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iTinMAi IIRRARY OF MEDICINE     NATIONAL L
MEDICI . 
 
 
 
A  MANUAL
\
•a   op
MEDICAL  JURISPRUDENCE.
                 BY

   ALFRED SWAINE TAYLOR, M.D., F.R.S.,
FELLOW OP THE ROYAL COLLEGE OP PHYSICIANS, AND PROFESSOR OF MEDICAL
      JURISPRUDENCE AND CHEMISTRY IN GUY'S HOSPITAL.
Qui nescit ignorare ignorat scire.
     SEVENTH AMERICAN EDITION,

REVISED FROM THE ADTHOR'S LATEST NOTES, AND EDITED WITH
       ADDITIONAL NOTES AND REFERENCES,
                   BY

           JOHN" J. REESE, M.D.,
PROFESSOR OP MEDICAL JURISPRUDENCE AND TOXICOLOGY IN THE UNIVERSITY OF PENNSYLVANIA,
   FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA, HONORARY MEMBER
           OF THE NEW YORK MEDICO-LEGAL 80CIETY.
WITH  ILLUSTRATIONS ON WOOD.

     PHILADELPHIA:
HENET  0.  LEA.
          1873. 
w
<oOO

 1673
Entered according to the Act of Congress, in the year 1873, by
               HENRY  C.  LEA,
in the OflBce of the Librarian of Congress. All rights reserved.
   PHILADELPHIA!
COLLINS, PRINTER. 
AMERICAN  PUBLISHER'S'  NOTICE.
  In preparing for the press this seventh American edition of the
" Manual of Medical Jurisprudence" the editor has, through the
courtesy of Dr. Taylor, enjoyed the very great advantage of con-
sulting the sheets of the new edition of the author's larger work,
"The Principles and Practice of Medical Jurisprudence," which is
now ready for publication  in London.   This  has  enabled him to
introduce the author's latest views upon the various topics discussed,
which are believed to bring the work fully up to the present time.
  The notes of the  former editor, Dr. Hartshorne, as also the nu-
merous valuable  references to American practice and decisions by
his successor, Mr. Penrose, have been retained, with but few slight
exceptions: they will be found inclosed in brackets, distinguished
by the letters [H.] and [P.].  The additions made by the present
editor, from the  material at his command, amount to  about one
hundred pages; and his own notes are designated by the letter [R.].
  Several subjects not treated of in the former edition have  been
noticed in the pYesent one; and the work it is hoped will be found
to merit a continuance of  the confidence which it has so long en^
joyed as a standard authority.
Philadelphia, September, 1873. 
 
PREFACE TO THE  AMERICAN  EDITION.
  In the year 1825, when a medical student at Guy's Hospital, I
accidentally  met with  a work entitled  " Elements  of Medical
Jurisprudence, by Theodoric Romeyn Beck, 2d ed., with notes by
W. Dunlop."   I have  that volume  now  before me, and I well
remember the deep interest with which I read and studied its
contents.   I  was then a student of two years' standing, and the
subject, from the lucid  manner in which  it was treated by the
author, fixed my attention, and induced me for the time to put
aside anatomy and physiology for the sake of this new branch of
medical science. No lectures on the subject were then delivered
in England, and Dr. Beck's work was the leading authority for
lawyers and medical men.
   I  believe  that the sight of this book was the turning point of
my  selection of Medical Jurisprudence  as a  special object for
study and practice.  After six years of medical study in the schools
of England, France, and Italy, I received the appointment of
Lecturer  on Medical  Jurisprudence from  the  Treasurer  and
Governors of Guy's Hospital, and  from March,  1831,  I have
delivered  an annual course of lectures on  this  subject in the
Medical Schools connected with the hospital.
   In looking back over the forty-eight years  since I received my
first lesson in Medical Jurisprudence from the work of the late Dr.
T. R. Beck,  it is a great gratification to me  to feel that I have
been able to contribute to the literature of the science, and  that
my contributions have  been so highly appreciated in the country
which gave  birth to Dr. Beck.  For many years, his was the  only 
ii
PREFACE  TO THE AMERICAN  EDITION.
work on the subject in England and America.   It is a satisfaction
to me to know that I have been  able to make some  return to the
country of his birth for the impulse which the study of his excellent
treatise gave to me in my early days as a medical student.  Dr. T.
R. Beck has passed away, but his work, which had  reached a tenth
edition in 1851, will carry down his  name to future years, as one
of the most erudite and  distinguished writers on Medical Juris-
prudence. 
               P E E F A 0 E

                      TO
                    i
THE  EIGHTH  ENGLISH  EDITION.
  In preparing for the press the eighth edition of the Manual of
Medical Jurisprudence, it has been considered advisable to make
a few changes in the volume.   The subjects have been reduced in
extent by the omission of the details of cases, which  now find a
more  appropriate place in the large work lately published under
the title of  The  Principles  and  Practice  of  Medical  Juris-
prudence.   Those facts only are retained which are likely to be of
practical utility to students of medicine and law, as well as to junior
medical practitioners.  For the information and guidance of medi-
cal men, two chapters on evidence and the duties and responsibilities
of medical witnesses have been placed at the commencement of the
volume, and some medico-legal subjects, not hitherto treated in the
previous editions, have been introduced.  Among other changes
may be noticed the introduction of numerous engravings represent-
ing the crystalline forms of  poisons and the apparatus used for
their detection.  From the additions thus made, it is  hoped that
this edition of the Manual will be found  a convenient guidance to
medico-legal practice.

   15 St. James's Terrace, Regent's Park:
              May, 1866. 
 
CONTENTS.
                    MEDICAL  EVIDENCE.

                            CHAPTER I.
                                                                  PAGE
The practice of Medical Jurisprudence—Medical and medico-legal duties—In-
  spection of bodies in death from wounds or poisoning—Uses of notes—
  Medico-legal reports—Dying declarations     .      .      .            .17

                           CHAPTER  II.

Coroners' inquests—Trial at the assizes—Subpoenas—Examination in court-
  Duties of medical witnesses—Rules for the delivery of evidence   .      .  37

                           CHAPTER III.

Causes of  death—Sudden death—Syncope—Asphyxia—Coma—Signs or in-
  dications of death—Cessation of circulation and respiration—Cooling of the
  body—Cadaveric rigidity—The eyes—The  skin—Circulation of the blood—
  Putrefaction—Cadaveric lividity—Adipocere  .      .      .      .      .57
POISONING.
                           CHAPTER IV.

Definition of the term Poison—Deadly poisons—Mechanical irritants—Law in
  relation to administering poison—Influence of  habit and idiosyncrasy—
  Classification—Special characters of Irritant,  Corrosive, and Neurotic poi-
  sons     ..........  79"

                            CHAPTER V.

Evidence of poisoning in the living body—Action of poison increased or dimi-
  nished  by  disease—Symptoms connected  with food  or medicine—Several
  persons attacked simultaneously—Evidence from  the detection  of poison in
  the  food, etc.    .      .      .      .      .      •      •      ■     .89

                           CHAPTER VI.

On the evidence of poisoning in the dead body—Period at which poisons prove
  fatal—Chronic poisoning—Appearances  produced by the  different classes of
  poisons—Redness of mucous membrane  mistaken  for inflammation—Ulcera-
  tion and corrosion—Softening—Perforation of the stomach from poison and
  disease    .......•••  98

                           CHAPTER  VII.

Irritant Poisons.—Sulphuric acid or  Oil of vitriol—Nitric acid or Aquafor-
  tis—Hydrochloric acid—Symptoms—Appearances—Analysis      .     . 110 
viii
CONTENTS.
                          CHAPTER VIII.
                                                                   PAGB
Poisoning by Vegetable Acids—Oxalic  acid—Symptoms and appearances-
  Chemical analysis—Acid oxalate of potash or Salt of sorrel—Tartaric  and
  Acetic acids  '.....••••  1/2U

                           CHAPTER IX.

Poisoning by Alkalies and Alkaline salts—Potash, Soda, and Ammonia—Ni-
  trate and Sulphate of potash—Chloride of barium    .      .      •      -128

                            CHAPTER  X.

Phosphorus—Symptoms and appearances—Chronic poisoning—Chemical anal-
  ysis—Red or Allotropic Phosphorus—Iodine  .      .      .      •      -133

                           CHAPTER XI.

Metallic Irritants.— Arsenic—Arsenious acid—Symptoms—Chronic  poi-
  soning—Appearances after  death—Fatal dose—Chemical analysis—Arse-
  nites—Arsenic acid—Orpiment and other compounds      .      .      .  140

                           CHAPTER XII.

Poisoning by Mercury—Corrosive sublimate—Symptoms—Chronic poisoning
  —Appearances after death—Chemical  analysis—Process for mercury in or-
  ganic liquids—White and red precipitates—Mercuric methide and other com-
  pounds   .      .      •      •      •      •      •      •      •      .160

                          CHAPTER XIII.

On poisoning with Lead—Sugar of Lead—Symptoms—Appearances after death
  —Chemical analysis—Lead in organic mixtures—Carbonate, or White lead—
  Chronic poisoning—Poisoning with Copper—Blue vitriol—Symptoms—Ap-
  pearances—Chemical analysis—Copper in organic liquids   .      .      .  169

                           CHAPTER XIV.

Tartar emetic—Symptoms—Appearances—Chronic poisoning—Chemical anal-
  ysis—Chloride or butter of antimony—Poisoning with  salts of Zinc and  Iron 176

                            CHAPTER  XV.

Vegetable and Animal Irritants.—Vegetable  Irritants—Aloes—Savin—
   Croton oil—Colchicum—Hellebore—"Yellow Jessamine—Carbolic acid—Ani-
  mal Irritants—Cantharides—Noxious Animal Food—Fish, Mussels, Cheese,
   Sausages—Poisoned Flesh of Animals—Trichiniasis .     .      .      .186

                           CHAPTER XVI.

Neurotic  Poisons.—Opium—Symptoms — Appearances—Its action  on in-
   fants—Poisoning with opiate compounds—Morphia and its salts—Process for
   detecting Opium in organic mixtures  ...... 205

                           CHAPTER XVII.

Prussic acid—Symptoms and appearances—Tests for the acid—Process for or-
   ganic mixtures—Cyanide of Potassium—Essential oil of bitter almonds—Ni-
   trobebzole—Bichloride of Methylene—Fusel oil      ...      . 212

                          CHAPTER XVIII.

Alcohol—Ether—Chloroform—Hydrate  of Chloral—Camphor—Tobacco—Ni-
   cotina—Cocculus indicus—Picrotoxine—Calabar bean—Fungi—Henbane  . 222 
CONTENTS.
IX
                          CHAPTER XIX.
                                                                   PAGE
Nux vomica—Strychnia—Symptoms and appearances—Chemical and micro-
  scopical analysis of Nux vomica and Strychnia—Process for organic mix-
  tures—Brucia    ......... 233

                           CHAPTER XX.

Conium maculatum (Hemlock)—Conia—GSnanthe crocata—iEthusa cynapium
  Aconite or monkshood—Aconitina    ...... 240


                          CHAPTER XXI.

Atropia belladonna or Deadly nightshade—Poisoning by Atropia—Lobelia—
  Foxglove—Digitaline—Datura stramonium or Thornapple—Daturia       . 249
         WOUNDS AND PERSONAL  INJURIES.


                         CHAPTER XXII.

Definition of a wound—Danger to life—Grievous bodily harm—Examination
  of wounds—Description of wounds—Characters of wounds inflicted on the
  living and dead body—Ecchymosis on the living and dead—Effects of vio-
  lence on the dead body—Ecchymosis not always a result of violence      . 258


                         CHAPTER XXIII.

Evidence of the use of a weapon—Characters of wounds caused by weapons—
  Incised,  Punctured, Lacerated, and  Contused Wounds—Stabs and cuts—
  What are weapons ?—Examination of the dress—Imputed or self-inflicted
  wounds   .......... 267

                         CHAPTER XXIV.

Wounds indicative of homicide, suicide, or accident—Evidence from the situa-
  tion of a wound—Evidence from nature  and extent—Evidence from the di-
  rection of a wound—Wounds  inflicted by  the right or left hand—Several
  wounds—Use of several weapons     ...... 275


                          CHAPTER XXV.

Evidence from circumstances—The position of the body and of the weapon—
  Evidence from blood, hair and other substances on weapons—Marks of blood
  on clothing and furniture, on the deceased,  and on the assailant    .     . 282


                         CHAPTER XXVI.

Chemical examination of blood-stains—Stains of blood on linen and other stuffs
  —Age or date of the stain—Other stains resembling  blood—Blood  on wea-
  pons—Arterial and Venous  blood—Varieties of blood—Blood of man and
  animals—Microscopical evidence     ...... 291


                         CHAPTER XXVII.

The cause of death from wounds—Wounds directly or  indirectly fatal—Death
  from hemorrhage—internal bleeding—Death from mechanical injury and
  shock—Death  from numerous personal injuries irrespective of any mortal
  wound   .......... 310 
X
CONTENTS.
                         CHAPTER  XXVIII.
                                                                     PAGE
Death of wounded persons from natural causes—Distinction between real and
  apparent cause—Death from wounds, or latent disease—Accelerating cause
  —Death from wounds after long periods—Avoidable causes of death—Neg-
  lect—Imprudence—Unskilful treatment—Unhealthy state of the body      . 318

                          CHAPTER  XXIX.

Wounds  indirectly fatal—Tetanus following wounds—Erysipelas—Delirium
  tremens—Gangrene—Death from surgical operations—Primary and  second-
  ary causes of death—Unskilfulness in operations—Pyaemia—Medical respon-
  sibility in reference to operations—Actions for malapraxis    .       .       328

                          CHAPTER XXX.

Cicatrization of wounch?—Evidence  from cicatrices—Changes  in an incised
  wound—Are cicatrices when once formed indelible ?—Characters of cicatrices
  —Colored cicatrices—Tattoo marks   ...... 336

                          CHAPTER XXXI.

Wounds of the head—Concussion—How distinguished from intoxication—Effu-
  sion of blood as a result of violence, disease, or mental excitement—Wounds
  of the face—Deformity as a consequence of wounds of the face—Injuries to
  the spine and spinal marrow—Fractures of the vertebra     .       .      . 340

                         CHAPTER  XXXII.

Wounds of the chest—Wounds and ruptures of the  lungs and heart—Wounds
  of large bloodvessels—Wounds and ruptures of the diaphragm—Direction of
  wounds of the chest—Wounds of  the abdomen—Death from blows on the
  cavity—Ruptures of  the liver, gall-bladder,  spleen, kidneys, intestines,
  stomach, and urinary bladder—Wounds of the genital organs      .      . 351

                         CHAPTER XXXIII.

Fractures—Produced by a blow with a weapon, or by a fall—Brittleness of the
  bones—Fractures caused by slight muscular exertion—In the living and dead
  body—Has a bone ever been fractured ?—Locomotion—Dislocation from vio-
  lence, or natural causes—Medical opinions—Action for malapraxis  .      . 363

                         CHAPTER XXXIV.

Gunshot wounds—In the living and dead body—Was the piece fired near or
  from a distance ?—Accidental, suicidal, or homicidal wounds—Position of the
  wounded person when shot—Wounds from small shot—Wounds from wad-
  ding and gunpowder    ......               368

                         CHAPTER  XXXV.

Death from burns and scalds—Symptoms—Stupor—Cause of death—Post-mor-
  tem appearances—Burns on the dead body—Accident, homicide, or suicide-
  Wounds caused by fire—Scalding—Burns by corrosive liquids              375
                           ASPHYXIA.

                         CHAPTER XXXVI.

Drowning.—Cause of death—Secondary causes—Post-mortem appearances-
  Medical proofs of death from drowning—Specific gravity of the body—Co-
  incidental causes of death—Marks of violence—Accidental fractures—Homi-
  cidal and suicidal drowning    .                                        004 
CONTENTS.
xi
                        CHAPTER  XXXVII.
                                                                    PAGE
Hanging.—Cause of death—Death from the secondary effects—Post-mortem
  appearances—Mark of the cord or ligature—Was death caused by hanging?—
  Hanging after death—Summary of medical evidence—Marks of violence on
  the hanged—Was the hanging the result of accident, suicide or homicide ?—
 • The position of the body      ....... 404


                        CHAPTER XXXVIII.

Strangulation.—Cause  of death—Appearance  after death—Was  death
  caused  by strangulation, or was the constriction applied to the neck after
  death?—Marks of violence—Accidental, homicidal, and suicidal strangula-
  tion      .      .      .      .      .       .      .      .       .      .421

                         CHAPTER  XXXIX.

Suffocation.—Suffocation from mechanical causes—Cause of death—Appear-
  ances after death—Evidence of  death from suffocation—Accidental, suicidal,
  and homicida^suffocation—Smothering       ..... 436


                           CHAPTER XL.

Gaseous  Poisons.—Carbonic   acid—Symptoms—Appearances—Analysis—
  Effects of charcoal vapor—Carbonic oxide—Coal and coke vapor—Sulphur-
  ous acid—Vapors of lime, cement, and brick-kilns—Confined air—Coal gas—
  Carburetted hydrogen—Nitrous oxide        ..... 446


                          CHAPTER   XLI.

Sulphuretted Hydrogen  Gas—Its poisonous  properties—Symptoms—Post-
  mortem appearances—Effluvia from drains and sewers—Analysis—Mephitic
  vapors—Exhalations from the dead    ...... 466


                          CHAPTER  XLII.

Lightning, Cold, Heat, Starvation.—Effects  of the electric fluid—Post-
  mortem appearances—Cold an  occasional  cause of death—Symptoms—Cir-
  cumstances which accelerate  death—Post-mortem appearances—Case  of
  murder by cold—Effect  of heat—Starvation a rare cause of death—Symp-
  toms—Appearances after death—Legal relations     .... 475
                           PREGNANCY.


                          CHAPTER XLIII.

Signs of pregnancy—Suppression of the menses—Prominence of the abdomen—
  Quickening—Sounds of the foetal heart—Changes in the mouth and neck of
  the uterus—Feigned pregnancy—Concealed  pregnancy—Pregnancy in the
  dead—Impregnation in a state of unconsciousness—Legal relations        . 494


                          CHAPTER XLIV.

Delivery.—Delivery in the living—Concealed delivery—Abortion in the early
  stages of pregnancy—Signs of recent and  remote delivery—'Feigned  de-
  livery—Delivery in a state of unconsciousness—Signs of delivery in the
  dead—True and false corpora lutea—Characters of the ovum or embryo—
  Moles—Concealment of birth   ....... 507 
Xll
CONTENTS.
                           CHAPTER  XLV.
                                                                      PAGE
Criminal Abortion.—Abortion from natural cause—Criminal causes—Me-
  chanical means—Medical substances—Signs of abortion—Specific abortives
  —Local applications—Feigned abortion—Meaning of the word   noxious
  as applied to drugs—On inducing premature labor—Proof of pregnancy not
  necessary—Abortion of monsters—Moles and hydatids      .      •       •  5<3b
                           INFANTICIDE.


                           CHAPTER XLVI.

Nature of the crime—Proof of life—Medical evidence at inquests—Uterine age
  or maturity of the child—Viability—Characters of the child from the sixth
  to the ninth month—Signs of maturity—Rules for inspecting the body     . 548
                                                           •

                           CHAPTER XLVII.

Evidence of life  before respiration—Putrefaction in utero—Evidence of life
  after  respiration—Color, volume, consistency, and  absolute weight of the
  lungs—Static test—Weight increased by respiration  .... 554


                         CHAPTER XLVIII.

The hydrostatic test—Sinking of the lungs  from disease, or atelectasis—Life
  with perfect atelectasis or entire absence of air from the lungs—Erroneous
  medical inference from sinking of the  lungs—Floating of the  lungs  from
  putrefaction—Effects of putrefaction on the lungs   .      .       .      .563


                           CHAPTER  XLIX.

Floating of the lungs from  artificial inflation—Inflation not distinguishable
  from imperfect respiration—Results of compression—Improper objections to
  the hydrostatic test—Respiration before birth—Respiration a sign of life, not
  of live birth—General conclusions    .      .       .      .       .      .509


                             CHAPTER  L.

On the proofs  of a child having been born alive—Evidence from respiration—
  Marks of violence, and  natural changes in the foetal vessels—The discovery
  of food in the stomach—General conclusions  .....  575


                             CHAPTER LI.

Causes  of death in new-born  children—Proportion of  children born dead-
  Natural causes of death—A  protracted delivery—Debility—Bleeding  from
  laceration of the navel-string—Compression of the navel-string—Malforma-
  tion—Destruction of Monstrous births—Deaths from congenital diseases   .  589


                             CHAPTER LII.

Violent  causes  of death in new-born  children—Suffocation—Drowning—
  Death of the child from cold  and exposure.—Starvation—Death from imma-
  turity—Wounds in new-born  children—Fractures  of the skull, accidental
  and criminal—Twisting  of the  neck—Violence in self-delivery—Power of
  locomotion and exertion in females after delivery    .     .            . 594 
CONTENTS.
xliii
                           CHAPTER LIII.
                                                                    PAGE
Death of the child from strangulation—Strangulation by the navel-string—Ac-
  cidental marks resembling those of strangulation—Constriction before and
  after death—Before and after breathing—Before and after the severance of
  the navel-string—Examination of the mother        .... 609
                   BIRTH, INHERITANCE.

                          CHAPTER LIV.

Evidence of live birth in civil cases—Legal rights of the foetus in utero—Date
  of birth—Difference between entire and partial birth—Signs of live  birth
  independently of respiration  or  crying—Vagitus  uterinus—Tenancy  by
  courtesy—Csesarean extraction of children—Legal birth—Post-mortem births
  —Monsters—Deprivation of legal rights—Minority and majority   .      . 619


                           CHAPTER  LV.

Legitimacy.—Presumption of legitimacy—Natural period of gestation—Du-
  ration of pregnancy from one intercourse—Premature births—Short periods
  of gestation—Viability—Earliest period at which a child may be born living
  —Evidence  from the state of the child—Protracted births—The period of
  gestation not fixed by law      ....... 639


                           CHAPTER  LVI.

Paternity.— Disputed paternity—Parental  likeness—Affiliation — Posthu-
  mous  children — Superfoetation in relation to  legitimacy — Supposititious
  children—Sexual malformations       ...... 657
                 IMPOTENCY,  STERILITY.

                          CHAPTER LVII.

Impotency.—Causes—Procreative power in the male—Puberty—Age  for vi-
  rility—Virility of crypsorchides and monorchides—Sterility.—Procreative
  power in the female—Earliest and latest periods for child-bearing—Legal
  relations  .....••••• 680
                               RAPE.

                          CHAPTER  LVIII.

Nature of the crime—Sources of medical evidence—Rape on infants and chil-
  dren—Marks of violence—Purulent discharges  from the vagina—Evidence
  from gonorrhoea and syphilis—Rape on girls after puberty—Defloration-
  Signs of virginity       ....••••

                           CHAPTER LIX.

Rape on married and adult women—Circumstances under which it  may be
  perpetrated on adult women—Loss of physical evidence—Pregnancy follow-
  ing rape—Microscopical evidence     ....•■ 
xiv
CONTENTS.
                             INSANITY.


                            CHAPTER LX.
                                                                     PAGE
What is insanity ?—Medical definitions—Distinctions of sane from insane per-
  sons—Moral insanity—Legal definitions—" Non compos mentis"—Symptoms
  of incipient insanity—Hallucinations and illusions—Lucid intervals .       . 729


                           CHAPTER LXI.

Varieties  of insanity—Mania—Abstinence  from  food—Delusions regarding
  poison — Delirium distinguished from mania—Monomania —Dementia —
  Idiocy—Imbecility—Hereditary transmission—Feigned insanity—Appear-
  ance  after death—Eccentricity  .             ..... 737


                           CHAPTER LXII.

Medico-legal questions in relation to the insane—Imposition of restraint—-Ille-
  gal imposition  of restraint—Violence of temper—Certificates of insanity—
  Rules for the discharge of lunatics    ...... 749


                          CHAPTER LXIII.

Interdiction—Commissions of lunacy—Examination of alleged lunatics—Medi-
  cal and legal tests of competency—Conflict of evidence and opinion       . 75 9


                          CHAPTER  LXIV.

Civil responsibility—Testamentary capacity—Wills made by the insane—Test
  of capacity—Evidence of delusion—Eccentricity in wills    .      .      . 771


                           CHAPTER LXV.

The plea or defence of insanity—Circumstances under which it is admissible—
  Homicidal  insanity—Moral insanity—Symptoms—Legal tests—Medical tests
  —Delusion—Tests of irresponsibility—Medical evidence     .      .      . 781


                          CHAPTER  LXVI.

Suicidal mania—Suicide not necessarily an indication  of insanity—Suicide a
  felony—In relation to life insurance—Hereditary taint—Puerperal mania—
  Pyromania — Kleptomania — Dipsomania — Erotomania — Responsibility of
  drunkards—Delirium tremens—Somnambulism—Deafness and dumbness   . 800
                       LIFE  INSURANCE.


                         CHAPTER  LXVII.

Principles of Life Insurance—Questions to persons who insure their lives__
  Medical questions—What diseases have, and what have not, a tendency to
  shorten life?—Legal decisions respecting  the meaning of these words__Con-
  cealment  of diseases—What is  material concealment?—Concealment of
  habits—What is intemperance?—Proximate and  remote  effects—Delirium
  tremens — Epilepsy—Phthisis—Abstinence—Vegetarianism — Opium-eating
  —Inveterate smoking—Insanity—Voidance of policies by suicide—Insurance
  murders  .      .     .      .      .      .      ,      .       .        §22 
ILLUSTRATIONS.
FIG.
 1
 2
 3
 4
 5
    Crystals of oxalic acid
    Crystals of oxalate of lime
    Crystals of nitrate of soda
    Crystals of arsenic from sublimation
    Metallic sublimates of arsenic
  6 Crystals of arsenic from solution .
  7 Deposits from Marsh's process
  8 Apparatus used for detecting arsenic in the tissues
  9 Apparatus for Marsh's process
 10 Deposit of metallic arsenic by heat
 11 Flask used for Reinsch's process .
 12 Crystals of corrosive sublimate by sublimation
 13 Crystals of corrosive sublimate by solution in water
 14 Crystals of corrosive sublimate by solution in alcohol
 15 Sublimate of metallic mercury in globules
 16 Sugar of lead crystals from a solution
 17 Sugar of lead crystals magnified 80 diameters
 18 Crystals of tartar emetic
 19 Tips of the leaves of savin
 20 Trichina spiralis in its capsule
 21 Trichina spiralis in abdominal muscles of man
 22 Single trichina spiralis from human muscle
 23 Trichina spiralis encysted in pork
 24 Crystals of morphia from the hydrochlorate
 25 Crystals of cyanide of silver
 26 Berry of cocculus indicus  .
 27 Seeds of henbane
 28  Silky hairs qf nux vomica
 29 Crystals of strychnia
 30 Crystals of strychnia from sulphate
 31 Crystals of chromate of strychnia
 32 Crystals of sulphate of brucia
 33 Seeds of hemlock
 34 Seeds of 03nanthe crocata
 35 Seeds of JEthusa cynapium
 36 Root of aconite
37 Root of horseradish
38 Seeds of aconite
39 Seeds of belladonna 
XVI
LIST  OF ILLUSTRATIONS.
FIG.
40 Seeds of lobelia
41 Seeds of foxglove   .
42 Seeds of stramonium
43 Crystals of daturia
44 Fibres of cotton magnified
45 Fibres of linen magnified
46 Fibres of silk magnified
47 Fibres of woollen magnified
48 Fibres of ancient woollen
49 Fibres of ancient linen
50 Blood-corpuscles magnified
51 Corpuscles of blood in linen fibre
52 Human blood-corpuscles with fibrin
53 Human blood-corpuscles dried
54 Hrematin crystals
55 Blood-crystals from blood of man and fish
56 Blood-crystals from dried human blood
57 Section of  the ergot of rye
58 Heart with ductus arteriosus in its foetal state
59 Heart with ductus arteriosus contracting
60 Granules of wheat-starch and of arrowroot
61 Oil-globules of human and cow's milk
62 Oil globules of human milk and colostrum
63 Epithelial  scales    ....
64 Microscopical appearances of meconium  . 
MEDICAL   JURISPRUDENCE.
MEDICAL EVIDENCE.
                     CHAPTER  I.

THE PRACTICE OF  MEDICAL JURISPRUDENCE.—MEDICAL AND  MEDICO-
  LEGAL DUTIES.--INSPECTION  OF  BODIES IN DEATH FROM WOUNDS, OR
  POISONING.—USE OF NOTES.—MEDICO-LEGAL REPORTS.—DYING DECLA-
  RATIONS.

  Medical Jurisprudence—or, as it is sometimes called, Forensic,
Legal, or State  Medicine—may be defined to  be that  science
which teaches the application of every branch of medical  knowl-
edge to  the purposes of  the law; hence its limits are, on the one
hand, the  requirements of the law, and on  the other, the whole
range of  medicine.   Anatomy, physiology, medicine, surgery,
chemistry, physics and botany, lend their aid as necessity arises ;
and in some cases all these branches of science  are required to
enable a court of law to arrive  at a proper  conclusion  on a con-
tested question affecting life or property.
  The purpose of this work is to bring, as far as possible, within a
limited compass, those subjects which especially demand inquiry,
and which  more particularly concern the duties of  the educated
physician  and surgeon.  The definition above given necessarily
implies that a medical jurist  should have a theoretical and practi-
cal  knowledge of all branches of the profession, a large range of
experience and  the rare power of adapting his  knowledge  and
experience  to emergencies.   He should be  able to  elucidate any
difficult medico-legal question which may arise, and be prepared
at all times to  make a  cautious selection of such medical facts,
and a proper application  of such medical principles, as may be ne-
cessary to  enable a judge to place  the  subject in an intelligible
light before a jury, and to enable  a jury to arrive  at a just con-
clusion.
  The variety of subjects of which  a medical jurist  is required to
have knowledge may well alarm a student, and lead him to sup-
pose that, as lie cannot  make himself perfectly acquainted with
all, he m;iy well forego the labor of preparing  himself  in an v.
      2 
L8
DUTIES  OF PHYSICIANS AND
But this would be taking an erroneous view of his position.   This
description of the qualifications necessary to constitute a normal
witness in a court of law must not deter him from entering on the
study.   It is assuredly beyond the  mental  power of any  individual
that he should  be at  the same time profoundly versed  in all the
principles of medicine and jurisprudence, and that he should be
able to answer all possible questions, and encounter and remove
all medical  difficulties that may occur during the trial of a civil
or criminal case.  All' that the law expects from a medical man is
a fair average knowledge, not merely of his profession, but of that
which falls  more peculiarly under the province of a medical wit-
ness.   There can be  no doubt that the more  perfectly  a man has
made himself master of his profession, the better will lie be fitted
to follow the principles and apply himself to the practice of medi-
cal jurisprudence; but he must divest himself of the notion that
these principles can  be  spontaneously acquired,  or  that they are
necessarily derived from the study of those isolated branches of
medicine  upon which medical jurisprudence is based.   The  mate-
rials for the medical jurist undoubtedly  exist in these collateral
sciences; but they require to be assorted, selected, and moulded
into shape, before" they can be applied to any useful or practical
purpose.
   The duties of a medical jurist are distinct from those  of a physi-
cian or surgeon ;  the latter looks only to  the treatment of disease
or accident and the saving of life ; but the object of the former, in
a  large proportion of cases, is, whether in reference to the  living
or dead, to aid the law in fixing on the perpetrator of  a crime, or
to rescue an innocent person from a falsely imputed crime.  Thus
he may be required to determine whether, in a particular case, the
cause of death is natural or violent; and  for  this purpose it will
be necessary for  him to make an entirely new application of  his
professional knowledge.  He has now the difficult task  of making
a  selection  from those parts of the medical  sciences which bear
upon the legal  proof and development of crime.
   Some members of  the profession have been inclined to look upon
medico-legal practice as  an unnecessary addition to their ordinary
duties ; but there are few who have been long engaged  in practice,
who have not  found themselves occasionally  placed  in situations
of difficulty from the accidental  occurrence  of  cases  demanding
medico-legal investigation.   A  medical man  is summoned to
attend a person  laboring under the effects of poison  criminally
administered, but at the time he may have  no knowledge or even
suspicion that poison is the  cause of the symptoms.   In spite of
the best treatment,  death ensues ; here the functions of the medi-
cal  man end, and those of a medical witness  begin.  It is utterly
impossible that he can now avoid giving  evidence, or shift  the re-
sponsibility on another—the law will insist upon his  appearance,
 first in the court of the coroner, and afterwards at the Assizes.   It
 will here be assumed that as a registered  member of the profession
he is  fully competent to  answer every question put  to him by 
SURGEONS  IN ACTING AS WITNESSES.         19
judge and counsel relative to the general effects of poisons ; the
quantity required to destroy life; and the time within which a
poison may prove fatal.  It may be objected to his evidence, that
the deceased had died from the effects  of disease, and  not from
poison, in which case the cross-examination will lead to a searching
inquiry into all those  diseases which resemble poisoning in their
symptoms  and post-mortem appearances as well as  the  means of
making a certain distinction between them; and the fallacies to
which the chemical processes for the detection of poison are liable.
On another occasion, a medical man may be called to render assist-
ance to  one who has been stabbed in a quarrel, and who speedily
dies from the wound.  The office of the surgeon here ceases, while
that of  the medical jurist commences.  He must now  be prepared
to answer numerous questions, all bearing  upon the legal proof of
crime, all  necessary in law, although apparently superfluous in
surgery.  Thus he may be asked to state the precise characters of
a wound  inflicted upon the body of a man soon after death; and
by what means a particular wound was inflicted ?  Was it homi-
cidal, or accidental ?  The amount of blood lost ?  Whether the
person could have moved, or performed any act after receiving it ?
Are certain red spots  found upon his clothes, or upon a knife be-
longing to him, owing to effused blood or other causes ?  Whether
any, and what statements were  made by the dying man, and what
were the precise circumstances under which they were made ?  It
need  hardly be observed that questions of this nature are rarely
noticed, except in a cursory manner, by professors of chemistry and
surgery, and a medical man is not  likely to acquire the  means of
answering them by intuition.   On the other hand, regarding our-
selves as living in a  civilized  state, in which the detection and
punishment of crimes against life and property are indispensable
to the security of all, it is impossible to overrate their importance.
Unless a witness is able to return  answers  to these questions when
a public necessity occurs, a guilty  man may  escape punishment,
while an innocent  man may be condemne'd.  He may thus most
seriously  injure his own reputation, for it is certain that his quali-
fications as a'physician, surgeon, or general practitioner, however
great, will not shield him from  general reprobation.
   Thus, then, it is obvious that the duties of  a medical jurist are
of a highly responsible nature and of great importance to  society,
while the cases which call them into exercise are of purely acciden-
tal occurrence.  A medical practitioner who thinks himself secure
in the most retired corner of the kingdom, is liable to find himself
suddenly summoned as a witness on a  trial, to answer questions
which perhaps during a  long period of practice he had been led to
regard as unimportant.  Under the circumstances it is scarcely pos-
sible that he can avoid exposing his deficiencies, and the final ques-
tion will  be, Have you ever attended to, or  thought of these subjects
before?   A negative answer to this question, while it commonly
brings with it public  censure, will  in most instances  lead to the
acquittal of the accused, in spite of strong presumptions  of guilt. 
20
MEDICAL CONTRASTED WITH
  I have endeavored to avoid overdrawing this picture ;  its truth
will, I am sure, be felt and acknowledged by those who have been
a i'ew years engaged in practice.  The records of our courts of law
contain many unfortunate exposures, which might have been easily
avoided, had the witnesses only availed themselves of the opportu-
nities afforded to them while students, of acquiring a knowledge
of the subject; but  they had unreflectingly acted  on the principle,
that medical jurisprudence was a dry, dull, and useless study, and
that the practice of it was remote and speculative.   This feeling is,
however, fast disappearing.  Those who  have been compelled by
circumstances to give their attention to it, have in  subsequent cases
taken care to prepare  themselves  for the  ordeal  through which
every medical  witness must pass.
  Some medical men who have treated  legal medicine with m-
difference have occasionally ventured to act as witnesses, thinking
that the subjects on which they were likely to  be examined were
so little known to judge and counsel, that even hazardous or rash
statements would escape observation: such witnesses, however, have
often found to their cost that  they were laboring under a fatal
delusion.  Various circumstances have led, in recent times, to the
acquisition of much medico-legal knowledge by lawyers, especially
in relation to questions connected with wounds, child-murder and
poisoning, and they are not slow in detecting  and  exposing a mere
pretender who attempts to shelter himself by vague or evasive state-
ments and technical language.   Another fact  must be  borne  in
mind : there are few counsel engaged in any civil  or criminal case
of importance, who do not  take care to fortify themselves  under
medical  advice,  with a  full knowledge of the views of  standard
medical writers  on  the subject  in  dispute ; and with  these  works
before them and with their proverbial acuteness, he must indeed be
a clever witness who can succeed  in  passing off an erroneous  or
evasive answer to a  medico-legal question.
  It is a frequent charge against members of the medical profession
that they are  the worst witnesses  on matters of fact and opinion.
I believe this to be an unmerited censure.  Those  who are ready to
made this charge overlook the number, complexity and difficulty
of the questions which are put to medical men compared with those
put to  other witnesses.  They also forget that medical men are
much more  frequently summoned as witnesses than the members of
the two other learned professions.  Their evidence obtains much
greater publicity, and is necessarily exposed to  a wider circle of
criticism.  The fact is, that good and bad witnesses are to be met
with in every profession, and under equal conditions there is no rea-
son to suppose that  one would furnish a greater number of incompe-
tent witnesses than another.  It is certainly the fault of medical men
that they are  not generally prepared for the questions which are
likely to arise in a case on which they know  they will be required
to give evidence.   This want of preparation frequently applies to
facts as well as to opinions.  Thus, in reference to a case on which
a charge of murder  or manslaughter may be ultimately founded a 
MEDICO-LEGAL  OBSERVATION.
21
medical man who is called in omits to observe many circumstances,
because at the time they appear to him to have little importance,
although  at the subsequent trial he  may find, to his dismay, that
they actually  become  the turning points  of  innocence or guilt.
Medical observation  as a result of professional habits is, on these
occasions, in general confined to only one set of circumstances—the
recognition and treatment of accident or disease; but medico-legal
observation should take a much wider range than this, and should
be directed to all the surrounding facts and  incidents of a case.
The essential difference in the two kinds of practice is, that circum-
stances which  are of no interest in a medical or surgical point of
view, are  often of the greatest value and importance in legal medi-
cine.   It is obvious, that, if they are not  observed by a medical wit-
ness when he is  first  summoned to the injured  person, whether
dying  or  dead, it will be out of his power to meet many of the
questions  which must arise in the  progress of  the case.  The non-
observance of these facts is a serious  evil, and often carries with it,
although  unjustly, an imputation of professional ignorance.
  The first duty, therefore, of a medical jurist is to  cultivate a
faculty of minute observation of medical and moral circumstances.
This, when combined with a general knowledge of wha£ the law
requires  as evidence, wTill enable  him  to  meet in a  satisfactory
manner all the scientific questions that may be necessary  for the
elucidation of a case.   The exercise  of this faculty is by no means
inconsistent with the  performance  of his duties as a surgeon.  A
learned judge  on one occasion remarked that" a medical man, when
he sees a dead body,   should notice  everything."  Undoubtedly he
should observe everything which  could throw a  light upon the
production of wounds or other injuries found upon it.  It should
not be left to policemen  to say whether there were any marks of
blood on the dress or on the hands of the deceased, or on the furni-
ture in the room.  The dress of the deceased as well as the body
should be always closely examined on the spot  by the medical
man.   The importance of this precaution is well  illustrated by a
certain case in which a man just escaped committal on what would
have proved a' false charge of murder,  by reason of the examina-
tion of an article of  dress accidentally  produced at the adjourned
inquest.
  There is another  point which  is frequently omitted on these
occasions, and the omission  may give rise to great inconvenience,
if not  to  a failure of justice.  Thus, in reference to a dead body,
no observation is made at the time of the visit whether it  or  any
part of it is cold or warm ;  whether the limbs are cold and rigid,
or cold and pliant.   In a medical and surgical view these condi-
tions  of the body are of no importance  whatever, but medico-
legally, if the facts are observed, they may enable a  witness to
speak with greater or less probability on the time of  death:  this
may make all the difference between the acquittal and conviction
of a person charged with murder.  The  case of Gardner, elsewhere
related, will show the  importance of observations of this kind. 
22  RULES FOR  OBSERVING ALLEGED CASES OF HOMIC
  It may stimulate the attention  of a medical  practitioner  in
reference to these inquiries if he is informed that the great art of
counsel, who defend persons charged with murderer manslaughter,
consists in endeavoring to discover what he omitted to do.  Al-
though sometimes the omission may be  really of no medical im-
portance whatever, yet it is usually placed before the jury in such a
strong light that the accused obtains the benefit of a doubt.  The
omission may be  attributed to professional  ignorance, or, what is
worse, to professional bias—a determination to find proofs of guilt
against the " unhappy prisoner at the bar"—when the facts might
be innocently explained by a want of experience on the part of the
witness in dealing with  cases of this nature.
  Before any inquiry is instituted by a magistrate or coroner, and
before any suspicious circumstances have come to light, a medical
man may be summoned to  a  person dying  from the effects of a
wound, or from the secret administration of poison.  The dying
person may make to him a declaration or statement as to the cir-
cumstances  under which  the  wound was inflicted or the poison
administered: he may also mention the names of the person  or
persons concerned in the assault or the administration.  This dying
declaration or statement,  according to the  circumstances under
which it is made, may become of material importance in the prose-
cution of a party charged with murder or  manslaughter.  It  is
therefore proper that a practitioner should observe and make notes
of the exact condition of the patient;  whether, when he makes the
statement, he is  under the conviction or belief  that he is dying.
It has been thought that it was also necessary to prove that the
wounded man had lost all hope of recovery:  but as a learned judge
has justly remarked, it is very difficult, if not impossible, to say on
these occasions, when, if ever, the feeling of hope completely deserts
a man.  It is  sufficient for all legal purposes, if he expresses his
belief that he is dying.
   Hence, when the case is  likely to  prove  fatal, it  is the duty of
the  medical man to warn the patient in the presence of his rela-
tives or friends, of his dangerous  condition.  If the wound  or
poison is not likely to prove rapidly fatal, the attendance of a
magistrate  to take down the statement in  due legal form, would
relieve the medical man of all responsibility.  Should any  state-
 ment, however, be made to him under these  circumstances, it is
 his  duty to make, on the spot, a note of the words actually used.
 There should be no paraphrase or translation of them, but they
 should be the ipsissima verba  of the dying  man.   It is not for the
 witness, but for the court, to  interpret what is  thus stated.   A
 medical man on these occasions should not render himself officious
 in extracting information.  He may receive that which is volunta-
 rily uttered, and, either  immediately or on the  earliest  possible
 opportunity,  write down the statement as  it was made.  Any
 question  should be simply confined to the purpose of explaining
 what may appear to him to be ambiguous,  or contradictory in the
 declaration itself. 
RULES  FOR OBSERVING ALLEGED CASES OF  HOMICIDE.  23

  In reference to persons who have died from the effects of wounds,
poison', or other violent causes, the initiatory proceedings connected
with the  inquiry usually take place in the court of the coroner ;
and unless the medical man in attendance is supposed to be impli-
cated by maltreatment, or otherwise in the  death of the person,
the duty  of making an examination of the dead body devolves
upon him.  He may not have seen  the person while living; and
in this  case it  will be necessary that he should give his attention
to those circumstances which may be of importance in the future
inquiry.  He should note as far as it can be ascertained :  1.  The
exact time of death, if known, and thus determine how long a
period the person has survived. 2.  The attitude, position, and con-
dition of the body.  3. The  state of the dress.   4.  All surrounding
objects.   Any bottles, paper-packets, weapons, or spilled liquids
lying about should be collected and preserved, and their position
with regard to  the body of deceased should  be  noted.   5. Any
vomited matters near the deceased should be collected.  In  making
a post-mortem  examination of the  body  the  following  additional
points should be attended to : 6. The external appearance of the
body, whether  the surface is livid or pallid.   7.  Note the state of
the countenance.  8. Note all marks of violence  on the person, or
discomposure of the dress, marks of  blood, etc.   9. The situation,
form and direction of all wounds should be  accurately  noticed.
10. The presence or absence of warmth or  coldness in the legs,
arms, abdomen,  mouth, or armpits.   11. The presence of cadaveric
rigidity in any part  of the  body.   To give any value to the two
last-mentioned  characters, it is  necessary for  the practitioner to
observe  the nature of the floor on which the body  is lying, whether
the body is clothed  or naked, young  or old, fat or emaciated.
These conditions create  a difference, in  respect to the cooling of
the body and the access of rigidity.  12. If found dead—When
was the deceased last seen  living, or known to  have been alive ?
13. Note  all  circumstances leading to a suspicion of suicide or
murder.  14. The time  after death  at  which the inspection  is
made.   15. Observe the state of the abdominal viscera.  If the
stomach and intestines are found  inflamed, the  seat of  imflam-
mation  should  be exactly specified ; also all marks of softening,
ulceration, effusion of blood, corrosion, or perforation.  The sto-
mach should  be removed and placed in a separate vessel, ligatures
being applied to the two ends.  If cut open for  examination at this
period, this should  be performed in a  clean dish, and with such
care that none of the contents are lost, or are allowed to mix with
the contents of the intestines.  16.  The contents of the stomach,
if this organ is opened during the inspection,  should be collected
in a clean graduated vessel: notice, a, the quantity; b, the odor
tried by several persons; c, the color; d, acid or alkaline  reaction ;
e, presence of blood, mucus, or bile; /, presence  of undigested food;
and here it may be as well to observe, that the  presence of farina-
ceous matters (bread) would be indicated by the addition of iodine
water, if the contents were not alkaline—of fat, by heat; g, other 
24   RULES FOR OBSERVING ALLEGED CASES OF HOMICIDE.

special characters.  17. The  contents of the duodenum should be
separately collected, ligatures being applied to it.   18. Observe the
state of the large intestines, especially the rectum, and note the
condition of their contents.  The discovery of hardened feces in
the  rectum would prove  that  purging had not  existed  recently
before death.   19. The state of the windpipe, throat, and gullet,
whether  there  are in these parts any foreign substances, or marks
of inflammation and corrosion.   This is of essential importance,^
it throws a light upon a variety of questions which  may  arise
respecting  death by suffocation from mechanical  causes, or the
nature of a substance swallowed.  20. The state of the lungs and
heart; all morbid changes noted.  21. The state of the brain and
spinal marrow.  22. The condition  of the uterus, ovaries,  and
genital organs  should be  examined, as, in  the female, poison has
been sometimes  introduced  into  the system  by  the vagina, or
wounds have  been inflicted  internally.  23.  The liver  with the
gall-bladder should be removed for a chemical examination.  24.
The urinary bladder, with any fluid contained in  it,  should be
removed  and placed in a separate jar.
  Such are the points to which, in the greater number of cases of
violent death, a medical jurist should give his attention.  By means
of these data, noted according to the particular case to which they
are adapted, he will in general be enabled, without difficulty, to
determine  the  probable time of death, and the actual  means by
which death was brought about.  He may thereby have it in his
power, if the  case be one of poisoning, to  point out the dish or
article of food which had contained the poison, and to throw light
upon any disputed question of suicide or murder in relation to the
deceased.   Many cases of death  from wounds or poison are rendered
obscure, owing to these points not having been attended to in the
first instance.
  It is not  necessary in this place to enter into any details respect-
ing the mode  of performing  an  inspection.  The  only essential
points in addition to those  above mentioned are, 1.  To examine
all the important organs for  marks of natural disease;  and 2. To
note down  any unusual pathological  appearances, or abnormal de-
viations ; although they may at  the time appear to have no bearing
on the cause of death.  It is  useful to bear in mind on these occa-
sions, that the body is inspected, not  merely to  show that  the
person has  died from poison, but to prove that he has not died from
any natural cause.  Medical practitioners commonly give their at-
tention exclusively to the first  point; while  lawyers, who defend
accused parties, very properly direct a most searching examination
to the last-mentioned point, i. e. the healthy or unhealthy state of
those organs which are  essential to life.  The usual causes of sud-
den death have their seats commonly in the brain, the heart  and
its great vessels, or in the  lungs.  Marks of effusion of blood, con-
gestion, inflammation, suppuration, or a diseased condition of the
valves of the heart, should be sought for and accurately noted.  It
has also  been  recommended  that  an examination of the spinal 
             INSPECTION OF  EXHUMED BODIES.           25

marrow should be made.  If the cause of death be obscure after
the general examination of the  body, there is good reason for  in-
specting the condition of this organ.
  [In medico-legal cases, involving the question of life and death,
the examination of the body of the deceased cannot possibly be too
thorough and exhaustive ; the omission of any one organ is a radi-
cal  defect.   This is well illustrated  in  two leading cases in  the
United  States within the past  year (1872),—that of Mrs. E.  G-.
Wharton charged with  poisoning General Ketchum, and that of
Dr. Paul Schceppe charged with poisoning Miss Steinnecke.   In
neither  case, was  the post-mortem examination sufficiently com-
plete.  In the first case, where the symptoms of  the deceased were
certainly more in accordance with disease than with  tartar emetic
(the alleged) poisoning, and where competent medical authority
ascribed it  to cerebro spinal meningitis, no examination  of  the
spinal marrow was made.  In  the latter  case, in which the symp-
toms  were those of apoplexy and of ursemic poisoning, the kidneys
and several other organs were entirely overlooked.  In certain ob-
scure cases, it may even become necessary to institute a microscopic
examination, especially  of the brain and  heart.—R.]
  Exhumation of bodies.—Sometimes the inspection of  a body is
required to be made  long after interment.  So long as the coffin
remains entire, there may be the expectation of discovering certain
kinds of mineral poison in the organs; but  decomposition may
have  advanced so far as to destroy all pathological evidence.  The
inspection in such cases is commonly confined to the abdominal
viscera.   The stomach is often found so thin and collapsed, that
the anterior and posterior walls appear to form only one coat.  This
organ should be removed with the duodenum, and ligatures should
be applied to each.  The liver, spleen and kidneys should also  be
removed, in order that  they may, if necessary, be separately ana-
lyzed.  If poison is not found in one or more of these parts, it is
not likely that  it will  be discovered in the  body.  It  has been
recommended that a portion of earth immediately above and below
the coffin should be removed for analysis, as it may contain arsenic ;
but this appears to me  to be an unnecessary piece of refinement
when the coffin is entire, or when the abdominal parietes still cover
the viscera.  If  decomposition has so far advanced as to have  led
to an admixture of earth with the viscera, and the poison is found
in minute quantity in the tissues only,  the source  of the poison
may be regarded as doubtful.  The body of a deceased person when
exhumed, should be  identified  by some  friend or relative, in  the
presence of the medical  examiner.   In one  case of murder  by
poison,  the evidence almost failed, owing to this precaution  not
having been taken.
  It is  important  that  the viscera taken from a body which  has
been long in the grave  should be sealed up immediately.  They
should not be allowed  to come in contact  with any metal, nor with
any surface except that  of clean glass, porcelain, or wood.  It  has 
26        IDENTITY OF ARTICLES FOR  ANALYSIS.

been recommended that they should be washed with chloride of
lime, or placed in alcohol; but this is decidedly improper ; the use
of any preservative chemical liquid would  not only embarrass the
future analysis, but would render a special  examination of an un-
used portion of the liquid  necessary, the identity of which would
have to be unequivocally established. Preservation from air in clean
glass vessels, with well-fitted corks, 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  being  adduced of the
identity of the vomited  matters or other liquids  taken  from the
body of a deceased person, when poisoning is suspected.  Supposing
that, during the examination, the stomach and viscera are removed
from the body, they should never  be placed on any surface, or in
any vessel, until we have first ascertained that the surface or ves-
sel is perfectly clean.  [It is safer and more satisfactory that all the
vessels and apparatus used  should be perfectly new.—R.]  If this
point be not attended to, it will be  in the power of counsel for the
defence to raise  a doubt in the  minds of  the  jury, whether the
poisonous substance might  not have been accidentally present in
the vessel used.  This may be regarded as a very remote presump-
tion; but, nevertheless, it is upon technical  objections of this  kind
that acquittals follow in spite of  the  strongest  presumptions of
guilt.  This is  a question for which every medical witness should
be prepared, whether he is giying his  evidence at a coroner's in-
quest, or in a court of law.  Many might feel  disposed to regard
matters of this kind as involving unnecessary nicety and care, but
if they are  neglected it is possible that a case  may be at  once
stopped : so that the care subsequently bestowed  upon a chemical
analysis will be labor thrown away.  Evidence of the presence of
poison in the contents of a stomach was once rejected at  a trial for
murder, because they had been  hastily thrown into a jar borrowed
from a neighboring grocer's shop; and it could not be satisfactorily
proved that the jar was clean and entirely free from traces of poison
(in which the grocer  dealt) when used  for  this purpose.
  [A case has been communicated to the editor by Prof. R. Bridges,
in which the search for arsenic in the  body failed to detect  that
poison, but  where zinc  in considerable quantities was found.  It
turned out, on inquiry, that the  stomach, etc. had been carelessly
thrown into an old tin can, which had been formerly used for hold-
ing zinc paint, before being sent to the analyst.—R.]  When the
life of a human^ being  is  at stake, as  in a charge of murder by
poisoning, the slightest  doubt is  always very properly interpreted
in favor of the accused.
  Not only must clean vessels be used for receiving  any  liquid de-
tained for subsequent chemical analysis, but care must be taken
that the identity of a substance is  preserved, or the  most correct
analysis, afterwards made, will be  inadmissible as evidence.   The
suspected  substance, when  once placed  in the hands of  a medical
man, should never be let out of his  sight or  custody.  It  should be 
       PRESERVATION OF ARTICLES  FOR  ANALYSIS.     27

kept sealed under his private seal, and locked up while in his pos-
session, in a closet to which no other person has a key.   If he has
once let it out of his hands, and allowed it to pass through  the
hands of several other persons, then he  complicates  the  evidence
for the prosecution, by rendering it indispensable for these persons
to state  under what circumstances it was placed while in their
possession.   The exposure of a suspected substance on a table, or in
a closet or room, to which many have access, may be fatal to its
identity ; for  the chemical evidence,  so  important in  a criminal
investigation,  will  probably be altogether rejected by the court.
When any article (e. g. a stomach or  other  organ) is reserved for
analysis, care should be taken to attach immediately to it, or to the
vessel containing it, a parchment or wooden label, upon which is
plainly written, in ink, the name of the  deceased  and the date of
removal, including  the day of the week and  month.  This is espe-
cially necessary when there are two or more articles for analysis.
I have known the greatest inconvenience to result from the neglect
of this simple precaution.  [This rule  in relation to identity cannot
be too rigorously enforced.  A striking illustration is afforded in a
recent case (State of Virginia v.  Mrs.  E.  E.  Lloyd, charged with
poisoning her daughter with arsenic).   At the trial, it was found
that the person who had conveyed the stomach to the analyst, had
died in the interim.  Although several grains  of arsenic were said
to have  been  detected, still, as the identity of the stomach could
not be positively established, the court very properly ruled out the
evidence for want of this single link in the chain.—R.]
   Preserving articles for analysis.—In  removing viscera  or liquids
from the body, and reserving them for analysis, it is necessary to
observe certain precautions.  A clean vessel with a wide mouth
should be selected; it should be only sufficiently large to hold the
organ, or liquid (the  less air remaining in it the better);  it should
be secured by a closely-fitting  cork, covered  with  fine skin or
bladder.  Another piece of skin should then be tied over the mouth,
or, for this, sheet caoutchouc  or gutta-percha may be substituted
with advantage.   It should lastly be covered with  tinfoil and a
layer of white leather.  In this  way any loss by evaporation or
decomposition is  prevented, and  the viscera  may be  preserved (in
a cool place)  for some time.  If the  mouth of the  vessel be too
wide for a cork, the other articles cannot be dipensed with.  Paper
only  should not be  used ; I  have known  the  appearances  after
death of the viscera of an infant, suspected to have died  from poi-
son, entirely destroyed by drying, from the evaporation which took
place through the  layers of paper with which the vessel in which
they  were contained was  covered.  The practitioner should bear
in mind that  all these matters are likely to  come out in evidence;
and whatever is worth doing at all is worth doing  well.   For
reasons already stated, antiseptic  chemical compounds  should not
be used.  The addition of a  small quantity of chloroform to the
viscera will, without complicating the  analysis, tend  to preserve
them. 
28
USE OF  NOTES IN EVIDENCE.
  The articles used for the preservation of viscera should be in all
cases scrupulously examined.  Some kinds of calico are dressed with
arsenic and starch pastes, and many kinds of wrapping-paper as
well as wall-papers are strongly impregnated with this poison.   An
observation made by Mr. Aickin, of Belfast, shows that this is not
an  unnecessary caution.  This gentleman was engaged in exam-
ining the body of a child, in order to determine the causq of death.
The organs were healthy, and as no sufficient cause presented itself,
he removed the stomach, with a view of making  an analysis of its
contents.  He was suddenly called away; and, to  preserve  the
stomach, he  wrapped it in a piece  of paper (used  for papering
rooms), placing it on the uncolored side, and he locked it in a closet
until the following day.  Assisted by a friend,  he  then analyzed the
contents, and found  a trace of morphia, with a pretty large quan-
tity of arsenic.   As  the symptoms from which the child had died
were not those of poisoning with arsenic, and there were no appear-
ances of the action of this substance on the body, he came to the
conclusion  that its presence must have been owing to some extra-
neous cause.  He examined a portion  of the wall-paper in which
the stomach  had been wrapped,  and  then found that part of it
which was  colored yellow was tinted with sulphide of arsenic or
orpiment!  It was therefore evident, as orpiment  contains white
arsenic, that  the  stomach and its contents had  imbibed a portion
of the poison during the night.  (" Lancet," June 23,1855, p. 632.)
This  satisfactorily accounted .for the presence  of arsenic under
circumstances which might have given rise  to  a false charge of
murder.  Nearly all wall-papers having  any tinge of green or
golden yellow in them, contain arsenic, and this arsenic spreads by
imbibition  to other parts of the paper not so tinted.  It would, of
course, be  proper  to avoid in all cases the  use of any wrapper
having upon it mineral colors of any description.    Mr. Aickin's
case shows in a striking point of view the danger of  trusting to
chemical analysis alone.  Unless we look to physiology and  pa-
thology, a most erroneous opinion may  be expressed.
  The results of an analysis, in the shape of sublimates or precipi-
tates, should  be  preserved as evidence, distinctly labelled in small
glass  tubes, hermetically sealed.   They can then, if asked  for, be
produced for  examination, at the inquest or trial.
  On the use of Notes.—It has already been recommended, as a rule
in these criminal investigations, that a practitioner  should make
notes of what he observes in regard to symptoms, appearances after
death, and  the  results  of a  chemical analysis.  His  own observa-
tions should be kept  distinct from observation given him by others.
He  may base his conclusions on the former, but  not  on the latter.
From the common forms of law in this country, a  person charo-ed
with  the crime of poisoning may remain imprisoned, if at a  dis-
tance from the metropolis, for some months before  he is brouo-ht
to trial.  It  is  obvious, however clear the circumstances may5 at
the time appear to a practitioner, that it will require more than
ordinary powers  of memory to retain,  for  so  long  a  period  a  dis- 
MEDICO-LEGAL REPORTS.
29
tinct recollection of all the facts.of the case.   If he is unprovided
with notes, and his memory is defective, then the case will turn in
favor of the prisoner, for  he  will be the person to benefit by the
neglect of the witness.  In adopting  the plan here recommended,
such a  result may be easily prevented.  It may be remarked that
the law relative to the admissibility of notes or memoranda is very
strict, and in trials for murder is rigorously enforced by the judges.
In order  £o render such notes or memoranda admissible, it is in-
dispensably necessary that they should be taken on the spot at the
time the  observations are made, or as soon afterwards as practica-
ble ; and, further, it must be remembered that a witness can refer
to them only to refresh his  memory.  If  from indistinctness of
writing or other causes, a copy of the notes has been subsequently
made,  a witness should not destroy the original notes, but  have
them ready for production.  [See on this subject " Greenleaf's Evi-
dence," vol. i. §§ 436-439.  Also, " Alison's Treatise on the Practice
of the Criminal Law," pp. 540-542.—P.]
  So in reference to all other written memoranda connected with
the case as to the medicines prescribed for the deceased, the visits
made to him, etc., the witness should be prepared to produce them
and  explain any alterations or erasures which may  be found in his
books.   Counsel are entitled to look at and examine all documents
of this  kind which are produced or used by the witness in giving
his evidence.
  Medico-legal Reports.—One of the duties of  a medical jurist is to
draw up a report of the results of his examination : 1, in regard to
symptoms;  2, in  regard  to  appearances after  death; and, 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 in-
vestigating cases of poisoning (p. 23).  It need hardly be  observed
that the time at which the person was first seen, and the circum-
stances  under which the  attendance  of the  practitioner  was re-
quired, as well as the period of death, should be particularly stated.
The  hour, the day of the week, and the month, should be invariably
mentioned.  Some  medical witnesses  merely  state the day of the
week, without that of the month, or vice versa.  At a trial this
sometimes creates  great  confusion, by  rendering a reference to
almanacs  necessary.  The  words yesterday, next day, etc., should
never be  used.  The facts which  it will be necessary to enter in
the  report are specially stated under the heads of  investigation
(see p. 24).  If these facts  are not  observed in the order there set
down, their value as evidence  of  the cause  of death, or of the
criminality or innocence of particular persons, will be entirely lost.
In drawing up a report of  symptoms and appearances after death,
the facts should be  in the first instance plainly and concisely stated
seriatim, in language easily intelligible to non-professional men.  A
reporter is not called upon to display his erudition, but to make
himself understood.  If technical terms are employed, their mean-
ing should be stated in parentheses.  When  a subject is thoroughly
understood, there can  be  no  difficulty in rendering  it in simple 
30
MEDICO-LEGAL  REPORTS.
language; and when it is not well understood, the practitioner is
not" in a position to make any report.  Magistrates, coroners, and
barristers are very acute, and easily detect  ignorance, even when
it appears under the mask of erudition.
  In  recording facts, a reporter should not encumber his  state-
ments with  opinions, inferences, or comments.  The  facts should
be first stated, and the conclusions should be reserved  until the
end of the  report.   The  language in which conclusions  are ex-
pressed, should be precise and clear.  It must be remembered that
these  are intended to form a concise summary of the whole report,
upon  which the judgment of a magistrate, or the decision of a
coroner's jury,  will be ultimately  based.   They should  be most
strictly confined to the matters which  are the subject of inquiry,
and which have actually fallen  under the observation of the wit-
ness.  Thus, they commonly refer to the following question: What
was the  cause  of death ?  What are the medical circumstances
which lead you to  suppose that death was caused by violence ?
What are the circumstances which lead you to  suppose that  death
was not caused by natural disease ?  Answers to one or all of these
questions com/prise, in general, all  that a reporter is  required to
introduce into the conclusions of his report.
  The reporter must remember that his conclusions are to be  based
only upon medical facts, not upon moral circumstances, unless he is
specially required to express his  opinion with regard to them when
they are  of a medico-moral nature.  Further, they must be founded
only on  what he has  himself seen  or  observed. Any information
derived from others should  not be made the  basis of an opinion
either in evidence, or in  a  medico-legal report.   It  is  scarcely
necessary to remark that a conclusion based upon mere probabili-
ties is of  no value as evidence.
  In  drawing up a report on the results of a chemical analysis, the
following rules  may be borne in mind.  A liquid or solid is re-
ceived for analysis:  1. When, and of whom, or  how received?
2.  In what state was it received—secured in any way, or exposed ?
3.  If  more than one substance  received, each to be separately and
distinctly labelled ; appearance of the vessel, its capacity, and the
quantity of  liquid  (by measure) or solid  (by weight) contained
therein.   4.  Where and when did you  proceed to make the  analy-
sis, and  where was the substance  kept during the  intermediate
period ?  5. Did any one assist you, or did  you make the analysis
yourself?  6. Physical characters of the substance.  7.  Processes
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) whether the
analysis  has or has not been  properly made.  8.  Supposing the
substance to contain poison—is this in a pure state, or mixed°with
any other body ? 9. The  strength of the poison, if an acid  or if it
be  in solution:  in all cases, the quantity of poison found  deter-
mined if possible by actual weighing.  10. Supposing no poison to 
MEDICO-LEGAL  REPORTS.
31
be contained in it, what was the nature of the substance ?  Did it
contain anything of a noxious  nature, i.e. likely to injure health,
or destroy life ?  11. Could the supposed poisonous substance exist
naturally, or be produced within the body?  12.  Was it present
in any of the liquids or solids employed in the chemical analysis ?
13. Was it contained  in any of the articles of food  or medicine
taken by the deceased ?  14. Is its presence to  be ascribed to the
use of any mineral matter employed by injection  after death for
the preservation of the body of  the deceased ?  15.  What quantity
of poison was actually separated in the free or absorbed state ?  16.
How much of the substance found would, under the circumstances,
be likely to destroy life ?
  There are few reports in which answers to some of these ques-
tions,  although not formally put, will not be required; and unless
the whole of them are borne  in mind by the operator at the time
an  analysis is undertaken, those which  are  omitted can  never re-
ceive  an answer, however  important to the  ends of justice that
answer may ultimately become.
  There are frequently defects  in these  reports which it is desira-
ble to point out.   The statements  are sometimes drawn up in ex-
aggerated language; at others  they are overloaded with technical
and therefore unintelligible  terms, and the writer is seldom suffi-
ciently  careful to keep his facts distinct from his comments.   The
former  may be  useful as evidence; the latter are inadmissible.
   With respect to the first  of these defects, it is very much  the
practice of medical men, in drawing  up reports of medical cases
for professional purposes, to use, unthinkingly, exaggerated language.
Thus, it may be observed in the description of an ordinary post-
mortem examination,  the lining-membrane  of the  stomach is de-
scribed as being "intensely"  inflamed, or some  partis "consider-
ably" injected, or a cavity is " enormously" distended.  Expressions
thus loosely employed, convey to the  legal mind a widely-different
meaning from  that intended by the reporter.  Let  him who is
inclined to use  them bear in  mind that barristers look much more
closely  to the strict meaning  of words than medical men, and that
they are always disposed to distrust the judgment  of one who
cannot  speak or write without resorting to the use of the super-
lative degree.
   The free use of technical terms in drawing up reports should be
avoided.  Putting aside those  cases in which a medical man be-
lieves  that he is displaying his erudition by the selection and use
of such terms, there can be  no doubt that  the greater number of
medical practitioners fall into this practice from mere habit.  They
think they are addressing the report to the president and members
of some medical society, instead of a coroner and jury who have
never in their reading or experience  met with such terms, and to
whom  therefore they  are perfectly unintelligible.   In a report on
the appearances in the body of a man who had suffered from chronic
insanity, which was submitted to me for explanation, the following
passage occurred :   " The only morbid appearance in the brain was 
32
MEDICO-LEGAL  REPORTS.
an atheromatous deposit in the pons Varolii, near the situation of
the locus niger."  In  another document, the reporter  stated, for
the information of a coroner's jury, that  the " integuments of the
cranium were  reflected, and the calvarium was  exposed."   If  a
reporter will use such terms  as these or others of a similar kind,
such as " parietes of the abdomen," " epigastrium," " hypertrophy
of the liver," when it would  require no more trouble to put what
he means in plain English, he must be prepared to have his mean-
ing perverted,  or wholly misunderstood.  Setting aside the men
who act as jurors, it may be observed that educated persons, such
as coroners and magistrates, do not commonly include professional
terms  within the range of their studies.   There are  but few of
them who  understand  the  difference  between perineum and peri-
toneum, or the  meaning of the words hemispheres of the brain, pia
mater, puncta cruenta, corpora quadrigemina, centrum  ovale, etc.
They are not likely to  know the difference between the cardia and
pylorus, nor the  nature or situation  of the duodenum, jejunum,
ileum, or caecum, and are as ready to consider them to  be  parts of
the liver or urinary bladder,as of the intestines.   On one occasion,
I heard a learned judge ask for an  explanation of the meaning of
the term " alimentary canal."  A slight consideration will  show
to any medical  practitioner that refined professional language is
wholly misplaced in a report which is intended to inform and con-
vince the minds of ordinary men upon plain matters of  fact.
  The last  point which calls for comment in reference to  medical
reports, is the loose manner in which facts and comments on facts,
as well as hearsay statements, are sometimes found blended.   If a
reporter takes care to eliminate facts from comment, his report is
admissible, and may be read  at the inquest or  trial as evidence.
The facts are for the jury; the comments upon the facts, introduced
by the reporter, may or may not be correct,  and are  therefore not
evidence.   Their correctness  or relevancy  to the  case  will be
elicited in  the  cross-examination.   As a rule, nothing  should be
entered in  a report which is not connected with the  subject of
inquiry, and which has not actually fallen  under the observation
of the  reporter.  The  introduction of hearsay  statements,  i. e.
statements  made  by others, or of circumstances which have come
to  his  knowledge  through  public rumor, should be carefully
avoided.
  Upon the medical report, and such evidence as  may be required
to explain it, an accused person may be committed for trial at the
Assizes, either  by a coroner or a magistrate.  In the first stao-e of
the proceedings, under these  circumstances, the  medical witness
goes before the grand jury, and there, after the  administration of
an oath, he is  required to make a general statement of what he
knows of the matter.  Such questions are put as may be necessary
to elucidate the cause of death ; and on the finding of a  true bill
for murder or  manslaughter, the accused is placed  upon  his trial
before  one  of the learned  judges of Assize.   Accordino- to the
variable  circumstances attending such cases, the medical&evidence 
DYING DECLARATIONS.
33
is  called for at an early, or late stage of the proceedings.  When
it is at all doubtful whether the  cause of death was owing to any
criminal act, it is called for at the commencement of the case, in
order to lay a foundation for further inquiry.
  It is  necessary  that a medical  witness  should remember that
copies of his report  and  depositions, either before a coroner or
magistrate, are usually placed in the hands  of counsel as well as of
the learned judge, and that his evidence, as it is given at the trial,
is compared word  for word with that which has been already put
on  record.  There is reason to  believe that this is not generally
known  to members of the medical profession, and thus it happens
that either from failure of memory, want of accurate observation,
or  carelessness in giving evidence at a coroner's inquest, medical
witnesses lay themselves open to severe censure, either by stating
matters differently at the.trial, or by giving a very different com-
plexion to the facts.   Any serious  deviations from what is on
record will of course tell unfavorably for the witness, supply mate-
rials for a severe cross-examination, and form an excellent ground
of defence for the  prisoner.  The witness's weakness is the prison-
er's opportunity, and of course his counsel will not lose the occasion
of  impressing upon the jury that a man who can on oath give two
different accounts of  the same transaction,  is not to be believed on
either.
   [Dying declarations.—"The general principle on which this spe-
cies of evidence is admitted was stated by Lord Chief Baron Eyre
to  be this:  That  they are declarations  made in  extremity, when
the party is  at the point of death, and when every hope of this
world is gone; when every motive to falsehood is silenced, and the
mind is induced by the most powerful considerations to speak the
truth.  A situation so solemn  and so awful is considered by the
law as creating an obligation equal to that which is imposed by a
positive oath in a court of justice.
   " It was at  one time held by respectable authorities  that this
general principle warranted the admission of dying declarations in
all cases, civil and criminal; but it  is now well  settled  that they
are admissible, as such, only in cases of homicide, ' where the death of
the deceased is the  subject of the  charge, and  the circumstances of the
death are the  subject of the dying declaration.'
   " The persons whose declarations are thus  admitted are considered
as standing in the same situation as if they were sworn; the danger
of impending death  being equivalent to the sanction of an oath.
It  follows, therefore, that where the declarant, if living, would have
been incompetent to testify, by reason of infamy or the like, his dying
declarations are inadmissible ; and, as an oath derives the value of
its sanction  from  the  religious sense of the party's accountability
to  his Maker, and the deep impression that he is soon to  render to
Him the final account; wherever  it appears that the declarant was
incapable of  this religious  sense of accountability, whether from infi-
delity, imbecility \of mind, or  tender age,  the declarations are alike
inadmissible.
       3 
34
DYING  DECLARATIONS.
  "On the other hand, as the testimony of an accomplice is  ad-
missible against his fellow, the dying declarations  of a particeps
criminis in an act which resulted in his own death, are admissible
against one  indicted  for the same murder."  lb. §  157.   On
principle, therefore,  the  dying declarations  of an accomplice
should, to justify  a  conviction, require the same  corroboration
that is necessary where he testifies as a living witness (see Joy on
the Evidence of Accomplices); but as to this the judges in Tinck-
ler's case (1  East.  PI.  Cr. 354-56) were  divided,  the  majority,
however, thinking that they were sufficient without corroboration.
And as husband and wife may testify against each other in all
cases of personal injuries inflicted  by  either upon the other,  the
dying  declarations  of either are admissible where the other party
is charged with the murder of the declarant. The People v. Green,
1 Denio R. 614.
  It is essential to the admissibility of these declarations, and  is a
preliminary fact, to  be proved by the party offering them in  evidence,
that they were made under a sense of impending death.
  It is not essential, however,  that the consciousness of impending
death  should be expressed by the dying man himself; it may be
collected either from  the circumstances of the case,  as the nature
of the wound and  state of the body, or  from expressions used by
the deceased.   Com. v. Murray, 2 Ash. 41;  Com. v.. Williams, lb.
69; State v. Gillick, 7 Clarke (Iowa) 287;  State v. Nash, lb.  347.
See also People v. Lee, 17 Cal. 76;  People v. Ybarra, lb.  166;  Kil-
patrick v. Commonwealth, 7 Casey 198.
  The length of time which elapses between the declarations and
the death furnishes no rule as to the admissibility or rejection of
the evidence.    In  Woodcock's case, 2 Leach's Or.  Cas.  563,  the
declarations were made forty-eight hours  before death; in Tinck-
ler's case, 1 East. P. C. 345, ten days, and in Rex v. Mosley, Cr.
Cas. 97,  eleven  days before death ; and all were received.  It is
the impression of almost immediate dissolution, and not the rapid
succession  of death in point  of fact,  that renders the testimony
admissible.  Hence, where declarant at  the  time  believed  his
death  to be impending  and certain, the  declarations were com-
petent, notwithstanding that he subsequently revived, and thought
he might recover.   State v. Nash, 7 Clarke (Iowa) 347.
  The language of  the text-books, and of the authorities generally,
is, that "where it appears that the declarant had 'any hope' of
recovery, however  slight  it may  have  been,  and  though death
actually ensued shortly afterwards, the declarations are inadmissi-
ble."   1  Greenleaf § 158; Phillips on Evidence  200.  But in
Regina v.  Pym ("Law Times," 1846, p. 500), where it  appeared
that the declarant  had a firm belief that  death was approaching,
although  it appeared  that he hoped and thought it not impossible
that he might recover, Erle, J., in admitting the evidence, said:
"It has  no doubt been held in some cases that all hope must be
given  up, but this  is now decided  not to be necessary.  Indeed if
it were so, no declarations could be received, for scarcely a human 
DYING  DECLARATIONS.
35
being could be found, under  any circumstances, who would not
retain some hope.  The law admits these declarations, not because
recovery is impossible, but because there is a conviction of approach-
ing death."
  The word hope is  used in two senses:  first, as implying belief,
expectation; and second, wish or desire.  In the latter sense it must
always exist, and that seems to be the meaning as used in the case
last cited.  Where it is  used as synonymous with belief or expec-
tation, its existence would render the declarations inadmissible;
since "hoping"  in that  sense to recover  would  be wholly  incon-
sistent with the alleged belief that death was impending.
  The declarations are admissible only as to those things which
declarant  would have been competent to testify if sworn  in the
case, viz., relevant facts, not mere matters of opinion.
  They are admissible in favor of, no less than against the party
charged with the death.
  It is  no objection to their admissibility that  they were elicited
by leading questions, or by pressing and earnest urgings.   They
must, however,  be complete in themselves: for if it  appears  that
the declarant intended  to  connect  them with or qualify them by,
other statements, which he is prevented by any cause from making,
they will  not be received.  1 Greenleaf, §  159.
  The circumstances under which  the declarations were made are
to be shown  to the judge: it  being his province, and not that of
the  jury,  to  determine whether  they are admissible.   Com.  v.
Murray, 2 Ash. 41; McHugh v.  State, 31  Alabama 317; People v.
Glenn, 10 Cal. 32; State  v. Howard, 32 Vermont 380.
  Still, however, the credibility of the evidence is entirely with
the  jury, who, if they do not  believe that  the deceased really was
in such circumstances as the other witnesses may have testified to,
nifty give no weight to the declarations.
  If the  statement  of the deceased was  reduced to writing, and
signed by him, it must be produced,  if existing, and secondary
evidence of the declarations cannot be admitted.   State v. Tweedy,
11  Iowa  350.   But it is  not essential that a subscribing witness
thereto should  be produced,  or his  absence  accounted for.  Mc-
Hugh v. State, 31 Ala. 317.  And where the declarations had been
repeated at different times, at one of which they were under oath,
and informally reduced to  writing by one witness, and at the others
they were not, it was held that the latter might be proved by
parol, if the other could not  be produced.  Rex v. Reason, 1 Str.
499, 500;  State  v. Tweedy, supra.  So,  if the deposition has  been
taken, and is inadmissible as such for want of compliance with
some statutory  requirement, it seems it may still  be treated as a
dying declaration.
  Great caution, however, is to be observed in the use of this kind
of evidence, because it is  to  be recollected that the accused may
not  have  been confronted with the declarant, nor does he ever have
the  power of cross-examination, which  is quite as  essential to the
eliciting of all the truth as the obligation of  an oath can be.   Be- 
36
DYING  DECLARATIONS.
sides which, the particulars of the evidence, to which the deceased
Las spoken, are in general likely to have occurred under circum-
stances of confusion and surprise, calculated to prevent their being
accurately observed; and leading both  to mistakes as to identity
of persons, and to the omission  of facts essentially important to
the completeness and truth of the narrative. 1 Greenleaf,  § 162 ;
Evans's Pothier on Obligations 255.
  In  the  case  of Commonwealth v. Lamb, tried in the  Oyer and
Terminer of Philadelphia, in March, 1854, the deceased, who died
from  the effects of blows upon the head inflicted by a gang who
attacked him in the dark, had declared  positively that the defend-
ant was the person who  had struck him.  The declarations were
not received  because  of failure in the preliminary proof, and  the
prosecution was abandoned.  The defendant was a very respectable
young man, and could have clearly established his innocence,  but
the case showed how little reliance can be placed on this species of
evidence, especially in questions of identity. (See, also, a case men-
tioned in the former edition of this work, p. 179.)
  The objection, tljat receiving dying declarations was a violation
of the article of the Declaration of Rights that every subject shah
have a right to confront the witnesses against him face to face,  has
been  made, but not  sustained by the  courts.   Com. v. Carey, 12
Cush. (Mass.) 246; Burr ell v. State, 18 Texas 713;  People v.  Glenn,
10 Cal. 32 ; State v. Nash, 7 Clarke (Iowa) 347. ^
  It is to be observed that while  dying  declarations are restricted
to the case of trial for the homicide of the declarant, this applies
only to declarations  offered on the  sole  ground  that they were
made in extremis; for where they constitute part of the res gestae,
or come within the  exception  of declarations  against interest, or
the like, they are admissible as in other cases;  irrespective  of  the
fact, that the declarant was under apprehension of death.
  It is evidently, however, no part of the duty  of the medical wit-
ness or other person  present when declarations are made to deter-
mine whether they will  be admissible or not.  This question is to
be left to the judges before whom the case shall be tried ; and  the
witness should carefully remember what is stated,  writing it down
immediately, or at  the earliest moment  possible, stating all that
was said, and  using  the identical language of the declarant,  not
simply giving what  he conceives to be the meaning or substance
of it.—P.] 
CORONERS' INQUESTS.
37
                      CHAPTER  II.

CORONERS' INQUESTS.—TRIAL  AT THE ASSIZES.—SUBPCENAS.—EXAMI-
   NATION IN  COURT.—DUTIES OF MEDICAL WITNESSES.—RULES  FOR
   THE DELIVERY OF EVIDENCE.

   Coroners' inquests.—The  proceedings  at  coroners' inquests are
treated too lightly by medical men.  The ignorant and uneducated
class of persons who often constitute the jury, as well as the cir-
cumstances  under which  the inquiry usually takes  place,  are  not
calculated to inspire great respect for these initiatory proceedings;
but still by law and custom coroners' inquisitions are and have
been for ages in this country, the only tribunals for  inquiring into
and determining the cause of death in cases of suspected violence;
and they are therefore deserving of more attention than is usually
shown to them by medical witnesses.  As  a rule, in  all inquests
which are likely to end  in a committal of the accused person, a
medical man  who  is giving his evidence before a  coroner, in the
room of a small country inn,  or in a village school-room, is vir-
tually delivering it before a judge of assize;  and this fact alone, if
not a respect for the court, should induce him to give the evidence
guardedly, and with a due consideration to the serious results to
which it may ultimately lead.  The  4th Edward  I.  stat. 2,  on
which coroners profess  to act, directs  that  " upon information,"
they shall " go to the place where any be slain or suddenly dead,"
and make due inquiry as to the cause, etc., before a jury  selected
from  persons  living in  the neighborhood.  The information upon
which a coroner generally acts is, 1.  Notice from a beadle, or other
officer of the  parish (whose zeal is  sometimes stimulated by a fee
or salary), of any death from sudden or supposed unusual  causes.
2. Notice from a medical man who may have attended  the  de-
ceased,  and  who communicates his suspicion that the cause  of
death is not natural.  3. Notice from a registrar of deaths  that no
cause has been assigned  in a particular case, or that there has been
a rapid death after a short  illness.  The conclusion to which ex-
perience leads  in  reference to these inquiries  is, that  the system
affords no certainty for the detection of  crime; that it affords no
protection to  those who  are wrongly charged with crime;  and
lastly, that in some cases  it  screens a criminal by a verdict based
upon  an imperfect inquiry, in which the important medical facts
are either not  understood, or are misinterpreted by the juiy.
  Many persons  who  occupy  the  office of coroner are  neither
medically nor judicially 'qualified for the proper performance  of
the duties of the office.  The system of electing a man to hold such 
38                 CORONERS' INQUESTS.
an office as this (one demanding special medical  knowledge of the
causes of death, and good %af knowledge of the law of evidence)
by freeholders of the lowest degree, is so intrinsically absurd, that
it is quite wonderful how, with improved civilization, it has main-
tained  its ground  in  such  a country as England.   The election of
a Lord Chancellor, of the judge of our courts of law, or of County
Court judges, might  be  with equal reason  left in the hands of
voters  of  this class, men who have no knowledge  of the duties of
the office, or of the skill and learning required in one who is really
competent to fill it.  The election of a good and capable person as
coroner is, therefore, a matter of pure accident.  No preliminary
test of ability or capacity  is required.  [The same is lamentably
true in most parts of the United States; the office being usually
the bestowal of political favoritism.—R.]
  Under the present system coroners are empowered by the Medi-
cal  Witnesses' Act (6 and 7 William IV. c. 89) to  issue an order
for the attendance of  any legally-qualified practitioner, " being at
the time in actual practice in or near  the place where the death
has happened ;" a fee of two  guineas is the maximum allowed for
making a post-mortem examination, and, if considered necessary
by the jury, a chemical analysis of the stomach and  intestines.  A
penalty of five pounds is attached to disobedience of this order,
except for reasonable cause.   Mr. Rumsey has correctly represented
the unsatisfactory position in which medical men  are placed by
such an arrangement.  He observes:   " It  is no  discredit to  a
practitioner engaged in the toilsome routine of ordinary  medical
duties, if  he should feel himself at a loss when called upon for  a
decisive opinion in some obscure case of poisoning or infanticide.
His scanty opportunities for  the study of these  subjects  and for
making post-mortem examinations cannot  suffice to  qualify him
for answering the delicate and important questions which he must
answer before a jury can find a proper verdict."  ..." The
custom of indiscriminately  summoning medical  practitioners of all
sorts, and of  all degrees  of pathological knowledge and  forensic
skill has sadly depreciated  the value of medical evidence in courts
of justice. Public confidence in the  profession has been  shaken,
and the appearance of a ' doctor' in  the witness-box is but too often
a signal for sport among gentlemen of  the  long robe."  (" Essays
on State Medicine," p.  356.)  Under  such  a loose and imperfect
system, the results must necessarily be disastrous.
  No medical man can be  compelled to undertake  that which he
feels incompetent to perform, and some medical practitioners who
have felt  this want of experience have properly declined to make
chemical analyses  involving so serious a responsibility.  It is thus
that, in many cases of importance, analyses for coroners'  inquests
are now  referred  to  chemical experts, and the  practitioner dis-
charges himself of that responsibility which the Medical Witnesses'
Act imposes upon  him without any adequate remuneration.
  Before  quitting  this subject, it is necessary to observe that medi-
cal men are  too ready to give their opinion of the cause of death 
TRIAL  A\ THE  ASSIZES.
39
for a coroner's inquest without making an inspection of the body.
No  man is compelled to give an opinion  upon insufficient data,
and if by the institution of a judicial  inquiry there are grounds
for believing that a death has not been natural, no medical opinion
of the cause should be given in the absence of an inspection.  Such
an opinion must always be conjectural, and may involve the medi-
cal man in an unpleasant responsibility.
  Trial at the Assizes.—The  next  stage of the proceedings in a
criminal case brings a medical witness before a superior  court.
For this purpose a subpoena is issued.   It need hardly be observed
that every witness is bound to obey a subpoena, when with  it  his
reasonable expenses  for journey, etc., are  tendered to him, but he
is not bound to attend at the trial except upon a subpoena.   [In
criminal cases no tender of fees, etc., is in general necessary on  the
part of the government, in order to compel its witnesses to attend;
it being the duty of every citizen to obey a call of that description,
and it being also a case  in which  he is himself in some sense a
party.  But  his fees will in general be finally paid from the pub-
lic treasury.  In all such  cases, the accused is entitled to have
compulsory process for obtaining witnesses  in his favor.  (1 Green-
leafs  Ev. § 311.)—P.]
  There are some questions connected with this subject which it
will be proper to consider in this place.  If a subpazna is served on
an ordinary or skilled  medical witness, is  he  bound  to obey it ?  In
Beits  v.  Clifford (Warwick Lent  Assizes,  1858)  the late Lord
Campbell stated, in answer  to a question, that a scientific witness
was not bound to attend upon being served  with  a subpoena, and
,that he  ought not  to be  subpoenaed.  If the witness knew any
question of fact, he might be compelled to attend, but he could not
be compelled to give his attendance to speak to matters of opinion.
In Rich  v. Pierpoint, an  action for malapraxis, Dr. Lee was  sum-
moned against his will to give evidence on the part of the plain-
tiff.   He stated  that on the evening before the trial a solicitor
called on him, and left a subpoena with him.   Dr. Lee would not
hear any account of the  case which the solicitor proposed to give,
and expressed his  resolution to have nothing to do with the trial.
The solicitor informed him  that he would be required to pay the
usual  penalty if  he did not attend.   He went down to Kingston,
and was warned not to leave the court until the  trial was over.
He heard  the evidence on the part  of the  plaintiff, and upon this
and the medical  evidence he gave his opinion—not much in favor
of the party who summoned him, and not much against him.  Dr.
Lee considered that he could not avoid attending the trial  under
these  circumstances.  (" Medical Times and Gazette," April  12,
1862,  p. 389.)
  In  the  case of  Webb v.  Page  ("Carrington's  and  Kirwan's
Reports,"  p. 23) the late Mr.  Justice Maule  ruled as follows:
"There is a distinction," said his lordship, "between the case of a
man who sees a fact  and is called to prove it  in a court of justice,
and that of a man who is selected by a party to give his opinion 
40              OBEDIENCE  TO A  SUBPCENA.
on a matter on which he is peculiarly conversant from the nature
of his employment in life.  The former is bound, as a matter of
public duty, to speak to a fact which happens to have fallen within
his own knowledge—without such testimony the course of justice
must be stopped.   The latter  is under no such obligation ;  there is
no such necessity for his evidence, and the party who selects him
must pay him."  In the case referred to by Mr. Justice Maule, a
skilled witness  had been subpoenaed, but  he refused to give evi-
dence unless first paid for his  services and loss of time.   ("Medical
Times  and Gazette," April 26,  1862, p. 432.)  A  barrister, who
quotes  this ruling,  goes  on to say:  " There  is one  reason why I
should not advise any person  in the position of a skilled witness
totally to disregard a subpoena.  It is quite clear that should such
a person fail  to attend a trial no attachment could  issue, even if
he were called  as is usual  upon  the subpoena, because the party
subpoenaing him  could not make the requisite affidavits  that  he
was damnified by the witness's absence, and in what respect.  But
such party might bring  an action for damages; and although he
would recover none, he might not only worry, but might even put
the defendant  to a  considerable expense, as taxed costs by  no
means include the entire  costs in such cases.   Although, therefore,
I could not advise a total neglect of the  subpoena, the safest course
would  be to obey it, and demand expenses before giving evidence.
Such  expenses would  be  only  those allowed for  a professional
witness (not special fees),  but if the person so subpoenaed were
willing to run  the risk of  an action, he might safely absent him-
self without any fear of an  attachment from the  court  for con-
tempt."  With regard to  the question whether a skilled witness
would  be permitted to demand a high fee for his attendance under
such circumstances, the writer adds: "To permit  him legally to
demand a  high  fee would perhaps look  somewhat like legally
countenancing a  bribe."   At all events there is  no such legal
recognition.
   Lord Campbell's dictum in reference to the distinction between
fact and opinion confers no practical benefit on witnesses.   It is at
all times difficult in science, and in the  medical sciences par-
ticularly, to separate them  ; and if a man  appears  to  testify to a
medical or scientific fact, he cannot  avoid giving  an  opinion
arising out of the fact.   In a recent action against a druggist for
a mistake in  compounding  medicine,  an attempt was made to
procure my opinion as a skilled witness at the trial, by reason of
facts obtained  from the report of a chemical analysis,  the  real
object of which  was, at the time,  entirely concealed.  The  suit
was fortunately compromised, and my  attendance was not neces-
sary, but such a  case should  convey a caution to chemical experts.
They may  be employed  secretly and under untrue  statements to
make  analyses; these become facts on which they may be sum-
moned like  ordinary witnesses  to give  opinions,  as  skilled  wit-
nesses, while the  payment of the usual fee for a skilled witness is
evaded. 
MEDICAL WITNESSES.                  41
  Medical witnesses.—Assuming that the medical man has obeyed
the subpoena, he will now be required to attend before the court,
and to state, in the face of adverse counsel, the opinions which he
has formed  from the medical facts of the case,  as  well as  the
grounds  for  these opinions.   He will then,  for  the first  time,
undergo the ordeal of a public examination.
  Before being sworn to deliver  his evidence, a medical or scien-
tific witness may claim  the  payment of his customary fees, unless
an  arrangement  has already been made between him and  the
solicitors who have sent him a subpoena.  These fees are generally
made a matter of private arrangement between the witness and
the attorney.  Unless there is  such  an arrangement,  or  some
written document to show an agreement as to the amount,  the
witness will be paid according  to a tariff which  will not even
suffice to indemnify him for  the expenses necessarily incurred by  a
journey to, or residence in, an assize town; not to mention the loss
occasioned in his practice during this forced absence from it.  This
is necessarily a source of great dissatisfaction among members of
the medical profession.  The country impounds  their services for
the administration of justice, without making a proper remunera-
tion to them.   In some  exceptional cases, a special  application
made to  the Court may have the effect of rectifying this matter.
  "Some medico-legal writers have  considered it necessary to  lay
down rules  respecting the  manner in which a medical  witness
should give his evidence;  how he is to act on a cross-examination,
and in what way he  is to recover himself on re-examination.  Any
advice upon this head appears to  me to be quite superfluous; since
experience shows that  these rules, like those  given  to  prevent
drowning, are invariably forgotten  at the very moment when  the
individual is in  the situation  in which it is supposed he most
requires  them.   A man who goes  to testify to the truth to  the
best of his ability should  bear  in mind two points:   1. That he
should be well  prepared on  all parts of the subject on which he is
about to give evidence.  He should act, on these  occasions, upon
the advice contained in the Latin motto, ne tentes  aut perfice ;  2.
That  his demeanor should be that of an educated man, and suited
to the serious occasion on which he appears, even although he may
feel himself provoked, or irritated by the course of examination
adopted.   A medical witness must not show a  testy disposition in
having his professional qualifications, his experience, his means of .
knowledge, or the grounds for  his  opinions very  closely  investi-
gated : he should rather prepare himself to meet with good humor
the attempts of an adverse counsel to involve him in contradiction,
and show, by his answers, that he has only a desire to state the
truth.  Law and custom have long established that a barrister, in
defending a prisoner charged with  murder, has  a  right to make
use of all fair  and  even what  may appear  to the witness unfair
means for the defence.  Nothing can tend more to lower a witness
in the opinion of the court and jury, or diminish the value of  his
evidence, than the manifestation of a disposition to deal with  his 
42
MEDICAL SECRETS.
 examiner as if he were a  personal enemy, to evade the questions
 put, or  to  answer them with flippancy or anger.  All such exhi-
 bitions  invariably end in  the discomfiture of the witness.  It has
 been suggested that  medical men, on these occasions, might take
 a  lesson from lawyers, and observe how little they allow forensic
 differences, which they put on with their professional costume, to
 influence them in their intercourse with each  other or with an
 adverse judge or jury.
   Medical  men have complained, and on many occasions justly, of
 the license of counsel.  On  this subject  it may be well to consider
 what has been said by one of the highest authorities on the bench,
 Chief Justice Erie: "The  law trusts the advocate with a privilege
 in respect  to the liberty of speech, which is, in  practice, bounded
 only by his  own  sense of  duty; and  he may have to  speak upon
 subjects concerning the deepest interests of social life, and  the
 innermost feelings of the  soul.   The law also trusts  him with a
 power of insisting upon answers to the most painful  questioning,
 and  this power again is in practice,  only controlled  by his  own
 view of the interests of truth."  (Judgment in Kennedy v. Broun,
 1862.)  Thus it  will be  seen  that  almost unlimited powers  of
 interrogation are intrusted to counsel by the law,  and it is a serious
 question whether the unrestricted use (which it has been justly re-
 marked means only the frequent abuse) of these  enormous powers
 is  necessary or even favorable to the administration of justice.
   One of the most severe reprimands on this abuse came from the
 same learned judge  in  a  case which was before him in 1857; it
 was  addressed to a  learned sergeant,  now deceased,  and was to
 this  effect: A question  had  been put throwing  on the witness an
 imputation for which  there was really no foundation.   The learned
judge then said:  " The freedom of question allowed to the bar was
 a public nuisance, and the barrister who made such an imputation
 ought to be prosecuted.  If a question had relation to the truth,
 he was  most anxious it should be put, but to cast haphazard im-
 putations at the  suggestion of a person (an attorney) who might
 have no scruples as to what he did,.was a degree of mischief that
 made him wish that  a  party should be prosecuted.  He begged
 leave to say that  in  his experience he had seen counsel so abuse
 their privilege, that he had cordially wished a power could be in-
 stituted that they might be prosecuted for a misdemeanor."  It is
 the general practice to say that the obnoxious questions are in the
 instructions, but a barrister can always exercise a power of putting,
or not putting a question which may be found there.  But putting
 it he clearly adopts it, and frequently to the great damage of his
own  case.  This is at present the only check  upon the practice,
for learned  judges seldom interfere unless directly appealed to by
 the witness.
  Some medical men  have claimed a privilege not to answer cer-
tain  questions which  are put to  them, on the   ground that the
matters  have come to their  knowledge through private and con-
fidential communications with their patients.  It is rio-ht  to state 
MEDICAL PRIVILEGE.
43
at once that the law concedes no special privilege of this nature to
members of the medical profession.  No  man is bound to reply to
any question if the answer would  tend in any way to incriminate
himself—for no  man is compelled  to be a witness against  himself.
With this exception all questions must be answered, provided they
are  relevant to the case, and their irrelevancy is a matter for the
consideration of  the learned judge who presides.  A witness must
remember, therefore, that there are no medical secrets.
  In  the case of the Duchess of Kingston  this privilege  of with-
holding statements was claimed by a medical witness, but  rejected.
In a  case in which a  female was indicted for the murder of her
infant, a surgeon was  called to prove  certain confessions  made to
him  by the  woman during  his attendance.  He objected, on the
ground that he was then attending her as a private patient.  The
learned judge (Park, J.) said this was not a sufficient reason to
prevent a disclosure for the purposes of justice, and he was ordered
to answer the  questions.  (Beck's " Med.  Jurisprudence," vol. ii. p.
922.)  Any statements  therefore which are made to physicians or
surgeons while attending persons  in  a private capacity, although
they are not to be volunteered in evidence, must be given in answer
to questions, whatever  consequences may  ensue. Cases of poisoning
and wounding, duelling and child-murder, as well as cases  which
involve questions  of life-insurance, divorce, or the  legitimacy of
offspring, may be materially affected  by the answers of the medical
man on matters which have been the subject of private communi-
cations.  A professional  man who claims  a  privilege where none
is allowed, is simply endeavoring to set himself above the  law.  It
is absurd to suppose that there is any  real breach  of confidence
under these circumstances,  because, as Dr. Gordon Smith  justly
observes, " Society in general receives the authority of courts as
paramount to all obstacles and private considerations," so that in
yielding to such  authority, a professional man will be  fully ac-
quitted even in the opinion  of those who may be  the  sufferers.
The expressed opinion of the judge will  be a full indemnity for
the witness. ("Analysis of Medical Evidence," p. 98.)  I was once
present at a trial  for  murder by  poison, when in the course of a
cross-examination  counsel for the prisoner  asked the medical wit-
ness what remedy or antidote he  had employed when he  was first
called to attend the deceased.  He appealed to the judge  to know
whether he was bound to answer such a question as that.  Judge :
" Yes, unless you have reason to believe that your antidote  killed
the deceased.  In that case you are not bound to answer it'."  The
question was immediately answered.
  Any medical man,  however, who  voluntarily violated  the con-
fidence  reposed in him by a patient, or who communicated pro-
fessional secrets  to counsel  apart from a public necessity  in court,
would justly lay himself open to severe censure.
  In  Wright v." Wilkes (June,  1865),  a suit involving the validity
of the will of  a lady, the only question before the Vice-Chancel lor
(Kinderslcy) was as to the costs, occasioned by the refusal of a 
44                  MEDICAL PRIVILEGE.
medical witness to answer a question as to the disease  of which
the testatrix died.  The witness had attended the testatrix, and
on being asked of what disease she died, he refused to answer  on
the ground  of  professional  privilege, and also that the question
was  irrelevant.   The  Vice-Chancellor  said, that  he could not
nossibly see  the relevancy of the  question, and, further, ot  what
use it was to examine witnesses at all in the cause   No reason
was given for so doing.   The question of costs would, prima facie,
have been left  till the hearing but that it was a dangerous prece-
dent to allow a witness to decline  answering on  such  grounds.
His honor was clearly of opinion that the witness could not claim
professional  confidence or irrelevancy as an excuse for  not answer-
ing the question, and he must pay the costs.   From this judgment
it will be perceived, that even the refusing to answer an irrelevant
question may lead to the infliction of a heavy penalty on a medical
practitioner.  A man who refuses to answer a question which the
court considers to be  relevant and proper,  may  render himself
liable to imprisonment  for  contempt of court.  [By  the Revised
Statutes of New York (vol. ii. p. 652, § 103), and of Missouri (Code
of 1835, p. 623, § 17), " No person duly authorized to practise physic
or surgery shall be allowed  to disclose any information which  he
may have acquired in attending any patient in a professional cha-
racter, and which information was necessary to enable him to pre-
scribe for such patient as a physician, or to do any act for him as
a surgeon."—P.]
  This question of medical privilege has presented itself on  some
recent  occasions in a medico-ethical aspect, as where, for instance,
during his attendance on a patient, a suspicion arises in the mind
of a medical man that  the  person is undergoing  slow poisoning.
It has been supposed that when, under these  circumstances, the
poisoner was in the medical profession, there would be a  breach of
etiquette in communicating  to others the suspicion  entertained.
There is no code of medical etiquette by which any member of the
profession is bound to conceal the fact of poisoning which he be-
lieves to be going on before his eyes, whether perpetrated  by a
medical man or any other person;  and at the same time  there is a
higher code of  ethics which makes  the  prevention of secret  mur-
der and the safety of society paramount to  all other considerations.
  A medical man must take care not to charge another with a
serious crime upon loose suspicions.  If from  the  nature of the
symptoms, the absence of any natural cause for the illness, and the
inefficiency  of ordinary remedies, he suspects that the patient is
under  the  influence of poison, it  is his duty to lose no time in
confirming or removing that suspicion by a proper  medical and
chemical investigation.   If his suspicion is confirmed by the dis-
covery of poison in the  food or urine, then steps must be immedi-
ately taken to save the life of the patient.  In  Reg.  v. Wooler
(Durham Winter Assizes, 1865), in which the prisoner was charo-ed
with the murder of his wife by  secretly  administerino- to her
arsenic, three medical gentlemen were in attendance.   TTiere was 
MEDICAL PRIVILEGE.
45
a  suspicion that arsenic was being administered  to  the  deceased
nineteen days before her death, but the fact was not  made known
because  these gentlemen were  unable to  satisfy  themselves  con-
clusively that arsenic was present in the urine.  They appealed to
a  high authority to aid  them, but the advice reached them too
late—the patient had died, and, as it was clearly proved,  from the
effects of  arsenic.   The learned judge who tried  this case said,
" When the idea of poisoning struck them they  ought to have
communicated their suspicion to the husband if they did not sus-
pect him,  and if they did  suspect  him, they ought to have gone
before a magistrate, and not have gone on from the 8th to the 27th
of June seeing the woman murdered before their eyes."
   Dr.  Christison, in commenting  upon this  case, very  properly
takes exception  to this advice, and there can be no doubt  that any
man acting upon it would expose himself to an action for slander.
" Ideas" of poisoning often arise in cases of disease where the symp-
toms deviate a little from  the  ordinary course, but they are  dis-
missed on  further observation.  If, in the absence of  the means or
knowledge of applying chemical tests, or of taking the opinion of
others experienced in toxicology, a medical man charged  the hus-
band of a lady with secret poisoning, or went  before  a magistrate
and charged him publicly, he would be acting with rashness, ruin
his own practice and reputation, and be  mulct in  heavy  damages
for the irreparable injury done by a false accusation.   Such a  step
should be taken upon something more than an idea or a suspicion.
A prudent and conscientious man will always await the  result of
a  chemical analysis before giving publicity to a suspicion which
may, after all, turn out to be quite unfounded; and he will lose no
time in obtaining this  necessary confirmation or a removal of his
doubts.
   [Unquestionably, it is the first and paramount duty of the medi-
cal attendant  to  protect his patient, in a case of suspected poison-
ing ; but he should  be equally careful  not  to  raise the suspicion
against another—very  possibly an innocent person—without  the
fullest and most unequivocal proofs.-  The practice of some medi-
cal " experts" in swearing to the presence of poison, not only when,
in the language  of Dr. Christison, " the symptoms deviate a little
from the ordinary course," but even  when they are perfectly recon-
cilable with those of ordinary disease, cannot  be  too severely re-
probated ; especially when  such " expert" opinions  are maintained
in non-fatal cases, in the absence of all chemical tests on  the food
and drinks, and on the urine and other excreta of the patient.—R.]
   When the  suspicion  is  confirmed, there is  some difference of
opinion as  to  the course  to be pursued.   Dr. Christison advises
that when  the medical man is satisfied of the fact of  poisoning he
should  communicate his  eonviction to the patient  himself,  and
that he ought not to be deterred by the  chance of  injury to his
patient from making even so dreadful a disclosure.  He will have
thus taken the surest preparative step to  prevent a repetition of
the poisoning.   Whether this  communication be made to the pa- 
46
EXAMINATION-IN-CHIEF.
tient or not, the proper course will be to place the matter  ram-
diately in the hands of a magistrate for investigation.  Some } ears
since I was consulted in a case of supposed  slow poisoning.  Ine
symptoms suffered by a lady, taken as  a whole, were not recon-
cilable with  any disease. The medical gentleman had an  idea
that poison might possibly be the cause,  but before acting upon
this idea he sent to me a portion of  urine for examination.  Anti-
mony was found in it, and the cause of the symptoms was at once
explained.  He communicated the  result of the analysis to  the
members of the family, and  the symptoms of poisoning ceased
from that time!  The error committed by medical men  even  on
these occasions is not in claiming a privilege of concealment, but
in allowing a doubt  upon so serious a question to remain in their
minds for days or weeks.
  This question was  again brought into prominence at the trial of
Dr. Pritchard, at Edinburgh (July,  1865), on the charge of poi-
soning his wife with  antimony. One of the  medical witnesses,
who saw the deceased a fortnight before her death  and  at other
times, stated in his evidence at the trial, that he suspected she was
suffering from the effects of antimony when he first  saw her;  but
it seems that there the matter was allowed to remain.  No one
was accused, but no step was  taken  to prevent  the continuance of
the poisoning, the suspicion of which turned out to be well  founded.
The Lord Justice Clerk, who tried this case, is reported to have
said that no notions of medical etiquette should be permitted to
interfere with those higher  duties which every right-minded man
owes to his  neighbor, and which are to be expected in a tenfold
degree  from every medical man, because his life is solemnly de-
voted to the preservation of life, and the prevention of its destruc-
tion.
   Examination-in-chief.—The  ordinary course  of proceeding in a
criminal case is thus concisely stated by Mr.  Fitzjames Stephen
(" Criminal Law of England," pp.  168, 282).   After opening  the
case the counsel for the crown calls the witnesses, and examines
them according to the rules of evidence—that is, he brings out, by
 questions which do not  suggest  their  answers, the facts relevant to
 the issue to be  tried which  are within  his personal knowledge.
 Those questions which suggest the answers are called " leading"
 questions.  With one exception it is  not  the  practice to allow
 these  to be put in  this part of the examination.  The  exception
 according to Mr. Stephen is:  " When the judge is satisfied, either
 by a witness's demeanor, or by contradictions  between the  evi-
 dence and the  depositions, that he is trying  to keep back  the truth
 and favor the prisoner, he may, in his discretion, allow the counsel
 for the  crown to ask  leading questions, and, as the phrase is, to
 treat the witness as hostile."   When the examination-in-chief is
 closed, the next step is the cross-examination.
    Cross-examination.—In this, the second stage, the counsel for the
 prisoner extracts from the medical  witness,  by questions which  may
 suggest the answers in the strongest form, any facts that may appear 
CROSS-EXAMINATION.
47
to be favorable to  the  client, and which he believes to be within
the witness's knowledge.  Leading questions are not only allowable
in this part of the examination, but, according to good authority,
a counsel for the defence can hardly lead to much.  The theory of
the law is  that  the witness is unfavorable to the prisoner and has
come to bear evidence against him.  The more he has shown him-
self by conduct  or conversation a partisan in the  case, the  more
severely, will he be treated.  Anything which he may have said in
the hearing of others, or published in journals, or even written in
private letters (if the contents transpire) in reference to the case or
the guilt of the prisoner, is now brought to light, although he may
have supposed that what he did say was in perfect  confidence.  It
is at this stage of the case that any exaggerations which may have
been most favorably received  by  the counsel for the prosecution
are  reduced to  their true  proportions.  Any bias by which the
mind of a witness  may have been influenced, or any imperfection
or confusion of memory as to facts, is here brought out. (Stephen,
p. 177.)  It is in this part of his examination that the witness will
be closely questioned as  to his qualifications, the time during which
he has been engaged in  practice, the accuracy of his judgment, his
general professional knowledge, and his  special experience in refer-
ence to the matter in issue, the number of cases  he has seen, etc.
Straightforward answers should be given  to all  questions.  No
harm can  be  done to the witness by the answers unless they are
given evasively, since  it is not to be  supposed  that the witness
wishes to represent himself differently from what he is. If he does
make the attempt, he will assuredly fail.
   The most striking distinction between the examination-in-chief
and cross-examination is in reference to leading questions.   It rests
upon the assumption that there is a danger that a witness will say
whatever is suggested  to  him by the one side, and conceal every-
thing that is not extorted from him on  the other.  It need scarcely
be  observed that witnesses whose  evidence is of little importance
in the case, are rarely cross-examined.  This is reserved in its most
stringent form  for  those whose facts  and opinions are likely to
affect the fate of a prisoner in a criminal trial.  In dealing with a
skilled witness whose evidence  may be of importance, the questions
in cross-examination are usually put by the counsel for the prisoner
with great caution, or  the answers  brought out may be more ad-
verse to his own case  than those elicited in the examination-in-
chief.
   Re-examination.—The cross-examination is usually followed by a
re-examination on the part of  the counsel for the crown, or of the
counsel by whom the witness has been called.  The object of this
is to clear  up or explain  any portion of the evidence which may
have been  rendered obscure or  doubtful by the cross-examination.
It is sometimes  unnecessary to put a question, and if the witness
has given his evidence consistently and  fairly, no questions may be
asked.  As a rule, the re-examination  must be  confined to those
matters which  have arisen out of  the cross-examination.  Any 
48
QUOTATIONS FROM  BOOKS.
questions upon new subjects may render a further cross-exam na-
tion  on them  necessary.  In reference to facts  a medical witness
must bear  in  mind that he should not allow his testimony to, be
influenced  by  the consequences which may follow from ms  state-
ment of them, or their probable effect on any case which is_ under
trial.  In reference to opinions, their possible influence on the fate
of a prisoner  should  inspire caution  in forming  them, but when
once formed they should be honestly and candidly stated without
re-ard to consequences.  It will be well to remember, in reference
to each stage of the examination, what a great medical authority
has said • " To make a show and appear learned  and ingenious in
natural knowledge may flatter vanity.  To know facts,  to separate
them from supposition, to arrange and connect them, to make them
plain to ordinary capacities, and, above all, to point out their useful
applications, should be the chief object of ambition."   (William
Hunter.)
   Quotations from books.—It is a not unfrequent custom  with coun-
sel to refer  to medical works during the examination of a witness.
He is expected to have a fair knowledge of the writings of pro-
fessional men  on the subject of inquiry. The authority is men-
tioned, the  passage is quoted, and the witness may be  then asked
whether he agrees with the views of the author, or whether he
differs, and if so, his reasons.  In cases connected with medical
treatment, the views of the profession are and have been so various,
that a barrister would have no great difficulty in finding some
book to oppose to the opinions of  a witness.  Standard works of
recent date are so well known to the profession that there are few
medical men engaged in practice who are not well acquainted with,
and able to explain the views of the writers, and how far they agree
or conflict with his own.   The witness must be on his  guard that
the question is fairly put, and  that it is properly taken with the
context, or he may  unexpectedly find himself involved in  a diffi-
culty.   On one occasion, I found that a learned gentleman stopped
in his quotation at a comma, and on another occasion the quota-
tion ended at  a colon—the remainder  of  the sentence in each case
materially weakening  the inference which it was intended to draw
with the apparent sanction of the witness.
   When a  quotation from a standard work is thus opposed to the
evidence of a  medical witness, he should take care by reference to
the work itself to see that the passage is correctly quoted.  A re-
markable instance of the importance of this caution has been com-
municated  to me by a former pupil.  At the Swansea Lent Assizes
1869, an action was brought against a railway company for com-
pensation for  personal .injury.  Plaintiff was proved to  have had
pneumonia shortly after the accident, and the counsel for the com-
pany wished to show that the pneumonia had not arisen from any
physical injury. In cross-examining the medical witness he asked,
" Cannot pneumonia be produced by shock ?" Witness : " I do not
believe it to be possible."  Counsel: " What! do you mean to say
you do not believe what is asserted in fact by no  less an authority 
EXAMINATION OF WITNESSES.
49
than Professor Tajdor?   Have you  read  Dr.  Taylor's  work  on
'Medical  Jurisprudence?'"  Witness:  "Yes."  Counsel:  "Have
you seen the  last edition ?"  Witness:  " No."   Counsel: " I have
it here (turning over the leaves of a book), and a case is given of
pneumonia being caused by shock."  (Witness in confusion.)  It
was subsequently discovered on referring  to  the  work, that the
case in question was one in which the lung had been wounded by
a fractured rib.  The cause of the  pneumonia was thus sufficiently
explained; it  was proved to have been a result of physical injury
and not of shock!  A reference at the time to  the work which is
quoted is always necessary, if any  use is to  be made of a quotation.
Without suggesting that there is intentional misrepresentation to
bear out a particular view of the case, a barrister, in dealing with
the medical facts, may wholly misunderstand the author's views
and statements, and in some instances wrongly assign to  the au-
thor opinions which he  has merely quoted from other authorities
for comment or illustration.
   Presence in  court.—In  England, medical  and scientific witnesses,
except under special circumstances, are allowed  to  be  present in
court and hear the whole of the evidence  in the case.  This is in
some instances absolutely  necessary if the  court  requires medical
opinions,  for  unless the witnesses are  fully acquainted with the
facts  they can give no opinions, and they can only become fully
acquainted  with the facts by being allowed  to  be present and
hearing the evidence in court.   If excluded, the judge or counsel
will be compelled to read to the witness notes  of  the evidence be-
fore an opinion can be  given, and  it may then appear  that some
small point which counsel did not think of importance is omitted;
this if known to the witness might, however, materially affect his
opinion.  A failure of justice is likely to occur when medical wit-
nesses are excluded, and it is  generally when there is no defence,
or a  false defence, that  the right of excluding them is exercised.
The rule in Scotland is similar:  medical  and scientific witnesses
are allowed to be in court  during  the trial.
   The examination of the witnesses for the crown is followed by
the defence of the prisoner, either in person or by his counsel, who
acts throughout the part  of an advocate, simply securing for his
client every advantage the facts  or the law may afford  him.  In
other words, he sees that  his  client  is  strictly tried according to
law, and  not  condemned contrary to law.   A key to some of the
difficulties which medical witnesses  must be prepared to encounter
will be found in the exposition given by Mr. Stephen of the tacit
rules which regulate the duties of counsel for the prosecution and
defence.  " In practice it is universally admitted that the counsel
for the prosecution is morally  and professionally bound  always to
keep in sight the ultimate object—namely, the discovery of truth;
whereas no such obligation is laid upon the prisoner and those who
represent him, because it is too much to expect of human nature
that  they should discharge it, and it  is  better  not to impose an
obligation which is sure to be systematically violated.  Both sides,
       4 
50                RULES  RESPECTING  THE
on the other hand, are  bound in the strongest way not to do any-
thing to propagate falsehood.  The counsel for the crown is  bound
not to suppress any fact  within his knowledge favorable to the
prisoner ;  and, on the other hand, the counsel for the  prisoner is
bound not to bring to light facts within his knowledge unfavor-
able to the prisoner."  " The counsel for the crown may not use
arguments to prove the guilt of the prisoner which he does not
himself believe to be just, and  he  is bound to warn the  jury of
objections which may diminish  the weight of his arguments ; in
short, as far as regards the evidence which he brings forward, his
speech should as much as possible resemble  the summing-up of the
judge.  He should  contend not  for the success of his cause at all
events, but for the full recognition by the judge and jury of that
side of the truth which makes in favor of it.  On the other hand,
the counsel for the  prisoner may use arguments which  he does not
believe  to be just.  It  is the business of the jury, after hearing the
judge, to say whether they are or are not just."  (Op. cit., pp. 160
and 168.)  The  last remark  shows what appears  to be a  serious
defect in the administration of the criminal law.  While in a case
of misdemeanor, a prisoner may be tried by  a special jury, in a case
of felony, involving an analysis of important questions of medical
science  in  reference to murder  or manslaughter,  the  trial takes
place  before a common and comparatively ignorant jury.   Such a
jury is hardly in a position to cope with an ingenious counsel, who
has it in his power to misrepresent and  distort medical facts and
opinions in any manner that  he pleases.  The defences made are
frequently such as no barrister would venture to place before a jury
of educated men.   These " powerful" or " forcible" addresses, as
they are termed by the press, full of burning eloquence  and im-
passioned logic,  have frequently withdrawn the attention  of the
jury from the real  facts, and have  procured verdicts of acquittal
contrary to the evidence and all the medical circumstances of the
case.
   Another observation made  by Mr. Stephen more nearly concerns
the medical witness :  " There are  many obligations which effect
each  side equally.  Neither is at liberty to attempt to browbeat,
intimidate^or confuse a witness, although  they  may expose any
real confusion which  exists in  his mind, or test,  by the  strictest
cross-examination, the accuracy of his statements.   Neither is at
liberty wilfully to  misunderstand a witness, or  to misstate, in  his
address to the jury, the effect of what he has said, either by distor-
tion or suppression.   The  neglect  or  observation  of these and
other rules of the same kind  practically establishes a wide distinc-
tion, and  one which is easily recognized, between  those who exer-
cise a noble profession and those who disgrace it."  (Op. cit., p. 168.)
   The treatment of  a  medical witness, in passing through the
ordeal of an examination at a criminal trial, will depend, therefore
very.much upon the  class of counsel who is opposed to him.  As-
suming that he is properly prepared for the discharge of his duties
and that the questions put to him are answered fairly  and truly' 
EXAMINATION OF WITNESSES.
51
according to his knowledge and experience, without exaggeration
or concealment, he has  no reason to fear any attempt at intimida-
tion.  Barristers, for the  most part, know that by this line of
conduct they lose more with  the jury than they gain by the at-
tempt to confuse the witness ;  and as their ultimate and sole object
is  a favorable  verdict,  they will generally avoid conduct which
must necessarily place this verdict in jeopardy.
  The  normal  barrister, as depicted by Mr. Fitzjames Stephen, is
not at liberty in his address to the jury, to misrepresent, either by
distortion or suppression, the  medical facts or opinions given in a
case.  According to ni} experience, however, misrepresentation is
a not unfrequent practice, and one of  which  medical  witnesses
have very strong reason to complain.   Whether such  misstate-
ments are wilful or not it  may be difficult to determine, but their
effect.on the jury is well known to those who  employ them, and
they frequently escape the observation of the counsel on the other
side, and even of the  learned judge, unless he is well  versed in
medical subjects.  It is also worthy of remark,  that if a misstate-
ment is thus made, it  is  by a remarkable coincidence always in
favor of  the view of the  counsel who makes  it, when a  proper
examination of his notes would, in general, show him that he was
wrong.
  Then as to the question of intimidation, this is sometimes carried
very far.  On a trial for murder by poisoning,  I have heard a re-
spectable  country practitioner, who had given his evidence for the
crown in a fair and proper manner, thus addressed in cross-exami-
nation by a learned counsel,  now deceased: " On your oath, sir,
and in the face of the whole profession, will you venture to persist
in that  statement ?" etc.   A  public writer in commenting on this
subject, says:  " But the hardest and most unfair part of the sys-
tem (of cross-examination) is  when witnesses have to bear a loud
and insulting tone or gesture  without remonstrance or retaliation.
A counsel may very plainly imply that a respectable witness is a
person of  doubtful character, and not to be believed on his oath, or
that he is ignorant, and a bungler in his profession ; but if the
witness  retorts that the barrister's  eloquence and sympathies are
hired, or if he gives vent  to any other words of retaliation in his
natural  indignation, the court is against him."   Whatever may be
the importance of a case  to  a prisoner,  nothing can justify the
putting of questions in a loud and insulting tone to a skilled pro-
fessional witness.
  I quite agree with the writer  whose opinion I have already
quoted,  that " every contemptuous and even  uncourteous expres-
sion, every query leading nowhere, except to the end  of  confusing
the mind  or irritating the temper of a witness, ought surely to be
reckoned as overpassing the legitimate limits of the counsel's office,
and as such be  regarded with  universal disapprobation."  It may
be that criminal cases fall more into the hands of the second class
of barristers to whom  Mr. Stephen alludes—namely, those who
disgrace a noble profession.   But it is a widely spread opinion in 
52
EXAMINATION OF  WITNESSES.
the medical profession, that this style of examining educated men,
who are perhaps  compelled  most unwillingly to appear on a sub-
poena to testify to facts, is certainly not adapted to elicit the truth,
but rather to  favor the escape of criminals and give impunity to
crime.
  It may be fairly admitted  that a man. who puts himself forward
as a witness, and  attempts to elucidate what he only succeeds in
rendering more obscure, should  receive no favor at the hands of
the bar.  Dr. Elwell, a member of the legal as well as of the medical
profession, observes that " No witness is ever compelled to appear
and  testify to what  he  does not  know.   He may be compelled to
attend  in court in obedience to a subpoena, but if he attempts to
testify  upon a subject requiring opinions upon which  he  has no
well-settled or well-defined ideas, it  is his own fault, and he alone
is to blame ; for no one but himself can know so well as he, until
he has  exposed himself, how unfit he is for the occasion." (Medico-
legal Treatise  on " Malpractice and Medical Evidence,"  by J. J.
Ewell,  M.D., Member of the Cleveland Bar, New York,  1860, p.
302.)   But let  us take the case of a practitioner, who, in a country
district, has  gone  through twenty }7ears of practice with honor and
credit in his neighborhood, and who  is suddenly called to a case in
which  a man  is found dead from a wound in his throat.  Under
the Medical  Witnesses' Act  he is compelled to make an examina-
tion  of the body  for a coroner's inquest.  At a great loss of time,
and  for  no  adequate  remuneration, he attends the inquest  and
gives his evidence; he is bound over,  nolens volens, to appear for
the-first time  as  a witness  at a  criminal trial,  and to testify, 1st,
to the throat being cut, and 2dly, to give his opinion  to the court
on the  cause of death, and whether the wound was inflicted by the
deceased on  himself, or  by another  person.   A medical man  who
limited himself to the statement of the bare fact that the deceased's
throat  was cut need not  appear at all, for this evidence might  be
supplied by a constable or policeman ;  but the law presumes from
his profession, that the  medical  man made a proper examination
of the  wound, with a view to determine to the best of his ability,
whether it was the cause of death and whether it was or was  not
self-inflicted.   It  is difficult to  understand how a medical  man,
although before this occurrence  he  may never have seen a case of
cut-throat, could excuse himself  from giving an answer to  these
questions, both of which involve  purely matters of opinion.  If he
excused himself altogether from  giving answers, there would  be a
failure of justice, and no conviction for such a common form of
murder could  ever take place.   If,  on  the other hand, he answers
these questions to the best of his ability, he may reasonably com-
plain that while thus compelled to appear as a witness to testify to
what he does know, his evidence should, by rules of law, be made
the subject  of abuse  and ridicule before his  neighbors' when he
expresses his opinion  from  the  facts; and  that the  counsel  who
examines him legally possesses an unlimited power of misrepre
senting his views.  A medical  man is certainly not benefited by 
         RULES FOR THE  DELIVERY  OF EVIDENCE.       53

 being described as an ignoramus or a blunderer in his profession,
 whom no  one ought to trust.  The truth is, in medical evidence
 facts and opinions cannot be separated, and if medical practitioners
 were restricted in their  evidence  only to those facts which they
 had  observed  in  a  case, in Avhich no other professional man saw
 the  person living or dead, it is difficult to understand how crime
 could be detected and punished.  These remarks of course do not
 apply to cases in which  the opinions of medical experts  can  be
 taken.   Here it would be desirable that one who has not had ex-
 perience on the subject should avoid giving any opinion; he might
 simply state the facts, and decline from want of experience to give
 an opinion on the conclusions  to which they lead.  In pursuing
 any other course, he will  find that  the whole weight  of the cross-
 examination will fall upon him.
   There are other remarks  on  this subject  made by Dr. Elwell,
 which those who  are compelled to attend as witnesses in a court
 of law will do well to bear in mind: " However anxious an  incom-
 petent witness may be to appear learned, and however  hard  he
 may labor to show it, he will ever  find it a difficult business  to
 make the court and counsel believe that  he is really so.  To appear
 really learned he  must be able  to  make the  subject on which  he
 gives  an opinion clear, and to give satisfactory reasons for this
 opinion.  He must  be not only a thinker, but must satisfy others
 that he is  master of his subject.  Take almost any one of the im-
 portant  scientific  questions  upon which  a professional witness is
 called to pass an opinion, and  unless he  has looked  at the subject
 before with a purpose to understand it—comprehending  its extent,
 weight, and relations—he will  find it to  have  suddenly assumed
 an importance he had  not suspected, just at the time when the
 discovery will add to his confusion.  It is better to make this dis-
 covery in the quiet  stillness and security of solitude, than  under
 the  eye  of a  judge and  the severe scrutiny of counsel.  A man,
 whether learned  or  not—whether in court or out of court—will
 talk  clearly upon a  subject he well  understands, whether it  is
 scientific or otherwise, but unless  it is clear in his own mind his
 account of  it will be  confused and unsatisfactory." (Op. eit., p. 303.)
 This is undoubtedly the test to which every man should rigorously
 submit himself before entering the witness-box.
   Rules for the delivery of evidence.—There are a few rules bearing
 upon medical evidence which,  if observed, may save the witness
 from interruption or reproof and place him in a favorable position
 with the court:—
   1. The questions put on either side should receive direct answers,
 and  the manner of the witness should not be perceptibly different
 whether he is replying to a question put by the counsel for the
 prosecution or for the defence.
   For reasons elsewhere assigned (p. 47),  most of the questions put
 by counsel  in cross-examination  will admit of an answer " yes," or
" no."  If, from the  ingenious or casuistical mode in which the
 question is framed, the witness should feel that  the simple affima- 
54    RULES FOR DELIVERY OF  MEDICAL EVIDENCE.
tive or negative might  mislead the court, then, after giving the
answer, he can appeal to the judge to allow him to qualify it, or
add to it any matter within his ovm knowledge and which is at the
same time  relevant to the case.  The witness must remember that
he takes an oath to state the  truth, the whole truth, and  nothing
but the truth.  On the other  hand, while the counsel for the de-
fence is bound not to introduce falsehood, his object is not the dis-
covery or development of truth.  Unless the witness is on his guard,
he may  find,  when the  learned counsel who has cross-examined
him addresses the jury, that his affirmatives and negatives may be
worked into a shape representing the reverse of what he intended.
   Some counsel  adopt the  ingenious  plan  of compressing two or
three questions into one.  A witness unthinkingly answers the last,
or  that which most fixes his attention.  The same  answer may
not be strictly applicable to all, but the witness  may find, when
too late, that it  is made  so  in the defence.  In this case he should
ask for a severance of the questions, and give separate replies.
   Direct answers are necessary, because  it  is only by them  that
the case  can be brought  clearly before the court and jury in all
its details.   Medical witnesses sometimes forget this, and fall into
answers to questions  floating in their own minds, or which they
think are likely  to  be put to them.  They are also sometimes dis-
posed to anticipate  many questions by one  general  answer.  This
simply creates confusion, and the witness will be told' by counsel
to keep to the question, and that he is coming to the other matters
presently.
  Care should be taken by the medical witness not to argue with
the learned counsel.  Argument is not evidence, and the entering
into it disturbs the order of tfje proceedings.  Arguments between
counsel and witnesses, and even between  medical witnesses them-
selves, are  freely allowed in the French courts,  but in England
such a practice is not recognized.  The mode in which questions
are put by counsel in cross-examination sometimes tends to  the
introduction of argument, but the witness should avoid the temp-
tation to enter into it.  What he says under such circumstances is
not evidence, except in the form  of answers to questions, and he is
there only for the purpose of stating what is relevant in the case.
  There is a difference between evidence and testimony.  A medi-
cal witness sometimes gives much in the form of testimony which
amounts  to very little as evidence.   When  he does  not attend to
the questions, he testifies to a variety of subjects which have no
bearing on  the case, and do not constitute evidence.  The decision
on what is and what is not evidence lies with the  judo-e.
  2. The replies should  be concise, distinct, and  audTbl'e, and, ex-
cept where  explanation may  be necessary, they should be'con fined
strictly to the terms  of  the questions.   The  learned judo-e who
tries the case, generally takes full notes of the medical evidence-
hence the necessity for a slow and distinct delivery of the evidence
Some witnesses have a singular habit  of not  answering the ques-
tion which  is asked but one which is not asked.   Others o-iVe an 
      RULES FOR  DELIVERY  OF MEDICAL  EVIDENCE.    55

answer in such a voluble form, in the shape of a small speech or
lecture, that there is great difficulty in reducing it  to its proper
proportions.  A witness who is so profuse of information generally
supplies abundant matter for a long and troublesome cross-exami-
nation.
  It has  been a question whether a witness should volunteer evi-
dence, assuming that the examination-in-chief and cross-examina-
tion have failed to bring out all  that he knows of the  case.  If
that which he has to state is  some matter of fact within his own
knowledge, or an opinion based on facts within his knowledge, he
will be allowed, on application to the judge, to make the statement
in spite of the efforts of counsel on either side to shut it out.
  It is scarcely necessary to observe, that the language in which
the answers are returned should be plain and simple.  Counsel who
are unacquainted with medical terms frequently misapply them, or
use  them in a wrong sense.  There are few barristers  who are
aware that the term " symptom" is confined to the living body, and
" appearance" to the dead ; and the witness  may thus find himself
questioned on the " appearances" when he first saw the patient, or
the " symptoms" which he observed on the post-mortem examina-
tion of the stomach and bowels.   On a trial for murder, in which
one of the questions at issue was whether dysentery or poison was
the cause of death,  the learned counsel puzzled one of the medical
witnesses by  asking him whether during his attendance he found
any traces of udysuria" in the feces ! There is no doubt he intended
to refer to a state of the feces, like that met with  in dysentery,
but the professional term employed by him  signified a " difficulty
in passing urine."   A judicious witness will avoid anything like a
triumph over his examiner under such circumstances, and simply
put him right.
  3. Answers to questions should be neither ambiguous, undecided,
nor evasive.  An ambiguous answer necessarily leaves the witness's
meaning doubtful, and  calls for an explanation.  An undecided
answer—indicated by the words " I believe," or " I think," or "It
might be,"—is not sufficient for evidence.   Did  the  wound cause
death ?   Was death caused by loss of blood or poison ?   If, by a
proper consideration of all the medical facts, the witness has come
to a conclusion on the  subject, his answer should be expressed in
plain and decided language, either in the affirmative or negative.
A man who has formed no conclusion is not in a position to give
evidence.  No opinion should be given for which the witness is not
prepared to assign reasons, and except by permission of the court,
no medical opinion  should be expressed on facts  or circumstances
observed by others.   A  hesitating witness  will  be met with the
question, Have you  any doubt about it ? or, Was it so or not ?—to
which a reply in the affirmative or negative must be given.  If the
witness fairly entertains doubts about the matter at issue, it is his
duty  to express them, and not allow them to be extorted from him
piecemeal by  a series of questions. 
56    RULES FOR DELIVERY OF  MEDICAL EVIDENCE.

  Chemical witnesses have occasionally certified to the discovery
of " imperceptible," " unmistakable," or " undoubted" traces of
poison in the liver, etc.  Such terms naturally convey to the shrewd
mind of an examiner that the witness has some  lurking doubt or
suspicion of mistake in his  mind, for that of which we are sure
requires no such terms to express our meaning.   If poison has been
discovered, the statement of fact is sufficient.
  4.  The replies  should  be made in simple language, free from
technicality.  Some remarks have been elsewhere made in reference
to the use of technical terms in drawing up medico-legal reports
(p. 31).  If medical men could be made aware of the ridicule which
they thus bring on their evidence otherwise good, they would at
once strive to dispense with such language.  A witness is perhaps
unconsciously led to speak as  if he were addressing  a medical
assembly, instead of plain men like the members of a common jury
who are  wholly ignorant  of the meaning of medical terms, and
barristers who are but imperfectly acquainted with them.  There
are few Assizes which do not afford many illustrations of the injury
done  to scientific evidence and the  clear understanding of a case,
by the technical language in which it is given.   A court may be
told that the " integuments were reflected from the thorax, and the
costal cartilages laid bare, when a wound was  found which  had
penetrated through  the anterior mediastinum," and had involved
the arch of the  aorta, etc.   A simple cut in the skin is described
as " an incision  in the integuments."  In a case  of alleged child-
murder, a medical witness being asked for a plain opinion of the
cause of death, said that it was owing " to atelectasis and a general
engorgement of the pulmonary tissue."  On a trial for an assault
which took place at the  Assizes, some years since, a surgeon, in
giving his evidence, informed  the  court that on examining the
prosecutor, he found him suffering from  a severe contusion of the
integuments under the left orbit, with great extravasation of blood
and  ecchymosis in the surrounding cellular tissue, which was in
a tumefied state.   There was  also considerable  abrasion of the
cuticle."  "Judge: You mean, I suppose, that the  man had a bad
black eye.   Witness: Yes.  Judge: Then why not say so at once?"
It would be easy to multiply examples of this kind.
   This is not science, but pedantry, and if such language  is em-
ployed by a witness with a view of impressing the court with some
idea of his learning, it wholly fails of its effect.  Barristers and
reporters put down their pens in despair, and the time of the court
is wasted until  the witness has  condescended to translate  his ideas
into ordinary language. 
CAUSES OF  DEATH.
57
                     CHAPTER  III.

CAUSES  OF DEATH.—SUDDEN  DEATH.—SYNCOPE, ASPHYXIA,  COMA.—
  SIGNS OR INDICATIONS OF DEATH.—CESSATION OF CIRCULATION AND
  RESPIRATION.--COOLING OF THE BODY.--CADAVERIC RIGIDITY.--THE
  EYES.—THE SKIN.—COAGULATION OF  THE BLOOD.—PUTREFACTION.—
  CADAVERIC  LIVIDITY.--ADIPOCERE.

  Medical jurisprudence takes cognizance of all violent causes of
death, and is only indirectly involved in those cases of natural death
which simulate the effects of violence.   Thus all causes which
operate to produce death suddenly, as by syncope, asphyxia, or coma,
especially demand the attention  of a medical jurist.  These  may
be either natural or violent;  and the  distinction between them is
of importance,  since the  guilt or innocence of a person  charged
with crime may depend on a correct determination of the cause.
  The continuance of life depends upon the proper and regulated
action of the heart, the lungs, and the brain, and the interdepend-
ence of these organs is such that the  arrest of the functions of one
of them is speedily followed by the arrest of the  functions of the
others.  Hence, these three organs have been called the tripod of
life.   When the suspension of the motions of the  heart is the pri-
mary cause of death, the person is said to die by syncope.  The term
asphyxia is applied to death which begins by the lungs;  and coma
to that which arises from a  primary disturbance of the functions
of the brain.
  Syncope (evyxottta).—In  order that the  action of  the heart should
be maintained, it is necessary, first, that the blood supplied  to it
should be in sufficient quantity, and, secondly, that this blood should
be of proper  quality.   In death  from hemorrhage we have an in-
stance of deficiency, and in death from certain poisons as well  as
diseases, an  illustration of defect of blood.  In ordinary  syncope
(fainting or swooning) there is simply a deficiency in the quantity
of blood which passes through  the  heart, although  there is no
actual loss of  this fluid  from the circulation.   Certain  diseases
which affect the muscular structure of the heart, as well as its
membranous  valves and  bloodvessels, may  also lead to a sudden
arrest of  its  functions.   These  morbid  conditions produce a me-
chanical impediment to the motions of the organ by which the
blood is propelled, and death by syncope is .the necessary result.
  When death  takes  place by the heart, the right and left cavities
of this organ are found to contain blood in  the normal proportion
in which that fluid is ordinarily circulated. This retention of blood
in these cavities arises from the sudden stoppage  of the heart's 
58
DEATH FROM SYNCOPE.
contractions.  Blood is found in the large veins (venre cavfe), as
well as in the arterial trunks.  There is no congestion or accumu-
lation of blood in the lungs or the brain.
   Asphyxia (d priv. and <j<j>ugis pulse) signifying pulselessness.  This
state is induced by any cause which arrests the function of respi-
ration.  The term apnoea (from  i  priv. and nvi^ I respire) is more
appropriate; for the  state  of syncope  might  equally be called
asphyxia.   The various forms of death  by suffocation,  as  in  the
obstruction of the air-passages from mechanical causes, in drown-
ing, hanging,  and  strangulation,  furnish  illustrations  of death
commencing by the lungs, or asphyxia.  The effect of cutting off
air from the lungs is that the blood is not aerated, and it is there-
fore circulated in a  state unfitted  to support the nutrition of  the
heart and brain, without which life cannot continue beyond a few
minutes.  It is necessarily distributed with the impurities derived
from the waste of tissue, and thus acts as a poison in all the organs.
It is incapable of sustaining nerve-force or muscular irritability.
It stagnates in the capillary vessels of the lungs, produces a languid
action of the heart by its circulation through the  muscular struc-
ture of this organ, and it causes insensibility by  its distribution
through the bloodvessels  of the brain.   The lungs are essential to
the circulation by purifying the  blood; the brain from the neces-
sity of supplying the proper stimulus—nerve-force.  Death from
asphyxia may be therefore regarded as death from defect of blood.
The observations of the late Sir  B.  Brodie ("Lectures on  Pa-
thology," 66)  and others  have clearly  proved that in  spite of  the
impurity of the blood, the heart will continue to act, and the  cir-
culation to  be maintained for two or three minutes or longer after
breathing has entirely ceased.  This may be proved by hanging or
strangling  an animal, and observing the condition of  the  heart
during the stage of insensibility.  As the action  of this organ con-
tinues after the animal has ceased to breathe, life is not actually
extinct; and under favorable circumstances, it may be restored, if
no injury be done to the air-cells of the lungs, so long as this action
continues.   Supposing that the suspension of respiration is com-
plete, the action of the heart gradually slackens and finally stops.
It is at this period  of the complete arrest of the  motions  of  the
heart, that asphyxia passes into death.  Apnoea is determined by
the time at  which respiration is completely arrested.   The circula-
tion of the unaerated blood through the brain appears to annihilate
sensibility, so that no consciousness or feeling exists; the person is
to all appearances, dead.  There  are many diseases which operate
fatally by arresting  the functions of the lungs, and  these may be
regarded as  furnishing the natural causes of asphyxia.  The violent
causes, including not only the ordinary modes of  suffocation  but
the effects of certain poisons, are not difficult to appreciate, provided
a true history of the case  can be obtained.
  In death by the lungs, as the circulation of the blood is primarily
arrested in these  organs, the pulmonary artery, the  rio-ht cavities
of the heart and the venae cavse are found gorged with blood'  The 
DEATH FROM COMA.
59
pulmonary veins, the left cavities of the  heart  and the aorta, are
either empty or contain but little  blood.  In certain cases  of as-
phyxia, the right cavities of the heart, as well as  the left, have been
found empty.   When the access of air to the lungs  is suddenly and
completely cut off, the circulation  of  the blood is very speedily
arrested ;  but supposing the occlusion of the air-passages to be par-
tial or  gradual, the circulation of the blood may continue for a
time, and thus cause  congestion of certain organs.   Hence, the
appearances in asphyxia differ greatly.  A mixed  condition  under
the name of syncopal asphyxia has been described by some patholo-
gists.  In this, the cavities of the heart are found empty.
   Coma.—Besides a due supply of properly aerated  blood, the brain
requires for the exercise of its functions a proper quantity of blood,
so that either by  the  sudden withdrawal of this fluid, or  by a
distribution of impure blood, these  are arrested.  A person thus
affected falls into a state of complete insensibility (coma), so that
it is  impossible to rouse him.   The functions  of the heart and
lungs are not suddenly arrested under these circumstances.  They
appear  to be less dependent on the brain than  the brain  is upon
them; but this is rather a question of degree.  A due supply of
nerve-force is required for the action of the muscles, whether  of the
heart or of the chest; and when this is withdrawn, the heart  ceases
to pulsate, and the respiratory muscles cease to act: circulation and
respiration are thus arrested by the absence of innervation.   This
is sometimes described as death by paralysis of the heart and lungs.
The blood is neither aerated  nor circulated.  Sudden death  from
apoplexy is  an illustration of  death by the brain.  Coma may also
be a  result of the introduction of certain poisons  into the blood,
and of fractures of the skull  leading to compression of the  brain
or destruction of its substance.  In death by the brain, the appear-
ances observed consist chiefly in a congested state of the  cerebral
membranes  and  substance of the brain.   As,  before  death, the
breathing is affected, the lungs are congested, and  blood accumu-
lates  in the cavities of the heart, more on the  right than on the
left side.
   The appearances described as characteristic of the different modes
of death by the heart, lungs  and brain, are  liable to variation by
reason of  the intimate relations of these organs.  Thus, there may
be a mixed condition of syncope and asphyxia, or of asphyxia with
cerebral congestion.
   With regard to the interruption of the functions of the brain as
a result of pressure by the effusion of blood or serum, it is  to  be
observed that a very small quantity  effused at  the base or in the
substance of the medulla  oblongata, is sufficient to cause death ;
while generally speaking a larger quantity is required to be effused
in the membranes, ventricles,  or substance of the brain, in order to
produce a fatal result.   [In some cases of violent death  by fracture
of the skull, the supervention of coma is very  gradual, in  conse-
quence of the slow effusion of blwod into  the brain from the rup-
tured vessel.—R.]   In cases of chronic hydrocephalus, in which the 
60
INDICATIONS OF  DEATH.
brain has resisted the pressure of a large accumulation of serum for
many years, a slight and  sudden increase  in  the  quantity at any
period of life may lead to  coma and death by apoplexy.  This con-
dition may be mistaken for narcotic poisoning.
  All causes of death, whether from  disease or violence, are refer-
able to an effect produced primarily on the heart, the lungs, or the
brain; but, as it has been elsewhere stated, death  does not  take
place until the action of the heart has entirely ceased.   The arrest
of the circulation produces an immediate impression upon the func-
tions of the brain and lungs ; while the lungs and brain are affected,
and can  only affect each other indirectly through the medium of
the circulation ; hence, systemic death, or the  death  of the  body, is
resolvable into death by syncope or a failure  of the action of the
heart, and this depends in all cases either upon defect or deficiency
of blood.
  The natural  causes of sudden death may be generally traced  to
some injury or impediment to the action of the heart, lungs, or
brain.  It would be foreign to the objects of this manual to give a
description of  them.  The violent causes are those which demand
the especial  attention of a medical jurist; they will  be considered
hereafter. In  its relations to medicine and medical  jurisprudence
the subject of sudden death has been most fully treated by Herrich
and Kopp("Der plotzliche Tod aus ineren Ursachen," Regensburg,
1848); as well as M. Devergie (" Ann. d'Hyg.," 1838, 2, 145).  To
these works  I must refer the reader for further information on the
causes, as well as on the appearances met with in  the  bodies  of
persons dying suddenly from natural causes.
  The violent causes of death, whether sudden  or protracted, which
chiefly require the skill of a medical jurist for their elucidation,
are  poisoning, wounds, and personal  injuries, such  as  burns and
scalds, as well as those forms of death  which commence by the
lungs, including drowning, hanging, strangulation and suffocation.
In  nearly all cases, the body of the  deceased is produced, and a
medical opinion can be based upon a careful examination.
  Signs or Indications of Death.—The  verification of  death is occa-
sionally a duty thrown on the medical jurist.  Certain signs or in-
dications have been pointed out as proving that death is real, and
not apparent.  These are taken in the order of their  importance.
 _ 1. The cessation of circulation and respiration.—The heart is con-
sidered to be the organ in which life begins and ends—the primum
vivens and ultimum moriens—the first to live  and the last to die.
The proof of death is the proof of cessation of the heart's action for
a certain period.  The more visible indication of death is the cessa-
tion of breathing, and in the opinion of the late Sir B. Brodie, the
entire cessation of breathing alone may be regarded as a decisive
test of the extinction of life.  The movements of respiration caunot
be overlooked  by any one  who does not  choose to overlook them
and the  heart never continues to act for  more than four or five
minutes after respiration has ceased.   The proofs of  the continued
action of this organ are,  however, less  obvious to  the unskilled 
INDICATIONS  OF DEATH.                61
observer, than the movements of the chest; hence the visible ces-
sation of these movements, i. e., of breathing, for a period of five
minutes  furnishes a certain  proof that the  person is really dead.
But the skilled observer would apply the test of auscultation, and
before giving an opinion would satisfy himself of the permanent
cessation of the heart's action.  It is impossible to admit that the
heart can remain for  even half an hour in a state of inaction in a
human being, and then spontaneously recover its activity.
  [The  case  of Colonel Townshend, mentioned  by Dr. Cheyne, is
an apparent exception to this rule.  He possessed  the remarkable
power of a seeming voluntary death, i. e., of suspending the action
of the heart and lungs for the period of half an hour.  His condi-
tion most probably resembled that of an animal  in a state of hyber-
nation, during which  the heart-beats are reduced to an extremely
low figure, and it appears to be actually dead ; but unquestionably,
the functions of both heart and  lungs are going on, though in a
very feeble degree.—R.]
  There are some forms of the disease affecting the nervous system,
as, for example, hysteria accompanied by tetanus, or coma and cata-
lepsy, the symptoms  of which are  occasionally  such as closely to
simulate death.  Respiration and circulation appear either to cease
entirely, or to be carried on so feebly, that, to  uninformed obser-
vers, the persons affected  may seem to be really dead.  Catalepsy,
or,  as it is vulgarly called,  trance, in which the person lies in  an
unconscious  state, may thus assume the appearance of  death ; but
the warmth of the body is retained, the limbs are  flexible, and the
heart and lungs continue to act, although less vigorously than
natural.   (For a remarkable case of this kind, see " Medical Times
and Gazette," 1870,  1, 495.)  Cases of  prolonged and profound
sleep of a natural kind, which have also been described as cases of
trance, cannot be mistaken for death.  Dr. Cousins met with a  re-
markable instance which  may be taken as the  type of others.   A
man of  healthy habits, forty-three  years of age, was at intervals
subject  to attacks of long and  persistent sleep.   He would retire to
bed at his usual hour, and, without any warning symptoms, sud-
denly and almost  immediately fall into a profound  sleep, from
which all the usual means would fail to arouse him.  In this state,
his face and ears were pale ;  the skin was pale and generally warm,
but his  feet were cold and livid, and the limbs quite relaxed.  His
pulse was soft, slow, and feeble; his respirations almost impercep-
tible, amounting to about eight or nine in a minute.  He appeared
like a person in  a refreshing, tranquil slumber.  There was  no
stertor or snoring.  The longest period he ever passed in profound
sleep was  five days  and five nights.  He  frequently  slept three
days and occasionally four days without waking, but his average
period was two days.   His secretions were suppressed, and no food
was required.  He commonly awoke suddenly, had no conscious-
ness of the lapse of time, and retained a good remembrance of the
last occurrences before he fell intQ this state.   He had no dreams.
(" Medical Times and Gazette," April 18, 1863, p. 396.) 
62
COOLING OF  THE BODY.
   2. Cooling of the body.—The average  temperature of the interior
of the livingbody in health varies from 98° to 100°, and this it re-
tains so long as life continues, whether the temperature of the air
is below zero or above 140°.  It is liable to be increased in some
diseases, and to be diminished  in  others.  In a case of typh^d
fever, the blood was found to have a temperature of 113 .   When
life  is extinguished, the body gradually  loses the heat which  it
possessed at the moment of death, just like so much  inert organic
matter  artificially raised  to the same temperature, and it  cools
down to the temperature of the  air to which  it is exposed.   The
time usually assigned for the cooling of the dead human body is
from fifteen to twenty hours, but it varies according to the condition
of the'body at the time of death, the mode of death, and the cir-
cumstances under which  it  has  been  placed.   Thus, if  exposed
naked to a cold atmosphere, the cooling is very rapid.  If the body
is well covered, the cooling takes place slowly.  When death has
taken place suddenly, from  accident, apoplexy, or  acute disease, a
body has been observed to retain its heat for a long period.
  Can  the warmth of the human body be retained in its normal
state for any length of time  after death ? We might  suppose, d
priori, that this question should be  at  once answered in the nega-
tive ; but  there are  numerous authentic  observations which show
that heat may be sometimes long  retained by the dead body, both
on the surface as well as in the cavities;  and it has been  noticed,
in certain  fatal  diseases, that the temperature has actually  risen
in the body after death.  This exceptional retention of heat has
given rise  to the erroneous suspicion that the person was still living.
Doubts were entertained for several days  respecting the death of
the well-known Professor Dieffenbach, of Berlin.  The unusual re-
tention of heat, and the  delay of  the putrefactive process, led to the
supposition that be was  only  in a state  of apparent death.
  It can scarcely be imagined that  the production of heat should
continue in a really dead body ; and yet certain  facts connected
with the  malignant  cholera, yellow  fever,  and other  diseases,
appear to  establish the possibility of this.  In some cases of death
from malignant cholera, when epidemic in this country, in 1832-3,
the body,  which  had  become moderately cold, was observed  sud-
denly to resume its warmth, so  that the temperature is stated to
have risen some time after death as high as 87°, although circula-
tion and respiration had entirely ceased.   In another instance the
temperature was observed to rise  from  79°  to 92° after death.
This singular  phenomenon, like  numerous others  connected with
that disease, has received no  adequate explanation.  According to
Valentin the occurrence of post-mortem heat is common  to all dead
bodies, the difference being only in degree.  It is said  to be most
rapidly developed after death from injuries to the nervous centres,
especially  the brain.   In cerebro-spinal  meningitis the temperature
has risen after death from 104° to 111° Fahrenheit, and in a fatal
case of  smallpox, attended with  much delirium, Simon observed
that the thermometer rose at death from  104° to 113° (" Lancet " 
CADAVERIC RIGIDITY.
63
1870, vol. i. p. 21).  This production of heat after the cessation of
breathing must be taken as positive evidence of some  latent vital
power or chemical force still lingering about the circulating system ;
for in real  death, the animal body, when it has once become cold,
is no more capable of spontaneously generating heat within itself,
than any of the inert and lifeless solids by which it is surrounded.
   In a case of  death  from Asiatic cholera, Mr. Rumsey observed
that half an hour  after the complete cessation of respiration and
circulation, the muscles of the arms underwent spontaneously vari-
ous motions of contraction and relaxation, continuing for upwards
of an hour, and that  although previously cold, they then became
evidently warmer.  The restoration of warmth after the body has
become cold in such cases, can only be explained by supposing that
there still remains about it some  lingering trace of vital action ;
although this may not be indicated by the presence of the ordinary
signs of active life.   The  facts  connected with  the  production of
heat in the dead  body have  not received  much attention  from
physiologists.
   Dr. John Davy met with some very high temperatures in the
dead body.  In a case of  rheumatism, after the viscera had been
exposed for nearly ten minutes, the mercury of a theremometer,
placed  under  the left ventricle,  rose to 113°, and when  in contact
with the  lobulus Spigelii of the liver, to 112°.   In a second sub-
ject, examined  six hours after death, the thermometer  under the
left ventricle indicated a temperature of 108°, and when in contact
with the lobulus Spigelii 107°.  In these cases, the patients were
ill but a short  time, and died suddenly ; and the temperature of
the  apartment in which  the observations  were made, was 86°.
This increase of temperature after death has been referred to putre-
faction ; but Dr. Dowler has shown that it takes place  soon after
death, and before rigidity  sets in.  Some of the cases reported by
Dr. Wilks and myself also show that it may take place independ-
ently of putrefaction.  (" Guy's  Hosp. Rep." Oct. 1863, cases 4, 26,
30, p. 184.)  Dr. Dowler has called this condition post-mortem calori-
city ; he has noticed it as a common occurrence, in a warm climate,
in the  bodies of persons who have died from yellow fever.   The
heat of the body, according to him, continues to increase  for several
hours after death.  The alleged effect of loss of blood in accelerating
the cooling of the human body when death has occurred suddenly
from hemorrhage, has no foundation in fact.   The  only physical
difference which it would  be  likely to create, would be by simply
reducing the amount of fluids in  the body to undergo the cooling
process.  In a well-marked case, the loss of four pounds made no
appreciable difference in the rate of cooling.
   3.  Cadaveric rigidity.  Rigor mortis.—In from  five to six hours
after death, and generally while the body is in the act of cooling,
the muscles of the limbs are observed to become hard and contracted
in the  attitude in which the  body is placed ;  the joints are stiff,
and  the trunk firm  and unyielding.  This peculiar condition is
known  under  the name of cadaveric rigidity.  The  first effect of 
64
CADAVERIC RIGIDITY.
death from  any cause is in most  cases a general relaxation of the
whole of the muscular system.   The  lower jaw drops, the eyelids
lose their tension, the limbs are soft and flabby, and the joints are
quite flexible.   The  muscular tissue may be considered as passing
through  three stages in a dead body.  1.  It is, at first, flaccid but
contractile, although it may be remarked  that  muscles  contracted
by living force in 'the act of  dying, do not necessarily become re-
laxed in  death ;  2. It becomes rigid and incapable of contraction;
and 3.  It is once more relaxed, and does not  regain its  power of
contractility.  The body now passes  into the  first stage of putre-
faction.  The  first stage  defines the duration of muscular irri-
tability ; the  second stage, that of  cadaveric rigidity ; and the
third, that of the commencement of chemical changes, or putre-
faction.
  The time at which rigidity occurs after death, as well as its dura-
tion, is affected by various circumstances.   It generally commences
within five or six hours, and lasts from sixteen to twenty-four hours.
Experiment shows that the seat of this phenomenon is in the mus-
cular system, for the rigidity disappears  immediately  on the re-
moval or division of the  muscles.  According  to the experiments
of Beclard and others, the rigid condition of the muscles is wholly
independent of the integrity of the nervous system : for a division
of the nerves leading to the particular muscles, or even  the entire
removal  of the brain, has not been found to prevent it, or to retard
its occurrence.  It haa also been observed, that when death has
taken place from  paralysis, hemiplegia, or apoplexy, the rigidity
has been as strongly manifested by the muscles of  the paralytic or
hemiplegic, as by those on the healthy side, provided they are well
nourished and retain some irritability.  The muscles of  shattered
limbs in  death from  comminuted factures, do not take on this con-
dition.   It is probable that the rigidity is due to a vital action in
the muscular fibre; and possibly, as John Hunter imagined, it may
be the last effect of the vital  force on the muscular system.   Ac-
cording  to Kussmaul the living  metamorphosis of the  muscle has
ceased ;  the muscle becoming rigid is a dying—the perfectly rigid,
is a dead muscle.  Rigidity is in general observed to  take  place
simultaneously with the coagulation of the blood  throughout the
body.  Some  have considered it to depend upon  this; but not to
mention that the alleged cause appears to be wholly inadequate to
the effect produced, the  rigidity sometimes occurs while the body
is warm and the blood fluid, therefore this cannot be the true ex-
planation : moreover, it closely resembles  the  rigidity  of syncope
and asphyxia, which can have no reference to the coagulation of
the blood.
   Ceteris paribus, rigidity is always more  strongly manifested and
continues for  a  longer period, in those bodies in which the mus-
cular system is healthy and fully developed.  It has been observed
that the time  at which it appears after death in muscular subiects
is longer than in other cases.                                   '
   In a case of death from hemorrhage, in which four  pounds of 
CADAVERIC RIGIDITY.
65
blood were suddenly lost from the axillary artery, it was observed
that eight hours after death the arms and legs were pliant;  and it
was not until twelve hours after death, when the body was becom-
ing cold, that rigidity  manifested  itself.   Death by  hemorrhage,
therefore, does not accelerate this condition ;  it appears to have no
more influence  upon the period of its occurrence than it has upon
the cooling of the body.  So with  regard to irritant  poisoning in
an acute form;  no difference was observed in reference to the rate
of cooling or the commencement of rigidity in a well-marked case
of death from arsenic, in eleven hours.   In a case of suffocation by
charcoal vapor, Nysten  observed that rigidity did not make its ap-
pearance  until  sixteen hours after  death, and it is stated to have
lasted for the long period of seven days.   In other instances of suf-
focation, this protraction of cadaveric rigidity has not been noticed.
  In these cases, the slow access of this state depends less  on the
mode of death  than on the irritability of the muscles at the time
of death.  This is always  great  when the nutrition of the muscles
is perfect, a condition which exists in cases of violent death, as from
decapitation, sudden hemorrhage, or some form of asphyxia.  Dr.
Symonds has seen a body in a state of rigidity eight days after death
by  hanging.  Nysten found that there was muscular irritability in
the body of a decapitated man twenty-six hours after the head had
been severed from the body ;  and Brown S^quard states as the gene-
ral result of his experience, that in the bodies of healthy persons
decapitated or asphyxiated, cadaveric rigidity did not appear sooner
than ten or twelve hours after death, and that it lasted more than
a week, even when the weather was warm.   He has  found in the
muscles of the limbs of two decapitated men some degree of irrita-
bility, thirteen and fourteen hours after death.
  According to Nysten, cadaveric rigidity first appears in the mus-
cles of the trunk and neck; it then takes place in the muscles of
the upper extremities, and lastly, in those of the lower.  In regard
to its disappearance, the muscles of the lower extremities will often
be found rigid while those of the trunk and upper extremities are
again in a state of relaxation.  In the particular limbs, it commonly
proceeds from above downwards, and it generally passes off  in the
same  order.  It  always sets in, increases,  and decreases  imper-
ceptibly and  gradually, in which respect it differs strikingly from
the rigidity of muscles as a result of disease.   (" Kiissmaul, Viertel-
jahrschrift fiir die praktische Heilkunde, 1856," B. 2, s. 67.  See
also a translation by Dr. Moore, "Dublin Quar. Jour. Med.  Sci."
1856, vol. 22, p.  490.)  A more  recent observer, M. Larcher, who
Btatcs that he has examined more  than six hundred  dead human
bodies, as well as the bodies of a great number of animals, assigns
the following course, unless convulsions may have been present at
the time of the death.   It commences in the lower jaw—affects the
lower limbs—and afterwards the neck and the upper limbs.  Those
muscles  which are the  first to become rigid are the longest to
retain rigidity.   ("Ann.- d'Hyg." 1869, 1, 469.)
  It will now be  necessary to consider whether a living body ever
      5 
66
CADAVERIC RIGIDITY.
assumes a condition analogous to that of cadaveric rig dity.  Te-
tanus, apoplexy,  catalepsy,  hysteria,  syncope  and asph} xia  nave
been  stated to" present  symptoms which  might lead to doubt re-
specting the reality of death from this sign.  There a^ho^ ,
these striking differences: in rigidity from any of these■dieses,
the warmth of the body  is commonly in great ^ preserved ^
not on the surface, in  the rectum and flexures of the joints  the
rigidity of disease takes  place simultaneously with the apparent
suspension of life from the attack; and  lastly, the whole of the
bodv becomes equally rigid at the same moment, owing to the ex-
istence of a universal muscular spasm.             m
   The observations of M. Brown Sequard have furnished an expla-
nation of many of the  difficulties connected with the  occurrence,
and disappearance of cadaveric rigidity.  _(" On the Relations be-
tween Muscular Irritability, Cadaveric Rigidity, and Putrefaction
"Proc. R. S."May 1861,  p.  204.)  This  physiologist  agrees^ with
Nysten and others that  the greater the degree of muscular irrita-
bility at the time of death, the later cadaveric rigidity sets in, and
the longer it lasts ; and the later also putrefaction appears, and the
more slowlv it progresses.   Miiller and Gierlichs had already shown
rio-idity does not occur until the muscles have lost their irritability,
ortheir power of contracting on the application of ordinary stimuli;
that in frogs, in  which, as in other reptiles, muscular irritability is
very persistent, rigidity is often not established until three or four
days after death ; that in birds, on the other hand, in which mus-
cular irritability remains but a  short time after death, rigidity
ensues quickly.  Further, all circumstances which  cause  a speedy
exhaustion of muscular  irritability during life, induce  an early
occurrence of cadaveric rigidity, while those conditions by which
 the appearance of irritability is delayed, retard its access.   (" Baly
 and Kirke's Physiology," 1848, p. 9.)  M. Brown Sequard observed
 as a result of his experiments  on animals, that when the tempera-
 ture of the muscles was diminished before death, their  irritability
 lasted long after death; cadaveric rigidity set in late, and lasted
 long; and putrefaction appeared late and proceeded slowly. What-
 ever exhausts muscular  irritability, such as violent exercise or ex-
 ertion, accelerates rigidity in the dead,  and, in an equal degree,
 putrefaction; this applies  to  observations on  man, as well as on
 animals.  Rigidity takes place rapidly in the dead bodies of cattle
 that have been overdriven, or of animals that have been hunted to
 death.  The bodies of soldiers killed in the early part of a battle
 become rigid slowly, while the bodies of those who are  killed  at
 the  close, after  many hours of violont muscular exertion, become
 rigid  almost immediately.  This may  explain the  singular fact
 recorded  by military men, that  the  dead  bodies are sometimes
 found on the field of battle stiffened in the attitude of  kneeling or
 sitting, with their weapons clenched firmly in their hands.  There
 has been no  relaxation in death, but the muscles appear to have at
  once passed from a living contraction into a rigid condition.  This
  also throws light upon a fact to be presently noticed, that suicides 
CADAVERIC RIGIDITY.
67
are sometimes found with weapons grasped in their hands, and
their bodies stiffened in the attitudes in which they have died.  It
may be inferred  in  these cases that  from  some cause  operating
during life, the muscular irritability was  exhausted at the time
of death.   Hence the greatest differences are observed to exist  in
regard to the commencement of cadaveric rigidity and putrefaction,
in consequence of the variable degree of muscular irritability  at
the time of death.  Dr. Brinton, U. S., has  recorded his  experience
in this curious subject during  the American war.  In  many who
had died instantaneously from  brain  and heart wounds, the body
was rigid  throughout,  and  the position was that of the last mo-
ment of life.  He has  called this instantaneous rigor.  After the
battle of Antietam in 1862,  he counted within a small space forty
dead  bodies, mostly with chest wounds.  There were  some with
their armes raised  rigidly in the air, and others with  their legs
drawn up and fixed.  In not a  few the body was curved forwards
and fixed.  These attitudes were not those of the relaxation of
death, but were  rather of a seemingly active  character, and the
muscles  remaining rigid and inflexible as the  result of spasmodic
muscular action in the last moment of life.  (" Amer. Jour. Med.
Sci.," Jan. 1870, p. 87.  Also  "Lancet," 1870, 1, 276.)  In refer-
ence  to  deaths from malignant cholera, Brown Sequard observed,
that  cadaveric rigidity appeared late  and lasted  long in those
patients who  died quickly,  that is,  before a prolonged alteration of
nutrition, and that  those muscles which had been attacked with
violent and frequent cramps, became rigid very soon after death,
and remained so  only for a short time.  M. Ollivier found that the
bodies of cholera patients were  frequently rigid in from six to eight
hours after death, while the muscles which were the seat of this
rigidity were  still warm, and on making an incision into them, the
blood readily  flowed out.
   A similar error has arisen respecting the bodies of persons killed
by lightning.   John Hunter thought that cadaveric rigidity did
 not occur  in this mode of violent death ; but the late Sir. B. Brodie
 found that the body of an animal killed by electricity became, as
 usual, rigid after death.
   In an accident which occurred in France, in August, 1846, a group
 of laborers was struck by the electric fluid : four were killed on the
 spot, and five or  six severely wounded.  It was remarked that  the
 person whose body  bore the most  extensive marks of  injury had
 worn a goat-skin.  There were several lacerations about this body,
 and in three  hours after death it became perfectly rigid.  (" Med.
 Gaz. " vol. 38, p. 351.)  In  a case of death from lightning,  commu-
 nicated  to the " Medical Gazette," by  Dr. F.  J. Brown,  rigidity
 was strongly  marked in the limbs about twenty-eight  hours after
 death (vol. 47, p. 844).  In  May, 1854, during a storm, a man was
 struck by the electric fluid.   He made a short exclamation, and
 immediately expired.  It was  observed in this case that the body
 became rigid  after death.   Facts are now sufficiently numerous to 
68
THE EYES.
 enable us to say that the old opinion of the  non-occurrence of
 rigidity in the bodies of  persons killed by lightning is unfounded.
   At a certain  period after death, the heart is found  rigid and
 firmly contracted.  If examined at this time, it may appear to be
 in a state of spasm, and to have its walls thickened, while the cavity
 of the left ventricle may be described as being much smaller than
 in the normal state.   Sir James Paget has  pointed out that this
 natural condition of the heart after death has led to pathological
 mistakes, the walls being described as thickened, and the cavities
 diminished in size, and the heart itself as being in a state of con-
 centric hypertrophy from disease.   On the other hand, the perfect
 relaxation of the heart which follows at a later period after  death,
 has  been mistaken for, and described as a morbid flabbiness and
 flaccidity.  Spasm and paralysis cannot be inferred to have existed
 when we discover these conditions of the heart in the recently dead
 body.
   Under the action of poisons like  strychnia, and those alkaloids
 which cause death by convulsions, the more violent and frequent
 the convulsions, the sooner cadaveric rigidity sets in.
   4. The Eyes.—Shortly  after  death, the cornea becomes dull, its
 brightness and prominence disappear, the globe becomes  collapsed,
 and, after a time, the  surface of the membrane is wrinkled.   Louis
 long since  observed, that the eyes of  the dead became flaccid and
 soft  in a very few hours after dissolution, and that a film was
 formed over them ; this condition he considered to be characteristic
 of death.   It is necessary to observe, however, that while this  ap-
 pearance is not always met with in  the dead  body, it is sometimes
 found in the living.   In those who have died from apoplexy, or
 from the inhalation of carbonic acid gas, the eyes have  often pre-
 served their brilliancy and prominence for a length of time.  This
 has also been observed in those who have been poisoned by prussic
 acid, cyanide of potassium, or the essential oil of bitter almonds.
 Incipient putrefactive changes may, by forcing the blood towards
 the  head, cause a prominence and brilliancy of these  organs,  in
 those bodies in  which they were  dull and collapsed soon  after
 death.  On the other  hand, the film over the eye and the collapse
 of the globe have been  observed  in cases  of  malignant cholera
several hours before death, and while the heart  was" still beatino-.
 (" Ann. d'Hygiene," 1848, 1, 104.)                              °
   M. Larcher has  pointed out a new sign which he calls cadaveric
 imbibition of the globe of the eye.   This appears in the shape of a
 blackish  stain on  the  sclerotic coat on the outer side.   This is at
 first slight, but becomes gradually deeper.  It  is followed  by a
 similar patch or spot on the sclerotic in the  inner  side.   They ex-
 tend towards  the  centre  of the eye, approaching  each  other, and
forming the segment  of  an ellipse.  This appearance is probably
due to the sclerotic becoming thinner in these parts by evaporation
and the dark pigment  showing itself through it.  M. Larcher de-
scribes this mark as  the  forerunner of  putrefaction,  following
rigidity, but preceding even the green tint which is seen in  the 
         THE  SKIN—COAGULATION OF  THE BLOOD.       69

skin of the abdomen at the commencement of this process.   (" Ann.
d'Hyg.,  "1869, 1, 468.)   Kiissmaul  states  that no conclusion  can
be drawn from the width of the pupils in death, as to the diameter
which they presented at the latest period of life.  This statement
is of some practical importance in reference to post-mortem appear-
ances, in cases of alleged narcotic poisoning.  M. Ripault noticed
that in real death, the' iris is perfectly flaccid.   This is seen when
the globe is compressed in two opposite directions at the same time.
If the person is living, the pupil retains its circular form, notwith-
standing the compression.  If dead, the circular form is lost, and
the aperture becomes irregular.  Dr.  Fleming has noticed that  a
solution  of atropia, which by causing dilatation of the pupil would
in a few minutes reduce the living iris to a mere line, has no action
on the iris of the.dead eye; but this result probably depends on
the time after death at which the  liquid is applied.  Jobst and
Hesse found that two drops of an aqueous solution of physostigmia
(the poisonous alkaloid of the Calabar bean) applied to the  eye of a
rabbit an hour  after death from natural causes, caused the pupil to
contract  to one-fourth, compared with the  other eye, and it re-
mained in this condition.  (" Chem. News," March 5, 1864, p. 109.)
In cases  of catalepsy or trance simulating death, the pupil retains
its contractile power.   It contracts under a strong light, and dilates
when  the light is withdrawn.  In  real death, the pupil is not af-
fected by light.
  5. The Skin.—After dissolution, the skin  is observed to become
extremely pallid and waxy-looking, owing to the absence of all cir-
culation. In some parts it becomes covered, as the body cools, by
livid  discolorations (cadaveric ecchymosis); this is especially  the
case in those instances where death has taken place by sudden vio-
lence.  One of  the most striking changes in the skin is its entire
loss of elasticity.   In  the living body, if any part of the surface be
compressed, the skin will readily return to its original form on re-
moving the pressure.   Thus, in a doubtful case, a flatness of those
parts  which have been allowed to lie upon an even surface may be
regarded as a sign of  real death, provided the other concomitant
changes  are observed.
  6. Coagulation of the blood has been enumerated among the signs of
death.  M. Donne* suggested that, in order to determine the reality
of death  before the access of putrefaction, a small portion of blood
should be drawn  from a vessel, and it should then be observed
whether  it coagulated or not.  If instead of a red homogeneous
coagulable liquid, we  obtain only a  reddish  colored uncoagulable
serum, from which the particles speedily subsided as a red sediment,
we shall  be justified in inferring that life has ceased—a conclusion
at -which we could not arrive if even the smallest portion of coagu-
lum should be formed.   This appears to be a fair physiological test,
and easy of  application.  When the blood  has once coagulated,
there  must be an arrest of circulation ; and although it might be-
come  again fluid,  this would be only under the influence of putre-
faction, and it  would not thereby  recover a coagulating power. 
70
PUTREFACTION.
One of the great characters of blood effused from a living body is,
that it coagulates speedily after its effusion.  Blood sprinkled from
a dead body is more liquid ;  it has less coagulating property.  _
  The blood coagulates in most cases after death, but at a variable
time after the  cessation of the heart's action.  When blood is re-
moved from the living body, coagulation commences in from five
to ten minutes.  In the dead body, it probably does not commence
until it begins to cool.   Hence the  fact of coagulation does not
prove that the person is living.  Dr. Wilks has observed that when
a body is examined eight or ten hours after death, it is notunusual
to find the blood which may have flowed from it as a liquid, form-
ing a firm clot on the table ; and that which is effused  into the
chest  during the examination often  forms after some  time a very
firm coagulum.  (" Guy's Hospital Reports," Oct. 1863, p. 183.)  It
has been stated that the blood of  persons killed by lightning does
not coagulate, but this  statement is erroneous.   Certain diseases
appear to influence the coagulation of the blood.  Mr. Savory has
observed that coagulation has been partial or imperfect in cases of
death from delirium tremens; and it is well  known that in rapid
death from  certain vegetable poisons the blood is found  fluid and
of a darker color than natural, even when the examination is made
soon after death.
  If we allow a proper interval to elapse after the supposed death
of a person, there can be  no difficulty in  solving  the question,
whether the body is really dead, even before any of those changes
which arise  from putrefaction have  manifested  themselves.   The
circumstances on which we  may rely as furnishing  conclusive evi-
dence  of death, are the  following: 1. The absence  of circulation
and respiration for at least an hour, the stethoscope being employed
if necessary; 2. The gradual cooling of the body to the temperature
of the air, the trunk remaining warm while the members are cold;
and 3. As the body cools, a gradual supervention of a rigid state
of the muscles, successively  attacking  the limbs and trunk, and
ultimately spreading through the whole muscular system.  When
these conditions are observed, the proofs of death are conclusive;
it is  unnecessary  to wait  for  any  sign of  putrefaction.  These
changes are as certainly the forerunners of putrefaction as the pro-
cess of putrefaction is itself the forerunner of the entire destruction
of the body.  I believe it may be safely said that there has not been
a single instance of resuscitation after rigidity had once commenced
in a body.  During the raging of epidemics, if additional evidence
be required for early burial, it might be obtained by exposing a
superficial muscle to the galvanic stimulus.  If  the fibres do not
contract, death is certain.   If  they do, this  is no proof that the
person can  be restored to active  life;  but further time may be
allowed before the body is committed to the grave.
   Putrefaction.—By putrefaction we are to understand those chemi-
cal changes which spontaneously take place in dead animal matter
during which offensive gases are evolved. . The ultimate effect of
these changes is, after a  longer or shorter period, to  reduce the or- 
PUTREFACTION.
71
ganie to the condition of inorganic compounds, consisting chiefly
of water, ammonia, and carbonic acid.  It is in the stage of transi-
tion that  noxious effluvia are  evolved  from which the  process
derives its name.  These consist of compounds of nitrogen, sulphur,
phosphorus, and carbon with hydrogen.
  This process does not  begin to manifest itself in the dead body
until after the cessation of cadaveric  rigidity, and generally about
the third day.  It is then observed, if the body has been exposed
to the atmosphere in an apartment of mean temperature (60°), that
the  limbs  and trunk become supple  and pliant, and yield a faint
odor.  The skin covering the abdomen becomes of a pale greenish
color,  which  gradually  deepens.  A similar  discoloration slowly
makes  its appearance in the  chest, between the ribs, in the  face,
the neck, the  legs, and lastly, in the  arms.   The color appears to
depend on the decomposition and infiltration of the animal fluids,
especially the blood, into the skin.   In the neck  and limbs it is
observed to be more  marked in the  situation of the  large venous
trunks; and sometimes, indeed, the course of the superficial veins
is accurately traced out by greenish-blue or dark lines, which have
been mistaken for marks of violence.   Gaseous products are formed,
not  only in the hollow  organs of the abdomen, but beneath the
skin generally, so that on making an incision, the edges of the skin
are rapidly forced apart  or everted.   The reaction of  this confined
gas accounts for the occasional escape of alimentary and fecal matter
from the outlets ; as also for the escape of blood some days after
death from wounds involving any of  the large veins.
  Putrefaction takes place with  variable rapidity.   It commonly
shows itself about the second or third day in warm  weather, and
about  the  fifth or sixth  day in cold weather.  In some  instances,
however, the body has been  found in an advanced  state of putre-
faction in the short period of sixteen hours after death, and in others
the process has  been greatly protracted.  The time of its  appear-
ance is dependent  on the duration  of cadaveric rigidity, and  the
condition of the body at  the time of death.
  It never begins until cadaveric rigidity has ceased, and therefore
not until the muscles of the  body have entirely lost their irrita-
bility.  Whatever conditions of the body during life or after death
may operate to  cause the disappearance  of muscular irritability,
will pari ]mssu accelerate rigidity and putrefaction,  and vice versa.
  There are three primary conditions which are indispensable to the
establishment of this process in a dead body.  These are: 1st, a
certain temperature; 2d, the presence of moisture; and 3d, the free
access of air.
  Temperature.—The process is found to go on most favorably in a
temperature varying from 70° to 100°.   It will commence, other
circumstances  concurring, at any temperature above 50° ; but at
32° it appears to be wholly arrested.   The dead body may thus be
preserved a considerable  time in snow, ice, or in a frozen soil;  but
if, after removal, it  is exposed to a temperature between 70° and
100°, the  ordinary putrefactive changes are  stated to take  place 
72
PUTREFACTION.
with  more than  their usual rapidity.  At a high temperature,
again, i.e., about 212°, putrefaction  is arrested.  The soft  animal
solids lose their water, become hard and brittle masses, and may
now be exposed to the atmosphere without undergoing any further
change.  A heat  between 100° and  212° may also  speedily put a
stop to the process, by causing a rapid evaporation of the water
contained within the  solids.  They become  thereby dried and
coagulated.  Thus it is that bodies buried in the hot and  arid sands
of Egypt are dug up,  many years after interment, in the state of
desiccated mummies, putrefactive decomposition having beenlong
since arrested.  The effect of temperature on this process is strikingly
seen in the influence of season.   A dead body exposed to air  during
summer, when the  thermometer is above 60° or 70°, may undergo
more  marked putrefactive changes  in twenty-four hours  than, a
similar body exposed for a week or ten days in winter.   This is a
fact which demands consideration, when an opinion is required to
be formed respecting the date of death of a body concerning which
nothing is known.
   The presence of moisture.—Unless  the animal  substance  is im-
pregnated with water or  moisture, it is impossible  that putrefac-
tion can take place.  The animal solids commonly contain sufficient
water for the spontaneous establishment of the process.  In a human
body weighing 150 lbs., there are about 100  lbs. of water  (" Brande
and Taylor's  Chemistry," p. 831).   The soft organs differ  much
from each other  in respect  to the  quantity of liquid  contained
in them, and therefore in the degree in which they are prone  to
putrefaction.   Thus the brain and the eye  are in this respect con-
trasted with the teeth, bones, hair  and nails.   The fluids  of the
eye are rapidly decomposed, while the teeth and hair may remain
for centuries unchanged.
  Influence of air.—Putrefaction  may take place to a slight extent
independently of  air, but  the process is soon arrested; and  hence
bodies sealed permanently in leaden  coffins  are found  perfect and
may be identified after very long periods of time.   The products
in all cases in which air is excluded, are chiefly of an ammoniacal
nature.   Air operates by its free oxygen combining with the ani-
mal elements, and forming gaseous and liquid products.
  [Besides these external causes,  there are others, subjective or in-
herent in the body, such  as  age, sex, state of the body,  manner of
death, influence of disease,etc.  Aged bodies decompose slowly, pro-
bably on account of their comparative want of moisture, whilst the
bodies of new-born children rapidly putrefy, for the opposite  reason.
H at and flabby bodies undergo decomposition more rapidly than lean
ones, because they contain more fluids; the same is said to be true
of the bodies of women dying in childbed.  In cases of very sud-
den death in  persons of previously  sound health, putrefaction  is
more rapid than when  it  has resulted from an  exhausting disease.
TV hen the blood has been impoverished, as in typhus, and when
the body has  previously been much  contused (provided  it has not
been protected from the influence of the air, as when buried under 
         CADAVERIC  LIVIDITY  AND ECCHYMOSIS.        73

rubbish), the process of decomposition is  accelerated.   It is also
rapid after  death from suffocation by smoke, coal-gas, or sulphur-
etted hydrogen;  also by  strangulation, drowning, and asphyxia
generally;  also  after narcotic poisoning;  but it is slower after
death from phosphorus, alcohol, sulphuric acid and arsenic.
  The order of decomposition of  the internal organs, according to
Prof. Casper, is as follows: Trachea and larynx, brain of young
infants, stomach  and intestines, spleen, omentum and mesentery,
liver, brain of adults, heart and lungs, kidney, bladder and oesopha-
gus, pancreas, diaphragm, large vessels (especially the arteries) and
last of all, the uterus. —R.]
  Cadaveric  lividity and ecchymosis.—There are certain external
changes which  take place in a dead body before the  access of, or
during putrefaction, to which it is necessary that a medical  jurist
should attend.   There is what is  called cadaveric lividity, which
comes on during the act of  cooling.   At  a  still more advanced
period, dark livid spots or patches are met with in the skin, to
which the name of suggillation or post-mortem ecchymosis has been
given (see " Henke  Zeitschrift der  S. A.," vol. i. p. 199).   These
appearances have often been  mistaken for the effects of violence
applied during life, and serious mistakes have thence arisen.  Inno-
cent persons have been  accused  of  murder or manslaughter, and
have been  tried  on charges afterwards proved to be groundless.
Sir R. Christison refers to two cases, in one of which  two persons
were convicted, and in the other, three narrowly escaped convic-
tion, upon a mistake of this kind.
  These spontaneous changes in the dead body must, therefore, be
attended to  by the surgeon.   They may be  considered by dividing
them into  those which  take place before  putrefaction,  and those
which take place afterwards.
  The first form  (before putrefaction) is dependent on a stagnation
of blood in the capillary vessels.  So long as there is life, the capil-
lary circulation continues.   This may be ascertained by puncturing
the  skin or lip  with a fine needle; if the  capillary circulation is
going on, a  drop  of blood will escape, otherwise not.   When after
death the capillaries have lost their contractility, the blood appears
to stagnate in them in an  irregular  manner, producing  lividity.
The skin of the body, although pale at the time of death, becomes
covered  during the act of cooling by extensive patches of a bluish
or slate color, diffusing  themselves over the greater  part of  the
trunk and limbs. The color is sometimes of a deep purple, often
mottled,  but generally  abruptly terminating in the  white skin.
This kind of ecchymosis is chiefly seen on the bodies of those who
have died suddenly in full health^ or* by a violent death, as in apo-
plexy, hanging,  drowning,  suffocation from charcoal vapor, and
other causes.  In the latter case, it has been found in some instances
to be especially developed.   It is rarely seen in the bodies of those
who have died from loss of blood; the skin is in these cases com-
monly pallid.  When the skin in which the lividity is seated is
divided, it is seen that the  color is  confined to the upper layer of 
74       CADAVERIC LIVIDITY AND ECCHYMOSIS.
the true skin (cutis), or to the space between the cuticle and cutis,
and  never to extend through the latter.  There is no sanguineous
effusion, but apparently a simple congestion in the minute capillary
vessels.
  Sometimes this  lividity is disposed in a peculiar  form over the
body.  If a stout and muscular person has died suddenly, and the
body, wrapped  closely in  a  sheet, is allowed to cool, the lividity
may be sometimes  disposed in the form of  a number of stripes or
bands over the whole surface—the congestion of the vessels taking
place in the interstices of the folds, while the parts  actually com-
pressed remain white. The appearance of the body is such that we
caa hardly divest our minds of the idea that the person must have
been flogged.  The unbroken  state of the cuticle, with the other
characters just  now mentioned, are, however,  sufficient to distin-
guish this appearance from  the effects of violence.   This kind of
lividity is known under the name of vibices.   It is often seen on the
backs of  subjects that have been allowed to  cool either in their
clothes or on any rough and uneven surfaces.  A few years  since
I saw a well-marked case of vibices, in which the suspicion was so
strong that violence had been used to the deceased, that a coroner's
inquest took place.  The forepart of the body was covered with
stripes, which were of a red  and livid color:  they appeared to cor-
respond exactly to  the folds of a sheet drawn tightly across the
chest; and it was  subsequently ascertained that the body of the
deceased  had been  treated in this  manner after death.  The blood
was superficially diffused, and the cuticle uninjured.   The circum-
stance above mentioned at once satisfactorily explained the cause
of the appearance.   These vibices  or weals, like the  cadaveric livi-
dity already described,  are  commonly seen  in plethoric persons;
they indicate great vigor of circulation at the moment of death.
But  lividity in the dead body occasionally presents itself under a
more deceptive  form than in either of the instances just mentioned.
This is well shown in the case of a man who died in November,
1837, on  board of the Dreadnought hospital ship.   The subject of
this  case, set. 33, died suddenly from disease  of the heart.  Just
before death the deceased had been auscultated, and no  marks then
existed on the  skin.  The body, after about eighteen hours, was
examined, and  then it was  found to present, in detached places,
patches of discoloration or ecchymosis, varying in size  from  small
spots to several inches in  diameter.  Although closely simulating
bruises or marks  of violence  during life,  a slight  examination
showed that they were  owing to  simple lividity, because  those
parts of the back and limbs which were not compressed by the sur-
face  on which the  body of the deceased was  lying, were the only
parts discolored.   The calves of the legs, the  loins, and the back,
which bore the pressure, were white.  On cutting into these patches',
the layers of the skin, as well as the tissues beneath, were throuo-h-
out  reddened by congested blood, and small  rounded  semi-coagu-
lated masses oozed out  from the cellular  membrane on slight
pressure. 
ADIPOCERE.
75
   These characters somewhat resembled those produced by violence
on the living body ;  but there was another, and, I believe, an unex-
ampled circumstance, in which the resemblance to vital ecchymosis
existed.   Around many of the patches there was a wide border, or
zone, of a pale straw color, with various shades of green and blue,
precisely similar to those which are seen in the gradual disappear-
ance  of  an  ecchymosis from the  living body.  By most medical
jurists it has been hitherto considered that the zones of  color are
peculiar to vital ecchymosis, and are never seen in the ecchymosis
produced after death.  The occurrence of this case  shows with
what caution general rules should be framed for  medico-legal prac-
tice.  Had  the body of this person  been  found lying dead and
exposed on a high road, and had it been proved that another man
had been seen quarrelling with him, what might  have  been the
opinion  expressed ?   We can scarcely hesitate to say, unfavorable
to the accused  person.  This kind of ecchymosis could have been
distinguished from that of violence during life only by the unruffled
state of  the skin, and the slight effusion of blood, compared with
the extent of discolored surface.  It is worthy  of note, also, that
the chief seat of ecchymosis was in those parts which were recum-
bent  or  depending.   The formation  of the colored zones  around
some of the patches  of lividity was fully explained by the fact of
the man having labored under general  dropsy.  The serum effused
in the cells here  acted upon  and diluted  the liquid blood, as it
exuded from the vessels, and diffused it around, much in  the same
manner as the serous exhalation of the  cellular membrane acts on
the blood effused in the living body.
   Adipocere.—The substance called adipocere was first observed and
described by Fourcroy during the  removal  of vast  numbers of
bodies from the Cimetiere des Innocens in Paris.  He gave to it this
name, owing to its properties being intermediate between those of
wax and fat.  He considered it to be constituted of  fatty matter
and  ammonia.  From an  analysis by Chevreul, the substance de-
scribed by Fourcroy was proved to be a real ammoniacal soap with
some extraneous   coloring  matter, which gave  it a yellowish or
brown color.  It contained, besides, a bitter substance not defined,
and an odoriferous principle, to which it owed its smell.  Chevreul
also  detected  in  some specimens, lime, potash  and  salts.  The
composition of adipocere does not appear to be uniform : it is liable
to vary according to  the nature of the medium to which  the body
has been exposed.  Thus, in hard or river water, the white sub-
stance so called, discovered in the dead body, is formed of a base of
lime ; so, in bodies laid in graves or vaults which are traversed by
springs of water containing sulphate or carbonate  of lime, an adi-
pocere of stearate  and oleate of lime is found as a hard white solid.
It is not improbable,  as Orfila  has suggested, that in  the first
instance an  ammoniacal soap is produced, and that this is subse-
quently converted  into a calcareous soap by contact with calcareous
water.
  Any part of the human body may undergo this  change, but all 
76
ADIPOCERE.
parts are not equally susceptible of it.   In order that the adipocere
described by Fourcroy should be found, it is indispensable that the
animal fat should be in contact with substances containing  nitro-
gen. Experiment has clearly established that neither pure fat, nor
pure fibrin, when kept apart, will become saponified.  Orfila  found
by comparative experiments, that the skin deprived of all fat did
not undergo this change; but when the fat was allowed to adhere
to it, it became saponified.   Upon the knowledge of these facts, the
following theory of the production of adipocere was founded.  The
fat, containing  no  nitrogen, could  not furnish ammonia; conse-
quently it could not spontaneously change  into  this substance.
The fibrin of the muscular system' was therefore supposed to pro-
duce ammonia  by giving  off hydrogen  and nitrogen ; and this
alkali combined with the fatty acids of  the body to  form a soap
(see " Ure's  Dictionary," art. Adipocere).   As the fat of the body
is contained in a cellular membrane  (a nitrogenous compound), and
is traversed by the  blood and other nitrogenous fluids, the nitrogen
is as readily furnished by  these as  by the fibrin of the muscles.
So again, the skin and fat, separated from the muscles, will become
converted into adipocere.  The fibrin of muscles, therefore, although
unquestionably it may be one source  of the ammonia, is not the sole
source.   Oil or fat  exists throughout the soft  organs and tissues of
the whole body; hence every part may undergo this transforma-
tion. ' When the change is complete, the  body maintains  its con-
dition  for many years.  Thus,  in  one instance, after seventeen
years' burial in a grave, an exhumed body  was found to be con-
verted  into  this substance, and  many of  the organs could still be
identified ("Phil. Med. Exam.," April, 1847, p. 247).
  The  period  required for saponification  to  take  place varies
according to circumstances.  Devergie states that the body of a
newly-born child in the soil of- water-closets may become  entirely
saponified in from  six weeks to two months ; while in a drowned
subject in water, saponification may  be partially met with in three
or four months; and in one buried  in a damp grave, from two to
three years may sometimes elapse before saponification is complete.
There is  no  doubt, however, that the process may take place par-
tially in the  dead body within much  shorter periods than these.  A
body floating in water has  been found converted into this adipo-
cerous  state in a little  more than five weeks ; and with regard to
the period in an ordinary grave, I may refer to the case of a female,
exhumed at Bristol,  in 1835, after fourteen months' interment.
The lower part of the body was here found adipocerous. It appears
that the grave was very damp, and  the line of adipocerous  trans-
formation in the deceased was bounded by the  level to which the
water had reached.   These  facts are of  more importance than may
at first sight appear, since a legal question of survivorship, in at
least two cases, has turned upon the shortest period required for
the production of true adipocere in the dead body.
  Properties of adipocere.—Fourcroy and  other French  chemists
describe  adipocere  as an unctuous, soapy substance,  varyino- in 
INSPECTIONS.
77
color from a pale white to various shades of yellow or brown.  In
the first instance it is soft, but becomes harder and lighter in color
when dried.  It melts at 200°, and when strongly heated in air
gives oft* an ammoniacal odor, inflames, and burns.  It is easily
suspended in cold water, and  forms  an opaque mixture on boiling.
Acids decompose the solution by combining with the bases, forming
salts.   When heated with  lime, ammonia is evolved.  It  is  only
partly dissolved by boiling alcohol.  Adipocere with a calcareous
base is  harder  and whiter than  that which  contains ammonia.
There is no trace of organic structure in either.
  Inspections.—The necessity for appointing a skilled independent
inspector of bodies in all suspected  cases demanding inquiry, will
be apparent from other considerations.   Under the present  system,
a person who has destroyed the life of  another by poison  may be
present at the post-mortem inspection of the body  of  his  victim,
and may use his efforts to defeat the objects of the inquiry.  Wil-
liam Palmer, a medical man, was thus allowed to  be present at the
inspection of the body of Cook.  He nominated the  persons, one of
them an inexperienced young man who had never before inspected
a body in a case of death from poison, and he stood  over  them while
they were  engaged in the office.   The stomach  of the deceased
when received  for analysis was cut open throughout its length.
The injury to this organ, by which at least a portion of the contents
was lost, occurred during the inspection, and is said  to have arisen
from Palmer having accidentally (as it was alleged) pushed against
the youth who was making the inspection 1  After  the vicera had
been placed in a jar and secured with a bladder, Palmer found an
opportunity of  cutting the bladder with a knife and inverting the
jar, and this probably led  to a further loss of  the contents.   In a
case of exhumation in which  I was  consulted, the  viscera had been
carefully removed  and placed (as it  was supposed) in separate  jars,
which were properly secured and labelled.  When the  jar  labelled
" Stomach and Contents"  was opened  by the analyst  to whom it
had been sent, it was found empty.  From inquiries subsequently
made, there was but little  doubt that a person who was interested
in preventing an analysis was permitted  to be present at the inspec-
tion, and that he had  taken the opportunity, when the inspectors
were otherwise occupied, of  removing  the stomach from the jar
and again secretly returning  it into the abdomen  before the body
was sewn up, or otherwise disposing  of it. Acts of this kind should
be impossible in the present day, and the best security against their
occurrence  would be the appointment of a skilled  inspector  in  a
district, to  conduct all  post-mortem examinations for coroner's
inquests.
   A charge of malapraxis is sometimes raised against a  medical
man, in consequence of the  death of a patient. The examination of
the body may, by order of a coroner, be unknowingly placed in the
hands either of a professional rival,  or of a friend  of the person in-
culpated.  This is not just, either to the practitioner or the public.
There is nothing more easy, medically speaking, than to exaggerate 
78
INSPECTIONS.
appearances in a body, or to assign to the action of medicines, or
to the use of surgical instruments, post-mortem conditions to which
an independent  and experienced anatomical inspector would pro-
bably attach no importance.  Supposing the question to be that a
patient  has died from an overdose  of  opium, said to  have been
found in  the  stomach—if the  analysis  has  been intrusted by  a
coroner to any  professional rival, or to an incompetent  analyst
selected by him, the injury done may  be irreparable.  These  are
not imaginary cases: they have occurred and must occur until
special inspectors and analysts  are appointed in place of men who
are now taken by chance, by the fact of their living in the vicinity,
or of their being called to  see the person while dying.
  [In cases involving the all-important issues of life and death, we
cannot but regard it as a serious error to commit the responsible
duty of the exhumation of a body, and its subsequent anatomical
and chemical examination exclusively to the State's  experts, where
no opportunity is allowed to the experts for the defence to be pre-
sent.  To say the least, such a  procedure has very much of an ex
parte look, and must necessarily  subject the persons thus  profession-
ally employed to a suspicion of prejudice.   In the " Review" of
the Wharton-Ketchum trial (" Amer. Journ. of Med. Sci.," April,
1872) we took occasion to condemn this practice  as unfair  both to
the accused and to the cause of j ustice.  In this case, the body of
the deceased was thrice examined,  and exclusively by the State's
expert witnesses; and, on one of these occasions, secretly—without
even the knowledge of the counsel for the defence!—R.] 
DEFINITION  OF A POISON.
79
POISONING.
                      CHAPTER IV.

DEFINITION  OF  THE  TERM  POISON.—DEADLY POISONS.—MECHANICAL
  IRRITANTS.--LAW IN RELATION TO THE ADMINISTERING OF POISONS.--
  INFLUENCE OF HABIT AND IDIOSYNCRASY.—CLASSIFICATION.—SPECIAL
  CHARACTERS OF IRRITANT, CORROSIVE AND NEUROTIC POISONS.

  Definition.—A Poison is commonly defined  to be a  substance,
which, when  administered or taken in small quantity, is  capable of
acting deleteriously on the body; in popular language, this term is
applied only to those  substances which destroy  life in small doses.
This popular view of the nature of a poison is too restricted for the
purposes of medical  jurisprudence.   It would obviously exclude
numerous compounds, the poisonous properties of which cannot be
disputed—as, for  example, the  salts of copper, tin, zinc, lead, and
antimon}7;  these,  generally speaking, act as  poisons only when
administered in large doses.  Some substances, such as nitre, have
not been observed to  have a noxious action except when taken in
large quantity, while arsenic acts as a poison in a small dose; but
in a medico-legal view, whether a  man dies from the effects of an
ounce  of nitre, or two  grains of arsenic, the responsibility  of the
person who criminally administers  the substance,  is  the  same.
Each may be regarded as a poison, differing from the other only in
its degree of  activity, and in  its mode of operation.  The result is
the same; death is caused by the substance taken, and the quantity
required to destroy life, even if it could be always accurately deter-
mined, cannot enable us  to distinguish  a poisonous from a non-
poisonous substance.   If, then, a medical witness be asked " what is
a poison?"  he must beware of adopting this popular definition, or
of confining  the  term  poison to a substance which is  capable of
operating as such in a small dose taken at once.
  In legal  medicine, it is  difficult to give such a definition of a
poison as shall be entirely free  from objection.  Perhaps the most
comprehensive which can be suggested is this: "A poison  is a sub-
stance which, when absorbed into the blood, is capable of seriously
affecting health, or of destroying life."  There are  various  chan-
nels bv which poisons enter the blood ; some are  in the form of gases
or vapors; these operate rapidly through the lungs;  others are
liquid  or solid, and these may reach the blood  either through the 
80
MEDICINES AND POISONS.
skin or through a wound;  but more commonly through the lining
membrane of the stomach or bowels, as when  they are taken  or
administered in the ordinary manner.  The latter chiefly give rise
to medico-legal investigations.  Some substances act as poisons, by
any one  of these  channels ; thus arsenic is a poison whether  it
enters the  blood through the lungs, the skin, or the stomach and
bowels; but such poisons as those of the viper, of rabies, and of glan-
ders, appear to affect the body only through a wound in the skin.
When introduced into the stomach, these animal poisons have been
found to be inert.  In adopting the above definition of a poison in a
medical sense, it is proper to remark that there are some substances
which are regarded as poisons, although absorption into the blood
does not appear to be necessary to their action. The mineral acids and
alkalies belong to this class of bodies.  They are corrosive poisons;
they operate injuriously  by causing the destruction of living parts;
and whether applied to  the skin, the stomach, or (in the form  of
vapor) to the  air-cells of the lungs, they destroy life by the local
changes to which they give rise, and the inflammation which is a
consequence of their action.
  It is not easy to define the boundary between a medicine and a
poison.  It is  usually considered that a medicine in a large dose is
a poison, and a poison in a small  dose is  a medicine; but a medi-
cine such as tartarized  antimony may be easily converted into a
poison, by  giving it in small doses at short intervals, either under
states of  the body  not adapted to  receive it,  or in cases in which it
exerts  an injuriously depressing  effect.  Some  deaths have been
lately occasioned by this wilful misuse of antimony in doses which
might be described as medicinal, although in the cases referred to,
no other  intention could have existed, in  the secret administration
of this substance, than that of destroying life.   A person may die
either from a  large dose of a substance  given at once, or from a
number of small doses given at such intervals that the system can-
not recover from the effects of one before another is  administered.
This remark applies to a great number of medicines which  are not
commonly  included in a list of poisons.
  In reference to the medical definition of a poison, it is necessary  to
observe that the law does not regard the maimer in which the sub-
stance  administered acts.   If it be capable of destroying life or  of
injuring health, it is of little importance, so far as the responsibility
of a prisoner is  concerned, whether its action  on the body is of a
mechanical or chemical  nature, and whether it operates fatally by
absorption  into the blood or not.  Thus a substance which simply
acts mechanically on the stomach  or bowels may, if wilfully admin-
istered with intent to injure, involve a person in a  criminal charge,
as much as if  he had administered  arsenic or any of the ordinary
poisons.  It is then, necessary that we should consider  what the
law strictly means by the  act of poisoning.  If  the substance cri-
minally administered destroys life, whatever may be its nature  or
riiode of operation, the accused  is tried on  a charge of murder  or
manslaughter, and the duty of a medical witness consists in showing 
LAW  IN RELATION TO  POISONS.
81
that the substance taken was the certain cause of death.  If, how-
ever, death be not the  consequence, then the accused may be tried
for the attempt to murder by poison (24 and 25 Vict., c. 100, s. 11,
Aug. 1861).  The words of this  statute are general, and embrace
all kinds of substances whether they are popularly or professionally
regarded as poisons or  not.  Thus it is laid down that—
  " Whosoever shall administer, or cause to be administered to or
taken by  any person,  any poison,  or  other  destructive  thing, with
intent to commit murder, shall be guilty of felony."
  Whether the administering be followed by any bodily injury or
not, the act is still a felony, provided the intent has been to commit
murder.   The attempt to administer or the  attempt to cause to be
administered to, or to be taken  by  any person, any poison or other
destructive thing, with the like intent, although no bodily injury be
effected,  is also a felony (s. 14).  If any doubt formerly  existed
whether  the  external application of poisons, e. g., by wounds or
ulcerated surfaces, would be included in the words " administering
or taking," they  are now entirely removed by the Criminal Law
Consolidation Act (Aug. 1861).   The 22d section specially applies
to such an offence, and the 15th section provides that "Whosoever
shall, by any means  other than  those  specified in  any of the pre-
ceding sections of this  act, attempt to  commit murder, shall be
guilty of felony." Mr. Greaves justly remarks, with regard to this
important addition to the statute law, that " the malicious may now
rest satisfied that every attempt to  murder which their perverted
ingenuity may devise, or their fiendish malignity suggest, will fall
within some clause of this act, and may be visited with penal servi-
tude for life."  (" Notes on Crim. Law Consolidation," p. 49.)  Under
section 22 of this statute,  in reference to  attempted  poisoning,
some offences  are comprised, which formerly escaped punishment:
"Whosoever shall unlawfully apply or administer to, or cause to be
taken by, or attempt to apply or administer  to, or attempt to cause
to be administered to or  taken by any person, any chloroform, lau-
danum, or other stupefying or overpowering drug, matter, or thing,
with intent, in any of  such  cases, thereby to enable himself or any
other person  to commit, or with intent, etc., to assist any other
person  in committing  any  indictable offence, shall be  guilty of
felony."  A case under this  section of the new statute was referred
to me in September, 1863.  A medical gentleman was charged with
" attempting to cause to  be administered" to an  infant a poisonous
dose of laudanum. It was stated by a woman who nursed the child
that the accused  delivered to her two bottles containing a brown
liquid, labelled " one teaspoonful every three hours," and directed
her to give it to the  child.   None was given.  Some months after
the death of the child  from natural  causes, this  charge was raised,
and  the  bottles, still  full of liquid,  were  produced as evidence
against the accused.   On analysis I found that the prescribed dose
contained about five minims of laudanum, or nearly one-half grain
of opium—a dose likely to  prove fatal to an infant only a month
old.  Assuming the  statement of the nurse who made the charge
      6 
82
LAW  IN RELATION  TO  POISONS.
to be true, the only inference to be drawn from the prescription of
such  a dose for an infant  by a medical man, would be that  he
intended to destroy the life  of  the child.  The  charge fell  to the
ground, as clear proof was given that the woman who made it was
not to be believed  on  her oath, and that it had originated in a
desire to extort money.
  [The Revised  Criminal Code  of Pennsylvania, passed  March  31,
1860, contains various  provisions upon the  subject  of the  use  of
poisons, which  are  substantially the same as the provisions of the
English statutes mentioned in the text.   (See §§ 81-83.)  Section
70 forbids  the sale  of  morphia, strychnia, arsenic, prussic acid,  or
corrosive sublimate, except upon the  prescription of a physician  or
on the personal  application of some  respectable  inhabitant of full
age.  In all cases, the word " poison" to be legibly marked on the
label of the vessel in which  it  is contained.   A memorandum  of
all sales other than under prescription of a physician to be kept  in
a register, with  name and residence of purchaser, quantity sold, and
date.   Penalty for breach, a  fine not  exceeding §50.—P.]
  Poison is not  always administered with intent to murder.  On
many occasions  it has been mixed with food, and thus administered
with a view to  injure  or annoy a person.  Cantharides have been
thus frequently given,  and in one instance. (Nov. 1859) eight mem-
bers of a  family suffered from  severe  symptoms of poisoning  by
reason of the wanton administration  of this drug.  In April, 1860,
several members of a  family suffered from  severe sickness, as a
result of tobacco having been put into water contained in  a tea-
kettle ; and tartar emetic  has been in some cases dissolved in beer
or other liquids as  a mere frolic, without any proved or probable
intention on  the part of the offender to destroy life.  The case  of
McMullen (Liverpool Autumn Assizes, 1856) revealed an extensive
system of  poisoning in the northern counties, in  which  tartar
emetic was the substance employed.  This drug, mixed with cream
of tartar, was openly sold  by druggists under the name of " quiet-
ness powders," and the  evidence established that women gave these
powders to their husbands with a view to cure them of habits  of
drunkenness. Hitherto, when the intent of murder was not proved,
the offender  has escaped, although great  bodily injury may have
been done by his wanton or malicious act. Sections 23, 24, and 25
of Consolidation Act, c. 100, provide for this omission:—
  "23. Whosoever shall unlawfully and maliciously administer to,
or cause to be administered  to or taken  by any other person, any
poison or other destructive or noxious thing, so as thereby to endanger
the life of such a person, or so  as thereby to inflict upon such per-
son any grievous bodily harm, shall be guilty of felony."
  " 24. Whosoever shall unlawfully and maliciously administer to,
or cause to be administered to or taken by any other person  any
poison or other destructive or noxious thing, with intent to injure
aggrieve, or annoy such person, shall be guilty of a misdemeanor "
  " 25. If, upon the trial  of any person charged with the  felony
above mentioned, the jury shall not be satisfied that such person is 
MECHANICAL IRRITANTS.
83
guilty thereof, but shall be satisfied that he is guilty of the misde-
meanor above mentioned, then  and in every other such case the
jury may acquit the accused of such felony, and find him guilty of
such misdemeanor."
  It will be perceived that the words of the statute leave the ques-
tion " What is a poison ?"  to depend upon the medical evidence
adduced: and in order to include all substances of an injurious nature,
although they may not be strictly speaking poisons, the words " de-
structive or noxious thing" are employed.  Hence, on these occasions,
a medical witness must be prepared to prove that the substance was
either a poison or a destructive or noxious thing.  In a trial which
took place at the Essex  Lent Assizes,  1850 {Reg. v. Hayward), a
woman was charged with administering white precipitate to her hus-
band with intent to kill.   She was  acquitted on the ground that
there was no  evidence to show that white precipitate was either a
poison or a destructive thing.  It is, however, placed beyond doubt
that this substance is not only capable of producing all the effects
of  an irritant poison, but of destroying human life ;  hence, this
acquittal was based on a pure mistake.   White hellebore, Lobelia in-
filata, and Oil of turpentine have  been erroneously pronounced not to
be  poisons under similar circumstances ;  in fact, when this question
is raised, unless the medical evidence received by a court be very
closely investigated, great mistakes may arise, owing, perhaps to
want of experience, or want  of reflection on  the part  of those to
whom the question is put.
   The quantity of a poisonous substance found in an article of food,
or in a dead body, does not affect the culpability of a person indicted
for administering it. In the case of Hartley (C. C. C. May 12,1850),
in which an  attempt was made to administer sulphuric acid mixed
with coffee, Cresswell J., stated—if poison be administered  with
intent to murder, it is not necessary there should be enough  in the
article administered to cause death.  If any poison be there, and
the intent be proved, the crime of attempting to administer poison
is complete.   Erie, J., ruled to  the same effect, in reference  to the
discovery of a small quantity of arsenic in a dead body, in Reg. v.
Bacon  (Lincoln  Summer Assizes,  1857).  In Reg. v.  Southgate
(Chelmsford  Lent Assizes), Parke B., said, in reply to an objection
taken, it was quite immaterial to define or prove in what vehicle a
poison was given, or whether it was administered in a solid or liquid
state.
   Mechanical irritants.—The substance administered  may not be a
poison in the medical  signification of the term, and it  may not be
popularly considered as such: yet, when taken, it may be noxious
to health or destructive to life.   We have examples of substances
of this description in iron-filings, powdered glass, sponge, pins and
needles, and  such like bodies, which have been administered with
the wilful design of injuring, and have on various occasions given
rise to criminal charges.  In cases of this kind, the legal guilt of a
prisoner may often depend on the meaning assigned by a medical
witness to the words destructive thing.  Thus, to take an example, 
84          INFLUENCE  OF  HABIT ON POISONS.
liquid mercury might be poured down the throat of an infant, with
the deliberate intention to destroy it.  A question of a purely
medical nature will then arise whether mercury be a "destructive
thing" or not; and the conviction of a prisoner will probably depend
on the answer.   Should a difference of opinion exist, an occurrence
by no means unusual in medical evidence, the prisoner will, accord-
ing to  the humane principle of our law, receive the benefit of the
doubt.
  Influence of Habit on Poisons.—Habit, it is well known, diminishes
the effects of certain poisons:  thus it is that opium, when frequently
taken by  a  person, loses its  effects for a  time, and requires to be
administered in  a much larger dose.  Indeed, confirmed opium-
eaters have  been  enabled to  take at once, a quantity of the drug
which would have infallibly killed them, had they commenced with
it in the first instance.   Evan infants and  children,  who are well
known to be especially susceptible of the  effects of opium, and are
liable to be poisoned by small doses, may, 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. Grainger, in the " Report
of the  Children's Employment Commission."  It appears that the
system  of drugging children with opium in the factory districts,
commences as soon after birth as possible;  and the close is gradually
increased  until the  child takes from fifteen  to twenty drops of
laudauum at once!  This has the effect of throwing it into a leth-
argic stupor. Healthy children of the same  age would be killed by
a dose of five drops. The same influence of habit is manifested more
or less in  the use of tobacco, alcohol, ether, chloroform, morphia,
strychnia, and other alkaloids.  Dr. Christison has remarked that
this influence is chiefly confined to poisons derived from the organic
kingdom: it is so limited with regard to mineral substances  that
it can scarcely be said to exist. It is stated on respectable authority
that certain  peasants in Styria are addicted to the practice of arsenic-
eating, and  that  they carry it on for many years without suffering
fromthe  usual effects of this poison.  Dr. Roscoe  has published a
case in which, according to information supplied to him, a Styrian
peasant took in one day four grains and a half, and on the day fol-
lowing five  grains and a half of arsenic, crushing the mineral be-
tween his teeth and swallowing it.  The day after he had swallowed
the second dose, the man left the place in his usual health and there
is no further record of him.   Dr. C. Maclagan  states  that he saw a
Styrian peasant, 33t. 26, swallow between four and five grains of
white arsenic in powder.  In  two hours, some urine which he passed
contained arsenic.  This man suffered no  ill effects; he stated that
he had  taken arsenic for a year and a half  without  any injury to
his health.  He took at first rather less than  a grain every fortnight.
In another  case, a man, set.  46, swallowed six grains.  In three
quarters of an hour, it was found that arsenic was eliminated with
the urine.   (" Ed. Med. Journ.," Sept. 1864, p. 200.)  Dr. Knapp
informed Dr. Maclagan, that a man once took in his presence seven
and a half grains of arsenic, and no injurious effects were produced. 
INFLUENCE OF  IDIOSYNCRASY.
85
(" Ed. Med. Journ.," Jan. 1865, p. 669.)  Such cases as these admit
of no explanation on English experience.   Habit appears to have
so little influence on arsenic, under the most careful medicinal use
of it in this country, that I believe no medical practitioner has ever
succeeded in  causing a patient to take two grains at a dose, the
smallest quantity yet known to have destroyed life.  Mr.  Hunt,
who has had  a large experience in the use of this mineral, fixes the
maximum dose to be given with safety, at one grain.
  The following  case, reported in  the same journal (August, 1864,
p. 116), by Dr.  Parkes, of Halifax, shows the danger incurred  by
this practice.  A man who had taken arsenic for a period of three
or four years died under  the usual  symptoms of chronic poisoning.
As  far as it could be ascertained, the daily dose taken by deceased
for  the last five months of his life, was from two to three  grains.
From the beginning of the practice he had suffered from symptoms
of poisoning with  arsenic, which  gradually assumed the  form of
arsenical cachexia;  but he referred the symptoms to  other causes,
and concealed the practice from his friends.   His system never be-
came habituated to the poison.   This is a result which may be gen-
erally expected.   If the  exceptional  cases  observed in  Styria are
supposed to prove that arsenic may be taken in large doses with
impunity  they would lead to error.  Such cases  have no practical
bearing in legal medicine.  If the practice of arsenic-eating pro-
duces no symptoms, then no question of poisoning can arise.   If, as
in the above case, it does produce symptoms, then it falls within
the range of ordinary experience.
  The alleged  impunity of the Styrians,  in  the  habitual  use of
arsenic, may  be occasionally quoted to explain the  detection of the
poison in a dead  body, or a motive for its purchase; but no scien-
tific witness who has seen anything of the operation  of arsenic in
this country can  allow these statements to influence his opinion of
its effects on human beings.  Those who profess to believe in this
practice, would be among the  last  to  make  a trial of it either on
their own persons, or among their friends.
  The only form  in which I have known the question of habit to
be seriously raised in medical jurisprudence is this: whether, while
the more prominent effects  of poison are thereby diminished, the
insidious or latent effects on the constitution are at the  same time
counteracted.  The answer  is  of some importance in relation to
the subject of life insurance; for the concealment of the practice
of opium-eating by a person whose  life was insured, has already
given rise to an action, in which medical evidence on this  subject
was rendered necessary.   As a general principle, we must  admit
that habit cannot altogether  counteract the insidious effects of
poisons; and that the practice of taking them is liable to give rise
to disease or to impair the constitution.
  Influence of Idiosyncrasy.—Idiosyncrasy  differs from habit:  it
does not, like habit, diminish  the  effect of a poison; for it is not
commonly found  that any particular  state of body is a safeguard
against the effects of these  powerful  agents.  Some constitutions 
86
CLASSIFICATION OF POISONS.
are observed to be much  more affected  than others by  certain
poisons:  thus  opium, arsenic,  mercury, lead, and antimony are
substances of this description, and this difference in their effect is
ascribed to idiosyncrasy.   Dr. Christison  mentions a remarkable
instance in which a gentleman unaccustomed to the use of opium,
took nearly an ouuce of  laudanum  without any effect.   ("On
Poisons,"  33.)  This  form  of idiosyncrasy is very rare.  Certain
substances generally reputed harmless, and  indeed, used as articles
of food, are observed  to affect some persons like poisons.   This is
the case  with  pork, certain  kinds  of shell-fish and  mushrooms.
There may be nothing poisonous in the food itself; butit acts as a
poison in particular constitutions—whether from its being in these
cases a poison per se, or rendered so  by changes during the process
of digestion, it is difficult  to say.   The subject of idiosyncrasy is
of importance in a  medico-legal view, when symptoms resembling
those of poisoning follow a meal consisting of a particular kind of
food.  In such a case, without a knowledge of this peculiar condi-
tion, we might  hastily attribute to poison, effects which were really
due to another cause.  It would appear that in some instances idio-
syncrasy may be 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 without injury, may find  at another  period that it will dis-
agree with him.   When  pork has been disused as an article of
diet for many years it cannot always be resumed with impunity.
In cases in which the  powers of life have become enfeebled by age,
the susceptibility of the system to poisons is increased:  thus aged
persons may be killed by comparatively small doses of arsenic and
opium.  Cases  of acquired idiosyncrasy are very rare:  it appears
to be, if we may so  apply the term, a congenital condition.   There
are, however, certain  diseases which appear to confer a power of
supporting large and even poisonous doses  of some substances.
Very large doses of  opium  have been taken without  producing
dangerous symptoms by persons laboring under tetanus and hydro-
phobia.   This condition is called tolerance.  It has been witnessed
in diseases of  the lungs in reference  to  the  use of antimonial
medicines.
   Classification of Poisons.—Poisons have been divided into three
classes, according to their mode of action on the system ; namely,
Irritants, Narcotics, and Narcotico-Irritants.  This classification
is a modification of that originally proposed by Orfila.  The Nar-
cotics and Narcotico-irritants may, however, be regarded as  consti-
tuting one large class—the Neurotics, as their special action is to
affect directly one or more  parts of the nervous system.   The Neu-
rotic  poisons admit of a subdivision into Cerebral, Spinal, and
Cebro-spinal, according to whether the poisonous  substance affects
directly the brain, the spinal marrow, or both of these organs.
   Irritants.—The  irritants  are possessed  of these common char-
acters:  When taken in  ordinary doses, they occasion speedily
violent vomiting and purging.   The  symptoms are  either accom-
panied or followed by pain in the stomach and bowels.  The pecu- 
NEUROTIC  POISONS.
87
liar effects of the poison are manifested  chiefly on these organs,
which, as their name implies, they irritate  and  inflame.  Many
substances belonging to this  class of poisons possess corrosive pro-
perties ; such as the strong mineral acids, caustic alkalies, bromine,
corrosive sublimate, and others.  These, in the act of swallowing,
are commonly accompanied by an acrid or burning taste, extending
from the mouth down the gullet to  the stomach.  Some  irritants
do not possess any corrosive action—of which we have examples in
arsenic, the  poisonous salts  of baryta, carbonate of lead and can-
tharides ; these are often called pure irritants.   They exert no
destructive chemical action on the tissues with which they come in
contact; they simply irritate and inflame them.
  Difference between Corrosive and Irritant Poisons.—As  a  result of
the action of corrosive poisons, symptoms are commonly  manifested
immediately, because mere  contact produces the destruction of a
part.   In the action  of the  purely irritant poisons, the symptoms
are generally more slowly manifested, 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 rarely with the  rapidity of
corrosive poisons.  It is important in a practical view, to ascertain
whether, in an unknown case, the poison which a person, requiring
immediate treatment, may have swallowed, is irritant or corrosive.
This may be commonly determined by a knowledge of the time at
which the symptoms appeared after the suspected substance was
taken.  We  may thus  often easily distinguish between a case of
poisoning from arsenic and one from corrosive sublimate.  There
is also another point which may be noticed.   As the corrosive sub-
stance exerts a decidedly chemical  action, an examination of the
mouth and throat may enable us in some cases to solve the question.
  It has already been stated that there are many irritant poisons
which have  no corrosive properties, but every corrosive  may act as
an irritant.   Thus the action of corrosive sublimate is  that of an
irritant poison, as, while it destroys some parts of the coats of the
stomach and intestines, it irritates and inflames others.  So again
most corrosive poisons may  lose their corrosive properties  by dilu-
tion with water, and then they act simply as irritants.  This is the
case with the mineral acids and bromine.   In some instances, it is
not easy to say whether an  irritant poison possesses corrosive pro-
perties or not.  Thus oxalic acid acts  immediately, and blanches
and softens the mucous membrane of  the mouth and throat, but I
have not met with any  decided marks  of chemical corrosion  pro-
duced  by it  in the stomach or viscera.  Irritant poisons, for the
most part, belong to the mineral kingdom ; and they may be divided
into the Non-metallic and Mebdlic irritants.  There are a few derived
from the animal and vegetable kingdoms; but these, if we except
cantharides, are not often employed criminally.   Some of the gases
likewise belong to the class of irritant poisons.
  Neurotics.—Neurotic poisons act upon the nervous system, and
their operation  is  confined chiefly to the brain and spinal marrow. 
88
NEUROTIC POISONS.
 Either immediately or some time after the poison has been swallowed,
 the patient suffers from headache, giddiness, numbness, paralysis,
 stupor, and in some instances, convulsions.  They have not an acrid
 burning taste like the corrosive irritants; and they rarefygive rise
 to vomiting or purging. When these symptoms follow the ingestion
 of the poison into the stomach, the effect may be generally ascribed
 either to the form or quantity in which it has been taken, and the
 mechanical effect on the stomach thereby produced, or to the poison
 being combined  with some irritating substance, such as alcohol.
 The pure narcotics, or Cerebral poisons, are not found to irritate or
 inflame the stomach and bowels.
   Notwithstanding the well-defined boundary thus apparently ex-
 isting between these two classes of poisons, it must not be supposed
 that the substances arranged in each class always act in the manner
 indicated.  Some irritants have been observed to affect the brain or
 the spinal marrow, and this may be either a primary or a secondary
 consequence of their action.   Arsenic and  oxalic acid, although
 classed as irritants, have in some  instances given rise  to symptoms
 closely resembling those of narcotic poisoning,—namely, coma, pa-
 ralysis and tetanic convulsions. In a case of poisoning by arsenic,
 which occurred to Dr. Morehead, of Bombay, the symptoms of nar-
 cotism were so strongly marked, that it was believed at first the man
 had taken a narcotic.   (" Med. Gaz." vol. 43, p. 1055.)   I have met
 with a case of poisoning by arsenic in which there was paralysis of
 the limbs, with an entire absence of purging, during the eight clays
 that the deceased survived.  On the other hand, in a case or" poison-
 ing  by a large dose of opium, there was an  absence of the usual
 symptoms of cerebral disturbance, and the presence of others resem-
 bling  those  of  irritant poisoning—namely,  pain  and  vomiting.
 Thus, then, we must not allow ourselves to  be misled by the idea
 that the symptoms are always clearly indicative of  the kind of
 poison taken.  The narcotic or cerebral poisons are few in number,
 and belong to the vegetable kingdom.  Some of the poisonous gases
 possess a narcotic action.
   Narcotico-irritants.  (Spinal and Cerebro-spinal Poisons.)—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 effects on
 the brain and spinal marrow.    In the  state of vegetables, as leaves,
 seeds, or  roots, they possess the property, like  irritants, of irritating
 and inflaming the stomach and  bowels.  As familiar examples we
 may point to  nux  vomica, monkshood,  hemlock  and poisonous
mushrooms.  This class of poisons is very numerous, embracing a
 large  variety of well-known vegetable substances; but they rarely
 form a subject of  difficulty to a medical practitioner.  The  fact of
the symptoms occurring  after  a meal at which some suspicious
vegetables may have been eaten, coupled with the  nature of the
symptoms themselves, will commonly indicate the class to which 
         EVIDENCE OF POISONING  IN THE  LIVING.      89

the poison belongs.   Some of these poisons have a hot acrid taste;
others, like aconite or monkshood, produce a sense of numbness or
tingling, while others again have an intensely bitter taste, as nux
vomica, strychnia, veratria and  picrotoxia.   Strychnia  may  be
regarded as a pure spinal poison.
                       CHAPTER  V.

 EVIDENCE OF POISONING IN THE LIVING  BODY.—ACTION OF POISONS IN-
   CREASED OR  DIMINISHED  BY DISEASE.—SYMPTOMS CONNECTED WITH
   FOOD OR MEDICINE.—SEVERAL PERSONS ATTACKED SIMULTANEOUSLY.—
   EVIDENCE FROM THE DETECTION OF POISON IN THE FOOD, ETC.

   We now proceed to consider the evidence of poisoning in the liv-
 ing body.  To the practitioner, the diagnosis of a case of poisoning
 is of great importance, as by mistaking the symptoms produced by
 a poison for those arising from  natural disease, he may omit  to
 employ the remedial  measures which have  been found efficacious in
 counteracting its effects, and thus lead to the certain death of the
 patient.   To a medical jurist, a correct knowledge of the symptoms
 furnishes the chief evidence of poisoning,  in those cases in which
 persons are charged with the malicious and unlawful administration
 of poison.   The symptoms produced during life, constitute also an
 important part of the evidence in  those instances in which a poison
 proves fatal.  At present, however, we will suppose the case to be,
 that poison has been  taken, and the patient survives.  Most toxico-
 logical 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 immedi-
 ately or within a very short period after they have been swallowed.
 Their  operation,  under such  circumstances, cannot be suspended,
 and then manifest itself after an indefinite interval; although this
 was formerly a matter of universal belief, and gave rise to many
 absurd accounts of what was termed slow poisoning.
  The symptoms of  poisoning  by  nicotina,  prussic acid, oxalic
 acid, or  the salts of  strychnia, appear immediately,  or generally
 within a very few minutes  after the poison has been  swallowed.
 In  an  exceptional case, in which the dose of  prussic acid was
 small, and insufficient to 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." vol.  59, p. 72.)
The symptoms caused by arsenic  and  other irritants, and, indeed,
by all poisons generally, are commonly manifested in from half an 
90
INFLUENCE OF  DISEASE.
 hour to an hour.  It is rare that the appearance  of symptoms is
 protracted for two hours,  except  under certain peculiar states of
 the system.  It is said that some narcotic poisons, such as the poi-
 sonous mushrooms, may remain in the stomach twelve or twenty-
 four  hours without giving rise to symptoms';  and this is also
 affirmed to be the case with some animal irritants, such as decayed
 meat; but with regard to the first point, it has been shown by Dr.
 Peddie that mushrooms have produced symptoms in half an hour;
 and a case has  fallen under my own observation, in which the
 symptoms from  noxious animal food came  on within  as short a
 time after the meal, as is commonly observed in irritant poisoning
 by mineral substances.  In some cases of poisoning by phosphorus,
 no symptoms have occurred until after the lapse of several hours.
   Influence of Disease.—A  diseased  state of the body may render a
 person comparatively unsusceptible of the action of certain poisons,
 while in  other instances it may increase their action, and render
 them fatal in small doses.   In dysentery and tetanus a person  may
 take, without being materially affected, a quantity of opium suffi-
 cient to  kill an adult  in average  health.  In  mania, cholera,
 hysteria, and delirium tremens, large doses of opium may  be borne
 with comparative impunity (p. 86).  In a  case of hemiplegia, a
 woman  set. 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 adult.   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," vol. 1, p. 231.)  It has also been  remarked that per-
 sons affected with  tetanus are  not easily salivated by mercury.
 The morbid  state appears to create  the power  of resisting the
 ordinary  effects of poisons.  (" Colles's Lectures," vol. 1, p.  77.)
 The effect of certain diseases of the nervous system, as well as of
 habit/either in retarding the appearance of symptoms, or in blunt-
 ing the  operations of a poison, it is not difficult  to appreciate ;
 they are cases which can present no practical  difficulty to a medical
jurist,  On the other hand, in certain diseased states, of the system,
 there may be  an increased susceptibility of the action  of poison.
 Thus, in those persons who have a disposition to apoplexy, a small
 dose of opium may act more quickly and prove fatal.  In  a person
 laboring under inflammation of the stomach or bowels, there would
 be an increased susceptibility of the  effects of arsenic, antimony,
 or other irritants.  In debility from any cause these mineral  sub-
 stances would also act injuriously even in ordinary doses.  Anti-
 mony is a most powerful depressant, and might, by its effect on the
 heart, cause death by  syncope.
  The influence of disease  in increasing the operation of poison
has been  noticed in cases  of diseased  kidney (granular defenera-
tion), in which small  doses of mercury have produced severe  sali-
 vation, leading to exhaustion and death.  In diseases of the luno-s
affecting aged persons, opium in medicinal doses, has been observed 
          SYMPTOMS APPEARING  DURING  HEALTH.       91

 to exert a poisonous action.  The effect of the drug appears to be
 intensified by the disease.  This  observation applies equally to
 morphia.   Chloroform vapor in ordinary quantity has been  found
 to produce fatal effects, in cases in which there was latent disease
 of the  heart, or of the coronary arteries of this organ.   A fatty
 condition of the muscular tissue leading to great feebleness of the
 heart's  action, appears to be highly favorable to death by syncope,
 under the use of chloroform.
  A  knowledge of these facts is  of importance in  reference to
 charges of malapraxis  when  death  has arisen from  ordinary or
 extraordinary doses of medicines, administered to persons laboring
 under disease.  In such cases, another mode of treatment should
 be substituted, or a smaller dose than usual given, and its effects
 carefully  watched.  In  some instances, however,  full and large
 doses of powerful drugs  have been recklessly given,  and when a
 fatal  result has followed, there has  been  a strong  disposition to
 refer  death to the supposed disease, of which, however, sometimes
 no trace could  be found in the body.  An experienced physician,
 well acquainted with pathological anatomy, informs me that since
 the use of chloroform has become general, and deaths under its use
 are not unfrequent,  a  fattiness and  flabbiness  of the muscular
 structure of the heart has been sought for and almost universally
 found!  The  fatal  result has not been attributed to its real cause,
 the imprudent  or  careless administration  of  chloroform,  but to
 some minute structural  changes revealed by the microscope in  the
 substance of the organ.
  iSyinptoms appear during a state of health.—Symptoms of poisoning
 may manifest themselves in a person while in a state ofperfect hecdth,
 without any apparent cause.  This  rule is, of course open to nume-
 rous exceptions, because the person on whose  life an  attempt has
 been  made, may be  actually  laboring under disease; and under
 these circumstances the symptoms  may be so obscure as to disarm
 all suspicion.   When poison  is secretly exhibited  in  medicine, a
 practitioner is very liable  to be deceived, especially if the disease
 under which the person is laboring  is of an acute nature, and is
 attended by symptoms of disorder in the alimentary canal.  Several
 cases  of poisoning have occurred in  which arsenic was criminally
 substituted for medicine, and given  to the parties while laboring
 under a disorder of the bowels.   We are, however,  justified in
 saying,  with respect to this character  of poisoning, that when in a
 previously  healthy person,  violent  vomiting and  purging  occur
 suddenly and without  any assignable cause, such as pregnancy,
 disease, or indiscretion in diet, to account for them, there is strong
 reason to  suspect that irritant poison has been taken.  When  the
person is already laboring under disease,  we must be especially
watchful on the occurrence  of any sudden change in the character
or violence of the  symptoms, unless  such change can  be easily
accounted for on common or  well-known  medical  principles.   In
most cases of criminal poisoning, we meet with alarming symptoms
 without any  obvious or sufficient natural causes to explain them. 
92
EVIDENCE  OF POISONING.
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 ajter
some kind of food or medicine has been taken.—This is by far the most
important character of poisoning in the living body._ It has been
already stated that most poisons begin to operate within an hour
after they have been swallowed ; and although there are few excep-
tions to this remark, yet they occur under circumstances easily to
be appreciated by a practitioner.  Thus, then, it follows that, sup-
posing the symptoms under which a person is laboring, to depend
on poison, the substance has most probably been swallowed,  either
in food or medicine, from half an hour to an hour previously.  It
must be observed, however, that causes  may occur in which the
poison has not. been  introduced by the mouth.   Oil of vitriol and
other corrosive liquids have been thrown up the recturn in_ injec-
tions,  and  have thus caused death;  the external application of
arsenic, corrosive sublimate and cantharides  to  ulcerated surfaces
has destroyed life.   In  one case, arsenic was introduced into the
vagina of a female, and  she died in five days under all the  symp-
toms of arsenical poisoning.  (Schneider, "Ann. der. ges. Staatsarz-
neikunde," i. 299.)  Such  cases 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 may be proved that the person could not have taken the poison
in the usual way, by the mouth.  Again, persons may be destroyed
by the vapors of ether, chloroform, prussic acid, or other  powerful
volatile  poisons, introduced  into  the body through  the  lungs.
Such a mode  of suicide, or  murder, might disarm suspicion, from
the fact of no noxious material being found in the stomach.
  Let us suppose, however, the circumstances to have been such
that these secret means of destruction could not have been resorted
to, and that the poison is one of those most commonly selected by
a murderer, such as arsenic, tartar emetic, oxalic acid, or corrosive
sublimate, then we may expect that this character of poisoning will
be made evident to us, and that something must have been swal-
lowed by the patient shortly before the alarming symptoms appeared.
By observations attentively made, it may be in our power to  con-
nect the appearance of the symptoms with the use of a particular
article of food, and thus indirectly lead to the detection of a crim-
inal.   Supposing  that  many hours  have  passed  since  food or
medicine was taken  by the patient, without any effect  ensuino-—it
is probable that the symptoms are due to natural causes, and not to
poison.
  When symptoms resembling those of  poisoning speedily  follow
the ingestion of food or  medicine,  there is, however, reasonable
ground for suspicion; but  caution should be observed in drawing 
           TIME  OF OCCURRENCE OF  SYMPTOMS.         93

 inferences, since the most  extraordinary coincidences  sometimes
 present themselves.   In the case of Sir Theodosius Boughton, who
 was poisoned by his brother-in-law Donellan, in 1781, the fact of
 alarming symptoms  coming on in  two minutes after  the deceased
 had swallowed what was supposed to be a simple medical draught,
 was a most important  part of the evidence against the prisoner.
 There is no doubt that laurel-water had  been substituted for the
 medicine by the prisoner, and that this had caused the symptoms
 which preceded death.  The practice  of substituting  poisonous
 mixtures for medical draughts or powders is by no means unusual,
 although it might be supposed  to indicate a degree of refinement
 and knowledge not commonly to be found  among  criminals.
 Medical  practitioners are thus apt to be imposed upon, and the fol-
 lowing case, related by a deceased judge, will serve as  a caution:
 An apothecary prepared a draught, into which another person put
 poison, intending thereby  to destroy  the life of  the patient for
 whom the medicine was prescribed.  The patient, not liking  the
 taste of the draught, and thinking there was something suspicious
 about  it, sent it back to the apothecary, who, knowing the ingredi-
 ents of which  he had composed it, and wishing to prove to his
 patient that he had done  nothing  wrong, drank it  himself, and
 died from  the effects.  He  was  thus the unconscious agent of his
 own death; and although the draught was intended for another,
 the party who  poisoned it  was held guilty  of murder.  This case
 contains a warning  to  medical  witnesses.   It is not  unusual, on
 trials for poisoning, when the poison is conveyed through medicine,
 to find a medical witness offering to swallow his own draught in
 a court of law, in order to furnish a convincing practical illustra-
 tion of the innocence of the medicine!   It need hardly be observed
 that an exhibition of this kind is never required of  a medical wit-
 ness.   If any doubt be raised of the innocent properties of a draught
 or  powder, a chemical analysis of its  contents  will be far more
 satisfactory, and attended with no kind of risk to the practitioner.
  On the other hand, the occurrence of symptoms resembling those
 produced by poisoning, soon after food or medicine has been taken,
 may be a pure coincidence.   In such a  case, poison is always sus-
 pected by the vulgar ; and it will be the duty of a medical jurist to
 guard against the encouragement of such  a suspicion,  until he has
 strong  grounds to believe it to be well founded.  No public retrac-
 tation or apology can ever make  amends for the injury which may
 in this way be inflicted on the  reputation of another; for those
 who hear the accusation may never hear the defence.  In all such
 cases, a practitioner may entertain a suspicion, but, until  confirmed
 by  facts, he  should  avoid  expressing it,  or  giving it  publicity.
 When  death is  not a consequence, it is difficult to clear up such
cases, except by the aid of a chemical analysis ; but this, as we
know,  is  not always applicable.   If death ensue, the real cause is
usually apparent, and a suspicion of poisoning is thus often removed
by an examination of the body. 
94      EVIDENCE OF POISONING  FROM  SYMPTO
  3  In voisoninq, 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,   lhus, suppos-
ing that after a meal made by several persons from the same dish,
only one suffers, the suspicion of poisoning is considerably weakened.
The poisoned article of food may be detected by observing whether
they who suffer under any symptoms of poisoning  have  partaken
of one particular solid or liquid in common. In a case of accidental
poisoning at a dinner-party, a medical man who was present ob-
served that those who suffered had  taken port-wine only ; the con-
tents of the bottle were examined, and  found to  be a  saturated
solution of arsenic in  wine.   In general, considerable reliance may
be placed upon this character, because it is improbable that any
common cause of disease should suddenly attack with violent symp-
toms of a similar character, many healthy persons at the same time,
and within a short period after having partaken of food together.
We must beware of supposing that, when poison is really present,
all will be attacked with precisely similar symptoms ; because there
are many circumstances which may modify their nature and pro-
gress.  In general, that person who has partaken most freely of the
poisoned dish will suffer most severely; but even this does not always
follow.   There is  a well-known  case, recorded by Bonnet, where,
among  several persons who partook of a dish poisoned with arsenic,
they who had eaten little and did not vomit, speedily died ; while
others,  who  had  partaken largely of the dish, and had in conse-
quence vomited freely, recovered.
   It was just now remarked, that there was no disease resembling
poisoning which is likely to attack several healthy persons  at the
same time and in the same manner.  This is undoubtedly true as
 a general principle, but the following case will show that mistakes
 may occasionally arise even under these circumstances.  It occurred
 in London during the prevalence of the malignant cholera in 1832.
 Four of the members of a family, living in a state of great domes-
 tic  unhappiness, sat down to dinner in apparently good health:
 some time after the meal, the father, mother and daughter were
 suddenly seized with violent vomiting and purging.  The evacua-
 tions were tinged  with blood, while the  blueness of the skin, ob-
 served  in cases of malignant cholera, was  absent.  Two of these
 persons died.  The son, who was known to have borne  ill-will
 against his father and mother, and who  suffered no symptoms on
 this occasion, was  accused of having poisoned them.  At the in-
 quest, however, it was clearly shown by the medical   attendant,
 that the diseased  persons had really died of malignant cholera,  and
 there was no reason to  suspect that any poison had been adminis-
 tered to them.  In this instance, it will be perceived that symptoms
 resembling those of irritant  poison, appeared suddenly  in  several
 individuals in perfect health, and shortly after a meal. We hereby
 learn that the utility of any rules for investigating cases of  poison- 
           DISCOVERY OF POISON IN FOOD, ETC.        95

ing, depends entirely on the judgment and  discretion  with which
they are applied to particular cases.
  It is well  to bear in mind, in conducting these inquiries, that
symptoms resembling  those  produced by irritant  poison, may be
sometimes traced to food.   Meat, rendered unwholesome by disease
or decay, pork, bacon, sausages, cheese and bread, as well as certain
kinds of shell-fish, may give rise to  symptoms  of poisoning,  and
even cause death.  Such cases  may be  regarded as  poisoning  by
animal or vegetable irritants.   All the  characters above  described
as indicative of poisoning,  may be observed, and the difficulty of
forming an opinion is often increased by the fact that  some of the
persons attacked, may have previously partaken of the same kind
of food without inconvenience.
  4.  The discovery of  poison in  the food taken, or in the matters
vomited.—One of the strongest  proofs of poisoning  in the living
subject, is the detection of poison by chemical analysis, or, if of a
vegetable nature, by  a microscopical examination, either in  the
food taken by the person laboring  under  its  effects, or in  the
matters vomited, or, after the lapse of a few hours, in the urine.
The evidence is  of course more satisfactory when the  poison is
detected  in the matters vomited, or in the urine, than in  the food ;
because this will  show that it  has really been taken,  and it will
readily account for the symptoms.  If the vomited  matters have
been thrown away, we must examine the food of which the patient
may have partaken.   Should the results in both cases be negative,
and no trace of poison be found in the urine, it is probable that the
symptoms were due to  disease.
  [On  no account should  a  chemical examination of the food,
vomited matters and urine be neglected, as without it, the evidence
of poison is altogether inconclusive.—R.]
  In investigating a case of poisoning in a living subject, a medi-
cal jurist must remember, that poisoning is sometimes feigned,  and
at others imputed. It is easy for an artful person to put poison into
food, as well  as to  introduce it into the matters  vomited or dis-
charged from the bowels, and to accuse another of having adminis-
tered it.  There are few of these accusers who go so far as to swal-
low poison under such circumstances, as  there  is a great dread of
poisonous substances among this class of criminals ; and  it will be
at once apparent, that it would require a person well versed in tox-
icology, to feign a series of symptoms which  would impose upon
a practitioner  at all acquainted with the subject.   In short, the
difficulty reduces itself to this: What inference can be  drawn from
a chemical detection of poison  in food?   All  that a medical man
can say is, whether poison is or is not present in a particular article
of food:  he must leave it to the  authorities of the law to develop
the alleged  attempt at administration.   If the poison  has been
actually administered or taken, then we should expect  to find that
the person had suffered from the usual symptoms.  The absence of
these symptoms would be a strong fact against the alleged admin-
istration.   The detection of poison in the matters vomited, affords 
96
FEIGNED AND  IMPUTED POISONING.
 no decisive proof that it has  been swallowed, except under two
 circumstances: 1. When the accuser has previously labored under
 the usual  symptoms of poisoning, in which case there can be no
 feio-nino-, and the  question of  imputation  is a matter to be estab-
 lished %y  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 reliance can
 be placed.   The  detection of absorbed poison in  the  urine fur-
 nishes a clear proof  that poison has been  taken, that it has passed
 into the blood, and has been subsequently eliminated.
   When a medical  man is called to a case of suspected poisoning,
 it is necessary that he should know to what points he ought to give
 his attention.  It is very proper  that every effort should be made
 by him  to save life when the individual is living: but while en-
 gaged in one duty, it is also in his  power to  perform another (sup-
 posing the case to be one of suspected criminal poisoning), namely,
 to  note down many circumstances  which may tend to detect  the
 perpetrator of a crime.   There is no person  so well fitted to ob-
 serve these points as a 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 unmindful of  his duty as a member of
 society, if  he did. not aid the cause of justice  by extending  his
 scientific knowledge to  the detection of crime.  It is much to  the
 credit of the medical profession,  that the crime of murder by poi-
 soning—a  form of death from which no  caution or foresight can
 protect a person, is so frequently brought to light, by the announce-
 ment of suspicious facts of a medical nature to  magistrates and
 coroners; and on several occasions the highest compliments have
 been  passed by judges on medical men who have been thus indi-
 rectly the  means of bringing atrocious criminals to the  bar of
 justice.
   The following  appear to me to  be  the principal points which
 demand the attention of a medical jurist in all cases of suspected
 poisoning: 1. With respect to
   Symptoms.—1.  The time  of their occurrence—their nature.  2.
 The exact  period at which they  were observed to take place after
 a meal, or  after food or  medicine  had been taken.   3. The order of
 their occurrence.  4. Whether there was any remission  or inter-
 mission  in their  progress, or, whether they  continued to become
 more and  more aggravated until death.  5.  Whether the patient
 had labored under any previous illness.  6. Whether the symptoms
 were  observed to recur  more violently after a particular meal, or
 after  any particular kind  of  food  or medicine.   7. Whether the
 patient has vomited:—the vomited matters, if any (especially those
first ejected), should be  procured:  their odor, color, and acid or
 alkaline reaction  noted, as well as  their quantity.  8. If none be
 procurable, and the vomiting has taken place on the dress furniture
 or floor of  the room—then a portion of the clothing, sheet, or carpet^ 
       CONSIDERATIONS IN  SUSPECTED  POISONING.      97

may be cut out and reserved for analysis:—if the vomiting has
occurred on a deal floor, a portion of the wood may be scraped or
cut out:—or if on a stone pavement, then a clean sponge soaked in
distilled water may be used to remove any traces of the substance.
The vessel in which vomited  matters  have been contained will
often furnish valuable evidence, since heavy mineral poisons fall to
the bottom, or adhere  to the sides.  9. Endeavor to ascertain the
probable nature of the food or medicine last taken, and the exact
time at which it was taken.  10. Ascertain  the nature of  all the
different articles of food  used at  a  meal.  11. Any suspected
articles of food, as well as the vomited matters, should be sealed up
as soon as possible in clean glass vessels, labelled, and reserved for
analysis.  12.  Note  down in  their own words,  all explanations
voluntarily made by persons present, or who are supposed to be
concerned  in  the suspected  poisoning.  13.  Whether  more than
one person partook  of the  food or medicine:—if so, whether all
these persons were affected, and how ?  14. Whether the same kind
of  food or medicine had been taken before by the patient or other
persons, without ill effects following.
   [As has been  shown  by the author, it is  not possible from the
symptoms  alone to do more than merely infer  the probability of a
poison, inasmuch as there is no poison that possesses absolutely
characteristic symptoms ; (if so, there would  be no necessity for a
chemical  analysis.)  The great uncertainty on this point should
suggest extreme caution to " experts"  in testifying to the presence
of  poison from the  symptoms alone.  In  the  late (second)  trial of
Mrs. Wharton, 1873, at Annapolis, on the charge of attempting
to  poison  Eugene Van Ness, the State's medical witnesses under-
took to testify to the presence  of tartar-emetic, among the  various
alleged poisons, merely from certain symptoms—nausea, vomiting
and general debility—which were quite the reverse of the symp-
toms that these same "experts," along with others, swore to in the
former Wharton trial, as  constituting a main ground for their
opinion as to the presence  of antimony in the stomach of Gen.
Ketchum!  In this  second  case, all the symptoms were shown by
the defence to be logically  ascribable  to disease.   Moreover, no
antidotes were administered, and no means employed to get rid of
the alleged poison;  no examination was made of the suspected food
or drinks, and no search for it either in the vomited matters, or in
the urine !—R.]
7 
98    EVIDENCE  OF  POISONING IN THE DEAD BODY.
                     CHAPTER  VI.

ON THE EVIDENCE OF POISONING IN THE DEAD BODY.—PERIOD AT WHICH
  POISONS PROVE FATAL.—CHRONIC POISONING.—APPEARANCE PRODUCED
  BY THE DIFFERENT CLASSES OF POISONS.—REDNESS  OF  THE MUCOUS
  MEMBRANE  MISTAKEN  FOR INFLAMMATION.—ULCERATION AND COR-
  ROSION.—SOFTENING.—PERFORATION OF THE STOMACH  FROM POISON
  AND DISEASE.

  Supposing that the person is dead, and we are required to deter-
mine whether the case is one of poisoning or not, we must, in  the
first instance, endeavor to ascertain all the particulars which have
been considered in the  last chapter, as indicative of poisoning in
the living body.   Should the deceased have died from poison, the
circumstances of  the attack, and  the  symptoms preceding death
ought to correspond with the characters already described; and in
these investigations, it is well to bear in mind the following rule :
There is no one symptom or pathological condition which  is pecu-
liar to poisoning; but at the same time there is probably no disease
which presents all those characters which are met with in a special
case of poisoning.   The additional evidence to be derived from  the
death of a person, may be considered under the  following heads:—
  1. The time at which death takes place after the first  occurrence of
symptoms.—This question requires examination, because the  more
common poisons, when taken in fatal doses, generally cause death
within definite periods of time.  By an attention to this point, we
may, in  some instances, be enabled to negative a charge of poison-
ing, and in others to form an opinion of the kind of poison which
has been taken.   In a court of law, a medical practitioner  is often
required to  state the usual period  of time  within which  poisons
prove fatal.   It is to be observed that, not only do poisons differ
from each other in this respect, but the same substance, according
to the  form or quantity in which it has been taken, may differ in
the rapidity of its action.   A large dose of  prussic acid, i. e. from
half an ounce to an ounce, may destroy life in less than two minutes.
In ordinary cases  of poisoning by this substance a person dies, i. e.
all  signs of life  have commonly  ceased,  in from  ten to  twenty
minutes: if he survives half an hour, there is some  hope of re-
covery.   In the cases of seven epileptics, accidentally  poisoned by
a similar dose of this acid in one of the Parisian hospitals, the first
died in about twenty minutes, the seventh survived three-quarters
of an hour.   Oxalic acid, one of the most energetic  of  the common
poisons, when taken in a dose of from half  an ounce  to an ounce
may destroy life in from ten minutes to an hour: if the poison is 
         TIME  IN WHICH POISONS PROVE FATAL.       99

not perfectly dissolved when swallowed, it is a  longer  time in
proving fatal.  The  strong  mineral  acids, in poisonous doses, des-
troy life  in  about eighteen  or twenty-four hours.  Arsenic, under
the form of  arsenious acid (white arsenic), operates fatally in from
eighteen  hours to three  or  four days.  It has, however, in  more
than one instance, killed  a person in  two hours.  Opium, either as
a solid or under the  form of laudanum, commonly proves  fatal in
from six to twelve hours ;  but it has been known, in several in-
stances, to destroy life in less than three hours : they who survive
the effects of this poison  for twelve hours, are considered to have a
fair chance  of recovery.   This must be understood to be merely a
statement of the average results, as nearly as we are warranted in
giving an opinion  ; but the  medical jurist will of course be  aware
that the  fatal period may be protracted or shortened, according to
all those  circumstances which have  been elsewhere stated to affect
the actions of poisons.
  There  are various  forms  which this question may assume.  It
may be said  that the death of a person, alleged to have taken poison,
has occurred either too rapidly or too slowly to justify a suspicion
of poisoning.  The following case will serve as an illustration: A
woman of the name of Russell was tried and convicted at the Lewes
Summer  Assizes, in 1826, for the murder of her husband, by poison-
ing him with arsenic. The poison was detected in the stomach ;
but the fact of poisoning was disputed by some medical witnesses,
for this among other  reasons, that the deceased had died three hours
after the only meal at which the poison could have been adminis-
tered to him.  The authority of Sir A. Cooper and  others was cited
to show that, according to their experience, they had never known
a case of poisoning by arsenic to have proved fatal in less than seven
hours.  This may be admitted, but, at the same  time, there was suffi-
cient authority on the other side to  establish that some cases had
actually proved fatal in three or four hours.   So far as  this objec-
tion was  concerned, the prisoner was properly convicted.  In refer-
ence to the medical question raised at this trial, I may observe that
two distinct cases have  since occurred in which  the  individuals
died certainly within two hours after taking arsenic; and  several
instances have been  reported, in which death  has  taken place in
from three to four hours after the  administration of this  poison..
It seems  extraordinary in the present day, that any attempt should
have been made by a professional man to negative a charge of
criminal  poisoning upon so weak a ground as this ;  but this opinion
was expressed many years ago, when the facts connected with poison-
ing were  but little  known. It is quite obvious that there is nothing,
so'far as we  know, to prevent arsenic from destroying life in an
hour, or  even within a shorter period.  A  case will be hereafter
related, in which death  took place from  arsenic probably within
twenty minutes.   These  matters can be  settled only by a  careful
observation  of numerous cases, and  not by any a priori reasoning,.
or by a limited individual experience.
  In all instances of  sudden death there is generally a strong ten- 
100
SLOW  OR  CHRONIC POISONING.
dency on the part of the public 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, and yet be due to poison.  This pre-
judice  continually gives rise to  the most unfounded suspicions of
poisoning, and, at the same time, leads  to cases of chronic or slow
poison being frequently mistaken for natural  disease.   One of the
means recommended  for distinguishing  narcotic poisoning  from
apoplexy or disease of the heart, is the 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 poisons  likely to operate with  such fatal rapidity are prussic
acid or nicotina.  Poisoning by opium is commonly protracted for
five  or six hours.   This poison has never been known to destroy
life instantaneously, or within a few minutes.  Thus, then, it may
happen that death will occur with such  rapidity as to render it im-
possible, under the circumstances, to attribute it to narcotic poison.
  Chronic poisoning.—When  a poison destroys life rapidly, it is
called a case of acute poisoning, to  distinguish it from the chronic
form, i. e., in which death takes place slowly.   Chronic poisoning
is a  subject which has of late frequently required medico-legal in-
vestigation.  Most poisons, when their effects are not rapidly mani-
fested, owing either to the smallness of  the dose or to timely treat-
ment, are capable  of  slowly undermining the powers of life, and
killing the patient by producing emaciation and exhaustion.   This
is sometimes observed in the action  of arsenic, corrosive sublimate,
and tartarized antimony, but it has been remarked also in cases of
poisoning by the mineral acids and  caustic alkalies.  Death is here
an indirect consequence: in  poisoning by the acids  or alkalies,
either  stricture of the gullet is induced, or the lining membrane of
the stomach is destroyed, and the process of  digestion impaired, a
condition which leads to exhaustion and death.  The time at which
these indirect effects  may prove fatal, is  of course liable to vary.
A person has been known to die from a stricture  of the gullet,
brought  on by sulphuric acid, eleven months  after the poison was
swallowed ; and there is no reason to doubt that instances may
occur of  a still more protracted nature.   In cases of  chronic poison-
ing there  is  sometimes great difficulty in assigning death exclu-
sively  to the original action of the poisbn, since the habits of life
of the  person, a tendency to disease, and other circumstances, may
have occurred eijher to accelerate  or produce a fatal  result!  To
connect a stricture of the gullet proving fatal, with the effects of
poisoning by a mineral  acid, it would  be necessary to show that
there was no tendency to this disease before the acid was admin-
istered;  that the symptoms appeared soon after the first  effects of
the  poison went off; that these symptoms continued to become
aggravated until the time of death; and lastly that there was no
other cause to which death could with any probabilitv be referred
These  remarks apply equally to the secondary fatal  effects of any
poison, such, for instance, as the salivation occasionally induced by 
    EVIDENCE FROM APPEARANCES AFTER DEATH.    101

corrosive sublimate, and the exhaustion and depression which are
caused by tartarized antimony, when the acute symptoms of poison-
ing by these substances have passed away.
  The characters of chronic poisoning have of late years acquired
a special interest for the medical jurist.  There is a difficulty about
them which no accuracy of observation or judgment can surmount.
The poison or poisons, if found in the dead body at all, must neces-
sarily exist in fractional parts of a grain.  This alone will be suffi-
cient to create a doubt whether death has been caused by the poison,
although it is quite consistent with medical experience that a person
may die from chronic poisoning, and little or none of the poison be
found in the body after death.  In the case of Mrs. James (Reg. v.
 Winslow), not more than the tenth  part of a grain was found in the
whole of  the tissues of the body; in  the case of Isabella Banks
(Reg. v. Smcthurst), the  quantity was greater than this, but less than
a grain altogether;  while in the  case of  Mrs. Peters, of Yeovil,
examined by Mr. Heripath,  none was found in the body, although
this chemist had extracted a quantity of  antimony as sulphide
from the urine of deceased, in less than nine days before death.   In
this case Dr. Garland had also found antimony in the evacuations
during  life, and  had  referred the intermittent irritation of the
stomach and  bowels, from  which deceased had suffered, to the
secret  use of  this  mineral.   The jury returned  a verdict that
deceased had died from disease, and that death was accelerated by
some  irritant.  (" Lancet,"  August 4th, 1860, p. 119.)   On some
recent trials for poisoning (Reg. v.  William Palmer, C. C. C. 1856),
it has been a contested scientific question, whether a person can die
from poison and no trace of the poison remain in the body.   Mr.
Herapath's evidence  in Mrs. Peters' case not only now proves the
affirmative, but goes to show that antimony may act fatally and be
entirely eliminated from  the system  in about  a week.  (" Med.
Times and Gaz.," Aug. 25, Sep. 12, and 29,1860, pp. 190, 271, 317.)
  2. Evidence from appearances in the body.—One of the chief means
of  determining whether a  person had died  from poison,  is  an
examination  of the  body after death.   In relation to  external
appearances, there are none indicative of  poisoning upon which
we  can safely rely.   It was formerly supposed that the bodies of
persons who were poisoned, putrified  more  rapidly  than those of
others who had died from  natural disease; and evidence for or
against poisoning was at  one time  derived from  the external
appearance of the body.   This is now known t® be an error; the
bodies of persons poisoned are not more rapidly decomposed cceteris
paribus, than those of  others who  have died a sudden and violent
death from any cause whatever.
  Irritant poisons act chiefly  upon the stomach and intestines, which
they irritate, inflame and corrode.  We may  likewise meet  with
all  the consequences of inflammation, such as softening, thickening,
ulceration, perforation, or gangrene.   Sometimes the coats of the
viscera  are thickened,  at other times thinned and softened, by the
action of  an irritant. 
102       REDNESS  OF THE  MUCOUS MEMBRANE.

  Neurotic (Cerebral and /S^W) poisons do not commonly leave any
well-marked appearances in the body.  The stomach and intestines
present no unnatural changes.  There may be greater or less fulness
of the vessels of the brain and spinal marrow, as well as  of their
membranes; but even this is  often so slight as to escape notice,
unless attention  be particularly directed  to these organs.   Effusion
of blood is rarely found.
  The Narcotico-irritants or Cerebro-spinal poisons may affect either
the brain, or the stomach and bowels, and commonly all these parts
according to their peculiar mode of action.
  It is important to bear in mind, that both Irrritants and Neurotics
may destroy life without leaving any appreciable  changes in the
body.   To such cases as these, the remarks about  to be made do
not apply.   The proofs of  poisoning must,  in  such exceptional
cases,  be procured  entirely from  other sources.   Any  evidence
derivable from the appearances in the body of a person poisoned,
will be imperfect unless we are able to distinguish them from those
analogous changes often met with as the  results of ordinary disease.
These are confined to the  mucous membrane of the  stomach and
bowels.   They are redness,  ulceration, softening  and perforation.
Each of these conditions may depend upon disease, as well as upon
the action of irritant poisons.
  Redness.—It is a main character of the irritants to produce, as a
result of inflammation, redness of the mucous or lining membrane
of the stomach and small intestines.  This redness,  when first seen,
is usually of a deep crimson color, becoming brighter by exposure
to air.  It may be diffused over the whole mucous membrane ; at
other  times it is seen in patches, dots, or lines (strise), spread irregu-
larly over the surface of the stomach.  It is sometimes met with
at the smaller, but more commonly at the larger end of this organ,
and again we  occasionally  find the folds or prominences only of
the mucous membrane presenting this red or inflamed appearance.
Redness of the mucous membrane may, however, be due to gastritis
or gastroenteritis as a result of  disease ;  and in order to assign the
true cause  of  the. inflammation, it will be necessary to have an
account of the symptoms preceding death, or some  chemical proofs
of the existence of irritant poison in the  contents of the stomach or
in the tissues of the body.
  In the healthy state, the mucous membrane of  the stomach is
pale and white, or nearly so, except during digestion, when  it is
slightly reddened ; and some observers have remarked that  a slight
redness has often remained in the stomachs of those who haveolied
during the performance of the digestive process.   When in contact
with the spleen or liver, after death, the  stomach is apt to acquire
a deep livid color from the  transudation of blood; and  it is well
known that the bowels acquire a somewhat similar color from the
gravitation of  biood which always takes place after death. None
of these appearances are likely to be mistaken for the action of an
irritant  poison.
  There is an important class of cases in which redness of  the mu- 
ULCERATION OF THE STOMACH.
103
cous membrane of the stomach is found after death, not dependent
on the action of poison, or any easily assignable cause.  These cases,
owing to their being  so little known, and involved in much ob-
scurity, deserve the attention of a medical jurist, since the appear-
ances closely resemble those produced by irritant poison.   A person
may  die  without  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 distinguish-
able 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  which  have been  made of  the  appearance
presented  by  the stomach, are preserved in the Museum collection.
  Great dispute  has  arisen respecting the length  of  time during
which redness of the stomach produced  by an irritant will be re-
cognizable and easily distinguishable  from putrefactive changes.
It is sufficient to say, that no certain rule can be laid down on the
subject: it must be left  to  the knowledge and discretion of the
witness.  I have distinctly seen the well-marked appearances of
inflammation produced by arsenic in  the stomach  and  duodenum
in an exhumed body twenty-eight days after interment (Reg. v. Jen-
nings, Berks  Lent Ass. 1845); and in another instance, referred to
me by Mr. Lewis, the coroner for Essex, in August, 1846, the red-
dened state of the mucous membrane, in a case of arsenical poison-
ing, was plainly perceptible on removing a layer of arsenic, nine-
teen months after interment.   (See, on this question, a case  of sus-
pected poisoning by Orfila, " Annales d'Hyg." 1839, vol. 1, p. 127.)
If,  however,  there  should be a reasonable doubt respecting the
cause of redness, and no poison is detected, it would be unsafe to
rely upon  this appearance alone as evidence of poisoning.
   Ulceration.—In irritant poisoning, the stomach is  occasionally
found ulcerated; but  this is, comparatively speaking, a rare occur-
rence.   In such cases the mucous  membrane is removed in small
distinct circular patches, under the  edges of which the poison (ar-
senic) may be found.  Ulceration of the stomach is a more common
result of disease, than of the action  of poison.  As a  consequence
of disease, it  is very insidious, going on often for weeks together,
without giving any indication of its existence, except perhaps slight
gastric disturbance with occasional nausea, vomiting, and loss of
appetite.  In this case, the  ulceration is commonly seen in small
circumscribed patches.  It is worthy  of remark,  as  a  means of
distinction, that ulceration has never been known to  take place
from  arsenic  or any irritant poison, until symptoms indicative of
irritant poisoning have occurred.  In ulceration from disease, the
mucous membrane is commonly only reddened in the neighborhood
of the  ulcer.   In  ulceration from poison, the redness is generally
diffused over other parts of the stomach, as well as over the duo-
denum and small intestines.  A case, however, occurred in Guy's
Hospital, some years ago, in which, with a small circular patch of
ulceration near the  cardiac opening, the whole mucous  membrane
was red and injected; but this singular condition of the stomach, 
104  SOFTENING AND  PERFORATION  OF  THE  STOMACH.

so closely resembling  the effects of an  irritant  poison, was unac-
companied by any marked symptoms of irritation during life.  The
history of a case previous to death will thus commonly enable us to
determine to what cause the ulceration found, may be due.
  Care must be  taken to distinguish  ulceration  from corrosion.
Ulceration is a vital process: the substance of a part is removed by
the absorbents, as a simple result of inflammation.  Corrosion, on
the other hand, is a chemical action; the parts are removed  by the
immediate contact of the poison: they are decomposed; their vitality
is destroyed, and they combine with the corrosive matter itself.
Ulceration requires time for its establishment, while corrosion is
either an instantaneous, or a very rapid effect.
  Softening.—The coats of the stomach are not unfrequently found
so soft as to yield and break down under very slight pressure; and
this may be  the 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 of the stomach,
wdien caused by poison, is produced by those substances only which
possess corrosive properties, it follows that in such cases, traces  of
their action will be perceived in the mouth, throat and  gullet.  In
softening from disease, the change will be confined to the stomach
alone, and it is commonly found only at the cardiac or greater end
of the organ.  When softening is  really caused  by an irritant
poison, it is generally attended  by other striking and unambiguous
marks of its operation.   Softening is not to be regarded as a com-
mon character of poisoning: it  is only an occasional appearance. I
have met with an instance in which the coats of the stomach were
considerably hardened by sulphuric acid.  Softening can never be
inferred to have proceeded from poison, unless  other well-marked
changes are present, or unless the poison is discovered in the  soft-
ened parts.   The stomachs of infants have  been frequently found
softened from natural causes: such cases could not be mistaken for
poisoning, since  the history of them during life, the want of other
appearances indicative of poisoning and the total absence of  poison
from the viscera would prevent such a suspicion from being enter-
tained.
   Perforation.—The stomach may become perforated, either  as a
result of poisoning or disease.
   Perforation from poisoning may arise: 1, from  corrosion ; 2, from
ulceration.   The perforation by corrosion is by far the most com-
mon variety of perforation from poisoning.  It is occasionally wit-
nessed when the  strong  mineral acids have been taken, especially
sulphuric acid; the stomach, in such cases, is blackened and exten-
sively destroyed, the aperture is  large,  the edges  are rough and
irregular, and the coats are easily lacerated.  The acid escapes into
the abdomen, and may be readily detected there by  chemical analy-
sis.  The perforation  from ulceration,  caused by  irritant  poison
(arsenic), is  but little known.  There  are but  few instances  on
record.   In a great number of poisoned subjects examined  during
many years past at Guy's Hospital, not  a  single  case  has occurred. 
PERFORATION  FROM  DISEASE.
105
It must, then, be looked upon as a rare appearance in cases of irri-
tant poisoning.
  Perforation from disease.—This is by no means an unusual  con-
dition.  Many cases  of this  disease will be  found reported  else-
where.  (" Guy's Hosp. Rep." No. 8.)  It is invariably fatal when
it proceeds so far that the contents of the stomach escape into the
abdomen; but sometimes  the stomach  becomes glued to the pan-
creas or other organs during  the  ulcerative process, and the person
may recover.  Several instances of this kind of adhesion have  been
met with  in inspections.  The symptoms from perforation com-
monly attack a person  suddenly, while apparently  enjoying perfect
health.  Hence  these  cases may be easily mistaken  for  those  of
irritant poisoning.  The principal  facts observed  with regard  to
this formidable disease  are the following: 1. It  often  attacks
young women from eighteen to twenty-three years of age.  2. The
preceding illness is extremely slight; sometimes there is mere loss
of appetite,  or a capricious appetite, with uneasiness after eating.
3. The attack commences with a sudden and most  severe pain in
the  abdomen, generally soon after a meal.  In irritant poisoning
the  pain  usually  comes  on gradually, and slowly  increases  in
severity.  4. Vomiting, if it exists at all, is  commonly slight, and
is chiefly  confined to  what is swallowed.   There is no purging:
the  bowrels  are generally constipated.   In irritant  poisoning the
vomiting  is usually severe, and purging  seldom absent.  5. The
person dies commonly  in from eighteen to thirty-six hours; this is
also the average period of death  in the most common form of irri-
tant poisoning, i. e. by arsenic; but in no case yet  recorded has
arsenic caused  perforation  of  the stomach within twenty-four
hours ; and it appears probable that a considerable time must elapse
before such  an  effect  could be  produced  by this, or any irritant.
6. In perforation from disease, the symptoms and death are clearly
referable to peritonitis.   7.  In the perforation from 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 aperture, are usually thickened for
some distance;  and when  cut  they have almost a  cartilaginous
hardness.  These characters of the aperture will not alone indicate
whether it  is the result  of poisoning or disease ; but the absence
of poison from the stomach, with the want of other characteristic
marks of irritant  poisoning, would enable us to say that disease
was the cause.  Besides  the history of the case during life would
materially assist us in  our judgment.  The great  risk in all these
cases is, that the effects of disease may be mistaken for those of
poisoning ; for we are not likely to  mistake  perforation caused by
irritant poison for the  result of disease.  Notwithstanding the well-
marked difference above described, it is common to meet with  cases 
106   SPONTANEOUS OR GELATINIZED  PERFORATION.

of imputed poisoning, where death has really occurred from peri-
tonitis following perforation.  I have been required 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 wTas exhumed after several months' burial, and
the stomach was found perforated  from disease in the usual  situa-
tion.   [Intestinal perforation sometimes occurs from sudden  strain
or effort, or external violence.—IT.]
  Spontaneous or gelatinized perforation.—The  stomach is occasion-
ally  subject  to  a  spontaneous change,  by which  its coats  are
softened, and give way generally at the cardiac or greater end.  As
the effusion  of the  contents of the  organ, in such  a case,  never
gives rise to peritoneal inflammation, and no symptoms occur prior
to death to indicate the existence of so extensive a  destruction of
parts, it is presumed  to be a change in the dead body, and the coats
of the stomach  are  supposed to undergo a process of solution or
digestion.  It is commonly attributed to the solvent  action of the
gastric juice,—the  spleen, diaphragm, and other viscera being some-
times softened.  My colleague, Dr. Wilks, who has for many years
conducted  the inspections at  Guy's Hospital, informs me that this
post-mortem  or  cadaveric perforation  of the stomach is so rare a
condition, that it is not met with  once in five hundred cases.  In
the last two cases  in  which it was  observed, one patient had died
from albuminuria and the other from head-affection ;  but in neither
of these could there be found any peculiarities regarding their food,
the time of the last meal, or the state of the bodies  to account for
the spontaneous destruction  of the coats  of the stomach.   (For
remarks  on this subject  by  Dr. Budd,  see " Med.  Gaz." vol. 39,
p. 895.)  In January, 1845, I met with an instance of this perfora-
tion in a child between two and three years of age.   It was seized
with  convulsions, became insensible, and died twenty-three  hours
afterwards.  After death,  the  greater  end of  the  stomach was
found destroyed to the extent of three  inches; and the edges were
softened and  blackened.   There  was no food  in  the stomach, and
nothing had passed  into the  organ for thirty-two hours before
death !  It was therefore impossible to ascribe death to the perfora-
tion, or the perforation to poison.  (For a full account of this case,
see "Med. Gaz." vol. 36, p. 32.)  An inspection of the body, with
a general history of the case will commonly suffice to remove any
doubt in forming an opinion whether the extensive destruction so
commonly  met with, has or has  not arisen from poison.  Thus, in
a cadaveric perforation, the aperture is generally situated in that
part of the stomach which lies to the left of the cardia;  it is very
large, of an irregular form, and ragged  and pulpy  at 'the edges,
which have the appearance of being scraped.  The mucous  mem-
brane of the stomach is not found inflamed.   There is occasionally
slight redness, with dark brown or almost black lines (striae) in and
near the dissolved  coats, which have an acid reaction.  It can only
be confounded with perforation by the action of corrosives ; but the
well-marked symptoms during life, and the  detection of the poison 
MICROSCOPIC EXAMINATION.
107
after death, together with the changes in the throat and gullet,
will at once indicate the perforation produced by corrosive poison.
  [It is vitally important that the post-mortem examiner should be
qualified by practical training and experience, as well as judgment,
to understand fully and distinctly the appearances referred to in the
foregoing chapter.  We fear, however, that the responsibility is too
often assumed in this country by practitioners who  have no right
or reason to pretend to the indispensable qualifications, and whose
ignorance and indiscretion might easily be exposed by a well  di-
rected  cross-examination.  The case of John Hendrickson, Jr., con-
victed, on altogether insufficient medical  testimony, of poisoning
his  wife with aconite, affords a lamentable instance of this kind of
perversion of medico-legal investigation.   (See " Am. Journ. Med.
Sci.," October, 1855, p.  447, for an able and justly severe review of
the medical  evidence  in this trial by Dr. C. Lee.)   But it is not
only in the observation of the anatomical  appearances, even when
fully competent to recognize  their  true characters, that we must
exercise the greatest caution.   The  evidence afforded by the sight
and smell of matters in the alimentary canal or other portions of
the body, although sometimes very significant,  should  always be
subjected to the closest scrutiny.  Odor and color are proverbially
uncertain ; and although the recognition of peculiarities of form is
less liable to error, yet when these are so minute as to require the
employment  of  the microscope to determine them, the faculty of
discriminating is at present restricted to an extremely limited cir-
cle  of observers.   In the hands of a judicious and genuine expert
in this mode of exploration, the microscope doubtless may be, as it
already has been, resorted to with the happiest  effect in corrobora-
tion of other more appreciable signs ; still our inclination is to look
with particular reserve upon all results derived  from such a source
alone.   We fully agree nevertheless with  Dr. M. Stille  in his  in-
dorsement of the views of Dr. Frazer, that the value of  the micro-
scope in identifying the presence of some vegetable poisons by their
botanical characters has not received the attention which it deserves.
(Wharton and StillC, " Med. Jurisp.," 2d ed. p. 474.)  Dr. Frazer,
in his  interesting paper on the subject, gives some  very valuable
hints, and concludes with  detailed instructions, which, while they
must prove in the highest degree useful to the accomplished micro-
scopist, at the same time demonstrate the absolute necessity of a
special  training on the part of any one who  may desire to avail
himself of such difficult tests.
  "In  such cases I would propose,"  says Dr. Frazer, " that, aided
by the history of symptoms, an aid of which we always avail our-
selves in other forms of poisoning, the microscope  be employed in
their investigation ; and the most certain way, I believe, to accom-
plish this result, especially for those  not very intimately acquainted
with the peculiar differential characters of the plants, is to compare
whatever vegetable fragments may be ejected by vomiting during
life, or found in the body after death, with some recent  specimens
of those vegetables which are most suspected to have been the cause 
108
MICROSCOPIC EXAMINATION.
of the accident.  I have satisfied myself  in this manner that  the
leaves especially of aconite,  henbane, foxglove, belladonna and
several other of our  indigenous poisonous plants can be easily re-
cognized, and that they present distinctive characters adequate to
establish ample ground for their discrimination.
  " The point in such an investigation, which we require to  deter-
mine in the first instance, is identically similar  to the first step in
deciding on the nature of a botanical specimen ; if the specimen con-
sists altogether of cellular tissue, it is to be  classed as one of  the
' cellulares,'  and possibly may prove to be some of the poisonous
fungi; should it, however, yield us distinct  evidence of vascular
tissue, thus  demonstrating its more exalted place in the botanist's
systematic arrangements, in that case we will have as our next duty,
supposing it is a fragment of leaf which we are examining, to decide
on the nature of the venation, which at once points out whether it
constituted a portion of  an exogenous or  of an  endogenous plant,
the latter having the well-known parallel venation, and the former
presenting  an equally distinctive reticulated arrangement.  Hav-
ing advanced so far, we then have four other points, at least, for
aiding our further identification of its source.
  " 1st. The presence or absence of  hairs, their relative abundance
on the upper or under surface of the leaf, and their shape, composi-
tion and arrangement.
  " 2d.  The appearance of the epiderm on the upper surface of the
leaf, the form of the cells of which it is composed, the existence or
non-existence of stomata, and if they are present, their shape, size
and disposition in the epiderm.
  " 3d.  Similar observations on the epiderm of the under surface
of the leaf.
  " 4th. The disposition of the parenchyma of the leaf, and the de-
velopment of various crystalline matter (raphides) in  this tissue,
and their form when  they exist.
  " An  agreement in these four points, with corresponding appear-
ances in a recent specimen, would, I conceive, afford more than an
equivalent to the degree of moral certainty which is now derived
from a chemical analysis of a  mineral  poison ;  and I can readily
understand, with the scientific aids now at our disposal, that just
as the chemist is able to place securely in a sealed tube, and exhibit
before the  court sublimates of arsenic and mercury as undoubted
evidence of his analytic skill, so the microscopic observer might
produce, to corroborate  his testimony, accurate drawings of the
fragments of a poisonous plant, printed by solar light, as photo-
graphs,  or more clearly obtained with the aid of a pencil or camera."
(See " Edinb. Monthly Journ. of Med.," April, 1855, from "Dublin
Hosp. Gaz.")—H.]
   [For  a full discussion of  the importance and relative value of
the  chemical analysis for establishing the proof of poisonino*, see
" Taylor On Poisons," Chap. XI. From the foregoing  remarks, it
will easily be understood how dangerous it would  be, in*a case invo'lv- 
                MICROSCOPIC  EXAMINATION.             109

ing life and death to rely either upon symptoms or the autopsic ap-
pearances, or even upon both, as affording positive proof of poison.
A leading American authority, uses the following  judicious lan-
guage  upon this point:  "These  verifications (the  symptoms and
the autopsy) once established, and a harmony between the lesions
shown  by the physician or physiologist, and the  substance dis-
covered by chemical analysis being settled, then, and only then, can
the conclusion be reached that death was due to poison." (Wharton
and Stille's "Med.  Juris.," 1873, vol. ii. p. 287.)  We would not
however, be understood to say that the chemical evidence is always
indispensable for proving the administration of poison.  In certain
cases, for good reasons, this chemical detection  is impossible ; but
in these exceptional instances, the other two factors—the symptoms
and the anatomical lesions—as likewise the moral circumstances of
the  case, should be so positive and  unequivocal, as  to  leave no
shadow of doubt.—R.] 
HO            SULPHURIC ACID — SYMPTOMS.
IRRITANT  POISONS.
                    CHAPTER  VII.

