara, who was delivered on the 309th day after a single
intercourse.
   Dr. Lockwood has published the following as the result of his experience. The
actual duration of the term of  gestation in  the human subject was ascertained
by him in four cases:—No. 1, aged 19, duration 272 days, first confinement;
No. 2, aged 30, first confinement, duration 276 days; No. 3, aged 17, duration
270 days; No. 4, aged  44, seventh confinement, duration 284 days, the child
weighing fourteen pounds.   (Brit. Amer. Jour., Dec 1847, 214.)  M. Devilliers 
400          DURATION OF PREGNANCY.   DATE OF CONCEPTION.
   has still more recently published the particulars of nine cases, in which the date
   of conception, from a single intercourse, was accurately determined.   Delivery
   took  place at the following periods:—229, 246, 257, 267, 301, 276-281, 278-
   283,  270, and 266-272 days.   (Gaz. Med., Mars 4,  1848.) ,
      Cause of the variations.—From analogical observations made  on animals, it
   has been supposed that this variation in the period depended on the male: others
♦  have  assigned it to peculiarities  in the female  constitution.   It appears  proba-
   ble, from recent researches, that the duration of the pregnant state is really de-
   pendent on the relative excitability of the uterine system at the menstrual  pe-
   riods.  Numerous facts tend to show, that notwithstanding the  general suppres-
   sion of the menses, there is  great excitement of the uterine system at what would
   have  been, in the unimpregnated state,  the regular menstrual  periods.   Some-
   times, as it has been elsewhere stated, this really amounts to a periodical discharge
   of blood.  There is also great reason to believe that abortion takes place more
   readily at these than at other  periods.   Hence many eminent  accoucheurs  are
   inclined to consider  that the  duration of pregnancy is really a multiple of the
   menstrual period; and that in the majority of females it will occur at what would
   have  been the tenth menstrual period, or forty weeks from the date of concep-
   tion (Gaz. Medicale, 4 Decembre, 1847, p. 968;) and according to  the degree of
   excitement of the uterine system,> the child may be expelled a  period earlier or
   a period later than that which is assigned as the more usual natural term.  It is
   a remarkable confirmation of this view, that the  menstrual function is again com-
   monly established one month after parturition.  Admitting that conception may
   occur at any time between  two menstrual periods, this theory  will explain the
   variations which have been  noticed in the duration of pregnancy after one inter-
   course.  Dr. Rigby thinks that parturition takes place at the fortieth week,  be-
   cause the  development of the child then acts by distending the uterus, which
   in its irritable  state, tends to throw it off.   It is  not, however, found that
   the duration of pregnancy is at all dependent on the  size and weight of the child,
   or that children born at the fortieth week resemble each other in these respects.
   Hence the commencement of parturition cannot be ascribed to the  physical con-
   formation of the child.  It would be desirable to know whether this periodicity
   can be invariably traced in  the time at which labour commences.  Some females
   menstruate every three weeks:  so far as I can  ascertain, it has  not been shown
   that in them, the correspondence of gestation to the menstrual periods has been
   made out.   Such females should, according to the theory, bear children to the
   thirteenth  period from the  date of the last, cessation.  Dr. Clay believes, from
   the observations which he  has made, that the variation in the period of ges-
   tation is dependent on the age of the female as  well as  of the male.   He consi-
   ders  that the term of gestation  is extended  in proportion to the  age of the fe-
   male, and  that while in a female of 17 the period may be taken at 270 days,—
   in a woman of 44 it would extend, to 284 days.  Again, when a  female has been
   impregnated by a male much older than herself, the term of  utero-gestation is,
   in his opinion, longer  than  would be assigned to a female of this  age, and vice
   versa.  (Record of Obstetric Medicine,  June,  1848, 212.)  A very extensive
   series of observations will be required in order to support this ingenious theory.
      Date of conception.—Another cause of the differences may  be  that the date
   of conception is not precisely the same in different females.  It  is customary for
   physiologists to date conception from intercourse: but the researches of Bischoff
   and Raciborski have shown that a variable interval may elapse  according to the
   situation of the ovum at the time.  Bischoff believes that the ovum escapes from
   the Graafian follicle at the time when the menstrual discharge is about to cease;
   and he is of opinion, that to be fecundated, it must be acted on while it is in  the
   Fallopian tube.   Hence he considers, in order that impregnation  should take
   place, that there must be an intercourse within eight or twelve days from the ces-
   sation of the menstrual discharge.  Raciborski thinks the time  more limited. 
PREMATURE BIRTHS.   SHORT PERIODS OF GESTATION.         401
Out of sixteen women who gave him such information as enabled him to deter-
mine the time of fecundation, there was only one in whom this occurred so late
as ten days after the cessation of the menstrual flux; and in this one, the menses
had been suddenly arrested several days before their usual time of  cessation, so
that the extrusion of the ovum did not probably take place until about two days
prior to the  act of intercourse to which it owed its  fecundation.   (Baly and
Kirke's Recent Advances in Physiology, 1848, 58.)  These authors also state
that Naegele is accustomed to reckon the duration of pregnancy at  nine months
and eight days from  the last menstrual period, and in normal cases he has found
this to be correct.  The variation in  the period  from this cause is, however, pro-
bably slight.
   Whatever may be the explanation, adopted, it is obvious that in a medico-legal
view, the only conclusion at which we can arrive is,  that the period of gestation
in the human female is not, as it was formerly  supposed to be, a fixed and inva-
riable term.
   Premature  births.  Short periods of gestation.—From the preceding remarks
we may regard all births before the thirty-eighth week as premature,  and all those
which occur after the fortieth week  as protracted cases; and one great point for
a medical witness to determine will be, whether the characters presented by a
child correspond to those which it should present, supposing it to be legitimately
born.  AVhen the birth is premature, this sort of corroborative evidence may be
sometimes obtained; because, assuming that there has been no access  between
the parties  before marriage, children born at  the fifth, sixth, or even seventh
month after marriage, cannot, if the offspring  of the husband, present the  cha-
racters of those born at the full period.  It is not so with protracted births; for
children are not more developed in protracted cases, than they are in those which
occur at the usual period.  (For an  account of the characters presented by chil-
dren at different ages, see ante, pp. 284, 372.)
   In  judging from  the marks of development on  the  body of a child, we must
make full allowance for the exceptions to which they are liable.  The nearer the
supposed premature delivery approaches to the  full period of gestation, the more
difficult will be the formation of an opinion. Although the characters of a seven
months' child are usually well marked,  and may be  known by common observa-
tion, it is not easy to distinguish a child born  at  the  eighth, from one born at
the ninth month.  Burns observes  that it is possible for gestation to be com-
pleted, and the child perfected to its natural size, a week  or two sooner than the
end of the ninth month;  and other accoucheurs corroborate this  view.   In a
series of cases which occurred to M. Devilliers, the following were the weights
of children  born at the respective periods:—
229 days   .     .    .    4*6 pounds av.  270 days  .     .    .   6-8 pounds av.
246  "...    4-88  "        272  "...   7*3    "
257   "...    6-68  "        283  "    .     .    •   6*     "
267   "...    7-71  "

Hence the weight of a child born in the fortieth week may be less than that of
another born in the  thirty-seventh week of gestation.   The weight in the third
case may be taken as the average weight of the mature child, and the delivery
took place three weeks before the usual  period.   (See Gazette Medicale, 4 Mars,
1848, p. 168.)  Thus, then, a child, born at the eighth month, may be the off-
spring of the husband:—at the ninth,  of an adulterer; but medical facts could
not enable a witness to draw any distinction.   It is here that moral  proofs are
necessary;  for without these the legitimacy of a child in such a  case could not
he successfully disputed.   AVith respect to twin children  the greatest differences
are sometimes  observed.  In a case which occurred to Mr. West the first child
born weighed only a pound  and a  half; the  second weighed  more than three
pounds, and both lived several hours.   Their  uterine  age must  have been the
       26 
402
VIABILITY IN RELATION TO LEGITIMACY.
same.  In another premature twin case which occurred to the same gentleman,
one child weighed two pounds and a quarter, and the other two pounds and three
quarters.  (Med. Times, Feb. 23,1850, p. 147.)
  The survivance of a  child has been supposed to furnish additional  evidence;
for it is well known, that under a certain age children are not born living, or if
born living, they speedily die.   Therefore it has been argued, if a child born at
the fifth  or sixth month after the first cohabitation  be  born living or survive,
this should be taken as a proof of its  illegitimacy.  The following remarks will,
however, show that an argument of this kind may be overstrained.
   Viability.   Earliest period at which a child may be born  living.—According
to the English  law, it  is not necessary that the  child,  when  born, should be
capable of living or viable, in order that it should take its civil rights.   Thus it
may be born at a very early period of gestation:—it may be immature, and not
likely to survive: or again, it may be born  at the full period of pregnancy, but
it may be obviously labouring under some defective organization, or some mortal
disease, which must necessarily cause its death within a very short period after
its  birth.  Fortunately, all these points are of no importance in relation to the
right of inheritance: the  English medical jurist has only to prove that there
were  signs of life after birth,—whether the child were mature or immature, dis-
eased or healthy, is a matter which does not at all enter into the investigation.
  In this respect, our law appears to be more simple and just than that which
prevails in France.   By art. 725 of the Code Napoleon,  no  child which is  born
alive, can inherit, unless it be born, as the law terms it,  viable.  The  meaning
of this word is not defined by the law itself, and there are probably no two law-
yers, or physicians, of that country, who place upon  it the same interpretation.
The French law seems to intend (Devergie, i. 700; Briand, 173,) by viability in
a new-born child, that it should be capable of living out of the  womb of its mother,
and independently of her;—also that it should be  capable of living for a longer
or shorter period after birth.   It would have been  difficult for any system of
jurisprudence to have laid down a more vague or incorrect  principle than  this;
and medical witnesses  may consider  themselves fortunate, that  in this country
they have not to take part in the litigation to which such a principle must neces-
sarily give rise.
   The effect of the French law is this:—a child may be born alive; it may breathe
and cry, and survive its birth  for some considerable time;  yet upon  arbitrary
medical principles, founded upon the period of gestation at which the child is
born, on its length, its  weight, the colour of its skin, the length of its  hair, and
form of its nails, it may be pronounced not  viable; i. e. not capable of inheriting
and transmitting property!   But then, again, the child  may be externally pro-
nounced viable,  and live four  or five days; yet, on  inspecting the body after
death, if disease of the lungs, brain, or any organ, which had its origin previous
to birth, be found, it will be pronounced the contrary, and the rights of property
are thus made to rest upon the  most trivial and unsettled conditions.   The pre-
sumption is, however, in favour of the legal rights of the offspring, when it has
been clearly proved  that  it has lived after it was born.  The viability of the
child is presumed, and those who would then benefit by the allegation of non-
maturity, must prove it.   (Briand, Man. Complet de Med. Leg. 1846,173.)
   It may at first sight  appear to some not quite consistent with justice, that a
child which  is born  immature, or labouring under  disease, owing to  which it
cannot long survive  its birth, should possess the same rights of inheritance  as
one which is born mature  and perfectly healthy; but this evif to society, if it be
admitted as  such, is of far less  magnitude than the adopting of a system which
must constantly  lead to subtile  casuistical distinctions, and thereby create  error
and confusion.   So long  as  there is  no well defined line between a child which
is considered capable of living and one which is not, gross injustice must neces-
sarily be inflicted by any rule of law similar to that which is  admitted in the
Code of France. 
CHILDREN BORN LIVING AT EARLY PERIODS.
403
  The question to be considered is,—What is the earliest period at which a child
can be born, to enable it to live and to continue in life after its birth?   It is now
universally admitted, that children  born at the seventh month of gestation are
capable of living, although they are more delicate, and in general require greater
care and attention to preserve them, than children born at the ninth month:—
the chances are, however, very much against their surviving.  It was the opinion
of Dr.  William Hunter, and it is  one in which most obstetric authorities  agree,
that few children born  before the  seventh month are capable of arriving at matu-
rity.   They may be  born alive at  any period between the  sixth and seventh
months, or even,  in some instances, earlier than the sixth: but this is  rare, and
if born living, they commonly die soon after birth.  There is  one case on record,
of a child having been  born  living  so early as the fourth month of gestation
(Brit, and For. Med. Rev. ii. 236;) and another of recent occurrence, in  which
a female aborted at the fourth month and a half of pregnancy.   M. Maisonneuve
was not called to this case for two hours: he  then found  the  foetus in its mem-
branes, and on laying these open,  to his surprise it was still moving.   He applied
warmth, and partially succeeded in  restoring it; for in a few minutes the respi-
ratory  motions were performed with regularity, but the child  died in about six
hours.   (Journal de Medecine, and Med. Gaz. xxxix. 97.)  In two instances of
abortion about the fifth month, Dr. Davies, of Hertford, noticed that the foetus
showed signs of  life after  its  birth,  by moving its limbs (Med. Gaz. xl. 1022;)
and the following case, in which a child, born at  the fifth month, survived up-
wards of twelve hours,  is reported  by Mr. Smythe.  A  female  in  her second
pregnancy, and in the 147th  day  of gestation, had severe  flooding with rupture
of the membranes.  Labour occurred on the following night, when a small but
well formed foetus was expelled, giving no  other  indication of life than a  feeble
action  of the heart and a strong pulsation in the umbilical  cord.  It was resusci-
tated, and cried as strongly as a child born at  the full period of pregnancy.   It
weighed less than two pounds, and measured exactly twelve inches.  It swallowed
some nourishment, but died about  twelve hours  after birth.   The  membranae
pupillares were entire,—the  testicles had not descended,—the head  was well
covered with hair.   The  length  and weight,  as  well as  the  presence  of hair,
indicate a foetus between the  sixth and seventh months; but, as it is alleged by
the reporter, that from peculiar  circumstances, the mother  of the  infant was
correct in the dates, we  are compelled to infer that this  was an extraordinary
case of premature development.   There was clearly nothing in the organization
of the child to prevent its  growing to the age  of maturity;  in other words,  it was
viable.  (Med. Chir. Rev. July, 1844, 366.)   Another case is reported, in  which
a child born at five months and a  half survived its birth between three and four
hours (Med. Gaz. xix. 865;) and on a trial for child-murder (Reg.  v. West, Not-
tingham Lent Assizes, 1848,) a midwife was indicted for causing the death of  a
child, by bringing about  the  premature delivery of  the mother, when she was
between the fifth and sixth month of pregnancy.  The child in this instance
lived five hours after its birth.   Capuron mentions  an instance where a child
was born at the sixth month and a half of pregnancy, and at the time he reported
the case, the child was two years  old, and enjoyed excellent health.   In another
instance, the child was born  at the same period, and lived  to the  age of ten
years.  (Med. Leg. des Ace. pp.  162, 208.)   In a case  which fell under  my
own knowledge, a child was born  at the sixth month and a half of gestation, and
lived a fortnight.   (See another case, Med. Gaz. xxxii. p. 623.)   Capuron con-
siders that a child born at the 180th day, or at the sixth month after conception,
might be  sufficiently mature to live; %. e. that there would be no reason to pre-
sume that it was illegitimate, merely because it  survived its premature  birth.
On  the other hand, if born before the sixth  month with  sufficient maturity to
live, this fact, although  by no means a proof, affords, in  his  opinion, a strong
presumption of its illegitimacy.  Of eight cases of children born living (by abor- 
 404               LEGITIMACY.   CASE OF FAMA CLAMOSA.

 tion) at the sixth month, Mr. AAHutehead states  that seven  perished within six
 hours after birth, and one only attained to  the age of ten days.   (On Abortion,
 240.)   Dr. Riittell, who has examined this subject with great care, states, as the
 result of his experience, that he attended a married woman,  who was afterwards
 delivered of a living child in the fifth month of  her pregnancy.   The child sur-
 vived its birth for twenty-four hours.   He  delivered another woman in the sixth
 month of her pregnancy, of twins,—one was dead, and the other continued alive
 for three hours, its life being indicated only by the visible pulsation of the heart:
 there was no perceptible respiration.  This fact corroborates the remarks made
 elsewhere, as to life without respiration, in cases of infanticide (ante, p. 294;) it
 has also an immediate bearing  on the proof of life in reference  to tenancy by
 courtesy (ante, p. 391.)  In another instance of the birth of male twins at the
 sixth month, each weighed  three pounds.   Dr. Riittell saw  them a year after
 their birth, and they were then two healthy strong children.  (Henke, Zeitschrift
 der S. A., 1844, 241.)  Dr. Barker, of Dumfries, has recently reported a case,
 in which a child was born  at the 158th day of  gestation, or twenty-two weeks
 and four days after intercourse.  The size  and weight  of the child corresponded
 with the period at which it was born.  It weighed one  pound, and measured
 eleven  inches.   It  had only rudimentary  nails, and almost no  hair, except a
 little of slightly reddish colour on the back of the head.   The eyelids were closed,
 and did not open until the  second day.  The nails were hardly visible; the skin
 was shrivelled.  The child  did not suck properly until after the lapse of a month,
_ and she did not walk until she was nineteen months  old.  AVhen  born it was
 wrapped up in a box, and placed before the fire.   Three years and a half after-
 wards, this child was in a thriving state, and very healthy,  but of small make.
 She weighed  twenty-nine pounds and a half.   (Med. Times, Sep. 7, 1850, p.
 249;  also Oct. 12, p.  392.)   Mr. Annan, surgeon, of Kinross, has recorded a
 case in which a child was born  between the end  of the sixth and the middle of
 the seventh month,  and lived  for a period  of four months and  eight days.  It
 weighed a pound and a half when seven days old.  (Med. Times, Sept. 9,1848,
 p.  304.)  In a case which  occurred to Dr. Outrepont,  of Bamberg (reported in
 Henke's Zeitschrift, vol. vi.,) there was the strongest reason to believe that ges-
 tation could not have exceeded twenty-seven weeks.   The child weighed, when
 born, one pound and a half, and measured  thirteen and a half inches.   The skin
 was covered with down, and much wrinkled,—the extremities were small,—the
 nails appeared like white folds of skin, and the testicles had not descended. It
 breathed as soon as it was  born, and by great care its life was preserved.  It is
 singular that its development was very slow, until it reached what would have
 corresponded to the  forty-second week of gestation.  Dr.  Outrepont saw this
 child when it had attained  the  age of eleven years, and then it appeared of the
 size of a boy of eight years.  The only remarkable point about this case is the
 length of time which the child  lived.   In a case quoted in the Lancet, Aug. 23,
 1851, p. 177, a child born  at six months and ten days was thriving satisfactorily
 when four months old.   (See  also Med. Times,  Feb.  16, 1850, p. 129.)  It is
 therefore clear, that children born at the seventh, and even at or about the sixth
 month, may be reared, and  that their survivance for months or years cannot be
 taken as evidence of illegitimacy.  In forming a judgment on these occasions, we
 are bound to look less at the period &t which the child is  born, than to the marks of
 development about its body.  The case of  Mr. Smythe (supra) is corroborative
 of this view.  Such, I believe, are the principal medical facts connected with
 the question of premature births; and the  following singular case will serve as
 an illustration of the  difficulties sometimes  experienced in  forming a medical
 opinion.
    The  Kinghorn case.—In  October, 1835,  an investigation (fama  clamosa)
 took place before one of the Presbyteries of Scotland,  in reference to certain re-
 ports which had been circulated, to the prejudice of a minister of the district. 
LEGITIMACY.  CASE OF FAMA CLAMOSA.
405
 It appears that the marriage of this gentleman took place on the 3d of March,
 and his lady gave birth to a female child on the 24th of August following; i. e.
 one hundred and seventy-four days,  or  nearly six calendar months, after the
 marriage, and the child continued to live until the 20th of March, 1836.   AVhen
 born it was very weak, and according to the evidence of the  accoucheur and
 others, who saw it, it was decidedly immature.  The birth of a living child, to-
 gether with its survivance for so long  a period, led, however, to the report that
 there must have been intercourse between the parties previously to the marriage.
 It was contended that the period was too short for the child to have been begot-
 ten in wedlock.  Dr. Hamilton, of Edinburgh, on being applied to by the Pres-
 bytery, said that his own experience was  opposed to the probability of a child
 born at the sixth lunar month surviving: (the  time in this case was six lunar
 months and six days;)  but he referred to two cases, where children born under
 similar circumstances had survived their  birth  for  a  long period.   In one, the
 lady was delivered within five lunar months (twenty weeks) after the marriage,
 and Dr. Pitcairn and others gave it as their opinion, that  it had been begotten
 within wedlock:  in  the other, a woman  gave birth to a  child nineteen weeks
 after conception, and it lived  a year and a half.   Dr. Thatcher, who examined
 the child in the case here reported, nineteen days after its birtb, gave  it as his
 opinion, that it might have been begotten on or after the 3d of March;  and the
 circumstance of its having been reared  in the  premature  state  in which it was
 born on the 24th of August following, was no  objection  to  this opinion.  He
 considered the  complaint made against the minister groundless.   The case went
 through several appeals, and was not finally decided until May,  1839, when the
 libel was found not proven, and the defendant was absolved from censure.   Many
 medical witnesses gave  evidence on the occasion—the majority of  them being
 strongly in favour of this having been a legitimate and premature birth.   (See
 Record of  Proceedings, &c, Edinburgh, 1839; Med.'Gaz. xvii. 92; also  Med.
 Chir. Rev. xxxi. 424.)   Although not connected with  the medical  part of the
 case, it should be observed, that the character of the  parties  was free  from all
 suspicion, that  no concealment had been practised by them, and  that no prepa-
 ration  had  been made  for the early birth of the child.  There were, it is true,
 unusual marks of development about this child, considering the  early period of
 its  birth; yet these were not sufficient, any more than  the fact of its surviving,
 to induce the belief that it had been  begotten out of  wedlock.  One  case has
 been already mentioned, where a  child born at a  still earlier period survived
 several hours, and others where children born rather later  lived  for two and ten
 years.  It would be in the highest degree unjust to impute  illegitimacy to the
 offspring, or a want of chastity to the parents, merely from the fact of a six months'
 child being born living and surviving its birth.   There are, indeed, no justifiable
 medical grounds for adopting such an opinion,—a fact clearly brought  out by a
 question put to Dr.  Campbell,  the chief medical witness in  favour of the alleged
 antenuptial conception.   In his examination in chief, he admitted  that he had
 himself seen the case of a six months' child  who survived for several days.   He
 was then required to say, whether he could  assign any reason why, if after such
 a period of gestation it is possible to prolong life for days, it should not be pos-
 sible to extend  it for months!   He could obviously give no reason.   (Record of
 Proceedings, &c, 55.)   The great injury which may  be  done by  speculative
 medical opinions, such as those  given  against  the  chastity of the  parties con-
 cerned  in these  proceedings, will be apparent from  the record of a  case which
 occurred to Dr. Halpin, of Cavan, in  1845:—A healthy  vroman, ast.  84, the
 mother of five children, was delivered in the sixth month of her pregnancy of a
 female  child.   It was rolled in flannel, and  laid in a warm place.   Contrary to
 expectation, the child survived, sucked vigorously, and  was healthy in every re-
 spect.  The ossification  of  the bones of the head was  very imperfect, and the
sutures broad enough to admit of the  middle finger being laid  between them; 
406               SURVIVANCE NO PROOF OF ILLEGITIMACY.
 and the fontanelles were of corresponding large size.   The weight of the child,
 on the fourth day after birth, was two pounds thirteen ounces; and on the thirty-
 fourth day, three pounds seven ounces.   The child was alive  and well when last
 seen, on the fourth of March,—i. e. four months after birth: she then weighed
 eight  pounds eight  ounces.   After this Dr. Halpin lost  sight of her, as the
 mother left that part of the country.  (Dublin  Quarterly Journal, May, 1846,
 583.)   See also Dr. Barker's case, ante,  p.  404.
   If the facts of these cases  be compared with  those of the Kinghorn case, it
 will be found that there were no just medical grounds for the imputation that
 the child had been begotten out of wedlock.   In the latter, six months' children
 were living and  healthy after four months  and three years and a half, respectively;
 in  the former, it was supposed that  the child must have passed the sixth month
 (of uterine life,) because it survived seven months!   In Dr. Halpin's  case, the
 child,  four days after birth, weighed two pounds thirteen ounces—(a six months'
 child  rarely exceeding  two pounds:) in the Scotch  case, it was considered that
 it must have been  much beyond the sixth month, because (a fortnight after its
 birth) it weighed three pounds!  These cases deserve  to be borne in mind, when
 much  reliance is placed  upon  the appearances presented by children, as positive
 evidence of the  stage of uterine life  which they have reached.
   Evidence from the state of development  of the offspring.—The fact that a child
 born at nine months is small,  and resembles in size and weight a seven or eight
 months' child, cannot be taken as a proof of illegitimacy.  It has been already
 stated, that children born at the full period vary considerably in size and weight;
 yet, although small, there  are commonly about them the appearances of develop-
 ment.   This is  especially apparent in the features.  If there be a general want
 of  development, and if certain foetal peculiarities remain—as, for example, the
 membranae  pupillares, or (in  the male) the testes do not  occupy the scrotum,
 —these facts  may lead to' a strong presumption that  the child  has not reached
 the full period.   On  the other hand, when  a child is  born with all the signs of
 maturity about it, at or under seven months (from possible access of the husband,)
 then there is the strongest reason to believe that it is  illegitimate.   No instance
 is recorded in which children have reached maturity two months earlier than the
 natural period.   There are many cases of retarded development; but, so far as I
 know,  this kind  of premature development in the foetus has never been observed.
 In the  Scotch case above  related, the  child  was more developed than such children
 commonly are at the same  period of uterine life: but these differences are slight.
 The great progressive stage of development is in the last two months of gestation:
 the changes which  the foetus undergoes are greater, and more marked, at this
 than at any other period.   At eight months there might be some difficulty in
 forming an  opinion;  but it appears to me, that at seven  months it would be
 impossible for an accoucheur to commit an  error on this point.   If the body of
 the child were large and  fully developed, he would consider it to have been born
 at the  full period of gestation; and  attribute any opinion which had led to  the
 supposition that it was a seven months' child, to have  arisen from some mistake
 in the  calculation.   Dr. Beck states it as barely possible that  a child born at
 seven months may occasionally be of such a size as to  be considered mature; yet
he qualifies this  statement by the remark, that the assertion  is most frequently
made by those whose character is in danger of being destroyed.  The question is,
however,—Has a really seven months' child ever been born, so developed as to be
 mistaken for one that was mature?  He adduces no case of this kind in support
 of his opinion.  There can be no doubt of the correctness of his statement, that
 a mature child, born before seven  full  months  after connexion, ought to be
 considered illegitimate:  but  it would be  difficult  to maintain  this  position
 consistently with the above admission; for a  child is as likely to acquire pre-
mature development during the latter half of the sixth as at the seventh month.
 In  making  this remark, I ought to mention that Dr. Riittel, an experienced 
CASES OF PREMATURE DEVELOPMENT.
407
observer, has met with several cases where females have been delivered two and
even three weeks before the expiration of the ordinary term (two hundred and
eighty days,) and the children were as perfectly developed, to all appearance, as
those born at the full period.  (Henke, Zeitschrift, 1844, p. 246.)   This question
may arise in cases  of divorce, and  the fact be received as proof of the  act of
adultery.  In the case of Maclean, (House of Lords, March, 1851,) it was proved
that the earliest intercourse which could have been had with the husband was on
the 22d  December,  1847; while according to the medical evidence the child
was born on the 6th July, 1848, and was a full-grown nine months' baby.   This
was received  as proof of adultery on the part of the wife.  In Heathcoie's case
(March, 1851,) it was proved that the husband returned on the 24th November,
1849, and the wife  was delivered of  a full-grown child on the 18th  May, 1850.
This was also taken as proof of the alleged adultery.
   In Hawkins' case, May, 1852, it was proved that there had been no access of
the husband, owing  to his absence between the 16th May, 1850, and the 23d
March, 1851.  A full-grown and mature child was born on the 2d June,  1851:
hlmce, to have been the child of the husband, gestation must have been extended
to a year and sixteen  days, or reduced to a period of only seventy-one  days.
This was taken as clear proof of adultery on the  part of the wife.   It is to be
remarked of  this case that the husband had slept  with his wife  after his return,
even up to five  minutes of the time of her delivery, without suspecting his wife's
pregnancy;  and her female attendant, who had been in the habit of seeing her
daily, did not observe any alteration in her personal appearance.   This created a
little difficulty in the case; but it merely serves  to  show either  that a  visible
prominence of  the  abdomen is by no means a  constant accompaniment  of the
pregnant state, or that it may be very readily concealed.
   The following case in reference to development  has been communicated to me
by one of my pupils.  It  is  well calculated to show the  characters of a  seven
months' child,  and  to corroborate the views adopted by physiologists respecting
the means of determining the period of uterine life which the foetus  may have
reached.   Mrs. F. was married  on  the  7th April, 1846, and was delivered by
my  informant  of a male child  at seven o'clock  on the  evening of the 19th
October following,—the period of gestation being equal to 195  days, or twenty-
eight weeks.   The  infant cried  strongly, and  lived until nine  o'clock the
following morning.   The  skin was  of a  deep  pink or  rose  colour, beautifully
soft, and covered with  a fine down.   The membranae pupillares were absent, and
the  pupils were well formed,—the nails were complete,—the testicles had not
descended into the  scrotum,—its length was fifteen  inches, and its weight two
pounds eight ounces.  Its weight, and the non-descent of the testicles, at once
referred it to a uterine age of seven months.
   In addition to the other circumstances mentioned, it is observed that children
at the seventh  month do not so readily take  the breast as those which have
reached the ninth;  and their power of sucking is much more feeble.
   AVhen the question comes to this, that  to be the offspring of the husband, it
must be  a six  months' child, and it is  born mature, there can be no room  to
doubt its illegitimacy.  This question was raised in the Exchequer Sittings  (Janu-
ary, 1847,)  on a motion  for  a  new  trial in the  case of Eager  v. Grimxvood.
The action was one of seduction, and the principal witness in the cause, a young
girl  on being  cross-examined, stated that she was first connected with the de-
fendant a few days  before Christmas, 1845, and that the birth of  the child took
place in the June following,—i. e. in about six calendar months.    Under these
circumstances,  as the child appeared to have been full  grown, the Chief  Baron,
assuming the statement of the dates to be correct, intimated it to be his opinion,
that the  action could not be maintained,  as the foundation of it was the loss of
service, arising from the defendant's intercourse with the daughter,  and her sub-
sequent  confinement;  and that  it was impossible that he could have  been  the 
408                 CASES OF PROTRACTED GESTATION.

father of the child in question.  The jury found for the defendant.   A rule for
a new trial was  granted, chiefly on the  ground that the woman  had, from  con-
fusion in giving her testimony, made a mistake in the period.
  Protracted births.—Long qjcriods of gestation.—The questions connected with
retarded gestation have  given  rise to considerable discussion in legal medicine.
That  gestation may be retarded or protracted beyond the fortieth week, is now,
I believe,  not disputed by any obstetric writer of reputation.'  Some individuals
have denied it, because they have not met with such cases; but the medico-legal
relations of  such questions do not depend upon the solitary experience of prac-
titioners.  It is only by the accumulation of well ascertained  facts from all au-
thentic sources that medical knowledge can be made available to the purposes of the
law: otherwise, owing to the mere accident of a witness not having met with any
exceptional case, a Court may be entirely misled in its judgment by trusting to
his  opinion.   It is more important to attend to this, because  most of the cases
involving questions of contested legitimacy or the chastity of individuals, turn
upon protracted rather than upon premature delivery.
  In  the  standard  works on  midwifery will be  found authentic  reports  of
cases  in which  gestation  continued  to  the  forty-first, forty-second, forty-third,
and even  the forty-fourth week.   Dr. Murphy regards  301 days, or 43 weeks,
as the average limit of gestation.  (Obstetric  Report, p. 4.)   Dr. Lee met with
a case in which  he  had no doubt  that the pregnancy lasted two hundred and
eighty-seven days:—the labour did not take place until forty-one weeks after the
departure  of the husband  of this lady for the East Indies.   (Med. Gaz. xxxi.
917.)   Dr.  William Hunter met  with  two  instances where gestation was  pro-
tracted until the forty-second week.  Dr. Montgomery met with a case in which
delivery did not ensue  until between the forty-second  and forty-fourth week.
(Med. Gaz. xix.  646.)  Dr. Merriman has published a valuable table on the sub-
ject of protracted gestation, on which the most experienced accoucheurs have been
in the habit of relying.   Of one  hundred and fourteen pregnancies calculated
by him  from the last day at which the  females menstruated,  and in which the
children appeared to be mature, the following were the periods:—
In the 37th week    .      .     .3
       38th     .    .      .     .13
       39th     .     .      .     .14
       40th     .     .      .     .33
In the 41st week
       42d
       43d
       44th
22
15
10
 4
   Another well marked case, occurring forty-four weeks precisely after the ces-
sation of the catamenia, has been communicated to me by Dr. S. W. J. Merriman.
   From these results Dr. Merriman considers that the greater number of women
complete gestation in  the fortieth week from the cessation of the catamenia,
and next to that in the forty-first.   In the evidence given by this gentleman be-
fore the House of Lords in 1825, the case of longest protraction  on which he
was able to rely, was that of a married female, who was in the habit of calcu-
lating from the last day on which her monthly period ceased.  This  lady was de-
livered 309 days, or forty-four weeks and one day from the time  at which she
supposed that she had  conceived.   In another case mentioned by the  witness
the period was 303 days, or forty-three weeks and  two days  from the ter-
mination of  the  last monthly period.  It was  objected  to this  evidence  by
the Attorney-General that as it  was impossible to fix the exact  date  of con-
ception, and as the female might  have really conceived only a day or two before
the expected return of menstruation, twenty-eight days, or four weeks, might
be deducted from the periods assigned  by the witness.   Admitting   the va-
lidity of this objection,—and the  fact upon which it is based is indisputable,—it
followed that the longest protracted case observed by Dr. Merriman might have
really been  only a case  of  ordinary gestation extending to forty weeks  and one
day.  An objection of  this kind may of course be successfully urged in law  to 
LEGITIMACY.  PROTRACTED GESTATION.
409
any inference from a  calculation so made, and it was thus that  in the Gardner
Peerage case, the medical evidence failed to render it certain that  gestation might
be so protracted as to cover the legitimacy of the claimant.  It  is therefore ob-
viously of the greatest importance, in considering this question,  to make full al-
lowance for a possible error; and in calculating the pregnancy from the last day
of the last menstrual period, to'deduct the interval of menstruation, if known,
and  at least twenty-eight days, if unknown.  It must be remembered that in
these cases of contested legitimacy, the offspring is commonly  the result  of  a
single intercourse.  The date of conception is therefore fixed, and a comparison
can only be  instituted between the period of gestation thence deduced, and the
periods taken in other cases which are free from  any chance of error.
   My friend, Dr. Murphy, of  University College, has  furnished me with some
valuable data in reference to this subject.  Out of 1S2  accurately observed cases
in which special inquiries were made of  the females, the deliveries  took place
from the date of the last  appearance of the catamenia at the following periods in
weeks.    The details are fully given in his Report of the Obstetric Practice of
University College Hospital for 1844.
In the  33d week
       34th   .
       36th   .
       37th   .
       38th   .
       39th   (9 months.)
 5
 3
 6
11
12
24
In the 40th week
       41st
       42d
       43d
       44th
       45th
2o
32
25
19
 9
11
   The most protracted of the  cases in the table was No. 182.   The period of
gestation was 329 days, or deducting twenty-eight  days (the ascertained men-
strual  interval,) 301  days, or  forty-three weeks; i. e. three  weeks beyond  the
usual period, or that allowed  by those medical witnesses who gave  evidence
against the possible protraction of pregnancy in the Gardner Peerage case.
   It will now be proper to direct attention to  some still more remarkable pro-
tracted cases which are recorded  by writers of repute, and which have either
fallen under their own observation, or under that of  friends upon whose judg-
ment they could rely.  Among these a case is reported by Dr. Beck  to have
occurred in America in 1840, in which gestation is stated to have extended to
313 days, or forty-four weeks and five days; but, as the facts are not fully de-
tailed,  I prefer taking  for illustration two well  marked  cases observed by Dr.
Murphy, and recorded in his Obstetric Report for 1844.   In  No. 183, a healthy
married woman,  aet. 26, pregnant with her third child, was delivered 342 days
from the last appearance of the menses.   The  date at which they were last ob-
served  by her was the 1st September, and  the woman was delivered on the  9th
August of the following year.   In No. 184, a  married woman, aged 33, preg-
nant with her fifth child, delivery took place at  an  interval of 352 days.  The
menses last appeared on the 1st of March, and the child was born on the 16th
of the following  February.  In both instances  the menstrual interval  was  ob-
served  to be four weeks; therefore, deducting twenty-eight days, the periods of
gestation in these two cases will be—
No. 183   (342—28)   314 days    ....    44 weeks and 6 days
No. 184   (352—28)   324  "     .      ;     .     .46     "2  "

   As these cases are of a somewhat remarkable  kind, the facts are specially de-
tailed.   Dr. Murphy observes,  in respect to the  longest  case, "that the date of
the last menstrual discharge in  this, as in other  cases, was recorded before par-
turition took place; thus preventing the possibility of  misstating this fact for the
purpose of making it appear that  gestation was inordinately prolonged.  Men-
struation, however, is sometimes suspended, or may return at irregular intervals
during pregnancies; it was possible, therefore,  that the catamenia might have 
410
LEGITIMACY.  PROTRACTED GESTATION.
appeared in this irregular way, occurring but once, and that time being put two
months before conception.   It was necessary to avoid this source of error.   This
irregularity did not take place in either of these cases, and  in  the last instance
there was an  interval of four years between the present  and the previous preg-
nancy, during the whole of which period  to the time  of conception  the menses
were  quite regular."   (Report, page  7.)   Dr. Murphy  has  since published
another case which occurred in his practice in 1849: the duration of pregnancy
was 351 days, or deducting the monthly period (351—28) 323 days.  (See Med.
Gaz. 1851, vol.  xlviii. p. 683.)  I am  indebted to  Dr. S. AV.  Merriman for  a
reference to another case, which goes one day beyond the  longest of  Dr. Mur-
phy's, i. e. 325  days, or forty-six weeks and  three  days.   This  is  reported by
Dr. Power, in his work  on Human Pregnancy.
   These cases appear to me to be conclusive of the question,  and to  furnish a
complete answer to the objection taken to Dr. Merriman's evidence in the Gardner
Peerage case.  All women may not have such unusually protracted pregnancies;
indeed, it is well ascertained that no two women are alike in this respect, and no
two successive pregnancies in the same female are alike  in duration.  Then,
again, all practitioners may not have  met with such protracted  cases.   The fact
being clearly ascertained in one case,  renders it  unnecessary to search  for more,
unless we doubt the credibility of a reporter well qualified  to  observe, and who
could have had no motive to serve but that of stating a plain truth as it came
before him.  On this part of the  question  I  think it is unnecessary to argue.
The advocates of a fixed and limitable period differ from each  other by a space
of ten or twelve days, and each must either take his own  experience for the final
decision of this question, or it must be allowed that men of  equal powers of ob-
servation with themselves have met with cases which have gone beyond their
own fluctuating  limits.
   Dr. Murphy has so completely anticipated the objection which might be urged
on the ground of the menstrual function being possibly suspended from some
hidden morbid cause one or two months before the actual date of  conception,
that it is scarcely necessary to make  any remarks  upon it. If it is  to be ad-
mitted under these circumstances, it would be only equally just to admit that in
any given case the ordinary and so-called fixed period, calculated from the ces-
sation of menstruation, is based on a  fallacy.  Thus, it might be urged the men-
strual function  continues  for several intervals after  conception.   The woman
may have conceived  in  the month before the cessation of the catamenia, and
thus  four weeks should be added to  the period.  Dr. Murphy observes of his
cases, that periodic discharges resembling the catamenia took place during preg-
nancy; in one  case to the time of quickening, and  then ceased; in  another up
to the eighth month; in a third throughout the whole period of pregnancy.  In
all these cases the discharge was described  as being in every respect similar  to
menstrual. This view of the question may appear to prove that no reliance can
be placed on  the time of the cessation of the catamenia as evidence of the period
of pregnancy;  but if, as in case No.  184, a married woman had been  perfectly
regular for four years previously, the cessation of the  discharge would  assuredly
furnish evidence of the  strongest possible kind.  Its continuance  might, as  it
happens daily, have given rise to error, and have actually led to the period being
unduly shortened in the opinion of the female.   In  the Gardner Peerage case,
the Attorney-General was quite willing to  rely upon  the cessation of the  men-
strual discharge as a good criterion of the duration of pregnancy, when by such
a mode of calculation this was  not made to exceed forty weeks.   But this con-
dition must  be  either taken, or rejected altogether, as evidence:  if the former,
we have no right, in alleged protracted cases, to refer the suppression  to disease,
for the sake of  shortening the period, when we do not refer its  continuance  to
disease, because  it would tend to lengthen it: if the latter, it would  be in the
highest degree unjust not to give to a claimant the beneficial presumption of his 
PERIOD OF GESTATION NOT FIXED.
411
 haying  been born legitimate, when the cases  adduced in evidence against his
 claim are actually based upon precisely the same mode of calculation!   Such
 protracted cases as those observed by Dr. Murphy may not be frequent; but it
 is the fact of their possible occurrence, rather than their frequency, which should
 be regarded in  determining questions of contested legitimacy.
   It has been  supposed that cases of lengthened gestation were nothing more
 than instances  of protracted  parturition;  the pains indicative of delivery com-
 mencing at the  usual time, but continuing over a much longer period than usual.
 In an instance mentioned by  Dr. Jorg, a woman went her full time, but the par-
 turition lasted a fortnight longer, the symptoms appearing and then disappearing.
 Admitting that this occasionally happens, still it shows that gestation from a par-
 ticular pregnancy may be protracted considerably beyond  the ordinary period.
 It is impossible to admit that these protracted cases  depend upon some mistake
 being made  in the calculation of the period, since this calculation was founded
 on the same principles as those adopted  in cases of ordinary pregnancy.  Hence,
 if there was a mistake in the one case, there would be in the other:  if an error
 in the exception, there would be an error in the rule.  Either the average term
 of  pregnancy is wrongly calculated by most accoucheurs at the thirty-eighth or
 fortieth week, or it is rightly calculated to extend occasionally to the forty-fourth,
 or, as in Dr. Murphy's case, to the forty-sixth week.  'But even setting aside  the
 palpable answer to an objection of this nature, some of the cases were instances
 of  impregnation from one intercourse;  and therefore it is quite impossible that
 any such mistake could have  arisen respecting them.   (See ante, p. 400.)
   Tlie sex of the child has no influence.—There is no reason to believe that the
 sex of the child has any  direct influence on the length of the pregnancy.  It has
 been supposed  that gestation was longer with male  than female children; and
 evidence of this kind was tendered in the Gardner Peerage case.  The medical
 witness stated, that the average period was 280 days for a female, and 290 days
 for a male child.  The Solicitor-General very properly inquired—Supposing the
 child is an hermaphrodite, what then is the time?  The witness said—He would
 take between the two!  It is  not observed that children labouring under sexual
 deformity are born earlier or later than those in which the sexual organs are per-
 fectly developed.  As an answer to this singular hypothesis it may be observed,
 that of Dr. Murphy's two most protracted cases (Nos. 183 and 184, ante, p. 409,)
 the one was a female, and the other a male  child.
  Period of gestation not fixed by law.—In all  cases of contested legitimacy,
 the question respecting  the period of gestation, when  it arises, is left entirely
 open  by the  law.  No period  has been  fixed within which, or beyond which, a
 child, if born in wedlock, will  be presumed illegitimate.  The decision of a Court
 of law would be founded, quoad the duration of pregnancy,  on the opinions of
 experienced  practitioners selected for the occasion, and  each case would be de-
 cided on its own merits.   Precedents can have but little influence  on these  oc-
 casions, because a Court  may  think fit to pronounce  illegitimate, on non-medi-
 cal grounds,  a child born in the  thirty-eighth week of  gestation; while it may
 decide that another was legitimate that had been  born  in the  forty-third week.
 By some law-authorities forty weeks are set down as the  "ultimum temqms
qmriendi:"—but the impression among  jurists and physicians in modern times
 being that the period of human gestation is wholly independent of any legal dictum,
 it is not the custom of the Courts to act  upon this as a  rule.  Nevertheless, it is
 clear that in  some cases the  law must interpose, and pronounce for a reasonable
 limit.  In  the case of Cotterall v. Cotterall,  decided in the  Consistory Court,
July, 1847, the  husband  had proceeded  against  the wife for a divorce on the
ground of adultery.   The main proof was  based on the fact,  that in order  to
have been the child of the husband, it must have been born after twelve months'
gestation.  The  husband had  left his wife in New South AArales, and was absent
for that period of time without possibility of access.   Dr. Lushington, without 
412
LEGITIMACY.  PROTRACTED CASES.
entering into the question of protracted gestation, upon proof of the allegation,
at once pronounced for  the divorce.   Such a duration  of pregnancy is not sup-
ported by any known facts, and is altogether opposed to medical probability.
   In two instances, children have been pronounced legitimate, which were born,
the one in forty-one weeks and three days, and the other in forty-one weeks and
four days, after the death of the husband.  In the following case (Auderlon v.
 Gibbs, 1834,) the Vice-Chancellor decided that a child bom ten months, or about
forty-two weeks  after intercourse with the husband,  was legitimate.  A  verdict
had been already returned, establishing the legitimacy of the plaintiff; and an
attempt was now made to set this aside, among other grounds, upon the plea that
the offspring was illegitimate,  because it had been born at so long  a period after
possible access.   It appeared that the mother of  the plaintiff for some time be-
fore and at the period of the birth had been living in  adulterous intercourse; and
that about ten months before the birth of this child she had had a private interview
with her husband, when it was assumed that there had been access, but the par-
ties did not meet afterwards.    Before the adultery, they had lived together two
years without having had issue; and in the present  instance the child  was born
after a period of forty-two  weeks,—facts which were  considered to establish its
illegitimacy.  The opinions of Sir Charles Clarke and other medical men were
adduced at the trial, and these  limited the extreme period of gestation to forty
weeks; but they at the same time declared that the subject was involved in dark-
ness and uncertainty.   The Vice-Chancellor considered that the jury at the trial
had given a proper verdict by finding for the plaintiff's  legitimacy.  The jury
were not to decide by whom the child  had been  begotten, but whether it could
by any possibility be the child  of the husband.   With respect to the period of
gestation, there was no  difficulty.  Sir Charles  Clarke, and other authorities,
confessed that the subject was  involved in darkness and mystery;  and that the
Faculty of medicine knew nothing certain about it.   There was no positive evi-
dence as to the exact day on which the child was born,  nor  on which the inter-
view between the husband and wife took  place.  Therefore this would allow of
the period of gestation being reduced to about forty-two  weeks or  less.   The le-
gitimacy of the plaintiff was in his opinion legally established.  From this case
it will be seen that a child may be affiliated on the husband, although the wife
may be living at  the same time in adulterous intercourse with another  person.
   Gardner Peerage case.—One of the most interesting cases in relation to this
subject was the Gardner Peerage case, which came before the House of Lords in
1825; and  a full account of which has  been published by Dr. Lyall.   (Med.
Evid. in Gardner Peerage Case, 1827.)  Alan Legge  Gardner, the son of Lord
Gardner by his second wife, petitioned to have his  name inscribed as  a peer on
the  Parliament  roll.   The peerage was,  however, claimed by another  person,
Henry Fenton Jadis, who alleged  that  he was the son of Lord Gardner by his
first and subsequently divorced wife.   It was contended  that the latter was ille-
gitimate; and in order to establish this  point, the evidence adduced was partly
medical and  partly moral.  Lady Gardner, the mother of the alleged illegitimate
child, parted from her  husband, on board of his ship, on  the 30th of January,
1802.   Lord Gardner went to the AVest Indies, and did not again see his wife
until the 11th of July following.  The child whose legitimacy was disputed was
born on the 8 th of December of that year.   Therefore, the  plain medical ques-
tion, taking the extreme view, was, whether a child  born 311  days (forty-four
weeks and  three days)  after intercourse  (from January to  December,) or 150
days (twenty-one weeks and three days) from July  to December,  could  be con-
 sidered to be the child of Lord Gardner.   If these questions were answered in
the affirmative, then it followed that this must have been a very premature or a
very protracted  birth.   There was no pretence that this was a premature case,
 the child having been  mature when born.   The question then was reduced to
 this—AVas this alleged  protracted gestation of 311 days consistent with  medical 
LEGITIMACY.  THE GARDNER PEERAGE CASE.            413
experience?  Many medical witnesses, comprising the principal obstetric prac-
titioners in the kingdom, were examined on this point.   Their evidence was very
conflicting, but a large majority concurred in the opinion that natural  gestation
might be protracted to a period which would cover the birth of the alleged illegiti-
mate child. On the moral side of the question, it was clearly proved that Lady Gard-
ner, after the departure of her husband, was living in open adulterous intercourse
with a Mr. Jadis; and on this ground Lord Gardner obtained a  divorce from her
after his return.  He subsequently married a second wife,  by whom he had the
claimant, Alan Legge Gardner.   It was contended  that the  other claimant was
really the son of Lady Gardner by Mr. Jadis.  The decision of the House was,
that this claimant was illegitimate; and that the title should descend to the son
of the second Lady Gardner.
   The decision appears  to have been chiefly based on moral circumstances; for
had not the first Lady Gardner been living in open  adulterous intercourse at the
time of her husband's departure, it is highly probable, from the  medical evidence
bearing that way, that the legitimacy of the  child would have  been allowed.
Again, supposing the child had been born two or three weeks earlier, the question
would have resolved itself into this—who had begotten the child?—the husband
or the adulterer.  This could not have been  decided, and then, probably, as in
the more recent case of Anderton v.  Gibbs (supra,) the rule  of law would have
pronounced the husband to have been  the father.   The House then must have
considered, that the medical opinions, without cases to  support them, could not
be safely received.  It is obvious that the possibility of gestation being protracted
must stop somewhere, and the Court probably thought that they had here reached
that point.   Morally speaking, the decision could not be  impugned; but medi-
cally speaking, it was  incorrect; inasmuch as a court of law never pretends to
settle who begat a child, when the pregnancy might by any  possibility be as-
cribed to the husband or an adulterer.  The House of Lords, however, here de-
cided that the adulterer begat the child;  and by implication their decision in-
volved this medical point,—that it is quite impossible the  husband can be the
father of a child born forty-four weeks and three days after access!  No case was
adduced to show that so long a gestation had ever been known to occur; for, as
it has been already remarked, the mode of calculation adopted in Dr. Merrirnan's
cases rendered them unavailable as evidence.   That in a medical point of view
the decision of the House of Lords, so far as it related to protracted  gestation,
was erroneous, must now be apparent; for while their Lordships did not directly
come to a resolution that the one claimant was illegitimate, because he could only
have been born after 311 days'  gestation, they decided  that  the  other claimant
was the only son and rightful heir of Lord Gardner.   A reference to  the  cases
 reported by  Dr. Murphy (ante, p. 409,) will show that gestation  may  be pro-
tracted to three, and even thirteen days, beyond the period denied to be possible
on this occasion.  Supposing this case to be re-heard, and the evidence of Dr.
 Murphy called for, could the House vindicate its former decision?  It would be
found that they had virtually pronounced to  be impossible what  had actually
come to pass;  and either the decision would be the other way,  or it would be
contrary to that general rule of law upon which so  many decisions have been
framed, that  even although the wife may be living in adultery, the husband shall
 be presumed to be the father of her children, unless there is a clear proof of non-
 access—or 0f absolute impossibility from the duration of the pregnancy.  Of the
 seventeen medical witnesses examined on this occasion, five  supported the opinion
 that the duration of  human utero-gestation was limited to about  nine calendar
months, /. e. from thirty-nine to forty weeks,  or from 278  to 280  days; or,
strictly speaking, from  270 to 280 days:  one of the witnesses, indeed, said from
265 to 2S0 days.  Those gentlemen, of course, gave their negative to the possi-
bility, unless by miracle, that Henry Fenton  Jadis, alias Gardner, could have
been the product of a 311 days' gestation.   On the other side, of twelve medical 
414
EVIDENCE FROM THE STATE OF THE CHILD.
 gentlemen who seemed to agree with respect to the above-mentioned period as
 the natural term of gestation, most  of them maintained the -possibility  of  preg-
 nancy being protracted to nine and a half, ten, or eleven calendar  months, and
 of course to 311 days,—the alleged term of gestation at which the counter-claimant
 was born; and thus admitted the possibility that Mr. H. F. Jadis, alias Gardner,
 might be a ten and a half months' child.   (Lyall's Med. Evid. on the Duration
 of Pregnancy, &c, p. viii.)  The conclusion at which the majority arrived has
 now been confirmed by the occurrence of several well marked cases; and the facts
 should serve as a caution to those witnesses who on speculative subjects lay down
 a limit to what  is possible merely from the  experience which they may  have ac-
 quired.  The decision of the House of Lords, admitting that it was consistent
 with justice in this instance, can, it appears to me, only be defended on the  prin-
 ciple that when a married woman has had  intercourse about the same period with
 her husband and an adulterer, her offspring should be bastardized on the  mere
 proof of her adultery.   But this is entirely contrary to decisions in other  cases
 (ante, p. 412.)
   Within  a very recent period a case has  been decided in the  United States in
 favour of the legitimacy of a child, in which gestation was protracted to 317 days,
 or forty-five weeks and two days.  (Commonwealth versus Porter; Amer. Journ.
 Med. Science, October, 1845, p. 383.)
   Evidence from the, state of the child.—In these protracted births it is not ob-
 served that the child is more developed, or of larger size, than at the usual period.
 In one of the longest cases of protracted gestation on record (324 days) the child
 was not above the average  size,  although,  when Dr. Murphy saw it, six months
 afterwards, it was unusually  large and fat for a child of that  age.   (Obstetric
 Report, 1844.)  This would lead to the inference, that when the child has reached
 a certain stage of development it ceases to grow.   This view is borne out by the
 observations of  Dr. Riittel.  (Henke, Zeitschrift, 1844, p. 247.)  This gentle-
 man has not remarked that the  size  of the child  increases in proportion to the
 length of the gestation.  In protracted human and animal gestation the offspring
 is not remarkable for size and weight.   In both cases robust  mothers have had
 small children, and small mothers strong and sometimes unusually large children.
   The following case  (Luscombe v. Prettyjohn, Exeter Summer Ass. 1840) will
 show how unsettled legal opinions are upon these points; and that disputed ques-
 tions of gestation are sometimes decided without medical evidence, although there
 are few instances in which  it is more urgently required.  An action was  brought
 against the defendant, by a farmer, to recover compensation for the loss of his
 daughter's services.  It was alleged that the defendant had seduced her, and that
 she was delivered  of a  child of which  he was the father.  He denied  that the
 child was his, among other reasons, on the ground that it was born two hundred
 and  ninety-nine days, or forty-two weeks and five days after intercourse.   No
 medical evidence was called to show  that gestation might be thus far protracted;
 but  the judge, in summing up, made the following observations:—"Upon the
 evidence it was almost impossible that he  (the defendant) was the father.   Sup-
 posing that she (the woman) were right, that would place the  birth at nine ca-
 lendar months three weeks and five days."   [The last meeting between the parties
 was  had on the 9th of February, and the child was born on the 5th December,
 1838, which is equal to an interval of 299 days.]   After adverting to some me-
 dical authorities relative to gestation, he said:—"He would rather  believe that
 she had yielded to some other attempt on  her chastity, than that so wide a de-
 parture from  the  usual course  of nature had taken place!"  The jury did not
 concur in  this view, and they returned a verdict  for  the plaintiff,  thereby pro-
 nouncing an opinion which is well borne out by medical  experience, that the de-
 fendant might have been the father  of the  child,  although forty-two weeks and
five days had elapsed since  the last access.   (Lancet, Aug. 1840.)  Had the ver-
 dict been the other way, there would have been fair ground, medically speaking, 
            LEGITIMACY.  DECISIONS ON PROTRACTED GESTATION.        415

for a new trial;  for the summing up was undoubtedly made on an entirely mis-
taken view of medical doctrines.  It amounted to this, that the chastity of every
married woman who bears a child in the forty-third week of pregnancy after the
absence or death of the husband, is to be impeached,—and the legitimacy of her
child is to be set aside on bare proof of the fact!
   In a well marked instance of gestation from a single intercourse, noticed by
Dr. Reid, the interval was 293 days,—only six days earlier than the period here
pronounced to be incompatible with legitimacy; and by referring to the cases of
Dr. Rigby and Dr. Merriman, it will be seen that the periods of gestation from
a single intercourse have varied to a much greater degree than the two here put
in comparison.   It is very true that  a limit must be placed somewhere; but the
cases reported by Dr. Murphy (ante, p. 409) prove that gestation  is  not so limited
as it was here assumed to be.  This shows the risk to which the decision of such
questions is exposed, when medical evidence is not called for on matters so strictly
professional.   As a contrast to this case, the following, which was tried in the
United States, in January term, 1844, is of some interest.   (The Commonwealth
v. Porter;  Cambria County, Pa.)   The facts were somewhat similar.  The de-
fendant was indicted for fornication and bastardy.  Prosecutrix, aged 23, had
intercourse with the  defendant on the 24th September,  1842, and  with no other
person before or subsequently.   She was delivered of a  child on the 7th August,
1843,—i. e. 317 days, or after forty-five weeks and two days' gestation: she  swore
that the defendant was the father of the child.  The catamenia ceased about three
weeks after intercourse, and they only appeared  again  slightly  about five weeks
before the child was born.   At this time she had pains, which continued more
or less until her delivery.  She first  knew that she was pregnant  three or four
weeks after connexion.   The defence was, that from the period of time which
had elapsed, the defendant could not be the father of the child.  He, therefore,
merely proved his absence, and that he did not return until after the birth of the
child.   No evidence was adduced to impeach the character or conduct of the
female.   It was  proved that she had always borne a good reputation, and that
she had been seduced by the defendant under promise of marriage.  Dr. Rodrigue
deposed,  that, in a practice of nineteen years, he had attended some hundreds of
cases of midwifery; and the longest period of gestation which he had known was
ten months.   He considered the pains described by prosecutrix to have been the
commencing pains of labour.   The Court charged the jury strongly in favour of
the medical testimony of protracted gestation, and they returned a verdict  of
guilty,  thereby finding that the defendant was the father of the  child.  It  tran-
spired that a wife  of one of the jurymen had during one pregnancy gone ten
months.   (Amer. Journ. Med.  Sciences, Oct. 1845, p. 338.)  Dr. Rodrigue,
who reports this trial, states that a case subsequently came to his knowledge,  in
which gestation continued for a period of 320 days.
   It would appear that the question of protracted gestation is frequently raised
in the United States  under these circumstances.  Another case of bastardy ( The
Commonwealth v. Hooner) was tried in May, 1846, in which the  alleged duration
of pregnancy must have been 313 days, or 44 weeks and 5 days.  The prosecu-
trix deposed that she had had intercourse with the defendant on March 23d, 1845,
and not subsequently,—a fact established by the evidence; and the child, a large
healthy male, was proved to have been born on the 30th January, 1846.  Twelve
physicians were examined on the trial, and as usual they differed from each other.
Some regarded it as possible, but not probable, that gestation  might  be so pro-
tracted as to reach 313 days.   Various medical works were quoted on the  sub-
ject.   The Court charged the jury that, although unusual and improbable, this
length of gestation was not impossible; and they returned a verdict finding that
the defendant was the father of the  child.   (Dub. Med. Press,  Nov.  4th, 1846,
296.)   In the case of Dyson v. Dyson (Vice-Chancellor's Court, Feb. 18,1852,)
it was proved that the husband left his wife in Madeira, in  Feb. 1849, that she 
416
CASES IN REFERENCE TO ACCESS.
returned to England in the August following, and the child whose legitimacy was
contested was born on the 8th Jan. 1850.   It was contended that this was a case
of protracted gestation, and the evidence of several medical men to the effect that
gestation might be protracted for 330, or even 336 days, was quoted in support
of this view.   In this case there was a period  of 336 days.  The Alce-Chancellor
having referred to the Gardner Peerage case, declined to make a decree in favour
of the legitimacy of the plaintiff.  (Legal Examiner,  Feb. 21,  1852, p. 93.)
   In extra-uterine pregnancy,  the foetus  may be carried for  many years.   Dr.
Craddock relates a  case, in  which gestation was thus protracted  for the long
period of twenty-two years.  (Phil. Med. Exam. May 1846, 286.)
   Mistakes  in the mode of computation.—Great mistakes have arisen in the
calculation of  the period  of gestation by the use  of the word month—some
intending by this,  lunar, and  others calendar months.  Nine lunar months
would be equal to  two hundred and fifty-two days, while the average of nine
calendar months would  be two  hundred  and seventy days—the  latter period
varying according to the particular months of the year over which the pregnancy
may extend.   To prevent  such mistakes,  or  that misunderstanding of evidence
which has so frequently arisen, it would be  advisable  that  medical witnesses
should always express  the period of gestation in weeks or days.  It would be
also proper to  adopt the plan  of always commencing the calculation from the
period of the last cessation of the catamenia, rather than from two weeks later.
The latter rule is often followed, and  this discrepancy  creates confusion.
   It  will be seen by the foregoing  cases and remarks, that  in these suits of
contested legitimacy the general practice consists in  establishing  possibility of
access on the part of the husband:—when this is proved, the medical question
arises, whether  the term  of  gestation falls within those  limits assigned by the
best  medical experience.  Legitimacy  has been allowed where gestation was
probably protracted to the forty-third week (Anderton  v.  Gibbs, p. 412;) and in
the United States, where it extended to forty-five xoeeks and two days, ( Common-
wealth v. Porter, p. 415.)   It has been disallowed in the English Courts, although
probably on non-medical grounds, where  it was protracted to forty-four weeks
and three days ( Gardner Peerage case, p. 412;) and  in  one case because it had
extended to forty-two weeks and five days (p. 414.)
   Cases  in reference to proof of access.—In the case of Cope v. Cope (North.
Spring Circ.  1833)  an  action was brought by the plaintiff, for his share of a
legacy, to a part of which he declared himself entitled, as being the son of the
deceased testator's brother.  There  was no  doubt that the plaintiff was  born
during lawful wedlock; but it was contended that he was an illegitimate child:—
therefore  it remained with the  defendants to establish his illegitimacy by evi-
dence.  The  defendants rested their case, 1st, on the entry in the parish register,
which represented the  plaintiff to be an illegitimate  child; 2dly, on non-access
between the husband and wife.   The husband, having separated from the wife,
went  to reside  at about  fourteen miles distance from her.  He was absent for
several years;  but it was contended that  he was always  within a short distance
of the wife.   During  his absence, the wife formed  an  illicit connexion with
another man, and at this time the plaintiff was born: but it was rendered probable
that the  husband had visited the wife  before  and after  the birth of the child.
It appears that both  the mother and her husband regarded this child as illegiti-
mate;  and an attempt was made, on the part of the defendant's counsel, to put
in declarations  to that effect; but the Court interposed;  and Alderson,  B. said
—" Lord Hardwicke had decided that the mother could not be allowed to give
evidence on such a point, as she could not discharge the husband of the birth of the
child; and d fortiori the husband could not be permitted to discharge himself.  Lord
Mansfield and Lord  Hardwicke had both  decided that illegitimacy could only
be proved by the fact of there being no marriage, or by the proof of" non-access:
and  it was  held, on the  grounds of decency and  morality, that the parties 
LEGITIMACY.   CASE OF MORRIS V. DAVIS.
417
themselves should not be allowed to prove non-access after their marriage."  In
summing  up, he further observed, " that if a child be born in marriage during
the life-time of  the  husband, that child in law is presumed legitimate.   The
plaintiff in this case is the youngest child, and was born after four other children,
and  during the  lifetime  of the reputed father;  and he is  in law, therefore,
legitimate, unless the fact were proved, which it was for the jury to decide upon,
viz. that the husband had not opportunities of access.   If a husband have access,
and others at the same time have  criminal intimacy with his wife, still a child
born in such a case  is legitimate in the  eye  of the law.    But if the parties are
living  separate, and the wife  is notoriously living in open  adultery, and  the
husband have opportunities of access, yet under such circumstances, it would be
monstrous to suppose that he would avail himself of these,—then the legitimacy
of a child, so born, could not be established."   The jury returned a verdict for
the plaintiff,  finding that he was legitimate.
  From this  case we learn what kind of evidence  the law requires in order to
establish access or non-access.   In order to defeat the legal presumption of access,
where husband and wife are living near to each other, something more than mere
probability of non-intercourse must be  adduced.   It is true,  that  in this case,
the wife, while separated  from her husband, was living  in open adultery—but
non-access of the husband was far  from being clearly established.  On  the
contrary,  access was rendered probable by evidence:—therefore a verdict was
returned,  finding the plaintiff legitimate.  It will be seen that very little value
is set on baptismal  registries, as evidence of legitimacy, or the contrary; also
that the declaration  of  a  parent will  not be received by a Court as evidence of
the illegitimacy of the reputed offspring.
  The case of Morris v. Davis, which came before the Lord Chancellor in 1830,
is also of  interest.   This  was a suit  of contested  legitimacy, which had been
pending for eighteen years before the Courts; and which was finally left by both
parties to  be  disposed of by the judgment of his lordship, on the facts and on
the law of the case.   The plaintiff was the son of a Mrs.  Morris, and claimed to
be the son of Mr. Morris; but it was  contended that, although born in wedlock,
he was illegitimate.   The husband and wife had voluntarily separated; but lived
for many  years within a short distance of each other.  The wife was living with
an adulterer; and fourteen years  after  the  separation, this child, the plaintiff,
was born.   The wife saw her husband  occasionally, but  concealed the birth of
the child  from him.   The  man with whom  she was living considered it, and
always treated it, as  his own; and Mr. Morris  remained  for seventeen years in
ignorance of the birth or even of the existence of the child.  His lordship having
stated the  law of the case, as  already given, said the question was one of fact
and not of law.   There was an apparent difficulty in the  case, owing to this,—
that the parties, although separated, were proved  to have met occasionally:—
there was, therefore, unquestionably opportunity of access:—but it  so happened,
that none  of these meetings would correspond with the time requisite for the birth
of the child to render it legitimate.  This fact, together  with the general bad
conduct of the mother, and her open adulterous intercourse, led him  to pronounce
that the plaintiff was an illegitimate child; and that he was not the son of Mr.
Morris.  This judgment was not opposed to the rule of law, nor was it founded
upon a mere balance of probabilities, but entirely upon the facts of the case.
27 
418
DISPUTED PATERNITY.
PATERNITY.
                             CHAPTER LIII.

DISPUTED PATERNITY—EVIDENCE  FROM LIKENESS—DOUGLAS PEERAGE CASE—PARENTAL
  LIKENESS--AFFILIATION.--POSTHUMOUS CHILDREN.--SUPERFCETATION IN RELATION TO LE-
  GITIMACY—CIRCUMSTANCES UNDER WHICH IT IS SUPPOSED TO OCCUR--SUPERCONCEPTION.
  —SUPPOSITITIOUS  CHILDREN—RELATION  OF THE SUBJECT  TO  FEIGNED DELIVERY AND
  LEGITIMACY.

  Disputed paternity.—It has been stated that the law does not pretend to de-
termine who begat  a child when it has been born during wedlock, and from
circumstances might be the child either of the husband or an adulterer.  But
medical jurists have recommended that family likeness should be looked to on
these occasions,—not merely a likeness in feature and figure, but in gesture and
other personal peculiarities which may have characterized the alleged parent.
These are called questions of paternity: they seldom  occur, and when they do
present themselves, the evidence thus  procured, even if affirmative, is properly
regarded as only corroborative.   In the Townshend Peerage case, brought before
the House  of Lords in  May, 1843, this argument  of  family likeness was used
and admitted by their lordships.  The party whose legitimacy was in question
was sworn  by one of the witnesses to bear so strong a likeness  as a child to the
alleged adulterer, that he should have known him among five hundred children.
The proceedings in the Douglas Peerage case (1769) also show that evidence of this
kind is of some importance.  This peerage was claimed  on appeal to the House of
Lords by the survivor of two brothers, Archibald Douglas, after the death of the
alleged  parents, Sir  John and Lady Douglas.   The claim was  disputed, on fiie
ground that the appellant and his deceased brother were supposititious children.
Much stress was laid in favour of their legitimacy,  on  the fact  that they closely
resembled—the one Sir John, and  the other Lady Douglas.   The resemblance
was general,—it was evident both in their features, gestures, and habits.  Lord
Mansfield,  in delivering judgment, made the following judicious remarks, which
comprise all that can be said on the subject.   "I have always considered likeness
as an argument of a child being the son of a parent, and the rather as  the dis-
tinction between individuals in the  human species is more discernible than be-
tween other animals.  A man  may survey ten thousand people before he sees
two faces exactly alike, and in an army of a hundred thousand men, every man
may be known 'from another.   If there should be a likeness of feature, there may
be a difference in the voice, gesture, or other characters;  whereas a family like-
ness runs generally through all of these; for in every thing there  is a resemblance,
as of feature, voice, attitude, and action."   From  this account, it will be seen
that evidence from family likeness  is  not  strictly medico-legal,—it can  be fur-
nished  only by friends  and relatives who have known the parties well, and are
competent  to speak of the facts from personal acquaintance with them.   It will
also be apparent that the affirmative evidence in such cases will be stronger than 
PARENTAL LIKENESS.   AFFILIATION.                 419
that which is negative; for it could hardly be inferred that a person was illegiti-
mate, because he did not resemble his parent.
  Parental likeness.—Parental likeness may be occasionally indicated by colour
or peculiarities belonging to the varieties of mankind, as of the intermixture of
the Negro with  one of the Caucasian  variety.   In such a case the evidence
afforded becomes much stronger; and supposing that two men of different varieties
have intercourse about the  same  time with  the same female, the colour of the
skin may enable a Court to determine the question of paternity.   It is said to
have happened, on more  than one occasion,  that a black woman has given birth
at one time to a black child and a mulatto; and Dr. Cunningham  refers to a
case in which a negress recently gave birth  to twins, one a black and the other
a white child.   (Lancet, May 9, 1846, 525.)   This was probably a case of su-
perconception.
  Personal deformities are not necessarily transmitted from parent to child; yet
it would appear, from the  subjoined case, that a disputed question of  affiliation
has been settled on this principle.  A woman  alleged that a gentleman in whose
service she had  lived, was  the father of a child of which she had been recently
delivered.  The solicitor who appeared to support the affiliation  rested his case
chiefly on the fact that the child had  been born with five fingers and a thumb
on  the right hand, the defendant himself having  been born with a similar mal-
 formation on both of his hands.  It was argued on the other side, that the de-
 formity might have arisen from the mother's imagination, as, while pregnant, she
 was constantly in the habit of seeing the defendant.  The magistrates decided that
 he  was the father of the child, and condemned  him to pay the necessary expenses
 for its support.   (Med. Times, March  6, 1847, p. 47.)  ■ It is very likely that
 the decision was here influenced by moral circumstances; for otherwise the defen-
 dant might have been the victim of a coincidence.  Six-fingered children are, it
 is well known, born  occasionally of five-fingered  parents; and as the  deformity
 existed only  on  one hand in the child, while it was on both hands in the parent,
 the medical  proof that it was actually transmitted  by generation was certainly
 not clearly made out.  In  some instances  attempts have been made to fix the
 paternity of  a child  by  the colour of the hair, but  this  evidence is far less con-
 clusive than  that  afforded  by the colour of the skin.   In the case of Frazer v.
 Bagley (Feb., 1844,) the wife of the plaintiff was alleged to have had criminal
 intercourse with the defendant, and the last two children were alleged to be the
 offspring of the latter.   The plaintiff and his wife had  dark hair, as well as all
 the children  with the exception of the last two:—these had red hair, and it was
 further proved that defendant had red whiskers and sandy hair.  No particular
 stress was  laid upon this evidence, but it was received as a kind of indirect proof.
 But  little  confidence can be placed on facts of this  description, since red-haired
 children are  often born to  parents who have dark hair; and in one case the chil-
 dren born  in wedlock were observed to have dark and red hair alternately.
    Affiliation.—Questions of paternity are involved in those relating to affiliation.
 A  party may allege that he is not the father  of a particular child, by reason of
 certain circumstances upon which a medical opinion may be required.  The ne-
 cessary transmission of gonorrhoea or syphilis by intercourse, may thus become
 a medical question.   In September, 1844, a man was required, under the law of
 bastardy, to  support  two children  alleged  by a female  to be his.   The time of
 gestation was within  nine  months.  The accused denied that he had had  inter-
 course with the  deceased, or that he could have been the father, since he was at
 the time under  medical  treatment for the venereal  disease.  The medical ques-
 tions may  therefore assume this shape:—1. Are these diseases  invariably trans-
 mitted by intercourse ?—2.  Do they interfere with the act of procreation ?  Under
 common circumstances they must both be answered in the negative.
    A singular case of bastardy is reported to have occurred in the Canton of Ap-
 penzell.   The question was, which of two persons, who had had intercourse with 
420
POSTHUMOUS CHILDREN.
the sania woman within a period of seventeen days, was the father of the illegiti-
mate child borne  by the woman.   The Council, to which the case was referred,
gravely resolved to postpone their decision  until the features of  the child were
so far developed as to enable them to decide  from paternal likeness.   The equity
of this difficult case would have been met by compelling each man to contribute
to the support of the child!  (Schneider's Annalen der Staatsarzneikunde, 1836,
1 B. s. 470.)   The following, which is a more doubtful case, was the subject of
a communication  to the Lancet (March 13,  1847, 263.)   Two men, A. and B.,
had intercourse, unknown to each other, with a young woman of delicate health;
and after this had continued for some years, she was delivered of a female child,
nine calendar months and three days after sexual intercourse with A., and nine
calendar months, less five days, after similar intercourse with B.; or at the end of
279 days after intercourse with A., and at the end of 271 days after intercourse
with B.; that is, a period of eight days elapsed between the periods of intercourse
of the two men, and the woman had no menstrual  discharge in the mean time,
and it is not believed she knew any other man.   She went her full time, had a
good  labour, and  produced a fine  healthy girl; had a plentiful supply of milk,
and enjoyed better health during her pregnancy and suckling than at any other
time.   The woman died, and the circumstances of this mixed intercourse having
become known to A. and B., they both refused to maintain the child.   A. con-
tended, that as the woman was not delivered until nine months  and three days
after  connexion with him, it was physically impossible that the child  could  be
his.  B. contended, on the other hand, that 280 days, and not nine months, is
the period of gestation; and that the child having been born 279  days after con-
nexion with A., and only 271  days after connexion with B., it was  therefore
probable that the child was  begotten by A.  There was no perceptible likeness
of either of the men in the child, but a marked  likeness of the mother.
   It is obvious, from the remarks elsewhere made  (ante, p. 415,) that the two
periods, 271 and  279 days, are comprised within the common range of gestation:
hence there would be no medical  ground for  affiliating  the child to one more
than  the other.   As in the former case, justice to the offspring and to each pos-
sible  father requires that they should  be  both bound to support the  child.
These questions of affiliation, when the interval is  less than six or eight weeks,
can rarely be determined by medical evidence.   In  a twin case, it would be only
just that one child should be affiliated  to each individual.  In a recent case of
affiliation, an attempt was made to set aside the order of a magistrate fixing the
paternity on the  putative father, on the ground that, as the intercourse was had,
and the child conceived in France, although born  in  England, it was removed
from the jurisdiction of an English magistrate, and should be left to the French
Courts.   The  objection was overruled, and the  alleged father was ordered to
pay the usual sum for maintenance.
   Posthumous children.—It has been supposed, that a case involving a question
of paternity might present itself on the marriage of a widow soon after the death
of her  first husband.   If a child were born after the lapse of  ten  months, it
might be a question whether it was a child of the  first or second  marriage—of
the dead or the living  husband;  and although there might be  no dispute con-
cerning its legitimacy,  yet it would be difficult to settle its paternity.  Such a
case appears hypothetical.  In order that any doubt should exist, a woman must
marry within, at the furthest, six weeks after  the death of her first husband, or
else the birth of  the child would fall beyond the furthest limit  of gestation, so
far as he was  concerned.  The customs of society are, however, a bar to such
marriages; and admitting that a child was so born, that it might  be the offspring
of either husband, then the fact of its having  been born during  the marriage of
the second husband, would presumptively fix  the offspring upon him, unless it
could be shown that there was no possibility of access on his  part.   If there
were a supposed  greater likeness to the first than the second husband, still this 
CASES OF SUPER-CONCEPTION.
421
 would not be allowed to defeat the legal presumption of the  real parentage of
 the child.  It appears to me, that evidence much  stronger than this woufd be
 required for such a purpose.  (See Henke, Zeitschrift, 1838; ii. 432.)

                              SUPERFCETATION.
    Superfoetation in relation to legitimacy.—Most medico-legal writers, in treat-
 ing of legitimacy, have considered it necessary to introduce the subject of super-
 fcetation.  By this we are  to understand, that a second  conception  may follow
 the first, and that gestation may go on to its full period in each case, independ-
 ently of  the other,—so that if a woman were  impregnated, when  in the third
 month  of gestation, she would bear  the  first child mature at the end of  nine
 months, and the second child,  also  mature, at  the end  of twelve months after
 the first conception.   This subject has been  said to involve "not only the con-
 jugal fidelity of a wife, but the disposition of property, and much of the comfort
 and happiness of society."  Its  importance to a medical  jurist appears to me to
 have been considerably exaggerated.   So far as I have  been able to ascertain,
 not only is there no legal case involving this question, to be met with in  the ju-
 dicial records of  this  country, but none, in reference to this state, is ever likely
 to occur which would present the  least difficulty to a medical practitioner.   If
 we admit that a woman may, during  marriage, present  such an extraordinary
 deviation from the common course of nature, as to produce two perfectly mature
 and fully developed children, the  one three or four months after the other, how
 can such an event be any imputation  on her fidelity?  Superfoetation, if it occur
 at all, may occur in married life, and  during connubial intercourse.   The  follow-
 ing appears to be the only possible case wherein a medical opinion might be re-
 quired  respecting this alleged  phenomenon.   A married woman,  six  months
 after the absence or death of her first husband,  gives birth to an apparently ma-
 ture child, which dies.  Three  months afterwards,  and nine months after  the
 absence or death  of her husband, she may allege that she  has given birth to ano-
 ther  child, also  mature: a medical  question  may arise, whether two  mature
 children could be so born, that the birth of one should follow three months after
 the birth of the other,—or whether this might  not  be a case, by no means un-
 common, of twin children, the one being born prematurely, and the other at  the
 full period.  (For  a case of this kind, at  two months' interval, see Med. Gaz.
 xxxvii.  27; and for another at eight days' interval, see the  same journal, vol.
 xlvii. p. 227.)   Admitting  that  both the children were  mature, and therefore
 that it was a case of superfoetation, the first  delivery must have taken place in
 the presence  of witnesses, and it would then  have been known whether another
 child remained in the uterus or not.  If the two children were born within the
 common period of gestation after the absence or  death of the husband, then their
 legitimacy would be  presumed, until the fact of non-access were clearly estab-
 lished.   The mere circumstance  of their being  apparently mature, and born at
 different periods,  would per se furnish no evidence of their illegitimacy.   On the
 other  hand, if one or  both of them were born out of the  ordinary period, then,
 according to the evidence given,  they  might or  might not be pronounced illegi-
 timate.   The law therefore appears to have no sort of cognizance of the subject
 of superfoetation as such; it  is entirely merged in the question of protracted ges-
 tation, which has already been fully considered.
   Super-conception.—AVhether superfoetation can really  take place or not, is a
 question which has given rise to much controversy.  That one  conception may
 follow another within a  short period, and that  twins may thus be the result of
 two distinct conceptions, is a probable  occurrence.  This, indeed, is what may
 be termed super-conception.  But when  gestation has already gone to the second
month, it is highly improbable that  there should be a second conception.   In
two cases, however, in which two men had  intercourse with the same female
within the period of seventeen and eight days respectively—cases favourable to 
422                ALLEGED CASES OF SUPERFOETATION.

super-conception,—there was, in each  case, only one child, and  the  paternity
was actually disputed.   (See ante, p. 420.)  It would appear, from the researches
of Donne, that there is a limit to this power of super-conception.   He has found
that the mucus secreted from the vagina of pregnant females is, by reason of
its  great acidity, completely destructive of  the existence of the zoosperms, and
therefore renders the  spermatic fluid unprolific.   (See  post, Sterility.)  It
does not appear, however, that  the  vaginal mucus becomes more acid at this
period; but, according to Mr.  Whitehead, the effect is due to this  acid secretion
not being partially neutralized,  as in the unimpregnated state, by the  alkaline
mucous secretion of the uterus.  (On Abortion, 406.)  At what period of preg-
nancy the vaginal mucus begins to  act destructively on the zoosperms, has not
yet been determined;  but further researches may show  that  we have in this
chemico-physiological effect a  complete answer  to the doctrine of superfoetation.
   Cases of alleged superfoetation appear readily explicable on the supposition
that the woman was pregnant with twins, and  that one was born prematurely,
and the other at the full  time, or later.   The following  case, reported by Dr.
Mobus, of Dieburg, (Henke's Zeitschrift der S. A. 1837,) will serve to illustrate
this subject:—A healthy roamed woman, about  thirty-five years of  age, was
safely delivered of a girl, on the 16th of October, 1833.   The child is described
as having been well formed, and having borne about it all the signs of maturity.
This woman, it is to be observed, had previously had several children in a regular
manner.  Soon after her delivery and the expulsion  of  the  placenta, she felt,
on  this occasion, something still moving within  her.  On examination, the os
uteri was found completely contracted, and the organ itself so drawn  up as to
render  it difficult  to be reached; but the motions  of  a second child were  still
plainly distinguishable through the parietes of the distended abdomen.   Her de-
livery was not followed by the appearance of lochia or by the secretion  of milk.
The breasts remained flaccid, and there was no fever. On the 18 th of November,
thirty-three days after her first confinement, this woman, while alone and unassisted,
was suddenly delivered of another  girl, which,  according to Dr. Mobus, was
healthy, and bore no signs of over-maturity about it.   The reporter alleges, that
this case most unequivocally establishes the doctrine of superfoetation.   The two
births  took  place at an  interval of thirty-three days, and the two  children were,
it is stated, when born, equally well  formed and mature: but Dr. Mobus did not
see the second child until twenty-four hours after birth.
   This appears to have been nothing more than a twin case, in which one  child
was born before the other.  Dr. Mobus considers  that the first child was born
at the usual period of gestation, it  being described as mature; and the  other,
thirty-three days after that period,—having been, in his view, conceived so many
days later than the first child.   If, however, we imagine that in this, as it often
happens in twin  cases,  one twin was more developed than the other,  and that
the most developed was the first expelled; or that  it is not always easy to com-
pare the degree of development in two children, when one is born before the
other, and they are not seen together, we shall have an explanation of the facts,
without resorting to the hypothesis of two distinct conceptions.  As to the signs
of over-maturity, alluded to, they are not met with.   If we are to believe authentic
reports, a child born  at the thirty-ninth week is  not to  be distinguished from
one born at the forty-third or forty-fourth (ante,  p. 414;) and children born at
the full period vary much in size and weight.  A longer period may be required
to bring the child to maturity in some women than in others;  and in a woman
with twins, it is well known that the two children may arrive at the same degree
of maturity within  different  periods,—one requiring, perhaps, several  weeks
longer than  the other for  its full development.
   Cases of abortion of one twin, the other remaining in utero, are by no means
uncommon.   Two cases of this kind are referred to in the Ed. Med. and  Surg.
Journal.  (July, 1839, p. 289.)  In one, abortion took place at three months, 
SUPPOSITITIOUS CHILDREN.
423
 while  the woman went to her full time and was delivered of a healthy child at
 nine months.  In the second, one foetus was  expelled at about four and a half
 months, while four months afterwards, a full-grown child was born.  Even under
 a malformation which might be supposed to be favourable  to its occurrence,
 namely, the presence of a bilocular uterus, it has been found that impregnation
 has taken place in one cornu only.   (See Med. Gaz. xix. 507.)  A singular in-
 stance is however recorded in the same journal (xx. 508,) where a woman, six
 months after  marriage, bore a four  months'  child, and forty weeks after mar-
 riage, mature  twins.  On examination, the uterus  and vagina were both found
 double, and each vagina had a separate orifice.  Dr. Horlbeck, U. S., states that
 he met with a case in which a well grown foetus of six months was simultaneously
 expelled with  an embryo  about six weeks old!  (Med. Gaz. xliv. p. 87.)  In a
 late number of the Medical Times,  Dr. Foley has  published the account of a
 case in which  the mole was expelled  from the uterus at an early period of preg-
 nancy, while the female was delivered  about  the usual period of a living and
 well formed although weakly child, which survived its birth three days (Jan. 31,
 1852, p. 104.)  [See a paper by Dr. Lopez, in Am. Jour. Med. Sci. Oct. 1846,
 for numerous cases of apparent superfoetation; also a case by Dr. Carter, in the
 Phil. Med. Ex. 1849, 523.—H.]
   Monstrosity and  Superfoetation.—A most extraordinary case of monstrosity,
 involving the questions of superfoetation and paternity, is stated to have occurred
 at Alexandria in Egypt.   A Fellah woman was delivered of a dicephalous mon-
 ster, of which one head was white, and apparently about the eighth  month of
 uterine life, while the other head was black, possessing in other respects the ne-
 gro conformation, and this head was fully developed.   The  monster was born
 dead, and the mother died soon after her delivery.   The change in the colour of
 the skin commenced at the neck  of the black head,  and was found by M. Prus,
 an eminent sanitary physician at the  port of Alexandria,  to be due to the  exis-
 tence of a colouring matter similar to that found in the skin of the Negro race.
 The husband of the woman was  a Fellah, whose skin was of a brownish colour.
 There were Negro labourers in the port, but it could not be ascertained whether
 the woman had had intercourse with  any of them.   It is therefore impossible to
 say whether this was or was not a case  of impregnation about the same time by
 two men of  different races.  Admitting that  this occurred, it is difficult to un-
 derstand why the black colour should have been confined to the head only.  (See
 L'Union Medicale, 5 Aout, 1848.)

                        SUPPOSITITIOUS CHILDREN.
   Another medico-legal case in relation to legitimacy, occurs where a woman
 feigns delivery, and represents the child of another person to be her offspring:—
 or she may substitute the living child of another woman for a dead child of
 which she herself has been delivered; or for a mole  or hydatids which may have
 passed from her.   So again, a male may be substituted for a female child, and
 vice versa.   The practising of a fraud of this  nature  may seriously affect the
 rights of inheritance of parties;  but it cannot be  accomplished without  great
 dexterity and cunning, or without the  co-operation of  several accomplices.  Frauds
 of this kind have, in general, been committed  by the aid of a low class of mid-
 wives.   One instance occurred at Chelsea, in July, 1842, where  the fraud was
 brought to light by the death of the supposititious  child.  The calling in of a
 professional man would infallibly lead to discovery, when the question was simply
 whether delivery had or had not taken place; but if  it be  alleged that one living
 child has been substituted for another,  the proof of  this can depend on medical
 evidence only when the age of the supposititious child does not happen to cor-
respond to the pretended delivery. (See Ann. d'Hyg. 1829, ii. 227.) The legiti-
macy of the claimant of the Douglass peerage was disputed on  this ground, but
 apparently without  foundation (ante, p. 418.)  A  remarkable case of this de- 
424
SUPPOSITITIOUS CHILDREN.
scription will be  found in Henke's Zeitschrift der S. A. 1845, ii. 172; and a
trial has recently taken place in England, involving the  alleged substitution of
a child, but requiring no medical evidence for its elucidation.  (Day v. Day,
Leicester Lent Ass. 1845.)
   The manner in which an imposition of this kind may be carried out is well
shown by a case which occurred recently in France.  The female was, in this
instance, a deaf and dumb woman, married; and it appeared that the husband
was in collusion with her.  It was not in her power to make any disposition of
some property to which the children of her marriage would be entitled, and by
the advice of her husband she simulated pregnancy in order to deprive the heir-
at-law of the property, to which he would be entitled at  her death.   The facts,
as far as they could be ascertained, were  as follow:—The woman was forty-two
years of age, and  although married for a period of twenty years, had borne no
children.  On this occasion, admitting her statement to be true, she was delivered
without any medical assistance.  All her acquaintances and friends were ready to
depose, that for six months she had  presented the usual appearances of real
pregnancy, and that she had manifested the usual  indisposition  attending preg-
nancy, including occasional faintings at the parish church!  For the heir-at-law
it was contended, that she had'substituted, for her  false accouchement, the child
of a person named Peyrins, born only a few days before;  and that she had made
a false declaration of  the birth.   A midwife was ready to depose that the deaf
and dumb woman had never been a mother.  The  decision in this singular case
is not stated. ' (Ann. d'Hyg. 1847, i. 463.)  It is obvious that it can only be by
the accident of the simultaneous delivery of another female in secrecy (whose
pregnancy is unsuspected,) that a trick of this kind can be successfully prac-
tised.
  A case involving this question (Hutchins v. Hutchins)  was heard in the Vice-
Chancellor's Court in May, 1851.   The amount of ingenuity required to perpe-
trate a fraud of this kind was only equalled by the skill with which the facta
were exposed, and justice was ultimately  done to a rightful claimant. 
SEXUAL MALFORMATION.
425
HERMAPHRODITISM.
                             CHAPTER  LIV.

 SEXUAL MALFORMATION—HERMAPHRODITISM--ANDROGYNUS--ANDROGYNA--DISTINCTION OF
   SEX--MISTAKES IN THE SEX OF CHILDREN--RULES FOR DIAGNOSIS--CASES.--CAUSES OF
   SEXUAL DEFORMITY IN THE FCETUS—LEGAL RELATIONS—CASES IN WHICH THE DETERMINA-
   TION  OF THE SEX IS NECESSARY.--IMPUTATION OF HERMAPHRODITISM--THE RIGHTS OF
   ELECTORS DEPENDENT ON A NORMAL CONDITION OF THE SEXUAL ORGANS.—CONCEALED SEX.

   General remarks.—The legitimacy of a  child is open to be contested under
 other circumstances than those connected with  the  duration of gestation.   The
 alleged parent may have laboured under physical incapacity;  if a male, he may
 have been affected with impotency;  if a female, with sterility; and if either of
 these conditions  be proved,  the illegitimacy of  the  child will be established,
 although the alleged period of gestation may be  comprised within the ordinary
 limits.   The sexual conditions now about to be considered have also an important
 bearing in relation to divorce, and occasionally to the civil rights of the child who
 may be the subject of the malformation.   One of the most common and obvious
 causes  of impotency or sterility is malformation of the sexual organs, to which
 species of monstrosity the term hermaphroditism is commonly applied.

                          SEXUAL MALFORMATION.
   Owing to  arrested development, during the growth of the  foetus, the sexual
 organs, which can scarcely be distinguished  in  the  foetus at the  fourth month,
 occasionally assume an abnormal arrangement.  These  organs appear to  be at
 that time more or less mixed; and sometimes the  male, and at others the female
 characters predominate.  In the former case, these beings are called androgyni,
 and  in the latter androgynae.  With this defective sexual development, the other
 peculiarities of the sexes are either wanting, or we find them more or less blended.
 AVhen, therefore, the being is a male with malformation of the generative organs,
 it is called androgynus—when a female with a like malformation, androgyna.
 There can be no difficulty in identifying such cases, and, according to the degree
 of malformation, a  medical jurist can have no hesitation in pronouncing these
 subjects to be incurably impotent.  The organs are commonly so  defective as to
 be wholly unfitted for the functions of either sex.   It is not  meant to be said,
 that it is in all cases easy to assign the sex, but this is of minor importance; the
 main question is, whether the malformation  be or be not  such as to justify di-
 vorce, or the imputation of illegitimacy upon children claiming to be the offspring
 of these beings.
   Distinction of sex.—The determination of the sex in these cases of  deformity
 has been considered to be  necessary under  certain circumstances; as when, for
 instance, a title or entailed  inheritance of lands is in question.  Lord Coke has
 stated, that according to the  law of England, a  hermaphrodite  may be either
 male or female, and it shall  succeed according to the kind of sex which doth pre-
 vail.   Thus, it is obvious that the law will decide each case according to the spe-
 cial circumstances attending it: but it must  not be supposed that  the decision is
so easy as Lord Coke's doctrine would imply.   There are many cases in which 
426
DISTINCTION OF SEX.
neither sex can be said to prevail.  The beings are positively neuter.  The great
character of the male would consist in the presence of testicles, and of the female
in the presence of a uterus and ovaries.  In a case which occurred to Mr. Grigor,
both the testicles and ovaries were wanting: there  was no essential character of
either sex, and even during life it would have been impossible to say whether
this being was male or female.  (Cormack's Monthly Journal, July, 1845,492.)
In the same journal (page 531) is reported another case, where, notwithstanding
the external resemblance to a female, the presence of one testicle  in a scrotum
showed that this individual was of the male sex.   Yet this person passed for a
woman until he had reached his 26th year!   It is  rare that there is external
malformation without internal defect, and even where the female character pre-
ponderates in the person, it is not improbable that the uterus or the  ovaries may
be absent, or the former may be malformed.  Such beings are not known to men-
struate, and even if there be capacity for intercourse, they are permanently ste-
rile.   Sexual desires are, however, commonly absent.
   AArhen the subject is young, mistakes respecting the  sex are more common
than when it is advanced in life.   So soon as the period of puberty is  past, cer-
tain changes take place in the configuration of the body, which may aid the me-
dical practitioner in forming an opinion.   Thus a grave  tone of voice, the pre-
sence of a beard, the width of the shoulders, and narrowness of the pelvis, will
indicate caeteris paribus the male sex:  while, when these  conditions are absent,
and there is a rotundity of the  members, with want of prominence in the mus-
cles, and a development of the mammae, we may pronounce upon the female sex
predominating.  Although no testicles be apparent, still the being may be of the
male sex, since it is well known that in persons  otherwise well  formed these
organs  occasionally do not  descend  to  occupy the  scrotum.   Dr. Harris,  of
Clarkesville, has  related a very singular  case, in which, although  no testicles
could be found, there was a short but naturally formed penis, through which the
being regularly menstruated!  The female character predominated in the  corpo-
real development, and there was the rudiment of a vagina.   (Med. Gaz. xl. 562.)
The fact that the being menstruated, was here sufficient to assign it to the female
sex.   How easily mistakes may be made in the sex  of young  children is shown
by a case which occurred to  Mr. Terry, and is quoted in Cormack's Journal,
April, 1845, p. 307.   The child was christened as  a  female, and so considered
by the parents for two months, when, owing to some defect in the passage of the
urine, it was brought to Mr. Terry, and he found  that there was malformation
of the  penis—no vagina, a scrotum, with one testicle down and the other de-
scending.  He therefore pronounced it to be  a male, and its costume was altered
accordingly.   The presence of a beard and whiskers is usually considered  to
characterize  a male, but the growth of  hair on  the  chin  and face is sometimes
more profuse in females than in the generality of males.  Dr. Chowne had lately
to examine a female named Josephine Boisdechine  on behalf of a man who was
about to marry her, but who  required  a  certificate as to the real sex of his in-
tended wife!   Dr. Chowne examined the woman, and found nothing in her ex-
ternal conformation indicative of doubtful sex.   The breasts were large and full,
and the only resemblance to a male was in an abundant beard and very profuse
whiskers.  The upper lip was free from hair.  (See Lancet, Oct. 11,1851, p. 335.)
  This case  has been published in  full by Dr. Chowne, in the Lancet for May 1,
1852, page 421.   He has appended an  engraving which displays a profuse beard
and whiskers.   It is stated that this female was born with a quantity of hair on
her chin, and that at eight years of age the beard was two inches long!
  In some cases an external examination will entirely fail in indicating the sex,
and even the opportunity of a post-mortem  examination may leave the case in
doubt.   An ingenious writer has laid it down that there are analogous organs in
the two sexes which are never found  in the  same subject, and the separate ex-
istence of which would enable us to determine the sex.  These analogous parts 
ORIGIN OF SEXUAL MALFORMATIONS.
427
are the penis and the clitoris—the scrotum and the labia—the testicles and the
ovaries—the prostate gland and the uterus.   This, however, is an artificial, and,
as facts show, an incorrect means of diagnosis.   If a penis could always be
clearly distinguished from a clitoris, and a scrotum from the labia, the rule might
be serviceable; but  it fails where it is most required, i. c. in the mixed condi-
tions.   As to the other means of diagnosis, even if correct, they will only enable
an examiner to distinguish sex in the dead, whereas it is  during the life of the
being that the law requires the aid of medical science  in  the  solution of these
questions.   The reader will find,  in the Medical Times and Gazette, an  account
of some remarkable cases of sexual malformation by Mr. Curling (Jan. 24,1852,
p. 84;) by Mr. Fletcher (Feb. 7, 1852, p. 136;) and  by Mr. Brodhurst (Feb.
21, 1852, page 187.)
   Mixed cases.—A case has been already mentioned in which  neither testicles
nor ovaries were found after death, and more than one has occurred where  both
have been found,—a case of intermixture of the sexes, or  real hermaphroditism,
physically speaking,  but of course without the power of self-impregnation.  The
following case is mentioned by Briand:—The subject was about eighteen years
of age when he died.  The body  was partly that of a male in configuration, and
partly that of a female.   An examination of the sexual organs, externally, led
to no  satisfactory diagnosis;—and on a post-mortem  inspection, a testicle was
found  in what was supposed to be the left labium,  with an epididymis and  sper-
matic cord attached  to it as usual; while on the other side were an ovary, Fal-
lopian tube, and the  rudiments of a uterus.   The  authenticity of this case was
for some time a matter of dispute: but another, equally singular in its features,
occurred to Prof. Mayer of Bonn.  This case clearly shows that such extraordi-
nary deviations may be met with in nature.   The  person examined  by Mayer
died in 1835, at the  age of 55.   Different opinions had been formed during his
lifetime respecting his sex  by the  first anatomists in Europe, some affirming that
it was  a male, while  others contended that it was a female.  This difference of
opinion is sufficient to prove  that an external examination does not always enable
even a good anatomist to pronounce an opinion of the probable sex of the being.
In his  body was found,  on the right side, a withered testicle, with a  penis  and
prostate gland, as male  peculiarities:—while on the left  side was an ovarium,
with a uterus, vagina, and  Fallopian tube.   (Med. Gaz. xix. p. 135.)   It should
be stated, that the general  configuration of the body in this case was that of a
female; but there was a duality of sex.
   Causes.—The causes  of  this singular malformation of the sexual organs, like
all other kinds of monstrosity, are involved in mystery.   We know that in the
early part of utero-gestation the sex of the foetus cannot be distinguished; while,
even when it has reached the fourth month, the genital organs are so similar that
the sex can seldom be determined on inspection.  Some organs of the body ap-
pear to be formed by equal and symmetrical portions, which gradually approxi-
mate and unite in the median line of the body.  We observe this mode of union
in the  bones  of the  cranium, sternum, and spine,  as also  in the various fissures
or raphes of the skin, which are  the remains of a union between two  equal and
symmetrical parts of an organ, now become one.  In regard to defects  in organi-
zation, it may be remarked, that  they almost invariably occur in or about some
part of the median line; and they appear to proceed from a mere arrest of growth
or development, in those particular parts, either  on one side or both, during the
early staoe of uterine existence.  In this respect, the fissures sometimes observed
in the palatine bones, in the palate itself, or in the lip,—the openings occasion-
ally noticed in the sternum, diaphragm, anterior parietes of the bladder, as well
as in the vertebral canal, are precisely analogous in origin  to the defective deve-
lopment of the sexual organs.  There is nothing absolutely removed or lost, but
there is an arrest of development; an opening, or fissure, which nature intended
to be only temporary, becomes permanent through an arrest of growth.  In the 
428
SEXUAL MALFORMATION.   LEGAL RELATIONS.
evolution of the male genital organs, the part corresponding to the scrotum is at
first always divided by a considerable  fissure; and the penis and the  clitoris
having, at this period of life, much the same kind of physical exterior, the sexual
organs cannot be well defined.  Should  this fissure  in the  male not be filled up
afterwards, then we shall have the most  common variety of  sexual malformation,
—the hermaphroditic form,  with  the male predominating.   These observations
are not of course applicable to those cases in which the sexes are positively mixed.
In these instances  there appears to be a  separate sexual organization on the two
sides of the body,  with an imperfect development of each  set of sexual organs.
According to Weber, there is in the prostate gland a rudimentary uterus in every
male.  (Baly and  Kirkes' Recent Advances in Physiology, 1848, 112.)   (For
some interesting observations on this subject, by Dr. Knox, see Med. Gaz., Nov.
and Dec. 1843.)
  One circumstance is worthy of note, namely, that sexual monstrosity appears
occasionally to occur in the successive pregnancies of a well formed female.   My
colleague, Dr. Lever, met with a singular instance  of this  in a female aged 28.
She had given birth to four  children in three confinements,  the first being a twin
labour; both the children males; and in both there was an arrest of development
of the  sexual organs.  On the third delivery the child was a male, and its sexual
organs presented the same deformity as  those of the twins.   (Med. Gaz. xxxviii.
946.)
  Legal relations.—These beings, owing to defective development, are impotent
and sterile.   Questions connected with the legitimacy of offspring and divorce
may, therefore, be  raised with respect to them.   This part  of the subject will be
considered hereafter.   Sexual monstrosity is not a ground  for depriving a being
of the rights of inheritance except under peculiar legal conditions.   Thus, a right
of succession  or inheritance to landed  estate may depend upon the sex of the
offspring,—as where, for instance, two children are born, the first a hermaphro-
dite, the second a  well  formed male child.  The parents die, and a title of no-
bility or  lands may fall to  the first-born  male.  Here  the sex of the first-born
must be  determined before possession  can be had.  In a case of this  kind, if
medical evidence should establish that  male  peculiarities  predominated  in the
first-born, the second child would be cut off.   Again, if an estate were limited
by  entailment, as where it is settled upon heirs, male or female, of a  particular
family, the birth of a  hermaphrodite, an  only child, would create the legal ne-
cessity for a positive determination  of the  predominance of sex.   So,  if the her-
maphrodite live but a few minutes after birth, and then die, the rights of persons
may be subsequently much affected by the medical attendant having come to an
opinion respecting its sex.   Since we cannot determine under what circumstances
litigation may ensue, it is always  right in a doubtful case to observe the sex, and
make  notes on the spot, when a child thus malformed survives its birth but
for a short period.  The question  of tenancy by courtesy, or  the right of the
father  to landed estate of which the wife "was  seized, will  depend  entirely upon
the attention of the accoucheur to this point.   (See Tenancy by Courtesy, ante,
page 391.)
  When these beings have reached the  adult age, other questions may arise with
respect to them.    According to an old law  of France, a hermaphrodite was
permitted to choose one sex, and thereafter compelled to keep it!   Hermaphro-
dites, or sexual monsters, were formerly ranked with infamous  persons; and it
has been  a serious question in our courts, whether the calling a man a herma-
phrodite was not such  a libel or slander upon  him as to render it a ground for a
civil action.   In a case reported by Chitty (Med. Jur. 374,) the use of this term
was held not to be actionable unless it was proved that it had been attended with
actual  damage.  A dancing-master brought an action against a party for calling
him a hermaphrodite, and it was decided that it was not  sustainable:—1. Be-
cause such a union of the sexes cannot exist in fact, and every one must be sup- 
RIGHTS OF ELECTORS DEPENDENT ON SEX.
429
 posed to know it; consequently the assertion could not be supposed to prejudice.
 2. Because, admitting the possibility of such a double function, the party would
 be just as good, and perhaps even a safer dancing-master, than if only one per-
 fect sex had been discoverable, consequently the words would not, in legal pre-
 sumption, injure him in his profession or occupation!
   I am indebted to a learned  member of the  bar for a note on the case of the
 Chevalier d'Eon.   There was a great dispute concerning the sex of the Chevalier,
 and it came before a Court of Law on an action to recover a wager under the
 following  circumstances  (Da Costa v. Jones, 2d vol. Cowper's Reports, p. 729.)
 The plaintiff declared that the defendant, on the 4th October, 1771, in conside-
 ration that the plaintiff would  then pay him seventy-five guineas, undertook to
 pay to the plaintiff  three hundred pounds, in case the Chevalier  should at any
 time prove to be a female.   The cause was tried before Lord Mansfield, at Guild-
 hall, and the jury found a verdict for the plaintiff, damages j6300, thereby af-
 firming that the Chevalier was a female.   A motion was subsequently made on
 behalf of  the defendant to arrest  the judgment, or at least to stay the  proceed-
 ings, on the ground that the  action could not be supported,  as  being upon a
 wager tending to introduce indecent evidence, and also as being  one which ma-
 terially affected the interest of  a third person.   The question thus raised on the
 motion was argued before the Court of King's Bench, and the judges unanimous-
 ly agreed that the judgment must be arrested; the law not allowing wagers upon
 subjects leading to the introduction of indecent evidence, (this being contra bonos
 mores) or upon such subjects as are calculated to have an injurious effect upon
 the interests or character of a third person.
   Irrespective of this decision, the verdict was based upon what subsequently
 turned out  to be untrue.   The Chevalier was really a  male, and  not a female.
 He was carefully examined by Sir  Anthony Carlisle, who satisfied  all present
 of the perfect condition of the testicles.  (See Paris and Fonblanque, i.  p. 229.)
   It would appear from a very singular case, reported by Dr. Barry, that in the
 United States the  rights of citizenship, and the power of voting for members of
 Congress, have depended  on the determination of sex.  In  March, 1843, he was
 requested to examine the  case of Levi Suydam, aged 23 years, a native of Salis-
 bury, Con.   At the exciting and warmly contested election of the spring of that
 year, almost every thing bearing the semblance of the human form, of the male
 sex, was brought to the ballot-box.  It was at this  time, and under these circum-
 stances, that the above-mentioned person was presented by the AVhigs to be made
 a  freeman; he was challenged by the opposite party on the ground that he was
 more a female than a male, and that, in his physical organization  he partook of
 both sexes.
   The following was the  result of  the first examination:—On exposing his per-
 son, Dr. Barry found a mons veneris covered with  hair in the usual way; an im-
 perforate penis, subject to erections, and about two inches and a half in length,
 with corresponding dimensions:  the  dorsum of the penis was connected by the
 cuticle and cellular membrane to the pubis, leaving about an  inch and a half
 free, or not bound up, and towards  the  pubic  region.  This penis  had a well
 formed  glans,—a depression in the usual  place of the  meatus urinarius, with a
 well defined prepuce and foramen.   The scrotum was. not fully developed, inas-
 much as it was but half the usual size, and not pendulous.   In  the scrotum,
 and on the right side of the penis, there was one testicle of the size of a com-
 mon filbert, with a  spermatic cord attached.  In  the  perineum,  at the root of
 the corpora cavernosa, an opening existed through which  micturition was per-
formed: this opening was large enough to admit the introduction of an ordinary
sized catheter.  Having found a penis and one  testicle, though imperfectly de-
veloped, and without further examination, Dr. Barry gave it as his opinion, that
the person in question was a male citizen,  and consequently entitled to vote and
enjoy all the privileges of a freeman! 
430
A CASE OF DOUBTFUL SEX.
  On the morning of the 1st Monday in April (election day,) Dr. Barry was in-
formed that Dr. Ticknor would oppose Suydam's admission.  Suydam came for-
ward; and Dr. Ticknor objected to him as a  female.   Dr. Barry then stated to
the meeting, that from an examination he had made, he considered  the person
in question to be a male, and requested that  Dr. Ticknor might, with the con-
sent of Suydam, retire into an adjoining room, and examine  for  himself.   This
was done, when Dr. Ticknor stated to the meeting  that he was  convinced that
Suydam was a male.  Suydam accordingly  was admitted a freeman, and  his
vote was received and registered.
   A few days after the election, Dr. Barry heard that  Suydam had  regular ca-
tamenia.  The sister of Suydam informed him that she had washed for him for
years, and that he menstruated as regularly, but not so profusely, as most women.
Suydam, when questioned, very unwillingly  confessed  that such was the fact.
He was again examined by the two physicians, when  the following additional
particulars were elicited:—Said Suydam  is five feet two inches in height, light-
coloured hair, fair complexion, with  a beardless chin, and decidedly of a san-
guineous temperament, narrow shoulders and broad hips; in short, every way of
a feminine figure.  There were well developed mammae with nipples and areolae.
On passing a female catheter into the opening through which micturition was
performed, and through which, he again  stated, he had a periodical bloody dis-
charge monthly,—instead of traversing a  canal and drawing off urine, the catheter
appeared  to enter immediately a passage similar to  the vagina, three or four
inches in depth, and in which there was  a considerable play of the instrument.
He stated that he had amorous desires, and that, at  such times, his inclination
was for the male sex:  his feminine  propensities, such as a fondness for gay co-
lours, for pieces of calico, comparing and  placing them together, and an aversion
for bodily labour, and an inability to perform  the same, were remarked by many.
   Dr. Barry further learned  from an old lady, who was present  at the birth of
Suydam, that on the second day after his birth, Dr. Delamater, who  attended aa
accoucheur, made with an instrument the opening through which he has ever
since performed micturition.  (American Jour, of the Med. Sciences, July, 1847.)
   This  is certainly a very puzzling case,  and one to which Lord Coke's rule for
a decision, i. e. the prevalence of sex, is hardly applicable.   The presence of a
penis and one testicle referred the being  to  a male, while the bodily configura-
tion, and still more strongly the periodical menstrual  discharge,  referred him to
the female sex.   The right of voting might have been fairly objected  to, because,
while the female characters were decided, the organs  indicative of the male  sex
are described as having been very imperfectly developed.
   [A case of doubtful sex, which may hereafter give  rise to much greater per-
plexity than the foregoing, and for still more  important and complicated reasons,
has lately been reported with remarks by Prof. S. D. Gross.   (Am.  Jour. Med.
Sci., Oct., 1852, 386.)  It possesses unusual interest and importance on account
of the very high position of its reporter, as well as on account  of the novel, and,
as we feel bound to say, most unjustifiable operation which was  resorted to as a
remedial or palliative measure, and is now suggested as illustrating " a new prin-
ciple in juridical medicine."  This palliative  operation consists in an attempt
by castration to  destroy all sexuality in an infant, because that infant had been
already so unfortunate as to be born with imperfect sexual organs!
   The subject of the case was three years of age when first seen  by Dr. Gross,
having  been born on the 10th of July, 1846.   "She" (we here quote the Dr.'s
language, without, however,  being convinced of the character  of sex implied by
the personal, pronoun used,)  "had always up to this  period been regarded  as a
girl, and had been so pronounced at her birth by the accoucheur.   At the  age of
two, however, she began to evince the taste, disposition and feelings of the other
sex; she rejected dolls and  similar  articles of  amusement, and  became fond of
boyish  sports.   She  was well grown and perfectly healthy,  and quite fleshy. 
HERMAPHRODITISM.  PECULIAR CASE.
431
Her hair was  dark and  long, the eyes black, and the whole  expression most
agreeable.  A careful examination of the external genitals disclosed the follow-
ing circumstances:  there was neither a penis  nor a vagina; but instead of the
former there was a small clitoris, and instead of the latter a superficial depression
or cul-de-sac, covered with mucous membrane, and devoid of every thing like an
aperture or inlet.   The urethra occupied the usual situation, i. e. usual in the
female we suppose,  and appeared to be entirely natural: the nymphae were  re-
markably diminutive;  but  the  labia were well developed and  contained each a
well formed testis, quite as large and consistent as this organ generally is at the
same age in boys.  Her hips  and chest, thighs and superior extremities were
perfect."  The foregoing constitutes the only anatomical description given, and
although not a very precise  and full one, it is yet sufficiently decisive to estab-
lish at  least the predominance of the male  sex, suggested by the child's own
natural language.   No uterus or ovaries appear to have  been  found or sought
after;  nor do we find any peculiarities of external formation noticed that do not
sometimes occur in the most common variety of hermaphroditic malformation,
i. e. the male variety, in which there is arrest of development but no intermixture
of the sexes,  the distinctive organism being masculine.   (See  ante,  p. 428.)
Having ascertained that the case "was one of malformation of the genital organs,
usually denominated hermaphroditism, the question occurred whether any thing
could or ought to be done to deprive the poor child of that portion of the genital
apparatus which, if permitted to remain until the age of puberty, would be sure
to be followed by sexual desire, and which might thus conduce to the establish-
ment of a matrimonial connexion."
   After much deliberation, aided by the counsel of  medical  friends, and  espe-
cially by that  of a colleague of  high standing, (who considered that "it would be
an aet of kindness and of humanity to the poor child, standing as she did towards
society in the  relation, not of a boy or a girl,  but of a neuter,  to deprive her of
an appendage  of so useless  a nature; one which might, if allowed to proceed in
its development, ultimately lead to the ruin of her character and peace of mind,")
and encouraged by  the expressed anxiety of the parents to save  their child "from
future suffering and misfortune—Dr. Gross at length determined upon excision
of the testes.   Accordingly, on the 20th of July, 1849, the  patient being then
over three years old, he removed each testicle from its place in the corresponding
labium.   "The testes," he remarks, "were carefully examined after  removal,
 and were found to  be  perfectly formed in every respect.   The spermatic  cords
 were natural."  Here then we have, what is  rare during life  in these cases, a
 certain amount of  confirmatory  evidence  from internal  anatomical inspection,
 that the child operated on was a male child.  The question of sex, however, is not
 the material one here, although it may come up more seriously some years hence
 elsewhere, and we shall not dwell upon it in this place.
   To go on a  little further, however, it may be stated that the emasculation ap-
pears to be complete, for we are informed that, in the course of the three years
 since elapsed,  the "disposition  and habits have materially changed, and are now
 those  of a  girl: she  takes  great  delight in  sewing and housework, and  she
 no longer indulges in  riding sticks and  other  boyish  exercises."  This entire
 change from the natural language of one sex to that of  the other, especially if
 eventually followed by development of the breasts, the catamenial flow (and other
characteristics of the female sex,) would give rise  to the suspicion that  there
were at least one ovary to be  taken  away, besides the two  testicles, and that,
after all, the good work had been only half done, since the dreaded matrimonial
catastrophe might be as imminent as ever.
   "A defective organization of  the external genitals,"  Dr. Gross  forcibly ob-
serves, and he might have added of the internal also, "is one of the most dread-
ful misfortunes that  can possibly befall any human being.  There is nothing
that exerts so baneful an influence over his moral and social  feelings, which car- 
432
HERMAPHRODITISM.  PECULIAR CASE.
ries with it such a sense of  self-abasement and mental degradation, or which so
thoroughly ' maketh the  heart  sick,' as  the  conviction of such  an individual
that he is for ever debarred  from the joys and pleasures of married life, an out-
cast  from society, hated, despised, and  reviled and  persecuted by the world."
Again, "if hermaphrodites are no longer burnt and drowned, stoned and perse-
cuted,  and mocked and reviled, they are invariably regarded with  a  degree of
prejudice, amounting generally to positive aversion; and as unfit  for any offices
of dignity, divine, legal, or political.   If such be the fact, and no  one can doubt
it, [it is doubted] every suggestion calculated to ameliorate the condition of this
unfortunate class of beings, by  depriving them of their only incentives to ma-
trimony, and thereby dooming them to everlasting celibacy, should be hailed as
a valuable contribution to the science and humanity of the age."   In these dif-
ferent  quotations, given at  greater length we  fear  than  the subject actually
claims, we have endeavoured to  present all the material facts of the case and all
the arguments stated in support of the precedent  suggested in connexion with
the case.  Having gone thus far, we must say that the reasons  offered would,
with many minds, as  they do with ours, operate more conclusively against the
operation, than in its  favour.   In the first place, admitting, what is  taken for
granted without sufficient reason, that the establishment of a matrimonial con-
nexion, or the  attempt to establish one, may be a necessary consequence or a
necessarily probable consequence, of the existence of sexual passion,  still expe-
rience  shows  that the  extinguishment of sexual feeling does  not remove  this
dreaded liability;  for it is well  known that impotent persons of  both sexes are
married, and do seek matrimonial alliances, notwithstanding their legal as well as
physical disability.  We thus see that removal of the testes does not deprive in-
dividuals of their "only incentives to matrimony," although it may legally doom
them to "everlasting celibacy."   If the unfortunate subject of  this  case is to
grow up as an attractive woman, the liability  to matrimonial proposals must be
almost certain,  and cannot fail to create a vast deal of painful  embarrassment,
not to  say grievous disappointment, involving most unpleasant and unsatisfying
explanations, much of  which, for all that can  be  proven to the contrary, might
have been avoided by attention to the dictates of a less officious humanity, and
a more patient  watching of the dictates of nature in the person most concerned.
If the  so called hermaphrodite be an object of so much commiseration  in his na-
tural condition, even at full growth, how can  he be made less so by a still  more
degrading and universally detested mutilation?  This mutilation not only lowers
him still further  in  his social condition, but stunts, depraves, and distorts his
whole development, physical and psychological, increases  the  difficulty in later
life of  distinguishing his predominant sex, thereby affecting his legal and poli-
tical rights, and finally deprives  him of the inalienable privilege of subduing and
controlling in his own  way those sexual manifestations which are habitually ig-
nored by hundreds and thousands of both sexes, whose circumstances, of various
kinds,  place them beyond the pale of married life.
   In a word, then, the precedent proposed  cannot  be sustained, because, 1st,
the mutilation  is inflicted at an  age when the party most concerned, and the
only one who ought to be consulted, can have  no voice in the matter.   2dly,
by violently interfering with the  course of nature, it may seriously impair the
development of mind  and body, and so far mask the physical and functional
changes characteristic of the sexes at  the different epochs of life, as to make it
difficult, if not impossible, to determine the real sex when  in due  time this shall
come to be inquired into for political  and business purposes.   3dly, it does not
attain the end of removing the sole inducements to matrimonial enterprises, which
is  the grand object kept in view by its author; and, therefore, 4th, the utmost it
does is to remove a tantalizing  desire, and lessen the liability to  disagreeable
exposures and disappointment, while it aggravates a  distressing and mortifying
infirmity by superadding another that  is equally mortifying, if not equally dis- 
CONCEALED SEX.
433
tressing, and which need never be required as a mere matter of expediency by
any reasonable person.—H.]
   Concealed sex.—It is almost superfluous to say, that in some cases sex cannot
be determined by the dress, appearance, or even voice of the individual.   Cases
in which males have passed for many years unsuspectedly as females, and  vice
versa, have  been  very numerous.   In  some instances the secret has only been
disclosed by death.   Facts of this kind belong rather to the annals of imposture
than to those of medical jurisprudence.   A somewhat singular  case of  this
description,  that of Eliza Edwards, occurred to me in 1833.   An unclaimed
body was  sent to Guy's Hospital, by the Inspector of  Anatomy,  as a female.
On removing the  dress, however, it was found to be that of a male!   From some
suspicion respecting the cause  of death, and the habits of this person, a coroner's
inquest was held.  It turned out that the  deceased, whose age was 24,  had
assumed the dress of a female at the age of 14; and had performed in many parts
of England  as an  actress.  The features had a somewhat feminine character; the
hair was very long, and parted in the centre;  the beard had been  plucked  out,
and the remains of this  under  the chin had been concealed by a peculiar style of
dress.   It was remarked during  life that  the voice was hoarse.  The breasts
were like  those of a male, and the male sexual organs were perfectly developed.
They had evidently been subjected to great traction, and appeared  to have been
drawn forward to the lower part of the abdomen.  The state of the rectum left
no doubt of the abominable practices to which this individual had been addicted.
It was found that death had taken place from natural causes.  The most remark-
able circumstance in the case is, that the deceased had been attended in his last
illness by an eminent physician for disease of the lungs; and so accurately was
the imposition maintained, that his medical attendant  did not  entertain  a  sus-
picion of the real sex of his patient!   (Med. and Phys. Jour., Feb. 1833, 168.)
28 
434
CAUSES OF IMPOTENCY.
IMPOTENCY.   STERILITY.
                             CHAPTER LV.