SULPHURIC ACID, OR OIL OF VITRIOL.—NITRIC ACID, OR AQUA FORTIS.—
  hydrochloric acid.—symptoms.--appearances and analysis.

              Sulphuric Acid, or Oil of Vitriol.

  Symptoms.—When this poison is swallowed in  a concentrated
form, the symptoms produced come on either immediately, or during
the act of swallowing.  There  is violent burning  pain, extending
through the throat and gullet to the stomach, and the pain is often
so severe that the body  is bent.  There is an escape of gaseous
and frothy matter, followed by retching and vomiting, the latter
accompanied by the discharge of shreds of tough  mucus and of a
liquid of a dark coffee-ground color, mixed with blood.  The mouth
is excoriated, the lining membrane and surface of the tongue white,
or resembling  soaked parchment; in one instance the appearance
of the  mouth was as if it had been smeared with white paint.
After a time, the membrane acquires a gray or brownish color; the
mouth  is filled with a thick viscid substance consisting of saliva,
mucus, and the  corroded membrane : this renders  speaking and
swallowing difficult. If  the poison has been  administered by a
spoon, or the phial containing it has been passed to the back of the
throat, the mouth may escape the chemical action of the acid.  A
medical witness must bear this circumstance  in mind, when he is
called  to examine an infant suspected to have been poisoned by
sulphuric  acid.  Around  the  lips and on the  neck may be found
spots of a brown color from the spilling of the acid  and its action
on the skin.  There is great difficulty of breathing, owing to the
swelling and  excoriation of the throat and larynx, and the coun-
tenance has from this cause, a bluish or livid appearance; the least
motion of the abdominal  muscles is attended with increase  of pain.
The stomach is so  irritable, that whatever is swallowed is imme-
diately ejected, and the vomiting is commonly violent  and inces-
sant.   The matters first  vomited generally  contain the  poison:
they are acid, and if they fall  on a limestone pavement there is
effervescence ;  if on colored articles of dress, the color is sometimes
altered to  a  red  or yellow, or it is entirely discharged and the
texture of the stuff destroyed; on a black cloth dress, the  spots 
APPEARANCES AFTER  DEATH.
Ill
produced by the concentrated acid are reddish-brown, and  remain
moist for a considerable time.   After a time there is exhaustion,
accompanied  by great weakness ; the pulse becomes  quick, small,
and feeble, the skin cold, mottled, and covered with clammy sweat.
There is generally great thirst,  with  obstinate constipation of the
bowels; should any evacuations take  place, they are  commonly
either of a dark-brown or leaden color, in some instances almost
black,  arising from  an admixture of altered blood.  There are
sometimes convulsive motions  of the muscles, especially those  of
the face and lips.  The countenance, if not livid  from  obstructed
respiration, is pale, expressive of great  anxiety and intense suffer-
ing.   The intellectual faculties are quite clear, and death  usually
takes place very suddenly, in from eighteen  to twenty-four hours
after  the poison  has  been  taken.   Sulphate  of  indigo produces
similar symptoms.  The vomited  matters  are  however bluish-
black.
  Appearances after death.—The marked effects of this  poison are
not always observed in the stomach; they may be confined to the
region of  the throat and windpipe.   In an inspection of the body,
the whole course of the  alimentary canal  from the mouth down-
wards, should be  examined; since in recent or acute cases it is  in
the throat and gullet that we generally obtain strong evidence of the
action of a corrosive poison.   The discovery  of the usual marks  of
corrosion in these parts is always highly corroborative of the signs
of poisoning found in the stomach.   During the inspection, the
examiner  must not omit  to notice any spots  on the skin produced
by the action  of the acid: these are commonly of a dark-brown
color, and are situated about the mouth, lips, and  neck.
  The appearances met with in the body of a person who has died
from the effects of this acid vary, according to whether death has
taken place rapidly or slowly.   Supposing the case to have proved
rapidly fatal, the membrane  lining the mouth  may be found
white, softened, and corroded.  The  mucous membrane of the
throat and gullet  is commonly found  corroded, having a brown-
black, or ash-gray  color, and blOod is effused  in patches  beneath  it.
The corroded membrane  of the gullet is occasionally disposed  in
longitudinal  folds, portions of it being  partly  detached.   The
stomach, if not perforated, is collapsed and contracted.   On laying
it open, the contents are commonly found of a dark-brown or black
color and of a tarry consistency, being formed  in great  part  of
mucus and altered blood. The contents may or may not be acid,
according to the time the patient has survived, and the treatment
which has been adopted.   On removing them, the  stomach may  be
seen traversed by black lines, or the whole of the mucous mem-
brane may be stained black or of a dark-brown color.   On stretch-
ing the coats,  the red color indicative of inflammation  may  be
sometimes seen in the parts beneath, or surrounding the blackened
portions.  When the stomach is perforated, the coats are softened,
and the edge of the aperture is commonly black and irregular.  In
removing the stomach, the  opening is liable  to  be  made larger 
112
FATAL  DOSE.
by the mere weight of the organ.  The contents do not always
escape;  but when this happens, the surrounding parts are attacked
bv the poison.  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 perfora-
tion.  In  some rare cases, the lining  membrane of the aorta has
been found strongly reddened.  When a person has survived for
eighteen or twenty hours, traces of corrosive  and inflammatory
action may be found in the small intestines.   In one  case  the
mucous membrane of the ileum was corroded.  The interior of the
windpipe, as well as  of the bronchial  tubes, has also presented
marks of the local action of the acid.   The acid has thus destroyed
life without reaching  the  stomach.  A remarkable  instance in
which the poison penetrated into  and destroyed both lungs  has
been  reported  by  Sir William Gull.  (See " Med. Gaz.," vol. 45, p.
1102.)  It is important for a medical witness to bear in mind, that
the mouth, throat, and gullet are  not always found  in  the state
above described.  Dr. Ogle met with a  case in which the membrane
of the tongue  was but slightly affected.   The man had swallowed
a large dose of the acid, and had died in nine hours.  (" Med. Times
and Gazette,"  April 21,1860.)   Strange as it may appear, cases are
recorded in which, notwithstanding the introduction of this poison
into the stomach, the gullet has escaped its chemical action.  Mr.
Dickinson has reported a case of poisoning with sulphuric acid, in
which there was no  corrosion of  the  mouth and throat.  The
patient, a female, set. 52, recovered in  about five months.  (" Lan-
cet," Nov.  26,  1853, p. 502.)
  Fated dose.—The  dangerous effects  of  sulphuric acid appear to
arise rather from its degree of concentration, than from  the  abso-
lute quantity taken.  The quantity actually required to prove fatal;
must depend on many circumstances.   If the stomach is  full when
the poison is swallowed, the action of the acid may be spent on the
food  and not  on the  stomach ; and a larger quantity might then
be taken than would suffice to destroy life if the organ were empty.
The smallest quantity which is described as having  proved fatal
was in the following case:  Half a teaspoonful of  concentrated sul-
phuric acid was given to a  child about a year old by mistake for
castor oil.   The  usual symptoms came on, with great disturbance
of breathing;  and the child died in twenty-four hours, the quantity
here  taken could not have exceeded forty  drops.  (" Med. Gaz.,"
vol. 29, p. 147.)   It  is, however, doubtful  whether  this  small
quantity would have proved fatal to an adult.   The smallest fatal
dose which Dr.  Christison states  he has found  recorded, is  one
drachm; it was taken in mistake by a young man, and killed him
in  seven  days.   (Op. cit., 162.)  Even when diluted,  the acid will
destroy life rapidly.   A man swallowed, on an empty stomach, six
drachms  of the  strongest  acid diluted with eighteen-drachms of
water.   He suffered from the usual  symptoms,  and died in two
hours and a half.  (" Med. Times and Gaz.," 1863, vol. 1, p. 183.)
   The average period at which death takes place in cases of acute 
                    CHEMICAL ANALYSIS.                 113

poisoning by sulphuric acid, is from eighteen to twenty-four hours.
The shortest case recorded occurred to M. Rapp.  A man, set. 50,
swallowed three ounces and a half of concentrated sulphuric acid;
he died in three-quarters of an hour.  ("Gazette MeMicale," Dec. 28,
1850.)  On the other hand, there are numerous instances reported
in which the poison proved fatal from secondary causes, at periods
varying from one week to several months.
   Chemical analysis.—If the acid is in a pure state and concentrated,
it possesses  these  properties: 1. Wood,  sugar, or other organic
matter plunged  into it, is  speedily carbonized or charred, either
with  or without  the application of heat.  2. When boiled with
wood, copper-cuttings, or mercury, it evolves fumes of sulphuric
acid;  this is immediately known by the odor, as well as  by the
acid  vapor  first  rendering blue, and  then bleaching, starch-paper
dipped in a solution of iodic  acid.   3. When mixed with an equal
bulk of water, great heat is evolved—nearly 200° F., in  a  cold
vessel.
   Sulphuric acid when diluted does not carbonize organic substances.
One test  only is required for its detection, namely a solution  of a
salt of baryta—either the nitrate, or chloride of barium.   Having
ascertained by test-paper that the suspected liquid is  acid, we add
to a portion of it a few drops of nitric acid, and then a solution of
nitrate of baryta.   If sulphuric acid is present, a dense white pre-
cipitate of sulphate of baryta will fall down; this is insoluble in
all acids  and alkalies.   If  the precipitate is  collected, dried, and
heated to redness in a small platinum crucible, or in a folded piece
of platinum foil, with five or six parts of charcoal powder, it will,
 if a suphate, be converted  into sulphide of barium.   To prove
this, we add to the calcined residue, hydrochloric acid, at the  same
 time suspending over it a slip  of filtering paper moistened with a
 solution  of  acetate of lead.  If the precipitate obtained is a sul-
 phate, the gas evolved will be. sulphuretted hydrogen, known by its
 odor, and by its turning a  salt of lead of a brown color.  The
 cyanide or ferrocyanide of potassium  may be used  as a reducing
 agent in  place of charcoal, in a proportion about equal to  that of
 the sulphate of baryta.  The experiment  may then be performed
 in a  reduction-tube in the flame of a spirit lamp.   On breaking the
 glass and laying the incinerated residue  on paper or card wetted
 with a salt of lead, a brown  stain indicative of sulphide of lead is
 produced.
   In liquids containing organic  matter.—If sulphuric acid is mixed
 with such liquids as porter, coffee, or tea, the process for its detection
 is substantially the same, the liquid being first  rendered clear by
 filtration.   The  precipitated sulphate  of baryta, if mixed  with
 organic matter, may be purified by boiling it in strong nitric  acid;
 but this is  not commonly necessary, as the reduction of the dried
 precipitate may be equally well performed with the impure, as with
 the pure sulphate.  Some liquids, such as vinegar, porter, and most
 wines, generally contain sulphuric  acid or a sulphate, but the acid
 is in small proportion;  therefore, if there is an abundant  precipi-
       8 
114          DETECTION  IN ORGANIC LIQUIDS.
tate  there can be no doubt, cceteris 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 barytic test,
it is not necessary that the liquid should be absolutely clear, pro-
vided it is not so thick as to interfere mechanically with the preci-
pitation of the sulphate  of baryta.   So far with regard to articles
administered, or of which the administration has been  attempted.
This process may be applied to the examination of matters vomited
and of the contents of the  stomach—care being taken to separate the
insoluble parts by  filtration, or by the  process of dialysis, before
adding the test.  The coats of the  stomach should be cut up, and
then boiled in distilled water.   Sulphuric acid may be detected on
articles of clothing by a similar process.   The concentrated acid pro-
duces brown stains on black cloth; the spots remain damp, and the
fibre of the  stuff is gradually softened and corroded.  The stained
portion of cloth should be boiled in water, and the solution filtered
and tested with a salt of barium.  If any free acid is present, the
stained stuff and the solution obtained from it will redden litmus
paper.  It may  thus be  detected after  the lapse  of  twenty-seven
years.
  It is a medico-legal fact of considerable importance, that the con-
tents of a stomach,  in a case  of poisoning  by sulphuric acid, are
sometimes  entirely free from any traces of this poison, even when
it has been swallowed in  large quantity.   The acid is not commonly
found when the person has been  under  treatment, when there has
been  considerable vomiting, aided by  the drinking of water or
other simple liquids, or when he has survived several days.  If the
case has been  under treatment, the  acid is either wholly absent or
neutralized by antidotes.  A girl swallowed four or five ounces of
diluted vitriol, and died  in eighteen hours.  No portion of the acid
could be detected in the stomach ; but she had vomited considera-
bly, and the acid was easily proved to exist in the vomited matters,
by examining a portion  of the sheet of a bed which had become
wetted by them.  In another case, nearly two ounces  of the con-
centrated acid were swallowed; the patient died in  twenty-five
hours; the stomach was extensively acted on, and yet  no trace of
the acid could be discovered in the contents.  The liquidity of the
poison, and the facility  with which it becomes mixed  with other
liquids and  ejected  by vomiting, will readily furnish an explanation
of this fact.  In many cases of poisoning by sulphuric  acid, there-
fore, a medical witness must  be prepared to find  that chemical
analysis will furnish only negative results.   This, however, is not
inconsistent with death having taken place from  the poison. Prof.
Casper relates three fatal cases that occurred to himself, in none of
which the poison could be found after death.  In one  instance, in
which death took place  on the eleventh day, I found  no trace of
sulphuric acid in the body.  If the stomach should  be perforated,
the contents will be found in the abdomen, or perhaps in the lower
part of the cavity of the  pelvis :  they may then be collected, boiled 
NITRIC ACID.
115
with distilled water, and the solution examined for the acid by the
process already described.  If the contents of the stomach are highly
putrefied, the sulphuric acid may be found combined with ammonia.

                  Nitric Acid. Aqua Fortis.

  Symptoms.—When nitric acid is taken  in a concentrated state,
the symptoms  bear a close resemblance  to those produced by sul-
phuric acid.  They come on immediately, and the swallowing of the
acid is accompanied by intense burning pain in the throat  and
o-ullet  extending downwards to the stomach :  there are  gaseous
eructations, from the chemical action of the poison, swelling of the
abdomen, violent vomiting of liquid or  solid matters, mixed with
altered blood of a dark brown color, and shreds of yellowish-colored
mucus, having a  strong acid  reaction.   The abdomen is generally
exquisitely tender:  but in one well-marked case of poisoning by the
acid, the pain was chiefly confined to the throat: probably the poison
had not reached the stomach.   The mucous membrane of the mouth
is commonly soft and white, after a  time becoming yellow, or even
brown; the teeth are also white, and the  enamel is partially des-
troyed by the chemical action of the acid.  There is great difficulty
of  speaking-and swallowing, the mouth  being filled with viscid
mucus: the power of swallowing is, indeed, sometimes entirely lost.
On opening the mouth, the tongue may  be found swollen, and of a
citron color; the tonsils are also swollen and enlarged ; the teeth
are yellow and corroded.  As the symptoms progress, the pulse be-
comes small, frequent and irregular, the surface  of the body ex-
tremely cold, and there  are frequent rigors (shivering).  The swal-
lowing of liquids increases the severity of the pain, and occasions
vomiting.  There is obstinate constipation.  Death takes  place in
from eighteen to twenty-four hours, and is sometimes preceded by
a kind of stupor, from which the patient is easily  roused.   The in-
tellectual faculties commonly remain clear until the last.
  The vapor of this acid  is destructive to life.   In March, 1854r
Mr. Haywood, a chemist of Sheffield, lost his life under the follow-
ing circumstances: He was pouring a  mixture of nitric and sul-
phuric acids from a carboy containing  about sixty pounds, when
by  some accident the vessel  was broken.  For a few minutes he
inhaled the fumes of the mixed acids, but it does not appear that
any of the liquid fell over him.   Three hours after the accident, he
was sitting up and appeared to be in moderately good health.   He
was then seen by a medical man, and  complained merely of some
cuts about his hands.  He coughed violently.  In three hours more
there was difficulty of breathing, with increase of the cough.  There
was a sense of tightness at the lower part of the throat, and the
pulse was hard.   At times he said he could scarcely breathe.   He
died eleven hours after the accident.  On inspection, there was con-
gestion of the windpipe  and bronchial tubes, with effusion of blood
in the latter.  The heart was flaccid, and contained but little blood ;
and the lining membrane of the heart and aorta was inflamed.  The 
116            APPEARANCES AFTER DEATH.

blood gave a slightly acid reaction with  test-paper.  The windpipe
was not examined.  It is very probable the seat of mischief was
in this organ, and that the deceased  died from  inflammatory effu-
sion and enlargement of the parts about the opening of the wind-
pipe.   ("Lancet,"  April  }5,  1854, p. 430.)  A  similar accident
occurred to Mr. Stewart and to one of the janitors of an educational
institution in  Edinburgh in  March, 1863.   They both  died from
the effects of the acid vapor.
  Appearances after death.—Supposing death to have taken place
rapidly from the liquid  acid, the following appearances  may be
met with: The  skin of the mouth  and lips will present various
shades of  color, from an orange-yellow to a brown.  Yellow  spots
produced by the spilling of the acid may be found about the hands
and neck.   The  membrane lining the mouth is sometimes white,
at others of a citron color; the teeth are white, but present some-
times a yellowish color.  The throat and windpipe are much  in-
flamed. The lining membrane of the gullet is softened, and of a
yellow or  brown color, easily detached, often in long shreds.  The
windpipe is more vascular than usual, and the lungs are congested.
The  most  strongly marked  changes are,  however, seen  in  the
stomach.   When not perforated, this organ may be found distended
with gas, its mucous membrane partially inflamed and  covered by
patches of a yellow, brown, or green color, or it  may be even black.
Its coats  may be so much softened, as  to break down  under the
slightest pressure.   In the  duodenum similar  changes are found;
but in some cases the small intestines have  presented no other ap-
pearance  than that of slight redness. It might  be supposed that
the stomach would be in general perforated by this corrosive liquid;
but perforation has not been often observed.  In  a case which proved
fatal after the long period of six months,  there was, at the intestinal
end of the stomach, a distinct cicatrix with puckering and harden-
ing of the surrounding mucous membrane, causing a slight  contrac-
tion of the intestinal orifice. The only other appearance consisted in
some  dark longitudinal lines on  the posterior surface of the lining
membrane of  the gullet.   This  had  probably  been caused by the
acid.   (" Lancet," Nov. 24,1860, p. 510.)
   The smallest quantity of  this acid  which  I find reported to have
destroyed life, is about two  drachms.  It was in the case of a boy,
aged thirteen: he died in thirty-six hours.  Death commonly takes
place within twenty-four  liours.  Sobernheim  relates  a  case of
poisoning  by nitric acid, which  proved  fatal in one hour and three
quarters.   (Op.  cit.  402.)   This  I believe to be the most  rapidly
fatal instance  on record,  where the acid acted as a poison.   The
usual well-marked effects were found in the gullet, stomach, and
small intestines.  In infants, life may be destroyed by this poison
in a  few  minutes,  should  it happen to affect  the larynx.   The
longest case is, perhaps, that  recorded by Tartra, where a woman
died from exhaustion, produced by the secondary effects of the acid,
eight months after having swallowed it. 
CHEMICAL ANALYSIS.
117
  Chemical  analysis.  In  the simple state.—This acid  may be met
with either  concentrated or diluted.   The concentrated acid varies
in color from a deep orange-red to a light straw-yellow.  It may be
recognized,  1. By evolving acid fumes when exposed to the air or
when heated.   2.  By its staining organic matter, yellow or brown,
the color being heightened and turned to a reddish tint by contact
with caustic alkalies.  3.  AVhen mixed with  a few copper cuttings,
it is rapidly decomposed, a deep red acid  vapor is  given off, and
a bluish colored  solution of nitrate of copper is formed.   Tin or
mercury may be substituted for copper in this experiment.   4. The
addition of gold-leaf and a few drops of hydrochloric acid : if nitric
acid is present, the gold will be dissolved on warming the mixture.
Common aqua fortis (nitric acid) sometimes contains as impurity,
a sufficiency of hydrochloric acid to dissolve gold-leaf by heat.
  In the diluted state.—This acid is not  precipitated like  the sul-
phuric, by any common reagent, since all its  alkaline combinations
are  soluble in water.  1. The liquid has a highly acid reaction, and
(if  not too  diluted) on boiling it with some copper turnings, red
fumes of nitrous acid vapor are given off, the liquid acquiring a blue
color at the  same time.  2. A streak made  on white paper with the
diluted acid does not carbonize it when heated;  but a scarcely
visible yellow stain is left.  3. The liquid is neither precipitated by
nitrate of baryta, nor by  nitrate of silver.   These two last experi-
ments  give  merely negative  results:  they  serve to  show that sul-
phuric and hydrochloric acids are absent.
  In order  to detect nitric acid  when mixed Avith water or other
liquids, the  liquid should be carefully neutralized by potash, and
then evaporated  slowly to obtain crystals.  If the liquid contain
nitric acid, these crystals  will possess the following characters: 1.
They appear in the form of lengthened 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 prismatic crystals.   This character distinguishes the
nitrate of potash from a large number of  salts. 2. When moist-
ened with  strong sulphuric acid,  the powdered crystals slowly
evolve a colorless  acid vapor.  By this test,  the nitrate is known
from every other deflagrating salt.  3. A portion of the powdered
crystals should be 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 im-
mediately ensues, by which red  fumes of nitrous acid  are evolved,
recognizable by their color, odor  and acid  reaction.   In operating
on a small quantity of nitrate free from chloride, the crystals may
be placed in a watch-glass and  mixed with  one or two drops  of
concentrated sulphuric acid and a few copper filings.  Invert over
this another watch-glass  containing  a small slip of blue litmus-
paper wetted, and a slip of starch-paper moistened with a  solution
of iodide of potassium.   After  a  longer  or shorter interval the
litmus will  be  reddened, and the starch-paper will assume a blue- 
118
CHEMICAL ANALYSIS.
 black color.  If the nitrate should be mixed with much chloride,
 then the power of dissolving leaf-gold on boiling the dry salt with
 strong hydrochloric acid, furnishes the best means of detection.
 4. We add to the crystals a small  portion of gold-leaf  and hydro-
 chloric  acid;  then  boil for a few  minutes.   The gold  will  either
 wholly  or entirely disappear, if nitric acid  or a nitrate is present.
 Its partial solution will be indicated by a dark purple or brown
 color on the addition of chloride of tin to the liquid after boiling.
   In liquids containing organic  matter.—Nitric acid may be admin-
 istered  in such  liquids as tea,  vinegar, or porter.  In this case,
 besides  the  acid reaction, there will be a peculiar smell produced
 by  the  strong acid, when  mixed  with  substances of  an organic
 nature.   The  application  of the usual tests  may be here counter-
 acted ; thus, unless the quantity of- nitric acid in the liquid is con-
 siderable, the orange-red fumes  of nitrous acid  are not  evolved on
 boiling it with copper cuttings.  If the liquid is viscid, this visci-
 dity must be destroyed by dilution with water;  and in  all cases, if
 any solid or insoluble substances are present, as in the matters vomited
 or contents of the stomach, it must  be filtered, in order to separate
 the insoluble  portions.  If  we  succeed in procuring a  clear acid
 liquor, the color may be  disregarded.   After warming the acid,
 we should carefully neutralize it with a weak solution of carbonate
 of potash ;  it may then be  concentrated  by  evaporation.   Paper
 dipped into this liquid  and dried, burns with deflagration, and a
 few drops on a glass  slide will  yield crystals possessing those pro-
 perties which have been described as  characteristic of the com-
 pound of potash with nitric acid.  The crystals so obtained may be
 colored and impure; but this does not interfere with the action of
 the  most important test for nitric acid, namely, the mixture of
 copper filings  and sulphuric acid.  The crystals may, however, if
 necessary, be  purified by washing them with  ether or alcohol.
 These  liquids do  not  dissolve the nitrate of potash, but will often
 serve to  remove from  it the organic matters by which it  is colored.
 When either  the nitric acid, or  the nitrate  into which it has been
 converted, is mixed with common salt, the copper  test  cannot be
 employed.  In such a case the  gold test will furnish the best evi-
 dence.   Hydrochloric  acid with a small portion of gold-leaf may be
 added to the dried residue, and the mixture boiled.  If nitric acid
 or a nitrate is present, even in minute proportion, some  portion of
 the  gold will be dissolved, a fact demonstrable  by the addition of
 chloride  of  tin.
 .  W\tv\G fYrid  ™y be detected  in stains on  clothinq, if  recent, by
 simply boiling the stained cloth in water, with or without the addi-
 tion of a small quantity of carbonate  of potash.  The  carbonate
must be  used when  an acid liquid is not obtained by boilino- the
stained cloth in distilled water.   A simple method of detecting the
acid is to boil at once a piece of  the stained cloth with a fragment
 of leaf-gold and hydrochloric acid.  If nitric acid is present in the
stain, a portion of the  gold will  be dissolved. 
HYDROCHLORIC  ACID — ANALYSIS.          119
             Hydrochloric  Acid.  Muriatic Acid.

  This acid, which is also called Muriatic Acid, and is popularly
known under the name of Spirit of Salt, is but seldom taken as a
poison.  In the few cases which have been hitherto observed, the
symptoms and appearances have been similar  to  those caused  by
nitric acid.  The following case will show the nature of the s}Tmp-
toms.  A woman swallowed half an ounce of concentrated hydro-
chloric acid, and  in  three-quarters of an hour, the prominent
symptoms were burning pain  in the  throat  and stomach, feeble
pulse, cold  and clammy  skin, retching and vomiting of a brown
matter streaked with blood and  containing shreds of membrane.
There  was great exhaustion.   The throat became  swollen, the
patient lost the power of swallowing, and died in eighteen hours.
She retained her senses until the last.   The appearances in the body
were as follows: the mucous membrane of the mouth and throat
was  white, softened, and destroyed in many places Iry the corrosive
action of the acid.  The membrane of the gullet was red and  in-
flamed.  The back part of the stomach near the pylorus was black,
stripped of its  mucous membrane (which was generally softened),
and  marked with black lines.   It was not perforated.  (" Lancet,"
July 16,1859, p. 59.)  For a more detailed account of poisoning by
this  acid, see " On Poisons," second  edition, p. 289.
   Chemical  analysis.—In a concentrated  state, hydrochloric  acid
evolves copious fumes.  The pure acid  is nearly colorless; the com-
mercial acid is of a lemon-yellow color, and frequently contains iron,
arsenic, antimony, common salt and other  impurities.   When
boiled with a small quantity of peroxide of manganese, chlorine is
evolved.   It  does not dissolve gold-leaf until a few drops of nitric
acid have been added to it, and the mixture heated.  In the diluted
state, these properties are lost.   It may then be recognized by the
dense white precipitate which it gives when a solution of nitrate of
silver is added to it.  This precipitate is insoluble in nitric acid;
it acquires a  purple and black color if exposed to light; and when
heated, it melts without decomposition, forming a yellowish-colored
substance, on cooling.
   In organic liquids.—After  proper  dilution with distilled water,
the liquid should  be  distilled  at a low temperature, and the dis-
tillate tested as above.
   Hydrochloric acid, as well as alkaline chlorides, is a natural con-
stituent of the fluids of the  alimentary canal.  The presence of
local chemical changes  in  the throat and stomach, would show
whether the acid had been taken as a poison.  If the acid is found
only in small quantity,  no  inference of poisoning can be drawn
unless there  are distinct marks of its chemical  action upon the
throat and  stomach.   It darkens the blood  like sulphuric  acid,
although  it  has not  the same degree of carbonating action  on
organic matter. 
120
OXALIC  ACID—SYMPTOMS.
                   CHAPTER  VIII.

POISONING  BY VEGETABLE  ACIDS. — OXALIC ACID. — SYMPTOMS  AND
  APPEARANCES.—CHEMICAL ANALYSIS.—ACID  OXALATE  OF POTASH
  OR SALT OF  SORREL.—TARTARIC AND ACETIC ACIDS.—[AROMATIC
  VINEGAR.]
                        Oxalic  Acid.
  Symptoms.—If this poison is taken in a large dose, i. e. from half
an ounce to an ounce of the crystals dissolved in water, a hot burn-
ing acid taste is experienced during the act of swallowing it.  This
islccompanied by a similar sensation extending through the gullet
to the stomach.  There  is sometimes a sense  of  constriction  or
suffocation;  the  countenance  is livid, and the surfaceof the skin
soon becomes cold and clammy.  Vomiting  occurs either imme-
diately or within a few minutes.   Should the  poison_ be diluted,
there is merely a sensation of strong acidity, and vomiting may not
occur until after a quarter of an hour or twenty minutes.  In some
cases there has  been  little or no vomiting; while in others, this
symptom has been incessant until death.  In one case, in which  an
ounce of the acid was swallowed, the  vomiting with  pain in the
stomach continued until the fifth day, when the man died suddenly
(" Lancet," Nov. 24,  1860, p. 509), and in  another in which the
poison was much diluted, vomiting  did not occur for seven hours.
(" Christison," 221.) The vomited matters are highly acid, and have
a greenish-brown or  almost  black  color; they consist chiefly of
mucus and altered blood.  The patient complains of great pain and
tenderness in the abdomen, with a burning sensation in the stomach.
There are cold clammy perspirations and convulsions.   There is in
general an entire prostration of strength, so that if the person is in
the erect position, he falls;  there is likewise  unconsciousness of
surrounding objects, and a kind of stupor from which, however, the
patient may be without  difficulty roused.  Owing to the severity
of the pain, the legs are sometimes drawn up towards the abdomen,
or the patient rolls about on the floor or bed.   The pulse is small,
irregular, and scarcely prrceptible; the skin cold and clammy ; and
there  is a sensation of numbness  in the limbs with spasmodic
breathing.  The inspirations are deep, and a long interval elapses
between them.  Should  the patient  survive the first effects of the
poison, the following symptoms may appear: soreness of the mouth,
 constriction and burning pain in the throat with pain in swallow-
 ing, tenderness in  the abdomen, and irritability of  the stomach, so
that there is frequent vomiting, accompanied by purging.  The
 tongue is swollen, and there is great thirst. 
APPEARANCES AFTER  DEATH.
121
  Appearances after death.—The mucous membrane of the tongue,
mouth, throat, and gullet is  softened and commonly white, as if
bleached, but it is  sometimes coated with a portion of the brown
mucous  matter discharged from the stomach.  This latter organ
contains a dark-brown mucous liquid, often acid, and having almost
a gelatinous consistency.  On removing the contents, the mucous
membrane will be  seen pale and softened, without always present-
ing marks of inflammation or  abrasion, if death  has taken place
rapidly.   This membrane is  white, soft  and brittle, easily raised
by the scalpel, and presents the appearance which we might suppose
it would assume after having been for some  time  boiled  in water.
The small vessels are seen ramifying over the surface, filled with
dark-colored blood, apparently solidified within them.  The lining
membrane of the gullet presents the same characters.  It is pale,
and appears as if it had been boiled in water, or digested in alcohol;
it has been found strongly raised in longitudinal folds, interrupted
by patches where  the membrane  has become abraded.  In a case
which was fatal in eight hours, the tongue was covered with white
specks;  the  gullet was not inflamed, but the stomach  was exten-
sively destroyed, and had a gangrenous appearance.  Portions of the
mucous membrane were  detached, exposing  the  muscular coat.
With respect  to the intestines, the upper portion may  be found
inflamed; but, unless the case is protracted, the appearances in the
bowels are not strongly marked.
  I am  indebted to  Mr. Welch for the following case: A woman,
aged 28, swallowed three drachms of the crystallized acid.  She was
found quite dead in one hour afterwards.  On examining the body,.
both lungs were observed to be extensively congested, and the heart
and large  vessels were full of a dark-colored blood.  The stomach
contained about three-quarters of a pint of a dark-brown fluid, and
its  lining membrane was  generally reddened.  The other organs,
except the brain, were healthy, and this presented appearances indi-
cative of  long-standing disease.  This case is remarkable from the
smallness  of the dose, the rapidity of death, and the  early produc-
tion of  a well-marked  redness of the mucous membrane of  the
stomach.  The diseased state  of  the  body may have tended to
accelerate death from the  poison.   In one instance the larynx was
found filled with frothy mucus, and the left  side of the heart and
the lungs  were gorged with dark-colored fluid blood.   In another,
the appearances of sanguinous  apoplexy  were found  in the brain.
A person  fell dead  after  retching violently.  Apoplexy was sup-
posed to be the cause of death.   On an inspection of the body, it
was found that a large clot of blood was  effused on the brain, and
this appeared  to account  for death satisfactorily.  But when the
stomach was examined, oxalic acid was detected in it.  This poison
had been taken, and  had produced its usual  effects.   The deceased
had taken it  with  suicidal  intention, and  the violent  vomiting
which it caused had led to death by apoplexy from effusion of blood.
(" Lancet," 1863, 1,  p. 47.)   Without  a proper chemical investi-
gation, it  is obvious  that the  real  cause of death would have  been 
122
CHEMICAL ANALYSIS.
in this instance overlooked.  In  a few  cases  there have  been
scarcely any morbid appearances produced  by this poison.
  It  is worthy of observation that the  glairy contents  of the
stomach do not always indicate strong acidity until after  they
have  been  boiled in water.  Oxalic acid does not appear to have a
strongly corrosive action of the stomach, like that possessed by the
mineral  acids.   It is therefore rare to hear of the coats  of the
organ being  perforated by it.  The acid, when in a contracted
state, renders the  mucous coat soft and brittle, and perforation of
the coats may occur either during life or after death as a result of
its chemical action.  Dr. Wood has recorded the case of a female,
set. 27, found dead, whose death had been obviously caused by
oxalic acid, but the quantity taken, and  the duration of the  case,
were  unknown.   The stomach presented, at its upper and fore part
near the cardiac opening, an irregular aperture of a size to admit
the point of the finger.
  The smallest quantity of this poison which has been known to
destroy life is one drachm (sixty grains).  The boy, set. 16, took the
poison in the solid form, and was found in about an hour insensible,
pulseless, and his jaws spasmodically closed.   He had vomited some
bloody matter; his tongue and lips were unusually pale, but there
was no excoriation.  He died in eight hours.  (" Lancet," Dec. 1,
1855.)  Two  cases occurred at Guy's Hospital, in  each of which
half an ounce of oxalic acid had been  swallowed.  Active treat-
ment was adopted, and  bot*h patients recovered.  When the dose
of oxalic acid is half an  ounce and upwards, death commonly takes
placewithin  an hour; but there are  numerous  exceptions to this
rapidity of action.  Dr. Christison  mentions an instance in which
an ounce of oxalic acid killed a girl  in thirty minutes;  and another
in which the same quantity destroyed life in ten minutes ;  but in
a third case death  did not occur until the fifth day.   The late Dr.
Ogilvy, of  Coventry, has reported  a  case  of poisoning by oxalic
acid, in which it is  probable  that  death  took place within  three
minutes after the poison  had been swallowed.  The quantity of the
acid taken  could not be  determined.
  Chemical analysis.  In the simple state.—This acid  may be met
with, either as a solid, or  in solution in water.   Solid oxalic  acid
                       crystallizes in long slender prisms, which,
                       when perfect, are  four-sided.  In this re-
                       spect, it differs from other common acids,
                       mineral and vegetable.  The crystals are
                       unchangeable in air; they are soluble in
                       water and  alcohol, forming strongly acid
                       solutions.   When  heated  on  platinum
                       foil they melt, and are entirely dissipated
                       in vapor without combustion and without
                       being carbonized.  Heated in a close tube,
                       they melt, and the vapor is condensed in a
                       white crystalline sublimate in a cold part
                       of the tube.   There should be no residue
                       whatever if the acid is pure ; but the com-
Crystals of Oxalic Acid, magnified
       30 diameters, 
CHEMICAL ANALY'SIS.
123
mercial acid generally leaves a slight residue of fixed impurity.
By this effect of heat, oxalic acid is easily distinguished from those
crystalline salts for which it has been sometimes fatally mistaken,
namely, the  sulphates of magnesia and  zinc.  These leave white
residues in the form of anhydrous salts.
   Test*.  1.  Nitrate of silver.—When added to a solution of oxalic
acid, it produces an abundant white precipitate of oxalate of silver.
A solution containing so small a quantity of  oxalic acid as not to
redden litmus-paper, is affected by this test;  but when the quantity
of poison is small, it would be always advisable to concentrate the
liquid by evaporation before  applying it. The oxalate of silver is
identified by the following properties:  It  is  completely dissolved
by cold nitric acid; if collected on a filter, thoroughly  dried, and
heated on thin platinum  foil, it is entirely dissipated in  a white
vapor with  a  slight  detonation;  when the  oxalate  is in  small
quantity, this detonation may be observed in detached particles, on
burning the filter previously well dried. 2.  Sulphate of lime.—A
solution of oxalic acid is precipitated white by lime-water and all
the salts  of lime.  Lime-water is itself objectionable  as a  test,
because it is precipitated white by several other acids.  The salt of
lime, which, as a test, is open to the least objection, is the sulphate.
As this is not a  very soluble salt, its solution must be added in
rather large quantity to the  suspected  acid poisonous liquid pre-
viously concentrated.  A white precipitate  of oxalate of  lime is
slowly formed.  This precipitate should possess the  following pro-
perties : It ought  to  be  immediately dissolved by nitric or hydro-
chloric acid; and it ought not to be dissolved by the tartaric, acetic,
or any vegetable acid.
   In organic liquids.—The process is the same,  whether it is applied
to  liquids in which the poison is  administered,  or  to the matters
vomited, or, lastly, to the contents of the stomach.  Should the liquid
be  very acid, we must filter it to  separate any insoluble matters;
should it  not be very acid, the whole may be boiled, if necessary,
with distilled water filtered, and concentrated by evaporation.  As
a trial test we may employ sulphate of copper, or lime-water.
  From milk, gruel, coffee, blood, mucus and  other viscid  liquids,
oxalic acid  is  readily separated by the  process  of  dialysis.  The
liquid should be  first boiled—the coats of the stomach (cut  up)
being included, if necessary.  The distilled water  placed in  the
outside of the tube will receive the acid.   This  may be concentrated
by evaporation.  Prismatic crystals may then  be procured, and the
silver  and lime tests  may  be  applied.  Oxalic acid  may be com-
pletely separated from the boiled and filtered organic liquid by the
following process: To the filtered liquid, acidulated with acetic
acid, acetate of lead should  be added until there  is no further pre-
cipitation ; and the white precipitate formed, collected, and washed.
If any oxalic acid  was present in the liquid, it would exist in this
precipitate under the form of oxalate of lead.  Diffuse the  precipi-
tate in water, and pass into the liquid, for  about half an  hour, a
current of sulphuretted  hydrogen gas,  taking care  that the  gas 
124
CHEMICAL ANALYSIS.
 comes in contact with every  portion of  the precipitate.   Black
 sulphide of lead will be thrown down; and with  it commonly the
 greater part of the organic matter mixed with the oxalate of lead.
 Filter, to separate the sulphide of lead ;  the filtered liquid may be
 clear and slightly acid.   Concentrate by evaporation ; the sulphu-
 retted hydrogen  dissolved in  the liquid is thereby expelled, and
 oxalic acid may be ultimately obtained crystallized by slow evapo-
 ration in a watch-glass or on a glass-slide, for  microscopical obser-
 vation.   If there was no oxalic acid  in the precipitate, no crystals
 will be procured by evaporation.  If crystals are obtained, they
 must  be  dissolved in water, and tested  in the manner above di-
 rected.  Should the organic liquid contain sulphuric acid or sul-
 phates, these should be separated before precipitation by lead is
 resorted to.
   The presence of oxalic acid in an organic liquid  may be detected
 by another method: Place a portion  of  the liquid containing the
                           poison in a beaker, and insert in this a
          J_lg- ^            tube secured  with  skin, containing a
                           sol ution of sulphate of lime. By osmosis,
                           the oxalic  acid will penetrate the mem-
          q         \     brane, and will form inside the mouth
            o (0^>  \    °f ^e latter a deposit of crystals of oxa-
   ^/?^°/i^\   I   ^ate 0I> lime> known by their octahedral
    a <9 0  & &  V $       form.
     0)  ° ^ <^  ^     /     Sometimes the chemical evidence may
      ^^j     ^ &   I    depend on  stains on articles of clothing.
         P  ^  ^   /     Oxalic acid discharges the color of some
                           dyes, and  slowly  reddens others; but
                           unless the stuff has been washed,  the
 crystals of oxalate of nme obtained   acid remains in the fabric and may there
by dialysis of coffee, containing oxalic   I^j+^j   T,  j            U1<V ull<=ic
acid.  Magnified 350 diameters.        De detected.   It does not corrode or de-
 „      ■.,.,„„       stro7 the 8tuff like mineral acids.  In
Reg. v. Moms (C. C. C. December, 1866) it was  proved that  the
prisoner had attempted to administer a  liquid  poison forcibly to
her daughter, a girl aged  six years.   It  was sour in taste, made
her  lips smart, and caused vomiting.   There  was dryness of the
lips  and inflammation of the lining membrane of the mouth.   No
portion of the substance administered could be procured, but a crys-
rtrl« nftT81! Ml 0XSi° ^ W*8 °btalned fr0m 80me BtoillS OH the
diess of the  child.   The woman was convicted
  As oxalic acid  is very  soluble in alcohol, this liquid may be
stomach  ^r/07^  f°r  SeParati*g  * from the  contents o/the
stomach and from many  organic compounds.  Crystals may be 
       acid oxalate of  potash — tartaric acid.    125

          Acid Oxalate of Potash, or Salt of Sorrel.

   Symptoms and effects.—The poisonous effects of this salt entirely
 depend on the  oxalic acid which it contains.  It is much used for
 the purpose of bleaching straw and removing ink-stains, and is sold
 for this purpose under the name of essential salt of lemons.  Its poi-
 sonous properties are not generally known, or no doubt it would be
 frequently substituted for oxalic acid.  Out of three cases of poison-
 ing  by this substance, two  proved fatal,  while in the  other  the
 patient recovered.  In the case of recovery, a young lady, aged
 twenty, swallowed an ounce'of the salt dissolved in warm water.
 She  was not seen by any one for an hour and a half; she was then
 found on the floor, faint and exhausted, having previously vomited
 considerably.  There was great depression, the skin cold and clammy,
 the pulse feeble, and  there was a  scalding  sensation in the  throat
 and stomach. There was also continued shivering.  Proper medical
 treatment was adopted, and she recovered  in two days, still suffer-
 ing from debility and great irritation of the stomach.   During the
 state of depression, it was remarked that the membranes of the eyes
 were much  injected, and the pupils dilated.  There was also great
 dimness of vision.  (" Med.  Gaz." vol. 27, p. 480.)
   This salt  destroys life almost as rapidly as oxalic acid itself; and
 in the symptoms which it produces, it closely resembles that poison.
 In one case, half an ounce killed an adult in so short a time as eight
 minutes ; but probably the fatal effects were in this instance  accele-
 rated by the debilitated state of the person who took it. In another
 case, reported by M.  Chevallier, death took  place in  ten minutes.
 (" Ann. d'Hyg." 1850, vol. 1, p. 162.)  In some instances this poison-
 ous substance has been supplied by mistake for cream of tartar, and
 has thus caused death.
   Chemical  analysis.—It is  not very soluble in  cold water, but its
 solution may be readily mistaken for that of oxalic acid. 1st, it has
 an acid reaction ; and 2d, it is precipitated by nitrate of silver and
 sulphate of lime, like oxalic acid:  but with the  latter test the pre-
 cipitation is much  more copious.   It is distinguished from oxalic
 acid: 1, by its crystals, which when slowly produced on a glass
 slide assume the shape of small rhombic prisms, sometimes grouped
 in a plumose form ; and 2, by heating a portion on platinum foil:
 while oxalic acid is volatile, the binoxalate leaves  an ash, which,
 when sufficiently heated, is white  and alkaline; it may be proved
 to contain carbonate of potash by  its dissolving with effervescence
 in diluted nitric acid, and forming nitrate of potash.

                        Tartaric Acid.

  Symptoms and appearances.—Tartaric acid has not been considered
to possess any poisonous properties; but one  case has  occurred, in
which there was no doubt that it acted as an irritant, and destroyed
life.  The case referred to was the subject of a trial for manslaughter
at the Central Criminal Court (Reg. v.  Watkins), in January, 1845. 
126                    ACETIC  ACID.
The accused gave the deceased, a man aged twenty-four, by mis-
take one ounce of tartaric acid instead of aperient salts,   lhe de-
ceased swallowed the whole dissolved in half a pint of warm water
at a dose:  he immediately exclaimed that  he was  poisoned; he
complained of having a burning sensation in his throat and stomach,
as though he had drunk oil of vitriol, and that he could compare it
to nothino- but being all on fire.  Soda and magnesia were admin-
istered 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 published by M. Devergie.  (" Ann.
d'Hyg.," 1851, vol. ii. p. 432.)  This  case gave rise to a controversy
between the late M. Orfila and M. Devergie, the points in dispute
relating chiefly to the processes for the detection of the acid in the
stomach  and tissues.  (See "Ann. d'Hyg.," 1852,  vol. i. pp. 199,
382, and vol. ii. p. 230.)

                        Acetic Acid.

   This acid has been generally excluded from the class of poisons.
Common vinegar, which contains only  five per cent, of acetic acid,
has often been taken in'large doses without injurious consequences.
From the experiments performed by Orfila on dogs, and from one
case which  he reports as having occurred in the human subject,
acetic acid, when concentrated, appears to exert an irritant action
on the body.  (" Annales d'Hygi5ne," 1831, vol. ii. p. 159; also
" Toxicologic," vol. ii. p. 198.)  This  is not more than  we might
have expected, seeing that the  concentrated acid  is  highly corro-
sive.  In the case  referred to, the deceased, a young female aged
nineteen, was found dying on the highway. She suffered from con-
vulsions—complained of pain in the stomach, and died  in  a  very
short time.  On inspection, the stomach was found neither softened
nor corroded, but its mucous membrane near the pylorus was almost
black.   The mucous glands were prominent, and the vessels were
filled with black coagulated blood.
  Vinegar, which may be regarded as an organic mixture contain-
ing but a very small proportion of acetic acid (five  per cent.), may
be examined by  distilling a portion,  and testing the distilled liquid
for the acid.   Vinegar, as it exists in commerce, always contaius a
small quantity of sulphuric acid, and occasionally traces of  arsenic
and lead.  In  general it is easily recognized  by its odor.  Pelletan
observed in  the  case of a child that  the abuse of vinegar led  to  a
thinning of the  mucous membrane of  the stomach ; and  Landerer
remarked that the milk of a wet-nurse who had been in the habit
of taking large  quantities of the Vinegar of Roses, became thin,
very acid, and deficient in casein and  oil.  The infant which she 
POISONING  BY POTASH  AND SODA.         127
was suckling gradually wasted and died, and  the woman herself
suffered severely.  (" Heller's Archiv.," 1847, 2 H. S. 185.)
  [Aromatic vinegar, which is a stronger preparation (containing
at least ninety per cent, of acetic acid), rendered  still more irrita-
ting by the  aromatic  oils dissolved in it, may be unintentionally
used in such a manner as to produce very serious, if not fatal injury.
We have attended a lady whose husband, in his anxiety to restore
her from a fainting fit, had poured a quantity of  aromatic vinegar
into her nostrils.   The result of this accident was  the corrosion and
subsequent violent  inflammation  of the  lining membrane of the
nostrils and  of the posterior surface of the soft palate.   The same
amount of irritation, extending into either the larynx or oesophagus,
would probably have destroyed her life.—H.]
                      CHAPTERIX.

 POISONING  BY ALKALIES AND  ALKALINE  SALTS.—POTASH, SODA, AND
   AMMONIA.—NITRATE  AND  SULPHATE  OF  POTASH. — CHLORIDE  OF
   BARIUM.

                       Potash and Soda.  .

   Symptoms.—The symptoms produced by potash and soda, when
 taken in large doses, are similar, so that one description will serve
 for both.   The most common form in which these poisons are met
 with,  is in the state of pearlash (carbonate of potash) and soap-lees
 (carbonate of soda).  The person  experiences, during the  act  of
 swallowing, an acrid caustic taste, owing to the alkaline liquid, if
 sufficiently concentrated, excoriating the mucous membrane.  There
 is a persistent sensation of burning heat  in the throat, extending
 down the gullet to the stomach. Vomiting is not always observed ;
 but when it does occur, the vomited matters are sometimes  mixed
 with blood of a dark brown color, and  with detached portions  or
 flakes of mucous membrane;  this effect depending on the degree of
 causticity in the liquid swallowed.  The  surface is cold and clammy;
 there is purging, with severe  pain in the abdomen, resembling colic.
 The pulse is quick  and feeble.   In the course of a short  time, the
 lips, tongue, and throat become swollen,  soft, and red.
  Period of death.—The  most rapidly fatal case of poisoning  by
 alkalies which I have found reported is  that of a  boy, who died  in '
 three hours after swallowing  three ounces of a strong solution  of
carbonate  of  potash.  In a case which occurred in 1835, a  child,
aged three years, took a small quantity of concentrated solution  of
pearlash, which  had deliquesced, and died  in twenty-four  hours.
Death was caused in this instance  by the inflammation induced in
the larynx, causing suffocation.  In this respect, the caustic alkalies
may destroy life rapidly, like the mineral acids.   But death may 
128
APPEARANCES AFTER DEATH.
 be also a slow result of these poisons.   Thus, in an instance which
 was communicated to me, a lady swallowed, by mistake, one ounce
 and a half of the common solution of potash of the shops, which
 contains about 5 per cent, of caustic  alkali.   She recovered from
 the first symptoms of irritation, but died seven weeks  afterwards,
 from pure exhaustion, becoming greatly emaciated before her death.
 The  alkali  had probably destroyed the lining membrane  of the
 stomach, and had thus impaired digestion.
   Appearances after death.—In recent  cases there are marks of the
 local action of the poison on the  mucous membrane of  the mouth,
 throat, and gullet.  This membrane has been found softened, de-
 tached, and inflamed in patches of a deep chocolate color, sometimes
 almost black.  A similar appearance has been  met with in the
 mucous membrane of the larynx  and windpipe.  The stomach has
 had its mucous surface  destroyed in patches, and there  has been
 partial inflammation.  In one instance, as a result of the action of
 soda, I found it  puckered and blackened.  The quantity  of these
 alkaline poisons  required to, destroy life is unknown.   The fatal
 effects depend rather on the degree of concentration of the liquid,
 than  on the absolute quantity of alkali present.
   Chemical analysis.—Solutions of Potash and Soda have a strongly
 alkaline reaction;  they  are distinguished from those of their re-
                         spective carbonates by giving brown pre-
                         cipitates with a solution of nitrate of sil-
                         ver.  The Carbonates, on the other hand,
                         yield a whitish-yellow precipitate.  Pot-
                         ash is known from Soda by the following
                         characters :  1.  Its solution, when not too
                         much diluted with water, is precipitated
                         of a canary-yellow color by perchloride
                         of platinum.   2. It is precipitated  in
                         granular  white crystals, on adding the
                         alkaline  liquid gradually to  a strong
                         solution of  tartaric acid, containing  a
                         small  quantity of  alcohol,  and occa-
                         sionally stirring  the mixture.   Soda is
  , .  ,   ...          „   not precipitated by either of these tests,
 which will serve equally  to distinguish the satis of potash from those
 of soda, if we except the acid oxalate  and acid tartrate of potash:
 these, from being but little soluble  in  water, are not precipitated.
 3. It we neutralize the two alkalies by diluted nitric acid, and crys-
 tallize the liquid  on a slip of glass-should the alkali be potash,
 the crystals will have the form of long slender fluted prims ; if soda,
 of rhombic plates.  (Fig. 3.)   4.  Potash and  its salts are  known
 by their giving a reddish-violet color, while soda and its salts give
 a bright yellow color to the colorless flame of alcohol         g
   In  liquids  containing organic matter.—Such  liquids  are frothv

^^pM^61^^11'^ peCuUar ^ineod^and^
soapy to the feel.   The organic liquid may be evaporated  to dry-
                  - a capsule to char the animal  and vegetable
Crystals of Nitrate of Soda, magnified
       30 diameters.
ness, then heated in 
POISONING  BY  AMMONIA.
129
matter, and the alkali wrll be recovered from  it in a state of car-
bonate, by  digesting the residuary ash in distilled water.

               Ammonia.   Spirit of Hartshorn.

  The vapor of strong ammonia is poisonous.  It may destroy life
by producing violent inflammation of the larynx, or of the lungs
and air-passages.   It is often injudiciously employed to  rouse per-
sons from  a fit.  A case is  on record of an epileptic having died
under all the symptoms of croup, two days after the application of
strong ammonia to the nostrils.   This had been employed to rouse
him from  a fit.  A singular case of recovery from the poisonous
effects of this  vapor, by Dr.  Sanchard, is reported in the "Annales
d'Hygicme" (Janvier, 1841).  A  case of  poisoning by  the vapor
breathed in the manufacture of ice  from  liquefied ammonia is
reported  (Hiezmann's " Jahresbericht Toxicologic," 1872, p. 470).
The effects were chiefly  manifested  in the  lungs, and many days
elapsed before  recovery took place.
  Symptoms and appearances.—The strong solution of ammonia pro-
duces symptoms similar to  those described in speaking of potash,
but as it is much more irritating, it produces a choking sensation,
followed by intense heat and burning pain in the throat, gullet and
stomach.
  Serious injury to the organs of respiration is one of the results
of the action  of this poison.   A gentleman  liable to attacks of
fainting died in three days, after swallowing a quantity of a liquid
administered to him by his son.  This  liquid, which was at the
time  believed  to be sal  volatile,  was, in fact, a  strong solution of
ammonia.   The deceased complained immediately of a  sensation
of choking and strangling in the act of vomiting.  Symptoms of
difficulty of breathing set in,  with other signs of irritation in the
throat and stomach. The mucous membrane of the mouth and
throat was corroded and dissolved, and it  was  evident  that the
liquid had  caused  great  local  irritation.   The difficulty of breath-
ing was such  as  to threaten  suffocation, and at one time it was
thought that an operation  must be resorted to.   The state of the
patient, however,  precluded its performance,  and he died on the
third day.
  On inspection, the viscera presented strong  marks of corrosion,
The covering  of the tongue was  softened, and had peeled off; the
linino- membrane of the air-passages was softened  and covered with
layers of false membrane,  the result of inflammation;  and the
larger bronchial tubes were completely obstructed by casts  or cylin-
ders of this membrane.  The  lining membrane  of the gullet was
softened, and at the lower part, near its junction with the stomach,
the tube was  completely dissolved  and destroyed.  There was an
aperture in the stomach  in its anterior wall, about one inch and a
half in diameter;  the edges were soft, ragged, and blackened, pre-
senting an  appearance of solution.   The contents of the  stomach
had  escaped.  On  the inside,  the vessels were injected with dark-
       9 
130        POISONING BY NITRATE  OF POTASH.
                                       mil effusions of blood in
                                        'he coats were thinned
                                        'he blackened and con-
3eTa™^t™nc7oFthe~lining"membrane  somewhat resembled
that which is seen in poisoning by sulphuric or oxalic acid   the
mucous matter on the  coats of the stomach was feebly acid.  No
poison of any kind  was found in the layer of  mucus or m the
coats   There was not in any part the slightest trace of ammonia,
the poison which had caused the mischief.  The deceased had lived
three  days; remedies had been used, and every trace of ammonia
had disappeared.  The  immediate cause of death was an  obstruc-
tion of the air-tubes, as  a result  of inflammation,  caused by the
local  irritant action  of the liquid;  it was  quite  obvious that a
quantity had entered the windpipe.  The perforation of the stomach
had probably taken place shortly before death, or there would have
been marks of peritonitis.  The injury to the  stomach and gullet
would have been sufficient to cause death, even supposing that the
liquid had not penetrated into the lungs.
  Carbonate of ammonia.—The concentrated solution of  this salt
(sal volatile) is probably more  active as a poison than is commonly
supposed.  A  man  in a  fit of  passion, swallowed about five
fluidrachms of a solution of sal volatile.  In ten  minutes, he was
seized with stupor and insensibility; but upon the application of
stimulant remedies he recovered.  He suffered for some time after-
wards, from severe irritation about the throat and gullet.
  A female, set. 19, while in a state of  unconsciousness, was made
to swallow a quantity of hartshorn.  She felt a severe pain in the
stomach immediately, and in about an hour afterwards she vomited
some  blood.  This vomiting of blood continued for several days.
These symptoms were followed by great irritability of the  stomach,
and the constant rejection of food.  There was obstinate  constipa-
tion of the bowels, with emaciation and loss of strength.   She died
in about three months  from the time at which she had swallowed
the alkaline poison.  On inspection, the gullet was found healthy;
the orifice, at its junction with the stomach, was slightly contracted.
The intestinal opening (pylorus) was contracted to the size of a
crowquill, and the coats were thickened.  On the posterior wall of
the stomach there was a dense cicatrix of the size of half a crown,
and from this point fibrous bands ramified  in various directions.
The duodenum and other parts of the intestinal canal were healthy.
("Med. Times and Gazette," Nov. 26, 1853, p. 554.)
  Chemical analysis.—Ammonia is distinguished from potash and
soda by its pungent  odor and entire volatility.  The carbonate of
ammonia may be  known from other salts by its alkaline reaction,
its odor, and its volatility as a solid, and from pure ammonia by its
effervescing on the addition of an acid.

           Nitrate of Potash.   Nitre.  Saltpetre.

  There  appears to be some uncertainty in the action of this salt,
both as to the symptoms and the fatal  effects  on the body.   Mr. 
sulphate  of potash.
131
Fuller, of Oswestry, communicated to me a case which proved fatal
in December, 1863.  A man swallowed an ounce of nitre, mixed
with water, by mistake for Epsom salts, about nine  o'clock in the
morning.   It produced vomiting with severe pain, but no purging.
There was coldness of the surface and lividity of the face.  Death
took place in three hours. On inspection, the mucous membrane of
the stomach was found highly inflamed, especially towards the mid-
dle of the greater curvature, where for several inches it resembled
scarlet cloth.  The pylorus and duodenum were of a deep crimson
color.  The peritoneal  surface was very vascular, especially over the
stomach, the vessels having  a vermilion red color, as if they had
been injected.  The heart and lungs were healthy, the blood was
fluid and more florid than natural.  The other organs presented no
unusual appearance.   No analysis was made of the contents of the
stomach, but that the  nitre  was the cause of death no doubt could
be entertained, and a verdict was returned accordingly at the cor-
oner's inquest.
  Analysis.—For the chemical properties and method of detecting
this salt, see page 117.

                     Sulphate of Potash.

  Symptoms and  appearances.—The question whether this should
be regarded as an irritant poisonous salt or not, was  much debated
among members of the profession, in reference to a case which was
tried at the Central Criminal Court in October, 1843.  (The Queen
v. Haynes.)  The accused had given to the deceased, the night
before  her death, two  ounces of sulphate of potash, dissolved  in
water; and it was alleged that a fortnight previously to this, she
had taken  in divided doses, as much as a quarter of a pound of the
salt.  The woman thought  that she was pregnant, but  this was
disproved by an examination of the body; and it was charged that
the prisoner had given her the salt with the intention of causing a
miscarriage.  After the last  dose, she was seized with sickness, and
died within a very short time.  The stomach was  found empty,.
but highly inflamed; and there was blood effused  on the brain.
One medical witness referred death  to the action of the  sulphate
as an irritant poison ;  the other to  apoplexy, as an indirect result
of the violent vomiting caused by it.  The prisoner  was acquitted
of the charge of murder, but subsequently found  guilty of admin-
istering the substance with intent to  procure  abortion.   Both of
the witnesses admitted that, in small doses, the salt was innocent;.
but that in the dose of two ounces, it might produce dangerous effects.
Several  other  fatal cases are recorded.   (See  "Ann. d'Hygi&ne,"
Avril, 1842.)
  According to Mr. Mowbray ("Medical Gazette," vol. 33, p. 54),.
sulphate of potash is much employed in France as a  popular abor-
tive.  He quotes several  instances in which, in large doses, it pro-
duced severe symptoms, resembling those of irritant poisoning, audi
even death. In one case, two drachms acted powerfully; and in
another that fell under his own observation, four drachms of the 
132
SALTS of baryta.
salt administered to a lady after her confinement, had all the effects
of an irritant poison.                                   ,
  There  is no doubt that  the most simple purgative salts may,
under certain circumstances, and when given in large doses, destroy
life   A case is elsewhere related, in which sulphate of magnesia
caused death, and gave rise to  a criminal charge in this country.
(On Poisons," 2d ed. p. 4.)   It is said that sulphate of potash has
in some cases caused vomiting and other serious symptoms, from
its containing as impurity sulphate of zinc.  This, it present, would
be easily discovered by the  appropriate tests
  A more serious impurity  has been lately detected hy Mr. Bussy,
namely the arseniate of potash.  He found this poison ma sample
of sulphate,  supplied  by a wholesale house  in Paris.  ('Pharm.
Jourm" May, 1872, p.  954.)   This impurity may be derived from
arsenical  sulphuric acid  used  in its manufacture.   It would be
proper to test for arsenic  any sample of sulphate which hascaused
irritation.   (See Arsenic.)   Arsenic may thus find its way into all
medicines in which sulphate of potash is used, e.g., the compound
colocynth pill and the  compound powder of ipecacuanha.
   Sulphate of potash may  be  easily identified.   It  is in  hard dry
crystals, soluble in water,  forming  a neutral  solution in which
potash  and sulphuric  acid may be discovered by the appropriate
tests.

                      Salts  of Baryta.

   Chloride of barium.  Symptoms.—A woman, set. 23, took by  mis-
 take for Epsom salts  less than a  teaspoonful (100 grains) of the
 chloride.  This was at 12.30, 1st  October, 1858.  In half an hour
 there was a feeling of  deadly sickness, with sharp burning pains in
 the stomach and bowels.   Vomiting and purging set in violently,
 the purging being attended with straining.  An hour and a  half
 after she had taken the  poison, the following  symptoms were ob-
 served by Mr. Walsh.   Face  pale  and anxious, eyes deeply sunk,
 surface cold, heart's action feeble, pulse scarcely perceptible, tongue
 natural and warm, loss of  muscular power, sensation  and intelli-
 gence not  affected, pupils natural.  Fluids taken were instantly
 rejected with a ropy mucus.   There was pain in the stomach,  sing-
 ing in the ears, twitching  of  the face, and twisting of the legs and
 arms.  At 9 P. M. the symptoms had abated, but at 2 A. M. (i. e. in
 about fourteen hours) the  purging had returned, and the symptoms
 were much worse.  There was a loss of voluntary muscular power.
 The breathing was slow and labored, and indicated effusion in the
 bronchial tubes, but the woman was sensible.   Soon after 3 A. M.
 she was convulsed, and  these  convulsions continued in paroxysms
 for two hours, when she died, seventeen hours after taking the
 poison.   During the fits she  had several  watery evacuations, and
 consciousness was  lost.  There was no  post-mortem examination.
 ("Lancet," 1859, vol.  1, p. 211.)
    The  Carbonate of baryta is said to have destroyed life in two 
PHOSPHORUS.
133
cases, in each of which only one drachm was taken; but the follow-
ing case, which occurred to Dr. Wilson, shows that this compound
is  not so  poisonous  as the chloride.   A young woman swallowed
half a teacupful of the powdered carbonate, mixed with water, at a
time when she had been fasting twenty-four hours.  There was no
particular taste.   In  two hours, she experienced dimness of sight,
double vision, ringing in the ears, pain in the head, and throbbing
in the temples, with  a sensation of distension and weight at the pit
of the stomach.  There was also palpitation of the heart.   After a
time she complained of pain in the legs and knees, and cramps  in
the calves.  She vomited twice a fluid like chalk and  water.  The
skin was  hot and dry, the  pulse  frequent, full, and  hard.  The
symptoms gradually  abated, and she recovered, although the  pain
in the head and stomach continued for a longtime.  ("Med. Gaz."
xiv. 448.)   The carbonate  is used as a poison for  rats and mice.
  Analysis.—Chloride of barium crystallizes in  plates:  it is soluble
in water.  1. The solution yields an insoluble  white precipitate
with  sulphuric acid or an alkaline sulphate.   This precipitate is
nearly insoluble in  nitric acid.   2. The powdered salt, burnt  on
platinum wire in a smokeless flame, imparts to it a greenish-yellow
color.  3.  Chlorine  may  be detected by a solution of  nitrate  of
silver.
   Carbonate of baryta is a  white insoluble powder.  It is  entirely
dissolved with effervescence (carbonic acid) by diluted hydrochloric
acid.   On evaporation, it yields crystalline plates of the chloride of
barium, which may be tested by the processes above mentioned.
                      CHAPTER X.

PHOSPHORUS.— SYMPTOMS AND  APPEARANCES.— CHRONIC  POISONING.—
  FATAL  DOSE.—CHEMICAL ANALYSIS. — RED OR  ALLOTROPIC PHOS-
  PHORUS.

  Phosphorus is not often used in attempts at murder.   The smell
and taste as well as luminosity commonly reveal its presence.  At
the Norwich Autumn Assizes, 1871 (Reg. v.  Fisher), a  girl of
eighteen was convicted of an attempt to poison a family.  She  put
a vermin compound containing phosphorus into a teapot containing
tea.  When hot water was poured on  it, the smell at once led to
suspicion.  Phosphorus was found in  it, taken from  a pot care-
lessly left about the house.  The girl was convicted, and sentenced
to penal servitude  for life.  The late Professor  Casper of  Berlin,
describes a case in  which the luminous appearance of the poisoned
food  led to a suspicion of poisoning with  phosphorus, and this  was
subsequently proved.  A woman put a preparation of  phosphorus
into some soup, and gave  it to her  husband.  He ate it in a dark 
134
PHOSPHORUS — SYMPTOMS.
room  in the presence of some friends, and they noticed  that  the
liquid as he stirred it was luminous.  (Viertcljahrsschrift,  July,
1864 )  In this way a person may be warned and a life saved.  (See
"Ann. d'Hyg." 1870, 2, 203.)                  #
  Symptoms.—Phosphorus acts as an irritant poison, but its opera-
tion is attended with some uncertainty, according to the state in
which it is taken.  The symptoms are frequently slow in appearing:
it is only after some hours,  and sometimes even  one  or two days,
that signs of irritation with convulsions and spasms appear; but
when  these  once come on, the case proceeds rapidly  to a fatal
termination.  In the first instance the patient experiences a disa-
greeable taste resembling that of garlic, which is peculiar to this
poison.   An alliaceous or  garlic" odor may be  perceived in the
breath.  There is an acrid  burning sensation in the throat, with
intense thirst, nausea, severe pain and  heat, with tenderness and a
pricking  sensation in the stomach, followed by distension of the
abdomen and frequent vomiting.  The vomited matters are black,
or of  a dark green or coffee-ground color, and have the  odor of
garlic: white vapors may be seen to proceed from them, and in the
dark they may even appear phosphorescent.  Purging has been
noticed among the symptoms, and the  motions have been observed
to be  luminous in the dark.  The pulse  is small, frequent, and
scarcely perceptible.  There is  great prostration  of strength, and
coldness of the skin with other symptoms of collapse.  The patient
may die quietly in a comatose state, or be  convulsed  before death.
Jaundice has been  observed among  the symptoms.
  A woman, set. 26,  swallowed a decoction  of lucifer-matches in
coffee.  In an hour an emetic was given to her, and she vomited
half a pint of clear glairy fluid, having the smell of phosphorus,
and containing particles  of blue coloring matter (Prussian  blue)
derived from the matches.  She had no pain in  the stomach, and
no purging.   In  four days she appeared to have  recovered; but
about  this time there was bleeding from the nose; she was jaun-
diced, and blood appeared in the matter vomited.  Febrile symp-
toms set in with purpura, and she died in about a week after taking
the poison.  (" Ed. Monthly Journal," Oct. 1860.) On April  20,
1861,  a girl swallowed a quantity of phosphorus paste.  When seen
soon afterwards by Mr. Parsons of Bridgewater, her lips as well as
parts of her dress were smeared with this substance, and there was
a strong odor of  phosphorus in her breath.   Her countenance was
tranquil: her pulse regular: there  was no  sickness or nausea, and
she complained of nothing but  slight thirst.   Her symptoms were
so slight that they excited no suspicion that the girl had swallowed
the poison.  She passed a restless night, and the next  day she com-
plained of heat in the mouth and throat, and of a slight sensation
of nausea and retching.  There was no pain or  tenderness in the
region of the stomach, the  pulse was  regular but weak.  On  the
22d she dressed herself and  was able to walk about the ward •  she
left the  hospital  and went  home, having walked a mile •  she had
her tea as usual at  night, and went  to bed.   On the following day, 
               PHOSPHORUS — APPEARANCES.            135

the 23d, she complained of pain in  her bowels, with sickness and
purging.   These symptoms became worse.  On the 25th there was
pain in the bowels, which were  tender  on pressure and  slightly
tympanitic.   The  pulse was intermittent, and the girl was fast
sinking.   She died on the 26th, having survived the effects of  the
poison  nearly a week, and no well-marked symptoms having set in
until the fifth day.  An inspection of the  body was not permitted,
and the only fact  observed after death  was a tendency to rapid
putrefaction.  The whole of the  body became  speedily livid, and
the finger-nails were blue—a condition noticed by a witness to have
existed before death.  (For other cases, see " Ann. d'Hyg." 1869,
2, 397.)
  It will be perceived that, in reference to the delay in the appear-
ance of symptoms, their slightness taken as a whole, and the time
at which death occurred, this case is similar to the one previously
related.  If it were not for the peculiar character of the circum-
stantial evidence, these cases might easily throw a practitioner off
his guard  in forming an opinion.
  Chronic poisoning.—Chronic  poisoning by phosphorus is accom-
panied by nauseous eructation, frequent vomiting, a sense of heat
in the stomach, purging, straining, pains  in the joints, wasting,
hectic  fever, and disease of the stomach, under which  the patient
slowly sinks.   Some interest is attached to the  chronic  form of
poisoning by  phosphorus from the  researches  of Dr.  Strohl and
others, on the effects of the vapor upon persons engaged in the man-
ufacture of phosphorus or lucifer matches.  It has been remarked
that such  persons  have suffered from necrosis of  the jaw, carious
teeth, and abscesses.  There has  been  also great  irritation of the
respiratory  organs, and bronchitis  has  frequently shown itself
among them.  "(See " On Poisons," 2d edit. p. 345.)
  Appearances.—Among the appearances produced by phosphorus
are marks of irritation and inflammation  in the stomach and intes-
tines.   The stomach has  been found much contracted,  and its
mucous membrane inflamed, occasionally softened and presenting
purple or violet-colored spots.  Mr. Worbe found  the stomach per-
forated in three places in a dog which had been poisoned by a solu-
tion of phosphorus in oil.  In one fatal case the body was found in
a state of  great muscular rigidity.   The membranes of the brain
were congested, and there was serious effusion between  them.  The
substance  of the brain was also congested.   The heart was  flaccid
and nearly empty.  The mucous membrane of the stomach, gullet
and small intestines was very red, and there were patches in which
the membrane was destroyed.   When  the  stomach was opened, a
white vapor escaped, accompanied by a  strong smell of phosphorus.
This organ contained a tablespoonful of  a viscid  greenish matter,
from which  particles of  phosphorus with some Prussian blue (used
as a coloring for  the phosphorus  paste),  subsided on standing.
("Lancet," June 13, 1857, p.  600.)  The mucous membrane has
been found raised in small bladders or vesications, but this appear-
ance was  probably owing  to  putrefaction,  as the body was not 
136         phosphorus—PERIOD of death.
examined  until twenty-three days after  death.   Schuchard, de-
scribes the blood as dark and fluid, and it does not become red on
exposure to the air.   Ecchymoses are sometimes found on the skin
and on the surfaces of various organs  (" Brit, and For. Med. Rev.
1857  vol  19  p 506.   " Journal de Chimie Medicale, 1857, p. 84.)
Anion* the appearances met  with in the acute form of poisoning is
a fatt? degeneration  of the  voluntary  muscles as well  as of the
liver/heart and kidneys.   (See a paper on this subject by Dr.
Moore, "Dublin Medical Press," Nov. 15, 1865.)         m
  The viscera, and even the flesh of  animals recently poisoned by
phosphorus, have the peculiar odor of this substance, and they are
frequently luminous in the dark.   (Galtier, " Toxicologic," vol. 1,
p. 184.)  Mr. Clowes informed me, that in examining some fowls
which had been poisoned with phosphorus, he was struck with the
strono-odor of this substance on opening the gizzards, and with the
appearance of a fine white  fume, which was luminous when ob-
served in a dark room.  In the case of a woman who  died  while
taking phosphorus medicinally, it was remarked that the whole of
the viscera were luminous,—thus indicating the universal diffusion
of this poison  by absorption.  (Casper's " Wochenschrift," 21 and
28 Feb. 1846,115,135.)
   Fatal dose.— That  phosphorus is a powerful poison, is  proved by
two cases quoted by Sir R.  Christison.  In one, death was caused
by a grain and a half in  twelve days; in the other, by two grains
in about eight clays.   It  has been  supposed  to operate as a poison
only by becoming converted into phosphorous acid ; but although
this conversion takes place, it is  probable that phosphorus  passes
directly into the blood, since the urine  voided during life has been
observed  to be luminous:  hence it is itself probably a blood-poison.
   Period  at which death takes place.—This has varied greatly,  in the
cases hitherto observed, from a few hours to a week.   In  a case
 related by Orfila, death took place in four hours.  In another also
related by him, death occurred only  after  seventeen days.   Dr.
Habershon quotes a  case  which is said to have proved fatal in half
an hour.   (" Med. Chir. Trans." 1867, vol. 50.)  This is the shortest
 period recorded.   In  general, several  days elapse  before a fatal
 result occurs, and during this time the patient undergoes much
 suffering. This was observed in a young woman who swallowed a
 quantity  of phosphorus-paste intended for poisoning rats.  She did
 not die until  the fifth day.  (" Journal de Chimie Med." 1845, p.
 508.)  In two cases  of acute poisoning with phosphorus communi-
 cated to  me  by the late Dr. W. D.  Moore, one proved fatal in
 seventy-two, and the other  in eighty-eight  hours.   The symptoms
 and  appearances were similar to those already described.  Fatty
 degeneration of the liver and other  organs was especially marked.
 ("The Medical Press," Nov. 15, 1865, p. 434.)  In a case  which
 occurred  to Dr. Anderson, a child aged one year and eight months
 had  sucked the heads off about twenty phosphorus-matches before
 it  was detected.  No symptoms  appeared  until the second day,
 when the child was  drowsy  and slept for twenty hours.   Castor oil 
PHOSPHORUS — ANALYSIS.
137
and oil of turpentine were given.  On the fourth day, it vomited;
the skin  was hot, tongue dry, there was great thirst with a quick
pulse  and cold extremities.  On the sixth day, there  was much
vomiting of a matter  like coffee-grounds (altered  blood).   There
was great pain in the stomach; the child became unconscious, and
gradually sunk, dying  on the seventh day after taking the poison.
There was no purging, but the motions were passed involuntarily,
containing coagulated blood.   An alliaceous odor was perceived in
the breath during the progress of the case, and the body had a
yellowish (icteric) tint.   There was no odor of phosphorus  noticed
on post-mortem  inspection, nor were the viscera luminous in the
dark.  Phosphorus  could not  be detected by  Mitscherlich's pro-
cess.  («  Lancet," 1871-2,189.)
   Chemical arialysis.—Phosphorus is a  solid, of waxy consistency,
havinga peculiar odor and taste resembling garlic.  It is the odor
and taste which  prevent it from being criminally employed as a
poison, and render  it  easy of detection  in  articles  of food.  It
evolves a white vapor in  daylight, and a faint bluish luminosity in
the dark.  It melts and  takes fire at a temperature of 113°, burn-
ing with a bright yellow flame, and producing thick white acid
vapors by combustion.   It is not soluble in water, although water
in which it has been kept acquires poisonous properties by reason
of the phosphorous acid  formed.   It is dissolved by alcohol, ether,
chloroform and the oils.   Its most perfect solvent is  the sulphide
of carbon.
   Organic mixtures.—The smell which phosphorus imparts to solids
and liquids is  remarkably characteristic.  When it  has been taken
in a solid form, the  particles may be separated  as  a  sediment, by
washing the contents  of the stomach  in water.   These may be
melted under  water into one mass, either by  plunging the tube
containing them into  hot water, or by pouring hot water upon
them in  a glass.  If a portion of the organic liquid  is exposed in
the dark, the  particles of phosphorus will be easilj- recognized by
their luminosity, as  well as by their combustion when  the surface
on which the material is  spread is heated.   Owing to its great solu-
bility in sulphide of carbon, phosphorus may be separated from
many organic matters by digestion  with  this  liquid.   It  is thus
procured from flour  and  phosphorus-paste, or from  the residue of
the contents of the  stomach after washing and decantation. On
the spontaneous  evaporation  of  the sulphide,  decanted from the
organic liquid or solid, the phosphorus may  be  procured in  small
globules  or beads.  These are ignited when touched with a hot wire,
and burn with the bright flame of phosphorus.
  If the phosphorus is in a state of solution, or is  in  too  small
quantity  to be dissolved out of the material by sulphide of  carbon,
its presence may be indicated by distilling the liquid containing it
in the dark—the  boiling  point being raised by the addition of sul-
phuric acid.   The vapor appears luminous  as it is condensed in the
glass  condensing-tube.   So delicate  is  the process  of distillation,
which was first suggested by Mitscherlich, that  in one experiment 
138
PHOSPHORUS — IODINE.
with the head of a single lucifer-match the luminosity appeared tor
half an hour in the condensing-tube.  The  most absolute darkness
is required for the success of this experiment.
   [It should be remembered that the presence of the vapor of alco-
hol  chloroform, etc. (substances  in  which the viscera of tlm body
may have been preserved), may entirely prevent  the  luminosity in
the above experiment.—R.]
   If the person has survived several days, it is not likely that any
free phosphorus will be found in the  stomach or contents  None
was found in the stomach contents or fatty liver of the girl on the
sixth dav (page 134), but the distillation process succeeded with the
broken top of the pot which had held the phosphorus-paste, although
this was empty and had  been thrown  into a tub of water.   In Dr.
. Habershon's case of death on the fifth day, none was found by Dr.
Stevenson  in the  stomach or  contents.  The phosphorus in these
 cases is oxidized rapidly, and thus, like other poisons, it may disap-
pear from the body.  Under these circumstances, it may according
 to some authorities be still discovered as phosphoric acid, combined
 with some base—probably  ammonia ;  but as the phosphates are
 found in the secretions, which  are  generally  acid, it would be
 difficult to satisfy an English  court  that their presence  proved
 poisoning  by phosphorus, unless the  symptoms, appearances and
 circumstantial evidence were so  strong that chemical evidence was
 scarcely necessary.
   The  remarkable substance, known  under the name of  allotropic
phosphorus, is not possessed of poisonous properties.   This fact, long
 since announced by Liebig (" Letters on Chemistry," 165), has been
 since confirmed by experiment.   It has been  given to animals in
 doses of thirty grains without causing symptoms of poisoning.  In
 October, 1860, a woman, set. 26, swallowed the composition scraped
 from a number of lucifer matches made with allotropic phosphorus.
 She suffered  no  inconvenience.  She procured other  matches of
 common phosphorus, took a decoction of them  in coffee, and died
 from the effects.
   Analysis.—Allotropic  phosphorus is easily recognized by its red
 color and infusibility.  When a mixture containing it is heated to
 about  500°, it burns like common phosphorus, and yields  similar
 products.   It is insoluble in all liquids, and by its  insolubility in
 sulphide of carbon it is distinguished and  separated from common
 phosphorus.  It has no  odor or taste, and is not luminous in the
 dark.
                             Iodine.

   Symptoms.—From experiments on animals, as well as from obser-
 vation of its effects on man, iodine has a strong local  action as an
 irritant on the stomach  and bowels.   In large doses, it occasions a
 burning heat in the throat, severe pain in the abdomen, with vomit-
 ing and purging; the vomited matters having the peculiar odor of
 iodine, and being of  a  yellow color, except when any farinaceous
 food has been taken, in which case  they are blue, or  even black. 
IODINE.
139
The fecal matters may also contain iodine  if the poison has been
taken in the solid  state.  Besides these symptoms, there is great
thirst,  with anxiety,  headache,  giddiness,  trembling and convul-
sive  movements of the limbs, and fainting; these last symptoms
indicating that the poison has become absorbed.  When taken for
some time in small  doses, it gives rise to salivation, vomiting and
purging, pain in the stomach and cramps; the pulse becomes small
and frequent; there is a general wasting of the body; and  it has
been observed that,  in this form of chronic poisoning, certain glands
are liable to become  affected and diminished  by absorption—the
breasts  in the female, and  the testicles in the male.  Iodine pro-
duces these secondary effects (iodism), whether it  is taken  inter-
nally, or applied externally.
  Iodine is rarely used as a poison.   In May, 1864, an attempt was
made by a woman to  poison a fellow-servant by mixing tincture of
iodine with food in a plate.  The remarkable discoloration  of the
farinaceous food which it produced led to suspicion, and prevented
any ill effects from  following.  Iodine gives a blue, green, or dark
color fO most organic liquids, and imparts to them a peculiar odor.
It stains the skin and other organic substances yellow, the color
being removed  by an  alkali.   When in strong solution, it is corro-
sive, and destroys the parts which  it touches; in this state it has
been maliciously employed for throwing on the person.
  Appearances after death.—As this is an  irritant as well as a corro-
sive poison,  the  lining membrane of the gullet, stomach and intes-
tines is found inflamed and excoriated.  In one instance, the mucous
membrane near  the pylorus was corroded, and detached in a space
of two or three inches.
  Analysis.—The odor is  sufficient to identify it.   This may be
concealed  by alkalies  or alkaline substance.   When  heated,  it
sublimes in  a purple  vapor.   The addition of a cold solution of
starch produces  a blue color, but  many substances  prevent this re-
action.  It is very soluble in sulphide of  carbon, forming a rich
pink solution.  The sulphide has the property of removing it from
water and other liquids in which it is dissolved.  It may thus be
separated for chemical examination, by decanting the watery liquid
from  the  sulphide  which,  on evaporation, leaves  the iodine in
crystals. 
140
ARSENIC — SYMPTOMS.
METALLIC  IRRITANTS.
                     CHAPTER  XI.

ARSENIC. — ARSENIOUS  ACID. — SYMPTOMS. — CHRONIC  POISONING. —
  APPEARANCES AFTER DEATH.—FATAL DOSE.—CHEMICAL ANALYSIS —
  ARSENITES.—ARSENIC ACID.—ORPIMENT AND OTHER COMPOUNDS.

  White  arsenic.  Arsenious acid.—-The term White Arsenic  is
commonly applied to the  arsenious acid of chemists. _ It is  seen
under the form of a white powder visibly crystalline in a strong
light, or when viewed with a lens.  It is also met with, but more
rarely, in opaque brittle masses resembling enamel.  It is called an
acid from its power of combining with alkalies, but it possesses a
feeble acid reaction when dissolved in water.  It is often described
as having an acrid taste, but this does not appear to  be correct ; a
small quantity of it has certainly no appreciable taste, a fact which
may be  established by direct experiment, and might be inferred
from its  sparing solubility in liquids.  It would appear from nu-
merous  cases on  record, that it has been unconsciously taken in
fatal quantities, in all descriptions of food, without exciting the
least sensation on the tongue.   Most  of those persons who  have
been criminally, or accidentally destroyed by arsenic, have not been
aware of any taste in taking the  poisoned substance.  In  cases in
which the powder has been taken in large quantity, it is described
as having had a roughish taste.   Water boiled for an hour on the
poison and  allowed to cool, holds dissolved the 40th part of its
weight, or about  twelve grains in one ounce. If boiled for a shorter
time, not more than the 80th part will be dissolved.  Cold 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 of arsenic to nearly one fluidounce of water.  When
arsenic  in powder  is mixed  with cold liquids,  a portion of the
powder floats and adheres to the sides  of the vessel.   This appear-
ance has sometimes led to a suspicion of poisoning.
  Symptoms.—These will  vary according to the form and dose in
which the poison has been administered.  The time  at which they
come on, is  generally in from half an hour to an hour after the'
poison has  been  swallowed.  This is  the average period.  I have
known them to  appear in a quarter of an hour.   In all cases in
which arsenic enters the system from without, as by  its application 
ARSENIC — SYMPTOMS.
141
to the skin, or to ulcerated or diseased surfaces, the  symptoms are
rarely manifested until after the lapse of some hours, or even days.
   The person first experiences a feeling of sinking or faintness, de-
pression, nausea, followed by sickness, with an intense burning pain
in the region of the stomach, increased by pressure.   The pain in
the abdomen becomes more and more severe, and there is violent
vomiting of a brown turbid matter, mixed with mucus, and some-
times streaked  with blood.  These symptoms are followed by purg-
ing, which is more or less violent, and this is accompanied by severe
cramps in the calves of the legs.  The matters discharged from the
stomach  and bowels have had in some instances a yellowish color,
as it was supposed, from a partial conversion of the  poison of sul-
phuret, but more probably from an admixture of bile.  The vomited
matters  are in  some cases colored with blood, and the mixture of
blood with  bile has  often given to them  a green or brown color.
In other cases, they may consist of a large quantity of mucus ejected
in a flaky  state and having a milky-white appearance, as if from
admixture  with the poison.   The color of the vomited matters may-
be blue or black when colored arsenic has been taken, or the admix-
ture of bile may render them of a deep green color.   The vomiting
is in general violent and incessant, and  is excited by any liquid or
solid taken into the stomach.   There is tenesmus (straining), and
the discharges by the bowels are  frequently tinged with  blood.
There is  a  sense of constriction, with  a feeling  of burning heat in
the  throat, commonly accompanied  by the most intense thirst.
The pulse is small, veiy frequent, and irregular  ; sometimes wholly
imperceptible.  The skin is cold and clammy in the stage of col-
lapse ; at other times it  is very hot.   The respiration is painful
from the tender state of  the stomach.   There is great'restlessness,
but  before  death, stupor sometimes  supervenes,  with paralysis,
tetanic convulsions, or spasms in the muscles  of the extremities.
In one instance trismus (lock-jaw) appeared in three-quarters of an
hour.  (" Orfila,"  vol. 1,  p. 449.)  Although  pain  is in general
among the  early and well-marked symptoms,  arsenic appears in
some cases  to destroy sensibility.  In  a  case in which the  stomach
was found  intensely inflamed  after death, the patient complained
of no pain during  the time she survived.
   [Cases of poisoning by arsenic present the greatest possible variety
in the character, combination and severity of the symptoms. Most
frequently  the  symptoms are  those just described.  In a second
class, they are those  of collapse—there  being extreme  prostration
of strength, a cold clammy skin, a frequent, almost  imperceptible
pulse, or  one as low as thirty or forty  beats in a minute.   A third
class is marked by the patient falling  into a profound sleep, which
terminates  in a fatal coma.   (See " Guy's  Forensic  Medicine,'"
1868.)—R.]
   Chronic j>oisoning.—Should  the person  recover from  the  first
effects, and  the case be protracted, or should the dose have been
small and administered at intervals, there will  be inflammation of
the conjunctiva1, with suffusion of the eyes and intolerance of light, 
142      ARSENIC — APPEARANCES AFTER DEAT
conditions which are, however, often present among  the early
symptoms above described.  (" 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 erruption attending
scarlet fever.   Local paralysis, preceded by numbness or tingling
in the fingers and toes, and other  symptoms of nervous disorder,
are also common consequences.  Exfoliation of the cuticle and skin
of the tongue, with the falling off of the hair has likewise been
witnessed.   (Case of  the  Turners, 1815, Marshall, 119.)   Saliva-
tion has been observed to follow, especially when small doses of the
poison have been given for a length of time.  (" Med. Gaz.  vol.
16, p. 790.)  Strangury and jaundice have been noticed among the
secondary symptoms.  (" Marshall  on Arsenic," 44, 111.)
   Arsenic  is  not  an accumulative  poison ;  it  is  temporarily
deposited in the organs after absorption, but is rapidly eliminated
by the  urine;  and in from two  to  three  weeks, if  the  person
survives, the  whole of that which  has  been absorbed may  be
removed from the body.   Dr. C. Maclagan states that it begins to
pass out of the body by the urine  as early as three-quarters of  an
hour after it has been taken (p.  50).
   Appearances  after death.—The principal changes  produced  by
arsenic  are generally confined to the stomach  and bowels.   They
are commonly well  marked in  proportion to the largeness of the
dose, and the  length of time which the  person has survived after
taking  the poison.   Our  attention must  be first  directed  to the
stomach. Arsenic seems to have a specific effect on this organ: for,
by whatever channel the poison may have entered into the system,
whether through a wounded, diseased, or  ulcerated surface, or  by
the act  of swallowing, the stomach has been found inflamed.  The
mucous membrane  of the  stomach is sometimes partly detached
and is covered with a layer  of mucus, mixed with blood or bile,
and with a thick white pasty-looking substance containing arsenic.
It is commonly found  red and inflamed in  dotted  or striated
patches, extending between the two apertures; the color, which is
of a dull or brownish-red, becomes  brighter on  exposure to the air:
at other times it is of a deep crimson hue, interspersed with black-
looking lines, or patches of altered blood.  The  redness is  usually
most strongly marked at the greater  end; in  one case it  may be
found spread over the whole mucous surface, giving to it the appear-
ance of red velvet; in another it will be chiefly seen on the pronii-.
nences or folds of the membrane.  In one instance, the coats were
thickened and of a gelatinous consistency, without any marked
inflammatory redness.
   The stomach has been  found highly inflamed in a case which
proved  fatal in two hours.  Thus it would appear that intense inflam-
mation of the  mucous membrane  may be observed within a very
short period.   This organ usually contains a mucous liquid of a
dark color tinged with blood.  The coats are sometimes thickened
in patches, being raised  up into  a  sort of tumor, with  arsenic 
ARSENIC—FATAL DOSE.
143
imbedded in them :  at other times they have been found thinned.
The  mucous membrane is  rarely found  ulcerated, and  still more
rarely gangrenous.   Ulceration of the membrane, as the  result of
the action of arsenic, has been found as early as ten hours after the
poison had been taken.   Perforation of the coats is not a common
result of arsenical poisoning: there are but few instances on record.
Various appearances are said to have been met with in the lungs,
heart, brain and urinary organs;  but they are not so characteristic
of arsenical poisoning as to  admit of medico-legal use  in enabling
a medical man to distinguish poisoning from disease.  It is to the
stomach  and intestines  that he must look as the basis of reliable
evidence in regard to appearances  after  death.   Dr. Wilks met
with an ecchymosed condition of the lining membrane of the left
ventricle of the heart in a case in which  a man died  in twelve
hours, from acute poisoning by  arsenic.   In a few instances, the
mouth, throat and gullet have  been found inflamed, but in general
there are no changes in  these parts'to attract particular attention.
  The mucous membrane of the small intestines may  be inflamed
throughout, but commonly the  inflammatory redness is confined to
the upper part, i. e. the duodenum, especially to that portion of it
which joins the stomach.  Of the  large  intestines,  the rectum
appears to  be  the  most prone to inflammation.   The  liver, spleen
and kidneys present no appearances which can be  connected with
the action of  arsenic, although these, like the  other  soft organs,
may  become receptacles  of  the absorbed  poison.  It is worthy of
observation in  relation to the known antiseptic properties of arsenic,
that  the  parts especially affected by this  poison (the stomach and
intestines) occasionally retain the well-marked character of irritant
poisoning for a long time after death.  Absorbed arsenic does not,
however, appear to prevent the decomposition of the soft organs in
which it is deposited.
  Arsenic  may destroy  life  as the result of external application to
any diseased or ulcerated surface, or to  a  wound.   (See "Guy's
Hospital Reports," Get. 1864, p. 220.)
  Fatal dote.—The smallest fatal dose of arsenic hitherto recorded
is two grains.  (" Provincial  \\led. Journal," June 28, 1848, p.  347;
also  " Medical Gazette," vol. 39, p.  116.)   Under circumstances
favorable to the operation of this poison, the fatal dose in an adult
may be assigned at from two to three grains.  Large doses of arsenic
commonly destroy life in from  eighteen hours to three days.   The
average time at which death takes place is twenty-four hours;  but
the poison  may destroy life  within a much shorter period.   In a
case which occurred in April, 1849, death took place iu two and a
half  hours.  ("Guy's Hospital Reports,"  Oct. 1850, 183.  See also
"Ann. d'Hyg." 1837, vol. 1, p. 339.)  Mr. Foster  of Huntingdon,
met with the  case of a child  under  three years of age, who  died
within two hours from the effects of arsenic.  One case is said to
have  proved fatal in twenty minutes.  On the other hand, life is
occasionally protracted  for  many days.   In October, 1847, a  man
who had swallowed 220 grains of arsenic  was admitted into Guy's 
144
ARSENIC — ANALYSIS.
Hospital, and died on the seventh day.  In the case of Dr. Alexan-
der,/death took place on the sixteenth day; and although^ a large
quantity of arsenic had been taken, no traces were  found in the
body   ("Med. Times and Gazette," April 18,1857, p. 389)  In an
instance in which  arsenic was applied  externally to  the head, the
person did not die until the twentieth day.            _  _
  The longest duration of a case of poisoning by arsenic is probably
that reported bv Belloc.  A woman, set. 56, employed a solution of
arsenic in water to cure the  itch, which had resisted the usual
remedies.  The skin became covered with an erysipelatous eruption,
and the itch was cured, but she experienced severe suffering.  Her
health gradually failed, and she  died after the lapse of two years,
having suffered during the  whole of this period from a general
tremor of the limbs.  '(" Conrs de Med. Leg." 121.)
  A girl, a?t. 9, died  rather suddenly, after an illness of about ten
days.S The mother had rubbed some precipitate ointment mixed
with  arsenic on the head of the child which was diseased.  Her
object, she stated, was  to kill the vermin on the scalp.   No  symp-
toms  of  note were observed until about the fifth day after  the
application, when the child appeared ill and complained of thirst.
On  the eighth  day she was  very unwell; there had been cramp,
with  slight  action on the bowels, but  no vomiting.   She became
drowsy, and  died on the tenth day.   Mr. Haward examined the
body, and forwarded to me  the  viscera for chemical analysis, the
case being very obscure.  The lining membrane of the stomach and
duodenum was inflamed:  in  the stomach the inflammation was
well marked  towards the greater end : these were the principal post-
mortem appearances.  Traces of arsenic were found in the mucous
fluids of the stomach,  in the coats of the stomach and intestines,
and in four ounces of  the liver, but arsenic of a solid form could
nowhere be detected.  A portion  of the diseased  hairy scalp was
examined, and yielded  arsenic as well as mercury (from white pre-
cipitate) in large proportion,—the arsenic  being estimated at from
two to three grains.
  The remarkable features of the case were  these :  no symptoms
appeared until  after the fourth  day, and then only great thirst;
there  was slight purging, with cramps, on the eighth day, and death
took  place  on the tenth,  without  any vomiting.  Arsenic  was
found in the stomach  and  contents, and its presence there  might
have  led to an erroneous inference  of its having been criminally
administered by the mouth.  It was,  however, merely in  traces,
and obviously  enough the result  of  mucous elimination.   The
nature and mode of occurrence of the symptoms were also opposed
to any other presumption.   That absorbed  arsenic may be thus
transferred from the blood to the stomach and intestines,  has been
distinctly proved  by the experiments of Dr. Pavy and myself.
(" Guy's Hospital Reports," 1860, 6,  397.)
  Chemical analysis.   Arsenic as a solid.—In the simple state, white
arsenic may be identified by the  following properties:  1. A small
quantity of the powder placed  on platinum foil is entirely vola- 
ARSENIC — ANALYSIS.
145,
Fie. 4.
Fig. 5.
 Ordinary redac-
tion  tube, with
two  sublimates ;
the upper, brown-
ish  black;  the
lower, the pure
metal in an annu-
lar deposit.
    Crystals of Arsenious Acid by sublimation, magnified 30 diameters.

tilized at a moderate heat (370°) in a white vapor.
If a small portion of the white powder be very slowly
heated in a glass tube of narrow bore,  it will be sub-
limed without melting,  and form a ring of minute
octahedral  crystals, remarkable for their lustre and
brilliancy.   Under a microscope  of high magnifying
power (250 diameters), the appearance of these crystals
is highly characteristic (Fig. 4). 2. On boiling a small
quantity of the powder in distilled water, it is not
readily dissolved, but it partly floats in a sort of film,
while a part becomes aggregated in small lumps at the
bottom  of the vessel.  It requires long  boiling,  in
order that it  should become dissolved and equally
diffused through water.
  3.   When a small  portion of  the white powder,
i. e. from one-fourth to one-twentieth part of a grain,
is heated with two parts  of  soda flux (obtained by
incinerating acetate or tartrate of soda in a  close vessel) [or with
an excess of  perfectly  dried  ferrocyanide of potassium.—R.] in  a
glass  tube about  three inches  long,  and from one-eighth to  a
quarter of an inch in  diameter, it is  decomposed: a ring of me-
tallic arsenic  of an iron-gray color is  sublimed and  deposited in
a cool part of the tube.  During the reduction there is a percep-
tible  odor, resembling  that of garlic, which is possessed by me-
tallic arsenic  only, while passing from a state of vapor to arsen-
ious  acid.  In this experiment of reduction, there  are frequently
two rings deposited in the tube (Fig. 5):  the upper and larger ring
has a brown color, and appears to be a mixture of finely divided
metallic arsenic and arsenious acid; the lower ring is small and
consists of the pure metal.  The appearance presented by these
sublimates is  indicated  in  the annexed  illustration.   By  heating
gently the tube containing the sublimate (reduced to powder) in
another tube of larger diameter, the metallic arsenic, during volati-
lization, forms octahedral crystals of arsenious acid, which, after
examination by the microscope, may be dissolved in a few drops of
water, and tested by one or more of the liquid reagents.
  The metallic sublimates, or the  crystals  produced  from them,
      10 
146
ARSENIC—LIQUID TESTS.
may be further subjected to the following process: Break the glass
on which the sublimate is deposited,  into fragments, and digest
these in a few drops of  the strongest nitric acid containing nitrous
acid previously proved to be free from arsenic.  The sublimate is
thereby converted into arsenic acid.  The acid solution  should be
evaporated to  dryness;  the white uncrystalline  residue obtained
should be dissolved in a few drops  of distilled water, and a strong
solution of nitrate, or of ammonio-nitrate, of silver added in small
quantity to the residue.  A brick-red  coloration indicates arsenic
acid, and thus  proves incontestably that the sublimate was  of an
arsenical nature.  The upper  or  brownish-looking sublimate may
be readily converted into one of the pure metal, by gently heating
it in the flame of a spirit lamp.  Arsenious acid is then volatilized,
and an iron-gray deposit of metallic arsenic appears.   If the heat
is continued,"the whole of the metallic  sublimate is volatilized and
deposited in a  cool  part of the tube,  in transparent and colorless
octahedra of arsenious acid.   This is  the special character  of an
arsenical sublimate:  it  may be thus distinguished from sublimates
of  all metals, or  metalloids.  The lower metallic  sublimate  pro-
cured by reduction  sometimes  presents itself, not in an annual
form,  but in detached  particles  of a  somewhat globular shape.
These are of an iron-gray color, quite unlike sublimed mercury, and
when examined by the microscope, it may be seen  that they con-
sist  of crystalline masses nucleated, and that they are not strictly
spherical.  This sublimate is  frequently produced in the last stage,
when  the residue in the tube is strongly heated.   The process of
reduction, with the corroborative results above mentioned, is, wheu
thus applied, conclusive of the arsenical  nature of the substance
under examination.
  Arsenic in solution in water.  Liquid  tests.—The solution of arse-
nious acid is clear, colorless, possesses scarcely any perceptible taste,
and has but a feebly acid reaction.  In this state, we should  first
evaporate slowly a few drops  on  a glass  slide, when a crystalline
                        deposit  will be obtained.   On examining
                        this  with a microscope, it will be found to
                         consist  of numerous minute  octahedral
                         crystals, presenting triangular surfaces by
                         reflected  light.   (See Fig.  6.)
                          _ 1. Silver test.—On adding to the solu-
                         tion of .white arsenic ammonio-nitrate of
                         silver,  a  pale yellow precipitate of arse-
                         nite of silver  falls down; changing, under
                         exposure to  daylight, to an olive-green
                         color.   The test  is  made  by adding  to a
                         strong solution of nitrate of silver, a weak
                         solution  of ammonia, and continuing to
                         add the latter, until the brown  oxide of
                         silver, at first thrown down, is almost re-
            The yellow precipitate  is  soluble in  nitric, tartaric,
Fig. 6.
Crystals of Arsenious Acid from i
 solution, magnified 124 diameters.
dissolved. 
marsh's  PROCESS.                  147
citric and acetic acids, as well as in ammonia.  It is not dissolved
by potash or soda.
  2. Copper test.—On  adding to another portion  of  the solution
ammonio-sulphate of copper,  a light-green  precipitate (arsenite of
copper) is formed, the tint of which varies according to the pro-
portion of arsenic  present, and  the quantity of the  test added:
hence, if  the  arsenic is  in small proportion, no green precipitate
at first appears;  the liquid simply acquires a blue color from the
test.  In  less  than an hour, if arsenic is  present, a bright green
deposit is formed, which may be easily separated from the  blue
liquid by decantation.  This test is made by  adding  ammonia
to a weak solution of sulphate  of copper, until the  bluish-white
precipitate, at first produced, is nearly redissolved; it should not
be used in large quantity if concentrated, as  the  deep blue color
tends to obscure or conceal the green precipitate formed.  The dried
precipitate  of arsenite  of copper, when  slowly and moderately
heated in a well-dried reduction-tube, will yield a ring of octahe-
dral crystals  of arsenious acid—oxide of copper being left  as a
residue.
  3. Sulphuretted hydrogen test.—The gas may be procured by adding
to sulphide  of iron in a proper apparatus, a mixture of one part of
strong sulphuric acid and three parts of water.  The arsenical liquid
should be slightly acidulated with pure diluted  hydrochloric acid,
before the gas is passed into it: at least, care should be taken  that
it is not alkaline.   A yellow precipitate (orpiment) is immediately
produced  if arsenic is present, and it may be collected after boiling
the liquid sufficiently to drive off any surplus gas.   It is  known to
be sulphide of arsenic by the following properties:  1. It is insolu-
ble in water, alcohol, and ether, as well as in diluted  hydrochloric
acid, and  vegetable acids: but it is  decomposed by strong nitric
and nitro-hydrochloric acids.  2. It is immediately  dissolved by
potash, soda^ or ammonia ; forming, if no organic matter is present,
a colorless solution.  3.  When dried  and  heated with three parts
of soda-flux, or an equal part of  dry cyanide of potassium [or still
better, with dried ferrocyanide of potassium.—R.], it yields a subli-
mate of metallic arsenic.
  Marsh's process.  Hydrogen test.—The action of this test depends
on the decomposition of arsenious acid and its soluble compounds^
by nascent hydrogen evolved from the action of diluted  sulphuric
or hydrochloric acid on zinc.   The materials should be first proved
to be free from arsenic.  The apparatus is of the  most simple kindr
and is so well known as to need  no description or illustration.  The
arsenic may be introduced into the short leg of the tube  in the
state of powder; but it is far better to. dissolve it in water, by boil-
ing, either with or without the addition of a  few  drops  of hydro-
chloric acid.  The metallic arsenic  combines with the hydrogen,
forming arsenuretted hydrogen gas, which possesses the  following
properties:   1. Filtering paper wetted with a solution of nitrate of
silver is  immediately blackened by the gas—the  silver being re-
duced to the  metallic  state.  Lead-paper  is not changed in color 
148
REINSCH 'S  PROCESS.
unless sulphuretted hydrogen is also present.   2.  It  burns with a
pale bluish-white flame, and thick white smoke (arsenious  acid).
8  A slip of glass or white porcelain held  in  the flame near  the
point (for  not too long a time) acquires a dark stain from the de-
posit of metallic arsenic upon it.   This deposit presents a metallic
Fustre in the centre (a), a white film of arsenious acid on the outside
fc)  and between the two a dark  ring  of a pulverulent  substance
 b  which, when viewed  by transmitted  light, is hair-brown in
v ;'                   color towards  the  margin,  but perfectly
        Fig. 7.         opaque in the  centre.   In order to  deter-
                      mine the arsenical nature of the deposits,
                      the following plan may be adopted: Several
                      of them should be received and accumulated
                      in  small porcelain capsules, held in  the
                      flame of  the burning gas. . To one,  add a
                      solution of chloride of lime; the arsenical
                      deposit  is  immediately dissolved.   To a
                      second, add  a  solution  of sulphide of  am-
                      monium ; the metallic deposit is detached,
  DepositobtaT^dbyMarsh's   but not perfectly dissolved:  yet  on evapo-
       Apparatus.        ration  it yields a pale yellow film of  sul-
  A Metal B.Mixed deposit.     ^   f arsenic#   To a thir(J a(}d  a  few
  C Arsenious acid.         Jr       „,    ,           • ,  •      j.  •  •
                       drops of the  strongest nitric containing
 some nitrous  acid.   The deposit is dissolved: evaporate the acid
 solution gently to  dryness ; carefully  neutralize  the  residue, and
 add one or two drops of a strong solution of nitrate of silver.  A
 brick-red stain, or a dark red precipitate of arsenate of silver  will
 be produced.
   Reinsch's process.—In the application of this process, the  liquid
 suspected to contain arsenic, or the solid dissolved in distilled water,
 is boiled with from one-sixth to one-eighth part of pure hydrochloric
 acid (proved to be free from arsenic), and a small slip  of copper is
 then introduced.  A slip  of polished  copper  foil (electric copper)
 about a quarter of an inch square, attached to the  end of  a  thin
 platinum wire, may be employed for the experiment.   The  copper
 must be first proved to be free from arsenic, as this is a very com-
 mon contamination of commercial copper in the form of foil, gauze,
 or wire.   If arsenic is present  in the liquid, even  in small quantity,
 the polished copper  acquires  either immediately or within a few
 minutes a dark iron-gray coating from the deposit of this  metal.
 This is apt to scale off, if the arsenic is in large quantity, or if the
 liquid is very acid or long boiled.   We remove the slip of copper,
 wash it in water, dry it, and  gently heat  it in  a small  reduction
 tube, when arsenious acid will be  sublimed in minute ochtahedral
 crystals: if these should not be apparent from one piece of copper,
 several may be successively introduced.  When the quantity  of
 arsenic is small, the polished copper merely acquires a faint bluish
 tint.  The deposit is in  all cases materially affected by the quantity
 of water  present, or, in other words, the degree of  dilution, and
 sometimes it will appear only after the liquid has been much con- 
ARSENIC IN ORGANIC  MATTERS.           149
centrated by evaporation.  The presence of arsenic as an impurity
in copper may be detected by the following method suggested by
Mr. Abel.   Add to pure hydrochloric acid, diluted with six parts
of water, one or two drops of a weak solution of  persulphate or
perchloride of iron.  Boil the acid liquid and introduce the copper,
well cleaned and  polished, into the boiling liquid.  Arsenicated
copper soon acquires a dark tarnish, while the non-arsenicated (elec-
tric) copper retains its color under these circumstances.
  Arsenic in organic matters.—Arsenic may exist in an insoluble form
—i. e., as a crystalline powder—in the contents of the stomach, or
any liquid article of food.   If coarsely powdered it may be sepa-
rated as a heavy sediment, by careful washing with distilled water,
and then dried and tested by the reduction process  (p. 145).  Any
liquid for analysis should be strained through muslin  or  filtered
through paper  in order to  separate all insoluble matters:  these
should be well pressed and drained.   Should the liquid be colored,
this  is  of little moment, provided it is clear.  If viscid, it should
be diluted in water, and boiled with  a small quantity of hydro-
chloric  acid; on standing, a deposit may take place, and this should
be separated by a filter.   As a trial test, we may now boil in a por-
tion  of the liquid, acidulated with  pure hydrochloric acid, a slip
of pure  copper  highly polished, and examine any deposit  on the
metal  by the method above described.  If the copper  comes out
unchanged,  there is no detectable quantity of arsenic present.
  Let us assume that the organic liquid is milk or beer; it will
be necessary to  determine whether any arsenic is dissolved in it.
Filter  a portion;  place  it in a  dialysing tube,  and immerse the
mouth of the tube  in distilled water.  In a few  hours the  arsenic
will have traversed the animal membrane, and will be found in a
clear and nearly colorless solution in water.   The fluid tests may
then be applied to this  liquid for the detection of arsenic.   They
should never be applied directly to colored organic liquids.  Yiscid
mucous and farinaceous liquids containing arsenic, may be thus
treated, and the arsenic speedily detected.
  When arsenic is present in an organic liquid in large quantity,
it may be precipitated as sulphide by a  current of washed sul-
phuretted hydrogen.  The liquid should be boiled, filtered, and acidu-
lated with hydrochloric acid before passing the gas into it.  When
precipitation has ceased, the liquid should be again filtered, the pre-
cipitate collected, dried, and weighed.   By operating on a measured
portion  of the solution, the amount  of white arsenic present may
be determined by the weight of the  sulphide obtained ;  five parts
by weight of sulphide being  equal to four  parts of white  arsenic.
The properties of the yellow precipitate should be verified  accord-
ing to the rules mentioned at page 147.
  In  some  cases arsenic may  be present, but in  a quantity too
small to be precipitated  as  sulphide by sulphuretted hydrogen.
In others, the presence of certain substances may interfere with or
prevent precipitation.   The  presence of any alkaline in a liquid
prevents the formation of a  precipitate.  For this reason the sul- 
150
DISTILLATION  PROCESS.
phide of ammonium must not be  used in place of  sulphuretted
hydrogen.  It does not precipitate  a solution of arsenic  until an
acid is  added, and acids will precipitate from the test itself sul-
phur, which  has  been mistaken for the sulphide of arsenic.  An
erroneous charge of poisoning has  been based on  this  chemical
mistake.
  Distillation process.—When the poison is  in so small a quantity
that it does not admit of precipitation by sulphuretted hydrogen,
and no solid  particles of arsenic are found in the  stomach, in its
contents, or in any article of food, another method may be resorted
to for detecting its presence.   This  method equally applies to the
detection of arsenic deposited as a result of absorption in  the soft
organs of the body, as in the liver, kidney, or heart, and to arsenic
in all its forms, except  the pure  insoluble sulphide or orpiment.
The substance, whether food, blood, mucus, the liver, or other organ,
should be first thoroughly dried, either by exposure, to a current of
air or by a water-bath.  The dried  solid should then be broken
into  small  portions and placed in  a flask  or retort of sufficient
capacity, with a  sufficient quantity of the  strongest hydrochloric
acid (free from arsenic) to drench it completely.  After some hours'
digestion in the cold, the retort or flask (a) containing the  mixture
         Apparatus for distilling organic and mineral substances containing Arsenic.

-which should be of such a size that the materials should not fill
III *T      °5e-t}!lrd or Jne-half of its capacity-should be fitted
«nd w£Dg ?F?r8mS, ^.OO.aad then gradually heated by a
sand-bath until the acid hquid  begins  to pass over!  A metallic
head formed of a cone of tin plate, should be placed over the retort
?he unner rtt° "^ ^ l"** and  Prevent  condensation in
L, TVZ-P  * °? the ^essel  A sma11 flask  receiver (d) with a
 oose y-fitting cork may be employed to collect the product   This
should contain a small quantity of  distilled water so as to fix and
condense any vapors that may pass over.  The receiver as well as

^ZmTi^p shrld be  kept c°o1 b^wet^'" ^
witn cold water diffused on a layer of blotting-paper nlaced over
it.  A perfect  condensation of tne distilled ifquK insured by 
                   DISTILLATION  PROCESS.                151

this  arrangement.  This distillation may be carried to dryness on
a sand-bath, or nearly so ;  and it  may be sometimes advisable, in
order to insure the separation of the whole of the arsenic as chlo-
ride, to add to the residue on the retort when cold, another portion
of pure and concentrated hydrochloric acid, and distill to dryness.
I have, however, found  that portions of dried  liver and stomach
gave up every trace of arsenic by one distillation, when a sufficient
quantity of hydrochloric acid had been  used, and the process was
slowly conducted by a regulated sand-bath heat.
  The liquid product may be colored, turbid, and highly offensive
if distilled from decomposed animal matter.   Exposure to the air
for a few hours sometimes removes the offensiveness, and there is a
precipitation of sulphur, or of some sulphide of  arsenic.  The dis-
tillate may be separated from any deposit by filtration, and if still
turbid, it may be  again distilled at a lower heat to separate it from
any organic matter that  may have come over.   If there is a yellow
deposit, it should be examined for sulphide of arsenic.
  If arsenic is  present in the substance  submitted to distillation,
the distillate will contain arsenic  in the form of soluble chloride  ;
this does not escape from a diluted solution at  common tempera-
tures.  The quantity of  dry organic substance  used in the  experi-
ment must depend on the quantity of arsenic  present, as revealed
by a preliminary trial with Reinsch's process.   If large,  two or
three drachms of the dried  substance, or even less, will yield suffi-
cient chloride of arsenic for further proceedings.  For the absorbed
and deposited poison, half an ounce of the dried organ, correspond-
ing to two ounces of the soft  organ, will frequently suffice; but a
negative conclusion of the absence of arsenic should not be drawn
from a smaller quantity  than two to four ounces of the dried sub-
stance, whether liver, kidney, or heart.   These tissues, it must be
remembered, contain  about  76 per cent, of water.  If oily matters
should be  distilled over, this may be  separated by passing the
distillate through a paper filter wetted with water.
  The distilled liquid, containing chloride of arsenic, should if clear
be submitted to a further stage of analysis.  For this purpose one-
third of it should be diluted with three or four parts of water, and
boiled in a clean flask.   When boiling, a piece of bright copper-foil
(free from arsenic),  of about the size of the sixteenth of a square
inch, should  be introduced.   If there is chloride of arsenic in the
liquid, even up to the ^^th of a grain, its presence will be indi-
cated by a change of color,  and by the deposit of a dark metallic
film on the copper.   If the  liquid should be too much diluted for
this  purpose, it may be  concentrated on  the polished copper, and
the deposit will after a time be apparent.   If the quantity of arsenic
present is believed to be very small, the surface of copper introduced
should be  proportionately  small.  Bettendorff's  process may  be
also employed for the detection of small quantities of arsenic in the
distillate: Add to a solution of chloride of tin its bulk of fuming
hydrochloric acid.  Warm this mixture, and then add to it a few
drops of the distillate.  The presence and proportion of arsenic are 
152
DISTILLATION PROCESS.
indicated by a dark-brown precipitate consisting of reduced arsenic.
(For an account of this test  see Wigger's " Jahresbericht  1871,
p  h^)  The remaining two-thirds  of the  distilled  liquid, suffi-
ciently diluted, should now be introduced into a Marsh's tube, or
into an evolution flask provided with a funnel-tube, the capacity of
which must be regulated by the quantity of acid liquid to be ex-
amined.  The kind of  apparatus  employed  in this stage is repre-
sented in the engraving, Fig. 9.  a the flask with funnel-tube b,
and containing  piece c ; the  funnel-tube  should be long enough
iust to dip below the surface  of the  acid  liquid.  The short  con-
necting piece is bent at a right angle, and, like b, is carried through
Apparatus for testing chloride of arsenic obtained by distillation.
Fig. 10.
     Portion of tube separated with a deposit of metallic arsenic in the contracted portion.

a closely fitting cork in the neck of the flask.  This tube should be
only long enough to go through the cork, and its open end should
be bevelled off to a fine point, so that any vapor which is condensed
on it may fall back as liquid  into the flask,  d is the drying tube
containing fragments of chloride of calcium, secured by cotton at
both ends.   At the flask end  of this tube  should be placed some
well-dried bibulous paper, saturated with acetate of lead.  This has
the advantage of stopping  any gaseous sulphur compound, which
may escape from the zinc or acid liquid,  e e, a hard and not easily
fusible glass tube, free from lead, contracted in two situations K k',
to about the diameter of the tenth of an inch or less, the tube itself
having  a diameter of from a quarter to  three-eighths of an inch.
f f are supports made of a  stout wire, to  prevent the tube from
falling when heated to redness,  a is a test  glass to hold  one or
two drachms of a strong solution of nitrate of silver,  h is a Bun-
sen's air gas jet, which gives a stronger heat than a spirit-lamp,
although the latter may be used.
   The arrangement being thus made, the zinc and hydrochloric
acid are first tested as to their freedom from arsenic.  Portions of
pure zinc are placed in the flask a, the parts of the apparatus are
then connected, and pure hydrochloric acid, diluted with three or 
DISTILLATION PROCESS.
153
four parts of water, is poured into the flask by the funnel b, which
operates as a safety valve.  Bubbles of air and gas speedily appear
in the liquid in g, if the corks fit well and the whole of the ar-
rangements are air-tight.   Pure zinc is sometimes but imperfectly
acted on by the acid.  In this case some clean platinum wire or foil
may be wound round the  bars of the zinc, and the evolution of
hydrogen will be thus accelerated.   It is, however, better that the
hydrogen should come off rather slowly.  If the materials are pure,
the solution of nitrate of silver should undergo no change of color.
The glass o should be placed on a sheet of white paper, whereby the
slightest tinge of brown or black  is made perceptible.   When all
the air is  expelled from the tube, the smokeless flame h may be
applied to it at about one inch in front of a contraction of the tube,
as indicated in the engraving, and  the  glass heated to  redness.
No metallic deposit  should take place at k.  If the materials are
quite pure, the  transparency of the glass  tube  at  k will  be un-
changed.   From a quarter to half an hour will be  sufficient for
this experiment.
  The silver solution is allowed to  become saturated with the gas.
Any escape of the gas from the glass, or by leakage from any of the
junctions of the apparatus, is at once indicated by holding near to
the spot, filtering paper wetted with  nitrate of silver.  This is in-
stantly blackened.   The glass with the silver solution is removed,
the end of the tube well washed, or another tube substituted for  e
e, and this is allowed to dip into about one drachm of the strongest
nitric acid, containing much nitrous acid in a test-glass similar to
g, or into a small porcelain capsule.  After a time, the acid loses its
color, and the metallic arsenic of the gas is converted into arsenic
acid, which may be obtained by evaporation.
  The further testing of the products is  a very simple process.  1.
The silver  solution contains arsenic in the state of arsenious  acid
dissolved, with some excess of nitrate of silver.  By one or  two
nitrations  it is obtained colorless and clear.  A  weak solution of
ammonia is then added  to it, and yellow arsenite of silver is at
once precipitated (see p. 146).   The nitric acid liquid is evaporated
to dryness in a small porcelain capsule.  One or two drops of water
are added to the residue, with a drop of weak ammonia if it should
be very acid. A strong solution of nitrate of silver is then added
to it; arsenate of silver, of its well-known brick-red color, is imme-
diately produced.  3. The portions of tube  k k' with the metallic
deposits in them may be separated  by a file, and then hermetically
sealed, or, if necessary, one or more of them may be tested by the
methods described in a preceding page (see p. 145.)
  AVith these results, the evidence  of the presence of arsenic may
be considered to be conclusive.  The poison is obtained by this pro-
cess, not only in its pure metallic state, but  in the distinct forms
of its  two well-known oxides—arsenious and arsenic acids.  Any
demonstration beyond this  is superfluous.   It will be observed  that
Reinsch's process is here employed as an adjunct to Marsh's process 
154      DETECTION OF ARSENIC IN THE TISSUES.
     Fig. 11.       in an improved form, in which the burning  of
                 the gas is unnecessary.
                   Reinsch's process alone  may be  employed for
                 detecting arsenic, deposited as a result of absorp-
                 tion,  in  the liver,  kidneys, or other  organs.
                 About four ounces of the  recent organ, or more,
                 if necessarv, cut into small pieces, may be boiled
                 in a flask in a mixture of one part of pure hydro-
                 chloric acid and four of water, until  the struc-
                 ture of the organ is broken up.  The flask may
                 be of  the shape represented, in the annexed en-
Fiask employed in the  p.ravin(y and either a naked spirit-flame or a sand-
 ;rEU';;:ir.r  Bath may be employed.  A  small glass funnel
                 should be placed in the neck  of the flask.  Ihis
receives and condenses the vapor which falls back into the flask.  By
this arrangement the boiling may be continued for a long time, with-
out material loss by evaporation.  The flask should not be more than
half full, and heated gently until all froth is expelled.   A slip  of
fine platinum wire, having a small piece of pure copper-foil, should
be immersed in the liquid when boiling.  This enables the operator
to remove the copper and examine it at intervals, after immersing
it in distilled water.   If it is much coated with a metallic deposit,
larger portions of copper-foil may be successively introduced until
the liquid is exhausted.  The deposit  on the  copper may then be
tested by the method described at page 148.
  It might be supposed that arsenic would escape as chloride in this
method of operating, but when hydrochloric acid is  diluted with
six or eight parts  of water, little or no volatile chloride is distilled
over.   In reference to the recent organs, a larger proportion of acid
may be used, because three-fourths of the weight of the animal sub-
stance really consists of water.
  I have not here described the various carbonizing processes which
have been recommended by Orfila and other French medical jurists
for the purpose of destroying organic  matter.  If M.  Blondlot's
observations  are correct, they have been the  source  of  great and
unsuspected errors in medico-legal analyses—sometimes withdraw-
ing the poison altogether,  and sometimes causing it to reappear
under circumstances which are liable to create a fallacy. (" Annales
d'Hygiene," 1864, 1, 152.)
  It is important, in reference to the presence of absorbed arsenic
in the tissues, to observe that it may be found  at an  early period,
when it is either  absent, or only doubtfully present in other parts.
In a case referred to me in May, 1854, the deceased, Burton,  died
within four hours after  he had been attacked with symptoms  of
poisoning by arsenic.  Arsenic was found in small quantity in the
stomach, duodenum  and rectum.   It was also detected in the liver
and spleen; and the proportion found was greater in the latter than
in the  former organ.  In  November, 1861,  a man died from the
effects of arsenic  in the  most acute  form, soon after  his  admission
into Guy's Hospital.  He had swallowed unknowingly a large dose 
QUANTITY  FOUND  IN A  BODY.
155
of the poison in water. His wife left him at 1.30 P. M., quite well:
during her absence he swallowed the poison, and on her return at
4, she found him very ill and suffering from vomiting and purging.
He was brought to the hospital, and died soon afterwards.  Barely
three hours could have elapsed from the time at which the poison
was taken until his death.  There were the usual appearances in the
stomach, intense inflammation, especially at the pyloric end ; and
gritty portions of arsenic mixed with masses of coagulated mucus,
and false  membranes were found in the contents.  The intestines
were inflamed, and portions of arsenic were discovered as low as
the csecum.   Arsenic was found  abundantly in the stomach, and a
comparatively large quantity of the poison was detected in half an
ounce of the dried liver, as well as in the spleen and kidney.  Hence
it is obvious that the poison may be rapidly absorbed and copiously
deposited within  three hours,  the quantity thus found depending
apparently on the dose taken.  In preserving viscera for analysis, a
portion of the liver should  therefore always be examined.  If the
person has  lived  fifteen  or sixteen days after having taken  the
poison, no trace may be found in the tissues or in any part of the
body.   Orfila long  since expressed this opinion from his experi-
ments on animals; its correctness has been strikingly confirmed by
the case of Dr. Alexander, who died in sixteen days from a large
dose of arsenic taken  by  mistake in arrowroot.  The late Dr.  Geo-
ghegan, who was deputed to make an analysis of the stomach and
other viscera, found no trace of the poison, either absorbed or unab-
sorbed, in any part of the body which he examined.  (See " Med.
Times  and Gazette," April 18, 1857, p. 389.)  It  is  the more ne-
cessary that the fact of entire  elimination should be remembered,
because, it had been incorrectly impressed on the public mind that
no person can die from poison, except the poison be found by chemi-
cal analysis in the body after death.
   It need hardly be observed that the quantity of arsenic found in
the stomach or other organs can convey no accurate idea of the quan-
tity actually taken by the deceased, since more or less of the poison
may have been removed  by violent vomiting and purging, as well
as by absorption and elimination.  A large quantity found in the
stomach or bowels indicates a large dose ; but the finding of a small
quantity does not prove that the dose was small.  Notwithstanding
these very obvious causes for the removal of a poison from the body,
there is a strong  prejudice  among lawyers that the chemical evi-
dence is  defective unless  the  quantity  found is sufficient to cause
death.   It would  be just as reasonable, in a case in which a man
has been killed by a discharge of small shot, to insist upon a failure
of proof of the cause of death, because  only a single pellet has been
found in the body.  The value of chemical evidence  does not de-
pend on the discovery of any  particular quantity of poison in  the
stomach—it is merely necessary that  the evidence of its presence
should be clear, distinct, conclusive and satisfactory.   At the same
time, a reasonable objection ma}7 be taken to a dogmatic reliance
upon the  alleged  discovery in a dead  body, of minute fractional 
156
fowler's solution.
 portions of a grain ;  and, considering the  great liability to fallacy
 from  the  accidental  presence of arsenic in the articles used, the
 chemical evidence in the French  case of Madame Laffarge (1840),
 in which  the whole quantity discovered in  the dead body  was
 stated to  be  the  hundred and thirtieth part of a grain, was of a
 most  unsatisfactory kind, and should  have been rejected by the
 court.  No man with any respect for his character^ or for the com-
 mon sense of a jury, would base chemical evidence on the thousandth,
 or less than the thousandth, part of a grain of poison in a case of
 life and death ; although, for the purpose of procuring the acquittal
 of a criminal, he  may safely boast of his  alleged power to detect
 this, or even a smaller quantity.
   If a person 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; in another case by Dr. Glover after twelve years (" Lan-
 cet," July 9,  1853, p. 41); and in  a remarkable instance which
 occurred to Dr. Webster, of Boston, it  was discovered in the re-
 mains of a  body, after fourteen years' burial in a tomb.  It has been
 sought for, and not found, at much shorter periods after death when
 there was a 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 death.  The  longer a person
 has survived after taking this poison, the less probable is \t,cceteris
 paribus, that arsenic will be found in the remains.
   The condition of the arsenic found in a dead  stomach should be
 specially noticed.  A witness should be  prepared to say whether it
 is in fine powder or in coarse fragments ; whether it is mixed with
 soot or indigo,  or whether it is in the ordinary state of white
 arsenic.  These points may be material as evidence in reference to
 proof of possession, of purchase, or administration.
   Arsenic is not a  normal constituent of the body.   Under no cir-
 cumstances is it found in the tissues after death, except in cases in
 which it has been  taken or administered.


         Arsenite of Potash.  Liquor Arsenicalis.
                     (Fowler's Solution.)

   Symptoms and appearances.—There is, so far as I know, only one
case recorded in which this solution has destroyed life.  A woman
took half an  ounce  (= two grains  of  arsenic) in  divided doses,
during a period of five days, and died from the  effects.   There was
no vomiting pr purging but after death the stomach and intestines
were found  inflamed.   ("Provincial  Journal,"  June  28, 1848, p.

   Analysis-The solution has the odor of tincture of lavender  is

it  confamffoT1"' and hf ^ alkaHne reaCti0n'   Oneflrdounceot'
it  contains four grains of arsenious  acid.   It gives at once a ereen
precipitate (arsenite of copper) with the  sulphate of eoppert aid a 
scheele's green.
157
yellow precipitate with nitrate of silver.  Acidulated with  hydro-
chloric acid, and treated with a current  of sulphuretted hydrogen
gas, it yields a yellow sulphide; and when  boiled with this acid
and pure copper, a deposit is obtained which readily furnishes by
heat octahedral crystals of arsenious acid.
  Fly-water is a name applied to solutions of various arsenical com-
pounds in water.   Mixtures of this kind are formed by dissolving
one part of the arsenite of soda or potash 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.

   Arsenite  of Copper.   Scheele's Green.   Emerald  Green.

  This is the only metallic arsenite which is  met with in commerce
and the arts, and it constitutes, wholly or in part, a great variety
of green pigments, known  as Emerald green  (aceto-arsenite of
copper) employed  for paper-hangings, mineral  green, Brunswick,
Schwcinfurt, or Vienna green.  It is thus found in the form of oil-
paint in cakes, in boxes of water colors,  spread over confectionery,
in wafers, in adhesive envelopes, in wrappers for chocolate, isin-
glass, etc., and  lastly, and most  abundantly, in various kinds of
green decorative papers used for covering the walls of sitting and
bedrooms.
  Although this compound is insoluble  in water, it is sufficiently
soluble in the acid mucous fluids of the stomach to be taken up by
the absorbents, and carried as a poison into the  blood.   The symp-
toms and appearances which it produces resemble those caused by
arsenious acid or white arsenic.
  In a case which was the subject of a criminal trial, this substance
was proved  to have caused the death of a gentleman by reason of
its having been employed to give a rich green color to some blanc-
mange served at a public dinner: the person who employed it con-
sidering 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 im-
prisonment.  (Reg. v. Franklin and Randall,  Northampton Summer
Assizes, 1848.)
  The symptoms of poisoning which have been observed in persons
who have inhabited rooms  of  which the walls were covered with
this arsenical compound, are as follows:  Dryness and irritation ot
the throat, with cough, irritation of the mucous membrane of the
eyes and nostrils, dry cough, languor,  headache, loss of appetite,
nausea, colicky pains, numbness, cramp, irritability of bowels, at-
tended with mucous discharges, great  prostration  of  strength, a
feverish condition, and wasting of the body.  These symptoms may
not all present themselves intone case ;  they are derived from the
examination of numerous cases which  have been  referred to me.
No suspicion of the cause had been entertained until all ordinary
treatment failed to impart relief, and an analysis of the paper had 
158
SCHEELE 'S GREEN.
 been made.   The connection  of the symptoms with this cause ap-
 pears to have been in some instance clearly established by the fact
 that after the removal of the paper, especially from bedrooms, the
 symptoms have disappeared.  It is, however, proper to observe that,
 as in reference to the manufacture of white lead, comparatively few
 of those who are exposed, suffer from symptoms of poisoning.
   Various deaths from the use of this paper are recorded; and it is
 probable that to the noxious practice of covering the walls  of our
 sitting and bedrooms with arsenic, many insidious cases  of  illness
 and chronic disease may be'referred.  Mr. Orton published  in the
 "London Medical Review" some remarks on this form of poisoning,
 with cases demonstrating  the danger and fatality arising from the
 use of the paper.   The noxious  arsenical  compound is also much
 used for coloring artificial flowers, wreaths, and tarlatan dresses.
 Dressmakers occasionally  suffer seriously from this form of poison-
 ing.  Two women were employed to make some green tarlatan into
 ball-dresses.  They noticed an unpleasant smell and taste, and their
 eyes were affected during  the performance of the work.  The symp-
 toms from which they suffered were swelling  of the eyelids,  con-
 gestion of the conjunctivae, copious secretion of tears.   The one
 most affected experienced  on  the second day salivation, with an
 unpleasant taste in the m©uth, cramps  in  the  limbs, great  thirst,
 restlessness, and difficulty of breathing.   These symptoms lasted in
 one patient eight and in the other fourteen days.  Riedel, of Berlin,
 who describes these cases,  suffered severely from a similar train of
 symptoms  for several days, as a result of handling the  poisoned
 dresses for the purpose of analysis.  He found  that  the stuff con-
 tained thirteen per  cent,  of its weight  of arsenic.  (Husemann,
 " Jahresbericht der Tox. 1871, p. 525 ; also " Jahresbericht," 1872,
 p. 480.)  I will add to this list the case of a ladv (July, 1872) who
 suffered severely from symptoms of arsenical poisoning, by reason
 of her having worn, on one occasion  only, a dress of this descrip-
 tion. Paper used for adhesive envelopes, for wrapping confection-
 ery, children's food,  isinglass, chocolate, etc., is also frequently
 colored with it.  Under proper sanitary  legislation the manufacture
 of this paper would be prohibited.
   Analysis^-For the chemical characters of Scheele's Green, see
 p. 147    1 he wall-paper pigment called Emerald Green is a mix-
 ture of arsenite and acetate of copper.  The color is  most intense,
 even by candle-light   The presence of arsenic in  this compound
 may be easily detected by all the tests for solid arsenic (p. 145); but
 the following is a simple method which admits of speedy applica-
 tion.  A slip of the suspected paper should be soaked in a moder-
 ately strong solution of ammonia.  The green color is removed, and
 the blue ammoniuret of copper is formed and  dissolved  in  a few
 nf pint   i £ re-8UH estabiishes 0% the presence  of a compound
 of copper soluble in ammonia.   If the ammonia does not become
crvsVl  nfVt8  T  a/TC pr6Sen,t; if U d0^ become blue, a large
small ^                   be Pkced in a white 8aucer and  a
small portion of the blue liquid poured over it.  The  presence of 
       ARSENIC ACID — ARSENURETTED  HYDROGEN.    159

arsenic is revealed by the production of yellow arsenite of silver over
the surface of the crystal.

             Arsenic Acid.   Alkaline Arsenates.

  Arsenic acid 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 instance in support
of this opinion.  I have not been able to find any case of poisoning
by it in the human subject.  The arsenates 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. Christi-
son states that, in the course of his  reading  he has met with only
two reported cases of poisoning  by arsenate of potash.  (Op.  cit.,

  Analysis.—Arsenic acid  is  a white uncrystalline deliquescent
solid.  1.  It  is very soluble in water, forming a  highly acid solu-
tion.  2. It is  precipitated of a brick-red color by nitrate or the
ammonio-nitrate of silver.

       Sulphides,  or Sulphurets of Arsenic.  Orpiment.

  Orpiment or Yellow Arsenic owes its  poisonous properties to
the presence of a variable proportion of arsenious acid, sometimes
amounting to as much as 30 per cent, of its  weight.   Orpiment is
much employed in the arts, in painting, dyeing, paper-staining, and
even in the coloring of toys and sweetmeats for children, but is not
often used as a poison!
  Orpiment produces symptoms  and appearances  similar  to those
caused by arsenious acid ; but  the  dose  required  to destroy life
varies according to the proportion of arsenious acid with  which it
happens to be mixed.   This is not a common form of poisoning;
the yellow color of the  poison would  lead  to suspicion: but by
reason of  this color, orpiment may be given  or taken by mistake
for mustard or turmeric.
  Analysis.—The powdered sulphide yields a solution of arsenious
acid on boiling it in water acidulated with hydrochloric acid.  It
readily gives the well-known sublimates of metallic arsenic, either
with soda-flux, or  ferrocyanide  of potassium (see p. 147).  Boiled
in strong nitric acid, it is converted into arsenic acid.

                   Arsenuretted Hydrogen.

  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  four instances.  (See " On
Poisons.")   One of them  is  comparatively  recent.   (" Chemical
News," Dec. 26,1863, p. 307.) 
160  MERCURIAL  POISONING — CORROSIVE  SUBLIMATE.
                     CHAPTER  XII.

POISONING BY MERCURY.' — CORROSIVE  SUBLIMATE. — SYMPTOMS. —
   CHRONIC  POISONING.--APPEARANCES  AFTER  DEATH.--CHEMICAL
   ANALYSIS.—PROCESS FOR  MERCURY IN  ORGANIC LIQUIDS.—WHITE
   AND RED  PRECIPITATES.—MERCURIC  METHIDE  AND  OTHER  COM-
   POUNDS.

   Metallic mercury is not regarded as a poison.  A large quantity
of it in the fluid state may be swallowed without affecting health,
or without causing more uneasiness than that which may arise from
its great weight.  It rapidly passes through the bowels.  If the
mercury is breathed or swallowed in a state of vapor, or if applied
to the skin or mucous membrane in a state of extreme mechanical
division, in which state it appears to be easily susceptible of oxida-
tion, it is liable to be absorbed, and to produce a poisonous action
on the body.   The effects are principally manifested by salivation,
by trembling and involuntary motions of the limbs, loss of appetite,
and emaciation.   These symptoms  are occasionally seen  in work-
men engaged in trades in which  they are exposed to the inhalation
of mercurial  vapors.

                    Corrosive Sublimate.

   This substance has received a variety of chemical names.  It has
been at various times called  Oxymuriate,  Chloride,  Bichloride, and
Perchloride of Mercury.  To prevent any confusion  from scientific
chemical nomenclature, the old and popular name of Corrosive Sub-
limate, expressing the principal properties of the substance, is here
retained.  It is commonly seen under the form of heavy crystalline
masses, or of a white crystalline powder.  Its taste is powerfully
austere  and  metallic, so that  no poisonous quantity of it could be
easily swallowed, without the person becoming immediately aware
of it. It is very soluble m water, hot or cold, and speedily sinks in
it, m which  properties it differs strikingly from arsenic.  It also
readily dissolves in alcohol and ether.
  Symptoms.—The symptoms produced by corrosive sublimate gen-
erally 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 con-
striction almost  amounting to suffocation, with burning heat in
the  throat,  extending  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.  There is nausea, 
            CORROSIVE SUBLIMATE — SYMPTOMS.         161

with frequent vomiting of long  stringy masses of white mucus,
mixed with blood, attended with severe pain in the abdomen and
profuse  purging.   The countenance  is  sometimes  swollen and
flushed, in other cases it has been pale and anxious.  The pulse is
small, frequent and irregular, and is scarcely preceptible when the
symptoms become aggravated.   The tongue is white and shrivelled;
the skin cold  and clammy; the breathing difficult; and death is
commonly  preceded  by fainting, convulsions, or general  insensi-
bility.   The  external  parts of the  mouth, when  examined, are
swollen, and sometimes present  a white 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.
(" Guy's Hospital Reports,"  April, 1844, p. 24.)  This symptom
was observed in a case reported by  Dr. Wegeler (" Casper's Woch-
enscrift," Jan. 10, 1846, p. 30), in which a youth, set. 17, swallowed
three drachms of the poison, and died on the sixth day.  During
the last three days no urine was secreted.   The case was otherwise
remarkable 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 salivation  came on on the third, and the
patient died on the ninth day.   ("Lancet," Dec. 13 and 27, 1845,
pp. 650, 698.)
   The  external application of  corrosive sublimate  to  tumors or
ulcers may destroy life with all the usual symptoms of acute mer-r
curial poisoning.   In September, 1871, a girl, set. 9, died from the
effects of this poison, locally applied to the scalp for the treatment
of ringworm.  The  liquid applied  was alcohol, containing eighty
grains  of  corrosive  sublimate  to the ounce.   She suffered from
mercurial  poisoning in a severe form, and died on the fifth day
after the application.   This case is  instructive  to medical men.
(See " Pharm. Joum.," Sept. 9, 1871, p. 216; " Lancet," 1871, 2,
473; and " Med.  Times and Gazette," 1871, 2, 353.)  No theory of
 idiosyncrasy is required to account  for death under such circum-
stances.
   This poison differs from arsenic: 1, in having a well-marked
 taste;  2, in producing violent symptoms in a few minutes;  and 3,
 in the fact that  the "evacuations are more frequently mixed with
 blood.   The symptoms produced by corrosive  sublimate, in the
 first instance, resemble those of cholera;  if the person should sur-
 vive several days, they are more like those of dysentery—violent
 Btraining and shreddy mucous  discharges mixed with blood, being
 frequently observed.
    Slow  or chronic poisoning.—The  symptoms are much modified
 when the poison is taken in small doses at intervals, for some days
 or weeks.  There are colicky pains with nausea, vomiting, general
        11 
162
APPEARANCES AFTER DEATH.
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 arev indicated by irrita-
bility or looseness of the bowels, difficulty of breathing, spitting of
blood, cough, general  trembling or convulsive movement^ of the
limbs and  palsy, with  fever  and emaciation, under which the
patient sinks.  One of the most marked  effects of  slow or chronic
poisoning by mercurial preparations is salivation, or ptyalism, indi-
cated by an increased  flow of saliva.  This is by no means a neces-
sary 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  placing reliance upon this symptom, it must
be remembered that salivation  may arise from a variety of causes
irrespective of  the  use  of mercury.   The  chemical detection  of
mercury  in the saliva  would settle the question.
  Appearances after death.—These, as in the case  of arsenic, are
chiefly confined to the stomach and bowels.  Corrosive sublimate,
however, affects the mouth, throat, and  gullet; the mucous mem-
brane is  softened, of a white or bluish-gray color, and sometimes
inflamed; that lining the  gullet  is  similarly affected, and partly
corroded and softened.  The mucous membrane of the stomach is
more or less inflamed,  sometimes in patches; and there are masses
of black extravasated  blood found beneath it.  Occasionally it has
a slate-gray color, and the mucous  coat beneath  may be found
reddened.  A case occurred in Guy's Hospital, in which the mucous
membrane was  simply inflamed ; it much resembled the condition
presented in cases 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 large and small intestines, especially in
the caecum.   In a case  reported by Dr. Herapath, in which  a scruple
was taken,  and  death occurred on the ninth  day, the mucous mem-
brane of  the stomach was softened, but there were no well-marked
appearances of the irritant action of the poison on this organ.  The
csecum had been the  seat of the  most violent inflammation, the
whole surface being  of a deep black-red  color, and  there were
patches of  sloughing  in the coats.  (" Lancet," Dec. 27,  1845, p.
700 ; " Edinburgh Monthly Journal," Dec. 1851, p. 532.)  Perfora-
tion of the stomach is rare as an  effect  of  this poison; there is, I
believe,  only one  case on record.  Appearances like those  just
described, have been seen  in the alimentary canal, 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.
  The smallest dose which  is reported to have destroyed life is three 
CHEMICAL ANALYSIS.
163
Fie. 12.
 grains.  This was in the case of a child, and the quantity was accu-
 rately determined from the fact  of its having been  made up by
 mistake for three grains of calomel, which a physician intended to
 order.  It is  probable  that, under favorable circumstances, from
 three to five grains, or even less, would destroy an adult.
   In an  acute case  a  person commonly dies in from one to five
 days, but death  may take  place  much sooner  or  later than this.
 In the shortest fatal case on record the man died  in less than half
 an hour,  but  the quantity of poison  was  not  ascertained.   (" On
 Poisons, Corrosive Sublimate.")
   Chemical analysis.—Corrosive sublimate is usually seen in heavy,
 crystalline masses, or in the form of a  white powder.   In the solid
 state: 1.  When the powder is heated on platinum foil or mica, it
 melts, and  is volatilized in  a white  vapor, without leaving any
 residue.  2. When heated in a close tube,
 it melts and forms a sublimate, consisting
 of prismatic crystals sometimes stellated.
 (Fig. 12.)  3.  The  powder  is changed in
 color by the following reagents : iodide of
 potassium produces a bright  scarlet, pot-
 ash a yellow,  and sulphide of ammonium
 a  black compound ;  ammonia does not
 alter its color.  4. The mercury and chlo-
 rine may be  discovered by one process:
 heat the powder  with four  parts of dried
 carbonate of soda (obtained by incinerat-
 ing the bicarbonate), until  the residue in
 the  reduction tube  fuses  and  becomes
 white; a sublimate of metallic  mercury
 in distinct and well-defined globules will
 be obtained.   Detach by a  file the end of  the tube containing the
 fused residue,  wdiich is chloride of sodium with some undecomposed
 carbonate ; digest it in water with nitric acid, and  apply heat until
 it is entirely dissolved; then add  to the solution nitrate of silver;
 a white precipitate of chloride of silver, insoluble in nitric acid, will
 be at once produced.  The solid is thus  proved -to contain both
 mercury and chlorine; and  the only  compound of these elements
 which is soluble in  water is corrosive sublimate.
   In  solution  in water.   A few drops of the solution of corrosive
 sublimate evaporated on a glass-slide  yield slender opaque  silky
 prisms.  (Fig. 13.)  When a weak solution of iodide of potassium
 is dropped on them, they acquire a bright scarlet color.  This scarlet
 coloration, which may be obtained from the minutest crystals and
 only one drop of  solution, proves that the body dissolved in water
 is  corrosive sublimate; it  is  thus distinguished from every other
 mineral  poison, and  all other substances  whatever.   1. Proto-
chloride of tin added  to a solution of corrosive sublimate, produces
a black precipitate which, after it has been boiled, is resolved into
globules of metallic mercury.  2.  Sulphuretted  hydrogen and sul-
 Stellated crystals obtained by heat
ing corrosive sublimate, magnified
30 diameters. 
164
in  organic liquids.
phide of ammonium produce, after a time, a black sulphide  no
 duble in alkalies or diluted acids.   3. If the liquid is acidulated
with  hydrochloric acid,  and bright copper-foil wire  or gauze is
plunged  into  it, the  copper will  acquire a  silvery-white deposit,
Fie. 13.
Fig. 14.
Prismatic crystals of corrosive sublimate from a
  solution in water, magnified 30 diameters.
Crystals of corrosive sublimate from a solution in
     alcohol, magnified 80 diameters.
even in the cold, but more rapidly by heat,  When the copper with
the metallic  deposit is heated in a tube, globules of mercury  are
sublimed.
  In organic  liquids.—-The liquid should be separated by filtration
from any insoluble  portions.  The latter should be pressed, dried,
and set aside for a separate analysis.  The liquid portion should be
slightly acidulated with  hydrochloric acid, warmed, and  a slip of
copper foil or gauze introduced; if this is not immediately coated
with  mercury, it  should be  allowed to remain for some hours.
When a deposit has taken place on the copper, it should be removed,
washed in water, and  afterwards in ether, and dried.   When  the
quantity of corrosive sublimate dissolved in an  organic liquid is
moderately large, it may be removed by means of ether.  Place
the filtered liquid supposed to contain the poison, in a stoppered
tube; add  to it, twice its  volume of pure ether,  and agitate  the
liquid at intervals for a few minutes.  Allow the liquid to subside,
pour off the  ether into a dial-glass, and  submit it to  spontaneous
evaporation.   As the  ether passes off, the corrosive sublimate  will
be deposited in white silky-looking prisms. These may be purified,
if necessary,  by solution in water or alcohol, and the. solution again
crystallized.   Corrosive sublimate may thus be  separated from
arsenic and  other  mineral poisons in  solution.  If mercury  and
arsenic are associated in a poisonous mixture, or in the tissues, the
arsenic may  be entirely removed by distillation (page 150).
  Masses of corrosive sublimate may be sometimes locked up in
thick  viscid mucus; and in  such cases, the coarse powder being
heavy, it may be separated by simply agitating the viscid  liquid in
water, and then decanting the upper portion suddenly.  This poison
is decomposed and precipitated by many organic principles, such as 
IN THE  TISSUES, ETC.
165
albumen, fibrin, mucous membrane, also by gluten, tannic acid, and
other vegetable  substances.   Thus, then, we cannot always expect
to find it  in  the  stomach, in a state of
solution.   Other methods of analysis are          Fig. 15.
chiefly  directed to the separation  of the
mercury only.  The suspected liquid is
boiled,  filtered,  and acidulated with hy-
drochloric  acid.  1. To one portion  add
protochloride  of tin in excess, again  boil
the liquid  and filter to separate the mer-
cury, the whole of which is precipitated
as a  black powder, or in  gray globules.
On boiling this  deposit in  strong hydro-
chloric  acid,  the small globules coalesce
to form liquid mercury. 2. Into another
portion of the liquid,  introduce copper-
gauze, foil, or wire, and gently warm it.   The copper  is covered
with  a layer of silvery-white metal, either immediately or in a few
hours.   A  large quantity  of copper may  be thus coated.  The
coated copper should be digested  in  warm  alcohol or ether, dried
and heated in a reduction-tube, when a sublimate in silvery-white
globules will be obtained, well marked by their opacity, lustre, and
sphericity  when examined by the microscope.   (Fig.  15.)  The
sublimate of metallic  mercury differs from  that of arsenic in the
fact that when heated, it sublimes simply as metal without change.
It is not oxidized (like metallic arsenic) by heating it in a reduc-
tion-tube, but is simply transferred  with its  metallic lustre and
globular form from one part of the tube to another.   In the event
of a doubt  existing respecting the nature of the sublimate, the fol-
lowing experiment will remove it.  Cut off by a file the portion of
glass  on which the globules are deposited:  introduce this into  a
wide  short tube, with a few drops of hydrochloric and half the
quantity of nitric acid.  Heat the acid liquid,  and carry it to dry-
ness on a sand-bath.  White prismatic crystals of corrosive  subli-
mate  will remain, if the sublimate  was of a mercurial nature, and
too great a heat has  not  been applied.  On  touching the white
residue  cautiously with a drop of solution of iodide of potassium,
the crystals will acquire a scarlet-red color.
  In place  of  copper, a slip  of gold foil  may be wound around  a
slip of zinc foil, and introduced into the liquid.  The  gold is soon
covered with a silvery-white layer of mercury,  which may be sepa-
rated  from  it by heat in a reduction-tube, or by the action of nitric
acid, and the nitrate thus formed may be subsequently  tested by
the chloride of tin.
  The tissues, etc.—The urine may be evaporated to dryness, and the
dry residue or extract  treated by the following process, which is
the same as that  required  for the tissues.   From four  to  eight
ounces of the liver or other organs should be dried, broken up, and
then boiled until dissolved in one part of pure hydrochloric acid and
four parts of water.  The acid liquid may be strained through linen, 
166
IN  THE  SALIVA.
and the residue pressed.  The liquid, if in large quantity, should
now be concentrated by gentle evaporation, and while still slightly
warm, a  small piece  of copper-gauze (proved to be free from mer-
cury) should be introduced, at the end of a fine platinum wire, into
the acid liquid.  The copper may acquire a white,  gray, or silvery
tarnish in a few minutes, or not until after twenty-four  hours.  It
may be removed, washed in  water and alcohol, and dried and ex-
amined by a low power of the microscope.  The deposition of any
white  metal on the copper will then  be perceptible.   It may be
rolled into a pellet and heated in a dry reduction-tube, when minute
globules may appear as a sublimate.   The sublimate  in the tube
should be examined with a microscope, and the copper should in
all eases be heated, whether the red color of this metal  appears to
be covered or  not by any deposit.  (See Fig. 15.)
   If arsenic should be present in the  tissues at  the same time, and
the acid mixture is boiled, arsenic and mercury will be deposited
together; and when the copper is heated, the globules of mercury
will be obtained nucleated or intermixed with octahedral crystals
of arsenious acid. In a case of exhumation after twenty-one months'
burial, these mixed sublimates were  obtained by the  examination
of the rectum of the deceased.   (Reg. v. Bacon, Lincoln Summer
Assizes, 1857.) It appeared in evidence that arsenic had been ad-
ministered to  the woman a day or two before death, and a dose of
calomel had been prescribed more recently.  This accounted for the
presence of the mixed sublimates.
  Arsenic is not readily deposited  on  copper in the cold, while mer-
cury is readily deposited, at  all temperatures,  from acid liquids.
We may sometimes take advantage of  this difference  in chemical
properties, to obtain a separate deposit of this metal.
  In the  living body, mercury is eliminated by the  saliva as well as
by the urine.  About one drachm of  this fluid will suffice  for the
detection of mercury by the following process. Acidulate the saliva
with one-fourth of its volume of pure hydrochloric  acid.   Immerse
in this a portion of copper gauze, about the sixteenth of an inch
square, attached to a fine platinum wire.  Place the tube contain-
ing the liquid in a warm place for  a  few hours.   If mercury is
present in the saliva, the  copper  gauze will be whitened.   Other
portions may then be introduced until the mercury  ceases to be
deposited.  The pieces of copper should  be washed in  water and
ether, and dried; examined by a low power of the  microscope, and
then heated  in a small reduction-tube.  Globules of mercury visible
under the microscope  will then be obtained.  In a case of inunc-
tion with mercury the metal was  thus detected in  the saliva on
the third day.   There was painful swelling of the  salivary glands,
with  the peculiar  metallic taste  produced  by mercury    This
analysis of the saliva may not only furnish evidence that the person
is under the influence of mercurial poison, but it will prove  in a
case otherwise  doubtful, whether the salivation from which a person
is suffering is owing to mercury or some other cause.  An  exami-
nation of the  saliva  should  be  made in other cases of metallic 
WHITE  PRECIPITATE.                 167
poisoning, as arsenic, antimony  and other metals might be thus
detected in the act of elimination from the living body.
  The analysis may show the presence of mercury, but not of corro-
rosive sublimate, in the body.  Whether the mercurial compound
had acted  as a poison or not, must be  determined from symptoms
and appearances. Whether it had been given or taken as a medicine
or not, is a conclusion which must also be  determined from other
circumstances.  The proof that the mercury was really in the form
of corrosive sublimate could only be derived from the discovery of
some undissolved portions of the solid poison in the stomach or its
contents, or from a separation of the poison itself by means of ether.
If thus obtained after filtration of an organic liquid, it would show
its presence in the  form of a soluble salt: and it may be remarked
that all the soluble salts are poisonous, and are rarely used inter-
nally  as medicines.  If undissolved,  the absorbed mercury may
have been derived  from some  mercurial medicine innocently taken
by the deceased.  Nothing  is  more common than to discover traces
of mercury in the stomach,  bowels, liver, kidneys, or other  organs
of a dead body.  No importance can be attached to this discovery, in
the absence of evidence that the deceased has actually suffered from
symptoms of mercurial poisoning.  As to the mercury found in the
tissues, it may have been derived from a  soluble or insoluble com-
pound, or from exposure to  the vapors of the metal or of its salts,
in various trades.

                     White Precipitate.

  Ammoniated mercury.—The  symptoms which it produces are
violent vomiting,  cramps,  great thirst,  purging and pain  in the
stomach and bowels, with  convulsions.  Tenderness of the gums
and salivation have been observed among  the  symptoms.  After
death, there is more or less inflammation of the stomach and bowels.
Experiments on dogs and rabbits have shown that this is a  formi-
dable  poison.  The greater  number of recoveries have been  proba-
bly owing to the substance  being early rejected by vomiting.  Rab-
bits, which do not  vomit, were killed by a dose of four and five
grains in a few hours.  After death, mercury was found deposited
in various organs, but more  in the kidneys than in the other viscera.
For additional facts connected with the  action  of  this poison see
"Guy's Hospital Reports," October, 1860, p. 483.
  Analysis.—White precipitate is a chalky-looking compound con-
taining about eighty per cent, of mercury.   It is insoluble in water
and alcohol.  As it is sold in the shops it frequently contains as an
impurity corrosive  sublimate to the amount of one or two per cent.
It is-  not used internally, but it is much employed by the  poorer
classes in the treatment of ringworm.  It is soluble in acids, is not
blackened by alkalies, and  it  yields a mercurial sublimate when
heated with carbonate of soda.  Chloride of tin produces with it a
black  deposit  of mercury.  If boiled in a solution of potash, it
evolves ammonia, and yellow  oxide of mercury is precipitated.   It 
168        poisoning  by  mercuric  methide.

may be detected in organic fluids and solids by boiling them in one
part of hydrochloric acid and four parts of water.  The mercury
may then be separated by means of copper.

                      Red Precipitate.

  Red oxide of mercury.—This substance is poisonous, but instances
of poisoning by it are very rare.  One case occurred at Guy's Hos-
pital in 1833.  The patient recovered in four days.
  Analysis.—By its great weight and insolubility in water, it may
be  separated  from all liquids.  Its red color identifies it.  When
heated in a close  tube, it is  resolved  into oxygen and  mercury,
the latter of which is deposited in globules.
  Cinnabar.  Vermilion.  Persulphide of Mercury.—The term Cin-
nabar 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 coloring confectionery  and  wafers.  It is stated to have  proved
fatal to animals in the proportion of from thirty to seventy grains,
when applied externally to a wound.  Cinnabar is sometimes used
for giving a red color to ointments, e.g. the sulphur ointment: and
it is also improperly employed by some dentists  as a coloring
matter to vulcanized rubber for mounting artificial  teeth.   Al-
though this insoluble compound of mercury cannot be regarded as
an  active irritant poison in the stomach, the placing of  it in such a
situation that it should be always in contact with the mucous fluids
of the mouth, is liable to lead to the usual consequences of chronic
poisoning by mercury.
  Dr. Sutro has published a short abstract  of a  case in which  the
vapor of  vermilion, applied externally, produced severe symptoms.
A Avoman, by the  advice of a quack, applied this vapor to a can-
cerous breast.  She suffered  very severely from severe salivation
and fever for four weeks.
  Other  compounds of mercury, such as calomel, the nitrates, sul-
phates, the cyanides, and sulpho-cyanide, have given rise  to accident,
and in a few instances have destroyed life; but  they rarely  require
the notice of the practitioner.

  A new form of mercurial poisoning, however, has  been brought
to light by a fatal accident which occurred at  St. Bartholomew's
Hospital in 1865, and this, from its exceptional  character, is de-
serving of a short notice.


                Mercuric Methide, or Methyl.

  Symptoms.—In February, 1865, a chemical assistant in the labo-
ratory of St. Bartholomew's Hospital,  who had been engaged for
nearly three months in preparing mercuric methide, and who had
been thus exposed to breathe the noxious vapors evolved in the
process, was seized with dimness of sight,  numbness of the hands, 
ACETATE, OR  S'UGAR  of lead.            169
deafness, great weakness, swelling and tenderness of the gums; he
moved his arms and legs with difficulty, and could  not stand with-
out support.  In spite of treatment he became worse; an offensive
odor issued from his breath and body, he became at times maniacal,
and he died eleven days after his admission into the hospital.
  Appearances.—The brain was  congested, especially the gray mat-
ter, and there was congestion of the  liver and kidneys.   As none
of the liquid had been  swallowed, there was no appearance in the
stomach and bowels calling for special notice.
  Another assistant who had been exposed to the noxious vapors
for a shorter time, suffered from similar symptoms.  He had  offen-
sive breath, spongy gums, general impairment of the senses, and an
affection of the brain producing idiocy, in which state he remains.
(" St. Bartholomew's Hospital Reports," Oct. 1865 ;  also " Chem.
News," Nov. 3, 1865, p. 213.)
  The mercuric methide is a heavy colorless liquid containing 87
per cent, of mercury.   Its effects on the nervous system  are more
intensified than those  ohserved  among workmen  who have been
engaged in water gilding.  It would have been more satisfactory
had it been determined whether mercury was present in the tissues
of the person who died from the effects of the vapor.
                    CHAPTER  XIII.

on  poisoning with lead.—sugar  of lead.—symptoms.--appear-
  ances after death.—chemical analysis.--lead in organic mix-
  tures.—carbonate, or white lead.—chronic poisoning.--poison-
  ing with copper.—blue vitriol.—symptoms.—appearances.—
  chemical analysis.—copper in organic liquids.

                       Sugar of  Lead.

  Acetate of lead.  Symptoms.—Acetate, or sugar of lead  is by no
means an active poison.   In  medical practice  it has often been
given in considerable  doses without any serious effects resulting.
When it has been taken in a dose  of from one to two ounces, the
following symptoms have  been observed: a burning pricking sen-
sation in the throat, with dryness and thirst, vomiting and uneasi-
ness at  the pit of the stomach, followed by severe colic.  The
abdomen is tense, and  its walls are sometimes drawn in.  The pain
is relieved by pressure, and has  intermissions.   There is generally
constipation of the bowels. If any feces are passed, they  are com-
monly of a dark color, indicative of the conversion of a portion of
the lead into sulphide. The skin is cold, and there is great pros-
tration of strength.   When the case is protracted, the patient has
been observed to suffer from cramp in the calves of the legs, pain 
170
CHEMICAL ANALYSIS.
 in the inside of the thighs, numbness, and sometimes paralysis  of
 the limbs.  The affection of the nervous system is otherwise indi-
 cated by giddiness, torpor, and even coma.  A well-marked blue
 line  has  been  noticed round the margin of the gums, where they
 join the teeth.  For a remarkable series of cases  of poisoning by
 acetate of lead which has  been reported by Mr. Bancks, of Stour-
 bridge, see " Lancet," May 5, 1849, p. 478.
   Appearances.—In one  acute  case, the  mucous membrane of the
 stomach was found removed in several  places, especially near the
 intestinal opening; and most of the intestines were in  a state of
 high inflammation.  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 those parts 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 action  on  the mucous
 membrane.   When the  acetate of lead was given in a state of
 albuminate dissolved in acetic acid, death  took place with great
 rapidity; but on inspection, the stomach was not found corroded.
 This corrosive  action belongs to the neutral salt, and is  not mani-
 fested when the dose is small, or when the  poison is combined with
 an acid.
   Nothing is actually known concerning the fatal dose of this sub-
 stance ; but it may be taken in comparatively large quantity without
 producing serious  effects.  Thirty or forty grains have been given
 daily, in divided doses, without injury.
   Chemical analysis. Acetate of lead as a solid.—1.  If a portion  of
 the  powder  is heated  in a small  reduction-tube, it  melts, then
 becomes  solid: again melts, acquiring a dark color, and gives off
 vapors of acetic acid, easily recognized by its odor and reaction on
 litmus paper. A black mass is left in the tube, consisting of  carbon
 and reduced metallic lead.  No sublimate is formed.  If heated on
 mica, yellow  oxide of lead with reduced metal remains.   2. It is
 very soluble in water, even when cold; spring water is turned milky
 by it, from the presence of carbonic acid and sulphates.  3. A small
 portion of the  powder dropped into a solution of iodide of potas-
 sium acquires a bright yellow color.  4.  When dropped into solu-
 tion of potash  it remains white.  5. With sulphuretted hydrogen
 water or sulphide  of ammonium, it  is  turned black,—in  which
 respect it resembles the white salts of some  other metals.  6.  When
 the powder is boiled in a tube with diluted sulphuric acid, acetic
 TJ\ if0'? bj.i!t8  °d°r an? volatility, scapes.  All these proper-
 ties taken together, prove that the salt is the acetate of lead.
  Acetate of lead in solution.-l. A small quantity, slowly evaporated
 on a glass slide, will give slender white prismatic  crystalsf which
are turned yellow by iodide of potassium, and  black  by sulphide

wh£? W™t\   • Dttd SUlphuHc add Produces an^abundant
Mhite precipitate,  insoluble in  nitric acid, but soluble in  hydro-
chloric acid and in a large excess of potash.  3. It is precipitated of 
DETECTION OF LEAD  IN  ORGANIC  LIQUIDS.     171
Fie- 16.
Crystals of acetate of lead, magnified
        30 diameters.
 a bright yellow color by the  iodide of
 potassium;  the yellow iodide of lead is
 soluble  in  potash,  forming  a  colorless
 solution.  It is also dissolved  by  con-
 centrated  hydrochloric  acid.   4.  Sul-
 phide of ammonium or  sulphurretted  hy-
 drogen gas, produces a deep  black pre-
 cipitate even when less than the 100,000th
 part of the salt is dissolved.   5. Place a
 few drops of the solution on clean platinum
 foil, acidulate it with acetic acid, then ap-
 ply through the solution, to  the surface
 of  the  platinum, a thin  polished slip of
 zinc:  crystals of metallic lead are  in-
 stantly deposited on  the zinc:  by  this
 method, a small quantity of the metal may be detected and collected.
   Lead in organic liquids.—The acetate of lead is  precipitated by
 many organic principles,  especially  by albumen and tannic acid.
 Thus, we may have to analyze either an organic liquid containing
 lead, or a solid precipitate consisting of mucus or mucous membrane,
 or albumen intimately united to oxide of lead.  The liquid should
 be filtered and examined by a trial test,
 i. e., either  by adding  to  a portion, sul-
 phuric  acid,  when  sulphate of lead is
 precipitated,  or by  exposing  bibulous
 paper, dipped into the suspected liquid,
 to  a free current of sulphuretted hydro-
 gen gas.  If the paper  is not  stained
 brown, there  is no perceptible quantity
 of lead dissolved ; if it is stained brown,
 we dilute the liquid if necessary, in order
 to  destroy its viscidity, and pass into it
 a current of washed sulphuretted hydro-
 gen gas until all chemical action  has
 ceased.   The  black  sulphide  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, into nitrate of lead soluble
 in water.  This  liquid, when filtered, may  be  evaporated to dry-
 ness, the crystalline residue dissolved in  water, and the tests for
 lead then applied to the solution.  As a trial test some portion of
 the liquid  acidulated with nitric acid and placed in a platinum
 capsule may be treated  with zinc. When the zinc and the platinum
 come in contact, metallic lead is  separated.  If the quantity is too
 small for the application of all the tests, we may first add sulphuric
 acid ; should a white precipitate be formed, soluble in potash (free
from oxide of lead), and this alkaline solution be again turned black
by sulphide of ammonium, this is sufficient evidence of the presence
of lead.  Should there be  no lead dissolved, we must decompose the
solid and insoluble matters by boiling them in  nitric acid slightly
Crystals of acetate of lead, magnified
       80 diameters. 
172            CHRONIC POISONING BY LEAD.
diluted, filter, and test the filtered liquid, previously neutralized;
or we may evaporate at once to dryness, destroy the organic matter
by heat, and redissolve the residue in nitric acid for testing.
  In the tissues.—The organic matter, such as a part of the liver or
other oro-an, should be dried and incinerated in a porcelain vessel.
The ash"should be heated with a small quantity of strong mtric
acid, and then evaporated to dryness.  The dry residue should be
digested  in a small quantity of distilled  water (free from lead),
filtered, and after it  has been  slightly acidulated with nitric acid,
a current of washed sulphuretted hydrogen gas should be passed
into it,   The production of a brown color or a brown precipitate in
a slightly acid liquid, indicates the presence of lead.  Lead may
be detected in the dry residue of urine, and of spring or river water.
   Goulard's extract is a solution of subacetate of lead, the oxide of
the metal  being  in excess.   Goulard water is a  mixture  of one
drachm and a half of this  solution with a pint of water. The effects
of these compounds when  swallowed, or applied locally, are similar
to those caused by the acetate.
   White lead.   Carbonate of lead.—This  is an insoluble chalky-
looking compound, which, like other salts of lead, may give rise to
the usual symptoms of lead poisoning.  In  one instance it appears
to have proved fatal.   Most of the cases of poisoning by that sub-
stance have been of a chronic  character,—carbonate of lead being
one of the products of the action of water upon lead.
   Chronic poisoning.—Colica pictonum, or Painter's colic, may be con-
sidered as the chronic form of poisoning by carbonate of lead.  The
symptoms are  usually well marked.  There is  at first pain with a
sense of sinking commonly in or about the region of the navel (the
seat of the colon).  Next to pain  there is  obstinate  constipation,
retraction of the skin and abdomen, loss of appetite, thirst, fetid
odor of the breath, and general emaciation, with paralysis of a pecu-
liar kind affecting the extensor muscles, and causing a dropping of
the wrist,  or showing itself in a general  paralysis of the limbs.
The skin  acquires a sallow or  earthy color, generally well marked
in the face, and the patient experiences a sweetish, styptic, or astrin-
gent taste  in the mouth.  A symptom of a peculiar nature was first
pointed out by the late Dr. Burton (" Med. Gaz." vol. 25,  p. 687),
namely, a blueness of the  edges of the gums, where these join the
bodies of the teeth ; the teeth  are of a brownish color.   The blue
line on the gums may be  regarded as a distinguishing sign  of lead-
colic.  Chronic poisoning with lead often kills the patient, since a
great amount of  mischief is done  before the  cause  is discovered.
The only appearances found after death have been a  contraction of
the cavity of the  large  and  small intestines, and a considerable
thickening of the coats. These changes have been especially noticed
in the colon—the seat of  colic.   The various circumstances  under
which this form of poisoning is liable to occur are elsewhere fully
described.   (See " On Poisons," also  " Principles  of Med.  Jur."
1873.)  Cases of poisoning are sometimes observed as the result of
the introduction of oxide of lead  into the system through  wine, 
POISONING BY COPPER.
173
beer, cider, milk, and other  liquids.   Earthenware  glazed  with
litharge imparts oxide of lead to fat in dripping, also to acid liquids.
Snuff is sometimes adulterated with red lead, to  improve its  color,
and some cases of lead poisoning have occurred from the use of such
snuff.  A spurious tinfoil, consisting chiefly of lead faced with tin,
is much used as a covering or wrapper for articles of food.  When
exposed to damp, this metallic  alloy undergoes  chemical changes
whereby carbonate  of lead  is produced.  Children's farinaceous
food has thus become impregnated with  lead.   [During  the year
1866, whole families, in one of the counties of the State of New
York, were poisoned by the use of flour manufactured at a mill, the
owner of which had been in the habit of filling the cavities in the
mill-stones with lead.—P.]

                     Poisoning  by Copper.

  All the salts of copper are poisonous.  The two most commonly
known  in commerce are the Sulphate or Blue Vitriol, and the
SUHACETATE Or VERDIGRIS.
  Blue Vitriol.   Sulphate  of copper.  Symptoms. — Sulphate  of
copper has been frequently given for the purpose of procuring abor-
tion.  In doses of half an ounce and upwards, it acts as a  powerful
irritant on adults, and a  much smaller quantity would  suffice to
destroy infants or children.   The salt  speedily causes vomiting of
the most violent kind ;  this sometimes expels the poison  from the
stomach, and the person  recovers.  There is  headache, pain in the
abdomen, with purging; the pain is of a colicky character; and  in
aggravated cases, there are spasms of the extremities and convul-
sions.  Dr. Perceval met with an  instance in which violent convul-
sions were  produced in a young woman  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 body, may
be mentioned jaundice.   This has been observed to attend poison-
ing by  the sulphate, as well as  by Scheele's green.  The vomited
matters are remarkable for being generally of a blue or green color;
broken  crystals of blue vitriol were discovered  in them, in a case
in which the poison was taken  in the state  of coarse powder.   If
the green  color of the vomited  liquid is owing  to altered bile, it
will not acquire a blue tint on  adding to a  portion of it a strong
solution of ammonia;  but if caused by a salt of copper, this change
of color will  serve to  indicate the fact.  The medical dose of sul-
phate of copper as an emetic, is from five to fifteen grains, and as a
tonic, from one to three or four grains.
  Appearances.—In the few fatal cases which have been hitherto
examined, the mucous membrane of the stomach and intestines has
been found more or less thickened and inflamed, and in some cases
eroded and softened.  The gullet has  presented an inflammatory
appearance.   In one case of poisoning by verdigris, the stomach was
inflamed and  thickened, especially towards the intestinal opening, 
174     ANALYSIS.  COPPER IN  ORGANIC LIQUIDS.
the orifice of which, from the general thickening, was almost oblite-
rated.  The small intestines were throughout inflamed, and perfora-
tion had taken place, so that  part of the green liquid was effused
into  the abdomen.   The large intestines were  distended  m  some
parts, and contracted in others, and the rectum was ulcerated onits
inner surface.  (" Orfila, Toxicologic," vol. 1, p. 623.)   The lining
membrane of the alimentary canal has been found throughout of a
deep green color, owing to small particles of the copper salt (verdi-
gris) adhering to it.                             .
  Chemical analysis.—The salts of copper, whether in the solid state
or in solution, are generally known by their blue or  green color.
Tests.—1. Solution of ammonia: this gives, in a solution of a salt of
copper, a bluish-white precipitate, which is soluble in excess of the
test, forming a deep violet-blue liquid.  2. Ferrocyanide of potassium
gives, in a very diluted solution, a rich claret-red precipitate ; if the
quantity of  copper is small, the liquid acquires merely a light-red
color; if large, the precipitate is of a deep red-brown color, and of
a gelatinous consistency.  The ferrocyanide of potassium will act on
the violet-blue solution produced by ammonia, provided it is diluted,
and a few drops of diluted sulphuric acid are added, in order to neu-
tralize the ammonia: one portion of the liquid may thus be tried
by the two tests.  3. Sulphuretted hydrogen gas,  or sulphide of am-
monium, gives a deep chocolate-brown precipitate, even  in an acid
solution;  or if the copper  is in small proportion, merely a light-
brown color.  4. A  slip of polished iron (a  common  needle) sus-
pended by a thread in the liquid slightly acidulated writh sulphuric
acid  is speedily coated with a red layer  of  copper, even when the
salt is in very small proportion. If the needle is left 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 iron coated
with copper, may be at once immersed in ammonia and exposed to
air:  the  liquid then becomes slowly blue.   Half a grain of sul-
phate of copper dissolved in sixteen ounces of water may be thus
easily detected.  It was long since proposed by Orfila to substitute
phosphorus for polished iron.  This substance most effectually sepa-
rates metallic copper from  its salts, even when  they are dissolved
in organic liquids.  5. The  Galvanic Test.—Ii a few drops of the
copper solution are placed on platinum-foil, slightly acidulated with
a diluted acid, and the platinum is  then touched through the solu-
tion with a  slip of zinc-foil, metallic copper,  of  its well-known red
color, is  immediately deposited on the platinum.   When the
quantity of  copper is small, there is merely a brown  stain;  but a
blue  liquid is formed by pouring on it ammonia, and exposing it
to air.   A coil of fine platinum and zinc wire may be substituted
for the foil.
  Copper  in organic liquids.—The oxide of copper is liable  to be
precipitated by certain organic principles, e.g., 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 
CHEMICAL ANALYSIS.
175
salt.  A portion at least of the salt of copper is, therefore, commonly
held dissolved.  In  such cases  the liquid is usually of a greenish
color, and has  a strong  coppery'or metallic taste, even when the
copper salt is in far less than a poisonous proportion.  The sulphate
of  copper, used  in  medicine and chemistry,  sometimes  contains
traces of arsenic.   About ten grains of the crystallized sulphate will
be sufficient to yield evidence of the presence of this poison. When
the sulphate has been given as an emetic, traces of arsenic may be
found in  the contents of the stomach  or in the matters vomited.
Sulphate of copper is occasionally met with as a fraudulent addition
to bread.  (" Horn's Vierteljahrsschrift," 1870,1, 322.  Also " Med.
Times and Gaz.," 1871, 1, 509.)
   A polished needle, or fine iron wire may be used in these liquids
as a trial-test for the presence of  the salts of  copper.  If in large
quantity, the copper may be precipitated by sulphuretted hydrogen,
the sulphide collected, dried and converted into a soluble sulphate
by the action  of strong nitric acid.  If in small  quantity, the
following is the most expeditious method of obtaining copper from
any organic  liquid which contains a soluble poisonous salt of this
metal.  Having filtered the organic liquid, let a portion of  it be
placed in a  clean platinum capsule, or crucible.  A few drops of
diluted sulphuric acid may be added, and a slip of zinc foil intro-
duced.  Wherever the platinum is touched by the zinc, metallic
copper is deposited;  and  after having in this  way  coated the
platinum  capsule, the surplus liquid may  be  poured off and the
capsule well washed out.  The deposited copper is then dissolved
in nitric acid, and the tests  may be applied, after the  excess of acid
has been driven off by heat, and the residue dissolved in water.
   In the tissues or urine.—Dry and incinerate  the organic matter.
Digest the  residuary ash in pure hydrochloric acid by heat, and
then evaporate nearly to dryness.   The residue may be dissolved in
a small quantity of water, and a polished needle immersed for some
hours.  The metallic deposit, if any, on the  needle, may be recog-
nized as copper, either by its color or by the action  of ammonia.
Traces of copper have been found  in many kinds of food as well as
in  the tissues  of the body, irrespective 'of the introduction of a
copper salt as a poison.
   Copper in food.—The medico-legal history of poisoning by copper
would be incomplete without some remarks on the action of cer-
tain articles of food on  this metal, when  it  is used for culinary
purposes.   This is not an unfrequent form of accidental poisoning.
The symptoms rarely appear until after the lapse of three or four
hours, or even a much longer period.  There is commonly nausea,
with colicky pains and cramps in the limbs.  If the copper vessel
is kept perfectly clean, and the food prepared in it is allowed to
cool in other vessels, there is not much  risk of  its acquiring a poi-
sonous 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, 1, 102.)
  Copper  vessels are often tinned on the inside.   The  tin thus used 
176          POISONING WITH TARTAR  EMETIC.

is frequently alloyed with a large proportion of lead, and thus lead-
poisoning may be substituted for poisoning with copper.  According
to Paasch, of Berlin, many of the'accidents attributed to this form
of cupreous poisoning are really due to other causes.  (Casper's
"Vierteljahrsschrift,"'" 1852, B. i. II. i.  S. 78.)  It  has been else-
where stated that  all the ordinary copper employed  for culinary
utensils, contains arsenic.  In those cases in  which  the  metal is
converted into insoluble oxides or salts by acids or fat, the arsenic
may be found in an insoluble form in the green incrustation pro-
duced.  When copper thus forms an insoluble salt, I have not found
any arsenic dissolved.
  It has  been stated that an impure gold alloy used by some of the
lower class  of dentists has been so largely composed of copper, as
to affect the health of those who  have used the  plates for the sup-
port of artificial  teeth.  The acid and salts in  the saliva facilitate
the production of a poisonous salt of copper, and probably set free
arsenic.
  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 color.  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 color.   If the fruit  or  pickle is
placed in a solution of ammonia,  and copper is contained in it, 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 some-
times produced,  and in young persons these may assume an alarm-
ing character.  (See "Falconer,"  p.  87.)
                     CHAPTER XIV.

TARTAR EMETIC—SYMPTOMS.—APPEARANCES.—CHRONIC  POISONING-
  chemical  analysis.—chloride or butter of antimony.__poison-
  ing with salts of zinc and iron.

                       Tartar Emetic

  Stibiated tartar.  Tartarated  antimony.   Symptoms and Effects.—
When tartar emetic is taken in a poisonous dose, a strono- metallic
taste is perceived in the mouth during the act of swallowing. There
is great heat and constriction of the throat, with difficultyof swal-
lowing, violent burning pain in the region of the stomach, followed
by incessant vomiting, profuse purging, faintness, and extreme de-
pression.   The pulse is small and rapid, sometimes  imperceptible; 
POISONING WITH TARTAR EMETIC.          177
the skin cold, and covered with a  clammy perspiration; and the
respiration is painful.   Should the case prove fatal, death  may be
preceded by giddiness, insensibility, great prostration of strength,
and sometimes violent spasms of the muscles  of the limbs, which
may assume either a clonic, or a tetanic character.  Such  are the
symptoms in an  acute  case of poisoning by this substance.  The
quantity actually required to destroy life is unknown.  One  drachm
taken at a dose proved fatal in ten hours, in spite of early and fre-
quent vomiting.   ("Med. Gaz." vol. 45, p. 801.)
  Appearances.—The following cases show the nature of the appear-
ances likely to be found after death.   Two children, a boy aged five
years, and a girl aged three years, each swallowed a powder contain-
ing 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 inflamed, and covered with
a whitish-yellow viscid secretion; this  was observed throughout
the intestines, although the color was  of a deeper yellow in the
large intestines; there  was no ulceration.  The peritoneal coat of
the stomach was inflamed. The mucous membrane of this  organ
was also 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 dark bloody fluid,  having a slightly acid
reaction) were adherent to it; and in one case, there was  a patch of
lymph.   The tests used did not indicate the presence of  antimony.
With regard to  other appearances, the tongue was covered with a
white fur, and appeared soddened; the throat was not inflamed ; the
windpipe and gullet had  a natural appearance.  On opening the
head, the dura mater was  found congested;  the longitudinal sinus
contained a  coagulum of lymph, and but little blood.  The vessels
of the surface of the brain were much injected with dark Wood,
the whole surface having a  deep purple color.   Every portion of
the brain, when  cut, presented many bloody points.  The  cerebel-
lum and medulla oblongata were also congested; there was no effu-
sion in the ventricles or at the base  of the brain.  In the  body of
the girl, the morbid appearances were similar; there were  in addir
tion on the arms, legs, and neck,patches resembling the.eruption of
Bcarlatina,   The arachnoid membrane was more opaque than usual;
and on the  mucous membrane of the stomach, where the inflam-
mation 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.)
  Criminal  trials for poisoning with tartar emetic in the acute form 
178         POISONING  WITH TARTAR EMETIC.
are rare.  It is a poison which cannot easily be  given in a large
dose without producing speedily well-marked effects; and as vom-
iting is a common symptom, the poison is thus early ejected from
the stomach.
  An  extraordinary trial for  murder by alleged  poisoning with
this substance took place at Annapolis, IT. S., in December, 1871.
Mrs. E. Wharton was charged with poisoning her friend General
Ketchum.   The  trial lasted  fifty-two days, and  an  astonishing
amount of scientific evidence was brought forward for the prosecu-
tion and defence, apparently owing to the high social position of the
parties, for there is nothing, medically speaking, in the case  itself
that might not have been settled in forty-eight  hours.   The Gen-
eral died after a short illness, but the symptoms, taken as awhole,
bore no resemblance to those observed in poisoning with antimony;
and but for the alleged discovery of twenty grains  of tartar emetic
in the  stomach after  death, no suspicion of poisoning would  have
probably arisen.  (See " Guy's  Hospital  Reports" for Oct. 1857, in
which  thirty-seven cases of poisoning by antimony are recorded.)
The appearances in  the body  proved  nothing for, or  against an-
timonial poisoning,  and  some physicians of experience deposed
that the symptoms  and appearances  were consistent with disease
affecting  the  membranes of the  brain and  spinal  marrow.  On
examining the chemical evidence, it  appears that  the  process by
sulphuretted hydrogen alone was employed,  and a red-brown sul-
phide,  resembling that  of antimony in chemical properties, was
obtained; but the quantity obtained as sulphide was only four-
tenths  of a grain, estimated as  equivalent to eight-tenths  of a grain
of tartar emetic.  Thus, the chemical analysis brought  out only a
fraction of a grain, not amounting to one-twentieth part of the
quantity said to be present; and no separation of antimony in the
metallic state was made to corroborate  the inference  drawn  from
the precipitate produced  by sulphuretted hydrogen.   No chemical
results were produced in court, although twenty grains would have
allowed of the production of metallic antimony in a  few minutes
by copper,  tin, zinc, and  platinum, or  by Marsh's process.  The
evidence that antimony was really there was not satisfactory; and
that twenty grains were  present in the stomach was wholly un-
proved.  The  chemical evidence does not, therefore, conflict with
the pathological evidence, for it failed to show with clearness and
distinctness the presence and proportion of poison said to have been
found.   The jury upon such weak evidence properly acquitted the
prisoner. (" Report of Trial of Mrs. E. G. Wharton on the Charge of
Poisoning Gen. W. S. Ketchum," Dec. 1871, Jan. 1872, in "Balti-
more Gazette;" "American Journ.  Med. Sci." April, 1872, p. 329.)
  It has been  hitherto supposed that the cases in which this poi-
son has proved fatal have  been few ; but I have elsewhere reported
thirty-seven, of which sixteen were fatal.  The smallest fatal dose
was in a child, three-quarters of a grain, and in a adult, two grains;
but in this instance there were circumstances which favored the
fatal operation of the poison.  (" Guy's Hospital Reports," Oct. 1857.) 
CHEMICAL ANALYSIS.
179
  In cases of chronic poisoning by this substance, the principal symp-
toms are as follows: great nausea, vomiting of mucus and bilious
liquids, great depression, watery purging, followed often by consti-
pation of the bowels, small, contracted, and  frequent pulse, loss of
voice and muscular strength, coldness of the skin, with  clammy
perspiration, and death from complete exhaustion.  Several cases
have occurred in this country, which show that  tartar emetic  has
been thus criminally employed.
  Chemical analysis.  Tartar emetic as  a solid.—In the state of pow-
der, it is white and crystalline.  1. It  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  metallic taste;
it is  insoluble in alcohol.   2. The powder dropped  into sulphide of
ammonium is turned of a deep reddish-brown color, and is thereby
known from other poisonous metallic salts.  3. When heated  in a
reduction-tube, it is 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 gray-
ish-blue metallic lustre.  No metallic sublimate is produced in this
experiment by the heat of a spirit-lamp.  4.  When boiled in water
containing one-sixth of pure hydrochloric acid, and metallic copper
is immersed in the liquid, a gray deposit of antimony takes place
on this metal.   The color of the deposit is  violet-red if the quan-
tity  is very  small, but the deposit is black and pulverulent, if very
large.   5. The solution acidulated  with one-tenth part of hydro-
chloric acid gives, in the cold, a black deposit on a surface of pure
tin.   A slip of pure tin-foil may be used in this experiment.  This
serves to distinguish antimony from  arsenic.  A  better  mode of
distinguishing antimony from arsenic is by boiling in a mixture of
protochloride of tin  and strong  hydrochloric acid: all  arsenical
compounds are precipitated as brown metallic arsenic; while tartar
emetic is not affected.
   Tartar emetic in solution.—1.  On slowly evaporating a small quan-
tity  on a slip of glass, it will crystallize in tetrahedra, and in deriva-
tives  of the  octahedron.   If   obtained
from a very diluted solution, this crystal-           Fig. 18.
lization  is confused, and resembles  that
of arsenic.  2. Diluted  nitric acid, added
to the solution, throws down a white pre-
cipitate  (subnitrate of  antimony); the
other two mineral acids act in  the same
way ;  but, as they precipitate numerous
other metallic  solutions, there are objec-
tions to them which do not  hold with re-
spect to nitric acid. The white precipitate
thus  formed  possesses the  remarkable
property of being easily and entirely dip- Cry8tals of ^T^euc magnified
solved by a solution of tartaric acid:  it         30 diameters.
is also soluble in a large excess  of nitric
acid, so that if much of the test be added at once,  no precipitate is
 
180
CHEMICAL ANALYSIS.
produced.  3.  Ferrocyanide of potassium does not precipitate  the
LTution, whereby tartarized antimony is known from most other
metallic poisons.  4. Sulphide of ammonium, or sulphuretted hydrogen
^produces in the solution a reddish orange-colored precipitate,
aifferhig in color from every other metallic sulphide   The precipi-
tate is not readily soluble in ammonia or tartaric acid but it is dis-
solved in the dry state by strong hydrochloric acid.  The only  test
available when the quantity of tartarized antimony present is small,
is a current of sulphuretted hydrogen gas.                 .
   In liquids containing organic matter.--Tartar emetic is precipitated
by tannic acid in all its forms, but not readily by albumen or mu-
cous membrane: therefore it may be found partly dissolved, in the
liquids of the  stomach, provided no antidote has been administered.
As a trial test, if the liquid is much colored a portion of it may be
submitted to dialysis in a tube, like arsenic (p. 149); tartar emetic
may be  thus  obtained in water, in a pure state, for testing,   lhe
organic liquid should 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 sulphide is col-
lected,'washed, and dried.  If it is the sulphide of antimony, it will
have an orange-red, or brown  color, it will be insoluble in a solu-
tion of ammonia, and when dried will be dissolved by a small quan-
tity of boiling hydrochloric acid (forming chloride  of antimony)
 with  the  evolution of  sulphuretted  hydrogen  gas.  The  boiling
 should be continued for several minutes, until the liquid is colorless.
 On adding this solution, if not too acid, to water, a white precipi-
 tate of oxychloride of antimony (powder of Algaroth or Algarotti,
 Mercuries Vitas) falls down.   This is characteristic  of antimony.
 [We can hardly regard  this test as absolutely characteristic of anti-
 mony, inasmuch as the colored precipitate which  may often be ob-
 tained by the action of sulphuretted hydrogen on a simple  acid
 solution of certain organic substances, is more or less soluble in boil-
 ing hydrochloric acid ; and this solution, when thrown into water, will
 yield a white precipitate.—R.]   A portion of the  acid liquid may be
 introduced with pure zinc and sulphuric  acid into a Marsh's tube
 or apparatus, like that described at p. 147.  The gas which escapes
 at the jet produces a deep black deposit on paper impregnated with
 a solution of nitrate of silver;  but unless sulphur is present it pro-
 duces no change on paper impregnated with  a salt of lead.   When
 ignited, it burns with a pale yellowish-white flame, producing white
 fumes of teroxide of antimony.   Porcelain, or  glass depressed on
 the flame, receives  a black deposit of reduced  metallic  antimony,
 with grayish-colored layers of oxide at the circumference.  There
 is no metallic lustre, such as is produced  by arsenic, under similar
 circumstances, but on examining the reverse side of the glass, a dim
 metallic lustre will be perceptible.   This  deposit, unlike arsenic, is
 not dissolved by chloride of lime.   If a current of the gas is heated
 to redness in a glass-tube, a tin-white ring of metallic antimony will
 be deposited close to the  heated spot.  This is much  more fixed
 than the deposit of arsenic, and  cannot, like it, be  resolved into a 
       DETECTION OF ANTIMONY IN THE TISSUES.     181

white sublimate of octahedral crystals.   If the gas is made to pass
through a small quantity of fuming nitric acid containing nitrous
acid, it is decomposed, the  antimony is  peroxidized, and  may be
obtained as a white, insoluble residue on  evaporation.  A solution
of nitrate of silver produces  no change of color in this deposit; but
if one or two drops  of ammonia are added, there is a black  precipi-
tate of antimonide of silver.
  The following method of detecting antimony, when dissolved in
any organic liquid,  is based upon the principle by which copper and
other metals may be detected under similar circumstances (p. 174).
Acidulate a portion of the suspected liquid with hydrochloric acid,
and place it in  a shallow platinum capsule.   Touch the platinum,
through the acid liquid, with a piece of pure zinc-foil.  Hydrogen
is evolved, and wherever the metals come in contact, metallic anti-
mony, in the state of a black powder, is deposited on the surface of
the platinum.  The liquid should be poured off, and the  capsule
thoroughly  washed with distilled water.   This may be effected
without disturbing  the deposit.  A small quantity of sulphide of
ammonium  poured  on  the black deposit, speedily dissolves it (if
antimony) by the aid of heat, and on evaporation, an orange-red
sulphide of antimony remains.  This may  be  dissolved by a few
drops of strong hydrochloric acid, and on adding the acid liquid to
water, hydrated oxychloride of antimony is precipitated.   By this
process antimony in small quantity may be  detected in any liquid
containing organic matter.   In place  of sulphide of ammonium,
nitric acid may be employed to oxidize the metallic deposit, and the
dry residue treated  as described below.
  In the tissues.—The antimony may be  in so small a quantity, as
it is deposited in the organs, that  neither the sulphuretted hydro-
gen  nor the galvanic process will yield any satisfactory  results.
The liver or other organs should be finely cut up, and boiled in a
mixture of one part of hydrochloric acid and five parts of water.
After some time, the liquid may be tested by introducing into it a
slip  of polished copper-foil  free from antimony.  If antimony  is
present in small quantity, the copper will acquire a reddish or violet-
colored deposit on its surface : if in large quantity, the deposit will
be gray with a metallic lustre, or sometimes in the state of a black
powder.  These deposits'do not yield octahedral crystals like those
obtained from arsenic.   A slip of pure tin-foil may be suspended in
the cold in another portion of the acid liquid, diluted so that the
hydrochloric acid forms only one-tenth  part by measure.   Either
immediately, or in the course of a few hours, if antimony is present,
the tin is covered with a black deposit of metallic antimony. As
arsenic is not deposited on  pure tin under similar circumstances,
this furnishes a ready method of detecting the admixture  of anti-
mony with arsenic.   These may be regarded as trial tests.   For the
demonstration of the presence of antimony, when in mere traces,
we may resort to  the following process, by which antimony may
be completely separated from organic substances.   Coil a portion of
pure zinc-foil round a portion of clean platinum-foil, and introduce 
182              DETECTION OF  ANTIMONY.
the two metals into the hydrochloric-acid decoction of the tissues,
iust sufficiently diluted to prevent too violent an action on the zinc.
Warm the organic liquid, and suspend  the coils in it.  Sooner or
later, accordino; to the quantity of antimony present, the platinum
will be coated with an adhering black powder of metallic antimony.
Wash the platinum-foil, and digest it in  strong nitric acid.  So
soon as the black deposit of antimony is  dissolved from its surface,
the platinum may be  removed.   Add a few drops  of nitric acid,
and evaporate the acid liquid to  dryness.   The residue redissolved
in hydrochloric acid, and the solution diluted and treated with a
current of sulphuretted hydrogen, will yield an  orange-red sulphide
of antimony.  This black deposit of antimony is readily dissolved
from platinum-foil by sulphide of ammonium, yielding on evapora-
tion an orange-red sulphide of antimony ; it is soluble in nitric, but
not in hydrochloric  acid.  When kept for a few days in contact
with water and air,  the black metallic deposit is sometimes con-
verted into white oxide of antimony, and entirely disappears.
  Antimony  in the metallic state  is so easily procured from a small
quantity of material, by one  or other of  the above-mentioned pro-
cesses, that on no account should this be omitted.   The procuring
of the metal  may be made subsidiary to  the procuring of the sul-
phide, as the  metal can be  easily oxidized and  converted into sul-
phide in a pure form,and obtained entirely free from organic matter.
A reliance on a small quantity of a colored precipitate from sulphu-
retted hydrogen  alone, would be most unsatisfactory as chemical
evidence.
  [It is undoubtedly quite as important, in a trial for alleged poi-
soning by antimony, that themetal should be produced in evidence,
as it is in a  case of arsenical poisoning.  We see no reason why
antimony should be made an exception to the  general rule, which
is observed in the cases of poisoning by mercury, arsenic, lead, zinc,
copper, etc.—R.]
  The detection of antimony in the stomach, or even in the tissues,
does not  necessarily indicate that  it has been criminally admin-
istered, or has caused death; but its presence there should  be rea-
sonably accounted for, as antimony may have been  unlawfully
administered.  In several  cases  of suspected death  from poison,
deposits  on copper, evidently of an  antimonial nature, have been
obtained from  the liver or tissues.   On inquiry it has been found
that antimpnial medicines had  been taken shortly before  death.
[It is very important to. examine the urine  for its presence  durin*
life.—R.]
  Chloride, or Butter of antimony.—This is  a strongly corrosive poison
by reason of  the  acid with which the antimony is combined.  It
has caused death in several instances.  The symptoms and appear-
ances  resemble those  produced by concentrated  hydrochloric acid. 
PREPARATIONS  OF  ZINC.
183
                     Preparations of Zinc

   Sulphate of zinc.  White vitriol.  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,
 followed by purging.   After death the stomach has been found
 inflamed.  The sulphate appears to  act as a pure irritant; it has no
 corrosive properties.   This salt may cause death indirectly as the
 result of exhaustion from violent vomiting, when an ordinary dose
 has been given to a person already  debilitated by disease.  In one
 case a lady recovered after taking sixty-seven  grains (" Lancet,"
 May 17, 1856).  In another, which  occurred in May, 1872, commu-
 nicated to me by Dr. Mackintosh, of Downing, a man set. 20 recovered
 in a few days after taking an ounce of sulphate of zinc by mistake
 for Epsom salts.   There was early vomiting and purging of a most
 violent kind, with great prostration of strength.  The greater part
 of this large dose was no doubt thus carried out of  the body.
   In cases of epilipsy, the late Dr. Babington gave sulphate of zinc
 in doses of two scruples, three times a day, having first commenced
 with small doses.  No ill effects  followed, and none of the usual
 symptoms of irritation were observed.  This may have been owing
 to a tolerance of the medicine.  With respect to the oxide of zinc,
 Dr. Marcet states that he has prescribed it in large doses  without
 injury to health.  One patient, an epileptic, took as much as one
 pound in seven months, the largest quantity taken in one day being
 seventy grains.  Although he did not suffer from the remedy, the
 disease was not cured.  (" Lancet," March 1, 1862,  p. 224.)
   Chloride  of  zinc.   Symptoms and appearances.—This, which  is
 commonly sold under the name of " Sir W. Burnett's fluid," is  a
 corrosive poison, and is much used  as a  deodorizer. The patient
 experiences a  sense of heat and burning in the mouth and throat,
 in the act  of swallowing the liquid, which has been frequently
 fatally  mistaken  for  fluid  magnesia.   There  is a burning and
 griping pain in the stomach, nausea followed by violent retching
 and vomiting—the vomited matters being streaked with blood and
 mixed with much flaky mucus, with shreds of mucous  membrane.
 This has produced an appearance of frothiness about the mouth.
 Violent purging has been observed among the symptoms.   A stage
 of collapse supervenes, and the skin becomes cold and livid.
  After death from this poison, the lining membrane of the mouth
 and throat has been found white  and opaque, that of the stomach
 has sometimes been hard and leathery, at others corrugated, opaque,
 and of a dark leaden color.   The lungs and kidneys are congested.
 The chloride is both a corrosive and  irritant poison, exerting also a
 peculiar action on the nervous system.   If a person survives the
 acute stage, he may  die in the chronic stage from stricture of the
 gullet or pylorus, or from emaciation and exhaustion as a result of
 the local action of the poison of this organ.
  Aiadysis.—In these two  compounds, the  zinc is detected by the
aqueous solutions giving white precipitates with a current of sul- 
184
PREPARATIONS OF IRON.
phuretted hydrogen gas, while the sulphuric acid or chlorine may
be recognized by their respective tests.
  Zinc can be detected in the tissues only by incineration, and an
examination of the ash.   The chloride is, however, sometimes used
for the preservation of the dead body.   This might account for its
occasional presence.

                    Preparations of Iron.

  Sulphate of iron.   Copperas.   Green vitriol—-This compound has
been several times administered with  malicious intention.   One
death from  it  took place in 1837-8.  It cannot, however, be an
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,'' p. 506.)  Green
vitriol, or copperas, is sometimes given as an abortive. At the Not-
tingham Autumn  Assizes, 1859, a woman of the name  of Riley
was indicted for administering  copperas to two children.  She put
the substance into gruel.   It gave to the gruel a greenish color and
a peculiar taste, which led to the discovery.   It caused  sickness,
but no other serious symptoms.  As there was no evidence of an
intent to murder, and it was  then not unlawful to administer poi-
son with any other intent, the prisoner was acquitted.   This salt
has been much used for criminal purposes in France.  (See " Medi-
cal Gazette," vol. 47, p. 307 ; also "Ann. d'Hyg.," 1850, vol. 1, pp.
180, 416 ; and 1851, vol. 1, p. 155 ; vol.  2, p. 337.)
   Muriate of iron.   Tincture of perchloride of iron.—This is an acid
solution of perchloride of iron  in rectified spirit; it is a red-brown
color, and is much employed  as a medicine.  It is sometimes made
with wood-spirit, or methylated spirit, which gives to it a peculiar
odor.  Dr. Christison relates an instance in which a man by mis-
take swallowed an ounce and a half of this liquid.  The symptoms
were somewhat like those  produced by hydrochloric acid.  He  at
first rallied, but died in about five weeks. The stomach was found
partially inflamed, and thickened towards the intestinal end.
   Comparatively small doses of this solution may seriously affect
pregnant females, and among the criminal uses to which it has been
put, may be mentioned that of procuring abortion. At the Lincoln
Lent Assizes, 1863 (Reg. v. Rumble), a  druggist was convicted  of
having supplied this noxious  compound to a woman with the intent
to procure her miscarriage.  The  health of the woman was greatly
injured by the administration of  this liquid.

   The above are the principal metallic irritants; but the compounds
of tin, silver, gold, bismuth, and chromium have also an  irritant action.
Cases of poisoning by these substances are, however, very rare.
   [Subnitrate of bismuth.  Pearl white.—-This substance is at present,
much used in medicine, in doses varying from five to thirty grains,
m certain forms of dyspepsia, diarrhoea, etc.  In some cases  that have
been reported, in which large doses proved highly irritating, and even 
SUBNITRATE  OF BISMUTH.
185
fatal, there is strong reason for suspecting the presence of arsenic
as an impurity in  the medicine.  The author states (" Prin. and
Prac. of Med. Juris." 1873), that the medicinal subnitrate generally
contains  arsenic.  He found  arsenic in a comparatively large  pro-
portion in samples obtained from three respectable druggists.  Three
specimens out  of five contained it.   The arsenic  may easily be
detected  by dissolving the subnitrate in pure hydrochloric  acid
slightly diluted, and  using a Marsh's  apparatus.   This impurity
may modify a legal opinion as to the presence of traces of arsenic
in a body, where bismuth has been previously administered medi-
cinally.  A case of this nature (State  of Virginia v. 3Irs. E. E.
Lloyd, 1872)  has recently occurred, in which the  defence  ascribed
the existence of a fraction of a grain of arsenic, alleged to have been
found  in  the liver of the deceased,  to the subnitrate  of  bismuth
which had been administered before death; this bismuth was after-
wards found to be contaminated with arsenic.   The prisoner was
acquitted.—R.J 
186
VEGETABLE IRRITANTS.
VEGETABLE AND ANIMAL  IRRITANTS.
                     CHAPTER XV.

VEGETABLE IRRITANTS.—ALOES.—SAVIN.—CROTON OIL.—GOLCIIICUM.—
  HELLEBORE.--ANIMAL IRRITANTS.—CANTHARIDES.--NOXIOUS ANIMAL
  POOD.—FISH.— MUSSELS.— CHEESE.— SAUSAGES.— POISONED FLESH OF
  ANIMALS.—TRICHINIASIS.

  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 frequently, or in large quantities,  to excite  severe
vomiting, purging, and other symptoms of irritation.  Aloes and
colocynth mixed are said to be the basis of a certain quack medi-
cine 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.
  Hierapicra (Holy bitter) is a popular aloetic compound, and one
death is recorded to have been produced by it in 1837-8.   There
is reason to believe that  it is occasionally used for  the purpose of
procuring criminal abortion.  A man was tried and convicted of
this offence at  the Aylesbury Lent Assizes, 1857 (Reg. v. White),
and the noxious properties of this compound then became a subject
of inquiry.  The dose and the condition of the woman to whom it
is administered will of course affect the answer to this question.
At the  trial above mentioned, it was properly considered to be a
noxious substance  within the meaning of the statute.  The fact
that, under  the name of Pubis Aloes cum Canelld, it was formerly
admitted into  the British Pharmacopoeia, cannot justify  the mis-
chievous uses to which it may be  put.  Hierapicra is  a snuff-
colored powder, of an intensely bitter  taste.  It consists of four
parts, by weight, of aloes, and one  part, by  weight, of powdered
canella bark.  The proper medicinal dose was formerly  fixed at
from five to fifteen grains.  Its injurious  effects on  pregnant
females  are  chiefly due to the aloes.  This specially affects the
rectum,  and by contiguity, under  violent irritation or purging, 
POISONING  WITH COLCHICUM.
187
Fig. 19.
Tips of the leaves of Savin magnified
       30 diameters.
may affect the uterus.   From the taste and color which it imparts
to liquids, it is not probable  that it could be taken by  a female
unknowingly.
  Savin (Juniperus Sabina).—This is a well-known plant, the leaves
of which contain an irritant poison in the form of an acrid volatile
oil of a remarkable odor.  They exert an irritant action, both in the
state of infusion  and powder.  They yield by distillation a light
yellow oil, on which the irritant properties  of the plant depend.
The powder is sometimes used  in medi-
cine,  in a dose  of from five  to twenty
grains.  Savin is  not  often  taken  as a
poison for the specific purpose of destroy-
ing life ;  but this is occasionally an in-
direct result of its use as a popular means
of procuring abortion.   In this manner
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
violent pain in  the abdomen, vomiting,
and strangury.   After death, the gullet,
stomach,and intestines, with the kidneys,
have been found either much  inflamed or
congested.  It has no action  as  an abor-
tive, except, like other irritants, 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 jeopardy the life
of  a  woman ; and when abortion  follows, she  generally  falls a
victim.  This poison  may be identified  by microscopic examina-
tion of portions of the  leaves  found in the stomach.
   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.
  M. Chevallier reports two cases of poisoning by this oil.   In one,
a druggist swallowed by mistake for cod-liver oil half an  ounce of
croton oil.   He felt a burning sensation in the throat and  stomach,
soon followed by  vomiting and copious purging, with  symptoms of
collapse.   He did not recover until after a fortnight.   In the other
case, quoted from Devergie, a man, set. 25, swallowed by mistake
two drachms and a  half of  the oil.  The most violent  purging,
with  collapse took place, and  the patient  died in four hours.
("Ann. d'Hyg." 1871,  1, 409.)
  31cadow-saffron (Colchicum).—Meadow-saffron (Colchicum autum-
nal e) contains a poisonous alkaloid—colchicina—the effects  of which
on animals are similar  to those of veratria, the alkaloid existing in
white hellebore.   The  most  noxious parts of the plant  are the
bulbs (or roots) and seeds, but the leaves and flowers  have also an
irritant action.
  Symptoms and appearances.—The symptoms in cases of poisoning
by colchicum are generally well marked.  There is burning pain in
the throat and stomach, intense  thirst, violent vomiting and purg- 
188
POISONING WITH HELLEBORE.
ino- leading  rapidly to exhaustion, coldness and clamminess of the
skin, excessive depression, and great weakness.  The pulse is small,
weak and fluttering, and  death appears to take place from com-
plete exhaustion, without convulsions or loss of consciousness.
Among four cases presenting these symptoms, one person died on
the  second,  one on  the  fifth, one on  the  eighth, and one on the
fourteenth day.  In another case of poisoning by wine of colchicum,
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 being convulsed or  manifesting any
sign of cerebral disturbance.   The chief morbid appearance was a
patch of redness in the mucous membrane of the stomach, near the
cardiac  orifice ; the intestines were slightly inflamed.   The head
was not examined.  ("Medical Gazette," vol. 10, p. 161; see also
Casper, " Ger.  Med.," p.  450.)   In a case of poisoning by the medi-
cinal administration of  colchicum, 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 into the mucous follicles.  The
mucous membrane has been found softened in two cases of poisoning
by the tincture.  In two other cases, in which an ounce and a half
of the tincture  was taken, and death ensued in  forty-eight  hours, no
morbid  appearances were  found.   (Casper, "Ger.  Med.," 1857, p.
451, and see  his "Vierteljahrschrift,"  1860,  vol.  1, p.  1.)   See
" Prin. and Prac. of Med. Jurisp.," 1873.
   Colchicina.—The  noxious properties  of colchicum are  owing to
the presence of this alkaloid, which is remarkable for acquiring  a
reddish-violet color  on the addition of strong nitric acid.  It may
be separated from liquids containing it by  a process similar to that
described for strychnia.  (See Strychnia.)

             Black, White and  Green Hellebore.

   Symptoms and appearances.—According to Wibmer, the roots of
the black hellebore possess the greatest activity; but the leaves are
also highly poisonous when used in the form of infusion.   By lono-
boiling the poisonous properties of the plant are diminished, proba°-
bly owing to the loss of  the volatile principle, which is an acrid oil.
1 he roots and  leaves have a local irritant action, producing violent
vomiting and purging in small closes, with severe pain in  the abdo-
men, followed  by cold sweats, convulsions, insensibility and death.
Ihe powdered root, in  a  dose  of a few grains, acts like a drastic
purgative.   In a, case reported by Morgagni, half a drachm of the
aqueous extract killed a  man, aet. 50, in eight hours. The symptoms
were severe pain m the abdomen and violent vomiting. After death,
the whole of the  alimentary  canal was  found inflamed,  but  espe-
cially the large intestines.  (Wibmer, op. cit., Helleborus.) A case
i.  quoted by the same writer, in which a tablespoonful of the finely 
           NOXIOUS  PROPERTIES  OF VERATRIA.        189

powdered root (taken by mistake for rhubarb) caused severe symp-
toms of irritant poisoning, which did not disappear  for four hours.
The man recovered on the fourth day.  The experiments performed
by Orfila on animals, show that this poison acts like a local irritant
when applied to a wound.  (Op. cit., vol. 2, p. 369.)  Hellebore is a
favorite remedy for worms among quacks and rural doctresses.   It
is not, therefore surprising that it should be occasionally adminis-
tered in an overdose, and cause  death.  In December,  1862, Dr.
Edwards met with a case in which a gentleman had swallowed ex-
perimentally one drachm of tincture of green hellebore (veratrum
viride), equal to twelve grains of the powder.  He was found soon
afterwards in a collapsed state, features sunk, skin cold, and covered
with a profuse clammy sweat, pulse scarcely perceptible.   He com-
plained of intense pain in the region of the  stomach.  There was no
purging.  These  symptoms  were  relieved  by treatment, and the
next morning the patient had recovered.  (" Med.  Times and Ga-
zette," 1863,1, 5.)
   Veratria.—White hellebore owes its  noxious properties to the
alkaloid veratria, which is itself a powerful poison.   The late Mr.
Callaway communicated to  me  the following case.  A physician
prescribed medicinally for a lady, one grain of veratria  divided
into fifty  pills, and three were directed to be taken for a dose.
Not long after the dose had been swallowed, the patient was found
insensible, the surface  cold, the pulse failing, and there was  every
symptom of approaching dissolution.   She  remained some hours in
a doubtful condition,  but ultimately recovered.   Supposing the
medicine to have been well mixed, and  the pills equally divided,
not more than one-sixteenth of a grain of veratria was here taken !
The common veratria of the shops is sometimes  given medicinally,
in doses of one-sixth of a grain.   Poisoning by  veratria  is a rare
occurrence.  I have not met with an  instance in which  this alka-
loid has  been administered with criminal intention.   With the
exception of the case above mentioned, there is no experience of its
operation as a poison on man.  Judging from its effects on animals,
it would cause vomiting and convulsions, with insensibility.
   Analysis.—In the state in which it is usually seen, it is a brown-
ish-white powder, scarcely soluble in  boiling  water, but dissolved
by alcohol, ether, and  benzole.   Acids readily dissolve it, forming
salts which on evaporation do not yield crystals.  The powder has
a hot, acrid taste, and  if any  portion  enters the nostrils, it causes
most violent sneezing, lasting for  some  time.  Strong nitric acid
gives to the powder a  light red color, becoming ochreous after a
time.  Hydrochloric acid, strong, and diluted, with  the aid of heat,
produces  a dingy red  tint.   The  best test for  its presence is the
dilute sulphuric acid, which by a gentle heat strikes a rich crimson-
red color, which is destroyed by a solution  of chlorine, but not by
chloride of tin.
   Veratria differs from colchicina in its insolubility in water, as well
as in the action of strong nitric and diluted sulphuric acids.  Veratria
may be brought into solution in organic liquids, by acetic acid and 
190                 YELLOW JESAMINE.
heat.   The liquid is treated with potash and two parts of benzole
will yield the alkaloid if present, on decanting and evaporating the
benzolic solution.  The tests may then be  applied to the  residue.
It has not yet been detected in the tissues.

         Yellow Jesamine.  Gelsemium Sempervirens.

  An alcoholic extract of the root of this plant has been  used in
the United States for  medicinal purposes.   It has acted as a poison
and destroyed life, but its exact place as  a poison  cannot yet be
satisfactorily assigned. From a case reported by Dr. Walmsley (see
" American Journal of Pharmacy," Jan. 1870) it appears to belong
rather to the irritant than the narcotic class of substances.
  A young healthy married woman  took by mistake  three tea-
spoonfuls of the fluid extract of gelsemium—a concentrated tincture
of the root containing 480 grains to the ounce.  In two hours after
taking the extract, she complained of  pain in the stomach, nausea
and dimness of vision.  These symptoms were followed by great
restlessness, ineffectual efforts  to vomit, and general perspiration.
In four hours,  the  pulse was  feeble,  irregular,  and intermittent.
There was great  prostration, with irregular  and slow  breathing.
The skin was dry, the limbs were cold, the pupils dilated  and in-
sensible to light; the eyes  were fixed, and there was inability to
raise the eyelids.  The vital powers rapidly gave way, and without
convulsion, death occurred in seven hours and a half after  the poison
had been  taken.  On inspection after death nothing characteristic
was discovered.
  Analysis.—Dr.  Wormley discovered  that the  extract  contained
an alkaloid (gelseminine)  separable by ether or chloroform, and  an
organic acid (gelseminic acid).   The latter he was  able  to obtain
crystallized in  various forms  by  solution and  sublimation.  He
found that if a small  quantity of this  acid, or its salts, in a solid
state was treated with a drop of concentrated nitric acid, it became
yellow or reddish, according to the quantity.   When an excess of
ammonia  was  added, it  acquired  a  blood-red  color.  The  T^th
part  of a grain was  sufficient for this reaction.  The solution in
potash is fluorescent, presenting a deep blue coloration on the sur-
face.   Gelseminic acid was  thus detected  in  the contents of the
stomach some months after death.
  The alkaloid gelseminine is, according to  Dr. Wormley, a potent
poison.  One-eighth of a grain by hypodermic  injection killed a
rabbit in one hour and a half.  In fifteen minutes there were symp-
toms of great distress,  and the animal was restless. In forty minutes
there was great prostration,  inability to move, respiration gasping
and the pupils were dilated, but there were no convulsions    From
his experiments, Dr. Wormley infers that the quantity which proved
fatal to the woman in the  above-mentioned case, could not have
exceeded the sixth part of a grain. 
carbolic acid.
191
                        Carbolic Acid.

  Carbolic acid is a crystalline product of the fractional distillation
of the oil of tar.  The crystals of carbolic acid melt at 95°, and the
oily-looking liquid boils and is entirely volatilized at 370°.  Many
instances of poisoning by this substance  are  now  on  record, the
greater number having arisen from accident.   It has such a power-
ful odor  and taste that it could not be easily administered with
homicidal intent.  In a concentrated form, it has  a strong  local
action, and is a corrosive irritant, but  it affects the brain like a
narcotic poison.  It acts on the unbroken skin, whitens it, hardens
it, and destroys its sensibility for some  time.  It acts in a similar
way on  the mucous membrane, whitening, hardening  and corru-
gating it.  In one instance, it is reported to have destroyed life as
the result of external application.   (" Brit. Med.  Journal," Oct. 8,
1870.)   Five deaths are recorded  to have  taken place from this
poison in four years (1863-7).
  Symptoms and appearances.—When the poison is swallowed in
solution in a moderately concentrated state, the patient  experiences
a hot burning sensation extending from  the mouth to the stomach.
The symptoms come on in the act of swallowing ; the lining mem-
brane of the mouth is whitened and hardened.  There is severe
pain in the stomach, with vomiting of a frothy mucus.  The skin
is cold and clammy, the lips, eyelids, and ears are lived ; the pulse
120  and intermittent;  breathing difficult,  with frothing at the
mouth.   There is insensibility, which comes on speedily, and passes
into coma with stertorous breathing; a strong color of carbolic acid
in the breath  and in the room; the pupils are contracted and in-
sensible to light.  The stools and urine, when  passed, have been
dark colored.   Among  the appearances after  death the following
have been observed : the interior of the  mouth and jaws whitened,
sometimes corroded; the  oesophagus also white, hard,  and corru-
gated.   The coats of the stomach have  presented a horny consist-
ency, without any signs of inflammation.  The lungs have  been
found gorged with blood, and the bronchia filled with a brown-red
thick mucus.
  Fatal dose.—A woman died from swallowing  a wineglassful of
carbolic acid, probably a weak aqueous solution.  She did not speak
after taking it, and died in about half an hour.  (" Pharm. Journ."
July 1872, p. 75.)  In 1867, a child, under two years, was brought
into Guy's Hospital  laboring under the effects of this  poison.  It
had  taken two teaspoonfuls of the ordinary brown  liquid carbolic
acid. This proved fatal in  twelve  hours.   (" Guy's Hospital Re-
ports," 1867, p. 233.)  In another case a tablespoonful proved fatal
to a young man.   It has caused death  rapidly.   In a  case which
occurred to Mr. Jeffreys, an adult died in fifty minutes after taking
from one to two tablespoonfuls of the liquid acid.  (See Husemann's
" Jahresbericht," 1872, p.  523.)
  Analysis.—The strong and peculiar odor perceptible in the breath,
or the vomited matters, and in the room, generally  suffice to indi- 
192
POISONING BY CANTHARIDES.
cate the nature of the poison.  Carbolic acid is partially dissolved
by water, and is very soluble in alcohol or solution of potassa.  It
has an acid reaction, and gives a greasy stain to paper, and burns
with a smoky flame.   There is no test for its presence so delicate as
the odor.  When this cannot be perceived, other tests fail.

                      Animal Irritants.

  Cantharides (Spanish Flies).  Symptoms.—When  cantharides
are taken in powder, in the dose of one or two drachms, they give
rise to the following symptoms:  a burning sensation in the throat,
great difficulty of swallowing, violent pain in  the abdomen, with
nausea and vomiting of a bloody mucus: there is also  great thirst
with dryness of the fauces.  As the case proceeds, a heavy dull pain
is commonly experienced in the loins, and there is an 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 a
violent griping kind.   Purging 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 or copper-colored
particles may be commonly seen on  examination, whereby the
nature of the poison taken, if it has been taken in powder, will be
at once indicated.  After a time there is priapism, and the genital
organs are swollen and inflamed, both in the male and female. When
the case proves fatal, death is usually preceded by faintness, giddi-
ness and convulsions.   The tincture of cantharides produces similar
symptoms; they are, however, more speedily induced, and the burn-
ing sensation in the stomach and constriction of the throat are more
strongly marked; this symptom is often so severe as to render it
impossible for the person to swallow;  and the act of  swallowing
gives rise to excruciating pain in the throat and abdomen.  *
  Appearances.—In one well-marked case, the whole of the alimen-
tary canal, from the mouth downwards, was in a state of inflam-
mation.  The mouth  and tongue seemed to be deprived  of their
mucous membrane.  The  ureters, kidneys and internal organs of
generation were also inflamed.   In  another instance, in which an
ounce of the tincture was swallowed, and death did not occur for
fourteen days, the mucous membrane of the stomach was not in-
flamed ;  but it was pulpy, and easily detached.  The kidneys were,
however, inflamed.  The brain has been found congested, and ulcera-
tion of the bladder is said to have been met with.   There are 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.
  The quantity required to produce serious symptoms, or to destroy
life, has been a frequent subject of medico-legal inquiry.  The medi-
cinal dose of the tincture is from ten minims gradually increased to
^erflu\(lraJC!im; of the Powder from one  to two grains.   (Pereira,
  Mat. Med.  part 2, vol. ii. p. 754.  Doses  above  these, whether of 
noxious animal food.
193
the powder or the  tincture, are likely to  be injurious, and to give
rise to sympsoms of poisoning.  The smallest quantity of the powder
which has been known  to destroy life, was in the case of a young
woman, quoted  by Orfila; the quantity taken  was estimated at
twenty-four grains,  in two doses. She died in four days; but as abor-
tion preceded death, this may have been concerned  in accelerating
that event.  An ounce of the tincture has been  known to destroy
life.   It was taken by a boy, set.  17, and he died in fourteen days.
This,  I believe, is the  smallest  dose of the tincture which has
proved fatal.
   Chemical analysis.—For the detection of the powder, M. Poumet
recommends that the sediment obtained from  the suspected liquids,
should be mixed with alcohol spread on sheets of glass, and allowed
to evaporate spontaneously to dryness.  The shining  scales will then
be seen, on examining the glass by reflected light, either on  one or
both  surfaces.  ("  Ann. d'Hyg." Oct. 1842.)  As the powder is in-
soluble in water, some portion of it  may generally  be obtained by
washing and decantation.  The sediment may also be examined on
a glass-slide with  the microscope.  If no portion of the  powdered
flies can be obtained, the suspected liquids or solids should be brought
to dryness and the dry  residue digested in successive quantities of
ether until exhausted.  This will dissolve the cantharidine.   The
ethereal solutions  are evaporated to an extract, and some of this
extract, spread on  oil-silk, may be applied to  a thin portion  of the
skin of the arm, or to the lips.   The production of a blister with
serum, under these circumstances is considered to indicate the pre-
sence of  cantharidine.   By this  method Burruel discovered  can-
tharides in chocolate (" Ann. d'Hyg.," 1835,1, p. 455).  Chloroform
has been employed in preference to ether.   As the extract contains
frequently  a  green oil  and fat, which prevent  cantharidine from
crystallizing, it  has been recommended to employ sulphide of car-
bon,  in order to  separate these  impurities,  the cantharidine not
being soluble in the sulphide.
   Cantharidine is a neutral crystallizable principle.   It may be ob-
tained in the crystalline form, by the spontaneous  evaporation of
its solutions in ether and chloroform.  As ten grains of the powder
contain only  the 215th part of a grain, it will not be in the power
of an analyst to extract cantharidine unless the powder  is present
in comparatively large quantity.   The T^gth of  a grain of cantha-
ridine dissolved  in ether is said to possess vesicating properties.

                     Noxious Animal Food.

   Certain kinds of animal food are found to produce, occasionally,
symptoms resembling those of irritant poisoning.  In some instances
this poisonous effect appears to be due to idiosyncrasy; for only
one person out of  several partaking  of the food, may  be affected.
These cases are of  importance to the medical jurist,  since they may
give rise to unfounded charges of criminal poisoning.   In the ab-
sence of any  demonstrable poison, we must test the  question of
      13 
194       NOXIOUS  ANIMAL FOOD — SHELL-FISH.
 idiosyncrasy 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 per-
 sons are affected simultaneously with similar symptoms, 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 caused symptoms of irritant poisoning, may be mentioned cer-
 tain shell-fish (mussels), cheese, bacon, sausages, diseased pork, and
 animal flesh in a diseased or putrescent state.
   Poisonous fish.  Mussels.—Of all varieties of shell-fish, none have
 so frequently given rise to accidents as the common mussel.  The
 symptoms which it produces are  uneasiness and sense of weight in
 the stomach, sensation of numbness in the extremities, heat, dry-
 ness, and constriction  in  the  mouth and throat, thirst, shivering,
 difficulty of breathing, cramps in the legs, swelling and inflamma-
 tion of the eyelids, with a profuse secretion of tears, and  heat and
 itching of the skin, followed by an eruption resembling nettle-rash.
 These symptoms are sometimes accompanied by colic, vomiting, and
 purging.  They may occur within ten minutes  or a quarter of an
 hour; but their appearance has been delayed for twenty-four hours.
 There is  generally great  exhaustion and debility. These symp-
 toms have proceeded from the eating of not more than ten or twelve
 mussels.  Two cases, reported by Dr. Christison, proved fatal, the
 one in three, and the other in about seven  hours.  In general, how-
 ever, especially when there is free vomiting, the patients recover.
 In the inspection of the two fatal cases above mentioned, no appear-
 ance was found to account  for death.   A case in which two mus-
 sels produced, in a boy aged ten, alarming symptoms,  followed by
 an eruption resembling scarlatina and nettle-rash, will be found
 elsewhere reported (" Guy's Hosp. Reports," Oct. 1850,  p. 213).  In
 July, 1860,  a number  of persons living at Tralee  were poisoned
 under the following circumstances. A woman picked up  some
 mussels which she found at the bottom of the basin of a ship-canal.
 She distributed them among her neighbors, and during the night,
 twenty-one persons who had eaten them, were attacked with symp-
 toms of poisoning.   Three children died, and six individuals were
 placed in imminent peril.  The  rest  were soon  out  of danger.
 Eight  of  the twenty-one  persons attacked were adults  ("Med.
 Times and Gazette," July 28,1860.)  In October, 1862, an accident
 occurred at  Liverpool in which a woman died in about four hours,
 after having eaten some mussels taken from a ship in the docks.
 lhere were severe pam and vomiting among the symptoms, which
 generally  resemble those  of arsenical  poisoning   Several other
 persons  were made seriously  ill,  but  recoverecf.   Although the
 vessel was not sheathed with copper or yellow metal, it was^oated
sTituent^6611 Plgmeut' °f which arsenic  ™y  ^ve been a con-

  The poisonous action of mussels can be referred neither to putre-
faction nor  disease;  nor in  all cases, to idiosyncrasy, since in one
instance those mussels only which had been taken from a particular 
NOXIOUS ANIMAL  FOOD—CHEESE.
195
 spot were poisonous ;  all persons who partook of them suffered, and
 a dog to which some  of them were given, was killed.  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 irrita-
 tion from  Avhich  they suffered.  ("Ann. d'Hyg.,"  1837, vol. 1, p.
 358.)  Copper is  not, however, present in all cases, and it is there-
 fore probable that there is in some, if not in all instances, an animal
 poison present in the fish.  (See "Ann. d'Hyg.," 1851, vol. 1, p.
 387, vol. 2, p. 108.) 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  partially decayed before it is  used, or to
 the noxious effects of the pickle.   For some remarks by Dr. Ham-
 ilton on  the poisonous properties of fish, see the " Pharmaceutical
 Journal," Jan. 1853, p. 344.
   Cheese.—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, or to the production of an irritant oil.  Again, it has
 been supposed that the poison is occasionally derived  from certain
 vegetables on which the cows feed.  In 1858 a case was referred to
 me for examination, in which twenty-five persons had suffered from
 vomiting and purging more or less violent, owing to their having
 partaken, of cheese.   The only articles of food taken in common
 were  bread, beer, and cheese.  The bread and beer were excluded
 from any suspicion of containing poison.   All the persons recovered.
 On a  close examination of the cheese I found it to be strongly acid;
 it had an offensive musty smell, and yielded a quantity of acrid oil
 to ether.  It had  not been properly pressed, and the casein had
 undergone a chemical change.  The ashes yielded copper and lead
 in traces.   The cheese had acquired irritant properties, not from the
 presence  of any  poisonous  matter  added to it, but from partial
 decay.  There was  abundant evidence that cheese from the same
 dairy had  been  eaten without causing  any injurious symptoms.
 This negative evidence, however, is quite consistent with one cheese
 acquiring noxious  properties.  We must  not lose  sight of the fact
 that cheese may  actually contain poison mixed  with it through
 ignorance.   Orpiment or chromate of lead may be  used as coloring,
 and the discovery of such mineral substances would at once account
 for  the  irritant  effects.   (See  " Pharmaceutical  Journal,"  Aug.
 1862, p. 89.)  The milk and cheese of some of the North American
 provinces is said  to be occasionally rendered poisonous by the fact
 that cows pasture at  certain seasons on vegetables of a noxious
 kind.   In February, 1865, twelve cases of poisoning from this cause
 were  reported to  the  Medico-Chirurgical Society of Edinburgh.
 The symptoms came on in about three hours after the cheese had
 been eaten.  There was severe pain in the stomach, cramp, violent
vomiting of a greenish fluid, soreness of the throat, and a cold, 
196     NOXIOUS ANIMAL  FOO D — DISEASED  PORK.

clammy condition of the skin.  All re covered-recovery ^ingpr^
ceded by profuse perspiration.  (" Ed. Med. Journ.,  1865, 1, 8.4.)
  Sausaae voiwi -The symptoms caused by sausage-poison partake
of IZZico- Srftant character;  they are very slow in appearing-
sometimes two, three, or four days may e apse be ore they manifest
themselves.  This poison is of a  formidable kind ; its effects have
been cl leflv observed in Germany.   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 poisonous
property was supposed  to depend on a partial decomposition of the
fatty parts of the sausages.   It is said, that when  extremely putre-
fied they are not poisonous.  In a case in which I was consulted, a
few slices of a German sausage, evidently of old manufacture, but not
putrescent, caused the death of a child, with violent symptoms of irn-
tation of the stomach and bowels.   I  examined a portion of the sau-
sao-e • it contained no poisonous matter which admitted of detection.
The fatty  portions were rancid, and the lean  portions very dry.
There was no doubt, however, that  it had been the cause of the
symptoms and death of the child.  Dr. Tripe has  published a com-
plete account of the effects produced by sausage poison.   (" Brit, and
For.  Med. Rev.," Jan. 1860, page 197.)   It  appears  that in No-
vember, 1859, sausages made and sold by a  pork butcher, at Kings-
 land,  were eaten more or  less by sixty-six  persons, of  whom
 sixty-four were attacked with violent symptoms in from three and
 a half to thirty-six hours subsequently to the meal.  One case only
 proved fatal, on the seventh day.  No symptoms appeared in this
 man until after the lapse of six hours.  It seems that  he had eaten
 one of  the sausages raw and three cooked.  He was attacked with
 severe  vomiting, and  purging followed  by shivering; there was
 pain in the abdomen, violent  headache  and great  prostration.
 The pulse was  feeble  and quick, and  there was  delirium.  These
 symptoms underwent  a remission, but he had a relapse, became
 comatose, and  died on the seventh day.  Latterly, he chiefly com-
 plained of pain in the bowels.  Dr. Letheby found, on inspection,
 no signs of inflammation, or of the action  of an irritant in the
 stomach.  The small  intestines were much inflamed at the lower
 end, and the gall-bladder was distended.  The other organs were
 healthy.  The  viscera contained  no vegetable or mineral poison.
 The sausages were made with heifer-beef, pork-fat, sage and pepper.
 There  was-no  evidence of anything  noxious  about them, and a
 chemical  analysis  yielded nothing  of a poisonous nature. There
 could, however, be no doubt that the sausages had caused the symp-
 toms and death ;  the food in this case acting as a narcotico-irritant
 poison.
    Pork.   Bacon.—These common articles of  food occasionally give
 rise to symptoms so closely resembling those of  irritant  poisoning
 as to be easily mistaken for them.   In some cases the effect appears
 to be due to idiosycrasy ; but in others it can  be explained only 
        NOXIOUS  ANIMAL FOOD — DISEASED PORK.     197

by supposing  the food to  have a directly poisonous action.  The
noxious effects of pork have been particularly shown by the cases
published  by the late Dr.  Mac-Divitt.  (" Ed. Med.  and  Surg.
Journ.," Oct. 1836.)   As pork is sometimes salted in leaden vessels,
lead may be found in it; but fresh pork has been observed to have
a noxious action. In January, 1864, Mr. Kesteven met with a case
in which all the members of a family were attacked with symp-
toms of irritant poisoning,  after eating a leg of pork.   The prin-
cipal symptoms were nausea, vomiting, griping pains in the abdo-
men and purging;  but dogs and cats fed upon the meat did not
appear to suffer. Other portions of the animal from which the leg
was taken were eaten by other families,  and  no symptoms  of
poisoning  were  produced.  I examined  the  fatty portion  of the
food without discovering any trace of the ordinary poisons.  The
effects could,  therefore, only be referred  to some  change in this
particular joint.
  These cases of poisoning  by animal food have of  late been very
fully examined by Mr. Simon and Mr. Gamgee.  These gentlemen
haved traced the injurious  effects of pork to a diseased condition
of the pig, owing to the animal having been fed on  improper food.
The term measly pork  is  now very  well known  to apply  to a
diseased condition of the flesh of the  animal, in which  it is filled
with a parasite called cysticercus, which is believed to be the larva
of the tapeworm.  This parasite undergoes full development when
in the shape of food it reaches the human intestines.  Mr. Gamgee
expresses his confidence that there are between 40,000 and  50,000
measly pigs in  Ireland, most of which are sent to  Great Britain
for consumption ; and his  impression is that for every measly pig
in the kingdom, there is at  least one human  being affected with
tapeworm.   These  parasites may not directly kill  a person who
cats this noxious food, but they favor the  development of fatal
disease.  He also remarks  that a microscopical thread-worm, the
trichina spiralis, brings the muscular flesh of swine into a state in
which a small quantity of it eaten raw, or in an imperfectly cooked
state,  may suffice to destroy life.  As regards the possible ill  effects
from  consuming, in a  well-cooked state, the flesh  of animals af-
flicted with anthrax  or carbuncular fever, evidence is still imperfect,
but he believes  that  human life may be endangered by it.  An
opinion has been expressed that boils and  perhaps other like affec-
tions are caused  in the human subject by the consumption of dis-
eased  meat.  According to Mr. Gamgee, at a convict  establish-
ment where diseased cattle are eaten inNlarge quantities, and especi-
ally cattle afflicted  with lung disease, as many as forty and fifty
cases of boils and carbuncles occur in a month among  1500 con-
victs.   (Simon's " Annual Report," 1863.) This lends support to
the theory that  diseased animal  food  is  highly favorable to the
production of carbuncular disease.
  It has been shown that the parasites found in the flesh of  this
and other animals  are not easily killed  by boiling, roasting, or
smoking, and  that those are liable to suffer the most who habitu- 
198
THE TRICHINA  SPIRALIS.
ally eat the raw or partly-cooked flesh.  The flesh of the pig con-
taining cysticercus presents, in the cooked  state, the  following ap-
pearances:  When boiled it is paler than wholesome meat; it appears
dryer in patches, and the muscular fibres are more separated than
usual.   When these are opened, the parasites are seen in the inter-
stices, appearing as opaque white spots of the size of a hemp-seed,
and presenting much the same aspect as  when living.  The caudal
bladder attached  to their  bodies disappears  when  the peat is
thoroughly cooked, and the body of the animal then appears isolated
in the middle of the muscular tissue.  It is friable, and breaks down
easily under pressure with a crackling sound, owing to the presence
of calcareous matter.  In this state it does not appear to be neces-
sarily productive of  injury (" Ann. d'Hyg." 1864, vol. 1, p.  249),
although such food must be regarded as  most unwholesome.  All
the members of a family were seized with vomiting, purging and
syncope, after having eaten a dish  of pork.   A medical man exam-
ined the meat, and found it full of cysticercus.   A  pork-butcher
was accused of having sold bad  meat, but  it was proved to  have
been some cheap pork bought  of a hawker of  provisions.   ("Ann.
d'Hyg." 1864, vol. 1, p. 246.)  If the cysticercus did not cause the
symptoms in this case, the meat had undergone  some change suffi-
cient to impart to it irritant properties.  These  parasites  occur in
all the fleshy parts of the body.  I have  seen them in the human
heart, as well as in the flesh of animals.   My colleague, Mr. Hilton,
first showed them to me in the living state, in the muscles of the
thigh of a man, in 1834.  They are not commonly found in the
fatty portions of man and animals, and are  less  common  in  sheep
and oxen than  in pigs.
  Trichiniasis.—The fatal malad}-, arising from the introduction of
the trichina spiralis  into the  human body, has recently attracted
much attention in  France and  Germany;  and  among others, Dr.
Keller, of Darmstadt, has published some important facts illustrating
Fig. 20.
Fig. 21.
W
 Magnified view of Trichina
spiralis in its Capsule.
 a The worm coiled.
 6 The capsules.
 Trichina spiralis in the abdominal muscles
of a man :  natural size of the capsules con-
taining the worm.
the symptoms produced, and the mode in which this parasite causes
death.   Dr. Keller considers that it  is a question well worthy of
the attention of medical jurists, whether many cases of death from
suspected irritant poisoning, in which no  poisonous matter could 
THE TRICHINA  SPIRALIS.               199
be detected in the body, may not have been really due to trichina
disease.
  The trichina (from 0p<.'§, a hair) spiralis, a flesh-worm, is  found
chiefly in the course of the fibres of all the striped muscles of the
trunk and limbs, most frequently on those of the front of the chest,
neck and abdomen.  It has also been found on the muscular fibres
of the heart and oesophagus.   The parasites appear in the form of
very small ovoid bodies, or capsules, perceptible to the eye as white
specks, in the midst of the muscular fibres, but only distinctly seen
by the aid of a magnifying glass.  The trichina, or worm, is coiled
up in  the centre  of each oval capsule, the greater diameter of which
is always parallel to the muscular fibre with which it is closely in-
corporated.  The engraving at the foot  of page 198  is taken from
a preparation in  the Museum of Guy's Hospital; it represents a
portion of the  abdominal muscles of a man, covered with trichinae
in situ, and as  nearly as possible of the  natural  size.  Other  illus-
trations in the same page represent three of the capsules b b b mag-
nified, with the trichina coiled up in the centre of one of them.
  These parasites are  frequently so numerous as to give to the red
flesh a white  speckled appearance.  According to Dr. Keller, as
many as 300,000 have been counted in half a pound  of  raw meat;
and Dr. Pietra Santa affirms that one gramme (about sixteen grains)
of diseased meat may contain 6000 trichinae, each having from sixty
to eighty embryos.  (" Ann. d'Hyg." 1864, vol. 1, p. 317.)
  The actual size of the capsule has been  variously stated.  From
an examination of two sets of specimens in the muscles of the throat
and abdomen,  I estimated the long diameter to be the ^gth of  an
inch, and the short diameter T^th.  The worm itself is said  to be
the /0th of an inch in length.   The capsules are remarkably uni-
form  in  size.  They are  built up  at the  expense of the muscular
structure by which they are surrounded.
  The history of this  animal has been given by numerous patholo-
gists.   (" Hodgkin's Lectures on Morbid Anatomy," 1836, vol. 1,
p. 211.)  A full description of its anatomy and habits by Dr.  Bris-
towe and Mr. Rainey  will be  found in  the " Transactions of the
Pathological Society " for 1853-54, p. 274.  More  recent accounts
of its influence on health by Dr. Pietra Santa, have been published
in the  "Ann. d'Hyg." 1864, vol. 1, p. 305 ("La Trichina spiralis"),
and by Drs. Schultze and Lucke in Casper's " Vierteljahrschrift fur
gerichtliche Medicin," 1864, No. 1, p. 103,and No. 2, p. 269. Dr.
Lucke's paper  is  of especial interest, as its title, "Die Trichinen vor
dcm Forum" implies,  since it points to  the  medico-legal bearings
of the subject, and the possible danger of confounding the ravages
of this parasite with the obscure effects produced in certain forms
of chronic irritant poisoning.
  From these researches  it  is  now clearly established that the
trichina is a viviparous parasite, which passes  the  greater part  of
its existence in the chrysalis state in the muscular system, until, by
the consumption of this muscle as food, it finds in the stomach and
intestines of another warm-blooded animal a favorable medium for 
200
THE TRICHINA  SPIRALIS.
its full development into  an intestinal worm.  According to Vir-
chow and Zenker, the trichina not only frequently  presents itself
in the human organism, but this organism is most favorable to its
development.  The period of  incubation of the chrysalis_ in the
stomach and bowels of man, or of warm-blooded animals, is from
six to eight days ; and during this time it there thrives and propa-
gates to  an almost incredible extent.  Dr. Keller  states that in
three or four days the females produce 100 or more_ young ones,
which begin on the sixth day to leave the  parent animal; and he
estimates that in a few days after the ingestion of half a pound of
meat, the stomach and intestinal canal of. a person may contain
thirty millions of these minute worms. M. Herbst found the mus-
cles  of two dogs which  had been fed upon parts of a badger con-
taining worms, to be  loaded  with these  parasites.  When  once
introduced into the stomach and intestines, the worms leave their
capsules,  become free, and produce young, which migrate through
the walls of the intestines into the muscles; there they become en-
cysted, and are ultimately found appropriating and  destroying the
muscular substance to a greater or less extent.   The sudden libera-
tion of a  large number of these worms causes irritation and inflam-
mation in the  bowels, attended by peculiar symptoms resembling
in some respects those of  poisoning.
   It is worthy of note that trichinse are more frequently found in
pork and articles of food  derived from it, than in any other kind
of meat.   Measly  pork appears to be sometimes of a trichinous
character.  Further,  the  vitality of the parasites is not  destroyed
unless the meat, or other  substances in which  they are located, has
been subjected to a temperature equal to that  of boiling water for
a sufficient time to insure that every particle  has been exposed to
this  degree of heat.  Salting  and smoking, or partial  cooking, is
not sufficient to destroy the worms in all parts of  the  food,  and
they have even  been found  living in putrefied meat.  This may
serve to   account  in  some cases  for the serious symptoms which
have followed the use of  pork as food, also of bacon, sausages  and
German sausages, which are generally made of raw  ham.
   The symptoms produced by the use of such food are, in the first
stage, those of intestinal  irritation, loss of appetite, sickness, pain,
general weakness of  the limbs, with diarrhoea, swelling of the eye-
lids  and of the joints, profuse clammy prespiration, and a wasting
fever, sometimes of  a typhoid character.   Death  is either  the
result of  paralysis (from  destruction of the muscular fibres), or of
peritonitis and  irritative fever.  During  the perforation of  the
coats of the intestines by these worms, the  mucous  membrane be-
comes irritated  and inflamed ; pus is formed  on  its surface, and
bloody evacuations are sometimes passed.  No case  is known in
which trichimasis, after  having  once declared itself, was arrested
by medical treatment.
   The noxious effects of this food on  human  beings are well illus-
trated by a series of  cases which  occurred  at Hettstadt, in the
Hartz mountains, in 1863.  (" British Med. Journal," Jan. 16, 
EPIDEMIC TRICHINIASIS.
201
1864, p. 75.)  One hundred and three persons partook of smoked
sausages made from a pig affected, as it turned out, with trichinous
disease.  The sausages  were fried, and  served  for dinner  in the
usual way.  On  the  following  day, several persons who had par-
taken of this food were attacked with severe pain in the bowels,
purging, loss of appetite, great  prostration of strength, and fever.
The  number of  persons attacked rapidly increased, symptoms of
peritonitis and pneumonia  manifested themselves, and these were
followed by paralysis of the intercostal muscles, and of the muscles
in front of the neck.  Eighty-three persons died from  the effects of
this  noxious food, and the remainder  were  seriously injured  in
health.  The remnants of sausage and  of pork  not  eaten at this
festival were examined, and were  found to be literally swarming
with encysted trichinae.  (See Casper's " Vierteljahrschrift,"  April,
1864, p. 286.)  The writer  in the above  journal  affirms that this
parasitic disease  does not  attack sheep, oxen, or horses, and that
beef is the safest of all  descriptions  of food, as  no parasites have
ever been discovered in it.   They have not been found in the blood
of animals whose muscles are liable to their attacks.
  [The " Chicago Medical  Journal" for August, 1866, contains an
article contributed by Dr. E. M. Smith of Linn  County, Iowa, in
which is  reported a case of poisoning of a family of  nine persons
by eating trichinous  pork. The}- were  all taken sick about the
same time in the early part of  May, 1866, after having eaten por-
tions of raw smoked ham some five or ten days before.  Dr.  Smith
was  not called in until they had been sick for a week or more; at
which time  " the prominent symptoms  observable were: more or
less diarrhoea ; tenderness of the abdomen; tongue thickly coated,
contracted and red about the edges;  oedema of the face in several
of the cases ; considerable  pneumonic irritation in some ; fever of
a typhoid character; pulse ranging  from 100 to 120 per minute;
great thirst and profuse  sweating; complaint  of soreness and
stiffness of the muscles, a difficulty of extending  the  limbs,  wake-
fulness at night, and excessive exhaustion.   Each case exhibited
more or less of  the  symptoms enumerated, the  difference  being
merely in intensity."  Five of the  patients  died (the first death
occurring on the  30th May, and the  last one the  17th June), upon
two  of whom post-mortem examinations were made. " Upon placing
minute particles of these muscles" (the  rectus femoris and biceps)
" under the glass, the parasites were seen in great numbers—the
veritable trichinoz spiralis.   Many of these  were very active, and
were readily seen to coil  and uncoil, and' to exhibit an activity
commensurate with the terrible work they  had  done.  I counted
twenty-six trichinae in one  field of the  glass; and upon placing a
piece of the rectus femoris J2 of an inch in  diameter, under the
object glass, 104 trichinae were  counted,  which would give  nearly
200,000 parasites  to the cubic inch."   " No lesions of  a pathologi-
cal character were found, the appearance of the viscera being  nearly
or quite normal.   Portions of  the muscles from  different parts of
the body were removed  for microscopic investigation; also  of the 
202
EPIDEMIC  TRICHINIASIS.
liver, spleen and lungs.   The voluntary muscles were swarming
with'trichinae; some were found in the lungs and spleen, but none
in the heart and liver."  The  patients who recovered had eaten
but a very small  quantity of the raw meat.  The observations of
Dr. Smith showed that it was probable that the " activity of  the
parasite begins to subside in from forty to fifty days from the first
indications of the malady."—P.]                      m
  Although little has been heard of trichinous disease in England,
it appears to have been prevalent in Germany.  In February, 1864,
a whole family was poisoned at  New York, and one member died
from eating part of a ham, which,  on microscopic examination,
was found lo  be full of the  trichina spiralis.   Death was referred
by the medical attendant to this cause.
  As means of distinction from irritant poisoning may be pointed
out the long time which commonly elapses between  the taking of
the  food  and the commencement  of the symptoms.   The pain,
vomiting,and purging are comparatively slight; the pain is in  the
bowels rather than in the stomach,  and peritonitis, pneumonia, and
fever are  not  commonly results .of the action  of irritant poisons,
while they appear to  be constant  symptoms in trichiniasis.  The
absence of ordinary poison in the food, in the urine, and the evacu-
ations, at any stage, may also be taken as conclusive evidence against
irritant poisoning in its usual form.
  In suspected cases, a new method of research must be  added to
those already  in use.  If any  of the food can be obtained,  this
must be examined for the parasite by the aid of the  microscope.
If the case proves fatal, the voluntary muscles of the deceased must
undergo a similar examination.
  In the "Canada Medical Journal" for 1870-1, Dr. J. B. Edwards

           Fig. 22.                           Fig. 23.
Single trichina spiralis from human muscle     Trichina spiralis encysted in pork.  This engrav
     magnified 150 diameters.          ing represents the completely encysted worm la
                              horizontal section showing six apparent stumps,
                              which proves that the worm lies in three convolu-
                              tions when it has attained its full size.
has published  a full  account of the best methods  of detecting
trichinae in the flesh of man and animals.  He  has furnished me 
           PUTRESCENT  FOOD — POISONED GAME.        203

with some excellent photographs of the worms in situ in  human
and animal muscle, of which engravings are annexed.
  In some cases which occurred at Montreal the cause of the symptoms
was at first obscure, but Dr. Edwards not only found trichinae in a
slice of a ham which had been eaten, but in the muscles of two of
the patients who recovered. He removed about five grains of mus-
cular tissue from the gastrocnemius muscle, and twelve grains of
the tibialis posticus.  In both of these portions of muscle about
forty worms were found.  (Op. cit. p. 517 ; see also Dr. Thudichum's
" Report to Privy Council for 1864-5.")
  Putrescent food.—The effects of disease on animal food must not
be confounded with those  which result  from decay or putrefaction.
The flesh  of the  most healthy animal  is rendered unfit for food
when it has passed into a putrescent state.  It is not  merely un-
wholesome, but highly irritant, causing rapidly vomiting, purging,
pain,  and  other symptoms of a severe kind.   Fortunately  these
symptoms lead at once to  the expulsion of the noxious food  from
the body, and the person  then recovers ;  the young, the old, and
the infirm may, however, be so prostrated by vomiting and purging,
that they may sink from exhaustion. Animal matter in a state of
partial decay, or in the transition stage of putrefaction, must be
regarded as of a poisonous nature.  Much of the cheap butcher's
meat sold  to the poor is in a  state of decay, and is quite unfit for
human  food.  In 1863, 114,000 pounds of  diseased,  and  76,000
pounds of putrid  meat were seized and condemned in the city of
London alone.  In  January, 1851, the  family of a surgeon near
London were all affected with symptoms resembling irritant poi-
soning, 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 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 hydrogen 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 color, 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 maybe 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. 
204                   POISONED GAME.
In some instances, grouse and'other game are maliciously destroyed
by the laying of corn, saturated with arsenic or other poisons, in the
localities" where the birds abound.  There is  no law to prevent the
sale of  poisoned game by  poulterers, and there  is no  precaution
which can be taken by the purchasers, except by observing whether
the birds have or have not been shot.   (See on this  subject, " On
Poisons ;" also a letter by Dr. Fuller, " Med. Gaz." vol. 42, p. 1036.)
  Mr. Taylor,  of Romsey,has directed attention (Sept. 1862) to the
serious symptoms produced by Canadian partridges eaten as food. A
lady who had  partaken of this food was, in about two hours and a
half, attacked  with the following symptoms.  She had sickness, and
became  insensible; the skin was cold, and no pulse could be  felt.
She was in a hopeless state for some  hours, and only slowly recov-
ered.  The birds were quite fresh, having been  packed in  ice.  In
another case, there were similiar symptoms  with  constriction of
the throat and great pain.   Animals were made  ill by this food.
It was believed that, in these cases, the birds had not been killed
by poison, but  that their  flesh had been rendered poisonous by some
vegetable which they had eaten.
  [Frequent cases of poisoning from eating the flesh of the pheasant
(Tetrao umbellus) have occurred  in the United  States.   This bird,
during the  winter season, has sometimes caused dangerous symp-
toms  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 here 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, in the former edition of this work, is not 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.—II.] 
SYMPTOMS OF  POISONING WITH  OPIUM.       205
NEUROTIC POISONS.
  (NARCOTIC, OR CEREBRAL POISONS.)
                     CHAPTER XVI.

opium. — symptoms.—appearances.— its action on  infants.—poi-
   soning with opiate compounds.—morphia and its salts.—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 are—giddiness, drowsiness,  a  strong
tendency to sleep, stupor, succeeded by perfect insensibility, the
person lying motionless, with the eyes closed as if  in a sound sleep.
In this state 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 difficult, 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
person becomes comatose, the breathing is slow and stertorous; the
pulse slow and full.   The skin is occasionally cold  and pallid.  The
pupils, in the  early stage, are  contracted;  in the later stage, and
when progressing to a fatal termination,  they may be found di-
lated.  In a case referred to me in 1846, one pupil was  contracted
and the other dilated.  In infants and  children they are generally
much  contracted.   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 purging; and, if vomiting  takes place freely before stupor sets
in, there is great hope of recovery.  This symptom is chiefly ob-
served 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 peculiar odor of  opium is occasionally perceptible in
the breath.   Nausea and vomiting, with headache, loss of appetite
and lassitude, often  follow on recovery.  In cases likely to prove
fatal, the muscles of the limbs feel flabby  and relaxed, the lower
jaw drops, the pulse is  feeble and imperceptible, the  sphincters are
in a state of relaxation, the pupils are unaffected by light, the tern- 
206
POISONING  WITH OPIUM.
perature of the body is low, there is a loud mucous rattle m breath-
ing and convulsions are sometimes observed before death, but more
commonly in children than in adults.   One of the marked effects of
this poison is to suspend all the secretions except that of the skin.
Even during the lethargic  state, the skin,  although cold, is often
copiously bathed in  perspiration.  It is a question yet to be deter-
mined, whether this may not be a medium by which the poison is
principally eliminated.  The contracted state of the pupils has been
hitherto considered to furnish a valuable distinctive sign of poison-
ing with opium or the salts of morphia.  In relying upon  it, it is
necessary to bear in mind the fact pointed out by Dr. Wilks, that,
in apoplexy, which is seated in the pons Varolii, the pupils are also
contracted.  He describes two cases of  this  form of apoplexy which
were mistaken for poisoning by  opium in consequence of this con-
dition of the pupils.   (" Med. Times and Gazette," 1863, 1, p. 214.)
The symptoms above described  usually commence in from half an
hour to an  hour after the poison  has  been swallowed.    Sometimes
they come on in a few minutes, especially in children; and at other
times their appearance is protracted for a long period.
   It has been  frequently observed, on these occasions, that a person
has recovered from the first symptoms, and has then had a relapse,
and died.   There is some medico-legal interest connected with
this state, which has been called secondary asphyxia from opium,
although  there appears to be no good  reason for giving to it this
name.
   Appearances.—In a case which proved fatal in fifteen hours, the
vessels  of the head  were found unusually  congested  throughout.
On the surface of the fore 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 men-
tioned as  a common appearance  in cases of poisoning by opium.
There  is also engorgement of the lungs ; most frequently observed,
according to Dr. Christison, in  those  cases which have been pre-
ceded  by convulsions.  (Op. cit., p. 732.)  Among  the external
appearances there is often great lividity of the skin.  Extravasation
of blood on the brain is rarely seen ; serous effusions in the ventri-
cles, or between  the membranes, are  sometimes  met with.  The
stomach is so  seldom found otherwise than in a healthy state, that
the inflammatory redness said to have  been occasionally seen, may
have been  due to accidental causes.  From this account of the
appearances in the dead body, it will be seen that there is nothing
but a fulness of the vessels of the brain, which can be looked upon
as specially indicative of poisoning by opium, and even this is not
always present.   A congested  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  medicinal dose of opium, in extract or powder, for a healthy 
POISONING  WITH MORPHIA.
207
adult, varies from half a  grain to two grains.   Five grains would
be a very full dose.   The medicinal dose of the tincture (laudanum)
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 set. 32,  died very speedily in a con-
vulsive fit, after having taken two pills, each containing about one
grain and a quarter of extract of opium.  This  quantity is equiva-
lent to four grains of crude opium.  (" Med.  Gaz.," vol. 37, p. 236.)
The smallest fatal dose of the tincture in an adult, which I have found
recorded,  is two drachms.  ("Ed. Med. and Surg. Journ.," July,
1840.)  In connection with this subject, it is important for a medi-
cal 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 pecu-
liarly susceptible of the effects of this poison.  The syrup of poppies,
paregoric elixir, Godfrey's cordial, and Dolby's carminative owe their
narcotic effects to the presence of opium.  The  symptoms and ap-
pearances  which  they produce when  taken in a large  dose are
similar to those caused by opium, or its tincture.
   Mrs. Winslow's "Soothing  Syrup," called  also  "Quietness,"
appears to be a compound resembling syrup of poppies.  Its effects
are those of a narcotic.   Two doses of this  caused the death of a
child  aged fifteen months,  with the usual symptoms of narcotic
poisoning (" Pharm.  Journ." 1872, 618.)  An analysis of this syrup
showed that one ounce of it contained nearly one grain of morphia
with other opium  alkaloids. (" Pharm. Journ." June, 1872, 975.)
It is not surprising that  it should prove fatal  to infants, in small
doses.
   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 there may be  a  partial recovery, or a remission of the
symptoms, and afterwards  a fatal relapse.  The symptoms, how-
ever,  generally progress  steadily to  a fatal  termination, or the
stupor suddenly disappears, vomiting  ensues, and the person  re-
covers.  Several instances are recorded  of this poison having de-
stroyed 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 men-
tioned by him which lasted  only three hours.  Mr. Barwis, of Mel-
ton, communicated to me the  case of an adult (November, 1863)
which proved fatal in three  hours and a half.
  On  the  other hand,  the cases are  sometimes  much  protracted.
There arc several instances of death in fifteen or seventeen hours.
I have known one case fatal in twenty-two hours, and among those
collected by Sir R. Christison, the longest lasted twenty-four hours.
(Op. cit, 712.)
  Morphia  and its  salts.—Morphia is  the  poisonous alkaloid of
opium, of which it forms from five to ten per cent.  The two prin- 
208
POISONING  WITH MORPHIA.
cipal salts  of this alkaloid  are  the  hydrochlorate  and the  acetate.
[The sulphate is most commonly used in the United States.—R.]
Opium owes its narcotic properties chiefly to the presence of mor-
phia in combination with meconic acid.  A dose of one grain of a
salt of morphia has destroyed life.
  According to Orfila, in nineteen-twentieths of allcases, the pupils
will be found strongly  contracted, a statement which I  believe to
be correct; the few exceptional cases were  those in which the close
was  excessive,  and the symptoms were unusually  violent.  The
state of the pupils gave rise to a great difference of opinion among
the medical witnesses on the trial of Dr. Castaing.  (" On Poisons, '
2d  ed. p. 619.)   The condition of  the pulse varies greatly.  It has
been found small and feeble, sometimes full and slow.  In some
cases there is great irritability as well as itching of the skin, and
irritability of the bladder with difficulty of passing urine. _ Vomit-
ing and purging have been  met with in those instances in which
the dose was large.
  Poisoning by morphia may take place as the result of external
application.  I am indebted to a friend for a remarkable  illustra-
tion of its fatal  effects by  absorption.   In September, 1867, a
woman suffering  from cancer of the breast in a state of ulceration
applied to a druggist at Bungay for some medicine to relieve pain.
He applied at once thirty grains of morphia, covering the surface of
the ulcer.  The woman soon afterwards became insensible.  When
seen by a medical man she was quite unconscious—the pupils were
contracted, the skin very cold, the pulse full and compressible.  The
woman was in a hopeless state.  She died in ten hours after the
application of the morphia to the breast.   The druggist, when ex-
amined at the inquest, said that in his judgment the application was
right and proper, and in spite of medical evidence that the symp-
toms and  death  were referable to morphia by absorption, the jury
returned a verdict of death from natural causes.
   Chemical analysis.  Opium.—There are  no means of detecting
opium itself, either in its solid or liquid  state, except by its smell
and other physical  properties, or by giving a portion  of the sus-
pected substance  to an animal, and observing whether any narcotic
effects are produced.  The smell is said to be peculiar, but a similar
smell is possessed by lactucarium, which contains neither meconic
acid nor morphia.  The odor is a good concomitant test of the pre-
sence of the drug, whether it be in a free state, or dissolved in
alcohol or water,  but is not perceptible when the  solution is much
diluted.  The analysis in cases of poisoning by opium,  is therefore
limited to the detection of morphia and the acid with which  it is
combined—meconic acid.
 _ Morphia.—Morphia may be identified by the  following  proper-
ties: 1. It crystallizes in small prisms, which are white and perfect,
according to their degree of purity.  These crystals may be ob-
tained by adding weak ammonia to a solution of morphia in hydro-
chloric acid.  (Fig. 24.)  2. When heated on platinum, the crystals
melt, become dark-colored,ancl burn like a resin with a yellow smoky 
CHEMICAL ANALYSIS.
209
flame,  leaving a  carbonaceous  residue.
If this experiment is performed in  a
small reduction-tube, it will be found, by
employing test-paper, that ammonia is
one of the products of decomposition.  3.
It is scarcely soluble in cold water, as it
requires 1000 parts  to dissolve it; it is
soluble in  100 parts boiling water, and
the hot solution has a faint  alkaline re-
action.  By  its insolubility in water, it
is readily  known from its salts.  It is
not very soluble in ether, thus differing   crystals of^r^hiT obtained by
from narCOtilia;  but  it is  dissolved by  adding ammonia lo a solution of the
forty parts of cold, and rather less than  hydrochlora^ magnified 121 diam-
this quantity of boiling alcohol; also by
chloroform.   It is dissolved by a solution of potash or soda, from
which  it cannot be removed by ether.   It is very soluble in acetic
ether, and  this liquid  has been employed as a substitute  for ether
in procuring morphia from organic  liquids.  4. It is easily dis-
solved by a very small quantity of all diluted acids, mineral  and
vegetable.   5. Morphia and its solutions have a bitter  taste.   6.
The salts of morphia are not precipitated in a crystalline form by
solutions of sulphocyanide of potassium, ferricyanide of potassium,
nor chromate of potash.  In this respect they are strikingly distin-
guished from the salts of strychnia,  which give well-marked crys-
talline precipitates with these  three reagents.
   Tests.—In order to apply the chemical tests for morphia, the alka-
loid may be  dissolved in a few drops of a diluted  acid, either the
acetic or the hydrochloric.   If the hydrochlorate or the acetate of
morphia is presented for analysis, the salt may be at once dissolved
in a small quantity of boiling water.  The tests for this alkaloid
are the following:   1.  Nitric acid.  This, when added  to a moder-
ately strong  solution of a salt  of morphia, produces slowly a deep
orange-red color.  If added to the crystals of morphia  or its salts,
deutoxide of nitrogen is evolved ; the morphia is entirely dissolved,
and the solution  acquires instantly the deep  red  color  above  de-
scribed ;  becoming,  however, lighter  by standing.   In order that
this effect should follow, the solution of morphia must not be too
•much  diluted, and  the acid must be strong and added  in pretty-
large quantity.   The  color  is rendered much lighter  by boiling ;
therefore the test should never be added to a hot solution.  2. Per-
chloride of  iron (sesquichloride), or colorless  persulphate:  either  of
these solutions, when saturated (and neutralized by a small quantity
of potash, if necessary), produces an inky-blue color in a solution of
morphia.   If the quantity of morphia is small, or the test has a
deep red or yellow  tint, the color is  greenish.  The blue  color is
entirely removed by acids, and 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 may be  observed that the blue
given by the  test in a solution of morphia is entirely destroyed by
       14 
210      TESTS FOR MORPHIA AND MECONIC  ACID.

nitric acid, and replaced by an orange-red color, 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
with sulphide of carbon.   A solution of iodic acid should be mixed
with its volume of sulphide of carbon.   There should be no. change
of color.  On adding a small  quantity  of these mixed liquids to
morphia or  its salts, either solid or  in solution, the iodine is  sepa-
rated from iodic acid and dissolved by the sulphide, which sinks to
the bottom, acquiring a pink or red color, varying in its intensity
according to the quantity of morphia  present.  This reaction dis-
tinguishes morphia from all the other alkaloids which do not de-
compose iodic  acid.   The presence of  morphia may be thus easily
detected in  one drop of the tincture of opium, in chlorodyne, or
other liquids, in spite of the presence  of organic matter.  4. Sul-
phuric acid and bichromate of j>otash.  When strong sulphuric acid
is poured  on pure morphia in a solid state, there is either no effect,
or the alkaloid acquires a light pinkish  color.  On adding to this
a drop of  solution of bichromate of potash, or a small fragment of
a crystal,  it immediately becomes green (from oxide of chromium),
and retains this color for some time.  5.  Sulphomolybdic acid.   This
is made by dissolving with a gentle heat five or six grains of  pow-
dered  molybdate of  ammonia in two drachms of strong sulphuric
acid.  The liquid should be freshly prepared and kept from contact
with air and organic matter.  When one or two drops are rubbed
with dry morphia  or any of its salts, an  intense reddish purple or
crimson color is produced.  This changes to a dingy green, and ulti-
mately to a splendid sapphire blue.   A minute trace of morphia is
thus revealed.
  This test produces no change in strychnia, but the mixture slowly
acquires^ pale blue tint.  The presence of morphia in strychnia is
thus easily detected.  When poured on brucia, this  acquires a  rose-
red  color, becoming greenish-brown,  and ultimately dark   blue.
When mixed with veratria, the  liquid becomes greenish-brown, and
gradually passes to a darker shade. The margin becomes purple,
and ultimately the whole mixture acquires a deep blue  color.   On
chloral hydrate, sulphomolybdic acid produces no change.  [Its action
on salicine closely resembles that produced on morphia.—R.]
  Meconic acid.—This is a solid crystalline acid, seen commonly in
scaly crystals of a pale reddish color.  It is combined with morphia'
in opium, of which, according to Mulder, it forms on an  average
six per cent,.; and it serves to render this alkaloid soluble in water
and  other inenstrua.  Tests.—Many tests have  been  proposed for
meconic amd, but  there  is only one upon which any reliance can
be placed, namely, the perchloride or persulphate of iron.  This test
produces,  even  in a  diluted solution of meconic acid, a deep red
color;  and it is owing to the presence of this acid that a salt of
iron strikes a red color  in tincture  and infusion of opium, as well
as in all  liquids containing traces  of  meconate of morphia —the
effects of  the iron-test  with morphia  being counteracted by the 
      DETECTION  OF OPIUM IN  ORGANIC  MIXTURES.   211

presence of meconic acid.  The red color of the meconate of iron is
not easily destroyed by diluted mineral acids, by a solution of cor-
rosive sublimate, or 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 by the production  of the
tannate of  iron.  The dark color is removed by a little dilute sul-
phuric acid.
  Detection of opium in organic mixtures.—Opium itself may be re-
garded 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 quan-
tity and death is speedy, we can succeed in  detecting meconate of
morphia in the stomach. The poison is probabby removed by vomit-
ing, or  absorption.  If the matter  is solid,  it should be  cut into
small slices;  if liquid, evaporated to an extract; and, in either case,
digested with a large quantity of rectified spirit, slightly acidulated
with acetic acid.  The residue should  be well pressed in linen ; the
alcoholic liquid should then be evaporated in a water-bath until it
is almost dry.  The residue should be  digested in water, filtered
and treated with acetate of lead, until there is no further precipita-
tion.  This 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, dissolved in the
filtered liquid (containing the morphia) should now be precipitated
by a current of  sulphuretted hydrogen, the black sulphide of lead
separated by filtration, and the filtered 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, if present in sufficient quantity, may be dissolved out
and tested.    If the alcoholic liquid is still  much colored, it may be
again evaporated  and taken up by water.  Animal  charcoal de-
prives it of color, but at the same time removes the morphia,  if this
is in small  quantity.  If there  is a sufficient quantity of pure ace-
tate present, the addition of a drop of solution of ammonia to a
portion of the liquid, on a slide, will produce crystals of the form
of slender prisms, which are somewhat  deliquescent  (see Fig. 18).
The remainder may be tested by the nitric and iodic acids.  The
meconate of lead left on the filter is readily decomposed by boiling 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. ' 
212
PRUSSIC  ACID — SYMPTOMS.
                    CHAPTER  XVII.

 prussic acid.—symptoms  and appearances.—tests  for the acid.
   —process  for organic mixtures.—cyanide  of potassium.—
   essential oil of bitter almonds.—nitrobenzole.—bichloride of
   methylene.—fusel oil.

                Hydrocyanic, or Prussic Acid.

   Symptoms.—This acid has a hot bitter taste, and an odor resem-
 bling  that  of  bitter almonds diluted.   The  time  at  which the
 symptoms of poisoning commence varies, but it is generally within
 a few minutes after the poison has been swallowed.   When a large
 dose has been taken, as from  half an ounce to an ounce of diluted
 acid, the symptoms usually 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 glisten-
 ing, the pupils  dilated and unaffected  by light, the  limbs flaccid,
 the skin cold and covered with a clammy perspiration; there is
 convulsive  breathing at  long intervals, and the patient appears
 dead in the intermediate period; the  pulse  is imperceptible, and
 involuntary evacuations are occasionally passed.   The respiration
 is slow, deep, gasping, and occasionally heaving, or sobbing.  It is
 generally convulsive, but  when  the  coma or insensibility is pro-
 found, it may be  stertorous.  This was observed in  a  case which
 occurred to Dr. Christison. (" Edinburgh Monthly Journal," Feb-
 ruary,  1850, p. 97.)  Stertorous breathing has not been  hitherto
 recorded by toxicologists  as one of the symptoms of poisoning by
 prussic acid.  Convulsions  of the  limbs and body, with a spasmodic
 closure of the jaw, are sometimes noticed among the symptoms.
  Appearajices.—The body when seen soon after death often exhales
 the odor of prussic acid ; but if it has remained exposed before it is
 seen, and it it  has been exposed to the open  air, or in a shower of
 rain, the odor may not be  perceptible ; again,  the odor may be con-
 cealed  by tobacco-smoke,  peppermint,  copaiba,  or  other powerful
 odors.   In  a case in which a person poisoned  himself with two
ounces of the acid, and his body  was  examined twenty-eio-ht hours
after death  the vapor of  prussic acid,  which escaped on  opening
 the stomach was so powerful that the  inspectors were seized with
dizziness.  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 symptoms 
PRUSSIC  ACID—FATAL DOSE.             213
 should be delayed.   (See case by Sir R. Christison.)   Owing to the
 great volatility of the poison, the vessel, if left uncorked, may not
 retain the odor when found.   Putrefaction is said to be accelerated
 in these cases ;  but from what I have been able to collect, there
 seems to be no ground for this opinion.
   Externally, the skin  is commonly livid, or is tinged of  a violet
 color; the nails are blue, the fingers  clenched, and the toes  con-
 tracted ; the jaws  firmly  closed, with foam  or  froth about  the
 mouth,  the face often pale, but sometimes bloated and swollen, and
 the eyes have been  observed to be wide  open, fixed, glassy, very
 prominent and glistening, with the pupils dilated; but a similar
 condition of the eyes has been observed in other kinds of violent
 death.  Infernally, the venous system  is gorged with dark-colored
 liquid blood; the stomach and  intestines  may be in their natural
 state ; but in several instances  they have  been found more or less
 congested.   The mucous membrane of the  stomach 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 appearance
 met with in arsenical poisoning.   This is also the condition of the
 human  stomach, so far as observed.
   The smallest dose of  this acid which is  reported to have caused
 death, was in a case which occurred to  Mr. Hicks. ("Med. Gaz.,"
 vol. 35, p. 896.)   A healthy adult woman,  died in twenty minutes
 from a dose equivalent to nine-tenths of a grain of anhydrous prussic
 acid.  This corresponds to about twenty grains of Scheele's acid.  In
 a case reported by Mr. T. Taylor (" Med. Gaz.,"  vol.  36, p. 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.   From the  facts  hitherto observed, 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
 destroy  the life of an adult.   This I believe  to be the  nearest ap-
 proach that  we can make to the  smallest fatal dose.
  When a dose of two drachms and upwards has been taken, we
 may probably take the average period  for  death at from two to ten
 minutes.  In Mr. Hicks's case, twenty grains of Scheele's acid de-
 stroyed life in twenty minutes.  It is only when a dose  is just in a
 fatal proportion, that we find  a person 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.
  Chemical analysis.—Prussic acid is limpid like water ;  it possesses
 a faint acid reaction, and its vapor has a peculiar odor, which when
 the acid is concentrated, although  not  at first  preceptible, is suffi-
 cient to  produce giddiness, insensibility, and other alarming symp-
 toms. The tests which are best  adapted for the detection of this
poison, either in liquid or vapor, are equally applicable whether the
acid is concentrated or diluted, and, so far as the detection of the
 vapor is  concerned, whether  the acid  is pure or mixed.   In  the 
214
CHEMICAL ANALYSIS.
nmple state, the tests are three in number:  the Silver, the Iron and
the Sulphur tests.  1. The Silver test.  (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 hydrochloric acid.   c.  The precipitate, when well
dried, and heated in a small reduction-tube, yields cyanogen, which
may be burnt as  it issues, producing a  rose-red flame with a blue
halo.   This is a well-marked character, and at once identifies  the
acid which yielded the precipitate as prussic acid.  For the detec
tion of  prussic acid in vapor, hold over the liquid a watch-glass
moistened  in the centre with  a drop of  a  solution of nitrate of
silver.  Cyanide of silver, indicated by the formation of an opaque
white film in the  solution, is immediately produced, if only in a
moderate state of concentration.  One  drop of a diluted acid con-
taining less than ^th of a grain of the anhydrous acid produces
speedily a visible effect.   When, the  prussic acid is  more diluted,
a few minutes are  required ; and the opaque  film begins to show
                        itself at the edges  of the silver solution.
        Fig. 25.          In this case, the action may be accelerated
                        by the heat of the hand.  If the vapor is
                        allowed  to  reach  the nitrate  of silver
                        gradually,  and much diluted with air,
                        then instead of an opaque film of cyanide
                        of silver, crystals well  defined under  the
                        microscope will be slowly produced, and
                        these will constitute  an additional proof
                        of the presence of  the acid  in a  state of
                        vapor.   As  shown  in Fig. 25, these crys-
                        tals have the form of slender prisms with
                        oblique terminations.  They often hang
                        together in groups, and generally require
                        a high magnifying  power to render them
                        visible.   2.  The Iron-test.—-The object of
the application  of this  test, is  the  production of Prussian blue.
Add  to a small quantity of the  suspected poisonous liquid a few
drops of potash  and of a solution of green  sulphate of iron [that
has been exposed to the air  for some time, to partially peroxidize
it.—R.].  A dirty-green or brownish precipitate falls; on shaking
this for a few minutes, and then adding dilute hydrochloric or sul-
phuric acid,  the  liquid becomes  blue;  and  Prussian  blue, of its
well-known color, unaffected by  diluted  acids, subsides.   If  the
prussic acid is in  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 deep-blue color in the mass.
Ihe iron-test may be employed  for  the detection of the vapor of
prussic acid,  by the same method  as  that described in speakino- of
^5>
 Crystals of Cyanide of Silver from
the vapor of prussic acid, magnified
124 diameters. 
CHEMICAL ANALYSIS.
215
the silver-test.  For this purpose we place a few drops of a solution
of potash in a watch-glass or saucer, and invert it over the suspected
liquid.  After a few minutes' exposure, a drop of solution of green
sulphate of iron may be added, and then a drop of diluted hydro-
chloric acid, when Prussian  blue will appear.   The silver and the
iron-tests may be easily conjoined  in testing the same quantity of
poison.  If the precipitated cyanide of silver, obtained by the addi-
tion of nitrate of silver to the suspected liquid, is  dried  and then
moistened with strong hydrochloric acid, the  vapor  may be col-
lected  in  a watch-glass or saucer,  on the plan above  described.
Prussian blue will  be procured, and thus corroborate the action of
the silver-test.  3.  The Sulphur test.—Some years since Liebig pro-
posed the  following process  for detecting prussic  acid as a liquid.
(" Oesterreichische  Med. Wochenschrift,"  Marz 27, 1847, p. 396.)
If a small quantity of the bisulphide of ammonia is added to a few
drops of  a  solution of prussic acid, and  the mixture  is gently
warmed, it becomes colorless, and, on'evaporation, leaves crystals
of sulphocyanite of ammonia—the sulphocyanic acid being indicated
by the intense blood-red color produced on adding  to the dry resi-
due a solution  of a nearly neutral persalt of iron: this  red color
immediately disappears on adding  a  few drops of a solution of
corrosive sublimate.
   The great utility of the sulphur-test.however, is in its application
to the detection of the minutest portion of prussic acid when in a
state of vapor.   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, having in
its centre one drop of the bisulphide of  ammonium.  No change
apparently takes place  in the sulphide;  but if the upper watch-
glass  is removed  after the  lapse of from half a  minute to ten
minutes, according to  the quantity and strength  of the  prussic
acid present, crystallized sulphocyanide of ammonium will  be ob-
tained on  gently evaporating the drop of liquid to  dryness.  With
an acid of from three to five per  cent, the action  is completed in
ten seconds.  The addition of one drop of the neutral persulphate
of iron (free from nitric acid), to the dried  residue, brings out the
blood-red  color  instantly, which  is intense in proportion to the
quantity of sulphocyanate present.  I have elsewhere made some
remarks on the application of this process for the detection of prus-
sic acid.   (See " Med. Gaz."  1847, vol. 39, p. 765.)
   [A new test, attributed to Schoenbein, has lately been brought
into notice ("Brit, and For. Med.-Chir. Review," Oct. 1869,) as one
of extreme delicacy.  It is prepared as follows : Dissolve forty-five
grains of guaiacum in three ounces of alcohol, and with this solution
saturate a sheet of thin white filtering paper;  this is to be dried
and cut up  into slips.  Next, dissolve fifteen  grains of sulphate
of copper  in an ounce  and a  half  of distilled water.  When the
test is to  be applied, dip a slip of the test-paper  into the copper
solution, and hold it over the vessel, or substance  containing the
hydrocyanic acid; very soon the paper assumes  a deep blue color. 
216        PRUSSIC ACID  IN ORGANIC LIQUIDS.

  This is certainly a test of great delicacy; but unfortunately, it
is  not characteristic of prussic acid, since the same blue color is
brought  out  by the  presence of ozone in various forms.  Besides,
in cases where the supposed quantity of the hydrocyanic acid is
very minute, and the vessel containing it is warmed, the mere dry-
ing of the test-paper, will cause it to assume a blue color, even with-
out the presence of the poison.—R.]
  Prussic acid in organic liquids.  Detection by vapor without distilla-
tion.—The organic liquid may be placed in a wide-mouthed bottle,
to which a watch-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 for the vapor, in the manner above described.  If the^^th of
a grain of prussic acid is present, and not too largely diluted, it
will be detected (at a temperature of 60°) by the drop of nitrate of
silver being converted into  an opaque white or crystalline film of
cyanide of silver, the chemical change commencing at the margin.
We may then substitute for the nitrate of silver the bisulphide of
ammonium, and proceed in  the manner  above described.  It  may
be sometimes necessary to  place  the  bottle in  a basin of warm
water.   If  the solution of  silver  is  tarnished  by sulphurretted
hydrogen, as a result of putrefaction, the sulphur-test alone should
be  used.   By this  process, I have detected prussic 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 longer,
the acid had entirely disappeared.
   If  traces of the poison are found, then 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 test may now be applied to the distilled liquid.
   [In the search for free prussic acid in the stomach by distillation,
the analyst should avoid the use of sulphuric acid, since this acid
will  decompose the sulphocyanide existing in  the saliva (which
would be likely to  be  found in the stomach),  as  also  any ferro-
cyanide, and thereby evolve traces of prussic acid.
   In  the celebrated case of  Dr. Schoeppe, tried at Carlisle, Pa., in
1868  and 1872,  this was made a capital point in  the defence.  The
prosecution endeavored to sustain the charge of poisoning by prus-
sic acid (although there was not a characteristic symptom of this
poison  exhibited before death), by the allegation that the analyst,
Prof. Aiken, of Baltimore, had discovered faint traces of it in the
liquid obtained  by distilling the stomach along with sulphuric acid.
It was very properly objected that the addition of this  acid would
render it impossible for the chemist  to determine whether  any
free prussic acid had been originally present, or not; even admitting
the reliability of the " faint traces" alleged.
   One of the latest American authorities (" Wharton and Stille's
Med. Jurisp.," 1873, p. 515), speaking of this acid, says ..." it may
certainly become a question of serious import whether the traces of 
        POISONING  WITH CY'ANIDE OF  POTASSIUM.     217

it found afterwards may not be due to some other cause than its
ingestion into the stomach.  Thus, if the contents of the stomach
be subjected to distillation with an acid, it may possibly happen that
the sulphocyanide of  potassium which sometimes exists in  minute
traces in the saliva, may be decomposed, and  evidence of  prussic
acid be thus obtained."—R.]
  In the tissues.—Soon after death, the poison may be easily detected
in the blood, secretions or any of the soft organs, by placing them
in a bottle, and collecting the vapor in the manner already described.
This will be found to  be far more convenient and satisfactory than
the process of distillation. In  the case of a dog poisoned b}r a large
dose of prussic acid, Mr. Hicks brought to me the stomach  after it
had been exposed twenty-four hours, and thoroughly washed under
a current of water, and yet the poison was really detected by  placing
the whole organ in  a  bottle, and absorbing the vapor  by nitrate of
silver.   This shows how completely the animal tissues at death are
penetrated by prussic  acid, and how firmly for a  time it is retained
by them.  The poison has been thus discovered,  in experiments on
animals, in the blood and in the serous exhalations  of the chest.
It has been detected with tissues as late as seven  weeks after death,
by the sulphur-test.
   If the body is in a putrefied state, the prussic  acid may have
been converted into fixed sulphocyanide of ammonium.  In order to
detect this salt in the stomach or its contents, we should digest the
parts finely  cut up in  hot alcohol, filter the alcoholic liquid, evapo-
rate to dryness, and take up any crystalline residue with water.   A
solution of a persalt of iron added to this will indicate the presence
of a sulphocyanide, by imparting to it an intensely red color.

                     Cyanide of Potassium.

   Symptoms.—This  salt  has a bitter taste, producing first a sense of
coldness on  the  tongue, followed by a feeling of constriction, and
burning heat in the  throat.   It is  one  of the most formidable
poisons  known to chemists.  It has destroyed life in a quarter of
an hour.   A dose of five grains has proved fatal  in three instances.
In one case the person died in  two hours.  ("Chem. News," Sep. 5,
1863.)   The symptoms which  the  cyanide produces are similar to
those occasioned by prussic acid; insensibility,  spasmodic  respira-
tion, convulsions, with tetanic stiffness of the jaws and body.  They
appear in a  few  seconds or minutes, and run through their course
with great rapidity.
  Appearances.—In  a  case in which an inspection of the body was
made two daj-s  after death, there  was no remarkable odor: the
muscles were rigid; the face and fore part of the trunk, pale; the
hack part livid, except those portions which had sustained pressure.
The fingers and toes were convulsively bent inwards, the nails blue,
eyelids half-closed, lips pale, the vessels of the  brain filled with
bluish-red (blaurothem)  blood.  On making a section  of the  brain
and spinal marrow,  bloody points were observed.  The lungs were 
218        ESSENTIAL OIL OF  BITTER  ALMONDS.
congested posteriorly, and on cutting into them, a strong odor of
bitter almonds was perceived ; a yellowish mucus was found in the
stomach, which  yielded on  analysis cyanide  of  potassium,  lhe
mucous membrane was reddened  near  the intestinal  end.   lhe
poison was not detected in any part of the body except the contents
of the stomach and intestines.  (" Casper's Wochenschrift,  Oct. 4,
1845, 657.)                      ,■,.-,.•         +i    i •
  Cyanide of potassium has a local chemical action upon the skin;
and if this is abraded or wounded, it may be absorbed and produce
serious effects.   Some accidents of this  kind have  occurred in the
practice of photography.  (" Ann. d'Hyg." 1863, vol. l,p. 454.)
  Analysis.—This  substance is usually  seen in hard white masses.
It is  deliquescent, and very soluble in  water  ; the solution, when
pure, is colorless, and has  a  strong alkaline reaction, a soapy feel,
and a powerful odor  of prussic acid.  It is not very soluble in cold
alcohol.  1.  It is decomposed by all acids, and  prussic acid is set
free.  2.  The potash is precipitated by  tartaric  acid and chloride
of platinum.  3. It gives a white precipitate with nitrate of silver,
which, when dried and heated, possesses all the properties of cya-
nide of silver (ante, p. 214).   This precipitate is easily redissolved
by a slight excess of the solution of cyanide  of potassium.   4. If
a solution of proto-sulphate of iron is added  to a solution  of the
cyanide of potassium, and after agitation, diluted  sulphuric  acid,
Prussian blue will result.


              Essential  Oil of Bitter Almonds.

  This liquid, which is used for the purpose of  giving flavor and
odor  to  confectionery, owes its poisonous properties chiefly to the
presence  of  prussic acid.  It contains a variable  quantity  of this
poison, which has been found in it in  a proportion of from eight
to twelve per cent.   Almond flavor, or essence of peach kernels, con-
tains one drachm of  the essential oil to seven  drachms of rectified
spirit.
  Symptoms.—The following may be taken as  a summary: lividity
of the face;  eyes glassy, prominent, fixed, and staring ; pupils di-
lated and insensible to light;  jaws spasmodically closed;  frothy
mucus about the mouth ; in some cases, vomiting of food ; coldness
of the skin ; heaving and intermittent respiration, in some instances
stertorous;  absence of the pulse; head  spasmodically drawn  back-
wards, and sometimes the trunk ; general relaxation of the limbs;
an odor of bitter almonds about the mouth.
  Appearances.—In one fatal case nine hours after death, no odor of
almonds was perceptible  in the  chest, head,  or  heart, nor in the
blood.  The lungs and heart were healthy ; the vessels of the brain
were congested, and there was a general  effusion of serum on the
hemispheres.  The lining membrane  of the stomach was  much
congested.   On  opening it,  the odor of bitter almonds was  quite
perceptible.   (See  " Prov. Med. Journ."  Sept. 11,  1844, p.  364.) 
NITROBENZOLE.
219
The  blood  with which  the venous system is gorged is generally
liquid and  of a dark color.
  Analysis.—The essential oil, which is  often called  peach-nut oil,
is  colorless when pure, but it commonly has a pale yellow color,
and  a strong odor of bitter almonds, by which it may be at once
identified.  It has a hot burning taste,  and a feebly  acid reaction.
The  smell and taste are generally sufficient for its  identification;
but nitrobenzole possesses the same odor, and has been mistaken
for it.   It  produces, when dropped on paper, a greasy stain which
does not entirely disappear by the application of heat.   It has a
sp. gr. of 1.043 ; hence it sinks in water, which dissolves about one-
thirtieth part.  It is soluble in alcohol and ether in all proportions.
When mixed with a few drops of strong sulphuric acid, it  forms a
rich  crimson-red liquid which, if exposed to air, acquires a yellow
color.  Trussic  acid may be detected in it by dissolving the oil in
alcohol and adding a solution of potash  and green sulphate  of iron.
On the addition of a diluted acid, Prussian blue remains.

             Nitrobenzole.—(Essence of Mirbane).

  This liquid, which is largely  employed  as a substitute  for the
essential oil of bitter almonds in perfumery and confectionery, has
now taken  its place among narcotic poisons.  It has been mistaken
for essential oil of bitter almonds, but its mode of operation is dif-
ferent.   In 1859, the late Professor Casper, of Berlin, published an
account of this liquid under the name of " A new Poison."   (" Vier-
teljahrschrift," B. 16, p. 1.)  Its  effects  on a  rabbit and a dog are
here described.  Two drachms of it were  given to a rabbit with-
out any symptoms  being produced ;  two drachms were then given
to the  animal at intervals of ten minutes or a quarter of an hour
until the rabbit had taken one ounce. In a minute and a half after
the last dose, the animal fell suddenly on its  left side.   The pupils
were dilated, while  the  limbs and tail  were strongly  convulsed.
The  animal died in a minute.  The dose was probably unnecessarily
large, but the result shows that nitrobenzole in a large dose destroys
life rapidly.  On opening the body, the powerful odor of the liquid
was everywhere perceptible, even  in the blood.  This odor remained
strongly in the body when  it  was again examined  fourteen  days
after death.  Twenty cubic centimetres  (about five drachms) given
to a middle-sized dog  produced no remarkable symptoms.   After
some hours the animal was observed to be dull  and languid; in
twelve  hours there was profound coma with slow  breathing and
coldness of  the skin: but  there were no convulsions.  The animal
was then killed.  All the solids and liquids of the bod}-, including
the blood, had a strong odor of nitrobenzole, and some drops of the
oily liquid  were separated from the contents of the stomach.  The
fluid on which it floated  had an alkaline reaction.   The blood re-
tained the odor for several days.
  In reference to the symptoms produced in man, the cases which
have yet occurred show that it is an insidious poison, both in liquid 
220
symptoms and  appearances.
and vapor.  There is a burning taste in the mouth, followed by a
sensation of numbness and tingling in the tongue and lips. _ There
is no immediate insensibility, as in poisoning by prussic acid, and
there are no convulsions.  The eyes are bright and glassy, the fea-
tures pale and  ghastly, the lips and nails purple, as  if stained by
blackberries, the skin clammy and the pulse feeble.  The mind may
be clear for an hour, or several hours after the poison has been swal-
lowed.   The patient then becomes suddenly unconscious—the jaws
fixed, the hands clenched and blue, and the muscles rigid and con-
vulsed.   In one case, there  was vomiting of a liquid having the
odor of nitrobenzole.  The  breathing  was slow, and  the  pulse
scarcel y  perceptible.  Reaction set in^in about eleven hours, and
recovery took  place.  ("Guy's Hospital Reports,"  Oct.  1864,  p.
192.)  In a case, examined  by Dr. Letheby, the appearances were
as follows:  the superficial vessels were  much  gorged with blood,
which was black and fluid.   The  lungs were congested, the cavi-
ties  of  the  heart  were full of  blood, the liver was of a purple
color, the brain and its membranes were congested, and there was
much bloody serosity in the ventricles.
   This compound has a narcotic action, but it  differs from the or-
dinary narcotics in its powerful and persistent odor, which would
render it difficult for a person to administer it, either in liquid or
vapor, unknowingly to another;  in the production of profound
coma at  an uncertain interval  after the  stupor;  and in the rapidly
fatal effects when coma has followed.  It operates powerfully as a
poison in vapor as  well as in  liquid state; but so far as cases have
been yet observed in the human subject, the  symptoms resembling
those of the first  stage  of  narcotic poisoning have  very soon
appeared.  The rapidly-fatal cases  only would be likely to be mis-
taken for apoplexy, but in these the poison would  be detected by
its odor.
   Analysis.—Nitrobenzole is  a pale,  lemon-colored liquid, of a
strong odor resembling that of bitter almonds.   It  has a pungent,
hot, disagreeable taste.  It gives to confectionery the smell, but
not  the  pleasant taste of oil  of bitter  almonds.   It destroys the
color of litmus, and gives a greasy stain to paper, leaving a yellow
mark when the stain disappears.  It sinks in water, and is partly
dissolved, giving to it a yellowish color.  It is  soluble in  alcohol,
ether and chloroform, but when agitated with water, it is in great
part separated from its ethereal and chloroformic solutions.  It has
no basic qualities ;  its aqueous solution is not  precipitated either
by tannic acid, or the chloriodide of mercury and potassium.  It is
highly combustible, burning with a yellow smoky flame.  It yields
no Prussian  blue when mixed with sulphate of iron, alcohol, and
potash, and its vapor produces no cyanide of  silver in a solution of
the nitrate.  It is distinguished from all other  liquids, exceptiug
the essential oil of  almonds, by its odor, and from  this oil by the
following test:  Pour a few drops of each on a plate, and add a drop
of strong sulphuric acid.  The oil of almonds acquires a rich crim-
son color with a yellow border, the nitrobenzole produces no color. 
               FUSEL-OIL — amylic alcohol.           221

In order to  separate it  from organic liquids, they may be acidu-
lated with sulphuric acid, and submitted to distillation.

                  Bichloride  of Methylene.

  The vapor of this highly  volatile  liquid has been  proposed by
Dr. Richardson as a substitute  for the vapor of chloroform in sur-
gical operations.  It was thought to be less likely to cause death.
  Like all these anaesthetic  vapors it has destroyed life on several
occasions, even when given  with  care.  The history of the fatal
cases is similar to that which chloroform vapors  has furnished on
numerous occasions.

                 Fusel-Oil.  Amylic Alcohol.

  This liquid is also known  under the name of Potato-spirit or Oil
of grain.  It is of an alcoholic nature, but less volatile than alco-
hol and ether:  hence it is commonly a product at the latter part
of the  distillation  of spirit from fermented potatoes and cereal
grains, imparting a disagreeable odor and taste to  the brandies pro-
duced.   Its  vapor, when respired  in a diluted state, is irritating to
the lungs; it produces headache,  nausea, and a  feeling of giddi-
ness, with a sense of suffocation and inability to  stand  or walk.
This spirit is used in certain manufactures, as in  the separation of
oils and fat, and the question has arisen how far the vapors would
be injurious to the health of workmen.   There can be no doubt
that the vapor is noxious when breathed, and that the work could
not be  carried on  with safety unless there were free and perfect
ventilation.  Three drachms killed a rabbit within an hour.  Half
an ounce caused death in a  quarter of an hour,  and one ounce in
four minutes.  Fusel-oil,  as a liquid, appears to have at first a
stimulating  and afterwards  a depressing action.   In small quan-
tities it produces intoxication.  (See " London Med. Gaz," vol. 35,
p. 430.)  This liquid is absorbed into the blood, and after a time
may be detected by its peculiar odor in the breath.  Its toxicologi-
cal effects are more potent in the state of vapor, than when taken
as a liquid into the stomach. 
222
POISONING WITH ALCOHOL.
                   CHAPTER XVIII.

ALCOHOL —ETHER.—CHLOROFORM.—HYDRATE OF CHLORAL.—CAMPHOR.
  — TOBACCO.   (NICOTINA.) —COCCULUS INDICUS.   (PICROTOXINE.) —
  CALABAR BEAN.—FUNGI.—HENBANE.

                          Alcohol.

  Symptoms.—In general, the symptoms produced by alcohol come
on m the course of a few minutes.  There is confusion of thought,
with inability to stand or walk, a tottering gait and giddiness, fol-
lowed by stupor and coma.   Should the person recover from this
stao-e, vomiting supervenes.  The insensibility produced by alcohol
may not come on until after a  certain period and then  suddenly.
Dr. Christison met with an instance in which a person 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 may apparently recover from the first
effects—then suddenly become insensible, and die convulsed. There
is a ghastly or vacant expression on the features, which are some-
times suffused  and bloated, the lips are  livid, and the pupils are
dilated and fixed:  if they possess the power of contracting under
the influence of light, it is a favorable  sign.  The conjunctivae, or
whites of  the eyes, are generally much suffused.   The breath has
an alcoholic odor.   The more concentrated  the alcohol, the more
rapidly are the  symptoms induced, and they are also more severe
in their character.  Diluted alcohol commonly produces a stage of
excitement before stupor, while in the action of concentrated alco-
hol there may be profound  coma in a few miuutes.   The cause of
death may be generally  traced to congestion of the brain or lungs,
or both.   Alcohol may act as a poison by its vapor.  If the concen-
trated vapor be respired, it will produce the usual  effects of intoxi-
cation.  There is a case on record in which a child  two years of age
was thrown into an apoplectic stupor by the alcoholic vapor of eau
de Cologne.  In this manner, a child might be destroyed, and no
trace of the poison found in the stomach.
  The symptoms arising from apoplexy, from concussion of the
brain, or the effects of opium, have been sometimes mistaken for
those of poisoning by  alcohol, and  persons have  been  wrongly
charged with being drunk.  With respect to concussion, a difficulty
can arise only in reference  to the more advanced  stage of poison-
ing by alcohol,  i. e. in which there is profound coma.  Intoxication
may in general be easily distinguished by the odor of the breath,
for so long as the symptoms continue, the alcohol  is eliminated by 
POISONING  WITH ALCOHOL.             223
the lungs.  If there should be no perceptible odor of any alcoholic
liquid, the presumption is that the symptoms are not due to intoxi-
cation.  When the alcoholic odor is perceptible, the symptoms may
still be combined with the effects of apoplexy or concussion—a fact
which can be cleared up only by a history of the case, or a careful
examination of the head for marks of violence.  In poisoning by
opium there will be a strong smell of this drug in the breath, the
symptoms come on  much more gradually,  and are marked  by
drowsiness and stupor passing into complete lethargy, with general
relaxation of the muscles, and inability to walk.  In poisoning by
alcohol, there is either great excitement some time before the stupor,
which comes on suddenly, or the person is found in a state of deep
coma a few minutes after having taken the poison.   In poisoning
by opium the face is pale, and the pupils are contracted:—in poison-
ing by alcohol, the face is usually flushed, and the pupils dilated.
  Appearances.—The stomach has been found intensely congested or
inflamed, the mucous membrane presenting  in one case  a bright
red, and in  another a dark  red-brown color.  When death has
taken place rapidly, there may be a peculiar odor of  spirits in the
contents; but this will not be perceived if the quantity taken was
small, or many hours have elapsed  before the  inspection  is made.
The brain and its membranes are  found congested, and, in some
instances,  there is effusion of blood or  serum beneath the inner
membrane.
  Analysis.—When a large dose has been taken and the  case has
proved rapidly fatal, the contents of the stomach may have  the odor
of alcohol, or of the alcoholic liquid taken.  The odor is not always
perceptible, or it  may be  concealed by other odors.   In a case of
poisoning by gin,  the liquid drawn  from the stomach by the pump
in seven hours had no odor.  The smell of brandy has entirely dis-
appeared in twelve hours.  The whole of the  contents or of the
suspected liquid should be distilled in a water-bath, with  a proper
condensing apparatus attached.  If the liquid has an acid reaction,
it should be first neutralized either by a solution of carbonate of
potash, or soda.   The watery  distillate obtained should be mixed
with chloride of calcium, or anhydrous sulphate of copper, in suffi-
cient quantity, and submitted to a second distillation in a smaller
retort, by a water-bath.  The liquid obtained by the second distilla-
tion should be agitated with rather more carbonate of potash than
it will dissolve, in  a small tube provided with a stopper, and allowed
to stand.  A stratum of alcohol, if present, will, after a time, float
on the surface, and may be drawn off by a pipette and examined.
It may be identified by its odor, taste, inflammability and its action
on bichromate of potassa  with sulphuric acid.
  The following method will allow of the detection of a quantity
of alcohol too small for separation by the  process above mentioned.
Make a mixture of strong sulphuric acid and a saturated  solution
of bichromate of potash :  moisten with this mixture a few fibres of
asbestos, and inclose them in a glass tube connected with the retort
or flask in which distillation is carried on.  For this purpose, a flask 
224  EFFECTS PRODUCED  BY  ETHER  AND CHLOROFORM.

or tube similar to those used for the  detection of chloroform vapor
will be found serviceable.  The smallest portion  of alcohol-vapor
passing over the asbestos immediately renders it green, by convert-
ing the chromic acid to  oxide of  chromium.  This may serve as a
trial  test, or for evidence, according to circumstances.  The tube
may be removed, and the condensed vapor collected for the appli-
cation of the other tests.  Ether and  pyroxylic spirit produce a
similar result.
  From lapse of time, the  effects of treatment, or absorption and
elimination, there may be no trace of alcohol in the stomach or  in-
testines, nevertheless the person may have died from the effects.
In a case, fatal in eight  hours, which occurred to the late Dr. Geo-
gheo-an, no alcohol was.found in the stomach.  One cause of failure
may sometimes be traced to the  distillation being restricted to a
portion of the contents.  It is advisable to distil  the  whole, as, if
necessary, the  distillate  or  the residue  can be examined for other
poisons.

                            Ether.

  Symptoms and effects.—Ether, in moderate doses, has a hot burn-
ing taste, and produces during swallowing a sense of heat and con-
striction  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
large quantities with comparative impunity.  The effects produced
on the system when a large dose has been taken are similar to those
occasioned  by  alcohol.  In the body of a dog poisoned by ether, the
whole of the  mucous membrane of the stomach  was found of a
blackish-red color, and  with  the other coats intensely inflamed.
There was  slight inflammation of the  duodenum; but the rest of
the alimentary canal was in a healthy condition.   The heart con-
tained black blood partly coagulated : the lungs were gorged with
fluid blood.  (Orfila, op. cit. ii. 531.)  Ether as a liquid has not, so
far as I  know, destroyed the life of a human being; but when its
vapor has been breathed, it has caused death in several instances.
(See " On Poisons," 2d ed.,p.  731.)
  Analysis.—When  ether  has been taken as a liquid it may be
separated from the contents of the stomach by the process described
for alcohol.  It is well known by its odor and inflammability.

                          Chloroform.

  Symptoms.—Chloroform, when taken in a large  dose, appears to
affect the system like alcohol: but as a liquid, it cannot be regarded
as an active poison.  A man  swallowed four ounces of chloroform.
He was able to walk for a  considerable distance after taking this
dose, but he subsequently fell into a state of coma ;  the pupils were
dilated, the breathing was stertorous,  the skin cold, the pulse  im-
perceptible, and there were general convulsions.  He recovered in  five 
           EFFECTS  PRODUCED BY CHLOROFORM.        225

days.  (" Med. Gaz.," vol. 47, p. 675.)  A boy, set. 4, was found by
his i'ather in a state of total insensibility.   It appeared that he had
swallowed  a  drachm  of chloroform, and  soon afterwards  laid his
head on his mother's lap,and then lost all consciousness. In about
twenty minutes he was insensible, cold, and pulseless.  Mustard
plasters were applied to his legs; tbey acted well, but produced no
impression on the sensibility.   His breathing varied ; it was some-
times natural, at other times stertorous.  He became warmer, his
pulse full and regular; and he  continued three hours in  this state,
when lie died, quite calmly without  a  struggle, in spite of every
effort made for his recovery.   This  is the smallest dose of liquid
chloroform that  is known to have destroyed life.
   G/dnrnform vapor.—The vapor when  respired in a concentrated
form is speedily  fatal to life.   If it is diluted with a certain pro-
portion of air, it produces insensibility, with entire loss of muscular
power, in from eight to ten minutes, and the  patient rapidly re-
covers after the vapor is withdrawn.  Cases of death from the inha-
lation of the vapor for surgical purposes are numerous,  and the
symptoms  and post-mortem appearances are well-marked.  (" On
Poisons," 2d  Edit. p. 738 ; also "Lancet," April,  1859, p. 400, and
April 23, p. 425.)  In some instances, death has  taken place within
two minutes from the commencement of inhalation.  In one, in
which only thirty drops had been taken in vapor, the patient died
in one minute,  and in another, so small a quantity as fifteen or
twenty  drops proved speedily  fatal.  ("Table of  Fatal  Cases," by
Dr. "Warren,  U.  S. p. 23.)  Its fatal effects do not depend  so much
on the absolute quantity as on the proportion in which it is breathed
in a state of mixture with atmospheric air.  It has been stated that
the average proportion of this vapor for medicinal purposes, should
not exceed 3| per cent., and that 4| is a maximum quantity to be
taken with safety.  The proportion should be only slowly increased.
The vapor should not  be  given after a  long fast, after a full meal,
or while the  person is in a sitting or erect posture. (" Ed. Monthly
Journ.," Aug. 1864.)  The  vapor of this liquid operating  through
the lungs, has destroyed life more rapidly, and  in a smaller dose,
than any other  poison known.  Its  fatal operation is  sometimes
suddenly manifested apparently by an accumulative effect on the
blood, after the withdrawal of the vapor.  In one case witnessed by
a friend, the  heart suddenly ceased to beat four minutes after the
vapor had  been  withdrawn.  The digital arteries which had been
divided in the operation, ceased to bleed.  The man was dead.  The
fatal effects are generally ascribed to idiosyncrasy, or to the unfore-
seen condition of a fatty or  flabby heart.  In cases of alleged  rob-
bery and rape, it has been sometimes stated that the person assaulted
was rendered suddenly insensible by chloroform ; but chloroform
vapor does not produce immediate insensibility, unless  it  also pro-
duces asphyxia and death.
   Chloroform is a heavy colorless liquid, sp. gr. 1.484, neutral in its
reaction, sinking in water in globules, and only to a slight extent
dissolving in this liquid.  It has a fragrant odor, like that of apples.
       15" 
226               HYDRATE  OF CHLORAL.

It is very volatile, but not combustible, and, like alcohol, dissolves
camphor.   At a red heat it  is  resolved  into chlorine and hydro-
chloric acid.   On this effect a process has  been suggested for sepa-
rating it from the blood and tissues, when it has proved fatal in the
form of vapor.   The substance  supposed to  contain chloroform is
placed in a flask, the neck of which is fitted with a cork perforated
to admit  a hard glass tube, bent at right angles, and having a
length of from twelve to fifteen inches.   The flask  is gradually
plunged into water at  about 160°, and at the same time the middle
portion of the tube is heated to full redness by an air-gas jet.  At
a red heat, chloroform vapor is  decomposed, and chlorine  and  hy-
drochloric acid are among the products of  its decomposition.  Lit-
mus paper applied to the" mouth of the tube is  reddened ; starch
paper wetted with iodide of potassium is rendered blue, and nitrate
of silver is precipitated white.  Two drops of pure chloroform were
thus readily detected,  and so persistent was the vapor in the closed
vessel, that it was detected after one, two, and even  three weeks.
Two drops added to a quantity of putrefied blood were detected by
a similar process after a fortnight, the flask being closed, but  the
mouth of the tube remaining exposed to air.  This method of de-
tecting chloroform by  its products appears to be quite satisfactory.
In  practice, however,  it will be found  a  very difficult  matter to
detect it, even where we know it has been administered.

                    Hydrate of Chloral.

  This is a solid crystalline substance produced from the reaction of
chlorine on alcohol, and the subsequent addition of a small quantity
of water.  It has been much used of  late as a substitute  for opium.
In doses of twenty to thirty grains it has  been found  to operate as
a sedative and narcotic, without producing any stage of excitemeut.
It has been given in very large doses, sometimes with benefit  and
at other times causing  dangerous symptoms followed  by death.
The deaths have been frequently sudden, and no remarkable symp-
toms have preceded dissolution.   The person has passed from sleep
into death.
   A patient under Dr. Hubershon at Guy's, took half a drachm of
the hydrate at night.   He became unconscious almost immediately
after swallowing the draught—the face aud hands turned livid and
cold, and breathing took place only at long intervals, indeed for
about five hours  death  seemed to  be  impending.  He recovered
next day.  ("Lancet," 1870, 2, 402.)  A  case  is  reported in the
same journal in which a  dose of 160  grains was given by mis-
take to an hospital patient, a middle-aged  man.  The man slept
well and recovered, notwithstanding the large dose taken.  Dr. N.
Smith, of Baltimore,  met with  two  cases  in which  sudden death
followed ordinary doses, and in one instance a drachm  and  a  half
thrown in by the rectum produced rapid  insensibility, and caused
death in three hours.  ("Lancet," 1871, 2, 466.) 
CAMPHOR — TOBACCO.
227
  It has been supposed to prove fatal in consequence of being con-
verted, in the blood, into chloroform and formic acid, through  the
agency of the alkalies of the blood.

                           Camphor.

  Symptejms and appearances.—Camphor operates on the brain  and
nervous system. In one case which occurred to Mr. Hallet, a woman
swallowed in the morning about twenty grains 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 respira-
tion difficult, but she suffered  no  pain in any part.   On the admin-
istration 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 difficulty of breathing,
however, continued more or less for several weeks.  This is  the
smallest dose of camphor which appears to have been attended with
serious symptoms in an adult.  It has proved fatal  to infants and
children, the symptoms  being  chiefly vomiting and  purging, with
violent convulsions.
  A case of poisoning by camphor would be recognized by the odor
of the breath, a symptom which would attract  the  attention of a
non-professional  person.   The presence  of  this substance in the
stomach would be at once indicated by  its odor.

                           Tobacco.

   Symptoms.—The effects which tobacco produces, when  taken in
a large dose, either in  the  form of powder or infusion, are well
marked.   The symptoms are faintncss,  nausea, vomiting, giddiness,
delirium, loss of power in the  limbs, general relaxation of the mus-
cular system, trembling, complete prostration of strength, coldness
of the surface with cold clammy  perspiration, convulsive  move-
ments, paralysis, and death.   In some cases there is  purging, with
violent pain in the abdomen;  in others there is  rather a  sense of
sinking or depression in the region of the heart passing into syn-
cope, or creating a feeling  of impending dissolution. With  the
above-mentioned symptoms  there is dilatation of the pupils with
insensibility to light, dimness of  sight with confusion of ideas, a
small, weak, and  scarcely perceptible pulse,  difficulty of breathing
and involuntary discharge of urine.   Tobacco owes its poisonous
properties to the presence of a liquid volatile alkaloid, Nicotina.
   Nicotina.—This  is a  deadly poison, and, like prussic acid, it
destroys life in small doses  with great rapidity.  I found that a
rabbit was killed by a single drop in three minutes and a half.   In
fifteen seconds the animal lost all power of standing, was  violently
convulsed in its  fore and hind legs, and its back was arched con- 
228
TOBACCO—
ANALYSIS.
 vulsively (opisthotonos).  A frothy alkaline mucus escaped from its
 mouth, having the odor of  nicotina.   ("Guys Hospital Reports,"
 Oct. 1858,  p. 355.)  A case  of poisoning by this alkaloid which oc-
 curred  in  Belgium in  1851, was the subject of a trial for murder.
 ("Ann. d'Hyg.," 1851,  2, pp. 167 and 147.)  In another case which
 proved fatal in from three to five minutes, the appearances observed
 were a general relaxation of the  muscles, prominent and  staring
 eyes, bloated features, great fulness, with lividity about the neck.
 There was  no odor resembling nicotina or tobacco perceptible about
 the body.   When the body -was examined  between two  and three
 days after  death, putrefaction had occurred.   The swelling of the
 neck was found to arise from an effusion of dark liquid blood, espe-
 cially in the course of the veins.   The scalp and the membranes of
 the brain,  were filled with dark-colored blood.  The lungs were en-
 gorged, and of a dark purple color.  The cavities of the heart were
 empty, with the exception of the left auricle, which contained two
 drachms of dark-colored blood.   The stomach contained a choco-
 late-colored fluid, in which nicotina  was detected ;  the  mucous
 membrane  was of a dark crimson red color, from the most  intense
 congestion.  There was no odor excepting  that  of putrefaction.
 The liver was congested and of a purple black color.  The blood
 throughout the body was black and liquid, but in some parts it had
 the consistency of treacle.
   Analysis.—A sample  of nicotina which I examined had a pale
 amber color, and evolved a peculiar acrid odor, affecting the  nose
 and  eyes, resembling, when diluted, that of stale tobacco-smoke.
 It had  the consistency of a thin oil, gave a greasy stain to paper
 which soon disappeared,-owing to its volatility.   When  heated on
 platinum or on paper, it burnt with a bright yellow flame, emitting
 a thick black smoke.  It was powerfully alkaline, and imparted a
 strong alkaline reaction to water without readily  dissolving in it.
 The aqueous solution, even  when much diluted, retained the pecu-
 liar odor.  Nicotina is dissolved by alcohol and ether, and the latter
 liquid will remove it from its  aqueous solution.  1. Chloride of
 platinum produces in the aqueous solution  an orange-yellow crys-
 talline precipitate.   2. Corrosive sublimate gives  a white precipi-
 tate.  3. Arsenio-nitrate of silver gives a yellow precipitate. In all
 these characters nicotina resembles ammonia; the differences, apart
 from the odor (which is an important distinction), are, 4. Iodine
 water gives a brown precipitate (in ammonia there is no precipitate,
 the  color  is discharged).  5.  Tannic acid gives a whitish yellow
 precipitate  (in ammonia there is no precipitate, but a  red  color is
 imparted).   6. Chloride of  potassium  and mercury copiously pre-
 cipitate  it, even when  much diluted.   7. Gallic acid  gives no
 precipitate   (in ammonia  it produces a pinkish-red colo?, rapidly
 changing to an olive green).  8.  Sulphuric acid and bichromate of
 potash produce with it  a green color by the liberation of oxide of
chromium.   (See " Guy's Hospital Reports,"  Oct. 1858, p. 354.)
  Organic mixtures.—To separate nicotina from the contents of the
stomach, these should be digested in  cold distilled water, acidu- 
LEVANT  NUT.
229
lated with sulphuric acid in the proportion of a drop to an ounce.
This liquid is strained, filtered, and the residue pressed.   It is then
to be evaporated to one-half in a  water-bath,  digested  with its
bulk of cold alcohol, filtered, and  the alcoholic  liquid evaporated
in a water-bath.  The sulphate of nicotina is now dissolved out of
the residue by a small quantity of water, and the  solution  is ren-
dered alkaline by potash and then shaken in a tube with  its bulk
of ether; the ethereal liquid is allowed to evaporate in a  series of
watch-glasses, and if nicotina be present the alkaloid will be left in
small oily-looking globules.  The odor may not be perceptible until
the residue is  heated, when its  peculiar acridity will be brought
out.   A few drops of water should be added to the residue in each
glass—it will be found to  be strongly alkaline, and the  different
tests may then be applied.  It was by this process that I discovered
the poison in the  body of the  gentleman whose case is above re-
lated.  In reference to  the rabbit killed by a single drop (supra),
nicotina was found  in the  stomach and its contents; there was a
trace found  in half an ounce of the blood of the animal., and  the
poison was clearly detected after a week  in  the tongue  and soft
parts of the  throat of the animal, but there was no trace of nicotina
in the  liver, heart or lungs.

               Levant Nut.   (Cocculus Indicus.)

   Symptoms  and effects.—This is  the fruit  or  berry  of  the Ana-
mirta Cocculus (Levant Nut), imported from the  East Indies.  The
berry contains from one to two per            Fi  26
cent, of a poisonous principle (Picro-      a        '   &         c
toxine).  The shell  or husk contains
no picro toxine, but a non-poisonous
principle called menispermine.  The
seeds, in powddr or decoction, give
rise tO liaUSea, Vomiting and griping   a Berry of Cocculus Indicus, natural size.
pains, followed  by stupor and intox-  b The s,ame seen,iI1 section with one-haw
F  . '    m.            j}     T           °^ t'le semilunar kernel.
lcatlOll.  1 here are, SO  tar aS 1 am   e The kernel, containing picrotoxine.
aware, only  two well-authenticated
instances of  this substance having  proved fatal to man.   Several
men suffered from this poison in 1829, near Liverpool; each had a
glass of rum strongly impregnated with cocculus  indicus.  One died
that evening; the rest recovered.  ("Traill's Outlines," 146.) Of the
second case, the following details have been published: A boy,  set.
12, was persuaded by his companions to swallow two scruples  of
the composition used for  poisoning fish.  It contained cocculus
indicus.  In a few minutes he perceived an unpleasant taste, with
burning pain in the gullet and  stomach, not relieved by frequent
vomiting—as well as pain  extending over the whole of the abdo-
men.   In  spite of  treatment, a violent  attack  of gastro-enteritis
supervened,  and there was much  febrile excitement,  followed  by
delirium and purging, under which the patient sank on  the nine-
teenth day after taking  the poison.   On inspection, the vessels  of
 
230
ORDEAL OR CALABAR BEAN.
the pia mater were congested with dark-colored liquid blood. There
was serous effusion  in the ventricles of the brain, and the right lung
was congested.  In the abdomen there were all the marks  of peri-
tonitis in an advanced stage.  The stomach was discolored, and its
coats  were thinner  and softer  than natural.  (Canstatt, "Jahres-
bericht," 1844, 5, 298.)  Porter, ale, and beer owe their intoxicating
properties in some instances to  a decoction or extract of these ber-
ries.  For some remarks  on this, adulteration of beer and other
liquids, and a process for separating the poisonous principle, picro-
toxine, by amylic alcohol, see "Chemical News," March 12, 1864,
p. 123.   Cocculus indicus operates readily as a poison on animals,
and it has thus been frequently used for the malicious destruction
of fish and game.  In one instance referred to me, there was reason
to believe that 270  young  pheasants had been poisoned by grain
soaked in a decoction of this substance.   Barber's poisoned wheat
for the destruction of birds owes its poisonous properties to cocculus
indicus.   (Horsley.)
   The poisonous principle of the berry of cocculus indicus, called
picrotoxine, has a remarkably bitter  taste.

       Ordeal or Calabar Bean (Physostigma venenosum).

   The Calabar bean is a large leguminous seed of a dark color, re-
sembling a garden bean, but much thicker and more rounded in its
form.  It is brought from the western coast of Africa, and is there
employed by the natives as an ordeal bean when persons  are sus-
pected of witchcraft.   The common belief  is  that the innocent
vomit and are safe, while the guilty retain the poison and die from
its effects.  So strong is popular confidence in this test, that those
who  are suspected  voluntarily take an emulsion of this dreadful
seed,  and, as Sir R.  Christison  remarks, many an innocent person
thus pays the penalty of his rash reliance on this superstitious cus-
tom.  As it is a firm matter of  faith that if a man dies he is guilty,
such  a custom is beyond the reach of any appeal to reason.
   This bean owes  its properties to the presence of  an alkaloidal
substance called Physostigmia.   It is found in the cotyledon, and the
process adopted for its separation by Jobst and Hasse is described
in the "  Chemical News" for March 5,1864,  p. 109.
   A drop of the extract applied to the  eye of an animal produces,
m from ten minutes to a quarter of an  hour, a remarkable contrac-
tion of the pupil.   This has been observed to last in children for
fifteen or twenty hours.  (Bouchardat, " Ann. de Therapeutique,"
1864, p. 73.)   In this respect, the poison is eminently distinguished
from atropia, daturia, and .hyoscyamia, which cause excessive dila-
tation of the pupil.  Dr. Harley found in his experiments with this
substance, that it causes contraction of  the pupil when taken inter-
nally, as well as when applied locally.  It  paralyzed the motor
nerves, and left the  intellect and muscular irritability unimpaired.
It destroyed life by paralyzing the respiratory muscles, and although
it weakened the heart's power, it  neither stopped the circulation 
POISONING  WITH MUSHROOMS.
231
nor arrested the heart's action.  It is not, according to him, a car-
diac, but a respiratory poison.  It is closely allied in its effects  to
woorara and conia, but more to the latter.  It differs from both in
its tendency to produce muscular twitchings, and in its power of
causing contraction of the pupil.  Neither woorara nor conia has
any effect on the iris.   (" Lancet," 1863, 1, 717.)

                 Poisonous Mushrooms (Fungi).

  Symptoms and effects.—The  noxious  species of mushrooms act
sometimes  as  narcotics, and  on  other occasions  as irritants.  It
would appear from the reports of  several  cases, that when the nar-
cotic  symptoms are excited, they come on soon after the meal at
which the mushrooms have been  eaten, and they are chiefly mani-
fested  by drowsiness,  giddiness,  dimness of sight, and debility.
The person appears as  if  intoxicated, and  there are  sometimes
singular  illusions of sense.  The  pupils are dilated.  Spasms and
convulsions have been occasionally witnessed among the symptoms,
chiefly in fatal cases. When the drowsiness passes off, there is gene-
rally nausea and vomiting; but sometimes vomiting and purging
precede the stupor.  If the  symptoms do not occur until many
hours after the meal, they partake more of the  character of irrita-
tion ; indicated by  pain and swelling  of the abdomen, vomiting
and purging.  In a recent case of poisoning  by mushrooms, there
was slight  vomiting about an hour and  a half  after the meal, but
no violent symptoms  until after  the lapse  of ten hours.  Several
cases, in  which the  symptoms did not  appear for fourteen hours,
are reported in the " Medical Gazette," (vol. 25, p. 110).  In some
instances, the symptoms of poisoning have  not commenced until
thirty hours after the  meal ;  and in these, narcotism followed the
symptoms of irritation.  It might be supposed  that these variable
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 another like narcotics.  In most cases, recovery
takes place, especially if there is early vomiting.  In the instances
which have proved fatal, there has been greater or less inflamma-
tion of the stomach and bowels, with congestion of the vessels of
the brain.  (See " Med. Gaz." vol. 46, p.  307; vol. 47, p. 673 ; and
" Journ.  de Chimie MeU" 1853, p. 694.)
  In  the Guy's Hospital Reports for October, 1865, p. 382,1 have
recorded two fatal cases—a mother and daughter, who  died from
the effects of the Amanita citrina, a yellow-colored fungus, gathered
in mistake for mushrooms.  The  woman  fried the fungi, and  they
were  eaten for supper.  No symptoms appeared for seven hours.
The child when  seen  by a  medical man was  feverish and thirsty,
and the pupils were strongly dilated.  There was severe pain in the
stomach, and a  sense  of constriction  in the throat.   The  child
became convulsed  and insensible, and  died forty-one hours after
eating the  fungi.  The mother and another child suffered from
similar  symptoms; the  mother  partially  recovered, but had a 
232             POISONING WITH  HENBANE.

relapse, and died on the fifth day.  No inspection of the bodies
was made.
  These fungi can only be recognized by their botanical characters.
Portions of them may be found in the food, or in the contents of
the stomach; but if there has  been vomiting  and purging, it is
probable that the whole of the substance will be expelled.  Fungi
contain but little solid matter.

                Henbane.   (Hyoscyamus niger.)

  Symptoms and appearances.—The seeds, roots  and leaves of this
plant are poisonous.  When the dose is not sufficient to destroy life,
               the symptoms are: general excitement, fulness of
   Fig. 27.      the pulse, flushing of the face, weight in the head,
               giddiness, loss of power and tremulous motion of
               the  limbs,  somnolency, dilatation of  the  pupils,
               double vision, nausea, and vomiting.  After a time
               these symptoms pass off, leaving  the patient merely
               languid.   When  a large  quantity of  the  root  or
               leaves has been eaten (an accident which has occurred
               from the plant having been mistaken for other vege-
               tables), more serious effects are manifested. In addi-
  0 ©   a    tion to the above symptoms  in an aggravated form,
     Q         there will be loss or incoherency of speech, delirium,
 seeds of Henbane,  confusion  of thought,  insensibility,  coma, and
 a Natural size.     sometimes, a  state resembling insanity; the pupils
 o Magnified 30 di-       •          •     •       —       */ 7     i i.
ameters.          ^re 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 respira-
tion deep and laborious.  (See " Med. Gaz." vol. 47, p. 640.)  Occa-
sionally there is nausea with vomiting and purging.   Death may
take place in a few hours or  days, according to  the severity of the
symptoms.  The special effect of this poisonous plant is manifested
in its tendency to produce  a general paralysis of  the nervous
system.
  Analysis.—When  the vegetable has been eaten, it can  be identi-
fied only by its botanical characters.  The seeds are very small and
hard; they are  furrowed on the surface, and  may be easily con-
founded with those of belladonna.  They are of an oblong, oval or
pyriform shape.  The leaves are peculiar in shape and other char-
acters, by which they may  be easily identified.  The  poisonous
properties of henbane are known to be owing to the presence of a
crystalline alkaloidal body, which is called Hyoscyamia.   It is very
difficult of extraction.  The crystals have a silky lustre; they  are
not very soluble in water, but are easily dissolved by alcohol and
ether.   It has an alkaline reaction, and its saline solutions are pre-
cipitated by tannic  acid.   It  has  an acrid  disagreeable taste,
resembling  that  of tobacco.  It is highly poisonous, and causes
dilatation of the pupils.
 
NUX  VOMICA  AND
STRYCHNIA.
233
                        (SPINAL POISONS.)
                     CHAPTER  XIX.

NUX VOMICA.—STRYCHNIA.—SYMPTOMS AND APPEARANCES.—CHEMICAL
  AND  MICROSCOPICAL  ANALYSIS OF NUX VOMICA  AND STRYCHNIA.—
  PROCESS FOR ORGANIC MIXTURES.—BRUCIA.

                   Nux Vomica.  Strychnia.

  Nux Vomica in powder has a bitter taste, and cannot therefore
be easily administered in a poisonous dose without exciting suspi-
cion.   It owes its poisonous properties to the presence of from one
to one-half per cent, of  the  alkaloid strychnia, associated with an-
other alkaloid  named brucia.  Strychnia itself has a very bitter
taste, even in very small  quantity ; but as it destroys life in a small
dose, and it may be given in the form of  pills or professedly ad-
ministered as quinine  or other medicines, it offers every facility for
criminal administration.
  Symptoms.—At a variable interval after taking either nux vomica
or strychnia in a poisonous  dose, the person experiences a sense of
uneasiness and restlessness, accompanied by a feeling of impending
suffocation.   There  is a shuddering or a trembling of  the whole
frame,  with twitchings and jerkings of the head and limbs.  Tetanic
convulsions  then commence suddenly with great violence, and
nearly  all the muscles of  the body are simultaneously affected.  The
limbs are stretched out  involuntarily, the hands are clenched ; the
head after some convulsive jerkings is bent backwards,  and the
whole of the body becomes as stiff as a board.  As the convulsions
increase in frequency and severity, the body assumes a  bow-like
form (opisthotonos), being arched in  the back and resting on the
head and heels.  The head is firmly bent backwards, and the soles
of the  feet are  incurvated or arched, and everted, the legs some-
times separated.  The abdomen is hard and tense, and  the chest
spasmodically fixed, so that respiration appears to be arrested.  The
face assumes a dusky,  livid or congested appearance, with a drawn,
wild or anxious aspect, the eyeballs are prominent and staring, and
the lips are livid.  The intellect is clear, and the sufferings, during
this violent spasm  of the voluntary  muscles,  are severe.   The
patient in vain seeks for  relief in gasping for air and in requiring
to be turned over, moved or held.  The muscles of the lower jaw,
which are the first to  be affected in tetanus from disease, are gen-
erally the last to be affected by this poison.  The jaw is not always
fixed during  a  paroxysm.   The  patient can frequently speak and
swallow, and  great thirst has been observed among the symptoms. 
234               STRYCHNIA—SYMPTOMS.

In some cases of poisoning  by nux vomica, the jaw has been fixed
by muscular spasm;  but, unlike the lock-jaw of disease,  this has
come on  suddenly in full intensity with tetanic  spasms in other
muscles, and there have been intermissions which are not witnessed
in the tetanus  of disease.  The sudden and universal convulsion
affecting the voluntary muscles has  sometimes been so violent that
the patient has been  jerked off the bed.  After an interval of half
a minute to one or two  minutes, the convulsions  subside, there is
an  intermission,  the patient  feels  exhausted, and  is  sometimes
bathed in perspiration.  It has been noticed in some of  thesecases
that the pupils during the paroxysm are dilated, while in the inter-
mission they are  contracted.  The  pulse  during the  spasms is so
quick that it can scarcely be counted.  Slight causes, such as  an
attempt  to move, a sudden noise, or gently touching  the  patient,
will frequently  bring on a recurrence of the convulsions.  In cases
likely to prove  fatal, they rapidly succeed each other and  increase
in severity and  duration until at length the patient dies  utterly ex-
hausted.   The tetanic symptoms produced by strychnia,  when once
clearly established, progress  rapidly either to death  or recovery.
The person is conscious, and the mind is commonly clear to the last.
He has a strong apprehension of death.  The duration of the case,
when the symptoms  have set in, is  reckoned by minutes,  while in
the tetanus of disease, when fatal, it  is reckoned by hours, days, and
even weeks.  As a general statement of the course of these cases of
poisoning, within two hours from the commencement of the symp-
toms the person either dies or recovers, according to the severity of
the paroxysms and the strength of  his constitution.   Death some-
times takes place in a  paroxysm.   (See  case by Mr.  Lawrence,
" Lancet," June,  1861, p. 572.)
  The time at which the symptoms commence appears from the recorded
cases to be subject to great variation.  In poisoning by nux vomica,
the symptoms are generally more slow in appearing than in poison-
ing by strychnia.   Until  they set in suddenly, the patient is capable
of walking, talking, and going through his or her usual occupations.
In a case which occurred to  M. Pellarin,  a  man  swallowed about
300 grains of nux vomica and no symptoms appeared for two hours.
He died speedily in a violent convulsive fit.  (" Ann. d'Hyg." 1861,
vol. 2, p. 431.)  On an average in poisoning by strychnia, the symp-
toms appear in from five to twenty  minutes.  The longest interval
recorded was in  the following case: A boy, ast. 12, swallowed a
pill containing  three grains of strychnia.   No symptoms appeared
for three  hours; they then set in, in the usual way, and  death took
place in  ten minutes. It was clearly proved that the  pills, taken
had been composed  of three grains  of strychnia with mucilage:
they had been prepared eight months previously for the purpose of
poisoning dogs;  hence  the}^ were hard, and underwent only slow
solution  m the body.  (" Lancet," 1861, 2, 480.)
   The form in which the poison is administered or applied has a
considerable  influence on the time at which the symptoms com- 
       APPEARANCES  AFTER  DEATH—FATAL DOSE.    235

mence.  Thus when strychnia is given in pills,  especially if, as in
the above case, they are  hard, the symptoms are much longer in
appearing than when the poison is taken in solution.
  Appearances after death.—In general  the  body is  relaxed at the
time of death, and stiffens afterwards:  but the commencement and
duration of the rigid state depend on various conditions.
  Among the internal appearances which have  been  met with in
different  cases, are congestion of the  membranes and substance of
the brain, as also  of the upper part of the spinal marrow, with con-
gestion of the lungs.  The  heart is contracted and empty ; but its
right cavities in  some instances  have been distended with liquid
hloocl. The blood has been found black and liquid throughout the
body.  The mucous membrane of the stomach has occasionally pre-
sented slight  patches of ecchymosis or congestion, probably depend-
ing on extraneous causes,—such  as the  process of digestion, the
presence  of food, or of alcoholic liquids.   In  most instances, the
stomach and  intestines have been found quite healthy, and it is not
in the nature of this poison either to inflame or irritate the mucous
membrane.   Of the appearances observed in poisoning by strychnia,
there are none which can be considered strictly characteristic.
Congestion of the membranes of the  brain and spinal marrow is
probably  the  most common.
  The sixteenth part of a  grain of strychnia killed a child between
two and three years of age  in four hours.   The smallest fatal dose
in an adult was in the case of Dr. Warner.   Half a grain of the
sulphate  of strychnia here destroyed  life.   ("  On Poisoning  by
Strychnia," pp. 138, 139.)  So powerful are the effects of this drug
in certain cases, that ordinary medicinal doses can scarcely be borne.
Symptoms of its poisonous action have frequently been unexpectedly
produced.
  With respect to nux vomica, three grains of the alcoholic extract
have destroyed life.  The smallest fatal dose of nux vomica in pow-
der was in a case  reported by Hoffmann, and quoted by Christison
(p. 901),  also by  Traill (" Outlines," p. 137).  Thirty grains of the
powder, given in two doses of fifteen grains each,  proved fatal.  The
poison was given  by mistake  for bark to a patient laboring under
quartan fever.  This is about equivalent to the weight of one full-
sized seed, and to only one-third of a grain of strychnia  in  two
doses.
  In fatal cases, death generally takes place within two hours after
the taking of strychnia.  One of the most rapidly fatal cases re-
corded is that of Dr.  Warner.  The symptoms commenced in  five
minutes and  he was dead in  twenty minutes.  In the case of J. P.
Cook, the symptoms commenced in an  hour and a quarter, and he
died in twenty minutes.   In poisoning  by nux vomica, death may
occur within two hours; but Dr. Christison  mentions a case in
which a man died in fifteen minutes after taking a dose.  This is
probably the shortest period known.
   Vermin and insect killers.—Although it is difficult to  procure 
236
CHEMICAL ANALYSIS.
strychnia at a druggist's shop, it is extensively sold to the public by
grocers, oilmen, and others, under the name of Vermin Killers, in
threepenny and sixpenny packets.  Butler's Vermin Killer consists
of a mixture of flour, soot, and strychnia.   I have found  the six-
penny packet  to weigh about a drachm, and to contain from two
to three grains of strychnia.  As the poison is mechanically mixed
with  the other ingredients, and  is  probably manufactured on a
large  scale, the proportion of strychnia is liable to variation.   The
threepenny packet  contains about half  the quantity of strychnia,
but this is quite sufficient to destroy the life of an adult.   In place
of soot, Prussian blue is sometimes  used as a  coloring substance.
Battle's  Vermin Killer is a powder  similar  to that of  Butler, con-
taining  a fatal proportion of strychnia, as it  is sold  in  packets.
These powders are a fertile source of poisoning either through acci-
dent or design; they are openly sold by ignorant  people to others
still more ignorant.
   Chemical analysis.—Nux  vomica is well  known as a flat round
kernel, about  the  size of a shilling, with  radiating silken fibres,
                         slightly raised  in the centre. It is of a
         Fig. 28.           light brown color, and covered with  a fine
                         silky down. (See Fig. 28.) It  is very hard,
                         brittle, tough,  and difficult to pulverize.
                         The powder is  of a gray brown color, like
                         that of liquorice; it is sometimes met with
                         in a coarsely rasped state; it has an in-
                         tensely bitter  taste;  it yields  to  water
                         and alcohol, strychnia, brucia,  igasuric,
                         or stryclinic aci'cl, and some common vege-
                         table principles. Heated on platinum foil,
                         it burns  with a  yellow smoky flame.
                         Nitric acid  turns  it of a dark orange-red
                         color, which is destroyed by chloride of
                         tin.  These proportions  are  sufficient  to
distinguish it from various  medicinal powders which it resembles.
The aqueous infusion or  decoction is deeply  reddened by nitric acid,
and is freely precipitated by tincture of  galls.   Persulphate of iron
gives with it  an olive-green tint.
   Strychnia.—The  alkaloid may be  readily obtained crystallized
from  an alcoholic solution.  The crystal is very small, and its form is
subject to great variation, according  to the  strength of  the solution,
rapidity or slowness of evaporation, the  presence of foreign matters,
etc.  It  is commonly seen in octahedra,  sometimes lengthened into
prisms of a peculiar  shape, bevelled at the ends, and crossing each
other at angles of 60°.   (See Fig. 29.)   There areas many as six or
eight varieties of crystals, so that too much importance must  not be
attached to this branch  of the analysis.   As strychnia is  procured
from  the solutions  of its salts by the  addition  of ammonia, it is
usually deposited in  long slender prisms.   (Fig. 30.)
   1.  Strychnia is white, of an intensely bitter  taste, even when
 
CHEMICAL  ANALYSIS.
237
it forms only 1T^vth part  of a solution.   2. When heated on
platinum, it  melts and  burns  like a  resin, with  a black smoky
flame ; in a close tube it yields ammonia.   3.  It is not perceptibly
dissolved  by  cold  water;  it  requires  7000 parts  for  its  solution.
4. It is  easily dissolved by acids, and is precipitated from  the con-
centrated  solutions by potash, in which it is insoluble. 5. Strong
nitric acid imparts to it, if not perfectly pure,  a reddish  color,
Fig. 29.                            Fig. 30.
 Various forms of Crystals of Strychnia, as       Crystals of Strychnia obtained by adding am-
they were obtained from an alcohol solution.     monia to the sulphate.  Magnified 121 diameters.
Magnified 221 diameters.

owing to  the presence of brucia.   6. Sulphuric acid produces no
apparent change in it;  but when to  the mixture, a small crystal of
bichromate  of potash, of ferricyanide of  potassium, or a  small
quantity of black oxide  of manganese, or of peroxide  of lead is
added, a series of  beautiful  blue, purple and violet colors appear,
which pass rapidly to  a  light flesh-red tint.  Among these sub-
stances black oxide of manganese will be found preferable.
   Mr. Horsley has suggested that a solution of strychnia should
be sufficiently concentrated, and  then precipitated by chromate of
potash; the crystals  may be examined microscopically; they are
generally  seen in  tufts of radiated  prisms  of a yellow color.  On
being touched with  strong  sulphuric acid, the  color reactions of
strychnia  are  at  once brought  out.  Picric  or carbazotic acid,
recommended  by Dr. Guy, is even a  more delicate precipitant of a
solution of strychnia.  It gives small tufts or groups of stellated
crystals.
  Strvehina has been  fatally mistaken for santonine (" Lancet,"
1870, 1,  598),  salicine, and jalapine, and  has  caused  death  on
several occasions.  Jalapine does not  crystallize, and the crystalline
forms of santonine  and  salicine  are very different  from those of
strychnia.
  These two vegetable principles differ from strychnia in  their
properties.   When heated in close tubes, they give off acid vapors.
Salicine is soluble  in water.  Santonine is not soluble in water, but
is dissolved by alcohol.  Tannic acid and the chloriodide of potassium
and mercury do not precipitate the  solutions, while  they  readily 
238         STRYCHNIA IN ORGANIC  MIXTURES.
Fig. 31.
Crystals of Chromate of Strychnia
    magnified 121 diameters.
precipitate those of strychnia.   Nitric acid has  no  effect upon
either, while sulphuric acid, which does not change santonine, gives
a pink red color to salicine.
  In Organic mixtures a modification of the process originally sug-
gested by Stas is employed for the separation of this poisoin  The
                         principle of its operation  consists in dis-
                         solving the strychnia by a  gentle heat
                         out of the tissue or organ finely cut  up,
                         by means of  rectified spirit  mixed with
                         a small quantity of acetic acid.  The
                         liquid is  strained, and  the  residue  well
                         pressed and  washed  with  alcohol; the
                         acid solution of strychnia thus obtained
                         is concentrated  in  a water-bath.   The
                         concentrated  liquor  is  neutralized  by
                         potash, and  a slight excess of alkali is
                         added.  The  alkalized   liquid  is then
                         shaken in a  long  stoppered tube, with
                         twice its volume of ether, or a mixture
                         consisting of two parts of ether and one
of chloroform.   These liquids  dissolve the strychnia set free by the
alkali.   The ethereal solution is separated from the watery liquid
by a pipette, and submitted to spontaneous evaporation, when, if
strychnia is present, the  alkaloid will  be obtained, but generally
associated with oily and other organic matters, which  interfere
with the productions of crystals.  The impure residue left by the
ether is heated  in a  water-bath, with  a few drops of strong sul-
phuric acid; this  destroys the organic ■ matter.  Water is added,
and the acid liquid is filtered  through paper, neutralized by potash,
and again treated with ether, when  strychnia will  be obtained in
small and slender prisms.   The crystals, after an examination by the
microscope (see Fig. 30, p. 237), are treated with sulphuric acid and
peroxide of manganese, and the color-reactions of strychnia, if the
alkaloid is present, will appear.  Mr. Bloxam has recommended the
use of benzole in place of ether.   Strychnia is  freely soluble in
benzole, and this liquid will remove the alkaloid from  water, when
precipitated by an alkali.   The crystals of strychnia deposited
from the benzolic solution are isolated, and in  the form of trun-
cated  octahedra.  When the residue from benzole is  treated with
sulphuric acid, it acquires  a  pinkish  tinge.  The color tests for
strychnia added to the mixture act but slowly, and  the only one
which acts satisfactorily is  the peroxide of manganese.   It  pro-
duces  an intense blue, which  is along time in passing to the purple
and red  shades.  Benzole appears to be  a better solvent of strychnia
than ether.
   Persons may die from strychnia, and no trace of  the poison be
found in the body.   In a case of poisoning by this  alkaloid, which
was the  subject of a trial  for murder at Perry Co., Pa., in the April
term of 1861, Dr. Reese, of Philadelphia, made separate analyses 
POISONING  WITH  BRUCIA.              239
of the contents of the stomach and the contents of the intestines,
as well as  of the  tissues, and  each one of these was repeated to
avoid all possible error.  Yet there was no evidence of the presence
of strychnia by the bitter taste of the final extract, or by the color
tests.  The witness, by a comparative experiment, satisfied himself
that he could detect the  half-millionth of a grain (" Amer. Journ.
Med. Sci."  Oct, 1861), but in this power of detecting so small a
quantity of stiwchnia in a pure state he had already been antici-
pated by Mr. W. Copney (" Pharm. Journ." July, 1856, p. 24).  In
Dr. Reese's case, the quantity  taken  was unknown,  the woman
lived five or  six hours, and the body was not examined until six
weeks after death.   A small but fatal dose, and the duration of the
case will sufficiently account  for  the negative results, without
resorting to any other hypothesis.   In the case of Mrs. Salter, who
died from a dose of strychnia in September, 1869, death  probably
took place  within two or three hours, but the most careful  examina-
tion made of the stomach and liver by Mr. Horsley of Cheltenham,
led to a negative result.  Strychnia, in the opinion of all the  medi-
cal witnesses, was the cause of death, but no trace of strychnia could
be detected in the  body by one well  qualified to detect it.   There
was some reason to think that the poison  had been taken in solu-
tion, but even under these circumstances it must have been rapidly
 absorbed, diffused, and eliminated.  Stiwchnia has been detected in
 the liver and other viscera of the body, even after putrefaction had
 set in.  It has also been found  in the blood.
   [See paper  by the Editor, "On the  Influence of  Morphia in
 Disguising the Color-test of Strychnia ;"  also " On the Comparative
 Bitterness  of Strychnia," and " On the Physiological  or  Frog-test
 for Strychnia," in  the "Am. Journ. of Med. Sci.," Oct. 1861.—R.]
   [Strychnia is largely consumed by the hunters and farmers in the
 United States as a poison for dogs, wolves, and  other carnivorous
 animals ; and cases of unintentional and accidental poisoning with
 it are more common in this country than formerly.  " Proc.  of the
 Am. Pharmac. Assoc." 1853, p. 11.—H.]
   Brucia.— Brucia is an alkaloid generally associated with  strychnia
 in the seeds of nux vomica, but it is more abundantly contained in
 the bark of the tree.  It is  not so powerful a poison as strychnia,
 but the symptoms which it produces  are similar.  It is considered
 to have about one-sixth  of the strength of strychnia.   It  is not
 affected  by the color-tests employed for the detection of strychnia,
 and it acquires an intense red  color on the addition of nitric acid.
 [This is  changed to violet by  the action of chloride  of tin.—R.]
 It is much more soluble  in water than strychnia, and has a bitter
 taste.  Its aqueous solution is strongly alkaline, and by spontaneous
 evaporation it yields groups of slender prismatic crystals arranged
 in a fan-like shape.  Unlike strychnia, it cannot  be crystallized
 from a solution in benzole, and only imperfectly from  a solution
 in alcohol.  Hydrochloric and  iodic acids produce in it no change,
 either in the cold or when heated.  Sulphuric  acid gives to it a 
240
POISONING  WITH HEMLOCK.
Ficr.
pink  red  color without carbonizing  it,  The sulphate of brucia
crystallizes in well-defined prisms  truncated  at  the ends._  They
                        arc larger  and longer than the prisms  of
                        strychnia.   (See.Fig. 32.)  From  a case
                        of poisoning with this alkaloid which has
                        occurred to' Dr. Edwards of Liverpool, it
                        is necessary to give a caution to medical
                        men  respecting the possible criminal use
                        of brucia.  The symptoms which it causes
                        so closely resemble those of poisoning with
                        strychnia  that in the event of death the
                        latter poison only may be sought for and
                        not found.   The tetanic symptoms are
                        more slowly produced, and the poison  is
                        not so rapidly fatal as strychnia, but these
                        conditions may  be  altered by the large
                        quantity given.   When in any suspected
case, the color-tests for strychnia fail to show the presence of this
alkaloid, nitric acid should be added to the crystalline  residue ob-
tained, as in the process for strychnia, by the use  of ether, or chlo-
roformic ether.  The intense reddening produced  by this test, with
the other characters above mentioned, will indicate the  presence of
brucia.
Crystals of Sulphate of Brucia, mag-
     nified 121 diameters.
                    (CEREBRO-SPINAL POISONS.)
                     CHAPTER XX.

conium  maculatum  (hemlock.) — conia. — c3nanthe  crocata. —-
  jethusa cynapium.—aconite, or monkshood.—aconitina.

      Common, or Spotted Hemlock.  (Conium maculatum.)

  Symptoms and appearances.—The effects  produced by hemlock
have not been uniform ;  in some instances there have been stupor,
coma, and slight convulsions:  while in other  cases, the action of
the poison has been chiefly manifested on  the spinal marrow—i. e.
it has produced paralysis of the muscular  system.   A man ate a
large quantity of hemlock-plant, by mistake for parsley.  In from
fifteen to twenty minutes there was loss of power in the lower ex-
tremities; but he  apparently suffered no pain.   In walking, he
staggered as if he was drunk;  at length  his limbs refused to sup-
port him, and he fell.   On being raised, his legs dragged after him,
and when his arms were lifted, they fell  like inert masses, and
remained immovable.  There was perfect paralysis of the upper and
lower extremities within two hours after  he had taken the poison.
There was loss of power of swallowing, and a  partial paralysis of
sensation, but no convulsions, only slight occasional motions of the 
poisoning  with hemlock.
241
left leg;  the pupils were fixed.   Three hours after eating the hem-
lock, the respiratory movements had ceased.  Death took place in
three hours and a quarter; it was evidently caused  by gradual
asphyxia from paralysis of the muscles of respiration; but the in-
tellect was perfectly clear until shortly before death.  On inspection,
there was slight serous effusion  beneath the arachnoid membrane.
The substance of the brain was soft; on section, there were numerous
bloody points, but the  organ was otherwise healthy.  The lungs
were gorged with dark fluid blood; the heart was soft and flabby.
The stomach  contained a  green-colored pulpy  mass resembling
parsley.  The mucous coat  was  much congested, especially at its
greater  end.   Here there were  numerous extravasations  of dark
blood below the membrane, over a space of about the size of the
hand.   The intestines  were healthy,  here and  there presenting
patches  of congestion in the mucous coat.  The blood throughout
the body was fluid, and of a dark color.
   In  a  case which was the  subject  of a  trial for murder (Reg. v.
Bowyer, Ipswich Summer Assizes, 1848), the child died in one hour
after  swallowing part of a  teacupful of  a decoction of hemlock,
alleged to have been administered by the mother.  The child sipped
the decoction, until it lost the power of holding the cup ; it became
insensible and paralyzed, and died in the chair in  a sitting posture.
There were no morbid appearances, and  no hemlock leaves  were
found in the body, these having subsided in the cup, and being left
in the dregs.   The child had been poisoned by the upper stratum
of clear liquid.   The  mother was  acquitted
for want  of  proof, the  death  of the child        Fig. 33.
having taken place in secrecy.
   Hemlock is known from most other plants
which resemble it  by its large round smooth
stem, with dark purple spots.  The leaves  are
of a dark green color, and smooth  and shining.
Every portion of the plant has a peculiar and
disagreeable smell  when bruised, resembling
cat's urine, or, according to some, the odor of
mice.  It is strongly brought out when the
stem,  leaves, or seeds  are rubbed with a solu-
tion of caustic potash.  An illustration of the
Seeds Of hemlock, is annexed  (Fig. 33).  They  a Seed of Hemlock, natural
are peculiar in their form, and are easily dis-   size-
tinguished  from  the seeds of other umbelli-   diamete™6' magD' e
ferous plants.   A person may  be  poisoned  c Group of seeds.
by a decoction of leaves of hemlock, and no
leaves be found in the stomach  or  bowels (case of Bowyer, supra).
In this case the stomach had been emptied, and the contents lost,
before it was sent to me! No trace of conia was found.
  The poisonous alkaloid of hemlock is known under the names of
'■onia,  concin, conicine and  conicina.  It  resembles  nicotina and
ammonia in its  liquidity, volatile  reaction,  and in some of  its
chemical  properties.  It is a liquid of oily consistency, of a. pale
      16
 
242
PROPERTIES OF  CONIA.
yellow color, powerfully alkaline, and has, when its vapor is di-
luted, a smell resembling  that of mice, and an acrid  bitter taste.
It gives a volatile greasy stain to paper, and burns with a yellow
flame and thick smoke.  1.  It is not colored or affected by nitric,
sulphuric, or hydrochloric acid ;  the last-mentioned acid  produces
with it, dense white fumes of hydrochlorate of conia, and on heat-
ing the mixture, this  salt remains in prismatic crystals.  [Prof.
Wormley states ("Micro-chemistry of Poisons," p. 449), that when
strong sulphuric acid is brought into contact with pure conine, the
mixture assumes a pale red color, which increases in intensity, and
after a time becomes nearly blood-red.   The action of nitric and
sulphuric acids is nearly similar, especially that of the former.—R.]
2. It  is not dissolved  by water, but floats  on it in oily  globules.
It is soluble in alcohol and  ether, and this  last-mentioned liquid
removes it from its aqueous  solution, and leaves it in oily globules
on evaporation.   In reference to its presence in organic mixtures,
it may be detected by its peculiar odor, or  by distilling the liquid
with a solution of potash, and examining the distillate.
  The reactions produced by tests on small quantities should be
distrusted, unless there is strong evidence of the action of the poison
on  the body from  the  sj^mptoms.  As in  reference to strychnia,
veratria and other alkaloids, an incautious operator may readily
come to the conclusion that he  has found  " traces,"  and ascribe
death  to the poison.  The following case occurred in  Germany a
few years since.  A man died very suddenly, i. e. in two hours and
a half after going  to  bed, and  it was alleged that his wife had
poisoned him.  The persons commissioned  to make the analysis
deposed  that they had found traces of conia in the stomach, in-
testines and kidneys,  and they came  to  the conclusion  that the
man had died  from the effects of hemlock, which implicated his
wife in a charge of murder.   Some doubt appears to have arisen in
the minds of the  authorities on this point, and the matter was then
referred to Mitscherlich and Casper, of Berlin, and they found that
the chemical processes pursued failed to detect conia in the body—
that there was nothing to indicate that deceased had  taken hem-
lock or conia in any form, and that  the state of the windpipe suf-
ficiently accounted for the  sudden death  of  deceased.  He had
eaten and drunk  freely, had  vomited after going to bed ; a portion
of the food had entered the  trachea and had suffocated  him !  (Sec
Casper's " Vierteljahrschrift," 1859, p. 194.)

               Water-Hemlock.  (Cicuta Virosa.)

  Symptoms and appearances.—The symptoms produced by the roots
of  this plant are giddiness, dimness of sight, headache,  and diffi-
culty of breathing.  There is burning pain in the stomach, with
vomiting, and  these symptoms are accompanied by heat  and dry-
ness of the throat.  Convulsions have been observed to precede
death.  In  the case of three children in  convulsions from this
poison, Metzdorff found an injected state of the mucous membrane 
          POISONING WITH  (ENANTHE CROCATA.        243

of the stomach, with redness of the air-passages, as well  as of the
cardia, and pylorus;  the vessels of the brain and  the sinuses were
filled with dark liquid blood.  (Wibmer, " Cicuta," 119.)

       Hemlock Water-Dropwort.   ((Enanthe Crocata.)

  This umbelliferous plant  grows on the banks of rivers, streams
and ditches.  It is one of the  most poisonous of the order, and is
considered  to  be one  of  the most virulent of English vegetable
poisons.
  Symptoms and appearances.—In April, 1857, two cases of poison-
ing with this plant occurred at West  Boldon, in Durham.   Two
laborers ate some  of the roots of the cenanthe.   They were found
soon afterwards lying  insensible and speechless, their faces  livid,
tongues swollen and  protruded, and there were convulsive move-
ments of their teeth,  frothy mucus with blood about their mouths,
eyes full and projecting,  pupils dilated, breathing  stertorous  and
labored, with occasional general convulsions.  They both died in
an hour and a half from the time at which they were first discov-
ered.   On inspection, it was  found that there  had  been  bleeding
from the ears ; the abdomen was lived and  swollen.  The stomach
contained a gruelly liquid with some of the partly digested roots  ;
on removing this liquid, the membrane was found  congested  and
softened.  The lungs were engorged with dark liquid blood, and
the blood contained in  the heart was in a similar state.  Mr. Boyle,
to whom these cases  occurred, forwarded to me a  portion of the
roots, and there was  no  doubt that they were the roots  of the
cenanthe crocata.   (For other cases see "Medical Gazette," vol. 34,
p. 288.)
  It is not often that attempts are made to destroy others by the
administration  of  these vegetable poisons;  but  a  case occurred in
France  in which  a "woman  attempted to poison  her husband by
mixing slices  of the  root of this plant with his soup.  His suspi-
cions were excited by the  acrid taste of the soup.  The woman was
tried for the crime, and M. Toulmouche deposed at the trial, that
the plant from which the  root had been taken, was the  cenanthe
crocata—that it was a  powerful poison, and might cause  death in
two or three hours. The prisoner was convicted, and condemned to
ten years at the  galleys.  ("Gaz. Med.," Jan.  3,  1846, 18;  also
"Journ. de Chim. Med.," 1845, 533.)
   The cenanthe crocata can be identified only by its botanical char-
acters. The leaves are  of a dark green color, with a reddish colored
border.   They have no unpleasant odor when rubbed.  The seeds,
of which an illustration is  anuexed (Fig.  34), are peculiar.   The
plant bears a greater  resemblance to celery than most of the other
umbellifera1.  Its stem  is channelled, round, smooth, and branched,
of a yellowish-red color, and growing to the height of two or three
feet.  The root consists of a series of oblong  tubercles, with  long
slender fibres.   It is of a yellowish-white color, and not unpleasant 
244
POISONING  WITH  J1THUSA  CYNAPIUM.
to the taste.  It is the most active part  of the  plant.   The leaves
yield much tannic acid to water, but the decoction appears to con-
Fier. 34.
   Seeds of CEnanthe Crocata.  a Natural size, b Magnified 30 diameters, c One-half of a seed
              maguified. d One-half natural size, e Group of seeds.

tain no alkaloidal base, since the chloriodide of potassium and mer-
cury produces no precipitate in it.   The  roots and stems of this
plant  are more frequently eaten than the leaves or seeds.

             Fool's Parsley.   (.zEthusa Cynapium.)

  Fool's Parsley, or Lesser Hemlock, is very common in gardens
and hedgerows.  The leaves  so closely resemble those of parsley
that they have often been gathered for them by  mistake.
  Symptoms and appearances.—In  May, 1845, a girl aged five years,
in good health, ate the bulbs of the sethusa by mistake for }roung
turnips.   She was suddenly seized with pain in the  abdomen, fol-
lowed by sickness, but no vomiting.   She complained of feeling
very ill.   On trying to eat, she could not swallow.  She was inca-
pable of answering questions, and her countenance bore a wild ex-
pression.  The lower jaw became  fixed, so as to prevent anything
being introduced into the mouth.   She then became insensible, and
died in an hour from the commencement of the symptoms; so far as
                      could be ascertained, there were no convul-
       Fig- 35.          sious.  A  second child, aged  three  years,
                      shortly  after  eating  the  same substance,
                      was  attacked with  pain in  the  stomach,
                      sickness, vomiting and profuse perspiration.
                      She soon recovered, with the  exception of
                      suffering severe griping pains without purg-
                      ing, but these disappeared on the following
                      day.  A  third child, of the same age, suf-
                      fered from  similar symptoms.  Recovery in
                      the two last cases was probably due  to the
                      plant having been eaten on a full stomach,
                      and to the  effect of early and copious vomit-
                      ing.  ("Med. Times," Aug. 23,1845, p. 408.)
  Seeds of Fool's Parsley.        rj^  i^ jg kn0W]Q frQm g^en parS]ey
 a Natural size.            i   .■«   ±    -.,   i» •.   i      °i      iii
 b Magnified30 diameters.     by the  smell  of its  leaves  when rubbed,
 « Group of steds.          which  is peculiar, disagreeable, and very
 
POISONING  WITH  MONKSHOOD.            245
different from that possessed by the leaves of parsley.   The leaves
of Fool's Parsley are  finer, more acute, and of a darker green color.
The seeds are also peculiar.  They are represented in the annexed
illustration.  (Fig. 35.)  Its flower stem, which is striated, or slightly
grooved, is easily known from all other umbelliferous plants by the
beard, or three long pendulous leaves of the involucrum under the
flower.  The flowers are white, those of the garden parsley of a pale
yellow color.  The poisonous properties of the plant are believed
to be due to an alkaloid, which has not yet been isolated.

              Monkshood.  (Aconitum Xapellus.)

  This Avell-known garden plant is in  some parts of the country
called Wolfsbane, and in Ireland Blue-rocket.  The roots, seeds and
leaves are highly poisonous, owing to the presence of the alkaloid
aconitina; the root is especially noxious, and when the leaves have
fallen off, it  appears to possess its greatest virulence.  These parts
of the plant, when masticated, produce  a  peculiarly cool numbing
sensation, affecting the lips, tongue and interior of the mouth gen-
erally.  At first, the  root appears to be tasteless,  as the  effects are
only manifested after twenty minutes or half an hour.   From tast-
ing only a small portion  of the dried root, I found  that this disa-
greeable sensation remained on the  tongue and lips for four hours.
In larger quantity, the taste has been  described as burning, and
it is stated to have been followed  by a hot acrid sensation in  the
throat.
  Symptoms and appearances.—In from  a few minutes to an hour
after the poison has been  taken, the patient complains of numbness
and tingling in the mouth and throat, which are parched; there is
giddiness, with numbness and tingling in the limbs, a loss of power
in the legs, sometimes frothing at the mouth and severe pain in the
abdomen, followed by vomiting and purging.  In some cases the
patient is completely paralyzed  but retains his consciousness; in
others, the giddiness is followed by dimness of sight, delirium and
other cerebral  symptoms, but not amounting to the complete coma
produced by the cerebral or narcotic poisons.  The pupils are di-
lated, the pulse sinks, the skin is cold and livid, and the breathing
is difficult.  Convulsions are not commonly observed in man, or
they are indicated by general tremors or twitchings of  the volun-
tary muscles. The poison  produces convulsions in animals. Poison-
ing by the root of aconite is by no means unfrequent.  In the spring
or autumn, the root is liable to be mistaken for that of horseradish.
It has been  thus  accidentally eaten on several occasions and has
caused death.  A mistake of this kind led to fatal results in three
hours, in a case which  occurred at  Lambeth ; and  another  set of
cases occurred at  Dingwall, in Scotland, in January, 1856.  Here,
three persons were poisoned by reason  of their having had sauce
made with the root of aconite served at dinner with roast beef, in
place of horseradish  sauce!   They  were healthy adults; they all
iied within  three hours and a half.   Mistakes of this  kind show 
246
SYMPTOMS AND APPEARANCES.
deplorable ignorance, but there is always the risk of their occur-
rence when horseradish and aconite are grown near to each other
in a garden, at that season of the year when the leaves have fallen.
  The tincture of the root is a powerful poison.  In January, 1853,
a woman took by mistake  seventy minims  of Fleming's tincture of
the root, mixed with one  grain  of acetate of morphia.  In  a few
minutes she became very thirsty, complained of a burning sensation
and pain in her stomach, to relieve which she swallowed a quantity
of cold water.  In fifteen minutes there was violent vomiting, which
continued for two hours.   She lost the power of standing, and was
very restless.   The  pain in the stomach increased, and there  were
convulsive  movements  of  the muscles. She was conscious  until
shortly before her death, which took place  in about four hours after
she had taken the poison.  There were no general convulsions; the
pain in the stomach was well  marked throughout.   On inspection,
the membranes of the brain were congested, but  the brain itself was
firm and healthy.  The lungs were healthy; and  the heart was
flaccid, the uterus congested.   The stomach contained some mucus,
and the membrane at the larger curvature was  injected (reddened)
in patches, but otherwise natural.  The mucous membrane of the
duodenum was in a high state of inflammation, abraded in patches,
softened, and broken down.  Some spots were of a very dark color,
passing into mortification.  In October, 1852, an excise officer lost
his life by merely tasting Fleming's tincture of aconite, under the
supposition that  it was flavored spirit.  He was able to walk from
the Custom House over London Bridge, but he  died in about four
hours after taking the poison.
  The case of the man Hunt, who, in Xovember, 1863, destroyed
his wife and children by prussic acid,  presents some features of in-
terest in reference to the symptoms and appearances produced by
tincture  of aconite.   The quantity of tincture taken by him was not
determined ; but the man  was soon  afterwards seized with violent
spasmodic retching, face pale, skin cold and clammy,  pulse small
and  hardly perceptible, and the action of the  heart feeble.  The
pupils were much dilated^ and  the eyes  brilliant and sparkling;
the breathing was quiet and  regular, except during the fits.  He
complained of pain in  his heart.  In  attempting  to walk, he stag-
gered, and had no power to raise his arms.  He was perfectly con-
scious—called for writing materials,  and wrote  a few lines.  He
then became suddenly  worse, and a quarter of an hour before his
death he lost all power and  sensation in his  limbs, the sharpest
pinches producing  no  impression.  The pulse  was imperceptible.
There were no convulsions, but complete relaxation of  the limbs at
death, which  appeared to arise from  syncope, three-quarters of an
hour after he had taken the poison.   On inspection forty-two hours
after death, there was great rigidity of the muscles.  The substance
of the brain was  firm and  healthy ;  the vessels on the surface were
filled with  blood.  The heart was healthy; the right side was
greatly distended with dark fluid  blood ;  the left side contracted
and quite empty.  The lungs  were  healthy.  In the abdomen the 
ACONITE ROOT.
247
viscera were healthy, with the exception of the stomach and duo-
denum.   There was great capillary congestion at the larger end of
the stomach, the mucous  membrane having a bright red color.
There were marks of irritation, with softening and separation of
the mucous lining, the whole of  the membrane being in a highly
corrugated condition.  Traces of  aconitina were found  in the con-
tents of the stomach.  The deceased had provided himself with an
ounce of the tincture of aconite, and had swallowed the greater part
of this mixed with water.
  Analysis.—The botanical character of the leaves and  root, when
any portion can  be  obtained, will enable  a medical witness  to
identify this vegetable  poison.  The root has been frequently and
fatally mistaken for  horseradish, but there  are  these striking dif-
ferences : 1.  Aconite root is very short, conical and  tapers  rapidly
to a point (Fig. 36).  2. It is externally of an earthy-brown color—
internally white and of an earthy smell—the cut surface is rapidly

             Fig. 36.
Root of Aconite.
Root of Horseradish.
reddened by exposure to air. It has numerous long thin fibres pro-
ceeding from it.  3. It has at first a bitter taste, but after a quarter
of an hour or twenty minutes it produces a disagreeable sense of
tingling and numbness  on the lips and tongue. 1. Horseradish root
is long, cylindrical, or nearly so, and of the same thickness for many 
248
ACONITINA.
inches (Fig. 37).   2. It is externally whitish-yellow and has a
pungent odor when scraped.  3. Its taste is something bitter, but it
produces an immediate hot or pungent sensation.
  The leaves  of aconite or monkshood are of a  dark-green color
and  of  a  peculiar shape.  When masticated, they slowly produce
                        Qn the lips and tongue the persistent sense
        Pig. 38.          of tingling and numbness, with the sense
                        of coldness observed in  the root.   They
                        are less  powerful than the roots and seeds.
                        The seeds differ in appearance from those
                        of other poisonous plants (Fig. 38).
                          Aconitina.—The alkaloidal base of this
                        plant, aconitina or aconitia, is a  formid-
                        able poison, exceeding  all others in its
                        effects.   In one case, one-fiftieth part of a
                        grain nearly proved fatal  to an  elderly
                        lady (Pereira,  " Mat. "Med." vol. 2, pt. 2
b The same, magnified 30 diameters,  p. 695); and it is probable that one-tenth
                        part of  a grain of pure aconitina would
prove fatal to  a human being.  Some  samples of this alkaloid are,
however, much  less potent than  others, and the  chemical  proper-
ties  are also different.  (See paper by Schroff, " Reil's Journal fiir
Toxikologie," 3d  H. 1857, p. 335), and one by Liegeois ("Chem.
News," Oet. 24,1863, p. 201.)  This contains the account of a sim-
ple method for its extraction.
  A sample of  Euglish  aconitina possessed the following proper-
ties : It was  in whitish granular masses,  without any  distinctly
crystalline structure.  1.  When  heated it readily fused, and burnt
in the air with a bright yellow flame.  2.  Heated in a close tube,
it evolved first an alkaline, and then an acid vapor.  3.  It was
scarcely soluble in  water, but was dissolved by weak acids and
alcohol; it did not  readily crystallize.  4.  Nitric  acid dissolved it
without causing any change of color.  5. Sulphuric acid gave to it
a yellowish color, and green oxide of chromium was separated on
adding to it  a  crystal of bichromate  of potash.   Aconitina cannot
be separated from  its solutions  in a  crystalline state  by the addi-
tion of ammonia.  6. Tannic acid and the chloriodide of potassium
and mercury readily precipitated it.
  Aconitina is sufficiently soluble in ether to allow of its  separa-
tion  from organic liquids, by a  process similar  to that used for
strychnia.   Dr. Headland recommends  as  a physiological test, the
production of an alcoholic extract of the contents of  the stomach
and its application to animals.  One-twentieth of a grain will be
sufficient; the ^^th of a  grain  will poison a mouse;  the  T£0th,a
bird; and the y^uth causes tingling and numbness of the tip of
the tongue.  The T^xyth of a grain dissolved in spirit and  rubbed
into the skin  causes loss of feeling, lasting for some time.   (" Lan-
cet,  March 29,1856, p. 343.)  There  is a  great  difference in the
properties  of  this alkaloid according to the mode  in which it is
prepared.   (Bouchardat, "Ann.  de  The'rapeutique," 1864, pp. 48
and 54; also, "Annuaire," 1863, p. 41.) 
POISONING  WITH BELLADONNA.
249
                    CHAPTER XXI.

atr0pa belladonna, or deadly nightshade.—poisoning by atropia.
  —lobelia.--foxglove.--digitaline.--datura  stramonium, or
  thornapple.—daturia.

         Deadly Nightshade.  (Atropa Belladonna.)

  Syniptoms.—The symptoms which are produced  by the leaves,
berries, seeds and root of belladonna are of a uniform  character,
and, as a summary they may  be thus described:   Heat and dry-
ness of the mouth and throat, nausea, vomiting,  giddiness, indis-
tinct or double vision, delirum, great excitement,  convulsions fol-
lowed by stupor and lethargy.  The pupils are much dilated, and
the eyes  are  insensible to  light.  In two cases which occurred to
Mr. Tufnell,  the  pupils  were  contracted  during  sleep, although
dilated in  the  waking state.  ("Dublin  Med. Press,"  Jan.  5th,
1853.   "Journal  de Chimie Medicale," 1853, p.  695.)   Several
deaths from the poisonous effects of the berries occurred in London
in 1846.  The following case was admitted  into Guy's  Hospital:
A boy, set. 14, ate, soon after breakfast, about thirty of the berries
of the belladonna, which he had  bought as fruit in the streets.  In
about three hours he had the sensation of his face being swollen;
his throat  became hot  and dry, his vision  was impaired, objects
appeared  double, and they  seemed to revolve and run backwards.
His hands  and  face were flushed, and his ej^elids  swollen ; there
were occasional flashes of light before his eyes.  He tried to eat,
but could not swallow on account  of the  state of his throat.  In
endeavoring to walk home he stumbled and staggered; and he felt
giddy  whenever he attempted so raise  his  head.   His  parents
thought him intoxicated.; he was  incoherent; frequently counted
his money, and did not know the silver from the copper coin.  His
eyes had a fixed, brilliant and  dazzling  gaze; he  could  neither
hear nor speak plainly, and there was great  thirst;  he  caught at
imaginary objects in the air, and seemed to have lost all knowl-
edge of distance.  His fingers were in constant motion ; there wTas
headache, but neither  vomiting  nor purging.  He  did not reach
the hospital until nine hours had elapsed ;  and the syniptoms were
much  the same as those above described.   He attempted to get out
of bed with a reeling, drunken motion;  his speech was thick  and
indistinct;  the  pupils  were so strongly dilated that there was
merely a ring of iris, and the eyes were quite insensible  to light ;
the eyelids did not close when the hand 'was passed  suddenly
before them.  He had evidently lost the power of vision, although
he stared  fixedly at objects as if he saw them ; the nerves of com- 
250
BELLADONNA—APPEARANCES.
mon sensation were unaffected.   When placed on his legs he could
not stand.  His pulse was 90, feeble and  compressible; his mouth
was in constant motion, as if he were eating something. _  His blad-
der was full of urine on admission.  He continued in this state for
two  days, being occasionally conscious, when by a free evacuation
of the bowels, some small seeds were passed ; these were examined
and  ^identified as the seeds  of belladonna.  The boy  gradually
recovered, and  left  the hospital on the sixth day after his admis-
sion ; the progress of recovery was indicated by the  state of the
pupils, which  had then only acquired their natural size and power
of contraction.  In three- other  cases which  occurred at  the same
time, the berries having been baked  in a pie, pains in the limbs,
drowsiness, insensibility, and convulsions were  among the symp-
toms.  In two instances of poisoning  by  the berries related by Dr.
Moll, the symptoms bore a strong resemblance to those of delirium
tremens, but among them were heat and  dryness of the  throat,
loss of power of swallowing, incoherent speech, double vision,  and
strange  spectral illusions, with occasional fits of wild and ungovern-
able laughter.   On the following morning both  these patients
recovered as if from a dream ; but they suffered for some time from
languor, thirst, and dryness of the throat;  the  pupils  also con-
tinued  dilated.  (Casper's " Wochenschrift," 10  Jan. 1846,  p.  26.)
Two cases, showing the poisonous effects of the berries on children,
are quoted in  the " Edinburgh Medical and Surgical   Journal."
(Vol. 29, p. 452.)
  Appearances.—The appearances observed in several cases of  poi-
soning with the berries which proved fatal  in London during the
autumn or 1846, were as follows: the vessels of the brain  were con-
gested with liquid blood ; the stomach and intestines were pale  and
flaccid; there were  some  red spots towards the cardiac end.  In
other fatal cases, in which the appearances have  been reported, the
vessels of the brain and its membranes were found distended with
thick black blood.  Red spots have also  been observed around the
throat and gullet, and  congested patches  of  a dark purple color on
the coats of the stomach.  In some instances the mucous mem-
brane has been completely dyed by the juice of the berries.  A  boy
set. 5, after having  eaten a quantity of  the berries of  the bella-
donna, went  to bed, was  very  restless, vomited once, and  died in
convulsions about fifteen hours  after having taken the poison.  On
inspection, the eyes were half open, with  an intense lustre; the
pupils dilated; the mouth was spasmodically closed and the sphinc-
ter ani relaxed.  The cerebral vessels  were distended with dark-
colored  blood ;  the substance of the brain, cerebellum, and medulla
oblongata, presented neumerous bloody points.   In the throat and
gullet there were several patches of redness.  In  the stomach there
was some fluid, with three open berries; the mucous membrane was
of a reddish-blue color in various parts.  (Case of Dr.  Rosenberger,
Canstatt's " Jahresb." 1844, v. 295.)
  Analysis.—The indigestible nature of the leaves, fruit, and seeds
will commonly lead to their detection in the matters vomited or 
PROPERTIES OF  ATROPIA.
251
passed by the bowels, or in the  contents 0/ the viscera after death.
The seeds of belladonna are  very small—they can be distinguished
by the  microscope  from  the  seeds  of  other
poisonous plants.   They are  of a  somewhat
oval  shape and of a dark color.  Under a low
magnifying power they present a honey-combed
surface (Fig. 39).  In henbane, the surface of the
seeds presents more irregular depressions, resem-
bling those seen on certain corals or madrepores.
The  coloring matter of the berry is of a deep
purple hue:  it is turned green by alkalies, and       ^ a &
red  by  acids.  The leaves would be known by         &  ®
their botanical characters, or a decoction  or in-  a s™J*r°J Jaiiadonna.
fusion of them by the  liquid causing dilatation  & Ma^Ldljodiameters.
of the pupil.
  Atropia.—Atropia is the name given to the alkaloidal principle
of belladonna; it is a powerful poison.  Some consider  it to be
identical with  daturia, the  poisonous alkaloid of thornapple, but
this  is not yet satisfactorily established, either chemically or phy-
siologically.  Symptoms of  poisoning have been produced by the
application of a weak solution  of atropia  to the eyes.  One-eighth
of a grain injected beneath the skin for the relief of sciatica, caused
all the syniptoms of poisoning  with  belladonna. •  One grain used
endermically  nearly proved fatal at Guy's Hospital, and in the fol-
lowing case reported by Mr. Leaeh (" Med. Times and Gaz." July
6, 1865, p. 34)—a man  who  swallowed, by mistake, a grain of sul-
phate of atropia in solution, had  a  narrow escape of his  life.  In
an hour afterwards, the following symptoms were observed: the
pupils  were enormously dilated so  that  the  irides were scarcely
visible; the eyes  moved restlessly from side  to side.  The pulse
was  very quick, and the  patient  appeared  as  if intoxicated.  In
another hour his hands were cold, the pulse was weak, and there
was  loss of power in the limbs.  He became restless, incoherent,
and  unconscious  of preceding  events.  There was also delirium.
In a later stage there was a morbid sensitiveness to sounds and
objects, the tongue was furred and the skin was dry and hot. The
pupils continued dilated for a week, and for several days there was
a partial paralysis of the bladder.  He recovered in a fortnight.
  The criminal administration of atropia is a rare  event in this
country.  A  trial for  murder  by this  alkaloid took place at the
Manchester Lent  Assizes, 1872 (Reg. v. Steele).  The prisoner, who
was  a  nurse  in the workhouse, was  charged  with  administering
atropia to the senior surgeon, Air. Harris, and thereby causing his
death.   The  deceased was taken suddenly ill  after  his breakfast,
aud died under the usual symptoms  of poisoning with atropia,  in
about twelve hours.  The poison was detected in the body by Mr.
Calvert,  and  also in a liquid  found in the room—a solution  of
atropia  in  spirit.  Milk was the vehicle  through which it was
taken.   The  milk as sent from the  kitchen contained nothing in-
jurious, but that  found in deceased's room was tasted by two of 
252
PROPERTIES OF  ATROPIA.
the nurses and both suffered  from  poisoning  by atropia.  The
prisoner had access  to this room, and, it was alleged that she had
a strong motive for this criminal act, but there was no direct proof
to show that she put  the poison  into the milk, and she was
acquitted.
  Analysis.—Atropia is a  white crystalline substance, not  very
soluble  in water, but easily dissolved  by  alcohol, ether, and diluted
acids.   It does not  readily crystallize, but it forms crystallizable
salts.   Ammonia added to the  solution of sulphate of atropia does
not separate the alkaloid in distinct  crystals.  In this  respect it
differs from  morphia and  strychnia.  When atropia is heated on
platinum it  melts, darkens in color, and burns with  a yellowish
smoky flame.   Sulphuric, hydrochloric and nitric acids dissolve it
without any change of color.  Water added to the mixture of sul-
phuric  acid produces no change; but a crystal of bichromate  of
potash produces a green color from the formation of oxide of chro-
mium.  Tannic acid precipitates the alkaloid from its solutions;
but the most effectual precipitant is the chloriodide of potassium and
mercury, which throws down  a dense white precipitate even  in
very diluted  solutions.  Atropia is also precipitated by chloride of
gold, but unlike strychnia, it is not precipitated by sulphoeyanide
of potassium, or chromate of potash.  It may be detected  in, and
separated from, organic liquids by the process of  Stas.   (See  page
238.)   According  to Winckler, atropia  is precipitated most  com-
plete^  from  all its solutions by the chloriodide of potassium and
mercury.  By the use of this precipitant he was able to determine
the proportion of atropia contained in the powder of the dry leaves
and root.  In the leaves the alkaloid varies from 0.41  to 0.49 per
cent, and in the root it amounts to 0.48 per cent. (" Pharm. Journ."
June, 187^,  p. 1029.)'  [According to Wormley ("Micro-chem. of
Poisons," p. 630), the most characteristic test for  atropia is a  solu-
tion of  bromine in hydrobromic acid ;  this reagent produces, even in
highly diluted solutions of atropia, a yellow amorphous  precipitate,
which shortly becomes crystalline.—R.]
  There are no absolute or certain chemical tests  for this alkaloid
when contained in an organic liquid.  The only test  usually em-
ployed is of a physiological nature, namely, the  effect produced on
the pupil by small quantities of liquid, or extract, containing traces
of atropia: the pupil is largely  dilated, and the eye  loses its in-
sensibility to light.   Datura, hyoscyamia and digitaline also pro-
duce  dilatation of  the  pupil; poisonous mushrooms  and other
noxious organic  matters  have a similar effect, so that  there is
nothing conclusive in this result, unless there is also strong evidence
from  symptoms that belladonna  has   been actually taken or ad-
ministered.
  At  the Exeter Autumn  Assizes for  1865 (Reg. v.  Sprague), a
medical man was  charged with attempting to  poison his  wife
and other persons with atropia, which  it was alleged  had  been
placed  in a rabbit pie.  The evidence failed to show  at the trial 
                 POISONING WITH LOBELIA.              253

that the prisoner or any other person could have mixed poison
with the pie, much less such a poison as this, whieh in the dose of
one or two grains, either  destroys life or produces serious illness
continuing for some time.   The symptoms, as described, resembled
those caused by noxious food, and  differed  in many respects from
those of poisoning by atropia.  The only fact on which this chemi-
cal theory seemed to rest was that the pupils of those who ate of
the pie and  were taken ill afterwards, were dilated and a portion
of the extract of the scrapings of the pie dish is said to have caused
a dilatation of  the  pupil of the analyst.  (See "Med. Times and
Gazette," August 12,1866, p. 168 ; also " Chemical News," August
11,1865, p.  72.)  It  is stated that  the supposed poison was sepa-
rated from the baked leg of a rabbit by soaking it in dilute hydro-
chloric  acid; but according  to  those who have  examined the
properties of atropia, this alkaloid melts at 194°, is entirely volatile
under 300°, and is then in great part decomposed.  (" Chemie der
Organischen Alkalien, Schwartzkopf," p. 317.)  The«whole of the
scientific theory rested upon the dilatation of the pupils; but this,
although presumptive, is  not positive evidence of atropia having
been administered.

             Indian Tobacco.   (Lobelia Inflata.)

  The powdered leaves of Indian tobacco contain an acrid principle,
lobelin, which is capable of producing poisonous effects on the brain
and spinal marrow, attended with  irritation of  the stomach and
bowels.   When administered in doses of from ten  to twenty grains,
lobelia operates as an emetic ; but in larger quantity it acts delete-
riously.   In one case a man lost his life by swallowing one drachm
of the powdered leaves, prescribed by a quack.  The person was seen
by a medical practitioner  soon after he had taken the poison; he
was evidently suffering great pain,  but he was quite unconscious ;
the pulse was small,  and the pupils were  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 congested.  (" Pharm. Times,"
May 1, 1847, p. 182.)  The seeds of lobelia are equally poisouous.
In the " Medical  Times and Gazette," Nov. 26, 1853, p. 568, two
cases are reported in which  the seeds proved fatal.  In one the
mucous  membrane of the stomach was highly inflamed.   Another
case is referred to in the  same journal,  March 12, 1853,  p.  270.
There have been many inquests and  trials for manslaughter in this
country  as the result  of the improper  administration of the leaves
of the Lobelia inflata by ignorant quacks, calling themselves medical
botanists and dealers in vegetable medicines.  The medical evidence
given on these trials has proved that in large doses lobelia is a most
noxious  drug. 
254
POISONING WITH FOXGLOVE.
  Lobelia is seen  in  the form  of a greenish-colored powder (frag-
ments of leaves).   This powder acquires a reddish-brown color from
                    strong nitric acid, and is blackened by concen-
                    trated sulphuric  acid.   Iodine water has no
                    effect upon the infusion.   The proto- and per-
                    sulphate of iron produce with it a dark-green
                    color,  the persulphate very rapidly.   The
                    leaves and seeds  contain a resinoid substance
                    called Lobelin, which has the smell and taste
                    of the plant.   It acts as a powerful emetic in
        a            doses of from one-half to one  grain.   The
  ""'/"- -_"-        leaves of  lobelia  are generally seen in frag-
                    ments which do not readily admit of identifi-
    seeds of Lobeha.      cation by  the microscope.   The seeds are very
b Magnified™ diameters.     small, of a lengthened oval  shape (Fig. 40),
                    reticulated on the surface  with projecting
hairs or fibres, and of a light brown color.  The discovery of them
among  the fragments of leaves would furnish a sufficient proof of
the presence of lobelia.

               Foxglove.  (Digitalis Purpurea.)

  Symptoms and effects.—Cases  of poisoning with foxglove  are not
very common.  A boy who swallowed six ounces of a strong de-
coction  of the leaves 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 was slow, small, and irregular;  coma  followed, and the boy
died twenty-two hours after taking the poison.  On inspection, the
membranes of the  brain were found much injected, and the mucous
lining of the stomach was partially inflamed.   The prisoner was
acquitted of the charge because he had only given his fatal advice
on the application  of the friends of the deceased !   (" Ed. Med. and
Surg. Journ.," 27,  223.)  A young  man swallowed a  strong decoc-
tion of foxglove by mistake for purgative medicine.   He was soon
seized with vomiting, pain in the abdomen, and purging.  In the
afternoon he fell  asleep.   At midnight he awoke, was attacked
with violent sickness, colic, and convulsions;  the pupils were di-
lated  and insensible to light;  the  pulse was  slow and irregular.
He died twenty-two hours after taking the  poison.  (Wilmer, op.
cit., Digitalis.)  A few grains  of the powdered leaves have been
known to produce giddiness, languor, dimness of sight, and other
nervous symptoms.  A drachm has, however, been taken without
causing  death;  but in  this instance it  produced violent vomiting.
A common effect of the poison is to produce great depression of the
heart's action.
  Analysis.—When foxglove has been taken in substance, {. e. in
the form of seeds or leaves, or any portion of these has been  swal- 
POISONING  WITH  THORNAPPLE.           255
lowed in  a  decoction  or infusion, fragments
may be found in the stomach and bowels.  In
reference to the infusion, decoction, tincture,
or extract, except there be sufficient to allow
of the separation of digitaline, there is no chemi-
cal process known by which the poison may be
recognized.   If any fragments  of  leaves or   **°.\'°~,$\°.-
seeds are found in the contents of the stomach
or in food, they may be  identified by the aid     seeds of Foxglove.
of the  microscope.   The annexed illustration  ill^Jll'^rn^.
(Fig. 41) represents the seeds of foxglove ; they
are of a reddish-brown color, remarkably small, oblong, and some-
what angular in shape.  They have peculiar markings.  By the aid
of the microscope, they may be easily distinguished from the seeds
of hyoscyamus, datura, belladonna, and most other poisonous plants.
  Digitaline is the active principle of foxglove.  It constitutes one
per cent, of the dried leaves.  Its physiological properties have been
fully investigated by M. Homolle (" Journal de Pharmacie," Janvier,
1845-57; also, by Bouchardat, "Ann.  de Thdrapeutique," 1864, p.
155).  It is an  uncrystallizable substance, and has no well-defined
chemical characters.
  Pure digitaline itself operates as a poison on man and animals  in
very small doses.  The T'sth of a  grain, which  is considered  to be
equal to eight  grains  of the well-prepared  powder of the  dried
leaves, is sufficient to cause symptoms of poisoning.  Doses of from
•j'jth to ^'2cl part of a grain have lowered the pulse and caused
nausea,  vomiting, griping, purging, and an increased secretion of
urine.   (Pereira, "Mat. Med.," vol. 2, p. 528.)  Doses of from one-
quarter to one-half of  a  grain would probably prove fatal to life.
Digitaline has acquired some notority by reason of the trial of Dr.
De la Pommerais, at  Paris, in May, 1864, for the murder of a woman
named Pauw.   (See " Principles of Med. Jur.," p. 438, also " Ann.
d'Hygiene," 1864, torn. 2, p. 105.)

              Thornapple.  (Datura  Stramonium.)

  Symptoms and appearances.—The symptoms produced by stramo-
nium  whether the leaves or seeds are used, are as follows:  Soon
after the poison has been taken there is giddiness, dimness of sight,
a sense of fainting, insensibility,  fixed and dilated pupils, flushed
countenance, and a slow and full  pulse.   Sometimes there is great
restlessness, with a hot and red skin, and a wild and staring expres-
sion in the countenance, the breathing  hurried  and gasping, inces-
sant talking without distinct articulation, and there are attempts
to drive away, or grasp at, imaginary objects.   There is picking at
the bedclothes, with  paroxysms of excessive laughter,  and, if the
person  can walk, it   is with  a staggering gait  and he falls to the
ground as if intoxicated, or completely exhausted.  The  seeds of
datura were used by the Thugs of India for rendering their victims
powerless and insensible. 
256               PROPERTIES OF DATURIA.

  Appearances.—In a  well-marked case of poisoning by stramo-
nium-seeds, in which death took place in less than eight hours, the
following appearances were found: Great congestion of the vessels
of the brain and its membranes, the brain firm and highly injected,
choroid plexus turgid, ventricles containing serum, substance of the
lungs congested, and the heart flaccid.  The stomach  contained
about four  ounces of digested food mixed with eighty-nine seeds of
stramonium.   There were two patches of extravasation in the mu-
cous coat—one on  the larger curvature, and the  other near  the
pylorus.  Many seeds and fragments were also found in  the intes-
tines.  (" Lancet,"  Sept. 18,1847, p. 298.)   In another case there
were marks of diffused inflammation about the cardiac end of  the
stomach.
  Analysis.—The seeds of stramonium, from which accidents have
most frequently occurred, are flattened, kidney-shaped, but half
oval, rough, and of a dark-brown or black color.  They are liable
to be mistaken for the  seeds of capsicum.  Of the dry datura stra-
monium, there are about eight seeds to a grain.   They are of an
oblong kidney-shape, and of a dark-brown or  black  color. The
illustration (Fig. 42) shows their appearance under a low power of
the microscope.   The leaves of the common datura stramonium  are
well characterized by their peculiar shape.
Fig. 42.                         Fig. 43.
Seeds of Datura Stramonium.            Crystals of Daturia, magnified 30
 a Natural size.                            iameters.
 b Magnified 30 diameters.
  Daturia.—The poisonous properties of thornapple  are owing to
the  presence  of an  alkaloid, daturia, which forms about one per
cent, of the dried vegetable.   Some have  considered  this alkaloid
to be identical  with atropia, but the physiological properties are
different.   See Bouchardat, "Ann. de Therapeutique," 1864, p. 24.
[Prof. Wormley believes  these two  alkaloids to be identical  in
both their physiological and chemical  properties.  The bromine test
answers equally well  for each.—R.]  Daturia crystallizes in long
colorless prisms or needles (Fig. 43); it has a bitter taste, somewhat
acrid, and  slightly resembling that of  tobacco.   It  is poisonous.
The eighth  of a grain killed a sparrow in  three hours.  When
placed on the  eye, or introduced into  the cellular membrane of an 
                 PROPERTIES OF DATURIA.              257

animal, it is observed, like atropia, to cause dilatation of the pupil.
When heated in a tube it is decomposed, and ammonia is evolved,
as with other alkaloids.  It is soluble in water, and the solution
has an alkaline reaction.   It is precipitated by tannic atid and by
the chloriodide of potassium and mercury.  Nitric and hydrochloric
acids dissolve it without producing any change of color.  Sulphuric
acid produces with  the  crystals, a  pale  rose-red  color which be-
comes paler when the acid mixture is diluted with water.

  The bark, seeds, berries, and leaves of the Laburnum, Yen:, and
Trivet, have in a  few cases  given rise  to  symptoms of poisoning.
These poisons affect the brain and the alimentary canal, producing
vomiting and purging, followed by insensibility and convulsions.
17 
258
WOUNDS — MEDICO-LEGAL  DEFINITIONS.
WOUNDS  AND  PERSONAL  INJURIES.
                    CHAPTER XXII.

DEFINITION  OF A WOUND.—DANGER TO LIFE.—GRIEVOUS  BODILY HARM.
  —EXAMINATION OF WOUNDS.—DESCRIPTION OF WOUNDS.--CHARACTERS
  OF WOUNDS INFLICTED ON THE LIVING AND DEAD BODY.--ECCHYMOSIS
  ON THE LIVING AND DEAD.—EFFECTS OF VIOLENCE ON THE DEAD BODY.
  —ECCHYMOSIS NOT ALWAYS A RESULT OF VIOLENCE.

  Definition.—In a medico-legal sense a wound implies a breach of
continuity in the structures of the body, whether external or inter-
nal, suddenly occasioned by mechanical  violence.   This  definition
therefore includes injuries to the skin, or mucous membrane of the
outlets of the body, dislocations and fractures, whether  simple or
compound, as well as ruptures of the viscera.  In a medical point of
view, a wound is commonly restricted to those external injuries in
which the skin is implicated;  but in legal medicine, the term has a
much wider signification.
  Danger to life.—When a wound has been criminally inflicted on
a person by the wilful act of another, one of the first questions
which presents  itself for consideration is  how  far the injury  is
dangerous to life.  In order to justify the detention of the accused,
a magistrate may require a medical opinion or a written  statement
from the surgeon in attendance.  The meaning of the words " dan-
gerous to life," is left entirely to the professional knowledge of a
witness.  It is not sufficient on these occasions that he should make
a naked declaration 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 inquired  into by 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 immi-
nent.  A wound  of  a  great bloodvessel,  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 assist-
ance be rendered, these injuries will most probably prove  fatal, and,
indeed, they often  destroy life in spite of  the  best surgical treat-
ment.  When, however, the danger is remote, as in a puncture or
laceration of the hand or foot, which may be followed by tetanus,
or in a laceration of the scalp, which may be followed by erysipelas, 
WOUNDS — DANGER TO  LIFE.
259
or in penetrating wounds of the orbit, which may be attended by
fatal inflammation of the brain or its membranes, the case is some-
what different.   Such injuries as these are not directly dangerous
to life—they are only liable to be  attended with danger in certain
cases, and under certain circumstances; hence the medical opinion
must be qualified.  The law, on these occasions, appears to contem-
plate 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 punctures 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, whether a particular wound
is or is 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
hest deduced from the results  of the observations of good surgical
authorities, in relation to injuries of different  parts of the body.
[In case of application for release on bail, the medical attendant
may be called upon  to testify as to the amount of danger to life
involved in the injury inflicted, and must be governed in his depo-
sition by the principles here  laid down.  The opinion should be
qualified in every case of injury not directly dangerous to life, but
only incidentally liable to fatal termination.  Unless this distinc-
tion be clearly expressed, great  injustice may be done  in with-
holding  a  privilege  which  the law  expressly grants in cases of
trifling wounds.—II.]
   Wounds causing  grievous bodily harm.—A wound may not be dan-
gerous to life, but it may have produced "grievous bodily harm." 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.  In some cases the nature or the  situation of a 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 happen either that the wound itself
is not of a serious  nature, and yet the intention of a prisoner may
have been to do grievous  bodily harm to the wounded person, or
the injury may be really serious, and }Tet  the prisoner may not
have intended to do grievous bodily harm.
  In Reg. v. Davis (Chelmsford Aut. Ass. 1871) a man was charged
with wounding with intent to do grievous bodily harm.   It ap-
peared from the medical  evidence that  the prisoner, half drunk,
and during a quarrel, suddenly stabbed the prosecutor, inflicting a
dangerous wound,  with which he was laid up for a month.  For a
fortnight he was in danger.  It was contended that there was no
intent  to produce  grievous  bodily harm.  Bramwell B.  said the
jury might satisfy themselves on that point by looking to the cir-
cumstances of the  case.  Could a man inflict such a wound as this
without having an intention to inflict grievous bodily injury?  The
prisoner was not so drunk but that he knew what he was  doing, 
260
EXAMINATION OF WOUNDS.
   and all the circumstances showed premeditation and intention—
   the nature of the wound, the weapon used, and the  part of the
   body struck where an injary was so likely to be dangerous.  The
   prisoner was found guilty of the intent.
     Examination of wounds.—In examining a wound on a dead body,
   it is proper to observe its situation, extent, length, breadth, depth
   and direction  ; whether there is about it eff'used blood, either liquid
   or coagulated, and whether there is ecchymosis, i. e. a livid discolo-
   ration of the skin from the effused blood.  It should also be ascer-
   tained whether the surrounding parts are swollen, whether adhesive
   matter, or pus is eff'used, whether the edges of the wound are gan-
   grenous, or any foreign substances are present in  it.   Care must be
   taken that putrefaction is not mistaken for a gangrenous  condition
   of the wound.   The wound may be examined by gently introducing
   into it a bougie, and carrying on the dissection around this instru-
   ment, avoiding as much as possible any interference with the exter-
   nal 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 dissection, every muscle, vessel, nerve or organ
   involved in the  injury should be traced and described.   This will
   enable a witness to answer many collateral  questions that may un-
   expectedly arise during the inquiry.  Another point should be espe-
   cially attended to:  a medical practitioner has frequently contented
   himself with confining his dissection to the injured part,  thinking
   that on the trial of  the accused the questions of  counsel  would be
   limited to the situation and extent 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 important
   organs and cavities of the body have been closely examined ; since
   it maybe affirmed that a natural cause of death might haveexisted
   in  that organ or cavity which the medical witness had neglected to
   examine.  It rests with the practitioner to disprove the probability
   thus urged by counsel, but he is now destitute of facts on  which he
   can base an opinion ; legal ingenuity will  triumph, the witness will
   be discomfited, and the  prisoner, of whose  guilt there may be,
   morally speaking, but little doubt, will have the benefit of his inat-
   tention, and be acquitted by the jury.  In the medical reports on
   the examination of  the bodies of wounded persons, care should be
   taken to avoid the introduction of any remarks in the form of infer-
   ences  from the facts of the case.  The facts  should  be simply re-
   corded, and the inferences or comments reserved for evidence at the
   inquest or trial.  In making an inspection  of the wounded  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
   of which a portion may be found in the stomach  or bowels.  Even
   when there may be  no suspicion of poisoning, it will be  necessary
   to  observe the state of the stomach and its contents—i.e. to deter-
   mine whether it contains food, the nature of the  food, and the de- 
        WOUNDS  ON  THE LIVING  AND DEAD BODY.     261

gree to which it may have  undergone digestion.   In Reg. v. Spicer
(Berks Lent Assizes, 1846), the falsehood of one part of the prisoner's
defence was made evident by an examination of the stomach.   The
deceased was found dead  at the foot of a stair.   The prisoner
stated that after he and his wife had  had their dinner, he heard a
tall.  The woman  had died instantaneously, and the fall was heard
by neighbors at or near 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.
  Characters of a wound  inflicted  during life.—If  we find about a
wound marks of gangrene, the effusion of adhesive  or purulent
matter, or if the edges are  swollen and enlarged,  and cicatrization
has commenced, it is not only certain that the injury must have been
inflicted before death, but that the person 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  infliction 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 bleeding,  the blood having chiefly an
arterial character, and it will be found coagulated where it has fallen
on surrounding bodies.   The  edges of the wound are everted, and
the muscular and cellular  tissuearound is deeply reddened by eff'used
blood.   Coagula or clots 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 hemor-
rhage or bleeding, often of an  arterial character, with general diffu-
sion of blood in the surrounding  parts.   3. The presence of coagula.
The wound may not have involved any vessel, and there may be no
appearance of bleeding,  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
inflicted,—an opinion afterwards confirmed by the  confession of the
mother.
  Character of a wound made after death.—If the wound on a 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 charac-
ter, 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 wound in the living.  The edges
are  soft, yielding, and destitute  of  elasticity;  they are therefore in
close approximation. The cellular and muscular tissues around are
either not infiltrated with blood,  or only to a very partial extent.
There are  no coagula within the wound.   In experimenting upon
amputated limbs, I have found these characters possessed by a wound 
262
ECCHYMOSIS.
produced 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 body, divided arteries have no
marks of blood about them, while in the living body the fatal bleed-
ing commonly proceeds from these vessels.   Hence, in  a wound on
the living, it will be found that the surrounding vessels are empty.
The chief  characters of a wound  after death are, therefore: 1.
Absence of copious bleeding.  2. If there  is bleeding, it is exclu-
sively venous.   3.  The edges of the wound are close, not everted.
4.  There is no diffusion of blood  in the cellular tissue.  5.  There is
an absence  of coagula.   But it may happen that a wTound has been
inflicted soon after the breath has  left the body, and while  it 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.
  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 investiga-
tion, any one but a murderer would think of inflicting upon a body
immediately  after death  a wound 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,
medicalty speaking, a matter of  uncertainty.
  Ecchymosis from violence.—Contusions and contused wounds are
commonly  accompanied by a discoloration of the surrounding skin,
to which the term ecchymosis (fx2^, to pour out) is applied.  This
consists essentially in the extravasation, or effusion of blood gener-
ally from  small  ruptured vessels, into the surrounding cellular
membrane  beneath the skin.   An ecchymosis is commonly superfi-
cial, affecting only the layers of the skin, and showing itself exter-
nally, either immediately, or in the course of a short time, in the
form of a deep blue, or livid red patch; but the effusion may be so
deeply seated as not to present  any external discoloration  of the
skin.
  Violence inflicted on a  living body may not show itself under
the form of  ecchymosis until after death.  A man received from
behind  several kicks on  the  lower part of his 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., in 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.")  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; they may become apparent only after the body has been ex-
posed for some days, and the water has evaporated.
   A medical jurist must guard against the error of supposing that 
ECCHYMOSIS.
263
when a blow has been inflicted on a living person, it is necessary
that the  individual who is  maltreated should survive for a  long
period in order that ecchymosis should  be produced.  Among nu-
merous instances proving the contrary, the case of the Duchess of
Praslin (August, 1817)  may be mentioned.  This lady, who was
assassinated by her husband, was 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 inspection, there were the marks
of numerous  ecchymoses, which had resulted from the violent use
of a bruising  instrument.  (" Ann. d'Hyg." 1847, t. 2, p. 377.)
   The changes which take place in the color of an ecchymosed spot
are worthy of attention, since they may serve to aid the witness in
giving an opinion on the probable time at which a contusion has
been inflicted.   After a certain period—commonly in eighteen or
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 dis-
appearance, it passes successively through shades of a green, yellow
and lemon color.  During this  time, the spot is much increased in
extent, but the central portion of the.ecchymosis which received the
violence 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 effused blood by the
fluid of the cellular membrane, and its  slow and uniform disper-
sion throughout the cells.  The color is finally entirely removed by
the absorption of the blood.  The extent and situation of the ecchy-
mosis, 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 cir-
cumstances which  may  influence the  progress  of these  changes.
Thus, an ecchymosis is longer in disappearing in the old than in the
young.   Where the cellular membrane is dense, the ecchymosis,
ceteris paribus, is not so rapidly formed; nor, when formed, do the
above changes take place in it so speedily as when the  blood  is
effused into a loose portion of membrane, like that surrounding the
eye, or existing  in the scrotum.
   Evidences 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 wTas offered.
In hanging, the impression caused by the cord on the neck is some-
times 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 men-
tioned by Starkie, which shows  that the form  of an ecchymosis
may occasionally furnish presumptive evidence against an accused
party.  In an attempt at murder, the  prosecutor, in  his  own de-
fence, struck the assailant violently in the face with the key of the
house-door, this being the only weapon he had near at hand.   The
 ecchymosis which followed  this contusion corresponded in the im-
 pression produced on the face to the wards of the key; and it was 
264          CONTUSIONS ON THE  DEAD BODY.

chiefly through this  very singular and unexpected  source of evi-
dence that the assailant was afterwards identified and brought to
trial.   ("Law of Evidence," vol. 1, art. Cir. Ev.)
  Contusions on the dead.—Dr. Christison found that blows inflicted
on a dead body not more than two hours after  death, gave rise to
appearances on the skin similar to those which  resulted from blows
inflicted on a person recently before death.   The livid discoloration
thus produced generally arose from an effusion of the thinnest pos-
sible 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 per-
ceptible stratum of the true skin  itself.  He likewise found that
dark fluid blood might even be effused into the  cellular tissue in the
seat of the discolorations, so  as  to  blacken or  redden the mem-
branous partitions of the cells containing the fat; but this last effu-
sion was  never  extensive.   From this, then,  it  follows that, by
trusting  to external appearance only, contusions  made soon after
death  may be easily confounded with those which have been pro-
duced  by violence shortly 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 color in the ecchymosed patch,
in either of which cases there will be  no difficulty  in forming an
opinion.   Although ecchymosis, or an appearance analogous to it,
may be produced on a body after death, the changes  in color  are
then met  with under peculiar circumstances, as where the patient
is laboring under general dropsy, and the serum effused beneath the
skin may lead to the diffusion of the blood.  The most satisfactory
mark of distinction between the effects of blows on the living and
dead body, in  the opinion of Dr. Christison, is  the following: In a
contusion inflicted during  life, the ecchymosed  portion of cutis
(true skin) is generally dark and much discolored from the infiltra-
tion of blood throughout its whole thickness ; the skin at the same
time is increased in firmness and  tenacit}^.  This is not, however,
a uniform consequence of a contusion during life ; for a blow may
cause effusion  of blood beneath the skin without affecting the cutis
in the manner stated.   The state of  the skin here described cannot
be produced by a contusion on a dead body, although it is still an
open question whether it might not  be produced if the contusion
were inflicted  a few minutes 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,  Ave must look for other differential marks,
and when it does exist, we ought  to satisfy ourselves that the con-
tusion was not inflicted recently after death.
  Sir R. Christison's experiments lead to the conclusion that severe
blows  inflicted on a recently dead body produce  no greater degree
of ecchymosis or cutaneous discoloration than slight  blows inflicted
on the living.   Assuming  that the great extent  of an ecchymosis
would in  all cases serve to show that  the violence in  producing it
had been  inflicted during life, it must be remembered that the im-
portance  of these facts, in relation to medical  evidence, is  not 
         ECCHYMOSIS AS A  RESULT  OF  VIOLENCE.      265

affected by the extent of the discoloration.   It may be just as neces-
sary 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 or suffocation, if they can  be certainly pronounced
vital, may make all the difference between the acquittal and con-
viction of a person  charged with murder.  Again, slight ecchy-
mosis  on the  bodies  of the drowned may  excite a suspicion of
strangulation and subsequent immersion of the body in water.  So
in reference  to child-murder.   An  infant may  be destroyed by
violence, and only a  few slight marks of ecchymosis  found upon
its body.
  The practical inference from  these observations is, that discolora-
tions of the skin caused by blows  inflicted soon after death, may be
sometimes mistaken for marks of  violence on  the living body.   An
instance has been communicated to me, on respectable authority, in
which, for the sake of experiment, blows with a stick were inflicted
on the recently dead body of  a  woman,  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 de-
ceased 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 occurring.
  Ecchymosis in the dead body.   lividity.—Ecchymosis may present
itself in various forms on the skin of a dead body.  The  first form
when it occurs, is almost an immediate consequence of death, but
it is not fully developeel until the  body has cooled.  It is commonly
called cadaveric lividity.  It presents itself in  diffused patches ot
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 limbs, either on  their internal or external sur-
faces, or on their whole circumference, are often thus completely
ecchymosed.  The  appearance  is  wholly unlike  the effects of ex-
ternal violence.  Ecchymosis may be a result of putrefaction from
the fluid blood escaping from a vessel.  Effusions of blood beneath
the skin from  causes operating after death  may produce appear-
ances like  those caused by violence, and  in certain  exceptional
eases zones of color somewhat  resembling those of a disappearing
ecchymosis may be produced.
  Is E-chymosis a  necessary result of violence?—This medico-legal
question has often created great difficulty.  It has been repeatedly
asserted in courts of  lawT that  no  severe blow could have been in-
flicted on the body of a person found dead, in  consequence of the
absence of ecchymosis  or other indication of violence on the part
struck;  but  this assertion  is entirely opposed  to well-ascertained
facts.   However true the statement may be that severe contusions
are commonly  followed  by  ecchymosis, it is open to numerous ex- 
266      ECCHYMOSIS AS  A RESULT OF VIOLENCE.

ceptions; and unless these are known to a 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 presumption.
  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
also observed in respect to ruptures of the stomach, intestines  and
urinary bladder, from  violence  directly applied  to the abdomen.
Portal supposed that the mechanical impulse was simply transferred
through the supple parietes (or skin) of the abdomen to the viscera
behind, as in the striking of a bladder filled with water.  Whether
this be the true explanation or not, it is quite certain that the small
vessels of the skin often escape rupture from a sudden blow, so that
their contents are not effused.  A case is reported by Henke, in
which a laboring man died some hours after fighting with another,
and on an inspection of the  body the peritoneum was found exten-
sively inflamed, owing to an escape of the contents of the small in-
testines, 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
of greater experience were appealed to,  who at once admitted that
the laceration of  the intestines might have been caused by a blow,
even although there  was no appearance 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 in-
spection there was  no mark of injury externally, but the ileum
(small intestines)  was found  ruptured, its contents extravasated,
and the peritoneum extensively  inflamed.  (" On Homicide," p.
187.)  Dr. Williamson, of Leith, met with a case in which 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, a fact which 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.  See  also
Guy's Hosp. Reports, Oct. 1865, p. 285.)  Many other  cases might
be adduced in support of the statement  that ecchymosis is not a
necessary or  constant result of a severe blow ;  but these sufficiently
establish the fact.  This medico-legal question frequently arises in
cases in which the  bladder or liver  is ruptured, as, owing to the
general absence of marks of violence, it is often alleged in defence
that no blow or kick could have been inflicted  on this part of the
abdomen.  It is unnecessary to  say that this view is not in accord-
ance with facts. 
EVIDENCE  OF THE  USE  OF  A WEAPON.        267
                   CHAPTER  XXIII.

EVIDENCE OF THE USE OF A WEAPON.--CHARACTERS OF WOUNDS CAUSED
  I'.Y WEAPONS. — INCISED,  PUNCTURED,  LACERATED, AND CONTUSED
  WOUNDS.—STABS AND CUTS.--WHAT ARE WEAPONS?--EXAMINATION
  OF THE DRESS.--IMPUTED OR SELF-INFLICTED WOUNDS.

  Evidence of the use of a weapon.—It is not necessary to prove that
a weapon  has  been used for the production of a wound, for the
words of the new  statute are:  "Whosoever shall, by any means
whatsoever, wound, or cause any grievous bodily harm to a person,"
etc.; yet evidence of the use of a weapon  in  cases of assault  may
materially affect the amount of punishment awarded on conviction.
When  upon the clearest evidence, it is certain that a weapon  has
been used, it is  not  usual  for prisoners  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.   Schworer relates  the  following 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 stated that  the wound had  been caused by this
knife.  The wounded person  recovered ; but a year afterwards an
abscess formed in his face, and the broken point of the real weapon
was discharged  from it.  The wTound could not therefore have  been
produced  by  the knife which was brought  forward as  evidence
against the prisoner at the trial.   (" Lehre von dem Kindermorde.")
Although the criminality  of an act  is not affected 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  Renaud, by  Dr.  Boys de Loury, "Ann.
d'Hvg." 1839, t. 11, p. 170.  As to what is a  weapon, see Henke,
" Zeitschrift der S. A." 1844, vol.  1, p. 67.)
  Characters of wounds produced by weapons.—Let us now suppose
that no wreapon is discovered, and that  the  opinion of a witness is
to be founded only on an examination of a 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  generally  implies malice, and in
most cases a greater desire  to  injure  the  party assailed  than the
mere employment  of manual force. Some wounds, such as  cuts
and stabs, at once indicate that  they must  have  been produced by
weapons. 
 268  CHARACTERS OF INCISED  AND PUNCTURED WOUNDS.

   1. Incised wounds.—In incised wounds the sharpness of the instru-
 ment may be inferred from the cleanness and regularity with which
 the edges are cut; in stabs, also, the form and  depth of a wound
 will often indicate the kind of weapon employed.  Stabs some-
 times  have the characters  of  incised punctures, one  or both  ex-
 tremities of the wound being  cleanly  cut, according to whether
 the weapon is  single or double-edged.   Dupuytren has remarked
 that such  stabs, owing to the elasticity  of skin,  are  apparently
 smaller than the weapon—a point to be remembered in instituting
 a  comparison  between  the size of  a wound and  the instrument.
 A lateral motion of the weapon may, however, cause a consider-
 able enlargement of  the wound.  (See case  " Ann. d'Hyg." 1847, t.
 1, p. 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 sometimes 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 interference with it.
   Punctured wounds.—It is necessary to notice whether  the edges
 of a punctured wound are lacerated  and irregular,  or incised;
 because it may be alleged  in defence, that the wound was produced
 by a fall on some substance capable  of causing 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 pri-
 soners charged with the  murder,  to  her  having fallen on some
 broken glass;  but it was proved that the edges of the wound were
 bouhdeel everywhere 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
 general, wounds made by glass or earthenware 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 medical witness should never
 fail to make a minute examination of a wound which is  suspected
 to have been criminally inflicted.  These  medical  difficulties are
 now for the most part removed  by the 24th and  25th Victoria,
 Chapter 100.  This must not, howrever, lead the witness to suppose
 that a personal injury is not to be carefully examined with a view
 to the determination of this question.
   2. Lacerated and contused wounds.—Lacerated wounds do not  in
 general present greater difficulty with regard to their origin than
 those which are incised or punctured.  The means which produced
the laceration  are commonly well indicated by the appearance of
 the wound.  These injuries  are generally the result of  accident;
 they are, howTever, frequently met with on  the bodies of new-born
children, in  which case they may give rise  to  a  charge of infanti-
cide.   If it could be proved that they had arisen from the use of a
weapon, this would of course, go far to a conviction on a charge of 
INJURIES FROM BLOWS OR FALLS.
269
murder.  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 blowr of the fist, or a fall, by reason of the  deceased
having accidentally fallen  against some hard surface.  The ques-
tion 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 combined. The
skull  may, or may not  be fractureel:  and the  person may die of
concussion, inflammation of the brain, or from  effusion of blood.
The general defence is that the  deceased struck his heael against
some  hard  substance in  falling on the ground, and a surgeon is
asked whether the particular appearance  might not  be explaineel
on the supposition of a fall.   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  anel not by a fall.
Some circumstances, however, may occasionally enable him to form
an opinion on this point.  If there  are contuseel 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 are  on  the  summit of the head, it is highly
probable that they have been caused by  a weapon, since this is not
commonly a part which  can receive injury from a fall.  So if sand,
gravel, grass or other substances be found in a contused wound, this
will render it highly probable that the injury was really caused by
a fall.
  It matters not, under the new Statute on wounding, whether the
wound was produced directly by a weapon employed by an assailant,
or indirectly by any act  of violence  on his part.  A man may frac-
ture the skull of another either by striking him with a brick, or by
striking him with  his fist and thus causing  him to fall against a
brick.  Acquittals formerly took place  upon  technicalities of this
kind ("Law Times," March 21, 1846, p. 501);  but in Reg. v. Dodd
(Shrewsbury Summer Assizes, 1853) Coleridge J. expressed a strong
opinion  against  the distinction thus made.  The prisoner, it was
alleged, threw a stone at the deceased, who immediately fell on a
stone floor.   The  deceased was  able to go about for  several days,
but he died a week after he had sustained the violence, from  in-
flammation of the brain, as a result of fracture of the skull.  The
medical witness ascribed the fracture to a blow from a stone.   In
the defence it was urged that the fracture might just as -well have
arisen from a fall on a stone floor.  Coleridge J. held, if the prisoner
knocked the deceased  down,  that it would  make  no difference
whether the deceased died from a fall on a  stone floor, or from
injury produced by the stone which was thrown at him.
  [We think there can be  no doubt that a blow of the fist is capa-
ble of producing a fracture of the thin  portions of the skull, e. g.
the temporal region—and this either with, or without an  external
wound.  In a doubtful case, where the question, whether such a 
270         INJURIES FROM BLOWS OR FALLS.
fracture was caused by the fist, or by some weapon, a careful post-
mortem examination  of the  cranium would most probably deter-
mine the point;  the fracture from  the fist would  be very apt to be
radiated, while that resulting from a weapon, such  as a billy, or
a loaded cane, or a hammer, would be more regularly depressed, and
also more circumscribed.—R.]
  A doubt may arise whether a weapon has or has not been used
in reference to lacerated or contused wounds. Contused wounds on
bony surfaces, as on the head, sometimes present the appearance of
incised wounds, the skin being evenly separated.  When a wound
is recent, a careful examination will generally enable a witness to
form a correct opinion, but if some time has elapsed before a wound
is examined, great caution will be required in forming a judgment.
  A surgeon  should be cautious in listening to the statements of
others  that a weapon has been used, unless the wound itself bears
about it such characters as to leave the fact indisputable.  During
a scuffle, the person assaulted may be easily deceived as to the way
in which an accused party inflicted a wound upon him ; and a bad
motive may sometimes exist for imputing to an assailant the use
of a weapon during a quarrel.  In such  cases we should, as medical
witnesses, rather trust to the appearance of the wound for proof of
the use of a weapon, than to any account given by interested parties.
  A late learned judge suggested to me that some means of discrimi-
nation between the effects of falls and blows affecting the same parts
of the body, would greatly aid the administration of justice.  There
is no doubt that it would, but as no two cases  coming under this
class of injuries  are precisely alike, either  in the part wounded or
the amount of force employed, it is scarcely possible to introduce
general rules, or to make statistics practically available.  It is com-
monly supposed that a mere fall is not sufficient to produce the same
degree of injury that may be  caused by a blunt  weapon applied
suddenly to the head by human force;  but a severe fracture may
arise from a simple accident of this kind, and present nearly all the
characters of homicidal violence.  The difficulties at criminal trials
will, I think, be found to proceed, not so much from want of rules
to assign the violence to one condition or the other, as from a want
of proper  observation when the wounds  are first examined.  If
minute attention were given to an examination of these injuries
soon after their occurrence, circumstances would be noticed  which
would help the medical witness to a conclusion.   The defence that
they might have been produced by a fall, is not set up until a sub-
sequent  period, and the surgeon  is then  obliged to trust  to  his
memory for the main points of distinction.  Such improvised opin-
ions usually fail in impressing a jury.
  When it is a question which  of two weapons produced certain
bruised wounds found on the head, the difficulties of medical evi-
dence are increased.  Under these circumstances, the presence of
blood, hair, cotton, or woollen fibres on one of the weapons may
render it probable that this weapon was used.  In most instances,
an accurate observation of the form of a contused wound and an 
STABS AND  CUTS.
271
early comparison of it with the alleged -weapon or the substance
said to have produced it, will enable a witness to come to a correct
conclusion on the subject.  The situation, depth, and shape of the
wound may be such that no accidental fall could reasonably account
for its production.  In assaults on women, it is not unusual to find
that the complainant  herself endeavors to exculpate the assailant
(her husband) by ascribing the marks of violence, not to blows, but
to some accidental fall.  In August, 1864, a women deposed before
a magistrate that certain severe injuries which she had sustained
had been caused by her falling on a fender.  The medical man who
examined her found on the top of the head three distinct wounds
which were  bleeding.  Two appeared  as if they had been caused
by a blunt instrument; the third on the back part of the head was
a clean cut wound.   He considered that they had  been produced
by a chopper, and that none of them had been caused  by  a fall or
a series of falls.  The prisoner, on this evidence, was committed
for trial.
  3.  Stabs and cuts.—It has been remarked that  the law in some
cases attaches great importance to the clear proof of tile  use of a
weapon, and a medical man has therefore a certain responsibility
thrown upon him when, in the absence of a weapon and the denial
of its use, he is  called upon to  say whether one has or has not been
used.  In reference to cuts and  stabs there can in general be no diffi-
culty, for these  injuries carry with them distinct evidence of their
mode of proeluction.   Formerly stabbing and cutting were treated
as distinct from wounding, and very nice legal distinctions were
drawn between these  terms, which had the effect of procuring ac-
quittals on mere legal technicalities.  Under the new consolidated
Act, the  words "stab" and "cut"  are  properly omitted,  and  the
word " wound"  only has been retained.  Medical men would always
agree upon a stab or cut being a wound, but they might reasonably
differ upon the question whether in a given case a wound was really
a stab or cut.  It might be punctured, lacerated, or contused, anel
not fairly come under the professional description of a cut or a stab.
In the mean time  the only person  who derived benefit from this
grammatical confusion was the assailant who had inflicted the un-
defined injury  on  another.  A medical witness has now only to
prove that the personal injury falls strictly within the  meaning of
the term wound ; he is not called upon to prove the precise variety
of wounding to which the injury should be assigned. At the same
time he will always  be  prepared  with a full description of the
characters of an injury in case questions on the subject should be
put to him.
  What are weapons.—The new statute has removed  those legal
doubts which formerly arose in reference to  the true signification
of the term weapon.  Thus the  teeth, the hands or feet uncovered,
were  formerly held by the judges not to be weapons; and  injuries
produced by them, however severe, were  not treated  as  wounds
within the meaning of the statute.  Parties were tried on charges
of biting off fingers and noses, and although  the medical evidence 
272
EXAMINATION  OF  THE  DRESS.
proved that wounds of a severe kind had been  inflicted, and that
great disfigurement and mischief had been done to individuals, yet
the nature of the injury produced was not so much regarded as the
actual method by which it was accomplished. The persons charged
were acquitted under an indictment for " wounding," since wounds
in a legal sense could be produced only by weapons, while the  teeth,
hands, and  feet were not -weapons in law!
  Examination  of the dress.—This is sometimes a most important
part of the  duty of a medical man.   In a case of severe wounding,
of whatever kind, he should always require to see the dress of the
wounded person.   It may throw a material light upon the mode in
which a wound has been produced; it  may  remove an erroneous
suspicion of murder, and may  sometimes serve- to indicate  that a
wound has  been self-inflicted for the concealment  of other crimes,
or falsely to impute its infliction to other persons.  Marks of blood,
dirt, grass or  other substances on the clothing may also throw light
upon the mode of infliction.  So  again, the use of a weapon in
reference to cuts  and  stabs, may be inferred from  the dress pre-
senting corresponding cuts or  perforations.  Contused wounds by
bludgeons may, however,  be readily produced  through the dress
without tearing or injuring it. Considerable laceration of the skin
and muscles, and even severe fractures,  may be caused without ne-
cessarily penetrating the dress, supposing it to be  of an elastic or
yielding  nature.   In  self-inflicted  or  imputed  wounds, if of the
nature of cuts and stabs, there  is often  a want  of correspondence
between the perforations of the dress and the wounds on the person;
this is one of the characters by which the correctness of a statement
may be tested.   A severe  wound may be indirectly  produced by a
bruising 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 actually caused the -wound.  Cases of this kind must
be determined by the circumstances which accompany them.  Hence
it is obvious that a  medical  practitioner should always make a
minute and careful examination of wounds which are  likely to be-
come the subject  of  criminal charges, as well  as of the dress or
clothing worn by the wounded person at the time of the assault.
  If several wounds have been inflicted through  the dress, an ex-
amination  of this may sometimes  suffice to show which was first
received.   A man, in  struggling with  an assailant, received three
stabs with  a knife—two on the  left elbow, and  the third  in the
back.  The latter wTas at  about the level  of the eighth rib;—it
was vertical to the chest, and had clean edges.  The lower margin
was obtuse—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 
            CHARACTERS  OF IMPUTED WOUNDS.         273

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 cor-
rectness of the medical opinion was confirmed by the evidence at
the judicial inquiry.  (See "Ann.  d'Hygiene," 1847, p. 461.)
  Imputed self-inflicted  wounds.—A man  may produce on himself
one or more wounds for the  purpose of simulating a homicidal as-
sault, which he may allege to have  been committed upon him.  With
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 awray a suspicion of criminality from the wounded
person himself; but it is not always easy to trace a motive for the
self-infliction  of injuries;  and when a reasonable motive  is not at
once forthcoming,  persons are apt to be misled  and to credit  the
story.  Persons who have been convicted of thus imputing violence
to others, have  frequently borne  respectable characters  until  the
occurrence, and this has contributed to give support to their state-  ..
ments.  When a person 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 without  difficulty be cleared up  by circumstantial  evidence.
Imputed  wounds, if we except  the case  of an  actual attempt at
suicide, in which the injury is commonly  severe, are generally of a
superficial character, consisting of cuts or incisions not extending
belowr the true skin; deep stabs are seldom resorted to where the
purpose is not suicide, but merely to conceal other crimes.  Further,
these wrounds are in front of the person, and may be on the right or
left side,  according to whether  the person is right or left-handed.
They have also  been generally numerous, and widely scattered;
sometimes they have had a complete 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 con-
sidered mortal, and there is  in  general an entire want of  corres-
pondence  between the situation of the wounds on the person, and
the cuts or other marks on the dress. This is a fact which requires
special  attention.
  In comparing cuts on the dress wuth wounds on the person, there
are several circumstances to be attended to.   What articles of dress
were worn at the time of  the assault ?  In a case of actual stabbing
by another, all ought to present marks of perforation, corresponding
in direction, form, size,  sharpness  of the edges of the weapon,  etc.
In imputed wounds, the marks  on several layers of dress may not
correspond with each other in the  characters above mentioned.   It
is very difficult for a man simulating such injuries so to arrange his
      18 
 274        CHARACTERS OF  IMPUTED WOUNDS.

 clothes when off his person, as to decieve a careful examiner.  There
 will be some inconsistency or want of adjustment.   Apart from the
 fact that several stabs or cuts cannot exist on the same part of the
 clothes, without one or more being stained with blood on the out-
 side or inside, an impostor may either do too  much or too little, and
 thus lead to his detection.   In  a case which excited much public
 discussion in London many years since, a simple circumstance led
 to the inference that certain  stabs or cuts through  a  shirt had not
 been produced while the shirt was on, but while it was off the body.
 There were twTo cuts in  the shirt near to each  other, precisely
 similar in  size, form, and direction; in  fact, the knife  or dagger
 producing them must have  gone through a fold of  the shirt, so
 accurate was the correspondence.  Then, however, it  followed that
 the shirt could not have been upon  the body of the wounded per-
 son, as he  alleged, because a stab through a  shirt when worn over
 the  skin must, in order to reach the body, traverse  not only a fold
 (producing two cuts), but another layer in contact with the skin,
 and thus produce three cuts, or in the event of traversing two folds,
five cuts. In simulating the wounds by cuts on the shirt, the person
 is supposed to have forgotten this, and have  merely stabbed a fold
 of the shirt while lying on a table, or in some situation convenient
 for the purpose. This, among other facts, rendered it probable that
 the slight wounds on the chest were self-inflicted.
  It has been  contended that no rules  can be laid down for the
 detection of such  cases; each must be decided by the facts wdiich
 accompany it.  The  facts which a medical man must endeavor 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 depth 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, and, 4. The
 marks of  blood, and the quantity effused at the  spot wdiere the
 mortal struggle is alleged to  have taken place.
  It is worthy of remark, that imputed wounds are generally cuts
 or stabs.  They are seldom of the contused kind: the impostor can-
 not, in reference to contusions, so easily calculate upon the amount
 of mischief which is likely  to ensue.  Dr. Burgeret, however, has
 related some cases in which  females laboring under hysterical at-
 tacks  have inflicted  upon themselves severe contusions, and have
 charged innocent persons with attempts to murder.   ("Ann. d'Hyg."
 1863, vol. 1, p. 463.)   In general the inconsistency of the story is
 so palpable as to betray the imposture at  once ;  but the public are   J
 easily deceived, and much prejudice is often unjustly excited against
 those who have been falsely accused. Slight excoriations  or bruises
 may be magnified into marks of murderous violence;  and  if a
 medical man can be  found to admit  in an unqualified form that a
 severe blow can be inflicted and yet leave but slight  marks on the
 skin, the charge will be considered proved against the unfortunate
 accused. The case of M. Armand,a merchant of Montpellier, who was
 tried at the Assizes at Aix, in March, 1864, for an alleged murderous 
     EVIDENCE FROM THE SITUATION OF  A WOUND.   275

assault upon his servant Maurice Roux, furnishes a good illustra-
tion of the readiness with which the most inconsistent stories are
accepted by the public when they are supported by pseudo-medical
evidence.
  Pistol-shot wounds are sometimes voluntarily inflicted  for the
purpose of imputing murder, or extorting charity.   A man intend-
ing to commit suicide by firearms, and failing in the attempt, may,
from shame and a desire to conceal his act, attribute the wound to
the hand of some assassin.  In  examining such imputed wounds
they will not be found to involve vital parts, except in cases of at-
tempted suicide, and they will possess all  the characters  of  near-
wounds produced by gunpowder, wadding, or a bullet., The skin
around will be more  or less lacerated and bruised; there will be
much ecchymosis, 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
inflicted by a person on himself, must always partake of the cha-
racters of a near-wound.
                   CHAPTER  XXIV.

WOUNDS INDICATIVE  OF  HOMICIDE,  SUICIDE, OR ACCIDENT.—EVIDENCE
  FROM THE SITUATION  OF  A WOUND.—EVIDENCE FROM  NATURE AND
  EXTENT.—EVIDENCE FROM THE DIRECTION OF A WOUND.—WOUNDS
  INFLICTED BY THE  RIGHT, OR LEFT  HAND.—SEVERAL WOUNDS.—USE
  OF SEVERAL WEAPONS.

  Wounds indicative of homicide, suicide, or accident.—Supposing that
the wound which is found on  a dead body is proved to have been
caused before death, it may be necessary 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 in-
stances it may be so, and the settlement of it is then properly left
to the legal authorities;  but,  in a 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
should direct his  attention?  They are,  with regard to the wound,
1, its situation, 2,  its  nature and extent, and 3, its direction.
  1. Evidence from the  situation of a wound,.—Most medical jurists
agree, that wounds inflicted by a suicide, are usually confined  to
the fore, or lateral parts of the body.   The throat and che3t  are
commonly selected, when cutting instruments are employed; while 
276  EVIDENCE  FROM NATURE AND  EXTENT OF WOUND.

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.  Some have
regarded it as fully established in legal medicine, that when wounds
exist at the back part of the body, it is a positive proof that they
have not been self-inflicted.  This situation is  certainly 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  evi-
dence against the presumption of suicide.   A wound, traversingx
the body from behind to  before in a direct  line, is not  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 believe  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 ex-
pect to find suicidal wounds in what an anatomist would pronounce
to be, the most appropriate situation  to produce instant destruc-
tion.   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 a deliberate use of  the weapon.  Suicidal
wounds, are, however, sometimes found in unusual situations.  In
reference  to this  subject, it  has been  remarked, 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  cir-
cumstances, a suicide would be  incapable of producing on his own
person.  We cannot  always obtain certainty in  a question  of this
kind—the facts will  often allow  us to speak only with  different
degrees of probability.
   The situation of a wound sometimes serves to show whether it
is of  an accidental nature  or  not—a point often  insisted on in the
defence.  Accidental wounds are generally found on those parts of
the body which are exposed.  Some wounds, however, forbid  the
supposition of accident even when  exposed; as deeply  incised
wounds of the throat, and  gunshot wounds of the mouth  and tem-
ples.   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.
   2. Evidence from the  nature  and extent of a wound.—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  a considerable height, and is wounded  by the fall.  Circum- 
WOUNDS OF  THE THROAT.
277
stantial evidence will, however, rarely fail to clear up a case of this
description.  Greater difficulty may exist when life is destroyed by
a contused wound, voluntarily inflicted.  When persons laboring
under insanity commit suicide, they often inflict upon themselves
wounds of an extraordinary kind—such as would, at first view, lead
to a suspicion that they had been produced by the  hand of a mur-
derer ; and, therefore, the  rules which are here laid down  to dis-
tinguish homicidal from suicidal wound, must be guardedly applied
to cases of this  kind.
  The extent of a wound, by which we are to unelerstand the number
and importance of the parts injured, must in these cases be always
taken into consideration.   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 spine, 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 thus
completely elivided.   There are cases in which, perhaps with a firm
hand, there is a most determineel purpose of  self-elestruction.  In a
case of suicide,  observed by Marc, the weapon had divided all the
muscles  of the  neck, the  windpipe,  and gullet—had opened the
jugular veins and both carotid arteries—and had even grazed the
anterior ligaments of the  spine.   A wound  so extensive as  this, is
rarely seen in a case of suicide, but there  is no ground for the
assertion, that such extensive wounds in the throat are incompati-
ble with self-destruction.
  Incised wrounds in the throat are generally set down as presump-
tive of suicide,  but murderers  sometimes wound this  part for the
more effectual  concealment of crime.   Circumstances  connected
with the form and direction of a wound, may 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 hands  and  person of the deceased.  The peculiar
form of a wound on the throat  has sometimes led  to  a justifiable
suspicion of homicide.  In  one instance, a man was found dead with
his throat cut in the manner  in which  butchers are accustomed to
kill sheep.  This led  the  medical  man  to believe  that the wound
had been inflicted by a butcher.  The  police, guided  by this ob-
servation, arrested a butcher, who was subsequently tried and con-
victed of this act of murder.  In  some instances,  however,  it is
extremely difficult to say whether  the wound is homicidal  or sui-
cidal—the medical facts being equally  explicable  on  either hypo-
thesis.   (See case by Marc,  "Ann. d'Hyg." 1830, t. 2, p.  408;
another  by Devergie, ib.  414 ; and a third by M. Ollivier,  " Ann.
d'Hyg." 1836, t. 1, p. 324.) Regularity in a wound of the throat
has been considered  to be presumptive of suicide.   This was the
publicly-expressed opinion  of Sir Everard Home, in the well-known
case of Sellis.  The deceased was found lying on a bed, with his
throat extensively cut, and the edges of the incision were regular 
278     EVIDENCE  FROM  DIRECTION OF A  WOUND.

and even.  This condition of the wound, it was inferred, repudiated
the idea of homicide, but as a general principle, it  appears to me
to be a fallacious criterion.   A murderer, by surprising his victim
from behind—by having others at hand to assist him, or by direct-
ing his attack  against  one who is asleep  or intoxicated, or who
from age  or infirmity  is incapable of  offering resistance, may
easily produce a regular and  clean  incision  on the throat.   On the
other hand, the very irregularity of a wound has  been  regarded
as rather favoring the idea of suicide.
  '3. 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 accidental -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 per-
sons, the direction would, of course, be precisely the reverse.  Sui-
cidal wound 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 points 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 in-
strument with which the wound has been inflicted should be placed
in either hand of the deceased, and the  extremity moved towards
the wounded part, so that it  may be clearly seen whether the di-
rection  of the  wound  could or could  not 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 particular 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
front of the throat from behind, the direction will  be the same as
that commonly observed in  cases of suicide.  (See  on this point
the case of Reg. v. Dalmas, Cent. Crim. Court, May, 1844.)  Again,
if the person attacked is powerless, the wound may  be deliberately
made, so as to simulate a suicidal act; indeed  murderers  seldom
attack the throat, but with the design of simulating an act of sui-
cide,  A homicidal stab may also take the  same direction as one
which  is  suicidal, but  this would be  confined  to  those cases in
which the assailant 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, when the right  hand is commonly used, it
is the reverse.   Oblique wounds, passing from above downwards,
are common to homicide and suicide; but those which take an ob-
lique course from below upwards are generally indicative of homi-
cide, for it is extremely rare, that a person  bent  on 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 a wound,
deeply into the soft parts.  Those which are suicidal rarely possess 
           S-UICIDAL  AND ACCIDENTAL  WOUNDS.        279

 this character; they terminate gradually into 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 intricate subject of this
 nature, Ave have only these limited rules to guide us.  The instru-
 ment with which a wound is supposed to have  been  inflicted,
 should be adapted to the edges of the incision ;  its sharpness com-
 pared with the cleanness and evenness of the cut, and its  length
 with the depth of the incision or stab.  It is no  uncommon occur-
 rence for a murderer to substitute some instrument belonging to
 the deceased  or another person, for that which he has actually em-
 ployed ; and this by its  size, shape, bluntness or other peculiarities,
 may not account for the appearances presented by the wound.
   It is not often that any difficulty is experienced  in distinguish-
 ing a suicidal from an accidental wound.  When a wound has really
 been suicidally inflicted, there are generally  to be  found about it
 clear indications of design; and the  whole  of the circumstances
 are seldom reconcilable  with the supposition of  accident.  But if
 the position of the  deceased with  respect  to surrounding  objects
 has been disturbed, if the weapon has  been removed, and the body
 transported to a distance, then it will not always be easy to distin-
 guish 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 medical 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 un-
 necessary to dwell further  on  this subject, since the observations
 already made  will suggest  to a practitioner  the  course which he
 should pursue.  Circumstantial evidence is commonly sufficient to
 show whether a wound  has been accidentally received or not;  but
 as an accidental wound  may sometimes 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 in-
 spection of the wound.
  It would not be difficult to produce instances in wmich murderers
 have alleged,  in defence, that the wrounds observed on the bodies of
 their victims were of accidental origin, and  the allegations have
 been clearly refuted by medical evidence.  A witness must be pre-
 pared, therefore, in all  cases in which 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, on a question whether  the wound might
 not have been  accidental.  The law requires that it should be ren-
 dered evident to a jury,  before such a charge can be  sustained, that
 the fatal wound could not have had an accidental or suicidal origin.
  Wounds inflicted by the right  or left hand.—Some remarks have
 been made in  reference to 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  necessary  for a medical jurist to be  aware, that there
are many persons who are ambidextrous, i. e., who have equal facility 
 280  WOUNDS INFLICTED BY RIGHT  OR LEFT  HAND.

 in the use of the right and the left hand.  This may not be generally
 known to the friends of the deceased : and such persons are often
 pronounced, 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," p. 97.)  The man
 was found dead on his bed with his throat cut—the razor was dis-
 covered on the  left side of the bed ; whereas it was generally sup-
 posed and asserted that he was right-handed.   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 circum-
 stance of the razor being found on his left side, was at once ex-
 plained away.  The importance of making due allowance for the
 characters presented by wounds in the throat is also illustrated by
 a case which occurred in London in November, 1865.  A publican
 and his wife had  been frequently in the  habit of quarrelling. One
 night the wife  gave an alarm, and the man was found dead on the
 bed with his throat severely cut.  On examination, the fatal wound
 had all the characters of a left-handed cut, while the  deceased was
 generally believed to be right-handed ; and there was bloody water
 in a wash-hand basin in the room.  The wife, who bad marks of
 bruises upon her, said that she left her husband in the bedroom for
 a short time, and on her return found him dead.  The  suspicious
 facts were explained at the inquest by a daughter of the deceased
 by a former marriage.  She stated that her father had been  brought
 up as a wood-carver, a  trade which requires a man to use both hands
 equally well—that he had frequently threateneel to destroy himself,
 and that the blood in  the wash-hand basin was owing to her hav-
 ing washed her hands after she had touched  her father's  head.
 This  satisfactorily  explained  the  medical  circumstances which
 appeared at first to point to an  act of homicide.
  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  the body,  or the marks  of several
 attempts around the principal wound, have been considered to fur-
 nish presumptive evidence of murder.  But any inferences of this
kind must be  cautiously drawn, since not only mayT 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.
  The number, situation, and direction of the wounds found on a
 dead body may be medically inconsistent with the theory of a sui-
 cidal origin.  The following case occurred in New York in Sep-
 tember, 1839.   A woman  was found dead, and there were  many
wounds upon her body.   The  husband  was suspected of having
 killed  his wife, but he asserted that she had destroyed herself.
 This defence, however, was shown to  be inconsistent  with the
medical facts.   Three  physicians who  examined the  body deposed
that there were eleven wounds  (stabs), eight on and about the left
side of the thorax, one of which had  penetrated the pericardium, 
TWO, OR  MORE MORTAL  WOUNDS.          281
and divided the trunk of the pulmonary artery at its origin; and
the others  were  in the  back, near the left scapula.   It was con-
sidered to be quite impossible that these last-mentioned stabs could
have been produced by the deceased, and there was every reason  to
suppose that the stabs in front and at the back had been inflicted
at the same time by an assassin.  In acts of murder perpetrated  by
lunatics or  persons laboring under delirium tremens, it is usual to
find a large number of wounds on the body of the  person attacked.
In a case communicated to me  by Dr. Procter,  of York  (June,
1871), a man in a fit of delirium tremens killed his wife by cutting
and stabbing her.  Dr. Procter found on the body of deceased fifty-
six wounds, of which some were of a nature inconsistent with the
theory of self-infliction.   The object with such criminals is appa-
rently  not merely to kill, but to mangle the body  of the victim.
   The use of several weapons.—In general, suicides, when foiled  in
a first attempt, continue to use the same weapon ;  but sometimes,
after having made a severe wound in the throat, they will shoot
themselves, or adopt some other method of self-destruction.  These
cases can only appear complicated to  those who are unacquainted
with the facts relative  to self-murder.   Neither the 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 having been homicidal.  In one instance which
is reported, a lunatic, in  committing 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.   Thus
a stab  or cut may be  close to a contusion or contused wound, and
although a fall or other  accident might account for the latter, the
former would indicate violence separately inflicted.
   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 founel upon  a body, and particularly if one of
them is of  a stunning or stupefying  tendency (i. e. affecting the
head),  they must be considered incompatible with  suicide.  An in-
ference of this  kind can  be applied to those cases only in which the
two wrounds, 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 com-
monly 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 difficult
to say  whether one wound was likely to destroy life so rapidly as
to render it impossible for the person to have inflicteel another upon
himself;  but when there are several distinct incisions on the throat,
each involving important bloodvessels, there is good reason to infer
that they have resulted from an act of murder. 
282          EVIDENCE  FROM  CIRCUMSTANCES.
                    CHAPTER  XXV.

EVIDENCE  FROM  CIRCUMSTANCES.—THE POSITION OF  THE BODY.—OF
  THE WEAPON.—EVIDENCE FROM BLOOD, HAIR, AND OTHER SUBSTANCES
  ON WEAPONS.—MARKS OF BLOOD ON CLOTHING AND FURNITURE, ON
  THE DECEASED, AND ON THE ASSAILANT.

  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 circumstances 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  few in the profession
who, when summoned to aid justice by their science, in the detec-
tion of crime, do not seek for circumstances  by which to support
the medical evidence requireel of them.   A practitioner would cer-
tainly be wrong to base his professional  opinion on these circum-
stances, but it  is  scarcely possible  for him to avoid drawing an
inference from them as they fall under his observation.   Care must
be taken that  this  inference  is not overstrained.  The medical
evidence may be of itself weak, and insufficient to support the
charge against the accused; in such  a case, if any suspicious circum-
stances have come to his knowledge, he may be often unconsciously
induced to attach greater importance  to the medical facts than he
is justified in doing.  In short, he may, through a feeling of preju-
dice, which  it is not always easy to avoid, give an  undue force to
the medical evidence.  But if a proper degree of caution is used in
drawing inferences, and the circumstances are not allowed to create
a prejudice in his mind against the accused, a practitioner is bound
to observe and  record them;  for, being commonly the  first person
called to the deceased, many  facts capable of throwing an impor-
tant light on the cause of death, would  remain  unnoticed or un-
known, but  for his attention to them.  The position of a  dead
body, the suddenness of death, the discovery of a deadly poison, the
distance at  which a  knife or pistol  is found, the position of the
instrument—whether situated to the  right or left of the deceased,
the marks of blood or wounds about the person, or of blood on
the clothes  or  furniture  of  the apartment, are  facts which must
assist materially in developing  the real nature  of a  case, and in
giving force to  the medical opinion.  Many of these circumstances
can fall under the notice of him only who is first called to the de-
ceased ; and, indeed, if observed by another, no advantage could be
taken of them, except from the interpretation of a medical man. 
            WOUNDS — POSITION OF  THE BODY.         283

  At the same time,  a person  may  have died  suddenly,  and a
weapon or poison be found near the body, and yet the death may
have taken place from natural causes.  Due allowance must be made
for coincidences of this kind.   The purchase and possession of a
deadly poison shortly before a sudden death may create suspicion, but
a careful analysis may show that there is no poison in the body, and
further that the post-mortem appearances are consistent with natural
disease—and unless treated as exceptional in character, they are not
consistent with death from poison.  Mr. Stedman, of Guilford, met
with a case in  which a woman  was found dead  under very suspi-
cious circumstances.   Within half an hour of her death she had
sent a boy to a shop to purchase a packet of  Battle's vermin-killer
(strychnia).  He gave it to her, and left the house.  When he re-
turned at the time mentioned, he found her  leaning on  the table,
speechless and motionless.  She was then  dead.   There was no
rigidity, and no evidence of convulsions.  Some fluid was found in
the stomach, but in this there was no strychnia, and none  of the
blue coloring matter which had been sold with  the powder.  No
trace of the powder could be found on  the premises, and no  cup,
glass, or vessel in which the poison might have been mixed, could
be seen.  (" Med. Times and Gaz.," Jan. 14, 1865, p. 34.)  The  ab-
sence of any characteristic symptoms, and the non-detection of the
poison and its  coloring ingredient  under the  circumstances nega-
tived the suspicion of poisoning.  The  purchase, possession, and
the non-discovery of the purchased packet after  the death of the
woman, were  circumstances which created suspicion, but nothing
more.  The medical facts proved that the suspicion was unfounded.
The state of the lungs and heart accounted for sudden death.
  Among the questions which  present  themselves on these occa-
sions are the following: Is the position of a wounded body thai one
which a suicide could have assumed?  Is the distance of a weapon
from the body such as to render it improbable that it  could have
been placed there by the deceased ?  In answering either of these
questions, it is necessary to take into consideration  the  extent  of
the wound, and the time 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?  Are there any projecting  nails or other
articles which  might account for wounds on the body as the result
of accident?  These are questions, the answers to which may ma-
terially affect  the case ;  hence, a practitioner, in noticing and
recording the  circumstance involved in them, ought to exercise
due caution.
  The rules for investigating a case of alleged death from violence
have been elsewhere described (p. 22).  Among the additional cir-
cumstances to  which a medical  witness should especially direct his
attention on these occasions, are the following:—
  1. The position of the body.—The body may be found in a posi-
tion which the deceased could not have assumed on the supposition 
284             POSITION OF  THE WEAPON.
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 is any warmth about the body
—whether it is rigid, or in a state of decomposition, and to  what
degree this may have advanced.
  2. The position of the weapon.—If a person has died from an acci-
dental, or self-inflicted wound, likely to cause death either imme-
diately or within  a few  minutes, the weapon is commonly found
either near to the body, or within a short distance of it.  If found
near, it is proper to notice on which  side of the body it is lying;
if at a short distance, we must  consider whether  it might  have
fallen to  the spot, or have been thrown or placed there by the de-
ceased.   If there has been any interference with the body, evidence
from the  relative position of it and the weapon will be inadmissi-
ble.  In a case which was referred to me some years since, a woman
had evidently died from a severe  wound  in the throat, which was
homicidally inflicted ; the weapon, a razor, was found under the
left shoulder,—a most unusual situation, but which, it appears, it
had taken owiug to the  body having  been carelessly turned over
before it  was seen by the surgeon who was first called.
  It is compatible with  suicide  that a weapon may be found at
some distance, or  in  a concealed situation; but it is much  more
frequently 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.   In another case, the  bloody razor  closed, was found in
the deceased's pocket.  There is, however, one  circumstance in re-
lation to the weapon, which is strongly confirmatory  of  suicide.
If the instrument is firmly grasped in the hand of the deceased, no
better circumstantial evidence of suicide can 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 cadaveric 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 hand  of a dead person cannot be maele to grasp or
retain a weapon, like the hand which has firmly held it by power-
ful muscular contraction at the last moment of life.  In reference
to the weapon being found at a distance from the body, all the cir-
cumstances of the case should be taken  into consideration before
any opinion is  expressed.   If the weapon cannot be discovered, or
it is found concealed in a distant place, this is strongly presumptive
of homicide, provided the wound is of such a  nature  as to  prove
speedily  fatal.  If found near the body, it will  be proper to notice
whether the weapon is sharp or blunt, straight or bent, also whether 
BLOOD  AND HAIR  ON  WEAPONS.
285
the edge is, or is not notched.  These circumstances may throw a
light on the question of suicide or murder.
  3. Blood on weapons.—The weapon with which a wound has been
inflicted is not necessarily covered with blood.   The popular view
is that if much blood is found about a dead body, the weapon ought
always to be more or less bloody.   In reference to heavy blunt
instruments applied with force to the head, severe contusions and
fractures may be produced without  immediate effusion of  blood.
Unless the bludgeon is used in a subsequent struggle, or handled by a
bloody hand, no blood whatever may be  found  on the end which
produced the injuries.  In reference to 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 color.
The explanation of these facts appears to be that in  a rapid blow or
plunge, the vessels are compressed, so that a bleeding takes place
only after the sudden withdrawal, when the pressure is  removed.
Even if blood should be effused, the weapon, in being withdrawn,
is  sometimes cleanly wiped  against the edges of the wound, owing
to the elasticity  of the skin.  Thus the first stab through the dress
may not present any appearance of blood on the outside, but in a
second stab, with the same weapon, the outside of the dress should
present  a bloody mark,  unless  the weapon had previously been
wiped.  The  blood may have  been removed by washing from the
blade of a knife or dagger ; hence the handle and  inner portions,
the notch for opening  the blade and the indentations of any letters
stamped upon it should be closely examined.
   The blood on a weapon may be in a partly coagulated state, and
not diffused as a mere film.  This would render it probable that it
had issued from the body of a living person or animal, or from a
body recently dead. But the blood of a dead, animal dried in small
spots on the blade of a knife may sometimes present a similar ap-
pearance, and thus lead to a mistake in evidence.
   4. Hair and other substances on weapons.—In some instances, no
blood may exist on a weapon, but a few hairs or fibres may be found
adhering to it, if the weapon is of a bruising or cutting kind.  The
main question may be in  such  a case whether the fibres are of
cotton, linen, silk, or woollen,  and  whether the hair is  that of
a  human being  or of an animal.  The importance of examining
closely the hair  found on weapons is shown by a  case quoted by
Dr. Lyons, in which a  hatchet having  clotted blood and hair ad-
herent to it was produced  as  evidence against an  accused person,
under whose  bed this weapon had been found.  This, with other
circumstantial evidence, had turned public opinion strongly against
the prisoner;  but when the hair was examined  it was found not
to be human, but to have been taken from the body of some animal.
This  circumstance led to a more complete sifting of the evidence,
and the accused was acquitted.  It turned out that the accused
had killed an animal -with  the hatchet, and had carelessly thrown
the weapon under the bed.  ("Apology for the Microscope," p. 24.)
   Before any coagulated blood is removed from a weapon, it should 
286    HAIR AND  OTHER  SUBSTANCES  ON  WEAPONS.

be examined carefully bv the microscope.  Hairs, or fibres of cotton,
linen, wool or silk 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 Reg. v. Harrington (Essex
Lent Assizes, 1852) a razor was produced 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  cotton  nightcap.  This was a
strong  circumstance to show that  the razor  produced was  the
weapon with which the fatal wound had been inflicted.
  In Reg. v. Steel (Maidstone Summer Assizes, 1863),  Dr.  Pavy
and I examined the boots of the prisoner who was charged with
the murder of the deceased.  The marks of violence about the head
showed that the  assailant had trampled on the deceased after he
was on the ground, producing severe  wounds, which led to his
death.   Some hairs  were found firmly wedged beneath the large
hobnails  of the boots; and  in  certain dark stains of coagulated
blood on the leather, there were some red woollen fibres.  The hair
was compared with a portion cut from the head of the deceased,
and corresponded in color and size.   On inquiry it was found that
at the time of his death deceased wore round his  neck a red  woollen
comforter, of which the wool corresponded in color and appearance
with that taken  from the prisoner's boots.   The case was  brought
home to the prisoner by a variety of circumstances, all inconsistent
with his  innocence.  I  have  elsewhere referred  to the case of  Cass
(Reg. v. Cass, p. 413), in -which the dried blood  upon a knife lying
near the  body of  deceased, was found on a  microscopical examina-
tion to lock up within it certain fibres of woollen of a peculiar dark
dye, resembling the fibres taken from a coat worn by the prisoner.
  Fibres found upon weapons should,  if adherent to coagula, be
removed by careful digestion of the clot of blood in water, other-
wise they may be  at once examined in the dry state.   A magni-
fying  power of about  300 diameters may be  employed.  Under
these  circumstances cotton presents  itself  as  a  flattened band,
assuming more or less  a spiral  form (Fig. 44).  The fibre  of linen
derived from  flax is of a rectilinear form, with jointed  markings
at unequal distances, the fibre tapering to a point (Fig.  45).   Silk
and woollen have other characters by which they may be  identified.
Silk presents a regular cylindrical form, and there are no markings
upon the surface.   It has a strong refracting power on light, which
gives to  the fibre a well-defined boundary (Fig. 46).  The fibre of
woollen is irregular, contorted, of  unequal  thickness, and it has
peculiar markings of an imbricated  character on the surface (Fig.
47). This may be taken as the type of cloth, shoddy, alpaca, merino,
and a variety of other  fabrics worn as  clothing. • The hair of the
head presents itself in transparent cylinders, variously colored, with
markings resembling those of wool, but  hair is more uniform in 
      HAIR AND  OTHER SUBSTANCES ON WEAPONS.    287

width.  It has a cortical  and  medullary portion.  Human hairs
vary much  in size—some do  not  exceed the e^th of an inch.
The hairs of the eyebrows, like those of the eye-lashes, are coarser
and thicker than  those of the head, and are opaque, except  near
the point, where they become  transparent.  In  examining hairs
microscopically, it will be well to observe whether they are  of the

         Fig. 47.                Fig. 48.              Fig. 49.
Fibres of Woollen, magnified         Fibres of ancient     Fibres of ancient Linen, from
    300 diameters.            Woollen, magnified    an Egyptian Mummy, magni-
                         300 diameters.        fled 300 diameters,
same, or of different  colors or sizes, whether they are pointed at
one end or cut at both ends, and whether they have still attached
to them the bulb or sheath in which they grew.
  Foreign substances are sometimes found in contused and lacerated
wounds, which may throw a light on the mode in which they were
inflicted.  In gunshot wounds it is not unusual to find portions of
paper or other substances used  as wadding for the gun or pistol.
The preservation of articles  of this  description, or of portions of 
28.3
BLOOD  ON  CLOTHING.
the projectiles found under these circumstances, has proved a means
of fixing the crime upon the guilty person.   When a gun or pistol
is discharged near to the body, a  portion of the wadding  is gene-
rally carried into the large irregular wound  produced.  In a case of
stabbing, a portion of the weapon may be found in the wound.
  5.  Marks of blood on clothing or furniture.—It is proper to notice
all marks of blood on the clothes of the deceased, or in  the apart-
ment, and to observe where the greatest quantity of blood has been
effused; this is generally found on the spot  where the deceased has
died.   The deceased may have bled in more places than one ; if so,
it is proper to notice whether there is any communication in blood
between these different places.  Blood on distant clothes or furni-
ture may show whether the deceased has moved about, and whether
he has struggled much after  receiving the fatal wound.  Acts  of
locomotion by a wouiided person  who has died from loss of blood,
or by a criminal whose hands  and feet may be bloody, are generally
indicated by tracks or marks of blood.  The observation of these
marks, if made at the time that a dead body is found, is of great
importance.  They may be so situated as to show that the body  of
the deceased has been moved, or been interfered with  after death,
and thus throw a light upon the question whether the act has been
one of homicide or suicide. In reference to clothing, it is advisa-
ble, if it be possible, to have some clear proof that the clothes sent
for examination were actually worn by the  accused, or belonged  to
the deceased.  Serious mistakes are sometimes made, and  medical
opinions should therefore be expressed, with caution.
  It should be noticed on these occasions, whether the  blood is
deposited in large patches  on  clothing, or whether  it is sprinkled,
and also whether it is in large or small quantity.  The  sprinkling
may have proceeded from a wounded artery, or from a splashing of
blood as a result of continued violence.  We should  likewise ob-
serve whether, if the wound is in the  throat  or chest, blood has
flowed down in front of the clothes or person, or whether it has flowed
so as to  collect in  the  armpits, or on each side of the neck; for
these appearances will  sometimes show that  the wound  was in-
flicted when the  person was standing, sitting, or lying down.  If
the throat is 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 a 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 a wound was  inflicted, is  a frequent
question on inquests and criminal trials.
  When spots of blood are found upon articles of dress or furniture,
their form and direction may occasionally serve to furnish an  indi-
cation of the position of the wounded person with respect to them.
Thus, if the form of a Spot is oval and elongated, the  presumption
is that the person was placed  obliquely with respect to the stained
furniture during the hemorrhage.  (""Ann. d'Hyg." 1840, p. 397.) 
          MARKS OF BLOOD ON THE  ASSAILANT.       289

The  force with which the blood has  been thrown  out, will be in
some measure indicated 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.
  6.  Marks of blood or violence on the dead body.—In examining  a
dead body, attention  should be paid to the state of the mouth and
throat.   Assailants who make their attack during sleep, sometimes
endeavor to close  the mouth, or to compress the throat, so as to
prevent an alarm  being given.  In one instance, there were  the
marks of finger-nails around the mouth ; in another, ecchymosed im-
pressions, as if produced by a hand, were found upon the throat of
the deceased.   The hands of a dead person should always be exam-
ined ; niany recent cuts, excoriations, or incisions found upon them,
especially if on the back of the fingers or thumbs, will indicate that
there has been a mortal struggle with the assailant.  In the inspec-
tion, the examination of the"stomach should not be omitted.   The
presence or absence of food, mucus,  or blood may furnish evidence
of considerable importance in the  elucidation  of the case.  All
marks  or  stains of blood, or  dirt, on  a  dead body require special
observation.   The impression of a hand, or of some  of the fingers,
may  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 back of the left hand of the deceased, in such  a
position that it was  quite impossible the deceased himself could
have made the mark.  In all cases  it should be noticed whether
the inside or outside of the hand, or whether one or both hands  are
stained with blood; and the size and position of  the stains should
be described.   Marks of blood on the dress of a  wounded person,
or a  dead body, may often furnish  important circumstantial evi-
dence.   If there are several stabs or cuts  on the body involving the
dress, it should be observed whether the edges of one or more of
them are stained with blood, as if from  the wiping of a weapon,
and whether the stain is 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 imposT
ture. (See case by Dr. Bayard, "Ann. d'Hyg.," 1847, vol. 2, p. 219.)
  7. Marks of blood on the assailant.—It is a very common idea that
no person can commit a murder in which blood is effused, without
having his person  and clothes more  or  less covered with blood.
Xothing can be more erroneous.  On several occasions I have been
required to examine articles of clothing which had been worn  by
persons subsequently convicted of murder by wounding, and either
no blood has been found on any part of the dress, or only small
spots wholly out of proportion to the quantity of blood which must
have flowed from  the deceased.  (Reg. v.  Harrington, Chelmsford
Assizes, 1852.  Reg. v. Flack, Ipswich Assizes, 1853.  Reg. v. Cass,
Carlisle Assizes, 1860.   Reg. v.  Rowlands,  Beaumaris  Assizes, 
290       MARKS OF BLOOD ON THE ASSAILANT.

1861.  Reg.  v.  Edmonds,  Swansea  Assizes, 1862.)  In the case
of Gardner (C.  C. C. 1862), in which there had been  a large
effusion  of blood  from a  severe wound in the throat, no blood-
stains  were found  on the clothing of the  man  who was  con-
victed  of the murder.  It  is obvious that the throat of a person
while  standing,  sitting, or kneeling, may be cut  by a murderer
from behind,  and thus in  appearance simulate suicide.  Under
these circumstances the clothes of the assassin would escape being
stained with  blood.  The  flowing or spirting of blood upon  the
clothes of the assailant will depend upon his position in relation to
the deceased at the time of inflicting the wouud, and this must
always be a matter of pure speculation.  In entire violation of this
simple principle, the fact of a  prisoner's clothes not being marked
with blood has been on more than one occasion urged as a proof of
his innocence. (Reg. v. Dalmas, C. C. C, June, 1844.)  In this case,
the counsel for the prisoner wished to impress the jury, in what is
commonly denominated a "powerful" speech (in  which medical
facts and opinions  are usually ignored), that no person could  cut
the throat of another without having his clothes covered with blood;
and  as there was  not proved  to be any blood on his clothes,  the
prisoner  could not have been guilty of  the crime.^  The facts were
simply that the throat of the woman was cut while she was walk-
ing across Battersea Bridge, the prisoner having inflicted the wound
from behind 1 In the case of Lord  W. Russell, the act of murder
was committed by Curvoisier while in a state of nudity.  Police-
men are  frequently misled in searching for criminals, by looking
for blood on clothing as a necessary accompaniment of an act of
murder.   This also leads them to magnify stains of red paint, iron
rust and  fruit-stains on the dress of an accused  person into marks
of blood 1
  The  presence of spots of blood on articles of clothing, knives, etc.,
taken  from the persons of those who are accused of murder, may be
quite consistent  with  innocence.  Small spots or stains have often
an undue importance  attached to them.   I have  known minute
spots of blood on the shirt of a man tried for murder by wounding,
regarded as furnishing proof of criminality, until it was explained
that they were probably derived from flea-bites, and that some were
on one side and some on the other, showing that the shirt had been
worn on  the two sides.  The coarse clothing worn by laborers may
acquire blood-spots from a variety of accidental circumstances, which
the accused may not always be able to explain.   When he knows
the stains are there, and shows great anxiety to give some explana-
tion of their presence, as by falsely stating  that he had assisted in
killing a pig, a rabbit, or that  he was carrying game about him—
[or, as  in the case of Christian Berger, convicted of the murder of
Miss Watts in 1866, that  he had kicked a  piece of raw meat in a
butcher shop, and thus made his shoe bloody.—P.]—there may be
strong  ground for suspicion;  but a medical practitioner  should
always make  due allowance for the accidental presence of blood on
the clothes of working men. 
CHEMICAL EXAMINATION  OF BLOOD-STAINS.    291
                   CHAPTER XXVI.

CHEMICAL EXAMINATION OF BLOOD-STAINS.—STAINS OF BLOOD ON LINEN
  AND OTHER STUFFS.—AGE OR DATE OF THE STAINS.—OTHER STAINS
  RESEMBLING BLOOD.—BLOOD  ON WEAPONS.—ARTERIAL  AND VENOUS
  BLOOD.—VARIETIES OF BLOOD.—BLOOD OF MAN AND ANIMALS.—MICRO-
  SCOPICAL EVIDENCE.

  Examination of blood-stains.—It may appear at first sight an easy
matter to say whether certain  suspected spots or stains on articles
of clothing, furniture, or weapons are or are  not owing to blood;
hut in practice, great difficulty is often experienced in answering
the question.  If the stains are large and recent, most persons  may
be competent to  form an opinion ; but the physical characters of
blood are soon changed, even when the stuff is white and otherwise
favorable for an  examination.   If the stains, whether  recent or of
old standing, are upon dark dyed woollen  stuffs, as blue, black, or
brown cloth, or  if  they appear  in the form  of small or detached
spots, or in thin films on dark clothing or rusty weapons, no one
but a competent medical man should be allowed tqgive an opinion.
  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  coloring
matter, or hoematine. The chemical properties of the red  coloring
matter of  blood  are as follows:   1. It readily combines with  cold
distilled  water, forming,  if recent, a  bright red  solution.   2.  The
red color of this solution is not changed to a crimson, or a green
tint by a few drops of a weak solution of ammonia.  If the ammonia
is concentrated,  or  added  in  large  quantity, the red liquid will
acquire a brownish tint.  3. The red  liquid when heated to about
170° is coagulated—the color is entirely destroyed, and a muddy,
brown, flocculent precipitate is formed, the quantity of which will
depend on the quantity of coloring  matter and albumen present..
This coagulum, when collected on a filter and dried, forms a black
resinous-looking substance,  quite insoluble in water,  but readily
dissolved by boiling caustic potash, forming a  solution which is of a
greenish color by reflected, and reddish  by transmitted light.  4.
The red coloring matter of blood is always more  or less mixed with
albumen, and it  is this principle which gives  to a dried blood-stain
on  linen or cloth a well-marked stiffness.  Stains from cochineal
and the red colors  of  wine, flowers, and fruit,  do not cause any
stiffening of the  fibre of the stained stuff, nor  any appearance under
the microscope at all resembling the  dried  coagulum of blood.  5.
A solution of the red coloring matter of blood  in water produces
with tincture of guaiacum only a  reddish-white precipitate of the 
292    CHEMICAL EXAMINATION  OF BLOOD-STAINS.

resin.  On adding to this an ethereal solution of peroxide of hydrogen,
a beautiful blue color is more or less rapidly brought out.  If a
sufficient quantity of alcohol is added, the- precipitate will  be dis-
solved and a deep sapphire blue solution  will result.   Cochineal
and  other red coloring matters when thus treated give a reddish
color to the resin of the tincture of guaiacum, but undergo no change
on the addition of peroxide of hydrogen.  They are thus well marked
and distinguished  from blood.   Whether the blood is new  or old,
whether concentrated or exceedingly diluted, the test produces the
blue coloration.   It produces the change better in a diluted than in
a concentrated state.   A drop of blood diffused through six  ounces
of water may be thus detected in one or two  drachms of the mixture.
To the above tests some have added the action of strong nitric acid,
which coagulates  the red  coloring matter, turning it of a dirty
brown hue.  Such are the chemical properties  of recent  blood,
whether derived from the human body, or from that of any warm
red-blooded animal.
  Of the various red coloring matters extracted from vegetable and
animal substances, there are none which to the experienced eye, pre-
sent the peculiar  crimson  red  tint of blood,  especially when the
substance  is examined in a  good light by a  low power of the micro-
scope.   When solutions of these red  coloring  matters are treated
with ammonia, some, such as cochineal, logwood and the colors  of
roots and  woods, acquire a deep crimson tint, while others, such  as
the coloring  matter  of the rose and the red colors of flowers and
fruits, are  changed to a blue or green.  The red colors are not de-
stroyed by a  boiling temperature, and even when mixed with albu-
men, this principle   is coagulated, but the  red  coloring  matter
remains unchanged.   In the case of blood, the effect of heat is  to
destroy the color entirely,
  When these vegetable colors are found upon linen and similar
stuffs, they present under the microscope the  appearance of a uni-
form stain or dye, unlike blood in color.   There is no coagulum  to
be seen, and the stained stuff is not stiffened as it is by the serum
of dried blood.
  Stains of blood on linen and other stuffs.   Their age or date.—Sup-
posing the stuff to be white or nearly colorless, the spot of blood,
if recent, is of a red color; but it sooner or later becomes of a red-
dish-brown, or of  a deep red-brown color.  The change of color to
a reddish-browm 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, from the appearance, the date of
a stain even conjecturally.   In a large  stain of blood on linen,  no
change took  place during a period of five  years: it had a reddish-
brown color 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 colored stuffs,  or dirty clothes, it is of course
impossible to trace these physical  changes in stains of blood;  on
red-dyed stuff's the stain appears simply darker from the first, and 
DETECTION OF  BLOOD  ON  CLOTHING.        293
in all cases the fibre of the stuff is more or less stiffened, as a result
of the  drying of the albumen  associated with  the red-coloring
matter.   In examining an article of clothing,  attention should be
paid to the side of the stuff which  has  first received the stain;
sometimes both sides are stained.   The evidence  derived  from an
observation of this kind may be occasionally of importance.
  The new method of spectrum analysis as applied to blood fur-
nishes no precise information  as  to date.  It allows us to make a
distinction between  fresh blood  and that which has  undergone
chemical changes by deoxidation or otherwise,  but not  to  fix a
date.
  The suspected stain, if in  a dry state, should be first examined
in a strong light with a low power of the microscope.  If caused
by blood, it will not be a mere coloring of the fibres, but it will
have a shining, glossy appearance, and each fibre will be  observed
to be invested with a portion of dried coagulum or clot.   In  other
cases, minute  coagula or  clots presenting the appearance  of  dried
jelly will be seen in the meshes of the stained article of  clothing.
In certain lights, the clots may appear of a dark red color, but by
changing the light, bright translucent portions of a  peculiar  crim-
son tint will come into view.  The crimson stain of blood  is unlike
any other red  coloring matter, and  when  the  stained portion pre-
sents the character of a gloss}?- dry coagulum, the stain cannot be
easily mistaken by a practised eye for one caused by any other red
coloring  matter.  In fact, the microscope  puts the observer of a
small stain in the same  position as a non-professional person, who
unhesitatingly forms his judgment from a large quantity of  dried
blood.  Portions  of kino over a dress may  present occasionally
the appearance of coagulated blood ; but  kino  differs in color and
in chemical properties from  blood.  The microscopical observation
of a suspected stain on linen, cotton, or woollen, however small, is
generally sufficient to enable an expert to form an opinion  either in
the affirmative or negative.
  When the stain is on  black  or  dark-colored  cloth, no color will
be visible.  If owing to  blood, the fibre will, however, be stiffened,
and when viewed by reflected  light it may appear glossy from the
drying of albumen in serum.  The suspected spot should be wretted
with distilled water, and when the  cloth  is  thoroughly softened,
two or three layers of -white  blotting paper may be pressed upon it.
If blood is present reddish colored stains will  be  produced, some-
times extending through three or four folds of paper.  Any one of
these presenting color may be tested by adding tincture of guaia-
cum followed  by peroxide of hydrogen, and subsequently alcohol.
The blue coloration produced by blood will then  be apparent.  If
no color is thus obtained, on applying the filtering paper to wetted
cloth, no blood will be found.   In a case of murder, which was the
subject of a trial at the  Swansea Lent Assizes, 1868  (Reg. v.  Mor-
gan), it was proved that the deceased had been shot in a lonely hut
on the hills.  His only companion at the time  was his dog.  Some
spots of the blood fell on the hair of the  dog.  A portion of the 
294
PROCESSES  FOR  THE
hair was cut off and sent to me for examination.  Small portions
of fresh coagula were found in the hair.  The hair was wetted and
pressed strongly  on white blotting  paper; tincture of guaiacum,
and peroxide of hydrogen  applied to  the stains on paper gave at
once the  usual reactions of blood.   The  result was confirmed by
other experiments.   This method of  testing by transference of the
coloring matter from a dark to a white surface was first  suggested
by Dr. John Day, of Geelong, who has given so much attention to
this subject.
  In all cases in which a doubt may  exist, chemical and other pro-
cesses should be resorted to for confirmatory evidence.
  If the stain is of sufficient size,  a  slip of the dress, with the
stain upon it, may be removed and suspended by a thread in a test-
tube, containing a small quantity of distilled water.  After a few
minutes or a few seconds, should  the stain be  recent, a red liquid
will be seen falling  to the bottom of the test-tube, giving, when the
blood is fresh, a red color to the lower  stratum  of water, and when
of old standing,  a  dark red-brown color.   Should the  stuff be
thick and coarse, or not readily pervious to water, the separation
may not  take place in less than an hour.   If the quantity of
colored liquid thus  obtained is small, the supernatant clear water
may be carefully  poured off or drawn  off by a  pipette;  but it will
be found more convenient to use a small  tube and a small quantity
of water.   The colored liquid  may then be tested by weak ammo-
nia, and by the application  of  heat, as already described.  If
ammonia  produces  any effect upon the solution of blood, it is
simply to brighten it; this alkali never  changes the red color of
blood to green or crimson.
  When the stain is old, the solution  in water is very slowly ob-
tained, and does not present  the bright red  color of blood.  In
some cases, if the stain is of very old standing, and had been much
exposed to the atmosphere,  water will have scarcely any solvent
effect on it, and it may be found impossible to obtain a red-colored
liquid  even after  twenty-four hours' maceration.  At the most, the
water may acquire a pale brown or yellowish color, but wholly un-
like that imparted by blood.   In  such  a  case  it is  useless to add
ammonia.  We  may, however, generally form  a correct judgment
by the microscopical appearance of the stain before wetting it, and
by  obtaining crystals of hsematin with  the use of glacial acetic
acid (see p. 309, post).  Water may dissolve sufficient albumen (or
serum) to become opaline by heat, or  by the addition of nitric acid,
although we may fail to obtain any evidence  of the presence of
corpuscles.  From the results obtained by spectral analysis (post p.
302), it appears probable that acid and other vapors in the atmos-
phere aff'ect blood-stains and alter their  chemical properties.  Where
much coal  is burnt, sulphurous acid may operate in this manner.
Under other circumstances, when the  quantity of blood  effused is
moderately  large, it may be detected  by the process above men-
tioned, after the  lapse of a considerable time.  I have  thus de-
tected the blooel of the human  body, and of the bullock, on cotton, 
            DETECTION  OF BLOOD ON CLOTHING.        295

linen, and flannel, after the  lapse of three years.   If  the stuff is
dyed, we should proceed to examine the stains  found upon it  by a
similar process.  The dye  is commonly fixed, and  is not soluble in
water.  Thus, then, in testing for blood,  we rely upon:  1. The
solubility of the red coloring  matter  in water.  2.  The negative
action of ammonia.  3. The positive effect of heat in entirely co-
agulating and destroying  the red coloring matter.
  Should the linen or stuff which is stained with  blood have been
heated to a high temperature, the coloring  matter may, as a result
of coagulation, be  rendered  insoluble in water: but this is an ex-
ceptional condition.   In the case of a  body found wounded and
burnt, it would be proper  to  allow for such  a change, and the
chemical evidence would  fail.   Should  the blood-stain be  mixed
with  oil or grease, this will interfere with the solvent action of
water.  Should it  be on a plaster-wall or on wood, wTe must scrape
or cut out a portion, and digest it in a small quantity of water, in
a tube or watch-glass.   An unstained portion of the plaster or wood
should also be examined.
  There are red stains bearing  a resemblance to blood, which are
insoluble in water.  These  may  be identified by their special char-
acters.  Among them are:   1.  Certain 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 color, sometimes of a
bright or orange  red; they  are quite insoluble in water, but are
easily dissolved by diluted hydrochloric acid, and on adding ferro-
cyanide of potassium to the hydrochloric solution, the presence of
iron will be at once apparent.  Care should be  taken that the acid
used for this  purpose  contains no iron.  Another method is to
apply to the spot glacial acetic acid, followed in a few minutes by
a solution of tannic acid:  a bluish stain of ink  is produced.   Iron-
moulds are  generally distinguished by their brown color, and by
the absence of all  stiffening  of the fibre on the stained spot.   3.
Red paint.   Stains made  with  red paint containing peroxide of
iron, have been mistaken  for blood.  They may be easily known
by digesting them in diluted hydrochloric acid, and  applying to
the solution the tests for iron. Like those produced by iron-moulds,
they are quite insoluble in water, and therefore cannot be confounded
with blood-stains.  The same may be said of spots of the ammonio-
nitrate of silver changed by light, which I have known to be mis-
taken for old stains of blood.  The stuff on which the spots of blood
are found, may be  itself stained with a red dye or color, or it may
be dyed with iron ; in this case it will be necessary to test by the
same process a piece of the colored  or stained portion, in  order to
furnish negative evidence that the suspected stains are due to  blood.
4.  Among soluble  stains resembling those of blood, are the spots
produced by the juices of the mulberry, currant, gooseberry, and other
red fruits.   They may be sometimes recognized chemically, by drop-
ping on them a weak solution of ammonia—when the spot is turned
either of a bluish, olive-green, or green color.  The red of cochineal
is changed to a crimson on the addition of weak ammonia;  but a 
296
REMOVAL OF BLOOD-STAINS.
spot of blood thus treated  undergoes no change of color from the
addition  of the alkali.  Diluted acids  brighten  the red colors of
fruit stains, but they do not alter the  color of blood.  It is also
worthy of note that a. strong solution of chlorine bleaches the red
colors from fruit  stains, but when  applied to a stain of blood, it
turns the red coloring matter of a dark olive-green color, and does
not bleach it.  These effects are only well observed on white stuffs.
  If a colored liquid is obtained from a piece of the  stained stuff
suspended in water, it is easily distinguished from blood, by its ac-
quiring a green or crimson tint  on the addition of ammonia, and by
the red color not being  coagulated or destroyed when the liquid is
boiled.   A solution of  chlorine added  to the  colored liquid also
presents-  a ready  means of distinction.  The colors of fruits and
flowers are instantly destroyed—while the color derived from blood
is altered to a dingy olive, and  the albumen of the serum is precipi-
tated.  In some red stuffs,  the  dye  is often so bad, that water will
dissolve out a  portion of the color; but in this case, the  action of
ammonia, heat, and chlorine will serve readily to distinguish the
stains from blood.   The soluble red or brown stains given by woods
or roots,  such as Logwood, Brazil-wood, or Madder-root, are changed
to a crimson color by ammonia.   They contain tannic  acid, and ac-
quire a dark olive-green color when touched with a persalt of iron.
It may  be generally remarked of these stains, whether they are
soluble or insoluble in water, that, although to the naked eye they
may bear a  slight  resemblance to blood, they are wholly different
when examinee! microscopically.  The  distinction of color is well
marked,  and there is an absence of any  appearance of coagulum, or
of stiffening of the fibre.  When thus carefully examined, it is not
probable  that they can ever be  mistaken for blood.
  Removal  of blood-stains.   Examination of washed stains.—An
attempt  may have been made to wash out blood-stains, so that the
color may be  more  or less changed, and no chemical  evidence ob-
tainable.   There is a common  notion that certain chemical agents
will remove or destroy  these stains; but this is not the case; the
color may be altered, but when dried on the stuff it is not easily
discharged or bleached.  Chlorine, a most powerful  decolorizing
agent, turns the coloring matter of blood of a green-brown  color.
Hypochlorous acid has a similar effect.   This acid has been recom-
mended  as useful by its bleaching properties for distinguishing the
stain of  blood from all  other stains, excepting those  produced by
iron-rust.  Orfila has, however, shown that it is not fitted for such
a purpose, and that there  are  no better  methods of  testing  than
those above described.   ("Ann. d'Hyg."  1845,  2,  112.)  I  have
found that nothing removes a  blood-stain, whether  wet or dry, so
effectually as simple maceration in cold water, although, when the
stain is old, the process is sometimes slow.  Washed stains may now
be readily detected by means of guaiacum, provided they are on a
colorless  article of clothing.  A drop of the  tincture is poured on
the stuff, and if there is no change of color, peroxide  of hydrogen
is added. The blue color appears immediately, and becomes more 
            DETECTION  OF BLOOD ON  WEAPONS.        297

intense by the evaporation of the ether, or on the addition of alcohol
to dissolve the white resin.
  On an important trial for murder, at the Shrewsbury Lent Assizes,
1841 (Reg. v. Misters), this question as to  the power of certain chemi-
cal reagents  in discharging stains of blood was raised.   Alum was
traced to the possession of the prisoner; it was found dissolved in
a vessel in his bedroom, and it was supposed that he had  removed
the blood-stains from his shirt by the use of this salt.  Two medical
witnesses deposed that they had made experiments, and had found
that alum would  take the stains of blood out of linen; according
to one, sooner than soap and water. The results of my experiments
do not correspond with these.  I have not found that alum removes
stains of blood so readily as common  water; and  when alum is
added  to  a  solution of haematine in water, so far from the color
being discharged, it is slowly converted to a deep greenish-brown
liquid.  In one experiment, a slip of linen having upon it a stain
of dried blood of old  standing, was left in a solution of  alum for
twenty-four  hours, but not a particle of the red coloring matter had
been extracted, although  it was changed in color.  The  effect  of
yellow soap, as well as of potash, soda and their carbonates, is  to
change the red color of blood to a  deep  greenish-brown, like many
other reagents, but they do not exert on it any discharging or bleach-
ing power.
   Detection of blood on weapons.—When recent, and  on  a  polished
instrument,  stains of blood are easily recognized; but when of old
standing, or  on a  rusty piece of metal, it is a matter of some diffi-
culty to distinguish them from the stains produced by rust or other
causes.  If the stain  is  large and dry, a portion may be easily
scraped off;  this should be placed  in a watch-glass with some dis-
tilled water, the solution filtered to separate any oxide of iron, and
then tested.   If the water by simple maceration does not acquire a
red or red-brown color, the stain is not due to blood.  If it acquires
a red color, the solution may be tested  by the  methods above de-
scribed.  Sometimes the stain appears on a dagger or knife either
in the form of a thin yellowish or  reddish film, or in streaks, and
is so superficial that it cannot be mechanically detached.   We
should then  pour  a thin stratum of water on a piece  of plate-glass,
and lay the  stained part  of the weapon  upon the  surface.  The
water slowly dissolves the coloring matter of blood, and the colored
liquid may be examineel by the chemical  processes  above recom-
mended.   If the weapon has been  exposed to  heat, this  mode  of
testing may  fail.
  There is often a remarkable resemblance to the stains of blood on
metal, produced by the oxide or certain vegetable salts of iron.  If the
juice or pulp of lemon or orange is  spread upon a steel  blade, and
is exposed to the air for a few days, the resemblance to  blood pro-
duced  by the formation  of citrate of iron is occasionally so strong
that I  have  known well-informed surgeons to be completely de-
ceived: they have pronounced the spurious stain to be blood.  These
stains, which owe their color to citrate of iron, may be thus distin- 
298           ARTERIAL  AND VENOUS  BLOOD.
guished:  The substance is soluble in water, forming, when filtered,
a yellowish-brown solution, totally different from the red color of
blood under the same circumstances.  The solution  undergoes no
change of color on the  addition of ammonia.  It is unchanged in
color, but may be partially coagulated at a boiling temperature,
and it is at  once identified"as a salt of iron by giving a blue color
with  the ferrocyanide of potassium.  These stains of  the citrate of
iron are apt to be soft and deliquescent, while blood-stains are likely
to be  hard and brittle.
   It is not always easy to distinguish by sight a stain of blood on
a weapon from a mark produced by iron-rust.  When suspicion
exists, marks are  pronounced to be due  to  blood,  which under
other  circumstances would have  passed unnoticed.  One source of
difficulty is this: the iron-rust on an old knife is often mixed with
some article of food, or even with blood itself.  We must here pur-
sue the same mode of  examination as if the stain were of blood;
we macerate the weapon, or a portion of the colored deposit scraped
from  the surface, in  a small quantity of distilled water, and filter
the liquid.  If the stain is due to iron-rust alone, this will be sepa-
rated by filtration, and  the liquid will pass through colorless.  The
absence of blood is thereby demonstrated.   In blood-stains on rusty
weapons, blood and oxide of iron are  necessarily intermixed.  In
order to detect and  separate them the following plan may be
adopted: Scrape off  portions  of  the supposed  dry blood and  rust
into a porcelain capsule; moisten the substance with water and
let it stand covered.  If blood is present,  the water will acquire a
reddish-brown  hue, and the addition of guaiacum and peroxide of
hydrogen will show whether the red color  is owing to blood.  The
effect is  strongly marked when  the water  is allowed to evaporate
to dryness and leaves a reddish stain on the white porcelain.  The
guaiacum and peroxide of hydrogen have no action upon iron-rust.
This can be detected by the action of hydrochloric acid and  the
usual tests.
   All  the  particles  of dried blood acquire  a bluish  coloration
around  them, while  the particles of rust are  unchanged.  The
guaiacum and peroxide applied to the film of water on which  the
rusted weapon  had been placed  will give  a blue color if blood is
present, otherwise not.  By this process, blood was readily detected
on a  rusted knife used in an act of murder committed ten years
previously.  No blood was seen on the blade with the aid of a lens.
   From the foregoing  remarks,  we may justly infer that the che-
mical analysis of suspected spots  or stains on weapons and clothing
is  by no means an unimportant duty.  If we cannot always obtain
from these  experiments affirmative evidence,  they often  furnish
good  negative  proof, and thus tend  to remove unjust  suspicions
against accused parties.
   Arterial and venous blood.—It is not possible to distinguish  arte-
rial from venous blood by any physical or chemical characters, when
it  has been for some days effused, and is in a dry state upon arti-
cles of dress or furniture: but this, in medico-legal practice, is  not 
ARTERIAL  AND  VENOUS BLOOD.           299
often a subject of much importance, since there are few cases  of
severe wounds, either in the throat or other parts of the body,  in
which the two kinds of blood do not escape simultaneously.   The
most striking and apparent difference between them, when recently
effused, is the color—the arterial being of a bright scarlet, while the
venous is of a dark red hue ; but it is well known that  the latter,
when exposed to air for a short time, acquires a florid red or arte-
rial color; and  the  kinds of blood, when dried, cannot be distin-
guished  chemically by any known criterion.   Arterial  blood con-
tains more fibrin than venous, and coagulates more firmly.   The
microscope shows no appreciable difference in the blood-corpuscles,
and chemistry does  not enable us  to  apply any test so as to make
a satisfactory  distinction between them.  In this deficiency  of
microscopical and chemical evidence, an attempt has been made  to
establish  a elistinction by noticing the physical appearance of the
blood-stains.  Thus, it is alleged, the arterial blood will be  indi-
cated by its being sprinkled over surfaces upon which  it 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 ap-
pearance  of the blood, when it exists, will,  caeteris paribus, create
a strong  presumption  that  it was poured out from a living body,
for  after  the heart has ceased  to act, the  arteries lose the power  of
throwing out the blood in jets.  The sprinkling is usually observed
when the wounded  artery is small, and  the blood  is effused at a
distance.   This is a fact which a medical jurist should not over-
look, although, for the reasons stated, too great a reliance must not
be placed on it.  The spots of blood, if thrown out from a living
bloodvessel, speedily consolidate, and  the fibrin, with the greater
portion of the coloring matter, is  found of a deep reel color 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 gum-
med, when the spot  is recent, and when it has  been  effused upon a
non-absorbent surface.
  When  blood falls  upon porous articles of clothing, as linen or
cotton, it is absorbed, and  produces a dull stain.  In dark-colored
articles of dress, it  is sometimes difficult by daylight to perceive
these stains.  The part appears stiffened,  and has a dull red-brown
color, which is sometimes more perceptible  when seen  by the re-
flection of the light of a candle.  In trusting to the coagulation  of
the  sprinkled blood as evidence of its escape from a living vessel, it
must be remembered that three hours may elapse before it coagu-
lates in the healthy body after death.   Hence, blood which  has
escaped from a recently dead body, although  it would not be found
diffused as if by spurting, might, in so far  as coagulation is con-
cerned, assume the appearance  of having been effused from a living
body.
  In spite of the great advances made in the construction and use
of the microscope, there is  no method known by which the blood
of a man can be distinguished from that of a woman, or the  blood 
300
THE GUAIACUM  PROCESS.
of a child from that of an adult.  A medico-legal question has
arisen, on more than one occasion, whether there were any means
of distinguishing menstrual blood from that of the body generally.
This liquid contains fibrin, although the proportion is  less than in
venous or arterial blood, red coloring matter, and the other con-
stituents of blood.   The only differences  noticed are  of  an acci-
dental kind: 1st, that it  is  acid, owing  to  its admixture  with
vaginal mucus ; and 2d, that under the microscope it is mixed with
epithelial scales, which it has derived from the mucous membrane
in its passage through the vagina.  (Donne, " Cours de Microscopie,"
p.  139.)  in the bodies of women who had  died suddenly while
menstruating, Dr. Webber found coagulated blood upon the uterine
mucous membrane.   If, therefore, menstrual blood does not coagu-
late, it is simply because it has already coagulated^ within the uter-
ine cavity, and cannot do  so again; it is more fluid than ordinary
blood, because, during its trickling descent, it becomes  mixed with
watery urine and vaginal mucus.  ("Schmidt's Jahrb.,"  1847, 7,
139.)  A case  occurred  in France, which  induced the Minister of
Justice to refer the consideration of this question to the Academy
of Medicine.  The reporters, MM. Adelon, Moreau, and Le Canu,
came to the conclusion that there were no means of distinguishing
menstrual blood dried on clothing from that  which might be met
with in  a case of infanticide or abortion.  ("Ann. d'Hyg.," 1846,
1,  181.)
   The Guaiacum process.—Dr. John Day, of Geelong, Australia, was
the first to demonstrate by numerous experiments the proper mode
of employing the guaiacum test.  (" Australian Med. Journ." May
1867, and Xov. 1869.)  Schonbein had already discovered  that the
resin was blued by blood  in the presence  of a principle which he
called autozone (which had no action on the resin), and this prin-
ciple was soluble in ether.   His theory was  that autozone in contact
with blood  was changed  into  ozone, and blued the  resin;  but
whether  this theory  be or be not  correct, the  facts remain—1, that
the red coloring matter of blood  produces no change in  tincture
of guaiacum;  2, that it undergoes no change of color when mixed
with pure peroxide  of hydrogen dissolved in ether (autozone); 3,
that in the presence  of those two solutions the red coloring matter
of blood immediately renders the guaiacum resin blue ; 4, that no
red  coloring matter, animal or  vegetable, excepting  the reds of
blood (hsematine), has been  found to produce this  blue coloration
of guaiacum in the presence of peroxide of hydrogen.
   It may be here observed that the alcoholic solution of guaiacum
resin should be fresh made from the inner or unoxidized portions
of resin, and the solution kept in the dark.  The pure  ethereal
solution of peroxide of hydrogen  is procurable under the erroneous
name of  ozonized ether.
   M. Lefort has objected  to this process  on  the ground that the
resin of guaiacum is blued  by an " unlimited" number of substances
("avec un nombre presque  illimite de substances appartenant aux
trois regnes de la  nature," "Ann. d'Hygiene,"  1870, 2, 432); but 
THE SPECTRUM  PROCESS.
301
this objection is irrelevant and misleading.   Schonbein and Dr.
Day have  both proved  clearly that  the  coloring matter of blood
does not cause a bluing of guaiacum resin, and therefore it could
not possibly be mistaken  for  any one of the " unlimited" number
of substances, having nothing in common with blood, which change
the color of this resin.  It is  always proper in  practice to employ
the guaiacum first.  If this is  blued, then other methods of detect-
ing blood should be resorted to.  Out of a large number of cases, I
have not met with one instance during six years  in  which this
bluing of the guaiacum by direct contact formed any obstacle to
the detection of blood.
  The same remarks apply to the coloring matter of bile, which,
according  to Dr. Jamieson ("Australian Med. Journ." Oct. 1869),
produces a bluing of  the guaiacum resin in contact  with peroxide
of hydrogen.  In practice, stains of bile are so strongly marked by
their peculiar color, that  no one competent to undertake such in-
vestigations could fall  into an error of confounding  these with
blood-stains.   The mistakes which have  arisen  respecting blood on
clothes have been chiefly traceable to the presence of stains derived
from red fruits and flowers, artificial  red dyes, and some red mineral
substances, such as red oxide of iron.  M. Lefort.states that stains
produced by the red coloring matter of wine gave a blue color on
the addition of a mixture of guaiacum and peroxide, but this was
only after some hours' exposure!  (Op. cit.  p. 438.)   It  is the very
essence of this mode of testing, that the effect in blood is immediate,
or that  it takes place within  a few seconds.   No reliance can or
ought to be placed upon any change of color which requires hours
for its production, since the resin alone, or in mixture with peroxide,
is slowly blued under  long exposure to air.   If this mode of testing
were followed, the results  would be in all cases fallacious.
  The test operates equally well on fresh and old blood, and on
concentrated as well as very diluted blood, even on blood which
has been boiled.   In  conjunction with the spectroscope, it is  the
only certain method of discovering washed blood (vide infra).  Pro-
vided some small portion of red coloring matter remains, the change
to blue  is perceptible.  If the stain on the material gave no indi-
cation of color—whatever might be  the effect of this or any other
tests—it would be unsafe to affirm that blood was present.  On the
other  hand, the proper precautions being observed in the use of this
test, if there is no bluing of the guaiacum resin in the presence of
peroxide, it will be safe to say that the mark or stain is not owing
to blood.   Every prudent witness would avoid relying upon one test,
and therefore, as so small  a quantity of blood  is required for the
action of guaiacum, it will be always easy to reserve a portion for
the spectroscope and other chemical tests, so that not even a shadow
of an  objection should be raised against the results.
  Spectrum analysis.   Spectral test.—In the previous edition of this
work, the discovery made by Dr. Stokes on the  existence of a pecu-
liar spectrum for blood was briefly referred to.    ("Proc. R. S." vol.
13, No. Q6, p. 360.)  Since that time many researches on this sub- 
302                 SPECTRUM  ANALYSIS.
ject have been made by Mr. Sorby, of Sheffield, and other observers,
and the spectral analysis applied to blood has been made the subject
of evidence on various trials  for murder.   The great advantage of
this process is that it admits  of the  examination of blood without
in any way interfering with the subsequent application of the che-
mical tests already described.  We simply examine the light as it
traverses a solution of the red coloring matter, and with a proper
spectral eye-piece attached to a  microscope we notice whether the
colored spectrum has  undergone  any change.  If the red liquid
owes  its color to recent or  oxidized  blood, two  dark absorption
bands will be seen breaking the continuity of the colored spectrum.
These are  situated respectively at the  junction of the yellow with
the green rays, and in  the middle of the green rays.  If the blood
is quite recent and of  a bright red color (scarlet, hsematine, or
carmine) the two absorption bands are distinct and well defined.
   There can be no doubt that in the hands of a competent person,
and one skilled in micro-spectral observations, this optical method
will enable him to discover the  minutest traces of blood, provided
any red coloring matter  remains.   Thus Mr. Sorby states that a
spot of blood only one-tenth of an inch in diameter, or a quantity
of the red  coloring matter amounting to no more  than the T<H5oth
part of a grain, is sufficient to give  conclusive evidence of its pre-
sence by spectrum analysis.  Mr. Sorby thus detected  blood in the
form  of deoxidized  hsematin on the  rusty blade of a knife with
which the murder of Mrs. Gardner was  committed in 1862, after
the lapse of ten years.  Blood-stains which have been washed in
water, and blood which has  even been boiled or heated to 212°,
may be thus detected.  In the  latter case, ammonia with the aid
of a  gentle heat, is employed to dissolve the matters rendered in-
soluble by boiling.  Spectral analysis does not enable us to make
any distinction beyond that  of  recent and old blood, and this dis-
tinction cannot be so drawn  as to enable us to fix a specific or even
an approximate date.   Certain  accidental  conditions may rapidly
produce on blood the same effect as exposure to air for a long period
of time.   It indicates no distinction  in the blood of the sexes, of
the foetus  and adult, or  in the blood of man and animals.   As a
corroborative process  it furnishes most valuable  and trustworthy
evidence, and there is  no case in which blood admits of a chemical
examination, in which spectral analysis  does not admit of a safe
application before the  chemical  tests are applied.
   Preyer makes a distinction in the use of the spectroscope, which
it will be  well for the  medical  witness  to  bear in mind.   The
absence of the absorption bands in a  red  colored liquid, however
much it may resemble blood, proves that it is not blood, but some
other red  coloring matter.  This direct method, i. e., the demon-
stration by two absorption bands of the presence  of undecomposed
coloring matter (haemoglobin),  has  however only a limited appli-
cation. In practice, the proof of the presence of blood by the spec-
troscopic   examination of the  products  of its decomposition by
chemical  agents is not  satisfactory.  (Op. cit. p. 112.)   If certain 
DETECTION OF  BLOO D-CORPUSCLES.         303
spectra of an artificial kind produced by chemical agents are relied
upon  as  absolute proof of the presence of blood, the witness must
be prepared to state from personal experience, the effect of the che-
micals employed upon other red coloring matters.   In the hands of
experienced observers this difficulty would not arise.
  Microscopical evidence.  Blood-corpuscles.—Hitherto the micro-
scope has been referred to as an aid to the examiner in drawing  a
distinction between  the appearances presented by blood-stains in
the dry  state, and those caused by  other sub-
stances.  Its use, however, extends much beyond       Fig. 50.
this.  The spots or stains may be so small as not
to admit of removal, for the purpose of applying
chemical tests.  If an  examination  of the dry
stain  with a  low power (20 or 30  diameters)
justifies  further proceedings,  we may then em-
ploy the  microscope for the purpose of detecting   _,       ,,.,.,
i, J      ,.   i V        l •  i  ^i    i    d   ^   Blood-corpuscle highly
those peculiar bodies on which  the color of red       magnified.
blood is  known to depend.   The  red  coloring
matter of blood consists of minute colored cells or corpuscles, floating
in a clear liquid (serum).  The engraving (Fig. 50) shows the form
which the corpuscle presents in  the class  mammalia,   a represents
the circular form, when seen  in front, the shaded portion  being  a
depression which  under a certain disposition of the light assumes
the appearance of a solid and opaque  nucleus ; b represents the cor-
puscle seen edgewise, in which case it presents somewhat  the out-
line of a biconcave lens.  It owes  this form to the central depres-
sion on each face.  Other red coloring  matters, such as madder,
cochineal, or lac, do not owe their color to the independent cells or
corpuscles.   Hence, if corpuscles,  of the  form and size of  those
found in  mammalian blood, are visible under the microscope, there
can be no doubt  that the liquid  is blood.  Such  evidence can,
however, be safely received only from one who  has been accus-
tomed to the  use of  this instrument and to the examination of
blood. In order to examine the  suspected substance for corpuscles,
the best  plan  of proceeding, when the particles of coagulum  are
very small, is to breathe several times on a glass  slide, then place
the small fragments of coagulum  on the slide, and again  breathe
over them.  A slip of thin glass may then be laid upon them.  If
they consist of blood, a red margin will  soon  appear, and in  the
fluid portion, by the aid of a magnifying power of from 300 to 500
diameters, some of the corpuscles of the blood may be recognized.
They  are seldom so perfectly spherical  as in the  fresh state, and
they appear small, and frequently shrunk or corrugated.  In  some
cases, only fragments of the envelopes can be seen.   The condeused
moisture  of the breath may serve the purpose of water, in breaking
up the small portions  of  dried blood without destroying the cor-
puscles by too much dilution.
  If the  suspected clot is in  larger quantity, it may be removed
from the  stuff and placed to macerate  in one or two drops of water
on a glass slide.  It should be  covered with thin glass, in order to 
304        CHARACTERS OF  BLOOD-CORPUSCLES.
prevent rapid evaporation.   This method of extracting the corpus-
cles has frequently failed, owing to the quantity of water employed
having been too large.   Under these circumstances, the corpuscles
are distended,  become of  a globular  form, paler  and are finally
destroyed, while the water simply becomes colored.   It  is by no
means easy in all cases to obtain from dry coagula clear and distinct
evidence of  the presence of these corpuscules, especially when the
blood is  old.  In drying, the  blood-cells lose their form, and they
do not readily  resume it when again moistened.  Unless  they are
seen after a short maceration in a very small quantity of water, it,
is probable they will not be seen at all.  To accelerate their sepa-
ration, various chemical liquids have  been recommended.  The
strong solutions of sulphate of soda anel common salt, as well as
liquid albumen  and serum, have been  employed as fluid media for
breaking up the dried  clots of  blood.   There are disadvantages
attending the use of these;  and after many experiments, I  have
founel that a mixture of glycerine and water may be employed in
place of  pure water.   The  proportions which are most convenient
are one part by measure of glycerine, to three  parts by measure of
distilled water.  A solution of arsenious acid, in the proportion of
four grains to  an ounce of distilled water, as recommended by Dr.
Kunze, is also a rapid solvent of the coagula.   When this is used,
the examination should take place as  soon as the liquid begins to
be colored at the margin,  or the corpuscles may be destroyed, and
only fragments of  their envelopes seen.
  In  reference to stains on clothing, if they present any appearance
of dry coagula, these should be carefully scraped off, and treated in
                    the manner above described.  If no  portions
      Fig. 51.        of solid coagula can be procured, there will be
                    but little hope of obtaining evidence of the
                    presence of corpuscles in the suspected stain.
                    The stained portion may be cut out and mace-
                    rated in a  small  quantity of water.  Under
                    these circumstances, the corpuscles  may  be
                    sometimes seen aggregated, or in groups, in the
 a. corpuscles of Mood in  fibres of the stuff, as inthe subjoined engraving,
linen fibre; b, a group de-  .    . . .   ,    '  .    n ■, ■%  i        n   1 •
taChed                in which the stain of  blood was  on a shirt.
                    (Briand's " Manuel de Mdd. Leg." p. 747,1863.)
  The subjoined illustrations (Figs. 52 and 53) show the  appearances
presented by blood corpuscles, when examined  by a power of about
300 diameters,  and under different methods of treatment.   Fig. 52
represents the  appearance of a drop of healthy human blood.  The
red blood-cells are partly detached, partly united in rolls, and partly
in irregular clusters.  In the vacant spaces between them there are
delicate threads of fibrin.  The outlines of the blood-cells are ren-
dered, in some  instances, indistinct, by reason of this web  of fibrin
above them.
  In Fig. 53 the corpuscles are seen free from fibrin, and in groups
as well as singly.  Only a small portion of those which were in the
field have been  engraved.  The  shaded bodies are the white cor-
 
BLOOD OF MAN AND  ANIMALS.
305
puscles of the  blood ;  they are not so well defined in form, and
present an irregularity  of surface, by which they may be distin-
guished from the colored blood-cells.

          FiS-  53-                              Fig. 53.
  Human blood-corpuscles with fibrin.            Human blood-corpuscles from a dried
                                      specimen, maguined 319 diameters.

  Some practice in the use of the  microscope is required to enable
a medical man to arrive  at a correct conclusion in these investiga-
tions.  Granules of starch and the spores of  vegetables might be
mistaken for blood-corpuscles.   Erdmann states that in examining
some articles of clothing  in a case of suspected murder, he  thought
he had found blood-globules in  the liquid which he procured, out
he found on further  inspection that  they consisted  of the red-
colored  spores of  an  alga known as  the porphyridium cruentum.
("Ed. Med. Journal," Oct. 1862,p. 370.)  The size of their bodies
as well as their shape will sometimes aid the observer.  The blood-
corpuscles have a  definite  size;  the bodies  seen under the micro-
scope  may be either too  large or too  small  to fall within  the ex-
ceptional range  of size.   Hence  the  micrometer is  a  necessary
adjunct to the  instrument.  Granules of starch would be  indenti-
fied by the blue color imparted by iodine.
  Blood of man  and animals.—When  marks  of blood have been
detected on the dress of an accused person,  it  is by  no means  un-
usual  to find these marks accounted  for by his having been  en-
gaged in killing a pig, bullock, or sheep, or  in handling fish  or
dead game.  Of course, every allowance must  be made for a state-
ment like this, which can be proved or disproved only by  circum-
stances;  but the question here arises whether we  possess  any
certain means of distinguishing the blood of a human being from
that of an animal.
  Some years since, M. Barruel and other French medical jurists
affirmed that by mixing  fresh blood with one-third or one-half of
its bulk of strong sulphuric acid, and agitating the mixture with
a glass rod, a peculiar odor was evolved, which differed in the blood
of man  and  animals,  and  also in the blood of the sexes.  This
odor, it  was said,  resembled  that  of the cutaneous exhalation of
the  animal the blood  of which was made  the subject  of experi-
ment.  (See  Devergie, "MeU Leg." vol. 2, p. 907.)   It is true that
 
306
BLOOD OF  MAN AND ANIMALS.
strong sulphuric acid does give rise to a particular odor when mixed
with  fresh blood, probably owing to its decomposing action on
some of the animal principles; and it is possible that some persons
may discover a difference in the odor, if not according to the sex,
at least  according to  the  animal.   But assuming this to be true,
there  is probably not one individual among a thousand whose sense,
of smelling would  allow him to state, with undeniable certainty,
from what animal the unknown blood had  really been taken.  In
a case of some importance,  which occurred in Paris, the testing of
blood by odor completely failed in the hands  of M. Barruel and
two other eminent French medical jurists, MM. Tardieu and Cheva-
lier.   The mistakes made by these experts are  admitted by them-
selves to have been of so serious a nature as  to render this mode of
obtaining evidence  in any future case inadmissible.   (" Annales
d'Hyg."  1853, 1, 413.)   For additional remarks on this subject, see
paper in "Guy'sHospital Reports," Oct. 1851.
  There are no chemical differences between the blood of man and
animals.  The red coloring matter, the albumen and fibrin are the
same, and chemical tests produce on  them precisely similar results.
The microscopical differences refer to the shape and size of the cor-
puscles.  1.  With respect to shape.   In all animals with red blood,
the globules have a disk-like or flattened form.  In the mammalia,
excepting the camel tribe, the outline of the disk is circular  (Fig.
50 a).  In this tribe, and in  birds, fishes, and reptiles, the corpus-
cles have the form  of a lengthened  ellipse  or  oval.   In the  three
last-mentioned classes  of  animals  they have  a  central  nucleus,
■which gives to them an apparent ^prominence in the  centre.   The
blood corpuscles of all the mammalia, including those of the camel
tribe, have no central  nucleus, and they appear depressed in the
centre.   The microscope, therefore,  enables an observer to distin-
guish the blood of birds, fishes and reptiles  from that  of a human
being; and this may be of great importance as evidence.
  The chief microscopical  distinction between the blood of man
and domestic animals, consists in a minute difference in the size of
the corpuscles. This, however, is only an average difference; for
the corpuscles are found of different sizes in the blood of the same
animal.  In making use of this criterion, it would be necessary to
rely upon the size of the majority of the corpuscles seen in a given
area,  and under the same power of the microscope. It is a curious
fact that their size  bears  no relation to the  size of the  animal.
Thus, in the horse, ox, ass, cat,  mouse, pig and bat, they are, on
an average, nearly of the same size; the difference is so slight as
to be practically inappreciable.  In  these animals they are smaller
than  in man, and in  several of the  mammalia.  The corpuscles in
man, the dog, the rabbit and the hare are of nearly the same size.
In the blood of the sheep and goat,  they are smaller than in other
mammalia.    The size  of  the corpuscles  bears no proportion to
the age of the animal;  thus in the blood of the human fcetu- they
are to be found as large as in that of an adult. 
               BLOOD-CRYSTALS — H^EMATIN.             307

  The measured diameter of the corpuscles in human blood varies,
according to Gulliver,  from  2A<5tn to TuWth °f  an incn> the
average  size  in  both sexes  being j3Vuth of an inch.  From  an
examination of numerous specimens of fresh human blood, I have
found the average diameter of the globules to be the ^gV^th part
of an inch, the maximum  size  being  ^'offth, and  the minimum
j^^th of an inch.   The corpuscles of human blood are  larger
than those of domestic animals.   The subjoined measurements, in
fractions of an  inch, are those given by Mr.  Gulliver, excepting
the figures in brackets, which are from my own micrometrical ob-
servations.  The average diameter  is,  in  the  dog ??'?Trth  (max.
*sWh,min. T &'0TTth)—in the hare,lBV7th(max. S1foffth,min. b vWh),
in the mouse, gg^th—in the ass, ^^th—(rabbit, ^Vnth)—in the
pig, j^th.  (1213d)—in the ox, „'g7th—(in  the cow, jj'pth to
Wi^th)—in the cat, 7^dDth—in the horse, 7BV^th (y^th)—in the
sheep, -gj^th (5^3d to  BI»TIJth)—in the goat, gg'ggth.  These mea-
surements apply to recent blood, which has not been allowed to be-
come dry on animal or vegetable stuffs.  In this case, a distinction
might be made between the  blood of a human being and a sheep
or goat.   With  respect to the dog,  hare and rabbit it would be,
even under  these favorable  circumstances, a matter of some diffi-
culty.  When blood is  dried on clothing, and it  is necessary to
extract the  corpuscles by means of a liquid of a different nature
from the serum, we cannot rely on slight fractional differences, since
we cannot be sure that the corpuscles, after having been once dried
will ever reacquire in a foreign liquid, the exact size which they
had in serum. Medical evidence must  therefore be based, in such
cases, on mere speculation.   (See " Guy's Hospital Reports,"  vol. 7,
pt. 2, 1851.) _
   In reference to  this  question, therefore, it must  be regarded as
still unsolved.   There are no certain  methods of  distinguishing
microscopically,  or chemically,  the  blood of a human being from
that of an animal, when it  has been  once dried on an article of
clothing.  The extent to which a medical witness  is justified in
going on trials for murder, on which  the important question  arises,
appears to me to be this: the size and shape of the corpuscles may
or may not be consistent with their being the corpuscles of human
blood, but it is impossible, in the presence state of science, to affirm
that they are not those of some domestic animal, belonging  to the
class  mammalia.  For  information  on this  subject, see  Ritter's
Prize Essay, " Ueber die Ermittelung der Blutflecken in Kriminal-
lallen," Wurzburg, 1854, and Friedberg's "Histologic des Blutes,"
Berlin, 1852.  These  authors affirm, from their observations, that
it is not possible  to distinguish  by the microscope human from
animal blood, in criminal cases.  Evidence based upon such varying
averages as those above  given, must  be treated as speculative and
unsafe.
   Blood-crystals.  Hamatin.—Another process for the microscopical
detection of blood has been of late years suggested by some German 
308
BLOOD-CRYSTALS.
medical jurists.  It consists in procuring crystals from the dry red
coloring matter  of blood.  Lehmann and Kunze ascertained that
                         all red blood is capable of crystallization
        Fig- 54-           or of breaking up into crystalline forms,
                         from whatever  animal or organ it may
                         have  been taken.  Lehmann thus de-
                         scribes his method of procuring  these
                         hsematin  crystals:  A  drop  of blood
                         which has been kept a day, is allowed to
                         evaporate  on a glass slide; a drop of
                         distilled water is then added, and the
                         whole is covered with a slip of thin glass.
                         After a time, when the water has to some
                         extent evaporated, regular red-colored
                         crystals, of various sizes and forms, such
                         as those represented  in the quadrant a
of Fig. 54, are  visible.  Some are columnar and prismatic, while
others are  in the form of rhombic plates.   The second  quadrant,
b, represents the crystals procured, by a similar process, from the
heart-blood of a cat.  The third, c, crystals from the venous blood
of a guinea-pig, which appear in regular tetrahedra; and the fourth,
d, crystals from  the venous blood of  a squirrel, some of which are
prismatic, and others in the form of rhombic and hexahedral plates.
The hsematin-crystals are represented in this and the other engrav-
ings as transparent.  They are, in fact, translucent,  and under a
good light, of a well-marked red, or red-brown color.
  In Fig. 55  the first quadrant, a, shows  the prisms  and rhombic
plates obtained  by Lehmann from human venous, blood; b, blood-
crystals from human blood, in  rhombic plates, as delineated by
Robin and Verdeil (" Chimie Anatomique"), and c,  crystals ob-
Fig. 55.                        Fig. 56.
tained from human blood, by Dr. Kunze, by a process described
below.  Some of these have a rhombic form; others are shaped like
a hemp-seed; and  a few, being double at one  extremity, have the
appearance of a swallow's tail.  In the quadrant d are represented
crystals as obtained by Lehmann from the red blood of a fish. It is
to be observed of  these crystals that they are all colored, having
 
BLOOD-CRYSTALS.
309
more or less the red color of the blood in varying degrees of inten-
sity.
  In applying Lehmann's  process to a fragment of a dried clot of
human blood, which had been kept for six months, prismatic crys-
tals were seen, mixed with  bodies of an ovoid shape.   A number of
these are  delineated* in the last engraving  (Fig. 56).  They have
the characters of the phosphates and other salts of the blood.   No
rhombic plates, or tetrahedra, such as those described by Lehmann,
were seen.   The prismatic crystals had the characters of phosphate
of magnesia.  They were colorless on a red ground, which owed its
color to the dissolved haematin.
  The production of crystals from the coloring matter of blood, as
contained in a dry coagulum, may be easily effected by a process sug-
gested by Dr. Kunze, of Merseburg.   (Casper's " Vierteljahrschrift/'
April, 1864, p.  262.)   This gentleman recommends the strongest
glacial acetic acid.  As the object is not  here  to search for blood-
corpuscles, any stuff superficially stained is soaked in a small quan-
tity of water for one or two hours, until the coloring matter is dis-
solved, and a reddish-brown solution is obtained.   The red liquid is
evaporated to dryness,  and  the dry residue is boiled in an excess of
glacial acetic acid, until the acid is strongly  colored.  The  acid
liquid is poured off, and one or two particles of common salt are
well stirred into it.  It is then slowly evaporated  on a slide, or on
a watch-glass, at  a temperature of about  180°, and  the residue is
examined, either in the wet or dry state, by a microscopical power
of 300 to 500 diameters.  The blood-crystals, if present, appear in
groups, as small  dark specks.   They are somewhat irregular in
shape—have generally  a prismatic form, some with rhombic termi-
nations, while others assume a spindle shape, and others again are
joined at an angle, so as to  resemble a bird's tail, or they cross each
other like the letter X.  In repeating Kunze's experiments, I have
found that the use of common salt was not necessary.  It had the
effect of encumbering  the field of view with cubic and other crys-
tals of chloride of sodium.  Having removed a portion of the dried
coagulum  from human  blood, which had been kept loosely exposed
for  six months, I powdered it and boiled it in  glacial acetic acid,
in a small porcelain cup, until a quantity of coloring matter  had
ohviously  been dissolveel.  The acetic  acid, under these circum-
stances, acquireel  a dark reddish  or  reddish-brown color.  A few
drops of the clear liquid, evaporated on a slide,  left minute  red-
colored crystalline-looking masses. They were plainly distinguish-
able from the cubic crystals of common salt, naturally containeel
in the blood, as well as  from the phosphates.   They varied much in
size and shape, but generally assumed  the form of slender prisms
with irregular rhombic terminations.   Hannatin-crystals, as they
were thus procured from human blood, were  found to have an
average length of s^^th of an inch, and a width of g^isth of an
inch.  Those obtained  from sheep's blood were smaller than those
obtained from the blood of  man and  of  the bullock.   The general 
310       THE CAUSE OF DEATH FROM WOUNDS.
resemblance, however, is so great, that it would be  obviously im-
possible to base any distinction between human and animal  blood
upon  these observations.  The association of cubic crystals of  salt
with  these blood-crystals, when no  chloride of sodium has  been
added to the liquid, is an additional proof of the presence of blood,
as this is one of the principal saline constituents ol that fluid.  In
stains of  old date, I have  observed, in association with  hsematine
crystals, dagger crystals, resembling  those  of hydrochlorate of
ammonia.  Similar experiments were made with the coloring mat-
ters of  cochineal, logwood  and kino.  On treating  the first with
acetic acid, a  pink-red  color, differing from that of blood is pro-
duced, while the extracts  of logwood and kino give a yellowish-
brown color with this acid.  In no case, on evaporating the acid
solutions, were any crystals resembling those of hsematin or chlo-
ride of  sodium obtained.
                   CHAPTER  XXVII.

THE CAUSE OF DEATH FROM WOUNDS.—WOUNDS DIRECTLY OR INDIRECTLY
  FATAL.—DEATH FROM HEMORRHAGE.— INTERNAL BLEEDING.— DEATH
  FROM  MECHANICAL INJURY.—FROM SHOCK.—DEATH FROM NUMEKOUS
  PERSONAL INJURIES IRRESPECTIVE OF ANY MORTAL WOUND.

  It is important for a medical witness to bear in mind that in all
cases  of wounds criminally inflicted, the cause of death  must be
certain.   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  compres-
sion of  the  spinal marrow at the same  instant.  Hence,  it is our
duty, when several apparent causes for  death  exist,  to determine
which was the real cause ;  and in stating it to  the court, to be pre-
pared to offer our reasons for this opinion.  In most  cases of local
injury,  when a person dies speedily, there will be no great trouble
in settling whether disease or the injury was  the cause.   A diffi-
culty may, however, exist when a person has  recovered from the
first effects of a  wound, and has subsequently died.   Besides, there
may be cases in which the cause of death, in spite of the most
careful  deliberation, will be still obscure; or sometimes it  may
happen that the death of a person appears to be as much dependent
on bodily disease as on an  injury proved to have been  received at
the time he was laboring under disease.   How is an  opinion to be
expressed in such a case ?   The course which I apprehend a medical 
DEATH FROM LOSS OF BLOOD.
311
witness ought to pursue, provided he has duly deliberated on the
circunistanees before he appears in court, and his mind is equally
balanced between  the two causes, is to state at once his  doubt to
the jury without circumlocution, and not allow it to be extracted
from him in cross-examination.  It is the hesitating to assign a
satisfactory cause, or the assigning of many causes for death, that
gives such advantage to  a prisoner's  case, even when the general
evidence is  entirely against  him.   Occasionally, many causes of
death are assigned  by a medical witness, among which some have
a tendency to exculpate, and others to inculpate an accused person
in a greater or less degree, and it is left to the jury to select from
the number, one upon which to found a verdict.  In a case of this
kind an acquittal is commonly obtained.
   Wounds directly  or indirectly fatal.—A wound may cause  death
either directly or indirectly.   A wound operates as a direct cause of
death when the wounded person dies either immediately, or very
soon after its infliction, and there is no other cause internally or
externally to account  for death.  In  wounds which  cause  death
indirectly, it is assumed that the person survives for a certain period,
and that the wound  is  followed  by inflammation, suppuration,
pyaemia, gangrene, tetanus, erysipelas, or some other mortal disease,
which is a direct, and not an unusual consequence of the injury.
Under this head may be also arranged all those cases which  prove
fatal by reason of  surgical operations rendered imperatively  neces-
sary for  the treatment of an  injury—presuming that  these opera-
tions have been performed with ordinary skill and care.  We shall
for the  present consider only the direct causes of death in cases of
wounds.  They are three in  number: 1. Hemorrhage, or loss of
blood.  2. Great mechanical injury done to an organ important to
life.  3.  Shock, or concussion, affecting the brain or spinal marrow,
whereby the functions of one  or  more vital  organs  are  arrested,
sometimes with but slight injury to the  part struck or wounded.
From either of these  causes, a  wounded person may die  imme-
diately, or within  a few minutes.
   1. Death from hemorrhage.—Loss of blood operates by producing
fatal syncope (p. 57.)  A quantity of blood escaping from a vessel,
although insufficient to cause  death by affecting the heart and  cir-
culation, may readily destroy life by  disturbing the functions of
the organ or part into which it is eff'used.  Thus, a small quantity
effused in or upon  the substance of the  brain, or at its base, may
prove fatal by inducing fatal  compression ;  and again, if, in  a case
of wounded  throat, blood should flow into the windpipe, it may
cause death by asphyxia—/. e., by stopping the  respiratory process
(p. 58.)   In these cases it  is obvious  that  the  blood acts mechanic-
ally ; and in respect to the last condition, a  meelical  man, unless
circumspection is  used, may involve himself  in a charge  of  mala-
praxis.   If he  allows  the wound to  remain open, the wounded
person may die through hemorrhage—if he closes it too soon, he
may die through suffocation ;  and, in either case, the counsel for a
prisoner  will not fail to take advantage of a plausible objection of 
312
DEATH FROM LOSS OF BLOOD.
this kind.  In wounds of the chest, involving the heart and lungs,
death  is frequently due, not  so much to the actual quantity of
blood  effused, as to the pressure which it produces upon  these
organs.  A few ounces  effused in the cavity of the membrane in-
cluding the heart (pericardium), will entirely arrest the action of
this organ.
  The absolute quantity of blood required to be lost in order to prove
fatal, will, of course, vary  according to numerous circumstances.
The young, the  aged, they who are laboring under infirmity or
disease, will perishsooner from  loss  of blood than  others who are
healthy and vigorous.   Women, cceteris paribus, are more speedily
destroyed by bleeding than men.  Infants  are liable to die from
this cause, as a result of slight  wounds.  An  infant has been known
to bleed to death from the bite of a single leech, or from the  sim-
ple operation of lancing the gums. Even the healthy and vigorous,
when their vital powers have been depressed by maltreatment, or by
brutal violence, will sink under the loss of a  comparatively small
quantity of blood.   (" Watson on Homicide," p. 90.)  A medical
jurist must not  forget that some persons have a predisposition to
excessive bleeding from slight injuries; and this  condition is often
hereditary.  The slightest wound or puncture—the bite of a leech
or the extraction of a tooth—will be attended with a loss of blood
which cannot be  arrested, and which will slowly lead to death by
exhaustion.  Cases have been frequently recorded in  our medical
journals of fatal hemorrhage  following the  extraction of teeth,
when there had been previously nothing to indicate the probable
occurrence of death from so trivial a cause.  Such cases are without
difficulty  detected, since a surgeon may always infer, from the part
injured and the extent of the injury, whether the bleeding is likely
to be copious or  not.  When  a person bleeds  to death from what
would, under common  circumstances, be  a  simple wound, the ad-
mission of this fact may in certain  cases lessen  the responsibility
of an accused party.
  A sudden loss of blood has a much more serious consequence than
the same quantity lost slowly.   A person may fall into a fatal syn-
cope from a quantity of blood lost in a few seconds, which he would
have been able to bear without sinking, had it escaped slowly.  This
is the reason why the wound of an artery proves so much more
rapidly fatal than that of a vein.  Death speedily follows the wound
of a large artery like the carotid;  but it  takes  place with equal
certainty, although more slowly, from wounds of smaller arteries.
In a case  in which  one of the intercostal  arteries was wounded by
a small shot, hemorrhage caused death in thirty-eight hours.  The
loss of blood which follows the division of  the smaller branches of
the external carotid artery is  often sufficient to destroy life, unless
timely assistance be rendered.   If a wound is in a vascular  part,
although  no vessel of any importance be  divided, the person  may
die from  bleeding.   It is difficult to say what quantity of blood
should be lost, in order that a wound may prove  fatal.  The whole
quantity contained  in the body of an adult is calculated at about 
FATAL INTERNAL  BLEEDING.
313
one-fifth of  its weight—i. e., about  thirty pounds;  of this, one-
fourth is considered to be arterial, and the remaining three-fourths
are venous blood.  Some physiologists  have estimated the propor-
tion as one-eighth of the weight of the body.   (" Med. Times and
Gaz.," Aug.  28, 1858, p. 232.)  According to Mr. Watson, the loss
of from five to eight pounds is sufficient to prove fatal to adults.
But while this may be near the truth, many persons will die from
a much smaller quantity;  the rapidity with  which the  effusion
takes place having a considerable influence, as well as the age, sex,
and bodily condition of  the woundeel person.  It has been found,
by experiment, that a dog cannot bear the loss of more blood than
is equivalent to one-twelfth part of the weight of its body.
  Internal hemorrhage.—Hemorrhage may prove fatal,although the
blood does not visibly escape from the body.  In  incised  wounds,
the flow externally is commonly abundant; but in contused, punc-
tured and gunshot wounds, the 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
thus be slowly or rapidly effused.  The most fatal internal hemor-
rhages are those which follow ruptures of the organs from  violence
or disease.  .Ruptures of the heart, lungs, liver, and kidneys  have
thus caused  death.  In  November, 1864, a man who had been run
over was brought to Guy's Hospital.  He complained of pain in the
back, but there were no symptoms of severe injury, and no marks
of violence were seen on the skin of the back,  die  left the hospital
and walked  with some assistance to his home.   A  few hours after-
wards he was found dead in bed.   On inspection, there was a large
quantity of  blood effused  in the  abdomen.  This had proceedeel
from one  kidney, which had been ruptured transversely through
its whole substance.   In these cases the bleeding is not necessarily
immediate;  but  slight  muscular exertion  may  increase it and
accelerate death.  In death from  severe flagellation, blood may be
effused in large quantity beneath the skin and among the  mus-
cles ; this effusion will operate as  fatally as if it had flowed from
an open wound.
  The means of ascertaining whether a person had died from bleed-
ing by an open wound are these: Unless the wound is situated in a
vascular part, we shall find the vessel or vessels from which the blood
has issued, divided, the  neighboring vessels empty, and the  body
more or less  pallid; although this last condition is of course liable
to be met with in certain cases of disease,  as also under copious
venesection—points easily  determined  by an  examination.  The
blood will commonly be  found more or less clotted or coagulated
on those surfaces on which  it has fallen.  If,  with these signs,there
is an absence of disease likely to prove rapidly fatal, and no other
probable cause of death is apparent, it may be fairly referred to loss
of blood.  This  opinion  may, however, be materially modified in
reference to  open wounds, by the fact of the body not being seen 
314
DEATH FROM SHOCK.
on the spot where the injury was actually inflicted—by the wound
having been sponged—the blood removed by washing, and all traces
of bleeding destroyed.  Under these circumstances, the case must
in a great measure be made out by presumptive proof; and here a
medical witness may have the duty thrown upon him  of" examining
articles of dress, furniture, or weapons, for marks or stains of blood.
It must  not  be supposed that  all  the blood  met with  round a
wounded dead body, or in a cavity of the body, was actually effused
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, however, is not considerable, unless the veins
implicated are large, or the part is highly vascular, i. e., full of small
vessels.
  2. Death from great mechanical injury done to a vital organ.—We
have instances of this becoming a direct cause of death in the crush-
ing of the heart, lungs, or brain, by any heavy body passing over or
falling on the cavities, as in  railway accidents.  The severe me-
chanical injury is sometimes  accomplished by a considerable effu-
sion of blood, so that the person really dies  from hemorrhage; but
in other instances the quantity of blood lost is inconsiderable, and
the fatal effects may be referred to shock  to  the nervous system.
Sometimes a slight amount of violence may prove suddenly fatal.
These are, however, to be regarded as exceptional instances.
  3. Death from  shock.—This is sometimes a direct cause of death
under  the infliction of external violence; and in this case life is
destroyed without  the injury being to all appearances sufficient to
account  for  so speedily fatal  a result.   Mr. Savory has suggested
that death from shock is nothing more than death from temporary
exhaustion of nerve-force, the result of a violent, sudden, and ex-
cessive expenditure of it.  (" Lectures on Life  and Death," p. 171.)
Whatever theory may be adopted to explain it, there is no medical
doubt  that a person may die from what is termed shock,' without
any marks of severe injury being discovered on his body after death.
We have examples of this  mode of death in accidents from light-
ning, or from severe burns or scalds, in which the local injury is
often far from sufficient to explain the rapidly fatal consequences.
As instances of this form of death from violence, may be also cited
those cases in which a person has been suddenly killed by a blow
upon the upper part of the abdomen, or on the pit of the stomach,
which is supposed  to operate by producing a fatal impression on
the nerves and nerve-ganglia of the cardiac  plexus.   Whether this
be or be not the true explanation, it is  admitted by experienced
surgeons, that a person may die from so simple a cause without any
mark of a bruise  externally, or physical injury internally to account
for death.  On the skin there may be some abrasion or slight dis-
coloration ; but as  it has been  elsewhere stated these are neither
constant nor necessary accompaniments of a blow.   Concussion of
the brain, unattended  by visible  mechanical  injury,  furnishes 
DEATH FROM SHOCK.
315
another example of 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 an inspection, there may be merely
the mark of a bruise  on the scalp; in the  brain there may be no
rupture of vessels or laceration of substance, and all the other organs
of the  body may be found healthy.  In certain railway accidents
persons have died under somewhat similar circumstances.  There
has been no physical indication of a mortal injury, anel no cause
apparent to account for death.  This can  be referred only to the
shock or violent impression which the nervous system has sustained
from the blow or violence—an impression  which the vital powers
were wholly unable to  counteract  or resist.  A medical  witness
must give  his evidence with caution in such cases; since it is the
custom to rely in the defence upon the absence of any visible mortal
wound or  physical  injury to account for death, as a proof that no
injury  was done—a principle which, if once unrestrictedly admitted,
would  leave a  large number of deaths, undoubtedly occurring from
violence, wholly unexplained.
  There is another form of shock, which is of some importance in
medical jurisprudence.  A person may have received many injuries,
as by blows or stripes, not one of which, taken alone, could, in me-
dical language, be  termed mortal; and  yet he may die directly
from the effects of the violence, either on  the spot,  or very soon
afterwards.  In the absence of any  large effusion of blood beneath
the skin, eleath is  commonly referred to exhaustion, but this is only
another mode of expression ;  the exhaustion is itself dependent on
a fatal  influence or impression produced on  the nervous system.  A
prizefighter after having, during many rounds, sustained numerous
blows  on the  body, may,  either at or after the fight, sink and die
exhausted.   His body may present  marks of bruises, or even lace-
rated wounels, but there may be no internal changes to account for
death.   In common language, there is not a  single injury wdiich can
be termed mortal; and yet, supposing him to have had good health
previously to the fight, and all marks of disease indicative of sudden
death  to be absent, it is  impossible not to refer his death to the
direct  effect of the violence.  It is a well-ascertained medical fact,
that a  number of injuries,  each comparatively slight, are as capable
of operating fatally, as any single wound whereby some bloodvessel
or organ important  to life is  directly affected.   Age, sex, constitu-
tion and a previous state of health or disease may accelerate or
retard  the fatal consequences.
  A case of somewhat similar kind may present itself in the pun-
ishrqent of flagellation, which is  occasionally followed by death,
either  as a  direct consequence of shock, or from indirect causes,
such as inflammation and  its consequences.   At the trial of Gover-
nor Wall, the  judge directed the jury that the long continuance
and severity of pain (in flagellation) may be productive of  as fatal
consequences as if  instruments or weapons of a  destructive kind
were used.   It is not often that scholastic flagellation is a cause of
death  in this country.  One  case, however, which occurred a few 
316
MORTALITY OF WOUNDS.
years since, excited public attention  from the atrocity of the cir-
cumstances  attending  it.  It was the subject of a trial  for man-
slaughter at the Lewes Autumn Assizes, 1860 (Reg. v. Hopley).
The evidence showed  that the prisoner had  beaten deceased, a
youth of sixteen, most severely for nearly two  hours with a rope
and stick.   The external wounds were  slight,  but an inspection
showed that the muscles as well as all  the soft parts beneath the
skin had been considerably bruised and lacerated, and that there
were extensive eft'usions  of  blood in the cellular membrane of the
arms and legs.  There was  no  mortal  wound in the common sense
of the term, but there was no reasonable doubt that the deceased had
died from the violence inflicted on him by the prisoner.   His guilt
was established by the fact that he had endeavored to conceal the
effects  of his violence  by removing the  marks of blood—that he
had covered the body of the deceased with clothing so as to conceal
the bruises—that he had procured a coroner's inquest to be held in
haste,  and while concealing from the jury the fact that he had
beaten the youth  on the night of his death, stated that he had
found him dead, and suggested that he might have died of disease
of the heart.   There can be no doubt, from the  medical facts of
this case, that the deceased  died either while the prisoner was in-
flicting the violence or soon afterwards.  No attempt was made to
dispute the cause  of death.  Apart from the depressing effects on
the nervous system of long-continued and severe pain, there was
in this instance such an effusion of blood internally as would account
for the production of fatal syncope.
  From these considerations, it is obviously unreasonable to expect
that in every case of death from violence or maltreatment, there
must be some specific and visible mortal injury  to account for this
event.  When the circumstances accompanying death are unknown,
a medical opinion should certainly be expressed with caution; but
if we are informed that the deceased was in ordinary health and
vigor previous to the infliction  of the violence, and there is# no mor-
biel 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
number of injuries.  Among non-professional persons an unfounded
prejudice exists that no  persons can die  from violence unless there
be some distinctly mortal wound actually inflicted on the body.  By
this we are to understand a visible mechanical injury to some organ
or bloodvessel important to life; but this is obviously an erroneous
notion, since death may take  place from  the disturbance of the
functions of an organ important to life, without this being neces-
sarily accompanied by a  perceptible  alteration of structure.   The
prevalence of this popular error  often leads to a severe  cross-ex-
amination of medical witnesses.
  When there are  several wounds, it is difficult to decide on their
relative degree of mortality, and  on  the  share which each  may
have had in causing death.   By a wound being of itself 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 
MORTALITY OF WOUNDS.
317
that the body is healthy, and that no cause has intervened to bring
about or even accelerate  a fatal result.  The circumstances of a
person laboring under disease when wounded in a vital part, will
not, of course, throw any doubt upon the fact of such a  wound
being necessarily mortal, and of its having caused death.  If there
should be more wounds than one, it is easy to say 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: Would
the deceased have been likely to die at the  same time, and under
the same circumstances, had he not received the wound?  There
can obviously be  no general rule for determining the mortal  nature
of wounds.  Each case must be judged by the circumstances which
attend it.  In some continental States, the law requires that a medi-
cal witness should draw a distinction between a wound  which is
absolutely and one  which  is conditionally  mortal.  An absolutely
mortal wound is  defined to be that in which  the best medical assis-
tance being at hanel, being sent for, or actually rendered, the fatal
event could not be averted.  Wounds of the heart, aorta, and in-
ternal carotid arteries are of this nature.  A conditionally  mortal
wound is one in which, had medical assistance been at hand, been
sent  for, or timely rendered, the patient would, in all  probability
have recovered.  Wounds of the brachial, radial, and ulnar arteries
may  be taken as instances.  The responsibility of an assailant is
made to vary according to the class of injuries to which the  wound
may  be referred  by the medical witnesses; and. as it is  easy to
suppose, there is  seldom any agreement on this subject.  Our crimi-
nal law is entirely free  from such  subtleties.  The effect of the
wound, and the intent with which  it was inflicted, are looked to;
its anatomical relations, which must depend  on pure accident, are
never interpreted in the prisoner's favor.  Some  extenuation may,
perhaps, be occasionally admitted when a wound  proves  mortal,
through,an indirect  cause, as  inflammation or fever, and medical
advice was obtainable, but not obtained until  every  hope of re-
covery had disappeared.  It appears, however, from the case of the
Queen v. Thomas and  others (Gloucester Aut. Ass., 1841), that the
mere neglect to call in medical assistance is  not  allowed in law to
he a mitigatory circumstance in the event of death ensuing.  The
deceased died from the effects of a severe injury in the head, in-
flicted by the prisoner, but had  had no  medical assistance.  The
judge said it was possible  that, "if he  had had medical advice, he
might not have died; but whoever did a wrongful act must take
the whole  consequence of  it. It never  could make any difference
whether the party injured  had  or  had not the means or the mind
to apply for medical advice."  The prisoners were convicted.   Ac-
cording to Lord Hale, if a man  be wounded, and  the  wound, al-
though not in itself mortal, turn to a gangrene or fever for want
of proper applications, or  from neglect, and the man die of gan-
grene or fever, this  is  homicide  in the aggressor: for though the 
318       ACCELERATION OF  DEATH BY DISEASE.

fever or gangrene be the immediate cause of death, yet the wound
being the cause of the gangrene or fever is held the cause of death,
causa causati.  These nice questions relative to the  shades of re-
sponsibility  for personal injuries, occasionally arise  in  cases in
which persons  have been  wounded at  sea, on board of a ship in
which there was no surgeon.
                  CHAPTER XXVIII.