IMPOTENCY—DEFINITION—PHYSICAL CAUSES.  PROCREATIVE POWER IN THE MALE—PUBERTY
  --AGE OF  VIRILITY--LOSS OF VIRILE POWER BY AGE--DISEASES OF  THE TESTIS--POWERS
  OF CRYPSORCHIDES AND MONORCHIDES--SUPERNUMERARY TESTES--ARRESTED DEVELOP-
  MENT--MORAL CAUSES.   STERILITY--CAUSES OF--PROCREATIVE POWER IN THE FEMALE—
  PUBERTY--EARLIEST  AND  LATEST  AGES  FOR  CHILD-BEARINO--FEMALE  PRECOCITY—
  MENSTRUAL  CLIMACTERIC--AGE FOR CESSATION--REMEDIABLE CAUSES OF  STERILITY—
  LEGAL RELATIONS OF THE SUBJECT—CONTESTED LEGITIMACY AND DIVORCE.

                                IMPOTENCY.
  Definition.—Impotency is defined,—An incapacity for sexual intercourse.  It
may depend—1st, upon physical; 2d, upon moral causes.   With regard to the
latter, namely, the moral causes of impotency, a medical jurist has  no concern
whatever,—since no such  causes are recognised by law;  and he has no duty to
perform beyond the application of the principles of medicine to  the purposes of
the law.
  Impotency may depend on age,—on certain physical causes, e. g. disease,—or
on congenital malformation or defect.  With regard to physical causes, a division
must be made  between those which  are remediable, and those which are not.
The presence of disease of the testicle, such as atrophy or fungous tumours, may
give rise to incapacity; but the  incapacity may be sometimes removed by an
operation or  by medical treatment, and therefore  the  physical cause may be
removed:—in other words, it is remediable.   Now to such cases  as these the law
does not extend; but  it is  always  expected, in  alleged incapacity,  that the
practitioner examined on the subject  should be able to say whether  there be or
be not a prospect of cure.  Upon this point, his knowledge of his profession can
alone assist him;  no rules can be  laid down for his  guidance, for there may not
be two cases which will precisely  resemble  each other in their features.   Hence
it will be necessary to point out the chief causes of impotency  which are of an
irremediable nature, or those in which the incapacity is absolute and permanent;
—a point upon which  the law chiefly solicits a medical opinion.
  In strictness of language, the  definition of impotency, as above  given, may
exist in the female as well as in the male; and undoubtedly a physical incapacity
for sexual intercourse may exist in either sex.  As an instance of this incapacity
in the female,  may be mentioned occlusion  or obliteration of the vagina—a
condition  not necessarily indicative  of sterility.  The  mere occlusion  of the
vagina may be a remediable form of the malady; but its entire obliteration would
be absolute and irremediable.  This latter condition, however, is the only instance
of complete impotency in the female.   Protrusion of the uterus or of the bladder
into the vagina, are mentioned by some writers as causes of  physical incapacity
for  intercourse:  but  these forms  of disease may commonly be  remedied by art,
and therefore require no further notice.
  In professional language,  impotency is  applied exclusively  to  defect in the 
           COMMENCEMENT AND CESSATION OF SEXUAL FUNCTIONS.       435

 male sex; and the term sterility is confined to all those conditions in the female,
 which not only render intercourse impossible, but which render it unfruitful.
   Procreative power in the male.  Puberty.—Until the period of puberty, the
 testes remain small, and increase very little in size in proportion to other parts.
 Mr. Curling found  that  the size of the seminal tubes differed but little at the
 ages of eighteen months  and eight years.  (Diseases of the Testis, 40.)  The
 sexual function in the male depends entirely on the development of these organs;
 but the  age at which it appears differs in different individuals.  The age of
 puberty in a healthy male in this country varies from 14 to 17  years:  its ap-
 pearance is, however, affected by climate, constitution, and the moral circumstances
 under which the individual  is placed.  In some cases it is not fully developed
 until the age of 21.
   The  seminal secretion in the male is  not  considered to be prolific until  it
 contains  those  peculiar  filiform bodies which are known under the  name  of
 spermatozoa or zoosperms.  These are regarded by some physiologists as parasitic
 animals, but by others, with some probability, as freely moving cilia.  (Recent
 Advances, Baly and Kirkes, 1848.)  All agree that they are normal and essential
 constituents of the seminal fluid.   They are peculiar to the spermatic secretion,
 and, in healthy subjects, are always present in it after the age of puberty.  They
 disappear in  certain states of disease; and when not found, it is a fair inference
 that the individual  is  impotent, or that  he has lost the power of procreation.
 The age  at which they appear in the spermatic  secretion varies with all those
 causes which affect  puberty.   Mr. Curling informs me that  he found them  in
 the  secretion of a boy aged 18; but his  observations have not been  specially
 directed to this question.  There  is no doubt that in many cases they  appear
 much  earlier than this.   Sexual propensities are often strongly developed  in
 young children, and they may be prolific at a very early age.   Dr. Riittel  met
 with a case in which a female at the age of 14 became pregnant by a boy of the
 same age.  (Henke, Zeitschrift, der S. A. 1844, 249.)  This is the earliest stage
 at which, so far as I can ascertain, the procreative power has appeared  in the
 male.   In a case of contested legitimacy or affiliation, this question may have
 an important bearing.
   [See Am.  Jour.  Med.  Sci.  Oct. 1852,  561,  for a  case of "extraordinary
 Precocity in the Development of the male sexual Organs and muscular System
 in a Child Four Years old."   By Prof.  R.  K. Stone, of the National Med.
 Coll., Washington, D. C—H.]
   The person may be so young as to render it impossible that he should  be the
 father of a child imputed to him.  Cases  involving questions of  legitimacy on
 this  ground are not heard of in the present day;  but in ancient law-books there
 are decisions  relative to the  illegitimacy of children born  during marriage, be-
 cause the alleged fathers were seven, six, and  even three years old!  (Amos.)
   The following case in reference to the affiliation of children occurred in 1840;
 —A woman wished to affiliate  a child on a youth who was in his sixteenth year.
 The  boy denied that he was the father of the child;  and there was reason to sus-
 pect that the  imputation had been wrongly thrown upon him in order to  divert
 suspicion from  the real party.  There was some  difficulty in this case;  but  it
 appears to me that the rule for a medical man to follow on these occasions is this:
 —not to regard the mere age of the youth, whether he be above or below the ave-
 rage age of puberty,  but to observe whether the sexual organs be fully developed,
 and whether there be about him any of the ordinary marks of virility, indicated
 by muscular development, the growth of a beard, and a change in  the voice. If
 these signs be present, whatever may be his age, there is strong reason to sup-
 pose  that the  sexual functions are developed.  We occasionally hear of instances
 of extraordinary precocity;  but the development of the sexual power  is gene-
rally accompanied by other well marked changes in the individual.   Sometimes
these changes do not make their appearance until after the age of twenty-one. 
436             IMPOTENCY FROM AGE, DISEASE OR ACCIDENT.

  On the other hand, it may be a question at what time the procreative power
disappears in the male.  That impotency is one of the natural  consequences of
advanced age is undoubted: but this, as we  know, forms no legal impediment
to the marriage of parties however old. The legal presumption is, that the gene-
rative faculty does not disappear through age;  and if this be alleged, and legiti-
macy disputed on this ground, it must be satisfactorily proved.  This amounts
almost to an impossibility; because it is well known that there is no fixed age
at which  the sexual functions cease either in the male or female; and indivi-
duals, at least of the  male sex, who had passed the ages of sixty, seventy, and
even eighty years, have been known to be prolific.   In relation to this question,
it maybe mentioned as an interesting physiological fact, that Mr. Curling found
spermatozoa in the liquid  taken from  the testicles of a man upwards of seventy
years of age, and on one occasion in the testicles of a person aged eighty-seven.
(Diseases of the Testis, 40.)  Dr. Riittel mentions the case of a man who, at the
age of 92 years, married and had two children by his  wife!  When the procrea-
tive power even appears to be lost at  an advanced  age, the stimulus for inter-
course is often very great.  The same authority mentions cases in which these
erotic feelings were remarked by him in  reference to men between 75 and 86
years of  age.   (Henke, Zeitschrift,  1844,  252.)  In all  cases  of  protracted
virility it is observed that the general bodily powers are also retained in  an ex-
traordinary degree, showing the  very  close relation which exists between sexual
function and corporeal development even to the latest period of life.
   The English law on this subject was  clearly laid down in the Banbury Peer-
age case, brought before the House of Lords many years since.  Lord and Lady
Banbury had been married twenty-one years without having had issue, when his
lordship died at the age of eighty years.  The peerage was claimed by an indi-
vidual who called himself the son of  Lord Banbury;  but in fact it was alleged
that he was the  son of Lady Banbury  by an adulterer, during her husband's life.
According to the evidence, Lord Banbury did not appear to have been aware of
his existence; and the child had always been known by another name.  One of
the grounds upon which the legitimacy of the descent of the claimant was con-
tested was, that the deceased nobleman had become impotent through age; but
it was then stated on good legal authority, that the law placed no limit on the
powers and faculties of men.  The assumed impotency of the alleged parent on
the ground of age, could never be admitted as a proof of the illegitimacy of the
supposed offspring. The House decided against the claim, but not on the ground
of impotency from age in  the husband.  (See in reference to this subject, Henke,
Zeitschrift der S. A. 1842, ii. 162, 330.)
   Impotency from disease or accident.—The loss or destruction of the penis or
testicles,  either  by disease, accident, or from necessary operations, would be suf-
ficient to render an individual irremediably impotent.   The loss of one  or both
testicles from any of  these causes would be indicated by the presence of  distinct
cicatrices in the scrotum.   When both have been removed by operation, the in-
dividual  is incurably impotent;  but  if the organs be healthy, a sufficiency of
the spermatic fluid  to confer procreative powers  may remain  in  the ducts for
two or three weeks after the operation.  The loss of one testicle only does not
render  a man impotent.   Monorchides, as  they are called, have been known
to be prolific.  Cases of this kind must not be confounded  with those in which
one or  both testicles have not  descended into the scrotum.  In some rare in-
stances, the organs do not descend into the scrotum at the usual period;  but one
or both may remain in the abdomen,  or in the inguinal canals, and only descend
some time after birth; or one may be  found  in  the scrotum, and the other re-
main during life in the abdomen. In these cases the organs have been mistaken
for, and treated as ruptures by the application of a truss!   (Henke,  Zeitschrift
der S. A. 1844, i. 249.)   When one of the organs only has descended, there  is
no ground caeteris paribus to impute impotency. When neither has descended, the 
VIRILE POWERS OF MONORCHIDES AND CRYPSORCHIDES.        437
 scrotum will be found empty, without, any cicatrix, but all  the  other marks of
 virility may still be present.  These individuals have been called Crypsorchides.
 It has been said that in all such cases the testicles are  to be regarded as conge-
 nially deficient;  but this is an error.  Dissection has  clearly proved that  they
 have merely not: descended;  and although  remaining in the abdomen, there is
 no reason to believe that they were incapable of performing-.their functions.  This
 absence of the testicles is a state very rarely seen.   Mr. Marshall met with only
 one case of non-descent of one testicle in 1000 recruits,  and with one case of non-
 descent of both testicles in 10,000 recruits.  There are  three preparations, show-
 ing the non-descent of the testes, in the museum of Guy's Hospital: one of them
 was taken from a gentleman who shot himself from despondency at his supposed
 defective condition.  Hunter thought that the undescended testicles were im-
 perfect both in their organization  and  functions, and  that  crypsorchides  were
 invariably impotent.  But the recent researches of Mr. Curling and others  have
 shown that there is no foundation for this opinion.  My friend Mr. Cock informs
 me that he has taken notes of the cases of two men whose testicles had not de-
 scended, and in whom  the virile functions were perfect.  One of them  before
 he had reached the age of thirty years, had already married twice, and had had
 children by each wife, besides illegitimate children which were affiliated on him
 during the time he lived in service!   In general it will be found that the usual
 signs of virility have appeared about the  person.   If, in a case  of non-descent
 there  should  be  a non-development of  the  other  external  organs, and this
 is  accompanied by a total want of the  characters  of  virility, no doubt can be
 entertained that the individual is irremediably impotent.   The testicles may, in
 such a  case, be really congenitally absent—a fact only ascertainable by a post-
 mortem examination.  I quite agree with the  opinion expressed by Mr. Curling
 which is confirmed by the facts above mentioned/that  the detention of  the tes-
 ticles in the  abdomen is  perfectly compatible with virility;  and  in cases where
 there are no external marks  of  effeminacy, or other grounds for suspecting im-
 potency, and the patient is subject  to erections, the imperfection does not^ofier
 any bar to marriage, nor is it a justifiable ground for divorce.
   The presence of what have been called supernumerary testicles does not affect
 the virile powers of the individual.   These have in general  been found, by dis-
 section, to be tumours connected with the  healthy glands, and not at all inter-
 fering with their functions.
   In some cases there is an arrest of development  in the external  organs.   In
 general, with this  there is no sexual desire. Mr. Farr met with a case in which
 in aman aged  forty-two, the sexual  organs remained undeveloped and in an in-
 fantile state.   There was  some difficulty in finding the  testes, in  consequence of
 their smallness.  On examining the contents of the gland  microscopically, no
 spermatozoa were found.  This person's voice  was effeminate, and he was devoid
 of hair on the chin and pubis.  (Med.  Gaz. xl. 857.)  It is not, however, always
 to be inferred, that an individual with undeveloped organs is incurably impotent.
 The following case is quoted by Mr. Curling:—A gentleman,  aged twenty-sixj
 consulted Mr. AVilson on the propriety of his marrying.   His penis and testicles
 very little exceeded in size those of a youth eight years of age, and he had never
 until this acquaintance with his intended wife, felt the desire of sexual inter-
 course.   He married, and became the  father  of a  family; and  at  the  age of
 twenty-eight, the organs had  acquired the full development of the adult,   (Op.
 cit. 95.)   Under wasting  of the testicles, or when the gland  is extensively dis-
 eased, and  the  sexual desire  disappears, there  can be  no doubt of impotency.
 The functions of these  organs are not, however, very readily impaired  by local
 disease.   The  spermatic secretion  is  still  properly formed, even when  only a
 small part of the gland remains healthy,—a fact proved by a microscopic ex-
 amination of the discharge.   Certain diseases of the appendages of the  testes
may, however,  render a person impotent.   The spermatic secretion is commonly
suspended in most severe diseases which affect the body. 
438
MALFORMATION.   STERILITY.
  A very frequent cause of impotency in^the adult, when the organs are appa-
rently sound, is spermatorrhoea, arising from abuse.  This, however, is remedi-
able to a greater or less extent by treatment.
  Of moral causes it is unnecessary to speak.   The sexual desire, like other
animal passions, is subject to great variation; and there are  instances on record,
in which men, otherwise healthy-looking and healthily formed, have experienced
no desires of this kind.   They are in a state of natural impotency;  a condition
which the Canon law designates as frigidity of constitution.  This is not to be
discovered by examination, but rather from  their own admission.
  On the absence of the penis as a cause of impotency, as well as on its defective
organization, some remarks  have been  already made in the preceding  section.
Sometimes the  defect is merely connected with  the urethra.  Thus the orifice
may open on the dorsum penis, and in other cases underneath the organ, so that
the urethra may terminate at a variable distance from the glans  penis.   Those
labouring under the former  defect  are  said to have epispadia;  and under
the  latter, hypospadia.   The  power, to  have fruitful intercourse will in
either case depend on the situation of the urethral  aperture.  Riittel knew an
instance of a hypospadian having several  children.  (Henke, Zeitschrift, 1844,
258.)
  Since the publication of the former edition of this work, some discussion has
taken place in the medical journals respecting  the virile powers of those  who are
affected with hypospadia.   In September, 1850,  a lad, aged  seventeen, was  sum-
moned before the magistrates of Kidderminster on a charge of affiliation in refer-
ence to the pregnancy of a girl  aged  eighteen.  The defence was, that he cou4d
not be the father of the child, because there was such a malformation of the penis
as to prevent prolific intercourse.   On examination, the  urethra was found to
terminate on the under  surface of the penis, about an inch and a half from the
glans, by a small elliptical orifice, which allowed the urine  to pass, but with some
difficulty.  One medical witness gave it as  his  opinion, that it was  not impos-
sible, but highly improbable, that the defendant should become a father;  another
freely admitted the boy's capacity, and it was decided against the accused.  (Med.
Times, Sept. 21, 1850, p. 321.)   There can be no doubt  that this was a correct
decision.  When the urine can  pass, the  seminal fluid  can  pass;  and the only
question is, whether  the intromission can be such as that the misplaced orifice
should come in contact with any part of  the vagina.  Cases illustrative of the
fully prolific powers of hypospadians will be found in the  Med. Times, Sept. 14,
1850, p. 292; and Oct.  12,1850, p. 392.  Similar remarks apply to epispadians.
These malformations are sometimes remediable:  but whether remediable or not,
they are not, under any circumstances, to be regarded as absolute  causes of im-
potency.
  The incapacity for intercourse in  either sex may arise from extensive disease
affecting parts  in and  around the organs of  generation.   The medical opinion
here must be regulated entirely by the circumstances attending each case.

                                STERILITY.
  Definition.—Sterility is usually defined to be  "the inability to procreate, or a
want of aptitude for impregnation."  It is  not usual to speak of  sterility in the
male, although there may be  procreative  incapacity; because the defective con-
dition in this sex is fully expressed  by the word impotency.  In  the strictness
of language, a male who has been castrated is sterile;  but it is sufficient to say that
he is impotent.  It is possible that many apparently healthy and well formed males
may be sterile without being impotent, i. e. that  they may have intercourse  with-
out procreating—for the power to copulate must not be confounded with that of
procreation: but it is more  probable  that the  defect in such cases rests with the
female, and not with  the male.  Sterility  should, therefore, imply that condition
of the female in which  there is  an "inability to  conceive."   This appears to be 
             RETARDED AND PREMATURE PUBERTY IN FEMALES.         439

the true meaning of the term, and the sense in which it is used, not. only by the
best writers, but in common phraseology.
  Procreative power in the female.   Puberty.—In the female, the procreative
power is supposed not to exist until after  the commencement of menstruation,
and to cease upon the cessation of this periodical secretion.  The menstrual func-
tion is commonly established in females in  this climate between the ages of four-
teen and sixteen; but it may occur much earlier: indeed, in some rare instances,
a discharge resembling the menstrual  has  been known to occur in mere infants.
In other cases its appearance has been protracted to a much later period.
  According to Dr. Riittel, the menstrual function appears in the smallest number
of females at 12, 13, and  14 years, and in  the  largest  number at 16, 17,  and
18.  In many it is only first established at from 19 to 21 years; and  he states
that at this age he has often found the uterus very small, and quite undeveloped.
Perhaps, in this country, the most frequent age for menstruation may be taken
at 15 years.  It is liable to be accelerated in its appearance by certain  moral  and
physical conditions under  which the female is placed.  The most common inter-
vals for the appearance of the function  are twenty-eight and  twenty-one days.
It is sometimes late in life before  it appears.   Dr. Camps found that it had  not
appeared in a married woman, aet. 30, who had  borne no children.  (Med. Gaz.
xxxix. 409.)  Another case is mentioned  in the same volume where it appeared
for the first time at 47 (p. 567.)  So soon as this function  commences, the fe-
male may be considered to have acquired  procreative power;  but a female may
conceive before the function has commenced,  during the time of its occurrence,
or after it has ceased.  From facts elsewhere  stated there is some reason to be-
lieve that the period which immediately precedes or follows the discharge is  that
which is most favourable to  conception.
   It is important to remember that  these changes in  the uterus may produce
remarkable effects by sympathy  with the brain and nervous  system.  At or
about this period, more especially if any cause of obstruction exist, females be-
come irritable, easily excited, and they have been known to  perpetrate, without
motive, crimes of great enormity, such  as murder  and  arson.   A propensity to
steal also sometimes manifests itself.   It has been remarked that acts of arson
have been frequently committed by young girls at this period of life, and the
crime has spread by  imitation.  The case  of Brixey, tried for the murder-of an
infant, and acquitted  on the ground  of insanity, will serve as an illustration of
the morbid effect produced on the brain by disordered menstruation.   (See post,
Insanity.)  The state of the  mind should be therefore carefully watched at this
period of life.   Chlorosis or  amenorrhcea may give rise to temporary insanity.
 Puberty in the male may be attended with  similar morbid propensities; but these
are not so commonly witnessed in this as in the female sex.
   Pregnancy before  menstrxiation.—The occurrence of menstruation is not in-
dispensable to  pregnancy.  Many cases are  on record where women who have
never menstruated have conceived and borne  children.   One case is reported in
which a female, aged 25,  became pregnant and bore a child, and menstruation
 was only  regularly established afterwards.  (Lancet, Feb.  1842.)  Dr. Murphy
mentions  another case of  pregnancy previous to menstruation, in a woman  aged
 23.  (Obstetric Reports,  1844, p. 7.)  Numerous cases of conception without
 previous menstruation are quoted by Capuron,  (Med. Leg. des Ace. 96;)  and
 no less than nine instances of pregnancy before menstruation have been collected
 by Mr. AVhitehead.   The females were  all in excellent health during the whole
 time, and one did not menstruate until  more than two years after the  marriage
had been  consummated.   (On Abortion, 223; see, also, Orfila, Med. Leg. 1848,
i. 257.)  Another case has been recently reported.  (Med. Gaz. vol. xliv. p. 969.)
   Instances of premature puberty in  the female are now very numerous:—they
are far more common than in the male  sex.   Mr. Whitmore met with the  case
of a female child who, from a. few days after birth, had her catamenia regularly
at periods of three weeks and two or three days, until  she had attained the age 
440
AGE AT WHICH MENSTRUATION CEASES.
of four  years, when  she died.  On inspection after death, she  appeared like a
much older  girl.   The breasts were unusually large,  and the female organs and
lower limbs were considerably developed.   (North. Jour. Med. July, 1845, p.
70.)  Another case has been recently reported in the Lancet (Jan. 29, 1848, p.
137.)   This was a child aged three years.   The breasts were as healthily deve-
loped as in  an adult of  twenty years; and the female organs were also as much
developed as in a girl at the age of  puberty.  It was found that this child had
the appearance of a little old woman, who had been  regularly menstruating for
twelve months.  (For other cases of menstruation at five years, see Med. Gaz.
xxv. 548; and at three years, vol. xlvii. p. 244.)   In these instances there is
great reason to believe that the procreative powers are very early developed; but
it is not common to hear of such young females becoming impregnated.   A case
is mentioned by Dr.  Beck, where a female menstruated at one year: she  became
pregnant and  was delivered of a child when  little more than ten years old.   Dr.
Walker met with a case in which the menstrual  function was established at the
age of eleven  and a half years, and the patient was  delivered of a living child
when only twelve years and eight months old.   (Amer.  Jour. Med. Sci., Oct.
1846, p. 547.) In another, observed by Riittel,  already referred to, a female of
the age of fourteen became pregnant by a boy of the same age.   He also refers
to three others, where one girl of the age of nine, and two  of the age of thirteen,
became pregnant (loc. cit.)  The first of these three cases represents the  earliest
age for pregnancy yet assigned by any author.
   I am indebted to Sir Eardley Wilinot, Bart., for the particulars of an interest-
ing case which was the subject of a  trial on the Midland Circuit.  At  the Co-
ventry Summer Assizes,  1848 (Reg.  v.  Chattaway,) he  conducted  the prose-
cution against a  man,  aet. 45, for a misdemeanor in having had carnal know-
ledge of a girl named Sprason, between the ages of ten and twelve year3.  AArhen
intercourse was first  had, the girl was eleven years and eight months old: it was
repeated several times subsequently; and when  the prosecutrix  gave her  evi-
dence in Court, it appeared from the  statement of the mother that the child was
in the last month of her pregnancy.   She was then not quite twelve years and
six months  old.   Sir E. Wilinot  ascertained by  inquiry that menstruation  had
commenced  in this girl at the age of ten years  and two months, and had con-
tinued regularly up  to  December, 1847,  which was  about the  time when she
first had intercourse with the prisoner.  It appears that she was a factory girl;
and to the heat, confinement, and association with males, to which girls are sub-
jected in this employment may be referred the early commencement of puberty.
AVhen menstruation has thus commenced, conception may always be the result
of sexual intercourse.   The prisoner was convicted, and sentenced to two years'
imprisonment  with hard labour.   The  reader will find some additional particu-
lars  in  reference  to  this case by Mr. Smith, of  Coventry (Med. Gaz. vol. xlii.
page 751.)
   Age  at which  menstruation ceases.   Menstrual climacteric.—The  average
period at which this function ceases in the female is usually at the age of  from
forty to fifty:  but as it may  commence very  early, so it may continue very late
in life.  In  one case it has  been known to cease at the age of  23; in another
instance it has continued to the age of 66 and even of 75 years.  (AVhitehead, op.
cit. 145, et seq.)  In a case  which occurred to Capuron, it continued beyond 60
(op. cit. p. 98;) but  a more remarkable case, both of late menstruation and late
pregnancy, is quoted by Orfila from Bernstein.  A female  in whom the function
appeared at  20, menstruated until her 99th year.  Her first child was born when
she was 47,  and her  seventh and last, when she was 60.   (Med. Leg. 4eme ed.
1848, i. 257; see, also, Briand, Man.  Complet de  Med. Leg. 1846, 137.)  From
these facts, it is clear that it is impossible to fix the  age of a female by the period
at which this "change of life " occurs. At the best, it can only be an average of
a certain number of instances.  This question arose in the case of  Clark v.  Tatom,
(Kingston Lent Assizes, 1848) in reference to the identity of a  female, through 
AGE FOR THE CESSATION OF CHILD-BEARING.
441
whom property was claimed by the husband, who was the plaintiff in the action.
The marriage had taken place  in  1794: the parties separated in 1809;  and the
plantiff's wife, as it was alleged, died in  1843, when, by  direction of the de-
fendant, the age of 55 was put upon the lid of her coffin.  A medical gentleman
who  attended her in 1841, deposed that from being  then in her  menstrual cli-
macteric, he should consider her  not to have been  more than 50 at that time.
He stated that the  general period for the  cessation of menstruation was 44: it
was rarely protracted to the age of  50.   On this assumption, it was impossible
that the deceased could have been the plaintiff's wife, because at the time of the
marriage she would have been  only three years old!   On the part of the plaintiff,
direct evidence was given to show that the deceased was his wife; and it there-
fore remains to be considered whether the  adverse medical opinion is consistent
with medical experience.   It is obvious, from the cases above quoted, that men-
struation may continue to 66 or 70 years of age, and that this may have been
an exceptional  instance.   The plaintiff had a  clear right to this medical pre-
sumption in his favour; and admitting that his  wife was 17 at her marriage, she
would have been menstruating in her 66th  year.   Hence it is evident that the
medical facts of the case were compatible with the evidence  adduced on the part
of the plaintiff.  At the trial these well known  exceptional cases of menstrua-
tion beyond the 50th year were not  even  referred to; nevertheless the jury re-
turned a verdict in favour of the plaintiff.
   Is it possible for a female to become pregnant after menstruation has ceased?
—It is commonly asserted and believed that, under these circumstances, a woman
becomes sterile.   This is doubtless the general  rule; but in a medico-legal view
it is necessary to take notice of the exceptions.  Mr. Pearson, of Staleybridge,
communicated to the Lancet, some years ago, the case of a  lady, aged 44, who,
up to September, 1836, had given birth to nine children.   After this,  the cata-
menia appeared only slightly at the regular periods until July, 1838, when they
entirely ceased.   Owing to this, she supposed that she was  not liable to become
pregnant; but on the 31st of  December, 1^39, therefore eighteen months after
the entire cessation  of the menses, she was delivered of her  tenth  child.  Hence
conception must have taken place at from  eight  to nine months  after  the final
cessation of the discharge.
   Latest age for pregnancy.—The age at which women cease to bear children is
usually from forty to fifty years;  but as they may menstruate, so they may con-
ceive, beyond the last of these  periods.   Besides, the facts above mentioned show
that the continuance of menstruation is not  absolutely necessary for conception.
Numerous instances are on record of females advanced in  life bearing children.
A case is reported by Schmidt in  which a  well formed female, who was  married
at the age of nineteen, did not bear a child  until  she had reached the age of fifty.
Riittel observed in twelve women that they bore their last children at ages varying
from forty-five  to fifty.  Ottinger met with an  instance of a  female bearing a
child at fifty.  Cederschjald another, where the  woman was fifty-three, and men-
struation still continued.   Haller records  two cases in which women at  sixty-
three and seventy respectively bore children.  (Briand, Man.  Complet de  Med.
Leg. 137.)  Nevermann  has drawn up a table in reference to the late ages of
life in which women have  borne children.   Out of 1000 cases in  10,000 births,
he found that 436 children were borne by females at the ages respectively—
Of 41 years	101
42 .	113
43 .	70
44 . . .	58
45 .	43
46 . . .	12
47 .	13
Of 48 years
   49
   50
   52
   53
   54
A case has been communicated to the Med. Gaz. (xxxix. 950) by Dr. Davies, 
442
CAUSES OF STERILITY.
of Hertford, in which a woman was fifty-five when her last child was born.   She
menstruated up to that time.
  We  cannot pretend to fix  the  age at which pregnancy ceases to be possible,
and beyond which it cannot occur.   Questions of this kind have a very important
bearing on the subject of legitimacy;  and unless the law looks to something
more than ordinary experience in such matters, the decisions of  Courts may be
inequitable.   The legitimacy of the claimant of the Douglas Peerage, about the
middle of the last century, was contested, among other grounds, on the presumed
loss  of procreated power in the female said to be the mother, who was in the
fiftieth year of her age at the time of the alleged birth, and who therefore must
have conceived when in her forty-ninth year.   Lords Camden  and Mansfield
decided that this  was no objection to the legitimacy of the  appellant.  The fal-
lacy of trusting to a ground of this kind as evidence of illegitimacy is proved by
a reference to the numerous cases already quoted.   One somewhat similar to that
of the Douglas Peerage occurred in France in 1754.   Francois Fajat claimed
an estate as heir  to his mother.   His claim was resisted on  the ground that, ac-
cording to the baptismal registry,  his mother could not have been the legitimate
heiress of the party through whom the claim accrued; because her alleged mother
would then have been in her fifty-eighth year, and this, it was  contended, was
beyond the age of child-bearing.  Ancient records were searched, and the  claim
of legitimacy was admitted, because menstruation and conception had been known
to occur at periods of life even later than this.   (Capuron, Med. Leg. des Ac-
couch. 93.)   This author quotes a case in which a healthy woman menstruated
until she  had passed her sixtieth year, and her last child was born when she was
sixty years of age.  (98.)   Other cases of births at the age of  sixty-three and
sixty-five  are  referred to; but these  appear to be of a less authentic kind.
   The truth is, in giving a decision,  the law is bound to  look to the anomalies
connected with the exercise of the generative function;  and  therefore the limited
experience of a few witnesses, casually  taken, can hardly  be expected to supply
satisfactory answers to questions of  this kind.   It establishes no  presumptions
respecting the presence or absence  of this  power at any period of life; and it
therefore  leaves each case to rest upon the whole of the circumstances which at-
tend it.
   Causes of sterility.—The causes of sterility in the female system are very nu-
merous.  Some  of them depend  upon peculiarities of constitution, the sexual
organs being  well formed and developed,—others upon latent changes or conge-
nital defects in the uterus and its appendages, only discoverable  by an examina-
tion after death.
   Sterility rarely becomes a medical question in  contested cases of legitimacy;
for a claim on the part of an individual to be the offspring of a particular woman,
unless the female were in collusion with the claimant, could only be made after
 her death;  and  if not disproved by medical evidence, showing  that the woman
 could not have borne children, it would in general be easily set aside by circum-
 stances.  If  the uterus, ovaries,  or  other parts,  were congenitally defective or
 absent, or if there were external sexual malformation, accompanied by occlusion
 or obliteration of the vagina, a medical witness could have no difficulty in saying
 that the woman  must have been sterile.  A mere occlusion of the vagina, remo-
 vable by  operation, does not necessarily indicate sterility, for the  internal parts
 may be healthy  and sound.   In some instances, the ovaries or  the uterus may
 be entirely absent, or the Fallopian  tubes may be obliterated,—facts which can-
 not in all cases be determined during life;  in other instances these  organs may
 exist, but be defectively developed.  Dr. Coley relates a case in which, in a fe-
 male set. 26, it was found after death that the uterus  was not larger than in an
 infant of one or  two years of age.   The os and cervix uteri were not larger than
 a crow-quill in diameter, but perfectly defined: one of the  ovaries was incomplete.
 The patient had  on a few occasions observed an appearance resembling menstru-
 ation.  (Obstet. Record, May, 1848; 169.) 
CAUSES OF STERILITY.
443
   Some of the physical causes of sterility in the female are, however, removable
by art.   Thus, when the vagina is unnaturally closed, this condition may be
often remedied by operation.  An instance of this kind is related  by Mr. Dum-
ville (Medical Gazette, xl. 1116) in which the female subsequently married and
bore a child.  It is a fact worthy of notice, that if the internal organs be in their
normal condition, the slightest aperture will suffice for impregnation.  Penetra-
tion is not necessary.  Women have thus been known to conceive under circum-
stances which appeared quite adverse to the possibility of conception; and when
they had arrived at the full time, it has been found necessary to make a free in-
cision into the parts which resisted the passage of the child's head.  A remark-
able case of this kind, which occurred to Dr. Simmons, is quoted  in the Lancet
(June 19, 1847, p. 651,) and there are many others of a similar nature on re-
cord.  Sometimes the external passage is free, but the occlusion may be at the
os uteri.  This is a cause of sterility which, however, admits of remedy by ope-
ration.   A  case of  this kind was  lately successfully  treated by  my colleague,
Dr. Oldham (Med. Gaz.  xxxviii. 919.)
   An absence of the menstrual  function (amenorrhcea) has  been described as a
cause of sterility; but  several cases have been already mentioned, which  show
that females who have never menstruated, and who are otherwise healthy and
well formed, may become impregnated.   When, however, the absence of men-
struation depends on occlusion of the mouth of the uterus or other physical causes
of the like nature, there will of course be sterility.   If, in other respects, the fe-
male be well formed, she cannot be regarded as in a necessarily incurable condi-
tion.   Dr. Oldham has lately published two cases in which the females had at-
tained the age of forty-eight years without having menstruated (Med. Times and
Gaz., March 27, 1852, p. 311.)   There was general good health,  with a proper
development of  the sexual organs, in both.  An inordinate  periodical  discharge
(dysmenorrhea^,) depending on uterine  disease, is a very frequent cause of ste-
rility.   The disturbed state of health which accompanies this morbid condition
may be, however, itself unfavourable to conception.  There is a popular notion
that women  during menstruation and lactation are sterile;  but this is incorrect,
(Henke, Zeitschrift, 1844,263.)   Leucorrhcea, or that morbid state of the uterus
and vagina which accompanies it, is commonly set down as a cause of sterility;
but it is well known that some females, who have for  years suffered from  leu-
corrhoeal discharge, have conceived and borne  children.   M. Donne thinks that
this  fact is  explicable on  chemical principles.   He has observed that the zoo-
sperms, on which fecundation depends, live and are active in the vaginal secretion
on some occasions, while their motions are speedily arrested on others.  In the
latter case, he  has found the mucus strongly acid, and he considers that this may
act noxiously,  and destroy the zoosperms.  The uterine mucus is  alkaline, and
in general the zoosperms are unaffected  by it:  in cases, however, where it was
strongly alkaline, their motions  were also destroyed.   (Cours de Microscopie,
300.)  Further  observations are required before  this theory can be admitted.
The physiology of conception, as  to the precise time and circumstances under
which it occurs,  is altogether a mystery.   Well organized and healthy women
remain sometimes married for  years without  bearing  children: when, without
any apparent change of habit, they become impregnated, even after a barrenness
of fifteen or twenty years.  Any diseased condition of the system is unfavourable
to impregnation, and a fortiori diseases affecting the uterus  or ovaries.  Of all
these diseases,  chronic endo-uteritis, or what may be called  irritable uterus, is,
in Air. Whitehead's opinion, one of the most frequent causes of sterility.   (On
Abortion, 400.)   Change of air and climate has in some instances  alone sufficed
to remove sterility, probably by relieving this diseased condition of the generative
organs.   It has been remarked, too, of males  and females, that there has often
been a return of procreative power after recovery from an attack of fever.
  On the whole, the physical and irremediable causes of sterility in the female 
444              MEDICAL EVIDENCE IN SUITS OF DIVORCE.
 are not so apparent as  in the male, because in the  former the generative appa-
 ratus is placed  internally, and slight  changes in its various  parts, sufficient  to
 produce permanent sterility, cannot be determined by an examination.
    Legal relations  of  the subject.  Divorce.—Sexual  malformation,  involving
 impotency or sterility, constitutes one of the canonical impediments to marriage,
 and if matrimony be contracted  by a  party labouring under such malformation,
 the contract is voidable.  Canonists  have reckoned fourteen impediments  to
 matrimony,  enumerated in the following quaint  hexameters.   (Poynter's Doc-
 trine, 84:)—
                  " Error, conditio, votum, cognatio, crimen
                   Cultus disparitas, vis, ordo, ligamen, honestas,
 1                 Si sis affinis, si forte coire nequibus,
                   Si parochi et duplicis desit preesentia testis.
                   Raptave sit mulier, parti nee reddita tutse
                   Haec facienda vetant con nubia, facta retractunt."

 In the marriage contract there is implied a  capability of consummation, and the
 incapacity of either party in this respect constitutes a ground  for annulling the
 agreement.  "Vir et mulier si se conjunxerint, si postea dixerit mulier de viro
 quod non possit coire cum eo, si potest (per verum  indicium) probare quod ve-
 rum sit, accipiat alium (Caus. 23.)  Quia matrimonium ordinatum fuit non solum
 ad evitandam fornicationem,  sed etiam ad  proles procreandas:  si matrimonium
 (tale quale)  fuerit, inter virum et mulierem de facto solemnizatum, qui omnino
 inhabiles sunt, non propter setatem, sed propter aliquod naturale impedimentum
 ad proles suscitandas, utpote propter importentiam et frigiditatem, maleficentiam,
 et  similia, quae ipso jure reddant hujusmodi matrimonium nullum.  Haec im-
 pedimenta naturalia aliquando contingunt tarn in muliere quam in viro et pars
 gravata agere potest in causa nullitatis matrimonii."   (Oughton, tit. 193, sec.
 1T')              .      .    ,
   As to presumed incapacity  from age, the  law takes no cognizance of it.  The
 Pappian law of the reign of Tiberius forbade women under  fifty  to marry men
 of sixty, and vice versa, but it  is now known that  females are* prolific beyond
 fifty, and males beyond sixty.
   The impediment constituting impotency  may arise either from malformation,
 what the law calls frigidity of constitution, or  any physical cause, of whatever
 nature, which may render intercourse  impossible.  AVhen the physical defect is
 not apparent and irremediable, a continued cohabitation of three years is required
 before a suit can be entertained (Ayliffe's Parergon;) but according to Oughton
 —"haec triennalis expectatio  non est necessaria  ubi statim  possit constare de
 impotentia coeundi." ' Suit for a sentence of nullity may be promoted by either
 party, and the medical proof required  to  found a sentence must be such as to
 satisfy the Court that the incapacity pleaded was in existence at the time of the
 marriage, and that it still remains without remedy.  There should be no delay
 in instituting the suit, and there should be  proof that the impediment was not
 known to the complaining party at the time of the contract.  A longer delay in
 making the complaint is allowed  to a female, without prejudicing her case, than
 to a male, by reason of the modesty of her sex.   In a case which came before
 the Ecclesiastical Courts in 1845, a singular question arose whether, when there
 was a capacity of intercourse on the part of the female, with a certainty that from
 physical defect it could  never be prolific, this was sufficient to entitle the hus-
 band to a divorce.  The female was examined by Drs. Bird, Lever, and Cape;
 and they reported that  the sexual organs were undeveloped, like those of girls
 who had not  reached puberty, that the  vagina was only three-quarters of an inch
in depth, and that there was  no uterus.  They stated  that sexual intercourse
 might  take place  in an imperfect way; but that conception  could not result.
 On a second examination, seven months afterwards, it was found that the  vagina
 had become elongated, and had then a depth of two  inches: but there were no
medical means of improving its condition or  removing the defect. 
                    I

                  MEDICAL EVIDENCE IN SUITS OF DIVORCE.              445

   It was contended for the husband that the defect was natural and irremediable,
 and that he was entitled to a sentence of nullity of marriage.  On the part of the
 wife, it was insisted that in order to entitle a party to this sentence, there must
 be an utter impossibility of sexual intercourse.  The  case, it was argued, was
 one of mere sterility, which was  no ground for a sentence.  Actual consumma-
 tion had taken place.  Dr. Lushington, in pronouncing judgment, said, that mere
 incapability of conception, is not a sufficient ground whereon to found a decree of
 nullity.   The only question is, whether the female is or is not capable of sexual
 intercourse, or if at present incapacitated, whether that incapacity  admits of re-
 moval.   A power of sexual intercourse is necessary to  constitute  the marriage
 bond; and this  intercourse must be ordinary and complete, not partial and im-
 perfect; yet it would not be proper  to say that every degree of imperfection would
 deprive it of its  natural character.  If it be so  imperfect as to be scarcely natu-
 ral, it is, legally speaking, no intercourse at all.  As to conception, there is no
 doubt that the malformation is incurable.  If there were a reasonable probability
 that the female  could be made capable of natural coitus, the marriage could not
 be pronounced void;  if she could not  be made capable of more than an incipient,
 imperfect,  and unnatural coitus,  then it would  be void.   Dr. Cape stated that
 under present circumstances there could only be restricted and limited connexion :
 it could not be called perfect and complete.   The vagina might possibly become
 a little more elongated, but this would expose the female to danger. From these
 facts the marriage was pronounced null and void.   (See American Journal of
 Med. Sci. Jan. 1848, 305.)
   Hence we may  infer, that  if the vagina  had  been of  its natural length, not-
 withstanding the absence of  the  uterus  and the impossibility of conception, a
 sentence of nullity would not  have  been pronounced.  This is rather conflicting
 with the doctrine, that the main  object of a marriage, valid in law, is ad proles
 procreandas.
   The nature  of the medical  evidence required on these occasions will  be best
 understood by the following extract from Oughton:—" Ad probandum defectus
 judex compellere potest virum ad exhibendum praesentiam suam et ad ostenden-
 dum in aliquo loco secreto (per judicem assignando) pudenda sua, seu illos cor-
 poris defectus  quos mulier objicit (si ex inspectione  corporis  apparere possint)
 medicis et chirurgis peritis prius judicialiter in praesentia partis adversae, de dili-
 genter inspiciendo virum et de referendo in scriptis eorum judicium juratis.   Et
 si medicorum et chirurgorum  judicium sit quod morbis vel defectus viri fuerit
 insanabilis et incurabilis (tamen tenentur in relatione eorum judici ipsum  mor-
 bum seu defectum specificare ne circumveniatur  Ecclesia) et quod  in eorum sci-
 ential, doctrina,  experientia morbus aut  defectus hujusmodi nullA re aut arte
 medica curari  possit mulier obtinebit  in causa : hoc addito et allegato ex parte
 mulieris, quod ipsa sit juvenis et at procreationem apta et quod per  tres annos in
 simul pernoctarunt et quod  quamvis a marito  cognosci cupiebat,  ab  eo tamen
 cognita non fuit  nee cognosci  potuit.  Et si defectus non  possunt directe per
 medicos et  chirurgos juratos, judicari  aut decerni; vel  forsan dubia sit eorum
 relatio; allegetu  rex parte mulieris, non solum quae ultimo recitata sunt, sed etiam
 hoc  addito:—Quod sit virgo  intacta nee a  quoquam cognita.  Et ad hoc pro-
 bandum judicialiter jurandae sunt obstetrices ad  inspiciendum mulierem, an vera
 sint haec allegata.  Et si judicio hujusmodi obstetricam; reperta  fuerit virgo,
 saltern femina intacta nee a quoquam cognita; et si vir non possit aliquos de-
 fectus objicere contra uxorem, ob quos cognosci non possit; haec dictarum muli-
 erum relatio cum judicio medicorum et chirurgorum (quamvis dubio) una cum
 caeteris praedictis indicii (videlicit in eo quod mulier sit juvenis, et quod concu-
 buit cum viro,  per  triennium, ac quod ex aspectu apta et idonea videatur ad pro-
 creationem  sufficiunt ad divortium; seu potius ad pronunciandum nullum  ab
initio matrimonium fuisse inter hujusmodi personas; easque ab invicem, et ab
omni vinculo et  fcedere conjugali, liberas et immunes fuisse et esse.   Et notu 
446
MEDICAL EVIDENCE IN SUITS OF DIVORCE.
quod si defectus objiciantur contra mulierem probandi sunt isto  modo  per in-
spectionem et relationem."
   A case of this kind came before the Vice-Chancellor's Court, in February,
1845, ( Wilson v.  Wilson,) in which the female produced medical  certificates to
prove that she was "virgo intacta!"  In drawing up certificates  of this kind,
the medical reporter should bear in mind  that females have  become pregnant
with what is commonly regarded as the chief sign of virginity intact.  Indeed,
the division of the hymen has been often rendered  necessary for the delivery of
the child.  Negative evidence of non-consummation from the physical condition
of the female, is therefore of much less value, caeteris paribus, than the affirma-
tive evidence from the  existence of a physical defect in the male.
   When the defect is not apparent on an examination, the case is  attended with
considerable difficulty.   Divorce has, however, been granted even in these cases,
when the husband has acknowledged his incapacity, and when, notwithstanding
cohabitation  for  some years, this admission has been confirmed by an  exami-
nation of the wife.   Even where the male organs do not appear well developed,
and sexual desire  is absent, great caution is required  in drawing up a  report.
In the case of Bury, the marriage was dissolved  on the ground of impotency:
but  this  man  afterwards married, and  had issue,—a fact which proved  that,
"ecclesia circumveniatur."  This  gave  rise to a difficult question;  for it was
contended, if the divorce was null, the  second marriage was unlawful and the
issue illegitimate.   It  was decided, however, that the second marriage was only
voidable; and  that, until  dissolved, it remained a lawful marriage, and the
children during coverture were legitimate.  In investigating a case of this kind,
where there is no apparent physical  defect  or malformation, it is necessary to
examine the  bodily  state of  the individual, whether he  be effeminate, or  have
about him any or all of the usual  marks which attend a virile state.   In the
latter case the impotency may be temporary; and it would be decidedly unsafe
to pronounce an opinion adverse to the existence of a procreative power.
   From these considerations, it will be perceived, that in order to justify a suit
of divorce, on the. ground of impotency or sterility, the impediment  to intercourse
or procreation must be apparent and irremediable; it must also have existed be-
fore the marriage of the parties, and have been entirely unknown  to the person
suing for the divorce:  if it has supervened after the marriage, this is no  ground
for a suit.  The nature of the impediment is to be determined by private medical
opinions or  affidavits, based on an examination of  both parties.   There  is one
remarkable circumstance with respect to  these cases; namely, that in nearly all
of them, the suit is by  the female against the male;  although there is no reason
whatever to suppose that impotency and sexual malformation are more common
in males than sterility  in  females.   We  rarely hear of a man  instituting a suit
of divorce on the  ground of sterility (incapacity) in the wife;  it is, I believe, in
most instances, that the wife promotes the suit on  the ground of impotency in
the husband.  The  difficulty of establishing incapacity in the  female, and the
facility  of proving impotency in the male, may probably account  for the differ-
ence.  Suits of this kind are sometimes instituted many months and years after
the union of the parties; but it is pretty certain that the desire for separation in
these cases often depends  on  some other cause, which the law would  not recog-
nise as  sufficient  of itself, while it would admit the plea of impotency.  The
French  law very judiciously applies  the principle of condonation  to such cases,
so that no suit for nullity  of marriage can be entertained, if cohabitation  have
continued for six months after the  discovery of the personal defect.  This ap-
pears to me more consistent with justice than our own law: but practically, these
suits, after protracted cohabitation, are always regarded with great suspicion. 
RAPE.
447
RAPE
                             CHAPTER LVI.

 MATURE OF THE CRIME—SOURCES OF MEDICAL EVIDENCE—RAPE ON CHILDREN—LEGAL COM-
   PLETION—PROOFS OF PENETRATION—ABSENCE OF  MARKS OF VIOLENCE.   PURULENT
   DISCHARGES  FROM THE VAGINA—EVIDENCE FROM GONORRHOEA AND  SYPHILIS.   FROM
   MARKS OF VIOLENCE—RAPE ON YOUNG  FEMALES AFTER PUBERTY.  DEFLORATION—SIGNS
   OF VIRGINITY—PROOFS OF  INTERCOURSE.  RAPE ON THE  MARRIED—RAPE UNDER THE
   INFLUENCE OF NARCOTICS—ON  IDIOTS.  MICROSCOPICAL EVIDENCE^LEGAL  RELATIONS
   SODOMY.

   Nature of the crime.   Sources of medical evidence.—Rape is defined in law
 to be the carnal knowledge of a woman by force, and against her will.  In an-
 cient times it was punished by castration,—a punishment which, according to
 Dr. Griffiths,  is still  retained  in Virginia and Missouri, when the crime is per-
 petrated by a coloured man on a white woman.   For a long period it was pu-
 nished as a capital crime in this country, but transportation for life was substituted
 for this punishment by 4  and  5  Vict. c. lvi. s. 3.  Since this change was made
 in the law, it  has been alleged, on good authority, that the crime has undergone
 a considerable increase.   On the average of four years, rapes increased 57 per
 cent  (Law Times, Jan. 4, 1845;) and it was stated officially in Parliament, in
 1847-8, that  the increase had actually amounted to 90 per cent, since the abo-
 lition of capital punishment!  Medical evidence is occasionally  required to sup-
 port a charge  of rape; but it is seldom more than corroborative, because the facts
 are in general sufficiently  apparent from the statement of the prosecutrix. There
 is, however, one case  in which medical evidence is of some importance; namely,
 when a false accusation is made.  In some  instances, as  in  respect to rape on
 young children, the charge may be founded on mistake; but in others there is
 little doubt that it is often wilfully and designedly made for motives into which
 it is here unnecessary to inquire.  Professor Amos remarked, some years since,
 that for  one real  rape tried on  the  Circuits, there were  on the average twelve
 pretended cases!   In some few instances, these  false  charges are set aside  by
 medical evidence;  but perhaps in the majority, they are developed by the incon-
 sistencies in the statement of the prosecutrix herself.  The duty of a medical wit-
 ness on these occasions is  very simple; and perhaps this will be  best understood
 by considering the subject in relation to females at different ages. It may be ob-
 served, that the consent of the female does not excuse or alter the nature of the
 crime when she is  under  ten years of age, since consent at this  period of life is
 invalid; and the carnal knowledge  of such a female is rape in law. Even the so-
 licitation of the child  does not excuse it.
   On being called to  examine the person of a female  on whom a rape  is alleged
 to have been  committed,  the  first circumstance  which the practitioner should
notice, is the precise time at which he is summoned,—taking an early opportunity
of comparing his watch with some neighbouring clock.   This may appear a very
trivial matter, and one wholly irrelevant to the duties of a medical practitioner; but 
448
PROOFS OF RAPE ON CHILDREN.
it is to be observed, that the time at which a surgeon is required to examine the
prosecutrix may form a most material part of the subsequent inquiry.   It will
be highly important to the prisoner, if it can be proved that  the female did not
take the  earliest opportunity to  complain; and it may be also  the means of
defeating an alibi, falsely set up by the prisoner in his defence.
  Medical evidence of  rape  may be  derived from four sources:—1. Marks of
violence about the genitals.  2. Marks of violence on the person of the prosecutrix
or prisoner.  3. The  presence  of stains of the spermatic fluid, or of blood, on
the clothes of the prosecutrix  or prisoner.  4.  The existence of gonorrhoea or
syphilis  in one  or  both.   This evidence  will vary according to the following
circumstances:—

                               ON CHILDREN.
  The sexual organs should in these cases present traces of injury, if the crime
has been completed, and there  has been any resistance on the part of the child;
for it is impossible to  conceive that forcible intercourse should take place without
the production of  ecchymosis, the effusion of  blood, or the laceration of the
pudendum.  It has been propounded as a  serious question, whether a rape  can
be perpetrated on a child of this age by an adult man; and medical witnesses at
trials have been found to adopt diametrically opposite views on this point.   For
the legal establishment  of the crime, proof of penetration only is demanded; and
it would appear from a decision in  the case of Rex v. Russen, that a degree of
penetration so slight as not to injure  the hymen, would be sufficient to complete
the crime.  In  the case  alluded to, the hymen of the child was proved to be
entire, and under the direction of the judge, the prisoner  was  convicted  and
executed.  This trial took place in 1777; but the late Baron Gurney subsequently
held, on a trial which  took  place  before him, that there must be  a sufficient
penetration of the male organ to rupture the hymen; and unless this membrane
was found ruptured, the crime would not be complete in law.  (Rex v. Gammon,
Archbold, Crim. Plea. 406.)   This decision was afterwards overruled by the
judges, in a case reserved for their consideration by Coleridge, J., and  reported
in 9 Carrington and Payne.   (See also the case of Reg. v. Lines, 1 Carrington
and Kirwan's Reports.)   It  is now, therefore, an admitted principle, that a
sufficient degree of penetration to constitute rape in law, may take place without
necessarily rupturing  the hymen;  but  there  must  be  medical  evidence to
show that, in a special case, there was  actual penetration:—the degree of
penetration is quite immaterial.   It  is true that  there could not be a complete
introduction of the adult male  organ into the vagina of a child without a rapture
or laceration of the soft parts; but the absence of such marks of violence would
not justify a medical witness in denying the perpetration of  the crime, since the
law does not require proof of a complete introduction.   Penetration to the vulva
is sufficient.
   Proofs  of penetration.—In a case brought before a magistrate  a few years
since, the evidence left no doubt that  the crime had been committed on the person
of a  girl about ten years old.   The  surgeon stated  that there were  considerable
marks of violence about  the pudendum, but  completion (i.  e. penetration) was,
in his opinion, physically impossible on a child under ten years of  age.   Upon
this  evidence the charge of felony was abandoned.   In the following case the
child was older, but  the facts  bear immediately upon  the question which we are
here discussing.   It was tried at the Central Criminal Court, March, 1843; and
the particulars were  communicated to the profession  by Mr. Adams.  (Lancet,
March 25, 1843.)   A  man was  charged with a  rape upon  his own child, aged
fourteen.  Mr. Adams  examined  the child  about  two  days after the  alleged
perpetration of the crime;  and he found no injury  about the vulva or adjacent
parts, and the hymen was unruptured.  He gave a positive opinion at the trial,
 that  no  rape  had been committed.   Two other medical witnesses, men of expe- 
RAPE ON CHILDREN.  MARKS OF VIOLENCE.
449
rienee and integrity, stated their belief that the crime had been perpetrated.  It
appears that  they had examined the child soon after the alleged offence, and a
day or two before Mr.  Adams.  The prisoner was  acquitted" of the rape, but
found. guilty of the assault.  The absence of any marks of injury about the
vulva,  so short a time after  the alleged  criminal act, and the fact of the hymen
being  unruptured, in some  measure  justified the opinion of Mr. Adams, that
there was no  medical proof  of a rape having been committed: at the same time
he candidly restricts his opinion, by saying,  that if by rape we are to understand
penetration to the vulva, then was  it effected; but there was no evidence to show
vaginal penetration; on the contrary, the unruptured state of the hymen in a
forcible intercourse was against this view.   The  only remark which this case
requires, is, that the statute  law says nothing about the rupture of the hymen as
part of the evidence; it merely requires proof of penetration.   This may occur,
and the hymen remain  intact.   The  distinction here drawn by the witness has
no real existence. _ From the decisions of our judges, vulval penetration, whether
with or without violence, is  as much a rape as vaginal penetration.
  In Scotland this question came formally before the judges in the case of Macrae.
(High Court  of Justiciary,  1841.)  It was  insisted  by the prisoner's counsel,
that there should be proof of full  and complete penetration;  and there was
no sufficient evidence to show that penetration had taken place into the canal of
the vagina beyond, the vulva.  Lord Meadowbank charged the jury to the effect,
that the evidence of the prisoner's guilt was complete;  that  scientific and ana-
tomical distinctions as to where the vagina commenced, were worthless in a charge
of rape; and that by the law of Scotland it was  enough if the woman's body
were entered.   In a case like this,  where there was no evidence of emission, and
the girl was young, he did not consider it necessary to show to what extent pene-
tration of the parts had  taken place,—whether it had gone past the hymen, into
what was anatomically called the hymen, or even so far only as to touch the hymen.
The prisoner  was convicted.  (Cormack's Edin. Jour. January, 1846, p. 48.)
  Absence of marks of violence.—AArhen, as in the case above related, there are
no marks of violence or physical injury about the pudendum of a child, whether
because none  originally existed, or they had existed and disappeared in the course
of time, a medical witness must leave the proof of rape to others.  He can only
answer  questions of possibility or probability, according  to  the  special facts
proved.  On  the other  hand, if marks of mechanical violence be present, they
must not always be  hastily  assumed as furnishing proof of rape; for cases  are
recorded, in which such injuries have been  purposely produced on young chil-
dren, as a foundation for false charges against individuals.   The proof  or dis-
proof of facts of this kind must rest more upon general  than on medical evi-
dence,  unless the  injuries obviously indicate  the use of some weapon or  instru-
ment.  It should be remembered that the  hymen is not always present in young
children:—it may be, according to some, congenitally deficient, or, what is more
probable, it may have been  removed by ulceration or suppurative inflammation
of the  parts,—a disease to which female infants of a scrofulous habit  are very
subject.  The mere absence of  the membrane, therefore, can  afford no  proof of
the perpetration of the  crime, unless we find traces of its having been recently
torn by violence.
  Purulent discharges from the vagina.—The existence of a purulent discharge
from the vagina has  been erroneously adduced as a sign of rape in these young
subjects.  The parents,  or other ignorant  persons, who examine the child, often
look upon this as a positive proof of impure intercourse; and perhaps lay a charge
against an innocent person, who may have been observed to take particular  no-
tice of  the child.   Some cases are  reported, by which it would appear that indi-
viduals have thus narrowly, escaped conviction for a crime which had really not
been perpetrated.  This discharge is very common  as  a result of  vaginitis  in
young children.   It often arises from dentition, or local  causes of irritation,—
       29 
450
PURULENT DISCHARGES FROM THE VAGINA.
as worms or uncleanly habits, and  is observed especially in children of a scro-
fulous habit.  It is met with in girls up to  six or seven years of age; and chil-
dren thus affected have been tutored to lay imputations  against  innocent  per-
sons,  for the purpose of extorting money.   This state may commonly be distin-
guished from the effects of violence by the hymen  being entire—the non-dila-
tation or laceration of the vagina—the red and inflammatory condition of the
mucous membrane, and the abundance  of the purulent discharge, which is com-
monly much greater than that which takes place as a result of violence.   Capuron
mentions two cases, in which  charges of rape on  children were falsely made
against innocent persons, on account of the existence of a purulent discharge,
the nature of  which had  been mistaken.  (Med. Leg. des Accouchemens, 41.)
For some judicious remarks on this subject,  by Mr. Kesteven, see Med. Gaz.
xlvii. p. 372.
   If the child be labouring under  syphilis or gonorrhoea, this is caeteris paribus
evidence of impure intercourse, either with the ravisher or some  other person;
but we should be well assured, before  giving an opinion, that the discharge  is
really of a gonorrhceal, and not simply of  a  common inflammatory character.
The party accused might be at the time free from that disease, or, if labouring
under it, then we should expect that the discharge suddenly made its appearance
in the child with its usual  severe  symptoms, at a certain interval of time after
the presumed  intercourse;  i. e. from the third to the eighth day*.  When these
conditions do not exist, it is extremely  difficult to form a medical opinion on the
subject, since there are no certain means of distinguishing sporadic discharges
from those which are gonorrhoea!   Under these  circumstances, proof  must be
derived from  non-medical sources. A case occurred to  M. Biessy, in which a
mere mucous discharge in a girl was pronounced to be syphilitic, and the party
who was falsely accused of rape narrowly escaped  conviction.    (Briand, Man.
Complet de Med. Leg. 1846, 81.)  We should  further distinctly satisfy ourselves
that the gonorrhoea in the child, if it exist, could not have arisen from  infection
by any accident irrespective of intercourse.  This limitation is rendered neces-
 sary  by the publication of a report of  two  interesting cases by Dr.AA\ B. Ryan
(Med. Gaz. xlvii. p. 744,) in which two sisters, one of one year, and the other of
four years of  age, received the infection by reason of their being  washed  in a
vessel and with a sponge used  by a young woman affected with profuse  gonor-
rhoea! discharge.  Dr. Ryan clearly traced the origin of the disease to  this  very
unexpected accident.   Had an accusation of rape  been made against  a  man
labouring under gonorrhoea, it  is not at all improbable that this condition of the
 children would have been taken as an  unanswerable proof of his guilt.  Cases of
 this kind, thus accurately observed, convey an  important  caution to  medical wit-
 nesses : i. e. that they should not infer criminal intercourse merely from the  exis-
tence of a gonorrhocal  discharge,  in the absence of marks of violence  to the
 genitals or  other corroborative proofs.
   As a summary of these remarks with respect to purulent  discharges, we  may
 observe, that they should never be admitted as furnishing corroborative evidence
 of rape, except—1, when the accused  party is labouring  under gonorrhceal dis-
 charge;—2, when the date of its appearance in the child is from the third to the
 eighth day after the  alleged  intercourse;—3, when it  has been satisfactorily
 established that the child had not, previously to the assault, any such discharge.
 It may be said, however, that all these conditions may exist, and yet the prisoner
 be innocent;  for a child may,  either through mistake or  design, accuse an inno-
 cent person.   This, however,  removes the case  entirely from the hands  of a
 medical jurist.
   In the case  of The Queen v.Mosely  (Cent. Crim. Court, Sept., 1843,) the pro-
 secutrix, a child between twelve and thirteen years of age, charged the defendant
 with having committed a rape  upon her, alleging that she had made all the  re-
 sistance in her power.  Dr. Merriman  stated  that  he examined  the prosecutrix 
ON YOUNG FEMALES AFTER PUBERTY.
451
two or three days after the alleged offence was committed, but could not give any
decided  opinion  on the case, although there was every appearance of violence
having been  used.   Another medical witness stated that  the  prosecutrix had
been under  his  care for  the  last eight or nine days for a disease (gonorrhoea,)
with which,  in his opinion, she  had been infected for a considerable time; and
a third proved that the prisoner was not  infected with this disease.   Dr. Merri-
man, however, is reported to have said that the prosecutrix was not  labouring
under the disease when he examined her.   It is difficult to explain how this dis-
crepancy on  a.matter of fact of some importance could have arisen.   The jury
acquitted the prisoner, probably not trusting to the statement made by the prose-
cutrix.  In  another  case, Reg. v. MDonough, (Cent. Crim. Court, Oct., 1843,)
Mr. French and  Mr.  Tucker deposed that the gonorrhoea under which  the prose-
cutrix (ast. 15) laboured, had probably not existed longer than a week,—it might
have  been of longer standing, but  it certainly  could  not  have existed for  six
weeks, the date  at which it was alleged  that the rape was perpetrated by the
prisoner, and the disease  communicated.  Upon  this evidence the  prisoner was
acquitted.
   The following case was tried at the St. Louis' Criminal Court.  A man named
31' Comas was charged with an attempt to violate a child  aet. 9.  The evidence
against the prisoner was chiefly based on an extorted admission from  the prose-
cutrix, and on the discovery on her clothes of certain  stains  supposed to have
been produced by seminal fluid.  The mother examined the pudenda, and found
them inflamed and discharging matter, although  several weeks had elapsed since
the alleged  attempt.  A medical practitioner was called to the girl: he found
the nymphae and orifice in a state of inflammation, which might have arisen from
some morbid cause;  but  he was unable  to  give  any positive opinion respecting
the nature of the discharge. About eight days after this, the girl was examined
by Dr. Stevens:  the parts were still much inflamed, and discharging muco-puru-
lent matter.   The hymen was uninjured.   The defence of the prisoner was, that
he was not guilty of the assault, and that he was  not labouring under gonorrhoea
at the time of the alleged attempt.   He was convicted, and sentenced to three
years' imprisonment.  (British  American  Journal,  May, 1848, p. 19.)  It is
quite possible that this was a case of vaginal catarrh mistaken for gonorrhoea;
for, as it has been already stated, there are no certain means of distinguishing the
two kinds of discharges.   The jury, however, appear to have put faith in the testi-
mony of the  prosecutrix.  The case was therefore  decided by moral circumstances,
and not by medical evidence.   The existence of an unruptured hymen merely
proved that there had not been a violent attempt at carnal intercourse.
   Marks of violence.—With respect to  marks of violence on  the  body of the
child, these are  seldom  met with, because  no  resistance is commonly made.
Bruises or contusions may occasionally be seen on the lower extremities.

                    ON YOUNG FEMALES AFTER PUBERTY.
   AVh/m the crime is committed on a female from the age of ten to twelve years,
the facts are much the same as those already referred to, with respect to children
below the age of ten  years.  There is, however, some difference in the legal com-
plexion of the offence.  If carnal intercourse be had with the consent of a female
between the ages of ten and twelve years, the offender is guilty of a misdemeanor
only.  Above the age of twelve  years, the consent of the female does  away with
any imputation  of legal  offence. Females who have  passed this  age are con-
sidered to be capable of offering some resistance to the perpetration of the crime;
and  therefore in a true charge, we should expect to find not only marks of vio-
lence about the pudendum, but also injuries of greater or less extent about  the
body and extremities.  It is probable that in these cases, if the charge were well
founded, the hymen would be ruptured, as the intercourse is always presumed to
be violent; but there might be some degree of penetration without this being a 
452
RAPE.   DEFLORATION.
necessary result, especially if the membrane were placed far up.  At any rate a
young female at this  age may sustain all the  injury, morally and physically,
which the perpetration of the crime can possibly bring down upon her, whatever
may have been the degree of penetration; and for this reason, it is laid down in
our law,  that the crime consists in the mere proof of penetration.   The fact is,
however, generally clearly made out by the statement of the female.  With re-
spect to marks of violence on the person, the exact form, position, and extent of
these should be noticed; because a false accusation of rape may be sometimes de-
tected by the violence being in a situation in which it was not probable that the
ravisher would have produced  it.   AVhen bruises are found, the presence or ab-
sence of the usual zones of colour may occasionally throw light upon the time at
which the alleged assault was committed.  As these marks  of violence on the
person are not likely to have been produced with the concurrence of the female,
they are  considered to furnish some proof of the intercourse having been against
her will.  But the physical appearances of rape about the  pudendum may be
found, whether the connexion has been voluntary or involuntary. Thus rupture
of the hymen, laceration of the vagina, with effusion of coagula of blood, swelling
and inflammation of the vulva, and stains of blood on the person or dress, may
be met with in both cases.  In making an  examination, the greatest care should
be taken by the practitioner to fix a probable date for the marks of injury to the
genitals or other parts of the body, as it is by the aid of such observations that
the truth or falsity of a charge may be sometimes clearly established.
   Unmarried  females of the age here supposed  are  liable to muco-purulent dis-
charges from the vagina, under which the hymen may be destroyed.   This kind
of discharge arises from inflammation of the vagina, and has  been  observed to
follow an attack of scarlatina.   When it exists, its real cause requires the closest
scrutiny  of the  practitioner.   (See  remarks by Dr. Barnes,  Med. Gaz. xlvi. p.
65.)  At a more advanced age, young females are frequently  subject to leucor-
rhcea.  These cases are not  likely to be  mistaken for gonorrhoea;   as here the
female has it in her power to give some account of the circumstances, from which
a medical opinion may be easily formed.
   Defloration.   Signs  of virginity.—It will be necessary to  say  a few words
respecting the signs of virginity,—a subject upon which, in some  medico-legal
works, a great deal of poetical  discussion  appears to  me to have been wasted.
Independently of cases of rape, this question may occasionally assume a  practical
bearing in relation to the  signs  of defloration.   In civil cases a medical witness
may be asked whether a particular female has ever had intercourse or not.  Proof
of this fact  may be necessary in order to rebut or substantiate statements made
in evidence.   The question may be, not whether the female  has had a child or
not,  for this would resolve itself into the proof whether  delivery had or had not
taken place;—it may be  limited to the probability  or possibility of intercourse
on her part, at some antecedent period.  Now,  a medical jurist, when consulted
in such a case, can only be guided  by the presence or  absence of the external
signs of  virginity.  The hymen may be intact, but  this does  not prove non-in-
tercourse, because females have been known to conceive with  the hymen unin-
jured; and an operation for a division of this membrane has been actually neces-
sary before delivery could take place.  (Henke's Zeitschrift der S.  A.  1843, ii.
149.)  This may be explained by the membrane being hard and resisting, and
at the same time small in extent, i. e. only partially  closing the vagina.  Under
opposite  conditions, the persistence of this membrane might  fairly lead to the
inference that the female  was chaste, and that there had been no  intercourse;
but  the  hymen may be destroyed  by ulceration, as a result  of inflammation of
the genital organs.  When the membrane  has been thus destroyed by disease or
other causes, or when it is congenitally absent, the opinion must be more or less
conjectural; for one intercourse could hardly so affect the capacity of the vagina, as
to render the fact evident through life, and there is no other datum upon which 
RAPE ON MARRIED FEMALES.
453
a medical opinion could be based.  The presence of the hymen is of course quite
incompatible with the assumption that the female has borne a child.  A question
of this kind incidentally arose in the case of Frazer v. Bagley (Common Pleas,
Feb., 1844.)  It was alleged by defendant, that the plaintiff, a married man, had
had adulterous intercourse with a young female, and that at an antecedent period
she had left her  home for the purpose of giving birth to a child privately.  Dr.
Ashwell  was called  upon to examine  the  party, and  he deposed that,  in his
opinion, the female was a virgin, and had never had a child.   (See also Henke,
1844, i. 259.)  It is possible, however, that there may be abortion at the early
periods of pregnancy, without this being attended with the destruction of the
hymen.
   This question  may become of importance, not only as it may affect the reputa-
tion of a female, but the credibility and character of the party who makes the
charge of a want of  chastity.  In 1845, a gentleman, then assistant-surgeon in
the Bombay army, was brought to a court-martial on a charge of having delibe-
rately and falsely asserted that on several occasions he  had had connexion with
a native female.   This was denied by the woman, and evidence was adduced to
show that she had still what  is commonly regarded as the main sign of virginity,
namely, an unruptured hymen.  In consequence of this, the gentleman was found
guilty, and  cashiered.   The native female was at the time about to be married,
and this rendered the investigation all  the  more important.   An assistant-sur-
geon, who examined the girl, deposed that he found the membrane of a semilunar
form, and tensely drawn across the vagina; and this evidence was corroborated
by that  of a midwife.   The inculpated party took up a double line of defence:
1, That the examination of the female was  incomplete; 2, that the hymen, if
present, would not justify the witness in saying  that intercourse could not pos-
sibly have taken place.   On the first point it is unnecessary here to make a re-
mark; but it  appeared, from their own admission, that the witnesses had never
before examined  females with this particular object.  Assuming that there was
no mistake, it becomes  a question whether non-intercourse could in this instance
be inferred from the  presence of  the membrane.  Fruitful intercourse, it is well
known, may take place without rupture of the hymen.   Some instances of this
kind were referred to at the  court-martial, but such cases must be regarded as of
an exceptional nature.   The real question is, whether, unless  it be in an ab-
normal state, intercourse can possibly occur between young and active persons
without a rupture of  this membrane.   Intercourse is not likely to be confined,
under these circumstances, to mere penetration of the vulva.   The membrane in
this female is stated to  have been tensely drawn across the canal, and it was not
tough; it  was  therefore in a condition rendering it most easy for rupture.  In
the case of an old man, or of one of weak virile power,  vulval intercourse might
be had without destroying the membrane.   Such a case could  only be decided
by the special circumstances which accompanied it.   The presence of the hymen
unruptured affords a  presumptive but not an absolute proof that the female is a
virgin; and it shows clearly that there can have been no vaginal penetration.
Admitting the statements of the examiners  to be correct, it  is very improbable
that  this female had  had sexual  intercourse  on several  or even on one occasion:
hence the imputation on her chastity was unfounded.

                            ON  THE  MARRIED.
  The remarks already made apply to married women, with this difference, that
when the female  has  already been in habits of intercourse with the other sex,
there  is commonly much less injury  done  to the  genital organs.  _ The  hymen
will,  in these cases, be found destroyed, and the vulva dilated.  _ Still, as the in-
tercourse is presumed to be against the consent of the woman, it is most likely
that under proper resistance some  injury will be done to the pudendum, and there
will be also, most probably,  extensive marks of violence on  the body and  ex- 
454                POSSIBILITY OF PERPETRATING RAPE.

tremities.   Such cases are generally settled without medical evidence, from the
statement of the female alone, corroborated, as it  should be, by circumstances.
A distinguished barrister, of great experience in the criminal law, has suggested
to me that this statement regarding the presence of marks of violence on the pu-
dendum of a married woman, on whom a rape is alleged to have been committed,
requires some qualification.  He informs me  that  he was concerned in the pro-
secution of two cases of rape on  married females,  in which the crime was com-
pleted in spite of the resistance of the female, and there were no marks of vio-
lence on the genital organs. In one (Reg. v.  Owen and others, 1839,) it appears
that while an accomplice held the head of the female, with  her face downwards,
between his thighs, the prisoner had  forcible  intercourse with the woman from
behind,—her thighs having been first widely separated.   In the second case, an
accomplice held the woman down on a bed by her  neck, while  the prisoner sepa-
rated her thighs, and thus had intercourse with her.  She was examined nine hours
afterwards by an experienced surgeon, and he found no mark or trace of violence
or injury  on or any where near her  pudendum.  There were bruises on her arms,
neck and  legs, where she had been  forcibly held down.  In both of these cases,
it will be  seen that the woman had not to struggle with a  single assailant; and
there can be no doubt that if a married woman be rendered powerless by many
being combined against  her, or if she be rendered insensible by intoxicating
drinks, or narcotic vapours, a rape may be perpetrated without any injury what-
ever to the pudendum.   The gentleman to whom  I am indebted  for  the above
cases has  suggested  that a separation  of the  thighs in a  married woman will
cause such a dilatation of the parts as to render it easy for the male organ to
penetrate  the vagina without leaving any traces of violence on the labia or the
female organs generally.   This is undoubtedly the true explanation.
  AVhen a charge  of this kind is made by a prostitute, it is very justly received
with suspicion, and the case is narrowly scrutinized.   Something more than
medical evidence would be  required to establish a charge  of  rape, under these
circumstances.   The question turns here, as  in all cases of rape upon adult fe-
males, on the fact of consent having been previously given or not.   This is the
point at which the greater number of these cases of alleged rape break  down;
and  it need hardly be observed, that this question has no relation to the duties of
a medical witness;—all that he can do is to establish, occasionally, whether or
not sexual intercourse has been had, with or without some  violence.   It is obvi-
ous that  there may be some marks of violence about the  pudendum, or  on the
person, and yet the conduct of  the  female may have been such as to imply con-
sent on her part.   AVe must not suppose, as it appears to be commonly done,
that medical proof of intercourse is tantamount to  proof of rape.
  Possibility of perpetrating rape.—Some medical jurists have  argued  that a
rape cannot be perpetrated on an adult female of  good health and vigour; and
they have treated accusations made under these circumstances as false.  AVhether
on any criminal charge a rape has  been committed or not, is, of course, a ques-
tion of fact for a jury, and  not  for a medical witness.  The  fact of the crime
having been actually perpetrated can  be determined only  from the evidence of
the prosecutrix and other witnesses.   Still a medical man  may be able to point
out  to the Court circumstances which might  otherwise escape notice.  Setting
aside the  cases  of  infants, lunatics, and weak and delicate females, it does not
appear probable that  intercourse could be accomplished against the  consent of
a healthy adult female, except  under  the following conditions:-—1. AVhen nar-
cotics or intoxicating liquids have  been administered to her, either by the pri-
soner or through his collusion.   It matters not in a case  of this  kind whether
the narcotics have been given merely for  the purpose of exciting the female, or
with the deliberate intention of  having intercourse with her while she  was in-
toxicated,—the prisoner  is  equally guilty.  (See Reg. v.  Camplin, Law Times,
June 28, 1845; also  Med.  Gaz. xxxvi. 433.)  The  nature  of the substance 
                MICROSCOPICAL EVIDENCE IN CASES OF RAPE.'            455

whereby insensibility is produced  is of course unimportant.   Thus the vapours
of ether and chloroform have been  criminally used in  attempts at rape.  In a
case which occurred in France, a dentist was convicted of a rape upon a female,
to whom he had administered the  vapour of ether.  The prosecutrix was not per-
fectly unconscious; but she was wholly unable to offer  any  resistance.  (Med.
Gaz.  xl. 865.)  Even when the state of uneonsciousness arises from natural in-
firmity, as in idiocy or insanity, carnal intercourse with a female will be regarded
as rape.   (Reg. v. Ryan, C. C. C. Sept. 1846.)  The female was in this case an
idiot, and it was proved that her habits were not loose or indecent.  Piatt, B. held
that if she was in a state of unconsciousness at the time the connexion took place,
whether it was produced by any act of the prisoner or by any act of her own, any
one having connexion with her would be guilty of rape.   The prisoner was con-
victed.   It may be a question whether a man can have forcible intercourse with
a female while in a state of unconsciousness from natural sleep.   A man was
recently charged with rape before  a police-magistrate, and the prosecutrix swore
that he had effected his purpose during her sleep.   The bare possibility of the
offence being perpetrated  under these circumstances cannot be denied;  but this
admission  would only apply  to a case where the  sleep was preternatural  or
lethargic.  In this instance the female was a prostitute, and the charge impro-
bable : all such cases can be determined only by the special  facts  which accom-
pany them. 2. AVhen a woman falls into a state of syncope from terror or exhaus-
tion.   3. AVhen several persons are combined against the female,  in which case
we may expect to find some marks of  violence about her person.  4. A woman
may yield  to a ravisher, under threats of death or duress,—in this case her con-
sent does not excuse the crime: but this is rather a legal than a  medical ques-
tion.
   Loss of physical evidence.—It is necessary to observe, in relation to the exami-
nation of females, that the marks  of rape, however  strong in the first instance,
soon  disappear or become obscure, especially in those who  have  been  already
habituated to sexual intercourse.  After two, three,  or four days, unless there has.
been  a very unusual  degree of violence, no traces  of the crime may be found
about the genital organs.  In  unmarried females, and  in children, when there
has been much violence, these  marks may persist  and be apparent for a week
or longer.  Supposing at the period of examination no such marks exist, it may
be necessary to consider whether there has been time for them to disappear since
the alleged perpetration of the offence; but in such cases it is rarely in a witness's
power to express an affirmative opinion of the perpetration of the crime:  he must
leave this  to be proved by the general and circumstantial evidence.  Marks of
violence  on the person can never establish a rape;  they merely indicate, caeteris
paribus, that the crime  has been attempted.
  Pregnancy following  rape.—It was formerly a debated question, whether, in
a case of real rape, pregnancy could possibly follow; and this was even proposed
as a rude test of the truth of a charge made by a female!  Such a question re-
quires no discussion in the  present day.   Impregnation, it is well known, does
not depend on the consciousness or volition of the  female.   If the state of the
uterine organs be in a condition favourable to impregnation, this may take place
as readily as if the intercourse  was voluntary.   Even penetration  is not abso-
lutely necessary for impregnation.   (See case by Dr.  Oldham, Med. Gaz. xliv.
p. 48.)
  Microscopical evidence.—Of late years, it has been proposed to add to the medi-
cal evidence in rape, the examination of spots or stains on the linen  of the prose-
cutrix and prisoner.  (Ann.  d'Hyg.  1834, 210;  1*89, 134.)   Thus, it has
been recommended to infuse the stained linen in water, and examine the liquid
with a good microscope, in order to observe whether it contains zoosperms. Cases
of rape  have in general been  tried in this country without reference  to this
species of evidence;  nor is it easy to perceive how  this can be necessary to the
proof of the crime, when the present law of England demands only proof of pene- 
456
MICROSCOPICAL EVIDENCE FROM THE FEMALE.
tration, and not of emission.   Thus, a rape  may be legally completed without
reference to emission; and, medically speaking, it  appears  quite possible  that
there might be emission without any penetration.  Admitting that certain stains
of this description are found on the clothes of an accused party,—Are^hese  to
be taken as furnishing undeniable proof of the legal completion of rape?   It
appears to  me that without corroborative proofs from the state of the female
organs they cannot be so taken; and, therefore, the affirmative evidence from the
microscope, under these circumstances, is as liable to lead to error as that which
is purely negative.  The fact that spermatic stains are found on the linen of the
prosecutrix may, however, become occasionally of importance in assaults; as the
following  case, which was tried  at Edinburgh, Nov. 27th, 1843, will show.
(Reg. v. Hamilton.)  The prisoner, who was at the  time labouring under gonor-
rhoea, was  charged with a criminal assault on a  child.  The shift worn by the
prosecutrix, with other articles  belonging to the prisoner, were submitted to Mr.
Goodsir and Dr. Simpson for  examination.   Some of the stains on  the linen
were  of a  yellow colour, and were believed to be  those of gonorrhoea; others,
characterized by a faint colour and a peculiar odour, were considered to  be stains
caused by the spermatic secretion.  Digested in water, they yielded a turbid so-
lution of a peculiar odour; and when submitted to  a powerful microscope, sper-
matozoa were  detected.   The majority of them were mutilated, the long slender
filaments being broken off; but perfect specimens were seen, which differed from
the living spermatozoa only in being motionless.   The stains on the linen of the
prisoner and the  prosecutrix were similar.   The prisoner was convicted of an
assault  with  intent to ravish,  and transported for fourteen years.   (Cormack's
Edinburgh Journal, April, 1844.)
  The zoosperm, or spermatozoon, has a flattened,  oval, and  perfectly transpa-
rent body,  terminating in a filiform tapering tail, which together measure from
l-500th to l-600th of  an inch.   (Curling, op. cit. 38.)  It has been already
stated that these bodies are the chief characteristic  of the healthy spermatic se-
cretion.  They are not found in the very young, in the very old, or in those who
are labouring  under long-standing disease.  They have been considered to be in-
dependent  animalcules; but Miiller and other physiologists deny this.  (Recent
Advances,  by Baly and Kirkes, 43.) They move for many hours out of  the body
when kept at a normal temperature, and even retain their rapid  motions when
the spermatic  liquid is mixed with water; but these motions cease immediately
on the addition of urine.  According to these physiologists the zoosperms  may
retain vitality in the body of a female for a period of s©ven or eight days  (p. 610.)
  Analysis of stains.—In  order  to  detect the zoosperms, Dr. Hassall recom-
mends that the stained linen should be digested in serum or albumen. M. Bayard
employs water gently warmed,  and continues the maceration for some hours.  It
is important that the linen should not be rubbed or handled roughly, as the forms
of the zoosperms would be thereby broken down and destroyed.   The aqueous
solution should be filtered, and a  small quantity of  the deposit left on the filter,
placed in the field of  a powerful microscope, when the zoosperms will be seen of
the form above described.  This, when observed, is  a clear proof of the presence
of the spermatic secretion:  there is no other test, chemical or physical, which
can be applied to the  detection  of it.  It is worthy of remark, that the zoosperms
in the different species of mammalia differ in size and shape; but there are  none
which precisely resemble those formed in  the  human secretion.  Dr. Hassall
states that  he  has detected, by the microscope, zoosperms in stains six weeks old
(Micros. Anat. vi. 205;) and M. Bayard has been able to detect them  in stains
after six years! (Man. Prat, de  Med. Leg. 277.)  M. Donne, an excellent micro-
scopist, states, on the other hand,  that he has never been able  to procure satis-
factory  evidence of the presence of these zoosperms  in stains which have become
dried.  He believes  that the fine rounded  fibres of the stuff (linen) might  be
very easily mistaken for them.  (Cours de Microscopic, p. 304.)  This is an im- 
EVIDENCE OF VIOLATION IN THE DEAD.
457
 portant objection, and it shows that microscopical evidence should be received with
 caution, and only from persons well versed in the use of the instrument.
   31 icroscopical evidence frnm the female.—It may become necessary to determine
 whether intercourse has or has not recently taken place.  All observers agree that
 within a  certain period after connexion the fact may be established  by the ex-
 amination of  the vaginal mucus.   A small quantity of  this placed  upon glass,
 and diluted with water, will be found to contain  zoosperms, if the suspicion be
 correct.  M. Bayard states that he has  thus detected them in the vaginal mucus
 of females, not subject to morbid discharges, at various intervals up to three days
 after  intercourse (op. cit. 277;) and Donne found them under similar  circum-
 stances in a female who had been admitted into the hospital the day before.  (Op.
 cit. 305.)  This  evidence may become of great value in a charge of rape; but
 it may be destroyed by the presence of leucorrhcea:  and it is open to an objec-
 tion, that  in certain morbid states of the vaginal mucus of the human female,
 there  is found in it an infusory animalcule, called  by Donne  the Trichomonas
 vagina-.  This has a larger body, and a shorter tail, than the zoosperm; but the
 witness who trusts to the use of the microscope on such  occasions, may be fairly
 asked, whether he is able to distinguish the spermatozoa from the trichomonades.
 They who are not used to microscopical investigations may be easily deceived,
 especially when the  spermatozoa are dead and mutilated.
   Marks of blood.—Marks of blood  upon the linen can, of course, furnish no
 evidence unless taken with other circumstances.  The linen may be intentionally
 spotted or stained with blood for the purpose of giving apparent support to a false
 accusation. Dr. Bayard met with a case of this kind, in which a woman charged
 a youth with having committed a rape upon her infant child.   On examination,
 the sexual organs were found uninjured; and on inspecting the marks of blood
 on the clothes of the child, it was observed that the stains had been produced
 on the outside, and  bore  the  appearance of smearing.   The whole fibre of the
 stuff had not even been completely penetrated by the liquid.   These facts esta-
 blished the falsehood of the charge.  (Ann. d'Hyg. 1847, ii. 219.)  It may be
 a question whether  the  marks of  blood  on  the linen of  the prosecutrix  were
 caused by effusion as a result of violence, or by menstrual discharge.   The men-
 strual fluid in the normal state is said to be entirely free from fibrin; but in re-
 spect to the red  colour, the presence of red  corpuscles,  and of serum,  the two
 kinds of blood are similar.  That fibrin  is frequently present, and in large quan-
 tity, in the menstrual blood, is obvious  from its being occasionally  discharged in
 a clotted state: hence  the discovery of fibrin in the stain would by no  means ne-
 cessarily imply that  the blood was from a wound, and not due to menstrual dis-
 charge, while its non-discovery would not prove the blood to be menstrual. Small
 quantities of fibrin are not readily separable from linen stained by  blood as a re-
 sult of effusion; and supposing the stain to have been caused by imbibition from
 another article of dress already stained, the secondary stain would be free from
 fibrin,  which would remain  in the  stuff originally wetted.  A man might  thus
 wrongly pronounce this secondary stain  to be due to menstrual blood.  Even the
 discovery of epithelial  scales and mucus, by the microscope, would not prove the
 stain to be menstrual, unless it could be shown that the mucus was effused with
 the blood which  caused  the stain.  (See  ante, p. 222.)   It may be right to
 state, for the information of medical practitioners who  have  hitherto thought
 that they could very easily distinguish menstrual blood and swear to  it, on charges
 of rape, that a few years since, the French Academy of Medicine appointed as a
 committee, MM. Adelon, De Lens, Moreau, and Le Canu, to examine  this ques-
 tion in the most comprehensive manner.  These gentlemen reported that, in the
 present state of science, there is no method  by which menstrual  blood can be
distinguished from that effused from the  blood-vessels in  a case of infanticide
or abortion. Ann. d'Hyg. 1846, i. 181.)
  Evidence of violation in the dead.—Sometimes the body of a female is found 
458
RAPE BY FEMALES ON MALES.
dead, and a medical witness is required to determine whether her person has or
has not been violated before death.  There is here some difficulty, because there
will be no statement from the prosecutrix herself.  The witness can seldom do
more than express a conjectural opinion from the discovery of marks of violence
on the person and about the genital organs.   Even if spermatozoa were detected
in the  liquid of the vagina, this would merely prove that  there had been inter-
course; whether violent or not, must depend  on circumstantial evidence.
   Legal relations.—The statute-law which refers to  this crime is the 9 Geo. IA".
c.  xxxi.  s. 17,  18.   According to  the eighteenth section, "Carnal knowledge
shall be  deemed  complete upon proof of penetration  only."  The words  are,
perhaps,  not sufficiently precise; for by one judge, the law  was thus interpreted;
Carnal knowledge, i.  e.  penetration, is not complete, unless  the hymen be
ruptured.  This,  as it  has been suggested, would divide penetration into vulval
and  vaginal,  the former  not constituting  rape,  but a common  assault.   The
majority of the judges, however, have not admitted a distinction of this kind.
They have strictly adhered to the obvious and literal meaning  of the words of the
law, and have regarded the rupture of the hymen, not  as a necessary proof, but
as strong evidence of penetration.   The question of penetration is not for the
medical witness, but for the jury to decide from the whole of the facts.  In the
case of a child,  the prisoner was seen perpetrating the act, but it was proved that
the hymen, which  was normally placed, was not ruptured;  yet this case  was
decided like that of Rex v. Russen: the crime was considered to be  complete.
Thus, then, when the material evidence of penetration (rupture of the hymen)
is  wanting, proofs may be derived from other and non-medical sources.
   [In  New York,  Pennsylvania,  Virginia,  New Jersey, Vermont,  and  New '
Hampshire, the punishment for rape is imprisonment for a long period, with or
without fine, as the particular law may direct.
   In Louisiana it is* imprisonment  for life,  and in Massachusetts, Rhode Island,
Delaware, and South  Carolina, it is a capital offence.  In Tennessee, Alabama,
and Louisiana,  a  rape, or attempt at rape, by a coloured man on a white woman is
also punishable by death; whilst in Virginia  and Missouri the same is punished
by castration.
   Although rape is defined to be  a carnal knowledge of a woman  against her
consent,  by force, menace, or fraud, of such a character as to deprive her of her
power of resistance, there has,  as  stated in the text, been  much  diversity of
opinion as to what  constitutes the  carnal knowledge.  In some of our states, as
Pennsylvania, New York, Illinois, and Louisiana, Tennessee  and Indiana, pene-
tration is held  sufficient in all but  the first by special enactment, in the others
by decisions.   In some of the other states,  however, acquittals have taken place
from want of proof of the occurrence of emission.   Vide last Am. ed.—H]
   Rape  by females on males.—So far as I can ascertain, this crime is unknown
to the English  law.   Several cases  of this kind have, however, come  before the
French Criminal Courts.   In 1845, a female, aged  18, was charged with having
been guilty of an act  of indecency,  with violence, on the person of Xavier T.f  a
boy under the  age  of  15 years.  She was found guilty, and condemned to ten
years'  imprisonment.   In another  case, which occurred in 1X42, a girl, aged 18,
was charged with rape on two children,—the one 11, and the other 13  years of
age.   It appeared in evidence that  the accused enticed the two boys into a field,
and there had  forcible connexion with  them.  This female was proved to  have
had a  preternatural contraction of  the vagina, which prevented intercourse with
adult  males.   She was found to be labouring under syphilitic disease; and the
proof of her  offence was completed by the disease having  been  communicated to
the  two boys.    She was condemned by the Court  of Assizes of the Seine to
fifteen years' hard labour at the galleys.   (Ann.  d'Hyg. 1847, i. 463.)  By the
penal code of France, it is a crime in either  sex to  attempt intercourse with the
other, whether with or without violence, when the child is under eleven years of 
UNNATURAL CRIMES.
459
age.  That this offence is perpetrated in England cannot  be doubted.   It is by
no means unusual to find in the wards of hospitals, mere  boys affected with the
venereal disease.  In  some instances this may be due to  precocious  puberty;
but, in  others, it  can  only be  ascribed to that unnatural  connexion of adult
females with mere children, which is punished as a crime in  the other sex.  The
only accessible medical proof would consist in the transmission of gonorrhoea or
syphilis from the woman to the child.

                          Sodomy.   Bestiality.
  This  crime  is defined, the unnatural connexion of a man with  mankind or
with an animal.   The evidence required to establish it is the same as in rape,
and therefore penetration alone  is sufficient to constitute it.   There are, however,
two exceptions: it is not necessary to prove the  offence to have been committed
against the consent of the person upon whom it was perpetrated; and 2dly, both
agent and patient (if consenting) are  equally guilty;  but  the  guilty associate is
a competent witness.   In one  case (Rex v. Wiseman,) a  man was  indicted for
having committed this offence with a woman, and a majority of the  judges held
that this was within the statute.  Unless the individual be in a state of insen-
sibility, it is not possible to conceive that this offence could be  perpetrated on
an adult of either sex against the will of the party.   The slightest resistance will
suffice to prevent its perpetration.  In August 1849, a question on this point was
referred to me from Kingston,  Jamaica.  A man was  convicted, and  sentenced
to transportation for life, for the crime of sodomy, alleged to have been committed
on the complaining party while he was  asleep.   The only evidence  against him
was the statement of  the complainant.   The opinion  given was in conformity
with  that of Dr. J. Ferguson,  who referred the case to  me, namely, that the
perpetration of the act during a state of natural sleep was  contrary to all proba-
bility.  If the crime be committed on a  boy under fourteen years, it is felony in
the agent only; and the same, it should seem, as to a girl under twelve.   (Arch-
bold,  409.)  The act  must be in the part where it is usually committed in the
viotim or associate of the crime, and if done elsewhere it is not sodomy.
  The facts are  commonly sufficiently proved without medical evidence, except
in the case of young persons, when marks of physical violence will in general be
sufficiently apparent.  In some cases, proof of the fact may be obtained by resorting
to microscopical evidence.  (See Donne, op, cit. 305.)  Trials for this  crime are
very frequent,  although it was  not, like rape,  specially excepted from capital
punishment by the 4th and 5th Vict.  cap. lvi.  It is  also said to be on the in-
crease.  (Law  Times,  Jan. 4th, 1845.)   There cannot be the slightest doubt
that false charges of this crime  are more numerous than those of rape, and that
this is too often a very successful mode of extortion.   This is  rather  a legal
than a medical  question: but it is especially deserving of notice, that these  ac-
cusations are most frequently made by soldiers and policemen I 
46Q
ASPHYXIA,  drowning.
ASPHYXIA.
DROWNING.
                            CHAPTER  LVII.

DROWNING--CAUSE OF DEATH--DEATH NOT CAUSED BY APOPLEXY--ASPHYXIA--MIXED CASES
  --DEATH FROM SECONDARY CAUSES--PERIOD AT WHICH DEATH TAKES PLACE--PERIOD FOR
  RESUSCITATION—CASES OP RECOVERY--TREATMENT--POST-MORTEM  APPEARANCES—RIGI-
  DITY AND  SPASM IN THE DROWNED--EXTERNAL AND INTERNAL APPEARANCES--WAS DEATH
  CAUSED BY DROWNING? —SUBSTANCES GRASPED IN THE HANDS—WATER IN THE STOMACH
  --MUCOUS FROTH IN  THE TRACHEA AND LUNGS--WATER IN THE LUNGS--DESTRUCTION OF
  POST-MORTEM APPEARANCES--SPECIFIC GRAVITY OF THE HUMAN BODY LIVING AND DEAD—
  SURVIVORSHIP OF THE DROWNED--SUMMARY OF MEDICAL EVIDENCE--MARKS OF VIOLENCE
  ON THE DROWNED--ACCIDENTAL FRACTURES--WAS THE DROWNING THE RESULT OF HOMI-
  CIDE," SUICIDE, OR ACCIDENT?—DROWNING IN  SHALLOW WATER—BY PARTIAL IMMERSION
  OF THE BODY.

   The  cause of death.—Many opinions have been entertained respecting the
manner in  which death takes place by drowning.   It was at one time supposed
that the water which passed into the stomach of a drowning  animal  had an in-
jurious effect, and operated as the immediate cause of death.  This opinion pre-
vailed before the importance of the respiratory process in the economy was fully
understood.  It would, however, have been easy to show the insufficiency of this
explanation by a simple appeal to facts.  Water is not invariably found in the
stomachs of the drowned; and again, it may be introduced into the stomach in
much larger quantity than we are accustomed to meet with it in the body of a
drowned person,  without producing any  deleterious  effect.  The presence of
water in the bronchial ramifications of the lungs has  been suggested as the pro-
bable cause of death: it was thought  that it operated here by arresting the
circulation  of blood in the minute pulmonary vessels.  This explanation of the
cause of death in drowning  would imply that  water  was always present in the
lungs of the drowned, which, however, is not the case: and, indeed, when found,
it is often met with in small and variable quantity; facts which  sufficiently show
that this hypothesis cannot be entertained.   The spasmodic  closure of the glottis
tends to prevent the entrance of water  into the trachea.   Death has been also
attributed to collapse  of the  lungs, by which  the  blood is  presumed to be me-
chanically prevented  from traversing the pulmonary structure.   It is a generally
admitted fact, that a considerable quantity of air is, in most cases, expelled from
the lungs during the act of drowning, but these organs are  not commonly found
collapsed in drowned animals; and when this condition is observed, it is rather
to be  regarded as a consequence, than a cause, of death.
  Death not caused by Apoplexy.—Some  have ascribed death in drowning to a
congested state of the cerebral vessels,—in other words, they conceive that death 
APOPLEXY.   ASPHYXIA.
461
takes place in most cases by a species of apoplexy.   That a congested state  of
the cerebral vessels is often met with in the bodies of the drowned, is a fact which
cannot be disputed;  but the same degree of congestion is  observed, not only  in
other cases of asphyxia, but also in the inspection of bodies where death has pro- *
ceeded from various  causes unconnected with cerebral disturbance.   There is no
ground, therefore, for attributing death to an apoplectic attack;—a mere fulness
of the  cerebral vessels is  certainly of itself insufficient to justify this view, for
upon the same evidence we might pronounce three-fourths of those deaths which
are distinctly referrible to other causes, to be dependent on  apoplexy.   The ob-
struction to the passage of the blood through  the  lungs  is sufficient to explain
why we meet with a sanguineous congestion in the cerebral vessels of  drowned
subjects;  and there is great reason to believe that the occurrence of  this conges-
tion  is posterior  to the interruption of the cerebral functions.  The most charac-
teristic post-mortem  appearance  of apoplexy—extravasation of blood—is rarely
seen in the drowned; and probably, where it exists, it might be traced to me-
chanical violence before submersion, or to the head coming in contact with hard
bodies  beneath the water.   I  have met with only two instances reported, where
extravasation  of blood on  the brain was found:—the one was in  the  case of Leo-
pold, Duke of Brunswick, who was drowned in the Oder, during  the German war
(see Henke, Gericht. Med. 327,)  and the  other was  a case which  occurred  in
London in 1839.  In  general, the term apoplexy  is applied to those cases  of
drowning where there is  great  fulness of the cerebral vessels; but, in most  of
these, there are also signs of death from asphyxia.
   Asphyxia.—No doubt now exists among physiologists that death by drowning
is due  to asphyxia or suffocation, in which condition the blood is  either circulated
in a state unfitted to support animal life, or its  circulation through  the minute
vessels of the  lungs is wholly  arrested.   The latter view is now  more commonly
adopted, and  to this arrest of the pulmonary circulation may  be  ascribed the
gorged or congested condition of the lungs of the drowned when death has really
taken place from asphyxia.  The  observations of Sir  B. Brodie (Lectures on Pa-
thology, 66) and others, clearly prove, however, that  the circulation  may be car-
ried  on for two or three minutes after respiration has ceased, so that there is not
a  sudden cessation  of the heart's action.   Asphyxia is  induced in drowning,
owing to a physical impediment to the introduction  of air, and we  have, there-
fore, in this form of death, a simple illustration of this state.  The medium  in
which the individual is immersed acts mechanically and as effectually as a rope
or ligature around the neck;  for although air  escapes from the lungs, and water
may penetrate into the minute air-tubes, yet no air can enter to  supply the place
of that which has already expended a certain quantity  of its oxygen on the blood.
Hence this fluid must circulate, if it circulate  at all,  in a state  unfitted for the
support of existence, and death will ensue.   AVhen an individual falls into water,
and  is  exposed to this kind of death, vain attempts  are in the first instance made
to respire.   At each time the  drowning person rises to the surface  a portion  of
air is received into the lungs,  but owing to the mouth being on a level with the
liquid, water also enters and passes into the fauces.   A large quantity of water
thus usually passes into the mouth, which the individual feels himself irresistibly
compelled to swallow.   The struggle for life may continue for a longer or shorter
period, according to  the strength of the  person, but the result is, that the blood
in the lungs becomes imperfectly  aerated, and exhaustion follows.   The mouth
then sinks altogether below the  level of the water,  air can  no longer enter into
the lungs,—a portion of that which they contain is expelled, and rises in bubbles
to the surface: an indescribable feeling of delirium, with  a ringing sensation in
the ears, supervenes,—the person then  loses all consciousness, and dies asphyx-
iated.  Before death, and while the body is  submersed, frequent  attempts are
made to breathe, but  at  each effort air escapes from  the lungs, so that these
organs may, according to  the duration of the struggle, become partially emptied 
462
DEATH FROM SYNCOPE AND APOPLEXY.
and be found collapsed after death.  The action of the heart continues for a few
minutes after the lungs have ceased to act,—dark-coloured blood is circulated,—
convulsive motions of the body follow, and the contents of the stomach are some-
times ejected prior to dissolution.  There is not the least sensation of pain, and,
as in other cases of asphyxia, if the  individual recover, there is a  total uncon-
sciousness of suffering during the period when the access of air was cut off from
the lurrgs.   I state this from having  accidentally experienced all the phenomena
of drowning up to the complete  loss  of sensibility and consciousness.   (See in
reference to this form of asphyxia a  paper by Mr. Eccles, Med.  Gaz., vol. xliv.,
page 657.)
   Some persons who fall into water are observed to sink at once without making
any attempt to extricate themselves.  This may arise from the stunning produced
by the fall;  and if the fall take place from a great height, the effect is probably
aided by the forcible compression which the  thorax then sustains, whereby the
lungs become in great part emptied.   Should the  person be intoxicated or other-
wise incapacitated, as by striking his head  in falling, he may not  again rise.
These different conditions under which death may take place will sufficiently ac-
count for the great difference in the appearances met with in the bodies of those
who have died under these circumstances.   Some  medical jurists have considered
that they who are submerged while living, frequently perish by syncope, and in
other instances by what has been termed syncopal asphyxia—a mixed condition.
It has been supposed that the state of terror into which a person may be thrown
prior to submersion, would be sufficient  to  bring on syncope;  and this, it was
presumed, offered an adequate explanation of the  recovery of the  apparently
drowned, when the body  had remained a long time in water.   It may readily be
admitted that in some instances the mental shock  may be so great  to a  person
falling into water as to induce  syncope; but it is impossible to determine how
often this occurs, and  its  occurrence appears to be  founded rather upon presump-
tion than upon actual observation.
   Mixed cases.—It is obvious  that they who die  from apoplexy, concussion, or
syncope, at  or  about  the time they fall into water, cannot be said to die from
drowning.   An individual so situated makes no effort to respire, and it  is only
by interfering with respiration that the water operates.  Admitting,  then, that
in strictness asphyxia is  the sole cause of death in drowning, these mixed case?
are of interest  in  medical jurisprudence only because the apparent may be mis-
taken for the real cause.   It may be  occasionally necessary to determine whether
the person really die by drowning or not, i. e., whether he was asphyxiated by
water or not; since an answer  to this question may materially  affect the position
of a prisoner charged with homicide.  The only conclusion at which we can ar-
rive is, that  many persons may fall into water, and appear to be  drowned, whose
deaths have actually  preceded their submersion.  They may have died from
fright or terror at their situation, or have been killed  by their heads coming ac-
cidentally in contact with hard bodies during the fall, or even with the surface
of water itself;  for this may be sometimes sufficiently resisting to produce con-
cussion of the brain, when the fall is from  a  great height, and the  head come?
first in contact with the water.    It is probable that some also perish owing to a
shock received at the pit of the  stomach by  the violence of the fall.   A shock
thus received in the region of  the heart might possibly suspend the functions of
that organ, and kill  the  person by inducing  sudden  syncope.  A case is men-
tioned in the Dublin Medical Journal, for May, 1837, which appears to bear  out
this view.  Again, there may be extensive but latent disease of the heart, which
may fully account for sudden death irrespective  of submersion.  (See case in
Lancet, Nov. 16,  1850,  p. 550.)  [Dr. Brownsegnard attributes death  in  the
asphyxia or  apnoea of drowning to the  immediate  accumulation of carbonic acid
in the blood, and  to the rapidly exhausting  excitation of the  heart and brain
produced  by the  stimulant action of the accumulated acid upon these organs. 
DROWNING.   PERIOD OF DEATH.
463
This theory will account for many of the deaths from secondary causes, also for
the fatal termination in what has been called secondary asphyxia after temporary
hanging, or strangling and suffocation, as well as drowning.  (See Philad. Med.
Ex. 1852.)—II.]
   Death from secondary causes.—Drowning may operate indirectly as the cause
of death.   Thus it has been  repeatedly remarked that persons who have been
rescued from water in a living state have died in spite of the application of the
usual restoratives, after the lapse of some minutes or hours; others have lingered
for one or two days, and then have sunk apparently from exhaustion.  In those
who perish soon after removal from the water, death may arise from the exhaustion
produced by the struggles of the individual for life, aided by the long contact of
the body with a cold medium.  AVhen death takes place at  a remote period, it
may be due  to  disease, and the  question will then be, whether the disease was
produced  by the immersion in water or not.   Such  cases occasionally present
themselves before our Courts  of Assize.   In one of these  (Reg. v. Pulham,
Gloucester Summer Assizes, 1845,) the prisoner was charged with the death of
the deceased by pushing him into a pond of water, from  the effects of which he
died.  The deceased was  an old man; he was taken out of  the water in a very
exhausted condition, and  died  five weeks afterwards.  One medical witness re-
ferred death to the effects of the immersion;  but as he had not attended the de-
ceased after the violence, and there was no clear account  of the cause of death,
the prisoner was acquitted.   In most of these cases it will be found exceedingly
difficult to connect death with the immersion, when the fatal result does not  take
place until after so long a period.  AVe must rely upon the nature of the disease
alleged to have been caused by immersion,—e. g. inflammation of some cavity
or organ, and its progress  until death without intermediate recovery or  interfe-
rence by improper treatment,—as the basis of our evidence.
   According to  M.  Devergie (Med. Leg. ii. 336,) of one hundred individual?
 who fall into the water, or are exposed  to the  chances  of drowning, the following
 may be taken as the numerical ratio of the causes of death:—
 Asphyxia, pure     ....   25*0  "]
 ---------and Syncope   .     .     ■ ? 62-5  f A«T>hvxia
 •------------Cereb. Congestion    .5      J
 Syncope,  Apoplexy, or Concussion     .......