DEATH OF WOUNDED PERSONS FROM NATURAL CAUSES.—DISTINCTION BE-
  TWEEN REAL AND APPARENT CAUSE.—DEATH FROM WOUNDS OR LA-
  TENT DISEASE.—ACCELERATING CAUSE.—DEATH FROM WOUNDS AFTER
  LONG PERIODS.—AVOIDABLE  CAUSE  OF DEATH.—NEGLECT.—IMPRU-
  DENCE.—UNSKILFUL TREATMENT.—UNHEALTHY STATE OF BODY.

  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 persons, death may appear to be a
direct result of the injury, the case  can  only be cleared up by the
assistance of  a medical practitioner.   Such a coincidence has been
witnessed in  many instances of attempted suicide.  A man has in-
flicted a severe wound on himself while laboring  under disease;
or some morbid change, tending  to  destroy life, has occurred  sub-
sequently to  the infliction of a  wound, and death has followed.
Again, a natural cause of death  may be lurking  within the body
at the time that a wound is criminally inflicted, and  a close atten-
tion to the symptoms preceding, and the appearances after  death,
can alone enable a surgeon to  distinguish the real  cause.  A  mail
may  be severely wounded, and  yet death may take place from
rupture of the heart, the bursting of an aneurism, from apoplexy,
phthisis, or other morbid  causes which  it  is here unnecessary to
specify.  ("Cormack's  Ed. Jour." May, 1846,  p. 343.)  If death
can  be clearly traced  to  any of  these diseases  by an experienced
surgeon, the  prisoner cannot  be charged with  manslaughter; for
the medical witness may give his opinion  that  death would have
taken place about the same time and under the same circumstances
whether the wound had been  inflicted or not.
  On  these occasions one of  the "following questions may arise:
Was  the death of the person accelerated by the wound, or was the
disease under which he was laboring so aggravated by the wound
as to  produce  a more speedily fatal  termination ?   The answer to
either of these questions must depend on the circumstances of each
case,  and  the witness's ability to draw a  proper  conclusion  from
these circumstances.  The maliciously accelerating of the death of
another already laboring under disease is criminal;  for in a  legal 
        WHICH  OF  TWO WOUNDS CAUSED  DEATH.      319

sense that which  accelerates, causes.  In  Reg.  v.  Timms (Oxford
Lent Ass. 1870), it was proved that prisoner had  struck deceased
some blows on the head with a hatchet.   In twelve days, under
treatment, he  had  partly recovered from the  effects, but  in six
weeks afterwards he was seized with inflammation of the brain,
with convulsions, and died.  On inspection, disease of the kidneys
was found, of  which  there  had been no  symptoms.  Death  was
referred to this disease, and  inflammation  of the brain as the result
of the blows.  The learned  judge  directed the jury, that if they
believed the blows conduced in  part to the death  of the deceased,
it was manslaughter,  notwithstanding that other causes combined
with the blows to account for  death.  The prisoner was convicted.
Lord Hale, in  remarking upon  the necessity of proving that the
act of a prisoner caused the death of a person, says:  " It is necessary
that the death should  have  been occasioned  by some corporeal
injury done  to the party by force, or by poison, or by some  me-
chanical means which occasion death ; for although a person may,
in foro conscientice, be as guilty of murder  by working on the pas-
sions or fears of another, and  as certainly occasion death by such
means, as if he had used a sword or pistol for the purpose, he is not
the object of temporal punishment."  (I. 247.)   Several acquittals
have taken  place of late years, in cases in which the deaths of
persons  have  been  occasioned by terror,  or  dread of  impending
danger, produced  by acts of violence on the part of the prisoners ;
not, however, giving rise to bodily injury  in the deceased.
   Which of two wounds caused death.—It is possible  that a man may
receive two wounds on provocation, at different times, and from
different persons, and die after receiving the second: in such a case,
the course of justice may require that a medical witness should state
which wound was the cause of death.   Let us  take the following
illustration: A man receives during a quarrel a gunshot wound in
the shoulder.  He is going on well, with  a prospect of recovery,
when in another quarrel he receives a severe penetrating -wound in
the chest  or abdomen from another person, and after lingering
under the effects of these wounds for a longer or shorter period, he
dies.  If the gunshot  wound was clearly shown to have been the
cause of death, the second prisoner could not be convicted of man-
slaughter; or if the stab  was evidently the cause of death, the  first
prisoner would be acquitted  on a similar charge.  It might be  pos-
sible for a surgeon to decide the  question summarily, when, for
instance, death speedily followed the second wound ; and on inspec-
tion of the body,  the heart or  a large vessel is  discovered to have
been penetrated ;  or, on  the  other  hand, extensive sloughing suffi-
cient to account  for death, might take  place  from  the  gunshot
wound, and on inspection, the stab might be found to be of a slight
nature—not involving any vital parts.   In either of these cases, all
would depend  upon the science, skill, and judgment of the medical
practitioner; his  evidence would be so important  that no correct
decision could  be arrived  at without it;  he would be, in fact, called
upon substantially to distinguish the guilty from the innocent.  On 
320  DEATH FOLLOWING  SLIGHT  PERSONAL  INJURIES.

some occasions  death may appear to  be equally a consequence^
either or both of the wounds ;  in which case, probably both parties
would be liable to a charge of manslaughter.   (See " Ann. d'Hyg."
1835, vol. 2, p. 432.)  The second wound, which is here supposed
to have been the act of another, may be inflicted by a wounded
person on himself, in an attempt at suicide, or  it may have an acci-
dental origin.   The witness would then have to determine whether
the wounded person  died from the wound inflicted  by himself, or
from that which he had previously received.
  It may happen that the wounded person has taken poison, and
has actually died from its effects, and  not from the injuries or mal-
treatment.   Again, a wounded person may have been the subject
of subsequent ill-treatment, and the question  will  arise—to which
of the two causes his death was  really due.   It is to be observed
of these cases, that  the supervening disease, the poison, or the sub-
sequent ill-treatment, should  be of such a nature as to account for
sudden or rapid death; since it would be no answer to a charge of
death from violence, to say that there were marks of chronic disease
in the  body, unless it was of such a nature as to  account for the
sudden  destruction  of life under the symptoms which actually pre-
ceded death.  In the medical jurisprudence  of wounds, there is
probably no question which so frequently presents itself as this : It
is admitted that the violence was inflicted, but it is asserted that
death was due to some other cause, and the onus  of proof lies on
the medical evidence.  Among numerous cases  which have occurred
in England during  the last twenty years, I  find that the latent
causes of death in wounded persons have been chiefly inflammation
of the  thoracic or  abdominal viscera, apoplexy,  diseases of the
heart and large bloodvessels, phthisis, ruptures of the stomach and
bowels from disease, internal strangulation, and the rupture of deep-
seated abscesses.  In some of  these cases the  person was in a good
state of health up to the time of the violence, and in others there
was a slight indisposition.  The  history is nearly the same in all:
it was only by careful conduct on the part of the medical witnesses
that the true cause of death was  ascertained.  It is obvious that
questions of malapraxis  and  life-insurance,  giving rise to civil
actions, may have a close relation to this subject.
   Death following slight personal injuries.—An imputation has oc-
casionally been thrown on the master of a school,  when a boy has
died soon after he has been punished in an ordinary way, and when
there has been no suggestion that an undue amount of violence was
used. In such cases there has been commonly  some unhealthy state
of the  body to explain the fatal result.  When the disease which
gives rise to doubt  is seated in a part which  is remote from  that
which  sustained the violence, all that is required is that the exami-
nation of the body should be conducted with ordinary care.  If the
disease  should happen to be in the part injured (the head or chest),
the case is more perplexing.   The difficulty can then  be removed
only by attentively  considering the usual consequences of such inju-
ries.  The violence may have been too slight to  account for the 
DEATH AFTER A  LONG  PERIOD.
321
diseased  appearance; and  the  disease itself, although  situated in
the part injured, may be  regarded  as  an unusual consequence of
such an injury.  On the other hand, the presence of chronic disease
will form no exculpation of acts of violence of this nature.
  Death from wounds after long periods.—Certain kinds  of injuries
are not  immediately followed by  serious  consequences, but  a
wounded person may die after a longer  or shorter period of time,
and his death may be as much a consequence of the injury as if it
had taken  place on the spot.  The aggressor, however, is just as
responsible as if the deceased had been directly killed  by his vio-
lence, provided the fatal  result can  be traced  to the  usual and
probable consequences  of  the  injury.  Wounds of the head  are
especially liable to cause death insidiously;  the wounded person
may in the first instance recover—he may appear to be going on
well, when, without  any obvious cause,  he will suddenly expire.
It is scarcely necessary to observe  that in general  an examination
of the  body will suffice to determine whether death is to  be ascribed
to the  wound or not.  In severe injuries affecting the spinal marrow,
death is not an immediate consequence, unless that part of the organ
which  is above the origin of the phrenic nerves (supplying the dia-
phragm)  is wounded.   Injuries affecting the  lower portion of the
spinal column do not  commonly prove fatal until after  some days
or weeks ; but the symptoms manifested by the patient during life,
as well as the appearances observed in the body after  death; will
sufficiently connect  the injury with that event.  Death  may follow
a wound, and be a consequence of that wound, at almost  any period
after its infliction.   It is necessary, however, in order to maintain
a charge of homicide, that death should  be  strictly and clearly
traceable to the injury, and not be dependent  on any other cause.
A doubt on this point must, of course, lead to an acquittal of the
accused.
  Many cases might be quoted in illustration of the length of time
which  may elapse before death  takes place from certain kinds of
injuries—the injured  person having  ultimately fallen a victim to
their indirect consequences. A case is related by Sir A. Cooper of
a gentleman who died from the effects of an injury to the head re-
ceived  about two }Tears previously.  The connection of death with
the wound was clearly made out by the continuance of  the symp-
toms of cerebral disturbance during the  long period which he sur-
vived.  Another case is mentioned  by Hoffbauer, in which a person
died from the effects of concussion  of the brain as the result of an
injury received  eleven years before.   (" Ueber die Kopfverletzun-
gen," 1842, p. 57.)
  There is a singular rule in our law relative to the period at which
a person dies from the wound—namely, that the assailant shall not
be adjudged guilty of homicide, unless death takes place within a
year and  a day after  the  infliction of the wound.   (Archbold, p.
345.)  In practice, the existence of this rule is  of little importance,
but in  principle it  is erroneous.  Most wounds  leading to death
generally destroy life within two or three  months after their inflic-
     2i 
322           SECONDARY  CAUSES  OF  DEATH.
tion ; sometimes the person does not die for five or six months, and
in more rare instances, death does not ensue until alter the lapse of
twelve months, or even several years.  These protracted cases occur
especially in respect to injuries of the head and  chest.   Stnct jus-
tice demands that the responsibility of a person who has inflicted a
wound should depend upon  its having really caused death, and not
upon the precise period at which death  takes place; for this must
be a purely accidental circumstance.                         m
  Secondary causes  of death.—A person who recovers from the im-
mediate effects of a wound may die from fever, inflammation or its
consequences,  pyaemia,  erysipelas,  delirium tremens,  tetanus,  or
gangrene ; or an operation required during the treatment of a wound
may prove fatal.  These are what may be called secondary causes
of death, or  secondary consequences  of a wound.  The power  of
deciding on the responsibility of an accused person for an  event
which depends only in an indirect manner on an injury originally
inflicted by him, rests  of course with  the authorities  of the law.
But it is impossible  that they can decide  so difficult  and  nice a
question in the absence of satisfactory  medical  evidence ; and on
the other hand, it is right  that a  medical witness should under-
stand the importance of the duty here required of him.  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 a person may be  so broken up by dissipated habits
as to render a wound fatal which in a healthy subject might have
run through its course mildly, and have healed.  When the fever
or erysipelas can be traced to a wound,  or  there is no  other appa-
rent cause of aggravation to which either of these disordered states
of the body can be attributed, they can scarcely be regarded by a
medical practitioner as unexpected and unusual consequences, espe-
cially when the injury  is extensive, and seated in certain parts  of
the body, as in the scalp.  If death take place under these circum-
stances, the prisoner will be held as much responsible for the result
as if the wound  had proved  directly mortal.   This principle has
been  frequently admitted by our law,  and indeed, were  it  other-
wise, many reckless 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  so liable to vary in its rela-
tions  in  every case ; but when a wound is not serious, and the
secondary cause of death is evidently due to constitutional peculi-
arities from acquired habits of dissipation, the ends of justice are
probably fully answered by an acquittal; in  fact, such cases do not
often pass beyond a coroner's inquest.
   The secondary causes of death may be arranged under the follow-
ing heads:—
   1.  The cause is unavoidable.—Of this  kind are tetanus, following
laceration of tendinous and nervous structures—erysipelas follow-
ing lacerated wounds of the scalp—peritoneal inflammation follow-
ing blows on the abdomen  with or without  rupture of the bladder
or intestines, and effusion of  their contents—strangulation  of the 
        <

         AVOIDABLE AND UNAVOIDABLE  CAUSES.      323

intestines (phrenic hernia) following rupture of the diaphragm, and
others  of  a like nature.   Here, supposing proper medical treat-
ment and regimen to  have been pursued, the secondary cause  of
death was 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 im-
properly treated  they prove fatal.   In  the  latter case, it will be a
question for a witness to determine how far the treatment aggra-
vated the  effects of the violence, and from his answer to this the
jury may have to decide on the degree of criminality which attaches
to the  accused.   Let us  suppose, for  instance, that an  ignorant
person  has removed a clot of blood, which sealed up the extremity
of a bloodvessel,  in consequence of which fatal bleeding has ensued ;
or that he has caused death by unnecessarily interfering with a
penetrating wound of the chest or abdomen ;  it would scarcely  be
just to  hold the aggressor responsible, since, but for the gross igno-
rance and unskilfulness of his attendant, the wounded person might
have recovered  from  the effects of the wound.   When  death  is
really traceable to the negligence or unskilfulness of a surgeon who
is called to attend on a wounded'person, this  circumstance ought
to be, and commonly is, admitted in mitigation, supposing that the
wound was not originally of a mortal nature.  Lord Hale observes:
"It is  sufficient to constitute murder, that the party dies of the
wound given by the prisoner, although the wound was not origi-
nally mortal, but became so in consequence of negligence or unskil-
ful treatment; but it is otherwise where death arises, not from the
wound, but from unskilful applications or operations used for the
purpose of curing  it."  (1, 428.) The medical jurist will  perceive
that a very nice  distinction is  here drawn by this great judge, be-
tween death as it results from a wound rendered mortal by improper
treatment, and death as it results from improper treatment, irres-
pective of the wound.  In the majority of cases such a distinction
could scarcely be established, except upon speculative grounds; and
in no case, probably, would there be any accordance iu the  opinions
of medical witnesses.  In slight and unimportant wounds, it might
not be  difficult to distinguish the effects resulting from bad treat-
ment from those connected with the wound, but there can be few
cases of severe injury to the person, wherein a distinction of this
nature  could be  safely made;  and the probability is that no con-
viction of murder would now take  place, if the medical evidence
showed that the  injury was not originally mortal, but only became
so by unskilful or improper treatment.  In such a case, it would
be impossible to ascribe  death to the wound, or to its usual or
probable consequences; and without this it is not easy to  perceive
on what principle an aggressor could be made responsible for the
result.  [In Commonwealth v. Hackett, 2 Allen (Massachusetts) 136,
it was  held that one wdio has wilfully inflicted upon another  a
dangerous wound, with a deadly weapon, from which death ensues,
is guilty of murder or manslaughter, as the evidence may prove, 
324      DEATH FROM IMPRUDENCE OR NEGLECT.

although through want of care or skill, the improper treatment of
the wound by surgeons may have contributed to the  death.   See
also Commonwealth v.  Green, 1 Ash. 289.—P.]
  3.  Comparative skill in treatment—li death has been caused by a
wound, the  responsibility of a person is not altered by the allega-
tion that under more favorable circumstances and with more skilful
treatment, a  fatal result might have been  averted.  At the same
time, it is obvious that a serious responsibility is thrown on practi-
tioners who  undertake the management of cases of criminal wound-
ing.   Any deviation  from ordinary practice  should  therefore be
made with the greatest caution, since novelties in practice will, in
the event of a fatal result, form one of the best grounds of defence
in the hands of a prisoner's counsel. On these occasions, every point
connected with the surgical treatment will be the subject of rigorous
inquiry and adverse professional criticism.   In the case of a severe
lacerated wound in the hand or foot, followed by fatal tetanus, it
may be said that  the wounded person would not  have died  had
amputation  been at once performed.   In this instance, however, a
practitioner may justify himself by showing either that the injury
was too slight to require amputation, or that  the health or other
circumstances connected with the  deceased would not allow of its
being performed with  any   reasonable hope  of success.  On  the
other hand, if  the practitioner  performed amputation, and  the
patient died, then  it would be urged that the operation was prema-
ture, or wholly unjustifiable, and  that it had caused death.   Here
the surgeon is bound to show that the  operation was necessary
according to  the  ordinary  rules  of practice.   The  treatment of
severe incised wounds of the throat, when the windpipe is involved,
sometimes places a practitioner in an embarrassing position.  If the
wound  is left  open, death may take place  from bleeding; if it be
prematurely closed, blood may be infused into the windpipe and
cause death by suffocation.
   4.  The cause avoidable but for imprudence or neglect on  the part of
a  wounded person.—A man, who  has been severely wounded in a
quarrel, may obstinately refuse medical assistance, or he may insist
upon taking exercise, or using an improper diet, contrary to  the
advice of his  medical attendant;  or by other imprudent practices,
he may thwart  the best conceived plans for his recovery.   Let us
take a common case as an illustration.  A man receives a blow on
the head in  a pugilistic combat, from the first effects of which he re-
covers ; but after having received surgical assistance, he indulges in
excessive drinking, and dies.  The aggressor is tried on a charge of
manslaughter, and found guilty.  Death, under these circumstances,
is commonly attributed by the medical witness to effusion of blood
on the brain; but it cannot be denied that the excitement produced
by intoxicating liquors, will sometimes satisfactorily account for the
fatal symptoms.  In the case which we are here supposing, such an
admission might be made, and the prisoner receive the benefit of it;
for the imprudence or negligence of a wounded person ought not,
morally speaking,  to be considered as adding weight to the offence 
         DEATH FROM IMPRUDENCE  OR  NEGLECT.      325

of the aggressor.  If the symptoms were from the first unfavorable,
or the wound likelv to prove mortal, circumstances of this  kind
could not be received in mitigation.  Our judges have shown them-
selves at all  times unwilling to admit them.  The legal responsi-
bility of the assailant is the same, whether the deceased die on the
spot, or some days, weeks, or months afterwards, unless it can be
distinctly proved that his death was immediately connected with the
imprudence or excess of which he was guilty, and  wholly indepen-
dent of the wound. But, although a prisoner should be found guilty
of manslaughter under these circumstances, the punishment  is so
adjusted by our law as  to leave  a considerable discretionary power
in the hands of a judge.  This is, indeed, tantamount  to a direct
legal provision, comprehending each different shade of guilt ; a man
is held  responsible for a wound rendered accidentally mortal  by
events over which he  could  have no control, but which in them-
selves ought  to be regarded as in some degree exculpatory.  The
punishment attached to his offence may be severe or slight, accord-
ing to the representation made by a medical witness of the circum
stances which rendered  the wound mortal;  if he negiect to state the
full influence of imprudence or excess on the part of the wounded
person, where either has existed, over the progress of  the wound,
he may cause the prisoner to be punished with undue severity.  The
humanity of our judges is such, that when medical evidence is clear
and consistent on a point of this nature,  and there are no circum-
stances in aggravation, they commonly pass a mild sentence.  (See
case by M.  tillivier, "Ann. d'Hyg.," 1842, p. 128.)  The neglect to
call  in a medical practitioner, or the refusal to receive medical ad-
vice, will not, however, according to the decision in Reg. v. Thomas
(Gloucester Aut. Ass. 1841), be considered a mitigatory circumstance
in favor of  the prisoner, even although the wound was susceptible
of being cured.  A man may receive a lacerated wound of a limb,
which is followed by tetanus or  gangrene, and thus proves fatal;  he
may have declined receiving medical advice, or have  obstinately
refused  amputation, although  proposed by his medical  attendant.
This would not operate as a mitigatory circumstance on the part of
an assailant, because a wounded person is not compelled to call for
medical assistance, or to submit to an operation, and a medical wit-
ness could not always be in a condition to swear that the operation
would have positively  saved his life; he  can merely  affirm that it
might have afforded him a better chance of recovery.   Again, a
person may receive  a blow on  the head,  producing fracture, with
great depression of bone, and symptoms of compression of the brain;
a surgeon may propose the operation of trephining  to elevate the
depressed bone, but the friends  of the wounded  man  may not per-
mit the operation to be  performed.  In such a case, his line of duty
will be to state the facts to the court, and  it is probable that in the
event of conviction there would be some mitigation of punishment;
because such  an injury, if left to itself, must in general prove mor-
tal, and no doubt could exist in the mind of any surgeon, as to the
absolute necessity for the operation.  But the neglect or improper 
326            UNHEALTHY  STATE OF BODY.
conduct of a person who receives a wound thus rendered fatal, does
not exculpate the aggressor.   The crime is either murder or man-
slaughter.
  5. The cause avoidable but for an  abnormal or unhealthy state of
the  body of the wounded person.— Wounds which are comparatively
slight sometimes prove indirectly fatal, owing to the person  being
in an unhealthy condition at the time of their infliction.  In bad
constitutions,  compound fractures or  slight wounds, which in a
healthy person would have a favorable termination, are followed by
gangrene, fever, or erysipelas, proving fatal.   Here the responsibility
of an assailant for the death may become reduced, so that, although
found guilty of manslaughter, a mild punishment might be inflicted.
The consequence may "be, medically speaking, unusual or  unex-
pected, and, but for  circumstances wholly independent of the  act of
the accused, would not have been likely to destroy life.   In general,
in the absence of malice, this appears to be the point to which the
law closely looks, in order to make out the  responsibility of the
accused—namely, that the fatal secondary cause must be something
not unusual or unexpected as a consequence of this particular injury.
The medico-legal question presents itself under this form:  Would
the same amount of injury have been likely to cause death in a per-
son of ordinary health and vigor? Men who have suddenly changed
their habits of living, and  have passed from a full diet to abstemi-
ousness, are sometimes unable to bear  up against  comparatively
slight injuries, and often sink from the secondary consequences.  So
a man otherwise healthy laboring under rupture, may receive a blow
on the groin, attended with laceration of the  intestine, gangrene,
and death ; another with a calculus in the kidney may be struck in
the loins  and die, in consequence of the calculus perforating the
bloodvessels and causing fatal bleeding or subsequent inflammation.
  It must be evident that there  exist numerous internal diseases,
such as aneurism and various  morbid affections of the heart and
brain, which are liable to  be rendered fatal by slight external vio-
lence.  The law, as applied to  these cases, is thus stated by Lord
Hale: " It is sufficient to prove that the death of a person was  accel-
erated by the malicious act of the  prisoner,  although the former
labored under a mortal disease at the time of the act."  (1, 428.)  In
most of these cases  there is an absence of intention  to destroy life,
but the nature of the wound, as well as the means by which it was
inflicted, will often  suffice to develop the intention of the prisoner.
An accurate description of the injury, if slight, may afford strong
evidence in favor of the accused, since  the law does  not so  much
regard the means used by him to perpetrate the violence, as the
actual intention to  kill, or  to do great bodily harm.
  Serious injury, causing death by secondary consequences, will ad-
mit of no exculpation when an assailant was aware, or ought to have
been aware, of the condition of the person whom he  struck.   Thus,
if a person notoriously ill, or a woman while pregnant, be maltreated,
and death ensue from a secondary cause, the assailant will be held re-
sponsible; because he ought to have known that violence of any kind 
          DEATH UNDER  ABNORMAL CONDITIONS.      327

to persons so situated,must be atteneled with dangerous consequences.
So, if the person maltreated be an infant or a decrepit old man, or
one laboring under a mortal disease, it is notorious that a compari-
tively slight degree of violence will destroy life in these cases, and
the prisoner would properly be held responsible.  A wound which
accelerates death causes death, and may therefore render the aggres-
sor responsible for murder or manslaughter, according to the circum-
stances.  The  commissioners appointed to define  the criminal law
on the subject of homicide  thus  express themselves:  " Art. 3. It
is homicide, although the  effect of the injury be merely to accelerate
the death of one laboring under some  previous injury or infirmity,
or although, if timely  remedies  or  skilful  treatment had been
applied, death might have been prevented."  This  is conformable
to the decision of our judges.  According to Lord  Hale, if a man
has a disease which in all  likelihood would terminate his  life in a
short time, and another give him a wound  or  hurt which hastens
his death, this is such a killing as constitutes murder.   (Archbold,
p. 345.)
  6.  Abnormal conditions.—When an assailant could not have been
aware of the existence of  a  diseaseel  or an abnormal condition of
parts in the  wounded person,  the  question is somewhat different.
In many persons the  skull  is preternaturally  thin, and  in most
persons it is so in those  places corresponding to the glandulre Pac-
chioni.  In a case of this kind, a moderate blow on the head might
cause fracture, accompanied  by  effusion of blood, depression of
hone, or subsequent inflammation of the brain and  its membranes,
any of which causes might  prove fatal.  In some  persons  all the
hones of the body are unusually brittle, so  that  they are fractured
by the slightest force.  Inflammation,  gangrene and death may
follow, when no consielerable  violence  has  been used; but these
being unexpected consequences,  and  depending  on an abnormal
condition of parts unknown to the prisoner, his responsibility may
not,  cceteris  paribus, be so  great  as  under  other  circumstances.
This condition of the bones  can be determined only by a  medical
practitioner.  Facts of this  kind show that the degree of  violence
used in an assault cannot always be measured by the effects, unless
a careful examination of the injured part is previously made.
  Some German medical jurists have  contended that an unnatural
transposition of [tarts should become  a mitigating circumstance—
as when, for example, the  heart or some large vessel  is not in its
usual position, and is there wounded;  but this doctrine will receive
no sanction  from an English court of law, as the responsibility of
persons for  these criminal offences does not rest upon the perfect
anatomical structure of  the deceased!   At the same time it might
become a  question whether, if death occurred from a superficial
wound, Avhereby a large artery  taking an  abnormal course was
divided—there might not  be, cazteris paribus, some  ground  for di-
minishing the degree of responsibility.
  7.  Difficulty  of proof in  death from secondary causes.—When  a
person is charged with having caused the death of another through 
328
DEATH FROM TETANUS.
violence terminating in some fatal disease, the case often admits of
a skilful  defence, and this in proportion to the length of time after
the violence, at which the  deceased dies.  The disease, it may be
urged, is liable to appear in all persons, even  the most healthy ; or
it may arise from causes unconnected with the violence.  In ad-
mitting these points, it must be  remembered that death may  be
proved to have been indirectly a consequence of the wound by the
facts: 1, that  the supervention  of the  secondary cause,  although
not a common event,  lay in the natural course of things;  2, that
there did  not exist any accidental circumstances which were likely
to have given rise to this  secondary cause independently of the
wound.  The  proof of the  first  point amounts to nothing, unless
the evidence on the second point is conclusive.
                    CHAPTER  XXIX.

WOUNDS INDIRECTLY FATAL.—TETANUS FOLLOWING WOUNDS.—ERYSIPE-
  LAS.—DELIRIUM   TREMENS.—GANGRENE.--DEATH  FROM  SURGICAL
  OPERATIONS.—PRIMARY AND SECONDARY CAUSES OF DEATH.—UNSKIL-
  FULNESS  IN OPERATIONS.—PYEMIA.--MEDICAL  RESPONSIBILITY  IN
  REFERENCE TO OPERATIONS.--ACTIONS FOR MALAPRAXIS.

  Tetanus following ivounds.—Tetanus  frequently presents itself as
a secondary fatal consequence of wounds, especially of those which
are lacerated or contused, and  affect nervous and tendinous struc-
tures.   It has often occurred as a result of slight bruises or lacera-
tions, when the injury was so superficial as to excite no alarm ; and
it is a disease which gives no warning of its appearance.  Tetanus
may come on spontaneously, i. e., independently  of the existence of
any wound on the body.  Cases have  been  brought into the Lon-
don hospitals, in which the  only 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.)  It is scaicely pos-
sible to distinguish, by the symptoms, tetanus from wounds (trau-
matic) from that which occurs spontaneously as  a result of natural
causes (idiopathic).  In endeavoring to connect its appearance with
a particular -wound or personal injury, it will be proper to observe
—1, whether there were any symptoms indicative of it before the
maltreatment; 2, whether any probable cause  could  have  inter-
vened to produce  it, between the time of its appearance and the
time at which the violence was inflicted; 3, whether  the deceased
ever rallied from the effects of  the  violence.  The time at which
tetanus  usually makes its  appearance,  when  it is  a result of a
wound, is from the third to the sixth  day ; but it may not appear
until three or four weeks after the injury, and  the  exciting cause
may still be traced to the wound which  may have healed.  When
resulting from  a wound, it is generally fatal. 
           DEATH FROM SURGICAL  OPERATIONS.        329

  A medical practitioner is bound to exercise great caution before
lie itronounees an opinion that a fatal attack of tetanus has arisen
either from spontaneous causes, or from slight blows or personal
injuries.  A rigorous inquiry should be made into all the attendant
eiicumstances.  Slight punctured wounds, operating as  a cause of
tetanus, have been overlooked or only discovered by accident  after
death, and it is highly probable that many cases have been set down
its idiopathic tetanus in which, by proper inquiry, the disease might
have been traced to a wound or some personal injury.   In one in-
stance  the tetanus was at first considered to  be idiopathic;  but
shortly before death a small black mark was observed on  the thumb
nail.  On making  inquiry, it was found that a few days  previously
to the  attack  a splinter of wood had accidentally penetrated the
thumb.   The patient attached so little  importance to the accident
that he diel not mention the circumstance to his medical  attendant.
This was  no doubt the sole cause of the disease.   Many trials for
murder  have occurred in  this  country, in which  tetanus was the
immediate cause of death; and the defence has generally rested
upon the probable  origin of the disease from accidental causes.
  Erysipelas, like tetanus, may be a fatal result of slight injuries.
Wounds affecting the scalp are liable to be followed by this disease.
Burns and scalds  sometimes prove  fatal through this  secondary
cause.  Some constitutions are  particularly prone to erysipelatous
inflammation, and  thus, wounds comparatively slight  may have  a
fatal termination.   When a wounded  person  has died  from  this
disease, an assailant cannot be made responsible for the fatal result,
unless the erysipelas is clearly traced to the injury.  The medical
facts that the person assaulted has never recovered from  the effects
of the  violence, and that the  inflammation set  up has suddenly
assumed an erysipelatous  character, are sufficient to establish this
connection.  If there has been recovery, and  an interval of some
days has elapsed, a doubt may arise respecting the connection of
the erysipelas with the violence inflicted.  This disease is occasion-
ally idiopathic, i. e., it appears like tetanus without any  assignable
cause.
  It is sometimes difficult to establish the connection of erysipelas
with a wound, especially when the disease occurs after some  time
and in a remote part  of the body, not  implicated in the wound.
When this connection cannot be distinctly made out, there will be
an acquittal.
  Delirium tremens is a disease which frequently presents itself as
a secondary consequence  of  injuries  to persons  of  intemperate
habits.   Whether the injury be slight or severe, this disease  may
equally supervene and  prove fatal.  It  is observeel occasionally as
a consequence of operations required  for the treatment of wounded
persons.   The  remarks made at  p. 326 upon  the influence of un-
healthy constitutions on wounds, apply  with especial force to cases
of this description.
  Death from  surgical operations.—In the treatment  of wounds,
surgical operations are frequently resorted to, and a wounded  per- 
330
DEATH FROM SURGICAL
OPERATIONS.
son mav die either during the performance of an operation, or from
its consequences.   A question will thence arise, whether the person
who inflicted the wound should be held responsible  for the fatal
result,  The law regards a surgical operation as part of the treat-
ment, and if undertaken bona fide, and performed with reasonable
care and skill, the aggressor will be held responsible, whatever may
be the result.  The necessity for the  operation and the mode of
performing it, will be left to'the operator's judgment.  As the de-
fence may turn upon the operation having been performed unneces-
sarily, and in a bungling and unskilful manner, it will be right for
a practitioner, if possible, to defer it until he has had the advice
and assistance of. other  practitioners.   According to Lord  Hale, if
death takes place from an unskilful operation, performed for the cure
of a  wound, and not from the wound, the responsibility of  the
prisoner ceases ; but this eminent lawyer does  not  appear to have
considered that death may take place as a consequence of the most
skilful operation required for the treatment of a wound, and yet be
wholly independent of the wound itself.
  If the operation has been performed by the medical witness him-  •
self, and the necessity for its performance is questioned by counsel
for the  prisoner, it is open to the witness to give the requisite  ex-
planation in his evidence.  It would appear from a recent case, tried
before Shee, J., that the necessity for an operation will not be  as-
sumeel; but if called in question, it must  be proved by witnesses
for the prosecution.  In Reg. v. Moreland (C. C. C, Sept. 20, 1865),
the prisoner threw deceased on the ground and fractured  his leg.
The limb was amputated at the London Hospital, and the man sub-
sequently  died.  Counsel for the prisoner asked the surgeon from
the hospital who spoke to the death of the deceased whether an
operation  was necessary.  The witness said he could not tell, as he
had not charge of the case previous to the operation.  Counsel then
raised the question whether prisoner or the doctors had caused  the
man's death.  The counsel for the prosecution suggested that  the
court might accept as a fact that amputation would not have been
performed hael it not been necessary:  but the learned judge said
that would not do.   They must deal wTith the case on the evidence
before them. He then observed to the jury that, although undoubt-
edly amputation would not be adopted  at such  a  place  as  the
London Hospital without the necessity for it, yet evielence to that
effect must be before them  on oath.  They could not act on what
they had every reason  to believe; therefore they must acquit  the
prisoner.  The failure of justice in this case rested with those who
were concerned for the prosecution.  The operator,  who could pro-
bably have satisfied the court that  he  had not  cut off' the wrong
leg, and that there were good reasons for performing the operation,
was not called as a witness: but in  his place a gentleman was suui-
moned who  could not answer these necessary questions.
  Death is by no means an unusual result of severe operations, the
secondary consequences  under  which  the patient  may die being
very numerous, even when  the case  is most skilfully managed'. 
           DEATH  FROM  SURGICAL  OPERATIONS.        331

 Sometimes the patient will die on the table, although but little
 blood may have been  lost,   Fear, pain  and sudden shock  to the
 nervous system have caused death under these circumstances.  The
 most  common indirect  causes  of death  after severe  operations,
 are secondary hemorrhage, erysipelas, tetanus, delirium  tremens,
 pyaemia  and  hectic  fever,  with  gangrene of the stump.   Mr.
 Travers observes, that "a pre-existing disease of the liver, kidney,
 or testicles, though chronic, and in itself  not alarming  to the con-
 stitution, becomes a drag upon its elasticity, and stands  in the way
 of recovery.  Inspection of the body after death frequently explains
 the unfavorable result of operations that promise well, by discover-
 ing one or more organs in a state of chronic disease, which had not
 previously deranged the health in a degree sufficient to give notice
 of its existence, and which might, therefore, have remained quiet
 for years to come, had no extraordinary call been  made upon the
 powers of the system."  (" On Constitutional Irritation," p. 45,121,
 et seq.)
  Should an operation be  unnecessarily or unskilfully performed,
 the responsibility of an aggressor would, it is presumed, cease, if
 the death of a wounded party should be clearly traced to it.  Thus,
 if in  carelessly bleeding a wounded person, the  brachial  artery
 should be laid open ("Ann. d'Hyg.," 1834, t. 2, p. 445), or if, in
 performing amputation, a large artery  be improperly secured, so
 that the patient in either case dies from  loss of  blood, the prisoner
 could not be equitably held responsible; because it would be pun-
 ishing him for an  event depending on the unskilfulness of a medical
 practitioner.   According to Piatt B. a prisoner  will be  held re-
 sponsible, if  the  original  wound  were  likely  to produce  death,
 although unskilfully treated.  Supposing the bleeding or  amputa-
 tion to be performed with ordinary care  and skill—and yet,  in the
 cue case, inflammation of  the veins, and in the other  erysipelas,
 tetanus, gangrene, or fever should destroy life,  the  prisoner will be
 liable for the consequences.  The practice of the law is strictly con-
 sistent with justice.   Should the operation be considered  to be
 absolutely required  for the treatment of a wound, which, according
 to all  probability, would prove mortal without it—should it be per-
 formed with ordinary skill, and  still death ensue as a direct or in-
 direct consequence, it is only just that the person who inflicted the
 injury should be held responsible for the result.  It is presumed in
 these cases, that were the patient  left to himself, he would, in all
 probability, die from  the effects  of the  wound.   If, therefore, a
 surgeon, knowing that an operation would give  a chance of saving
 life on such an occasion, did not perform it, it might be  contended
 in the defence, that the deceased  had died, not from the wound,
 but from the incompetency and neglect of his  medical attendant.
 Hence it follows  that  if, during this necessary treatment, unfore-
seen though not unusual causes cut short life, no exculpation should
be admitted, if it  went to attack the best-directed efforts made for
the preservation of life.  (See "Ann. d'Hyg." 1835, t. 1,  p. 231.)
If an  operation is rendered  necessary by reason of the improper 
332     OPERATIONS UNDER  A  MISTAKEN  OPINION.

treatment of the wound, the responsibility of an assailant  for a
fatal result ceases.
  Medical responsibility in the  administration of chloroform.—In a
large  number of operations  it is now the general practice among
surgeons to administer chloroform vapor, not only to allay pain but
to prevent that  exhaustion to the  patient which  is likely to arise
from protracted  surgical  proceedings.  In spite of care on the part
of the operator,  this" vapor is  liable to destroy life in an unexpected
manner, and the patient may die either before the operation is com-
menced or during its performance.  The facts may leave no doubt
that the wounded person died  from chloroform, and  not from the
wound or the operation.   On inspection of the body, the heart may
be found in  an unhealthy state, a fact which is usually considered
sufficient to account for the fatal effects of chloroform vapor.  In a
case of this kind—AVhat becomes of the responsibility of the persou
who inflicted the original wound?   Xo decision, so far as I know,
has ever been given on  this point,   Was  the use of chloroform
vapor in a  professional   view  a necessary part  of the treatment?
Was it skilfully and properly administered ?  Could  the eliseased
condition of the  heart which rendered  the effects of the vapor more
fatal than usual  have been detected by the operator, so as to show
the impropriety  of administering it in this  case?   These questions
should receive satisfactory answers before the aggressor is rendered
responsible for death under such  peculiar circumstances.
  By an operation  being absolutely required, are we to understand
that it is necessary  to preserve life, i. e., that the wound will prob-
ably prove fatal  without it?   Bleeding and cupping  may be neces-
sary as part of the treatment of a  wounded person; but unless it
could be sworn that this treatment was required, in the judgment
of the surgeon, for the preservation of  life from the injury inflicted,
it is doubtful whether, in the event of death occurring from these
simple operations, the  assailant would be held responsible for the
fatal result.  From cases hitherto  decided, it would appear that
the law regards three circumstances  in death  following  surgical
operations:  1st,  the necessity of the operation itself; 2d, the com-
petency of the operator; and 3d, the fact that the wound would be
likely to prove mortal without it.
   Operations under a mistaken  opinion.—It may happen that the
wound is not of a mortal nature, and that, although an operation
was skilfully performed, it was not necessary to save life; in other
words, the wounded person may die from the immediate results of
a serious operation, performed  under  a mistaken view of the case.
It is well known to surgeons that a cancerous tumor has been occa-
sionally mistaken for aneurism, an artery  has been  secured, and
death has followed.
  Let us assume that a  man  laboring  under a slight  aneurismal
dilatation of a large artery receives  a  "blow  on the part; the tumor
gradually increases, and is mistaken for an  abscess by three or four
surgeons, whose professional standing would permit  their  general
competency from being  questioned.   Under a wrong diagnosis, it 
FATAL RESULT FROM PYEMIA.
333
is opened, and the patient dies on the spot; in such a case it would
be unjust to make the aggressor liable; for, even admitting  that
the aneurism resulted from the blow, and that a competent surgeon
acted  with  bona fides, the treatment would  be  unskilful, and the
ease would fall  under the rule laid  down by Lord Hale (ante, p.
330).  The  real facts, however,  may not transpire until after the
death  of the wounded person;  and it  may then be alleged by a
prisoner's counsel  that the operation  was not necessary to save life,
and that the wounded man might have recovered without it.  From
the ruling of our judges on various occasions in which this question
has arisen, it would appear that the relative degree of skill possessed
by medical  men is  not  a question for a jury in  a criminal case;
although in  a civil case, as in an action for  malapraxis, the whole
of the medical facts are invariably submitted to their judgment.
This difference can only be justified by the assumption, that a man
who inflicts  a wound must take  all the consequences, good or bad.
Xo operation would have been required but for the injury, and the
prisoner ought not to escape on account of want of skill in a surgeon,
or of a mistake made by a skilful operator.   It was decided in the
eases of Rex v. Quain and  Reg.  v. Pym, that although  the  indict-
ment  alleged that the deceased died of the wound, while  in fact
he died from the results of an operation, yet it -was good in point
of law.
  Fatal diseases following operations.—When a wounded person is
taken to an  hospital in which gangrene or erysipelas is diffusing
itself by infectious propagation, and he is attacked by one of these
diseases before or  after the performance of an operation, and dies,
a prisoner may be held  responsible for the fatal result.   It  might
be contended that the transportation of the wounded man  to such
a locality was not absolutely necessary for his treatment, or for the
preservation of his life, and that he would not have died, but for
the accidental presence of an infectious disease.   Cases of thi3 kind
cannot be easily determined by any general rules.
  Pyamia.—In addition to erysipelas and tetanus, there is another
cause  of  death which is liable to follow personal  injuries and ope-
rations,  namely, pycemia, or the introduction of pus into the blooel
by absorption or by  the mouths of divided bloodvessels.  The puru-
lent matter appears  to act as a poison, and one of its marked effects
is to coagulate the blood either  in the large vessels or in  the capil-
laries.  According to Dr. Wilks's observations, pyaemia  is seldom
observed after superficial injuries during the process of healing, or
after wounds resulting from  simple  operations, but it  occurs fre-
quently  when a bone is involved  either in the injury or as the result
of an operation.  Inflammation of the cellular membrane surround-
ing bone is a condition highly favorable to its occurrence.   It has
been stated  that the cause of death in one-half of the cases of am-
putation  is  pyaemia.  (See  a  paper on this subject by Dr. Wilks,
"Guy's  Hospital  Reports," 1861,  p;  119.)  The  medical witness
must remember that pyaemia, like tetanus and erysipelas, may arise 
334      MEDICAL RESPONSIBILITY  IN OPERATIONS.

from  causes totally  irrespective  of  wounds or personal injuries.
(Cases by Dr. Habershon, " Guy's Hospital Reports," 1859, p. 179.)
  Medical responsibility in operations.  Malapraxis.—This is a very
wide  subject, but it can here be only glanced at in a few of its lead-
ing features.   It was held by Lord Ellenborough, thatif a person
acting in a medical capacity be guilty of misconduct arising either
from  gross ignorance or criminal inattention, by which a patient
dies, he  is  guilty of manslaughter.  Faults, such  as omissions, or
errors in judgment, to which all are liable, are not visited with this
amount  of criminality.   The same rule applies to the licensed as to
the unlicensed practitioner; but  it would  appear, from the charge
of Williams, J. (Winchester Spring Ass. 1847), that a degree of un-
skilfulness which might lead to the conviction of a licensed, would
justify the acquittal of an unlicensed person.  This was in the case
of a midwife, aged 72, alleged to have caused the death of a woman
on whom she had been called to attend.  " The charge," said  the
learned  judge, " appeared to  be that by want of skill or attention
to her duties, she had caused the death of the woman upon whom
she was attending.   In  order  to constitute this offence, it must be
shown that the party was  guilty of criminal  misconduct, either
arising from gross ignorance, or want of skill, or gross inattention.
With respect to the degree of want of skill, he must say, that it was
not to be expected that a midwife, who was called in to attend a
person in the humble class of the deceased, a soklier's wife, should
exhibit  what a regular medical practitioner would call competent
skill.   It was enough if she  applied that humble skill which, in
ordinary cases, would lead to  a  safe delivery.   She was not bound
to have skill  sufficient  to  meet peculiar  and  extraordinary exi-
gencies, although in the case of a regular medical man, such skill
might be required.   The class of this humble practitioner was  ab-
solutely  necessary for the poorer classes, and, although on the one
hand  it  was fit  the law should protect a patient, by punishment for
gross  want of skill, yet he thought there would be much to be
lamented if it was applied with such severity as to render  a party
not possessing  skill  of  this  kind liable  to punishment for man-
slaughter I"
  Charges of manslaughter  have frequently been  brought against
medical  practitioners in cases of midwifery.   In some instances
gross  mismanagement has been proved; the uterus, and  even parts
of the viscera, have  been torn away, and in such cases convictions
have  very  properly followed.  It is well known, however, that
much difference of opinion exists among the most eminent  practi-
tioners  of  midwifery respecting  the treatment to be pursued in
certain cases of difficulty, as where the after-birth presents (placenta
praevia).  There are  eminent accoucheurs who advise in this case
entirely opposite modes of practice, and who look upon that pur-
sued by the other as of the most dangerous kind.  When death is
not a  result of medical treatment, an action for damages may be
brought  against the practitioner for malapraxis.  From the evi-
dence given on some of these occasions, it appears that an action of 
       MEDICAL RESPONSIBILITY  IN OPERATIONS.     335

this kind is occasionally resorted to as a very convenient way of
settling a long account.
  It has been a question whether slight deviations from the ordi-
nary mode of performing operations should  involve a practitioner
in a charge of malapraxis.   I am not aware that this question has
been raised in England ; but a remarkable instance occurred in the
United States a few years since, in which an action was brought
and damages were recovered against a medical  man  for alleged
negligence in vaccinating a young woman (case of H L. London).
Some inflammation of the skin  followed  the  operation, which, it
was alleged, was performed nearer to the  elbow-joint  than was
usual.  The plaintiff soon recovered from the effects.   The most
singular feature of this case  was the ruling of the judge: he said—
" In performing the operation of vaccination or  inoculation, the
physician is liable for all consequences if he  neglects the usual pre-
cautions, or fails to insert the virus in that part of the arm usually
selected for the purpose; notwithstanding many other parts of the
body might be proved to be equally proper and even more suitable
locations!"  If this be law,  it is a very singular specimen of trans-
atlantic jurisprudence.   It might as well be ruled that legs should
always be amputated at the  same spot; and  in case of  neglect  of
this rule, that the operator should be made reponsible for the result!
  When, on these occasions, there is a  division of opinion among
men of equal experience  respecting  the necessity for an operation,
or the proper performance  of it, a practitioner who  is  made de-
fendant has a right to expect that a verdict will be returned in his
favor;  since it is not to  be supposed that in  order to recover pay-
ment for a bill, or to  answer a charge of unskilfulness, a  man's
practice should receive the  unanimous  approval of the whole of his
professional  brethren, especially  in cases in  which  there  is an
acknowledged difference of  opinion respecting the treatment.  On
this showing, a man would never be able to  recover his charges for
the treatment of a case of severe burn  or  scald, since  some practi-
tioners consider it malapraxis to adopt the stimulating, while others
equally regard  it  as malapraxis to adopt the  cooling plan  of treat-
ment !  All that  appears to  be expected is a reasonable accordance
in treatment with received professional doctrines. 
336
CICATRIZATION  OF WOUNDS.
                    CHAPTER XXX.

CICATRIZATION OF WOUNDS--EVIDENCE FROM CICATRICES—CUANOES IN
  AN INCISED WOUND—ARE CICATRICES, WHEN ONCE FORMED, INDELIBLE?
  —CHARACTERS OF CICATRICES—IDENTITY PROVED OR DISPROVED BY
  CICATRICES—COLORED CICATRICES—TATTOO MARKS.

  Cicatrization of wounds.—The period of time at which a particular
wound was inflicted may  become  a medico-legal question, both in
relation to the living and  the deael.  The identity of a person, and
the correctness of a statement made by  an  accused party, may be
sometimes determined by an examination of a wound or its cicatrix.
So, if a dead  body be found with marks of violence upon it, and
evidence adduced that  the deceased was maltreated at some par-
ticular period before his death, it will be necessary for a practitioner
to state whether, from the appearance of the injuries, they could or
could not have been inflicted at, or about the time assigned.
  An incised wound inflicted on the living body gradually heals by
adhesion, when no circumstances interfere to prevent the union of
the edges.  For eight or ten hours the edges remain bloody; they
then begin to swell, showing the access of inflammation.  If  the
parts are 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  clown, then makes its appearance between the edges; this
causes them gradually to unite, and thus is produced what is termed
a cicatrix.  Cicatrization is complete about the twelfth or fifteenth
day, if the wound is simple, of little depth and  width, and only
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 legs are longer in healing than those
on the upper part of the body.  If a wound is situated near a joint,
so that  the edges are continually separated by the motion of  the
parts, cicatrization is retarded.  2. On the extent; a deep or wide
wound  is long  in  undergoing cicatrization.   Wounds involving
many and different structures are also longer in healing than those
simply affecting skin and muscles.  3.  On  the age and health of
the wounded  person ;  the process of cicatrization is slow in  old
persons as well  as in  those who  are diseased and infirm.  In  an
incised -wound, the cicatrix is generally  straight and regular;  but
it is semilunar if the cut is oblique.  It is soft, red and tender if
cicatrization is recent;  it  is hard,  white  and firm if of long stand-
ing.  On compressing the skin around an old cicatrix, its situation 
CHARACTERS OF  CICATRICES.
337
and form are well marked by the blood not readily entering into it
on removing the pressure.
  Is a cicatrix, when once formed, ever removed, or so altered by time as
to be no longer  recogniz<d)lc?—This is a  question which sometimes
presents itself to a medical jurist  both in  civil  and criminal pro-
ceedings.  When a cicatrix has been produced by the healing of a
wound involving a loss of substance in the cutis or true skin, it is
permanent.  In wounds involving the whole substance of the skin,
the cicatrix  which is  once formed does  not disappear, although it
may undergo some changes in after life.  Wounds which heal by
suppuration and granulation generally leave behind them cicatrices
which remain for life.  The marks arising from the pustules of vac-
cination, smallpox, herpes zoster, and those produced by setons and
issues,  leave cicatrices easily recognizable at any period.  In an
early stage, a cicatrix is redder than the surrounding skin, but after
some months or years, it becomes white, firm'and shining.  The
time required for these changes cannot be defined.  In one  person
they may take place  in  a few months, and in another only after
Borne years.  The tissue of which a cicatrix is formed is different
from that of the skin; it is harder, and contains less blood, and is
destitute of a colored  deposit (rete  mucosum), so that its Whiteness,
which is remarkable  on the cicatrized skin of a negro, is retained
through life.  If any  cicatrices were easily obliterated, it would be
those which are even and regular—the results of incised wounds by
sharp instruments ; but I have observed that cicatrices of this kind
have certainly retained their characters unchanged, in one instance
for twenty, and in another for twrenty-five years.   According  to
the observations of Dupuytren and Delpech, the substance of a cica-
trix is not converted into true skin—it never acquires arete mucosum,
i. e. the membrane which gives color to the skin.  Although this
is generally true of incised and punctured  wounds, yet contused
and lacerated wounds on the legs of persons  advanced in  life fre-
quently present a brown discoloration—from the  deposit of a brown
pigment.  In the cicatrices of lacerated and contused wounds, the
form of the weapon with which the wound was  inflicted is some-
times indicated.   It  is not, however, easy to distinguish the cica-
trix of a stab from that produced by a pistol-bullet fired from a
distance.  In both cases the edges may be rounded and irregular,
and the cicatrix  puckered, unless the stab has been produced by a
broad-bladed weapon.   If no mark  of cutting  can be perceived
within a few  months of the period  at which a severe  wound is
alleged  to have  been  inflicted, it is  reasonable to infer that there
has been some mistake, or that the circumstances have been greatly
exaggerated.
   Characters of cicatrices.  Their age or date.—It is important to
observe that all cicatrices are of smaller size  than  the original
wound, for there is a contraction of the skin during the process of
healing.
  There  are no  appearances in  a  cicatrix which will  allow us to
fix the  date at which the wound leading  to its production was
      22 
338      CICATRICES FROM  WOUNDS OR DISEASE.

inflicted, and it is most difficult to say how or by what means it
was  inflicted.  If the person is living, he may give a description
of the injury and the  date of its production, consistent or incon-
sistent with the appearances  presented.  As  Casper justly remarks
("Ger. Med." 1, 115), it requires more than  two, three,or four
weeks to produce the  hard  white shining appearance of  an old
cicatrix ; but when it has once acquired these characters, there are
no medical data for enabling us to say whether the injury was
inflicted two, three, or even  ten years before.  A proper attention
to the number, situation, and  appearances presented by cicatrices
on the  living or dead body, will, however, sometimes  enable a
medical witness to establish or disprove the identity of persons.
  Cicatrices from wounds or  disease.  Imputed.—As there are im-
puted wounds, so there may be imputed cicatrices.  It is  rare to
hear of frauds  of this  description.  It is more likely that an im-
postor may seek to  gain his object by attributing the cicatrices of
wounds  accidentally received to other  causes,  or  by  ascribing
cicatrices which have  resulted from  disease,  to  some particular
cause occurring in early life.  By a remarkable  coincidence, two
persons may have cicatrices on or, about the same part of the body,
produced by cuts, punctures,  or abscesses in early life ; and  serious
mistakes may  be made  under these circumstances.  A case  is
reported to have occurred in France  in 1794,  in which  a  man
named Lesurgues was tried, convicted and  executed for robbery
and murder.  There were some doubts at the time as to his identity,
and  strong exertions were made to save his life.  Soon after his
execution the real  murderer was discovered, between  whom and
Lesurgues, who had no hand or part in the crime, there existed
a wonderful  resemblance  in stature, complexion, and  features.
But  the most extraordinary part of the case was that Lesurgues,
like  the real criminal, had a cicatrix or scar on the forehead, and
another  on the hand ; and there is no  doubt that these points of
resemblance,  which upon  a  proper scientific  examination might
have been  proved to be really  different,  became the turning-point
of the case, and led to the  conviction of an innocent person.
  On the other hand, a vulgar impostor, with old scars upon his
person, may make use  of  them as proofs of identity.  Such  scars
may exist: they may be clearly proved to be of old date, and  they
may be assigned to causes which cannot be  disproved except by a
close medical  examination.   The  scars  or  cicatrices may  have
arisen from scrofulous ulcers or abscesses, in which case it would
not be difficult to distinguish them from the cicatrices of wounds.
A question of this  kind may occasionally present  some difficulty,
but a close examination of the  cicatrix, with  a consideration of the
statement of the person as to its mode of production, will enable a
practitioner to  arrive at a satisfactory conclusion respecting its
origin.   Scrofulous ulcers are generally observed to leave  irregular
and deeply-furrowed cicatrices, with smooth depressions, surrounded
by hard and uneven margins.  According to Schneider, the scorbutic
cicatrix is  dark, bluish-red in  color, soft to  the  touch, somewhat 
          COLORED  CICATRICES—TATTOO  MARKS.       339

raised and rather painful; in the course of time it becomes flatter,
of a reddish-brown color, approaching to green (?) in the centre,
and very thin and easily injured.  Syphilitic cicatrices are charac-
terized by great loss of substance ; they approximate the margins
of the deep ulcers before their granulations have had time to reach
the surface.   Glandular cicatrices are irregularly tumefied, gene-
rally deep, hardened, and of a reddish-brown color. These varieties
cannot easily be mistaken for thecicatrices of wounds.  Cicatrices
from smallpox or vaccination are well known and easily identified.
  Colored cicatrices. Tattoo marks.—Small punctured wounds made
into the true skin with  three  or four sharp needles, dipped in
coloring  matter, leave marks which  may or may not be  indelible
according to the mode in  which the operation is performed.  This
subject has been noticed by medical jurists.  It has been made use
of as evidence  in  cases of disputed  identity.   See papers by Dr.
Tardieu, " Ann.  d'Hyg." 1855,  1,  171 ; also by Dr. Horteloup, in
the same journal,  1870, vol. 2, p.  440; and Casper's  Gerichtliche
Medicin, vol. 1, p. 115.  The  colors employed in tattooing are
indigo, charcoal (gunpowder), China ink, and vermilion.  Although
China ink is black, its effect when introduced in a white skin is to
produce a blue, or bluish-colored mark.  The foreign matter thus
introduced  mechanically into these minute  punctured wounds
causes  inflammation,  but this  soon passes off, and  the  coloring
matter  remains permanently encysted  in  the substance of the
cutis, or below it.  It  has been there found after death.
   From  researches made by competent observers,  these colored
marks  are not  necessarily indelible.   They have been observed to
remain for fifty years  and  upwards, when the  coloring matter was
carbonaceous, for forty years in a case in which red cinnabar was
used ; but it is not so much from the lapse of  time as from other
causes  that  these marks become faint  and ultimately disappear.
The depth in the  cutis to which the needles have been carried,
and the nature  of  the coloring matter employed, are the chief cir-
cumstances on wliich the durability of these marks depends.  The
red colors are the most disposed to fade, while  the black, especially
that of China ink, is among the most persistent.  In one instance
of a near relative I  have known the marks from this  color to
remain unchanged, in  the  skin of the inside of  the arm, for thirty-
seven years.  The thinner the skin, and the less the depth to which
the needles have penetrated, the more readily do these marks fade
and disappear.  Something also  must be set down to the skill and
experience of the operator.   Casper states that while he has seen
the tattoo marks remaining  in some cases  after forty  years  and
upwards, in two instances  they had entirely disappeared  after
thirty-six and thirty-eight years respectively.  (Op.  cit.  p. 116.)
It is possible to  remove these marks by caustic applications, or the
actual cautery,  but such an  act is usually indicated by  the pro-
duction of cicatrices ;  for if the tattooing is complete, the removal
can be  effected only  by  the destruction  of  the cutis.  In  one 
340
WOUNDS OF  THE HEAD.
instance  of  attempted removal, a fatal result followed.  ("Ann.
d'Hvg." 1855,1,199.)
  Medico-legal questions connected with these colored  marks on
the skin, have been hitherto  confined  to  the  identity of persons
charged with crime.   If it is  alleged that they have existed and
disappeared  by time or artificial means, medical evidence may be
required to  show how far this is  probable.  When found on the
skin, it is impossible to assign  a date for their production, for after
one or two years have elapsed  they will remain unchanged for life.
The medical facts connected with cicatrices were made a subject
of close investigation in the celebrated Tichborne case (Tic'hborne
v. Lushington), C. P., May, 1871-2.
                   CHAPTER XXXI.

WOUNDS OF THE  HEAD.—CONCUSSION.—HOW DISTINGUISHED FROM IN-
  TOXICATION.—EFFUSION OF BLOOD AS A RESULT OF VIOLENCE, DISEASE,
  OR MENTAL EXCITEMENT.—WOUNDS OF THE FACE.--DEFORMITY AS  A
  CONSEQUENCE OF WOUNDS OF THE FACE.—INJURIES TO THE SPINE AND
  SPINAL MARROW.—FRACTURES OF THE VERTEBRA.

  The danger of w7ounds, and  their influence in causing death, are
the two principal points to  which the attention of a medical jurist
must be directed.

                    Wounds of the Head.

  Incised wounds, affecting the scalp, unless of great extent, rarely
produce any serious effects. When the wound is contused or accom-
panied by much laceration of the skin, it is highly dangerous in
consequence of the tendency which the inflammatory process has
to assume an erysipelatous character.  The results of these wounds
are, however, such as to set all general rules of prognosis at defiance.
Slight punctured wounds will sometimes terminate fatally in conse-
quence of inflammation, followed by extensive suppuration ; while,
on  the other hand, a man may  recover from a lacerated wound by
which the greater part of the skin may have been stripped from the
bone.  There  are two sources of danger in wounds of the scalp: 1.
The access of erysipelatous inflammation.  2.  Inflammation of the
tendinous structures, followed or not by a process of suppuration.
Either of these secondary effects may be a consequence of slight or
severe wounds, and prove fatal.   Neither can be regarded as an
unusual result of a severe wound of the scalp, but when one or the
other follows a slight injury, there is  reason to suspect that the
patient may have been constitutionally  predisposed to the attack.
Bad treatment may likewise lead to a fatal result from a wound not 
CONCUSSION OF THE BRAIN.            341
 serious in the first instance, but the question—how far the respon-
 sibility of an aggressor would be affected by a circumstance of this
 nature has been considered in another place (ante, p. 324).  Wounds
 of the head are dangerous in proportion as they affect the brain ;
 and it is rare that a severe contused wound is unaccompanied  by
 some injury to this organ. There is, however, a difficulty which a
 practitioner has here to contend with—namely, that it is scarcely
 possible to predict from external appearances, the degree of mischief
 which has been  produced within.  These  injuries, as it is  well
 known, are capricious in their after-effects—the slightest contusions
 may be attended with fatal  consequences, while fractures, accom-
 panied by great depression of bone, and an absolute loss of substance
 of the brain, are sometimes followed by perfect recovery.  Another
 difficulty in the way of forming a correct opinion consists in the
 fact, that a person may recover from the first  effects of an injury,
 but after some days or weeks  he will suddenly die ; and on exami-
 nation of the body, the greater part of the brain will  be found de-
 stroyed   by suppuration, although  no symptoms  of mischief  may
 have  manifested themselves until within a few hours of death.
   Concussion.—The common  effect of a violent blow on the head
 is to produce concussion or effusion of blood, or both.  Concussion
 is usually indicated by fainting, insensibility,, or  sudden death oc-
 curring immediately after the application of external violence.  In
 concussion the symptoms come on at once, and the patient some-
 times dies without any tendency to reaction manifesting itself.  In
 the most severe form, the person  drops at  the very moment when
 struck and dies on the spot.   (Chelius's " Surgery," vol. 1, p. 408.)
 In other cases, he may linger  in a  state of insensibility for several
 days or weeks and then die.  In concussion there is generally more
 or less vomiting.   It is important to remember that  neither com-
 pression  nor physical  injury  to the brain is  necessary to render
 concussion  fatal.  This may be entirely  dependent on  shock to the
 nervous system.  After death, no particular morbid change may be
 discovered  in the body, or there may be merely the mark of a slight
 bruise on the head.  The state of insensibilitj- observed in concus-
 sion may be only  apparent: some consciousness may be retained.
  Inflammation may follow the primary shock from  concussion;
 suppuration may take place, and the patient die after  the lapse of
 several wreeks, or  even  months.  It  is necessaiw in a medico-legal
 point  of  view to notice that a person may move about anel occupy
 himself, while apparently convalescent, for a week or ten days after
 recovery  from  the first shock, and  then suddenly be  seized with
 fatal  symptoms, and  die.  This  apparent recovery leads to the
 common supposition,  that  death must have been produced  by some
 intervening cause, and  not by the  original violence to the head, a
point generally urged in the defence of such cases.  When the in-
flammation that follows  concussion  is of a chronic character, the
person may suffer  from pain  in the head and vomiting, and die
after the  lapse  of weeks, months, or even years.  Concussion may
sometimes take place as a consequence of a violent fall on the feet, 
 342  CONCUSSION DISTINGUISHED  FROM  INTOXICATION.

 in which case the head receives a shock through the medium of the
 spinal column.  The skull may be thereby extensively fractured at
 the base, and the brain may be even shattered by such a fall.  This
 was the cause of death in the case of the Duke of Orleans.   (" Med.
 Gaz.," vol. 36, p. 368.)
   Concussion distinguished from intoxication.—The symptoms under
 which a wounded person is laboring may be sometimes attributed
 to intoxication, and a medical witness may be asked what difference
 exists between this state and  that of concussion.   The history of
 the case wall, in  general, suffice to establish  a distinction, but this
 cannot always be obtained.   It is commonly said that  the  odor of
 the breath will enable a surgeon  to detect intoxication; but it is
 obvious that a man may meet  with concussion after having drunk
 liquor insufficient  to cause  intoxication, or concussion may take
 place while  he is  intoxicated—a combination  which frequently
 occurs.   Under such circumstances  we must wait for time to de-
 velop the real  nature of the case.   Concussion may be so slight as
 sometimes closely to resemble  intoxication, and  from the absence
 of  all marks of violence to the head and  the existence  of a spirit-
 uous odor in the breath, the  medical examiner might  be easily
 deceived.   If there be no perceptible odor in  the breath, the pre-
 sumption is  that the symptoms are not  due to intoxication.  On
 the other hand, intoxication may be so great as to give rise to the
 apprehension of fatal consequences, and the coexistence of a mark
 of violence on the head might  lead to error in the formation of an
 opinion.  What is the line of  conduct to be pursued on such occa-
 sions?  The  examiner should weigh all the circumstances, and if
 there be one  cause  for the symptoms more probable than another,
 he  should adopt it;  if there be any doubt, this should be  stated to
 the court.
  There is nothing in the state of the brain in  a dead body, wkicb
 will enable a practitioner to distinguish whether concussion or in-
 toxication had existed, and had been the cause of the symptoms.
 The vessels may  be congested in both cases.   The discovery of an
 alcoholic liquid in  the stomach might lead to a presumption that
 deceased had been intoxicated, while marks of violence on the head
 might favor the view that he had suffered from concussion.  When
 both conditions are found, the examination of the body cannot lead
 to a solution of the question.   The  answer must then depend on
 the special circumstances proved, and, if procurable, on the nature
 of the syniptoms preceding death.   It  is to be feared that medical
 witnesses  are not sufficiently careful, on  these occasions, to deter-
 mine whether there are signs of  intoxication about  an injured
 person.  Subsequent proceedings may render this a material  part of
 the inquiry.                                            '
  The distinction of apoplexy from drunkenness involves great diffi-
culties.   In these cases we have to deal with the true diagnosis of
 alcoholic or narcotic poisoning (p. 222).  Dr. Jackson has directed
 attention to this medical question in a  case reported in the  " Med.
 Times and Gaz." 1871, 1, 360.  Some instructive cases, in  reference 
          INJURIES TO THE BRAIN BY EFFUSION.       343

to this complication of wounds, have been published by M. Tar-
dieu.  (See " Med. Gaz.," vol. 44,  p. 347.)
   Extravasation, or effusion of Blood.—A blow on the  head may
destroy life by causing  an effusion of blood  either on the surface
or in the substance of the brain.   In  pugilistic  combats, when a
person is thus struck, he commonly falls, and death may take place
in a few minutes.   On inspection, blood may  be  found  effused
either at the base, or in the ventricles of the brain, and the ques-
tion will present itself—Did the  injury which caused  death arise
from a blow or a fall ?  (See page 276.)  A heavy  blow  on the
head may cause  fatal effusion of blood; but on these occasions the
effusion commonly  arises from the  violent concussion wdiich the
injured person sustains by the fall. A medical witness will, there-
fore, in general, be compelled to admit that the fatal effusion might
have taken place either from a blow or a fall.  If the fall has re-
sulted  from  accident,  and  not from  a blow, this will, of course,
absolve the accused from responsibility for the fatal results.  This
subject has important applications in legal medicine, for this is one
of the most common causes of death from injuries to the head, and
there are generally  many cases of this  description tried at the
assizes.  Effusion may occur from  violence, with or without frac-
ture, and it  may take  place without being accompanied by any
external marks of injury.
   In cases of injures to the head proving fatal by effusion of blood
on the brain, a person may recover from the first effects of the vio-
lence, and apparently be going on  well, when he  will suddenly be-
come worse and  die.  Effusion  takes  place slowly at first;  it may
be arrested by the effects of stupor from concussion,  by a portion
of the blood coagulating around the ruptured orifices of the vessels,
or by some other mechanical impediment to its escape; but after a
longer or shorter period, especially if the person be excited or dis-
turbed, the bleeding will recur, and destroy life by producing com-
pression of the brain.  How many hours or days are required in
order that  such an increased  effusion should take place after  an
accident, it  is impossible to say; but in severe cases, it is gener-
ally  observed to follow the injury within a short time.   Sir Astley
Cooper has related a case of a gentleman who was thrown out of a
chaise, and fell upon his head with  such violence as to  stun  him in
the first instance.  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  effusion of blood on the  brain.
When the brain  has sustained laceration from violence, in addition
to insensibility, convulsions  are frequently observed.
  Effusion of blood from disease or violence.—Blood may  be found
effused in various situations within the interior of the skull; and
the cause of the  effusion may be either disease or violence.  The 
344
EFFUSION  OF BLOOD.
skill of a medical  jurist is often  required  to  determine which of
these causes is the more probable, as where, for instance, a pugilist
has died, after having received severe injuries to the head, and his
adversary is tried  on a  charge of manslaughter.  On these  occa-
sions it is often urged in the defence, that the bleeding might have
arisen either from a diseased state  of the vessels of the brain; or,
if the evidence render it probable that the blow was the cause,
that the effects of the blow were aggravated by a diseased condition
of the vessels, or by the  excitement into which  the deceased was
thrown, either from the effects of intoxication, or passion.  AVhen
the brain is not lacerated by violence, the blood is effused either
on the  surface of  the  hemispheres, between  the  membranes, or
at the base.  When the effusion is caused by violence, the effused
blood is not always found under the spot where  the blow was in-
flicted, but  occasional^, by  counter-stroke on the surface of the
brain, directly opposite to it,—a case which a medical witness has
frequently been required to explain on trials, and  which depends
on the same cause as fracture by counter-stroke, i. e. on a separation
of parts (laceration of the brain, effusion of blood, or even  frac-
ture of  the  bones)  at the point of the skull directly  opposite to
that which  sustains the violence.   Thus, fracture of the base of
the skull is frequently the result of severe violence applied to the
top of the head (vertex).  Effusions of  blood from  a diseased  state
of the vessels more  commonly take place in the substance of the
brain, but they sometimes occur on the surface of the organ, as a
result of mere excitement or over-exertion of the muscular powers.
A diseased condition  of the vessels,  and probably a softening of
the substance of the brain, will on these occasions be apparent on
inspection.
  If the effusion  depend  on disease, the arteries  around may be
found in  a diseased condition, or the  brain itself may be found
softened and disorganized.  The state of the brain and its vessels
should  be closely  examined in  all cases of alleged violence,  since
hemorrhage may take place either from excitement, or slight blows,
whenever this diseased condition exists.  It has occasionally hap-
pened, especially in old  persons, that the person has dropped down
dead  without a blow being struck, and that  death  has   been
wrongly imputed to violence.  Cerebral hemorrhage from disease
rarely occurs in persons under forty years of age.  Frequent in-
temperance and violent passion may, however, easUy create a ten-
dency to it in younger  persons.  As an  effect of  violence it may
take place in persons of all  ages, but when the marks of violence
are slight, a witness must exercise  great  caution before he alleges
that  the effusion  was produced by a blow, especially when  it is
found that the deceased was of intemperate habits.
  Another, condition besides intoxication and  passion has  been
said to  favor a rupture of vessels  and an effusion  of blood on the
brain—namely, a thickened state of the substance of the left ven-
tricle of the heart.   According to  some pathologists, this morbid
condition favors the occurrence  of cerebral hemorrhage by the 
INJURIES TO  THE BRAIN.
345
force with  which  the ventricle propels the blood  to the brain.
Unless the brain is softened and the vessels are diseased, it is, how-
ever, doubtful whether this  condition  of the heart would have
much influence.
  As a summary of these remarks, wre may say that in effusions of
blood from violence, the blood generally issues from a vessel which
is plainly seen to be torn, as the middle artery of the brain, or the
lateral sinus.   The effused blood is commonly found on the surface
of the brain, and not in its substance, unless the organ be lacerated.
When situated between the dura mater and the skull, but especially
when immediately below the seat of violence, or directly opposite
to it by counter-stroke, this is strong evidence, cceteris paribus, that
it has proceeded from a blow.  When there is a fracture of the
skull, the  presumption of the extravasation being due to violence
is great, because there is not only a sufficient, but an obvious cause,
while the idea of its having proceeded from disease only is remote
and  speculative.  When, besides  these  conditions, there is no re-
markable  congestion of the brain and other spots—when the sub-
stance of the brain is firm, and the vessels are to all appearance
free  from disease, we  have the strongest reason to believe that the
effusion must have been due to  violence, and to no other cause
whatever.
  The evidence given on some trials, when the main question has
turned upon the cause of an effusion of blood on the brain, in the
case  of a person who has sustained violent injuries to the head, has
rather tended to reflect disgrace on medical  science.  It has  been
made to appear from  the mouth of the medical witness, either di-
rectly or by implication, that no sort  of mechanical violence ap-
plied to the head of a man in a state of drunkenness or passion—■
of one whose cerebral vessels were probably diseased, or the sub-
stance of wdiose heart might be thickened—could have had any
effect in producing a fatal extravasation found in the head after
death!  In spite of an individual having received a violent blow
with a bludgeon, sufficient to have killed a stout and vigorous man,
or of his having been thrown with considerable force with his head
against a stone-floor, an unqualified admission is often made that
excitement  alone, or drunkenness alone,  would  account for the
effusion without reference to the blow !  In putting the most favor-
able  construction upon these cases, when wre have clear evidence of
great violence having been useel to the head, with the presence of
the usual  post-mortem  appearances, our opinion  should be  that
the excitement or drunkenness might have predisposed to, but was
not the immediate cause of, the cerebral hemorrhage.  There seems
to be no good reason for  assuming that  apoplexy  from  natural
causes always occurs, by a peculiar coincidence, just at the  time
that  a person receives  a violent blow with a bludgeon on the head,
or for giving to  the assailant the benefit of this hypothetical ex-
planation.   A mere inspection of the body does not always lead to
the discovery of the cause  of an  effusion on the brain.   The vio-
lence causing an eft'usion of blood  may have been slight, and unless 
346      EFFUSION  OF BLOOD  FROM  EXCITEMENT.

attention  is particularly directed  to  the  subject, it  may be over-
looked.  The  condition of the effused blood should be  accurately
noticed, in order to determine whether it  presents any marks indi-
cative of its being recent or of old standing.
  Spontaneous effusions or effusions from  disease are not easily dis-
tinguished from those which are the result of violence to the head.
Dr.'Wilks has pointed out that in most  instances of severe injury
attended with effusion of blood, the structure of the brain is found
bruised.   In meningeal apoplexy (apoplexy of the membranes), the
source of  the blood is a vein of the pia mater or inner membrane,
and sometimes a large arterial trunk.  The difficulty chiefly arises
in those cases  in which effusion is  found after slight violence and
there is, at the same time, disease of the bloodvessels of the brain.
Dr. Wilks gives the result of several  inspections in which effusion
was owing to  disease, to violence,  and to  a mixeel condition.  (See
" Guy's Hospital Reports," 1859, p. 120.)
  Effusion of blood from excitement.—When engaged in the investi-
gation of  these cases, it is always  a fair matter of inquiry whether
the violence was  not of itself sufficiently7 great  to account  for the
effusion, without the supposition  of  coexisting disease  or  excite-
ment.  Admitting  that the  rupture of a  bloodvessel, and the  ex-
tensive eft'usion of  blood on the brain may take place from simple
excitement and passion, yet this is an event comparatively7 rare, at
least  in the young and healthy, while nothing is  more common
than that these results should follow violent injuries to the head,
whatever  the  age or condition of  the person.   A medical witness
should remember that on these occasions, if he  is unable to  say
positively whether the effusion was due to the  excitement  or  the
blows, he  will satisfy the court if  he only state  clearly that which
is, in his  own mind, the  more probable  cause  of death ; and by
weighing  all  the circumstances of  the  case beforehand, he will
rarely fail to find that one cause was more probable than the other.
Thus, if a man, excited by passion and intoxication, is struck on
the head, and the  blow is slight—such  as  an unaffected  person
■would probably have sustained without  injury—yet in this case
insensibility and death follow, and, on examination, a quantity of
blood  is found effused in  the substance  of the brain, can  it be a
matter of doubt with the practitioner that the effusion was  chiefly
due to the excitement under which the deceased was laboring?  To
take a converse instance:  a  man, engaged  in  a personal conflict
with  another, is  struck most violently on the head, or falls with
 reat force on this part of  his body ;  on inspection it is found that
 eath has arisen from effusion of blood on the surface of the brain,
and it would be no unexpected consequence of the violence inflicted,
that a similar  appearance should be met with in an individual calm
and  unexcited.  Can the practitioner hesitate to say, under these
circumstances, that the blow would  satisfactorily account  for the
effusion, without reference to any  coexisting causes of excitement?
These may be  allowed to have their influence in  giving an increased 
DATE  OF EFFUSIONS.
347
tendency to cerebral hemorrhage, or in aggravating the consequence
of the blow, but no further.
  Date of effusions.—Recent effusions  of blood are  recognized by
their red color, and the consistency and  appearance of the clot or
coagulum.  After some days the clots acquire a chocolate or brown
color, and  this passes  gradually into an ochreous tint, which may
be met with in from twelve to twenty-five days after  the violence.
Coagula of effused  blood also  undergo changes in structure and
consistency; when old they are firmer, and  there is much lymph,
which  is sometimes disposed in membranous layers  of a  fibrous
structure, and these are adherent to the dura mater  and  the brain.
The surface of this organ sometimes presents a mark indicative of
pressure.
  When a medical man is  required to give  an opinion of the date
of an effusion found  on the brain, great caution is required.   A
surgeon may not be able to fix the precise date, but it  may be in
his power to say whether the blood has been effused for a few elays,
weeks, or months.
  When a blow on the head  is of a heavy, bruising kind, the
whole substance of the skull may be  fractured without  a division
of the skin.  There is one remarkable  circumstance connected with
fractures accompanied by depression of bone,  which here requires
to be mentioned—namely, that the person has been sensible so long
as the foreign substance which produced the fracture and  depres-
sion  remained  wedged  in  the  brain, and  that insensibility and
other fatal  symptoms  began to manifest themselves only after its
removal.  This  being admitted, it may be urged in defence, that
death was really caused by medical interference.  But it is a suffi-
cient answer to state, that the wounded person must have died from
inflammation of the brain if the foreign body had been allowed to
remain ; and that it is  consistent with the  soundest  principles of
practice to  remove all such foreign substances without delay.  In
fractures of the skull with depression, it may become a question
whether the surgeon  raised the depressed portion of bone so soon
as he ought to have done.
  A blow on the head may produce a  fracture  of the inner table of
the skull, and  cause death  by7 compression as  a result of the frac-
ture  on the effusion of blood.  In Reg. v. Hadwen (Lancaster Aut.
Ass.  1871), prisoner struck a boy a severe blow on  the head.  He
became sick and unconscious, fell into a state of collapse, and died
the next day.  On inspection, the inner table  of the skull was founel
to be fractured, and there was eft'usion of blood on the brain.
  In reference  to persons found dead with  severe injuries to the
head attended with fracture and  effusion of blood on the brain, a
medical man may be required to say  whether such an amount of
violence is or is not consistent with the retention of muscular exer-
tion, and power of locomotion  by the deceased.  For instance, a
man  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 
348
WOUNDS OF  THE FACE.
might be a strong disposition to assert that the deceased must have
been murdered—the injuries  being  such that they could not have
been produced by himself, there  being at the same time no w7eapon
near,  and no elevated spot from which  he could have fallen.   The
discovery, after death, of severe injury to the head, with great effu-
sion of blood on the brain, must not, however, lead a  surgeon to
suppose that the person who sustained the violence had been imme-
diately incapacitated.  There  are various cases recorded which show
that a power to move has been retained  under conditions w7hich
might be supposed to render a person incapable of moving from the
spot.  Full allowance must be made on those occasions for the pos-
sible exercise of locomotion  by  the deceased.   Although  a large
quantity of blood may be found after death pressing on the substance
of the brain, it does not follow that this effusion and pressure were
the immediate result of the violence.
   Wounds  of the brain.—Wrouncls of the  brain sometimes prove
instantaneously mortal, even when  slight, while in other cases,
recoveries take place from  contused or  punctured wounds of this
organ, contrary to all  expectation.  When a person  survives the
first effects of the injury, there  are two sources of danger which
await him :  1. The production of fungus from the exposed portion
of the brain ; and 2. Inflammation and its consequences.  The pro-
cess of inflammation, it must be remembered, is very slowly estab-
lished in this organ ; it may  not manifest itself until from three to
ten weeks after the injury.   In one  remarkable  case, where a child
was accidentally shot through the brain, the ball having traversed
both hemispheres, no symptoms of cerebral inflammation manifested
themselves  for twenty-six  days.  The child died on the twenty-
ninth day.   (" Med. Gaz."  vol. 39, p. 41.)
   [Many instances have been reported where portions of the brain
have been destroyed as the  result of accident, and yet life has been
preserved.  A remarkable  case is recorded in the " Amer. Journ.
Med.  Sci.," July 1850, by Prof.  Bigelow, of Boston.  A man was
preparing a charge of powder for blasting rocks; a premature ex-
plosion ensued, which resulted in projecting a bar of iron weighing
thirteen and  a quarter pounds, three feet seven inches in  length,
and one  and a quarter inches in diameter, directly through his
head, and high into  the  air.  The man  was  slightly convulsed
at first, but he soon recovered his senses, riding some  distance to
his home, and giving a clear account of his accident.   His subse-
quent recovery was complete, with the exception of the  loss of one
eye.  Wounds of the base of the brain and of the cerebellum are
the most fatal.—R.]
   Wounds of the face.—When wounds of the face are of any extent,
they are usually followed by great deformity ; and when they pene-
trate  the cavities in which the  organs  of  the  senses are situated,
they7 often prove fatal,  either by involving the  brain and its mem-
branes, or by giving rise to inflammation of this organ. Wounds
of the eyebrows are not of so simple a nature as might at first sight
be supposed.  Besides being attended by deformity when they heal, 
INJURIES TO  THE SPINE.
349
they are liable to  cause during the  process of healing, serious dis-
orders of the neighboring parts.  Amaurosis and neuralgia are re-
corded among the secondary and  not unusual consequences of such
wounds, when the supra-orbitar nerve has become implicated.  Under
certain conditions of the Jbody, 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 e}-e has  been known
to occur from  a contused wound, not of a violent nature, on the
right eyebrow.  Wounds apparently confined to  the external parts
of the face frequently conceal deep-seated mischief.   A sharp  in-
strument penetrating  the  eyelid, and passing upwards with any
force, will produce fracture of the orbitar plate of the frontal bone,
which is known to be extremely thin, and even injure the brain
beyond.
  Deformity as a consequence of wounds of the face.—Wounds of the
face when at  all extensive,  are  always  followed, in healing,  by
greater  or less deformity.  A  medical  witness may, perhaps, find
these questions put to him in relation to them :  Is the wound likely
to be attended with deformity ?   Could such a wound of the face
heal without deformity ? or, Could the deformity, if it exist, have
been produced by any other  cause than the wound ?  These ques-
tions are of some importance.  A  person may allege  that he was
severely Avounded in the face, when  the medical witness, on exami-
nation, may find no trace of such a wound as that described.  Again,
a person may seek damages from  another in a civil action, by alleg-
ing that  a particular  deformity  was produced by a wound, when
the medical witness may be able  to trace its origin to disease, or to
some accidental cause.

                    Injuries to the Spine.

  Injuries to the spine and spinal marrow seldom require medico-
legal investigation ;  but this organ is liable to concussion from blows,
to compression from fracture of the vertebrae or the effusion of blood,
with all  the secondary  consequences attending such accidents.   Con-
cussion of the spinal marrow commonly produces paralysis, affecting
the bladder, rectum, or lower limbs.   These symptoms may  not
appear at once, but come on after some hours or days.  After death
no traces of mechanical  injury may be discovered.  Blows on the
spine, unattended with fracture  or  dislocation, may, according to
the observation of Sir B. Brodie, be followed by  inflammation and
softening of the spinal marrow.   A slight injury has  thus been
known to cause death, by giving  rise to inflammation of the spinal
marrow.   This organ is also liable to  compression from slight
causes, and death may occur from paralysis of the nerves of re-
spiration.
  Fractures of the vertebra;.—These fractures are generally attended
by displacement, and thus  produce  compression of the spinal mar-
row. They are the  more rapidly fatal in proportion as the  injury 
350
INJURIES TO  THE SPINE.
is high up in the vertebral column.  The whole of the body becomes
paralyzed below the seat of injury, by the compression of the spinal
marrow7.   If the seat of compression is above the fourth cervical
vertebra,  death is  commonly  immediate;  asphyxia results from
paralysis of the nerves which supply the diaphragm, and which are
necessary to respiration.   In falls on the summit of the head from a
height, it sometimes happens, not only that the skull is extensively
fractured, but that  the dentiform process of the second vertebra is
broken off, owing to the head being doubled under the body. This
injury to the second vertebra  may  be the cause  of death.  From
a case related by the  late Mr. Phillips, it w7ould appear that this
accident  is not always attended by fatal compression of the spinal
marrow.   (" Ed. M.  &  S. J." Jan. 1838.)   In  one instance the person
survived fifteen months (ib. Oct.  1845, p. 527); and  in  another, in
which the fracture w7as caused by the patient turning in bed while
his head  w7as pressed on the pillow,  death  did not take place for six-
teen months.  (Copland, "Diet. Pr. Med.," Paralysis.)   On several
criminal  trials, this injury was proved to have been the cause of
death: and in a case  tried at  Glasgow (the  King against Reid, p.
27), it became  a material question, how7 far  such a fracture might
result from disease.  It may happen that caries of the bone, or dis-
ease of the transverse ligament will cause a separation of the denti-
form process from the  second cervical vertebra.   [See Sir A. Cooper's
case of spontaneous luxation of the second  cervical  vertebra, from
caries of the odontoid process.  (Cooper on  Dislocations and Frac-
tures, p.  463.)—R.]   The state of the bone in these alleged fatal
accidents should, therefore, be closely examined. In fractures of
the vertebrae, a person  is generally so  disabled,  whatever may be
the situation of the fracture, that he cannot walk or exert himself.
  Injuries to the spine and its contents are generally the result of
falls or blows, either on  the head or the lower part of the column.
The secondary  consequences  of these  injuries are  sometimes so
insidious as to disarm  suspicion, and  death may take  place quite
unexpectedly some  weeks after the  accident.  Spicula of bone sepa-
rated by7 fractures,  ma}7 remain adherent  for some time ; and, by a
sudden turn' of the head, be  forced off, and  destroy life by pene-
trating the spinal marrow7, at a long period after the infliction of the
injury.   This has been knowm to happen  in fractures involving the
margin of the  foramen magnum, and in such cases death is imme-
diate. The spinal marrow has been in some instances wounded in
its  upper part by sharp-pointed instruments  introduced between the
vertebrae.  Death  is  an instantaneous  result when the wound is
above the third cervical vertebra; there is  no  part of the spine
where a weapon can so  easily penetrate as this, especially if the
neck be  slightly bent forward.  The external wound thus made
may be very small, and if produced with any  obliquity  by drawing
aside the integuments, it might be easily overlooked, or it might
be set down as superficial. 
WOUNDS OF THE CHEST.
351
                   CHAPTER  XXXII.

WOUNDS OF  THE CHEST.—AVOUNDS AND  RUPTURES OF THE LUNGS AND
  HEART.—WOUNDS OF LARGE BLOODVESSELS.--WOUNDS AND RUPTURES
  OF THE DIAPHRAGM.—DIRECTION OF AVOUNDS OF THE CHEST.--WOUNDS
  OF THE ABDOMEN.--DEATH FROM BLOAVS ON  THE CAVITY.--RUPTURES
  OF THE LIArER, GALL-BLADDER, SPLEEN, KIDNEYS, INTESTINES, STO-
  MACH AND URINARY BLADDER.—AVOUNDS OF THE GENITAL ORGANS.

  Wounds of the chest.—Wounds  of the  chest  have been  divided
into those Avhich are confined to the parietes or walls and those
which penetrate the cavity.  Incised or punctured wounds of the
parietes of the chest are  rarely followed by dangerous consequences.
The bleeding is not considerable, and  is generally arrested Avithout
much elifficulty.   They heal either by adhesion or suppuration, and
unless their effects are aggravated by  incidental circumstances, the
person recovers.   Contusions or contused wounds of  the chest are,
however, far more dangerous, and the danger is always in a ratio to
the degree of violence used.  Such  injuries when severe, are ordi-
narily accompanied by fractures of the ribs or sternum—by a rup-
ture of the  viscera within the -cavityr, including the diaphragm—
by profuse bleeding—or, as an after-effect, by inflammation of the
lungs, Avith or Avithout suppuration. Fractures of the ribs are
dangerous for several  reasons: the bones may be  splintered and
driven imvards, thereby Avounding  the lungs and causing hemor-
rhage, or leading to inflammation of the  pleura or lungs.   In frac-
tures of the upper ribs, the prognosis is less favorable than in those
of the loAver, because commonly a much greater degree of violence
is  required to  produce the fracture.  A  simple fracture of  the
sternum or chest-bone without displacement of the  bone, is rarely
attended with  danger, unless the concussion has at the  same time
produced mischief internally, which will  be known  by the symp-
toms.  AVhen, however, the bone is depressed as well as fractured,
the viscera behind may be mortally  injured.  In a case of depressed
fracture  of the sternum, recorded  by M. Sanson, the person  died
after the lapse of thirteen days; and  on inspection, it was found
that the fractured portion of bone had produced a transverse wound
of the heart about an inch in length.  The cavities of the organ
had not been penetrated, but the piece of bone was exactly adapted
to the depression produced by it on  the parietes. (Devergie, " Med.
Leg." vol. 2, p. 243.) A witness will frequently be required to take
into consideration the effects of contusions on the thorax, Avith or
without fracture, in cases of death from pugilistic combats, which
formerly gave rise to numerous trials  on charges of manslaughter.
Wounds penetrating into  the  cavity of the chest  are generally 
352        WOUNDS  OF THE  LUNGS  AND HEART.

dangerous, even when slight, in consequence of the numerous acci-
dents with  Avhich they  are  liable to be complicated.  In these
Avounds, the lungs are most  commonly injured; but, according to
the direction of the weapon, the heart, or the great vessels connected
with it, as well as the oesophagus (gullet) or thoracic duct, may share
in the mischief.
   Wounds of the  lungs.—The  immediate cause of danger from
wounds of these  organs  is  the  consequent hemorrhage, which is
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 determined by the quantity of blood Avhich
escapes from the wound  ; for it may flow internally,  and collect
within the  cavity of the pleura,  impeding respiration.  This is
especially to be apprehended when the external orifice of the wound
is small and oblique, and one of the intercostal arteries has been
touched by the weapon.   A wound of the lung is generally known,
among other synnptoms, by the frothiness and  florid  color of the
blood which issues from the orifice, as well as by the expectoration
of blood.   The lungs may sustain serious injury from a blow or fall,
and yet there may be no external marks of violence  or symptoms
indicative of danger for some hours.  During the convalescence of
a person who has survived the first effects of a penetrating wound
of the chest, the surgeon should observe  whether death, Avhen it
occurs, may not have been caused either by imprudence on  the part
of the patient, or by  abuse of regimen or other misconduct; for cir-
cumstances of this nature may be occasionally treated as mitigatory
on the trial  of the assailant.   It is properly recommended  that in
all cases Avhere a person is progressing to recovery, a  relaxation of
the antiphlogistic regimen should  be made with great circumspec-
tion.  Too much nourishment,  too  frequent talking, or any exer-
tion are  circumstances that  may cause a  rene\val of the bleeding
and extravasation.
   Wounds of the heart.—Wounds of the heart are among the most
fatal of penetrating Avounds  of  the chest.  It  was  formerly con-
sidered that all Avounds of this organ were necessarily and instantly
mortal.   Undoubtedly, when either of the cavities is laid open to
a large extent, the bleeding is so profuse on the withdrawal of the
Aveapon, that death must be immediate.  But  when the wound is
small, and penetrates into the cavities of the  heart obliquely, life
may be prolonged for a considerable period ;  and cases are on record
in Avhich it is probable that  such wounds would have healed,  and
the patients have finally recovered, but  for the supervention of
other diseases which destroy  life.
   [Numerous examples of wounds of the heart not directly fatal
are cited by Beck (ii. 329-332) and by Stille (" Wh. and Stille," 2d
ed. p. 580).  We  know of at least three others, occurring in Phil-
adelphia, not noted in these works, in Avhich the victim Avas proved
to have walked  several steps after having  been wounded in  the
heart.  See  " Proc. of Path.  Soc. of Phila.," in " K. A. Med.-Qhir. 
WOUNDS OF  THE HEART.               353
Rev.," March, 1859, p. 200 ; also " Xew York Med. Times," April,
1855, for the case of Poole, referred to aboA7e  from Dr. Darling;
and in the same journal (May, 1855), " Statistical Observations on
Wounds of the Heart, and  on their relations to Forensic Med.:"
Avith a table of forty-two recorded cases, by Dr. Purple;  also " Am.
Journ. Med.  Sciences," July,  1861, p.  293, for a case of bullet in
the Avail of the heart for twenty years.   See, further, a paper " On
Wounds of the Heart," by Dr. Jno. Redman Coxe, " Am. Journ.
Med. Sci.," Aug. 1829, 307 ; and " Archiv.  G6n6r. de Med.," Sept.
1839, for a valuable paper " On Penetrating Wounds of the Heart,"
by M. Jobert De Lamballe.—H.]
  It was the opinion  of Dupuytren, that these injuries were not
necessarily fatal, although I believe, Avith one  exception, there is
no case  on record in Avhich a person has recovered from  a penetrat-
ing wound of the  cavities of the heart.  (" Ed.  M. and S. J." Oct.
1844, 557  ; also "Ann. d'Hyg." 1846, t. 1, p. 212.)  There  are few,
probably,  Avho will be inclined to consider them curable ; a remote
possibility of simple Avounds 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 tAventy-nine instances  of penetrating Avounds of the heart,
only two  proved  fatal within forty-eight  hours.   In  the others
death took place at the varying periods of  from four  to twenty-
eight days after the  infliction of the Avound.  (Devergie, " Med.
Leg." vol. 2,  p. 253.)  These differences in the time at which death
occurs, as  well as the fact that wounds of the heart do not instantly
destroy  life, have been ascribed to the peculiar disposition of the
muscular  fibres of the organ, and to the manner in which they are
penetrated by a weapon.  It appears from  the observations of M.
Ollivier and  others, that  the right cavities of the heart are more
frequently Avounded than  the left, and of these  the right ventricle
is most commonly the seat  of injury.  Out of  sixty-four  cases of
wounds of this organ, twenty-nine were situated in the right ven-
tricle, twelve in the left ventricle, nine  in the two ventricles, three
in the right auricle, and one in the left auricle.   These differences
are readily accounted for  by the relative situation of the cavities.
It appears also that wounds of the right ventricle are not only the
most frequent, but of all others they are the most rapidly fatal.  It
is considered that the suddenness of death in severe  wounds of the
cavities  of this organ, is  to be ascribed not merely to  the loss of
blood, but to the degree of compression which the heart experiences
from  that which  escapes into the bag of the  pericardium.  In
reference  to the direction of  penetrating Avounds of the  chest, it
may be  proper to state that the base of the heart corresponds to
the upper margin of the third rib on the left side; and the apex to
the lower margin of the fifth rib on the same side.
  A penetrating Avound of the heart Avas formerly considered  to be
instantaneously mortal, and the usual medical opinion at coroners'
      23 
354
AVOUNDS OF  LARGE  ARTERIES.
inquests was, that a person so wounded, must have dropped down
dead  on the  spot.  More accurate  observations  have,  however,
shown that this is  an erroneous, and in medico-legal practice, a
highly dangerous doctrine.  The Due de Berri, Avho was murdered
in Paris in 1820, survived eight hours after having received a
Wound of the  left ventricle.  Other and more remarkable instances
of survivorship have  been recorded ; and  it may be stated  that,
although in a surgical view, a question of this kind is of little im-
portance, the case is very different in legal medicine.  Upon it may
depend  the decision  of questions relative  to suicide, murder, or
justifiable  homicide.   When  the cavities of the heart, especially
the auricles, are extensively laid open, death is likely to be an im-
mediate result; but persons Avho have  sustained  wounds of this
organ have frequently lived sufficiently long to exercise a poAver of
volition  and  locomotion.  In  reference to  penetrating  Avounds
(stabs), little  or no  blood probably escapes from the heart in the
first instance, but it may afterwards ooze gently, or suddenly burst
out in fatal quantity.   It must not, therefore, be supposed, when a
person is  found  dead Avith a wound of the heart, attended  with
abundant hemorrhage, either  that the flow of blood took place in
an instant, or that the person died immediately, and was utterly
incapable of exercising any voluntary power.
  The heart  is liable  to be  ruptured either from disease or acci-
dent.  In  the latter case the organ generally gives way towards
the base, and  through one of  its cavities on the right side.   Dr.
Hope asserts that in rupture from natural causes, it is the left side
of the heart, and particularly the left ventricle, in which a rupture
is most frequently found.  The symptoms  are  sudden pain, col-
lapse, cramps, cold extremities and rapid death.  According to the
circumstances under which they occur, cases of rupture from dis-
ease may  excite a suspicion of death from violence.  Sometimes
the substance of the heart may be found to have  undergone  fatty
degeneration.  As a medico-legal subject, it is worthy of note, that
when this alarming accident proceeds from  blows or falls, it is not
always  accompanied by  marks of external violence—or any frac
ture or other injury  to  the  exterior of the chest.  The natural
causes of  rupture of the  heart are violent  mental emotions,  such
as anger, fright, terror, paroxysms of passion, sudden or excessive
muscular efforts, or violent physical exertions in constrained posi-
tions.   The heart, like any other muscle, may also give way from
its OAvn powerful contraction.   When the heart  is in a diseased
condition, any slight causes of excitement are sufficient to produce
rupture and  sudden death.  The mere  exercise of walking may
thus give rise to fatal consequences.
   Wounds of arteries and veins.—Wounds of the large arterial and
venous  trunks around the heart, must be considered as mortal:
death is  generally instantaneous from  the  sudden  and profuse
bleeding -which attends them.  With regard to these fatal effusions
of blood within the chest, as  well as in  the other great cavities, it
may be proper to mention that, from Avhatever vessel or vessels the 
               WOUNDS  OF  LARGE  ARTERIES.           355

blood may have  issued, it is  not commonly found coagulated to
any extent,  The greater part of it generally preserves the liquid
state ;  and  it is rare  that so much as one-half of the  quantity
effused is met with  in  the form of  coagulum.  These  effusions of
blood in the chest may be sometimes traced to wounds of the
intercostal  and the internal mammary  arteries,  or of  the vena
azygos.
  Wounds of the carotid arteries have been considered elsewhere in
reference to wounds of the throat.   Questions relative to the power
of locomotion  perhaps more  frequently occur  Avith  respect  to
Avounds of  these bloodvessels of  the neck than of the heart—sui-
cide and murder being  more commonly perpetrated by  the inflic-
tion of such Avounds.   Wounds of the carotid arteries  are often
pronounced instantaneously mortal.   A witness  may  deliberately
state that the person could not possibly have survived an instant.
This is a very hazardous opinion, for it occasionally comes out on
inquiry,  that if such a wound had been instantaneously  mortal,
then, in defiance of rational probability, or of the strongest pre-
sumptive evidence to the contrary, the deceased  must have been
murdered!   A  medical opinion of  this kind has not only been re-
futed by circumstances, but by the evidence of eye-Avitnesses.   A
medical Avitness is then compelled to admit that his rules forjudg-
ing of  the mortality of wounds are erroneous, and that the person
may have survived for a longer or shorter period.  There are seve-
ral cases on record Avhich show that Avounds involving the common
carotid artery and its branches, as well as the internal jugular vein,
do not prevent a person from exercising voluntary power, and even
running a certain distance.  There is another circumstance which
requires notice in relation to severe  wounds in the throat—namely,
that although a person may have the power of locomotion, he may
not be able to use his voice so as to call for assistance.   It some-
times excites surprise  at an  inquest, how a murder may, in this
way, be quietly committed Avithout persons in an adjoining room
hearing any noise; but the fact is well known medically, that
when the Avindpipe is divided, as it  generally is on these  occasions,
the voice is lost,
  In reference  to severe wounds  involving bloodvessels, while we
may allow  that persons may surviA^e for a sufficient  time to per-
form various acts of volition and locomotion, yet the presence of a
mortal wound, especially Avhen of a nature to be accompanied by a
great loss of blood, must prevent  all struggling or violent exertion
on the  part of the wounded person; such  exertion we must con-
sider to  be quite  incompatible  Avith his condition.   A medical
jurist may thus have it in his poAArer to determine whether a mortal
Avound found on the deceased  has or has not been inflicted for the
purpose of murder.  Of  wounds of other bloodvessels, whether
arteries or veins, it is  unnecessary to make any further remarks.
Death is generally OAving to loss of blood, and the bleeding from a
comparatively small vessel may prove  fatal, according to its size,
situation, and the state  of the wrounded person. 
356
RUPTURES  OF  THE DIAPHRAGM.
  Death from the entrance of air into wounded veins.—In wounds of
veins there is an occasional and a peculiar cause of death which re-
quires a remark, namely, the entrance of air by the open mouth of
the divided vessel.
  It has been  long known that air injected into the jugular vein
would  destroy life by interfering Avith the functions of the heart;
but the exact nature of this accident, as it occurs in operations, is
not well  understood.  (Ferguson's " Surgery," p. 444.)^  According
to some, the air rushes into the cavity of the vessel owing te atmos-
pheric  pressure during  the expansion of  the heart, while others
believe it to be dependent on aspiration in the act of breathing:
but in some  alleged cases of  this  kind, death has been probably
caused by loss -of blood.   When  the bleeding  is slight, and the
hissing sound is heard at the time of  the incision, it may fairly be
ascribed to the entrance of air.  This opinion would be confirmed
by the discovery of a frothy state of the blood in the right cavities
of the heart.
   Wounds and ruptures  of the diaphragm.—The  diaphragm, or
muscular partition between the chest and abdomen, is liable to be
wrounded either by weapons which penetrate the cavity of the chest
or abdomen, or by the ribs when fractured by violent blows  or falls;
but, under any circumstances, wounds of this muscle are not likely
to occur without implicating other important organs  that are in
contact with it.   It  is scarcely possible, therefore, to estimate the
danger of  these injuries abstractedly, as a medical opinion must
materially depend upon the concomitant mischief of the adjoining
viscera.  Slight penetrating Avounds  of the diaphragm may heal
like those of other muscular parts: and cases of this  kind are on
record.   There is, however, especially Avhen the  wound   is of a
lacerated kind, a consecutive source of mischief which no remedial
means  can avert—namely, that after the wound has, to all appear-
ance, healed, the life of  a  person may be cut short by the strangu-
lation of a portion of the stomach  or bowels in the half-cicatrized
aperture.   In  a case of this description, when  death occurs at a
long period after the infliction  of a  wound, the Avitness may pro-
bably be required  to say—Whether  the wound was the cause of
death? or whether there were any other circumstances which Avould
have caused or facilitated the production of a hernia.  The degree of
culpability of an aggressor may materially depend upon the answers
returned to these questions. Phrenic hernia, as this form of internal
rupture is termed, is not by any means an unusual or unexpected fatal
consequence of a wound of the diaphragm ; and therefore it would
appear at first sight, that death, at wdiatever period this event may
occur, should be referred to the original wound. But the case may
present some difficulties, as it is possible that a slight blow on the
stomach, received subsequently to the wound, or even any violent ex-
ertion on the part of the deceased, might have produced the fatal
strangulation. A person may survive with a large phrenic hernia for
a considerable period, and die from some other cause.  It has been
stated that a person  is completely incapacitated and rendered inca- 
WOUNDS OF  THE ABDOMEN.
357
pable of exertion or locomotion by a rupture of the diaphragm. This
statement, however, has been based on limited  observation.  The
general effect of such an injury is to incapacitate  a person, but cases
are recorded  in which, in spite  of the  rupture, a  person has pos-
sessed the poAver of moving and walking to a considerable distance.
  The  most serious injuries to the diaphragm are unquestionably
those  which  are  produced by violent contusions  or falls on the
abdomen, at a time when the stomach and intestines are distended.
In these  cases the muscular fibres may be ruptured to a greater or
less extent; but the bleeding is  not considerable, rarely exceeding
two, three,  or four  ounces.   A  uniform result  of  these ruptures,
Avhen extensive, is a protrusion of the  stomach into the chest, with
sometimes a  rupture of the coats of this organ  and extravasation
of its  contents.   Severe  lacerations  of the diaphragm  are more
readily produced during the  act of inspiration  than during expi
ration—the fibres of the muscles being then stretched, and receiv-
ing, while in this state of tension, the w7hole of the force. According
to Devergie, the rupture most frequently takes place in the central
tendinous structure, Avhere it is united with the  left muscular por-
tion above the crura.  He has remarked that it occurs more com-
monly on the left side than on the right,  (Op.  cit., vol.  2, p. 250.)
It has been supposed that death would  be an immediate consequence
of this accident; but this vieAv is not supported by facts.  In a case
of extensive rupture of the diaphragm, related by  Devergie, in Avhich
the stomach and  colon Avere found in the chest, the person lived
nine months after the only accident that  could have produced  it,
and then died from another cause.   Besides  the  stomach, it some-
times happens that the liver, spleen, or intestines pass through the
opening and, like it, these organs are liable to become strangulated;
the lungs are at  the same time so compressed that respiration is
stopped,  and  asphyxia or suffocation may be an immediate result.
   Direction of wounds in the chest.—In judging of the direction taken
by Avounds  Avhich traverse the chest from front to back, it is neces-
sary to remember the great difference that exists in the level of the
same  rib anteriorly and  posteriorly.  This must be  especially
attended to Avhen we are  called upon to  state  the  direction  of a
traversing Avound from the description of it given by another.  The
point here  referred  to had an important bearing in the  case  of a
fatal gunshot w7ound, which was the subject of  a criminal charge
some  years since.  (Henke's " Zeitschrift," 1836.)   It must not  be
forgotten that a wound immediately below the chest bone, will in
its fore  part involve the viscera  of  the abdomen, in  the back
part those of the chest, and in its  central part it will traverse the
diaphragm.
   Wounds  of the parietes of the abdomen.—Incised and  punctured
Avounds,  which  affect the parietes or coverings of the abdomen
Avithout penetrating  the cavity, are not quite of so simple a nature
as might at first sight  be imagined.    The  clanger 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. 
358
WOUNDS  OF  THE  ABDOMEN.
Among the sources of danger from superficial wounds, is inflam-
mation, folloAved by suppuration beneath the tendinous membrane
Avhich covers the abbominal  muscles.  The matter formed is very
liable to accumulate within  the  sheath  of the muscles, and  this
may prove  fatal unless proper treatment be adopted.  The inflam-
mation will sometimes extend to the peritoneum, and thus rapidly
destroy life. As improper medical treatment may, in either of these
cases, cause a superficial wound'of the abdomen to take a fatal ter-
mination, it will be necessary  for a medical witness to consider hoAv
far the consequences of the act of the prisoner have been aggravated
by wilful neglect or unskilfulness.   But Avhen these wounds take a
favorable course  and heal, there is an after effect to be dreaded—
namely, a protrusion  of the  \7iscera at the cicatrized spot, consti-
tuting ventral hernia.  When  the wound  has involved the mus-
cular fibres transversely to their course, the cicatrix Avhich follows
is commonly far less capable of resisting the pressure of the viscera
within, than any other parts  of the parietes.   A  hernia may take
place, and this, like other herniae, if neglected, is  liable to become
strangulated, aud lead to the destruction  of life.  The walls of the
abdomen, owing to the protrusion  of this  cavity, are easily pene-
trated by pointed  instruments, and it requires but a slight force
to traverse them  completely  and Avound  the  intestines.  A slight
wound may thus prove fatal,  by causing peritoneal inflammation.
   Contusions are attended generally with  far more serious effects on
the cavity  of the abdomen than  on the chest.   This arises from
the coverings of the abdomen having less power  to resist external
shocks.   In the first  place, death may be the immediate result of
a  blow in  the upper  and  central portions;  no particular morbid
changes may be apparent on  inspection, and the violence may have
been so slight as not to have produced any ecchymosed mark  on
the skin.   Death has  been ascribed in these cases to a fatal shock
transmitted to the system through  a violent  impression produced
on the nerve-centre—called the solar plexus.  Some remarks have
already been made on sudden death from blows on this part of the
abdomen.  Travers, Alison, Watson, Cooper and  other writers  on
surgical injuries, have referred to cases of this kind as of not  un-
frequent occurrence.   They  are of considerable  importance in a
medico-legal point of view, as, in  the absence  of marks of physical
injury in the part struck, a jury might be led  to doubt whether the
blow could have  been the cause of death.  Some surgeons have
thought that these cases have not  been  accurately observed, and
that in  those Avhich  terminate  fatally, a more careful  inspection
would probably have shown visible changes  in the organic struc-
tures.  The fact, however, remains: persons have died  soon after
receiving severe blows on the upper part  of the abdomen, and  the
medical men Avho have examined the bodies for the express pur-
pose of eletecting physical injuries, have not found any to  record.
Moreover,  they have not found in any part of the body a natural
cause of sudden death.  Blows on the abdomen, AA7hen they do not
destroy life by shock,  may cause death by inducing peritoneal  in- 
RUPTURES OF  THE LIVER.
359
flammation.  Violence of a severe kind applied to the abdomen is
not always indicated by ecchymosis or injury to the skin. Effusions
of blood in the sheaths or tendinous  coverings of the muscles may
or may not be indicative of violence.  One fact must here be borne
in mind, to prevent mistakes in examining a body after death,
namely, that blood may be found copiously effused in and around
the abdominal muscles, quite irrespective of the application of vio-
lence.  (Reid's "Physiological Researches," p. 511.)  The  absence
of ecchymosis, or abrasion of the skin, in these cases, is sufficient to
show that such extensive effusions are not caused by violence. Blows
adequate to produce a laceration of the vessels  and hemorrhage,
would most probably be attended Avith ecchymosis—and some visi-
ble injury to the skin.  At any rate, when such marks  of violence
are not visible, and there is no  evidence  of a bloAv having  been
struck, a Avitness would act wisely in  declining to attribute the mere
effusion of blood to the act of another person.   Deeply penetrating
wounds of the abdomen are generally fatal by reason of the injury
done to the intestines and other organs.
  Ruptures of the liver.—BIoavsou the abdomen may prove fatal by
causing a rupture of the  liver or other viscera, Avith extravasation
of blood ; and as it has been elsewhere stated, these serious injuries
may occur without being attended with any marks of external A7io-
lence.  Of all the internal organs, the liver and spleen are the most
exposed to rupture, owing to their compact structure,  Avhich pre-
vents them from yielding to a  sudden shock, like the stomach and
intestines.   Ruptures of  the liver may occur from falls or blows ;
but this organ may be ruptured merely by  a sudden action of the
abdominal  muscles.  Ruptures of the  liver generally occur on the
convex surface and anterior margin,  seldom extending through the
Avhole substance of the organ, but consisting of fissures, varying
from one to two  inches in depth.  The right lobe, from its size, is
more usually affected than the left.  Their  usual direction is from
before backwards, with a slight obliquity ; they rarely intersect the
liver transversely.   The  lacerated edges are not much separated,
while the surfaces present a granular appearance.  But little blood
is met with in the laceration ;  it is commonly found effused in the
lower [tart of the cavity of the peritoneum, or in the holloAv of the
pelvis, and is only in part coagulated.  Ruptures of the liver, unless
they run far backwards and involve  the vena cava or portal A7ein,
are not in general attended with any considerable effusion of blood;
but the bleeding, should  this vessel  be implicated, is sufficient to
cause the instant destruction of life.  Under other circumstances, a
person may surviATe some-hours, as the blood may escape only slowly,
or it may be suddenly effused in fatal quantity after some hours or
days, as a result of violent exertion or  of fresh violence applied to
the abdomen.  Ruptures  of the liver generally7 prove  fatal  Avithin
forty-eight hours.  One case has been related in which  the person
survived for eight days ; and a case occurred to Dr. Wilks in Avhich
a person in Guy's Hospital survived  this  serious accident ten days.
  Wounds and ruptures of the gall-bladder are necessarily attended 
360            RUPTURES OF THE BLADDER.
with the effusion of bile.  This irritant fluid finds its w7ay into the
cavity of the abdomen, and the person dies from peritonitis.
  Rupture of the spleen.—Rupture of the  spleen  may occur either
from violence or disease ; and it would appear that a slight degree of
violence may in some cases cause a rupture of this organ, Avithout
any marks of injury appearing externally.
  Rupture of the kidneys.—The  kidneys are occasionally ruptured
from violence ;  but this appears to be a rare accident.  A rupture
of the kidney  may be produced without causing any prominent
symptoms, and prove fatal in a feAv hours.   It may be remarked
generally that  ruptures  of  the liver, spleen and kidneys, unless
attended with immediate and copious bleeding, are not inconsistent
with  a person  having the power to move and  Avalk.   In a case
which occurred at Guy's Hospital, a man had retained the power
of walking for  some  distance, although on inspection after death,
one kidney was found torn in halves from an accident.
  Ruptures and wounds of the intestines.—Ruptures of the intestines
sometimes occur from disease; and,  in a case of rupture alleged to
have been produced by violence, we must always take this possible
objection to our opinion into account.  The ruptured part of  the
bowel should be carefully examined, in order to see whether there
are any signs of ulceration or softening about it.  If not, and there
is clear evidence of violence having been used, it is  impossible to
admit this speculative  objection.  If Avith the  proof of violence
there should  also be a diseased condition of the bowel, we  may be
required to say whether this  did not create a greater  liability to
rupture—a point which must be generally conceded.
  Punctured wounds, Avhich merely touch the boAvels without lay-
ing open the cavity,  are liable to cause death by peritonitis. These
injuries to the  intestines sometimes  destroy life by shock;  there is
but little blood effused, and the Avounded person dies before perito-
nitis can be set up.  Severe Avounds  to the intestines may, however,
be inflicted almost without the consciousness of the individual, and
 he wounded person  may be able to Avalk a considerable distance.
(" Med. Gaz." vol. 46, p. 24.)
   Wounds  and ruptures of the stomach.—Wounds and ruptures of
the stomach  may cause death by shock ; ruptures commonly give
rise to severe pain, which of itself is sufficient to  bring about rapid
dissolution.   It is proper to state, hoAvever, that  the  stomach may
be ruptured from spontaneous causes, as in cases  of ulceration as a
result of disease ; but sometimes there is no morbid cause apparent.
  Ruptures of the bladder.—This injury, w7hich  has on several occa-
sions given rise to medico-legal  discussion,- is frequently the  result
of blows on the lower part of the abdomen.   The principal ques-
tions in reference to  the accident are:  Was the rupture the result
of Avilful violence, or of an accidental fall ? or did it  proceed from
spontaneous  causes,  as from over-distension ?  The spot in AArhich
rupture commonly takes place is in the upper and back  part, where
the bladder is  covered by the peritoneum.  The aperture is some-
times large, at others small; but the effect is that the urine is effused, 
RUPTURES OF  THE BLADDER.            361
and death takes place sooner or later, from peritoneal inflammation.
It is commonly stateel that ruptures, Avhen attended Avith extrava-
sation of urine into the peritoneal  cavity, are uniformly fatal;  but
if the rupture occurs in the under part of the bladder, or the urine
finds its way into the cellular tissue, the medical opinion is not so
unfavorable.  The  usual period at w7hich death occurs from this
accident is in from three to seven days; but Mr. Ellis met with a
case in Avhich the person did not die until the fifteenth day.  The
eause of death is obviously peritoneal inflammation; but a person
may die suddenly from this injury, as a simple result of shock.
  When ruptures of the bladder are produceel by blows, they are
rarely accompanied by marks of ecchymosis, or of injury to the skin.
Thus,* then, there may be no means of extinguishing, by external
examination, wliether a  rupture Avas really due to violence or to
spontaneous causes. They  who are  unacquainted w7ith this fact,
might be disposed  to refer the rupture to disease, on the supposition
that violence should ahvays be  indicated by some visible external
injury ; but there  are numerous cases on record Avhich show that
this vieAv is erroneous.
  As an attempt may be made, in cases in Avhich death has resulted
from this injury, to refer rupture of this organ to natural causes, it
may be observed that this is an unusual  occurrence;  a rupture  ia
almost ahvays the  result of violence directly  applied to the part
while the organ is  in a distended state.  A spontaneous rupture may,
however, occur:  1. When there is paralysis, Avith a Avant of power
to expel the urine; 2.  When the bladder is ulcerated or othenvise
diseased;   3. When there is  an obstruction in the  urethra from
stricture or other  causes.  The causes of spontaneous rupture are
easily recognizable  by  ascertaining the previous condition of the
deceased, or examining  the bladder and  urethra after death.  If a
man Avere in good  health prior to being struck ; if he suddenly felt
intense pain, could  not pass his urine afterAvards, 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 othenvise
in a healthy condition, there can be no doubt that the Woav must
have  been  the sole  cause of rupture and death.  In such a case, to
attribute  the rupture to  spontaneous or natural causes would be
equal to denying all kind of causation.  As to the absence of marks
of violence externally, this would be a difficulty only to those Avho
had not  previously made themselves acquainted  Avith the facts
attending this and other accidents affecting the viscera of the ab-
domen (p. 265).  Xevertheless, a medical Avitness must be prepared
to hear the same line of defence continually brought fonA7ard, as it
is always the object of  a counsel to make the best of  a case for the
prisoner.   With medical facts,  opinions and doctrines he does not
concern himself, so long as they do not serve  his purpose.  A dis-
eased state of the  bladder might  probably diminish the responsi-
bility of an accused person for the  consequences ;  therefore the
state of this organ  should be  closely looked to on  these occasions.
A distended state of the organ can be no mitigatory circumstance, 
362         WOUNDS  OF  THE  GENITAL ORGANS.

since it is only when the bladder is in this condition  that rupture
is  liable  to  occur.  This can hardly  be regarded as an abnormal
condition of the organ.  An accidental fall forwards  over  a hard
surface Avhen the bladder is distended Avith urine may lead to rup-
ture.   The person generally experiences intense  pain in the lower
part of the  abdomen, and  there is an inability to pass  the urine.
Although a man is liable to be  rendered powerless on  sustaining
a rupture of the bladder from a heavy bloAV or fall, there are several
well-authenticated cases on record which prove that a man may
walk some distance, and move about even for two or three hours
afterwards.
  In punctured and incised Avounds of the bladder, the urine is im-
mediately extravasated, but in gunshot wounds, the extravasation
does not commonly take place until  the  sloughs have  separated.
Thus,  life may be protracted longer in cases of gunshot than under
other Avounds of the bladder. For the discovery of  extravasated
liquids or blood,  in  wounds  and other injuries to the  abdominal
viscera, we must look to the cavity of the pelvis, as it is here that,
for obvious  reasons, such liquids have a tendency to collect.
   Wounds of the genitcd organs.—Wounds of these organs do not
often   require the  attention of  a medical jurist;  such wounds,
whether in  the  male or female, may, hoAvever, prove fatal to life
by excessive bleeding.   Self-castration or mutilation  is sometimes
observed among  male lunatics and idiots.  When timely assistance
is rendered, a fatal  result  may be averted.   Incised,  lacerated, or
even contused wounds  on  the female genitals may prove fatal by
loss of blood, not from the wound involving any large  vessel, but
from the numerous small vessels  which are divided.  When deeply
incised wounds are  inflicted upon the genital organs of  either sex,
the fact of their  existence  in such a situation, at once proves wilful
and deliberate malice  on  the part of the assailant.  Accident is
wholly out  of the  question, and suicide  is improbable, except in
cases of confirmed idiocy and lunacy.  Such  Avounds  require to be
carefully  examined ; for the proof of the kind of wound, when
fatal,  may  be tantamount to a  proof of murder.   A practitioner
may be sometimes required to determine  whether wounds affecting
the female  organs  have resulted from  accident, have been self-
inflicted, or inflicted by others with  homicidal intention.   The re-
marks elseAAdiere made on the  subject  of  imputed  wounds will
apply to cases of  this description.  [In the  Oyer and Terminer of
Meigs  County, Ohio, February  Term, 1866,  Mary  Broderick was
indicted for having caused  the death of her  husband  by " pur-
posely and maliciously with her right hand  grasping and wrench-
ing the penis of  the said Patrick Broderick with intent to inflict a
mortal wound;  by means Avhereof,  the urethra, with the  corpus
spongiosum and corpus cavernosum, was  broken  and  severed, and
from  the effects thereof the said Patrick Broderick died on the
eleventh day thereafter."   The defendant Avas found guilty  of man-
slaughter by the jury.   A motion for a new trial was  made, Avhich
had not, Avhen the case was reported, been disposed of.  See " Cm- 
FRACTURES — CAUSES.
363
cinnati Journal of Medicine," July,  1866, p. 316, where this case
is reported, together with instancesof similar injury resulting from
accident, in an article by Dr. Geo. C. Blackman.—P.]
  Contused wounds on the female genitals may prove fatal, by the
laceration of parts leading to great loss of blood.  Several trials
for manslaughter have  taken place,  in  which this Avas proved to
have been the cause of death.  There may be such a loss of blood
in these cases as to destroy  life, although no large bloodvessel  is
implicated in the injury.  A contused wound  on the vuh7a may
occasionally present an ambiguous appearance, and be mistaken for
an incised Avound.   When the soft parts of the body are struck by
a bloAvor kick,  if there is a bony surface beneath, a longitudinal
rent may appear as a result of the force being received by the bone.
A kick on the vulva, or a fall on  this part, may produce a similar
injury, and unless  carefully examined may  lead  to  the inference
that a weapon has been used for its  production.  It is Avell knoAvn
that some females are subject to frequent discharges of blood from
the genital organs from natural causes.  When the bleeeling imme-
diately  follows  a bloAv,  and the woman has  not been subject to
such a  discharge, the fair  presumption  is that  violence Avas the
cause:  but when the Aoav of blooel appears only a long time after
the alleged violence, of Avhich  no traces can  be seen,  it is  most
probably due to natural causes.
  It may be alleged in defence, that  the  injuries found on the
body Avere inflicted after death, and  not while the deceased was
living.  Kicks  or  blows on  the vulva, if they destroy life at all,
cause  death  by copious effusion of blood.  Violence to this part
after death wTould not produce such  an eft'usion as Avould account
for death.  There are also  other  distinguishing characters, which
have been elseAvhere pointed out.
                 CHAPTER  XXXIII.

fractures.—produced by a blow avith a weapon  or by a fall.—■
  brittleness of the bones.--fractures  caused by slight muscu-
  lar exertion.—in the living and dead body.—has a bone ever
  been fractured ?--locomotion.—dislocation.—from violence or
  natural causes.—medical opinions.--actions for 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 
364              SPONTANEOUS FRACTURES.
blow, whether by the use of a weapon or not.   It  is obvious that
the answers must be regulated  by the  circumstances of each  case.
In examining a fracture, it is important to determine, if possible,
whether a weapon has or has not been  used, and this may be some-
times ascertained by the state  of  the  parts.  It is a common de-
fence, on these occasions, to attribute the fracture to an accidental
fall.  Fractures more readily occur from equal degrees of force in
the old, than in the young, and in the  young  rather than in the
adult; because it is at the adult period of life that the bones pos-
sess their  maximum degree of firmness and solidity.  The  bones
of aged persons are sometimes very brittle, and slight  violence will
then produce fracture.  This has been regarded as  an extenuating
circumstance, Avhen the fracture  produced by a slight  blow was
followed by death.   Certain  diseases, such as  syphilis, arthritis,
cancer, scurvy and rachitis, render bones more  fragile ;  but  they
are sometimes preternaturally brittle in apparently healthy persons,
and this brittleness appears to  be  hereditary.  In such cases, a de-
fence might fairly rest upon an abnormal condition  of the bones, if
the violence producing the fracture  wras slight.  Several  trials
have taken place in wdiich this brittleness  of the bones became a
subject of inquiry.  In a case of fractured skull leading to  death
from  inflammation of the brain, it Avas proved that the bones of
the skull were occasionally thin and brittle, and this led to a miti-
gation of punishment.  The orbitar plate of the  frontal bone is
very thin, and it may be fractured by a bloAV on the eye.  Death
may,  under these circumstances, result from inflammation of the
brain.
  Spontaneous fractures.—In a case in which there is no appearance
of disease, a fracture may be ascribed to spontaneous causes.  Thus
bones have been fractured by moderate muscular  exertion.   The
elbow (olecranon), heel-bone (os calcis), and knee-pan (patella) are
particularly exposed to this accident.   The long bones are seldom
the subject of an accident of this kind; but the arm (os humeri) in
a healthy man has been broken by the simple muscular exertion of
throwing  a cricket-ball.  (" Medical  Gazette," vol. 16, 659.)  Mr.
May reports the case of a young  lady, who fractured the neck of
the scapula by  suddenly throwing a necklace  round  her  neck.
(" Med.  Gaz.," Oct. 1842.)  In July, 1858, a gentleman, set. 40, was
in the act of boAvling at cricket,  when  on delivering the ball  he
and some bystanders heard distinctly a sharp crack like the break-
ing of a dry piece of  Avood.  He fell to the ground  as  if he had
been shot.   The thigh-bone was found to be fractured, and evidently
from  muscular exertion only.   Xo person can meet  with an acci-
dent of this kind without being  instantly conscious of it.   It is
probable that in these instances, if there were any opportunity of
examining  the bone,  it would  be  found to have undergone  some
chemical change in its composition, Avhich had rendered it brittle.
In fractures arising from this cause there w7ill be no abrasion  of the
skin,  nor any appearance to indicate that a blow has  been struck;
while the marks of a  blow Avould, of course, remove all idea  of the 
RECENT AND  OLD FRACTURES.            365
fracture having had a spontaneous origin.  It is most unusual that
the ribs should  be fractured from muscular exertion; but a case
occurred to Dr. Groninger, which shoAvs that this accident  may
really occur.  It is only of medico-legal importance, inasmuch as
the injury  might be ascribed to violence:  but the absence of any
external appearance indicative of a blow Avould render it probable
that this was not the cause.
  Fractures are not dangerous to life, unless, when of a compound
nature, and they occur in old persons, or in those who are debilitated
by disease or dissipated habits.   They may then cause death by in-
ducing irritative fevers, erysipelas, gangrene, tetanus, pyaemia, or
delirium tremens.
  Fractures in the living and dead body.—It is  not  always easy to
say whether a fracture has been produced before, or after death.   A
fracture produced shortly after death, while the body is warm, and
another produced shortly before death, will present similar charac-
ters, except that in the former case there might be less blood eff'used.
A fracture  caused  ten or twelve hours before death would be indi-
cated by a copious effusion of blood into the surrounding parts and
between the fractured edges of  the bones, as Avell as by the lacera-
tion of the muscles; or if for a longer period before death, there
may be the  marks of inflammation.  Fractures caused several hours
after death  are not accompanied by an effusion of blood.  A medical
witness may be  asked, How long  did the deceased survive after
receiving the fracture ?  This is a question which  can be decided
only by an  examination of the  fractured part.   Unless the person
has survived eighteen or twenty-four hours, there are commonly no
appreciable changes.   After this  time, lymph  is poured out from
the surrounding structures.  This slowly becomes  hard  from  the
deposition of phosphate of lime, and forms what is called a " callus."
In the process of time, the callus acquires all  the hardness of  the
original bone.   The death of a person may take place during these
changes, and a medical  man may then  have to state  the period at
Avhich the  fracture probably happened, in order to  connect  the
violence with the  act of a  particular person.  Unfortunately7, we
have no satisfactory data, if Ave except the extreme stages of this
process of repair, upon which to ground an opinion.   We can say
whether a person lived for a Jong or a short  time after receiving a
fracture, but to specify  the exact time is clearly7 impossible;  since
this process of restoration in bone varies according to age, constitu-
tion,  and  many other  circumstances.   In  young  persons, bones
unite rapidly, in the old, slowly; in the diseased and unhealthy, the
process of union is sIoav, and sometimes does not take place at all.
In those who are at the  time affected with a  mortal disease there is
no attempt at reparation.   According to Villerme', the  callus as-
sumes a cartilaginous structure in from sixteen to twenty-five days;
and  it becomes  ossified  in  a period varying from three weeks to
three months.  It  requires, however, a period of from six to eight
months  for  the  callus to acquire  all the hardness, firmness, and
power of resisting shocks possessed by the original bone.    A force 
366
DISLOCATIONS.
applied to a recently united bone will break it through the callus
or bond of union, Avhile after the period stated, the bone Avill break
as readily through  any other part.   It is generally assumed, that
the period  required for the  union of a simple fracture, is, for the
thigh-bone, six  weeks, for the tibia (leg), five weeks; for the os
humeri (arm), four  weeks ; and for the ulna and radius (forearm),
three weeks; for the ribs about the same period:  but cases  have
been  known in which the ribs had not perfectly united  in tAvo
months, and in some fractures of the other bones, it was found that
union had not taken  place in four months.   In a case Avhich oc-
curred to Dr. Reid, a fracture of the tibia, the principal bone of the
leg, healed in three Aveeks.
  Has a bone ever been fractured ?—This question is sometimes put
in reference to the living body.  It is well known that a bone seldom
unites so evenly that the point of ossific union is not indicated by a
node  or projection.   Some bones are so exposed as to be well placed
for this examination, as the radius,  the clavicle, and tibia—these
being but little  covered by skin; in  others the detection is  diffi-
cult.   It is impossible for us to say when  the fracture took place;
it may have been for six months or six years—as, after the former
period, the bone undergoes no perceptible  change.  These facts are
of importance in relation to the dead is well as to the living; since
they will enable us to answer questions respecting the identity of
skeletons found  under suspicious circumstances:  and here medical
evidence may take a wider range, for a fracture in any bone may be
discovered, if not by external examination, at least by sawing the
bone longitudinally through the suspected broken part, when, should
the suspicion be correct, the  bony shell will be found thicker and
less regular in the situation of the united fracture than in the other
parts.  So, in such  cases, it will be easy to say whether a fracture
is recent or of old standing.
  Locomotion.—With respect to the power of locomotion after a frac-
ture, it may be observed, that when the injury is in the arm or  in
the ribs—unless many of the ribs are broken or the fractures are on
both sides—a jferson may be able to move about, although he is un-
fitted for struggling or making great exertion.  Fractures of the
leg generally incapacitate persons from moving except  to short
distances.

                         Dislocations.

  Dislocations are not frequent in  the old or in those persons whose
bones are brittle.   They rarely form  a subject for  medico-legal in-
vestigation.  A witness is liable  to be asked,  what degree of force,
and acting in which direction, would produce a dislocation—ques-
tions not difficult to ansAver.   They are not dangerous to life, unless
of a compound nature, when death may take place from secondary
causes.  A dislocation which has occurred in the living body  may be
known after death by a laceration of the soft parts in  the neighbor-
hood of the joint, and by the copious eff'usion and coagulation of 
         DETECTION  OF FRACTURES — MALAPRAXIS.     367

blood.   If of old standing, a dislocation would be identified by the
cicatrices in surrounding structures.  Dislocations may occur from
natural causes, as from  disease and destruction of the ligaments in a
joint;  also from violent muscular spasm  during an  epileptic con-
vulsion.   Dr. Dymock met with an instance of dislocation of the
shoulder fonvards during puerperal convulsions.  ("Ed. Med. and
Surg. Journal," April, 1843 ;  see also " Lancet," April, 1845, p. 440.)
A [toAver of locomotion may exist, except when the injury is in the
lower limbs ; but  it has been observed, that for some time after a
dislocation of the  hip-joint, considerable  power  over the limb re-
mains ; it is only after a fe\v hours that the limb becomes fixed in
one position.   Exertion with  the dislocated member is in all cases
out of the question.
  Detection of fractures.  (Malapraxis.)—There are certain fractures
of an obscure kind Avhich closely resemble  dislocations.  This has
been pointed out  by Sir A. Cooper, in relation to fractures of the
anatomical neck of the os humeri (arm-bone).  (" Guy's Hosp. Rep."
No. 9. p. 272.)  This accident might easily be mistaken for a dislo-
cation of the shoulder.  (" Med. Gaz." vol. 36, 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
Burgeon, and heavy damages recovered.   It  could only be by a dis-
section of the part  after death that the real nature of the case Avould
be ascertained.   It is requisite, therefore, that great  caution should
be used in giving an opinion.  The same observations apply to frac-
tures of the neck of the thigh-bone, although Avith less force, because
this  is a more common accident.   It is Avell known  that fractures
and  dislocations, when cured, are often attended Avith  some slight
deformity of the limb, or Avith some impairment of its functions.  This
result is occasionally inevitable under the best treatment; but it is
commonly set dowui as a sign of unskilfulness in the medical attend-
ant.  An action for malapraxis is instituted, and in spite of good evi-
dence in his favor, the surgeon is sometimes heavily fined for a result
Avhich 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 competeut medical  tribunal, which alone  should be em-
powered to decide whether  or  not unskilfulness had  really been
shown in the management of a case.  The system of allowing each
party to select his OAvn medical Avitnesses invariably  leads to a con-
flict of opinion and evidence.
   [It should not be forgotten that shortening of the leg frequently
occurs after severe contusion of the hip, without any fmcture, arising
from interstitial absorption of the neck of the femur.  This is well
illustrated by Mr.  Gulliver, in "Edin. Med.  Journ." vol. xlvi. 1836 ;
also  by Sir J. Paget, in "Brit. Med. Journ." Feb. 19, 1870.   This
accident has given  rise to an action for  alleged malapraxis.  See
" Philadelphia Med. Times," Dec. 1, 1870.—R.]
  [The proof of ordinary care and skill and judgment exercised in
the treatment of a case is a sufficient defence in laAV against a claim
for damages on account of alleged malpractice;  but  it is too  apt to 
368
GUNSHOT WOUNDS.
fail Avith the juries in this country, and will not protect the victim
of a prosecution from its attendant expenses.   Although our judges,
in many instances, have done their best to secure just verdicts, the
juries are notoriously stupid and unjust; so that the only real secu-
rity to the attending surgeon is an indemnity bond against all con-
sequent prosecution, to  be previously assumed by the patient.—II.]
                   CHAPTER XXXIV.

 GUNSHOT WOUNDS.—IN THE LIVING  AND DEAD BODY.—WAS THE PIECE
   FIRED NEAR, OR  FROM A DISTANCE ?--ACCIDENTAL, SUICIDAL, OR HOM-
   ICIDAL WOUNDS.—POSITION OF THE AVOUNDED PERSON WHEN SHOT.—
   WOUNDS FROM SMALL SHOT.—WOUNDS FROM WADDING AND GUNPOAVDER.

   Gunshot wounds are of the contused kind, but they differ from
 other Avounds in the fact that the vitality of the parts  struck by
 the projectile is destroyed, and this leads ultimately to a process of
 sloughing.
   The medico-legal questions which arise out of gunshot wounds,
 are similar to those Avhich have been examined in relation to other
' wounds.   They are dangerous to life, especially when they penetrate
 or traverse any of the great cavities of the body.   Death may take
 place directly, either from loss of blood or from shock ; although
 immeeliate or copious bleeding is not a common  character of these
 injuries.   Death from  shock is occasionally witnessed.  Indirectly,
 these wounds are attended with much  danger; sloughing generally
 takes place uniformly throughout the whole of the parts perforated,
 and inflammation or fatal bleeding may cut short life.  If the person
 survives the first  effects, he may die at  almost any period from sup-
 purative fever, erysipelas, gangrene, or from the results of operations
 absolutely required for his treatment.   Gunshot  wounds may thus
 destroy life after  long periods of time.
   A medical Avitness 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 eff'usion of
 blood and the  formation of coagula will indicate that the person
 was living when  it was received.  If  a gunshot w7ound has been
 produced  in a dead body, no blood will be  effused unless the bullet
 strikes a large vein.
    Was the piece fired near, or from a distance ?—A gunshot wound
 produced  by the muzzle of a piece being placed near to the surface
 of the body, has the following character:  There  may be tAvo aper-
 tures, the one of entrance and the other of exit;  but it sometimes
 happens that the  bullet lodges and does not pass out.  The edges
 of the aperture of entrance are  generally torn and lacerated, and
 appear blackened, as if they had been burnt;  this  arises from the 
GUNSHOT AVOUNDS.                  369
heat and flame of the gunpoAvder at the moment of explosion.  The
skin is often ecchymosed, and is much discolored  by the  poAvder;
the clothes covering the body are blackened by the discharge, and
sometimes ignited by the flame.  If the muzzle of  the piece was
not  in  immediate contact with the  part struck,  the wound is
rounded; but if there has been direct  contact, the skin, besides
being burnt, is torn and  much lacerated.  The bleeding is usually
slight, and Avhen it occurs it is more commonly observed from  the
orifice of exit than from  that of entrance.   It should be remarkeel
that the aperture of entrance is round only when the bullet strikes
point blank, or nearly so.  If it should strike obliquely, the orifice
Avill have more or less of an oval or valvular form; and by an ob-
servation of this kind Ave may sometimes  determine the  relative
position of the assailant Avith respect  to  a wounded  person.  Sup-
posing the  bullet to haA7e been fired from a moderate distance,  but
so near as to have had sufficient momentum to traverse the body,
then the appearance of the  wound will be different.  The  orifice of
entrance Avill be  well defined, round or oval, according to  the  cir-
cumstances—the skin slightly depressed—the edges presenting a
faintly bruised appearance; but the surrounding parts are neither
blackened nor burnt, and they do not present  any  marks of bleed-
ing.  In these cases the  orifice of exit is large, irregular, the edges
someAvhat everted, and the skin lacerated,  but free  from  any  ap-
pearances of blackness or burning;  it  is generally three  or four
times as large as the entrance-aperture.   The orifice  of entrance is,
howrever, generally large  and irregular Avhen the bullet strikes near
the extremity of its range.   [Surgical authorities  generally assert
that the entrance-orifice is somewhat smaller than  the exit-orifice.
Prof. Casper, hoAvever, declares that the former is always the larger,
adding that " all the more recent original  observers very  properly
unite in this conclusion,  Avhich is the opposite of  that which  Avas
formerly maintained."—R.]   Under common circumstances,   the
entrance-aperture may have the appearance  of being smaller than
the projectile, owing to the elasticity of the living skin.   ("Ann.
d'Hyg." 1839, t. 2, p.  319.)   It is the  same with  the aperture in
the dress, Avhen this is formed of an elastic material.  According
to Dupuytren, the hole in the dress is always  smaller than that
made by a bullet in the skin.  These points should be remembered
in fitting projectiles to wTounds Avhich they are  supposed  to have
produced.
  The question  whether  a piece was fired near to, or at a distance
from, the Avounded person, may be of some importance either on a
charge of homicide, or of  alleged suicide.  Two persons may quarrel,
one having a loaded weapon in his hand, Avhich  he may allege to
have been accidentally discharged, and to have killed the deceased.
If the allegation is true, we ought to find on the body the mark*
of a near Avound; if, hoAvever, its characters were such that it  had
obviously been produced  from a distance, and therefore after the
quarrel, medical  proof of  the  fact might imply malice, and involve
the accused in a  charge of murder.  It has been  said that when a 
370    SUICIDAL OR HOMICIDAL GUNSHOT  WOUNDS.

bullet is fired near, it commonly traverses the body ; and therefore
it  has  been rather  hastily assumed, that when  there  is only one
external wound, and the bullet  has lodged in the body, this is a
proof that the piece has been fired from a distance.  This inference
is, however, erroneous.  A bullet may be fired close to a person and
yet not traverse the body, either from its impulsive force not being
sufficiently great, or from its meeting a great resistance in its course.
Many cases might be cited to shoAV that in the  near wounds  pro-
duced by suicides and murderers, the bullets have not always tra-
versed  the  body7.  In suicide, when the piece is discharged into the
mouth, the projectile often lodges in some part of the head.  It is
not in  the poAver of a witness to say, from the mere fact of a bullet
lodging or  traversing, whether the assassin was far off or near, at
the time the deceased was w7ounded.  The latter point may be some-
times readily determined by the marks of injury and burning about
the skin and dress.   When a gun or pistol is discharged at the dis-
tance of three or four yards from the person, it will not, of course,
produce those marks of blackening, burning  and bruising on the
skin which are found when the muzzle is within a few inches of the
body.  A wound which does not  present these  appearances may
remove the suspicion of suicide, and create a strong presumption
of homicide.  Dr. Lachese found  that  in  firing a gun at the dis-
tance of four feet, the skin was only partially blackened.  It would
be very important in a case of this kind to notice the direction of
the wound, as well as the relative position of the assailant and as-
sailed, as stated by witnesses, or deduced from circumstances.
   When a ball traverses the body, it sometimes  happens  that the
two apertures  are opposite to each other, although the  ball may
not have taken a rectilinear course betAveen them, but have been
variously deflected  by the subjacent soft parts.   This deflection of
a ball  from a rectilinear course is met with in those cases in which
it happens to strike obliquely a curved surface, and it is found that
when the ball enters and does not pass  out, its course is often cir-
cuitous, so that it  is not always easy to say in what part of the
body it will be found.
   A witness may be asked—When was the gunshot wound inflicted,
and how long did  the wounded person survive  after receiving it ?
Like other wounds, a gunshot wound undergoes no change for eight
or ten hours after its infliction.  Our judgment in reference to these
questions may be assisted by observing the parts which are involved,
although we cannot always infer from the quantity of blood found
near the body that the bleeding was  an immediate consequence of
the wound, or that the whole of the blood was effused at once.  We
cannot, then, always affirm that the deceased could not have moved
or exerted himself in some degree, after  receiving it.   The exertion
thus made  subsequently to  his being wounded may have actually
caused the fatal bleeding.
   Suicidal, or homicidal gunshot  wounds.—When  it  is  doubtful
whether the wound was the result of suicide or homicide, the point
may be sometimes determined by  paying attention to its situation 
WOUNDS  FROM  SMALL-SHOT.
371
and direction.  Suicided gunshot wounds are almost always directed
to a vital part—to the heart or to the brain.   They possess those
characters which belong to wounds inflicted near to the body: the
skin is discolored or burnt; the wound wide and lacerated; the hand
Avhich discharged the weapon often blackened, and sometimes  still
grasping the pistol.   The ball may or  may not  have traversed, as
this will depend on the momentum which it derived from the charge,
and the resistance that it experienced.
  Accidental gunshot Avounds bear the  characters of near wounds ;
they may touch vital parts, but, if the body has not been disturbed',
the presence or absence of design  in the infliction  of  a wound is
commonly made apparent by the relative position of the body and
the  Aveapon.  They frequently arise  from persons  drawing  the
charges of guns or pistols with the muzzle pointed  towards them,
and  they are then situated in front; at other times they are  pro-
duced by persons pulling towards them  through hedges,  or dragging
after them, loaded guns.  In the latter case "the wound is behincf,
and  it may strongly  resemble a  homicidal wound, although  the
circumstances under which the body is found generally suffice to
explain the matter.   (See " Ann.  d'Hyg." 1860, t. 1, p. 443.)   In
suicide, there is commonly strong  evidence of  design;  in accident,
all  evidence of design is wanting.   Suicides  sometimes make use
of extraordinary weapons, or use weapons  in an extraordinary
manner.
  Position of the wounded person when shot.—Did the deceased receive
the shot while standing, falling, or lying down?  Was the piece,
when discharged, pointed from the shoulder?  These questions can
only be answered by reference to  the  particular  circumstances of
the case.  In general,  when a person is shot Avhile standing, and the
piece is pointed from the shoulder,  the wound is more or less trans-
verse ; but due allowance must be  made for the deflection of balls
after penetration.  Was the deceased shot Avhile running away, or
when approaching the person av!io fired  ?  This  question is answered
by observing, in the case of a traversing wound, in Avhich alone any
difficulty can arise, whether the entrance-orifice be situated in front
or behind.
  Wounds from small-shot.—Death is sometimes occasioned by small-
shot ; and here several medico-legal  questions present  themselves.
Small-shot may  act in twTo ways:  1. It either strikes  without
spreading, in which case the discharge is  ahvays near  the person,
and its action  is much more dangerous than that of a single ball,
because it produces  extensive  lacerations; or 2.  It strikes after it
has  spread, and here the discharge must have been distant and com-
paratively little mischief is done. Dr. Lachese ascertained, by many
experiments on dead bodies, that  in  order to produce with small-
shot, a round  opening somewhat  resembling  that produced by  a
bullet, the discharge should take place  point-blank at the distance
of about ten or tAvelve inches from  the surface of the body.  When
the elistance was from twelve to eighteen  inches, the opening made
was irregular, and the borders were much lacerated; at thirty-six 
372    WOUNDS FROM  WADDING  AND GUNPOWDER.

inches, a central opening Avas entirely lost, and the surface of the
body was  covered with shot,  The effect after this was found to
depend on the distance, the goodness of the gun, and the strength
of the charge  (" Ann. d'Hyg." 1836, p. 386); but the shot is, in
general, much scattered over the surface of the body.  ^ From these
results we may form an opinion of the distance at which the piece
was fired.
  It is difficult to conceive that small-shot can, under any circum-
stances, produce  a single entrance-wound, having some appearance
of circularity about it, without at the same time singeing or burn-
ing the skin or dress.  The difficulty of laying down any general rules
respecting the wounds produced by small-shot at their  entrance and
exit, Avill  be apparent from the following facts, communicated to
me recently by two medical  gentlemen. A boy was  shot  in the
neck by the accidental discharge of his gun, loaded with an ounce
of Xo. 8 shot. He died instantly. He w7as leaning forwards on the
muzzle, so that it was nearly in contact with the skin of the neck.
A large round hole was produced, one inch and a half in diameter,
the edges of which wTere slightly blackened with powder. The exit-
aperture which was at  the back of the neck,  a little to the  left of
the third cervical vertebra, was a mere slit in the skin, scarcely an
inch long, with  the  long diameter placed vertically.  The small-
ness of this aperture may ha\Te been owing to  the greater part of
the charge being lodged in  that body.  The entrance-aperture,
although rounded, was too large to be mistaken for a bullet-wound;
it was evidently a near wound, from the blackening of the edges.
On the other hand, Dr. LoAve informs me that in some experiments
performed" by his brother, it was found that a round aperture might
be produced by a discharge of small-shot at a much greater distance
from the object than that assigned by Dr. Lachese. Admitting such
exceptional instances, and assuming the general correctness of the
inference drawn by Dr. Lachese, from the results of his experiments
in discharging  small-shot  at dead bodies placed at different dis-
tances, it does not seem probable that a wound from small-shot can,
under any circumstances, be mistaken for one produced by a leaden
bullet.  A dicharge of small-shot,  in contact with the skin or close
to it, will however produce, not a round opening, but a severe lace-
rated wound.
   Small-shot is rarely observed to traverse the  body entirely unless
discharged so near as to make a clean round opening; but a single
pellet reaching the body may destroy life.  There may be no exit-
aperture, or it may be smaller than that of entrance.  Such  minute
wounds might be easily overlooked in the examination of  a dead
body.  Small-shot, even when Avounding only the skin of the back
superficially, 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 gun loaded with w7adding,
or even with gunpowder only, may cause death.  In these cases, an
impulsive force is given by the explosion, and the substance becomes 
        WOUNDS  FROM  WADDING AND GUNPOAVDER.    373

a dangerous projectile.  The lighter the projectile—the shorter the
distance to which  it is carried; but when discharged near to the
body, it may produce a fatal penetrating Avound.  A portion of the
dress may be carried into the Avound, and lead to death from bleed-
ing; or if the wounded person recover from the first effects, he may
subsequently sink  under  an attack of tetanus or  erysipelas.  It  is
unfortunate that so much ignorance prevails on this point; for fatal
accidents frequently occur from persons discharging guns at others
in sport—an act which they think they may perform Avithout danger,
because they are not loaded with ball or shot.
  It has been observed, that persons in attempting to commit suicide
have occasionally forgotten  to put a bullet into the pistol; never-
theless, the discharge of a piece into the mouth has sufficed, from the
effect of the wadding only, to produce a considerable destruction of
parts, and to cause a serious loss of blood.   Fatal accidents have
frequently taken place from the discharge of Avadding from cannon
during  reviews.  It is not easy to  say at Avhat distance a weapon
thus charged Avith  Avadding and poAvder would cease to produce mis-
chief, since this must depend on the impulsive force given by the
poAvder, and on the size of the piece.   Dr. Lachese has ascertained
by experiment, that a piece charged Avith gunpoAvder, is capable  of
producing a penetrating wound somewhat resembling that caused by
small-shot, Avhen the piece is large, strongly charged, and fired Avithin
six inches of the surface of the body.  (" Ann. d'H}Tg." 1836, p. 368.)
This arises from a  portion of the poAvder ahvays escaping combus-
tion at the time of discharge, and each grain then acts like a pellet
of small-shot.   Under any  circumstances, a  discharge of  powder
only contuses the skin, producing ecchymosis, and often lacerating
it, if the piece be fired near.  The dress is burnt and the skin scorched
from the globe of flame formed by the combustion of the poAvder;
many particles of gunpoAvder may be actually driven into the true
skin.   All the substances here spoken of  are considered to be pro-
jectiles ; and the weapons are helel in laAV to be loaeled 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 distauce at Avhich  these light projectiles
cease to be harmless.  The ansAA7er must  be  governed by  circum-
stances; but it will in all cases materially depend on the strength  of
the charge.  Dr. Swift, U. S., has performed some experiments with
a pistol  loaded Avith gunpowder and wadding,  in order to determine
the effect of discharges at different distances.  At twelve inches dis-
tance from a dead body, he found that the clothes Avere lacerated and
the skin abraded, but the Avadding did not  penetrate; at six inches,
the clothes Avere lacerated, and the Avadding penetrated to the depth
of half an inch ; at two inches, the wound produced, Avhich was two
inches deep, AA'as ragged and blackened; at one anel a half inch from
the chest, the Avadding passed into the cavity between the ribs, and
in a second experiment it carried aAvay a portion of a rib.   (" Med.
Gaz." vol. 40, p. 734.)  These results confirm those obtained by Dr.
Lachese. 
374      IDENTITY FROM FLASH OF  GUNPOWDER.

  Identity from the flash of gunpowder.—Among the singular questions
which have arisen out of this subject is the folloAviug: Whether the
person who fires a gun or pistol at another during a dark night can
be identified by means of the light produced in the discharge?  This
question was first referred to the class of Physical Sciences in France,
in 1809, and they answered it  in the negative.  A case tending to
show that their decision was erroneous Avas  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 enabled to identify the prisoner.
This  statement was confirmed by  the deposition of the -wounded
party. Desgranges, of Lyons, performed many experiments on this
subject, and he concluded  that  on a dark night, and away from
every source of light, the person who fired the gun might be iden-
tified within a moderate distance.   If the flash Avas  very strong,
the smoke very dense, and  the distance great, the person firing the
piece could not be identified.  The question  was  raised in this
country, in the  case of  Reg.  v. White, at the Croydon  Autumn
Assizes, 1839.  A gentleman was  shot at AAdiile driving  home in
his gig during a dark night; he was wounded in the elbow.  When
he observed the flash of the gun, he saw that the piece w7as levelled
towards  him, and the  light of the flash enabled him  to recognize
at once the features of  the  accused.  In cross-examination he said
he Avas quite sure he could see the prisoner, and that  he was  not
mistaken as to his identity.   The accused was skilfully defended,
and he was acquitted.   Evidence of this  kind has, how7ever, been
received  in an English  Court of Law. A similar case was tried at
the Lewes Lent Assizes, 1862  (Reg. v. Stapley).   The prisoner shot
at the prosecutor, a  gamekeeper, on a dark evening in December,
and the latter swore  that he distinctly saw the prisoner by the flash
of the gun, and could identify him by the  light on  his features.
His evidence was corroborated by three other witnesses, who saw
him not  far from the spot, and by one who saw him in the  act of
running  away. He was convicted.   A case is quoted by Paris and
Fonblanque (Rex v. Haines), in which some police-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  remarkable shape in the
head and shoulders, and that he had since identified the horse at a
stable in London. He also perceived, by the  same flash of light,
that the person had on a rough brown great-coat.  This evidence
was considered to be satisfactory.
   From  the information Avhich I have been able to collect on this
point, it appears to me there can be no doubt that an assailant may
be thus occasionally  identified.  It is widely different, however, in
respect to the following case  referred  to by Mfiller, in his " Phy-
siology," namely, Avhere a man declared that he recognized a robber
through the  light produce by a bloAV on his eye  in the dark!   As
Miiller observes, this is a clear impossibility, because the flashes
thus perceived are  unattended with the emission  of light,  and 
BURNS AND  SCALDS.
375
therefore can never be visible to any other person than the subject
of them, and it is not possible that they can ever make other objects
visible.  (For  some remarks on this subject by Dr. Schilbach, see
Henke's " Zeitschrift der S. A." 1842, 1,197.)  Dr. Krugelstein has
lately opposed the inference deduced by Miiller, and has  supported
his  vieAvs by  cases, Avhich, however, do  not  appear to  me  to be
satisfactory.  (Henke's " Zeitschrift der S. A." 1845, 3,172.)
  Examination of fire-arms.—An attempt has been made by French
medical jurists to determine for how7 long a period a gun or  pistol
found near a dead body, may have been discharged; but it  is out
of our poAver to lay doAvn any precise rules on such a subject.  All
that we can say is, a quantity of sulphide of potassium, mixed with
charcoal, is left  adhering to the  barrel of the piece, when recently
discharged; and this is indicated by its forming a strong alkaline
solution with Avater, evolving an odor of sulphuretted hydrogen, and
giving a deep-brown precipitate Avith a solution of acetate of lead.
After some hours or days, according to the degree of exposure to
air and moisture, the saline residue becomes converted into sulphate
of potash, forming a neutral solution with water, and giving a  white
precipitate  with  acetate of lead.  If a considerable time has elapsed
since the piece was discharged, Oxide of iron Avith traces of sulphate
may be found.  (See "Ann. d'Hyg." 1834, 458; 1839, 107;  1842,
368.)
                   CHAPTER XXXV.

DEATH FROM  BURNS  AND  SCALDS.— SYMPTOMS.—STUPOR.— CAUSE  OF
  DEATH.—POST-MORTEM APPEARANCES.—BURNS ON THE  DEAD BODY.—
  ACCIDENT, HOMICIDE, OR SUICIDE.--AVOUNDS CAUSED BY  FIRE.—SCALD-
  ING.—BURNS BY CORROSIVE LIQUIDS.

  Burns and scalds.—A burn is an injury produced by the  applica-
tion of a heated substance to the surface of the  body;  AA7hile a scald
results from the application of a liquid at or near its boiling point,
under the  same  circumstances.   There seems to be no real distinc-
tion betAveen a burn and a scald in reference to  the effects produced
on the body ; the injury resulting from boiling mercury or melted
lead might take either appellation.   Xevertheless as a matter of
medical evidence, it may be important to  state  Avhether the injury
found on a body was  caused  by such a liquid as  boiling water, or
by a heated solid.  If the former, the injury might be  ascribed to
accident; if the latter, to criminal design.   A scald  produced  by
boiling Avater would be indicated by a sodden state of the skin and
flesh, but there Avould be no  destruction of substance.  In  a burn
by a heated solid, the parts may be more or less destroyed, or even
charred ;  the cuticle may be found blackened,  dry, almost of a
horny consistency, and presenting a shrivelled appearance.  This 
376          CAUSE  OF DEATH —APPEARANCES.

distinction, however, AA'Ould only apply to  scalds from Avater.  A
scald from melted lead (620°) could not be distinguished from a
burn produced by a solid heated to the same  temperature.  Some
of the oils boil at 500°, and they produce by contact  with the
skin, burns as severe as those caused by  melted  metals.   Burns
from flame such as that of gas are indicated by extensive scorching
of the skin, while burns from gunpowder are  known not only by
the scorching, but by  the small particles of unburnt carbon Avhich
are imbedded in the skin.
  Xeither a burn nor a scald appears to be considered as a wound
in laAV;  but in the statute of wounding they7 are included among
bodily injuries dangerous to life.  Burns and scalds may be regarded
as dangerous in proportion  to the extent of surface (of skin) Avhich
they cover, as Avell as the depth to which they extend.   The extent
of surface involved in a superficial burn, as a result of exposure to
flame, is of  greater importance  than the entire destruction of a
small part of the body through an intensely heated solid.   When
the burn is extensive, death may ensue either from the severity of
the pain produced, or from a sympathetic shock to  the nervous
system.   Death  takes place rapidly from  burns, in children  and
nen7ous females ;  but in adults  and old persons, there is  a better
chance of recovery.
   Cause of death.—In  some instances, especially in children, stupor
and insensibility have rapidly supervened, owing to sympathy Avith
the brain ; and these  symptoms  have been followed by coma  and
death.  Of the cause of death in persons exposed to fire, but little
need be said. In large conflagrations persons are frequently simply
suffocated, from the want  of proper air or the respiration of the
products of combustion—carbonic  acid or carbonic oxide.   The
former darkens  the blood  ; the latter renders it lighter in color.
In other cases, where a large volume of flame suddenly falls upon
the body and the person is still able to breathe, the fatal effect may
be due to shock—a sudden and violent impression on the nervous
system.   A person may recover from the first effects of severe burns,
but ultimately sink from exhaustion or from an attack of tetanus.
(" Med.  Times and Gaz.," April 26, 1854, p. 406.)
   Post-mortem appearances.—In  examining the body of a  person
found burnt, all matters connected  with sex and identity should be
first duly observed.  Dr. Griinbaum has reported a case in which
he was required to examine certain carbonized remains in Avhich, in
spite of the destruction of  the sexual organs, he was able to deter-
mine the sex.  (Horn's " Vierteljahrshrift," Oct. 1864.)   When a
body has been entirely consumed  by fire,  the presence of a large
quantity of phosphate of lime in the ashes would indicate animal
remains.  The bones are never completely destroyed ; they become
white, and portions of them retain their form under the action of
a most intense fire.
   When death  has been caused by severe pain, no changes have
been detected in the dead body;  but, in some fatal cases, it has been
found on inspection that there were patches of redness on the bron- 
        BURNS  ON  THE LIVING AND  DEAD  BODY.      377

chial mucous membrane, as Avell as on the alimentary canal.   The
brain has been found gorged, anel the ventricles have contained an
abundance of serosity.  The serous liquids of the pericardium and
pleura  have also been in  larger quantity than natural.   In short,
besides congestion, there is generally abundant serous effusion in
one of  the three great cavities, especially in the head.  This arises
from the sudden reflux of blood into the interior, as an effect of the
local injury.  In death from fires in houses, the persons are usually
suffocated, and there are the appearances of this kind of death (see
Suffocation).  In a case in Avhich a Avoman died on the thirteenth
day from a superficial burn involving the skin of the loAver part of
her body, the stomach was found inflamed at its greater extremity,
and the duodenum at its  lower portion—the  mucous folds of the
intestines ha\Te a scarlet color.  The other intestines as far as the
caecum, Avere also  more or less inflamed.  ("Amer. Jour.  Med. Sci-
ences," Jan. 1861, p. 137.)   If  the person survives the first effects,
he may die  from  inflammation, suppuration, gangrene, irritation,
or fever, or he may be worn out bj7 exhaustion.
  Did  the burning take place before or after death?—Vesication.—The
production of vesication or of blisters containing serum, is commonly
regarded as an essential character  of a  burn which has been  pro-
duced during life, but it is not a necessary or  invariable effect of a
burn on the living body. Vesication is especially observed in scalds,
or in those cases in which the skin has been burnt  by flame or by
the ignition of the clothes, provided the cuticle has not been de-
stroyed.  It is not so commonly observeel in burns produced  by
intensely heated  solids.  In vesication,  the cuticle is raised from
the true skin beneath, and is converted into one or more blisters
containing serum or a serous liquid, Avhile the skin around is of a
deep-red color.  It is uncertain as to the time at which it  appears ;
it may be produced in a few minutes, or sometimes not for several
hours ; hence death may take place before vesication occurs, and the
nou-discovery of this condition does not Avarrant the opinion that
the burn could not have taken  place during life.   If the  cuticle is
removed from a vesicated  part of the living body, the skin beneath
will become intensely reddened, but if the cuticle is stripped off a
dead body, the skin will become hard, dry, and  of a horny-yelloAV
color;  it does not acquire the  intense scarlet injection  Avhich is
acquired by  the living skin Avhen vesicated and exposed.
  In cases in AAThich persons, Avhile living, have suffered  from gen-
eral dropsy,  it has been found, on the application  of heat to their
bodies after  death, blisters containing serum or a serous liquid have
been formed; hence, in drawing a conclusion from the examination
of burns on the body of a person affected Avith general dropsy, it is
necessary to be cautious.  In such cases  it would not be  possible,
from the mere presence of serous blisters, to say whether  the burn
took place before  or after death.  The late Dr. Wright found in his
experiments  on the dead body, that if a sufficient heat Avere applied
to Avithin  half an hour or longer after death, blisters containing
serum Avere sooner or later produced.  In short, as long as the body 
378      BURNS ON THE  LIVING AND DEAD  BODY.

was AA7arm and the joints -were flexible, the effects of fire AA-ere simi-
lar to those observed on the living.  Other experimentalists have
found that blisters were produced, but  they did not contain serum.
The result no doubt depends on the time after death at which  the
experiment is performed.
  Accident has enabled me  to describe the results within  a very
short period after death.  The body of a drowned man, within a fe\v
minutes after the accident, Avas removed from the Avater and placed
in a AATarm (hot?) bath.  It Avas found impossible to resuscitate him,
but owing to the great heat, of the water, portions of the  cuticle
came off, Avhen the body Avas removed.  On inspection there Avere
several vesications filled with bloody serum  over a considerable  por-
tion of the skin, especially of the extremities.   There was  no ana-
sarca here to account  for their production; and the fact of their
occurrence appears to bear  out the view  of Dr. Wright, that  the
production of a serous blister on a dead body depends on the amount
of latent organic life remaining in it.   In this  case the man was
pulseless, and to all appearance dead, when placed in the hot bath ;
hence the effects of hot water on the living and recently dead body,
so far as the production of serous blisters is concerned, are  similar.
Dr. Chambers has lately published the results of numerous experi-
ments on the effects of burns on the living and dead body.  These
have been made on the bodies of persons, from the moment of death
until  twenty  hours  after dissolution, and some were  performed
before death.  The general results of his researches are—that vesi-
cations, or blisters, may be produced by burns both on the living
and dead  bod}7;  that they are produced at a lower temperature in
the living than in the  dead; that in the living a burn produces
great capillary congestion, with the eft'usion of serum in the blis-
ters, and that this serum Avhen heated with nitric acid, sets into a
nearly solid coagulum.  The blisters produced in a dead body, even
a feAv minutes after death, contain a thin watery serum, which is
only rendered opaline or milky by heat  and the action of nitric
acid.  ("Ann. d'Hyg.," 1859, vol. 1, p. 342.)   When the  body is
cold and rigid, blisters containing air or vapor alone are produced.
  In burns, especially in those produced  by red-hot solids, other
effects besides vesication follow7.   The  edge of the skin immedi-
ately around the part burnt is commonly of a dead white, and close
to this is a deep red line, gradually shaded off into the surrounding
skin, which is reddened. The diffused redness is removable by pres-
sure, and disappears with life; the red line here referred to, Iioav-
ever, is  not removable by pressure, and  is persistent after death.
This line of redness is not always met with in severe  burns, and
when a person survives  one  or two days, its production appears to
depend  upon a power of reaction  in the  system.   Thus  then, its
absence furnishes no proof of the burn having been produced after
death, for it is not a  necessary accompaniment  of  a  burn  during
life.   Dr. Wright considered that in a Ioav state of vitality, a line
of redness might not  be produced by a severe burn on the living 
           ACCIDENTAL AND  HOMICIDAL BURNS.        379

body, and that more certain  reliance may be placed on the red
marks found beneath the blisters and crusts of vital burns.  These
latter Avere Avell marked when he found the line  of redness itself
indistinct.  (Op. cit., p. 25.)    The researches of  Dr. Chambert
confirm  this view.  In  a burn on  a living person, if the  skin has
not been entirely charred and destroyed, the cutis will present a
dotted or pointed redness—these dots or  points  corresponding to
the sudiparous (perspiratory), and hair-follicles.   After complete
death, a burn does not produce any such  effect;  the cutis is of a
dead-white on its surface and in  its substance.  In one experiment
performed ten minutes after death, there w7as no redness of the skin,
either beneath the blisters or in the surrounding parts.  ("Ann.
d'Hyg.," 1859, vol. l,p. 368.)  This reddened or congested state of
the bare skin is more constant than any other appearance, and forms
at present the best criterion of the infliction of a burn on the living
body.  The conclusions which, it appears to me, we may draw from
the foregoing statements, are: 1. That, as a general rule, when we
discover blisters  with  effusion of  serum, or a  line of redness, or
both, and a reddened or congested  state of the skin about a burnt
part of the body, we are justified  in saying  that the burn has oc-
curred during life.  2. That when these appearances are not met
with, it  by no means follows that the burn had not been produced
in the living body.
  When several burns are found  on a dead body,  it may be a ques-
tion whether  they were all produced at the same time.  This is a
point which can  be determined  only by observing whether  any of
them present signs of gangrenous separation, of suppuration,  granu-
lation, or other changes that take place in a living body after acci-
dents of this kind.  The Avitness may be  asked, Hoav 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 inelicate Avhen death actually
took place.   There may have been no time for inflammation or its
consequences to become established.  Suppuration generally follows
vesication, and in severe cases, it may occur on the second or third
day ; but often not until a later period.   In regard to gangrene,
this takes place when the vitality of a part  burned is destroyed.
The  time of  its  occurrence is uncertain,  but  it sometimes very
speedily folloAvs the accident.
  The subject of scalding scarcely  requires a separate notice.  A
scald from boiling Avater would, Avhen recent, be  indicated  by the
production of serous blisters, or  a sodden  state  of the skin,  which
appears Avhite and soft.   The living structures  are not charred or
destroyed as by the application of a red-hot solid.
  Accident, homicide, or suicide.—It is  rare that  murder is  perpe-
trated by burning; the dead body is either burnt  for the purpose of
entirely  destroying it, or the clothes are fired soon after a  person
has been killed, in order to conceal wounds or other violent  means
of death, and to  make it appear as if the deceased had been acci- 
380        ALLEGED  SPONTANEOUS  COMBUSTION.

dentally destroyed by fire.  Deatli by burning is either the resnlt of
accident or homicide, most  commonly the  former;  but medical
evidence may give rise to a suspicion of murder under two circum-
stances :  1.  When it is evident that  several parts of the body have
been fired at the same time, and the burns are such as not_ readily
to be explained by the same accident, or by the accidental ignition
of the clothes; 2. When there are marks of homicidal violence on
the body; but these marks, if we except fractures of the bones, may
be easily effaced when the burn is  extensive.
   Time required for the burning of a dead body.—It may be a medico-
legal question whether, on discovering a body much burnt, it could
be determined from its appearance Iioav long a period it would re-
quire to produce the amount of destruction observed.   An ans\A7er
to such a question may be necessary, in order to connect  a person
Avith the perpetration of an  alleged crime, but the question does
not admit of a precise answer.  A conjecture only can be formed
from the facts  proved in each particular  case.  The  human  body
contains a large proportion of Avater (72 per cent.); this  gives to
the soft structures a power of resisting combustion.   At the  same
time there is a quantity of  fat in the body, varying  in different
parts, but amounting to an average of about five per cent.  The fat
or oil tends  to increase its combustibility, and this is still further
increased if  the body is placed on any combustible article Avhich
can imbibe the oil, such as  a rug  or  deal floor.   The nature of the
dress will also make a difference.   Under a strong and active flame,
Avhich  might subsequently burn  out before  the eliscovery of the
body, there would be a degree of destruction in half an hour which
a more slow and smothered combustion would not effect in several
hours.
  It is from a  want of due consideration of these facts that some of
the older medico-legal writers have given support to the hypothesis
of spontaneous combustion.  It  has been supposed that'in certain cases
the dead body has been more destroyed than seemed consistent with
the fact of ordinary combustion from articles  of dress or furniture ;
but this arose from waut of  sufficient experience on  the effects of
heat on the body.  Then, as the  means by  which the dress of a
person  had become ignited were generally destroyed with the body,
it was thought that a human being might, under certain conditions,
be consumed by fire spontaneously  generated  Avithin him.   This
extravagant hypothesis, Avhich is on  a par with the belief in witch-
craft, and requires an  equal amount  of credulity to receive it, has,
however, found advocates in modern  times. In March, 1850, a man
named Stauff Avas tried at Darmstadt for the murder of the Countess
of Goerlitz.  He had assaulted the deceased  in  her chamber, and
then set fire to the furniture with a vieAv to conceal his crime.  The
body and dress Avere partially consumed.  As the means by which
the fire was  applied were not at once apparent, and the assassin had
locked the doors of the room, some medical men took up the theory
that the deceased had died from spontaneous combustion. 
      INJURIES PRODUCED BY CORROSIVE LIQUIDS.   381

  The facts of the case were referred to Prof. Liebig and Bischoff,
of Giessen ; and  their report Avas issued in March, 1850, at which
date the man Stauff'was put on his trial.   They found no difficulty
in concluding that a murder had been perpetrated, and  the body
wilfully burnt after death for the purpose  of concealing the crime.
There was some doubt Avhether the deceased had died from strangu-
lation, or from violence to the head.   Stauff Avas convicted chiefly
upon circumstantial evidence.  He subsequently confessed that the
Countess had entered her room as he Avas in the act of committing
a robbery.  A struggle  took place;  he seized  her by the throat,
strangled her, and afterwards placed the body in a  chair, piling
around it combustible  articles of furniture.  He set fire to  these
with the view of destroying the proofs of his crime.  It was observed
that  the tongue of the deceased  was  protruded, as it is in violent
strangulation, and that in its charred state it retained the position
given to it by the act of murder.   Other instances  of alleged spon-
taneous  combustion, if properly investigated, would  have turned
out to be cases of accidental, or homicidal  burning.
  Spontaneous combustion  may  take  place in some kinds of vege-
table and  mineral substances,  but not in  the animal body, living
or dead.
  Corrosive liquids.—Among the cases in  which medical evidence
is sometimes  required,  are  those  of throwing mineral acids, alka-
lies,  or other corrosive  liquids  on the person.   This  crime was at
one time prevalent, and until the recent alteration in the criminal
law there was no adequate punishment for it (24 & 25 Vict. c. 100,
s. 29).  On one occasion an assailant escaped  a charge of felony,
because it could not be  considered, in  laAv, that sulphuric acid was
capable of producing a  wound—the  man  having been indicted for
Avounding!  This case clearly  showed a strong necessity for some
legal definition of a wound, as Avell as the uncertainty of medical
opinions ;  for while one  surgeon considered that  the injury pro-
duced AA7as a wound, another thought that  it Avas not.  The judges
decided that it Avas not a wound  Avithin the meaning of the Act.
The statute above mentioned, while it punishes the offence, omits
all reference  to  a definition  of the word wound.   The nature of
the liquid thrown is merely defined, in general  terms, to be " any
corrosive fluid or  any destructive  substance"—a point which will
require medical evidence for its elucidation.
  In common language, and according to the  statute, the injury
thus  produced by  a mineral acid such as  oil of vitriol, is called a
burn, but it is Avholly different in its origin, as Avell as in its pro-
gress. I do not know that there has been a single instance in wdiich
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 broAvn when sulphuric acid has been used, and yellow 
382    INJURIES  PRODUCED  BY  CORROSIVE LIQUIDS.

when nitric or muriatic acid has been employed.   The eschar or
destroyed part is  soft  and not dry  as  in a burn  from a heated
solid.  The skin touched by a concentrated acid is  destroyed and
sloughs away, to the extent of the part on which  the corrosive
liquid was applied, leaving a suppurating and granulating surface.
There is no  capillary congestion  or redness  of the skin around
the injury as  in a burn ; but the  color  of the injured part may
throw some light upon the nature of the  corrosive substance used.
Thus, while oil of vitriol (sulphuric acid) produces  dark-brown
stains, aqua-fortis  (nitric acid)  produces yellow or yelloAAr-brown
stains on the skin.  Articles of dress are also  differently colored
by these acids.  The period at which a person may recover from
an injury of this kind depends on its degree and extent, as well as
on the part affected by the corrosive liquid.   Although a person
may not die from  the direct effects of the acid, yet in certain irri-
table constitutions the inflammation Avhich follows in deep-seated
parts may prove fatal.  In infants, or delicate  nervous females, an
extensive injury thus produced  may readily destroy life.  In one
instance, sulphuric acid thrown  on the face produced inflammation
of the eye, for which bleeding was prescribed.   The person died of
phlebitis (inflammation of the vein), as the result of this bleeding.
The nature of the acid may be determined by applying wetted
linen  to the  part when  the injury is recent, and  examining the
liquid thus absorbed.  In general, however, evidence is readily ob-
tained by examining the spots or stains left on  articles of clothing
or furniture.  Oil  of vitriol is most commonly  used.  The caustic
alkalies may be used under these circumstances, as  well as numer-
ous  other  liquids, on-which the only  medical opinion required
would be, w7hether the  article employed  should or  should not be
considered as a corrosive liquid  or a destructive substance.  To
constitute a felony, it is not now necessary that the person should
have  sustained, from  the  act  of  throwing,  any  bodily  injury.
Unless vital reaction has taken place, there are no means of dis-
tinguishing  the  effects of a corrosive liquid  on the living from
those produced on the dead body.   (" Ann. d'Hyg.," 1859, vol. 1, p.

  The mineral acids are sometimes  used  in other ways for the de-
struction  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 her ear, which
continued  for three days, whereby she became weak  and exhausted.
Soon afterwards there w7as copious bleeding, and a portion of mem-
brane escaped.  She lost  the use of her right arm, and became
completely deaf.   Suppuration  took place from the ear, and blood
escaped daily.  She gradually sank, and  died  six weeks  after the
injury, the right  half of the body  being convulsed before death.
On inspection, a portion of the  external  ear was wanting, and the
ear passage was much  wider than natural.  The brain,  near the
petrous portion of the temporal bone, was softened, and the bone 
      INJURIES  PRODUCED BY CORROSIVE LIQUIDS.   333

itself diseased (carious).  The injury had led to death indirectly
by producing disease of the brain.  (" Med. Gaz." vol. 17, p. 89.)
  In a case tried at Aberdeen, the evidence proved that a Avoman
had poured oil of vitriol doAvn the throat of her husband, while he
Avas lying asleep Avith his mouth open.  She was convicted of the
murder.  In a more recent  case, a woman  killed her husband  by
pouring a solution of corrosive sublimate down his throat while he
was sleeping.  These, however, Avere treated as cases of poisoning,
as death did not depend on the local or external mischief produced
by the corrosive agent employed. 
384
•   DEATH  FROM  DROWNING.
ASPHYXIA.
DROWNING.
                  CHAPTER XXXVI.

CAUSE OF DEATH.—SECONDARY CAUSES.—POST-MORTEM APPEARANCES.
  —MEDICAL PROOFS OF DEATH FROM DROAVN1NG.—SPECIFIC GRAVITY OF
  THE BODY.—CO-INCIDENTAL CAUSES OF DEATH.—MARKS OF VIOLENCE.
  —ACCIDENTAL FRACTURES.—HOMICIDAL AND SUICIDAL DROWNING.

  Under the  term Asphyxia or Apnoea are included those forms of
violent death in which the act of respiration is primarily arrested
(p. 58).  These comprise death  from drowning, hanging, strangula-
tion and suffocation; and in this section, the fatal effects of light-
ning, cold and starvation will be considered.
  Asphyxia is induced in drowning  owing to a  physical impedi-
ment to the introduction of air into the lungs.  The  medium in
which  the person is  immersed acts  mechanically, and even more
effectually than a rope or ligature round the neck ; for although air
escapes  from the lungs, and water penetrates into the minute air-
tubes, y7et no  air can  enter to supply the place of that Avhich has
already expended its oxygen on the blood.  Hence, this fluid must
circulate, in the first feAv minutes after submersion, in a state un-
fitted for the support of life (unaerated);  but the person lives, and
is susceptible of recovery Avithin a short interval.  After the entire
suspension of respiration, the action of the heart gradually slackens,
and finally stops.   It  is at  this period of the arrest of circulation
that asphyxia  passes  into death.  Asphyxia is determined  by the
period at which respiration is completely arrested ; but the point of
time at  Avhich death from drowning occurs, is  fixed by the moment
at which the action of the heart ceases.   This varies considerably,
according to age, sex, state of health, and other circumstances.
  When a person falls into water, and retains his consciousness,
violent attempts are made to breathe ; at each time that he rises to
the surface a portion of air is received into the lungs, but, owing to
the mouth being on a  level Avith the liquid, water also enters and
passes into the throat,   A quantity of Avater thus usually enters the
mouth,  Avhich the  droAvning  person is irresistibly compelled to 
DROWNING — CAUSE  OF  DEATH.
385
swallow.   In his efforts to breath wdiile his head is beloAv Avater,
a portion of this liquid is  drawn into the air-tubes and cells of the
lungs.  The struggle for life may continue  for a longer or shorter
period, according to  the age, sex and strength of the person; but
the result is that the blood in the lungs is  imperfectly aerated, the
person  becomes exhausted, and insensibility follows.   The mouth
then sinks altogether below the level of the water ; air can no longer
enter into the lungs; a portion of that which they contain is expelled,
and  rises in bubbles  to the surface;  an   indiscribable feeling of
delirium, with a ringing sensation in the ears, supervenes; the per-
son loses all consciousness, and sinks asphyxiated.  In the state of
asphyxia, while  the  dark-colored blood is circulated,  convulsive
movements of the body take place, and the  contents of the stomach
are sometimes ejected by  vomiting.   There does not appear to be
any  sensation of pain,  and, as in other cases of asphyxia, if the
person recover, there is a total unconsciousness of suffering during
the period when the access of air was cut off from the lungs.   Some
persons Avho fall into water  are observed to sink at once, without
making any attempt to extricate themselves.  This may arise either
from sudden syncope, or  from the  stunning produced by the fall.
Should the person be  intoxicated, or otherwise incapacitated, as by
striking his head in falling, he may not again rise. These different
conditions  under  which  death  may take place will  sufficiently
account for  the difference  in the appearances met with in the bodies
of those Avho have died in water.  A fatal result may be accelerated
by the impression  suddenly produced upon  the skin, from the diffe-
rence of temperature  betAveen the body and  the Avater.   To those
who are not accustomed to water, a sudden immersion produces a
great and rapid cooling of the surface, and forces the blood into the
internal organs.  There is difficulty of breathing, or severe spas-
modic  respiration, Avith  giddiness and other symptoms, which may
render a person powerless to extricate himself.   The effect of cold
on the skin  is seen in the contracted state of the cutis in the bodies
of those avIio have been droAvned during the winter.  It is calculated
that in 25 per cent, of all av!io are drowned, the cause of death is
pure asphyxia, and that  in the remainder, syncope and cerebral con-
gestion amounting to apoplexy may have a share in causing death.
   In regard to the time required for death to take place by drown-
ing, it  may be observed that wrhen the mouth is. so covered by water
that air cannot enter, asphyxia comes on in the course of one or two
minutes at the farthest, and the time at which this occurs does not
appear to vary materially.  Perfect insensibility has supervened after
one minute's submersion, and it is probable that in most cases a few
seconds Avould suffice  for the commencement of asphyxia.  In this
Btate the person can make  no efforts to save himself, and death com-
monly  ensues in from two  to five minutes.   The power of restoring
life depends not merely  on the time that the body may have been
submerged,  but on the condition of the lungs at the time of its re-
moval  from the water.  Experiments lately conducted by a com-
mittee of the Medio-Chirurgical  Society have clearly proved that,
       25 
386         EFFECT OF  AVATER ON THE  LUNGS.
as a form of asphyxia, drowning is pot only more speedily fatal to
life than ordinary suffocation, but from the effects produced on the
lungs by water, the chance of recovery is lessened.
  The committee found that the difference in the results Avas not
owing to exhaustion from struggling, from the violent efforts made
to breathe, or from the effect of cold in immersing the Avhole of the
body, but to introduction of water by aspiration into  the  minute
air-tubes and cells of the lungs.   This conclusion Avas derived from
the following experiments:  Two dogs of the same  size Avere  sub-
merged at the same moment, but one had his windpipe plugged, so
that  no air or water could enter, while the other had  not.  After
two minutes they were taken out together ; the one with the wind-
pipe  pluggeel recovered at once, the other died.  In three experi-
ments dogs Avith  their windpipes plugged were  kept beloAV water
for four minutes:  the animals  recovered perfectly when removed
from  the  wrater.   (Report on  Suspended  Animation, Med.-Chir.
Trans., 1862, p. 449.)  An inspection  of the bodies at once revealed
the difference.  In animals simply deprived of air by plugging the
windpipe, the  lungs were merely congested ;  but in those which
were submerged in their ordinary condition, the lungs, besides being
more  congested and showing ecchymosed points on the surface  and
in the substance, contained in their bronchial tubes a bloody mucous
froth, formed of water, blood and mucus, which completely filled
the small air-tubes.   The respiratory efforts  made  by the  animal
before death had caused the  production of  this  froth, which
formed a  mechanical impediment to the entrance of air  by  the
movements of the chest, as in  respiration.  This mucous froth or
foam  issued from the lungs  on  section, and appeared to penetrate
their  entire substance, which was saturated AATith Avater tinged with
blood.  The lungs were sodden with water, heavy, soft, doughy,
retained an impression produced by the finger, and were incapable
of collapsing.  In the lungs of animals which  recovered  after a
short submersion, little or none of this mucous froth Avas found in
the air-cells.  In the  fatal cases, the quantity Avas great in  propor-
tion to the time of  submersion.  There is no doubt that it is pro-
duced by the violent  efforts to  breathe, which are made Avithin a
minute after submersion.
  It may be inferred from these results that the power of recovery
in human beings has  a direct relation  to the presence of mucous
froth in the  air-tubes, and to the penetration of the substance of the
lungs with water.   The larger  the amount of froth  produced  and
the greater the penetration, the less the hope of recovery; for when
the lungs have undergone  these  changes they are physically unfitted
either to receive or expel air by respiration—they are incapable of
collapsing.  These circumstances will account for the fact that per-
sons  have been resuscitated in  droAvning under  various and even
opposite modes of treatment, and even under no treatment at all.
It is  right that every reasonable  effort should be made to  restore
life, but if the lungs are sodden with water, their functions cannot
be restored by any mode of treatment.  The committee found that 
TREATMENT  OF  THE DROWNED.
387
four minutes' complete submersion effectually killed dogs, although
after removal from water, the heart continued to beat from fourto
five minutes.   The  continuance of the heart's action furnishes,
therefore, no criterion of the poAver of recovery.  A human being,
as a rule, dies if submersed for a period of from four to five minutes.
In a few exceptional cases, persons have been resuscitated after this
period, but it is most probable that in these the lungs had sustained
no damage.
   Treatment.—The facts above mentioned  have a close relation to
the treatment of the drowned.  The subject is hardly of a medico-
legal  nature, but  occasionally questions have  arisen  at  coroners'
inquest  in reference to the propriety of the treatment adopted by a
medical practitioner.  When it is stated that  conflicting  methods
have been apparently equally successful, it will be preceived that
there  is great difficulty  in making a selection or laying down rules.
Artificial inflation of the  lungs appears a priori to be the proper
plan for resuscitation.   The late Dr. Woolley, who  had  consider-
able experience  in treating  the drowned, informed  me that, as a
rule, he had seen no  benefit from the introduction of air  by artifi-
cial processes (see " Med. Gaz." vol. 17, p. 663), and that the warm
bath (at 100°),  Avith frictions to the skin, had been  in his hands
the most successful means of treatment. When some signs of ani-
mation Avere not elicited by  the Avarm bath, there Avas but little
hope of  any other plan succeeding.  Artificial inflation in some
form  is  iioav, hoAvever, generally  employed,  in addition  to the
application of Avarmth and stimulating frictions to the skin.  The
committee of the  Medico-Chirurgical  Society,  discarding  the use
of apparatus which  is rarely at hand when most required, recom-
mends the method of inflating the lungs suggested by Dr. Silvester,
" in which the action of  the pectoral  and other muscles passing
from the shoulders to the parietes of the chest  in deep inspiration,
is imitated."  This plan has  been  adopted by the Royal  Humane
Society.   The committee have demonstrated by experiment that it
is superior to the method recommended by the late Dr. Marshall
Hall, inasmuch as  it commences with the act of inspiration, Avhile
the latter begins with expiration, and  it more completely fills and
empties the air-cells of the lungs:   1.  Remove from the neck and
chest all articles of clothing;  2. Wipe  the body dry, and cover it
with dry cloths; 3.  Clear the nostrils, mouth, and  throat of all
mucous froth, or of substances likely to interfere with  free respi-
ration :  pull forward the  tongue, and keep it in this position so
that it may not fall back and  cover the opening of the windpipe;
4. Place the body at full length with the face downwards,  the fore-
head resting on one  arm: this is for the  purpose of allowing all
fluids  to floAv  readily out of the  mouth;  5. Ammonia, aromatic
vinegar, snuff, or other stimulants, maybe cautiously applied to the
nostrils; and 6. If respiration  is not quickly restored spontaneously,
then the  body should  be placed upon its back, Avith the head
slightly  raised.   The arms should  be  gently carried outwards and
upwards from the chest, raised above the head, and maintained in 
388         DEATH  FROM SECONDARY CAUSES.
this position for about tAvo seconds.   By this moA-ement air pene-
trates into the lungs as  during the act of inspiration.   The arms
are now7 lowered and  brought closely to the  sides of the chest, by
which  expiration is effected.   Pressure on the loAver part of the
chest-bone (sternum) aids  this expiratory action.   This movement
should also  occupy two seconds.  These  alternate  movements  of
the arms may  be repeated from  twelve to  fourteen times in a
minute.   All rough  handling should be avoided.  So soon as any
spontaneous respiratory action is observed,  warmth may  be ap-
plied to the skin by the Avarm bath  or otherwise, and stimulating
frictions may be used, or  simple  frictions Avith warm flannel, etc.
Heat should be applied especially to  the region of the heart, the
loins, soles of the feet, and palms of the hands.   When  the power
of swallowing  returns,  warm water  alone or with a little brandy
as a stimulant, may be given.  The patient  should then be placed
in bed  and allowed to sleep.,
  This treatment should be persisted in for some hours, except in
those cases in  which the  body has  been long under water, and is
taken out cold  and  rigid.  In Dr. Douglas's case there Avere  no
signs of  returning animation until after the treatment had been
carried on for eight and a  half hours.   The tendency to restoration
is indicated by the occurrence of  slight flushing in the  face, with
convulsive tAvitchings in  the facial  muscles, warmth of the skin,
grasping or sobbing respiration at intervals, and sometimes convul-
sive  movements of the  body and limbs.   The unfavorable signs
are : Complete  insensibility, coldness, and paleness of the body ; no
spontaneous act of respiration; entire absence of pulsation in the
region of the heart;  the eyelids half-closed, the pupils dilated, the
lower jaw stiff, the fingers half bent  inwards, and the mouth and
nostrils  containing  mucous  froth, which is continually escaping
from them.   The chances of recovery are great in  proportion to
the shortness of the interval between the last expiratory efforts in
the state of asphyxia and exposure  to the  air.   In a  very large
proportion of  all  cases of recovery  after submersion, the act of
respiration in the form  of sobbing, sighing, or gasping commences
spontaneously  soon after  the person has  reached the air, and the
only treatment then  required is not to interfere  with this natural
action of the chest.
   Death from secondary causes.—Drowning may operate  indirectly
as the cause of death.  Thus, it has been repeatedly  remarked that
persons who have been rescued from the water in a living state, and
w7ho have apparently recovered from the effects of submersion, have
died, in  spite  of treatment, after the lapse of  some minutes or
hours; others have lingered for one or two days, and then have sunk
apparently from exhaustion.  In those who perish soon after removal
from water, death may arise either  from exhaustion or from the
obstruction  of  respiration by the penetration of  water into the
air-cells  of the lungs.   Dr. Marcet states that spasm of the glottis
has been among the severe secondary symptoms in persons Avho have
been removed from water apparently drowmed.  A severe spasm of 
       EXTERNAL appearances  after drowning.    389

this kind manifested itself in one case Avhile placing the patient in
a warm bath.  ("Med. Times and Gazette," February, 1857, p. 148.)
When death takes place at a remote  period, it may be caused by
disease ; and a question may7 thence arise, avnether the disease Avas
produced by the immersion in water or not.  Such cases occasionally
present themselves before our courts of assize.
  Post-mortem appearances.—The external and internal appearances
produced by droAvning vary according to the  length of time during
Avhich the body may have remained in Avater, and the  period that
may have elapsed after  its removal and  before it is  examined.
Thus, in reference to the bodies of two persons drowned by a com-
mon accident, if one is removed and examined immediately, and
the other is not removed from the wTater until after the  lapse of
several days, and is then inspected, the appearances will be different.
So, if the tAvo bodies are removed at the same time, and one is
immediately examined, while the other is not  inspected until a
month after removal, the proofs of drowning which may be dis-
coverable  in  the former,  will probably  have disappeared in the
latter.  A protracted exposure of the drowned body either  to water
or air, especially if the temperature is high, renders an inspection
useless for the purpose of  evidence.
  External appearances.—Supposing that the body has remained in
the Avater only a few  hours after death, and the  inspection  has
taken place immediately on its removal, the skin will be found cold
and pallid—sometimes contracted under the form of "cutis anserina."
This contracted state of the skin when found furnishes strong evi-
dence of the body having  gone into the water living.  The skin is
often  covered  to  a greater or less extent by livid  discolorations;
the face is  pale and  calm, with a  placid expression; the eyes are
half-open, the eyelids livid, and the pupils dilated; the mouth closed,
or half-open, the tongue SAVollen anel congested—frequently pushed
forwards  to the  inner surface of the lips, sometimes indented or
even lacerated by the teeth; and the lips, together with the nos-
trils, are  covered Avith a  mucous  froth  Avhich issues from  them.
Kanzler has noticed in the male subject a remarkable retraction of
the penis.   In men Avho have gone living into the water and been
drowned, this appearance  has  been repeatedly observed  by Casper
and Kanzler ; and the former states that he has not met with this
condition of the  male organ  after any other form of deatli.  In
strong and robust men it has been found short, and strongly retracted
into the skin.  (" Ger.  Leich. Oeffn." ii. 109.)
  The body and  limbs of a  person recently  droAvned are usually
found relaxed, but cadaveric rigidity appears to come on quickly
in cases of  droAvning, aud the body is often  stiffened in  the con-
vulsed or distorted attitude Avhich it  may have had at the time of
death.  In  a case observed by Mr.  Beardsley, the body of a man
Avho was droAvned under ice, Avas found \vith  the arms stiffened in
the attitude in Avhich he Avas endeavoring to support himself on the
ice.
  Among the casual external appearances, it has been noticed that 
390    INTERNAL  APPEARANCES AFTER DROWNING.

the fingers and surface of the  body occasionally present abrasions.
Gravel, sand, mud, weeds, or other substances may be found locked
within the hands or  nails of droAvned persons; for in the act of
drowning, as common experience testifies, a person will grasp at any
object within his reach, and in his effort to extricate himself, he
may excoriate or wound his fingers.   Substances floating in the
Avater  are also  sometimes  found in the nose, mouth and  ears.
There are, however, many cases of drowning in Avhich such appear-
ances do not exist.  There may be no substances for the drowning
person  to  grasp; this will depend in a great degree upon  the^ fact
of the water being deep  or  shallow, of its being confined within
a narroAV  channel or  not, and many other  contingencies. In all
cases Avhen the person is  senseless before he falls in the water, or
when his death is occasioned by syncope, he will, of course, be in-
capable of making those exertions Avhich  are necessary to the pro-
duction of this appearance;  and it is probable that this frequently
occurs among women who are accidentally  drowned.  When the
body has remained several days in wTater, the slcin of  the  palms of
the hands and soles of the feet is found thickened, white  and sod-
den, as a result of imbibition.
  Internal appearances.—In  a recently drowned body, the lungs
and  heart present the appearances usually indicative of asphyxia
(p. 58).  The venous system is generally  gorged Avith  dark-colored
liquid blood.  If death has not taken place  from asphyxia, or if
the body has remained a long time in Avater before an  inspection is
made, the lungs and heart will not present the character  about to
be described.  Some physiologists have asserted that the blood re-
mains fluid  in  the  bodies of the droAvned; but more importance
has been attached to this appearance than it really merits.  Some
observers  have found the blood coagulated in the drowned, and I
have seen  coagula, like those usually met with after death, in the
bodies of  animals which  were droAvnedfor the sake of experiment.
If the blood is found generally liquid, this may be due to the im-
bibition of water, or to putrefactive changes.   Riedell found the
blood in the heart and large vessels to contain coagula, in inspec-
tions made from two hours to five days after death. (" Med. Gaz."
vol. 46, p. 478.)  Hence  it follows  that  the blood may be found
either coagulated or uncoagulated, in those who go into the water
living, and die by drowning.
  The lungs are sometimes congested, and more generally.distended
than collapsed.  Casper and Kanzler, as  a rule, found them much
increased  in volume, and completely filling the cavity of the chest,
so that when the chest was  opened they protruded out of it; but
this did not depend on mere fulness of blood.   The most accurate
observations, show in recent cases of droAvning  that the lungs are
generally  distended and in a flabby condition.  Owing to the pene-
tration of their substance  by water,  they have  lost their  usual
elasticity, so that an impression made upon them by a finger is pre-
served,-as in an ©edematous  limb.  Riedell has pointed out this
flabby and dilated condition of the lungs as a special characteristic 
POST-MORTEM  APPEARANCES.
391
of drowning: although they floated, he found that they were three
or four times as heavy as in their natural state, owing to the Avater
in their substance.  (" Med. Gaz.," vol. 46, p. 478.)  On making a
section of any part of the lungs,  a bloody frothy liquid escapes—
air and water being mixed together in the air-cells.  These appear-
ances are only likely to be observed, in a w7ell-marked form, when
the body is examined soon after death.   The windpipe,  bronchi
and minute air-tubes of the lungs, in  a recently droAvned body, are
filled more or less Avith a mucous froth, tinged Avith  blood, as a re-
sult of the last violent efforts at respiration, Avhen the mouth has
sunk below the level of the water.  This appearance is not always
met Avith.  Thus it has not been found in the  bodies of those avIio
have sunk at once below the surface  and have not  again risen to
breathe.   But from recent experiments on animals, made by the
committee of the Medico-Chirurgical Society, its presence in the
air passage  does  not  depend on  the  fact of a person rising to the
surface—although this may increase the quantity—but rather upon
the violent spasmodic efforts made to breath, under  circumstances
in Avhich Avater alone can enter the lungs.   These  facts sIioav that
a mucous froth is produced in the air-passages even in two minutes,
Avheu there is entire submersion of the head; and   its quantity
appears to be in proportion to  the length  of submersion, and the
violence of the efforts made to  breathe.
  The presence in the air-passages of a  mucous  froth, frequently
tinged with blood, may be regarded as a characteristic of asphyxia
by drowning.  When discovered in the lungs, associated Avith a
Avatery condition  of these organs, it furnishes  a satisfactory proof
of this mode of death.  As its presence depends on the retention
of air in thin vesicles diffused through the air-tubes, it is obvious
that, except in recent inspection, i. e.,  Avithin a few hours of death,
it may have Avholly or partly disappeared.  Water passing in and
out  by  the Avindpipe  may destroy it—also the exposure of the
body to a high temperature.  This may  account for the fact that
it is  not always observed in  the inspection of the  bodies of the
droAvned, Avhen removed from water.  Violent efforts at respiration
may, however, produce it—especially if, owing to the loss of power
of swallowing, any liquid should find its way into  the Avindpipe.
Independently of the  presence of water  (sometimes mixed with
mud, sand, or AA-eeds) in the  larger air-tubes,  a portion of this
liquid  is generally drawn into the lungs by convulsive efforts at
respiration.   It fills the cells  and penetrates the substance of the
organs, giving to them the flabby or doughy consistency already
described.  In some cases the  contents  of the  stomach   may be
found in  the  Avindpipe and lungs; this occurs when a person has
been droAvned Avith a full stomach.  Vomiting takes place, and
the vomited matters are  drawn  into the lungs by the attempt to
breathe.
  The  state of the  heart in the drowned  has given rise  to some
discussion.  In death from asphyxia, the right  cavities generally
contain blood, while  the left cavities are either empty, or they 
392
POST-MORTEM  APPEARANCES.
contain much less than the right.   Out of fifty-three inspections
made by Dr. Ogston, the right cavities were found empty only in
tAvo cases, and the left cavities empty in fourteen.  (" Med. Gaz.,"
vol. 48, p. 291.)   In a case of droAvning which AA-as examined by
Mr. Bishop, the right side of the heart contained  scarcely  any
blood ; and  in another case, communicated to me December, 1857,
the only medical difficulty regarding death by drowning  presented
itself in an emptiness or  non-distension of the  right cavities of
this organ.  The facts and observations accumulated by my friend
Dr. Xorman Chevers, of the Calcutta Medical Board, show that a
full condition of the heart, although a common, is not an invariable
concomitant of asphyxia, either from drowning or any other cause.
(" Medical Jurisprudence for  India," 1856, p. 441.)  It  has  been
elsewhere remarked, that the action of the heart continues  after
the stoppage of respiration, and that the period at Avhich this organ
ceases to contract is variable.  Hence, in  some cases there may be
sufficient power in the right cavities to contract upon their contents,
and  to  expel, more or less completely, the last traces of blood
received by them from the body.   Emptiness of the right cavities
of the heart must not, therefore, be regarded as  inconsistent w7ith
death from drowning; at the same  time, it cannot be taken  as a
proof that the  person has died from asphyxia.  Dr. Riedell states
that  in half the number of instances which had fallen  under his
observation, the two  sides of the heart contained equal quantities
of blood; in the other half, the right side contained the larger
proportion.   In  one case only, the emptiness of the left  side  con-
trasted strongly  w7ith the fulness of the right.
  A greater or less  fulness of the vessels of the brain is described
as one of the appearances met with in drowning ; but this, when it
exists, is probably a consequence of a congested state of the lungs.
Some remarks have been already made on this  subject, and from
these it is evident that the state of the cerebral vessels can afford
no  presumption that  death  has taken  place by drowning.   In
regard to the cases which I have had an opportunity of examining,
the quantity of blood contained within  the  cerebral vessels has
rarely been so great as to call for particular notice.
  In  examining the abdomen, it will commonly be found that the
stomach contains Avater, wdiich appears to enter into this organ by
the act of swallowing during the struggle for life.  This may be
salt or fresh, according to the  medium in Avhich the droAvning has
taken place.  The quantity is subject to great variation ; sometimes
it is large, at other  times  small, and in  some instances no water
whatever is  to be met Avith.   The absence of water may probably
indicate a rapid death, as there could have been no power to swallow.
Orfila has remarked, that the mucous membrane of the stomach
and boAvels  is occasionally much discolored in  drowned subjects.
He observed also, that when droAvning took place Avhile the process
of digestion was going on, the mucous membrane of the stomach
often had a pinkish-red or violet tint.   When the dead body had
remained a long time in  Avater, this membrane was observed to 
SUBSTANCES  GRASPED IN  THE HANDS.       393
acquire a deep violet or broAvn color.  A knoAvledge of this fact
may be of some importance in those cases in which a person is
suspected to have been  poisoned previously to submersion.  It has
been said that the diaphragm is generally much raised towards the
chest;  but this may depend on gaseous putrefaction, and the increase
in the  size of the abdomen by the formation of gas in the intestines.
The urinary bladder in some cases contains urine; in others it is
perfectly empty.  Casper found it empty in one-half of the cases
which  he examined.  It is  obvious  that the state  in which the
bladder is found must  depend  upon  its condition  at the time  at
which  the droAvning occurred.  (See, in reference to the appearances
in the drowned, a paper by Dr. Ogston, " Med. Gaz.," vol. 47, pp.
763, 854, et seq.; also another by Dr.  Riedell, "Med.  Gaz.," vol.
46, p. 478 ; and Casper, " Ger. Leich-Oeff.," vol. 1, p. 87; 2, p. 105 ;
and " Klinische Xovellen," 1863, p. 523.)
   Was death caused by drowning?—For a correct solution of this
question, it will be  necessary to consider the appearances met Avith
in the drowned, and to determine how far they are characteristic
of this form of death.   Among  the  external  signs of droAvning,
when the  body is seen soon after death, are paleness of the surface,
a contracted state of the skin  (cutis anserina), and  the  presence of
a mucous froth  about the nostrils and lips.  The absence of these
appearances, hoAvever, would not prove that the person bad not
been drowned;  for if  the body had remained some time in water,
or if it had been long exposed to air before it was seen by a medical
man, the skin Avould undergo various changes in its condition and
color, and mucous  froth Avould  no longer be found adhering to the
nostrils and lips.
   State of the skin.—The goose-skin, or  cutis  anserina, which  is
frequently observed in the droAvned, shows that the skin possessed
the living poAver of contractility at the time of immersion. Wagner
suggests that the appearance might be produced in a dead body if
thrown into cold water immediately  after death,  i. e., Avhile the
skin is warm.   As  none but assassins Avould be likely to resort  to
this proceeding, the objection would, if admitted, leaA7e the fact  of
drowning still  to be  made out by an  internal  inspection.  This
contracted state of the skin could hardly be mistaken for a naturally
rough or horny  skin, as suggested by Casper.  ("Ger. Leich.-Oeffn."
vol.  1, p.  89.)   As  this condition of the skin is  not  invariably
present, even in the recently droAvned, and as it is observed chiefly
in drowning during cold Aveather, its absence must not be taken  to
negative the hypothesis of droAvning.
  Substances grasped in  the  hands.—Foreign substances, such  as
graA7el, dirt, Aveeds, or grass, are  sometimes found  locked within
the hand  or lodged under  the nails of drowned subjects.  This
fact may occasionally afford strong circumstantial evidence of the
manner in Avhich a person  has died.   If  materials  are  found
 rasped Avithin  the hands of the deceased which have  evidently
 een torn from the banks of a canal or river, or  from the bottom
of the Avater in  Avhich the body is found, we have strong presump- 
394
WATER IN THE STOMACH.
five evidence that the person died Avithin the Avater.  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
A7alue attached to this sign, Ave are assuming 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 occurred in any other way than by drowning.   If the
substance locked Avithin  the fingers or finger-nails is sand of the
same character as that existing at the bottom of the river or pond,
it is difficult to conceive  any stronger fact to establish death from
submersion.  The  abrasion  of  the fingers  is a circumstance of
minor importance;  no \Talue could  be attached to this  state of the
fingers as an indication of  a  person having perished by droAvning,
unless it Avere in conjunction with the appearances above described.
A witness wTould be constrained to admit in many cases, that the
fingers  might become abraded  or  excoriated after death, or even
before submersion;  while in no case  could he be called  upon to
make, in regard to substances found grasped within the hands, an
admission which Avould invalidate the  evidence deducible from
this condition.   This must then  be  regarded as a satisfactory proof
of a person having  been  alive after his body Avas in the water.  It
is well knoAvn that wdien tAvo or three are drowned  by the same
accident, they are not unfrequently found clasped within each other's
arms,—a fact Avhich at once proves that they must have been living
when submerged;  so if a dead body is discovered still holding to
a rope, cable, or oar, no further evidence is required to show that
the deceased must have died  from drowning.
  The internal appearance upon  which medical jurists chiefly rely
as proofs of this kind of death  are—first, Avater in the stomach;
and secondly, Avater with a mucous froth in the air-passages and
lungs.
  1. Water in the stomach.—Dr. Riedell found that in the majority
of cases of droAvning, water passed into the  stomach.   In  animals
previously killed, anel placed for tw7enty-four hours in water with
the mouth Avide open, no fluid penetrated to the stomach.  (" Med.
Gaz.," vol. 46, p. 478.)  Water commonly passes into the stomach
of a living animal Avhile drowning, by the act of SAA7allow7ing.  It
has been observed that when an animal is  stunned prior to sub-
mersion, Avater does not  pass into the gullet, and when  syncope
occurs, none Avill be found.  As  a proof that its entrance into this
organ depends on the act  of SAvallowing, it may be  stated that the
quantity in the stomach  is greater  Avhen  an animal is allowed to
come frequently to  the surface  and respire, than when it is main-
tained altogether below the surface.  The power of swalloAving is
immediately suspended on the occurrence of asphyxia, and in this
way we may satisfactorily 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 w7hich water is not present in
the stomach.  It was found by Dr.  Ogston, of Dundee, in five cases'
out of seven.  (" Ed. Med. and Surg. Journ.," Jan. 1837.)   Water 
WATER  IN THE AIR PASSAGES.            395
does not readily penetrate into the stomach  of a  body Avhich has
been thrown in after death ; the sides of the gullet applying them-
selves too closely to each other to allow of the passage of fluid.   It
putrefaction has advanced to any extent, some water may enter;
but a medical man may easily judge from the general state of the
body, Iioav far this process may have been concerned in the admis-
sion of fluid into the stomach and intestines.  Orfila has suggested
that water  may be  found in  the stomach of a person apparently
drowned, in consequence of this liquid  having been drunk by the
deceased, or artificially injected by another into the  stomach after
death.  It  is  difficult to conceive under Avhat circumstances the
latter objection could be made, or AA7hat  purpose it would  answer ;
hut in relying upon the presence of water in the  stomach, it may
be admitted that the  deceased may have drunk Avater  before his
body was submerged.  The mere discovery of Avater in the stomach,
except under  circumstances  to  be presently mentioned,  is not,
therefore, a necessary proof that it has been SAvallowed during the
act of drowning.
  It is of course presumed  that  the  liquid contained Avithin the
stomach is of the same  nature as that  in  which  the body is im-
mersed ; for it  is possible that fresh w7ater  may  be found in the
stomach of a person drowned in salt  Avater, and in such a case  it
would be obviously improper for a medical Avitness to affirm from
the mere presence of Avater, that the  person had died Avhere his
body was discovered.  If the water contain  mud, straAv, duckAveed,
moss,  or any substances  like these existing  in the  pond or river
where the  droAvning occurred, it  is a  proof, Avhen the inspection is
recent, of its having been swallowed  by a living person.  The ab-
sence of water from the stomach cannot, however, lead  to the in-
ference that the person  has not died  from  drowning, because  in
some instances it is not swalloAved, and in others it  may drain aAvay
and he lost  after death before an inspection is made.
  2. Water with mucous froth in the air passages and lungs.—If the
body is carefully removed from  the Avater, and is examined soon
after removal,  these appearances,  which furnish  satisfactory evi-
dence  of death from droAvning, will be found.  Dr.  Riedell regards
the presence of a mucous froth as a constant  sign of this kind of
death.  In  all  his experiments and obseiwations, he states that he
found a frothy flufd in  the  windpipe, bronchi and lungs; after
death it gradually disappears from the air-tubes by exosmosis, but
not from the lungs.   The  fluidity of  this froth is, he contends, a
distinctive character of death from drowning, and  is  not met Avith
in any other case (" Med. Gaz.," vol. 46, p.  478).  The  presence of
;i frothy fluid  would  undoubtedly  sIioav that liquid, from  some
cause, had  penetrated  into  the  air-passages; and Avhen taken in
conjunction Avith  the presence of Avater in  the substance of the
lungs, it may be considered to furnish  conclusive evidence of death
from drowning.  On  the  other hand,  its absence does not  neces-
sanly prove that a person has not died  from  this cause.   If none
is found  in  a body  recently after  death, this may have been the 
396         FOREIGN  MATTERS  IN THE  LUNGS.
result of syncope or apoplexy, and there may have been no conclu-
sive effort at breathing prior to death.   A mucous froth may not
be found when the body has remained for  a long period in the
water after death, since by the free passage of this fluid into and
out of the air-tubes,  the froth,  although  formed in the. first in-
stance, may have disappeared.  If, after removal  from  the  water,
the body "is exposed  to  the air  for  several days before it  is ex-
amined, it is rare that this appearance is seen.  The mucous froth
may have been formed in the Avindpipe, but  it may have entirely
disappeared.
  3. Water and foreign  substances in the lungs.-—It has been  else-
where stated that in the act of droAvning, water is  drawn Avith con-
siderable force into the  lungs, by violent attempts at inspiration.
The aspiratory force thus exerted by the lungs is considerable. It
has been found that when the heads of animals are plunged below
mercury, some of this fluid metal, in spite of its density, is actually
drawn into the lungs, and globules of it have been found in the air-
cells.   A fortiori, this takes  place in a greater degree with water
which is forcibly drawn into, and permeates the spongy texture of
the lungs, rendering death more rapid and recovery more difficult
than in other forms of asphyxia.   This aspiratory force of the lungs
has been measured, and  is found, in  small animals, to be equal to
raising a column of mercury four inches in  height.  Xot only is
water thus  drawn in, but sand,  mud, weeds, or other substances
floating in it, are also carried into the air-tubes and cells of the
lungs.   When the Avater  is mixed with Aveeds or  mud, and Avater
presenting the same admixture is found in the throat and stomach,
this is strong evidence  that the body has been plunged into the
medium when the power of breathing and swallowing still existed,
and hence that the deceased has  been droAvned.  All attention to
the condition of the stomach and lungs together, will therefore be
of importance in cases of alleged child-murder by  drowning, since
it may aid in proving or  disproving the charge.
  When a dead body  is thrown into water, and has remained there
some time, Avater, Avith fine particles of sand, mud, or Aveeds,  may
pass through the Avindpipe into the lungs, and there  be deposited.
Dr. Chevers, of Calcutta, was required to examine the body  of a
child found in a tank at  a distance from the  house of the parents.
The internal appearances shoAved that the child had died by drown-
ing.  The  air-passages contained green vegetable  matter, and the
right air-tube was almost completely filled with so large a portion
of an aquatic weed doubled together, that it appeared astonishing
how such a body  could  have passed  into the Avindpipe.  It Avas
proved that no Aveed of this kind greAV in the tank Avhere the body
was found.   Further inquiry led  to the discovery  that the body of
the boy had been found by a woman in a tank near his house, in
which the wreed found in the air-passages grevv abundantly.  This
female carried the corpse to the more distant tank which belonged
to a person against whom she bore  a grudge!   Water under  these
circumstances, however, does not penetrate into the substance of the 
GENERAL CONCLUSIONS.
397
lungs  as by aspirations during life, and the amount Avhich passes
through the chink of the glottis is small.   If simply an after-death
efl'ect, the Avater is found in the larger air-tubes-unaccompanied by
mucous froth.   In most cases, hoAvever, the effect  of aspiration, as a
result of living power, is so manifest, that the examiner can  have
no difficulty in forming an opinion.
  From these observations it Avill be perceived that the only char-
acters on Avhich reliance can be placed,  as medical proofs of death
from droAvning, are—first, the presence of a mucous froth in the
windpipe and air-tubes ; secondly, of Avater in the air-tubes and air-
cells of the  lungs ; and thirdly, of water in the stomach.   An early
inspection of the body may thus  enable a medical man to come to
a  satisfactory  conclusion  that death was  or  was not caused by
drowning.  The longer this inspection is  delayed, the more ambigu-
ous the evidence becomes,  since  the froth slowly disappears from
the air-tubes, Avhile water may penetrate  into the lungs and stomach.
The great cause of failure in obtaining medical proofs of droAvning
is generally the unavoidable delay before an inspection is made.
  . If, in examining a body taken from water, w7e find upon it marks
of violence, or severe internal injuries sufficient to destroy life, there
is strong ground for suspicion.  Why the body of a person who has
really died  from natural causes should  be afterwards thrown into
water, it would not be easy to explain upon any hypothesis of inno-
cence, but we  can readily appreciate the motive  when murderous
violence has been used.  After  the  lapse  of  five or six  weeks,
especially if the  body has been  removed from the  Avater for the
greater part of that period, none of the usual appearances of drown-
ing Avill be met with ;  in the present day, no practitioner would
think of seeking for evidence under such circumstances.
   In consequence of the uncertainty attendant on the appearances
of drowning, barristers have considerable advantage in cross-examin-
ing those medical witnesses Avho appear to support the theory of
the prosecution that deatli took  place from this  cause.  Legal in-
genuity is  here often strained to  the utmost, to show that there is
no certain sign of drowming, and therefore that the deceased must
have died from some other cause.  The general impression among
non-medical persons appears to  be  that, Avhether in  drowning or
suffocation, there ought to be some  particular visible change in some
part of the  body to indicate at once  the cause of death ; but it need
hardly be said  that this notion  is  founded on false vieAvs, and if
the reception of medical evidence on the cause of deatli be made to
depend on the  production of some such positive and visible change
of structure, then it would be better at once not to place the parties
charged Avith the crime upon their  trial, because it could never be
proved against  them.   A medical inference of droAvning is founded
upon a certain  series of facts, to each of wdiich, individually, it  may
be easy to  oppose plausible objections; but taken together they
furnish evidence as strong as is commonly required for proof of any
other kind  of death.
  In death  from droAvning, a question respecting the specific gravity 
   398          SPECIFIC GRAVITY  OF  THE BODY.

   of the human body may incidentally arise.   In the healthy living
   body, this is made up of the combined specific gravity of its differ-
   ent parts; so that, as in all heterogeneous  solids, it is a  complex
   quantity.  In the first place, about 72 per cent, of the weight of the
   body consists of water—hence the question  of specific gravity can
   refer only to the remaining 28 per  cent, of dry solids.  The only
   part of the body  which is lighter  than water is  fat.  The specific
   gravity of this is 0.92,  and it is calculated  that the proportion of
   fat in an adult is about five per cent, of  the weight of the body, or
   one-twentieth part.   The  specific gravity  of muscle is  1.085, of
   brain 1.04, of the soft organs generally 1.05, of the lungs containing
   air 0.94, and of bone, the heaviest part of the body, 2.01. The light-
   ness  of the fatty portions is more  than counterbalanced by the
   weight of the skeleton (about ten-and-half pounds in the male, and
   nine pounds in the female), so that the naked human  body, placed
   on water, has a slight tendency to sink.  This tendency diminishes
   just in proportion to the quantity of the body immersed ; because
   all those parts Avhich are out of water, not being supported  by water,
   become so much additional  absolute weight to the portion im-
   mersed.  Hence, the frequent cause of death by  drowning.  An
   inexperienced person exhausts himself by exertion, raises  his arms
   continually out of the  water, and  as often sinks, owing  to  their
,   weight having just so much effect on his body as if a leaden weight
   had been suddenly applied to his feet to sink him.  When the whole
   of the living body is immersed, the specific gravity, owing to the
   expansion of the chest, differs so little from that of water, that a
   very slight motion of the hands or feet Avill suffice to keep a person
   on the surface.   The head, owing to the weight of the bones of the
   skull, has always a  tendency  to sink below the level of water, and
   muscular force is required to  keep it above  the surface.  There are
   two circumstances which cause the specific gravity of the body to
   vary.  If the quantity  of fat  is proportionally large, it will be  di-
   minished ; and such a person  will float more readily than another
   in an opposite condition.   On the other  hand, a large proportion of
   bone  renders a person heavier  than his bulk of Avater,  and his body
   Avill  sink more rapidly  than that of another.  These two modifying
   causes  of buoyancy  are liable to constant variation; hence the dif-
   ferent accounts given  by  experimentalists  relative to the specific
   gravity of the  human body.  The bodies of women are, cceteris
   paribus, of less specific gravity than those of men;  the skeleton is
   smaller, and there is a  greater proportion of fat—hence they more
   readily float.  Infants  and young children  float w7ith the greatest
   ease ; the quantity of fat is usually in large proportion, and the bones
   are light—the earthy matter  being  not yet fully deposited.  Thus,
   in infanticide by drowning, the body of the child rises  very speedily
   to the  surface—if, indeed, it  does not remain altogether upon it.
     There are some other points to be considered  in  relation to  the
   buoyancy of the living  human body. 1. Respiration.—It is the fact
   of the lungs being filled with air that gives the general  lightness
   to it.  If these  organs are emptied Avhile  the face is under water 
          MARKS OF VIOLENCE ON THE DROWNED.      399

and the person cannot inhale again, the body  remains specifically
heavier than  Avater, and will sink.  Hence it  follows that, cceteris
•paribus, a person Avith a large and capacious chest floats more easily
than one Avhose chest is small and  contracted.  Hence also, in a
living  person, the body has a tendency to rise out of Avater during
inspiration, and to sink during expiration—the quantity of  AA-ater
displaced  under these two opposite conditions of the respiratory
organs  being  very different.   The entrance into water with the
chest nearly emptied as the result of a loud  scream or shriek, is
A7ery unfavorable to the buoyancy of the body.   The fact of clothes
being on the person may also make a difference—either, from their
nature, in  serving to  buoy up the  body, or from their weight to
sink it more deeply.  Women  are sometimes saved from drowning
by reason of theii\clothes floating, and thus presenting a large sur-
face to the water; it is partly owing to this circumstance that the
bodies of droAvned women often remain floating on  the Avater im-
mediately after death.
   It may be  laid  doAvn as a general rule, that the recently dead
body unclothed is, when left to itself, heavier than water, and sinks
when immersed.  The  expulsion  of air from  the lungs and  their
penetration by water, combined with the  fact  that the bones and
all the soft parts, excepting the fat, are of greater specific  gravity
than water, offer a sufficient explanation of the sinking.   After a
variable period, generally not more than a feAv 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;  2dly, on the na-
ture of the water—whether salt or fresh ; 3dly, on the access of heat
and air in facilitating putrefaction.  If the gases generated find an
escape, the body Avill sink;  more gases may form,  and  then it Avill
again rise, so  that the sinking and rising may become alternate
phenomena.  A small quantity of air collected in the abdomen, as
a result of  putrefaction, will suffice  for the floating of the  body.
Thus, taking the specific gravity  of the dead  body at 1.08 to 1.1,
it would require but little air to keep it at or  near the surface of
the water.  But a dead body, Avhether death  has  been caused by
drowning or not, may not sink at all, OAving  to some  one of the
counteracting  causes above mentioned.  Several cases are reported
in which the bodies of persons recently drowned have floated.
  Marks of violence on the drowned.—The chief inquiry  Avith regard
to marks of violence on the bodies of the drowned is whether they
have resulted  from accident or design.  In forming an opinion, a
witness must  give due value  to  the  accidents to Avhich  a  body
floating loosely in Avater may be exposed.  Bruises or  ecchymoses
of considerable extent are  sometimes  seen on  the droAvned,  when
the bodies  have  been carried  by a current  against  mechanical
obstacles in a navigable river or canal.  If the deceased fell  from
a considerable height  into Avater, his  body in falling may  have
struck  against a rock  or projection, and have  produced extensive
marks of violence.  Dead bodies  taken out of wells often  present con-
siderable marks of violence of a vital character when the deceased 
400      MARKS  OF  VIOLENCE ON THE  DROWNED.

persons have fallen in  accidentally, or have throAvn themselves in
intentionally.  The presence  of these  marks must not create a
hasty suspicion of  murder. It is manifestly impossible to lay down'
any specific rules for forming a decision in cases of this kind, since,
probably, no  tw7o instances will be met Avith Avhich will be perfectly
similar in the details.  In clearing up these doubtful points, every-
thing  must depend on the tact and experience of the practitioner
who is called upon to conduct an investigation.  The first question
which he has .to determine is, whether  the  injuries on the body
Avere  produced before, or after death.  (See Wounds, ante, p. 261.)
If after death, then they ought to be obviously of accidental origin.
Accidental violence may sometimes be of a serious nature, so serious
that a practitioner might Avell  doubt whether it did not indicate
that the deceased  had been violently treated prior to submersion.
If a dead body were taken out of water, with one or both limbs
dislocated, or the  vertebrae of the neck fractured, and a surgeon
AAas asked wdiether such injuries could be accidental and coincident
with or consequent on  drowning, the answer would probably be in
the negative.  But an instance has occurred in which both arms
wrere accidentally dislocated at the shoulders in the act of droAvning,
as the result of a fall into the Avater from a great height.
   The great point with  regard to  all 'marks of violence on  the
drowned is to throAv light upon the questions—1st, Avhether drown-
ing was really the  cause  of  death ;  and 2dly, whether, if  so, the
act was  the  result  of accident, suicide, or  homicide.  This  last
question does not concern a medical Avitness so much as a jury, who
Avill determine it from  the facts, medical  and  general, proved before
them.
   There  is one case, of rare  occurrence, in  which  a practitioner
Avould be apt to be misled by trusting to appearances found on  the
drowned.  If a dead body were removed from Avater with  a deep
ecchymosed circle  round  the neck, evidently produced by a cord or
ligature, but no traces of wdiich could be  found, it is not improbable
that a suspicion Avould be  at  once raised that deceased had been
murdered by strangulation, and the  body aftenvards thrown  into
Avater.  A  case occurred some  years since in Avhich a  mark was
produced on the neck  of a woman who was accidentally drowned,
as a result of the compression produced by the string of  her cloak.
Marks resembling those of strangulation have been produced on
the necks of dead bodies floating in water, where they have been
driven by a strong  current against the  stumps of  trees or other
obstacles in the stream.
   It might be said, that  in cases of this description, circumstantial
evidence Avould commonly show how the mark had originated. In
admitting the  truth of this observation, we must remember that
circumstances, as matters of proof, do not always  present them-
selves to our  notice, or occur  to our judgment, at the precise time
that the law  stands most in  need of them.   While then,  we use
great caution in drawing an  inference when  there are such strong 
          HOMICIDAL AND SUICIDAL DROWNING.       401

grounds for suspicion, we should  not neglect to examine carefully
the most trivial appearances.
  Fractures are not often met with in the drowned as the result of
accident.  Certain fractures  likely to be followed  by immediate
death may forbid the  supposition of their having occurred after
drowning, and a careful examination of the body may show that
they Avere  not likely to have arisen from accident at or about the
time of submersion.
  The  medico-legal question has arisen whether fractures  of the
vertebrae of the neck can occur from accident alone, at or  about the
time of drowning.  In  August, 1858, a gentleman, in jumping from
a bathing-machine head-foremost into Avater more shalloAv than  he
had  expected, caused  a fracture and displacement of the cervical
vertebrae, Avhich led to  death.  Mr. South quotes the case of a man
Avho threw himself into a m7er to bathe, from a height of seven  or
eight feet, the Avater being only three feet deep.  He rose  to the
Burface, but fell back senseless.   When he recovered his  conscious-
ness, the account he gave of the accident Avas, that he felt his hands
touch the bottom of the river, but to save his head drew it violently
back, upon which he lost all consciousness.  He died in  about ten
hours,  and on examination the skin of the back of the neck was
much ecchymosed, the interspaces of the muscles were gorged, and
the spinal  canal Avas filled with blood.  The body of the fifth ver-
tebra of the neck wras broken across about the middle of  its depth,
and the two pieces Avere completely separated from the lateral parts.
As there was no mark  of contusion or dirt on the head, Reveillon,
Avho reports the case, believes that the fracture arose from muscular
action, and not  from a bloAV received by striking the bottom; but
this is  doubtful.   In another instance related by Air. South, a sailor
jumped headlong into the sea to bathe, a sail being spread three feet
beloAv the surface.  He immediately became motionless, and died  in
forty-eight hours.  The fourth and fifth vertebrae of the neck were
found extensively fractured, and the spinal marrow Avas crushed and
lacerated.   (" Chelius's Surgery," part 6, Fractures.)  In  this case
the fracture must have resulted from contact with the water, or the
sail; but as the latter was freely floating, this Avould be a yielding
medium ; hence this serious  injury may occur accidentally in cases
in which we might not be prepared to look for it.
   Was drowning the result of homicide, suicide, or accident ?—Al-
though the question whether the act of drowning was the result
of suicide  or  murder properly falls Avithin  the province of a jury,
there are  certain  points  in relation to it which require  to be
noticed by a medical witness.  In  the first place, it is not to be
imagined that an examination of the body will develop any differ-
ences in either of the three supposed kinds of death.  So far as the
phenomena of drowning are concerned, they are the same, and they
are accompanied Avitn" the same appearances after  death in each
case.  In drowning Avhich is accidental or suicidal, it is not usual
as it has already been observed, to  meet with marks of violence on
the person except such as are purely of accidental origin, and have
       26 
402
ACCIDENTAL DROAVNING.
commonly been produced after death.  In accidental drowning this
is  almost a constant rule";  but if the  person has fallen from any
height, his body may be injured in the fall, either by projections on
the bank of a river or canal, or by mere concussion on the Avater;
alloAvance for either of which  Ave must be prepared to make, ac-
cording to the situation of the spot from which the person is sup-
posed to have fallen.
  It is calculated that in  England drowning is the cause of death
in nearly one-half of all suicides;  but this of course will vary ac-
cording to localities.  In suicidal droAvning Ave have a difficulty to
encounter, Avhich Ave do not  meet Avith  in that Avhich is accidental.
A man may have attempted  suicide by some other means pre-
viously to  throwing  himself into the water;  thus then,  besides
the accidental violence of accidental drowning, Ave may meet with
violence  on the  person evidently indicating Avilful perpetration.
What is the nature of this violence?   Is it to be defined?  Can it
always be distinguished from  that which is positively homicidal f
The answers to these questions must depend on the circumstances
proved in each case.
  Drowning in shallow water.—Homicide has been sometimes pre-
sumed from the  peculiar circumstances under  wmich a body has
been discovered.   Thus, for instance, it has been a debated  ques-
tion whether a  person intent  on suicide can  voluntarily drown
himself in shallow wTater, as in a bath, by turning upon his face,
and retaining this position Avith his mouth below the level of the
water.  This question has been long since settled in the affirmative
by the occurrence of well-authenticated cases.   It appears to have
been  raised originally on  the  theoretical view that the resolution
of a suicide Avould 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 feAV inches deep will  produce all the phe-
nomena of death  by droAvning, with  the  exception that little or
no Avater would  probably be found  in the stomach.  A man may
thus  die in tAvo or three minutes.   Devergie mentions an instance
which occurred in May, 1833, where a man  was found drowned in
a small stream,  his  face towards  the ground, and  his head  just
covered by the water, Avhich Avas not more  than a foot in depth.
On dissection, there  were all the appearances of drowning present,
and a large quantity of sand and gravel Avas found occupying the
windpipe and smaller air-tubes.  (Op. cit., vol. 2, p. 332.)   A case
is mentioned by Dr. Smith,  in wdiich a woman committed suicide
by breaking  a  hole in  the  ice of a pond,  during the Avinter, and
thrusting her head into the water, the  rest  of her body being out.
A man wras found dead with his face dowmvards in a small stream
of water only six inches deep.   The water Avas so shalloAV that it
did not cover the deceased's body, or his head.  There Avas clear
evidence that this was a  case of suicidal drowning.   Although a
person has for a short time the poAver of removing  from a position
in which he must speedily  die, that power is  soon  lost.  If  the 
ACCIDENTAL DROAVNING.
403
mouth is kept beloAv Avater by a strong voluntary effort for half a
minute  or longer, the  unaerated blood is  circulated through the
brain, and the person becomes powerless, so  that his fate is not now
in his own hands.  Lunatics and other persons have thus destroyed
themselves in shallow baths, although left unAvatched by the atten-
dant for only four or five minutes.  The discovery of dead bodies
under these circumstances is, therefore, quite consistent with sui-
cide,, but it does not necessarily prove that the act Avas suicidal.  It
cannot be denied that a person if young or enfeebled by disease or
age may  be  held  by others in such  a position sufficiently long to
produce deatli from droAvning; but if he is capable of making re-
sistance,  Ave  ought to find some marks of violence on the limbs or
body.  So again, such a position  is by no means incompatible Avith
accidental droAvning;  and on this it may happen that a medical
practitioner  will be called to express an opinion.  A man in a stare
of deep intoxication, or when suddenly attacked  by syncope, epi-
lepsy, or apoplexy, may fall with his face in a gutter, ditch, or small
pool of water ; he  may die in this position, not having the power to
extricate himself.   Even marks of violence on  the body must not
be too hastily7 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 Avas found dead with his face in some
melted snow, and  there wrere several severe contusions on his body.
The evidence shoAved that, after a quarrel he  had  left a neighbor-
ing inn much intoxicated ; and it Avas rendered extremely probable
that he had  perished accidentally on his Avay  home.  There was
no reason to  suppose  that he had  been murdered.  Infants, from
mere helplessness,  may be drowned under  similar circumstances;
but at the same time an assassin may select this mode of  destroy-
ing life in order to give the appearance of accident.
  Ligedures  on the hands and feet.—When a drowned body is re-
moved from water  Avith the hands or the hands and feet bound with
cords, it is usually considered that Ave have  therein  presumptive
evidence of homicide; but numerous  cases  are  recorded in which
suicides have actually bound themselves in this manner, or have
attached  heavy weights to their bodies before throwing themselves
into water, for  the express  purpose  of prewenting any chance of
their escaping death. 
404             HANGING — CAUSE OF  DEATH.
HANGING.
                  CHAPTER  XXXVII.

CAUSES  OF  DEATH.—DEATH  FROM  THE  SECONDARY EFFECTS.—POST-
  MORTEM APPEARANCES.—MARK OF  THE CORD OR LIGATURE.—WAS
  DEATH CAUSED BY HANGING?—HANGING AFTER DEATH.—SUMMARY OF
  MEDICAL EVIDENCE.—MARKS OF VIOLENCE ON THE HANGED.—WAS THE
  HANGING  THE  RESULT  OF  ACCIDENT,  SUICIDE, OR HOMICIDE?—THE
  POSITION OF THE BODY.

  Cause of death.—By hanging,  wye are to understand that kind of
death in which the body is Avholly or partially suspended by the
neck, and the constricting  force is the weight of the body itself;
Avhile in strangulation, the constricting force  is due to some other
cause.   In both  cases death  commonly results  from asphyxia (p. 58),
although this must depend in a  great measure upon the  position of
the ligature on the neck,  as Avell as on the degree of pressure pro-
duced.  If the cord is loose, or applied to the upper part of the
neck, a  small  quantity of the air may  still  reach the  lungs, and
then the cerebral circulation may become interrupted by the  com-
pression of the great vessels of the neck.   In  this case, apoplexj7 of
the congestive kind is induced, and operates as the immediate cause
of death.  It is easy to conceive that there may be a mixed con-
dition of asphyxia  and apoplexy, and according to the observa-
tions of Professors Casper and Remer, this is  actually met with in
a great  number of cases of death from hanging.  According to the
former,  out of 83 cases 68 AATere  of the mixed  condition; according
to the latter, there Avere 62  mixed, out of a total of 85.
  It has been observed in  the  execution  of  criminals,  that death
takes place  at  different intervals of time after suspension.  This
difference is probably dependent on  the greater  or less degree of
constriction produced by  the ligature.  If the rope should  press
upon the larynx, or above this organ, the closure of the air passages
will not be so complete  as if  pressed upon  the  windpipe imme-
diately  below  the cricoid  cartilage.  A slight degree of  respiration
might in the former case  continue for a short interval, by AA'hich
the life  of a person would be  prolonged, while in the latter, death
would be immediate.  If the Avindpipe is in part ossified, the pres-
sure of  the ligature is less perfect, and death  will then  take  place
more slowly.   Louis found that  an  occasional cause of death in
hanging was a  displacement  of the second vertebra of the neck,
whereby the spinal marrow7 was suddenly compressed.   As a gene- 
           HANGING — LOSS  OF  CONSCIOUSNESS.        405

ral rule, this cause of  death is only  likely to be observed in corpu-
lent or heavy bodies, when a long  fall  is given  to  the  cord, and
when much violence has been at the  same time  employed  by the
executioner.  Fractures of the vertebrae  may occasionally occur,
and prove fatal  by compressing the spinal  marrow.   Death may
also be causeel by the effusion of blood on the spinal membranes
(sheath), thereby giving rise  to  fatal  compression.  This is likely
to happen when the  head falls,  or is bent  suddenly backwards,
so that the weight of the body is  supported on the back  of the
neck.
  Death from hanging appears  to take place very rapidly, and
Avithout causing any  suffering to the person. It is  observed that
in those who are criminally executed, there are often violent con-
vulsions of the limbs  and trunk.  There is no reason, however,  to
believe that the individual suffers pain, any more than in the con-
vulsions of an epileptic fit.  On recovery, there is an entire loss  of
consciousness of pain in  both  cases.   The  circulation  of dark-
colored blood through the brain  and  spinal cord  may account for
these  effects.  Efforts to inspire are  made for one or two minutes
after the closure, or compression of  the Avindpipe.  The diaphragm
and intercostal muscles act  spasmodically,  but  no  air enters the
lungs; and it is probable that in the act of hanging, part  of the air
contained in  the  organs is convulsively expelled. When the- 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  varies  according to  circum-
stances.  Supposing the hanging to  be unattended with violence  to
parts about the neck,  some persons  might be  resuscitated after five
minutes' suspension or longer;  but then it has been  observed that
they have subsequently died from  secondary causes affecting the
brain and nervous  system.   Others, again,  may  not  be  recovered
when they are cut down immediately after suspension—a fact which
depends probably on  the different  degrees to which asphyxia  or
apoplexy has extended.   When the ligature is so  placed as to press
on the windpipe below the larynx, insensibility and death are almost
instantaneous.
  We learn from those who have been resuscitated, as well  as from
experiments performed by persons upon themselves, that the insen-
sibility of asphyxia comes on in the most insidious manner, in death
from hanging, and  that a slight constriction of  the  windpipe will
speedily produce loss of consciousness and muscular power.   (" De-
vergie," 2, 370.)   The only symptoms of Avhich the hanged  persons
have been conscious,  were a  ringing  in  the  ears, a  flash of light
before the eyes, then darkness and  oblivion.   The only profitable
inference, in a medico-legal vieAV, Avhich can  be drawm from obser-
vations of this kind is, that  asphyxia is not  only rapidly induced,
but that it supervenes under circumstances Avhere it Avould not  be
generally expected to  occur—i. e., when the Aveight of the  body is
in great part supported.  M. Fleischmann found  that a cord might
be placed around his neck between the chin and os hyoides, and 
406              EXTERNAL  APPEARANCES.

tightened either laterally or posteriorly  Avithout perceptibly inter-
rupting respiration; but while the respiratory  process was thus
carried on, his face became red, his eyes prominent, and his head
felt hot.   These symptoms were followed by a sense of weight, a
feeling of incipient stupefaction, and a  hissing noise in the ears.
On the occurrence of this last  symptom, the experiment, he says,
should be discontinued, or the consequences may be serious! His
first experiment on himself lasted two minutes; but in the second,
owing to the cord by  its  pressure  more completely interrupting
respiration, the noise in the ears appeared in half a minute.  When
the pressure was applied on the Avindpipe  the effect was instanta-
neous, but when on the  cricoid cartilage it Avas  not immediate.  If
it wTas applied betAveen the os hyoides and the thyroid cartilage, or
on the os hyoides itself, the period during which a person  could
breathe was  extremely  short;  and this  result Avas  more striking
Avhen the act of expiration w7as performed at the moment  of ap-
plying the pressure.  The death of Scott, the  American diver, in
January, 1840, shows how readily  asphyxia may be induced by a
slight compression of the throat, even when a person might be sup-
posed to have both the  knoAvledge and the power to save himself.
This man Avas in the habit of making public experiments on  hang-
ing, and had frequently before gone through them Avithout danger;
but on the last occasion, it is probable that a slight shifting of the
ligature from under the jawbone caused so much compression on
the throat between the chin and the larynx, as  speedily to produce
asphyxia.  No attempt Avas made to save him until it was too late,
and  he w7as  not brought to a  hospital until thirty-three minutes
had  elapsed.  He was allowed to hang thirteen minutes—the spec-
tators thinking that the deceased was only prolonging the experi-
ment for their gratification!   The  very  insidious  and painless
manner in which a person who is suspended passes  from life into
death, is also well illustrated in the report of the  case of Hornshaw,
published  by Dr.  Chowne.   ("Lancet," April  17, 1847, p. 404.)
This man Avas on three occasions resuscitated from hanging—a feat
which, like Scott, he had performed in  London  for public gratifi-
cation.   He  stated that on the last occasion he lost  his  senses
almost  at once;  it seemed as if he could not  get his breath, and
that some great weight was attached to his feet; he felt that he
could not move his hands or legs to  save himself, and  that the power
of thinking Avas gone.  It is  not  improbable that  many persons
have thus lost their lives by privately attempting  these experi-
ments, and their cases have been wrongly set doAvn to  acts of suicide.
There is reason to believe that boys have thus frequently but uninten-
tionally destroyed themselves, from a strange principle of imitation
or curiosity.
   Post-mortem appearances.—The external appearances met with in
the hanged have been generally taken by medico-legal Avritersfrom
those seen in the bodies of persons who  have been criminally exe-
cuted, or Avho have been violently hanged.   Thus among them are
the following:  Lividity and SAvelling of the face, especially of the 
EXTERNAL APPEARANCES.              407
lips, which appear distorted ; the ey7elids are swollen, and of a bluish
color; the  eyes red, projecting fonvards, and sometimes  partially
forced out. of their cavities; the tongue enlarged, livid, and either
compressed  betAAreen the teeth or sometimes protruded, the loAA7er
jaw is retracted, and a bloody froth sometimes exists about the lips
and nostrils.  There is a deep and ecchy7mosed impression around
the neck, indicating the course of the cord, the skin  being occa-
sionally excoriated ;  laceration of the muscles and ligaments in the
hyoideal region;  laceration or contusion of the larynx, or  of the
upper part of the Avindpipe.  There are also, commonly, circum-
scribed patches of ecchymosis, varjnng in  extent, about the upper
part of the body and the upper and lower  limbs, with  a deep livid
discoloration of  the hands ;  the fingers are generally much con-
tracted, or firmly clenched, and the hands and nails, as well as the
ears, are livid ; the urine and feces are sometimes involuntarily ex-
pelled at the moment of death.  Such appearances  Avill rarely be
found in those cases of suicidal hanging which are likely to come
before a medical practitioner.   In these, the face is generally pale,
and the mark on the neck is a simple depression in the skin, usually
without ecchymosis, and acquiring a horny or parchment color only
after some time.  Esquirol found, in one  instance, that w7hen the
body Avas examined immediately after death, the face Avas not livid;
but it first began to assume a violet hue in eight  or ten  hours.
He thought that Avhen the cord Avas left round the  neck the face
would be livid, but  if removed immediately after suspension, pale.
This vieAv is  not, hoAvever, borne out by observation.  The tongue
is not always protruded.   Devergie found that there was protru-
sion of this organ in eleven cases out of twenty-seven.  This pro-
trusion Avas formerly supposed to depend upon the position  of the
ligature: thus, it w7as  said, Avhen this Avas below  the  cricoid car-
tilage, the whole of the larynx was draAvn  upwards, and the tongue
carried  forwards  with  it, Avhile Avhen above the  os hyoides the
tongue wras drawn backAvards.   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 droAvning and suffocation.  Besides, the
protrusion has not been found to have  any direct relation  to the
position of the ligature.
  There is another appearance on Avhich a remark  may be made—
namely, the state of the hands.  As a general rule,  in violent hang-
ing or strangulation, the hands are clenched.  This  appearance may
not always be found, as it may exist and  be destroyed before the
body undergoes medical inspection.   When the constriction  of the
neck is produced suddenly, and Avith great violence, we may expect
to meet Avith it,   Thus, it is found in the cases of executed crimi-
nals, and in strangulation  attended  with  great violence,  AAdiether
the act be due to  homicide or suicide.  In cases in Avhich  the con-
striction is gradually produced, the clenched state  of the  hands
may not be found.  Convulsions generally  attend violent  hanging 
.  408
INTERNAL  APPEARANCES.
or strangulation.  The influence of these on the attitude or dress
may not be apparent unless the body be sitting or lying._
  Internally, we meet with the appearances of asphyxia—i. e.  en-
gorgement of the lungs and venous  system generally with dark-
colored fluid blood;  the  lungs otherwise  present no  particular
appearances.   The  right side  of the  heart  and the great vessels
connected with it are^commonly distended with blood.   But when
the inspection  has  been delayed for several days, this  distension
may not  be observed.  The mucous membrane of the windpipe is
more or less congested, and is sometimes covered with a fine bloody
mucous froth.   This may be owing to imperfectly obstructed respi-
ration, and to  spasmodic efforts at breathing.   The vessels of  the
brain are commonly found congested;  and in some rare instances, it
is said extravasation of blood has been met w7ith on the membranes
or in the substance of the organ.  Effusion of blood is, however, so
rare that Remer found this appearance described only once among
one hundred and one cases; and in one hundred and six  cases re-
corded by Casper it was not found  in a single instance.   In  one
case of death from hanging, Sir B. Brodie found a large effusion of
blood in the substance of the brain, and he refers to another casein
which there was a  considerable effusion  between the membranes.
("Lectures on  Pathology," p.  58.)  The venous congestion of  the
cerebral  vessels is,  hoAvever, rarely greater  than in other  cases of
asphyxia, and  is probably dependent  on the degree in which  the
lungs have become engorged.  In most instances there is increased
redness of the  substance of the brain,  so that, on making a section
of the hemispheres a  greater number of bloody points (puncta cru-
enta) than usual will appear.   The kidneys have been found much
congested.   A more important circumstance has been  noticed by
Dr. Yelloly—namely, that in examining the stomachs of five crimi-
nals who have  been hanged, he found great congestion in all, Avhile
there Avas blood coagulated upon  the mucous  membrane  in two.
Such an appearance might, it is obvious, be attributed in a suspi-
cious case to the action of some irritant substance.  (See " Ann.
d'Hyg." 1830, p. 166 ; 1835, p. 208 ; 1838, p. 471.)  In the case of
Good, who was executed for murder some years since, the  stomach
was found on inspection to present over its whole  surface a well-
marked redness, resembling the effect produced by an irritant poison.
The redness was especially observed  at  the pyloric end, where it
assumed a  someAvhat striated character.  A drawing representing
the  appearance of the interior of the stomach  is preserved in  the
Museum collection of Guy's Hospital.  In a case examined by  Mr.
Stuart, of Azimghur, in 1854, the stomach and intestines, especially
the  inner coat of the former, Avere much congested and inflamed,
as if the  man had died from poisoning.  The contents of the  stomach
were analyzed, but no poison was found.  Dr. Chevers, who quotes
this case, states that  he has more than once verified Dr. Yelloly's
observation, and has found the mucous membrane of the  stomach
much congested in deatli from hanging.  (" Medical Jurisprudence
for India," p. 397.) 
APPEARANCES  OF THE  NECK.
409
  The most striking external appearance, hoAvever, is the mark pro-
duced on the neck by the ligature.  The skin is commonly depressed,
and sometimes ecchymosed, but rarely throughout its Avhole extent;
it is frequently free from all traces of discoloration as the result of
ecchymosis, the skin in the depression being then hard, brown, or
of a parchment color and consistency ; or there may be only a thin
line of blue or livid  color  in the  upper or loAver border  of  the
depression, and chiefly in front.   The course of the mark is gene-
rally oblique, being lowTer in the fore-part than behind, and it is
often interrupted.   It is most commonly above the larynx.  If the
noose should  happen to be in front, the mark may be circular, the
jaw preventing the ligature from rising upwards in the same degree
before as it commonly does behind.   The mark is generally single,
but Ave may meet with  it double, as Avhen the ligature has been
formed into two circles  or loops previously to its application.  Its
other characters will depend upon  the nature  of the ligature  em-
ployed.  Thus, a large  and wide  ligature rarely produces  ecchy-
mosis—the mark is Avide and superficial;  but a small ligature pro-
duces a  narroAv and deep impression, sometimes accompanied with
laceration of the cuticle and effusion beneath the skin.
   The ligature or cord should always be examined for blood, hair,
or other suspicious substances.
   It Avas formerly believed that the impression on the skin produced
by the cord was invariably discolored  from effusion of blood, or
ecchymosis; but more correct observation has shown that this con-
dition is an exception to the general rule.  When ecchymosis does
exist, it is commonly superficial and of  slight extent.  There is
rarely, if ever, effusion of blood in the cellular tissue. In the bodies
of persons who ha\7e been criminally executed, it is not  unusual to
find ecchymosis, but even here it is  not always  present, or only in
front of the neck.   Dr.  Croker King, in examining the  neck of an
executed criminal, did not discover the smallest eft'usion  of blood in
the course of the cord, although in this case  the body had been
allowed to fall from a height of seven feet and a half, Avith a fearful
jerk.  (" Dublin Quarterly Journal," No. 35, Aug. 1854, p. 86 ; and
"Cases of Ruptured Intestine," 1855, p. 12.)  The theory  of  the
production of  ecchymosis has  been carried so far that a livid mark
in the course of the cord Avas formerly said to be the best criterion
for distinguishing hanging in the living from hanging in the dead
body!  This statement, however, is  not  in accordance  Avith facts.
In a large number of cases the skin,  instead of being blue or livid,
or presenting an effusion of blood in the  cellular tissue beneath, is
hard, and  of a yellow color, resembling parchment.  It has that
appearance Avhich the cutis commonly assumes Avhen the cuticle has
been removed from it tAVO or three days;  and, on dissecting it  off,
the cellular membrane beneath often appears condensed and of a
silvery Avhiteness.  Dr. Chevers states that in cases of death from
hanging, he has not met with any ecchymosis in the skin along  the
course of the mark. (Op. cit. p. 406.)  In some instances the mark
has presented  itself simply as a Avhite depression; this has been 
410
INJURY TO  THE MUSCLES.
chiefly observed in fat subjects.  The observations of Casper on this
point are as follows: out of seventy-one cases, there was no ecchy-
mosis produced by the cord in fifty, and thus in tAvo-thirds of all
the cases  examined, it was entirely absent.   He also found that
there was no difference in the appearance whether the ligature was
removed sooner or later after death.
  Injuries to the muscles and  deep-seated parts of the neck are, of
course, only likely to be seen when considerable violence has been
used in hanging.  In one or t\vo instances the lining membrane of
the common carotid artery has been found lacerated.  Congestion
and swelling of the genital organs in both sexes have been set down
among the common consequences of hanging; but many observers
have  not met with these conditions, and it is doubtful  whether,
unless the body is examined speedily after suspension, any marked
difference Avould be discovered.  A more common sign, perhaps, is
the discharge of the spermatic secretion in the male, by a spasmodic
action, at  the moment at AA7hich death  takes place.  It appears to
me that no reliance can be placed upon evidence derivable from this
appearance, and yet it has sufficed to give rise to a violent contro-
versy among French medical jurists.  (" Ann. d'HArg."1839, vol. 1,
pp. 169, 467 ; vol. 2, p. 393 ;  1840, vol. 2, p. 314.)  Unless death
from  hanging is strongly established  by other facts,  neither the
examination of the linen of the deceased, nor the application of the
microscope to the mucous fluid found  in the urethra, would be of
any  practical \7alue in elucidating the question—at least to the
satisfaction  of an English jury.
  The folloAving may be regarded as- a summary of the appearances
in hanging, Avhen  death has really taken  place from  asphyxia.
The countenance is either livid or pale, the eyes are prominent, the
tongue  congested and occasionally protruded, the  lower jaw re-
tracted ; the skin is covered with patches of cadaveric lividity, the
hands are livid and clenched; an  oblique mark  is  found on the
neck—sometimes presenting traces of ecchymosis ; commonly, how-
ever, the skin is only brown in color and hardened.  The larynx,
wnndpipe  and  subjacent  muscles are  lacerated, depressed or dis-
colored.  The vessels of the brain are congested, as well as those of
the lungs and  the right cavities of the heart.  A mucous froth
tinged with blood  is  occasionally found in  the Avindpipe.  These
appearances Avill of course be modified, or they may7 be altogether
absent,  Avhen death has arisen from  a  disorder of the cerebral cir-
culation, or  from injury to the spinal marrow, either by effusion of
blood, fracture, or displacement,
  [Dr. John Packard, of Philadelphia, has kindly  furnished me
w7ith  the  folloAving  notes of the post-mortem examination in the
case of  Anton  Probst, convicted  of the murder of the Dearing
family, and  executed June 8, 1866.
  " The examination Avas  made  about  twenty-nine hours  after the
hanging.  The face Avas mottled purplish,  in a  very marked de-
gree, by post-mortem change.   The  under or posterior portion of
the body  and  extremities Avere also  mottled by hypostatic con- 
WAS  DEATH CAUSED BY HANGING?         411
gestion, but less so than the  face.  The  eyes  were not protruded,
nor had the tongue been bitten.  The mark of the cord Avas very
distinct on the neck, except at a point a little beloAv and in front of
the left  ear, where the knot had been ;  here the skin Avas un-
changed. _  The mark was purplish-brown.  On the right side, the
Rterno-cleido-mastoid  muscle Avas  ruptured  nearly through; ap-
parently just where the cord had pressed it,
  " Both  the greater cornua of the hyoid  bone were broken
through obliquely, near their origins.  The  laryngeal cartilages,
as Avell as the great vessels of the neck,  were intact.  No fracture
or dislocation of the cervical vertebrae existed, nor Avas there any
discoverable lesion of the spinal cord.  (The thorax and  abdomen
having been opened before the saAving of the cranium, the state o>f
the brain is not accurately known.)
  " The heart and, great vessels were empty ;  the lungs quite free from
congestion.  All the abdominal viscera were healthy.  No* evidence
of priaprism or sexual excitement existed.  Deatli seemed to have
been caused by pressure upon the great nerves (the pneumogastric
and phrenic) distributed to the organs of circulation and respira-
tion."—P.]
   Was death caused by hanging?—When a person  is found  dead,
and  his  body is suspended,  it may be a  question Avhether  death
really took place from hanging or not.  In investigating a case of
this kind, it is necessary to draw a distinction between  the exter-
nal and internal appearances of the  body.  The former  alone can
assist us in  returning  an ansAver to this question; the internal
appearances of the body can  famish only the  general signs of as-
phyxia, and  enable us to say  Avhether  any latent cause of death
existed or not.
  The mark  of the  cord.—Among the external  appearances it is
chiefly to the mark produced by the cord on the neck that medical
jurists have looked for the determination of this question. As the
form, position, and other  characteristics of this  mark have been
already described, it will now be  necessary to allude to it only  as
furnishing evidence of life at the time of  its  production. It has
been stated, that so far from  being constantly  livid or ecchymosed,
this condition is, in reality, not seen  in more than one-half of the
cases Avhich occur.   But admitting that we find ecchymosis in the
course of the ligature, are we ahvays to infer that it  must have
been applied while the person was living?  There  are cases which
show that the presence of active life is  not necessary for the produc-
tion of ecchymosis in the mark; and  from the experiments of De-
vergie, it would appear that if a body is  hanged immediately or a
short time  after death, an ecchymosed mark may7 be produced on
the  neck by the ligature.  (Op. cit, vol. 2, p. 408.)  If a few hours
were suffered to elapse, so that the body  had  become cold before
suspension, no ecchymosis Avas produced  by the ligature.   Profes-
sor Vrolik  of Amsterdam  found, however, that a  slightly  livid
mark Avas produced on the neck of a  dead  body, which had  been
suspended after the lapse of an hour from the time of deatli.  (Cas- 
412        EFFECTS  OF HANGING AFTER DEATH.

per "Woch.," Feb. 1838.)  Hence this condition of the mark in a
body found  dead merely indicates, either that the deceased must
have been  hanged while living, or very soon after the breath had
left his body.  It would be for a jury to decide between these two
assumptions ; and to  consider why, when  a man had really died
from any other cause, his body should have been hanged in secrecy
immediately after death. (See " Ann. d'Hyg." 1842, vol. 1, p. 134.)
The circumstance that an ecchymosed mark may be produced  by
suspending a recently dead body bears out the statement of Merz-
dorff—that it would be in the highest degree difficult, if not utterly
impossible, to determine medically, from an inspection, Avhether a
man had been hanged Avhile living, or Avhether he had been first
suffocated, and his body suspended immediately after death.   In
making this admission, it is  proper to bear in mind that that Avhich
is difficult to a conscientious medical jurist in confining himself to
the medical facts, is often easily decided by a jury from  these, as
well as the general evidence afforded to them.
  Sometimes, besides  ecchymosis, there are abrasions of the skin
in the course of the  cord, and these are known to  have been pro-
duced during life by the effusion  of blood Avhich accompanies them.
Devergie never met with this appearance in the hanging of a dead
body, even Avhen the hanging took place immediately after death.
The discovery of effused coagula in or about  the  spinal column
would render it  probable that the deceased  must have been hanged
Avhile living.  Such  marks  of violence are, however, rare  in cases
of hanging; and when they are found, it  might be assumed that
the effusion and coagulation of blood  had been caused by  violence
offered to the neck  immediately after death: but this  assumption
may be met by the question  already suggested—namely, why death
by  hanging should be simulated in the body of a person \vho is
alleged to have died from another cause ?
  With regard to the other, or more common kind of mark in sui-
cidal hanging, it can  scarcely be said to furnish any evidence in
relation  to the question which we  are here  considering.  The
depression  may  be hard and brown, although  it does not usually
acquire this color until some hours have elapsed after death; for it
appears  to depend simply  upon a desiccation  or  drying of that
portion of  the  skin Avhich  has  been  compressed by the  ligature.
Sometimes the  upper  and lower borders  only  of  the  depression
present a faint line of redness or lividity ; and it is worthy of remark,
that when  the ligature presents any knots or  irregularities, those
portions of skin which sustain the greatest compression are white,
while those which are uncompressed are found more or less ecchy-
mosed.  It is in this manner that the form of a ligature is sometimes
accurately  brought out.  It  may be remarked of these depressions
produced by the cord,  that  the  characters  which they present are
the same whether the  hanging has  taken place during life or soon
after death—the appearances may be similar in the two cases.
  The experiments performed on dead bodies  by Casper and other
observers sIioav  that the ordinary or non-ecchymosed  mark caused 
             SUMMARY  OF  MEDICAL EVIDENCE.          413

by hanging during life may be produced by a ligature applied to the
neck of a subject within two hours, or at a much longer period after
death ; consequently, the presence of this mark on  the  neck is no
criterion Avhether the hanging took place during life, or after death.
The changes in the skin beneath the mark are also destitute of any
distinctive characters; there is the same condensation of the cellular
membrane whether the hanging has occurred in the  living or dead.
These changes are the simple result of a physical cause—mechanical
compression.
   Summary of medical evidence.—From the foregoing considerations
we draw the  conclusion that there is no distinctive  sign by Avhich
the hanging of a living person can be determined from an inspection
of the dead body.  All the external marks  may be simulated in a
dead body; and the internal appearances furnish no characteristic
evidence whatever.  Still, AA'hen  the greater number  of the signs
enumerated are  present, and there is no other satisfactory cause to
account for death, Ave  haA-e  strong reason to presume that the
deceased has died from hanging.   We  must not, however, abandon
medical evidence on these occasions, merely because plausible objec-
tions may be  taken to isolated portions of it. Facts  may shoAV that
hoAvever A7alid  such objections  may be  in  the abstract, theyT are
wholly inapplicable in the concrete, i. e. to the particular  case under
investigation.   Perhaps the greatest medical  difficulties occur in
reference to cases of suicide, OAving to the slight appearances Avhich
attend this form of death ; but on  these occasions, moral and cir-
cumstantial proofs are so generally forthcoming, that  a  medical
inspection of the body is scarcely ever deemed necessary by a coroner.
If, then, it is  admitted by a medical jurist, that it is  not  in all cases
possible to distinguish hanging in the living from  hanging in the
dead, the admission must be considered as having reference to cases
wherein persons destroy themselves, and not to cases inAvhich they
are destroyed  by others.  Even  if a doubt were  raised  in  any par-
ticular instance, it is more than probable that circumstantial evi-
dence Avould  furnish  data for a  decision, and thus satisfactorily
make up for the Avant of strict medico-legal proofs.
   If Avhen Ave found a deeply ecchymosed or livid mark  around the
neck of a dead subject, wTe said, all other circumstances being equal,
that the person had most probably died from hanging, we should
not be departing from a proper discharge of our duty ; since, although
it is medically possible that such a mark may,  by a certain amount
of skill, be produced after death, yet as itAvould be only  a murderer
Avho Avould think of hanging up a recently dead  body to simulate
suicide, so it is certain that in this case there Avould be some obvious
indications of another kind of violent death about the person.  The
absence of these, and  the presence of  ecchymosis in the course of
the cord, would, it appears to me, leave the question of  hanging
during life decidedly  settled in the  affirmative.   Some  caution
should be used in expressing an opinion  that  hanging  took place
after death, in cases in which there  is  no ecchymosis in the seat of
the ligature;  because, while such  an  opinion would  be generally 
414      MARKS  OF VIOLENCE ON THE  HANGED.

correct, it might in some instances lead to the concealment of the
real mode of  death.   Many  facts  already  adduced  show  that
numerous cases of hanging during life Avould  be pronounced to be
cases  of hanging  after death, if the  absence  of ecchymosis  were
taken  as  a  criterion.  The mere discovery of marks of violence
about the person is not of itself  sufficient to rebut the presumption
of death from  hanging on these occasions.   The violence  should
at least be of such a nature as to account for the immediate destruc-
tion of life, or it can throw no light upon the  question whether the
person might not have died from hanging, in spite of the marks of
maltreatment found upon the body.
  If, in reference to a body found hanging, a medical jurist should
assert that death had not  taken  place from this  cause, this would
be tantamount to declaring that the deceased  must have been mur-
dered ; because it is difficult to suppose that any one but a murderer
would have a  reasonable motive for hanging up a  recently dead
person.  This hanging after death has been frequently carried out
with the view of concealing the  real mode of death, and of making
the act appear to be one of suicide.
  Marks of violence on the hanged.—The presence of marks of vio-
lence on the body of a hanged person is important, and it will, there-
fore, be proper for a witness to notice accurately their situation,
extent, and direction.  Having satisfied himself that they must
have been received during life, he will have to consider the proba-
bility of their being of accidental origin or not.  These* marks of
violence are not always to be regarded  as  furnishing unequivocal
proofs  of murder; for it  is possible that they may  have been pro-
duced by the person himself before hanging, and not succeeding in
comitting suicide by these attempts, he may subsequently have re-
solved to accomplish his  purpose by suspending himself.  Let the
witness duly reflect on  these circumstances  before he allows his
opinion to implicate any suspected  individual;  let  him consider
that a  hanged subject  may bear the  marks of a gunshot wound,
his throat may be cut, his person lacerated  or  disfigured, and  yet,
before a suspicion of homicide is allowed to be entertained, it ought
to be clearly shown that such injuries could not, by airy probability,
have been self-inflicted.   The importance of observing  caution in
such a case will be still more manifest when there is no ecchymosis
produced  by the cord, and the face does not present  the usual ap-
pearances of hanging.
  Marks  of violence on a hanged subject  may in some cases be
fairly ascribed to accident.  If the person has  precipitated himself
with any violence from a chair or table in a furnished  apartment,
he  may have  fallen  against  articles  of furniture, and thus have
caused  lacerations and bruises, especially on  the limbs or body.
The rope may have given Avay, and the person, in falling, have in-
jured himself;  but he may afterwards have had resolution enough
to suspend himself again.  Such an  occurrence may be rare; but
when  the presence  of these injuries is made to form the chief
ground of accusation against another person, their  possibly acci- 
         ACCIDENTAL AND HOMICIDAL HANGING.      415

dental origin ought not to be lost sight of by a considerate witness.
If Ave suppose the deceased to have been hanged in a state of intoxi-
cation or stupefaction,  medical evidence alone will rarely  suffice to
determine the question of homicide or suicide.   The absence of all
marks of violence from the body might actually lull  suspicion.   It
is proper on these occasions to look  to the hands of the deceased,
since it is Avith  these that a  person  defends himself; and, unless
taken unawares, it is almost certain if the hanging were homicidal,
that there Avould be traces of violence on these parts.   The clothes
would be torn and discomposed, and the wdiole  appearance of  the
deceased would be that of one who had done his utmost to resist a
violent  murderous attack.   There might be some injuries Avhich
could not be attributed  to accident under the circumstances. Among
these Ave may enumerate fractures, dislocations, deeply penetrating
incised and gunshot wounds.  Noav the question is—Do these serious
injuries necessarily establish homicidal hanging? The answer must
be in the negative ; although when fractures or  dislocations exist,
there are strong grounds for suspicion.  ("Ann. dTIyg." 1842, vol.
1, p.  160.)
  Suicides frequently make  attempts on their lives by various
means, as by poison, the use of razors, knives or pistols,  and  still
retain poAver to hang themselves. Such cases as these are generally
determined by circumstantial evidence.   A suicide may attempt to
destroy himself Avith a  knife, or pistol; he may fail in the attempt,
and ultimately hang himself.  Any description of wound, provided
it be such as to alloAV of a person surviving  a sufficient time, may
thus be found  on a hanged subject, anel yet constitute no proof
whatever of murder. If  there are circumstances about the wound
or injury which show that it  could not have  been  self-inflicted,
this of course will affect the conclusion ; but when such circum-
stances  are not met with, a cautious medical  jurist  should  say,
in answer to inquires respecting the origin  of  these Avounds, that
they may have  been inflicted either by  the deceased  himself, or
by another.  The medical  facts of the case might  be consistent
with either view.  In one instance of suicidal hanging, there Avere
lacerated wounds upon the head, and a  handkerchief  Avas found
blocking up the  mouth.  Of course if, in any case, the Avounds  or
injuries are of a decidedly mortal nature, and have probably caused
death, the presumption of murder is very strong; for Avho but  a
murderer would suspend  the  dead body  of  a person  so Avounded,
immediately after death?  ("Ann. d'Hyg." 1835, vol.  2, p.  410.)
   Was the hanging the result of accident, homicide, or suicide f—Most
medical jurists have passed over the subject of  accidental hanging,
probably believing it to be impossible.  In the sense commonly im-
plied by the term it is certainly  unusual, but although rare, it is a
possible occurrence.  Circumstantial evidence will always  suffice
for the  discrimination of accidental hanging ; and we have, there-
fore, merely to inquire whether, Avhen the body of a person is found
hanging under circumstances Avhich do not allow of the suspicion
of accident, the act has  been the result of suicide, or of homicide.  A 
416        HOMICIDAL AND SUICIDAL HANGING.

medical witness must remember that this is strictly a question for
the jury.  It is not for him to say whether a man has hanged him-
self or been hanged by others, but merely to state, when required,
those medical circumstances which support or rebut one or the other
presumption.  The jury, under  the  direction of the judge, will
arrive at a conclusion, from the whole of the evidence, medical and
non-medical.
  It has been truly observed, that of  all the  forms of committing
murder, hanging is one of the most difficult, and it is, therefore, but
seldom resorted  to.  In most cases when a person has been hanged
by others, it  has been after death, in  order to  avert a  suspicion
of homicide.   Hence, the  discovery  of a person hanging affords
prima facie evidence of suicide,—supposing it to be rendered abso-
lutely certain  that death has taken  place from this cause.  We
must, however, admit that a man may  be murdered  by hanging,
and that the appearances about his body will not afford the smallest
evidence of the fact.  The  circumstances Avhich will justify a med-
ical jurist in making this admission are the folloAving: First, when
the person hanged is feeble, and the assailant a strong healthy man.
Thus a child, a youth, a female, or a person at any period of life, worn
out and exhausted  by disease or infirmity, may be destroyed by hang-
ing.  Secondly,  when the person hanged, although usually strong
and vigorous, is at the time in a state of intoxication, stupefied by
narcotics, or exhausted by his attempts to defend himself.  Thirdly,
in all cases, murder may be committed by hanging, when many are
combined against  one person.  With these exceptions, then, a prac-
titioner will be correct in deciding, in a suspected case, in favor of
the presumption of suicide. Unless the person labored under stupe-
faction, intoxication, or great bodily weakness, Ave  must  expect to
find in homicidal  hanging, marks of violence about the body; for
there are few aa71io would allow themselves to be murdered without
offering some resistance—notwithstanding the assertion of Mahon,
that some might submit to this mode of  death with philosophical
resignation, Avhen  they saw that resistance was hopeless!
  Some medical jurists have thought that the mark left by the cord
on the neck Avould serve as a criterion of murder, on Avhich we might
depend.   Thus it  has been said, if the mark is circular and situated
at the loAver part of the neck, it is an  unequivocal proof of murder.
In hanging, the mark of the cord is generally oblique, being higher
at the back part of the neck, in consequence of the loop formed by
it yielding more in this direction than in front.  But it is an error
to suppose that  this want of obliquity in the impression can afford
any evidence in favor of the act having been homicidal.  Its form
will depend in a great degree upon the fact of  the body being sup-
ported or not, for  it is the Aveight of the body which causes its obli-
quity ; it will  also depend on  the manner  in which the cord is
adjusted.  A case of suicidal hanging is related by Orfila, in Avhich
the mark of the cord extended horizontally round the  neck from
behind forwards.   (" Med. Leg." torn. 2,  p. 376.)  The slip-knot of
the cord was in front of the neck, and  it is obvious that Avhen the 
CIRCUMSTANTIAL  EVIDENCE.
417
cord is thus adjusted by a  suicide, there will be scarcely any obli-
quity  in the depression produced  by it.   Equally ill-founded is the
assertion, that the existence of two impressions on the neck  affords
positive proof of homicide.  One of these impressions may be at
the loAver  part of the neck, and circular—the  other at the  upper
part and oblique ; it is therefore contended, that the deceased must
have been  strangled in the first instance, and afterwards hanged.
The possibility of a prior attempt being made by a suicide to strangle
himself, and thus produce  the mark, is not  adverted to.  " Si Ton
observe les deux  impressions," says  Mahon, " l'assassinat est alors
parfaitement prouveV'  It is fortunate that there are facts on record
to oppose  to this very positive statement.   One of the first cases
reported by Esquirol is that of a female lunatic Avho  committed
suicide by hanging herself, and on Avhose neck two distinct impres-
sions Avere seen—the one circular, the other oblique! These appear
to have arisen from the cord having been passed twice  round the
neck, the  body being at the same  time  partially  supported.   In
some instances a  presumption of homicidal interference  may exist
if there are tAvo distinct impressions, but it cannot be admitted that
they establish the fact of murder.
  The injury clone to the neck by the  cord or ligature can rarely
afford any clue to the manner in Avhich hanging took place, unless
the circumstances under which the body is found favor the presump-
tion of homicide or suicide. Thus, the laceration of the muscles and
vessels of the neck, the rupture* of the windpipe and the displace-
ment of the larynx, the  stretching of  the ligaments of the spine,
and effusion of blood on  the sheath  of the spinal marrow may be
observed in suicidal, as in  homicidal hanging.  The presumption,
however, is obviously in favor of the latter, when these violent in-
juries are found to be accompanied  by fracture or displacement of
the vertebrae of the neck, and the  body of the deceased is not cor-
pulent, the ligature  by which he is suspended is not of a nature to
produce them, and the fall  of the body has not been great.
  A much-disputed  question has arisen in medical jurisprudence,
whether the vertebrae of the neck can become fractured or displaced
in suicidal hanging.   Most medical  jurists deny the possibility of
this accident occurring—the displacement or fracture of these ver-
tebrae being rarely observed, even in  criminal executions, when the
greatest violence has been used  by the executioner.   So far as I am
aware, there is no case of suicide on record in which such an injury
to the neck has been found.
  Circumstantial evidence.—In all doubtful instances we should not
lose sight of moral and circumstantial evidence.  We should ascer-
tain Avhether the individual had been previously disposed to commit
suicide or not;  Ave should observe whether the doors and Avindows
of the apartments  had been  secured on the inside, or on the outside ;
whether the dress of the  deceased is at all torn or discomposed, or
his  hair disheA7elled ; whether the attitude of the body is such as to
sIioav interference  after death;  whether there are marks of blood
about  the body, or the ligature, or in the room ; whether the hands
      27 
418   EVIDENCE FROM THE POSITION  OF THE  BODY.

are bloody, or present marks of wounding or struggling ; Avhether
the rope or ligature corresponds to  the impression seen around the
neck ; and lastly, whether the cord is of sufficient strength  to sup-
port the weight of the deceased.  The strongest evidence of homi-
cide is often found in the attitude and the state of the dress of the
dead bod}7; it may or may not indicate interference or change after
death irreconcilable with the supposition of death from suicide or
accident.  On this point the minutest circumstance may become of
considerable importance as medical evidence.   When there are in-
dications of violent struggling, the  dress may  be found disordered,
unless it has been smoothed or arranged  by the murderer after the
death of the deceased.   There may  of course be no evidence of dis-
order or discomposure of the dress, in the case of a female, when
the body is freely suspended.  These points  fall, it  is true, more
Avithin the province of the officers of justice than of a medical prac-
titioner ; but  the latter is generally the first  who is called to see
the deceased, and therefore, unless such facts are noticed by him on
his visit, they may  remain  altogether  unknoAvn.   The medical
opinion of the actual cause of death, however,  should be based only
on medical facts, but circumstantial evidence has on  various occa-
sions assisted in clearing up a doubtful case.  Louis states that on
removing the body of a man wdio was found hanging, the rope Avas
observed to be stained with  blood.   This simple circumstance led
to further investigation, by Avhich it was discovered that the person
had  been murdered, and his bo'dy afterwards suspended.  The
presence of marks on the neck indicative of strangulation, such as
the cord was not likely to ha\Te produced, may lead to a suspicion
that the hanging folloAved death.
   The position of the body.—Lastly,  it has been contended that the
position  of the dead body may serve to  distinguish  suicidal from
homicidal  hanging.   This point was strenuously  argued on the
investigation Avhich took place relative to the death of the Prince
de Conde in  1830.  This case involves two glaring errors in refer-
ence to  medical evidence on death  from hanging:  1st, that a per-
son cannot die from  hanging when  the body is in any way  sup-
ported,  and therefore that  murder must have been perpetrated;
2dly, that in all cases of  deatli from  hanging, the mark produced
on the  neck by the cord  or ligature  must  be discolored or ecchy-
mosed.   If not ecchymosed, it is assumed that death must have
taken place from some  other cause, and the body have been after-
wards suspended for the concealment  of crime.   It is scarcely
necessary to  state'that these propositions are utterly inconsistent
with  well-knoAvn facts.  Since this  trial,  many cases have been
recorded in which death has taken place from hanging when the
feet were in contact with the ground, or the  persons were  almost
sitting  or  recumbent;  they may be regarded  as mixed cases  of
hanging and strangulation.  The reports of eleven cases of suicidal
hanging or strangulation A\Thich I have collected within a few years,
give the following results: in three, the deceased were found nearly
recumbent; in four, in a kneeling posture—the body being more or 
       EVIDENCE  FROM  THE  POSITION OF  THE BODY.   419

 less supported by  the  legs; and  in four, the persons  were found
 sitting.^  In one case, the deceased, a prisoner, Avas  found hanging
 to the iron bar of the Avindow of his prison, which Avas so low dial;
 he Avas almost in a sitting posture.
   Remer found that among one hundred and one cases of suicidal
 hanging, in fourteen, the body Avas either standing or kneeling, and
 in one instance, it Avas in a sitting posture.   Dr. Duchesne has pub-
 lished an account of fifty-eight cases in Avhich the suspension of the
 body Avas^  partial—the  feet or trunk being more or less  supported.
 Twenty-six of these cases are new.  The" reporter draAvs  the con-
 clusion that suicide by hanging is consistent with any posture of the
 body, even Avhen resting upon the tAvo feet.   ("Ann. d'Hyg.," Oct.
 1845, vol.  2, pp. 141 and 346.)  Further evidence  need not be ad-
 duced to shoAvhoAv unfounded is that popular opinion Avhich Avould
 attach the idea of homicidal interference to cases in which a bodv
 is  loosely suspended, or in Avhich the feet are in contact with any
 support.  We ought rather to consider  these facts as removing a
 suspicion of homicide; for there are probably few murderers Avho
 would suspend their victims, either living or dead, Avithout taking
 care that the suspension was not partial, but complete. Besides, the
 facts of  many of these cases are readily explicable; thus, if the
 ligature  is formed  of yielding  materials, or if it is only loosely
 attached, it will yield to the  weight of  the  body after death, and
 alloAV the feet to touch  the floor, Avhich they might not have done
 in the first instance.  If there is reason  to  believe that the 'body
 has not altered its position after suspension, Ave must remember the
 facility Avith which insensibility comes on, and the  rapidity  Avith
 which death commonly ensues in  this form of asphyxia.  (See p.
 385, also "Med. Gaz." vol. 44, p. 85.)
   The limbs secured in  suicidal  hanging.—One  or  twTo points are
 Avorthy of notice in relation  to this medico-legal question.   The
 hands or legs, but more  commonly the former, have been found tied
 in  cases of undoubted suicidal hanging ("Ann.  d'Hyg." 1832, vol.
 1, p. 419);  and yet it has been gravely debated whether it Avas pos-
 sible for a person to tie  or bind up his hands, and afterwards hang
 himself!   It is unnecessary to examine  the ingenious  arguments
 which have been urged against the possibility of an act of this
 kind  being performed,  since they are refuted by  Avell-ascertained
 facts.
   It has  also been a debated question, whether  corporeal infirmity,
 or some  peculiarity affecting  the hands,  might not interfere w7ith
 the poAver of an individual to suspend himself.  This question can
 be  decided only by reference  to the special  circumstances of the
 case.  In the case of the Prince de  Conde, it was  alleged that he
 could not have hanged  himself, in  consequence of  a defect in the
 power of one hand; it was said that he could not  have made the
 knots in Avhich the craA'ats, by wdiich he was suspended, Avere tied.
 Allegations of this  kind appear to have  been too  hastily made in
this and  other instances.  A determined  purpose will often make
up for a great degree of corporeal  infirmity ; and unless Ave make 
420   EVIDENCE  FROM THE  POSITION  OF THE  BODY.

full allowance for this in suicide, Ave shall always be exposed to
error in drawing our conclusions.   Blindness is no obstacle to this
mode of perpetrating suicide ; and in reference  to age, suicide  by
hanging has been perpetrated by a boy of nine, and by a man of
ninety-seven years of age.

  [Some interesting observations and experiments with  reference
to the  eyes of persons executed by hanging, were made at the
execution of Anton Probst, by Dr. E. Dyer, of this city: " Fracture
of the crystalline lens, as a result of death from violent  hanging,
has, I believe, never been noticed.  The following case and experi-
ments  show that it is possible, and that it has probably been over-
looked in many cases where post-mortem  examinations have been
made:—
  " Anton Probst was hung in Philadelphia, June 8th, 1866, eet. 24.
Weight, 174| lbs.   The drop was three feet; length of cord five
feet.  There were no convulsions.  Previous to the execution both
eyes were examined carefully with the ophthalmoscope, and Avere
found  normal.   Thirty-five minutes after the drop fell, the eyes
were again examined with  the ophthalmoscope by an electric light
(charcoal points).   In  the  right  eye there was seen a horizontal
line running across the lens ;  it was not sharp, but from it minute
lines ran up and  dowm, some longer and some  shorter.  It gave
exactly the appearance of a crack  in a  clear cake of ice.   As the
eyeball was rolled downwards, it was evident that there was a crack
or rupture in the crystalline lens, which extended from the anterior
capsule backwards to the middle of the  lens.  It had a remarkable
opalescent or iridescent appearance. The anterior capsule was rup-
tured.  This fracture was about a line below the horizontal diame-
ter of the lens. In the left eye the same appearances  was observed,
but in a less degree.  The capsule was evidently ruptured, but the
rupture of the lens-substance did not  extend so deep.  The eyes
were removed and carefully dissected.   All the observations made
with the ophthalmoscope were entirely corroborated.  The capsule
of the right eye was broken from one edge of the lens to the other,
and the lens itself was broken  open to the centre.  The left cap-
sule was ruptured, and in the lens-substance the rupture extended
about a line backwards.
   "Three large dogs were hung in the following  manner: The
rope was adjusted around the neck and made fast to a cross-beam.
A  man held  the dog up  to the beam  and let him fall, following
him with his  hands, and  as the rope  became taut, the force was
continued by the man pressing  the dog  down with all his force.
This added at least twenty pounds to the weight of the dog.  All
the dogs weighed over thirty pounds.  Dog No. 1 died without
struggles.  Both lenses were fractured.   Dog No. 2 died hard, and
with convulsions Avhich lasted 8-10  minutes.  No lesion of either
lens was observed.  Dog No.  3 died with a few spasms.  The right
lens was fractured ; the left was intact.
   " It will be  observed that one man and three  dogs wrere hung— 
          CAUSE OF  DEATH IN  STRANGULATION.       421

four subjects in all.  In three  out of the four, fracture of the lens
was found. In two of the four, in both eyes, and in one in a siugle
eye only.  The fracture was most marked on the side opposite the
knot.   Of the eight ej7es in these four  subjects,.five shoAved a frac-
ture of the capsule of the lens, and the lens-substance itself  in a
greater or less degree.  For a more  detailed account of these cases
see'NeAv  York  Medical  Journal,'  vol. iii., and ' Transactions of
the American Ophthalmological Society,' third year."—P.]
STRANGULATION.
                 CHAPTER  XXXVIII.

CAUSE OF DEATH.—APPEARANCES AFTER DEATH.—WAS DEATH CAUSED
  BY STRANGULATION, OR AVAS THE CONSTRICTION APPLIED TO THE NECK
  AFTER DEATH ?—MARKS OF VIOLENCE.—ACCIDENTAL, HOMICIDAL AND
  SUICIDAL STRANGULATION.

  Strangulation.—Cause of death.—Hanging and strangulation are
usually treated together, and some medical jurists  have admitted
no  distinction in the meaning of these terms.  In hanging, the
phenomena of asphyxia take place in consequence of the suspen-
sion of the body,  while in strangulation, asphyxia may be induced
not only by the constriction produced by a ligature around the neck
independently of  suspension, but by the simple application of pres-
sure, through the  fingers  or  otherwise, on the Avindpipe.  M. Tar-
dieu considers that the two modes of death should be kept distinct.
The external and  internal  appearances in some respects differ; and
while the proof of death from hanging leads  to the strongest pre-
sumption  of  suicide, the proof of  death from  strangulation  is
equally  presumptive of murder.   (Sur la Strangulation, "Ann.
d'Hyg.," 1859, vol. 1, p. 107.)   This medical  jurist defines "stran-
gulation to be an  act of violence, in  which constriction is applied
directly to the neck, either around it or in the fore-part, so as to
prevent the passage of air, and thereby suddenly suspending respi-
ration and life."   This definition obviously includes hanging, and
every person Avho is hanged may be said to be strangled; but while
there  is only one  method of producing death by hanging, there
are  A-arious methods of producing death  from strangulation.  A
person may be strangled  by the use of a cord, band, or ligature
drawn tight  round the neck, or by manual violence to the front
of the neck, whereby respiration is prevented.  The cause of death
is asphyxia or apnoea.   The rapidity with Avhich it takes place Avill 
422
POST-MORTEM  APPEARANCES.
depend on the degree and  situation of the  pressure, and the com-
pleteness with which the act of breathing is obstructed.
  M. Faure applied a ligature forcibly and suddenly to the neck of
a middle-sized  dog.  For  fifty-five seconds the animal did  not ap-
pear  to suffer;  but  he  suddenly  became violently  agitated, his
body stift'ened, and he rolled convulsively on  the ground.  A bloody
froth issued from his nostrils and throat, and he made frequent and
violent efforts to respire.  In three minutes and a half he was dead.
In  a second experiment, an  elastic tube was introduced into the
Avindpipe, Avhich admitted  of being gradually closed  by pressure.
The animal could bear the pressure up to the reduction of one-half
of the calibre of the tube ;  but beyond this he suffered greatly, and
when  the  pressure was increased  he had  convulsions.  The dog
died, in  great suffering, before the  tube was  completely  closed.
(" Ann. d'Hyg.," 1859, vol. 1, p. 122.)  It is probable that  human
beings die more  quickly7 than animals, especially from the effects of
manual strangulation.  A  sudden  and violent compression of the
Avindpipe  renders a person  powerless to call  for assistance and give
alarm, and  it causes almost immediate  insensibility and  death,
Avithout convulsions.  When a ligature or bandage  is used, the
pressure is not so complete, and death takes  place more slowly with
convulsive  movements.   The  circulation of  dark-colored  blood
continues for a short interval (about  four minutes), as in other
cases of asphyxia.  Owing to this, the face  and lips in accidental
strangulation have been observed  to  acquire a dark leaden hue.
This arises partly from the arrest of the current of venous blood
as the result of compression of the vessels, and partly from the
circulation of unaerated blood.  There is a fair chance for recovery
if the cause of constriction  is removed, and air is  permitted to
have access  to the lungs within a  period of five minutes;  this is
on the assumption that no great mechanical injury has  been done
to the neck.
  In the act of strangulation a much greater degree of violence is
commonly employed than is  necessary to cause death ; and hence
the marks produced  on  the  skin of the neck  will be, generally
speaking,  much  more evident than in hanging, Avhere the mere
weight of the body is the medium  by which the Avindpipe is com-
pressed.
  Post-mortem appearances.—The appearances after death are similar
to those of hanging,but the injury done to the parts about the neck
is commonly greater. Externally.—If much force has been used in
producing the constriction,  the windpipe,  Avith the  muscles and
vessels in  the fore-part of the neck, may be  found cut or lacerated,
and the vertebras of the  neck may  be fractured.  The face is com-
monly livid and SAvollen, the eyes wide  open, prominent, and con-
gested, and  the  pupils are dilated.  The tongue is swollen, dark-
colored, and protruded ; it  is sometimes bitten by the  teeth, and a
bloody froth escapes from  the mouth and nostrils.   The principal
external signs of strangulation are  seen in the marks on the neck,
produced  either by  a cord or  manual pressure.  M. Tardieu has 
MARK PRODUCED  BY  THE  LIGATURE.        423
described another  appearance which  might be  overlooked.  This
consists in the presence of numerous small spots of ecchymosis upon
the skin of the face, neck, and chest,  as well as in the conjunctivae
of the eyes.  These parts present a dotted redness, which has, how-
ever, been met Avith in other cases besides death from strangulation.
("Ann. d'Hyg." 1859, vol. 1, p. 125.)
  The mark on the neck when a ligature has been used is commonly
described as a depression, wide but not deep, and corresponding  in
its characters  to the form and thickness of the  ligature and the
mode in which it  has been  secured.   Too much importance must
not be attachedto  this supposed correspondence when the ligature
is not forthcoming.  In a case of accidental strangulation which I
saw in November, 1864, the mark round  the neck presented the
appearance which might be expected from the use of a narrow cord.
But, in this instance, a soft silk neckerchief was the means of con-
striction, and the peculiar narrowness  of the mark on one side, Avas
OAving  to the great tightness with Avhich  it had been drawn.   The
mark or  impression produced by a ligature is  generally circular,
from the mode  in which the pressure is produced.   It may  be
situated at any part of  the  neck, but it is more commonly below
the Avindpipe.   In manual strangulation the marks of bruising and
ecchymosis will be in the front of the neck, chiefly about the larynx
and below it.  The circular  direction  of the mark produced by the
ligature is not an absolute indication  that strangulation has taken
place Avithout suspension of  the body, since cases of hanging have
occurred  in which a circular mark has been observed  ; and it  is
possible that some degree  of obliquity  may occasionally exist  in
the course of the depression  produced by a ligature in strangula-
tion.  A medical jurist ought, therefore, to weigh all the facts con-
nected Avith the position of the body,  and the nature and direction
of the  ligature, before  he forms an opinion, from the appearances
presented by the mark on the neck, Avhether the person has been
hanged or not.  Greater importance is  to be attached to the lividity,
ecchymosis, and abrasion of  the skin in the course of  the ligature,
than to the circularity or obliquity of the depression  produced by
it.  In the strangling of a living person by a cord, it  is scarcely
possible that a murderer can  avoid producing on the neck marks
of severe injury, and in the existence  of these Ave have evidence  of
the violent manner in Avhich death has taken place.
  On the other hand, a person may be strangled, and yet the liga-
ture, in consequence of its being soft and of a yielding nature, will
not cause a perceptible depression or ecchymosis—scarcely anything
more than a slight  depression of  the skin.  If we except cases  of
suicide, such a  condition  must be rare;  because  assailants usually
produce a much  more violent constriction of the neck than is ne-
cessary to insure the deatli of a person.  The general lividity of the
body, contraction of the fingers, Avith  clenching of the hands and
SAvelling and protrusion of the tongue, are more marked in strangu-
lation than  in  hanging.   A  thin mucous froth tinged with blood
is  occasionally found in the air-passages in both cases.  In some 
424
INTERNAL  APPEARANCES.
instances of strangulation, it is said, blood has escaped from one or
both ears during the act; but it is not a usual appearance.  In two
well-marked cases, in which  I Avas  consulted, the constriction of
the neck was carried to a great degree, but there was no bleeding
from the ears.  Dr. Geoghegan has informed me that in one instance
of suicidal strangulation which he examined, the constriction  had
been produced by a ribbon, and the violence applied  was sufficient
to produce bleeding from one ear; on dissection, this was found to
have resulted from a rupture of the membrane of the drum of the
ear.  There was no froth at the mouth or nostrils, and scarcely any
lividity or swelling of the  face.   It was further observed that the
mark on the neck, which was deep, almost disappeared on the re-
moval of the ligature.   Sir W. Wilde, of Dublin, met with a case
in which rupture of the membrane of  the drum of  the ear, with
effusion of blood, Avas caused by strangulation.  Bleeding from the
ears, as  a result of rupture of the  membrane of the drum, must
however, be regarded as an exceptional  appearance.  Dr. Chevers
does not  mention it as haviug  been  noticed in any one of the
numerous cases which  he has collected in his Indian experience,
although bleeding from the nostrils had been observed.  (" Med.
Jur. for India," 1856, p. 374.)  Without rupture of the  membrane
of the drum, blood could not issue from the ears, and in  order that
this membrane should be ruptured, certain conditions not commonly
met with may be required.
   Internally.—In a case which occurred to Dr. Fuller, the body of
a woman who had been homicidally strangled presented  the follow-
ing appearances.  The skin of the head, face, neck and chest Avas
darker than natural, and discolored underneath, particularly that
of the scalp.   The brain was suffused  with  dark blood, the lungs
gorged and of a dark color, the bowels of a dusky-red color.  The
eyes were somewhat protruded and blood-shot, the lips SAVollen and
darker than natural, the tongue  slightly protruding between the
teeth, and froth issuing from the nostrils.  There was  a mark of
pressure  behind the right  ear, and other marks on  the neck  and
chest,  with discoloration  of the muscles.   (Chevers's  " Medical
Jurisprudence for  India,"  p. 378 ; see also p. 387.)   In a  case of
suicidal  strangulation  Avhich occurred at Liverpool, in 1863, the
body of the deceased was found—dead, cold, and rigid—about seven
hours after he had been seen alive.   The arms Avere  fixed, and the
hands raised a little above the breast.  Round the neck, just below
the cricoid cartilage, was a strip of the deceased's shirt,  which had
been used as a ligature ;  it Avas tied at the back of the neck.  There
was slight ecchymosis in the mark beneath.  The skin  of the face
had a dark red-color, and was dotted with spots of a deeper red.
The conjunctivas were ecchymosed, and some blood had  escaped
from the  nose.  The brain w7as congested, and  much fluid  effused.
The heart was empty; the lungs were deep in color (congested.)
(" Lancet," Aug. 15, 1863, p. 183.)   Many of the cases  of strangu-
lation which have presented themselves have been too superficially
examined.  The most  complete account of the appearances is  that 
            STATE  OF  THE HEART AND LUNGS.         425

giA-en by M. Tardieu.  It is based on observations made in twenty-
eight inspections.  ("Ann. d'Hyg."  1859, vol. 1, p. 132.)  The
lining membrane of the larynx and windpipe Avas more or less red-
dened from congestion;  sometimes it was  livid, or of a dark-red
color.  There  was a bloody froth extending into the air-tubes.
The state of the lungs was variable.  Contrary to what is generally
alleged  to  be  characteristic  of  death by asphyxia, M. Tardieu
found these organs  to contain but little blood.  Sometimes they
were congested, at  other times normal.   There w7ere ruptures  of
the superficial  air-cells, producing  patches  of emphysema,  Avhich
were seen singly or in groups.   This  condition, which was  rarely
absent, gave to  the surface  of the  lungs the  appearance of being
covered  with white  layers of thin false  membrane.  When these
patches  were punctured,  air escaped.  There  was an  absence  of
that condition of the lungs which he observed in death from simple
suffocation, namely, dotted ecchymosis on the surface, immediately
below the investing membrane (the pleura.)  Throughout the sub-
stance of the lungs,  effusions of blood varying in size Avere, how-
eA7er, generally found, provided an early inspection of the body was
made.   When some days had elapsed, the lungs were found pale  or
congested, without any ecchymosed or mottled appearance. The
ruptured air-cells with air beneath them, were still visible on the
surface.
  The heart presents no uniform condition ;  it is sometimes quite
empty, and at others, it contains dark fluid blood.  The brain  is
occasionally congested, but more commonly in its natural state.
In one instance blood was found effused on the brain, but this is an
unusual appearance.  It has also been stated that a congested state
of the sexual organs, both in males and females, was one  of the
appearances connected  Avith  strangulation, but this has not been
confirmed by careful observers.  M. Tardieu met writh nothing  to
call for notice  in this respect in  the numerous cases Avhich he ex-
amined.  The  involuntary discharge of feces, urine  and seminal
fluid, described as one of the characters of death by hanging, may
equally occur in death from  strangulation.   No importance can be
attached to this as a sign of death  from asphyxia in any form.   It
frequently occurs in sudden and violent death from  any cause, and
there are many  instances of death from asphyxia in  which it is not
observed.  Among the occasional appearances of violent strangula-
tion may be mentioned injury to the windpipe and  the  muscles  of
the neck around it.  One case, in which the rings of the Avindpipe
were split as a  result of pressure, Avas  communicated to me by Dr.
Inmau, of Liverpool.  Several instances of laceration and rupture
of the Avindpipe are quoted by Dr. Chevers.  (Op. cit. pp. 381,384.)
In one instance, the ossified thyroid cartilage had been broken and
forced iiiAvards, causing suffocation.  In Reg. v. O'Brien (Liverpool
Winter Assizes, 1857), a case of  alleged  murder by strangulation,
the cartilage of the Avindpipe Avas broken ; and in the case of  Pinck-
hard, the windpipe was broken longitudinally-  In reference to frac-
tures of the larynx, see Casper, "Klinische Novellen," 1863, p. 497. 
426   MEDICAL PROOFS OF DEATH FROM STRANGULATION.

In suspected homicidal strangulation it is ahvays proper to examine
the contents of the stomach for narcotic poison.   In all cases, the
cord or ligature, if forthcoming, should  be carefully examined, in
order to determine whether it bears upon it marks  of blood, or
whether hair or other substances are adhering to it.  A portion of
it should be reserved for the purposes of identity.  In two instances
of homicidal  strangulation, the ligatures found  round the  dead
bodies were proved to correspond with portions of the same mate-
rial found in the possession  of the persons who were charged with
the murders.  In removing the ligature from the neck, the precise
mode in which it is tied or secured should be noticed, as this may
be a fact of importance in reference to the allegation of suicide.
  The medico-legal questions relative to strangulation are of the
same nature as those which have been already considered in treating
of hanging.  Thus, in examining the body of a person suspected to
have been strangled, we  may be required to answTer the folloAving
question:—
   Was death  caused by strangulation, or was the  constricting force
applied to the neck after death ?  Medical jurists have hitherto con-
sidered that the internal appearances throAv no light upon this ques-
tion.  This opinion  probably arose from the fact that inspections
have not been made until some days after death, when the peculiar
appearances of strangulation have been  merged in those of putre-
faction.  The state of  the  lungs, however, may be considered as
characteristic.  It  would be impossible, by the application of a liga-
ture round the neck of a dead body to produce rupture of the air-
cells on the surface  of  the  lungs, and effusions of blood in their
substance.   The state of the eyes  and of the inside of the  larynx
and windpipe in  persons who have  been strangled could  not  be
imitated by any constriction of the  neck after death;  no  bloody
mucous froth Avould be  found  in  the windpipe or air-tubes.  The
external appearances have been considered to furnish more accurate
means of distinction.   Although the condition of the neck gene-
rally yields the strongest evidence, it will be proper to  seek for that
appearance of dotted redness or ecchymosis in the  skin of the face,
neck and chest, described by Tardieu.  The state of the eyes, as to
their prominence  and the congestion of  the  membranes, as well as
the position of the tongue, should also be examined.   The ecchy-
mosis about the depression  of the neck, when a ligature has been
employed, with the accompanying swelling and lividity of the face,
are  phenomena not likely to be simulated in a dead body by the
application of any degree of violence.   When the  constriction is
produced within a few minutes after death, an ecchymosed depres-
sion may result;  but it is improbable  that  there  should  be any
lividity or swelling of the countenance.  Prof. Casper found that
when the constricting force was not  applied to  the neck until six
hours after death,  the mark indicative of vital strangulation could
not  be produced.  It is doubtful whether  it could be produced in
the dead body an hour after death.  The period  cannot be deter- 
MEDICAL PROOFS  OF DEATH  FROM  STRANGULATION.   427

mined with  positive certainty;  the results would probably vary,
according to the rapidity with which the body had cooled.
  It is difficult to conceive under Avhat circumstances an attempt
to simulate  strangulation in  a recently dead body could be made,
unless for the purpose of throAving suspicion upon an innocent per-
son connected Avith the deceased.   When  an  individual has  be^n
murdered, it is not likely that the murderer would attempt  to pro-
duce the appearances of strangulation on a body after death, under
the idea of concealing his crime; for strangulation is in most  cases
an actual result of homicide,  and is rarely seen as an act of suicide.
In the absence of ecchymosis from the neck, it Avill be difficult to
form an opinion, unless from circumstantial evidence;  but there
may not be an ecchymosed circle ; for a person may be strangled by
the application of pressure to the windpipe through the medium of
the finger-nails, or of any hard or. resisting substance.  The ecchy-
mosis in such a case will be  in detatched spots or patches.   In the
absence of all marks of violence  round the neck, we  should be cau-
tious in giving an opinion which may affect the life of an accused
party; for it is not probable that homicidal strangulation could be
accomplished without  the production of some appearances  of vio-
lence on the skin  over the larynx or windpipe.  It is doubtful
Avhether strangulation can ever take  place  without some mark
being found on the  neck indicative of the means  used.  The bare
possibility of death being caused in this manner, without leaving
any appreciable trace of violence, must be admitted ; although the
admission scarcely  applies to those cases Avhich  require medico-
legal  investigation.   Suicides and murderers generally  employ
much more violence  than is  necessary for the purpose of destruc-
tion—hence detection is easy.  But if a soft and elastic band w7ere
applied to the neck, Avith a gradually7 regulated force, it  is possible
that a person might die strangled, Avithout any external sign being
discovered to  indicate the manner of his death.   Indian surgeons
inform  us that the  Thugs, and  other robbers met  Avith in India,
are thus accustomed to destroy their victims with the dexterity of
practised murderers.  A case involving this question of  strangula-
tion Avithout marks of violence  on the neck,  was tried in  France,
and from the medical evidence decided in the affirmative.   (" Gaz.
Med." 9 Mai, 1846, p. 375.) The medical witness should,  Iioav-
ever, be prepared to consider  whether, in the absence of any mark,
death might not have  proceeded  from another cause, anel leaA7e it
to the authorities of  the  laAV to  decide, from  circumstances, in
favor of  or against the prisoner.   There is, I  conceive, nothing to
justify a medical witness in stating that death has proceeded from
strangulation, if there should be no appearance of lividity, ecchy-
mosis, or other violence about the neck or face of the deceased.
Congestion in the organs of  generation is an appearance Avhich it
Avould not be safe to take as evidence of death from  strangulation.
The state of the countenance alone will  scarcely warrant the ex-
pression of an opinion: for there  are many kinds of death in Avhich
the features may become livid and distorted from  causes  totally 
428   MEDICAL PROOFS  OF DEATH  FROM  STRANGULATION.

unconnected with the application of external violence to the throat,
unless accompanied  by other Avell-marked signs of  this  mode of
death.  So, again, the eyes and tongue may be protruded as a result
of putrefactive changes.
  Let not a witness, then, lend  himself as an  instrument for the
condemnation of a person against whom nothing but a strong sus-
picion from circumstances may be raised, and where medical  evi-
dence is unable to furnish any  distinct and conclusive proofs of
death from strangulation.  This caution is especially necessary in
reference to the inspection of bodies which are  in a state of putre-
faction.   A  medical man, already provided with a  theory of the
cause of death by the discovery of a rope or other means of  con-
striction, may easily arrive at the conclusion that death has taken
place from strangulation.  The absence of the  usual confirmatory
appearances in the  body may be ascribed  to  decomposition,  and
those caused  by decomposition may  be  set down to strangulation.
When there  is obvious  mechanical  violence to the neck, such as
fracture of the larynx or Avindpipe,  with laceration of the muscles
beneath, a visible depression, such as a cord,  a  ligature, or manual
pressure would produce,  a  medical opinion  may be fairly given in
spite of putrefaction.  But when in a putrefied  body, indistinct
marks on the  neck, or  patches of  discoloration  are relied upon
as evidence of  a homicide, there is great risk of a serious medical
mistake.
  In cases of alleged drowning, it is sometimes the practice to ask
a medical witness how far his opinion of the cause of death has been
influenced b}7 the discovery  of  the  dead body  in  or near wrater.
In cases of alleged strangulation a similar question may be put in
reference to the discovery of a rope or ligature round the  neck of
the deceased, or in the apartment in which the  dead body is found.
A medical opinion should rest upon the clear  and obvious effects
produced on the neck, and on the structures below the skin,  and
not upon the mere presence of a cord or ligature.   This might be
put round the neck of a dead body, or near to  it, for a malicious
purpose.  The act of strangulation should be, medically speaking,
as distinctly provable without the production of a rope, as the act
of stabbing without the production of the knife which inflicted the
stab.  If these principles are not strictly adhered to in practice,
polrCemen would be as competent as medical experts to give  evi-
dence of the cause of death in cases of alleged strangulation.

  It is scarcely necessary to state that all marks of violence on the
body of a supposed strangled person  should be accurately noted, as
the questions respecting them, however slight the marks  may be,
are material.  The witness will  be expected to state whether they
were inflicted before or after death; if  before, whether  they were
sufficient to account for death, or whether they were such as to be
explicable on the supposition of  an accidental, suicidal, or  homi-
cidal origin.  It should be observed whether there exist any morbid
changes, sufficient to account for death, in either of the three great 
SUICIDAL STRANGULATION.              429
cavities of the body, as this kind of evidence may be essential in
the progress of the case.   In reference to females, Avhether children
or adults, the surgeon should  not  neglect to examine the sexual
organs,  to  ascertain Avhether  there are any marks of violation.
Cases have occurred  in  which rape  has been perpetrated,  and
strangulation resorted  to for the purpose of concealing the crime.
  Strangulation, like hanging, is occasionally the result of accident,
but the occurrence may be looked upon as rare.  When the body
is not suspended, it is commonly more in the power of a person to
assist himself, and escape from the constriction ; hence cases of acci-
dental strangulation are less frequent than those of accidental hang-
ing. As a general rule, cases in which the constriction of the neck
has been produced by some accident, present no difficulty to a medi-
cal  jurist, provided the relations of  the body to surrounding objects
and the compressing force have not  been disturbed.   Should it hap-
pen, however, that the body has been  removed  from the place in
which it Avas first discovered, or the ligature taken from the neck,
Ave  can only establish a presumption of accident from the descrip-
tion ghren.
  When a charge of murder is instituted against a person, an at-
tempt is not unfrequently made by  counsel for the defence to shoAV
the probability that the deceased might have fallen while in a state
of intoxication, and have become accidentally strangled, either by
a tight cravat, or by some foreign substance exerting pressure on the
windpipe.  If we admit  the possibility of an occurrence of this
nature, we must not lose sight of the existence of other more pro-
bable modes of death ;  nor should we allow our judgment to be so
swayed as to abandon  what is probable for that which is merely
possible.
  Suicidal  strangulation.—This  mode  of suicide is of  rare occur-
rence, and except under particular circumstances, impossible.  The
possibility of an individual strangling  himself w7as  for a long time
denied by medical jurists ; for it was presumed that when the force
was applied by the hand, all  power would  be lost  as soon as  the
compression of the windpipe commenced.  This reasoning, which
is physiologically correct, is, hoAvever, only applicable to those cases
iii'Avhich the windpipe is voluntarily  compressed by the fingers.
when a person determined on  suicide allows the windpipe to be
compressed, by leaning Avith the Avhole weight of  his  body on a
cord passed round his neck and attached to a fixed  point, he may
perish in this manner almost as readily  as if he had hanged himself;
for  insensibility and death will soon supeiwene.  In the chapter on
Hanging, it Avas stated that suicides were often found with  their
bodies in close contact with the ground; and cases  are reported in
which  strangulation Avas accomplished, in the manner above  de-
scribed, Avhile the suicide Avas in a sitting or  kneeling posture (p.
418).  On other occasions, the peculiar disposition or nature of the
ligature has enabled a person bent on suicide to strangle himself
without much difficulty.  An instance is related by Orfila, in which
tAvo craATats, that Avere tAvisted several times round the neck of the 
430
HOMICIDAL STRANGULATION.
deceased, Avho w7as discovered lying on his bed, had effectually served
the purpose of self-destruction.  (""Med. Leg." vol. 2, p. 389.) Some-
times strangulation has been suicidally effected by a rough  cord
passed repeatedly round  the neck, and tightened  by being pulled
w7ith each hand.  The number of coils would still cause some  pres-
sure to be exerted even when the grasp was relaxed by death.  (See
"Guy's Hospital Reports," Oct, 1851.)  Other cases are related, in
which  suicides have succeeded in  strangling themselves by tighten-
ing the ligature with a stick (see " Guy's Hospital Reports,"  Oct.
1851); or w7hen the ligature was formed of thick and rough  material,
by simpl}7 tying it in a knot.
  Although  suicidal strangulation  may be  effected under unex-
pected  circumstances, yet in a case of murder by  strangulation, it
Avould  not be easy to simulate suicide; it would at any rate require
great skill and premeditated contrivance on the part of a murderer,
so to dispose the body of his victim, or to place it in such a  rela-
tion to surrounding objects, as to render a suspicion of suicide  even
probable.   Thus, if the cord or ligature  should  be found loose  or
detached—if the ecchymosis or mark in the neck  should not accu-
rately correspond to the  points of greatest pressure—if, moreover,
the means of compression were not evident when the body was first
discovered and before it had been removed from its situation, there
Avould  be fair grouuds for presuming that the act was  homicidal.
In those cases in which strangulation has resulted from a  compres-
sion of the Avindpipe by  the fingers,  and where there are  fixed ec-
chymosed marks indicative of direct manual violence, Ave  have the
strongest presumptive evidence of murder; for neither accident nor
suicide could be urged as affording  a satisfactory explanation  of
their presence.
  Homicidal strangulation.—Strangulation occasionally comes before
our courts as a question of murder; and when  a  person  has  been
tried upon a charge of this kind,  the circumstances have been com-
monly so clear, as to render the duty of a medical  witness one  of a
simple nature.  When the cause of death is contested, or when it is
contended in defence that the strangulation is suicidal, a medical
Avitness must be prepared to give his reasons for affirming that the
act Avas not done by the deceased himself.  He must be prepared to
meet and explain the differences between the case  under investiga-
tion and those reported cases  which are  admitted to  have  been
suicidal.   The attitude of the body, the condition of the dress, the
means of strangulation, the presence of marks of violence or of blood
on the person of the deceased—on his clothes, on the furniture of the
room, or on  the rope or ligature, are circumstances from  which, if
observed at  the time, important medical inferences may be drawn.
As a rule, whosoever attempts to imitate suicide under such a form
of murder must, when the facts are properly investigated, inevitably
fail in his object.   The assassin either does too little, or he does too
much.   In one case of murder by strangulation,  the woman who
perpetrated  the crime had been a nurse in an infirmary, and accus-
tomed  to lay out dead bodies.  After the act of murder she appears 
HOMICIDAL STRANGULATION.
431
 to have  carried out  unthinkingly, her  professional  practice, by
 smoothing the clothes under  the body, placing the legs at full
 length, the arms  out straight by the side, and the  hands open and
 laid out! _ Such a condition of the body Avas quite inexplicable on
 the supposition of suicide, considering the amount of violence which
 must have attended the strangulation.  In another case, the criminal
 had attempted to make the death appear like an act of suicide by
 placing the  lower end of  the  rope near the hand of  the deceased;
 but he selected the left hand when the  deceased Avas  right-handed,
 and he did not leave enough rope free from the  neck for either  hand
 to grasp  in order to produce the very violent constriction of the neck
 which had  been caused  by the tAvo  inner  coils.  Both of  these
 criminals confessed their  crimes before  execution.
   It is proper to notice, in this place, the frequent occurrence within
 a recent period of what are called " Garotte robberies."  The system
 of murder normally pursued by the Thugs in India appears to have
 been imported into England, and  many lives have  been destroyed
 in the manufacturing  districts and in  large towns, by the employ-
 ment of strangulation for  the purposes of robbery.  In  spite of many
 convictions, there is reason to believe that many criminals still set
 the law at defiance.  The rigorous  proof required of facts Avhich
 under these assaults  can  rarely  admit of proof, confers complete
 impunity on the assailants.  The attack is made during darkness ;
 the person is seized by the windpipe from behind, or a bandage is
 thrown around his neck; and this is suddenly tightened while
 accomplices are engaged  in perpetrating robbery.  The nature of
 the assault by pressure on the Avindpipe, renders it impossible to
 giATe an alarm  or call  for assistance.  The person  assaulted, if he
 should recover, is seldom able to identify an assailant; he is attacked
 from behind, is rendered immediately senseless and powerless, and
 can rarely offer resistance.  Recovery or death in such  cases depends
 on the lapse of a few seconds, more  or less, during which the con-
 striction  of the neck is continued—on  the degree  of constriction,
 and on the age, sex  and strength of  constitution of the person
 assaulted.  An attempt at strangulation, as in garotting, besides
 inflicting  serious local  injury to the Avindpipe  and other parts  near
 to it, may cause a state of insensibility Avhich may  continue for
 some hours.   There is  severe pain in the throat, with difficulty of
 speaking  and  swallowing, and if the  larynx  be seriously7 injured
 there may be loss of voice.  Dumbness, however, is not one of the
 secondary symptoms; and loss of voice is usually only temporary
 during the pressure.  By the 24th and 25th Victoria, c.  100, s. 14,
 it is enacted, inter alia, that " whosoever shall attempt  to drown,
 suffocate, or strangle any  person with  intent  to commit murder,
 shall, Avhether any bodily injury be effected or not, be guilty of
 felony; and being  convicted thereof shall be liable, at the discre-
 tion of the court, to be kept in penal servitude for life, or for any
 term not  less  than three  years, ... or to be  imprisoned for any
term not exceeding tAvo years."   As the intent in these cases  is to
perpetrate robbery, and  not murder, another  section (21) has been 
432         MARKS  OF  VIOLENCE  ON  THE  BODY.

framed, for the prevention of the crime of garotting: " Whosoever
shall  by any  means  whatsoever,  attempt to  choke, suffocate or
strangle any other person, or shall,  by any means  calculated to
choke, suffocate,  or strangle, attempt to  render  any other person
insensible,  unconscious, or incapable  of resistance, with intent, in
any of such cases, to enable himself, or any other person, to commit,
or with intent in any of such cases thereby to assist any other
person  in  committing any indictable  offence,_ shall be  guilty of
felony; and being convicted thereof  shall be liable, at the discre-
tion of the court, to be kept in penal servitude for life, or for any
term not less than three years, .  . . or to be imprisoned for any term
not exceeding tAvo years," etc.
   Metrks of violence.—It may be inquired whether marks of violence
on the  body, or blood-stains on the  clothes, furniture, or in the
apartment, do not afford strong evidence of homicidal strangulation.
The answer is—if the marks of violence are such that they could
not possibly haA7e 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  can be returned are exceptions to the  rule.   It  is not
ahvays  in our power  to distinguish accidental or self-inflicted from
homicidal violence ; and we are always bound to  look to the proba-
bility of accident, or of previous  attempts  at suicide, being  the
source  of those  personal injuries  which  may be apparent on a
strangled body.  There may be several marks on the neck, but then
the person  may  have tried to strangle himself more  than once.
The throat may be cut; there may be a deep-seated stab or gunshot
wound, involving some of the  important  organs of  the  body; or
poison may be found in the stomach ; but in a purely medical point
of view, how are Ave to  know that the deceased did not actually
make the marks, inflict  the wounds, or take the poison  before he
succeeded in strangling himself?   In  the chapters on Drowning
and Hanging, we have seen what  suicides can do when they are
desperately bent on destroying themselves.   Wounds and personal
injuries often create  serious difficulties to a  medical jurist, which
it requires  the greatest caution and prudence on his part to meet
and explain.
   The prejudice of the public mind is such, that  the discovery of a
strangled person, with any marks of a personal injury or of poison-
ing in the stomach, would, in most cases, lead to a charge of mur-
der, unless the facts rendered it clearly impossible that any attempt
could have been made on his life.   It is against this prejudice that
a  medical  witness must strenuously guard himself;  he may be
abused  in  not  joining in the outcry of the vulgar, but  the best
recompense for this abuse will be the conviction that he is inter-
posing  the shield of science to  protect a possibly innocent  fellow-
creature from  the senseless denunciations of ignorance.  Further,
before a charge of murder by strangulation  is raised against any
person  from marks and appearances found  on a dead body, care
should be taken that  they admit of no other probable explanation 
CIRCUMSTANTIAL  EVIDENCE.
433
than the direct application of violence.  Even if marks indicative
of strangulation are discovered, the question arises Avhether they
may not have been  produced by the deceased upon  himself in an
attempt at suicide which may have failed.   If the body of a per-
son is allowed to cool Avith a handkerchief, band, or tightly-fitting
collar round  the neck, a mark resembling that of strangulation will
be produced.  Before any opinion is  given that murder has been
perpetrated or  attempted, the  medical proofs on Avhich reliance is
placed should be clear, distinct, conclusive, and satisfactory.
  In the dead bodies of infants and children, in whom the neck is
short, a mark is occasionally seen Avhich arises from the bending of
the head; and in short-necked persons a similar mark or elepression
has been  noticed after death, in  front of the neck.  These marks
are then rendered more  prominently by their assuming a livid ap-
pearance.  They might, at  first, be mistaken for marks produced
by a ligature in an attempted strangulation.   In one case a death
from  apoplexy was  attributed to homicidal  strangulation from a
cadaveric change of this kind.   ("Ann. d'Hyg." 1859, vol.  1, p.
139, and vol. £6, p. 149.) This matter was set right by the late M.
Ollivier.  Homicidal strangulation may be perpetrated on the weak
and infirm Avithout  causing any noise or creating alarm.   In  the
first place, if the throat is at once seized and firmly compressed
no cry can be made, nor any noise produced to excite the attention
of  those  who are  near.   In June,  1857,  an aged woman  Avas
strangled in her shop by an  apprentice in  so short a time  and
with such facility, that her husband, wTho was only separated from
her by a slight partition, heard no noise or disturbance during this
act of murder.  ("Ann. d'Hyg." 1859, vol. 1, p. 157.)
  It cannot  be disputed that in  contested questions  of suicidal  or
homicidal strangulation, rare as they are, we  must be often greatly
indebted to evidence founded on circumstances, as well as to moral
presumptions.  How far a medical jurist may be allowed to make
use of these  in the formation of an opinion, it will be for the court
to determine.  Generally speaking, his duty is  rigorously confined
to the furnishing of medical evidence from medical data alone; but
instances present themselves in which this rule  must be departed
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 a ligature, the state of
the dress, and the attitude of the deceased when discovered, although
not strictly7 medical  circumstances, bear directly upon medical opin-
ions ; and that evidence ought not to be objected to Avhich is partly
founded upon facts of this nature.   It must occur to all, that with-
out circumstantial evidence, the best medical  opinion in these cases
will often amount to nothing.  It may be, for example, no  more
than this: the case is either one of homicide or suicide; and \vhy is
such an indefinite answer to be returned?  Because,in the abstract
view of strangulation, it is not easy to determine whether a liga-
ture was suicidally applied round the neck or not.  The appearances
may be in many cases the same, and where they are different, this
      28 
434              IMPUTED STRANGULATION.
difference may be due to accident, so that it is a mistake to suppose
that Ave must look  to medical circumstances alone for clearing up
this intricate question.  On some occasions, the theory of homicide
or suicide will be equally consistent with the facts.
  In all cases of fatal strangulation resulting from an act of suicide,
the means by which strangulation was produced must be found
upon the neck.  The condition of the mark on the neck, the course
and direction of the  cord, the mode in which it was secured or
fixed in  order to produce  effective pressure  on the windpipe, the
amount of injury to the muscles and  parts beneath, are  circum-
stances from Avhich, if observed  at  the  time,  a correct  medical
opinion may generally be  formed.  If the means of constriction
are removed, or the cord or ligature is  loosely applied, these facts,
unless explained, are presumptive of homicidal interference.
  There is another condition in which a presumption of homicide
will be justifiable.   A man, in strangling himself, is not likely to
vary the means.  The act is commonly due to a sudden impulse, if
Ave may judge from the moral proofs afforded in the instances on
record.   The article Avhich is nearest to the suicide*is seized, and
made the instrument of self-destruction. It has already been stated
as doubtful whether a person  could strangle himself by the mere
application of the finger to the windpipe; the discovery of such
marks only as would indicate this  kind of strangulation, therefore,
renders suicide in the highest degree improbable.   But these marks
may be sometimes  ascribed to the deceased having fallen with his
hand possibly applied to his neck, and the inference will be drawn
that they have accidentally resulted from the pressure of his oAvn
fingers.  This is an improbable mode of accounting for the produc-
tion of ecchymosis  or excoriation of the  skin in  the front of  the
neck.  If, besides these marks of  fingers, we find a circular mark,
with a ligature  still around the neck, the presumption of murder
becomes very strong.  It may be  said that a person might at first
try to strangle himself Avith his fingers, and,  not succeeding, might
afterwards employ  a cord.   But the  degree to  which the coin-
cidental  impressions exist  will assuredly in general remove  this
objection.
  Imputed strangulation.—Hitherto the subject of strangulation  has
been  considered in  reference to  the dead.  But  a living  person
may charge another Avith  attempting murder under such circum-
stances, and  here a medical jurist Avill  have the not very arduous
duty of detecting and exposing the  imposture.  It has been con-
sidered so improbable that any  one w7ould  seriously7 attempt to
strangle himself, and then  impute the act to another, that medical
jurists have  given  but little  attention to this  subject.   A  case
which has been recently tried in France (Affaire Armand et Maurice
Roux, March, 1864) has sIioavii the great importance of it, and how
easily medical men  and the public may be deceived by a plausible
story.  As in reference to imputed wounds, so  in these cases, im-
postors rarely produce such injury to themselves as to place their
lives in jeopardy. The cord is loose round the neck, or there Avould 
                 IMPUTED  STRANGULATION.              435

be speedy death ; it is not so secured as to  press with great force
on the air-passages, to cause  the  tongue to protrude, or to produce
lividity of the  face and neck, or ecchymosis in the conjuncture
and  the skin.   It is  either a ligature or a rope Avhich  is used by
the impostor; he does not commonly resort to manual violence to
his throat.  The marked feature of a really homicidal attempt is
in the great amount of violence done to the  neck; and the account
given by the impostor will be inconsistent  in its details, and  not
reconcilable with the ordinary effects of homicidal strangulation.
Tardieu met Avith a case, in Avhich a young  woman of good social
position, Avishing to excite some public sympathy, alleged that  she
had  been made the victim of a political conspiracy.  One evening
she Avas found at the door of her  room, apparently in a very alarm-
ing state;  she could not speak, but indicated, partly by  gestures,
and  partly by Avriting, that  as she was entering  her room a man
had attempted to strangle her by  pressing his hand upon her neck,
and at the same time had stabbed her in the chest Avith a dagger.
On close examination it Avas found  that the two  stabs had pene-
trated only to the outer clothing.   But the most  singular effect of
the alleged attempt at strangulation was that,-instead of producing
a difficulty of speaking and  alteration of  the voice, it  had been
followed by complete dumbness!   M.  Tardieu, who Avas  officially
authorized to examine the case, could find on the  neck no trace of
any attempt at strangulation  ; and on assuring the young lady that
the loss of voice under such  circumstances could not last for more
than a minute, she at once admitted that there Avas no foundation
for the charge!  (" Ann.  d'Hyg.," 1859, vol.  1, p. 163.)  On this
occasion, no person Avas accused ; but the case is different Avhen, for
the purpose of extortion or other  base motives, one or more persons
are charged Avith an attempt at  murder.  A flagrant instance of
this  kind occurred in France, in which a Avealthy  merchant of
Montpellier AAras charged by his servant, Maurice Roux, Avith having
attempted to murder him by strangulation.  The case Avas tried in
March, 1864, before the Court of Assizes of the Bouches du Rhone;
and,  fortunately for the interests of justice, as Aveli as for the credit
of medico-legal science in France, it ended in a complete acquittal
of the accused.  (Affaire  Armand et Maurice Roux,  Paris, 1864.
" Relation Medico-legale de l'Affaire Armand," etc., par A. Tardieu.
" Annales d'Hygiene et de Me"decine Legale," 1864, vol. 1, p. 415.)
  It  may be observed in reference to these imputed cases, that men
Avho  deliberately strangle others, either draAv  a cord tightly, or
secure it by a  knot.  The pressure to the neck is not so gentle as
to  leave no mark Avhatever,  or to alloAv the strangled person to
breathe  and Avatch all that goes on around him.  Slight marks of
violence about the neck should be viewed Avith great suspicion on
these occasions.   As a rule, a man does not half-strangle any more
than he half-stabs or half-poisons  another;  but the impostor stops
short of this stage,  as he has no intention to destroy himself.   If,
as is most improbable in attempted  homicide, the  cord is left only
loosely coiled around  the neck, the  person assaulted  necessarily 
436          SUFFOCATION. — CAUSE  OF  DEATH.

retains the  power of breathing and calling  for assistance;  but if
the hand of a  murderer has been at Avork, it is effectually tight-
ened, and the person dies in a feAv minutes. A charge of this kind
where there can  be no Avitness  but the  person making it, requires
to be supported, not by medical  probabilities or possibilities, but
by the strongest  medical facts.   These ought to sIioav that there
are marks of violence on the neck such  as an assassin  Avould be
likely to inflict, and, at the same  time, such as the person making
the charge would not  be likely to produce, or have  the poAver of
producing on himself.
SUFFOCATION.
                  CHAPTER  XXXIX.

SUFFOCATION FROM MECHANICAL CAUSES.—CAUSE OF  DEATH.—APPEAR-
  ANCES  AFTER DEATH.—EVIDENCE OF DEATH FROM SUFFOCATION-
  ACCIDENTAL, SUICIDAL, AND HOMICIDAL SUFFOCATION.—SMOTHERING.

  By suffocation Ave are to understand that condition in which air
is prevented from penetrating into the lungs, not by constriction of
the Avindpipe, but by some mechanical cause operating on the mouth
externally, or on the throat, Avindpipe, or air-passages internally.  In
this sense it will be perceived that drowning is one form of death
from suffocation, the water  being an effectual medium for prevent-
ing access of air to the lungs.
  The term suffocation is applied to various conditions in which
the symptoms and effects differ.  There may be a simple privation
of air; the air respired ma}7 not be reneAved for the Avant of proper
ventilation ; or, lastly, the air which is breathed may be mixed Avith
certain noxious gases or vapors, which, by absorption into the blood
through  the air-cells of the lungs, may  destroy life like poisons.
The syniptoms preceding death, the disposition to recovery, and the
post-mortem appearances in fatal cases, Avill differ under these cir-
cumstances.  It will be sufficient, at  present, to consider the most
simple form of suffocation which is Avithin the reach of experiment,
namely,  that which depends on the privation of air  by substances
blocking up the air-passages, or by the covering of the  mouth and
nostrils.   The Committee  of the Medico-Chirurgical Society per-
formed a series of experiments on dogs, in AAThich a tube Avas inserted
into the  windpipe, and  breathing either  took  place or Avas com-
pletely arrested, according to Avhether the tube was  kept open or
dosed by an accurately fitting plug.  When the tube Avas closed 
             VARIOUS MODES  OF  SUFFOCATION.         437

the animal, after a variable number of seconds, made strong efforts
to breathe; and when these ceased, unless air was speedily admitted,
it died.  From nine experiments on the dog, the average duration
of the respiratory movements, after the animal had been completely
deprived of air, Avas  four minutes  and five seconds.  The average
duration of the heart's action was seven minutes and eleA7en seconds;
and it  further appeared that, on an average, the heart's action con-
tinued for three minutes and fifteen seconds  after the animal had
ceased  to make respiratory efforts.  In respect to the rapidity with
Avhich  death  takes place in animals, the following conclusions were
drawn  : 1st, a dog may be deprived of air during a period of three
minutes and  fifty seconds, and afterwards recover Avithout  the ap-
plication of artificial means ; and 2dly, a dog is unlikely to recover,
if left to itself, after having been deprived of air during a period of
four minutes and ten seconds.  As in droAvning, the shorter the
interval between the last respiratory efforts and the re-admission of
air, the greater the chance of recovery.  (" Med.-Chir. Trans." 1862,
vol. 45, p. 454.)
   The  results of these experiments in reference to the duration of
life under privation of air may be considered applicable to a human
being.   It is  not likely that a man would survive under these cir-
cumstances longer than a  dog, and it may be fairly inferred that
the life of a man Avould be destroyed  in from four to five minutes
after the poAver of breathing had been completely arrested.
   There are many varieties of death by suffocation, all of Avhich are
of great medico-legal interest:  1. The close application of the hand
over the  mouth and nostrils, or the placing of a plaster or cloth over
these parts, combined  Avith  pressure  on the chest:  this was for-
merly not an unfrequent form of homicidal suffocation.   2.  Smoth-
ering, or the covering of the head and face Avith articles of clothing,
etc., Avhich effectually  prevent breathing.   3. The accidental  or
forcible introduction of foreign bodies into the mouth and  throat.
4. The floAV of blood into the Avindpipe from  a severe wound in the
throat, or from the bursting of a bloodvessel  or aneurismal sac.  5.
In Avounds of the throat, Avhen the Avindpipe is completely divided,
the lower end may be so draAvn into the wound  as  to  produce  a
closure of the orifice, and intercept the passage of  air.  One or the
other of these causes frequently operates to render a Avound in the
throat fatal.   6. The plunging of  the face  into  mud, snow, dust,
feathers, or similar substances.  In all  these cases, death takes place
from asphyxia, and  \vith great rapidity if the chest sustains at the
same time any degree of forcible compression.   7. Swelling or spasm
of the glottis produced by the contact of corrosive substances.  A
ease was referred to me, in July, 1848, in Avhich death Avas probably
thus caused by the application  of a strong solution of pernitrate of
mercury to an ulcer in the throat.
  Suffocation may arise from morbid causes operating mechanically
to prevent respiration, such as a diseased state of  the parts about
the throat, an enlargement of the glands, the bursting of a tonsil-
lary abscess, or the effusion of lymph, blood, or pus into the w7ind- 
438       ACCIDENTAL SUFFOCATION  FROM  FOOD.

pipe, or about the opening of the larynx (rima glottidis).   Any of
these causes may suddenly arrest the act of breathing, a fact which
can only be determined by a careful examination of the air-passages.
Accidental suffocation may arise from large masses of food blocking
up the larynx.  If  the  glottis (the  opening of the Avindpipe) be
completely closed by food, death may take place suddenly; although
the person so situated may be capable of making some exertion or
of moving from the spot.  Dr. Mackenzie relates a case in Avhich a
man Avas'suddenly choked by swalloAving a large piece of meat; he
immediately Avalked across the street to a chemist's shop, and soon
after entering it he fell doAvn in a  state of insensibility.   After
death the throat Avas found to be filled with a piece of beef, Avhich
rested on  the glottis, and had pressed the epiglottis forAvard. Part
of the mass had entered the windpipe through the rima glottidis,
and had thus causeel death by suffocation.  It is  probable that, in
this and similar cases, the foreign body does not so completely close
the aperture as to prevent some degree of respiration, but the blood
being imperfectly  aerated, asphyxia is speedily induced.  ("Ed.
Month. Journ." July, 1851, p. 68.)   In a case which occurred in
April,  1858, a youth, set. 17, lost his life owing to an oyster  be-
coming impacted in the air-passages during the act of swalloAving.
Suffocation is also frequently the result of the lodgment in the air-
passages of substances vomited.
  A person  has been  Avrongly charged with causing the death of
another, when the cause Avas  really owing to the impaction of food
in the  larynx. A remarkable  instance of this kind (which is re-
ported in  the " Lancet" for March 9,1850, p. 313), occurred atllill-
ingdon.   Deceased  had had  a  quarrel with the  accused, who was
his  son-in-law, and  they were seen to fall to the  ground together,
Avhile struggling and fighting.  They were separated.  About two
hours afterwards the deceased, Avho appeared quite Avell, Avas  ob-
served to  rise from the dinner-table and leave the room.  He Avas
found leaning against the cottage, as if in a falling position, and
he  expired in tAvo  or three  minutes!   The person with Avhom  de-
ceased  had been fighting Avas charged Avith manslaughter before a
magistrate.   At the  inquest the medical witness stated that he
found the organs of the body, excepting the brain, in a very healthy
state.   The  brain  Avas excessively" congested, and  he  attributed
death to  apoplexy.  The coroner desired the witness to  examine
the mouth and throat (Avhich he had  omitted to do at the inspec-
tion), as from the suddenness of death after eating, he (the coroner)
thought the  man might have been choked.  This opinion  turned
out to  be  correct.   A large piece of meat Avas found Avedged in  the
opening of  the throat; this  had caused  death  by suffocation; it
hael not completely closed the air-passages in the first instance;
hence the man was able  to move from the dinner-table.   The person
accused of manslaughter was discharged.
  A medical iurist, however, must not lose sight  of the fact that a
foreign  substance may be homicidally impacted in the larynx, and
that, except by a careful examination of the  body, death may be 
             SUFFOCATION. — MODE  OF  DEATH.           439

 wrongly assigned to accident.  A case  reported  by Dr. Littlejohn
 is in this respect instructive.  In examining the body of  a Avoman
 Avho it Avas stated had died suddenly, he found a quart-bottle cork
 inserted tightly into the upper part of the larynx.  The sealed end
 Avas uppermost, and Avas roughened by the passage of the screw.
 Fractures of the ribs Avere found, and it Avas quite clear that deceased
 had not died a natural death.  It Avas suggested that the deceased,
 while extracting the  cork  from the bottle Avith  her  teeth, might,
 by  the sudden impetus of the contained fluids, have drawn it into
 the position in which it was found. But this theory Avas negatived
 by  the sealed end of the cork being uppermost in the throat, as well
 as by the structure  of the parts. The  medical opinion was that the
 cork must have been forcibly placed there by another person, Avhile
 the Avoman Avas in a helpless state of intoxication.  There Avas no
 reason to doubt that this Avas a deliberate act of murder.  Five per-
 sons Avere present with the deceased at the time of her death, but it
 Avas impossible to fix Avith  certainty upon the person Avho  had com-
 mitted the act, and the man on whom  the strongest  suspicion fell
 Avas acquitted on a  verdict of " not proven."  (" Ed. Med. Journ."
 Dec. 1855, p. 511; and for a report of the trial, the same journal,
 p. 540.)
  In suffocation, death takes place from apncea or asphyxia ; and
 this occurs Avith a rapidity proportioned to the  degree of impedi-
 ment existing to the  passage of the air.  There  does not seem to
 be any reason to attribute  death to apoplexy.   The congestion of
 the cerebral vessels may be regarded as a consequence of the dis-
 turbance of the functions of the lungs.   If the veins of the neck
 were opened,  so as to prevent an accumulation of  blood in  the
 vessels of the brain, it is pretty certain that the prevention of respi-
 ration would destroy life under the same circumstances, and within
 the same period of time;  therefore Ave  may regard deatli from suffo-
 cation as resulting from pure asphyxia.   In treating a case of suf-
 focation we ha\Te simply to  allow of the reneAval of air by removing,
 if this be possible, the mechanical obstacle to respiration.   The re-
 sults of experiments on dogs show that,  even with a perfect closure
 of the Avindpipe, an  animal may recover spontaneously after nearly •
four minutes' deprivation of air; and there is every reason to believe
 that a human  being might recover  after the same length of  time.
 If fhTe  minutes have elapsed there Avill be but  little hope of re-
 covery.   In  drowning, the chances of recovery continue  only for
 half the period observed in  suffocation ;  the lungs are injured, and
 the Avater by which they are penetrated forms  a physical obstacle
 to the free admission of air.  In hanging and strangulation,  there
 is sometimes great violence done to the parts about the neck.  In
 suffocation, these accidental obstacles to  recovery do not exist; the
 surgeon has simply to readmit the air into the  lungs.   All experi-
 ments go to sIioav that, even in this  form of asphyxia, which  is
 most favorable for recovery, the complete suspension of respiration
 for five minutes is fatal.  Hanging and strangulation prove fatal 
 440             POST-MORTEM  APPEARANCES.

 from asphyxia in the same period of time, and  drowning probably
 within half this period.
    Post-mortem appearances.—There are rarely any considerable marks
 of violence externally.  When the body has become perfectly cold,
 there may be patches of lividity diffused over the skin;  but these
 are not always present.   The lips are livid ;  the skin of the face and
  neck may be pale, or present a dusky-violet tint, with small patches
 of ecchymosis.  The eyes are congested;  there is a mucous froth
 about  the lips and mouth. The mouth, throat and parts  about the
 windpipe should be carefully  examined for foreign substances.  In-
 ternally, the lungs and right cavities of the  heart may be  found die-   i
 tended with blood.   The state of the lungs anel heart is, hoAvever,
 subject to variation.  The lungs are not necessarily found congested;
 and sometimes, as in a case referred to me  in November,  1864, one
 lung may be found congested and the other not.  M. Tardieu states,
 from his obseiwations, that the lungs are of a reddish color, some-
 times even pale, not distended, and presenting, occasionally, only a
 slight degree of congestion at the base and posteriorly.   A special
 character Avhich he states he has invariably noticed in these organs
 consists in the  presence of small  ecchymosed spots or patches be-
 neath the pleura or investing membrane.  He describes these spots
 as of a dark color, and varying in size from a pin's head to a lentil.
 In the adult they are of still larger size. Their number is variable;
 sometimes five or six may be found, at others twenty or thirty ; and
 in other cases the surface of the lungs may be so studded Avith them
 as to give to it a granite-like appearance. These spots of ecchymosis
 are  sometimes  agglomerated, at  other times separated,  but their
 outline is generally distinct and  Avell-defined on the surface of the
 lungs.  They are most frequently seen at the root of the lungs, at
  its  base, and about its lower margin.  They are OAving to small
 effusions  of blood  from ruptured  vessels,  like  true  ecchymosis.
  They may be distinguished so long as the tissue of the lung remains
 unchanged.  M. Tardieu states that he has  seen these subpjeural
 ecchymoses  in  the body of  an  infant, ten  months  after death!
 (" Ann. d'Hyg." 1855, vol. 2, p.  379.)  He admits,  hoAvever, that
* they may also be found in the  bodies of  children that have not
  breathed; hence no inference of death from suffocation  should be
  draAvn from this appearance  in the lungs of children, unless they
  have  actually received air.   In  three  instances, he met  with this
  appearance in  lungs which sank in water, and  had all  the usual
  characters of these organs in  a foetal state.   The children had been
  born living, prematurely, and under conditions in  Avhich life by
  respiration  could not be  perfectly established ; one  of  them had
  made several cries Avithout effectually receiving air into  the lungs
  (loc. cit.).   (See  Casper's "  Klinische  Novellen," 1863, p.  471.)
  This struggle to breathe may have produced  the appearance  re-
 sembling that of suffocation  ; in new-born children that die from
 suffocation, the thymus gland has been found in a similar condition.
    This dotted appearance of the surface of  the lungs in suffocation
 is not attended with the apoplectic effusions  in their  substance 
POST-MORTEM  APPEARANCES.
441
which are met Avith in death from strangulation.  Emphysema, or
escape of air from rupture of the air-cells, is occasionally observed.
The more rapidly suffocation has taken place the more strongly
marked is this  appearance of ecchymosed  spots.   On  the other
hand, Avhen the interruption of breathing has been sIoav and gradual,
the substance of the lungs is more congested Avith  blood, and then
these dots anel patches are merged in the general violet color of the
surface of the organs.  The lining membrane of the Avindpipe and
larger air-tubes is sometimes pale, but commonly dark-colored Avhen
the lungs are congested.  In the  air-passages, there is occasionally
a frothy redelish-colored liquid in small vesicles.
  The heart presents no special appearance indicative of the mode
of death, if we except the  presence of small spots  of ecchymosis
found beloAv  the im7esting membrane, like those met Avith on the
lungs.   They have been found near the roots or origin of the great
vessels,  but are  not so frequently observed  in  this organ as in the
lungs.   The blood is generally dark and fluid ; sometimes  coagula
are met Avith.  The stomach and intestines  have been observed to
present  patches  of lividity.  Casper has found the  kidneys  more
strongly congesteel with  blood than the liver, spleen,  and other
organs.   The vessels of the brain are  sometimes congested, but at
other times they do  not appear  to be more than ordinarily full.
Their condition  may be affected  by  the congested state of the
lungs, as Avell as by  the slowness  or  rapidity Avith Avhich death
takes place.  Other appearances Avhich have been described are of
an accidental nature, and  are  not connected with death  from
suffocation.
  In a  case of alleged murder by  suffocation, respecting Avhich I
was consulted in December, 1857, the following appearances Avere
met with.  The body Avas lying on  the  bed ; the  right  leg Avas
drawn up towards  the body—the right arm Avas  bent, Avith the
hand directed toAvards the face ;  the left hand  W7as lying upon the
chest.   The lips were livid, the tongue protruded and savoIIcii, and
there Avas a bloody fluid  issuing  from the nostrils.   There Avas  no
mark of constriction on the  neck; the eyes were half-open; the
body Avas rigid  anel  still Avarm.   The face  and neck Avere much
SAvollen, and  the skin of these parts, as Avell as of the chest, abdo-
men, arms, and  legs, av as  covered Avith dark livid  patches.  The
brain A\7as gorged Avith venous blood.  The heart  Avas soft and
flaccid, and its cavities were empty.   The  mucous membrane, as
well  as  the tissues  of the air-passages, were much congested Avith
dark liquid blood: the blood Avas everyAvhere liquid.  The stomach
contained a small quantity of a dark-colored liquid, and the greater
end Avas reddened.  The spleen Avas congested.  The emptiness of
the cavities of the heart Avas at first considered to be inconsistent
with death from asphyxia;  but this condition of the heart  is occa-
sionally found.   It may be stated  that in this case the deceased, a
female, Avas greatly exhausted by sickness and purging.  On the
second day of her illness she Avas found dead in the state  described,
and her husband Avas  charged with having suffocated her. 
442       PROOFS  OF  DEATH FROM  SUFFOCATION.

  Evidence of death from  suffocation.—In medical  jurisprudence
there is not, perhaps, an instance in which Ave have  feAver medical
data upon Avhich to base an opinion, than in a case of alleged death
from suffocation.  The inspection of the body of a person suffocated,
if Ave except the peculiar condition of the surface of the lungs
lately pointed out by M. Tardieu, presents so little that is peculiar,
that a medical man, unless his suspicions have been roused by cir-
cumstantial evidence, or by the discovery of foreign substances in
the air-passages, would  probably pass it over as a  case of death
without any assignable cause—in other  Avords, from  natural causes.
In examining the  body of the woman Campbell, Avho was suffo-
cated by Burke in Edinburgh, Dr. Christison was unable to come
to any conclusion  respecting  the cause of death until some light
had been throAvn on the case by collateral evidence.   On this occa-
sion, a violent death was suspected, because there were marks of
violence externally, and the face of the  deceased presented some of
the characters of  strangulation.   These  conditions, hoAvever, are
by no means essential to death from suffocation, and Avhen they
exist  they can  only be regarded as purely accidental  accompani-
ments.  Appearances similar to those found in the bodies of suffo-
cated persons, if we except the dotted ecchymosis on the lungs, are
frequently met with in inspections when death has  taken place as
a consequence of disease or accident.  They can, therefore, furnish
no conclusive evidence of the kind of death ; they scarcely permit
a witness to establish  a presumption on' the  subject, until, by a
careful examination of the body, he has ascertained that there is
no other cause of death depending on organic disease or on violence.
Medical evidence may, hoAvever, be serviceable in some instances.
Thus, let the general evidence establish  that a deceased person has
probably been suffocated, the witness may have it in his power to
state that the appearances in the body are consistent with this kind
of death; that the  body is in all respects  healthy and sound, and
that death was probably sudden—as Avhere, for instance, undigested
food is discovered in the stomach.  The presence of ecchymosis on
the surface of the lungs may justify a  strong opinion of death by
suffocation Avhen no other cause  is apparent.  In all cases of this
description, we must bear in mind that an opinion relative to the
supposed cause of death is to be  formed from  the medical circum-
stances, and from what we have ourselves seen, unless it be other-
wise  alloAved by the  court.  From  this  want of clear evidence,
great difference  of  opinion on the cause of death frequently exists
among medical witnesses.
  Accidental  suffocation is not unfreqnent; and there are various
conditions under Avhich a person may die suffocated only discover-
able after death.  1. Diseases about  the tongue, larynx, or throat
may have advanced to such an extent as effectually to prevent
breathing.  2.  The deceased may  have fallen, and the mouth be-
come covered Avith dust  or other substances; and if helpless, as
in the case of an infant or an aged  person, or  of one who is in-
toxicated, death may thus easily take  place.  A child was found 
          CAUSES  OF  ACCIDENTAL SUFFOCATION.       443

dead in a room, Avith  its face in the ashes under a grate; it had
fallen during the absence of the mother, and, from its helpless con-
dition,  had speedily  become suffocated.   Some  of the ashes Avere
found in the Avindpipe.  (" Med. Gaz.," vol 17, p. 642.)  For a case
in Avhich  suffocation Avas caused by a pea, see the same journal,
vol. 29, p. 146.  In  trials for murder  or  manslaughter, a medical
opinon respecting the accidental  suffocation of a drunken person,
under similar circumstances, is occasionally required.  These per-
sons, it must be remembered, are  generally as  helpless as children ;
if they fall  in a position so that the  mouth is covered, they may
may be so powerless from intoxication as  not to be able to escape.
3. A portion of food may  have  remained fixed  in the larynx or
throat.  Children are sometimes accidentally suffocated  by drink-
ing boiling Avater from a tea-kettle.  The parts above the larynx
then become swollen from the action of the hot  Avater, and breath-
ing cannot take place.   4. Accielental  suffocation is not uncommon
among infants, Avhen they sleep Avith adult persons.   A child may
be in this wray speedily destroyed.  Even  the  close wrapping of a
child's head in a shaAvl to protect it from cold may effectually kill
it,  Avithout any convulsive struggles to indicate  the  danger  to
Avhich  it is exposed.   Convulsions by  no  means necessarily attend
on death from suffocation.
  Those  incidents of  accidental suffocation Avhich  depend   on
disease, or on the impaction of food, are easily knoAvn by a careful
examination of the  parts about  the  throat; generally  speaking,
they present no difficulty.   In other instances—Avhen a child or a
drunken person is presumed to have been suffocated owing to the
position in Avhich he has fallen, evidence  as to the position of  the
body, or even the actual sight  of the  body, is  necessary before
forming  an opinion.   The  folloAving  questions may  here arise:
Was the position such as to be explicable on the supposition of acci-
dent ?  Was it not such a position as  might have been given to it
by a murderer ?  Could not  the deceased have  had strength or
presence of mind  to  escape ?  Could he have been actually suffo-
cated in the position in which his body Avas discovered?  A little
reflection upon the circumstances—for here something more than
medical circumstance will  be required—may enable us to give
satisfactory ansAvers to these questions.
  Some singular cases are on record, in Avhich persons have wilfully
destroyed themselves by blocking up the throat mechanically.  An
instance of this form of suicide is reported in the " Edin. Med. and
Surg. Journ.," April, 1842.  A woman confined in prison forced a
hard cotton-plug into the back of her  throat.   The cavities of the
chest and abdomen had been already examined, and a medical cer-
tificate given that the deceased had died of apoplexy!   The body
was sent to one of the anatomical schools, and  on reinspection it
was accidentally found that the throat Avas firmly blocked up Avith
a plug of spindle cotton.
  Ho)nicidal suffocation is not very common, although it is a ready
means  of perpetrating murder.   Hitherto, the  cases which have 
444
SMOTHERING OF  INFANTS.
come before our  courts  have been those either of infants, of the
aged and infirm, or of persons enfeebled by  illness.   Death by
suffocation is most difficult to detect, and unless the assailant has
employed an unnecessary degree of violence, it is probable that the
crime may pass altogether unsuspected.   Homicide by  suffocation
Avould not be attempted  on healthy adult persons, unless they were
in a state of intoxication, and thereby rendered  defenceless.   It is
certain that most individuals would have it in their poAver, unless
greatly incapacitated  by  disease or intoxication, to offer such a
degree of resistance as would leave upon their bodies indubitable
evidence  of murderous  violence.  Death by suffocation may be
considered as presumptive of homicide, unless the facts are.clearly
referable to accident.  Accidental suffocation is, however, so palpa-
ble from the position  of the body and other circumstances, that
when death is clearly traced to this cause, it is not easy to conceive
a case in which it would be  difficult to distinguish it from one of
actual murder.  In some instances, the very means  that have been
adopted to produce suffocation may forbid the supposition of acci-
dent, and clearly establish the fact of  homicide.
   The suffocation of new-born children, by the introduction of sub-
stances into the mouth, is  not unfrequent. (See Infanticide.)  The
unnecessary force employed generally leaves traces of violence, Avhich
may be easily discovered by  a careful  examination, even should it
happen that the substance used for  the murderous purpc>se has been
removed.
   It is necessary  to point out a dangerous practice common among
ignorant nurses, Avhich, without exciting suspicion on the part of a
coroner or medical Avitness, may be an occasional cause of death in
infants.   In order to quiet a child, and to enable a nurse to  sleep
Avithout disturbance, a bag made of wash-leather or rag, containing
sugar, is  thrust  into  the child's  mouth.  It is thus  completely
gagged, and the child soon becomes quiet, respiring chiefly through
the nostrils.  If these by an accident  become obstructed, or by the
act of aspiration the bag should  fall to the back  of the throat,
death by suffocation must inevitably  result, the  infant  being per-
fectly helpless!   The suspension of breathing may be  so gradual
that the child may die without crying or convulsions.  The removal
of the bag from the mouth,  as no violence had been used, will re-
move every trace of the cause of death ; and in order to exculpate
herself, the guilty person may ascribe death to " fits."  The detec-
tion of this dangerous practice  can only be a matter of pure acci-
dent ; hence a fatal case can be rarely the  subject of a coroner's
inquest, and even then medical evidence may fail to throAV any light
upon the cause of death.
   According to the late  Mr.  Wakley,  infants are frequently found
dead OAving to their being suckled at  night Avhile the Avoman is in
bed.  The child's face is pressed on the breast; mother  and  child
fall fast asleep; the head slips beneath the clothes, and the child is
then quietly suffocated.   There  is no mark of pressure or violence
on the body.  (" Lancet," Jan. 1.6,1858, p. 69.) A case, apparently of 
               POST-MORTEM APPEARANCES.             445

this kind, Avas  communicated to me by Mr. ^Tason, in Sept. 1860.
The child (fh7e days  old) died quietly on  its mother's arm Avhile
lying in bed.   There Avas  much lividity about the head, neck  and
back ; but there were no marks of violence.   The bronchial tubes
of the right  lung contained bright  florid blood.  The left  lung
was gorged  with  blood,  but  none had escaped.   The heart  Avas
firmly contracted, and there was only a small quantity of blood in
its right cavities.
  The appearances presented by the  bodies of children avIio  haA7e
died under these circumstances may be thus described from actual
cases: Externally:  features placid ; lips congested ; eyes not unduly
prominent;  conjunctivae  rather reddened;  hands clinched;  no
patches  of ecchymosis to be anyAvhere detected.   Internally: Head
—patches of  effused blood here and  there seen beneath the  peri-
cranium ; great congestion of the pia mater, accompanied by num-
berless effusions of blood, varying in  size  from a pin's point to a
silver penny in  superficial extent ; a little clear fluid in the ventri-
cles; some frothy mucus in the windpipe and bronchi, with redness
of their lining membrane.  The lungs are much congested  and
crepitant, Avhilst beneath  the  pleura?, blood had been everyAvhere
effused,  presenting  numerous small  bright-red patches, and  fine
points;  all the blood of the substance of the lungs Avas Avithin  its
vessels.  The pericardium  contained some  serum, and Avas spotted
in its whole extent after the manner described ;  the vasa  vasorum
of the  heart's  great vessels  and  thoracic  aorta  Avere minutely
injected.  The right cavities of the  heart, in all the cases, contained
dark liquid blood ; the left cavities were nearly empty ; the tissue
of the organ Avas free  from effused blood.  The surface only of the
thymus gland Avas mottled like the heart.
  There is a prevalent notion that congestion of the lungs is an in-
variable accompaniment of death from suffocation, and Avhere this
was not found, it has  been hastily assumed that death had taken
place from some other cause.   It is  desirable, in reference to future
cases, to point out  the fallacy involved in the assumption that con-
gestion of the lungs is necessarily present in death from suffocation.
Mr. AVatson observes that the gorged state of the right side of the
heart and lungs is greatest Avhere the act of suffocation (asphyxia)
has been slow and gradual, by the access of air to the lungs  not
having  been  completely prevented.  When,  on the  other hand,
death has taken place quickly or suddenly from  this cause, there is
little or no  unusual  congestion of blood  in the lungs or heart.
(" On Homicide," p. 115.)  At page 118, he describes a case of death
from suffocation in Avhich the lungs Avere natural; and in the case
of Campbell, for whose murder by suffocation Burke w7as convicted
and executed  in 1828-9, Dr. Christison and Mr. NeAvbigging found
the organs Avithin the chest perfectly natural, the lungs remarkably
so, and unusually free from infiltration.  The blood  in the  heart
and great vessels, as Avell as throughout the body, was fluid and
black.  ("Ed. Med. and Surg. Journ." vol. 31, p. 239.) Again, in
the case  of Carlo Ferrari, for the murder of Avhom Bishop and Wil- 
446
SUFFOCATION  BY  GASES.
Hams wTere convicted and executed in London  in  1831, the  lungs
were  healthy  and not congested; the heart was rather small, con-
tracted, and its four cavities Avere perfectly empty.   The prisoners
in this case confessed that they destroyed the deceased by suffoca-
tion.  From these facts, it will be perceived that the actual state of
the lungs and heart, in the  bodies of those Avho have been notori-
ously murdered by suffocation, is that which has been wrongfully
pronounced to be inconsistent Avith this mode of death.
                        CHAPTER  XL.

   GASEOUS  POISONS.—CARBONIC  ACID.—SYMPTOMS. — APPEARANCES.—
     ANALYSIS.—EFFECTS OF CHARCOAL-VAPOR.--CARBONIC OXIDE.—COAL
     AND COKE VAPOR.--SULPHUROUS ACID.--VAPORS OF LIME, CEMENT, AND
     BRICK-KILNS.—CONFINED AIR.—COAL-GAS.—CARBURETTED HYDROGEN.
     —SULPHURETTED HYDROGEN.--EFFLUVIA OF DRAINS AND SEAVERS.

     Mode of action of gaseous poisons.—In following common language,
   a medical jurist is compelled to apply the term  suffocation to an-
   other variety of death, namely, to that of poisoning by gases.  Phys-
   iological  accuracy must  here be sacrificed, in order that Ave may
   make ourselves generally intelligible.  Thus, if a person die  from
   the effects of carbonic acid, of confined air, of sulphuretted hydro-
   gen,  or of other noxious  gases, he  is commonly said to  die suffo-
   cated.  Strictly speaking, he dies poisoned—as  much  so as  if he
   had taken oxalic or hydrocyanic acid.  The only differences are:
   1.  That the poison, instead of being liquid or solid, is gaseous ; and
   2. Instead of being applied to the mucous membrane of the stomach,
   it affects  that of the air-cells of the lungs.   In the action of arseni-
   uretted hydrogen Ave have a clear instance of poisoning  by a gas,
   and  in the respiration of the narcotic vapors  of chloroform and
   ether Ave have also illustrations of this form of poisoning.  Owing to
   the fact that the poisonous material is in a finely divided  state, and
   that  in the air-cells of the lungs it meets at  once with  a  large ab-
   sorbing surface, and instantly enters the blood, the effects are  more
   rapid, and cceteris paribus, more powerful.  It has been remarked,
fc  too, that  some (and probably all) of these aerial poisons have an ac-
   cumulative action, i. e., their effects continue to increase for a  short
   period, even after a person has ceased to  respire them.
     The cause of death mistaken.—The greater number of  the poison-
   ous gases are chiefly complex products of art, and are never likely
   to be met Avith in the atmosphere so abundantly as to produce inju-
   rious consequences; hence, fatal accidents arising from their  inha-
   lation most commonly occur under circumstances which  can leave
   no question respecting the real cause of death.  The peculiar effects
   of all of these it will not  be  necessary to  describe in  this place; but 
            SUFFOCATION  BY  CARBONIC ACID.          447

there are two, a knoAvledge of the properties and operation 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 employed with any certainty as in-
struments of murder ; and if they Avere so employed, the fact could
be established only by  circumstantial evidence.  One alleged in-
stance of murder by carbonic acid is, hoAvever, reported by M. De-
vergie.  ("Ann. d'Hyg." 1837, vol. 1, p. 201.) Death, when arising
from the respiration of any of the gases, is generally attributable to
suicide or accident.   In France, it is by no means uncommon for a
person to commit self-destruction  by sleeping in a closed apartment,
in which charcoal has been suffered to burn ; while in England, ac-
cidental deaths are sometimes heard of, Avherecoal or coke has been
employed as fuel in small and ill-ventilated rooms.  On such occa-
sions, a person may be found dead Avithout any apparent cause to
the casual observer.  The face may appear pale or livid, and the
skin may be covered with patches of lividity.  The discovery of a
body under these circumstances will commonly be sufficient, in the
eyes of the vulgar, to create a suspicion  of murder; and some per-
son, with whom the deceased may have been at that period on bad
terms, will perhaps be pointed out as the murderer.  In such a case,
it is obvious that the establishment of the innocence of the accused,
will depend entirely on the discrimination and judgment of a med-
ical practitioner.  An instance, illustrative of the consequences of
this popular prejudice, occurred in London in 1823.   Six persons
were lodging in the same apartment, where they were all in the
habit  of sleeping.   One  morning, an alarm was  given by one of
them, a female, who stated that on rising she found her companions
dead.   Four were  discovered to  be really dead,  but the fifth, a
married man, Avhose Avife Avas one of the victims, Avas recovering.
He Avas knoAvn to have  been on intimate terms Avith  the Avoman
Avho gave the alarm, and it was  immediately supposed that  they
had conspired together to destroy  the Avhole party, in order to get
rid of the Avife.  The Avoman who was  accused of  the crime Avas
imprisoned, and an account of the supposed barbarous murder Avas
soon  printed  and circulated  in the  metropolis.   Many articles of
food about the house Avere  analyzed in order to discover Avhether
they contained poison, Avhen the circumstances Avere explained by
the man stating that he had placed a pan of burning coals betAveen
the tAvo beds before going to sleep, and that the doors and windoAvs
of the apartment Avere closed.  (Christison, p. 583.)  A set of cases
of a similar kind,  in Avhich there  Avas at first a strong suspicion of
poisoning, has been  reported in  the  "Medical Gazette," by Mr.
Smith, of Liverpool (vol. 36, p. 937 ; see also "Ann. d'Hyg." 1843,
vol. 2, p. 56).

                        Carbonic Acid.

  This gas is freely liberated in  respiration, combustion, and fer-
mentation ; it is also produced in  the calcination of  chalk or lime- 
448          SUFFOCATION  BY  CARBONIC  ACID.
        *
stone, and is sometimes diffused through the shafts and galleries of
coal-mines, Avhere it is  commonly called " choke-damp."  Carbonic
acid-gas is likewise met with in Avells, cellars and other excavations
in the earth.   In these cases, it is generally found most abundantly
on the soil, or at the lower part of the Avell; and it appears to pro-
ceed from the decomposition of animal and vegetable  matters con-
fined in such situations.  The slow evaporation of water strongly
charged Avith the gas, Avhile trickling over the sides of these exca-
vations, may likeAvise assist in contaminating the air.  Damp saw-
dust or straw slowly absorbs oxygen  from a confined atmosphere,
and sets free carbonic acid.
  Sir Humphrey Davy believed that carbonic acid, in a perfectly
pure state, did not pass into the trachea when an attempt was made
to respire it; the glottis seemed to close  spasmodically at the mo-
ment that the gas came in  contact with  it.   On  diluting the car-
bonic acid with about tAvice  its volume of air, he found that he
could breathe it; but it soon produced symptoms of giddiness and
somnolency.  In a diluted state, there  is no doubt that  it penetrates
into the lungs, and that it is absorbed and circulated with the blood.
In estimating the effects of this gas  when  mixed with air, a dis-
tinction must be made.  The  gas  may be simply added to the air,
or it may be produced at the expense  of the oxygen in the inclosed
space or apartment.  In the  latter case, it must be  remembered
that every volume of carbonic  acid  thus produced represents an
equal volume of oxygen removed.  Such  an atmosphere  is, there-
fore, more destructive than another in Avhich the air and gas are in
simple admixture.  If we assume that in  each case  the noxious
atmosphere  contains 10 per cent, of carbonic  acid, then in one in-
stance there Avill be 7 per cent, more of oxygen and 7 per cent, less
of nitrogen than in the other, since  the production of 10 parts of
carbonic acid as a result of combustion implies the loss of 10 parts
of oxygen.   This difference in  the proportions may not be, prac-
tically speaking, correct, because there is  no apartment sufficiently
closed to prevent air rushing in from the exterior while combustion
is going on within it; but, nevertheless, the above statement may
be taken as an approximation to the  truth.
   The statements made by chemists  and physiologists, respecting
the proportion of carbonic acid  in air required to produce noxious
or fatal effects on human beings, are  very conflicting.  Small ani-
mals, such as birds and mice,  have been generally made the subject
of experiments,  but the result thus obtained cannot be satisfactorily
applied to show the relative action of carbonic acid on man. Ber-
zelius stated that a proportion of 5 per cent, in  air was not injurious,
and that such a mixture might be usefully employed  in the treat-
ment of consumption.   (" Traite de Chimie," t. 2, p. 83.)  Allen and
Pepys inferred,  from their experiments on guinea-pigs, that 10 per
cent, of the gas  Avould prove fatal to  man.  In the more recent ex-
periments of Bernard this inference is corroborated by the fact that
a bird died in two and a half hours in an atmosphere consisting (in
100 parts) of  9.5 of carbonic acid, 28 of oxygen, 62.5 of nitrogen. 
POISONOUS proportions.
449
("Les Substances Toxiques," 1857, p. 135.)  In this case the  pro-
portion was less than 10 per cent., while the proportion of oxygen
Avas 7 per cent, more than that existing in the atmosphere.  On=the
other hand, Demarquay says that one part of carbonic acid  and
three parts of air (25 per cent.) produce in man but slight discom-
fort after being breathed for some time.  According to this writer,
most of the accidents caused  by charcoal-vapor, confined air, and
gases in fermenting vats are wrongly ascribed to carbonic acid, and
should be attributed  to carbonic oxide,  sulphuretted  hydrogen,
alcoholic  vapors, or other  gases not yet understood.  (" Chem.
News," Aug.  4, 1865.)  Those who have employed mixtures of car-
bonic acid and air for anaesthetic purposes have stated that air con-
taining 20 per cent, of carbonic acid may be breathed Avithout any
injurious effects.  Such a mixture would be composed (inlOO parts)
of 20 of carbonic acid, 16 of oxygen, and 64 of nitrogen.   In  this
mixture, if carefully made, oxy-combustion cannot be" maintained ;
hence, if there was no error in the above proportions, it follows that
a man  can breathe  with safety and  live in air in which a candle
will not  burn.   Bernard's  carefully performed  experiments are
adverse to these statements.  He found that animals died in atmos-
pheres in which  the proportion of carbonic acid varied from 12 to
18 per cent., while  the amount of oxygen varied from 5 to 30 per
cent.  (" Les  Substances Toxiques," p. 140.)   When it is asserted
that a person can thus  breathe Avith  impunity proportions which
are fatal to life, it would be desirable to know how such mixtures
were made, and whether  proper care had been taken  to prevent
respiration of air by the  mouth and nostrils, while the supposed
poisonous mixture  was  being inhaled.  Such  statements, founded
on  imperfect experiments, are highly mischievous, for they may
lead to deatli in cases in which the mixture is accurately made, and
administered to a person whose mouth and nostrils are closed against
the ordinary atmosphere.
  Symptoms.—The  symptoms of poisoning by carbonic acid vary
according to the proportion  in the air Avhich is  breathed.  In a
concentrated state, there is sudden insensibility, followed by death,
unless  the person is immediately removed into pure air.  When
the air is gradually  poisoned, and contains its lowest poisonous  pro-
portion, insensibility comes on more slowly,  and as  in ordinary
narcotic poisoning,  is  preceded by giddiness, somnolency, and loss
of muscular power. When the gas is in  a  fatal proportion, the
symptoms commonly observed are as follows:  A sensation of great
weight in the head; a sense of pressure in the temples; a ringing
in the ears, Avith a pungent sensation in the nose ; a strong tendency
to sleep, accompanied by giddiness; and so great a loss of muscular
power, that, if the  person be  at the  time in an erect posture, he
instantly falls  to  the ground  as if struck.  The breathing, which
is observed to be at first difficult and stertorous, becomes suspended.
The  action of the heart, which on the first accession of the symp-
toms is very violent, soon ceases; sensibility is lost, and the person
now falls  into a profound coma, or  state of apparent death.  The
      2y 
450       post-mortem appearances—ANALYSIS.

warmth of the body still continues;  the limbs are  relaxed  and
flexible, but they have  been observed  in some  instances to become
rigid, or even occasionally convulsed.   The countenance  is livid,
or of a  leaden  color, especially about  the  eyelids and  lips, but on
some occasions it has been  pale  and placid.   The access  of these
symptoms  is stated to have  been sometimes accompanied by a
pleasing sensation of delirium, while at others, the most acute pains
have been suffered.   In some instances, there appears to have  been
irritability of the stomach, for the affected person has vomited the
contents of his stomach in a semi-digested state.  Those who  have
been  resuscitated have felt pain in the  head, or pain and  soreness
over the body for several days ; while, in a feAV severe cases, paraly-
sis of the muscles of the face has supervened on recovery.
   Post-mortem appearances.—In some instances, the face has  been
found livid and swollen and the features distorted,  but more gene-
rally, it has been pale and placid, as if the person had died  Avithout
a struggle in the position in Avhich his body was  found.  The skin
is sometimes livid, or  presents patches of lividity, and the limbs
are quite flaccid.  The pupils have been found  dilated.   Internally,
the venous system is filled with liquid blood  of  a dark color.   In
death from carbonic acid as a result of combustion, the blood has
sometimes had  a light-red color.   The  vessels .of  the lungs  and
brain are  observed  to be  especially in a state of  congestion.   The
tongue  appears  swTollen, and sometimes the  mucous membrane of
the  intestinal canal presents dark ecchymosed patches.  The  fol-
loAving  appearances were met Avith thirty hours after death in the
bodies of  two adults, male  and female, who  died  from the acci-
dental introduction of carbonic acid into their  bedroom from burn-
ing  ashes.  Externally, there was nothing unnatural, excepting a
feAV slight discolorations on the back of the man ; internally, there
w7as  congestion of the membranes and great  vessels of the brain.
Each lateral ventricle  contained  about  half  an ounce of  clear
serum ; the lungs were gorged Avith dark blood, and the lining mem-
brane of the  air-tubes (bronchi) Avas slightly  reddened. The left
sides of the heart were nearly   empty:  the right contained a
quantity of dark half-coagulated blood. The stomachs were healthy.
The  bodies Avere found on the floor of the bedroom in easy positions.
The  deceased persons had had the power to  get  out of bed, but
were unable  to escape  from  the chamber.  It will  be perceived
from this description that there  is  nothing very characteristic in
the appearances, and thus it is ahvays  easy to  ascribe death to apo-
plexy or some other cause;  but it should be remembered that car-
bonic acid itself is a narcotic poison, inducing cerebral congestion
and apoplexy.
   Analysis.—Sometimes a medical jurist may  be required  to state
for the purposes of justice, the nature of the gaseous mixture in
which a person may have  died.   There Avill be no difficulty in
determining  Avhether carbonic acid is, or is  not,  the  deleterious
agent in such a mixture.  When it exists in a confined atmosphere
its presence may be identified, if previously collected in a proper 
TESTS FOR  CARBONIC  ACID.              451
vessel, by the following characters : 1. It extinguishes a taper if the
proportion  be above 12 or 15 per cent.  2.  Lime-water, or a  solu-
tion of subacetate of  lead, is instantly precipitated  Avhite  Avhen
poured into a jar of the gas; and the precipitate thus formed may be
collected by filtration, and proved to possess  the Avell-knoAvn pro-
perties of carbonate of lime, or lead.   Air containing only 1 per
cent, of carbonic acid affects lime-Avater:  if it  amounts to  2 per
cent., a fe\v cubic inches wi 11  suffice  to show its presence by the
lime-Avater test.  The  proportion in which  carbonic acid exists in a
mixture may be determined by introducing into a measured quan-
tify, in a graduated tube over mercury, a strong  solution of potash.
Absorption Avill take place after a certain time, and the degree of
absorption  will indicate the proportion of  carbonic  acid  present.
When this gas exists in a  confined  spot, as in  a Avell or cellar, it
may be got rid of by placing within the stratum a pan containing
the hydrate of lime  loosely mixed Avith water; by exciting com-
bustion at the mouth of the pit; or, Avhat  is better when available,
by a jet of  high pressure steam.   Lives  are often successively lost
on these  occasions, in  consequence of one person descending after
another, in the foolish expectation of at least  being able to attach
a rope to the body of his companion.   The moment that the mouth
conies Avithin  the  level of the invisible stratum of gas, muscular
power is lost, and the person  commonly sinks lifeless.  Carbonic
acid may be  collected  for the purpose  of testing, by loAvering a
bottle  filled  Avith fine sand, by  means of a string  attached  to
the neck, and  guiding the  bottle by another string attached to its
base.  When the bottle is Avithin  the  stratum, it should be turned
Avith its mouth downwards ; and Avhen the  sand has fallen out, it
may be  rapidly  raised, with its  mouth upwards, by  pulling the
string attached to the  neck.
  Combustion in mixtures containing carbonic acid.—In  reference to
suffocation  by carbonic acid, there is  one  circumstance which re-
quires attention.  It is a matter of popular belief—and, in fact, it
is generally asserted by Avriters on asphyxia—that the burning of
a candle in  a suspected mixture of carbonic acid and air, is a satis-
factory proof that it may be respired  with safety.  The  results of
some experiments on  this  subject have  led me  to the conclusion
that a candle Avill burn in air Avhich is combined with even 10  or
12 per cent, of its volume of carbonic acid gas; and although such
mixtures might not prove immediately fatal to man, yet they Avould
soon give rise to giddiness, insensibility, and ultimately death,  in
those"who, after  having  been once  immersed in them,  did  not
hasten to quit  the spot.  In air containing a  smaller proportion
than this (5 or 6  per  cent.), a candle Avill readily burn, but it is
probable that such a mixture could not  be long respired  Avithout
causing serious symptoms; hence the burning of a candle can be no
criterion of safety against the effects of carbonic  acid.  It  is  true
that in gaseous mixtures, where a  candle is extinguished, it Avould
not be safe to venture; but the converse  of this  proposition is not
true—namely,  that a  mixture in which  a candle  burns  may be 
452
CHARCOAL-VAPOR.
always respired with safety.  It has been observed on several occa-
sions", that the  combustion  of charcoal  has  been maintained in a
room in which persons have been found in a state of insensibility
from breathing the vapors.

 Charcoal-vapor.  Carbonic Oxide.   Gases of Blast Furnaces.

  The vapor extricated during the combustion of charcoal  is not
pure carbonic acid, but a mixture  of gases.  It operates  fatally
when respired, partly in consequence of the carbonic acid contained
in it, and partly from the presence of a variable  proportion of car-
bonic oxide.  The proportion of these gases, however, is subject to
variation, according to whether the combustion is  vivid or not,
When the charcoal burns vividly, the quantity of carbonic oxide
Avas found by Orfila to be less  than when  it is either nearly extin-
guished, or beginning to burn.  In  the  former  case, the carbonic
oxide Avas in the proportion of about 11 per cent, by volume—in the
latter, the proportion amounted to about 14 per cent.  Leblanc
found that charcoal burning in the open air produced about J per
cent, of carbonic oxide.   There is  no doubt  that  a  low or imper-
fect combustion is more  favorable  to the production of this gas,
and it is considered to operate  more powerfully "on the  body than
carbonic acid.  According  to Leblanc, a bird was killed instantly
by breathing an air containing 4 or 5 per cent, of carbonic oxide;
only 1 per cent, sufficed to  cause  death in two  minutes.  (" Ann.
d'Hyg." 1843, vol. 2, p. 54.)  Charcoal-vapor  may  be regarded  as
a mixture of carbonic acid, carbonic oxide, aqueous vapor, and air
partially deoxidized.   There is also associated  Avith it, at  a Ioav
temperature, a small quantity of carburetted hydrogen.  This does
not appear to take  any  part in the fatal effects produced by the
vapor;  these are owTing to the action of carbonic acid and carbonic
oxide, and according to Bernard a mixture of the two is more de-
structive than either gas separately.  (" Les Substances Toxiques,"
p. 212.)   M. Leblanc endeavors to determine the proportion  of the
gases in  charcoal-vapor,  when this was in  such a condition as to
prove fatal to animal life.  The vapor Avas conducted from some
fully ignited fuel, into an  inclosed space in which there Avas a
middle-sized dog  whose  condition could be  watched.   In ten
minutes the animal fell exhausted, and in twenty minutes it died,
after some hard breathing.   A candle burnt with  its usual bright-
ness in the closed room, and it was only  ten minutes after the death
of the dog that the flame of the candle, from becoming paler and
paler was extinguished.  The air of the chamber was at this time
collected and analyzed; it  contained, in 100 parts—carbonic acid,
4.61; carbonic  oxide, 0.54; carburetted hydrogen,  0.04; oxygen,
19.19;  and nitrogen, 75.62.  It Avould thus appear that less than 5
per cent, of carbonic acid is  fatal to  life When so  little as J per
cent, of carbonic oxide is mixed with it.  (Bernard, op. cit.  p. 159.)
The burning of a  candle  under the circumstances will  also show
that oxy-combustion may be maintained  in a  mixture by which 
              symptoms and appearances.           453

an animal is killed, and therefore that combustion can furnish no
criterion of safety in apartments in which charcoal has been burnt.
  Symptoms and appearances after death.—The following case, illus-
trating the  effects of charcoal-vapor, occurred to Air. Collambell.
(" Med. Gaz." vol.  27, p. 693.)   In January, 1841, a man was en-
gaged to clean the  Avindows of three  small rooms on the basement-
floor of a house.  The first room had a door opening  into a court-
yard ; the others merely communicated Avith each other by a central
door, and there Avas no fireplace in any one of  them.  A brazier of
burning charcoal had  been placed in the outer room for the purpose
of drying it, but it appeared that the deceased had shut the outer
door, and had removed the brazier into the inner room of the three,
leaving the communicating doors open.   In two hours the man Avas
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
Avere bright and staring, the pupils widely dilated, the lips blood-
less, the jaws firmly fixed, the tongue protruding, and the face and
the  limbs Ave re cold.  Some frothy mucus had escaped from the
mouth.   The person Avho  discovered the deceased found the ashes
in the brazier still  burning, and he experienced great oppression in
breathing.   An inquest was held, but without an inspection of the
body, and  a verdict  of " accidental death" returned.  The body
was afterwards privately inspected by Dr. Collambell.  On opening
the head, the vessels on the surface of the brain were found much
distended Avith dark liquid blood ; the pia mater was bedewed Avith
serum.  The brain was of unusually  firm consistency, and  numer-
ous bloody points appeared on making a section of it.  The lateral
ventricles Avere distended  with  about an ounce and a half of  pale
serum, and the vessels of the plexus choroides were much congested.
The cerebellum Avas firm, and presented on section numerous bloody
points.  About tAvo ounces of serum, tinged with blood, were col-
lected from  the base  of the skull.   The lungs had a slate color.
On the left side of the  chest there Avere 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 Avith
blood, escaped.  The bronchial tubes  were filled with a frothy fluid
tinged Avith blood.   The pericardium contained an ounce of pale
serum; the heart Avas enlarged, its cavities contained no blood; the
liver and  kidneys  were, however, much gorged.   There  was no
doubt that the cause of death Avas the inhalation of charcoal-vapor;
and it is probable that the man  died from respiring but a compara-
tively small proportion.  The capacity of the chambers must  have
nearly reached tAvo thousand  cubic  feet; the deceased had  been
there only tAvo hours, and Avhen the persen who discovered  him
entered the  rooms, the air was  not so vitiated but that he could
breathe, although Avith some  oppression.  The fuel Avas then  in a
state of combustion. In a  case of death from charcoal-vapor, Avhich
was referred to me  for examination in 1851, there Avas a considerable
effusion of blood in the submucous  tissue of  the stomach.  This
appearance led to a strong suspicion of irritant poisoning.  A full 
454
CHARCOAL-VAPOR.
 investigation of the circumstances, however, showed that the sus-
 picion was unfounded.   The vapor had descended through  a flue
 communicating with the bedroom in which deceased slept with her
 husband.; it destroyed the wife, and nearly killed the husband.  A
 stove with burning charcoal had been placed in the room  above
 that in which the couple slept, and an iron pipe  conveyed the pro-
 ducts of combustion into  a flue, whence they descended into the
 bedroom and caused the  fatal  accident.  In one fatal case there
 was copious bleeding from the nose.  (" Med. Gaz." vol. 47, p. 412.)
 In a case which occurred to M.  Guerard, the liver and spleen were
 found gorged with  a dark liquid blood ; the heart was collapsed
 and  its cavities were empty, but liquid and  dark-colored  blood
 floAved from the  large vessels.   The Avindpipe and bronchi had a
 red color, and Ave re  filled Avith frothy mucus.   The membranes of
 the brain were congested,  and the sinuses gorged with fluid blood.
 The face was pale, the  eyelids were closed, and the pupils natural.
 There Avere livid  patches  over  the body.  ("Ann. d' Hyg." 1843,
 vol.  2, p. 57.)
   It often excites surprise  on  these occasions that no  exertion is
 made to escape, when it would apparently7 require but slight efforts
 on the part of the person affected.  The action of this vapor is very
 insidious;  one  of its first effects  is to create an utter prostration of
 strength, so that even on a person awake and active, the gas may
 speedily produce a perfect inability to move or to call for assistance.
 For  a case illustrative of the dangerous effect of the diluted vapor,
 see " Ed. Med.  and Surg. Journ." vol. 1, p. 541.   In this instance, a
 charcoal brazier was left,  only for  a  short time, in the  cell  of a
 prison.  It Avas removed, and the prisoners went to sleep.  They ex-
 perienced no particular  effects at first, but after some  hours two
 were found dead.  Thus, then, an atmosphere Avhieh can be breathed
 for a short time Avith impunity, may ultimately destroy life.
   M. Devergie has sho\Vn that the smothered combustion of wood
 may lead to the evolution of a noxious vapor (carbonic oxide), and
 give rise to dangerous consequences.  ("Ann. d'Hyg.," 1835, vol. 1, p.
 442.)  His remarks have  been  recently confirmed by  two cases
 published by MM. Bayard and Tardieu.  A man and his Avife Avere
 found dead in bed.  There was  a smoky vapor  in the apartment,
 but no fire had been lighted  in the  grate, and  the chimney Avas
 blocked up.  The planks  of the floor  were Avidely separated, and
 there was a large hole in the boards at the foot of the bed commu-
 nicating with the apartment below.  It was found, on examination,
 that some joists connected  Avith  the flue of an iron  plate, Avhich
 had been heated for making confectionery the previous day, were
 in a  smouldering state; that the vapor had entered the bedroom of
 the deceased through the crevices in the floor, and, not finding a
 vent by the chimney, had led to these fatal results.  It is remark-
able  that the source of combustion was  nearly nine yards distant,
and one person, who slept nearer to the  flue of the iron plate, en-
 tirely escaped.  In the body of the husband, the skin was of a red-
dish  tint, the  blood liquid, the cavities of the heart empty, the 
effects of carbonic  oxide.
455
lungs gorged, and there were no subpleural ecchymoses.  In  the
body of the Avife, there Avas less redness of the skin ; the blood Avas
coagulated  in  the  cavities of the heart,  principally on the right
side extending to the vessels; less engorgement of the lungs, and a
great number of subpleural ecchymoses, indicating that  strong
efforts had been made to  respire.   There Avas at first  a rumor of
poisoning, Avhich Avas only remoA7ed by a  close examination of  the
locality.  ("Ann. d'Hyg.," Oct. 1845, p. 369.)
  It may be observed in  reference to  this vapor, that Avhen pro-
duced from burning charcoal or wood—in spite of the great density
of carbonic acid, the noxious gas is diffused rapidly throughout the
Avhole of an apartment.  This is owing partly to the effect  of  the
heated current of air, and partly to the law of the diffusion of gases,
Avhereby heavy and light gases are soon uniformly intermixed.
  Carbonic oxide.—The noxious  effects of the vapor of burning
charcoal are considered to be partly due to the presence of carbonic
oxide.   The action of this gas upon animal life has been made  a
subject of experiment by Bernard (" Lecons sur les  Substances Tox-
iques," p. 164.)  An atmosphere containing from 5 to 6 per cent, of
it will destroy life.   The blood is brightened in color by this gas,
while it is darkened  by carbonic acid.   Bernard has observed that
this bright color has been  retained for three weeks; and he consid-
ers the mode of action of this gaseous  poison to be, that it  prevents
the arterial blood of the body from becoming venous,  Avhile car-
bonic acid operates by preventing the venous blood from becoming
arterial.  (Op.  cit, pp. 182, 195.)
  This condition of the blood as a result of the action of  carbonic
oxide may occasion some doubt of the cause  of death, in  cases  of
suffocation by  fire.  In April, 1858, an inquiry took place into the
cause of death  of fourteen  persons, OAving  to a fire in  a house in
Bloomsbury.   The medical Avitness, on examining the bodies, found
a redness of the muscles and a redness of the blood.  He therefore
thought that death Avas not caused by suffocation, but from the in-
halation of arsenical vapors, owring to some  minerals  containing
arsenic having been partially consumed during the fire.  But there
was a total Avant of evidence  to  show that the vapors of arsenic,
when breathed, would cause death so speedily as the noxious gases
evolved by fire, or that they Avould  retlden the blood or  muscles.
On the other hand, the respiration of  carbonic oxide w^ould ex-
plain these facts.   It is worthy of remark that in many of the ob-
served cases of death from charcoal-vapor, the  blood has had a
darker color than natural: the greater solubility or carbonic  acid,
and the larger proportion in Avhich it is produced, may account for
this effect.
  The action of carbonic oxide on the  body is that of a pure nar-
cotic poison.   M. Tourdes has ascertained  that  rabbits  died  in
twenty-three minutes, Avhen  kept in an  atmosphere  containing
l-15th of its volume of pure carbonic oxide;  Avhen the proportion
was 1-8Oth they died in  thirty-seven minutes, and Avhen l-8th in
seven minutes.   Dr. Letheby states that in his experiments a mix- 
456
VAPORS OF COAL  AND COKE.
ture of I per cent, killed small birds in three minutes, and of 1 per
cent, in about half this time.  The animals showed no sign of pain:
they fell in a state of insensibility, and either died at once, Avithout
convulsions, or they gradually passed into a state of profound coma.
He found, on inspection, that the blood was redder than usual, that
the muscles of the heart w7ere someAvhat gorged, and that the brain
was congested.   ("Lancet," March 1, 1862, p. 219.)   Dr.  Hoppe-
Seyler states that animals which  had been made to breathe car-
bonic oxide Avere restored by continuing  for some time artificial
respiration, and  under these circumstances, the gas was expired as
carbonic acid, having  undergone further  oxidation in the blood.
This Avriter has suggested a method for detecting the presence of
carbonic oxide in the blood by spectral analysis.  (" Chem.  Xews,"
Aug.  4, 1865, p. 58.)
  Among the appearances observed in  animals destroyed  by this
gas, Ssabinski has pointed out an anaemic condition of the  spleen.
This organ had a rose-red color, but Avhen a section of it Avas made,
scarcely any blood floAved from  it. (Horn's " Vierteljahrsschrift,"
1867, 2, 171.)

           Coal and Coke Vapors.  Sulphurous Acid.

  Products from burning coal and coke.—The gases extricated in the
smothered  combustion of coal or coke are  of a compound  nature.
In addition to carbonic acid and carbonic  oxide,  we may expect to
find in the atmosphere of a close room in Avhich such a combustion
has been going on, sulphurous  acid gas; and from coal, in addition
to this, the sulphuretted and carburetted hydrogen gases.  These
emanations are equally fatal  to life;  but in consequence of their
very irritating properties, they give warning of their presence, and
are, therefore, less liable to occasion fatal accidents.  From an acci-
dent which occurred at Colchester a few years since, in which two
children lost their lives, it would appear that some persons are so
ignorant as to believe  that the vapor of coke is less fatal than  the
vapor of charcoal.   The sulphurous acid gas, when existing in a
small proportion in air, has the effect of irritating the air-passages
so violently that, if accidentally respired,  it Avould commonly com-
pel the person to leave the spot before the vapors had become suffi-
ciently concentrated to destroy  life.  Nevertheless, accidents from
the combustion of coal and coke sometimes (recur.
   Symptoms and appearances.—The following cases will convey a
knowledge of the symptoms and appearances which may be met
Avith  on these occasions.  Some years since four persons, in a state of
asphyxia, Avere brought into Guy's Hospital.  It appeared  that on
the previous evening they had shut themselves up in the forecastle
of a coal-brig, and had made a fire.  About six or seven o'clock on
the same evening, some of the crew accidentally placed a covering
over the flue on the outside, and thus stopped the escape of smoke
from  the fire, which was  made of a kind of coal containing much
sulphur.  Early in  the morning one  of the  crew, on  opening the 
            vapors of  lime and  brick-kilns.        457

 hatches, observed three of the inmates  lying on the floor  senseless
 and frothing at the mouth, and the fourth in his crib in a similar
 condition.   The air in the place Avas most offensive.  After the
 men were brought on deck one of them, aged 21, began to recover,
 ami when brought to thej&ospital  he seemed only giddv, as if in-
 toxicated; he soon completely recovered.  Another^ aged' 40, after
 breathing oxygen-gas, and having brandy and  ammonia adminis-
 tered to him, showed no symptoms of  recovery, but died in a few
 hours.  A third, aged 17, soon  began to rally, and in a  short time
 he was able to answer questions;  he declared that at  the  time of
 the accident he felt no pain, sense of oppression,  or weight, either
 in his head or chest.  The fourth, aged 15, died the following day,
 having sIioavii no symptoms of rallying.   Stimulants were  admin-
 istered, and  warm fomentations Avere used, but all  efforts to produce
 reaction failed.   The appearances presented by these persons wdien
 brought in, AA-ere as folloAvs: The lips Avere purple, the countenance
 was livid, and the surface  of  the body  cold; the  hands and nails
 were  purple; the breathing was quick and short—the  pulse small,
 quick, and feeble; the pupils Avere fixed, and there was total in-
 sensibility.  The body of the man aged 40 was inspected four hours
 after  death.  The membranes of the brain Avere congested, and there
 was a large quantity of fluid under the arachnoid or middle mem-
 brane; the  sinuses  Avere gorged with  blood; the lungs w7ere in  a
 state of great congestion, as \A7ere also the right cavities of the heart.
 It was remarked that, in its  congested condition, this corpse  was
 similar in appearance  to that  of an executed culprit.  The body of
 the lad aged 15 w7as inspected about thirty-three hours after death.
 Under the pia mater, or  inner membrane of the  brain, Avas ob-
 served one small ecchymosed spot;  in  the substance of the brain
 there were more bloody points than usual; a small quantity of fluid
 was found under  the arachnoid membrane, and  the  sinuses were
 full of coagulated blood.  The lungs sliOAved no  congestion, but the
 right cavities of the heart  Avere much distended with blood.  (For
 a report  of cases of  recovery from  the  effects of coal-vapor, see
 " Med. Gaz." vol.  9, p. 935 ; also " Dub. Med. Press," Jan. 31, 1849,
 p. 69, and "  Med.  Gaz." vol. 43, p. 937.)
  Analysis.—Sulphurous acid is immediately knoAvn by its poAverful '
 and suffocating odor, which resembles that of burning sulphur.  The
 best test for its presence is a mixture of iodic acid and starch, Avhich
 speedily acquires a blue color  Avhen exposetl to the vapor.
  The products of the combustion of impure coal-gas are equally
 destructive to life ;  they consist of carbonic acid and sulphurous
 and nitric acids.


          Vapors of Lime, Brick and Cement-Kilns.

  Gaseous products from lime-burning.—In the burning of lime, car-
bonic acid is giA-en out abundantly, but, owing to the nature of the
fuel used, carbonic oxide and sulphurous acid are mixed  with it.
Persons Avho have  incautiously slept  in the  neighborhood of a 
 458             effects  of  confined air.

 burning lime-kiln during a winter's night, have been destroyed by
 the respiration of these vapors.   The discovery of a dead body in
 such a situation would commonly suffice to indicate the real cause
 of death ;  but a  practitioner ought not to be the less prepared to
 show that there existed no other apparent cause of death about the
 person.  It is obvious that a  person might be murdered, and the
 body placed  subsequently near a kiln by the murderer in order to
 avert suspicion.   If there  are no marks of external violence, the
 stomach should be carefully examined for poison ; in the absence of
 all external and  internal  injuries, medical evidence will avail but
 little; for  a person might be criminally suffocated, and his body, if
 found under the circumstances above stated, would present scarcely
 any appearances  upon which a  medical opinion  could be  securely
 based.   The vapors of brick-kilns are equally deleterious,  the prin-
 cipal agent being carbonic acid mixed with carbonic oxide ;  although
 I have found that, according to the stage of combustion of the fuel,
 ammonia, hydrochloric acid, sulphuretted hydrogen,and sulphurous
 acid may be evolved.  In September, 1842, tAvo boys were found
 dead on a  brick-kiln near London, Avhither they had gone for the
 purpose of roasting potatoes.  Although the cause of death in both
 cases was clearly suffocation, in one instance the body was extremely
 livid Avhile in the other there  was no lividity  whatever!  Such
 accidents are frequent ;  in November, 1844, an inquest AA7as held at
 Manchester on the body of a man who had died  under similar cir-
 cumstances.  The vapors of cement-kilns are  quite  as  noxious  as
 those of brick-kilns; carbonic and  sulphurous acids predominate
 in them.

                         Confined Air.

   Symptoms and effects.—An animal confined within a certain quan-
 tity of air, which it is compelled to breathe, will soon fall into a
 state of lifelessness.  A human being in the same Avay may be
 suffocated, if confined in a close  apartment wdiere the air is not sub-
ject to  change or renewal, Avhile the  products  of  respiration are
accumulated ; and the effects are hastened when  a number of per-
sons are crowded together  in a  small space.  The  change which
 air, thus contaminated by breathing, undergoes maybe very simply
 stated.   The quantity of nitrogen in 100 parts will remain nearly
 the same ;  the quantity of oxygen will probably vary from 8  to 12
 per cent., while the remainder w7ill be made up chiefly of carbonic
 acid.  If many persons are crowded together, the air will acquire a
 high temperature, and will be saturated with aqueous A7aporAvhich
 contains decomposing animal matter derived from the lungs and
 skin.  From this statement, it is evident that air which  has been
 contaminated by continued respiration will operate fatally on the
 human body, partly in consequence of its being deficient in oxygen,
 and partly from  the noxious effects of the carbonic acid contained
 in it.  The proportion in which carbonic acid exists in respired air
 is subject to variation ; according to the experiments of Allen and 
           COAL-GAS — CARBURETTED HYDROGEN.       459

Pepys, it ncA-er exceeds 10 per cent, by volume of the mixture, hoAv
frequently soever it may have been received into and expelled from
the lungs.  The influence of respiration on air may be thus stated :
An adult consumes from one to tAvo gallons of air per minute, and
the air expired contains from 4 to 5 per cent, of carbonic acid ; but
it is a remarkable fact that, Avhen a person continues to breathe the
same  air, the  proportion of carbonic acid expelled is reduced  at
each successive respiration.   When the amount in air has reached
10 or 12 per cent, no more is thrown off by the lungs, and the blood
is no longer depurated.   For healthy existence, a  human being re-
quires 20  cubic feet or 125 gallons of air per  hour.  A common
candle Avill consume as much as two gallons of air per minute, or
render thatquantity of air  unfit for respiration.   Dalton found
that the air in crowded rooms contained about  1 per cent, of car-
bonic acid, the atmospheric  proportion  being therefore increased
nearly tAventy-fold.  It is certain that  insensibility and death would
ensue in a human adult before the Avhole of the oxygen  of the con-
fined air had disappeared;  but the opportunity can rarely present
itself  for analyzing such a contaminated mixture, and  hence it is
impossible to specify the exact proportion  in Avhich carbonic  acid
would exist Avhen the confined air proved fatal to persons Avho had
respired it.  M. Lassaigne has shown, by  direct experiment, that
the carbonic acid in the air of close rooms is  not  collected  on the
floor, but equally diffused throughout.  The whole mass of air is,
in fact, vitiated, and  requires renewal. .("Med. Gaz."  vol. 38, p.
351;  see also  "Report  on Mines,"  1864, App.  B,  p.  196, and
" Chemical Xews," Feb. 17,1865, p. 79.)

              Coal-Gas.  Carburetted Hydrogen.

  Coal-gas  is a compound Avhich,  Avhen respired, acts directly as a
poison.  Many fatal accidents have occurred from the respiration
of air contaminated with it.   Its composition is subject  to much
variation, according to circumstances.  Mitscherlich found that it
was principally composed of light carburetted hydrogen, hydrogen,
and carbonic oxitle, in the proportions of 6Q per cent, of  the first,
21.3 of the second, and  11  of the  third.   M.  Tourdes  found that
the proportions of light carburetted hydrogen and carbonic oxide
were nearly equal, i. e., about 22 per cent.   An analysis of coal-gas
as supplied to  London shoAvs that in 1000 parts it contains—of
hydrogen, 464.3 ;  of light  carburetted hydrogen, 389.3 ;  carbonic
oxide, 56.2;  olefiant gas, 3^.6; Avatery vapor, 24.8; nitrogen, 22.2;
carbonic acid,  4.6.   The difference in  composition  depends on the
heat to Avhich the gas has been submitted.  Some consider that car-
bonic oxide is the poisonous principle ; but there is no doubt that
the hydrocarbons also have a specially noxious influence, although
the use of the safety-lamp in mines proves  that a mixture of light
carburetted hydrogen Avith air in an  explosive proportion, may be
inspired Avithout producing serious effects. 
460                EFFECTS  OF  COAL-GAS.
  Symptoms and appearances after death.—The symptoms produced
by coal-gas, when mixed in a large proportion with air, are—giddi-
ness,  headache, nausea with vomiting, confusion of  intellect, loss
of consciousness, general weakness and depression, partial paralysis,
convulsions, and the usual phenomena  of asphyxia. ^ The appear-
ances after death will be understood from the following cases.  In
January, 1841, a  family residing at Strasburg respired  for  forty
hours an atmosphere contaminated with coal-gas, Avhich had escaped
from a pipe passing near the cellar of the  house in which  they
lodged.   On the discovery of the accident four of the family were
found dead.  The father and mother still breathed, but in spite of
treatment,  the father died  in twenty-four hours ;  the mother re-
coArered.   When the five bodies were inspected there was  a  great
difference in  the  appearances ;  but the  principal changes observed
were, congestion of the brain and its membranes—the pia mater
(inner  membrane)  being gorged Avith blood, and the whole sur-
face of the brain intensely red.  In  three of the cases, there was
an  eff'usion of blood (coagulated) on the dura mater and in the
spinal canal.  The lining membrane of the air-passages was strongly
injected, and there was spread  over it a thick viscid froth tinged
Avith blood; the substance of the lungs Avas  of a bright-red color,
and the blood in the vessels was coagulated.  ("Ann. d'Hyg." Jan.
1842.)  In  tAvo cases communicated  by Mr. Teale to the  " Guy's
Hospital  Reports" (No. 8), there was found congestion of the  brain
and its membranes, Avith injection of the lining membrane of the
air-passages ; the blood was remarkably liquid.   An aged female
and her granddaughter, who had been annoyed by the  escape of
gas during the day, retired to bed, and they Avere found dead about
twelve hours afterwards.
  Mr. Bloxam has published a  case of poisoning by coal-gas, AAThich
shows how easily life may be destroyed by it.  In November,  1861,
he  saw the deceased, avIio was  a gas-fitter;  he was supported in a
sitting posture on the floor.  The man had accidentally respired
coal-gas while connecting a tube with a meter.  The skin was cold,
the cornea glazed, and  the face pale  and placid; there Avas  some
froth about the  mouth, the pupils were rather dilated,  and the
limbs supple.   There was a strong smell of gas in the place.  He
was working in a closet, and he Avas found insensible on the top of
a pair of steps in a sitting posture—his head on one side, his  arms
hanging down, and his  back leaning  against the wall, in the atti-
tude in which he Avas engaged at his work.  He had evidently
died quietly and placidly on his seat, and had made no attempt to
decend the steps.  He was last seen  alh7e an hour before he was
found dead, and he  no doubt died rapidly from  the inhalation of
the gas.   An inspection of the body  was ma'de twenty-four hours
after death.   Externally, the skin  of the  face and  upper part of
the body was  pale—rigidity was well-marked, and there was  gene-
ral lividity of the back of the body as well as of the limbs.  The
blood was  everywhere fluid.  The  brain and its  membranes Avere
not congested, but were rather pale than otherwise ;  the ventricles 
EFFECTS OF COAL-GAS.
461
contained a pale serum.  The brain and cerebellum were apparently
healthy.  There was a strong odor of coal-gas on exposing the brain.
The lungs were of a dark-red color, and did not collapse on raising
the chest-bone; they w7ere dark at the back of the lobes from gra-
vitation of blood ; their structure was healthy.   The windpipe and
bronchi contained frothy mucus in some quantity.   A powerful
odor of gas was  perceived  on compressing the  lungs.  The heart
Avas healthy; the right cavities were distended with blood—the left
were nearly empty;  the bood was  everywhere  black.  There was
congestion of the abnormal viscera, but no  other  unusual appear-
ance.   (" Med.-Chir. Trans." 1862, vol. 45, p. 103.)
  In the  cases above related, the effects produced by coal-gas were
OAving  to the long-continued respiration of it in a  diluted state.
The  quantity contained in the  air of the rooms must have  been
very small: in M. Tourdes' case it  was probably not  more than 8
or 9 per cent., because at a  little above this proportion the mixture
with air becomes explosive  ; and there had been no explosion in this
case, although in the  apartment in Avhich the  person was found
dead, a stove had been for a long time in  active combustion, and a
candle  had been completely burnt out.  In Mr. Teale's cases, those
who entered  the house perceived  a strong smell of coal-gas, but
still  the  air  could be  breathed.   Coal-gas, therefore, like  other
aerial poisons, may destroy  life if long respired, although so diluted
as not to produce any serious effects in the first  instance.   Insensi-
bility may, however, be an  early symptom in a very diluteel atmos-
phere, and  unless the person is speedily removed into fresh air he
will  die.   In a case which  occurred to  Mr. Jessop, a  man entered
a large open pipe four feet in diameter, Avhich  had  been used for
gas, to  look for a leak.   He  thought all  the gas had been let off.
On entering the pipe, he perceived a strong smell, and remembered
nothing further.  Hew7as taken to the infirmary in an unconscious
state, suffering from violent muscular contractions.  He recovered
in tAvo days.  (" Lancet," 1870, 2,  816.)  The respiration of this
gas renders a man entirely poAverless to  give any alarm or make
any effort to save himself.  Stupefaction,  and Avith this, loss of all
muscular powyer, speedily follow the inhalation of diluted coal-gas.
("Ann. d'Hyg." 1870, 1,60.)
  Coal-gas owes  its peculiar odor chiefly to the  vapor of naphtha:
its presence is thus indicated: The odor  begins to be  perceptible
in air when the gas forms only the 1000th part; it  is easily per-
ceived  Avhen  forming the  700th part; but  the odor is  strongly
marked Avhen it forms  the  150th part (Tourdes).  In  most houses
in which  gas is  burnt, the odor, owing to leakage, is plainly per-
ceived ; and it is a serious question Avhether health and  life may
not often  be affected by the long-continued respiration of an atmos-
phere containing but a small  proportion.  The odor will always
convey  a  sufficient warning against its poisonous effects.  It should
be known that this gas will  penetrate into  dAvellings in an insidious
manner.  In  Mr. Teale's cases, the pipe from which  the gas had
escaped was situated about ten feet from the AATall of  the bedroom 
462                   NITROUS  OXIDE.
Avhere  the women slept;  the gas had permeated through the loose
earth and  rubbish, and  had entered the apartment through  the
floor.  I have  notes of several other cases  in which coal gas  has
thus destroyed life by leakage into bedrooms.  (See " Lancet," 1872,

  It is impossible to determine exactly AAdiat proportion of this gas
in air will  destroy life.  An atmosphere  containing from 7 to 12
per cent, has been found to destroy dogs  and  rabbits  in a  few
minutes; when the proportion was from 1J to 2 per cent, it  had
little or no effect.   AVith respect to man,  it  may  destroy life if
long breathed Avhen forming about 9 per cent., i. e., Avhen it is in
less than an explosive proportion.  (See " British and Foreign Med.
Rev.,"  vol.  20, p. 253 ; also, " Ann. d'Hyg." 1830, 1, 457 ; also 1870,
1, 63.)   The late Dr. Aldis  observed in  his  experiments, that in
ordinary coal-gas mixed  Avith air, rats Avere rendered insensible in
half a  minute, and died in a minute and a half to tAvo minutes.
There AATas  before death spasmodic action  of the diaphragm.  The
gas was alloAved to enter slowly into a bell-jar of air in  which  the
animals were placed.  ("  Aled. and Chir. Trans." 1862, 45, 100.)
  Analysis.—The circumstances under Avhich the accident occurs
will generally suffice to establish  the nature of the noxious agent.
Coahgas burns Avith a bright white light, producing carbonic acid
and water.  A taper should be cautiously applied to a small quantity;
since, Avhen the gas is mixed with the air in  the proportion of from
11 to 14 per cent., it is dangerously explosive.  For this reason no
lighted candle  should  be taken into an apartment where an acci-
dent has occurred, until  all  the doors and windows have been for
some time kept open, and the smell of gas has entirely disappeared.
(See " Aled. Gaz." vol. 42, p. 343.)  The combustion of  the gas, or
its explosion Avith air, is a sufficient test of its nature ; the peculiar
odor and the Avant of action on a salt of lead, if the gas is pure, will
distinguish it from sulphuretted hydrogen.

                        Nitrous Oxide.

  Recent cases of death  from the inhalation of this gas render a
short notice of it necessary7.  Sir Humphry Davy was  the first to
sIioav by experiments on  himself that, under certain precautions, it
might be breathed without danger to life, and that it had the effect
of producing an  agreeable species of intoxication.  Sir Humphry
in one  experiment  breathed  three quarts, in another  nine quarts,
and in a third twenty  quarts of unmingled  nitrous oxide. (Brew-
ster's " Natural  Magic,"  p. 345.)   He suffered no  injury from in-
haling  these quantities, either at the time, or subsequently.  I have
seen it  taken in quantities  of about two to three quarts  in more
than five hundred cases, without any ill effects following. In three
cases, the first  symptoms were pallor of the countenance, lividity
of the  lips, a staggering  gait, followed by violent muscular exer-
tions.  These effects passed off in from three to five minutes.  In
a few cases, a feeling of exhaustion, with headache and pain in  the 
NITROUS OXIDE.
463
chest, folio Aved  the inhalation.  Sir Daniel Brewster-describes, on
the authority of  Professor Silliman, two  cases  in  Avhich some
remarkable  after-effects were  produced.   A young man Avho took
nitrous oxide for the sake of experiment Avas  seized with a fit of
delirium, and after making some violent exertions, fell exhausted
on the ground ; convulsions  followed  and he uttered the most
piercing shrieks and cries.   These  symptoms  continued for two
hours ; he Avas perfectly unconscious of what he was doing, and was
in every respect like a maniac.  On recovery he stated  that  his
feelings vibrated between the  most perfect happiness and  the most
consummate misery.  He recovered in three or four days, suffering
only from a feeling of fatigue and exhaustion.
  The other case Avas that of  a man of  mature age and of a grave
and respectable character.  He had been suffering from bodily and
mental debility just before taking the gas, of which he inhaled
three quarts. The consequences were an astonishing invigoration
of his Avhole system,  with a great increase of muscular  power.
These effects were  felt for at least thirty hours, and in a greater or
less degree for more than a week.  (Brewster's " Natural Alagic,'
p. 349.)
  Passing from  these  exceptional  cases, no instance of the  gas
proving fatal has been  recorded until recentl}7.   Nitrous oxide  has
been employed extensively by oculists and dentists as  a substitute
for chloroform and ether, and, so far as  it is known, with greater
safety than these  two anaesthetics,  the effects passing off more
rapidly and leaving no  unpleasant  after-consequences.   In these
cases, too,  it has been administered in doses, not of quarts,  as in  the
early  experiments  of Davy, but of  gallons.  At  the  same  time,
nitrous oxide cannot be substituted  for atmospheric air, without
danger to  life.   It cannot produce  in  the blood  those oxidative
changes on Avhich life depends, which are produced by the uncom-
bined oxygen of the air.  It is absorbed into the blood and changes
its color to a deep purple, as indicated by the change of color in the
lips.   An  animal soon dies in this gas  Avhen air is not supplied ;
and from the syniptoms preceding death, namely, convulsions and
insensibility, it must be regarded as a neurotic poison, but not of a
dangerous  kind.
  In January 1873 it was administered by a dentist at Exeter to a
lady, eet. 38, at her oavh  desire, in order to annul pain during the
extraction  of a molar tooth.   A physician carefully examined her
before the  operation, and found that  there was nothing to  preclude
the use of the gas.   The nitrous oxide Avas pure ; it had been safely
used for other "patients from the same condenser, and an apparatus
was employed so as to secure the removal of the expired air.  The
total quantity administered was about six gallons.   This could not
be regarded as an  overdose.  Sir H.  Davy himself breathed Avith
safety five  gallons in one of his experiments.  Soon after the com-
mencement of the inhalation, it was observed that the pulse became
rapid and  less full,  indicating an action on the  heart;  the patient
was then sensible, and the apparatus  was removed.  The operation 
464
NITROUS OXIDE.
Avas  commenced, but  the lady insisted on having  the  gas again.
She took it; insensibility came on, and the operation was completed.
Immediately afterwards, the face became livid, the features began
to swell, and the tongue protruded.  In  spite of every effort to re-
store her, she did not recover from the state of insensibility ; she
breathed two or three times, and the pulse then ceased.  No inspec-
tion  of the body was made.   The above-mentioned facts AArere given
in evidence at the coroner's inquest, and  the medical opinion was
that death had been caused  by the gas  in. producing paralysis of
respiration, and that  in this case  no forethought could have pre-
vented the result.  The jury returned a verdict of homicide by mis-
adventure.  (" Lancet," 1, 178.)
  It has been suggested that death may have taken place from suf-
focation, by blood entering the air-passages;  but while  there were
no symptoms indicative of this, the facts conclusively prove that
the gas operated as a blood-poison to destroy life.
  Nitrous  oxide as an anaesthetic.—Some observations  on the com-
parative effects of nitrous oxide, bichloride of methylene, and cholo- •
form as anaesthetics, haA7e been published by Mr. R. Rendle, Surgical
Registrar of Guy's Hospital.   (" Brit. Med. Journ." Oct. 16,1869.)
He gave the nitrous oxide in twenty7-four cases, the gas being re-
breathed and the carbonic acid of the expired  air removed by slaked
lime.  The persons to whom it was given varied from 3 to 73 years
of age.  It was given chiefly7 for short operations on the eyes and
teeth.   The shortest period in which anaesthesia was produced Avas
sixty seconds;  the longest, 150 ; the average w7as about a minute
and  a half.  Anaesthesia was maintained thirteen  minutes in one
case, six minutes in five cases, four minutes in five, two minutes in
tAvelve, and one minute in one case.  Intervals  of breathing air
Avere allowed in all  but one. The  period during  which  air was
admitted varied very much, and herein lies probably the secrelof
preventing fatal accidents.   When  the  quantity of air admitted
Avas  small, anaesthesia was still produced, though less rapidly, and
the blueness of the lips and skin Avas less marked.
  A woman, aet. 48,  was under the influence of the gas  in one
minute.  It  Avas continued for five minutes longer, without any
admission of air.  At the end of this time she Avas unusually blue,
and  the breathing and pulse were very slow  and failing.  The gas
Avas  removed, and the woman turned over on her left side,—the plan
of restoration employed at Guy's Hospital when unpleasant symp-
toms occur.  This woman must  have been  very near  death, and
probably would have died had she been in the sitting posture. She
gradually recovered, and walked away in five minutes more.  One
man who  began to imbibe the gas for the extraction of a tooth,
pushed  away the inhaler, and refused to continue breathing  the gas.
He complained of very  unpleasant symptoms in his head for some
hours after, but these passed  off.  One Avoman complained of head-
ache.  In one case, that of a child aet. 4, vomiting followed.  In a
child aet. 3, Avhere anaesthesia was  maintained for a minute and a
half, tAvo intervals of breathing air having been allowed, the respi- 
NITROUS OXIDE.
465
 ration ceased and the pulse sank so as to be scarcely perceptible for
 several seconds.   The gas Avas  removed, and the child Avas turned
 slowly over on his left side.  He gave a  deep sigh ; the pulse and
 respiration gradually returned, and he completely recovered in five
 minutes.
   According to Air. Rendle, the advantages of nitrous oxide are the
 rapid production of, and recovery from, anaesthesia, the absence of
 sickness, and the agreeable taste. He considers it safe  for all opera-
 tions, short or long, eA7en to a duration of twenty minutes, provided
 there be a due admission of air at proper  intervals.  But that great
 care is required in its use is shown by the alarming symptoms Avhich
 occurred in some of the cases.   Among its disadvantages are these :
 it is apt to produce rigidity of the muscles, with muscular tAvitch-
 ing and congestion.  Mr. Tomes met with cases in which recovery
 Avas sIoav;  there AA7as feeble pulse, irregular breathing, loss of appe-
 tite, and a necessity for  stimulants.   In  one instance, coma was
 produced ;  and other cases are reported of sudden supervention of
• dangerous symptoms—sickness and apparent death.
   It would appear, therefore, that  the danger from nitrous  oxide
 arises chiefly from the continuous administration  of the gas,  Avith-
 out  allowing proper intervals  for the breathing of  air.   In one
 case, supra, Air.  Rendle gaA7e the pure  gas for six minutes without
 the  admission of air.   Death did not result, although the symp-
 toms were  very alarming for  a feAV minutes.   ("Brit. Journal of
 Dental Science," May, 1871.)
   The fatal case above related has given rise to some difference of
 opinion.  As the body Avas not inspected, the  cause of death can
 only be a matter of  inference, but all the facts knoAvn point to this
 conclusion—the only practical one Avhich concerns the  public—that
 but for the administration of the nitrous oxide, this lady w7ould not
 haA7e died.   Whether  the  proximate cause was asphyxia  from
 paralysis of  the  muscles  of respiration, or  from  the entrance  of
 blood into the air-passages, is not very important.  According to
 the  report of a committee appointed  to  investigate the effects of
 nitrous  oxide as an anaesthetic, the gas operated by preventing oxi-
 dation-changes in the  blood, and, as  in death from asphyxia, the
 respiration Avas arrested before the heart ceased to beat.  (" Lancet,"
 1872, 2, 687.) See also a reference to asphyxia, vol. 1, p. 163. For
 some additional remarks on this case see "Lancet,"  1873, 1, 245.
 At page 254  of the same volume will be found a report of the case
 by Air.  Browne  Mason.   [See  an excellent paper by Dr. F. D.
 Weisse, read before  the N. Y. Med.-Leg. Society, in " N. Y. Daily
 Register," Feb. 17,1873.—R.]
   It is evident that much is still to be learned respecting the ope-
 ration of nitrons oxide on the human  body.  One  experienced
 administrator contends that air must  be occasionally admitted in
 order to prevent  fatal  effects, Avhile another states that, according
 to his experience, the giving of  air prevents complete insensibility,
 and  therefore does  not fulfil  the purpose  for which the gas is
 administered.  (" Lancet," 1872, 2,762.)  The nitrous oxide has
      30 
466           SULPHURETTED HYDROGEN GAS.
beyond doubt caused few7er  accidents than  ether and chloroform;
but there is a very narrow line between life and death in the action
of this, as well as all anesthetics; and it should  therefore only be
given by a  skilled administrator.
                     CHAPTER  XLI.

SULPHURETTED HYDROGEN GAS.—ITS POISONOUS PROPERTIES.—SYMPTOMS.
  --POST-MORTEM APPEARANCES.--EFFLUVIA OF DRAINS AND SEAVERS.—
  ANALYSIS.—MEPHITIC VAPORS.—EXHALATIONS FROM THE DEAD.

  Sulphuretted Hydrogen has a morepoAverful action on the body
than either carbonic acid or charcoal vapor.  Persons are some-
times accidentally killed by it;  but the very offensive odor which
a small portion of it  communicates to a large quantity of air is
sufficient to announce its presence, and thus, with due caution, to
prevent any dangerous consequences.  Sulphurretted hydrogen gas
wThen respired in  its pure state, is  instantaneously fatal.  It exerts
equally deleterious effects upon all orders of animals, and upon all
the textures of the  body.  It has been  found to destroy life even
Avhen it is allowed  to remain  in contact Avith the skin.   AVhen
introduced into the lungs of  animals, even in a diluted state, it has
given  rise to fatal consequences.   Thus  The'nard found that  air
AArhich contained  g^th of its  volume of this gas Avould  destroy
a dog, and that when the gas existed in the proportion of ^th
it sufficed  to kill a horse.  The latter  researches  of AI. Parent
Duchatelet have, hoAvever, showm that the poisonous effects of the
gas have been someAvhat exaggerated, at least in the application of
these results to man.   He observed  that workmen  breathed Avith
impunity an atmosphere containing 1 per cent,  of sulphuretted
hydrogen; and he states that he himself  respired, without serious
symptoms  ensuing,  air which  contained three per cent.  In most
drains and sewers rats and other vermin  are found to live in large
numbers; and, according to  Gaultier de  Claubry, the air  in those
localities  contains from 2 to  8 per cent.  (" Devergie," vol. 2, p.
520.) One  fact, however, is worthy the attention of medical jurists
—namely,  that the  breathing of an  atmosphere only slightly  im-
pregnated with  the gas may, if long continued, seriously affect a
person, destroy health, and  even  cause  deatli.  M. d'Arcet was
required to examine a lodging  in Paris, in Avhich  three young and
healthy men had died successively7, in  the course of a few years,
under similar symptoms.  The lodging  consisted  of  a  bedroom
with a chimney,  and an ill-ventilated ante-room.  The  pipe of the
privy passed down one angle of the  room by the head of  the bed,
and the wall in this part was damp from infiltration.  At  the time
of the examination, there was  no perceptible smell in the room, 
          SULPHURETTED HYDROGEN — SYMPTOMS.      4ti7

 although  it Avas  small  and low.  Af. d'Arcet attributed the mor-
 tality 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.," Juliet, 1836.)  The men who AA7ere
 engaged in Avorking at the Thames tunnel suffered severely during
 the excavation, from the presence of this gas in the atmosphere in
 which they were obliged to work.  As  a result of breathing this
 atmosphere, the strongest and most robust men were, in the course
 of a few months, reduced to an  extreme state of exhaustion, and
 several  died.   The  symptoms Avith which they Avere first affected
 were giddiness, sickness, and general debility; they became  emaci-
 ated, and fell into a state of Ioav fever, accompanied by delirium.
 In one case which I saw, the  face of the man Avas pale, the  lips  of
 a violet hue,  the eyes sunk Avith dark areolae around them, and the
 whole muscular system  was flabby and emaciated.
  Symptoms.—The symptoms produced by sulphuretted  hydrogen
 on the human body vary according to the degree of concentration
 in which it is respired.   When breathed  in a moderately diluted
 state, the person speedily falls inanimate.  An immediate removal
 to pure air, and the  application of stimulants, with cold affusion,
 may, however, suffice to restore life.  According to the account
 given by those avIio  have recovered, this state  of  inanimation  is
 preceded by a sense of weight in  the stomach and in the temples ;
 also by giddiness, nausea, sudden weakness, and loss of motion and
 sensation.  If the gas in a still less  concentrated state be respired
 for some time, coma, insensibility, or tetanus Avith delirium  super-
 venes,  preceded by  convulsions, or pain  and  Aveakness  over  the
 whole body.  The skin in such cases is commonly cold, the pulse
 irregular, and the breathing laborious. AVhen the air is but slightly
 contaminated with the gas, it may be breathed for a long time with-
 out producing any serious symptoms; sometimes there is a feeling
 of nausea or sickness, accompanied by pain  in  the head, or dif-
 fused pains in the abdomen.  The symptoms are often observed to
 affect those who are engaged in chemical manipulations with this
 gas.  Sulphuretted hydrogen appears to act like a narcotic poison
 when highly concentrated, but like  a narcotic irritant Avhen  much
 diluted Avith air.  It is absorbed into the blood, to Avhich it gives  a
 brownish-black color, and it is in this state circulated throughout
 the body.  In all cases, a noxious atmosphere containing this  gas is
 indicated by  an offensive smell, producing  nausea and  sickness.
 For a case of poisoning by this gas, in which the person recovered,
 see " Aledical  Gazette," vol. 43, p. 871.
  Appearances after death.—On examining the bodies of persons who
 have died from the effects of sulphuretted hydrogen, when respired
 in a concentrated form, and the inspection is recent, the  following
appearances have  been  observed: The mucous membrane of the
nose and throat is commonly covered by a broAvnish viscid  fluid.
An offensive odor  is exhaled from all the cavities and soft parts of
the body.  These exhalations, if received  into  the lungs of  those
engaged in making the  inspection, sometimes give rise to nausea 
468   FATAL EFFECTS OF SULPHURETTED  HYDROGEN.

and other unpleasant symptoms, and may even cause syncope or
asphyxia.  The muscles of the body are of a dark color, and are not
susceptible of the galvanic stimulus.  The lungs, liver, and the soft
organs generally, are distended Avith black liquid blood.   There is
also great congestion about the right side of the heart, and the blood
has been found everywhere liquid  and dark-colored; the  body
rapidly undergoes the putrefactive process.   When death has oc-
curred from the respiration of this gas in a more diluted form, the
appearances are less marked.  There is then general congestion of
the internal organs,.with a dark and liquid state of the blood.  In
fact, in such cases the  appearances  can  scarcely be distinguished
from thos,e produced by carbonic acid.  Four men lost their lives
in the Fleet Lane SeAver in February, 1861; they Avere found dead,
and there wras no doubt that sulphuretted hydrogen was the cause
of death.  An account of the appearances presented by the  bodies
is given in the " Lancet," by Mr. Holden and Dr. Letheby (February
23, 1861, p. 187).  The eyes  and mouth were open, the  lips and
tongue livid, the pupils widely dilated, the blood black and fluid,
the lungs congested, the heart full of black fluid  blood, the right
side gorged, and there was a bloody froth in the windpipe.  In the
brain, the large vessels of the  dura mater were full of black fluid
blood.
  In June, 1857, six persons lost their lives, at Cleator Moor, near
Whitehaven, by the respiration of sulphuretted hydrogen in a di-
luted form, by reason of their  having slept in small, close non-ven-
tilated rooms, into Avhich  the gas had  penetrated.  Three  of the
deceased persons—a  husband,  Avife, and child, of one family (Arm-
strong)—had retired to rest, in their usual health, on  the night of
the 9th of June.  Two of them Avere found the next morning dead
in bed, and  a third (the child) was found in a state of insensibility,
and lingered until the afternoon of the same day, when  she died.
The fourth, a healthy adult, retired to sleep in his  bed, Avith his
door closed, and he  was found dead in an hour.  The fifth, a child,
AA-as taken ill on the morning  of the 11th, and died the same day.
The sixth was taken ill on the morning of the 10th, and died on
the 12th of June.
   The symptoms complained of by some who recovered were nausea,
sickness, giddiness,  and insensibility.   Ou inspection  of  the body
of one child, the pupils were found dilated—viscid mucus escaped
from the nostrils—there was congestion of the lungs  and kidneys,
as well as of the membranes of the brain.   In the adult who died
in an hour, the pupils w7ere natural, the jaAvs firmly clenched, the
fingers contracted, and  the nails blue ;  there was  great  cadaveric
lividity, and a quantity of fluid with frothy mucus issued from the
nostrils and mouth.  The lungs were much congested, and  serum
was effused in the cavity of the chest.  The heart contained a little
fluid  blood, and was  someAvhat flaccid.  The membrane of the
windpipe and gullet was  redder than natural.  In the windpipe
there was frothy mucus.  The stomach, as Avell as the large and
small  intestines, were  highly congested, but  othenvise  healthy. 
GASES  OF SEWERS  AND DRAINS.          469
The brain and its membranes were greatly engorged  with blood,
which, as in  the body generally, Avas very dark and fluid.  Air.  J.
B. Wilson, Avho examined the body of the child, drew the conclu-
sion, which was confirmed by the subsequent inquiry, that death
had been caused  by sulphuretted hydrogen.  Dr.  Thompson,  wdio
examined the body of the man, also inferred that some noxious gas
or gases had  destroyed  life.  Having been required by the Home
Office to investigate the cause of death in these cases, I visited
Cleator on the 22d of June, and found that the cottages  in which
the accidents had  occurred were  b.uilt upon a heap of iron-slag,
which also abutted on the premises behind.  This slag contained,
among other matters, sulphide of iron and sulphide of calcium.  A
foul smell, compared to that of cinders extinguished by Avater, had
for some time been perceived about  the rooms, chiefly at night,
when the doors and windows  were closed ; and the day'before the
occurrence a  heavy storm of  rain  had  washed through  the slag-
heap, and aggravated the effects.   The  heap of slag Avas burning
in certain parts, and  sulphuretted hydrogen was  evolved in  large
quantities at a depth of a few feet beloAv.  At the time of my visit,
e. e., a fortnight after the deaths, on removing the flags in the lower
rooms, the slag beloAv was found damp, and sulphuretted hydrogen
was still issuing from it.  The white-lead paint in the closets was
partly converted  into black sulphuret,  and  this chemical change
was found in patches on the chamber door of one  small  room  in
which tAvo persons had died.
  It is highly probable that the sulphuretted hydrogen was mixed
with other gases  and vapors, as it is never found pure except in a
chemical laboratory ; but the circumstances left no doubt that it
was the principal agent of death.  This seems to have been clearly
established by the fact, that after a channel had been cut through
the slag-heap, and the slag removed, no further accidents occurred.
  Sewer gases. Effluvia of drains and  sewers.—The most  common
form of accidental poisoning by sulphuretted hydrogen (for it is rare
that a case  occurs  Avhich is  not purely accidental) is Avitnessed
among nightmen and others who are engaged in cleaning out drains
and sewers, or in the removal of nightsoil.  These accidents are
much more frequent in France than in England, the soil being often
allowed to collect in such quantities in  Paris and other large con-
tinental cities, as to  render its removal a highly dangerous occupa-
tion  for the  workmen.   According to  the results of Thenard's
observations, there are two species of compound gases, or mechanical
mixtures of gases, Avhich are commonly met Avith in the exhalations
of privies.  The first compound  consists of a large proportion  of
atmospheric air holding diffused through it, in the form of vapor,
the sulphide of ammonium.  The sulphide i3 contained abundantly
in the water  of the soil, and is constantly rising from  it  in vapor,
and diffusing itself in the surrounding atmosphere.  It is this vapor
which gives the unpleasant and pungent odor to the effluvia, and
causes an increased  secretion  of  tears  in those Avho  unguardedly
expose themselves to such exhalations.    The symptoms produced by 
470
GASES  OF CESSPOOLS.
the breathing of this gaseous mixture, when in a concentrated state,
bear a close  resemblance to those which result from the action of
sulphuretted hydrogen gas.  If a person is but slightly affected, he
will probably complain of nausea and  sickness; his skin aviII be
cold, his respiration free but irregular;  the pulse is commonly fre-
quent, and the voluntary muscles, especially those of the chest, are
affected by  spasmodic twitchings.   If more strongly affected, lie
loses all power of sense and motion ; the skin becomes cold, the lips
and face assume a violet hue, the mouth is covered by a bloody and
frothy mucus ; the pulse is small, frequent, and irregular, the respi-
ration hurried, laborious, and convulsive ; and the limbs and trunk
are in a state of general relaxation.   If still more severely affected,
death may take  place immediately ; or should the person  survive a
few hours, in addition to the above  symptoms there will be short
but violent  spasmodic twitchings of the muscles, sometimes even
accompanied bv tetanic spasms.  (See " Ann. d'Hyg." 1829, 2, 70.)
If the person is  sensible, he will commonly suffer the most severe
pain, and  the pulse may become so quick and irregular that it can-
not be counted.   When the symptoms .are of such a formidable
nature,  it  is rare that a recovery takes place.   The appearances met
with on making an examination of the body are similar to those
observed in death  from sulphuretted  hydrogen.  The inspection
should be made  with caution, for a too-frequent respiration of the
poisonous exhalations may seriously affect those who undertake it.
   The fluid matter of cesspools is generally saturated with this gas,
and contains much sulphide of ammonium, which is always escap-
ing from  it in vapor.   This fluid is noxious, and if swallowed in
quantity may cause death.
   The following case,  which has some relation to this  subject,
occurred in  London in  1831:  TAventy-tAvo boys, living at a board-
ing-school at Clapham, were seized  in the course of three or four
hours with  alarming symptoms of irritation in  the  stomach and
bowel's, spasms of the muscles of the arms, and excessive prostration
of strength. One  child, that  had  been similarly  attacked three
days before, died  in twenty-five hours, and  one among  the last
attacked died in twenty-three hours.  Both of the bodies were ex-
amined after death : in the first the mucous glands of the intestines
wrere found  enlarged and, as it were, tubereulated;  in the second
the mucous coat of the small  intestines was found ulcerated, and
that of the colon softened.  At first, it Avas suspected that the boys
had been  poisoned, but an analysis of the food did not lead to the
discovery of any noxious substance.  The only circumstance which
was considered sufficient to explain the accident was, that  two days
before  the first  child Avas seized, a foul cesspool  had been opened,
and the materials diffused over a garden adjoining  the  children's
play ground.  This Avas the source of the noxious effluvia, accord-
ing to the opinion expressed by six medical practitioners.  (" Chris-
tison on Poisons," p. 810.)
   [The epidemic  which  affected so many of the visitors of the
National  Hotel in Washington, D. C, during the winter'  aud 
          TESTS FOR  SULPHURETTED HYDROGEN.       471

spring of 1857, and well known in the United States as the " Na-
tional Hotel Disease," affords a remarkable illustration of this form
of atmospheric poisoning, in a which a large number of persons of
both sexes Avere attacked Avith violent  irritation of the  alimentary
canal, generally of the large intestines ;  many  having  died,  after
variable periods of  illness, and in some instances, after repeated
relapses.   The symptoms of irritation  of the stomach and  boAvels
presented so_ generally by the guests of this hotel, at a time of high
political excitement, gave rise  to a suspicion of matallic  poisoning,
Avhich for  a while  became  the popular belief.   The  evidence pre-
sented at  the  inquest  of the  local Board of Health, however, en-
tirely contradicted this theory, and showed not only that no irri-
tant poison could have been used  in  the food, and that the symp-
toms were not those of metallic irritation,  but  that  they were
those of poisoning by seAver emanations; and  that such emana-
tions had been  present to a dangerous extent in the most fre-
quented parts of the house, during"the whole of the three months
of the epidemic visitation.   The officers of the Board of Health
discovered a stream of  sewer  gas Avhich was flowing  through  a
defective inlet, from a badly working culvert directly into the cel-
lar of the hotel, with force enough to extinguish a lighted candle.
Abundant evidences from other sources, equally indisputable, might
be presented in corroboration.   Repeated instances occurred of "in-
dividuals being taken ill after a visit to the hotel, Avho had neither
eaten or drunk anything  while  in the house; and the  offensive
smell observed about  the building, especially  in the  lower rooms,
had been very generally observed.  This fetor was aggravated (lur-
ing the prevalance of cold  Aveather, at which time the Avindows
and doors  Ave re closed, and  the disease increased in violence.  The
pathological condition  was ascertained to be  that  of ulcerative
diarrhoea,  " a  superficial eiythematous or  catarrhal inflammation
of the mucous membrane of the  colon."  We have witnessed this
peculiar effect of cesspool  exhalations  in various  degrees, so fre-
quently among prison convicts, that we were satisfied as to its true
origin, before the investigations had been undertaken to contradict
the erroneous hypothesis of poisoned food or drink.  An epidemic
of diarrhoea  and  general intestinal  irritation, the exact  counter-
part of the National Hotel disease, might at any time be developed
among the inmates of our prisons by a neglect of the usual cleans-
ing of the  privy pans and pipes.  See on this subject, " Am. Journ.
ofAled. Sci.," Jan. 1858, p. 97;  "Boston Aled. and Surg.  Journ.,"
vol. hi., 1857, pp. 305, 371,  422; "New York Journ. of Aled.,"
July, 1857, p. 90 ; " Virg. Aled.  and Surg.  Journ.," vol. viii. 1857,
pp. 478, 514 ; "Trans. Coll. of Phys. of Philad.," Nevv  Series, vol.
hi. No. 3,  1857, p. 128.—II.]
  Analysis.—The recognition of these  gases and vapors  is a simple
operation.   The odor which theyr possess is sufficient to determine
their presence, even w7hen they are diluted  with a large  quantity
of atmospheric air.   The sidphuretfed. hydrogen gas is  at once iden-
tified by its action on paper previously dipped in a solution of a salt 
472       TESTS FOR  SULPHURETTED HYDROGEN.

of lead ;  if present, even in very small proportion (TlJT>\>oTjth part),
the moistened paper speedily acquires a brownish-black stain from
the production of a sulphuret  of lead.  It  must  not  be  supposed
that sulphuretted hydrogen, when  it has proved  fatal in a diluted
form, can be detected in the lungs, stomach, or blood of a dead
body.  When the body is recently removed  from a drain  or sewer,
the gas may be found pervading the whole of the tissues; but in
other cases it will be as useless to look for it as for carbonic acid in
poisoning by this gas.  Noxious gases are not long retained by the
tissues; a short  exposure will suffice to  remove all traces of them.
The examination of the  locality can  alone throw a light upon the
cause of  death.  The proportion of the gas found in an apartment
will, how7ever, rarely be a criterion of the quantity Avhich has de-
stroyed   life.  A person going into  a room where the  deceased
bodies are lying may notice only a  disagreeable or a stifling  smell,
but he may  be able to breathe for a longer or shorter period Avith
the  door or windoAv  open.  It is not  the  respiration of a few
minutes, but the breathing of the diluted noxious atmosphere for
many hours, that really destroys life.  The best method of detect-
ing sulphuretted hydrogen when present in a dead body (not putre-
fied) is to place a piece of card, glazed with lead, in  the muscles
or soft organs; it will sooner or later be tarnished, and  acquire a
brown color, if the gas is present.
  Sulphuretted hydrogen may be proved to exist by the lead test
in the vapor of sulphide of ammonium Avhen mixed with air, and
the presence of ammonia is indicated in the  compound by its vola-
tile  alkaline reaction on  test-paper; also by  holding, in a Aressel
containing the paper recently collected, a rod dipped in strong hy-
drochloric acid,—the production of dense white fumes announces
the formation of hydrochlorate of ammonia.  The presence of this
vapor in any mixture is at once  indicated  by introducing paper
Avetted  with a solution  of nitroprusside of  sodium: the sulphide
produces with it a rich  crimson color.   If sulphuretted hydrogen
alone is present, the nitroprusside paper undergoes no change.  It
is a fact, Avhich cannot be too universally knoAvn. that a candle will
readily burn in a mixture of either of these  gases w7ith air Avhich,
if respired, Avould  suffice to destroy life.  (" Ann. d'Hyg.," 1829,
2, 69.)   The candle-test should be  applied with  caution in places
where these effluvia are collected and  confined in sewers or close
cesspools.  AVhen sulphuretted hydrogen is diffused in a proportion
of about 7 per cent, with air, it forms a dangerously explosive mix-
ture. Dr. Perrin has lately investigated this subject, " Mephitisme
des Fosses d'aisances."   (Ann. d'Hyg.," 1872,  2, 73.)
   It is worthy of  remark that the air of a  cesspool may be often
respired  Avith safety until the wrorkmen commence removing the soil,
Avhen a  large quantity of mephitic vapor  may  suddenly escape,
which will lead to the immediate suffocation of all present.  Several
persons have been killed by trusting  to  the  previous burning of a
candle, in ignorance of this fact.  In descending in order to render
assistance to persons who are lifeless, the  person should on these
occasions, whether sulphuretted hydrogen or carbonic acid be the 
EXHALATIONS FROM THE DEAD.
473
cause, make a moderate inspiration of pure air and hold his breath
while in the noxious mixture.   In an accident Avhich occurred in
"Whitechapel, in  August,  1857,  three men died  speedily  from
breathing  the vapor of an  old  sewer, and  two others nearly lost
their lives in attempting to assist  them.  The best plan for getting
rid of the gas is by a free exposure of the locality, or  by exciting
active combustion in it.  According to Parent Duchatelet, men can
Avork in an atmosphere containing from 2 to 3 per cent, of sulphu-
retted hydrogen.   The air  of one of the principal sewers of Paris
gave the folloAving results, on analysis, in 100  parts:  Oxygen,
13.79 ; nitrogen, 81.21 ; carbonic acid, 2.01; sulphuretted hydrogen,
2.99.
  Another gaseous mixture in the form  of deoxidized air Avas
found by Thenard in the seAvers of Paris; it Avas  composed, in 100
parts, of nitrogen 94, of oxygen 2, and of carbonic acid 4.  Some-
times the carbonic acid is combined with ammonia, and then it may
be regarded chiefly as a  mixture of nitrogen  holding diffused
through it the vapor of carbonate of  ammonia, which is sufficient
to render it highly irritating to the mucous membrane of the ej7es
and nose.   Its action on  the human body Avhen breathed will be
readily understood  from  its chemical  composition.  In  its opera-
tion  it is essentially negative, and destroys life by cutting off the
access of oxygen.   The small proportion of carbonic acid or of car-
bonate of  ammonia existing in  it cannot give rise to the asphj'xia
which so rapidly follows its inhalation.   The chances  of recovery
are much greater in persons who become asphyxiated  from the
breathing of this  compound, than in those who are exposed to the
influence of the preceding.   Commonly, the immediate removal to
a  current  of pure air is  sufficient  to  bring  about  a  recovery.
Should death take place, it  will be found on inspection  that the in-
ternal appearances  are the  same as those Avhich  are met with in
death from suffocation.
  Analysis.—This compound  has no  offensive smell;  it extin-
guishes a taper; the carbonic acid contained in it may be removed
by caustic potash, and  then it will be  seen  that  the great bulk of
the mixture is formed  of nitrogen—a gas  Avhich, by its negative
properties, cannot be  easily confounded with any other.   In  a
mixed atmosphere of carbonic acid and sulphuretted hydrogen, the
two gases may be separated by  agitating the mixture Avith a solu-
tion  of  acetate  of lead, and treating  the  precipitate  with  acetic
acid, Avhich dissolves the carbonate and leaves sulphide of lead.

                  exhalations from the dead.

  It  may be proper in this place to make a few remarks on the
alleged danger of  the exhalations given off by dead  bodies in a
state of putrescence.  Formerly, there existed  a  groundless fear
relative  to the examination of a putrefied dead body ;  and during
the last century, on several  important occasions, medical Avitnesses
refused  to examine the bodies of  deceased persons, avIio Avere pre-
sumed to have  been murdered,  alleging that it was an occupation 
474           EXHALATIONS FROM THE DEAD.

which might be attended with serious consequences to themselves.
Orfila has collected many accounts of the fatal effects which are re-
corded to have followed the removal of the dead some time after
interment.  (" Traite des Exhumations," vol. 1, pp. 2 et seq.) He
alloAvs, hoAvever, that the  details  of most of  these cases are exag-
gerated, and attributes to other causes the effects which followeu.
Indeed, the observations of Thouret and Fourcroy provethat these
dangers are restricted within a narrow compass, and that in general,
with common precautions, dead bodies may be  disinterred, and
transported from one locality to  another, without any risk to those
engaged in carrying  on the exhumations.  About the latter part
of the last century, from fifteen  to twenty thousand bodies, in al-
most every stage of putrefaction, were removed from the Cimetiere
des Innocens in Paris; and the accidents that occurred during the
operations, w7hich lasted ten months, were, comparatively speaking,
feAV.  The Avorkmen acknowledged to Fourcroy7 that it was only in
removing the  recently interred corpses, and those Avhich Ave re not
far advanced in decomposition, that  they incurred any danger.  In
these cases, the abdomen appeared to be much  distended with gase-
ous matter ; if ruptured, the rupture commonly took place about the
navel, and there issued  a bloody fetid liquid,  accompanied  by the
evolution of a  mephitic vapor—probably a  mixture of carbonic
acid and sulphuretted hydrogen.  Those who  breathed  this vapor,
as it escaped from  the body, fell  instantly into a state of asphyxia
and died; Avhile others Avho Avere  at  a  distance, and wdio conse-
quently breathed it  in a diluted state, were affected Avith  nausea,
giddiness, or fainting, lasting some hours, and followed by Aveakness
and trembling of the limbs.  Some  years since, when  it was the
practice to bury the  dead in the  crowded churchyards of London,
lives w7ere frequently lost by reason of the noxious gases and efflu-
via Avhich at once  filled every grave  as it was made.  These gases
Avere chiefly carbonic acid  and sulphuretted hydrogen; they have
been already  fully  described.   A  grave  twenty  feet deep Avas
usually dug between strata of exposed coffins, and this grave was
kept open until it  was filled with bodies.  In September, 1838, tAvo
persons Avere killed by the effluvia which had collected in  one of
these deep graves kept open in Aldgate Churclryard. (See, in refer-
ence to this subject, Henke's " Zeitschrift,"  1840, vol. 2, p. 446;
"Ann.  d'Hyg.," 1832,  p.  216;  1840, p. 131;  1840, pp.  28, 32.)
With ordinary precautions, and the care of well-known deodorizers,
the remains of the dead may be  removed and  transported to other
localities without injury to the living.  Within a feAV years, many
bodies  have been  thus  removed, Avithout ill  effects, from London
cemeteries, as that of St. Andrew's,  Holborn,  and Old St. Paneras.
Some remarks on this subject by Al.  Devergie  will be found in the
" Ann. d'Hyg.," 1869, 2, 78.
  In addition  to these  exhalations from the dead, there are other
gases and vapors of a poisonous nature, which  are for the most part
artificial  products.  It  is  seldom  that individuals  are  exposed to
respire them in  such quantity as to  cause serious symptoms or to
endanger life. 
DEATH FROM  LIGHTNING.
475
LIGHTNING.  COLD.  HEAT.  STARVATION.
                   CHAPTER XLII.

lightning.—effects of the  electric fluid.—cause of death.—
  post-mortem appearances.—cases.--legal relations.—cold an
  occasional  cause of death.—symptoms.—circumstances  avhich
  accelerate death.--post-mortem appearances.—case of murder
  by cold.—effect of heat.—starvation a rare cause of death.
  —symptoms.—appearances after death.—legal relations.

                         Lightning.

  Effects  of the electric fluid.—Death by  lightning  is sufficiently
common  to require that  a medical jurist should be prepared to
understand the phenomena Avhich accompany it; but there is a
more important reason Avhy7 he should devote some attention to this
subject—that  is, that  the appearances left by the electric fluid on
the human body sometimes closely resemble those produced by great
mechanical violence.  Thus, a person may be found dead in an open
field, or on the higlnvay; his body may present the  marks of con-
tusion, laceration, or fracture; and to one unacquainted Avith the
fact that such violence occasionally results from the effect of this
subtle force, it might appear that the deceased had been maltreated,
and probably7 murdered.
  In fourteen years (1853-65)  242  deaths from lightning were
registered in England and AYales,  of which  199  were males and 43
were females.   The numbers in each year fluctuate considerably.
Xearly all the deaths  took place among persons engaged in Avork
out of doors, /. e., field-laborers and others.  AVe do not often hear
of persons being killed by lightning  in dAvellings.   In 1870 there
were nineteen deaths registered  from  lightning.
  Cause of death.—The electric fluid  appears to act fatally by pro-
ducing a violent shock to the brain and nervous system.  In general
there  is no sense of pain; the person falls at  once into  a state of
unconsciousness.   In a case Avhich did not prove fatal, the person,
who Avas seen soon after the accident,  Avas found  laboring under the
following symptoms*  Insensibility; deep, sIoav,  and  uninterrupted
respiration; entire relaxation of the muscular  system; the pulse
6oft and slow; the pupils  dilated, but  sensible  to light.  ("Aled.
Gaz.," vol. 14, p.  654.)  It will be seen that  these  are the  usual
symptoms of concussion of the brain.   The effect of a slight shock 
476            APPEARANCES AFTER DEATH.
is that of producing stunning;  and wdien persons Avho have been
severely struck recover, they suffer from noises in the ears, paralysis,
and other symptoms of nervous disorder.  ("Aled.  Times," July 15,
1848.)  Insanity has even been known to follow a stroke of light-
ning.   (Conolly's "Report of Hanwell,"  1839.)   In one case the
person remained delirious for three days, and when he recovered, he
had completely lost his  memory.  ("Lancet," August  3, 1839, p.
582.)   A boy, set. 4, received a severe shock on the 11th Alay, Avas
seized with  tetanus on the 13th, and  died in four hours.   ("Aled.
Times and Gaz.," Alay 26, 1855.)  In another instance, an old man
wdio took shelter under  a tree, felt as if  a vivid flash had struck
him in the face; he did not fall, but he became almost blind.  He
suffered for  some days  from frontal  headache, and loss of sight
supervened.   (" Aled. Times and Gaz.," July  24, 1858.)
  It may be observed of the effects  of lightning, generally, that
death is  either immediate, or the individual recovers.   A person
may hoAvever linger, and die from the effects of severe  lacerations
or burns  indirectly produced. A case  occurred in this city, in July,
1838, where death  was  thus caused  indirectly by the effects of
electricity.  The folloAving case of  recovery illustrates further the
action of the electric fluid: Three persons were  struck by lightning
at the same time.  In one, a healthy man, set. 26, the symptoms
were severe.  An hour and a half after the stroke he lay  completely
unconscious, as if in a fit of apoplexy  ; his pulse w7as below 60, full
and hard; his respiration snoring, his pupils dilated and insensible.
There were frequent twitchings of the arms and hands; the thumbs
were fixed and immovable, and the jaws  firmly clenched.  Severe
spasms then came on, so that  four men  could scarcely hold the
patient in his bed; and his body was drawn to the left side.  When
these symptoms had abated, he was copiously bled;  cold was applied
to the head, a blister to the nape of the neck, and mustard-poultices
to the legs;  stimulating  injections  and opium Avere also adminis-
tered.  In the course of tAventy-four hours  consciousness slowly
returned,  and the  man soon  completely recovered.   The  only
external injury discoverable Avas 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.)   These red streaks or marks sometimes  assume
a remarkable  disposition over the  skin.  (See case by  Dr. Horst-
mann, Casper's " Vierteljahrsch."  April 1863, p. 308.)
  Appearances after death.—The  suddenness of death is such that
the body sometimes preserves the attitude in which it was struck.
(" Med. Times and Gaz.," Feb. 18,1860, p. 167.)  Generally speak-
ing, there are, externally, marks of contusion and  laceration about
the spot where the electric current has entered or passed  out:—
sometimes a severe lacerated wound  has  existed: on other occa-
sions there  has  been no wound or laceration, but  an extensive
ecchymosis,  which,  according to  Meyer, is most commonly found
on the skin of the back.   In one instance, which occurred in Lon-
don in Alay, 1839, there were no  marks of external violence;  and 
       FATAL EFFECTS PRODUCED  BY  LIGHTNING.     477

several similar cases are quoted from American journals in the
"Medical Times"  (Alay 3, 1845, p. 82).  The clothes are  in almost
all cases rent and  torn, and partially singed, giving rise to a pecu-
liar odor—sometimes even rolled up in shreds, and carried to a dis-
tance.  They are occasionally found partially burnt, but this is not
a frequent occurrence.  Aletallic substances about the  person  pre-
sent traces of fusion, and articles of steel have been observed to
acquire magnetic polarity.  Dr. West has informed me, that in a
case to which he was called, in AA'hich a boy, set. 18, had  been  in-
stantly struck dead by lightning, he observed that a knife in the
pocket of the deceased had acquired strong magnetic polarity.  This
case further shoAvs that which has frequenthy been noticed—namely,
that Avhile much violence has been done to the  dress, the parts of
the body covered by it had escaped injury.   The deceased Avore at
the time of the accident a pair of strong leather boots; these Avere
torn to shreds, probably OAving to the  presence of iron  nails in the
soles, but the feet of the deceased presented no mark of  injury! An
accident by lightning occurred in the  presence of a  friend of mine,
by Avhich a healthy man was instantaneously killed. A cap which
the man Avore had a hole through it;  his hair Avas singed, his shoes
were burst open, and  his trousers torn.  The Avoodwork of the
building down which the electric fluid passed was merely split, and
there was no mark of burning.  I have examined, in  several  in-
stances, the wood of trees Avhich have been struck  by the electric
fluid; in each case it has presented only  the appearance of rending
by mechanical force.
   Wounds and burns are sometimes met with on the body.  The
wounds have commonly been lacerated  punctures, like stabs pro-
duced by a blunt dagger.  In the case of a person Avho was struck
but not killed, a deep wound Avas  produced in one thigh, almost
laying bare the femoral artery.   This  person was struck, as many
others have been, Avhile in the act of opening an umbrella during a
storm.   Fractures of the bones have not been commonly observed:
in a case mentioned by Pouillet, the skull was  severely fractured,
and the bones were depressed.  (" Traite de Physique, Elect. At-
niosph.")
  In May, 1864, Dr.  Mackintosh, of Littleport, was called  to  see
three persons Avhohad been struck Avith lightning about twenty min-
utes previously.   They had taken shelter under a haystack, Avhich
had been set on fire by the same  flash.  1. A boy, aged 10, Avas
then able to Avalk, although  unable to move his legs immediately
after the occurrence.  All that  he  remembered was—he saAv the
stack on lire, and  called to his father ; he felt dizzy all  over, and
unable to  move.  His hair and clothes were not singed, and the
metallic buttons on his dress showed  no signs  of fusion.  On  re-
moving his clothes a slight  odor of singing wTas perceptible.   He
complained of pain at the lower part of the abdomen.   There Avere
several red streaks, of about a finger's breadth, running  obliquely
downwards and inwards on either side of the chest to  the middle
line in front of the abdomen ; they then descended over the pubes, 
478     FATAL EFFECTS PRODUCED BY LIGHTNING.

and were lost in the perineum.  It does not appear that there was
any abrasion of the skin.  This boy perfectly recovered;  the  red
streaks disappeared gradually, and could  hardly be traced four
days after the injury.  2. Another boy, aged 11, lay  prostrate and
unconscious, with an expression of grim terror and  suffering; he
frothed at the  mouth, moaned piteously, and flung  his legs and
arms  about in all directions.   The breathing was deep, slow7, and
laborious;  the heart palpitating, pulse weak  and very irregular;
the pupils were dilated, and insensible to light.  There Avere in this
case several red streaks converging from the neck and shoulders to
the middle of the chest-bone, and passing over the abdomen until
they Avere lost on the pubes.   There were similar streaks radiating
for a few inches from the tuber ischii on each hip, in different  di-
rections, until they were lost in the skin.   It appears that this boy
was in a sitting posture when struck.   The hair on the back of his
head  and neck was singed, and the peculiar odor of singing was
perceived, although his clothes  showed no traces of  burning, nor
the metallic buttons of fusion.   The boy became conscious in five
hours, and rapidly recovered.   The red  streaks gradually disap-
peared, leaving streaks of a scaly glistening white appearance, which
ultimately left  no trace  of their existence.  3. A man, aged 46.
Like the two others, he was in a sitting posture, and he appeared
to have been killed on the spot; he had not moved hand or foot.
The countenance was  placid, and the pupils were widely dilated.
The electric fluid had produced a large lacerated wound of the scalp,
at the junction of the occipital Avith the parietal bones, but without
producing any fracture.  The electric fluid appeared to have passed
down each side of the head, between the soft parts and the cranium.
On the left side it  had passed downwards in front to the left ear,
and terminated on the side of the neck, rupturing bloodvessels and
muscles, and causing swelling of the parts with effusion of blood.
It presented the appearance of an extensive bruise caused  by me-
chanical violence.   On the right side, the current had passed down
to the space above the collar-bone, causing lividity and swelling of
the right ear as well as of the adjacent skin ; and  it terminated in
a  dark-blue  mangled  patch of skin, in which there  were  several
free communications with the surface.  The hair on the back of the
head Avas slightly singed, and that in front of the chest was singed
quite close to the skin, but the  hair which covered the Avound in
the scalp, Avhere the current had entered, w7as uninjured.  The
clothes were neither torn nor burnt, and the metallic  buttons were
not fused.   The clothes of all three were  very Avet.  The hat Avas
not examined.   The  left side-pocket of the trousers  contained
several  lucifer-matches and a  tin  tobacco-box, which Avere  unaf-
fected  by the electric discharge.   The right pocket contained a
knife, which had acquired strong magnetic polarity. The body was
placed in a warm room, and it is worthy of remark that cadaveric
rigidity came on in fourteen  hours after death.  (" Lancet," July
30, 1864, p. 118.)  It is to be regretted that no post-mortem exami-
nation was allowed.  It is probable that the brain sustained severe 
           FATAL ACCIDENTS FROM LIGHTNING.        479

injury, causing immediate death.  These cases singularly present
the effects of lightning in three degrees—the eff'ect of a slight shock
in No. 1, of a severe shock in No.^2, and of a fatal shock in No. 3.
There Avas but little bodily injury in either case, and  no appearance
of burning.  The marks on the skin in Nos. 1 and 2 could not have
been mistaken for violence, but the wound to the scalp and the in-
juries to the neck in No. 3 might have  been ascribed to  the vio-
lence of another, had not the circumstances been fully knoAvn.  The
clothes probably escaped burning or tearing by reason of their being
Avet, and their readily conducting the electric fluid.
   The bums occasionally found on the bodies of persons Avho have
been struck by lightning have been hitherto ascribed to the igni-
tion of the clothes.  It appears, hoAvever, from the subjoined cases,
that burns even  of a  severe  kind  may be the  result of a direct
agency of the  electric  fluid itself upon the body.   The  late Dr.
Geoghegan, met with the  case of a girl who had been struck by
lightning ;  there Avas burning of the thigh and buttocks to the first
and second degrees, but the clothes did not show7 any signs of com-
bustion.  On the 16th of July, 1852, a man, aet. 23, while engaged
in milking a cow in a wooden shed, during a severe thunder storm,
suddenly observed a vivid flash of lightning, Avhich killed the cow
instantly, and  inflicted serious injuries upon himself. He was seen
sixteen hours after the accident, and a severe burn Avas found upon
his person, extending from the right hip to the shoulder, and  cov-
ering a large portion of the front and side of the  body.  His mind
was then AA'andering, and there Avere symptoms  of  inflammatory
fever.  The man was confined to his bed for seventeen days, at the
end of Avhich time the injuries had not perfectly healed.  On ex-
amining his dress, the right sleeve of his shirt Avas found burnt to
shreds, but there AAras no material burning of any  other part of the
dress. The case is singular, inasmuch as it show7s that the dress may
be burnt Avithout the surface of the body being simultaneously in-
jured ;  and further, that a burn  may be  produced  on  the  body,
although the clothes covering the part may have escaped combus-
tion.  Air. Fleming has described the cases  of eight persons who
were struck by lightning,  and on the bodies of some  of these there
were marks of severe  burns.   The  dresses  were, in parts, much
singed.  These cases shoAv, in  a remarkable manner, the intense
heat evolved  in the instantaneous  passage of the  electric fluid
through the clothes  and body.   The persons struck Avere benumbed
or paralyzed in various  degrees, but all ultimately recovered ;  but
the burns Avere so severe that some months elapsed before they Avere
entirely healed.   (" GlasgOAV Aled. Journal,'"  Oct. 1859, p. 257.)
  The folloAving complete account of the external and internal ap-
pearances found in the body of a healthy middle-aged laborer, who
was killed  by a  stroke  of lightning, has  been published by  Dr.
8ehaffcr:  The  man  was AArorking  in the fields Avith  several  other
laborers, just after a thunder storm had passed over, and had appa-
rently subsided.  He Avas endeavoring to kindle a light Avith a flint
and steel, when the lightning struck him.  For a moment after the 
480        FATAL  ACCIDENTS  FROM  LIGHTNING.

shock he stood still, and then his body fell heavily to the ground.
The electric fluid entered at the  upper part of his forehead, perfo-
rating and tearing  his  hat  at that part; it seemed  then to have
become divided into two currents, which passed down the sides of
the body, along the lower limbs, and out at the feet.  On the upper
part of the forehead was found a soft swelling, of a dark-blue color,
and about the size of the palm of a hand ; the hair Avhich 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 sur-
face of the chest, over which it passed between the left nipple and
the armpijt; and so made its way over  the body to the left inguinal
region, where it formed a large, irregular, scorched-looking (bran-
dige) patch on the skin. From this point, a dark-red streak again
continued its downward course, passing over the great trochanter,
then  along the outer surface of the  left leg  to  the back of the
foot, where it  terminated in several  small dark-blue spots.  The
other streak, which proceeded from the ecchymosed swelling on the
forehead, passed directly to  the right  ear, which Avas considerably
SAVollen and of a dark-blue  color; from the- ear it ran doAvnwards
and  backwards along  the  neck, crossed the right border of the
scapula, and eventually reached the  right groin, where a scorched
patch of skin similar to that in  the left groin was found.  From
this part, the discolored streak continued down the outer side of the
right leg  to the termination on the back of the foot, just as on the
left side.  It is remarkable that, although the hair on the forehead,
as well as that which occurred in any part of the track taken by
the electric current down to the groin, Avas not burnt, yet at the
groin itself, and  at every part hence  to the foot over Avhich the
electric stream had passed,  the hairs Avere 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 Avore round his
abdomen  at the time of the accident; the belt'was completely de-
stroyed.   Nothing  further  Avorthy of  notice was  observed on the
exterior of the body7, Avith 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 Avas effused in other parts of the  scalp correspond-
ing to the SAvollen  discolored patches outside; about four ounces
had been effused.  The vessels  of  the cerebral  membranes were
greatly congested, and the brain  itself contained much blood, espe-
cially observed in the choroid plexuses.  A large quantity of reddish
mucus was found in the larynx, Avindpipe, and air-tubes; the lungs
w7ere loaded Avith dark blood ; there was a great deficiency of blood
in the cavities of the heart and in the  large  vessels;  the  blood-
vessels of the stomach  and  intestines were more than usually con-
gested ; the right lobe  of  the liver was of a  dark-red  color, and
loaded with blood, especially the part Avhich corresponded  to the
burnt patch of skin at the lowrer part  of the abdomen;  the spleen
also was large, and filled writh blood.   Much blood Avas found accu- 
           PROOFS OF DAMAGE BY LIGHTNING.         481

mulated in the substance of the muscles of the abdomen, at those
parts which lay beneath the burnt surfaces outside.  (" Oesterreich.
Aled. AVochenschrift," 6th June, 1846.)  It was formerly supposed
that  the blood Avas never found coagulated in persons killed by
lightning, and that the body did not become rigid after  death.
Experience has shown, however,  that these  statements  are not
correct.
  Ecchymoses of greater or less extent are sometimes found  on the
bodies of those who have been killed by lightning.  Thus ecchymoses
have been occasionally disposed  in an arborescent form oyer the
surface  of the  skin.   When  persons  have  been killed  Avhile
standing under or  near trees, and  such arborescent  ecchymoses
are found, they have  been described as presenting the picture  of
a.tree.   This  has  even formed the subject for medical evidence  at
an inquest, in a case of death from lightning.  ("Australian Aled.
Journ.,"  Sept. 1870, p. 295.)  A youth Avas killed by lightning.
There were marks of contusion on the  left side of the body, and it
was noticed that there was extreme rigidity on that side.  The hair
on the back  of the head was  burnt off.   The  pupils of both eyes
were much dilated, and blood oozed from  the left nostril.  The
surgeon then  stated that he  observed on the skin of the chest the
perfect impression of a young  tree inverted, of a dark color, as if
tattooed on the skin.   It resembled the tree which grew near the
place of the  accident!  The deceased, it seems, when struck had
two or three layers of Avoollen cloth  buttoned over his chest.  His
cap was torn to pieces.  The  trowsers on  the  left side Avere  torn
from the hip  to the stockings, Avhich were torn open, as Avell as the
boot.  He had died from injury  to the brain.
  Ranke has  endeavored to determine the relative conducting power
of living muscle Avhich constitutes so large  a portion of the body.
The  conclusion at Avhich  he  has arrived is that the conducting
power of muscle in reference  to electricity is three million times
weaker than that of mercury, and fifteen million times beloAv that
of copper. (BroAvn-Sequard, " Proc. R. S.," No. 44.)  NotAvithstand-
ing these results, the human  body is often struck under circum-
stances Avhere, according to theory, it should escape.  There is also
another difficulty.  Of three or more persons together, one  or two
only may be struck, although  there is no apparent reason Avhy the
electric fluid should select one body more than another.  Af. Toude
met Avith the following cases in 1869:  Three soldiers were  sitting
under a tree during a storm.   They Avere struck doAvn by lightning,
and tAvo were killed on the spot.  There were loftier trees in the
neighborhood—a  lightning conductor Avas not far off, and an iron
raihvay bridge, as Avell as a river.  The electric fluid struck the
lower tree, and passed through  the bodies of the men in place of
being carried  off by the surrounding conductors.  ("Ann. d'Hyg.,"
1871,1, 478.)  In June, 1871, a coachman AAdiile driving a carriage
was killed on the box during a storm, while the footman sitting by
his side escaped uninjured.  The electric fluid had struck the coach-
man on the head, destroyed his hat, and rent his clothes.  It passed
      31 
482       ACTION FOR DAMAGES  BY  LIGHTNING.

through his body, tore a large hole in the cushion on Avhich he was
sitting, and except the shattering of the glass, did no injury to the
carriage, nor to those who Avere  inside.   At about the same time,
three men Avere mowing in a field during the storm.   They put
down their  scythes and sought  shelter;  but as  they were leaving
the field, they were all three  struck  to the  ground by lightning.
One only was killed.  It was found that he had been struck on the
right side, where  he wore  a steel chain with a watch.  This Avas
broken to pieces.  In another accident occurring at the same date,
a man aet. 74 was struck while standing under a fir-tree.   He was
taken up in an insensible state, and soon died.  There was a jagged
wound over the right eye, and a great part of the surface of the
body Avas burnt, including the hair, whiskers, eyebroAvs, and eye-
lashes.  The boots were burnt off the feet, and the hat and trousers
were  torn  to pieces.  In these cases, no doubt  one body received
more of the electric fluid than another, and in the fatal cases, there
were  appearances in the condition of the bodies and  the clothes
sufficient to point to death by lightning, even if the facts had not
been known.
  The external  injuries in  these  cases  resemble those caused by
violence, but the peculiar form,  extent and direction of the ecchy-
moses, as Avell as the presence of marks of burning, either on the
clothes or the body, were sufficient to distinguish them as injuries
produced by the electric fluid.
  Legal relations.—Rare as the combination of circumstances must
be in which a medico-legal question can  arise in reference to the
action of the electric fluid on the body, a case Avas tried in France,
in October, 1845, in which medical evidence respecting the charac-
ters of wounds caused by electricity was  of considerable importance.
In August of that year, some buildings were destroyed at Malaunay
near Rouen, as it  was alleged, on the one side by a thunderstorm,
on the other by a whirlwind ; and as the parties were insured against
lightning, they brought an  action for recovering the amount in-
sured.  The evidence in favor of the accident having been due to
electricity consisted—first, in the alleged carbonized  appearances
of the leaves of some trees and shrubs growing near ;  and secondly,
in the characters of the wounds on  the bodies of several persons
Avho Avere injured at the time of the occurrence.  M. Lesauvage
stated at the trial, that there Avas an  appearance of  dark stains
scattered  over the bodies, and that those who survived suffered
from torpor, paius in  limbs,  and a 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 Avitness
attributed most of the wounds  to the effects of electricity. Af.
Funel deposed, that in some of the dead  bodies which he examined,
the face and  neck were bloated and discolored, as if death had
taken place from asphyxia.  It does not appear, however, that there
were any circumstances decisively proving that the buildings had
been destroyed by lightning.  M. Pouillet has given an accurate 
FATAL EFFECTS OF  COLD.
433
 description of the storm: he believed that although, as deposed to
 by some of the witnesses at the trial, it may have  been attended
 with thunder and lightning, the buildings Avith  the surrounding
 trees AArere overthrown by the  mere force of the Avind, and not by
 the electric fluid.  The description given bears out  this view, but
 at the same time, it is unusual  that trees Avhen struck, unless old
 or dry and withered, should present any marks of combustion about
 the  leaves or trunk.  (See " Comptes Rendus,"  Sept. 1845 ; also
 "Med. Gaz.," vol. 36, p. 1133.)   The scientific evidence Avas of the
 most conflicting kind.  The Royal  Court of Rouen decided that
 the disaster Avas occasioned by the atmosphere ; and,  without enter-
 ing into the  various theories of storms,  condemned the insurance
 companies to pay the amounts claimed.  ("Law Times," Alarch
 14,1846, p. 490.)

                             Cold.

   Cause of death.—The protracted exposure of the human body to
 a low temperature may destroy life; and although in  this country
 cases but rarely occur in Avhich  cold alone operates fatally, it is not
 unusual, during a severe winter, to hear of persons in a state of
 misery and destitution,  being  found dead  in  exposed situations.
 On these occasions, we may reasonably  suspect that the Avant of
 proper food and nourishment has accelerated  death.  It  is, Iioav-
 eA7er, convenient to make a  distinction between the  effects of cold
 and  of starvation on the system, as the symptoms preceding deatli
 and  the  rapidity Avith Avhich it takes place, are  different in  the
 two  cases.
   Symptoms.—A moderate degree of cold is Avell known to have an
 invigorating  effect upon the body; but if the  cold  be severe, and
 the exposure  to it long-continued, Avhile the calorific function is not
 maintained by AArarmth of clothing or exercise, the  skin becomes
 pale, and the muscles become gradually stiff and contract Avith diffi-
 culty, especially those of the face and extremities.  Sensibility is.
 lost,  a state of torpor ensues, followed by profound sleep from which
 the person cannot be  readily roused ; in this state of lethargyr the
 vital  functions  gradually cease, and the person  finally  perishes..
 Such are the  general effects  of intense cold upon the body; its in-
 fluence on the nervous system is seen in the numbness, torpor, and
 sleepiness Avhich have been described as consequences of a long ex-
 posure to severe cold.  Giddiness, dimness  of sight, tetanus and
 paralysis haA7e in  some cases preceded the fatal insensibility.  It
 has been  found  that temperature materially affects the amount of
 oxygen taken by the blood.  At a Ioav temperature, this fluid takes
 less oxygen;  hence it becomes  less oxygenated, and this state of
 the blood affects the condition of the  brain and  nervous  system.
 (Bernard, op.  cit. p. 114.)  It Avas observed during  the retreat of
 the French from AIoscoav,  that those Avho Avere most  severely affected
 by cold often reeled about as if in a state of intoxication ; they also
complained of giddiness and indistinctness of vision, and sank under
a feeling of lassitude into a state of lethargic stupor,  from Avhich it 
484          COLD — ACCELERATION OF  DEATH.

Avas found impossible to rouse them.  Sometimes the nervous system
Avas 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 Avithin the Polar circle.
The late researches of M. Pouchet on the effects of a freezing tem-
perature on animals have led him to the  conclusion that deatli is
due to a physical change in the blood-globules, and not to any effect
on the nervous system."  The first phenomenon produced  by cold is
a contraction of the capillary ATessels to such an  extent that  the
blood-globules cannot enter them ; these vessels, therefore, remain
completely empty.  The second  phenomenon  is  an  alteration of
these globules, amounting to their complete disorganization. Under
these  circumstances an  animal cannot be  restored.   (" Chemical
NeAvs,"  Dec. 1,1865, p. 263.)  A human being may7, however, per-
ish from a degree of cold not sufficient to produce congelation.
  Circumstances  which accelerate  death.—There are certain condi-
tions Avhich may accelerate death from cold.  In all cases in Avhich
there  is exhaustion  in  the nervous system—as  in those Avho are
Avorn out by disease or fatigue, in the aged  or infirm, or, lastly, in
persons who are  addicted to the use of intoxicating liquors—the
fatal effects of cold are more rapidly  manifested than  in others
Avho are healthy7 and temperate.   It  has been uniformly  remarked
that whenever the nervous energy is impaired, either by intoxica-
tion or exhaustion from  fatigue, a  man  dies  quickly from cold.
The  exposure of drunken persons,  during  a  severe Avinter, may
therefore suffice  to destroy life,  although the cold may not be so
intense as to effect others Avho Avere temperate.  Casualties of this
nature sometimes occur  during the Avinter season in this metropo-
lis; and a knoAvledge of  the influence of  intoxication, in  acceler-
ating death under such  circumstances,  may occasionally serve to
remove a doubt in the mind of a practitioner respecting the real
cause.   Infants,  especially Avhen neAvly born, easily perish from ex-
posure to cold.   Cold, when accompanied by rain and sleet, appears
to have a more powerful depressing influence  than w7hen 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 persons Avho clung to a wreck, tAvo sat on
the only part that wTas not submerged ;  of the others, all Avere con-
stantly immersed in the sea, and most of them up to the  shoulders.
Three only perished, two of whom were generally out of the sea, but
frequently overwhelmed by the surge, and at other times exposed to
heavy shoAvers of sleet and snoAv, and to a high and piercing Avind.
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 Avas  a  weakly man.
The remaining eleven who  had been more  or less completely sub-
merged, were  taken from  the wreck  the next day, after twenty-
three hours' exposure, and they recovered.   The person among the 
           COLD—APPEARANCES  AFTER  DEATH.         485

whole who seemed to have suffered least Avas a negro; of the other
survivors, several Avere by no means strong men, and most of them
had been inured to the Avarm climate of Carolina."
  Appearances after death.—Opportunities rarely occur of examin-
ing bodies when death results purely from exposure to cold.  The
skin is commonly pallid, and the viscera of the chest and abdomen
as Avell as the brain are congested Avith blood.  Dr. Kellie, of Leith,
found in tAvo cases Avhich he examined, a redness of the small in-
testines from the congestion of the capillary  vessels, and  a great
effusion  in the  ventricles of the brain.   A sufficient  number of
cases have not yet been inspected to enable us to determine hoAv far
these two last-mentioned appearances are to be  regarded as conse-
quences of death from cold ;  but all observers have found a general
congestion of the bloodvessels and viscera.  In consequence of the
great congestion uniformly met Avith in the vessels and sinuses of
the brain, some pathologists have regarded death from  cold as re-
sulting from an  attack of apoplexy ; but the symptoms which pre-
cede death do not bear out this vieAV.  Effusions of blood have not
yet been observed, and a mere fulness of the cerebral vessels  after
deatli is not in itself sufficient to justify this  opinion.   It Avill be
observed that,  on the whole,  these  appearances  are  remarkably
similar to those  Avhich are found in death from severe  burns and
scalds.  Thus then a medical jurist will perceive, that in order to
come to a decision Avhether, on the discovery of a dead body, death
has taken place from cold or not, is a task of some difficulty.  The
season of the year—the place and circumstances under  Avhich the
bod}- of the deceased  is  found—together  with  the absence of all
other possible causes of death (such  as  from violent injuries or in-
ternal disease), form  the only basis for a medical opinion.   Death
from cold is not  to be determined except by negative or presump-
tive evidence; for there is no organic change, either externally or
internally, sufficiently characteristic of it to enable a medical  man
to give a positive opinion on the subject.
  Under the name of Coldstroke Dr. Hartshorne has described a
case showing the fatal effects of a slight exposure to intense  cold
suddenly applied to  the body. A youth ret. 14 exposed himself for
a few  minutes  in his night-dress  at an open windoAV, during a
winter's night, the thermometer having fallen  50°  from the day
temperature.  He felt thoroughly chilled, and the next day he AA7as
suffering from headache, drowsiness, and vomiting—the skin  hot,
the pulse hard  and quick.   On the second day he became  restless
and delirious, and on the following morning he died.  There was
no cause for this fatal attack of illness excepting the few minutes'
exposure on removing from a Avarm bed to the piercing wind  of a
cold winter's night.  "Other instances are recorded in which persons
have become delirious, ami died from the  effects of a slight expo-
sure to severe cold.  (Amer. Jour. Aled. Soc, October, 1861, p. 432.)
Many of the fatal cases registered during a  severe winter are OAving
to this direct eff'ect of cold.   A  complete history of the effects of 
486
EFFECTS OF  HEAT.
cold and  the  phenomena connected with this  kind  of death  is
gh7en by Dr. Hoche, of Zeitz, in Horn's " Vierteljahrsschrift'' for
1868, 2, 44.

                            Heat.

  Intense  heat.—The effect  of an intensely-heated atmosphere in
causing death has been  but  little studied.  I have been consulted
in one case, in Avhich the captain of a vessel Avas charged with man-
slaughter, for  causing a man to be lashed within a short  distance
of a stoke-hole of a steam furnace in  the hold of a vessel.   The
man died apparently from the effects of this exposure.  The engine-
rooms of steamers  in the tropics have  been observed to have a
temperature as  high as 140° ; and engineers after a time become
habituated to this excessive heat, without  appearing to suffer
materially in health.  In certain manufactures, the body appears to
acquire  a pow7er, by habit, of resisting these high temperatures—
still, it has been proved that many suffer severely.        >
  In the Turkish bath, higher  temperatures than this have been
noted, but there is reason to believe that serious symptoms have
been occasionally produced in persons unaccustomed to them, and
that  in one  or tAvo cases death has  resulted.   In attempting to
breathe air heated to temperatures vaiwing from 180° to 200°, there
is a sense of suffocation  with a feeling of dizziness and other symp-
toms indicative of an effect on the brain; the circulation is enor-
mously  quickened.
  In July, 1861, an inquest was held in London on the body of a
stoker of an Aberdeen steamship.  He had been by trade a grocer,
and was not accustomed to excessive heat.  While occupied before
the engine furnace  he Avas observed to  fall suddenly on the floor in
a state of insensibility; when carried on  deck it was found that he
Avas dead.  All that was discovered on a post-mortem examination
Avas an effusion of serum into the ventricles of the brain ; death had
been caused by sudden  apoplexy.  Intense heat appears to operate
by inducing congestion of the brain (heat-apoplexy).  In some cases
a person may sink and die suddenly from exhaustion ; or symptoms
of cerebral disturbance  may continue for some time, and  the  case
ultimately prove fatal.   In 1870, 112 deaths from sunstroke were
registered in England.
   Death from sunstroke, when not immediately fatal, is preceded
by some well-marked symptoms, such as weakness, giddiness, head-
ache, disturbed vision, flushing of the face, folloAved by oppression
and difficulty of breathing, and in some  cases stupor passing  into
profound coma.  The skin is dry and hot, and the heat of the body
is much greater than natural.  ("Ann. d'Hyg.," 1867, 1, 423.)  In
one case, observed  by Dr. Sieviking, the  patient, a  boy aet. 13, re-
mained in a state of semi-consciousness for four days, and then had
a cataleptic seizure.  (" Lancet," 1870, 2, 184.)   Dr. Passauer has
fully considered this subject in reference to armies in Horn's "Vier-
teljahrsschrift," 1867, 1,185.  The symptoms in cases of sunstroke 
EFFECTS OF STARVATION.
487
have not been ahvays accurately recorded.  In one instance, a med-
ical man, avIio suffered from an attack while on a voyage in  the
tropics, was unable to note and describe  the symptoms from  the
commencement of the attack up to the eighth day, Avhen he recov-
ered.  (" Lancet," 1872, 1, 464; also 2, 128.)
  [Dr. H. C. A\rood (Boyleston Prize Essay, Phila., 1872), considers
that intense heat  of skin is characteristic of true sun-stroke;  the
temperature reaching, in some instances, to 110°, or  even 113° F.
In all autopsies made by him, the heart was firmly contracted, espe-
cially the left ventricle.  He ascribes the flaccidity of the heart
noticed by others, to the fact that the examination was not made
for many hours after death, during which time  putrefaction  had
set in.  Dr. Wood found that congestion  of  the  brain or  effusion
into the A'entricles Avas not of frequent occurrence; nor did he ob-
serve any change  in the blood, microscopically.—R.]

                         Starvation.

  Death from the mere privation of food is a rare event, although,
if Ave Avere to form an opinion from the verdicts of coroner's juries,
its occurrence would not appear to be uncommon in this and other
large cities. In one of the Annual Registration Returns it is stated
that 130 persons died from starvation.   Such cases must, however,
be received with some distrust, as care is  rarely taken to ascertain
precisely Iioav far  bodily disease may have been concerned in causing
death.   Still, it cannot be denied that starvation  should be classed
among the forms  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 rarely, arising from an obstinate determina-
tion to commit suicide in those from Avhom all other means of self-
destruction are cut off.
  Symptoms.—The symptoms which attend on  the  privation  of
food, or  the supply of improper food, have been variously described.
Referring to cases which occurred during the Irish famine of 1847,
Dr. Donovan  states that the  persons avIio suffered described  the
pain of hunger as at  first very acute, but  said  that after  tAventy-
four hours had been  passed Avithout  food, the pain subsided, and
Avas succeeded by  a feeling of weakness  and sinking, experienced
principally in the  region of the stomach; accompanied Avith insati-
able thirst, a strong desire for cold Avater, and a distressing feeling
of coldness over the entire surface of the body.  In a short time the
face and limbs became frightfully emaciated ; the eyes acquired a
peculiar stare ; the skin exhaled an  offensive smell, and Avas coat-
ered Avith a broAvnish filthy-looking coating, almost as indelible as
varnish.   This he Avas at first inclined to regard as incrusted filth,
but further experience convinced him that it Avas a secretion poured
out from the exhalants on the surface  of  the body.   The  sufferer
tottered  in AA'alking, like a drunken man; his voice Avas AA7eak,like
that of a person affected with cholera; he Avhined like a child, and 
488              EFFECTS  OF STARVATION.
burst into tears on the slightest occasion.  In respect to the mental
faculties,  their prostration kept  pace with  the  general wreck of
bodily power; in many there Avas a state of imbecility^in some
almost complete idiocy;  but  in no instance Avas there  delirium or
mania, which has been described as a symptom of protracted absti-
nence among  shipwrecked mariners.  (" Dub. Med. Press," Feb-
ruary, 1848, p. 67.)
  Among the symptoms, there is severe pain in the region of  the
stomach, a suppression of the feces, or, if discharged, they are in
small quantity, dry, and  dark-colored ;  the  urine is scanty, high-
colored, and turbid; the intellect is dull.  The  person  may be  ex-
hausted, and remain w7ithout motion in one position, or be seized
with a furious delirium, which may drive him to acts  of violence.
In the last stage, the body is reduced to an extreme state of emacia-
tion, and before death it evolves  an offensive odor, like  that of
incipient putrefaction.  The excretions have also a putrescent odor.
The surface of the skin may be covered with spots  (petechias), and
the person finally dies, in some cases  slightly convulsed.  (Op.  cit.
p. 415.)  M. Chassat  found, in his experiments on animals, that in
some instances, the animal died after having had successive attacks
of convulsions. (Beck's " Aled.  Jurisp.," vol. 2, p.  80.)
  In a case which fell under the notice of Dr. Sloan, a healthy man,
set.  65, was by an  accident shut up in a coal-mine for tAventy-three
days without food.  When found, he was conscious, and he recog-
nized and named his  deliverers.  He Avas so Aveak that he  could
scarcely raise his hand to his mouth, and so much emaciated as to
excite the surprise of his fellow-Avorkmen by the extreme lightness
of his body.  Under careful treatment he so far recovered as to give
an account of his feelings.  For the first two days,  hunger was  his
most urgent symptom.  This passed off, and he then began to suffer
from severe thirst, which he allayed by drinking some foul water.
After ten days he  became so weak that he was unable to move from
the  spot where  he had lain  down.   He  slept but  little,  and not
soundly—never entirely losing  the consciousness of his situation.
His boAvels acted only once, but he passed urine freely.  The mat-
ter  brought from his bowels by injections Avas dark-colored, like
meconium, and very fetid.   He died on the third day after his re-
moval, in spite of every  effort to  save him, and on  the day of  his
death he Avas in the folloAving state; his  features Avere sharp and
pale, his eyes sunk ; the skin of the.abdomen seemed to touch  the
backbone,  Avhich could be distinctly felt through it; his body pre-
sented more emaciation than Dr.  Sloan had ever seen produced  by
disease ; he had altogether a dried appearance, very much like that
of natural mummies found in catacombs ; his pulse Avas gone;  his
voice Avas in a whisper, like the vox cholerica ; there Avas uneasiness,
increased by pressure, in the  region of the stomach; his  intellect
Avas sound, and remained so until death.  (" Aled. Gaz.," vol. 17, p.
265.) This case confirms the  observation of Dr. Donovan, that deli-
rium is not a necessary attendant on protracted abstinence; and it
proves incontestably that a person may die from the effects of  ab- 
APPEARANCES  AFTER  DEATH.
489
stinence or starvation, in spite of the best-directed efforts for  re-
covery.  Air. Thornhill  reports, in the same journal, the  cases of
eight men and a boy Avho were shut up in a coal-mine for eight days
Avithout food (" Aled. Gaz.," vol. 17, p. 390); but the symptoms here
noted Avere rather those of hunger than of long abstinence.  They
all suffered from excessive thirst; they were all troubled with ocu-
lar illusions, showing cerebral excitement. The occurrence of ocular
spectra, and other symptoms indicative of a depressed state of the
nervous system, has also been noticed by Casper.  (" Handbuch der
Uer. Aled.," 1857, vol. 1, p. 374.)  According  to Dr. Martin, the
emaciation in starvation is characteristic; it is a withering or shriv-
elling up of the skin, Avhich has lost its elasticity, giving to youth
the aspect of age.  Death, Avhen not hastened by disease, is sIoav and
imperceptible, or it  is precipitated by syncope  from sudden effort,
or by exposure to severe  cold.   Delirium is not, according to him,
a symptom of  starvation.  (" Aled.  Times  and Gaz.,"  March 30,
1861, p. 344.)   The period  which  it requires for an individual to
perish  from hunger is subject to variation; it will depend mate-
rially upon the fact  Avhether a person has had it in his power or not
to take at intervals  a portion of liquid, to relieve the overpoAvering
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 healthy7 person, under perfect absti-
nence,  deatli Avould  not commonly take place  in a shorter period
than a Aveek or ten  days.  This opinion appears to derive support
from the results of those cases in which there  has been abstinence
OAving  to disease in  the  throat and difficulty of SAAralloAving food.
Age, sex,  state of health, and the effects of  exposure  to cold, may
accelerate or retard  a fatal termination.
  Appearances after  death.—There are but few details of the appear-
ances presented by the bodies of those aa'Iio have died from starva-
tion, and the cases themselves are too rare  to  enable us to decide
with certainty upon the accuracy of the reports  Avhich have hitherto
appeared on the subject.   The  body is shrunk  and  emaciated, and
remarkable for its lightness.  The skin is dry, shrivelled, and free
from fat.  The muscles are soft, deprived of fat, and much reduced
in size.  The stomach and intestines are usually found collapsed,
contracted, and empty—the mucous membrane being thinned and
sometimes  ulcerated.  The liver, lungs, heart, kidneys, and the
great vessels connected Avith these organs are collapsed and destitute
of blood;  the heart  and  kidneys free  from  any surrounding fat—
the gall-bladder distended Avith bile—the  omentum shrunk and
destitute of fat.  In Dr.  Sloan's case (supra)  the body Avas observed
to be  extremely  emaciated;  the intestines were collapsed,  the
stomach was distended Avith air, and slightly reddened at its greater
extremity.  The omentum had almost disappeared ; it was entirely
destitute of fat. The liver was small, and the gall-bladder distended
with bile.   The other viscera were in their normal state.  (" Aled.
Gaz.," vol. 17, p. 389.) Air. Tomkins, of Yeovil, inspected the body
of a man who died  from  starvation  in February, 1838.   The face 
490
APPEARANCES AFTER DEATH.
Avas much shrunk and emaciated ;  the eyes were open, and presented
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 (" Dublin Med. Press," Feb. 2,1848,
p. 66.)  The skin was tough, and  there Avas scarcely any  cellular
membrane to be seen.  The tongue, lips, and  throat were dry and
rough.  A peculiar odor was exhaled  from the body.  The lungs
Avere shrunk and contracted; the investing membrane was slightly
inflamed.  The  stomach and intestines  were empty,  but  quite
healthy ; the gall-bladder was nearly full of bile, and the surround-
ing parts Avere much tinged by this liquid.  The urinary bladder
was empty and contracted.   (" Lancet," Alarch, 1838.)
  In  some cases inspected  during the  Irish famine, Dr. Donovan
states that the appearances which he Avitnessed were extreme emacia-
tion, total absorption of the fatty matter on the surface of the body,
total  disappearance of the  omentum, and a peculiarly thin condi-
tion of the small intestines, which in such cases Avere 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  Avas able to recognize a portion of raw
green cabbage in the duodenum of a man who had died from star-
vation.   This thin condition of the coats of the intestines he looks
upon  as the strongest proof of this mode of death.  The gall-bladder
was usually full, and the parts in the vicinityr of it were much tinged
by7 the cadaATeric exudation of bile; the urinary bladder was gen-
erally contracted and empty, and  the  heart pale, soft, and flabby;
there  Avas no abnormal appearance in the brain or lungs.  Dr. Alartin
assigns  as a condition of the intestines diagnostic of  starvation,
that they are not only contracted  but  shrunken and diminished in
size, shortened in length as well as in calibre, and like a mere cord,
as if the canal was obliterated.  (" Aled. Times and Gazette," Alarch
30, 1861.)  He met with this state in  three cases:  once in  starva-
tion from want of food, and twice from total obstruction to its in-
gestion.  Air. Fletcher found the  following appearances in the case
of two children, named Aspinall, Avho died from starvation—the
elder  aged one year and ten months, the younger four months.  In
the body of the elder there was extreme emaciation, without the
slightest trace of disease in any of the viscera.  Some dirty creamy
fluid  and four cherry-stones were  found in the small intestines, but
no distinctly fecal  matter, a few  grains of which, hoAvever, were
found in the large intestines ; scarcely a trace of fat Avas visible.
In the infant the same  appearances were presented, although the
emaciation had not  proceeded to  the same extent.  The evidence
produced on the trial proved that the mother spent in drink the
money given to  her for household expenses, and that the children's
food  and clothing were  neglected.  The  prisoners were tried for
Avilful murder, in accordance Avith the verdict of the coroner's jury.
The judge ruled that the wife in law was the husband's servant,
and if it Avere  proved  that he had supplied her with sufficient
money, he must be  acquitted; if he had  not, the wife  must be ac- 
PRETENDED  FASTING.
191
quitted.  The jury acquitted the man and brought in a verdict of
manslaughter against the Avoman, avIio was sentenced to tAvo years'
imprisonment.  (" Proceedings of Liverpool Medical Society," 1855-
56.)  In some of these alleged  deaths by starvation, ulceration of
the boAvels is met with.   This has been considered to arise from
want of food ; but Dr. Donovan did not  meet Avith it in those avIio
died of lingering starvation.  ("Dublin  Aled. Press," Feb. 2, 1848,
p. m.)
  These appearances, in order to throw any light upon the cause of
death, should be accompanied by an otherwise healthy state  of the
body;  since  it  is well  knoAvn, they may be produced  by many
organic diseases, and death may be thus  due  to disease, and  not to
the mere privation of food.  It Avill not be ahvays easy to say Avhether
the emaciation  depends on disease or want of food, unless we are
put in possession of a complete history of the case.  On this account,
in all charges of homicidal starvation, the defence generally turns
upon the co-existence of disease in the body, and the sufficiency of
this to account for death.
  Delirium may be the result of great bodily weakness, on AA7hat-
eArer cause depending ; it is probably more  rare in cases of chronic
diarrhoea  than  in those  of protracted abstinence.   Too  much
importance must not be attached to its presence or absence on these
occasions, since experience shoAvs that there are feAV cases  of starva-
tion accurately observed, in which the symptoms have been strictly
accordant; and it Avould be  going  too  far to  assert that the  occur-
rence  of delirium  before death would justify a  medical witness
in asserting that death could not have been  caused by starvation,
Avhen  the condition of the body and the  Avhole history of the case
allowed of no other reasonable  interpretation  of the facts.
   Voluntary starvation.  Pretended fasting.—There are  a  few cases
recorded  in which persons have voluntarily abstained  from food,
liquid or solid, for the purpose of self-destruction.  Suicide, as a
result of perfect abstinence is, hoAvever, exceedingly rare ; the per-
son cannot resist the  intolerable thirst, or the desire for food, Avhen
placed Avithin his reach.  As it requires  a period of about eight or
ten days for the destruction of life under these circumstances, in
the acute form of starvation, the resolution to abstain can be  rarely
maintained, and for the purpose of self-destruction starvation  would
never  be resorted to, except Avhere all other means of destroying life
were removed.
  Pretended fasting has been a subject of imposture at various times.
The case of Ann Moore, of Tetbury, is  noticed  by most medical
jurists, as showing how easily the public, eA7en the educated public,
may be deceived, and how lucrative such  an imposition, Avhen it
has once taken hold of the public mind, may become.  According
to her account, she began to abstain from food in Alarch, 1807, and
continued  fasting for six years. It was then discovered, hy close
watching,  that her daughter secretly gave her food and drink.  It
i* stated", howeA7er, that during  the last Avatch she had no food of
any kind for a period of nine days and nine nights.  (" Beck. Aled. 
492        VOLUNTARY OR PRETENDED FASTING.

Jur.," 1, 58.)  An imposture of this kind  can only be detected by
the most minute observation. The case of Sarah Jacobs, the Welsh
Fasting Girl, December, 1869, shoAvs that a watch  too strictly kept
may have the imposture revealed by the actual death of the person.
This girl, set. 13, is stated to have voluntarily abstained from  any
kind  of food  for  a  period  of two years.  She had  kept  her  bed
during  that time—lying in  it decorated as a bride, visited by hun-
dreds of persons—in fact, she was thus publicly exhibited by her
parents  as a girl of miraculous powers. Her  lips  Avere moistened
with water once a fortnight, but, according to the parents, no food
was taken.  Four professional nurses from Guy's Hospital  were set
to Avatch  the girl, and the  result Avas,  that after passing  through
the usual stages of actual starvation she  died on  the ninth day!
She refused to take food at any time, and voluntarily accepted a
lingering  death rather than reveal the exposure.  Her parents and
those around her alloAved her to die!   An inquest  Avas held, and a
post-mortem examination gave  the following appearances: The
body  was plump and Avell-formed;  the membranes of the brain
were  much injected, the brain  itself  Avas  healthy and of proper
consistency.  There  Avas a  layer of fat from  half an inch to an
inch thick beneath the  skin of the chest and abdomen.  The con-
tents  of the chest Avere  healthy.   The stomach  contained three
teaspoonfuls of a  semi-gelatinous substance of the consistency of
syrup, having a slight acid reaction.   The small  intestines Avere
empty, and presented no attenuation or thinning of the coats.  In
the colon and rectum there Avas  half a pound of solid excrement
in a hard state, Avhich might have been  there, according to  the
Avitness, a  fortnight  or  longer.   The  liver Avas healthy, the gall-
bladder greatly distended Avith bile ; the kidneys and  spleen Avere
healthy, and the urinary bladder Avas empty.
  The medical evidence Avas to the effect  that the child had died
from exhaustion as  the result of starvation, and the jury returned
a verdict of death from starvation from the criminal neglect of the
parents  to administer  food.  They Avere  tried  on the charge of
manslaughter, at the Carmarthen  Summer Assizes, 1870.   (Reg. v.
Jacobs and wife.)  An attempt Avas  made in the defence  to refer
death to shock, and not to the Avant of food.  The medical facts relied
upon  in support of  this theory  were  the  presence of fat in  the
bodyr, and  the absence  of any thinning of the coats of the intes-
tines; but,  as Dr. Fowler  very  properly  pointed  out ("Lancet,"
1870,  2, p. 150), these conditions are only like to be met Avith after
long or  chronic fasting, where the person has survived many Aveeks
on insufficient or  unnutritious food.  In the case of this  girl, the
only proved abstinence from food was during the  last eight days
of her life, and this  period of time Avould  not suffice for the entire
removal of the fat and the thinning of the coats of the intestines.
The  prisoners were convicted of causing the death of their child
by  criminal negligence.   The  father Avas sentenced to  tAvelve
months' imprisonment, and the mother to six months'.  (" Lancet,"
1872,  2, 132.) 
          VOLUNTARY  OR  PRETENDED FASTING.        493

  The desire of a section of the public to knoAv Avhether a human
being could live two years Avithout food has thus  been gratified at
the cost of life !   Any one acquainted with the rudiments of phy-
siology Avould knoAv that the application of the tests of Avatching,
if  really efficient, could only end  in death!  A Avriter justly re-
marks, in reference  to this case of lamentable credulity :  " It is not
science, but superstition, even to inquire into the possibility of any
human being living a conscious life without food.  The very pro-
fession to  do so  is  either disease, fanaticism,  or imposture, and
should  be treated as such." 
494
SIGNS OF  PREGNANCY.
PREGNANCY.
                   CHAPTER  XLIII.

signs of pregnancy.—suppression of the  menses.—prominence of
   the abdomen.— quickening.— sounds of  the  fcetal  heart.—
   changes in the mouth and neck of the uterus.—feigned preg-
   nancy.--concealed  pregnancy.—pregnancy  in the dead.—im-
   pregnation in a state of unconsciousness.—legal relations.

                      Signs of Pregnancy.

   Suppression of the menses.—It is well knoAvn that in the greater
number of healthy  females, so soon as conception has taken place,
this secretion is arrested.   But there are  certain abnormal condi-
tions Avhich must not be overlooked.  There are some cases recorded
which show that women in Avhom the menses have never appeared,
may become pregnant.  This, however, is allowed by all accoucheurs
to be rare; and when it occurs, which Ave may readily learn from
the account of the woman, it will be necessary to  search  for other
signs in order to determine the question of pregnancy.  Irregularity
as to the period at Avhich the function takes place is common among
females.  This irregularity may depend upon the age of the person,
or upon disease, either of Avhich  causes it will not be difficult to
recognize.  Their continuance after  completion may make a preg-
nancy appear short.  A case is reported  in  which a woman Avas
married in the summer of  1856, and  the menses continued after as
before marriage.  In October, 1857, they ceased for the first time,
and in the following December  the Avoman was delivered of a full-
grown child ; as the abdomen was not much enlarged, she thought
she AA7as only twTo months  pregnant.   (" Aled. Times and Gazette,"
April 30, 1850.)  It is  Avell-knoAvn that there  are numerous dis-
orders of  the uterus  under which, irrespective of pregnancy, the
menses may become suppressed.   The continuance  of the  men-
strual discharge, Avhen once set  up, is not a necessary condition for
impregnation.  Dr. Alurphy has reported the case  of a AvomaiiAvho
for sixteen  years  went on bearing  children, eight  in  number,
Avithout having had  during that period any appearance of the
menses.  The late Dr. Reicl, Avho quotes  this case, mentions five
instances that fell  within  his  oavii knowledge in Avhich females
became pregnant notwithstanding a long previous cessation of the
discharge.  (" Lancet," September  10,1853, p. 236.)  The absence 
SIGNS OF PREGNANCY.
495
 of the menses as a consequence of pregnancy is generally indicated
 by the good health which a female enjoys ; and although disease
 may coincide with pregnancy, yet a careful practitioner will be able
 to estimate from the symptoms to Avhich 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 Avoman, but during the Avhole course of pregnancy
 (Dr. Murphy's " Obstetric Report," 1844, p. 9 ; also  Henke's " Zeit-
 schrift der S. A.," 1844, p. 265.)   Air. AvTiitehead has collected seven
 well-marked instances of menstruation during  pregnancy. (" On
 Abortion," p. 218.)  These facts show that we must°be cautious in
 forming an opinion ; and not assert  that because a discharge con-
 tinues, pregnancy cannot possibly exist, or because there is no dis-
 charge a female must be pregnant.  The retention of the menses
 within the uterus from any cause, may produce enlargement of the
 abdomen, and  give rise to  some  of  the external symptoms of
 pregnancy.
   Feigned menstruation.—The menses may be either suppressed or
 retained; but if there be any strong motive for the  concealment of
 her condition, a woman may feign menstruation.  Dr. Montgomery
 detected  a case of  this kind, by the examination of the areola; of
 the breasts.   The Avoman had stained her linen with blood in order
 to make it appear that the menses continued, but she subsequently
 admitted that this Avas an imposition. It has been stated that there
 are differences betAveen menstrual and ordinary blood, but there
 are no certain chemical means of distinguishing them.
  Prominence of the  abdomen.—A gradual and progressive enlarge-
 ment of the abdomen is a Avell-marked character of pregnancy ;  the
 skin becomes  stretched, and  the navel almost obliterated. This
 enlargement in general begins to be obvious about the third month,
 although there are some women of peculiar  structure in Avhom the
 enlargement may7 not become perceptible  until the fifth or sixth
 month, or even later; still it may be detected on examination.   In
 fact, this sign  can never be absent in pregnancy, although it may
 not be so apparent in some females as it is in others.  The objection
 Avhich 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 Avitness in the various kinds of dropsy, or  in sup-
 pressed and retained menses—diseases which in several instances,
 haAre been mistaken for  pregnancy by eminent practitioners.  On
 the other hand, instances are  not Avanting in Avhich, OAving to  the
 persistence of  menstruation and the absence of quickening,  the
 gravid uterus has been actually tapped by mistake for an  ovarian
 tumor; the operation being speedily folloAA7ecl by the birth of a full-
 grown child !  (AVhitehead " On Abortion," p. 186); but the history
 of a case  Avill  in general enable a practitioner to form a  correct
 opinion.
  [In  the Court of Oyer and Terminer of Cumberland County,
Pennsyh7ania, August, 1859, in  the  case of Commonwealth v. Mc-
Manus, the defendant Avas indicted for infanticide and for conceal- 
496
SIGNS OF  PREGNANCY.
ment of the death of a bastard child.  The evidence on the part of
the Common\A7ealth AA7as, that the prisoner had Avalked to the office
of a physician residing some considerable distance from her resi-
dence, and that he, after an examination, declared that she Avas far
gone in pregnancy, so far indeed  that  he had distinctly felt the
sutures in the head of the child !   A few days afterwards another
physician  was called in by defendant's mother.  He declared that
she Avas Avith child, and would very soon  be confined; Avhereupoh
the mother indignantly ordered him from the house.  Subsequently,
on the same day, an old  woman, a neighbor, called at the request
of the. mother.   She found the prisoner and her mother in a room
together.   The prisoner, av1io Avas  seated on a bucket apparently
undergoing the pains of  labor, seemed to pull from herself some-
thing Avhich she squeezed violently.  The Avitness heard the falling
of a body into the bucket, but saAV nothing.  This occurred on
Friday.   On the Monday folloAving, the prisoner Avent in a wagon
to a house some miles distant, carrying Avith her a covered basket.
This she placed  in the closet of  the room Avhere she  was to sleep.
AVhile it Avas there, the woman who owned the house having occa-
sion to go into the room, perceived a most disagreeable and offensive
odor, Avhich upon investigation she discovered proceeded from the
prisoner's basket in the closet.   In the  evening the prisoner took
her basket for the purpose, as she said, of going to the house of an
acquaintance, who lived  beyond  the creek near by; Avhen she re-
turned the basket Avas empty, and the  odor had disappeared.  A
few days  after, the body of a neAv-born infant  Avas found in the
creek several miles below where  the prisoner had crossed.  This, it
Avas alleged by the Commonwealth, was the prisoner's child,  Avhich
had been strangled by her, and subsequently thrown into the AA-ater.
   It Avas proved, however, that the prisoner never had given birth
to a child, or even been pregnant.   That for years she had suffered
from suppression of the menses.   The physician who originally
attended her  proved that he had  recommended her  to sit  over a
bucket of steaming water as a means of obtaining relief.   What
the old  woman had heard fall into the bucket was a clot of blood,
loosened by the effects of hot vapor.  The odor in the basket came
from a bottle containing a quack lotion of herbs, with which she
Avas in the habit of washing herself, and Avhich had been broken
Avhen she jumped from  the wagon upon reaching her destination.
The defendant was acquitted.—P.]
   A change in the breasts.—These organs in a pregnant Avoman are
full and prominent, and the areolae around  the nipples  undergo
changes of color which Dr. Alontgomery and others regard as highly
characteristic of the pregnant state.  A mere fulness or pain in the
breasts, and even in some rare instances the secretion of milk, may
arise from other causes than pregnancy.   Severe uterine or ovarian
irritation may cause the breasts to  become painful  and swollen.
The fulness  of  the breasts from  pregnancy  is not commonly ob-
servable until about the second or third month.   A more  or less
transparent fluid is secreted  by  the gland-tissue of the breast, and 
           SIGNS OF PREGNANCY.   QUICKENING.         497

can be expressed from the nipples.  This secretion of milk may
occur in a non-pregnant female as a result of uterine  or ovarian
disease.   These cases, hoAvever, are not very common;  but after a
woman has once secreted milk, the secretion is easily reproduced in
the breasts by very slight causes, quite independently of pregnancy.
  The areola  is generally observed  during pregnancy  to "become
considerably darker in color, and larger in diameter.  The skin of
which the areola is formed is soft, moist, and slightly tumid.  The
little glandular follicles about it are prominent, and often becleAved
with a secretion; the change of color has been the most  attended
to.   The areolae are commonly Avell marked in from the second to
the fourth month of pregnancy—the intensity of color being the
last  condition of the areola to appear.  The  prominence of the
glandular follicles does not ahvays exist in pregnancy, and the are-
ola may become large and  dark-colored from other causes ; conse-
quently, these signs are only to be looked upon as corroborative.
In females of dark complexion, the areolae are naturally dark, irre-
spective of pregnancy ; and  in some advanced  cases these changes
in the areolae are entirely absent.   (" Edin. Month. Jour.," Alarch,
1848, p.  693.)  Dr. Alontgomery has described as a sign of preg-
nancy the existence of a brown line extending from  the  pubes  to
the navel, especially in  women of dark complexion, and a  dark-
colored but not raised  areola of about  a quarter of  an inch  in
breadth around the navel; but this also may lie produced by uterine
or ovarian disease.
  Quickening.—The signs above given are applicable to the early,
as well as to the late stages of utero-gestation;  but that which we
have here to consider is one  Avhich is rarely manifested until about
the fourth or fifth month.  Quickening is  the  name  applied  to
peculiar  sensations  experienced by a woman about  this stage of
pregnancy.  The symptoms are popularly ascribed to the  first per-
ception of the movements of the  foetus,  Avhich  occur  Avhen the
uterus begins  to rise out of the pelvis; and to these movements,
as well as probably to a change of position in  the uterus, the sensa-
tion is perhaps really due.  The movements of  the foetus are per-
ceptible to the mother before they are made evident b)7 an external
examination.   The  term is  derived from the  old  Saxon  Avord
" quick," signifying living ;  as, at the time when medical science
was in its infancy, it Avas considered that the foetus  only  received
vitality Avhen the mother experienced the sensation of its  motion !
On the occurrence of quickening there is generally a great disturb-
ance of the system, indicated  by  syncope, nausea, and other dis-
tressing symptoms.  After  a short time the female recovers; and
if sickness has hitherto attended the pregnant  state, it has been
frequently observed  to disappear  when  the period of quickening
has passed.
  No evidence but that of the female  can satisfactorily establish
the fact of quickening; and this it is necessary to bear  in mind,
since, in  some cases in  Avhich  pregnancy is an  object  of  medico-
legal importance, proof of quickening  may be  demanded by law,
      32 
498
SIGNS OF  PREGNANCY.
Dr. Reid remarks  (" Lancet,"  September  10,  1853, p. 237), with
respect to this sign, that few  Avomen can tell the exact day on
which they first feel it; and a large proportion cannot place it Avith-
in a range of fourteen days, Avhich is of little assistance in the cal-
culation of the probable date of delivery.   Women avIio profess to
be most exact in noting the period of quickening, differ from each
other as to the time.  There is much self-deception as to this symp-
tom.  The discovery'of the movements of a child  by an examiner
is really a proof that  the usual period of quickening is past, but
their  non-discovery at the time of the examination  is no proof
whatever that the Avoman has not  quickened, since the move-
ments are by no means constant, and may be accidentally suspended
even at several successive examinations.  Besides, cases every now
and then occur in which Avell-formed, healthy Avomen do not ex-
perience the sensation of quickening during  the whole course of
pregnancy;  and, Avhat is of more importance,  the movements of
the child may be at no time perceptible to the examiner.  The un-
certainty of quickening as  a sign  of pregnancy  is too Avell knoAvn
to require more than adverting to.  Women have  been known to
mistake other sensations  for it, and in the end it has been proved
that they Avere not pregnant.   A woman may declare that she has
felt quickening Avhen she has  not;  and unless  the movements of
the child are perceived by the  examiner at the  time, hoAv is he to
confirm or disprove her statement ?   Quickening, then  (so far as it
concerns  the statement of the woman), cannot  be  relied on  as a
proof of  pregnancy; but  if the movements of  a child can be felt
hy the examiner through the  abdomen, this  is clear evidence not
only of the  woman being pregnant, but of her having passed the
period  of quickening.  Taking this general experience of accou-
cheurs, quickening happens from the tenth to the twenty-fifth Aveek
of pregnancy ;  but  the greater number of instances occur betAveen
the twelfth and  sixteenth Aveek,  or betAveen the fourteenth and eigh-
teenth week after the last menstruation.
  From  these  observations, it w7ill  be seen that an examiner  may
sometimes detect the movements  of the child   about the third or
fourth  month, at  others  not  until  the fifth or  sixth, and in other
instances not at all, throughout pregnancy.  Even in those cases in
which  the  movements of  the child have  indisputably existed,
they are not ahvays to be perceived; hence, several examinations
should be resorted  to before any opinion can  be  fairly expressed
from their absence.   The best mode of examining the abdomen for
foetal movements  is to alloAv  the hand to remain at rest on the
abdomen.  If the patient  has  quickened  recently, the impulse is
slight, and generally at only one  spot, Avhich, however, is seldom
the same. Should she have advanced further, then the movements
will be more rolling, and the parts of the  child be detected at the
same  time.   In making  these  examinations, a  diagnosis may be
facilitated by previously immersing the hand  in  cold Avater, and
then suddenly applying it to the abdomen.  When the  movements
of the child are distinctly7 perceived through the skin of the abdo- 
SOUNDS OF THE FCETAL  HEART.
499
men, they constitute a certain sign of pregnancy; but  their  non-
discovery at a particular time is no proof that a female is not preg-
nant.   The "jury of matrons"  probably trust to this sign; hence,
their verdicts commonly turn out to be erroneous.  Therels another
source of fallacy Avhich may present itself Avhen an artful woman
is desirous of making it appear  that she is pregnant—namely, that
a woman  may  simulate the movements of a  child by a peculiar
action of the abdominal muscles.   Aledical practitioners of  repute
have been  deceived for a time by this artifice, but this  occurred
before the discovery of chloroform, or the stethoscope.
  Sounds of the  fatal heart.—Another  sign is that which is derived
from auscultation.  By the application of the  ear or a stethoscope
to the abdomen, at or  about the fifth month of pregnancy (rarely
earlier), the pulsations of the foetal heart may be recognized and
counted.  These pulsations are  not synchronous Avith those  in the
arteries of the mother; they are much more rapid, and thus it  is
impossible, to mistake them.   Their  frequency, according to Dr.
Hope, is in an inverse ratio to the  stage of gestation, being 160 at
the fifth and 120 at  the ninth  month.   Sometimes, howeA7er, the
foetal  pulse may descend  to 80 or even 60 beats a minute.  This
sign, Avhen present (like the foetal  moA7ements), not only establishes
the fact of pregnancy beyond all dispute, but shows that the child
is living.  The  sound of the fcetal heart is, liOAATever, not ahvays
perceptible: when the child  is dead, of course  it Avill 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 Avill depend very much
upon the position of the child's  body,  the quantity of liquor amnii,
the presence of disease, and other circumstances.  Thus the sounds
may be distinctly heard at one time, and not at another ; they may
be absent for a Aveek or fortnight, and then will reappear; so that,
although their presence affords the strongest affirmative evidence,
their absence furnishes  uncertain  negative evidence ; and several
examinations should  be made, in the latter case, before an opinion
is formed.  The earliest time at which the pulsations may  be heard.
has been stated  to be about the fourth  month, but they Avill be best
heard after the  sixth month.  The reason why the  sounds of the
fcetal heart are not ahvays perceived is owing, not only to  changes
in the positions of the child, but to the  vibrations having to traverse
the liquor amnii and the soft  layers  of the skin of the abdomen.
The presence of much  fat in  these layers intercepts them.   The
point Avhere the sounds  can be most readily perceived is in the
centre  of  a line draAvn from the navel to the anterior  inferior
Bpinous  process  of the  ilium on either side—perhaps  most com-
monly on the right.  AAlien clearly detected, they furnish an une-
quivocal sign of the pregnant  state.   Besides the  sounds of the
tictal heart', there are other sounds to Avhich  the name of " pla-
cental murmur," or uterine sounds, has  been given. These are heard
from an earlier date, i.e., at any time  after  the third  month.  As
they may occur in  connection Avith fibroid tumors  of the uterus,
they do not necessarily indicate pregnancy.  (See a paper on  this 
500    CHANGES IN THE UTERUS.  B ALLOTTE MENT.

subject by Dr. Druitt, " Aled.  Times and Gaz.," Jan. 21, 1860; also
another by Dr.  Copeman, of Norwich, " Obstet. Trans.," 1869.)
  In reference to these signs of the pregnant state, it may be ob-
served that if the motions  of  the child, or sounds of the heart, be
perceptible, no  other evidence of pregnancy need be  sought for.
The mere suppression of the menses, prominence of the abdomen,
and fulness of the breasts, cannot alone establish the facts; but
unless the morbid causes of these abnormal states of the system he
clearly and satisfactorily obvious to the examiner, it is a fair pre-
sumption from the symptoms,  that the Avoman is pregnant.  In any
case in Avhich a doubt exists, Ave should require sufficient time  to
form a correct opinion.
  Changes in the mouth and neck of the iderus.—The signs heretofore
mentioned are  chiefly relied on in medical practice; but it must be
remembered that no case can possibly occur in civil or criminal juris-
prudence, in Avhich it will not  be  in the power of a medical Avitness
to make an examination of the woman.   He may then form a safe
judgment from the changes Avhich  take place in  the neck  of the
uterus, and  from  the sensation imparted to the fingers by the pre-
sence of a rounded body (like  the foetus) floating in a liquid, Avhen
an  impulse is gi\7en to the uterus from beloAv.   Up to the fifth or
sixth month of pregnancy, the  neck of the uterus  may be com-
monly felt projecting into the vagina ; it is of its usual length, hard
and firm.  After that period,  the uterus rises into the pelvis, and
the neck is spread out, shorter and shorter, the aperture increasing
in size and becoming rounded.  ToAvards the end of gestation, the
neck  of the uterus appears to  be  lost, becoming like  a thin mem-
brane, and sometimes no aperture can be felt.
  A w7ell-marked test of pregnancy is the motion perceptible to the
finger, on giving a sudden impulse to the child through  the neck
of the uterus.  Capuron calls  this the touchstone in the distinction
of the pregnant state ; Avithout it, he considers a medical jurist may
be  easily deceived.  To this passive motion of a 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 preg-
nancy becomes advanced,  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.   This motion  to  the  child can  also  be
given through the abdomen, by external ballottement in tAvo Avays:
either by the patient lying on her  side, the hands placed  on the
most depending part of the uterus, or by placing the patient on her
elboAvs and knees ; the uterus  Avill then fall forwards, the  child also
will fall in contact Avith the front Avail of the uterus, and  its pre-
sence thus  be made more perceptible.   This latter mode is best
adapted for the early stages of pregnane}'.
  As most of these signs refer to an advanced stage, a Avitness may
be  asked Avhat are the unequivocal indications of pregnancy before
the fifth and sixth month ?   The answ7er to this question is of little
moment to a medical jurist, since  he is rarely required to  give an 
FEIGNED  PREGNANCY.
501
opinion under these circumstances.  In all legal cases, when preg-
nancy is alleged or suspected, it is the practice for a judge or mag-
istrate, on a representation  being made by a medical Avitness, to
postpone the decision, one, two, or three months, according  to the
time required for obtaining certain evidence.  The evidence Avill
consist in plainly  distinguishing—1. A  rounded  body  floating
freely in a tumor, w7hich alternately relaxes and contracts.   2. The
movements of a foetus ;  and 3. The sounds of the foetal heart. The
most experienced men agree, that before the sixth month, the changes
in the  neck and mouth of the uterus are of themselves  too  uncer-
tain to enable  an  examiner  to form a safe  opinion ;  and, a fortiori,
it is impossible to trust  to external signs alone.
   Air.  AVhitehead dissents  from this  vieAA7, 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 Avith certainty the existence of preg-
nancy during its earlier  stages—from a feAA7 days after conception to
the middle or end of the fourth month, Avhen auscultation first be-
comes available.   In the  fourth week, the lips of the mouth of the
uterus at the centre of their margins are permanently separated to
the extent of  one or  tAA7o lines;  and  the  os  tincae (the aperture)
itself, Avhich Avas  before  a  mere  chink  Avith parallel boundaries,
forms an  elliptical or sometimes rounded aperture, Avhich is occupied
by a deposit of transparent gelatinous mucus.  At six or eight AveeJ.cs,
it is decidedly' oval or irregularly circular, Avith a puckered or in-
dented boundary having  a  relaxed and lobulated character.  The
Avhole circumference of  the neck  is enlarged, and the commissures,
or angles of the mouth, are obliterated.   The mouth continues of
this irregular form throughout the Avhole period of gestation ;  but
from the" time of quickening to the end of the seventh month, the
progressive changes are not so marked as to  form a guide for de-
termining the period  of  pregnancy.  (" On  Abortion," p. 204.)
This condition of the mouth of the uterus must not  be confounded
Avith  its  menstrual state  in the  early stages, nor  Avith a diseased
state in the latter stage  of gestation.
   [A  bluish or  dusky  color of the vagina,  produced by venous
congestion, Avas originally declared by Jacquemin to be  an almost
certain sign of pregnancy in females who-are not subject  to haemor-
rhoids.  This  statement has been confirmed by  Kluge,  Parent-
Duchatelet, Kilian, AVistrand, and Montgomery, the last of whom
says, "In every instance,  Avithout a single exception, in Avhich  I
have found  this  appearance distinctly marked, pregnancy coex-
isted." (Sig. and  Symp. of Preg., 2d eel. p. 245.)   It should, how-
ever, be remembered that  pregnancy may exist, although this sign
may not be visible. (Wharton & Stille, Aled. Jurisp., 1873, ii. p. 15.)
The presence of kiestein in  the urine is no longer regarded as afford-
ing positive proof of pregnancy.—R.]
  ^Feigned pregnancy.—Pregnancy has  been sometime^ feigned  or
simulated for the purpose of extorting charity, of obtaining a settle-
ment in a parish, or of compelling marriage; but it is scarcely ne-
cessary to observe  that  an impostor may  be  easily detected by  a 
502
"DE VENTRE  INSPICIENDO."
AA7ell-informed practitioner, since a woman ahvays feigns an advanced
state of pregnancy.  Although she may state that she has some of
the symptoms depending upon pregnancy (and, unless she has already
borne children, she will not be able to sustain a cross-examination
even respecting these), yet it is not possible for her to simulate Avith-
out detection, a distension of the abdomen, or the state of the breasts.
If she submits to an examination, the imposition must be detected ;
if she refuses, the inference will be that she is an impostor.  Females
have been known  to possess the power of giving apparent  promi-
nence to the abdomen, and even of simulating the movements of a
child by the aid of the abdominal muscles.  By placing them under
the influence of chloroform, the abdomen at once collapses, and the
imposture is detected.  These cases of spurious pregnancy are some-
times met Avith in hysteric females.
  De ventre inspiciendo.—One of the casesin English laAv^in which
pregnancy requires to be verified, is of a civil nature.  It is in rela-
tion  to the Chancery writ " de ventre inspiciendo."   A Avoman may
assert that she is pregnant  at the time of her husband's death, and
the heir-at-laAV may sue  out a Avrit 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
Avithin a recent period, the decision of the question of pregnancy
Avas  left to twelve matrons and twelve respectable men, according
to the strict terms of the ancient writ; but in some late cases it
has been considered advisable to depart from this absurd custom,
and to place the decision in the hands of skilled medical  practi-
tioners, or obstetric experts.
  Plea of pregnancy in bar  of execution.—The second case in Avhich
pregnancy requires to be verified, in English laAV, is in relation to
criminal jurisprudence.   AVhen a AA7oman is capitally convicted, she
may plead pregnancy in bar of execution.   The judge  will then
direct a jury of twelve married Avomen " de circumstantibus," to be
empanelled, and SAvorn to  try, in the words of the laAV, " Avhether
the prisoner be Avith child  of a quick child, or not."  If they find
her quick with child, she is respited ; othenvise, the  sentence will
take effect.  In admitting the humanity of the principle by Avhich
a pregnant woman is  respited until after her delivery, there are
tAvo  serious objections to the practice of the common laAV, Avhereby
it is made to fall short of what, in a civilized  country, society has
a right to expect from it: these are—1st, that the question of preg-
nancy is allowed  to be  determined by a jury of ignorant Avomen
accidentally present  in court;  and 2clly, that the respite  is made
to depend, not upon proof of pregnancy, but upon the fact of a
Avoman 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 Avould be a matter of accident (ante p. 498).  Quicken-
ing is a sign not easily established, except by extorting a confession
from the female, as by making her  give evidence against  herself; 
      PLEA OF  PREGNANCY IN BAR  OF  EXECUTION.    503

and this is the only possible way in Avhich, in a doubtful  case, the
question could be determined by a jury of matrons.   They com-
monly trust to feeling externally the movements of a foetus, but this
is at all  times a purely accidental circumstance, and they may not be
perceptible at the time of the examination.  It must be obvious,
on the least reflection, that the  means resorted to by the English
la\v to determine such a question are bad, and are quite unfitted for
the present state of society.  Several modern cases sIioav that a jury
of matrons  may  be  easily deceived Avith  respect to this sign of
pregnancy.  In Rex v. Wright  (Xonvich Lent Assizes, 1832)  the
prisoner Avas found guilty of the murder of her husband by poison.
She pleaded pregnancy in bar of execution.  The judge empanelled
a jury of matrons ; and they, after a form of examination had been
gone through, brought in a verdict of " not quick Avith child."  The
Avoman  Avould have been executed had not several  medical practi-
tioners of Norwich represented to the judge that the method taken
to determine pregnancy and quickening Avas so unsatisfactory that
no reliance could  be  placed upon it.  The prisoner Avas  then ex-
amined  by some medical men, and Avas found  to have passed the
usual period of quickening !  The judge respited the prisoner, and
the correctness of the medical opinion Avas confirmed by the female
being delivered, Avithin four months aftenvards, of a healthy full-
grown child.  (See " Aled. Gaz.," vol. 12, p.  22.)  Still  the jury of
matrons is occasionally resorted to.  Thus in  the case of Reg. v.
 Weslwood (Stafford AVinter Assizes, 1843), the matrons  were sum-
moned to examine a female capitally convicted, and they negatived
the plea!  It is not a little remarkable that, although in  so many
cases the matrons have  given a Avrong verdict, and  that in no  in-
stance can they give a right one except as a matter of pure conjec-
ture,  this antiquated practice still continues.  It Avas revived at
the Central Criminal Court in 1847.   (Reg.  v. Hunt, September,
1847.)   This woman  Avas convicted of murder; she pleaded preg-
nancy, and the matrons Avere  empannellecl and clirecteel to  use
" their best skill " to determine Avhether the prisoner " Avas big Avith
a quick child or  not."  It Avas 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 laAV Avas di-
rected to take its course ; and the Avoman Avould have been executed
but for the interference of the Secretary of State.  He directed that
the prisoner should be examined by competent medical men, avIio
ascertained that she Avas really pregnant, and  had actually passed
that stage in Avhich quickening is most commonly perceived.   She
was therefore respited, and the error in the verdict of the  matrons
was clearly proved by the birth of  a child on the 28th December!
  The value of the opinion of a jury of matrons upon such matters
may be estimated  from the following facts.   The late Dr.  Reid  re-
cords a case of an expert midwife Avho, Avhen examined in the cele-
brated Gardner Peerage  cause, deposed "that she had herself once
gone ten months with child—that she Avas always right  in her cal-
culations—that she ahvays fainted aAvay at quickening, etc., so that 
504  IMPREGNATION  IN A  STATE  OF UNCONSCIOUSNESS.

she could never be deceived."  Some time after the trial she applied
to Dr. Reicl, convinced on such grounds that she Avas seven months
pregnant; but, on examination, Dr. Reid found that there was no
pregnancy at all!
  The doctrine of quickening has been  abandoned in relation to
the laAV of criminal abortion; and there is still greater  reason for
its immediate abolition  in reference to pregnant  females capitally
convicted.  This change  would, however,  be attended with but
little benefit, if the decision of the question of pregnancy Avere still
to remain in  the hands  of " matrons."  The  record  of  their  mis-
takes sufficiently establishes the correctness of this view; for if they
are unable to recognize  the pregnant  state of the fifth month, and
if, as experts, they are liable to be deceived about their own condi-
tion, they cannot fail to be  mistaken in their opinions at earlier
periods, in examining other Avomen.  It is, indeed, an extraordinary
circumstance, that when married Avomen advanced in pregnancy
are themselves  continually deceived,  and are obliged  to  consult
medical men  respecting their  condition, they should be specially
selected by the  law as the persons best qualified to pronounce an
opinion upon the pregnancy of a woman, in a case  involving the
infliction of capital punishment.  It Avould be considered inhuman
to execute, knowingly,  a pregnant Avoman, but the imputation of
inhumanity is not the less deserved  by a custom Avhich virtually
leaves the issue  in the hands of ignorant and incompetent persons,
avIio may be accidentally present at a criminal trial.  The Ameri-
cans are certainly in advance of us in their legislation on this sub-
ject.  Thus, by  the revised statutes of 'New York, Avhen 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, w7ho shall have poAver to subpoena Avitnesses.
   Concealed pregnancy.—By the laAV  of  Scotland, if a woman con-
ceals her pregnancy during the  Avhole  period thereof, and if the
child of Avhich she Avas  pregnant be found dead, or is amissing, she
is guilty of an offence,  and is  liable  to  prosecution.  Evidence is
sometimes given as to outAvard appearances indicative of pregnancy;
but the main proof of  a woman having been  pregnant, and that
which is relied  on for conviction, is clear and  distinct evidence of
the actual delivery of a  child.  This is generally furnished by medi-
cal Avitnesses.   The Scotch law,  by  making  the concealment of
pregnancy, under the circumstances  above  mentioned, an  offence,
proceeds on  the  principle that every pregnant female is bound to
make preparations for the safe delivery of a child ; and it is there-
fore assumed that if a child be born clandestinely, Avithout prepara-
tion, and  is found dead, or is  amissing, its death is owing to the
Avant of such preparation.
   ImpregnoMon  in a state  of unconsciousness.—It Avas formerly a
question whether a woman  could become  pregnant without her
knowledge.   This may  undoubtedly happen, when intercourse has
taken place during profound sleep (lethargy), or Avhen a woman has
been thrown  into this state by narcotic drugs, or vapors.   But it is 
UNCONSCIOUS  PREGNANCY.
505
difficult to admit that an}7 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 Avoman
endowed Avith ordinary intellect could not avoid suspecting her con-
dition, after the fourth or fifth  month; and this  alone Avould be
sufficient to induce her  to  seek advice, whereby the fact Avould be-
come knoAvn to her.  When a Avoman is impregnated in a lethargic
state, it is unlikely that she  should go  beyond  the sixth month,
Avithout being fully aware of her pregnancy;  and if her motives
Avere innocent, she Avould  undoubtedly make some communication
to her friends.  Capuron mentions a case of this kind, in which the
fact  of pregnancy  Avas  first ascertained at the end of the fourth
month, by the woman having complained to one  of her sisters of a
strange  sensation Avhich she experienced in the  loAver part of her
abdomen.  (" Aled. Leg. des Accouchemens," p. 86.)  In a case re-
lated by Air. Skey, a young Avoman Avho had had  intercourse know-
ingly, Avas supposed not to have been aware of her pregnancy until
the seventh month; but there is  reason to believe that this Avoman
was  guilty of deception.   ("Aled.  Gaz.," vol. 39, p. 212.)  There
are generally, in these cases, strong motives for  falsehood; hence
such stories  require close investigation before they are allowed to
influence the opinion of a practitioner.  A case occurred in Sep-
tember, 1857, in Avhich a woman, aet.  22, described as modest and
decorous in her behavior, then advanced to the sixth month of preg-
nancy, asserted that she had  not consciously had connection Avith
any one, although  she specified a date at which she remembered
she had lost her consciousness—at which  date  intercourse might
have been had!  On being questioned, she denied that she had had
at any  time  any soreness or pain in her private  parts.   Although
there may be unconscious intercourse and pregnancy, it  is  not
probable that in the case of a virgin, there should be such inter-
course Avithout the production of pain, soreness, or laceration ;  and
these symptoms, if not perceived at the  time, should be felt subse-
quently and  create a suspicion, if not an actual knowledge, of what
had happened.  This rendered the account which the woman gave
Avholly improbable.  The fact that she Avas able to fix  a date for
her unconsciousness, Avith  an  accuracy in accordance Avith her con-
dition, Avas also a suspicious circumstance.
   Unconscious pregnancy.—It is  quite probable  that women  Avho
are living in connubial intercourse may become  pregnant Avithout
being conscious of  it.  Dr. R'uttel  mentions the  case of a Avoman,
set. 41,  avIio had been married upwards of sixteen years, and Avho,
Avhile returning from a neighboring village, Avas suddenly delh'ered
other first child, Avhen only a few days before she had been com-
plaining that she Avas not  likely  to have any children.   The child
was born living and mature. (Henke, " Zeitschrift der S. A.," 1844,
p. 264.)  Air. Long met with a case  in  which a married woman,
set. 24, subject  to" irregular menstruation, consulted  him  for an
attack of spasms.   On his arrival, he found that she had suddenly
given birth to a seventh-months  child.  Neither her husband nor 
506      EVIDENCE  OF  PREGNANCY IN THE DEAD.

herself had the slightest idea that she was  pregnant.   She had
noticed that she had become  somewhat stout,  and that her breasts
were more full than natural.   She attributed her condition  to im-
proved health, and the cessation of the menstrual discharge was set
down to some accidental cause.  (" Med. Times and Gazette," June
13,1857, p. 592.  See also a case at full term by Dr. Tanner,  " Obstet.
Trans.," vol. 4, p. 113.)   I am indebted to a distinguished judge for
the following fact in reference to unconscious pregnancy: A married
lady, who  had not had a child for a period of nineteen years, found
herself, as she thought, getting unusually stout.  She Avas moving
about with her family to different places.  At last her size alarmed
her,  and she thought she Avas suffering from dropsy ; she consulted
a physician, Avho informed her that  she was in an  adA7anced state
of pregnancy.   She treated this  opinion with  great contempt.  In
travelling with  her daughter, they arrived at a  miserable inn; on
the night of their arrival, this lady was seized with pains  of labor,
and  Avas delivered of a child.  She had  made no preparation for the
'birth,  and, up to the moment when she was seized with labor-pains,
she had not, Avith all her former experience, the slightest idea  that
she was pregnant.   (For other cases  in Avhich married women have
had  no consciousness  of pregnancy,  see " Lancet,"  June 16, 1860,
p. 609, and June 30,1860, p.  643.)  Instances  of this kind are im-
portant in reference to  alleged unconscious  delivery in  females
charged with infanticide. At the  same time, all  cases in which
there are motives for pleading unconscious intercourse or pregnancy,
require close  examination ;  they  will frequently be found to be
quite unworthy of belief.
   Pregnancy in  the  dead.—There is no special case  in law  wherein
the fact  of pregnancy requires to be verified  after the death of a
Avoman; but an examination may be  necessary in  order to  deter-
mine the identity of a body, or to rescue the reputation of a woman
from a charge of unchastity.  The discovery of an embryo  or foetus
with its membranes, in the uterus A\Tould of course at once solve the
question, when the necessity for an examination occurred ;  and the
practitioner will remember that, even supposing many years to have
elapsed since interment, and the body to have been  reduced to a
skeleton, still, if the foetus had reached the period  at Avhich ossifi-
cation takes place, traces of its bones Avill be found amidst the bones
of the Avoman.  In examining the body of a female long after death,
for the purpose  of determining  whether she was or was not preg-
nant at the time of deatli, it maybe proper to bear in mind that the
unimpregnated uterus undergoes decomposition much more slowly
than other soft organs.   In the case of a female who had been missing
for a period of nine months—whose body was found in the soil of a
privy, so decomposed that the bones  separated from  the soft parts—
the uterus w7as of a reddish color, hard when felt, and its substance
was  firm Avhen cut.  The fact was of importance.  It Avas alleged
that the deceased was pregnant by a young man, and  that  in order
to conceal her condition he had murdered her.  From the state of
the  uterus, Casper was  able  to  affirm that this organ was  in its 
DELIVERY.
507
virgin condition, and that the deceased Avas  not pregnant at the
time of her death.  On this representation the accused Avas liberated
(" Ger.  Leich. Oeff'n.," vol. 1, p. 93.)   In examining bodies many
months after interment, and in  one case upwards of a year, I have
been surprised to find, that Avhile other soft organs were decomposed,
the uterus had  scarcely  undergone  any change;  its substance Avas
still firm and hard.   It may happen  that the appearances in the
uterus are sufficient to create a  strong  suspicion that a woman has
been pregnant, but the ovum, embryo,  or foetus may have been ex-
pelled ;  in this case several medico-legal questions will arise  in
reference to delivery.
DELIVERY.
                   CHAPTER  XL IV.