                                                                     100 0

   From this table we learn that out of one hundred bodies removed dead from
 water, where death was due either directly or indirectly to  immersion,-—if the
 body were removed immediately after  death and examined  soon  after removal,
 the signs of drowning would be present in about 25:—they would be imperfectly
 apparent (asphyxia more or less marked) in about 62, and they would be wholly
 absent in about 12.   This table  may not represent the actual truth, but as the
 medical jurists of Paris have ample opportunities of examining the drowned, it
 is probably as near an approximation as the present state of science will permit
 us to reach.   (For a full  examination of the causes  of  death  in drowning, by
 Dr. Loeffler, see Henke, Zeitschrift der S. A. 1844, i. 1.)
   Period at which death takes place.—A witness may be asked how long a time
 is required for death to take place by  drowning. In giving an answer to this
 question, it must be remembered that  all who fall into water, and are exposed to
 the risk of drowning, do not really die by this kind of death.  Thus all cases of
 death from syncope^r apoplexy must be excluded from our consideration. Again
 some persons who are strong, who are good swimmers, and retain their presence
 of mind, may support themselves for a length of time in water, while others who
 are weak and  delicate  may struggle only for a few seconds, and then sink ex-
hausted and  lifeless.   There are two very different points  involved in this 
464
DROWNING.  PERIOD FOR RESUSCITATION.
inquiry:—1. How long can a person remain beneath  the surface of water with-
out becoming asphyxiated (drowned?), and 2.  After what  period of  entire sub-
mersion of the body may we hope to resuscitate.a person?  In regard to the first
point, it may be remarked, that when the mouth is so covered  that air cannot
enter, asphyxia supervenes in the course of one or two minutes at the  farthest,
and the time at which  this occurs does  not  appear to vary materially with  the
individual.  It has been observed that perfect  insensibility has supervened after
a minute's submersion, and it is probable that in most  cases  a few moments
would suffice for the commencement of asphyxia.  In the case of a healthy diver
who was accidentally submersed, at Spithead, in July, 1842, for a minute and a
half, without the power of breathing, at the depth of eighty feet, it was observed
that when drawn up he was faint but  sensible.   (Med. Gaz. xxxi. 90.)  Obser-
vations made upon sponge and pearl-divers show for how short a period a human
being, even when practised in the art  of diving, can continue without breathing.
Dr. Lefevre, of Rochefort, found that  among the Navarino sponge-divers, accus-
tomed as they were to the practice of  diving, there was not one who could sus-
tain entire submersion  of the body for two consecutive minutes.  The average
period  of  entire submersion was seventy-six  seconds.  (Med.  Gaz. xvi. 608.)
According to Mr. Marshall, the best pearl-divers of Ceylon could rarely sustain a
submersion of more than fifty seconds.   Thus, then, it would appear from these
and other observations, that asphyxia  is probably induced in most individuals in
the course of a few seconds, and that at the furthest  it occurs in from a minute
to a minute and a half.
   Period for resuscitation.—The second point to be  considered is—how long a
period of entire submersion is required for death to take place, %. e. when is there
no further hope of resuscitating a drowned  subject?   This question is of great
importance in relation to the treatment of the drowned.  The insensibility which
is the result of  submersion will give to a body which  has been immersed only a
few minutes or even  seconds, the characters of apparent death; but we are not,
therefore,  to desist from applying all the means in  our power to  restore anima-
tion.  On  the  contrary, it is only a proper act of humanity  that the means
should be  applied without delay, even to subjects which have remained so long
in water as to afford, physiologically speaking, but little hope of ultimate resus-
citation.   A man who would neglect the application of these would consign the
body to certain death, while, by adopting an opposite  course, he might,  perhaps,
unexpectedly to  himself, succeed in  restoring a  fellow-creature to existence.
Hence we are not  to allow ourselves  to be influenced, in  the treatment of  the
drowned, by the shortness of the period at which death most  commonly takes
place; for it is possible  that  two  individuals may be  drowned  under the same
circumstances, and treated, on removal from water, in the same way; yet  the
means of resuscitation will be effectual  in one case, while they may totally fail
in the other.  It ought to be borne in mind that the  susceptibility to the resto-
ration of life may be different in the two subjects :  were this not the case, it would
be impossible to explain why, under the most judicious treatment, every effort
will fail in restoring animation in a subject which has been submerged only two
minutes, while  the same  means will  perfectly succeed in resuscitating another
subject which may have been submerged five or even ten minutes.  Devergie states
that it has been found impossible to restore some who had not been entirely sub-
merged  for more than a minute, and when the bodies were removed with all the
warmth and pliancy of  life about  them; but, on  the other hand, others have
been resuscitated who,  there was reason to believe, had been entirely submerged
for five minutes.   It is  necessary that these circumstances should be clearly ex-
plained; for many of the marvellous recoveries  reported have no doubt  been
cases of the resuscitation  of  individuals who had not  been entirely submerged,
i. e. with the head below water, for the period' alleged.   If we are called upon
to state  physiologically, how we can reconcile  the accounts of resuscitation  after 
RECOVERY AFTER LONG SUBMERSION.
465
 the body has remained for a quarter of an hour  or  even for a longer period, in
 water, with the fact of the general occurrence of death within the short interval
 of a few seconds or minutes from the time of submersion, we must look upon
 such accounts, provided their authenticity be placed  beyond all doubt, as extraor-
 dinary exceptions to a very widely-extended  rule.   It  is necessary to observe
 that the head of the subject may not have been under water  during the whole of
 this time; the individual may have struggled long, and  have risen frequently to
 the surface, or the upper part of his body may have received support from some
 mechanical obstacle.   All these circumstances, as well as the depth of the water
 in which the body is found, should be duly considered before we proceed to ad-
 mit statements which  are opposed to facts  well  established  by experiment and
 observation.  In most of the cases on record the  evidence has been derived from
 ill-informed and ignorant persons, who were but little fitted to convey accurate
 information upon so important a question, and whose opinions we should be ex-
 tremely cautious in receiving. Besides, the  period of submersion has been stated
 upon conjecture, not upon actual observation of the time.
   Recovery after submersion for long periods.—The  following facts  may, it  ap-
 pears to me, be  relied on, in relation to this question.   Mr. AVoolley, a medical
 assistant of the  Royal Humane  Society, has met with only one case in the  Re-
 cords of the Society, in which the individual was resuscitated after five minutes
 submersion (Lancet, Oct. 1841.)  In  the Report  of  the R. H. Society for 1840,
 there were two cases of successful resuscitation after one minute and a half,—
 and two cases after three  entire  minutes' submersion.  In a  case communicated
 to me by Mr. Bloomfield, in 1841, a boy recovered after a submersion of from
 five to ten minutes.  In another, communicated to the Lancet by Mr. Smethurst
 (July, 1841,) a girl aged two years recovered  after ten minutes' immersion—it
 is not quite certain whether,  in this instance, the head was under water during
 the whole of this time.  A case of recovery after six minutes' alleged submer-
 sion will be found in the Med. Gaz. (xxix. 78:) and  in a case communicated to
 the Medical Times (Dec. 2, 1848, p. 125,) by Dr. Octavian Royle, it was inferred
 that there was partial recovery after a submersion of  at least eight, and probably
 thirteen minutes.   In vol. xxxi.  p. 448, of the Med. Gaz., is perhaps one of  the
 most  remarkable of these cases, where an individual is stated to have been re-
 suscitated after fourteen minutes' submersion;  and the case carries with it great
 probability, although the time was derived rather  as a matter of calculation from
 circumstances than from actual observation.  This is the longest authentic period
 with which I have been able to  meet.   Cases of  alleged recovery after half an
 hour, and  even  three quarters of an  hour,  will be found reported:  some have
 en leavoured to explain  these by assuming that the individuals in question were
 restored from a form of syncope which had occurred in consequence of the mental
 shock experienced at the moment of submersion.  It has been admitted that
 syncope may occur under these  circumstances, and  it is  possible also  that the
 susceptibility of  resuscitation may remain longer in a subject labouring under
 syncope, than  in one who has perished by asphyxia;  but the question here  ob-
 viously presents  itself, whether the lungs can cease to act, and the heart to cir-
 culate blood, for the period of half an hour, consistently with the maintenance
 of life.  The medical jurist must remember, that neither of these functions can
 continue when the  body remains  entirely submerged; for it  is impossible that
 air can enter into the lungs, and  we know that the circulation, provided syncope
 be not  previously induced, is not maintained above  three or four minutes in a
 person so situated.   There are few, indeed, who would be disposed to admit that
 respiration and circulation could  remain so long entirely suspended in any indi-
 vidual, whether he be in a state of  syncope or asphyxia, without the complete  de-
struction of life,  or if they did admit the possible occurrence of so great a devia-
tion from the common phenomena of vitality, they would  require  better evidence
for such an admission than that by which these cases are  usually supported.  In
       30 
466
TREATMENT OF TnE DROWNED.
numerous experiments on drowned animals, I have never found that life could
be restored after the animal had remained entirely submerged for the space of
four minutes.  In one case, where a stout healthy man had been submerged five
minutes, and every means for resuscitation speedily used, the result was unfa-
vourable.  AVe are, then,  bound unhesitatingly to declare, that in drowning, life
is very speedily  destroyed,—that  the time within  which resuscitation may be
successfully attempted is subject to variation,—and, lastly, that the cases which
have been hitherto recorded of restoration  after lengthened submersion of half
an hour and upwards, are  to be regarded as extravagant fables.  I am glad to be
supported in these views by the observations of so experienced a  writer as Sir
B. Brodie.  (Lectures on  Pathology, 90.)
   [The researches  of M. Bronsegnard  would seem  to  show that vital action
may continue no longer in water of a low temperature than it will in water of a
more moderate one, as the effect of cold is to retard the  excitation of the heart
and cerebro-nervous system, which in asphyxia, or forced apncea,  exhausts  the
powers of life.  (See Phila. Med.  Ex. 1852.)—H.]
   Treatment.—A question has often arisen at  coroners'  inquests whether death
may not have been really due to neglect in the treatment.  The principles to be
observed are, 1. To wipe the body dry.  2. To keep the head and shoulders
raised.   3.  To restore the warmth of the body.   This may be  done, according
to the means at  hand, by warm blankets, bottles of hot water, bags of hot sand
or  salt,  the warm water-bath, or  the warm air-bath.   (For an account of the
latter, see Med. Gaz. Sept. 1838.)  The warmth should be especially applied to
the feet and abdomen. 4. The cautious application of stimulants, such as diluted
ammonia, to the nostrils.  5. Having cleared  the mouth and fauces, we should
move the chest, in order to simulate the  act of respiration. 6. The employment
of stimulating embrocations, such as the Lin. Camph. Com. rubbed by a warm
flannel on the trunk and  the  extremities.   It is not advisable to  employ vene-
section until signs of recovery appear, nor even then unless this treatment should
be indicated by great cerebral congestion.  Much difference of opinion exists on
the  propriety of introducing air into the lungs  by artificial processes.  Mr.
AVoolley, who has had considerable experience in the treatment of the drowned,
denies its efficacy (Med. Gaz. xvii. 663,) and states that in the cases in which he
had been successful  in resuscitating them he had not inflated the lungs.   This
is certainly strong evidence against the alleged necessity for the practice, and it
is corroborated by the observation of Dr. Douglass (Med. Gaz. xxxi. 449,) in one
of the most remarkable cases of resuscitation on record; for the individual here
had been fourteen  minutes under water, and  no  signs  of returning animation
were evinced, until the treatment—which consisted simply in the  application of
warmth and constant friction—had been persisted  in for eight hours and a half
from the time of  the accident!   Inflation of the  lungs  was tried, but not per-
sisted in, as, while it did not appear to be attended with  any good effect, it inter-
fered with the rubbing, on which  the greatest dependence was placed.
   Artificial inflation is, however, commonly used, and it is said successfully;—
but other means, under which alone the apparently drowned have often recovered,
have been  simultaneously  employed; so that it is rather difficult  to say what
share the inflation may have had in the  recovery.   Certainly it should never be
allowed to interfere with the application of those means  by which warmth is re-
stored to the skin.  M. Marc states that more good is done by drawing  air out
of the lungs than by artificially inflating  the organs.  His experience was against
the  latter practice.  Theoretically  speaking, artificial inflation appears to be
strongly indicated.  Dr. Harvey considers it to be the best mode  of treatment
(Med. Gaz. xxxvi. 897;) and Mr. Bloomfield  informs me that he has found it
to be a most effectual plan to introduce air by applying the mouth to the mouth
of the deceased.  A very ingenious apparatus for performing artificial respiration
has been contrived  by Dr.  Sibson.  (Med. Gaz. xli. 271.)   This should super- 
POST-MORTEM APPEARANCES.
467
sede the old plan of the bellows, or of a tube introduced into the nostrils.  (Bro-
die's Lectures on Pathology, 78.)  In employing any of these methods, the larynx
should be pressed against the oesophagus and spine, and the artificial respirations
should be renewed at about the same intervals as the natural respiration;  i e.
about sixteen in a minute, and the same quantity of air, as  nearly as possible,
should be introduced each time, as would be respired naturally.  Too much force
must  not be employed, or the lungs will be injured.  In  all cases, the mouth
and fauces  should, in the first instance, be cleared of mucus and froth.  Elec-
tricity, and electro-magnetism to the spine and the region of the heart, have been
recommended; but the obvious objection is, that the means are not commonly at
hand, and whatever  is done on  these  occasions must be done quickly.   Many
years  since, Dr. Durrant advised the employment of oxygen (Med. Gaz. xxv. p.
848;) and if the gas were ready  for use there would be a good prospect of suc-
cess.   Dr.  Wilson has suggested  that it may be readily procured by heating a-
mixture of five parts of powdered chlorate of potash with one part of powdered
red oxide of iron.   It has been long known that the chlorate mixed with one-
eighth of its weight of  oxide of manganese, readily  evolves oxygen.   These
powders  may be kept ready prepared in well stoppered bottles.   (Med. Gaz.
xxxvi. p. 434.)
 ^  Although the individual may have been only one minute submerged, if much
time has elapsed before the means for resuscitation are employed, there can be
no hope  of success.   It has been stated that,  after ten  or fifteen minutes'  sub-
mersion, there is but little hope of recovery;• yet these attempts at restoring ani-
mation often fail from the delay which ensues in  obtaining the means.   Thus
there  will be  a better chance of recovering one who has been five minutes sub-
merged, where  the  treatment  is immediate, than  another who may have  been
only two minutes  submerged, but where a delay of from ten to fifteen minutes
has occurred in the application of the means.   This obstacle to recovery is often
overlooked,—attention being paid to the period of submersion only.   On these
occasions we should  not be justified in declining to employ the means of resus-
citation, merely  because  the  body was  cold and apparently  lifeless.  Another
point  to be considered is, for how long a period should the efforts at restoration
be continued.   AVhen the treatment is commenced under  circumstances which
justify a fair  hope of success, it would be proper to  continue the treatment for
at least an hour.   In Mr. Bloomfield's  case, an hour and a half elapsed before
there  were  any signs of returning animation.  In Dr. Douglass'  case, resuscita-
tion began  to be only feebly established after eight hours and a half spent in th"
treatment!   There is no  doubt  that this case would have been  abandoned  as
hopeless  by many long before this period, especially as the man had been  sub-
merged fourteen minutes; and thus, perhaps, many persons are lost who might
be recovered by perseverance.   The tendency to restoration is often evinced by
the occurrence of slight  lividity in the face, with convulsive twitchings in  the
facial  muscles;  and before recovery takes place there are sometimes  convulsive
movements of the limbs and trunk.  In Paris, from 1821 to 1826, out of five
hundred  and seventy-six  cases of drowning, four hundred and thirty were resus-
citated.
   Post-mortem  appearances.—In conducting the examination of the body of a
drowned  person, it is necessary to  remember that the external and internal ap-
pearances will vary much, according to the length of time during which the body
may have remained in the water, or the period which may have elapsed after its
removal and before it is examined.  Two subjects may be taken out of water
at  the same time—one may be examined immediately, while the examination of
the other may be deferred for several days.   In these cases the post-mortem ap-
pearances will be no longer similar; and the differences will be particularly great
when  the last-mentioned body has been  exposed to a high temperature and to
the free access of air.
   External appearances.—Supposing that the body  has remained in the water 
468                     POST-MORTEM APPEARANCES.
only a few hours after death, and the inspection has taken place immediately on
its removal, the skin will be found cold and pallid—sometimes contracted under
the form  of cutis anserina.   (Ed.  Med.  and Surg. Jour., Jan. 1837.)  It is
often covered to a greater  or less  extent by livid discolorations.  The face is
pale and calm, with a placid expression, the eyes are half  open, and  the pupils
dilated; the mouth  closed  or half open, the tongue swollen  and  congested,
frequently pushed forwards to the internal edges of the lips, sometimes lacerated
by the teeth;—and the lips, together with the nostrils, covered by a mucous froth
which oozes from them.
  Rigidity and spasm.—The body  may be found rigid, and the hands clenched.
An important question arose in the case of The Queen v.  George (Hereford Lent
Assizes, 1847),  as to whether drowning was  likely to produce  a convulsed or
contracted state of the limbs.   The prisoner was  indicted for the murder of  her
infant child, by drowning it.   AVhen  taken from the water (in the month of
December,) about  nine days after the supposed murder,  there were no marks of
external violence.  The arms and  legs were  contracted, and the hands closed.
On inspection, the vessels of the brain  were congested, the lungs were collapsed,
and there was farinaceous food in the stomach, partially  digested.   The state of
the trachea, and the presence or absence of mucous froth, are  not referred to.
It will be seen, from this description,  that there  was no appearance to  indicate
death from drowning with any certainty, and the  medical witness admitted that
but for the discovery of the body in water, the suspicion of death from drowning
would not have been entertained.   From the state of the  brain, it might have
been referred to convulsions.  The defence was, that the child had probably died of
convulsions, and that in order to dispose of the body, the prisoner had  stripped
it of its clothes, and thrown it into the water after death.   The medical evidence
failed  to show that  the child had died from  drowning, and the prisoner was
acquitted.
  The contracted state of the child's limbs appeared to create a difficulty in  the
defence.   The clothes of  the  child were  neither cut nor torn,  and the  medical
witness considered, that had the limbs  been as contracted as they were when  the
body was found, they could not have been removed without cutting or tearing.
The medical question therefore was, whether  the state of the child's  limbs  did
not  prove that it had been  put into the water while  living.   As  the usual
appearances of death from asphyxia were entirely wanting, it is proper to consider
whether there may not be some explanation of the facts  consistently with death
before immersion.   The admission made  by the witness  in cross-examination
appears to supply all that is necessary for this explanation.  If the child had
died of convulsions,  if the clothes were then  removed, and the body thrown in
immediately, the sudden  effect of  the cold water might  have  occasioned  the
contraction  of the  limbs; or the  child  may not  have been really, but only
apparently dead, when the mother stripped it.  If some time had elapsed before
immersion, so that the body had become  cold, then the  limbs would have been
found either relaxed or  stiffened in a straight position.   The persistence of this
contracted state for  so many days  may be explained by the immersion having
taken place at the coldest season of the year.
  In general, when the dead bodies of the drowned are taken from water, the
limbs are found relaxed; but this must depend on the period at which  they are
removed.   Rigidity takes place, after death in water, perhaps more rapidly than
in air.   If the water be intensely  cold, and the  individual have struggled vio-
lently, the last struggles of life may be indicated by the contorted state of  the
limbs  persisting through rigidity.  Mr. Beardsley,  a former  pupil, has com-
municated to me the following case which he had to examine.   A  young man,
while skating, fell through the ice of a pond about seven yards  deep.   This  was
in February, 1847.   He  was not totally immersed, for  he kept his head  and
shoulders out of the water above the ice,  with his arms resting upon it; and as 
DROWNING.  CHANGES FROM PUTREFACTION.            469
 the ice gave way under his weight, he sprang  on to a fresh portion.   Before
 assistance could be rendered, he sank to  the bottom.  The  body was removed
 the next day: it was found at  the bottom of the pond, beneath the hole in the
 ice.   The arms of the deceased were quite stiff', and still retained the position in
 which he had rested upon the ice: his legs were quite extended, and the muscles
 on  the fore  part of the thigh were  very much contracted, as if they had  been
 powerfully exerted in keeping him erect while he was hanging on the ice.  There
 was no appearance of his having attempted to breathe after he had gone below
 the water.   His countenance was quite natural,—there was no water or froth in
 his mouth;  and in Mr.  Beardsley's opinion, the  subject had the appearance of a
 body immersed after death from some other cause.  It does not appear that there
 was any internal inspection.  Mr. Beardsley's opinion was, that the water being
 about  32°,  the  man  was in reality killed  by cold, or frozen;  and there is no
 doubt, that  if this did  not operate  as  the  direct cause of death, it materially
 accelerated it.
   This case is of interest in reference  to a point to  be presently adverted to;
 namely, the  fact of drowned persons  being often' discovered with substances firmly
 grasped in the hands.   A contracted state of the muscles  at the time of death
 may pass into perfect rigidity by the effect of cold water; and thus the attitude,
 or  the last  act  of life of the individual, may  be preserved.   It  is precisely
 analogous to what has been called cadaverous spasm.
    Changes from putrefaction.—If  the body have been submerged for  a  long
 period, or have remained long exposed before inspection, the  skin will be found
 variously discoloured, according to  the  degree to which putrefaction  may have
 advanced.   If three or four months have elapsed before its removal from water,
 the skin covering the  legs may be, in the first  instance, of  a  deep  blue  colour:
 but when  the body is exposed to air, this colour gradually disappears, and the
 skin becomes brown.  The influence of  air upon the skin of  a drowned subject
 is most remarkable in the face and thorax.   AVhen the body has remained for
 some days in water, and has been exposed for a few hours only after its removal,
 the temperature of the atmosphere being moderately high, the face will commonly
 be found livid and bloated, and the  features  so distorted that they will be with
 difficulty recognisable.   The change chiefly consists in the skin becoming at first
 of a livid brown colour, which gradually passes into a deep green.   That these
 effects are to be ascribed to the free  contact of air appears evident from the fact
 that they are most fully developed in those parts  of the body which are the most
 exposed to the atmosphere.  Thus,  the changes  of colour  in the skin are not
 commonly met with where any parts of the cutaneous surface have been in close
 contact, as in the axillae and inner surfaces  of the upper and lower extremities,
 where  the former have  been closely applied to the sides of the  trunk, and the
 latter have remained in close proximity to each other.   For the same reason, the
 discoloration is not commonly observed at the back of a subject, or in those parts
 where  the body has been closely wrapped in clothes.
   Abrasions.—There  is another external appearance which  is sometimes  met
 with in the  drowned; the  fingers occasionally present abrasions; and  gravel,
 sand, or other substances, may be found locked within the hands or nails of
 drowned subjects: for  in the act of drowning, as common experience testifies, an
 individual will grasp at any object within his reach, and in his efforts to extricate
 himself, he may excoriate or wound his fingers.  There are, however, many cases
 of drowning, in which this appearance is  absent.  There may be no substance
 for the drowning  person  to  grasp;—this will depend in a great degree upon the
 fact of the water  being deep or shallow, of its being confined within a narrow
 channel or not, and many other contingencies.  In all cases, when the individual
 is senseless before he falls into water, or when his  death is occasioned by syncope
 from sudden terror, he will, of course, be incapable of making those exertions
which are necessary to the production of this appearance.   The skin of the palms 
470
DROWNING.   INTERNAL APPEARANCES.
of the hands and soles of the feet is found thickened, white and sodden from im-
bibition, when the body has remained several days in water.
   Internal appearances.—On examining the body internally, we  may expect to
find, in a recently drowned subject, that the viscera of the  thorax will  present
the appearances  indicative of asphyxia.  The right cavities of the  heart,  and the
vessels connected with them, are  distended with blood,—the lungs  are sometimes
found gorged, and at  others pale and collapsed.   If death has not  taken place
from asphyxia, or if the subject has remained a long time in water before the in-
spection is made, the  viscera of the thorax will not present the characters above
described.  Independently of the changes which may have taken place in conse-
quence  of putrefaction, the right  cavities of the  heart, and the  vessels imme-
diately  connected with them, may  be found collapsed,  and generally destitute  of
blood.    Some physiologists have  asserted that the blood  remains fluid in the
bodies of the drowned.  Orfila observes, that with one exception, he  has  not met
with blood in a coagulated state, in the examination of  a drowned person.   Much
more importance has been attached to this appearance than it  really merits.
Some observers have found the blood coagulated in the drowned;  and I have re-
peatedly seen coagula, like those usually met with after death, in  the  bodies  of
animals which were drowned for the sake of experiment.  If the blood be gene-
rally found liquid, this may be due to the imbibition of water,  or to  putrefactive
changes.   The state of the blood in the drowned formed a subject of inquiry  in
the case of Reg.  v. Barker and others.  (York Winter Ass. 1846.)  From the
remarks above made,  it will be perceived that it may be found either coagulated
or uncoagulated  in those who go into the water living, and die  by  drowning.   A
greater  or less fulness of the vessels of the brain is described as  one of the ap-
pearances met with in a drowned subject; but this, when it exists, is probably a
consequence of  the  congested state of the  lungs.  Some  remarks have been
already made on this  subject, and from these it is evident  that the state of the
cerebral vessels can afford no presumption that death has taken place by drowning.
In regard to the cases which I have had an opportunity of examining, the quan-
tity of blood contained within the  cerebral vessels has rarely been so great as  to
call for particular notice.
   In examining  the viscera of the  abdomen, it will commonly  be found that the
stomach contains a certain quantity of water, which appears to enter into this
organ by deglutition.   The quantity is subject to great variation; sometimes it
is large, at other times small;  and  in some instances, no water whatever is to be
met with.  This probably depends on the rapidity of death.   Orfila has remarked,
that the alimentary canal is occasionally much discoloured in  drowned subjects.
He observed, also, that when drowning took place while the process of digestion
was going on, the mucous membrane of the  stomach often had a  pinkish-red  or
violet tint.  AVhen the drowned subject had remained a long time in water, the
lining membrane of the stomach was observed to acquire  a very deep violet  or
brown colour.   A knowledge  of this fact will be of  importance  in those cases
where the subject removed from water is suspected to  have been poisoned pre-
viously to submersion.  Among the other appearances met with  in  the  body  of
a recently drowned person, which require to be mentioned, is  the presence of a
mucous froth, sometimes  of a sanguineous hue, covering the lining membrane  of
the trachea, which may be itself slightly reddened.  AVater is also occasionally
found in the ramifications of the air-tubes, but in very variable quantity.  If the
body has remained a long time in water, or if, after removal, it has been  exposed
to the air several days previously to the inspection being made, there is commonly
no appearance of mucous froth in  the trachea or its ramifications.   See, in refe-
rence to the post-mortem appearances  in the drowned, a paper by Dr.  Ogston,
Med. Gaz., vol.  xlvii., pp. 763,  854, et seq.:  also another by Dr. Riedell, Med.
Gaz., xlvi., p. 478.
   Cases.—Mr. Bishop communicated to me the result of an inspection made by 
DROWNING.   POST-MORTEM APPEARANCES.
471
Dr. Bull of  Hereford and himself, in the case of a female whose body had been
in the water about an hour  and a half.   The inspection was made twenty-four
hours after death.   The  contracted  state of the skin (cutis anserina) was well
marked.   The vessels of the membranes of the brain were somewhat congested,
the principal seat of engorgement being at the base.   The tongue was neither
swollen nor indented, but pallid.   Mucous froth in considerable quantity was
found in the trachea:—the vesicles were exceedingly minute in the  upper part,
but at the lower portion of  the tube they were as large as  a  mustard-seed.  A
small quantity of clear fluid flowed through the bronchial tubes when  the lungs
were  raised.   The  lungs were not collapsed:  they crepitated on  pressure, and
were rather bloodless anteriorly:—posteriorly they were somewhat gorged with
blood, apparently from gravitation.  The stomach had about  a  pint of fluid in
it, which  seemed to be water mixed with  some undigested meat.  The  lining
membrane was slightly pink in colour.   The  right side of the heart was very
fiabby, and contained scarcely any blood.   The blood throughout  the body was
quite fluid.  The appearances of asphyxia were not so well marked in the lungs
and heart of this subject,  as they usually are;  nevertheless, the state of the
trachea,  bronchial tubes and stomach,  was quite characteristic of death from
drowning.
   As a contrast to this, and as showing the variable nature of  the appearance^
met with in the drowned, the  following case, reported by  Professor Dunglison,
may be quoted.
   A woman, in full health,  was observed to be intoxicated on the  banks of the
Schuylkill, U. S., about one hour before her body was discovered in very shallow
water.   She could  not  therefore have remained long under water.   The  body
was examined by Dr. Farquharson, one of the  resident physicians, about sixteen
hours after death.  The  face was swollen, and  of a mottled purple colour.   The
arms and thighs presented patches of discoloration,  and  a  small  quantity of
whitish froth issued from the mouth, the amount of which  was not increased by
pressure upon the chest,  although a small quantity of watery fluid escaped when
the body was turned over.   On opening the chest, numerous old pleuritic adhe-
sions were found, on the removal of which, and by the consequent compression
of the lungs, a discharge of watery froth took place from  the mouth.  All the
parts of the pulmonary tissue were gorged with blood, and were much heavier
arid of a darker red colour than in the normal state.  The posterior portions of
both lungs were more engorged underneath, or from position.   The trachea and
bronchial tubes contained the same kind of watery froth or-frothy mucus, as that
which had  issued from  the  mouth.  The liver was large, engorged, and  of a
bright red colour.  The  right cavities of the  heart and the coronary veins were
filled with dark fluid blood.   The left cavities were e*mpty.   Such, observes the
Professor, are the main phenomena occasioned by the mode of death—asphyxia
from  drowning.  (Phil.  Med. Examiner, March, 1845, 169.)
   Mr. Semple, of Islington, reported  in  the Lancet (May 29, 1841,)^two cases
of drowning, in each of  which he had made a careful post-mortem inspection.
The subjects were both adult females.   In one, the cerebral vessels were nearly
empty,—the lungs  rather voluminous: the bronchial  tubes containing a small
quantity of frothy mucus,—and the right side of the heart was filled with fluid
blood (] lb.)   There were slight marks of inflammatory redness about the mem-
branes of the stomach and intestines,—accounted for in the stomach by digestion
going on at the time of death.  The organ contained about a quart of fluid mat-
ter,  consisting of food  mixed with water,—probably swallowed in the  act  of
drowning: there were no traces of poison in the stomach or marks of violence on
the body.
   In the other case, the eyes were half open, hands not clenched, fingers straight:
—cerebral vessels very much  congested.   The lungs were voluminous; trachea
empty;  bronchial tubes  in their smaller ramifications filled with a soapy  (?) te- 
 472       DROWNING.  EVIDENCE FROM WATER IN THE STOMACH.

 nacious mucus.  The right side of the heart and larger veins were distended
 with fluid blood.  The oesophagus contained a clear watery fluid,—the stomach,
 three ounces of a clear fluid destitute of smell and colour, with the exception of
 a green tint from a minute quantity of vegetable matter, resembling the conferva!
 of ponds.   Liver much congested.  This woman was found drowned in a shallow
 pond.   Both subjects were examined recently after death.
   Has death caused by drowning?—It is obvious that  for a correct solution of
 this question, we shall have to consider  the appearances met with in the bodies
 of the drowned, and to determine how far they are characteristic of this form of
 death.  Among the external signs of drowning, when the body is seen soon after
 death, are paleness of the surface, and the presence of a mucous froth about the
 nostrils and lips.  The absence of these appearances, however, would not prove
 that the individual had not been drowned;  for if the body has remained some
 time in water, or if it has been long exposed to air before  it is seen b}- a medical
 practitioner, the cutaneous surface may have undergone various changes of colour,
 and mucous froth may no longer be found adhering to the nostrils and lips.   In
 speaking of the external  appearances of the body, it was stated that foreign sub-
 stances are sometimes locked within  the hands  or lodged under  the  nails of
 drowned subjects.  This fact may occasionally afford  strong circumstantial evi-
 dence  of the  manner in which the  individual has died.
   Substances grasped in the hands.—If materials be grasped within the hands
 of the deceased, which have evidently been torn from  the banks of a canal or
river, or from the bottom of the water in which the body is found, we have strong
presumptive evidence  that the individual died within  the  water.   For although
it  is  possible to imagine that  the  deceased  may have struggled on the bank
and have been killed prior to submersion, yet  in the value attached to this sign,
we are presuming that there are no marks of  violence on the  person, nor  any
 other appearances about the body sufficiently striking to  lead  the examiner to
 suspect that death had taken place in any other way than by drowning.  If the
 substance locked within the fingers or finger-nails be sand of the same character
as that existing at the bottom of the  river or pond, it is  difficult to conceive any
stronger evidence to establish the fact of death having taken  place subsequently
to submersion.   The abrasion of the fingers is a circumstance of minor  import-
ance,—no value could be attached to this state of the fingers as an indication of
the individual having perished  by drowning,  unless it were in conjunction with
the appearances above described.   A witness would be constrained to admit,  in
many cases, that  the  extremities of the fingers might become abraded  or exco-
riated after death, or even before submersion, while in no case could he be called
upon to make, in regard  to substances found  grasped within the hands, an ad-
mission which would invalidate  the evidence deducible from this condition.  This
must be regarded as a most satisfactory proof of the individual having been alive
after his body was in  the water.  It is well known that  when two or three per-
sons are drowned by the same accident, they are not unfrequently found clasped
within each other's arms,—a fact which at once proves that they must have been
living when submerged.  So if a dead body be  discovered still holding to a rope,
cable or oar, no further evidence is required to  show that the deceased must have
 died by drowning.  The signs upon which medical jurists chiefly rely as proofs
of death from drowning are,—1, water in the  stomach;  and 2, water with a mu-
 cous froth in the trachea and lungs.
   Water in the stomach.—It  has  been  remarked that water commonly passes
into the stomach  of a  living animal while drowning, and  this most probably takes
place by the act  of deglutition; for it has been observed  that when an animal
is stunned prior to submersion, water does not pass into the oesophagus.  As a
proof that its entrance into that organ depends on deglutition, it may be stated
that the quantity contained within the stomach is greater when the animal is al-
lowed to come frequently to the surface and respire, than when it is  maintained 
MUCOUS FROTH IN THE TRACHEA AND LUNGS.
473
 altogether below the surface.  The power of swallowing is immediately suspended
 on the occurrence of asphyxia, and in this way may we perhaps most  satisfac-
 torily account for the difference observed in the two cases.  The water thus found
 is in variable quantity;  and there are some cases of drowning in which  water is
 not discovered in the stomach.  It was found by Dr. Ogston, of Dundee, in  five
 cases out of seven.   (Ed. Med. and Sur. Jour. Jan. 1837.)  In dissecting cats
 which had been drowned, I have repeatedly remarked the absence of water from
 the stomach: in these instances, the animals had been invariably kept under
 water from the first moment of their submersion, and thus  in a condition  but
 little favourable  to the exercise of deglutition. AVater does not readily penetrate
 into the stomach of a subject which has been thrown in after death; the sides of
 the oesophagus applying themselves too closely to each other, to allow of  the pas-
 sage of the fluid.  If putrefaction has advanced  to any extent, it is possible that
 water may enter; but the practitioner will easily j udge from the general state of the
 body how far this process may have been concerned in the admission of fluid into
 the stomach and alimentary canal.  Orfila has suggested that water may be found
 in the stomach  of a subject apparently drowned, in consequence of this liquid
 having been drunk by the individual or artificially injected by another into the
 stomach after death.  It is difficult to conceive under what circumstances such
 an injection could  be made, or what purpose  it would  answer.   The quantity
 would determine whether it was likely to have been drunk by the person before
 immersion.  It  is of course presumed, that the liquid contained within  this or-
 gan is of the same nature as that in which  the body is immersed; for it is pos-
 sible that fresh water may be found in the stomach of a person drowned in salt
 water, and  in such a case it would  be obviously improper for a medical  witness
 to affirm, from the mere existence of water in this organ, that the individual had
 died within the  medium in which  his body was discovered.  If the  water con-
 tain mud, straw, duckweed, moss, or any substance existing in the pond  or river
 where the drowning occurred, this is a proof, when the  inspection is recent, of
 its having  been swallowed by a living person.  In the well known case of Mary
 AshfordfRex. v. Thornton, AVarwick Summer Ass. 1817) duckweed'with about
 half a pint of water was found in the stomach of the deceased.   The  body was
 discovered in a pond in which duckweed was growing. This fact, notwithstanding
 the presence of other marks of violence, proved that the deceased must  have been
 living when immersed.   The following  case occurred at Maidstone, in July,
 1843.   The body of a young woman was found  in the Medway, under circum-
 stances that led  to a suspicion of  murder.   The medical witness deposed that
 there were  no marks of external violence, nor any sign of the deceased  having
 struggled with the supposed murderers.   There was some long grass at the back
 of the mouth, and in the fauces.   The grass was not the same as that growing
 on the banks of  the river, but  such as grew at  the bottom, and which  the de-
 ceased had  probably swallowed after having gone living into the water. On this
 evidence the  accused was  discharged.   In an  interesting case investigated by
 Mr.  Image  (Reg. v. Camt,) Bury St. Edmunds  Lent Assizes, 1851,)  the body
 of deceased was  found with her head among water-weeds, some  of which were
 discovered in her throat, and the finger-nails were filled with sand and mud, as
 if clutched  convulsively.   These facts aided in proving that deceased  had died
 by drowning.  The  absence of water from the stomach cannot, however,  lead to
 the inference that the person has not died by drowning, because in  some  in-
 stances it is not  swallowed, and in others  it may drain away and be  lost after
 death.
   Mucous froth  in  the trachea  and lungs.—The interior of the trachea in a
 drowned  subject is frequently covered by a mucous froth, and this is stated in
 some instances to have been so abundant as to have filled the air-tubes and their
ramifications.  It is sometimes disposed in a layer of minute vesicles tinged with
blood.  The origin of this  appearance has been variously accounted for; but it 
474         DROWNING.  EVIDENCE FROM WATER IN THE LUNGS.

is probable that it  is produced  by the simple agitation or admixture of the air
respired during the act of drowning with the mucous secretion of the air-passages,
which  perhaps under these circumstances is more copiously poured out.   This
mucous froth is not always  met with in drowned subjects: 1.  It has not been
found in the bodies of those who have sunk at once below the  surface.  2.  The
appearance may not be seen when the subject has remained for a long period in
the water after death, since  by the free passage of  this fluid into and out of the
trachea, the mucous froth, although formed in the first instance, will disappear.
3.  If, after removal from the water, the subject be exposed to the air for several
days before it  is examined, it is rare that this appearance is seen.   4. The mu-
cous froth may have been formed in the trachea, but it may have entirely disap-
peared, owing to the incautious manner in which the body has been handled on
its removal from the water.  Thus, if the subject be removed from water with
the head depending,  any fluid  which may be contained within the lungs  will
escape; and in passing through the trachea, this fluid will effectually obliterate
the frothy appearance.  A similar appearance has been found in the bodies of
those who have been hanged, or who have died from apoplexy.   The introduction
of any liquid into the trachea during deglutition may produce  it.  A case is re-
ported where,  in poisoning  by  laudanum, water containing sulphuric ether was
forced  down the  throat of  a person after the power of  swallowing  had ceased.
On dissection  a quantity of reddish froth was found filling up part, of the tra-
chea.  Dr. Riedell  looks upon the presence of  this froth in  the air-tubes as a
constant sign of death by submersion, when the body is recently inspected: Med.
Gaz. xlvi. p. 478.
   Water in the lungs.—Many contradictory statements have appeared relative
to the  presence of water in the lungs of the drowned.  It is an. appearance only
occasionally met with; for the glottis does not in every case of drowning become
so effectually closed as  to  prevent the introduction of a portion of liquid  into
the pulmonary cells.  In certain cases  no water is found in the air-tubes after
death,  and when present, the quantity depends on many contingencies.   It is
commonly small, often about an ounce, but it is subject to variation, and is pro-
bably affected by the number of forced attempts at respiration made by the drown-
ing animal.  In experiments on animals, I have not remarked any difference in the
quantity whether the animal was allowed to rise to the surface and respire, or whe-
ther it was maintained altogether below.  There is but little doubt that the quan-
tity may become increased after death,  because it is now well known that water
will penetrate into the lungs, before the access of putrefaction, when a body has
been thrown in dead.   It is important  for a medical jurist to bear this in mind,
as it may influence materially the opinion which he may be disposed to form on
the discovery  of water in the lungs of  an apparently drowned subject.   AVater
may therefore be present in the  lungs, and yet it  will afford  no evidence of
drowning. When the water in the lungs is mixed with weeds or mud, and water
presenting the same admixture is found in the throat and stomach, this is strong
evidence that  the body has been plunged into water, when the power of breathing
and swallowing still existed, and therefore that the deceased has been drowned.
An attention to the condition of the stomach and lungs will therefore be of im-
portance in cases of alleged child-murder by drowning, since it may aid in proving
or disproving  the charge.   In a case tried at the Central Criminal Court, April,
1851,  in which I was consulted by Mr. Tyte of  Harrow, some greenish-coloured
mud was found in the throat, lungs, and stomach  of an infant whose body had
been removed from a  pond.   The prisoner was acquitted, because it was sug-
gested that she might have thrown the  body of her child into the water when
she  believed it to be  dead, and one or  two gasps might have  accounted for the
appearances presented by the stomach and lungs!  It has been suggested that
water may have been injected into the  lungs after death, in which case an incor-
rect opinion might be  formed  from its presence, if the body were discovered 
DROWNING.  FLOATING OF THE BODY IN WATER.           475
 on the bank of a river or canal.   This, however, is an obstacle but little likely
 to interfere with any medical investigation.  On the other hand, the absence of
 water from the lungs of a  subject found apparently drowned, must not be con-
 sidered to indicate that death was not a consequence of drowning; for if the body
 of a drowned person be allowed to remain with the head depending, the water
 originally contained within the lungs will drain out; or if it be long exposed be-
 fore undergoing an examination, the probability is, that none will be discovered
 in these organs, since in the progress of time it may disappear by imbibition and
 evaporation.   According to Dr. Riedell, the lungs are very flabby, and are greatly
 increased in weight.
   Want of evidence on inspection.—It may be fairly considered  that  after  the
 lapse of five  or six tveeks, especially if the body have been  removed  from  the
 water for the greater part of that period, none of the usual appearances of drown-
 ing will be met with: in the present day, no practitioner would think of seeking for
 evidence under such circumstances.  The medical opinions expressed by the wit-
 nesses for  the prosecution at  the trial of Spencer Couper,  for the murder  of
 Sarah  Stout (Hertford Assizes, !<#>!),) are therefore worthy  of remark, if only
 as affording an example of what is to be avoided on these occasions.
   The body of the deceased was found floating  in a stream  probably not more
 than thirteen  hours after  she  was missed.  It was buried, and six  weeks after-
 wards was exhumed and examined.   No  water was  found in the stomach  or
 lungs, which were not  putrefied.   Six medical men deposed, that when a  person
 was drowned,  water was invariably taken into the stomach  and lungs; and  as
 none was found in this instance, they were of opinion that deceased came to her
 death by some other means;—in other words, that, as  alleged in the indictment,
 she had been  murdered by the prisoner, and her dead body afterwards thrown
 into the water!  The prisoner  asked one of  these witnesses whether,  after  six
 weeks time, water would remain in the body ?  The reply was, that there should
 be some, because "it can't come out after the body is dead, but by putrefaction;
 and there was no putrefaction."  The witness does not appear to have had the
 least suspicion that the deceased might have died without swallowing any water,
 or that  the quantity swallowed might have been small, and entirely lost in six
 weeks by transudation  through the soft parietes  of the stomach!  The prisoner
 was acquitted.
   Specific gravity of the body.—At the trial  of  Spencer  Couper, above alluded
 to, the buoyancy of the human body, living and  dead, formed an important part
 of the inquiry.  The body of the deceased was found floating at about five or six
 inches below the surface of the water, which was only five feet in depth.  From
 this circumstance it was assumed that she could not have  gone living into the
 water, because, as it was alleged, and attempted to be  proved by scientific and
 nautical testimony for the prosecution, the body of every  person who died  in
 water sank, while a dead body thrown into water floated!  A sailor was called
 to support this strange  piece of nautical philosophy; and although his statements
 were contradictory,  he  swore that in all the battles and shipwrecks in which he
 had been  engaged, he had uniformly observed  that those who were  drowned
 floated; while those whose bodies were thrown in dead sank!  Hence, he con-
 tended,  it was  necessary to attach weights to the bodies of those who died at sea.
 "Why," said this witness, "should Government be at that  vast charge to allow
 threescore or  fourscore weight  of iron to sink every man, but only that their
 swimming about should not be a discouragement to others?"   (Smith's Anal, of
 Med. Ev. 278.)  The medical witnesses for the prosecution contented themselves
 with stating that the bodies of persons who were drowned sank, without taking
into consideration that there were circumstances here which might have accounted
for the floating, and have  entirely set aside the  hypothesis  of death  before im-
mersion.  This female  was drowned in her clothes: there  were some stakes near
the body, which might  have aided  in supporting it; and the  presence of  air  or 
476        DROWNING.   SPECIFIC GRAVITY OF THE HUMAN BODY.

gases in  the  intestines would have sufficed to explain a simple fact, by which
the Court and scientific witnesses appear to have been completely bewildered.
Other sailors were  called for the defence, who deposed, that  after battles and
shipwrecks, they had always observed the bodies of the dead  to sink, and that
weights were attached to bodies buried at sea, not  for the purpose of sinking
them, but of preventing them floating afterwards by putrefaction.
  Although it is not likely that the life of any one will ever again be endangered
by a question  of  this kind,  it is proper to state a few facts connected with the
specific gravity of the human body.
  The specific gravity of the  human body, in the  living healthy state, is made
up of the combined specific gravities of its different parts;—so that, as in all
heterogeneous solids, it is a  very complex quantity.  The only part of the body
which is lighter  than water is fat.  The specific  gravity of this  is 0-92; the
specific gravity of muscle  is  1*085; and of bone,—the heaviest part of the body,
—2*01.  The lightness of the fatty portions is far more than counterbalanced by
the weight of the skeleton, so that the naked human body, placed on water, has
always a tendency to sink.  This tendency diminishes just in proportion to the
quantity of the body immersed;—because all those parts which are  out of water,
not being supported by water, become so much additional absolute weight to the
portion immersed.   Hence the frequent cause of death by drowning.  An inex-
perienced person exhausts himself by exertion, raises his arms continually out of
the water, and as often sinks, owing  to their weight having just so much effect
upon his body as if a leaden weight had been suddenly applied to his feet to sink
him.   AVhen the whole of the living body is immersed, the specific gravity, owing
to the expansion of the chest,  differs so little from that of water, that very slight
exertion  will suffice to keep  an individual on the surface.
  From what has been observed  relative to the component parts  of the body,
there are two circumstances which must  cause  its  specific  gravity to vary.  If
the quantity of fat be abundant, it will be  diminished;  and such an individual
will float more readily than another in an opposite condition.  On the other hand,
the abundance of bone will render a person heavier than his bulk of water; and
his body will sink more rapidly than  that of another. Now these two modifying
causes of buoyancy are liable to constant variation;  hence, the different accounts
given by experimentalists relative to  the specific gravity of the human subject.
The bodies of females are, caeteris paribus, of less specific gravity than those of
males : the skeleton is smaller, and there is a greater  abundance of fat.   Very
young children float with  the greatest ease: the quantity of fat is usually in large
proportion, and the bones are  light,—the earthy matter being not yet freely de-
posited.  Thus, in infanticide by drowning,  the body of the child rises very
speedily  to the surface,—if, indeed, it does not remain altogether upon it.
  There are some other points to be  considered in  relation to the buoyancy of
the living human subject.  1. Respiration.—It is  the fact of the lungs being
filled with air that gives the general lightness to it.   If these organs were emp-
tied, and the chest contracted, then the  specific gravity would  be considerably
increased: hence it follows,  that, ccvteris paribus, an individual with a large and
capacious thorax floats more readily than one whose chest is small and contracted.
Hence, also, the body has a tendency to rise out of water during inspiration, and
to sink during expiration:—the quantity of water displaced under these two op-
posite conditions of the respiratory organs being very different.
  The fact of clothes being on the person will make a difference;  either, from
their nature, serving to buoy him up, or to sink him more deeply.   Females are
sometimes saved from drowning by reason of their clothes presenting a large sur-
face; and it is owing to this that  the bodies of drowned females  often remain
floating  on  the water immediately after death.  This happened in the  case of
Sarah  Stout (ante, page 475.)   In a case  of  suicide at Plymouth, (January,
1849,) it was proved at the inquest that the body of the deceased floated on the 
                PRESUMED SURVIVORSHIP IN THE DROWNED.            477

sea-water for half an hour after the act of drowning.  It was probably buoyed
up by the clothes.
   So far with the living subject.  It  may be laid clown as a general rule, that
the recently dead body is, when left to itself, always heavier than water, and
sinks when immersed.   The emptiness of the chest, combined with the fact that
the bones and all the soft parts, excepting the fat, are heavier than water, offers
a sufficient explanation  of the  sinking.   After a variable  period, generally not
more than a few days, the body will rise  again to the surface, and float.  The
period of its rising will depend—1st, on the specific gravity of the body;  2d,  on
the nature of the water; 3d, on the access of heat and air, in facilitating putre-
faction.   If the gases generated find an escape, the body will sink:—more gases
may form, and then it will again rise, so that the sinking and rising may become
alternate phenomena.
   A very small quantity of air, derived  from putrefaction, will  suffice  for the
floating of the body.  Thus, taking the specific gravity of the dead body even at
1.08, it would require but little air to keep it at or near the surface of the water.
The bodies of the drowned, when they float from  putrefaction, generally rise to
the surface about the fourth or fifth day after submersion in shallow water, un-
less held down by mechanical  obstacles.  But a  dead  body may be  prevented
from  sinking at all, partly, as it has been observed, in consequence of the clothes,
and partly in consequence of its having been caught and supported by stakes, or
other obstacles in the water,—or from the presence of a quantity of  air in the
intestines.
   Survivorship of the drowned.  Decomposition in water.—Some medical jurists
have  proposed the question, whether, when several persons  fall into water at the
same moment, and are  drowned,  we  can determine which among  them was
drowned first, or which survived the others.   M. Devergie attempts to bring for-
ward an answer to this question, from the state of the heart, lungs, and brain
(op. cit. 321;) but it is needless to say, that  the condition of these organs can
furnish  no certain evidence.  Even if a medical practitioner chose to adopt such
hypothetical views, it is certain that they would not be received as evidence by
an English Court of Law.   When two bodies are  found  in the same  spot in a
river, it is allowable to  form a limited presumption (from  the different degrees
of putrefaction in the two) as to which has been submerged  for the longer period.
   The body of a drowned person after  lying  for some time in water undergoes
the usual putrefactive changes indicated  by discoloration of  the  skiu and mus-
cles, with softening of the animal substance (ante, page 469-;) but in some cases,
where the circumstances are favourable, a change of a peculiar kind takes place.
This consists in the slow conversion of the fatty parts of the body into a species
of soap  called adipocire.   The experiments of Chevreul  have proved that this
compound is nothing more than an animal soap with a base of ammonia or lime,
the former alkali being the result of the decomposition of the nitrogenized prin-
ciples of the body, while the fat becomes acidified.  A medico-legal question has
more  than once arisen respecting the length of time which a body should remain
in water, in order that  this  adipocerous  transformation  of the tissues  may be
observed.  Dr. Gibbs, of Bath, found that by macerating  muscle in water for
about a  month, he was able  to procure only a small quantity of adipocire.  Dr.
Harlan,  of Philadelphia, observed  that the integuments of a cranium were, by
maceration, converted into adipocire in about six  weeks.   In some experiments
which I have made on the subject, the conversion of muscle and fat to adipocire
was not  complete in stagnant water under a period of two months.  Thus, then,
we may  say, that a month is about the earliest period  at  which  the  change is
likely to be observed.  The experiments of Orfila and Devergie prove, that with
bodies interred in the soil the change is much longer in taking place.   The fol-
lowing singular case, which was tried at the AVarwick  Lent Assizes, in 1805,
will show the medico-legal relations of this subject.  A gentleman, who was in- 
478            DROWNING.   SUMMARY OF MEDICAL EVIDENCE.
solvent, left his home on the 3d  November; and on the 12th December follow-
ing his body was found  floating  in the river much decomposed, and  the  dress
rotten.  There was no doubt  that he had committed suicide.   A few days after
he was missed, a commission  of bankruptcy had been issued  against him; and
the question was, whether  he was or was not living at the time  it was issued.
If not living, then the commission was void.   As nothing positive was known
on the subject, the only evidence on the point was derived from an examination
of the body.  The muscles of  the lower part of  the abdomen and the glutei were
found to have become converted into adipocire; and from this fact, it wa^j in-
ferred to be in the highest degree probable that his body had been in the water
during the whole period of his absence—thirty-nine days;  in  short, that he had
drowned himself  on the day he left the house.   Several medical witnesses were
summoned on both sides.  Dr. Gibbs and two others gave a strong opinion that
from the slow formation of adipocire in the drowned, it was reasonable to  infer
that the body of the deceased had been in the water for the whole period of five
weeks and four days.  The jury returned a verdict in accordance with this view,
namely, that the deceased was not living at the time the commission was issued
against him.  The late Mr. Callaway informed me that he was required to give
evidence in a similar case in the year 1836.
   Summary of medical evidence.—We have now reviewed the whole of the evi-
dence which the post-mortem examination of a  drowned subject is capable  of af-
fording to a medical witness.   It will be seen that the  only characters met witli
internally, upon which any confidence  can  be placed  to indicate that  the indi-
vidual has been drowned, are the presence of water in the  stomach, and the pre-
sence of a mucous froth on the lining membrane of the trachea; but at the same
time, the restrictions to the admission of these signs, as positive evidence  of
drowning, may be such  as to throw great uncertainty on the  correctness  of a
medico-legal opinion founded simply on their existence.   The practitioner must
then determine, before he decides positively in a question of this nature, whether
there be any appearance about the person which would  lead  to the suspicion
that death has been caused  in  another way.  When  he  has provided himself
with this negative evidence, and he finds that the characters of drowning, already
enumerated, are present,—or, if absent, he  can, with any show of probability,
account for their absence, he is then justified in giving a decided opinion on the
subject.
   A man  died suddenly in the Rue St.-Antoine, at Paris, in  February, 1830,
and was soon after brought to the Morgue.   The body underwent a minute exa-
mination; but there was no mark of violence externally, nor was there any mor-
bid change to account for death internally.   In the course of the dissection, it
was found that the larynx, trachea, and air-tubes contained a frothy mucus.  In
the larynx this was white, but it had a  red colour in the air tubes.   M. Devergie,
who conducted the  inspection, states,  that it only differed from the froth, as it
exists in the trachea of the drowned, in the circumstance of its being in larger
vesicles;—but he candidly owns, that  had he not been certain of the contrary,
he should have presumed that he was  examining the body of a person who had
died by drowning.   Besides  this appearance, there was a large quantity of water
in the stomach, amounting to almost  a pint;  and the lungs were gorged with
blood, as in cases of asphyxia.
   Supposing that this body had been thrown into the river after death, it is clear
that most  medical men, relying upon  what are usually regarded as well marked
proofs  of this kind of death, would have declared this to have been a case of
drowning.  A practitioner could not  be censured for  forming such an opinion,
since it would be founded upon the best ascertained rules of past experience; and
there are no others by which  a medical jurist can be guided.  In the mean time,
we  learn, by the  occurrence of such a case, how cautious we ought to be in ex-
pressing a positive opinion in a question of this nature, even where medical cir-
cumstances exist to support it. 
MEDICAL EVIDENCE IN CASES OF DROWNING.
479
  If, however, a case of this kind be of rare occurrence, we will take an instance
of an opposite description.  An individual may be suffocated, or may die from
apoplexy, or from the sudden attack of any fatal disease which may not be indi-
cated  by any well  marked post-mortem appearances: the body is thrown into
water, and remains there a few days.   When taken out, water may be found in
the lungs, but there may be none in the stomach; and there may  be no mucous
froth in the trachea;—yet how is a practitioner to determine whether  death has
actually taken place within the water or not?  In the case of a suffocated body,
without traces of external violence, it would be impossible;  since we  have seen
that individuals may die in the water, or at the moment  of immersion, and,
therefore, under circumstances in which the appearances of drowning  would be
entirely wanting.
   If, in examining a body taken from water, we  discover traces of mortal dis-
ease, or marks of external violence sufficient to destroy life, then there is always
room for suspicion.   AVhy the body of a person, who has really died  from na-
tural causes, should be afterwards thrown into water, it would not be easy to ex-
plain;  but we can readily appreciate the motive where  murderous violence has
been used.
   In consequence of the uncertainty attendant on the appearances of drowning,
barristers have considerable advantage in cross-examining those medical witnesses
who appear for the prosecution.   Legal ingenuity is here often carried  to the
utmost, to show that there is no  positive or well defined sign of drowning; and,
therefore, the inference is drawn that  the deceased must have died from  some
other cause.   A trial took place  at the  Central Criminal Court, April, 1841, in
which  the witnesses were  very severely examined  on the appearances caused by .
drowning.  (The Queen v. Longlcy.)  The general impression among non-medi-
cal persons appears to be,  that whether in drowning  or  suffocation, there ought
to be some particular visible change to indicate at  once the kind of death; but it
need hardly be said that this notion is founded on very false views; and  if the
reception of medical evidence as  to the cause of death be made to depend on the
production of some such positive and visible change, then  it would be better at
once not to place the  parties charged with the offence upon  their trial, because
the crime could never be proved against them.  A medical inference of drowning
is founded upon a certain  series of facts, to each of  which individually it might
be easy to oppose plausible  objections; but, taken together, they often furnish
evidence as strong as is commonly required for proof of any other kind of death.
In the case above referred to, the prisoner was cleverly defended.   The deceased,
a child, was drowned by the mother.   AArhen the body was removed from water,
the mouth was closed: the prisoner's counsel  wanted to  make it appear  that  it
was most usual to find the mouth open in cases of  drowning;  and  then went on
to say, "that the only proof of suffocation by drowning which had been adduced
by the medical witness was the  frothy mucus found  in the air-cells;—that  it
could not have  gone through the mouth  was quite  certain, because the mouth
was proved to have been closed.  The air might have passed into the air-cells of
the child, whilst struggling in its mother's arms, just as well as whilst struggling
in water!"   After what has been stated, it is not  necessary to point out the fal-
lacy of the assumptions involved in this argument;  but it is much to be  regretted,
that medical evidence should be  allowed to be presented to a jury  in such a per-
verted form.   The wonder is, that even in a case of undoubted criminality (as in
that particular instance) a conviction should ever  occur.   (See also the case of
The Queen v.  Owen, Thomas, and Ellis, Stafford Lent Assizes, 1840.)   In a
ease in which Mr. Image,  of Bury St. Edmunds, gave evidence (Reg.  v. Carnt,
Suffolk  Lent Assizes, 1851,) the medical facts, although furnishing conclusive
evidence of drowning when taken together, were individually objected to.  The
deceased was found dead in  a pond.   The body was removed after it  had been
lying about four hours in the water, and was carefully examined by Mr. Image 
480
MARKS OF VIOLENCE ON THE DROWNED.
forty-one hours after death.   The hair was hanging back, wet, very muddy, with
leaves  and weed entangled,  the  ears  were muddy, the  right eye ecchymosed,
pupils  slightly dilated, lips bluish, and there were  bluish  patches on the  face.
Slight  scratches were observable on the right side of the face.  The jaws were
fixed, teeth  tightly clenched, and  the  tongue not protruding.   The nails were
filled with sand  and  mud.   There were  severe  bruises on both  arms near the
elbow, equal in extent and  intensity.   The  tongue was greatly congested, and
covered with froth and mud,  which extended backwards  to the  throat and nos-
trils, as well as into the larynx and trachea or windpipe, and the upper divisions
of the  air tubes of the lungs.   The lungs were engorged and greatly distended:
when cut in any part, frothy mucus was  abundantly poured out, and much fluid
escaped on pressure.  There were small pieces  of  green weed in the air-tubes
(corresponding to weed  in the  pond.)  The vessels  of the neck were distended
with dark-coloured liquid blood, without any  coagulum.   The  stomach was
healthy; it contained partially digested food, with about a pint of liquid mixed
with mud and sand.  The liver was enormously congested, bleeding  profusely at
every section.  The bladder was quite empty, and contracted to the smallest size.
The sinuses of the brain were not much distended, nor was the substance of the
organ greatly congested.  Mr. Image gave an opinion, which was perfectly justified
by these appearances, that the deceased had died by drowning, and that she had
probably  been held forcibly under water.   The accuracy of this opinion was
established by the confession of the criminal  before execution.
   Marks of violence on  the drowned.—The chief inquiry with regard to marks
of violence  on the  bodies of the drowned is, whether they have resulted from
accident or design,  and  in forming  an opinion a witness must give due value to
the accidents to which a body, floating loosely in water, may be  exposed.  Ec-
chymoses of considerable size are sometimes seen on drowned subjects, where they
have been carried by  a current against mechanical  obstacles in a river or canal.
If the deceased fell from a  considerable height into water, his body, in falling,
may have struck against a rock or projection, and have produced a very extensive
mark of violence.   Dead bodies taken out of wells,  the deceased persons having
fallen  in accidentally, or having thrown themselves in intentionally, often present
considerable marks of violence  of a vital character.   The presence of these must
not create a hasty suspicion of murder.   It is manifestly impossible to lay down
any specific rules for forming a decision  in cases of this kind, since probably no
two instances will be  met with which will be perfectly similar.   In  clearing up
these doubtful points, every thing must depend  on  the tact and acumen of the
practitioner who is called upon to  conduct the  investigation.   The first point
which  he has to determine is, whether the injuries on the body were produced
before or after death.  (See ante, AVounds.)  If after death, then  they ought
to be obviously of accidental origin.  Accidental violence may sometimes be of
a very serious nature,—so serious that a practitioner might well  doubt whether
it did not indicate that the deceased had been violently injured prior to submer-
sion.  If a dead body were taken out of water, with one  or both extremities dis-
located, or the cervical vertebrae fractured, and a surgeon were  asked whether
such injuries could  be accidental, and coincident with, or consequent on drowning,
the answer would  probably be in  the negative: but an instance has occurred
where  both  arms have become accidentally dislocated at the shoulders in the act
of drowning.  I allude  to the case of a man,  who some years since, jumped from
the parapet of London  Bridge into the Thames.   This  exploit, it appears, the
man had previously performed with impunity, but in this instance he sank and
was drowned.  Both  his arms were found dislocated, in consequence, it is pre-
sumed, of his having fallen with them in the horizontal position, instead of placing
them closely to his sides.  The concussion on falling into the water,  had sufficed
to produce the accident.  (Smith's For.  Med. p. 228.)   Here, then, we have a
proof that even the mechanical resistance  offered by water alone, may give rise 
               MARKS OF STRANGULATION IN THE DROWNED.            481

to marks of very violent injury on the person.   Extravasation of blood may take
place into the cavities from this cause.   Dr. N. Chevers informs me that he as-
sisted in examining the body of a sailor who fell into the water, vertex downwards;
and it was found that there was an  extravasation of blood in the head, beneath
the arachnoid membrane.
  It has been observed, with respect to superficial marks of violence, that brxtises
or contusions are not always visible on the bodies of the drowned, when they are
first removed from water.   This may be owing to the skin  having abundantly
imbibed water,—the colour of the ecchymosis  being thereby concealed.  After
a short exposure to  air, the water  evaporates, and the  bruise or contusion be-
comes visible.   The great point with regard to all marks  of violence on  the
drowned, is to throw light upon the questions: 1, whether drowning was really
the cause of death; and 2, whether, if so, the  act was the  result of accident,
suicide, or homicide.   This last question does not concern a medical witness so
much as the jury,  who will determine it from the facts proved before them.
  There is one case of rare occurrence, in which a  practitioner would be apt to
be misled by trusting to the appearances found on the drowned.  If a dead body
were removed from water with a deep ecchymosed circle  round the neck, evi-
dently produced by a cord or ligature, but no traces of which could be found, it
is not improbable that a suspicion would be at once raised, that the deceased had
been murdered  by strangulation, and the body afterwards  thrown into water.
An accident occurred a few years since, in which a gentleman and his wife were
thrown into the water by the overturning of a small  boat.  The lady was drowned.
On an  examination  of the body, subsequently made, a livid circle was found
round her neck, as if she had been strangled.  She  had evidently died by drown-
ing, but the mark  had been produced by the string of a cloak which she wore at
the time of the accident.  In her struggles to reach the boat, it is presumed that
the tide had drifted the cloak  in  the opposite direction, and thus produced  the
appearance of strangulation.  It is not improbable that this accelerated death.
Barzellotti  mentions the case of a man who was drowned in the Po, while being
escorted along the  banks of the river,  as a prisoner, by a party of soldiers.   The
man attempted  to escape, and was drowned.  Besides  the ordinary marks of
drowning, there was a  deep livid  circle, extending completely round the neck,
and immediately below this, another mark, but paler in colour.   The skin over
the trachea was ecchymosed.   It was supposed that the  deceased had  been
strangled by the soldiers, and  his body thrown into the water, but from the ap-
pearance of the  marks, and other circumstances, Barzellotti  gave it as  his opi-
nion, that they were produced by the collar of a coarse linen shirt which had been
tightly buttoned around the man's neck,—the collar had retracted  from the im-
bibition of water, and had thus caused the appearance of strangulation, like any
other ligature.   (Questioni di Medicini Legale, i.  329.   For another  case, see
Henke's Zeitschrift, 1840, i. 126, Erg. H.)   The following case was mentioned
to me as having occurred during the heavy floods  in the winter of 1839.  A
man was carried away and drowned in  attempting to  ford a  swollen  stream.
AVhen the body was found, it had been so placed by the current, that the fore-part
of the neck was locked against the stump of a tree,  giving rise to an ecchymosed
patch like that which is commonly produced by manual  strangulation.   For an
interesting case, in which there was  much violence to  the  neck, see  Henke's
Zeitschrift, 1842,  i. 258, Erg. H.
  It might be said that in cases of this description circumstantial evidence would
commonly show how the mark had originated.   In admitting the truth of this
observation, we must remember that circumstances, as matters of proof, do not
always present themselves to our notice, or occur to our judgment, at the precise
time that the course of justice stands most in need of them.  While, then, we
use great caution in drawing an inference where there are such  strong grounds
for suspicion, we should not neglect  to examine carefully the most trivial ap-
       31 
482
ACCIDENTAL FRACTURES IN THE DROWNED.
pearances.   In one remarkable case of murder, where the body of the deceased
was discovered in a mill-stream, there was only one slight ecchymosed depression
in the fore-part of the neck, as if from a finger.   The surgeon suspected from
this that the deceased had been strangled.  The marks of drowning in the body
were wanting;  and the suspicion of the real cause of death was afterwards con-
firmed by the detection of the criminal.
   Accidental fractures in the drowned.—Fractures are not often met with in the
drowned as the result of accident during or after the act of submersion.   Certain
fractures likely to  be followed by immediate death may forbid the supposition of
their having occurred after the act of submersion, and a careful examination of
the body may show that they were not  likely to have arisen from accident at or
about the time of submersion.  This point was raised in the case of Reg. v. Ket-
tleband (Nottingham AVinter Ass. 1843,) where  the prisoner was charged with
the murder  of  his son, a boy aged ten years.  The deceased was found dead in
a pond soon after he had been seen healthy and well.   An inquest was held, and
as usual no  inspection of the body was required  by the coroner, and the jury
were directed  to return a verdict of "found drowned."   An inspection was, how-
ever,  subsequently made.   The neck  was observed to be very loose, and on  fur-
ther examination the processus dentatus  was found to be separated from  the atlas,
and the ligaments were ruptured!   The three  medical witnesses who  gave  evi-
dence  at the trial, deposed that this displacement had caused death by compressing
the spinal marrow,—that the injury had occurred during life,—that it was not
likely to have been caused by accident  from a fall into the water, as there  was
no mark of a bruise about the head,  and the pond was proved to be small, with
a soft  muddy bottom.   All agreed that such  an  injury was not likely to have
arisen from a blow or a fall under any circumstances, because it required for its
production that the body should be fixed,  and  the head forcibly rotated on the
trunk.  It was in itself sufficient  to  account for immediate  death, and it could
not occur by accident after death from any other cause.  Hence it was inferred,
—1, that death could not have been caused by  drowning; 2, that it had resulted
from  the compression of the spinal marrow, by displacement of the second  ver-
tebra; and, 3dly, that this injury must have been intentionally produced by some
person.   Circumstances fixed the crime on the  prisoner, and the jury  returned a
verdict of manslaughter; although the nature of the injury, admitting that it was
not the result of accident, proved that the prisoner must have acted with a most
eool and deliberate intention to destroy life!   This case furnishes a serious com-
mentary on the practice of certain coroners, in denying the necessity for an in-
spection, and in directing what is called an open  verdict of "found  drowned,"
when  a body is taken out of water!
   It  is  an  important medico-legal question,  whether fractures of the cervical
 vertebrae can  occur from accident alone, about the time of drowning.  In the
above case, the medical witnesses had  probably good reasons for denying that the
 injury was accidental, although such  an opinion cannot always be  expressed
 merely from the absence of marks of violence on the head.   Mr. South  quotes
 the case of a man who threw himself into a river to bathe from a height of seven
 or eight feet, the water being only three feet deep.  He rose to the surface, but
 fell back senseless.   When he recovered his consciousness, the account he gave
 of the accident was, that he felt his hands touch the bottom of the river, but to
 save  his head drew it violently back, upon which he lost all consciousness.   He
 died  in about ten hours, and on examination the back of the neck was much ec-
 chymosed—the interspaces of the muscles were gorged, and the vertebral canal
 filled with  blood.  The  body of the fifth cervical vertebra was broken across
 about the middle  of its depth, and the two pieces were completely separated  from
 the lateral parts.   As there was no mark  of contusion or dirt on the head, Re-
 veillon, who reports the case, believes  that the fracture arose from muscular ac-
 tion,  and not from a blow received by striking the bottom; but this is doubtful. 
HOMICIDAL, SUICIDAL AND ACCIDENTAL DROWNING.         483
In another instance related by Mr. South, a sailor jumped headlong into the sea
to bathe, a sail being spread three feet  below the surface.   He immediately be-
came motionless, and died in forty-eight hours.   The  fourth  and fifth cervical
vertebrae were found extensively fractured, and  the  spinal marrow was crushed
and lacerated.   (Chelius's Surgery, Part vi., Fractures.)   In this case the frac-
ture must have resulted from contact with the water or the sail; but as the latter
was freely floating, this would be a yielding medium; hence this serious injury
may occur accidentally in cases in which we  might not be  prepared to look for
it.   (For an important  medico-legal case, involving many questions connected
with marks  of violence on the drowned, see Ann. d'Hyg. 1839, ii. 195.)
   Was the drowning the result of homicide, suicide, or accident?—Although the
question, whether the act of drowning was the result of suicide or murder, pro-
perly falls within the province of a jury, there are certain points in relation to it
which here require to be noticed by a medical witness.  In  the  first place, it is
not  to  be imagined that a  post-mortem examination of the body will develope
any differences in either of the three supposed kinds  of death.  So far as the
phenomena  of drowning  are concerned,  they are the same;  and are accompanied
by the same post-mortem appearances in each case.   In drowning which is acci-
dental or suicidal, it is  not common, as it has already been observed, to meet
with marks  of violence on the person, except such as are  purely of accidental
origin, and have commonly been produced after death.   In accidental drowning,
this is almost a constant rule; but if  the individual  has fallen from any height,
his person may be injured in the fall either by projecting bodies on the banks of
a river or  canal, or by mere  concussion on the water, allowance for  either of
which we must be prepared to make, according to the situation of the spot from
which the party is supposed to have fallen.
   It is calculated that drowning is the cause of  death  in nearly one-half  of  all
suicides; but this of course will vary according to localities. In  suicidal drowning
we have a difficulty to encounter which  we do not meet with in that which is ac-
cidental.  A man may have attempted suicide by some other  means, previously
to precipitating himself in the water: thus, then, besides the accidental violence
of accidental drowning, we may meet with violence on the person evidently indi-
cating wilful perpetration.  AVhat is the nature of this violence?   Is it to be de-
fined?  Can it always be distinguished  from that which is positively homicidal?
The answers to these questions must depend on the circumstances proved in each
case.
   A man may attempt to hang or to strangle himself, and  not succeeding, may
afterwards drown himself.  Here we should find a mark on the neck, which many
would at once deem presumptive of murder.   If the  suicide had neglected to re-
move the cord from his neck, death would be considered still more clearly to have
arisen from  murder.    A suicide may produce a severe penetrating wound on his
person, and  afterwards drown himself.   In such a case, it is not even the neces-
sarily mortal nature  of the injury which would allow us to come to a prompt de-
cision;  for although a man labouring, for instance,  under a penetrating wound
of the heart, or a deeply incised wound of the neck, is not likely to run far, or
to require to drown himself in order to die, yet instances  are on record where
such wounds have been inflicted on the brink  of the water and even at  the mo-
ment of precipitation, to ensure a speedy death.   The same  remark also applies
where a gun-shot wound of great extent exists on the body, as when the abdomen,
chest, or head has been traversed by a pistol-bullet; for suicides have been known
to shoot themselves immediately before throwing themselves into water.   But of
all cases, perhaps, that of the evidence of poisoning, by the discovery of poison in
the body of  the drowned person, is calculated to produce the greatest ambiguity;
since it is obvious that the deceased may have taken  poison, and, before its fatal
operation on the system, have had time to complete the act of  suicide by drowning.
A case of this kind has been communicated to me by Dr. Barker, of Bedford.   A 
484
DROWNING IN SHALLOW WATER.
young lady committed suicide by drowning, and on examining the  stomach ar-
senic was found therein, which she had swallowed previously to throwing herself
into the water.  These difficulties, it is true, are commonly removed by circum-
stantial evidence; but this is wholly collateral to the duties of a medical witness.
He must treat the case as one which is purely medical; for when the Court puts
a question to him relative to the possibility of any of the above coincidences ex-
isting, he is obliged to give an abstract answer either in the affirmative or negative.
If his opinion were  founded wholly on circumstantial evidence, and not on me-
dical principles, it would be rejected, since it is for the jury alone to connect the
circumstantial with the medical evidence.
   Are there no rules, then, it may be asked, to  distinguish  suicidal from homi-
cidal  drowning?   Medically  speaking, the drowning is  presumptively suicidal
when there are no marks of violence;  and it is  presumptively homicidal when
severe vital injuries, of a more or less speedily mortal or dangerous  character,
and not likely to have had an accidental origin, are met  with.  The latter pre-
sumption is founded on the fact, that murder by drowning is extremely rare
without previous violence being used by the murderer.  The homicide generally
leads to  his  own detection by inflicting more violence than is necessary for the
destruction of his victim.
   In all  these cases, when the facts are unknown, there  is a rule which, it ap-
pears to me, the examiner ought to follow;  and that is, never to pronounce a
positive opinion in favour of  homicidal drowning from violence on the person of
the deceased, unless the violence  be  so  situated on the  body that it could not
have  been self-inflicted,  and unless it be of a nature to have  destroyed life
speedily.
   Drowning in shallow water.—Homicide has been  sometimes presumed from
the peculiar circumstances under which  the  body has been discovered.  Thus,
for instance,  it has been  a debated question, whether a person intent  on suicide
can actually drown himself in shallow water.  This question has been long since
settled in the affirmative by the occurrence of some well authenticated cases:  it
appears to have been raised originally on  the theoretical view, that the resolution
of a suicide would fail him in such a situation, and that having the  means of
escape, he would lose no time in extricating himself.  It  need  hardly be stated
that the  mere immersion of the mouth in water not more than a few inches deep,
will produce  all the phenomena  of death by drowning,  with the exception that
little or no water would probably be found in the stomach.  Devergie mentions
an instance which occurred in May, 1833, where a man was found drowned in a
small stream, his face towards the ground, and his head just covered  by the water,
which was not more than afoot in depth.  On dissection, there were all the ap-
pearances of drowning present, and a large quantity of sand and gravel was found
occupying the  trachea and bronchial ramifications.   (Op. cit. ii.  332.)  A case
is mentioned by Dr. Smith,  in which a woman committed  suicide by breaking
a hole in the ice of a pond, during the winter,  and thrusting her head into the
water, the rest of her body being out.   In May, 1837,  a man was found dead
near Mitcham  in Surrey.  He was discovered lying on his face in a small stream
of water only six inches deep.   The water was so shallow  that it  did not cover
the deceased's body or his head.   There was clear evidence that this was a case
of suicidal drowning.
   The discovery of bodies under these circumstances does not necessarily establish
that the act was suicidal.  It is  quite possible that one  or more  murderers may
hold a person's head in  such a position  sufficiently long  to destroy life;  but  as
the party might be capable of making resistance, we ought then to find marks of
violence on the body.   So, again, such  a position  is by no means  incompatible
with accidental drowning; and on this it may happen that a medical practitioner
will be called to express an  opinion.   A man, in a state of deep intoxication,
may fall with  his face in a  gutter  or ditch;  he may die in this position, not 
DROWNING.  LIGATURES ON THE HANDS AND FEET.          485
having the power to extricate  himself.  Even violence on his person must not
be too hastily construed into proofs of murder.  Not long since, a case of this
description gave rise  to a trial for murder in  one of our midland counties.   A
man was found dead with his face in some  melted snow; and there were several
severe contusions on his body.  The evidence showed that, after a quarrel, he
left  a neighbouring inn  deeply intoxicated;  and it  was rendered extremely
probable that he had  perished accidentally on his way home.   There was no
reason to suppose that he had been murdered.   Infants, from mere helplessness,
may be drowned under similar  circumstances.
   Drowning from partial immersion.—There  is no  doubt that murder by
drowning may be perpetrated without the whole of the body being immersed  in
water.  An interesting case of this kind, which was the  subject of a criminal
trial, was referred to me by Mr. Aldred, of Norwich, in March, 1841.   The case
was tried at the Norwich Lent  Assizes of that year (The Queen v. Yaxley,) and
the prisoner was convicted.  It appeared that the mode in which the prisoner
destroyed her infant child was by immersing its  head  for a few minutes in a
pail of water. ^  She removed it before it was  quite dead,  but it soon  died with
slight convulsive motions of the limbs.  The  case was rendered obscure by the
fact that the whole  of  the body had evidently  not been immersed; and the only
conceivable means of  drowning were in a small duck-pond adjoining the house,
which was covered  with weeds; but no weed was found in the stomach of the
child, although  a quantity of water was there present.   The death of a child
under these singular circumstances is,  however, quite compatible with accident.
Mr. Tubbs, of Upwell Isle, has communicated to  me the following  case, which
fell under his notice  in  April, 1848. He was called to see a child set.  18
months, which was  stated to be dying.  On his  arrival at the cottage, he found
it dead: the skin was cold, and the countenance calm and pale, with the exception
of a livid discoloration in the centre of each cheek.  The eyelids, as well as the
mouth, were half open.  The  pupils  were largely dilated.  A frothy mucus,
tinged with blood, was escaping from the mouth and nostrils.   The tongue was
swollen, and protruded  forwards.  The mother of the infant, a respectable woman,
gave the following account:—She was washing in one room, while the child was
in an adjoining  room,  the door between being kept open, by a pail  half full  of
water.  She went out of the house for about two minutes, and on her return she
found the child with its head downwards in the pail of water, the heels and part
of the body hanging over the side of the pail.   She snatched it out  and tried  to
revive it, but without  effect.    There was  no reason to doubt the truth of her
statement, and at the  inquest the jury returned a verdict of accidental death.
The helplessness of an infant at this age, and  the rapidity with which asphyxia
supervenes, sufficiently account for its death under these circumstances.
   A case  occurred in London,  in 1841, where a drunken  man was  drowned by
falling on the bank  of the Surrey Canal, with his head partly in the water, while
the greater part  of his body lay on the bank out of the water.   It was  by partial
immersion that the Italian boy, Carlo Ferrari, was destroyed some years since by
Bishop and Williams, who afterwards attempted to sell the body for the purposes
of dissection.  The  murderers first intoxicated  the deceased, and then suspended
him  by the heels in a  well, so  that his mouth was but a few inches below the
level  of the water.   A medical man, therefore, must not  allow himself to be
deceived respecting  the cause of death on finding that the whole of the body has
not been immersed.  In  this  form of murder, when the inspection  is recent,
water with or without weeds or other foreign  matters may be found in the  ear-
passages.
  Ligatures on the hands and feet.—AVhen a  drowned subject is removed from
water with the hands  and feet bound by cords, it  is usually considered that we
have therein strong presumptive evidence of homicide;  but numerous cases are
recorded where suicides have actually bound  themselves in this manner before 
486
WEIGHTS ATTACHED TO THE BODY.
throwing themselves into water, probably for the express purpose of preventing
any chance of their escaping death.   In July, 1832, the  body of a full-grown
man was removed from the Seine, his neck, legs,  and hands being secured
together by a cord furnished with  slip-knots.  There was no doubt that he had
died by drowning, and that the act was one of deliberate suicide, the cord being
so placed on his body that an individual could easily place it on himself.   In
this case there was no  great degree of ecchymosis produced by the cord;  nor is
it likely there should  be, when it was arranged by a suicide,  since  his  object
would be  merely that of rendering himself helpless by securing his arms  and
legs.   This he would  doubtless accomplish without giving himself much pain.
If the marks bear the  evidence of  violent constriction, especially on both wrists
or on the fore part of the neck, the presumption of murder becomes very strong.
In a case of this kind, it would be obviously of great importance to determine
whether the deceased  had really died by drowning or not; since, if his  death
had not been due to drowning,  the fact of his body being discovered in water so
bound, would furnish the strongest possible evidence  of murder.  (Ann. d'Hyg.
1833, i. 207.)
   Weights attached to the body.—If a body be taken out of water with  heavy
weights attached to it, the question of accident, as in  the former case, is done
away with.  It must be either homicide or suicide;  and doubtless many  would
be apt to suspect that it was a case of murder.  Several instances have, however,
occurred where persons have committed suicide by drowning, and heavy weights
have been found attached to their feet and hands, or in or about the dress.
   Age.—Another question which  may be considered is this:—Does the  age of
a drowned subject rebut the presumption of suicide, even when there is no other
ground for suspecting  murder?  In  the case of an  infant, this question must
assuredly be answered in  the affirmative.   If the body of a new-born child be
discovered  drowned  in water,  the case must be  one of accident  or murder.
Murder is generally presumed by our law on the clear evidence that drowning
was the cause of death; it is then for the accused party (commonly the mother)
to satisfy the Court that the drowning was accidental.  The  discovery of  any
wounds, or other marks of wilful violence, would altogether  do away with  the
presumption of accident.  It must, however, be proved that the child died from
drowning, since a woman may merely have placed its dead body in water for the
purpose of concealment.
   But we cannot  so easily fix the  age at which the suspicion of suicide  would
cease to be rebutted thereby.  The question might arise on the  discovery of the
drowned body of  a child not more  than  three or four years of age; and in  this
case suicide would be highly improbable.   Such young subjects are often drowned
by accident, but then there  are facts usually forthcoming which remove all  the
difficulties from the  investigation.   The youngest age of suicide by drowning
which I have met with was in a boy of  13: in two other cases  of girls aged 13
and even 11, suicide by drowning was attempted.  (Ann. d'Hyg. 1836, ii. 402.)
After 13, suicide  by drowning has been known to have been committed at every
period of life up to the age of 86.   Suicide by drowning is, however, almost aa
rare  in advanced age as in extreme infancy. 
HANGING.   CAUSE OF DEATH.
487
HANGING.
                            CHAPTER LVIII.

CAUSE OF DEATH—RAPIDITY OF DEATH—DEATH FROM THE SECONDARY EFFECTS—TREATMENT
  —PERIOD AT WHICH DEATH TAKES PLACE--POST-MORTEM APPEARANCES--MARK OF THE
  CORD OR LIGATURE--UNECCHYMOSED MARKS--OTHER APPEARANCES--WAS DEATH CAUSED
  BY HANGING ?--HANGING POST  MORTEM--SUMMARY OF MEDICAL EVIDENCE--CIRCUMSTAN-
  TIAL EVIDENCE--MARKS OF VIOLENCE ON THE HANGED--WAS THE HANGING THE RESULT
  OF ACCIDENT,  SUICIDE, OR HOMICIDE?--HOMICIDAL HANGING--INJURY TO *THE CERVICAL
  VERTEBRAE--THE POSITION OF THE BODY--THE LIMBS SECURED--POWER OF SELF-SUSPENSION.

   Cause of death.—By hanging we  are to understand  that kind of death in
which the body is wholly or partially suspended by the neck, and the constricting
force is  the weight of the body itself; while, in  strangulation, the constricting
force is due  to some other cause.  In both cases death  commonly results from
asphyxia, although this must depend in  a great measure upon the position of
the ligature  on the neck.   If this be loose, or  applied to the upper part of the
neck, a small quantity of air may still  reach  the lungs;  and then the  cerebral
circulation becomes interrupted by the  compression of the  great vessels of the
neck.  In this case, apoplexy of the congestive kind is induced, and operates as
the immediate  cause of death.  It is easy to conceive that there may be  a mixed
condition of asphyxia and apoplexy, and according to the observations of Professors
Casper and Reiner, this is actually met with in the greater number  of instances.
The following  tables represent the results at which they have arrived from the
examination of a large number of cases:—
                                      Remer.              Casper.
      Apoplexy    ....     9     ...   9
      Asphyxia    ....     6     ...   14
      Mixed conditions ...   68     ...   62
                   Total ...    83     ...   85

  It has been frequently observed, in the execution of criminals, that death does
not constantly ensue within the same period of time; and we may probably best
explain this fact by a reference to the greater or less degree  of constriction pro-
duced by the ligature.  If the rope should press upon the larynx or above that
organ,  the occlusion of the air-passages will  not  be so complete as if it pressed
upon the trachea  immediately below the cricoid cartilage.  A slight degree of
respiration  might,  in the former case, continue for a short interval, by which the
life of the person would be prolonged; while in the  latter, death would be imme-
diate.  If the trachea be in part ossified, the  pressure of the  cord is less perfect,
and death will then take place more slowly.  It has been supposed that the im-
mediate cause of the stoppage of respiration was a pressure  produced by the cord
on the  nerves of the neck; but it must be considered as very improbable  that,
under the circumstances in which hanging generally takes place, the cord should 
488
HANGING.  RAPIDITY OF DEATH.
 exert any pressure on the nerves sufficient to produce death.  In  the  greater
 number of cases of suicidal hanging, which are commonly unattended with much
 violence,  the  pressure on these  nerves  cannot  obviously exist;  and in violent
 hanging,  the projection of the anterior parts of the neck must suffice to prevent
 these slender nervous filaments from becoming exposed to such a degree of com-
 pression as directly to impede the exercise of  their functions.
   There is an occasional cause of death  in hanging, which appears to have been
 first brought to the notice of the profession by Louis.  Having remarked  that,
 in public executions, death sometimes took place with great rapidity, and in other
 cases more slowly, he was led to inquire  into the circumstances.   He found that
 in the cases of rapid death, the executioner was in the habit of giving a violent
 rotatory motion to the body of the criminal  at the moment it was turned off,
 whereby a displacement of the dentiform process of  the second cervical vertebra
 took place, so that the spinal marrow became  suddenly compressed.  This cause
 of death  must be extremely rare:  as  a general  rule, it is only likely to be ob-
 served in very corpulent subjects, where a long fall is given to the cord, and where
 much violence has  been at  the same time employed by the executioner.   It is
 seldom met with in subjects criminally executed; and in cases of suicidal hang-
 ing it is so rare, that Devergie found the ligaments between the first and second
 Cervical vertebrae ruptured  only  once  in fifty-two  cases.   M. de la Fosse consi-
 ders, from the observations which  he has made on the subject, that, in violent
 hanging,  the dentiform  process of  the second cervical vertebra  is much more
 likely to be fractured than  to become displaced, and he found this in the case
 of an executed criminal.  On an examination of the body of this  subject, he
 discovered that the first two cervical vertebrae had been completely separated from
 the remainder of the spinal column  by the  rupture  of the  intevertebral sub-
 stance,  and that  they were  firmly attached by their ligaments  to the occipital
 bone.   The dentiform process and  body of the second vertebra  were detached
 from the  bony ring, but were still connected as  usual with  the anterior  arch of
 the atlas.  The spinal marrow had become compressed by the fractured portions
 of the vertebrae.   Probably further  observations would show that  the  injury to
 the spine is not always of the same nature, and that fractures of the vertebras
 are really more frequent than simple luxations of the odontoid  process; but in
 the mean time, we must admit that such injuries may occur in hanging, and that
 when they do occur, death must  be very sudden.  But death may proceed from
 mere effusion of blood on the spinal  sheath, thereby giving rise to fatal compres-
 sion.   This is  likely to happen when  the head falls, or  is bent suddenly back-
 wards, so that the weight of the body is supported on the back of the neck.  See
 an interesting case of this kind by Mr. Campbell de Morgan (post.)
   Rapidity of death.—Death from  hanging appears to take place very rapidly,
 and without causing any suffering to  the individual.  It is observed, that in those
 who are criminally executed there are often violent convulsions of the limbs and
 trunk.  There is no reason, however, to  believe  that the individual suffers pain,
 any more than in  the  convulsions of an epileptic fit.  On  recovery there is an
 entire  loss of consciousness of  pain in both cases.   The  circulation of dark-
 coloured blood through the brain and spinal cord may account for these  effects.
 Efforts to inspire are made for from one to two minutes after the closure or  com-
pression of the trachea.   The diaphragm and  intercostal muscles  act spasmodi-
cally, but no air enters the lungs, and it is probable that in the act of hanging,
part of  the air contained in  the organs is convulsively expelled.   When the sus-
pension of the  body has  only continued a few minutes, it has often  been found
impossible to restore life; and indeed the period at which resuscitation may take
place will vary in different subjects according  to circumstances.   Supposing the
hanging to be unattended with violence  to parts about the neck, it is possible
that some individuals might  be  resuscitated  after  five minutes' suspension or
longer.   Others, again, may not  be  recovered when they are cut down imme- 
TREATMENT OF THE HANGED.
489
  diately after suspension,-—a fact which depends probably on the different degrees
  to which asphyxia or apoplexy has extended.
    Death from the secondary effects.—-It by no means follows that because we have
  succeeded in restoring the respiratory process, the individual is safe.  Death often
  takes place by a fatal relapse at various periods after the accident.  A case of this
  description has been published by Sir B. Brodie.   A boy, get. 17, was found hang-
  ing.  AVhen cut down he was insensible; his face livid, his lips'of a dark purpfe
  colour, pulse not perceptible, pupils dilated and motionless.  Artificial respira-
  tion was used, and in a quarter of an hour the diaphragm began to  act.  He
  breathed at irregular intervals with stertor, and with a rattling noise in the throat.
  The pulse became perceptible, but often flagging, and the surface of the body was
  cold.  The countenance was still livid, but the  pulse and breathing improved.
  At the end of another hour an attempt was  unsuccessfully made  to take some
  blood from the arm, and the patient was placed in a warm bath.  The breathing
  was stertorous  through  the night, and in the morning twelve ounces of blood
  were taken from the arm, but there was no relief.  He continued insensible, cold
  on the surface, and frothing at the mouth, and he died twenty-four hours after
  he was cut down.  The body was carefully examined.   The vessels of the brain
  were very turgid with blood:—this was the only morbid appearance.  In another
  instance, a labouring man, who had hanged himself, was cut down in a state of
  insensibility.  He lay for a considerable time  breathing with apoplectic stertor,
  but eventually recovered. (Lectures on Pathology, 72.)  Dr. Shearman has re-
  ported in the Lancet (Jan. 6, 1844,) a case in which a powerful  athletic man,
  who had been committed to prison for theft,  hung himself.   He was found  ap-
  parently  dead, hanging by his own handkerchief.  He was cut down, and seen
  by Dr. S. half an hour after the occurrence.  The man was then apparently life-
  less,—he neither  breathed nor moved, nor had any perceptible circulation.  The
  face  and  neck were much swollen and livid, and the ecchymosed mark of the
  cord was immediately below the  thyroid cartilage: the fingers were bent, and
  the hands nearly clenched.  His head was raised, the windows were thrown open,
  and blood abstracted from the arm, which was put into hot water, in order to in-
  crease the flow.   In a few minutes the man began to breathe:—the bleeding was
  allowed to continue until the pulse was felt at the wrist, and the pupil contracted
  completely on the application of a lighted candle.  The breathing was stertorous.
  Brandy and water were poured into the stomach, and warmth was applied to the
  extremities.  In the course of a few hours he rallied very much,—his pulse had
  become firmer and quicker (130,)—his head was  hot,—he was very restless, un-
 manageable, and violently convulsed in the arms and legs.  Shortly before death
 he was calm, and spoke several times.  He suddenly became exhausted, and died
 nineteen hours after he was found hanging.  This was probably a mixed case of
 asphyxia and apoplexy.  The medical treatment appears to have been very proper.
 The unsuccessful result may perhaps be ascribed to the injury sustained by the
 cerebral circulation from constriction of the neck.  In hanging, as well as in
 drowning, therefore, a person may in the first instance  recover, but subsequently
 die in spite of the best treatment.
   [We remember  two cases in which the patients were dangerously ill from fever
 resembling typhus, for several weeks, immediately after having been cut down
 and resuscitated from the effects of a voluntary suspension.  There might  have
 been other causes for the fever in each of the cases, but  none existed that were
 not more likely to be predisposing than exciting causes.—H.]
   Treatment.—Artificial respiration,  cold affusion when the skin  is warm, with
 the vapour of ammonia and other stimuli, may be employed on these occasions.
 If there should be much cerebral congestion on recovery, venesection may be re-
 sorted to.   The introduction of oxygen into the lungs, or the application of elec-
 tricity or electro-magnetism in the course of the spine, [or to the heart, taking
great  care to employ a gentle current,] might be attended with benefit; but much 
490
TREATMENT OF THE HANGED.
will depend, as in drowning, upon the time at which assistance is rendered after
the body has been cut down.  The  following case  of recovery, in which, how-
ever, asphyxia was not complete, was reported  in the Lancet, Nov. 1839.  A
robust woman, aged thirty-three, hung herself while slightly intoxicated.   She
was missed about ten minutes before she was found suspended to a bedstead, but
how long she had been thus hanging it was impossible to determine.  Medical as-
sistance was rendered to her in about ten minutes after she had  been cut down.
She was then quite insensible,--—her respiration slow and laborious, and her pulse
barely perceptible.  The countenance was pale,—there was no lividity: the lower
jaw was depressed, the extremities were moderately warm, and  the hands con-
vulsively clenched,—the pupils were somewhat dilated, and barely susceptible of
the stimulus of light.   A dusky red mark,  of a quarter of an inch in breadth,
was distinctly observed encircling the upper part of the neck, forming an angle
over the ramus of the jaw on the right side, where the knot of the ligature (a
silk handkerchief) had rested; and in consequence  of this the  constriction was
incomplete.  The patient was twice copiously bled, mustard poultices were ap-
plied to the calves of the legs, hot water to  the feet, and cold applications to the
head.  After thirty-two ounces of blood had been  abstracted,  in half an  hour
the breathing  became stertorous, the pupils fully dilated,  the lower jaw fell fur-
ther, the sphincters became relaxed, and the patient appeared to be rapidly sink-
ing.  Ammoniacal liniment was rubbed on the chest, and the woman so far re-
covered in  an  hour as to be able to swallow: but although she was conscious of
pain, she remained comatose until the  evening, when she became perfectly sensi-
ble of surrounding objects.   This was evidently a case of imperfect suspension,
where, from respiration still continuing, there was every hope of recovery.  The
cerebral circulation had here become disordered.
   In the following case, which occurred to Mr. Noyce, cold affusion speedily re-
suscitated the individual. A man had been hanging about two or three minutes
when he was cut down, and in four or five  minutes afterwards he was seen by
Mr. Noyce.  He had then ceased to breathe : his features were pallid, and the
conjunctivae injected with blood.  The  heart's action continued, although feebly;
the pulse being about 80, and very weak.   Artificial respiration was tried with-
out  any benefit, when  cold  affusion was resorted to.  This, after a very short
time, led to the complete establishment of respiration:  at  each affusion there was
a deep inspiration.   The man was bled to sixteen ounces, and he soon recovered
his consciousness.   (Med. Gaz. xxxvii. 75.)
   This case bears  out the views long since published by Sir B.  Brodie, namely,
that after respiration has ceased, the heart still continues  to act, and to circulate
dark-coloured blood,  for a period of three or four minutes, to  the brain and other
parts of the system.  The exact period of time will,  however, depend on the
strength of the individual.   [And probably  the temperature of his body and that
of the surrounding  atmosphere.—H.]  It is on this ground that there is great
hope of restoring the individual by artificial respiration.  The dark-coloured blood
acts as a poison, [through its carbonic  acid] and slowly destroys life.   (Lectures
on Pathology, &c. 66—70.)  In  the after-treatment, it is advisable that blood
should be only sparingly abstracted, to relieve any cerebral congestion; because
the vital powers are much  reduced under the circumstances.   Convulsions, and
even paralysis, have been  observed  to  precede recovery in experiments on  ani-
mals.  [We are inclined to think that in a  large majority of cases of suspended
animation,  whether from drowning,  suffocation or strangling, it would be much
more advisable to secure, if possible, an additional supply of red blood by the
operation of transfusion than to abstract any blood whatever.  Some few cases are
benefited by the cautious withdrawal of black blood; but it must not be forgot-
ten that the patient is in a state of asthenia, for want of  reparative oxygenated
red  blood,  to counteract the exhausting stimulus and other  poisonous effects of
the super-carbonated black blood.—H.] 
HANGING.   POST-MORTEM APPEARANCES.
491
  Period at which death takes place.—We learn from those who  have been
resuscitated, as well as from  experiments performed by individuals upon them-
selves, that asphyxia  comes  on in the most  insidious manner in death from
hanging; and that the slightest constriction of the trachea will speedily produce
insensibility.  (Devergie, ii. 370.)  The symptoms of which the persons have
been conscious were a ringing in the ears, a flash of light before the eyes, then
darkness and  stupor.   The only profitable  inference, in a medico-legal view,
which can be drawn from observations of this kind is, that asphyxia is not only
very rapidly induced,  but that it supervenes under circumstances where it would
not be generally expected to  occur, i. e. when  the body of  the  individual is in
great part supported.   M. Fleichmann found that a cord might be  placed round
the neck between the  chin and os hyoides, and tightened either laterally or pos-
teriorly without perceptibly interrupting respiration: but while the  respiratory
process was thus  carried on,  the face became  red, the eyes prominent, and the
head felt hot.   These symptoms were followed by a sense of weight, a feeling of
incipient stupefaction, and a  hissing noise in the ears.   On  the occurrence of
this last symptom, the experiment  should be discontinued, or the consequences
may be serious.   The  first experiment  lasted two minutes; but in the second,
owing  to the cord by its pressure more  completely interrupting  respiration, the
noise in the  ears appeared in half a minute.  AVhen the pressure was applied on
the trachea,  the effect was instantaneous, but  when on  the cricoid cartilage it
was not immediate.  When it was applied between the os hyoides and the thyroid
cartilage, or  on the os hyoides itself, the period during which an individual could
respire was extremely short;  and  this  result was more striking when the act of
expiration was performed at the moment of  applying the pressure.   The death
of Scott, the American diver,  in January, 1840, shows how very readily asphyxia
may be induced by slight compression of the throat, even where a person might
be supposed  to have both the knowledge and the power to save himself.  This
man was in  the habit of making public experiments on  hanging,  and had fre-
quently before  gone through them without danger;  but on this occasion, it is
probable that  a slight shifting of  the ligature from under the jaw-bone caused
so much compression on the throat between the chin and larynx, as speedily to
produce asphyxia.  No attempt was made to save him until it was  too late, and
he was not brought to an hospital until thirty-three minutes  had elapsed.  He
was allowed  to hang thirteen minutes,—the spectators thinking that the deceased
was only prolonging the experiment for their gratification!   The very insidious
and painless manner in which an individual who  is suspended  passes from life to
death, is well illustrated in the report of the case of Hornshaiv, published by Dr.
Chowne.  (Lancet, April 17, 1847, 404.)   This man was on three occasions
resuscitated from hanging,—a feat, which, like Scott, he had performed for public
gratification.   He stated that he lost his senses  almost at once; that it seemed
as if he could not get his breath, and  that  some great weight was attached to
his feet;  he  felt that he  could not move his hands or legs to save  himself, and
that the power of thinking was gone.   It is not improbable that many persons
have thus lost their lives by privately attempting  these experiments, and their
cases have been wrongly set  down as cases  of suicide.  There is, I think, no
doubt that boys have  thus  frequently but unintentionally destroyed themselves
out of a strange principle of imitation or curiosity.  The following is  one among
many cases of this kind.   In  August, 1844, a  boy, aged fourteen, witnessed an
execution at Nottingham, and he was afterwards  heard to say he should like to
know how hanging felt.  On the same afternoon, he was found suspended by a
cord from a tree, quite dead; and  from the circumstance there could be little
doubt that he  had been  experimenting on the theory and practice of hanging,
and that he did not intend  to  destroy himself.   The jury returned a verdict of
"accidental hanging."
  Post-mortem appearances.—The  following external characters of  the body are 
492              HANGING.  POST-MORTEM APPEARANCES.

laid down as indicative of hanging by most medico-legal writers.  Lividity and
swelling of the face, especially of the lips, which appear distorted;—the eyelids
are swollen, and of a bluish colour; the eyes red, projecting forwards, and some-
times partially forced out of the orbitar cavities;—the tongue enlarged, livid,
and either compressed between the  teeth or frequently protruded:—the lower
jaw is retracted, and a sanguineous  froth sometimes exists about  the lips and
nostrils.   There is a deep and ecchymosed impression around the neck, indicating
the course of the cord, the skin being occasionally excoriated;—laceration of the
muscles and ligaments in the hyoideal region;—laceration  or contusion of the
larynx or of the upper part of the trachea.  There are also commonly circum-
scribed  patches of ecchymosis varying in extent about the upper part of the
trunk and the upper and lower  extremities, with  a deep livid discoloration of
the hands.  The fingers  are generally much contracted or firmly clenched, and
the hands and nails are livid.  The urine and faeces are sometimes involuntarily
expelled at the moment of  death.   Internally, we meet with  the appearances
described under the head of asphyxia.  The right side of the heart,  and the
great vessels connected with it, are commonly distended with blood.  But when
the inspection has been delayed for several days, this distention may not always
be observed.  The vessels of the brain are commonly found congested; and, in
some rare instances, it is said extravasation of blood has been met on the mem-
branes and in the  substance of the organ.  Extravasation of blood is, however,
so rare, that Remer found this appearance only once among one hundred and one
cases; and in one  hundred and six cases, observed by Casper, it was not found
in a single instance.  In one case of death from hanging, Sir B. Brodie found
a large  extravasation of  blood in the substance of  the brain; and  he refers to
another case, in which there was a considerable extravasation between the mem-
branes.    (Lectures on Pathology, 58.)  The venous congestion of the  cerebral
vessels is  rarely greater than in other cases of asphyxia, and is  probably depen-
dent on the degree to which the lungs have become engorged.   In most instances
there is increased  vascularity of the substance of the brain, so that, on  making
a section  of the hemispheres, a greater number of bloody points than usual will
appear.   [Care must be  taken, if possible, to distinguish these appearances from
those which are said to arise from concussion of the  brain.  In the  latter case
the points of blood are minute extravasations of fluid blood, while in the former
they  are  divided blood vessels filled with coagulated blood generally, and dis-
tinguished by the  ease with which the small clots may be  removed.   The dis-
tinction is a difficult one, however, and perhaps not  yet fully established—Dr.
Bright  was the first to point it out.   See B. and F. Med. Chir. Rev. Jan.  1853,
68,—H.]   In addition to these morbid changes, a mucous froth, sometimes of a
sanguineous hue, has been described to  exist in the trachea;  but this is only
likely to be met with in  cases in which the obstruction to  respiration has been
incomplete.   A more important circumstance  has been  noticed by Dr. Yelloly,
namely, that  in examining the stomachs of five criminals who had been hanged,
he found  great congestion in all;  while there was blood extravasated and coagu-
lated upon the mucous  membrane  in two.   Such an appearance might, it is
obvious, be attributed in  a suspicious case to the action of some irritant substance.
(See Ann. d'Hyg. 1830, 166;  1835, 208; 1838, 471.)
   These external post-mortem appearances have been chiefly derived from the ex-
amination of  the bodies  of executed criminals.  Such well marked characters are
not generally met with  in cases  of suicidal hanging; and  therefore it will be
proper to state what are  the  principal differences.   Thus, the face is sometimes
pale,—a condition commonly seen in those cases in which there has been but
little obstruction to the cerebral circulation, either from the  softness or looseness
of the ligature.   Esquirol found, in one instance,  that when the  body was ex-
amined immediately after death, the face was not livid; but it first began to as-
sume a violet hue in eight or ten hours.   He thought that when the  cord was 
HANGING.  MARK ON THE NECK.
493
left round the neck the face would be livid; but, if removed  immediately after
suspension, pale.   This view is not, however, borne out by observation.  The
tongue is not always protruded.   Devergie found that there  was protrusion of
this organ only in  eleven cases out  of twenty-seven.  This protrusion was for-
merly supposed to depend upon the position of the ligature:—thus it  was said
when this was below the  cricoid cartilage, the whole  of the larynx was drawn
upwards, and the  tongue carried forwards with it, while, when above the os
hyoides, the tongue  was drawn backwards.  The  protrusion or  non-protrusion
of the tongue does  not  depend upon any mechanical effect of this kind, but
simply upon congestion;  for it is occasionally met with thus protruding in  cases
of drowning  and in other forms of asphyxia.   Besides, the protrusion  has not
been found to have any direct relation to the positicm  of the ligature.
   Mark of the cord or ligature.—The most striking external appearance,  how-
ever, is the mark produced on the neck by the ligature.   The skin is commonly
depressed, and sometimes ecchymosed, but rarely throughout its whole extent:
it is very frequently free from all traces of ecchymosis, the skin in the depression
being then hard, brown, or of a parchment colour and  consistency, or there may
be only a thin line of ecchymosis in the upper or lower border of the depression.
The course of the mark is generally oblique, being lower in the fore part  than
behind.  If the noose should happen to be in front, the mark may be circular,
the jaw preventing the ligature from rising upwards in the same degree before,
as it commonly does behind.   The  mark is generally single, but we may meet
with it double, as where  the ligature has been formed into two circles or  loops
previously to its application.   Its other characters will depend upon the nature
of the ligature employed.  Thus  a large  and wide  ligature  rarely produces ec-
chymosis,—the mark is  wide and superficial, but a small ligature produces a
narrow and deep impression, sometimes accompanied with laceration of the cuticle
and effusion beneath the skin.   From the  statistical returns of Devergie and
Casper, it would appear that a cord or rope is employed in more than one-half
of all the cases of hanging which occur.   In other instances various articles of
dress were fonud to have been employed.
   Medical jurists have considered it proper to examine into the position of  the
ligature, as this may sometimes form a question in cases of suspected murder by
hanging.  The following table will show that in more than two-thirds of all cases
of suicidal hanging, the ligature is found  encircling the neck between the chin
and os hyoides.
                                             Remer
       Above the  larynx.......38   .
       On the larynx      .......7
       Below the larynx.......2

                                              47
   Unecchymosed marks or depressions.—It was formerly believed, that  the  im-
pression produced by the cord was invariably ecchymosed, but more correct ob-
servation  has shown that this  is  probably the  exception to the general rule.
When ecchymosis  does exist, it is commonly superficial, and of very slight  ex-
tent.   There is rarely, if ever, effusion of  blood  in  the cellular tissue.   Dr.
Riecke, of Stuttgard, in  his observations on hanging,  found only once in thirty
cases an extravasation of blood beneath or on both sides of the depression pro-
duced  by the ligature.   The tongue was  generally between the teeth, and m
most cases wounded by them.  He attributed death  to stretching of  the spinal
marrow.   (Henke's Zeitsch. 1840,  27 Erg. H. 332.)  In the bodies of individu-
als who have been criminally executed, it  is not  unusual to find ecchymosis;
 butevcn here it is not always present.   In a case which I had  an opportunity
of examining some years since, there was only  a slight  trace of ecchymosis in
Devergie.   Casper.
  20   .   .  59
   7   .   .   9
   1   .   .   0
28       68 
494              HANGING.  POST-MORTEM APPEARANCES.