 DELIVERY IN THE LIVING.—CONCEALED DELIVERY.—ABORTION IN THE
   EARLY STAGES OF PREGNANCY.—SIGNS  OF  RECENT AND REMOTE  DE-
   LIVERY.—FEIGNED  DELIVERY.--DELIVERY IN  A STATE OF UNCON-
   SCIOUSNESS.—SIGNS OF DELIVERY IN THE  DEAD.--TRUE  AND FALSE
   CORPORA LUTE A.--CHARACTERS OF THE OVUM OR EMBRYO.—MOLES.—
   CONCEALMENT OF  BIRTH.

   Delivery is a subject Avhich much more frequently requires med-
 ico-legal intervention than pregnancy.  It will be sufficient to state
 that the concealment of birth,  the crimes  of abortion and infanti-
 cide, Avith questions relative to supposititious children, are closely
 dependent on the proof of parturition.  This subject Avill admit of
 being considered under tAvo heads: 1. As  it relates  to delivery in
 the living ;—2. As it relates  to  delivery in the dead.  In under-
 taking the investigation, Ave ought, if possible, to ascertain, either
 from the female herself, or from  those  around her, whether there
 was  reason  to  suspect that  she had  been pregnant.  If Ave can
 acquire  any  knoAvledge on this point it will materially facilitate
 our inquiry; but this  is not ahvays possible.    It  has generally
 happened, that previous pregnancy has been so concealed that fevv
 who saAv the Avoman  suspected  her  condition; then again, a? the
admission of her delivery may  be  the strongest proof of her crim-
inality, she Avill perhaps resolutely deny it; and a medical practi-
tioner has no right  to extort this admission from her.  From this
it Avill be seen that  a medical Avitness must often be prepared to
prove  the fact of  delivery against the Avoman avIio is criminally
charged. 
508      EVIDENCE  OF  DELIVERY  IN  THE  LIVING.

  Delivery in the living.   Concealed delivery.—The signs of delivery
in a living woman vary materially, according to the time at Avhich
this event has taken place.  In common language, if the contents of
the uterus are expelled before  the  sixth  month, the Avoman is said
to miscarry, or to have an abortion ; if after the sixth month, she is
said to have a premature labor.  The law does not admit any such
distinction: the expulsion of the ovum, foetus, or child by criminal
violence, at any period of utero-gestation,  is regarded as a miscar-
riage or abortion.  It has been Avell  observed that  the signs of de-
livery are indistinct in proportion  to the immaturity of the ovum.
Thus, Avdien it takes place at the second  or third month, there are
scarcely any proofs Avhich can be  derh7ed  from an examination of
the Avoman.   All the ordinary signs of  delivery at the full period
Avill be absent—the development  of the embryo not having been
sufficient to cause any prominence in the abdomen, or to give rise
to those changes in the system AA'hich take place previously to the
birth of a mature child: e. g., enlargement of the breasts and dila-
tation of the mouth of the uterus.  Abortion at  this  period (the
second or third month) is generally  accompanied by loss of blood,
Avhich  may manifest  itself by its effects on the body.   This, how-
ever, can only give rise to  a suspicion.   At a later perioel of gesta-
tion, there may be a discharge  resembling the lochia, and the mouth
of the uterus may be found enlarged and soft; but from the small
size of the foetus, the outlet will present  no positive evidence of
delivery.  The quantity of blood lost may be  greater, and may
have a more decided effect  on  the system.  Of course, if the ovum,
foetus, or any of  its membranes be found, then the  presumption of
abortion  will be strongly supported: but  women who designedly
conceal  their  condition, will  commonly take effectual means to
prevent the examiner from obtaining evidence of this kind.
  In order to determine the signs of a " miscarriage," as it is termed
by our law, at an advanced period of gestation, it Avillbe necessary
to describe those Avhich are considered to be.characteristic of deliv-
ery at the full period.  In these cases there will be only  a difference
in degree ; the signs being more numerous and more clearly marked
in proportion to the lateness of the period at Avhich the contents of
the uterus are expelled.  The  signs of delivery may be enumerated
in the following order:—
  Signs of recent delivery  in  the living.—The female is weak, the
countenance pale, the eyes are surrounded by livid areolae, and there
is an appearance of general indisposition.  Any severe illness may,
hoAvever, give rise to similar symptoms.  Their sudden  occurrence,
from a state of previous good health, especially Avhen pregnancy is
knoAVn or suspected, will create a strong suspicion.   The breasts are
large and full, especially about the third or fourth day after delivery;
the nipples are enlarged, and the areolae around them present all the
characters of advanced pregnancy.
  1.  The skin of the  abdomen is  relaxed,  sometimes thrown  into
folds: the cuticle interrupted  by light-colored broken streaks, pass-
ing especially from the groins and pubes to\vards the navel, Avhich 
SIGNS OF RECENT DELIVERY.
509
is more or less stretched and altered in  appearance.   Any disease
Avhich has caused enlargement of the abdomen may  give rise to a
similar appearance in the skin, so that when taken alone, much con-
fidence cannot be placed in these lines or streaks as proofs of delivery7.
The round form of the enlarged and semi-contracted uterus may be
felt at the lower part of the abdomen, generally lying toward one
or the other side.   The apparent size of this organ will depend upon
the degree to Avhich it has contracted, and therefore greatly upon the
time at Avhich an examination is made. Dr. Afontgomery has pointed
out the existence of a dark line  extending from  the  pubes  to the
navel, with a dark areolae around the latter, in cases of recent de-
livery ; but  he has found this line  to exist independently of preg-
nancy and delivery—in one case in a girl aged 10, and in another
instance, in a lady laboring under an ovarian tumor.
  2. The organs of generation will be found externally swollen, con-
tused, or eA-en lacerated, with clots of blood about them.  The outlet
is much dilated,  the  vagina relaxed, the mouth of the uterus con-
siderably open, and its margin completely relaxed.  The neck of the
uterus is shortened, and scarcely perceptible; and the body.of this
organ is from two to four times the size which it has in the  unim-
pregnated state.  It occasionally happens that the neck of the  uterus
is larcerated on one side during the passage of the head in primiparae ;
should this be found, or a cicatrix,  it Avill much  assist in proving
delivery.
  3.  The presence of  the lochia.—This is a discharge, at  first of a
sero-sanguineous liquid, but Avhich  afterwards  appears as a brown
or green-colored  serum.  It  commences soon after  delivery, and
continues  from a Aveek to a fortnight, or even longer; it may be
absent after  the third clay.   The discharge has so peculiar an odor
that some have regarded this.alone as furnishing strong-evidence of
recent delhrery.
  The signs Avhich have been here enumerated are found only AA7hen
no delay has taken place in making the examination, and the woman
has been recently delivered.  In some  strong and  vigorous females,
the body resumes its natural state within a few days,  and the traces
of parturition may have wholly disappeared or have become so
ambiguous as to furnish no satisfactory evidence.  In others  again,
proofs of delivery will be obtainable for  a fortnight or three  weeks
afterwards.  In most cases, however, it is difficult, if not impossible,
to say, after the lapse of eight or ten days, that delivery has certainly
taken place, the signs having commonly by that time disappeared.
In all cases, the earlier the period at which an examination is made
the more satisfactory will be the evidence obtained. Dr. Afontgomery
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  ordinary  condition, especially the mouth
and neck of the uterus, which hardly differed from their natural and
unimpregnatcd form.  ("Cyc. Pr. Aled.," loc. cit.)  This inquiry be-
comes of considerable importance in a case of alleged child-murder.
When the body of a child is not found until after tAvo or three weeks 
510
DELIVERY AT  A REMOTE PERIOD.
from the time of its birth, and the suspected woman denies that she
has been delivered of a child, she will probably not deny her preg-
nancy, but may assert that she has  had an abortion at an early
period.  (See a case by Dr. AValther, of Labiau, in Casper's "Vier-
teljahrschrift," Oct. 1863, p. 275.)   In cases of  abortion at an early
period, the placenta is not ahvays discharged at the time.   ("Aled.
Times and Gaz.," March 12,1859.)   A microscopical examination of
discharges might reveal placental, or chorionic structures.

  Signs of  delivery at a remote  period.—A  question  may arise
Avhether it is in the  poAver of a medical practitioner to determine
the period at which  delh7ery took place, i. e., hoAV long a time  has
elapsed.  This  becomes necessary Avhen, in cases of concealed birth,
abortion, or infanticide (some time after suspected  parturition), a
child is found, and  it is  required to determine Avhether the time
Avhich has elapsed since the birth of the child, either dead or living,
corresponds with the supposed delivery of a suspected woman.  An
opinion may  be given Avithin eight or ten days after delivery, from
the state of the breasts; of the discharges (lochia), and of the mouth
of the uterus;  but it becomes difficult after the sixth  day ; and
when the tenth or tAvelfth day has passed it is still  more difficult.
After tAvo or 'three  months, it  may be regarded  as  impossible to
assign the period  of delivery with any degree of precision.  (See
Devergie, "Med. Leg.," \7ol. 1, p. 446.)
  In a case of pretended delivery, contested legitimacy, or disputed
chastity, a medical jurist may be required to say whether a woman
has, at any antecedent period of her life, been delivered of a child.
This question, it must be  remarked, can be raised only in respect to
delivery at the full period, since there is no doubt that abortion in
the early stages of pregnancy may take place, and leaATe no traces of
such an event discoverable  in  after-life.   Indeed, a  f'evv  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:
shining streaks on the skin of the abdomen, a brown mark reaching
from the navel to the pubes, and the state of the  mouth of  the
uterus, Avhich is said never to close so effectually as in the virgin.
In  regard to  the appearance  of  the skin of  the abdomen, it
may  be remarked, that any morbid  causes giving rise to  a  dis-
tension  of the cavity—as ovarian  enlargement or dropsy—will
produce the same  effect; so, also,  to  a certain extent, extreme
emaciation from a state of obesity.   (See " Med. Times  and Gaz.,"
April 17, 1861, p. 450, on  False  Cicatrices.)   Then again, these
marks on the skin are not always persistent throughout life.  Be-
sides, a woman, according to  the statements of good observers,
may be not  only  once, but  repeatedly delivered, Avithout having
these marks produced.  ("Aled. Times and Gaz.," June 9,1860, p.
583.)
  AVith regard to the state of  the  mouth of the uterus, it is liable
to vary  in different Avomen, and to be affected by disease, so that a 
          FEIGNED AND  UNCONSCIOUS  DELIVERY.      511

certain judgment cannot ahvays be formed from its condition.  In
a Avomau avIio 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 tincae (tench's  mouth).  Air. AVhitehead
has observed that, in a woman avIio has borne children, the mouth
becomes elongated, and loses the slight bend at each of its extremi-
ties ;  the labia are thickened, and more nearly of equal size; the
commissures are less clearly defined, and the Avhole of the neck is
enlarged, and not so compact in texture.   (" On Abortion," p. 195.)
It must lie remembered, however, that the condition of the mouth
of the uterus, even  in the virgin, varies  at each menstrual period.
Should  there be congenital occlusion of the vagina, or the hymen
he found imperforate, this will at once negative a previous delivery;
hut the  latter condition will  not  negative  a previous pregnancy,
since  a  Avoman may have  been  impregnated, and have had  an
abortion in an  early stage  of pregnancy, Avithout a  necessary
destruction of the hymen.   This sort  of negative  evidence may
however, be sometimes  of great value.  There is  a  total Avant  of
good affirmative evidence of delivery at  a remote  period in the
living, if Ave except  that which is furnished  by the presence  of
cicatrices in the vagina or of a cicatrix as a result  of  lacerated
perineum.  It is rare, hoAvever, that any decision  on  this subject
is required  in  medical jurisprudence.   It  might  be demanded,
either in a case  of infanticide, Avhen  a Avoman Avas accused  of
having destroyed her alleged offspring some months or years before;
or in a case of contested  legitimacy7, Avhen a female  is accused  of
having substituted  a child of Avhich she pretends she  has been
delivered at some remote period of time.
  Feigned delivery.—Delivery has  often  been  feigned by Avomen
for the  purpose  of extorting charity, compelling  marriage, or
disinheriting parties Avho have claims  to an estate, and in  other
cases Avithout 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
delhery  which is  assumed.   The  latter would, if  pretended, be
generally cleared up by an examination, as Avell as by circumstantial
evidence.  (See case, " Aled. Gaz.," vol. 19, p. 231; also another by
Capuron, " Aled. Leg. des Accouchemens," p. 110.)   [The case of
Airs. Cunningham, in Xew York, Avill suggest itself  to the  mind
of the American reader.—P.]

  Can a woman  be  delivered unconsciously?—Another important
question relative to delivery in the living, is whether a Avoman can
be delivered Avithout being conscious of it.  The signs of delivery
may be  discovered  by a  practitioner;  the offspring  may also be
found ; the woman  may admit the fact of her delivery, but allege
that she Avas totally unconscious of it.  The only medico-legal case
in Avhich this plea is occasionally raised is in infanticide;  and as
the possibility of the occurrence may be questioned, the practitioner
must be provided Avith a  knoAvledge of those facts Avhich' medico- 
512
UNCONSCIOUS  DELIVERY.
legal writers have accumulated respecting it.  There  is  no doubt
that a woman may be delh-ered unconsciously during profound sleep,
while laboring under coma, apoplexy, asphyxia or syncope; or when
suffering from the eff'ects of narcotic poisons—e. g., the vapors of
chloroform and ether, or intoxicating liquors.  It is said, also, that
delivery has taken place spontaneously  while a  female Avas in the
act of dying.  This, however, has no bearing on the present ques-
tion.  It is in those cases Avhere a female, after her recovery, pleads
unconsciousness of delivery that medical practitioners are chiefly con-
sulted.  Besides the cases enumerated, hysteria, when accompanied
by loss of sense and motion, has been mentioned as a state in AA7hich
parturition is liable to occur unconsciously.  We need not be sur-
prised at delivery taking place under these circumstances, Avhen Ave
consider that the contractile power of the uterus is altogether inde-
pendent of volition: but, unless the morbid states already mentioned
are accompanied by the most profound  lethargy and entire  loss of
sensation, it can rarely happen that  the contractions of this organ
in its efforts to expel the child, should not at  once rouse a Avoman
into consciousness.  We ought particularly to expect this in primi-
parae, i. e., in those who have never borne children.  At  the same
time, it  must be remembered  that parturition in some Avomen,
especially Avhen the pelvis is wide and  the  child  small, may take
place Avith such rapidity and ease as scarcely to be accompanied by
pain.
  It has been observed that,  when a Avoman has frequently borne
children, delivery sometimes takes place Avithout effort, and Avithout
any consciousness on her part.   On other occasions, a Avoman may
lie in a kind of torpor or stupor, or suffer from eclampsia (puerperal
convulsions), and have no  recollection of her delivery.   The follow-
ing case is possible:  A Avoman may be delivered while  under the
influence of eclampsia, Avhich might have attacked her before labor
set in ; and after delivery, but before complete recovery, she might
become maniacal—a not unfrequent condition—during which inter-
val she may have killed  or injured her child : or the child may have
been born dead,  or suffering from some accidental  injury.  She
would with truth assert her entire ignorance of it.  Her  statement
would be verified by a bitten tongue, a congested conjunctiva, or face.
Should albumen be found in the urine, this fact Avould be still more
confirmative. Of course, eclampsia might occur Avithout these results.
The statement might be disproved by finding her actions had shoAvn
care and design in other circumstances, at the time she said she AATas
unconscious.  Air. King has described the case of a Avoman, aged 36,
the mother of nine children.   She received his assistance in her
tenth labor ; Avhen summoned, she was lying calmly and placidly in
bed, and was perfectly insensible.  He found that the child had been
expelled Avith the placenta.   The Avoman did not recover her sensi-
bility for ten or twTelve  hours, and then stated that she had no
recollection of the birth of the child, or of any  circumstances con-
nected with that event: she suffered no pain or uneasiness. Another
case is mentioned by this gentleman, in which sensation appeared to 
UNCONSCIOUS DELIVERY.
513
he entirely paralyzed during labor.  (" Aled. Times," Alay 15,1847,
p.  234.)  It  is beyond doubt that profound lethargy occasionally
makes its appearance about the time of delivery.   Dr. Schulze  met
with a case in Avhich a Avoman remained in a state of sleep for three
days, and Avas delivered while in this unconscious condition: on
awaking, she had no recollection of having suffered any pain during
delivery.  (" Ann. d'Hyg.," 1845, vol.  1, p. 216 ; " Aled. Gaz.," vol.
36, p. 40.)  Dr. Afontgomery relates the case of a lady, the mother
of several children, avIio, on one occasion, Avas unconsciously delh7-
ered  during sleep.  (" Cyc. Pr. Aled."; see also case in  "Brit,  and
For. Aled. Rev.," Xo. 9, p. 256.)   Dr. Palfrey describes a case in
Avhich labor commenced and  progressed in a Avoman to the  second
stage during sleep.  (" Lancet," 1854,  vol. 1. p. 36.")
   The results obtained by the use of the vapors of chloroform  and
ether sIioav that the expulsive efforts of the  uterus are often as ener-
getic in the  unconscious, as in the conscious state.  It may  appear
extraordinary, hoAvever, that a primiparous Avoman, unless rendered
unconscious  by narcotic substances, should be delivered Avithout suf-
fering pain: nevertheless, a .case of this kind is  recorded  by Dr.
Wharrie.  The Avoman's age Avas 21; she had been in labor about
six hours ; she complained of  no pain, and the child Avas born Avith-
out effort or consciousness.   The child Avas healthy but small, Aveigh-
ing rather more than four pounds.  (" Cormack's  Journal,"  Janu-
ary, 1846, p.  12.)   XotAvithstanding this and other eases, it is in the
highest degree improbable that any primiparous female should be
delivered during ordi net ry sleep Avithout being aroused, and brought
to a sense of her condition.
   There is another condition in which  a Avoman 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 Avith
child murder, must here claim our attention.  Thus, she will allege
that Avhile suffering from pain, she felt  a strong desire to relieve her
bowels: that she Avent to the Avater-closet for that purpose, and  Avas
there delivered Avithout knowing anything of the occurrence until it
was too late to save the child.  This kind  of desire is a very com-
mon symptom of the parturient state ; and in private practice,  it is
often difficult to restrain a Avoman from yielding to the feeling, Avhen
it  certainly  Avould be attended with hazard to the child.   (" Aled..
Times and Gaz.," April 4, 1857, p. 347.)  AVe must therefore admit
that an accident  of this kind  can occur; although here, as in every
other instance in which unconscious delivery is pleaded, a medical
ivitness ought to inform himself, or be informed, of all the particu-
lars which are stated to have  attended delivery, before he gives an
answer applicable to the ease.  As a general rule, it cannot be denied
that delivery may take place under these circumstances, and a woman
not be conscious of it; but before Ave make this admission in regard
to  any particular instance, we ought to have a statement of all  the
facts from the female herself.  It is thus that Ave shall avoid the risk
of seeing a premature medical opinion set aside by the subsequent
production of circumstantial evidence.   Besides, it has been properly
      33 
514             POST-MORTEM PARTURITION.
observed that, after an accident of this kind, a woman  cannot be
ignorant of her having been  delivered.  AVomen avIio have  raised
this plea in cases of child-murder have often been knoAvn to maintain
that they Avere unconscious of their pregnancy, and thus have at-
tempted to excuse themselves for not having prepared the articles
necessary for childbirth.  It is possible that a Avoman, especially one
Avho is pregnant for the first time, may not be aware of her preg-
nancy in the earlier stage ; but it is rare for one to adA7ance  to the
full term Avithout being  conscious of it.   AVomen who  have borne
children have not unfrequently consulted  medical  men;  and al-
though  nearly  at  full term, they have  been unconscious of their
state.  In the majority  of instances,  it may be presumed  that a
woman  thus situated must have had some reason to suspect her con-
dition ;  and if only a suspicion existed in the mind of one Avho did
not contemplate the  destruction of her offspring, there ivould as-
suredly  be many  circumstances  forthcoming Avhich  Avould at once
establish her innocence.  If this remark applies to married women,
it applies with still greater force to those Avho are unmarried, since
the fact of illicit connection, and the fear of its consequences, must
render them peculiarly alive to all those changes which, by common
repute, take place in the female system during pregnancy.
  Post-mortem parturition.—Several  instances  of this kind  have
been recorded (" Aled. Press," Oct. 9,1872), and they have all  arisen
from the same cause—the extrusion of the foetus from the relaxed
uterus, as a result of the accumulation of the gases of putrefaction.
Post-mortem parturition formerly gave rise  to many superstitious
notions, but the facts connected with this  condition, are iioav fully
understood.  (See "Lancet," 1872, 1, 596.)   If the  body is  not in
a decomposed state, it is unusual to find  the uterus retaining  the
power of expelling  the foetus  by its oavii  muscular contractions
after the death of the Avoman.  It is obvious that in certain cases
this condition might be  used to cover and conceal a case of criminal
abortion.  The subject has been lately brought before the Aledico-
Legal  Society of Paris  by my friend  Dr. Louis  Penard. ("Ann.
d'Hyg.,"  1873, 1, 213.)  He  Avas required to report on  an alleged
case of  delivery7 thirty-six hours after the deatli of the  Avoman, in
Avhich the question of expulsion by gaseous putrefaction could not
arise.   In July, 1872, a young Avoman died under  suspicious  cir-
cumstances, after  eight  days' illness.  It Avas only just  before  her
death that the medical man  in attendance discovered that she Avas
pregnant, and had probably  reached the fifth month.  He made no
examination after death,  and Avhen the body Avas  laid out there
Avas no unusual appearance.   When raised to be placed in a coffin
thirty-six hours after  death, a foetus fell from  betAveen the legs of
the Avoman.   On examining the  body the uterus Avas  found Avith
the placenta attached, inverted and extended from the outlet.  Dr.
Penard, after fully considering the case as submitted to him, came
to the  conclusion that after the  death of the Avoman, the  uterus
Avould not retain the  power of expelling  the foetus, and inverting
itself by spontaneous  muscular contraction.  No doubt there are 
            PROOFS OF DELIVERY IN  THE DEAD.        515

great difficulties in admitting  that a spontaneous  action  of the
uterus after the death of the Avoman should be so powerful as not
merely to expel the foetus and  placenta, but actually to invert or
cause  prolapsus of the organ ; still the occurrence of such cases
rests upon good authority.   (See " Obstetric Transactions," 1873, p.
255.)  In these rare instances, it is probable that the women had
reached  the  full term, and parturition might  have commenced
before death.  In the case related by Dr. Penard, the woman had
only reached the fifth month, and  at  this stage of pregnancy it is
improbable that the post-mortem contractions of the uterus, Avithout
any assignable cause, would have operated to expel the child and
invert the organ.   It  is more reasonable to suppose that in this
case there  had been  criminal  interference.  ("Lancet," 1872,1,
517, 596, and 2, 119.)   The subject of post-mortem parturition has
been lately brought before the Obstetric  Society by Dr. Aveling
("Obstet, Transactions," 1873,  14, 240), and be has here reported
thirty cases of this kind.  The principal conclusions at Avhich he
has arrived are that the uterus  may expel  its contents after death
save in cases in which no symptoms of natural parturition  can be
discovered before death.  He also  considers that expulsion of the
placenta, spontaneous evolution of the foetus, and prolapsus, inver-
sion and rupture of the uterus, may equally take place post-mortem.
He refers these effects either to a contracting poAver remaining in
the uterus after the death of the rest of the body, or to the pressure
exerted on the uterus  by the gases of putrefaction, the latter being
the more frequent cause.  His cases have also led him to a conclu-
sion having an important bearing on the medico-legal  relations of
this subject—that after the death of the Avoman, a child may con-
tinue to live in the uterus for many hours, but when a Avoman dies
undelivered, no time should be lost in removing the foetus.   (Op.
cit. p. 255.)

  Signs of delivery in the deeid body.—It Avill noAv be proper  to  ex-
amine the signs of delivery which are derivable from an examination
of the body of a woman after death.   Occasionally we may  obtain
some history of the case during life, by  Avhich our labor will be much
facilitated; but, on the other hand, every fact may be studiously
concealed from us, and then  we may be required to prove not only
the delivery but the previous pregnancy.   These investigations rela-
tive to pregnancy and delivery in the  dead body are almost  exclu-
sively confined to cases of criminal abortion, Avhere the contents of
the uterus have been  expelled at the sacrifice of the life of the
woman.   Death commonly ensues in these cases within two or three
days after delivery, and then satisfactory proofs are obtainable by7 a
post-mortem examination ; but if the woman has survived three or
four weeks, it Avill  be as difficult to determine delivery in the dead
as in the living subject.   This remark applies to delivery  at the full
period; for if the  uterus have expelled its contents  in the first
months of pregnancy, the traces of this expulsion will have gene-
rally disappeared in the course of a few days. 
516   MEDICAL PROOFS OF  DELIVERY  IN THE  DEAD  BODY.

  The following  may be taken as the chief appearances Avhen the
body of a woman is examined soon after delivery at the full period.
The uterus is like a large flattened pouch from nine to twelve inches
long, its mouth being wide open.  The cavity contains coagula of
blood, or a sanguineous fluid ; and its surface is covered with the
remains  of a decidua—the outermost membrane of  the embryo or
foetus.  In the part  to Avhich the placenta has  been attached, the
substance of the organ  appears  exposed, presenting several large
semilunar, or valvular openings.   This portion  of the uterus  has
been found of a very7 dark color, which has given rise to a suspicion
that the organ was  gangrenous.  > The vessels are extremely large
and numerous.  The  Fallopian tubes, round ligaments, and ovaria
are so vascular (full of blood) that they have a  purple color.  The
spot Avhence the ovum has escaped is more  congested than the rest
of the ovarian surface.  Obstetric writers differ greatly in their
statements 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 women than in
others, and partly, perhaps, by the circumstance of the birth having
been, in  some instances,  premature.   Dr. Afontgomery states that,
after delivery at the full period, and under perfect contraction of the
uterus, if the body be  examined  within a  day or t\vo, the  uterus
will be found seven inches long and four broad.   Its substance, on
making a section, will be from an  inch to an  inch and a half in
thickness, and  will present the orifices of a  great number of large
vessels.  At the encl of a week, the uterus is betAveen five and  six
inches, and at the end of a fortnight, about five inches in length;
the density of its structure has, during this period, increased, and its
substance has considerably diminished.  The  inner surface  is still
bloody, and covered partially with a pulpy membrane resembling
the decidua.   The orbicular  direction of  the  fibres around the
internal  orifices of the Fallopian tubes is, at this time, very distinct.
In about a month, the uterus will  have become fully contracted;
but the mouth rarely, if  ever, closes so completely as in the virgin
state.
  In  a case examined by Dr. Barnes, in which a primipara, aged
26, died  from puerperal fever, on the  sixth day after delivery,  the
following appearances were  met Avith in the uterus: The internal
surface was blackened and  congested, especially in  those parts to
AAdiich the placenta had been attached.  There Avas the appearance
of suppurative action in this  part,  The substance  of the  uterus
Avas healthy ; there Avas no pus in the sinuses.  The os uteri showed
considerable  ecchymosis.  The  vagina  Avas  healthy;  the iliac
veins contained nothing  but loosely coagulated  blood.  There Avas
in the left ovary7 a small  well-marked corpus luteum, having a cen-
tral cavity.  (" Aled. Gaz.," vol. 41, p. 294.)  This condition of the
uterus must not  be  confounded  Avith the appearances which  are
observed when death takes  place during menstruation.  Dr. Judee
found in the bodies of three Avomen Avho had died during menstru-
ation, that the uterus Avas  somewhat  enlarged—its  Avails being 
            EVIDENCE FROM CORPORA LUTEA. '         517

thickened and its interior lined by a reddish gelatinous layer about
TV2tIi of an  inch thick consisting of a capillary netAvork of vessels,
inclosed in a mucous-like membrane.  AVhen this was removed, the
uterus beloAv Avas found to be Avhite and firm.   The  interior of the
neck was of a grayish color; the lips Avere swollen, of a dull-red,
bluish, or even black color.  On  compressing this part, small drops
of blood issued.  This Avas not observed either in the neck or boclv
of the vagina.  A  section of the uterus presented only the normal
fibrous tissue ; but at the level of the mouth (os uteri), there Avas a
mass of tissue resembling a portion of apoplectic lung.  The blood
during menstruation, according  to  this gentleman,  issues entirely
from the highly congested mouth of the uterus.  (" Gaz. des Hop'i-
taux," Xo. 39, and "Aled. Times and Gaz.," June 23,1855.)   An
ecchymosed condition of the neck of the uterus  is very commonly
found  as  the  result of an easy labor, and  therefore forms a good
guide  Avhere present.  This point must  be borne in mind in refe-
rence to criminal abortion, inasmuch as the neck has the appearance
as if violence had been employed.
  From the statement of appearances given above,  it will be seen
that there must be  considerable difficulty in determining the period
prior to death at Avhich  delh7ery took place.  The difficulty is in-
creased when a woman has been  prematurely delivered, or when
deatli  has not taken place until some time after delivery.  A medi-
cal opinion may be then in some degree strengthened by searching
for those signs Avhich have been described as  characteristic of  de-
livery in  the living.  These, if present, Avill ahvays furnish  strong
corroborative evidence, not only  of the fact of delivery, but of  the
period at Avhich it  had probably  occurred.
  Corpora lute a.—The condition of the ovaries has been considered
to furnish strong evidence, not so much of delivery  as of previous
pregnancy.   These organs, as it  has been  already stated, Avhen ex-
amined soon after delivery are found of a deep purple color, owing
to their extreme  vascularity.   If the woman has really  been preg-
nant, Ave may expect to  find, on  one of the ovaries, the appearance
which is denominated a corpus luteum.   The accounts given by ob-
stetric writers of the characters of corpora lutea, and the evidence
which they are capable of furnishing in  legal medicine, are very
conflicting.  According to Dr.  Afontgomery, in a true corpus luteum
(i. e., of pregnancy), the ovary presents a protuberance Avith a  dis-
tinct cicatrix on  the part Avhence the ovum has escaped.   The pro-
tuberant portion will be  found  on section to have an  oval form,  and
to be of a dull yellow color—hence the name corpus luteum.  It is
full of blood, and in texture resembles the section of a kidney.   It
is of its greatest size in the early stage of pregnancy, and gradually
diminishes as  gestation advances.  In the centre  of this section
there may be either  a cavity or a radiated Avhite cicatrix (scar), ac-
cording to the period at Avhich the examination is made.  The cavity
remains for about three or four months after conception, and is  sur-
rounded by a strong white cyst:  as gestation advances, the opposite
sides approximate,  and a radiated white cicatrix  results.  The  size 
518
FALSE  CORPORA  LUTEA.
and vascularity of the corpus  luteum are considerably diminished
by the time gestation is completed, and in about five or six months
afterwards—i.e., fourteen months after its first formation—it dis-
appears altogether  from the ovary; so  that the corpus luteum of
one conception is not found with that  of another, unless a prema-
ture expulsion of the contents of the uterus has taken place.   (" Cyc.
Pr. Aled. Pregnancy," p. 496 ; see also " Edinburgh  Monthly Jour-
nal," Jan. 1845, p. 58.)   The presence of  a  corpus luteum, as it is
here described, does not prove that a woman has borne a child.  In
the opinion of some obstetric authorities, it  establishes that concep-
tion has taken place ; but the embryo may have been converted into
a mole or a blighted foetus, and  expelled at an early period.
  It Avas formerly supposed that one true corpus luteum only was
met Avith in pregnancy Avith one  child ; but among other facts which
shoAv that such an inference is erroneous, is a singular case reported
by Dr. Renaud to the Afanchester Pathological Society.   He ex-
amined the body of a woman who died in  the seventh month of her
pregnancy, and from whose uterus he  extracted  a foetus.  There
Avere no traces of a blighted ovum.  The ovary, however, presented
two distinct and well-marked corpora lutea.  ("Med. Gaz.," vol. 39,
p. 599.)  Had the ovary alone been .examined, it might have been
supposed that this female had had twins.
  The  corpus  luteum is of its greatest  size in  the early stage of
pregnancy, and gradually diminishes as gestation advances.  From
the third month to the  full term it has a dingy yellow color  on
section.
  According to Dr. Paterson, the false corpora lutea, or those which
are produced irrespective of pregnancy, may be  distinguished  from
the true, by the following signs: The false bodies have in general
an  irregular  form,  and Avant  either a central cavity lined with a
distinct membrane, or & puckered  cicatrix: they have no concentric
radii, and  are frequently numerous  on both ovaries.  Dr. Rams-
botham agrees Avith Drs. Montgomery7 and Paterson in considering
that the true corpus luteum—i. e., that derived  from  conception-
is known either by its having a central cavity, sometimes unoccupied,
at others filled Avith the blood Avhich was effused at the time that
the coats  gave Avay, or, if it should be of more  ancient date, by its
presenting stelliform  radiated white lines (a puckered cicatrix), re-
sulting from the closi ng of this cavity. (" Obstetric Aledicine," p. 49.)
  In opposition to these vieAvs Dr. Knox, an experienced anatomist,
asserts that there is- no distinctive character whereby what is called
the true can be distinguished 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, independently of
intercourse; and the  time of their disappearance  from the ovary
varies from three months to an  almost  indefinite  period.  ("Aled.
Gaz.,"  Dec. 22, 1843.)   That there is considerable difficulty in dis-
tinguishing true from false corpora lutea, is proved by reference to
a case reported in the " Aledical Gazette," (vol. 34, p. 623), in Avhich
tAvo experienced observers differed.  Dr. Lee thought  that a prepa- 
             FORMATION OF CORPORA LUTEA.          519

ration Avhich was the subject  of examination was  not a corpus lu-
teum, while Mr. AVharton Jones thought that it was—founding
his  decision on  a  microscopical examination.   This difference of
opinion  shows that a distinction is by no means so simple a matter
as some writers assert.   Air. AV. Jones  agrees Avith Dr.  Knox in
considering that a corpus  luteum may occur in the ovaries  inde-
pendently of intercourse, and that the existence of one in this organ
Avould therefore afford  no proof Avhatever of intercourse  having
taken place.  The  discovery of the ovum in the uterus, in process of
development, eould  alone, in the present state of  our knowledge,'
warrant an affirmative opinion on this point in a court of laAV; and
this I believe to be the safest vieAv of this much-contested question.
On  the other hand, the absence of a corpus luteum from the 0A7ary
would not in all cases warrant an opinion that conception had not
taken place.
  The researches of Professor Bisehoff (" Med. Gaz.," vol. 35, p. 443,
et seq.) have shown that the production of a corpus luteum is by no
means necessarily  connected with conception.   The ova undergo a
periodical maturation, about the time of menstruation, and escape
from the ovary or are extruded Avhether there be conception or not;
hence fecundation is more likely to  occur when intercourse is had
about this period.   This is also the  opinion of Raciborski; indeed
some  physiologists regard menstruation as the alternative  of con-
ception (" Dub. Quart. Journ.," Alay 1846, p. 426), and consider that
there is no period so favorable to conception as that which immedi-
ately follows the cessation of the menses.
  The late Drs. Baly and Kirkes, Avho investigated the subject of
true and false corpora lutea, concluded from their researches, that
cases seldom  occur in Avhich the mere presence of a corpus  luteum
can be taken  as a  proof  of previous   impregnation; and  they con-
sider the following rules to be deducible from the facts Avhich they
have collected:  1. A corpus  luteum in its early stage (that  is, a
large vesicle filled  Avith coagulated blood, having a ruptured orifice,
and a thin layer of yellow matter within its walls) affords no proof
of impregnation having  taken  place.  2. From the presence of a
corpus  luteum, the opening of Avhich is closed, and the cavity re-
duced or obliterated  (only a stellate cicatrix remaining), no conclu-
sion as to pregnancy having existed can be draAvn, if the corpus
luteum be of small size, and  does not  contain so much yelloAv sub-
stance as Avould form a mass the size of a small pea.  3. A similar
corpus luteum  of  larger size  than a common pea, Avould furnish
strong presumptive  evidence, not only of impregnation having taken
place, but of pregnancy having existed during several  weeks at
least; and the evidence  Avould approximate more and more to com-
plete proof, in  proportion as  the  size  of  the  corpus luteum  Avas
greater.   (Op. cit. p.  57.)
  From  this  statement,  it will be perceived that  the difference is
only relative and arbitrary, chiefly depending on the size :  and as in
pregnancy, corpora lutea are found of variable size, Avhile in men-
struation tliey may,  under great excitement, attain a large  size, it 
 520      CHARACTERS  OF THE  OVUM OR EMBRYO.

 is obvious that no safe inference can be drawn from their presence,
 irrespective of other signs of impregnation.  The terms true and
fcdse, therefore, are inappropriate; and  serious mistakes may arise
 by a reception of evidence on this point.  The Law requires absolute
 certainty, not merely probability or presumption; and, in the pre-
 sent stage of physiology, the proof falls short of that Avhich is neces-
 sary to guide the verdict  of a jury.  At a trial for attempted  abor-
 tion, Reg. v. Goodcdl (Notts Lent Assizes, 1846), on examining the
 body of a Avoman on Avhom the attempt  had been  made, it Avas
 alleged that she was not pregnant: but on inspecting  the  ovary, a
 corpus  luteum was there  discovered.  This was  described as false,
 apparently because there Avas no other proof of impregnation.  Had
 an embryo or its membranes been found in the uterus, or had there
 been some proof of their expulsion, it would probably have  been
 described as true.   Dr. Aleigs, an experienced Avriter, says that cor-
 pora lutea may vary in size, but in all cases  they are real.  Physi-
 ologically speaking, they  do  not admit of a division into true and
 false.  (" Females "and their  Diseases,"  1818, p. 43 ; see "Ed. Alon.
 Jour.," Oct. 1851,  p. 305.)
   From these considerations, therefore, it appears to  me that the
 only conclusion  to which Ave can come  is, that medical evidence
 respecting the nature of a corpus luteum, in an unknown case, if
 received by a court of law at all, should be received with the greatest
 caution, and only from a Avitness of great experience.   The old doc-
 trine on this subject, that the presence of such a body on the ovary
 affords certain and undeniable  evidence  of  impregnation, may be
 regarded as completely subverted.
   Characters of the ovum or embryo to the sixth month.—Hitherto the
 examination has been  confined to  the Avoman, but it is now neces-
 sary to describe  the characters of  the ovum or embryo and its
 enveloping membranes at  the early stages of pregnancy, since, Avhen
 this can be procured, it may furnish good medical evidence.  The
 " ovum" signifies  the  embryo and  its membranous  coverings; the
 " embryo" is the body Avhich is afterwards converted into the foetus ;
 the term " foetus"  is applied to the embryo after the third or fourth
 month of gestation. If the ovum be expelled within a month  after
 conception, it is scarcely possible to detect it, OAving to its small size,
 and its being enveloped in coagula of blood.   Burns examined three
 uteri within the first month, where no expulsion had  taken place,
 but even under these favorable circumstances he failed in discovering
 the ovum.  At first, the  ovum contains no visible  embryo, but it
 appears to consist  merely  of vesicular membranous coverings.   Ac-
 cording  to this authority, when first  distinctly seen  through  its
 membranes, it is of an  oblong form, and about a line (the twelfth of
 an inch) in length.  At the sixth week,  it is slightly curved, resem-
 bling as it floats, a split pea.  In the seventh week, it is equal in size
 to a small bee; and by the end of the  second  month, it  is bent, and
 as long as a kidney bean.  After the second month, development
 goes on rapidly ; the features are in part Avell marked, and the limbs
 are gradually  Avell  formed.   At the third month, the foetus weighs 
         DEVELOPMENT OF THE EMBRYO — MOLES.      521

from one to tw7o ounces; Avhen stretched out, it measures about three
inches, and the genital organs, although the sex is not then distin-
guishable, are  large in proportion to the  rest of the body.  The
membranes are larger than a goose's egg.  At the fourth month, the
foetus is from five to six inches long, and weighs from two to three
ounces: at the fifth month, it measures from six to seven inches, and
weighs from five to seven ounces ; and at the sixth month, its length
is from eight to ten inches, and its Aveight about a pound.   (For the
characters of  the child beyond this period,  see " Infanticide.")
The great difficulty will consist in determining the nature of the
supposed ovum or embryo betAveen the second and third month.  In
making the examination, it should be placed inAvater, and all coagula
gently Avashed aAvay from the membranous coverings, or removed by
some blunt instrument.   Alcohol  may be  used as a substitute for
water,  after the blood has been removed.  If the embryo cannot be
found,  the decidua and chorion, or portions of them, may be recog-
nized ;  the former, by its  forming the  outer investment Avith  its
smooth internal and rough external or uterine surface ; the latter, by
the villous or shaggy appearance of that portion of it Avhich should
have become the placenta.  BetAveen the third and fourth month, the
fetus may be commonly identified Avithout  much difficulty.  The
ovum in  many instances escapes first, leaving the decidua behind.
This comes aAvay after a time, but it is important to remember that
in some states  of the virgin, decidua-like structures are thrown off
from the  uterine mucous membrane, Avhich, Avhen  examined by the
microscope, resemble the true decidua.  Both are constituted of the
innermost portion of the uterine mucous membrane, and contain all
its elements.
  Jllotcs.—The true mole is the result of conception, the foetus of
which has died in consequence of the effusion of blood into the decidua
and the various membranes, and, should a  placenta exist, into  its
structure.  The sac of the  amnion has frequently burst, and the
ovum has escaped, or it has died and  been  dissolved by the liquor
amnii or serous liquid, which is found turbid.  The remains of the
umbilical cord are frequently found on the  interior of the amnial
sac.  Nodules  are found projecting into the cavity, which are pro-
duced  by the effusion of blood outside the sac.   Sometimes the
cavity is almost obliterated, the main bulk being made up of effused
bloocl.  In the ATarieties of  moles it is not difficult to recognize all
the membranes ;  the microscope Avill al\vays enable the examiner to
detect the chorion villi.  Such a mole, of course, proves conception;
but solid  bodies are expelled from  the uterus Avhich have  not this
origin,  and may occur in the virgin : these are called false motes.
A clot  of bloocl may become dense, and, losing some of its coloring
matter, exhibit appearances Avhich cannot  be  distinguished  from
the true mole except by the microscope.  Polypi may also resemble
a mole ; but a  careful examination Avould readily shoAV the absence
of  ovular membranous structures.  Sometimes a  large exfoliation
of  the vaginal epithelium may take place, and before its expulsion
become condensed, so as to cause suspicion.  The microscope will, 
522         vesicular moles of  the uterus.
however, shoAV that it consists of only tessellated, epithelium.  Moles
may coexist with true pregnancy, in a case of tAvins.  The symptoms
accompanying a mole resemble those of pregnancy;  and the appear-
ances produced by its expulsion are not to be distinguished from those
attending the abortion of a foetus at  an early period of gestation.
The only means of distinction would  be derived from an examina-
tion of the expelled matters.  The  local injury produced  by the
expulsion of these bodies  on the  organs  of generation is by no
means as great  as that  caused by delivery at the full period.
   Vesicular mole (Hydatiniform degeneration of the chorion).—When
by some accident the foetus dies  at any time before the complete
formation  of  the placenta,  the  villi of  the chorion, instead of
completely dying, retain a  certain  amount of  vital  force; the
consequence of Avhich is  that in some parts  growth goes on imper-
fectly, serous fluid is effused Avithin, and the part is distended into
a globular form.  This, occurring frequently in the course of each
villus, gives it a beaded appearance, and the Avhole mass appears some-
thing like a bunch of grapes. The size, however, of each vesicular body
varies much in different  specimens, and also in different portions of
the same specimen, some being only detectable by the microscope,
while others are as large as the largest grape.  On the largest kinds
are generally to be found small villi, undergoing  more or  less the
same process of change.
  Thus it Avill be observed that the vesicular groAvths are attached
one to another by delicate threads—the  unchanged stem  of the
villus.  This will readily serve  to  distinguish  them from  true
hydatids  (Dr. Graily  Hewitt, " Obstetric  Transactions," vol. 1, p.
249), concerning  the distinction  between Avhich much confusion
has existed, and questions have arisen as  to Avhether the vesicular
mole can  exist, or be produced iu the virgin.  From Avhat has just
been sIioavii, it Avill be  perceived that this latter cannot arise except
as a result of impregnation.   It is exceedingly rare to find  true
hydatids in the uterus at all, still more so for them to be discharged
through the cavity of  the uterus.  Dr. Hicks informs me that no
authentic account of such  a case is on record.   But even if  it Avere
not so, the slightest  examination  by  the unaided  eye Avould show
Avhether the vesicles were attached to each other as above mentioned,
or Avhether the smaller were inclosed Avithin the  larger cysts, or
floating Avithout any attachment Avhatever.   The  use of the term
" hydatid" does much to perpetuate  the  error.  How long this
vesicular  mole  may remain in utero is uncertain ;  accurate infor-
mation is required on  this point.  Certainly it  may remain more
than a year, and  possibly many years.  The rapidity Avith Avhich
they grow is very great, but this is  readily explained by the fact
that it is a simultaneous enlargement of myriads of parts. A
Avoman at the third month of pregnancy may be as large as at the
seventh month ; she may ultimately attain a size exceeding  that
of the full term.   Cases of twin-conception are  not uncommon, in
Avhich one ovum  becomes vesicular, the  other  going  on  towards
maturity.   (Dr.  Hall Davis, " Obstetric  Transactions," vol. 3,  p. 
      mistakes from  the condition  of  uterus.    523

177.)  Again, one ovum may become vesicular, Avhile  the other is
converted into a fleshy mole.  In some rare cases, a portion only of
the chorion is changed into this form of  mole, Avhile the proper
formation of the placenta may go on in the normal manner.
  The question here arises—Can the mature  placenta be so con-
verted?  Should a portion be left behind in a healthy state, can it
assume the vesicular degeneration ?  From all  that is at present
knoAvn, this is exceedingly improbable ; from observations made of
late years, it appears that the change only takes place in the chorion
villi before the formation of  a placenta.  It is much more probable
that, should a Avoman have  no intercourse after labor, but  yet
expel a true vesicular mole, that it was  a tAvin ovum which was
not expelled  during labor.   In an early stage of  pregnancy, a
decidual covering will  always be found, more  or less complete,
around the mole; but  if the size  of  the mass is great, then,
although present, it will be less observable, being spread over a
larger surface.  A corpus luteum will  also be found, but  not so
perfectly formed as in normal pregnancy.
  The  ordinary  symptoms  of  pregnancy  accompany this  state,
although in all forms of mole-pregnancy it is imperfectly marked,
or only proceeds  to a certain point.  (See case " Obstetric Record,"
vol. 1, p. 21.)   It is also to be remembered that  the effects of the
expulsion of a mole are very similar to  those of abortion.  These
facts may have an important bearing on  medico-legal practice, and
in this respect the following  case, reported by the  late Dr. Chowne
to the Westminster Aledical  Society,  November, 1844, Avill  be
found of interest: A  woman  was seized with pains resembling
those of labor, and a mass of uterine hydatids was expelled, Avhich
was supposed to have been in the uterus  about five months. AVhen
the Avoman  was examined about thirty-six hours afterwards, there
were all the signs of recent delivery about her.  The parts of gene-
ration presented the usual appearances met Avith in the  expulsion
of a foetus:  the  breasts  Avere  enlarged, the  arolee  elevated, of a
brown color, the  follicles prominent, and the organs evidently con-
taining milk.  The occurrence of this  case  led  Dr. Chowne  to
think that, bad the body of  an infant been found Avith  marks of
violence upon it, concealed in the house Avhere this woman had
lived, it Avould probably have  been pronounced to have been her
child.   A medical man might  have strengthened  the suspicion of
criminality by declaring that there Avere  all  the  signs of recent
delivery about her.  It may be observed, hoAvever, that in such a
case the Avoman would probably have statetl that no child, but some
tumor, had come aAvay from  her; and a medical man Avould not be
justified in swearing that appearances of delivery absolutely indi-
cated, under all  circumstances, that  a Avoman must  have been de-
livered of a child.   On the  contrary, it is a well-known  medical
fact, that similar appearances may arise  from the expulsion of  the
various forms of mole.   (See a case  of Air. Pearson's, " Aledical
Times," Dec. 30, 1848.)  Circumstantial evidence would be against
her only on the assumption that some person had wilfully concealed 
524
concealment  of birth.
or made aAA7ay  Avith substantial proofs of  her innocence, i.  e.,
the mass Avhich had been expelled.   Dr. Fischer met with a case in
which a woman gaA7e birth secretly to a child, Avhose death led  to
a charge of child-murder against her, and  t\vo months afterwards
she passed a mole or blighted  foetus, in reference to which a ques-
tion  of  superfcetation  was raised.   (Horn's "Vierteljahrschrift,"
1866, 2, 22.)
  Concealment  of birth.—Aledical evidence respecting  delivery is
required  in  tAvo cases:  1st, Avhen  the birth  of a child is wilfully
concealed ; and 2dly, Avhen the contents of the uterus have been
prematurely expelled by criminal  means.  The concealment  of
pregnancy is no offence in the English laAV; but the concealment
of delivery or of the birth of a child is a misdemeanor, by the 24 & 25
Vic. c. 100, sec. 60, the words of Avhich are to the following effect:
" If any woman shall be delivered of a child,  every person w7ho shall
by any secret disposition of the dead body of the said  child, whether
such child died before, at, or after its birth, endeavor to conceal the
birth thereof, shall  be guilty of a misdemeanor, and  being con-
victed thereof  shall be  liable  at the discretion of the court to be
imprisoned for  any  term not exceeding tAvo years, with or Avithout
hard labor."  A proviso is added to the effect, that any person tried
for the murder of any child, and acquitted thereof,  may be found
guilty of concealment of birth, if it shall  appear in evidence that
the child had recently been born, and that such person did by some
secret disposition of the dead  body  endeavor to  conceal the birth.
Various  interpretations haA7e  been  put upon the terms "conceal-
ment" or " secret disposition of the body."  This part of the evi-
dence does not affect a medical Avitness, unless he himself has found
the dead body or wras present Avhen it Avas found.  It will rest Avith
the judge to determine whether the body  has been  so  disposed of
as to constitute legally a misdemeanor.   (Reg. v. Clarke, Chelms-
ford Summer Assizes, 1864.)
  This is an offence of which women charged Avith child-murder
are commonly convicted in England; Avhile the Scotch laAV punishes
women for the concealment of pregnancy  if the child  be dead or
missing.  (Alison's " Criminal  LaAV," p. 153.)  The medical evidence
on trials for this misdemeanor is  exclusively derived from an ex-
amination of the mother; and  thus, much will  depend upon the
time at which this is made.   AVith  respect to the child, its body
need not even be produced, provided there be satisfactory evidence
of its death ; the body7 may have been secretly buried or burnt, and
in the latter case it may be necessary to examine the ashes.
  According to the statute, the child must be dead—the conceal-
ment of  the birth of a living  child not being any offence, unless it
should happen to die  before  its birth Avas made knoAvn.  In the
case of  The Queen v. Woodman (Kingston  Lent Assizes, 1844), the
woman Avas acquitted because the child Avas living Avhen concealed.
Air. Chitty says, that in order to constitute  the offence, the child
must have advanced to the end of the seventh month (" Alecl. Jur.,"
p. 412);  but it  is to be presumed that the concealment of the birth 
concealment  of birth.
525
of a dead child at the sixth or under the seventh month, Avould be
as much an infringement of the statute as if it w7ere more advanced.
The concealment of the aborted but undeveloped ovum or embryo
—of a monster, i.  e., a child Avithout human shape, a mole or other
morbid growth—Avould not probably be considered a contravention
of the statute.  I am not aware that there  has been any judicial
decision on this point.   Air. Lane communicated to the "Aledical
Times" (Aug. 1845), a case in Avhich a charge  of concealed birth
was dismissed by the magistrates  of Surrey, because the conceal-
ment referred to a child born at the eighth month in its membranes.
The Avoman stated that she did not consider it to be a child I  If
this decision is correct, the  main object of the statute (i.  e., to  pre-
vent secret delivery, so often leading to murder) may be effectually
evaded.  The case, being entirely  neAv, should  have been sent for
trial, and the decision left to the proper interpreters of the laAV; a
magisterial decision can  furnish no precedent on a question of  this
kind.  This woman must have been delivered of a child, foetus, or
embryo, or  of  course there would  have been no pretence for  the
charge.  That a child  may be thus born and  removed  from  the
membranes alive is a fact established by experience.  Dr. Brunton
reported to the Obstetrical Society, a case in Avhich the entire ovum
was expelled at the seventh month of gestation, and the child  was
rescued alive, although born fifteen minutes before being taken  out
of the  membranes.   ("Aled.  Times and  Gaz.," 1871, 1, 412).   In
another  case of sudden  delivery, the child in its membranes with
the placenta were  discharged into a bucket.  It Avas not rescued in
time to save life.  (" Amer. Journ. Aled. Sci.," April, 1870, p. 430.)
  It is not material  here, as in the case of alleged  infanticide, to
prove when the child died—Avhether before, during, or after its
birth ; and thus those subtleties and technicalities Avhich are  met
with in cases of child-murder are aA7oidecl.  In  regard to proof of
concealment, and  what  constitutes it, these  are essentially legal
points; but a medical practitioner may sometimes benefit an accused
person, if he can  prove  that the woman had made application to
him on the subject of her pregnancy and delivery.  The laAV is espe-
cially  lenient  under such  circumstances.  Questions connected
with concealment of birth do not fall under the jurisdiction of
the coroner;  the  medical  evidence is therefore required  by  a
magistrate. 
526                 criminal abortion.
CRIMINAL  ABORTION.
                     CHAPTER  XLV.

ABORTION FROM NATURAL CAUSES.— CRIMINAL  CAUSES.— MECHANICAL
  MEANS.--MEDICINAL  SUBSTANCES.— SIGNS OF ABORTION.— SPECIFIC
  ABORTIVES.—LOCAL  APPLICATIONS.—FEIGNED ABORTION.—MEANING
  OF THE AVORD NOXIOUS AS APPLIED TO DRUGS.--ON INDUCING PREMA-
  TURE LABOR.—PROOF OF PREGNANCY NOT  NECESSARY.—ABORTION OF
  MONSTERS.—MOLES AND HYDATIDS.

  By abortion is commonly understood, in medicine, the expulsion
of the contents of the uterus before the sixth month of gestation.  If
the expulsion takes place betAveen the sixth  and ninth month, the
woman is said to have a premature labor. The law7 makes no dis-
tinction of this  kind, but  the  term abortion is applied to the ex-
pulsion of  the foetus at any period of pregnancy before  the term of
gestation is completed;  and in this  sense it is synonymous with
the popular  term  miscarriage.  Criminal  abortion  is rarely  at-
tempted before  the  third  month ;  it is perhaps most common
betAveen 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 laAV;  but a medical witness should
be Avell acquainted with the causes Avhich are called natural, in con-
tradistinction  to others Avhich depend on the application of violence.
These natural  causes are so frequent, that according to Air. ^White-
head's observation, of 2000 pregnancies, one in seven terminated in
abortion.   They are commonly ascribable to peculiarities in the
female system, to the presence of uterine or other diseases, or to
some  moral shock sustained by a Avoman during pregnancy.  Any
diseases which strongly  affect  the uterus, or general  system of a
woman, may give rise to abortion.  An attack of smallpox has been
known to produce it; and it has been suggested by Air. 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.," vol. 36, p. 164; Ramsbotham's " Obstetric Medicine,"
p. 655.)  These  facts  deserve attention, Avhen 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 Avhich may give rise 
           ABORTION BY  MECHANICAL  MEANS.         527

to abortion, the reader may consult the AA'ork of Afr. AVhitehead
(" On Abortion and Sterility," p. 252 ; also, for the effects of undue
laceration  and disease of the  placenta, in causing abortion, see
" Med. Times and Gaz.," Dec. 4, 1852, p. 580, and Alarch 19, 1853,
p. 302.) _ In considering the  operation of these causes, it is proper
to bear in mind that during pregnancy the uterus is subject to a
natural periodical  excitement, corresponding to what Avould have
been the menstrual period dating  from the last cessation.   Hence,
comparatively trivial causes  operating at these periods may lead to
an expulsion of the foetus.
  The violent causes of abortion may be of an accidental, or criminal
nature. In general, the distinction will not be difficult; the kind of
violence, and  the adequacy of the alleged cause to produce abortion
will be apparent from the evidence.  In reference to criminal cases,
the causes may be referred either, 1st, to the use of mechanical means,
or 2dly, of irritating medicinal substances acting upon the uterus, or
bowels.  They operate  Avith  greater certainty just in proportion as
the pregnancy is advanced.
  Mcclianical  means.—Among the  mechanical causes may be men-
tioned  severe  exercise, the violent agitation of  the  body, as by
riding or driving o\Ter a rough pavement,—in which case no marks
of violence Avould be apparent.  Any physical shock  sustained by
the body may operate indirectly on the uterus.  Violent pressure or
bloAvs on  the  abdomen are  sometimes  resorted to; but in these
cases the marks of violence will be commonly perceptible.   Instru-
ments have been devised for the purpose of piercing the.membranes,
destroying the child, and thereby leading to its expulsion.   Dever-
gie speaks of such instruments being Avell known in England, and
of English mid wives deriving  a  living  from the practice of this
crime.  (Op. cit. vol. 1, p. 285.)  Although  this must be regarded
as an  exaggerated statement, it cannot be denied that cases have
transpired Avhich show that the crime is frequently perpetrated by
persons avIio  basely derive a profit from  the practice; and  for one
ease that  comes to light, probably a dozen are effectually concealed.
In the evidence given on four trials Avithin a recent period, the case
presented no feature of novelty or  interest.  Instruments Avere em-
ployed, and drugs in large doses were  proved to have  been admin-
istered.
  Alechanical  means are undoubtedly more effectual in producing
abortion than medicinal substances; yet from the fact of such at-
tempts being made by ignorant persons, the Avoman generally dies
from inflammation of the Avomb, or peritoneum, or other serious
after-consequences.  A case  was tried  some years since, in which
the evidence shoAved that the  prisoner hail attempted to produce
abortion in the deceased by thrusting wooden skeAvers in the substance
of the uterus.   Inflammation and gangrene took  place, and  the
woman died.   The prisoner Avas convicted and executed for murder.
(For a similar case by Air. Al'Pherson,see"Med.Gaz."vol. 36, p. 102 ;
see also another case in the same journal, vol. 45, p. 693.) [See report
of a remarkable case of attempted criminal abortion, by Dr.  T. Gail- 
528  ABORTION FROM RUPTURE  OF  THE  MEMBRANES.

lard Thomas in "Am.  Jour. Aled. Sci.," April, 1873, in which the
woman introduced into  her oavii abdominal cavity an umbrella wire
16J inches long.  This  wire had  passed  through the vaginal wall
and escaped into the peritoneal cavity, traversing beloAv the intes-
tines just  over the large vessels on the spine, across the abdomen to
the liver,  then  glancing off from the right lobe  backwards to the
diaphragm,  which it penetrated, and then plunged into the right
lung for the distance of two inches.  The woman died of pneumo-
nia, on the  fifteenth day.—R.] This kind of  injury to the uterus
ahvays implies  the interference of some other  person in the perpe-
tration of the crime.  Mechanical means can seldom be applied to
the uterus without leaving marks of violence on  the organ, as well
as on the  body of the  child.  If the mother  should  die, a result
which generally takes place, an inspection will  at once settle the
point.  ("Ann.  d'Hyg."  1834,191; 1838, vol. 1, p. 425 ; 1839, vol. 2,
p. 109.)   An important  case of this kind Avas the subject of a crim-
inal trial  in Scotland in 1858 (case of Reid,  "Medical  Gazette,"
December 11, 1858).  The uterus  near  its mouth presented t\vo
openings  in its substance, described as punctured Avounds by the
medical witnesses for the prosecution, Avho made the examination—
and as the openings of torn bloodvessels by others, who Avere called
for the  defence.  There was  also  a rupture  of  one ovary.  The
prisoner was convicted ;  but  the medical man who Avas supposed to
have been the principal agent in the crime, committed suicide.  The
case is chiefly important as showing  that any apparent mechanical
injury to the uterus should be minutely examined, so that no doubt
of the cause may afterwards be entertained.   If, in a case of this
kind, the  mother survives and the child be expelled, then marks of
violence will be found on its body.  These marks may not be suffi-
cient to account for its death ;  but this is  not here the question.   If
it can be proved that they have not resulted from accidental causes
during gestation  or subsequently to delivery,  then their presence
may furnish 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 bleeding from the arm.
This effect may follow as a result of  shock produced by the loss of
blood.   An examination  of the  veins of the arms would show
Avhether any such attempt had been made.
   There can be no doubt that  of all the exciting causes of abortion,
the most effectual, and that Avhich most certainly brings on the ex-
pulsive action of the uterus,  is the destruction  of the ovum or em-
bryo. If by accident or design, the ovular membranes should become
ruptured,  gestation is arrested, and abortion necessarily ensues.  At
any period of pregnancy, therefore, a puncture through the mem-
branes will  sooner or  later occasion  the  eAracuation of the uterus.
(Ramsbotham's " Obstetric Aledicine," p. 655.)  This  auther re-
marks that the performance of the operation  demands a most ac-
curate knowledge of the anatomy  of the ovum  and the maternal
structures, as well as of  the state of deA7elopment which the neck of
the uterus assumes at different periods of pregnancy. 
     ABORTION FROM RUPTURE OF  THE MEMBRANES.   529

  In medical practice, for the induction of premature  labor, the
membranes are ruptured, either  by the use of a female catheter,
or by an instrument of this shape, but including a blade like a
tonsihlancet.   Unless  the inner membrane or amnion  be opened,
gestation may still proceed, and abortion will not take place. When
the membranes are completely penetrated, and  the Waters are dis-
charged, uterine action is invariably induced; but the time Avhich
elapses from the performance of the operation to the commencement
of labor, is subject  to great variation.  Dr. Ramsbotham states
that he  has known  the uterus begin to act in ten hours after the
rupture, but in another case a Aveek elapsed before its action  com-
menced.  As a general  rule, uterine action  is fully established in
fifty or sixty hours.   It must not be supposed, however, that where
a criminal intention exists, so long a period is required for remov-
ing the  contents of  the uterus.  The cases above  referred to  Avere
cases of  obstetric practice, in Avhich there was no desire to expose
the female  to the slightest  risk, and premature labor Avas openly
induced. In a criminal attempt by7 a medical practitioner, in Avhich
the Avoman would be a consenting party to the act, the removal of
the embryo or  foetus might  be effected in a much  shorter period of
time. At any rate, the time for the completion of abortion could not
be measured by cases in Avhich the  uterus has been left to undergo
spontaneous contraction after the membranes had been punctured,
and the  Avaters had escaped.   There Avould, however, be great clanger
to a Avornan in the necessary  manipulations  required.   The reader
will find reports, by  M. Tardieu, of numerous cases of abortion as a
result of mechanical means applied to  the uterus, in  " Annales
d'Hygiene," 1855, vol. 1, p.  406 ;  and some good practical remarks
by the same writer, on the mode  in Avhich these inquiries should be
conducted, in the "Annales  d'Hygiene," 1856, vol. 1, p. 141.
  It is  obvious  that this mode of perpetrating  abortion is  only
likely to succeed in the hands  of persons who have a  complete
anatomical  knowledge of the parts.   The  certain death of the
Avoman  will convert the crime to murder, Avhen instruments are
introduced  into her body by persons Avho are ignorant  of anatomy.
It is to be regretted that members of the  medical profession  have
on several occasions misused their professional knowledge, and  have
exposed  themselves to prosecutions for  this crime.  Sometimes, it
is probable  the charge has been raised falsely, or through misappre-
hension  on the part  of the Avoman ; at others, the  evidence has left
it very clear that the charge was Avell founded.  Of late years, medi-
cal men  have rather freely used the speculum.   When this instru
ment  has been improperly   or unnecessarily used on a  pregnant
woman,  a charge of attempted  abortion  by instruments may be
easily raised against a medical practitioner.  A trial took place at
the Exeter Lent Assizes, 1854 (Reg.  v. Griffin and Venn), in which it
was charged that the accused, Venn (a surgeon), had feloniously
used an  instrument  with the intent to procure the miscarriage of
the prosecutrix.  According to the evidence, Venn had on several
occasions passed a round polished instrument into the body of the
      34 
530
FROM  MEDICINAL SUBSTANCES.
woman, once in a coppice, and at another time  in a field.   The de-
fence was, that the surgeon had merely used a speculum to ascertain
Avhether the girl was  pregnant, in order to know how to prescribe
for her; and that it was"absurd to suppose that he had  ever in-
tended to procure abortion, for this had not followed, and it might
have been easily produced by him at any period of pregnancy if
the medical man had wished  it.   The  prisoners were acquitted.
Admitting the statements of the prosecutrix  and the prisoner to
be correct, it may be  remarked that medical practitioners, in the
lawful exercise of their profession, do not commonly use a speculum
in open fields or coppices to determine Avhether a female  is preg-
nant or not; and it  is a well-knoAvn fact that a speculum is not
required for determining the question of pregnancy at all.  This
case conveys a serious caution to members of the medical profession.

  Medicinal substances.—These are, perhaps,  more  frequently re-
sorted  to for inducing  criminal abortion than other means; but
they rarely ansAver the  intended purpose; and when this result is
obtained,  it is generally at the expense of the life of the woman.
Alineral poisons have been ignorantly employed for this nefarious
object—such as arsenic, corrosive  sublimate, sulphate of copper,
muriate of iron, and  metallic mercury7 (Reg. v. Wright, Abingdon
Autumn Assizes, 1855), and  other irritants.  Croton-oil, gamboge,
colocynth, aloes (Henke, " Zeitschrift," 1844, vol.  2, p. 203), hiera
picra (a mixture of aloes and canella), elaterium, and other drastic
purgatives, have also  been used for a similar purpose. Purgatives
which  produce much  straining, and powerful emetics or diuretics,
Avill readily excite  abortion in  the advanced stages of pregnancy;
but these violent medicines fail in their effect at the earlier stages.
A decoction of fern  or of broom-tops has been  sometimes used.
The decoction of broom acts as a strong diuretic.  The substances
just mentioned exert  an indirect action on the uterus by producing
a  shock to the general system.   But  there is a certain  class  of
bodies, called emmenagogues, Avhich have  a specific action on the
uterus itself.  Among  these, the ergot of rye, or  Secale  cornutum,
may be particularly noticed.  Other vegetable, animal and mineral
substances, which may  be enumerated as  having acquired popular
repute for procuring  abortion are  savin, cantharides (see  p. 192),
rue, iron filings, squills, grains of paradise (Reg. v. Rushforth, York
Autumn  Assizes, 1857), pennyroyal, black hellebore and tansy*
M. Tardieu relates  three cases in Avhich a strong  decoction of rue
produced  abortion at  the fourth, fifth, and beyond the sixth month
respectively,  and the Avoman recovered.   (" Ann. d'Hyg.,"  1855,
vol. 1, p. 403.)  Its operation as an  abortive was generally preceded
by  well-marked  nervous symptoms—e.  g. giddiness  and stupor,
depression of the action of the heart, with nausea and severe pain
in the  stomach.   (" Ann. d'Hyg.,"  1856, vol. 1, p. 135.)  In April,
1856, a medical  man Avas convicted before the Central Criminal
Court of Sydney, of administering  extract of  belladonna in a sup-
pository, with a  view7 to procure abortion.  In a  case Avhich oc- 
SPECIFIC  ABORTIVES — ERGOT.
531
curred  in  France, iodide of potassium Avas pronounced by three
medical men  to  be an abortive  (" Aled. Times and  Gazette," Jan.
29, 1859), but the grounds for this opinion are not gh7en.  Xone
of these substances have any influence  on the  uterus, except in
affecting it indirectly by their irritant action on the system.   In
the Coroners' return for 1837-8, there Avere four cases of the admin-
istration of savin and other drugs, with the view of procuring abor-
tion.  In three of these cases,the mother died undelivered; in the
fourth,the child  perished.

  Specific abortives. Ergot of rye, or  Secede cornutum.—This sub
stance has been found, in many instances, to bring on violent action
of the  uterus at an advanced stage of gestation, or Avhen efforts at
parturition had  already commenced.   There is, hoAvever, consider-
able difference of opinion respecting its alleged  specific  properties.
According to Dr. Lee, it has no eff'ect, at least in the early stages of
gestation, although given in very large doses.  ("Aled.  Gaz." vol.
25, p. 10 ;  see also " Edin.  Aled. and  Surg.  Journ."  A7ol. 53, p. 27.)
Dr. Kluge, of Berlin,  found that its properties varied according to
Avhether it Avas gathered before, or after harvest; in the former case
it had  an energetic action, Avhile in the latter, it  AA7as poAverless.
The properties of the  secale are  but little known to the vulgar in
this country ; and this may account for the fact of our rarely hear-
ing of cases in Avhich  it has been criminally administered  by mid-
whes to pregnant Avomen.  Dr.  Beatty states that when used in
obstetric practice, it is liable, by absorption into the system of the
mother, Avhich may take place Avithin tAvo hours, to endanger the
life of the child.   (" Dub. Aled.  Journ." Alay, 1844, p. 202.)  This
question Avas  actually referred by the French Government to the
Academy of  Aledicine in 1845, as there Avas reason  to think that,
under its employment in the practice of midwifery, children Avere
frequently born dead.   ("Ann. d'Hyg." 1846, vol.  1, p. 204; see
also " Aled. Gaz." vol. 46, p. 680.)  In confirmation of Dr. Beatty's
statement, Drs. Al'Clintock and Hardy report, that, out of thirty
cases in which it  was administered, twenty children Avere born dead.
("Practical Observations," p. 95.)  Dr. Ramsbotham considers that
the drug may operate  fatally on a child according  to the circum-
stances  under Avhich it is administered ; but that, unless it excites
the  expulsive action of the uterus, it has  no effect on  the child's
system.  (Op. cit. p. 319 ;  also cases by Air. Paterson, " Edin. Aled.
and Surg. Journ." vol. i>o, p. 142.)   According to  M.  Alillet, in
commenced, or imminent abortion, ergot procures a safe and prompt
termination ;  and he never met Avith a case in which it injured the
child.  ("Aled. Chir. Rev." July, 1835, p. 41.)
  On trial for criminal abortion, perpetrated or attempted, a medi-
cal Avitness must  be prepared for a close examination on the specific
emmenagogue properties of the  ergot of rye on the  uterus, as Avell
as its general action as a poison  on the woman and child.  A case,
which occurred a feAV  years since (Reg. v. Colder, Exeter Lent As-
sizes, 1844), has been  reported, with comments  on this subject, by 
532
SPECIFIC  ABORTIVES — ERGOT.
Dr. Shapter ("Prov. Aled. Journ.," April 10, 1844.) It was alleged
on this occasion, that savin, cantharides and ergot had been respec-
tively given by the prisoner, a medical man, for the purpose of pro-
curing miscarriage.  The prosecutrix was a woman of notoriously
bad character, and the prisoner Avas acquitted.  There were three
medical Avitnesses, Avho agreed that savin and cantharides were only
likely to occasion  abortion indirectly, i. e. by powerfully affecting
the system—the vieAv commonly entertained  by professional men.
Some difference of opinion existed with regard to ergot.  Dr. Shap-
ter stated, in his evidence, that he did not think  the ergot would
act unless the natural action of the uterus had already commenced
—a statement supported by a number of authorities. Subsequently
to the trial, he collected the observations of many obstetric Avriters,
and so far  modified his opinion as to admit that the ergot might
occasionally exert a specific action on the uterus, in oases of advanced
pregnancy, even when uterine  action had not already commenced.
His summary on this subject is one of the best which has been pub-
lished.  Dr.  Ramsbotham  has  reported three  cases from which it
Avould appear that the ergot may in some instances exert  a direct
action on the impregnated and  quiescent uterus.  In these instances,
the women were in or about the eighth month of pregnancy.  (" Aled.
Gaz.," vol. 14, p. 434.)  This observation has been fully confirmed
by further experience on the use of the drug.  (" Aled. Times and
Gaz.," Jan.  7, 1854, p. 8;  see also his " Obstetric Medicine and
Surgery," p. 198.)  Dr. J. H. Davis believes  that it is a  specific
excitant of uterine action, and  points out the cases in which, in his
opinion, it may be safely employed.   (" Lancet," Oct. 11,1845, p.
393.)  In one instance in which, owing to distortion  of  the pel-
vis, it was necessary to bring  on  labor six weeks before the full
period, Mr. Raynes found that  ergot in the form of  infusion in re-
peated doses excited the action of the uterus,  and delivery was
accomplished writhin fifty-eight hours of the taking of the first dose.
The uterus was in a quiescent  state before  the medicine was given
to the patient.   (" Med. Times  and Gaz.," March 14, 1857, p. 260.)
Air. Whitehead, who has had  considerable experience on this sub-
ject, has found that its action is very uncertain.  In a case under
his care, that of a woman with deformed pelvis, it Avas considered
advisable to procure abortion in the fifth month  of pregnancy; the
ergot alone was employed, and at first Avith the desired eff'ect. It Avas
given in three  successive pregnancies ; and in each instance labor-
pains came on after eight or ten doses had been administered, and
expulsion Avas effected by the end of the third day.  It Avas perseyer-
ingly tried in a fourth pregnancy in the same woman, and failed
completely.  ("On Abortion,"   p. 254.)   It also failed in a case in
the hands of Dr. Oldham.   (" Med.  Gaz.," vol. 44, p. 49.)  Never-
theless, the balance of evidence is decidedly in favor of its specific
action, as a direct uterine excitant; and according to Dr. Griffiths,
this is so Avell known to the inhabitants of the United States, that
it is there in frequent use as a popular abortive.   Perhaps the differ-
ences which have been observed in its action may have  depended 
ACTION OF  THE ERGOT OF RYE.
533
on the quality of the drug, as Avell as on the period at Avhich it was
administered.  Admitting that the  uterus is subject to periodical
excitement corresponding to the menstrual periods, it is probable
that the action of ergot may be more poAverfully abortive at these
than at other times.  In a case in which I Avas  consulted in 1860,
an attempt had been made to administer secretly the ethereal tinc-
ture of ergot.
  A case occurred  at Brighton, in October, 1864, in Avhich a ques-
tion arose respecting the fatal effects of this drug on a woman Avho
had taken it for a  long period, obviously Avith a view to procure
abortion.  She died, however, Avithout abortion having taken place ;
and the  question at issue Avas,  AA7hether this drug had, or had not,
caused her death.   The dose  taken Avas, I am  informed, about a
teaspoonful of the tincture of ergot three times a day, for a period
of eleven Aveeks.  On inspection, patches of inflammation were found
on the mucous membrane of the stomach after  death.   No other
cause for death Avas apparent, and one  medical Avitness assigned it
to the poisonous irritant action of the ergot, as, at the early stage
of pregnancy Avhich she had reached (the third  month), this sub-
stance Avould not be likely to act  as an abortive.  Another medical
gentleman Avho gave evidence at the inquest, asserted that death
could never be primarily caused byT ergot of rye.   The qualification
introduced into this medical opinion is of small importance.   The
deceased  Avoman is reported to  have taken a large quantity of the
tincture,  and it  is  immaterial  Avhether the drug killed her by a
primary or secondary operation.  Al. Tardieu describes the case of
a Avoman, set. 24, Avho aborted in the fourth month of pregnancy, as
a result  of the administration  of ergot in  poAvder;  she died from
peritonitis in  about tAventy-four hours.  The ergot Avas  found in
fragments in the loAver third  of the boAvels.  (" Ann.  d'Hyg.,"
1855, vol. 1, p. 404.)  At  the same time, this medical jurist states
that, in his opinion, ergot of rye has no direct action as an abortive.
("Ann. d'Hyg.," 1865, vol. 1, p. 139.)   In respect to its operation,
it may be observed that the effects produced  by  its administration
are not such as readily to excite  suspicion.   It does not cause the
decided symptoms of irritation  observed in the action of savin, nor
the nervous symptoms  Avhich  are  usually  produced by  rue.  In
medicinal doses,  given at  proper  intervals, the only  marked  effect
Avhich it produces on a pregnant Avoman is a loAvering of the pulse.
Sometimes other symptoms of  a  severe character have presented
themsehes.  ("Ann. d'Hyg.," 1856, vol. 1, p.  140.)  If a person
dies from  the effects of  the drug, the results are legally the  same
whether its  operation as a noxious  substance is of  a primary, or
secondary kind.
  Action of ergot.—In doses of from half a drachm to two drachms,
ergot in  poAvder has caused nausea, vomiting, dryness of the throat,
great thirst, aversion to  food, pain in the abdomen, slight purging,
pain  in the head, stupor, and dilatation of the pupils.   (Pereira,
"Alat. Aled.," vol. 2, pt. 1, p. 111.)  Paralysis is said to have been
observed among  the symptoms.  (See paper by Air. Wright, "  Edin. 
534
ACTION OF THE ERGOT  OF  RYE.
Aled. and Surg. Journ.," vol. 53, p. 14.) The meclicinaldose of the
powder, in uterine  diseases is from 5 to 15 grains.  It is employed
in a larger dose (from 20 to 60 grains at interA'als of half an hour)
to excite uterine  action  either  for abortion or parturition.  The
dose of the tincture is one drachm  (a  teaspoonful); this is con-
sidered to be equivalent to 20 grains of the poAvder.   The dose of
the ethereal tincture, according to Pereira, Avhen employed for the
purpose of exciting uterine action, is  one drachm every half hour
for three or four doses.   (Op. cit. p. 119.)  Ergot must be regarded
as a noxious substance,  and by some authorities it is ranked among
narcotico-irritant poisons.  It does not easily cause death in one
large dose, but its  fatal operation appears to  be  more strikingly
developed by its  long-continued use  in small  or  medicinal doses.
Its active properties are considered to be due to the presence of an
oil Avhich is  soluble in ether.   It  also contains a solid principle,
ergotin, which exerts a  poisonous action  on animals.  The reader
will find a large  collection of eases,  illustrating the properties of
this drug, in Wibmer  (" Arzneimittel und Gifte,"  vol. 2, p. 80—
Sphacelia segetum ;  see also Pereira, " Alat. Med." vol. 2, pt. 1,102).
  Analysis.—The form and characters of the ergot in mass are Avell
known to professional men.  In  the annexed illustrations, 1 repre-
sents the ergot of rye of its usual form and size.  The outer coat is
dark-colored, almost black, and it is more or less grooved or fluted
longitudinally, and pointed at each end.   It is brittle, and breaks

                             Fig. 57.
The Ergot of Rye.
w7ith  a spongy or soft rough fracture.   2  2 represent transA7erse
sections of the ergot of rye.  The outer coat here forms a dark out-
line with depressions.  The  substance is of a pale reddish-white
color.  If a  thin  slice is wetted Avith a Aveak solution of potash,
and is examined under a  low power of the microscope, the outer
dark coat gradually assumes a crimson or purple tint.  Small frag-
ments may be thus identified.  3 represents  a transverse section of
the ergot magnified thirty  diameters.  The sjxmgy character  of
this substance a Avith its  dark coat b, is here more distinctly de-
lineated.
  The poAvder of 'ergot evolves a faint  fishy odor, especially if 
SAVIN — OIL OF  SAVIN.
535
rubbed with a solution of potash, and the solution acquires a dingv-
red color.   In the form of tincture, alcoholic or ethereal, one test
is the peculiar odor of the extract AA7hen treated with potash.  This
may, hoAvever, be concealed  by other odors.  Sometimes  small
particles of ergot, presenting a pink-red color and a dark external
coat, may  be detected in the sediment by the microscope.  AVhen
ergot has  been taken in  poAvder, fragments of it  may  be  found
scattered over the lining-membrane  of the stomach  or  bowels ;
these may be identified by the characters described.   The ethereal
tincture evaporated to  an extract,  leaves an oily-looking residue,
Avhich, when treated Avith a solution of potash, acquires a light or
pinkish-red color.
  Savin.   Oil of savin.—This vegetable substance  possesses great
popular repute as an  aborth7e.  In  a case Avhich I Avas required to
investigate in 1845, it Avas a question Avhether savin, Avhich  had
been taken in  the state of poAvdered  leaves, and had caused  the
death of a Avoman, exerted  any specific action on  the  uterus to
induce  labor.  The reply Avas  given, that  in large  doses it  acted
only indirectly as an  abortive  by irritant  properties.   See " Aled.
Gaz.,"  vol. 36, p. 646.)  It is proper to remember that the infusion
is more.poAverful than the decoction;  since  the  poison, being  a
volatile oil,  is dissipated by long  boiling.  Savin is,  b.OAAre\7er,
commonly taken or administered in the form of poAvdered leaves.
The irritant action of this powder  has been elseAvhere  considered
(p. 187).   Any portion of the leaves  dried  and  rubbed will emit
the peculiar odor of savin, by Avhich it may be identified.  Unless
some traces  of the leaves are found in the  sediment, there are no
tests for detecting the decoction or infusion.   For the microscopical
appearance of the tips of the leaves see illustration at p. 187.
  In a  case tried at the Cornwall Lent Assizes, 1852 (Reg. v. Pascoe),
the accused, a medical man, was convicted and sentenced  to  trans-
portation for administering oil of savin to a  Avoman,  with  intent to
procure miscarriage.   The proof of  intent rested partly on medical,
and partly on moral circumstances.   It appeared that the prisoner
had given fourteen drops of the oil, divided into three doses, daily—
a quantit}7 which, according to the medical  evidence at  the  trial,
was greater than should have been prescribed for any lawful pur-
pose.  The medical dose, as an emmenagogue, on the authority7 of
Christison, is  from tAvo to five minims, and according to Pereira
from two  to  six  drops.   The quantity given by the  prisoner,
although a full dose, avus not, therefore, greater than these authorities
recommend;  and  his criminality appears to have  rested not so
much on the dose given, as on the question Avhether he knew, or,
as a medical man, had reason to suspect, that the female for Avhom
he prescribed it Avas pregnant.  Xo medical authority Avould recom-
mend oil of savin in  full  dose's for pregnant  females;  and  Avith
regard to the existence, or non-existence of  pregnancy in a special
case, medical men are reasonably presumed  to have better means
of satisfying themselves than  non-professional persons.   The  pri-
soner's  innocence therefore rested  on  the  presumption that he 
536        SPECIFIC  ABORTIVES —OIL  OF  TANSY.

implicitly believed  what  the prosecutrix told him regarding her
condition—that he  had no reason to suspect her  pregnancy, and
therefore did not hesitate to select and prescribe a medicine which
certainly has an evil  reputation, and is  rarely used  by  regular
practitioners.   According  to the evidence of  the prosecutrix, she
informed  the prisoner that she had disease of  the heart and liver,
and that nothing more Avas the matter Avith her.   It is  absurd  to
suppose that oil of savin would  be  prescribed by a medical  man
for such a disease  as this.   The prisoner, on the hypothesis of
innocence, must have intended  the medicine to act on the uterus,
and  must  have inferred  the existence  of an  obstruction of  men-
struation from  natural causes irrespective of pregnancy.   The jury
do not appear to have  given him credit  for such ignorance of his
profession, and this probably led to his conviction.  There can, it
appears to me, be  no doubt that the oil was administered Avith a
guilty intention.   Every qualified practitioner, acting  bona fide,
would undoubtedly satisfy himself  that a young  Avoman whose
menses were obstructed was not pregnant, before he prescribed full
doses of this oil three times a dayT,  or he would  fairly lay himself
open to a suspicion  of criminality.  If pregnancy—a frequent cause
of obstructed menstruation—Avere only suspected, this would be suffi-
cient to deter a practitioner of common prudence from prescribing,
in any dose, a drug Avhich  may exert a serious action on the uterine
system.  (A report of the  case of Air. Pascoe will be found in the
"Med. Times and Gazette," April 17, 1852, p. 404.)
   The oil of savin is obtained by the distillation of the tops, in the
proportion of  about 3 per cent, by weight.  It has a yelloAvish
color, and  the  peculiar terebinthinate odor of  the plant, by which
alone it may be recognized.  It may be separated from the contents
of the stomach by agitating them in a  bottle  with its  volume of
ether, in which the oil is very soluble.  The ether may be aftenvards
removed by distillation.  The oil of savin forms a  turbid  mixture
with alcohol (.826).   When  treated with  its volume of sulphuric
acid, it acquires a  dark-broAvn  color, and Avhen this  mixture is
added to distilled  Avater, a dense  white  precipitate is separated.
The odor is the best test.
   Oil of tansy.—Dr. Hartshorne states that in the United States
the oil of tansy (Tanacetum vulgare) has acquired the character of a
popular abortive, and  caused death in  several instances.  In Eng-
land, this oil and  the herb have been chiefly  employed for the
purpose of expelling Avorms.  Dr. Pereira  quotes a case in Avhich
half an ounce of the oil proved fatal.  The symptoms were spasms,
Avith convulsive movements, and  impeded  respiration;  no inflam-
mation of the stomach or bowels was discovered upon  dissection.
(" Matt. Med.," vol. 2, pt.  2, p. 26.)   The  cases referred to by Dr.
Hartshorne are—1.  A teaspoonful of the volatile oil Avas taken by
a girl in mistake for the essence.  She  complained  of  giddiness,
and  became insensible in  ten minutes:  convulsions came  on, with
frothing at the mouth, difficult  respiration, and  irregular pulse,
and she died in one hour after taking the oil. ("Amer. Journ. Aled. 
SAFFRON — MINERAL IRRITANTS.           537
Sci.," July, 1852, p.  279.)  2.  The  second case occurred  to  Dr.
Dalton, and is  reported by him in the same journal for January,
1852, p. 136.  A healthy looking girl, set. 21, took eleven drachms
of oil of tansy  about  six  hours after a hearty dinner.   She  was
found insensible and in convulsions soon after  she  had  taken  the
drug.  She died in three hours and a half.   A strong odor of tansy
was obseiwed in the breath before death, and on inspection in the
peritoneal  cavity, stomach, and even the interior of  the heart.
The  uterus contained a well-formed foetus  about four months  old,
which  did  not, either in itself or  its membranes, present  any
evidence of having been  disturbed.  3. In a third case (reported
in "Amer.  Journ. Med. Sci.," for Alay, 1835), a woman  but a  feAV
weeks pregnant, took half an ounce of the  oil; she did not entirely
lose her consciousness until three-quarters of an hour had elapsed,
although she Avas convulsed at intervals before that time.  She died,
Avithout  abortion being produced, within  tAvo hours after  taking
the poison.   (For another case  see  "Med. Times and Gazette,'"
April 13,1861.)  These facts shoAV that, Avhile oil of tansy possesses
no specific  action on the uterus as an abortive, and does not even
affect this organ or its contents by sympathy, it. is capable of acting
as a  powerful poison on the brain and nervous system,  and of de-
stroying  life  rapidly.  The oil Avould be  easily recognized, either
before  or after distillation of the contents of the  stomach, by its
peculiar and penetrating odor.  It is very soluble in ether; and this
may be employed for its separation.
  Saffron.—A  decoction  of  the dried stigmas of  saffron (Crocus
satirus), has been employed as a popular abortive.   Dr. Thomsen,
of Schleswig, has reported a case in  which abortion  occurred in a
Avoman Avho had taken repeated doses of a  decoction  of  saffron
Avith starch.  There w7as reason to believe, hoAvever, that manipu-
lations per vaginam had also  been resorted to, and these  may have
had  the  principal  share in bringing about the result.  (Horn's
"• Vierteljahrschrift," October, 1864, p. 315.)  According to Pereira,
although saffron Avas formerly used as an emmenagogue and to pro-
mote uterine contractions, it  is not established by any trustAvorthy
observations that it possesses any  medicinal  properties.  (" Alat.
Aled.," vol. 2, pt. 1, p. 219.) In modern medicine, its chief use is to
give  color anel  flavor to liquids.  It has been  observed, that Avhen
administered to pregnant women, the yellow coloring-matter  has
been absorbed, and the foetus  in utero has been stained by it. This
appearance in the body of the foetus  might lead to a suspicion ot
its use, although no injury to the woman may have resulted.
  It  is  remarkable that the action of the  most powerful mineral
irritant poisons  has  sometimes  failed to  affect the  gravid  uterus.
In July, 1845, a case Avas  referred to me for examination  by Air.
T. Carter, of Xewbury, in Avhich a female,  aged 22 years, who had
passed the fifth month of  pregnancy, took a large dose of arsenic,
and died in less than seven  hours, having suffered from  severe
vomiting and purging during that time ;  yet abortion did not take
place!  The effects of mineral substauces upon the body have been 
538       ABORTION FROM LOCAL APPLICATIONS.

fully described in the section on Poisoning.  Among them, atten-
tion may be especially directed to the action of  muriate of iron.
(See p. 146.)  In a case tried at the Lincoln Summer Assizes, 1863,
(Reg. v. Rumble), the prisoner, a druggist, Avas convicted of supply-
ing this  compound for the purpose of procuring the abortion of a
pregnant  Avoman.   It  had  not that effect, but \t very seriously
injured her  health ; the prisoner also gave cantharides in pills.   In
reference to  the medicinal use of mercury, it may be proper to state
that Dr.  Solomon  has reported  tAvo cases,  in  Avhich  premature
delivery  appeared to folloAV the  mercurialization of the system.
(Casper's " Wochenschrift," June, 1845 ; "  Aled. Gazette," vol. 36,
p. 658.)
  Local  applications.  Injections.—In a  case Avhich  occurred  in
France, it Avas proved that abortion had been caused by the injec-
tion of  some corrosive  or irritating substance into the vagina.
The female  genitals, as Avell as the abdominal viscera, AArere found
in a high state of  inflammation.   (" Aled.  Gaz.," vol. 37, p. 171.)
This is an  unusual  mode of perpetrating the crime, but it is one
which  can  hardly escape detection.   An   analysis of the tissues
might  be required, in order to determine the nature of the sub-
stance  used.  It appears  from the trial which took place at  the
York Summer Assizes, 1853, that  this mode of attempting to pro-
duce criminal abortion has been the subject of a prosecution in this
country.   It was established by the evidence that some liquid was
injected into the vagina Avith a syringe, but there Avas  no proof of
the nature of this liquid ; and as it Avas not shoAAm to be of a noxious
nature, the learned  judge Avho tried the  case directed an acquittal.
(" Lancet,"  July 23, 1853, p. 89.)   If it is essential that medical
proof should be given that the liquid injected Avas of a noxious
nature, then a  loop-hole  is  left for the perpetration of the crime
Avith impunity.  I am informed by an obstetric practitioner of ex-
perience that an abortion  might be induced  by the frequent employ-
ment of injections of water alone, and  that this  is occasionally
resorted to in practice, as a safe and convenient mode of effecting it.
Numerous innocent liquids might be substituted for water.  The
words of the recent statute, however, by "other means whatsoever,"
Avould  doubtless  be considered to  cover  the use  of  any liquid,
whether  noxious or innoxious.
  In general, when the  criminal means taken  to procure abortion
are effectual in causing the expulsion of the  child, it comes into the
world dead; but it may be born alive, and die after its birth.  Under
these circumstances, although no violence is applied directly to the
body of the child, but its death is simply the result of immaturity
or the feeble state in Avhich it Avas born, the person causiug such
abortion  might render himself liable  to an  indictment for murder.
  Signs of abortion in the  living and dead.—These have been already
considered in a previous  chapter.   (See " Delivery," ante, pp. 507
and  515.) The examination may extend to the Avoman either living
or dead.   In the former case, there Avill be some difficulty, if the
abortion  has occurred at an early period of gestation, and several 
APPEARANCES IN  THE BODY.
539
days haA'e elapsed before the examination is made; in the latter
case, the iiiA-estigation is not ahA'ays free from difficulty.  One fact
here requires to be especially noticed.  It is believed by many phy-
siologists that menstruation is a state in some measure vicarious to
conception, and the appearances presented by the generative organs,
during the menstrual period, are somewhat similar to those Avhich
are  observed after conception in its early stage.  Air. Whitehead
remarks, that in persons avIio have died  while the menses  Avere
flowing, the uterine Avails  were thickened  and spongy, and the
mucous lining was more or less swollen and suffused.   The neck and
lips of the uterus Avere SAvollen, the orifice Avas open, and the  Angi-
nal  membrane and clitoris involved in the increased action.   One
of the ovaries Avas found larger and more congested than ordinarily,
presenting evidences  of the recent escape  of an  ovum.   (" On
Abortion," p. 196.)   Unless  these  facts are attended to, an ex-
aminer may form an erroneous opinion respecting the chastity of a
deceased female.  For some  remarks on the mode of conducting
the examination of the woman, and of the embryo or foetus in
cases of  abortion, see "Annales  d'Hygiene" for  1856 (vol. 1, pp.
149 and 153).
  Important questions may arise Avhen it is alleged that abortion
has been caused by the use of instruments, and death is referred to
peritonitis as the result of their employment.  In these cases, a
medical opinion should not be based upon the statements either of
the female or of her  friends, but upon some distinct and satisfactory
medical proofs, that mechanical violence has been done to the uterus,
its contents, or its appendages.  Peritonitis,  or inflammation of the
lining  membrane  of the abdomen, may arise  from a variety of
causes.  If Ave assign it to  a particular cause, and thus implicate
another in a felonious cause, Ave should do this only upon medical
facts obtained by an examination of the dead body ; Ave should deal
with such cases as if Ave knew nothing of their history.  In Alay,
1863, I A\ras consulted by Air. Lewis, coroner  for Essex, in reference
to the  death of a woman named Susannah Barker.  It  Avas  sup-
posed  that her death had been caused by attempts made to produce
criminal abortion.   The medical gentleman aaIio examined this case
thought that the fatal peritonitis had been caused by the introduc-
tion of instruments into the vagina, and that  this might occur Avith-
out leaving after death any traces of their employment. At the same
time it was admitted that  a speculum used  in the ordinary Avay
would not produce peritonitis, and it was alleged in defence, that
a speculum only had been used.
  The connection of the peritonitis with the alleged manipulations
of the  unlicensed practitioner rested more on surmise  than proof.
The absence of any  bruise, puncture, or larceration affecting the
vagina,  uterus,  or foetus, Avith  the fact that, whatever may  have
been the instruments used, the membranes were left entire, rendered
it impossible to assign the peritonitis with absolute certainty to the
acts of the person who was  charged with causing the death of the
woman.  For anything that  appeared to  the  contrary, he might 
540
ABORTION — LEGAL RELATIONS.
have used a speculum, and it is well known that this instrument,
although  frequently introduced into the vagina,  does not cause
peritonitis.  The connection of the  peritonitis Avith instrumental
violence, therefore, was not in this case established, and the jury by
their verdict discharged the  suspected  person.  They could  not
haA7e done othenvise^for there was not the  slightest medical proof
that any instrument had been introduced into the  vagina with a
felonious intention.
  Feigned abortion.—For various motives, into the consideration of
Avhich it is here unnecessary to enter, a woman may charge another
Avith having attempted or perpetrated a crime of abortion.   Such a
charge is not common because, if untrue, its falsity may be easily
demonstrated.  A young Avoman, admitted  into Guy's Hospital in
April, 1846, charged a policeman (Avho, according to her statement,
had had forcible intercourse Avith her) Avith having giving her some
substance to produce abortion, and  with having  subsequently ef-
fected this mechanically.  She was not examined until nearly two
months after the alleged perpetration of the crime,  Avhen the late
Dr. Lever found that there Avas no reason to believe she had e\rer
been pregnant.  This Avas a case of feigned abortion.   AVhen charges
of this serious kind are brought forward, they are ahvays  open to
the greatest suspicion, unless made immediately after the alleged
attempt, as  it is then only  that  an examination can determine
Avhether they are true or false. If so  long  delayed, as in this in-
stance, without  any satisfactory reason, the presumption is that
they are false.
  Legal relations.—[See " Revised Criminal Code of Pennsylvania,"
§§ 87, 88.—P.]   In the statute for the consolidation of the criminal
law (24 & 25 Vic, chap. 100, ss. 58 and 59), the nature of this crime,
and the proofs required  to establish it have been more explicitly
stated than in former acts.  By clause 58 (on attempts to procure
abortion),  it is enacted that " Every woman, being with child, Avho,
Avith intent  to procure her own miscarriage, shall unlawfully ad-
minister to herself any poison  or other noxious thing, or shall  un-
lawfully use any  instrument or other means Avhatsoever Avith like
intent, and Avhosoever,  with intent  to procure miscarriage of any
Avoman, whether she  be or be not with child, shall unlawfully adminis-
ter, etc., shall be guilty of felony."  Formerly, Avomen who endeaA7-
ored to produce  abortion  in themselves were not  guilty  of any
offence against the law.  In Reg. v. Warboy (Cent. Crim.  Court,
August, 1862), the prisoner, a Avidow, was convicted as an accessory
before the fact to the felonious using by one Morgan of a  certain
instrument upon herself with intent thereby  to produce miscarriage.
  The latter portion of clause 58 makes it immaterial Avhether the
woman Avere  or  were not with child, in accordance with  the de-
cision of the judges in Reg. v. Goodhall(l Dem. C. C. p. 187), and
Reg. v. Goodchild (2 C. & K. p. 293.)  Clause 59 is  to the  follow-
ing effect: "Whosoever  shall  unlawfully  supply or procure any
poison or other noxious thing, knowing that the same is intended
to be unlawfully used or employed with intent to procure the mis- 
"NOXIOUS" SUBSTANCES.
541
carriage of any Avoman, whether she be or be not with child shall
be guilty of a misdemeanor;  and being convicted thereof, shall be
liable, at the discretion of the court, to be kept in penal servitude
for the term of three years, or to be imprisoned for any term not ex-
ceeding tAA7o years."  This clause is intended to check the obtaining
of poison, etc., for the purpose of causing abortion, by making both
the person avIio supplies, and the person Avho procures it, guilty of
misdemeanor.   It  Avill  be  obseiwed in  reference to these clauses,
that  the  means employed,  whatever their nature, must  have been
used Avith an intent to procure the  miscarriage of a woman, a point
which  Avill be sufficiently established by a plain medical statement
of the means employed.   Supposing that a drug has been used, the
Avitness Avill have to state Avhether it is "a poison or other noxious
thing;" for this must be proved in order that the  prisoner should
be convicted of the crime.  I must refer the reader to Avhat has
been said elseAvhere (ante,  p. 83), in order that he may be  able to
judge Iioav far the substance administered Avould  fall  under the
description above  given.   AVhether it Avould,  or Avould  not, have
the effect intended, i.  e., of inducing abortion, is perfectly immate-
rial.
   Some uncertainty may exist as to the strict meaning of the Avord
noxious.  All will alloAV that the w7ord implies something injurious
to the system ; but a difference of opinion may arise among medical
Avitnesses Avith respect to its application to the substance under dis-
cussion—as, for example, Avith respect to rue or savin.  To confine
the term " noxious," therefore, to wliat is strictly speaking a poison
perse, would be giving a latitude  to attempts at criminal abortion,
Avhich  would render the laAV inoperative.   The small quantity of
the substance taken at once does not affect the  question, provided
the dose  be frequently repeated.  In a trial which took place at the
Norwich Lent  Assizes, 1846 (Reg. v. Whisker), it was proved that
the prisoner had caused to be taken by the  prosecutrix a quantity
of white hellebore, in powTder, for the purpose of procuring abortion.
One  medical Avitness said he considered hellebore to be noxious to
the system, but he knew of no case in which it had produced death  ;
and under these circumstances he did not feel  himself justified in
calling it a poison. Another medical witness stated that, in his
opinion, it belonged to the class of  poisons.  The judge, in summing
up, told the jury that that  Avas to  be regarded as a poisonous drug
which, in common parlance, Avas generally understood and taken to
be such; and he thought the evidence sufficiently strong to  bring
hellebore within the meaning of t"he statute.   The jury found the
prisoner guilty, alleging that in  their belief Avhite hellebore Avas  a
poison.  "("Aled. Gaz.,"  vol.  37, p.  830.)  The only circumstance
calling for remark  in this case is, that any doubt should have been
entertained by a medical practitioner respecting the poisonous pro-
perties  of white hellebore.  It is a powerful  vegetable irritant, and
has caused death in several instances; yet on this occasion it appears
to have been admitted to be noxious, but not poisonous! The nature
of the  substance administered,  and that it is noxious, should  be 
542     CRIMINAL ABORTION —JUDICIAL  DECISIONS.

proved.  Xo speculative evidence is favorably received when some
portion of the substance cannot be procured.   In Reg. v.  Taylor
(Exeter Winter Ass., 1859) some powders had been given by the
prisoner to a girl with the view of inducing abortion.   Xo portion
of the powders could be obtained for examination: but tAvo medi-
cal gentlemen who heard the evidence gave their opinion that the
povvders were of a noxious nature.  In the defence, it Avas urged
that this had  not been proved.  The jury adopted this vieAv, and
returned a verdict of acquittal.
  In reference  to  the proof of this crime, it is not required under
the circumstances, that any specific injury should  have been done to
the Avoman, or that abortion should have followed in order to com-
plete  the offence.  There-is every reason to believe that the crime
is frequent, but its perpetration is secret. Applications are continu-
ally made  to  druggists by the loAver class of people  for drugs for
this purpose : the applicants appear to have no idea of the criminal-
ity of the act.  (See, in reference to the frequency of this crime, a
paper in the " Aledical Gazette," vol. 46, p. 487;  also " Aled. Times
and Gaz.," Nov. 21, 1857, pp. 524, 537.)
  [The  frightful frequency of intentional abortion in this  country
has long been notorious, no less than the extraordinary ignorance
as to  its criminality, even among well-educated persons. The recent
able efforts of Profs.  Storer, Hodge, and others, especially of Dr.
Storer, Avith the formal action of the American Aledical Association
(" Trans.," xii. p. 75) Avill do much tOAA7ards effecting a much needed
reformation of public opinion, as well as of legal practice,  in this
matter. Dr. Storer (in chap. vii. of his series of articles on Criminal
Abortion, published in vol. iii.  1859,  of the  "  X. A. Aled.-Chir.
Rev." of Philada.) gives a complete and comprehensive exhibit of
the laws of each of the United  States and of the ruling decisions in
relation to criminal abortion.   His concluding  summary is suffi-
ciently important  to justify our quoting it in full, at the same time
that Ave must  refer to  the previous  pages of the same paper for a
minute and Avell arranged statement of the statutory and judicial
practice in each of the individual States.
  " The  destruction of an unborn child is  not at the present day
murder at  the  common laAV, though such was formerly the case (1
Russell,'Crimes,' 671;  1 Vesey, 86 ; 3 Coke, 'Inst.,' 50 ; 1 Hawkins,
C. B., s. 16 ; 1 Hale, 434; 1 East, P. C, 90 ; 3 Chitty, ' Crim. Law,'
798 ;  Wharton, ' Crim. Law,' 537);  to constitute Avhich crime, the
person killed must at  the time  of death have been ali\re (Davis,
' Crim.  Justice,' 486), as we have shown the foetus to be from the
time of conception, and 'a reasonable creature in being'(Archbold,
'Crim. Pleading,'  490);  a quality in this  connection denied to the
child  by the laAV, though in all other relations it inconsistently
allows and affirms it; as it does also, and always, from the  moment
of birth, even  though the funis is undh7ided and the placenta still
attached.   (Reginciv. Trilloe, 2  Moody, 0.  C, 260, 413.)
  " To cause abortion  after quickening is not, as such, murder or 
       CRIMINAL  ABORTION — JUDICIAL  DECISIONS.     543

manslaughter at common laAV, but a high misdemeanor.  (The State
v. Cooper, 2 Zabriskie, 52; Hanes, 'U. S. Digest,' 5.)
  " AVhether to cause, or to attempt, abortion before quickening is
a penal offence at common law, has  been differently decided.  In
several of the States, as Alaine, Alassachusetts, and Xew Jersey, it
has been ruled by the  Supreme Court not to be indictable, even as
an assault, if done Avith  the consent of the woman ; on the ground
that only in case of high crimes is the person assaulted incapable of
assenting.  (The Commonwealth v. Parker, 9 Atetcalf, 263 ;  The Com-
monwealth v. Bangs, 9 Alass. 387 ; The State v. Cooper, 2  Zabriskie,
57; Danes,  ' U. S. Digest,' 5 ; Smith v. State, 33 Alaine (3 Red.), 48.)
The Pennsylvania court, hoAvever, has discarded this doctrine, and
has decided that  the  moment the womb is instinct Avith embryo
life, and gestation  has  begun, the crime may  be perpetrated.
(Bishop, 'Crim. Luav,' 386; Mills v.  The Commonw., 1 Harris, Pa,,
631, 633.)
  " The distinction alluded to with regard to quickening, isalloAAred
by an  acknowledged legal authority  (Wharton,  ' Crim. Luav of the
U. S.,' 537), to be at open variance not  only Avith medical experi-
ence but Avith all other  principles of the common haw.  (1 Russel,
'Crimes,' 661 ; 1 Vesey, 86 ; 3 Coke, 'Inst.,' 50; 1 Hawkins, c. 13,
s. 16 ; Bracton, i. 3, c. 21.)   The civil rights of an infant in utero
are respected equally throughout gestation ; at every stage of which
process, no  matter 1ioav early, it may be appointed executor ('Bac.
Ah.,' tit. Infants), is capable of taking as legatee (2 Vernon, 710),
or under a marriage  settlement (Doe  v.  Clark, 2  II. Bl. 399 ; 2
Vesey, Jr., 673;  Thellusson v.  Woodford, 4 Aresey, 340 ; Swift  v.
Duffield,6 Serg.  & RaAvle, 38), may take specifically as 'a  child'
under a general devise (Fearne, 429), and may obtain an  injunction
to stay Avaste.  (2 Vernon, 710 ; The Commonwealth v. Leniain, 6
'Penn. Law Journ.' 29 ; Brightly, 441.)
  Wk AVhen, in an attempt to procure an abortion, there is  an evident
intent to produce the death of the mother, and her death does actu-
ally occur, such attempt becomes murder at common law. (1 Hale,
90; The Commonw.  v. Chauncey, 1 Ashmead, 227; Smith v. State,
83 Maine (3 Red.), 48);  but Avhen  nothing more is intended than
to commit the misdemeanor, it is only manslaughter (Ibid.; Hanes,
'U. S. Digest,' 5), being an  instance of homicide from  individual
malice toAvard a third party, when  the  fatal  bloAv falls on the de-
ceased by mistake.  It has been said, hoAveATer, that this last is not
the true doctrine, the destruction of  an  infant in utero being, even
at  common laAV,  in some respects  felonious, and  the act in  its
nature malicious  and deliberate,  and   necessarily  attended  with
danger to the person on Avhom it  is  performed.   (Wharton, 'LaAV
ofllomicide,' 44.)
  " The use of violence upon a Avoman, with an attempt to produce
her miscarriage Avithout her consent, rules Chief Justice ShaAv of
Massachusetts, is an assault highly aggravated by such wicked pur-
pose, and would be indictable at common laAV.   So where, upon a
similar attempt, the death of the mother ensues, the party making 
544    CRIMINAL ABORTION—JUDICIAL DECISIONS.

such an attempt, with or Avithout her consent, is guilty of murder.
on the ground that it is an act done Avithout lawful purpose, danger-
ous to life, and that the  consent of the woman  cannot take aAvay
the imputation of malice, any more than in case of a duel, where
in like manner there is the consent  of the parties.  (The Commonw.
v. Parker, 9 Aletcalf, 263, 265 ;  Davis, 'Crim. Jus.,' 281.)
   " Though to kill the foetus in utero  is as  such, by the common
law, no murder, yet if it be born  alive, and die  subsequently to
birth from the wounds it received in the Avomb, or from the means
used to expel it, the offence becomes murder in those who cause or
employ them.   (1 Blackstone, 129;  Rex v. Senior, 1  Moody, C. C,
346 ;  3 Inst., 50 ; Wharton, C. L., 537 ; Ibid., ' LaAV of Homicide,'
93.)   If a person, intending to procure abortion, does an act which
causes the child to be born earlier than its  natural time, and there-
fore in a state much less  capable of  living,  and it after\A7ards die in
consequence of such premature exposure,  the person who by this
misconduct brings the child into the world, and puts it into a situa-
tion in Avhich it "cannot live, is guilty of murder, though no direct
injury to the  child be proved ; "and the mere existence of a possi-
bility that something might have been done to prevent the death,
does  not lessen the crime.  (Rex  v. West, 2 Carr.  & Kir. 784; 1
Bishop, C. L., 255 ; Wharton, 'LaAV of Homicide,' 93.)
   " The  earlier English  statutes, from  their peculiar phraseology,
held  pregnancy essential for the commission of the crime (Rex v.
Scudder, 1 Aloody, 216 ; 3 Car. & P.  605; overruling Rex v. Phillips,
3 Campbell, 73 ; Russell, Cr., 763, note); yet an attempt to produce
abortion is now indictable at common  law  (if  made  without her
consent?) though  it fail by reason of the woman being, in fact,and
contrary to the belief of the party, not pregnant.  (Regina v. Good-
child, 2 Car. & Kir. 293 ; Rex v.  Goodhall, 1 Den.,  C. C, 187; 3
Campbell, 76.)  For  though as no man  would attempt Avhat he
absolutely knew he could not in fact perform, nor would be deemed
in laAV to  have so attempted, and  as every one being conclusively
presumed to understand the law, no man  can legally intend Avhat
is legally impossible, the rule as to facts is  different; for men are
not conclusively held by the law7  to know7 facts.  And if a man
fails  in  what  he undertakes,  because  of  an impossibility in fact,
which he did not knoAv, he is just as  answerable as if the failure
Avere from any other cause.  (1 Bishop, ' Crim. La\v,' 518.)
   " If our previous assumptions of the actual character of criminal
 abortion be granted, and Ave believe that they have been proved to
 a demonstration, it must folloAV from the subsequent remarks, that
 the common law, both in theory and in practice, is insufficient to
 control the crime ; that in many States of this Union, the statutory
 laws do not recognize its true nature ; that they draw umvarrantable
 distinctions of guilt;  that they are not sufficiently comprehensive,
 directly  allowing many  criminals to  escape,  permitting uncon-
 summated attempts, and improperly  discriminating betAveen the
 measures employed ; that they require proofs often unnecessary or
 impossible to afford; that they neglect to establish  a standard of 
     PREMATURE  LABOR—MEDICAL RESPONSIBILITY.   545

justification, and thereby  sanction  many clear instances of  the
crime; that by a system of punishments wholly incommensurate
with those inflicted with all other offences Avhatsoever, they thus
encourage instead of preventing  its increase;  and that in many
respects they are at variance, not merely Avith equity and abstract
justice, but Avith the fundamental principles of laAV itself."  "Con-
tributions  to  Obstetric  Jurisprudence."   By Horatio R.  Storer,
M.D., of Boston.  "Criminal Abortion,"  part vii., from "X. Am.
Med.-Chir. Rev.," vol. hi., Xo. 5, Sept., 1859, pp. 851 to 854.   See
also the other  five numbers of vol. iii. of  the same journal for the
remainder of this excellent series of papers on the subject.—H.]
  On inducing premature labor.   Medical responsibility.—It may be
proper to offer here a few  remarks  upon the common practice of
inducing premature  labor,  in certain  cases  of  disease, of defor-
mity  of  the  pelvis,  and  in cases of excessive vomiting from
pregnancy.  This practice has  been condemned as immoral  and
illegal; but it  is impossible  to  admit  that  there  can  be  any
immorality in  performing  an operation to give a chance of  saving
the life of a woman, Avhen, by neglecting to perform it, it is  almost
certain that both  herself and the child will perish.  (See on the
morality, safety, and utility of the practice, Ramsbotham's " Obstet.
Med.," p. 315.)   The question  respecting  its illegality cannot be
entertained; for the means are administered or applied with the
bona fide hope of benefiting the female, and not with any criminal
design.  It  is  true that the  law makes no exception in favor of
medical men who adopt this  practice, nor does  it in the statute
on wounding make any exceptions in favor of surgical operations ;
but that which is performed Avithout evil intentions Avould not be
held to be unlawful.  The necessity for  the practice ought to be
apparent: thus, for instance, it should be shown that delivery  was
not likely to take place naturally, without seriously  endangering
the life of a woman.   It is questionable  whether, under any cir-
cumstances, it would be justifiable to bring on premature expulsion,
merely for  the  purpose of attempting to save the life of a child,
since  the operation, unless performed  with care,'is accompanied
with risk  to the life of  the mother.  The grounds  upon  Avhich
matiy eminent authorities  have objected  to  this  practice, are: 1.
That there are few cases in Avhich parturition, if  left to itself,
might  not take place at the full period;  2. The toleration  of  the
practice would lead to great criminal abuse; 3. It is  attended with
danger to the mother and child.  It is undoubtedly  true that par-
turition Avill sometimes  take  place safely at the full time, even
when the deformity of the pelvis is apparently so great as to  lead
many accoucheurs to suppose natural delivery to be  utterly impos-
sible.   Dr. Lilburn has reported the case of a woman Avho labored
under great deformity of the pelvis, but av!io Avas twice delivered
in safety and the child survived.   (" Aled. Gaz.," vol. 19, p. 933.)
It is therefore  not improbable  that many cases of  the kind  are
prematurely treated,  Avhich if left to themselves, would probably
do well without  interference.  Hence, a cautious selection should
      35 
546        CHEMICAL  EVIDENCE — BLOOD STAINS.

be made, because the operation is necessarily attended Avith some
risk to the woman and child.   All that we can say is, that, accord-
ing to general professional experience, it places  her  in a better
position  than she would be in if the case were left to itself.  It
appears to  me that  before a practitioner  resolves upon performing
an operation of this kind, he should hold a consultation with others";
and, before it is performed, he should feel well assured that natural
delivery cannot take place  Avithout greater risk to the  life of the
mother than the operation itself would create. These rules may not
be observed in practice; but the non-observance  of them is neces-
sarily attended with some responsibility to a practitioner.  In the
event of the death  of the mother or  child, he exposes himself to
a prosecution for a criminal offence, from the imputation  of  which
even an  acquittal v\rill not  ahvays clear him  in  the eyes of the
public.   If the child were born alive, and died merely as a result
of its immaturity, this might give rise to a charge of manslaughter.
Within a recent period, several practitioners have been tried upon
charges of  criminal abortion—whether justly  or  unjustly it is not
necessary to consider; but they had obviously  neglected  to adopt
those  simple  measures  of prudence, the observance  of  which
would have been at once an answer to a criminal charge.   Because
one practitioner may have frequently and successfully  induced
premature  labor, without observing these rules, and without any
imputation on his  character, this cannot shield another Avho may
be less fortunately situated.  A charge is only likely to arise when
a man has  been unfortunate; and the responsibility of one operator
cannot be measured by the success of others.
  Proof of pregnancy is not  essential  to the  crime of  abortion.
The attempt on a Avoman, proved not to be pregnant, involves a
pierson in equal responsibility.   So, if the body expelled is a monster,
an extra-uterine conception or a blighted foetus (a mole), the crime
of abortion is as complete as if the woman wTas delivered of a child.
It will be observed  that in the  statute the word  miscarriage is used.
In a popular  sense  (and  here  a popular appears to have  been pur-
posely selected in preference to a medical term), miscarriage signifies
the violent expulsion not merely of a child, but of moles and other
diseased groAvths, or even  of coagula of  blood.   In  these "last-
mentioned  cases, the woman is not actually pregnant although she
and the accused may imagine that she is.  But whether the  uterus
contains these morbid growths, or Avhether the organ is in the virgin
state, the person Avho has used the means with intent may still be
convicted of an  attempt to procure abortion.
  Chemical evidence.  Blood in abortion.  Liquor amnii.—In the
event of an abortion having taken place, stains produced by blood
or by the  waters (liquor amnii) may be found on the linen of a
woman, and a practitioner  may be required to say whether these
stains are of a nature to throw any light upon the perpetration of
the crime.  A Avoman Avho has aborted may allege that the stains
are  those of the menstrual discharge.   Speaking generally, there is
no practical distinction betAveen menstrual and other blood.  The 
                ABORTION — BLOOD  STAINS.             547

menstrual blood contains less fibrin, is commonly acid and watery
from admixture Avith  the mucous discharges, and Avhen examined
by the microscope it presents epithelial scales, or cells derived from
the mucous membrane.  These scales or cells belong to the columnar
variety.   Xot  much reliance can be pilacecl upon their discovery,
since the mucous  membrane of the  organs of respiration is lined
with similar cells.   Hence, expectorated blood  might be mistaken
for menstrual.   Cells of a similar shape line  the Avhole of the mu-
cous membrane from the stomach to the anus.   The blood of piles
might thus be  confounded Avith  menstrual blood.  The blood dis-
charged  in abortion will present the  usual characters of blood else-
where described;  but  it may be diluted by the Avaters simultane
ously discharged  (p.  291).   This  question  received  the  special
attention of the French Academy a few years since, in reference to
the crime of abortion ; and  the report  made  was to the effect that
in the present state of science, there was no certain method by Avhich
the blood  of menstruation could be  practically distinguished from
the blood  discharged in a case of abortion or  infanticide ("Ann.
d'Hyg.," 1846, vol. i. p. 181).  In a more recent case, AIA1. Devergie
and Chevallier A\7ere required to state Avhether certain stains on  the
dress of a woman,  supposed to  have  aborted,  were or Avere  not
caused by the waters (liquor amnii).  A chemical analysis merely
revealed the presence of an albuminous liquid.  The most elaborate
experiments satisfied the reporters that neither by the odor, nor by
any other process, could the liquor  amnii, dried on linen, be iden-
tified. (See "Ann. d'Hyg.,"  1852, vol. 2, p. 414.)  It may, however,
be of importance  to observe that this liquid  slightly discolors and
stiffens the fibre of the stuff on Avhich it has been effused, and that
it can be readily extracted by cold  water.  The solution possesses
all the properties of albumen.  The  amount of albumen contained
in the liquor amnii decreases as gestation advances.  At the fourth
month, it forms 10.77  per cent,  of the  liquid; at the fifth  month
7.67; at the sixth month, 6.67; and  at the  ninth month, only 0.82.
M. Chevallier's experiments sIioav that the  amniotic liquid  has  all
the usual chemical properties of a very diluted solution of albumen
("Ann. d'Hyg.," 1856,  vol. i. p. 156). 
548
INFANTICIDE.
INFANTICIDE.
                    CHAPTER  XLVI.

NATUBE OF  THE CRIME.—PROOF  OF  LIFE.—MEDICAL EVIDENCE  AT
  INQUESTS.—UTERINE AGE, OR MATURITY OF THE CHILD.—VIABILITY.—
  CHARACTERS OF THE CHILD FROM THE SIXTH TO THE NINTH MONTH.—
  SIGNS OF MATURITY.—RULES FOR INSPECTING THE BODY.

  The subject of child-murder has of late years attracted the atten-
tion of medical jurists by reason of the facility with which the
crime may be perpetrated, and the great  difficulty of bringing it
home to the  offender.  The  reports of inquests show that the
deaths of infants  are very  numerous, and  that they frequently
occur  under circumstances involving  great suspicion.   In his
annual report for 1862-63, Dr. Lankester, coroner for the central
division of Middlesex, states that there Avere 68 deaths  of neiv-
born children in his1 district, and in 53 of these, verdicts of wilful
murder were returned against persons unknown ;  it appears accord-
ing to this report, that the crime is more frequent amongst women
in domestic  service than in any other class.   There is  usually con-
siderable reluctance on  the  part  of a jury to return  a verdict of
wilful murder, when the  mother has been discovered.   In all
instances  in w7hich the evidence  of guilt has been so clear that
coroners' juries have found verdicts of wilful murder, the prisoners
have  been subsequently acquitted on their trials.  Such  is the
history of cases in which  the crime  has been detected, and  as the
present state of  the law offers every facility to a woman thus
detected, to  escape  punishment, the extensive existence  of the
crime of infanticide will not excite surprise.   (" Annual Report,"
1864, p. 83.)  In the report of the Committee appointed to inquire
on the best  means  of preventing  the  destruction of  the lives of
infants (July, 1871), it  is stated that the number of infants found
dead in the  Metropolitan and City Police districts during the year
1870, wTas 276, and the return up  to May 19, 1871, showed a total
of 105.  The greater number  of  these infants  were less than a
Aveek old.   From  the statistics of crime in Ireland published in
December, 1871, the same failure in the administration of the law
is observed  there.   Infants form less than 3 per cent, of the popu-
lation according  to  the  census,  but  murders of infants  are in
England and Ireland considerably more numerous than  murders
of adults.   In Ireland, according to Dr. Hancock, the latter are 
NATURE  OF  THE  CRIME.
549
37 times the number of murders occurring in the rest of the popu-
lation ; in England and  Wales, 55  times.  Out of 139 cases  in
which  a  coroner's jury found  that  infants had been  murdered,
arrests were made in 95 instances;  but it is a striking proof of the
strong  feeling against capital  punishment  for  infanticide  that,
though 42  persons  were  convicted of lesser offences, not one con-
viction for murder Avas obtained.
  Nature of the crime.—By infanticide  we are  to  understand  in
medical jurisprudence, the murder of a new-born child.   The Eng-
lish laAV, however, does not regard child-murder as a spiecific crime;
it is treated  like any other case of murder, and is tried by  those
rules of evidence Avhich are admitted in cases of felonious homicide.
In stating that infanticide is the term applied to the murder of a
new-born child, it is  not  thereby implied that the wilful killing
should take place  within any particular period after birth.   Pro-
vided the child be actually born, and  its body entirely7 in the
world, it matters not whether it has been destroyed within a feAV
minutes, or not until several days after its birth.  In the greater
number of cases of infanticide, hoAvever, we find that the murder
is commonly  perpetrated either at the time of birth, or within a
few hours afterwards.
  AI. Lanjardiere, a skilled advocate of the French Bar, says that
to constitute infanticide, there must be—1, a  Avilful killing;  2,
the  child must be living; and 3, it must be new-born.   The wilful
killing is proved by direct or circumstantial evidence; the fact of
living is taken as synonymous w7ith breathing, and the words neAAT-
born, recens natus, may be applied  to a child from a few moments
after birth until the cicatrization of the navel is completed.   (See
"Ann. d'Hyg.," 1868, 1, 463.)
  Although the laAV of England treats a case of infanticide as one
of ordinary murder, yet  there  is a difference in the nature of the
medical evidence required to establish the murder of a new-born
child.  It is well known that many children come into the world
dead, and that others die  from various causes either during, or soon
after birth ;  in the latter,  the signs of their having lived are
frequently  indistinct.  Hence,  to provide against the  danger  of
erroneous convictions, the la\v assumes that  every new-born child
has been  born dead, until the contrary appears from the medical
or other  evidence.   The onus of proof that  a living child has
been destroyed is  thereby thrown on the prosecution, and no evi-
dence imputing  murder  can be received, unless it is  first  made
certain, by medical or other  facts, that the child survived its birth,
and was legally a living child when the alleged violence was offered
to it.   Hence, there is a most difficult duty cast upon  a medical
witness on  these occasions.  In the greater number of cases, the
woman is delivered in secrecy, and  no one is present to give evidence
respecting the birth of the child.  It is under these circumstances
that medical evidence is  especially required.
  In cases of child-murder, medical evidence is commonly founded
on an examination of the body of the child; but it must be  borne 
550             UTERINE  AGE OR MATURITY.
in mind, that a Avoman may be found guilty of the crime, although
the  body of  the child is not  discovered:  it may  have  been
destroyed by  burning, or otherwise disposed  of, and  a  medical
witness may have only a few calcined bones to examine.  ("Ann.
d'Hyg.," 1845, 2, 129.)  In these cases of  the  non-production  of
the body, good legal evidence of the murder would, hoAA7ever, be
demanded;  and  this  evidence  should be  such,  as  would  fully
establish a matter of  fact before a jury.   The production of the
body of the child, is  therefore  no more necessary to  conviction
than in any other case of murder.  A Avoman has been tried within
the last few years for the murder of her child, the body of which
was  never discovered.   In most instances,  however, the body of
the child is found, an inquest  is held, and medical  evidence  is
demanded.
   Uterine age, or  maturity of the child.—One of the first questions
Avhich a Avitness has to  consider in a case of alleged child-murder
is that Avhich relates to the age, or probable degree of maturity
Avhich the deceased child may have attained in utero.  The reason
for making this inquiry is, that the chances  of natural death, in all
new-born children, are great in proportion to  their immaturity:
and that, supposing them to have survived birth, the signs  of their
having breathed are commonly obscure. It is found that the greater
number of children who are the subjects of these investigations,
have reached the eighth or ninth month of  gestation ; yet  charges
of murder might be extended to the wilful  destruction of children
at the seventh month, or under,  provided the evidence of life after
birth was clear and satisfactory.
  The following  are the characters w7hereby wre may judge of the
uterine age  of a child from the  sixth to the ninth month of gesta-
tion, a period which may be considered to  comprise cases of abor-
tion as well as child-murder:—
  1. Between the sixth and  seventh month:  The  child measures
from the vertex to the sole of the foot, from ten to twelve inches,
and Aveighs  from one  to three pounds.  The head is large in pro-
portion to the trunk;  the  eyelids are adherent,  and the pupils are
closed by membranes  (membranse  pupillares).  The skin  is of a
reddish color, and the nails are  formed; the hair loses its silvery
lustre which it previously possessed, and becomes darker.   Ossifi-
cation proceeds rapidly in the chest bone, and in the bones of the
foot;  the brain continues smooth on  its surface;  there is no
appearance of convulsions.   In the male, the testicles will be found
in the abdominal cavity, lying upon the psoae muscles, immediately
beloAv the kidneys.
  2.  BetAveen  the seventh and eighth months:  The child now mea-
sures between thirteen and fourteen inches in length, and weighs
from three to  four pounds.  The skin is thick, of a more decidedly
fibrous structure, and covered Avith a white  unctious matter which
appears for the first time.  Fat is deposited in  the cellular tissue,
whereby the body becomes round and  plump; the skin previously
to this is of  a  reddish color, and commonly more or less shrivelled ; 
      APPEARANCES  INDICATIVE OF UTERINE  AGE.    551

the  nails, Avhich are somewhat  firm, do  not  quite reach to the
extremities of the  fingers; the hair is  long, thick, and colored ;
ossification advances throughout the skeleton; valvule conniventes
appear in the small intestines, and meconium  is found occupying
the  csecum and colon.   The testicles in the male about this period
commence their descent; or rather, the  child's  head being down-
wards, their ascent toAvards the scrotum.   The time at Avhich these
organs  change  their  position is probably subject  to  variation.
According to J. Hunter, the testicles are situated  in the abdomen
at the seventh, and  in  the scrotum at the ninth month.  Bums
believes that at the eighth month they Avill commonly be found in
the  inguinal canals. The observation of the position of these organs
in a new-born male child is of considerable importance in relation
to maturity, and it may have an influence on  questions of  legiti-
macy as Avell as of  child-murder.  Air. Curling thus describes their
change of position:  At different periods between the fifth  and
sixth months of foetal existence, or sometimes even later, the testi-
cle  begins  to  move from its situation near the kidney towards the
abdominal ring, Avhich it usually reaches about the seventh month.
During the eighth  month it generally traverses the inguinal canal,
and by the end of  the ninth arrives at the bottom of the scrotum,
in which  situation it is commonly7 found  at birth.  ("Diseases of
the Testis," 2d ed., p. 17.)   Its absence from the scrotum does not
necessarily indicate that the  child is immature, because the organ
sometimes does not reach the scrotum until after birth.
  3. BetAveen the eighth and  ninth months:  The child  is from fif-
teen to sixteen  inches  in  length, and  AA7eighs from four to  five
pounds.   The eyelids are no  longer adherent,  and the membratite
pupillares have disappeared.   The quantity of fat deposited beneath
the skin is increased, and  the hair and nails are well  developed.
The surface of the  brain is grooved or fissured, but presents no reg-
ular convolutions;  and the cineritious  matter is not yet apparent.
The meconium  occupies almost entirely the large intestines;  and
the gall-bladder contains some liquid  resembling bile.   The testi-
cles in the male may be found occupying some part of the inguinal
canal, or  they may be in the scrotum.  The left  testicle is some-
times in the scrotum, while the right is situated about the  exter-
nal  ring.
  4. Ninth month.   Signs of maturity.—At  the ninth month,_the
average length of the body  is about eighteen inches, and its Aveight
from six toleven pounds; the male child is generally rather longer,
and weighs rather more than the female.  Extraordinary deviations
in length  and Aveight are  occasionally  met Avith.  Air.  Owens has
recorded a case in  which a child at delivery measured twenty-four
inches in  length,  and  weighed seventeen pounds twelve ounces
(" Lancet," December, 1838), and Dr. Meadows has reported an-
other in which  a child measured after death thirty-two inches, and
weighed eighteen  pounds  tAvo  ounces.   It survived four  hours.
("Med. Times and Gaz.," August 4, 1860.)  In a case which I was
required to examine in June,  1842, the child, a male, measured 
552
SIGNS OF  MATURITY.
 twenty-two inches,  and weighed twelve pounds and a half.   (For
 some practical remarks on this subject, by Dr. Ellsasser, see Henke's
 " Zeitschrift, 1841, vol.  2, p. 235.)  According to Dr. Duncan, the
 length and weight of a child vary according to the age of' the mother.
 They are greatest among children  Avhen the mother is from 25 to
 29  years of age.  When a  woman is  25,  the  child  weighs less.
 The child of a woman at 22,  weighed seven pounds three ounces,
 and that of a woman at 30, seven pounds seven ounces. The length
 varied in a less degree, being, for the different ages, at or about nine-
 teen inches.  (" Ed. Monthly  Journal," Dec. 1864, p. 500.)
   At the full pieriod, the head of a  child is large, and forms nearly
 one-fourth of the whole length of the body.  The cellular tissue is
 filled with fat, so as to give considerable plumpness  to the whole
 form, wdiilethe 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, Avhich may be sometimes simulated in a premature child,
 by  the shrinking of the skin after death.  The testicles in the male
 are generally within the  scrotum.   Ossification will be found to
 have advanced considerably  throughout the skeleton.   The surface
 of the brain presents convolutions, and the cineritious or gray matter
 begins to show itself.  The internal organs, principally those of the
 chest, undergo marked changes, if  the act of respiration has been
 performed by the child before, during, or after its birth.
  The characters which have been here described as belonging to a
 child at the different stages of gestation, must be regarded as repre-
 senting an average statement.  They are, it is well known, open to
 numerous exceptions ; for some children at the ninth month are but
 little more developed than others at the seventh.   Twins are gene-
 rally smaller and less developed than single children :—the average
 weight of a twin child is not more than five pounds, and very  often
 below this.  The safest rule to follow in endeavoring to determine
 the uterine age of a child is to rely upon a majority of the charac-
 ters which it presents.   That child  only can be regarded as mature,
 which presents the greater number of the characters described, that
 are met Avith in children at or about the ninth month of gestation.
  If the age of the child has been determined: whether it be under
 or over the seventh month, the rules for a further investigation will
 be the same.  Should the child be under the seventh  month, the
 medical  presumption will be, that it was  born dead ; but if it has
 arrived at the full period, then the presumption  is that it was  born
 alive.
  Conclusions.—The following may be taken as a summary of the
 principal facts upon  which our opinion  respecting the uterine age
 of a child may be based :—
  1. At six months.—Length, from nine to ten inches;  weight, one
 to two pounds;  eyelids agglutinated;  pupils closed by membranae
pupillares ; testicles not apparent in the male.
  2. At seven months.—Length,  from thirteen to fourteen inches ;
Aveight, three to four pounds ; eyrelids not adherent; membranee pu- 
INSPECTION  OF  THE BODY.
553
pillares  disappearing;  nails  imperfectly developed;  testicles not
apparent in the male.
  3. At eight months.—Length, from fourteen  to sixteen inches ;
weight, from four to five pounds; membranse pupfillares  absent;
nails perfectly developed, and reaching to  the  end  of the  fingers;
testicles in the inguinal canal.
  4. At nine months.—Length, from sixteen to  twenty-one  inches ;
weight, from five to nine pounds; membranse pupillares  absent;
head avcII covered Avith  fine hair; testicles in  the  scrotum ; skin
pale; the finger nails Avell formed  and reaching to the ends of the
fingers ; features perfect—these and the body are well developed even
when the length and weight of the child are less than those above
assigned.
  5.  The point of attachment of the umbilical cord,  Avith  respect
to the length  of the body, affords no certain evidence  of the degree
of maturity.
  Inspection of the body.—The questions Avhich a medical jurist has
to solve, in examining  the body  of a neAv-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. AVhether it has been born
alive; 4. The period of time which has elapsed since  its death;  5.
The cause of death—Avhether violent or natural.
  Hence, before commencing the inspection—
  1.  The length  (measured from  the summit of the head to the
sole of the foot) and weight of the body should be taken; 2. The
presence or absence of external foetal peculiarities noticed;  3. Any
peculiar marks or indications of deformity Avhereby identity may
be sometimes established; 4.  All  marks of violence, in the shape
of wounds, bruises,  or  lacerations, and  the kind of instrument  or
weapon by  which they were  probably produced ; 5. AVhether the
umbilical cord has been cut, or tied, or lacerated ;  the appearance
of the  divided vessels, and the length of that portion which is still
attached to  the  body of the child; 6.  The presence  or absence  of
cernix  cascosa about  the  groins, arm-pits, or neck—the presence  of
this substance proves that a child has not been Avashed or attended
to;  7. It Avill be  necessary to state whether there are about the
body any marks of putrefaction, indicated  by a separation of the
cuticle, change of color in the skin,  or offensive odor.  It  is obvi-
ous, that unless these circumstances  are noticed before the inspec-
tion is  commenced,  they7 may be entirely lost as evidence.   Xotes
should  be made on the spot, and the original retained, even if copies
be subsequently made.
  A medical  man cannot be too careful in  noticing upon the body
of the child any characters which  may serve as proofs of ideutity.
He must remember that the defence  may be that the child is not
that of the woman charged Avith murder. This  observation applies
especially to the examination of the bodies of  children  that may
have survived their birth for some  days.  The body may be found
wrapped in paper or in  some articles of clothing Avhich  may help
to establish  identity.  If the child has survived its birth, it would 
554       PROOFS OF LIFE BEFORE  RESPIRATION.

be proper to form an opinion at once for Iioav many days. ^ The state
of the umbilical cord, and Avhether the part to Avhich it is attached
is in the process of healing, or already healed, are facts which may
help a medical opinion respecting  the date of birth.  In addition
to these points, the sex and color of the hair should be noted, any
particular marks on the skin (mother's  marks),  and, of course, all
Avounds or  other injuries, their cause or mode of production, and
their situation.
                  CHAPTER  XLVII.

EVIDENCE OF LIFE BEFORE RESPIRATION.--PUTREFACTION  IN  UTEHO.—
  EVIDENCE OF LIFE AFTER RESPIRATION.--COLOR, VOLUME, CONSISTENCY,
  AND ABSOLUTE WEIGHT OF THE LUNGS.—STATIC TEST.—AVEIGHT IN-
  CREASED BY RESPIRATION.

  The question whether a child AA7as, or was not, born alive, is of
great importance in  a case of alleged child-murder;  and it is un-
fortunately one which, in respect  to  the proofs  upon Avhich medi-
cal evidence is commonly founded, has  given rise to  considerable
controversy.  When it is  stated  that in most cases of alleged in-
fanticide which  end in acquittals in spite of the  strongest moral
presumptions of guilt, the proof fails on this pjoint only, it must
be obvious that this question  especially claims  the  attention of a
medical jurist.   The medical evidence of a  child having been alive
Avhen violence was offered to it at its birth or afterwards, may be
divided into tAvo parts:  1, that which is obtainable  before the act
of respiration is performed ; and 2, that which is obtainable after-
Avards.  At present, it will be  proper to confine our  attention to
the question,  whether  the child was  legally living when it was
maltreated—the fact of its having been born  alive will be a matter
for future  consideration.   These two  questions  have been fre-
quently but improperly associated, thus rendering the  subject con-
fused ; but it  must be so obvious as scarcely to require stating, that
violence of a murderous kind  may  be offered  to  a  living child
before it is entirely born; and that owing  to this violence it may
come into the Avorld dead.
  Proofs of life before respiration.—It Avas formerly supposed, if the
lungs  contained  no air, that the child could not have breathed,
and  must  have been born dead; but this is now proved to be an
error.   Children have been known to breathe feebly, and  continue
in existence many hours, without visibly distending  the cells of the
lungs Avith air; the absence of air  from the lungs, therefore, fur-
nishes no proof either that respiration has not been performed, or
that the child has  not  lived.   The restoration of many  children
apparently born dead is a clear proof that  many are born living
who might be pronounced dead, simply because breathing and life 
            SIGNS OF  PUTREFACTION IN  UTERO.         555

have been considered synonymous terms.  That our law-authorities
will admit evidence of life in a child before the establishment of
respiration, is clear from the decision of Rex v. Brain, in which
the judge said, that a  child might be born alive, and not breathe
for some time  after  its birth (" Archbold,  Crim.  Plead.," 377), as
also from the  charge  of Coltman J. in the  case of Rex v. Sell is
(Xorf. Spr. Circ. 1837).  In  this  instance it was alleged that the
prisoner  had murdered her child  by  cutting off  its head.  The
judge directed the jury, that if the child Avas  alive at the time
of the  act, it .was not necessary,  in order to  constitute murder
that it  should have  breathed.    In fact,  it would  appear that
respiration is regarded as only one proof of  life; and the laAV will,
therefore, receive  any other kind of evidence which may satisfac-
torily shoAV  that  the  child  has lived, and  make  up for the proof
commonly derived from the  state of the  lungs.  It will be first
necessary for a medical  practitioner to  prove that the child  under
examination  has  recently died, or  in other words, that there arc
good grounds for believing it to have been  recently living.  Hence,
if the body is highly putrefied, either from the  child  having died
in the uterus some time before birth, or from  its having been born
and its body  not  discovered until putrefaction  had far advanced
both internally and externally, the case is utterly hopeless.   The
medical Avitness will  in general be  compelled to abandon the in-
vestigation, because the body can  furnish no evidence whatever of
life after birth.  The examination of the thoracic  organs Avould
throAv no light on the case, for here we are assuming that the lungs
are in their foetal  condition.
  Signs of putrefaction in utero.—The phenomena of putrefaction
in air have been elsewhere described ; but the changes Avhich  ensue
when a child dies and is  retained within  the uterus, may  be
briefly adverted to, because they may sometimes form a subject for
judicial inquiry.
  In an advanced state of uterine putrefaction, the body of the child
is so flaccid,  that  Avhen placed on a table it becomes almost flattened
by  the mere gravitation  of its parts.   The  skin is of a reddish-
brown color, not green, as in a putrefied body exposed to air.   The
cuticle covering the feet and hands is Avhite, and  sometimes raised
in blisters; the cellular membrane is filled Avith a reddish-colored
serum, the bones are movable, and readily  detached from the soft
parts. In the opinion of Devergie, the principal  difference between
uterine and  atmospheric putrefaction in the body of a neAv-born
child, is seen  in the color assumed by the  skin ; but  it must be
remembered, that should the child  remain  exposed to the air after
its expulsion, the skin may acquire  the color observed in  cases of
atmospheric puitrefaction.  The changes  which  have just been de-
scribed are such as Ave may expect to find Avhen a child has been
retained in the uterus eight or ten days after  its death.   AVhen it
has remained for some Aveeks in the uterine cavity, the body has
occasionally been found in an adipocerous state, or even incrusted
with phosphate of lime.  If in any case we are able to state dis- 
556       EVIDENCE FROM  MARKS OF  VIOLENCE.

tinctly  that  the body of a child  has undergone uterine and not
atmospheric  putrefaction, it is clear that it could not have come
into the Avorld alive, and no question  of murder would  arise.
Under ordinary putrefaction in air, a child may have been really
brought into the world living, and the process may have destroyed
every proof of that fact.
  A medical man cannot  rely upon  the presence of offensive dis-
charges before birth as absolute evidence of the death of the foetus.
In tAvo instances Dr. Hicks met with Avell-marked  putridity of the
discharges before  the birth of the  child, yet  in  one of these, the
child Avas born alive and strong.   In the other, there w7as evidence
of life in the child (loc. cit.).
  Evidence from marks of violence.—It has  been proposed  to  seek
for evidence of life, under these  circumstances, by observing the
characters presented by marks of  violence on the body.  In general,
when children  are murdered,  the amount of violence  inflicted is
considerably greater than that Avhich  is required to  destroy them,
whereby satisfactory  proofs of the crime are occasionally obtained.
On the other hand, the body of a still-born child, dead from natural
causes, is often covered with lividities and  ecchymoses; the foetal
blood does not coagulate Avith  the same  firmness  as in the adult:
hence the evidence derivable from the extent, situation, and charac-
ters  of  marks  of violence,  is generally of too vague and uncer-
tain a  kind to allow of  the expression of a medical opinion that
the  child was living when the  violence  was offered to it.  The
characters which have been already described as peculiar to wounds
and  contusions  inflicted during  life,  may  be  met with  in a child
whether it  has breathed, or died without breathing.   So, again,
these characters are open to the exceptions there pointed out; for
they will be equally present, supposing the  wounds  to  have been
inflicted immediately after the cessation of respiration or circula-
tion in the child, or after the cessation of circulation only—if the
act of respiration has not been performed.   Marks of violence on
the body of a child that had died in utero tAventy-four or forty-
eight hours  before it was born, Avould  not present the characters of
injuries  inflicted  on  the living.   There Avould be no ecchymosis
and  no effused coagula of bloocl.   These  marks, when they exist,
although they may establish that a child was  either living, or but
recently dead at the time they were inflicted, can  never show that
it was  born alive.  Injuries met with  on the bodies of children
alleged to have been  born dead ought, however, to be of such a
nature as to be readily explicable on the supposition of their having
arisen from  accident.   If, from their  nature, extent, or  situation,
they are such  as  to  evince a wilful  design to injure, it  is a fair
ground for a jury—not for a medical witness, to inquire Avhy these
extensive wounds, or  other  marks of violence,  were inflicted on a
child, if, as it is alleged, it Avas really born  dead.   It must be con-
fessed that in such a case, there would be a strong moral presump-
tion of murder, although  medical  proof of life,  or actually live
birth, might totally fail. 
           PROOFS  OF  LIFE  AFTER RESPIRATION.       557

  As a  summary of these remarks,  it  may  be  observed, that
although  physiologically,  a child  may live for a  certain period
after its birth without breathing—and legally its destruction dur-
ing this period would amount to murder,—yet there are at present
no satisfactory medical data to enable a witness to  express a posi-
tive opinion  on this point.  If other evidence were adduced of a
child having  lived and been destroyed under these circumstances—
as where, for example, a  woman causes herself to be delivered in.a
water-bath, or an accomplice covers the  mouth of an infant in the
act of birth, or immediately after  it is bdrn—a  medical Avitness
would  be justified in asserting that the absence  of the signs of
respiration in the lungs was no proof that the child had been born
dead.  Indeed, it is  apparent that the process could  not be esta-
blished, OAving 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 Avell-ascertained medical
principles, and not for the purpose of procuring either the convic-
tion or acquittal of persons accused  of offences against the law.
In general, those cases in  Avhich questions  relative to life before
respiration might arise are stopped  in  the  Coroner's  Court—the
usual practice being, Avhen the signs of respiration are absent or
imperfect,  to  pronounce that  the child was  born dead.  If the
lungs sank in Avater, the presence of marks of violence on the body
would  be considered as  furnishing no evidence:—for the sinkino-
of the lungs would, in general, be taken as a proof of still-birth. "
  There  is a class of cases in Avhich a child is born alive, but its
lungs remain  in  the  foetal  condition, i. e., they present  no appear-
ance of having  received air by the  act of breathing.   These are
cases of atelectasis (p. 564).  The appearances in the body are the
same as in still-born  children.  Prof.  Donders, who  met with  one
of these cases in Avhich he pronounced the child to be  still-born
when it Avas distinctly proved that it had lived twelve hours, says
truly, " Where the signs  of an  extra-uterine life, which  does  not
betray itself by air in the  lungs  are to be found, futurity must
declare."
  The  absence  of air from the lungs may  really be the result of
the forcible prevention of respiration in the act of birth.  There
cannot  be  the slightest  medical doubt that living children  are
occasionally thus destroyed : they die,  not from the actual infliction
of violence, but  because, either through design or accident,  the
performance of that  act which is necessary to  maintain existence
when the child is born, is prevented.  Such a case has not yet been
decided, although from the dicta of our judges, it would probably
involve a charge of murder.
  Proofs of life  after respiration.—There is no doubt that the proof
of the act of respiration furnishes  the best and strongest evidence
of a child having lived at or about the time it was born.   It  does
not, hoAvever, sIioav that a child has been born alive.  The physical
changes in the body of a child, which result from  the establishment 
558
EXAMINATION OF THE LUNGS.
of this  process take  place  in  the lungs immediately, and in the
heart and  its appendages  more slowly.  It is therefore chiefly to
the lungs that  a medical  witness looks for proofs of respiration.
Sometimes, however, these organs are found in their foetal condition,
or nearly so;—for although a  child may have  survived  its birth
many hours, there may be no  evidence of the  fact from the state
of the lungs.  To such cases, the remarks  now about  to  be  made
cannot of course apply:—the proofs of life must then be sought
for elseAvhere, and if none can be found, the case is  beyond  the
reach of medical evideuce.  But it is obvious that the occasional
occurrence  of cases of this description can  present no  objection to
our still seeking for proofs of life in  the  state of the lungs, any
more than  the fact of poison not being always  discovered in  the
body of one avIio has died from poisoning,  Avould  be a bar to  our
seeking for the proofs of poison in any unknoAvn case which pre-
sented himself.  It is the more necessary to insist upon this point,
because some have  held, that, as  we cannot always derive proofs
of life from an examination of the lungs of new-born  children, we
should abandon all evidence of this description and leave  the  case
in its original obscurity.   The very object of medical jurisprudence
is to endeavor to  remove these  difficulties, and  to show  in every
department of the  science, the degree to Avhich Ave may safely
trust the medical proofs of crime, however insufficient,  inconsistent,
or contradictory they may at first  sight appear.
   Examination of the lungs.—The  cavity of the  chest  may be  con-
veniently laid opien  by carrying incisions from below  the clavicles
downwards, on each  side from about half the  length of the ribs
backwards.  The  diaphragm should  be separated from the carti-
lages Avithout opening the abdomen ; the ribs sawn or cut  through,
and the flap) formed by the anterior parietes of the chest turned
upwards.   The differences in the relative position of the organs of .
the chest before and after respiration may be thus stated:   1.  If a
child has not breathed, the thymus gland, as large as the heart, will
be found occuprying the upper  and middle portions of the chest;
the  heart  within its  membrane (pericardium)  is situated in  the
lower and  middle piortion, 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 Avanting.   In  some
instances, they project slightly  fonvards by their anterior margins,
but  in no  instance, unless congested, infiltrated, or  otherwise dis-
eased, do they cover and conceal the heart.   The thymus  gland, is
sometimes  of a pale  fawn, at others of a  deep livid color;  but
there is no  percepitible difference in this organ in new-born children,
before or after the  performance of respiration.   2. On the  other
hand, when a child has fully breathed,  the most striking differences
will be  observed in the color and  prominence of the lungs.   They
are of a light  red hue, project forwards, appear to fill the entire
cavity of the chest, and  cover, and  in great piart conceal by their
anterior margins, the heart and its membrane.  We may meet with
every variety in the appearances betAveen these two extremes; for 
               EXAMINATION  OF THE  LUNGS.             559

the process of respiration often requires a considerable time in order
that  it should  be fully  established, especially in children which
are of a Aveakly 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 Avhich a child has lived, but  according to the
perfection Avith Avhich respiration has been performed.   Although,
as a general rule, the lungs are  more perfectly filled Avith air in
proportion to the time during Avhich a child survives its birth, yet
this is open to  numerous  exceptions.  The physical characters of
the lungs iioav require notice.
   Color.—The color of the lungs  before respiration is bluish-red, or
deep violet, but it is subject  to variation.  Some medical jurists
have compared  it  to  the color of the spleen.   A  short exposure to
air will  materially brighten the color in the parts exposed, so that
it should  be observed and recorded  immediately on opening the
chest.  After respiration, the lungs acquire a light red hue in pro-
portion to the degree  in which the process has been performed.  If
imperfectly established, they will be  mottled, generally about the
anterior surfaces and  margins, the patches of light red being inter-
mixed Avith the livid foetal hue, and being slightly raised, as if  by
distension, above the general surface of the organs.   The light red
tint changes after a short exposure to air, to a bright scarlet.
   This change in the color of the lungs is not  a necessary, nor is it
an invariable consequence of a child having lived  after its birth.  I
haA7e knoAvn a child to live twenty-four hours breathing feebly, and
on examining the body, the color of the lungs was identical with
that of the organs in the foetal state.   The change of color is then
a usual, but by no  means a  necessary, consequence of the enjoyment
of life;  so  that the retention of the foetal color  does  not furnish
positive evidence  of  still  birth.  Again,  the  circumstance of the
lungs having a  light red  color is not an infallible criterion of the
child having lived and breathed ; for the artificial introduction of
air by a tracheal tube, or otherwise, in  the attempt to  resuscitate
a still-born child,  is attended with the same physical change.   In
the course of numerous experiments, pmrposely made, I have found
no appreciable difference.  Bernt  says, that artificial inflation will
not produce a scarlet red color in the organs, and therefore that this
is a criterion of respiration. (" Ed. Aled.  and Surg. Journ.," vol. 26,
p. 367.)   I  have not only observed this color to be absent after res-
piration, but have actually produced it by artificial inflation in the
lungs of a dead  child.   Dr. Falk, of  Berlin,  has made numerous
observations on the color of the lungs during uterine life and after
birth.  (" Ann. d'Hyg.,"  1869? 2, 462.)  It has been already stated
that the color varies much in  new-born  children,  irrespective of
respiration.
  Volume.—Before respiration, the lungs are in  general scarcely visi-
ble, unless forcibly draAvn forwards in the chest. AVhen  it  has been
perfectly accomplished, the volume is so much increased,  that the
bag of the  heart (pericardium) is almost concealed by them.   Res- 
560    EXAMINATION  OF THE  LUNGS — STATIC TEST.

piration  must, however, have been perfectly performed  in  order
that this condition should exist to the full extent described.
  Consistency.—The lungs, before respiration, feel like the liver, or
any other of the soft organs of the body.  They are firm under the
finger, but their substance may be lacerated  by violent compression.
After respiration has been fully performed, there is a distinct sensa-
tion of Avhat is termed crepitation, on compressing them, i. e., air is
felt within them.   If a  thin  section of the lung is submitted to
examination Avith a low  poAver of the microscope, before respiration,
it Avill present the solid appearance of a section of the liver, spleen,
or kidney; after respiration, air-cells will be  distinctly seen in it.
These conditions of the lungs  must, of course, depend on the degree
to Avhich respiration has  been  carried.   The lungs of children that
have  lived for a considerable  time after birth will sometimes give
no feeling of crepitation under the finger.   Crepitation may also
result from  putrefaction, and from  artificial  inflation.  Generally
speaking, lungs of this  kind  present the other f'cetal characters;
thus, they are small and of a livid color, and no air-cells may be
detected on a microscopical examination.
  Absolute weight of the lungs.   The static test.—The absolute Aveight
of the lungs before respiration is  less  than that which they have
after  the establishment of the  process.   From this an inference has
been drawn  that the absolute weight of the lungs in an unknown
case, compared with certain averages, Avill aid the inquirer in ascer-
taining whether respiration has or has not  been performed.  In
order to determine the weight of the lungs, these organs should be
carefully separated by dissection from the heart and thymus gland,
and  removed with  the trachea and bronchi attached.  Previously
to their removal, ligatures  should be placed on the pulmonary ves-
sels, so that no blood may escape from the  lungs.  They should
now be weighed, and the w7eight accurately notechin grains.  The
average weight before respiration, derived from nine cases, was found
to be 649 grains.  According  to Dr. Traill,  the weight varies from
430 to 600  grains.  It is  of  importance in taking the Aveight of
these organs, to observe whether the child is  at or near maturity,
and whether its body is fully developed, or of about the average size
and weight ; owing to a neglect of this rule,  it is highly probable
that comparisons  have been made of the absolute weight of the
lungs in children of different ages, which a  full statement of the
facts would  not have  justified.  If it  be small  and immature, or
unusually large, the lungs  will weigh  either less or more than the
average.  The average w7eight of the lungs after respiration derived
from  three cases, was 927  grains ; but  in making an estimate of
this  kind, much will depend upon  the degree to which respiration
has been carried.  In three cases, in which the children  lived half
an hour, six hours, and twenty-four hours respectively, the process
had been so  imperfectly performed, that the lungs varied but little
in weight from the average before respiration.  (" G. H. Rep.," Xo.
V.)  The truth is, we cannot compare the lungs of  children as to
Aveight, by  the time which they  may  have survived birth, but 
BEFORE AND AFTER RESPIRATION.         561
rather by the degree  to Avhich the lungs have been penetrated by
air.  Another circumstance must also be considered  in  basing an
opinion on the absolute Aveight of the lungs.   Although there "does
not appear to be any strict  normal relation between the weights of
the body and lungs in new-born children, yet it is certain that in
the bodies of children of unusual Aveight, the lungs will be found
much heavier than the average, whether the  child  has breathed
or not.  The body_ may vary from six  to eighteen  pounds;  the
lungs under these circumstances will also differ in weight.
  The healthy lungs of mature new-born children, become heavier
after respiration, and according to its degree; and where a deviation
from this rule is observed, it may probably be explained by  the
circumstance that the lungs of an immature, have been  compared
with those of a  mature child; the  lungs of an undeveloped twin
with those of one not a twin; or the lungs of one Avhich has breathed
imperfectly Avith those of another in Avhich respiration has become
well  established.  The following table represents  the weight of the   *
lungs, in four cases: it will shoAV how much the organs are liable to
vary in weight after birth, according to the degree of respiration:—
      Case 1.  Born dead.....Weight, 687 grs.
          2.  Lived 6 hours     ....       "774
          3.  Lived 24 hours    ....       "675
          4.  Lived 9 hours     .   .    .    .       "    851'

  Relying upon the mere weight of the lungs, it might be inferred
from this table, that the organs would Aveigh  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, AA7hether 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 Avith the lungs in the foetal,
than in the  respired state.   They merely show Avhat  is very well
known and admitted by all medical jurists, that there are some
instances in Avhich the fact  of respiration cannot be determined by
the application of the static, or any  other test to the lungs, simply
because  they contain no air.  Increased Aveight,  therefore, is only
one among several circumstances, to which a medical jurist should
attend.
  Great Aveight of the lungs can obviously furnish no proof of respi-
ration, unless this is accompanied by the other  physical changes
indicative of the process; as, for example, increase in volume from
the presence of air, crepitation, and the detection  of air-cells by  the
microscope.  If the lungs are heavy, and at the same time contain
little or no air, the increase of Aveight must depend upon disease or
other abnormal causes—not upon respiration.   In one case which I
had to examine, the lungs Avere large, and Aveighed upAvards of 1200
grains.  They contained no air; when divided into thirty pieces,  not
one portion floated, nor could any air be seen on the closest examina-
tion.  It was therefore clearly impossible to ascribe  a Aveight so much
      86 
562         SPECIFIC GRAVITY OF  THE LUNGS.
above the average to the effects of respiration.   On the other hand,
in a  case communicated to me by Air. Cann of  DaAvlish, the lungs
of a new-born child apparently full-grown, although fully distended
with air, weighed only 626 grains.  In this case, the  body of the
child weighed only six pounds, and a quantity of blood had no doubt
escaped from the lungs, OAving to the pulmonary vessels not having
been tied before their removal from the chest.   It must not be for-
gotten that all the physical characters presented by lungs that have
respired are liable to certain fallacies; but, as in the evidence derived
from tests used in poisoning, these may be removed, or the force of
the objection diminished, by not basing an opinion on  one or two
conditions only. AVe should take the Avhole combined ;  for it Avould
be as wrong to  regard great weight in the lungs taken  alone as an
absolute proof of respiration, as it Avould be to  clraAv the same in-
ference from a mere change in the color, volume, or consistency of
the organs.
   Ai. Ploucquet proposed to determine Avhether the act of respira-
tion had taken  place or not, by a  comparison of  the absolute weight
of the lungs Avith  the weight  of  the body of a child.   This, Avhich
has been called  the test of Ploucquet, is based  on the  fallacy that
there is an invariable relation betAveen the Aveights of the lungs and
bodies of  new-born children. Xo such relation exists; and this
method of arriving at a solution  of  the question of respiration has
been abandoned by all medical jurists.
   Hie  specific gravity of the lungs.—The specific gravity  of the lungs
is greater before, than after respiration; for although the organs
become absolutely heavier by  the establishment of the  process, this
is owing, not to the air, but to the additional quantity of blood re-
ceived into them.   The air thus received so increases the volume of
the lungs as to more than counteract the additional Aveight derived
from the blood, and thus apparently to diminish their specific grav-
ity.  Under these circumstances, they readily float on water.  From
several experiments, I have found that  the specific gravity of the
lungs before respiration, i. e. in the foetal condition, varies from 1.04
to 1.05.  They are about one-tAventieth part heavier than their bulk
of Avater.  After respiration, the specific gravity of the lungs Avith 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 wTater.   The introduction of a small quantity of air Avill render
the lungs buoyant in Avater; and an alteration of the volume sufficient
for this purpose, would not be perceptible to the eye.  It will  be
understood that the specific gravity of the substance of the lungs is
unchanged ; the organs are rendered only apparently lighter by the
air contained in their cells, on the same principle as a bladder filled
Avith air.   Hence it folloAvs that the apparent diminution of specific
gravity will take place Avhether the air is derived from respiration,
artificial inflation, or putrefaction.  It is on this property of the
lungs that the application of what  is termed the hydrostatic test, or
the docimasia pulmonaris, is  founded—a subject which may be ap-
propriately considered in another chapter. 
THE HYDROSTATIC  TEST.
563
  Com-lnsions.—The general conclusions Avhich maybe draAvn from
the contents of this chapiter are:—
  1. That a child may be born alive, and be criminally destroyed
before it has breathed.
  2. That the  presence of any marks indicative of putrefaction
in the uterus proves that the child must have come into the world
dead.
  3. That there are no  certain medical  signs by which a child
which has not  breathed can  be proved to have been living Avhen it
was maltreated.
  4. That a new-born child may be destroyed by the prevention of
respiration during delivery.
  5. That by taking together the  color, volume, consistency, abso-
lute Aveight, and buoyancy of the lungs, we may be able to draw an
inference Avhether the child has or  has not breathed.
  6. That the_lungs increase in weight according to the degree to
which respiration is  established, and not  necessarily according to
the period which the child has survived birth.
  7. That no reliance can be placed upon the test of Ploucquet, or
the proportionate Aveight of  the lungs to the body.
                  CHAPTER  XLVIII.

THE HYDROSTATIC TEST.—SINKIXU OF  THE LUNGS  FROM  DISEASE  OR
  ATELECTASIS.—LIFE AVITH PERFECT ATELECTASIS OR ENTIRE ABSENCE
  OF AIR FROM  THE  LUNGS.—ERRONEOUS MEDICAL  INFERENCE  FROM
  SINKING OF THE LUNGS.—FLOATING OF THE  LUNGS FROM PUTREFAC-
  TION.—EFFECTS OF PUTREFACTION ON THE LUNGS.

  The hydrostatic test.—The mode of employing this test is extremely
simple.  Having removed the lungs from the chest, they should be-
placed, still connected with the  air-tubes, upon the surface of dis-
tilled, or river water.  If they sink,  it should be noted whether
the sinking takes place rapidly or sloAvly.  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 Avill sink.
Supposing that both lungs sink, it Avill then  be  proper to divide
each into twelve or fifteen pieces, and place  these pieces separately
on Avater.   If,  after this, they all sink, the inference  is,  that
although the child may have lived and survived its birth, there is
no evidence of its having breathed.   On  the other  hand,  the organs
when placed on water may float; it should then be noticed Avhether
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 Avhich  respiration
has taken place.  It Avill  iioav be propter to separate the lungs, and 
564         SINKING OF THE  LUNGS  IN WATER.
determine Avhether the buoyancy is due  to one or  both.  Each
lung should  be divided, as before, and each  piece separately tried.
If all  the pieces float, even after  firm compression, we have good
evidence, cceteris paribus, that respiration has been  very perfectly
performed.   Should any of the divided portions sink in water,
either before or after compression, our opinion should be modified
accordingly.   Some have recommended  that the  lungs should  be
placed on water with  the  heart and thymus gland attached; but
there appears to be no good reason for this, since it is as easy to
form an opinion of the degree of buoyancy possessed by the lungs,
from the readiness with Avhich  they float, as  by observing Avhether
or not they have the piower to support these two organs.
   AVith regard to the inference derivable from the use of this test,
it should be observed that  the floating of the lungs in Avateris not,
as it is often incorrectly represented to be, a proof that a child has
been born alive ; nor is the fact of  their sinking in water any proof
that a child was born dead.   The floating, under the limitations  to
be  described, proves only that a  child  has  breathed, the sinking,
either that it has not breathed, or breathed but  imperfectly.   The
fact of a child having been born living or dead,  has, strictly speak-
ing, no relation to the employment of the hydrostatic test.  There
are  cases  of  infanticide Avhich  may be readily established Avithout
resorting  to  this test, and others Avhich cannot be piroved by its
use; all that the laAV requires is proof that a child has  been born
living; and Avhether this  proof be furnished by the state of the
lungs  through the hydrostatic test, or in any other manner, is  of
no moment.   The signs of life are commonly sought for in the
lungs, because it is in these organs that the changes produced by a
new7 state of existence are  most distinctly perceived;  but this
examination may  be  dispensed with when  the woman confesses
that the  child Avas born alive; when others have seen it manifest
life  by motion  or otherwise  after its  birth ;  or, lastly, in  cases
where, Avithout  being seen, it has  been heard to cry.   The crying
of a child has been admitted as evidence of live  birth  on several
trials  for infanticide;  although, as it is elsewhere stated, a  child
may utter a cry and die before its body is entirely born.  Among
the  objections which have been  urged to the employment of the
hydrostatic test, we have first to consider those which concern the
sinking of the lungs in w7ater.
   Sinking of the lungs from disease  or atelectasis.—It is said that the
hydrostatic test cannot shoAV whether a child has or has not survived
its birth, because  the lungs of children  that have lived for a con-
siderable period have been observed to sink entirely in water.  In
some instances, this may depend on disease, tending to consolidate
the air-cells, as hepatization or scirrhus ;  in others, on oedema or con-
gestion: but these cases can create  no difficulty, since the cause of
the lungs sinking in water, would be at once obvious on examina-
tion.  The hepatized portion of lung may be known by the firmness
with winch it resists cutting  with  a knife, as also by the fact that
it is impossible to distend  it artificially with'air.  On the  other 
CASES  OF  ATELECTASIS.
565
hand, there are cases in which the lungs appear healthy and unaf-
fected : all  that  Ave can  perceive is,  that  they retain  their fcetal
condition.  This is a very different state from that of hepatization,
because the lungs may, in this case, be made to receive  air by arti-
ficial inflation.  It is remarkable  that life should continue for
many hours, and sometimes even for days,  under such a condition;
but the occasional  existence of this  state of the lungs in a living
child is placed beyond all dispute;  the explanation of the causes
upon Avhich it depends—Iioav it is that a child may live  for hours
or days, and no signs of respiration be discovered in its body after
death, is, hoAvever, involved in difficulty.  The lungs appear to be
simply  unexpanded, or to retain  their fcetal condition; a state to
which the name of atelectasis has been given.   This condition may
be found in the whole, or in a part of the organs.
  Dr. Albert met with a  case, in which a child died thirty-six hours
after its  birth, having been  attacked by convulsions at  intervals
during that time.  On inspection, the Avhole of the right, and the
lower portion of  the  left lung Avere found to be in  their fcetal con-
dition, and they immediately sank Avhen immersed in Avater. There
was no diseased appearance in the organs, and the undistended por-
tions Avere easily tilled by blowing air into them.  (Henke's " Zeit-
schrift," 1837, vol.  ii. p. 422.) AI. Depaul found that in many cases
in Avhich children  had died  suddenly after breathing  for several
hours or days, there was no  other  morbid appearance to be  per-
ceived than an unexpanded condition of a large portion of the lungs.
(" Aled. Gaz.," vol. xxxix. p.  283.)
  It is quite necessary for a  medical jurist to be  aw7are that the
state of the lungs Avhich is here called atelectasis, is by no means
unfrequent among  neAV-born children, although attention  has  been
only of late years draAvn to the subject.   When no portion of air
is found  in the  lungs of a child, there is no test by which such a
case can  be  distinguished from one  in Avhich  the  child  has come
into  the world dead.  These cases of atelectasis are ordinarily set
down as  exceptions to a  general rule; but I believe they are more
common  than  some medical jurists are inclined to  admit.  In ex-
amining  the body  of a child, the history of Avhich  is unknown, it
is proper that  the possible occurrence of such cases should be Avell
borne in mind.  It appears to me not improbable that many such
come yearly before coroners  in this country, and that they are dis-
missed  as cases of stillborn children,  notAvithstanding that marks
of violence are often  found  upon the bodies.   If, as it  has  been
already observed, the  lungs  sink in  Avater, this fact alone is com-
monly, although  improperly, regarded as sufficient evidence of still-
birth!  This is assuredly putting the most humane interpretation
on the circumstances, and so far the result is not to be objected to;
but we should  take care, in carrying out this principle,_that Ave do
not throw obstacles in the way of a subsequent judicial  inquiry,
and lead  to the  concealment of crime.  Professor  Bernt  met Avith
an instance  in Avhich a  seven-months' child died  two  hours after
birth; and when its lungs Ave re divided and placed in water, every 
566
ERRONEOUS  MEDICAL EVIDENCE.
portion 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.  AL," p. 374.)  In this case the navel-string  separated natu-
rally before death.  Orfila found, in a child which had lived  eleven
hours, every portion of the lungs when divided, to  sink on immer-
sion.   In three  other  instances,  in which the  children  survhed
birth four, six, and ten hours, the  lungs also sank when divided;
two of these were mature.  ("Aled  Leg.," vol. i. p.  375.)
  Dr. Vernon  attended a  healthy woman, who was delivered of a
child at about the sixth month of her  pregnancy.  The child Avas
born before his arrival, and he heard it  crying strongly from  under
the bed-clothes as he entered the room.   After removal from  the
mother, the child  cried at intervals, and  it Avas observed that its
chest rose  and fell as in ordinary breathing.   It lived five hours,
and it  then appeared to die from feebleness and exhaustion.  It was
a female child, and very small; the body weighed 2 lbs. 13 oz., and
its  length Avas 12f inches; the eyelids  were adherent.  The lungs
were of a purplish-red color, and slightly overlapped the bag of  the
heart;  they sank in water both entire and when divided into small
pieces; they were  not crepitant,  and broke down under firm com-
pression ; there was no  appearance of air-cells in a section  of  the
lungs when examined by the microscope.  The  ductus arteriosus
and foramen  ovale were  in  the fcetal state.   (" Lancet," Feb. 3,
1855, p. 121.)   A still more remarkable case  recently occurred to
Prof. Donders of Utretch.   (Report by Dr. Aloore, "  Dublin Aledical
Press," Nov. 22, 1865, p. 456.)  The body of the child was sixteen
inches  in length, and weighed nearly five pounds.   It was  probably
a seven months' child.  The lungs were of a brown  color, and sank
in water entire and Avhen divided.   There Avas no  crepitation, and
on pressure only a reddish fluid without air escaped.   The bladder
was empty ; there was no  food in  the  stomach, but there Avas me-
conium in  the large intestine.  From this state of facts, Prof. Don-
ders concluded  that  the  child was  immature—stillborn—only a
short time dead, and remaining  in the uterus only a short time
after death.  It transpired, hoAvever, that the child had been born
alive, had survived its birth twelve hours, and had  cried distinctly
after it was born.  As the lungs could be readily  inflated, and as
the child had cried, he concluded  that air had been received into
the lungs, and had been again slowly expelled, the child dying in a
kind of asphyxiated state.  I may add to these instances two Avhich
have occurred under my own  observation.  In one, the  case of a
mature male child, the lungs sank in water, although the child had
survived birth for a period of six hours.   In the other,  the case of a
female  twin, the child survived twenty-four hours ;  and after death
the lungs were divided into  thirty pieces ; but  not a  single piece
floated ; showing therefore that, although life had been thus pro-
tracted,  not one-thirtieth  piart of  the  structure  of the lungs had
received from  respiration sufficient air to render it buoyant. (" Guy's
Hospital Reports," No. 5, p. 355.)  In  the latter instance no par- 
FAILURE  OF HYDROSTATIC  TEST.
567
ticular remark was made, during life, respecting the breathing of
the child.
  These cases show most clearly that buoyancy of the lungs is not
a necessary consequence of a child having lived and breathed for
some time after birth.  Probably, had these cases called for medico-
legal inquiry, the lungs would have been cut to pieces ; the sinking
of the divided pieces in water, either  before or after compression,
would have been setdoAvn as negativing the act of respiration, and,
unless other strong evidence had been forthcoming, it would have
been asserted that the children had been born dead.  Here, again,
\Are perceive the necessity of not hastily assuming that a child has
been born  dead  because  its lungs sink in Avater.  There may be no
good medical evidence of such a child having lived after birth, but
assuredly the mere sinking does not Avarrant the common and posi-
tive dictum,  that  the child  was necessarily dead Avhen born ; it
would be  as  reasonable  to  pronounce, in a question of poisoning,
that the fact of an individual having died from poison Avas nega-
tived  by the non-discovery of a poisonous substance in the stomach
of the deceased.
   It must be apiparent, on reflection, that cases of this description
are beyond the  reach of the hydrostatic, as Avell as of all other tests
applied to  the respiratory organs; because the lungs do not receive
and retain a sufficient quantity of air to give buoyancy after death,
although the children may have lived some hours. The hydrostatic
test is no more  capable of showing that such children as these have
lived, than it is of indicating from Avhat cause they have died. Facts
of this kind demonstrate that a passive existence  may be for some
time maintained under a state of the respiratory process  not to be
discovered after deatli.   In the opinion of some, these cases form a
serious objection to the hydrostatic test; but it is difficult to under-
stand hoAv they can affect  its general application—or why, because
signs  of respiration do not always exist in the lungs of children that
have lived, we are not to rely upon them Avhen  they are actually
found.  These singular instances pirove that Ave are greatly in want
of some fact to  indicate life after birth, when the signs of respiration
are absent.   Until we discover this, Ave must, of course, make the
best use of that knoAvledge which lies  at our disposal; taking care
to apply it to those cases alone to Avhich experience sIioavs it to be
safely adapted.   In the  mean time, the common inference that a
child  has been born dead because its lungs sink in water, is never
likely to implicate an innocent party; it can only operate by some-
times leading to the liberation of the guilty.
  It has been recommended that medical jurists should consider as
dead every child that has not breathed, i. e., whose lungs sink in water;
but they avIio give this advice at the same time admit that children
may come into the Avorld  living Avithout  breathing, and the  laAV
holds, under the decision of its expounders, that respiration is only
one, and not an  exclusive, proof of life.  In order to establish life,
or even  live birth,  respiration need  not ahvays be proved, either in
civil or criminal cases.   A medical jurist would, therefore, be no 
568        FLOATING OF  THE LUNGS IN  AVATER.

more justified in asserting that  all such children were necessarily
born dead, than that they Avere born living: and in stating what is
the plain and obvious truth, it is not possible that his statement can
ever be the means of involving an innocent person.   It  is certain,
however, in departing from  the truth, and stating what is contrary
to well-known facts, that when the lungs of a child sink in Avater,
it is safe and just to consider such child as having been  born dead,
he is incurring the risk of exculpating a really guilty person; for
it cannot be too strongly  borne in mind, that a woman is not now
charged with  murder, merely because the lungs of her child float
or sink in water, but  because there are upon its body marks of vio-
lent injuries apparently sufficient to account for the death of a new-
born child, or there are strong moral presumptions of her guilt.
   Floating of the lungs from other causes than respiration.—Another
series of objections has been urged to the hydrostatic test, based on
the fact that the lungs may receive air  and acquire buoyancy from
other causes than respiration.   These causes are tAvo:  putrefaction
and artificial  inflation.   Putrefaction.—The  lungs  of a stillborn
child, Avhen allowed to remain in the chest, are slow  in undergoing
putrefaction; but, nevertheless, they sooner or later acquire sufficient
air to render them buoyant in water. When the lungs are putrefied,
this will be determined, in general, by putrefaction having extended
throughout all the soft p>arts of the body. The organs, according to
the degree of putrefaction, will be found soft, of a  dark green  or
brown color, and of a highly offensive odor;  the serous membrane
covering the surface will  be raised  in large visible  bladders, from
which the air may be forced out by very moderate compression.  It
has been remarked that, under the same conditions, gaseous putre-
faction takes place as rapidly in the liver, heart, and thymus gland
of a newT-born child,  as in the lungs; Ave should, therefore, notice
the general state of the body.  The distension of the lungs with gas
from putrefaction  cannot  be easily overlooked or mistaken for the
air of respiration.  The  answer to  any objection founded on  the
putrefied state of these organs, must at once  suggest  itself.  It is
impossible that any well-informed medical witness  can  expect  to
obtain satisfactory evidence from experiments on lungs  in such  a
condition.   He should abandon the case, and declare that in regard
to the  question of respiration, medical evidence cannot establish
either the affirmative or the negative.  The fact of his  not  being
able to give the evidence required cannot be  imputed as a matter
of blame to him, or ascribed to any deficiencies in the hydrostatic
test; this is due to purely accidental circumstances.
   In a case reported by Henke, the lungs and other organs in the
body of a child Avere found in an advanced state of putrefaction.  A
medical witness gave  an opinion that the child was  born dead, but
the prisoner afterwards confessed that it had been born living. The
medical opinion could have been  no more than a conjecture, the
condition  of the body not  alloAving any correct conclusion  to  be
draAvn.  This fact shows that  it is always better to leave a doubtful
case as we find it,  than to express a positive opinion that the child 
          ARTIFICIAL INFLATION O.F THE LUNGS.       569

has been born living or dead.  If on these occasions a witness were
simply to assure a jury, that medical evidence could not solve the
question Avhether the child had lived or not—if he were to assert,
what is really the fact, that his experiments would not allow him to
say Avhether the child had or had not breathed—it is certain that
no innocent person would ever be convicted, or a guilty person ac-
quitted, upon his evidence.  It is for a jury only  to judge of guilt
from all the circumstances laid before them; but it is assuredly not
for a medical witness to prevent further investigation, and put an
end to the case, when there is good reason for doubt.   It is his duty
to state that doubt, and leave the decision of guilt or innocence in
the hands  of the court.
  Conclusions.—The general conclusions which may be drawn re-
specting the application of  the hydrostatic test in cases of  infanti-
cide,  are the following:—
  1.  That  the hydrostatic test can only sIioav whether a child has,
or has not breathed—it does not enable us to determine whether a
child has been born living, or dead.
  2.  That  the lungs  of children that have  lived after birth may
sink  in Avater, owing to their  not  having received air, or to their
being in a  diseased condition.
  3.  That  a child may live for some time Avhen  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 (Avhether whole or divided) in
water, is not a proof  that a child has been born dead.
  6.  That  the lungs of  children Avhich have not breathed and have
been  born dead, may float on water from putrefaction.
  7.  That  the lungs, as situated in the chest, undergo putrefaction
very sloAvly;—that if but slightly putrefied, the gases may be easily
forced out  by compression,  and if much putrefied, either the case
must be abandoned,  or other sources of evidence sought for.
                   CHAPTER  XLIX.

FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION.—INFLATION NOT
  DISTINGUISHABLE FROM IMPERFECT RESPIRATION.—RESULTS OF COM-
  PRESSION.—IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST.—RES-
  PIRATION BEFORE BIRTH.--RESPIRATION A SIGN OF LIFE, NOT OF LIVE
  BIRTH.—GENERAL CONCLUSIONS.

  Artificial inflation.—It has been alleged that the lungs of a still-
born child  may be made to assume, by artificial inflation,  i. e., by
blowing air into them, all  the characters assigned  to those which
have undergone respiration.  Thus, it is said, a child may not  have 
570       ARTIFICIAL  INFLATION  OF  THE LUNGS.

breathed, and yet the application of the hydrostatic test would, in
such a case, lead to the inference that  it had.  It will be seen that
the force of this objection goes to attack  directly the inference
derivable from the discovery of air in  the  lungs.   There is  only
one form under which this objection can be admitted, namely, as it
applies  to lungs Avhich have been inflated Avhile lying in the cavity
of the chest.   Any experiments performed  on them after their re-
moval from this cavity, can have no practical bearing, since, in a
case of  infanticide, we have to consider only the degree to Avhich
the lungs may be  distended  Avith air by a person avIio is fairly
endeavoring to resuscitate a  stillborn child.  Assuming that the
experiment  has been successfully performed, and that the lungs
have been artificially inflated, they would resemble, in their partial
distension with air and other physical characters, those of children
which had  breathed imperfectly.  Like them, they may float on
Avater;  but  on cutting them  into  pieces,  some of these AATould be
found to sink.   If the pieces Avhich  float are firmly  compressed
either by means of a folded cloth, or between the fingers, they will
lose their air and  sink.   When this pressure is  piroduced under
water, it will be seen that bubbles of  air escape, but mere pressure
with  the fingers Avill  not, in general, suffice  to expel  the Avhole.
The same result  is obtained when the divided  portions of lungs,
which have  breathed  imp>er'fectly, are submitted to pressure.  If,
hoAvever, the act of breathing has been perfectly performed, and
the air-cells are well filled, the air  cannot  be expelled by pressure,
or by any  force short of the destruction  of the substance of the
lungs.  This difference in the effect of pxressure  has been hitherto
regarded as  a criterion to distinguish lungs that have fully breathed
from  those which have been  simply inflated;  but Dr. Hicks  met
with  a  case which sIioavs that  pressure Avill not always effect the
expulsion of air, artificially introduced into the lungs of a child
born  dead ;  hence, by an exclusive reliance on this method, a medi-
cal man might be led  to infer that a lung, artificially inflated, had
received air  by respiration.  Dr. Hicks delivered a woman of a
full-grown child; it was stillborn, and there was no effort at respi-
ration.   An attempt was made to resuscitate the child, but unsuc-
cessfully, by blowing air into the  lungs through  a catheter.   On
inspection, the lungs wTere observed to be of large size, but they
did not present the usual  appearances of lungs Avhich had breathed.
Although about  three-fourths of the organs had received air by
inflation, they Avere of a  pale faAvn color,  like the thymus gland;
still the air was contained in the minute air-cells.  They floated on
Avater, as well as all the pieces (fifteen or  sixteen) into which  they
were divided.  When  compressed between the  fingers under water,
small bubbles of air escaped:  but no amount of compression, short
of destroying their structure, caused  these pieces to sink.  A fact
of this  kind, although perhaps exceptional, shows  that the  non-
expulsion of air from  lungs by compression must not be regarded
as an absolute proof of respiration.   It must  be taken  with other
circumstances, e. g., absolute  aveight and  color, as a fact, to show 
          APPLICATIONS  OF  HYDROSTATIC  TEST.        571

that  the child has either breathed, or has had  its lungs perfectly
inflated in a bond fide attempt to restore life after birth, either by
the mother, or by some person  present at the birth.  In  cases of
this kind, the only course left open to a medical witness is, to state
that  the  evidence derived  from experiments on the lungs left it
uncertain  Avhether the child  in question had breathed, or had had
its lungs  artificially inflated.   A jury will  then knoAv  how to
return their verdict; for it must be remembered, they have always
circumstances, as Avell as medical opinions, to guide their judgment;
and  it is upon the whole, and not upon a part, of the evidence laid
before them that their verdict is founded.
  If asked to state in what cases  the  pulmonary tests are capjable
of assisting a medical jurist, the answer, it appears  to  me, would
be:  1st. They will clearly sIioav that a new-born child  has lh7ed,
when, during its life, it has  fully and perfectly breathed.  Cases of
this  description form a certain number of those Avhich come before
our courts of assize.  To them the most serious objections are not
applicable; and the few which might be made  to the medical in-
ferences are not difficult to answer.  2dly. They Avill alloAv a Avit-
ness to say, that the lungs must have received air either by respira-
tion, or by artificial inflation. These are the cases in  Avhich a  child
has died soon after birth, and Avhere the respiratory changes are
but  imperfectly manifested in the lungs.  They probably form a
large proportion of those Avhich fall under the jurisdiction of the
criminal laAV.  It might be considered that the qualification in
the  inference  here drawn would  neutralize its force ; but it  must
be remembered, that there are few instances of actual and deliber-
ate child-murder wherein artificial inflation  could become even a
possible defence for an accused person.   So unusual is this kind of
defence,  that  among the numerous trials for infanticide Avhich
have taken  place in this country for many years past, I have not
been able  to meet Avith a single  instance in Avhich it Avas alleged,
as an objection to the medical evidence derived from  the buoyancy
of the kings, that  the  prisoner had inflated them in order to re-
suscitate  her child.  The  reason  is  obvious; had such a defence
been attempted, the whole of the circumstantial evidence would at
once have set it aside.  When, in the suspected murder of an adult,
a medical man  swears that a  fatal Avound Avas such that the de-
ceased might have inflicted it on himself, or that the prisoner might
have produced it, he is placing the jury  in a  position very similar
to that in which he places them in a case of child-murder, when he
says that the child  might have  breathed, or its lungs might have
been  artificially  inflated.  How would  a jury decide in the  two
cases? Assuredly, by connecting certain facts Avith which a medi-
cal Avitness is not concerned, but Avhich may, in their opinion, satis-
factorily  supply the place of  what is deficient in his  evidence.  It
is not for  him to speculate on the probabilities of respiration, or
of artificial inflation ; but it is  for them to consider Avhether the
accused was, or was not likely, under the particular circumstances
of the ease, to have resorted  to  an experiment of this nature.  It 
 572       APPLICATIONS OF HYDROSTATIC TEST.

 has been suggested that some person might inflate the lungs of a
 dead child, in order to raise a charge of murder against its mother;
 but this suggestion  piresupposes, on the piart of a  criminal, a pro-
 found knowledge of the difficulties of medical jurisprudence ; and
 even then the question of murder does not  depend merely on the
 presence of air in the lungs.   Such a case is very  unlikely to pre-
 sent itself;  indeed, its occurrence is no more probable than that in
 poisoning it should be considered  a good  defence that some person
 might have  introduced poison into the body by injections, after
 death.  The circumstances of the case will commonly furnish  a
 sufficient ansAver to such hypothetical views.
   The hydrostatic test  ought  not,  therefore,  to  be lightly con-
 demned  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  conscientious  medical
 jurist cannot always draw a positive distinction between the eff'ects
 of respiration and artificial inflation  on the lungs; still a jury may
 be in a situation to  relieve  him from this  difficulty.  In short, it
 Avould be as reasonable  to contend that all  persons charged Avith
 murder should be  acquitted because homicidal are not ahvays to be
 distinguished from  suicidal  wounds, as to  argue  that all cases of
 infanticide should be abandoned  because these two conditions are
 not distinguishable by any certain  medical signs.   If juries do
 frequently  dismiss such  cases, it  is, I apprehend, to be  ascribed
 rather to their great unAvillingness to become the means of admin-
 istering what they consider to be  se\7ere laws, than  to their want
 of poAver to balance and decide  on the probabilities laid  before
 them.  If the pulmonary test were wholly  set aside, it is easy to
 conceive what would be the consequences.   Let us suppose that a
 new-born child is found, under suspicious circumstances, with its
 throat cut; we are called upon  to admit that it is impossible for
 medical eA7idence to  establish whether the child has  lived or not,
 and therefore we are to decline  making  an  inspection of its body.
 But this would be the  same as declaring that child-murder could
 never be proved  against an  accused party, and  that new-born
 children might  henceforth  be  destroyed  with  impunity!  It
 appears to  me that  conduct of  this kind on the part of a medical
 Avitness,  Avould  be  Avholly  unwarrantable; for  we  may  some-
 times acquire, by an inspection,  as great a certainty of respira-
 tion  having been performed, and therefore  of a  child having
 lived, as of any other fact  of a medico-legal  nature.  Cases of
 poisoning often give rise to  greater difficulties  to a medical jurist;
 as Avhere, for example, he attempts  to  found his  opinion of the
 cause of  death on  sympitoms alone, or on apipearances in the dead
 body.  But we may  put the question in this  light.  In the body of
a healthy full-grown child, which has but recently died, we find the
lungs filling the cavity of the chest, of a light red color, spongy,
 crepitant beneath  the  finger,  weighing  at  least two  ounces, and,
 Avhen divided into numerous  pieces, each piece  floating on Avater,
 even  after violent compression.   Is  it possible  in such a case to 
         RESPIRATION BEFORE, OR DURING  BIRTH.     573

doubt that respiration has been performed ?  If there is no certainty
here, it appears to me that  medical experience is but little fitted in
any case  to guide us in our  inquiries.   It  Avould be  difficult to
point out an  instance  in  which  an affirmative  medical opinion
Avould be more surely Avarranted  by the data  upon which it  was
founded.
  Jtezpiration  before, or  during birth.—It  has been already  stated
that the  pulmonary tests are fitted to prove only whether a child
has, or has not  lived to breathe.  Neither the hydrostatic, nor any-
other test can  positively show that the body of a child Avas entirely
bom  alive Avhen the act  of  breathing was performed.  As this is a
subject Avhich generally gives  rise to some  discussion in cases of
child-murder, I shall here make a few remarks on it.  1st. Respira-
tion  may be performed Avhile the child is in the  uterus, after the
rupture of the membranes—the mouth of the child being at  the os
uteri.  This is what is termed  vagitus uterinus; its  occurrence,
although extremely • rare,  seems to me to rest  upon  undisputed
authority.  2dly. A child  may breathe while its head is in the
vagina, either during a presentation of the head, or of  the breech.
This has been termed vagitus  vaginalis.   It is not very common,
but it must be set down as a possible occurrence.  3dly. A child
may breathe Avhile 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 Ave find it in some children that have actually
been born, and have survived their birth for several hours.   This
is the most usual form of respiration before  birth.  In the vagitus
uterinus or vaginalis the lungs receive but a very small  quantity of
air;  in respiration after protrusion of the head the  lungs may be
sometimes  found moderately well filled, although never, perhaps,
possessing  all  the characteristic properties  of those which have
fully  respired.   The w7ell-known  occurrence of respiration  under
either of these three conditions, strikingly displays the fallacy ot
making this process, as some have done, the certain boundary of
extra-uterine life.  A child may breathe  in  the uterus or vagina,
or with its head at the outlet, and die before its body is born; the
discoA7ery of its  having respired would not, therefore,  be any sort
of proof of its  having enjoyed Avhat has been termed " extra-uterine
life."   (For a  Avell-marked case  of this  kind, see  "Med.  Gaz.,"
vol. 38, p. 394; and another, communicated to  me by Dr. Crothers,
of Toy, will be found in "Guy's Hospital Reports," October, 1850,
p. 231.)  The death of a child which has breathed in the uterus or
vagina from natural causes, before its entire  birth, is a possible
occurrence; but its death from natural causes before birth, after it
has  breathed by the protrusion of its head from  the outlet, is an
unusual event.  All that we  can say is—it may take place; but
death under these circumstances would be the exception to a very
general rule.   Oberkamp  states that, in four  successive deliveries
of the same woman, the  children breathed  during  delivery, but
died before thev Avere born. 
574   HYDROSTATIC TEST — GENERAL CONCLUSIONS.

  Respiration a sign of life, not of live birth.—The hydrostatic test is
only capable of determining that respiration has taken place; it can-
not show Avhether this process Avas established during birth or after-
wards.  The fact of a child having the power of breathing  before
it is entirely born, does not therefore constitute the smallest objec-
tion to its employment;  although upon this ground, Ave find  the
use of it in  any case clenounced'by many eminent members of the
medical and legal professions.   Thus, Archbold says, "A^ery little
confidence is placed in this test as to the lungs floating, particularly
if the child were dead any length of time before the experiment
was made."  ("Criminal Pleading," p. 367.)   Mathews speaks of
the test as being "quite exploded" ("Digest," p. 251); and Jervis
makes the  same remark ("On  Coroners," p. 127).  It is  obvious
that most members of the  law  Avho have treated this subject have
adopted, Avithout sufficient examination, the statements  of  Dr.
William Hunter.  This author observes:  "A child will commonly
breathe as soon as its mouth is born or protruded from the mother;
and in that  case may lose its life before its body be born, especially
when there  happens to be a considerable interval between Avhat Ave
may call the birth of the child's head and the protrusion of its body.
And if this  may happen  Avhere the best assistance is at hand, it is
still more likely to happen when there is  none, that is, Avhere the
woman  is delivered by  herself."   ("On the Uncertainty of the
Signs of Alurder in the Case of  Bastard Children," p. 33.)
  Dr. Hunter  here exposes, in plain language,  the fallacy of trust-
ing to signs of  respiration  alone as evidence of a child having been
born alive.   The truth of his remarks is, in the present day, gene-
rally admitted; and if, among  medico-legal  writers, we find some
still treating of respiration  as a certain  proof of live birth, it is from
their not having sufficiently considered, the probability  of a child
breathing and dying before its  body is entirely extruded.
  Conclusions.—The general conclusions respecting the employment
of the hydrostatic test, to be drawn from the  contents of this
chapter, are:—
  1. That the artificial inflation of the lungs of a child born dead
will cause them to float in Avater.
  2. That lungs artificially inflated while in the  chest resemble
those organs in Avhich respiration  has  been only imperfectly estab-
lished.
  3. That in cases of inflation of the lungs in the chest, the air
may be generally expelled  from the divided portions of lungs by
firm compression, so as to cause them to sink.
  4. That the same result occurs Avith lungs in which respiration
has been imperfectly established.
  5. That when lungs have undergone perfect respiration, the air
cannot be expelled  by compression of the divided parts, so as to
cause them  to sink.
  6. That the artificial inflation of fcetal lungs causes  no alteration
of weight;  and as the weight increases in proportion to the degree 
             AVHAT CONSTITUTES  LIVE  BIRTH?          575

of respiration,  so in healthy lungs  Avith great buoyancy, there
should be great weight if the air has been derived from respiration.
  7.  That Ave should base our judgment of a child having breathed
upon great weight and great buoyancy of the lungs combined; that
the one condition Avithout  the other  is open to the objection that
the air may  not have been  derived from respiration.
  8.  That a  floating of the lungs  in  Avater  proves, cazteris paribus,
that a child  has breathed either at, during, or after  birth ;  it does
not prove that  a  child Avas born alive, or that it has died a violent
death.
  9.  That the sinking of the lungs, as a result of the expulsion of
air from them by compression, does not necessarily prove that the
child Avas born dead.  It  merely  proves  that the air contained  in
them Avas derhred either from artificial inflation, or from the im-
perfect establishment of the respiratory pirocess.
  10. That the hydrostatic test is  not applicable to  determine the
fact of respiration, or non-respiration in all cases of alleged child-
murder;  but that,  Avith ordinary precautions,  it may  be safely
employed in the majority of such cases.
  11. That a child may breathe  before, during, or after birth; but
the hydrostatic test Avill not enable us to say, in the greater number
of cases, at Avhich of these  periods the act  of respiration was per-
formed.
  12. That respiration is a sign of life, and not necessarily of live
birth.
  13. Hence, medical evidence is required to shoAV aat1i ether a child
breathed after it Avas entirely born, and Avhether the act of violence
which  caused its  death Avas applied to it while so breathing.
  These conclusions are here expressed with brevity.   Some of them
may require qualification ;  but for the circumstances which qualify
them, the reader  is referred to the contents of the chapter.
                       CHAPTER  L.

ON THE PROOFS OF A CHILD HAVING BEEN BORN ALIVE.—EVIDENCE FROM
  RESPIRATION.—FROM MARKS OF VIOLENCE.—FROM NATURAL CHANGES
  IN THE  FCETAL VESSELS.—FROM THE  DISCOVERY OF  FOOD IN  THE
  STOMACH.—GENERAL CONCLUSIONS.

  On a trial for  child-murder, the important medical question  has
hitherto been:  AVas the child completely born  alh7e?  The inter-
pretation set upon these Avords by all the judges Avas that the Avhole
bodv of a child should  be entirely delivered from the body of the
mother, before  the question of its death  from violence could be
entertained.  Some learned  judges even held that a child was not
legally  born alive until it was severed from the body of the mother.
In cases in which death had obviously taken place from criminal 
576    PROPOSED CHANGES IN  THE CRIMINAL LAW.

violence, the medical witness Avas suddenly stopped in his evidence
by being asked for some infallible proof of  live birth in a legal
sense.   As a medical man, not present at the delivery, could rarely
be in a condition to off'er such proof, the case  broke doAvn, and the
accused Avas acquitted of the charge of  murder.  If  a medical
witness ventured to say that  he  formed his  opinion of live birth
from the presence of air in the  lungs, and the usual appearances
produced in these organs by the  act of breathing, he A\7as immedi-
ately met with the objection that a child might breathe during the
act of  birth, and die before its body was born, and yet the appear-
ances would be the same.   To this there was generally no reply ;*
but every medical man could perceive that an  exceptional condition
Avas thus strained into a rule,  simply to procure an acquittal on a
capital charge.  Some children are wilfully injured and destroyed
during delivery, but  the greater number are, no  doubt, destroyed
soon after they have been entirely born ; still, there is nothing of a
medical nature to distinguish one set of cases from another.  In
each the child may have breathed, and the lungs may contain air;
Avhile, at the same time, the fatal violence—whether indicated by
wounds, fractures, burns, or marks of  strangulation on the neck—
would be the same ; there would  be no medical difference; and it is
obvious, from the  nature of things, there could not be any appear-
ances,  by which the partially born could be distinguished from the
completely born child.  Aledical  evidence went, on these occasions,
as far as it could be reasonably carried.  It established tAvo  facts:
1, that the child Avas living at or about the time of its  birth, and
when the violence was inflicted upon it; and, 2, that  the violence
itself was sufficient to  cause  death, and was, in fact, the cause of
death.
  The Capital Punishment Commission, whose attention had been
especially  directed to the frequent failures of justice  in trials  for
infanticide, have  in their  recent Report (Dec. 1865), made some
important suggestions, Avhich,  if carried into legislation, will relieve
medical evidence of some of those insuperable difficulties Avhich it
has hitherto had to encounter in cases of infanticide,  and  at  the
same time remove that Avhich has hitherto been a stigma upon  our
criminal law7.  I quote the following passages from this report :—
  " The crime of infanticide, as distinguished from murder in gene-
ral, is not known to the English law.  The moment a child is born
alive, it is as much under the protection of the law as an adult.
  " 14. AVe have considered Avhether the failure of justice, Avhich
undoubtedly often occurs in such  cases, may not be  obviated by
some change in the law which shall add to the protection of new-
born children.  The principal obstacle Avhich  now prevents the  due
enforcement of the law is the extreme difficulty of giving positive
proof that the child alleged to have been murdered was completely
born alive.
  "15. We ha\7e given this important and  difficult subject  our
serious attention, and we have arrh7ed at the opinion that an Act
should be passed  making  it an offence, punishable with penal  ser- 
       PROPOSED CHANGES IN THE CRIMINAL LAAV.    577

vitude or imprisonment, at the discretion of the court, unlaAvfully
and maliciously to inflict  grievTous  bodily harm or serious injury
upon  a child during its birth, or within seven days aftenvards, in
case  such child has  subsequently died.   No proof that the child
was completely born alive should be required.  AVith respect to the
offence of concealment of birth, Ave think  that no person should be
liable to be convicted of such offence upon an indictment for murder,
but should  be tried upon a separate indictment.  The  accused
should not be entitled to be acquitted in either of  the  above cases,
if it  should  be  proved on the trial  that  the offence  amounted to
murder or manslaughter."
  It would apqiear from these paragraphs that provided a child has
died from injuries unlawfully inflicted upon it, either during  its
birth  or within seven days afterwards, the person guilty of  such
violence may be convicted of a statutable offence involving  a severe
punishment.   It will not be necessary that  the medical  evidence
should proA7e  that the child Avas completely born  alive, or severed
from the body of the mother at the time that the violence Avas in-
flicted upon it.  This will  not, however, alter the state of the huv,
or affect  criminal  responsibility, when the facts establish an act of
murder or manslaughter.  The proposed change is intended to meet
the tivo medical difficulties of proof  of complete birth, and of vio-
lence inflicted during or after birth.   The  operation of such an Aet
will  be practically to repeal the  puuishment of death in  cases of
infanticide,  because, judging from  past  experience,  the  greater
number of these charges will resolve themselves into the statutable
offence punishable Avith penal servitude, or imprisonment.   Under
the proposed neAV system of legislation, the proof of entire or com-
plete birth would be no longer necessary;  but proof of live birth
is not dispensed Avith Avhen the charge is  one of murder,  or man-
slaughter.  Two sets of cases may present themselves  for  medical
evidence:  1, those in which violence  is applied to the child during
birth, but the child is born alive, and dies  from the violence either
immediately or within a feAV days; and, 2, those in which the vio-
lence is applied, and the child dies from its eff'ects, before it is born,
or in the act of being born,—as in that form of infanticide in Avhich
a woman is  delivered in a bath, and the child, AA7hen born,  dies
from the prevention of respiration, or where a child is  deliberately
strangled or suffocated w7hen its head presents.  In the second set
of cases, there can be no medical proof of  live birth ; hence, these
are likely to  be  treated as cases  of  stillbirth.   The complete de-
struction of children during birth by wilful violence can apparently
neither be defined, nor punished as a legal  offence.  This exception
in the proposed legislation on infanticide obviously depends on the
impossibility of distinguishing a child Avhich  has died from natural
causes in the act of birth, from one which has been destroyed by in-
juries  inflicted during its birth.   Afarks of violence may be found
on the dead bodies of both or neither; but allowing that they are
of a fatal character, and that the proof of the exact time of their
infliction is unimportant, how is a witness to be in a position to say
      37 
578    LIVE BIRTH — EVIDENCE FROM RESPIRATION.

that the child died from the injuries subsequently to its birth ; and
yet without proof of this, a criminal may escape.  The material part
of the medical proof, then, on these occasions will be to sIioav  to the
satisfaction of a court that the  injuries  did  not prove fatal until
after the birth of the child.  The legal assumption in the defence
will be that the child died from them before it Avas born, and that it
came into the w7orld dead.   A difficulty of this kind may, hoAvever,
be removed by the terms of the proposed new statute.  One learned
judge has strongly expressed his opinion that the wilful destruction
of a child during  birth, or  before it  is completely born, should be
treated as  a distinct  offence, and that there  should not be  an ac-
quittal  on the ground that the medical evidence did not prove the
child to have been completely born ;  leaving it to  the discretion of
the judge to direct a  charge of murder to be  made.
   As the  question of live  birth may still  therefore incidentally
arise, it will be necessary to consider the  medical  facts upon Avhich
reliance is  placed  as furnishing evidence of a child having come
into the world living, or of its having been born alive.
   Evidence from  respiration.—As a general  rule,  there will  be no
perceptible difference in the state of the lungs, whether the act of
respiration is performed by  a child during birth, or after it is born,
provided that its death speedily follow its birth.   But should we
find that this  process has  been perfectly established,, i. e., that the
lungs p>resent all  those conditions which have been described as
characteristic of full and perfect breathing, there is great reason to
presume that the process, even if it had commenced during birth,
must have continued after the child was entirely born.  This pre-
sumption becomes still stronger when the child  is immature; for
generally speaking, such children must be  born  and continue to
breathe for many  hours after birth, in order that their lungs should
present the characters  of  complete  respiration.   The process  is
seldom so  established before birth as to give to these organs a feel-
ing  of  crepitation under pressure; the  existence  of  this character
should, therefore, be sought for.  A witness who relied upon it as
a conclusive proof of breathing  after birth, might  be  asked by
counsel, whether  it were not possible for some children to remain
so long at the outlet with the head  protruding, as to render the
lungs crepitant from frequent respiration before birth.  Admitting
the  bare possibility of this  occurrence, he should endeavor to ascer-
tain whether there were any probable  cause which could thus have
protracted delivery while the head of the child Avas in this position;
as also, what natural cause could have produced its death when its
head was  protruding and respiration had been so  freely performed
as to give crepitation to the lungs.  The presence or absence of the
 usual scalp-tumor might throw7 some light upon the case.   If, when
present, it  did not prove live  birth, it  might indicate protracted
delivery, and shoAV that the child had  been recently living. The
late Professor Casper, of Berlin, has cut the Gordian knot of this
difficulty, by assuming, that breathing before birth takes place
only in protracted delivery, in which the  assistance of an accou- 
         EVIDENCE FROM  THE  UMBILICAL CORD.       579

cheur is required.   In those cases which are likely to gh7e rise to
criminal investigations, he assumes that the birth of the child takes
place quickly, and that in rapid delivery the child does not breathe
until it is born alive.  Hence his  conclusion is—if in the body of a
child (secretly dispiosed  of) the lungs are found to contain air by
the hydrostatic test, this air did not enter the lungs at or before
birth but afterwards, and the child Avas  born alive.  (" Gerichtl.
Medicin," vol.  1, p.  710.)  Such  a conclusion is not in accordance
with the facts ascertained regarding the act of respiration in new-
born children ; it may be that they rarely die from natural causes
after they have once breathed, but that they can breathe and cry
during birth is a fact which cannot be disputed.  Further, there is
no test known by Avhich air received into the lungs during birth,
can be distinguished from that  which has  entered these  organs
after the chikl has been  born alive.
  Evidence  from  marks  of  violence.—If marks of  violence, appa-
rently inflicted about the same  time, are  found on different and
remote parts of the body, and these marks bear the characters of
those produced during life, it  is rendered probable that the Avhole
of the body of the child Avas in the world when they Avere caused.
Marks of severe violence on one part, as the head or breech, would
not always justify such a presumption, because it might be fairly
objected that they had been unintentionally produced by the woman
in her  attempts at  self-delivery, and yet  the child not have been
born alive.  It would be for a witness to form an opinion from the
circumstances accompanying the  particular case, whether they had
been thus occasioned.  From this it will  be seen that,  in making
an examination after death, it is proper that every mark of injury
on the body of a child, even if slight, should be noted down.  Abra-
sions of the skin, burns, and punctures, should  be  noted, and the
throat examined for marks of pressure by  a cord, or by the fingers.
  Evidence from certain changes  in  the body.—In a  child that has
been born alive, or has survived its birth for a period of from  twelve
to twenty-four hours, that portion of the  umbilical cord Avhich is
contiguous to the abdomen undergoes certain changes; it dries and
becomes sloAvly shrivelled, and in from three to five days, it sepa-
rates from the  body without cicatrization.
  The cord  does not separate at the part which is tied, but close to
the abdomen.  It separates generally within five days, by a process
of sloughing, the skin connected with the dead portion  of the cord
presenting a red line, arising from  capillary congestion.  During
the separation of the navel-string, the umbilical vessels are gradually
closed.  According  to Billard, the obliteration of these vessels is
effected in a peculiar manner.  The calibre diminishes as a result of
a concentric thickening of the coats, so that, Avhile the vessel retains
its apparent size, its cavity is gradually blocked up.  A quill would
represent the form of the vessel in the fcetal state,  and a tobacco-
pipe  in the obliterated  state.  It is only by cutting through the
vessel that the degree of obliteration can be determined. The state 
580   EVIDENCE FROM HEART  AND  FCETAL VESSELS.

of the umbilical cord has furnished good evidence of live birth, Avhen
the other circumstances of the case have yielded no information.
   The changes in the umbilical cord, especially those indicative of
its separation and cicatrization, clearly prove that a child has sur-
vived its birth, whatever may be the results of experiments on  the
lungs; but the difficulty is, that they require some  days for their
production, and in practice it is necessary to procure some signs of
survivorship of only a few minutes, or at furthest of a few hours.
The same remark applies to the exfoliation of the cuticle, in a new-
born  child ; such  a condition of the skin can rarely be found in cases
of infanticide.  The absence of meconium from the intestines, and
of urine from  the  bladder, are  not proofs of live birth, for these
may be discharged during  birth, and yet  the child not be born
alive.
   State of the skin.—In the greater number of new7-born children,
the skin has a dark-red color, probably owing to the first effect of
the atmosphere upon it. Within an hour it begins to get of a lighter
red, and so it remains for one or two days.  According to Dr. Elsasser,
it becomes again darker about the end of the second, or on the third
day, and is then of a brownish-red color.  This lasts for three or
four days,  unless  a yellowness appears  from jaundice.  It is then
more or less yellow.   It is about the sixth or seventh day that the
skin  acquires a  reddish-white color such as it afterwards retains.
(Henke's " Zeitschrift der S. A." 1842, vol. 2, p. 223.)
  Evidence from changes in the heart and fcetal vessels.  JDocimasia
circulations.—It  has  been supposed that the state  of the ductus
arteriosus, ductus venosus, and foramen ovale would aid a medical
jurist in forming an opinion wdiether a child had survived its birth.
In general, as a result of the establishment of respiration, it is found
that the communication between the auricles  of  the  heart by the
foramen ovale becomes closed  ; and that  the  two vessels or ducts,
after gradually contracting, become obliterated,  or  are  converted
into fibrous cords.  AVhatever may be the conclusions from experi-
ments on the lungs, it has been contended that the closure  of the
foramen and of these vessels would infallibly  indicate that a child
had breathed.  This inference, however, has been too hastily drawn.
Recent researches have shown  that there are some serious objec-
tions to any  conclusions based on the  state of these fcetal vessels;
their closure, as a natural process, ahvays takes place slowly, and
sometimes is not completed until many  years  after  birth.  Thus,
then, in the generality of cases of infanticide, in which necessarily
the child  survives but for a short p>eriod, no evidence of the fact
will be procurable from an  examination of the heart and fcetal
vessels.
  Ductus arteriosus (Arterial duct).—The ductus arteriosus is a vessel
about half an inch long, Avhich in the foetus forms a direct commu-
nication between the right ventricle of the heart and the aorta; it
conveys the larger proportion  of the  blood from the heart to the
aorta without passing through the lungs.  So soon  as respiration
is established its function is at an end, and it then begins to close. 
      EVIDENCE FROM HEART AND  FCETAL VESSELS.   581

In Figs. 58 and 59 the different parts of the fcetal heart are seen in
outline—in  Fig.  58  as  they appear before, and in Fig. 59 as they
appear after, perfect respiration:  1, the  aorta  ;  2, the pulmonary
artery; 3 3, the  right and  left branches of the  pulmonary artery
going to the  right  and left lungs;  4, the ductus arteriosus, short
and Avide in Fig.  58, and in Fig. 59 contracted at the end where it
joins the under part  of  the  arch of the aorta.  Professor Bernt of

            Fig. 58.                           Fig. 59.
     Heart of the new-born child with       Heart of the child with the duct undergoing con-
   tha ductus arteriosus in its  foetal      tractions as the result of the establishment of res-
   state,                         piration.

 Vienna, who has made  many observations on this subject, drew  the
 folloAving conclusions respecting the period required for the closure
 of the ductus  arteriosus in children AAThich  have been born alive
 and  have lived after birth:  1. If a child has lived only a few
 seconds, the aortal end of the duct appears  contracted, and the ves-
 sel, instead of being cylindrical throughout, acquires the form of a
 truncated cone.  2. If a child has lived for several hours, or a whole
 day,  the duct becomes again cylindrical,  although shortened and
 contracted in diameter.  Its size  is about equal  to a goose-quill; it
 is, therefore, much smaller than  its root, and about as large as either
 of the two branches of the pulmonary  artery, which have in  the
 mean time become  increased in size.  3. If a child has lived for
 several days or a whole week, the duct contracts to the diameter of a
 few lines—about equal to a crow-quill,  while the tAvo branches of
 the pulmonary arteries are  equal in size to a goose-quill.  4. The
 duct  is found perfectly  closed  and quite impervious at a much
 later period, i. e., after the lapse of an uncertain number of Aveeks
 or even months.
  As a general rule, the peculiar parts of the  fcetal circulation  are
 rarely obliterated  by a  normal process before  the eighth or tenth
 day after birth.  The obliteration, according  to Bernt and Orfila,
 takes place in the following order:  1.  The umbilical arteries; 2.
 The ductus A7enosus; 3.  Theductus arteriosus; and 4. The foramen
 ovale.  (Orfila, " Aled.  Leg.," 1848,  vol. 2, p. 210.)  The circum-
stances connected Avith  the closure of  these foetal vessels have been
satisfactorily  investigated by Dr. Elsiisser.   Among 70 stillborn
children, they  Avere  found open  in 69.   Among 300 children Avho
 
582
LIVE BIRTH — EVIDENCE FROM
died soon after  birth, 80 out of 108  prematurely born  and living
from one to eight days, presented all  the passages open ; 127 out of
192 infants  born at the full  time had all  the passages open, but
partly contracted.   The ductus arteriosus  was open in 55 cases,
and completely closed in 10 cases; the  ductus venosus was open in
81, and completely closed in 37 cases; while the foramen ovale Avas
open  in  47, and completely closed in  18 cases only.   These facts,
according to Dr. Elsasser, prove  that the vessels  peculiar to the
fcetal circulation remain open  as a rule, for  some time after birth,
and  that it is  not  possible to determine accurately, by days, the
period of their closure.  This physiologist remarked that the closure
commenced and was often completed  in the  ductus venosus, before
it manifested  itself in the other vessels.  The complete closure, in
by far the greater number of  cases, takes place within the first six
weeks after birth, and the instances of  obliteration before birth, or
before the period mentioned after  birth  must be regarded as rare
exceptions.  (" Aled.  Times and Gaz.,"  Alay  21, 1853, p. 530.)
   From these  facts, the "docimasia circulationis" may be considered
as useless to a medical jurist.   It either proves  nothing, or it may
lead to a fatal error.   It is the  more  necessary to point out the
fallacies  to which it is liable, because hitherto medical jurists have
been  disposed to place  great  reliance  upon it, in cases in which
medical evidence from the state of the  lungs w7as wanting.
   Evidence from the state of  the alimentary canal.—Good evidence  of
live birth may be sometimes derived  from the discovery of certain
liquids or solids in the stomach and intestines, such as blood, milk,
or farinaceous or saccharine  articles of  food;  for it is  not at all
probable  that these  substances  should find their Avay into the
stomach or intestines of  a child who  was really born  dead.
   1. Starch.—In the case of a new-born  child,  Dr. Geoghegan dis-
covered, by the application of iodine-water, the presence of fari-
naceous food  in the contents  of the  stomach;  hence the question
of live birth  was clearly  settled in the affirmative.  On another
occasion Dr. Francis employed this  method of testing Avith satis-
factory results, in a case in  Avhich the investigation was beset with
unusual  difficulties.  He wTas  required by the  coroner to examine
the body of a  neAv-born child, found under suspicious circumstances.
The examination of the lungs left no  doubt that respiration had
taken place; and the fact that the child had been born alive was
fully  established  by  the  discovery  in  the stomach of a small
quantity of farinaceous food.  On digesting in diluted water a
fragment of the pulp found in this  organ, and adding a drop  of
a solution of iodine, an  intense indigo-blue  color  appeared imme-
diately.  The application of this chemical test, therefore, removed
any doubts which might have been entertained on the question of
live birth.  (" Aled. Gaz.," vol. 37, p.  460.) The quantity of starch
present may, however, be too small to  produce  with water a solu-
tion which would be colored  by iodine in the  manner described.
A portion of the contents of the stomach should then be placed on 
CHEMICAL ANALYSIS OF CONTEXTS  OF  STOMACH.  533
Granules of
wheat starch.
  Magnified 319 diameters.
a glass  slide, diluted with a little water if viscid, and examined
under the microscope with a power of about 300  diameters.  The
granules (if present) may then  be dis-
tinctly seen,  having the shape peculiar
to each variety of starch, and  not unfre-
quently mixed with  oil-globules and epi-
thelial scales derived from the mucous
membrane.  By  the addition of strong
iodine-water, their shape and size will be
brought out by the intensely blue  color
Avhich they acquire.   Blue fragments  of
an irregular shape indicate the presence
of bread.  The annexed engraving (Fio-.
60) represents two  varieties  of starch,
either of which may be found  in the
stomachs of infants; in a the rounded
granules of wheat starch are represented,
and in b the ovoid granules of arrowroot.
The micrometrical measurements of the granules shoAV, for those
of Avheat, which are irregularly spherical, diameters varying from
gij'i.-fjth  to  Tx'.^th of  an inch in  size.   Alany have an  average
diameter of ^^th of an inch.   The  ovoid granule  of arroAvroot
is go-ffth of an inch in length, and yg'^oth of an inch in Avidth.
  2.  Sugar.—In a case Avhich I  Avas required to examine, the pre-
sence  of sugar Avas readily detected in the contents of the stomach
by the application of Trommer's test.  In order to apply this test,
a few drops  of  weak solution of  sulphate of copper should  be
added to a portion of the cold concentrated  aqueous extract of the
contents of the stomach.  An excess of a solution of pure potash
is then added, and the liquid boiled.   If sugar be present, the sub-
oxide of copper is immediately precipitated of a yelloAvish or red-
dish color.  With white sugar the  same decomposition is effected,
but more sloAvly.   If starch only be present, black oxide of copiper
may  be thrown  down, but there will be no production of a red
precipitate.  The formation of the red oxide of copper under these
circumstances proves that some saccharine substance is present.   In
reference to the application of the sugar-test, howrever, it must be re-
marked that  starch is easily convertible into sugar by a chemical
action of saliva or mucus, so that the test may appear to indicate
sugar in small quantity7, Avhen the  result may be really due to the
presence of some converted starch.
  3. Milk.— Th is liquid may be found in the stomach of a neAv-born
child;  it may be  identified microscopically in the fluids of  the
stomach by the  numerous and Avell-defined  oil-globules which it
contains.  It is not possible to distinguish human from cow's milk
under these circumstances.  In both, the  globules Avhich are sphe-
rical  in all aspects,  are  remarkable  for their transparency in the
centre, and their dark margin.  They vary considerably in size.   I
have  found those of the cow to have by measurement the follow-
ing diameters: Maximum, ^.^th of an inch; minimum, rs^th; 
584        EVIDENCE  FROM EPITHELIAL  SCALES.
and medium size, ^fith of an inch.  They are distinguished from
blood-corpuscles by their shape and lustre, and from starch granules
by the fact that they are not colored, or changed by iodine-water.
Colostrum  is  the name applied  to the  milk  first secreted  after
delivery;  it contains, in addition to  oil-globules, numerous  sphe-
rical granular bodies (Fig. 62,  b).  AVhen milk is present, lactine

              Fig. 61.
Oil-globules of    Oil-globules of
 Human Milk.     Cow's Milk.
   Magnified 319 diameters.
Oil-globules of    Colostrum with
Human Milk.    granular bodies.
    Magnified 450 diameters.
or sugar of milk is generally found in the contents of the stomach
by  the appropriate  sugar-test  (supra).   The casein, or solid prin-
ciple  of milk, precipitates  oxide of  copper  from  the sulphate;
but on adding an  excess  of a  solution  of potash, the oxide is
redissolved,  forming  a purple  or violet-colored  solution.   It is
rapidly coagulated by  the  digestive principle (pepsine) contained
in the  gastric juice,  so that the casein may be found  in small
soft  masses  adhering  to  the  lining  membrane of the stomach.
It should  be observed that albumen forms a deep violet-colored
solution with sulphate of copper and potash, but the red suboxide
of copper is not precipitated on boiling, unless sugar is mixed Avith it.
  4. Epithelial scales.—The epithelial  scales commonly  found asso-
                            ciated with articles of food in the sto-
                            mach are of various shapes and sizes;
                            they are  flat, oval, or rounded,  and
                            sometimes  polygonal.  They are  nu-
                            cleated, and from their pavement-like
                            appearance  they are  called  "tessel-
                            lated."   In  Fig. 63, b, an epithelial
                            scale from the mucous membrane of
                            the inside of the mouth, is  represented
                            magnified  570 diameters.   In the long
                            axis it was the 3^th of an inch, and
                            in the  shortest  ^ioth of  an  inch in
                            diameter.   The central nucleus  Avas
                             ^'ooth of  an inch  in  diameter,  and
                                                  These epithelial
scales are very numerous, much intermixed, and so thin and trans-
   Tessellated epithelial scales.
a from Sharpey: 6 from observation.
the small granules around it tj^'o^th of an inch 
EVIDENCE  FROM  BLOOD.               585
parent that they are often only distinctly seen at the edges, which
are occasionally folded, or slightly turned over.
  Besides the substances mentioned, other solids and fluids, such as
blood and meconium (the fecal discharges of the foetus) may be found
in the stomach  of a  new-born  child, and a  question  may  arise
whether their presence indicates that the child was fully born.  It
is not impossible that a child might  be fed, and exert a power of
swallowing when its head protruded from the outlet, and its  body
was still in the body of the mother.  Children have been known
to exert a power of sucking or aspiration under these circumstances,
and Avith this  a poAver of  SAvallowing might be exercised.    In
defending a prisoner  on a charge of child-murder counsel would
scarcely resort to a defence of this kind.  That the  starch, sugar,
or milk, etc., found in the stomach, should have been given  to a
child  when its body was only half-born, is so improbable an hypo-
thesis, that the most inexperienced lawyer would hardly resort to it
to account for the presence of food in this organ.
   AVhen the substances found in the stomach are not in the  form
of food, but are fluids connected Avith the child or the mother, the
case  is different. These may penetrate into the lungs or stomach
during birth, either by aspiration or the act of swallowing:  they
thus indicate that the child  was living, but they do not necessarily
sIioav that its  body was  entirely in the Avorld when  they  were
swallowed.
   5.  Blood.—An instance  is related by Dr.  Doring in which a
spoonful of coagulated  blood was found in the stomach of a  new-
born child.  The inner  surfaces of the gullet and windpipe  were
also  covered  with blood.   Dr. Doring inferred from these  facts
that the child had been born alive;  for the blood, in his opinion,
could have entered the stomach only by swallowing, after the  birth
of the child, and while it was probably lying with its  face  in a
pool  of bloocl.   Taken alone, hoAvever, such an inference would not
be justifiable from the facts  as stated.   Blood might be accidentally
dniAvn into the throat from the discharges of the mother  during
the passage of  the  child's head through the outlet, and yet the
child  may not  have been born  alive.   The power of swallowing
may be exerted by the child during birth, either before or after the
act of breathing.  This power  appears  to be  exerted even by the
fcetus in utero.
  Blood may be recognized in the contents of the stomach not only
by the color which it imparts to the mucous liquids present, but by
the aid  of the  microscope.   This subject has been  already  fully
considered in another part of this work (p. 303).
  Dr. Robinson has made  some  researches  on the contents of the
fcetal  stomach during uterine life.   He finds that  the  substances
vfhich naturally exist in the stomach of a foetus before birth are of
an albuminous  and mucous nature.  His observations were made
on the stomachs of tAvo human foetuses, and  on those of the calf,
lamb and  rabbit.  The conclusions  at  which  he arrived were: 1.
That the stomach of the foetus, during the latter period of its ute- 
586
THE MECONIUM.
rine existence, invariably contains a  peculiar substance differing
from  the uterine  liquid (liquor amnii), and generally of a nutri-
tious (?)  nature.  2.  That in physical and chemical properties, this
substance A7aries in different animals, being in no tAvo species pre-
cisely similar.  3.  That in each fcetal animal the contents of the
stomach  vary at different periods;  in  the earlier stages of its de-
velopment consisting chiefly of liquor amnii, to  which the other
peculiar  matters are gradually  added.  4. That  the liquor amnii
continues to be swallowed by the foetus up to the time of birth, and
consequently after the formation of these matters  and their appear-
ance in the stomach.  5. That the mixture of this more solid and
nutritious substance with the liquor amnii constitutes the material
submitted to the  process of  chymification in the fcetal intestines.
He considers the  contents  of the  alimentary canal  to be chiefly
derived  from the  salivary secretion, and that gastric juice is not
secreted  until after respiration has  been established.  The medical
jurist will perceive, therefore, that the  discovery of  farinaceous
food, milk, or sugar in the stomach will furnish evidence of birth,
since substances of this kind are not found naturally in this organ.
  Dr. H. J. Grosse states that in the early stages of uterine life the
alimentary canal contains merely a mucous liquid.  At  the third
month, there is a  more copious  secretion—a clear non-albuminous
acid liquid is found in the stomach, and a soft chymous liquid  is
present in the small intestines.  Up to the fifth  month, the small
intestines contain  meconium of  a grayish color.   After this period
the meconium becomes  gradually of a deeper color,  and it passes
into the  large intestine.  When the child has attained uterine ma-
turity, the  meconium  in  the jejunum  is whitish ; in the ileum,
yellow;  in  the csecum,  greenish-yelloAv ; in  the  ascending colon,
green, with less yellow; and in the rectum, green-black, like poppy-
juice (hence the name from, from ntxav, " a poppy").  It is a mixture
of the constituent parts of bile-colored granules, of epithelium from
the mucous membrane lining the intestines, and of mucous matters
probably derived from the destruction of the epithelial cells.   Afe-
conium  is generally discharged from the bowels  of a child within
forty-eight hours  after  birth, or at the latest on the third day.   It
then appears of the consistency of honey, of a very dark-green (almost
black) color, with very  little yellow coloring-matter in it.  It has
no disagreeable odor.  Its specific  gravity is 1.148.  (" Des Taches
au Point de vue Medico-legale," 1863, p. 75.)
  6. Meconium.—This name is applied to the excrementitious matter
produced and retained in the intestines during fcetal life. It may  be
found in the stomach of a new-born child, and a question will thence
arise Avhether its presence there should be taken as a piroof of entire
live birth.   It may be discharged from the child during delivery,
in cases in which there is a difficult or protracted labor.  In the
act of breathing it may enter the throat Avith other discharges, and
thus  be  found in the stomach.   That a breathing child can thus
SAvalloAV meconium cannot be disputed, but assuming  that in the
body of  a child which  has not lived to breathe this  substance is 
THE MECONIUM.
587
found in the air-passages and stomach, hoAv is the  conclusion af-
fected ?  In the following case, Dr. Fleisher was required to examine
the body of a  new-born child which was said  to have been born
dead.  He  found meconium in the large intestines (the colon and
rectum), and a greenish-yellow-colored liquid in the cavity of the
stomach, in the larynx, Avindpipe, and gullet.   In the  air-passages
it Avas in well-marked quantity.  The lungs contained no air, but
possessed all the usual fcetal characters.   When cut into pieces and
placed on Avater, all the pieces sank.  It apjpeared that a woman
was present at the birth, who observed that  the  child  did not
breathe, but was born dead.  It was not bathed or Avashed, and no
air was bloAvn  into its  lungs.  From the general appearance and
properties of the liquid found in the stomach and air-passages, Dr.
Fleisher had no doubt that it was meconium from the intestines of
the child.   It could not have been  swalloAved  after the child was
born, but  must have been accidentally drawn into its throat by
efforts to breathe during  birth.  Some of the  meconium had pro-
bably been discharged from the bowels of the  child during labor,
and as the mouth passed over this liquid a portion was drawn into
the throat  by aspiration.   When once there, the instinctive act of
swallowing would  immediately convey  a portion of  it  into the
stomach.  As the facts connected with the birth were well knoAvn,
this appears to  be the only reasonable explanation.  (See report of
the case in Casper's " Vierteljahrschrift," 1863, vol. 1, p. 97; also
for another case, " Med. Times and Gazette," August 3,1861, p. 116.)
  The presence of  fluids therefore—such as  blood, meconium, or the
watery  discharges  attending delivery—in the stomach and air-pas-
sages of a new-born child, does not  prove live birth,  but merely in-
dicates the existence of some living actions in the child at or about
the time of its birth.  In a case Avhich occurred to Dr. Ramsbotham,
a woman was suddenly  delivered of a child while sitting over a
slop-pail of dirty water.   On examining the body, it Avas  obvious
that it  had not breathed.   There w7as no air in the lungs, but a
quantity of dirty  Avater like  that  in the pail Avas  found  in the
stomach.  This could have  entered  the  organ  only by the act of
SAvalloAving, and in Dr. Ramsbotham's opinion, the child had sAval-
loAved the liquid under some fcetal attempt to breathe.  The coroner
Avho held  the  inquest directed the  jury  that  the child Avas born
dead ; but most physiologists will consider that the power of SAval-
loAving cannot  be exerted by a dead  child; and  as its body must
have been entirely7 delivered in order to have fallen into the liquid,
there was proof that it  had been born living, and that in this in-
stance it had died after it was entirely born, by the prevention of
the act of breathing.
  The meconium may be  generally  recognized  by its dirty-green
color and general appearance, as well as by the absence of any offen-
sive odor, Avhich it does not acquire until after the third or fourth
day, Avhen it becomes mixed Avith feculent  matter.  Its  microsco-
pical characters are represented in the annexed engraving (Fig. 64).
In the air-passages it  is sometimes  associated with vernix caseosa,
and hairs derived from the skiu.  (" Aled. Times and Gazette," June 
588       GENERAL  CONCLUSIONS  ON LIVE  BIRTH.
 Microscopical appearances of Me-
conium :—a crystals of cholester-
ine ; 6 epithelial scales ; c masses
of green coloring-matter of bile
(biliverdin) ; d e granules.
  Magnified 150 diameters.
       Fig. 64.          l, 1861, p. 591,  and Aug. 3, 1861, p. 117;
                       see also "Ann. d'Hyg.," 1855, vol. 2, p. 445.)
                         But little  need be said on its chemical
                       properties; still, as the detection of stains of
                       meconium on  clothing  may occasionally
                       form a part of the medical evidence, a feAv
                       observations are here required.   The stains
                       wThich it produces are of a brownish-green
                       color, very difficult to remove by washing.
                       They  stiffen  the stuff,  and  are  usually
                       slightly raised above the surface Avithout
                       ahvays penetrating  it.   Meconium forms
                       with Avater a greenish-colored liquid, hav-
                       ing an acid  reaction; a  boiling heat does
                       not affect  the  solution.  Nitric  acid  and
                       sulphuric acid with sugar yield Avith it the
                       green  and red-colored compounds which
                       they produce with bile.   Cholesterine may
                       be separated  from it by hot ether.
                         It  may be remarked, in  reference to stains
produced by the faeces of a  child  which  has  survived birth, that
until the fifth or sixth day, they retain a dark-green or greenish-
yelloAv color.  On the seventh day after birth, they generally ac-
quire a bright-yellow color, like that  of the  yelk of an egg;  and
this color, if the child is in health, they w7ill retain during all the
time that it is suckled.
  The slightest consideration will show that the various signs of
live birth above described are weak, and of purely accidental occur-
rence.   If a child is destroyed either during birth, or within a few
minutes  afterAvards, 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 will be the same in the
two cases.  It is most probable that  in  the  greater  number of in-
stances of child-murder, a child is actually destroyed either during
birth, or immediately afterAvarcls; and, therefore,  the  characters
above described can rarely be available in practice.   If any excep-
tion be made, it is with respect to the nature, situation, and extent
of marks of violence ; but the presence of these depends on mere
accident.  Hence, then, we come to  the conclusion that although
medical evidence can generally show, from the state of  the lungs,
that a child has really lived, it can rarely be in a condition to prove,
in a case of infanticide, that its  life certainly continued after its
birth.   We could only venture upon this inference when the signs
of breathing were full and complete, or when some  article  of food
was found in the stomach.
  Conclusions.—The general conclusions which may  be drawn  from
the facts contained in this chapter, on the question whether a child
has or has not been born alive, are as follows:—
  1. That if the lungs be fully and perfectly distended with air by
the act  of breathing, this affords a strong presumption that the 
NATURAL CAUSES  OF  DEATH.
589
child has been born alive, since breathing during birth is in general
only partial and imperfect.
  2. That the presence of marks of severe violence on various parts
of the body, if possessing vital characters, renders it probable that
the child was born alive when the violence Avas inflicted.
  3. That certain changes in the umbilical vessels, and the separa-
tion (by a vital process) and the cicatrization of the umbilical cord,
as well as a  general peeling or scaling-off  of the cuticle, indicate
live birth.
  4. That the absence of meconium from the intestines and of urine
from the  bladder, are not proofs  that a.child has been born alive,
since these liquids may be discharged during the act of birth.
  5. That the open or contracted state of the foramen oval or ductus
arteriosus furnishes no evidence of a  child having been born alive.
These parts may become closed and contracted before birth, and there-
fore be found closed in a child born dead ; or they may remain open
after birth in a child born living, even subsequently to the establish-
ment of respiration.
  6. That the presence of farinaceous or other food  in the stomach
proves that  a child has been entirely  born alive.
  7. That the presence of blood, meconium, vernix  caseosa, or  the
discharges in the stomach and air-passages, does  not prove  that  a
child Avas born alive.
  8. That irrespective of the  above conclusions,  there is no certain
medical sign Avhich indicates that  a child that has died at  or about
the time of  birth, has been born alive.
                      CHAPTER LI.

CAUSES OF DEATH  IN  NEW-BORN  CHILDREN.—PROPORTION OF CHILDREN
  BORN DEAD.--NATURAL CAUSES  OF DEATH.—A PROTRACTED DELIVERY.
  —DEBILITY.--BLEEDING FROM  LACERATION OF THE NAVEL STRING.—
  COMPRESSION OF  THE NAVEL-STRING.—MALFORMATION.—DESTRUCTION
  OP MONSTROUS BIRTHS.--DEATH FROM CONGENITAL DISEASE.

  Causes of death in new-born children.—The next important  ques-
tion in  a case of infanticide,  and that  upon which a charge of
murder  essentially rests, is: AVhat was the cause of death?   1. It
is admitted that a child may die during birth or afterwards.   2. In
either of these cases it may die  from natural or violent causes.   The
violent causes may have originated in accident or in criminal design.
The last condition only involves the  corpus delicti of child-murder.
If "death has clearly proceeded  from natural causes, it is of no im-
portance to settle Avhether the cause operated during or after birth.
All charge of criminality is thenceforth at an end.
  It is well known that of children born under ordinary circum- 
590            NATURAL CAUSES OF DEATH.
stances, a great number die from natural causes either during birth
or soon afterwards; and in every case of child-murder, death will he
presumed to have arisen from some cause of this kind until the con-
trary appears from the medical evidence.  This throAvs the onus of
proof entirely on the prosecution.   Alany children  die before per-
forming the act of respiration; and thus a large number come into
the world dead, or stillborn.  The proportion of stillborn among
legitimate children, as it is derived from statistical tables extending
over a  series of years, and embracing not fewer than eight millions
of births, varies from one in eighteen to one in twenty of all births.
(" Brit, and For. Med. Rev.," No.  7, p. 235.)   In immature and ille-
gitimate children, forming the greater number of those which give
rise to charges of child-murder, the proportionate mortality is much
greater;  probably about one in eight or ten.   Stillbirths  are much
more frequent in first than in after-pregnancies.  These facts should
be, borne in mind, when we are  estimating the probability of  the
cause of deatli  being natural.   Thus, children are much more  fre-
quently born dead among primiparous than among non-primiparous
females.  According to Dr. Lawrence's observations, the proportion
of deaths is 1 to 11 of the primiparous and  1 to 31.2 among  the
non-primiparous.  (" Edin. Med. Journ.," March, 1863, p. 815.)  In
most cases  of child-murder, the woman  is primiparous.
   Should breathing be established by the protrusion of the child's
head from  the outlet, or during the birth of the body, the chances
of death from natural causes are considerably diminished.  Never-
theless, as Dr. Hunter long ago suggested, a child may breathe and
die.   Thus, according to this author, "If the child makes but one
gasp and instantly dies, the lungs will swim in water as  readily as
if it had breathed longer and had then been strangled." In general,
it would require more than  one gasp to cause the  lungs to  swim
readily in water; but Avaiving this point, the real  question is: If
the child breathed either during or after birth, what could have
caused its death ?   The number of gasps which a child may make,
or which may be required for the lungs to swim in water, is  of no
moment; the point to  be considered is, A\Thether its death Avas due
to causes of an accidental or criminal nature.   So again observes Dr.
Hunter: "We  frequently see children born, who, from circum-
stances in their constitution, or in the nature of the labor, are  but
barely alive, and after breathing a minute or tAvo, or an hour or two,
die, in spite of all our attention.  And why may not this misfortune
happen to  a woman who is brought to bed by herself ?"   (Op. cit.)
The substance of this remark is, that many children may die natu-
rally after having been born alive; and in Dr. Hunter's time, these
cases were  not perhaps sufficiently attended to.  In the present day,
however, the case is different; a charge of child murder is-seldom
raised, except in those instances where there  are the most obvious
marks of seA7ere and niortal injuries on the body of a child; and un-
less it be intended to defend and justify the practice of infanticide,
it must be admitted that the discovery of violence of this kind on
the  body of a  new-born infant renders a full inquiry into the cir- 
NATURAL CAUSES OF DEATH.
591
cumstances necessary.  Among the natural causes of the death of a
child may be enumerated the following:—
  1. A protracted delivery.—The death of a child may proceed, in
this case, from injury suffered by the head during the violent con-
tractions of the uterus, or from an interruption to the circulation in
the umbilical cord before respiration is established.  A child, espe-
cially  if feeble and delicate, may die from exhaustion  under these
circumstances.  This cause of death may be suspected when a sero-
sanguinolent tumor (called cephalcematoma, or caput succedaneum) is
found on the head of a  child, and the head itself is deformed or
elongated; internally, by the congested state of the vessels of the
brain.  The existence of deformity in the pelvis of the Avoman
might corroborate this  view; but  in primiparous Avomen (among
whom charges of child-murder chiefly lie) with well-formed peh7es,
delivery is frequently protracted.  It is presumed that there  are
no marks of violence on the body of the  child, excepting those
Avhich may have reasonably arisen from accident in attempts at self-
delivery.
  2. Debility.—A child may be born either prematurely,  or at  the
full period, and not survive its birth, owing to a natural feebleness
of system.   This is observed among  immature  children ;  and it
is a condition especially dwelt on  by Dr. Hunter.  Such children
may continue in existence for several hours, breathing  feebly, and
may then die from mere  Aveakness.   These cases may be recognized
by the immature  condition of the body, and the  appearance of a
general Avant of development.
  3. Bleeding from laceration of the navel-string.—A child  may die
from loss of blood, OAving to a premature separation of the  placenta,
or an accidental rupture of the navel-string.  In the latter  case, it it
said the loss of blood is  not  likely to prove fatal if breathing has
been established ;  but an instance is reported in which a child died
from bleeding even  under these circumstances.  (Henke's " Zeits-
chrift," 1839, Erg. H., p. 200 ; also  1840, vol.  1, p.  347, and vol. 2,
p. 105 ; "Ann. d'Hyg.," 1831, vol. 2, p. 128.)   Bleeding  from  the
cord has in some cases  taken place at various periods after birth,
and has  led to the  death  of the child.  (" Edin. Alonth. Journ.,"'
July, 1847, p. 70.)   Death  from bleeding may be commonly recog-
nized, by the blanched appearance of the body7, and a want of blood
in the internal organs; but there are several instances on record, in
which the cord Avas ruptured close to the abdomen without causing
the death of the  child.  Bleeding  from the vessels of the navel-
string may prove fatal several days after birth, even when a child
has been properly attended to, and  the navel-string has separated
by the natural  pirocess.   Air. Willing has  reported a  case of this
kind, in Avhicb, in spite of every application, the  child died from
loss of blood six days after the cord had separated.   ("Aled. Times
and Gaz.," Alarch 25,1854, p. 287.)   The impossibility of  arresting
the bleeding in this case appeared to depend upon a great deficiency
of fibrin  in the blood, and a consequent want  of tendency to coag-
ulation. 
592
NATURAL CAUSES OF DEATH.
  4. Compression of the navel-string.—AVhcn a child is born by the
feet or buttocks,the cord may be so compressed under strong uterine
contraction that the circulation between the mother and child Avill
be arrested, and the latter will die.   The same fatal compression
may follow when, during delivery, the cord becomes twisted round
the neck.  A child has been known to die under these circumstances
before parturition, the cord having become twisted round its neck
in the uterus.   ("Med. Gaz.," Oct. 1840, p. 122; also vol. 19, pp.
232, 233.)  On  these occasions, the child is sometimes described to
have  died from strangulation, but  it is evident that before  the
establishment of respiration, such a form of expression is improper.
There are few,  or no appearances indicative of the cause of death.
There may be  lividity about  the  head and face, with a mark or
furrow on the  neck, and  congestion of the brain internally; it is,
hoAvever, necessary  to remember that the brain of a child is always
more congested than that of an adult.
  5. Malformation.   Monstrosity.—There may be a deficiency, or de-
fect of some vital organ which Avould  at  once  account for a child
dying either during delivery, or soon after its birth.  Two cases
are reported, in one of which  the  child died from an absolute defi-
ciency of the gullet, the  pharynx  terminating  in a cul-de-sac;  in
the other, the duodenum was obliterated for more than an inch, and
this malformation had occasioned the child's death.   (" Aled. Gaz.,"
vol. 26, p. 542.)  In a third,  recorded by Mr. Fairbairn, a child
w7as suffocated  by a retraction of the base of the tongue, owing to
defect of the frsenum.   (" North Journ. Aled.," Alarch, 1849, p. 278.)
The non-establishment  of respiration sometimes arises from  the
mouth and fauces  of the child being filled Avith mucus.   An en-
larged thyroid gland has occasionally led to the deatli of a new-born
child by suffocation.   (" Edin. Month Journ.," July,  1847, p. 64.)
The epiglottis is sometimes fixed  over  the glottis so as to prevent
the entrance of air.  In a case wThich occurred to Dr. Hicks, a child
w7as saved by the introduction of a finger ; the  air suddenly rushed
in, and the child was enabled to breathe.  But a child may be born
in this state when no person is at hand to assist  the woman ; in this
case it will die  ; and the  lungs  being found in the fcetal  or unex-
panded condition, it will  be pronounced still-born.   Obstruction of
the air-passages is a frequent  cause of death among still-born chil-
dren.
  The varieties of malformation are very numerous, but there  can
be no difficulty in determining whether they are such as to account
for death.  Persons are not allowed to destroy monstrous births;
and the presence of any marks of violence in such cases should be
regarded with  suspicion.   It is  the more necessary to make this
statement, as there is an idea among the vulgar  that it is not illegal
to destroy a monstrous birth.  Mr. Poole, of Cirencester, communi-
cated to me a case which  occurred some years since in  his practice.
A lady was delivered of a most hideous dicephalous (tAvo-headed)
monster.  In his absence, and at  the earnest  solicitations of  the
friends, the nurse destroyed it.  The question Avas, Avas this woman 
NATURAL CAUSES OF DEATH.
593
guilty of murder?  The only case in reference to this point Avhich
is recorded by medico-legal Avriters, is that of two women Avho were
tried at the York Assizes in 1812, for drowning a child which was
born Avith some malformation of the head, in consequence of Avhich
it Avas likely that it could not survive many hours.   It did not ap-
pear that there had been any malice or concealment on the part of
the prisoners, avIio were  not aware  of the  illegality of the act.
(Paris and  Fonblanque) (" Med.  Jur.," vol. 1, p. 228.)  The absence
of malicious intention Avould probably lead to an acquittal  on a
charge of murder;  but such an act Avould doubtless amount to  man-
slaughter;  the degree of monstrosity or the viability of the offspring
cannot be received as an extenuating  circumstance.   As to the first,
if a liberty of judging Avhat Avas  monstrous and Avhat not, Avere
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 Avhoever accelerates death causes it ; hence, the fact that the
offspring is not likely7 to live more than a few hours does not justify
the act of one avIio prematurely destroys it.
  6. Atelectasis.—This, as it has been elsewhere explained, implies
simply an  unexpanded state of the  lungs.   In some  cases  it is
complete, in others, partial.   (See ante, p. 565.) It can scarcely7 be
regarded as a diseased condition, as the bod}7 of the child may be
otherwise healthy ; the lungs themselves are in a normal state, and
they can be easily expanded by the artificial  introduction of air.
That they are not so expanded during birth or afterwards may arise
from feebleness in the child.
  7. Congenital disease.—It  has  been  elseAvhere stated that a child
may be born laboring under such a degree of congenital disease as
to render it incapable of living.  The discovery of any of  the fcetal
organs  merely in a morbid  condition amounts to  nothing, unless
the disease has advanced to a degree Avhich Avould be sufficient to
account for death.   There are, doubtless, many obscure affections,
particularly of the brain, which are liable to destroy the life of a
child Avithout leaving any Avell-marked changes in the dead body.
According  to Dr.  Burgess,  apoplex}7 and  asphyxia are common
causes of death among new-born children.   (" Aled.  Gaz.," vol. 26,.
p. 492; Henke's " Zeitschrift der  S.  A.," 1843, p.  67.)  Probably
diseases of  the lungs  are  of the greatest importance in a medico-
legal point of view, because  by directly affecting  the organs of
respiration, they render it impossible  for a child to live, or to sur-
vive its birth by a  long period.  These  diseases in  the fcetal  state
are principally congestion,  hepatization, tubercle,  scirrhus, and
oedema; the existence of any of which it is not difficult to discover.
They render the structure of the  lungs heavier than  water, and
thus prevent the organs from acquiring  that  buoyancy Avhich  in
their healthier state they are known to possess.  It is not common
to find the lungs diseased throughout; a portion may be sufficiently
healthy to allow of a partial performance of respiration.
  Conclusions.—The following conclusions may be drawn  from the
preceding remarks:—
      3tf 
594
VIOLENT CAUSES OF DEATH.
  1.  That a large number of illegitimate children, especially when
immature, are born dead from natural causes.
  2.  That a child may die from exhaustion as the result of a pro-
tracted labor.
  3.  That if a  child  be  prematurely born, or if it  be small and
weak even at the natural period, it may die from mere debility, or
want of poAver in the  constitution either to commence, or to con-
tinue the act of respiration.
  4.  A child may die from loss of blood, owing to accidental rup-
ture  of the cord during delivery; it may even die from this cause
after it has breathed.
  5.  That fatal bleeding is more likely  to occur when the cord has
been cut close to the abdomen, than when it has been lacerated or
cut at a distance from the navel.
  6.  That the division of the cord, whether by rupture or incision,
without ligature,  is  by  no  means necessarily fatal  to a  healthy
mature child.
  7.  That a child may die from accidental compression of the cord
during delivery—the  circulation  between  the  mother and child
being thereby arrested before respiration had commenced.
  8.  That death may speedily follow birth from some malformation
or defect, or defective condition of important organs.
  9.  That a child  may  die from congenital  disease affecting the
organs of respiration, or the air passages.
                     CHAPTER  LI I.

VIOLENT  CAUSES OF DEATH IN NEW-BORN CHILDREN.—SUFFOCATION.—
  DROWNING.—DEATH OF THE CHILD FROM COLD AND EXPOSURE.—STAR-
  VATION.—DEATH FROM IMMATURITY.--WOUNDS IN  NEW-BORN CHIL-
  DREN.—FRACTURES OF  THE SKULL, ACCIDENTAL AND CRIMINAL.—
  TWISTING  OF THE NECK.--VIOLENCE IN SELF-DELIVERY.—POWER OF
  LOCOMOTION  AND EXERTION IN FEMALES AFTER DELIVERY.

   Violent causes of death.—In  this  chapter we have to  consider
those modes of death Avhich are totally independent of the ex-
istence of congenital disease, or other natural causes.   In  most
cases of alleged child-murder, the body of the child bears about it
the marks of physical  injury, such as those which are  indicative
of  strangulation, wounds,  burns, and fractures.  The marks of
violence may be such as to leave no doubt that they were wilfully
inflicted.
  In order to render a person criminally responsible, it  must be
proved that the injuries were unlawfully inflicted on a living child,
and that they were the cause of death. Assuming that the altera-
tions in the  law regarding the destruction of newT-born  children 
DEATH FROM SUFFOCATION.
595
will be carried out (p. 576), cases of child-murder will include all
those in Avhich it is proved that the violence was wilfully inflicted
during or  after birth, and that it was subsequently the cause of
death.   If  the child has died  after birth, from  violence carelessly
or ignorantly inflicted during  birth or afterAvards, this will consti-
tute a case  of manslaughter.  A question of medical responsibility
may be raised under these  circumstances, as where a medical man
is charged with having caused the death of a child by gross ignor-
ance and carelessness in the delivery of a woman.  The following
instance  is reported by Chitty (" Med. Jur.," p. 416; also ArcfT-
bold, p. 345): A man of the name  of Senior,  avIio, it appears, was
an unlicensed medical practitioner, was tried for the manslaughter
of an infant, by injuries inflicted on it at its birth.  The prisoner
practised midwifery, and Avas  called to attend the prosecutrix, Avho
Avas taken in labor.  The evidence  showed  that Avhen the head of
the child presented, the  prisoner, by some mismanagement, frac-
tured, and  otherwise so injured the cranium, that  the child died
immediately after  it was born.   It Avas argued, in defence, that
as the child was  not  born (in ventre  sa  mere) at the time the
wounds and injuries wTere inflicted, the prisoner could not be guilty
of manslaughter.  The judge, however, held that as the child Avas
born alive and had subsequently died from the violence, the  case
might be one of manslaughter.  This opinion was afterwards con-
firmed by  the other judges, and the prisoner was  convicted and
sentenced to imprisonment. From  the decision in this case, it Avill
be seen that if the  prisoner  had effectually  destroyed the child
before it Avas entirely born, he would not have been guilty of any
crime.
  1.  Suffocation.—This is  a common cause of death in new-born
children.   A wet  cloth may be placed over the child's  mouth, or
thrust into this cavity, either during birth or afterwards, and before
or after the performance  of respiration.  To the latter case only
could the term suffocation be strictly applied.  A child may be
thus destroyed by being allowed to remain closely compressed under
the bed-clothes  after delivery, or  by7 its head being  thrust  into
straAv, feathers, ashes, and  similar substances.   The appearances in
the body are seldom sufficient to excite a suspicion of the cause of
death, unless undue violence  has been employed.  There  is  com-
monly merely lividity about the head and face, with slight  conges-
tion of the lungs.  A careful examination of the mouth and throat
should be made, as foreign  substances are sometimes found in this
situation, affording circumstantial  evidence of the mode in which
the suffocation has taken place.  Thus, wood,  straw, feathers, dust,
toAV, or a hard plug of linen may be, and in some cases have been,
found blocking  up the  mouth and throat, draAvn into these parts
by aspiration when  the mouth  of a child  has been covered with
such substances.   If a child has lived sufficiently long to be fed, it
may be accidentally suffocated by the entrance of portions of solid
food, such as the curd of milk, into the windpipe and air-passages.
  A neAv-born child may be suffocated by having its head held over 
596
DEATH FROM SUFFOCATION.
noxious vapors, such  as  the exhalations of a privy or of burning
sulphur; and it is here  necessary to remind a  medical jurist that
other highly poisonous vapors, e. g., chloroform, may be used by a
criminal Avithout leaving any traces upon  the body—except, pos-
sibly, for a short time, that  Avhich  may depend upon their peculiar
odor.  There are  but few of these cases of suffocation in which
a positive medical opinion of the causes of death could be given,
unless some circumstantial evidence were produced, and the witness
Ave re allowed to  say  whether the alleged  facts Avere  or were  not
sufficient to account for death.  (" Annales d'Hyg.," 1832, vol. 1, p.
621.)
  On the other hand, if it  be  even clearly proved that death  has
been caused by suffocation, it must be remembered that a child may
be accidentally suffocated, and the crime of murder falsely imputed.
Dr. J. Al. Duncan, quoting the observations of Dr. Buhl, states that
obstruction of the air-passages by  mucus  and other matters, is  a
frequent cause of death in new-born  children.  Among twenty-seven
children dying in  labor or shortly after birth, eleven died from ob-
struction of the air-passages  with foreign matters.  Eight were born
dead, and of those which Avere alive at birth, none survived the first
day.  In ten of these  cases, the obstruction was  produced by  a
greenish-broAvn slimy  mass (meconium and mucus) filling the larynx
and Avindpipe.  In two of the cases, in which the child died during
delivery, air was  found  in the lungs, and in only one of these  the
air had been derived from  the act of  respiration during  birth.
(" Edin. Alonthly Aled.  Journ.," April, 1863, p. 924 ; also " Aled.
Times and Gazette,"  August 3, 1861, p. 117.)  In  Dr. Hicks' case
(p. 592) the base of the tongue in a new7-born child was so draAvn
down by spasmodic action, as to close the glottis by pressing back-
wards the  epiglottis.   The  child Avas saved by simply raising  the
epiglottis, when air rushed in, and breathing Avas established; but
many children must be born under  similar conditions  when no as-
sistance is  at hand.   Cases  of this  kind, hoAvever,  rarely give rise
to charges of child-murder, as no air is found in the lungs. A child
might be killed during delivery by pressure applied to the chest;
this  might be such as not to produce any marks of violence. If the
child had  not  breathed, there would  be nothing  to  indicate  the
mode of death ;  if air had  entered the  lungs, then the usual ap-
pearances Avould be found in these organs (p. 557).   In dealing with
a case of this kind, it should be remembered that  a child Avith its
head born, but detained in  the outlet  by the size of its shoulders,
might die  from  pressure  exerted on the chest by the vagina.   It
might have breathed, but be born dead with the  marks of suffo-
cation about it.   There is another accidental cause of  the death of
a neAv-born child  during delivery:  the membranes or caul  may be
carried  forAvard  over  the head and face, and the act of breathing
thus mechanically prevented.  If no assistance is at hand, the child,
although born living, will die soon after birth in consequence of
the prevention of respiration.  If,  when the dead body is found,
the membranes are no longer there, the cause of the prevention of 
DEATH FROM SUFFOCATION.
597
respiration would not be apparent.  The child, although born living,
Avould  probably be  pronounced to have  been born dead.   (" Aled.
Times  and Gaz.," January, 1863, p. 126.)  The delivery of a child
with a mask or caul around its  head is not an unfrequent occur-
rence.  In June, 1862, Air. Blenkinsop, of Warwick, communicated
to me  a  case in which a mature and healthy child so born was
alloAved to pjerish by those who  had access to it.   The caul was
simply not removed, so that  breathing could  not be set up.   The
lungs contained no air.   There Avas  congestion of the brain and
lividity of the  body, but no mark of violence.  There was  some
evidence  that the child had been born living, and that the cause of
deatli was the  prevention of respiration by omission to do  that
Avhich was necessary.  As the  medical evidence showed that  the
child had not breathed, the Coroner held  that it had never had any
(legal) existence, and that there was no ground for further  investi-
gation.   Dr. Hunter, who Avas well aAA7are of the risk to which a
Avoman might  be thus exposed, observes in relation to this state
of things:—"When a woman is delivered by herself, a strong child
may be born perfectly alive, and die in a very few minutes for want
of breath, either by being on its face in a pool formed by the natural
discharges, or upon  wet clothes: or by the wet things over it col-
lapsing and excluding air, or drawn close to its mouth and  nose by
the suction of breathing.  An unhappy woman delivered by herself,
distracted in her mind and exhausted in her body, will not have
strength or recollection enough to fly instantly to the relief of her
child." (Op. cit. p. 35.) It may be added  that a primiparous woman
may faint, or be  Avholly unconscious of her situation; or, if conscious,
she may  be  ignorant of the necessity of removing  the child, and
thus it may be suffocated without her having been  intentionally
accessory to  its death.  In such cases, however, there should be no
marks of violence on the  body, or if present, they should be of such
a nature  and in such a situation, as to be readily explicable on the
supposition of an accidental origin.
  An infant is easily destroyed by suffocation.  If the mouth and
nostrils are kept covered for a few minutes, by the face being closely
wrapped in clothes, asphyxia may come on without this being indi-
cated by  convulsions or any other marked  symptoms (see p. 444).
A suspicion of murder may arise in such  cases ; but the absence  of
marks of  violence, with an explanation of the circumstances will
rarely allow the case to be carried beyond an inquest.  Sometimes
the body is found maltreated, Avith severe fractures or contusions on
the skull, and  marks of strangulation on the neck, concealed in a
feather-bed or privy, or cut up and burnt.  This kind of violence
may properly excite a suspicion of murder,  and lead  to the belief
that the  allegation  of death from  accidental suffocation is a mere
pretence.   This, however,  is purely a question  for a jury, and not
for a medical witness.  Unless the case be of a  glaring nature, the
violence is considered to have been employed for the purpose rather
of concealing the birth of a child than of destroying it.
  The appearances in the  body in  cases of death from suffocation 
598    APPEARANCES IN  DEATH FROM DROWNING.

have been elsewhere described, in reference to adults (p. 440); they
are  similar in new-born  children, provided respiration has been
fully performed.  M. Tardieu attaches great importance to the dis-
covery of subpleural  ecchymoses in the lungs of children;  he has
also noticed small eft'usions of blood on the  surface and in the sub-
stance of the thymus-gland.  ("Ann. d'Hyg.," 1855, vol. ii. p. 379.)
If the lungs float on water, as the result of breathing, then the ap-
pearances described will be met with ;  but  it is worthy of remark
that in three instances A!. Tardieu met with similar appearances in
children whose lungs had not received air, and sank when placed
on  water.  They were children prematurely born, and under con-
ditions which prevented full vital development.  One born in the
Hospital of Riboisere uttered several cries, but, in spite of this, the
lungs contained  no  air.  The  subpleural ecchymoses met Avith in
children under these circumstances, are ascribed by M. Tardieu to
the efforts made to breathe after birth (loc. cit.).   Partial emphy-
sema of the lungs is occasionally observed.
  At page 444 ante some remarks have been made on the suffocation
of new-born children, by thrusting foreign substances into the mouth.
In  May, 1872, Dr. Afoon, of Lancaster^" consulted me on the follow-
ing case.  A servant girl had given birth  to a healthy child.   This
child Avas found alive about a quarter of  an hour afterwards, in a
privy, and it lived a feAV minutes after the discoA7ery.  Its jaw was
broken, its  cheek torn, and  the mouth contained ashes, some of
which were found in the back part of  the throat.   The body was
blanched, and there had evidently been a great loss of blood from
the wounds and  the  torn umbilical cord.  There was no engorge-
ment of the  lungs, or any subpleural ecchymoses.  The  lining
membrane of the trachea was stained with ashes, and a small cinder
Avas found in the left branches.
  In this case there w7as no question respecting live birth, as the
child was living w7hen found, but what  was  the cause of death, and
wTas this accidental or the result of violence wilfully applied after
birth ?  In  the opinion of Dr.  Moon the  mouth of the child had
been forcibly torn open and  filled with ashes in order to suffocate
it.   These  ashes must have been draAvn by aspiration into the air-
piassages, and death Avas caused partly by  suffocation and partly by
hemorrhage from the w7ounds,  the  child's  body  being  bloodless.
The condition of the lungs was not  inconsistent with death from
suffocation.   For some remarks on death  from suffocation in child-
murder, with  reports of cases, see a paper  by M. Severin Caussd,
"Ann. d'Hyg.," 1869, 2, 122, 443.
  2. Drowning.—The fact of drowning cannot  be verified by any
appearances on the body of a child Avhich has not breathed.   Thus,
if a woman caused herself to be delivered in a bath, and the child
was forcibly retained under water (a case Avhich is said to have oc-
curred), it would of course die; but no evidence of the  mode of
death would be found in the  body.   After respiration, the signs of
drowning will be the same as those met with in  the adult.  (See p.
390.) The main question for a witness to decide will be, Avhether 
        APPEARANCES IN  DEATH  FROM  DROAVNING.     599

the child Avas  put into  the Avater living, or dead ?  Infanticide by
drowning is by no means common; the child is generally suffocated,
strangled, or destroyed in other ways, and its body is then throAvn
into water  in order to conceal the real manner of its death.  The
fact of the  dead  body of an infant being found in water must not
allow  a Avitness to be throAvn off his guard ; although a verdict of
"found drowned" is so commonly returned in these cases, the body
should be carefully inspected in order to determine what was really
the cause of death.  All marks of violence on the bodies of children
that have died by drowning should be such as to  have resulted
from accidental causes.   The throat and air-passages should be par-
ticularly examined.
  It is not necessary that the whole of the body of a child should
be submerged, in  order that it may be destroyed by drowning; the
mere immersion of the head in water,  or the covering of the mouth
by liquid, will suffice to  produce the usual effects of asphyxia. The
outlets  of  the ears and the air-passages should  be  examined for
foreign substances which may be deposited in them.
  XeAV-born children may be drowned or suffocated by being thrown
into mud, or into the soil of a pirivy.  Sometimes the child is de-
stroyed by other  means, and its bodj7  is thus disposed of for the
purpose of concealment.  Should there be a large quantity of liquid
present, the phenomena  are those of droAvning.  The  liquid portion
of the soil abounding in sulphide of ammonium may then be found,
if the child Avas  thrown in living, in the air-passages, gullet or
stomach.   The mere discovery of  soil in the mouth would not
suffice to shoAV that the  child was living Avhen immersed; but the
presence of foreign substances, such as dirt, straAv, or ashes, in the
air-passages, gullet,  and stomach, has usually  been taken  as a
medical proof that the child Avas living Avhen immersed in the dirt,
etc., and that  the substances had been drawn into the passages by
aspiration,  or by the act of swalloAving.
  On  these occasions the  defence may be: 1. That  the child Avas
born dead,  and that the  body Avas thrown  in  for concealment; but
the medical evidence may shoAV that it had breathed, and had pro-
bably  been born living.   2.  It  may be  alleged that the  child
breathed for a few moments after birth, had then  died, and that
the Avoman had  attempted  to conceal the dead  body.  A medical
Avitness may be here asked, Avhether a woman  could have had power
to convey the  body to the place—a pioint Avhich  must, as a general
rule, be conceded.   3. It is most commonly urged, that the woman
being compelled  to go to the privy, was there delivered unconsciously
or unexpectedly;  that her Avaters had broken in the watercloset,
and that she  had no idea of anything more having happened; or
that the child had dropped from her, and Avas either suff'ocated or
prevented from  breathing.  (" Aled. Times and  Gazette," Dec. 21,
1861, p. 646.)  All these circumstances may readily  occur;  but on
the other hand, the explanation may  be inconsistent with some of
the medical facts.   (See a ease by M. Adelon, " Ann. d'Hyg.," 1855,
vol. 2, pi, 453 ; also Casper's " Kliniscbe JSTovellen," 1863, p. 585.) 
600     APPEARANCES IN  DEATH FROM DROWNING.

Thus, the head or the limbs of a child may be found to have been
separated or divided by some cutting instrument, or a cord or other
ligature may be found tightly bound round its neck, or there may-
be a tightly-fitting plug in the throat.  Then, again, the body may
be entire, but the umbilical cord may be cleanly cut.  This would
tend to set aside the explanation of  the child having accidentally
dropped from the female; because in such an accident the cord
should ahvays be found ruptured.  The pjractitioner should make a
careful  examination of the divided ends of  the cord by  the  aid of
a lens, or  a rupture may be mistaken for a section with a sharp in-
strument.   Mr.  Higginson, of  Liverpool, has published a case of
some interest in this point of view.  The child fell from the mother,
and the cord broke spontaneously. " The torn ends were," he states,
" nearly as sharp-edged and flat as if  cut."  ("Aled.  Gaz.," vol. 48,
p. 985.)  This case goes to p>rove that a careless or hasty examina-
tion of the ends of the cord may lead to a serious mistake.
  AVhen the cord is lacerated, this Avill be, cceteris paribus, in favor
of the woman's  statement as to the mode in which her delivery oc-
curred.   Drowning may be the result of  accident from sudden
delivery.  A woman in an advanced state  of pregnancy,  Avhile
sitting  on a chamber-vessel was suddenly  delivered.  The  child
fell into the fluids  in the vessel, and before assistance could be
rendered, it was dead.
  Whether, in any instance, the drowning of a child was  accidental
or criminal, must be a question for a jury to determine from all
the facts laid before them.   The situation in Avhich the body of an
infant is found may plainly contradict the supposition of accident.
On the other hand, a child may be accidentally drowned by its
mouth  falling into a pool of the  discharges  during delivery, al-
though this would  be rather a case of  suffocation.  The throat,
windpipe, and stomach of the child should always be examined on
these occasions, as mud, sticks, straw, weeds, or other substances
may be found in these parts, indicating, according to circumstances,
that the child had been put into the  water  living, and that it had
been droAvned in a particular pond or vessel.
  The  folloAving, Avhich is reported by  Dr. Tenneson, is of some
interest in this respect.   ("Ann. d'Hyg.," 1872,1,438):  In this
case, a neAv-born child recovered after it  had remained four  hours
in a drain-pipe connected with  a cesspool which  received the soil
of privies.  A girl was charged with attempting  child-murder.
It was  proved that she  had been  recently  delivered.  She stated
tha"", she had been to the privy for a natural purpose, and Avas there
suddenly delivered.   A full-grown child  Avas found in  the  large
drain-pipe, between the privy and the cesspool.  It Avas alive, and
wTas restored by  the Avarm bath and other means.  On examining
it, there were no marks of  violence ; the cord had been ruptured as
by a fall, while there was nothing to sIioav an attempt at murder.
The  appearances presented by the  body of  the child  were consis-
tent with  the woman's statements.  The preservation of its life
was remarkable.  The first part of the drain-pipe was wide enough 
          DEATH  FROM  COLD AND  STARVATION.       601

to admit the body, which lodged at the  lower part, near a bend.
It Avas thus saved from falling into the cesspool.   The drain-pipe
contained air and no sewer gases—hence the child could breathe,
and before removal it Avas heard to cry.  M. Devergie  suggested
that its life had been saved OAving to the noxious gases being kept
down by the drying of the surface of the soil.
  3.  Cold.—A new-born  child may be easily destroyed by simply
exposing it uncovered, or but slightly covered, to a cold atmosphere.
In a case of this kind  there  may be no marks of violence on the
body, or these may be slight and evidently of accidental  origin.
In death from cold the only appearance  occasionally met Avith has
been congestion of the brain, with or Avithout  serious effusions  in
the ventricles.  (See Cold, p. 483.)  The evidence in these cases
must  be purely circumstantial.   The medical Avitness may have  to
consider  Iioav 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 neAv-born child  is easily affected by a low temperature, and that
warm clothing is required for the preservation of its life.  An in-
spection of the body should never be omitted  on these  occasions,
because it might turn out that there was some latent cause of natu-
ral death Avhich would at once do away with the charge of murder.
Admitting that the child  died from cold, it becomes  necessary  to
inquire whether it was exposed with a malicious intention that it
should thus perish.   Unless wilful malice be made out, the accused
cannot be convicted of murder.   In general, females do not expose
their  children for the purpose of destroying them, but for the pur-
pose of abandoning them ; hence it is rare to hear of convictions
for child-murder where cold was the cause of death, although some
medical jurists have called this infanticide by omission, an offence
which does not appear to be recognized  by the English law.
  4. Starvation.—A new-born child kept long  Avithout  food will
die, and no evidence of the fact  may be derivable from an exami-
nation of the body.  There may be no marks of violence exter-
nally, nor any pathological changes internally, to account for death.
This  is a rare form of murder, except as it may be accidentally
combined with exposure to cold.  In order to convict  the mother,
it is necessary to shoAV that the  child was wilfully  kept without
food, Avith the criminal design of destroying it.  Mere neglect  or
imprudence will not make the case infanticide.  The only appear-
ance likely to be found on an examination of the body would  be
complete emptiness of the alimentary canal.  AVithout corrobora-
tive circumstantial evidence, this would not suffice to establish the
cause of death; a medical witness could  only form a probable con-
iecture on the point. In a suspected case of this kind, the contents
of the stomach should be tested for farinaceous  and other kinds  of
food.
  5. Immaturity in  cases of Abortion.—From the case of  Reg.  v.
West (Nottingham Lent Assizes, 1848), it Avould appear that if by
the perpetration of abortion, or  the criminal inducement of pre- 
602
INFANTICIDE FROM  WOUNDS.
mature labor, a child be born living at so  early a period of uterine
life that  it  dies  merely from immaturity, the person  causing  the
abortion, or leading  to a premature birth, may be tried on a charge
of murder.   A midwife Avas alleged to have perpetrated abortion
on a female Avho Avas betAveen the fifth and  sixth month of preg-
nancy.  The child Avas 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 indicath7e of the cause, may
be mentioned Avounds, strangulation,  and  poisoning.
  6. Wounds.—Probably this is one of the most frequent causes of
death in  cases of  child-murder.   Wounds may, however, be found
on the body of a  child Avhich has died from some other cause.  The
principal questions which a  medical Avitness has to ansAver are: 1.
AVhether the Avounds AArere inflicted on the body of the child before
or after  death.   2. Whether they were sufficient to  account  for
death; and  3, whether they resulted from accident, or criminal de-
sign.   The child  may have been destroyed by burning, and evidence
must then be sought for by an examination of the state of the skin.
All these questions have been fully considered in treating the subject
of AVounds, and they therefore do not require any- special notice in
this place.
  Incised wounds found on the bodies of  children may be referred
to the  use of a knife or scissors by the prisoner  in attempting to
sever the navel-string, and they may  therefore be due  to accident.
This point should not be  forgotten, for a  wound even of a severe
kind might be thus accidentally inflicted.   In such cases Ave should
ahvays expect to  find the  navel-string cut, and not lacerated.  The
end of it may, for the purpose of examination, be stretched  out on
a piece of Avhite card.  This will  in general suffice to show whether
it has been  cut or torn.  Wounds, however slight, should  not be
overlooked:  minute punctures or incisions  externally may corre-
spond to deep-seated injury  of vital  organs.  The  spinal marrow
is said to have been wounded by needles or stilettoes introduced
between the vertebrae,  the skin having been drawn down before the
w-ound Avas inflicted, in order to  give  it a valvular character,  and
to render it apparently superficial.   The brain is also said to have
been Avounded, by similar Aveapons, either through the nose or the
thinner parts of the skull (the fontanelles).
  In some instances the body of  a child is found cut to pieces,  and
the allegation in  defence may be that the child was stillborn,  and
the body thus treated merely for the purpose of concealment.   Dr.
Toulmouche has reported a case of this kind, which Avas the subject
of a trial in France in 1852.   As the Avoman had not destroyed the
lungs, experiments on these organs gave satisfactory results of  per-
fect respiration.  The cavities of the heart and  great vessels were
empty ; the  body was generally drained of blood, and the  skin 
FRACTURES OF THE  SKULL.
603
throughout very pale.  This led to the inference that the mutila-
tions must have been inflicted while the child Avas living ; and  as
all the parts Avere healthy and no natural cause of death apparent,
Dr. Toulmouche  ascribed  the death of the child to the wounds.
The Avoman was convicted, and condemned to twenty 37ears' confine-
ment in the galleys.  ("Ann. d'Hyg., 1853, vol. 2, p. 200.)  In this
country she wrould probably have escaped under a verdict of " con-
cealment of birth," and have been sentenced to a year's imprison-
ment.
  Injuries to the head.—It has been elsewhere stated  that, during a
protracted delivery, there was formed on the head of a child a tumor
containing either serum, blood, or a mixture of the tAvo. If a woman
has been secretly delivered, non-professional persons may ascribe a
tumor of this  kind to violence, whereas it may really have been
produced by natural causes.  The  tumor is generally situated  on
one of the parietal bones, its situation depending on that part of the
head Avhich presents during delivery.  After the discharge of the
waters,  the scalp is firmly compressed by the mouth of the uterus,
and subsequently by the os externum. This pressure interferes with
the circulation  through the skin, and causes the compressed portion
of the scalp to swell.   In the  simplest form of  this  tumor serum
only is found in the swollen part;  occasionally this  is mixed with
blood, and there are small  ecchymoses  of  the scalp, as Avell as  of
the pericranium and skull, but there is generally no injury to the
bones, nor is there any laceration of the skin externally.   In other
cases, blood is found effused  in the tumor either under the scalp), the
membrane  covering the skull (pericranium), or within  the skull
itself.   The term  caput succedaneum is appdied to a tumor which
has this natural origin (p. 591.)  The sanguineous, is more  likely
to be confounded with  the effects of  violence, than the serous
tumor:  but it may be identified by the scalp  being ahvays unin-
jured, although it  may present redness and  lividity.  Violence from
1)1oavs or falls Avhich would produce  bloody effusions beneath the
scalp, or Avithin the skull, Avould in general be indicated by injury
to the skin, or by  fracture of the bones.
  The only injuries to the head which require to be  specially con-
sidered  in relation to  infanticide, are fractures  of the skull; and
here the question to which we may chiefly confine our attention  is,
Avhether the fracture arose from accident or criminal violence. The
rules for determining whether these injuries were inflicted during
life or after death have been  elsewhere considered.   (See AVounds,
p. 258).
  Although it has been a matter of frequent observation, that great
violence may be done  to the  head of a child  during parturition
Avithout necessarily giving rise to fracture, yet it is placed beyond
all doubt, that such au 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 Avhich  the head sometimes
experiences in  p>assing  the mouth of the uterus, may  suffice for the 
604         FRACTURES FROM UTERINE  ACTION.

production of fracture.  (See " Edin. Aled. and Surg. Journ.," vol.
26, p. 75.)
  It was formerly supposed that fractures of the skull in new-born
children Avere alw7ay7s indicative of criminal  violence; but  cases
which have occurred in obstetric  practice have established the cer-
tainty of their accidental occurrence.   These accidental fractures,
it is to  be  observed, are generally slight;  they commonly amount
merely to fissures in the bones,  beginning at the sutures, and ex-
tending dowmvards for about an  inch or less into the body of the
bone.  According to Dr. Weber,  the frontal and parietal bones are
the only bones liable to be fissured or fractured by the action of
the uterus during delivery;  and in the  greater number of cases re-
ported, the parietal bones only have presented marks of fracture.
  The possible occurrence of an injury of this kind, as the result of
uterine action, has been strained in several cases of child-murder, to
explain  the origin of fractures which could not fairly or reasonably
be assigned to such an accident.  A case was tried at Glasgow, in
April, 1852 (case of Ann Irwin), in which there was no doubt, from
the state of the lungs, that the child had fully breathed, and there
was  violence  to  the  head which satisfactorily accounted for its
death.  The whole of the right side of the head was deeply ecchy-
mosed, and there was a large quantity of  coagulated  blood lying
beneath the scalp.  In the centre of the right parietal bone there
was  a fracture extending across the vertex for fully four inches, and
involving a part of the parietal bone on the opposite side;  it was
in a continuous even line, not radiated and  not depressed. The  peri-
cranium, bones, and soft parts in the track of the fracture were
deeply ecchymosed, while on the surface of the brain, particularly
on the right side, there was a copious effusion of clotted blood. It
was  impossible to refer severe injuries of this kind to the action of
the  uterus in delivery, or to  violence  applied after death.  The
prisoner alleged  that the child was stillborn.  (See " Edin. Monthly
Journ.," June, 1852.)
  Accidental fractures and effusions of blood, Avhich are caused by
uterine action, may be in general  recognized by their slight extent.
In cases of murder by violence to the  head, the injuries are com-
monly much more severe:  the bones are driven in, the brain  pro-
trudes, and the scalp is extensively lacerated.   Such severe injuries
as these cannot be ascribed to the action of the uterus in parturi-
tion. Here, however, it may be fairly urged, that the woman Avas
unexpectedly seized with labor, that  the  child was  expelled sud-
denly by the  violent  efforts of the uterus, and that  the injuries
might have arisen from its head coming in contact with some  hard
surface—as a floor or pavement. It must be admitted that a woman
may be thus suddenly and unexpectedly delivered while in the erect
posture, although this is not common among primiparous women;
and that injuries may be thus accidentally  produced on the head of
a child.
  A woman is often unable to distinguish the sense of fulness, pro-
duced by the descent of a child, from  the feeling Avhich leads her 
            FRACTURES FROM  UTERINE ACTION.        605

to suppose that she is about to have an evacuation: and thus  it is
dangerous, w7hen a labor has advanced, to allow a Avoman to yield
to this feeling, for there is nothing more  probable than  that the
child Avill be suddenly born.  Air. Rankin, of Carluke, has reported
tAvo cases of this description, Avhere there could not be the slightest
suspicion of criminality.  In one, a primipara, the child was actu-
ally born under these circumstances, but  its  life Avas fortunately
saved ; had there been no other convenience than  a privy it must
have been inevitably lost.  In the second, although a  case of third
pregnancy, the  female  Avas  equally  deceived by her  sensations.
("Edin. Month. Jour.," Jan. 1846, p. 11.)  It is true that this alleged
mistaken sensation forms a frequent and specious defence on charges
of child-murder; but still a medical jurist is bound to admit, that
an accident which  occurs to women of the middle class,  may also
occur to the p>oor,  without necessarily implying guilt.
  The folloAving case shows that a fracture of  the skull of a child
may occur w7hen a  woman is delivered  in the erect  posture.  In
this instance there Avas merely the appearance of a bruise on the
head, and the navel-string Avas ruptured (not cut) three inches from
the navel.  The  child did not suffer from the fall, and continued
well until six days after its birth, when it was seized  Avith convul-
sions  and died.  A  fissure of about  an  inch  and a half in  length
was found in the uppier part of the left parietal bone.  A clot of
blood was found in  this situation betAveen the dura mater and bone,
and there was congestion of the vessels of the membranes; with
this exception there was no morbid appearance in the  body.  (" As
sociation Journal," Oct.  14, 1853, p.  901.)  Dr. Porter Smith, of
Bath, communicated to me  a case, which occurred in November,
1856, in Avhich the facts were similar to  those above related.  In
consequence of the concealment of the body, hoAvever, the mother
was charged Avith murder.   The right pjarietal bone was fractured,
and there was effusion of blood internally, but there  was  no mark
of external violence.   The cord had been ruptured at  a distance of
two-and-a-half inches from the navel.  The stomach  of the child
contained the usual albuminous and  mucous matters of the fcetal
state, Avithout any  appearance of  food.  The lungs contained air,
and Avere highly crepitant; the foramen ovale  and the ductus arte-
riosus Avere in their fcetal condition.   The child had probably been
droAvned  in the discharges from want of assistance at the time of
birth.  The woman, avIio admitted that  the  child fell from her
suddenly, was acquitted.   Dr. Olshausen  has published four cases
of sudden delivery, in each of which  the child dropped from the
woman; and in tw7o of  them there  Avere fissures  in  the  parietal
bones.  The children recovered from  the effects of the accidents.
(" Med. Times and Gazette," Sept. 1860;  " Am. Jour. Aled. Sci.,"
Jan. 1861, p. 279.)  Other cases of rapid  delivery in the erect pos-
ture are reported in  the " Lancet" (Jan. 5, 1861, p. 13).   In these
there Avas no injury to the child, although in one case, the  delivery
took place on the deck of a vessel.
  A medical witness  would  find  no difficulty  in  determining the 
606  FRACTURES  OF THE  BONES  OF HEAD  FROM  FALLS.

probability of this  explanation of the accidental  origin  of such
fractures, if he Avere made acquainted with all the  facts connected
with the delivery.  But the acquisition of this knoAvledge  must be
accidental; and it will in general be out of his power to obtain it.
When the fractures are accompanied  by cuts, punctures, or lacera-
tion of the scalp or face, although their production might be ac-
counted for by an alleged fall during parturition, the cause of these
Avounds Avould still remain to be explained.
  In fractures of the bones of the head in neAV-born children, the
pn-esence of effusions of blood on the outside of the  skull, or on the
membranes Avithin, is one of the most common appearances.  Effu-
sions of blood beneath the skin of the scalp are by no means uncom-
mon in  new7-born  children,  and are not necessarily indicative of
criminal  violence.   Each case, however, must be  decided by the
circumstances attending it.   Eft'usions  on  the membranes and in
the substance of the brain are generally the results of great  violence
to the head.
   Length of the umbilical cord.—It has been recommended  on these
occasions, that  we should observe  the length of  one or both por-
tions of the umbilical cord, and notice whether it is cut or lacerated,
as these facts may, it is  presumed, throw some light  on the ques-
tion.   But a medical witness can  seldom procure the entire  cord
for examination, although it will generally be in  his power to as-
certain whether it  was cut or lacerated, by examining the portion
which is  attached to the body of the  child.   The cord varies in
length—the average being from eighteen to twenty inches: but it
has been  met with  so short as six  inches (" Lancet," June 13,1846,
p. 660), and even five  inches (" Lancet," July 11, 1846, p.  49).  In
a tAvin-case which occurred to Air. Stedman, of Guildford,  the cord
was only four  inches  long.  (" Lancet," Aug. 28,  1841.)  On  the
other hand, in one instance, where it was found twice tAvisted round
the child's neck, it Avas fifty-three inches long.   Dr. Churchill found,
out of 391 cases, that the shortest cord was twelve inches, and the
longest fifty-four inches in  length.  In January,  1850, Dr.  Tyler
Smith presented to the AVestminster Medical Society a  cord fifty-
nine inches and a half in length.  In a case reported by Air. Wood
it was sixty-one inches long, and  coiled twice round  the abdomen
of the child.  (" Med. Gaz.," vol. 45, p. 263.)   As the Avhole of the
cord can rarely be obtained, it is  unnecessary to discuss the ques-
tion, whether it was long enough to  admit of  the falling of the
child without rupture.  It has been remarked that, when  the cord
is  ruptured  from  accidental causes during  delivery, the rupture
takes  place either near to the placental or the navel end, more com-
monly within a few inches of the navel. In twenty-one of the cases
observed by Klein, it was found to have been forcibly torn out of
the abdomen;  but  it may be torn or lacerated  at any part of its
length, although the rupture is  commonly observed near to one
extremity.  Among the cases of sudden  delivery reported by Dr.
 Olshausen, the cord was torn through at three inches from the navel
 in one,  and no bleeding followed.   In two, the  cord \\-as torn 
PHYSICAL  POWERS OF RECENTLY DELIVERED WOMEN.   607

through its  middle, and at first there was great bleeding;  in three
other cases,  it Avas torn close to the navel, and no  bleeding  had
occurred.  In four, the cord was torn at five or six inches from the
naveh and there Avas no bleeding, although it remained untied for
ten minutes.
   Twisting of the neck.—Children are sometimes destroyed in the act
of birth by the neck being forcibly tw7isted, whereby a displacement
of the cervical vertebras, Avith injury to the spinal  marroAV, may
occur, and destroy life.   Such injuries are immediately discovered
by an examination of the body.  It should be remembered  that the
neck of a child is very short, and that it always possesses consider-
able mobility.
   Violence in self delivery.—When the marks of violence found on
the head, neck,  or body of a child cannot be easily referred to  ute-
rine action,  or to an accidental  fall, it is common to ascribe them
to the efforts made by a woman  in her attempts to deliver herself—
the  destruction  of the child being an accidental result  of these
efforts.   A  medical opinion  in  such  cases  must depend upon the
nature, situation and extent of the injuries ;  and each case  must be
therefore  decided  by the circumstances attending it.  A  medical
witness, hoAveA-er, should always be prepared to allow that a woman
at the time  of her delivery, owing  to pain and anxiety may be de-
prived of all judgment,  and may destroy her offspring  without
being conscious  of what she is doing.   It is therefore a sound prin-
ciple of law that mere  appearances of violence on a  child's body
are not per se sufficient, unless there is some evidence to show that
the  violence Avas  knoAvingly and intentionally  inflicted  or  the
appearances  are of such a  kind  as of themselves to indicate inten-
tional murder.  (Alison.)   But, judging  from cases which have
hitherto occurred,  it Avould be difficult  to suggest any appearances
which would be  considered by a jury to indicate murderous violence.
  Power of exertion in recently-delivered women.—On these occasions,
a Avitness  will often find himself questioned respecting the strength
or capability for exertion evinced  by the  loAver  class  of women
shortly after child-birth.  Dr. Alison remarks that many respecta-
ble medical  practitioners, judging only  from what  they have
observed among the higher ranks, are liable to be  led into  an erro-
neous opinion, Avhich may affect their  evidence.  He mentions  a
case, in Avhich a  woman accused  of child-murder walked a  distance
of twenty-eight  miles in a single day, with her child on her back,
tAvo or three days after her delivery.  (Case of Anderson, Aberdeen
Spring Circular, 1829.)  Instances have even occurred in Avhich
women have walked six and  eight miles, on the very day  of their
delivery, Avithout sensible inconvenience.  ("Criminal Law," p. 161.)
In one case (Smith, Ayr  Spring Circ. 1824), the woman was engaged
in reaping—she retired to a little distance, effected her delivery by
herself, and went on with her work for the remainder of the day,
appearing  only a little  thinner  and paler  than usual.  In Reg. v.
Stouter (Wells Aut. Ass. 1865), two witnesses proved that  the pri- 
608  PHYSICAL  POWERS OF RECENTLY DELIVERED WOMEN.

soner, who was tried for the murder of her child, was at Avork with
them in  a field about 800 yards from a pond, in which the body
was afterwards found.  They left the prisoner weeding, returned in
about an hour, and she Avas not then in the field.  After a time
she returned, sat  on a bank, and then  resumed her work.   The
Avitnesses  noticed that on  her  return there Avas a great difference
in her appearance.   In the short interval she had been delivered,
had  disposed of the body of the child, and  resumed her work, as
if nothing had happened.  A firm resolution, with a desire to conceal
her shame, may enable a woman, immediately after her delivery,
to perform acts connected  with the disposal of the body of her
child which, from ordinary experience, might appear to be far beyond
her strength.
  Conclusions.—The conclusions to be derived from the contents of
this chapiter are:—
  1.  That a new-born child may die  from violent causes of  an ac-
cidental nature.
  2.  That some forms of  violent death are not necessarily attended
with external signs  indicative of violence.
  3.  That a child may be accidentally suffocated during delivery.
  4.  That the usual marks of death from suffocation or drowning
are not apparent except  in the bodies of children Avhich  have
breathed.
  5.  That the state  of the umbilical cord may often furnish impor-
tant  evidence.
  6.  That some females  recently delivered  may have  strength to
exert themselves and walk a great distance.
  7.  That a neAv-born child may speedily die from exposure to cold
or from want of food.
  8.  That slight  fractures of the bones  of the cranium may arise
from  the  action  of the uterus on  the  head of the child during
delivery.
  9.  That women may be unexpectedly delivered while in an erect
posture; the umbilical cord is under these circumstances sometimes
ruptured, and the child may sustain injury by the fall.
  10. That the violence found on the body of a child may be some-
times referred to  attempts innocently made by a female to aid her
delivery. 
DEATH OF THE  CHILD  FROM  STRANGULATION.   609
                    CHAPTER  LIU.

DEATH OF THE CHILD  FROM STRANGULATION.—STRANGULATION BY THE
  NAVEL-STRING.—ACCIDENTAL MARKS RESEMBLING THOSE OF STRANGU-
  LATION.—CONSTRICTION  BEFORE  AND AFTER DEATH.—BEFORE AND
  AFTER BREATHING.--BEFORE AND AFTER THE  SEVERANCE OF THE
  NAVEL-STRING.—EXAMINATION OF THE MOTHER.

  Among the forms of violent death which are generally attended
Avith appearances indicative of criminal design are the folloAving:—
  7.  Strangulation.—The destruction of-a neAv-born child by stran-
gulation is not an unfrequent  form of child-murder; and here  a
medical jurist has to encounter the difficulty that the strangulation
may have been accidentally produced by the tAvisting of the umbili-
cal cord round the neck, during delivery.   AVe must not hastily con-
clude, from the red and swollen apptearance of the head and face of a
child Avhen found dead, that it has been destroyed by strangulation.
There  is no doubt that errors Avere formerly made w7ith respect to
this appearance; for  Dr. Hunter observes: "When a child's head
or face looks SAvollen, 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 knoAA-
that  there is nothing more  common in natural  births, and that
the swelling and deep color go gradually off if the child lives but
a few days.  This appearance is particularly observable  in those
cases Avhere the navel-string happens to gird the child's  neck, and
Avhere its head happens to be born some time before its body-." (Op.
cit. p. 27.)
  Strangulation by the navel-string can of course refer to those cases
only  in Avhich it becomes firmly7 twisted  round the neck after the
child has breathed.  This is rather a rare occurrence, because under
these circumstances death more commonly takes place by compres-
sion of the cord,  and  by the consequent arrest of circulation  before
the act of breathing  is performed.   The  only internal appearance
met with in death from this cause is a congested state of the cere-
bral vessels.   The presence of ecchymosis on the scalp, as Avell as
of lividity of the face, is very common in new-born children Avhen
the labor has been tedious and difficult; and therefore, unless there
were some distinct marks of pressure about the neck, with a pro-
trusion of the tongue, such appearances  Avould not justify any sus-
picion of death from  strangulation.
  It  has  been  supposed, that  the strangulation produced by the
wilful application of  any extraneous constricting force to the necky
would be knoAvn from the accidental strangulation caused by the
      39 
610     STRANGULATION BY THE  UMBILICAL CORD.

cord, by the fact that in the former case there would  be a livid or
ecchymosed mark or depression on  the neck, while  in the latter,
there would not.   Severe violence to the neck of a neAv-born child
may produce in the seat of constriction not only ecchymosis, but a
laceration of the skin, muscles, and  windpipe; but these  appear-
ances are not ahvays present in homicidal strangulation.  In April,
1861, Dr. Evans, of Sunderland, communicated  to me the particu-
lars of the case of a new-born  child which  had been destroyed by
strangulation.  Great violence had  been  used, but  there was no
trace of discoloration in the course of the ligature, or of ecchymosis
in the tissues beneath.  The muscles compressed were very dark in
color.   In most cases Avhen a ligature is applied to the neck during
life, the skin above and below it becomes  much swollen, and pre-
sents an cedematous character.  This indicates an application of
violence when there is still some vital power in the body of the
child.   The navel-string itself may be used as a means of constric-
tion, and the mark or depression may sometimes present an apptear-
ance of ecchymosis.  Among various cases which might be quoted
in support of this statement, is the following, reported by Mr. Fos-
ter.  In April, 1846, he was summoned to attend a lady in  labor
with her first child.   The labor was  of a lingering kind, owung to
the size of the head ; and the  child came into the world dead.  The
navel-string w-as found  coiled  three times round the neck, passing
under the right armpit; and upon removing it three parallel dis-
colored depressions were distinctly evident.  These extended com-
pletely  round the neck, and corresponded to the course taken by
the coils.   The child appeared as if it had  been strangled.  (" Mecl.
Gaz.," vol. 37, p.  485.)  Had this child  been  born  secretly, this
state of the neck might have created a strong suspicion of homi-
cidal violence.   Strangulation after birth  could not, however, have
been alleged, because there would have been no proof of respiration.
When a blue mark is found on the neck of a child whose lungs re-
tain their  fcetal characters, it is fair  to presume, cceteris paribus,
that it has been accidentally occasioned by the tAvisting of the um-
bilical cord during delivery.   Mr. Price has communicated to the
same journal the account  of  a case in which the  cord, which was
short, Avas so tightly twisted around the neck  of  a child, that he
was compelled to divide it before  delivery could be accomplished.
There w7as in this  instance a deep groove formed on the neck, con-
veying  the impression to himself and a medical friend that, in  the
absence of any knowledge of the facts, they would have been pre-
pared to say that the child had  been wilfully strangled by a rope.
(" Med. Gaz.," vol. 38, p. 40.)  A diagnosis might have been formed,
as in the preceding case, by examining the state of the lungs.  Dr.
Mutter met with a case in which a child was born dead, and the
cord was tightly twisted round its neck; when  removed, the neck
exhibited a livid circle of a finger's breadth, smooth and shining:
but on cutting into this mark, no ecchymosis was found. (" North.
Journ. Med.," Jan. 1845, p. 190.)
   Dr. Williamson, of Leith, has directed attention to an important 
       STRANGULATION BY THE  UMBILICAL  CORD.    611

fact connected Avith the state of the lungs in a neA\7-born child, and
the medical opinions which may be expressed from their condition
as furnishing evidence of live birth.  Referring to Air. Price's case,
in Avhich the cord was tightly tAvisted round the neck of the child,
he states  that in similar cases Avhich have occurred  to himself, the
child  has breathed immediately  on the  birth of the head ; but,
OAving to the shortness of the cord, the child would have been stran-
gled and  born dead, unless he had divided it.   Thus, then, a child
might die apparently strangled, and not be born alive, although it
might have  so breathed during birth that the lungs would present
all  the characters of respiration.   If the circumstances were not
knoAvn, a medical man might be led to say that the child had been
born alive, and had been destroyed by strangulation.  (" Edin. Aled.
Journ.," Feb. 1858, p. 714.)  The proof of respiration, as it has been
elsewhere stated, is, however, not necessarily a proof of live birth.
  From  these cases, it w7ill  be  perceived that ecchymosis in the
depression on the neck furnishes no distinction betAveen constriction
produced by criminal means, and that which may result accidentally
from the naArel-string.  In the folloAving case ("Ann. d'Hyg.," 1841,
vol. 1, p.  127), a Avoman charged with the murder  of her  child by-
strangulation appears to have been unjustly condemned. The child
had fully and perfectly breathed ; the lungs weighed one thousand
grains ; and Avhen divided, every portion floated on water, even after
firm compression.  There was a circular  depression on the neck,
Avhich was superficially ecchymosed  in some parts.   From  an inves-
tigation  of the facts, this appeared to have been a case in which a
mark  on  the  neck Avas  accidentally produced by  the  umbilical
cord,  during attempts at  self-delivery on  the  part of the woman ;
she was nevertheless  convicted and condemned to a severe punish-
ment, chiefly from the opinion expressed by two medical witnesses,
that a soft and yielding substance like the umbilical cord could not
produce a depression and ecchymosis on the neck of a child during
birth. They attributed the mark to the Avilful application of a liga-
ture like a garter; but the experiments of Dr. Negrier clearly show
that the umbilical cord has sufficient strength to produce fatal con-
striction.
  In  the  same volume of the " Annales d'Hygiene" (at p. 428),
will be found the report of another case, suggesting many import-
ant reflections in regard to the medical jurisprudence of infanticide.
In this instance, the navel-string and the membranes were actually
used by the female as a means of strangulation ; the child had not
breathed, but Avas  thereby prevented from breathing.  There was
superficial ecchymosis on each side over  the  muscles of the neck.
The defence Avas, that the child Avas born with the cord around its
neck,  and that it Avas from this circumstance accidentally strangled;
but the medical evidence  tended to show that the cord  had been
violently stretched and  employed  as  a  means of  strangulation.
The child had not  breathed, and  the medical witnesses considered
that it had been  born dead, owing to  the violence used by the
woman.   The cause of  death here Avas certainly not strangulation, 
612
DEATH FROM STRANGULATION.
but arrested circulation.   In the mean time, the case proves that
ecchymosis (a blue mark) may be the result of  violent constriction
produced by the navel-string.   A case  occurred to Mr. Al'Cann in
September, 1838, in which the navel-string, w7hich  was of its full
length, had  been used  as  the  means of strangulation.   It was
twisted once around the  neck, passed under the left arm, over the
shoulder,  and around the neck  again, forming a noose or knot,
which, pressing upon the throat, must have caused strangulation,
as the tongue was protruded, and  there w7ere other clear indica-
tions of the  child  having been  strangled.  The  hydrostatic test
applied to the lungs proved that respiration had been performed.
  When the mark on the neck is deep, broad, much ecchymosed,
and there is extravasation of blood beneath, with injury to the mus-
cles or trachea, and ruffling or laceration of the skin, it is impossi-
ble to attribute these appearances to accidental compression by the
navel-string.   The  lividity produced by  it in the  cases hitherto
observed has been only slight  and partial, and unaccompanied by-
laceration of the skin, or injury to deep-seated  parts.   On the
other hand, in homicidal strangulation, as much more  violence is
commonly used than is necessary for destroying life, we may expect
to find great ecchymosis and extensive injury to  the surrounding soft
parts.  On some occasions, all difficulty is removed  by the discovery
of a rope, tape, or ligature, tied tightly round the neck; or, if this
be not found, the proofs  of some ligature  having been used will  be
discoA7ered in the indentations or irregularly-ecchymosed spots left
on the skin ; the depressed portions of skin being generally white,
and the raised edges livid or cedematous.
  It has been doubted wdiether a child can be born with the navel-
string so tightly round the neck as to produce great depression of
the skin and ecchymosis, i. e., to simulate homicidal strangulation,
and at the same time perform the act of respiration fully and com-
pletely.  It is important, therefore, when this  hypothesis is raised
in order to account for a suspicious mark  on the neck, to examine
closely the state of  the lungs.  Unless  the cord be designedly put
round the neck of the child after the head has protruded, the effect
of the expulsive efforts of the uterus, when a coil has become acci-
dentally twisted round the neck, would be to tighten the cord, com-
press the vessels, and kill the  child by arresting the maternal cir-
culation, at the same time that this pressure would effectually pre-
vent the act of breathing.  Hence the lungs  usually present the
appearances met with in stillborn children generally ; but the case
which occurred to Dr. Williamson (p. 611) show-s that this state of
things may sometimes occur, and that a child may breathe, and die,
strangled by the umbilical cord before its body  is entirely born.
Medical witnesses, however, should not be too ready to  accept such
a suggestion ; a careful examination of the neck will show whether
a ligature  has or has not  been wilfully applied after birth.  In
Reg. v. Robinson (Lewes  Summer Assizes, 1853), there was around
the neck, the mark of a ligature which had been  tied  very tightly.
The  child  had fully breathed, and according to the medical evi- 
              DEATH  FROM  STRANGULATION.            613

dence it had died from strangulation, OAving to an accidental twist-
ing of the cord during delivery.  In examining a suspicious mark
on the neck of a neAv-born infant, it is proper to notice Avhether it
does not, by its form or course, present some peculiar indentations
which  may render  it certain that a  ligature has  been Avilfully
employed after birth.  When it is found that  a child has fully
breathed, the  presence  of a  deeply-ecchymosed or an cedematous
mark on  the neck with  injury to the  skin and muscles is, cceteris
paribus, presumptive of homicidal strangulation.  Death from acci-
dental constriction of the cord during delivery should, as a general
rule,  leave the lungs in their fcetal condition.
  Aiarks  on the neck of a child may  be accidentally produced by
the navel-string  Avithout  necessarily destroying  the  child's life.
Two  cases of this kind  are  reported by  Professor Busch (" Brit.
and For. Aled. Rev.," vol. 10, p. 579): and a child may be destroyed
without ecchymosis being a necessary consequence  of  the  con-
striction produced by it.  There is much less risk of strangulation
from twisting of the cord during birth, than is commonly believed.
Out of  190 cases, Dr. Churchill  found the  cord round the neck in
fifty-two children, and the shortest cord  so disposed was eighteen
inches long; Dr. NCgrier found it round the neck in twenty cases
out of 166 natural labors.  ("Ann. d'Hyg.," 1841, vol. 1, p. 137.)
  The appearances met Avith  in the body in death  from strangula-
tion have been elsewhere fully7 considered (p. 422).   The  facts of a
case communicated to me, in March, 1865, by Air. Cann, of Dawlish,
Avill,  hoAvever, serve  to shoAV the appearances as they may present
themselves  in a new-born child.   A maid-servant in a family was
secretly delivered of a child.   When  the body w7as found, it Avas
observed  to be full-groAvn,  and  there was a piece of tape tAvice
round the neck, Avhich had been tied tightly in a bow.  The tongue
protruded between the lips;  two  deep  furroAvs Avere  found round
the neck after the removal  of  the  tape;  there was great oedema
Avith swelling of the skin between and above them, and the right
hand Avas  clenched.  The lungs were of a  light-red  color; they
filled the chest, Avere highly crepitant, and floated readily on Avater,
even  when  divided  into  sixteen  pieces, and these had been  sub-
mitted  to  strong pressure.   They Aveighed, however,  only 626
grains.   The heart Avas healthy ; the right side contained some co-
agula of blood—the  left side Avas empty; the foramen ovale Avas
open.   The  scalp was much congested,  the congestions almost
amounting  to small effusions of blood; the pia mater was also con-
gested.   The inference drawn from these facts Avere, that the child
had been born alive, and that it had died from strangulation.  The
lungs were  as light as they usually are in  the fcetal state, showing
that,  although they had received air, the pulmonary circulation
had not been perfectly established.
  Accidental marks resembling those of strangulation.—In the forepart
of the neck of a child, a mark or depression is sometimes accident-
ally produced by forcibly bending the head forward on the chest,
especially Avhen this has been done repeatedly and recently after 
614    APPEARANCES RESEMBLING  STRANGULATION.

death, while the body is warm.  It may occur, also, as an accident
during labor.   Such a mark must  not be mistaken for the effect of
homicidal violence.  It has been a question Avhether, independently
of the constriction produced by the umbilical cord, the neck of the
uterus might not cause, during its contractions, an ecchymosed mark
on the neck.  I am not aAvare that there is any case reported Avhich
bears out this view7; and it seems highly improbable that any such
result should follow.
  The discoloration may be in detached spots or patches—situated
in the fore part of the neck, and evidently not arising from the em-
ployment of any ligature.   These marks  may depend on the forcible
application of the fingers to the  fore part of the neck of the child,
and the indentations have been known to correspond—a fact Avhich
has at once led to a suspicion of  the cause of pressure and the mode
of death.  At  the  same time it should be borne in mind that a
superficial  mottling of the skin occurs after  death  in neAv-born
infants, in parts where moderate pressure only may have been acci-
dentally produced.   This would not be attended with ecchymosis,
and its true nature would be at  once determined by comparing the
discolored  spots with the surrounding skin.  It may be alleged, in
defence, that such marks might have been accidentally produced : 1.
By the forcible pressure produced by the child's head during labor. 2.
They will be more commonly referred to violent attempts made by
a woman at self-delivery, during a paroxysm of pain.  This expla-
nation is admissible, so long as  it is confined to injuries Avhich, by
any reasonable construction, might be  caused during labor;  but
supposing the marks to have been certainly produced after the com-
plete  birth of the body, it Avill not of course apply.
  Among  marks simulating violence*, which are  sometimes found
on the necks of new-born children, Mr. Harvey has pointed  out one
of a singular kind.  In February, 1846, he Avas present at a deliv-
ery in which a child was expelled  rather suddenly;  and  after mak-
ing two  or three  convulsive gasps, it died.   AVhilst  endeavoring to
restore animation, he observed a bright red mark extending com-
pletely across  the upper and fore part of the neck,  from one angle
of the lower jaAv to the other, as though it had been piroduced by-
strangulation with a cord, except that the mark was not continued
round to the  back of the neck.  It was of a vivid red color, and
not like  a bruise  or ecchymosis,  but it had very much the appear-
ance of a recent excoriation.   It was most clearly defined  in front,
where it Avas about a quarter of  an inch in breadth, and it became
diffused  at the sides.  The face  was not swollen, and there Avas no
fulness of the veins.  ("Aled. Gaz.," vol. 39, p. 379.)   A  distinction
in this instance might have been based upon the color of the mark,
the uninjured  state of the cuticle,  and the absence of congestion of
the face and venous system.  Nevertheless, the fact is of some im-
portance, and should be borne in mind during  the examination of
the body of a new-born  child  alleged to have been  strangled.
Another case,  Avhich was  the subject of a coroner's inquest, was
published by Mr. Rose in the same journal (vol. 37, p. 530), in which 
      APPEARANCES RESEMBLING  STRANGULATION.    615

red marks  on each side of the nose of  a new-born child were mis-
taken for the effects of violence applied to the nostrils during a
supposed attempt at suffocation.  Air. Rose examined them closely,
and  considered  that they were ncevi (mother's marks), and  had
nothing to do with the death of the  infant.
  A medical witness may be asked on these occasions, whether he
will undertake to swear that the ligature or the fingers had been
applied to the neck of the child before,  or after its death, or before,
or after  it had breathed.  It is proper to  observe that, so  far as
external marks of strangulation are concerned, there is no difference
in the apipearances, whether the constriction takes place during life,
or immediately after death while  the body is warm.  Casper's ex-
periments render it highly probable, that when a constricting force
is applied to the neck of a dead child, at any time within an hour
after death, the  marks cannot  with certainty be distinguished by
any appearance  from  those made on a living body.  ("Wochen-
schrift," Jan., 1837;  see also p. 344, ante.) With regard to the second
point, it may be stated, that whether the child has breathed or not,
provided it be living, and the blood circulating, marks of  violence
on  the neck Avill present precisely- the same characters.
  In the absence of any visible  discoloration of the skin, it may be a
question  whether this  should be taken as evidence of the means of
constriction not having been applied during life.  What Ave 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 a recently dead child; although  we might expect that
there would be few cases of deliberate child-murder in which when
strangulation was resorted to, there would not be some ecchymosed
mark or discoloration, chiefly from the presumption that great and
unnecessary force is suddenly7 applied.  Besides, it is not improbable
that a slighter force Avould cause ecchymosis on the skin of a new-
born infant, than AA7ould be required to produce such an appearance
on that of  an adult.
  Another question has been put, which the proposed change in the
statute laAV will hereafter exclude—namely, whether a  medical wit-
ness Avill undertake to say that  the constricting force had not been
applied to  the neck of the child until  after its body had  been en-
tirely born.  This, of course, must be a pure matter of speculation.
The apipearance caused by a ligature applied to the neck of a living
child Avould not be  different Avhether the child Avas  partially, or
entirely born.  If the child  has actually breathed, the appearances
in the body Avould  be the same, and there.are no medical facts by
which  it could be  determined  Avhether the act  of strangulation
proved fatal during birth or afterwards.  A medical witness has
also  had  this question put to him: Whether the strangulation oc-
curred  before, or  after  the navel-string w-as severed.  It would
appear that the severance of the cord has been sometimes regarded
in law as a test of an independent circulation being established in
the child  ;  but this is obviously  an error, depending on the want of
propier  information respecting  the phenomena  which accompany 
616
DEATH FROM POISON.
birth.  Respiration, and therefore an independent circulation, may
take place before  the  cord is divided ; and  its severance, which is
never likely to occur  until after entire birth, cannot consequently
be considered as a boundary between a  child which  is really born
alive, and one which  is born dead.  A premature severance might
possibly endanger the life of a child, instead of giving it an inde-
pendent existence.  A healthy and vigorous child may continue to
live and  breathe  independently  of the mother, before the division
of the cord, and  the  time at which the severance is made depends
on mere accident. Hence, the marks of  strangulation on the neck
of a living and breathing  child must be the same whether the cord
has been  divided, or not.  The entire birth of the body is, hoAvever,
now considered to be complete, although the navel-string has not
been divided.
  8.  Poisoning.—This is placed among the possible means of perpe-
trating child-murder,  but  we rarely hear  of new-born children  being
thus destroyed.   The  earliest age at which I have  knoAvn a trial to
take place for the murder of a child by poison Avas  two months.
(Rex v. South, Norf. Aut.  Circ, 1834.)  A quantity- of arsenic Avas
given to an infant, and it died in three hours and a  quarter after
the administration of  the poison.   At this age, the case can scarcely
be called one of infanticide, in a medico-legal signification, because
all that it would  be necessary to ptrove would be the cause of death ;
the question of life or live birth Avould  not require  to be entered
into.   If, in a case of child-murder, death from poison  should be
suspected, it must be sought for in the usual way.   Some cases have
occurred, in which children have been wilfully destroyed aAveek or
tAvo after birth, by the administration of opium, or excessive doses
of purgative medicine.
  M. S^verin Causse' refers to cases of this kind which have occurred
in France.  A woman was sentenced to  eight years' imprisonment
for the crime of poisoning her  new-born child with concentrated
sulphuric acid.   In another case, a woman was convicted of poison-
ing  her  infant with phosphorus  scraped  from  lucifer matches.
("Ann. d'Hyg.," 1869, 2, 124.)   There  Avould be no difficulty in
proving the presence  of the poison under these circumstances.  In
some instances, it has been found on the napkins used for the  child.
(Reg. v. North, Guildford  Summer Ass. 1846.)
  In cases in which infants are  destroyed by poison,  there is gene-
rally  great difficulty  in tracing the act of  administration to the
guilty person.  The fluid  food given to them renders the admixture
of pioison easy, and as many persons may have access to this food,
it is often impossible to fix  upon the criminal.   In one instance
which came to my knowledge, an illegitimate child had been placed
out to nurse by its mother, a woman in good social position. It was
noticed that after each visit paid by the  mother the child was sick,
and after repeated attacks of illness, the child died. On inspection,
arsenic was found in the body, and this was beyond doubt the cause
of death.   There  was  no suspicion against the nurse ;  but a strong
suspicion fell on  the  mother, from the circumstances above  men- 
EXAMINATION OF THE MOTHER.
617
tioned.  There was evidence, however, that the child was not at
any time fed by the mother when she visited it, and that the mother
had no access to the child's food.  No poison could be traced to her
possession, and she was not seen by the nurse, who was present, to
give anything to the  infant.   The only fact  that transpired was
that, at each visit, she  took it in her arms and was observed to rub
its gums with her fingers, and soon after her visits, sickness followed.
There Avas reason to believe that she had concealed small quantities
of arsenic under her finger-nails, and  that  she had administered
the poison while rubbing the gums of the child !
  Examination of the mother.—The duties of a medical practitioner,
so far as they relate to  the mother of the child, generally the accused
party, are slight.  He may be required  to prove, by an examination
made under an order from proper authority, whether a woman has,
or has not been recently delivered of a child, and to state the pro-
bable period at which  the delivery took  place.  (See Delivery, p.
507.)   This examination may be necessary in  order to connect her
delivery with  the period which may have elapsed since the birth
and death of  the child.  Unless the examination of the Avoman be
made w-ithin twelve or fifteen days, no satisfactory evidence can in
general be obtained. It has happened, on more than one occasion,
that medical men have assumed to themselves the right of enforcing
an examination of a suspected woman, and, by threats or otherwise,
have compelled her to  undergo this.  Such a course of couduct is
in the highest degree indecent and improper ; if a Avoman Avillingly
consents to an examination, or an order be obtained from a magis-
trate or other official persoil^ the case is different.  In  taking this
authority upon himself, a medical man  is forcibly compelling  an
accused party to produce positive proof of her guilt—a principle
which is entirely opposed to the spirit and practice of English juris-
prudence.  The mischievous  results of such officiousness on the piart
of a medical  practitioner are wrell illustrated by the case of  Weir
and wife v. Hodgson (Liverpool Winter Assizes, 1861).   The  dead
body of a  child had been found near  the house of the  plaintiff.
The defendant, a surgeon, went Avith the inspector of police to see
Airs. Weir; and having  informed her that she Avas suspected of
having  had a child, told  her that he had come to examine her by
the authority of the laAV, and that she must submit.  She refused
at first, and proposed to send for a medical man whom she knew.
In the end, the defendant examined her, and there Avas no ground
for the charge. The jury returned a verdict of 200£. damages for
the assault.  The police can give no legal power to a medical man
to make such an examination in a suspected  case, and the ultimate
consent of the woman,  if extorted by threats or intimidation, will
be no answer to a charge of assault.
  In August, 1871, a  case  occurred near Leominster, which has
placed the question of medical responsiblity in cases  of alleged in-
fanticide in a painful light.  A young  lady, the sister of  a clergy-
man, committed suicide rather than submit to  a physical  examina-
tion by tAvo medical men, under the order of a coroner.  The coroner 
618
DEATH FROM POISON.
held an inquest on the body of a child, a case of alleged infanticide.
A suspicion arose that this young lady had been recently delivered.
Two  medical gentlemen, armed  Avith  a  Avritten order from the
coroner, went to the rectory Avhere this young lady w-as residing,
and requested an interview with her for the purpose of ascertaining
whether she  had recently had a child.  She  refused to see them,
and  subsequently destroyed  herself.  All the particulars of this
tragedy have not been made known, but this attempt to examine
this woman for the purpose of obtaining evidence against her on a
charge  of child-murder,  appears to have had such an effect on her
mind as to lead  to  suicide.  The fragmentary particulars  of this
sad case will be found  in the " Lancet," for 1871, 2, 333-474, and
477.   The medical gentlemen, in endeavoring to justify themselves
for the  part AA'hich they took in the matter, rely upon the  written
order of a coroner, but  they have not published the order.   The
editor of the " Lancet," in commenting  on  this case, says  truly
enough, that no  coroner, even  of  " twenty-eight years' standing,"
can order the performance of an illegal act, and should he do so,
refusal  is clearly j ustifiable.
   Conclusions.—The following conclusions may be drawn from the
preceding remarks:—
   1. That congestion of  the  face and head in a new-born  child is
not a proof of death from strangulation.
   2. That  strangulation can take  place  only  in children which
have breathed.
   3. That a child may be strangled during birth by the accidental
twisting of the navel-string round its Aeck.
   4. That the navel-string may produce a livid or ecchymosed de-
pression on the neck, like any other ligature.
   5. The marks on  the neck, arising from accidental causes, may
resemble those which arise from strangulation.
   6.  That the effect of constriction on the neck, either by the navel-
string or any other ligature, is the same if  the child be living,
w7hether it has or has not breathed.
   7. That the effect is the same whether the child has been partially,
or entirely born.
   8. That the effect of a  ligature on the neck of a living child is the
same, Avhether the navel-string has, or has not been severed.
   9. That  a new-born child  may die from strangulation, without
this  fact being necessarily indicated  by ecchymosis on the  neck.
This depends on the nature of the ligature, and the amount  of force
used. 
BIRTH--INHERITANCE.                619
BIRTH.  INHERITANCE.
                     CHAPTER  LIV.

EVIDENCE OF LIVE BIRTH IN CIVIL CASES.—LEGAL RIGHTS OF TnE FOETUS
  IN UTERO.—DATE OF BIRTH.—DIFFERENCES BETWEEN ENTIRE AND PAR-
  TIAL BIRTH.—SIGNS OF LIVE  BIRTH INDEPENDENT  OF BREATHING OR
  CRYING.—VAGITUS UTERINUS.—TENANCY BY COURTESY.—CESAREAN
  EXTRACTION OF CHILDREN.--LEGAL BIRTH.—POST-MORTEM BIRTHS.—
  MONSTERS.—AVHAT CONSTITUTES A MONSTER IN  LAAV.—DEPRIVATION
  OF LEGAL RIGHTS.--DOUBLE MONSTERS.--MINORITY AND MAJORITY.

  Live birth  in civil cases.—The law of England has not defined  the
meaning of the term Birth, in reference to civil jurisprudence; but
if we are to  be guided by the numerous decisions Avhich have been
made  on trials for  infanticide, it must  be regarded as signifying
" the entire delivery of  the child," with  or without its separation
from the body of the  mother.  (See Infanticide ; see also Chitty,
"Aled. Journ.," 412.)   So long as an infant remains in the uterus
it is said in law to be "en. ventre sa mire;" but it is legally supposed
to be  born for many purposes.  (" Blackstone's Comm.," vol. 1, pi.
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 is born alive.  So  the
fcetus  may be made an executor ; but it is very judiciously provided
that an infant cannot  act as such until it has attained the  age of
seventeen years.   The Roman and English systems of law apply  the
same term (venter) to the unborn child ; when born dead it is called
abortus, abortion ; when alive, partus, infans, infant.   In 1871  the
folloAving case affecting the venter came before the Court of Admi-
ralty.   A ship was damaged, in collision with  another, called  the
" Elentheria," and a man named Noyes, one of the crew of the dam-
aged ship, was killed.  The  AvidoAv claimed  of the proprietors of
the " Elentheria," damages  in respect of a child Avith which  she
was then pregnant.  Sir II. Phillimore held that the child was  en-
titled to recover for the loss sustained  of its father, although the
damages could not be assessed until the child Avas born.  The maxim
of English law derived from  the  Roman Uav is that a child " en
ventre  sa  mire" is to be considered as actually born if any question
arises  for its benefit.   This ruling Avas confirmed by Lord West-
bury in Blasson v. Blasson, but this fiction is  applicable only  for 
620
PARTIAL AND ENTIRE  BIRTH.
enabling such child to take a benefit to which it would have been
entitled if actually born.  In the case decided by Sir R. Phillimore
the action of the Court Avas suspended until  the child Avas born, as
if stillborn there Avould be an  end to any claim.  (" Aled. Times
and Gaz.," 1871, p. 146.)
  Date of birth.—Aledical evidence has occasionally been demanded
in courts of law respecting the actual date of birth of individuals,
in cases  in which a period of a few days, hours, or even minutes
w7as required to prove the attainment of majority, and therefore  a
legal responsibility for the performance of civil contracts into which
the parties had entered, either  knoAvingly  or  ignorantly,  Avhen
minors.   Some cases of this kind have been  decided by the evi-
dence of the accoucheur himself; others, Avhen the accoucheur was
dead, by the production of his  case-books; and it is worthy of no-
tice  that  the strictness and punctuality of  some medical practi-
tioners, in making Avritten memoranda of cases attended  by them,
have in more than one instance led to  a satisfactory settlement of
such suits, and  the avoidance of costly litigation.   The piroof of
the exact date of birth is also of considerable importance in certain
cases of contested legitimacy.
  The most important medico-legal questions connected Avith this
subject are those which arise in contested suits  relative to succes-
sion, or the inheritance of property.  A child that is born alive, or
has come entirely into the world in a living state, may by the Eng-
lish law, inherit and transmit property to  its heirs, even although
its death  has immediately, and perhaps  from morbid causes neces-
sarily, foliow-ed its birth.   Should the child be born dead, whether
it died in the womb, or during the act of birth, it does not acquire
any civil rights;  for it is not regarded legally as a life in being,
unless it manifests some sign  of life after it is  entirely born and
separated from  the mother.  Some have  considered that partial
birth, provided a child is living, should suffice to confer the same
rights on  the offspring as the proof of entire  birth.  The following
case has been  adduced by Sir C.  Locock in  support of this view,
although  the question  here was rather in  reference  to the actual
date of birth, than to the acquisition of civil  rights therefrom: the
principle is, however, the same.   On a Saturday evening a lady was
taken in labor with her first child.  The head and one arm were
born tAvo or three minutes before a neighboring clock struck twelve.
There was a cessation  of pain for several minutes, during which
time the child cried and breathed freely.  The rest of the body was
not expelled until full five  minutes after the  same clock had struck
twelve.  Was the child born on the Saturday, or on the Sunday?
Certainly the birth was not completed until the Sunday ; the child
was still partly within the body of the mother—the circulation Avas
still kept  up through the  umbilical vessels;  " but,"  continues Sir
C. Locock, "I gave my opinion that the child was born on the
Saturday.  I considered that the child had then commenced an
independent existence.   The fcetal life had then to all intents and
purposes ceased ; and breathing—a function incompatible with the 
PARTIAL  AND ENTIRE BIRTH.
621
condition of a foetus—had commenced.  The navel-string will, it is
true, go  on pulsating for many minutes  after an infant has been
brought  completely into  the world, crying  and kicking, unless it
be compressed artificially ; and  yet no one'will say that a child  in
such a case is not born  until Ave 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."   ("Aled.
Gaz.," vol. 12, p. 636.)  However reasonable, medically speaking,
this view may appear, a medical jurist must shape his evidence ac-
cording to what the laAV  demands.  It has  been  elsewhere stated
(Infanticide), that our judges have distinctly laid down  the law
that no  child  can  be considered to be legally born until the whole
of its body has come entirely into the world.   This is in relation to
criminal jurisprudence, in which case, if in  any the rule should be
relaxed,  because  its relaxation would tend to punish the Avilful
destruction of living infants partially  born.  This child could not,
therefore, have been  born on  the Saturday, because the laAV does
not regard partial birth as an  entire birth; and respiration and
birth are not synonymous terms. Supposing  this child to have died
before its body Avas entirely extruded, it could not  be said, even
medically, that it was born  alive ; and  certainly it  could  not be
considered, according to the present state of the law, to have  ac-
quired the rights of a child born living.  The reasonableness of the
opinion that partial birth should suffice for all  the legal purposes
of entire  birth is a distinct question, and one over which a medical
witness has no sort of control.   Whatever apparent injustice may
be done by adhering to  this rule in respect  to the civil rights  of
persons, there is no doubt that the evil is really of great magnitude
in relation to criminal jurisprudence; for it Avould appear, from the
present state of the criminal law, that the destruction of partially-
born children, although alive and healthy, is not, legally-speaking,
child-murder.
  On the other hand, some difficulty might arise in civil  cases if
the bare  extrusion  of a part of the body sufficed for all the legal
purposes of entire birth.   It might become a  casuistical question as
to how much of a child's  body should be in  the w7orld  in order to
constitute legal birth; for there is no reason Avhy, in a medical view,
the extrusion of the head and shoulders should constitute birth any
more than the extrusion of a hand or foot.
  Admitting, then, that a child must be  entirely born in order that
it should acquire civil rights, it will next  be necessary  to examine
the medical proofs required to shoAV that  it  has been born alive.
The question  here is  different from that of  live birth in reference
to child-murder.  We must presume that a medical man is present
at a delivery in Avhich a child is born  in a doubtful state, or Avhere
its death  speedily fohWs its birth.  The civil rights of  a child and
its heirs  Avill depend  upon  the  careful observation, made by him,
of the circumstances attending the delivery.   It is proper that he
should note Avhen the birth is completed, by the body of the child 
622
signs of live-birth.
being entirely out of the body of the mother.   Children born at or
about midnight are thus liable to have the date of birth wrongly
registered; and the legal difference of twenty-four hours, Avhich a
few seconds or minutes may make,  may hereafter affect their OAvn
rights if they survive, or those of others if they die.   The birthday
of the illustrious Duke of Wellington was entered  in the parish
register as the 30th of April, 1769, while there is abundant evidence
for fixing it on the  1st  of May; in fact, he was  born just  after
tAvelve o'clock in the night between the 30th of April and the 1st
of Alay.   Nothing can be more simple than for an  accoucheur  to
fix the true date, not by  the hour at Avhich labor commences, but
at the time at which it is completed.
  Signs of live birth independently of respiration, or crying.—The visi-
ble respiration of a child after its birth,  or as it may be manifested by
its crying, is an undoubted sign 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, has been regarded as a sufficient proof of live
birth.  The latter sign has been judicially so pronounced—a fortiori,
therefore, the  motion of a limb will be  considered sufficient legal
evidence,  in an English Court of law,  of life after  birth.  It is  to
be observed that the length of time  during which  these signs of
life continue after a child is born is wholly immaterial: all that is
required to be established is, that they were  positively manifested.
A child Avhich 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 Avill be better understood from the following
case (Fish v. Palmer), which is reported to have been tried  in the
Court of Exchequer in 1806.  (" Beck's Aled. Jur.," vol. 1, p. 354.)
The Avife of the plaintiff Fish was possessed of landed estate in her
own right.  She died in 1796,  after having given birth to a child
which was supposed at the time to  have been born  dead.  In con-
sequence of the plaintiff's not having  had a living child (as it was
assumed) during the marriage, the  estate of the Avife Avas claimed
and  taken by the defendant Palmer, her heir-at-law—the husband
being obliged  to surrender it under the circumstances.  From infor-
mation derived many years after the death of his wife, from some
women who were piresent at the delivery, the plaintiff was led  to
believe that the child had not been born dead, and that the  estate
had therefore been surrendered to the plaintiff under a mistake. An
action was brought to decide this question in 1806, ten years after the
death of the wife, and it lay with the plaintiff to prove his allega-
tion that the child had been born living.  Dr. Lyon, the accoucheur,
had  died some time before the  trial; but it was proved  that he had
declared the child  to have been living an hour  before it was born,
that he had directed  a warm  bath to be prepared, and Avhen the
child was born, gave it to the nurse to place in the bath.
   The child neither cried, nor moved after its birth, nor did it mani-
fest any sign of active existence; but  the two women  Avho placed 
signs of live-birth.
623
the child  in  the bath  swore that when  it Avas immersed there
appeared tAvice a twitching or tremidous motion of the lips.  They
informed the accoucheur of this, and he directed them to blow into
its throat, but it did not show any further signs of life.   The main
question in the trial  was whether this tremulous motion of the
lips was a sufficient  proof of the  child  having been  born alive.
The obstetric experts Avho were summoned to give evidence on this
occasion differed in opinion.  Drs. Babington and Haighton stated
that had the child been  born dead, or had the  vital principle been
extinct, there could have been no muscular movement in any part
of its body;  therefore the child had, in  their opinion, been born
alive, and had manifested some evidence of life after its birth.   Dr.
hennian, who  Avas called for the defendant,  dissented  from this
view.  He contended that from the evidence the child  had not been
born alive, and in explanation of this  drew a  distinction between
uterine and extra-uterine life.   He attributed the tremulous move-
ments of the  lips after  birth to  the remains of uterine life.  The
Jury, hoAvever, under the direction of the Court, did not adopt this
vieAv of the case.   They- pronounced by their verdict that the child
had been born living,  and the pilaintiff thus recovered an estate of
Avhich he had been for ten years deprived.
  From the result of this case it would appear that the English laAV
does not recognize any distinction between uterine and  extra-uterine
life, as drawn by Dr. Denman. The question is simply life or death—
living  or dead ?  Dr.  Denman did  not assert  that the child was
born dead.  On the contrary7, he assigned the movements observed
by the  witnesses to the continuance  of life—but of uterine life.
The act of breathing is commonly set down as  the boundary; but a
child is not necessarily  dead until  it  breathes, as the recovery of
numerous children born with uterine life clearly proves. The fallacy
of trusting to breathing as a criterion  in the living or  dead body
is fully shown in the chapter on Infanticide.   Breathing is justly
regarded by the English law as only one sign of life;  and proof of
the possession of acth7e and vigorous life  is not required.  It can-
not be admitted, physiologically, that any tremulous motion of the
muscles can ever take  place  spontaneously in  the body of a child
really dead, and the spasmodic movement of  the lip differs only
in degree from the motion of a leg or arm, or of a rib by the inter-
costal muscles.  If a certain quantity or degree of life were required
to be proved, instead of the bare fact of its actual presence or entire
absence, the most subtle medical distinctions would be continually
dniAvn.   Non-professional persons might  be easily deceh-ed as to
the act  of  breathing in these feeble subjects, and an  examination
of the dead body- Avould not suffice to remove the doubt, since new-
born infants may live for hours without any air being found in the
lungs; but a person is  not so likely7 to be deceived about the move-
ment of an arm, a leg, or a lip.
  It has been objected to this view of the case  that the movements
described may be the  mere remains of muscular irritability, and
not a sign of actual life or the vital force ; but it seems to .me that 
624     SCOTCH LAAV  IN RELATION to live-birth.

this is practically an admission of the presence of life, or vital force
under another name.  Aluscular  irritability  and spontaneous con-
tractions are not manifested in bodies really  dead, and  their spon-
taneous occurrence proves that some vital poAver must  still remain
in the body of a child.
  Some medical jurists have contended  that  there should be, in all
cases, evidence not only of the breathing, but of the crying of a
child, in order to justify a medical  opinion that it Avas  born alive;
but according to Blackstone (" Commentaries," vol. 2,ch. 8, p. 127),
" Crying, indeed, is  the strongest  evidence, but it is not the only
evidence;" and  Coke says, "If it  be  born  alive it is sufficient,
though  it  be  not heard  to cry, for peradventure it may be born
dumb ;" he also describes " motion, stirring, and the like," as proofs
of a child having been born alive.   So  far the decision in Fish v.
Palmer is borne out by good legal authority; and we may consider
that although the mere  Avarmth of the body Avould  not be evidence
of live birth, yet the slightest  trace of vital action, in its common
and true physiological acceptation—such as crying, breathing, pul-
sation, or motion—observed after entire birth and  separation from
the mother, would be deemed, in English  laAV, a sufficient proof of
the child having come into the w-orld alive.
  A late eminent Scotch judge informed me that in Scotland, the
husband's right of courtesy, or life-rent in his wife's estate, depiends
upon  there having been a child of the marriage born alive; and
for the proof  of  live birth  it is required to  be shown, not merely
that it had breathed, but that the child had cried after it Avas born.
Dr. Beck remarks that the Scotch law is more precise than the
English, in thus demanding proof of crying ; but it should be added
that it is more unjust.  The case of Dobie v. Richardson (Court of
Session,  1765) is sufficient to prove this.   Dobie's wife brought
forth a child  about nine months after  marriage Avhich breathed,
raised one eye-lid, and expired in convulsions about half an hour
after its birth, but was not heard to cry.  The mother died in child-
bed, and the question was whether  the jus mariti  was  not lost by
the death of the Avife within the year, without a child of the mar-
riage which had been heard to cry.   The  decree made  in the case
was, that as the  wife did  not  live a year and a day after her mar-
riage, and as it Avas not  proved that the child or foetus, of which
she Avas delivered, Avas heard to cry, the husband was not entitled
to any part of his deceased Avife's  effects  (" Beck's Aled. Jur.," 1
358).   The learned judges in this case did not stultify themselves
by affirming that the child in question was born dead.  This is a
physiological and not a legal point.  A child Avhich died in convul-
sions half an hour after its birth could  not be described as  having
been dead.  The laAV  of any country may assume its OAvn standard
of life at birth.   The Scotch  law thus  assumes "audible crying,"
but it cannot alter the physiological fact that a child may be born
living without crying.  It is  not merely a  living  but a "crying"
child which conveys the right  of courtesy to the husband across the 
PARTIAL  AND ENTIRE BIRTH.
625
border.  This will be further seen from the decision in the case of
Blaekie (Court  of  Session, 1833).
  There is some reason to believe that,  in any future case, this will
not be taken as a precedent.  The attainment of greater knowledge
on the nature  and the proofs  of life from the "results of medical
experience and  observation, and the fact that these physiological
questions have become more generally known and better understood,
will probably lead  to  a  different decision.  That  there should not
be a po\ver of proving life (Avhen the death of a child takes place
speedily after birth) except  by direct evidence  that the  child had
cried, is in truth a view of the matter wholly indefensible.  From
what Avill be hereafter stated (Vagitus uterinus, infra)  it will be
seen that the  crying child is not necessarily a sign of live birth, for
it may cry during  the act of birth, and  die before its body is born ;
while the fact  that it breathes and moves after  birth, although
from accidental circumstances it may  not  cry, is unexceptionable
evidence of its  having been born alive.
  The case of Brock v. Kelly involved  a claim by7 a Avidow to the
estate of her  husband,  on the  ground  that a child born tAventy
years before had been born living, although it Avas at first supposed
to have  been  stillborn.   The  case came  before Vice-Chancellor
Stuart in April 1861, and his  decision confirmed  the A7ieAvs here
expressed.  Dr. Freeman  noticed  at the birth of this  child, and
after separation from the  mother, that there Avas a slight pulsation
in the cord, showing a feeble  but independent circulation.   There
Avas no other  indication of breathing than an  arched state of the
chest.  He had, it  ap>pears, made an entry in his diary of the birth
being that of a live child, and believing it to be alive, he caused it
to be placed in  Avarm water to sustain  its vitality ;  he felt sure of
its being alh7e for the reason above assigned.   This statement was
confirmed by  the nurse, avIio had been  heard to say that the child
Avas born alive, but died the same day.   This  may  be regarded as
strong evidence that the child Avas  really born Avith  life, although
in a passive state of excitation.  At the time when these observa-
tions Avere made, namely, twenty years  before, the legal question of"
live birth AA7as not  raised, and  there could have been  no conceivable
motive for misstating the  facts, or inventing a state of things to
suit a legal claim.
  Dr. Tyler Smith supported  the opinion  of  Dr. Freeman in an
affidavit, considering that the fact that pulsation Avas observed in
the umbilical cord  after delivery Avas a physiological proof that the
child in question Avas not  born dead.  On the  other side, Drs. Lee
and Ramsbotham  gave their opinion that there Avas no proof in
this case of breathing having taken place after  birth,  and that
nothing less  than breathing could establish the fact of live birth!
The child, therefore,  in their judgment, was not born  alive.  In
their judgments a child  must breathe before it can be said to
possess independent life.  The Vice-Chancellor decided  the  proof
of breathing was not necessary, and held that there was sufficient
leual  evidence of life after birth in  the pulsation observed by the
      40 
626
PARTIAL AND ENTIRE BIRTH.
accoucheur.  This decision is in accordance Avith law and common
sense.  Pulsations indicate  an  action of the heart, as much as
motion of the chest indicates an action of the intercostal muscle.
  There is a difficulty in relying upon the suggested proof derivable
from the presence of air in the lungs.  It is well knoAvn, and  cases
are described under  the  section of Infanticide, that a  child may
breathe and  die  before its body is born.  Therefore, unless  there
are eye-witnesses to testify to the act of visible breathing, the test
is  not only valueless, but fallacious.  It would  mislead  a court of
law.  On the other hand, children are born and live for many hours
in a state of  passive existence Avithout visibly breathing, and after
death no  air is  found in the lungs.   These are the cases Avhich
would be truly pronounced stillborn by those who w7ere not present
at the birth, although the accoucheur and nurse may have distinctly
seen movements of the arms, legs, or lips, or even a convulsed state
of the body !   Alany cases of  this kind are described in the section
on  Infanticide ;  for such cases  of life without  respiration  have
been  thought to form a serious obstacle to any inference from ex-
periments on the lungs.
  The following case, in which all the  facts were accurately ob-
served in reference to the manifestations of signs of life after birth,
and the duration of life in a new-born child, clearly proves that the
English Courts are correct in relying upon proofs of life, irrespective
of breathing or crying.  It  shoAvs, too, that  the decision of Vice-
Chancellor Stuart in the case of Brock v. Kelly Avas based on sound
physiological reasons, and that any other decision would have been
unjust.  This case occurred  to Dr. Seale, U. S.  ("  Arner. Journ.
Aled. Sci.," July 1870, p. 278.)  He induced  labor in a  woman by-
ergot of rye, at about the seventh  month of gestation.  A  large
child was born after some difficulty, but it did not make the slightest
effort to breathe.  There Avas distinct pulsation in the cord.  AVas
this child  living or dead ?  As it  had not breathed, according to
some accoucheurs, it would be regarded  as dead.  The pulsation of
the cord would be treated as of no importance, i. e., as giving no
indication of life after birth.   But this child Avas really born living,
a fact proved by AA7hat followed.  Flagellation and alternate sprink-
ling with  hot and cold water produced a violent spasmodic con-
traction of the diaphragm, which caused the entire infra-mammary
region to be very much depressed.  There Avas no doubt that this
was a case of atelectasis pulmonum, or inexpansibility of the lungs,
a state which continued for five minutes  after the birth of the child.
The cord  Avas now severed, and about half an ounce of blood was
allowed to flow sloAvly from the fcetal end.  The tongue, which had
fallen back,  was draAvn  forward.   A sudden spirt of a drachm of
blood flowed when  the constriction was relieved, and  the  child
began to  breathe very feebly, and  so continued to breathe at long
intervals.  The heart beat  very feebly.   The pupils were widely
dilated, they did not respond to the influence of a bright light, and
the child was suffering from all the symptoms of compression of 
PARTIAL AND ENTIRE  BIRTH.
627
the brain.   This condition lasted one hour, when the child ceased
breathing.
  According to the evidence of Drs. Lee and  Ramsbotham in the
case of Brock v. Kelly (p. 625 ante) this child was born dead, and
would have been so pronounced for the first five minutes after birth,
the pulsation of the cord and the spasmodic movement of the dia-
phragm being regarded by them only as indications of uterine life.
Yet it is clear that this child was born living—that it lived before
the act of breathing, which  after all was performed only  in the
most imperfect manner.   To have pronounced it dead Avithin the
first five  minutes of its birth, and living for an hour afterwards,
would have been inconsistent; yet if the slight indications pointed
out Avere  not signs of continued life these  conclusions would neces-
sarily be drawn, involving a reductio ad absurdum.  The child Avould
have had  no power of inheriting or transmitting property for the
first five  minutes after its birth because it was  dead, and Avould
have acquired this poAver for the last fifty minutes because it was
living!  According to the French law a child so living for five
minutes, or an hour, after birth Avould be pronounced non-viable and
incapable of acquiring or transmitting property.
  A healthy7 full-groAvn child recently born may make an attempt
at inspiration, but the closure of the larynx from convulsions, or
some irritant such as the vaginal discharges, meconium, etc., may
impede the entry of air into the lungs.   The chest in this  case  is
arched, the head thrown back, and there is a convulsive rigidity of
the muscular system ; the tongue  is firmly retracted, especially at
its base.   Unless the finger  of  the accoucheur is passed quickly
down to the base of the tongue, and the epiglottis raised by pressing
it forwards, the child would never inspire, although it might have
a perfect  capacity7 to  breathe.  Dr. Braxton  Hicks met Avith a case
of this  kind  ; the air entered the lungs immediately after the above
operation, and  the child breathed  and lived.  According  to the
theories propounded in reference to the cases  of  Fish v.  Palmer
and Brock v. Kelly, this child would have  been pronounced dead or
stillborn  up  to the time at which the accoucheur removed  the im-
pediment to its breathing.  It has been observed that a respiratory
action ensues upon any stoppiage of the placental supply to the child,
and, moreover, that this  may occur in the uterus as well as in the
vagina; and it has been remarked that foreign substances, which
had been  draAvn in under these circumstances, may be found in the
bronchial tubes.  If this be so, then the finding of the natural se-
cretions in the bronchial  tubes Avould not be an absolute proof of
inspiration having been  established; it Avould merely  show that
there had been an action of the chest during birth similar to that
of inspiration.   Still this must be  regarded as a living action, and
therefore  indicative of life in the child.
  There is no doubt that the best" test to apply to such cases for the
determination  of physiological life  is auscultation.  The beating of
the heart, as determined by the ear or the stethoscope, applied even
for five consecutive minutes, is an undoubted sign of life, in a phy- 
628
PARTIAL AND ENTIRE BIRTH.
siological sense, Avhether the  child  breathes, cries, or moves.  AI.
Bouchut noticed, on  one occasion, that this kind of passive life
continued  in  an  infant  for  tAventy-three  hours after its  birth.
Feeble but distinct pulsations were heard  at  long intervals, but
there was no motion of the ribs.  Attempts at  resuscitation Avere
made, but the motions of the heart became more and more feeble,
until they  entirely ceased.  An examination shoAved that the lungs
had  not received air.  As Ave take the cessation of the heart's action
to be the only certain evidence of death, so the existence of  pulsa-
tion  in the heart or arteries, when  clearly perceived by the ear,
stethoscope, or finger, is positive evidence of life in a physiological
sense. Is this legal life ?   Would the wilful destruction of such a
child constitute murder ?  Would this proof of pulsation Avithout
muscular motion, breathing, crying, or any other sign of active life,
confer tenancy by  courtesy, or transfer an  estate  by inheritance or
survivorship?  M. Bouchut justly  observes that apparent  death
succeeding-to birth, and  characterized by the presence of a beating
of the heart and an absence of respiration, is only a diseased condi-
tion of the new-born child (see " Atelectasis," Infanticide) ; and,
Avhether  it is cured of this or  dies, it is living, although it has not
breathed; or, as a German j urist remarks, " Scheintod ist Scheinleben."
By taking away its right of succession, the law punishes  the child
and  its heirs for a malady  with which it is born (" Gaz. des Hop.,"
1855, No.  124; and  "Med. Times and Gaz.," August  19,1856).
They Avho contend that crying or breathing alone should be taken
as a sign of life after birth, would of course pronounce  such a child
to have been born dead, even at the time that they might be listen-
ing to the  pulsations of its heart!  (Casper, " Klinische Novellen,"
1863, p. 564.)   Such pulsations would  probably7 be referred by them
to the remains of uterine life.
   Vagitus  uterinus.—Let us suppose that  the  evidence of a  child
having been born alive is stated to be that it was heard to cry—it
may  be  a question for  a medical  witness, in cross-examination,
whether  this is to be  taken as an absolute proof of live birth.   The
answer must be in the negative, because a child may cry before its
body is entirely born ; or there may have been what is called vagitus
uterinus—a uterifle cry after the rupture of the membranes.   (See
Infanticide.)   It  is quite certain that a child may breathe  with-
out crying, but  it cannot  cry without breathing ; yet neither the
crying nor the breathing  is an  absolute proof that the  child Avas
actually born alive.  As in all cases of this description there must
be eye-witnesses, either professional or not; the evidence will not
rest  solely  upon a  mere medical possibility of the occurrence of such
a cry before birth ; and proof will be required of the crying of the
child after it was born.  The  determination of the momentary ex-
istence of children after birth  is,of importance in a legal point of
view, in  reference to the folloAving subject.

   Tenancy by courtesy.—This  signifies, according to Blackstone
(" Com." vol. 2, p. 426), a tenant by the Courts of England.  The
nature of  this tenancy has been already explained.   (See the case 
PARTIAL  AND ENTIRE BIRTH.
629
of Fish v. Pdrner, p. 622, and Broe-k v. Kelly, p. 625.)   If a married
woman possessed of estate die, the estate passes  from the husband
to her heir-at-hiAv, unless there has been a child  born living of the
marriage, in which case the husband acquires a life-interest in the
property._  The only defence of this singular custom is that it is of
great antiquity.   An unsuccessful attempt was made a feAV years
since to substitute for it the reasonable provision  that the marriage
alone should entitle the husband to a right which he can now onTy
acquire by the fulfilment of certain accidental conditions.  Incura-
ble sterility, a protracted labor, deformity in the pelvis of the wife,
or the necessary performance of craniotomy on a healthy well formed
child, may, under this custom, lead to an aA7ersion of the  inheri-
tance.  The tenancy, in contested cases, is generally established or
dispu-oved by medical evidence;  and  the folloAving are the condi-
tions which the laAV requires in order that the right should exist:—
   1. The child must be born alive.—Cases have been already related,
wherein the motion of a lip and a pulsation of  the umbilical cord
were held to be sufficient proofs of live birth.  Some physiologists
have objected to these as inadequate proofs of life ;  and if the ques-
tion Avere one of  physiology, and not of laAV, there might be some
ground for the  objection.  In truth, hoAvever, the law does  not
require proof of  active  life in a child, but  merely some evidence,
hoAvever  slight, that it  has been  born living; and the  amount of
proof to satisfy the purposes  of  justice must of course  rest Avith
those who are expounders of the haw.   Rare as these cases are, one
has been the subject of tAvo trials (Llewellyn  v. Gardiner and others,
Mafford Lent  Assizes,  1854; and Gardiner  v. Llewellyn, Stafford
Summer Assizes,  1856).   This Avas an action of ejectment brought
to try the plaintiff's right to a life-interest in the  property of his
deceased Avife.   The plaintiff claimed as tenant  by the courtesy  of
England, and his right depended  upon Avhether  his deceased wife
had  had a child bore alive.  According to the plaintiff's evidence,
his Avife had taken a long walk, she being at the  time in about the
seventh month of her pregnancy (November, 1851); and, having
been taken ill during the night, she was suddenly7 delivered  of a
child, Avhich lived for about a quarter of an hour.  He stated  that
he  heard the  child cry.   The plaintiff immediately fetched his
sister, and returned Avith her to his Avife in a few minutes, and she
deposed that she heard the child cry tAvice. This evidence was relied
upon as conclusive that  the child had  been born alive, although  it
appears on the same evidence to have died before anything could
be done towards dressing it.   The  case for the defendants at  the
first  trial AA7as that*the wife Avas a girl of delicate health  and liable
to epileptic fits;  that  Avhen little more than  16, she had  been mar-
ried to  the plaintiff Avithout the consent  of  her mother; and evi-
dence Avas  given  to shoAV the improbability of the child having
been born  alh-e, there  being reason to  believe, from the conduct of
the plaintiff and other circumstances, that it  never could have had
more than  a foetal  existence.  There  had been no medical exami-
nation ; the body Avas buried the same day, and, as in the case of 
630
PARTIAL AND ENTIRE  BIRTH.
stillborn children, neither the birth nor the  burial Avas registered.
AVightman, J., left it  to the jury to say w-hether the positive evi-
dence given by the  plaintiff and his sister had been rebutted by
the evidence given for the defendant, and the other circumstances
of the case.  The jury found a  verdict in favor of the  husband's
claim.  At the second trial, ordered  by the Court of Chancery
(Stafford Summer Assizes, 1856), the plaintiff LleAvellyn Avas made
defendant; and medical  and other  evidence w7as adduced to show
that the child could  not  have reached an age at Avhich, it  could
either breathe or cry.  The age was variously assigned at the fourth
or fifth month  of gestation.  The body7 of the  child AA7as not seen
by any  medical man, and the non-professional Avitnesses who saw it
differed entirely regarding its size and appearance; so that, in fact,
the  case rested mainly  on  the credibility  of  the statements  of
LleAvellyn  and  his sister.  There were no med.iccd facts to guide the
jury.  The late Baron Alderson, in summing up, said the question
simply  AA-as whether  Eliza Bennett, aftenvards Eliza LleAvellyn,
was delivered of a living child during the time she was a Avife.  If
they- had a doubt on the subject, and could not tell whether it was
born alive  or not, they must find a verdict for the plaintiffs (Gardi-
ner) ; they could not find for the defendant Llew7ellyn unless  they
were satisfied  that  the  child was in  a state of life in the world,
during the time the husband w-as married to the wife.  The verdict
of the jury was to the effect that they did not believe the child Avas
born alive: it was, therefore, a reversal of the former verdict.
  It has been usually considered that the crying of a child, properly
attested by disinterested witnesses, is  sufficient evidence of live
birth.  This is, in fact, one of  the tests given by Lord Coke.  In
the  section on Infanticide, some cases are related in Avhich new-
born children survived birth several hours, but manifested no sign
of active life either by crying, or in any other mode, and after death
there was no air in  the  lungs.   As in  cases  of  infanticide, if the
evidence of live birth rests entirely  on an examination after death,
the absence of  air from the lungs will not necessarily show that a
child has come into  the world dead, nor will the presence of air in
these organs prove that it has been born alive, because it may have
breathed and  died before  birth.  The child must be heard to cry,
or be seen  to breathe, or move after  birth.  The fact that the lungs
are  not distended with air, and that  they immediately sink  in
water, either when entire or when divided into small pieces, is no
proof that a child has not breathed and cried during birth and
afterAvards. (See cases by Dr. Vernon and Dr. Davies.  Infanticide.)
Although  in Dr.  Vernon's case the child hact only reached the
sixth month, it was  strong enough  to cry; and yet probably, had
its history been unknoAvn, some medical experts AA-ould have been
prepared to swear, from an examination of the lungs, that it must
have been born dead, and certainly could not have had the power
of uttering a cry!  A child born at the fifth month has been known
to cry (see  Legitimacy) ; but the state of its lungs is not recorded.
In the  case of Gardiner v. Llewellyn, a medical witness avIio ap- 
                PARTIAL AND  ENTIRE  BIRTH.            631

 peaivd for the plaintiff stated as his belief that a child born at the
 fifth month could not breathe, and if it  could  not breathe (so as  to
 fill the lungs) it  co"uld not cry!   This may have been consistent
 with his experience, but it is not consistent with facts observed by
 others. ^  One of the greatest difficulties that laAvyers have to con-
 tend with in getting at medical truth, is this strong disposition on
 the part of witnesses to act upon a foregone conclusion, and to ' fix'
 all natural  events by an  exclusive reference to their  individual
 experience.   In Llewellyn's case, the only evidence of  the  child
 being born  alive rested  on the testimony of strongly-interested
 persons, Llewellyn and his sister.  The alleged fact on Avhich they
 based their case was that they had heard the child cry; but taking
 the other evidence  in the case, the jury placed no confidence  in
 their statement.
   It would  be indeed  most unsafe as a rule to receive evidence on
 points of this nature, i. e. of breathing, crying, or movements  of
 the limbs of new-born children, except from medical men present
 at the time, or from  persons not interested in the results of the
 case.  In general, medical opinions have been  received on  these
 occasions.  Nothing would be more easy than to assert that a child
, at birth cried or moved, and  it Avould  be utterly impossible, from
 an inspection of the body, to disprove these statements.
   2. The child must be  born while the mother is living.  Ccesarean ex-
 traction.—From this it apjpears that if a living child were removed
 from the outlet, or extracted from the uterus by the Cesarean ope-
 ration, after  the death of the mother, the husband would not be
 entitled to enjoy his wife's estate, although the child might survive
 its removal or extraction, and  succeed to the estate on attaining its
 majority.  How such a case would be decided  in the present day it
 is difficult  to determine;  but  one instance is quoted by  most
 medico-legal Avriters from Lord Coke, in which, about three centu-
 ries ago, the decision went against the husband, in consequence  of
 the child having been removed  from the uterus by the Csesarean
 section  after the death  of the  Avife.  In the case of Llew7ellyn
 (supra), the late Baron Alderson ruled that the husband could not
 take the estate unless the child was proved to have been born during
 the marriage, i. e, Avhile the Avife Avas living.   Although there  is
 no recent English case  in which this question has arisen  in reference
 to the performance of the Cesarean operation, a case which occurred
 in France in 1834 will show the points to Avhich medical evidence
 must  be directed  on these occasions.    In April, 1834, a Avoman
 named L'Hotellier, about eight months pregnant, was  seized with
 convulsions and died.   A quarter  of an hour after her death, Dr.
 Cabaret extracted the  child by the Csesarean operation.   The ques-
 tion Avas, AVas  this child a living or a dead child at the time of its
 removal ?  Dr. Cabaret, the operator, deposed that he saw its chest
and ribs move, that there Avas pulsation in the umbilical cord, and
also at its base after it was cut off, and  that on laying his hand on
the region of the heart, he felt this organ  beating.  The body was
placed  in a Avarm  bath, and immediately on  immersion  the  right 
632            PARTIAL  AND ENTIRE BIRTH.

hand was raised toAvards the head, and there Avas a slight respiration.
After this the child Avas motionless.  Dr. Cabaret considered  that
it  had  breathed, though  feebly, and for the Space of about five
minutes.  This testimony Avas confirmed by several women  who
Avere present at the delivery.
  On the other hand, a physician SAvore that the child  must have
been born  dead, since he had  been for eleven hours in  attendance
on the woman previous to her decease, and  had felt no motion in
the uterus.  This witness, hoAvever, Avas not present at the operation
for the removal of the child.  Thirty-three days after the extraction
of  the child, the body was  exhumed and  examined.  The lungs
were compact, of a reddish-broAvn color, and the left was emphyse-
matous.   This portion of" the lungs, cut  into pieces, floated on
Avater.  There was meconium in the intestines, but the stomach and
urinary bladder were enipity.
  On this  state of facts Velpeau gave  his opinion that the child
had been born alive ; but Orfila, Dubois,  and Pelleton said that in
their judgments it had not been born alive.   Orfila assigned the
condition of the lungs to  putrefaction, and  Dubois considered the
pulsation in the cord to prove that extra-uterine life Avas not esta-
blished ; in other words, that the child had not breathed.
  The Court submitted these conflicting opinions to three experts—
Drs. Alarjolin, Roux, and Marc. According to them, the movements
of  the  arm observed  by  Dr. Cabaret Avas  mechanical (not vital),
owing to the stimulus of immersion  acting on the remains of fcetal
life.  As to respiration, if a child  breathed  ever so feebly for  five
minutes, it is remarkable that it raised no cry, not even those feeble
sounds produced when the air penetrates no further than the trachea.
Finally, the pulsations of the cord cease  as soon as respiration com-
mences.  The post-mortem inspection proved nothing in favor of
the child having  been born alive.   The  arched  state of the chest
and the condition of the lungs were due to putrefaction, and not
to the act of breathing.
  From these considerations, and believing that all the indications
might be referred to the remains of fcetal life, they gave it as their
opinion that this child had not breathed, anel consequently (?)  had
not lived.  ("Ann. d'Hyg.," 1838,1, 98; and Beck's " Aled. Journ.,''
vol. 1. p. 360.)
  Upon the strict rules of English laAV such a case would not haA7e
given  rise to any question  in  reference to the jus mariti.  The
proof's of life in the child were much stronger than in the case of
Fish v. Palmer (p. 622, ante.)  The evidence of the physician and of
the women present at the extraction of the  child shows that there
was a pulsation of the cord—a visible act of breathing, pulsation of
the heart, and the spontaneous movement of an arm when the child
Avas placed in a warm  bath.  The fact that  another physician, avIio
did not see the child extracted, had not perceived any movements
in the uterus for some hours before,  amounts to nothing.
  The suggestion of the expterts that the movement of the arm was
mechanical Avas an evasion of the  true question.   A  really dead 
PARTIAL AND  ENTIRE  BIRTH.
633
body might lie put into  a Avarm bath without such a mechanical
force being exerted.  The stimulus of warm Avater has no effect on
a dead body ;  but it is quite  consistent with  the fact of this child
being living, that Avhen put into a Avarm  bath, there was a move-
ment of a limb and an act of respiration.
   But under any circumstances, unless the alleged facts w7ere dis-
proved by eye-witnesses, the theoretical opinions of experts should
not be alloAved to set aside the direct and independent evidence of the
operating physician and of the other persons  in attendance.  Ac-
cording to English Law, this child Avould have been pronounced
living.  Even the referee-experts did not  positively say that it Avas
"born dead."  They someAvhat evasively say, " This child has not
lived," implying by this that  it has not breathed perfectly, and has
not manifested Avhat they call active extra-uterine life.   Further,
if it had lived, it Avas a viable child, i. e., there Avas nothing in its
conformation to prevent it from continuing to live.
   The husband or representative of the deceased parturient Avoman
may object to the performance of this operation, even although the
child may be living in the womb, and there  may be a reasonable
hope, by an immediate operation, of extracting it living.   The late
Dr. Lever informed me that on tAvo occasions, in 1858, the husbands
thus refused to allow him to  operate on the dead body- of the wife.
I apprehend that no medical man Avould proceed to operate by force,
or against the will  of the husband ; at the same time, in refusing
his permission, the husband is not guilty of any legal offence.   The
practice on the Continent has been to undertake it while the AA7oman
was living, and the result has sIioavii  that, in a large number of
cases, it may thus be performed successfully, both with regard to
mother and child.
   Important legal consequences  may hereafter ensue from  a more
general adoption of this practice in England in respect to deformed
females.  Thus, supposing in  any case a child  were removed  alive
while the mother was  living,  both of them  dying shortly after-
wards, AVould the husband become a tenant by courtesy?   The law-
says that the child must  be born; and some lawyers would  find
ground for arguing Avhether extraction by the Cesarean operation
should be  regarded as "legal birth." " Illud  autem valde  con-
troversum est  inter jurisconsultos, an  is  qui editus  est,  exsecto
matris ventre,  reputetur partus  naturalis  et  legitimus et successi-
onis capax."  (Caranza.)  According to Fonblanque, the question
is  settled in the  affirmative—a child extracted is a child born.
("  Aled Journ.," A7ol. 1, p. 236.)  Our ancient law authorities do not
appear to have contemplated  that such an  operation would ever be
undertaken on a living female.   The w7ords of Lord Coke, Avhich
are considered  to express the  state of the  English law, are, " If a
woman seised of lands in fee taketh husband, and  by him is bigge
with child, and in her travell dyeth, and the child is ripped out of
her body alive, yet shall he not be tenant  by  the curtesie, because
the child was not born during the marriage, nor in  the life of the
wife, but in the mean time her  land descended." According to other 
634
MONSTROSITY.
authorities, the Csesarean operation does  not divert  the course  of
descent, or divest the husband of the life-estate, provided the child
be born alive, and the mother was living when the child was born.
(" Obstetric Record," vol.  3, p. 66.)  Birth and extraction by the
Cesarean operation are, therefore, treated as similar conditions.
  Aledical jurists have differed respecting the period of gestation
at which the operation should be performed.  This would, of course,
depend on the earliest period at which a child might be born capa-
ble of living.  In reference to tenancy by courtesy, a child  might
be extracted alive as early as the fifth month, but it would not be
likely to survive unless it was at or about  the  seventh month.
When a woman dies undelivered, it is difficult to say for how7 long
a period the child ma}7 survive in the uterus.  It has been  stated
that a child might thus continue to live  for many hours, but this
is not borne out by any facts, and the physician who  makes the
suggestion says that no  time should be lost in removing the foetus.
In the French case above quoted, p. 631, the child was removed alive
a quarter of an  hour after the death  of the woman.   Dr. Aladge
operated in a case of convulsions twenty minutes after  the  death  of
the Avoman, but the child was then dead.  There were no signs  of
uterine  action  after the mother's death.   ("Amer. Journ. Med.
Sci.," July, 1872, p. 585.)  Some have alleged, that unless the ope-
ration is performed immediately after the death of the woman, the
child would not be extracted living.  The condition of the foetus
in utero is, however, peculiar, and quite distinct from that  of a
child living by the act of respiration.  It is piossible, therefore, that
there may be a limited  survivorship, and that the operation may
be performed so late as an hour after the death of the woman, with
the possibility of extracting a living child.
  Birth of the child after the death of the woman.—The post-mortem
birth of a dead child can give rise to no question  in  connection
with tenancy by courtesy.    This part of the  subject  has been
elsew7here further considered.  (See under Delivery, ante p. 514.)
But  it may happen  that the  child is  born after the  death of the
woman, and survives its birth, as in the following case.  A Avoman
died during labor.  The accoucheur who was summoned found the
head of the child presenting, but too high up in the pelvis to allow
of the application of the forceps to aid delivery.  He immediately
introduced his hand into the uterus, and a quarter of an hour after
the death of the mother, and twenty hours after the  rupture of the
membranes, he extracted a male infant in a state of apparent death.
The  child, which was well formed, Avas speedily resuscitated by the
application of the ordinary means.  (" Berlin Medicin. Zeit.," July,
1836.)  Had  this case occurred in England, it Avould  probably have
been decided, according to  the old precedent, that  the  husband
could not  become a tenant by courtesy, because by the death of the
mother  the marriage was dissolved, and the  land had descended
before the child was born!
  3.  The child must be born  capable of inheriting.   Monstrosity.—If
the  woman is  delivered of a monster, which cannot inherit, the 
MONSTROSITY.
635
husband does not acquire a right of tenancy.   The connection of
teratology or monstrosity Avith medical jurisprudence has been most
ably investigated by Af. St.-Hilaire.   Although legal questions con-
nected with monstrous births do not often occur, yet it is proper
that a medical Avitness should be acquainted with certain  facts re-
flecting them.   The laAV of England has given  no precise definition
of Avhat is intended by a monster.  According  to Lord Coke, it is a
being " Avhich 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, w-ill not  constitute a
monster in law, so far as the succession to property is considered,
provided the being still  have " human shape."  Even  a  supernu-
merary leg Avould not probably be alloAved to avert an inheritance!
Various classifications of monsters have been made, but these are of
no  assistance whatever to a medical jurist, because each case  must
be decided by the peculiarities attending it; and his duty will not
be to state the class and order of the monster,  but simply in  what
respect it differs from a normal human  being.  In consequence of
the want of a sufficient number of precedents on this  subject, it is
difficult to  say what degree of monstrosity would be required in
laAV in order to cut off the civil rights of  a being.  Monsters may
be  acephalous (headless), dicephalous (two heads Avith  one  body),
or disomatous (two bodies with one  head).  Others again, like the
Siamese tAvins,  have two distinct bodies united by a broad band of
skin.  AVould an acephalous monster be  considered as devoid of
human shape?  Would a disomatous monster be alloAved to inherit
as one?—to marry as one?—or hoAV would legal punishment be in-
flicted in the event of one of the bodies infringing the laws?   Such
are the singular questions which have been propounded by medical
casuists in relation to these  beings; and there is obviously ample
room for the exercise  of  much legal ingenuity in respect to these
questions.   According to St.-Hilaire, the  rule Avhich has  been fol-
loAved in all countries respecting these monstrosities is  to consider
every monster,  with two equally deA7eloped heads, whether it be
disomatous or not, as two beings; and every monster with a single
head, under the same circumstances, as a single being.  He ascribes
the origin of this rule to the performance  of the rite of baptism in
all Christian countries upon each head, when  the monster is dice-
phalous.   This view7 appears rational Avhen we consider that Avith
tAvo heads there are tAvo moral individualities  ; while with a single
head, there  is one Avill  and  one moral individuality.  But it is
doubtful hoAv far this doctrine would be  accepted by jurists aifd
legislators.
  The Siamese twins, Chang and Eng, may be  regarded as forming
the most remarkable duplex monster of modern times.   They Avere
horn in 1811, and appeared first in England in 1830, and  after-
wards in 1869.   They are united by a broad thick band, extending
from the loAver part of the chest-bone to the  other (cartilage ensi-
formis).  The band is four inches in length, and seven inches in cir- 
636
MINORITY  AND MAJORITY.
cumference.   The nerves and bloodvessels of  each meet in the
centre of it, but  there is no direct blood-communication  bet\A7een
the two.  There  are  tw-o distinct hearts,  the pulses having been
observed to differ in  frequency and character.  The respiration is
wholly7 independent of each other.   Their mental operations are
entirely distinct,  and  they have been known to differ in opinion on
the question of bathing, etc.  In short, they are really tAvo distinct
men, with the misfortune of having this connecting band between
them.
  Under the circumstances  mentioned, it would have been impos-
sible in relation  to civil and criminal jurisprudence to make both
responsible for the acts of one.   Living for forty years in America,
they exercised the rights of  citizenship as independent persons, and
had married  two sisters, entering into the  contract as separate
beings.  No  charge of bigamy was ^raised against them  for this
double union.  It is clear, from this independence of will and
action, that  one  might kill a person  under circumstances which
A\7ould constitute murder or manslaughter, the  other not being an
assenting party, and endeavoring to prevent the perpetration of the
crime.  The application of the criminal law7 would, as in the Pari-
sian case related by St.-Hilaire, become a subject of great difficulty.
No punishment could be inflicted on the guilty Avithout necessarily-
involving the innocent (undivided)  moiety.  Such cases of mon-
strosity must  be  regarded as setting  at defiance all  the ordinary
rules of law, whether  civil, criminal, or canonical.  Another duplex
monster, Mellie and  Christine, was exhibited in London in 1871.
(See "  Lancet," 1871,  1, 725.)   Like  the Siamese twins, they Avere
tAvo independent  beings, females, united by a band extending from
one os coccygis to the other. They were in all respects independent
in thought and action.
  Alalpositions, transpositions, or defects of the internal organs of
any of the cavities, do not form monstrous births within the mean-
ing of the English law.   The legal question relates only to  external
shape, not to internal  conformation.  It is  proper to  state  that no
person is justified in destroying a monster at birth.

  Minority and majority.—The word minor is synonymous Avith that
of infant (infans)  and  is applied in law to any  one under the age of
twenty-one years.  The age of a person may render him incompe-
tent to the performance of civil duties.   Alinors are frequently called
upon to act as Avitnesses in civil and criminal cases.  In rapes com-
mitted upon children, it is especially  important to notice whether
the prosecutrix is or is not competent to give evidence.  The laAv has
fixed no age for testimonial competency, and I have never heard of
the question being referred to a medical practitioner.   The child is
ahvays orally examined  by the court, and it  is soon rendered ap-
parent by the ansAvers whether the Avitness possesses a proper knowl-
edge of the nature and obligations of an oath.  If  not, his or her
testimony is not received, or, in a case of rape, the trial is postponed,
and the  child  is  placed under instruction, to appear again at the
following sessions or assizes.  The competency of a child as a wit- 
MINORITY AND  MAJORITY.
637
 ness, therefore, does not depend on age, but upon its degree of un-
 derstanding.  In respect  to criminal  responsibility as affected by
 age, it was  held  by Keating, J., in a recent  case  (Reg. v.  Cowley,
 1860), in Avhich the prisoner, a boy aged eight years, AA-as charged
 with felony, that up to seven years of  age the laAV presumed that a
 child could  not distinguish right from wrong, so as to be  capable
 of crime; and evidence Avas not admissible to prove that  he  pos-
 sessed that  capacity.  After the  age  of seven, and up to fourteen
 years, although the laAV presumed a child to be prima facie  inca-
 pable of crime, this presumption might  be rebutted by evidence
 Avhich  shoAved  that he  had what Avas called a  mischievous dis-
 cretion.  [The  maxim  in this case is " mcditia  supplet cetatum."—P.]
 In  the  case referred to, there  was no evidence of that sort,  and
 therefore his lordship directed the jury to acquit the prisoner.   In
 another case, tried before the same learned  judge in Alay, 1863
 (Whitby v. Hodgson), an action  for trespass and false imprisonment
 Avas brought against a man for giving into custody on a charge of
 stealing, a boy under six years of age. It appeared that the child
 had stolen some wood; but it was held that at this age, and under
 seven years,  a child Avas in point of law doli incapax, hence  the de-
 fendant was not justified in giving the boy into custody. The jury
 returned a verdict with damages against him.
  According to the principles of our law, a male at fourteen is con-
 sidered to be at years of discretion, and he then becomes responsible
 for his actions ; at twenty-one he attains majority, and is at his own
 disposal, and may alienate his lands, goods and chattels by deed or
 will.  It is only when this age has been attained that an individual
 can be  SAvorn to serve on  a jury.  The period at which a male is
 considered to have  attained full age varies indifferent countries:
 thus, in the kingdom of Naples it was formerly fixed at eighteen
 years; in Holland  at twenty-five; but generally throughout  the
 States of Europe the laAV prescribes twenty-one years,—the same as
 the commou-laAv of England.
  A child under fourteen indicted for murder must be proved to
 have been conscious of the nature of the act.  In the case of  Reg. v.
 Vamplew (Lincoln  Summer Assizes, 1862), a girl  under fourteen
 years of age was convicted of destroying  the  life of a child by7
 strychnia. It Avas shoAvn that she was competent to understand the
 nature of the act. Under fourteen, a male infant is  presumed to be
 incapable on the ground of incapacity, of committing a rape as a
 principal in  the first degree, or even of committing an assault Avith
 intent to perpetrate this crime; but if  the boy have a mischievous
 discretion, he may be convicted as a principal in the second degree.
 The patient  may be convicted of an unnatural crime, although  the
 agent be under fourteen.  A female under the age of ten years is
 presumed  to be  incapable  of  consenting to sexual  intercourse.
 ("Taylor on Evidence," vol. 1, p. 117.)
  A person  attains  his legal majority, or is completely of age  the
first instant of the day before the twenty-first anniversary of his birth-
day, although forty-seven hours and fifty-nine  minutes short of the 
638
MINORITY  AND MAJORITY.
complete number of days counting by hours; and this mode of cal-
culating age and time is applicable to all other ages before and after
twenty-one.  This is on  the  principle  that a part of a day is, in a
legal point of vieAV, equal to the Avhole of a day.  A feAV minutes
or hours may thus determine the attainment of majority, and Avith
this, the responsibility of minors for civil  contracts, or the validity
of their wills. By 1 Vic. c. 26, no Avill made by any person under
the age of tAventy-one years shall be valid ; and as the clay of a per-
son's birth is included in the computation of his age, and there being
in laAV no fraction of a day, a valid will may be made at any time on
the day before that which is usually considered the tAventy-first an-
niversary of birth. [The laAV (in general) " does not recognize frac-
tions of a day;"  that is, it does not consider the hour at Avhich an
event takes place, and looks upon it as the same thing whether a
birth occurs upon the last or upon the first minute of the day.  At
the last moment, therefore, of the day preceding a person's twenty-
first birthday, he actually completes his twenty-first year; but upon
the same principle, the laAV looking upon the day as a unit, regards
the first moment of it as a completion of the year, just as much as
the last moment; and hence, though his birth may not have occurred
until the last hour of the day on which he Avas  born, the law re-
gards him  as of age on the first hour  of the day preceding, or 48
hours earlier than in point of fact he completes his twenty-first
year.—P.]
  There is another aspect in which this question of age may be
vieAved—namely, in reference to the responsibility of accused per-
sons for debts, or alleged criminal acts.  In Reg. v. Thornhill (Staf-
ford, Lent Assizes, 1865), the prisoner AA7as indicted for a misdemeanor
in carnally knowing and abusing one Mary Sambrook, being a girl
above the age of 10 and under the age  of 12 years.  It appeared in
evidence that the girl's birthday was on the fifth of December 1852,
and the offence was alleged to have been committed on the 4th of
December,  1864.  The question then arose  whether the  girl  was
under  the  age of 12 years, so as to bring  the offence within the
statute.  It was objected by the prisoner's Counsel, that as  on the
5th of December the  girl Avould enter on her 13th year, she  had
therefore completed her 12th  year on the 4th of December, and that
the laAV did not recognize a fraction of a day in such  a case, so that
she Avas 12 years old as much on the first hour of that day as on the
last—and his lordship (Pigott, B.) so held.   The indictment  con-
tained counts  alleging rape and assault, but, after the cross-exami-
nation of the  girl, his  lordship stopped the case, and the prisoner
was acquitted.   It is obvious that this principle would equally apply
to charges of felony for the carnal knowledge of children  under 10
years of age,  as well as to the misdemeanor of taking girls under
the age of 16 years from the custody of their parents, or of stealing
children under the age of 14 years from their parents or guardians.
(24 and .25  Vict. c. 100, ss. 50, 51, 55, 56.)  The proof of'the exact
date of birth sometimes rests with the medical man. 
PRESUMPTION OF  LEGITIMACY.
639
  The subject of plural births has been regarded as appertaining to
medical jurisprudence; but I am not  aAvare that there is any case
on record in Avhich  the evidence of a medical  man  has been re-
quired respecting it.   It  is a simple question  of  primogeniture,
which has been generally settled by the aid of depositions or decla-
rations of old relations, or servants present at the birth.  Of course,
in the absence of eye-Avitnesses the  question of priority of birth
must be a  matter of conjecture.   It  cannot be  determined by the
size or Aveight of the child,  but it  might be  determined by7 the
observation of  certain  marks or deformities in one, or more of the
children.
LEGITIMACY.
                     CHAPTER  LV.

PRESUMPTION OF LEGITIMACY.—NATURAL PERIOD OF GESTATION.—DURA-
  TION OF PREGNANCY FROM ONE INTERCOURSE.—PREMATURE BIRTHS.—
  SHORT PERIODS  OF GESTATION.—VIABILITY.—EARLIEST PERIOD  AT
  WHICH A CHILD MAY BE BORN LIVING.—EVIDENCE FROM THE STATE
  OF THE CHILD.—PROTRACTED BIRTHS.--A  PERIOD OF GESTATION NOT
  FIXED BY LAW.

  Legal presumption of legitimacy.—Every child born either in laAv-
ful matrimony, or Avithin a period after the deatli of the husband,
in accordance with the natural duration of gestation, is considered
by the English law  to be the child of the husband, unless the con-
trary be made clearly to  appear  by medical or moral  evidence, or
by both combined.   [In a recent case in Pennsylvania, Dennison v.
Page (5 Casey,  420), Avhere a child  was  born  three months after
marriage,  which  the husband  instantly  disclaimed, and  never,
during nis life, recognized,  it was  held, that w7here a child is born
during wedlock, of  Avhich the mother was visibly pregnant at the
marriage, it is presumed, juris et de jure, to be the offspring of the
husband, and that its illegitimacy cannot  be proved by the mother
after the husband's death.  But see the very able dissenting opinion
of LoAvrie,  J., 1 Grant, 377.—P.]  It  is only in  reference to medi-
cal evidence that the subject of Legitimacy can  here be considered ;
but it is extremely rare to  find a case  of this kind determined  by
medical evidence alone.   There are generally circumstances Avhich
show that  a child whose legitimacy is disputed is the offspring of
adultery, Avhile the medical facts  may be perfectly reconcilable with
the  supposition that the claimant  is the  child  of the husband.
These cases, therefore, have been repeatedly decided from moral 
640
PRESUMPTION OF  LEGITIMACY.
 evidence alone—the medical evidence respecting the period of ges-
 tation, or pihysical  capacity in the parties  leaving the matter in
 doubt.  The present  state of the English  laAV on this subject apt-
 pears to be this: A child  born during marriage is deemed illegiti-
 mate, when, by good  medical  or other evidence, it Avas proved that
 it Avas impossible for the husband to be the father—Avhether from
 his being under the age of puberty, from  his laboring under physi-
 cal incapacity as a result of age or natural  infirmity, or  from the
 length of time which may have  elapsed  since  he could  have had
 intercourse, Avhether  by reason of absence,  or death.  When the
 question  turns upon any of these conditions, medical  science is re-
 quired for its solution, and on these  occasions  skilled experts are
 usually  selected by the litigants.   With  proof of  non-access of
 the husband, or immorality on the part of the  mother, so important
 on these  occasions, a medical Avitness  is not in the least concerned.
 In cases of contested  legitimacy, the  English  law does not regard
 the date of conception, Avhich cannot be fixed,  but the date of birth,
 Avhich can be fixed.   Medical evidence  may- relate—'1st, to the
 actual length of the p>eriod of gestation; this may be in  a  given
 case so short or so  long, as to render it medically impossible that
 the husband could be the father.   2dly, there  may be physical in-
 capacity in the husband to procreate: he may  be too old or too
 young—or he may labor under some  physical defect rendering it
 impossible that he  should  be the  father.   3dly, there may be ste-
 rility  or incapacity in the Avife, rendering it  impossible  that  the
 child should be the offspring of a particular Avoman ; in other words,
 the claimant may be a supiposititious child.
   In  some  instances, the law assumes without medical evidence
 that the offspring is illegitimate, as where  the husband  and Avife
 have  been legally divorced " a vinculo matrimonii."   When children
 are born AA7here 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 betAveen
 the laws  of England  and Scotland.  A child born of pareuts in
 Scotland  before  marriage,  is  rendered  legitimate  by their subse-
 quent marriage.  In England the offspring is illegitimate, whether
 the parents marry or not after its birth.
   Children  born  after the  death of the wife or  husband.—It appears
 that a child born after the death of the Avife, provided she has been
 lawfully married, is legitimate, although  the marriage is dissolved
 by the death.   This  is  not a mere  hypothetical question.   Two
 cases  have already been quoted (ante, pp. 631-4), in Avhich living
 children Avere born  after the death of the women; these facts are of
 spiecial interest in  relation to tenancy by courtesy.  Whether  the
 birth  takes place by the aid of art through the outlet, or  by even-
 tration, as in the Csesarean  section, the husband, if the wife be at
 the time dead, cannot  legally claim the  estate; but the child thus
 born out of marriage is legitimate, and if it live may, on attaining
 its majority, take the estate of Avhich  the  mother Avas seised.  (See
ante, Ccesarean extraction, p. 631.)  The fact  that the  English  la\v 
NATURAL PERIOD OF GESTATION.
641
disregards the time, place, or date  of conception  might therefore
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 Cesarean  operation  after the death of the mother; hence it
would  neither be  begotten nor born in wedlock; and yet, accordino;
to the  principles of the  English law, it Avould be the legitimate
offspring of the marriage.
  It sometimes happens that a child is born after  the death of the
husband.  Conception is assumed to have taken place during wed-
lock: and although the child is not born in Avedlock,the presump-
tion is  in favor of ligitimacy, unless  non-access or physical inca-
pacity  be distinctly proved.  The legal questions  which may arise
under such circumstances are elsewhere considered.
  Natural period of gestation.  Duration from  one intercourse.—The
first point to be considered is—What is the natural period of ges-
tation, and  Avhether this  is fixed  or  variable.  According to the
testimony of experienced accoucheurs, the average duration of ges-
tation  in the human female is comprised  betAveen the thirty-eighth
and fortieth weeks after conception.  Numerous facts show that the
greater number of children are  naturally born between these two
periods.  Out  of 186 cases reported  by Dr. Alurphy, the  greater
number of deliveries took place on the  285th  day (" Obstetric  Re-
ports," 1844); but his opinion is that 301 days may be taken as the
average limit of gestation.   ("Lancet,"  Nov. 11, 1844,  p. 284.)
Dr. Blundell considered that the average period Avas 274 days; Sir
J. Simpson (Bromwick v.  Waters,  Chester Lent  Assizes,  1863, p.
S25) 277 days, i. e. nine  calendar months  and a w-eek;  and other
accoucheurs of  repute  have  fixed upon  280 days.  Among  500
cases observed by the late  Dr. Reid, there were 283 in which the
period  of gestation was within 280  days, and 217 cases in Avhich it
went beyond this period.   Dr. Duncan  found, in a group of  forty-
six  cases, that 275 days is the average interval between that which
he terms " insemination " (intercourse) and  parturition.  The largest
number of cases on any particular day AA7as seven on the 274th day.
("■ Edin. Alonthly Journal," 1854, vol. 9, p.  230.) The most common
cause of this variation in time is, that the usual  mode of  calcula-
tion, by reference to the suppression of the menstrual discharge.
even in a healthy female, may lead  to a possible error of tAvo, three
or even four Aveeks, since there is no sign Avhereby, in the majority
of Avomen, the actual time  of conception can be determined.  Some
females have been able to determine, by pieculiar sensations, the time
at which they-  have conceived ; but  as a general rule, this  must be
a matter of pure conjecture, when they  are living in connubial
intercourse.
  On the other  hand, accidental and isolated cases have clearly-
proved  that a great difference naturally exists  among Avomen Avith
respect  to the period of gestation ; and  it is probable that in no
tAvo  is  it necessarily the same.   AVhen there has been only  one
intercourse, the duration  of pregnancy may be certainly calculated
without reference  to any changes in the female constitution: for
      41 
642        AVERAGE  DURATION  OF  GESTATION.

the date of conception, within certain  limits to be presently men-
tioned,  Avould be  fixed.  Observations  of this kind  have shoAvn
that women have differed from each other; and in several instances
the time has exceeded or fallen short of the period of  forty Aveeks,
which has been usually set down as the  legal limit of natural
gestation.  In three cases of one intercourse knoAvn  to the late Dr.
Rigby, labor came on in 260, 264, and 276 days, making a  differ-
ence of sixteen days.  (" Aled. Times," March 14, 1846, p. 471.)  In
three other instances Avhich w-ere privately communicated to me
by Dr. S. W. J.  Alerriman, labor commenced  at 281, 283, and 286
days  respectively  after one intercourse;  and in  a case Avhich
occurred to Dr. Reicl, the labor  did not commence  until after the
lapse of  293 days  from a single intercourse.  (" Lancet," July 20,
1850, p. 79.)   In another case accurately observed,  communicated
to me in March, 1865, the gestation lasted 281 days.  Alenstruation
had ceased on the 16th Sept., intercourse took place on the 20th,
quickening occurred  on the 23d  January  folloAving, and a full-
grown male child Avas  born on the 28th June folloAving.  In tAA7o
cases, for Avhich I am indebted to the late  Air. Carrington, the
females w-ere delivered  respectively in  249 and 260 days after a
single intercourse.  In a third,  in Avhich pregnancy Avas the result
of a  rape,  there was an interval  of 261 days  betAveen intercourse
and  delivery.  Hence  it will be  perceived that  in well-observed
cases, Avhere there could  be no motive for misstatement, and in
Avhich the characters of the women, some  of Avhom were married
and had already  borne children, Avere 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 reported by Dr. Reid.  This is worthy of remark, because
in one case (Luscombe v. Pettyjohn), it was held that 299 days, only
six days longer than in Dr. Reid's observation, was an  impossible
period for human  gestation!  In addition to the above facts, show-
ing  the  variability of  the  period after a  single intercourse, the
following may be  cited.  Dr. Alacilwain, U. S., has reported a case
of gestation, Avhich he thinks must have  extended to 296 or at
least 293 days.   ("Amer. Journ. Med. Sci."  July,  1848.)  I am
indebted to my colleague, Dr. Oldham, for nine cases, which have
fallen under his observation, in which the duration of pregnancy
from a single intercourse Avas accurately observed:—
     Case.               Days.          Case.               Davs.
      1  ....  266             6   ....  281
      2  ....  268            7   ....  283
      3  ....  271             8   ....  284
      4  ....  280             9   ....  285
      3  .    .   .   .280

  It is to be observed of these cases that Nos. 4, 5, and 6 represent
the periods of gestation in the same Avoman at different times.  Dr.
Lockwood has published the following as the result of his experi-
ence.  The actual duration of the term of gestation in the human
subject,  i. e.,  the  interval between  intercourse and delivery,  was 
CAUSE  OF  THE VARIATIONS.
643
ascertained by him in  four cases :  No. 1, aged 19, duration  272
days (first confinement);  No. 2, aged 30 (first confinement), dura-
tion  276 days ; No. 3, aged 17, duration 270 days; No. 4, aged 44
(seventh confinement), duration 284 days, the child Aveighing four-
teen  pounds.   (" Brit. Amer. Jour." Dec. 1847, p. 214.)  Af. "Devil-
Hers  has also published the  particulars of nine cases, in which the
interval from a single  intercourse  was  accurately determined.
Delivery took place at the  following; periods: 229, 246,257, 267 301
276-281, 278-283, 270, and  266-272 days, making an  extreme
difference  of  49  days  in the earliest and the latest periods betAveen
intercourse and delivery.  (" Gaz. AlCd." Alars 4, 1848.)
  Out of thirty  cases of single or Avell-defined coitus, collected by
Ahlfeld, gestation varied  from 233 days to  one case of 313 days.
The  average of all Avas 269.17, Avhich corresponds closely  with the
period obtained  by other modes  of  observation.   ("Amer.  Jour
Med. Sci." Oct. 1870,  p. 566.)
  Cause, of the variations.—It appears probable from recent researches,
that the duration of the  pregnant state may be dependent on  the
relath7e excitability of the uterine system at the menstrual periods.
Numerous facts  tend to show that, notwithstanding  the general
suppression of the menses, there is great excitement of the uterine
system  at what would have been,  in the unimpregnated state, the
regular  menstrual periods.  There is also  great reason to believe
that abortion takes place  more readily at  these, than  at  other
periods.  Hence, some accoucheurs are inclined to consider that the
duration of pregnancy is really a multiple of  the menstrual period;
and  that in the  majority of women  it Avill  occur at what Avould
have been  the tenth  menstrual period,  or forty Aveeks from  the
date of  intercourse and  supposed conception (" Gaz. Aledicale,  4
Decembre, 1847, p. 968);  and, according to  the degree of excite-
ment of the uterine system, the child may  be expelled at  a period
earlier, or a pieriod later than that which  is  assigned as  the more
usual natural  term.
  It  has been suppiosed that  cases of lengthened  gestation were
nothing more than instances of protracted parturition: the pains
indicative of  delivery commencing at the usual time, but continu-
ing more or less at intervals over a much longer period than usual.
In an instance mentioned  by Dr. Jorg, a Avoman Avent her full time,
but piarturition lasted a fortnight  longer, the symptoms appearing
and then disappearing.  Admitting that this occasionally  happens,
still  it  shoAvs  that gestation from a particular  pregnancy may be
protracted considerably beyond the ordinary period.
  There is no' reason to belie\7e that the sex of the child has any
direct influence on the length of the pregnancy.  It has been stated
that  gestation Avas longer with male than female children ; and
evidence of this kind Avas actually tendered  in the Gardner Peerage
ease.   As  an  ansAver  to  this  singular hypothesis, it may be  ob-
served that of Dr. Alurphy's two  protracted  cases, the one was  a
female, and the other  a male child.
  There is reason to believe that the date of conception after a single 
644
DATE  OF CONCEPTION.
intercourse varies in different women, and in the same woman.  It
is customary for physiologists to date conception from intercourse:
but the researches of Bischoff and  Raciborski have shown that a
variable interval may elaptse, according to the situation of the ovum
at the time.  It has also been supposed that Avomen conceive more
readily at some periods than at others, and that intercourse  had
within eight to tAvelve days from  the cessation of the menstrual
discharge, is more favorable to conception than at any other period.
Dr. Oldham met with a case in Avhich  impregnation took place
tAvelve days after  menstruation; and he states that he has known
it to  occur at  the respective times of ten clays, twelve days, and
even  twenty-one days after the  monthly period ; and he knoAvs of
no fact  to disprove the opinion that the human female is suscepti-
ble of impregnation at  any time between her monthly periods.
According  to Dr. Duncan, a single  insemination at  any period of
the interval between two menstrual periods may result in fecunda-
tion.  (" Edin. Afonthly Journal," 1854, vol. 9, p. 233.)
  The experience  of Dr. Oldham is confirmed by that of the late
Dr. Reid.  This gentleman admits that impregnation is more likely
to occur immediately after the termination of a menstrual period
than at any time during the interval.  The next most likely period
is immediately  previous to the occurrence of menstruation, and the
probability of conception becomes slighter as the time is more dis-
tant from this epoch; but there is no pieriod in the menstrual inter-
val at which impregnation may not occur.  ("Lancet,"  Sept. 3,
1853.)  According to Raciborski, from observations made in Paris
on one hundred women, no more than six or  seven had become
impregnated at the mid-term  from the menstrual  periods.    In
several cases of single  intercourse, the dates being certain, concep-
tion took place twelve and fourteen days after menstruation.  It
may be therefore fairly taken as a fact, irrespective of any modern
theories of ovulation, that a woman may conceive from intercourse
had  at  the inter-menstrual  pieriod (mid-period), although,  in a
given number  of  instances, it is probable that the conceptions
Avould be more numerous Avithin six or seven days after the cessa-
tion of the  menses than at any other time.
  In these cases it is assumed  that  intercourse and  conception are
synchronous, but recent physiological researches have proved that
the date of conception is not fixed by the date of intercourse.  The
time occupied by the descent of the  ovum along the Fallopian tube
varies, Avhile the time required for the passage  of the male fluid to
meet the ovum  is  also subject to variation.  The investigations of
Bischoff and Valentin  show that the spermatozoa may retain their
movements, and probably their fecundating power, for so long a
period as seven days within the  bod}- of  a female.  Fecundation
cannot result unless the matured ovum meets these bodies in a living
condition ;  and conception may be regarded, in the language of Dr.
Meigs, as the fixation of a fecundated ovum upon the living surface
of the woman.  Conception may, therefore take place either in a few
hours, or, according to ATalentin's obserA-ations, at so long a pieriod 
PREMATURE  BIRTHS.
645
as seven days, after intercourse.  But they do not satisfactorily ex-
plain such extreme differences as Avere observed in the cases of Dr.
Rigby and Dr. Reid (thirty-three days), or in those of M. Devilliers
(forty-nine days)—ante p. 643.   We must therefore be prepared to
admit, either that conception may in some cases be delayed for so
long a period as from five to seven weeks after intercourse, or that
there may be a difference of from five to seven weeks  in the dura-
tion of pregnancy.   Whatever may be the explanation adopted, it
is obvious that, in a medico-legal vieAv, the only conclusion at which
Ave  can arrive is, that the period of gestation in Avoman is not,as it
Avas formerly supposed to be, a fixed and invariable term.
  Great mistakes have arisen in the calculation of the period by the
use of the word  " month"—some  intending by this a lunar and
others a calendar month.   Nine lunar months would be equal to 252
days, Avhile the average of nine calendar months Avould be 270 days
—the latter period A7arying according to the particular months of the
year over Avhich the pregnancy might extend. To prevent mistakes,
or that misunderstanding of evidence which has so frequently arisen,
it Avould be advisable that medical witnesses should always express
the period of gestation in weeks or days,  concerning which there
can be no misunderstanding:  it would be also proper to adopt the
plan of always commencing the calculation from the period of the
last cessation of the menses, rather than from two weeks later.  The
latter rule is often followed, and this discrepancy is another cause of
confusion.
  Premature births.   Short periods of gestation.—From the preceding
remarks, Ave may  regard all births before the thirty-eighth week as
premature, and all those  which occur after the fortieth Aveek as
protracted cases;  and one great point for a medical witness to de-
termine is, whether  the  external characters presented by  a child
correspond to those  which  it  should present, supposing it  to be
legitimately born.  AVhen the birth is premature, this sort of cor-
roborative evidence may be sometimes obtained ; because, assuming
that there has been no access between the parties before marriage,
children  born at the fifth or sixth month after marriage cannot, if
the offspring  of the  husband,  present the characters of  those  born
at the full period.  It is  not so with protracted births, for children
are  not more  developed in protracted cases  than  they are in  those
which occur at the usual period.  This Avould lead to the  infer-
ence that AA7hen a child  has reached a certain stage  of develop-
ment it ceases to groAv;  a vieAv which is borne out by the observa-
tions of  Dr.  Riittel.   (Henke's " Zeitschrift," 1844, p.  247.)   This
gentleman observed that the size of a  child did not increase in pro-
portion to the length of gestation.  In protracted  human and ani-
mal gestation, the offspring  is not remarkable for size and weight.
Thus robust mothers have had  small children, and  small mothers
strong, and sometimes unusually large children.  Dr. Aturphy states
that he met with  a fully-developed child which was born  after a
gestation of only 251 days. (" Lancet," Nov. 30,1844, p. 284.) For 
646
SHORT  PERIODS  OF  GESTATION.
an account of the characters presented by children at different uterine
ages, see Infanticide (p. 550).
  Development of the child.—In judging from marks of development
on the body of a child, as a test of uterine age, we must make full
allowance for the  exceptions to which they are  liable.  The nearer
the supposed premature delivery approaches  to the full  period of
gestation, the  more difficult will be the formation of an opinion.
Although the  characters of a seven-months' child as a general rule,
are usually Avell marked, and  may be knoAvn by common observa-
tion, it is not possible to distinguish with absolute certainty a child
born at the eighth from one born at the ninth month.  Burns ob-
serves that gestation may be completed, and the child  perfected to
its natural size, a  week or two sooner  than the end of the ninth
month; and other accoucheurs corroborate this view.  (Dr. Alurphy,
in " Lancet," Nov. 30, 1844, p. 284.)
  When, however, the facts are such that to be the offspring of the
husband it must be a six-months' child, and it is born mature, there
can be no reason to doubt that it is illegitimate. (Eager v. Grim-
wood, Exchequer Sittings, Jan. 7, 1847.)  But the fact that a child
born  at nine  months is small and resembles in size and Aveight a
seven or eight-months' child, cannot be taken as a medical proof of
illegitimacy.  Children born at the full period vary7 considerably in
size and weight; yet, although small, there  is commonly about
them an appearance of development, which is especially apparent in
the features.  If there be a general want of development in the body,
and if certain fcetal peculiarities remain ; as, for example, the mera-
branse pupillares, or, in the male, the testes do not occupy the scro-
tum ; these facts  lead to a strong presumption that the  child has
not reached the full period.  On the other hand, when a child  is
born with the full signs of maturity about  it, at or under  seven
months from  piossible  access of the husband, there is an equally
strong presumption that it is  illegitimate.  The great progressive
stage of development is considered to be during the last tAvo months
of gestation; the changes Avhich the foetus undergoes are greater and
more marked  at this than at any other time.  The general opinion
is that an eight-months' child is not with any certainty to be dis-
tinguished from one born at the ninth month.  If the  body of a
child is large  and fully developed, it would  be considered to have
been born at  the full  period  of gestation, and  any opinion which
had led to the supposition that it was a seven-months' child, would
be attributed  to some mistake in the  calculation.  Dr. Beck states
it as barely possible that a child born at seven months may occasion-
ally be of such a size as  to be considered mature, yet he qualifies
this statement by the remark, that the assertion is most frequently
made  by those whose character is in danger  of being destroyed.
The important medical  question is, however, has a really seven-
months' child ever been born so developed as to be mistaken by an
experienced person for one that was mature ?   He adduces no case
of this kind in support of his opinion.  There can be no doubt of
the correctness of his statement that a mature child, born before seven 
EARLIEST  VIABILITY OF CHILDREN.         647
full months after intercourse, ought to be considered  illegitimate;
but it Avould be difficult to maintain this proposition consistently
with the above admission,for there is no obvious reason why a child
should not acquire premature development during the latter half
of the sixth, as Avell as at the seventh month.
   Viability.—The fact that a child has had the strength to survive
its birth for a certain period  has been supposed  to  furnish  addi-
tional evidence of maturity; for it is well known  that  under a
certain age children are not born living, or, if living, they speedily
die.  Therefore it has been argued,  if a child born at the fifth or
sixth month after the first cohabitation, be born living, or survive,
this should, ipso facto, be taken as a proof of its illegitimacy.  Ac-
cording to the  English law, it is not necessary that a child, Avhen
born, should be capable of living, or viable, in order that it should
take its civil rights.  Thus, it may  be born at an early period of
gestation: it may be immature, and not likely to survive: or, again,
it may be born at the full period of gestation, but it may be ob-
viously  laboring under some defective organization, or some mortal
disease, which  must necessarily cause its death within a short time
after its birth.   Fortunately, these points are of no importance in
relation to the  right of inheritance ;  an English medical jurist has
only to  prove that there was some well-marked physiological  sign
of life  after  birth—Avhether the child was mature  or immature,
diseased or healthy, is  a matter which  does  not at all enter into
the investigation.  In  this  respect  our  law appears to be  more
simple and just than that which prevails  in France.   By Art. 725
of the Code Napole'on, no child that  is born alive can inherit, unless
it is born, as the laAv terms it, viable.   The meaning  of this  Avord
is not defined by the law itself, and there are probably no two laAV-
yers or  physicians  in that country Avho place upion it the  same
interpretation.   The French laAV seems to intend (Devergie, vol. 1,
p. 700;  Briand, p.  173) by viability in a ne\v-born  child, that it
should have breathed and be capable of living out of the womb of
its mother and  independently of her; also, that it should be capable
of living for a longer or shorter  period after its birth.  It Avould be
difficult for any system of jurisprudence to lay doAvn a more vague
or incorrect principle than this; and medical Avitnesses may con-
sider themselves fortunate that  in this country they  have not to
take part in the unsatisfactory litigation to which such a principle
must necessarily give rise.
  The question, therefore, to be  considered is—What is the earliest
period of uterine life at Avhich a  healthily-formed child can be born
living, and Avith a capacity to live after its birth and to attain ma-
turity?   It is iioav 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, hoAvever, very much against their surviving. It Avas the opinion
of Dr. William  Hunter, and it is one in Avhich most modern authori-
ties concur, that fe\v children born before seven calendar months (or 
648
EARLY VIABILITY.
210 days) are capable of living to manhood.   They may be born
alive at any period betAA-een 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.," vol. 2, p. 236); and
another in AA7hich a  woman aborted  at the fourth-and-a-half month
of pregnancy.  AI. Alaisonneuve saw the woman tAvo hours  after
delivery : he then found  the foetus in its membranes, and on laying
these op>en, to his surprise it was still moving.  He applied Avarmth,
and succeeded in p>artially restoring it; for in a few minutes the
respiratory movements w-ere performed with regularity, but in  spite
of the establishment of respiration, the child died about six hours
after its birth.  (" Journal de Aledecine," and Aled. Gaz.," vol. 39,
p. 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 (" Aled. Gaz.," vol. 40, p. 1022);
and the  folloAving  case,  in which a child  born at the fifth month
survived upwards of tAvelve  hours, occurred  to Air. Smj-the.  A
female in her second pregnancy, and in the 147th day of gestation,
had severe flooding with rupture of the membranes.  Labor oc-
curred on the following night, Avhen a small but well-formed foetus
Avas expelled, giving no other  indication of life than a feeble action
of the  heart, and a  strong pulsation in the  umbilical cord.   It was
resuscitated, and cried as strongly as a child born at the full  period
of pregnancy.  It weighed less than two pounds, and measured ex-
actly twelve inches.  It SAvallowed some  nourishment, but  died
about twelve hours after birth.  The membranse pupillares  were
entire—the testicles had not descended—the head was well covered
with hair.   The length and Aveight, as well as the presence of hair,
indicated a foetus between the sixth and seventh months;  but, as
it is asserted that the period of gestation is accurately given, this
must be regarded as an extraordinary instance of pireniature devel-
opment.  There was clearly  nothing  in the  organization of this
child to have prevented  its groAving to the age of maturity—in
other words,  it was viable.   ("Med. Chir. Rev.," July, 1844,  p.
266.)
   In November, 1865, Air. Carter communicated to me the partic-
ulars of a case in Avhich a child was born living at the fifth month
of gestation.  It cried slightly when it Avas born, and during the
half hour that it was kepyt unsevered from  its  mother  it made fre-
quent efforts to breathe.  It was perfectly formed.  It was about
one foot in length,  and its weight was fully one pound and a quar-
ter.  It died soon after it Avas born.   A case is  reported, in Avhich
a child born at five-and-a-half months survived its birth between
three and four hours ("Med. Gaz.," vol. 19, p. 165);  and on a trial
for child-murder (Reg. v. West, Nottingham Lent Assizes, 1848), a
midAvife was indicted for causing the death of a child by bringing
about the premature delivery of the mother, when she Avas between
the fifth and sixth months of pregnancy.  The child in this instance 
EARLY VIABILITY.
649
   lived five hours after its birth.  Capuron mentions  an instance  in
   which a child Avas born at the sixth-and-a-half month of pregnancy,
   and at the time he reported the case it Avas two years old, and en-
   joyed excellent  health.  In another instance a child was born  at
   the same period, and lived to the  age  of ten years.   (" Aled. Leg.
   des Ace.,"  pp.  162,  208.)  In  a  case which fell under  my own
   knowledge, a child Avas born at the sixth-and-a-half month of ges-
   tation, and lived a fortnight.  (See another case, " Aled. Gaz.," vol.
   32, p. 623.)  Capuron considers that a child born at the 180th day,
   or at the sixth month after conception, may be sufficiently mature
   to live, i. e., that there would be no reason to presume it was illegiti-
   mate, nierelj7 because it survived its premature birth.  On the other
   hand, if born before the sixth  month, with sufficient maturity to
   live, this fact, although by no means a proof, affords, in his opinion,
   a strong presumption of its illegitimacy.  Of eight cases of children
   born living (by abortion) at the sixth month, Air. Whitehead states
   that seven perished Avithin six hours  after birth,  and  one only
   attained to the age of ten days.  (" On Abortion," p. 249.)
     Dr. Ruttel, avIio has examined the subject Avith great care, states,
   as the result of his experience,  that he attended a married woman,
   who Avas afterwards delivered of a living child in the fifth month of
   her pregnancy ; the child survived its birth for tAventy-four hours.
   He delivered another woman of  twins, in the sixth month of her preg-
   nancy ; one was dead, and the other continued alive for three hours,
   its life being indicated only by the visible pulsation  of the heart,
   but there Avas no perceptible respiration.  This fact corroborates the
   remarks made elsewhere, as to life without active  respiration (In-
   fanticide, p. 554); it has also  an immediate bearing on the proof
I   of life in reference to tenancy by courtesy (p. 628).  In another in-
   stance of the birth of male twins, at the sixth month, each weighed
   three pounds.  Dr. Ruttel saw  them a year after their birth, and_
   they Avere  then tAvo healthy strong children. (Henke's " Zeitschrift'
   der S. A.," 1844, p. 241.)  Dr. Barker,  of Dumfries, met with a case,
   in which a female child was born  at the 158th day  of gestation, or
   twenty-two Aveeks and four days after  intercourse.   The size and
   Aveight of  the child corresponded  with the period at which it was
   born: it Aveighed one pound, and  measured eleven inches.  It had
   only rudimentary nails, and very little hair on the back of the head ;
   the eyelids were closed, and remained  closed, until the second day ;
   the nails Avere 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 AA-as nineteen months old. AVhen born, the child
   was wrapped up and  placed in a box before the fire.  Three and a
   half years afterwards, this child  was in a thriving state and healthy,
   but of small make;  she weighed twenty-nine  pounds and a half.
   (" Aled. Times," Sept. 1850, p.^259 ; also Oct. 12, p. 392.)  Mr. Annan,
   surgeon, of Kinross, has recorded a case in which a child was born
   between the end of the sixth and the middle of the seventh month,
   and lived for a period of four months and eight days ; it weighed
   a  pound and a half when seven days old.  (" Med. Times," Sept. 9, 
650
PROTRACTED  BIRTHS.
 1848, p. 304.)  In a case Avhich occurred to Dr. Outrepont of Bam-
 berg (reported  in  Henke's  " Zeitschrift," vol.  6), there was  the
 strongest reason to believe that gestation could not have exceeded
 twenty-seven weeks.  The child (a male) weighed, when born,  one
 pound  and' a half, and measured  thirteen and a half inches. The
 skin was covered Avith doAvn  and  much wrinkled—the limbs were
 small—the nails appeared like white folds of skin, and the testicles
 had not  descended.   It breathed as soon  as  it was born, and by
 great care its  life  was preserved.   It is singular that its develop-
 ment Avas very slow  until it had reached a  period which Avould
 have corresponded  to the  forty-second week of  gestation.   Dr.
 Outrepont saAv the  child Avhen he had  attained the age of eleven
 years, and then he appeared to be of the size of a boy of eight years.
 The only remarkable  point  about the case is the length of time
 which  the child lived.  In a case quoted in the " Lancet," Aug. 23,
 1851, p. 177), a child born at  six months and ten days Avas thriving
 satisfactorily when four months  old.   (See  also  " Aled. Times,"
 Feb. 16, 1850,  p. 129.)
   Hence it may be considered as established that children born at
 the seventh,^and even at or about the sixth month, may be reared,
 and that the fact of their surviving for months or years cannot be
 taken  as evidence of  illegitimacy7.  In  forming our judgment on
 these occasions, Ave  are bound to look less at the period  at Avhich a
 child is born,  than at the  marks of development about the body.
 The case reported by Air. Smythe, p. 648, is corroborative of this
 vieAv.   Dr. Bonnar has recently published a tabulated view of 112
 cases of premature  births of living children—the dates of gestation
 extending from the 120th to the 210th day. Among these cases 35
 children died Avithin  the first twenty-four hours ; 13 more before
 the completion of one week; 1 in six weeks; 4 in four months. The
 folloAving lh7ed, or Avere living at the date of the report; 1, seven and
*a half months; 8, from one to two years; 1, three and a  half years;
 5, from ten to  fifteen years; 6, to adult age; 5 lived not stated how
 long.   ("Critical Inquiry- regarding Supierfcetation," 1865, p. 13.)
   Protracted births.  Long periods of gestation.—The questions con-
 nected  with  retarded gestation have given rise to considerable dis-
 cussion in legal medicine.   That gestation may be retarded or pro-
 tracted beyond the fortieth Aveek  is now, I believe, not disputed by
 any obstetric writer of reputation.  Some accoucheurs haAre denied
 it, because they have not met with such cases; but the medico-legal
 relations of such questions do not depend upon  the solitary expe-
 rience  of practitioners.  It  is only by  the accumulation of well-
 ascertained facts from all authentic sources that medical knowledge
 can be  made available for the purposes of the laAV; otherwise, OAving
 to the  mere accident of a witness not having  met Avith any excep-
 tional  instance, a court may be entirely misled in its judgment by
 trusting to his opinion.  It is the more important to attend to this,
 because most of the cases  involving questions either of contested
 legitimacy, or the chastity of females, turn upion protracted rather
 than upon premature  delivery. 
              LONG PERIODS OF GESTATION.           651

  In standard works on Alhhvifery will be found authentic reports
of cases m Avhich gestation continued to the forty-first, forty-second,
forty-third, and even to the forty-fourth week.  Dr. Alurphy regards
"01  days, or forty-three Aveeks, as the average limit of gestation.
(u Obstetric Report," p. 4.)  Dr. Lee met Avith a case in which  he
had no doubt that the pregnancy lasted 287 days ; the labor did not
take place  until forty-one weeks after the departure of the husband
to the West  Indies.  ("Aled. Gaz.," vol. 31, p. 917.)  Dr. AVilliam
Hunter met  Avith two instances  in  Avhich gestation Avas protracted
until  the  forty-second week.  Dr. Montgomery  met with a case in
which delivery did not ensue until betAveen the forty-second and
forty-fourth  weeks.  (" Aled. Gaz.," vol. 19, p. 646.)  Dr. Aierriman
has published a valuable table on the subject of protracted gestation,
on Avhich the most experienced accoucheurs have been in the habit
of relying.  Of 114  pregnancies, calculated by him from the last
day at which the females menstruated, and in Avhich children ap-
peared to be mature, the following were the periods:—
In the 37th week   .    .   .       3 i In the 41st week    .   .    .    .22
  "  38th  "   .    .   .    .  13 I   "  42d  "     .   .    .    .  13
  "  39th  "   .    .   .    .  14   "  43d  "     .   .    .    .10
  "  40th  "   .    .   .    .  33 I   "  44th "     ....   4
  Another well-marked case, occurring forty-four weeks  precisely
after the cessation  of the menses, has been communicated to me by
Dr. S. AV.  J. Aierriman.
  From these  results, Dr. Merriman considers that  in the greater
number of Avomen  gestation is completed in the fortieth Aveek from •
the cessation of the menses, and next to this pieriod, in the forty-first.
In the evidence given by7 this gentleman in the Gardner Peerage case
before the House of Lords in 1825, the case of longest protraction
on Avhich  he was  able to rely Avas that of a married woman, Avho
Avas in the habit of calculating from the last  day on  which  her
monthly period ceased.  This lady Avas delivered 309 days, or forty-
four Aveeks and one day, from the time at which she supposed that
she had conceived.   In another case mentioned by the witness  the
period Avas 303 days, or forty-three weeks and two days  from  the
termination  of the last monthly pieriod.  It was objected to this
evidence, by the Attorney-General, that it was  impossible to fix
the exact date  of conception, and, as the female  might have really
conceived  only a day or  tAvo before the expected return of men-
struation,  twenty-eight days (or four  weeks)  should be deducted
from the periods assigned by the Avitness.   Admitting the validity
of this objection—and the fact upon Avhich it is  based is indispu-
table—it folloAved that the longest  protracted case observed by  Dr.
Merriman  might have really been only a case of  ordinary gestation
extending  to "forty  Aveeks and one day.  An objection of this kind
may of course  be successfully urged in law to any inference from a
calculation so made, and it Avas thus  in the Gardner Peerage case, the
medical  evidence failed to render it certain that gestation might be
so protracted as to  support the legitimacy of the claimant: namely 
652         CASES OF PROTRACTED  GESTATION.

to 311 days, or forty-four Aveeks and three days.  Hence, in consi-
dering this question, it is necessary to make full allowance for such
a cause of error; and, in calculating the pregnancy from  the last
day of the last menstrual period, we should deduct the interval of
menstruation, if known, and at least twenty-eight days if unknoAvn.
In these cases of contested legitimacy, the offspring is commonly
the result of  a single intercourse, hence the  date of conception is
fixed Avithin  limits already described (p. 641): and  a comparison
can be instituted  only betAveen the period  of  gestation thence
deduced, and the periods taken in  other cases which are equally
free from error.
  A Avell-marked case of gestation passing  beyond  what is com-
monly set down as the average period was communicated to me by
Mr. Howell, of Walton-on-Naze.   This occurred  in a healthy
woman, aged 30, who  had borne three children, the youngest being
4 years old.  She had menstruated with regularity up to the third
week  in June:  the menses then  stopped without  any apparent
cause.  Her delivery took place 323 days after their last appearance.
Allowing that impregnation occurred at the intermenstrual period,
this Avould make the gestation 309 days; or assuming that impreg-
nation did not occur until twenty-eight days from the date of the
last menstruation, this Avould make the period 295  days, or forty-
two Aveeks and one  day.
  A case is reported by Dr. Power in his work on " Human Preg-
nancy," in which gestation is said  to have extended to 325 days.
Mr. ChattaAvay of Knighton, a former  pupil, communicated to me
the following instance of protracted gestation.  A healthy woman,
set. 36, the wife of a farmer, applied to  him to attend her in her
confinement,  which she expected to take place in September, 1856.
The menses appeared  for the last time  in December, 1855, and she
quickened in the beginning of April, 1856.   About the middle of
September (i. e. on  the 283d day, dating  from the last menstrua-
tion), Air. Chattaway  Avas summoned to attend her, and he found
her laboring under severe false pains;  there was also a discharge
of mucus tinged with blood.  The  case Avent on until  the 19th
November, 1856, when the patient was delivered of a female child
of the average size.   It would thus appear, according to the ordi-
nary mode of calculation, that deducting twenty-eight days from
the last appearance  of the menses,  gestation Avas protracted in this
instance to 330 days, or forty-seven weeks and one day.
  Protracted cases of gestation are always open to the objection that
the menstrual function may have been suspended from some hidden
morbid cause, one or two months before the actual date of concep-
tion, and that there may have been some error in the calculation by
which the period has  been determined.  If, however, the objection
is admitted under  these circumstances, it would be only equally
just to admit that in any given case the ordinary and so-called fixed
pieriod, also calculated from the cessation of menstruation, is based
on a fallacy.  The menstrual function may have accidentally ceased,
or continued for several intervals after conception, and thus a cor- 
            CASES OF PROTRACTED  GESTATION.         653

responding change should be made in fixing the ordinary period of
(Testation.  This vieAv of the question implies that no reliance can
he placed on the date of the cessation of the menses as evidence of
the actual duration of pregnancy, Avhether natural, premature, or
protracted.   Aly colleague Dr. Hicks informs me that he met with a
case in Avhich the pregnancy of a woman appeared to be protracted
to betAveen tAvelve and thirteen months.   There was every reason to
believe that this woman became pregnant during the absence of the
menses, and  that these  had been suspended some time before the
intercourse took place.   This is  no doubt the explanation of a large
number of cases of alleged  protracted gestation.
  It is, however, difficult to admit that all the protracted cases re-
corded by different observers have depended upon  mistakes being
made  in the  calculation of the period, since this calculation is based
on the same principles as those  adopted in cases of ordinary preg-
nancy.  Hence, if there is a mistake  in the one case,  there would
be in the other;  if an  error in the  exception, there Avould be an
error in the rule.  Either the average term of pregnane)7 is Avrongly
calculated  by most accoucheurs  at  the thirty-eighth or  fortieth
week, or it is rightly calculated to extend occasionally  to the forty-
fourth, or, admitting these protracted cases, to the forty-sixth Aveek.
But, even setting aside the  obvious answer to  an objection of this
nature, some of  the protracted cases observed  Avere  instances  of
impregnation from a  single intercourse;  and, making due allow-
ance for the interval for conception, the general inference would
not be affected, and no fallacy could  have arisen in these  cases of
protraction, from mistakes dependent on the cessation of menstrua-
tion.
  The late Dr. Reid's conclusions, derived from numerous facts and
cases, represent the views of an experienced observer on this much-
disputed question.  They are—" 1.  The duration of pregnancy  is
not altogether a fixed period; it varies someAvhat in the human
female, as it  does in the lower orders of animals.  2.  This devia-
tion, however, is not to any great extent;  the only certain data of
calculation are those dependent on the known  time of conception (of
Intercourse ?).  3. The average duration of the pregnant state, Avhen
calculated  from  this  event, is  about 275 days, or it  may have a
range  of from 270 to 280 days.   4.  There is no  full or satisfactory
evidence of  gestation having  been  prolonged beyond 293  days.
5.  The Code Napoleon, which allows 300 days, may be regarded  as
liberal. 6.  The menstrual period must generally serve as our guide
in default of some exact knoAvledge;  it is, hoAvever, often fallacious,
and is only  a  means of approximation to the probable  time  of
parturition.  7.  The fortieth Aveek after the last appearance of the
menses is the most-likely period, and the forty-first week the next."
  Dr.  Duncan  ("Edin.  Monthly Journal," 1854,  vol. 9, p.  230)
dniAvs  the  following conclusions regarding the duration of preg-
nancy :  1. That the interval betAveen conception and parturition
(the real duration of pregnancy) has not been exactly ascertained.
in any case.  2.  That  the average interval  betAveen insemination 
651
DURATION OF GESTATION.
(intercourse) and  parturition  (commonly called the duration of
pregnancy)  is 275 days.  3. That  the average intervals between
the end of menstruation and parturition have no standard length,
but vary within certain limits.  4. That while  absolute proof of
the prolongation of real pregnancy beyond its usual limits is still
deficient, there is evidence to establish the probability that it may
be protracted  beyond such  limits  to  the extent of three, or even
four Aveeks.
  It will be perceived  from the conclusions drawn by Dr. Reid,
that he admits a variation of 23  days, i. e., from  270 days (the
shortest pieriod) to 293 days, the longest knoAvn to himself from a
single intercourse.  There appears  to be  no valid reason why the
variation  should  not be even greater than  that  which  is here
assigned, and  why the  duration of pregnancy might  not extend
occasionally to 296 and  even 301 days.  It is merely a question of
individual  experience.   An accoucheur Avho admitted  a variation
of 23 days, and av!io had knoAvn gestation to be protracted to the
293d after intercourse, would hesitate to pronounce a child illegiti-
mate merely because it  had been born on the 296th or the  300th
day7 after possible access  of the husband. There is no doubt a limit
to gestation, but it  is  not  in our poAver to fix it;  hence Ave find
obstetric writers of repute adopting periods  Avhich  have no point
of agreement  among themselves.   Some  stop short at 280  days;
others, like Dr. Reid, fix  the maximum yet knoAvn at 293  days;
Dr. Afurpliy alloAvs from his experience at least 324  days; and Dr.
Aleigs considers that gestation may be continued to twelve months,
or 365 days. (" Obstetrics, the Science and the Art," 1849, p. 194.)
The fact is, the term has not yet been  fixed even  approximately by
medical science; hence, it is  a disputed case, other circumstances
must be looked to in order to lead a court of law to a safe decision.
It is at present hopeless  to  reconcile the  conflicting medical opin-
ions Avhich  exist  on  the subject of the duration of pregnancy in
the human female.  There  is, indeed, only one point on which all
modern observers  agree—namely, that the period cannot be limited
to a fixed and  invariable number  of  days or weeks but that it is
liable to variation according to circumstances not fully understood.
   It has been elsewhere observed that the date of intercourse does
not furnish us with the date of conception ; and according to some
authorities all evidence  connected with the function of menstruation
is untrustworthy.  In spite of these objections, the menstrual period
must generally serve as a guide in default of more certain criteria.
It is, however, a curious fact, and one which the mind  of an acute
lawyer will not fail to appreciate, that the date of the cessation of
the  menses is taken by some physicians as a guide (in married life
with constant intercourse), so long as gestation does  not extend
beyond  280 days;  while, supposing it to extend to  300 days, they
will assume that  some other cause than pjregnancy must have led
to an earlier suppression, and thus to an error in the calculation!
There may be no more evidence of suppression from a morbid cause
in the one case than in  the  other, and the period of 280 days may 
       PEBI0D OF GESTATION NOT  FIXED BY LAW.    655

be as much based on error, as the period of 300 days.  It is strange
that  clever Avriters, who  adopt this  mode of making  facts square
Avith a foregone conclusion,  do not  perceive  that  they must, in
fairness, either reject altogether  the evidence derivable from  a
cessation  of the menses, or admit it adversely to their own vieAvs,
in cases in which the facts connected with the cessation have been
as carefully observed and recorded by others, as by themselves.
  Period  of gestation not fixed  by  law.—In all cases of contested
legitimacy, the question respecting the duration of gestation, Avhen
it arises, is left entirely open by the English laAV.   The French laAV,
under the " Code Napioldon," alloAvs 300 days, and the Prussian law
301 days ; but no period  has been fixed by English jurists Avithin
which, or  beyond which, a child, if born in wedlock, will be pre-
sumed to be illegitimate.  The decision of a  court of laAV would be
founded, quoad the duration of pregnancy, on the opinions of ex-
perts selected for the occasion, and each case would  be  decided on
its oavii merits.  Precedents can have but little influence on these
occasions,  because a court may think fit to pronounce illegitimate,
on non-medical grounds, a child born in the thirty-eight week of
gestation, AA7hile it may decide that another was legitimate that had
been born in the forty-third week.  By some laAV-authorities forty
weeks (or  280  days), and by others forty-three weeks (or 291 days),
have been taken as the " ultimum tempus pariendi;"  but as the
period of human gestation is wholly- independent  of legal  dicta, it
is not the  custom of courts to act upon any definite rule.   Never-
theless, it  is clear in some extreme cases that the laAV may fairly
interpose,  and  pronounce for a reasonable limit.   In the case of
Cotterall v. Cotterall (decided in the Consistory Court, July, 1847), a
child  Avas  born during the marriage, and the husband  proceeded
against the Avife for a divorce on the ground of adultery.  The main
proof AA-as  based on the fact that in order to have been the child of
the husband it must have been  born after twelve months' gestation.
Dr. Lushington, Avithout entering  into  the question of protracted
gestation, upon proof of this allegation, at once pronounced for the
divorce.  Such a duration of pregnancy is  not supported  by any
knoAvn facts, and is altogether opposed to medical probability.  In
suits of contested legitimacy the general practice consists in estab-
lishing possibility of access on the part of the husband:  when this
is proved, the medical question arises, Avhether the term of gestation
falls within the limits assigned by the best medical experience.  In
two instances, children have been  pronounced legitimate, which
were born, the one  in forty-one weeks and three days, and the other
in forty-one Aveeks and four days, after  the death of the husband.
Legitimacy has  been allowed where gestation Avas p>robably pro-
tracted to the forty-third week  (Anderton v. Gibbs,  1854).   In the
United States, a decision in favor of paternity has been made in a
case in Avhich  gestation extended  to forty-five weeks and tAvo days
{Commonwcalthv. Porter).   Legitimacy has been disallowed  in the
English Courts, although  pirobably on non-medical grounds, Avhere
it was protracted to forty-four weeks and three days (Gardner Peerage 
656
THE GARDNER PEERAGE CASE.
case, 1825);  in one  case, piaternity was denied (judicially)  because
 festation had extended to forty-two weeks and five clay7s (Luscombe v.
 rettyjohn), and in another (Dyson), because it had extended to forty-
eight weeks.
  Few trials in relation to legitimacy have excited more attention
among jurists than the Gardner Peerage  case, which came before
the House of Lords in 1825.  A full account of the medical evidence
has been pmblished by Dr. Lyall.  (" Aled. Evid. in Gardner Peer-
age case," 1827.)  Alan Legge Gardner, the son of Lord Gardner
by his second wife,  petitioned to have his name inscribed as a peer
on  the Parliament Roll.   The  peerage was, however, claimed  by
another person, Henry Fenton  Jadis alias  Gardner, who  alleged
that he was the son of Lord Gardner by his first and  subsequently
divorced wife.  It was contended  that the latter Avas illegitimate;
and in order to establish this point, the evidence adduced was partly
medical and partly moral.   The child Avhose legitimacy was  dis-
puted, was born on the 8th of December  of that year.   Therefore
the plain medical'question, taking the extreme view, was whether
a child born 311 days (forty-four weeks and three days, from January
to December), or 150 days (twenty-one weeks and three days—from
July7 to December) after possible intercourse, could be the child of
the husband, Lord Gardner.   If these questions Avere answered in
the affirmative, then it folloAved that this must have been either a
premature or protracted birth.  There Avas no pretence that  it was
a piremature case, the child having been mature when born.  The
question then Avas reduced to this—Was this alleged  protracted
gestation of 311 days consistent with medical experience?   Alany
medical witnesses, comprising the principal obstetric practitioners
in the kingdom, were examined on this poiut.  Their evidence was
conflicting, but a majority concurred  in the  opinion  that  natural
gestation might be protracted to  a period which  would certainly
cover the birth of the alleged illegitimate child.  On the moral side
of the question, it Avas clearly proved that Lady Gardner, after the
departure of her  husband, Avas living in open adulterous intercourse
with a Air. Jaclis; 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 Avas
contended that the other claimant Avas really the son of Lady Gard-
ner by Air.  Jadis. The decision of the House was that this claimant
was illegitimate, and that the title should  descend  to the son of  the
second Lady Gardner.
   The decision appears to have been chiefly based on moral  circum-
stances :  for had not the first Lady Gardner been living in adultery
at the time of her husband's departure, it is highly- probable, from
the medical evidence bearing strongly that way, that the legitimacy
of the  child Avould have been  admitted. Morally speaking,  the
decision could not be impunged, but medically speaking it assumed
that gestation  could never be  protracted to the  311th day after
probable intercourse.  Considering that conception  is not necessarily
the immediate result of intercourse (p. 644),  and that Ave have no 
DISPUTED  PATERNITY.
657
data for fixing the precise time of its occurrence, this decision could
hardly  be supported on medical grounds.  We should not be justi-
fied in  affirming that every child born  forty-four Aveeks and three
days after the opportunity of intercourse Avith the husband AA-as
ex necessitate  rei an illegitimate child,  and that the Avife Avas an
adulteress.  It  is true that their lordships did not decide directly
that the one claimant was illegitimate,  because he could not have
been born only after 311 days' gestation;  but their decision practi-
cally led to this result, as the other claimant was pronounced to be
the only son and rightful heir of Lord Gardner.   Of the seventeen
medical experts examined on this occasion, five supported the opin-
ion that the duration of human pregnancy was limited to about nine
calendar months, i e. from thirty-nine to  forty Aveeks, or from 273
to 280  days—or, strictly speaking, from  270 to 280  days; one of the
witnesses, indeed, said from 265 to 280 days.  These Avitnesses, of
course, gave a negative to the  possibility, unless by miracle, that
Henry  Fenton Jadis alias Gardner could  have  been the product of
311 days' gestation.  On the other side, of twelve medical  gentle-
men, who seemed to agree Avith  respect to the above-mentioned
period  as the  natural term  of gestation, the greater number main-
tained  the possibility of pregnancy being protracted to nine-and-a-
half, ten, or even eleven calendar months, and of course to 311 days
—the alleged term of gestation, at which the counter claimant Avas
born—and they thus admitted the possibility that Air. H. F. Jadis
alias Gardner  might  be  a  ten-and-a-half months' child.   (Lyall's
"Aled.  Evid.  on the Duration of Pregnancy," etc., p. 8.)
PATERNITY.
                   CHAPTER LVI.

DISPUTED PATERNITY. — PARENTAL  LIKENESS. — AFFILIATION. — POST-
  HUMOUS CHILDREN.--SUPERFCETATION   IN   RELATION  TO  LEGITI-
  MACY.—SUPPOSITITIOUS CHILDREN.—SEXUAL MALFORMATIONS.

  Disputed paternity.  Parental likeness.—It has  been stated  that
the laAV does not pretend to determine who begat a child when it
has been born  during wedlock, and from circumstances  it might
be the child either of the husband, or of an adulterer. But medical
jurists have recommended that family-likeness should be looked to
on these occasions—not merely a likeness in feature and figure, but
in gesture and other personal peculiarities  which may have cha-
racterized the alleged parent.   These are called questions of pater-
nity ; they seldom occur except in reference to cases of bastardy, and
      42 
658
DISPUTED PATERNITY.
when they do present themselves, the evidence thus produced, even
if affirmative, is properly regarded as  only corroborative.  In the
Townshend Peerage case (House  of Lords, Alay, 1843), a presump-
tion based on family-likeness was admitted by their lordships.  The
person Avhose legitimacy Avas in question was sworn by one of the
Avitnesses  to  bear  so strong  a likeness as  a child to  the alleged
adulterer, that he should have  known him among five hundred
children.
  The proceedings in the Douglas Peerage case (1767-9) show that
evidence of this kind is  occasionally  of some importance.  The
peerage was claimed by Archibald Douglas—the survivor of two
brothers after the deatli of the alleged  parents, Sir John and Lady
Douglas.  The claim Avas disputed, on  the ground that the appel-
lant and his deceased brother were supposititious children.   Evi-
dence  for and  against the legitimacy of the  claimant had  been
collected from every quarter,  and after  it had been most minutely
sifted and criticized, the case came on for judgment, in the Court of
Session in Scotland, on the 7th of July,  1767.  So important Avas
the cause  deemed, that the fifteen judges took eight days to deliver
their opinions.   The  result was  that seven of  the judges voted in
favor of the  identity or legitimacy of Mr.  SteAvart, and seven
against it; the Lord President, Avho had the casting  vote, agreed
with the latter, by which Archibald Douglas,  alias SteAvart, Avas
cast on the world without either name or estate—thus furnishing
one among numerous instances that learned judges as Avell as doc-
tors can differ, with precisely the same facts before  them.  An
appeal from  this decision was taken  to the  House of Lords, by
which the judgment in the Court of Session was  reversed in 1769,
and Archibald Stewart (or Douglas) declared to be the undoubted
son of Lady Jane, the sister of  the previous  holder of the  title.
Aluch stress was laid, in favor of the legitimacy of these children,
on the fact that they closely  resembled—the one Sir John, and the
other Lady Douglas.  The resemblance was said  to be  general; it
was evident in their features, gesture and habits.   LordAlansfield,
in delivering judgment, make the folloAving remarks, which com-
prise all  that  can  be said  on this subject: " I  have  always con-
sidered likeness as an argument  of a child  being the son of a
parent, and the rather as the distinction between individuals in the
human species is more discernible than between other animals.  A
man may survey ten  thousand  people before he sees tAvo faces
exactly alike;  and in an army of a hundred thousand  men, every
man may be known from another.  If there should be a likeness
of feature, there may be a difference in the voice, gesture, or  other
characters, whereas a family likeness runs generally  through all
these ; for in everything there is a resemblance, as of feature, voice,
attitude,  and action."  This kind of  evidence has been strongly
objected  to  from  its uncertainty-; and  I am  informed,  on good
authority, that it  was in this instance  much disputed Avhether one
of the children did resemble Lady Douglas, but it seemes to have
been generally admitted that the other child resembled the hus- 
       PATERNITY FROM PERSONAL PECULIARITIES.    659

band. Sir John.  From  this account  it will be seen that evidence
from family7 likeness is not strictly medico-legal; it can be furnished
only by friends and relatives avIio have knoAvn the parties Avell, and
are competent to speak of the facts from personal  acquaintance
with them.  It Avill also be apparent that  the arffimative evidence
in such cases will be  stronger  than that which is negative, for it
could hardly be  inferred that a person Avas illegitimate because he
did not resemble his parent.
   Parental likeness  may be occasionally indicated by color or pecu-
liarities belonging to the varieties of mankind, as of the intermix-
ture of the Negro, or  Mongolian, with  one  of  the Caucasian
variety.  In  such  a  case the  evidence afforded  becomes  much
stronger;  and supposing that two  men of different varieties have
intercourse about the same time with  the same woman, the color
of the skin of the offspring might  enable a court to determine the
question  of paternity.  It  is stated  to have  happened,  on more
than one  occasion, that a black  Avoman has given birth at  the same
time to a black child and a mulatto; Dr.  Cunningham refers to  a
case in Avhich a negress  gave birth to twins, one  a black and the
other a white child.   (" Lancet," Alay 9, 1846, p.  525.)  This Avas
probably  a case of superconception.  In Stothard v. Aldridge (Bail
Court, January, 1856), the plaintiff sued the defendant for damages
for the seduction of his  Avife.  The defendant Avas a man  of color,
and the child born of the alleged adulterous intercourse was  proved
by the medical witness to have  been born colored and with  woolly
hair.  The husband and wife Avere both light.  This peculiarity
fixed the paternity of the child on  the black defendant.
   Personal deformities are not necessarily transmitted from  parent
to child ;  yet it Avould appear from the subjoined  case, that a dis-
puted question of affiliation has been  settled on this principle. A
woman alleged that a gentleman in  whose service she had lived,
was the father of a child of Avhich she had  been recently delivered.
The solicitor Avho  appeared to support the affiliation, rested his
case chiefly on the fact  that  the  child had been born with fh-e
fingers and a thumb on the  right hand, the  defendant himself
having been  born  Avith a similar malformation  on both  of his
hands. It Avas argued, on the other side, that the deformity might
have arisen from the mother's imagination, as, while pregnant, she
was constantly in the habit of seeing  the defendant.   The  magis-
trates decided that he Avas the father of the child, and condemned
him to pay the necessary expenses for its support.  (" Aled. Times,"
March  6,  1847, p. 47.)  It is very likely that the decision was here
influenced by  moral  circumstances, for otherwise the defendant
might have "been the  victim of a coincidence.  Six-fingered  chil-
dren are, it is  Avell  knoAvn,  born occasionally  of  five-fingered
parents; and  as  the deformity existed only on one hand  in the
child,  Avhile it was on both hands in the  parent, the medical proof
that it was  actually transmitted  by generation was certainly not
Nearly made out.  In  some instances, attempts have been made to
fix the  paternity of  a  child by the color of the  hair, but  this evi- 
 660       EVIDENCE IN  CASES OF AFFILIATION.

 deuce is far  less conclusive than that afforded by the color of the
 skin.  In the case of Frazer v. Bagley (Feb. 1844) it Avas  alleged
 that the wife of the plaintiff had had criminal intercourse  with
 the defendant; and the last two children Ave re stated to be the off-
 spring of the latter.  The  plaintiff and his  Avife had  dark hair,
 as Avell as all the children, with the exception of the last two;
 these had red hair;  and it was  further proved that the defendant
 had red whiskers and sandy hair.  No particular stress Avas laid
 upon this evidence, but it was received as a kind of indirect proof.
 Not much  confidence can  be  placed in facts of this description,
 since red-haired children are often born to parents avIio have  dark
 hair;  and in one case, the  children born in wedlock were observed
 to have dark and red hair alternately.

   Affiliation.'—Questions of paternity are involved in those relating
 to affiliation.  A man may allege that he is not the father of a par-
 ticular child, by  reason of certain circumstances upon Avhich a
 medical operation may be required.  The necessary 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 tAvo children alleged by a female to be his;
 the time of gestation was within nine months.   The accused denied
 that he had had intercourse with the deceased, or that he could
 have been the father, since he was at the time under medical treat-
 ment for venereal disease.  The medical questions may therefore
 assume this shape: 1.  Are these diseases invariably- transmitted by
 intercourse?  2. Do  they interfere  with the act  of procreation?
 Under common  circumstances they must both  be ansAvered in the
 negative.
  A singular case of bastardy is reported to  have  occurred in
 Apipenzell, Switzerland.  The question was, which of two persons,
 who had had intercourse with the same woman Avithin a period of
 seventeen days, was the father of an illegitimate child borne by the
 woman?  The council, to which the case was referred, gravely re-
 solved to postpone their decision until the features of the child  were
 so far developed as to enable them to  decide from paternal likeness.
 The equity of this difficult case Avould 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, 336): two men, A and B, had
 intercourse,  unknown to each other, with a young woman of deli-
 cate health ;  and after this  had continued for some years, she was
 delivered of a female child—nine calendar months and three days
 after sexual  intercourse Avith A, and nine calendar months, less five
 days, after similar intercourse with B ; or at the end of 279  days
 after intercourse with A, and at the end of 271 days after intercourse
 with B:  that is, a period of eight days elapsed between the periods
 of intercourse with the two  men.  The woman had no  menstrual
discharge in the mean time, and it is not believed that she knew any 
          EVIDENCE IN CASES  OF AFFILIATION.       661

other man ; she went her full time, had a good labor, and produced
a fine healthy girl;  she had a plentiful supply of milk, and enjoyed
better health during her pregnancy and suckling than at any other
time.   The woman died, and the circumstances of the mixed inter-
course having become knoAvn .to A and  B, they both refused  to
maintain the child.   A contended that, as the Avoman Avas not de-
livered until nine months  and three days after the connection Avith
him, it Avas physically impossible the child could be his.   B con-
tended, on the other hand, that 280 days, and not nine months, is the
period of gestation; and that the child having been born 279 days
after connection Avith A, and only 271 days after connection with B,
it was therefore probable that the child Avas begotten by A.  There
was no perceptible likeness to either of the men in the child, but a
marked likeness to the mother.  It is obvious from the remarks else-
where made (ante, p. 642), that the periods  of 271 and 279 days
are comprised within the ordinary range of gestation:  hence there
would be no medical ground for affiliating the  child  to one more
than the other.   AVhen two men have intercourse with the same
female on the same day, it is impossible to settle the paternity- except
by the accident of likeness; as in the former case, justice  to the
offspring and to each piossible father requires that  each should be
bound to support the child.  In cases of affiliation under the law
of bastardy, the evidence of the mother, if corroborated, is received
in support of a question of  disputed paternity; but sometimes these
cases are decided by the length of the period of gestation.   A man
may prove, or a woman may state, that the intercourse took place
at such a remote period as to be inconsistent  Avith the ordinary
duration of pregnancy.  On this point some remarks  have been
made elsewhere (ante, p. 655).   In the United States it appears that
very long dates are allowed in bastardy cases ;  Avhile in this country
the tendency is to reject medical evidence  altogether.   In a case at
Cheltenham (July, 1853), the date of intercourse Avas proved to have
been 319 days before the birth of the child.  The medical evidence
on the Avhole Avas in favor  of this pirotraction—one of the witnesses
having met with tAvo cases in Avhich gestation was  protracted, as
he believed, to 310 days from intercourse—but the case Avas sum-
marily dismissed.
  These questions of affiliation, when the  interval is less than six
or eight Aveeks, 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 Avas had
and the child  conceived in France, although born in  England, it
was removed from the jurisdiction of an  English magistrate, and
Bhould be  left  to the  French  courts.  The objection was properly
overruled, and the alleged  father Avas ordered to pay the usual sum
for maintenance.  The place of birth should properly fix the lia-
bility, as any other rule would be too vague.  From Avhat has been
else\vhere stated, it will  be perceived that intercourse  might take 
662
POSTHUMOUS CHILDREN.
place in Scotland, followed by conception in England, and birth in
Ireland.  So that there is a due relation betAveen the date of inter-
course and the date of birth, no other proof is required.
  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 Avere
born after the lapse of ten months, it might be a question Avhether
it Avas a child of the first or second marriage—of the dead  or the
living husband ; and although there might be no dispute concern-
ing its legitimacy, yet it would be difficult to settle its paternity.
Such a case appears hypothetical.  [Lord Hale, hoAvever, mentions
the tAvo following cases: " 18 R.  2, where a Avoman in such  a case,
immediately after the death of  the first husband, took a  second
husband, and had issue born forty weeks and eleven days after the
death of the first husband, it was held to be the issue of the  second
husband.   Ah 4 Car. in Cur. Ward, and afterwards, P. 5 Car. B. R.
Thecar marries a lewd woman, but she doth not cohabit with him
and is suspected of incontinency Avith Duncomb: Thecar dies: Dun-
comb within three weeks after the death of Thecar marries her;
281 days and 16 hours after his  death she is delivered of  a son.
Here it Avas agreed,  1. If she had not  married Duncomb, Avithout
question the issue should not be a bastard, but should be adjudged
the son of Thecar.  2. No averment shall be received that Thecar
did not cohabit with his Avife.  3. Though it is  possible that the
son might  be begotten after the husband's death, yet being a ques-
tion of fact, it Avas to be tried by a jury,  and the son Avas found to
be the issue of Thecar."  Hale AISS.—P.]  In order that any doubt
should exist, a  Avoman  must  marry within, at the furthest, six
weeks after the death of her first husband, or the birth of the child
would fall  beyond the furthest limit of gestation, so far as he Avas
concerned.  The customs of society are, hoAvever, a bar to such
marriages;  and  admitting that a child  was so  born, and that it
might  be the offspring of either husband, then the fact of its having
been born during the marriage of the  second husband Avould pre-
sumptively fix the offspring upon him, unless it could be  shown
that there  Avas no possibility of access on his part.   If there Avas a
supposed greater likeness to the first than the second husband, still
this Avould not be  alloAved to defeat the  legal presumption  of the
real parentage of the child.  It appears to me that evidence much
stronger than this Avould  be required for  such a pmrpose.  (See
Henke's " Zeitschrift," 1838, vol.  2, p. 432.)
  Superfoetation in relation to legitimacy.—Alost medico-legal writers,
in treating legitimacy, have considered  it  necessary to introduce
the subject of superfcetatiou.  By this  Ave are to understand that a
second conception  may at any time follow the first, and that gesta-
tion may go on to its full period in each  instance, independently of
the other:  so that  if a woman were impregnated Avhen  in the third
month of gestation, she Avould bear the first child mature in  nine
months, and the second  child, also mature, at the end  of  tAvelve
months after the first conception.  This  subject  has been said  to 
     SUPERFCETATION IN  RELATION TO LEGITIMACY.  663

involve "not only the conjugal fidelity of a wife, but the disposi-
tion of property, and much of the comfort and happiness of society."
Its importance to a  medical jurist appears to me to have been here
considerably exaggerated.   So far as I have been able to ascertain,
not only is there no legal case involving this question  to be met
with in the judicial records of this country, but none in reference
to this state is ever likely to occur, which would create the least
practical difficulty.  If  Ave admit that a woman may, during mar-
riage, present such a deviation from the common course of nature,
as to produce two  perfectly mature and fully-developed children,
the one three or four months  after the other, how can such an event
be any imputation on her fidelity ?  Superfcetation, if  it occur  at
all, may occur  as  readily in married  life, during connubial  inter-
course, as among unmarried women.  The following appears to  be
the only possible case  wherein  a medical opinion  might  be re-
quired respecting this alleged phenomenon.  A married woman,
six months after the absence or death of her first husband, gives
birth to an apparently mature child, that dies; three months after-
wards, and nine months after the absence or death of her husband,
she may allege that she  has given birth to another  child, also ma-
ture.  A medical question may arise, Avhether two mature children
could be so born, that the birth of one should follow three months
after the birth of the other; or whether this might not be a case,
by no means uncommon, of tAvin-children—the one being born pre-
maturely, and the other at the full period. (For a case of this kind,
at two months' interval, see "Med. Gaz.," vol. 37, p. 27; and for
another at eight days' interval, see the same journal, vol. 47, p. 227;
for a third, at  thirty-two days' interval,  "Am. Journ.  Aled.  Sci.,"
April, 1845, p.  503.)  In one  case the abortion of one foetus occur-
red at the third month, Avhile the other attained the full period.
("Assoc. Aledical Journal," November 11, 1853, p. 997.)
  Admitting that each  child Avhen born was mature and fully de-
veloped, and therefore that the  second  child presented a case  of
superfcetation,  the  first delivery must  have taken  place  in the
presence of witnesses, and it Avould then have been known whether
another child remained in the uterus or not.  If the two children
were born Avithin the  usual period  of gestation after the absence  or
death of the  husband, then their legitimacy would  be presumed,
until the fact of non-access had been clearly established.  The mere
circumstance of their being apparently mature, and born at  differ-
ent periods, would 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 illegitimate.  The  laAV,  therefore, ap-
pears to have no sort of cognizance of the subject of superfcetation,
as such;  it is generally merged in the question of protracted gesta-
tion, which has already  been fully considered.
  Until the mouth of the uterus is completely closed as a result  of
the development of  an embryo, it is ptossible that conception may
take place from intercourse subsequently to a previous conception. 
664  SUPERFCETATION IN  RELATION  TO LEGITIMACY.

The  exact period at which this closure occurs  has not been deter-
mined: but according to Dr. Duncan, the menstrual secretion may
find its Avay through the mouth of the uterus for at least two months,
and probably three months after conception.  If this be the case, a
second conception might occur  two or three months after a first
conception ;   but  I  am  not  aAvare of any  facts to  support this
statement.
  It cannot  be denied that superconception may- occur in cases in
which  tAvo separate intercourses have been  had within a few days
of each other; and, according to some, twins may be generally re-
garded as the result of  this double conception at different periods.
(Ramsbotham's " Obstet. Aled.," p. 500.)  Dr. Carter has reported
the following case in the "Philadelphia Medical Examiner": A
negro woman, quite  black, set.  23,  and of good constitution, had
borne three children  previously to her last labor.  She stated that
in April, 1848, she had  had connection Avith a Avhite man, and on
the following day with  a black man.   This was about a week or
ten days before the cessation of the menses.  In the middle of Feb-
ruary,  1849, she Avas cleliA-erecl of twins, one of the children (the
firstborn) being as dark as negro children generally are, while the
other Avas a mulatto.   The woman believed that they were begotten
by different  fathers;  and this Avas rendered highly- probable by the
difference in the color of the  skin.  (" Edin. Alonth. Journ.," Alay,
1850, p>. 485.)   The reader will find several cases of a similar kind
reported by Dr. Ramsbothan.  (Op. cit. p. 501.)
  Many of the old cases of superfcetation are explicable on the sup-
position that  a woman was pregnant with tAvins, and that one of
these was born prematurely, and the other at the full time or later.
  Cases of abortion or delivery of one tAvin, the other remaining in
utero, are by no means  uncommon.   In addition to those  already
quoted, two are referred to in the " Edinburgh Aledical and Sur-
gical Journal" (1839,  p.  289).  In one, abortion took place at three
months, Avhile the woman Avent to her full time and Avas delivered
of a healthy child at nine months.  In the second, one foetus was
expelled at about four and a half months, Avhile four months after-
wards  a  full-groAvn child was born.   In a third case, reported  by
Dr. Nevins, a woman was delivered of a foetus, prematurely; and
six weeks afterAvards she Avas  delivered of a full-groAvn child.
("Med. Gaz.," vol.  46, p.  983;  see  also "Aled.  Times and Gaz.,"
May 2, 1857.)  Even  under a malformation which might  be sup-
posed to be favorable to its  occurrence, namely, the presence of a
bilocular uterus, it  has  been found  that  impregnation has taken
place in  one cornu only.  (See  " Aled.  Gaz." vol. 19, p. 507.)  A
singular instance is, however, recorded in the same journal (vol. 20,
p. 508), where a  woman six months after marriage, bore a four-
months'child, and forty weeks after marriage gave birth to mature
twins.   On examination, the uterus and vagina Avere 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 
     SUPERF03TATI0N IN RELATION TO  LEGITIMACY.   665

 weeks old!  ("Aled. Gaz.," vol. 44, p. 87.)  In the " Aledical Times"
 (Jan.  31,1852, p. 104), Dr.  Foley has published the account of a
 case  in Avhich a mole Avas expelled from  the uterus at an early
 period of pregnancy, Avhile the  woman AA7as  delivered,  about the
 usual period, of a living and Avell-formed although weakly child,
 which survived its birth three days.  (See  also "Dublin Quarterly-
 Journal," Feb. 1859, p. 221;  and "Lancet," August  2, 1862.)
 M. Garimond  has contributed a case of the  ordinary kind, in Avhich
 a woman Avas delivered of one child fully developed, and of another
 at seven months, dating from the last menstruation. ("Ann. d'Hyg."
 1867, 1, 456.)  This may have been simply a case of tAvins, impreg-
 nation taking place at  the same  time, but one tAvin less developed
 than the other.   Dr. Paxton, of  Kilmarnock, met with  a case in
 which a question of infanticide arose out of the suppiosed condition
 of superhetation.   ("Glasgow Aledical Journal," Jan. 1866.)
   Dr. Bonnar has lately examined the subject of superfcetation in
 another aspect, and some of the  facts Avhich  he has brought  for-
 ward are not  consistent with  the  theory  of the birth of twins at
 different  intervals (" A Critical  Inquiry regarding Superfcetation,
 with Cases," 1865).   The first question to Avhich his researches were
 directed Avas—at Avhat period after parturition are the female pro-
 creative  organs  capable of  again exercising their functions?   It
 has been supposed that a period of thirty days must elapse in order
 to enable the organs to reacquire  procreative poAver; but according
 to Dr. Bonnar, the  earliest period may  be taken at the fourteenth
 day after delivery.  Impregnation is not likely7 to take place until
 the organs have resumed their  natural condition, and this will de-
 pend on the disappearance of the signs of recent delivery—such as
 the tender and swollen state of the vagina, the enlargement of the
 uterus Avith its relaxed  mouth, and lochial discharge. The persis-
 tence of the lochial discharge, the average  duration of Avhich after
 delh7ery Dr. Bonnar considers to be from one to three or four Aveeks,
 is  of the  greatest importance, as  it is most likely to interfere Avith
 impregnation.   The time for the restoration  of the sexual organs
 to their natural state varies in different Avomen, so  that the  date
 for re-impregnation must be more or less conjectural.
  It has been usually considered that  after  the  second or third
 month of pregnancy the cavity of the uterus is so sealed up in the
 development of the embryo as a result of impregnation, that it is im-
 possible that any fruitful intercourse can take place. In two instances,
 hoAvever, according to Dr. Bonnar, viable children were born of the
 same Avoman at five and a half  and four months respectively after
 the first delivery.   On  the  theory  of superconception the uterine
 organs must have been susceptible  of a second impregnation up to
 the fourth month of gestation  But if the children Avere not born
 manure, the poAver of re-impregnation must have existed for one or
 two months longer than the period usually assigned—i. e., up to
 the fifth or sixth  months of a pregnancy already existing.  These
 researches may- help to explain some legal difficulties Avhich have
occurred in reference to gestation.   They- furnish a curious comment 
666
SUPPOSITITIOUS CHILDREN.
upon the suggestion made by some medical jurists, that superfceta-
tion involves the conjugal fidelity of a wife, for no suspicion of ille-
gitimacy could be for a moment entertained simply on account of
the shortness of the interval between the two deliveries of the same
married Avoman.
  Supposititious children.—Another medico-legal case, in relation to
legitimacy, occurs when a woman feigns  delivery, and  represents
the child of another person to be her offspring.   She may substitute
the living  child of another woman for a  dead child of Avhich  she
herself has been delivered, or for a  mole which  may have  passed
from her.   So, again, a male may be substituted for a female child,
and vice versa.   The  practising  of a fraud of this nature may se-
riously affect the rights of inheritance of parties ; but it cannot be
accomplished Avithout great dexterity and cunning, or without  the
co-operation of several accomplices.  Frauds of this kind have, in
general, been committed  by  the aid of a low class of  widwives.
One instance occurred at  Chelsea, in July, 1842, Avhere  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 Avas simply whether delivery had, or had not taken
place; but  if it be  alleged  that one living child has been substituted
for another, the piroof of this can depend on medical evidence only
when the age of the supposititious child does  not happen to corre-
spond to the date  of the pretended delivery.  (See "Ann. d'Hyg.,"
1829, vol. 2, p. 227.)   The  legitimacy of the claimant of the Douglas
Peerage Avas disputed on this ground, but  apparently Avithout foun-
dation.   A remarkable case  of  this description  will be found in
Henke's " Zeitschrift der S. A." (1845, vol. 2, p. 172); and a trial took
place some years since in  England, involving the alleged substitu-
tion of a child, but  requiring no medical evidence for its elucida-
tion.  (Day v. Day, Leicester Lent Ass. 1845.)  In another case it
was proved that a Avoman had substituted a doll for the  dead body
of a child of Avhich she pretended she  had been delivered.  In a
case mentioned by Dr. Cheevers, one  Mussamat Ja.noo, a midAvife of
Hisar, being  employed to attend a Avoman in her confinement, per-
suaded her that the  child of which she had been delivered was a
monster Avith two  heads, not fit to be looked at; she afterAvards said
that it Avas dead,  and she would take it  away and  bury it.  She
accordingly went  aAvay.   Next  morning, the midwife's services
being required, she was sent for.  She excused  herself from going
under the  poretence that she (the midwife) had just been delivered
of a child.  This improbable story excited suspicion, and the police
were called in ; she declared that the child was her own.   This  she
also maintained at the trial.   It appeared, hoAvever, from the  evi-
dence of midAvives avIio examined her  shortly after the discovery
of the child in her house, and also  by the deposition of the civil
surgeon, that she exhibited no signs of recent confinement.  Several
of the neighbors,  who were constantly  in the habit of seeing her,
deposed that she had  not exhibited any outward signs of pregnancy.
She did not attempt to prove how she  had disposed of the body of 
SUBSTITUTION OF CHILDREN.
667
the child which she alleged had died immediately after its birth.
She Avas convicted, and sentenced to imprisonment for seven years.
("Aled. Jur. for India," p. 512, from the " Nizamut AclaAvlut Re-
ports," 26th April, 1853.)
  Cases involving a question of substitution are not very common.
One of these (Hutchins v. Hutchins) was heard in the Vice Chancel-
lor's Court in Alay, 1851; and in this the amount of ingenuity re-
quired to perpetrate the fraud Avas only equalled  by the skill Avith
which the facts were exposed, and justice  ultimately done, to the
rightful claimant.  In another (Gedney v. Smith, Rolls Court, Nov.
1864) the fraud was nearly successful, and but for the dying declara-
tion of the  Avoman herself, would probably  have escaped detection
and exposure.
  A more daring attempt  of this  kind  came before the House of
Lords in 1870, in reference to a claim for the earldom of AVickloAV
(The Wicklow Peerage case, Committee for Privileges, April 1,1870).
The title and estate of  the Earl of Wicklow passed at his death to
his brother's issue.  The first in succession Avas  George Howard,
who, after a career of dissipation, had died in October, 1864.  He
had  been married  in  February, 1863, to  Ellen Richardson, the,
daughter of a gentleman's  coachman.  In default of issue, the
estate  devolved on his  brother  Charles,  the second  in  succession.
Ellen Howard produced a male child who, she alleged, Avas born on
the 16th Alay, 1864, and avIio, if such were the case, would be the
rightful  Earl.   No medical  man and  no nurse  attended Airs.
HoAvard, although  it  Avas her  first  confinement, and  the infant
Avas  a seven months' child.   It was never registered,  and never
baptized.  There Avas  further strong evidence that  she had not
borne  a  child, and that the child which she had produced as her
own Avas obtained by her in August, 1864, from a girl aa71io had been
recently delivered in the Liverpool workhouse.  Airs. Howard Avas
clearly identified  as  the person aat1io had  taken  away a child at
this  time.   Her story Avas thus proved to  be false.   The House of
Lords decided against  the claim, and came to the conclusion that
the Avitnesses had been guilty of pierjury.
  The cases that have hitherto been tried, illustrate the importance
of accurate observation on the part of medical men in their practice
as accoucheurs.  Notes of all cases  should  be made and preserved,
including dates of attendance, etc., daily symptoms, and treatment.
This should be an invariable rule when a medical man is suddenly
called upon to attend  in her confinement  a Avoman Avho may not
have previously consulted him.  If he has had no previous knoAvledge
of the pregnancy of a woman, and if when "he arrives, the child is
said to have been born and in the hands of  a nurse, he should most
distinctly satisfy himself, by a personal examination, that the Avoman
has been actually delivered.  He should  also observe whether  the
child  presents the apjpearance of a  new-born child in reference to
the state' of its skin, the appearance of  the cut  navel-string, and
other circumstances.   It is an aAvkAvard thing for a medical man to
hear at a trial many years afterAvards, that his patient  Avas not de- 
668
SEXUAL MALFORMATIONS.
livered of a  child, that a post-mortem examination of her body
had shown that she had never borne a child, and that the supposed
new-born babe was, at the date of his first visit, several days old—
in  short, to find  that he himself has been  cleverly made to give
support  to a fraud.

  Hermaphroditism.   Sexual malformation.—The legitimacy of a
child is open to be contested under other circumstances than those
connected with the duration of gestation.  The alleged parent may
have  labored  under physical incapacity: if a male, he  may have
been affected with impotency; if a  female, she  may have  labored
under sterility; and if either of these conditions  be proved,  the
illegitimacy  of a  child Avill be established, although the alleged
period of gestation may be  comprised within the ordinary limits.
The sexual conditions now about to be considered have also impor-
tant bearings in relation to divorce, and occasionally to the civil
rights of a child that  may be the subject  of the  malformation.
One of the most common and obvious causes of impotency, or ste-
rility is  malformation of the sexual organs, to  Avhich  species of
monstrosity the term hermaphroditism is  commonly applied.
  Owing to arrested development, during the growth of  the foetus,
the sexual organs, Avhich can scarcely be distinguished at  the fourth
month, occasionally assume an abnormal arrangement.  These organs
appear to be  at that time more or less mixed; and sometimes the
male, and at others the female characters predominate.   AVith this
defecth7e sexual development, the other  peculiarities of the sexes
are either wanting, or we find them more or less blended.  AVhen,
therefore, the being has the characters of a male with malformation
of the generative organs it is called androgynous—when the charac-
ters are  those of a female with  a like malformation, androgyna.
There can be no difficulty in identifying such cases; and, according
t,o the degree of malformation, a medical jurist can  have no hesita-
tion in pronouncing these persons  to be  incurably impotent.  The
organs are commonly so defective as to be wholly unfitted  for  the
functions of either sex.   It is not intended to be said that it is in
all  cases  easy to assign the sex, but this is of minor importance;
the main question is, whether the malformation is  or is not such
as to justify divorce, or the  imputation  of illegitimacy  upon chil-
dren claiming to be the offspring of these beings.
  Distinction of sex.—The determination of sex in these cases of de-
formity has  been  considered  to be  necessary under certain circum-
stances ;  as  when, for instance, a title of entailed inheritance of
lands is in question.  Lord  Coke has stated that, according to the
laAV of England, an hermaphrodite may be either male  or female,
and it shall succeed according to the kind of sex which doth pre-
vail.   Thus it is obvious, that the law will decide each case accord-
ing to the special circumstances attending it: but it must  not be
supposed that the decision is so easy as Lord Coke's doctrine would
imply.   There are many cases in  Avhieh neither sex can be said to
prevail.  The beings are positively neuter.   The chief character of 
DISTINCTION  OF SEX.
669
the male would consist in the presence of  testicles,  and of the
female in the presence of a  uterus and ovaries.  But  in a case
which occurred  to  Air. Grigor, both the testicles and the ovaries
Avere  Avanting; there Ave re  no essential characters of either sex,
and during life it would have been impossible to say whether this
being Avas male  or female.   (" Cormack's Monthly Journal,"  July,
1845, p. 492.)  In the same journal (p. 531) is reported another case,
in Avhich, notAvithstanding  the external resemblance  to  a female,
the presence of one testicle in a scrotum showed that this individual
Avas of the male sex.  Yet this person passed for a Avoman until he
had  reached his 26th year!   It is rare that there is external mal-
formation  Avithout  internal  defect, and even when  the female
character preponderates  in the person, it is not improbable that the
uterus or the  ovaries may be absent, or the former may be mal-
formed.  Such beings are not known to menstruate; and even  if
there be capacity for intercourse, they are permanently sterile.
Sexual desires are, however, commonly absent.
  When the person is young, mistakes respecting the sex are  more
common than at an advanced period of life.   So soon as the age of
puberty is passed, certain changes  take  place in the configuration
of the body, which  may aid a medical practitioner in forming an
opinion.  Thus, a grave tone of voice, the presence of a beard, the
width of the shoulders,  and  narrowness of the pelvis will indicate,
cceteris paribus, the  male sex: Avhile when  these conditions are
absent, and  there is a  rotundity  of the members, Avith  Avant of
prominence in the muscles, and a development of the  mammse, we
may pronounce upon the female sex predominating.  Although no
testicles are apparent, still the being may be of the male sex, since it
is well known that in persons othenvise Avell formed these organs
occasionally do not descend to occupy the scrotum.  Dr. Harris, of
Clarksville, has related a singular case, in which, although no  testi-
cles could be found, there was a short but naturally-formed penis,
through which the being regularly  menstruated 1   The female  char-
acter predominated in the corporeal development, and there was the
rudiment of a vagina (" Aled. Gaz.,"  vol. xl. p. 562).  The fact that the
being menstruated  AA-as here sufficient  to assign it to the female
sex.   Hoav easily mistakes may be made in the sex of young chil-
dren is shown by a case Avhich occurred to Air. Terry, and is quoted
in "Cormack's Journal" (April, 1845, p. 307).    'The child was
christened as a female, and was so considered by the  parents for
tAvo months, Avhen,  owing to some defect in the passage of the
urine, it was brought to Air. Terry, and he found there was a mal-
formation of the penis—no vagina, a  scrotum  with one testicle
doAvn and the other descending.  He therefore pronounced it  to be
a male, and its costume was  altered  accordingly.  Another case
occurred within my knoAvledge in  1872, in which a boy  had  been
christened and brought up as a girl up to the age of  13, when, in
consequence of a change in the voice and certain masculine habits,
some  doubts arose  about  the sex. On consultation with  Sir W.
Ferguson, he pronounced the child to be of the male  sex, and its 
670
DISTINCTION OF SEX.
name and dress were altered accordingly.   The testicles were re-
tained  in the abdomen, and this probably deceived the accoucheur
and the nurse at the time of the birth.
  A case of doubtful  sex occurred  to  Dr.  Flume.  The bodily
formation was that of a male, and the external organs presented
chiefly the male characters ; but on an inspection, there Avere found
a uterus y-ith ovaries and Fallopian tubes.  This being had never
menstruated.  This writer thinks that the shape of the pelvis fur-
nishes  the best criterion of  the sex.  (" American Journal Aled.
Sci.," 1872, p. 512.)
  In a paper published in the " Guy's Hospital  Reports," 1867 (p.
419), Air. Bryant has described various malformations of the sexual
organs.  In one of these there was an entire absence of vagina, and
in another a great development of the clitoris, causing it to re-
semble the male organ.  There were a glans and prepuce, the latter
being very large.  There was a depression, but  no urethra, in the
usual situation  of the urethral organ.
  The  presence of a beard  and Avhiskers is  usually considered to
characterize a male, but the growth of hair on the chin and face is
sometimes as profuse in women as in men.  Dr. Chowne examined
a female  named Joseph Boisdechine, on behalf  of a man Avho Avas
about to marry  her, but who required a certificate as to the real sex
of his intended  wife before he entered into a  matrimonial engage-
ment !   Dr. Chowne found nothing  in her external conformation
indicative of doubtful sex.  The breasts were large and full, and the
only7 resemblance to a male was in the abundance of beard and pro-
fuse whiskers.   The upper lip Avas free from hair.  (See " Lancet,"
Oct. 11, 1851, p. 335 ; Jan. 15,1853, p. Q6 ;  " Med. Times  and Gaz.,"
Jan. 15, 1853, p. 71.)  Dr. Chowne has published a full account
of this case in  the " Lancet" for Alay 1, 1852 (p. 421).  He  has
appended an engraving, which  displays the  female  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 Avas
two inches long!  In some instances this growth of hair in  women
is connected with sexual malformation.  I have known an instance
in which a Russian countess had  so much hair upon her chin that
she Avas obliged to shave like a man.  The following case of hairy
development in a  Avoman has been reported  by Dr. Hills:  Al.  O,
set.  42, dressmaker, suffering from mania, was  admitted into the
Norfolk Asylum, 1865.  She had a vigorous growth of hair on the
lips and chin, for which depilatories had been used, but these made
matters Avorse.   The upper part of the body is masculine in form,
and the breasts are undeveloped, as in the male sex.  The lower
part of the body is feminine in  outline, and the  voice has the femi-
nine tone and character. The clitoris Avas largely developed, having
a distinct prepuce.  There were no testicles in  the labia, or in the
inguinal canals.  There was a  distinct vagina,  and the finger  ap-
peared to touch an os uteri.   At an early age she had the slightest
possible  signs of menstruation on three consecutive occasions.  In
her girlhood she Avould not associate with other children.  While 
          MIXED CASES OF  HERMAPHRODITISM.        671

in the asylum she evinced strong sexual passions, and behaved  in-
decently to the attendants.  She had  thick  mustachos. and a full
beard.  (" Lancet," June 25, 1873, p. 129.)   An  engraving accom-
panies this paper, in which the hair and beard appear as much  de-
veloped as in the male sex.
  In some cases, an external examination will entirely fail in indi-
cating the sex, and even the opportunity of  an examination of the
dead body may leave the case in doubt.  An ingenious writer has
laid it down that there are analogous organs in the two sexes which
are  never found in the same subject,  and the separate existence of
which Avould enable us to determine the sex.  These analogous parts
are the pienis and the clitoris—the scrotum and the labia—the testi-
cles and the ovaries—the prostate gland and the uterus.  This, hoAv-
ever, is an artificial and,  as facts show, an incorrect means of dis-
tinction.  (See  report of a case, in which  a body resembling the
prostate gland and a uterus existed in the same being, "Aled. Times
and Gaz.," Feb. 18,1860, p. 177.)  If a penis could ahvays be clearly
distinguished from a clitoris, and a  scrotum from the  labia, the
rule  might be  serviceable;  but it  fails where it is most required,
i. e., in the mixed conditions. As to the other means of distinction,
even if correct,  they will  only enable an examiner to form an opin-
ion of sex in the dead, whereas  it is during the life of one of  these
beings that the law requires the aid of medical science in the solu-
tion of these questions.  The reader will find, in  the " Aled. Times
and Gaz.,",an account of some remarkable cases  of sexual  malfor-
mation by Air. Curling (Jan. 24,1852, p. 84); by Air. Fletcher (Feb.
7,1852, p. 136); by Mr. Broadhurst (Feb. 21, 1852, pi. 187); and
by Air. AVaters  (May 21, 1853,  p.  538.)  Other  cases, reported by
Mr. Alann and Mr. Churchill, will be found in the "Association
Journal," 1853  (Aug. 19, p. 720, and Sept. 9, p.  799).
  Mixed cases.—A case has been already mentioned in which neither
testicles nor ovaries Avere found after death,  and  more than one in-
stance has occurred in Avhich both have been found—a case of inter-
mixture of the sexes  or real hermaphroditism, physically speaking,
but of course Avithout the functional  power of  self-impregnation.
The folloAving case is mentioned by Briand:  The subject Avas about
eighteen years of age Avhen he died.   The body was partly that of
a male in configuration, and partly that of a female.  An examina-
tion of the sexual organs, externally, led to no satisfactory  distinc-
tion ; and on inspection after death a testicle  Avas found in Avhat Avas
supposed to be the left labium, with an epididymis and a spermatic
cord attached to it as usual; Avhile on the other side Avere an ovary,
Fallopian tube, and the rudiments of  a uterus.   The authenticity
of this case was for some  time  a  matter of dispute; but another,
equally singular in its features,  occurred to  Prof. Mayer, of Bonn.
This case clearly shows that such extraordinary  deviations may be
met Avith in nature.  The person examined by Mayer died in 1835,
at the age of 55.  Different opinions had been formed during  the
lifetime of  the  being respecting the sex, by the first anatomists in
Europe: some affirming that it  was a  male, Avhile others contended 
672            HERMAPHRODITISM—CAUSES.
that it Avas a female.   This difference of opinion is sufficient to
prove that external examination does not ahA-ays enable even a good
anatomist to pronounce an opinion on the probable  sex of the being.
In the dead body was found, on the right side, a withered testicle,
with a penis and prostate gland, as male peculiarities ; while on the
left side was an ovary, with a uterus, vagina, and Fallopian tube.
("Aled. Gaz.," vol. xix.  p. 135.)  It should be stated that the gen-
eral configuration of the body in this case was that of a female; but
there Avas a duality of sex.   The right half of the body Avas male,
and the left half female.
  But cases may present themselves in Avhich there is really no sex;
the person cannot be assigned either to the male or female variety.
Al. Tardieu has given a  report of  a case apparently of this kind, in
the "Annales d'Hygiene" (1872, 2, 149).  In these beings it is
probable that there may be rudimentary organs of one or the other
sex.   This being was married  as a woman at the age of 25.   Her
husband lived with her  for  more  than two years before he took
steps for a separation.  It then  turned out that the physical confor-
mation of this person rendered a consummation of the marriage im-
possible.   The wife was found to  have no  organs  essential to the
female sex.  There were neither breasts, vagina, uterus, nor ovaries.
The pelvis was more like that of the male than of the female, and
although then 27 years of age, the being had not  menstruated and
had  not  suffered from  any periodical lucular or abdominal pains.
On the other hand, with the exception of  the conformation of the
pelvis and the absence of breasts,  there was no male development.
When, on the one hand, there is an absence of vagina and uterus,
and on the other of penis and testicles, it may be  fairly said that
this being had no sex.
  Causes.—The causes of malformation of the sexual organs, as of
all other kinds of monstrosity, are involved in mystery.  We know
that in the early- part of utero-gestation, the sex of a 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 deter-
mined on inspection.  Some organs or parts appear to be formed by
equal and symmetrical portions, which gradually approximate and
unite in the median line of the body.   We observe this mode of
union in the bones of the head, chest, and  spine, as also in the vari-
ous fissures (raphes) of the skin, which are the remains of a union
betAveen tAvo equal and symmetrical parts of an organ, noAv become
one.   In regard to defects in organization, it may be remarked that
they almost invariably occur in or about some part of the median
line;  and they appear to proceed  from a mere arrest of  growth or
development of those particular parts, either on one side or both,
during the early stage of uterine existence.  In  this respect, the
fissures sometimes observecl in the  palatine bones, in  the palate
itself, or  in the lip—the openings occasionally noticed in the chest,
diaphragm, anterior parietes of the bladder, as Avell as in the spinal
canal, are precisely analogous in origin to the defective development
of the sexual organs.  There is nothing absolutely7 removed or lost, 
        LEGAL  RELATIONS  OF  HERMAPHRODITES.     673

but there is an arrest of development; an opening, or fissure, which
nature intended to be only temporary, becomes permanent by reason
of an arrest of groAvth.  In the evolution of the male genital organs,
the part corresponding to the scrotum is at first ahvays divided by a
considerable fissure: and the penis and clitoris having, at this period
of life, much the same kind of physical exterior, the sexual organs
cannot be Avell defined.   Should this fissure in the male not be after-
wards filled up, then Ave shall  have the  most  common variety of
sexual malformation—the hermaphroditic form, with the male pre-
dominating.  These observations are not, of course, applicable  to
those  cases  in Avhich the  sexes  are positively mixed.  In  these
instances there appears to be a separate sexual organization on the
two sides of the body, Avith an imperfect development of each set
of sexual organs.  According to Weber,  there is in the prostate
gland a rudimentary uterus  in every male.  (" Baly and Kirke's
Recent Advances in Physiology," 1848, p.  112.  Also papjers by Dr.
Knox, "Aled. Gaz.," Nov. and Dec. 1843.)
  One circumstance is worthy of note,  namely, that sexual mon-
strosity  appears occasionally to occur in the  successive pregnancies
of a Avell-formed female.   The late Dr. Lever met Avith a singular
instance of this in a female aged 28.  She had  given  birth to four
children in  the three confinements, the first being a twin  labor;
both the children males; and in both there was an arrest of develop-
ment of the sexual organs.  On the third  delivery, the child Avas a
male,  and its sexual organs presented the  same deformity as those
of the twins.  (" Med. Gaz.," vol. xxxviii. p. 946.)
  Legal relations.—These beings,  OAving to defecth7e development,
are impotent and sterile.  Questions connected Avith the  legitimacy
of offspring, divorce and affiliation may, therefore, be raised Avith
respect to them.   Sexual monstrosity is not a ground for depriving
a being  of the rights  of inheritance, except under peculiar  legal
conditions.   Thus, a right of succession or  inheritance to landed
estate may depend  upon the sex of the offspring—as Avhere, for
instance, tAvo children are born, the first hermaphrodite,  the second
a well-formed male child.  The piarents die, and a title of nobility
or lands may fall to the first-born male.  Here, the sex of the first-
born must be determined before possession can be had.   In a case
of this kind, if  medical evidence  should establish that male pecu-
liarities  predominate in  the first-born, the second child Avould be
cut off.  Again,  if an estate Avere limited by entailment, as where
it is settledupon heirs male and female of a particular family, the
birth of  an hermaphrodite, an only  child, would create the legal
necessity for a positive determination of the predominance of sex.
^o, if  the hermapmrodite live but  a feAV 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 Ave cannot determine under Avhat circumstances litiga-
tion may ensue, it is ahvays right  in a doubtful  case to observe the
sex, and make notes on the spot when a child thus malformed sur-
vives its birth but for a  short period.  The question of tenancy by
      43 
674      LEGAL  RELATIONS  OF  HERMAPHRODITES.
      i
courtesy, or the right of the husband to landed  estate of AA-hich
the wife was seized, will depend entirely upon the attention of the
accoucheur to this point.  (See " Tenancy by Courtesy," ante, page
628.)
  When these beings have reached  adult age, other questions  may
arise Avith respect to them.  According to an old law  of  France,
an hermaphrodite Avas permitted to choose one sex, and thereafter
compelled to keep it!  Hermaphrodites,  or sexual  monsters, Avere
formerly ranked Avith infamous persons: and it has been a grave
question in our courts, whether  the calling a man an hermaphro-
dite was  not such a libel  or  slander upon him as to render it a
ground for a civil action.   In  a  case reported by  Chitty  (" Aled.
Jour.," 374), the  use of this term  Avas held not to be actionable
unless it was proved that it had been attended with special damage.
A dancing-master brought an action against a party for calling  him
an hermaphrodite, and it was decided that it was not sustainable:
1. Because such a union of the  sexes cannot exist in fact, and every
one must be supposed to know  it; consequently the assertion could
not be supposed to prejudice.  2. Because, admitting the possibility
of such a double  function, the party would  be  just as good,  and
perhaps even a safer dancing-master, than  if only one perfect sex
had been discoverable;  consequently  the words would not,  in legal
presumption, injure him in his profession or occupation!
  I am indebted to a learned member of the bar for a note on the
remarkable case of the  Chevalier d'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  circum-
stances (Da  Costa  v. Jones, "CoAvper's  Reports," vol. ii.  p. 729).
The plaintiff claimed of the defendant  a sum  of three hundred
pounds.  On the 4th of October, 1771, plaintiff paid to the defend-
ant seventy-five guineas,  on the condition that he, the plaintiff,
should receive from the defendant a sum of three hundred  pounds
in case the Chevalier  d'Eon  should at any time pirove  to be a
female.  The cause was tried before Lord Mansfield, at Guildhall,
and the jury found a verdict for the plaintiff, damages  three hun-
dred pounds, thereby affirming that the Che\7alier was a female.  A
motion was subsequently made  on behalf of the defendant to arrest
the judgment, or at least  to stay the proceedings, on  the  ground
that the action could not  be supported, as being upon a wager
tending to introduce indecent evidence, and also as being one Avhich
materially affected the interests  of a third person.  The question
thus raised on the motion was  argued before the  Court of King's
Bench, and the judges unanimously  agreed that the judgment must
be arrested ; the law not allowing wagers upon subjects leading to
the introduction of indecent evidence (this being contra bonos mores),
nor upon such subjects  as are calculated to  have an injurious
effect upon the interests or character of a third person.  Irrespec-
tive of this decision, the verdict was based upon what subsequently
turned out to be untrue.  The Chevalier Avas really a male,  and not
a female.  He was carefully examined  by Sir  Anthony Carlisle, 
         ELECTORAL  RIGHTS OF HERMAPHRODITES.      675

who satisfied all  present of the perfect condition of the testicles.
(See Paris and Fonblanque, vol. i. p. 229.)l
  It Avould appear, from a singular case reported by Dr. Barry, that,
in the United States, the rights of citizenship and the privilege of
voting for members of Congress have depended on the determina-
tion of sex.   In Alarch, 1843, he was requested to examine the case
of Levi Suyda.m, aged 23 years, a  native of Salisbury, Conn.  At
the exciting and warmly contested election of the spring  of that
year, almost everything bearing the semblance of the human form,
of the male sex, is stated to  have  been brought to the ballot-box.
It Avas at this time, and  under these circumstances, that the above-
mentioned person was presented by the whigs to be made a freeman.
He was challenged by the opposite piarty, 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 fird
examination by Dr. Barry.   There was a mons veneris covered Avith
hair in the usual way; an imperforate penis, subject to erections,
and about two inches and a half in length, Avith corresponding di-
mensions ; the dorsum of the penis  Avas 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 Avell-formed glans ; a depression in the usual place of the mea-
tus urinarius, Avith a well-defined prepuce and foramen.  The scrotum
was not fully7 developed, inasmuch as it was but half the usual size,
and not pendulous.  In the  scrotum, and on the  right  side of the
penis, there  Avas one testicle of the  size of a common filbert, with a
spermatic cord attached.  In the pernineum, at  the root of the cor-
pora cavernosa, an opening existed through which micturition was
performed; this opjening Avas large enough to admit the introduction
of an  ordinary-sized catheter.   Having found a penis  and one
testicle, though  imperfectly developed, Dr. Barry, Avithout further
examination, gave it as his opinion, that the person in question Avas
a male citizen, and consequently entitled  to vote and enjoy all the
privileges of a freeman /
  On the morning of the first Alonday in April (election day), Dr.

  1 [The Chevalier D'Eon had  served as a  military officer, had acted as a di-
plomatist, and had fought duels, but his appearance was very effeminate ; and after
he had resided some years in England, frequenting race-courses and gaming-houses
in male attire, Mr. DaCosta wagered a large sum Avith Mr. Jones that the supposed
Chevalier was a woman, and brought the  action mentioned in the text, which re-
sulted as there stated.   Lord  Campbell, speaking of this case, says : " Although
the verdict was set aside on legal grounds, it was allowed to settle many other bets
which had been laid on the same question.  The Annual Register for 1766, p. 167,
says, ' By this decision, no less a sum than £75,000 will remain in this country,
which Avould otherwise have been  transmitted to Paris.   The Chevalier has left
England, declaring that  she has no  interest whatever in the policies opened on her
sex.'  The Chevalier,  then assuming female attire, remained in France, supported
by a pension from the French GoA-emment, for having long been a spy of Louis
XV., till the breaking out of the Revolution in 1790.   He then came to England,
and, being in great distress, lived Avith a lady of reputation as her companion ; but
dying in the year 1810, was found on a post-mortem  examination, to be indeed of
the sex Avhich he had originally claimed, and in all respects perfectly forme'd."—
Lives of the Chief Justices, vol. 2,  324 (Life of Lord Mansfield.)—P.] 
676        DESTRUCTION OF  SEX BY OPERATION.

Barry Avas informed that Dr. Ticknor would oppose Suydam's ad-
mission on medical grounds.  Suydam came forward, and Dr. Tick-
nor objected  to him as a female, and therefore not entitled to vote.
Dr. Barry then stated to the meeting, that, from an examination he
had made, he considered the person in question to be a male, and re-
quested that Dr. Ticknor might, with the consent of Suydam, retire
into an adjoining room, and examine for himself.  This Avas done,
when Dr. Ticknor ultimately came to the conclusion  that  Suydam
was  a male.  Suydam accordingly Avas admitted a freeman; and his
vote Avas received and registered.
  A few days after the election, Dr. Barry heard that Suydam had
regularly menstruated.  The sister of Suydam informed him that
she  had washed for him for years, and that he menstruated as
regularly, but not so profusely, as  most women.  Suydam, when
questioned, very unwillingly confessed that such was the fact.  He
Avas  again examined by tAvo physicians, when the following addi-
tional particulars were elicited:  Said Suydam is five feet two  inches
in height, light-colored hair, fair complexion, with a beardless chin,
and  decidedly a sanguineous temperament, narrow shoulders  and
broad hips; -in short, every way of a feminine figure.   There were
well-developed breasts with nipples and areolae.  On passing a female
catheter into the opening through which micturition was performed,
and through Avhich, he again sfated, he had a periodically bloody-
discharge monthly, instead of traversing a canal and draAving off
urine, the catheter appeared to enter immediately a passage similar
to the vagina, three or four inches  in depth,  and in which there
Avas  a considerable play of the instrument.   He stated that he had
amorous desires, and that, at such times, his inclination was for the
male sex;  his  feminine  propensities, such  as  a  fondness  for  gay
colors, for pieces of calico, comparing and placing them together,
and  an aversion for bodily labor, and an inability to perform the
same, were remarked by many.   Dr. Barry further learned from an
old lady, Avho was  present at the birth of Suydam, that on the
second day after his birth, Dr.  Delamater, who attended as  accou-
cheur, made with an instrument the opening through Avhich he had
ever since performed micturition.  (" American Journ. of the Aled.
Sciences," July, 1847.)
  This  Avas certainly an embarrassing case—one  to  Avhich Lord
Coke's rule for a decision, i. e., the prevalence of either sex, is hardly
applicable.  The presence of a  penis  and one testicle referred the
being to the male, while the bodily  configuration, and still more
strongly the  periodical  menstrual discharge, referred him  to the
female sex.  The right of voting might have been fairly objected
to, because, while the female characters Avere  decided, the organs
indicative of the male sex are described as having been imperfectly
developed.
  Dr. Hartshorne, an American physician, quotes a case in  Avhich
an attempt Avas made by Dr. Gross, a surgeon in  the United  States,
to destroy all sexuality, and thereby all rights of citizenship, in the
case of an  infant Avhose sexual  organs were imperfect.  (A  report 
           DESTRUCTION OF SEX BY OPERATION.        677

of this case will be found in the " American Journal of Aled. Sci."
for Oct. 1852, and the  " Ed. Alonthly Journ." for Jan. 1853.)  The
child, Avhen seen by Dr. Gross, was three years of age, and had al wa vs
up to that period been regarded as a girl, and in fact,had been so
pronounced at her birth by the accoucheur.   At the age of tAvo years
she began to evince the taste, disposition, and feelings of  the "male
sex; she rejected dolls and similar articles of amusement, and be-
came fond of boyish sports.  She Avas Avell grown, perfectly healthy,
and quite fleshy.  Her hair was dark and long, the eyes black, and
the Avhole expression most agreeable.  A careful examination of the
external genitals disclosed the folloAving circumstances. There Avas
neither a penis nor a vagina; but instead of the former there Avas a
small clitoris, and  instead of the  latter a superficial depression or
cul-de-sac covered Avith mucous membrane, anel devoid of everything
like  an aperture  or inlet.   The urethra occupied the usual situation
(in the female?) and appeared to be natural; the  nymphae were re-
markably diminutive, but  the  labia Avere well developed, and con-
tained each a well-formed testicle quite as large, and as firm as this
organ generally is in boys at the same age.   The hips, chest, thighs,
and  upper extremities were perfect.  From this description it is
pretty clear that the child was an androgynus, or there was imper-
fect development of the sexual organs, Avith predominance of those
of the male.   There was  no indication of uterus or  ovaries, nor any-
external  peculiarity, except that Avhich is frequently met with in
hermaphrodites, in which there is an arrest of male development,
hut no intermixture of the sexes.  Dr. Gross considered that for the
child's future Avelfare and happiness, it Avould be better that it should
have no testicles at all, than that it should retain them under such an
imperfect developunent of the other organs.  He therefore removed
them by operation from the labia or divided scrotum, and had the
dissatisfaction to find that they7 Avere perfectly formed in every respect,
and that the spermatic cords were quite natural.  The operation Avas
performed in July, 1819, and  three }-ears subsequently (in 1852) it
Avas found that emasculation was complete,  for the disposition and
habits of the being had  materially changed, and Avere those  of a
girl ; she Avas found to take great delight in  sewing and houseAvork,
and  she  no longer indulged  in riding sticks, and other boyish
exercises.
  The reasons assigned  for the  performance of this operation—
namely,  the entire  deprivation of sex, and thereby of any sexual
feelings in after-life—apipear to me to be unsatisfactory. It is clear,
from  Dr. Gross's description,  that this  being was  deprived of the
rights and privileges of a male by the removal of the testicles.  (See
the case of Levi Suydam, ante, p. 675.)  Dr. Gross appears to have
contemplated the case only in a matrimonial point  of view; but in
a country Avhere the rights of citizenship and  power of voting for
members of Congress are much valued, where they depend  on direct
proofs of sex, and are so strongly contested  by opposing parties—it
is a serious question Avhether he has not here struck a severe blow 
67S
CASES OF CONCEALED  SEX.
at the political rights of these beings, in thus wilfully destroying
the physical evidence of the male sex !  In this country, it might
have been a question whether he had not rendered himself liable in
damages for thus tampering Avith the laws of  nature. ^
  Concealed, sex.—It is almost superfluous to say that in some cases
sex cannot be determined by the dress, appearance, or even voice of
the individual.  Cases in which males have passed for many years
unsuspectedly  as females, and vice versa, have  been numerous.   In
some instances the secret has  been disclosed only by death.  Facts
of this kind belong rather to the annals of imposture than to those
of medical jurisprudence.  A somewhat  singular case of this de-
scription, that of Eliza Edwards, occurred to  me in  1833.  An un-
claimed body Avas  sent to Guy's Hospital, by  the Inspector of ana-
tomy, as a female.  On  removing the dress, hoAvever, it Avas found
to be that of  a male !   From some suspicion respecting the cause
of death, and the habits of this person, a coroner's inquest was held.
It turned out that the  deceased, whose age was twenty-four, had
assumed the dress of a female at the age of fourteen, and had per-
formed  in  many parts of England as an actress.  The features had
a somewhat feminine character; the hair was very long, and parted.
in the centre; the beard had been plucked out, and the remains of
this under the chin had  been concealed by a peculiar style of dress.
It was remarked during life that the voice was hoarse. The breasts
were*like those of a male, and the male  sexual organs were per-
fectly developed.  They had evidently  been subjected  to great
traction, and  appeared to have  been drawn forward to the loAver
part of the abdomen.  The state of the rectum left no doubt of the
abominable practices to which this  individual had been addicted.
It was found that death had taken place from natural causes.  The
most remarkable circumstance in the case is, that the deceased had
been attended in his last illness by an eminent physician (now de-
ceased)  for disease of the lungs; and so Avell Avas the imposition
maintained, that  his medical attendant  did  not entertain a sus-
picion of the  real sex of his patient!   (" Aled. and Pbys. Jour.,"
Feb. 1833, p. 168.)
  A more remarkable case, in which a female had successfully per-
sonated a  male  for many years, occurred in  1865.  I refer to the
case of Dr. James Barry, who was Avell knoAvn  as Staff Assistant-
Surgeon and Inspector of Hospitals. She died  in 1865, at the age
of 80; and although suspicions had existed among those Avho had
personally known  her, that she labored under some sexual defect,
it was only proved after her death that she  was really a woman.
She is reported  to have been the illegitimate child of a nobleman.
When, where, and how she passed through her medical studies no
one knows, but she contrived to obtain a diploma as Doctor of Ale-
dicine from Edinburgh when only- fifteen years of age.  The learned
examiners of the Edinburgh College may at  this time have  been
easily deceived respecting the sex  of the candidate.   The young
physician entered the army, and served at the Cape  of Good Hope, 
CASES OF CONCEALED  SEX.
679
St. Helena, the Ionian Islands, Malta, and the AVest Indies.  Al-
though eccentric, she is said to have displayed on various occasions
irreat professional skill.  She AA-as noted for being very quarrelsome,
and on one occasion at the Cape she challenged and  fought a duel
with a brother officer.  In due course she retired  from the service,
received a pension, and was made Inspector of Hospitals. In 1857-8,
and subsequently, I saw Dr.  Barry, and had the opportunity of ob-
serving  her for several days.  Her appearance and  manners were
effeminate.  Her face and hands Avere smooth and Avhite, like those
of a woman ; she had no beard or whiskers.  She was irritable and
vain; she was Avell informed and able to talk on most professional
subjects in a manner which showed that she had studied them Avith
care.  Her habits were peculiar; she  Avas a vegetarian in  diet, and
at dinner ate fruit or vegetables, Avhich she first soaked thoroughly
in water in order to remove, as she informed her friends, the ani-
malcula up>on  them.  She was thin,  and in stature resembled  a
woman, her limbs being small, but in good proportion. Her voice
was shrill and squeaking, quite unlike that a man.   The impres-
sion left upon  the mind  of all those who saw her  Avas  that she
labored  under some sexual malformation.  After her death, how-
ever, it was found that she had the sexual organs of a woman.  She
had specially- desired that no post-mortem examination of her body
should be made, but  this order was disobeyed,  a  special  report
having been ordered by the authorities.   It is difficult to compre-
hend how, in assuming the attributes and duties of an army medical
officer, she could have so  successfully maintained  the deception
through a long life.   Whether she menstruated or  not  does not
appear;  although ahvays accompanied by a  black man as a valet,
she AA-as  very secret with him, and would not allow him to be pre-
sent while she was dressing.  She  is said to  have always worn  a
peculiar and tight-fitting dress.  Her military companions and as-
sociates  may have rested content with  the  belief that  she was
laboring under some sexual defect; but the  army Aledical  Board
appears to have been easily deceived, as it did  not hesitate to grant
titles,  privileges,  and pensions  to a woman wearing the attire of  a
man. 
680
CAUSES  OF  IMPOTENCY.
IMPOTENCY.  STERILITY.
                   CHAPTER LVII.

IMPOTENCY.—CAUSES.—PROCREATIVE  POAVER IN THE MALE.—PUBERTY.
  —AGE FOR VIRILITY.—VIRILITY OF CRYPSORCHIDES AND MONORCHIDES.
  —STERILITY.—PROCREATIA-E POAVER IN THE FEMALE.—EARLIEST AND
  LATEST PERIODS FOR CHILD-BEARING.—LEGAL RELATIONS.

  Definition.—Impotency is defined to be an  incapacity for  sexual
intercourse.  It may depend—1st, upon physical, 2dly, upon moral
causes.  With regard to the moral causes of impotency they do not
concern a medical jurist.   Such causes are not recognized by law,
and he has no duty to perform beyond the application of the prin-
ciples of medicine to the purposes of the law.
  Causes.—Impotency may arise from age, from certain physical
causes, e. g., disease, or from congenital malformation or defect. With
regarcl to physical causes, a distinction must be made betAveen those
Avhich are  remediable, and those Avhich are not.   The presence of a
disease of the testicle, such as atrophy or fungous tumor, may give
rise to  incapacity;  but this incapacity may be sometimes removed
by an operation or by medical treatment, and therefore the physical
cause may be removed ; in other words, it is remediable.  To such
cases as these the law does not extend ; but it is always expected, in
alleged incapacity, that the practitioner examined on the subject
should  be  able  to say whether there is or is not a prospect of cure.
In forming a judgment upon  this point a good  knowledge of his
profession can alone assist him; no rules can be  laid down for his
guidance, for there may not be two cases that Avill precisely resem-
ble each other in their features.  Hence, it  will be necessary in this
place, to point  out  the chief causes of impotency which are of an
irremediable  nature, or those  in which the incapacity is absolute
and permanent,—a point upon which a medical opinion is chiefly
required.
  In strictness of language, the definition  of impotency, as above
given, may be applied to  a female  as well  as to  a male ; and  un-
doubtedly,  a physical incapacity for sexual intercourse may exist in
either sex.   As an instance of this incapacity in the female, may
be mentioned occlusion of the  vagina—a condition not necessarily
indicative of sterility.   The mere  occlusion of the vagina may be
a remediable form of the malady; but its entire obliteration would 
           PROCREATIVE POAVER  IN THE  MALE.        681

be absolute and  irremediable.   This latter  condition, hoAvever, is
the only iustance of complete  impotency in a female.  A protru-
sion of the uterus or of the bladder into the vagina is mentioned by
Borne avliters as a cause of physical incapacity for intercourse; but
these  forms  of disease may be commonly  remedied by  art, and
therefore require no further notice in this place.
  In professional language, the term  impotency  has been hitherto
applied  exclusively to a defect in the  male sex; and the  term ste-
rility is usually confined to all those conditions in the female which
not only render intercourse impossible, but which render it unfruit-
ful.  A male may, however, be sterile without being impotent—a
condition observed in some crypsorchides; or he may be impotent
Avithout being sterile, as where proper intercourse  is prevented by
reason of physical defect in the virile  member, although  the testi-
cles may be in a  normal condition.  See on this subject, Curling on
" Sterility in Alan" (1864).  This author points outthat sterility in
the male, apart from impotency, may depend on three causes—1st,
malposition of the testicles;  2dly, obstructions in the  excretory
ducts; and 3dly7, impediments to the  escape of the seminal fluid.
A man may not  be impotent, i. e., incapable of intercourse; but, by
reason of one of the conditions above mentioned, such intercourse
Avould be unfruitful.
  In reference to the male, the English law does not appear to go
beyond the establishment of impotency from some clear and demon-
strable cause; and, unless the alleged sterility Avere accompanied by
impotency, it would take no cognizance of that condition.   Further,
sterility from such causes could  hardly be demonstrated during
the life of a person—it would  rest chiefly on presumption or pro-
bability.
  Procreative power in the male.  Puberty.—Until the period  of
puberty the testicles are small, and they increase very little in size
in proportion to other parts.   Air. Curling found that the size  of
the seminal tubes differed but  little at  the ages of 18 months and 8
years.  The sexual function in  the male depiends entirely on the
development of these organs ;  but the age at which it  appears dif-
fers in different piersons.  The age of puberty in a healthy male in
this country varies from 14 to  17 years ; its appearance is, hoAvever,
affected by climate, constitution, and the moral circumstances under
which the individual is placed:  in some cases it is  not fully devel-
oped until the age  of 21.
  The access of puberty in the male  is indirectly connected with
the subject of rape.   A boy under the age of fourteen years is pre-
sumed in laAV to be incapable  of committing a rap>e.  (1 Hale,  p.
631, and AlatheAv's "Digest," p. 57.)  This presumption is probably
based  on the supposition that  a boy at that age is impotent.  The
statute laAV, hoAvever, now merely requires proof of penetration, and
rape, therefore, may be pihysically perpetrated by a boy at or even
under 14 years of age.  In Reg.  v. King (York Winter Assizes, 1853),
a boy aged fifteen Avas convicted of rape on a girl under 10 years of
age." In a case  elseAvhere related (see Rape), a boy aged 19 com- 
682
ILLEGITIMACY AND IMPOTENCY.
municated syphilis to a girl of 6 years of age.   It  appears  that in
India, puberty shows itself much earlier in the male.  Dr. Chevers,
quoting from the " Xizamut AdaAvlut Reports," states that a boy
of 13 or 14 years of age was found guilty of rape, and sentenced, in
consideration of his youth, to three years'  imprisonment.   A lad of
fourteen was convicted of rape on a girl of the same age; and in
another case a boy only ten years old, was convicted  of rape on a
girl 3 years of age!  He Avas sentenced  to a year's imprisonment.
("Aled. Journ. for India," p. 463.)
  The seminal secretion in the male is not considered to be prolific
until it contains those peculiar filiform  bodies which are knoAvn
under the name of spermatozoa, or zoosperms.  These  are regarded
by some physiologists as parasitic animals, but by others, Avith some
probability, as freely moving cilia.  (" Recent Advances," Baly and
Kirkes, 1848.)  All agree that they are normal and essential con-
stituents of the healthy and prolific seminal fluid.   They are pecu-
liar  to the  spermatic secretion, and,  in healthy males, are always
present in it after the age of puberty.  They disappear in certain
states of disease,  and sometimes  in advanced  age: they have not
been found in the undeveloped testicles  of crypsorchides.   In cases
in which they are absent, from whatever cause, it is a fair inference
that the person is impotent, or that he  has lost the power of pro-
creation.  (See on this subject " Observations on Sterility in Man,"
by T. B. Curling, 1864.)  In this pamphlet one case  is related in
Avhich a man aged 42, avIio was married, and whose wife had borne
a son then 8  years  of age, had  died after four days' illness from
strangulated hernia.  The testicles,  from the  fact of their being
found in the inguinal canal, were examined separately by Drs. Gosse-
lin and Godard, and no spermatozoa were discovered in either of
them; but these may have been formerly present, though absent at
the time  of examination, as the child begotten  was then eight
years of age.  In this long interval, the  secretion may have under-
gone a change, and have become unprolific.
  The presence of spermatozoa in the  seminal secretion  is indis-
pensable to the impregnation of  a female—in fact, the fecundating
power resides in these living and moving molecules. It is a curious
fact, too, that  active  motion  in  the  spermatozoon is essential to
fecundation ; thus, when they are motionless, ova  are not  impreg-
nated by them, and the power of impregnation is  in proportion to
the activity of this motion.  The impotence arising from advanced
age in the human subject, is probably not  so much owing  to a de-
ficiency of spermatozoa in the male secretion, as to their  power of
motion being exceedingly feeble.  We learn, further, that impreg-
nation is more certain when the quantity of spermatozoa  supplied
to the ovum is not reduced  to a  minimum ; hence, whatever may
be the precise  quantity of the spermatic secretion  necessary to
effect normal impregnation, it is proved that a definite quantity of
spermatozoa, or of healthy sp»ermatic fluid, is required  to fecundate.
  Impotency from aye.—It may be fairly assumed that a male is in-
capable of procreating  until  spermatozoa have appeared in the 
ILLEGITIMACY  AND IMPOTENCY.
683
seminal  secretion,  and that be  loses this poAver  when  they dis-
appear.  The age at which  they are formed varies Avith  all the
causes that  affect  puberty.   In one  instance they were found by
Casper in  the seminal fluid of a crypsorchid boy- only 14| years
old, and  Air. Curling found them in the secretion of a boy aged 18.
This gentleman  found spermatozoa  in the  liquid  taken from the
testicles  of a  man  upwards  of seventy years  of age,  and  on one
occasion, in the testicles of a person aged eighty-seven.  ATagner
Btates that they are to  be found in the secretions  of men betAveen
70 and 80 years of  age.  Af.  Rayer found them in the secretion of
a man aged 82 years (" Gaz.  Aled.," Juin  2, 1849.)   Other cases  of
a similar kind are  recorded by Debrou.  ("Gaz.  Hebdom.," 4th
Janvier, 1861, p. 6.)  Facts tend to render it highly- probable that
the fecundating power may  be retained by the male up to  the age
of 100.  According to Dr.  Dupley, the  seminal fluid of old  men
contains spermatozoa even when they are beyond the age for fecun-
dation (" Aled. Times and Gazette," June 4, 1853, p. 581); but he
does not state the circumstance Avhich enabled him to arrive at this
conclusion.   Sexual  propensities are  often  strongly developed  in
children, and thus  they may be prolific at an early age.  Dr. Rut-
tel met  Avith  a  case in  Avhich a female  at the age of 14,  became
pregnant by a boy  of the same age.  (" Henke's Zeitschrift der  S.
A.," 1844, p. 249.)   This  is  the earliest  age at which, so  far as I
can ascertain, the procreative power has appeared in the male.  Dr.
Hartshorne refers to an instance of extraordinary development  of
the male sexual organs in  a child 4 years old.   (" Amer. Journ.
Med. Sci.," Oct. 1852, p. 561.)  In a case of contested legitimacy or
affiliation, this question regarding the age  at Avhich a procreative
power appears in the male, may have an  important bearing on the
issue. Thus the person may be so young as to render it impossible
that he  should be  the father of a child imputed to him.  Cases
involving questions of  legitimacy on this ground  are not heard  of
in the present day; but  in ancient law-books, there are decisions
relative  to  the  illegitimacy of children born  during marriage,
because  the alleged fathers were  7, 6,  and  eA7en 3 years  old!
(Amos.)
   The following case in reference to the  affiliation of  children oc-
cured in 1840; a Avoman wished to affiliate a child on a youth  Avho
was in his sixteenth year.  The boy denied  that he was the father
of the child:  and there was  reason to suspect that the imputation
had been wrongly thrown upon him, in  order to  divert suspicion
from the real offender.  There Avas some difficulty in this case; but
it appears to me that the rule for a medical  man to folloAv on these
occasions is this : not to regard the mere age of the youth, Avhether
he is above  or below the average age of puberty, but to  observe
whether the  sexual organs are fully developed, and whether there
are about him any  of the marks of virility,  indicated by muscular
development, the growth of a beard, and a change in the voice.
If these  sio-ns are present, whatever may  be his age, there is strong 
684           ILLEGITIMACY AND IMPOTENCY.

reason to suppose that the sexual functions are developed.  A\re ae-
casionally hear  of instances  of extraordinary  precocity-; but  the
development of sexual poAver is generally accompanied by  other
well-marked changes in the person.  Sometimes these changes do
not make their appearance until  after  the age of 21.   [Some re-
markable cases of precocious puberty are  given in  Wharton and
Stille's Aledical Jurisprudence, § 424.—P.]
  On the other hand, it may be a question at what  time the pro-
creative poAver disappears in a male. That impotency is one of the
natural consequences of advanced age is undoubted; but this, as we
know, forms no legal impediment to the marriage of parties, how-
ever old.  The legal presumption  is, that the  generative faculty
does not disapipear through age; and if this be alleged, and legiti-
macy disputed on this ground, it must be  satisfactorily proved by
those Avho  Avould benefit by the  allegation.  This amounts to
almost an impossibility, because it  is Avell known that there is no
fixed age at Avhich the sexual functions cease either in the male or
the female; and  individuals, at least of the male  sex, who had
reached the ages of 60, 70, and even 80 years, have been known to
be capable of fruitful intercourse.   M.  Dunley  believes, from  his
anatomical  observations on  the bodies  of aged persons, that  the
causes of impotency (sterility) in  advanced age  are to be found
rather in the excretory than in the  secretory apparatus.  Thus, he
has met Avith obliterations in  the canal of the epididymis, the  vas
deferens, and  the vesiculse, the effect of which is to prevent  the
accumulation and passage of the seminal fluid.   (" Med. Times and
Gazette," June 28,1856, p. 650.)   Lord Erskine,  in the Banbury
Peerage claim, quoted the case of Sir Stephen Fox, Avho Avas mar-
ried at 77, and had four children, the last AA7hen he was 81.   Dr.
Schneider met with a case in which a man of 71  had  a child by
his wife, who  Avas only 17. (" Henke's Zeitschrift," 1842, vol. 2, p.
165.) Dr. Ruttel mentions the case of a  man who, at the age of
92 years, married and  had two children by his wife.  When  the
procreative power even appears to  be lost at an advanced age,  the
stimulus for intercourse is often very great.  The same authority
mentions cases in which these erotic feelings were remarked by him
in reference to  men between 75  and  86 years of age.  (Henke's
" Zeitschrift," 1844, p. 252.)   In all cases  of prolonged virility, it
is observed that the bodily and mental powers are also retained in
an extraordinary degree, showing the close relation which exists be-
tween the sexual function and corporeal and mental development,
eA7en to the  latest period  of  life.   Sir S. Romilly remarked, in re-
ference to the  retention of procreative power in advanced age, that
the liberality of the English laAV on this subject was excessive; for
there was no age, from  seven  upwards, at which a man had been
denied the  power of procreating  children!   (See, in  reference to
this subject, Henke's " Zeitschrift der S. A.," 1842, p. 332.)   Alales
at the age of 14, and females  at the age of 12, are legally compe-
tent to contract marriage. 
   IMPOTENCY  FROM  LOCAL DISEASE OR ACCIDENT.   685

  Impotency from local disease or accident.—The loss or destruction
of the penis or testicles, either by disease, accident, or from neces-
sary operations, would be sufficient  to  render a man irremediably
impotent.  The loss of one or both testicles,  from any of these
causes, AA-ould be indicated by the presence of distinct cicatrices in
the scrotum.   When both have been  removed by  operation, the
person  is incurably impotent;  but  if  the  organs are  healthy, a
sufficiency of the  spermatic fluid to confer procreative poAvers may
remain in the ducts for two or three  weeks after the  operation.
Thus it is that animals have been known to be prolific for a certain
time after castration; and one  case  is on record in Avhich a man,
both of Avhose testicles had been carried off by a gunshot, is said
to have retained  the poAver  of impregnating  his Avife after  the
healing of the wound.  (See a paper by Dr. Krugelstein, Henke's
"Zeitschrift," 1842, vol. 1, pp. 348 and 352.)  The loss of one testi-
cle only, by accident or operation, does not render a man impotent.
Monorchides, as  they are  called, have been  known to be  prolific.
Cases of this kind must not be confounded Avith those in Avhich
one or both testicles have not descended into the scrotum.
   In some  rare instances, the  testicles do not descend into  the
scrotum at the usual period; but one or both  may remain in  the
abdomen, or in the inguinal canals, and only descend some time after
birth; or the one  may be found in  the scrotum, and the other re-
main during life in the abdomen, or both may be retained in  the
abdomen.  In some cases of partial  descent the organs have been
mistaken for, and  treated as, ruptures by the application of a truss!
(Henke's "Zeitschrift der S. A." 1844, vol. 1, p. 249; Curling  on
"Disease of the Testis," 2d ed. p. 31.)   In one instance, the attempt
to reduce the tumor mistaken for hernia, and the application  of a
truss, caused the  death  of the  person.  (" Aled. Times  and Gaz.,"
March  2, 1861, p. 240.)   When one testicle only has  descended,
there is no  ground, cceteris paribus, to impute  impotency: the de-
scended organ has been found healthy, and to contain spermatozoa,
while the retained testicle and  its ducts have not been found to
contain spermatozoa.  Air.  Curling has collected six  of these cases,
of which four fell  under his oavii observation.   (" On Sterility in
Man," 1846, p.  6, and " Med.  Times  and  Gaz.," Feb.  23, 1861.)
When neither testicle has  descended, the  scrotum will be found
empty, without  any scar indicative  of a removal by operation, but
the other marks  of virility  may still be present.   These persons
have been called Crypsorchides.   It has been stated that  in such
cases the testicles have been regarded as congenitally defective, and
further, that the individual, although capable of sexual intercourse,
is incurably sterile.
  The non-descent of the testicles is a state rarely seen.   Mr. Mar-
shall met with only one case of non-descent of one testicle m 1000
recruits, and Avith one case of non-descent of both testicles in 10,000
recruits.   There are three preparations, shoAviiig the  non-descent of
these organs, in the  museum of Guy's Hospital: one of them was
taken from a gentleman who shot himself from despondency at his 
 686     ALLEGED STERILITY OF CR YPSO RCHIDES.

 supposed defective condition.  Hunter thought that the undescended
 testicles were ahvays imperfect in both their structure and functions,
 and that crypsorchides Avere invariably impotent (sterile).  Some
 recent researches have tended to support the views of  Hunter.   In
 January, 1860,  Air. Partridge communicated  to  the  Pathological
 Society the case of a man of 25, in whom both testicles Avere found
 in the abdomen.  Several specimens of the secretion were examined,
 and no  spermatozoa were detected.  Another case was examined
 with a like result (" Lancet," January, 1860, p. 66), and a third  by
 Air. Curling (" Aled. Times  and Gaz.," February 23,  1861).  The
 conclusions to Avhich these observations have led  is, that although
 in cases of non-descent  there may be a capacity of sexual intercourse,
 it would not be prolific: the person will be sterile.  According to
 this view, malposition of the organs may be taken as synonymous
 with defective condition: as a result of this malposition they are
 not capable of secreting prolific spermatic  fluid, and the  person is
 as  sterile as if he  had no testicles.  The  cases of monorchides re-
 ported by Mr. Curling (Op. cit. p. 8) to some  extent  support this
 theory, since spermatozoa were  found only in the  fluid of that tes-
 ticle Avhich occupied its usual position in the scrotum.  He has also
 collected from various sources seven cases of crypjsorchides, in Avhich
 both testicles were either in the abdomen, or in the inguinal  canals;
 the fluid contained in them was  destitute of spermatozoa, and
 although impotency did not exist, these persons either were, or were
 presumed to be  unprolific.  Al. Godard has  noticed that horses
 whose testicles are retained in  the abdomen, although capable  of
 intercourse, are sterile.
  On the other side of the question there are, however, facts Avhich
 are wholly inconsistent with this theory.   Many years since I pub-
 lished an account of two cases of crypsorchides communicated  to
 me by my friend and  colleague  Air. Cock.   The testicles in these
 men had not descended, but their virile functions  were undisputed.
 One of them, before he had reached the age of 30 years,  had been
 twice married, and had had children by each Avife, besides illegiti-
 mate children which were affiliated on him during the time he
 lived in service.   In a report of  cases of hernia by Air. Poland
 (" Guy's Hospital Reports," 1843, vol. 1, p. 163), there is the case
 of a man, aged 29, a crypsorchid, whose testicles had never descended.
 Air. Poland states that  there was not the slightest trace of  scrotum;
 the penis Avas well developed, and there were all the other signs of
 virility.  This man married when he was 20 : he had had two chil-
 dren  by his first Avife; and at the time of his admission into the
 hospital  had been married two years to a second Avife.  In  January,
1862, I  saw, in Guy's  Hospital, a patient under Air. Durham: the
testicles  of this man had not descended—they were lodged in the
inguinal canals.  The  man  was 32 years of age, well developed,
with  every appearance of virility about him, and with the same
masculine development which is seen in other men of the same age.
This  man  was married, and  had had  two  children by  his Avife.
Since puberty, he had  ahvays been competent, and he ridiculed the 
VIRILE  P0AVERS  OF  CRYPSORCHIDES.        687
idea that his testicles were inefficient.  Another case is referred to
by Air. Curling (Op. cit. p. 9), Avhich occurred to Dr. Debrou, of
Orleans.  The testicles  Avere in the inguinal canals ; there AA-as no
scrotum.   The man had been married, and had had one son by his
wife.  These  facts prove that crypsorchides, in some cases, have a
poAver of procreation like normally constituted men.  Casper relates
a case in which a crypsorchid was charged with an unnatural offence.
He Avas a boy between 14 and 15 years of age, and it appeared that
he had been guilty  of  unnatural conduct towards  another boy 8
years of age.   Spermatozoa were  detected by Casper  on his shirt
sixteen days after the act.   On examining the boy, both testicles
were found in the inguinal canals.  (" Ger. Aled." vol. 2, p. 187.)
   By these facts, therefore, it is satisfactorily established that cryp-
sorchides are not necessarily sterile, and that no absolute rule can be
laid doAvn respecting the existence or non-existence of prolific power
under such circumstances.   It has been objected that in the above
instances of prolific power spermatozoa have not been proved to exist
in the spermatic secretion^ of the individuals, and that the evidence
is therefore incomplete.   But these bodies have not been proved to
be absent, and most persons will agree that there is no better evidence
of prolific power than the procreation of children, whether sperma-
tozoa are, or are not detected ; a matter Avhich will sometimes depend
on the accuracy of observation or experience of the examiners or,
it may be, on a morbid state of the secretion.  If none  AA7ere found
under these circumstances, it would  only  pirove that  our present
theories of generation would require to be  modified.  One affirma-
tive instance is sufficient, for all the purposes of law, to overthrow
ninety-nine negative  instances; and  as  a  physiological fact, it is
obvious that the organs Avhich have not descended are not ahvays
defective in structure or function.   The cases hitherto observed are
so nearly balanced that it is difficult to say Avhether it is the rule or
the exception that crypsorchides should be found prolific; the facts
above mentioned clearly prove  that there  is no reasonable ground
for pronouncing them to be absolutely sterile or unprolific merely
because their testicles are not in the scrotum.  If with a non-descent
of these  organs, there should be  a non-development of  the other
external organs, and this  is accompanied  by a total want of the
characters of virility, then  the person may be impotent or sterile.
The testicles may, in such  a  case,  be  either congenitally absent or
physically imperfect,—a fact only  ascertainable by an examination
of the body after death.  On the other hand, in cases in which there
are no external marks of effeminacy, or other grounds for suspecting
a want of procreative power, and the person is capable of sexual in-
tercourse, this imperfection does not offer any bar to marriage, nor
is it a sufficient ground for divorce. It would not justify a medical
man in denying the paternity of a child on a question of affiliation,
bastardy,  or inheritance; and so long as a power of sexual  inter-
course existed, it Avould  not justify him in pronouncing a person to
be incurably sterile.   The capacity for  sexual intercourse is the fact
to Avhich the Enolish  laAV commonly looks  on these  occasions.   If 
688        EFFECT OF SEXUAL  MALFORMATION.

this exists, then it will hardly entertain the question—surrounded
as it may be with conflicting medical opinions—Avhether, from the
mere retention  of the organs in the abdomen, the fluid secreted is
or is not, microscopically speaking, of a  prolific nature ?  AVomen
may be sterile from a variety of causes affecting the internal organs,
only ascertainable after death.  The ovaries may be so diseased that
no prolific intercourse can take  place, although there may be no
physical incapacity.  In a case related elseAvhere,  the  incapability
of conception on the part of a woman Avas held by Dr. Lushington
not to be a sufficient ground for pronouncing a sentence of nullity
of marriage (post);  and doubtless the want of poAver on the part of
a man  to effect impregnation, unless  it depended on some visible
physical defect, would be viewed in a similar  light.   Such persons
are not  impotent, but sterile, and sterility in an irremediable form
is rather assumed than demonstrated to exist.
  The presence of what have been called supernumerary testicles
does not affect  the virile powers of the individual.  These have in
general been found, by dissection, to be tujnors, connected with the
healthy glands, and not at all adding  to or interfering Avith their
functions.  Even the presence of two or three penes, according to
Alencle, is no bar to the exercise of sexual power, provided only one
possesses the normal  characters of the male organ.  (" Ausfiihrl.
Handb. d. ger.  Aled.," vol. 4, p.  337.)   In the summer of 1865, a
Portuguese youth, aged 19, I. B. dos Sautos, was seen  by many
medical men in London.  He was Avell formed except in  reference
to the sexual organs.  He had two complete and Avell-formed penes,
placed side by side; the right somewhat smaller than the left, and
both subject to erection at the same time.  He stated that he used
the left in sexual intercourse.   On the outside of each penis was a
scrotum with one testicle fully developed.   BetAveen them Avas a
shrunken scrotum which contained two  testicles until he was ten
years old, Avhen they ascended into the abdomen.  When the bladder
acted, urine issued from both penes. An engraving of this remark-
able malformation is given in the  history of the case.   (" Lancet,"
July 29, 1865, p. 124.)
   In some instances there is an arrest of development in the exter-
nal organs; and with this there is generally an absence  of sexual
desire.   Certain diseases of the appendages  of the  testicles may,
however, render a person sterile.   The spermatic secretion is  com-
monly suspended in most severe diseases Avhich affect the  body.  A
frequent cause  of impotency (sterility) in the adult, when the or-
gans are apparently sound, is spermatorrhoea arising from abuse.
This, however,  is remediable  to a greater or less extent by treat-
ment.   (See Curling, " Diseases  of the Testis," 2d ed. p.  386 ;  also
" Med.  Times and Gazette," Jan.  23,1858, p. 95.)  The incapacity
for intercourse in either sex may arise from extensive disease affecting
parts in, and around the organs of generation.  The medical opinion
here must be  regulated entirely  by  the circumstances attending
each case.
   On the absence of the penis, as  well as on its  defective  organiza- 
IMPOTENCY  FROM DISEASE.
689
tion, as causes of incapacity, some remarks have been already made.
Sometimes the defect is merely connected with the urethra.  Thus,
the orifice may be on the  dorsum penis, and  in  other cases under-
neath the organ, so that the urethra  may terminate  at  a variable
distance from the glans penis.   Those laboring under the former
defect are said to have epispadia, and under the  latter, hypospadia.
The poAver to have fruitful intercourse will  in either case depend on
the situation of the urethral aperture.  Ruttel kneAV an  instance of
a hypospiadian having several children. (Henke's " Zeitschrift, 1844,
p. 258.)  Some doubt  has existed  respecting the virile powers of
those Avho are affected with hypospadia.  In September, 1850, a lad,
aged 17, was summoned before the magistrates of Kidderminster on
a charge of affiliation, in reference to the pregnancy  of  a girl aged
18.   The defence was that he could not be the  father of a  child,
because there Avas 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 alloAved
the urine to ptass, but with  some difficulty.  One medical Avitness
gave it  as  his opinion that it was not impossible, but  highly im-
probable, that the defendant should possess procreative  power;
another freely admitted the boy's capacity, and the case was decided
against him.  ("Aled. Times," Sept. 21,1850, p. 321.)  This decision
was physiologically correct.  When tbe urine can pass, the seminal
fluid can pass ; and the only question is, whether the intromission
can be such as that the  misplaced orifice should come in contact
with any part of the vagina?  This  must depend on the situation
of the orifice.   [Cases illustrative of the fully  prolific powers of
hypospadians Avill be found in the " Med. Times," Sept.  14,1850, p.
292, and Oct. 12, 1850, p. 392.   An instance of the virility of an
hypospadian has also been published by Air. Noble, of Alanchester,
in the " Assoc. Med. Jour.," Alarch, 1853, p. 236.]  Similar remarks
apply to episp>adians.  These malformations are sometimes remedia-
ble ; but whether remediable or not, they are not, under  any cir-
cumstances, to be regarded as absolute causes of impotency.
  Impotency from general disease.—The influence  of local disease in
affecting virility has been  already considered.  But there is a class
of caseswhich may come before a practitioner, in Avhich, with well-
formed and healthy organs in the male, there will be a state of im-
potency.  Sometimes this  may depend on natural weakness of con-
stitution, or on  a want of  proper development of the muscular and
nervous system: at other times it is due to certain diseases producing
nervous exhaustion, and it is then of a temporary nature—persisting
while the body is still suffering from the disease, and disappearing
on recovery.  As a converse fact, there are some diseases which
appear to bring out the dormant virile powers of persons, or to excite
to a higher degree of intensity those  which already exist.   Thus it
is said that in conA7alescence from fever there is, occasionally, ex-
traordinary salaciousness:  but this statement requires confirmation.
Again, there are  diseases which  neither interrupt  nor affect  the
      44 
690
IMPOTENCY FROM DISEASE.
exercise of the sexual functions.   As a general rule, diseases which
do not affect the brain and spinal marrow, and which  are not at-
tended with great debility, do not prevent fruitful intercourse.  On
the other hand, diseases which are attended or followed by great
debility, suspend  or destroy- 'sexual power.  Among these may be
mentioned water in the chest, general dropsy, especially if attended
with effusion in the sexual organs, nervous and malignant fevers
which affect the brain, apoplexy, palsy, and other diseases which
directly attack the brain or spinal marrow.  These last-mentioned
diseases probably act by suspending the secretion, or altering  the
nature of the prolific fluid, as well as by preventing that erection
of the male organ without which intercourse  cannot  take place.
The sexual function is  so intimately  allied to  bodily vigor and
nervous energy, that the integrity of the one may be pronounced to
be essential to the integrity of the other.  Habits of drunkenness
and the abuse of alcoholic liquids, tobacco, or opium, may give rise
to impotency by the injury done to the brain and nervous system.
(The reader will find this subject fully discussed by Mende, " Aus-
fiihrl. Ilandb. der ger. Med.," vol. 4, p.  349.)
  In  Wood v. Hotham, Jan. 7, 1864, the defendant, a surgeon, Avas
sued for a sum of money for his wife's maintenance.  He alleged, in
defence, that his wife had been guilty of adultery, and that one of
two children born during the marriage was not his.   He  gave as a
reason for this  that at the time he was so ill that it was impossible
he  could  have had connection  with his wife.   He, however, was
then in the habit of sleeping with her, and he was sufficiently strong
to go his round of daily visits.  The learned judge, in remarking
upon this point, said if  such evidence were to be held  sufficient
proof of illegitimacy, the whole of the laAV relating to the access
and non-access of a husband must be  set aside.  The jury returned
a verdict for  the plaintiff.  [See the case of Page  v.  Dennison, 5
Casey, 420, cited ante.—P.]
   Diseases and injuries of the spinal cord producing paraplegia
have no direct effect on the testicles, but destroy the power to copu-
late.   (Curling, Op. cit. p. 371.)  When there is a wasting of the
testicles, as a result of general piaralysis of long standing, there can
be  no doubt of impotency ; but Mr. Curling quotes  a  case from a
foreign writer, in which, under paralysis (paraplegia) of some years'
duration, a man retained  sufficient sexual power to have prolific
intercourse.  When the paralytic person  is advanced  in  age, it is
highly probable that  he  is impiotent.  In December, 1857, a case
was referred to me, in a question of bastardy, for my  opinion on a
capacity for intercourse under  the  following circumstances.   A
woman required an order of affiliation on the putative  father of
her bastard child.  She Avas a. widow, and the  illicit connection
took place about two months before her husband's  death.   The
husband was at  the time 84 years of age; he was bedridden, and
for many weeks before his death he could not move in  his bed, and
was unable  to pass his urine  without assistance.   The medical
opinion of those who examined him was that he was impotent from 
           PROCREATIVE  POWER IN  THE FEMALE.       691

 physical infirmity, and in this opinion I concurred:  stating, hoAV-
 ever, that  unless the  male organs were  diseased or destroyed, it
 could not  be  said that intercourse was impossible.  It was, how-
 eA-er, Avholly improbable that the husband could have been the father
 of the child.
  BIoavs on the  head or spine, by affecting the brain  and  spinal
 marrow, may  piroduce impotency.  Several cases  of   impotency
 from this  cause  are  related by Curling (op.  cit. p.  362).  It has
 been noticed that blows on the under and back part of the head, in
 the region  of the cerebell um, have  been followed by  loss of sexual
 power  on  recovery.  Sometimes this is  temporary; but at other
 times, when there is Avasting of  the testicles, it is permanent and
 irremediable.
   Of moral causes it  is unnecessary to speak. The sexual desire
 like other animal passions, is subject to great variation ; and there
 are  instances  on  record in  which men, otherAvise 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 LaAV designates as frigidity of constitution.  This is not to
 be discovered by external examination, but rather  from their own
 admission.   Under this head we may class hypochondriacal affec-
 tions.

  Sterility.   Definition.—Sterility is usually defined to be " the  in-
 ability to procreate, or a want of aptitude in the female for impreg-
 nation.  It is not usual to speak of sterility in the male, although
 there may be procreative incapacity;  because the  defective condi-
 tion in this sex, from Avhatever cause, is, in a legal point of view,
 included under the term " impotency " (see  p. 680, ante).   In the
 strictness of language, a male who has been castrated is sterile ; but
 it is commonly said that  he is  impotent.  Alany apparently well-
 formed males maybe sterile without being impotent, i. e., they may
 have intercourse without procreating ; for the power of copulating
 must not  be confounded  with that of procreation.  Mr.  Curling
 has pointed out that various causes may  render a male  sterile, al-
 though he may retain a poAver of sexual intercourse, and thus can-
 not be  regarded  as impotent in a legal sense.  ("Diseases of the
 Testis,"  ed. 2, p. 216.)  Some crypsorchides may be sterile, or de-
 ficient in procreating power, while at  the same time  impotency or
 incapacity for intercourse may not exist.  In reference to  Avomen,
 sterility implies that condition in which there is an  " inability to
 conceive."  This appears to be the true meaning of the term, and
 the sense in which it is used not only by the best writers, but in
 common phraseology.
  Procreative power in the female.  Puberty.—-In the female, the pro-
 creative  power is supjposed not to exist until after the commence-
 ment of menstruation,  and to cease   upon  the  cessation of this
periodical secretion.  The menstrual  function is commonly estab-
lished in females in this climate betAA7een the ages of fourteen and
sixteen;  but it may occur  much  earlier—indeed, in some rare in- 
692        PREGNANCY  BEFORE  MENSTRUATION.

stances, a discharge resembling the  menstrual has been known to
occur in mere infants.  In other cases its appearance has been pro-
tracted to a much later period.  According to Dr. Ruttel, the men-
strual function appears in  the smallest number of females at 12, 13,
and 14, and in the largest  number at 16,17, and 18 years. In some
it is only first established  at from 19 to 21 years; and he states at
this age he has often found the uterus small and quite undeveloped.
The  earliest and  latest  periods in a large number  of cases Avere
respectively  9  and 23 years.  ("Lancet/' Nov.  30, 1814, p. 283.)
Perhaps, in this country, the most frequent age for the commence-
ment of menstruation may be taken at 15.  It is liable to be accel-
erated in its appearance  by certain moral and  physical conditions
under which  a girl  may  be pilaced.  The most common intervals
for the appearance of this  function are twenty-eight and twenty-
one days.  It sometimes  does not  appear until late in life. Dr.
Camps found it had not  appeared in a married woman, set. 30, Avho
had borne no children.  (" Med. Gaz.," vol. 32, p. 409.)  Another
case is mentioned in the same volume where  it  appeared  for the
first time at the age of 47  (p. 567).   So soon as this function com-
mences, a woman may be  considered to have acquired procreative
power;  but a female may  conceive  before the function has com-
menced, during the time of  its occurrence, or after it has  ceased.
From facts elseAvhere stated,  there is some  reason to believe that the
period Avhich immediately  precedes or follows the discharge is most
favorable to conception; although the  experience of many accou-
cheurs has shown that impregnation may take place  at any time
between one menstruation  and another.
  It  is  important to remember that these  changes in  the uterus
may  produce remarkable  effects by sympathy with the brain and
nervous system.   At, or about the  time  of puberty,  especially  if
any cause of obstruction  exist, females  become irritable,  easily
excited, and they have been  known to perpetrate, without motiA7e,
crimes of great enormity, such as murder  and arson.  A propensity
to steal  is also stated  sometimes  to manifest  itself.   (See post,
Kleptomania.)   It  has  been  remarked  that acts of arson have
been frequently committed by  girls  at  this period of life, and the
crime has spread by imitation.  The state of the mind should be
therefore carefully watched at this time, and any causes of  violent
excitement removed. Irregularity,  difficulty, or  suppression  of
the menstrual  secretion  may  give rise  to  temporary insanity.
Puberty in the male may be  attended with similar morbid pro-
pensities, but these are not so commonly-witnessed as in the female
sex.
  Pregnancy before menstruation.—The previous occurrence of men-
struation  is not  indispensable to pregnancy : many cases  are on
record in which women who have never menstruated have conceived
and borne children.  One  case is reported in which a woman, aged
25, became pregnant and bore a child, and menstruation Avas only
regularly established afterwards.  (" Lancet," February, 1842.) Dr.
Murphy mentions another instance of pregnancy previous to men- 
            PREMATURE  PUBERTY IN  FEMALES.         693

struation in a woman  aged 23.  (" Obstetric Reports," 1844, p. 7.)
Numerous cases of conception Avithout previous menstruation are
quoted by Capuron (" Aled. Leg. des Ace," p. 96); and  no fewer
than nine instances  of pregnancy before  menstruation have been
collected by Air. AVhitehead.  The Avomen Avere all  in  excellent
health  during the whole time, and  one did not menstruate until
more than  two years  after the marriage  had been consummated.
("On Abortion," p. 223 ;  see also Orfila, " Aldd. Leg.," 1848, vol. 1,
p.  257.)  Another  case  will  be  found reported  in the "Aledical
Gazette " (vol. 44, p. 969).  Dr. W. Taylor met with an instance in
which a girl aged  13, bore a  child before menstruation had ap-
peared.  ("Med Times and Gazette," Alarch  12, 1853, p. 277; see
also, for remarks on  this subject, " Edin.  Alonthly Journ.," July,
1850, p>. 73.)  The  late Dr. Ried  has stated  that  a patient of his
bore a child at  the  age of 17 without having previously men-
struated ; and he collected from various authorities a number of cases
of pregnancy  occurring in women  who  had  not menstruated.
(" Lancet," September  3, 1853, p. 296.)   [At a  recent meeting of
the College of Physicians of Philadelphia (Sept. 4,  1861), Dr. R. P.
Thomas stated that he  had lately, for the third  time, attended in
confinement a lady who had been  married about twelve years and
had given birth to six healthy children, although she had never
menstruated.  She Avas  married  at  22, and  had  always enjoyed
good health ; her labors were natural, with but  little show and no
subsequent  lochial discharge.  Dr. Hays, on  the  same  occasion,
mentioned the case of a lady patient  of  his, who had  menstruated
very rarely,  not  oftener  than  once a year, and yet had borne six
healthy children at intervals of fourteen months, and Avas a healthy-
woman.—H.]
  Instances of premature puberty in the female are  now numerous:
they are far  more common than in the male sex.  Air. AVhitmore
met with the case of a female child who, from 2k few days after birth
menstruated regularly, at periods of  three weeks and  two or three
days, until she had attained the age of 4 years, Avhen she died.  On
inspection after death  she appeared  like  a much older girl.  The
breasts were unusually large, and the female organs  and loAver limbs
were considerably7  developed.  (" North  Journ. Aled.," July, 1845,
p. 70.)   Another  case  is reported in the " Lancet" (January 29,
1848, p. 137); this  was a child aged 3 years.  The breasts were as
healthily developed as in an adult of 20 years, and the sexual organs
were also as much developed as in a girl  at the age  of  puberty.  It
was observed that this child, Avho had been regularly menstruating
for twelve months, had the appearance of a little  old AA-oman.   (For
other cases of menstruation at 5 years, see " Aled. Gaz.," vol. 25, p.
548 ; at 3 years, vol. 47, p.  244 ; and  at 3| years, "  Aled. Times and
Gazette," July 24,1858.)  In these instances there is great reason to
believe that a procreative power is also early developed;  but it is
not common to hear of such young females becoming impregnated.
A case is mentioned by Dr. Beck, in which a girl menstruated at 1
year; she became pregnant and Avas delivered of a child Avhen little 
694
MENSTRUAL  CLIMACTERIC.
 more than ten years old.  Dr. AValker met with a case in which the
 menstrual function was established at the age of 11J years, and the
 patient was delivered of a living child when only 12 years and 8
 months old.  ("Amer. Journ. Med. Sci.," October, 1846, p. 547.)
 In another, observed by Ruttel, already referred to, a female of the
 age of fourteen became pregnant by a boy of the same age.  He also
 quotes three other cases, where one girl of the age of nine, and two
 of the age of thirteen, became pregnant (loc. cit.).  The first of these
 three cases represents  the earliest age for  pregnancy yet assigned by
 any author. Dr. Wilson met with an instance in which a girl at the
 age of 13 years and 6 months gave birth to a full-grown child:  con-
 ception must have taken place when she was 12 years and 9 months
 old.    ("Edin. Aled.  Journ.,"  October,  1861.   See also Casper's
 " Vierteljahschrift," January,  1863, p. 180.)   Mr. Robertson men-
 tions the case of a factory girl who became pregnant in the eleventh
 year of her age.   In a case communicated to me a girl menstru-
 ated at ten years and two months, and became pregnant when eleven
 years and eight months old.
   Age at  which  menstruation ceases.   Menstrual climacteric.—The
 average age at which  this function ceases in women is usually from
 forty to fifty years: but  as it may commence  early, so it may con-
 tinue late in life.  In one case it has been known to cease at the age
 of 23, and in other instances it has continued  to the age of 66 and
 even  of 75  years.  (Whitehead, op. cit. p.  145 et seq.)  Dr. Royle
 describes three cases in two of which menstruation continued up to
 the age of 67.   (" Med. Times and Gaz.," Nov., 1860.) Mr. Thomas
 met with a case in which a woman had ceased  to menstruate at the
 age of forty-five, but  the discharge  suddenly  reappeared after an
 attack of  illness when she  had reached the age of sixty-nine.  The
 discharge  appeared several  times, but not with  monthly periodicity.
 It seems that her mother and sister had also menstruated at the ages
 of 69 and 60.  (" Med. Times and Gaz.,"  Aug.  7,1852, p. 148.)  In
 a case which occurred to Capuron, it continued beyond the age of
 60 (op. cit. p. 98); but a more remarkable  case both of late men-
 struation and late pregnancy, is quoted by Orfila from Bernstein. A
 woman in whom  the function appeared at 20, menstruated until her
 ninety-ninth year.  Her first child was born when she  was 47, and
 her seventh and  last when she was 60.   (" Alexl. Leg." 4£me ed.,
 1848, vol.  1, p. 257; see also Briand," Alan. Complet de  Med. Leg.,"
 1846, p. 137.)  From  these facts it is clear that it is impossible to
 fix the age of a woman by the period  at Avhich  this " change of
 life" occurs.  At the best, it  can  only be  an  average of a certain
 number of instances.
   Is it possible for a woman  to become pregnant after menstruation has
 ceased?—It is commonly asserted and believed that, after the cessa-
 tion  of menstruation, a woman is  sterile.   This is doubtless the
general rule; but  in  a medico-legal view  it  is necessary to take
notice of the exceptions.   Air. Pearson, of Staleybridge, communi-
cated  to the " Lancet," some years ago, the case of a lady, aged 44,
who up to September, 1836, had given birth to nine children.  After 
FECUNDITY — LATEST  AGE FOR PREGNANCY.     695
this the menses appeared only slightly at the regular periods until
July, 1838, when they- entirely ceased.  Owing to this she supposed
that she Avas not liable to become pregnant; but on the 31st Decem-
ber, 1839—therefore eighteen months after the entire cessation of
the menses—she Avas delivered of her tenth child.  Hence concep-
tion must have taken place at from eight to nine months after the
final cessation  of the discharge.
  Latest age for pregnancy.  Fecundity.—Numerous instances are on
record of women advanced in life bearing children.  A case is  re-
ported in Avhich a well-formed woman, who had been married nine-
teen years, did not bear a child  until she had reached the age of
fifty.  (Schmidt's  "Jahrbucher  d. Med.,"  1838,  S. 65;  Henke's
" Zeitschrift,"  1844, S. 251.)  In this case it is stated that menstru-
ation had  ceased two years before conception.   Ruttel observed in
tAvelve Avomen that they bore their last children at ages varying
from 45 to 50 years.   Ottinger met with an instance  of a woman
bearing a child at 50 ; Cederschjald with another, where the woman
was fifty-three and menstruation still continued.  Haller records tAvo
cases in which women  at sixty-three and  seventy respectively bore
children.   (Briand, " Alan. Comple't de Med. Leg.," p. 137.)  Never-
mann has  draAvn up a table in reference to the late  ages of life in
which Avomen  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
  42  .
43
44
45
46
47
101
113
 70
 58
 43
 12
 13
Of 48 years
  49
  50
  52
  53
  54
  A case was communicated to the " Aledical Gazette" (vol. 39, p.
950) by  Dr. Davies, of Hertford, in which a woman was fifty-five
years of age when her last child was born;  she menstruated up to
that time.  In Lord v. Colvin (Vice-Chancellor's Court, July, 1859),
one of the questions raised was AA7hether a woman set. 52, aa71io had
been married thirty years Avithout having children, had then passed
the age of child-bearing: her issue  would in  that case take the
benefit of certain property  under  a will.  It was decided that the
Avoman had not reached an age at which it could be said to be im-
possible that she might bear children.  In a return of the Registrar-
General for Scotland (Feb.  1862),  it is stated in the Table for Glas-
gow, that one mother who Avas only 18,  had had four children, one
who Avas 22 had had seven  children, and of tAvo Avho  were only 34,
the one had had thirteen and the  other fourteen children.   On the
other hand, two Avomen became mothers as late in life as at 51, four
at 52, and one mother AA7as registered as having given birth to a child
in the 57th year of her age.   [Upon this point Ave have the testi-
mony of Sir "Edward Coke, who tells us that in  his "time a woman
above three-score yeares old  hath had a childe."  Co. Litt., 40, a.—P.] 
696      MEDICO-LEGAL  RELATIONS  OF  STERILITY.