one spot where the knot  in the cord had produced  contusion.  That it should
commonly occur in criminal executions is not surprising, considering the violence
employed on these occasions; but it has been somewhat too hastily assumed that
these appearances in executed criminals are met with in all cases of death from
hanging.  This doctrine  has been carried so far, that a livid mark in the course
of the cord has been pronounced to be the best criterion for distinguishing hang-
ing in the living from hanging in the dead  body! It will be seen, however, that
no reliance can be place'd on this appearance.   In fifteen cases examined by M.
Klein, in twelve examined by M. Esquirol, and in  twenty-five cases of suicidal
hanging which occurred  to  M. Devergie (op. cit. ii. 394,) there was  no ecchy-
mosis whatever in the course  of the  ligature.  (Annales d'Hyg. 1832, 413;
1842, 146.)   Out of six cases, Fleichmann met with  only one instance.  In
three cases of suicidal hanging which I have had an opportunity of examining,
no ecchymosis had been produced by the ligature.  In all of these instances, the
skin, instead of being blue or livid, or presenting effusion of blood in the cellu-
lar tissue beneath, was hard and  of a yellow colour, resembling parchment.  It
had  that appearance which  the cutis  commonly assumes when  the cuticle has
been removed from it for two or three days; and on dissecting it off, the cellular
membrane beneath often appears condensed and of a silvery whiteness. In some
instances, the mark, instead of being livid or brown, has presented itself simply
as a white depression.  This has been observed in very fat subjects.   [Our ex-
perience in regard to the mark in a number of cases of suicidal hanging, coin-
cides with that of Dr. Taylor.—H.]  The  observations of Casper on this point
are as follow:—Out of seventy-one cases, there was no ecchymosis produced by the
cord in fifty;  and thus in two-thirds of the cases examined  it was entirely ab-
sent.  Casper also found that there was no difference in the result, whether the
ligature was removed sooner or later after death.  Remer considers  ecchymosis
in the course of the  cord to be a frequent appearance in hanging; but Devergie
very properly objects to the inference which he has drawn from his cases (op.
cit. ii. 397.)
   The  following singular case, which occurred to  Dr. Hinze, of Waldenburg,
will show that the presence of ecchymosis  in the mark does not depend, as Es-
quirol supposed, on the ligature being left around the neck.   A young man in a
fit of drunkenness hung himself with a stout cord.  In about half an hour after-
wards, he was cut down, and  attempts were made  to resuscitate him.  It was
perceived that the cord  had merely produced  a superficial  impression on the
neck, destitute of any appearance of ecchymosis.  Signs of returning life began
to manifest  themselves:—the attempts at resuscitation were continued for seve-
ral hours, but all signs of vital reaction disappeared; and now, when life was
about to become again extinct, to the astonishment of those present, the mark
on the neck, which had  been hitherto colourless,  became deeply  ecchymosed.
On an inspection being made the next day, it was  found that this ecchymosis
continued;  and that it was owing to a real subcutaneous effusion.   From the
appearances in the head, it was concluded  that the  deceased  had died from con-
gestive apoplexy.
   Other appearances.—Injuries to the muscles and deep-seated parts of the neck
are, of  course, only  likely to be seen where considerable violence has been used
in hanging.   In one or two instances,  the lining membrane of the common caro-
tid artery has been found lacerated.  Congestion and tumefaction of the genital
organs  in either sex, have been  set down  among the common  consequences of
hanging;—but many observers have never met with these conditions; and it in
doubtful whether, unless the  body be examined speedily  after  suspension, any
marked difference would be discovered.  A more common sign, perhaps, is the
discharge of the spermatic secretion in the male; but according to Casper, it is
the  mucous secretion of  the prostate gland which is  thus discharged at the mo-
ment at which death takes place.   He states that traces of this are met with in 
PROOFS OF DEATH FROM HANGING.
495
from one-third to one-fourth of all cases of death from hanging in the male.   It
appears to me that very little reliance can  be placed  upon  evidence derivable
from this sign, and yet it has sufficed to give  rise to a most violent controversy
among French medical jurists.  (Annales d'Hygiene, 1839, i. 169, 467; ii. 393;
1840, ii. 314.)   It is, I think, clear that unless death from hanging be strongly
established by other facts, neither the examination of the linen of the deceased,
nor the application of the microscope to the mucous fluid found in the urethra,
would be of any  practical value in elucidating the  question,—at least to the satis-
faction of an English  jury.   M. Donne  justly considers evidence of this kind
to be a piece  of scientific refinement, in which, by attempting to prove too much,
we prove nothing. Spermatic fluid may be found in the urethra of a person who
has died from natural causes; and Donne  has ascertained that  the ejaculation of
a portion of this fluid into  the urethra may even  take place in a subject hanged
up after death.   He has found the fluid in some of these cases to  contain living
zoosperms.   (Cours  de  Microscopie, 303.)  For  some remarks  on the relative
frequency of  these appearances, see Med.  Gaz. xliv. p. 84.
   Summary.—The following  may be regarded as a summary of the post-mortem
appearances,  when death has  taken place from asphyxia.  The countenance is
livid, or sometimes pale, the eyes are prominent, the tongue  congested and oc-
casionally protruded, the lower jaw retracted:—the skin  is covered with patches
of cadaverous ecchymosis: the hands are livid  and clenched,—an oblique mark is
found on the  neck,—sometimes presenting traces of ecchymosis: commonly, how-
ever, the skin is only brown in colour and hardened.   The larynx, trachea and
subjacent muscles, are  lacerated, depressed or discoloured.  The vessels of the
brain are congested,  as well as those of the lungs and the right cavities of the
heart.   A mucous froth is occasionally found in the trachea.  These appearances
will of course be modified, or they may  be altogether absent, when death  has
taken place from disorder of the cerebral circulation, or from injury to the spinal
marrow, either by effusion of blood, fracture, or displacement.
   Was death caused by lianging?—When  a person is found dead and the body
suspended, it may be a question  whether death really took place from hanging
or not.   In investigating a case of this kind, it is necessary to draw a  distinction
 between the  external and internal  appearances of the body.  The former alone
can  assist us  in  returning an answer to this question,—the internal appearances
of the body can  only enable us to say whether any latent cause of death existed
or not.   The microscopical examination of  the blood as  contained in the vessels
above  and below the seat of constriction,  has failed  to throw any light upon
this question.   (See Med. Gaz. xxxviii. 1042.)   Neither the state of the counte-
nance or skin, nor the  position of  the tongue, can afford any evidence  on the
subject of death from hanging.
   Evidence from the mark of the cord.—It is to  the mark produced by the cord
on the neck,  that medical jurists  have chiefly looked for the determination of this
question.   The  form, position, and other characters of this mark, having been
already described, it will be only  necessary to allude to it, as furnishing evidence
of life at the time of its production.   It  has been stated, that so far from being
constantly livid  or ecchymosed, this condition is, in reality, not seen in more than
one-half of the  cases which occur.   But admitting that we find  ecchymosis in
the course of the ligature, are we always to infer that this must  have been ap-
plied while the  individual was living?   The  case which occurred to  Dr. Hinze,
(p. 493) proves  that the presence of active life is not necessary for the produc-
tion of an ecchymosis  in  the mark; and from the experiments of Devergie, it
would appear that if a subject  be hanged immediately or a short time after
death, an ecchymosed mark may be produced  by the application of a ligature to
the neck (op. cit. ii. 408.)  If a few hours were suffered to elapse, so that the
body had become cold,  no ecchymosis was produced by the ligature.   Professor
Vrolik, of Amsterdam, found that  a slightly livid mark was produced on the 
496
EFFECTS ON HANGING POST-MORTEM.
neck of a dead body, which had  been suspended an hour after death, (Casper,
Woch  Feb  1838.)   Hence this  condition of the mark in a body found dead,
indicates either that the deceased  must have been hanged while living, or very
soon after the breath had left his body.  It would be for a jury to decide be-
tween these two assumptions; and to consider why, when a man had really died
from other causes, he should have been hanged in secrecy immediately after death!
(See Ann d'Hyg. 1842, i. 134.)  The circumstance that an  ecchymosed mark
may be produced by suspending a recently dead subject, bears put the statement
of Merzdorff—that it would be in the highest degree difficult, if not utterly im-
possible, to determine medically, from an inspection of the body, whether a man
had been handed while living, or  whether he had  been first suffocated,  and
hanged up immediately after death.   In making  this admission it is proper to
bear in mind, that that which is difficult to a conscientious medical jurist, is often
very easily decided by a jury from the general evidence afforded to them.
   Sometimes, besides ecchymosis, there are excoriations of the skin  m the course
of the cord; and these are known  to be vital by the effusion of blood.   Devergie
never met with this appearance in  the  dead body even when the hanging took
place immediately after death.  The discovery of effused coagula in or about the
spinal column, would render it very probable that the deceased must have been
hanged while  living.   Such marks of violence  are, however rare in cases of
hanging and when  they are found,  it might be assumed that the effusion and
coagulation of blood had been caused by violence offered to the neck tmmediately
after death; but this assumption  may be met by the question already suggested,
namely, why death by hanging should be simulated in the body of  a person who
was alleged to have  died from another cause!                   .          .
   With regard to the other, or more common kind of mark m suicidal hanging,
it can scarcely be said to furnish  any evidence in relation to  the question which
we are here considering.  The depression may be hard and brown although it does
 not usually acquire this colour until some hours have elapsed after death;  tor it
 appears to depend simply upon a desiccation of the portion  of  skin which has
 been compressed by the ligature.    Sometimes the upper and lower borders only .
 of the depression, present a faint line of redness or lividity;  and it is worthy of
 remark that, when the ligature presents any knots or irregularities, those portions
 of skin which sustain the greatest  compression are white, while those which are
 uncompressed may be found more or less ecchymosed.  It is  in  this way that
 the form of the ligature is  sometimes accurately brought out.  It may  be^re-
 marked of these depressions produced by the cord, that  the characters which they
 present are the same, whether the  hanging take place during  life or soon alter
 death —the appearances may be very similar m the two cases.          <
    Hanqinq post-mortem.—The following  are the results  of some experiments
 performed  by Casper:—1. A man, aged twenty-eight, was suspended an  hour
 after  death by a double  cord passed round the neck  above the  larynx.  Ihe
 body was cut down,  and examined twenty-four hours afterwards.  Between the
 larynx and os hyoides, there were two parallel depressions about a quarter of an
 inch deep—the skin having  a brown colour with a  slight tinge of blue, and a
 leathery consistency: in certain  parts it was slightly excoriated,   Ihere was  no
 extravasation of blood beneath, but the muscles which had undergone compression
 were of  a dark purple colour, and  the blood-vessels of the neck were congested
 The appearance of this subject was such, that any individual unacquainted with
 the facts, would have supposed,  on looking at it, that the person had really been
 hansed while living.   There was nothing to indicate that the hanging had taken
 place an hour after death.   2. The body of another young  man was hanged an
 hour after death, and an examination was made the following day.   Ihe two de-
 pressions produced by the double cord were of a yellowish brown colour, without
 ecchymosis.   The skin appeared  as if it had been burnt  or cut, and felt like
 parchment.   3. An old man who had died from dropsy was hanged two  hours 
HANGING.   SUMMARY OF MEDICAL EVIDENCE.
497
after death.   The impressions presented exactly the  same characters  as  in  the
preceding case.   (AVochenschrift fur die G. II., Januar, 1837.)   AVhen the con-
striction took place at a later period after death, there was no particular effect
produced.
   AVe learn from these experiments, as well as from those performed by other
observers, that the mark which is most usually seen in vital hanging, (non-ec-
chymosed,) may  be also produced by a ligature applied to  the neck of a subject
within two hours after death,—consequently the presence  of this mark on  the
neck is no criterion whether the  hanging took place during life  or after  death.
The changes in the skin beneath the mark are also destitute of any distinctive
characters: there is the same condensation of the cellular membrane, whether  the
hanging have occurred in the living or dead.   These changes are the simple re-
sult of a physical cause,—mechanical compression.
   Summary of medical evidence.—From the foregoing considerations, we draw
the conclusion that there is no distinctive sign by which the hanging of a living
person can be determined from an inspection of the dead body.  All the external
marks may be simulated in the dead subject, and the internal appearances furnish
no evidence whatever.  Still, when the greater number of the signs enumerated
are present, and  there is  no other satisfactory cause to account for death,  we
have strong reason to presume  that the deceased has died from hanging.  We
must not, however, abandon medical evidence  on  these occasions, merely because
plausible objections may be taken to it.   Facts may show that, however valid
such objections may be in the abstract, they are wholly inapplicable to the par-
ticular case ujider investigation.   Perhaps the greatest medical difficulties occur
in reference to cases of suicide, owing to the slight appearances which here  attend
this form of death;  but on these  occasions, moral and circumstantial proofs  are
so generally forthcoming,  that even an inspection of the  body is scarcely ever
deemed necessary by a coroner!   If, then, it  be admitted by a  medical  jurist,
that it is not in all cases possible to distinguish hanging in the living from hang-
ing in the dead, the  admission must be considered as having reference to cases
wherein  individuals destroy themselves, and not to cases where they are destroyed
by others.   Even if a doubt were raised in  any particular instance, it is more
than probable that circumstantial evidence would furnish data for a decision, and
thus satisfactorily make up for  the want of  ordinary medico-legal proofs.   If,
when we found a deeply ecchymosed mark around the neck  of a dead subject,
we said,  all other circumstances being equal, that the individual  had most pro-
bably died by hanging, we should not be departing from a proper discharge of
our duty; since, although it is medically possible that such a mark may be pro-
duced after death, yet as it would be only a murderer who would think of hanging
up a recently dead body to simulate suicide, so it is certain, that  in such a case
we should most probably find some very obvious indications of another kind of
violent death about the person.  The absence  of  these, and the presence of  ec-
chymosis in the course of the cord, would, it  appears to me, leave the question
of vital hanging decidedly settled  in the affirmative.  It is necessary that great
caution should be used in  expressing an opinion that the hanging probably took
place after death, merely from the absence of ecchymosis in the seat of the liga-
ture;  because, while this is  generally true, it may in particular cases lead to the
concealment of the real mode of death.  Many facts already adduced show that
numerous cases of hanging  during life would  be  pronounced to be post-mortem,
if this were taken as a criterion.    The mere discovery of violence about the per-
son is not of itself sufficient to rebut the presumption of  death from hanging  on
these occasions.   The violence should at least be of such a nature as to account
for the immediate destruction of life, or it can throw no light upon the question
whether the individual might not have died  from hanging,  in spite of the marks
of maltreatment found upon the body.
  If, in the case of a person found hangine, a medical jurist should assert that
       32 
498
HANGING.   CIRCUMSTANTIAL EVIDENCE.
death had not taken place from that cause, this would be tantamount to declaring
that the deceased must have been murdered:—because it is impossible to admit
that any but a murderer would hang up a recently dead person.   This has been
frequently done  for the  purpose  of concealing the real means of death, and
making the  act appear to be one of suicide.   The following  case is reported by
Deveaux.   A female was found suspended to a beam in a barn.  From  the ab-
sence of all the  marks of hanging about the face and  neck of the deceased, a
careful examination of the body was made.   In the course of the inspection, a
small penetrating wound, evidently inflicted  by a round instrument, was dis-
covered on the right side of the chest, but in great part  concealed by the mamma
of that side.  On tracing the wound, it was found to pass between the fifth and
sixth ribs, completely perforating the heart from the right to the left side.  A
considerable extravasation of blood had taken place internally,  which had been
the cause  of death.  It was therefore evident, from the result of this examination,
that the deceased had been killed, and  her body suspended after death.   (For a
precisely similar case by Prof. Vrolik,  see Casper, AVoch. Feb. 1838.)   Fodere
refers to a case in which an individual  was found hanging under somewhat simi-
lar circumstances, and on examination it was discovered that death had been
caused by the administration of poison,—the body having been subsequently sus-
pended.   In one instance Devergie discovered a quantity of plaster of Paris in
the stomach and intestines of a  person found  hanging.  There  are, however,
cases in which some embarrassment may occasionally arise.  It may be a ques-
tion whether the discovery of poison in the body of a person found hanging, is
not  incompatible with previous attempts at suicide by poison.  An  individual
has even been known to hang himself after or about the time that he had swal-
lowed a strong dose of prussic acid.  (See On Poisons, 662.)'
   Circumstantial evidence.—Circumstantial evidence has more than once assisted
 in clearing  up a doubtful case.   Louis states that on  removing the body of a
 man who was found hanging, the rope  was observed to be clotted with  blood.
This simple circumstance led to further investigation, by which it was discovered
that  the  person had been murdered, and his body afterwards suspended.  The
 presence of marks on the neck indicative of strangulation, such as the cord was
not likely to have produced, may lead  to a suspicion that the hanging followed
death.  In  April, 1829,  a boy was found hanging perfectly dead.   On inspect-
 ing the body,  a  round ecchymosed mark, about the  size of a dollar, was seen  on
 the fore part of the neck; and near it  were several impressions as of fingers in
 the  surrounding skin.   There was  neither depression nor ecchymosis in the
 course of the cord.   The inspection left no doubt that the deceased had died
 from asphyxia.  It was  subsequently discovered  that the  boy had been first
 strangled, and  afterwards hanged.  In another case  a man was found hang-
 ing in a room.   His body was so suspended from a hook, that the trunk was not
 more than nine  inches from the floor; and his legs were stretched out at length.
 The cord was  from two to three feet long, and but loosely passed round the neck.
 The furniture of the room was in great disorder, and some marks of dried blood
 were seen on one part of the floor.  The right side of  the head and face of the
 deceased presented several excoriated and ecchymosed marks.   There was a cir-
 cular impression around the neck produced by the cord;  but it was entirely free
 from ecchymosis.  On the left  side, a little  above  this impression, there was a
 strongly ecchymosed mark, which could be  traced round to the back of the head.
 Blood was found extravasated beneath  this  mark.  The lungs presented the cha-
 racters of asphyxia, but the examiners referred this to strangulation and not to
 hanging,  considering that the body had been suspended after death in order to
 give the appearance of suicide.   Had  there  been an  ecchymosed mark  on the
 neck, which could not have resulted from the suspending cord, the  case would
 have remained,  medically speaking, doubtful; because  it is well known that the
 affirmative  signs of hanging may be absent, and yet  the individual may thus
 have died.  (See the case of Pinckard, Strangulation, post.) 
HANGING.   MARKS OF VIOLENCE.                 499
  Marks of violence on the hanged.—The presence of marks of violence on the
body of a hanged  person is important;  and it will be  proper  for a witness to
notice accurately their situation, extent, and direction.   Having satisfied himself
that they must have been received during life, he will have to consider the pro-
bability of their being of accidental origin or not.   These marks of violence are
not always to be regarded as furnishing unequivocal proofs of murder; for it is
possible that they may have been inflicted by the individual himself before hang-
ing, and not succeeding in  committing suicide by these  attempts, he may subse-
quently have resolved to  accomplish his purpose by suspending himself.   Let
the witness duly reflect on  these circumstances before  he allows his opinion to
implicate any party,—let him consider that a hanged subject may bear the marks
of a gun-shot wound, his throat may be cut, his  person lacerated or disfigured,
and yet before a suspicion of homicide is allowed to be entertained, it ought to
be  clearly shown, that such injuries  could  not, by any probability, have been
self-inflicted.  The importance of observing caution in such a case will be still
more manifest, when there is no ecchymosis produced by the cord, and the face
does not present the usual characters of  hanging.   Marks of violence on  a
hanged subject may in some cases be fairly ascribed  to accident.   If the indi-
vidual have precipitated himself with any  violence from a chair  or  table in a
furnished apartment, he may have fallen against articles of furniture,  and have
given rise to lacerations and contusions, especially on the extremities.   Again,
it is possible to imagine that the rope may have given way, and the individual,
in falling, have injured his person;  but he may  afterwards have had resolution
enough to suspend himself  again.   Such an occurrence may be rare;  but when
the presence of these injuries is made to form the chief ground of accusation
against a party as the murderer, their accidental origin ought not to be  lost sight
of by a considerate witness.  If we suppose the person to have been hanged in
a state  of intoxication or stupefaction, medical evidence alone will rarely suffice
to determine the question of homicide or suicide.   The absence of all marks of
violence from the body  might actually lull suspicion.   It is proper on these oc-
casions to look to the hands of the deceased, since it is  with these that a person
defends himself; and, unless taken unawares, it is almost certain, if the hanging
were homicidal, that there  would be traces of violence  on these parts.  The
clothes would be torn and discomposed, and the whole appearance of the deceased
would  be that  of one who had done his utmost to resist a violent murderous at-
tack.   There are some injuries which could not be attributed to accident  under
the circumstances.   Among these we  may enumerate fractures, dislocations,
deeply penetrating incised or gun-shot wounds.   Now the question is, Do these
serious injuries necessarily establish  homicide?  The answer must be in  the ne-
gative; although,  where fractures or dislocations exist, there are very strong
grounds for suspicion.
  Suicides, it  must  be remembered, are  capable of making many attempts on
their lives by  various means.  In the  spring of  1836, a gentleman was found
dead, hanging in his bed-room at an inn.   His dress was much disordered,  and
blood,  which had issued from a deep wound in his throat, was found  scattered
over the floor.   From the facts proved, there was no doubt that  this had been
an act  of suicide; and that the deceased, previously to hanging himself, had  first
attempted to cut his throat.  Had  this body been found in an exposed situation,
this wound in  the throat might have given  rise to a suspicion of murder.   The
following somewhat remarkable case  occurred at  AAralworth in 1836.   A young
man was found hanging in his bedroom, quite dead.  He was suspended by his
cravat, and his feet were within an inch of the floor.  The door of the  room was
fastened on the  inside, and it was proved that no one  could have had access to
it.  An earthen pan was found near  the bed, containing  about a pint of blood,
which  appeared to have proceeded from a very deep incision in the bend of the
left arm of the deceased. The razor with which this had been inflicted was found 
500
HANGING.   MARKS OF VIOLENCE.
on the mantelpiece.  It came  out in evidence, that on the  night previously the
deceased had swallowed a quantity of arsenic, and had suffered severely from the
effects of  the poison;  although at the time it was  supposed that his  illness
was due to other causes.   In this case there were three modes by which suicide
was attempted.  The deceased had  first taken poison, then wounded, and after-
wards hanged himself.   There could be no doubt that death was caused by hang-
ing; and  had the wound  been inflicted, and the poison administered by other
parties, this opinion might  have been safely expressed.   Had the body been
found hanging  in a suspicious locality, these circumstances would have  created
a strong presumption of murder.  The following case is reported by M. Degranges:
—A man was found hanging in a room by a cord attached to a nail in the ceil-
ing.  In the upper and fore part of his neck there was a deep wound, through
which the cord passed. h A ladder was placed against the wall by the side of the
body.   About a pound'of coagulated blood was found on the floor, as well as in
different parts of  the apartment; and some  linen, covered  with blood, was dis-
covered near the body.  In a table-drawer, in the apartment above, was found
some  cord sprinkled with blood, as if a bloody hand had been  searching in  it.
On the staircase between the two apartments there was no trace of blood.  The
deceased's  apartment was  secured on the  inside by the door  being bolted.  An
opinion was demanded of the reporter respecting the manner in  which the de-
ceased had died, and the probability of his having been murdered.
  The deceased's clothes were spotted with blood, and his hands were also bloody.
The body externally did not present  the slightest trace of any ecchymosis or other
mark of violence.   The hands were likewise free from violence; the fingers con-
tracted, and the nails blue.  There  were patches of cadaverous lividity scattered
over the trunk; and it was  evident that the faeces  had been discharged.  The
face had a slight violet tint, and the  tongue projected about an  inch from the
mouth.  This organ had been forcibly compressed by  the teeth.   The wound in
the throat was situated between the chin and os hyoides, and extended from the
angle of the jaw  on one side to the opposite angle.   It had penetrated through
the cavity of the mouth to the pharynx, but had only divided some small branches
of the thyroideal artery: it  had evidently been inflicted after several attempts,
for its edges were irregularly cut. The cord, in passing through the wound, had
lacerated and extended it at the two  extremities.   The cerebral vessels were filled
with blood; the cervical vertebras were uninjured, and the stomach was free from
any trace  of poison.    The opinion  given from these data was to the effect, that
the deceased had died from hanging, and that he  had  hanged himself.
   When we consider  that in this  case the  deceased had  laid  open his  throat
as far as  the vertebral column, dividing the right superior thyroideal artery,
by  which  so  much  blood had  been  lost  that  it was  not  unlikely he would
have  soon fallen  into  a state  of syncope, it is remarkable that he  should have
had sufficient presence of  mind and muscular power to have done what the evi-
dence shows he must have done, namely, to  have placed a handkerchief on his
wound in order to arrest the  hemorrhage; to have gone up stairs to another room,
and have searched in a table drawer for the cord with which he intended to hang
himself; to have placed a  ladder against a wall, and to have made use of this for
the purpose of fixing a cord to a nail in the ceiling, an act which could only be
accomplished with great difficulty.  When we duly reflect on all these  circum-
stances, it does not appear extravagant that the  magistrate who ordered the  ex-
amination should have  been prepared to receive an account of the deceased having
been murdered.  A great deal, it is true, rested upon the moral and circumstan-
tial proofs; as, for example, on the previous state of mind of the deceased, and
the fact of his room having  been found secured on the inside.
   The remarks  made relative to  incised wounds will also apply to gun-shot
wounds.   A suicide may attempt to destroy himself with  a pistol;  he may fail
in  the attempt, and ultimately hang himself.   Any description  of a gun-shot 
HOMICIDAL HANGING.
501
wound, provided it be such as to allow of the individual surviving a sufficient
time, may thus be found on a hanged subject, and yet constitute no proof what-
ever of homicide.  If there be circumstances about  the wound  or injury which
prove that it could not have been self-inflicted, this of course alters the question ;
but where such circumstances are not met with, the cautious medical jurist should
say, in answer to inquiries respecting the origin of these wounds, that they may
have been inflicted either by the individual himself or by another.  There might be
no medical facts which would directly establish either view.  Of course, if, in any
case, the wounds  or injuries be of a decidedly mortal nature, and have probably
caused death, the presumption of murder amounts almost to positive certainty;
for who but a murderer would suspend the dead body of a person so wounded
immediately after death?  (Ann. d'Hyg. 1835, ii. p. 410.)  In one instance of
suicidal hanging,  there were lacerated wounds upon the head, and a  handkerchief
was found blocking up the mouth.  (Henke's Zeitschrift, 1838, ii. 257; 1839,
i. 207; also 1840, i. 135;  also B. and F. Med. Rev. No. xxiv.  p.  560.)
   Was the hanging the result of accident, homicide, or suicide?—Most medical
jurists have passed over the subject of accidental hanging, probably believing it
to be impossible.   In the sense commonly implied by the term, it is  certainly
unusual, but although rare, it is a possible occurrence.  Dr. Smith mentions a
case, which occurred some years  since, in which a girl of the age of thirteen was
hanged by pure accident.   She was swinging in a brewhouse, and near the rope
used by her for that purpose, was another for drawing up slaughtered sheep.  In
the course of the exercise, her head got through  a  noose of this  second cord,
which pulled her  out of  the swing, and kept her suspended  at a considerable
height until dead.   The following case was communicated to  me by one of my
pupils.  In December,  1833, an inquest was held  on the body of a boy aged ten
years.  It appeared in evidence that he had been playing with a child eight years
old, who was the  only witness of his  death.  The deceased  had been amusing
himself in swinging by fastening a piece of plaid gown to a loop in  a cord which
was suspended from a beam in the room.  In the act of swinging, he raised him-
self up, and gave himself a turn, when the loop of  rope  suddenly caught him
under the chin, and suspended him until life was entirely extinct.  The boy who
was in the room with him did not give any alarm for some time, thinking that
the deceased was at play.  The jury returned a verdict of'" accidentally hanged."
Another case occurred in London in 1836.   A man who was in the habit of ex-
ercising himself in gymnastics on the rope, was one morning  found  dead and
suspended in his bed-room.   The rope had passed twice round the body and once
round the neck, whereby it had caused death, although the legs of the deceased
were resting on the floor.   There was no doubt that the deceased had been acci-
dentally hanged.  These are two among several instances which have come to my
knowledge, and it will be seen that the circumstances under which they occurred
were sufficiently decisive of the manner in which  the hanging took place.  In-
deed, circumstantial evidence must always suffice  for the discrimination of acci-
dental hanging;  and we have therefore  merely to  inquire whether, when an
individual is found hanging under circumstances which do not allow of the sus-
picion of accident, the act be the result of suicide or of homicide.   The medical
witness must remember that this is strictly a question for the jury.   It is not for
him to say whether a man  has hanged himself or been hanged by others, but
merely to state, when required, those medical circumstances which support or
rebut one or the other presumption.
   Homicidal hanging.—It  has been  very truly observed, that of all the forms
of committing murder, hanging is one of the most difficult, and it  is, therefore,
but seldom  resorted to.   In most cases where au individual has been hanged by
others, it has  been after death, in order to avert  the  suspicion  of homicide:
Hence the discovery of a person  hanging affords prima facie evidence of suicide,
supposing it to be rendered absolutely certain that death has taken place in this 
502                   PROOF OF HOMICIDAL HANGING.
manner.   AA'e must, however, admit that an  individual may be murdered by
hanging, and the appearances  about his body  will not  afford the smallest evi-
dence of  the  fact.   The  circumstances which will justify a medical jurist in
making this admission- are the following.   First, when the person hanged  is
feeble, and the murderer a strong, healthy man. In such a case, a child, a youth,
a female, or an individual at any period of life, worn out and exhausted by dis-
ease or  infirmity, may be in this  way murdered.  Secondly, when the person
hanged, although usually strong and vigorous,  is at the time in a state of intoxi-
cation, stupefied by narcotics,  or exhausted  by his attempts to defend himself.
Thirdly, in all cases murder may be committed by hanging when many are com-
bined against one individual.   AVith these exceptions, then, a practitioner will be
correct in  deciding, in a suspected case, in favour of the presumption of suicide.
Unless the person labour under stupefaction, intoxication,  or great bodily weak-
ness, we must expect, in homicidal hanging, that there will be evident marks of
violence about  the  body; for there are few who would allow  themselves to
be murdered without offering resistance; notwithstanding the assertion of Mahon,
that some might submit to this mode of death with  philosophical resignation
when they saw that resistance was hopeless!   The following singular case of at-
tempted  murder by hanging  is mentioned in  Symes' Judiciary Reports, Edin-
burgh, 1827.  A woman, aged sixty-nine, was charged with attempting to hang
her husband, who was some years older.  It appeared that the prisoner contrived
to twist a  small rope three times round the neck of her husband, while he was
lying asleep.  She  then  tied  him up to. a beam  in the room  in such a manner
that when  the neighbours entered he was found lying at length  on  the floor,
with his head  raised about one foot above it. He was quite insensible; his hands
were lying powerless by his side, his face was livid, and it was some time before
he could be roused.   Had he remained three minutes longer in this position, he
would have died. According to his statement, he went to bed quite sober, and he
was not aware  of any thing which passed during the attempt to hang him, or after-
wards, until he was resuscitated. The prisoner  was convicted of the assault with-
out previous malice, she having had no ill-will  against her husband, and being at
the time intoxicated.  It can hardly be considered possible that any man should
be so sound asleep as not to be awakened by the attempt thus made to hang him.
The probability  is, that the prosecutor was, like his wife, intoxicated.  A case of
alleged murder by hanging, and of considerable difficulty in its medical relations,
was tried at the  Exeter Summer Assizes,  1851 (Reg. v. Rowe.)   Although the
prisoner was acquitted, there were some strong  facts leading to the belief  that
this could not have been an act of suicide. .
  Some medical jurists have thought that the mark left  by the cord on the neck
would serve as a, criterion on which we might  depend.  Thus it has been said,
if the mark be circular,  and placed at  the lower part  of  the  neck, it is an
unequivocal proof of nuirder.   In  hanging, the mark of the cord is generally
oblique, being higher at  the back part of the neck, in  consequence of the loop
formed by it yielding more in this direction than anteriorly.   But it is an error
to suppose that this want of obliquity in  the impression can afford any evidence
in favour of the act having  been homicidal.   Its form will depend in a  great
degree upon the fact of the body being supported or not,  for it is the weight of
the body which causes its obliquity: it will also depend  on the manner in which
the cord is adjusted.   A case  of suicidal hanging is related by Orfila, in which
the  mark of the cord extended  horizontally round the neck from behind forwards.
(Med. Leg. tome ii. p. 376.)  The slip-knot of the cord was in front of the
neck, and it is obvious that when the  cord is  thus adjusted by a suicide,  there
will be  scarcely any obliquity in the depression produced by it.   Equally ill-
founded is the assertion, that the existence of two imj)ressions on the neck affords
positive  proof  of homicide.  One of these impressions may be at the lower part
of the neck, and circular; the other at the upper part, and oblique: it is there- 
INJURIES TO THE NECK IN SUICIDAL HANGING.
503
 fore contended that the deceased must have been strangled in the first instance,
 and afterwards hanged.  The possibility of a prior attempt being made by a
 suicide to strangle himself, is not adverted to: " Si Ton observe les deux im-
 pressions," says Mahon, " l'assassinat est  alors  parfaitement prouve."   It is
 fortunate that there are facts on record to oppose to  this very decided statement.
 One of the first cases reported  by Esquirol is that of a female lunatic, who
 committed suicide by hanging herself, and on whose neck two distinct impressions
 were seen—the one circular,  the other oblique!  These appear to  have  arisen
 from the cord having  been  passed twice round the neck, the body being  at the
 same time partially supported.   In some instances,  a presumption of homicidal
 interference may  exist if there  be two  distinct impressions, but it cannot  be
 admitted that they establish the fact of murder.
   The injury done to the  neck by the cord  can  rarely afford any  clue to the
 manner in which hanging took place,  unless the circumstances under which the
 body is found favour the presumption of homicide or suicide.   Thus the laceration
 of the muscles and vessels of the neck, the rupture of the trachea and the dis-
 placement of the  larynx, stretching of the vertebral ligaments, and effusion on
 the spinal sheath, may be  observed in suicidal as in homicidal hanging.  The
 presumption, however, is obviously in favour of  the latter when these violent
 injuries are found to he accompanied by fracture or displacement of  the cervical
 vertebrae, and the body of the deceased is not corpulent,—the ligature by which
 he is suspended is not of a nature to produce them, and the fall of the body has
 not been great.
   Injury to the cervical vertebrae.—A much disputed question has arisen in me-
 dical jurisprudence, whether the cervical vertebras can become fractured or dis-
 placed in suicidal hanging.   Most medical jurists  deny the possibility of this ac-
 cident occurring,—the displacement or fracture of these vertebrae  being rarely
 observed, even in criminal executions, where the greatest violence has been often
 used by the executioner.  So far as I am aware, there is no case of suicide  on
 record in which this injury to the neck existed.   The case referred  to by Petit,
 which was left  to the  decision of Dr. Pfeffer, is unsatisfactory, because the body
 was not examined; and  it is  doubtful whether the  act  had really been one of
 suicide or not.   M. Ansiaux,  of  Liege, in inspecting the body of a woman who
 had hung herself, found extravasated blood behind  the first two cervical vertebras,
 which  were more widely separated posteriorly than  usual.  On removing the ver-
 tebrae, the posterior ligament of the spine was found ruptured, and the transverse
 ligament of the atlas so stretched that the odontoid process of the second vertebra
 was completely locked against  the .articular  surface. „ The  perpendicular and
 oblique ligaments  were entire.   The deceased was  a  stout healthy person: when
 discovered, her body was suspended from a beam at the distance of about a foot
 and a  half from the  floor.   She had evidently fallen with  considerable  force.
 The case of this female will  serve to show that severe injury to these deep-seated
 regions of  the neck may be occasionally met with in suicidal hanging.  A case
 somewhat similar to this has been reported by Mr. Campbell de Morgan.   (Lan-
 cet, Auoust 10, 1844.)  A married woman, aged  fifty, worn out and exhausted
 by disease, was found hanging quite lifeless  from  the rail of a  bed, which was
 not more than five feet eight inches from  the  ground.   The  front of her  body
 was turned round towards the bed, the head thrown  forcibly back,—the knot of
 the ligature, an old silk handkerchief, being placed in  the middle of the  under
 side of the chin.   Her heels were about three inches from the ground,—the
 knees being on a level with the bed-frame, and resting against it.  The body was
 seen by a medical  man about an hour after it was  cut down,—the features were
 perfectly calm,  and there was  no trace of congestion  about the face: it was pale,
 and in  all respects natural.  There was no lividity; the eyes were neither injected
 nor prominent; the tongue pale, lying far back in the mouth, and without any
mark of  indentation.   The cord-mark well defined, and, like parchment, dry, 
504
EVIDENCE FROM THE POSITION OF THE BODY.
brown, and hard, without any ecchymosis, but with a thin line of congestion at
the upper edge of the groove:—it was very deep  at the back  of the  neck, just
over the atlas, probably owing to the head hanging  backwards.  The mucous
membrane of the stomach was pale; the lungs natural;  no congestion of the
large veins or of the cavities of the heart: the two ventricles contained about an
equal quantity of blood.   These appearances seemed to show that death was not
caused either by asphyxia or by cerebral congestion.   Neither the trachea  nor
the great vessels of the neck could have sustained any pressure  or constriction.
The deep muscles over the second  and third cervical vertebrae were ecchymosed:
this ecchymosis extended  to the  sheath of the spinal marrow; and on the left
side, and exterior to the sheath, there was an extensive effusion  of blood firmly
coagulated.   There was no displacement of the second or other vertebrae, and
the ligaments were sound; but between the third and fourth vertebrae, there was
unusual mobility as if they had been stretched.   In this  case the body was not
heavy, and the fall, if any, could  have  been  but trifling.  The effusion on the
spinal marrow was the cause of death; and its origin was sufficiently explained
by the falling back of the head and  sudden  bending of  the cervical vertebrae.
Her husband and family were in an adjoining room, but heard no noise; it was
only by accident that the  deceased was discovered.
  In all doubtful instances, we should not lose sight of moral and circumstantial
evidence.   AVe should ascertain whether the individual had been previously dis-
posed to commit suicide or not;—we should observe whether the doors and win-
dows of the apartments be secured on the inside or on the outside;—whether the
dress of the deceased be at all torn or discomposed,  or his hair dishevelled;—
whether the rope or ligature correspond to the impression  seen around his neck;
—and lastly, whether the ligature be of sufficient  strength to support the weight
of the deceased.  (Case of Pinckard, post, p. 516.)  These points fall, it is true,
more within the province of the officers of justice than of a medical practitioner;
but the latter is generally the first who is called to see the deceased, and there-
fore, unless such facts were noticed by him on his visit, they might often remain
altogether unknown.
   The position of the body.—Lastly, it has been contended that the position of
the body may serve to distinguish suicidal from homicidal hanging.   This point
was strenuously argued on the investigation  which took place relative to the
death of the  Prince de  Condi in 1830.  According to the opinions of some of
the witnesses on that investigation, if the body of a man be found in an inclined
posture or so suspended  that his feet are in  contact  with the floor,  the idea of
suicide by hanging is at once negatived,—we are rather to suppose that the per-
son must have been otherwise destroyed, and his body afterwards placed in that
position by his murderers.  Here, then, we are called upon to admit that suicidal
hanging is improbable, if not  impossible, unless  the body of the deceased be
found freely  and absolutely suspended without any support!   This very strong
opinion, it will be seen, is not borne out by facts.   In order  that death should
take place by hanging, it is  not necessary that the body should  be  freely and
perfectly suspended.  Cases are of very frequent occurrence, where the bodies of
hanged persons are found with  the feet on the ground, kneeling, sitting, or even
in the recumbent posture.  These are truly mixed cases  of hanging  and stran-
gulation.   I  have now before me the reports of eleven cases of suicidal hanging
or strangulation which  have occurred within the last few years.  In three the
deceased were found nearly recumbent; in  four, in  a kneeling  posture,—the
body being more or less supported by the legs;  and in  four, the persons were
found sitting.  (For many singular  cases of  this kind, with plates, see Annales
d'Hyg.  1830, i. 166; 1831,  p. 157; 1834, i. 472.)  In  one instance,  the de-
ceased was found on his knees at the foot of  the bed, with his cravat round his
neck,—the other end being, thrown over the bed-rail, and then twisted tightly
round his right hand.   In another, the deceased,  a prisoner, was found dead in 
EVIDENCE FROM THE POSITION OF THE BODY.
505
  the sitting posture.   (Ann. d'Hyg. 1831, i. 196.)  He was hanging to the iron
  bar ot the window of his prison, which was so low that he was almost in a sitting
 posture.   Ihe ligature which he had employed was a cravat, but (what was more
  remarkable in the case) the hands of the deceased ivere found tied by another
  handkerchief.  The body was warm when discovered.   There was not  the least
  doubt of this having been an act of suicide; yet, as the reporter observes, had
  the body been found m an unfrequented spot, the discovery of the bands tied, if
  not the position, would have led to a strong suspicion of murder.   In the opinion
  ot the reporter, the deceased had contrived to tie his hands together by means of
  his teeth.  (Ann. d'Hyg. 1832, i. 419.)  Among the  cases collected by Esqui-
  rol, is the following.   A patient in La Charite  was found one morning hanging
  by a rope which was attached to the head of his bed.  He had fastened this by
  a loop round his neck, but his body was so retained, that when discovered he was
  on his knees by the side of his bed.  There are one or two other similar instances
  related by the same author, which I shall omit, and describe one that fell within
  my own knowledge.  In 1832, a man was found hanging in his room, with his
  knees bent forwards, and his feet resting upon the floor.  He had evidently been
  dead for some time, since cadaverous rigidity had already commenced.  The man-
  ner in which this person had committed suicide  was as  follows:—he had made a
  slip-knot with one  end of his  apron (he was a working mechanic) and having
  placed his neck in this, he threw the other end of the apron over the top of the
  door, and shutting the door behind him, he had succeeded in wedging it in firmly.
  At the same moment he had probably raised himself on  tip-toe, and then allowed
  himself to fall;  in this way he died.   The weight of his body had apparently
  sufficed to drag down a part of the apron, for it seemed as if it  had been very
  much stretched.   (See also a case by Dr. Albert, Henke, Zeitschrift, 1843, ii.
  50.)   [AVe know of a case in which a man hung himself with a drover's  whip,
  and was found dead reclining on the floor, at the foot of a low bedstead, with one
 end of the long lash around his neck, and the other end attached to the bed-post.
 See also Am. Journ. Med. Sci., Jan. 1853, from Med. Times and Gaz., for an
 analogous but still more  remarkable case, in which  the individual was found
 lying on his abdomen with his throat  pressing on a loop of leather suspended
 from the bed-post above.—H.]
   Remer found that out of one hundred and one cases of  suicidal hanging, in
 fourteen the  body was either standing or kneeling, and in one instance it was in
 a sitting posture.   Dr. Duchesne has recently published  an account of fifty-eight
 cases, in which the suspension of the body was partial,—the feet or trunk being
 more or less supported.   Twenty-six of these cases are new.  The reporter conies
 to the conclusion that suicide by hanging is compatible  with any posture of  the
 body, even when resting upon the two feet.   (Ann. d'Hyg., Oct.  1845, ii. 141
 and 346.)   Further evidence need not be adduced to show how unfounded is that
 opinion, which would attach the idea of homicidal interference  to cases where a
 body is loosely suspended, or where the  feet are in contact with  any support.
 AA e ought rather to consider these facts as removing  all  suspicion  of homicide;
 for  there  are  probably few murderers who would  suspend their victims, either
 living or dead, without taking care that the suspension was complete.  Besides,
 the facts of many of these cases are readily explicable:—thus, if the ligature be
 formed  of yielding materials  or it be loosely attached, it will  give way to the
 weight of the body after death, and allow the feet to touch the floor, which they
 might not have done in the first instance.   If there be reason to believe that the
 body has not altered its position after suspension, we must remember  the facility
 with which insensibility comes on, and the rapidity with which death commonly
 ensues in this  form of asphyxia.   (See Med. Gaz., vol. xliv., p. 85.)
  The limbs secured in suicidal hanging.—One  or  two other points are also
 worthy of notice in relation to this question.   The hands or the legs, but more
commonly the former, have been frequently found tied  in cases of  undoubted 
506
PROOFS OF SUICIDAL HANGING.
suicidal hanging (Ann. d'Hyg. 1832, i. 419;) and  yet it has been gravely de-
bated, whether it were possible for a person to tie  or bind up his bands, and
afterwards hang  himself!  It is unnecessary to examine the ingenious arguments
which have been urged against the possibility of an act of this  kind  being per-
formed ;  since among niany cases that might be quoted, two occurred in 1843,
in this metropolis, where the persons died  from hanging: the act was suicidal,
and the hands were found tied in both instances with  a silk handkerchief.   A
third case occurred at AVorcester in December, 1844, in which the deceased tied
his wrists with a silk handkerchief, and secured  to  this two flat irons in order
to increase the weight.  A remarkable  case of suicide in which the hands and
ankles were tightly secured has been communicated to the Medical Gazette, by
Mr. J. H. Taylor, vol. xlv. p. 388; see also cases in  Guy's Hospital Reports,
Oct. 1851.
   Power of self-suspension.—It has been a debated question, whether corporeal
infirmity, or some peculiarity affecting the hands, might not interfere with the
power of an individual to suspend himself.  This question can  be decided only
by reference to the special circumstances of the case.   In the case of the Prince
de Condi, it was alleged that he could not have hanged himself, in consequence
of a defect in the power of one hand:—it was said that he could not have made
the knots in which the cravats by which he was suspended were tied.   Allega-
tions of this kind appear to have been too hastily made in this and other instances.
A determined purpose will often make up  for a  great degree of corporeal infir-
mity; and unless we make full allowance for this in suicide, we shall always be
exposed  to error in drawing our conclusions.
   Is blindness a bar to suicidal hanging?—The answer to this question is de-
cidedly in the negative, not from theory, but from actual facts; although some
might be inclined to doubt whether a man labouring  under such an infirmity
could really thus  destroy himself.  In  February, 1837, an inquest was held  in
London, on the  body of a blind man, who was found dead hanging in an out-
house.   The evidence left not the smallest doubt of his having committed suicide.
Connected with  this, is the question how far weakness or infirmity from age may
interfere with this form of  suicide!  Suicide under any circumstances  among
young subjects is rare.  Out of one hundred and  ninety-eight suicides, observed
by M.  Esquirol, at the  Salpetriere, there  were  but two  instances of subjects
under fifteen years of age.   (Ann.  d'Hyg. 1836, ii. 400.)   The youngest age
at which I have  met with a case of suicidal hanging was in a boy of nine years,
who hanged himself at Hampstead, in April, 1837.   The greatest age was in the
case of a man of ninety-seven, which occurred in September, 1842.  In a former
part of this chapter, it has been stated  that asphyxia  in hanging may be very
insidiously induced, so that although the individual may have the power of easily
rescuing himself, yet this is impossible.   The  transition from  life to death in
such a case is as rapid as it  is imperceptible.  This  will explain why persons so
readily die from slight constriction of the trachea, when their bodies  are partly
supported, either standing, kneeling, or sitting:—why, also, it  is not necessary
that the cord or ligature should  be drawn tightly round the neck; and lastly,
why, as  it has frequently happened, this form of  suicide should be easily perpe-
trated by persons  labouring  under disease or  infirmity in a room where others
are present or near, but who are not aware of the act. This last circumstance
has in more than one instance  given rise  to an ill-founded  suspicion of murder.
AVhen an individual has obviously died by hanging, and the  presumption of
suicide is rebutted, or the act itself denied by a medical witness, the only alter-
native is, that it must amount to murder.   It  is not possible  to conceive that
the act of hanging another can ever admit of justification or excuse.   AVhen, in
the case of death from drowning or wounds, it is doubtful whether the act should
be referred to suicide or homicide, the admission of its having been homicidal
does not necessarily cut off  all hope from the accused.  The deceased may have 
PROOFS OF SUICIDAL HANGING.
507
been drowned or wounded accidentally, or he may have been drowned or wounded
intentionally; but under circumstances of great provocation.  _The aot, therefore,
may turn out to be a form of manslaughter.  In hanging, however, the  defence
could never be that the act was accidental, nor is it possible to believe that the
law would admit provocation as a justification for what must  have been so de-
liberately done.  The act itself, like  poisoning,  would be at once  evidence of
malice.   AA"ith this knowledge, then, of what the absolute denial of suicide must
lead to in a suspected case, a witness is bound to examine closely  every medical
presumption which can be  construed in  the least degree unfavourably to an
accused party.   One of the most remarkable casos on record is that of the Prince
de  Concli,  which occurred in ls.30, and  excited the  attention of  the medical
jurists of France and England.   It involves many of the  questions connected
with the medical jurisprudence of hanging.  (For a full account of this singular
case, which  in my opinion was one of suicide, I must refer the  reader to the
Ann. d'Hyg. 1831, p. 157.) 
508
STRANGULATION.  CAUSE OF DEATH.
STRANGULATION.
                             CHAPTER LIX.

CAUSE OF DEATH--POST-MORTEM APPEARANCES--WAS DEATH CAUSED BY STRANGULATION, OR
  WAS THE CONSTRICTION APPLIED TO THE NECK AFTER DEATH?--CASPER'S EXPERIMENTS
  ON POST-MORTEM  STRANGULATION--MARKS  OF VIOLENCE--ACCIDENTAL, HOMICIDAL, AND
  SUICIDAL STRANGULATION--CASES.

   Strangulation.   Cause of death.—Hanging  and strangulation are usually
treated together;  and some medical jurists have admitted no distinction in the
meaning of these  terms.  In hanging, the phenomena of asphyxia take place in
consequence of the suspension of the body, while in  strangulation, asphyxia may
be induced not only by the constriction produced by a ligature round the neck,
independently of  suspension, but by the simple application of pressure through
the fingers or otherwise to the  trachea.   It may, indeed, be said, that every in-
dividual who is hanged is literally strangled; but hanging is  only one form of
strangulation,  and sufficiently peculiar to  claim  a separate  consideration.   AVe
have now, therefore, to direct our attention to the other means which have been
employed to obstruct the respiratory process by external pressure on the trachea.
These have  commonly been arranged and treated  under the head  of manual
strangulation.   The cause of death is the same in the two cases, namely asphyxia;
and the rapidity with which death ensues in strangulation will depend in a great
degree on the force employed, and on the completeness with which the respiratory
process is obstructed.   In strangling, a much greater degree of violence is com-
monly employed  than is necessary to  cause  asphyxia; and  hence the  marks
produced on the skin of the neck will be, generally speaking, much more evident
than in hanging, where the mere weight  of the body is the medium by which
the trachea is  compressed.
   Post-mortem appearances.—The  post-mortem appearances  externally and in-
ternally are  the same in strangulation as in hanging, but the injury  done to the
parts about the neck is commonly greater in the former case than in the latter.
If much force has been used in producing the constriction, the trachea, with the
muscles and vessels in the fore part of the neck, may be found cut or lacerated,
and the cervical vertebras may be fractured.  The face  is more commonly livid
and swollen, the  eyes congested, and the  pupils are dilated.  The mark of the
ligature, if a ligature  has  been  used, is generally circular, and situated at the
lower part of  the neck.  Instances have, however,  been related where a circular
mark has been observed in hanging;  and it  is possible that some degree of
obliquity may occasionally exist in the course of the  depression produced by a
ligature in strangulation.   The  medical jurist ought, therefore, to weigh all the
circumstances connected with the position of the body, and the direction of the
ligature, before he forms an opinion whether the individual has been hanged or
strangled.   Much more importance is to be attached to the  lividity,  ecchymosis,
and abrasion of the skin in the course of the ligature, than to the circularity or
obliquity of  the depression produced by it.   In the  strangling of a living person 
STRANGULATION.  APPEARANCES IN THE DEAD BODY.        509
 by a cord  it  is scarcely possible that a murderer could avoid producing on the
 neck marks of violent injury; and in the existence of these, we have evidence
 ot the manner in which death has taken place, which we cannot always expect to
 find in hanging.   On the other  hand, a person  may be strangled, and  yet  the
 ligature, m consequence of its being soft and of a yielding nature, will not cause
 a very perceptible depression or ecchymosis.   Such instances must, of course, be
 rare; because murderers usually produce a much more violent constriction of the
 neck than  is necessary to ensure the death of their victims.  The general lividity
 of the body, contraction of the fingers, with clenching of the hands, and swelling
 or protrusion  of the tongue, are the same in strangulation as in hanging.  Mu-
 cous froth  may also be found in both cases.  The internal appearances are those
 of asphyxia,  The lungs and right cavities of the heart are distended with thick
 black  blood, while the left cavities are commonly empty.  The state of the brain
 calls for no particular notice.  The bloodvessels are sometimes found distended.
 In some^ instances of strangulation, it is said that blood has escaped from  the
 ears during the act; but, with a probable exception, to be hereafter mentioned,  I
 am not aware that there is any well-authenticated instance in which effusion of
 blood  was met with on the brain of a strangled subject.  (For an account of  the
 appearances in a  strangled body thirty-eight days after interment, see  Henke,
 Zeitschrift, 1842, i.  236; ii. 310.)
   The medico-legal questions relative to strangulation are of the same nature as
 those which have been  already discussed in treating of hanging.   Thus, in  ex-
 amining the body of a person suspected to have been strangled, we may be  re-
 quired to answer the following question:—
   11 as death  caused  by strangulation, or  was the constricting force applied to
 the neck  after death?—The internal  appearances of the body will yield no evi-
 dence whereby this  question can be solved;  but the external  appearances  are
 commonly  less ambiguous  than  in  a  corresponding  case  of  hanging.   The  ec-
 chymosis about the depression on the neck, when a ligature has been employed,
 with the accompanying turgescence and lividity of the face, are phenomena not
 likely to be simulated in a dead body by the application of any degree of violence.
 AVhen the  constriction is produced within a few minutes after dissolution, an ec-
 chymosed depression may result; but it is improbable that there should be any li-
 vidity or turgescence of the countenance.
   The experiments of Prof. Casper, referred to in treating of the subject of hang-
 ing, bear directly upon the question which we are now discussing.   He deter-
 mined, from his observations, that when the constricting force was not applied
 to the neck until six hours after death, the mark indicative of vital strangulation
 could  not  be  produced.   The  following is a summary of his  experiments  on
 strangulation in the dead body:—
   1.  Six hours after death, a double cord was tightly drawn  around the neck of
 a female, below the larynx.  On the  following  morning the cord was loosened,
 and the neck examined.   There was no particular appearance.   AVhen the skin
 had assumed its natural position, the  part  where the cord had been placed was
 scarcely distinguishable.—2. A man died of apoplexy, and thirteen hours after
 death a cord was as tightly drawn around  the neck, above the larynx, as possi-
 ble.   Six hours afterwards, on examining the  neck, a soft impression, easily re-
 moved by pressure, was perceptible.   There was no discoloration, nor any other
 change to be discovered in the skin.—3.  Twenty-four hours after death, a double
 cord was  very  tightly drawn around the neck of a male subject.   On  examina-
 tion the next day, there was a slight double depression, but  no  colour nor any
 other perceptible change.  This  experiment was repeated on another subject,
 with similar results.—1.  The last experiment was on the body of a child, about
 one year and a half old.   On the day after death, a small cord was tightly drawn
and secured around  the neck.   Twenty-four  hours afterwards,  a slight  bluish-
coloured mark was perceived.   It  was quite superficial, but sufficiently distinct 
510                 STRANGULATION.   MEDICAL PROOFS.
to strike the eye.   On cutting into the skin there was not any blood effused be-
neath.
   We learn from these experiments that when the attempt to simulate strangu-
lation in a dead subject is not made until six hours at least have  elapsed, there
is no risk of confounding the mark thus  produced with that which is formed
when the violence is applied to a living individual.   It  is  probable, that so far
as the ecchymosis is concerned, if  the attempt were made after an hour or two
hours had elapsed, it would wholly fail;  and with regard to the non-ecchymosed
mark, it is very doubtful whether it could be produced after three or four hours.
These periods, it must be remembered, are not settled with positive certainty:
the results would probably vary, according to  the degree of rapidity with which
the body had cooled.
   It  is difficult to conceive under  what circumstances  an  attempt to  simulate
strangulation  in a recently dead body could be made, unless  for the purpose of
throwing  suspicion upon an innocent person connected with the deceased. AVhen
an individual has been murdered, it is not likely that the murderer would attempt
to produce the appearances of strangulation on the body after death, under the
idea of concealing his crime; for strangulation is in most cases a positive result
of homicide, and  is very rarely seen as an act of suicide.  In the absence of
ecchymosis from the neck, it will  be difficult to form  an opinion, unless from
circumstantial evidence.   It must be remembered, however, that there  may not
always be an ecchymosed circle, for an  individual may be strangled by the ap-
plication of pressure to the trachea through  the  medium  of the  fingers, or of
any hard  or resisting material.  The ecchymosis  in  such a case will be  in de-
tached spots.  In the absence of all marks of violence about the neck, we should
be cautious in  giving an opinion which may affect the life of an accused party;
for it is not probable that homicidal strangulation could be accomplished without
the production of some appearances of violence about the larnyx or trachea.  It
is doubtful whether strangulation  ever takes place without some mark being
found on  the neck indicative of the means  used.   The bare possibility  of death
being caused in this manner without leaving  any appreciable trace of violence,
must be admitted, although the admission  scarcely applies to those cases which
require medico-legal investigation.  Suicides  and murderers generally employ
more violence than is necessary for the purpose of destruction; hence detection
is easy.  But if a very soft and elastic band were applied  to the neck with regu-
lated force, it is possible that an individual might  die strangled, without any ex-
ternal sign  being  discovered  to indicate  the manner of  his death.   Indian
surgeons  inform us  that  the Thugs,  and  other robbers of  the  Himalaya
mountains, are thus accustomed to destroy their victims, with the dexterity of
practised murderers.  A case  involving this  question of strangulation without
marks of violence, was recently tried in France, and from the medical  evidence
decided in the affirmative.   (Gaz. Med. 9  Mai, 1846, 375.)  The medical wit-
ness should, however, be prepared to consider whether, in the absence of any mark,
death might not have proceeded from another cause, and  leave it  to the autho-
rities of the law to  decide from circumstances in favour of, or against the pri-
soner.   There is, I conceive, nothing to justify a medical witness in stating that
death has proceeded from  strangulation, if there  should  be no  appearance  of
lividity, ecchymosis, or other violence about  the neck or  face of the deceased.
The  state of the  countenance alone will scarcely warrant the  expression of an
opinion; for there are  many kinds of death in which the features may become
livid and distorted from causes totally unconnected with the application  of exter-
nal violence to the  throat.   Let not a witness, then, lend himself as an instru-
ment in the hands of a counsel, for the condemnation of a person against whom
nothing but a strong  suspicion from  circumstances may be raised, and where
medical evidence is unable to throw any  light upon the  probability  of death
having resulted from  strangulation.  (See the trial  of  Mrs. Byrne, for murder, 
SUICIDAL STRANGULATION.
511
 Dublin Commission  Court, Aug. 1842.)  This  trial is full  of interest to the
 medical jurist   .Some post-mortem changes appear in this case to have been mis-
 taken tor marks of strangulation.
   Ait!'\K Vl'°ience-—lt is scarcely necessary to state that all marks of violence
 on the  body of a supposed  strangled  person  should be accurately noted, as
 the questions respecting them are material.  The witness will be  expected to
 state whether they were inflicted  before or after death; if before, whether they
 were sufficient to account for  death, or whether they were such as to be expli-
 cable on the supposition of an accidental, suicidal, or homicidal origin.  It should
 be observed whether  there exist any morbid changes, sufficient to account for
 death in either of the three great cavities  of the body,  as this kind of evidence
 may be very essential in the progress of the case.
   Was the strangulation the result of accident, suicide, or homicide?— Strangu-
 lation, like  hanging,  is occasionally the  result of accident; but the occurrence
 may be looked upon  as rare.   AVhen the body is not suspended, it is commonly
 more m the power of an individual to assist  himself, and escape from  the con-
 striction: hence accidental strangulation is perhaps less frequent than accidental
 hanging.   A few instances of accidental  strangulation are on record.   One is
 reported by the late Dr. Gordon  Smith.  The subject was a boy, who was accus-
 tomed to move about with a  heavy weight suspended by a  string around his
 neck.  One day he was found  dead in a chair.   The weight appeared  to have
 slipped, and to have drawn the cord tightly round the fore part of his neck.  In
 June, 1839, a girl was accidentally strangled in the following way :—She was em-
 ployed in carrying fish in  a basket at her back, supported by a leathern strap
 passing round the fore part of  her neck, above her shoulders in front.   She  was
 found dead, sitting on a stone wall; the  basket  had  slipped  off, probably while
 she was resting, and had thus raised the strap, which firmly compressed  the  tra-
 chea.  A similar case is recorded by Watson (Homicide.) 'There will be no
 difficulty in deciding  a question of accidental strangulation, from the sight of the
 body and the means of constriction. Should it happen, however, as it is not un-
 likely, that the body  has been removed from  the  position in which  it was first
 discovered, we can only establish  a presumption  of accident from the description
 given by those whp first discovered it.
   AArhen a charge of  murder is instituted against a party, an attempt is not un-
 frequently  made  by  counsel  for the  defence  to   show the probability that
 the deceased might have fallen  while in a state of intoxication, and have become
 accidentally strangled by a tight cravat, or by some foreign body  exerting
 pressure  on the trachea.   If we  admit the possibility of an occurrence of this
 nature, we must not lose sight  of the existence of other more probable modes of
 death, nor should we  allow our judgment to be so swayed as to abandon what is
 probable for that which is merely possible.
   Suicidal strangulation.—This mode of suicide must be regarded as of extremely
 rare  occurrence, and, except under particular circumstances, impossible.   The
 possibility of an individual strangling himself was  for a long time denied by
 medical jurists; for it was presumed that when the force was applied by  the
 hand, all power would be lost  so soon as  the compression of  the trachea com-
 menced.  This reasoning, which is physiologically correct, is, however,  only ap-
 plicable to  those cases in which the windpipe is voluntarily compressed by  the
 fingers.   AVhen an  individual,  determined on suicide, allows the trachea to  be-
 come compressed by leaning with the whole weight of his body on a ligature passed
 round his neck and attached to a fixed point, he may perish  in this way almost
 as readily as if he had hanged himself; for insensibility and death will soon su-
pervene.  In the chapter on Hanging, it was stated that suicides were often found
with their bodies in close contact  with the  ground;  and cases were referred to in
which strangulation was accomplished in the manner above described, while  the
suicide was in a sitting  or kneeling posture.   On other 'occasions, the  peculiar 
512
SUICIDAL STRANGULATION.
disposition or nature of  the  ligature has enabled a person  bent on suicide to
strangle himself without much difficulty.  An instance is related by Orfila, where
two cravats, which were twisted several times round the neck of the deceased, who
was discovered lying on his bed, had  effectually served the purpose of self-de-
struction.  (Med. Leg. ii. p. 389.)  Sometimes strangulation has been suicidally
effected by a rough cord  passed several times round the neck, and tightened by
being pulled with each hand.   The number of coils would cause the pressure to
be exerted even where the grasp was relaxed by death. (See Guy's Hospital Re-
ports, Oct. 1851.)  Other cases are related, in which suicides  have succeeded in
strangling themselves by tightening the ligature with a stick (see case by Mr.
Thorp, Guy's Hospital Reports, Oct., 1851;)  or  where this was formed of thick
and rough materials by  simply tying it  in a knot.   A young female of Monte-
vrin, in the Canton of Lagny, was found one morning, dead in bed, lying on her
face, with a woolen garter passed twice around her neck, and secured in  front by
two simple knots, strongly tied the one on the other.   The body was in an inci-
pient state of putrefaction, but still  there was a mark corresponding to  the liga-
ture.   This was shallow, of a  slight greenish colour, especially in front, and pre-
sented here and there ecchymosed spots;  posteriorly the mark was scarcely visi-
ble.   The face was livid and swollen: a  quantity of sanguineous mucus escaped
from the mouth and nostrils.   The  lips  were livid; the tongue protruded, and
firmly compressed between the  teeth: the body presented, over the trunk and
limbs, patches of ecchymosis.   On cutting into the mark on the neck, there was
no extravasation, neither was there any apparent injury to the deep-seated muscles
or adjacent parts: the lungs were gorged with blood, but the other.viscera of the
body  presented no particular  appearance.   The medical  examiners gave it as
their opinion, that the deceased  had died  from apoplexy resulting from strangu-
lation.   They stated that the head was not examined, and  they judged that apo-
plexy was the cause of death, from the condition of the face.   A more important
question was, whether the strangulation  was  suicidal or homicidal.   There was
some reason to  suspect the latter, and indeed a party was pointed out as the pro-
bable murderer;  but a rigorous medical investigation, relative to the state of the
person and clothes, as well as numerous collateral circumstances, satisfactorily
established that this was an act of self-destruction.  (Ann.  d'Hyg. 1829, ii. 440.
See also a case by Dr. Simeons, Henke,  Zeitschrift, 1843,  i. 335.)
   Sometimes the appearance of the mark on the neck will allow us to establish
a slight presumption for  or against homicide.   In homicidal strangulation, from
the unnecessary violence used, we may expect to find the skin much ecchymosed,
lacerated, or excoriated, and the deep-seated parts, such as the muscles and ves-
sels, as well as  the windpipe itself, more  or less bruised, lacerated, or extensively
injured.   Such violence  is not  commonly to be expected in suicidal  strangu-
lation.
   Supposing the marks  of fingers  to exist, the presumption is in favour of
homicide;  as also in all cases where the cause of strangulation is  not at once
apparent on the  discovery of  the  body.  Suicides are not  likely  to  strangle
themselves in  any other way than  by  a ligature applied  circularly.   If the
ligature be still around the neck of  the deceased, the  position of the knot may
throw  some light upon the case; if tied in two  or three knots at the  posterior
part of the neck, the presumption  is assuredly  in favour  of homicide.  Then,
again, the nature of the ligature  should be  attended to.  Suicides generally
employ those articles for ligatures which are nearest at hand,—such as cravats,
stockings, or garters.   Some medical jurists have attempted to limit the varieties
of suicidal strangulation; contending, that when a subject is  found strangled in
any other way  than in one of those arbitrarily laid down by them as essential to
suicide, it is evidence of murder.   The fact is, cases as yet are few, and each new
instance of suicidal strangulation presents us with something novel in the means
of its accomplishment-;  a sufficient proof, therefore,  that we ought to be very
cautious how we  decide these questions by hastily preconceived rules. 
SUICIDAL STRANGULATION.
513
   The way in which the notorious criminal, Greenacrc, attempted to destroy
 himself by suicidal strangulation, presented some novelty;  and certainly it does
 not fall within the  methods which, according to some medical jurists, suicides
 ought on these occasions to  adopt.  AAThen, in March, 1837, he was confined at
 a Station-House, he was found by the inspector who entered  the room  lying on
 the floor, with a handkerchief drawn tightly around his neck by means of a loop,
 into which he had inserted his foot.  AVhen first seen, his face was livid, and he
 was apparently dead: the handkerchief was cut, and venesection, with other means
 of resuscitation, were employed with success.   The  manner in which  General
 Pichegru was found strangled in prison gave rise to a strong suspicion of murder,
 merely from  the  singularity of the method adopted.  The ligature which he
 employed was found  tightened around his neck by means of a stick, which had
 been twisted, and then fixed behind one ear.  There was no lividity of the face.
 It was contended that Napoleon had  caused the  General to be strangled or
 suffocated, and that  the ligature was afterwards  applied.   The evidence of this
 having been an act of homicide  is very weak;  and so far  as the medical  cir-
 cumstances extend, there  is no reason to doubt that it was an act of suicide.  The
 only  obstacle to the admission of this, in the opinion  of some jurists, is  the
 employment of a  stick for the purpose of tightening the  ligature; but there are
 at least two similar cases  on record, in which the suspicion  of murder could  not
 be entertained: one of these is  referred to by Metzger (op. cit. p. 309.)  But
 there may be disease, such as paralysis, or deformity in one  or both of the upper
 extremities, which may render it impossible for  an individual to tie a ligature
 around his own neck.   The only caution here to be guarded against, is  that we
 do not push  this doctrine too  far.  When there is a fixed  resolution, many
 apparent  impossibilities may be  overcome by a suicide.   The following  case is,
 in this respect, interesting:—
   A middle-aged woman was brought into the Hotel-Dieu, March, 1833, labouring
 under such a degree of mental excitement as almost to amount to insanity.   Arery
 soon after her admission she destroyed herself by strangulation.  The nurse, in
 going round the ward, saw her lying at the side of the bed,  with her head  hanging
 out.   Upon examination, it  was found that she was quite dead, and that  there
 was a silk handkerchief around  her  neck.   The handkerchief had been carried
 twice round the neck, and  then tied in front.   The eyes and eyelids were strongly
 reddened  and swollen.   The mark  of the  ligature around the neck was  deep,
 ecchymosed, and partially excoriated: the brain, though a little vascular, was
 healthy.  The other viscera presented no appearance calling for notice.    (Ann.
 d'Hyg. 1833, ii. 158.)  It is worthy of  remark,  that  in this instance, in which
 there could be no doubt  of  suicidal strangulation, the deceased had lost four
fingers of her right  hand, so that that member had been, from  a very  early
 period, of but little service to her: nevertheless she contrived to tie the cravat
 round her neck with great firmness and dexterity.  It is  easy to conceive, that
 had her body been found in  a  suspicious locality, a plausible opinion of homi-
 cidal strangulation might  have been formed from the maimed condition of her
 hand.  This case, then, will  serve to teach  us a proper caution in drawing our
 inferences as to what persons,  labouring under any  corporeal infirmity, are capable
 of doing, when they make attempts on their own lives.
   Although the cases just  related  show  that suicidal strangulation may* be
effected under very singular circumstances, yet, in a case of murder by strangula-
tion, it would not  be  easy to simulate suicide: it would,  at any rate, require a
great deal of art and premeditated contrivance, on the part of a murderer, so to
dispose the body of his victim, or to place it in  such a relation to surrounding
objects, as to  render the  suspicion of suicide probable.   Thus, if the ligature
should be found loose or detached,—if the ecchymosis or  depression should not
accurately correspond to the points of greatest pressure,—if, moreover, the means
of compression were  not very evident when the  body was first discovered, and
       33 
514
PROOFS OF HOMICIDAL STRANGULATION.
before it had been removed from its situation, there would be very fair grounds
for presuming that the act was homicidal.  In those cases in which the strangula-
tion  has resulted from  compression of  the windpipe  by the  fingers, and where
there are fixed ecchymosed marks indicative of direct manual violence, we have
the strongest  presumptive evidence of murder; for neither accident nor suicide
could be urged as affording a satisfactory explanation  of their presence.
   Homicidal strangulation.—Strangulation occasionally comes before our courts
of law as a question of murder; and when a party has been tried upon a charge
of this kind, the circumstances have been commonly so clear, as to have rendered
the duty of a medical witness one of a very simple nature.   Difficulties do, how-
ever, occasionally arise, as may be seen by reference to the cases of The Queen v.
Taylor  (York Lent Assizes, 1842,) and The Queen  v. Greek  (Salisbury Lent
Assizes, 1843.)   See also  the important case of Queen v.  Reynolds  (Central
Criminal Court, Dec. 1842.)  Here it  was left uncertain, by the medical evidence,
whether death was due to  strangulation, or malicious exposure to cold; and as
the  indictment only charged the former act, the prisoners were  acquitted!  See
likewise the case of The Queen v. Fowles (Stafford Lent Assizes, 1841.)  For a
full  report of a case in which the question was, whether the  deceased had com-
mitted suicide by hanging, or had been strangled by her husband, I must refer
the reader to Cormack's Journal for 1844, p. 344.  The prisoner was acquitted
on a verdict of "Not proven."  An interesting case of alleged murder by strangu-
lation (Commonwealth v.  Flanagan,)  is  reported in the  American Jour,  of
Med. Sciences, Oct. 1845, p.  339.  See also the  case of Reg. v. Drory, Guy's
 Hosp. Reports, Oct. 1851.
   Cases.—The following case, reported in the Annales d'Hyg. (1829, ii. 447,)
presents several points of interest in relation to this form of death.   It was pro-
nounced to be a case of suicidal strangulation  by some, and of homicidal, by
others.   A servant girl, far advanced in pregnancy, was found dead in her bed.
According to the report of the surgeon who first saw her, the body was rigid, and
there was a handkerchief so firmly tied around the neck, that it was with some
difficulty removed.   A quantity of air and sanguineous mucus escaped from the
mouth and nostrils on its removal.   The body of the deceased, when first seen,
was lying in a constrained position with the face turned to the right.  The  knot
in the handkerchief, which  was tied round the neck, was on the left side, as it is
 customary to find it in  left-handed people.   This  remark was particularly made
by the  surgeon,  who happened to  be himself left-handed.  The  deceased was
not  left-handed;  and there was no reason to suspect that she had  intended to
commit suicide.   She went to bed  the night before in  her usual  health and
 spirits.   On examination of the body, no mark of violence was seen externally:
—but there were large patches of cadaverous ecchymosis scattered over the skin.
There was a deep impression  of a necklace  on the skin of the neck, which had
resulted, it was supposed, from the force with which  the handkerchief had been
tied.  The neck appeared swollen, especially on the right side.  On opening the
cranium, the cerebral vessels were found much distended, especially on the right
 side; and on this side about half an ounce of blood was found extravasated.   In
 the  mouth, the tongue projected forwards between the teeth, but was uninjured
 by them.  The contents of  the thorax and abdomen presented nothing unusual:
 —the lungs  were gorged with blood,  as they are generally found  in asphyxia.
   The  examiners  attributed death partly to apoplexy, and partly to interrupted
respiration, in consequence of the ligature  on the neck.   They considered that
 the  strangulation was not suicidal for the following reasons:—
   1. The handkerchief was tied in two knots, and the deceased could not have
 made more  than one; her senses would have failed her before she could have
made a second; or  at least before she could have made it so perfect as the first.
   2. If she  had  strangled herself, the knot of the  ligature would rather have
been on the  fore part of the neck, than on the left side. 
PROOFS OF HOMICIDAL STRANGULATION.
515
   The position in which the body was found, the cheerful conduct of the deceased
 on the night before her death, and the absence of all motive to induce her  to
 commit suicide, were  facts also dwelt upon  by the examiners;—but  they are
 manifestly of less weight than the first two assigned.  Strong suspicions fell upon
 a man with whom  the deceased had cohabited.   He was  arrested and charged
 with the murder.   He gave a very unsatisfactory account of himself, but it was
 clearly proved that he could not have been at the house of the deceased on the
 night on which her death took place.  It was also shown that he was not left-
 handed.   The prisoner upon this evidence was liberated.   The master, in whose
 house the deceased lived as servant, was left-handed; but there was no reason  to
 suspect him of the crime.   Other witnesses deposed that they saw no one in  or
 near the house on the night of the supposed murder: and  in consequence of no
 other clue  being discovered, and all means failing to find out the  presumed mur-
 derer, it was ordered that the medical facts of the case should be reconsidered.
   Many were inclined to suspect that the deceased had destroyed herself, others
 that she had died a  natural death.   The College of Brunswick was appealed  to
 by the  legal authorities, to  express  a formal opinion from the medical facts,
 whether the deceased had been murdered by strangulation, or whether she had
 died from natural causes.  The question of suicide appears to have been wholly
 abandoned.
   The College decided that the deceased could not have died by strangulation;
 because there was no ecchymosis produced  on the neck  by the handkerchief.
 They assigned apoplexy as the probable cause of death, from  the extravasation
 of blood met with in the right hemisphere of the brain.   They considered that
 the girl had herself tied the handkerchief round her neck, for the purpose  of
 keeping  herself warm, as  the night  on which  she died  was extremely  cold.
 They admitted the probability that she might have imprudently tied the hand-
 kerchief too tightly;—a circumstance which had perhaps facilitated the conges-
 tion of the cerebral vessels and extravasation of blood.
   The opinion expressed by the  College was drawn  up at  a  time when it was
 universally believed that the  mark of the cord, in vital strangulation, was always
 accompanied by ecchymosis;  and that the  non-discovery of this was a sufficient
 proof of strangulation after death.  The error of this opinion has been already
 sufficiently exposed:—therefore the argument, that the deceased had  not died
 by strangulation, falls to the  ground.   The reason assigned for the handkerchief
 being placed around  the neck appears wholly inconsistent with the facts.   It
 is scarcely  to be imagined that any individual who did not  contemplate  suicide
 would retire to rest with a handkerchief tied in  a double knot so tightly around
 the neck, as to render it very difficult to remove.   It was evidently so tight that
 strangulation might easily have resulted from the constriction.   The apoplectic
 appearances in the head may really have been due to the impeded circulation  of
 the blood, in consequence of the ligature:—at least it is as  easy to conceive this,
 as to admit that they should  have coincidently arisen from spontaneous causes.
 There was, therefore, nothing to contradict the opinion of death from strangula-
 tion :—no morbid cause capable of giving rise to sudden death (excepting cerebral
 extravasation, which has already been accounted for) was discovered in the body.
 Whether the ligature was placed round her neck  by the female herself, or by a
 murderer, is a matter of doubt:—yet when we consider that there was  nothing
 absolutely impossible in the act on her part,—that there were no appearances  of
 violence about her person or clothes,—and no evidence of any individual having
 had access  to the apartment,—it appears  most probable that the strangulation
 was suicidal.
  Since the former edition  of this work was  published, several important eases
of murder by strangulation have been brought to trial.  In two of these, I was
required to investigate the circumstances, and give evidence respecting the mode
in which death took  place,  and the  medical reasons which  led to the inference 
516
PROOFS OF HOMICIDAL STRANGULATION.
that the  deceased persons could not have died by their own hands.  For a full
report  of one of these cases (Reg. v. Drory, Essex Lent Assizes, 1851,) I must
refer the reader to Guy's Hosp. Rep. Oct. 1851.  The deceased in this case was
found strangled, with a rope coiled three times round her  neck, the two  inner
coils being tight and the outer coil loose, the end of the cord being placed loosely
near the left hand of the deceased, which was raised towards it.  The length of
the free portion of  cord was  not sufficient to allow of the  deceased grasping it
and tightening it to such a degree as to produce the  great amount of violence
found on the neck.  This, with other facts, tended  to prove  that the act must
have been one of murder.   In another case (Reg. v. Pinckard, Northampton
Lent Assizes, 1852,) it was proved that deceased was  found sitting in  a  corner
of her room, with a narrow tape round her neck, hung loosely and singly over a
small brass hook about three feet above  her head.   Her clothes were  placed
smoothly under her, and her  hands stretched out by her side.   There was a se-
vere bruise on the right eye,  and there were marks of blood on the tape, as well
as on the floor and wall of the room at a distance from the  body.   There was a
stain of blood on the knot of the tape where it passed over the hook;  and there
was no blood on the hands of the deceased.   The windpipe  for abonit an inch and
a half was lacerated longitudinally in its rings, and there was a deep mark round
the neck in the course of the doubled tape, as if from great pressure applied by
some person, or from the weight of the suspended body.   The latter hypothesis
was untenable.  The body of the deceased did not weigh less  than 126 pounds,
while the tape found round her neck broke with a weight of 49  pounds: hence
the deceased never could have been suspended by it.   This fact, with the smooth
arrangement of the clothes, the severe marks of violence on the body (inexplicable
on the hypothesis of suicide,) and the marks of blood and struggling in the room,
proved that there had been homicidal interference; and the crime was brought
home to the prisoner by a series of moral and circumstantial  proofs.   Both  of
these criminals confessed their crimes before execution.
   The reader will find the report of an interesting case of alleged death from
homicidal strangulation in the Med. Gaz. vol. xli. p. 295;  see also vol. xliv.  p.
1084.

   But it may be inquired whether marks of violence on the body, or blood-stains
on the clothes or furniture, do not afford strong evidence of homicidal strangu-
lation.   The answer is—if the marks of  violence be such that they could not
possibly  have arisen  from any accident before  death, or  that they  could not
possibly have been  self-inflicted, they afford the strongest  evidence of murder.
But the cases wherein so positive an answer may be returned, are the exceptions
to the rule.  It is not always in our power to distinguish accidental or self-in-
flicted, from homicidal violence; and we are always bound to  look to the possi-
bility of accident, or of previous attempts at suicide, being the source of those
personal injuries which may  be apparent on a strangled subject.
   In the following case, communicated to me by Dr. Campbell, of Lisburn, the
marks of injury to the neck clearly established homicidal strangulation.  The
dead body 6f an old man, aged 70 years, was  found  lying in a potato-field  ad-
joining his house, on the 10th of October, 1842.   His family consisted of a son,
the son's wife, and a male servant,  brother to the son's wife.   The deceased had
gone to gather potatoes for the servant who was digging.   On its being known
to their neighbours that the  body had been found in  the  field, suspicions were
excited that his death had resulted from violence.  An inspection  of  the body
was ordered.  The depending parts were very livid, owing to their position.  On
opening  the skull, a large quantity of dark fluid blood escaped: the membranes
of the brain were greatly injected, the sinuses gorged with blood, and the brain
itself was highly vascular.    Several clots of blood were observed in the lateral
ventricles, and some over the surface of the brain.  In the chest the lungs were 
PROOFS OF HOMICIDAL STRANGULATION.               517
 filled with very dark fluid blood, the air-cells were ruptured, and there was con-
 siderable emphysema.  The right side of the heart was  greatly distended with
 dark blood:  there  was nothing remarkable  in the abdominal  viscera, but the
 lining membrane of the stomach was congested.   The stomach was about half
 filled with potatoes.  On the neck, over the left wing of the thyroid cartilage,
 there was a very slight mark of a crescentic form, with a  corresponding, though
 slighter  mark on the opposite side;  and on removing the skin over those marks
 a considerable amount of coagulated blood was seen immediately beneath, and
 in the substance of the muscles.  On removing this, the left wing of the cartilage,
 which was ossified,  was found much depressed, and  traversed  by a fracture
 nearly an inch in length.  From the general appearances  presented by the body,
 together with the injury to the thyroid cartilage, an opinion was given that death
 had arisen from manual strangulation, and from the particular form of the ex-
 ternal marks over the neck,—by a left hand.   Several witnesses were examined,
 who proved that the deceased and  the servant were on bad terms, the deceased
 haviDg threatened to dismiss the servant, and that before  they had gone  to dig
 the potatoes, the servant said he would be revenged of his master.  The servant
 was committed for trial at the ensuing assizes.   One of the magistrates  present
 desired that  the prisoner might be requested to throw a stone, in order to ascer-
 tain if he was left-handed, which he did with  the left hand.   At the trial, the
 sister of the prisoner swore that she saw her brother strangling the old man; and
 several witnesses proved that he had maltreated the deceased on many previous
 occasions.  The counsel  for the defence advocated the prisoner's case so well,
 and proved the sister to be of so  improper a character, that the jury, having
 some doubt as to her veracity, acquitted him.   Dr. Campbell forwarded  to me
 the larynx, which was ossified,  and fractured in the ossified portion, as described
 in the report of the case.
   There may be several marks on the neck; but then the individual may have
 tried to strangle himself more than once.  The throat may be cut, or there may
 be a deep-seated stab or gun-shot wound, involving some of the important organs
 of the body:—but in a purely medical point of view, how are we to know that the
 deceased did not actually inflict those wounds upon himself?  In the chapters
 on Drowning and Hanging, we have seen what suicides  can do, when they are
 desperately bent on destroying themselves.  These injuries often create the most
 serious difficulties to the medical jurist, which  it requires the  greatest caution
 and prudence on his part to steer through.   The  prejudice of the public mind
 is such, that the discovery of a strangled person, with marks of personal injury
 or of poisoning in his stomach, would, in  most cases, lead to a declaration  of
 murder,  unless the facts rendered it clearly impossible  that any attempt could
 have been made on his life.   It is against this prejudice that the  medical witness
 must strenuously guard himself:—he may be abused for not joining in the out-
 cry of the vulgar;  but the best recompense for this abuse will be the conviction,
 that he is interposing the shield of science to protect a possibly innocent fellow-
 creature  from the senseless denunciations of ignorance.
   It cannot  be disputed that  in contested questions of  suicidal or homicidal
 strangulation, rare  as they are, we  must be  very often greatly indebted to evi-
 dence founded on circumstances, as well as to moral presumptions.  How far  a
 medical jurist may be allowed to make use of these in the formation of an opi-
 nion, it will be for the Court to determine.   Generally speaking, his duty is ri-
 gorously  confined to the furnishing of medical evidence from medical data alone;
 but instances present themselves in  which this rule must  be departed from,  or
 the course of justice will be impeded.   Besides, there are numerous circumstances
 of a collateral nature which may materially modify a medical opinion.   Thus,
the sight of the ligature, the  state of the dress, and the attitude of the deceased
when discovered, although not strictly medical circumstances, bear directly upon 
518               PROOFS OF HOMICIDAL STRANGULATION.
 them; and that evidence ought not to be objected to which  is partly founded
 upon facts of this nature.
   It must occur to all, that without circumstantial evidence the best medical opi-
 nion in these cases will often amount to nothing.  It may be, for example, no more
 than this: the case is either one of homicide or suicide; and why is such an in-
 definite answer to be. returned?   Because, in the abstract view of strangulation,
 it is not easy to determine whether a ligature  was suicidally applied round the
 neck or not.  The appearances may be in many cases the same; and where they
 are different, this  difference may be due to accident; so that it  is a mistake to
"suppose that we must look  to medical circumstances alone for clearing up this
 intricate question.
   There is, perhaps, one instance which may justify a presumption of homicide.
 A man, in strangling himself, is not likely to vary the means: it is commonly
 due to a sudden impulse, if we may judge from the  moral proofs afforded in the
 instances  on record.  The article  which is nearest to  the suicide is seized, and
 made the  instrument of destruction.   It has already been stated as doubtful
 whether a person could strangle  himself  by the mere application of  the fingers
 to the trachea; the discovery of such marks only as would  indicate this kind of
 strangulation, therefore, renders suicide in the highest degree improbable.  But
 if, besides these marks of fingers, we find  a circular mark, with the ligature still
 around the neck, the presumption of murder becomes, indeed, strong.  It may
 be said, that an individual might at first try to strangle himself with his fingers,
 and, not succeeding, might afterwards employ a cord.  But the degree to which
 the coincidental impressions exist will assuredly in general remove this objection.
 A murder was committed some years since in this country in  the manner here
 stated.   A gentleman of fortune was found strangled  on board of a ship in the
 port of Bristol.  Besides the mark of a rope drawn tightly round the neck, there
 were distinct impressions of nails and fingers in front of the throat.  An investi-
 gation took place, and the result proved,  as, indeed, this state of the neck ren-
 dered it almost certain, that the deceased had been murdered.  It was afterwards
 confessed  by one of the murderers, that they  had first strangled  him with their
 hands, and then drew the rope about his neck, to  insure  the certainty of his
 death.
  In concluding this  account of strangulation, it may be remarked, that attempts
 are sometimes  made  to  attribute  traces of violence on the neck to accidental
causes, notwithstanding  the almost entire certainty of their being  homicidal.
 Thus, when a man is  found dead with a mark on the neck, it will  be argued that
the deceased might have fallen while in a  state of intoxication, and have become
 strangled by his cravat, his head being at the  same time bent forwards.  The
witness will be asked  whether death was not possible under such  circumstances.
In returning an answer, he should take care to let it be understood, that what is
physically  possible is  not always medically probable.
  The marks of strangulation on  the throat may be sometimes ascribed to the
deceased having fallen with  his hand possibly applied to his neck, and the in-
ference will be drawn that they have accidentally resulted from the pressure of
his own fingers; but this is a very improbable mode of accounting for the pro-
duction of ecchymosis or excoriation of the skin. 
CAUSES OF SUFFOCATION.
519
SUFFOCATION.
                              CHAPTER LX.

 SUFFOCATION FROM MECHANICAL CAUSES—VARIOUS FORMS OF—CASES--CAUSE OF DEATH—
   POST-MORTEM APPEARANCES--EVIDENCE OF DEATH BY SUFFOCATION--ACCIDENTAL, SUI-
   CIDAL, AND HOMICIDAL SUFFOCATION--MEDICAL AND PHYSICAL EVIDENCE OF THE CAUSE
   OF DEATH--CASES--SMOTHERING.

   Suffocation from mechanical causes.—By suffocation we are  to  understand
 that condition in which the air is prevented from penetrating into the lungs, not
 by constriction  of the trachea, but by some mechanical cause operating on the
 mouth externally, or fauces and larynx internally.  In this sense, it will be per-
 ceived that  drowning is nothing more than death by suffocation.
   There are many varieties of death by suffocation, all  of which are of great
 medico-legal interest.  1. The continued pressure of  the  hand over the mouth
 and nostrils, or  the placing of a plaster or cloth over these parts, combined with
 pressure on the  thorax:  this was formerly not an unfrequent form of homicidal
 suffocation.   2.  Smothering, or the covering of the head and face with articles
 of clothing, &c, which  effectually prevent respiration.   3. The accidental  or
 forcible introduction  of  foreign bodies  into the  mouth  and throat.  4. The
 plunging of the face into mud, snow, dust, feathers, or similar substances.  In
 all of these  cases death takes place from asphyxia, and with great rapidity, if the
 chest sustains at the same time any degree of forcible compression.  5. Swelling
 or spasm of the  glottis produced by the contact of corrosive substances.  A case
 was referred to me in July, 1848, in which death was probably thus caused by
 the application of a strong solution of pernitrate of mercury to an ulcer in the
 fauces.
   Suffocation may also arise from morbid causes, such as a diseased state of the
 parts about  the fauces, a morbid enlargement of the thymus gland,  the sudden
 bursting of  a tonsillary abscess, or the effusion of lymph,  blood, or pus into the
 windpipe, or about the rima glottidis.   Any of these causes may suddenly arrest
 the respiratory function; a fact which can only be determined by a proper ex-
 amination of the body.   Two cases of death from suffocation produced by me-
 chanical causes  have been reported;  the one by Dr. Geoghegan, who has com-
 municated to me the particulars, and the other by Dr. Jackson, of Leith.  Dr.
 Geoghegan's case was that of  a boy, who died in half an  hour under alarming
 symptoms somewhat resembling those of poisoning, and it appeared that a simple
 medicinal powder had been given  to him about five minutes before the attack!
 On inspection, the lower part  of the trachea was found blocked up with cheesy
 scrofulous matter:—it was evident that the child had  died from asphyxia.  Dr.
Jackson's case is perhaps one of the most remarkable on record.  A man, aged
31, was put  to bed drunk, having previously vomited;  and shortly afterwards he
was found dead.   On inspection,  Dr.  Jackson discovered the usual appearances
of asphyxia, i. e. congestion of the lungs and of the right cavities of  the heart.
He was thus led to examine the trachea  carefully, and he found, lying over the 
520           MEDICAL PROOFS OF DEATH FROM SUFFOCATION.
rima glottidis, a thin and transparent piece of potato-skin, so closely applied to
the fissure as to prevent respiration.   The  man  had died suffocated from this
mechanical cause.   He had had potatoes for dinner the day before; the piece of
skin had probably been thrown up at the time of vomiting, and had been drawn
back by inspiration into the singular position in which it was found.  Owing to
intoxication, the deceased was probably unable to cough it up.  I agree with Dr.
Jackson in thinking that this case conveys a most important caution.  In Eng-
land, the  verdict would most probably have  been, "Died by the visitation of
God," without a post-mortem inspection!   The result clearly shows that in every
case of sudden death there should be a strict investigation  of all parts  of the
body.   (Ed. Med. and Surg. Journ., April, 1844, 390.)  I am indebted to Mr.
Richardson, of Mortlake, for an interesting case of death from suffocation, caused
by the vomiting of the  contents of a full  stomach, a portion of the food having
blocked up the  throat.  A similar case is reported  by Mr. Matthews, Lancet,
Aug. 31,  1850, p. 262.  Such facts  show  the absolute necessity of making  a
careful post-mortem  examination in  all cases of sudden death.  Children are
often suffocated from small portions of food penetrating into the air-passages;
and  unless an inspection be made, death may be easily referred to some natural
cause.  (See case by Mr. Synnot, Med. Gaz. xl. 994; and also Lancet, May 16,
1846, 561.)  In some instances,  a retraction of the base of the tongue may lead
to the suffocation of a new-born child.   (Seller's Journal, March, 1845, 278.)
   Cause  of death.—It has been already stated  that death takes place  by as-
phyxia; and this occurs with a rapidity proportioned to the degree of impediment
existing to the passage of the air.  There does not seem to be any reason to at-
tribute death to apoplexy.   The  congestion of the cerebral vessels may  be re-
garded as a consequence of the disturbance of the functions of the lungs.   If the
veins of the neck were opened so as to prevent an accumulation of blood in the
cerebral vessels,  it is  pretty certain  that the prevention of respiration would de-
stroy life  under the  same  circumstances  and within the same period of time.
Therefore we may regard death from suffocation as resulting from  pure asphyxia.
   Post-mortem appearances.—There are rarely any considerable marks of violence
externally.  AVhen the  body has become perfectly cold, there may be patches of
lividity diffused  over the skin;  but these are not always present.   The  lips are
livid, but  the skin of the face is often pale.  The mouth, throat, and parts about
the  larynx, should be examined for foreign  substances.  Internally the lungs
and  right cavities of the heart are distended with blood :—the left cavities either
contain but little blood, or are empty.   The viscera may here and there present
patches of ecchymosis.   The cerebral vessels  are  sometimes congested;  but at
other times they do not appear more than ordinarily full.   All other appearances
are of an accidental nature, and are not at all connected with death by suffocation.
(See cases by Casper, Med. Gaz.  vol. xliv.  p. 1084;  also a  series of  papers by
Mr.  B. AV. Richardson,  Med. Gaz. xlvii. p. 359, et seq.)
   Evidences of death from suffocation.—In medical jurisprudence, there is not,
perhaps, an instance in which we have fewer medical data upon which to base an
opinion, than in the  case of alleged death from suffocation.   The inspection of
the body of a person suffocated presents so little that is peculiar, that a medical
man, unless his suspicions were roused by  circumstantial evidence, or by the dis-
covery of foreign substances, would probably pass it over as a case of death with-
out any assignable cause;  in other words, from natural causes.   In  examining
the body of the woman Campbell, who was murdered by Burke, in Edinburgh,
Dr. Christison was unable to come to a conclusion respecting the  cause of death
until some light  had been thrown on  the  case by collateral evidence.  On this
occasion a violent death was suspected because there were marks of violence ex-
ternally, and the face of the deceased exhibited the characters of strangulation;
but these  conditions  are by no  means  essential to death from suffocation, and
when they exist, they can only be regarded as purely accidental accompaniments. 
ACCIDENTAL DEATH FROM SUFFOCATION.               521
 Appearances similar to those found in the bodies of suffocated persons are very
 frequently met with in post-mortem inspections when death has taken place as a
 consequence of disease or accident.  They can, therefore, furnish no positive evi-
 dence of the kind of death; they do not even permit us to establish  a presump-
 tion on the subject until, by a careful examination of the body, we  have  ascer-
 tained that there is no other cause of death depending  on organic disease or on
 violence.   Medical evidence may, however, be highly  serviceable in some in-
 stances.   Thus, let the general evidence establish that a deceased person has pro-
 bably been suffocated,—the witness may have it in his power to state that the
 appearances in the body are not opposed  to the supposition of this kind of death;
 that the body is in all respects healthy and sound;  and  that the death was pro-
 bably sudden, as where, for instance, undigested food is discovered in the stomach.
 In all cases of this description, we must bear in mind that our opinion relative
 to the supposed cause of death is to  be  formed from the medical circumstances
 only, unless it be otherwise ordered by the Court.  From this want of clear evi-
 dence, great difference of opinion on the  cause of death will exist among medical
 witnesses.   In the case of Reg.  v. Hey wood (Liverpool  Summer Ass. 1839,)
 some of the witnesses referred  death to suffocation, others to apoplexy.  (Lancet,
 Sept. 14,  1839, 896.)
   Accidental, suicidal, and  homicidal suffocation.   Suffocation is  by no means
 uncommon as an accident; and there are  several varieties  of accidents under
 which a person  may die  suffocated.   1.  Disease about the tongue, larynx, or
 fauces, may advance to such an extent as effectually to  impede respiration.  2.
 The deceased may have fallen, so  that the mouth became  covered with dust, or
 other substances; and if the subject be helpless, as an infant or an aged person,
 or one who is  intoxicated,  death may thus easily take place. A child was found
 dead in a room, with its face in the ashes under the grate.   It had fallen during
 the absence of the mother, and, from its  helpless condition, had speedily become
 suffocated.  Some of the ashes were found in the windpipe.   (Med. Gaz. xvii.
 p. 642.   For a case in which suffocation was caused by a pea, see the  same jour-
 nal, xxix. 146.)  In  trials for murder or manslaughter, a medical opinion re-
 specting the possibility of  the accidental suffocation of a drunken person, under
 similar circumstances, is very often required.  These subjects, it must  be remem-
 bered, are generally to be  considered  as  helpless as  children:—if they fall in a
 position so that the mouth be covered, it is possible that they may have  been so
 intoxicated as  not to be able  to escape. 3. A  portion of food may have remained
 fixed in the larynx  or fauces.  Children  are  often  accidentally suffocated  from
 drinking boiling water from a tea-kettle.   The parts about the  larynx then be-
 come  swollen from the action of the hot water, and respiration is arrested.  4.
 Accidental suffocation is not uncommon among infants, when they  sleep with
 adult persons.   A child may be in this way very speedily destroyed.   Even the
 close wrapping up of a child's  head may effectually kill it, without any convul-
 sive struggles to indicate the danger to which it is exposed.  These convulsions
 by no means necessarily attend on death  from suffocation.
  A few years since, a coroner's inquest  was held on the body of a child, which
 was found dead in a bed;  and I assisted a friend in the post-mortem  inspection.
 It was lying in a composed attitude on  the bed, with  the face nearly covered.
 There were faint traces of cadaverous lividity about the  neck and back; but the
 body did not present the least mark of violence. The face was pale, but the lips
 were livid.   On examining the chest, the great vessels connected with the  heart
 and lungs were  found congested  with blood.  The vessels of the brain  were
 empty.  There were no morbid  appearances whatever in any of the other organs.
 The account given by the  girl  who attended the child was, that she had laid  it
to sleep  about  nine o'clock in the morning, covering over the greater  part of its
face.  She  remained in the room;  but in the course of an hour, not hearing the
child breathe, she looked and found it dead.  The  only opinion which we were 
522
HOMICIDAL SUFFOCATION.
asked to give, was,—whether, from the circumstances, suffocation was probable?
AVe answered in the affirmative; and a verdict of accidental death was returned.
This case shows the ease with which an infant may be destroyed, even when its
respiration is only partially impeded.   The weight of the clothes may have com-
bined to cause death, by preventing the free expansion of the chest.
  Those instances of accidental suffocation which depend  on disease or the im-
paction  of food,  are easily  known by a post-mortem examination:—generally
speaking, they present  no  difficulty.   (See case,  Med. Gaz. vol. xlii.  p. 970;
also Lancet, Sept. 2, 1848, p. 259.)  But in other  cases, e. g. when a child or a
drunken person is presumed to have been suffocated owing to  the position in
which he has fallen, evidence as to the position of the body, or even actual sight
of the body, is necessary before  forming an opinion.  The following questions may
here arise:—Was the position such as to be explicable on the supposition of acci-
dent?   AVas it not such a position as might  have been given to it by a mur-
derer?  Could not the deceased have had strength or presence of mind to escape?
Could he have been actually suffocated  in the  position in which his body was
discovered?  A little reflection upon the  circumstances,—for  here  something
more than medical circumstances will be required,—may enable us  to give satis-
factory  answers to these questions.
  Suicidal suffocation.—As an act of suicide, suffocation is extremely rare.   It
would require a peculiar adaptation of means, and considerable resolution, in or-
der that a person should thus destroy himself.   The following case occurred  in
France  some years since.  A woman locked herself in her  room with  her young
child:—she placed herself under the bed clothes, and desired the child to pile the
several  articles of furniture  in  the room upon her.   AVhen the apartment was
entered  some hours afterwards, the woman was found dead.  She had evidently
been suffocated.   Had not the child clearly detailed the circumstances, a strong
and even justifiable suspicion of murder  might  have arisen.   In the case of a
body found with a plaster covering the mouth and nostrils, or the traces of  such
having  been applied, the witness might be asked whether  this could  have been
so placed by the individual  himself?  No such case has ever  occurred as an act
of suicide;  but we are not, therefore, to say it is impossible; all that we are jus-
tified in stating is, that it is  a highly improbable mode of self-destruction.
  Some singular  cases are on record, in which individuals have wilfully destroyed
themselves by blocking  up the  fauces mechanically.   A remarkable instance of
this form of suicide is  reported in the Ed. Med. and Surg. Jour.  April, 1842.
A woman, confined in  prison, forced a hard cotton  plug  into the  back  of the
fauces.   The cavities of the chest  and abdomen had been already examined, and
a medical certificate  given that the deceased  had died of  apoplexy!  The body
was sent to one of the anatomical schools, and, on re-inspection, it was then acci-
dentally found that  the fauces were firmly blocked up with a plug of spindle-
cotton.   A similar case was the subject of an inquest in London, in September,
1843.   The deceased here had thrust into her throat a large piece of rag, which
had been used in applying a  lotion.   She speedily died suffocated, and after death
the rag  was found lodged at the back part of the larynx.   The internal organs
in these cases present no particular appearances indicative  of the kind of death.
Such cases are very likely to be mistaken for apoplexy, and they certainly show
the absolute necessity for a careful post-mortem examination in every instance of
sudden  death.  (See Ed. Med. and Surg. Jour.  liv. 149; also, Med. Chir.  Rev.
xxviii. 410.)  The case of Reg. v. Heywood, Lancaster Sum.  Ass. 1839, proves
how easily a defence of  apoplexy  may be sustained in a case  of  alleged murder
by suffocation.
  Horn  icidal suffocation.—Homicide by suffocation is not very common, although
it is a very ready means  of perpetrating murder.   Hitherto, the cases which have
come before our courts of law have been those of infants  or of aged and infirm
persons.  In regard to the latter subjects, the rigorous administration of the law 
SUFFOCATION OF INFANTS.
523
 has succeeded in putting a check to this crime:  but with respect to children, it
 probably yet continues.  Infanticide by suffocation  is most difficult to detect;
 and, unless the murderer have employed a very unnecessary degree of violence,
 it is probable that the crime may pass altogether unsuspected.
   Homicide by suffocation would not be attempted on healthy adult persons, un-
 less they were in a state of intoxication, and thereby rendered defenceless.   It is
 certain that most individuals would have it in their power, unless greatly inca-
 pacitated by disease or intoxication, to offer such a degree of resistance as would
 leave upon their persons indubitable evidence of murderous violence.   Death by
 suffocation may be  considered as presumptive of  homicide, unless the facts be
 clearly referrible to accident.  Accidental suffocation is, however, so palpable from
 the position of the body and other circumstances, that when death is clearly traced
 to this cause, it is not easy to conceive a case in which it would  be  difficult to
 distinguish it from a case of murder.   In some instances, the very means which
 have been  adopted  to  produce it may forbid the  supposition  of accident, and
 clearly establish the fact of homicide.
   The suffocation of new-born children, by the introduction of substances into
 the mouth, is not very unfrequent.   (See ante, p. 331.)  The  unnecessary force
 employed generally  leaves traces of violence, which may be easily discovered by
 a careful examination, even should it happen that the substance  employed for
 the murderous  purpose has been removed.   M. Devergie  has suggested an ob-
 jection to evidence founded on a fact of this nature, that the  substance  might
 have been  introduced after death in order to create a suspicion  of  infanticide
 against the mother;  but such an objection could  hardly be  received, since the
 fact is only one  out of many which would be brought against an accused person.
 According to Devergie, the appearances produced by the introduction of a plug
 of linen into the mouth during life, are these:—the mouth contracting posteriorly,
 the pressure would be greater in this situation, consequently  the blood would be
 forced out  of the compressed mucous membrane of the palate.   Anteriorly, the
 pressure would  be less; and here the blood would accumulate, so that the mucous
 membrane  in this situation would become swollen and red.  In trusting to these
 characters, it must be remembered that similar appearances would probably re-
 sult if the plug were introduced immediately after death, as, also, that  even when
 introduced  during life, the characters might  be lost if the plug were removed
 from the mouth before the body had entirely cooled.
   It is necessary to point out a very dangerous practice common among ignorant
 nurses, which, without exciting suspicion on the part of a coroner or medical
 witness,  may be an occasional cause  of  death in infants.  In order to quiet  a
 child, and to enable  the nurse to sleep without disturbance, a bag made of wash-
 leather or  rag, containing sugar, is thrust into the child's mouth.   It is thus
 completely gagged, and the child soon  becomes quiet, respiring chiefly through
 the nostrils.  If these by any accident become obstructed, or by the act of respi-
 ration the bag should fall to the back of the  fauces, death by  suffocation must
 inevitably result,—the infant being perfectly helpless!  The suspension of  res-
 piration may be  so gradual that the child may die without crying or convulsions.
 The removal of the bag from the mouth will remove every trace of the cause of
 death;  for  no pressure is exerted;  and in order to exculpate herself,  the guilty
 person may ascribe death to "fits."   In one instance, within my knowledge, an
 infant  was  timely saved by the mother having discovered, while the nurse  was
 sleeping, a  mass of wash-leather projecting from the mouth  of the child.   The
 woman awoke, and attempted to remove and conceal it, but was detected.   The
 detection of this abominable practice can only be a matter of pure accident: hence,
a fatal  case can  be rarely the subject of a coroner's inquest, and medical evidence
may fail  to throw any light  upon it.   In one  instance only have I known it to
have given rise to a criminal  charge.   (Reg. v. Cox, A\rarwick Lent Assizes,
1848.)    The mother, a pauper female, was tried for the attempt to suffocate her 
524
HOMICIDAL SMOTHERING.
infant  eleven days old.  The child was discovered  by another person with a
piece of rag hanging from its mouth.   It was livid  in the face, but when the
rag was removed made a violent gasp, and recovered its breath.   There was no
malice on the part of the prisoner, but it was made a strong point in her favour
that instances had occurred in the workhouse of women putting rag  with sugar
on it into the mouths of infants to soothe and keep  them quiet!   The jury ac-
quitted her.  This admitted practice of infantile suffocation in the Warwick work-
house appears to have passed without reprimand or even comment, although this
plan of soothing infants is just as likely to be fatal to  them as surrounding
their necks with a ligature.

                               SMOTHERING.
  Smothering is only a variety  of suffocation, and consists in the mere covering
of the  mouth and nostrils in any way so as to prevent the free ingress and egress
of air.   Like drowning, hanging, or strangulation, it produces death by asphyxia.
In newly born infants it is not an unusual occurrence, sometimes originating in
accident, and at others in criminal design.  An infant is very speedily destroyed
by smothering.  If the  mouth  be  only lightly covered  over with clothing, or
slightly compressed,  so that respiration  is interrupted, as in the act of carrying
a child in the arms, this will suffice to  cause death;  and, as it has been already
remarked, death often takes place without being preceded by convulsions or other
striking symptoms.   Smothering is not often resorted  to as a means of perpe-
trating murder, except  in infants, or in debilitated and infirm adults.   Certain
trials, which took  place  some years since, clearly proved that individuals, in a
state of intoxication or infirmity, had been murdered by smothering, for the sake
of the money derived from the sale of the dead bodies!   It will be sufficient to
mention  the trials of Burke and Macdougall in  Edinburgh, and of Bishop and
 Williams in this metropolis, as affording ample evidence of the past existence of
this  horrible system  of secret murder.   (See Ed. Med. and Surg. Jour. April,
1829, p. 236.)   The victims were commonly destroyed by the murderer resting
with his whole weight upon the  thorax, so as to prevent the motion of the ribs,
and at the same time forcibly compressing the mouth and nostrils by his hands,
to prevent the ingress of air.   A case of this kind was referred to me for exami-
nation in 1831, (Rex v. Elizabeth Ross, Old Bailey S., Dec. 1831.)  It  was
remarkable for the fact that the  prisoner was convicted of homicidal suffocation,
although the body of the deceased was never discovered (see Med. Gaz. xxxviii.
481.)  In Nov. 1844, a man was convicted at the Assizes of the Seine of the
murder of a woman by placing a pitch-plaster over her face.  A trial for murder
by smothering took place at  the Lincoln Lent Assizes, 1843.   (The  Queen v.
Johnson.)  The prisoner, while committing  a burglary, tied the deceased  to a
bed, so that she could not move, and then  closely tucked the  clothes over her
head.  After remaining  some hours in this condition, the deceased died.   The
prisoner  was convicted and  executed.   For an  important case,  involving the
question of death from homicidal smothering, or from apoplexy, see  The Queen
v. Hey wood, Lancaster  Summer Ass. 1839.  As  an accident, smothering may
be conceived to take  place when  an individual falls in a state of intoxication and
debility,  so that his mouth becomes in  any way covered, or the access of air to
the mouth or nostrils is interrupted.   On an inspection of the body, the  ap-
pearances described under the head of  asphyxia will be met with in the organs
of circulation and respiration: hence in a suspected case of murder, we must look
for the common indications of asphyxia, and to  the circumstances under which
the body is found,  before we can offer an opinion on the probable cause of death.
(For some facts connected with this subject, see Ann. d'Hyg. 1837, ii. 485.) 
POISONOUS GASES.   CAUSE OF DEATH MISTAKEN.           525
                             CHAPTER  LXI.

GASEOUS  POISOXS—MODE  OF ACTION--ASPHYXIATING  AND POISONOUS GASES—CAUSE OF
  DEATH MISTAKEN--CARBONIC ACID--SYMPTOMS--APPEARANCES--MODE  OF  ACTION--AB-
  SORPTION--TREATMENT--ANALYSIS—CHARCOAL  VAPOUR--ITS  EFFECTS—PRODUCTS  OF
  BURNING WOOD--COAL  AND COKE-VAPOUR--SULPHUROUS ACID--VAPOUR OF LIME AND
  BRICK-KILNS--CONFINED AIR--EFFECT OF CARBONIC ACID ON COMBUSTION--ITS DIFFUSION
  —COAL GAS—CARBURETTED HYDROGEN--CARBONIC OXIDE.

  Mode of action of gaseous poisons.—In following common language, a medical
jurist is obliged to apply the term  suffocation to another variety of death;  viz.
to that of poisoning  by gases.   Physiological accuracy must  here be sacrificed,
in order that we may make ourselves generally intelligible.   Thus, if a person
die from the effect of carbonic acid,—of confined air,—of sulphuretted hydrogen,
or other noxious gases, he is commonly said to die suffocated.   Strictly speaking,
he dies poisoned;  as much so as  if he had taken oxalic  or  hydrocyanic acid.
The  only differences are,—1. That the poison, instead of being  liquid or solid,
is gaseous:  and—2. Instead of being applied to  the mucous membrane  of the
stomach, it affects that of the air-cells of the lungs.  In the case of arsenuretted
hydrogen (ante,  p. 93,) we have a clear instance of poisoning by a gas;  and in
the respiration of the  narcotic vapours of chloroform  and ether, we have  also
illustrations  of this form  of poisoning.  Owing to the fact  that  the poisonous
material is in a finely divided state, and that in the air-cells of the  lungs it meets
with a large absorbing surface, and instantly enters the blood, the effect is more
rapid, and, caeteris paribus, more powerful.  It has been remarked, too, that
some, and probably all of these aerial poisons, have an  accumulative action; i. e.
their effect continues to increase for a short period, even after the individual has
ceased to respire them.
  Asphyxiating and poisonous gases.—The numerous gases with which chemists
are acquainted are found to vary materially in their operation when introduced
into the lungs; and a division has been established among them, into those which
have a negative and into those which have a positive action.   The former alone
can be considered to  cause death by asphyxia or suffocation; for the gases which
have a positive influence must be regarded as poisons.   Now, experiment has
shown that there are but  two gases which  are  essentially negative in their ope-
ration,—these are hydrogen  and nitrogen;  all the others have a poisonous
action when  introduced into the  body. Indeed, with regard to hydrogen, some
doubt may be fairly entertained respecting its claim to be considered as a truly
negative agent;  for the researches of Allen and Pepys in this country, and the
observations of AVetterstedt in Sweden, have shown that it cannot be substituted
for  nitrogen  in  atmospheric air,  without  inducing somnolency and  lethargy.
(Berzelius, Traite de Chimie, vii. 106.)  If, then, we admit that the greater num-
ber of the gases are poisonous, it is  scarcely correct  to regard these bodies as
purely asphyxiating agents.   The state of lifelessness which follows their intro-
duction into the lungs, is not to be ascribed to the simple negation of air, as in
the case of drowning, hanging, or strangulation, but to a deleterious impression
produced on the system,  something analogous in its effects to that which is ob-
served to follow  the ingestion of a poisonous dose of hydrocyanic  acid. The dif-
ference  is, that the .poison is aerial, and applied to the surface of the lungs in-
stead  of the stomach;  but, strictly speaking, a person is no more suffocated by
carbonic acid than he is by arsenuretted hydrogen.
  The cause of death  mistaken.—The greater  number of the poisonous gases
are chiefly complex products of art, and  are  never likely to be met with  in the
atmosphere so abundantly as to produce injurious consequences:—hence fatal ac- 
526
CARBONIC ACID.
cidents, arising from their inhalation, most commonly occur under circumstances
which can leave  no question respecting the real cause of  death.  The peculiar
effects of all of these it will not be necessary to describe in this place; but there
are two, a knowledge of the properties and operations of which may, on certain
occasions, be required of a medical jurist:—these are, the carbonic acid and
sulphuretted hydrogen gases.  Agents of this description can rarely be em-
ployed with any certainty as instruments of murder; and if they were so em-
ployed, the fact could be established only by circumstantial evidence.  One al-
leged instance of murder by carbonic acid is, however, reported by M. Devergie.
(Ann. d'Hyg. 1837, i. 201.) Death, when arising from the respiration of  any of
the gases, is generally attributable to suicide or accident.   In France it is by no
means  uncommon for individuals to  commit  self-destruction by sleeping in a
closed apartment, in which charcoal has been suffered to burn; while  in England,
accidental deaths are sometimes heard  of, where coal has been employed as fuel
in small and  ill-ventilated rooms.  On  such  occasions a  person  may be found
dead without any apparent cause  to the casual observer,—the face  may appear
tumid and discoloured, and the cutaneous surface may be covered with  ecchymosed
patches.  The discovery of a body under these circumstances will commonly be
sufficient, in  the eyes of  the vulgar, to create  a suspicion  of murder;  and some
individual, with whom the deceased may have  been at that period on bad terms,
will, perhaps, be pointed out as the murderer.  In such a case, it is obvious that
the establishment of the  innocence of an accused party may depend entirely on
the discrimination and judgment of a medical practitioner.  An instance, illus-
trative of the consequences of this popular prejudice, occurred  in London in
1823.   Six persons were  lodging  in the same apartment, where they were all in
the habit of sleeping.  One morning an alarm was given  by one of them, a fe-
male, who stated that on rising she found her companions  dead.  Four were dis-
covered to be really dead, but the  fifth, a married man, whose wife was one of the
victims, was recovering.    He was known to have been on intimate terms with
the female who gave the alarm, and it was immediately supposed that they had
conspired together  to destroy the whole party, in order  to get rid  of the wife.
The woman who was accused of  the crime was imprisoned;  and an account of
the supposed murder was  soon printed and circulated in the metropolis.   Many
articles of food about the house were analyzed,  in order to  discover whether they
contained poison, when  the whole of  the circumstances were explained by the
man stating that he had placed a  pan of burning coals between the two beds be-
fore going to sleep, and that the doors and windows of the apartment  were closed.
(Christison, 583.)  A set of cases of a similar kind, in which there was at first
a very strong  suspicion of poisoning,  has been lately  reported in the Medical
Gazette, by Mr. Smith, of Liverpool (xxxvi. 937.)

                             CARBONIC ACID.
   Sources of.—This gas is freely liberated in respiration, combustion and fermen-
tation ;  it is also extricated in the calcination of chalk or limestone, and  it is abun-
dantly diffused through the shafts and galleries of coal-mines, where it is com-
monly  called choke-damp.  Carbonic acid gas is  likewise met with in wells, cellars,
and other excavations in the earth.  In these  cases it is  found most abundant
generally on the soil or at the lower part of the well;  and it appears to proceed
from the decomposition of animal and vegetable matters confined in such situations.
The slow evaporation of water strongly charged with the gas, while trickling over
the sides  of  these  excavations, may likewise  assist in contaminating the air.
Damp sawdust or straw slowly absorbs oxygen from a confined  atmosphere, and
sets free carbonic acid.
   Symptoms.—The symptoms of poisoning by this gas will vary according to
the degree of concentration in which it is  present in the atmosphere respired.
AVhen  it exists in a fatal proportion, the symptoms commonly observed are as 
CARBONIC ACID.  MODE OF ACTION ON THE BODY.           527
follow:—A sensation of great weight in the head, giddiness, a sense of constric-
tion in the temporal regions, a ringing  in the ears, with a pungent sensation in
the nose;  a strong tendency to sleep, accompanied by vertigo, and so great a loss
of muscular power,  that if the individual be at the time in an erect posture, he
instantly falls, as if struck to the ground.   The respiration,  which is observed
to be at first difficult and stertorous, becomes suspended.  The action of the heart,
which on the first accession of the symptoms is very violent, soon  ceases.  Sen-
sibility is lost, and the person now falls into a profound coma, or  state of appa-
rent death.  The warmth of the body still continues;  the limbs remain flexible,
but they have been observed  to become  rigid or even occasionally convulsed.
The countenance is commonly of a  livid or of a deep leaden  colour, especially
the eyelids and  lips, but on some occasions  it is stated to have been pale.   The
access of these symptoms has been  sometimes accompanied by a pleasing sensa-
tion of delirium, while at others, the most  acute pains have been suffered.   In
some instances there appears  to  have been  irritability of the stomach; for the
affected person has  ejected the contents of the stomach in a semi-digested state.
Those who have been resuscitated have often felt pain in the head, or pain and
soreness  over  the body for several  days; while, in a few severe cases, paralysis
of the muscles of the face has supervened on recovery.
   Post-mortem appearances.—Externally, the whole of the body appears as if it
were swollen, especially the face, which  is generally livid, and the features are
much distorted.  The  cutaneous surface is covered in parts by patches of a vio-
let hue, but, in some instances, the  skin has been extremely pale; the eyes are
generally prominent, and, in many  cases, retain  their usual brilliancy for some
time after death.  The body of an individual who has perished from the inhala-
tion of carbonic acid  is  said to retain the animal heat, caeteris  paribus, for a
longer period than usual; and hence, according to Orfila, cadaverous rigidity does
not commonly manifest itself until after the lapse of many hours.   In a case to
be related presently, the body was,  however, found  to have cooled considerably
within the short space of two hours.  On making a post-mortem inspection, the
venous system is found filled with blood of a dark colour;  and the vessels of the
 lungs and brain are observed to be especially in a  state  of  congestion.   The
tongue appears swollen, and it is stated by  Orfila that the mucous membrane of
 the intestinal canal is often interspersed with dark ecchymosed patches.
   It will be seen that  there  is nothing very characteristic  in  the post-mortem
 appearances, and thus it  is always   easy to  ascribe  death  to  apoplexy or some
 other cause; but it should be remembered  that  carbonic acid ^itself acts by in-
 ducing apoplexy or  cerebral congestion.  A stove  was  actually allowed to be
 patented a few years since, the principle of which was to allow of the escape of
 the products of combustion in an invisible form into an apartment!   There were
 many educated  persons so ignorant as  to believe that, because the  fumes were
invisible, they were inert; others speculated upon the quantity of carbonic acid
evolved being small!  The use of this  stove appears to have led to the death of
a man named  Trickey, in St. Michael's church, in 1838, and many other serious
accidents.  The case of Trickey is  in many respects worthy of the attention of
the medical jurist.   (See Lancet, Nov. 1838.)
   Mode of action on the body.—Some difference of opinion still exists respecting
the manner in which carbonic acid acts on  the body.   Sir Humphrey Davy as-
certained that carbonic acid, in a perfectly  pure state, did not pass into the tra-
chea when an attempt was made to respire it; the glottis seemed  to close spas-
modically at the moment that the gas came in contact with it.  On diluting the
carbonic acid  with  about  twice its volume of air, he found that he  could breathe
it; but it soon produced  symptoms of  vertigo and somnolency.   In  fact, in a
diluted state,  it is certain  that  it must penetrate into the lungs, or  otherwise it
would be impossible to explain why it  should produce  any other symptoms than
those witnessed in the inhalation of hydrogen or nitrogen.  The facts which have 
528
CARBONIC ACID.
been collected by Dr. Christison show, in a striking point of view, that carbonic
acid is a real and energetic poison of the narcotic kind.   If, as Nysten supposed,
it had a negative effect when respired, it ought to follow, that it might be substi-
tuted for nitrogen in the proportion in which that gas exists in atmospheric air.
But a mixture of carbonic acid and oxygen in atmospheric proportions, has been
shown  by M. Collard de Martigny to produce rapidly fatal effects upon  the animal
system.   Such a mixture cannot be breathed, even for a period of two minutes,
without giving rise to serious symptoms.
  Absorption.—When the gas  enters into the  pulmonary cells, it is probably
absorbed by the blood and circulated with that fluid throughout  the body.  Its
specific action on the brain may be inferred from the headache, vertigo, somno-
lency and coma, which follow its introduction, as also from the loss of muscular
power  in persons labouring under its effects, as well  as  the paralysis which is
sometimes seen in those who have recovered.
  Poisonous proportions.—A very small proportion of carbonic acid, when respired
for  a certain  time in  combination with air, will  suffice to destroy life in man or
in any of the  higher orders of animals.  It is generally admitted by physiologists,
that an atmosphere containing more than one-tenth of its volume of carbonic acid,
will, if introduced into the lungs, speedily prove fatal to human  life.   M.  Gue-
rard has lately called in cpiestion the general opinion  that carbonic acid is very
fatal to life.  He says it may be mixed in very large proportions with atmospheric
air without causing death, and attributes the noxious effects of charcoal-vapour to
carbonic oxide, which, he says, will prove fatal  when in the proportion of only
four or five per cent.   (Ann. d'Hyg. 1843, ii. 54.)  If 31. Guerard had extended
his  experiments to the Grotto del Cane, at Pozzuoli, near Naples, he would have
found that mixtures which he describes as innocent, are speedily  fatal to animal
life.  The "air of the Grotto is  a  mixture of carbonic acid, common air, and
aqueous vapour:  it contains no carbonic oxide;  and  I have not  only witnessed
its fatal effects on animals, but have myself experienced the incipient  symptoms
of poisoning by carbonic acid from  respiring it.
  It is necessary in these cases to make a distinction between the contamination
of air from the admixture of free carbonic acid, and the case where the carbonic
acid is formed by combustion or respiration in a  close apartment,  at the expense
of the oxygen actually contained in air.  Every volume of carbonic acid formed
by combustion indicates  an equal volume of oxygen  removed.    Such an  atmo-
sphere is, caeteris paribus, more destructive than another where the air and gas
are  in a state of simple admixture.   If we assume that in each  case the noxious
atmosphere contains ten per cent, of carbonic acid, then in the case of combustion
there will be  seven per cent, less of oxygen and seven per cent, more of nitrogen,
than where the gases are mixed, since the production of ten parts of carbonic
acid implies the  loss of ten parts of oxygen.   This difference in the proportions
may not  be, practically speaking, correct; because there is no apartment suffi-
ciently closed to prevent air rushing in from the exterior while combustion is
going on within it;  but nevertheless, the above  statement may be taken  as an
approximation to the truth.   AVhen the gas  is respired in the  lowest poisonous
proportion, the symptoms come on more slowly,  and  the  transition from life  to
death is frequently tranquil:  this is what we learn  from the histories of suicides.
The symptoms in such cases appear to resemble  closely those which indicate the
progressive influence of opium, or any other narcotic poison, on the body.
  Treatment.—The  best means for resuscitation are the employment of artificial
respiration and cold  affusion,  with  stimulating  embrocations to  the  chest and
extremities.  If the surface be cold, a warm bath  should be employed, and on
the  appearance of any signs of recovery, if there  should be congestion of the
cerebral vessels,  venesection may be performed.   If at hand, oxygen gas may
be introduced into the lungs.  A case, in which the  use of  this gas  is said  to
have been successful, is quoted in the Lancet, July 26, 1844, p. 531.   Oxygen 
DEATH FROM CHARCOAL-VAPOUR.
529
gas was used for this purpose nearly forty years ago, by the late Dr. Babin"-ton.
(Med. Chir. Trans, i. Art. 8.)
   Analysis.—Sometimes a medical jurist may be required to state, for the pur-
poses of justice, the nature of the gaseous mixture in which a  person  may have
died.  He will have but little difficulty in determining whether carbonic acid be
the deleterious agent in such a mixture.   AVhen it exists in a confined atmo-
sphere, its presence may be identified, if previously collected in a  proper vessel,
by the following characters.  1. It extinguishes  a taper if the  proportion be
above twelve or fifteen per cent.; and from  the  extreme density of the gas, the
smoke of the extinguished taper may be commonly seen to float  on its surface.
2. Lime-water, or a solution of subacetate of lead, is instantly precipitated white
when poured into a jar of the gas;  and the precipitate thus formed may be col-
lected by filtration, and proved to possess the well known properties of carbonate
of lime or lead.  Air containing  only one per cent, of carbonic acid scarcely
affects lime-water.   3. AVhen a solution of chloride of lime, coloured  by litmus,
is added, the blue colour, on agitating the liquid in the gas, is discharged.  This
clearly distinguishes carbonic  acid  from  nitrogen.  The proportion  in which
carbonic acid exists  in  a  mixture,  may be determined  by  introducing into a
measured quantity, in a graduated tube over mercury, a  strong solution of caustic
potash.  Absorption will take place after a  certain time,  and the  degree of ab-
sorption will indicate the proportion  of carbonic acid present.  AVhen this de-
structive agent exists in a confined spot, as in a well or cellar, it may be generally
got rid of by placing within the stratum a pan containing the hydrate of lime
loosely mixed into a paste with water,—by exciting combustion at the mouth of
the pit, or what is better, when available, by a jet of high pressure  steam.  [Pro-
bably the most effective agent for its removal is the strong liquor ammoniae, which
has been lately recommended, or the hydrate of lime (common white-wash) mixed
with a small proportion of carbonate  of ammonia.—H.]  Lives are  often  suc-
cessively lost on these occasions in  consequence of one  individual  descending
after another, in the foolish expectation of at least being able to attach a rope to
the body of his companion.   The moment that the mouth falls within the level
of the stratum, all power is lost, and the person commonly sinks  lifeless.   The
gas may be collected by lowering  a  bottle  filled with fine sand by means of a
string attached to the neck, and guiding the bottle  by another string attached to
its base.   AVhen the bottle is within the stratum, it should  be turned with its
mouth downwards, and when the sand has  fallen out,  rapidly raised with its
mouth upwards, by pulling the string attached to the neck.

                            CHARCOAL-VAPOUR.
   Products of burning charcoal.—The gas  extricated during the  combustion of
charcoal, according to the experiments of Orfila, is  not pure carbonic acid, but a
very  compound mixture.  It operates fatally when  respired,  chiefly  in conse-
quence of the carbonic acid contained in it: the proportion of this gas is,  how-
ever, subject to variation, according to whether the combustion be vivid  or not.
AVhen the charcoal  burns vividly, the quantity of  carbonic acid is, according to
Orfila, less than when it is either nearly extinguished or beginning to burn.   In
the former case, the carbonic acid is in the proportion of  about eleven per  cent.
by volume—in the  latter, the proportion amounts  to about  fourteen per cent.;
the remainder of the mixture is made up of air, of free nitrogen,  and  of a por-
tion of carburetted hydrogen, if the charcoal be not too intensely ignited. (Orfila.)
   Symptoms and post-mortem appearances.—The following case, illustrating the
effects of charcoal-vapour, has  been reported by Mr. Collambell.  (Med.  Gaz.
xxvii. 693.)   In January, 1841, a man was engaged to  clean the windows of
three small rooms on the basement-story of a house.  The first room had a door
opening into a courtyard—the others merely communicated with each  other by
a  central door, and  there was no  fire-place in any  one.    A brazier  of burning
       34 
530             CHARCOAL VAPOUR.  POWER OF LOCOMOTION.

charcoal had been placed in the outer room for the purpose of drying it, but it
appeared that the deceased had shut the outer door, and had removed the brazier
into  the  inner  room  of the three, leaving the communicating  doors open.  In
tioo hours the man was found quite dead, lying on the floor of the middle room.
The  countenance was  pale, as well as the whole of the skin; the eyes were bright
and  staring, the pupils widely dilated; the lips exsanguine; the jaw firmly fixed;
the tongue protruding, and the face and  extremities cold.   Some frothy mucus
had  escaped from the mouth.   The  person who discovered the deceased found
the ashes in the brazier still burning, and he experienced great oppression in
breathing.   An inquest was held without an  inspection, and  a verdict  of acci-
dental death returned.   The  body was afterwards privately inspected  by Mr.
Collambell.   On opening the head, the vessels on the surface of the brain were
found highly distended with dark liquid blood; the pia mater was bedewed with
serum.   The brain was  of unusually firm consistence, and numerous bloody
points appeared on making a section of it.  The lateral ventricles were distended
with about an ounce and a half of pale serum, and the vessels of the plexus cho-
roides were much congested.   The cerebellum was firm, and presented on section
numerous bloody points.  About two ounces of serum, tinged with blood, were
collected from the base of the skull.   The lungs had a  slate colour.   On the left
side of the chest there were eight ounces of serum, tinged with blood, and nearly
an equal quantity on the right side.   On cutting into the organs, a large quantity
of serous fluid,  mixed with blood, escaped.  The bronchial tubes were filled with
a frothy  fluid tinged with blood.   The pericardium contained  an  ounce of pale
serum: the heart was enlarged; the cavities contained no blood: the liver and
kidneys were, however, much  gorged.  There was no  doubt that the cause of
death was the  inhalation of charcoal-vapour; and it is probable that the man
died from respiring but a comparatively small proportion.   The capacity of the
chambers must have nearly reached two thousand cubic feet:  the deceased had
been there only two hours, and when the person who discovered him entered the
rooms, the' air was not so vitiated but that he could breathe, although with some
oppression.   The  fuel was then in a state of combustion.  In  one case which
was referred to me for examination in 1851, there was a considerable effusion of
blood in the submucous tissue of the  stomach.   This appearance led to a strong
suspicion of irritant poisoning.   In one fatal case there was copious bleeding from
the  nose.  (Med.  Gaz. xlvii. p. 412.)
   Power of locomotion.—It often  excites surprise on these occasions that no ex-
ertion is made  to escape, when it would apparently require but very slight efforts
on the part of the individual.   The fact is, that the action of the vapour is some-
times very insidious; one of its first effects  is to create an utter prostration of
strength, so that even on a person awake and active, as in the case above related,
the  gas may speedily produce a perfect inability to move or to call for assistance.
For some remarks on the action of charcoal-vapour, by Dr. Bird, see  Guy's Hos-
pital Reports, April, 1839;  and for a case illustrative of the dangerous effects of
the  diluted  vapour, see Ed. Med. and Surg. Journ. i. 541.  In this instance,  a
charcoal brazier was left only for a short time in the cell of a prison.  It was re-
moved, and the prisoners went to  sleep.   They experienced no particular effects
at first, but after some hours,  two were found dead.  Thus, then, an atmosphere
which may  be breathed for a short time with impunity, may ultimately destroy
life.
   In a case of alleged murder by  carbonic acid, which occurred in Paris  a few
years since, a question was put to the medical witnesses, respecting the quantity
of charcoal required  to be burnt in a particular  chamber in order to asphyxiate
 two adult individuals.  (Ann. d'Hyg. 1837, i. 201; 1840, 176; also, Brit, and
 For. Rev. xi. 240, and xxiii. 264.)  This question  could  of  course only be an-
 swered approximately;  because in burning charcoal, the sole product is not car-
 bonic acid, and the substance itself is by no  means pure carbon.  Then, again, 
COAL AND COKE VAPOUR.
531
 much of the carbonic acid formed may escape in various ways from an imperfectly
 closed apartment.   An attempt was made to infer the quantity of charcoal  con-
 sumed, from the weight of ashes  found in the apartment; but no satisfactory
 answer could be given to the question.  The prisoner was, however, convicted of
 murdering his wife by carbonic acid.
   Products of burning wood.—M. Devergie has shown that the slow combustion
 of wood may lead to the evolution of a noxious vapour, and give rise to dangerous
 consequences  (Ann. d'Hyg. 1835, i. 442.)   His  remarks have  been recently
 confirmed by two cases published by MM. Bayard and Tardieu.  A man and his
 wife were found dead in bed.  There was a smoky vapour in the apartment, but
 no fire had been lighted  in the grate, and the chimney was  blocked  up.   The
 planks of the floor were widely separated, and there was a  large hole in the boards
 at the foot of the bed,  communicating with the apartment below.   It was found,
 on examination, that some joists connected with the flue of an iron plate, which
 had been heated for making confectionary the previous day, were in  a smouldering
 state; that the vapour  had entered the bedroom of the deceased through the cre-
 vices in the floor,  and  not finding a vent by the chimney, had led to these fatal
 results.  It is remarkable that the source of combustion was  nearly nine yards
 distant, and one person, who slept nearer to the flue of  the iron  plate, entirely
 escaped.  In the husband, the skin was of a  reddish tint, the blood liquid, the
 cavities  of the heart empty, the lungs gorged, and there were no  subpleural ec-
 chymoses.   In the wife there was less redness of the skin, the blood was coagu-
 lated in the cavities of the heart, principally on the right  side, extending to the
 vessels;  less engorgement of the lungs, and a great number of subpleural ecchy-
 moses, indicating  that strong efforts  had been made to respire.   There was at
 first a rumour of poisoning, which  was only disproved by a close examination of
 the locality.   (Ann. d'Hyg., Oct.  1845, 362.)

                COAL AND COKE-VAPOUR.  SULPHUROUS ACID.
   Products from burning coal and coke.—The gases extricated in the smothered
 combustion of coal are of a compound nature.   In addition to carbonic acid, we
 may expect to find in the atmosphere of a close room, in which  such a combustion
 has been going on, sulphurous  acid gas, and the sulphuretted and carburetted
 hydrogen gases.   These emanations are equally fatal to life; but in consequence
 of their very irritating properties, they give warning of  their  presence, and are
 therefore less liable to  occasion fatal accidents.  The sulphurous acid gas, when
 existing in a very  small proportion in  air,  has the power of irritating the glottis
 so violently, that,  if accidentally respired, it would commonly compel  the  indi-
 vidual to leave the spot before the vapours had become sufficiently concentrated
 to destroy life.   Nevertheless, accidents from the combustion of coal sometimes
 occur.
   Symptoms and  appearances.—The  following cases will convey a knowledge
 of the symptoms and post-mortem appearances  which are commonly met with on
 these occasions.   Some years since, four individuals, in a state of asphyxia, were
 brought to  Guy's Hospital.  It appeared  that on the evening before,  they had
 shut themselves up in the forecastle of a coal-brig, and had made a fire.  About
 six or seven o'clock  the same evening, some  of the  crew accidentally placed a
 covering over the fire on the outside, and thus stopped the escape of smoke from
 the fire, which was made of a kind of coal containing much sulphur.   Early in
 the morning, one of the crew, on opening the hatches, observed three of the in-
 mates lying on the floor senseless and frothing  at the mouth;  the  fourth in his
 crib, in a similar condition.  The air in the place was most offensive.  After the
 men were brought on deck, one of them, aged  twenty-one, began to recover, and
 when brought to the hospital, he  seemed only giddy, as if intoxicated.   He soon
completely  recovered.   Another, aged forty,  after  breathing oxygen gas  and
having brandy and ammonia exhibited to him, showed no symptoms of recovery, 
532                 VAPOUR OF LIME AND BRICK-KILNS.

but died in a few hours.   A third, aged seventeen, soon began to rally, and in a
few hours was perfectly enabled to answer questions; he declared that he felt no
pain, sense of oppression or weight, either in his head or chest.  The fourth, aged
fifteen, died the following day, having exhibited no symptom of rallying.   Sti-
mulants were administered internally, and warm fomentations were used, but all
efforts to  produce reaction failed.  The  appearance  of the individuals  when
brought in, was as follows:—lips purple, countenance livid,  surface of- the body
cold, hands and nails purple, respiration very quick and short; pulse small, quick,
and feeble; pupils fixed, and there was total insensibility.  The body of the man,
aged forty, was inspected four hours after death.  The membranes  of the  brain
were congested, and there was a large quantity of fluid under  the  tunica arach-
noides.   The sinuses were gorged with blood.   The lungs were in a state of
great congestion,  as also the right cavities  of the heart.  It was remarked, that
this corpse was similar in appearance to that of an executed culprit.   The body
of the  lad, aged fifteen, was inspected about thirty-three hours after death.
Under the pia mater was observed one small ecchymosed spot; in the substance
of the brain there were more bloody points than usual; a small quantity of fluid
was found under  the tunica arachnoides, and the sinuses were full of coagulated
blood.  The  lungs  showed  no congestion, but the right cavities  of the  heart
were much distended with blood.  (For an account of two cases of recovery from
the effects of coal-vapour, see Med. Gaz.  ix. 935; also, Dub. Med. Press, Jan.
31, 1849, p.  69,  and Med. Gaz. xliii. p. 937.)
  An interesting case of the fatal effects of coal-vapour has been  published by
Dr. Davidson.  The man lost his life from sleeping in a closed room with  a fire
to which there was  no flue.   The lungs were found gorged  with blood, and the
trachea and bronchi were  filled with a frothy muco-sanguineous fluid; the mucous
membrane beneath  was slightly injected.   There was a small effusion in each
pleural cavity.   The right side of the heart was full of dark liquid blood.   The
dura mater was much injected; the sinuses of the brain and  the veins of the pia
mater were completely congested, and there was sub-anichnoid  effusion.   The
substance of  the  brain, when cut, presented numerous bloody points.   (Month.
Jour., April, 1847, 763.)  In the Medical Times and Gazette, (April, 3, 1852,
p. 353,) the reader will find  an account  of three  cases of recovery from the
effects of coal-vapour.
  [Several interesting cases are  related by Briand (Man. Comp. de Mid. Leg.
5th ed. 416, 419) to show the importance of closely examining the localities in
those cases of asphyxia where the source of the deleterious gas is not very evident.
(See ante, p. 526, in relation to suspicion of poisoning.)   In one of these cases
a man and wife were found dead in bed suffocated by gas produced by the charred
wood work in the neighbourhood of a fire in a room at the opposite  end of a long
corridor on the same floor.   The gas had worked its way under the floor until it
found a vent in a crack of the flooring of the unfortunate couple's chamber.  In
other instances the gas was drawn through stove pipes, and from one chimney
flue to another on different floors.—II.]
   Analysis.—Sulphurous  acid  is  immediately  known by its powerful and
suffocating odour, which resembles that of burning sulphur.  The best test for
its presence is a mixture  of iodic acid and  starch, which speedily acquires a blue
colour when exposed to the vapour.

                    VAPOUR OF LIME AND BRICK-KILNS.
   Gaseous products from lime-burning.—In the burning of lime,  carbonic acid
is given out  very abundantly and in a  pure form.   It has been owing to the
respiration of the gas thus extricated, that persons  who have incautiously slept
in the neighbourhood  of  a burning lime-kiln during a severe winter, have been
destroyed.   The  discovery of a dead body in such a situation would commonly
suffice to  demonstrate the real cause of death;  but a practitioner  ought not to
be the less prepared to show that there existed no other apparent cause of  death 
SUFFOCATION IN CONFINED AIR.
533
about the person.   It is obvious that an individual might be murdered, and his
body placed subsequently near the kiln by the murderer, in order to avert suspi-
cion.  If there be no external marks of violence, the stomach should be carefully
examined for poison: in the absence of all external and internal lesions, medical
evidence will avail but little; for a person might be criminally suffocated, and his
body, if found under the  circumstances above  stated, would present no appear-
ances upon which a medical opinion could be  securely based.  An  accident is
related by Fodere to have occurred at Marseilles in  1806, where seven persons
of a family were destroyed in consequence of their having slept on the ground-
floor of a house, in a court-yard of which a quantity of limestone was being burnt
into lime.  They had evidently become  alarmed, and  had attempted to escape;
for their bodies were found  lying in various positions.   The court-yard was en-
closed, and  the carbonic  acid had poured into  the apartment  through the im-
perfectly-closed window and door.   In November, 1838, a man died three days
after being  exposed  to the vapours of a  lime-kiln.   (Guy's Hosp. Rep., April,
1839.)   The vapour of a brick-kiln is equally deleterious, the principal  agent
being carbonic acid, although I have found that ammonia and muriatic acid are
also abundantly evolved.  In September, 1842, two boys were found dead on a
brick-kiln near London, whither they had gone for the purpose of roasting pota-
toes.  Although the cause of death in the two cases was clearly suffocation, in
one  instance the  body was  extremely livid, while in the other there was no
lividity whatever!   Such  accidents are very frequent.   In November, 1844, an
inquest was held at Manchester on the body of a man who had died under similar
circumstances.

                               CONFINED AIR.
   Symptoms and effects.—An animal confined  within a certain quantity of air,
which  it  is compelled to  respire, will soon fall into  a state of lifelessness.   A
human being in the  same  way may be suffocated, if confined in a close apartment
where  the air is  not subject to change or renewal, and this effect is hastened
when a number of persons are crowded together in a small space.  The change
which  air, thus contaminated by respiration,  undergoes, may be very simply
stated.  The quantity of nitrogen in a hundred parts will remain nearly the  same;
the quantity of oxygen will probably vary from eight to twelve per cent., while
the remainder will be made up chiefly of carbonic acid.   Such air will also have
a high temperature,  if many persons are crowded together, and will be saturated
with aqueous vapour containing animal matter poured out by the pulmonary and
cutaneous exhalants.   From this statement, it is evident that air which has been
contaminated by continued respiration will operate fatally on the human system,
partly in  consequence of its being deficient  in  oxygen, and  partly from the
deleterious effects of  the carbonic acid contained in it.   The proportion in  which
carbonic acid exists in respired air must be subject to great variation; according
to the experiments of Allen and Pepys, it never exceeds ten per cent, by volume
of the mixture,  how frequently soever it may have been received into and expelled
from the lungs.  Dalton found that the  air in crowded  rooms contained  about
one  per cent, of carbonic acid,  the  atmospheric proportion being therefore in-
creased  tenfold.  It is certain  that insensibility and  death  would  ensue in  a
human adult, before  the whole of the oxygen of the confined air had disappeared;
but  the opportunity  can rarely present itself of analyzing such a contaminated
mixture, and hence  it is  impossible to specify the  exact proportion in which
carbonic acid would exist,  when  the confined air had proved fatal to persons who
had respired it,   M. Lassaigne has shown, by direct experiment, that the carbonic
acid  in the air of close rooms is not collected on the floor, but equally diffused
throughout.   The whole  mass of air is  in fact vitiated, and requires renewal.
(Med. Gaz. xxxviii.  851.)
  Combustion in mixtures contain ing carbonic acid.—In reference to poisoning by
carbonic acid, there is one circumstance which requires attention.  It is a matter 
534
DIFFUSION OF CARBONIC ACID.
 of popular belief, and, in fact, it is generally asserted by writers on  asphyxia,
 that the burning of a candle in a suspected mixture of carbonic acid and air, is
 a satisfactory proof that it may be respired with safety. Recent observations have,
 however, tended to show that this statement is not  to be  relied on as affording
 an indication of security.   A case is related by Dr.  Christison, where  a servant,
 on entering a cellar  in which grape-juice was fermenting, was  suddenly seized
 with giddiness.  She dropped her candle on the floor, but  had time to leave the
 cellar  and shut the door behind her, when she fell down senseless.  Those who
 went to her assistance found, on opening the door, that the candle was still burn-
 ing.   Another case is referred to, where, in an attempt  at suicide, on entering
 the apartment, the person  was discovered  to be in a state of deep coma, while
 the pan of charcoal was still burning; and  in an instance  just now related, the
 same fact was observed.  The results of some experiments on this subject have led
 me to the conclusion that a candle will burn in air which is combined with even
 ten or twelve  and  a half per cent, of its volume of  carbonic acid gas, and
 although such  mixtures might  not prove immediately fatal to man, yet they
 would soon give rise to giddiness, vertigo, insensibility, and ultimately death, in
 those who, after having been once immersed in them, did not hasten to quit the
 spot.   In air containing a smaller proportion than this,-—(five or six per cent.,)
 —a candle will readily burn; but it is probable that such a mixture could not be
 long respired without causing fatal  symptoms:  hence the  burning of a candle
 can be  no criterion of safety against the effects of carbonic  acid.   It is perfectly
 true that, in gaseous mixtures where a candle is  extinguished, it would  not  be
 safe to  venture;  but the converse of this proposition  is not  true;  namely, that a
 mixture in which a candle burns may be always respired with safety.
   Diffusion of carbonic acid.—Of late years some important medico-legal ques-
 tions have arisen, relative to  the diffusion of this  gas in air, when produced by
 combustion.   It has been  supposed that, owing to its great  specific gravity
 (1.527,) it would collect on the floor of an apartment, would gradually rise up-
 wards,  and suffocate  individuals at  different times, according  to the  level on
 which  they might happen to  be placed.   Questions  on this point have been va-
 riously answered, and great  difference  of opinion has arisen  on  the subject.
 Medical witnesses have often  lost sight of two important points on which a cor-
 rect answer to this inquiry must be based:—1. The law of the diffusion of gases;
 and, 2. The effect of heat in  greatly diminishing  the specific gravity of a gas
 naturally heavy.  There  is no doubt that, in a  narrow or confined vessel,  ex-
 posed to air, carbonic acid is slow in escaping,—nevertheless it mixes and passes
 off with the air;—and in the course  of an hour or two, in spite of its great spe-
 cific gravity, none will be contained within the vessel.   The well known Grotto
 del Cane, at Pozzuoli, has been referred  to by those who  hold that carbonic acid
 always  tends to remain on the lowest level;  but it has  been forgotten that  in
 this, and  other similar cases,  carbonic acid  is continually issuing  from crevices
 in the  soil, so that that which is lost by diffusion  is continually replaced; hence
 the illustration proves nothing. It may suffice to state, that  air and carbonic acid
 mix readily on contact in all  proportions, although  they  enter into  no chemical
 combination.   Thus, then, at common temperatures, carbonic  acid  has no ten-
 dency to remain on the floor or soil, when there is a free  access of air or contact
 with other gases.  The heat of combustion diminishes the specific gravity of the
 gas, and the carbonic acid therefore  ascends with  the heated current of air, and
diffuses itself in the upper  part of  an apartment where  there are no  means  of
carrying it off.   This is a fact demonstrable by many simple experiments.   In
burning a quantity of charcoal actively in an open brazier raised above the floor
in a large apartment, I found that the  proportion of carbonic  acid was  nearly
equal in air taken from a  foot above and a foot  below the level of the  source of
combustion, there being no  currents to affect the results.   Hence it follows that
carbonic acid produced by combustion has no particular tendency to collect at the
lowest level; that it is uniformly diffused around, and probably it would  be found, 
SUFFOCATION BY COAL GAS.
535
by careful experiments, that within apartments of small dimensions—those in
which individuals are often accidentally suffocated—the upper strata of air con-
tain as much or even more carbonic acid  than the lower.  For this reason, an
apartment with a low ceiling is more dangerous, under these circumstances, than
one which is lofty.
   Summary.—In a very large  apartment, it would of  course be improper to
test the suffocating properties of the air by the examination of it at a great dis-
tance from the source of combustion; since a person situated near this spot might
be destroyed, while one at a distance might escape—the carbonic acid not having
completely diffused itself;  or supposing it to have become entirely diffused, the
proportion may be so small  as  to  render it  harmless.   It  is well known, by
the effects  of the vapour of a lime-kiln, that one lying  at the edge of the kiln
may be destroyed, while another at ten yards' distance, either on the same level
or below it, may entirely escape; and  it would not be possible, in  such a case,
to speculate upon  the proportion of carbonic  acid which had  destroyed life, ex-
cept by collecting the air from  the spot where the accident  occurred, and at or
about the time  of its occurrence.  Another fallacy appears to be, that because a
dead body is found recumbent, it is to  be  inferred that the individual must have
lain down and been  destroyed while sleeping.  The body  of a  dead person
must always be found thus lying on a floor, unless it be  supported; but suffo-
cation  may have actually taken place, or at  least have commenced, when the
deceased was in the sitting or erect posture.  Admitting  that  carbonic acid
diffuses itself rapidly from combustion in a small and closed apartment, it has
been supposed  that after having become mixed with  the  air, it would again in
great part separate, and, owing to its superior density, fall to the lowest level on
cooling.   In answer to this it may be  said,—1. That  there are no facts to sup-
port the opinion, while there are many against it;  for we do not find  that the
heaviest and  lightest gases, when  once  really mixed, ever again  separate from
each other.—2.  Practically this explanation amounts to nothing; because before
the gas had cooled and reacquired its  density, its asphyxiating properties would
probably have had their full  effect on  all  living persons within its  reach.  Per-
sons are not suffocated  by carbonic acid after the fuel is extinguished  and the
apartment cooled; but  the poisonous  action of the gas is commonly manifested
while the fuel is still burning.   The inferences which, it appears  to me, we are
entitled to draw from the preceding considerations, are,—1. That in a small and
close apartment, individuals are equally liable to be suffocated at all levels, from
the very equal and rapid diffusion of carbonic acid during combustion.—2. That
in a large apartment, unless the gas be very rapidly diffused  by a current of air,
—the air around the  source of combustion may become impregnated with a poi-
sonous proportion, while that  at a distance might  be still capable  of supporting
life, because carbonic acid requires time  for its perfect and equable diffusion in
a very  large space.

          COAL-GAS.   CARBURETTED HYDROGEN.   CARBONIC OXIDE.
   Since the introduction of coal-gas for the purposes of illumination, many fatal
accidents have  occurred from the respiration of air contaminated with it.  Coal-
gas is a compound body, acting  as a direct poison when respired.   Its composi-
tion  is  subject  to much variation, according  to  circumstances.    Mitscherlich
found that it was principally composed of light carburetted hydrogen, hydrogen,
and carbonic oxide, in the proportions of  66 per cent, of the first,  21*3 of the
second, and 11  of the third.   M. Tourdes found that the proportions of light car-
buretted hydrogen and carbonic oxide  were nearly equal, i.e. about 22 per cent.
The difference in composition depends on the heat  to which the gas has been
submitted.   Some consider that carbonic oxide is the poisonous principle;
but there is no  doubt that the hydro-carbons also have a noxious  influence, al-
though the use  of the safety-lamp in mines proves that a mixture of protocarbu- 
536
SUFFOCATION BY COAL-GAS.
retted hydrogen with air in a small proportion may be respired without producing
serious effects.
   Symptoms and post-mortem appearances.—The symptoms produced by coal-
gas when mixed in a large  proportion with  air, are vertigo, headache,  nausea
with vomiting, confusion of intellect with loss of consciousness, general weakness
and depression, partial paralysis, convulsions, and the  usual phenomena  of as-
phyxia.   The post-mortem appearances will be best understood from the  follow-
ing cases.  In  January, 1841, a family residing at Strasburg respired for forty
hours an atmosphere contaminated with coal-gas which had escaped from a pipe
passing near the cellar of the house where they lodged.   On the discovery of the
accident,  four of  the  family were found  dead.   The  father and mother still
breathed, but in spite of treatment, the father died in twenty-four  hours: the
mother recovered.   On a post-mortem examination of the five bodies there was a
great difference in the  appearances; but the principal points observed were con-
gestion  of the brain and its  membranes, the pia mater gorged with blood, and
the whole surface  of the brain intensely red.   In  three of the cases, there was
an effusion of coagulated  blood on the dura mater of the spinal canal.   The
lining membrane of the air-passages was strongly injected, and there was spread
over it a thick viscid froth tinged with blood; the substance of the lungs was of
a bright red colour, and the  blood was  coagulated.   (Ann. d'Hyg. Jan. 1842.)
In two  cases communicated by Mr. Teale  to  the  Guy's Hospital Reports (No.
viii.,) there was found congestion of the brain and  its membranes, with injection
of the lining membrane of the  air-passages.   In  these cases the blood was re-
markably liquid.  The circumstances under  which the accident occurred were
very similar.   An old  lady and her grand-daughter, who had been annoyed by
the escape of gas  during the day, retired  to  bed, and  were found dead  about
twelve hours afterwards.
  In  the cases above given, the effects produced by coal-gas were owing to the
long-continued  respiration of it in a diluted state.   The quantity contained  in
the air of the rooms must  have been very small; in M.  Tourdes' case it was pro-
bably not more than 8 or 9 per cent., because a little above this proportion the
mixture  with  air  becomes explosive,  and  there had been  no explosion  in this
case,  although  in  the  apartment in which the individuals were  found dead, a
stove had been  for a long time in active combustion, and a candle had been com-
pletely burnt out.  In Mr. Teale's case, those who entered the house perceived
a strong  smell of coal-gas; but still the air could be breathed.  Coal-gas,  there-
fore, like other  aerial poisons, may destroy life if long respired, although so di-
luted as not to  produce any serious effects  in the first instance!   This gas owes
its peculiar odour  to the vapour of naphtha:  the odour begins to be perceptible
in air when the gas forms only the 1000th part: it is easily perceived when form-
ing the  700th part, but the odour is well marked when it forms the  150th part
(Tourdes.)  In most houses  where  gas is burnt, the odour is plainly  perceived;
and it is a serious  question whether health and life may not often be affected by
the long continued respiration of an atmosphere containing  but a small propor-
tion.  The odour  will  always convey a  sufficient warning against its poisonous
effects.   It should be  known that  this gas  will penetrate into  dwellings in a
very insidious manner.  In Mr. Teale's cases, the  pipe from which the gas had
escaped was situated about ten feet from  the wall of  the  bed-room  where the
females slept.   The gas had permeated through the loose earth and rubbish, and
entered the apartment through the floor!   It is impossible to determine exactly
what  proportion of this gas in air will destroy life.  An atmosphere  containing
from  7 to 12 per cent, has been found  to destroy rabbits and  dogs in a few mi-
nutes: when the proportion was from 1| to 2 per cent,  it had little or no effect.
AVith respect to  man, it may destroy life if long respired when forming about 9
per cent., i e. when it is in less than an explosive proportion.   (See B.  and F.
Med.  Rev. xxix. 253;  also, Ann. d'Hyg. 1830, i. 457.)
  M. Tourdes has ascertained that rabbits died in twenty-three minutes when 
             POISONOUS EFFECTS OF SULPHURETTED  HYDROGEN.          537

kept in an  atmosphere containing l-15th of its bulk of pure  carbonic  oxide.
AVhen the  proportion was l-30th, they died in thirty-seven minutes, and when
l-8th, in seven minutes.   The action of this gas on the body is that of a pure
narcotic: it appears to be a powerful poison.
  Analysis.—The circumstances under which the accident occurs will generally
suffice to establish the nature of the gas.   Coal-gas burns with a bright white
light, producing carbonic acid and water.  A taper should be cautiously applied
to a small quantity;  since, when the gas is mixed with air in the proportion  of
from 11 to 14 per cent., it is dangerously explosive.   For this reason no lighted
candle should be taken into an apartment where an accident has occurred, until
all the doors and windows have been for some time kept open.   The  combustion
of the gas,  or its explosion with air, is a sufficient test  of its nature; the peculiar
odour, and the  want  of action on  a salt  of lead, will distinguish it  from  sulphu-
retted hydrogen.
  Carbonic oxide  is  known by the fact that when kindled it burns with  a  pale
blue light,  and produces carbonic  acid and water by its combustion.
                            CHAPTER  LXII.

 SULPHURETTED  HYDROGEN  GAS--ITS POISONOUS PROPERTIES--SYMPTOMS--POST-MORTEM
  APPEARANCES--EFFLUVIA OF DRAINS AND SEWERS--ANALYSIS--MEPHITIC VAPOURS--EX-
  HALATIONS OF THE DEAD.

   Poisonous proportions.—Sulphuretted  hydrogen, in a  toxicological point
 of view, may be considered next in  importance to carbonic  acid.  Individuals
 are occasionally accidentally killed by it; but  the  very offensive odour which  a
 small portion of it communicates to a large quantity of air,  is sufficient to  an-
 nounce its presence, and to prevent any dangerous consequences from  taking
 place.   The sulphuretted hydrogen gas, when respired in its pure state, is almost
 instantaneously mortal.  It exerts equally deleterious effects  upon all orders of
 animals, and upon all the textures of the body.  It has been  found to destroy
 life even when  it is allowed to remain in contact with  the skin.   Mr. Donovan
 states that a rabbit enclosed in  a bladder of sulphuretted hydrogen gas,  but al-
 lowed  to  breathe freely  in the atmosphere, perished  in ten minutes.  AVhen
 introduced into the lungs of animals, even  in a very diluted  state, it has been
 known to give rise to fatal  consequences.  Thus Thenard found that air which
 contained only  one eight-hundredth  of its volume of this  gas, would destroy a
 dog; and that when  the gas existed  in the proportion  of one two-hundred  and
 fiftieth, it sufficed to kill a horse.   The later researches of M. Parent-Duchatelet,
 however, seem  to show that the poisonous effects of the gas have been somewhat
 exaggerated, at least in the application  of  these results to man.   He observed
 that workmen breathed with impunity an atmosphere  containing one per cent.
 of sulphuretted hydrogen; and  he states that he himself respired, without  serious
 symptoms ensuing, air which  contained three per  cent.  In most  drains  and
 sewers, rats and other vermin are found to live in large numbers;  and, according
 to (faultier de Claubry, the air in those localities contains from two to eight per
 cent.   (Devergie, ii. 520.)   Thus admitting it to be a poison even more powerful
 than carbonic acid, it does not appear to be so energetic as Thenard's experiments
 would  lead us to suppose.  An atmosphere containing from six to eight per cent.
 of the  gas might speedily kill, although nothing certain is known  of the smallest
 proportion required to destroy human life.   One fact, however, is worthy of the
 attention of medical jurists, namely, that the respiration of an atmosphere  only
'slightly impregnated  with  the  gas, may, if long continued,  seriously affect an 
538               SULPHURETTED HYDROGEN.   SYMPTOMS.
individual, and even  cause  death.   M. d'Arcet had to examine a lodging in
Paris, in which three young and vigorous men had  died successively, in the
course of a few years, under similar symptoms.   The lodging consisted of a bed-
room with a chimney, and an ill-ventilated ante-room.   The pipe of the privy
passed down one angle of the room by the head of the bed, and the wall in this
part was damp from infiltration.   At the time of the examination there was no
perceptible smell in the room, although it was small and  low.   M. d'Arcet at-
tributed the mortality in the lodging to the  slow and  long-continued action of
the emanations from the pipe; and it is  highly probable that  this was the real
cause.   (Ann. d'Hyg. Juillet, 1836.)  The  men who were engaged in  working
at the Thames Tunnel suffered severely during the excavation from the presence
of this gas in the atmosphere in which they were obliged to work.  The  case was
referred to me for examination by Sir I. M. Brunei, in 1839.  The air as well
as the water which trickled through the roof, was found  to contain  sulphuretted
hydrogen:—it was  probably derived from the  action of the water on the  iron-
pyrites  in the clay.   The gas issued in sudden bursts, so as to be at times per-
ceptible by its odour.  By respiring this atmosphere, the strongest and  most
robust men were, in the course of a few months, reduced to an extreme state of
exhaustion, and several died.   The symptoms with which they were first affected
were giddiness, sickness,  and general debility: they became  emaciated, and fell
into a state of low fever,  accompanied by delirium.  In one case which I saw,
the face of the man was pale, the lips of a violet hue, the eyes sunk, with dark
areolae  around  them, and  the whole muscular system flabby and emaciated.
Chloride of lime and  other remedies were tried  for the  purification of  the air;
but the  evil did not entirely cease until the tunnel was so far completed that
there' was a communication  from one side  to  the  other, and free ventilation
throughout.
   Symptoms.—The symptoms produced by sulphuretted hydrogen on the human
system  vary according to the degree of concentration in which it is respired.
AVhen breathed in a moderately diluted state, the person speedily falls inanimate.
An immediate removal to pure air, venesection, and the application of stimulants,
with cold  affusion,  may, however, suffice to  restore  life.   According to the ac-
count given by those who have recovered, this state of inanimation is preceded
by a sense of weight in the  epigastrium  and  in the  region of the temples; also
by giddiness, nausea,  sudden weakness, and loss of motion  and sensation.  If
the gas  in a still less  concentrated state be respired for  some time, coma, or te-
tanus with delirium, supervenes,  preceded by convulsions or pain and weakness
over the whole of the body.  The skin, in  such cases, is commonly cold, the
pulse irregular, and the respiration laborious. AArhen the air is but very slightly
contaminated by the gas, it may be breathed  for a long  time without producing
any serious symptoms: sometimes there is a feeling of nausea, or sickness, accom-
panied by pain in the head, or diffused pains in the abdomen.  These symptoms
are often  observed to affect those who are engaged in  chemical manipulations
with this gas.  Sulphuretted hydrogen appears to act like a narcotic poison when
highly concentrated; but like a narcotico-irritant when much diluted with air.  It
is absorbed into the blood, to which it gives  a  brownish-black colour, and it is
in this state circulated throughout the body.  For an interesting case of poisoning
by this  gas, in which  the person  recovered, see Med. Gaz. vol. xlviii. p. 871.
   Post-mortem ag>pearances.—On examining the bodies  of persons who have
died from the  effects of sulphuretted hydrogen, the  following appearances have
been observed.  The mucous membrane of  the nose  and fauces is commonly
covered by a brownish viscid fluid.  A highly offensive odour is exhaled from all
the cavities and soft parts of the  body.  These  exhalations, if  received into  the
lungs of those  engaged in  making the  inspection, sometimes  give  rise to very
unpleasant symptoms, and may  even cause syncope  or  asphyxia.   The  muscles
of the body are of a dark colour,  and are not susceptible of the galvanic stimulus.
The lungs, liver, and the soft organs generally, are  distended with black liquid 
EFFLUVIA OF DRAINS.
539
blood.   There is also great congestion about the right side of the heart, and the
blood is said not to become coagulated after death: the body rapidly undergoes
the putrefactive process.
   Effluvia of drains and sewers.—The most common form of accidental poison-
ing by sulphuretted hydrogen, for it is rare that a case occurs which is not purely
accidental, is witnessed among night-men and others who are engaged in cleaning
out drains and sewers,  or in the removal of the soil of privies.  These accidents
are much more frequent in France than in England, the soil being often allowed
to collect in such quantities in Paris and other large continental  cities, as to
render the removal of  it a highly dangerous occupation for the workmen.  Ac-
cording to the results  of Thenard's  observations, there are two species of com-
pound  gases, or mechanical mixtures of gases, which are commonly met with in
the exhalations of privies.   The first compound consists of a large proportion of
atmospheric air holding diffused through it, in the form of vapour, the hydrosul-
phuret of ammonia.   The hydrosulphuret is contained abundantly in the water
of the soil, and is constantly rising from it in vapour, and diffusing itself in the sur-
rounding atmosphere.  It is this vapour which gives the highly unpleasant odour,
and causes an increased secretion of tears in those who unguardedly expose them-
selves  to such exhalations.   The symptoms produced by the respiration of this
gaseous mixture when  in a concentrated state,  bear a close resemblance to those
which  result from the action of sulphuretted  hydrogen gas.   If the person be
but slightly affected, he will probably complain of nausea and sickness; his skin
will be cold, his respiration free but  irregular;  the pulse is commonly frequent,
and the  voluntary muscles, especially those of the chest, are affected by spas-
modic  twitchings.  If more seriously affected, he loses all power of sense and
motion, the skin becomes cold,  the lips and face assume a violet hue, the mouth
is covered by a sanguineous  mucus,  the pulse is small, frequent, and irregular;
the respiration hurried, laborious, and convulsive;  and the limbs and trunk  are
in a state of general relaxation.   If  still more severely affected, death may take
place immediately, or  should the person survive a few hours, in addition to the
above  symptoms, there will  be short but violent spasmodic twitchings of the
muscles, sometimes even accompanied by opisthotonos. (See Ann d'Hyg. 1829,
ii. 70.)  If the individual be sensible, be will commonly suffer the most severe
pain, and the pulse may become so quick and irregular that it cannot be counted.
When  the  symptoms are of such a formidable nature, it is very rare that a re-
covery takes place.  The appearances met with on  making  a post-mortem ex-
amination of the body are  similar to those observed in death from sulphuretted
hydrogen.   The inspection should be made with caution; for a too frequent  res-
piration of the poisonous exhalations may  seriously affect the practitioner.  The
treatment is the  same as in poisoning by carbonic acid.
   A singular accident occurred in this metropolis in August, 1847, in which a
man lost his life by the  evolution of a quantity of sulphuretted hydrogen from
a foul  drain. It appears that shortly before the accident, a large quantity of oil
of vitriol had been poured down the drain communicating with the privy.  The
deceased entered the yard,  and  was soon afterwards found on the pavement in a
dying state.  On inspection of the body, the brain was healthy; but the lungs
were°gorged with blood, which had the offensive odour of sulphuretted hydrogen
gas.   The medical witness referred death to this gas, and stated that lime  had
been thrown into the drain, that sulphuret of calcium had probably been formed,
and that the sulphuretted hydrogen,  which had led to the death of the deceased,
had been evolved from this by the vitriol.  It is more  probable, however, that
the gas was  evolved by the  decomposition of the hydrosulphuret of ammonia,
which  always abounds  in such localities.
   The  following case, which has  a  close relation to this  subject, occurred iu
London in  1831:—Twenty-two boys, living at a boarding-school  at Clapham,
were seized, in the  course of three or four  hours, with  alarming symptoms of
violent irritation in the stomach and bowels, spasms of the muscles of the arm, 
540              ANALYSIS.   MEPHITIC VAPOUR OF DRAINS.
 and excessive prostration of strength.   One child, which had been similarly at-
 tacked three days before, died in twenty-five hours; and one, among the last at-
 tacked, died in twenty-three hours.  Both of the  bodies were  examined  after
 death: in the first, the mucous glands of the intestines were found enlarged, and,
 as it were, tuberculated. In the second, the mucous coat of the  small intestines
 was found ulcerated, and that of the colon softened.   At first  it was suspected
 that the boys had been poisoned, but an analysis of the food did not lead to the
 discovery of any noxious  substance.   The only circumstance  which was  con-
 sidered sufficient to explain the accident was, that two days before the first child
 was seized, a foul cesspool had been  opened, and the materials diffused over a
 garden adjoining the children's playing-ground. This was the opinion expressed
 by six medical practitioners.  (Christison on Poisons, 810.)
    Analysis.—The recognition of these gases is a very simple  operation.   The
 odour which they possess is sufficient  to determine  their  presence, even when
 they are diluted with a large quantity of atmospheric air.   The sulphuretted hy-
 drogen gas is at once identified  by its action on paper previously dipped in a
 soluble salt of lead: if present even in very small  proportion, the moistened
 paper  speedily acquires a  brownish black stain from sulphuret of lead.   The
 sulphuretted hydrogen may be also thus proved to exist in  the vapour of hydro-
 sulphuret of ammonia when mixed with  air;  and  the  presence of ammonia is
 indicated in the  compound, by the volatile alkaline reaction on  test-paper; also
 by holding in the vessel containing the vapour recently collected a rod dipped
 in strong muriatic acid: the production  of dense white fumes announces the for-
 mation of muriate of ammonia.  It is  a fact, which  cannot  be  too  universally
 known, that a candle will readily burn in a mixture of either of these bodies
 with air, which, if respired, would suffice to destroy life.  (Ann. d'Hyg. 1829, ii.
 69.) It is also worthy of remark, that the air of a cesspool may be often respired
 with safety, until the workmen commence removing the soil, when a large quantity _
 of  mephitic vapour may suddenly escape, which will lead to the immediate suf-
 focation of all present.  Several persons have been killed  by trusting to the
 burning of a candle, in ignorance of  this  fact.  The best plan for getting rid of
 the gas  is by a free  exposure of the locality, or by exciting active combustion
 in it.  According to Parent-Duchatelet, men  can work in an atmosphere con-
 taining from two to  three  per cent, of  sulphuretted hydrogen.   The air of one
 of  the principal sewers of Paris gave the following results, on analysis, in 100
 parts:—oxygen,  13*79; nitrogen, 81*21;  carbonic acid, 2*01; sulphuretted hy-
 drogen, 2*99.
    Mephitic vapour.—There is another species of deleterious  compound present
/ in these exhalations, of a very different  nature.  It is  more rarely met with than
 the  preceding, and consists, in 100 parts, according  to Thenard,—of nitrogen,
 90; of oxygen, 2, and  carbonic acid, 4.   Sometimes the  carbonic acid gas is
 combined with ammonia,  and then it may be regarded, chiefly, as a mixture of
 nitrogen holding diffused through it the vapour of carbonate of ammonia, which
 is sufficient to render it highly irritating  to the mucous membrane of  the eyes
 and nose.   Its action on the human body, when respired, will be readily under-
 stood from  this statement of its chemical composition.  In its operation it  must
 be regarded as exerting an  influence  essentially negative;  for the small propor-
 tion of carbonic acid or of carbonate of ammonia existing in it, cannot be sup-
 posed to give rise to the asphyxia which so rapidly follows its inhalation.  The
 chances of recovery  are much greater in persons who become asphyxiated from
 the inspiration of this compound, than in those who are exposed to the influence
 of  the preceding. Commonly the immediate  removal to a pure air is sufficient
 to bring about a  recovery;  for the asphyxia is originally induced owing to  there
 being an insufficient portion of oxygen  in the mixture to sustain life.  Should
 death take place, it will be found, on  a post-mortem inspection,  that the internal
 appearances are the  same as those which are met with in the examination of the
 bodies of the hanged or the drowned. 
EFFLUVIA OF THE GRAVE YARD.
541
   Analysis.—This compound extinguishes a taper: the carbonic acid contained
in it may be removed by caustic  potash, and then it will be seen that the great
bulk of the mixture is formed of nitrogen,—a gas which, by its negative proper-
ties, cannot be easily confounded with any other.   In a mixed atmosphere of
carbonic acid and sulphuretted  hydrogen, the  two gases may be separated by
agitating  the mixture with a solution of acetate of lead, and treating the pre-
cipitate with acetic acid, which  dissolves the carbonate and leaves  sulphuret of
lead.

                        EXHALATIONS OF THE DEAD.
   It may be proper in  this place to make a few remarks on the alleged danger
of the exhalations given off by dead bodies in  a state of putrefactive decompo-
sition.  Formerly there existed a groundless fear relative to the examination of
a putrefied dead body;  and during the last century, on several  important occa-
sions, medical witnesses refused to examine the bodies of deceased persons, who
were presumed to have  been murdered, alleging that it was an occupation which
might be  attended with serious consequences to themselves.  Orfila has collected
many accounts of the fatal effects which are recorded to have  followed the re-
moval of  the dead some time  after interment.  (Traite des Exhumations, vol. i.
p. 2, et seq.) He allows, however, that the details of most of these cases are ex-
aggerated, and attributes to other causes the effects which followed.  Indeed, the
observations of Thouret and  Fourcroy prove that these dangers are restricted
within a very narrow compass, and that in general, with common  precautions,
the dead may be  disinterred and  transported from one locality to another, with-
out any risk to  those engaged  in carrying on the exhumations.  About the latter
part of the last century, from fifteen to twenty thousand  bodies, in almost every
stage of decomposition, were removed from the Cimetiere des Innocens in Paris;
and the accidents that occurred during the operations, which lasted ten months,
were, comparatively speaking, few.  The workmen acknowledged to  Fourcroy,
that it was only in removing the recently interred corpses, and those which were
not far advanced in decomposition, that  they incurred  any danger.   In these
cases, the abdomen appeared to be much distended with gaseous matter,—if rup-
tured,  the rupture commonly took place about  the navel,  and there issued a
bloody fetid liquid,  accompanied by the evolution of a mephitic vapour,—pro-
bably a mixture of carbonic acid and sulphuretted hydrogen.  Those who respired
this vapour at the moment of its extrication, fell instantly into a state of asphyxia,
and died; while others, who were at a distance, and who consequently respired
it  in a diluted  state, were  affected with nausea, vertigo, or  syncope, lasting for
some hours, and followed by weakness and trembling of the  limbs.  Chloride of
lime was formerly employed for decomposing these vapours; but a strong solu-
tion of nitrate of lead, or chloride of zinc, may be substituted for it.  Peat char-
coal, or the charcoal of oak  bark (the refuse of tan-pits,)  has  also a powerful
deodorizing action.
   Several lives have been lost of  late years from the crowded state of the burial-
grounds of London.  A deep grave is dug, and this is kept open to be piled with
coffins until filled.  Persons venturing into these graves are immediately suffo-
cated.   The earth in these lpcalities is strongly impregnated with noxious exha-
lations, and no excavation  can be made without its becoming immediately con-
verted into a well of carbonic acid!  This appears to be the poisonous gas to
which fatal accidents in these  localities are most commonly due.  (See on this
subject Henke's Zeitschrift, 1840, ii. 440; Ann. d'Hyg. 1832, 216; 1840,131;
1843, 2S, 82.)
  In addition to these there are other gases of a poisonous nature which are for
the most part artificial  products.   It is seldom that  individuals are exposed to
respire them in such quantity  as to cause  serious symptoms or to endanger life.
For an account of these, I must  refer the reader to my work on Poisons. 
542
DEATH FROM LIGHTNING.
LIGHTNING.   COLD.  STARVATION.
                           CHAPTER LXIII.

LIGHTNING--EFFECTS OF THE  ELECTRIC FLUID—CAUSE OF DEATH--POST-MORTEM  APPEAR-
  ANCES--CASES--LEGAL RELATIONS--COLD--AN OCCASIONAL  CAUSE OF DEATH-- SYMP-
  TOMS--CIRCUMSTANCES WHICH ACCELERATE DEATH--POST-MORTEM APPEARANCES—CASE
  OF MURDER BY COLD--STARVATION--A RARE CAUSE OF DEATH--SYMPTOMS--POST-MORTEM
  APPEARANCES--SUMMARY OF MEDICAL EVIDENCE--LEGAL RELATIONS.

                                LIGHTNING.
  Effects of the electric fluid'.—Death by lightning is sufficiently common to re-
quire that a medical  jurist should be prepared  to  understand the phenomena
which accompany it; but there  is a more important reason why he should devote
some attention to this subject;  this is, that  the appearances left by the electric
fluid on the human body sometimes closely resemble those produced by extreme
mechanical violence.   Thus, a person may be found dead in an open field, or on
the highway; his body may present the marks of contusion, laceration, or frac-
ture ; and to one unacquainted with the fact that such violence occasionally results
from the passage of this subtle  and invisible  agent  through the animal system,
it might appear that  the deceased had been maltreated, and  probably murdered.
The greater number of deaths from the electric fluid takes place during the spring
and summer.  According  to the annual  report of  1838, there were 24 deaths
from lightning registered during that year, occurring in the following seasons:—
summer, 11; spring, 10;  autumn, 2; winter, 1.
   Cause of death.—The electric fluid appears to act fatally  by producing a vio-
lent shock to the brain and  nervous system.   In general there is  no sense of
pain—the individual  falls at once into a state of unconsciousness.  In a case which
did not prove fatal, the patient, who was seen soon after the  accident, was found
labouring under the following symptoms.  Insensibility; deep, slow, and inter-
rupted respiration; entire  relaxation of the muscular system; the pulse soft and
slow; the pupils  dilated  but sensible to light.   (Med. Gaz. xiv. 654.)  It will
be seen that these are the  symptoms of concussion of the brain.  The effect of a
slight shock is that of producing stunning; and when individuals who have been
severely struck recover, they suffer from ringing in the  ears,  paralysis, and other
symptoms of nervous disorder.   Insanity has even been known to follow a stroke of
lightning.   (Conolly's Report of Hanwell, 1839.)  In one case the individual
remained delirious for three days, and when he recovered he had completely lost
his memory.  (Lancet, Aug. 3, 1839, 582.)  Reaction  is best brought about,
in cases of slight shocks, by cold affusion.
  It may be observed of the effects of lightning generally, that death is either
immediate or the individual recovers.  A person may, however, linger,  and die
from the effects of severe  lacerations or burns indirectly produced.  A case oc-
curred in this city, in July, 1838, where death was thus caused  indirectly by
the effects of electricity.   The following case of recovery illustrates the action of 
                    LIGHTNING.  IGNITION OF THE CLOTHES.             543

the electric fluid:—Three persons were struck by lightning at  the same time.
In  one, a healthy  man, aged  26, the  symptoms  were very  severe.   An hour
and a half after the stroke, he lay completely unconscious, as if  in a fit of  apo-
plexy;—his pulse was below 60, full and hard, his respiration snoring, his pupils
dilated and insensible.   There were frequent twitchings of the arms and hands;
the thumbs were fixed  and immovable, and the jaws firmly clenched.  Severe
spasms then came on, so that four men could  scarcely hold  the patient in his
bed; and  his  body was drawn  to the left  side.   AArhen  these  symptoms  had
abated, he was copiously bled, cold was applied to the head,  and  a blister to the
nape of the neck, with  mustard poultices to the legs.   Stimulating enemata and
opium were also administered :  in the course of twenty-four hours consciousness
slowly returned, and the  man  soon completely recovered.   The only external
injury discoverable was a red streak  as broad as a finger, which  extended from
the left  temple over the neck and chest:  this disappeared  completely in a few
days.   (Brit,  and For. Med. Rev. Oct. 1842.)
   Post-mortem appearances.—Generally speaking, the body, externally, presents
marks of contusion and laceration about the spot  where  the  electric current has
entered  or passed out:—sometimes a severe lacerated wound has existed;—on
other occasions there has been  no wound or laceration, but a very extensive ec-
chymosis, which, according  to  Meyer, is most commonly found on the skin of
the back.   In one instance which occurred in London in May, 1839, there were
no external marks of violence whatever, and several similar cases are quoted from
American journals in  the Medical  Times (May  3, 1845, p.  82.)   I have not
met with the account of any case where the appearance of a burn has been  pro-
duced by the direct action  of a stroke of lightning; for in those instances  in
which burns have  been found  upon the body, it appears that  ignition  of the
clothes or articles of furniture had taken place, to which alone the burning was
to be  ascribed.  The clothes are  in almost all cases rent or  torn, and partially
singed, giving rise to a peculiar odour—sometimes even rolled up in shreds and
carried  to a distance.  Metallic substances  about the person present  traces of
fusion, and articles of  steel have been  observed  to acquire magnetic  polarity.
Actual ignition of the clothes is far from being a usual attendant on the passage
of a current of electricity through the human body.  AVounds are sometimes met
with on the body.   These have commonly been lacerated punctures, like stabs
produced by a blunt  dagger.  In the  recent case of an individual who was struck,
but not killed, a deep wound was produced in  one thigh, almost  laying bare the
femoral artery.  This individual was struck, as many others have been, while in
the act of opening an umbrella during a storm.  Fractures of the bones have not
been  commonly observed: in a  case mentioned  by Pouillet, the skull was se-
verely fractured, and the bones depressed. (Traite de Phys., Elect. Atmosph.)
   The following complete account  of  the  external and internal post-mortem
appearances found in the body of a healthy middle-aged labourer, who was killed
by a stroke  of lightning, has been published  by Dr. Schaffer.  The man  was
working in the fields with several other labourers, just after a thunder-storm had
passed over and had apparently subsided.   He was endeavouring  to  kindle a
light with a flint and steel, when the lightning struck him.   For a moment after
the shock he stood still, and then fell heavily to the ground.  The electric fluid
entered  at the upper part of his forehead, perforating and tearing his hat at  that
part:  it seemed  then to have become divided into two currents, which  passed
down the sides of the trunk, along the lower extremities,  and out at the  feet.
On the upper part of the forehead was found a soft swelling, of a dark blue colour,
and about the  size of  the palm of a hand: the hair which covered it was uninjured.
From this spot two dark red  streaks proceeded in different directions:—one of
these  passed to the left, running  over the temple, in front of the left ear, down
the neck to the surface of the chest, over which it passed between the left nipple
and the axilla, and so made its  way down the trunk to the left inguinal region, 
544              LIGHTNING.  POST-MORTEM APPEARANCES.

where it formed a large, irregular, scorched-looking (brandige) patch on the skin.
From this point the dark red streak again continued its downward course, passing
over the great trochanter, then along the outer surface of the left leg to the back
of the foot, where it terminated in several  small dark  blue spots.  The other
streak, which proceeded  from the  ecchymosed swelling on the  forehead, passed
directly to  the right ear, which was  considerably swollen and of a dark blue
colour:—from the ear it ran downwards, and backwards along the neck, crossed
the right border of the scapula, and eventually reached the right groin, where a
scorched patch of  skin similar to that in the right groin was found.  From this
part the discoloured streak  continued down the outer side of the leg to its termi-
nation on the  back of the foot, just as on the left  side.  It is  remarkable, that
although the hair on the forehead was not burnt, nor that which occurred in any
part of the track taken by the electric current down to the groin, yet at the groin
itself, and  at every part hence to the foot over which the electric stream passed,
the hairs were completely burnt.   The cause of the skin and hair in the groins
being burnt, is probably to be  referred to the buckles of  a belt which the man
wore round his abdomen at the time of  the  accident: the  belt was completely
destroyed.   Nothing further worthy of notice was observed on the exterior  of
the body, with the exception of the face being very red.   The swelling of the
head was found to be due to  the presence of a large  quantity of extravasated
blood.  The bone beneath was not injured.  Blood was  extravasated at other
parts of the scalp, corresponding to the swollen discoloured places outside; about
four ounces had been effused.   The vessels of the cerebral membranes were much
congested,  and the brain itself contained a large quantity of blood, especially the
choroid plexuses.  A large quantity of reddish mucus was found  in the larynx,
trachea, and air-tubes.   The  lungs were loaded with dark blood; there was a
great deficiency of blood in the cavities of the  heart  and in the  large vessels.
The blood-vessels of the stomach and intestines were more than usually congested.
The right  lobe of the liver  was  of a dark-red colour, and loaded with blood,
especially the part which corresponded to the burnt patch  of integument at the
lower part of the abdomen.  The  spleen also was large, and loaded  with blood.
Much blood was found accumulated in the substance of the muscles of the abdo-
men at those parts which lay beneath the burnt surfaces outside.   (Oesterreich.
Med. AVochenschrift, 6 Juni, 1846.)
   In another case, that of  an old  man killed by lightning, the external  surface
of the body presented very slight  marks of violence, except the left ear, which
was severely lacerated.   On opening the head,  the left  hemisphere of the brain
was found  entirely disorganized, forming a homogeneous mass, almost liquid, of a
grayish colour, and without a vestige of normal structure, except a small portion
of the corpus  striatum,  which had retained its natural appearance and situation.
The left lung  was partly injured.   The  skin of the  abdomen was marked  by
black longitudinal superficial lines.  On the skin of the left ankle there was an
ecchymosed spot, and at the point of the foot a deep wound.  The hat and shoes
of the deceased had been destroyed, but the rest of his clothes were uninjured.
(Heller's Journal, Feb. 1845, 245.)
   The  following appearances were found in the body of Professor Richman, who
was killed at St. Petersburgh, in 1753, while engaged in some experiments  on
atmospheric electrity.   On the left side of the forehead, where the deceased
had been struck  by the electric current, there  was a  round  ecchymosed spot.
There were eight  other  patches of ecchymosis of variable size, extending from
the neck to the hip, principally on the left side.   Some of these,  situated on the
trunk,  resembled the marks produced by gunpowder, when discharged in contact
with the skin.  The left shoe was torn open at the buckle without being singed
or burnt;  but the skin around was slightly ecchymosed.   Internally a  quantity
of blood was found extravasated in the trachea, the lungs, and the layers of  the
omentum.   The omentum presented  the appearance of having been violently 
LIGHTNING.  LEGAL RELATIONS.
545
contused.  (Marbach's Encyklopiidie,  Blitz.)  For  a  further  account of the
effects of the electric fluid on the human subject, see Henke, Zeitschrift der S.
A.  1844, i. 193.                           J   '           ;
  The blood is said not to become coagulated in the bodies of those who  have
been  killed by lightning, while the muscles  of such subjects are described as
being  constantly in a state of  perfect relaxation, and never  displaying any ap-
pearance of cadaverous rigidity.   These statements are not supported  by obser-
vation.  Experiments, carefully performed, have shown that blood through which
electric discharges have been transmitted will  coagulate as quickly as that which
has not been thus treated; and further, Sir C.  Scudamore discovered that, on ex-
amining  the  bodies of  animals killed by the  discharge of a powerful galvanic
buttery, the blood in the veins  was always in a solid state.  There is obviously,
therefore, nothing in the action of the electric fluid to retard or prevent  the co-
agulation of the blood.   With  respect to the alleged absence of cadaverous rigi-
dity, there are many circumstances which may accelerate or retard the accession
of  this state in the dead muscle,—it may take place and disappear quickly, and
the subject may not be seen at that particular  time  by the  medical examiner.
Sir B. Brodie remarked, that the body of an animal killed by electricity became,
as usual, rigid after death.  In an accident which occurred in France in August,
1846,  a group of labourers was struck by the electric fluid:—four were killed on
the spot, and five or six severely wounded.   It was remarked that the individual
whose body bore  the  most extensive  marks  of injury had worn a goat-skin.
There were severe lacerations about the body, and in three hours after death it
became perfectly rigid.  In most of those who were struck,  the skin was red-
dened, but the clothes bore no marks of burning.   (Med. Gaz.  xxxviii. 351.)
In  a more recent  case communicated to the Medical Gazette by Dr. F. J. Brown,
rigidity was strongly marked in the limbs about twenty-eight  hours after death.
(Vol. xlvii. page  844.)   Putrefaction is also said to  be hastened in these sub-
jects; but putrefaction is modified by many varying circumstances, and death by
lightning usually takes place during summer, when the process is most readily
developed.   It does not appear that the process takes place more speedily  than
in sudden or  violent death from any other  cause.   Very few  reports have  been
published of the appearances met with in the body, in cases of death from light-
ning.  The body of a person who has died  under these circumstances is seldom
examined for a coroner's inquest,—the cause of  death being sufficiently obvious
without a post-mortem examination.
  Legal  relations.—Rare as the combination of circumstances must be, in which
a medico-legal question  can arise in reference  to the  action of the electric  fluid
on  the body, a case was tried in France, in October, 1845, in which medical evi-
dence respecting the characters of wounds caused by  electricity was of  consider-
able importance.  In August of that year, some buildings were destroyed  at Ma-
launay near Rouen, as it was alleged, on the  one side by a thunder-storm, on
the other by a whirlwind; and as the parties were insured against lightning, they
brought an action for recovering  the amount insured.   The evidence in  favour
of the accident having been due to electricity consisted,—1st, in  the alleged car-
bonized appearance  of the leaves of some trees  and  shrubs growing near; and
2d, in  the characters of the wounds on the bodies of several persons who were in-
jured  at the time  of the occurrence.  M. Lesauvage stated at the trial that there
was an appearance of dark stains scattered over the bodies, and  those who sur-
vived suffered from torpor, pains  in the limbs, and partial paralysis of motion.
He  observed also, that decomposition took  place very speedily in the  bodies of
those who were killed.   In one instance the  muscles were torn  and lacerated,
and some small arteries divided.  This witness attributed most of the wounds to
a current of electricity.  M. Fund  deposed,  that in some of the dead bodies
which he examined, the face and  neck were bloated and discoloured,  as if death
had taken place from asphyxia.  It does not  appear, however, that  there  were
       35 
546       '   DEATH FROM COLD.  CIRCUMSTANCES AND EFFECTS.
any circumstances decisively proving  that the buildings had been destroyed by
lightning.  M. Pouillet has given an accurate description  of the storm: he be-
lieved that, although, as deposed to by some of the witnesses at the trial, it may
have been attended with thunder and lightning, the buildings with the surround-
ing trees were overthrown by the mere force of the wind, and not by the electric
fluid.  The description given bears out this view, but at  the same time it is, I
believe, a very rare circumstance that trees,  when struck,  unless old or  dry and
withered, bear any marks of  combustion about the leaves or  trunk;  and the
wounds on a  person  are not  likely to  present the characters  of burns, unless
there are at the same time  obvious marks of burning  about the clothes.   (See
Comptes Rendus, Sept. 1845; also,  Med.  Gaz. xxxvi. 1133.)   The scientific
evidence was of the most conflicting kind.   The Royal Court of Rouen decided
that the  disaster  was occasioned by the atmosphere; and without  entering into
the various theories of storms, condemned the Insurance  Companies to pay the
amount claimed.   (Law Times, March 14, 1846, 490.)

                                   COLD.
   An occasional cause of death.—The protracted exposure of  the human  body
to a very low  temperature may become a cause of death;  and although in this
country  cases but rarely  occur in which cold alone operates  fatally, it is not
unusual, during a severe winter, to hear of persons being  found dead in exposed
situations,  and in a state of misery and destitution.   On these occasions we may
reasonably suspect that the want of proper food and nourishment has accelerated
death.   It is, however, convenient to make a distinction  between the effects of
cold and of inanition on the system, as the symptoms preceding death, and the
rapidity with  which that event takes place, are very different in the two cases.
   Symptoms.—A moderate degree of cold is well known to have an invigorating
effect upon the body; but if the cold be severe, and  the exposure to it long
continued, while the  calorific  function is not maintained by warmth of clothing
or exercise, the skin becomes pale, and  the muscles become gradually stiff and
contract with difficulty, especially  those of the face and extremities.  Sensibility
speedily disappears,—a state  of torpor ensues, followed by profound sleep from
which the person cannot be  readily roused: in this  state  of lethargy the vital
functions gradually cease,  and the individual finally  perishes.   Such are the
general  effects of intense cold on  the body.   The effect of cold on the nervous
system  is  seen  in  the numbness,  torpor,  and  somnolency which  have been
described as consequences of a long exposure to a very low temperature.   Giddi-
ness, dimness of sight, tetanus and  paralysis, in  some cases  precede the fatal
insensibility  which involuntarily steals  on the individual.   It was  observed
during the retreat of the French from before Moscow, that those who were most
severely affected  by cold often reeled about as if in a state of intoxication,—they
also complained of vertigo and indistinctness of vision, and sank under a feeling
of lassitude into a state of  lethargic stupor, from which it was found impossible
to rouse them.  Sometimes the nervous,.system was  at once affected;—tetanic
 convulsions, followed by rigidity  of the whole of the  voluntary muscles, seized
the individual, and he rapidly fell a victim.   Symptoms indicative of a disturbance
 of the functions of the brain and nervous system  have also been experienced by
 Arctic travellers during their residence within the Polar circle.
    Circumstances which accelerate death.—There  are  certain  conditions which
 may accelerate death from cold.   In  all cases where  there is  exhaustion of the
 nervous system, as in the aged and infirm,—in those who  are worn out by disease
 or fatigue,—or, lastly, in those who  are  addicted to the use of intoxicating
 liquors, the fatal effects of cold are much more rapidly manifested than in others
 who are healthy and temperate.   It has been uniformly remarked, that whenever
 the nervous energy is impaired either by intoxication or exhaustion from fatigue,
 the subject falls an  easy victim to cold.  The exposure of persons in  a state of 
CASE OF MURDER BY COLD.
547
intoxication during a severe winter, may therefore suffice to destroy life, although
the cold might not be so intense as to affect others who were temperate.   Casu-
alties of this nature sometimes occur during the winter season in this metropolis;
and a knowledge of the  influence of intoxication in accelerating death under such
circumstances  may occasionally serve  to remove any doubt in the mind of a
practitioner respecting  the real cause.  Infants, especially when  newly born,
easily perish from  exposure to cold.  Cold, when accompanied by rain and sleet'
appears to have a more  powerfully depressing influence than when the air is dry
—probably  from the  effects of evaporation.   The following case by Dr. Currie
shows the  fatal effects  of cold winds  accompanied by humidity.   " Of  several
individuals who clung  to  a wreck, two sat on the only part that was not sub-
merged; of the others, all were constantly immersed in the sea, and most of them
up to the  shoulders.  Three only  perished, two of whom were generally out of
the sea, but frequently overwhelmed by the surge, and at other times exposed
to heavy showers of sleet and snow, and to a high and piercing wind.   Of these
two, one died after four hours' exposure, the second  died three  hours later,
although a strong  healthy adult, and  inured to cold  and hardship.   The third
that perished was a weakly man.   The remaining eleven, who had been more or
less completely submerged, were taken from the wreck the next day, after twenty-
three hours' exposure, and recovered.   The person among the whole who seemed
to have suffered least  was a  negro: of the other survivors, several were by no
means strong  men, and most of them had .been inured to the warm climate of
Carolina."
   Post-mortem appearances.—Opportunities rarely occur of examining  bodies,
when death results purely from  exposure to cold.   The surface is commonly
pallid, and the viscera of the chest  and abdomen as well as the brain are congested
with  blood.  Dr.  Kellie, of Leith, found  in  two cases, which he examined, a
redness of  the small intestines from turgescence of the capillary vessels, and a
great effusion into  the ventricles of the brain.   A sufficient number of cases have
not yet been inspected to enable us to determine how far these two last-mentioned
appearances are to be  regarded as consequences of death from cold; but  all
observers have found a general congestion of the vascular system internally.   In
consequence of the  great turgescence uniformly met with in the vessels  and
sinuses of the brain, some pathologists have regarded death from cold as resulting
from an attack of apoplexy; but the symptoms which precede  death do not bear
out this  view.   Extravasations of blood have not been  observed, and a mere
fulness of the cerebral vessels after death is not in itself sufficient to justify this •
opinion.  It will be observed, that on the whole these appearances are remarkably
similar to those which are found in death from severe burns and scalds.  Thus,
then, the medical jurist will perceive, that to come to a decision whether, on the
discovery of a dead body, death has taken place from cold or  not, is a task of
great difficulty.  The season of the year,—the place and circumstances under
which the deceased is found,—together  with  the absence of all  other possible
causes of death (such as from violent injuries or internal disease,) form the only
basis for a medical opinion.  Death from cold  is not to be determined  except by
negative or presumptive evidence, for there is no organic change, either externally
or internally, sufficiently characteristic of it to enable us to decide positively on
the subject.
   Case of murder by cold.—The  following is a singular medico-legal case,  in-
volving the question of  the fatal effects of cold upon the body.  A man and his
wife, residing at Lyons, were tried for the murder of their daughter, a girl aged
eleven, under the following circumstances:—On the 28th of December, at a time
when there was a severe degree of cold, the female prisoner compelled the de-
ceased to get out  of her bed, and place herself in  a vessel of  ice-cold water.
The child cried, and endeavoured  to escape from  the  bath, but she was by vio-
lence compelled to remain in the water.   The deceased complained of exhaustion 
548
STARVATION.   SYMPTOMS.
and dimness of  sight: the  prisoner  then threw a pail of iced water upon her
head, soon after which the child expired.   Death was properly ascribed to the
effects of this maltreatment, and the parties were convicted.  (Ann. d'Hyg. 1X81,
207.)   This case presents a refinement of cruelty which  is  rarely met  with in
the annals of crime.   Such a case  could only be proved  by circumstances; for
there would  be no post-mortem appearances  internally or externally to indicate
the mode  of death.  AVe learn by this, that the death of infants or children may
be caused by the external application of very cold liquids, coupled with exposure.
It would also appear from this case, that the brain and nervous system  become
sympathetically affected through  the skin, and not through the introduction of
cold air into the lungs.  Indeed, it  is well known, from the experience of Arctic
travellers, that air of a temperature  considerably below  zero  may be respired
without risk provided the skin be kept warm.

                                STARVATION.
   A rare cause of death.—Death from the mere privation of food is an extremely
rare event, although, if we were to form an opinion  from the verdicts of coro-
ners' juries, its occurrence would not appear  to be very uncommon in this  and
other large and populous cities.   In the Registration Returns for 1838-9, it is
stated that 130 persons died from starvation.  Such cases must, however, be
received with some distrust, as care is  rarely taken to ascertain precisely  how far
bodily disease may have been concerned in the death of the party.   Still, it can
not be denied that starvation should be classed among the causes of violent death,
being sometimes the result of criminal neglect or inattention in the treatment of
children or of infirm and decrepit persons, and thus constituting homicide; or
at other times, although very rarely, arising  from an obstinate determination to
commit suicide in those from whom all other means of self-destruction  are cut
off.   [This mode of  committing suicide is not  so very rare in this country, and
is very apt to succeed, sooner or later, in spite of the best endeavours on the part
of the medical attendants  and the most experienced nurses.  We have watched
several cases in this  city,  nearly all of which  terminated fatally.   There is in
most  cases,  probably, some form of dyspepsia,  which keeps up the hallucination
in regard  to  food or the aversion to it.—H.]
   Symptoms.—The  symptoms which  attend on  protracted abstinence are thus
described  by Rostan:—In the first instance, pain  is felt on the  epigastrium,
which is relieved by pressure. The countenance becomes pale and cadaverous,—
the eyes  become wild and  glistening,—the breath  hot,—the  mouth dry  and
parched.  An intolerable thirst supervenes, which, in all cases of attempted sui-
cide by starvation, has formed the most prominent symptom. The body becomes
emaciated, the eyes and cheek sink, and the prominences of the bones  are per-
ceptible :  the feeling of pain  is often so intense as to give  rise to fits of delirium.
There is the most complete prostration of strength, which renders the individual
incapable  of the least exertion.  After a longer or shorter period the body ex-
hales a fetid odour, the mucous membrane of the outlets becomes sometimes red
and inflamed, and life is commonly terminated by a  fit of maniacal delirium, or
the most horrible convulsions.   Dr. Donovan gives the following description of
those who suffered from the Irish famine in 1847:—they described the pain of
hunger as at first very acute, but said that after twenty-four hours  had been
passed without food, the pain subsided, and was succeeded by a feeling of weak-
ness and sinking, experienced principally in the epigastric  region, accompanied
with insatiable thirst, a strong desire for cold water, and a distressing feeling of
coldness over the entire surface of the body.   In a short time the face  and limbs
became frightfully emaciated; the eyes acquired a most peculiar stare; the skin
exhaled a peculiar and offensive fetor, and was covered with a brownish, filthy-
looking coating, almost as indelible as varnish.  This he was at first inclined to
regard as  incrusted filth, but further experience convinced him that it was a se- 
STARVATION.   POST-MORTEM APPEARANCES.
549
 cretion poured out from the exhalants on the surface of the body.  The sufferer
 tottered in walking, like a drunken man; his voice became weak, like that of a
 person in cholera; he whined like a child, and burst into tears on the slightest
 occasion. In respect to the mental faculties, their prostration kept pace with the
 general wreck of bodily power; in many there was a state of imbecility; in some,
 almost complete idiotism;  but in no instance was there delirium or mania, which
 is often described as a consequence of protracted abstinence among shipwrecked
 mariners.   (Dub. Med. Press, February, 1848, 67.)
   Period of death.—The  period which  it  requires for an individual to perish
 from hunger is  subject to variation.   It will depend  materially upon  the  fact,
 whether a person has it in his power or not  to take at intervals a portion of liquid
 to relieve the overpowering thirst which  is commonly experienced.  The smallest
 portion of liquid thus taken  occasionally, is found  to  be capable of  prolonging
 life.   It is probable that  in a healthy subject under perfect  abstinence, death
 would not commonly take place in  a shorter  period  than a week or ten days.
 This opinion appears to derive support  from the results of those cases in which
 there has been abstinence owing to disease about the organs of deglutition.
   Post-mortem appearances.—There are no very satisfactory details of the ap-
 pearances presented by the bodies of those who have died of inanition, and the cases
 themselves are too rare to  enable us to decide with certainty upon the accuracy
 of the reports which have hitherto appeared on the subject.  The body has been
 found much emaciated, the skin dry, and the stomach and intestines contracted
 and empty, the mucous membrane sometimes ulcerated;  the gall-bladder much
 distended with bile; the lungs, heart, and great vessels connected with these or-
 gans, collapsed and destitute of blood. The following account of the appearances
 met with in a fatal case of starvation has been published  by Dr. Sloan, of Ayr.
 A healthy man, aged 65, was by an accident shut up in a coal-mine twenty-three
 days.   For  the first ten days he was able to procure and  swallow a small quan-
 tity of foul water.  AVhen found, he could not make the least exertion, nor could
 he speak above a whisper.  Attempts were made  to recover him, but he died in
 three days,  perfectly exhausted.   On  inspection, the  body was  observed to be
 extremely emaciated;  the  intestines were collapsed, the stomach was distended
 with air, and slightly reddened at its cardiac  extremity.   The  liver was small,
 and the gall-bladder distended.   The  other viscera were in their normal state.
 (Med. Gaz.  xvii. 389.)  Mr. Tompkins,  of Yeovil,  inspected the body of a man
 who died from  starvation in February, 1838.   The face was much shrunk  and
 emaciated; the eyes open,  and presenting a fiery red appearance, as  intense as
 in a case of acute ophthalmia during life.   This red appearance has been met with
 by Dr.  Donovan in  death  from exposure  to cold.  (Dub. Med. Press, Feb. 2,
 1848, p. 66.)   The skin was  tough,  and there was scarcely any cellular mem-
 brane to be seen.  The tongue, lips, and fauces, were dry and rough.   A pecu-
 liar odour exhaled from the body.   The  lungs were shrunk and contracted; the
 pleura was slightly inflamed.  The stomach and intestines  were  empty, but quite
 healthy; the gall-bladder was nearly full of bile, and the surrounding parts were
 much tinged by this liquid.   The urinary bladder  was empty and contracted.
 (Lancet, March, 1S38.)  In some cases  inspected during  the Irish famine, Dr.
 Donovan states that the  appearances which he witnessed were  extreme emacia-
 tion, total absorption of the fatty matter  on the surface of  the body, total disap-
 pearance of the omentum, and a peculiarly thin condition of the small intestines,
 which, in such cases, were so transparent, that if the deceased had  taken  any
 food immediately before death, the contents could be seen through the coats of
 the bowel:  on one  occasion (at an  inquest,) he was able  to recognise a portion
 of raw green cabbage in the duodneum  of  a man who had died of inanition.
This condition of the coats  of the intestines he looks upon as the strongest proof
of starvation.  The gall-bladder was usually full, and  the parts in the vicinity
of it were much  tinged  from the cadaveric  exudation  of bile;  the urinary 
550
STARVATION.   LEGAL RELATIONS.
bladder was generally contracted and empty, and the heart pale, soft, and flabby:
there was no abnormal appearance in the brain or lungs.
   Summary of medical evidence.—These appearances, in order to throw any
light upon the cause of death, should be accompanied  by an otherwise healthy
state of the body;  since, as it is well known, they may be produced by many
organic diseases, and death may be thus due to disease, and not to the mere pri-
vation  of  food.   It will not, therefore, be easy to say whether the emaciation
depend on disease or want of food, unless we are put in possession of the history
of the  case.  On this account, in all charges of homicidal starvation, the defence
generally turns  upon the co-existence of disease in  the body, and the sufficiency of
this  to account  for death.  In some of these alleged deaths by starvation, ulcera-
tion  of the bowels is met with.   This has been considered to arise from want of
food, but Dr. Donovan did not meet with it in those who died of  lingering star-
vation.  (Dublin Med.  Press,  Feb. 2, 1848, 66.)   See, in reference to  medical
evidence, the case of The Queen v. Pryke, Chelmsford  Summer Ass. 1840.
   Legal relations.—Starvation is commonly the result  of accident or homicide;
but this is a question purely for the decision of a jury;  it cannot be elucidated
by medical evidence.   The withholding of food from an infant  forms a case of
homicide by starvation, on which a medical opinion may be occasionally required.
Mr.  Baron Gurney held that the mother and not the father was  bound to supply
sustenance to an infant.  The child in this case was ten weeks old, and the fa-
ther  was charged with wilful murder, on the ground that he had not supplied it
with food.   The grand jury ignored the bill under the instructions of the judge,
upon the ground above stated.  (The King v. Davey,  Exeter Lent Ass. 1835.)
But  where the husband and wife were charged with  the murder of an appren-
tice to  the husband, by  using him in a barbarous manner, and the opinion of
the medical witness was, that the boy had died from debility occasioned by the
want of proper nourishment, it was held that the wife was entitled to be acquitted,
as it  was the duty of the husband, and not of the wife, to provide sufficient food and
nourishment for the apprentice.  (The Kingx. Squire, Starkie,ii. 947.) Starvation
is rare as  an act of  homicide, but it must  not be  supposed that  the law implies
by this the absolute privation of food;  for if that  which is furnished to a person
be insufficient in quantity, or of improper quality, and death be a consequence,
malice being at the  same time proved, then the offender equally subjects himself
to a  charge of murder.  Not  many years since, a woman who  was accustomed
to take parish-apprentices, was tried and convicted of the murder of two children,
who  had died in consequence of the bad quality and small quantity of food fur-
nished to  them  by the prisoner. 
INSANITY.   MEDICAL AND LEGAL DEFINITIONS.
551
INSANITY.
                            CHAPTER  LXIV.

 LEGAL DEFINITIONS--LT'NACY--NON COMPOS MENTIS--UNSOUNDNESS OF MINT)—VARIETIES OF
   INSANITY--MANIA--HALLUCINATIONS--ILLUSION--DELUSION--MANIA DISTINGUISHED FROM
   DELIRIUM--MONOMANIA--KNOWN FROM  ECCENTRICITY--MORAL  INSANITY—DEMENTIA—
   IDIOCY--1 MBECILITY--POST-MORTEM  APPEARANCES--HEREDITARY  TRANSMISSION--
   FEIGNED INSANITY—MODE OF DETECTION.

   Legal definitions.—The law of England recognises two states of mental dis-
 order or alienation.  1. Dementia natural is, corresponding to idiocy; and 2.
 Dementia  advent it ia, or accidentalis, signifying general insanity, as it occurs in
 individuals who have once enjoyed reasoning power.  To this state the term lu-
 nacy is also applied, from an influence formerly supposed  to be exercised by the
 moon on the mind.  Lunacy is a term generally applied by lawyers to all those
 disordered states of mind which are known to medical men under the names of
 mania, monomania, and dementia; and which are generally, though not neces-
 sarily, accompanied by lucid intervals.  The main character of insanity, in a  legal
 view, is said to be  the existence of delusion; i. c.  that a person should believe
 something to exist  which does not exist, and that he should act upon this belief.
 Many persons may labour under harmless delusions, and still be fitted for  their
 social duties;  but should these delusions be such as to lead them to injure them-
 selves or_others in person or property, then the case is considered to require  legal
 interference.
   Unsoundness of mind.—Besides the terms Idiocy and Lunacy, we find another
 frequently employed in legal proceedings, namely, "unsound mind"—(noncom-
pos mentis)—of the exact meaning of which it is impossible to  give a consistent
 definition.   From various legal decisions, it would appear that the test for un-
 soundness of mind in law has no immediate reference to the mere existence of de-
 lusion, so much as  to proof of incapacity in the person, from some morbid con-
 dition of intellect, to manage his own affairs.  (Amos.)  Neither condition will
 suffice to establish unsoundness without the other;  for the intellect may be in a
 morbid state, and yet there may be no legal incompetency, or the incompetency
 alone may  exist, and depend on bodily infirmity or  want of education—a condi-
 tion which must not be confounded with insanity.   Thus, then,  a person may be
of unsound mind, i. e. legally incompetent to the control of his property, and yet
not come up to the strict  legal standard of lunacy  or idiocy.   Hence it will be
seen that it is impossible, in medical jurisprudence, to give any consistent  defi-
nition  of insanity.   A medical witness who ventures upon a definition, will
generally find himself involved in numerous inconsistencies.   No words  can
possibly comprise the variable characters which this malady is  liable to assume.
The power which is most manifestly deficient in the insane is generally the con-
trolling power of the will.
   Some medical practitioners have attempted to draw a distinction between in- 
552
INSANITY.  MANIA AND DELIRIUM.
sanity and unsoundness of mind.   A case occurred in 1839, in which a medical
man hesitated to sign a certificate for the confinement of an alleged lunatic, be-
cause in it the terms "unsound mind"  were used.   He said he would not have
hesitated to sign it had the term  "insane" been substituted.  The difference, if
any exist, is purely arbitrary, and depends on the fact, that unsound mind is a
legal and not a medical phrase, referring to an incapacity to manage affairs, which
insanity, in its most enlarged sense, may not always imply.  The law, however,
appears to admit some sort of distinction: for, according to Chitty, it is  a crimi-
nal and an indictable act maliciously to publish that any person is afflicted with
insanity, since it imputes to  the party a malady generally  inducing  mankind to
shun his society; although it is not  libellous to say that a man is not of sound
mind, because no one is of perfectly sound mind but the Deity!  (M. J. i. 351.)
In reference to the refusal to sign certificates, it is, however, an error to  suppose
that the use of one term can involve a practitioner in a greater share of respon-
sibility than the use of the other.
   Varieties of insanity.—Medical jurists have  commonly treated insanity under
four distinct  forms:  Mania, Monomania,  Dementia and Idiocy  (Amentia.)
This division was proposed by Esquirol, and although of  a purely artificial  na-
ture, it is highly convenient  for the arrangement  and classification of the facts
connected with the subject.   In  some instances there is  great difficulty in  as-
signing a particular case to either of  these divisions, which is owing to  the cir-
cumstance, that these states  of mind are frequently intermixed, and are apt to
pass and repass into each other.  On other occasions a case may present charac-
ters which appertain to  all the divisions.   Some psychologists have proposed two
subdivisions, namely, Incoherency and Imbecility; but the former  is merely a
mixed state of mania and dementia, while the latter is a term  applied  to those
cases of idiocy wherein the mental  faculties  are susceptible of  cultivation after
birth, without reaching the normal standard.  In a work  on  Medical Jurispru-
dence, it will be only necessary to state briefly the principal features of each of
these varieties of insanity.

   Mania.—In this form of insanity there is a  general derangement of the men-
tal faculties, accompanied by greater or less excitement, sometimes amounting
to violent fury.  The individual  is subject to  hallucinations and illusions,  the
difference in the meaning of  which terms it may here be proper to explain.  Hal-
lucinations are those sensations which are supposed by the patient to be produced
by external impressions, although no material  objects may act upon the senses
at the time.   (See on this  subject  remarks by Dr.  Sigmond, Journal  of Psy-
chol. Med. 1848, p. 585.)  Illusions are sensations  produced by the false per-
ception of objects.   (Marc.)   AVhen a man fancies he hears voices, while there
is profound silence, he  labours under a hallucination: when another imagines
that his ordinary food has an earthy or metallic taste, this  is an illusion.  Illu-
sions sometimes arise from internal  sensations, and give rise to the most singular
ideas.   AVhen a hallucination or an illusion  is believed  to have a real and posi-
tive existence, and this belief is not removed either by reflection or  an appeal to
the other senses, the individual is  said to labour under a delusion; but when
the false sensation is immediately detected, and is  not acted on as if it were real,
then the person is  sane.   Perhaps this is  the most striking distinction which it
is in our power to draw between sanity and insanity.   The acts of the insane are
generally connected with their delusions; but  it is extremely difficult  to trace
the connexion between them except by their own confession.   It has been re-
marked, that in mania there  is great insensibility to changes of temperature;  but
it must not be inferred from this that the patient is less susceptible than a sane
person of the injurious effects of cold.   The bodily susceptibility of insane per-
sons is  just as great, while they want that warning power which  the  sense of
feeling  gives to one who is sane.  It is necessary that  a medical jurist should 
                          INSANITY.  MONOMANIA.                      553

 be able to distinguish mania from delirium  depending on  bodily disease.  De-
 lirium very closely resembles the acute form of mania,—so closely that mistakes
 have occurred, and persons labouring under it have been improperly ordered into
 confinement as maniacs.  The following  are perhaps the best diagnostic differ-
 ences.   A disordered state of the mind is the first symptom remarked in mania;
 while delirium is a result of bodily disease, and there is greater febrile  excite-
 ment in it than in mania.   Delirium, being a mere symptom attendant  on the
 disease which produces it, exists so long as that disease, and no longer;  while
 mania, depending on  very different  causes, is persistent.   Delirium disappears
 suddenly, leaving the mind clear; while mania commonly experiences only re-
 missions.  (See Pagan, M. J. of Ins. 69.)
   Monomania.—This name  is applied to  that form of insanity in which  the
 mental alienation is partial.   The delusion  is  said to be confined either to  one
 subject or to one class of subjects. One fact is well ascertained, that monomania
 varies much in degree; for many persons affected with it are  able to direct their
 minds with reason and  propriety to  the performance of their social duties, so
 long as these do  not involve  any of the subjects of their delusions.   Further,
 they have occasionally an extraordinary power of controlling their thoughts  and
 emotions, as well as of concealing the delusions under which  they labour.  This
 implies a consciousness of their condition not met with in mania; and it also ap-
 pears to imply such a  power of self-control over their thoughts and actions, as to
 render them equally responsible with a sane person for many of their acts.  In
 a real case of monomania, it is not to be supposed that a man is insane upon one
 point only, and sane upon all other matters.   The only admissible view of this dis-
 order is that which was taken by Lord Lyndhurst, in one of his judgments.  In
 monomania, the  mind is unsound; not unsound in one point  only, and sound in
 all other respects, but this  unsoundness  manifests  itself principally with refer-
 ence to  some particular object or person.  (Prichard.)  There is no doubt that
 all  the mental  faculties are  more or less  affected: but the  affection is more
 strikingly manifested  in some than in others.   Monomania is very liable to be
 confounded with eccentricity: but there is this difference between them.  In mo-
 nomania, there is obviously a change of character,—the individual is different
 to what he was: in eccentricity,  such a  difference is not remarked; he  is,  and
 always has been, singular  in his ideas and actions.   An eccentric man may be
 convinced that what he is doing  is absurd and contrary to the general rules of
 society, but he professes to  set these  at defiance.  A true monomaniac cannot be
 convinced of his error, and he thinks that his acts are consistent with reason  and
 the general conduct of mankind.  In eccentricity there is the  will to do or not to
 do: in real monomania the controlling power of the will is lost.  Eccentric habits
 suddenly acquired are, however, presumptive of insanity.   It will be seen here-
 after that the diagnosis of these states is of considerable importance in relation
 to the testamentary capacity of individuals.
   Most medico-legal writers admit that insanity is not necessarily confined to
 the intellectual powers; but that it may also show itself without decided intellec-
 tual aberration in the feelings, passions, and emotions.  Thus it may appear under
 the form of a causeless suspicion, jealousy, or hatred  of others, especially of
 those to whom the individual ought to be  attached; and it  may also manifest
 itself under the form of a wild, reckless, and cruel disposition. This is what has
 been  called by Dr. Prichard "Moral insanity," to distinguish it from the other
 form affecting the mental powers, namely, "Intellectual insanity." It is, however,
 very doubtful whether moral insanity ever exists in any individual without greater
 or less disturbance of the  intellectual faculties.   The mental powers are  rarely
 disordered without the moral feelings partaking of the disorder: and conversely;
 it is not to be expected that the moral feelings  should become to any extent  per-
 verted without affecting the intellect.  The  intellectual disturbance may be very
d ifficult of detection; but in every case of true  insanity it is more or less present,
a nd it would probably be a dangerous rule to pronounce a man insane, when some 
554
INSANITY.   POST-MORTEM APPEARANCES.
evidence of its existence was not forthcoming.  The law hesitates at present to re-
cognise moral insanity, at least in civil cases:  hence,  however perverted the
affections may be, a medical jurist must look for some indications of intellectual
disturbance.  Monomania may be accompanied with a propensity to  homicide or
suicide, and according to many psychologists, with a disposition to incendiarism
or theft.  These  forms will be referred to hereafter,  in speaking of the criminal
responsibility of the insane.
   Dementia.—In this state there is' a total absence of all  reasoning  power;—
the mental faculties are not perverted, but destroyed.   There is a want of memory
as well as a want of consciousness on the part of the individual, of what he does
or says.  It is by no means an unfrequent consequence of mania or monomania,
—but it has been known to occur suddenly in individuals, as an effect of a strong
moral shock-.
   Idiocy.  Amentia.—Idiocy  is  characterized by the want of mental power being
congenital.  AVhile mania, monomania, and dementia, form the " dementia acci-
dentalis,"—idiocy forms the "dementia naturalis" of lawyers.  This intellectual
deficiency is marked by a peculiar  physiognomy, an  absence  of all  expression,
and a vague and unmeaning  look,  whereby an idiot may in general be clearly
identified.  In many cases  of congenital deficiency, the mind is capable of receiv-
ing a few ideas, and of profiting to a certain  extent by instruction.  To this state
the term Imbecility is applied.  It may be regarded  as a minor degree  of idiocy. ,
The mind of an imbecile can never  be brought to a healthy  standard of intellect,
like that of an ordinary person of the same age.  The degree to which congenital
deficiency of intellect exists is generally well marked by  the power of speech, or
of communicating ideas by language.   In idiocy there is no speech, or only an
utterance of single words:—in the better class of imbeciles, the  speech  is.but
little  affected; while there is  every grade between these two extremes.  Some
medical jurists have arranged  imbeciles in classes, according to their capacity to
receive instruction;  others, according  to their power of  speech:  but such divi-
sions  are practically without value,—each case  must be  judged by itself.   It is
by no means easy to draw a distinction between the better  classes of imbeciles,
and those who are ruptured sane,—since the minds of sane persons differ remark-
ably in their capacity to receive  instruction.  It has been well observed, that by
endeavouring to make a very close distinction of this kind,  one half of  the world
might reason itself into the right of confining the other half as insane!. Persons
affected with idiocy and imbecility do not suffer from hallucinations and illusions,
like those who labour under mania or monomania. Idiots and imbeciles are what
they always have been: there is  no  gradual loss or impairment of the intellec-
tual functions.  The term imbecility is often applied to that loss of mental power
which takes place as a result of extreme age: but this is with greater propriety
called senile dementia.
   Such are  the forms  under which  insanity or mental alienation presents itself
to our notice.  This classification has been adopted for the sake of convenience;
because by it a practitioner may be led to form a safe diagnosis of the  real state
of mind of a person.   It is not recognised in any of the  law-proceedings con-
nected with the  insane:—for  in these the term  unsoundness of mind, compre- <
bending lunacy and idiocy, is almost exclusively employed.   In adopting  this
arrangement, a medical jurist must take care not to fall  into an error which has
been  sometimes committed, i. e.  of pronouncing a person to be of sound mind,
because his case could not be easily placed in any one of these four great divisions
of insanity.  This would be as serious an error as that formerly committed by some
law-writers,—namely, of giving  restricted and incorrect definitions of lunacy and
idiocy, and then contending that, whoever was not a  lunatic or idiot according to
these  arbitrary legal definitions, must be a person of  sound mind!
   Post-mortem appearances.—In some cases a medical practitioner may be re-
quired to state whether  certain  appearances found in the brain of a deceased 
INSANITY.   HEREDITARY TRANSMISSION.
555
person do or do not indicate the past existence of a certain degree of insanity or
imbecility?  Such a question is only likely to arise in chronic cases, in which the
insanity from oral  testimony may be  disputed.  (Case of Stulz, Prerog. Court,
1852.)  The  appearances commonly met with on  an inspection are thickening
of the bones of the skull, close adhesions of the dura mater (the lining membrane,)
with great congestion of the pia mater, and opacity and thickening of the arach-
noid membrane.  There is  general fulness  of the blood-vessels of the brain,
with remains of cysts, hardened deposits, or even  abscesses in various  parts of
the substance of the brain.   Inferences from the  existence of these changes in
the brain must be drawn with caution, because it cannot be said that they ne-
cessarily indicate insanity; nevertheless, such chronic changes in the brain must
be considered as producing greater or  less derangement of the mental functions;
but the actual degree to which the impairment has existed ought properly to be
determined by evidence of the  conduct and actions of the deceased during life.
The reader will find some valuable  information on this subject in a paper by  Mr.
Fisher (Med. Gaz. xxxvii. p. 657;) and in another by Mr. Eccleston (Med. Gaz.
xlvii. p. 170;) also in some contributions to the Journal of Psychological Medi-
cine (1850, p. 521, and 1851, pp. 236 and 383,) by Mr. Holmes Coote.   See  also
Dr. Jamieson's Lectures, Med.  Gaz. xlvi. p. 652;  and a  paper by Dr. AVebster,
Journal of Psychol.  Med. 1849, p. 483; by Dr. Farre, in same volume,  p. 534;
and by Dr. Hitchman, in the volume  for 1850, pp. 228,  802, 501.
   Hereditary transmission.—The   hereditary transmission  of  the  malady  has
sometimes presented itself as a medico-legal question in relation to  the criminal
responsibility of the  insane.  According to Chitty, it  is an established rule of
law, "that proof that  other  members of the same family have  decidedly been
insane is not admissible either  in civil or criminal cases."   (Med. Jur.  i. 352.)
But recent decisions have shown that  this statement is not correct.   In  the case
of Reg. v. Ross Touchet,  1X44,  tried and acquitted on the ground of insanity for
shooting a man, Maule, J. held that evidence that the grandfather had been in-
sane may be adduced, after it has been proved by medical testimony that such a
disease is often hereditary in a family. It was also admitted in Oxford's case,—
the prisoner having been here tried for shooting at the Queen. (Law Times, Oct.
26, 1844.)  This kind of evidence has, however, been frequently rejected,  and
it is not admitted in the law of Scotland. ( Gibson's case, Edinburgh, Dec. 1844.)
There  can be no doubt, from the concurrent testimony of all writers on insanity,
that a  predisposition to the disease is frequently transmitted from parent to child
through  many  generations.   The  malady may not always  show itself  in such
cases, because the offspring may pass  through life without being exposed to  any
exciting cause; but in general it readily supervenes from very slight causes.  M.
Esquirol has remarked, that this hereditary taint is the most common of all the
causes to which insanity  can be referred, more especially as it exists among  the
higher classes of society.  Among the poor, about one-sixth of  all the cases may
be traced to hereditary transmission;  and other authorities have asserted that in
more than one half of all cases of insanity, no other cause can be found for the
malady.  As we might suppose, children which are born before insanity mani-
fests itself in the parents are less subject to the disorder than  those which  are
born afterwards.  AVhen one parent only is  insane, there is less tendency for the
predisposition to be transmitted than when both  are affected:  but according to
Esquirol,  this predisposition is much more  readily transmitted through the fe-
male than through the male parent.   Its transmission is also more strikingly re-
marked when it has been observed to  exist in several generations of lineal  an-
cestors; and, like other hereditary maladies, it appears to be subject to atavism;
/'. e. it  may disappear in one generation, and reappear in the next.   Further, the
children of drunken parents, and of those  who have been married late in  life,
are said to be more subject to insanity than those born under other circumstances.
AVhen  insanity is transmitted by hereditary descent, it appears often about  the 
556
FEIGNED INSANITY.
 same age, under the same form, and is  induced by the same exciting cause in
 the offspring as in ihe parent.   This it is proper for a medical jurist to bear in
 mind, in examining a plea of insanity in  criminal cases.  (See  Journal of
 Psychol. Med. 184S, p. 264.)
   Statistics.—The valuable tables of Esquirol shows that the age at which  in-
 sanity most commonly attacks  persons is thirty:—it rarely makes its appearance
 below the age of twenty, or above the age of fifty-five.   According to  a  Report
 published by the Commissioners of Lunacy for  1X50, there were in  that year
 under their supervision in  England and AVales, 15079  lunatics, namely, 7074
 males, and 8005 females.   Of  these, 11805  belonged to the  pauper class; and
 of the whole number 7140 were  confined in asylums.   Dr. Jamieson  has  pub-
 lished in his lectures some curious facts  regarding the  statistics of  insanity, to
 which I must refer the reader (Med.  Gaz. xlvi. p. 269;) and an able analysis of
 the Commissioners' Report will be found in the Journal  of Psychol. Med. 1850,
 p. 111.
   Feigned insanity.—Insanity is frequently feigned by persons accused of crimi-
 nal offences, in order to procure an acquittal  or  discharge.   In the first place,
 when this is suspected, it will be proper to  inquire whether the party have any
 motive for feigning the malady.  It  is  necessary to remember  that insanity is
 never assumed until after the commission of a crime and the actual detection of
 the criminal.  No one feigns insanity merely to avoid suspicion.  In general, as
 in most cases of imposture, the part is over acted—the person does too much or
 too little, and he betrays himself by inconsistencies  of conduct and  language
 which are never met with in real cases of insanity.   There is commonly some
 probable cause to which real insanity may be traced, but when the  malady is
 feigned,  there is no apparent cause:—in  this case the appearance of the assumed
 insanity is  always sudden:—in the real malady, the progress  of an  attack is
 generally gradual, and when the attack is really sudden, then it will be found to
 be due to some great moral shock or other very obvious cause.   Vie should ob-
 serve whether there has been any marked change of character in the individual,
 or whether his conduct, when he had no  interest to feign, was  such as it is now
 observed to  be.   Some difficulty may arise when fits  of eccentricity or strange-
 ness of character are deposed to by witnesses;  but these statements may. be in-
 consistent with each other, and the  previous  acts of the person  may bear no
 resemblance whatever to those performed by him in the recently assumed condi-
 tion.   A difficulty of this kind rarely presents  itself, since in an imposter, no
 act indicative of insanity  can be adduced for  any antecedent  period of his life:
 it is only after the perpetration of a crime  and its  detection, that  any action
 approaching to insane habits will be met  with.   In real insanity, the person will
 not admit that he is insane:—in the  feigned state, all his attempts are directed
 to make you believe  that he is mad; and  an  imposter may be induced to perform
 any act, if it be casually observed to another in his presence that the performance
 of such an act will furnish strong evidence of his insanity.
  Mania is  perhaps more  frequently assumed than any other  form, because the
 vulgar notion of insanity is, that it is made  up of violent action and vociferous
 and incoherent language:  but mania  rarely comes on suddenly, or without an
 obvious cause:—the  patient is also equally furious day and night, while the im-
poster is obliged to rest jffter bis violent exertions.  Dr. Burrows recommends
that close attention should be paid to the expression of the eye.  The mobility
of the features maybe as rapid as the  imagination is vivid; but when every
feature may vary, or be kept under control and be steady, the eye will  still indi-
cate the erring thought.   Its expression cannot be easily assumed.   In mania the
person sleeps but little, and the sleep is disturbed:—an imposter sleeps as soundly
as a  healthy individual:—the violence of the maniac continues whether he is
alone or not, while the imposter acts his part only when he thinks he is observed:
hence the imposition may be detected by watching him, when he is  not aware
that an eye is directed upon him. 
DETECTION OF FEIGNED INSANITY.
557
  Some stress has been laid on the fact, that assumed insanity commonly appears
suddenly and without probable cause; but while this may be allowed to have a
general value in forming a diagnosis, it is proper to bear in mind that the actual
commission of a crime has sometimes suddenly led  to an attack of mania in a
previously sane person.  Dr.  Pagan has related a very singular instance of  this
kind.   Two men were committed to prison on a charge of theft, and the officers
requested a poor  man, who was a shoemaker, to assist them  in conveying the
prisoners.  The man took a gun with him for better security.  During the journey,
one of the prisoners leaped from the cart and ran off.  The officers called to their
assistant to fire, and he thinking himself warranted to do so, fired, and wrounded
the prisoner severely in the back and  loins.   The man  who fired the gun was
himself immediately committed to gaol as a  criminal, and the  event made such
an impression upon him that he became violently maniacal.   AArhen scarcely
recovered, he was tried for the offence; and it was supposed that he was feigning
insanity.  He was convicted and sentenced to six months' imprisonment.  (Med.
Jur. of Ins. 82.)   This case proves that  a  person  may really be  attacked by
mania under circumstances in which justifiable suspicion might arise that he was
feigning.
  The feigning of monomania would  be a matter of some  difficulty, and easily
susceptible of detection. Dementia is more easily feigned:—in  general this state
comes on slowly, and  is obviously dependent on organic changes, as old age, apo-
plexy, paralysis or hemiplegia, or it is a consequence of long-continued mania or
monomania.  As this  form of insanity consists in an entire abolition of all men-
tal power, so the discovery of any connected ideas, reasoning or reflection, either
by language or gestures, would at once show that the case was not  one of  real
dementia.  Idiocy and imbecility could hardly be feigned successfully, because
these are states of congenital deficiency;  and it would  be easy to show, by re-
ference to the  past life of a person, whether he had or had not always been such
as he represents himself.  The difficult cases of feigned insanity  are really limited
to those forms of the  malady which are liable to attack an individual suddenly.
In a sudden attack of real insanity, there should be some  obvious cause:—the
non-existence of this, with  the presence of  a strong motive for deception,  will
always justify a suspicion that the malady has been assumed.
  The following is  a case of feigned insanity which was  the subject of a trial in
London, in 1833.  A married woman, aged fifty, was  charged with uttering a
forged cheque:—she had craftily procured the signature ofi a person under a false
pretence, and then forged his name to the  cheque.  AVhen required to plead, she
made no answer and appeared unconscious of the question.  She took up some
flowers  placed in the dock, and crumbled them  in  her fingers, which were in
continual motion.   She stared wildly at times, changing her  position,—turned
her back on the court,—muttered indistinct  exclamations, and made  a  humming
noise.  She was placed under some restraint in order to prevent her from jump-
ing out of the dock.  The first question which the jury was directed to try, was
whether she was of  "sound mind or not,"—it being a rule of law that no insane
person can be  called on to plead to an offence committed by him.  Evidence was
then adduced to show, that at previous periods of her life she had used  incohe-
rent language and was strange in her conduct.  It was also shown that her mo-
ther,  aunt, and  sister, had been insane.   Dr. Uwins  deposed that at  first he
thought the prisoner was feigning, for she appeared to be fully aware of  the im-
portance of the plea of  insanity, but when be heard that other members of her
family had had the disease,  he was induced to think  her insane, and  not ac-
countable for her actions.   Another  medical witness, who had attended her fa-
mily professionally, and had known the prisoner  long, thought she was not in-
sane, although he allowed that the apprehension of a criminal charge might bring
on an attack of insanity in a mind  subject to aberration.  Other witnesses de-
posed that they had never  observed  any acts of insanity about her;  and it was 
558                INSANITY.   IMPOSITION OF RESTRAINT.

further  proved that she was well  acquainted with the •method of drawing and
procuring money on bills.  AVhen  arrested, she tried to escape from the officer,
and conceal the money which she had procured by means of the forged  checpie.
The surgeon of the gaol  thought she was feigning: he visited her daily, and he
observed that her manner was changed so soon as she saw him.  AVhen asked
what  counsel  she would employ,  she returned a rational  answer, saying  that
"others would take  care of that:"—when charged with feigning, she made no
observation.  She put on a wild look when she knew that she was observed; but
when privately watched, her behaviour was that of a rational person:—she gene-
rally slept soundly.  The jury returned that she  was of  sound mind.  She was
then called on to plead to the charge, but she refused,—a circumstance rarely
observed  in the  conduct of a really insane  person.   She was tried, and found
guilty of  the charge.  There could be no reasonable doubt that this woman was
an impostress, and that she feigned insanity, well knowing what would be the
result of  the plea, if admitted.  Two circumstances rather tended to complicate
the case: 1. The proof of hereditary predisposition:  2. Her assumed silence,
whereby she did not easily  betray herself.   In  regard  to hereditary predispo-
sition, although valuable as collateral evidence, it cannot, of  course, be allowed
to outweigh general facts  indicative of perfect sanity.   For a singular case in
which a verdict was returned against strong medical evidence of alleged insanity,
see Lancet, January 18, 1845, p. 70: also, Ann.  d'Hyg. 1829, ii. 367, 376, and
a case by Dr.  Bayard,  Ann. d'Hyg. 1847, ii. 230.  (See  also  another case, Med.
Gaz. xlvii. p. 49, and a paper in Journ. Psychol. Med. 1848, p. 277.)
                            CHAPTER LXV.

MEDICO-LEGAL QUESTIONS  in RELATION TO THE INSANE—IMPOSITION OF RESTRAINT—ILLE-
  GAL IMPOSITION OF RESTRAINT--VIOLENCE OF  TEMPER--CERTIFICATES OF INSANITY—
  RULES FOR THE DISCHARGE OF  LL'NATICS.

  Medico-legal questions.—Among the questions which may come before a me-
dical jurist, in relation to the subject of insanity, are the following:—A practi-
tioner may be required to say whether a person affected with the malady should
or should not  be confined in a lunatic asylum,—whether he should be deprived
of his civil rights  by interdiction, or whether he be so completely cured of his
malady,  as to justify  his liberation from  confinement.   Then, again,  medical
evidence may go far to determine whether a will or deed, executed by an alleged
lunatic, should be set  aside;  whether a marriage contract should be  annulled;
and lastly, whether a criminal act was  committed by a person labouring under
insanity,—a question involving either the life, or, according to circumstances,
the perpetual imprisonment of  an accused party.
  Imposition  of restraint.—-By this we are to  understand the separation  of  a
lunatic from his friends or relatives with or without the confinement of his person
by force.   AVhat are the circumstances which  will justify a practitioner in ap-
plying restraint to the insane ?   The law has given great power in this respect
to members of the medical profession, but owing to  certain abuses,  this power
has been of late years  much restricted by various acts of the legislature.  Most
medico-legal writers  agree, that we are never justified in ordering restraint, ex-
cept when from the symptoms we have reason to apprehend that the lunatic will
injure his person or property, or the persons or property of others.   It is then
not sufficient to seek merely for evidence of delusion;  but if we discover that the
individual labours under some  delusion, it  is our duty to consider  how far this 
IMPOSITION OF RESTRAINT.
559
may prospectively endanger the well being of himself and his friends.   Unless
the delusion be such as to render it probable that  his own interests or  those of
others  may be  damaged  by his  insane conduct, careful  and judicious  superin-
tendence will answer all the purposes of the closest restraint.   (For some remarks
on  this subject, see  Med. Gaz. xliv. p. 1061.)  Some have justified the act of
resorting to restraint on all occasions, on  the  principle that  it may tend to the
cure of a patient  by removing the delusion.   In  this point of view the subject
has no relation to legal medicine.   It may be urged with more plausibility, that
by withholding restraint in incipient cases,  mischief may be done by the lunatic
to himself or others, and that  then it will be too late to interfere; but even here
proper superintendence will render close confinement unnecessary.  A medical
practitioner  must not be too ready to lend himself to the signing of certificates
for the imprisonment of persons who may be labouring under harmless delusions.
In  violent mania, or in monomania  with a homicidal or  a suicidal propensity,
there can be no doubt of the propriety of applying some  degree of restraint, for
here the necessity is imminent.   If a remarkable  change has suddenly taken
place in the character of the patient; if he  has become irritable, outrageous, or
threatened personal violence to any one, or  if he  has recklessly endangered the
interests of himself and family, he is undoubtedly a fit subject  for restraint.
(See Pagan, 75.)   The more  he  approaches to this condition, the less difficulty
we shall have in  coming to a decision, and in a really doubtful instance there
will be no impropriety in employing restraint;  since, although the person is
thereby deprived  of liberty, it is better that this should happen, than that he or
his friends should incur the risk of suffering severely by  his insane conduct.
   The forcible removal of a person to a lunatic asylum, unless the circumstances
are of  such a nature as to render immediate interference necessary on the ground
of admitted or proved insanity, is unjustifiable in law, and may involve those con-
cerned in the removal in a serious responsibility.   The case of Nottidge v. Ripley
(1849) is in this-respect of some interest.  A young  lady of fortune was here
clandestinely and violently removed from a  place to which she had voluntarily
retired,—examined by two medical witnesses nominated  by those who had thus
forcibly removed  her, and then closely confined in  a lunatic asylum for seventeen
months without being allowed to communicate in any  way with those members
 of  her family who alleged that she was not insane, and  who through these tor-
tuous proceedings were unable to discover  the retreat of their relative, and to
have the case publicly investigated.  At the trial for this abduction, the jury re-
turned a verdict against those who  were charged  with  the  offence (Med. Gaz.
xliv. p. 974.)  The allegation of insanity was denied, although it  was proved
that the plaintiff bad fallen into the hands of persons whose object was obviously
to possess themselves of her property, and that, like her  sisters, she had adopted
some absurd and  pseudo-religious notions.  If, however,  such violent  measures
were sanctioned before any preliminary inquiry, medical or  otherwise, were in-
stituted into the state of a person's mind, and upon the mere opinion of non-
medical persons or interested relatives, no  individual, whether  sane or insane,
could be assured of his liberty.   This case has called forth some criticisms which
the reader will do well to peruse.  (See Journ. Psychol. Med. 1849, p. 564; and
1850,  p. 14.)
   In the case of Hill v. Philp (Exchequer, Feb. 1852)  an action  was brought
by plaintiff to recover damages for alleged neglect and  unskilful treatment while
under  the defendant's care as  a lunatic patient. The plaintiff was examined, and
he  wished to impress the Court that he was then  perfectly sane.  His  cross-ex-
amination, however, elicited the belief that "he was descended from Leofric, the
wise Earl of Mercia, who was contemporary with  Edward the  Confessor."  It
was also proved that he had called for  water  from Jerusalem and the  Jordan!
In  short, there was abundant  evidence  of insanity, and the jury returned a ver-
dict for  the defendant.   The  case, however, conveys an  important  caution that 
560             LAW REGARDING CERTIFICATES OF INSANITY.

medical men should be careful in the imposition of restraint, as from the evidence
it appeared that unnecessary violence had been used on this occasion.  There is
another circumstance which renders this case of interest to medical practitioners,
namely, whether in the treatment of a lunatic  a medical man can justify the im-
position of restraint  by the  allegation that he acted under the directions of or
upon the request of  the wife or other relative, at  whose instigation the lunatic
may have been confined.  In Hill v.  Philj), the judges decided  that a medical
man is, under  such  circumstances, bound to  be guided by the directions  of a
wife, but that the directions must only be considered as guiding his judgment,
and  not as  absolutely dictating to him; that he is still bound to exercise his own
discretion,  so far as  to refrain from  doing any thing, or  adopting any course
which might be injurious to the patient.  A medical man is, therefore, ultimately
responsible for his treatment of a lunatic.  No person can give him authority to
do that which is not in accordance with general practice or the necessity of the
case.  (For a report of this case, and some judicious remarks upon the decision,
see the Legal Examiner, May 29, 1852,  pp. 307, 318.)
   In order to provide for the protection of lunatics and the prevention of undue
violence, or frequency in the application of restraint, the law compels the keepers
of asylums to enter in a book a report of each  case or of each occasion in which
any  mechanical restraint is resorted to.   An  omission  to make  this entry is a
misdemeanor; and at the Maidstone Lent Assizes,  1851, two medical gentlemen
were convicted and  fined for placing patients under  restraint without having
made the entries required by law (Reg.  v. Maddock.)   See also Med. Gaz. vol.
xlvii. p. 556; and a paper on the use and abuse of Restraint, Journ. Psychol.
Med. 1849, p. 240.
   Violence of temp>er must not be taken as a proof of insanity.   A man  may
have always had a violent temper, subject to occasional fits of aggravation, but
this  must not be confounded with mental disease.   In order to determine whether
the acts of a person  be due to  violent temper or  insanity, it will be proper to
ascertain what may have been his natural habits.  The great feature of insanity
is  change of character: a man  who is really insane is different to what he  has
previously  been; but it may be  proved, of a violent-tempered man,  that he has
always been the same.   The greatest abuses of the  restraint system have been
chiefly observed in respect to monomania, where individuals have been forcibly
imprisoned because they entertained some absurd delusions, over which, however,
they had so great a power of control,  as to render  it somewhat difficult even for
a shrewd and experienced examiner to detect them.   AA7hen, at last, after many
hours' cross examination, the existence of delusion has been made apparent, the
result has been looked upon as  furnishing matter for triumph and  exultation;
but, as Dr. Conolly justly remarks, one point in these cases appears to have been
wholly lost sight of,  namely,—AVhat  possible injury could  have resulted to the
patient or his friends from the existence of a  delusion over which he had  such
complete control and mastery, as to render it a most laborious task to obtain any
evidence of its presence?  (Indie, of Ins.)  It may be freely  admitted, that
where delusion does exist, there is reason to suppose that the mind must be more
or less disordered in  all its faculties; but such  patients require close watching,
not a rigorous imprisonment in an asylum.  The greatest danger is to be appre-
hended in all those cases where there is the least power of  self-control.
   Certificates of insanity.—It  will here  be necessary to state the circumstances
which  require the attention of  a practitioner when he is called  upon to sign a
certificate of insanity, whereby a person may be placed in confinement in an asy-
lum.  The act which specially  refers to this subject is the 8th and 9th Arictoria,
c.  100, ss.  45, 46, 47,  48, and  49.   This act,  which came into operation on the
4th  August, 1845, is a consolidation  of all the statutes on the regulation of the
care and  treatment  of lunatics.  Its provisions are very stringent, both with
respect to medical men who sign certificates, and those who keep asylums for the
reception of lunatics. 
LAW REGARDING CERTIFICATES OF INSANITY.             561
   According to section 45, no person (not a pauper) can  be received into or
 detained in any licensed house or hospital, without an order from some person,
 and two medical certificates, which  must be signed by two physicians, surgeons
 or apothecaries not in partnership, and each of whom shall  separately from  the
 other have personally examined  the person to whom it  relates not more than
 seven clear days previously to  the reception of such person into such house or
 hospital, and shall have signed and dated the same on the  day on which such
 person shall have been so examined.
   Form of medical certificate in the case of private patients, s. 45.
   I-------• being a  physician or surgeon or apothecary duly authorized  to  act
 as such, hereby certify that I have  this day examined A. B., the person named
 in the accompanying statement or order,  and that the said A. B. is a lunatic  [or
 an insane person, or  an idiot, or a person of unsound mind,] and a proper person
 to be confined, and that I have formed this opinion from the following fact or
 facts;  viz.
                   (Signed)                                     Name.
                                                              Place of abode.
   Dated this  day of  one thousand eight hundred and

   Under the same section, any physician, surgeon, or  apothecary, who  shall
 knowingly sign any  such medical  certificate as aforesaid, which shall untruly
 state any of the particulars required  by this  act, shall be guilty of a misdemeanor.
 Hence it follows that a medical assistant not duly licensed, cannot sign a certifi-
 cate for his  employer,  although  there  is reason to believe that the Act is thus
 occasionally evaded.  (Med. Gaz. xliii. 763.)
   The 46th section  orders, for the first time, that every medical practitioner
 signing such certificate  must specify facts upon which his opinion is formed, and
 whether these are derived  from his  own observation or from the  information of
 any other person.  The 47th section provides that in cases of emergency a person
 (not a pauper) may, under special circumstances (these being  stated in the order,)
 be received into a house or hospital  upon a certificate signed by one medical prac-
 titioner only, provided  that within  three  days, another such certificate shall  be
 signed by some other medical practitioner, not being connected with such  house
 or hospital, upon a like  examination. The detaining of a person upon one medical
 certificate only,  beyond the period of three days, without such further certificate,
 is a misdemeanor in the keeper of the house or hospital.
   By s. 48th the certificate of one medical practitioner only, signed according to
 the above rules, will  suffice for a paup>cr lunatic, provided  the party has been
 previously examined  by a justice, clergyman, or overseer, and has received  an
 order setting forth  the particulars of the case.
   By s. 49th no medical  practitioner, who  is interested in or attends a licensed
 house or hospital, or  whose father,  brother, son, or partner, is wholly or  partly
 the proprietor of or a regular professional attendant in such house or hospital,
 shall sign any certificate for the reception of a patient into it, "and any physi-
 cian, surgeon, or apothecary, who shall sign  any certificate contrary to any  of the
 provisions herein contained, or without having complied with all the provisions
 hereby required in  the case of the patient to whom the same shall relate, or who
 shall in such certificate describe his medical qualifications untruly, or shall un-
 truly state any thing  therein, shall be guilty of a misdemeanor."
   [Certain recent  actions  at  law in this  country in which heavy damages have
 been incurred by parties charged with arresting and detaining an alleged lunatic
 against the will and interests of the latter, have led to greater circumspection, not
 only among  the  friends  of  lunatics in the procurement of proper medical certifi-
cates and other forms required  for the admission of insane patients into hospitals,
but among the medical  advisers in the preliminary examinations of the patients,
and the filling up of their certificates.  The principal hospitals for the insane of
       36 
562            RULES REGARDING CERTIFICATES OF INSANITY.
United States have printed forms and  obligations, which  are furnished to the
friends of patients to be filled up and signed according to the law of the State,
and the rules of the hospital.  The form of the medical certificate generally re-
quires the patient to have been seen and  examined by the physician signing, on
the day on which the certificate is dated.   In all cases the certificate is expected
to apply only to the actual condition of the patient at  the time of signing, and
to be used without delay in order to be available.
   The  medical certificate must always be  accompanied by a formal  application
for admission of the patient, signed by a responsible guardian, near relative or
friend.   These papers have also annexed  to them a series of questions  relating
to the past  history and existing condition of the patient, the peculiar symptoms
of the case, and the probable cause of the attack; which questions are to be an-
swered by the friends and relatives, and the attending physician.
   Some hospitals require  the signature of two physicians  to the medical certifi-
cate, neither of them, of  course,  being connected with the hospitals  applied to.
The State Lunatic Hospital of New Jersey requires the medical certificate to be
formally deposed to by two physicians before a magistrate.
   Patients  sometimes obtain their discharge on a writ  of habeas corpus by
proving their apparent fitness to be at large, but are generally removed by friends
or discharged, when sufficiently recovered, at the discretion  of the superintendent.
We are not aware of any legal restriction in this  country on  the liberation of in-
sane patients except in cases of  homicidal or otherwise  dangerous lunatics,who
have been confined by order of a  magistrate or of a court of law.   Such  patients
can only be released by an authority similar to that which  first committed them.
There are patients of this class now in durance at the Eastern State Penitentiary
of Pennsylvania, and in the different State Asylums.—H.]
   As ignorance of the law is never allowed to be an excuse for its violation, so
a medical man, unless acquainted with all the particulars above-mentioned, may
easily subject himself to a prosecution;  and he is not likely to be spared the dis-
grace and mortification attendant upon this, should it so happen that the case is
of a doubtful nature.   The law expressly requires  from  each medical man a
separate visit, a separate personal examination of the alleged  lunatic,  and a sepa-
rate medical certificate, setting forth the special fact or facts, whether observed
by himself or derived from the information of others, upon which his opinion is
based.
   Specification of facts.—Medical practitioners have had  some difficulty in as-
signing the fact or facts upon which their judgment of the  insanity of  a party
was based.   (Med. Gaz. xxxvi. 1434; and xxxvii. 485.)  What will constitute
the description of a fact to render the certificate valid?   This important ques-
tion was raised and decided  in the case of Shuttleworth (Queen's  Bench, Nov.
17, 1847.)   An application was made  for  the  discharge of a lunatic on  the
ground that the medical certificates did not  set forth the facts from which the
opinion of those who signed them was derived.   In one, it was stated that the
lunatic  laboured under a variety of delusions, and that she was dirty and indecent
in the extreme.   In the other the certifier stated that he had formed  his opinion
from the conversation  which  he had that day had with her.   It was contended
that the statement in the first certificate was not  so  much  a  fact as a conclusion
drawn from other facts which ought to  have been mentioned in the certificate
itself.   Lord Denman, in giving the judgment of the Court, held that  the cer-
tificates were valid:—that it was not necessary to have all  the delusions  of an
insane person stated on the certificate.  The statement that the lunatic was dirty
and indecent in the extreme, was prima facie sufficient to justify the imputation
of insanity,  even if the certificate did not state that the patient laboured  under a
variety  of delusions.  The allegation that the opinion  respecting  insanity was
founded upon a conversation, was also  sufficient  to render the certificate valid.
(Med. Gaz.  xxxviii. 932;  also Law Times, Nov. 21, 1846, 145.)  It will  thus
be seen that a general statement of the circumstances which  have led  to the be- 
RULES REGARDING THE DISCHARGE OF LUNATICS.
563
lief of the insanity of a party, will be a sufficient compliance with the 46th sec-
tion of the statute to render the certificate valid.  In other respects the terms of
the certificate are sufficiently explanatory; and any violation of these will neces-
sarily subject a practitioner to a trial for a misdemeanor.   In June, 1848, a sur-
geon was tried and  convicted  at the Central Criminal Court of having certified
that he had examined a female lunatic on the day on which he put his name to
the document, when he had not  seen her for two or three months.  There was
no doubt of the insanity of the party, but as this was an untrue statement, he
was convicted of the offence.
  Discharge of lunatics.—In forming an opinion relative to the propriety of dis-
charging a person who has once been  confined as a lunatic  in an asylum, it is
proper to examine the particulars of his case with the same caution as if  the ob-
ject were to confine him for the first time.  The question of liberation  is com-
monly restricted, like  that of restraint, to cases of mania and monomania.  It
may so happen,  that an individual  has  a lucid interval at  the time of examina-
tion, in which case  it will be necessary  to make more than one visit.   One who
has been guilty  of a heinous crime like murder, should never, on any pretence,
be discharged.   There are often long lucid intervals in homicidal mania; and it
is impossible to be certain that the disease  is entirely removed.  If the  indi-
vidual has manifested the  least disposition to  suicide, we  should be  extremely
cautious of liberating him; for suicidal mania is often artfully concealed under
a cheerful exterior.   AVe cannot always test the propriety  of granting liberation
by  the lightness of  the offence for which a criminal lunatic has been confined.
The circumstances  under which the most trifling offence  has been committed
may show that the mind is wholly unsettled with regard to moral responsibility;
and such lunatics can  never be trusted, even when there is great improvement
in  their language  and deportment.   The unhappy result of prematurely dis-
charging a criminal lunatic, was seen in the case of a man named Thorn, other-
wise styling himself Sir AVilliam Courtenay.   He was  shot while  rioting with
many others near Canterbury  in June, 1838.   The whole life of this man seems
to have been made up of a mixture of eccentricity and insanity.  He was guilty of
the most  flagrant perjury, was  tried, found  insane, and  confined  as a lunatic.
After a lapse of about six months, it was thought that he was so much improved
as to allow of his discharge;  although even at this time,  it appears he  fancied
himself to be the Saviour !   On  his discharge, he was  guilty of many extrava-
gant acts; he collected a number of ignorant persons as his followers, and infected
them with his delusion.   He  resisted the military who were sent to  apprehend
him, and eleven lives were lost on the occasion.  A medical man cannot always
be responsible for  unfortunate consequences of this kind;  but  this  and  other
similar instances show that great risk  is incurred in hastily allowing  the dis-
charge of a lunatic, who has once been  guilty of a crime, however slight, so pal-
pably depending on a disordered mind.  The 8th and  9th of Arictoria, c. 100,
has placed certain restrictions on the power of liberating lunatics.   Under  s. 72,
the person originally signing the order which is required in addition to the medi-
cal  certificates,  may write an order for his discharge or removal:  but under  s. 75,
this order is of no effect, if a medical practitioner certify that in his opinion such
patient is  dangerous and unfit to be at large, together with the grounds on which
such opinion is founded, unless the commissioners or visiters shall, after the pro-
duction of such certificate, give their consent  in writing for the  removal or dis-
charge of such patient.  Under other clauses, additional powers of discharge are
given to the commissioners and visiters, subject to such restrictions as  to leave
the control for the most part in the hands of professional men.  These powers of
discharge do  not, however, apply either to  criminal lunatics, or to those found'
insane under a commission issued by the Lord Chancellor. 
564                EXAMINATION OF ALLEGED LUNATICS.
                            CHAPTER LXVI.

TESTIMONIAL CAPACITY OF LUNATICS--INTERDICTION--COMMISSIONS OF LUNACY--EXAMINA-
  TION OF ALLEGED LUNATICS--MEDICAL AND LEGAL TESTS OF COMPETENCY—LUCID INTER-
  VALS.

   Testimonial capacity of lunatics.—Since the former edition of this work was
published, a question  of some importance has arisen regarding the admissibility
of the testimony of lunatics concerning facts which they allege they have wit-
nessed.   In the cise of Reg. v. Hill, tried at the Central Criminal Court in the
spring of 1851, the evidence of a man named Donnelly was tendered  on the part
of the Crown.   (Jour, of  Psychol. Med., 1851, pp. 279  and 436.)  This  man
was a pauper lunatic, and was confined as  such in the  same ward with the de-
ceased, who, it was alleged, had  been  maltreated and killed by the prisoner.   It
was quite clear from the cross-examination of Donnelly at the trial,  that he la-
boured under insane delusions,—that he was constantly visited  by spirits, &c.:
but, nevertheless, he gave a clear and consistent account of the  mode  in which
deceased was treated by the prisoner,  and although he firmly believed in the ex-
istence of spirits and their power  of communicating with him, he appeared to have
a full knowledge of the difference between truth and falsehood.   His evidence
was received, and upon this the prisoner was convicted.   The  case was subse-
quently argued in the Exchequer Chamber before all the judges, and decided in
favour of the admissibility of the evidence.   It may now, therefore, be consi-
dered as settled that a lunatic who labours under delusions, but who in the judg-
ment  of a medical practitioner is capable of giving an account of any  transaction
that happened before his eyes, and who appears to understand the obligation of
an oath, may be called as  a witness.   (Reg. v. Hill, 2 Denison's Crown Cases,
254.)  The rule laid  down by Baron Parke is in accordance with this view; it
is for the judge to say whether the witness is admissible, and then his credibility
is a question for the jury.   As old legal dicta on the subject we  find the follow-
ing:—"An idiot shall not be allowed  to give  evidence, (Co. Litt.  b. 6;  Gilb.
Evidence, 144,) nor a lunatic (lb.) except  during the lucid interval;" (Arch-
bold,  Pleading and  Evidence in  Criminal Cases, 124,) but it is now  known and
admitted that the shades of insanity are infinite,—that some lunatics  are as fully
competent  to observe and remember facts, and to understand the obligations of
an oath, as persons who are sane;  hence, therefore, incompetency to give testi-
mony must not be inferred from a mere name assigned to a malady,  but it must
be decided  by the special condition of the lunatic.  Under any other view, crimes
of the greatest  enormity might  be perpetrated  in lunatic asylums without the
possibility of convicting the criminals.  It has been appropriately remarked by
a good authority, that the fact of incompetence to testify  is not necessarily con-
nected with the state of insanity; and  it would  be far more correct  to consider
it an independent fact to be established by a distinct order of proofs.  The truth
is, an analogy in a medico-legal sense has been too hastily assumed between the
act of testifying and that of  performing business contracts, and  other civil acts;
and, in consequence, has shared with them in the same sentence of disqualification
without an attempt to  ascertain the kind and degree of intellectual power which
they respectively require.   (Ray, Medical Jurisprudence of Insanity; see Medi-
cal Gazette, vol. xlvii. p. 150.)  In the spring of 1852,1  saw Donnelly, the wit-
ness  in  the above case, in  the Colney Hatch  Lunatic1 Asylum.   His powers of
observation and reasoning  were  very acute and quite sound, except  when refer-
ence was  made to his peculiar delusions regarding spirits.
  Interdiction.   Commissions of Lunacy.—By interdiction we are to understand
the depriving of a person labouring under mental disorder, of his civil rights; in 
            INSANITY.  INTERDICTION.  COMMISSION OF LUNACY.        565

 other words, preventing him from exercising  any control or management  over
 his affairs.  It may be with or without restraint, for one condition does not ne-
 cessarily imply the other.   AA'hen an  individual, from mental incompetency, is
 liable to be imposed upon by others, or is guilty of foolish and extravagant acts,
 whereby his property is damaged, a  Commission is commonly granted by the
 Court of Chancery, in order to determine whether he be  "compos" or "non
 compos mentis."   This writ is well known under  the name  of " de lunatico in-
 quirendo."   Before it can be issued, it is necessary, among other matters, that
 there should be affidavits, made by two or three physicians or surgeons, certifying
 to thednsanity of the party.   It has  been already explained  that the object of
 the law is to determine whether the incapacity to manage affairs be owing to some
 mental defect or  disorder, and not merely to want of education or bodily infir-
 mity,—otherwise all wealthy minors and infirm  persons might be  improperly
 deprived of the control of their affairs.  It is unfortunate that these commissions
 are conducted on so expensive  a scale as to render them applicable only to the
 wealthy classes of society; and even here the expenses attending such a simple
 inquiry as that for which the commission is issued, are often of the most ruinous
 kind, and the results are by no means satisfactory.   (See the  cases of Mr. Davies,
 Miss Bagster, and others.)  A\rhen insanity is  pleaded in a criminal case, one
 judge and twelve jurors will decide the question,  affecting as it does  the  life of
 a party, in a few hours, and at very  little expense!  It is difficult to understand
 why, in a question of competency to manage affairs, so many more functionaries
 should be required, so much more time, sometimes amounting to twelve or fifteen
 days, occupied, so many witnesses examined, and such enormous expenses should
 be  thereby incurred.   (See cases of  Miss  Bagster, July, 1832, and of Lady
 Kirkwall,  Feb. 1836.)  The property of tradesmen,  and of other persons of
 small means, is under such a system left unprotected.   This  expensive process
 of wasting an alleged lunatic's  fortune in order to determine whether he be or
 be not likely to  waste it  himself,  leads  to  the result  that,  compared with the
 number of lunatics  under confinement, the inquisitions are very few.  Out of
 3774 persons confined in 1850 above the pauper class,  there were only 338 cases
 in which inquisitions were held, i. e.  there  is only one  lunatic in  eleven whose
 property is  thus  protected by a commission, apparently because the  protection
 involves such an  enormous expenditure.   (Med. Gaz. vol. xlvi. p. 1023.
   One source of difficulty on these occarions  is, that medical witnesses are allowed
 to be summoned  by both parties, and the opinions given often exactly neutralize
 each other:  they  are hereby converted into partisans in the cause, as much as
 if they were counsel.   It has been well remarked, that a man, even unknown to
 himself, with the purest intentions and the most perfect rectitude, will insensibly
 lean to the side on which  he has been employed.  (Pagan, 301.)  The public
 are apt  to  infer,  from such  conflicting opinions  emanating from men of equal
 experience, that the difference cannot depend essentially on the medical  facts of
 the case; and that the question might be better determined  by non-professional
 persons.   See the case of Carpenter, Dublin 31 ed. Press, July 16, 1845, p. 46;
 also that of Mrs.  Cumming, in which the conflict  of medical  testimony was even
 greater than usual.   As there is to be a new inquiry in  this case, if the means
 of the alleged lunatic will allow of  the expenditure, it would not be proper at
 the present time to give an analysis of the evidence adduced at the  inquisition;
 but the reader will find a very elaborate report of the case in the Journal of
 Psychological Medicine for April, 1852.  The inquiry  occupied seventeen days!
 A remedy for this serious evil would be, that medical witnesses on such occasions
should be appointed, like the commissioners, by the Chancellor, and they would
be thereby made perfectly independent of both parties.   At  present they rather
occupy the position of medical  counsel than medical witnesses;  for it is quite
clear that no one  would be summoned whose views did  not coincide exactly with
those of the  party summoning him; and it is an opinion among some solicitors, 
566
EXAMINATION OF ALLEGED LUNATICS.
for which, unfortunately, there is an apparent reason, that medical evidence on
these occasions is a marketable commodity, and may be purchased  at graduated
prices!   The reader will find some remarks on this subject in the Medical Ga-
zette, vol. v. 719; xi. 740; and xvii. 816.
   Examination of alleged lunatics.—To determine whether a person is or is not
a fit subject for interdiction, it is necessary to bear in mind that it is not enough
to show there is delusion, as in the lighter cases of monomania, but we are bound
to determine how far the delusion affects the judgment of a party, so as to prevent
him, like other men, from managing his affairs with provident care and propriety.
In many instances, however, proof of delusion only is sought for;  and if this be
procured, it is  somewhat hastily inferred that the party is entirely incompetent
to the management of his property.  The most difficult cases are those involving
questions of  imbecility.  In conducting the examination of an alleged lunatic,
we should compare his mind as it is with what it has been;  and if it be a case
of supposed imbecility, a proper regard must be  had to age,  society, education,
and general conduct.  AVe should  also consider  whether the person  has been
treated by his friends and relations  as a lunatic or imbecile prior  to the issuing
of the commission.   A young person, whose education has been  much neglected,
and who has never been intrusted with the care of money, cannot be expected to
have much knowledge of the method of managing a large property.  Questions
are sometimes put on the moral responsibility of  man and the attributes  of God
to one who, perhaps, never heard of metaphysics.  Arithmetical questions are
asked which would embarrass many persons who are set down as sane and com-
petent.   In a case which occurred  a  few  years since, one examiner  asked  the
alleged imbecile, who said  he had  £1,200  in the  bank, and received £20 for
interest,—How much was that per cent.?   He said "he could  not tell;  he  was
no  good hand at arithmetic."  The counsel who appeared against the brieve or
commission afterwards put  the same arithmetical question to one of the medical
witnesses who had deposed to the imbecility of the party;  and this witness, an
educated man, confessed himself unable to answer it—a practical illustration of
the impropriety of pronouncing  a  person  to be  imbecile merely because he is
ignorant of what he has never been taught!  (Case of David Yoolow, 1837.)
If the capacity to manage affairs rested solely upon a knowledge of arithmetic,
many now go free who ought to be immediately placed under interdiction. This
is rather a  commercial test of insanity; but it will be found-  that it has been
applied in a very improper way to determine the capacity of young and ill-edu-
cated females.   Unless  the questions be  confined  to those subjects which  the
party has had either the opportunity or inclination to learn, a medical witness
will always incur the risk of confounding mere ignorance with imbecility.  Perhaps
one of the best tests of mental capacity will be found in determining the degree to
which, with ordinary opportunities, the individual has shown himself capable of
being instructed.   Too high a standard must not be assumed as a test for capa-
city.  The  mind of an  alleged imbecile should not be compared with  the most
perfect mind, but with  that of another person of average capacity, of the same
age and station in society, and who  has enjoyed like opportunities of instruction.
(See Ann. d'Hyg. 1836, i.  192.)
  A medical witness must  not allow himself to  be embarrassed by medical or
legal definitions of insanity.  The  malady may not have  the form of lunacy or
idiocy in a strictly legal view; nor of mania, monomania, dementia, or idiocy,
in a strictly medical view;  but still it may be a case of such mental disorder as
to create an incapacity for managing affairs. This is the point to which a medical
examiner has to direct his attention.  Dr.  Conolly has suggested one method of
testing the  state of mind, which it would be advisable to adopt, namely, to cause
the individual to express his thoughts in writing.   He would not here be led to
suspect that he was being subjected to an examination for a hostile purpose.   In
many cases, the evidence of a strong delusion existing in the mind has been 
SUPERSEDING COMMISSIONS.
567
derived from a will, deed, or letters written spontaneously by the lunatic or im-
becile, when there was considerable difficulty in obtaining this proof by a verbal
examination.
   Among many cases which might be here cited to illustrate the medical evidence
required and  received on  commissions of lunacy, one may be  selected which
excited much interest at the time of  its occurrence;  I allude  to that of Miss
Bagster, which underwent  inquiry in July, 1832.   It will  serve to  show upon
what slight grounds a verdict of "unsound mind" may be returned under com-
missions of lunacy, as they are at present conducted.  The subject of this inquiry
was shown by the evidence to be a frivolous and weak-minded girl, whose educa-
tion had been much neglected.   She was heiress to a large fortune, and contracted
a clandestine marriage unsuited to her  condition.   A commission was taken out
by her friends for the purpose of  annulling her marriage, by showing that she
was not at the time competent to give  rational consent.  The  general evidence
established that there had been great neglect in her education, and that she had
been especially indulged; but it did  not appear that she had ever been treated
by her friends as of unsound mind, nor, indeed, that any question of her insanity
had been raised, until after the marriage.   Seven  medical witnesses  summoned
to support the commission, deposed that she was of unsound mind.  On the other
side no witnesses were called, as it was considered that the allegation of insanity
was not made out.   The Commissioners, however, themselves, called Dr. Morrison
and Dr. Haslam, who deposed that her incompetency to manage her affairs arose,
not from unsoundness of mind, but from ignorance.  She gave one strong proof
of her sanity, namely, that she was aware of her deficiencies.  It seems to have
been allowed  that she  was capable of controlling herself,  and  concealing her
defects;  her answers to the  questions  put to her were pertinent, and were  for
the most part correctly made, and  she had capacity to  receive instruction.  She
was ignorant of arithmetic, but this  she had never been properly taught.  She
was young and inexperienced, and therefore unable to answer questions relative
to the management of a household.  The jury, by a majority of  twenty to two,
returned a verdict that she was of  unsound mind, and  had been so for the space
of two years—a time which covered the marriage.   (See, for an excellent medico-
legal report of this case,  Med. Gaz. x.  519, et  seq.)
   It is worthy of remark,  that the  only two medical witnesses,  independent of
both sides, who were summoned by  the Commissioners, gave a very strong opi-
nion that Miss Bagster was ignorant, and not of unsound mind; and that she
might, by instruction, be rendered competent to the management of her affairs.
AVe should imagine that where the question arose,  whether a young person was
or was not to be deprived of all civil  rights, there ought to be at least unanimity
among the medical opinions, or, if this were denied, then more weight should
be given to the negative than to the  affirmative side of the  question,  providing
if, as in this case, the negative view were supported by men impartially selected,
and of great experience and knowledge on the  subject of insanity. It  is not im-
probable that besides ignorance, there  may have been  some  degree of weakness
of mind about  this person; yet, taking the whole case, we  must attribute the
verdict of unsoundness, not so much to mental infirmity as to  incapacity, for
want of instruction, to  manage a  large fortune.   But if every  wealthy young
lady, whose education had  been much neglected,  had  her sanity tested on the
same points as  Miss Bagster, it  is certain that many who are now free agents
would be placed under interdiction!  It has been  attempted to justify the ver-
dict by the statement, that  it saved her from  the results of an imprudent mar-
riage—tne answer to which is, that commissions of lunacy are not intended to
shield persons whose minds are not really unsound, from the results of foolish
and imprudent acts!
  Commissions may be superseded, but the evidence in such a case must be as
strongly  in favour of sanity  as it  was before  in favour of insanity.   In Dyce 
568
MEDICAL EVIDENCE OF LUCID INTERVALS.
Sombre's case, July, 1844, the physicians of England and France came to di-
rectly opposite conclusions!  See the judgment of the  Lord Chancellor, as re-
ported in the Law Times, Sept. 28,  1844; also a notice of  a treatise on his own
case and the law of lunacy by Mr. Dyce Sombre, Journ. Psychol. Med. 1850, p.
409.   There have been few cases in which so great a difference of opinion has
existed among medical witnesses as in this.  Five English medical practitioners
of good standing were, however, in favour of the sanity of the party.   The de-
cision was against superseding the Commission, chiefly on the ground of the ex-
istence of delusion:  but the  most extraordinary part of the  case was, that the
alleged lunatic was allowed to have the uncontrolled use of a large portion of
his property!  (Med. Gaz. xl. 899.)  In  1851, arrangements were made for an
independent medical Commission to inquire into the mental state of this gentle-
man, and, if possible, to reconcile the conflicting medical opinions already given;
but before this was constituted, the alleged lunatic died.   For some remarks on
this case, see a letter by Dr. Mayo,  Med. Gaz. xlvi. p. 123.
   Lucid intervals.—By a lucid interval, we are to  understand a temporary ces-
sation of the insanity, or a perfect restoration  to reason.   Thus, then, it differs
entirely from a remission, in  which there is a mere abatement of the symptoms.
It has been said  that a lucid interval is only a more perfect remission;  and that
although the lunatic may act rationally and talk coherently, yet his brain is  in
an excitable state; and he labours under a greater disposition to a fresh attack of
insanity than one whose mind has never been affected.  Of this  there can be no
doubt,  but the same reasoning would tend to show that insanity is never cured;
for the predisposition to an attack is undoubtedly greater in a recovered lunatic
than in one who  is and has always been perfectly sane. Even admitting the cor-
rectness of this reasoning, it  cannot be denied that lunatics do  occasionally re-
cover for a longer or shorter period  to such a degree as to render them perfectly
conscious of, and legally responsible for their acts  like other persons.   The law
intends no more  than this by a lucid interval: it does not require proof that the
cure is so complete that even the predisposition to the disease should be entirely
extirpated.  Such proof,  if it could even be  procured, would be  totally irrele-
vant.  If a man  acts rationally and talks coherently, we can have no better proof
of a restoration to reason.  If  no delusion affecting his conduct remain in  his
mind, we need not concern ourselves about the degree of latent predisposition to
a fresh attack, which may still exist.
   Lucid intervals sometimes  appear suddenly in the  insane.   The person feels
as if awakened from a dream, and there is often a perfect consciousness of the
absurdity of the delusion under which he  was previously labouring.  The dura-
tion of the interval is uncertain;  it may last for a few minutes only, or may be
protracted for days, weeks, months, and even years.  In a medico-legal view, its
alleged existence must always be looked  upon with suspicion and doubt when
the interval  is very short.  The lucid intervals are most frequently seen in cases
of mania and monomania; they occasionally exist in dementia  when this state
is not chronic, but has succeeded a fit of intermittent or periodical mania.  They
are never met with in cases of idiocy and imbecility.  It is sometimes a matter
of great importance to be able to show whether or not  there exists, or has  ex-
isted, a lucid interval;  since, under these circumstances, the acts of an indi-
vidual  are deemed valid in law.   The mind should be tested, as in determining
whether the patient be labouring under insanity or not.   He should be able to
describe his feelings, and talk of  the subject of his delusion, without betraying
any signs of unnecessary vehemence or excitement.  It may happen that a person
who is the subject of a Commission of inquiry is,  at the time of examination,
under a lucid interval, in which case there may be some difficulty in forming an
opinion of the existence of insanity.  This occurred in the case of Lady Seymour
(July,  1838:) when examined before the Commission, her replies were so rational
and collected that no verdict could be given, and the case was adjourned.  AVhen 
RESPONSIBILITY IN CIVIL CASES.
569
the inquiry was resumed, it was satisfactorily proved that she was insane, not
merely by general and medical evidence, but by the terms of her will which had
been drawn up  by herself.   The same circumstance happened in the cases of
Mrs. Hartley and Mr. Pearce, who were the subjects of Commissions in 1843.
It has been said that a person in a lucid interval is held by law to be responsi-
ble for his acts, whether these be of a civil or  criminal nature.   In regard  to
criminal offences  committed during a lucid interval, it  is the  opinion of some
medical jurists that no person should  be convicted under such circumstances;
because there is a probability that he might at the time have been under the in-
fluence of that degree of cerebral irritation which renders a man insane.  (Pri-
chard.)  This remark applies more especially to those instances where the lucid
interval is very short.   Juries  now very seldom  convict, however  rationally in
appearance a crime  may have been perpetrated,  when it is clearly proved that
the accused was  really insane within a short period of the time of its perpetra-
tion.
                            CHAPTER LXVII.

 RESPONSIBILITY IN CIVIL CASES--INSANITY AS AN IMPEDIMENT TO MARRIAGE--DEEDS AND
   CONTRACTS--WILLS MADE BY THE INSANE--TESTAMENTARY CAPACITY--TEST OF CAPACITY
   —DELUSION IN THE DEED--ECCENTRICITY IN WILLS--WILLS IN SENILE DEMENTIA--WILLS
   IN EXTREMIS--RESTRICTION OF MEDICAL OPINIONS.

                     RESPONSIBILITY IN CIVIL  CASES.-
   Insanity as an impediment to marriage.—Insanity is deemed in law to be a
 civil impediment to marriage, because it is considered that there cannot be that
 rational consent which is necessary to the validity of the contract.  The marriage
 of a lunatic is therefore called a nullity, and is void ab initio.   All that the law
 requires is, that there should be good proof of insanity at or about the time of
 the contract.  If this be offered, and it be alleged that the contract was entered
 into during a lucid interval, then  the party who would benefit by the allegation
 must prove it.   The suitableness of the marriage, as well as the conduct of the
 party during or  after its performance, will also be considered by the Court.   In
 the case of Turner v. Myers, a lunatic who had recovered  from his  lunac}' in-
 stituted a suit to set aside  a  marriage which he  had contracted while in that
 state.   The marriage was declared void.  (Med. Gaz. viii. 481.)   The case of
 Baldry v.  Ellis, (Norwich  Summ. Ass. 1851,) will be  found  of interest in re-
 lation to the  matrimonial engagements of alleged lunatics.
   In the  case of  Read v.  Legard, (Court of  Exchequer, May 30,  1851,) a
 question arose whether a lunatic was responsible for necessaries supplied to the
 wife.  The articles supplied were for the sole use of the wife, the husband being
 a confirmed lunatic, and the inmate of an  asylum.  The Court held that the
 fact  of a husband being from the visitation of God unable to manage his affairs,
 did not absolve him from the  obligation which he contracted when he married,
 to provide necessaries for the support of  his wife.   He was then of sane mind,
 and  although he had subsequently become insane, that obligation was not re-
 vocable under the  circumstances.   (See  also a report of the  case of Seaton v.
 Adcock, Journ. Psychol. Med., 1851, p.  297.)
  The validity of civil contracts entered into by lunatics will depend mainly on
the circumstances which accompany  the act.  If there be nothing unreasonable
in the conduct of the lunatic, and  the party with whom  he contracts has  no
knowledge  or suspicion of the  insanity, then the contract will be binding on the
lunatic and his representatives.  It was so held in one of the most recent cases 
570          WILLS MADE BY THE INSANE.  TEST OF CAPACITY.
(Moulton v. Cameroux, Exchequer,  June, 1848.)  This was an action by the
administrator of a deceased person, to recover from  the defendant, as secretary
of an insurance office, the  sum paid  by him as the consideration for two annui-
ties, the foundation of  the  action being, that at the time of the arrangement in
question, the deceased was not in a  sound state of mind.  At the trial before
the Chief Baron it appeared that the negotiation had been conducted by the de-
ceased with apparent prudence, sanity, and judgment, and that the arrangement
entered into by him with the office was just such as any ordinarily prudent person
would have been expected to make with a view to his own interest.   The de-
ceased, who died very soon after the business had been arranged, was, both before
and after, in an unsound state of mind.   Under these circumstances this action
was brought by his representatives, and a verdict recovered by  them, subject to
the opinion of the Court on their right to recover as on the entire failure of con-
sideration.  The  Chief Baron, in giving judgment in favour of the defendant,
said it was sufficient for the purpose  of this case to lay it down as a general rule,
that when a person of  apparently sound  intellect enters into a contract such as
any other ordinary person would enter into with  others who act bond fide, and
the parties cannot be restored to their former condition, it is no ground for setting
aside the contract, that one of them was at the  time non compos  mentis.   On
appeal to  the  Exchequer  Chamber this judgment was affirmed in May, 1849.
(See also  the case of Staniland v. Willett, Arice Chancellor's Court, Nov. 1848.)
   Wills made by the insane.   Testamentary capacity.—Questions  involving the
testamentary capacity of individuals are of very frequent occurrence, and medical
evidence is commonly demanded.   AAhen property is bequeathed  by a testator
out of the usual order of succession, it may be alleged by the relatives that he
was wholly incompetent to understand the nature of the deed—either from actual
insanity, the imbecility of  age, or that natural failing of the mind which is so
often observed to occur on  the approach of death.  Bodily disease  or incapacity
does not affect the validity of a will, unless the  mind be directly or  indirectly
disturbed by it.   Some time since  a case occurred in France, in which a will was
contested  on the  ground that the testator, when he executed it, was labouring
under hemiplegia.  The opinion of Esquirol was demanded, and  he said  that
hemiplegia  might undoubtedly affect the brain, a fact clearly indicated by the
sight, hearing, and other  senses  becoming weakened;  yet this, in his  opinion,
did not necessarily indicate an impairment of the understanding. (Ann. d'Hyg.
1832, i. 203.)  A  man's mind, under these circumstances, may not be  so strong
as in robust health, but still  it may retain a disposing power.  In the case of
Harwood v. Baker, decided by the Privy Council in 1841, a will was pronounced
to be invalid, owing to the general state  of bodily disease in which the testator
was at the time of making it.   It appears that he was labouring under erysipelas
and fever, and these diseases had produced a degree of drowsiness and stupor
which rendered him incompetent to the act.  In the case of Day, (June, 1838,)
epilepsy was alleged to have affected the mind; and in the  case of  Blewitt,
(March, 1833,) paralysis  was adduced  as a ground of incompetency.  In all
cases of this kind, the law looks  exclusively to the actual  effect  of the bodily
disease upon the  mind; and this is commonly a purely medical question.  In
the  case of Pcnfold v.  Craxoford,  (C. P. Dec.  1843,) it was shown that the tes-
tator had  lost  his  speech  from an  attack of apoplexy; but it was proved, by
medical evidence, that his mental powers were good, and therefore a deed  made
subsequently to the attack was held  to be valid.  Integritas mentis non corporis
sanitas exigenda est.  In the case of Whyddon v. Billinghurst (Prerog. Court,
July, 1850,) a will was set aside because it was executed by the testatrix while
labouring under an attack  of cholera, in Sept., 1849, and proper means had not
been taken to test the capacity of the deceased, who,  at the time of its execution,
was reduced to an  extreme state of  weakness.
   Test of capacity.—A person is considered to be of a sane and disposing mind 
ECCENTRICITY IN WILLS.
571
 who knows the nature of the act which he is performing, and is fully aware of
 its consequences.   From some  decisions that have been made, it would appear
 that a state of mind for which a party might be placed under interdiction would
 not render him  incompetent to the making of a will.  The validity of the will
 of a lunatic was once allowed, although made while he was actually confined in
 an asylum, because the  act was  rational, and it was such  as  the lunatic, some
 years  prior to  the attack of insanity, announced  his  intention of making.
 (Coghlan's case; see also,  Re Garden,  Law Times, July 6, 1844, p. 258.)  The
 insanity of a party, when  not already found insane under a  commission, must
 not, in these cases, rest upon presumption, but be established by positive proof.
 The commission of suicide is often hastily assumed to be evidence of insanity;
 but it would not be allowed as  a proof of this state, even when a testator de-
 stroyed himself shortly after the execution of the will.  A case has been decided,
 where the testator committed suicide  three days after having  given instructions
 for his will; but the act was not allowed to be a proof of insanity, and the will
 was pronounced to be valid.   A similar case has been thus decided in the French
 Courts.   Besides, as we shall see hereafter, suicide is not deemed in law to be a
 proof  of insanity.
   Delusion in the deed.—The validity of deeds executed by persons affected with
 monomania often becomes  a subject of dispute.  The practice of the law here
 indicates that the  mere existence of a delusion in the mind of a person does not
 necessarily vitiate a deed, unless the  delusion form the groundwork of it, or
 unless the most decisive evidence  be given, that at the time  of executing the
 deed, the testator's mind was influenced by it.  Strong  evidence  is often de-
 rivable from the act itself, more especially where a testator has  drawn it up of
 his own accord.   In the case of Barton, (July, 1840,) the Ecclesiastical Court
 was chiefly guided in its decision by the nature of the instrument. The testator,
 it appeared, laboured under  the extraordinary delusion that he could dispose of
 his own property to himself, and make Himself his  own legatee and executor!
 This he had accordingly done.  The  instrument was pronounced to be invalid.
 But a will may be  manifestly unjust  to the surviving relatives of a testator, and
 it may display some of the extraordinary opinions  of the individual, yet it will
 not necessarily be void, unless the testamentary dispositions clearly indicate that
 they have  been formed under a delusion.  Some injustice may possibly be done
 by the rigorous adoption of this  principle, since delusion may certainly enter into
 a man's act, whether civil or criminal, without our being always able to discover
 it; but after all, it is perhaps  the most equitable way of construing the last
 wishes of the dead.
   Eccentricity in wills.—The evidence in these cases sometimes amounts to proof
 of eccentricity only on the part  of the testator, or in the deed itself; but a clear
 distinction must be here drawn.  The will of an eccentric man is such as might
 always have been  expected from him—the will of one labouring under insanity
 (delusion) is different from that which he would have made in an unaffected state;
 —the  instrument  is wholly different  from what it would  once have been (see
 page 553, ante.)   It has been justly observed, that the insane are eccentric  in
 their ideas, their language, or their conduct; but the merely eccentric have but
 a voluntary resemblance  to the insane.  (Jamieson's Lectures, Med. Gaz.  xlvi. p.
 180.)  In the case  of a Mr. Stott, a medical electrician, whose will was disputed
 by his daughter on the ground of insanity, it was proved that the  testator fancied
 he could  deliver  pregnant  women  by means  of  electricity,  and he  actually
 proposed to the wife of a baker living in the neighbourhood, to bring about her
 accouchement by an electrical machine!  The will was pronounced invalid, not
 so much on account of this  extreme  absurdity, as of the violent and unnatural
 treatment to which  he had  subjected his  daughter.   It  appeared  that  he had
taken,  as we now and then find in monomaniacs, a most unaccountable and cause-
less dislike to this  girl  from her earliest infancy.  Strange as it may appear, elec- 
572
INSANITY AND ECCENTRICITY IN WILLS.
tricity has been lately used as a means of aiding parturition, but under circum-
stances very different from those which gave rise to the absurd delusion  in the
case just related.   (Med. Gaz. xxxvi. p. 376.)   It has become a grave question,
whether proof of moral insanity, i. e. a perverted state of the moral feelings or
affections, independently of any direct evidence of intellectual disturbance, should
be a sufficient ground to set aside the act of a testator.   In the case of Frere v.
Peacocke (Prerogative Court, Oct. 1845,) this was the principal question at issue.
The counsel who  maintained the validity of the will  argued against the admis-
sibility of Pinel's doctrine of moral insanity, chiefly because there was a differ-
ence of opinion among those who adopted the doctrine, whether it was or was not
invariably accompanied by some mental derangement.   A doctrine thus  novel,
unsettled, and not sufficiently developed, could  not, it was urged, be safely ap-
plied to legal questions.  If a man who was free from delusions (as the deceased
in this case was,) and capable of acts of business (as he was,) might nevertheless
be held to have been insane, it would involve this branch of testamentary law in
utter confusion.  A man who was not a subject for a commission of lunacy, might
be held after death to have been morally insane.  The court would have to deal
with cases of kleptomania and pyromania, in which the individuals exhibited no
trace  of intellectual insanity or delusion of mind.   It was safer to rely upon the
ancient and general doctrine of these Courts, that there toas no insanity without
delusion,—its true criterion; and that in the present case the deceased, though
eccentric, was not of unsound mind.  The Court found that the will was valid,
and that there was no proof of  delusion.   The  deceased was a most  unamiable
being, but still his acts were not irrational, nor inconsistent with  soundness of
mind.  (Prerog.  Court,  Aug.  1846.)  In no  case probably, has eccentricity
come so near to insanity as in this.   The reasoning of counsel in support  of the
sanity of the testator would, however, go to the extent of excluding a plea of in-
sanity in many criminal cases in which our Courts have not hesitated to  receive
it; and therefore  it would lead to the novel conclusion, that a man affected with
moral insanity, who murdered his wife from  perverted  feeling, would be held
irresponsible for the act in criminal law; but if, under the same perverted feel-
ing, he bequeathed his property to an utter stranger, and left her penniless, the
deed would be valid in civil law ! There does not appear  to be any reason why
such  a distinction should be made;  even supposing the decision in the case of
Mr. Stott not to be in some respects adverse to it.
  AArills are sometimes contested more on the ground of  eccentricity than of in-
sane delusion;  but if eccentricity only be proved, a Court will not interfere. In
the case of Morgan v. Boys (1838,)  it was proved that the testator, by his will,
had left a large fortune to his housekeeper.  This will was disputed on the ground
that it bore intrinsic evidence of the deceased  not having been in a sane state of
mind at the time of making it.  After having bequeathed his  property to  a
stranger, the testator directed that his executors  should " cause some parts of his
bowels to  be  converted into fiddle-strings,—that others should be* sublimed into
smelling salts, and that the remainder of his body should be vitrefied  into lenses
for optical purposes!" He further added, in a letter attached to his will—"The
world may think  this to be done in a spirit of  singularity or whim,  but I have
a mortal aversion to funeral pomp, and I wish my body to be converted to pur-
poses useful to mankind."   Sir H.  Jenner, in  giving judgment, held that in-
sanity was not proved:—the facts merely amounted to eccentricity, and on this
ground he pronounced for the validity of the will.   It was proved that the de-
ceased had conducted his affairs with great shrewdness and ability; that  he not
only did not labour under imbecility of mind, but that he had been always treated
during life as a person of indisputable capacity by those with whom he had to
deal.   The best rule to guide the Court, the judge remarked, was the conduct
of parties towards the deceased; and the acts of  his relatives evinced  no distrust
of his sanity or capacity while he was living.   The  deceased had always been 
RESTRICTION OF MEDICAL OPINIONS.
573
noted for his eccentric habits, and he had actually consulted a physician upon
the possibility of his body being devoted to chemical  experiments after death.
In the case of Mudway v. Croft (Prerog. Court, Aug. 1843,)  a will contested
on the ground of insanity, but defended on the plea of eccentricity, Sir H. J.
Fust said,—"It is the prolonged departure, without an adequate external cause,
from the state of  feeling and modes of thinking usual to the individual when in
health, that is  the true feature of  disorder in mind."   See also the case of
 Waring v. Waring (Prerog. Court, Feb. 1847.)  The  case of Yglesias v. Dyke
(Prerog.  Court, May,  1852,) presents some singular points of interest  in refe-
rence to  the distinction between eccentricity and insanity.   The  testatrix had
bequeathed by her will a considerable amount of property, which was claimed by
the Crown, as she was illegitimate, and as.it was alleged incompetent to make a
will.  It was proved  that she was of dirty habits, and among other facts that
she kept twelve or fourteen dogs of both sexes, which were provided with kennels
in her drawing-room !    Two of the dogs slept in the same room, and one, which
was blind, slept in the same bed with her!  The testatrix also had a propensity
for guinea-pigs, and was subject to some singular delusions.  Some evidence was
adduced to show that, in  spite of these strange freaks, she was able to  manage
her own affairs; but the Court pronounced against  the  validity of the will, on
the ground that the testatrix had for a long period laboured under insane delu-
sions, and there was no proof that these had ceased.   Her  eccentricity was the
result of insanity.  See also the case of  Drydcn v. Fryer (Q. B. Dec. 1850,)
Journal Psychol. Med. 1851, p. 285.
   Wills in senile dementia.—Wills made in incipient dementia arising from ex-
treme age, (senile imbecility,) are sometimes disputed, either on the ground of
mental deficiency, or from the testator, owing to weakness of mind, having been
subjected to control and influence  on the part  of interested  persons.  If a
medical man be  present when the will is made, he may easily satisfy himself
of the state of mind of  the  testator, by requiring  him to repeat  from me-
mory the mode in which he has disposed of the bulk of his property.  Medical
men have sometimes  placed themselves in a serious position by becoming wit-
nesses to wills under these circumstances, without first assuring themselves of
the actual mental condition of the testator.  It would  always be a good ground
of justification, if, at the  request of the witness, the testator had been made to
repeat substantially the leading provisions of his will from memory.  If a dying
person cannot do  this without prompting  or suggestion, there is reason to believe
that he has not a sane and disposing mind.  It has been observed on some occa-
sions, when the mind has been weakened by disease, or infirmity from age, that
it has suddenly cleared  up before death, and the individual has unexpectedly ac-
quired a disposing capacity.   (Ann. d'Hyg. 1831,  370.)  In the case of Durnell
v. Corfield, (Prerog. Court, July, 1844,) where an old man of weakened capacity
had made a will in favour of  his medical  attendant, Dr. Lushington held that
there must be the clearest proof, not only of the factum of the instrument, but
of the testator's knowledge of its contents.  (Law Times, July 27,1844.)
   Wills in  extremis.—Wills  made by persons whose capacity during  life has
never been  doubted, while lying at  the point  of death, or, as  it is termed, in
extremis, are regarded with suspicion, and may be set aside, according to the
medical circumstances proved.  Many diseases, especially those which affect the
brain or nervous system, directly or  indirectly, are likely to produce a dulness
or confusion of intellect, under which a disposing power is lost.   Delirium some-
times  precedes death, in which case a will executed by the dying person would
be at once pronounced invalid.  [See Ray, Med. Jur. of Insanity, 304, for some
interesting cases.—IT.]
  Restriction of medical opinions.—In an important case, (Bainbrigge v. Bain-
brigge, Oxford Summer Ass., 1850,)  tried before Lord Campbell, in which the
testamentary capacity of the testator was disputed, it was held  that a  medical 
574
RESPONSIBILITY IN CRIMINAL CASES.
witness, although conversant with cases of insanity, cannot be asked his opinion
as to the insanity of a testator  founded upon the evidence given at the trial in
his hearing.  (4 Cox,  Criminal Cases, 454.)  See  on this  subject Med. Gaz.,
xlvi., p. 240.
                           CHAPTER LXVIII.

THE PLEA OF INSANITY—HOMICIDAL MONOMANIA--MORAL INSANITY--CAUSES—SYMPTOMS-
  LEGAL TESTS--MEDICAL TESTS--MOTIVE FOR CRIME--CONFESSION--ACCOMPLICES--DELU-
  SION  IN THE  ACT—SUMMARY—TEST OF IRRESPONSIBILITY—CASES IN ILLUSTRATION—
  SUMMARY OF MEDICAL EVIDENCE.

                    RESPONSIBILITY IN CRIMINAL CASES.
   The plea of insanity.—The rule of law with regard to this subject is, that no
man is responsible like a sane person for any act committed by him while in a
state of insanity.  This is a subject of considerable importance in a medico-
legal view; for should  a plea of insanity be improperly admitted in any criminal
case, then punishment is made to fall unequally on offenders; and  if, on the
other hand, it be improperly rejected, punishment  is administered with undue
severity.  A plea of insanity may be raised for the smallest offence  up to the
highest crime—murder;  but it is rarely raised in respect to smaller offences, be-
cause the close confinement to which the offender, if found insane, would neces-
sarily be subjected, would often be a heavier punishment than that which the
law actually prescribes  for the offence which he  may have committed.  In a case
of felonious assault lately tried, it was urged by the counsel in defence, that the
prisoner was insane; but the evidence on this  point was not by any means con-
clusive,—when it was  intimated by the Court that if this plea were admitted the
party would probably undergo a much longer imprisonment, than if on convic-
tion he received the legal punishment for the offence.   (See the case of the
Queen v. Reynolds, Bodmin Aut. Ass., 1843.)  The judge is reported to  have
said that there was no proof of insanity.  If the prisoner was pronounced in-
sane, he might be imprisoned for life, and therefore  he did not think that finding
would  benefit him!  A verdict of guilty was returned, and  the man was sen-
tenced to eighteen months' imprisonment.   This case shows at least  that a  de-
fence of this kind may be sometimes indiscreetly put  forward.   Murder, incen-
diarism, and theft, are  the crimes for which this plea has been chiefly raised—
and it has  been more  especially confined in this country to those cases where
persons have been charged with murder or attempts at murder.   The attempt to
establish this plea in cases of murder by poison, has generally ended in failure,
although there may  have  been proof of hereditary insanity.   (Reg. v. Gallop,
Somerset AVinter Ass. 1844, and Reg. v. Allnutt, C. C. C, Dec. 1847.)  The crime
of poisoning indicates  malice and deliberation in a  greater degree than it would
be in general safe to admit as co-existing with a state of insanity.  Alison, how-
ever, mentions one  case of  acquittal (Sparroxo, 1829,) in which this plea was
admitted.   The woman poured a large quantity of vitriolic acid down  the throat
of her own  child.  She  then ran to a neighbour's house in a state of evident
derangement,  saying that she had killed the devil.  Her insanity was clearly
proved, and she was acquitted.  (Crim. Law, 648.)  It is customary to say that
they who commit these heinous crimes while labouring under insanity, are irre-
sponsible.  By this we are not  to understand that they are allowed  to go free.
On the contrary, they  are subjected to  close confinement, commonly  perpetual,
as it assuredly ought to be in all  cases of murder; but depending on their re-
covery in respect to crimes of less magnitude.  A power is vested  in  the execu-
tive only, to discharge recovered lunatics, according to circumstances. 
HOMICIDAL MONOMANIA,
575
                          HOMICIDAL  MONOMANIA.

   Homicidal  monomania is commonly defined to be a state of partial insanity,
 accompanied by an impulse  to  the perpetration of murder; but most medical
 jurists admit that individuals who may not appear to labour under any intellectual
 aberration, are liable  to be seized with a sudden destructive impulse, under which
 they will destroy those to whom they are most fondly attached, or any person
 who may happen at  the time to be involved  in the  subject of their delusion.
 Sometimes the impulse is long felt, but concealed and restrained: there may be
 merely signs of depression and  melancholy about the individual, and eccentric
 or wayward habits, but nothing to lead to a suspicion of the fearful contention
 which may be going on within his mind.   Occasionally the murder may be per-
 petrated with great deliberation, and apparently under all the marks of sanity.
 These cases are rendered difficult by the fact that there may be no clear proof of
 the existence, past or present, of any disorder of the mind, so that it would ap-
 pear the chief evidence of the  existence  of insanity is in the act itself: of the
 existence of  insanity, in the common acceptation of the term, before and after
 the perpetration of the crime, there may be either no evidence whatever, or it
 may be so slight as not to amount to proof.   These cases  are  regarded as in-
 stances of insanity of  the moral  feelings  only, and this condition is  called
 "moral insanity."  An unrestricted admission of  this doctrine  would, it  is al-
 leged, go far to do away with all punishment for crime, for it would then be im-
 possible to draw a line between  insanity and moral  depravity, and the law will
 not excuse an act committed through moral depravity.
   The works  of Marc, Esquirol, and Prichard, abound in  illustrations  of this
 form of monomania; but I prefer selecting some of those which have  occurred in
 England.  The following  case was tried  on the Midland Circuit, July, 1837.
 (Reg. v. Greensmith.) The prisoner in this case was  charged with the murder of
 four of his children.   The facts here to be  related were partly brought out in evi-
 dence, and partly by his own confession. He was a person of industrious habits,
 and an affectionate  father; but  having fallen into  distressed circumstances, he
 destroyed his children by strangling them, in order,  as he said, that  they might
 not be turned into the streets.  The idea only came to him on the night of his
 perpetrating the crime.  After he had strangled two of his children in bed, he
 went down stairs, where he remained some time; but thinking he might as  well
 suffer for all as for two, he returned to the bed-room, and destroyed the two whom
 he had left  alive.  He shook hands with them before he strangled  them.   He
 left the house and went to a  neighbour's, but said nothing of the murder,  until
 he was apprehended the next day and  taken before the coroner,  when he made
 a full confession.  Not one of the witnesses had ever observed the slightest indi-
 cation  of insanity about him.  He made no defence; but several  medical practi-
 tioners came forward  to depose that he was insane.  The surgeon  of the gaol
 said that the man was feverish, complained of headache, and had been subject to
 disturbed sleep and sudden starts since the death of his wife, a short time before.
 He spoke of the crime he had committed without the  slightest excitement, and
 the witness said he had heard enough of the evidence to satisfy him that the pri-
 soner could not have  committed such a crime as this, and be in a sane state of
 mind.   Dr. Blake, physician  to the Nottingham Lunatic Asylum, said he was
 satisfied that the prisoner  laboured under  a delusion of mind.   The prisoner's
 grandmother and sister had  been under his care, the latter for entertaining a
 similar delusion, namely, a desire to destroy herself and her children.  The pri-
 soner was found guilty, and  sentence of death was  passed upon  him.   By the
 active interference of  Dr. Blake and others, he was subsequently respited on the
ground of insanity.   (See Med.  Chir. Rev. xxviii. 84.) For precisely analogous
cases,  followed by acquittals, see  Reg. v. Frost, Norwich Summer Ass. 1844;
and Reg.  v. Dickenson, C. C. O, March,  1844.  Other examples of homicidal 
576
CAUSES OF HOMICIDAL INSANITY.
monomania will be found in the cases of Nicolas Steinberg, who cut the throats
of his wife and four  children, and then destroyed  himself in Sept. 1834; of
Lucas, who destroyed  his three children in March, 1842;  and of a man named
Giles, who cut the throats of two of his infant children at Hoxton, in Jan. 1843.
In all of these cases  the unexpected act of murder was accompanied by suicide.
They may  be regarded as fearful examples of homicidal mania, in which there
were no previous symptoms of intellectual aberration  amounting  to insanity, in
the common meaning of the term, or of any irregularity of conduct on  the part
of the homicides to justify the  least interference with their civil liberty.  One
remarkable feature in these cases is, that the murderous act was directed against
those who were most closely connected with the homicides in blood, and to whom
they were attached by the tenderest ties.
  It appears to me that such crimes as  these cannot be fairly or  reasonably as-
cribed to the acts of sane individuals; and even those who are the most skeptical
on the existence of such  a form of insanity  as homicidal monomania, are in
general compelled  to admit that these dreadful  motiveless murders are the acts
of insane and irresponsible agents.   It may be a dangerous doctrine to adduce
the crime as evidence of  insanity, but these cases incontestably prove that there
are some instances in which this is the only procurable evidence.  (See also Reg.
v. Brixey, C.  C.  C,  May,  1845, post.)   My friend, Mr. Warren, who  de-
nies the existence of " moral insanity," quotes from the former  edition of this
work the cases of  Greensmith and Brixey, in  some remarks which he has made
on  the  plea of insanity (Blackwood's  Edinburgh  Magazine, No. 421, p. 547,)
but  he leaves it quite uncertain whether, in  his judgment, the  accused should
have been  executed for the murders, or whether  the acquittals on the ground of
insanity were right and proper.   The doctrine of moral insanity appears to me
to be fairly established by these two cases, for there was not in either the least
evidence of intellectual aberration, or of insane conduct, if we except the act per-
petrated;  and the acquittals produced no shock to  the public feeling like certain
cases of a  really doubtful kind.   Had  not the homicides  in some of the cases
above mentioned destroyed  themselves, it is  almost  morally certain  that they
would have been acquitted  on  the ground of insanity.  In the case of Stani-
nought, an acquittal actually took place: this  man, who had attempted suicide,
recovered,  was tried, acquitted on the ground of  insanity, and he afterwards de-
stroyed himself.
   Causes.—The causes of homicidal monomania are assigned  by Esquirol  to
cerebral  irritation induced  by  bodily  disease,  extensive  nervous excitement,
vicious education, erroneous notions  of religion, grief,  destitution, and  the
power of imitation.  AVith respect  to the latter, it is a fact that the publicity
given to horrible occurrences often excites  a homicidal  feeling.  (See case of
Hon. R.  Touchett, post.)   The sight of a  weapon, or  of the intended vic-
tim, also determines in an instant  the  perpetration of the act—the  individual
feeling himself drawn  on by an impulse which he  can neither resist nor control.
Disordered menstruation, arising from  sympathy  of the uterus with the brain,
may likewise operate as a cause;  and this it is  the more important to  observe,
because the individual may not have previously manifested  any sign whatever of
intellectual or moral insanity.   (Case of Brixey, post.)  Esquirol alludes to the
case of a  female,  who at every  menstrual period experienced a strong desire
to kill  her husband  and children, especially  when she saw them lying asleep.
Parturition is likewise a cause, and in this case the disorder assumes the form
of what is called  Puerperal  Mania.  (See post.)  It  is important  for  the
medical jurist to bear in mind that persons  who are likely to  be attacked  by
homicidal monomania  are not always characterized by a gloomy, melancholic, or
irritable disposition;  the disorder sometimes shows itself in those  who have been
remarkable for  their  kind and gentle demeanour and quiet  habits.   Thus,
then, in these cases,  the  murderous disposition gives no warning of its existence: 
legal tests of homicidal insanity.               577
this  may,  however, be  sometimes indicated by a  sudden change  of  charac-
ter.
  Symptoms.—Homicidal monomania, in its more common form, may make its
appearance at all ages, even in children not more than eight or ten years old :—
it is usually periodical, and  the  paroxysm is preceded by symptoms of  general
excitement.  The patient experiences  colicky pains, and a sense of beat in the
abdomen or chest,—headache, restlessness,—the face  is flushed or very pale,—
the pulse hard and full, and the whole body in a state of convulsive tremor.  An
act of violence  is committed without warning, and the patient appears  as if re-
lieved  from some oppressive feeling.    He may be  calm, and  express  neither
regret, remorse, nor  fear.  He may coolly contemplate his victim, confess the
deed, and at once surrender himself to justice.  In some rare instances he  may
conceal himself, hide  the weapon, and  endeavour to do away with all traces of
the crime.   The symptoms just  described have been  observed  to become more
aggravated in proportion  as the homicidal impulse was strong.  The propensity
to kill is sometimes a fixed idea, at others  intermittent; and  the patient can
no more banish it from his thoughts than a person affected with insanity can di-
vest himself of  the delusive ideas which occupy his mind.  (Esquirol, ii. 105.)
   Legal tests.—Admitting, then, the existence of this state of homicidal  mono-
mania, it will become a question, how, when pleaded for one charged with murder,
it is to be distinguished from a case where the crime has  been perpetrated by a
really sane person.   Tests, both medical and legal, have been  proposed.   The
legal test was explicitly stated in the  following terms by the whole of the judges '
in conference, in answer  to queries put by the House of  Lords in reference to
the case of M'Aaughten, who was tried  and acquitted on the ground of insanity
(June 19th, 1843.)
   Notwithstanding  a party commits a wrong act while labouring under the  idea
that  he was redressing a  supposed  grievance or injury, or under the impression
of obtaining some public  or private benefit, he is liable to punishment.  The jury
ought in all cases to be told that every man should  be considered of sane mind
until the contrary was clearly proved in evidence.  That before a plea of insanity
should be allowed, undoubted evidence ought  to be adduced that the accused was
of diseased mind, and that at the time he committed the act, he was not conscious
of right or wrong.  Every person was supposed to know what the law was, and
therefore nothing could  justify a wrong act, except it was clearly proved  that
the party did not know right from wrong.  If that was not satisfactorily proved,
the accused was liable to punishment.   If the delusion under which a person
laboured were only partial, the party accused was equally liable with a person
of sane mind.   If the accused killed another in self-defence, he would be entitled
to an acquittal; but if the crime were  committed for any supposed injury, he
would then be liable to the punishment  awarded by  the laws to  his crime.  (B.
and F. M.  R., July, 1843, p. 273.)
   It would appear from this, that the law, in order to render a man responsible
for a crime, looks for a consciousness of right and wrong, and a knowledge of the
consequences of the aet.   Thus, the complete possession of reason is not essential
to constitute the legal responsibility of an offender;  and it is also to be inferred,
from the results of several  cases,  that a man may be civilly incompetent, but
sufficiently sane to be made  criminally  responsible.   The proofs required in the
two cases are  essentially distinct.   It  has very properly been  objected to this
legal test, that  it  is  insufficient for the purpose intended:  it  cannot, in  a large
majority of cases, enable us to distinguish the insane homicide from the sane
criminal.   Many insane  persons have  committed acts which they knew to be
wrong, and of the criminality of which they were at the time perfectly conscious.
[AVe have heard undoubted lunatics boast that they  could not be  hung for the
crime of murder.  In one instance we were threatened by a lunatic, who reminded
us that he could not be punished for killing us.—H.]  They have been known
       37 
578
homicidal insanity,  motive for crime.
 to  murder others, in order to receive  the punishment of death at the hands of
 the law;'and therefore they must have been fully conscious of the wrongfulness
 of the act which  they were  perpetrating, and have  known that they were com-
 mitting an offence against the law of man.   In short, the criminal nature of the
 act has often been the sole motive for its  perpetration!   (See the case of Tou-
 chctt,  p. 584; also case, Ann. d'Hyg. 1S42, i. 363.)   It has  been suggested
 with  some truth, that it is rather the imperfect or defective appreciation of the
 motives to right or against wrong action which leads to crime among the insane,
 and not the mere ignorance of right and wrong.   Most lunatics have an abstract
 knowledge that right is right and wrong wrong, but in true insanity the voluntary
 power to control  thought and actions is impaired, limited, or overruled by insane
 motives.  A lunatic  may have  the power of  distinguishing right from wrong,
 but it is contended, from  a close observation of the insane, that he  has not the
 power of choosing right from wrong.   A criminal is punishable not merely be-
 cause he has the power of  distinguishing right from wrong, but because he vo-
 luntarily does the  wrong, having the  power to choose the right.  (Jamieson's
 Lectures on Insanity, Med. Gaz. xlvi. p.  827.)  In Greensmith's case (ante, p.
 575,) there was no doubt that the man knew he was doing wrong and what was
 contrary to law;  for after having murdered two of his children, he returned and
 murdered the others, considering that  he might as well  suffer for all as for two I
 The  case of Hadfield, who was  tried for shooting at George III. and acquitted
 on the ground of insanity, furnishes another striking example of the existence of
' insane delusion,  coupled with a full knowledge of the consequences  of  the act
 which he was about to commit.  He  knew that in firing at  the King  he was
 doing what was contrary to law, and that the punishment of death was attached
 to the crime of assassination;  but the  motive for the crime was that he might be
 put to death by others,—he would not take his own life.  Again, Martin, the
 incendiary, admitted that he knew  he was doing wrong,  according to the law of
 man, when  he set fire to  York Cathedral: he was conscious that  the act was
 illegal, but he said he had the command of God to  do it.  Thus, then, we find
 that  a full consciousness of the  illegality or wrongfulness of an act may exist in
 a man's mind at the time of its perpetration, and yet in spite of this he may be
 fairly acquitted on the ground of insanity.   Strangely enough, his acquittal will
 also  meet with the concurrence  of those who maintain that an utter unconscious-
 ness  of right and wrong is a necessary part of the proof hefore the plea of insanity
 can be received and the only  safe test by which we can  distinguish  sanity from
 insanity in the perpetration of crime!
    Medical tests.—It will now  be proper  to examine the tests which have been
 proposed by medical jurists for  detecting these cases of homicidal mania.
    1. The acts of homicide have generally been preceded by other striking pecu-
 liarities of conduct in the  individual,  often by a total change of character.  2.
 They have  in many instances previously or subsequently attempted suicide: they
 have expressed a wish to die  or to be  executed as criminals.
    These supposed criteria have  been repeatedly and very properly rejected, when
 tendered as medical proofs of insanity in Courts of Law.   They are of too vague
 a nature, and apply  as much  to eases of moral depravity as of actual insanity:
 in short, if these were admitted as proofs, they would serve as a  convenient
 shelter from punishment for many sane criminals.
    3. These acts are without motive: they are in opposition to all human motives.
 A man known to have been tenderly  attached to his wife and children, murders
 them:—a fond mother destroys her infant.
    Motive for crime.—It is hereby  assumed or applied that sane men never com-
 mit  a crime without an apparent motive; and  that an insane person never has a
 motive, or  one of  a delusive  nature only,  in the perpetration of a criminal act.
 If these positions were true, it  would be very easy to distinguish a sane from an
 insane criminal; but the rule wholly fails in  practice.   In the first place, the 
HOMICIDAL MANIA.  CONFESSION.
579
non-discovery is here taken as a proof of the non-existence of a motive;  while it
is undoubted that motives may exist for many atrocious  criminal acts without
our king able to  discover them—a  fact proved by the  numerous  recorded con-
fessions of criminals before execution, in cases in which, until these confessions
were made, no motive  for the perpetration of the crime  had appeared to the
acutest minds.  In the case of Courroisicr, who was convicted of the murder of
Lord AVilliam Russell in June,  1840, it was the reliance upon this alleged crite-
rion, before the secret proofs of  guilt accidentally came out, that led  many to
believe he could  not have committed the crime; and the  "absence of  motive"
was urged by his  counsel as the strongest proof of the man's innocence.   It was
ingeniously contended "that the most trifling action of human life had its spring
from some motive or other." This is undoubtedly true, but it is  not always in
the power of a man untainted  with crime to detect and  unravel the motives
which influence criminals in the perpetration of murder.   No reasonable motive
was ever discovered for the atrocious murders and mutilations perpetrated by
Grccnacre and  Good;  yet these persons were very properly made responsible for
their crimes!  On the trial of Francis for shooting at the Queen, the main ground
of the defence was, that the prisoner had no motive  for the act,  and therefore
was irresponsible; but he was convicted.  -It is difficult to  comprehend under
what circumstances any motive  for such an act as this could exist; and therefore
the admission of such a defence would have been like laying down the rule, that
the evidence of the perpetration of so heinous a crime should in  all cases be taken
as a proof of the existence of an irresponsible state of mind!  Crimes have been
sometimes committed without any apparent motive by sane  individuals, who were
at the time perfectly aware of the  criminality of their conduct.   No  mark of
insanity or delusion could be discovered about them, and they had nothing to
say in their defence.  They have, however, been very properly held responsible.
On the  other hand, lunatics confined in a lunatic asylum have been known to be
influenced by motives  in the perpetration  of crimes.  Thus they have often
murdered their keepers in revenge for ill treatment which they have experienced
at their hands.   (See the case of The Queen v. Farmer, York Spring  Assizes,
1837.)   This man was acquitted as insane, while the clear motive for the homi-
cide was revenge  and ill feeling.  In another case the act  of murder was perpe-
trated from jealousy.   (Reg. v.  Goule, Durham Summer Ass. 1845.)   On the
whole, the conclusion with respect to this assumed criterion is, that an  absence
of motive may, when there are other  strong  evidences of insanity,  favour  the
view of irresponsibility for crime; but the non-discovery of a motive for a criminal
act cannot of itself be taken as any proof of the existence of  homicidal monomania
in the perpetrator.  It is right to state, however, that the law invariably acts on
this humane principle;—the absence of  a sufficient motive affords a strong pre-
sumption of innocence,—the presence of one is no proof of guilt.
   4. The subsequent conduct  of the individual:—he  seeks no escape, delivers
himself up to justice, and acknowledges the crime laid  to his charge.
   Confession.—This is commonly characteristic of homicidal mania: for by the
sane criminal every attempt is made to conceal all traces  of the crime, and he
denies  it to the  last.   A case  occurred in September, 1843, which, however,
shows the fallacy of this criterion.   A man named Dadd, murdered his father
at Cobbam, under circumstances strongly indicative of  homicidal mania: he fled
to France after the perpetration of  the  crime, and was subsequently tried  and
acquitted on the ground of insanity.   (See also, another case, Ann. d'Hyg. 1829,
ii. 392.)  On the other hand,  it must be remembered that sane  persons who
destroy  the lives  of others  through revenge or anger,  often perpetrate  murder
openly,  and do not attempt to  deny or  conceal  the crime;  for they know that
denial or attempt at concealment would be hopeless.   Again,  a morbid love of
notoriety will often induce sane criminals to attempt assassination under circum-
stances where the attempt must necessarily be witnessed by hundreds, and there 
580
HOMICIDAL MANIA.   DELUSION IN THE ACT.
can be no possibility of escape.  The attacks made upon the life of the Queen
are sufficient to bear out this statement.
   5. The sane murderer has generally accomplices in vice or crime;  the homi-
cidal monomaniac has not.
   Accomplices.—Upon this it may be observed that some of the most atrocious
murders committed in modern times, as those perpetrated by Grccnacre, Good,
Courvoisicr, and others, were the acts of solitary individuals, who had neither
accomplices nor any assignable  inducements leading to the commission  of the
crimes.   It is, however, a fact  so far in favour of the existence  of  homicidal
insanity, that the insane never  have  accomplices  in the acts which they perpe-
trate.  These criteria can hardly be described as medical; they are circumstances
upon which a non-professional  man  may form  just as safe a judgment, as one
who has  made insanity a special study.
   Delusion in the act.—The presence of delusion has been  said to characterize
an act of homicidal monomania, while premeditation, precaution  and conceal-
ment, have been considered the essential features of the  act of a sane criminal.
AVith respect to delusion, it has been decided that the mere proof of the exis-
tence of  this does  not excuse  the act: if  the delusion heqwiiial,  the party ac-
cused is  still responsible;—and if the crime were committed for an imaginary
injury, he  would be held equally responsible.   (See ante,  p. 577.)   Much stress
was formerly laid upon  the delusion being connected ivith the act in cases of in-
sanity;  but it must be remembered that, except by the confessions of  insane
persons during convalescence, it is not commonly easy for a sane mind to connect
their most simple acts with the delusions under which they labour.   Every act
of homicide perpetrated by a really insane  person is doubtless  connected with
some delusion with which he  is afl'ected;  but it by no means follows, that one
who is sane should always be able to make out this connexion;  and it would be
therefore unjust to rest the irresponsibility of the accused upon an accidental dis-
covery of this kind.  Let the following cases  show how little a sane  person  is
able to connect the delusions of the insane with their acts. Marc mentions that
a  patient of his was continually in the habit of licking the plaster from the walls
of his cell,—in some places they had been  licked quite bare by this disgusting
practice.    It was only accidentally discovered that the act was  connected with
a  delusion, under which the man laboured, that he was licking and tasting the
most delicious fruits! Another patient was in the habit of running up and down
the ward, beating  his own shadow with a stick.  It turned out that he fancied
this shadow to be an army of rats in constant pursuit of him!  As  having closer
reference to the present subject, I may refer to the case  of  a young man, upon
whom an inquisition was held in 1843.  He was a person of mild  manners, and
he laboured under a delusion connected with windmills.   He would go any dis-
tance to gee a windmill,  and would sit watching one for days  together.  His
friends removed him to  a place where there were  no mills, in the hope that this
strange propensity Would wear away.   He  enticed a child into a wood, and  in
attempting to  murder it, cut and mangled its limbs with a knife in  a horrible
manner.    How would any sane person have connected this  delusion  respecting
windmills with attempted murder?   Yet it turned out that he had taken  the re-
solution to commit this  horrible crime, in the  hope that  he should be removed
as a punishment to some place where there would be a  mill!  (See Report on
Lunatics, Quart. Rev.,  1844.)   Lord Erskine's doctrine in Hadfield's  case  is
therefore,  medically speaking,  wholly untenable.   The  connexion of delusion
with the  act may exculpate an accused party;  but the non-establishment  of this
connexion  proves nothing.  It  may be further  observed,  that premeditation and
precaution are met with in crimes committed both by sane and insane  criminals;
although these, with subsequent concealment, are  certainly strong characteristics
of sanity.   It is also a  question, whether, when they are proved to have existed
in any criminal act, there might not have been such a power of self-control  in 
MEDICAL TEST OF IRRESPONSIBILITY.
581
the individual, although  in some degree  insane, as to justify the application of
punishment.  Are such individuals less beyond the influence of example than
one-half of the sane criminals who are punished?
   Summary.—The foregoing considerations lead to the inference, that there are
no  certain legal or medical  rules, whereby homicidal mania can be detected.
Each case must be determined  by the circumstances attending it: but the true
test for irresponsibility in these ambiguous cases appears  to be, whether the in-
dividual, at the time of the commission of the crime, had or had not a sufficient
power of control to govern his actions.  If from circumstances it can be inferred
that he had this power, whether his case may fall within  the above rules or not,
he should be made responsible and rendered liable to punishment.  If, however,
he was led to the perpetration of the act by an uncontrollable impulse,  or, in
other words, by an impulse which his mental condition did not allow him to con-
trol, (lesion de volonte, Esquirol,) whether' accompanied by deliberation or not,
then he is entitled to an  acquittal  as an irresponsible agent.  The power of con-
trolling an act appears to me to imply the existence  of such a state of sanity as
to render  the  party responsible.   It  has been  objected  that such a rule would
not include all cases of  intellectual insanity; but the proof might then be de-
rived from other sources,  such  as  the existence  of delusion, or insane conduct.
In the mean time  the rule  is applicable to those  cases  in which it is most  re-
quired, i. e. of moral insanity;  and in one instance there were no other facts
upon which a verdict could be  founded.   (Reg. v. Brixey, C. C. C, May,  1845,
p. 584.)  A test somewhat similar to this is constantly applied by juries,  under
the direction of  our judges, to distinguish murder from manslaughter; and it is
quite certain that sanity  and homicidal mania are not more nicely blended, than
are occasionally the  shades of guilt whereby manslaughter passes into murder.
The manner and circumstances under which a crime is committed will often allow
a fair inference to be drawn as  to  how far a power of self-control existed or was
exercised.  A man in a violent fit  of mania rushes with a drawn sword into  an
open street, and stabs the first person whom he meets;—another, worn out  by
poverty and destitution,  destroys  his  wife  and children  to prevent them from
starving, and then probably attempts to murder himself,—these are cases in which
there is fair ground to entertain a plea of irresponsibility; but when we  find a
man (Reg. v. M'Naughtcn) lurking for many days  together  in  a particular  lo-
cality, having about him a loaded weapon,—watching a particular individual who
frequents that locality,—a man who does not face the individual and shoot him,
but who coolly waits until he has an opportunity of  discharging the weapon un-
observed by his victim or others,—the circumstances appear to show such  a per-
fect adaptation  of means to ends, and  such a power of  controlling  his actions,
that one is quite at a loss to understand why a plea of irresponsibility should be
admitted except upon the fallacious ground, that no motive could be discovered
for the act,—a ground, however,  which was  not allowed to prevail in the cases
of Courvoisier, Francis and the perpetrators of other atrocious crimes !
   Test of irresponsibility.—There is  no novelty in the test here proposed; it is
more  or less advocated by Esquirol, Marc, Ray, Pagan,  Jamieson,  and the best
writers on the  medical jurisprudence of insanity.  Esquirol describes three forms
of homicidal monomania:  1, depending on aberration of intellect; 2, on perverted
moral feelings; 3, on diseased volition depriving the individual of  his moral li-
berty,  /. e. the power of  controlling his actions (impuissance  de la volonte  qui
prive 1'homme de sa liberte morale.)  (Mai. Mentales, ii.  842.)  M.  Marc adopts
throughout the opinions of Esquirol.   (De la Folie,  ii. 71.)   Dr. Ray, an intel-'
ligent American writer, considers that all forms of homicidal monomania are cha-
racterized by an "irresistible motiveless impulse to destroy life;" (Med. Jur. of
Insanity, 268;)  and Dr.  Pagan  properly observes,—" The very loss of the con-
trol over our actions which insanity infers, is that which  renders the acts which
are committed during its continuance undeserving of punishment."   (Med. Jur. 
582
CASES OF HOMICIDAL INSANITY.
 of Insanity, 211.)   The  test should be, according to Dr. Jamieson, "had the
 lunatic at the time of committing the deed a knowledge that it was criminal, and
 such a control over his  actions, as ought, if exerted, to have  hindered him from
 committing it."  (Med Gaz. xlvi. p. 827.)  Thus, then, it would appear from the
 concurrent views of medico-legal writers and of the most  experienced practical
 observers of the habits and  conduct of the insane, that we have  here the true
 criterion whereby the responsibility or irresponsibility of an accused party ought
 to be tested;  and although there will be  some difficulty in determining how far
 the individual did or did not  possess control over his act;—whether the  impulse
 was or was not irresistible, (impuissance de la volonte;) yet it must be borne in
 mind that the same objection  applies with equal force not only to the present legal
 test, (the existence or non-existence of a consciousness of right or wrong under
 which persons are yearly acquitted or executed,) but to every test or rule, medi-
 cal or legal, that has hitherto been proposed by physician or  jurist.
    Cases in illustration.—It is well known that individuals seized with a desire to
 kill,  have been  able, in some instances, to exercise a certain degree of  control
 over the impulse, and have thus  saved the  lives of their intended victims, and
 themselves from the imputation of a heinous crime.  Among many cases of this
 description to be found in medico-legal works, there is perhaps none which illus-
 trates the statement more  forcibly than the following by Mr. Daniell.  A patient
 labouring under disordered liver, without any sign of intellectual aberration, was
 found by him to be on one occasion in a state of great excitement.  He confessed
 that whilst talking with his wife and family, his eye caught the poker,—a desire
 to shed blood came upon him which he felt he could not  control.   He  shut his
 eyes and  tried to think of something else, but it was of no use.  At last, he could
 bear it no longer, and with a  voice of thunder he ordered them out of the room.
 Had they opposed him, he felt he must have murdered them  all.   (Prov. Med.
 Jour.  Nov. 12, 1845.)  This was a sudden fit of homicidal monomania, and it
 presents a fearful picture of the contending feelings which agitate  an individual
 labouring under it.   There was here, it will be observed,  not  an entire  depri-
 vation of self-control, or he would have  attacked his wife  and children without
 giving them any warning.  (For  other cases, see Esquirol, Maladies Mentales,
 ii. 807.)
   Much difference of opinion existed relative  to the case of  MNaxighten, who
 was tried for the murder  of  Mr. Drummond (Jan. 7,  1843,) and acquitted on
 the ground of insanity.   There is hardly a doubt, that had the deceased given
 any personal offence to this  individual before  the perpetration of the act, he
 would have been convicted; if the deceased, from feeling annoyed at his  follow-
 ing him, had struck  him  or  pushed him away before  the pistol was fired, it  is
 most probable that the plea of insanity would not have been  received.   In the
 acquittal of this man, it is evident that considerable importance was attached to
 the non-discovery of a motive; for had any kind of motive been apparent, it  is
 certain that an alleged "homicidal climax," occurring at the particular moment
 when the  deceased's back was turned, and after  several days' watching on the
 part of the assailant, would not have been admitted as a sufficient exculpatory
 plea!   If we except the  case  of Oxford, tried for shooting at the Queen, there
 is  perhaps no case on record in English jurisprudence where the facts in support
 of the  plea of insanity were so slight;  and when the cases of  Bellingham, Lees,
 and Cooper are considered, the two latter tried and executed within the last few
years, it must be  evident that  there are both uncertainty and injustice in the ope-
ration of our criminal law.  Either some individuals are most improperly acquitted
 on the plea of insanity, or others are most unjustly executed.  If the punishment
of death were abolished,  there is no doubt that less would be heard of this plea;
but in the mean time, it is unfortunate that there  is no  other way of avoiding
capital punishment, than by striving to  make it appear that the criminal is in-
sane!   (See Prichard, 399.)  It is on this point that medical  witnesses seem to 
CASES OF HOMICIDAL INSANITY.
583
 me to lose sight of their true position.  In giving an opinion of the mental con-
 dition of an offender, it is no part of their province to model that opinion accord-
 ing to the punishment which may follow if the plea be rejected, but according to
 the facts of the case.   The  Legislature only is responsible for the punishment
 adjudged to crimes.  It is certainly a great evil, that under the present mode of
 laying the question before a jury, the law operates  most unequally.   One case
 becomes a subject of prominent public interest, and every exertion is made to
 construe the most trivial eccentricities of character into proofs of insanity: an
 acquittal follows.   Another  case tried at the  assizes may excite no interest,—it
 is left to itself,—the accused is  convicted, and either executed or otherwise pu-
 nished; although the evidence of insanity, had it been as carefully sought for and
 brought out, would have been as strong in this as in the former instance (Reg.
 v. Stolzcr, Cent. Crim.. Court, Nov. 1843; also Reg. v. Laurence, Lewes Lent
 Ass.  1844, infra.)   That this kind of defence has, however, been carried too far,
 will be apparent from the  observation of Mr. Baron Gurney in the case  of The
 King v. Reynolds, where this learned judge said that "the defence of insanity
 had lately grown to a fearful height, and the  security of the public required that
 it should be Watched."  So also Mr. Justice Coltman, in the case of The  Queen
 v. Weyman, remarked, "that the defence of  insanity was  one which was to be
 watched with considerable strictness, because it was not any slight deviation from
 the conduct which a rational man would pursue under a given state of circum-
 stances, which would support such a line of  defence."   AVhen the punishment
 attached to an offence is not capital, it would appear that much stronger evidence
 is required to establish a plea of insanity than under other circumstances.  This
 will be seen by reference to the  case of The  Queen v.  Grove (Stafford Lent As-
 sizes, 1842.)   The evidence of insanity was considerably stronger than that ad-
 duced in the case of MlNalighten; yet the prisoner was convicted!   These two
 cases occurring so recently, the one after the other, display the great uncertainty
 attendant upon a plea of this kind.   So, again, it  would  be difficult to reconcile,
 upon medical grounds, the conviction of Francis  with the acquittal  of Oxford,
 both of them tried for the same crime (shooting at the Queen,) committed  under
 similar circumstances.  In the case of The Queen v.  Stoker (Cent. Crim. Court,
 Oct.  1843,) where the charge was one of murder by stabbing, the plea was re-
 jected, although no motive appeared, and there were some indications of insanity.
 In another case (The Queen v.  Rowe,) tried  at the  same time, the prisoner, an
 old man, deliberately  fired a loaded pistol at his master, because he had  dis-
 charged him from his service and would not take him back.  There was no mark
 of insanity either  in the act or in his previous conduct, but he was acquitted as
 insane, on the  lenient presumption that he might be labouring under the imbe-
 cility of age!
   The case of  Reg. v.  Laurence (Lewes Lent Ass.  1844,) affords a remarkable
 contrast to that of M'Naughtcn.  The prisoner had been arrested by a constable
 for a  petty theft: he was taken to the police-station, where  the inspector, who
 was an utter stranger to him, was at the time engaged in talking to some friends,
 his back being turned  to the prisoner.  The man suddenly seized a  poker  and
 struck the inspector a violent blow on  the skull,  from which he speedily died.
 The prisoner admitted that he struck the blow; that he had no motive for the
 act;  and that he would have struck any one  else who had been standing there
 at the timer  He also said he hoped the deceased would die;  he was glad  he had
 clone it, and he wished to  be hanged.   The  evidence at the trial showed that
 there  was no cause  of quarrel between the parties, but that the prisoner appeared
 to be  actuated by some sudden imqmlse, for which  not the slightest reason could
 be assigned.  This man was left to a chance defence, for the  Court was actually
obliged to assign counsel to him.  There was no  eloquent advocate, to make a
brilliant speech in  his favour; there were no medical witnesses, profoundlyversed
 in the subject of insanity, to contend for the existence of a "homicidal climax," 
584                   CASES OF HOMICIDAL INSANITY.
or of impulsive homicidal monomania; but there was simply a formal plea of in-
sanity, resting upon the fact of the deceased being  a stranger  to him, and of
there being, consequently, no motive for the act of murder. The jury negatived
this plea, and the prisoner was convicted and executed! The differences between
this case and that of MNaughten, were, that there was in Laurence less evidence
of deliberation, with stronger evidence of sudden  impulse; and there was not
sufficient interest about the  deceased, the prisoner, or his crime, to attract any
great public attention!
   This case had not long occurred, when another of a similar kind was the sub-
ject of  a trial at the Central Criminal Court (Reg. v. Hon. Ross Touchett, Oc-
tober, 1844.)   The  prisoner, a young  man, entered a shooting gallery in  Hol-
born, took up a pistol, and deliberately fired at the proprietor of the gallery while
his back was turned, thereby inflicting a wound which ultimately led to his death,
after the long period of eleven months.  The  prisoner was tried  for shooting
with intent to murder.  The defence was  insanity, founded on the absence of
motive  for the act and  on  the presumption  of hereditary taint.   After having
fired the pistol the prisoner said he did it on purpose, for he wished to  be hanged.
This was no evidence of intellectual aberration:  his landlady said he  was a very
regular and quiet person, and that he had complained of a sensation of boiling
at the top  of  his head!   Dr. Monro considered that at the time of the act the
prisoner was labouring  under mental  derangement.   He admitted to him that
he  had no knowledge  of Mr.  Smith (the person whom  he shot,) but that  he
wished  to be hanged, and had been brooding over  suicide  for  some years.   He
referred to the case of Laurence, who had killed a man at Brighton (supra,) and
said that he wished  to  do something of the same kind, in order to get himself
hanged.  He was acquitted on  the ground  of insanity.  What  distinction can
possibly be made by physician or jurist between these two cases,—or how is it
possible to lay down  rules for the future guidance of medical witnesses under
such capricious decisions?  The acquittal of Touchett may have  been perfectly
right; but then the conviction and the execution of Laurence was a public
wrong.
   The  principles of the English law have been closely scrutinized not only by
medico-legal writers, but  by men who have had long experience  in the manage-
ment of the  insane, and who have made themselves well acquainted with  their
habits;  and it has been abundantly proved, that the test of  responsibility as-
sumed by it is of a purely theoretical kind, and cannot be carried into practice.
With this admission, it appears to me unnecessary to occupy space  with meta-
physical discussions  regarding criminal responsibility; for however defective the
rules, if the practice of the law be in any one case in conformity with  that which
has been advised by the best writers on the medical jurisprudence of insanity,
although it may be adverse to the theory on which it is professedly based, this is
all with which we have  to concern ourselves: the  principle is admitted.  The
great defect in the English law is, not that it will not go to the full extent of the
doctrine of moral sanity, or of "uncontrollable impulse," (case  of Touchett,) but
the uncertainty of its application (case of Laurence.)  The cases referred to show
that an acquittal on  the plea of insanity is left to be a mere matter of accident.
  Among  a large number of cases which have occurred within a recent period,
I shall select  one, because it shows plainly that the law makes  no difficulty in
admitting the plea of insanity,—even when it depends on perverted  moral feel-
ing  only, or  on "irresistible impidse."   The most strenuous  advocate of irre-
sponsibility in cases of  moral insanity, can  desire no better precedent than that
furnished  by  the case  of Reg. v. Brixey  (Central Crim. Court, June, 1845.)
The prisoner was a quiet, inoffensive girl, a maid-servant in a respectable family.
She had laboured under disordered menstruation, and, a short time  before  the
occurrence, had  shown  some  violence of  temper about trivial domestic matters.
This was all the evidence of her alleged insanity—the rest was furnished by the 
CASES OF HOMICIDAL INSANITY.                   585
act of murder, a species of evidence which is not generally considered  to be ad-
missible.  She procured a knife from the kitchen on some trivial pretence, and
while the nurse was out of the room, cut the throat of her master's infant child.
She then went down stairs, and told her master what she had done.  She was
perfectly conscious of the crime she had committed, and showed much anxiety to
know whether she would be hanged or transported.  There was not the slightest
evidence that she was labouring under any delusion, or any intellectual aberration
whatever.  The prisoner was acquitted on the ground of insanity, probably caused
by obstructed menstruation.  (See Med. Gaz. xxxvi. 166, 247.)  In trying this
case by the medical rules laid down for detecting homicidal monomania (ante, p.
578,) we shall see that it falls under the 3d, 4th, and 5th only; i. e., absence of
motive,—no attempt to escape,—no accomplices.  Admitting the probability of
a connexion existing between amenorrhcea and insanity in the abstract,  there was
no more proof of insanity in the case of this girl than in that of Laurence;—
yet one was convicted and executed, while the other was  acquitted !  In the de-
fence of Brixey, Mr. Clarkson uttered a plain medical and legal truth, in stating
that "no general rules can be applied to cases of this sort.   Each case must  be
decided by the peculiar facts which accompany it."  Notwithstanding the prece-
dent furnished by this case, and another of a similar kind, Reg. v. Stowell (Med.
Gaz. xlvii. p.  569,) the Court will commonly look for some  clear and distinct
proof of mental delusion or intellectual aberration.  If there be no proof  of de-
lusion or of weakness of intellect  on the part of the accused, the plea of homi-
cidal insanity from irresistible impulse may still  be rejected. In the case of Reg.
v. Burton  (Huntingdon Summer Assizes, 1848,)  the prisoner was indicted for the
murder of his wife, by  cutting her throat.  It appeared that he had no motive for
killing her,—that he had been previously unwell, and restless at night,—that he did
not attempt to conceal  or deny the commission of the crime, and that he expressed
no  sorrow or  remorse  for it when perpetrated.   The medical witness attributed
the act to a sudden homicidal  impulse: the prisoner's reason was not  affected,
and he had not laboured under  delusions.  This appears to have been a proper
view of the case. The  learned judge dissented from the medical opinion, because
the excuse of an irresistible impulse, co-existing with  the full (?) possession of
reason, would justify any crime whatever.  It must be remembered, however,
that the plea of an irresistible impulse could not  be made when any motive ap-
peared for the act.  There appears to have been no stronger reason  for convict-
ing this prisoner than  for convicting Brixey. The jury, nevertheless, found him
guilty, while Brixey was acquitted!
  Numerous criminal  trials, involving  the plea  of insanity in cases of murder,
have taken place of late years.   Among these may be particularly specified the
cases  of Reg. v. Johnstone (see  Med.  Gaz. xxxvii. p.  421,) Reg.  v. Ovenston
(Journal  of  Psychol.  Med.  1848, p. 169,) Reg.  v. Aiinutt (Journal Psychol.
Med. 1848, p. 193,) and Reg. v. Parker.   In the first two, the prisoners were
acquitted on  the ground of insanity;  although I quite agree with Dr. Mayo, in
thinking that in Johnstone's case there was not the slightest proof  of insanity.,
(Clinical Facts,  208.)   In the case of Reg. v. Allnutt, the  prisoner, a boy aged
12, was convicted of poisoning his grandfather, under  circumstances indicative
of great contrivance and  deliberation.   The medical evidence entirely failed to
show that the prisoner was insane, and  he was  convicted.  The remarks made
by the judge who tried this  case (Rolfe, B.) are of some importance in relation
to this plea   "The witnesses called for the defence had described  the prisoner
as acting from uncontrollable impulse,  and they had made other statements, of
the value of which it would be for the jury to decide;  but he must say that it
was his opinion that such evidence ought to be scanned by juries with very great
iealousy and  suspicion, because it might tend to  the perfect justification of every
crime that was committed.   What was the meaning of not being able to resist
moral influence?  Every crime was committed  under an influence of such a de- 
586                   CASES OF HOMICIDAL INSANITY.
scription, and the object of the law was to compel persons to control these influ-
ences ;  and if it was made an excuse for a person who  had committed a crime,
that he had been goaded to it by some impulse, which medical men might choose
to say he could not control, he must  observe  that  such a doctrine  would be
fraught with very great danger to society."   The reader will do well to consult
Dr.  Mayo's remarks  on this  subject.   (Clinical Facts, 1847, p. 193;  also in
Med. Gaz. xxxvii. p. 421, and Journal of  Psychol.  Med. 1X48, p.  609.  See
cases in  Med. Gaz. xlii.  p. 255;  and Reg. v. Clarke, Norfolk Lent Assizes,
1851;  Reg. v. Monkhouse, C. C. C, Dec,  1849; and  Reg. v. Arnold,  Ayles-
bury Lent Assizes, 1850.)
   It cannot be denied that the doctrine  of "irresistible impulse" has been carried
in recent times to such an extent as to create a great distrust of medical evidence
on these occasions.   It is obviously easy to convert this into a plea  for the
extenuation of all kinds of crime for which  motives are not apparent, and thus
medical witnesses often expose themselves to severe rebuke.  They are certainly
not justified in setting up such a defence, unless they can draw a clear and com-
mon sense  distinction between impulses which are resistible and those which are
irresistible.
   In the case of Reg. v. Pate, tried in 1850 at the Central Criminal Court, the
prisoner was indicted for an assault on the Queen.  It was proved that he had
been guilty of strange and eccentric conduct, but there was no evidence to show
that he had not a reasonable control over his actions.   Dr. Conolly admitted that
the prisoner was labouring under no delusion, that he knew the distinction be-
tween a right and a wrong action, but was  subject to impulses of passion.  He
attributed his act to some sudden impulse which he was quite unable to control.
Other witnesses deposed that in their opinion, although  the prisoner was fully
conscious of his act, he was insane.   The  learned judge  (Baron Alderson) who
tried the case observed, in charging the jury, that it was not because a man was
insane that he was unpunishable; and  he must say upon this point there was
generally a very grievous  delusion in the  minds of medical men.  " The only
insanity which excused a man  for his  acts was that species of delusion which
conduced and  drove him to commit the act alleged against him.  They ought to
have proof of a formed disease of the mind,  a disease existing before the act was
committed, and which made the person  accused incapable of knowing, at the time
he did the  act, that it was a wrong act for him to do."  The jury convicted the
prisoner, and he was sentenced to transportation.   (Med. Gaz. xlvi. p. 152; and
Journ. Psychol. Med. 1850, p. 557.)  The plea of insanity was  here advanced
upon very  weak grounds.   Had the prisoner assaulted a policeman instead of
the  Queen, he would have been fined or imprisoned, and nothing heard of the
plea, although the rank of the person assaulted can make no difference respecting
the existence or non-existence of a diseased  state of mind.   (See some excellent
remarks on this case  by Dr. Forbes AVinslow,  Journal Psychol. Med. 1850, p.
445.)
   From the summing up of the learned judge, it would appear that the existence
of one degree  of insanity would admit of punishment for crime, while the exist-
ence of another degree would excuse it.  As it has  been already remarked in
speaking of testimonial capacity, nothing can be more absurd  than to apply one
general term  "insanity"  to  the  condition  of all  persons affected with  mental
disorder, and to pronounce them therefore all incompetent or all incapable, when
common sense suggests that we are bound to inquire into the amount of capacity
in each case.   If all persons are to be excused from  responsibility for crimes or
offences, because they entertain certain delusions,  or  are  guilty of eccentricity,
it would be better at once to make  one general rule, and render all their civil
acts void, and at the same time give them the benefit of irresponsibility  for any
criminal  acts,  without inquiring into the degree in which insanity exists.  Such
a practice would hardly be compatible with the due  exercise of justice,  or with
 he  safety  of society. 
THEORY AND PRACTICE OF THE LAW IN INSANITY.           587
   Dr. AVood, who has lately written on this subject, repudiates the doctrine that
 an insane person is necessarily irresponsible, and therefore unpunishable.   " All
 who  have had  the  opportunity of studying insanity, know full well  that with
 comparatively few exceptions, insane persons are not only powerfully influenced,
 but materially controlled, by the same motives which influence and control those
 who are still mixing in the world, and who have never been suspected  of mental
 derangement."   (Plea of Insanity, 1851, p. 4.)
   The great difference of opinion which exists between physicians and jurists in
 reference to this plea, appears to me t& consist in this:—Jurists aver that no
 degree of insanity should exempt from punishment for crime, unless it has reached
 that point that the individual is utterly unconscious of the difference between right
 and  wrong at the time of committing the alleged crime.  (See  paper  by Mr.
 Warren, op. cit.)  Physicians aver that this is really no test of the existence of
 insanity; that those who are labouring under confirmed insanity, and who have
 been confined in asylums for years, are fully conscious of the difference between
 right and wrong, and are quite able to appreciate the consequences of their acts.
 Again, those who have patiently watched  the insane  for years, agree that the
 legal test of utter unconsciousness of right and wrong in the performance  of acts,
 would in reality apply only to persons who were suffering from delirium—from
 a furious paroxysm of mania, or from confirmed  idiocy; and that if the rule
 suggested by Mr. AVarren,—that a person, in order to be acquitted on the  ground
 of insanity, should be  proved to be as unconscious of his  act as a  baby,—were
 strictly carried out, there is  scarcely an inmate of an asylum who  happened to
 destroy a keeper  or attendant, who would  not be convicted  and  executed for
 murder.  Such  a rule amounts to a reductio ad absurd um: it would abolish all
 distinction between the sane and  insane, and would consign to the same punish-
 ment the confirmed lunatic and the sane criminal.  This species of baby uncon-
 sciousness of action exists in idiots as in furious maniacs; but not in the majority
 of lunatics; and it may be safely asserted,  that if this criterion be the  true one,
 acquittals on the ground of insanity have involved a series of gross mistakes for
 the last fifty years.  The only irresponsible lunatics,  according to Mr. AVarren,
 are precisely those who would not even have reason enough to plead to an indict-
 ment.  Thus while  the medical  profession is condemned for adopting opinions
 which would lead to the acquittal of criminals, the writer recommends a rule which
 would certainly  lead to the execution of the greater number of confirmed lunatics
 charged with acts of homicide.  The practical failure of such a rule is  manifest,
 when it is found that persons are  frequently and justly acquitted who have de-
 stroyed life with a full and  perfect  consciousness  of the wrongfulness of their
 acts.   (See ante,  p. 578.)   In the  case of Dadd, who  was  acquitted  on the
 ground of insanity, and who  was proved to be a confirmed lunatic, it transpired
 that the man had  actually  provided himself with a passport and  fled to  France
 after destroying his father!   (See AVood on the Plea of Insanity, p. 41.)
   Having pointed out these inconsistencies, it is only proper to acknowledge
 that in theory the English law would  punish a lunatic just as it would  punish a
 sane man, provided the lunatic "had that degree of intellect which  enabled him
 to know and distinguish between  right and wrong; if he knew what would be
 the effects of his crime, and consciously committed it;  and if with that con-
 sciousness he wilfully committed  it."  In practice, however, it is placed beyond
 doubt that some who ought to be held responsible are improperly acquitted, on
 the legal fiction that they were  unconscious  of the wrongfulness  of their acts.
 Dr. AVood states, that of thirty-three males now confined as lunatics in  Bethlem,
 who have actually committed murder, not including those where an unsuccessful
 attempt was made to perpetrate the same crime, three are reported sane;  and he
feels quite satisfied that two of these were not insane at the time they committed
the murders; and of the fifteen females who  have actually committed  murder;
five are reported sane,  and  two of them ought, in his judgment, never to have
been acquitted on the ground of insanity.   (Plea, p.  50.)   These  facts, then, 
588
SUMMARY OF MEDICAL EVIDENCE.
are sufficient to show that the rule of law generally adopted does not err on the
side of severity:   The  only complaint that can be made is that it  operates with
inconsistency and uncertainty.
   Summary of medical evidence.—A strange and unaccountable notion prevails
in the public mind, that a homicidal lunatic is to be distinguished from a sane
criminal by some certain and invariable symptoms or characters, which it is the
business of a medical witness to display in evidence, and of a medico-legal writer
to describe.   But  a perusal of  the evidence given at a few trials will surely
satisfy those who entertain this notion, that each case must  stand  by itself.  It
is easy to  classify homicidal lunatics, and say that in one instance the murderous
act was committed from a motive; i e. revenge or jealousy;—in a second,  from
no motive, but from irresistible impulse;—in a third, from  illusion  or delusive
motive; i. e. mental delusion;—in a fourth, from perverted moral feeling.   This
classification probably comprises all the  varieties  of homicidal  insanity, but it
does not help us to ascertain, in a doubtful case, whether the act was or was not
committed under  any of these psychological  conditions.   It will  enable us to
classify those who are acquitted  on the  ground of insanity, but it entirely fails
in giving  us the power to distinguish the sane from the insane criminal.
   According to M. Esquirol, whose views, more or less modified, are adopted by
all writers on the medical jurisprudence of insanity, the facts hitherto observed
indicate three degrees of homicidal monomania:—
   1. In the first the propensity to kill is connected with absurd motives or actual
delusion.   The individual would be at once  pronounced insane by every body.
Cases of this description are not uncommon,  and they  create no difficulty what-
ever.   The accused are rarely allowed even to plead to the charge.
   2. In the second class, the desire to kill  is  connected with no known motive.
It is difficult to suppose that the individual could have had any real or imagi-
nary motive for the deed.  He appears to be led on by a blind impulse (Case by
Mr. Daniell, ante, p. 582.)
   3. In the third  class, the impulse to  kill is sudden, instantaneous, unreflect-
ing and uncontrollable (plus forte que la volonti.)   The act of homicide is per-
petrated without interest, without motive, and often on individuals who are most
fondly loved by the perpetrator.   (Maladies  Mentales, ii. 834.)
   These three forms differ from each other only in degree;—the first two being
strongly analogous to, but lighter modifications of the third.  All the cases which
came before M. Esquirol had these features in common:—an irritable constitu-
tion, great excitability—singularity or eccentricity of character; and previously
to the manifestation of the propensity, there was a gentle, kind, and affectionate
disposition.   As in other forms of insanity, there was  some well marked change
of character or  in the  mode of life.  The  period at  which the disorder  com-
menced and terminated could be easily defined, and the malady could be almost
always  referred to some moral or physical cause.  * In two  cases it was traced to
the result of puberty, and in four to the power  of  imitation.  Attempts at sui-
cide preceded or followed the attack; all wished to die, and some desired  to be
put to  death like criminals.  In none of the cases was there any motive for the
act of* homicide.
   M. Esquirol believes  that there are well marked distinctions between this state
and that of the  sane criminal.  Among these he  enumerates,  1st, the want of
accomplices in homicidal monomania.   2d, the criminal has always a motive—
the act of murder is only a means for gratifying some other more or less crimi-
nal passion; and it  is almost always accompanied by  some other wrongful act:
the contrary exists in homicidal monomania.  3d, the victims of the  criminal
are those  who oppose his desires or his wishes;  the victims of the monomaniac
are among those who are either  indifferent, or who are the most dear to him*—
4th, the criminal endeavours to conceal, and  if  taken, denies, the crime:  if he
confesses  it, it is  only with some reservation, and when  circumstances are too 
SUMMARY OF MEDICAL EVIDENCE.
589
strong against him; but he commonly denies it to the last moment.   It is the
reverse with  the  monomaniac.  The exceptions  to which these  characters are
open  have been  already considered (ante, p. 579.)  They have, undoubtedly,
greater value in their united than in their individual  application, and when in
any case they co-exist, there is strong reason to believe that the accused party is
irresponsible.   The great difficulty in these  cases is  to  distinguish  moral de-
pravity from insanity.  I quite agree with an excellent medico-legal writer on
this subject, that "no hideousness of depravity can amount to proof of insanity,
unsupported  by evidence of a judgment incapacitated, or a will fettered by dis-
ease.   In those cases of mental disorder  in which the emotions are  perverted,
and where there is  no clear proof of deranged intellect, cases which do from time
to time occur, the presumption of insanity in regard to a criminal action has to
be upheld by evidence of  suspension of the will," (Jamieson's Lectures on the
Med. Jur. of  Insanity, Med. Gaz. xlviii. p. 181.)  But it is not possible in
many cases to produce  satisfactory evidence of the suspension of the will:  this
suspension can only be assumed from  the act, which is admitted to be a dan-
gerous assumption, and one that might lead to the confusion of crime with  in-
sanity.  In subsequent lectures this writer describes the various conditions under
which it would be reasonable to consider homicide as an act of insanity (Vol.
xlvi.  pp. 527 and 827.)  Those cases are included in which "the action was mo-
tiveless,—the manifestation of a blind irresistible impulse, inconsistent with the
natural tendencies of the individual, and indicating in its circumstances the tem-
porary existence of a delirious loss of control," although  no intellectual derange-!
ment may be obvious.   The insanity is obviously in such cases assumed to exist.
   [The absence of motive, unless there is some other and better evidence of insa-
nity,  ought rather to be considered an aggravation of the crime.   We  agree with
Dr. Wood (ante, p. 587,) in the belief that the doctrine which releases the insane
from  responsibility and consequent liability to punishment for criminal acts, is un-
sound and dangerous when applied to many cases.  In the present state of our
knowledge, however, it would be even more difficult to make the true distinction be-
tween responsible and irresponsible lunatics than it now is to make that between
the sane  and insane.   Indeed  the whole question of responsibility  is yet  in a
most unsatisfactory position, and the plea of insanity is so  liable to abuse,  that
a natural regard  for the safety of the community requires  that in murder cases,
it should never  be allowed without an enforcement  of the  alternative  of im-
prisonment or secure confinement for life.—H.]
   Medical opinions.—Some doubt has  existed, whether a medical witness, on a
 trial  in which the plea of insanity is raised, could be asked  his opinion  respect-
ing the state of the prisoner's mind at the time of the  commission of  the alleged
crime,—whether the accused was conscious at the time of doing the  act that he
was acting contrary to law, or whether  he was then  labouring under any and
what delusion.   It has been now decided, by fourteen  judges out of fifteen, that
facts  tending to  lead to a strong  suspicion of insanity must be proved and ad-
mitted, before the opinion of medical witnesses can be received on these  points.
(See  Med. Gaz. xlvi. p. 240.)
   ["No defence,"  says Dr. Griffith in the last edition, "in cases of trial for mur-
der has been more frequent or more  successful of  late years in our courts than
that of insanity  on the part of  the prisoner.   Juries appear to have considered
that  the  adage of 'ira est  dementia brevis' should be allowed its fullest signi-
fication, and be  taken as an excuse for any act of violence.   The true grounds
are those stated by the judges as quoted  in the text, and they should be closely
enforced in all cases.   If our law, as in England, ordered the restraint  and re-
clusion of a prisoner acquitted of crime on the plea of insanity, it would matter
little which verdict was given;  but when, as in the ease here, the prisoner is ac-
quitted on the score of alleged insanity and permitted to go at large, the public
have  a right to demand why, if wilfully and knowingly criminal, he  is allowed 
590
SUICIDAL MANIA.
to escape unpunished;  and why, if insane, he is let loose to commit other acts
of violence with impunity.  The plea  has been, that as long as the law awards
death as the punishment for murder, every thing should be allowed in favour of
the accused.   This is  founded on humane feelings, no doubt, but is  morally
wrong.   Much of  the evil is attributable to the medical practitioners called as
witnesses in these  cases; for, as they are aware, if  they declare that the accused
is sane, they destroy bis last hopes of safety, they manage, without stating that
the prisoner is absolutely insane, to leave an impression on the minds of the jury
that he was not an  accountable being at the time of  the commission of the crime."
AVe entirely agree  with the views expressed in the  foregoing note of Dr. Griffith,
and are glad to perceive that they are beginning to prevail much more generally
than at the date of the doctor's writing.   The real desideratum is a law requiring
dangerous lunatics to be confined.—H.]
   It is proper that a medical witness should remember, in examining an accused
party, who is alleged to have committed a crime while labouring under insanity,
that the plea may  be good, and yet the individual be sane when examined. This
was observed in the case of a lunatic, who killed his  mother, in February, 1843.
There was no doubt that he was insane at the time of the act; but two days after-
wards he was found to be of a perfectly sound mind.   This sudden restoration
to reason is sometimes met with  in  cases of homicidal mania.   For a remarka-
ble case of this description, where the motive for a man killing his wife was appa-
rently jealousy, see report by MM.  Leuret  and Ollivier.  (Ann.  d'Hyg. 1843,
ii. 187; also, 1836, ii. 122.)  Lord Hale mentions a case, where a woman soon
after  her  delivery killed her infant.  She confessed the crime, was carried to
prison, fell into a deep sleep, wakened quite sane,  and wondered how she came
there. (See also the case of M'Callum, Alison, 650.)
                            CHAPTER LXIX.

SUICIDAL MANIA--SUICIDE NOT NECESSARILY INDICATIVE OF INSANITY--SUICIDE A FELONY
  --IN RELATION TO  LIFE-INSURANCE--HEREDITARY TAINT--PUERPERAL MANIA—PYRO-
  MANIA--KLEPTOMANIA—DRUNKENNESS—CIVIL AND CRIMINAL RESPONSIBILITY OF DRUNK-
  ARDS--ILLUSIONS--RESTRAINT—INTERDICTION--DELIRIUM •  TREMENS--SOMNAMBULISM—
  CIVIL AND CRIMINAL LIABILITIES OF THE DEAF AND DUMB.

                             SUICIDAL MANIA.
   Suicide not necessarily indicative of insanity.—In  monomania, especially in
that form which is  called melancholia or lypemania, there is often a strong pro-
pensity to the commission of suicide.   This may proceed from sudden  impulse
or from delusive reasoning.  Suicidal  mania is susceptible of  being spread by
imitation, more especially when the  mode of self-destruction adopted is accom-
panied by circumstances of a horrible kind, or exciting great notoriety.  The sight
of a weapon or of a  particular spot where a previous suicide has  been committed,
will often induce a person, who may have been hitherto unsuspected of any such
disposition, at once  to destroy himself.    In  some  instances an individual fancies
that he is oppressed and persecuted, that his prospects in life are ruined, when,
on  the contrary, his affairs are known to be flourishing.  He destroys himself
under this delusion.  In cases of this description, whether arising from -a momen-
tary insane impulse or  from delusive reasoning, there cannot be a doubt that the
act is one of insanity.   It is very different,  however, where  a real motive is ob-
viously present,—as where  an individual destroys himself to avoid disgrace or
impending ruin, because here the results are clearly  foreseen, and  the suicide
calculates that the  loss of life would be a smaller  evil than the  loss of honour 
SUICIDE IN RELATION TO LIFE-INSURANCE.
591
and fortune.  It may be urged that a motive of this kind will appear insufficient
to the  minds of most men;—but what known motive is there sufficient to ac-
count for parricide, infanticide, or  any other crime of the like horrible nature?
It appears to me we must allow either that all crime is the offspring of insanity,
or that suicide is occasionally the deliberate act of a sane person.   To say that
suicide is always per se evidence of insanity, is to say substantially that there is
no criminality in self-murder; for it is impossible to regard that act as a crime,
which is committed under a really insane delusion.   (See Ann. d'Hyg. 1881, i.
225.)  For some judicious remarks on this subject, see Lectures by Dr. Jamieson,
Med. Gaz. xlvi. p. 523, and Journ. Psychol. Med. 1850, p. 19.
   Suicide a felony.—The law of England very properly treats suicide  as felony:
those who have  attempted  and failed in its perpetration are treated as sane and
responsible  agents, unless there should be very clear evidence of their insanity
from other circumstances;  and  it is pretty certain  that the  evidence required to
establish this must be  much stronger than that sometimes  admitted in cases of
homicide.  Thus, had Oxford and 31'Naughten attempted to destroy themselves
and failed, and in making the attempt on their own lives by a pistol or  otherwise,
had accidentally led to the death of a bystander,  and had afterwards been  tried
for  the felony, it is  almost certain that they  would have been convicted.  The
hypothesis of a suicidal climax would have been rejected.   The facts adduced at
their trial would, most probably, under these  circumstances, have been deemed
insufficient to establish their insanity and consequent irresponsibility for  the at-
tempts on their own lives.
   Some singular medico-legal cases have lately occurred, involving  the question
—how far the act of attempting suicide is indicative of insanity.  In the case of
The Queen v. Rumball, (Cent. Crim. Court, May, 1843,) the prisoner was charged
with attempting to drown her child.  It appeared in  evidence that she fastened
her child to her dress, and threw herself into a canal with the  intention of de-
stroying herself.  She was rescued, and was subsequently tried and convicted of
 the felony of attempting to murder her child by drowning.  Had she not been
rescued, and had she succeeded in her purpose  of self-destruction, it is very proba-
ble that the verdict of a jury  would have been, as it so frequently is on  these
 occasions,—"Temporary insanity."  In the case of Reg. v. Fur-ley, (Cent. Crim.
 Court, April, 1844,) the prisoner was convicted of murder under similar  circum-
 stances, but the  sentence was subsequently  commuted.   In the  case  of The
  Queen v. Gathercole,  1839, a  man was  charged  with the  manslaughter of the
 deceased,  under the following singular  circumstances.   The prisoner threw
 himself into a canal for the purpose of drowning  himself: the deceased, who was
 passing, jumped in and rescued  him;  but by  some accident he was  himself
 drowned in the humane attempt.  The defence was, that the prisoner was at
 the time insane, and therefore not responsible for the death of the person who
 attempted to save him;  but this was negatived, and ^he prisoner was convicted.
 So if a man intending to shoot himself fails, and  by accident shoots a  bystander,
 he will be held responsible, unless there be very clear proof of insanity:—the
 act —the attempt itself, taken alone, will not be admitted as evidence.
    Suicide in relation to life-insurance.—It is well known that a policy of life-
 insurance is forfeited by the act of suicide, according to the rules of many Offices;
 but supposing it to have  been really an  act  of insanity, it  has been doubted
 whether the policy would  be legally forfeited.  In an equitable view, the policy
 should not be forfeited under  these circumstances, any more' than if the  party
 had died accidentally by his own  hands.   The condition  truly implies that the
 party puts himself to death deliberately, and  not unconsciously, while labouring
 under a fit of delirium or insanity.  The question was raised in the case of Bor-
 radaile v. Hunter  (Dec.  1841.)  This was  an  action brought to recover the
 amount of a policy of insurance effected on the life  of a clergyman  who  threw
 himself into the Thames from Arauxhall Bridge, and was drowned.  The  whole 
592
SUICIDE IN RELATION TO LIFE-INSURANCE.
question turned upon the legal  meaning of the words "die by his own hand,"
which formed the exception in the proviso to the payment of the policy.   At
the trial of the case, Erskine, J. told the jury, that if the deceased  threw himself
into the river, knowing  that he should destroy himself and intending so to  do,
the policy would be void:—they had further  to consider whether the  deceased
was capable of distinguishing between right and wrong at the time, or,  in other
words, whether he had a sufficient knowledge of the  consequences of the act to
make him a felo-de-se.  The jury found that the deceased threw himself into  the
water, intending to destroy himself, and that previously to that time there was no
evidence of insanity.  They were then directed to take the act itself, with the pre-
vious conduct of the deceased, into consideration, and say whether they thought
at the time he was capable  of knowing right from wrong.   They then found that
he threw himself from the  bridge with the intention  of  destroying himself, but
that he was not then capable of judging between right  and wrong.  The jury
were here evidently perplexed with the strict meaning of the words right and
wrong:—the first part of the verdict made the case one of felo-de-se, the last part
made it one of insanity.  The verdict was entered for the defendants; i. e. that
the deceased was a felo-de-se, and that the policy was therefore void.   The case
was subsequently argued before the four judges in the Common Pleas, May, 1843:
it was contended for the plaintiff, that according to the terms of the policy there
must have been an intention by the party assured, to "die by his own hands;" and
that an insane person could have no controllable intention.   The judges differed:
—three considered that there was no ground for saying that the  deceased was
affected by an uncontrollable impulse,—on the contrary, the jury had found that
he threw himself into the  river, knowing that  he should destroy himself, and
intending to do so.   In  their opinion, the act was one of felo-de-se,  and the policy
was void.  Tindal, C. J. considered that the verdict  should be for the  plaintiff,
thereby leading to the inference that the act of suicide was in this case the result
of insanity, and not of a felonious killing, to which alone he considered the  ex-
ception in the proviso should apply.  It is probable that if the term  "suicide"
had been inserted in the policy, instead of "die by his own hand," the decision
would have been in favour of the plaintiffs;  for  to vitiate a policy from an acci-
dental result depending on an attack  of insanity, and  flowing directly from that
attack, is virtually vitiating it for the insanity itself!   In this respect, it appears
that the learned Chief Justice took a most sound and equitable view of this ques-
tion, so important to the interests of those who have  insured  their lives.   It is
impossible  for a man to enter into a contract against  an attack of insanity, any
more than  against an attack of apoplexy!  The jury found  that the  deceased
was irresponsible for the act, and it is clear that the insurers and insured intended
no more, by using the term "die by his own hand," than the act of suicide.   By
this decision, therefore,  the insurers received the benefit of a wider interpretation
of the terms than that which either party could have  foreseen.
   This question was again  raised in the  case  of Sch wabe v. Clift, Liverpool
Summer Assizes, 1845.  (Med.  Gaz. xxxvi. 826.)  The  deceased,  whose  life
was insured, destroyed himself by taking sulphuric acid.  There  was clear evi-
dence of his being at the time in a state of insanity.  The jury here, under  the
direction of Cresswell, J., took a most proper view of  the subject, and returned  a
verdict for the plaintiffs, thereby deciding that  the  policy was not  vitiated  by
the mere act of suicide.  The learned judge held that to bring the case within
the terms of  the  exception, the party taking  his own life must  have been  an
accountable moral agent, and able to distingxiish right from wrong.   In this
case, the term "suicide" was used in the policy, which the learned judge held
to imply "a felonious killing."   Supposing that the insured party  was killed
by voluntarily precipitating  himself from a window  while in a fit of  delirium
from fever,  this would be an  act of suicide or dying by his own hand; but it
surely cannot be equitably contended that his heirs  should lose  the benefit of 
SUICIDE IN CASES OF LIFE-INSURANCE.      *         593
the insurance in consequence of an event depending on an accidental attack of a
disease which no one could have foreseen, and against which no one could guard.
If this principle be not admitted, the decision which must necessarily follow would
appear to be against all equity; if it be admitted, then it  must apply equally to
every case of mental disorder, the proof of the existence of this resting with those
who would benefit by the policy.   On an  appeal, the judgment in this case was,
however, reversed, the judges again differing. It was argued for the insurers, that
if a man retained just enough of intelligence to  produce death  by  competent
means, but was deprived  of all moral sense,  the policy was  void.  Against this
view, it was urged by one of the judges, that whether the intellect was destroyed
altogether, or  only partially, it would make no difference.   If death was the
result of disease, whether by affecting the senses or by affecting the reason (thus
leading to suicide,) the Insurance office was liable under the policy.   If the act
was not the act of  a sane and reasonable creature, it was not an act of suicide
within the meaning of the proviso.   Those judges who adopted the opposite view
held that the meaning of the words, as introduced into the exception, was—if the
party should kill himself intentionally.  The words were considered to include all
cases of voluntary self-destruction.   If a party voluntarily killed himself,' it was
of no consequence whether he was sane or not.  The majority of the  Court held
this view, and a new trial was granted.  Had all the judges been present to give
their opinions,  the  decision might have been different, for five  have  already ex-
pressed themselves, at various times, in favour of Jthe view, that the term "suicide"
in policies, applies, as it ought to do, only to cases in which there is no evidence
of insanity; while four have declared their  opinion to be, that it includes all
cases of "intentional" self-killing, whether the person be  sane or  insane.   It  is
difficult to understand how a man in a fit of delirium or insanity can  be said to
kill himself voluntarily or intentionally.   Will and intention imply the judgment
of a sane man in regard to  all civil and criminal acts; but a delirious or really
insane person acts under a delusion, and as the law would hold him irresponsible
in regard to others, his representatives should not suffer for an act which he was
himself incapable of controlling.   (Law Times, July  18, 1X46, p. 342.)
   The decision in this case is of great importance to  persons whose lives are in-
sured; for it may be made  to govern others;  and on this  principle, a man at-
tacked with delirium, and who during the fit precipitated himself from a window,
and was killed, would be declared a suicide within the meaning of the proviso,
and a policy of insurance on his  life would  be ipso facto void.  It will be per-
ceived from this decision, that the law, as at present interpreted by the majority
of the judges,  is, that whenever a person destroys himself intentionally, whatever
may be the state of his mind, the policy becomes void.  It also appears that ac-
cording to this legal view of the  question, a person may have  and exercise this
intention, although undoubtedly insane.  AVhether he have been  so found under
a commission,  or a verdict to this effect have been returned  by  a coroner's
jury, is therefore unimportant.  It must  be proved by those who would benefit
by  the policy that the party died  from his own act without intending to destroy
himself.   If  a man take poison, or shoot  himself, or commit any other act lead-
ing to his  own death, it must  be  shown that it was  the result of accident,
and not of design on  his part.   Some Insurance-offices  now insert  in the con-
tract a proviso by which, whether  the person be found felo-de-se  or not, the
policy shall  be forfeited;  but they reserve to themselves  a power of returning a
part or the whole value of the policy, calculated up to the day of death.  In the
mean time? they have the power of taking the fujl benefit of  the act of suicide
committed during a fit of delirium or insanity,  in which, as medical men  know,
there can exist no controllable intention, no freedom of judgment, and no real
exercise of will.  (See case, Prov. Med. Jour. Aug. 9, 1*48, 428.)
  From these cases one point is  clear,—the act of suicide is not treated  by the
law as a necessary proof of insanity; and  therefore  the ingenious  arguments
       38 
594
PUERPERAL MANIA.
which have been held  on this subject have but little  interest for  the  medical
jurist in a practical view.  It has been elsewhere stated that acts of suicide have
been mistaken for homicide, merely because the deceased had expressed no inten-
tion of  destroying himself, and had  manifested no disposition to the act by his
previous conduct.  This, however, is a very fallacious view of the subject;  since
suicide  from sudden impulse is by no means unfrequent; and evehVhere the act
bears about it marks of deliberation,  it is not to,be expected that  the individual
should previously announce  his intention;  for  this would be a sure way of de-
feating  his object. Perhaps  one of the most remarkable instances of  suicide from
sudden  impulse is the  following, which is related by Sir Charles Bell.   Many
years since, one of the surgeons of the Middlesex Hospital was in the  habit of
going every morning to be shaved by a barber in  the  neighbourhood, who was
known  as  a  steady, industrious man.  One'morning  some conversation arose
about an attempt at suicide which had recently occurred; and the  surgeon re-
marked that the man had not cut his throat in the right place. The barber then
casually inquired where the cut should  have been made, and the surgeon pointed
to the situation of the carotid artery.  A few minutes afterwards,  the  surgeon
was alarmed by hearing a noise at the back of  the shop, and on rushing to the
spot, found that the barber had cut his own throat with the razor with which he
had been shaving him.  The man speedily  died!
   If, as it  is  alleged, the act of suicide was in all cases  the offspring of insanity,
suicide  should be very frequent among the  insane.   Experience, however, is not
in favour of this assumption.  The report of the Commissioners  of Lunacy for
1850, shows that there  were then confined  as lunatics 15,079 persons, while the
suicides for the year among  this large number amounted to only eight, of which
six were perpetrated by strangulation.  As mechanical restraint is either abo-
lished or considerably  diminished in  most asylums, lunatics have now much
more liberty than formerly, and yet suicides among them are comparatively rare.
This favourable result must  be in part ascribed to active superintendence and
watching.
   Hereditary taint.—The tendency to suicide is undoubtedly hereditary.  Dr.
Burrows relates an instance in which this propensity declared  itself through
three generations:—in  the  first, the grandfather hanged  himself:  he left four
sons: one hanged himself, another cut his throat, and a third drowned himself in
an extraordinary  manner after having been  some months insane: the fourth died
a natural death, which, from his eccentricity  and unequal  mind, was scarcely to
be expected.   Two of these sons had large families : one  child of the third son
died insane—two others drowned themselves, another became  insane and made
the most determined attempts  on his life. Several of the progeny  of this family,
being the fourth generation, when they had  arrived at puberty, bore strong marks
of the same fatal propensity.

                            PUERPERAL MANIA.
   A homicidal propensity towards their offspring  sometimes manifests itself in
women  soon after parturition.   It seldom appears before the third day, often not
for a fortnight; and in some  instances not until  several  weeks after delivery.
The most frequent period is at or about the commencement of lactation, and be-
tween that and the cessation of the  lochia.   According to Esquirol, it  is gene-
rally attended by a suppression of the lochia and  milk.   The symptoms do  not
differ from those  of mania generally; but it may assume any of the other forms
of insanity; and in one  half of the cases it may be traced to hereditary tendency.
According  to Dr. Burrows, there is delirium, with a childish disposition for harm-
less mischief.   The woman  is  gay and joyous, laughing, singing,  loquacious, in-
clined to talk obscenely, and careless of every thing around.   She imagines that
her food is poisoned: she may conceal the suspicion, and merely avoid taking
what is offered  to her.   She can recognise  persons and  things, and can, though 
CASES OF PYROMANIA.
595
perhaps will not, answer direct questions.  Occasionally there is great depression
of spirits with melancholia.  These facts are of some importance in cases of al-
leged child-murder.   This state may last a few hours, or for some days or weeks,
[sometimes for months or years; but it generally goes off within a few months, if
not earlier.—H.] The murder of the child is generally either the result of a sudden
fit of delirium, or of an uncontrollable impulse, with a full knowledge of the wicked-
ness and illegality of the act,—so that the legal test of responsibility from a know-
ledge of right  and wrong cannot be applied to such cases.  Mothers have been
known, before the perpetration of the murder, to request their attendants to remove
the child.   Such cases are commonly distinguished from deliberate infanticide by
there being no attempt at concealment, nor any denial of the crime on detection.
Several trials involving a question of puerperal mania, have been decided, gene-
rally in favour of the  plea, within the  last few years.   Dr. Ashwell has remarked
that undue lactation may give rise to an attack of mania, under which the murder
of the offspring may be also perpetrated.  (Diseases of Women, 732.)  Females
in the pregnant state have been known to perpetrate this crime apparently from
some sudden perversion of their moral feelings.  I am  not aware that a plea of
exculpation on the ground of insanity has been admitted in this country under
these circumstances.   (See case, Ann.  d'Hyg. 1831, i. 374.)  [Puerperal insanity
certainly occurs to some women in the pregnant state, but we do  not remember
an instance in  this  country of criminal misconduct having been attributed to
such a cause.—H.]   For an able analysis of the present state of  our knowledge
on the subject of Puerperal Insanity, by Dr. Reid, see Jour. Psychol. Med. 1848.
pp.  128, 284.
                                PYROMANIA.
   Propensity to incendiarism.—This  is described as  a variety of monomania in
which there is a morbid disposition of mind, leading to acts of incendiarism with-
out  any motive.  It  is said to proceed from  sudden impulse, or from delusive
reasoning, but most  commonly the latter.  It has been chiefly remarked in fe-
males about the age of puberty, and is supposed to be connected with disordered
menstruation.    An extraordinary instance of pyromania is quoted in the  case of
Jonathan Martin, who fancied himself  to be  deputed  from God  to  burn down
the cathedral of York, in order to do away with the heresies which he supposed
to exist in the church.  It is said to be not uncommon in young  persons of both
sexes, about the age of puberty.  Admitting that a morbid impulse of this kind
may exist, it should  be very cautiously received as an exculpatory plea, since
otherwise it might be easily converted into a means for withdrawing real crimi-
nals from all legal control; and I would here especially direct the  attention of
the reader to an essay on  this  subject by Professor Casper, of Berlin, in which
he denies the  existence of such a propensity as connected with  insanity.   He
believes that incendiarism  is always a criminal act, and, unless there be clear evi-
dence of a perverted  mind, that it should be  always  punished as such.   (Denk-
wiirdigkeiten zur Med. Stat-Berlin, 1846, 255.)  This plea has been  already
admitted in English law (see cases, Med. Gaz. xii. 80,) but chiefly in those in-
stances in which there was strong reason to suspect intellectual aberration.  In
one recent case (Reg. v. White, Wilts Summer Ass. 1846,) the prisoner was con-
victed  on the principle that, although  of weak intellect, she knew right  from
wrong.   (See Ann. d'Hyg. 1833, ii. 357; 1834, ii. 94.)  Among several impor-
tant  trials in which this plea has been urged in defence, the one most interesting
to the  medical jurist is that of James  Gibson, tried before the  High Court of
Justiciary, Edinburgh (Dec. 23, 1844,) and of which a very full report  will be
found in Cormack's Edinburgh Journal, February, 1845,  page 141. The pri-
soner was charged with setting fire to certain premises, and the defence chiefly
rested upon the  allegation that he was  in a state of mind which rendered him
irresponsible for the  act.   The medical evidence was generally in favour of the 
596
KLEPTOMANIA.
insanity.  The Lord Justice Clerk  (Hope) in  a very elaborate  charge  to  the
jury, laid down for  their guidance most  of the legal propositions which have
been already discussed under homicidal mania.   He remarked, that they were
"not to consider insanity according to the definitions of medical men—especially
such fantastic and shadowy definitions as are  to be found  in  Bay, whose work
was quoted by the counsel for  the panel, and in many other medical works on
the subject."   He  adopted Mr. Alison's  view, that the  consciousness of right
and wrong must be applied to the particular aet, and not to crime in the abstract.
"The duty of deciding this question is with the jury; it is not to be  delegated
to medical men, and by relying upon their own judgment,  their decision would
be nearer the truth than that of any body of medical witnesses."  The jury nega-
tived the plea, and  the prisoner was sentenced to  transportation for  fourteen
years.  It appears to me, from the whole of the evidence,  that there was no more
insanity  in the case of this man than in the  case of M'Naughten;  and had
the latter robbed Mr. Drummond of his property, or burnt his house  down, in-
stead of  shooting him, he would probably have been convicted and transported.
In the case of Reg. v. Elder field, Guildford Summer Ass. 1844, the prisoner was
charged  with  arson, and Gurney,' B., left it  to the  jury to  say, not whether the
prisoner  had a weak or silly mind, but whether, at the time he committed  the
act, he was  in such  a state of  mind as to know what he was about, and to be
capable of distinguishing between right and wrong.   The prisoner was acquitted
on  the  ground of insanity.  In  another  case (Reg. v. Watts, Norwich Winter
Ass. 1844,) the plea was negatived under the direction of the judge.

                              KLEPTOMANIA.
   Propensity for theft.—This  term has been applied by Marc to that form of
monomania which manifests itself by a propensity to acts of theft.  It  has been
remarked by him and others that this propensity has often  shown itself in fe-
males labouring under disordered menstruation, or in those who were  far ad-
vanced in pregnancy, the motive being the mere wish of possession. Pregnancy,
according to him, should  be a  good exculpatory plea, when a well educated wo-
man, of  strictly moral conduct,  steals some unimportant article of no value com-
pared with her worldly means and position in society. There are many instances
on record showing that well educated persons moving in  a respectable sphere of
society have been guilty of petty acts of theft.   The articles taken have been
valueless compared with their means.   Instances of this kind have been brought
before our Police-courts;  and this motiveless impulse to theft has been  occasion-
ally pleaded;  but in most of them the following facts have been established by
evidence:—1. A perfect  consciousness of the act.   2. The article, although of
trifling value, has still been of some use to the person,—thus these females have
stolen articles only adapted to female use.  3. There have  been art and precau-
tion in endeavouring to conceal  the theft; and, 4, either a denial of the  act when
detected, or some evasive excuse.  AVhen  circumstances of this kind are proved,
either the parties should be made responsible, or theft  should be openly tole-
rated.  The evidence of a disordered state of the mind should not here be allowed
to depend on the nature of the act, or every morally depraved person might bring
forward  a plea of insanity for any crime or offence.  (See case, Ann.  d'Hyg.
1838, ii. 435.) /  AVhen the plea of insanity is raised in respect to other cases of
theft, the rule appears to be, per Tindal, C.  J., that there  should  be proof that
the prisoner was incompetent to know that the particular act in question was a
wrong one.   (Reg. v. Vaughan,  Monmouth Summer Ass. 1844.) In one in-
stance, an acquittal  took place  apparently on the ground of insanity (kleptoma-
nia) from amenorrhcea.   (Carlisle Summ. Ass. 1845, Reg. v.  Shepherd.)  Cor-
mack's Ed.  J., Aug. 1845, p. 632. 
DRUNKENNESS.  CRIMINAL RESPONSIBILITY.            597
                        DIPSOMANIA.  DRUNKENNESS.
   Civil responsibility of drunkards.—This state, which is called, in law, frenzy or
 " dementia affectata," is regarded as a temporary form of insanity.  Jurists and
 legislators have differed widely respecting the degree to which drunkards should
 be made responsible for  their acts.   When  the mind of a man is completely
 weakened by habitual drunkenness, then the law infers irresponsibility, unless it
 plainly appear that the individual was at the time of the act, whether of a civil or
 of a criminal nature, endowed with full consciousness and reason to know its good
 or evil tendency.  Any deed or agreement made by a party when drunk  is not
 invalidated by our law, except in the case where the intoxication has proceeded
 so far as to deprive him  of all consciousness of what he is doing; and a Court of
 Equity will not interfere in other cases, unless  the  drunkenness were the result
 of collusion by others for the purposes of fraud.  AVhen the drunkenness has
 occasioned a temporary loss of the reasoning powers, the  party is  incapable of
 giving a valid consent, and, therefore, cannot enter into a contract or agreement,
 for this implies aggregatio mentium,  i. e. a mutual assent  of the parties.   Par-
 tial  drunkenness, therefore, provided  the person knew what he was about, does
 not  vitiate a contract or agreement into which  he may have entered.  Thus the
 law  appears to make two states in drunkenness;—one where it has proceeded to
 but  a slight extent,  and  where it is considered  that there is still a power  of ra-
 tional consent;  another where it has proceeded  so far that the individual has no
 consciousness of the transaction, and therefore can give no rational consent. The
 proof of the existence of this last state would vitiate all the civil acts of a party.
 A confession made by a man while in a state of drunkenness, is legally admissible
 as evidence against him and others, provided it be corroborated by circumstances.
 In a case tried  a few years/since, the prisoner confessed, while  drunk,  that he
 had  committed a robbery and murder which  had taken place some time before,
 but  of which he had not been suspected.   He  mentioned a spot where the pro-
 perty of the murdered person had been concealed by him, and the whole of the
 circumstances of the murder.  The property was found as he had described, and
 the  case was clearly brought home to him, chiefly by collateral evidence from his
 own confession. He was convicted.  In a case tried at the  Central Criminal  Court
 in Oct. 1849,  a man pleaded his drunkenness at  the time of his first  marriage,
 as a defence to a charge  of bigamy.   There was some evidence to show  that  he
 was  drunk when the ceremony  was  performed.  He was, however, convicted.
 (Med. Gaz. xliv. p.  762.)
   Criminal responsibility of drunkards.—When homicide is  committed by a
 man in a state of drunkenness, this  is  held  to  be no excuse for the crime.   If
 voluntarily induced, whatever may be its degree, it is not admitted as a ground
 of irresponsibility,  even although the party  might not have contemplated  the
 crime when sober. (Reg. v. Reeves, Derby AVinter Assizes, 1844.)  Thus it would
 appear  that when  the state of  drunkenness is such that any civil act of the
 person would  be void, he may still be held  legally responsible for a crime like
 murder.  Some judges have  admitted a  plea of exculpation, where the  crime
 has been committed in a state of frenzy arising from habitual drunkenness;  but
 even this is not general.  The question, whether the person was or was not drunk
 at the time of committing a crime, may be,  however, occasionally of some  im-
 portance.   It was  held by Patteson, J., that although drunkenness is no  ex-
 cuse for any crime whatever, yet it is  of very great importance in cases where it
 is a question of  intention.  A person may be  so  drunk as  to be utterly unable to
 form any intention at all, and yet he may be guilty of very great violence.  (Reg.
 v. Cruse 8 C. & P. 546.)  Again, where it  is a question whether the accused was
actuated by malice  or  not, the jury will have to take the fact of drunkenness
 into  consideration, and this  may have an  influence upon  their verdict.   While,
 then drunkenness does not  furnish any excuse for a crime, it is  often material 
598
DELIRIUM TREMENS.
 with reference to the intent with which an act has been perpetrated.  (Law Times,
 Sept. 27, 1845, p. 542.) It  is obvious that if drunkenness were  to be readily
 admitted as a plea of irresponsibility, three-fourths of the whole of the crimes
 in this country would go unpunished.   In those cases where the head has  sus-
 tained any physical injury, as it often happens with soldiers and sailors, drunken-
 ness, even when existing to a slight extent, produces sometimes a fit of temporary
 insanity, leaving the mind clear when the drunken fit  is over.   The law makes
 no distinction between this state and ordinary  drunkenness, although  juries oc-
 casionally show by their verdicts that some difference  ought to be made.   (See
 cases in Alison, 653.)
   Illusions.—Hallucinations and illusions are  a very common effect of drunken-
 ness, and often lead to  the commission of criminal acts.  Marc  relates a case,
 where two friends being intoxicated, the one killed the other under an illusion
 that he was an evil spirit.   The  drunkenness  of the accused was  held to have
 been voluntary;  and he was condemned to  ten years' imprisonment with hard
 labour.  A case of this description was tried at the Norfolk Lent Assizes, 1840.
 (The Queen y.Patteson.) A man while intoxicated killed his friend, who  was
 also intoxicated, under the illusion that he was some other person who  had come
 to attack him.  The judge made the guilt of the prisoner to rest upon whether,
 had he been sober, he would have perpetrated  the  act under a similar illusion!
 As he had voluntarily brought himself into  a  state of intoxication, this was no
 justification.  He was found guilty of manslaughter, and sentenced to two months'
 imprisonment.
   The proof of drunkenness may fail, but still, if the party charged with  the
 death acted under an illusion, he will be acquitted.  In the case of  Reg. v. Price
 (Maidstone Summer Ass. 1846,) it was  proved that the prisoner, who  had been
 on friendly terms with the deceased, was going  home at night, having previously
 been in company with the deceased at a public house, when, according to his state-
 ment, a man sprang upon him from the hedge  by the  road-side, and demanded
 his money and his watch, or else he said he would have his life, and the prisoner
 closed with him and beat him severely, inflicting such injuries that he died very
 shortly afterwards.  This man turned  out to be the deceased, and it  was sup-
 posed that he made the pretended attempt to  rob the prisoner  out of a joke,
 which, however, ended in this fatal manner.   The prisoner all along told  the
 same story, and there did not appear to be the slightest ground for believing that
 it was untrue.  Coltman, J., after hearing the  evidence of the witnesses, said it
 appeared to be quite clear that the prisoner had acted under the impression that
 he was protecting  his own life from the attack  of a robber, and under such  cir-
 cumstances he could not be held to be criminally responsible.  The jury accord-
 ingly returned a verdict of not guilty, and the prisoner was discharged.
   Restraint.—Interdiction.—Drunkenness, even when  habitual,  is not a suffi-
cient ground for the imposition of restraint or  interdiction in the English law.
Thus, on a commission in Nov. 1836, (In re Holden) a jury returned that  the
party was of weak  mind and given to habits of drunkenness, but  that he was
not of unsound mind.   On  application, the  Lord Chancellor refused  to inter-
fere.

                            DELIRIUM TREMENS.
   This is a disordered state of mind which proceeds from  the  abuse of intoxi-
cating liquids.  Habitual drunkenness appears  to be the predisposing, while ab-
stinence from drink is the immediately exciting cause.   Thus, the disorder  fre-
quently does not show itself until the accustomed stimulus has been withdrawn
for a  certain period.  It commences with tremors of the hands, by which it is
known from ordinary delirium, and restlessness; and the individual is subject to
hallucinations and illusions,  sometimes of a horrible kind, referring to past  oc-
cupations or events.  The patients are often violent, and prone to commit  sui- 
SOMNAMBULISM.
599
cide or murder, more commonly the former; hence  they require close superin-
tendence.   Persons labouring under this disorder are incompetent to the perfor-
mance of  any civil act, unless the mind should clear up  be&re  death.  They
are not responsible for criminal acts committed while they are labouring under
an attack.  Acquittals have even taken place on charges of murder, where there
was deliberation as well as an apparent motive for the act.  Thus, then, although
this disorder is voluntarily brought on by habitual drunkenness, the law admits
it as a sufficient plea for irresponsibility; while in a case of confirmed drunken-
ness, it rejects the plea.  Why the mere circumstance of the one being a remote
consequence,  and the other not, should create  irresponsibility, it is difficult to
explain.   [In the one case the disordered intellect may be produced designedly
and intentionally, and nearly always knowingly, whereas the delirium of mania-
a-potu, in ordinary cases, comes  on like other diseases of the mind, is not a ne-
cessary or invariable result of indulgence in intoxicating drinks, and, except in
rare cases, cannot be  produced at will like ordinary intoxication.. The  plea in
the one case,  therefore,  might be made available to an unlimited and most dan-
gerous extent; but could not in the other, from the very nature of the affec-
tion.—H.]
   A. trial has recently taken place in  which the evidence showed that the homi-
cide had been committed by an individual while labouring under an attack of de-
lirium tremens (Reg.r. Simpson, Appleby Sum.  Ass. 1845.) The prisoner's mind
had become  unsettled from an  attack of this disorder  brought on  by habitual
drunkenness.  In another case, the plea was  also  admitted  without  difficulty.
(Reg. v. Watson,  York AVinter Ass. 1845.)  [See Ray, Med. Jur. of Insanity,
Lee's edition of  Guy's For. Med., and Beck's Med. Jur. vol. i., for a much more
extended and detailed discussion of the medico-legal relations of mental aliena-
tion than the limits of this manual allow.—H.]

                             SOMNAMBULISM.
   It has been a contested question among medical jurists, how far a person should
be held responsible for a criminal act, perpetrated in that half-conscious state
which exists  when an individual is suddenly roused from sleep. There is no
doubt that the mind is  at this time subject to hallucinations and illusions which
may be more persistent in some persons than in others; but it is difficult to
suppose, unless we imagine that there is a sudden access of insanity,  that an
individual should not recover from his  delusion, before he could perpetrate an
act like murder.   A  remarkable case  of this description, that of Bernard Sched-
maizig, will be found in Marc (i. 56;) and a trial involving this question occurred
in England a few years since.   A pedlar who was in the habit of walking about
the country armed with a sword-stick, was awakened one evening, while lying
asleep on the high road, by a man, who was  accidentally passing, seizing and
shaking him  by the shoulders.   The pedlar suddenly awoke, drew his sword, and
stabbed the man, who soon afterwards died.   He was  tried for manslaughter.
His irresponsibility was strongly urged by his counsel on the ground that he could
not have been conscious of an act  perpetrated in a half-waking state.  This was
strengthened by the opinion of the medical witness.   The prisoner was, however,
found guilty.  Under such circumstances,  it was not unlikely that an idea had
arisen in the prisoner's mind that he had been attacked by robbers, and therefore
stabbed the man  in self-defence.   (The Queen v. Milligan, Lincoln Aut. Assizes,
1*36.)  [A  somewhat  simila^case occurred in  this city, some two or three years
ago, in which a  man was sho\ with  a pistol by an  acquaintance whom he had
suddenly aroused from  sleep late at night in an open market  house.   The  plea
was that the  deceased was mistaken for a robber when the pistol was fired.  Jury
found a verdict of manslaughter.—H.]  The following remarkable case is quoted
by Mr. Best.   Two persons who had  been hunting during the day slept  together
at ni^ht.   One  of them was  renewing the chase in his dream, and  imagining 
600              RESPONSIBILITY OF THE DEAF AND DUMB.
himself present at the death of the stag, cried out, "I'll kill him! I'll kill him!"
The other awakened by the noise, got out of bed, and by the light of the moon
beheld the sleep«r give several deadly stabs with a knife on that part of  the bed
which his companion had just quitted.  Suppose a blow, given in this way, had
proved fatal, and the two men had been shown to have quarrelled previously to
retiring tb rest!   (Presumptions of Law and Fact.)  A defence of this kind may
be unduly strained.  Thus, where there is  enmity, with a motive for the act of
homicide, the murderer, while sleeping in the same  room, may  select the night
for an assault, and perpetrate the act in darkness, in order  the  more effectually
to screen himself.   In  the case of  Reg. v. Jackson, (Liverpool Autumn Ass.
1847,) it was urged in  defence, that the prisoner, who slept in the same room
with the prosecutor, had stabbed him in the throat, owing to some  sudden impulse,
during sleep; and the case of Milligan above given was quoted by the  learned
counsel, in support  of the view that the prisoner was irresponsible  for the act.
It was proved, however, that  the  prisoner had shown malicious feeling  against
the prosecutor, and that she had wished him dead.   The knife  with which the
wound had been inflicted bore the appearance of having been recently sharpened,
and the prisoner must have reached over her daughter (the prosecutor's wife)
who was sleeping in the  same bed with  him,  in order to  produce  the  wound.
These facts were quite adverse to the supposition of the act  having  been perpe-
trated under an impulse from sleep,  and the prisoner was convicted.   In another
case,  Reg. v. French (Dorset Autumn Ass. 1846,) it was proved that the pri-
soner, while  sleeping in the same  room, had killed the  deceased, who was a
stranger to him, under some delusion.  There was, however, clear evidence that
the prisoner was insane, and on this ground he was acquitted under the direction
of the judge.
   Somnambulism may become a subject of discussion under a  contested policy
of life-insurance, in which it may be provided that it shall be vitiated by suicide.
If a man falls from a height,  and is  killed while in a state of somnambulism—
would this be considered an act of suicide within the meaning of the  policy?.
The proviso  against suicide has been held to include  only  intentional  killing.
(See case, ante,  Borradaile v. Hunter, p. 591;  also,  Med. Gaz.  xxxvi. p. 826;)
and in death under these circumstances the killing cannot  be said to be inten-
tional; it can only be  regarded  as an accident.   Therefore  it is  reasonable to
infer that the policy would  not be void.   It is impossible, however, to lay
down any general rules  relative  to cases of this  description; since the circum-
stances attending each case will sufficiently explain how far it was likely that the
act of murder or suicide had been committed during a state of somnambulism, or
under an illusion continuing from a state of sleep.

                          THE DEAF AND DUMB.
   It was formerly laid down in the old law-books, that a person born deaf and
dumb was by presumption of law an idiot; but in modern practice, want of speech
and hearing does not imply want of capacity either in the understanding or me-
mory, but only  a difficulty in the  means of communicating  knowledge;  and
where it can  be  shown  that such a  person has understanding, which many in
that condition discover by signs,  he may  be tried, and  suffer judgment  and ex-
ecution.   (Archbold.)   A deaf  and  dumb person  is  not  incompetent to  give
evidence unless he be also blind.  He may be examined through the medium of
a sworn interpreter  who understands his  signs.   JUiis condition  does  not justify
restraint or interdiction, unless there be at the same time mental deficiency.  A
deaf and dumb person who has never been instructed is altogether irresponsible
for any action, civil  or criminal.  Such  a  person cannot  even be called on to
plead to a charge, when there is reason to suppose the nature of the proceedings
cannot be understood.   A  deaf and dumb  female was  charged  with cutting off
the head of her child.   By signs she pleaded  not guilty,  but she could not be 
             DETECTION OF FEIGNED DEAFNESS AND DUMBNESS.          601

made to understand the nature of the other proceedings against her.  Upon this
she was discharged, and subsequently confined as a criminal lunatic.  In Reg.
v. Goodman, (Stafford Summer Ass. 1841,) a deaf and dumb man was convicted
of theft and sentenced to imprisonment.   He was made to comprehend the pro-
ceedings by signs and talking with the fingers.   In Reg. v. Brooke, (Buckingham
Summer Ass. 1842,) the prisoner could read and write well.   He was charged
with feloniously cutting and stabbing.  The proceedings were  reported to him
in writing.  He was convicted, and the judge (Alderson, B.) having sentenced
him to a year's imprisonment, handed down his judgment in writing, which he
recommended  him to read and ponder over  in  prison!  In Reg. v. Jackson,
(Bedford Summer Ass. 1844,) Alderson,  B., held, that before the evidence of a
dumb witness can be received, the Court  must be satisfied that he understands
the obligation  of an oath.   It has been decided in the Ecclesiastical Courts, that
the consent of a  deaf  and dumb person given by signs, renders a matrimonial
contract valid, provided the individual have a full and proper understanding  of
their meaning.
   Feigned deafness and dumbness.—From these statements it will be perceived
that medical evidence is of but little importance in relation to the deaf and dumb.
Indeed, there are  only two cases in which this  kind of evidence is likely to be
called for: 1, where there is accompanying mental deficiency, in which case the
general rules given under insanity apply; and 2dly, where  there is  a suspicion
that the deafness  and dumbness  are feigned.  There can be commonly no great
difficulty in detecting an imposition  of this kind.  It will be found  that the
alleged deafness and  dumbness did not come on until a motive existed,  and that
there was no apparent cause, but the very suspicious one of evading the respon-
sibility for some  offence committed.  It  requires [great skill to maintain this
imposture.   Such persons are immediately thrown off their guard by addressing
them in a voice a  little above or a little below the common conversational tone.
A change  in the eye or the features will at once indicate that they hear what is
said.  The ignorant impostor may be dealt with on the principle of "ars est celare
artem," by seriously proposing in  a low  voice to some medical friend who may
be present, the necessity for the performance of some formidable surgical opera-
tion. * The production of amputating instruments has been known to have a
wonderful effect!  If the impostor can write, he may perhaps be detected by the
ingenious plan adopted by the Abbe Sicard.  When the  deaf and dumb are taught
to write they are  taught by the eye.   The letters are  only known to them by
form, and  their value in a word can be understood only by their exact relative
position with  respect to each other.   A  half-educated impostor will spell his
words, or divide them incorrectly, and the errors in spelling will have reference
to sound; therefore indicating that his knowledge has been acquired through the
ear, and not alone through the eye.   A man who had  defied all other means of
detection, wrote down several sentences, in which the misspelling was obviously
due to errors produced by the sound of the words.   The Abbe pronounced the
man to be an impostor without seeing him, and he subsequently conf^pgd the
imposition. 
*
* 
GLOSSARY.
603
GLOSSAKY.
Abdo'men, from abdere, to conceal.  The lower cavity of the body, containing the
, stomach, bowels, liver, and other organs.
Abnor'mal, from ab, from, and norma, rule.   Irregular;  a deviation from natural or-
  der or arrangement.
Abor'tion, from ab and oriri, to rise.  Applied to that which is prematurely produced:
  synonymous with Miscarriage.   The term is also applied to the product of an un-
  timely birth.
Abra'sion, from ab and radere, to rasp. A superficial loss of substance in small shreds,
  applied to the skin or mucous membrane.
Ab'scess, from abscedo  (abs and cedere,) I depart or separate from.  A collection of pus
  in a cavity as the result of disease.
Absorp'tion,  from  absorbere  (ab and sorbere,) to drink or suck  up.   A  function per-
  formed by  certain vessels  in the body,  called absorbents, as also by the veins.
Acar'dia, from a, priv., and  xap8M, the heart.  The state of a fcetus without a heart.
Aceph'alous, from a, priv., and xs$a%ri, the head.  A fcetus born without a head.
Achillis Tendo.  The strong tendon of the heel.
Ac'inus, from acinus, a grape-stone. The  termination of a secretory artery in a gland.
Ac'rid, from  axpoj, a point or summit.  Applied to substances  of an irritating kind.
Adeni'tis, from a§yv, a gland, and  itis, a termination, denoting inflammation. Glandu-
  lar inflammation.
Ar/iPocERE, from adeps, fat, and cera, wax.  A kind of soap formed from the decom-
  position of animal matter  in water.
Adynam'ic, from a, priv., and Swa^ij, strength.  Applied to debilitating diseases.
Albuminuria.  The condition of the urine in which it contains albumen.
Alexiphar'mic, from ntefyw, to repel, and fyappaxov, a poison.  An  antidote.
Allan'tois, from aM«s, a sausage, and n8o$, shape.  A sort of elongated bladder,
  forming one of the coverings of the fcetus.
Alope'cia, from aAxo-tj^, a fox.  Loss of the hair.
Alve'olar, from afveus, a cavity.   Applied to the sockets of the teeth.
Amenorrhce'a, from  a, priv., prp/} a month, and  ptto, I flow.  Suppression of the
  menses.
Amen'tia.  Applied to the state of idiocy.
Amnios, from apvos, a sheep. Applied to the innermost membrane covering the fcetus.
Anemia, from a, priv., and  ac^a,  blood.   Privation of blood.
Anjesthe'sia, from a,  priv.,  and acaeavofxai, I feel.   Privation of sensation.
Anasar'ca, from ova, through, and capS, the flesh.   Diffusion of fluid in the cellular
  membrane; general dropsy.
Anastomo'sis, from cwa, with,  and efopa, a mouth.   A communication  between two
  blood-vessels.
Anence'phalus, from a, priv., and syxttyaXos, brain.   A monster devoid ot brain.
An'eurism from avtvpwtw. to dilate.  The dilatation of an artery from disease.
Ankylosis, from ay^oj, crooked. Applied to a bony union of a joint from disease.
Anserina Cutis, from anser, a goose.   A contracted state of the skin from cold.
An'tidote, from av-ci,  against, and &$»pe, 1 give.  A remedy against poisoning.
Antiphlogistic, from avti, against, and fisya, I burn.   Opposed to inflammation.
Antiseptic, from avti, against, and arpttos, putrid.   Opposed to putrefaction. 
604
GLOSSARY.
Apncea, from a, priv.,  and jtvico, I breathe.   Prevention of breathing: synonymous
   with Asphyxia.
Are'ola, dim., from area, space. Applied to the spaces between the fibres of organs;
   also to the coloured circle surrounding the nipple.
Arthritis, from apOQov, a joint.  Inflammation of the joints.
Asphyx'ia, from a, priv., and <5<f>u§(.?, pulse.  Pulselessness.  It is applied to that state
   in which there is a suspension of respiration.
Asthen'ic, from a, priv., and odevos, force or strength. Applied to diseases of a debili-
   tating kind.
At'avism, from atavns,  an  ancestor.  A case in which a disease is lost in one genera-
   tion and reappears in the following.
Atelectasis, from ows?^, imperfect, and sxtaais, dilatation. That condition 6f the
   lungs in which they  have not been distended with air by respiration.     *
At'las.  The name applied to the first vertebra of the neck, owing to its supporting
   the globe of the head.
At'rophy,  from a, priv., and rp^co, I nourish.  Emaciation produced by any cause.
Axil'la.  The arm-pit.


Bron'chia, from |3poy^oj, the throat. The ramifications of the bronchi, which are two
  ■tubes formed by the division Of the trachea.


Cje'cum, from ccecus, blind, as it forms a  species of cul-de-sac.  The  upper part of  the
   large intestines.
Cal'lus.   The  flexible substance  deposited between  the  fractured ends of bones
   during the process of union.  ■
Carcino'ma, from xapxwos, a crab.  Applied to diseases of a cancerous nature.
Car'diac, from xapSua, the heart, or the upper orifice of the stomach.
Cerebei/lum, diminutive  of Cerebrum.   The lower and smaller portion of the brain.
Chron'ic, from ^pot-oj, time.   Applied to diseases which are of long duration.
Cica'trix, from the Latin,  signifying  the scar or mark left on the skin after the heal-
   ing of a wound or an ulcer.
Clon'ic, from x%ovo;, agitation.  Irregular convulsive motions of the muscles.
Col'ic,  A disease attended with severe pain, chiefly referred to the colon.
Co'lon, from xo%ov, hollow.  The middle and longest portion of the large intestines.
Co'ma.  A profound state  of sleep, in which it is extremely difficult to rouse the in-
   dividual.
Congestion, from congerere, to amass: synonymous with Engorgement. An accumu-
   lation of blood in an organ.
Conjunctiva, from conjungere, to join.   A mucous  membrane  so called because it
   joins together the ball of the  eye and  the eyelids.
Corro'sion, from con and rodere, to gnaw.   The action or effect  of corrosive sub-
   stances.
Crepita'tion, from crepitus, noise; a crackling sound.  It implies the sound and feel-
   ing imparted by air when contained in certain organs; e. g., the lungs.
Crypsor'chides, from xpv7ttu>, I  conceal,  and op^tj, testicle.. Applied to persons whose
   testicles have not descended.


Denta'ta.. The name applied to the  second vertebra of the neck, owing to its having
   a tdoth-like projection.
Diagnosis,  from §«*, and ywoattut, I know.  The discrimination of disease.
Di'aphragm, from Sua, between, and <j>pa<jtfw, 1 close.  A large muscle which forms the
   partition between the chest and abdomen.
Dip'somania, from Su-^a, thirst, and  mania.   An insan.e propensity for drinking.
Diso'matous, from Sue, twice, and oupa, the body.  A monster with two bodies.
Docima'sia, from Soy.iimC,<*>,  I try or prove.  Applied to certain means of testing.  Do-
   cimasia pulmonum.
Duc'tus Arteriosus. A vessel peculiar  to the fcetus, conveying the blood by a short
  course from the heart to the body.
Duode'num, from duodecim.  The upper part  of  the small intestines, connected with
  the stomach. Its length is about twelve fingers' breadth.
Du'ra Ma'ter.  The external covering of the brain:  a tough and firm membrane.
Dyspncea, from Svj, and rtvtw, I  breathe.  Difficulty of breathing. 
GLOSSARY.
605.
 Ecchymosis. from jx*wo, I pour out.   The effusion of blood by which a discoloration
   ot the skin is produced.
 Kmphysema, from » and fvsaco, I blow.  Inflation or a diffusion of air through the
   skin and soft organs.
 Emprosthot/.onos, from  ^rtpoaOtv, forwards, and  *£W« I stretch. A variety of teta-
  ^ nus in which the body is drawn forwards.
 Enteritis, from tvttpw, an  intestine, and His, denoting inflammation.  Inflamma-
   tion ot the bowels.
 Efider'mis  from t7to, upon, and SePlia, the true skin.  The scarf-skin, or cuticle, which
   covers the true skin.
 Epigas'trium, from srtuyaa-tpiov, the belly. The epigastric region.
 Epiglottis, from (7tu, upon, and yXuttu;, the glottis.  An oval' cartilaginous body
   placed over the glottis.
 Eptlepsy, from^itafi^w, I seize upon. A disease of the brain characterized by a
   loss of sensation and by convulsive motions of the muscles.
 Epispa'dia, from srti, above, and artau, I draw.  A malformation in which the urethra
   terminates on the upper part ©f the penis.
 Epithe'lium, from ertu, upon, and  6^, a nipple.   The thin layer which covers parts
   deprived of skin, such as the mucous membrane.
 Ero'sion, from e, and rodere, to eat away. The gradual destruction of a part by a cor-
   rosive substance.  It is often employed in the same sense as Ulceration.
 Erysip'elas, from fpVu, I draw on, and rtsXas, near.   Superficial inflammation of the
   skin with fever, rapidly extending to surrounding parts.
 Erythe'ma, from ipvdpoi, red.  An inflammatory state of the skin, applied to erysipe-
   las when local.
 Es'char.  A slough, a crust, or scab.
 Excor'iation, from  ex, and corium, the skin.  A  slight wound which removes  only
   the skin.
 Extravasa'tion, from  extra, out of, and vasa, vessels. Escape of  a fluid from the
   vessel or organ containing it.

 Fas'cia, from fascis, a bundle.  A membranous expansion covering the muscles, and
   binding them together.


 Gastritis, from ya<t*w, the stomach, and itis, denoting inflammation.  Inflammation
   of the  stomach.


 Hem'orrhage, from au/ia, blood, and p^eaa, I break out. A bleeding  or flow of blood.
 Hemiplegia, from r{[uov(, half, and sfkyoou, I strike. A kind  of paralysis in which one
   side of the body only is affected.
 Hyperemia, from vrtsg, over, and at^a, Wood.  Congestion  of blood in a part.
 Hyper'trophy, from vntp. beyond, and tfpo^, nourishment.   Applied to parts which
   become morbidly enlarged or developed from excessive nutrition.
 Hypochon'drium, from  vrto, under, and %ovSpos, a cartilage.   That part of the body on
  each side which lies under the cartilages of the lower ribs.
 Hypospa'dia, from vrto, under, and artau, I  draw.  A malformation in which the urethra
  terminates at the base  or under part of the penis.
 Hypos'tasis, from vrto, under, and  ataan,  the act of placing.  Morbid depositions in
  the body.


 Idiosyn'crasy, from uSuoc,  peculiar, aw, with, and xpaou;, temperament. A peculiarity
  of constitution.
 Il'eum, from hXsuv, to turn or twist.  The lower portion of the small intestines.
 Infiltra'tion,  infiltratio, from filtrare,  to filter.   Effusion; the  accumulation of fluid
  in the cells of any texture.
 Injec'ted, from injicere, to throw into.  An accumulation of blood in  the small blood-
  vessels, so as to produce redness in a part.
Intercos'tal, from inter,  between, and costa,  a rib. That which  is situated between
  the ribs.
Intussiscep'tio, from intus, within, and suscipio, I receive. A term applied to that con-
  dition of the intestine in which one  part becomes received into and locked within
  another. 
606                              glossary.
Jeju'num, from jejunus, empty.  The middle portion of the small intestines.

Klep'tomania, from x"Kerttu>, I steal, and mania.  Insanity with a propensity to steal.

Lar'ynx, >ap»jyi, a whistle.   The organ of voice situated in the front of the throat at
  the upper part of the trachea.
LEucoRRHCE'A,from tauxoc, white, and p£«, I flow. A white or coloured discharge from
  the vagina, called also fluor albus.
Lobe.  A round projecting part of an organ.
Lo'chia, from Xoxos, a woman in childbed.  A serous and sanguineous discharge fol-
  lowing delivery.

Maras'mus.  A wasting of the body.
Mea'tus.  A passage or canal.
Medulla Oblongata.  The portion of the cerebral mass which connects the brain
  with the spinal marrow.
Meninge'al, from jiw/wyi, a membrane.  Applied commonly to parts connected with
  the membranes of the brain.
Menorrhagia, from firjv, a month, and psia, I flow.   A profuse menstrual discharge.
Mes'entery, from  jUttroc, in the middle, and ivtspov, intestine.  Applied to the folds
  of the peritoneum which maintain the intestines in their respective situations.
Monor'chides, from povot, one, and opxug, testicle.   Persons with one testicle.

Neural'gia, from vtvpov, a nerve, and a\yos, pain.   Applied to diseases the chief fea-
  ture of which is pain in the  course of a nerve.

GEde'ma, from ouSsa, I am  swollen.  A swelling produced  by the accumulation of a
  serous fluid in the cellular texture under the skin.
OZsoph'agus, from ouo, 1 carry, and $ayco, I eat.   The gullet.
Olec'ranon, from u>%ivrj, the elbow,  and xpouw, the head.  The projecting point of the
  elbow.
Opisthot'onos, from ortuaOt, backwards, and -tswu, I stretch.  A species of tetanus in
  which the body  is bent backwards.

Paral'ysis, from rtapa, and %.va, I loosen.  Loss of voluntary motion and sensation in
  one or more parts of the body.
Pari'etes, from paries, a wall.  A name given to parts which form the boundaries of
  cavities.
Pericar'dium. from rtepu,  around, and xap<fta, the heart.  The membranous bag which
   envelopes the heart.
Peritone'um, from rtspu, around, and  Ttcuvu, I stretch.  The membrane which lines
  the interior of the abdominal cavity, and covers all the viscera.
Peritoni'tis.  Inflammation of the peritoneum; the terminal itis denoting inflamma-
   tion.
Pete'chijE.   Small  spots, similar  in shape and colour to flea-bites, which occur
   spontaneously on the skin.
Phar'ynx, from pepiuv, to carry.  The upper part  of the oesophagus or gullet at the
   back of the throat.
Phlebi'tis, from $te^, a vein, and itis, the termination for inflammation.  Inflamma-
   tion of a vein.
Phren'ic,  -fp^v, the mind.  A term applied to the diaphragm.
Pia Mater.   The  inner membrane of the brain, of delicate structure.  It covers the
   brain immediately, and  dips into its convolutions.
Placen'ta, signifying a cake.  The soft spongy body adherent to the uterus and con-
   nected with the fcetus  by the umbilical cord.
Pletho'ra, from rti.r)6u>, I fill.   Repletion or fulness.
 Pleu'ra, from pleuroma, the side or rib.   The serous membrane lining  the chest and
   covering the lungs.
 Pons  Varo'lii. An eminence on the upper part of the medulla oblongata, at the junc-
   tion of the  brain with  the spinal marrow.
 Progno'sis, from rtpo, before, and yuvooxu,, I know.  The judgment formed regarding
   the progress and termination of a disease.
 Pros'tate, from rtpo, before, and uotript, I  stand.   A glandular  body situated before
   the neck of the  bladder. 
glossary.
607
Pcr'pura.  Applied to a disease in which there are livid spots on the skin.  There
  is great prostration of slrength.
Pylo'rus, from rtvty, a gate, and ovpot, a guardian. The orifice of the stomach, where
  that organ joins the  intestines.
Py'romania, from rtvp, fire, and mania.  A propensity to  incendiarism.

Rec/tum, from rectus, straight.   The lower portion of the large intestines.
Rete Muco'sum.  A layer of the skin to which the colour of races is owing.  It is
  situated between the cuticle  and cutis, or true skin.
Ru'ce ;  ruga, wrinkle. Applied to the folds of the mucous membrane in the interior
  of the stomach and  bowels.

Scirr'hus, from gnuppog, hard. A disease in which parts become hardened, and assume
  a cancerous character.
Scrobic'ulus Cordis.   The pit  of the stomach.
Scro'tum, from scorteus, made of leather.  The firm skin  which covers the testicles.
Ster'torous; stertor.   The deep snoring which accompanies inspiration in apoplexy
  and in cases of narcotic poisoning.
Ster'num.  The chest-bone, to which the ribs are attached in front by cartilages.
Strang'ury, from cwpayyew, to  squeeze, and ovpov, urine.    Great difficulty in passing
  the urine.
Subsul'tus, from sub and satire, to make short leaps.  Involuntary and sudden con-
  tractions of the muscles.
Sugilla'tion, from sugillatio, a black mark.  Applied to a bruise,  and often  used
  synonymously with Ecchymosis.
Syn'cope, from ovyxort-tw, I fall  down. Sudden loss of sensation and motion from sus-
  pension of the action of the  heart.

Tenes'mus, from tuvw, I stretch. Frequent vain and painful desires to go to stool.
Teratol'ogy, from -ttpas, a monster, and xoyoc, discourse.  A description of monsters.
Tet'anus, from tuva.  Spasm  with rigidity of the muscles.  '
Tho'rax, 0copa|, a cuirass, or coat of mail.   The chest.
Ton'ic, from tavo, I stretch.  Applied to  spasm of the muscles when they are  in a
  fixed  state of rigidity.
Trache'a, from tpaxv?, rough,  and apT^pia, artery. An elastic cylindrical tube for the
  conveyance of air to the lungs.
Tris'mus, from tQutm, I gnash.   Spasmodic closure of the lower jaw.  Lock-jaw.
Turges'cence, from turgescere, to swell.   Applied to the enlargement or swelling of
  a part.

Val'vulje Conniven'tes.   The folds on the mucous membrane of the small intes-
  tines, so called from their converging or approaching one another.
Vas'cular,  from vas, a vessel.   That which belongs or relates to blood-vessels.
Ven'tricle, from ventriculus (dim. of venter,) small belly  or cavity. Small cavities in
  organs.
Ver'tebrjE, from vertere,  to turn.  The bones of the  spine.
Ver'tex.  The summit of the  head.
Vi'able, from via, a way. A term adopted from the French, to signify that condition
  of a new-born child in which its organs are so developed as to permit its continued
  existence.
Vib'ices.  Large purple spots  appearing on the  skin  in malignant  fevers; applied
  also to the striated marks of lividity sometimes seen on the dead body. 
 
                     INDEX.

\Theprincipal subjects are in capitals, the cases in italics.'}
Abdomen, wounds of the, 253;  peritonitis
  from blows on the, 254.
Abortion, 377; criminal  causes  of, 378;
  from drugs, 378;  post-mortem appear-
  ances, 381; feigned, 382; law relative to,
  382; medical responsibility in cases of,
  383; proofs required, 385; of monsters,
  386.
Abortives, specific, 379..
Abrasions in the drowned,  469.
Abstinence long, effects of, 547.
Acceleration of death in wounds, 226, 231.
Access presumed in  contested  legitimacy,
  397,416.
Acetate of lead, 104; of copper, 111; of mor-
  phia, 139.
Acetic acid, 71.
Acid,  sulphuric, 59; nitric, 63; muriatic,
  66;  oxalic, 67; tartaric, 70;  acetic, 71;
  arsenious, 74; arsenic, 92; meconic, 141;
  prussic, 142; carbonic, 526;  sulphurous,
  531.
Acid poisons, 59.
Aconite, poisoning by, 163.
Aconitina,  163.
Adipocere, production of, in the drowned,
  477.
JEthusa cynapium,  161.
Affiliation, questions of, 419.
Age of the  new-born child, rules for deter-
  mining, 284; medical questions  concern-
  ing,  393: no  legal impediment to mar-
  riage, 436; its effect on the crime of rape
  in relation to consent, 451; its influence
  on suicide, 486;  impotency, depending
  on, 436.
Ague drop, tasteless, 91.
Air, confined, suffocation from, 533; of drains
  and sewers, composition of, 539.
Albumen, detection of, in the stomach, 323.
Alcohol, poisoning by, 154.
Algaroth, powder of, 117.
Alienation, mental.   (See Insanity, 551.)
Alkalies, poisoning by, 71.
Allmitt, case of, 574.
Almonds, bitter, essential oil of, 149.
Almond flavour, 150.
Aloes,  poisoning by, 123.
Alum,  action of, on blood-stains, 219.
Amaurosis  from wounds of the orbit, 246.
Ambidextrous  persons, wounds produced
  by, 193.
Amenorrhcea, a cause of sterility, 443.
Amentia, 554.
Ammonia, poisoning by, 73.
Ammonio-chloride of mercury, 102.
Ammonio-sulphate of copper, 82.
Analysis, chemical, in  poisoning, 56; arti-
  cles preserved for, 56; rules for, 58.
Ancliffe, case of, 344.
Anderson, case of, 334.
Anderton v. Gills, 412.
Androgyni and Androgynce, 425.
Angus, Mr., case of, 374.
Animals, effects of prussic acid on,  144;
  analysis of blood of, 222.
Animal food, poisonous effects of, 131.
Animal irritants, 128.
Ankers, case of, 186.
Antimony, tartarized,  poisoning by,  114;
  chloride of, 118; detection of, 118.
Aorta, wounds of the, 251.
Aphonia from oxalic acid, 67.
Aqua fortis, 63.
Aram, Eugene, case of, 260.
Areolae of the breasts,  state of, in preg-
  nancy, 355.
Arseniates, alkaline, poisoning by the, 92.
Arsenic, metallic, 91; white, taste and so-
  lubility of, 75;  symptoms  caused by,
  75 ;  chronic poisoning by, 77 ; post-mor-
  tem appearances, 78;  death from exter-
  nal application of, 92; fatal doses, 79;
  doses of, influenced by habit, 37; period
  at which death occurs, 80;  analysis, as a
  solid,  81; in solution, 82 ; Marsh's pro-
  cess, 83; Reinsch's process, 84; analysis
  in organic mixtures, 85; in the tissues,
  88;  in the soil  of  cemeteries,  90;  in
  solids, 90; sulphurets of, 92;  contained
  in sulphuric acid and zinc, 84.
Arsenic acid, 92.
Arsenic, yellow, 92.
Arsenious acid, (see Arsenic,) 74.
Arsenites, alkaline, poisoning by, 91.
Arsenite of copper, 111.
Arsenuretted hydrogen, fatal effects of, 93.
Arteries, wounds of, 251.
Arterial and venous blood, 202.
Artificial inflation of the lungs, 305.
Ashford, case of, 473.
Asiatic cholera, mistaken for poisoning, 45.
Asphyxia, various forms of, 461; cause of
  death in, 462; from gases, 525.
Atavism in insanity, 555.
Atelectasis of the lungs, 299.
Atropa Belladonna, 164.
Auscultation in pregnancy, 356.
39 
610
INDEX.
Bacon, poisoning by, 132.
Bagster, Miss, case of, 563, 567.
Bainbrigge v. Bainlrigge,  573.
Baldry  v. Ellis, 565.
Ballottement in pregnancy, 357.
Balls, apertures produced by, 263; deflec-
  tion of, 265.
Balsoner, case of, 257.
Banbury peerage case, 436.
Barker, case of, 404.
Bastardy, adulterine, law regarding, 397.
Battley's sedative solution, 140.
Belladonna, 164.
Berries  of the yew,  167.
Bestiality, 459.
Bichloride of mercury, 101.
Bichromate of potash, 120.
Bicyanide of mercury, 103.
Binoxalate of potash, 71.
Birth,  proof of, in  criminal law, 316; in
  civil law, 387; concealment of, 375; date
  of,  393;  plural,  394; premature,  401;
  protracted, 408.
Births, post-mortem, 393; posthumous, 420.
Birtwhistle  v. Vardell, 398.
Bishop  and  Williams, case of, 524.
Bismuth, poisoning  by, 121.
Bitter Almonds, essential oil of,  149.
Bitter-sweet, effects of,  153.
Black drop, 139.
Bladder, ruptures of the, 255; spontaneous,
  256.
Blandy, case of, 48.
Bleeding, death from, (see Hemorrhage,)
  209.
Blight, case of, 198.
Blisters from burns and scalds, 273.
Blistering  fly, poisoning  by, 128.   (See
  Cantharides.)
Blood, marks of, in  death from  wounds,
  201;  state of the, in  wounds, 202 ; arterial
  and venous, 202;  on weapons, 200; evi-
  dence from spots, 203 ; tests for, 214; hu-
  man and animal,  222;  microscopical ex-
  amination of, 223;  extravasation on the
  brain, 244.
Blood-stains,  chemical  examination  of,
  214; on linen, 215;  distinguished from
  rust  and  fruit stains, 217; removal  of,
  218; on weapons, 219 ; caution respect-
  ing the analysis of,  221.
Blue  arsenic, 77.
Blue-rocket, poisoning by, 163.
Blue  stone, (see Blue  Vitriol,) 110.
Blue  Vitriol, 110.
Bocarme,  Count, case of, 165.
Body, examination of the, in poisoning, 48,
  54; exhumation of  the, 55; preternatural
  combustibility of the, 278; length and
  weight of the, in new-born children, 285;
  buoyancy of the, in drowning, 475; evi-
  dence from the position of the, in hanging,
  505.
Bolam, case of, 205.
Bones,  fractures of  the,  258 ; union by cal-
  lus, 251;  examination of exhumed, 260 ;
  of the fcetus, analysis of, 376.
Born alive,  signification of,  in  civil and
  criminal law, 316, 387.
Borradaile v. Hunter, 600.
Boughton, Sir T., case of,  13.
Boyer, case of, 162.
Brain, extravasation of blood on the, 244 ;
  wounds of the, 242; locomotion after se-
  vere injury to the, 237.
Brain, case of, 287, 346.
Bread, mouldy, poisonous action of, 126.
Breasts, changes in the,  in pregnancy, 354.
Brick-kilns, suffocation from the vapour of,
  533.
Brittlenes3 of the bones, 259.
Brixey, case of, 576, 584.
Brooke, case of, 601.
Brunswick green, HI.
Bryant, case of, 186.
Bullets, wounds produced by, 263.
Buoyancy of the lungs, 296; of the  body in
  drowning, 475.
Burke and M'Dougall, case of, 524.
Burns, Miss, case of, 374.
Burns and Scalds,  271;  before or after
  death, 273; characters of, in the living,
  274; in the dead, 274; the cause of death,
  278;  by corrosive liquids, 279 ,* from
  lightning, 542.
Butter of antimony, 118.
Butterfield, case of, 48.
Butcher, case of, 232.
Byron, case of, 347.
Cadaverous lividity,  181; spasm in drown-
  ing, 468.
Cesarean operation, 391.
Cdlamine, 120.
Calder, case of, 379.
Callus of bone, 259.
Calomel,  poisoning by,  101;  salivation
  from small doses of, 96.
Camplell, Dr., case of,  516.
Camphor,  poisoning by,  153;  compound
  tincture of, 139.  (See Paregoric  Elixir.)
Camplin, case of, 454.
Cancrum oris, 97.
Canalis venosus, closure of, 321.
Cantharides, 128; p. m. appearances, 128;
  fatal doses, 129 ; treatment and analysis,
  130.
Cantharidine, 130.
Capacity, testimonial, 564; testamentary,
  570.
Carbonate of potash and soda, 71;  of lead,
  108 ; of copper, 111; of zinc, 120.
Carbonic Acid, suffocation by, 526 ; p. m.
  appearances,  527 ; mode of action, 527;
  treatment, 528; analysis, 529; combustion
  in mixtures of, 533; rapid diffusion of, 534;
  alleged murder by, 530; of lime kilns, 532.
Carburetted hydrogen, suffocation by,'535.
Carbonic oxide, 535.
Carminative, Dalby's, 138.
Carnal knowledge, 449.
Carnt, case of, 473.
Carotid arteries,  locomotion  after  wounds
  of the, 239.
Cashin, Miss, case of, 280.
Castor-oil seeds, poisoning by, 125.
Catamenia, cessation of the, a sign  of preg-
  nancy, 353.   (See Menstruation.)
Catechu mistaken for blood, 218. 
INDEX.
611
Catsup, poisoning by,  167.   (See Mush-
  rooms.)
Caustic alkalies, poisoningby,71; lunar,120.
Cawley, case of, 176, 258.
Cemeteries, mephitic vapours of, 541.
Certificates of insanity, rules regarding, 561.
Cerusse, poisoning by, 107.
Charcoal vapour, effects of, 529.
Cheese, poisoning by, 132.
Chemical analysis,articles preserved for,56.
Chemical evidence in poisoning, sources of,
  70.
Cherry kernels, 151.
Cherry laurel-water, and oil, 151.
Cherry ratafia, poisoning by, 152.
Chest, wounds of the,  248; changes  pro-
  duced in the, by respiration, 290.
Child-murder, 281.   (See Infanticide.)
Child, new-born, age and maturity of, from
  the sixth to the ninth month, 284; proofs
  of live birth in the, 324; survivorship of,
  325.
Children, supposititious, 385.
Chloride of mercury (calomel,) 101; of cop-
  per, 111; of antimony, 118 ; of zinc, 119.
Cholera mistaken for poisoning, 43.
Christina Bitter, case of, 396.
Christopher, case of, 314.
Chrome, poisoning by, 121.
Chronic poisoning, 47;  by arsenic, 77 ; by
  mercury, 95 ;  lead, 108.
Cicatrix, nature of a, 234; evidence from,
  235.
Cicatrization of wounds, 234.
Cicuta virosa, 161.
Cinnabar, poisoning  by, 103.
Circulation, fcetal, changes produced in the,
  by respiration, 318, 321.
Circumstantial evidence, in wounds, 197.
Citrate of iron mistaken for blood, 219.
Civil responsibility of the insane, 569.
Clarke, case of, 260.
Classes of poisons, 39.
Classification of poisons, 39.
Clothing, analysis of acid stains on, 63, 66 ;
  of blood on, 215.
Cluderay, case of, 36.
Coagulation of blood, 217.
Coal-vapour, effects of, 531; gas, suffocation
  by, 535.
Cocculus Indicus, poisoning by, 165.
Coke-vapour, effects of, 531.
Colchicina, 160.
Colchicum, poisoning by, 160.
Cold,  death from, 546; appearances, 547;
  effects of, on the insane, 552;  infanticide
  by, 334 ; murder by,  547.
Colic, painter's, 108.
Collier, case of, 269.
Colica pictonum, 108.
Colocynth, action of, 123.
Coma from burns and scalds,  273.
Combustion, human, alleged, 278.
Commissions of lunacy,565; superseded,567.
Compos mentis, 551, 565.
Compression of the lungs, effects of,  307.
Concealment of birth, 375.
Concealment of pregnancy, 361.
Concealment of delivery, 363.
Concealed sex, 433.
Conception, 398,400.
Concussion of the brain, 242; known from in-
  toxication, 243; of the spinal marrow, 247.
Condi, Prince de, case of" the, 507.
Confessions, in drunkenness, 597.
Confined air, effects of, 533.
Congenital disease, a cause of death in new-
  born children, 329; defects, causes of im-
  potency and sterility, 437, 438.
Conium, poisoning by, 161.
Consciousness, retention of, in poisoning by
  prussic acid, 144; after severe injuries to
  the head, 237.
Contents of the stomach, rules for collect-
  ing, 53; identity of, preserved, 56.
Contracts made by  the  insane, when  in-
  valid, 569.
Contused wounds, 187.
Contusions  on the living and  dead,  179;
  when inflicted on the living, 236.
Cope v. Cope, 416.
Copper, poisoning by, 110; salts of, 110; in
  articles of food, 113; analysis of the salts
  of,  112; sulphate of, poisoning by, 110.
Copperas, poisoning  by, 120.
Cord, umbilical, point of insertion of the,
  285; death from compression of the, 328;
  evidence furnished by the, 317 ; strangu-
  lation by the, 342.
Cord, mark  of the, in hanging, 493.
Cordial, Godfrey's, 138.
Corpora lutea, 369; conflicting evidence re-
  specting, 370.
Corrosion distinguished from ulceration, 50.
Corrosive liquids,  burns from, 279.
Corrosive  Sublimate,  solubility,  taste,
  symptoms,  94;  salivation, an  effect  of,
  95;  p. m. appearances,  97;  fatal  dose,
  98; period of death, 98; chemical analy-
  sis, 98.
Cotterall V.  Cotterall, 411.
Counter-stroke, fractures by, 245.
Courtesy, tenancy by, 391.
Courvoisier, case of, 199, 579, 581.
Cowper, Spencer, case of, 475.
Cox, case of, 523.
Cranium, fractures of the, 238,  245;  acci-
  dental in the new-bom child, 337.
Crepitation of the lungs, 292.
Criminal Abortion, 377.
Criminal Responsibility in insanity, 574 ;
  in  drunkenness,  597;   somnambulism,
  599 ; in deafness and dumbness, 600.
Croton-oil, poisoning by, 124.
Cruse, case of, 597.
Crutchley, case of, 347.
Crypsorchides, virility of, 437.
Cuts and stabs, 187.
Cumming, Mrs.,  case of, 565.
Cyanide  of potassium, poisoning by,  151 ;
  of mercury, 103.
Cytisine, 166.
Cytisus laburnum, poisoning by, 166.

Dadd, case of, 57.9.
Dalby's carminative, 138. 
612
INDEX.
  Dalmas, case of, 193.
  Daly, case of, 262.
  Dalhousie v. M'Douall, 398.
  Darnel, bearded (Lolium temulentum,) 127.
  Date of birth, 393.
  Datura stramonium, poisoning by, 162.
  Daturia, 1G2.
  Dai v. Day, 42b.
  Day, case of, 570.
  Dead, exhalations from the, 541; contusions
   on the, 178.
  Deadly poison, 33.
  Deadly nightshade, 164.
  Deaf and dumb, 600.
 Deafness and dumbness, feigned, detection
   of,  601.
 Debility, death of the new-born child from,
   327.
 Decay, food rendered poisonous by, 132. «
 Decayed flesh, poisoning by, 132.
 Decoction of poppies, death from, 138.
 Deeds  executed by the insane, law regard-
   ing, 570 ;  by drunken men, 597.
 Defects, sexual, 425.
 Deformities, evidence from, in disputed pa-
   ternity, 419.
 Deformity from wounds  of the  face, 247;
   fractures and  dislocations, 261.
 Deflection of balls, 265.
 Defloration,  signs of, 452.
 Delirium, mistaken for insanity, 552.
 Delirium tremens, 598.
 Delivery, protracted,  death of the child
   from, 327; accidental, 333;  sudden,  in
   the  erect  posture, 337;  locomotion and
   exertion after, 334; signs of, in  the liv-
   ing, 364; feigned and unconscious, 366;
   during  sleep, 367; signs of,  in the dead,
   368 ; of moles and hydatids, 386.
 Delusion  the main  character  of insanity,
   552; connexion of, with  the acts of the
   insane, 571, 580.
 De lunatico inquirendo, 564.
 Dementia, 554,  573.
 D'Eon, Chevalier, case of, 429.
 Development, progress of,  in  the child,
   284; evidence from, in legitimacy, 401,
   406,407.
 De ventre inspiciendo, writ  of,  359.
 Destructive thing, meaning of,  in law, 34.
 Devonald v.  Hope, 358.
 Diaphragm,  ruptures  of the, 239,  252;
   wounds of  the, 252.
 Dickenson, case of, 575.
 Dicephalous monsters, 423.
 Digitalia,  161.
 Digitalis,  poisoning by, 161.
Dipsomania, 597.
 Direction  of wounds, evidence from, 192.
 Disease, action  of poisons aggravated  by,
   41;  mistaken  for poisoning,  42 ; latent,
   death from, in wounds, 225 ; accelerating
   death from personal injuries,  231.
 Disease, effect of, on the mind, 570.
 Diseased flesh poisonous, 132.
 Dislocations,  legal meaning  of, 171; from
   muscular   spasm,  261;  accidental  in
   drowning, 480.
  Disomatous monsters, 395.
  Divorce, medical  evidence in suits of, 441.
  Dixon, case of, 256.
  Docimasia pulmonaris, 297.   (See Hydro-
    static Test.)   Circulationis, 318, 3*24.
  Dore and Spry, case of, 78.   *
  Douglas peerage case, 418, 442.
  Double monsters, 395.
  Dover's powder, 139.
  Dress, evidencefrom the, in wounds,188,196.
  Dripping poisoned by lead, 109.
  Drowning—in child-murder, 332; cause of
    death in, 460, 462 ; period at which death
    occurs, 463 ; treatment, 466; appearances,
    467;  was death caused by?  472; buoy-
    ancy of the body in, 475 ; presumption of
    survivorship, 477;  summary of proofs,
    478;  origin of marks of violence in cases
    of,  480; homicidal or suicidal, 483; in
    shallow water, 484 ;  from partial immer-
    sion, 485; weights attached  to the body
    in, 486.
 Drugs used as abortives, 379.
 Drummond, Mr., case  of, 262, 596.
 Drunkenness, civil  and criminal  responsi-
   bility in  cases of, 596, 597 ; restraint in
   cases of, 598.
 Ductus arteriosus, closure  of, 318.
 Dujarrier, case of, 270.
 Duration of cases of poisoning, 46.
 Durnell v. Corfield, 573.
 Dyce Somlre's case, 568.
 Dyes, red, mistaken for blood, 217.
 Dyer's spirit, poisoning by, 120.

 Eager v. Grimwood, 407.
 Eccentricity mistaken for insanity, 553; in
   wills, 571.
 Ecchymosis, nature of, 176; seat of, and
   changes of colour in, 177; evidence from,
   178,180; production of, after death, 181;
   various causes  of, in  the  living, 180;
   spontaneous, in the dead, 182;  changes of
   colour in, 183 ; not always  a result of
   contusion,  183; exceptional  cases, 184;
   in strangulation  by the  umbilical  cord,
   342;  natural marks resembling, 343; in
   hanging, 495.
 Edwards, case of, 433.
 Effluvia of drains and sewers, 539.
 Elderfield, case of, 596.
 Elder leaves, effects of, 125.
 Electric fluid, action of, 542.   (See Light-
   ning.)
 Elixir, paregoric, 139.
 Ellison, case of, 199.
 Embryo, characters of the, to the  sixth
   month, 372.
 Emerald green, poisoning by, 111.
 Emetic, tartar, poisoning by, 114.
 Emphysema of the lungs, 303.
Enoch, case of, 346.
Epigastrium, death from blows on the, 253.
Epilepsy, its effect on the mind,  570.
Epileptics, Parisian, cases of the, 145.
Epispadians, 438.
Ergot of rye in  bread, 127; properties  of,
  as an abortive, 379. 
INDE
Erysipelas following wounds, 233.
Essex, Earl of, case of, 199.
Ether, poisoning by, 155.
Ether, vapour, 155.
Evidence, identity of articles for analysis,
  55; notes, when and how used in, 57 ;  of
  poisoning in the living, 41; in the dead,
  48;  circumstantial and  presumptive  in
  wounds, 198; medical, in fractures and
  dislocations, 259.
Examination of wounds, 173; of the female
  in child-murder, 349 ; of lunatics, 566.
Excitement a cause of extravasation, 245.
Exfoliation of the cuticle, 318.
Exhalations from the dead, 541.
Exhumation of bodies,  55.
Extent of wounds, 192.
Extract, Goulard's, poisoning by, 107.
Extra quatuor maria, rule of, 397.
Extra-uterine pregnancy, 386; life, 387.
Extravasation  of  blood on the brain, 244;
  causes and seat of, 215;  from excitement
  and intoxication, 245.

Face, wounds of the, 246.
Fajat, Francois, case of, 442.
Fama clamosa, 404.
Family likeness, evidence from, 419.
Farina, detection  of, in the stomach of the
  new-born child, 322.
Farmer, case of, 579.
Fasting, long, effects of, 548.
Fat poisoned by lead glaze, 109.
Features, evidence from the, 419.
Fever, death from, after wounds and opera-
  tions, 228.
Feigned poisoning, 45;  wounds, 205; preg-
  nancy, 358;  menstruation, 354; delivery,
  366;  insanity, 556; abortion, 382;  deaf-
  ness and dumbness, 601.
Fibrin, detection of, in blood-stains, 216.
Fish-poison, 131.
Fish v. Palmer, 346, 396.
Flagellation, death from, 211.
Flanagan, case of, 577.
Flesh, diseased, poisoning by,  133.
Flogging, military, death from, 211.
Fly-powder and water, death from, 91.
Fcetal circulation, changes in the, caused
  by respiration,  318, 320.
Fcetal stomach, contents of the, 323;  heart,
  sounds of the, 356.
Foeticide, 377.  (See Abortion.)
Foetus,  characters of  the, from conception
  to the sixth month,  372; from  the  sixth
  to the ninth  month, 284.
Food, poisonous, 131; death from privation
  of, 548.
Fool's parsley, poisoning by, 161.
Foramen ovale, closure of the, 321.
Fowler's mineral  solution, 91.
Fowles, case of, 514.
Fox, case of, 359.
Foxglove, poisoning by. 161.
Fractures of the skull, -238,242; of the
  spine, 217;  in  infanticide, 336; sponta-
  neous, 259;  before or after death,  259:
  period required for union of, 260;  proofs
:x.                                  613

  of, in exhumed bones, 260; locomotion
  after, 261; resembling dislocations, 261;
  accidental in the drowned, 482;  from
  lightning, 543.
 Fragilitas ossium, 259.
 Francis, case of, 581.
 Franklin, ca»e of, 112.
 Fratris possessio, 391.
 Frazer v. Bagley, 365, 419,453.
 Frere v. Peacock, 572.
 Frith, case of, 320.
 Frost, case of, 575.
 Fruits, preserved, poisoned by copper, 114.
 Fungi,  poisoning by, 167.
 Fungin, 167.

 Gall-bladder, ruptures of the, 254.
 Gallop, case of, 574.
 Gamboge, poisoning by, 123.
 Gammon, case of, 448.
 Gangrene of the mouth, 97.
 Gardiner peerage case, 416.
 Gas-coal, suffocation by, 535.
 Gaseous poisons, 525.
 Gelatinized (spontaneous) perforation of the
  stomach,  52.
 Genitals, wounds of the, 257.
 George, case of, 468.
 Gestation, natural period of, 398; duration
  from one intercourse, 399; premature,
  401; protracted, 408;  legal decisions re-
  specting,  416.
 Gilson, case of, 595.
 Giles, case of, 576.
 Gilmour, case of, 80.
 Glass,  characters of wounds  caused by,
  186.
 Glaze,  lead, poisonous effects of,  109.
 Godfrey's cordial, 138.
 Good, case of, 276.
 Goodall, case of, 385.
 Goodman, case of, 600.
 Gonorrhoea, evidence from, in cases of rape,
  450.
 Goule,  case of, 579.
 Goulard's extract, poisoning by, 107.
 Grave-yards, vapour of, 511.
 Greek,  case  of, 514.
 Greenacre, case of, 175, 579.
 Greensmith, case of, 575.
 Green vitriol, poisoning by, 120.
 Grievous bodily harm in wounds, 172.
 Grimwood, case of, 407.
 Grotta  del Cane, 528.
 Grove, case of, 5S.3.
 Gunpowder, wounds from,  268; identity
  from the flash of, 269.
 Guns, evidence of recent discharge of, 270.
 Gunshot Wounds,  262; before  or  after
  death,  263;  characters of, 263;  acci-
  dental or suicidal, 266; received before
  or behind, 267; from small  shot, 2U7;
  from wadding and gunpowder, 26S.

 Habit,  its influence on poisons, 37.
 Hacking, case of, 350.
 Hadfield, case of, 578.
 Haematalloscopy, 2:22. 
614
INDEX.
Hematosine, properties of, 214.
Hemorrhage, death  from,  208; internal,
  210; death of the new-born child from,
  328.
Hagg, case of, 348.
Haines, case of, 270.
Hak, evidence from the colout of the, in pa-
  ternity, 419.
Hallucination in insanity, 552.
Hamilton, case of, 456.
Hanging, death from, 487; injury to spinal
  marrow in, 488, 503; treatment and re-
  suscitation in cases of, 489;  rapidity of
  death in, 488; post-mortem appearances,
  491;  evidence of, from the mark  of the
  cord, 493, 495;  summary of proofs, 497 ;
  marks of violence on the body, 499; ho-
  micidal, 501; evidence from  position of
  the body in, 504.
Hartley, case of, 569,
Hartshorn, poisoning by, 73.
Harwood v. Baker, 570.
Hawkins, case of, 407.
Hay don, case of, 73.
Haynes, case of, 172, 385.
Hazell, case of, 200.
Head, wounds of the,  242;  locomotion  af-
  ter severe, 237.
Heart, locomotion after wounds of the, 238;
  wounds of the, 249.
Heathcote, case of, 407.
Hellebore, white, poisoning by,  36, 160.
Hemiplegia, its effects on the mind,  570.
Hemlock, poisoning by, 161.
Henbane, poisoning  by, 152.
Hepatization of the lungs in infanticide, 298.
Hereditary transmission of  insanity, 555,
  594.
Hermaphroditism, 425.
Hernia, phrenic, 252.
Hey wood, case of, 524.
Hiera picra, 124.
Hill  v. Philip, 559.
Hdl, case of, 564.
Hoffman's liquor, analysis of, 155.
Homicidal wounds, characters of, 189.
Homicidal Monomania, 575;  causes  of,
  and symptoms  of, 576, 577;  legal tests
   of, 577 ; medical tests of, 578 ; Esquirol's
   division of, 588; diagnosis of, 5SS ; sud-
  den recovery from attacks of, 590.
Hooner, Commonwealth v., 415.
Horder, case of, 340.
Hull, case of, 268.
Hulme, case of, 230.
Human combustion, 278.
 Hunger, death  from, 548.   (See Starva-
   tion.)
Hunt, case of, 360.
 Hunter (Dr. W.) on the hydrostatic test,
   313;  on the  accidental  suffocation  of
   new-born children, 327, 331;  on infanti-
   cide by strangulation, 341.
 Hydatids, uterine, expulsion of, 373, 386.
 Hydrochloric acid, 66.  (See   Muriatic
   Acid.)
 Hydrocyanic acid, poisoning by, 142.  (See
   Prussic Acid.)
i Hydrogen, arsenuretted, 93.
 Hydrogen, action of, when breathed, 525.
 Hydrogen test for arsenic, 83.
 Hydrostatic Test, 297;  evidence  fur-
    nished by, 315; objections  to the, from
    sinking  of the lungs, 298; from putre-
    faction, 303; artificial inflation,  305;  re-
    sults of compression, 309; erroneous  no-
    tions respecting the, 310.
 Hydrosulphuret of ammonia, action of  va-
    pour of, 540.
 Hyland, case of, 345.
 Hymen, evidence derived from the, in rape,
    449 ; as a sign of virginity, 452.
 Hyoscyamia, 152.
 Hyoscyamus, poisoning by, 152.
 Hypospadias, 438.

 Identity of substances  for  analysis, 55;
    from  fractured bones,  260;  from  the
    flash of gunpowder, 269; of the body in
    infanticide, 318.
  Idiocy, 554.
  Idiosyncrasy in poisoning, 38.
  Illusions in insanity, 552; in drunkenness,
    598.
  Imbecility, 552 ; senile, 553.
  Immaturity of the foetus, 283 ; death of the
    child from,  327; in cases of abortion,
    335; evidence from,  in cases of legiti-
    macy, 406, 407. '
  Impediments, canonical, to marriage, 444.
  Impotency,  434; from  age,  435;  disease
    and malformation, 436; as a ground of
    divorce, 446.
  Improper food, death from, 131.
  Imputed wounds, 205.
  Incapacity, sexual, 434.   (See Impotency.)
  Incendiarism, propensity to, 595.
  Incoherency, 552.
  Incompetency,  mental,  medical  tests of,
    566;  from ignorance, 567.
  Indictments, technicalities in, 34.
  Indigo, sulphate of, poisoning by, 63.
  Infanticide, 281;  evidence in cases of,
    282;  proofs  of life  before respiration,
    287;  after  respiration,  290 ; rules  for
    inspection of the body  in, 291;  static
    tests in, 292; Ploucquet's  tests in, 295;
    legal proofs of, 313; proofs of live birth
    in, 316; survivorship of the child in cases
    of, 325; natural  causes of death in,  327;
    violent causes of death, 330;  summary
    of medical proofs in,  340 ; frequent ac-
    quittals in cases of, 350.
  Infants, action of opium on, 137.
  Inflation, artificial, of the lungs, 35.5.
  Inheritance, questions relating to, 387.
  Insane, responsibility of the, in civil cases,
    569; in criminal cases, 574;  effects  of
    cold on the, 552.
  Insanity, legal definition of, 551; various
    forms of, 552;  hallucinations  and  allu-
    sions  in, 552;  moral,  553;  hereditary
    transmission  of, 555;  feigned,  556;  post
    mortem appearances of,  554;   statistics
    of, 556; rules for applying restraint in,
    558; certificates of, 560;  interdiction in 
INDEX.
615
  cases of,  5G4 ; lucid intervals in, 568 ;
  civil responsibility in cases of, 569; plea
  of, in criminal cases, 574; homicidal (see
  Homicidal  Monomania,)  575; restric-
  tion  of  medical opinions,  in cases  of,
  573,589.
Inspection  of  the  body,  rules for  the,  in
  poisoning, 54; in wounds,  173; in child-
  murder, 291.
Insurance, life, questions regarding, 591.
Intellectual insanity, 553.
Intercourse,  duration  of gestation  after,
  399;  proofs  of, 448, 451; carnal, legal
  proofs of, 447, 451.
Interdiction in insanity, 564.
Intervals, lucid, in  insanity,  568; validity
  of acts performed during, 569.
Intestines, ruptures of the, 255.
Intoxication distinguished from concussion,
  243; a cause of  fatal extravasation of
  blood, 242.
Iron filings, as an abortive, 379.
Iron, sulphate and muriate of, poisoning by,
  120.
Iron-moulds mistaken for blood-stains, 218.
Irritant poisons, general effects of, 39, 48.
Irritants, mechanical, 36; mineral, 59; ve-
  getable, 123;  animal,  128.

Jackson, case of, 601.
Jalap, effects of, 123.
Jennings, case of, 83.
Johnson, case of, 524.
Jorg on atelectasis, 299.
Juniperus Sabina, poisoning by, 124.
Jury of matrons, 360.

Kernels  and  seeds, prussic  acid  obtained
  from, 151.
Ketchup (catsup,) poisoning by, 167.
Kettleband, case of, 482.
Khan, Meer, case of, 260.
Kidneys, ruptures of the, 255.
Kiestein in the urine as a sign of pregnancy,
  357.
King's yellow a poison,  93.
Kinghom case, the, 404.
Kirkwall, Lady, case of,  565.
Klein  (Dr.) on the fractures  of the skull in
  new-born children, 338.
Kleptomania, 596.

Labour, premature, responsibility in  in-
  ducing, 383.
Laburnum, poisoning by, 166.
Lacerated wounds, 187.
Lactuca virosa and sativa, 153.
Lactucarium, 153.
Lapis  infernalis, 120.
Latent disease, death from, in wounds, 225.
Laudanum, poisoning by, 134.
Laurel-water and oil, poisoning by,  151.
Laurence, case of, 583.
Lead, poisoning by  acetate of, 105 ; carbo-
  nate, 108 ; oxides of, 109 ;  analysis of the
  salts of, 107; meconate of, 142.
Lead-glaze, poisonous  effects of, 109.
Legal tests of insanity in criminals, 577.
Legitimacy, legal presumption of, 397; of
  children born  after the  death  of the
  mother, 398; period of  gestation in refe-
  rence to, 398 ; disputed  from shortness of
  gestation, 404; viability in reference to,
  402 ;  proofs of, from the state of the off-
  spring, 401, 406, 414; disputed,  from
  long  periods of gestation, 413; in what
  cases admitted, 416; inferred  from pa-
  rental likeness, 419.
Lettuce opium, 153.
Leucorrhoea a cause of sterility, 443.
Life, legal and medical, 316,  387.
Life-insurance, questions relating to, 591.
Lightning, death from, 542 ;  post-mortem
  appearances, 543; civil action concern-
  ing the effects of, 545.
Likeness, parental, evidence from, 419.
Lime-kilns, suffocation by the vapour of,
  532.
Lines, case of, 448.
Liquids, boiling, death from, 35 ; corrosive,
  burns by, 279.
Litharge, poisoning by, 109.
Live-birth, proofs of, in child-murder, 287,
  316;  in civil  suits, 387;  evidence of,
  from crying, 390.
Liver, ruptures and wounds of the, 254.
Lividity, cadaverous, 181;  changes of colour
  in, 182.
Lobelia, poisoning by, 165.
Lofthouse, case of, 75.
Lochia, evidence from the, 365.
Lock-jaw, death  from, in  wounds, 231.
Locomotion  in poisoning by prussic  acid,
   144;  after severe personal injuries, 237 ;
   of females after recent delivery, 334.
Lolium  temulentum,  poisoning by, in
   bread, 127.
Long fasting, effects of, 548.
Longley, case  of, 479.
Lucas, case of, 576.
Lucid intervals, 568.
Lunacy, 551; commissions of, 564; act, le-
   gal provisions of the, 560.
Lunar caustic, poisoning by, 120.
Lunatics,  restraint applied  to,  558; dis-
   charge of, 563 ;  testimonial capacity of,
   564; examination of, 566; responsibility
   of, in civil cases, 569 ;'  wills by, 570; in-
   terdiction of, 564.
Lungs, wounds of the, 249 ; examination of,
   in new-born  children, 291 ;   variably
   affected  by  respiration,  292;  specific
   gravity of, 296;  atelectasis of, 298 ; pu-
   trefaction of, 303 ; artificial inflation of,
   305.
Lung tests, 292.
Luscombe v. Prettyjohn,  399, 415.

M'Callum, case of, 590.
M<Comas, case of, 451.
M'Cormick, case of, 80.
M'Donougk, case of, 451.
Macdougnl, case of, 334.
Maclean, case of, 407.
M'Naughten,  case of, 581.
Macrae, case of, 449. 
616
INDEX.
 Macintyre, case of, 332.
 Maddock, case of, 560.
 Magarity, case of, 267.
 Magistery of Bismuth, 121.
 Majority, questions relative to, 393 ; when
   attained, 394.
 Malapraxis, alleged, in fractures and dislo-
   cations, 261.
 Malformation,  death of the new-born child
   from, 328 ; sexual, 425.
 Malignant  cholera mistaken for poisoning,
   45.
 Mania, 552 ; insensibility to cold in, 552;
   puerperal, 594; homicidal, 575; suicidal,
   590.
 Marks of blood, evidence from  form and
   situation of, 200;  chemical  examination
   of, 214.
 Marriage, impediments to, 444; of the in-
   sane, 569.
 Marsh's test for arsenic, 83.
 Martin, Jonathan, case of, 595.
 Matrons,  jury of, 360.
 Maturity  of the  new-born  child, signs of,
   285.
 Meadow saffron, 160.
 Meal, symptoms of poisoning after a, 44.
 Mechanical injury, death  from, 211, 225.
 Mechanical irritants, 36.
 Meconic acid, tests for, 141.
 Medical   responsibility,  in  wounds, 233,
   261; in cases  of  insanity, 562 ; in deli-
   very, 383.
 Medico-legal Reports, 57.
 Meer, Khan, case of, 260.
 Membranes, child born in the, 375.
 Menispermum cocculus, 165.
 Menses, suppression of, in pregnancy, 353;
   a cause of insanity,  584, 439.
 Menses.   (See  Menstruation.)
 Menstrual blood, characters of, 222.
 Menstrual climacteric, 440.
 Menstruation, suppression of, a sign  of
   pregnancy, 353 ; pregnancy  before, 353,
   439;  feigned,  354;  conception during,
   370; relation of gestation to, 400; falla-
   cies in calculating pregnancy from, 410 ;
   age at which it appears, 439; appearance
   of, in infants, 440; age at which it ceases,
   440; pregnancy after  the cessation  of,
   441; its continuance to late periods  of
   life, 441; absence of, a cause of sterility,
   443 ; in hermaphrodites, 430.
 Mental alienation, 551.
 Mephitic  vapour of cemeteries, 541.
 Mercurius vitae, 117.
 Mercury, poisoning  by the salts  of, 94;
   bi-chloride of, 94;  chloride of, 101; am-
   monio-chloride,  102;   sulphurets, 103;
   oxide of, 102; sulphate  and bicyanide of,
   103; nitrates, 104.
Metallic irritants, 74.
Microscopical  evidence in  rape,  455;  in
   hanging, 495.
Midwifery, malapraxis in, 351.
Milk, detection of, in the stomach, 323.
Mitigate,  case of, 348.
Milk sickness, 133.
 Milligan, case of, 599.
 Mind, unsoundness of, 551.
 Mineral green, poisoning by, 111.
 Mineral poisons, 74.
 Mineral solution, Fowler's, 91.
 Mineral, turbith, 103.
 Minium, poisoning by, 109.
 Minor.   (See Minority.)
 Minority, questions relating to, 393.
 Miscarriage, legal meaning of, 377.
 Misters, case of, 218.
 Moles, nature of, 372 ; abortion of, 386.
 Monkhouse, case of, 586.
 Monkshood, poisoning by,  163.
 Monomania, 553;  homicidal, 577; suicidal,
  590.
 Monorchides, virility of, 436.
 Monsters, their  destruction not permitted,
  329; abortion of, 386; legal definition of,
  395; varieties,  395;   criminal responsi-
  bility of,  395.
 Moral insanity,  553, 576, 572.
 Morgan v.  Boys, 572.
 Morison's pills, death from, 123.
 Morphia  in opium, 135; and  its salts, poi-
  soning  by, 139;  chemical  analysis of,
  141.
 Morris v. Davis, 417.
 Mortality of wounds, 208.
 Mortiboys, case  of, 331,
 Mortlock, case of, 262.
 Mosely, case of, 450.
 Mother, examination  of the, in infanticide,
  349.
 Motives for crime, evidence from, 578.
 Mouldy bread, effects of, 126.
 Moulton v.  Cameroux, 570.
 Mouth, gangrene of the, 97.
 Mucor mucedo in bread, 126.
 Midway v.  Croft, 573.
 Munro v. Munro, 398.
 Muriate of  iron, 120; of morphia, 139.
 Muriatic Acid, poisoning  by, 66.
 Mussels, poisoning by, 131.
 Mushrooms, poisoning by,  167.
 Mutton, decayed, effects of, 132.

 Nsevi mistaken for marks of violence in in-
  fanticide,  344.
Narcotic poisons, general effects of, 40 ; va-
  rieties of, 139.
Narcotico-irritants, effects  of, 40 ; varieties
  of,  157.
Navel-string,  317,  339,  (see Umbilical
  cord.)
Needles and pins,  effects  of, when swal-
  lowed, 37.
Nicotiana tabacum, 164.
Nicotia, 164.
Nightshade, woody, effects of, 153 ; deadly,
  164.
 Nitrate of mercury, 104; of silver, 120; of
  bismuth,  121.
Nitric Acid, poisoning by,  63;  appear-
  ances, 64; fatal doses, 64;  analysis, 65 ;
  on articles of clothing, 66.
 Nitrogen,  action of, when breathed, 525.
 Non-compos mentis, 551. 
INDEX.
617
Nose, wounds of the, 246.
Notes, use of, in evidence, 58.
Nottidge v. Ripley, 559.
Noxious substances, legal meaning  of, 382.
Noyau, properties of, 151.
Nux vomica, poisoning by, 157.

(Edema of the lungs in infanticide, 298.
CEnanthe crocata, 161.
Oil of vitriol, poisoning by, 59.  (See Sul-
  phuric Acid.)
Oil of croton, 124.
Oil of savin, 124.
Oil of tansy, 124.
Oil of tar, 126.
Oil of bitter almonds, 149.
Oil of turpentine, 126.
Operations, surgical, death from, 232.
Operation, Csesarean, 391.
Opium,  poisoning  by,   134;  symptoms
  caused  by, 135; appearances, 135; fatal
  doses, 135 ; action of, on young children,
  137; process for detecting, 140.
Orbit, wounds of the, 246.
Orleans, Duke of, case of, 243.
Orpiment, poisoning by, 92.
Ossification, process of, 250;  in the  foetus,
  284;  defective,  simulating violence,
  339.
Ovum, examination of the, 372.
Over-maturity in the offspring, 422.
Owen and Thomas, case of, 479-
Oxalic Acid, symptoms  caused  by, 67 ;
  appearances and fatal doses  of, 68; period
  of death, 69; analysis, 69 ; in liquids con-
  taining organic matter, 69.
Oxford, case of, 582.
Oxide of mercury, 102 ; of lead, 109.
Oysters, poisonous effects of,  132.

Painter's colic, 108.
Palmer, Fish v. 389.
Pappian law, provisions of the, 444.
Paralysis from  lead, 105;  effect of,  on the
  mind, 570.
Paregoric elixir, 139.
Parental likeness, evidence from, 419.
Parturition  (see Delivery,)  363; induces
  insanity,  576.
Pascoe, case of, 380.
Patch, case of, 198.
Pate, case of, 586.
Paternity, questions relating to, 418.
Paterson, case of, 598.
Pearce, case of, 264.
Pearlash, poisoning by, 72.
Pearl, white, 121.
Pears, essence of Jargonelle,  150.
Penfold v. Crawford, 570.
Perforation  of the stomach  mistaken for
  poisoning, 50; varieties of, from poison
  and disease, 51.
Peritonitis a result of blows  on the  abdo-
  men, 354.
Periwinkles, irritant effects of, 132.
Peyrins, case of, 424.
Peytel, M., case of, 264.
Phelps, case of, 244.
Phillips, case of, 385.
Phrenic hernia, 252.
Pichegru, Gen., case of, 513.
Pickles, poisoned by copper, 114.
Picrotoxia, 166.
Pinckard, case of, 516.
Pins, administration of, to infants, 37.
Pippins, essence of, 150.
Plants, narcotico-irritant of the U. S., 169.
Plea  of  pregnancy, 359;  of  insanity in
  criminal cases,  585; uncertainty  of the
  law regarding, 587.
Plural births, 394.
Ploucquet's test, 295.
Poisons, definition of, 33; law respecting
  the administration of, 31; irritants and
  corrosives, 39;  narcotic  and narcotico-
  irritants, 40; slow and rapid deaths from,
  46; effects modified by disease, 41; ga-
  seous,  525.
Poisoned articles of food, identity of, 55.
Poisoning, rules for investigating cases of,
  56; evidence of, in the living, 53 ; sud-
  den death resembling, 47; disease mis-
  taken for, 45; chronic, 47;  evidence in
  the dead, 48; ulceration, corrosion, and
  softening in, 50 ; perforation, 50; chemi-
  cal analysis in, 56; infanticide by, 349.
Poisonous and non-poisonous substances, 36.
Poisonous food, 131.
Poisonous gases, 525.
Poppies, syrup and decoction of, 138.
Pork, poisoning by, 39, 132.
Porter, cocculus indicus in, 166.
Possessio fratris, 391.
Posthumous births, 393, 398; children, 420.
Post-mortem appearances, evidence from,
  in poisoning, 48; births, 398.
Potash and its carbonates, poisoning by, 72 ;
  analysis, 72 ; binoxalate of, 70 ; arsenite
  of, 91; bichromate of, 121; arseniate of,
  92.
Potassium, cyanide of, 151.
Poulton, case of, 314.
Praslin, Duke de, case of, 80,  177, 203,
  212.
Precipitate, white and red, 102.
Pregnancy,  signs of, 353;  feigned, 358 ;
  plea of,  in bar  of execution, 359 ; in a
  state  of unconsciousness,  3G2 ; conceal-
  ment of, 361; in the dead, 362 ;  proof of,
  in cases of abortion, 384 ;  extra-uterine,
  386;  longest duration of, 411;  prema-
  ture,'440;  earliest age for,  439;  latest,
  441; following rape, 455;  crimes perpe-
  trated during, 595.
Premature births, 401 ; labour, induction
  of, 383.
Preserving articles for analysis, 56.
Price, case of,  598.
Projectiles, whether fired near  or at a dis-
  tance,  263;  evidence  from,  265; non-
  discovery of, 265 ; deflection of, 265.
Protracted births, 408 ; gestation, 409.
Prussic Acid, varieties of, 142 ; symptoms
  caused  by,   143;  post-mortem  appear-
  ances,  145; taste and odour of, 143 ; fatal
  doses of, 146; acts of volition and loco- 
,618
INDEX.
  motion, 144 ; analysis, 147; detection of
  vapour in organic liquids, 143 ; obtained
  from seeds,  150.
Ptyalism, mercurial, (see Salivation) 95.
Puberty  in  males,  435; in females,  439;
  premature, 440.
Puerperal mania, 594.
Pulham, case  of, 463.
Pulmonary tests, 291.
Putrefaction, effects of, 183; uterine, 288 ;
  of the lungs, 303 ;  in the new-born child,
  325 ; in the drowned, 469.
Pyromania,  595.

Quickening, a sign of pregnancy, 355.
Quicksilver, 94.  (See Mercury.)

Race, case of, 268.
Railtan, case of, 326.
Rape, definition of, 447; proofs of, in chil-
  dren  under puberty,  448;  vulval and
  vaginal, 449;  evidence  from gonorrhceal
  discharge in, 450 ;  on females after pu-
  berty, 451; on adults,  454; on idiots,
  454;  pregnancy following, 455; micro-
  scopical  evidence  in, 455;  legal  deci-
  sions respecting,  458;  by  females on
  males, 458.
Ratafia, poisoning by, 151.
Raynon, case of, 234.
Realgar, poisoning by, 92.
Rectum, poisons administered by the, 43.
Red arsenic, 92.
Red dyes mistaken for blood, 217.
Redness  of  the  stomach  in poisoning and
  disease, 49.
Red oxide of mercury, 102.
Red precipitate, 102.
Reid, case of, 247.
Reeves, case of, 597.
Reinsch's process for arsenic, 81.
Reports, medico-legal, 57.
Respiration, prevention of, not murder, 290;
  signs of, in  the new-born child, 290; im-
  perfect, 299;  before birth, 312; a sign
  of life, not of live birth, 289, 290, 312.
Responsibility of the insane in civil cases,
  569;  in  criminal  cases, 574;  medical,
  after surgical operations,  232;  in  cases
  of abortion, 383.
Restraint in cases of insanity, 558 ; impro-
  per application of, 55.9.
Reynolds, case of, 574, 583.
Rhymes, case of, 79.
Richman, Prof., case of, 511.
Ross, case of, 524.
Rowe, case  of, 583.
Rules for investigating cases of poisoning,
  53.
Rupture of the  lungs, 249; stomach, 255;
  of the heart, 251;  of the diaphragm, 253;
  liver,  spleen,  and kidneys, 254;  intes-
  tines,  255 ;  the bladder, 255.
Rush, case  of, 271.
Russell, Lord W., case of, 199.
Russell, case of, 47.
Russen, case  of, 458.
Rust, stains of, mistaken for blood, 217.
Ryan, case of, 455.

Sabina Juniperus,  121.
Saffron, meadow, poisoning by> 160.
Saint Ignatius' bean, strychnia in, 160.
Sal volatile, 73.
Salivation, mercurial, 95.
Salmon, poisoning  by, 131.
Salt of sorrel, 70.
Sambucus nigra, 125.
Sanguineous tumors  in new-born children,
  342.
Saville, case of,  199.
Savin, poisoning by, 124;  as  an abortive.
  380.
Sausage poison, 132.
Sayers, case of,  253.
Scalds and burns, 271.
Scammony, 123.
Schedmaizig, case of, 599.
Scheele's green,  111.
Schwabe v.  Clift,  592.
Scirrhus of the lungs in infanticide, 298.
Sedative solution,  Battley's, 140.
Seeds, castor, poisoning by, 125.
Seeds, prussic acid obtained from, 150.
Self-delivery, violence inflicted  by females
  during, 340.
Sellis, case  of, 193, 202, 207,
Senior, case of, 352.
Senile dementia, wills made in,  573.
Seton, Mr.,  case of,  229.
Sewers and  drains, air of, 539.
Sex, distinction  of, 425; mistakes respect-
  ing, 426;  mixed and doubtful cases, 427 ;
  civil rights depending on, 428 ; concealed,
  433.
Sexual malformation, varieties  of,  425;
  causes of, 427 ; a cause of impotency, 444.
Seymour, Lady, case of, 568.
Shellfish, poisoning by, 131.
Shepherd, case of,  596.
Shuttleworth, case of,  562.
Shock, death from, in wounds, 211.
Shot, small, wounds by, 267.
Siamese twins, case of, 396.
Silver, nitrate of,  poisoning by, 120.
Simpson, case of,  599.
Situation of a wound, evidence from,  189.
Skin, evidence from the  colour of, 423.
Skull, fractures of the, 238,243; accidental.
   in parturition, 337 ;  defective ossification
   in the, 339.
Sleep,  delivery during,  367; rape during.
   455; homicide during, 599.
Small-shot, wounds by,  267.
Smith, case of,  160.
Smothering, death from, 524.
Soap-lees, poisoning by, 72.
Soda and its carbonate, poisoning by, 71.
Sodomy, 459.
Softening of the stomach from poison  and
   disease, 50.
Solania, 153.
Solanum dulcamara—nigrum, 153.
Somnambulism, responsibility in cases of.
   599 ;  in life-insurance and suicide, 600.
Sorrel, salt of, 70. 
INDEX.                                   619
South, case of, 349.
Southgate, case of, 36, 89.
Spanish flies, poisoning by, 128.
Spasm, cadaverous, 199, 472.
Spermatozoa, 435, 456, 495.
Sphacelia segetum. see ergot, 380.
Spicer, case of, 174,  196, 217.
Spinal marrow, injuries to  the, 247.
Spine, fractures of the, 247.
Spirit, Dyer's, poisoning by, 120.
Spirits (alcoholic) poisoning by, 154.
Spirits of hartshorn,  death from, 73.
Spirits of salt, 66, (see Muriatic Acid.)
Spleen, ruptures of the, 254.
Spontaneous combustion, 278.
Spontaneous perforation of the stomach, 52.
Squire, case of, 550.
Stabs and cuts, 187.
Stains, acid, on clothing,  62, 66; of blood
   on linen and weapons, 215, 219.
Staninought, case of, 576.
Starvation, death from,  548;  infanticide
   by, 335.
Static test, the, in infanticide, 292.
Statistics of still births, 327.
Sterility, causes of, 438, 412.
Stevens, case of, 338.
Steinberg, case of, 576.
Stoltzer,  case of, 583.
Stout, Sarah, case of, 475.
Stott, case of, 571.
Stibiated tartar, 114.
Still births, 327.
Stomach, perforation of the, 50;  redness of
   the,  49 ;  softening of, 50;  spontaneous
   perforation of, 52 ; wounds  and ruptures
   of the,  255;  fcetal, contents of the, 323.
Stramonium, poisoning by, 162.
Strangulation, infanticide by, 341; acci-
   dental, by the umbilical cord, 342;  in
   drowning, 481 ; appearances caused  by,
   508; accidental,  suicidal, or homicidal,
   511.
Stroud, case of, 382.
Strychnia, poisoning by, 159.
Stupor from burns, 273.
Subacetate of lead, 107; of copper, 111.
Subchloride of copper, 111.
Sublimate, corrosive, poisoning by, 94.
Subnitrate of bismuth, 121.
Sugar, detection of, in the stomach, 322.
Sugar of  lead, poisoning by, 104.
Suffocation, infanticide by, 330; mechani-
   cal causes of, 519;  post-mortem appear-
   ances, 520 ; evidence of death from, 520;
   accidental and suicidal, 521; homicidal,
   522; of young children, 523 ; from gases,
   525 ; by carbonic acid, 526; by charcoal
   vapour, 529; coal vapour, 531;  by  vapour
   of lime and brick-kilns, 532; confined
   air, 533;  by coal-gas, 535; sulphuretted
   hydrogen, 537.
Sugillation, nature of, 181.
Suicidal wounds, characters of,  191, 204;
   mania, 590.
Suicide  no  proof of insanity in law, 590,
   593; its  effects  on life-insurance, 591;
   hereditary disposition to, 594.
Sulphate of indigo, 63;  of copper, 110; of
  zinc, 118; of iron, 120.
Sulphuret of arsenic, poisoning by, 92; of
  mercury, 103.
Sulphuretted Hydrogen, symptoms of poi-
  soning by, 538 ; appearances, 538 ♦ analy-
  sis, 540 ; as  a test for arsenic, 83.
Sulphuric Acid, symptoms caused by, 59 ;
  appearances, 60 ; fatal doses, 61; analy-
  sis, 62 ; in organic mixtures, 62 ; on ar-
  ticles of clothing, 63.
Sulphurous acid, action of, 531.
Superconception, 421.
Superfoetation, 421.
Supposititious  children,  423.
Surgical operations,  fatality  of, 232 ; per-
  formed under mistaken diagnosis, 232.
Survivorship,  in gun-shot  wounds, 266; in
  new-born  children, 324; evidence from,
  in cases of legitimacy, 402; presumed in
  drowning, 477.
Suydam, Levi, case of, 429.
Symptoms of poisoning, nature of, 41.
Syphilis, evidence from, in  cases of rape,
  450.
Syrup of poppies, 138.

Tansy,  oil of,  124, 380.
Tar, oil of, 126.
Tartar Emetic, poisoning by, 114; 'symp-
  toms  and appearances, 115, 116 ; analy-
  sis, 116.
Tartaric acid, poisoning by, 70.
Tartarized antimony, 114.
Tasteless ague drop, 91.
Taxus baccata (see Yew,) 167.
 Taylor, case of, 336.
 Teague, case of, 200.
Teeth not weapons in law, 100.
Tenancy by courtesy, 391; legal  proofs re-
   quired for, 389, 428.
Teratology (see Monsters,) 395.
Testicles, period at which  they descend.
   284;  a sign  of maturity,  285;  non-de-
   scent of the, 437.
Test, static, 292; Ploucquet's, 295; hydro-
   static, 297.
Testamentary capacity, 570.
Testimonial capacity of lunatics,  564.
Tests of insanity, 566.
Tetanus, death from, in wounds, 231.
Theft, insane  propensity to, 596.
 Thorn, case of, 563.
 Thomas, case of, 230, 244,266.
Thornapple, poisoning by, 162.
 Thornton, case of, 473.
Throat, wounds of the, 192.
Tin, poisoning by the salts of, 120.
Tobacco, poisoning by, 164 ;  Indian, 165.
 Tottenham, case of, 267.
 Touchett, Hon. R., case of, 576, 584.
 Townsend peerage case, 418.
 Trichomonas  vaginae, 457.
 Trilloe, case of, 340.
Tumours, sanguineous, on the  heads of new-
   born children, 342.
Turbith mineral, 103.
 Turner, case of, 340. 
620
INDEX.
Turner v. Myers, case of, 569.
Turpentine, oil of, 126.
Twisting of the neck in new-born children,
  340.

Ulceration distinguished  from  corrosion,
  50 ; a result of arsenical poisoning, 78.
Ultimum tempus pariendi, 411.
Umbilical  cord, insertion of, as a  sign of
  maturity, 285;  evidence of  live birth
  from, 317,324; laceration of the, 328;
  severance of, 328; death  from compres-
  sion of  the, 328;  evidence of  murder
  from, 333 ; length of, 339; used for stran-
  gulation, 342 ; mark produced by, 342.
Unconscious  pregnancy,  362;  delivery,
  366.
Unnatural offences, 459.
Unsoundness of mind, 551.
Urinary bladder, rupture of the, 255,  256,
  257.
Urine, kiestein in the*, 357.
Uterine putrefaction,  288;  hydatids,  373,
  386;  respiration, 390; age or maturity of
  the child, 285.
Uterus, changes in  the, from pregnancy,
  357 ;  ballottement of the, in pregnancy,
  357;  examination of the, in the dead,
  362.

Vagina, poisons by the, 39.
Vagina, wounds of, 257.
Vaginas trichomonas, 457.
Vagitus uterinus and vaginalis, 390.
Vapour of charcoal, effects of, 529; of coal,
  531;  of chloroform, 156.
Varney, case of, 375.
Vaughan, case of, 596.
Vegetable irritant poisons, 123.
Veins,  wounds  of,  251; death  from  en-
  trance of air into, during operations, 251.
Venereal  disease in cases of rape, 450.
Ventre, inspiciendo de, writ of, 459.
Ventre  sa mere, in, 387.
Veratria,  160.'
Verdigris, natural and artificial, 111.
Vermilion, 103.
Vertebras, fractures of the,  247;  in drown-
  ing,  482; injuries  to the, in  hanging,
  488.
Vesications from burns and  scalds,  273.
Viability  of the child, in cases  of infanti-
  cide, 283; in monstrosity, 396; in legiti-
  macy, 402.
Vibices, nature of, 182.
Vinegar, poisoning by, 71.
Violation (see  Rape,) 447 ; evidence of, in
  the dead, 457.
Virginity, signs of, 452.
Virility,  proofs of, 435; precocious,  case
  of, 435.
Vitriol, oil of, poisoning by (see  Sulphu-
  ric Acid,)  59;  blue, poisoning by, 110;
  white,  118;  green, 120.
Volition,  retention of,  in poisoning  by prus-
  sic acid, 144; after severe injuries to the
  head, 237.
Vomited matters, analysis of, 55.
Wadding, wounds from, 268.
Wales, case of, 336.
Wall, Governor, case of, 212.
Walters, case of, 334.
Waring v.  Waring, 573.
Waters, case of, 334.
Watson,  case of, 599.
Watts, case of, 596.
Weapons,  whether   used  in  producing
  wounds,  185, 187; teeth not considered,
  188; circumstantial evidence regarding
  the discovery of, 199 ; blood  on, 200,219;
  hair on, 200 ; examination of, 219.
Webster, case of, 348.
Weight of  the child at different ages, 284;
  of the lungs in the new-born child, 292.
West, case  of,  335, 403.
Westwood,  case of, 275, 360.
Weyman, case of, 583.
Whisker, case of, 383.
White, case of, 595.
White precipitate, poisoning by, 102; lead,
  108; vitriol, 118.
White hellebore,  161.
Wills of the  insane, law regarding, 570;
  proofs of eccentricity in, 571; in extre-
  mis, 573 ; made in drunkenness, 597.
Wilson v.  Wilson, case of, 446.
Wine of colchicum, 160.
Wiseman, case of, 459.
Wolfsbane, poisoning by,  163.
Wood, smouldering, death from the vapour
  of, 531, 532.
Wood, case of, 335.
Woodman, case of, 376.
Woody nightshade, action of, 153.
Wounds, definition  of, medical and  legal,
  169,  170; dangerous to life, 171; pro-
  ducing grievous bodily harm, 172;  ex-
  amination of, 173;  vital and post-mortem,
  174,   175;  without  hemorrhage,   176;
  produced by weapons, 185; varieties of,
  185;  statute relative to, 188; homicidal
  and  suicidal, 189;  circumstantial  evi-
  dence  in, 197 ;  in  what position inflicted,
  198;  foreign substances in, 200; self-in-
  flicted, or imputed homicidal, 205; direct
  cause  of death, 208; fatal  from  hemor-
  rhage, 209;  mechanical injury and shock,
  211;  mortality  of, 213; death from la-
  tent disease in  cases of, 225; which of
  two caused death, 225;  the indirect cause
  of death, 227; fatal after  long  periods,
  227;  fatal from unskilful treatment, 229;
  fatal from imprudence, 230; circumstan-
  ces  diminishing responsibility, 230; ac-
  celeration of death  from,  231;  tetanus
  following, 231 ; fatal from surgical opera-
  tions, 232;  fatal  from erysipelas, 233;
  cicatrization of, 234; period of infliction
  of, 236; volition and  locomotion,  after
  severe,  237; of the head,  242;  of the
  face, 246; of the orbit, 246; the  nose,
  246;  the spinal marrow, 247; the chest,
  248; the lungs, 249; the heart, 249 ;  of
  the arterial  and venous trunks,  251 ;  of
  the diaphragm, 232 ; of the abdomen, 253 ;
  of the liver, gall-bladder, and spleen, 254 ; 
IXDEX.
021
  of the intestines and stomach, 255; of the
  bladder, 255 ;  of the genitals, 257; from
  gunpowder, 268;  gunshot, 262;  from
  burns, 271; on the new-born child in in-
  fanticide, 335.
Wren, case of, 345.
Wright, case  of, 346, 360.

Yaxley, case of, 485.
Yellow arsenic, poisoning by, 92.
Yellow, King's, poisoning by, 93.
Yew berries and leaves, poisoning by, 167.
Yglesias v. Dyke, 573.
Yoolow, case of, 566.

Zinc, poisoning by the sulphate and carbon-
  ate of, 118.
Zoosperms,  435;  evidence  from,  in rape,
  456 ;  in hanging, 495. 
 
 
 
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                         ARNOTT (NEILL), M. D.

ELEMENTS  OF  PHYSICS;   or  Natural  Philosophy, General  and  Medical.
  Written for universal use, in plain or non-technical language. A new edition, by Isaac Hays.
  M. D.  Complete in one octavo volume, of 484 pages, with about two hundred illustrations.
                      ABERCROMBIE (JOHN), M. D.

PATHOLOGICAL AND  PRACTICAL RESEARCHES ON  DISEASES  OF
  THE STOMACH, INTESTINAL CANAL, &c. Fourth edition, in one small octavo volume.
  of 260 pages.
                        BENNETT  (HENRY),  M. D.

A PRACTICAL TREATISE  ON  INFLAMMATION  OF THE  UTERUS
  AND ITS APPENDAGES,  and on Ulceration and Induration of the Neck of the Uterus. Third
  edition.  In one neat octavo volume, of 350 pages, with wood-cuts.

  We shall not call it a second edition, because,  as
Dr. Bennett truly observes, it is really a new work.
It will be found to contain not only a faithful histo-
ry of the various pathological changes produced by
inflammation in the uterus and its annexed organs,
in the different phases of female life, but also an ac-
curate analysis of the influence exercised by inflam-
mation in the production of the various morbid con-
ditions of the uterine system, hitherto described and
treated as functional.—British and Foreign Medico-
Chirurgical Review.

  Few works issue from the medical press 'which
are at once original and sound in doctrine ; but such,
we feel assured, is the admirable treatise now before
               BE ALE  (LIONEL JOHN), M. R. C. S., &c.
THE  LAWS OF  HEALTH  IN   RELATION  TO  MIND  AND  BODY.
 A Series of Letters from an old Practitioner to a Patient.  In one handsome volume, royal 12mo..
 extra cloth.
                       BILLING (ARCHIBALD), M.  D.

THE PRINCIPLES  OF MEDICINE.   Second American, from the Fifth and
  Improved London edition. In one handsome octavo volume, extra cloth, 250 pages.
              BLAKISTON (PEYTON),  M. D., F. R. S., &.C.
PRACTICAL   OBSERVATIONS   ON  CERTAIN  DISEASES   OF  THE
  CHEST, and on the Principles of Auscultation. In one volume. Svo., pp. 384.
                         BENEDICT (N.  D.), M. D.

COMPENDIUM  OF  LECTURES  ON THE  THEORY  AND  PRACTICE
  OF MEDICINE, delivered by Professor Chapman in the University of Pennsylvania. In one
  octavo volume, of 258 pages.
                       BURROWS (GEORGE),  M. D.

ON DISORDERS OF THE CEREBRAL  CIRCULATION, and  on the Con-
  nection between the Affections of the Brain and Diseases of the Heart.  In one 8vo. vol., with
  colored plates, pp. 21(5.
us.  The important practical precepts which the
author inculcates are all rigidly deduced from facts.
. . . Every page of the book is good, and eminently
practical. .  . . So far as we know and believe, it is
the best work on  the subject of which it treats.—
Monthly Journal of Medical Science.

  We refer our readers with satisfaction to this work
for information on a hitherto most obscure and diffi-
cult class of diseases.—London Medical Gazette.

  One of the best practical monographs amongst
modern English medical books.—Transylvania Med.
Journal. 
4
BLANCHARD  &  LEA'S  MEDICAL
                       BUDD (GEORGE), M. D., F.  R. S.,
                     Professor of  Medicine, in King's College, London.

ON  DISEASES  OF  THE  LIVER.    Second  American,  from  the second and
  enlarged London edition.  In one very handsome  octavo volume, with four beautifully colored
  plates, and numerous wood-cuts.  pp. 468.  New edition. [Now Ready.)

  The reputation which this work has obtained as a full and practical treatise on an important class
of diseases will not be diminished by this improved and enlarged edition.  It has been carefully and
thoroughly revised by the author;  the number of plales has been  increased, and  the style of its me-
chanical execution will be found materially improved.
  The full digest we have given of the new matter
introduced into  the present volume, is evidence of
the value we place on it.  The fact that the profes-
sion has required a second edition of a monograph
such as that before us, bears honorable testimony
to its usefulness.   For many years,  Dr. Budd's
work must be the authority of the preat mass of
British practitioners on the hepatic diseases ; and it
is satisfactory that the subject has been taken up by
so able and experienced a physician.—British and
Foreign Medico-Chirurgical Jieview.
  We cannot too strongly recommend  the diligent
study of this volume.  The work cannot fail to rank
the name of its author among the most enlightened
pathologists and soundest practitioners of the day.
—Medico-C hirurgical Review.
  We feel bound to say that Dr. Budd's treatise is
greatly in advance of its predecessors. It is the first
work in which the results of microscopical anatomy
and the discoveries of modern chemistry have been
brought fully to bear upon the pathology and treat-
ment of diseases of the liver; and it is the only work
in which a method of studying diseases of this organ,
founded  upon strictly inductive principles,  is  de-
veloped.— Dublin Medical Press.
  Having thus attempted to give a brief summary of
the more important contents of this work, we would,
in conclusion, recommend  it to every practitioner
and student as well worthy of a careful and patient
perusal— The New Orleans Medical and Surgical
Journal.
                    BLOOD  AND URINE (MANUALS ON).
BY JOHN  WILLIAM  GRIFFITH,  G. OWEN  REESE,  AND  ALFRED
  MARKWICK.  One thick volume, royal 12mo., extra cloth, with plates,  pp. 460.
                         BRIGHAM  (AMARIAH),  M.D.
ON  MENTAL CULTIVATION AND EXCITEMENT.   In  one neat volume,
  18mo., extra cloth.
                  BRODIE  (SIR BENJAMIN C),  M. D., &c.

CLINICAL  LECTURES  ON  SURGERY.   1 vol. 8vo., cloth.   350 pp.

                                 BY THE SAME AUTHOR.

PATHOLOGICAL  AND  SURGICAL  OBSERVATIONS  ON THE  DIS-
  EASES OF  THE JOINTS.  1 vol. 8vo., cloth, pp. 216.

                                 BY THE SAME AUTHOR.

LECTURES ON  THE  DISEASES OF THE  URINARY ORGANS.   1 vol.
  8vo., cloth,  pp. 214.
  *#* These three works may be had neatly bound together, forming a large volume of" BrodJe's
Surgical Works."  pp. 780.
                     BIRD (GOLDING), A. M., M. D., &.C.
URINARY   DEPOSITS :   THEIR   DIAGNOSIS,   PATHOLOGY,  AND
  THERAPEUTICAL INDICATIONS.  A new American, from the third and improved London
  edition.  With over sixty illustrations.  In one royal 12mo. volume, extra cloth,  pp. 33S.
  The new edition of Dr. Bird's work, though not
increased  in size, has  been greatly modified, and
much of it rewritten.   It now presents, in a com-
pendious form, the gist of all that is known and re-
liable in this department.  From its terse style and
convenient size, it is particularly applicable to the
student, to whom we cordially commend it.— The
Medical Examiner.
  It can scarcely be necessary for us to say anything
of the merits of this well-known Treatise, which so
admirably brings into practical application the re-
sults of those microscopical and chemical researches
regarding  the physiology and pathology of the uri-
nary secretion, which have contributed so much to
the  increase of our diagnostic powers, and lo the
extension and satisfactory employment of our thera-
peutic resources.  In the preparation of this new
edition of his work, it is obvious that  Dr. Golding
Bird has spared no pains to render it a faithful repre-
sentation of the present state of scientific knowledge
on the subject it embraces.
  Although, of course, there are many topics which
are  open to differences of opinion, we cannot point
to any well-substantiated result of  inquiry which
the author has overlooked.— The British and Foreign
Medico-C hirurgical Review.
                                 BY THE SAME AUTHOR.

ELEMENTS OF NATURAL PHILOSOPHY;  being an  Experimental  Intro-
  duction to the Physical Sciences.  Illustrated with nearly  four hundred wood-cuts.   From the
  third London edition.  In one neat volume, royal 12mo.  pp. 402. 
AND  SCIENTIFIC PUBLICATIONS.
5
                        BARTLETT (ELISHA), M. D.,
      Professor of Materia Medica and Medical Jurisprudence in the College of Physicians and
                                 Surgeons, New York.

THE  HISTORY, DIAGNOSIS,  AND  TREATMENT  OF  THE  FEVERS
  OF THE UNITED STATES.  Third  edition, revised and improved.  In one octavo volume,
  of six hundred pages, beautifully printed, and strongly bound.

  In preparing a new edition of this standard work, the author has availed himself of such  obser-
vations and investigations as have appeared since the publication of his last revision, and  he has
endeavored in every way to render it worthy of a continuance of the very marked favor with which
it has been hitherto received.

  The masterly and elegant treatise, by Dr. Bartlett
is invaluable to  the American student and practi-
tioner.—Dr. Holmes's Report to the Nat. Med. Asso-
ciation.
 We regard it, from the examination we have made
of it, the best work on fevers extant in our language,
and  as such cordially recommend it to the medical
public.—St. Louis Medical and Surgical Journal.

 Take it altogether, it is the most complete history
of our fevers which has  yet been  published, and
every practitioner should  avail himself of its con-
tents.— The Western Lancet.
  Of the value and importance of such a work, it is
needless here to speak ;  the profession of the United
States owe much to the  author for the very able
volume which he has presented to them, and for the
careful and judicious manner in which he  has exe-
cuted his task.  No one volume with which we are
acquainted  contains so complete a history of our
fevers as this.  To J)r. Bartlett we owe our best
thanks for the very able volume he has given us, as
embodying certainly the most complete, methodical,
and satisfactory account of our fevers anywhere to
be met with.— The Charleston  Med. Journal and
Review.
BY THE SAME AUTHOR.
AN  INQUIRY INTO  THE DEGREE OF  CERTAINTY  IN MEDICINE,
  and into the Nature and Extent of its Power over Disease.  In one volume, royal 12mo.  pp. 84.
                         BOWMAN (JOHN  E.), M.D.
PRACTICAL  HANDBOOK  OF  MEDICAL  CHEMISTRY.
  volume, royal 12mo., with numerous illustrations,  pp. 288.
In  one neat
BY THE SAME AUTHOR.
INTRODUCTION  TO  PRACTICAL  CHEMISTRY,   INCLUDING  ANA-
  LYSIS.  With numerous illustrations.  In one neat volume, royal 12mo.  pp. 350.
                          COLOMBAT DE  L'ISERE.

A TREATISE  ON  THE   DISEASES   OF  FEMALES, and on the  Special
  Hygiene of their Sex.  Translated, with many Notes and Additions, by C. D. Meigs,  M. D.
  Second edition, revised and improved.  In one large volume, octavo, with numerous wood-cuts.
  pp. 720.
  The treatise of M. Colombat is a learned and la-
borious commentary on these diseases, indicating
very considerable research, great accuracy of judg-
ment, and no inconsiderable personal experience.
With the copious notes and additions of its e.xperi
  M. Colombat De LTsere has not consecrated ten
years of studious toil and research to the frailer sex
in vain; and although we regret to hear it is at the
expense of health, he has imposed a debt of gratitude
as well upon the profession, as upon the mothers and
enced and very erudite translator and editor, Dr. I daughters of beautiful France, which that gallant
Meigs, it presents, probably, one of the' most corn- | nation  knows best how to acknowledge.—New Or
plete and comprehensive works on the subject we ! leans Medical Journal.
possess.—American, Med. Journal.
                 COPLAND  (JAMES), M. D., F. R. S., &c.

OF  THE  CAUSES,  NATURE,  AND  TREATMENT  OF  PALSY  AND
  APOPLEXY, and of the Forms, Seats, Complications, and Morbid Relations of Paralytic and
  Apoplectic Diseases.  In one volume, royal 12mo., extra cloth,  pp. 326.
                 CHAPMAN  (PROFESSOR  N.),  M. D.,  &c.

LECTURES  ON   FEVERS,  DROPSY,  GOUT, RHEUMATISM,  &c.  &c.
  In one neat 8vo. volume,  pp. 450.


                     CLYMER (MEREDITH), M. D., &.c.

FEVERS;  THEIR   DIAGNOSIS,  PATHOLOGY,  AND  TREATMENT.
  Prepared and Edited, with large Additions, from the Essays on Fever in Tweedie's Library of
  Practical Medicine.  In one octavo volume, of 600 pages.
                         CARSON (JOSEPH), M. D.,
          Professor of Materia Medica and Pharmacy in the University of Pennsylvania.

SYNOPSIS OF  THE COURSE  OF LECTURES ON MATERIA  MEDICA
  AND PHARMACY, delivered in the University of Pennsylvania.  In  one very neat octavo
  volume, of 208 pages. 
6
BLANCHARD & LEA'S MEDICAL
             CARPENTER (WILLIAM  B.), M. D., F.  R. S.,  &c,
           Examiner in Physiology and Comparative Anatomy in the University of London.

PRINCIPLES OF HUMAN  PHYSIOLOGY; with  their chief applications to
  Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine.  Fifth American, from
  the fourth and enlarged London edition.  With three hundred and fourteen illustrations.  Edited,
  with additions, by Francis Gurney Smith, M. D., Professor of the Institutes of Medicine in the
  Pennsylvania Medical College, &c.  In one very large and beautiful octavo volume, of about 1100
  large pages, handsomely printed and strongly bound in leather, with raised bands.  New edition.
  (Just Issued.)

                      From the Author's Preface to the present Edition.

  "When the author, on the completion of his 'Principles of General and Comparative Physiology,'
applied himself to the preparation of his ' Principles of Human Physiology,' for the press,  he found
that nothing short of a?i entire remodelling of the preceding edition would in any degree satisfy his
notions of what such a treatise ought lo be.  For although no fundamental  change had taken place
during the interval  in the fabric of Physiological Science, yet a large number of less important
modifications had been effected, which had combined to produce a very considerable alteration in
its aspect.   Moreover, the progressive maturation of his own views,  and his increased experience
as a teacher, had not only rendered him more keenly alive to the imperfections which were inherent
in its  original plan, but had caused him to look upon many topics in a  light very different from  that
under which he had previously regarded them; and, in  particular, he  felt a strong desire to give to
his work as practical a character as possible, without foregoing the  position which (he  trusts he
may say without presumption) he had succeeded  in gaining for it, as  a philosophical exposition of
one important department of Physiological Science.   He was led, therefore, to the determination
of, in reality, producing a  new treatise, in which only those parts of the old should be  retained,
which might express the existing state of knowledge, and of his own opinions on the points to which
they relate."

  The American edition  has been printed from sheets prepared for the purpose by the author, who
has introduced nearly one hundred illustrations not in the London edition ; while it has also enjoyed
the advantage of a careful superintendence on the part of the editor, who has added notices of such
more  recent investigations as had escaped the  author's attention.  Neither care nor expense has
been spared in the mechanical execution of the  work to render it superior to former editions, and it
is confidently presented as in every  way one of the handsomest volumes as yet placed before the
medical profession in this country.
  The most  complete work on the science in our
language.—Am. Med. Journal.

  The most complete exposition of physiology which
any language can at present  give.—Brit, and For.
Med.-Chirurg. Review.

  We have thus adverted  to some of the leading
"additions and alterations," which have been in-
troduced by the author into this edition of his phy-
siology.  These will be found, however, very far to
exceed the ordinary limits of a new edition, " the
old materials having been incorporated with the
new, rather than the new with the old."  It now
certainly presents the most complete treatise on the
subject within the reach of the American reader ;
and while, for availability as  a text-book, we may
perhaps regret its growth in bulk, we are sure that
the student of physiology will feel  the impossibility
of presenting  a  thorough digest of the facts of the
science within a more limited compass.—Medical
Examiner.

  The greatest, the most reliable, and the best book
on the subject which we know  of in  the English
language.—Stethoscope.

  The most complete work now extant in our lan-
guage.—N. O. Med. Register.

  We do not  hesitate a moment  in pronouncing it
the best text book in the English language. In this
new edition, theauthor has again displayed his great
zeal.  The work is almost  a  new one, having been
entirely remodelled ; avast amount of valuable ma-
terial has been added, and with great propriety, as-
signed its  appropriate place.—St. Louis Med. and
Surg. Journal.

  The best text-book in the  language on this ex-
tensive subject.—London Med. Times.

  A complete  cyclopaedia of this branch of science.
—N. Y. Med.  Times.
  The standard of authority on physiological sub-
jects. * * * In the present edition, to particularize
the alterations and additions which have been made,
would require a review of the whole work, since
scarcely a subject has not been revised and altered,
added to, or entirely remodelled to adapt it to the
present state of the science.—Charleston Med. Journ.

  The changes are too numerous to admit of an ex-
tended notice in this place.  At every point where
the recent diligent labors of organic chemists  and
micrographers have furnished interesting and valu-
able facts, they have been appropriated, and no pains
have been spared, in so incorporating and arranging
them that the work may constitute one harmonious
system.—Southern Med. and Surg. Journal.

  Any reader who desires a treatise on physiology
may  feel himself entirely safe in ordering  this.—
Western Bled, and Surg. Journal.

  From this hasty and imperfect allusion it will be
seen by our readers  that the alterations and addi-
tions to this edition render it almost a new work—
and we can assure our readers  that it is one of the
best summaries of the existing facts of physiological
science within the reach of the English student and
physician.—N.  Y. Journal of Medicine.

  The profession of this country,  and perhaps also
of Europe, have anxiously and for some time awaited
the announcement of this new edition of Carpenter's
Human Physiology.  His former  editions have for
many years been almost the only text-book on Phy-
siology in all our medical schools, and  its circula-
tion among the profession has been unsurpassed by
any work in any department of medical science.
  It is quite unnecessary for us  to speak of this
work as  its  merits  would  justify.  The mere an
nouncement of its appearance will  afford the highest
pleasure  to every student of Physiology, while its
perusal  will be of  infinite  service in  advancing
physiological science.—Ohio Med.  and Surg. Journ.
BY  THE SAME AUTHOR.
PRINCIPLES  OF  GENERAL  AND   COMPARATIVE   PHYSIOLOGY.
  Intended as an Introduction to  the  Study of Human Physiology; and as a Guide to the Philo-
  sophical pursuit of Natural History.  New and improved edition, (preparing.) 
AND  SCIENTIFIC  PUBLICATIONS.
7
                CARPENTER (WILLIAM  B.>, M. D.,  F. R. S.,
          Examiner in Physiology and Comparative Anatomy in the University of London.

ELEMENTS  (OR MANUAL) OF PHYSIOLOGY,  INCLUDING  PHYSIO-
  LOGICAL ANATOMY.  Second American, from a new and revised London edition.  With
  one hundred and ninety illustrations.  In one very handsome octavo volume. (Lately Issued.)

  In publishing the first edition of this work, its title was altered from that of the  London  volume
by the substitution of the word " Elements" for that of " Manual," and with the author's  sanction
the title of " Elements" is still retained as being more expressive of  the scope of the treatise.  A
comparison of the present edition with the former one will  show a material improvement, the
author having revised it thoroughly, with  a view of rendering it completely on a level with the
most advanced state of the  science.  By condensing the less  important portions, these numerous
additions have been introduced without  materially  increasing the bulk of the volume, and  while
numerous illustrations have been added, and the general  execution of the work improved, it has
been kept at its former very moderate price.
  To say that it is the best manual of Physiology
now before the public, would not do sufficient justice
to the author.—Buffalo Medical Journal.

  In his former works it would  seem that he had
exhausted the subjectof Physiology. In the present,
he gives the essence, as it were, of the whole.—N. Y.
Journal of Medicine.

  Those who have occasion for an elementary trea-
tise on Physiology, cannot do better than to possess
themselves of the manual of Dr. Carpenter.—Medical
Examiner.
 We do not hesitate to pronounce it the best and
most comprehensive system of modern surgery with
which we are acquainted.—Medico-C hirurgical Re-
view.

 The fullest and ablest digest extant of all that re-
lates to the present advanced state of surgical pa-
thology.—American Medical Journal.

 As complete as any system of Surgery can well
be.—Southern Medical and Surgical Journal.
  It is not needful that we should compare it with
the other pharmacopoeias extant,  which  enjoy and
merit the confidence of the profession : it is enough
to say that it appears to us as perfect as a Dispensa-
tory, in the present state of pharmaceutical science,
could be made.  If it omits any details pertaining to
this branch of knowledge which the student has a
right to expect in such a work, we confess the omis-
sion has escaped our scrutiny. We cordially recom-
mend this work to such of our readers as are in need
of a Dispensatory.  They cannot make choice of a
better.—Western Journ. of Medicine and Surgery.
  The best and most complete expose^ of modern
Physiology, in one volume, extant in the English
language.—St. Louis Medical Journal.

  With such an aid in his hand, there is no excuse
for the ignorance often displayed respecting the sub-
jects of which it treats.  From its unpretending di-
mensions, it may not be so esteemed by those anxious
to make a parade of their erudition;  but whoever
masters its contents will have reason to be proud of
his physiological  acquirements.  The illustrations
are well selected and finely executed.—Dublin Med.
Press.
  The mostlearned and complete systematic treatise
now extant.—Edinburgh Medical Journal.

  A complete encyclopaedia of surgical  science—a
very complete  surgical library—by far the most
complete and scientific system of  surgery in the
English language.—N. Y. Journal of Medicine,

  The most extensive and comprehensive account of
the  art and science of Surgery in our language.—
Lancet.
  There is not in any language a more complete and
perfect Treatise.—N. Y. Annalist.
  In conclusion,  we need scarcely say that we
strongly recommend this work to all classes of our
readers.  Asa Dispensatory and commentary on the
Pharmacopoeias, it is unrivalled  in the English or
any other  language.—The Dublin Quarterly Journal.

  We earnestly  recommend Dr.  Christison's  Dis-
pensatory to all our readers, as an indispensable
companion, not in the Study only, but in the Surgery
also.—British and Foreign Medical Review.
                                 BY THE SAME AUTHOR.

A PRIZE  ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN  HEALTH
  AND DISEASE.  In one neat 12mo. volume.


                           BY THE  SAME author.  (Preparing.)

THE MICROSCOPE AND ITS REVELATIONS.   In one handsome volume,
  beautifully illustrated with plates and wood-cuts.
                             CHELIUS (J. M.), M. D.,
                    Professor of Surgery in the University of Heidelberg, &c.

A SYSTEM  OF  SURGERY.   Translated  from  the German,  and accompanied
  with additional Notes and References, by John F. South. Complete in three very large octavo
  volumes, of nearly 2200 pages, strongly bound, with raised bands and double titles.
            CHRISTISON  (ROBERT), M. D., V. P. R. S. E.,  &c.

A DISPENSATORY; or,  Commentary on the Pharmacopoeias of Great Britain
  and the United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac-
  tions, Uses, and Doses of the Articles of the  Materia Medica.   Second edition, revised and im-
  proved, with a Supplement containing the most important New  Remedies.  With copious Addi-
  tions, and two hundred and thirteen large wood-engravings.  By R. Eglesfeld Griffith, M. D.
  In one very large and handsome octavo volume, of over 1000 pages. 
BLANCHARD & LEA'S  MEDICAL
                           CONDIE (D. F.), M. D., &c.

A PRACTICAL  TREATISE ON THE DISEASES OF CHILDREN.  Third
  edition, revised and augmented.  In one large volume, 8vo., of over 700 pages.
  Dr. Condie's scholarship, acumen? industry, and
practical sense are manifested in this, as in all his
numerous contributions to science.—Dr. Holmes's
Report to the American Medical Association.
  Taken as a whole, in our judgment, Dr. Condie's
Treatise is the one from the perusal of which the
practitioner in this country will rise with the great-
est satisfaction —Western Journal of Medicine and
Surgery.
  One of the best works upon the Diseases of Chil-
dren in the English  language.—Western Lancet.
  We feel assured from actual experience that no
physician's library can be complete without a copy
of this work.—N. Y. Journal of Medicine.
  Perhaps the most full and complete work now be-
fore the profession of the United States; indeed, we
may say in the English language. It is vastly supe-
rior to most of its predecessors.—Transylvania Med.
Journal.
  A veritable psediatric encyclopedia, and an honor
to American medical literature.—Ohio Medical and
Surgical Journal.
  Every important fact that has been verified re-
developed since the publication of the previous edi-
tion, either in relation to the nature, diagnosis, or
treatment of the diseases of children, has been ar-
ranged and incorporated into the body of the work ;
thus posting up to date, to use a counting-house
phrase, all the valuable facts and useful information
on the subject.  To the American practitioner, Dr.
Condie's remarks on the diseases of children  will
be invaluable,  and we accordingly advise those
who have failed to read this work to procure a copy,
and make themselves familiar with its sound princi-
ples.— The New Orleans Med. and Surg. Journal.

  We feel persuaded that the American medical  pro-
fession will soon regard  it  not only as a very good,
but as the very best "Practical  Treatise on the
Diseases of Children."—American Medical Journal.

  We  pronounced the first edition to be the  best
work  on the diseases of  children in the English
language, and, notwithstanding all that has been
published, we still regard it in that light.—Medical
Examiner.
                       COOPER (BRANSBY  B.), F. R. S.,
                            Senior Surgeon to Guy's Hospital, &c.

LECTURES ON THE  PRINCIPLES  AND  PRACTICE  OF  SURGERY.
  In one very large octavo volume, of 750 pages.  (Lately Issued).
  For twenty-five years Mr. Bransby Cooper has
been surgeon to Guy's Hospital; and the volume
before us may be  said to consist of an account of
the  results of his surgical experience during that
long period.  We cordially recommend Mr. Bransby
Cooper's  Lectures as a most valuable  addition to
our  surgical literature, and one which cannot fail
to be of service both to students and to those who
are actively engaged in the practice of their profes-
sion.—The Lancet.

  A good  book by a good man is always welcome ;
and Mr. Bransby Cooper's book does no discredit to
its paternity. It. has reminded us, in its easy style
and copious detail, more of Watson's Lectures, than
any book we have seen lately, and we should not
be surprised to  see it occupy a similar position to
that well-known 'work in professional  estimation.
It consists of seventy-five lectures on the most im-
portant surgical diseases.  To analyze such a work
is impossible, while so interesting is every lecture,
that we feel ourselves really at a loss what to select
for quotation.  The work is one which cannot fail
to become a favorite with the profession; and it pro-
mises  to supply a hiatus which the student of sur-
gery has often to deplore.—Medical Times.
                    COOPER (SIR ASTLEY P.),  F. R.  S., &c.

A TREATISE ON DISLOCATIONS  AND FRACTURES OF THE JOINTS.
  Edited by Bransby B. Cooper, F. R. S., &c.  With additional Observations by Prof. J. C.
  Warren.  A new American edition.   In one handsome octavo volume, with numerous illustra-
  tions on wood.


                                 BY  THE SAME AUTHOR.

ON THE ANATOMY  AND  TREATMENT  OF  ABDOMINAL  HERNIA.
  One large volume, imperial 8vo., with  over 130 lithographic figures.


                                 BY  THE SAME AUTHOR.

ON  THE  STRUCTURE  AND DISEASES  OF THE  TESTIS,  AND  ON
  THE THYMUS GLAND.  One vol.  imperial 8vo., with 177 figures, on29 plates.
                                 BY THE SAME AUTHOR.

ON THE ANATOMY  AND DISEASES  OF  THE  BREAST,  with  twenty-
  five Miscellaneous and Surgical Papers.  One large volume, imperial 8vo., with 252 figures, on
  36 plates.

  These three last volumes complete the surgical writings of Sir Astley Cooper.   They are very
handsomely printed, with a large number of lithographic plates, executed in the best style, and are
presented at exceedingly low prices. 
AND  SCIENTIFIC  PUBLICATIONS.
9
                CHURCHILL  (FLEETWOOD),  M. D., M. R. I. A.

ON THE  THEORY  AND PRACTICE OF MIDWIFERY.  A new American,
  from the last and improved English edition.  Edited, with Notes and Additions, by D.  Francis
  Co.ndie, M. D., author of a "Practical Treatise on  the Diseases of Children," &c.  With 139
  illustrations.  In one very handsome octavo volume, pp. 510.  (Lately Issued.)
  To bestow praise on a book that has received such
marked approbation would be superfluous. We need
only say,  therefore,  that if the first  edition was
thought worthy  of a favorable reception by  the
medical public, we can confidently affirm that this
will be found much more  so.  The lecturer,  the
practitioner, and the student, may all have recourse
to its pages, and derive from  their perusal much in-
terest and instruction in everything relating to theo-
retical and practical midwifery.—Dublin Quarterly
Journal of Medical Science.

  A work of very great merit, and  such as we can
confidently recommend to the study of  every obste-
tric practitioner.—London Medical Gazette.

  This  is certainly the most perfect  system extant.
[t is the best  adapted for the purposes  of a text-
book, and  that which he whoso necessities confine
him to  one  book, should select in preference  to all
others.—Southern Medical and Surgical Journal.

  The most popular 'work on midwifery ever issued
from the American press.—Charleston Med. Journal.

  Were we reduced to the necessity of having but
one  work  on midwifery, and permitted  to choose,
we  would unhesitatingly take Churchill.—Western
Med. and Surg. Journal.
  It is impossible to conceive  a more useful  and
elegant  manual  than Dr. Churchill's Practice of
Midwifery.—Provincial Medical Journal.

  Certainly, in our opinion, the very best work on
the  subject which exists.—N.  Y. Annalist.
  We regard this volume as possessing more claims
to completeness than any other of the kind with
which we are acquainted.  Most cordially and earn-
estly, therefore, do we commend it to our profession-
al brethren, and we feel assured that the stamp of
their approbation will indue time be impressed upon
it.  After an attentive perusal of its contents, we
hesitate not to say,  that it is one of the most com-
prehensive ever written upon the diseases of chil-
dren, and that, for copiousness of reference, extent of
research, and  perspicuity of detail, it is  scarcely lo
be equalled, and  not to be  excelled, in any  lan-
guage.—Dublin Quarterly Journal.

  After this meagre, and we know, very imperfect
notice of  Dr. Churchill's work, we  shall  conclude
by saying, that it is one that cannot fail from its co-
piousness, extensive research, and general accuracy,
to exalt still higher the reputation of the author in
this country.  The American reader will be particu-
larly pleased to find that Dr. Churchill has done full
justice throughout his work to the various A mericun
authors on  this subject.  The  names of Dewees,
Eberle, Condie, and Stewart, occur on nearly every
page, and these authors are constantly referred toby
the author in terms of the highest praise, and with
the most liberal courtesy.— The Medical Examiner.
  To these papers Dr. Churchill has appended notes,
embodying whatever information 1ms been hud be-
fore the profession since their authors' time.  He has
also  prefixed to the r,ss;iys on  Puerperal  Fever,
which  occupy the  larger portion of the volume, an
interesting historical  sketch of the  principal epi-
  No work holds a higher position, or is more de-
serving of being placed in the hands of the tyro,
the advanced student, or the practitioner.—Medical
Examiner.

  Previous editions, under the editorial supervision
of Prof R.  M. Huston,  have  been  received with
marked favor, and they deserved  it; but this, re-
printed from a very  late  Dublin edition, carefully
revised and brought up by the author to the present
time, does present  an unusually accurate and able
exposition of every important particular embraced
in the department of midwifery. # * The clearness,
directness, and precision  of its teachings, together
with the great amount of statistical research which
its text exhibits, have served to place it already in
the foremost rank of works in this department of re-
medial science.—N. O. Med. and Surg. Journal.

  In our opinion, it forms one of the best if not the
very best text-book and epitome of obstetric science
which we at present possess in the  English lan-
guage.— Monthly Journal  of Medical Science.

  The clearness and precision of style in which it is
written, and the great amount of statistical research
which it contains, have  served to place it in the first
rank of works in this department of medical science.
— N. Y. Journal of Medicine.

  Few treatises will be found  better adapted as a
text-book for the  student, or as  a manual for the
frequent consultation of the young practitioner.—
American Medical Journal.
  The present volume will sustain the reputation
acquired by the  author  from his  previous works.
The reader will find in it full and judicious direc-
tions for the management of infants at birth, and a
compendious, but clear account of the diseases to
which children are liable, and the most successful
mode of treating them.  We must not close this no-
tice without calling attention to the author's style,
which is perspicuous and polished to a degree, we
regret to say, not  generally characteristic of medical
works.  We recommend the work of Dr. Churchill
most cordially, both to students and  practitioners,
as a valuable and  reliable guide in the treatment of
the diseases of children.—Am. Journ. of the Med.
Sciences.

  We know of no work on this department of Prac-
tical Medicine which presents so candid and unpre-
judiced  a statement  or  posting  up of our actual
knowledge as this.—N. Y. Journal of Medicine.

  Its elnirns to merit both as a scientific and practi-
cal work, are of the highest order.  Whilst we
would not elevate it above every other treatise on
the same subject, we certainly believe that very few
are equal  to it, and none superior.—Southern Med.
and Surgical Journal.
demies of that disease.   The whole  forms a very
valuable collection of papers, by professional writers
of eminence, on some of the most important accidents
to which the puerperal female is liable.—American
Journal of Medical Sciences.
BY  THE SAME AUTHOR.
ON THE DISEASES  OF  INFANTS  AND CHILDREN.   In  one large and
  handsome volume of over 600 pages.
                                    BY THE  SAME  AUTHOR.

ESSAYS  ON  THE PUERPERAL  FEVER, AND  OTHER DISEASES PE-
  CULIAR TO  WOMEN.  Selected from ihe writings of British Authors previous to the close of
  the Eighteenth Century.  In one neat octavo volume, of about four hundred and fifty pages. 
10
BLANCHARD & LEA'S MEDICAL
           CHURCHILL  (FLEETWOOD),  M.  D., M. R. I. A.,  &c.

ON THE DISEASES  OF WOMEN; including those of Pregnancy  and  Child-
  bed.  A new American edition, revised by the Author.  With Notes and Additions, by D Fran-
  cis Condie, M. D., author of " A Practical Treatise on the Diseases of Children."  In one large
  and handsome octavo volume, with wood-cuts, pp. 684.   (Just Issued.)

                               From the Author's Preface.
  In reviewing this edition, at the request of my American publishers,' I have inserted several new
sections and chapters, and I have added, I believe, all the information we have derived from recent
researches; in addition to which the publishers have  been fortunate enough to secure the services
of an able and highly esteemed editor in Dr. Condie.
  We now regretfully take leave of Dr. Churchill's
book.  Had our typographical limits  permitted, we
should  gladly have borrowed  more from its richly
stored  pages.  In conclusion, we heartily recom-
mend it to the profession, and would at the same
time express our firm conviction that it will not only
add to the  reputation of its author, but will prove a
work of great and  extensive utility to obstetric
practitioners.—Dublin Medical Press.

  Former editions of this work have been noticed in
previous numbers of the Journal. The sentiments of
high commendation expressed  in those notices, have
only to be  repeated in this; not from the fact that
the profession at  large are not aWare  of the  high
merits which this work really possesses, but from a
desire to see the  principles and doctrines therein
contained more generally recognized,  and more uni-
versally carried out in practice.—N. Y. Journal of
Medicine.

  We know of no author who  deserves that appro-
bation,  on  "the diseases of females," to the  same
extent that Dr. Churchill does.  His, indeed, is the
only thorough treatise we know of on the subject;
and it may be commended to practitioners and  stu-
dents as a masterpiece in its particular department.
The former editions of this work have been com-
mended strongly in this journal, and they have won
their way to an extended, and a well-deserved popu-
 larity.  This fifth edition, before us. is well calcu-
 lated  to maintain Dr.  Churchill's  high reputation.
 It was revised and enlarged by the author, for his
 American publishers, and it seems to us that there is
 scarcely any species of desirable information on its
 subjects that may not  be found in this work.—The
 Western Journal of Medicine and Surgery.

  We are gratified to announce a  new and revised
 edition of Dr. Churchill's valuable work on the dis-
 eases of females  We have ever regarded it as one
 of the very best works  on the subjects embraced
 within its scope, in the English language; and the
 present edition, enlarged and revised by the author,
 renders it still more entitled to the  confidence of the
 profession.  The valuable  notes of Prof. Huston
 have been retained, and contribute, in no small de-
 gree,  to enhance the value of the work.  It is a
 source of congratulation that the publishers have
 permitted the  author to  be. in this  instance, his
 own editor, thus securing  all  the revision which
 an author alone is capable of making.—The Western
 Lancet.

  Asa comprehensive manual for students, or  a
 work of reference for practitioners, we only speak
 with common justice when we say that it surpasses
 any other that has ever issued on the same sub-
 ject from the British press.—The Dublin Quarterly
Journal.
                         DEWEES  (W.  P.),  M.D.,  &c.

A  COMPREHENSIVE  SYSTEM OF  MIDWIFERY.   Illustrated  by  occa-
  sional Cases and many Engravings.  Twelfth edition, with the Author's last Improvements and
  Corrections.  In one octavo volume, of 600 pages.  (Just Issued.)

                                 BY THE SAME AUTHOR.
A TREATISE ON  THE PHYSICAL  AND  MEDICAL  TREATMENT OF
  CHILDREN.  Tenth edition. In one volume, octavo, 548 pages.  (Just Issued.)
                                 BY THE SAME AUTHOR.

A TREATISE  ON  THE DISEASES  OF  FEMALES.   Tenth  edition.
  one volume, octavo, 532 pages, with plates.  (Just Issued.)
In
                    DICKSON  (PROFESSOR  S.  H.),  M.D.
ESSAYS ON  LIFE,  SLEEP,  PAIN,  INTELLECTION,  HYGIENE,  AND
  DEATH.  In one very handsome volume, royal 12mo.
                                DANA  (JAMES  D).

ZOOPHYTES AND CORALS.   In  one volume, imperial  quarto,  extra cloth,
  with wood-cuts.
                                         ALSO,
AN ATLAS TO  THE  ABOVE,  one volume, imperial folio, with  sixtj-one mag-
  nificent plates, colored after nature.  Bound in half morocco.

                                         ALSO,

ON  THE   STRUCTURE   AND  CLASSIFICATION  OF  ZOOPHYTES.
  Sold separate, one vol., cloth.
              DE  LA  BECHE (SIR  HENRY  T.), F.  R. S., &c.

THE  GEOLOGICAL OBSERVER.   In one very large  and  handsome octavo
  volume, of 700 pages.  With over three hundred wood-cuts.  (Just Issued.) 
AND  SCIENTIFIC  PUBLICATIONS.
11
                      DRUITT  (ROBERT),  M.R. C.S., &c.

THE PRINCIPLES  AND PRACTICE  OF  MODERN  SURGERY.   A new
  American, from the last and improved London edition.  Edited by F. W. Sargent,  M. D.,
  author of " Minor Surgery,"  &c.   Illustrated  with one hundred and  ninety-three wood-eny rav-
  ings.  In one very handsomely printed octavo volume, of 576 large pages.
  No work, in our opinion, equals it in presenting
so much valuable surgical matter in so small a
compass.—St. Louis Med. and Surgical Journal.

  Druitt's Surgery is too well known to the Ameri-
can medical profession to require its announcement
anywhere.  Probably no work of the kind has ever
been more cordially received and extensively circu-
lated than this  The fact that it comprehends in a
comparatively small compass, all the essential ele-
ments of theoretical and practical Surgery—that it
is found to contain reliable and authentic  informa-
tion on the nature and treatment  of nearly all surgi-
cal affections—is  a sufficient reason for the liberal
patronage it has obtained.  The work before us is a
new edition, greatly enlarged and extended by the
anthor—its practical  part having undergone a tho-
rough revision, with fifty pages of additional matter.
The editor, Dr. F. W. Sargent, of Philadelphia, has
contributed much  to enhance  the value of the work,
by such American improvements as are calculated
more  perfectly to adapt it to our own views and
practice  in this country.  It abounds everywhere
with spirited and life-like illustrations, which to the
young surgeon, especially, are of no  minor consi-
deration.  Every medical man frequently needs just
such a work as this, for immediate reference in mo-
ments of sudden emergency, when he has not time to
consult more  elaborate  treatises.  Its  mechanical
execution is of the very best quality, and as a whole,
it deserves and will receive from the profession, a
liberal patronage.—The Ohio Medical  and Surgical
Journal.

  The author has evidently ransacked every stand-
ard treatise of ancient and modern times, and all that
is really practically useful at the bedside will be
found in a form at once clear, distinct, and interest-
ing.—Edinburgh Monthly Medical Journal.

  Druitt's work, condensed,  systemati*, lucid, and
practical as it is, beyond most  works on Surgery
accessible to  the American  student, has had much
currency in this country, and under its present au-
spices promises to rise to yet higher favor.   The il-
lustrations of the volume are good, and. in a word,
the publishers have acquitted themselves  fully of
their duty.—The  Western  Journal of Medicine  and
Surgery.

  The most accurate and ample resume of  the pre-
sent state of Surgery that we are acquainted with—
Dublin Medical Journal.

  A better book on the principles and practice of
Surgery as now understood in England and America,
has not been given to the profession.—Boston Medi-
cal and Surgical Journal.

  An unsurpassable compendium, not  only of Sur-
gical, but of  Medical Practice.—London  Medical
Gazette.

  This work  merits our warmest commendations,
and we strongly recommend  it to young surgeons as
an admirable digest of the principles and practice of
modern Surgery.—Medical Gazette.

  It may be said with truth that  the work of Mr.
Druitt affords a  complete,  though brief and  con-
densed view, of the entire field of modern surgery.
We know of no work on the same subject having the
appearance of a  manual, which includes so many
topics of interest to the surgeon ; and the terse man-
ner in which each  has been treated evinces a most
enviable quality of mind on the part of the author,
who seems to have an innate power  of.searching
out and grasping  the leading facts and features of
the most elaborate productions  of the pen.  It is a
useful handbook for the practitioner, and we should
deem a teacher of surgery unpardonable who did not
recommend it to his pupils.  In our own opinion, it
is admirably adapted to the wants of the student.—
Provincial Medical and Surgical Journal.
           DUNGLISON,  FORBES,  TWEEDIE,  AND CONOLLY.

THE CYCLOPEDIA  OF  PRACTICAL  MEDICINE:  comprising Treatises on
  the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women
  and Children, Medical Jurisprudence, &c. &c.  In  four  large  super  royal  octavo volumes, of
  3254 double-columned pages, strongly and handsomely bound.

  *%* This work contains no less than four hundred  and eighteen distinct treatises, contributed by
sixty-eight distinguished physicians.

                                                unquestionably one of very great value to the prac-
                                                titioner.  This estimate of it  has not been formed
                                                from a hasty examination, but after an intimate ac-
                                                quaintance derived from  frequent consultation of it
                                                during  the past nine or ten  years.  The editors are
                                                practitioners of established reputation, and the list
                                                of contributors embraces  many of the most eminent
                                                professors and teachers of London, Edinburgh, Dub-
                                                lin, and Glasgow.  It is, indeed, the great merit of
                                                this work that the principal articles have been fur-
                                                nished  by practitioners who have not only devoted
                                                especial attention to the diseases about which  they
                                                have  written, but have also enjoyed opportunities
                                                for an extensive practical acquaintance with them,
                                                and whose reputation carries the assurance of their
                                                competency justly to appreciate  the opinions of
                                                others, while  it stamps their own doctrines with
                                                high and just authority.—American Medical Journ.
  The most complete work on Practical Medicine
extant;  or,  at least, in our  language.— Buffalo
Medical and Surgical Journal.

  For reference, it is above all price to every prac-
titioner.—Western Lancet.

  One of the most valuable medical publications of
the day—as a work of reference it is invaluable.—
Western Journal of Medicine and Surgery.

  It has been to us, both as learner and teacher, a
work lor ready and frequent reference, one in which
modern Emili'sh medicine is exhibited in the most
advantageous light.—Medical Examiner.

  AVe rejoice that this work is to be placed within
the reach of the profession in this country, it being
                          DUNGLISON  (ROBLEY),  M.D.,
        Professor of the Institutes of Medicine, in the Jefferson Medical College, Philadelphia.

HUMAN HEALTH;  or,  the  Influence of  Atmosphere  and  Locality, Change of
  Air and Climate, Seasons, Food, Clothing, Bathing, Exerci>e, Sleep, ckc. &c , on Healthy Man;
  constituting Elements of Hygiene.  Second edition, with many modifications and additions
  one octavo volume, of 164 pages.
In 
12
BLANCHARD  &  LEA'S  MEDICAL
                          DUNGLISON  (ROBLEY),  M.D.,
          Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia.

MEDICAL  LEXICON;  a  Dictionary  of Medical Science,  containinrx a concise
  Explanation of the various Subjects and Terms of Physiology, Pathology, Hygiene, Therapeutics,
  Pharmacology, Obstetrics, Medical Jurisprudence, &c.  With the French and other Synonymes;
  Notices of Climate and of celebrated Mineral Waters; Formulae for various Officinal, Empirical,
  and  Dietetic Preparations, etc.  Ninth edition,  revised.  In one  very thick octavo volume, of
  over nine  hundred large double-columned pages, strongly bound in leather, with raised bands.
  (Just Issued.)

  Every successive edition of this work bears the marks of the industry of the author, and of his
determination to keep it fully on a level with the most  advanced slate of medical  science.  Thus
the last two editions contained about nine thousand subjects andterius not comprised in the one
immediately preceding, and the present has not less than four thousand not in any former edition.
As a complete Medical  Dictionary, therefore, embracing over  FIFTY THOUSAND DEFINI-
TIONS, in all the branches of the science, it  is presented as meriting a continuance of the great
favor and popularity  which have carried it, within no very long space of time,  to a ninth edition.
  Every precaution has been taken in the preparation of the present volume, to render its mecha-
nical execution and  typographical accuracy worthy of its extended reputation and universal use.
The very extensive additions have been accommodated, without materially increasing the bulk of
the volume by the  employment of a small but  exceedingly clear type, cast for  this purpose.  The
press has been watched with great care, and every effort used  to insure the verbal accuracy so ne-
cessary to a work of this nature.  The whole is printed  on fine white paper; and, while thus exhi-
biting  in every respect so  great an improvement over former issues, it is presented at the original
exceedingly low price.
  A miracle of labor and industry in one who has
written able and voluminous works on nearly every
branch of medical science.  There could be no more
useful book to the student or  practitioner, in the
present advancing age, than one in which would be
found, in addition to the ordinary meaning and deri-
vation of medical  terms—so many of which are of
modern introduction—concise descriptions of their
explanation and employment; and all this and much
more is contained in the volume before us.  It is
therefore almost as indispensable to the other learned
professions as to our own.  In fact,  to all who may
have occasion to ascertain the meaning of any  word
belonging to the many branches of medicine.  From
a careful examination of the present edition, we can
vouch for  its accuracy,  and  for its being brought
quite up to thedate of publication ; the author states
in his preface that he has added to it about four  thou-
sand terms, which are not to be found in the prece-
ding one. — Dublin Quarterly  Journal of Medical
Sciences.
  On  the  appearance of the last edition  of this
valuable work, we  directed the attention of our
readers to  its peculiar  merits;  and we  need do
little  more than state,  in  reference to the present
reissue, that, notwithstanding the  large additions
previously made  to  it, no fewer  than four  thou-
sand terms, not to be found in the preceding edi-
tion, are  contained  in  the  volume  before  us.—
Whilst it is a wonderful monument of its author's
erudition and industry, it  is also a work of great
practical utility,  as  we can  testify from our own
experience; for we keep it constantly within our
reach,  and  make very  frequent  reference  to it,
nearly always finding in it the information we seek.
—British and Foreign Med.-Chirurg. Review.
  It has the rare merit that it certainly has no rival
in the English language for accuracy and extent
of references. The  terms generally include  short
physiological and pathological descriptions, so that,
as the  author justly  observes,  the reader does not
possess in this work a mere dictionary, but a book,
which, while it  instructs him in medical etymo-
logy,  furnishes him  with a large amount of useful
information.  The author's  labors  have been pro-
perly appreciated by his own countrymen ; and we
can only confirm their judgment, by recommending
this most useful volume to the notice of our cisat-
lantic readers. No medical library will be complete
without it.—London Med. Gazette.

  It is certainly more complete and comprehensive
than any with which  we are  acquainted in the
English language.  Few, in fact,  could be found
better qualified than Dr. Dunglison for the produc-
tion  of such  a work.  Learned, industrious, per-
severing, and accurate, he brings  to  the task all
the peculiar  talents necessary  for its successful
performance;  while, at the  same time, his fami-
liarity with the writings of the ancient and modern
" masters of our art," renders him skilful to note
the exact usage  of  the several terms of science,
and the various modifications which medical term-
inology has undergone  with the change of theo-
ries or the progress of improvement. — American
Journal of the Medical Sciences.

  One of the  most complete  and  copious known to
the cultivators of medical  science.—Boston Med.
Journal.
  A most complete Medical  Lexicon—certainly one
of the best works of the kind in  the language.—
Charleston Medical Journal.

   The  most  complete Medical  Dictionary  in  the
English language.— Western Lancet.

  It has not its superior, if indeed  its equal, in the
English language.—St. Louis Medical and Surgical
Journal.
  Familiar with  nearly all  the  medical dictiona-
ries  now in  print,  we consider the one before us
the most complete, and an indispensable adjunct to
every  medical library.—British American Medical
Journal.
  AVe repeat our declaration, that this is the best
Medical Dictionary  in the language.—West. Lancet.

  The very best Medical Dictionary now extant.—
Southern Medical and Surgical Journal.

  The  most  comprehensive and best English Dic-
tionary of medical terms extant.—Buffalo Medical
Journal.
                                    BY THE SAME AUTHOR.

THE PRACTICE  OF MEDICINE.   A Treatise on Special  Pathology and The-
  rapeuties.  Third Edition.  In two large octavo volumes, of fifteen hundred pages.

                                                ferings of the race.—Boston Medical and Surgical
                                                Journal.
  Upon every topic embraced in the work the latest
information  will  be  found carefully posted up.—
Medical Examiner.

  The  student of  medicine will find, in these two
elegant volumes,  a mine of facts, a gathering of
precepts and advice from the world of experience,
that will nerve him  with courage, and faithfully
direct him in his efforts to relieve the physical  suf-
  It is certainly the most complete treatise of which
we haveany knowledge.— Western Journal of Medi-
cine and Surgery.

  One of the most elaborate treatises of the kind
we have.—Southern Med. and Surg. Journal. 
AND SCIENTIFIC  PUBLICATIONS.
13
                         DUNGLISON  (ROBLEY),  M.D.,
          Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia.

HUMAN   PHYSIOLOGY.   Seventh  edition.   Thoroughly  revised  and exten-
  sively  modified and enlarged, with nearly five hundred illustrations.  In two large and hand-
  somely printed octavo volumes, containing nearly 1450 pages.

  On no  previous revision of this work has the author bestowed more care than on the present,
it  having been subjected to an entire scrutiny, not only as regards the important matters of
which  it  treats, but also the language in which they are conveyed;  and on no former occasion
has he felt as satisfied with  his endeavors to have  the work on a level with the existing state of
the science.

  The increased amount of  matter may  be estimated from the fact that the mere list of authors
referred  to  in  the preparation  of the additions to this  edition alone extends over  nine  large
aiid  closely  printed pages.   The number of illustrations  has been greatly extended,  the present
edition containing four hundred and seventy-four, while the last had but three hundred and sixty-
eight;  while, in addition to this, many new and superior wood-cuts have been substituted for those
which were not deemed sufficiently accurate or satisfactory.  The mechanical execution  of the
work has also been improved in every  respect, and the whole is confidently presented as worthy
the great and continued favor which it has so long received from the  profession.
  It has long  since taken rank as one of the medi-
cal classics of our  language.  To say that  it is by
fur the best text-book of physiology ever published
in this  country, is but  echoing the general testi-
mony of the profession.—N. Y. Journal of Medicine.

  There is no  single book we would Tecommend to
the student  or physician, with greater  confidence
than the present, because in it, will be found a mir-
ror of almost every standard physiological work of
the day.  We  most cordially recommend the work
to every member of the  profession, and  no  student
Bhould be without it.  It is  the completest work on
Physiology in the English language, and is highly
creditable to the author and publishers.—From the
Canadian Medical Journal.

  The most  complete and satisfactory system  of
Physiology in the English language.—Amer. Med.
Journal.

  The best work of the  kind in the  English lan-
guage.—Sillitnan's Journal.

  The most full and complete system of Physiology
in our language.— Western Lancet.
                                   BY THE SAME AUTHOR.

GENERAL  THERAPEUTICS  AND  MATERIA  MEDICA;  adapted for  a
  Medical Text-book.  Fourth edition, much improved.  With one hundred and eighty-two illus-
  trations.  In two large and handsomely printed octavo volumes, of 1000 pages.
  In this work of Dr. Dunglison, we recognize the
same untiring industry in the collection and em-
bodying of facts on the several subjects of which he
treats,  that has heretofore distinguished him, and
we cheerfully point to these volumes, as two of the
most interesting that we know of.  In  noticing the
additions to this, the  fourth edition, there  is very
little in the periodical or  annual literature of the
profession,  published  in  the  interval  which  has
elapsed sinde the issue of the first, that  has escaped
the careful  search of the  author.  Asa book for
reference, it is invaluable.— Charleston Med. Jour
nal and Review.

  It may be said to be the -work  now upon the sub-
jects upon which it treats.— Western Lancet.
  As a text-book for students, for whom it is par-
ticularly designed, we know of  none superior to
it.—St. Louis Medical and Surgical Journal.

  It purports to be a new edition, but it is rather
a new book,  so greatly has it been improved, both
in the amount and quality of the matter which it
contains.—N. O. Medical and Surgical Journal.

  We bespeak for this edition, from the profession,
an increase  of patronage  over any  of its former
ones, on account of its  increased merit. — N. Y.
Journal of Medicine.

  We consider this work unequalled.—Boston Med.
and Surg.  Journal.
                                   BY THE SAME AUTHOR.

NEW  REMEDIES, WITH FORMULAE FOR THEIR ADMINISTRATION,
  Sixth edition, with extensive Additions.  In one very large octavo volume, of over 750 pages.

  One of the most useful of the author's works.-  diseases  and for remedies, will be found greatly to
Southern Medical and Surgical Journal.            enhance its value.-x^u> York Med. Gazette.
  This well-known  and standard  book has now
reached its sixth edition, and has been enlarged and
improved by the introduction of all  the recent gifts
to therapeutics which the last few years have so
richly produced, including  the anaesthetic agents,
&c.  This elaborate and useful volume should be
found in every medical library, for as a book of re-
ference, for physicians, it is unsurpassed by any
other work in existence, and the double index for
  The great learning of the author, and his remark-
able industry in  pushing his  researches into every
source whence information is derivable, has enabled
him to throw together an extensive mass of facts
and statements, "accompanied by full reference to
authorities; which  last feature renders the work
practically valuable to investigators who desire to
examine the original papers.—The American Journal
of Pharmacy.
                    DUFTON  (WILLIAM),  M.R.C.S.,  &.C.

THE  NATURE  AND  TREATMENT  OF  DEAFNESS  AND  DISEASES
  OF THE EAR ; and the Treatment of the Deaf and Dumb.  One small 12mo. vol.  pp. 120. 
14
BLANCHARD  &  LEA'S  MEDICAL
                          DE JONGH  (L. J.), M. D.,  &c.
THE  THREE  KINDS  OF  COD-LIVER  OIL, comparatively considered, with
  their Chemical and Therapeutic  Properties.  Translated,  with an  Appendix and  Cases, by
  Edward Carey, M D.  To which is added an article on the  subject from "Dunglison on New
  Remedies."   In one small 12mo. volume, extra cloth.
                             DURLACHER (LEWIS).
A  TREATISE  ON  CORNS,  BUNIONS,  THE  DISEASES   OF  NAILS,
  AND  THE  GENERAL MANAGEMENT  OF  THE  FEET.  In  one 12mo. volume, cloth.
  pp. 134.
                             DAY (GEORGE E.),  M.  D.

A PRACTICAL TREATISE  ON  THE  DOMESTIC  MANAGEMENT  AND
  MORE  IMPORTANT DISEASES OF  ADVANCED  LIFE.  With an Appendix on  a new
  and successful mode of treating Lumbago and other forms of Chronic Rheumatism.  One volume,
  octavo, 226 pages.
                            ELLIS (BENJAMIN), M.D.

THE  MEDICAL  FORMULARY:  being a Collection of Prescriptions,  derived
  from the writings and practice of many of the most eminent physicians of America and Europe.
  To which  is added an Appendix, containing  the usual Dietetic Preparations and Antidotes for
  Poisons.   The whole accompanied  with a few brief Pharmaceutic and Medical Observations.
  Ninth edition, corrected and extended, by Samuel George Morton, M. D.  In one neat octavo
  volume, of two hundred and sixty-eight pages.
                      FERGUSSON  (WILLIAM), F. R. S.,
                     Professor  of Surgery  in King's College, London, &c.

A SYSTEM OF PRACTICAL  SURGERY.   Fourth American, from the third
  and enlarged London edition.  In one large and beautifully printed octavo volume, of about seven
  hundred pages, with three hundred and ninety-three handsome illustrations.  (Now Ready.)
  The most important subjects in connection with
practical  surgery -which have been more recently
brought under the notice of, and discussed by, the
surgeons of Great Britain, are fully and dispassion-
ately considered by Mr. Fergusson, and that which
was before wanting has now been  supplied, so that
we can now look upon it as a work on practical sur-
gery  instead of  one on operative surgery alone,
which many have hitherto considered it to be.  And
we think the author has shown a wise discretion in
making the additions on surgical disease which are
to be found in the  present volume, and has  very
much enhanced its value; for, besides two elaborate
chapters on the diseases of bones and joints, which
were wanting before, he has headed each chief sec-
tion of the work by a general description of the sur-
gical disease and injury of that  region of the body
which is treated of in each, prior to entering into the
consideration of the more special morbid conditions
and their treatment. There is  also,  as in former
editions, a sketch of the anatomy  of particular re-
gions.  We have now pointed out some of the prin-
cipal  additions  in  this  work.   There was some
ground formerly for the complaint before alluded to,
that it dwelt too exclusively on operative surgery ;
but this defect is now removed, and the book is more
than ever adapted for the purposes of the practitioner,
whether he confines himself more strictly  to the
operative department, or follows surgery on a more
comprehensive scale.—Medical Times  and Gazette.
  No work was ever written which  more  nearly
comprehended the necessities of  the student and
practitioner, and was  more  carefully arranged  to
that single purpose than this.—2V. Y. Med. and Surg.
Journal.
  The addition of many new pages makes this work
more than ever indispensable to the student and prac-
titioner.—Banking's Abstract, January, 1S53.

  For the general practitioner, who does not make
a specialty of surgery, it is  certainly invaluable.
The style is concise, pointed, and clear.  The de-
scriptions of the various operations_are concentrated
and accurate,  so that in cases of emergency, the
principles of the most difficult operations may be
obtained by a reference of a few moments to its
pages.—Western Lancet.

  As a book of reference for the surgeon and student
itis an admirable work, purely on the practice of
surgery, and not encumbered with any irrelevant
matter, nor with too much theory or discussion on
surgical subjects.—Stethoscope.

  Among  the numerous works upon surgery pub-
lished of late  years, we know of none we value
more highly than  the one before us.  It is perhaps
the very best we have for a text-book and  for ordi-
nary reference, being concise  and eminently practi-
cal.—Southern Med. and Surg. Journal.

  The nature and variety of  these additions, how-
ever, must render it of course impracticable to dwell
upon them here;  and the best we can do for the
book itself, as well as for our  readers, is to recom-
mend all who desire one of  the most  instructive
manuals of practical surgery,  to provide themselves
with copies for their  private reading.—Medical
Examiner.
                            FRICK  (CHARLES), M. D.
RENAL  AFFECTIONS;  their  Diagnosis  and  Pathology.
  One volume, royal 12mo., extra cloth.
With  illustrations.
                        GUTHRIE (G. J.),  F. R. S., &c.
THE  ANATOMY OF  THE  BLADDER  AND  URETHRA, and the Treat-
  ment of the Obstructions to which those Passages are liable.  In one volume, octavo, 150 pages. 
AND  SCIENTIFIC  PUBLICATIONS.                    15
                         FOWNES (GEORGE), PH. D.,  &.C.
ELEMENTARY   CIIE.MISTRY;  Theoretical  and Practical.   With  numerous
  illustrations   Third American, from a late London edition.   Edited, with Additions, by Robert
  Bridges, M. D.  In one large royal 12mo. volume, of over 500 pages, with about 180 wood-cuts,
  sheep, or extra cloth.
  The work of Dr. Fownes has long been before
the public, and its  merits have been fully appreci-
ated  as  the best text-book on  chemistry now in
existence.  We do not, of course, place it in a rank
superior to the works of Brande, Graham, Turner,
Gregory, or Grnelin, but we say that, as a work
for students, it is preferable to any of them.—Lon-
don Journal of Medicine.

  The rapid sale of this Manual evinces its adapta-
tion to the wants of the student of chemistry, whilst
the well-known merits of its lamented author have
constituted a  guarantee for its value, as a faithful
exposition of the general principles  and  most im-
portant facts of the science to which it professes to
be an introduction.—British and Foreign Medico-
Chirurgical Review.
  A work well adapted to the wants of the student.
It  is an excellent exposition of the chief doctrines
and facts of modern chemistry, originally intended
as a guide to the lectures of the author, corrected by
his own hand shortly before his death in 1849, and
recently revised by Dr. Hence Jones, who has made
some additions to  the chapter on animal chemistry.
Although not intended to supersede tlie more extended
treatises on chemistry, Professor Fownes's Manual
may, we think, be  often used as a work of reference,
even by those advanced in the study, who may be de-
sirous of refreshing their memory on some forgotten
point.  The size of the work, and still more the con-
densed yet perspicuous style in which it is written,
absolve it  from the charges  very properly urged
against most manuals termed popular, viz.: of omit-
ting details of indispensable importance, of avoiding
technical difficulties,  instead  of explaining them,
and of treating  subjects of high scientific interest
in an unscientific  way.—Edinburgh Monthly Jour-
nal of Me ileal Science.
                           GRAHAM  (THOMAS), F.  R. S.,
                    Professor of Chemistry in University College,  London,  &c

THE  ELEMENTS OF CHEMISTRY.   Including the application of the Science
  to the Arts.  With numerous illustrations.  With Notes and Additions, by Robert Bridges.
  M. D., &c. &c.   Second American, from the second and enlarged London edition
PART  I. (Lately Issued) large 8vo., 430 pages, 185 illustrations.
PART  II. (Preparing) to match.
  The great changes which the science of chemistry has undergone within the last few years, ren-
der a new edition  of a treatise  like the present,  almost  a new  work.  The author has devoted
several  years to the revision of his treatise, and has endeavored  to embody  in it every fact and
inference  of importance which has  been observed and  recorded by the  great body of chemical
investigators who are so rapidly changing the face of the science.   In this manner the work has
been greatly increased in size, and the number of illustrations doubled ; while the labors of the editor
have been directed towards the introduction  of such matters as have escaped the attention of the
author,  or as have arisen since the publication of the first portion of this edition in London, in 1850.
Printed in handsome style, and at a very low price, it is therefore  confidently presented to the pro-
fession  and the student as a very complete and thorough text-book of this important subject.
                            GROSS  (SAMUEL  D.), M.  D.,
                    Professor of Surgery in the Louisville Medical Institute, &c.
A PRACTICAL TREATISE ON  THE DISEASES  AND  INJURIES  OF
  THE URINARY ORGANS.  In one large and beautifully printed octavo volume, of over seven
  hundred pages.  With numerous illustrations
  A volume replete with truths and principles of the
utmost value in the investigation of these diseases.—
American Medical Journal.
  Dr. Gross has  brought all  his learning, experi-
ence, tact, and judgment to the task, and has pro-
duced a work worthy of his high reputation.  We
feel perfectly safe in recommending  it to our read-
ers as a  monograph  unequalled  in interest and
practical value by any other on  the  subject in our
language; and we cannot help saying, that we es-
teem it a matter  of just pride, that another work
so creditable to our country has been contributed
to our medical literature by a Western physician.
—The Western Journal of Medicine and Surgery.

  We regret that our limits preclude such a notice
as  this  valuable contribution  to  our  American
Medical  Literature merits.  We have  only room
to say that  the author deserves the thanks of the
profession for this elaborate production;  which
cannot fail to  augment  the exalted reputation ac-
quired by his former works, for which  he has been
honored at home and abroad.—N. Y. Med Gazette.

  Whoever will peruse  the vast amount of valuable
practical  information it contains, and  which we
have been unable even  to notice, will, we think,
agree with us, that there is no %vork  in the English
language which can make any just pretensions to
be its equal.   Secure in  the esteem  and confidence
of the profession in this  country, at least, its  distin-
guished author will doubtless receive their warmest
congratulations that he has succeeded in producing
a treatise so creditable to himself, and, as we hum-
bly believe, to American surgical literature.—N. Y.
Journal of Medicine.

  It has remained for an American writer to wipe
away this reproach ; and so completely has the task
been fulfilled, that we venture to  predict for Dr.
Gross's treatise a permanent place in the literature
of surgery, worthy to rank with the best works of
the present age.  Not merely is the matter good,
but the getting up of the volume is  most creditable
to transatlantic enterprise;  the paper and print
would do credit to a first-rate London establishment;
and the numerous wood-cuts which illustrate it, de-
monstrate that America is making rapid advances in
this department of art. We have, indeed, unfeigned
pleasure in congratulating all concerned in this pub-
lication,  on the result of  their labours; and expe-
rience a feeling something like whatunimatesa long-
expectant husband man, who, of ten times disappointed
by the produce of a favorite field, is at last agree-
ably surprised by  a stately crop which may bear
comparison with any of its former rivals.  The
grounds of our high appreciation of the work will
be obvious as we proceed; and we doubt not that
the  present facilities for obtaining American books
will induce many of our readers to verify our re-
commendation by their own perusal  of it.—British
and Foreign Medico-C hirurgical Review.
                   GRIFFITH  (JOHN  WILLIAM), M. D., &c.
A  PRACTICAL   MANUAL  ON  THE  BLOOD   AND SECRETIONS  OF
  THE HUMAN BODY.  Royal 12mo., with plates.   (See " Manuals on Blood and Uriue.") 
16
BLANCHARD &  LEA'S  MEDICAL
                           GLUGE (GOTTLIEB),  M.D.,
        Professor of Physiology and Pathological Anatomy in the University of Brussels, &c.

AN  ATLAS OF  PATHOLOGICAL  HISTOLOGY.   Translated, with Notes
  and Additions, by Joseph Leidy, M. D., Professor of Anatomy in the University of Pennsylva-
  nia.  In one volume, very large  imperial quarto, with  three hundred and twenty figures, plain
  and colored, on twelve copperplates.
  We are glad to see this excellent work of Gluge
translated into English by so competent a hand, and
put within the reach of the profession in this coun-
try.  The history of the development and changes of
the elements of pathological tissues, has  become
now a necessary introduction to the study of morbid
anatomy. It can no longer be looked upon as merely
accessory.  Bearing the same relation to it as does
normal histology to normal anatomy, it  appears to
us to be of still higher importance, since  it has a
closer and more direct bearing upon practical medi-
cine.  Whatever makes our  knowledge of diseased
structure clearer, must throw light also upon the
plan of cure, and show us, too, in many instances,
where a cure is  impossible.   This being, as far as
we know, the only work in which pathological his-
tology is separately treated of in a comprehensive
manner, it will, we  think, for this reason, be of infi-
nite service to those who desire  to investigate the
subject systematically, and who have felt the diffi-
culty of arranging in their mind  the unconnected
observations of a great number  of authors.  The
development of the morbid tissues, and the formation
of abnormal products, may now be followed and
studied with the same ease and satisfaction as the
best  arranged  system  of  physiology. — American
Med. Journal.

  Professor Gluge's work will be found a very valu-
able  addition to the  micrologist's collection. It
contains, in the compass of one volume, a concise
description and well-executed illustrations of the
elements to be observed under the microscope in the
principal pathological  lesions.—Dublin  Quarterly
Journal of Medical Science.
                      GRIFFITH  (ROBERT  EJ, M. D., &c.

A  UNIVERSAL FORMULARY, containing the methods of  Preparing and Ad-
  ministering Officinal and other Medicines.  The whole adapted to Physicians and Pharmaceu-
  tists.   In one large octavo volume, of 568 pages,  double columns.

  Dr. Griffith's Formulary is worthy of recommen-
dation, not only  on  account of the care which has
been bestowed on it by its estimable author, but for
its general accuracy, and the richness of its details.
—Medical Examiner.
  Most cordially we recommend  this Universal
Formulary, not forgetting its adaptation to drug-
gists and  apothecaries, who would find themselves
vastly improved by a familiar acquaintance with
this every-day book of medicine.—The Boston Med.
and Surg. Journal.

  A very useful work, and a most complete compen-
dium on the subject of materia medica.  We know
of no work in our language, or any other, so com-
prehensive in all its details.—London Lancet.
  Pre-eminent among the best and most useful com-
pilations of the present day will be found the work
before us, which can have been produced only at a
very great cost of thought  and labor.  A short de-
scription will suffice to show that we do not put
too high an estimate on this work. We are not cog-
nizant of the existence of a parallel work. Its value
will  be apparent to our readers from the sketch of
its contents above given. We strongly recommend
it to  all who are engaged either in practical medi-
cine, or more exclusively with its literature.—Lond.
Med. Gazette.

  A valuable acquisition to the medical practitioner,
and a useful book of reference to  the apothecary on
numerous occasions.—Amer. Journal of Pharmacy.
                                   BY THE SAME AUTHOR.

MEDICAL BOTANY; or, a  Description of all the  more  important  Plants used
  in  Medicine, and  of their  Properties, Uses, and Modes of Administration.  In one large octavo
  volume, of 704 pages, handsomely printed, with nearly 350 illustrations on wood.

                                                One of the few books which supply a positive de-
                                              ficiency in our medical literature.—Western Lancet.
  One of the greatest acquisitions to American medi-
cal literature. It should by all means be introduced,
at the very earliest period, into our medical schools,
and occupy a place in the library of every physician
in the land.—South-western Medical Advocate.
  Admirably calculated for  the physician and stu-
dent — we have seen  no work  which promises
greater advantages to the profession.—N. O. Med.
and Surg. Journal.
  We hope the day is not distant when this work
will not only be a text-book in every medical school
and college in the Union, but find a place in the li-
brary of every private practitioner.—N. Y. Journal
of Medicine.
                       GREGORY (WILLIAM), F.  R. S. E.,
                    Professor of Chemistry in the University of Edinburgh, &c.

LETTERS   TO  A  CANDID  INQUIRER   ON   ANIMAL   MAGNETISM.
  Description and Analysis of the Phenomena.  Details of Facts and Cases.  In one neat volume,
  royal 12mo., extra cloth.
                         GARDNER (D.  PEREIRA), M. D.

MEDICAL CHEMISTRY,  for th*e use of Students  and  the  Profession:  being a
  Manual of the Science, with its Applications to Toxicology, Physiology, Therapeutics, Hygiene,
  &c.  In one handsome royal 12mo. volume, with illustrations. 
AND SCIENTIFIC  PUBLICATIONS.
17
                            HASSE  (C.  E.),  M. D.
AN  ANATOMICAL  DESCRIPTION OF THE  DISEASES  OF RESPIRA-
  TION AND CIRCULATION.  Translated and Edited by Swaine.  In one volume, octavo.
                         HARRISON (JOHN), M.D.
AN  ESSAY  TOWARDS A  CORRECT  THEORY OF  THE  NERVOUS
  SYSTEM.  In one octavo volume, 292 pages.
                              HUNTER (JOHN).

TREATISE ON  THE  VENEREAL  DISEASE.  With Notes and numerous
  Additions, by Dr. Ph. Ricord, Surgeon to the "Venereal Hospital of Paris.  Translated from the
  French, with additional Notes, by F. J. Bumstead, M. D. In one octavo volume, with plates.
  (Nearly Ready.)

  Ricord's Annotations to Hunter's Treatise are very extensive, amounting to nearly half as much
as the original work, and bringing it thoroughly up to the present state of the subject.
                      HORNER (WILLIAM E.),  M. D.,
                  Professor of Anatomy in the University of Pennsylvania.

SPECIAL  ANATOMY  AND  HISTOLOGY.   Eighth edition.   Extensively
  revised and modified.  In two large octavo volumes, of more than one thousand pages, hand-
  somely printed, with over three hundred illustrations.

  This work has enjoyed a thorough  and laborious revision  on the part of the author, with the
view of bringing it fully up to the existing state of knowledge on the subject of general and special
anatomy.  To adapt it more perfectly to t he wants of the student, he has introduced a large number
of additional wood-engravings,  illustrative of the objects described, while the publishers have en-
deavored to render the mechanical execution of the work worthy of the extended reputation which
it has acquired.  The demand which has carried it to  an EIGHTH EDITION is a sufficient evi-
dence of the value of the work, and of its adaptation to the wants of the student and professional
reader.
               HORNER (W. E.) in connection with H. H. SMITH.

ANATOMICAL  ATLAS.   One volume, imperial 8vo.   (See Smith.)
                      HOBLYN (RICHARD D.), A. M.

A DICTIONARY  OF  THE TERMS USED IN MEDICINE AND  THE
  COLLATERAL  SCIENCES.  Revised, with numerous Additions, from the second London
  edition^ by Isaac Hays, M. D., &c.  In one large royal 12mo. volume, of four hundred and two
  pages, double columns.
  We cannot too strongly recommend this small and cheap volume to the library of every student and
practitioner.—Medico-C hirurgical Review.
                       HOPE (J.),  M. D., F. R. S., &c.
A TREATISE ON THE  DISEASES  OF  THE  HEART  AND  GREAT
  VESSELS.  Edited by Pennock.  In one volume, octavo, with plates, 572 pages.
               HERSCHEL (SIR JOHN F. W.), F. R. S.,  &c.

OUTLINES OF  ASTRONOMY.  New American, from the third London edition.
  In one neat volume, crown octavo, with six plates and numerous wood-cuts.  (Just Issued.)
            JOHNSTON  (ALEXANDER  KEITH), F. R. S.,  &c.

THE PHYSICAL ATLAS OF  NATURAL PHENOMENA.  For the use of
  Colleges, Academies, and Families.  In one large volume, imperial  quarto, handsomely  and
  strongly bound, with twenty-six Plates, engraved and colored in the best style.  Together wall
  112 pages of descriptive letter-press, and a very copious Index. 
18                     BLANCHARD &  LEA'S  MEDICAL
                     JONES  (T.  WHARTON),  F. R. S., &c.
THE  PRINCIPLES  AND  PRACTICE  OF  OPHTHALMIC   MEDICINE
  AND SURGERY.  Edited by Isaac Hays, M. D., &c.  In one very neat volume, large royal
  12mo., of 529 pages, with four plates, plain or colored, and ninety-eight wood-cuts.
  We are confident that the reader -will find, on
perusal, that the execution of the work amply fulfils
the promise  of the preface, and sustains, in every
point the already high reputation of the author as
an ophthalmic surgeon as well  as a phvsiologist
and pathologist.  The book is evidently the result
of much labor and  research, and has been written
with the greatest care and attention; it possesses
that best quality which a general work, like a sys-
tem or manual can show, viz.: thequality of having
all the materials wheneesoever derived, so thorough-
ly wrought  up, and  digested in the author's mind,
as to come forth with  the freshness and impressive-
ness of an original production. We regret that we
have received the book at so late a period as pre-
cludes our giving more than a mere notice of it, as,
although essentially and necessarily a compilation, it
contains many things which we  should be glad to
reproduce in our pages whether in the shape of new
pathological views,  of old  errors corrected,  or of
sound principles of practice in doubtful eases clearly
laid down.  But we  dare say most of our readers
will shortly have an opportunity of seeing  these in
their original  locality, as we entertain little doubt
that this book will become what its author hoped  it
might become, a manual for daily reference ami
consultation by the  student and the general practi-
tioner.  The work  is marked by that correctness,
clearness, and precision of  style  which distinguish
all the productions of the learned author.—British
and Foreign Medical Review.
                    KIRKES  (WILLIAM SENHOUSE),  M. D.,
             Demonslrator of Morbid Anatomy at St. Bartholomew's Hospital, &c.; and

                              JAMES PAGET,  F. R. S.,
            Lecturer on General Anatomy and Physiology in St. Bartholomew's Hospital.

A  MANUAL  OF  PHYSIOLOGY.   Second American,  from  the second  and
  improved London edition.  With one hundred  and sixty-five  illustrations.  In  one  large and
  handsome royal 12mo. volume,   pp.550.  (Just Issued.)

                                                The general favor with which the first edition of
                                              this work was received, and its adoption  as a favor-
                                              ite  text-book by many of our colleges, will insure a
                                              large circulation to  this improved edition.  It will
                                              fully  meet  the wants of the  student. — Southern
                                              Med. and Surg. Journal.

                                                It possesses the especial merit of being clear and
                                              concise, and at the same time affording a good out-
                                              line of Physiology.—Western Lancet.
  In the present edition, the Manual of Physiology
has been brought up to the actual condition of the
science, and fully sustains the reputation which it
has already so deservedly attained.  We consider
the work of MM. Kirkes and Paget to constitute one
of the very best handbooks of Physiology we possess
—presenting just such an outline of the science, com-
prising an account of its leading facts and generally
admitted principles, as the student requires during
his attendance upon a course of lectures, or for re-
ference whilst, preparing for examination!  The text
is fully and ably illustrated by a series of very supe-
rior wood-engravings, by which a comprehension of
some of the more intricate of the subjects treated of
is greatly facilitated.—Am. Medical Journal.
  We need only say, that, without entering into dis-
cussions of  unsettled questions, it contains all  the
recent improvements in this department of medical
science. For the student beginning this study, and
the practitioner who has but leisure to refresh his
memory, this book is invaluable, as it contains all
that it is important to know, without special details,
which  are  read with interest  only  by those who
would make a specialty, or desire to possessa  criti-
cal knowledge of the subject.—Charleston Medical
Journal.

  One of the best treatises that can be put into  the
hands of the student.—London Medical Gazette.
  Numerous new and superior illustrations have
been introduced for the purpose of making the sub-
ject of more easy comprehension by  the student.
This edition has evidently been prepared with great
care, and is handsomely printed on good paper, and
will prove a'very valuable book for  the student in
acquainting himself with all the  leading well-es-
tablished facts in physiology, and for the practitioner
as a work of reference.—New York Medical Times.

  Particularly adapted to those who desire to pos-
sess a concise digest of the  facts of Human Physi-
ology.—British and Foreign Med.-Chirurg. Review.

  We conscientiously recommend  it as an admira-
ble "Handbook of Physiology."—London Journal
of Medicine.
                              KNAPP (F.), PH.  D., &.c.

TE<11INOLOGY;  or, Chemistry applied to the Arts and to Manufactures.   Edited,
  with numerous Notes and Additions, by Dr. Edmund  Ronalds and Dr. Thomas Richardson.
  First American edition, with Notes and Additions, by Prof. Walter R. Johnson.  In two hand-
  some octavo volumes, printed and illustrated in the highest style of art, with about five hundred
  wood-engravings.
PHYSIOLOGICAL
  In one very large octavo volume.
             LEHMANN.
CHEMISTRY.    Translated  by George E. Day,  M.  D.
(Preparing.)
                       LEE (ROBERT), M.  D., F. R. S.,  &c.
CLINICAL   MIDWIFERY;  comprising the  Histories of  Five Hundred  and
  Forty-five Cases of Difficult, Preternatural, and Complicated Labor, with Commentaries.  From
  the second London edition.  In one royal 12mo. volume, extra cloth, of 238 pages. 
AND  SCIENTIFIC  PUBLICATIONS.
10
                        LAWRENCE  (W.),  F. R. S., &c.

A TREATISE   ON  DISEASES  OF  THE  EYE.   Third  American edition,
  much improved and enlarged.  With over two hundred illustrations.  By Isaac Hays, M. D.,
  Surgeon to Wills Hospital, Philadelphia, &c.  In one very large and  handsome octavo volume,
  of over eight hundred pages. This new edition to be ready by July.

  This work, by far the largest and most comprehensive on the subject within reach of the profes-
sion in this country, will receive an  entire revision on  the part of the editor.  Brought up in this
manner to the most advanced state of science, and presenting an equal improvement over its prede-
cessors as regards mechanical execution, it is confidently presented as worthy of the extended repu-
tation which it has hitherto enjoyed.

                                 BY THE  SAME AUTHOR.

A TREATISE  ON RUPTURES; from the  fifth London edition.   In one  octavo
  volume, sheep, 480 pages.
                            LEIDY  (JOSEPH), M. D.
                  Professor of Anatomy in the University of Pennsylvania, &c.

ATLAS  OF  PATHOLOGICAL  HISTOLOGY.   By Gottlieb Gluge, M. D.
  Translated from the German, with Additions, by Joseph Leidy, M. D , Professor of Anatomy
  in the University  of Pennsylvania.   In one vol., large imperial quarto, with 320 figures, plain
  and colored, on twelve plates.

     •                            by the same author.

HUMAN ANATOMY.   By Jones Quain, M. D.  From the fifth London edition.
  Edited by Richard Quain, F. R. S., and William Sharpey, M.D., F.R. S.,  Professors of
  Anatomy and Physiology,  in University College, London.  Revised, with Notes and Additions,
  by Joseph Leidy, M. D., Professor of Anatomy in the University of Pennsylvania.  Complete in
  two large 8vo. vols, of about 1300 pages, beautifully illustrated with over 500 engravings on wood.
                       LISTON (ROBERT),  F. R. S., &c.

LECTURES ON THE  OPERATIONS OF SURGERY, and on Diseases  and
  Accidents requiring Operations.  Edited, with numerous Additions and Alterations, by T. D.
  Mutter, M. D.  In one large and handsome octavo volume, of 566 pages, with 216 wood-cuts.
  We can only say, in conclusion, that  Listen's
Lectures, 'with Mutter's additions, should be in
every surgeon's library, and  in every student's
hand, who wishes to post up his surgical knowledge
to the present moment.—N. Y. Journ. of Medicine.
  The work furnishes a very clear and satisfactory
account of our knowledge in the important depart-
ment of science of which it treats.  Although the
medical schools of this country do not include the
study of physics in their course of instruction, yet
no student or practitioner should be ignorant of its
laws. Besides being of constant application in prac-
tice, such knowledge is of inestimable utility in fa-
cilitating the study of other branches of science. To
students, then, and to those who, having already en-
tered upon the active pursuits of business, are desir-
ous  to sustain and improve their knowledge of the
general truths of natural philosophy, we can recom-
mend this work as supplying  in a clear and satis
  It is a compendium of the modern practice of Sur-
gery as complete and accurate as any treatise of
similar dimensions in the English language.— West-
ern Lancet.
factory manner the information  they desire.—The
Virginia Med. and Surg. Journal.

  The present treatise is a most complete digest of
all that has been developed in relation to the great
forces of nature, Heat, Magnetism, and Electricity.
Their laws are elucidated in a manner both pleasing
and familiar, and at the. same time perfectly intelli-
gible to the  student.  The illustrations are suffi-
ciently numerous and appropriate, and altogether
we can cordially recommend the work as well-de-
serving the notice both of the practising physician
and the. student of medicine.—The Med. Examiner.
                                LALLEMAND  (M.).

THE   CAUSES,  SYMPTOMS,   AND  TREATMENT  OF   SPERMATOR-
  RIICEA.  Translated and edited by Henry J. McDougal.  In  one volume, octavo, 320 pages.
  Second Americau.edition.   (Now Ready.)
                    LARDNER  (DIONYSIUS),  D. C.  L., &c.

HANDBOOKS  OF   NATURAL   PHILOSOPHY   AND  ASTRONOMY.
  First Course, containing Mechanics, Hydrostatics, Hydraulics, Pneumatics, Sound, and Optics.
  In one large royal 12mo. volume, of 750 pages, with 424 wood-cuts. Second Course, containing
  Heat, Electricity, Magnetism, and Galvanism, one volume, large royal 12mo., of 450 pages, with
  250 illustrations.  Third Course (nearly ready), will contain Meteorology and Astronomy, with
  numerous steel-plates and wood-cuts. Revised, with numerous Additions, by the American editor. 
20
BLANCHARD  & LEA'S  MEDICAL
                          MEIGS (CHARLES  D.), M. D.,
            Professor of Obstetrics, &c, in the Jefferson Medical College. Philadelphia.

OBSTETRICS: THE  SCIENCE  AND  THE  ART.   Second  edition,  revised
  and improved.  With one hundred and thirty-one illustrations.  In one beautifully printed octavo
  volume, of seven hundred and fifty-two large pages.  (Lately Published.)

  The rapid demand for a second edition of this work is a sufficient evidence that  it has supplied
a desideratum  of the profession, notwithstanding the numerous treatises on the same subject which
have appeared within the last few years.   Adopting a  system of his own, the author has combined
the leading principles of his interesting and difficult subject, with a thorough  exposition of its rules
of practice, presenting the results of long and extensive experience and of  familiar acquaintance
with  all  the modern writers on this  department  of medicine.  As an American Treatise on Mid-
wifery, which has at once assumed the position of a classic, it possesses peculiar claims to the at-
tention and study of the practitioner and  student, while the numerous alterations and revisions
which it has undergone in the present edition are  shown by the great enlargement of the work,
which is not only increased as to the size of the page,  but also in the number.  Among other addi-
tions may be mentioned
          A NEW AND IMPORTANT  CHAPTER ON "CHILD-BED FEVER."
  As an elementary treatise—concise, but, withal,
clear and comprehensive—we know of no one better
adapted for the use of the student; while the young
practitioner will find in it a body of sound doctrine,
and a series of excellent practical directions, adapted
to all the conditions of the various forms of labor
and their results, which he will be induced, we are
persuaded, again and again to consult, and always
with profit. It has seldom been our lot to peruse a
work upon the  subject, from which  we have re-
ceived greater satisfaction, and which we believe to
be better calculated to communicate to the student
correct and definite views upon  the several topics
embraced within the scope of its teachings.—Am.
Journal of the Medical Sciences.
BY THE SAME AUTHOR.
WOMAN:  HER DISEASES  AND THEIR  REMEDIES.   A Series of Lee-
  tures to his Class.  Second edition, revised.  In one large and beautifully printed octavo volume,
  of nearly seven hundred large pages.
  It contains a vast amount of practical knowledge,
by one who has accurately observed  and retained
the experience of many years, and who tells the re-
sult in a free, familiar, and pleasant manner.—Dub-
lin Quarterly Journal.
  There is an off-hand fervor, a glow,  and a warm-
heartedness infecting the effort of Dr. Meigs, which
is entirely captivating, and which absolutely hur-
ries the reader through from beginning to end. Be-
sides, the  book  teems with solid instruction, and
it shows  the very highest evidence of  ability, viz.,
the clearness with  which the information is pre-
sented.  We know of no better test of one's under-
standing a subject than the evidence of the power
of lucidly explaining it.  The most elementary, as
well as the obscurest subjects, under  the pencil of
Prof. Meigs, are isolated and made to stand  out in
such bold relief, as to produce distinct impressions
upon  the mind  and memory of the reader. — The
Charleston Med. Journal.
  Professor Meigs has enlarged and amended this
great work, for such it  unquestionably is, having
passed the ordeal of criticism at home and abroad,
but been improved thereby ;  for in this  new edition
the author has introduced real improvements, and
increased the value  and utility of  the book im-
measurably.  It presents so many novel,  bright,
and sparkling thoughts;  such an exuberance of new
ideas on  almost every page, that we confess our-
selves to have become  enamored with the book
and its author; and cannot withhold our congratu-
lations from our Philadelphia confreres, that such a
teacher is in their service. We  regret that our
limits will not allow of a more extended notice of
this work, but must content ourselves with thus
commending it as worthy  of  diligent perusal by
physicians as well as students, who are seeking to
be thoroughly instructed in  the important practical
subjects of which it treats.—N. Y. Med. Gazette.
BY THE SAME  AUTHOR.
OBSERVATIONS  ON  CERTAIN  OF   THE   DISEASES  OF  YOUNG
  CHILDREN.   In one handsome octavo volume, of 214 pages.
  It puts forth no claims as  a systematic work,
but contains an amount of valuable and useful mat-
ter, scarcely to be found  in the same  space in our
home literature.  It cannot but prove an acceptable
offering to the profession at large.—N. Y. Journal of
Medicine.

  We take much pleasure  in  recommending this
excellent little work  to  the attention of medical
practitioners. It deserves their attention, and af-
ter they commence its perusal, they will not wil-
lingly abandon  it,  until  they have mastered  its
contents. We read the work while suffering from a
carbuncle, and its fascinating pages often beguiled
us into  forgetfulness of agonizing pain. May it
teach others to relieve the afflictions of the young.—
Western  Journal of Medicine and Surgery.

  The work  before us  is undoubtedly a valuable
addition  to the fund of  information which has al-
ready been treasured up on the subjects in question.
It is practical, and therefore  eminently adapted to
the general practitioner.  Dr.  Meigs's works have
the same  fascination which belongs  to himself.—
Medical Examiner.
ON  THE  NATURE,   SIGNS,   AND
  FEVER.  In one handsome octavo volume.
by the same  author.   (Preparing.)

                    TREATMENT
OF   PUERPERAL
                           by the same author.  (Preparing.)

A TREATISE ON  ACUTE  AND  CHRONIC  DISEASE  OF THE  NECK
  OF THE UTERUS.  With numerous plates,  drawn  and colored from nature in the highest
  style of art.   In one handsome octavo volume. 
AND SCIENTIFIC  PUBLICATIONS.
21
                           MILLER (JAMES),  F. R. S.  E.,
                     Professor of Surgery in the University of Edinburgh. &c.

PRINCIPLES OF  SURGERY.  Third  American, from the  second and revised
  Edinburgh edition.  Revised, with Additions, by F. W. Sargent, M. D., author of " Minor Sur-
  gery," &c.  In one large and very beautiful volume, of seven hundred and fifty-two pages,  with
  two hundred and forty exquisite illustrations on wood.   (Extensively used as a text-book.)

  The publishers have endeavored to render the present edition of this work, in every point of me-
chanical execution, worthy of its very high  reputation, and they confidently present  it to the pro-
fession as one  of the handsomest volumes as yet issued in this country.
  This edition is far superior, both in the abundance
and quality of its material, to any of the preceding.
We hope it will be extensively read, and  the sound
principles which are herein taught treasured up for
future application.  The work  takes  rank with
Watson's  Practice of Physic;  it certainly does  not
fall behind that  great work in  soundness of princi-
ple or depth of reasoning and research.  No  physi-
cian who values his reputation, or seeks the interests
ofhis clients, can acquit himself before his God and
the world without making himself familiar with  the
sound and  philosophical views developed in the fore-
going book.—New Orleans Medical and Surgical
Journal.
guage.  This  opinion,  deliberately formed after a
careful study of the first edition, we have had m)
cause to change on examining the  second.  This
edition has undergone thorough revision by the au-
thor;  many expressions have  been modified, and a
mass of new matter introduced.  The book is got up
in the finest style, and is an evidence of the progress
of typography in our country.—Charleston Medical
Journal and Review.
                                                 We recommend it to both student and practitioner,
                                               feeling assured that as  it now comes to us, it pre-
                                               sents the most satisfactory exposition of the modern
                                               doctrines of the principles of surgery to be found in
  „,..,    .   ,                                  any volume in any  language.—N. Y. Journal of
  Without doubt the ablest exposition of the prin-  Medicine.
ciples of that branch of the healing art in any Ian- I
                            by the same author.   (Now Ready.)

THE PRACTICE  OF  SURGERY.   Third American from  the  second Edin-
  burgh edition.  Edited, with Additions, by F. W. Sargent, M. D , one of the Surgeons  to Will's
  Hospital,  Arc   Illustrated by three hundred and nineteen engravings on wood.  In one large
  octavo volume, of over seven hundred pages.

  This new edition will be found greatly improved and enlarged, as well  by  the  addition  of much
new matter as by the introduction of a large  and  complete series  of handsome  illustrations.  An
equal improvement exists in the  mechanical execution of the work, rendering it in every respect
a companion volume to the "Principles."

  AVe had occasion in a former number of this Jour-
nal, to speak in  deservedly high terms of Professor
Miller's work on the " Principles of Surgery," and
we are happy to be able  to pronounce an equally
favorable judgment on the manner in which the pre-
sent volume is  executed.  *  *  *  AVe  feel  no
hesitation in recommending Professor Miller's two
volumes as affording to the student what the author
intended, namely, a complete text-book of Surgery.
—British and Foreign Medical Review.

  Although, as  we are modestly informed  in  the
preface, it is not put forth in  rivalry of the excel-
lent works on Practical  Surgery which already
exist, we think we may take upon ourselves  to say
that it will form a very successful and formidable
rival to most of them.—Northern Journ. of Medicine.

  Taken together they form a very condensed and
complete system of Surgery, not surpassed, as a
text-book, by any  work with which  we are ac-
quainted.—111. and Ind. Med. and Surg. Journal.

  Mr. Miller has said more in a few words than any
writer  since  the days of Celsus.—N. O. Med. and
Surg. Journal.
                                 MALGAIGNE (J. F.).

OPERATIVE  SURGERY, based on Normal and Pathological Anatomy.   Trans-
  lated from the French, by Frederick Brittan, A. B., M. D.  With numerous illustrations on
  wood.   In one handsome octavo volume, of nearly six hundred pages.
  AVe have long been accustomed to refer to it as one
of the most  valuable text-books in our library.—
Buffalo Med. and Surg. Journal.
  Certainly one of the best books published on ope-
rative surgery.—Edinburgh Medical Journal.
  To express in a few words our opinion of Mal-
gaigne's work, we unhesitatingly pronounce it the
very best guide in surgical operations that has come
before the profession in any language.—Charleston
Med. and Surg. Journal.
      MOHR (FRANCIS), PH.  D., AND REDWOOD  (TH EOPH I LUS).

PRACTICAL  PHARMACY.   Comprising the  Arrangements,  Apparatus,  and
  Manipulations of the Pharmaceutical Shop and Laboratory.  Edited, with extensive Additions,
  by Prof. William Procter, of the Philadelphia  College  of Pharmacy.  In one handsomely
  printed octavo volume, of 570 pages, with over 500 engravings on wood.
  It is a book, however, which will be in the hands
of almost every one who is much interested in phar-
maceutical operations, as we know of no other pub-
lication so well calculated to fill a void long felt.—
Medical Examiner.
  The book is strictly practical, and describes only
manipulations or methods of performing the nume-
rous processes the pharmaceutist has to go through,
in the preparation and manufacture of medicines,
together with all the apparatus and fixtures neces-
sary thereto.  On  these matters, this work is very
full and complete, and details, in a  style  uncom-
monly clear and lucid, not only the  more  compli-
cated and difficult  processes, but those not less im-
portant ones, the most simple and common.—Buffalo
Medical Journal.
  The country practitioner who is obliged to dis-
pense his own medicines, will find it a most valuable
assistant.—Monthly Journal and Retrospect. 
22
BLANCHARD  & LEA'S  MEDICAL
                         MACLISE  (JOSEPH),  SURGEON.

                 SURGICAL   ANATOMY.

                    forming one volume, very large imperial quarto.

With Sixty-eight large and splendid Plates, drawn in the best style, and beautifully colored.

        Containing one hundred and ninety Figures, many of them the size of life.
                    TOGETHER  WITH  COPIOUS  AND EXPLANATORY LETTER-PRESS.

Strongly and handsomely bound in extra cloth, being one of the cheapest and best executed Surgical
                              works as yet issued in this country.

                Copies can be sent by mail, in five parts,  done up in stout covers.

  This great work  being now concluded, the publishers  confidently present it to the attention of the
profession as worthy in every respect of their approbation and patronage.   No complete work  of
the kind has vet been published in the English language, and it therefore will supply a want  long
felt in this  country of an accurate and comprehensive Atlas of Surgical Anatomy to which the
student and practitioner can at  all times refer, to ascertain the exact relative position of the various
portions of the human frame towards each other and to the surface, as well as their abnormal de-
viations.  The importance of such awork to the student in the absence of anatomical material, and
to the practitioner when about  attempting an operation,  is  evident, while the price of the book, not-
withstanding the large size, beauty, and finish of the very numerous illustrations, is so  low as  to
place it within the reach of every member of the profession.   The publishers therefore confidently
anticipate a very extended circulation for this magnificent  work.
  One of the greatest artistic triumphs of the age
in Surgical  Anatomy.—British American  Medical
Journal.

  Too much cannot  be said in its praise; indeed,
we have not language to do it justice.—Ohio Medi-
cal and Surgical Journal.

  The most admirable surgical atlas we have seen.
To the  practitioner deprived of demonstrative dis-
sections upon the human subject, it is an invaluable
companion.—N. J. Medical Reporter.

  The most accurately engraved and beautifully
colored  plates we  have ever seen in an American
book—one of the best and cheapest surgical works
ever published.—Buffalo  Medical Journal.

  It is very rare that so  elegantly printed, so well
illustrated, and so useful a work, is offered at  so
moderate a price.—Charleston Medical Journal.

  Its  plates can boast  a  superiority which places
them almost beyond the reach of competition.—Medi-
cal Examiner.

  Every practitioner, we. think, should have a work
of this  kind within reach.—Southern Medical and
Surgical Journal.

  No  such lithographic illustrations  of surgical re-
gions have hitherto, we think, been given.—Boston
Medical and Surgical Journal.

  As a surgical  anatomist, Mr. Maclise has proba-
bly no superior.—British and Foreign Medico-Chi-
rurgical Review.

  Of great value to the student engaged in dissect-
ing, and to the surgeon at a distance from the means
of keeping up his anatomical knowledge.—Medical
Times.
  The mechanical  execution cannot be excelled.—
Transylvania Medical Journal.

  A work which has no parallel in  point of accu-
racy and cheapness in the English language.—N.  Y.
Journal^ of Medicine.

  To  all engaged in the study or practice  of their
profession, such a  work is almost indispensable.—
Dublin Quarterly Medical Journal.

  No  practitioner whose  means will admit should
fail to possess it.—Ranking''s Abstract.

  Country practitioners will find these plates of im-
mense value.—N. Y. Medical Gazette.
  AVe are extremely  gratified  to  announce to the
profession the completion of this truly magnificent
work, which, as a whole,  certainly stands  unri-
valled, both for accuracy of drawing, beauty  of
coloring, and all the requisite explanations of the
subject in hand.  To the publishers, the profession
in America  is deeply indebted for placing such a
valuable, such a useful work, at  its disposal, and
at such a moderate price.  It is  one of  the most
finished and complete pictures of Surgical Anato-
my ever offered to the  profession of America.—
With these plates before them, the student and prac-
titioner can never be at a loss, under the most despe-
rate  circumstances.  AVe do not  intend these for
commonplace compliments.  AVe  are sincere; be-
cause we know the work will be  found invaluable
to the young,  no less than the old, surgeon.  AAre
have  not space to point out  its beauties, and its
merits ; but we speak of it en masse, as a whole,
and strongly urge—especially those who, from their
position, may be debarred the privilege and opportu-
nity of inspecting the fresh  subject, to furnish them-
selves with the entire work.—The  New Orleans
Medical and Surgical Journal.

  This is by far the ablest work  on Surgical Ana-
tomy  that  has come under our observation.  AVe
know of no  other work  that would justify  a stu-
dent,  in any degree, for neglect of actual dissec-
tion.  A  careful study of  these plates, and of the
commentaries on them, would almost make an ana-
tomist of a diligent student.   And to one who has
studied anatomy by dissection,  this work is invalu-
able  as a perpetual remembrancer, in matters  of
knowledge  that may slip from the  memory.  The
practitioner  can scarcely consider  himself equipped
for the duties of his profession without such a work
as this, and this has no rival, in his library.  In
those  sudden emergencies  that so often arise, and
which require the instantaneous command of minute
anatomical knowledge, a work of this kind keeps the
details of the dissecting-room perpetually fresh in the
memory. AVe appeal to our readers, whether any
one can justifiably  undertake the practice of medi-
cine who is not prepared to give  all needful assist-
ance,  in all matters demanding  immediate relief.
AVe repeat  that no medical library, however large,
can be complete without Maclise's Surgical Ana-
tomy.  The American edition is well entitled to the
confidence of the profession, and  should command,
among them, an extensive sale.  The investment of
the amount of  the  cost of this work will  prove  to
be a very profitable one, and if practitioners would
qualify themselves  thoroughly with such  important
knowledge  as  is contained in  works of this kind,
there  would be fewer of them  sighing for employ-
ment.  The medical profession should spring towards
such an opportunity as is presented in this republica-
tion, to encourage  frequent repetitions of American
enterprise of this  kind.— The  Western Journal  of
Medicine and Surgery.
  g^" The very low price at which this work is furnished, and the beauty of its execution,
require an extended sale to compensate the publishers for the heavy expenses incurred. 
AND SCIENTIFIC  PUBLICATIONS.
23
                        MULLER (PROFESSOR J.),  M. D.

PRINCIPLES  OF  PHYSICS AND  METEOROLOGY.   Edited, with Addi-
  tions, by R Eglesfeld Griffith, M. D.  In  one large and handsome octavo volume,  extra
  ciotii, with 550 wood-cuts, and two colored plates.

.™Tm,eP?hfh!iCSOf.M.aller is,awork superb, complete. I tion to the scientific records of this country may be
Sdndte'68' want known to English Science  duly estimated by the fact that the cost of the origi-
of surn^in    fee"  >etw ■DPP1,ed-  The w"rk is I ™1 drawings and engravings alone has exceeded the
of surpassing interest. The value of this contribu-  sum of .£2,000 —Lancet
                   MAYNE (JOHN),  M . D., M . R. C. S.,  &c.

A DISPENSATORY AND THERAPEUTICAL REMEMBRANCER.  Com-
  prising the enure lists of Materia Medica, with every Practical Formula contained  in the three
  British 1 harmacopoeias.  With relative Tables subjoined, illustrating, by upwards of six hundred
  and sixty examples, the Extemporaneous Forms and  Combinations suitable for the different
  Medicines.   Edited, with the addition of the Formula; of the  United States Pharmacopoeia, by
  R. Eglesfeld Griffith, M. D.  In one 12mo. volume, extra cloth, of over 300 large pages.
                             MATTEUCCI (CARLO).
LECTURES ON THE PHYSICAL  PHENOMENA  OP LIVING BEINGS.
  Edited by Pereira.   In one neat royal 12mo. volume, extra cloth, with cuts, 388 pages.
                             MARKWICK (ALFRED).
A GUIDE  TO  THE  EXAMINATION OF  THE  URINE IN  HEALTH
  AND DISEASE.  Royal 12mo.   (See Manuals on Blood and Urine.)
                MEDLOCK  (HENRY), AND F.  SCHOEDLER.

BOOK  OF  NATURE; or Elements of the Science of Physics, Astronomy, Chem-
  istry, Mineralogy, Geology, Botany, Zoology, and Physiology.  (See Schoedler.)  In one vol.,
  large 12mo.  Au admirable work for families and District Schools.
                               NEILL (JOHN),  M. D.,
Demonstrator of Anatomy in the University of Pennsylvania; Surgeon to the Pennsylvania Hospital, &c;
                                             and
                      FRANCIS  GURNEY SMITH,  M.D.,
              Professor of Institutes of Medicine in the Pennsylvania Medical College.

AN  ANALYTICAL  COMPENDIUM  OF   THE   VARIOUS   BRANCHES
  OF MEDICAL SCIENCE ; for the Use and Examination of Students.  Second edition, revised
  and improved.  In one very large and handsomely  printed royal 12mo. volume, of over one
  thousand pages, with three hundred and fifty illustrations on wood.  Strongly  bound in  leather,
  with raised bands.  (Extensively used by students.)

                          PREFACE TO THE NEW EDITION.
  The speedy sale of a large impression of this work has afforded to the authors gratifying evidence
of the correctness of the views which actuated them in its preparation.  In meeting the  demand
for a second edition, they have therefore been desirous to render it more worthy of the favor with
which it has been received.   To accomplish this, they have spared neither time nor labor in embo-
dying in it such discoveries  and improvements as have been made since its first appearance, and
such alterations as have been suggested  by  its  practical use in the class and examination-room.
Considerable modifications have thus been introduced throughout  all the departments treaied of in
the volume, but more especially in the portion devoted to the "Practice of Medicine," which has
been entirely rearranged and rewritten.  The  authors  therefore again submit  their work to the
profession, with the  hope that their efforts may tend, however humbly, to advance the great cause
of medical education.
  Notwithstanding the increased size and improved execution of this  work, the price has not been
increased, and it is confidently presented as one of the cheapest volumes now before the profession.
  In  the rapid course of lectures, where work for
the students is heavy, and review necessary for an
examination, a compend is not only valuable, but
it is almost a sine qua non.  The one before us is,
in most of  the divisions, the most unexceptionable
of all books of the kind that  we know of.  The
newest and soundest doctrines and the latest im-
provements and discoveries are explicitly, though
concisely,  laid before  the student.  Of course it is
useless for us to recommend  it to all last course
students, but there is a class  to whom  we verv
sincerely commend this cheap  book  as worth  its
weight in  silver — that class  is the  graduates in
medicine of more  than ten years' standing, who
have not studied medicine since.  They will perhaps
find out from it that the science is not exactly now
what it was when they left it off.—The Stethoscope
  Having made free use of this volume in our ex-
aminations of pupils, we can speak from experi-
ence in recommending it as an admirable compend
for students, and as especially useful to preceptors
who exiimine their pupils.  It will save the teacher
much  labor by enabling him readily to recall all of
the  points upon which his pupils should  be ex-
amined. A work of this sort should be in the hands
ef every one who takes pupils into his office with a
view of examining them ;  and  this is unquestionably
the best of its class.  Let every practitioner who has
pupils provide himself with it, and he will find the
labor of refreshing his knowledge so much facilitated
that he will be able to do justice to his pupils at very
little cost of time or trouble to himself.—Transyl-
vania Med. Journal. 
24
BLANCHARD  & LEA'S MEDICAL
                NELIGAN (J.  MOORE),  M. D., M.  R. I. A., &c.

A  PRACTICAL  TREATISE  ON  DISEASES   OF  THE  SKIN.   In one
  neat royal 12mo. volume, of 334 pages.  (Just Issued.)

  "We know of no other treatise on this interesting I   The greatest value of Dr. Neligan's treatise con-
and important class of diseases that so happily meets | sists in the plain and thoroughly practical exposition
the urgent wants of the great mass of physicians.— I he has  given of this  class of maladies.—Brit, and
N. Y. Journal of Medicine.                      \ For. Med.-Chirurg. Review.
                      PHILLIPS  (BENJAMIN),  F. R. S., &c.

SCROFULA;   its  Nature, its  Prevalence, its Causes, and the Principles of its
  Treatment.  In one volume, octavo, with a plate.
             PEREIRA (JONATHAN), M. D.,  F. R. S., AND L. S.

THE  ELEMENTS  OF  MATERIA  MEDICA   AND  THERAPEUTICS.
  Third American edition, enlarged and improved by the author;  including Notices of most of the
  Medicinal Substances in use in the civilized world, and forming an Encyclopaedia of Materia
  Medica.  Edited by Joseph Carson, M. D., Professor of Materia Medica and Pharmacy in the
  University of Pennsylvania.  In two very large octavo volumes, on small type, with about four
  hundred illustrations.

Volume I.—Lately issued, containing the Inorganic Materia Medica,  over 800  pages, with  145
  illustrations.
Volume II.—Embracing the Organic Materia Medica, was left by the late author in nearly a com-
  plete state, is now revising with his MSS., by Alfred S. Taylor and G. Owen Rees, and may
  be expected in October 1853, with plates and several hundred wood-cuts.

  The present edition of this favorite and standard work, will be found far superior to its predeces-
sors.  Besides very  large additions and alterations which were  made in the last London edition,
the work has undergone a thorough revision on the part  of the author expressly for this country ;
and has farther received numerous additions from the editor.  It is thus greatly increased in size,
and  most completely brought up to the present state of our knowledge on this important subject.
A similar improvement will be found in its mechanical execution, being printed with new type on
fine white paper, with a greatly extended series of illustrations, engraved in the highest style of art.
  The 'work, in its present shape, and so far as can
be judged from the portion before the public, forms
the most comprehensive and complete treatise on
materia  medica extant in the English language.—
Dr. Pereira has  been at great pains to introduce
into his work, not only all the information on the
natural, chemical, and commercial  history of medi-
cines, which might be serviceable  to the physician
and surgeon, but whatever might  enable his read-
ers to understand thoroughly the mode of prepar-
ing and  manufacturing  various articles  employed
either for preparing medicines, or for certain pur-
poses in  the arts connected with materia  medica
and the practice of medicine.  The accounts of the
physiological and therapeutic effects of remedies are
given with great clearness  and accuracy, and in a
manner calculated  to interest as well as instruct
the reader.—The Edinburgh Medical and Surgical
Journal.
               PAGET (JAMES),  F. R. S.,  AND  W. S.  KIRKES.

MANUAL  OF  PHYSIOLOGY.   Second American  edition.   One  vol.,  large
  12mo.  (See Kirkes.)
                         PIRRIE (WILLIAM),  F. R. S.  E.,
                       Professor of Surgery in the University of Aberdeen.

THE  PRINCIPLES  AND  PRACTICE  OF  SURGERY.   Edited by John
  Neill, M. D., Demonstrator of Anatomy in the University  of Pennsylvania, Surgeon to  the
  Pennsylvania Hospital, &c.  In one very handsome octavo volume, of 780 pages, with 316 illus-
  trations.   (Just Issued.)
  However well it may be adapted for a text-book ]
(and in this respect it may compete with the best of
them) of this much  our reading has  convinced us,
that as a systematic treatise, it is carefully and ably
written, and can hardly fail to command a prominent
position in the library of practitioners; though not
complete  in the fullest  sense of the word, it never-
theless furnishes the student and practitioner with
as chaste  and conci'se a work as exists in our lan-
guage. The additions  to the volume by Dr. Neill,
are judicious;  and while they render it more com-
plete, greatly enhance its practical value, as a work
for  practitioners and  students.—N. Y. Journal of
Medicine.

  We know of no other surgical work of a  reason-
able size, wherein there is so much theory and prac-
tice, or where subjects  are more soundly or clearly
taught.—The Stethoscope.

  There is scarcely a  disease of the bone  or soft
parts, fracture, or dislocation, that is not illustrated
by accurate wood-engravings. Then, again, every
instrument employed by the surgeon is thus repre-
sented.  These engravings are not only correct, but
really beautiful, showing the astonishing degree of
perfection to which the art of wood-engraving has
arrived.  Prof. Pirrie, in the work before us, has
elaborately discussed the principles of surgery, and
a safe and effectual practice predicated upon  them.
Perhaps no work ppon this subject heretofore issued
is so full upon the science of the art of surgery.—
Nashville Journal of Medicine and Surgery.

  We have made ourselves more intimately acquaint-
ed with its details, and can now pronounce it to be
one of the best treatises on  surgery in  the English
language. In conclusion, we very strongly recom-
mend  this excellent work, both to the  practitioner
and student.—Canada Med. Journal.

  Our impression is, that as a manual for students,
Pirrie's is the best work extant.— Western Med. and
Surg. Journal. 
AND  SCIENTIFIC  PUBLICATIONS.                   25
                     RAMSBOTHAM  (FRANCIS H.),  M.D.

THE PRINCIPLES  AND  PRACTICE  OF OBSTETRIC  MEDICINE AND
  SURGERY, in reference to the Process of Parturition.  Sixth American, from  the last London
  edition.   Illustrated with one hundred and forty-eight Figures, on fifty-five Lithographic Plates.
  In one large and handsomely printed volume, imperial octavo, with 520 pages.

  In this edition, the plates have all been redrawn,  and the text carefully read and corrected.  It
is therefore presented as in every way worthy the favor with which it has so long been received.

                          From Prof. Hodge, of the University of Pa.
  To the  American public, it  is most valuable, from  its  intrinsic undoubted  excellence, and as being
the best authorized  exponent of British Midwifery. Its circulation will, I trust, be extensive throughout
our country.
  We recommend the student who desires to mas-
ter this difficult subject  with the least  possible
trouble, to possess himself at once of a copy of this
work.—American Journal of the Med. Sciences.
  It stands at the head of the long list of excellent
obstetric works published in the  last few years in
Great  Britain, Ireland, and  the  Continent of Eu-
rope.  We consider this  book  indispensable to the
library of every physician engaged in the practice
of midwifery.—Southern Med. and Surg. Journal.
  When  the. whole profession is thus unanimous
in placing such a work in the very first rank as
regards the extent and correctness of all the details
of the theory and practice of so important a branch
of learning, our commendation  or condemnation
would be of little consequence;  but  regarding  it
as the most useful of all works of the  kind, we
think it  but an act of justice to urge its claims
upon the profession.—N. O. Med. Journal.
                            RIGBY  (EDWARD),  M.D.
                       Physician to the General Lving-in Hospital, &c.

A  SYSTEM  OF  MIDWIFERY.   With  Notes  and  Additional  Illustrations.
  Second American Edition.  One volume octavo, 422 pages.

  The repeated demands for this work, which has now for some time been out of print, have in-
duced the publishers to prepare another edition.  The reputation which it has acquired for the
clearness of its views,  especially as regards the physiological portion of obstetrical science, will
secure  for it the confidence of tne profession.  A copy of the first edition was placed in the hands
of the late Professor Dewees, a few weeks before his "death, and obtained from him the expression
of his most favorable opinion.
                               RICORD  (PH.),  M. D.

HUNTER ON VENEREAL, with extensive Additions by Ricord.  (Nearly Ready.)
  See Hunter.
                            ROYLE  (J.  FORBES),  M.D.

MATERIA MEDICA AND THERAPEUTICS;  including the Preparations of
  the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States.  With many new
  medicines.  Edited by Joseph Carson, M. D., Professor of Materia Medica and Pharmacy in
  the University of Pennsylvania.  With ninety-eight illustrations.  In one large octavo volume,
  of about seven hundred pages.
  This work is, indeed, a most valuable one, and
will fill up an important vacancy that existed be-
tween Dr. Pereira's most  learned and complete
system of Materia Medica, and  the class of pro-
ductions on the other extreme, which are neces-
sarily imperfect from their small extent.—British
and Foreign Medical Review.
                             REESE (G. OWEN), M. D.

ON THE  ANALYSIS OF THE BLOOD AND  URINE  IN HEALTH  AND
  DISEASE, and on the Treatment of Urinary Diseases.  Royal 12mo., with plates.  (See Blood
  and Urine, Manuals of.)
                                RICORD  (P.),  M.  D.

A PRACTICAL TREATISE ON VENEREAL DISEASES.  Vith a Thera-
* peutical Summary and Special Formulary.  Translated by Sidney Doane, M. D. Fourth edition.
  One volume, octavo, 340 pages.
                     SKEY (FREDERICK C), F. R. S., &c.

OPERATIVE SURGERY.   In one very handsome  octavo volume of over  650
  pages, with about one hundred wood-cuts
  Its literary execution is superior to most surgical
treatises.  It abounds in excellent moral hints, and
is replete with original surgical expedients and sug-
gestions.— Buffalo Med. and Surg. Journal.

  With high talents, extensive practice, and a long
experience, Mr. Skey is  perhaps competent to the
task of writing a complete work on operative sur-
gery.—Charleston Med. Journal.
  We cannot withhold from this work our high com-
mendation. Students and practitioners will find it au
invaluable teacher and guide upon every topic con-
nected with this department.—N. Y. Medical Ga-
zette.

  A work of the very highest importance—a work
by itself.—London Med. Gazette. 
26
BLANCHARD &  LEA'S  MEDICAL
      SHARPEY (WILLIAM), M.D., QUAIN (JONES),  M.D., AND
                       QUAIN (RICHARD),  F. R. S., &.c.
HUMAN  ANATOMY.   Revised, with Notes  and Additions, by Joseph Leidy,
  M.D.  Complete in two large  octavo volumes, of about thirteen hundred pages.   Beautifully
  illustrated with over five hundred engravings on wood.
  It is indeed a work calculated to make an era in
anatomical study, by  placing before the student
every department of his science, with  a view  to
the  relative importance of each ;  and so skilfully
have the different parts been interwoven, that  no
one who makes this work the basis of his studies,
will  hereafter have any excuse for  neglecting  or
undervaluing any important particulars connected
with  the  structure  of  the human frame;  and
whether the bias of his  mind lead him in a more
especial manner  to surgery, physic, or physiology,
he will find here a work  at once so comprehensive
and practical as  to defend him from exclusiveness
on the one hand, and pedantry on the other.—
Monthly Journal and Retrospect of the  Medical
Sciences.
  We have no hesitation in recommending this trea-
tise on  anatomy as the most complete on that sub-
ject in  the English language; and  the only one,
perhaps, in any language,  which brings the state
of knowledge forward to  the most recent  disco-
veries.—The Edinburgh Med. and Surg. Journal.

  Admirably calculated to fulfil the object for which
it is intended.—Provincial Medical Journal.

  The most complete Treatise on Anatomy in the
English language.—Edinburgh Medical Journal.

  There is no work in  the English  language to be
preferred to Dr. Quain's Elements  of Anatomy.—
London Journal of Medicine.
   SMITH (HENRY H.),  M. D., AND HORNER (WILLIAM  E.),  M. D.

AN ANATOMICAL ATLAS, illustrative of the Structure of the  Human Body.
  In one volume, large imperial octavo, with about six hundred and fifty beautiful figures.

  With the view of extending the  sale of  this beautifully executed and complete " Anatomical
Atlas," the publishers have prepared a new edition, printed on both  sides of the page, thus mate-
rially reducing its cost, and enabling them to present it at a price about forty per cent, lower than
former editions, while, at the same time, the execution of each plate  is in no respect deteriorated,
and not a single figure is omitted.
  These figures are well selected, and present a
complete and accurate representation of that won-
derful fabric, the  human body.  The plan of this
Atlas, which renders it so peculiarly convenient
for the student, and its superb artistical execution,
have been already pointed out.  We must congratu-
late the student upon the completion of this Atlas,
as it is the most convenient work of the kind that
has yet appeared ; and we must add, the very beau-
tiful manner in which it is *' got up" is so creditable
to the country  as to be flattering to our  national
pride.—American Medical Journal.
                             SARGENT (F. W.),  M.  D.
ON BANDAGING AND  OTHER  POINTS  OF  MINOR  SURGERY.   In
  one handsome royal 12mo. volume of nearly 400 pages, with 128 wood-cuts.
  The very best manual of Minor Surgery we have
seen ; an American volume, with nearly four hundred
octavo pages of good practical lessons, illustrated
by about one hundred and  thirty wood-cuts.  In
these days of " trial," when a doctor's reputation
hangs upon a close hitch, or the roll of a bandage.
it would be well, perhaps, to carry such a journal as
Mr. Sargent's always in our coat-pocket, or, at all
events, to listen attentively to his instructions at
home.—Buffalo Med. Journal.
  We have carefully examined this work, and find it
well executed and admirably adapted to the use of
the student.  Besides the subjects usually embraced
in works on Minor Surgery, there is a short  chapter
on bathing, another on anaesthetic agents,  and an
appendix of formulas.  The author has given an ex-
cellentwork on this subject,and his publishers hava
illustrated and printed it in most beautiful style.—
The Charleston Medical Journal.
In  one  volume, octavo,
                              STANLEY (EDWARD).
A TREATISE ON DISEASES  OF  THE  BONES.
  extra cloth, 286 pages.

                          SMITH  (ROBERT WILLIAM).
A TREATISE ON FRACTURES  IN THE VICINITY  OF JOINTS, AND
  ON DISLOCATIONS.  One volume octavo, with 200 beautiful wood-cuts.
                             SIMON (JOHN), F. R. S.

GENERAL  PATHOLOGY,  as  conducive  to the  Establishment of  Rational
  Principles for the  Prevention  and Cure of Disease.  A Course of Lectures delivered  at St.
  Thomas's Hospital during the  summer Session of 1850. In one  neat octavo volume.  (Lately
  Issued.)
  His views are plainly and concisely stated, and in
such an attractive manner, as to enchain the atten-
tion of the reader, and should they be adopted by the
profession at large, are calculated  to produce im-
portant changes in medicine.  Physicians and stu-
dents will obtain from its perusal, not only the latest
discoveries in Pathology, but that which is even
more valuable, a systematic outline for the prosecu-
tion of their future studies and investigations. Alto-
gether, we look upon it as one of the most satisfactory
and rational treatises upon that branch now extant.
—Medical Examiner.
                           SMITH  (TYLER W.), M. D.,
                   Lecturer on Obstetrics in the Hunterian School of Medicine.
ON  PARTURITION,  AND  THE  PRINCIPLES  AND  PRACTICE  OF
  OBSTETRICS.  In one large duodecimo vo ume, of 400 pages. 
AND  SCIENTIFIC  PUBLICATIONS.
27
                            SOLLY (SAMUEL), F.  R. S.
THE  HUMAN  BRAIN;   its  Structure, Physiology,  and  Diseases.   With a
  Description of the Typical Forms of the Brain  in the Animal Kingdom.  From the Second and
  much enlarged London edition.  In one octavo volume, with 120 wood-cuts.
                       SCHOEDLER  (FRIEDRICH), PH.D.,
                        Professor of the Natural Sciences at Worms, &c.
THE  BOOK  OF  NATURE;  and Elementary Introduction  to the  Sciences of
  Physics, Astronomy. Chemistry, Mineralogy, Geology, Botany, Zoology, and Physiology. Trans-
  lated from  the sixth German edition, with Additions, by Henry Medlock, F.'C.S., &c.  And
  Additions and Alterations by the American Editor.  In one thick volume, small octavo, with over
  GOO illustrations on wood.  (Suitable for the higher Schools.)
          SMITH (F. GURNEY), M. D.,
ANALYTICAL  COMPENDIUM  OF
  MEDICAL  SCIENCE.  One vol., larsre 12mo.
AND JOHN  NEILL, M. D,
THE  VARIOUS
 (See Neill.)
BRANCHES  OF
                     TAYLOR  (ALFRED S.),  M.  D., F.  R. S.,
                Lecturer on Medical Jurisprudence and Chemistry in Guy's Hospital.
MEDICAL JURISPRUDENCE.   Third American, from the fourth and improved
  English Edition. With Notes and References to American Decisions, by Edward Hartshorne
  M. D.  In one large octavo volume, of about  seven hundred pages.   (Just Ready.)
  In the preparation of the  English edition, from which this has been printed, the author has found
it necessary to revise the whole of the chapters, as  well as to make numerous alterations and addi-
tions,  together with references to many recent cases of importance.  A Glossary has  also been
added for the convenience of those whose  studies have not been directed specially to this subject.
The notes of the American  editor embrace the additions formerly made by Dr. Griffith, who revised
the work on its first appearance in this country, together with such  new  matter as his experience
and the progress of the science have shown to be advisable.   The work may therefore be regarded
as fully on a level with the  most recent discoveries, and worthy of the reputation which it has ac-
quired as a complete and compendious guide for the physician and lawyer.
  So well is this work known to the members both
of the medical and legal professions, and so highly
is it appreciated by them, that it cannot be necessary
for us to say a word in its commendation ;  its having
already reached a fourth edition being the best pos-
sible testimony in its favor.  The author has ob-
viously subjected the entire work to a very careful
revision. We  find scattered through it  numerous
additions and alterations, some of them of consider-
able importance; and reference is made to a large
number of cases which have occurred since the date
of the last publication.—British and Foreign Med.-
Chirurg. Review.

  The  fourth edition of Dr. Taylor's  Manual of
Medical Jurisprudence needs merely a  simple an-
nouncement at  our hands; the merits of the 'work
have been freely canvassed by us on a former occa-
sion, and we have  now but to say that  the author
has spared no pains in keeping it on a par in all re-
spects with  the advance of both medical and legal
science.—Dublin Med. Journal.

  This work  of Dr. Taylor's is generally acknow-
ledged to be one of the ablest extant on the subject
of medical jurisprudence.  It is certainly one of the
most attractive books that we have met with;  sup-
plying so much both  to  interest and instruct, that
we do not hesitate  to affirm that after having once
commenced its perusal, few could be prevailed upon
to desist before completing it.  In the last London
edition, all the newly observed and accurately re-
corded facts have been inserted, including much that
is recent of Chemical, Microscopical, and Patholo-
gical research, besides papers on numerous subjects
never before published ;  in the supervision of this,
the third American, one of the last labors of the la-
mented Dr. Griffith, we find a goodly number of notes
and additions.  The publishers deserve the support
of the profession for the  publication of a work of
such sterling  merit.—Charleston Medical Journal
and Review.
  It is not excess of praise to say that the volume
before us is the very best treatise extant on Medical
Jurisprudence. In saying this, we do not wish to
be understood as detracting from the merits of the
excellent works of Beck, Ryan, Traill, Guy, and
others; but in interest and value we think it must
be conceded that Taylor is superior to anything that
has preceded it.  The author is already well known
to the profession by his valuable treatise on Poisons :
and the present volume will add materially to his
high reputation for accurate  and extensive  know-
ledge and discriminating judgment. Dr Griffith has,
in his notes, added m;iny matters of interest with
reference to American Statute Law, &e.. so that the
work is brought completely up to the wants of the
physician and lawyer at  the present day.—N. W.
Medical and Surgical Journal.
                                   BY THE  SAME AUTHOR.

ON POISONS, IN  RELATION TO  MEDICAL  JURISPRUDENCE  AND
  MEDICINE.  Edited, with Notes and Additions, by R. E. Griffith, M. D.  In one large octavo
  volume, of 688 pages.
  The most elaborate work on the subject that our
literature possesses.—British and Foreign Medico-
Chirurgical Review.
  It contains a vast body of facts, which embrace
all that is important  in  toxicology, all  that is
necessary to the guidance of the medical jurist, and
all that can be desired by the lawyer. — Medico-
Chirurgical Review.
  One of the most practical and trustworthy works
on Poisons in our language.—Western Journal of
Medicine.
  It is, so far as our knowledge extends, incompa-
rably the best upon the subject; in the highest de-
gree creditable to the author, entirely trustworthy,
and indispensable to the student and practitioner.—
N. Y. Annalist.
                     THOMSON (A. T.),  M. D., F. R. S.,  &c.
DOMESTIC  MANAGEMENT  OF  THE  SICK  ROOM,  necessary in  aid of
  Medical Treatment for the Cure of Diseases.  Edited by R. E. Griffith, M. D.  In one large
  royal 12mo. volume, with wood-cuts, 360 pages. 
28
BLANCHARD &  LEA'S  MEDICAL
         TODD (R. B.),  M. D.,  AND  BOWMAN  (WILLIAM),  F. R. S.

PHYSIOLOGICAL  ANATOMY  AND  PHYSIOLOGY  OF  MAN.  With
  numerous handsome wood-cuts.  Parts I, II, and III, in one octavo volume, 552 pages.  Part IV
  will complete the work.
  The distinguishing peculiarity of this work  is, that the authors investigate for themselves every
fact asserted ; and it  is the immense labor consequent upon the vast number of observations re-
quisite to carry out this plan, which has  so long delayed the appearance of its completion.  Part
IV, with numerous original illustrations,  is now appearing in the  Medical News and Library for
1853.  Those who have subscribed since the appearance of the preceding portion of the work can
have the three parts by mail, on remittance of $2 50 to the publishers.


  TRANSACTIONS OF  THE  AMERICAN  MEDICAL ASSOCIATION.

VOLUME V, for 1852,  large 8vo., of 940 pages,  with numerous maps.
  Also to be had, a few sets of the Transactions  from  1848  to 1851, in four large octavo volumes.
  These volumes are published by and sold on account oHhe Association.
                        WATSON (THOMAS),  M. D.,  &c.

LECTURES  ON   THE  PRINCIPLES  AND  PRACTICE  OF  PHYSIC.
  Third American, from the last London edition.  Revised, with Additions, by D. Francis Condie,
  M. D  , author of a " Treatise on  the Diseases of Children," &c.  In one octavo volume, of nearly
  eleven hundred large pages, strongly bound with raised bands.
  To say that  it is the very best work on the sub-
ject now extant, is but to echo the sentiment of the
medical  press throughout  the  country. — N. O.
Medical Journal.

  Of the text-books recently republished Watson is
very justly the principal  favorite.—Holmes's Rep.
to Nat. Med. Assoc.

  By universal consent the work ranks among the
very best text-books in our language.—Illinois and
Jndiana Med.  Journal.

  Regarded on all hands as one of the very best, if
not the very best, systematic treatise on practical
medicine extant.—St. Louis Med. Journal.
  Confessedly one of the very best works on the
principles and practice of physic  in the English or
any other language.—Med. Examiner.
  Asa text-book it has no equal;  as a compendium
of pathology and  practice no superior.—New York
Annalist.
  We know of no work better calculated for being
placed in the hands of the student, and for a text-
book; on every important point the author seems
to have posted up his  knowledge to the  day.—
Amer. Med. Journal.
  One of the most practically useful books  that
ever was presented to the  student. — N. Y. Mtd.
Journal,
                              WALSHE  (W.  H.l,  M. D.,
         Professor of the Principles and Practice of Medicine in University College, London.
DISEASES   OF  THE   HEART,  LUNGS,  AND   APPENDAGES;  their
  Symptoms and Treatment.  In one handsome volume, large royal 12mo., 512 pages.
  We consider this as the ablest work in the En-
glish language, on the subject of which it treats;
the author being the first stethoscopist of the day.
—Charleston Medical Journal.

  The examination we have given the above work,
convinces us that it is a complete system or treatise
upon the great speciality of Physical Diagnosis. To
give the reader a more perfect idea of what it con-
tains, we should be glad to copy the whole table of
contents and make some extracts from its pages, but
our limits forbid.  We have no hesitation in recom-
mending the work as one of  the most complete on
this subject in the English language; and yet it is
not so voluminous as to be objectionable on this ac-
count,  to  any  practitioner,  however pressing his
engagements.—Ohio Medical and Surgical Journal,
                               WHAT TO  OBSERVE

AT  THE  BEDSIDE  AND   AFTER  DEATH,  IN  MEDICAL  CASES.
  Published under the authority of the London Society for Medical Observation.  In one very
  handsome volume, royal 12mo., extra cloth.  (Just Issued.)
                                              correct diagnosis, it will prove exceedingly valua-
                                              ble.  The great difficulty with beginners, who have
                                              not been under the immediate training of an expe-
                                              rienced physician, is continually found to be in the
                                              appreciation of the true condition of the organs and
                                              tissues.   Let  such provide  themselves with  this
                                              work and study it thoroughly, and  they will find
                                              much of the difficulty removed.—Southern Medical
                                              and Surgical Journal.

                                                This is truly a very capital book.  The whole
                                              medical world will reap advantages from its publi-
                                              cation.  The medical journals will  soon show its
                                              influence on the character of the " Reports of Cases"
                                              which they  publish.  Drs. Ballard and Walshe have
                                              given to the  world, through a small but useful
                                              medical organization, a cheap but invaluable book.
                                              We do advise every reader of this notice to buy it
                                              and use it.  Unless he is so vain as to imagine him-
                                              self superior to the ordinary human capacity, he will
                                              in six  months see its inestimable  advantages.—
                                              Stethoscope.
  Did not the perusal of the work justify the high
opinion we have of it, the names of Dr. Walshe, the
originator, and of Dr. Ballard, as the editor of the
volume, would almost of itself have satisfied us that
it abounds in minute clinical accuracy. We need
not say that the execution of the whole reflects the
highest credit not only upon  the gentlemen men-
tioned, but upon all those engaged upon its produc-
tion.  In conclusion, we  are convinced that  the
possession of the work will be almost necessary to
every member  of  the  profession—that  it will  be
found indispensable to  the practical  physician, the
pathologist, the medical jurist, and above all to the
medical student.—London Medical Times.

  We hail the appearance of this book as the grand
desideratum.—Charleston Medical Journal.

  This little work,  if  carefully read by even old
practitioners, cannot fail to be productive of much
good; as a guide to the younger members of the pro-
fession in directing their attention specially to the
best mode of investigating cases so as to arrive at 
AND SCIENTIFIC  PUBLICATIONS.                   29
WILSON  (ERASMUS),  M.D.,
           Lecturer on Anatomy, London.
F. R. S.
A SYSTEM  OF  HUMAN  ANATOMY,  General and Special.   Fourth Ameri-
  can, from the last English edition.  Edited by Paul B. Goddard, A. M., M D.  With two hun-
  dred and fifty illustrations.  Beautifully printed, in one  large octavo volume, of nearly six hun-
  dred pages.

                                                It ofTers to the student all the assistance that can
                                              be expected from such a work.—Medical Examiner.
                                                The most complete and convenient manual for the
                                              student we  possess.—American Journal of Medical
                                              Science.
                                                In every  respect,  this work  as  an anatomical
                                              guide for the student and  practitioner, merits our
                                              warmest and most decided praise.—London Medical
                                              Gazette.
  In many, if not all the Colleges of the Union, it
has become a standard text-book.   This, of itself,
is sufficiently expressive of its value.  A work very
desirable to  the student;  one, the  possession of
which  will greatly facilitate  his  progress in  the
study of Practical Anatomy.—New York Journal of
Medicine.

  Its author ranks with the highest on Anatomy.—
Southern Medical and Surgical Journal.
                                  BY THE SAME AUTHOR.

THE  DISSECTOR;   or,  Practical and  Surgical Anatomy.   Modified  and Re-
  arranged, by Paul Beck Goddard, M. D.  A new edition, with Revisions and Additions.  In
  one large and handsome volume, royal 12mo., with one hundred and fifteen illustrations.

  In passing this work again through the press, the editor has made such additions and improve-
ments as the advance of anatomical knowledge has rendered necessary to maintain the work in the
high reputation which it has acquired in the schools of the United States, as a complete and faithful
guide to the student of practical anatomy.  A number of new illustrations have been added, espe-
cially in the portion relating to the complicated anatomy  of Hernia.  In mechanical execution the
work will be found superior to former editions.
                                   BY THE SAME AUTHOR.

ON  DISEASES  OF  THE  SKIN.   Third American, from  the third  London
  edition.  In one neat octavo volume, of about  five hundred pages, extra cloth.  (Just Issued.)

Also, to be had done up with fifteen beautiful steel plates, of which eight are exquisitely  colored ;
  representing the Normal and Pathological Anatomy of the Skin, together with accurately colored
  delineations of more than sixty varieties of disease", most of them the size of nature.  The Plates
  are also for sale separate, done up in boards.

  The increased size of this  edition is  sufficient  evidence that the  author has  not been content
with a mere republication, but has endeavored to maintain the high character of his work  as the
standard text-book on this interesting and difficult class of diseases.  He has thus introduced such
new matter as the experience of the last three or four years has suggested, and has made such
alterations as the progress of scientific investigation has rendered expedient.  The illustrations have
also been materially augmented, the number of plates being increased from eight to sixteen.
                                               this range of  diseases, engage the  practitioner's
                                               attention, and possesses the high quality—unknown,
                                               we believe, to every older manual—of being on a
                                               level with science's high-water mark; a sound book
                                               of practice.—London Med. Times.
  The "Diseases of the Skin," by Mr. Erasmus
Wilson, may now be regarded as the standard work
in that  department of  medical  literature.   The
plates by which this edition is accompanied leave
nothing to be desired, so far as excellence of delinea-
tion  and perfect accuracy of illustration are con-
cerned.—Medico-C hirurgical Review.

  As a practical guide to the classification, diag-
nosis, and treatment of the diseases of the skin, the
book is  complete.   We  know nothing, considered
in this aspect, better in our language; it is a safe
authority on  all  the ordinary  matters which, in
  Of these plates it is impossible to speak too highly.
The representations of the various forms of cuta-
neous disease are singularly accurate, and the color-
ing exceeds almost anything we have met with in
point of delicacy and  finish.—British and Foreign
Medical Review.
BY THE SAME AUTHOR.
ON  CONSTITUTIONAL   AND  HEREDITARY  SYPHILIS,  AND  ON
  SYPHILITIC ERUPTIONS.  In one small octavo volume, beautifully printed, with four exqui-
  site colored plates, presenting more than thirty varieties of syphilitic eruptions.
  This, in many respects, is a remarkable work, pre-
senting views of theory and principles of practice
which, if true, must change completely the existing
state of professional opinion.—New York Journal of
Medicine.
  Dr. Wilson's views on  the general subject of
Syphilis appear to us in the main sound  and judi-
cious, and we commend the book as an excellent
monograph on the subject.  Dr.  Wilson has pre-
sented  us  a very faithful  and  lucid description of
Syphilis and has cleared up many obscure points in
connection with its transmissibility. pathology and
sequelae. His facts and references will, we are satis-
fied,  be received  as  decisive, in regard to many
questiones vexatse.  They appear to  us entitled to
notice at some length. We have perhaps been some-
what prodigal of space in  our abstract of this book.
But it is certainly a very good resume of received
opinions on Syphilis, and presents, to many, original
and striking views on the subject.—Med. Examiner.
                    WHITEHEAD (JAMES),  F.  R. C. S., &c.

THE CAUSES AND  TREATMENT OF ABORTION  AND  STERILITY;
  being the Result of an Extended Practical Inquiry into the Physiological and Morbid Conditions
  of the Uterus.  In one volume, octavo, 368 pages. 
30                    BLANCHARD  & LEA'S MEDICAL
                                  WILDE (W.  R.),
                 Surgeon to St. Mark's Ophthalmic and Aural Hospital, Dublin.
AURAL  SURGERY,  AND  THE NATURE  AND  TREATMENT OF  DIS-
  EASES OF  THE EAR.  In one handsome octavo volume, with illustrations.   (Just Ready.)
  So little is generally known in this country concerning  the causes, symptoms, and treatment of
aural affections, that a practical and scientific  work on that subject, from  a practitioner of Mr.
Wilde's great experience, cannot fail to be productive  of much benefit,  by attracting attention
to this obscure  class of disea-es, which too frequently escape attention until past relief.  The im-
mense  number of cases  which have come under Mr. Wilde's observation for many years, have
afforded him opportunities rarely enjoyed for investigating this branch of medical science, and his
work may therefore be regarded as of the highest authority.
                           WEST (CHARLES),  M. D.,
                    Senior Physician to the Royal Infirmary for Children, &c.
LECTURES  ON  THE  DISEASES  OF  INFANCY AND  CHILDHOOD.
  In one volume, octavo, of four hundred and fifty pages.
  The Lectures of Dr. West, originally published in
the London Medical Gazette, form a most valuable
addition to this branch of practical medicine. For
many years physician to the Children's Infirmary,
his opportunities  for observing their diseases have
been most extensive, no less than 14,000 children
having been brought under his notice during the past
nine years.  These have evidently been studied with
great care, and the result has been the production of
the very best work in our language, so far as it goes,
on the diseases of this class of our patients. The
symptomatology and pathology of their diseases are
especially exhibited most clearly ; and we are con-
vinced that no one can read with care these lectures
without deriving  from them instruction of the most
important kind.—Charleston Med. Journal.
  Every portion of these lectures is marked by a ge-
neral accuracy of description, and by the soundness
of the views set forth in relation to the pathology
and therapeutics of the several maladies treated of.
The lectures on the diseases of the respiratory  ap-
paratus, about one-third of the whole number, are
particularly excellent, forming one of  the fullest
and most able accounts  of these affections, as they
present themselves during infancy and childhood,
in the English language.  The history of the seve-
ral forms of phthisis during these periods of exist-
ence, with their management, will be  read by all
with deep  interest.—The American Journal of the
Medical Sciences.
                    WILLIAMS  (C.  J.  B.), M. D.,  F.  R. S.,
                Professor of Clinical Medicine in University College,  London, &c.

PRINCIPLES  OP  MEDICINE;  comprising General  Pathology and Therapeu-
  tics, and a brief general view of Etiology, Nosology, Semeiology, Diagnosis, Prognosis,  and
  Hygienics.  Edited, with Additions, by Meredith Clymer, M.D.  Fourth American, from the
  last and enlarged London edition.  In one octavo volume, of nearly five hundred pages.  Now
  Ready.  This new edition has been materially enlarged and brought up by the editor.
  It possesses the strongest claims  to the  attention  of the medical student  and  practitioner, from
the admirable manner in which the various inquiries in the different branches of pathology are
investigated, combined, and generalized by an experienced practical physician, and directly applied
to the investigation and treatment of disease.—Editor's Preface.
  The best exposition in  our language, or, we be- 1   Few books have proved more useful, or met with
lieve, in any language, of rational medicine, in its | a more ready sale  than  this, and no practitioner
present improved  and  rapidly  improving  state.— I should regard his library as complete without it.
British and Foreign Medico-Chirurg. Review.     | —Ohio Med. and Surg. Journal.

                                 BY THE SAME AUTHOR.

A PRACTICAL  TREATISE  ON  DISEASES OF  THE  RESPIRATORY
  ORGANS; including  Diseases of the Larynx, Trachea, Lungs, and Pleurae.   With numerous
  Additions and Notes, by M. Clymer, M. D. With wood-cuts.  In one octavo volume, pp. SOS.
                           YOUATT (WILLIAM),  V. S.

THE   HORSE.   A  new edition, with  numerous illustrations;  together with  a
  general history of the Horse; a Dissertation on the American Trotting Horse ;  how Trained and
  Jockeyed; an Account of his Remarkable Performances; and an Essay on the Ass and ihe Mule.
  By J. S. Skinner, formerly Assistant  Postmaster-General, and  Editor of ihe Turf Register.
  One large octavo volume.

                                 BY THE SAME AUTHOR.

THE   DOG.   Edited  by  E.  J.  Lewis, M. D.   With  numerous  and  beautiful
  illustrations.  In one very handsome volume, crown Svo., crimson cloth, gilt.
              ILLUSTRATED  MEDICAL  CATALOGUE.
  BLANCHARD &  LEA have now ready a Catalogue of their Medical and  Surgical Publi-
cations, containing descriptions of the  works, with Notices of the Press, and specimens of
the Illustrations, making a pamphlet of forty-eight large octavo pages.  It has been prepared
with great care, and without regard to expense, forming one of the most beautiful specimens
of typographical execution as yet issued in this country.  Copies will be sent by mail, and
the postage  paid, on application to the  Publishers, by enclosing a three cent postage stamp. 
AND  SCIENTIFIC PUBLICATIONS.                    31
   B. & L.  subjoin a condensed list of their  publications in general and  educational
literature, of which more detailed catalogues will be furnished on application.

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CAMPBELLS (LORD) LIVES OF THE  CHIEF
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DIXON'S  LIFE OF WILLIAM PENN.  A new
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EXPLORING EXPEDITION, NARRATIVE OF
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32        BLANCHARD  &  LEA'S  SCIENTIFIC PUBL ICATIONS.
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