We  cannot, therefore, pretend to fix the age  beyond which preg-
nancy may not  occur.   Questions of this  kind have  an impor-
tant bearing on the subject of legitimacy ; and  unless the laAV looks
to something more than ordinary professional experience in such
matters, the decisions of courts must be inequitable.   Iu  tAA7o recent
cases, however, it appears to have been assumed that a woman could
not bear a child after the age of 53.   This was the decision of the
Alaster of the Rolls in Price v. Bousted, and  more recently the de-
cision has been followed by Kindersly, V. C, in Haynes  v. Haynes.
(Feb. 1866.) The petition in this case involved the question whether
a single lady, aged 53 in December, 1865, could be  considered as
past child-bearing, and it was decided in favor of the assumption.
These decisions are not reconcilable with the cases given at p. 694.
   Causes of sterility.—The  causes of sterility in the  female system
are very numerous.  Some of them depend upon peculiarities of
constitution, the  sexual organs being well formed and developed,
others upon latent changes, or congenital defects in the uterus and
its appendages, only  discoverable by an examination after death.
Sterility rarely becomes a  medical question in contested cases of
legitimacy ; for a claim on the part of a person to be the offspring
of a particular Avoman, unless she were in collusion with  the claim-
ant, could only be made after her death : and if not  disproved by
medical evidence, showing that the woman  could not have borne
children, it would in general be easily set aside by circumstances.
It may be most important  to  prove that  a woman was  in such a
bodily condition  that she never could  have  conceived, or  borne a
child.  If the uterus,  ovaries, or other parts  were  congenitally de-
fective or  absent, or  if there were external sexual malformation,
accompanied by occlusion or obliteration  of  the vagina, a medical
witness could have no difficulty in saying that the  woman must
have been sterile.  ("Aled. Times and Gazette," Jan. 23,  1858, p.
96.)   A mere occlusion of the vagina, removable by operation, does
not necessarily indicate sterility,  as  the internal  parts  may be
healthy and sound.  A congenital absence of the uterus and ovaries
is  not inconsistent Avith a  full development of other parts, as the
vagina, clitoris, and breasts.
 ^  Medico-legal relations  of the  subject.   Divorce.—Sexual  malforma-
tion, involving  impotency or sterility, constitutes one  of the canoni-
cal impediments to marriage, and if matrimony be contracted by a
party laboring under such malformation, the contract is voidable.
The impediment  constituting impotency may arise either from mal-
formation, from that which the law calls frigidity of constitution, or
any physical cause of Avhatever nature Avhich may render intercourse
impossible.  When the physical defect is not apparent and irreme-
diable, a continued cohabitation of three  years is required before
a suit can be entertained (Ayliff's "Parergon"); but  according to
Oughton—"hsec triennalis  expectatio  non est necessaria ubi statim
possit constare  de impotentia coeundi."  A suit for a sentence of
nullity may be  promoted by either party, and the medical proof
required to found a  sentence  must be such  as to satisfy the court 
SUITS FOR DIVORCE.                 697
 that the incapacity pleaded was in existence  at the time of the
 marriage, and that it still remained without remedy.  There should
 be no delay in instituting the suit, and there should be proof that
 the impediment was not known to the complaining party at  the
 time of the contract.  A longer delay in making the complaint is
 allowed to  a female, Avithout prejudicing her case, than to a male,
 by reason of the modesty of her sex.
  In a suit Avhich came before the ecclesiastical  courts in 1845, a
 singular  question arose, Avhether, Avhen  there was  a capacity for
 sexual intercourse on the part  of  a woman, with a  certainty that
 from physical defect it could never be prolific, this AA-as sufficient to
 entitle the husband to a divorce.  On the part of the  woman, it Avas
 insisted that in order to entitle a  party to a sentence of divorce,
 there must be  an utter impossibility of  sexual  intercourse.  The
 case, it Avas argued, was one of mere sterility, Avhich was no ground
 for a sentence.   Dr. Lushington, in pronouncing sentence, said that
 mere incapability of conception is not a sufficient ground whereon
 to found a decree  of  nullity.   The only question is whether  a
 female is or is not capiable of sexual intercourse ; or, if at present
 incapacitated, Avhether that incapacity admits of  removal; a power
 of sexual intercourse is necessary to constitute  the marriage-bond;
 and this intercourse must be ordinary and complete, not partial and.
 imperfect;  yet  it would not be piroper to  say that every degree of
 imperfection would deprive it of its natural character.  If it be so
 imperfect as to  be scarcely natural, it is, legally speaking, no inter-
 course at all.   As to conception, there is no doubt that the malfor-
 mation is incurable.  If there was a reasonable probability that the
 female could  be made capiable  of natural coitus, the marriage could
 not be pronounced void ; if she could not be made capable of more
 than an incipient, imperfect, and  unnatural coitus, then it would
 be void.
  From cases hitherto  decided, it  appears that  in order to justify a
 decree of divorce on the ground of impotency or sterility, the im-
 pediment to intercourse or pjrocreation should be established by good
 medical evidence, and it must be apparent and irremediable; it must
 also have existed before the marriage of the parties, and have been
 entirely unknoAvn to the person suing for the divorce; if it has super-
 vened after the marriage, this is no ground for a  suit.  The nature
 of the impediment is to be determined by private medical opinions
 or affidavits, based on an examination of both parties.  There is one
 remarkable circumstance with respect to these cases, namely, that
 in nearly all of them  the suit is by the woman  against the man;
 although there is no reason Avhatever to suppose that impotency and
 sexual malformation are more common in males, than malformation
 and sterility in  females.  We rarely hear of a husband instituting a
 suit of divorce on the ground of sterility (incapacity of procreation)
 in the Avife ; it is, I believe, in most instances, that the wife promotes
 the suit on the ground  of impotency or incapacity of intercourse in
 the husband.  The difficulty of establishing incapacity in the female,
and the facility of proving impotency from physical causes in the 
698                 SUITS FOR  DIVORCE.
male, may probably account for this difference.  Suits of this kind
are sometimes instituted many months and years after the union of
the persons ;  but it is pretty certain that the desire  for separation
in these cases often depends on some other cause, which the laAV
would not recognize as sufficient of itself, while it would admit the
plea of impotency.  The French law very judiciously applies the
principle of condonation to such cases, so that no suit for nullity of
marriage  can be entertained, if cohabitation has continued for six
months after the discovery of the personal defect.   This appears to
be more consistent with  justice  than our own law; but piratically,
these suits, after protracted cohabitation, are always regarded Avith
great suspicion. 
DEFINITION  OF RAPE.
699
RAPE.
                   CHAPTER  LVIII.

 NATURE OF THE CRIME.—SOURCES OF MEDICAL EVIDENCE.—RAPE ON IN-
  FANTS AND CHILDREN.--MARKS OF VIOLENCE.--PURULENT DISCHARGES
  FROM THE  VAGINA.—EVIDENCE FROM GONORRHOEA AND  SYPHILIS.—
  RAPE ON GIRLS AFTER PUBERTY.—DEFLORATION.—SIGNS OF VIRGINITY.

  Rape is defined in law to be the carnal knowledge of a woman by
 force, and against her will.  Medical evidence is commonly required
 to support a charge of rape, but it is seldom more than corrobora-
 tive ; the facts are, in general, sufficiently apparent from the state-
 ment of the prosecutrix.   There is, however, one case in which
 medical evidence is of  some  importance—namely, when a  false
 accusation is made.  In some  instances, as in respect  to rape on
 infants and children, the charge may be founded  on mistake; but
 in others there is little doubt that it is often wilfully and designedly
 made for motives into which it is here unnecessary to inquire.   The
 late Professor Amos remarked, that for one real rape  tried in the
 circuits, there were on the average twelve pretended cases! In some
 feAV instances, these false charges are  at once set aside  by medical
 evidence; in others, medical men  may be  sometimes  the dupes of
 designing persons ; but in  the majority, the falsehood of the charge
 is proved by inconsistencies in the  statement  of the  prosecutrix
 herself.   I am  informed that in  Scotland, where there is a public
 prosecutor, and  a careful preliminary inquiry, false charges of rape
 are exceedingly rare.  The consent of the  girl does not excuse or
 alter the nature of the crime when she is  under ten years of age,
 since consent at  this period of life is invalid ; and the carnal knowl-
 edge of such a girl is rape in laAV, and is made a felony by the 24
 & 25 Vict. c. 100, s. 50.  Even the solicitation of the  act on the
 part of  the child does not excuse it.
  [The  provisions of the Revised  Criminal Code of Pennsylvania,
 Act of 31st Alarch, 1860, §§ 91, 92, 93, upon this subject, are as fol-
 lows :—
  § 91.  If any person shall have unlaAvful carnal knowledge  of  a
woman, forcibly and against her will, or who being of the age of
fourteen years and upwards, shall unlawfully and carnally know and
abuse any woman child under the age of ten years, with or without
her consent:  such person shall be adjudged guilty of felonious rape, 
700         RAPE ON INFANTS AND CHILDREN.

and on  conviction, be  sentenced  to  pay a fine not exceeding one
thousand dollars, and to undergo an imprisonment, by separate or
solitary confinement at labor, not exceeding fifteen years.
  § 92. It shall not be necessary, in any case of rape, sodomy, or
carnal abuse of a female child under the age of ten years, to prove
the actual emission of seed, in order to constitute a carnal knowl-
edge, but  the carnal knoAvledge  shall be complete upon proof of
penetration only.
  § 93. If any person shall be guilty of committing an assault and
battery upon a female, with intent, forcibly and against  her will, to
have unlaAvful carnal knowledge  of such female, every- such person
shall be guilty of a misdemeanor, and, on conviction, be sentenced
to pay a fine not exceeding one thousand dollars, and to  undergo an
imprisonment, by separate or solitary confinement at labor, not ex-
ceeding five years.—P.]
  The duty of a medical witness  on  these occasions is very simple;
and perhaps this will be best understood by considering the subject
in relation to  females at different  ages.   On being called to examine
a person on whom a rape is alleged to have been committed, the first
circumstance which a practitioner should notice is the precise time
and date at Avhich he is summoned, taking an early opportunity of
comparing his watch with some  neighboring clock.   This may ap-
pear a trivial matter, and one wholly irrelevant to the duties of a
medical practitioner; but it is to be observed that the time at AA-hich
a surgeon is required to examine a prosecutrix may form a material
part of the subsequent inquiry.  It will be highly important to the
defence of a person accused, if it can be proved that the female did
not take the earliest opportunity to complain ; and it may be also
the means of defeating an alibi falsely set up  for the defence.  Aledi-
cal evidence in cases of rape may be derived from four sources: 1.
Marks of violence about the genitals.   2.  Marks of violence on the
person  of prosecutrix or prisoner.   3. The presence of stains of the
spermatic fluid or of blood on the clothes of the prosecutrix, or pri-
soner.  4. The existence of gonorrhoea or syphilis in  one, or both.
This evidence will vary according to the following circumstances:—

                 RAPE ON INFANTS AND CHILDREN.

  The sexual organs should in these cases present marks of injury
if the crime has been completed, and there has been any resistance on
the part of the child ; for it is impossible to conceive that forcible in-
tercourse should take place without  the production of ecchymosis,
the effusion of blood, or a laceration  of the pudendum.  Even with-
out reference to manual violence on the part of the assailant  if an
adult, the size of the male organ must generally cause  much local
injury in the attempt to enter the vagina of a child.  If the violation
has taken place within two or three clays, the apipearances presented
by the parts may be as folloAvs: 1. Inflammation, with more or less
abrasion of the lining membrane.   2. A muco-purulent discharge
from the vagina, of a ropy consistency and of a yellowish or greenish- 
MEDICAL  EVIDENCE.
701
yellow color, staining and stiffening the linen worn by the girl; the
mucous membrane of the urethra is  inflamed, rendering the dis-
charge of urine painful.  3. In recent cases, blood may be oozing
from the abraded membrane, or clots of blood may be found de-
posited in the vulva.  4.  The hymen may be entirely destroyed, or
(Avhat is more commonly observed) it may present on careful exami-
nation one or more slight cuts or lacerations.  OAving to the inflamed
state of the parts, the proper examination of the hymen is rendered
difficult—any attempt to separate the thighs for this purpose causing
great pain.   For this reason, also, the child walks with  difficulty
and complains of pain in walking.  5. Lastly, the vagina may be
unnaturally dilated.
  It has been propounded as a serious question, whether a rape can
be perpetrated on children of tender age by an adult man;  and medi-
cal witnesses at trials have adopted conflicting opinions.  Some are
inclined to  regard all such charges as unfounded, and  to seek for
other medical explanations of the symptoms above described.  This
practice has been carried of late years to an undue extent, simply
because  many of these charges have  been piroved to be false; but
common experience, supported as it is by the accurate observations
of Casper (" Ger. Med.," vol. 2, p. 130), shows that there is too fre-
quently a real foundation for the  charge  in reference to children,
and that a girl is not to be discredited merely because of her tender
age.  This  Avould be conferring impunity on the acts of a vile class
of offenders.  In all cases, there should  be good medical evidence,
and a corroboration  from circumstances.
  For the  legal  establishment  of  the crime, proof of penetration
only is demanded (24 & 25 Vict. c. 100, s. 63), and a sufficient de-
gree of penetration  to constitute rape in laAV may take place with
out necessarily rupturing the hymen.   There must be medical evi-
dence to shoAV that,  in a special case, there was actual penetration—
the degree of penetration being  quite immaterial.  It is true that
there could not be a complete introduction of the  adult male organ
into the vao-ina of a child without a rupture or laceration of the soft
parts ; but~the absence of such marks  of violence Avould not justify
a medical Avitness in denying the perpetration of the crime, since
the law does not require proof either of a complete, or of a violent
introduction.  It has been decided that penetration to  the vulva
alone, is sufficient to constitute this crime.  Aledical men have some-
times fallen into an error on this point, considering that when the
hymen was entire, rape could not  have been committed; but the
Statute LaAV says nothing about  the  rupture  of  the hymen as a
necessary part of the medical evidence; it merely  requires from
the medical witness proof of vulval penetration; this may occur,
and the hymen remain intact.
  In Scotland, this question came formally before  the judges in the
case of Macrae (High Court of Justiciary, 1841). It was insisted by
the prisoner's counsel, that there should be proof of  full and com-
plete penetration ; and there was no sufficient evidence to  shoAV that
penetration had taken place into the canal of the vagina beyond the 
702
MARKS OF VIOLENCE.
vulva.  Lord AleadoAvbank charged the jury to the effect, that the
evidence of the prisoner's guilt Avas complete ;  that scientific and
anatomical 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 was entered.   In a case like this,
where there was no evidence of emission, and the  girl was young,
he did not consider it necessary to show to what extent penetration
of the parts  had taken place—or to prove that it  had gone either
past the hymen, into what was anatomically called the hymen, or
eA7en  so far only as to touch the hymen.  The prisoner was con-
victed.  (" Cormack's Edin. Jour.," January, 1846, p. 48.)  I am in-
formed that up to the date of the case of Macrae, it had been the
practice with the Scotch judges to require proof of full and complete
penetration.   See on this question a paper by the  late Dr. Easton
(" GlasgOAV Med. Jour.," July, 1859, p. 129).  [" In  this country the
rule that there must be some entrance proved of the male within the
female organ, but that neither rupture of the hymen nor emission
need be proved, has been universally followed."  Wharton & Stille,
Aled.  Juris., p. 471.—H.]
  Marks of violence.—When  there are no marks of violence, or
physical injury about the pudendum of a child, whether because
none originally existed, or had disappeared in the course of time, a
medical witness must leave the  proof of  rape  to  others.  He can
only answer questions  of possibility or probability, according to
the special facts proved.  It is, however, in all cases his duty- to be
guarded  in  giving an. opinion  that  a rape has been perpetrated,
when there is a total absence of marks of  violence on the genitals.
It is true that rape in a legal sense may  be perpetrated without
necessarily producing such marks on a child, but then  the proof
of the crime will  not depend on medical evidence only.  The ab-
sence of marks of violence on the genitals, when an early examina-
tion has been made, furnishes a  strong presumption that rape has
not been committed  on these  young persons.  It is obvious that a
false charge might  be easily- made and sustained, if medical opin-
ions were hastily given on the statements of a mother and child,
when there was no  physical appearance to corroborate the accusa-
tion.  See on this  subject a paper  by M. Toulmouche, " Ann.
d'Hyg.," October 1  (8, p.  338).
  Supposing at the period of examination no marks exist, it may
be necessary to consider whether there has  been time for them to
disappear since the  alleged perpetration of the offence; but in such
cases, it is rarely in the power of a medical witness to express an
affirmative opinion  of the perpetration of the  crime; he should
leave  this to be proved by the general and circumstantial evidence.
Caspier met with a case in which a man set. 37 committed a rape on
a girl only eight years of age; he was seen in the act, and defended
himself on the plea of  drunkenness.   The girl was examined by a
medical man on the day following—the labia were  then  reddened,
and there was injection  of the membrane at the entrance of the
vagina, which was very sensitive.  As an illustration of the rapidity 
APPEARANCES IN CHILDREN.
703
with which the marks of rape disappear in young  children, when
not attended with great physical injury, it may be stated that this
girl Avas carefully examined by Casper eleven days after the assault.
The sexual organs were then in their natural state; there was not
the least appearance of local injury, and  no inference could have
been drawn at this date, that the girl had been subjected to any
violence.
  Aledical practitioners are not ahvays sufficiently careful in the in-
ferences Avhich they draw from an examination of children at dis-
tant periods after an  alleged rape.  They alloAv  themselves to be
deceived by a plausible story,  apparently consistent, and  thus see,
or think they see, proofs of  rape on examining the sexual organs
of a girl many weeks after the alleged  perpetration of the crime;
whereas, had the girl  been brought before them as a casual patient,
and no suggestion  of violent intercourse had been  made, they
would have probably  ridiculed the idea of basing a charge of rape
on so  slender a foundation.  The delay in  having the examination
made, unless satisfactorily explained, is in itself always a suspicious
circumstance.  Iu one case sent for trial to the assizes, but rejected
by the Grand  Jury,  a medical  man gave strong  evidence that  a
rape had been committed on a  girl seven years of age, although
he did not examine her until six weeks had elapsed from the date
assigned by the parents!
  On  the other hand,  when  marks of violence  on  the genitals are
present, they must not be hastily assumed as  furnishing  proofs of
rape;  for cases are recorded  in which such injuries have been pur-
posely- produced on young children by women, as a foundation for
false  charges against  persons Avith a view of extorting money7.
The proof or disproof of facts of this kind must  rest more upon
general than on medical evidence, unless the injuries obviously in-
dicate the use of some weapon or instrument.  It should be remem-
bered that the hymen  is not always present in ynung children; it
may be, according to  some, congenitally deficient, or, what is more
probable, it may have been destroyed by ulceration or suppurative
inflammation of the parts, a disease to  which  female infants of  a
scrofulous habit are very subject.  The  mere absence of this mem-
brane, therefore,  can  afford no  proof of the perpetration of the
crime, unless we  find traces of its having been recently torn by
violence.
  Other and more important deductions may, however, be draAvn
from the presence of severe injuries on the genitals,  i. e., of rupture,
or laceration of the vagina or perinaeum.  It is difficult  to obtain
accurate medical reports of these cases as they occur in  England:
but it is quite clear that the male  organ may produce much physi-
cal injury  Avhether the child does, or does not resist the attempt.
(Casper's " Vierteljahrschrift," April, 1863, p.  337.)  Dr. Chevers,
in referring to Indian experience, says that in a large proportion of
rapes on children, it was very  clearly proved that rather severe in-
juries  had  been inflicted on them.   In the "Nizamut Adawlut Re-
ports" (1853-5) there  are several instances recorded in which  the 
704  APPEARANCES  OF  GENITAL ORGANS  IN CHILDREN.

vagina was lacerated.  Out of 66 trials of rape, there were 25 con-
victions : and in one-half of these, the females Avere under the age
of twelve years.   In one case of  a girl, aet. 12, there was a rupture
of the loAver part of the vagina to the extent of half an inch.  In
another, a child of six, but apparently much younger, had suffered
as a result of rape, from rupture  of the hymen and laceration of the
perinaeum and vagina.   In one instance the violence proved  fatal,
but the medical particulars were not given.  (" Aled.  Journ.  for
India," p. 468.)  When it is alleged that injuries have been inten-
tionally produced on the genitals of a child  by mechanical means,
with a view of extorting money, in laying a false charge of rape,
the medical evidence can do no  more than  show that a girl with
such appearances about her sexual organs has suffered from  some
violence applied to the part; but whether by the human member, or
any other physical means, it would be impossible to say.  The only
chance of getting at the truth  in such a case, is by a rigorous  cross-
examination  of the mother  and child  in the absence  of  each
other.
  Sometimes, owing to the violence  used, the parts are much lace-
rated; and inflammation, folioAved by sloughing or mortification,
may set in and  destroy life, especially in children of an  unhealthy
habit.   Care should be taken that the symptoms of  a  malignant
form of disease  (noma) to which  female children when in a dirty or
neglected state  are liable, are not mistaken for the results of crimi-
nal violence.
  Some cases are reported, from  which it would appear that men
have narrowly  escaped conviction for a crime which had really not
been perpetrated.  Dr. Percival, in his " Medical  Ethics"  (3d ed.,
1849, p. 117), has related a case which has been the subject of fre-
quent quotation and comment  in reference to false charges of rape.
A girl, set. 4, was admitted into  the Manchester Infirmary, in Feb-
ruary, 1791, on account of a mortification of the female organs and
general depression  of strength.   She  had  been in bed with a boy
fourteen years old, and it Avas supposed that he had taken  criminal
liberties Avith her.   The mortification increased, and the child died.
The boy Avas tried on a charge of rape at the Lancaster Assizes, but
acquitted, on evidence being  adduced that several instances of a
similar disease  had appeared among girls about the same period of
time, in which  there Avas no reason to suspect injury or guilt.  In
one of these cases,  there was  typhus fever with a modification of
the genitals.  There Avas no cause of death  discoverable on inspec-
tion ; the lumbar glands were  of a dark color, but all the viscera
Avere sound.  This case, with the whole of Mr. Kinder Wood's
paper  on  the  subject,  has been republished  by Mr. Kesteven.
(" Med. Times  and Gaz.," 1859,  April 23 and 30.)
  On the other hand, fatal injury may be  done to these organs in
criminal assaults.  Mr. Colles  has reported  a case in which a rape
was committed  by an adult on a child eight years old ; it terminated
fatally from peritonitis, as a result of violence, six days after the
assault.  There were no marks of violence (bruises ?) externally, but 
           PURULENT DISCHARGES IN  CHILDREN.       705

 the orifice of the vagina was lacerated in its  entire circumference
 and the perinreum was nearly torn through.   It was found, on in-
 spection, that  the orifice, as Avell as the whole of the vagina, Avas
 in a state of gangrene, and its posterior wall had been lacerated
 at its line of  junction Avith the uterus to  the extent of an inch.
 There was no ulceration ;  the labia and clitoris  had not undergone
 any change.  (" Aled. Times and Gaz.," June 2, 1860, p. 560.) °The
 prisoner subsequently confessed his guilt.  A case was communi-
 cated by Dr. Al'Kinlay to the " Glasgow Aledical Journal" (July,
 1859, p. 140), which proves that extensive injuries maybe produced
 on a  child by the act of violation.   The girl in this instance Avas
 about six years of age, and very intelligent.   From her description
 of the assault, it  appears  that  she fainted,  probably OAving  to the
 severity of the piain.^  AVhen examined, it was found that the vagina
 was ruptured in various directions.  One laceration extended from
 the lower part doAvmvards, dividing the recto-vaginal septum and
 perimeum doAvn to the A7erge of the anus.   There Avas a lacerated
 opening  in the coats of the rectum ; the orifice of the vagina was
 lacerated upwards as  Avell as laterally; the parts were raw, swollen,
 and very tender.   When  the  child  Avas first seen, there Avas blood
 on the limbs and  clothes; she recovered from these serious injuries
 in about tAvo months.  In a case of alleged rape, it Avas a question
 raised in favor of the prisoner, Avhether rupture of the perinaeum
 could or could not be  effected in  rape on a girl.  Some eminent
 members of the profession appear to have doubted the possibility of
 rupture  being  produced  under these  circumstances  (see Sir W.
 Wilde's  paper, " Dub. Aled. Journal," February,  1859);  but the
 facts here recorded show that such an  opinion is erroneous.
  Purulent discharges  from the  vagina.   Vaginitis.  Infantile leucor-
 rhcca.—The existence of a purulent discharge  from the vagina, as
 a result  of vaginitis or inflammation of the vagina, has  been fre-
 quently  adduced as a sign of rape in young children.   The parents,
 or other ignorant persons Avho examine the child, often look upon
 this disease as  a positive proof  of impure intercourse; and pierhaps
 lay a  charge against  an innocent person, Avho may have been ob-
 served to take particular notice of the child.  A purulent discharge
 with aphthous ulceration of the mucous membrane is occasionally a
 result of vaginitis (inflammation of the vagina) in young children..
 It may arise from dentition, or local causes of irritation—as worms
 or uncleanly habits—and is observed especially in children of  a
 scrofulous habit.  It is frequently met Avith  in girls up to  six or
 seven  years of  age ; and children thus affected have been tutored to
 lay imputations against innocent persons for the purpose of extorting
 money.  This state may commonly be distinguished from the effects
 of violence, either by  the hymen being entire, or by the non-dilata-
 tion, or laceration of the vagina or perinaBuni; by the red and inflam-
matory condition of  the  mucous membrane;  by  the  absence of
blood, and the abundance  of the purulent discharge, which is com-
monly much greater than that which takes place as a mere result
of violence.  Capuron mentions two eases in which charges of rap>e
      45 
706       PURULENT  DISCHARGES IN  CHILDREN.

on children were falsely made against innocent persons, on account
of the existence of a purulent discharge  the nature  of Avhich had
been  mistaken.  ("Aled.  Leg. des Accouchemens," p. 41.)   Sir
Charles Locock observes  that" the purulent discharges of female
children are attended Avith redness and swelling of the sexual organs,
and are sometimes accompanied with excoriation and sloughing of
the skin, owing to the irritating nature of the matter.  They are so
connected Avith dentition, that they not only appear  with the first
and second set of teeth, but even when the wisdom  teeth are irri-
tating the system at a mature age.  Air. South, commenting on this
statement (" Chelius's Surgery," vol. 1, p. 161), justly remarks that
a knowledge of these facts " is highly necessary, and  is very pro-
perly insisted on, as there is no doubt that many men have suffered
capital punishment  from  the  ignorance of practitioners  on this
point: and even noAV, with our better knowledge, it is by no means
unfrequent to hear of medical men giving a decided  opinion which
is  almost certainly erroneous  upon the gonorrhceal character  of
pudendal discharges, and thus jeopardizing the character if not the
life of an innocent man.   In giving his opinion or evidence in such
cases, a practitioner is bound to speak with extreme caution, and
only on the most incontestable proof (Avhich by a mere examination
of the parts it is almost impossible for him to attain), before he makes
a positive statement as to the gonorrhceal character of a discharge."
Although the facts are, or ought to be, well known to medical men,
there is still much popular ignorance in  reference to this disease,
and  false charges of rape on  children  are now not unfrequently
made. Air. Kesteven met with a case in Avhich a discharge from
the vagina of a child  nine years of age Avas  considered by the
parents to indicate that intercourse had been had with  her.  There
was no mark of contusion or violence on  or about the pudendum or
in  the vagina, and the case was very properly pronounced to be one
of vaginitis.   ("Med. Gaz.," vol. 47, p. 372.)  A similar case was
referred to me, in which a soldier was supposed  to have infected a
child; but an investigation showed that it was a purulent discharge
depending on inflammation of  the vagina.
  A  gonorrhceal discharge is generally  very profuse—much more
profuse than  that purulent discharge which is simply the result of
such violence as is produced in the commission of rape.   There is
another fact worthy of notice, namely, that the last mentioned dis-
charge, besides being less profuse, lasts  for a much shorter time.
Casper has recommended that  in doubtful  cases, another examina-
tion of the sexual organs  should  be made in ten or twelve days.
If the purulent discharge has then ceased, or  is  ceasing, there is
good  reason to believe that it was not the result of gonorrhoea, but
of some temporary cause of inflammation in the mucous membrane.
(" Klinische Novellen," 1863, p. 10.)  Of false charges of rape arising
from  mistakes on the subject, he furnishes various instances (p. 19).
  Assuming that the surgeon is satisfied, from a careful examina-
tion, that the purulent discharge must have existed  before the  al-
leged assault, and that it is of the ordinary7 inflammatory character 
        LEUCORRHCEAL DISCHARGES  IN CHILDREN.    707

with which young girls are liable to be attacked, this would not
justify him in affirming that no rape had been attempted, or perpe-
trated on the child.  Girls laboring  under this disease may be the
subjects of rape, and it will then be  necessary to seek for further
evidence on the condition of the hymen, the lining membrane  of
the vagina, and the vulva.   If nothing is found beyond what is
consistent with disease, there is an absence of medical evidence  to
prove that any rape has been committed.  An aphthous state of the
membrane of the vagina  must not, under  these circumstances, be
ascribed to injury caused by mechanical violence.  (Casper's  "Ge-
richtliche Aledicin," vol.  2, p. 148.)
  Infantile leucorrhcea has been fully investigated by Sir W. Wilde,
of Dublin.  (" Medico-legal  Observations," etc.,  1853.)  This gen-
tleman has collected numerous instances illustrating in a remark-
able manner  the great clanger  to Avhich innocent persons are ex-
posed by reason of false charges of rape on children.  Two of these
are especially noticed in his  essay.  A charge was raised against a
respectable man, that he  had had intercourse with,  and produced
disease in, tAvo children.   The day and hour were circumstantially
given, extorted as it appears from the children by the parent, and
the man Avas put upon  his trial.  The appearances were such as are
usual in these  cases—a  purulent  discharge from the vagina with
some excoriation, but no  bruise, laceratiou, or mark of violence on
the pudendum.  There had  not been any penetration of the vagina.
The charge against the prisoner, although unsupported by  any affir-
mative circumstances, received some strength from the admission
made by one  medical witness for the pirosecution—namely, that the
appearances might have been the result of violence, and  that the
discharge might have been produced by friction with the member
of a healthy man.   (Wilde,  op. cit. p. 14.)   It was proved that the
prisoner Avas  not affected either with gonorrhoea or syphilis.  Drs.
Geoghegan, Churchill, and other medical Avitnesses of repute, gave
testimony to the effect that  the child AA7as laboring under  an ordi-
nary form of disease, and that there was no medical indication that
it had been subjected to any kind of  violence.  This testimony Avas
not considered  by  the  court to furnish a  complete ansAver to the
charge, since it was inferred that the appearances on the child might
have been caused by the  accused,  without  any marks  of violence
being left on the pudendum !  So strong was this feeling that, had
the case rested here, it is probable the accused would  have been
convicted upon the unsupported statement  of the child.   An alibi
was, hoAvever, clearly proved, and the man  was acquitted.   In this
instance, it will be perceived, it Avas alleged that a man Avho labored
under this disease had  caused a purulent discharge in a child! At
the same time, it A\-as admitted that  the pudendum had sustained
no violence Avhatever.  Aledically speaking, there appears to have
been not the slightest pretence for charging the accused with the
perpetration of rape; the  apipearances might, or might not have been
caused in the manner suggested.  Under  such loose medical evi-
dence as this no person would be  safe.  An acquittal from an un- 
708     LEUCORRHCEAL DISCHARGES  IN CHILDREN.

founded charge would depend upon the man who is accused being
able to prove a distinct  alibi, i. e., he must prove his innocence.
The statement of the child may be simple, and artlessly made.  At
this tender age a girl may be easily induced, by the fear of punish-
ment, and by the aid of leading questions  put by a parent, to admit
that some one had committed "an assault upon her. _ The statement
once made may be  persevered in, and its  inconsistency may not
always be brought out by cross-examination.
  If the child  is really laboring under syphilis or gonorrhoea, this
is, cceteris paribus, evidence of impure  intercourse, either  with the
ravisher, or some other person; but Ave should be well assured, before
giving an opinion, that the discharge is really of a gonorrhceal and
not simply of a common  inflammatory (purulent) character.  The
party accused may have been at the time free from the disease, or,
if laboring under it, then we should expect to find that the discharge
had suddenly made its appearance in the child, with its usual severe
symptoms, at a certain interval of time after the alleged intercourse
—i. e., from the third to the eighth day.  When these conditions do
not exist, it is extremely difficult to form a medical opinion on the
subject;  since  there are no  certain means, by the  microscope or
otherwise, of distinguishing common purulent  discharges  from
those which are gonorrhceal or syphilitic.  A case occurred to Al.
Biessy, in which a  merely mucous discharge  in a girl  was pro-
nounced to be sypliilitic, and the person who was falsely accused
of rape narrowly escaped conviction.  (Briang, " Alan.  Complet. de
Me'd. Leg.," 1846, p. 81.)  The pmrulent matter of gonorrhoea does
not differ microscopically from  that  produced in other  forms of
disease.
  We should further distinctly satisfy ourselves that gonorrhoea in
a child, if it exist, could not have arisen  from  infection  by any
accident irrespective of  intercourse.   This  limitation  is rendered
necessary by the publication of a report of two cases by Dr. W. B.
Ryan (" Med. Gaz.," vol. 47, p. 744), in which two  sisters, one of
one year, and the other of four years  of age, received the infection
by reason of their being washed in a vessel of AArater with a sponge
used by a young woman affected Avith profuse gonorrhceal discharge.
Dr. Ryan clearly traced the origin of  the discharge to this, unex-
pected accident.  Had an  accusation of  rape been made against  a
man laboring under gonorrhoea, it  is not at all improbable that this
condition of the children, resulting from an  unsuspected  accident,
would have been  taken  as  an  unanswerable proof of his guilt.
Cases of this kind, thus accurately observed, convey an important
caution to medical witnesses: i. e., that they should not infer crimi-
nal intercourse merely from the existence of a gonorrhceal discharge,
in the absence of marks of violence to the genitals, or of other strong
corroborative proofs.
  As a summary of these remarks with respect to purulent dis-
charges, we may observe  that they should not be admitted as fur-
nishing  corroborative evidence  of rape, except—1st, Avhen the
accused party is laboring  under gonorrhceal discharge ; 2dly7, Avhen 
       RAPE  ON  YOUNG FEMALES AFTER PUBERTY.    709

the date of its appearance in a child is from the third to the eighth
day after the alleged intercourse; and 3dly, when it has been satis-
factorily established that the  child had not suffered from any such
discharge previously to the assault.   It may be said, however, that
all these  conditions  may  exist, and yet the accused  be innocent;
for a child may, either through mistake or design, accuse an inno-
cent  person.  This, however, removes the case entirely from the
hands of  a medical jurist.   (The reader will  find much useful in-
formation on tfris subject in a paper by Dr. Penard," Ann. d'Hyo-.,"
1860, vol. 2, pp. 130, 345.)
  With respect to marks of violence on the body of a child, these
are seldom met Avith, because no  resistance is commonly made by
mere children.   Bruises or contusions may, however, be  found
occasionally on the legs.

           RAPE ON YOUNG FEMALES AFTER PUBERTY.

  When  the crime is committed on a girl from the age of ten to
tAveh-e years, the facts are much the  same as those already referred
to with respect to children below the age of ten years.  There is,
hoAveArer, some difference in  the legal complexion of the offence.
If carnal intercourse be had Avith the cousent of a female between
the ages of ten and twelve years, the offender is guilty of misde-
meanor only (24 & 25 Aric. c. 100, s. 51); above the  age of twelve
years, the consent of the girl does away with any imputation of a
legal offence.   Girls who have passed this age are considered capa-
ble of offering some resistance to the perpetration of the crime;
and therefore, in  a true charge,  we should expect to find not only
marks of violence about the pudendum, but also injuries of greater
or less extent upon the  body  and limbs.   It  is probable that in
these cases, if the charge Avere  well-founded, the hymen would be
ruptured, as the intercourse is always presumed to be  violent; but
there might be some degree  of penetration  Avithout this  being a
necessary result, especially if  the  membrane were small, or placed
far up.  At any  rate, a girl at this age may sustain all the injury,
morally- and physically, which  the perpetration of the crime can
possibly bring down upon her, whatever may have been the degree
of penetration; and for this  reason  it is  very properly laid doAvn
by our law, that  the  crime consists  in the mere proof of penetra-
tion.  The  fact,  however, is generally clearly made out by the
statement of a girl.   Girls of tender  age are sometimes violated by
boys; the amount of physical injury inflicted in such cases is less
than when the assailant is an adult.
  With respect to marks of violence on  the person, the exact form,
position,  and extent of these  should be noticed, also  their appear-
ance  Avhether recent or of old-standing.  A false accusation of rape
may  be sometimes detected by the violence being in a situation in
which it  was not probable that the ravisher  would have produced
it.  AVhen  bruises are found, the presence or absence  of the  usual
zones of color may  occasionally throw light upon the time at which 
710    RAPE  ON  YOUNG FEMALES  AFTER  PUBERTY.

the alleged assault was committed.  As these marks of violence on
the person are not likely to have  been  produced with  the concur-
rence of the girl, they are considered to furnish some proof of the
intercourse having been against her will.  But the physical appear-
ances of rape about the genital organs  may be found, Avhether the
connection has been voluntary or "involuntary.  Thus, recent rup-
ture of the hymen, laceration  of the  vagina with effusion of  co-
agula of blood, swelling and inflammation of the vulva, and stains
of blood upon the person,  dress, or furniture, may lje met with in
both cases.  In making an  examination, the greatest  care should
be taken by the practitioner to fix, at  the time of examination, a
probable  date for the marks of injury to  the genitals or other
parts of the body, as it is  by the aid of such observations that the
truth or falsity of  a charge may be sometimes clearly established.
   Girls and unmarried young women are liable to muco-purulent dis-
charges from the vagina, as a  result of which  the hymen may be
destroyed.   This kind of discharge arises  from inflammation of
the vagina (vaginitis), and it has been observed to follow an attack
of scarlatina.  When it  exists, its  real cause requires the closest
scrutiny.  At a more advanced age, young women are frequently
subject to leucorrhcea.  These  cases are not  likely to be mistaken
for gonorrhoea, as  here the female has in her poAver to give some
account of the circumstances, from  which a medical opinion may
be easily formed.  It is possible, however, that a  woman laboring
under leucorrhcea may charge  a man with the crime of rape, and
affirm that this discharge  had  arisen from the act of the man. An
inflamed and partially ulcerated (aphthous) state of the lining
membrane of the vulva may apparently give support to the accusa-
tion.  The discharge in leucorrhcea is of a mucous nature; that of
gonorrhoea is of a purulent character; but purulent discharges may
take place  from the vagina as the result of intense inflammation,
and quite irrespective of impure intercourse.   (" Chelius's Surgery,"
by South, vol. 1, p. 160.)  It would be impossible to  distinguish
such discharges from those of  gonorrhoea; while a leucorrhcealdis-
charge under great inflammatory  action may also resemble that of
gonorrhoea.
   Defloration.  Signs of virginity.—It will be necessary to say a few
words respecting the signs of virginity—a subject upon  which, in
some medico-legal  works, a great  amount of poetical discussion
appears to me to have been  wasted.   Independently7 of cases of
rape, this question may occasionally assume a practical bearing in
relation.to the signs of defloration.  In civil cases, a medical wit-
ness may be asked  whether a woman  has ever had intercourse or
not; and proof of the fact may be necessary in order to confirm or
rebut statements made by her in  evidence.  The  question may be,
not whether a female has  had  a child, for this would resolve itself
into a proof whether delivery had or had not taken place—it may
be limited to the probability or possibility  of intercourse on  her
part, at some antecedent period.   Noav, a medical  jurist, when con-
sulted in such a case, can be guided only by the presence or absence 
                    SIGNS OF VIRGINITY.                 711

of the external signs of virginity.  The hymen may be intact, but
this does  not prove  non-intercourse,  because  females have  been
knoAvn  to^conceive with  the  hymen uninjured;  and an operation
for a division of this membrane has been  actually- rendered neces-
sary before delivery could take  place.  (Henke's " Zeitschrift der
S. A.,'' 1843, vol. ii. p. 149.)  Two cases of impregnation Avithout
rupture of the hymen  are  reported in the " Xew Orleans Aledical
Gazette" for June, 1858 (pp.  217, 220).  The  hymen in each case
required to be divided to alloAv of the delivery of the child.  An-
other case is reported in the " American Journ. Aled. Sciences," for
April, 1859 (p. 576).  These facts may be  explained  by the mem-
brane being  hard and resisting and  at the  same time small in
extent, i. e., only partially closing the vagina.  Under opposite con-
ditions, the 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 mem-
brane has  been thus destroyed by disease or other causes, or Avhen
it is congenitally absent, a medical opinion must be  more  or  less
conjectural; for one intercourse could  hardly so affect the capacity
of the vagina, as to render the fact evident through life, and there
is no other datum upon Avhich an opinion could be based.  The
presence of the hymen is  of  course quite incompatible Avith  the
assumption that the female had borne a child.  A questiou  of this
kind incidentally arose in Frazer v. Ba.gley (Common  Pleas,  Feb.
1844).   It Avas alleged by defendant that  the  plaintiff, a married
man, had  had adulterous intercourse with a young woman, and that
at an antecedent pieriod she had  left her home for the purpose of
giving birth to a child privately.  The late Dr. AsliAvell Avas called
upon to examine the woman, and he deposed that, in his opinion,
she Avas a virgin, and had never had a child.  In  spite of this evi-
dence, the jury  returned a verdict for the defendant.  It is possible,
however, that abortion may take place at the early periods of preg-
nancy, Avithout  the necessary destruction of the hymen.   (See
Henke, " Zeitschrift," 1844, vol. i. p. 259.)
  The question is of importance not only as it may affect the repu-
tation of a woman, but the credibility and character of the person
who makes the imputation of a vvant  of chastitj7.  Fruitful inter-
course, it is Avell known, may take  place  Avithout rupture of the
hymen ; but such cases may be regarded as of an exceptional nature.
The real question is, Avhether,  unless the hymen be in an abnormal
state, intercourse can possibly  occur betAveen young and active per-
sons Avithout a rupture of this membrane.  Intercourse is not likely
to be confined, under  these circumstances, to a  mere penetration of
the vulva.   In the ease of an old man, or one of weak virile power,
vulval intercourse might be had Avithout destroying the membrane;
but such a case  could^only be decided by the special circumstances
which accompanied  it.   The presence of an  unruptured  hymen
aftbrds a presumptive, but not  an absolute proof that the woman is
a  virgin; and if of the ordinary size and shape,  and in the ordinary 
712     ALLEGED  UNCH ASTITY— ME DIC AL PROOFS.

situation, it shoAvs  clearly  that, although attempts at intercourse
may have been made, there can have been no  vaginal penetration.
  In the case of Delafosse v.  Fortescue (Exeter Lent Ass. 1853), Avhich
involved an action for defamation of character, the plaintiff, a mar-
ried man, £et. 64, had been charged with committing adultery with
a certain woman.   Several  Avitnesses for the defendant positively
SAvore that  they had seen these persons in carnal intercourse.  This
Avas denied by the plaintiff; and, as an answer to the case, medical
evidence was tendered to the effect that the woman with whom the
adulterous  intercourse was  alleged to have taken place  had been
examined, and the hymen Avas found intact.   In cross-examination
this was admitted not to be a conclusive criterion of virginity.  A
verdict was returned for the defendant.   The  form and situation of
the hymen in this case were not described; but it is to be presumed
that these  were  not such as to constitute a physical  bar to inter-
course,  or  this would haA-e been stated by  the medical Avitness.
Hence the  existence of  the membrane was not considered to dis-
prove the allegations of eye-Avitnesses.   A somewhat similar case
(Howes  v. Barber) was tried in  the Common  Pleas  in June, 1865.
Defendant  alleged that  he  had seen plaintiff,  as he believed, in in-
tercourse Avith an unmarried lady.  This was denied by the plain-
tiff and the lady, and to support this denial,  medical evidence Avas
called to shoAv that there had been  no  intercourse.   Drs. Oldham
and Barnes examined the  lady, and deposed  that  the hymen Avas
entire, and that  she Avas virgo  intacta.   In Scotland  this kind of
medical evidence is  not admissible.  I am indebted to  Air. Trayner,
a member of the  Scotch  Bar, for the subjoined case, in Avhich a Avife
sued the husband for divorce, on the ground, inter alia, that he had
committed adultery with C.  In defence, the  defendant denied the
adultery, and adduced C. as a witness, Avho swore that  such  connec-
tion had never taken place.  She also swore that she had submitted
to an inspectio corporis by Sir I. Simpson.   The defendant then pro-
posed to examine this gentleman, that he might speak to the result
of his examination.  He argued that this Avas  the best evidence that
he could adduce  in  support of his innocence, as if the  girl was still
a virgin, the adultery alleged could not  have been committed.  The
court refused to admit  the evidence, on  the ground  that it was
merely in  the form of an opinion from the learned professor; that
other medical men  might differ from him, even from the same ob-
servations; and that, as the court could not compel  C. to submit to
another examination, the proposed evidence must be considered ex
parte and inadmissible.  (Session Cases, Edinburgh, Feb.  11, 1860.)
In  Hunt v. Hunt a verdict was obtained at common law against
the alleged paramour in a  case of adultery, and the damages were
assessed at 50/.   It was subsequently proved that the lady Avas
virgo intacta!  So long as there are facts Avhich show that  women
have actually conceived with the hymen still in  its normal state,
it is inconsistent to  apply the term "virgo intacta" to women merely
because this membrane is entire.  A Avoman may assuredly have an 
RAPE  ON  ADULT  WOMEN.              713
unruptured hymen, and  yet not be a virgo intacta.  This can only
be decided by the special circumstances proved in each case.  Such
virgines  intcwta:  have frequently required the assistance of accou-
cheurs, and in due time  have been delivered of children!
                   CHAPTER  LIX.

RAPE ON MARRIED AND ADULT AVOMEN.—CIRCUMSTANCES UNDER WHICH
  IT  MAY  BE PERPETRATED  ON ADULT  WOMEN.—LOSS OF PHYSICAL
  EVIDENCE.—PREGNANCY  FOLLOWING  RAPE. — MICROSCOPICAL  EVI-
  DENCE.—SODOMY.

  On married and adult women.—The remarks already made apply
generally to married women, with  this difference—that Avhen a
woman has already been in habits of sexual intercourse, there is
commonly much less injury done to the genital organs.  The hymen
will, in these cases, be found destroyed, and the vulva dilated.  Still,
as the  intercourse is  presumed to be  against  the  consent of the
Avoman, it is most likely that Avhen there has been a proper resist-
ance some injury Avill be apparent on  the pudendum; and there
will be also, probably, extensive marks of violence on the body and
limbs.  Such cases are generally determined without medical evi-
dence, by the deposition of the woman, corroborated, as it should
always be, by circumstances.  An experienced  barrister has sug-
gested to me that this statement regarding the presence of marks
of violence on the pudendum of a married woman, on whom a rape
is alleged to have been committed, requires some qualification.  He
informed me that he AA7as engaged in the prosecution of tAvo cases
of rape on married women, in "which the crime was completed  in
spite of the resistance of the woman, and there Avere no marks of
violence on the genital organs in either  case.  (Reg. v. Owen and
others, Oxford Circuit, 1839.)  This may  happen when the assail-
ant is aided by accomplices.
  On the other hand,  the vagina alone may be the seat of violence,
and no marks to indicate a struggle or the application of force  be
found on the body.   I  Avas consulted  in April, 1862, on a case of
this description.   A Avoman was knocked doAvn, her clothes  Avere
pulled over her face, and the crime of rape Avas  perpetrated by the
assailant.  In the position in which she was held, Avith her arms
and hands covered over, she was half suffocated and  unable to offer
any effectual resistance.   She was examined on the evening of the
day of  the assault, by Dr. Alayne.  He found  no marks of violence
on her body, but the  mucous" membrane of the vagina at its com-
mencement was contused and some portions lacerated: blood was
oozino  from  these parts.  It was properly considered that, under 
714
RAPE  ON  ADULT  AVOMEN.
these circumstances, the statement of the  Avoman was consistent
with the fact that there were  no marks of violence  on her body.
There was no reason to suppose that the  injury to the vagina had
been caused in any other way  than by a criminal  assault. ^
  AVhen a charge of rape  is made by a prostitute, it is justly re-
ceived with suspicion, and the case is narrowly scrutinized.  Some-
thing more than medical evidence would  be required to establish a
charge under these circumstances.   The question  turns here, as in
all cases of rape upon adult women, on the fact of consent having
been previously given or not.   This is the point at which the greater
number of these cases of alleged  rape break down; and  it need
hardly be observed that this question has no relation  to the duties
of a medical witness: all that he  can  do is to establish, occasion-
ally, Avhether or not  sexual intercourse has  been had with, or Avith-
out some violence.  It is obvious that  there may be marks of vio-
lence about the pmdendum, or on the person, and yet the conduct of
the woman may have been such as to imply consent  on her part:
we must not suppose that medical  proof  of intercourse is tanta-
mount to  legal proof of rape.
  [While it is no defence that a  woman was a common strumpet,
or even that she was the defendant's mistress, the question of prior
chastity is always  a material one  to be considered by the medical
examiner, since unchastity  can be shoAvn by the defendant, not as
an excuse or justification, but as a fact throwing much light on the
subject.  (Wharton & Stille', 2d ed., p. 466.)
  In England, and in many of the United States, general evidence
of reputation may  be shown, but not particular acts of unchastity.
lb.   McCombs v. State,  8 Ohio (K S.) 643 ; People  v. Jackson, 3
Parker, C. R. (K Y.) 391.
  It has been held, however, that it is competent to inquire of the
prosecutrix, on cross-examination, as to particular acts  before and
after, at specified  times and places, with specified men.  State v.
Johnson, 2 Wms. (Vermont) 512.  In California, where the prosecu-
trix was the only witness, it was  held that evidence  that she had
committed acts of  lewdness with other men is admissible, and that
it is immaterial by whom these acts are proved, and that the prose-
cutrix need not be questioned about them.  People v. Benson, 6 Cal.
221.—P.]
  Possibility of  perpetrating rape  on adult  women.—Some medical
jurists have argued  that a rape cannot be  perpetrated on an adult
woman of good health and vigor; and they have treated all accusa-
tions made under  these circumstances as false.  AVhether, on any
criminal charge, a rape  has been committed  or not, is of course a
question of fact for a jury, and not for a medical witness.  The fact of
the crime having been actually perpetrated  can be determined only
from the evidence  of the prosecutrix and of  other witnesses;  still
a medical man may be able to point out to  the court circumstances
Avhich might otherwise escape notice.  Setting aside the cases of
infants, idiots, lunatics, and weak and delicate or aged women, it
does not appear probable that intercourse could be  accomplished 
          RAPE ON  AVOMEN  AVHILE  UNCONSCIOUS.       715

against the consent of a healthy adult, except under the following
conditions:—
  1. AVhen narcotics or intoxicating liquids have been administered
to her, either by the prisoner, or through his collusion.  It matters
not, in a case of this kind, whether the narcotics have been given
merely for the purpose of exciting the female, or Avith the deliberate
intention of having intercourse with her while she Avas intoxicated
—the prisoner is  equally  guilty.  (See Reg. v. Complin, " LaAV
Times," June  28, 1845 ; also " Aled.  Gaz.," vol.  36, p. 443.)  The
nature of the  substance  whereby insensibility  is produced  is of
course unimportant.  Thus the vapors of ether and chloroform have
been criminally used in attempts at rape.  In  a case Avhich occurred
in France, a dentist Avas convicted of a rape upon a Avoman, to Avhom
he had adminstered the vapor of ether.   The  prosecutrix was not
perfectly unconscious, but she was rendered Avholly unable to offer
any resistance.   (" Aled. Gaz.," vol. 40, p. 865.)  A dentist was re-
cently convicted of rape under somewhat similar circumstances in
the United States, but it was thought that the woman had made the
charge under some hallucination or delusion.   [The American case
here referred to is that of Beale, the dentist, convicted on extremely
vague and inconsistent, and entirely uncorroborated evidence of the
complainant, of violating a young  lady while she Avas stupefied and
disabled by7 the inhalation of ether.  This case  was  generally be-
lieved to be one of anaesthetic illusion, similar to many Avhich have «
since  been clearly testified to as having occurred in the experience
of different operators.  Seethe" Philada. Aled. Exam.," Dec. 1854,
for  a full  review  of  the case ; also  Wharton and Stille,  " Aled.
Jurisp.," §§  443, 445, 459.  See also  the same authors for a report
of the case of Dr. Davis Green, of Mercer Co., Ohio, convicted of
rape on a young girl while partially affected by chloroform adminis-
tered to her Avhile asleep.—H.]  In Reg. v. Snarey (AVinchester Lent
Assizes, 1859),  there Avas  a  clear attempt at  fraud.  The prosecu-
trix asserted  that she was instantly rendered  insensible by the pri-
soner forcibly apjplying a handkerchief to her face, and she accused
him of having committed a  rape on her.  The charge Avas disproved
by a distinct alibi,  as well  as by the improbability of all the circum-
stances.
  AVhen the state of unconsciousness arises from natural infirmity,
as in idiocy or insanity7, carnal intercourse Avith a woman is regarded
as rape.  (Reg.  v. Ryan, Cent. Crim. Court, September, 1846.)  The
woman Avas in this case an idiot, and it Avas proved  that her habits
AA-ere not loose or indecent.  Piatt, B. held that if she Avas in a state
of unconsciousness at the time the connection  took place, Avhether it
was produced by any act of the prisoner, or by any act of her oavh (?),
any one having intercourse Avith her Avould be guilty of rape.  The
prisoner Avas convicted.   [See also the case of State v. Crow (Com-
mon Pleas of Athens Co., Ohio) "  AVestern LaAV Journal," vol. x. p.
501.__P.]  In Reg. v. White (Northampton Winter Assizes, 1856),
the learned judge, in  charging the jury, stated that  some  doubts
were entertained Avhether  the crime of rape could be committed (in 
  716       RAPE ON WOMEN WHILE UNCONSCIOUS.

  law) on the person of a Avoman Avho had rendered herself perfectly
  insensible by drink, so as to be  unable  to make any resistance :  he
  thought it could not be alleged as an excuse for the man.  The ques-
  tion was  not  reserved, as the prisoner was acquitted of rape, and
  found guilty of an indecent assault.
    It may be a question whether a man can have intercourse with a
  woman without her knowledge while thus in a state of unconscious-
  ness from natural sleep.   Casper met with a solitary case in which a
  girl  aged 16  accused a  man  of having had  intercourse with her
  while she was sleeping in her bed, of which she was not conscious
  until he was in  the act of Avithdrawing from her.  On her own state-
  ment, she was virgo intacto up  to the elate of this occurrence.  Upon
  the facts  of the case, Casper came to  the  conclusion that, if her
  statement was true, the man could not have had intercourse with her
  without causing piain, and rousing her to a consciousness of her posi-
  tion.  The hymen was not destroyed, but  presented  lacerations  in
  tAvo places.  This and other facts showed that there had been inter-
  course, but did not prove that this had taken place A\7ithout the con-
  sciousness of the woman.  ("  Klinische Novellen," 1863, p. 31.)   A
  man was charged Avith rape before a police magistrate, and the pros-
  ecutrix SAvore that he had effected his purpose during her sleep. The
  bare possibility  of the offence being perpetrated under these circum-
  stances cannot be denied; but this admission could only apply to a
* case in Avhich the woman had been accustomed to sexual intercourse,
  and in which the sleep was preternatural or lethargic.   In this in-
  stance the woman  was a prostitute, and the charge improbable.   A
  respectable married woman who had had children, the wife of an inn-
  keeper, threw7 herself on her bed with her clothes on, late one evening,
  and fell fast asleep.  She Avas first awakened by finding a man upon
  her body, in the act of withdrawing from her.   This man,  William
  31cEwan, a servant in the house, was given into custody on a charge
  of rape.   In the first instance  he did  not deny the  act, and there
  was no reason to believe that  the prosecutrix was aware of the pri-
  soner's conduct until the crime Avas completed,and she Avas awakened
  in the manner described—apparently by the Aveight of the prisoner's
  body.  The prisoner was convicted  and sentenced to ten years' penal
  servitude.  (" Edin. Month. Journ.," December, 1862, p. 570.)   A
  case which may serve to throw a little light  up>on this question
  occurred  to Casper.  ("Gerichtliche  Aiedicin," vol. 2, p. 574.)   A
  married woman alleged  that  a  man had  had intercourse with her
  while in bed, and when she was asleep.  In her deposition, hoAvever,
  she admitted she was conscious that some one was  lying upon her,
  and that  she asked who  it was;  shoAving, as Casper  remarks, that
  she had a knowledge of Avhat  Avas going on, and some doubt whether
  the person was her husband.
    In reference to the question whether it is possible to commit a
  rape upon a woman while asleep, a majority of the Scotch judges
  decided, in the case of Sweenie (Irvine's "Judiciary  Reports," vol.
  3, p. 109), that  the feloniously having connection  Avith a Avoman
  while asleep was not indictable under the  name of rape, inasmuch 
          RAPE ON  WOMEN WHILE  UNCONSCIOUS.       717

as, apart from the force implied in the act of connection, there AA-as
no force used to overcome the will of the woman.   But they held,
hoAvever improbable it might be, it Avas quite possible  that a man
might haA-e connection Avith a Avoman while asleep.  (" Edin. Alonth
Journ.," December, 1862, p. 570.)
  [AVe are indebted, for a case in point, to our friend Dr. D. F. Lewis,
formerly of London, and now librarian  to the  Pennsylvania Hos-
pital of Philadelphia.   AVhile practising in London, in 1853, he Avas
called to attend a young woman previously well known to him as of
excellent character, and found her in a violent hysterical paroxysm,
brought on by the discovery that she had been violated, during sleep,
by her accepted admirer.   She had returned to her mother's home
with him, from a long Avalk, very much fatigued, and after having
drank a glass of ale, had sunk into a profound slumber, during Avhich
the act had been perpetrated without the slightest evidence" of con-
sciousness on her part.  This was admitted by her companion ; and
her prompt discovery  of the wrong, and  immediate alarm and agita-
tion, as Avell as her  known liability to unusually heavy sleep, fully
established the truth of her assertion.  The usual physical signs of
recent defloration were presented on her person.—II.]
  The  condition of the so-called magnetic or unnatural sleep has
given rise to a question connected with  the alleged perpetration of
rape.   A girl (aged 18) consulted a therapeutic  magnetizer as to her
health.   She  visited  him  daily  for  some days.  Four-and-a-half
months afterwards she discovered that she was pregnant, and made
a complaint to  the authorities against the magnetizer.  They di-
rected a physician and surgeon to  determine  the date of her preg-
nancy,  and Avhether the complainant might  have then been  vio-
lated and rendered pregnant contrary to her will, i. e., Avhether her
volition could have been completely or partially annihilated by
magnetism.  The medical inspectors Avere satisfied that the preg-
nancy did not extend further back thau four-and-a-half months;
and founding  their opinion on M. Husson's report, made to the
Academy in 1831, concluded that as a person in magnetic sleep is
insensible to every-  kind of torture, sexual intercourse  might then
take place Avith a young Avoman Avithout the participation of her
will, Avithout consciousness  of the  act,  and  consequently without
the power to resist  the act consummated on her. This opinion Avas
confirmed by that of Devergie.   (" Gazette Aledical de Paris," and
"Edin. Alonth. Journ.," December, 1860, p. 566.)  There is another
vieAv of this case Avhich  does  not seem to have occurred to the
French medical experts, namely: "JVon omnes dormiunt quce clausos
habent oculos."   [Where the testimony was to  the  effect that the
person  alleged to be  ravished Avas aAvakened  by the act  of the
prisoner, to which  she made no  resistance or  outcry, when there
was another person  in the room Avho could have heard her, it Avas
held not to be a case of rape.  Pollard v.  The State, 2 Clarke  (Iowa),
567.—P.]
  2. A rape may be  committed on an adult Avoman if she falls into
•d state of syncope, or is rendered powerless by  terror and exhaustion 
718
PREGNANCY  FOLLOWING RAPE.
from long struggling Avith her assailant.  An eminent judicial au-
thority has suggested to me that, in his opinion, too great distrust is
commonly shown in reference to the amount of resistance offered by
women of undoubted character.  Inability to resist from terror, or
from an overpowering feeling of helplessness, as Avell as horror at
her situation, may lead a Avoman to succumb to the force of a rav-
isher, without offering that degree of resistance which is generally
expected from a woman so situated. As a result of long experience,
he thinks that injustice is often done to respectable women by the
doctrine that resistance  was not continued long enough.
  3. AVhen several are combined against the female, in which case
we  may expect to find some marks of violence on her person, if not
on the genital organs.
  4. A woman may yield to a ravisher, under threats of death, or
duress ;  in  this case her consent does not excuse the crime, but this
is rather a legal  than a medical question.  An aged woman  can
scarcely be expected to resist a strong man.  Dr. Chevers mentions
a case in which a  man  was convicted of rape and  aggravated as-
sault on a woman of seventy years of age.
  Loss of physical evidence.—It  is necessary to observe, in relation
to the examination of married women, that the indications of rape
on the genitals, however well-marked  they may be  in the first in-
stance, either soon disappear or  become obscure, especially in those
who have been already habituated to sexual intercourse. After two,
three, or four days, unless there has been an unusual degree of vio-
lence, no traces of the crime may be found about the  genital organs.
In the case of an  adult  married woman examined  by Dr. Aiayne,
the appearances of injury which he discovered in  and  about  the
vagina had begun to heal in less than  forty-eight hours;  but in a
case examined by Caspier, on the  ninth day the lining membrane
of the vagina was still  reddened, and  the parts were painful.   In
this case the hymen was completely torn through.   (" Gerichtliche
Medicin," vol. 2, p. 157.) In married women, or in those accustomed
to sexual intercourse,  no inference can  be  drawn from a dilated
state of the vagina.  In unmarried women, and in children when
there has been much violence, these marks may persist and  be ap-
parent for a week or longer.  If there  has been great laceration of
the sexual organs, then certain appearances in the form of cica-
trices may remain; but in all cases  great caution should  be ob-
served in giving an opinion of rape having been perpetrated, from
an  examination even two  or three weeks after -the alleged com-
mission of the offence.   Marks of violence on the person can never
establish a rape;  they  merely indicate, cceteris paribus, that  the
crime may have been attempted.
  Pregnancy following Rape.—It has been a question, whether when
intercourse has taken place against the will of a woman, i. e., in the
perpetration of rape by violence, pregnancy could possibly follow.
It Avas, at one time, thought  that the will of a woman was ahvays
necessary to the act of impregnation, and therefore if she  became
pregnant, she must have consented  to the act, and that the charge of
/ 
EXAMINATION OF STAINS.
719
rape Avas unfounded.  Such a defence would not be admitted as an
answer to a charge of rape, or to show, under any circumstances,
that intercourse had been had with consent.  Conception, it is Avell
known, does not depend on the consciousness or volition of a female.
If the state of the uterine organs be in a condition favorable to im-
pregnation, this may take place as readily-as if the intercourse Avas
voluntary ; eA7en penetration  to the vagina is  not absolutely neces-
sary for impregnation.  See cases by Dr. Oldham, " Aled. Gaz.," vol.
•44 p. 48.)   In a case communicated to me by the late Air. Carring-
ton, a AAroman became pregnant, after a rape committed on  her by
a man who subsequently married her ; the date of intercourse Avas
accurately fixed, and a child was born after 263 days' gestation.
  It  has  been supposed, that  in cases of pregnancy folloAving rape,
in spite of resistance at first, a  woman may in the end have volun-
tarily joined in the act.   I  knoAv of no ground for  adopting this
theory; the general opinion is, that conception  may occur, and  is
neither accelerated, nor prevented by the volition of the sexes.  Af any
women in married life who anxiously Avish for children have none,
and vice versa ; and physical impediments do not suffice in all cases
to explain  these facts.  Women are reported to  have conceived
during the states of asphyxia, intoxication, and narcotism.  Dr. Ryan
mentions a case in Avhich a young Avoman became  unconsciously
pregnant from intercourse had with her by a man Avhile she Avas  in
a state of intoxication, and in Avhich it was clearly impossible that
her volition could have taken any share. (" Aled. Juris.," p. 245.) In
married life there is no doubt that women frequently become preg-
nant against their Avill,>and in a great number of cases Avithout any
consciousness of their condition until  pregnancy is  far advanced.
Those Avho affirm that without the active  will of the Avoman there
can be no conception, must deny the existence of  cases of impreg-
nation in a state  of unconsciousness (p. 504);  but the facts are too
strong and too numerous to be met with a single denial.  A medical
jurist, therefore, aa-1io relied upon pregnancy folloAving alleged rape,
as a proof of consent on the part of the Avoman, and Avho would infer
from this result that the intercourse must have  been voluntary on
her part, Avould inflict great injustice by such  an opinion.  The ex-
trusion of an ovum does not depend on the will of a woman, but is
a periodical condition ; the action of the spermatozoa on this ovum
is as much removed from the will of the woman, as it is from that
of the man.
  Examination of stains.—As part of the medical evidence  in cases
of rape, it may be necessary to examine spots or  stains on the  linen of
the prosecutrix and  the accused.  Cases of rape are, however, com-
monly tried in  this country without reference to this sp.ecies of evi-
dence ; and it  is  not easy to  perceive Iioav this can be necessary  to
the proof of the crime in the living, when the pireseut laAV of England
demands only proof of penetration, and not of emission. (24 and  25
Vict. c. 100, s. 03.)  Thus, a rape may be legally completed without
reference  to emission ; and, medically speaking,  it  appears quite
possible that there might be marks of emission Avithout any penetra- 
720              EXAMINATION  OF STAINS.
tion.  Admitting that certain stains of this description are found on
the clothes of an accused person,—are these to be taken as furnish-
ing undeniable proof of the legal completion of rape ?  It appears
to me that without corroborative evidence from the state of the
female organs, they cannot be so taken; and therefore the affirmative
evidence from the "microscope, under these circumstances, is as liable
to lead to error as that which  is purely negative.  The fact that sper-
matic stains are found on the  linen of the prosecutrix may, however,
become occasionally of importance in charges of assault with intent.
(Reg. v. Hamilton, Edinburgh, Nov. 27, 1843.)
  There are no chemical tests on which we can safely rely for the
detection of spermatic stains.  The appearance produced by a dried
spermatic stain on linen or cotton is like that produced by a diluted
solution of albumen.  The fibre of the stuff is  stiffened, and the
stain, particularly at the margin, has a slightly translucent appear-
ance, as if the stuff had been wetted by diluted gum or albumen,
but without any shining lustre.  In the dry state, the stain presents
no Avell-marked color or odor.   Slips of the stained linen, Avhen
soaked in a small quantity  of distilled water, yield  a muco-albumi-
nous liquid slightly alkaline.  It was long since noticed by Orfila
that this liquid, unlike a solution of albumen, was rendered rather
strongly yellow by diluted nitric acid.  By the action of Avarm
water, the stained linen, even although it may have been kept dry
for a considerable  period, has been  observed to evolve the peculiar
faint odor of the spermatic secretion.
  The stained  linen, or  a  portion of it, should be  cut out,  taking
care that it is not roughly handled.  It should be put into a small
porcelain capsule,  Avith a sufficiency of cold distilled water (eight or
ten drops) to soak it thoroughly, and to alloAv the fibre of the stuff
to become quite penetrated by the liquid.   Unless the stained stuff
is very  coarse, or is not easily penetrable  by Avater, the necessary
digestion will be completed in a quarter of an hour.  The stained
linen may then be removed, and any water loosely adhering to it
allowed to drain from it.   The soaked portion of the stain should
then be squeezed, so that some drops of the liquid may be collected
on several glass slides, already well  cleaned and  prepared  for  the
purpose.  The liquid thus obtained  by squeezing the stained linen
is slightly opaline.  It should now be covered with thin microscopic
glass, and examined by a  microscope.   The spermatozoa are best
seen in a good light, with a power  of 500  diameters ; the head is
ovoid and flattened—sometimes rather pointed; the tail  is from
nine to twelve times the length  of the head : they are usually asso-
ciated with granular bodies, and with epithelial scales.   Fibres of
cotton, linen, or wool  may  be also mixed with them: and they may
be mixed with pus, mucus, and  blood-globules.   Their  form is so
peculiar that, when once Avell seen  and examined,  they cannot be
confounded with  any other substance, vegetable or animal,  nor
with ordinary care, can any vegetable fibres be mistaken for them,
although these may be mistaken for their tails, or filaments.  Hence
the microscopical evidence  is not satisfactory unless it is based  on 
EXAMINATION OF STAINS.
721
the detection of at least one perfect spermatozoa.   Dr. Koblanek
expresses the  opinion that when they are not discovered  by the
process above described, the stains cannot be due to  the spermatic
secretion : in this, however, he is in error.  AVhen the stained article
of dress is of very coarse texture, when  it has been  much  rubbed,
much worn, or Avetted by urine, blood, mucus, or pus, it will be  a
matter of considerable difficulty to discover these bodies, although
there may really have been spermatic stains upon it.  Most of thSe
foreign substances, however, may be removed by the addition of one
or two drops of diluted acetic acid, which exerts no  dissolving ac-
tion on the bodies of the spermatozoa.  As it  has been elsewhere
stated, these bodies, although peculiar to the seminal fluid, are not
found in the very young, the very old, or in those who are laboring
under long-standing disease of the testicles (p. 682).   Even in the
cases of healthy married men, who have had children,  spermatozoa
are not  ahvays found in  the spermatic secretion; their presence,
size, and number are subject  to  great  uncertainty.  Exhaustion
from frequent intercourse, or constitutional causes without actual
bodily disease,  appear to influence  their production.    There  are
also various other conditions in which  they are not  found; these
have been fully examined by Casper (" Gerichliche Medicin," vol. 2,
p. 141).   Hence  the discovery of spermatozoa in stains on articles
of clothing demonstrates that they have been produced by the sper-
matic liquid; but their  non-discovery under  these circumstances,
does not prove that the stains have not been caused by this liquid.
Dr. Koblanek's conclusions on this subject are, therefore, not borne
out by facts.
  The detection of dead or motionless spermatozoa in stains may
be made at long periods after  emission, when the fluid has been
alloAved to dry.  In three cases, at intervals of from one week to
seven weeks after the perpetration of the crime, Casper Avas enabled
to demonstrate the presence of spermatozoa on articles of clothing,
and  thus to  furnish strong corroborative evidence.   (Op. cit., vol. 2,
p. 161.)   Dr. Koblanek made experiments on this subject, in refer-
ence to different periods of time; he found these bodies distinctly,
after three days, one month—three, four, six, nine, and  even twelve
months.  The number of distinct and perfect bodies diminished ac-
cording to the length of the period at which the examination was
made.   Thus, at the end of a year, only two perfect specimens could
be pierceived; but it may be stated, that  the discovery of one dis-
tinct and entire body is quite sufficient to justify a medical opinion
of the spermatic nature of the stain.  M. Bayard states that he
had been able to detect spermatozoa  in stains after the long period
of six years  !  (" Alan. Prat, de AleU Le"g.," p. 277.)
  A medical witness must be prepared to consider the precise value
of evidence  furnished by the  microscope, in the examination of
stains on the dress of a man accused of rape.   A shirt  may present
stains of blood,  urine, mucus, or gonorrhceal discharge, some of
which, but for the microscope, might be mistaken  for  spermatic
stains.   Admitting that, by the process above described, the micro-
      46 
722         RAPE — MICROSCOPICAL EVIDENCE.

scope enables an examiner to affirm that the stains have really been
caused by the spermatic secretion, this does not prove that a rape has
been committed, or even that intercourse has been necessarily had
with a woman.  Such  stains may arise from spontaneous natural
discharge, or from disease (spermatorrhoea), and therefore, in them-
selves, they afford  no proof of intercourse.   If, from other  circum-
stances in the case, it  should be clearly and satisfactorily proved
that there has been intercourse, then the presence of  blood  mixed
with the spermatic stains might, in certain cases, justify an  opinion
that violence had been used.  The discovery of spermatic stains on
the dress of a woman  furnishes stronger evidence  of intercourse,
attempted  or  perpetrated, than  their discovery on the dress of a
man; but admitting that intercourse  is thus proved, it may still
have taken place with the consent  of the woman.   These  stains,
when found on the clothing of girls and infants, afford a  strong
corroborative proof of  the perpetration  of the crime.
  31icroscopical evidence from the woman.—It may become necessary
to determine, in reference to a woman, whether intercourse has, or
has not recently taken place.   All observers agree that, within a
certain period  after connection, the fact may be established by the
examination of the vaginal mucus. A small quantity of this mucus
placed upon glass,  and  diluted with water, will  be found to contain
spermatozoa, if the suspicion be correct.   In addition to other
characters, it may  be remarked that  the living spermatozoa move
for many hours out of the body when kept at a  temperature of 98°,
and they even retain their rapid motions when the spermatic liquid
is mixed with water; but these motions cease immediately on the
addition of urine, or chemical re-agents.  According to Aliiller, the
spermatozoa may  retain vitality (or  free motion) in the body of a
woman, for the period  of seven or eight days, and even longer.  AI.
Bayard states that  he has thus detected them in the vaginal mucus of
females not subject to morbid discharges, at various intervals up to
three days after intercourse (op. cit., p. 277); and Donne' found them
under similar  circumstances, in a woman who  had been admitted
into the hospital the day before (op. cit., p.  305).  This evidence
may become of value  in a charge of rape, but it may be easily de-
stroyed by the presence of leucorrhcea: and it is open to an objec-
tion, that,  in  certain morbid  states of the vaginal  mucus of the
human female, there is found in it a microscopic animalcule, called
by Donne the  Trichomonas vagince ; but  this has a much larger body
and a shorter tail than the spermatozoon.  Other substances may
be sometimes found in the vaginal mucus; see  case by Dr. Lender
(Horn's "Vierteljahrschrift," April, 1865, p. 355).
  31arks of blood on clothing.—Afarks of blood upon  the  linen can,
of course, furnish no  evidence, unless  taken with other  circum-
stances.  The  linen may be intentionally spotted or stained Avith
blood for the purpose of  giving apparent supiport to a false accusa-
tion.  Dr. Bayard  met  with a case of this kind, in which a woman
charged a  youth with having  committed  a rape upon her infant
child.  On examination, the sexual organs were found uninjured; 
RAPE—BLOOD-STAINS.
723
and on inspecting the marks of blood on  the  clothes of the child,
it Avas observed that the stains were produced  on the outside of the
stuff, and  bore the appearance of smearing;  the whole fibre had
not even been completely penetrated by the liquid.  The falsehood
of the charge Avas thus established.  (" Ann. d'Hyg.," 1847, vol. 2,
p. 219.)  A case involving a false charge  of rape  Avas tried at the
GlasgoAV Autumn. Circuit in 1859.  One  of the witnesses, an  ac-
complice, proved that she  had purchased  some blood and  handed
it to the Avoman who  made the charge, and she  saw her  smear it
over her person and  on some sheets on  Avhich it was alleged the
rape was perpetrated.   The woman (Boyle) and her husband, who
made this false charge, were convicted  of  conspiracy.
  It may be a  question Avhether marks of blood on  the linen of a
prosecutrix Avere caused by effusion as a result of violence or by the
menstrual fluid.  In its normal state this fluid  is said to contain no
fibrin; but in  respect to  the  presence of red corpuscles  and of
serum,  it  resembles  blood.   That fibrin  is,  however,  frequently
present, and in large quantity, is  obvious  from its being occasion-
ally discharged in a clotted state ; hence, the discovery of fibrin in
a stain  Avould  by no  means necessarily imply that the blood was
not derived from the  menstrual fluid.   Supposing the blood-stain
to have been caused  by7 imbibition from  another article of  dress
already  stained, the  secondary stain  would  be free from fibrin,
which Avould remain in the stuff originally wetted.  A man might
thus wrongly- pronounce this secondary stain  to  be due to  men-
strual blood.   Even the presence of epithelial scales and mucus
would not prove the stain to be menstrual,  unless it could he shown
that the mucus was actually effused with  the  blood which caused
the stain.  The epithelial  scales  naturally found in vaginal mucus
are flat nucleated cells, oval, round, or polygonal in shape, and  vary-
ing in size.  They  are spread over the mucous membrane not only
of the  A7agina,  but of the mouth, pharynx,  oesophagus  (gullet),
conjunctiva, and the serous and  synovial  membranes.  (" Kirkes'
Physiology," p. 304.)  There must be great caution in relying  upon
this microscopical evidence.
  It may be right  to  state for the information of medical practi-
tioners Avho have hitherto thought  that they could easily distin-
guish menstrual blood, and SAvear to it on charges of rape, that a
few years since  the French Academy of Medicine appointed  as a
committee A1AI. Adelon, Moreau, and  Le Canu, to examine this
question in  the most  comprehensive manner.  These gentlemen
reported that, in the  present state  of  science, there is  no certain
method  by- Avhich menstrual blood can be distinguished from  that
effused from the bloodvessels in a  case of child-murder or abortion.
('Ann. d'Hyg.," 1846, vol. 1, p. 181;  see ante, p. 546.)
  Evidence of violation in the dead.—The body of a  child or Avoman
is found dead, and  a medical witness may be required to determine
whether her person has or  has  not been violated before death.
There  is here  some difficulty, because  there will be no statement
from the prosecutrix  herself.  The witness can  seldom do more 
724
SODOMY.  BESTIALITY.
than express a conjectural opinion, from the discovery of marks of
violence  on the person and about the genital organs.  Even  if
spermatozoa  were detected  in the liquid mucus of the vagina, or
on the dress of a woman, this would merely prove that there had
been intercourse; whether it had been violent or not, and against
the Avill of the Avoman, would depend on the circumstantial evi-
dence.  In a  case of murder  tried in Edinburgh some years ago,
the first point to determine  in  the dead body was, Avhether a rape
had, or had not been committed.   The examination  of the stains
on the dress was conclusive when taken in conjunction with the
other evidence.  The jury convicted the man of a rape,  but ac-
quitted him  of the murder.   For a case  in  which  evidence Avas
obtained on the examination of a  dead body see Casper's " Klinis-
che Novellen," p. 17.
  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  eighteen, was charged Avith having been guilty of an
act of indecency, with violence, on the  person of Xavier T., a boy
under the age of fifteen years.  She was found guilty, and con-
demned to ten years' imprisonment.  In another case, which oc-
curred in 1842, a girl, aged  eighteen, was charged with rape on
two children—the one eleven, and the other thirteen years of age.
It appeared in evidence that the accused enticed the tAvo boys into
a field, and there had forcible connection with them.  This female
was piroved to have had a preternatural contraction of the vagina,
which prevented intercourse with  adult males.  She was found to
be laboring under syphilitic disease, and the proof of her 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  labor at the galleys.   (" Ann. d'Hyg.,"
1847, vol. 1,  p. 463.)  Casper  describes cases of this  description
which have fallen under his observation.  (" Handbuch der Gericht-
lichen Afedicin," vol.  2, p. 129;  and " Klinische Novellen," 1863,
p. 15.)  By the Penal Code of France, it is a crime in either sex
to  attempit intercourse  with the other, whether with or without
violence, when the child is  under eleven years of age.   That this
offence is pjerpetrated 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 connection of adult females with  male children, which
is punished as a crime in the other sex.   The only accessible medi-
cal proof  would consist in the transmission of gonorrhoea or syphi-
lis  from the woman to the child.

                     Sodomy.  Bestiality.

  Pederastia, or Sodomy, is defined to be the  unnatural connection
of a man  Avith mankind, while the  term bestiality is applied to a 
SODOMY.   BESTIALITY.
725
similar connection with an animal.   The  evidence  required to es-
tablish this crime is the same as in rape, and therefore penetration
alone is sufficient to constitute it.  There  are, however, t\vo excep-
tions: 1st, it is  not necessary to prove the offence  to have been
committed against the consent  of the  person upon AA-hom  it Avas
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 com-
mitted this offence with a woman, and a majority of the  judges
held that this was within  the statute.   Unless  the  person is in  a
state of insensibility, it is  not possible to conceive that this offence
should be pierpetrated on an adult of either sex against his  or her
will;  the slightest resistance would suffice to pirevent its perpetra-
tion.  In August, 1849, a question on this point was referred to me
from Kingston, Jamaica.  A man was convicted, and sentenced to
transportation  for life, for the crime of sodomy, alleged to have
been committed  on  the complaining party  Avhile  he was  asleep.
The only evidence against him was the statement of the complain-
ant.  The opinion given  was in conformity with that of Dr. J.
Ferguson, avIio referred the case to me,  namely, that  the perpetra-
tion of the act during  a state of natural  sleep was contrary to all
probability.  The remarks already made in reference to rape during
sleep  may be applied with greater  force  to acts of this nature.
(p. 716.)  If this crime  be committed on a boy under fourteen years,
it is felony- in the agent only; and the same, it appears, as to a girl
under  tAvelve.    ("Archbold," p. 409.)   The act must be  in the
part where it is usually committed in the victim or associate of the
crime, and if done elsewhere it is not sodomy.
  The facts are commonly sufficiently proved Avithout medical evi-
dence, except in the case of young persons, Avhen marks of physical
violence Avill in general be sufficiently apparent.  In some instances
proof of the perpetration of the crime may be obtained by resort-
ing to microscopical evidence.   (See Donne, op. cit. p. 305.)  Stains
upon the linen of young persons may thus furnish evidence that the
crime has been attempted, if  not actually perpetrated.  For a case
of this kind see pi. 687.
  Trials for sodomy and  bestiality are very frequent, and convic-
tions of men and boys have taken  place for unnatural connection
with cows, mares, and  other female animals. It is punishable by
penal servitude for life, under the 24th and 25th Vict. c. 100, s. 61.
There cannot be the slightest doubt that false charges of sodomy
are more numerous than those of rap>e, and that this is too often  a
successful mode of extortion.  This is rather a legal than a medical
question ;  but it is especially deserving of notice, that  these accu-
sations are very  frequently made by soldiers and a bad class of
policemen!

  [It is a remarkable fact, that in cases of trials for rape, the maxim
of the laAV that innocence is to be presumed until guilt is proved, is
often reversed.  The most glaring inconsistencies and contradictions 
726
RAPE — LEGAL  DECISIONS.
on the part of the prosecution seem to escape the notice, or make
no  impression upon the mind of the jury.   The remarks of  Sir
Matthew Hale, so often quoted that they have become trite, contain
nevertheless a truth that  cannot be controverted ; " It is true," he
says (1 Hal. P. C.  635), " that rape is a most detestable crime, and
therefore ought severely and impartially to be punished with death ;
but it must be remembered that it is an accusation easy to be made,
hard to be proved, but harder to  be defended by the party though
innocent."  He then mentions some cases within his own observa-
tion of malicious prosecution of this crime, and adds: "I mention
these instances that Ave  may be  the  more cautious upon trials of
offences  of this nature, wherein  the court and jury may with so
much ease be imposed upon, without  great care and vigilance, the
heinousness of the offence many times transporting the judge and
jury with so much indignation, that they- are over-hastily carried on
to the conA7iction  of the persons accused  thereof by the confident
testimony of sometimes false and malicious witnesses."
  Many cases might be cited to illustrate these remarks; the books
are full of them, however, and it Avould be unnecessary to occupy
space by doing so.   The conviction of Dr. Beale, for instance, was
a surprise to the legal and medical professions, and  could only be
accounted for by this remarkable tendency on the part of the  jury.
In allusion to this  case, Mr. Wharton, in  treating of what degree
of penetration is  required to  complete the offence  of  rape, says
("Med. Juris." §  471): "Perhaps the furthest limit to which the
rule has reached, is in a recent case in Philadelphia, where, though
there was no medical examination, it was hekl that proof by the
prosecutrix of pain in the sexual organ, and of the juxtaposition
at the  time of the defendant's face to  her OAvn—she at the time
being in a dentist's chair, under the  influence of ether—Avas enough
to justify a jury in  pronouncing that there was penetration, and that
the penetration Avas sexual.  The general  result of both medical
and legal opinion, however,  is, that while  the learned and able
judge who tried the case, properly left it to the jury as a question
of fact as he was obliged to do, to determine Avhether penetration
had then taken place, the verdict was not sustained by the evidence,
and forms an  unsafe precedent for the future."   And in a note to
section 443 of the same work, the  following remarks are added:
" We sincerely believe that a great wrong may have been inflicted
upon an innocent man, which can only be compensated by- the pro-
bability that the fallible nature of the evidence upon which he was
convicted, will hereafter render it difficult to sustain an accusation
upon similar proof." In the same note is mentioned the case of a
dentist in Montreal, who was indicted in 1858, for attempting to
commit a rape upon one of his patients  under the influence of
chloroform.  At the trial, a witness testified  that his wife was un-
der the strongest  impression  that  she  had been violated by the
prisoner while under the influence of chloroform; yet her husband
was present during the whole time she was unconscious.  The ver- 
RAPE.
727
 diet of the jury was, "Guilty of an attempt to commit rape, with
 a recommendation to mercy I"1


   ' Sancho Panza's judgment, in the  case of rape which was heard  before him
 during his brilliant, though brief, administration as  governor of Barataria, was
 certainly more creditable to the cause of justice.  The historian thus reports it •
 " This cause was  no sooner ended,  than there came into court a woman keeping
 fast hold of a man, clad like a rich herdsman.   Slie came, crying aloud: 'Justice,
 my lord-governor, justice !  If I cannot find it on earth, I will seek it  in heaven !
 Lord-governor of  my soul, this wicked man surprised me in the middle of a field,
 and made use of my person as if it had been a dish-clout.   Woe is me ! he has
 robbed me of what I have kept above these three-and-twenty years, defending it
 against Moors and Christians, natives and foreigners.   Have I been as hard as a
 cork-tree, and preserved myself as entire as a salamander in the fire, or as wool
 among b:iers, that this honest man shall come with his clean hands to handle me?'
 'That  remains to be inquired  into,' said Sancho:  'let us now proceed to see
 whether this gallant's hands are clean or not;' and turning  to  the man, he asked
 him what he had to say in answer to  this woman's complaint.  The  man, all in
 confusion, replied:  ' Sir, I am a poor herdsman, and deal in swine ;  and this
 morning I went out of this  town, and having sold, under correction, be it spoken,
 four hogs, and what between dues and exactions, the officers took from me little
 less than they were worth.  As I was returning home, by the way I lighted upon
 this good dame, and the devil, the author of all  mischief, yoked  us together.  I
 paid her handsomely: but she, not  contented, laid hold of me, and has never let
 go of me until she has dragged me to  this place.  She says I forced her; but by
 the oath I have taken, or am to take, she lies.   This is the whole truth.' Then
 the governor asked him if he had any silver money about him.  The man answered
 that he had about twenty ducats in a leathern purse in his bosom.  Sancho ordered
 him to produce it, and deliver it just as it was to the plaintiff.  Pie did so  trembling:
 the woman took the purse,  and making a thousand curtsies, and praying to God
 for the life and health of the lord-governor, who  took such care of poor orphans
 and maidens, out of the court she went, holding the purse with both hands, taking
 care first to see if the money that was in it was silver.
   "She had no sooner left the room than Sancho said to the herdsman, who was in
 tears, and whose eyes and  heart were gone after  his purse; ' Honest man, follow
 that woman, and take away the purse from her, whether she will or not. and come
 back hither with it.'  This was not said to one deaf or stupid, for the man instantly
 flew after her like lightning, and went about what he was bidden.
   "All present were in  great suspense,  expecting the issue of this suit.  In a few
 minutes came in the man and woman, clinging together closer than the first time,
 she with her petticoat tucked up, and the purse lapped up in  it, and the  man strug-
 gling to take it from her, but in vain, she defended it so stoutly.  ' Justice from God
 and the world !' cried she at the top of her lungs; ' see, my lord-governor, the im-
 pudence and want of fear of this varlet, who,  in the midst of the town and of the
 street, would take from me the purse  your worship commanded to be givm to me.'
 ' And has he got it ?' demanded the governor.   ' Got it!' answered the woman : ' I
 would sooner let him take away my life than my purse.  A pretty baby I should be
 indeed!   Other-guise cats must claw my beard, and not such pitiful, sneaking tools
 as this.  Pincers and hammers, crows and chisels, shall not get it out of my clutches,
 nor even the paws of a lion.  My soul and body shall sooner part.'  ' She is in the
 right,' added the man;  ' I yield myself worsted and spent, and confess  I have not
 strength to take it from her.'  That said he left her.  Then said the governor to the
 woman]: ' Give me that purse, chaste and valiant heroine.'  She presently delivered
 it, and the governor returned it to the man, and said to the violent but not violated
 dumsel: ' Sister of mine, had you shown the same, or but half so much, courage and
 resolution in defending your chastity, as you have done in defending your purse, the
 strength of Hercules could not have forced you.   Begone, in God's name, and in an
ill hour, and be not found in all this island, nor in six leagues round about it, upon
pain of two hundred stripes.  Begone, instantly, I  say, thou prating,  shameless,
cheating hussy !'  The woman was confounded and went away, drooping her head,
and discontented; and the governor said to the man : ' Honest man, go home, in the
name of God, with your money, and henceforward, unless you have a mind to lose
it, take care not to  yoke with any body.'
  "The countryman gave him thanks as clownishly as he could, and went his way. 
728
RAPE.
  In  the case of People v. Benson, 6 Cal. 221, the court say  that
"no case of this class (rape) should go to the jury on the sole testi-
mony of the  prosecutrix, unsustained by facts and circumstances,
without the  court warning  them of the danger  of conviction on
such testimony."—P.]

The bystanders were in fresh admiration at the decisions and sentences of their new
governor, all Avhich, being noted down by his historiographer, were immediately
transmitted to  the  duke, who waited  for them with great impatience."   (Don
Quixote, vol. ii. 289.) 
DEFINITION  OF  INSANITY.
729
INSANITY.
                     CHAPTER  LX.

WHAT IS INSANITY ?—MEDICAL DEFINITIONS.—DISTINCTION  OF SANE
  FROM  INSANE PERSONS.--MORAL INSANITY.—LEGAL DEFINITIONS.—
  "NUN COMPOS MENTIS."—SYMPTOMS OF INCIPIENT  INSANITY.—HALLU-
  CINATIONS AND ILLUSIONS.—LUCID INTERVALS.

  Wiait is insanity?  31edical definitions.—The terms insanity, lu-
nacy, unsoundness of mind, mental derangement, madness, and men-
tal alienation or aberration have  been indifferently applied to those
states of disordered mind in which a person loses the power of regu-
lating his actions and conduct according to  the  ordinary rules of
society7.   In all cases of real insanity, the intellect is more or less
affected—hence the term intellectual insanity.  In a medical sense
this  implies a  deviation of the mental faculties from an assumed
normal or healthy standard.  In an insane person there may be no
bodily disease, but his language and habits  are changed—the rea-
soning power which he may have enjoyed in common with others
is lost or perverted, and he is no longer fitted to discharge  those
duties which his social position demands. Further, from perversion
of reason, he  may show a disposition to commit  acts which may
endanger his  OAvn life, or the lives of those around him.  It is at
this period that the laAV interferes for his OAvn protection, and  for
that  of society.
  Many attempts have been made by psychologists to define insa-
nity, but the definitions hitherto given are  so imperfect that it
Avould be difficult to find one which includes all who are insane,
and excludes all avIio  are sane.   This difficulty is fully accounted
for by the fact that mental disorder varies in its  degree, as well as
in its characters ; and the shades of disordered intellect in the early-
stages are so blended, as to be scarcely distinguishable from a state
of sanity. It  is this tAvilight condition of the  mind, Avhen it is fluc-
tuating between sanity and insanity, which no definition can com-
prise, especially as the mind differs in its power and manifestations
in most  persons, and it is therefore difficult to fix upon a standard
hy which a fair comparison can  be  made.   The vulgar  notion of
insanity is that it consists in an entire depm7ation of reason and
consciousness; but the slightest acquaintance Avith the insane,proves
that they are  not only perfectly conscious of  their actions in gene- 
 730       INTELLECTUAL  AND MORAL  INSANITY.

 ral, but that they reason upon their feelings and impressions. The
 late Dr. Abercromby considered insanity to consist in a loss of the
 faculty- of attention—the poAver by Avhich Ave are capable of chang-
 ing, controlling, arresting, or fixing the current of our thoughts.
 Dr. Conolly regards it as a disorder of the  poAver of comparison or
judgment, and Professor Marc as a loss of the faculty7 of volition ; so
 that, in the latter point of view, the acts of the insane are involun-
 tary, and depend upon impulses which they cannot control.
   These  definitions are defective, inasmuch  as they are not adapted
 to the various forms of the disease.  In some cases of insanity, as
 in confirmed idiocy, there is  no evidence of any exercise of the in-
 tellectual faculties:  but  in most instances, these faculties and the
 moral feelings are partially diseased, or partially destroyed, in every
 variety and degree.   Thus we may meet with  cases in which the
 faculties of attention, comparison, and volition are more or less im-
 paired or absent,  or, if  present, they are  never perfect, although
 each  may not be equally affected.  When no tAvo cases are precisely
 similar, no definition can include  all varieties of the disorder.  A
 medical witness who ventures upon a  definition, will generally find
 himself involved in numerous inconsistencies, for no words can pos-
 sibly comprise the variable characters  which this  malady is liable
 to assume.  Those w-ho take an interest in  definitions of insanity
 and who think they can defend them  from the critical acumen of
 lawyers, will find them fully set forth in their medical and  medico-
 legal aspects in a paper  by  Dr. Rorie.  ("Ed. Monthly Journal,"
 J11I3-, 1865, p. 13.)  There are, however, cases in Avhich a  medical
 man may find himself compelled, if not to define insanity, at least
 to show  some clear distinction between a sane and insane person.
 Thus, in cases in Avhich there has been an alleged breach of the law
 regarding the custody of  lunatics, it may be pleaded that the per-
 son is sane, and a  medical expert must then be  prepared to say
 Avhether the person  concerning whom the question  is raised, is
 idiotic, lunatic, or of unsound mind, and to assign satisfactory rea-
 sons for his opinion.
   [The difficulty of  definition is thus  expressed in a leader in the
 "London Times " of July 22, 1854, cited in Dr. Bucknill's Prize
 Essay on Criminal Lunacy (Law Library, vol. 92): "Nothing can
 be more slightly defined than the line of demarcation between sanity
 and insanity.  Physicians and lawyers have vexed themselves with
 attempts  at  definition in a case  Avhere  definition is impossible.
 There has never yet been given to the world anything in the shape
 of a formula upon this subject, which may not be torn to shreds in
 five minutes by any ordinary logician.   Make the definition too nar-
 row, it becomes meaningless; make it too wide, the whole  human
 race are involved in  the drag-net.  In strictness, we  are all mad
 when Ave give way to passion, to prejudice,  to vice, to vanity; but
 if all the passionate, prejudiced, vicious, and vain people  in this
world are to be locked up as lunatics, who is to keep the key of the
asylum?    As was very  fairly  observed, hoAvever, by a  learned
 Baron of  the  Exchequer, when  he was pressed by this argument, 
MORAL  INSANITY.
731
if AA-e are all mad, being all madmen, we must do the best we can
under such untoward circumstances.  There must be a kind of rough
understanding as to the forms of lunacy Avhich can't be  tolerated.
We Avill not interfere Avith the spendthrift, avIio is flinging his patri-
mony aAA-ay upon swindlers, harlots, and blacklegs, until he has de-
nuded himself of his possessions and incurred debt.  We have no-
thing to say to his brother madman, the miser, Avho pinches his belly
to SAvell the balance at his bankers—being 73 years of age, and
without family—but if he refuses to pay taxes, society will not ac-
cept his monomania as pleadable in bar."
  Perhaps the  definitions  of  sanity and  insanity by Dr. Bucknill
are as accurate  as the subject  admits of.  Sanity, he defines to be,
" that condition of the mind in which the emotions and instincts are
all in such a state of subordination to the will, that the latter can
direct and  control  their manifestations; in which, moreover, the
intellectual faculties  are capable of submitting  to  the Avill sound
reasons for its actions.  Such co-ordinate  action  of the faculties is
termed sanity;  a condition in Avhich that is  lost is termed insanity,
or derangement,  or alienation, or unsoundness, all terms having
reference to the deprivation of the power of the will so directed."
" It is evident," he adds, " that in this definition of sanity there are
three terms, the subjected emotions,  the directing intellect, and the
middle  term of  free will.   Supposing our nature to  be fallible
throughout its  composition, it  is evident that erroneous action may
originate at any of these points; the mutinous emotions may be
indomitable, the power of the will may be abortive, or the intellect
may mislead by false guidance.   Insanity may thus be Intellectual,
Emotional, or Volitional, and though in the concrete it is not easy
to find pure and  unmixed cases under either of  these heads, such
cases  do occasionally subject themselves to  observation.   The ex-
perienced psychopiathist will also find little difficulty in apportion-
ing a vast number of the other cases according to their predominant
character, under one or other of these headings.
  " Insanity, therefore, may be defined as, A condition of the mind in
which a fcdse action of conception or judgment, a defective power of the
will, or an uncontrollable violence of  the emotions  and instincts, have
separately or conjointly been produced by disease."—Bucknill on Crimi-
nal Lunacy, pp. 27, 28.—P.]
  Moral insanity.—In addition to that form of insanity in which the
mind is effected, known as intellectual insanity, Dr. Pritchard and
other medico-legal  writers have described a state which they- call
moral insanity (Mania sine delirio), Avhich is manifested simply by a
perverted or disordered state of the feelings, passions, and emotions,
irrespective of any apparent intellectual aberration.  There are no
hallucinations or illusions, and there is no evidence of delusion, but
simply a perversion  of the  moral sentiments.  Thus, it  is alleged
that this form  of insanity may appear in the shape of a causeless
suspicion, jealousy, or hatred of others, especially of those to whom
the affected person ought to be attached ; and  it may also manifest
itself  under  the form' of a Avild, reckless, and cruel disposition to- 
732
MORAL INSANITY.
wards mankind in general.  It does not seem probable,_ however,
that moral insanity, as thus defined, ever exists, or can exist in any
person without greater or less disturbance of the intellectual facul-
ties.  The mental powers are rarely disordered without the moral
feelings partaking of the disorder; and, conversely, it is not to be
expected that the moral feelings should become to any extent per-
verted without the intellect being affected, for perversion of moral
feeling is generally observed to  be one of the early symptoms of
disordered reason.  [See Bucknill on Criminal Lunacy, Apipendix,
note E.—P.]  The intellectual disturbance may be sometimes diffi-
cult of detection; but in every case of true insanity it is more or
less present, and it would be a highly dangerous  practice to pro-
nounce a person insane,  when some evidence of its existence Avas
not  forthcoming.  The laAV does not recognize moral insanity as
an  independent state;  hence, hoAvever  perverted the affections,
moral feelings, or sentiments  may be, a medical jurist must ahvays
look for some indications of disturbed reason.  Medically speaking,
there are, according to Dr. Pritchard, two  forms of insanity, moral
and intellectual; but in law there is only one—that which affects
the mind.  Moral insanity is not admitted as a  bar to responsibility
for civil or criminal acts,  except in so far as it  may be accompanied
by intellectual disturbance.  [But see the case  of Reg. v. Crockroft
(Leeds Autumn Assizes, 1865), cited post,  in chapter 63.  It is ad-
mitted in  Pennsylvania.   See cases of Com. v. Mosler, 4 Barr 266.
Com. v. Shurlock, 14 Leg. Int. 33.   lb. v. Smith, 15 Leg. Int. 33.
lb. v. Freath, 6 Am. Law Register, p. 400.  See also Lewis's Crim.
Law 404.  In most of the States, however, the laAV is as stated in
the text, and the test still is the knowledge  of right and wrong.
See Farrar v. State, 2 Ohio St. R. 54.  State v. Spencer, 1 Zabrieski
196  (New Jersey).  Fisher v. People, 23 111. 283.  Loeffner v. State
10 Ohio (N. S.) 598.—P.]   Dr. Mayo denies its existence, and con-
tends that no abnormal state of mind should confer irresponsibility
unless it involves intellectual as well as moral perversion.  (" Medi-
cal Testimony," p. 69.)  The late Sir B. Brodie also considered that
there are no reasonable grounds for admitting  this to  be  an inde-
pendent  form of insanity.  There  has been, as he suggests, much
mystification on the subject.   The term has been  applied to cases
in which the name of insanity ought not  to have been applied at
all, i. e., to " moral depravity," and also to cases in which delusions
have really existed, and which might therefore have been more pro-
perly classed with cases of ordinary mental aberration.  (" Psycho-
logical Inquiries," p. 99.)  Of one fact we may be w-ell  assured;
if in these cases of alleged moral insanity there is no indication of
a perversion of  intellect,  medical evidence is not required  to deter-
mine the fact, or the degree of responsibility in reference to these
persons.   Those who administer the law, and any man endowed
with plain common sense, will be as well qualified as a medical ex-
pert, to decide the  question of  criminal  responsibility.   Further,
until medical men can piroduce a clear and Avell-defined distinction
between moral  depravity and  moral insanity, such a doctrine, em- 
UNSOUNDNESS OF MIND.
733
ployed as it has been  for the exculpation of persons charged with
crime, should be rejected as inadmissible..
  Legal definitions.—The laAV of England recognizes two  states of
mental disorder or alienation:  1. Dementia naturalis, corresponding
to idiocy; and 2. Dementia  adventitia, or accidentalis,  signifying
general insanity as it occurs in persons who have once enjoyed rea-
soning  power.  To this state the term lunacy is also applied, from
an influence formerly supposed to be exercised on the mind by the
moon.  iMnacy is a  term  generally applied  to those  disordered
states of mind which are known to medical  men under  the names
of mania, monomania, and dementia; and Avhich are frequently,
although not  necessarily, accompanied  by  lucid  intervals.   The
main character of insanity, in a  legal view, is considered to be the
existence of delusion—i. e., that a person should believe something to
exist Avhich does not exist,  and that he should act upon  this belief.
Many persons may labor under harmless delusions, and still be fitted
for their social duties ; but should these delusions be such as to lead
them to injure themselves or others, in person or property, then the
case is considered to require legal interference.
  Beside the  terms Idiocy and Lunacy, we find  another frequently
employed in legal  proceedings, namely," unsoundness of mind"—(non
compos mentis)—of the exact meaning of Avhich it is impossible to
give a consistent definition.   From various legal decisions, it Avould
appear that the test for unsoundness of mind  in law has no imme-
diate reference to  the existence of delusion in the mind of a person,
so much as to proof of incapacity, from some morbid condition of
intellect, to manage his affairs with ordinary care and propriety.
(Amos.)  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  Avant of education-
conditions which must not be confounded  with mental  disorder.
Thus, then, a  person may be  of unsound mind, i. e., legally incom-
petent  to the  control of his property, and yet not come up to the
strict legal standard of lunacy or idiocy.
  ^ome medical practitioners have attempted to draw a  distinction
between insanity and unsoundness of mind. A case occurred in 1839,
in which a medical man hesitated  to sign a certificate for the con-
finement of an alleged  lunatic, because  in it  the words " unsound
mind" were used.   He said he would  not have hesitated to sign it
had the term " insane" been employed.  The 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, does  not always
imply.   The  laAV, howe\-er, appears to admit  some sort of distinc-
tion • for according to Chitty, it is a criminal and an indictable act
maliciously to publish  that any person is afflicted with insanity,
since it  imputes  to him a  malady generally inducing mankind to
shun his society; although it is not libellous  to say that a man is
not of sound mind, because no one is of perfectly sound mind but 
734        SYMPTOMS OF INSANITY—DELUSIONS.

the Deity!   (" Med. Jur.," vol. 1, p. 351.)  In reference to the sign-
ing of certificates of insanity, it is, however, an  error to suppose
that the use of one term can involve a practitioner in any greater
share of responsibility than the use of the other.
  Symptoms of incipient insanity.—-The  symptoms by Avhich insan-
ity is indicated at  an early stage are liable to great variation, ac-
cording to  the sex, age, and social position of the person.   In refer-
ence to suicide, the execution of wills, or the perpetration of crime,
we often find  after the death of the person, or at the trial which
follows the crime, that the most trivial and irrelevant circumstances
are brought forward as indications of  insanity.   This subject has
been ably treated by Dr. Forbes Winslow (" Obscure Diseases of the
Brain," p. 88), and  to  his work I must  refer the reader for much
useful information.  The  facts are there gathered chiefly from the
accounts furnished to him by those who have recovered.   There is
great irritability at the  most trifling  circumstances; impatience
of contradiction, loquacity, great difficulty in directing  attention
to, and steadily occupying the mind with any train of thought,
neglect of  usual  employment, sleeplessness, depression of  spirits
Avithout reasonable cause, a disposition to seclusion, doubts about
personal identity, followed by hallucinations and illusions.  A lady,
AA'ho  was gradually affected,  remained insane for nearly  eleven
months; she informed Dr. Winslow that during the whole of that
time  she fancied she was in  hell and  tormented  by  evil spirits;
she thought every person near her was the devil.  Sometimes a
patient fancies he is continually watched  by spies, that policemen
are looking after him, and that conspiracies and  plots among his
relatives or friends are going on secretly against hirn; he believes
that his food is drugged or  poisoned, and will refuse to eat.  Great
anxiety on any subject, followed by  headache, may  be  the fore-
runner of an attack; there  is generally an entire loss of interest in
the usual occupations, a silent  manner, and a great desire for soli-
tude.  In one instance, fits of immoderate laughter at the most
trivial  occurrences preceded  the  attack.   Sooner or later these
symptoms are attended by perverted taste or smell; by illusions of
hearing or  sight; voices are heard, and objects are seen, Avhich at
first perplex,  and then confuse the  patient; they continue until
he  feels overpowered metally and bodily; and  he then falls into
delusions regarding himself, his friends who are about  him, his
profession or occupation, and his worldly circumstances.
  Halluciations and illusions. Delusions.—These are the most strik-
ing symptoms which are met with in a confirmed state of insanity.
Hallucinations are those  sensations  which  are supposed by  the
p>atient  to be produced  by  external  impressions, although  no
material objects act upon  his senses at  the time; illusions, on the
other hand, are sensations produced by a false perception of objects.
A man has visions of all  kinds, including the forms  of the dead
and the living, floating before him when he is gazing upon vacancy.
He fancies he  hears voices speaking, or mysteriously whispering  to
him, while there is profound silence: these are halluciations.  An- 
               ILLUSIONS.  LUCID  INTERVALS.           735

 other may erroneously imagine that the taste or smell of his ordi-
 nary food is earthy, metallic, or poisonous, Avhen  the perversion is
 in his own senses:  these  are  illusions.  Both conditions depend
 upon  a disordered state of the mind.  Instances of hallucination
 are furnished  by the act of dreaming; while illusions occur often
 during the act of suddenly- waking from sleep,—giving  rise occa-
 sionally to serious questions involving criminal responsibility.  The
 state of insanity is in other points of  view analogous to dreaming.
 There  is equally a want of power  in  the two states  to change or
 control the current of thought passing through the mind.   Things
 which are impossible and inconsistent, are  believed to  have an
 actual  existence.   A voice heard during the act of dreaming some-
 times becomes an illusion connected with a current of thought then
 passing through the mind;  it is  the same in  a case of confirmed
 insanity, with this difference in the latter, that some power of will,
 or some exercise  of  reason may still exist.
  Illusions are sometimes met with in the sane; but when arising
 from external objects, the false perception is  soon corrected by a
 reference to the other senses; and herein consists the main difference
 between sanity and insanity,—namely, delusion, or a misleading of
 the mind.   When the hallucination or illusion  is believed to have a
 positive existence, and this belief is not removed either by reflection
 or an appeal to the other senses, the person is insane;  but when the
 false sensation is immediately detected by the judgment, and is not
 acted on as if it were real, then the person is sane.  Delusion, there-
 fore, properly- refers to the judgment, and illusion.to the senses.  The
 meaning of these terms is often confounded; but while delusion is
 ahvays connected with insanity, illusion is not necessarily indicative
 of mental disorder.   Hallucinations  and  illusions are the main
 features of those forms of insanity which are known  as mania and
 monomania.  They are rarely met with in. cases of idiocy and imbe-
 cility, sometimes in dementia ; but they are most common  in parox-
 ysms of mania.  Acts of murder may generally be traced  to their
 existence, for the person laboring under mania or monomania is un-
 able during a paroxysm to divest his mind of the belief that Avhat
 he sees has a positive existence before  him.   He feels impelled to
 suicide by the hallucination of voices calling to him, and to murder
 by the illusion  that  he is not destroying a wife, child, or friend, but
 an evil spirit substituted for them.   The acts of the insane are gen-
 erally  connected with their delusions, although it is not easy to trace
 the connection, except by their own admissions. When the acts are
 unusual and strange, it is most probable that they depend on hallu-
 cination, illusion, or both.
  Lucid intervals.—By a lucid interval, we are to understand in a
 legal sense, a temporary cessation of the insanity, or a perfect resto-
 ration to reason.   This state differs  entirely from a  remission, in
 which there is a mere abatement of the symptoms.  It has been said
 that a  lucid  interval is only a more perfect  remission, and that,
althouoli the lunatic  may act rationally and talk coherently, yet his
 brain is in  an excitable state, and he labors under a greater disposi- 
736
LUCID  INTERVALS.
 tion to a fresh attack of insanity than one whose mind has never been
 affected.   Of this there can be no  doubt, but  the same  reasoning
 Avould tend to show that insanity is never cured; for the predispo-
 sition to an attack is undoubtedly greater in a recovered lunatic than
 in one who is and has always been perfectly sane. _ Even admitting
 the correctness of this reasoning, it cannot be denied that lunatics
 do occasionally recover for a longer or shorter period, to such a de-
 gree as to render them perfectly conscious of, and legally responsible
 for their actions  like other persons. The law intends no more than
 this hy a lucid interval;  it does not require proof that the cure is so
 complete that even the predisposition to the disease is entirely ex-
 tirpated.  Such proof, if it could even be procured, w7ould be totally
 irrelevant.  If a man acts rationally and talks coherently, we can
 have no better proof of a restoration to reason.   If no  delusion af-
 fecting his conduct remained in his mind, we need not concern our-
 selves about the degree of latent predisposition to a  fresh attack
 which may still exist.  Lucid intervals sometimes appear suddenly
 in the insane ; the person feels as  if  aAvakened from a dream, and
 there is often a perfect consciousness of the absurdity of the  delu-
 sion under which he was previously laboring.  The duration of the
 interval is uncertain; it  may last for a few minutes only, or may be
 protracted for days, weeks, months, and even years.  In a medico-
 legal view, its alleged existence must be always looked upon with
 suspicion and doubt, when  the interval is very short.
   Lucid intervals are most frequently seen in cases of mania and
 monomania;  they occasionally exist in dementia Avhen this state is
 not  chronic, but has succeeded a fit  of intermittent or periodical
 mania.  They are never  met with in cases of idiocy and imbecility.
 It is sometimes  a matter of  great importance to be able to  show
 whether or not there exists, or has existed a lucid interval, since, in
 this state, the acts of persons are deemed valid in law.  The  mind
 should be  tested, as in determining whether the patient is laboring
 under insanity or not.   He should be able to describe his feelings,
 and talk of the subject of his delusion, without betraying any signs
 of unnecessary vehemence or excitement.  It may happen that  the
 person who is the subject of a Commission of Inquiry is at the time
 of examination under a  lucid interval, in which case there may be
 some difficulty in forming an opinion of the existence of insanity.
 It has been said that a  person in a lucid interval is considered by
 law to be  responsible for his acts, whether these are of a civil or
 criminal nature.  In regard to criminal offences committed during a
 lucid interval, it is the opinion of some medical jurists that no per-
 son should be convicted  under such circumstances, because there is
 a probability that he might at the time have been under the  influ-
 ence of that degree of cerebral irritation which renders a man in-
 sane. (Pritchard.)  This remark applies especially to those instances
 in which the lucid interval is very short.  Juries now seldom con-
 vict, however rationally  in  appearance a crime* may have been per-
'petrated, if it can be clearly proved that  the accused was really
 insane within a short period of the time of  its perpetration. 
VARIETIES  OF
INSANITY.
737
                    CHAPTER  LXI.

VARIETIES OF INSANITY.—MANIA.—ABSTINENCE FROM FOOD.—DELUSIONS
  REGARDING. POISON.—DELIRIUM DISTINGUISHED FROM MANIA.—MONO-
  MANIA.—DEMENTIA.--IDIOCY.--IMBECILITY.--HEREDITARY TRANS-
  MISSION.—FEIGNED INSANITY.—APPEARANCES AFTER DEATH.—ECCEN-
  TRICITY.

  Varieties of insanity.—Medical jurists have commonly recognized
four distinct forms of insanity: 31ania, 31onomania, Dementia and
Idiocy (Amentia).   This  division Avas prepared by Esquirol, and al-
though of a purely artificial nature, it is highly convenient for the
arrangement and classification of the facts connected Avith the sub-
ject.  Iu some instances there is great difficulty in assigning a par-
ticular case to either of  these divisions, which is  owing to the cir-
cumstance, that these states of disordered mind, if we except idiocy,
are  frequently intermixed, and are apt to pass and  repass into each
other.  On other  occasions a case may represent mixed characters
Avhich appertain to all the divisions.   Some psychologists have pro-
posed two subdivisions,  namely, Incoherency and Imbecility ; but the
former is merely a mixed state of mania and dementia, while the
latter is a term appilied  to those cases of idiocy Avherein the mental
faculties  are suscepitible of some degree of cultivation after birth,
without reaching the normal standard.
  3Iania.—In this form of insanity there is a general derangement
or perversion of the mental faculties, accompianied by greater or less
excitement, sometimes amounting to violent fury.   (Pagan's " Med.
Jur. of Insanity," p. 59: Marc. " De la Folie," vol. 1, p. 211.) Ideas
flow through the mind Avithout order or connection, the person losing
all control over his thoughts, and believing and acting upon them,
however  absurd and inconsistent  they  may be.  Rapidity of utter-
ance and incessant agitation accompany this state; there is also
great irritability, so  that not the least contradiction can  be borne.
Mania may take place suddenly, as after a  violent moral shock, but
in general it conies on sloAvly.  It may  be chronic or acute, recurrent
or continued.   There are very7 few cases which do not present  re-
missions, more or less complete ; and in some instances, after a vio-
lent attack, the reason appiears to be perfectly  restored,  forming
theii Avhat is termed  a lucid interval, the clear distinction of which,
in a legal point of vieAv, is of material importance.
  A person affected Avith mania sometimes  has  a dread or fear  of
everythino-  around him; he coAvers doAvn, tries to conceal himself,.
and shudders at the approach of any one. This state has been called
panophobia.
      47 
738
INSANITY — MANIA.
  There is a popular notion, that violent  fury is met with  in all
cases of mania ; but this is an error.  In some instances, as in those
just referred to (panophobia), this symptom  is  wanting.   These
persons are seldom  excited  to any  act of violence, and should
they give way to passion, they are easily subdued by the slightest
menace.
  In the  greater number of cases  of mania there is excitement,
coming on  in paroxysms w-ithout any obvious cause, and leading
the patients to acts of violence either  towards themselves or others.
These  are the instances  which chiefly- require close personal re-
straint; this, however, has a tendency  to increase the severity of the
fit,  and a more simple plan of treatment, i.e., of watching by personal
attendants, has been generally adopted.  The fits of violence  some-
times come on in a sudden and unexpected manner.
  In  recurrent mania  the attack  comes on  without any obvious
cause.   It may last for a week, a month, or even  longer.  There is
usually a stage of excitement followed  by depression before recovery.
Persons laboring under mania, especially Avhen it is associated, as it
frequently is, with paralysis,  are comparatively insensible to severe
injuries.   They will bear exposure to cold without  complaining,
and even conceal the existence of a fracture or other injury which
would cause great ptain to a sane person.  They will also sustain the
privation of food for a great length of time without  any apparent
injury to health.  In some instances, owing to a suspicion that the
food is poisoned, they refuse  to take any; it is  then necessary to
feed them with a stomach-pump.  (Winslow's " Obscure Diseases
of the Brain," p. 71.)  This  delusion  respecting  the  poisoning of
food is very common in the early stages  of  mania.  The patient
will fancy that he himself, or some fiworite animal, is undergoing
a process  of slow poisoning by a secret  enemy.  In the greater
number of cases of mania there is excitement coming on in parox-
ysms without  any obvious cause, and leading the person to acts of
violence either towards himself or others.
  It is necessary that a medical jurist should be able to distinguish
mania from delirium depending on bodily disease.   Delirium closely
resembles the acute form of mania—so closely that mistakes have
occurred,  and persons laboring under it  have  been  improperly
ordered into confinement as maniacs.  The folloAviijg are perhaps
the best differences: A disordered  state of the mind is the first
symptom  remarked in mania; while delirium is a result of bodily
disease, and there is greater febrile excitement in it than in mania.
Delirium, being a mere symptom  attendant  on the disease which
produces  it, exists so long as that disease, and no longer;  while
mania, depending on widely different causes, is persistent.  Delirium
disappears suddenly, leaving the mind  clear; while mania commonly
experiences only remissions.   (See " Pagan's Med. Jur. of Insanity,"
p. 69.)  In delirium there is generally acuteness of the senses.  In-
flammation of the brain or its membrane (phrenitis) is distinguished
from acute mania by the mode of its  attack, the presence of severe 
CHARACTERS OF  MONOMANIA.
739
pain in the head, and excessive sensibility Avith intolerance of light
and sound.
  Monomania.—This name is applied to that condition  in Avhich
the mental alienation is only partial; in other Avords, it is nothing
more than partial insanity.  In mania, the mind is disordered on
all kinds of subjects; in monomania, the disorder is confined chiefly
either to one subject or to one class of subjects.   Monomaniacs are
infected with false  ideas on  certain points, of which  they cannot
divest themselves, and out of Avhich they cannot be reasoned; they
start from false principles, but setting this aside, their inferences
and deductions from these principles often possess logical accuracy.
In every subject not connected with their special delusion, they are
like the rest of the Avorld ; they talk and reason as justly- upon facts
as before the  access of their malady7, but their general deportment,
habits, and character  are changed.  Thus, a  miser may become  a
spendthrift, and a hard-working and industrious  mechanic may piass
his time in idleness; a man of moral habits "will become immoral
in conversation and conduct, and  an abstemious man  may become
a drunkard.
  The monomania may  be so slight that the person will  have the
power of so controlling  his thoughts and actions, as to appear like
one who is sane, provided the subject of his delusion is not referred
to.  There is  no doubt that those avIio are affected Avith monomania
in an early stage, are frequently able to direct their minds Avith rea-
son and propriety to the performance of their social duties, so long
as these do  not involve any of the subjects  of their  delusions.
Their poAA7er of controlling  their thoughts and feelings, as AA-ell as
of concealing their delusions, implies  a certain  consciousness of
their condition not  usually met Avith in mania; and it also appears
to imply the existence of such control over their conduct, as to ren-
der them  equally responsible with  sane persons  for many of their
acts.   In a case of confirmed monomania, however, it  is not to be
supposed that a man is insane upon one  point only, and sane upon
all other subjects.  The only admissible vieAv of this disorder is that
which Avas taken by Lord Lyndhurst, in one of his judgments.  In
monomania the mind is unsound ; not unsound in one point only,
and sound in all other respects, but  this unsoundness manifests itself
principally with reference to some particular object or person.  (Pil-
chard.)  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.
  Monomaniacs frequently reason  with correctness from false pre-
mises.   A man fancying himself to be  made of butter, will avoid
going into the sun or^sitting near a  fire; another, who fancied
himself to be  made of glass, Avould alloAV no one  to  approach or
touch him lest  he should be broken.   A common delusion relates
to the presence of poison in food;  this leads to abstinence from all
kinds of food, or from food prepared by a particular person.  When
these harmless  and absurd delusions exist, they require no inter-
ference  unless they betray- the  person into acts of violence which 
740          MONOMANIA  AND ECCENTRICITY.

are likely to injure himself or others.   The mind may be generally
unsound, but if the conduct  of the person in the ordinary affairs
of life is not irrational, there.is no reasonable ground for interfer-
ing Avith his liberty  of  action.
  The delusion of a  monomaniac will  be generally uppermost in
his mind ; his will is powerless to dismiss it, just as in mania  the
will is powerless to stop the  constant  and rapid succession of  dif-
ferent and perhaps heterogeneous ideas which present  themselves
to the mind in this form of insanity.   In the first  stage of mono-
mania, the judgment may be  strong and the mind apparently sound
upon every point except the particular  subject of delusion, and
even in some instances, there may be such a control over this delu-
sion, that it would be difficult to  disco\7er whether or not there was
any just ground for imputing mental  unsoundness ; but in a more
advanced form of disease, the delusion,  Avhatever it may be,Avhether
relating to wealth, ambition, religion, or politics, so overpowers  the
patient that  he  loses self-control.  His character is  changed, and
his habits are such as to render him unfit for social intercourse; he
becomes incoherent; his ideas are perverted on all subjects, and he
gradually lapses into mania or dementia.  The last  condition hap-
pens when the monomania is of  long standing.  Monomania may
be remittent or intermittent, and  it is sometimes accompanied with
lucid intervals.   Its progress is  rapid, and  its termination often
unexpected ; in some instances the disease ceases suddenly without
any preA7ious warning, owing to the effect of a strong moral shock
or impression.
   Monomania, in its early stage, is liable to be confounded with
eccentricity ; but there is this difference between them:   In  mono-
mania there is obviously a change of  character—the  pierson is  dif-
ferent from what he was; in eccentricity, such a difference is  not
remarked; he is, and always has been, singular in his ideas and
actions—there is no  observable change of character.  An eccentric
man may be convinced that what he  is doing is absurd and con-
trary to the general  rules of society,  but he professes to set these
rules at defiance ;  a  true  monomaniac  cannot be convinced of his
error, and he thinks that his acts are consistent with reason and
the general  conduct  of  mankind.  In eccentricity, there is the will
to do, or not .to do ; in real monomania, the controlling poAver of the
will appears to  be lost.  Eccentric habits suddenly acquired  are,
hoAvever, presumptive insanity.   It will be seen hereafter, that the
distinction of these  states is  of considerable importance in relation
to the testamentary  capacity of persons.
   Monomania frequently assumes one of two forms:  either the
thoughts are lively and gay, or they are oppressed with gloomy
melancholy.   In the first state, the persons  will fancy themselves
to be kings and queens, and  overflowing Avith  wealth, Avhich  they
are prepared to distribute with regal profusion; in the second state,
we  find  silence,  seclusion,  and the  most  heart-rending sorrow.
The latter condition, by no means uncommon  as a form of mono-
mania, is called melancholia  (mania with depression), or lypemania 
DEMENTIA.
741
(urtr, sorrow).  Those who are affected Avith it suppose they have
committed some unpardonable sin, and pass their  hours in silence
and in the most gloomy forebodings of temporal and eternal pun-
ishment.  They do not sleep, and will sometimes neither eat, speak,
nor move; force must be used to make them take food and exercise.
In some instances, no persuasion can  conquer, their  silence; one
patient thus affected  was  not  heard to utter a word during four
years.  If spoken to, they shed tears, and violently  repulse the
person^vho addresses them.  Melancholia frequently leads to an act
of suicide or murder, and persons affected with it require very-close
watching.  In the lighter forms of the disease  there is no sign of
mental aberration, and the patient will go through his usual  routine
of duty,  but ahvays Avith  the  same desponding  air—so that his
occupation seems  scarcely to distract  his thoughts from the delu-
sion for a  single instant.  In  other  cases the delusion is so \A7ell
concealed that no suspicion exists, until an act of suicide leads to
inquiry, and some evidence of strangeness of conduct is then for
the first time  forthcoming.  There is either an entire  absence of
motive for the act, or the motive is based on a delusion.
  Dementia.—This  is  a  state  which,  although  sometimes con-
founded with mania, is very different in its characters.   Dementia,
when confirmed, consists  in a total absence of all reasoning poAver,
and an incapacity to pierceive  the true relations of things; the lan-
guage is incoherent, and the actions are inconsistent; the  patient
speaks Avithout being conscious  of the meaning of Avhat he is say-
ing ; memory is lost, and sometimes the same word or phrase is
repeated for many hours together;  words are  no longer connected
in meaning, as they are in  mania and monomania.  This  state is
often called fatuity ; it is  a not unfrequent consequence of mania or
monomania.
  Dementia varies in degree.   The disordered mind  of aged per-
sons is one form of dementia; here  AA-e  find  memory and  some
mental power,  although the memory is restricted  to objects long
since past, and the exertions of the  mind are only momentary.
Some pjersons in dementia are quiet, others are  in constant motion
as if in search  of  something.  There is generally a strong disposi-
tion manifested to collect all kinds of useless articles, Avhich are
hoarded up as  if they Avere of great value.  In some instances this
disease comes on gradually—the faculties, both  moral and intellec-
tual, decay one by one; Avhile in other instances,  although much
more rarely, dementia may  occur suddenly from a violent shock or
impression on the mind.  Dementia may be acute. or chronic,  re-
mittent or intermittent.  The countenance of the patient is gener-
ally p.ale, vacant, and Avithout expression, the  look vague and un-
certain, and tear's are abundantly shed from the slightest causes.
  The folloAvino- may be taken as the  most striking differences be-
tween mania and dementia:  In mania there is an incoherence of
ideas, but depending on  too great rapidity of  thought and excite-
ment'of the intellectual poAvers ; in  dementia there is a want of
ideas, and the incoherence depends on the loss of the p>OAver of con- 
742
IDIOCY  AND IMBECILITY.
necting them, owim? to defect of memory ;  volition is lost and the
brain seems in a state of collapse.  (Esquirol," Maladies Mentales,"
vol. 2, pp. 224 and 232.) In fact, in dementia there is a more or less
complete abolition of the moral, intellectual, and voluntary poAvers;
in mania, and also in monomania, they are in a state of perversion.
Dementia  is often  a consequence of  these states, and sometimes
alternates with them.
  Idiocy.   Imbecility.—Idiocy is the dementia naturalis of lawyers.
The term idiot is applied to one who from original defect has never
had mental poAver.   Idiocy differs from the other states of insanity
in the fact that it is marked by congenital deficiency of the mental
faculties.  There is  not  here a p>er\-ersion, or a loss of what has once
been acquired, but a state in which, from defective structure of the
brain, the individual has never been able to acquire any degree of
intellectual power to fit him for his social position.  It commences
with  life, and continues through it, although idiots are said rarely
to live beyond the age of thirty.   (Esquirol, '• Maladies Mentales,"
vol. 2, p. 284.) The deficiency of intellect is marked by a peculiar
physiognomy, an absence of  all  expression, and  a vague and un-
meaning look; there is no poAver of'speech, or only the  utterance
of a cry or sound ;  there is no will, but the actions of these beings
appear to depend upon  impulse, a poAver of imitation, or  mere ani-
mal instinct;  they recognize no one, they remember no one, and the
mind seems to be  a blank.   Such is the  picture of AArhat  may be
termed a  complete idiot.  In SAvitzerland, this state of idiocy is
often accompanied with great bodily deformity, and enlargement of
the thyroid gland, both in males and females; it  is there  termed
cretinism.  Cretins  resemble monsters more  than human beings.  A
confirmed idiot may in  almost all cases be recognized by the expres-
sion of countenance, and the form of the skull.
  Idiocy is not alAA7ays so complete as this description implies.  There
is a state scarely separable from idiocy, in which the mind is  capable
of receiving some ideas, and of profiting to a certain extent by in-
struction.   Owing, however, either to  original  defect, or to a defect
proceeding from arrested development of  the brain as a result of
disease, or other causes  operating after birth, the minds of such per-
sons are not capable of being brought to a healthy standard of intel-
lect, like that of an ordinary pierson of similar age and social posi-
tion.  This state is called imbecility; it is nothing more than idiocy
in a minor degree.   In  common language, persons laboring under it
are often called idiots,  but for the sake of precision in medical lan-
guage they are more correctly described as imbeciles.   (Esquirol,
op. cit. vol. 2, p. 286.)  In imbecility, the physical organization dif-
fers but little from the ordinary standard; the moral and intellectual
faculties are susceptible of cultivation, but to a less degree than in a
perfect man, and even this capacity does not exist beyond a certain
point.  Imbeciles neA7er attain a normal standard  of intellect, and
when placed in the same circumstances as other men, they never
make a similar use of their intellectual powers.  They can form no
abstract ideas, and sometimes their capacity to receive instruction is 
IMBECILITY.
743
limited only to a certain subject—as for instance arithmetic.  Their
memory- and judgment are limited, although sometimes the former
is remarkably strong.  They express themselves in a hesitating man-
ner, and differently from other men; they require time to perceive
the relations of objects Avhich  are  immediately perceived by sane
persons.  The degree to which  imbecility exists is well indicated by
the power of speech.   In idiots there is no speech, or only an utter-
ance of single Avords; in the better class of imbeciles the spteech is
often easy and unaffected, while there is every grade betAveen  these
two extremes.   Some have arranged imbeciles in classes, according
to their capacity to receive  instruction ; others according  to  their
power of speech;  but such divisions are practically Avithout value;
each case must be judged by itself.  The precise boundary between
idiocy and imbecility cannot be defined.  The major degrees of im-
becility approach  so closely to  those of idiocy, that there is no dis-
tinction betAveen them, and in  a practical view no distinction is re-
quired.   Idiocy has been here described as that condition in which
the congenital defect  is not susceptible of  being  removed  by any-
kind of instruction; but many medicodegal writers apply the term
idiot to one Avho does manifest capacity  to receive instruction,
although in a low degree.   The difference is immaterial so long as
the meaning of the word is understood.
   How are the minor degrees of imbecility to be distinguished from
sanity ?  This is  a question  by no means  easy to ansAver, for the
reason that sane persons differ remarkably- in their mental power to
receive instruction, to retain what they have been taught, and to
allow them to make a practical use of it in  the world for their OAvn
benefit.   Hoav many persons pass through  life  and advance in the
world,  Avho are yet undoubtedly weak-minded, and Avho have the
reputation among all who know  them of being so !   The truth is,
the lowest degrees of  intelligence legally constituting sound mind,
are not separable from the minor forms of imbecility, so far as the
moral and  intellectual faculties are concerned.  By running this
distinction  too closely, one  half  of the Avorld might  easily reason
itself into the right of confining the other half as insane.
   Idiocy and imbecility must  not be  confounded Avith mania and
monomania.  In  idiots  and imbeciles, ideas are Avanting, and the
power of thought is absent or  defective; in maniacs and monoma-
niacs, the ideas Aoav freely, but they are perverted, and the power of
thought is irregular and uncontrolled.  In idiocy and imbecility, Ave
do not  meet with the  hallucinations and illusions  Avhich constitute
the main features of mania and monomania.  Idiocy is much  more
likely to be confounded Avith dementia, and indeed, Avhen dementia
is confirmed and  complete (feduity), there is no appreciable differ-
ence, for in neither state is there any evidence of the exercise of
mental poAver.  In idiocy no ideas have ever been formed ;  in imbe-
cility they have been partially formed, but arrested ; in dementia
they have been more or less  completely formed, but have subse-
quently become entirely obliterated.   It is  important to remember
that in idiocy and imbecility there is no gradual loss or sudden im- 
744
HEREDITARY  TRANSMISSION.
pairment of the mental faculties,as is generally- observed in dementia;
the person is what he always has been ; mentally Aveak and unsus-
ceptible of any degree of improvement by instruction..
  From these remarks it will  be perceived that  imbecility is a
state existing from birth, or from childhood—for it is possible that
it may supervene from disease after birth, in a child in whom there
Avas no reason to suspect its existence—but it  is more common to
find the deficiency congenital.   Still, the  term is often applied to
that w-eakness of the mental powers Avhich takes place in the aged
at the close of life, even when the mind  has been  well developed
in maturity.  Thus we speak of the imbecility of age: this is truly
nothing more than a state of senile dementia,  and to apply to it the
term "imbecility" tends to create confusion.
  Such  then are the four forms under which insanity or mental
aberration may present itself to our notice, and although there are
occasionally mixed states, as of  mania and denientia (incoherency),
yet it is an important feature in  the distinction of mental disorders,
to observe that  in real insanity the characters presented  to us in
any given case clo not vary materially from those which have been
described as peculiar to each of these states.  This medical classifi-
cation, it must be remembered, is made for the sake  of convenience,
because by it a practitioner may be led to form a safe diagnosis of
the real state of mind of a person.  It is  not recognized in any of
the  law proceedings connected with  the  insane: for in these  the
term unsoundness  of mind—comprehending  lunacy,  idiocy, imbe-
cility, and  all forms of mental weakness—is almost  exclusively
employed.  In adopting this arrangement, a medical jurist must
take care  not to fall  into an error which  has been sometimes com-
mitted—i.e., of pronouncing a person to be of sound mind, because
his case could not be easily placed in any one of these four great
divisions of insanity.  This would be as  serious an  error as that
formerly committed by some law-authorities—namely, of giving
restricted and incorrect definitions of lunacy, idiocy  and imbecility,
and then contending that  whoever  was not a lunatic,  idiot, or
imbecile according to these arbitrary legal definitions, must be a
person of  sound  mind.
  Hereditary transmission.—The  hereditary transmission of insanity
has sometimes presented itself as a medico-legal question in relation
to the criminal responsibility of the insane.  According to Chitty,
it is an established rule of laAV, "that proof that other members of
the same family have decidedly been insane is not admissible either
in civil or criminal  cases."   ("Med. Jur." vol. 1, p.  352.)  But
recent decisions  have shown that this statement is not correct.  In
Reg. v.  Ross Touchet (1844), in Avhich the accused Avas  tried for
shooting a man, and acquitted on the ground of insanity, Maule,
J., held that evidence that the grandfather had been insane might
be adduced, after it  had been proved by medical  testimony .that
such a  disease is often hereditary in a family.  It was  also ad-
mitted in Oxford's case—the ptrisoner having been tried for shoot-
ing at the Queen (" Law Times," Oct. 26,1844), and since that date 
HEREDITARY TRANSMISSION.
745
it has been admitted in  a number of cases in which insanity Avas
urged as a defence on  a charge of murder.   [It was also admitted
in Pennsylvania, in the case of Smith v. Kramer1 (1 Am. Law. Reg.
p. 355), upon the question of a testator's sanity.   So in Massachu-
setts,  Baxter v. Abbott  (7 Gray  71).   In  DelaAvare,  in  a  trial for
murder, the  evidence was admitted, and it Avas said  "that reputa-
tion in the family of such cases (of insanity)  may be proved on the
principle  of births,  deaths, genealogies, etc."   (State v.  Windsor, 5
Harrington  512.)   In  State v.  Christmas  (6 Jones, LaAV  North
Carolina, 471), it Avas held that Avhere hereditary insanity is offered
as an excuse for crime, it must appear that the  kind of insanity
proposed to be  proven, as existing in the prisoner, is no temporary
malady; but that it is notorious, and of the same species as that
with which  other members of the family have been afflicted.—P.]

  1 [Chief Justice Gibson, in admitting the  evidence in this case, thus expressed
himself: ''I admit the deposition Avithout hesitation, notwithstanding the dicta of
Mr. Shelford ('Treat, on Lunacy,' 59), and  Mr. Chitty ('Med. Juris.' 355), that
it is an established rule of la\v not to admit proof of  insanity in other members of
the family in civil or criminal cases.  Established ?  When, where, and by whom ?
Certainly not by the House of Lords inMcAdam v. Walker (1 Dow's Par. Ca. 148),
the only case cited for it, for the question there was avowedly dodged.  That high
court would not shock common sense by affirming the order of the Scotch Court of
Sessions; nor would it gratuitously reverse it, where the decision could be safely
put on another ground.  The authority of a  judgment appealed from, and left in
dubio, cannot be very great."  ***** "Does not proof of hereditary madness
bear directly on the condition of the mind which is the subject of investigation ?
  " What if the point had been ruled by the Chancellor and laAV judges in the House
of Lords ?  Profoundly learned in the maxims of the laAV, they were profoundly
ignorant of the lights of physiology ; yet, free from the presumptuousness of which
ignorance is the foster-father, they refused to rush on the decision of a question to
which they felt themselves incompetent." *****  " When it is admitted by Mr.
Chitty  and  Mr. Shelford themselves, that insanity is a descendible quality, they
give up the  argument.   There can be nothing unreasonable in  referring wild,
furious, and unnatural actions, not otherwise accounted for, to the aberrations of
a mind, the reflex  of that of a crazy father.   Mr. Taylor, a distinguished lecturer
on Medical Jurisprudence in Guy's Hospital, London, says that 'in making a diag-
nosis of a case of insanity,  the first question  put is commonly in reference to the
present or past existence of the disorder in other members of the family.   There
can be no doubt, from the concurrent testimony of many Avriters on insanity, that
a disposition to the disease is frequently transmitted from parent to child, through
many generations.   M. Esquirol has remarked that this hereditary taint is the most
common of all the causes to which insanity can be referred.' (Taylor on Med. Juris.,
502.)"  ******" The  knowledge attained by men  of a subject with which they
have grappled  all  their lives, ought surely to prevail against knowledge gleaned
from the handbooks of a profession to which the gleaners did not belong.  Strange
that a source of information, open to every one else, should be closed to those who
are to pass on the fact!   Every man has observed that  there are families, through
which insanity has been handed down for generations." *  *  *
  "An objection to the inquisition which does not disclose the specific nature of the
ancestor's infirmity might stand in a different  light, but testimony which brings the
fact of madness home to him ought to be received like evidence of family likeness,
which,  though  less reliable,  was allowed to be corroborative proof of paternity in
the Douglas  Peerage case in 17G7, and again in the Townsend Peerage case in
1843."  *****  "In prosecutions for bastardy, the practice in the Quarter Ses-
sions was in my day, not exactly to give the child in  evidence, but to put it before
the iurv, sometimes by the  prosecutor, and sometimes by the putative father.  But
ancestral irre<nilarity in the action of the brain is more frequently transmitted than
any resemblance in form  or feature ; and it is difficult to imagine an objection to
evidence of it for purposes of corroboration."—P.] 
 746         DETECTION  OF  FEIGNED INSANITY.

 This kind of evidence has, hoAvever, been frequently rejected, and
 it is not admitted in the law of Scotland.  (Gibson's  case, Edin-
 burgh, December, 1844.)
   Feigned insanity.—Insanity is  frequently- feigned by persons ac-
 cused of criminal offences in order to procure an acquittal  or dis-
 charge.  In the first place, when feigning  is suspected, it will be
 proper to inquire whether the person has any motive for pretending
 to be insane.  ~No sane person feigns without a motive.  It is neces-
 sary to remember that insanity  is never assumed until  after the
 commission of a crime and the actual detection of the criminal. No
 one feigns insanity merely to  avoid suspicion.  In  general, as in
, most cases of imposture, the part is  overacted—the person does
 either too much or too little, and he betrays himself by inconsisten-
 cies of conduct and language which are never met  with in cases of
 real insanity.  There is commonly some probable  cause  to Avhich
 insanity may be traced, but when  the  malady is feigned there is
 no apparent cause: in this case the appearance of the assumed in-
 sanity is  always sudden—in the real  malady, the progress  of an
 attack is generally gradual; and when the attack is really sudden,
 then it Avill be found to be  due to some great moral shock or other
 very obvious cause.  We  should observe whether for some time
 previously there  has been  any marked change of character  in the
 person, or whether his conduct, when he had no interest to feign,
 presented any of the usual indications of a disordered mind.  Some
 difficulty may arise when fits of eccentricity or strangeness of char-
 acter are deposed to by witnesses; but these statements maybe
 inconsistent  with  each other, and  the  previous acts  of the person
 may bear no resemblance whatever to those performed by him in
 the recently assumed condition.   A difficulty of this kind  rarely
 presents itself, since in an impostor no act indicative of insanity can
 be adduced for any antecedent period  of his life:  it is only after
 the perpetration of a crime and its detection, that any action simu-
 lating the habits of the insane w-ill be met with.   In real insanity,
 the person will not admit that he is insane; in the feigned state all
 his attempts are directed to make you believe that  he is mad ; and
 an impostor  may be induced to perform any act, if it  be casually
 observed to another in his hearing, that the performance of such an
 act  will furnish strong evidence of his insanity.
   Mania is perhaps  more frequently assumed than  any  other form,
 because the vulgar notion of insanity is, that it is made up of vio-
 lent action, and vociferous and  incoherent  language:  but  mania
 rarely comes on suddenly, or without some  obvious cause.  A
 maniacal patient  is also equally7 furious day and  night,  Avhile an
 impostor is obliged to rest after his violent exertions.  Dr. BurroAvs
 recommends that close attention  should be  paid to the expression
 of the eye.  The  mobility  of the features may be as rapid as the
 imagination is vivid; but when every feature may vary, or be kept
 under control and be steady, the eye will still  indicate the  erring
 thought—its expression cannot be  easily assumed.   There is about
 the eyes in mania a restlessness Avhich cannot fail to  attract atten- 
APPEARANCES AFTER DEATH.
747
 tion ; the patient sleeps but little, and the sleep is disturbed—an
 impostor sleeps as soundly- as a healthy person.   The violence of a
 maniac continues whether he is alone or not, while the impostor
 acts his part only when he thinks he is observed; hence the impo-
 sition may he detected by watching him when he is not aware that
 an eye is directed upon him.
  The feigning of monomania is a matter of some difficulty:  it
 would be easily  susceptible of detection.  As in mania,  the part
 would be  overacted, and an  impostor w-ould thus betray himself.
 Dementia is  more easily feigned: in general, this state comes on
 sloAvly, and is obviously dependent on organic changes, as old age,
 apoplexy, paralysis, or hemiplegia;  or it is a consequence of recur-
 rent mania or monomania.  As this form of insanity consists in an
 entire abolition of all mental power, sq the  discovery of any con-
 nected ideas, reasoning or reflection, either  by language,  Avriting,
 or gestures, would at once show that the case AA7as not one of real
 dementia.   Idiocy and  imbecility could hardly be feigned success-
 fully,.because these are states of congenital deficiency, i. e., they
 must have existed  from birth.  Hence it Avould be easy to sIioav,
 by  reference to the antecedent life of a person, Avhether he has
 or has not  ahvays been such as he represents himself.   There  is
 another fact worthy of notice.  An impostor cannot long main-
 tain his part.  If the case is  really7 of long  duration without ma-
 terial change in symptoms and conduct, it is more likely to be one
 of real than  feigned  insanity. The difficult cases  of feigned in-
 sanity are really  limited to those forms of the malady Avhich are
 liable to attack a person suddenly.  But for a  sudden attack of
 real insanity there should always be some obvious cause: the non-
 existence of this,  with the presence of a strong motive for deception,
 Avill justify a suspicion that the malady has been assumed.
  Causes of insanity.—The causes of insanity may be either moral
 or physical.  A  full  account of them, Avith  the relative numbers
 attacked,  has been published by Dr.  HaAvkes.  (See " Lancet,"
 1872,  2, 666.) Among the  ordinary causes may be enumerated
 severe domestic affliction—loss of near  relatives  or  friends—great
 pecuniary losses—diappointments—long Avatching—anxieties either
 as to the health of friends or success in business—severe and long-
 continued mental exertion—excessive study—ambition—the puer-
 peral  state—amenorrhcea—masturbation—drunken  habits—over-
 excitement on the subject of religion or politics,  and in general all
 those disorders Avhich cause depression of health and spirits, and
which  are accompanied  by loss of sleep.  About one-third of the
existence of man  is passed in sleep, and this quiescence or repose is
as necessary- to mental as it is to bodily health.  One of the earliest
symptoms of insanity is extreme wakefulness.  (Millar, op. cit. p. 9.)
  Appearances after  death.—In some cases a medical practitioner
may be required to state Avhether certain appearances found in the
brain of a deceased person do, or do not indicate the past existence
of insanity, or imbecility.  Such  a question  is only likely-  to arise
in chronic cases,  in which the past existence of insanity from oral 
748            APPEARANCES  AFTER  DEATH.

testimony may be disputed.  (Case of Stulz, Prerog. Court, 1852.)
The appearances commonly met with on an inspection of the  head
are thickening of the bones of  the  skull, close adhesions of the
dura mater (the lining membrane), with great congestion of the pia
mater, and opiacity and thickening of the arachnoid or inner mem-
brane of the brain.   There is a general fulness  of the bloodvessels
of the brain, with remains of old cysts, hardened deposits, or even
abscesses in various parts of the cerebral substance.  Inferences from
the existence of these appearances in  the brain must, however, be
draAvn with caution, because it  cannot be said that they necessarily
indicate insanity ; neA7ertheless, such chronic changes must be con-
sidered as producing greater or less derangement of the  mental
functions;  but the actual degree to which the  impairment  has ex-
isted ought properly to be determined by evidence of the conduct
and actions of the deceased during life.   In a communication made
by Dr. Webster to the Medico-Chirurgical  Society in April, 1855,
there is a statistical  summary of the  appearances met Avith in the
examination of the bodies of 290  insane patients.  In 226 cases the
pia mater AA-as infiltrated; in 207 effusion had  taken place in the
ventricles; in 184 fulness of the bloodvessels in the brain or mem-
branes Avas observed; in  117 the arachnoid membrane was thick-
ened and opaque;  in 64 the color of  the brain appeared changed
from its natural hue; in 51 the bloody points (puncta cruenta) Avere
large and numerous upon the cut surface of the medullary substance;
while in 40 instances blood was effused, sometimes to a  considera-
ble extent, Avithin the cranium.  This effusion had evidently been
the immediate cause of death in most of the patients.  From these
data it appears that—first, infiltration of the pia mater; secondly,
effusion of fluid in the ventricles; and thirdly, fulness of the cranial
vessels, are the principal as also the most frequent  diseased altera-
tions  of structure observed in  patients  who die  while suffering
under symptoms of mental disorder.
  As neither the symptoms nor the duration of the insanity- is given,
it is  difficult to apply these results to special instances:  In the case
of Roberts v. Kerslake (Warwick Aut.  Assizes, 1854), the main  ques-
tion Avas whether certain appearances in the brain and its membranes
did or did not indicate disease of long  standing as well as insanity at
the particular date at Avhich a  will was  made.   Dr. Conolly and I
considered that the appearances were not inconsistent with the sup-
position that the testator AA-as sane at the time  of making his will.
("Journal of Psychological Med." Oct. 1854, p. 573.) 
IMPOSITION  OF  RESTRAINT.              749
                    CHAPTER  LXII.

 MEDICO-LEGAL  QUESTIONS  IN RELATION TO  THE INSANE.—IMPOSITION
  OF RESTRAINT.—ILLEGAL IMPOSITION OF RESTRAINT.--VIOLENCE  OF
  TEMPER.--CERTIFICATES OF INSANITY.—RULES FOR THE  DISCHARGE OF
  LUNATICS.

  Among the questions AA-hich may come before a medical jurist in
 relation to the subject of insanity are the folloAving: A practitioner
 may be required to say whether a person affected with the malady
 should, or should not be confined in a lunatic asylum—Avhether he
 should be deprived of his civil rights  by interdiction, or Avhether he
 is 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; Avhether a marriage-contract or debt should be annulled; and
 lastly, whether a criminal act was committed by a  person while
 laboring under insanity—a question involving either the life or,
 according to circumstances,,the perpetual imprisonment of a person
 accused of crime.
  Imposition of restraint.—By restraint, in a legal sense, we are  to
 understand the placing of attendants  to Avatch or control the actions
 of an alleged lunatic, or his forcible removal from friends or relatives,
 with or Avithout the confinement of his person by physical force.
 What are the circumstances which  will justify a practitioner  in
 applying restraint to the insane?   The laAV has given  great poAver
 in this respect to members of the medical profession, but, owing to
 certain abuses, the power has been of late years much  restricted by
 various Acts of the  Legislature.   Most medico-legal writers agree
 that we are not justified in ordering restraint except when, from
 symptoms witnessed by ourselves, we have reason to apprehend that
 the lunatic will injure his person or property, or the person or property
 of others.  It is then not sufficient to seek merely for evidence of the
 existence of some delusion, but to determine hoAv far that delusion,
 if present, affects the conduct of the person.   Unless  the delusion
 be such as to render it pjrobable that the patient's OAvn interests or
 those of others  may be damaged  by his insane conduct, careful
 superintendence will answer all the purposes of the closest restraint.
(For some remarks on this subject, see "Med. Gaz." vol. 44, p. 1061.)
The act of  resorting to restraint on all occasions has been justified
on the principle  that it may  tend to the cure of a patient, by
removing his delusion.   In this point of view, the subject has
reference to medical practice, and not to legal medicine.  It may be
urged Avith more plausibility, that  by withholding  restraint  in 
750    RULES  RESPECTING IMPOSITION OF RESTRAINT.

incipient cases, mischief may be done by the lunatic to himself or
others, and that then it will be too late to interfere; but even here
careful superintendence may render close confinement unnecessary.
  The legal rule for interference with the liberty of a person, Avhich
restraintlilways implies, may be inferred from the following state-
ment by Mr. J. F. Stephen: "There is a normal state in Avhich all
human creatures act on the same principles, and the general mean-
ing of sanity is, that the person  conducts himself in this normal
maimer; that he is acquainted Avith the circumstances by which he
is surrounded;  that he has objects in view in his actions, and that
he regulates his conduct with reference to them and to the general
considerations Avhich affect matters of that class."  (" General View
of the Criminal Law of England," pp. 87 et seq.) It cannot be too
strongly impressed on the mind of a medical man that, before he
employs the powers conferred upjon him by law to confine a person
who is said to be mad, he should have well in his mind Avhat laAA7yers
imply by the term " madness," in a practical sense.  As defined by-
Mr. Stephen, it means conduct of a certain character—not, as it  is
usually- interpreted by medical men, a certain  disease of the brain,
the existence of Avhich is speculative, but one of the effects of which,
if ptresent, is to produce  such conduct.  In examining  an alleged
lunatic, with a  vieAv of determining whether he should or should
not be placed in confinement, his conduct  must therefore be com-
peared Avith that of other men in a  normal state: and here, in order
to constitute sane behavior, Ave must look for a generic, and not for
a specific resemblance.  Any degree of ignorance, vice, or folly is
perfectly consistent with sane conduct in a legal sense.   The poAver
of restraint is not intended to be applied to such cases as these; they
are propterly under certain circumstances amenable to the criminal
law.   An ignorant, vicious, or foolish man may do a great amount
of mischief, but he has a liberty of choice and freedom of action;
and if from  folly  or  depravity he  selects  a bad course, he is not
therefore insane, but is as much responsible for his actions as a sane
man who prefers a good course.  Such a man should not be treated
as a lunatic, or confined in an asylum under a medical certificate. It
may be sometimes difficult to define the line which separates acts of
depravity from  those of insanity:  but  medical men have not been
in many cases sufficiently cautious in endeavoring  to make  a dis-
tinction.   Lawyers look closely to conduct as a ground of  inter-
ference Avith personal liberty: the  conduct  must be such as  to be
inconsistent with  the usual behavior  of a normally sane person
placed under similar circumstances.
  In examining a person proposed  to be placed under restraint, AA7e
must take care not to confound acts depending on violence of temper
with those which proceed from unsoundness of mind.  A man may
have always had a violent temper, subject to occasional fits of aggra-
vation ; but this condition must not be mistaken for mental disease.
In order to determine whether the acts of a person be due to violent
temper or insanity, it will be proper to ascertain  what may have
been his natural habits.  The great feature of  insanity is change of 
     RULES  RESPECTING IMPOSITION  OF RESTRAINT.   751

 character—a man avIio is really insane is different from what he has
 previously been ; but it may be proved of a violent-tempered man
 that he has ahA7ays been the same.  The greatest abuses of the re-
 straint system have been chiefly observed in respect to monomania,
 where persons have been forcibly imprisoned and confined in their
 persons, because they entertained some absurd delusions, over Avhich
 hoAvever, they had so great a power of control as to render it some-
 what difficult even for a shrewd and experienced examiner to detect
 them.  When at last after many hours' cross-examination, the ex-
 istence of a delusion  has been made apparent, the result has been
 looked upon as furnishing matter for triumph and exultation ; but,
 as Dr. Conolly justly remarks, one  point in  these cases appears to
 have been wholly lost sight of, namely—What possible injury could
 have resulted to  the patient or his friends from  the existence of a
 delusion over Avhich he had such complete control and mastery as to
 render it a most laborious task to obtain any evidence Avhatever of
 its existence ?  (" Indications  of Insanity.")  It  may be freely ad-
 mitted that Avhere delusion does exist, there is reason to suppose that
 the  mind must be more or less disordered in all its faculties;  but
 such patients require only close watching,  not a rigorous imprison-
 ment in an asylum.  The greatest danger is to be apprehended in all
 those cases where there is the least power of self-control.  The forci-
 ble removal of  a person from  his home to a  lunatic asylum, unless
 the circumstances are of such a nature as to render immediate inter-
 ference necessary on the ground of  admitted or proved insanity, is
 unjustifiable in law, and may involve those concerned in the removal
 in a serious responsibility.   In cases of incipient insanity,  interfer-
 ence  AA-ould not be  legally justifiable,  and a piractitioner placing
 restraint on a person so situated, might find himself defendant in an
 action for damages.
  In Hill v. Philp the judges decided  that a medical man, AA-hen
 called upon to give a certificate for the confinement of a person,
 may act upon the directions of a wife, but that the directions must
 be considered as only guiding his judgment, and not absolutely
 dictating  to  him and justifying his proceedings; that he is still
 bound to  exercise his own professional knoAvledge and discretion
 so far as  to refrain  from doing anything, or adopting any course
 which might be injurious to the patient.  A  medical man is, there-
 fore, ultimately responsible for the treatment of a lunatic: no person
 can give him authority to do that which is not in accordance Avith
 general  practice or the necessity of the case.   (For a report of this
 case, and some judicious remarks upon  the decision, see the " Legal
 Examiner," May 29,1852, pp. 307,318.) In Scott  v. Wakem (Guild-
 ford  Summer Assizes, 1862), the defendant, a medical practitioner,
 Avas sued for damages in placing under restraint, and without neces-
 sity or authority, a man laboring under delirium  tremens.   In this
 case the Avife denied that she had given any authority for interfer-
 ence, and on this point her evidence conflicted with that of the de-
fendant, the medical  man whom she had consulted.  Fortunately
the facts Avere adverse to her statement; but in future cases of this 
752
CERTIFICATES OF INSANITY.
kind, it would be desirable  for a  medical man to have a written
authority for such proceeding, bearing in mind that he does  not
exceed what is necessary, proper, or usual for  the treatment of the
person; and on this he must always exercise his own judgment,
irrespective of the opinions or suggestions of others.  Medical men,
even when acting most conscientiously in discharge of their duties,
cannot hope  to escape harassing and vexatious actions Avhen they
are called upon to deal Avith cases of delirium tremens.   The pecu-
liarity of this disorder is that, with the cause, it may soon disappear,
and thus  medical evidence may be easily procured to show that a
person, at a short pieriod  before or after the imposition of restraint,
\A7as in a sane state of mind and not  in a condition  to justify any
interference Avith his personal liberty.
  In order to pirovide for the protection of lunatics and for the pre-
vention of undue violence or frequency in the application of restraint,
the laAV compels the keepers of asylums to enter in a book a report
of each case, or of each occasion on which any mechanical restraint
is resorted to.  An omission to make this entry is a misdemeanor:
and at  the Maidstone Lent Assizes, 1851, two medical  men were
convicted and fined for  placing patients under restraint without
having made the  proper entries required by law. (Reg. v. Mad dock:
see also " Med. Gaz." vol. 47, p. 556 ; and a paper on the " Use and
Abuse of Restraint," in  the "Journ. Psychol. Med." 1849, p. 240.)

   Certificates of insanity.—It will here be necessary to state the cir-
cumstances Avhich require the attention of a practitioner Avhen he is
called upon to sign a certificate of insanity, whereby a person may
be placed in confinement in an asylum.  The  Acts which specially
refer to this subject are the 16th and 17th Victoria, c.  96 and 97.
These Acts, which  came into operation on the 1st  of  November
1853, are a consolidation of the statutes on the regulation of the
care and treatment of lunatics. Their provisions are very stringent,
both with respect to medical men who sign certificates, and those
who keep asylums for the reception of lunatics.  According to s. 74,
c. 97, no person (not a pauper) can be received into or detained  in
any asylum, without an  order from some person (generally the near-
est relative) and two medical certificates, which must be signed by
two physicians, surgeons, or apothecaries not in  partnership or an as-
sistant to the other, and  each of whom shall separately from the other
have personally examined the person to whom it relates not more
than seven clear days previously to the reception of such person into
such asylum.  These certificates need  not be  filled up, signed, and
dated  on the day of examination; but the examination  of the
patient must  be  made in  every case within seven clear days before
admission.
   The following  is the form of a medical certificate in  the case of
private patients:—

   I, the undersigned, being a (duly registered) physician or surgeon
or apothecary [here  set forth the qualification], and  being in actual 
                 CERTIFICATES OF  INSANITY.             753

 practice as such, hereby certify that I, on the    day of       , at
 [here insert the street and number of the  house (if any), or other  like
 particulars], in the county of      , etc., separately from any other
 medical practitioner, personally examined A. B., the person named
 in the accompanying statement or order, and that the said A. B. is
 a lunatic [or an idiot, or a person of unsound mind], and a proper
 person to be taken charge of and detained  under care  and  treat-
 ment, and  that I  have formed this  opinion upon the  folloAvino-
 grounds, viz.:—
   1. Facts  indicating  insanity observed  by myself [here state the
 facts].
   2. Other facts (if any) indicating insanity, communicated to me
 by others [here stcde the information, and from whom].
                  (Signed)                      Name.
                                               Place of abode.
   Dated this    day of       , One thousand eight hundred and

   Under s. 10, c. 96, no person can be received into any registered
 hospital or licensed house, or as a single patient, under any certifi-
 cate Avhich purports to be  founded only upon facts communicated
 by others.   A medical certificate may be amended, if incorrect or
 defective.  No medical  man  can receive as a boarder in his house
 any  insane person,  Avhether for medical treatment or otherwise, un-
 less  he has previously obtained  a  license from  the Commissioners
 of Lunacy, and one certificate duly signed  by two other medical
 men.  In January, 1861, a  medical  practitioner was  convicted of
 misdemeanor for thus receiving illegally a lunatic patient.  (Reg. v.
 Kelley, C. C. C, Jan. 29, 1861.)  This Avas  a  clear breach of  the
 regulations.  The defence Avas that he  was ignorant of the laAV,
 but this Avas no ansAver to the charge.  (" Med. Times and Gaz.,"
 Jan. 28, 1861, p. 105; and " Lancet," Feb. 9, 1861, p. 151.)
  Dr. Millar, who has had considerable  experience as the superin-
 tendent of a large  lunatic asylum, states that, as a rule, very feAV
 of the certificates which are brought Avith pirivate patients are cor-
 rectly filled up, notwithstanding the plainness of the instructions.
 The  omission of particulars apparently of no importance has often
 caused  them to be rejected as illegal;  and it will therefore  be use-
 ful to point out  the chief errors Avhich, according to this  gentle-
 man, are committed by  medical  men.  1st.  A  neglect in  stating
 the qualification which  empoAvers the medical practitioner to prac-
 tise.  It is not unusual  for the blank sptace to be filled up with the
 words " physician," " surgeon," or " apothecary," instead of insert-
 ing the qualification which enables him to practise in any of these
 capacities.  2dly. Omitting the address of the house at which the
 examination was made.  If there should  be no  number to the
 house, it Avill be sufficient to state, "At the dwelling house of----,
 in----street, village, etc."   3dly. Omitting the address and occu-
 pation of the person examined.   In nine cases  out of ten, accord-
 ing to  Dr. Millar,  an  omission of one of these three simple and
obvious particulars occurs—a degree of carelessness not creditable to
     48 
754             CERTIFICATES OF INSANITY.
the profession.   Medical men no doubt err from regarding them as
having no bearing whate\7er on the sanity or insanity of a patient.
(See Millar's " Hints on Insanity," p. 78.)
  By s. 13, c. 96, a medical practitioner who gives a false certificate,
or any person not being a registered physician, surgeon, or apothe-
cary in actual practice, who gives a certificate  as such, is  declared
to be guilty of  a misdemeanor.   For any act done by a registered
medical practitioner contrary  to any of the provisions of the Act
(although not declared to be a misdemeanor), he is subjected for each
proved offence to a penalty of twenty pounds.  By s. 36 the  Avords
" physician," " surgeon," or " apothecary" shall  respectively mean
one duly " licensed or registered to practise as such by, or as a mem-
ber of some College, University, Compiany, or Institution, legally
constituted and qualified to grant such authority or license in some
part of the  United Kingdom, or one Avho AA-as in practice as an apo-
thecary in England or Wales on  or before the  1st  day of  August,
1815, and being in actual  practice as such  physician, surgeon, or
apothecary." (16 & 17 Vict. cap. 96, s. 36.) Thus, the certificates of
Irish medical practitioners are valid for the confinement of lunatics
in England, and conversely those of English practitioners are valid
for asylums in Ireland.  A special Act has been passed for Scotland
(20 & 21  Vict. c. 71): and by sections 34 and 35 the rules regarding
certificates are similar to those of the English statute.
  A medical practitioner must not be too ready  to lend himself to
the signing of certificates for  the confinement of persons who may
be laboring under harmless delusions.  In violent mania, or in  mono-
mania with a homicidal or a suicidal propensity, there can  be no
doubt of the propriety of applying some degree of restraint, for
here the  necessity is imminent.   If a remarkable change  has sud-
denly taken place in the character of  a person,  if he has become
irritable, outrageous, or threatened personal violence  to any one, or
if he has recklessly endangered the interests of himself and family,
he is undoubtedly a fit subject  for  restraint.  (See  Pagan,  p. 75.)
The more he approaches to this condition, the less difficulty we shall
have in coming to a decision; and in a really doubtful  instance there
will be no impropriety in employing restraint; since, although the
person is thereby deprived of liberty, it is better that this should
happen than that he or his friends should incur the risk of suffering
severely by his insane conduct.
  The 74th section of cap.  97  provides that in  cases of emergency a
person (not a pauper) may, under special circumstances (these being
stated in the order), be received into a house or hospital, upon a cer-
tificate signed by one medical practitioner only, provided that within
three days two other  such certificates  are signed by two other me-
dical practitioners not being connected with such house or hospital,
upon a like examination.  The detaining of a person upon one
medical certificate  only beyond  the period of  three  days, without
such  further certificates, is a misdemeanor in the keeper  of the
house  or hospital.  By s. 67, c.  97, the certificate of one medical
practitioner only, signed according to the above rules, will  suffice 
CERTIFICATES OF INSANITY.
755
for a pauper lunatic, provided the person has been previously ex-
amined by a justice, clergyman, and overseer or relieving  officer.
By s. 12, c.  96, no medical practitioner Avho is interested in or
attends a licensed house or hospital, or whose father, brother, son,
partner, or assistant is wholly or partly the proprietor of, or a regular
professional  attendant  in, such house or hospital, shall sign any
certificate for the  reception of a patient into it.   It is obvious from
the terms of the Act that one person cannot sign a certificate as a
substitute for another, and yet there have been several instances of
its violation under  these  circumstances.  In  December,  1855, a
medical assistant was committed for trial because he had signed the
name of the surgeon with whom he was living to a certificate of in-
sanity for the confinement of a pauper lunatic.  There was no doubt
about the insanity of the person, and the plea urged in defence was
that the surgeon whose name was thus forged was in ill health, and
had given the assistant an authority to sign papers for him.  This,
hoAvever, was no justification of a violation of the terms of the Act:
the words of the  certificate are so explicit on this point,  that no
reasonable person  can have any doubt about their meaning.
  [The principal hospitals for the insane of the United States have
printed forms and obligations, which are  furnished to the  friends
of patients  to be  filled up and signed according to the law of the
State, and the rules of  the hospital.   The form of  the medical cer-
tificate generally  requires the  patient to  have  been  seen  and ex-
amined by the  physician signing, on the day on which the certifi-
cate is  dated.  In all cases, the certificate is expected to apply only
to the actual condition of the patient at the time of signing, and to
be used without delay in order to be available.
  The medical certificate must always be accompanied by a formal
application  for admission  of the patient,  signed by  a responsible
guardian, near relative or friend.   These papers have also annexed
to them, a series of questions relating to the past history and exist-
ing condition of the  patient, the pieculiar symptoms of the case, and
the probable cause of the attack; which questions are to be answered
by the  friends and relatives, and the attending physician.
  Some hospitals  require the signatures of two physicians to  the
medical certificate, neither of them, of course, being connected with
the hospitals applied to.   The State Lunatic Hospital of 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, but are generally- removed by friends or discharged, Avhen
sufficiently recovered, at the discretion of the superintendent^ We
are not aware of any legal restriction in this country on the libera-
tion of insane patients, except in cases of homicidal  or otherwise
dangerous lunatics, who have been confined by order of a magistrate
or of a court of  laAV.   Such patients can  only be  released by an
authority similar  to  that which first committed them.   There are
patients of this class now in durance at the Eastern State Peniten-
tiary of Pennsylvania, and in the different State Asylums.—H.] 
756              SPECIFICATION  OF  FACTS.

  As ignorance of  the  law is not allowed to  be an excuse for its
violation, so a medical man, unless acquainted Avith all the particu-
lars  above mentioned, may easily subject  himself  to a prosecution
or a civil action; and he is not likely to be spared the disgrace and
mortification attendant upon either, should it hapmen  that the case
is of a doubtful nature.   The law expressly requires from each
medical man a separate visit, a separate personal examination of the
alleged lunatic, and a separate medical certificate, setting forth the
special fact or facts (Avhether observed by  himself  or derived  from
the  information of others) upon Avhich his opinion is based.  Dr.
Conolly has shown that there are objections to the severity of the
restrictions regarding  the certificates   ("Journal  of  Medical Sci-
ence," April, 1861,  p. 127), but some recent cases have proved that
they are not even strong enough to prevent sane persons from being
Avrongfully sent as lunatics to asylums.
  Specification  of facts.—It will  be observed  that every medical
practitioner signing a certificate of insanity is required to  specify
the facts upon which his opinion is formed, and Avhether such facts are
derived from his own observation or from  the  information  of any
other person.   Medical practitioners have had  some difficulty in
performing this duty, i. e.,\n assigning the fact or facts upon which
their judgment of the insanity of a person  is based.  (" Med. Gaz.,"
vol. 36, p. 1434; and vol. 37, p. 485.)  What will constitute the de-
scription of a fact  to render  a certificate valid ?  This important
question was raised  and decided in the case of Shuttleworth (Queen's
Bench, Nov. 17, 1847).  An application was made for the discharge
of a lunatic on the  ground that the medical certificates did not set
forth the facts  from which the opinion of those who signed  them
Avas  derived.  In one it Avas stated that  the lunatic labored under a
variety of delusions, and that she was dirty and indecent in the extreme ;
in the other the certifier stated that he had formed his opinion from
the conversation which  he had that day had with her.   It was con-
tended that the statement in the first certificate was not so much a
fact  as a conclusion drawn from other facts, which ought to  have
been  mentioned in  the certificate itself.   Lord Denman, in giving
the judgment of the court, held  that the  certificates  Avere valid—
that it was not necessary to have all the delusions of an insane per-
son stated in  the certificate.   The statement that  the lunatic Avas
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  labored under  a variety of delusions: the
allegation that the  opinion respecting insanity  Avas founded upon a
conversation w-ith the  alleged lunatic was also sufficient to render
the certificate  valid.  ("Med. Gaz.," vol. 38,  p. 932; also "Law
Times," Nov.  21,1846, p. 145.)  Hence it folloAvs that  a  general
statement of the circumstances Avhich  have led to the belief in the
insanity of a person, will be  a sufficient  compliance  with  the re-
quirements of the statute to render a certificate valid, provided the
examination  has been  made bond fide,  and with due  care and at-
tention. 
PROOFS OF INSANITY.
757
  Dr. Millar has shown how little the Avords " Facts indicating in-
sanity observed by myself," are appreciated or even understood by
many medical men, who are legally empowered as registered mem-
bers of the profession to sign these certificates.   The facts are fre-
quently stated in a loose and careless manner, showing a complete
misapprehension of their meaning.  What is really required by the
law- is a statement of facts observed or witnessed by the  medical
man himself, which would carry conviction to  the mind of any
non-professional  man reading it, that the person to Avhom it re-
ferred was of unsound mind.   A  medical  man should in all cases
avoid giving  as  a  fact indicating insanity, any delusion which
might in reality have some foundation in truth.   With respect to
the second requirement of the st^ite—namely, " Other facts (if
any) indicating insanity communis ted by others "—it may be ob-
served that, although these do not supersede the facts  observed by
the medical man himself, they are of great importance  in throwing
light  upon  the propensities or habits of the  patient, and thus serve
as a guide for treatment.   (Op. cit., p. 79.)   A  medical man must
take care to draAv a clear distinction betAveen the  facts  observed bv
himself and the facts communicated to him by others, and  avoid
such vague expressions as that he " thinks " and " belieA-es," etc.
  As  every medical certificate, although  accepted  by the Commis-
sioners of Lunacy7, may become at a future  time  a subject of close
and hostile criticism in  court, a medical practitioner should be fully
prepared to justify the use of the terms which he has employed.
It is therefore desirable that he should  studiously- avoid any mis-
statement or  exaggeration  of  the symptoms.  One of the facts
cited  as indicative of insanity in an old  lady was, that she kept a
cockatoo!  In the case of Davies, the tea-dealer, Lord  Brougham,
then a counsel at the bar retained to oppose the commission against
the alleged lunatic, elicited from one of the witnesses as a fact
upon  Avhich he relied to indicate insanity—that Avhen asked the
question, Mr.  Davies did not knoAv hoAv much change he had in his
pocket!  Another relied upon the fact as indicative of  weak mind,
that the alleged lunatic had said he preferred seeing the people
come  from Epsom   races  rather than the  racing on  the course!
Vague and trivial facts Avhich do  not indicate insanity, naturally
tend to produce a feeling in the minds of the jury the very reverse
of that  for Avhich they are brought forward.  Thus, in this case,
although there could be no doubt, from what subsequently occurred,
that Mr. Davies Avas a lunatic, and a fit  and proper person to be
placed under restraint, yet  the  eloquence of Lord  Brougham, and
the result of a skilful cross-examination in  bringing  into  promi-
nence  the AA-eakness of the facts on which  the Avitness relied to
establish insanity, had such an influence with  the jury that they
returned a verdict in favor of the  lunatic,  and for a time he was
considered as  the unhappy victim of an  unjust persecution on the
part of his  mother and other relatives.  In a case referred to by
Dr. Bucknill, one of the medical men certifying to the insanity of
a gentleman,'avIio Avas at that time undoubtedly insane, had stated 
758
DISCHARGE OF  LUNATICS.
as facta observed by himself, that "his (the patient's) habits were in-
temperate,  and that he  had squandered  his property in mining
speculations."   But on cross-examination in the Queen's Bench, he
was obliged to confess that the only act of intemperance he  had
actually observed was the patient's drinking one glass of beer, and
that the squandering of property was the  loss of Avhat was to him
a mere trifle in a mining  speculation, which  eventually turned out
to be a very good one. (Millar's " Hints on Insanity," 1861, p. 187.)
Counsel properly hold a medical practitioner strictly to  the com-
mon and accepted meaning of the words which he uses.
  No professional man is compelled  to take upon himself the re-
sponsible duty of signing certificates of insanity; but if he does
undertake it, he must perform it with reasonable care and ordinary
skill.  If he certifies that a person is laboring under delusions, he
must take care that he understands  the meaning of the term and
what are the delusions; and admitting that he is correct in believ-
ing from his own observation that they  exist in the mind of the
patient, it must be remembered that, in order to justify restraint
or imprisonment in an asylum, the  law looks always to the influ-
ence of these delusions upon conduct.
  In reference to the important question of medical responsibility,
the folioAving observations were made  by the learned judge in the
case of Hall v. Semple (Q. B.  Dec.  1862):  " The  true  ground of
complaint is the negligence of the defendant, and the want of due
care in the discharge of the duty thrown upon  him; and I think
that if a person assumes the duty  of a medical man under  this
statute, and signs a certificate of insanity which is untrue, without
making the proper examination or inquiries which the circum-
stances of the case would require from a medical man using proper
care and skill  in such a matter—if he states  that which is untrue,
and damage ensues to the party thereby, he  is  liable to an action,
and it is to that I desire  to direct your particular attention.  In
point of laAV, if a medical man assumes, under this statute, the duty
of signing a certificate, without making due and proper examina-
tion which a medical man under such circumstances ought to make,
not in the exercise of the extremest  possible care, but in the exer-
cise of ordinary care, so that he is  guilty of culpable negligence,
and damage ensue, then  an action will lie against him, although
there may have been no improper motive, and the certificate may
not be false to his knowledge."  In  this case the jury found a ver-
dict for the plaintiff—that the certificate was untrue in effect, and
that it had been signed without proper examination and inquiries,
and without probable cause.

  Discharge of lunatics.—In forming  an opinion  relative to the
propriety of discharging 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 object were to confine him for
the first time.  The question of liberation is commonly restricted,
like that of restraint, to cases of mania and monomania.   It may so 
                 COMMISSIONS OF LUNACY.              759

happen that the person has had a lucid interval at the time of ex-
amination, in Avhich case it will be necessary to make more than one
visit.  One Avho has been guilty of  a heinous crime like murder
should never, on any pretence, be discharged.   There are often loner'
lucid intervals in homicidal mania, and it is impossible to be certain
that the disease is entirely removed.  If the person has manifested
the least disposition to suicide, we should be extremely cautious in
liberating him ; for suicidal mania is often artfully concealed under
a cheerful exterior.   We cannot always test the propriety of grant-
ing liberation by the lightness of the offence for which a criminal
lunatic has  been  confined.  The circumstances under which the
most trifling offence has been committed may show that  the mind
is wholly unsettled with regard to  moral responsibility; and such
lunatics can never be trusted, even when there is a great improve-
ment  in their language and deportment.
  The 16th and 17th of Victoria, c. 97, has placed certain restric-
tions on the power of liberating lunatics. Under ss. 83 and 84, the
person originally signing the order which is required in addition to
the medical certificates, may write  an order  for  the discharge or
removal; but under s.  84 this  order  is of no effect, if a medical
practitioner certify that in his opinion such patient is dangerous and
unfit to be at large, together with the  grounds on which his opin-
ion is founded,  unless the commissioners or visitors shall, after the
production of such certificate, give their consent in writing for the
removal or discharge of such patient.   Under other clauses, addi-
tional powers of discharge are given to the commissioners and visi-
tors, subject to such restrictions as to leave the control for the most
part in the  hands of professional men.   These powers of  discharge
do not, hoAvever, apply either to criminal lunatics or to those found
insane under a commission issued by the Lord Chancellor.
                  CHAPTER  LXIII.

INTERDICTION.—COMMISSIONS  OF LUNACY.—EXAMINATION OF ALLEGED
  LUNATICS.—MEDICAL  AND LEGAL TESTS OF COMPETENCY.—CONFLICT
  OF EVIDENCE AND OPINION.

  Interdiction.—By interdiction we are to understand the depriving
of a person laboring under mental disorder of his civil rights; in
other words, preventing him from exercising  any control or man-
agement over his affairs.   It may be with or without restraint, for
one condition does not necessarily imply the other, although there
is a  popular  idea  to  the contrary.   In Re Smith (June, 1862) an
order for a jury Avas issued to try the question of sanity or insanity,
and  in affirming the order,  Lord Justice Knight Bruce  made the
following statement: " It is desirable to remove  the  idea, but too 
760
COMMISSIONS OF LUNACY.
generally  entertained by persons  (common  persons) in different
stations of life, that the finding  by a jury that the person is of
unsound mind necessarily involves an interference with his  per-
sonal freedom:  it does not.  The court places no  further restraint
upon a lunatic than is  necessary  for  his protection, and I Avould
refer to the fact that there are  several lunatics living under the
protection of the  court who reside in their own houses, with large
establishments."
  When a person, from  mental incompetency, is liable to be im-
posed upon by others, or  is guilty of foolish and extravagant acts,
whereby his  property is damaged, a Commission is  commonly
granted by the Court of Chancery, in order to determine Avhetfyer
he be "compos" or unon compos  mentis."   This writ is Avell knoAvn
under the name of " de lunatico inquirendo."  Before it can be issued
it is necessary, among other matters, that there should be affidavits
made by tAvo or three physicians or surgeons, certifying to  the in-
sanity  of the party.  It has been already explained that the object
of the Commission is to determine  Avhether the  incapacity to man-
age  affairs is owing to  some mental defect or disorder, and not
merely  to  want of education or  bodily  infirmity—otherwise all
wealthy minors and infirm persons  might be improperly deprived
of the control of their property.  Formerly, Commissions Avere not
issued unless it was evident that lunacy or idiocy existed—for Aveak-
ness of mind  or imbecility Avas not considered sufficient to justify
legal interference.   This is  no longer  the case,—"unsoundness of
mind with incompetency" being all that the  laAV requires to be
established.   Thus, then, whether  the case be one of mania, mono-
mania, or dementia is not now the  question, but AA-hether the party
be compos, or non  compos  mentis ; if the latter, whether it be to a
degree to prevent him from controlling his property with careful
and provident management.   There was a strange contradiction in
our system of jurisprudence some years ago.  A person  who had a
delusion on  a  particular subject, although not affecting his social
duties, was deemed a fit  subject for a Commission, and deprived of
his civil rights merely because his mental disorder Avould fall under
the definition of lunacy.   On the other hand, one who had no delu-
sion, but great  mental Aveakness, such as to  incapacitate him from
properly managing his affairs, was not deemed  a fit subject for a
Commission; since weakness of mind and insanity were considered
to be two entirely dift'erent states—the latter alone requiring inter-
ference, although the injurious results were the same in  both cases.
  It is unfortunate that  these Commissions have been usually con-
ducted on so expensive a  scale as to render them applicable only to
the wealthy classes of society:  and even here the expenses attending
such a simple inquiry as  that  for which the Commission is issued,
have been  often of the  most ruinous kind, and  the results by no
means  satisfactory.  The Lord Chancellor has it now in his power
to direct an inquiry to be made before one or two Commissioners,
inwhich case a jury is dispensed Avith.  Evidence may  then be re-
ceived, and the decision left with  the commissioner or commissioners 
            CONFLICTING MEDICAL  EVIDENCE.          761

bo appointed.  The costs of an inquiry by this regulation are greatly
reduced ;  and even under the amended  law no Commission of Lu-
nacy can be had at a less expense than £60, and this only in uncon-
tested cases.  This form of proceeding is hoav adopted in the greater
number of cases, so that out of 575 commissions in ten years only
21 Avere before juries.  The Lunacy- Regulation Acts are the 16th
and 17th  Vict. c.  70 (1853), and the 25th and 26th Vict. c. 86 (Au-
gust, 1862).   The last-mentioned  Act  has  greatly improved  pro-
ceedings  in lunacy, and has removed much  of the injustice which
formerly prevailed.  In order to shorten these inquiries and lessen
the expenses, the order under s. 3 is to be  confined to the question
whether or not the person is " at  the time  of unsound mind  and
incapable of managing himself and his affairs."   Yo evidence on
his conduct is to be received as a proof of insanity unless it refers
to a period within two years of the date of  the inquiry.   In cases
of  contested  imbecility, this provision might exclude important
evidence, but there is a discretionary poAver  in the judge to admit
it.  Section 4 allows of the case being tried by a jury at common
law.  The alleged lunatic  is to  be examined  before the taking of
the evidence, and at the close of the proceedings, before the jury
consult on their A7erdict.  Under s. 12 power is given to the  Chan-
cellor to dispense with commissions in reference to persons who have
but small  property, and there are in this statute other strict rules
regarding the visiting of lunatics confined in asylums.
  One source of difficulty on these occasions is, that  medical  wit-
nesses are allowed  to be separately sought  out and summoned by
those who are for and  against the commission, and  the opinions
given by them often exactly neutralize each other.  Under these
circumstances they are converted into partisans in the cause as much
as if they were counsel.  It has been well  remarked, that a man
even unknown to himself, Avith the purest intentions and the most
perfect rectitude,  will insensibly lean to the side on which he has
been consulted or employed.  (Pagan, p. 301.)   The public are apt
to infer from such conflicting opinions emanating from men of equal
experience, that the difference cannot depend essentially on the med-
ical facts of a case, and that the question might as well or even bet-
ter be determined by non-professional persons.  See the case of 31rs.'
Gumming (" Journal of Psychological Medicine" for April, 1852),
in which  the conflict of medical testimony was even greater  than
usual.  A large portion of this lady's property was spent in deter-
miiiino- by a verdict that she Avas insane; and there Avas an intention
that the  remainder should be expended in  reversing the decision,
when the unfortunate lady died!
  One remedy for this serious evil Avould  be, that  medical experts
on such occasions should be selected and appointed by the Lord
Chancellor, to examine an alleged lunatic and give  evidence on  his
condition ; they should be in all cases  made perfectly independent
of both parties.   At present, they rather occupy the position of
medical counsel than medical witnesses, for it is quite clear that
no one would be summoned Avhose views  did not coincide Avith 
762
EXAMINATION OF  LUNATICS.
those of the party summoning  him;  and it is an  opinion among
some solicitors—for Avhich, unfortunately, there is apparent reason
—that medical evidence on these occasions is a remarkable commo-
dity, and may be purchased at  graduated prices 1   There are some
medical men who appear to think  that on these occasions they are
justified in sinking the witness in the advocate, and that they are
bound by a sort  of duty to make the best of the case for the per-
son who retains them ;  but this is a mistaken view of their position.
An advocate is not bound by an oath to state " the truth, the whole
truth, and nothing but the truth ;" but a scientific witness is placed
under this sacred obligation, and it is a duty which he owes to his
profession and to society that he should lay  aside all personal bias.
It may appear an innocent matter to suppiress some  facts and to
exaggerate the importance of others, in order to induce a jury to
pronounce one whose mental soundness is in question to be perfectly
sane  and competent:  but the same mercenary zeal which would
thus  lead to  the civil freedom  of an insane person, might on an-
other occasion  be employed in  unjustly- depriving a sane person of
his liberty.  The confidence of the public in  medical opinions in
reference to the insane person has been by recent  events already
much shaken; and it would be altogether destroyed,  and  such
opinions entirely dispensed with,  if  it were  once  known that a
medical man on these occasions accepted a retaining fee not to speak
the whole  truth  but, rightly or wrongly, to give his  evidence in
favor of the party who consulted him.  Whatever may be the dif-
ficulties of the case, experienced solicitors know that if  they only
search far enough they will generally fall upion some medical men
who will adopt their views.  (The reader will find some remarks on
this subject in the " Medical Gazette," vol. 5, p. 719 ; vol. 11, p. 740;
and vol. 17, p. 816.)
  Examination of alleged lunatics.—To determine whether a person
is, or is not a fit subject for interdiction, or deprivation of civil rights,
it is necessary to bear in mind that it  is not enough to show there is
delusion, as in the lighter cases of monomania;  but Ave  are bound to
ascertain how far the delusion affects the judgment of the person, so
as to prevent him, like other men, from managing his affairs with
provident care and propriety.   In  many instances, however, some
proof of delusion only  is sought for:  and if this be procured, it is
hastily inferred that the person must be entirely incompetent to
manage his property.   The most difficult cases are those which in-
volve questions of imbecility.   In  conducting the  defence of the
 Windham case (Dec. 1861), Sir  Hugh Cairns  was allowed by his
medical adviser to  make the following strange statement: "In a
case of insanity accompanied by delusion, the mode of investigat-
ing it so as to arrive at the truth is a matter of great difficulty and
doubt:  but in a case of imbecility, where there is  either no mind
at all or next  to none, the task of coming to a right and just deci-
sion is comparatively easy." Such a statement is the reverse of the
truth, and must have been made under some hazy notion that the
state of imbecility was identical with that  of idiocy.   One of his 
EXAMINATION OF  LUNATICS.
763
oavii witnesses (Dr. Sutherland), in a subsequent stage of the pro-
ceedings, corrected this error, by the admission in cross-examination,
that " drawing the line between soundness and unsoundness of mind
in cases  of"  imbecility, is one of the  most difficult  questions of
medical science."
  In conducting the examination of an alleged lunatic, we should
compare his mind as it is with what it is proved to have been; and
if it be a case of supposed imbecility, a proper regard must be had
to age, society, education, and general conduct.   We  should also
consider whether the person has been treated by his friends  and re-
lations as a lunatic or imbecile prior to the issuing of the commis-
sion.   A young person whose education has been much neglected,
and avIio has  never been intrusted with the  care of money, cannot
be expected to have much knowledge of the method of managing a
large property.  Questions are sometimes put on the moral respon-
sibility of man and the attributes of God, to one who, perhaps, never
heard of ethics or metaphysics.   Again, mathematical and arith-
metical questions, which would embarrass many persons Avho  are
set down as  sane and competent, are  sometimes put  in cases of
alleged imbecility.   In one  instance, a physician gave evidence on
a commission  that he found the alleged imbecile could not work
the first proposition in Euclid, but  this person admitted that  he had
always disliked mathematics.  In a  case, which occurred in Scot-
land, one examiner asked  the alleged  imbecile,  who  said he had
12Q01.  in the  Bank, and received 201. for interest—How much Avas
that per cent.?  He said he could  not tell; he was no  good hand at
arithmetic.  The counsel who appeared against the brieve or com-
mission afterwards put the same arithmetical question to one of the
medical witnesses Avho had deposed to the imbecility  of the party ;
and this witness, an educated man, confessed himself quite unable to
answer it—a practical illustration of the  impropriety of pronounc-
ing a person to be imbecile  or imcompetent merely because he is
ignorant of that which he has never been taught!  (Case of David
Yoolow.)  If the capacity  to manage affairs rested solely upon  a
knowledge of arithmetic, many now go free who ought to be imme-
diately placed under interdiction.   This is rather a commercial test
of insanity: but it will be found that it has been applied in a very
improper manner to  determine the capacity  of young and ill-edu-
cated Avomen.   Unless the questions are confined to  those subjects
which  the person has had either  the opportunity or inclination to
learn, a medical witness will always incur the risk of confounding
mere ignorance with imbecility.
  One of the best tests of mental  capacity will be found in deter-
mining the degree to which, with ordinary opportunities, a  person
has shown himself eapiable of being instructed; but too  high  a
Btandard must not  be assumed as  a test of capacity.   The mind of
an alleged imbecile should not be compared  Avith the most perfect
mind, but with that of another person  of average capacity, of the
same age and  station in society, and who has enjoyed like opportu-
uities of instruction.   It Avould be difficult to find tivo sane persons 
764
TESTS OF CAPACITY.
who were exactly equal in mental poAver: in some, one faculty is
prominently developed, in others another.  All that Ave have to look
for in these cases of  alleged unsoundness  is  an  average degree of
intellectual development, so as to qualify the person for performing
the duties of his station.  To Avin the confidence of an alleged luna-
tic for the purpose of examination, we should not treat his observa-
tions or delusions with levity, but rather seriously sympathize Avith
him in his troubles ; Ave should listen attentively to all he has to say,
for his suspicion will  be  excited by many questions being  put to
him.   If Ave cannot agree Avith his conclusions, we should not con-
tradict him abruptly, but endeavor to draAv him out by asking for
some corroborative  evidence of  his  statements.  Dr.  Millar has
properly advised that, before visiting the  patient, we should make
ourselves  thoroughly acquainted with  every particular connected
with his history and condition, and treat  him as much like a sane
person as  possible.  The insane are exceedingly suspicious, and
quick to detect any deceit practised on them.  They are also jealous
of the  intrusion of strangers, and, unless great tact is employed, will
look upon  a medical man as an enemy.   (" Hints on Insanity," p.
58.) The patient should be informed that his perceptions are merely
the result of natural disease ;  it is useless to tell him that he is under
a delusion Avhen his  perceptions, although sometimes exaggerated,
are too real to be doubted.   (Op. cit. p.  36.)
  The conflicting medical evidence given on Commissions of Lunacy
is in great part to be ascribed to the fact, that the whole of the mind
of the  person is not fairly examined.  One physician tests  one fac-
ulty, another,  another; each has his  own theory of  insanity, and
each his standard of competency.  The  witnesses in support of the
commission do not go so much to  test the actual  state of mind of
the person, as to discover Avhat they deem  proofs of insanity:  those
against the commission take an opposite course—they look only for
some proof of  soundness.  It cannot therefore  happen otherwise
than that dift'erent conclusions should be drawn under such different
modes of investigation.  There is another point which requires at-
tention in these cases.  Persons laboring under  a slight degree of
imbecility are very soon  irritated ;  they are  easily persuaded that
they- are ill used and persecuted ; and when they happen to be ques-
tioned by  parties who are represented as  their  enemies, they lose
their self-command, and are  no longer  able  to  answer questions,
Avhich  under their  ordinary state of mind  they would reply to wuth
perfect accuracy.  (Pagan, op. cit. p. 302.)
   A defective memory must not be hastily set down as a proof of
legal unsoundness.   This is more or less the natural result of age.
A man may not have a good memory, and yet have a mind sound
enough for the management of his affairs.   A defective memory in
an aged person, taken alone, proves nothing.   (See "Ann. d'Hyg."
1836, vol. 1, p. 192.)
   A medical Avitness must not alloAv himself to be embarrassed by
medical or legal definitions of insanity.  The malady may not as-
sume the form of lunacy or idiocy, in a strictly legal vievA-—nor of 
CASES OF IMBECILITY.
765
mania, monomania, dementia, or idiocy, in a strictly medical view;
but still it may be a case of such mental disorder as to create an  in-
capacity for managing affairs.  This is the point to which a medical
examiner has to direct his attention.  Cases of imbecility present
the greatest difficulty, and create the greatest  conflict of opinion
among medical witnesses.   Imbecility  strictly  implies a weak or
feeble mind, and the term  is properly applied  to  one who has an
intellect below par or below the normal average.   The vagueness
of these terms shows how difficult it  is  to draw a clear distinction
between legal sanity and that degree of mental weakness implied
by imbecility Avhich  would justify interdiction.  Insanity in the
common acceptation of the term cannot be  proved in these cases:
there will be no evidence of delusion, and there  may- be  such  an
amount of self-control as to enable a person to  maintain a conver-
sation.  Memory, judgment,  and other faculties, although weak,
are still present in a greater or less degree; and from one or two
interviews only, an examiner might be disposed to pronounce the
person of sound mind and competent to manage his own affairs.
There is a wide field for argument here; for it may be said Avith
some truth in a defence, "that the "doctors cannot put their fingers
on a single point indicative of insanity."  In short, each fact speci-
fied by them may be frittered away by the remark that every one
must have knoAvn some  person Avho had either a bad memory or a
weak  judgment; who squandered money, who wasted it on un-
worthy objects, who  hoarded it and refused to pay just debts, or
who lost it in foolish speculations, etc.   All this may be true, and
yet the person in  question may be  legally of unsound mind, and
properly interdicted.   As Dr.  Pagan justly remarks, there  is  a
facility' of disposition in an imbecile or weak-minded person, Avhich
lays him open to  be imposed  upon  by  the artful  and designing:
and our conclusion regarding his  competency  must, therefore, be
the result of a just  appreciation of his general knowledge of affairs,
derived from an examination of all his faculties.  We have to con-
sider Iioav far his imperfect mind Avould prevent him  from attend-
ing to his own interests, not in a manner Avhich would insure their
most profitable application, but in such a Avay as would prevent his
affairs from being  involved in ruin.   His  knoAvledge and under-
standing may be so imperfect that  his  property would necessarily
go to Avaste under his unassisted control.   When it is proved that
there has been habitual submission to the dictation of others, either
from a long habit of  being controlled, from  indifference, or fear-
when a man has allowed himself to be disobeyed or neglected  by
his servants, and to be openly cheated by- tradesmen—these circum-
stances furnish evidence of Aveakness  of mind, and a justification of
the opinion that there should  be interdiction.  (Op. cit. p.  203.)
On the other hand, if a person when  left to himself has  managed
his affairs with reasonable care and propriety, and  has acted inde-
pendently of others, there can  be  no stronger proof of his legal
competency.   [See  the very able opinion of Patton, P. J., in 31c-
Elroy's case, 6 W. & S. 451.—P.J 
766
TESTS OF  CAPACITY.
  The testamentary capacity of imbeciles may be tried by the same
rules.  A man who is of such an easy disposition as to be impro-
perly influenced  in  the  use of his property while living, may be
equally influenced by fear or control to make an improper disposi-
tion of it by his will; but  in this case the terms of the will, if
draAvn up by himself, will allow a fair judgment  to  be formed of
the mental soundness of the testator.  There is on these occasions
a method of  testing the state of mind which  has been suggested
by Dr. Conolly—namely, by inducing the  patient to  express his
thoughts in Avriting, as in a letter addressed either to his physician,
or to some confidential  friend.   This plan would probably often
succeed in developing the existence of a latent delusion, Avhen an
examination would  wholly fail; the patient would not be  led to
suspect that he was being subjected to an examination for a hostile
purpose.   The current of his thoughts would be uninfluenced  by
the suspicion, that the act of writing was  to test the state  of his
mind; and as no man can long write in a connected manner who
does not  think collectedly, so we may expect to find ample evidence
whether  a delusion really exists  in  his mind  or not.  There are
cases recorded in which  the evidence of delusion has been derived
from the terms of a will or deed Avritten or dictated by the lunatic
himself, when there was great difficulty in obtaining proof by an
oral examination.
  In idiocy there is no capacity for writing. In dementia, as there
is no memory, it commonly happens that the same word is written
over and  over again. No person in a state of dementia can write a
connected sentence, because before the last part of the sentence is
completed the first is entirely forgotten. In imbecility, we may meet
with every variety  of mental defect, but the state of the mind is
pretty well shown by the expression of the thoughts  in writing.
This method, it must be  remembered, cannot show whether  or not
a person  is capable of managing his affairs: it is a mere index of a
certain state of the mind, and must be coupled with general  habits
and conduct, before any conclusion is drawn from it relative to the
propriety of interdiction. It will often serve to detect the existence
of a delusion when other means fail.  Dr. Forbes Winslow attaches
some importance to handwriting as foreshadowing the occurrence
of general  paralysis with softening of the  brain.  This, however,
refers, not so much  to composition or style as correct Avriting and
spelling.   (Op. cit.  p. 464.)  The reader will find a complete essay
on  the writings  of the insane, and the medico-legal conclusions to
which they lead, by Dr.  Marc6, in the  " Ann. d'Hyg. Publique,"
1864, vol. 1, p. 379.  When a verdict of insanity is returned under
a commission, it must ahvays represent the party to be of unsound
mind, and by reason of that unsoundness to  be incompetent to
manage  his affairs.  A  date  must be fixed at which the insanity
first appeared, and this date should always be anterior to the issuing
of the commission.  If  there  be  lucid intervals, the space of time
occupied by these should also be defined.
  Among  cases  well calculated  to  show  the  conflict of medical 
THE WINDHAM  CASE.                 767
evidence is that of the late Mr. W. F. Windham (December, 1861).
Fifteen of the relatives of this gentleman petitioned for an inquiry
into his state of mind, on the ground that he labored under conge-
nital deficiency of  intellect, and this view was supported by strong
medical opinions; on the other side it was alleged that the mental
condition  of Mr.  Windham, if below the normal standard, was
merely the result  of a  neglected education.  The inquiry- lasted
thirty-three  days,  during which  140 Avitnesses were examined—
namely, fifty on the part of the petitioners, and ninety in  favor of
Mr. Windham, at a cost of about 30,000£.  There was no proof of
the Avant of  the  opportunity of education,  but strong reason  to
believe that the alleged imbecile had  not made use, like other boys
of his age, of the advantages which he had enjoyed.  He had been
sent  to Eton, but  had derived little benefit from his connection
with  that great public  school.   It  seems to have been admitted
that  as a boy he  was wholly unlike other boys, and when  he
attained his  majority, in August, 1861, his conduct Avas extrava-
gant, wild, and wholly inconsistent with  his social position.   At
the same time, he Avas not entirely deficient  in business  matters ;
for it was proved that his uncle, one of the petitioners, had shortly
before negotiated with him for the  sale of a piece of land of the
value of 1000£., thereby admitting his capacity to transact business.
The evidence received on this occasion was  allowed to extend to
the whole of his life, and it may be  observed that in cases of al-
leged imbecility it is not possible, without doing injustice, to pre-
vent the reception  of evidence from a long date.
   The result of this inquiry was  that the jury, by a majority of
fifteen to eight, returned the following verdict—" That Mr. Wind-
ham is of sound mind and capable Of taking care of himself and
his affairs."   After the verdict had been returned pronouncing him
sane and  competent, he was  guilty of many extravagant acts,  ex-
hausted a splendid fortune and became a bankrupt; shoAving that,
whatever legal soundness of mind he might possess in the opinion
of two-thirds of the jury, he practically did not evince that capacity
which they declared him to possess of taking care of himself or  his
affairs!
   A large section  of the public joined in the view prominently
put forward  at the inquiry by his counsel, Sir Hugh Cairns, that
this unfortunate young man had been made the victim of a charge
the most  cruel, unjust, and unjustifiable!  Insanity, it was urged,
in the ordinary acceptation of the word, did  not exist in his case.
There were  no  illusions, halluciations, or delusions ;  but as  these
are never met Avith in the form  of  unsoundness  imputed to Mr.
Windham, namely, imbecility, their  absence proved nothing for or
against the  existence of imbecility  or weakness  of mind.  But
what test is  there for imbecility except conduct and conversation ?
There was no incoherency of language, but  there was strong evi-
dence of  habits such as we do not meet with among men of really
reasonable mind;  but  opinions  were  divided on the  question,
whether  these  indicated unsoundness of mind,  or a mixture of 
768          CONFLICTING MEDICAL OPINIONS.

eccentricity and moral depravity from deficient  education.   A
majority of the jury took the latter view; and Lord Chelmsford,
in commenting upon this verdict in the House of Lords (March,
1862) said:   " The law as laid doAvn by Lord Lyndhurst applied to
cases short of insanity, but  they must be cases of unsoundness of
mind; and mere extra\-agances or follies, which  indicate imbecility,
Avould not be sufficient unless the imbecility amounted to unsound-
ness of mind."  The  legal  test  of  the existence  of this state of
mind, as we are told by high authority, is " conduct."  The laAvyer
means by madness "conduct of a certain character," while a phy-
sician means by it  " a certain disease one of the effects of which is
to produce  such conduct."   (" Crim. Law of England," by Fitz-
james Stephen, p. 87.) The whole evidence against Mr. Windham
bore upon  conduct, and from the  verdict  we  learn what sort of
conduct does not constitute madness in a legal  sense.  The marry-
ing of a  woman of disreputable character—the squandering upon
her of 14,000/.  in  jewelry,  and settling upon  her, without any
reasonable grounds, 800/. per annum, with  other extravagant acts
of a similar kind, do not  constitute "conduct of a certain char-
acter " sufficient to render a man non  compos mentis in the eyes of
the law ; but if these acts evince soundness of mind and a compe-
tency to  manage affairs, what are the acts which indicate unsound-
ness or incompetency ? On  the other  hand, we are told that the
physician looks to  the existence of  a certain disease; but a physi-
cian can  know nothing about the existence of disease of the brain
during life in any case of imbecility, except in  so  far as its effects
may be manifested by conduct.  We therefore  come round to the
legal test of " conduct," which  in Mr. Windham's case was con-
sidered to be quite consistent with the  provident management of a
large estate and a splendid fortune.  That the legal test was here a
failure in affording protection from wastefulness is proved by the
result—the loss of  the whole property from reckless extravagance!
  In reference to this and other cases," doctors"  have been strongly
condemned  for not agreeing among themselves on the subject of
insanity, and it has been suggested that persons of common sense
and  a practical knowledge of the world are  more qualified to judge
of soundness and  unsoundness than medical men.  In the Wind-
ham case,  which  elicited these censures, the  jury, consisting of
twenty-three men with a " practical knowledge of  the world," dif-
fered from each other even, more than the doctors—the number
being fifteen in favor  of a verdict of soundness  and eight in favor
of unsoundness of mind.  The  minority felt so strongly  on  the
error of the verdict of the majority, that  they specially signified
their dissent from it to the Lords Justices who had directed the in-
quiry. This great legal question was therefore  decided arithmetic-
ally by relative numbers, 15  to 8, as in the election of a Member of
Parliament!
  The chief objections to the evidence of medical experts on these
occasions would be removed, if they were nominated by the Lord
Chancellor or the  Lords  Justices, and if they  Avere thus made as 
COMMISSIONS OF LUNACY.
769
independent as special jurors.  So strong was the public feelino- in
reference to medical evidence after this inquiry, that the Lord Chan-
cellor actually proposed to exclude it altogether, in commissions of
lunacy, except in so far as it was based on facts within the personal
knoAvledge of the witnesses.   It was suggested that the general
scientific conclusions of experts should not be received as evidence.
This proposition, which would have been most injurious to the in-
terests of the insane, as well as the sane, did not meet with a favor-
able reception.
  A Commission of Lunacy may be  superseded, but the evidence
must then be as strongly in favor of sanity, as it Avas before in favor
of insanity.  The onus of proof is then thrown on the person who
has been found lunatic.

  [The Constitution of Pennsylvania vests in the Supreme Court
and the several courts of Common Pleas, the care of the persons and
estates of those who are non compos mentis.  In practice, however,
original j urisdiction in these cases is nearly, if not exclusively, con-
fined to the courts of Common Pleas.
  The act of 13th June, 1836, provides the manner of proceeding,
in cases of interdiction, by the issuing of a commission in the nature
of a writ de lunatico inquirendo to inquire into the lunacy or habit-
ual drunkenness of any person living within this commonwealth, or
having real or personal estate therein. The commission is issued upon
the application in Avriting, accompanied by affidavits, of a relation
by blood or marriage, of the person named, or of a person interested
in his estate : or (by act of 15th April, 1851), where there are no rel-
atives, upon the application of any distinguished person of the same
township, ward or borough, in which the alleged lunatic or habitual
drunkard resides.  There  may be one or three commissioners, who
are to " diligently inquire, by the oaths or affidavits of six good and
laAvful men of the county," whether the  party is a lunatic, etc.,
hoAv long he has been so,  whether he has lucid intervals, what
property he owns, and its value, etc. etc.;  and " the inquisition so
to he made " to return to the court at a time specified in the commis-
sion.   The  act (§ 67) defines the word " lunatic" as meaning " any
person of unsound mind, whether he may have been such from his
nativity, as idiots, or have become such from any cause whatever."
By § 63, it  is provided that  upon petition of the party setting forth
that  he is restored to a sound  state of mind,  the court shall take
proof of the facts, and if satisfied of the  truth of the allegations
of the petition, shall suspend, or as the court shall decide, altogether
supersede and determine the commission, the inquisition, appoint-
ment of a committee, and all subsequent proceedings.
  Though,  in the main, governed by the  principles applicable to
similar proceedings in the Court of Chancery, the provisions of this
act are much simpler and  less expensive.
  Where there is a traverse of the inquisition, the question is .not
Bimply whether unsoundness of mind exists, but whether it exists
to such an extent as to disqualify  the  traverser from conducting
      49 
770
COMMISSIONS OF LUNACY.
himself with personal safety to himself or others, or from managing
and disposing of his OAvn affairs and discharging his relative duties.
McElroy's case, 6 W. & S. 451.  The great object of the proceedings
under a commission of lunacy is to afford security and protection.
The fact that, as yet, the lunatic may not have squandered his pro-
perty is no security that he may not do it hereafter. _ The act is
precautionary in its design, and hence a disposition of mind or body,
which might lead to the wasting of an estate is sufficient to justify
the enforcement of its provisions.  lb.; Sill v. McKnight, 7 W & S.
245 ;  Ludwick v.  Commonwealth, 6 Harris 175.
   The same act (13th June, 1836) §§ 58-62, introduces the provi-
sions of 39 and 40 Geo. III. c. 94, relative to the subject of criminal
proceedings against piersons avIio Avere lunatics at  the time of the
commission of the offence, or Avho have become  so  since.   These
sections have been re-enacted by the new criminal code of 31st March,
1860. They provide that Avhen a jury shall acquit any person charged
with  crime or misdemeanor, on the  ground of insanity at the time
of the commission of the offence, or Avhen he shall be found to be
a lunatic  upion arraignment, such jury shall find specially the fact
of insanity and declare in their verdict that this was the ground of
acquittal.  The court may then order him to be kept in strict cus-
tody, so long as he shall remain of unsound mind, or he may be de-
livered to his friends, or to the guardians of the pioor upon the entry
of security that he shall be restrained by seclusion, or otherwise,
from  the commission of  any offence.  When the prosecutor fails to
ap>pear, and the prisoner would be otherwise discharged, if it appear
to the court upon affidavit of any credible person that the defendant
is insane, the court are required to order the district attorney to send
a written allegation of such insanity to the grand jury, who shall
make presentment  of their finding to the court;  and thereupon a
jury shall be impanelled to try the insanity of such person.
  Similar statutory provisions  exist in Massachusetts and Minne-
sota, and  perhaps in  other States  of the Union.   See Bonfanti v.
State, 2 Min.  123.
  The criminal courts of Pennsylvania may also upon petition in-
quire into the insanity of, and commit to the State Lunatic Asylum
persons unsafe to be at large, and those Avho are suffering unnecessary
hardship  of duress; Act of 14th April, 1845.    This  application
may be made by a married woman.   Shenango v.  Wayne, 10 Casey
184.  See also Brightly's Purdon's Dig., tit. " State Lunatic Asy-
lum."  Id., tit. " Lunatics and  Habitual Drunkards."  The act of
1845  also gives  the officers of the  poor authority to send insane
paupers to the State Asylum.
  These acts of course do  not  prevent  the sending of persons to
asylums by their friends, Avithout the intervention of the courts. All
such cases may, however, be brought before the courts upon  habeas  \
corpus.  See Dr. Hartshorne's note, ante, p. 755.  See also the case
of Hinchman v. Ritchie, Bright. R. 144.—P.] 
RESPONSIBILITY  IN CIVIL CASES.          771
                    CHAPTER  LXIV.

 CIVIL RESPONSIBILITY.—TESTAMENTARY CAPACITY.—AVILLS  MADE  BY
  THE INSANE.--TEST OF  CAPACITY.--EVIDENCE OF  DELUSION.—
  ECCENTRICITY IN WILLS.

  Responsibility  in  civil  cases.  Insanity as an impediment to mar-
 riage.—-Insanity is deemed in law to be a civil impediment to mar-
 riage, because it is considered that there cannot be that rational
 consent which is necessary to the validity  of  a contract.  The
 marriage of a lunatic  is therefore called  a nullity, and is void ab
 initio.  All that the law requires is that there should be good proof
 of insanity- at, or about the time of the contract.   If this be offered,
 and it be alleged that the contract was entered into during a lucid
 interval, then the party who would benefit by- the allegation must
 prove it.  The suitableness  of the marriage, as Avell as the conduct
 of the party7 during or after its performance, will  also be considered
 by the  court.  In  Turner v. Myers, a lunatic who  had recovered
 from  his lunacy instituted a suit to set aside  a marriage which he
 had contracted Avhile in that state!   The  marriage was declared
 void.   (" Med Gaz.," vol. viii. p. 481.)  The case of Baldry v. Ellis
 (Norwich Summer Ass.,  1851) Avill be found of interest in relation
 to the matrimonial engagements of alleged lunatics.
  [But though marriage Avith an idiot or lunatic be absolutely void,
 and no sentence  of  avoidancy be absolutely necessary (Browning v.
 Peane, 2 Phillimore, 1969),  yet, as well for the sake of the good
 order of society, as for the pjeace of mind of all persons concerned,
 it is expedient that the nullity of the marriage  should be ascertained
 and declared  by  the decree of a court of competent jurisdiction.   2
 Kent, Com. 76.—P.]
  In Reed v.  Legard (Court of Exchequer,  May 30, 1851), a ques-
 tion arose whether a lunatic Avas responsible for necessaries supplied
 to the wife.   The articles supplied were for  the sole use of the Avife,
 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/iffairs, did not absolve him from the
 obligation which he contracted when he married, to provide neces-
 saries for the supiport of  his wife.   He was  then of sane mind, and
 although he  had subsequently become insane, that obligation Avas
 not revocable  under the circumstances.  (See  also a report of the
 case of Seaton v. Adcock,  "Journ. Psychol. Med.," 1851, p. 297.)
  The validity of civil contracts entered into by lunatics will  de-
pend mainly on  the circumstances Avhich accompany the act.   If
there be nothing unreasonable in the conduct of the lunatic, and the 
772          RESPONSIBILITY IN  CIVIL  CASES.
party with Avhom 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 Jlonckton v. Cameraux (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 tAvo annuities,
the foundation of the action being, that at the time of the arrange-
ment in question the deceased was not in a sound state of mind. At
the trial before the Chief Baron it appeared that the negotiation had
been conducted by the deceased with apparent prudence, sanity, and
judgment, and that the arrangement entered into by him Avith the
office was just such as any ordinary prudent person would have been
expected to make with a vieAv to his own interest.  The deceased,
who died very soon after the business had been arranged, was, both
before and after, in an unsound  state  of mind.  Under these cir-
cumstances, this action was brought by his  representatives, and  a
verdict recovered by them, subject to  the opinion of the court on
their right to recover as on the entire failure of consideration. The
Chief Baron, in giving judgment in favor of the defendant, said it
was sufficient for the purpose of this case  to lay it doAvn as a gen-
eral rule, that Avhen  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, Vice-Chancellor's  Court,
Nov. 1848.)  In the case of Donat v. Haniquet (Guildhall Sittings,
1854), on an action to recover a sum of money, in Avhich the defence
was that the  defendant was of unsound mind at the time of the con-
tract, Crompton, J., held that unless it Avas shown that the plaintiff
had taken advantage of defendant's unsoundness of mind, he would
be entitled to recover the amount claimed.
  [In the case of Leach v. Marsh, " American  Law  Reg.,"  vol.  2
(N. S.), p>. 22, the Supreme Court of Maine decided that a judgment
recovered on  default, against a person admitted to have been non
compos mentis at the time  of  the  proceedings  in  the case,  will be
reversed on a writ of error brought by his administrators after his
decease.   The following is the  note of one of the editors (Hon. I.
F. Redfield)  of the Register: "It seems well settled  that contracts
by lunatics and persons of unsound mind, as a general rule, are not
binding."  Lincoln v. Buchmaster, 32 Vt. R. 652, and numerous cases
there cited.   But there are many exceptions to this rule:—
  1. Where  merchants, apparently sane, have purchased goods  in
the ordinary  course of their  business,  and have disposed of them,
in whole or in part, so that the goods cannot be restored to the seller,
there is no question  of the general  liability upon such contracts,
notwithstanding it should appear that the purchaser was in fact in-
sane at the time of the purchase.  Braes v. Lee, 10 Barr 56 ;  Molton
v. Camaraux, 2 Exch. R. 502;  S. C. 4 Id. 17.   And  the same rule 
           CIVIL RESPONSIBILITY OF LUNATICS.        773

extends to all cases where the seller has parted with his property in
good faith, and it is  not in the power of the lunatic  to restore it.
Even courts of equity refuse to interpose to set aside  the contracts
of lunatics, unless the parties can be restored to their  former condi-
tion, or the sane party has taken some unconscionable advantage in
the bargain.  Neil v. Morley, 9 Vesey 478.   The parties are left to
their legal rights.  Sageron v. Leaky, 2 Atk. R. 412.  The same rule
extends to contracts  made with infants.  Farrv. Sumner, 12 Vt. R
28 ; Tufty. Pike, 14  Id. 405 ; Weed v. Beebe, 21 Id. 495.  But the
recovery in both cases should be upon the  quantum meruit, rather
than upou the contract.
  2. Contracts for necessaries for the lunatic or his family are bind-
ing to the same extent, and much upon the same principles as similar
contracts by infants.    Thompson v. Leach, 3  Mod. R. 310 ; Seaver v.
Phelps, 11 Pick. R. 304, 306.  Some of the  American cases  go the
length of holding that no recovery can be  had against a lunatic,
upon a contract express or implied, unless  for  necessaries.  Seaver
v. Phelps, supra; Fitzgerald v. Reed, 9 Sm. and Marshall; Pearl v.
McDowell, 3 J. J. Marsh. 658; 2 Greeul. Ev. § 369 ; Lincoln v. Buck-
master, supra.
  The rule in regard to instituting legal proceedings against a luna-
tic is much the same as that which obtains  in the case of infants;
and there would seem to be more reason for a strict enforcement of
it in  the former case than in  the latter, since infants, long before
they get out  of their nonage, are entirely competent to select coun-
sel, and conduct the  defence of a suit.
  This  subject is very elaborately discussed by  Woodbury, J., in
Lang v. Whidden, 2 N. H. R. 435, where the authorities, prior to
that date (1822), will be  found very extensively  quoted, and the
subject  very  learnedly discussed, and  satisfactorily disposed of by
the court.  It is here said the guardian must be notified, in all cases,
or the judgment will be erroneous.
  The same rule has been adopted in many of the  American States.
Albridge v. Montgomery, 9 Ind. R.  302; Snowden v. Banbury, 11
Penna. St. R. 522; 2 Barb. Ch. R. 387 ;  Wright's Ap., 8 Barr 57; 6
B. Mon. R. 239.  But if  one Avho  is a  lunatic  be arrested or im-
prisoned in a civil suit, be is not entitled to his release on that ac-
count.   A  guardian ad litem may be  appointed, and the suit pro-
ceed.  Bush v.  Pettibone, 4 Comst. R. 300; Aldrich v. Williams, 12
Vt. R. 413.
  There seems to be no good ground to question the decision in the
principal case.  The same rule has long been established in regard
tojudo-ments rendered against infants, Avithout the appointment of
guardians ad litem.   2 Saund. R. 212, N. H.; Castlemain v.  Moody,
4 B & Ad. 90.  See also 3Iison v. Dennison, 15 Wendell 64;  Wead
v. 31ursh, 14  Vt. R.  77; Crockett v. Drew, 5 Gray  399.
  In the'case of Van Brunt v.  Taylor, 3  Philadelphia R. 123, it was
held bv the District  Court, that where an insane partner contracted
loans, the firm Avas liable, Avhether the money was misappropriated
by him or not. 
774
TEST OF  CAPACITY.
  By act of 13th June, 1836, § 44, no person, found by inquisition
to be a lunatic, can in Pennsylvania, be arrested or imprisoned on
menseor final process in any civil action, so long as  he shall remain
of unsound mind.—P.]
  Testamentary capacity.   Wills made by the insane.—Questions in-
volving the testamentary capacity of persons are of very frequent
occurrence, and medical evidence  is commonly required for their
solution.   When property is bequeathed by a testator out  of the
usual order of succession, it may be alleged by the relatives that he
was wholly incompetent to understand  the  nature of the deed—
either from actual insanity, the imbecility of age, or that natural
failing of the mind which is so often observed to occur from disease,
or on the approach of death.   Bodily disease or 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 exe-
cuted it, was laboring under hemiplegia.  The opinion of Esquirol
was required, and he said that hemiplegia might undoubtedly- affect
the brain—a fact clearly indicated by the sight, hearing, and other
senses becoming weakened;  yet this, in his opinion, did not neces-
sarily indicate an impairment of the  intellectual powers.  (" Ann.
d'Hyg.," 1832, vol.  1, p. 203.)  A man's mind, under these circum-
stances, may not  be so strong as in robust health, but still it may
retain a disposing  power.  In Harwood v. Baker,  decided by the
Privy Council in 1841, a will was  pronounced to be invalid owing
to the general state of bodily  disease in which the  testator was at
the time of making it.  It appears that he Avas laboring under ery-
sipelas and fever, and these diseases had produced a degree of drow-
siness and stupor which rendered him incompetent to the act.  In the
case of Day (June, 1838), epilepsy was alleged to have affected the
mind; and  in the case of Blewett(March, 1833), paralysis Avas adduced
as a ground of incompetency.  In all cases  of this kind, the law
looks exclusively to the actual effect of the bodily disease upon the
mind ; and  this is commonly a question to be determined by a jury
from the testimony of those avIio have attended the deceased, as  well
as from the evidence of medical experts.
  Test of capacity.—A person is considered to be of  a sane and dis-
posing mind who knoAvs  the nature of the act which he is perform-
ing, and is fully aware of its  consequences.  From some decisions
that have been made, it would appear that a state of mind for Avhich
a party might be placed under interdiction or deprived of the man-
agement of his affairs, would  not  render him incompetent to the
making of a will.  The validity of the will of a lunatic was  once
allowed, although made while he Avas actually confined in an asy-
lum, because the act was rational, and it was such as the lunatic
had' announced his intention  of making, some years  prior  to the
attack of insanity.  (Coghlan's case; see Re Gardxn, "Law Times,"
July 6,1844, p. 258; also the case of Cartwright, Mayo on " Medical
Testimony," p. 44.) In  Nichols and Freeman v. Binns (Probate
Court, Aug. 1858), the question was whether the will of a Mr.  Par- 
             DELUSION  IN THE WILL OR  DEED.          775

kinson,  made in a lunatic asylum  near Norwich, was  executed
during a lucid interval.  The jury found a verdict in favor of the
will.  The insanity of a person Avhen  not already found insane under
a commission, must not in these cases rest upon presumption or pro-
bability, but lie established by positive proof.  The act of suicide is
often hastily assumed to be evidence of insanity; but it would not
be alloAved as a proof of this  state, even when a testator had de-
stroyed  himself shortly after the execution of his will.   A case has
been decided  where the testator committed suicide three days after
having given instructions for his will; but the act was not admitted
as a proof, or even as a presumption of insanity- at the time, and the
will was pronounced to be valid.  In another case, Edwards v. Ed-
wards (Prerog. Court, Feb. 1854), it Avas proved that  the testator
had committed suicide three days after the execution of his Avill,
and there  Avas some evidence of eccentric habits almost amounting
to  insanity ;  but the will Avas  pronounced to be valid. Suicide is
not deemed in law to be a proof of the existence of  insanity.
   Delusion in the will or deed.—The validity of deeds executed by
persons  affected  with monomania is often a subject of dispute. The
practice of the law indicates that the mere existence of a delusion
in the mind of a person does not necessarily vitiate a deed, unless
the delusion  form the groundwork of  it, or  unless the most de-
cisive evidence be given that at the time of executing the deed, the
testator's  mind  was influenced  by it.  Strong  evidence is often
derivable from the act itself, especially when a testator has drawn
it up of his  own accord.  In the case of Barton (July, 1840) the
Ecclesiastical Court Avas chiefly guided in its decision by the nature
of the instrument.   The  testator, it appeared, labored under the
extraordinary delusion that he could dispose  of his own property
to himself, and make himself his own legatee and executor!   This
he had accordingly done.   The instrument was pronounced to be
invalid.  But a will may be manifestly unjust to the surviving
relatives of a testator, and it  may display some of the extraordi-
nary opinions of the  individual: yet it will not necessarily be void,
unless the testamentary dispositions  clearly indicate that they have
been formed under the influence of 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, and it may  not  be ahvays in our power to discover it;
but, after all, this is perhaps the most equitable mode of construing
the last Avishes of the dead.  According to Sir John Nichol, it is
not necessary in civil suits to connect the morbid imagination with
the act  itself; if the  mind is proved  to be unsound, the act is void.
In  Roberts v. Kerslake (Warwick Aut, Assizes, 1854), Lord Wens-
leydale  held that to vitiate a will, if it be  a case  of delirium, the
act must be traced to delirious  delusion, but if it be a case of lunacy
it need  not be traced to a delusion.
  Eccentricity in wills.—The  evidence  in  these  cases sometimes
amounts to proof of  eccentricity only on the part of the testator,
or in the deed itself; but a clear distinction  must be here draAvn. 
776
ECCENTRICITY IN WILLS.
The will of an eccentric man  is such as might  always have been
expected from him:  the will of one laboring under insanity  (delu-
sion) is different from that which he would have made in an unaf-
fected  state—the instrument is Avholly different from what it Avould
once have been.   It has been justly observed, that the insane are
eccentric in their ideas, their language, or their conduct:  but the
merely eccentric have but a voluntary resemblance  to  the insane.
(Jamieson's Lectures, "Med. Gaz.," vol.  46, p. 180.)   Wills are
sometimes  contested more  on the ground of eccentricity than of
insane delusion ; but if eccentricity only be proved, a court will not
interfere.   In the case of Morgan v. Boys (1838), it was proved that
the testator, by his will, had left a large fortune to his housekeeper.
The will was disputed on the ground that it bore intrinsic evidence
of the  deceased not having been in a sane state of mind at the time
of making  it.  After having bequeathed his property to a stranger,
the testator directed  that  his  executors should " cause some parts
of his bowels to be converted into fiddle-strings—that others should
be sublimed into smelling-salts, and that the remainder  of his body
should be vitrified into lenses  for optical  purposes!"   He further
added, in a letter attached to his will—" The world may think this
to be done  in a spirit of singularity or  whim; but I have  a moral
aversion to funeral pomp, and I Avish my body to be converted into
purposes useful to mankind."  Sir H. Jenner, in  giving judgment,
held that insanity was not proved: the facts merely amounted to
eccentricity, and on this ground he pronounced for the validity of
the will.   It Avas  proved that the deceased had conducted  his
affairs  with great shrewdness and ability; that he not only did not
labor under imbecility, but that he had been always treated during
life as  a person of indisputable capiacity  by those with Avhom he
had to deal.  The best  rule to guide the  court, the  Judge re-
marked, was the conduct of persons tOAvards the deceased; and the
acts of his relatives evinced no distrust of his  sanity  or capacity
while he was living.   The deceased had always been noted for his
eccentric habits, and he  had actually consulted a physician upon
the possibility- of his body being devoted to chemical experiments
after death.  In the case of Mudway v. Croft (Prerog. Court, Aug.
1843),  a will contested on the ground of insanity but defended on
the plea of eccentricity, Sir H.  J. Fust said—" It is  the prolonged
departure,  without an adequate external  cause, from the state of
feeling and modes of thinking usual  to  the individual Avhen in
health, that is the true feature  of disorder of the mind."
  The  folloAving case was the subject of litigation in Paris in 1864.
A Avealthy Portuguese gentleman named Machado  died in  1861,
having made a will Avith seventy-one codicils attached to it, some
of them containing provisions impossible of execution.   It Avas dis-
puted on the ground  of the  insanity of the testator.   One of the
codicils was  to this effect:  "I leave for  the Athenaeum of Paris
10,000 francs, the interest of which at 5 per cent. Avill be 500 francs.
Half of this interest to be paid to a Professor of  Natural History,
who shall lecture on the colors  and patterns of dresses, and on the 
WILLS  IN SENILE  DEMENTIA.
777
characters of animals."   Again: "My funeral shall take place at 3
P. M., the hour at Avhich  the  rooks of the Louvre come home to
dinner."   The  testator was especially fond of birds: he desired that
many stuffed specimens should  be placed in his coffin; that his ser-
vant should carry to the ceremony "one of my favorite birds in his
cage;" and  that certain birds should be let loose on the day of his
funeral.  The testator had during his life  erected his oavii tomb, on
Avhich  were engraved  a sun,  a bird, an ox, and  a dog, an egg
"proper" surmounting them; beneath was incribed, "Here reposes
the author of the ' Theory of  Likeness.' "  These and other facts of
a similar  kind were relied upon  as proofs of insanity, but it was
decided that the deceased Avas only vain,  not insane, and therefore
he had a  right to will  away his property7 as he pleased.  It was
proved in favor of his sanity, that in spite of these crotchets he had
Avhile living, managed his affairs with all the  caution of a  sane
person.
   Wills in senile dementia.—Wills made in incipient dementia aris-
ing from extreme  age (senile imbecility)  are  sometimes disputed,
either on the ground of mental  deficiency, or of the testator, owing
to Aveakness of mind, having been subjected  to control and  influ-
ence on  the part  of interested  persons.  If a medical man  be
present when a will is  executed, he may easily satisfy himself of
the state of  mind of the testator,  by requiring him to repeat from
memory the mode in  which he has disposed of the bulk of his
property.  A medical man has sometimes placed himself in a seri-
ous position by becoming a witness to a will Avithout first assuring
himself of the  actual mental condition of the  pterson making  it
(case of the Duchess of Manchester, 1854).  It would ahvays  be a
good ground of justification, if, at the request of the witness, the
testator had been made to repeat  substantially the leading provi-
sions of his  will from memory.  If a dying  or  sick person cannot
do this Avithout prompting or suggestion, there is reason to believe
that he has not a sane and  disposing mind.  It has been observed
on some occasions, Avhen the mind  has been Aveakened by disease
or intimity from age, that it  has suddenly cleared up before death,
and  the  person has unexpectedly   sIioavh  a diposing  capacity.
("Ann. d'Hyg.,"  1831, p. 360.)  In Dumell v. Corfield (Prerog.
Court, Jul}-, 1844), a case  in Avhich an old  man of Aveakened
capacity  had made a will in  favor of his medical attendant, Dr.
Lushino-ton  held that to render it valid there must be the clearest
proof not only of  the factum of the instrument, but of the  testa-
tor's knoAvledge of its contents.  [In Greenfield's  Estate, 2 Harris
(Penna.) 489, Avhere the decendent during her lifetime had at the
age of  eio-hty-six or eighty-seven, executed a  deed to persons who
Avere to hold in trust for her  for life, and after her death, to admin-
ister the property in the manner therein set forth, it Avas held, that
a provision in the  deed in favor of the counsel Avho drew or advised
it  for his services  to be formed as trustee, Avith  the further provi-
sions that  such trustee  might resign, without forfeiting his  com-
pensation, is void, at  least unless it be  proved that the grantor 
778        RESTRICTION OF  MEDICAL OPINIONS.
knew of the  particular provisions,  and  without influence from
those interested, assented to them.   If a doubt exists in this respect
the provision for  compensation is  invalid;  and the provision in
favor of the  other trustees who acted  in the arrangement of the
matter, through the counsel, or in connection Avith him, is also in-
valid.  The trustees may,  however, be  decreed compensation by
the proper tribunal.—P.]  ("Law  Times," July  27, 1844.)  In
West v. Sylvester (Nov. 1864), Sir. J. Wilde, in  pronouncing judg-
ment against a will propounded as  that of the  deceased, an aged
lady, said:  "At the time she executed the will of October, 1863,
although for  many purposes she might be said to be in her right
senses, she was nevertheless suffering from that failure and decrepi-
tude of memory which  prevented her  from having present to her
mind the proper objects of  her  bounty, and selecting those whom
she wished to partake of it."
  Wills made by persons whose capacity during life has  never been
doubted, Avhile lying at the  point of death, or, as it is termed, in
extremis, are justly regarded with suspicion, and may be set aside
according to   the  medical  circumstances  proved.  Many diseases,
especially those which aff'ect the brain or nervous system directly
or indirectly, are likely  to produce a dulness or confusion of intel-
lect,  under which a proper  disposing  power is  lost.   Delirium
sometimes precedes death, in which case a will executed by a dying
person would be at once pironounced invalid.  [By a statute law of
Pennsylvania (Act of 26 April, 1855), bequests  to public  institu-
tions  are invalid, without regard to the  testamentary capacity of
the party making  the bequest, if made within thirty days of death
of testator.—H.]
  In examining the capacity of persons under these circumstances,
we should  avoid putting leading questions—namely7, those which
suggest the answers " yes " or " no."  Thus, a dying man may hear
a document  read  over, and affirm, in  ans\ver to such  a question,
that it is in accordance  with his wishes, but  without understand-
ing its purport.  This is not satisfactory evidence of his having a
disposing mind; we should see that he is able to dictate the provi-
sions of the  document, and to repeat them substantially from
memory when required.  If he do this accurately, there can be no
doubt of his possessing complete testamentary  capacity.  But  it
may be objected that many dying men cannot be supposed capable
of such an  exertion of memory; the answer is  then very simple;
it is  better  that  the person  should die without a  will, and his
property be  distributed according  to  the law  of  intestacy, than
that,  through any  failing of the mind,  he should unknoAvingly cut
off the rights of those who have the strongest claims upon him.
  Restriction  of medical opinions.—In an important case (Bainbrigge
v. Bainbrigge, Oxford Summer Ass., 1850), tried before Lord Camp-
bell, in which the  testamentary capacity of a  testator was disputed,
it was held that a  medical  witness, although conversant with cases
of insanity, cannot be asked his opinion as to the insanity of a tes-
tator founded upon the evidence given at the trial in his hearing. 
     WILLS  OF  THE INSANE — ATTESTING  WITNESSES.  779

(4 Cox, " Criminal Cases," 454 ; see also on this subject " Med. Gaz.,"
vol. 40, p. 240.)   In the case of the Duchess of 31anchester, hoAvever,
the opinions of Drs. Sutherland, Mayo, and Conolly, on the compe-
tency of  the testatrix, were received  by the court, although based
upon the evidence given at the trial.

  [In general, every man is presumed to be sane until the contrary
is proved ; and hence it  has been held, that the burden of proving
unsoundness or imbecility of mind in a testator, is upon the party
impeaching the validity  of a will for that cause.   Especially, it is
said, is this the case with reference to wills attested by subscribing
witnesses, because it  is  the duty of  the latter " to be satisfied of
the testator's sanity before they subscribe the instrument" (Werst-
ler  v.  Custer, 10  Wright (Penna.) 502); and  under the  maxim
" omnia prazsumuntur  rite et solenniter  acta donee probetur in  contra-
rium," it is to be presumed that they have not neglected this duty.
Such is the rule in Pennsylvania, and in many of the other states
in the Union;  Werstler v. Custer, supra; Grabill v. Barr, 5 Barr
441;  Barber v. 31cFerren, 2 Casey 214; Rees  v. Stille, 2 Wright
138;  Jackson v.  Vandeusen, 5 Johns. 144 ; Dean v.  Dean, 1 Wil-
liams (Vt.) 746;  Trumbull v. Gibbons, 2 New Jersey 117 ; Hawkins
v. Grimes, 13  B. Monroe  (Ky.) 257; Perkins  v. Perkins, 39 New
Hamp. 163; Stubbs v. Houston,  33  Ala. 555; McDaniel v. Crosby,
19 Ark.  533 ;  Chandler v.  Feeris, 1 Harrington (Del.) 454.
  But, on the other hand, in Hams v. Ingledew, 3 P. Wms. 93, Sir
Joseph Jekyll, M. R.  said, " It must be observed that the proof of a
will is attended Avith  more solemnity than that of a deed:  the for-
mer being supposed to be  made Avhen the testator is in extremis:
and  therefore in equity, it is necessary to prove the sanity, which is
all presumed in the case of the latter."   See also Barry v. Bntlin, 1
Curtis 637;  Sutton v. Saddler, Com. B. 19 Law. Rep.  N. S. 703 ;
and  this is said  to be more particularly the rule Avhere the statute
relating  to Avills contains the provision (Avhich  indeed it generally
does) that the testator must be of " sound mind."  Cilleyv. Cilley,
34 Maine 162 ; Comstock v. Hadlyne, 8 Conn. 261; Crowningshield v.
Crowningshield, 2 Gray 524; Brooks y. Barrett, 7 Pick. 98, 99.
  The subject of testamentary  capacity is very fully- considered  in
Jarman on Wills, Perkin's Ed. vol. 1, p. 51, et seq.;  and in Wil-
liams on  Executors, vol. 1, p. 11, et seq.   To the authorities there
cited, may be added the recent cases of Vanpelt v. Vanpelt, 30 Barb.
(X. Y.) 134;  Dunham's  Ap., 27  Conn. 192; Stubbs  v. Houston, 33
Ala. 555; Rees v.  Stille,  2  Wright  138 ; Aiman v. Stout, 6 ib. 114;
Eckert v. Henry, 7 ib. 46 ;  Daniel v. Daniel, 3 ib.  191; Werstler v.
Custer 10 ib. 502.  In the case of  Vanpelt v.  Vanpelt, it was held
that though a testator's capacity Avas slender, yet, if the evidence is
sufficient to shoAV that he fully understood, and intended to make
the dispiosition which  he has made, the will must stand, however
unnatural and unjust may be  its  provisions.   And  in Stubbs  v.
Houston,  it Avas held,  that though a condition somewhat short of a 
7eo
ATTESTING  WITNESSES.
total deprivation of reason will  destroy testamentary capacity, yet
that a person not  competent to transact  the ordinary business of
life, may make a will.  The existence of insane delusions was held
in Dunham's Ap. not to incapacitate, if the testator has inind enough
to know and appreciate  his relations to the natural objects of his
bounty, and the  character and effect of the dispositions of his will.
In  Pennsylvania,  mere weakness  of intellect, hoAvever great, will
not take away testamentary capacity, provided the testator at the
time of executing his will, has a full and intelligent consciousness
of the nature and effect  of the act he  is engaged in, a knowledge
of the property he possesses, an understanding of the disposition he
wishes to make, and of the persons and objects he desires to par-
ticipate in  his  bounty.   It is not necessary, however, that  he
should collect all these in one review.   Daniels v. Daniels, Rees v.
Stille, etc.
  It is  the  duty of every one called upon to attest a will, to first
satisfy himself of the competency of the testator.  If he has doubts,
he should refuse to sign his name.  Courts have  spoken in the se-
verest terms of persons who, having become witnesses to wills, have
afterAvards come forward to testify as to  the insanity of the testator.
The act of attestation solemnly testifies the testator's competency;
so that the person avIio, believing that this does not exist, neverthe-
less signs his name as a witness, becomes an instrument in what he
himself considers a fraud.  Should such  witness afterwards attempt
to impeach his oavii act, and to prove that the testator did  not know
what he was doing when he made Avhat purported to  be his will,
though the evidence would not be positively inadmissible, very little
credit is to  be attached to it.   Rees v. Stille, 2 Wright 140.   The
older cases go so far as to say that the testimony7 should  not be re-
ceived at all, upon the maxim of the civil law, nemo allegans suam
turpitudinem est audiendus ; and in Lowe v. Jolliffe (1 W. Blackstone's
Rep. 365), Avhere, notwithstanding the testimony of the subscribing
witnesses against it, the  will was  supported, Lord Mansfield sent
for  those Avitnesses in order to  have them committed  for perjury:
but, as  the  reporter states, they very prudently  " had withdraAvn
themselves."  It is noAv  settled, however, that the question is one
not for the court but the jury, who are  to receive the evidence, but
Avith  the most scrupulous jealousy (Booth v. Blundell, 19 Ves. 504);
bearing in mind as declared by Woodward, J., in Werstler v. Custer,
10  Wright (Penna.) 502, that " no honest man will subscribe as a
witness to a will or other instrument, executed by an insane man,
an  imbecile, or an idiot."—P.] 
THE PLEA,  OR DEFENCE OF  INSANITY.        781
                    CHAPTER  LXV.

THE PLEA, OR DEFENCE  OF  INSANITY.—CIRCUMSTANCES UNDER  WHICH
  IT IS ADMISSIBLE.—HOMICIDAL INSANITY.—MORAL INSANITY.—SYMP-
  TOMS.—LEGAL TESTS.--MEDICAL TESTS.--DELUSION.—TESTS  OF IRRE-
  SPONSIBILITY.—MEDICAL EVIDENCE.

  The plea or defence of insanity.—Responsibility here signifies  no-
thing more than liability to punishment for crime, and a criminal
act implies the existence of intention, will, and malice.  (Stephen.)
When insanit}7 has reached a certain stage or degree, an act may be
perpetrated w-ithout malice; and in this sense the person is con-
sidered to be irresponsible in law.  This is a question of fact to be
determined by a jury  from the whole evidence  set before  them;
and the proof rests with those Avho make the allegation that the act
in question, whether murder or arson, Avas  not  done wilfully and
maliciously.  " The sanity of a man's  conduct," observes Mr. Ste-
phen, " involves the presence of intention and will  on all ordinary
occasions ; and if the act is one of those which the law forbids, it is
presumed to  be malicious  and wicked."   (Criminal law of Eng-
land,"  p. 89.)    This  subject is of considerable importance in a
medico-legal view ; for should a plea of insanity be improperly ad-
mitted in any criminal case, then punishment is  made to fall  un-
equally on offenders; and if, on the other hand, it be improperly
rejected, punishment is administered with undue severity.  The rule
of law is that no man is responsible like a sane person, for any act
committed by him while in a state of insanity.  The plea may be
raised for the* smallest offence up to the highest crime—murder;  but
it is rarely made  a defence in smaller offences, because the close
confinement to which an  accused  person, if found insane,  would
necessarily be subjected, would often be a heavier punishment than
that which the laAV actually prescribes for the offence Avhich he may
have committed.   In  a case of felonious assault, it was urged by
counsel in  defence that the prisoner was insane; but the evidence
on this point was not by any means conclusive—when it was inti-
mated by the court that, if this plea were admitted, the party Avould
probably undergo a much longer imprisonment than if on conviction
he received the  legal punishment for  the offence!   (The Queen v.
Reynolds, Bodmin Aut. Ass. 1843.)  The judge is reported to have
said that there was no proof of insanity.  If the prisoner Avas pro-
nounced insane, he might be imprisoned for life, and therefore he
did not think that finding Avould benefit him!  A verdict of guilty
was returned, and the man was sentenced to eighteen months' im-
prisonment. 'This case shows that a defence of this kind may be 
 782        RESPONSIBILITY FOR CRIMINAL ACTS.

 sometimes indiscreetly put forward.  Such a mode of dealing with
 the plea of  insanity, i. e., of making it a question of expediency de-
 pendent on the amount of punishment for the offence, must be pro-
 nounced  as unsafe and  indefensible.   Murder, incendiarism, and
 theft are the crimes for which  the plea of insanity is commonly
 raised; and it has been generally confined in  this country to those
 cases in which persons have been charged with murder, or attempts
 at murder.
   Murder may be perpetrated by one who is  obviously laboring
 under delirium or violent mania, or by  an idiot or imbecile.   Apart
 from the  circumstances connected with the criminal act, there may
 be evidence of such a disordered state of mind  in the person, as at
 once to exonerate him from that amount of responsibility which is
 exacted from one who is  sane.  The appearance of the accused, or
 the  testimony of a medical man, renders it unnecessary to go into
 the  evidence, and a verdict is returned  accordingly.   The cases of
 difficulty are those in which insanity  presents itself in a doubtful
 aspect, as in mania or imbecility.  The mental disorder may be of so
 slight a nature as not legally to justify an acquittal for murder. In
 order to exculpate a  person, it must be proved that insanity in a
 certain degree  existed at the time of the perpetration of the  act.
 Whether the prisoner is,  or is not insane when placed on his trial, is
 immaterial  in reference  to the question of responsibility7.   In the
 case of 3Iurray (tried before the High Court of Judiciary,  Edin-
 burgh, Nov. 1858), it was proved that the accused recovered his
 sanity eight hours after he  had  killed the deceased ;  but he A\Tas
 acquitted on the ground  of insanity at the time of committing the
 act.
  The proved existence  of mental disease does  not necessarily ex-
 empt a person from criminal responsibility.  Many a man whose
 mind is in an unsound state knows perfectly well whether he is doing
 wrong; and so long as he knoAvs that, he is considered to be subject
 to the criminal law.   The existence of a morbid delusion cannot
 always be alloAved to screen a criminal  from the  consequences of his
 own acts, while on the other hand there are  instances in which a
 plea of insanity may properly be alloAved, although no delusion can
 be proved.  Each  case must be taken  with all its  surrounding cir-
 cumstances, and legal theories of insanity are  chiefly  valuable, not
 as rigorous  axioms of law, but as cautions  to be  observed by the
jury/
  The great difference of opinion which exists between physicians
 and jurists in reference to this plea, appears to me to consist in this:
 Most jurists aver that no degree  of insanity should exempt from
 punishment for crime, unless it has reached that point that the person
 is utterly unconscious of the difference between right  and wrong at the
 time of committing the alleged  crime.  Physicians, on the  other
 hand, affirm that this  is not a proper test of the existence of that de-
 gree of insanity Avhich should exempt a man from punishment; that
 those who are laboring under confirmed insanity,  and who have been
 properly confined  in asylums  for years, are fully conscious  of the 
          RESPONSIBILITY FOR  CRIMINAL ACTS.       783

difference between right and wrong, and are quite able to appreciate
the illegality- as well as the consequences of their acts.  Again, those
Avho have patiently Avatched the insane for years, agree that the legal
test of utter unconsciousness of right  and wrong  in the perform-
ance of acts would, in reality, apply only to persons avIio were suffer-
ing from delirium, from a furious paroxysm of mania, or from con-
firmed idiocy ; and that if the rule suggested—that a person, in order
to be acquitted on the ground of insanity, should be first proved to
be as unconscious of his act as  a baby—were  strictly  carried out,
there is scarcely an inmate of an asylum, AA-ho happened to destroy
a keeper or attendant, who might not be executed for murder.  Such
a rule amounts to a reductio ad absurdum ;  it would abolish all dis-
tinction between  the sane and the insane, between the responsible
and the irresponsible ; and it Avould consign to the same punishment
the confirmed  lunatic and the sane criminal.  This species of baby
unconsciousness of action exists in idiots asAvell as in furious maniacs,
but not in the majority of  lunatics;  and it may be safely asserted
that, if this criterion be the true one, acquittals on the ground of
insanity have involved a series of gross  mistakes  for the last fifty
years.  It may be said that the consciousness of the insane is an in-
sane consciousness,  while the laAV implies the consciousness of a
Bound mind ; but  this involves a petitio principii.  There have been
numerous cases of acquittal in which, until the act  of homicide was
committed, there  was no imputation  either against  the sanity or the
sane consciousness of the accused.  Having pointed out these incon-
sistencies, it is only proper to acknowledge that in theory the Eng-
lish law w-ould punish a lunatic just as it Avould punish a sane mail,
provided the lunatic " had that degree of intellect which enabled
him  to know and distinguish betAveen right and Avrong, or Avhat Avas
lawful and unlawful; if he kneAv what would be the effects of his
crime, and consciously committed it; and further, if Avith that con-
sciousness he Avilfully and intentionally committed it."  In practice,
however, it is placed beyond doubt that some av1io ought to be con-
victed under these rules are acquitted on the legal fiction that they
were at the time unconscious  (or only insanely conscious)  of the
wrongfulness of their acts.  Dr. Wood states, that of thirty-three
men confined as lunatics in Bethlehem avIio had actually committed
murder, not including those Avhere an unsuccessful attempt was made
to perpetrate the same crime, three were reported sane ; he feels quite
satisfied that two of these were not insane at the  time they committed
the murders, and  of the fifteen  men who had actually committed
murder, five were reported sane, and two of them ought, in his judg-
ment, never to have been acquitted on the ground of insanity. (" Plea
of Insanity," p. 50.)  According  to Dr.  Hood, in the six years from
1852 to 1858,120 persons Avho Avere tried for murder, or attempt at
murder, or acts of personal violence  Avere acquitted on the ground
of insanity.  Of that number, 79  Avere received  into Bethlehem Hos-
pital,and in several instances they exhibited no symptoms of insanity
while they were resident in the asylum.  These facts, then, are suffi-
cient to show that the rule of law generally adopted does not err on 
784
HOMICIDAL INSANITY.
the side of severity.   The only complaint that can be made is that
it operates with uncertainty. Of late years, some learned judges have
admitted that there might be a consciousness that the act Avas wrong
and illegal, and yet the person would be exempted from criminal re-
sponsibility, provided it was proved by other circumstances^ that he
labored under a disease of the mind sufficient to prevent him from
exercising a proper control over his actions.
  When the defence of insanity is set up, in a charge of murder, in
order to Avarrant the jury in acquitting a prisoner, it must be proved
affirmatiA7ely that he w-as insane in a certain legcd sense, at the time of
perpetrating the act; if this be left in doubt, and if the crime charged
in the  indictment be proved, it is  their duty to convict him.  (Reg.
v. Stokes, 3 Car. and Kir. p. 185.)  It is necessary to impress upon
the mind of  the medical witness, that it is not medical, but legal
insanity7 which has to be proved  on  these occasions to the satisfac-
tion of a jury.  As no tAvo medical men agree about what is mad-
ness in a medical sense, and as some " mad doctors" have ever held
that all great criminals are necessarily insane, it  is obA7ious that the
power  to absolve from  responsibility could not be  placed  in the
hands  of the profession with a due regard to the protection of society,
or a safe administration of the law7.   The facts stated by Drs. Hood
and Wood, in reference to the admission of alleged criminal lunatics
into Bethlehem (supra), show that either by legal, or medical inge-
nuity,  or both combined, sane men are incarcerated as irresponsible
lunatics!
  Homicidal insanity.—Homicidal mania, or  monomania, is com-
monly defined to be a state of partial insanity,  accompanied by an
impulse to the perpetration of murder: hence it  is sometimes called
impulsive or paroxysmal mania.  There may, or may not, be evidence
of intellectual aberration; but the  main feature of the disorder is the
existence of a destructive impulse which, like a  delusion, cannot be
controlled by the patient.  This impulse, thus dominating over all
other feelings, leads a person to destroy those to whom  he is most
fondly attached, or any one who  may be involved in his delusion.
Sometimes the impulse is  long felt, but concealed and restrained:
there may be merely signs of depression and melancholy, Ioav spirits,
and loss of  appetite, as well  as eccentric or  wayward habits, but
nothing to lead to a suspicion of the fearful contention which may
be  going on Avithin the mind.   As in suicidal  mania, many of those
who are in habits of daily intercourse with the  patients have been
first astounded by the act of murder, and then only- for the first time
led to  conjecture that certain peculiarities of language or conduct,
scarcely noticed at the time, must have been symptoms of insanity.
Occasionally, the act of murder is perpetrated with great deliberation,
and apparently with all the marks of sanity.  These cases are ren-
dered  difficult by the fact that there may be no distinct proof of the
existence, past or present, of any disorder of  the mind, so that the
chief evidence of mental disorder is the act itself: of the existence of
insanity, in the common or legal  acceptation of the term, before and
after the perpetration of the crime, there may be either no evidence 
           SYMPTOMS  OF  HOMICIDAL INSANITY.        785

whatever, or it may be so slight as not to amount to proof.   Such
cases are  regarded and described  by some medico-legal writers as
instances of insanity of the moral feelings only, and this condition has
been called " Moral insanity" (p. 731). Its existence, as a state inde-
pendent of a simultaneous disturbance of the reason or intellect, is
denied by the great majority of lawyers, as Avell as by some eminent
medical authorities.  Whether such a condition exists or not is a
simple question of fact, to be established if possible by clear and
conclusive evidence.  Its existence in the case of a person charged
with murder appears to have rested hitherto on a mere medical dic-
tum.  Intelligible reasons have not been assigned by those Avitnesses
who have sought to satisfy a court  of laAV that this has as distinct an
existence as intellectual insanity ;  in general, it is only alleged, and
not proved to exist in a given case.  If its existence were satisfac-
torily established, it Avould, as Mr. Stephen observes, do away with
one of the essential ingredients of  crime—malice, and thus justify a
jury in acquitting a person charged Avith murder.  The accused on
these occasions is assumed to have been an involuntary agent.   As
Mr. Stephen suggests, it might be a good defence to admit that a
man loaded a pistol and pjointed it at the head of another, but that it
Avas fired  by a sudden involuntary7 action of the'necessary muscles,
and not by the prisoner's will.   The only difficulty is to get  a jury
to believe it!  The evidence given in supjport of the assertion that
a man is morally insane is, generally speaking, at least as consistent
Avith the theory that  he is a great  fool and a  great  rogue, as with
the theoiy that he is the subject of a special disease the existence of
Avhich is doubtful.  (" Criminal LaAV," p. 95.) There is nd doubt that
the unrestricted admission of such a theory would go far to do away
with all punishment for crime, for  it would render it utterly- impos-
sible to draw a line betAveen (moral) insanity and moral depravity.
What is crime but the perversion of moral feelings ? Moral insanity-
in a person of sound mind is a contradiction  in  terms; whenever
the mind  is sound, a man's conscience and sense of right and Avrong
will ahA7ays be sufficient to enable  him to restrain evil desires and
impulses.
  Symptoms.—Homicidal mania, in its  more common form, may
make its appearance at all ages, even in children; it is occasionally
periodical, and the paroxysm of insanity is preceded  by syniptoms
of general excitement.  The patient experiences colicky pains, and
a sense of heat in the abdomen or  chest,  headache, restlessness, and
loss of appetite, with  lowness of spirits;  the face is flushed or pale,
the pulse hard and full, and the Avhole body is in a state of convul-
sive  trembling.   An  act of violence is committed Avithout warning,
and the patient appears as if relieved from some oppressive feeling.
He may be calm, and express neither regret, remorse, nor fear;  he
may  coolly contemplate his victim, confess  the  deed, and at once
surrender himself to justice.  In some rare instances, he may- con-
ceal himself, hide the Aveapon, and, like  a sane criminal, endeavor
to obliterate all traeos of the crime—thus shoAving  a perfect con-
sciousness of the illegality or Avrongfulness of  the act, and a  desire
      50 
786        SYMPTOMS  OF HOMICIDAL  INSANITY.

to evade discovery.  These are, however, the main features of crime,
and unless there is independent evidence of mental disorder, or of
some bodily disease affecting the brain and destroying the poAver of
self-control, the conclusion must be that the  person  is sane and re-
sponsible.  The great  problem to be solved on these occasions is—
What are the plain practical distinctions betAveen defective reason-
ing power and perverted moral sense?  The  latter condition alone
should not exculpate a person, or absolve him  from punishment—
or persons undeniably  sane Avho have committed crimes, should be
equally exculpated, and absolved from punishment.
   The symptoms  above described have been observed to be more
aggravated in proportion as the  homicidal impulse Avas strong.
The propensity to kill is sometimes a  fixed idea, and the patient
can no more banish  it from his thoughts than a person  afflicted
with insanity can divest himself of the delusive ideas Avhich occupy
the mind.  (Esquirol,  vol. 2, p. 105.)   It has  been supposed that
Esquirol here  implies a state in wdiich there  is  no perversion of
intellect.   The facts which he  mentions, however,  clearly pi rove the
contrary;  for if a patient has not the power to  banish from his
thoughts this  propensity to kill, he has passed beyond the bounds
of reason, and is mail}7 insane.  The admission of this fact proves
that his mind  must be unsound.  Esquirol says—before the perpe-
tration of the act there may be no sign of irrational  conversation
or conduct;  but he asks the question:  because there is no proof of
irrationality, are we to assume that these  persons  possess  reason 1
Is it possible to reconcile the existence  of a rational state  of mind
Avith the murder of those who are  most dear  to  them?  (Op. cit.
vol. 2, p. 102.)  In Esquirol's vieAv, therefore, it may be taken that
mere  pierversion  of feelings (insanity), irrespective of some latent
aberration of intellect, does not exist, and moral insanity is a con-
ventional term for a state in which the proofs of mental  disturb-
ance are not so clear as in the generality of cases.
   An erroneous notion prevails in the public mind, that a homicidal
lunatic is easily to be  distinguished from a sane criminal, by some
certain and invariable  symptoms or characters, which it is the duty
of a medical witness to display in evidence,  and of a medico-legal
writer to describe.  But a perusal of the evidence given  at a few
trials will surely satisfy  those Avho hold this opinion, that each case
must stand by itself.  It is easy to classify homicidal lunatics, and
say that in one instance the murderous act was committed from a
motive, i. e., revenge or jealousy; in a  second, from no motive, but
 from irresistible impulse; in  a third, from illusion or delusive  mo-
tive, i. e., mental delusion; in a fourth, from perverted moral feeling,
without any sign of intellectual aberration.  This classification may
comprise all the \7arieties of homicidal  insanity, but it does not help
us to ascertain, in a doubtful case, whether  an act Avas or Avas not
committed under any  of these psychological conditions.   It enables
us to classify those who are acquitted on the ground of insanity, but
it entirely fails in giving us the power  to  distinguish a sane  from
an insane criminal, or  a reponsible from an  irresponsible agent. 
SYMPTOMS OF HOMICIDAL  INSANITY.        787
According to M. Esquirol, whose vieAvs, more or less modified, are
adopted by7  all writers on the medical jurisprudence of insanity,
the facts hitherto  observed indicate three  degrees  of  homicidal
mania:—
  1.  In  the  first degree, the propensity to kill is  connected with
absurd or irrational motives, or with actual  delusion.  The person
Avould be at  once pronounced insane.   Cases  of this description are
not uncommon, and they rarely create any difficulty.
  2.  In  the  second  degree, the desire to kill is  connected with no
known motive.  It is difficult to imagine a motive for the deed; the
person appears to have been  led on by some  impulse.  There may
have been delusion,  but there is no evidence of the pre-existence of
this.  With respect to this class of cases, Mr. Stephen observes:
"There  are  motives for all acts even  the maddest, but it  is fre-
quently impossible  to assign them  specifically.   It is, however,
generally impossible to form an opinion whether a given act was
done  from some  unknown  mad motive, or  from  some  unknown
sane motive."  (Op. cit. p. 88.)
  3. In the  third degree, the impulse to kill is sudden, instanta-
neous, unreflecting, uncontrollable (plus forte que la volonte).  The act
of homicide is perpetrated  without  interest, Avithout motive, and
often on persons Avho are most fondly loved by  the perpetrator.
(Esquirol "  Maladies Mentales," vol.  ii. p. 834.)  It is  this  form,
which has been called  "impulsive insanity," which has  given rise
to so much contention on  trials for murder in which insanity is set
up as a  defence, and therefore it will be well to consider this sub-
ject in a legal aspect.  Mr.  Stephen thus comments upon it: "It is
said that on particular occasions, men are seized with irrational or
irresistible impulses to kill, to  steal,  or to burn, and under the in-
fluence  of such impulses may sometimes commit acts Avhich  would
otherwise be most atrocious crimes.  It would  be  absurd to deny
the possibility7 that such impiulses may occur, or the fact that they
have occurred and have  been  acted on.  Instances are given in
Avhich the impulse was felt  and resisted.  The only question which
the existence of such impulses can raise in  the administration of
criminal justice, is whether the particular impulse Avas irresistible as
well as  unresisted.  If it  AA-as irresistible, the person accused is en-
titled to be  acquitted, because the act Avould not then be voluntary
and  not properly his act.  If the impulse Avas resistible, the fact that
it proceeded from disease  Avould be no excuse at all.   If a man's
nerves Avere so irritated by  a baby's crying that he instantly killed
it, his act would  be murder; it would not be  less murder if the
siime irritation  and corresponding desire were  produced by some
internal disease.  The great object of the criminal  law is to induce
people to control their impulses; and there is no reason w7hy, if they
can, they should not control insane as well as sane impulses. The
proof that  an  impulse  was irresistible depends  on the circum-
stances  of the particular case.  The commonest and strongest cases
are those of women who, Avithout motive  or  concealment, kill their 
788
HOMICIDAL INSANITY.
children after recovery from childbed" (puerperal mania).  (Op. cit.
p? 95.)
  The three forms in w-hich a homicidal propensity may thus pre-
sent itself in cases of insanity differ from each other  only in de-
gree—the first two being strongly analogous to, but lighter modifi-
cations of, the third.   All the cases Avhich came before M. Esquirol
had these features in common—an irritable constitution, great
excitability, singularity or eccentricity of character; and previously
to the manifestation of the homicidal feeling, there was^ a gentle,
kind, and affectionate disposition.   As in other forms of insanity,
there Avas some well-marked change of character in the mode of life;
and this may be taken as a proof that there must have been some
degree of intellectual disturbance.  The period  at which the dis-
order commenced and  terminated  could be easily defined, and the
attack could be almost ahvays referred  to some moral  or physical
cause.  Attempts at suicide preceded, or folloAved the attacks ; all
wished to die, and some desired  to be put to death like criminals.
In none of these cases  was there any discoverable  motive for the
act  of homicide.
  M. Esquirol believes that there are \A7ell-marked distinctions be-
tAveen this state and  that of the sane criminal.   Among these he
enumerates: 1. The want of accomplices in homicidal mania.  2.
The sane criminal  has always a motive—the act of  murder is only
a means for gratifying some other more or less criminal passion,
and is almost ahvays accompanied by some other wrongful act; the
contrary exists in homicidal mania.  3.  The victims of the crimi-
nal are those who  oppose  his desires or his wishes—the victims of
the monomaniac are among those who are either  indifferent to, or
who are the most dear to him.   4. The sane criminal endeavors to
conceal, and if taken, denies the crime ; if he confesses it, it is only
with some  reservation, and when circumstances are  too strong
against him ; but he commonly denies it to the last moment;—it is
the reverse with the monomaniac.   The exceptions to which these
characters are open will be  considered hereafter.   They  have, un-
doubtedly, greater value in their combined, than in their individual
application,  and when in any case  they  coexist, there is strong
reason to believe  that the person accused of murder is laboring
under a homicidal mania.  The great difficulty in these cases, Iioav-
ever, is to distinguish moral depravity from  insanity.  I agree Avith
a medico-legal Avriter on this  subject, that " no hideousness of de-
pravity can  amount to proof of insanity, unsupported by some evi-
dence of a judgment incapacitated, or of a will fettered by disease.
In  those  cases in which the  emotions are perverted, and where
there is no  clear proof of deranged  intellect—cases  which do from
time to time occur—the presumption of insanity in regard to a
criminal action has to  be upheld by evidence of a suspension of the
will from mental disease.   If it can be proved that the act was not
voluntary, this does aAvay with its criminal  nature."   (Jamieson's
Lectures  on the Med. Jur. of Insanity, " Med. Gaz.," vol. 48, p.
181.) But  it  is impossible in many cases  to produce satisfactory 
LEGAL TESTS.
789
evidence of the  suspension  of  the will  as  a result of disordered
mind;  this suspension can in general be assumed only from the act
itself—a dangerous  assumption, and one that might lead to the
crime of insanity7, and to the exculpation of all criminals.
  Legal tests.—Admitting the  existence of homicidal mania, as
thus defined by Esquirol, it may become  a question, how, Avhen
pleaded for one charged with murder, it  is to be practically distin-
guished from a case in which the  crime  has been perpetrated by a
really sane person.  Tests, both medical and  legal, have been pro-
posed.   The legal test was explicitly stated  in the following terms
by the  Avhole of the judges  in conference, in ansAver to queries put
by the  House of Lords in the case of M'Naughten, who was tried
and acquitted on the ground of insanity (June 19, 1843):—
  " Notwithstanding a party commits a wrong act while laboring
under  the idea that he was redressing a  supposed  grievance or
injury, or under the impression of obtaining some public or private
benefit, he is liable to punishment.  The jury ought in all cases to
be told that every man  should be considered of sane mind until
the contrary Avas clearly proved in evidence;  that, before a plea of
insanity should  be  ailoAA-ed, undoubted evidence ought  to be ad-
duced that the accused Avas  of  diseased mind, and that at the time
he committed the act he was not conscious of right or wrong.   Every
person  AA-as suppjosed to know what the law Avas, and  therefore
nothing could justifj7 a Avrong act, except it  Avas clearly proved that
the party did not know right  from wrong; if that was  not satis-
factorily proved, the accused was liable to punishment.  If the delu-
sion under Avhich a person labored Avere only partial, the party ac-
cused AA-as equally liable with  a person of  sane mind.  If the ac-
cused killed another in self-defence, he Avould be  entitled to an
acquittal; but if the crime Avere committed for any supposed injury,
he would  then be liable to the  punishment  aAvarded by the law to
his crime."  ("Brit, and For. Med.  Rev.," July, 1843, p. 273.)
[See Dr. Bucknill's remark  upon M'Naughten's case, and his criti-
cism upon the dicta of the  judges, in ansAver to the queries of the
House  of Lords.  Bucknill's  Essay on  Criminal Lunacy  ("Law
Library," vol. 92), p. 44 et seq.—P.]
  It Avould appear that the laAV, as thus laid down, in order to render
a man  responsible for crime, looks for a consciousness of right  and
wrong, and a knowledge of the consequences of the act;  while the ad-
ministration of justice rests on the principle that every one knoAvs
the law and fears its punishment.  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 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 pel-sons have committed acts which they knew to be Avrong, 
790
LEGAL  TESTS.
 and of the criminality of which they were at the time perfectly con-
 scious.  They have been known to  murder others, in order to re-
 ceive the  punishment of death at the hands of the law ; and there-
 fore they  must have been conscious of the wrongfulness, or rather
 of the illegality, of the act Avhich they Avere perpetrating, and have
 known that they were committing an offence punishable by the laAV
 of man.   In short, the criminal nature of the act has often been the
 sole motive for its perpetration 1  (" Ann. d'Hyg.," 1852, vol. 1, p.
 363.)  It  has been suggested, with some truth, that it is rather the
 imperfect or defective appreciation of the motives to right, or against
 wrong action which leads to crime among the insane, and not the
 mere ignorance of right and Avrong.  Most lunatics have an abstract
 knowledge that  right is right, and wrong wrong; but in true in-
 sanity, the voluntary poAver to control thought and actions, and to
 regulate conduct by this standard, is impaired, limited, or overruled
 by insane  motives.  A lunatic may have the power of distinguishing
 right from wrong, but he has not the power of choosing right from
 wrong. A criminal is punishable not  merely because he has the
 power of  distinguishing right from wrong, but  because he volun-
 tarily does the wrong, having the power to choose the right. (Jamie-
 son's Lectures on Insanity, "Med. Gaz.," vol. 46,  p. 827.)

  [Dr. Forbes Winslow, in speaking of the defence of insanity in
 criminal cases, uses the following language: " When such ques-
 tions have come before  the judicial tribunals of  the  country, the '
 presiding judge,  in his charge to  the jury, has invariably referred
 to the dicta of preceding administrators of the law, and has quoted
 their definition or description of insanity as an unerring test of the
 presence of mental derangement in any case in which the malady is
 alleged to exist.
  " How absurd, upon reflection, must such a  course of procedure
 be.   Has not our knowledge of the disorders of the* mind advanced
 during the last fifty years ?  Do we not knoAv more of insanity than
 our professional  brethren did who lived in the days of Coke, Mans-
 field, and Erskine ?  If so, how ridiculous it is to cite their opinions
 or to bind us doAvn to the authority of men Avhose information on
 this subject must of necessity have'been extremely limited and cir-
 cumscribed.  The judges of the land appear to have had no settled
 or clear vieAvs on the subject of  insanity."  *  *  *  « After an
 examination of the cases which have been brought forward in this
 work, it must be evident that the capability of' distinguishing be-
 tween right and  wrong,' is not an unerring test to which to appeal.
 A person may be perfectly competent to draAv a correct distinction
 betAveen right and wrong, and yet labor under a  form of  insanity  !
 which  ought unquestionably to protect him from legal or  moral  j
 responsibility."   ("Plea of  Insanity," p.  73.)  "The knowledge
 attained by men, of a subject Avhich they have grappled all  their
 lives," says Chief Justice Gibson, in Smith v. Kramer, 1 Am. Law.
 Reg. 353, " ought surely  to prevail against knowledge gleaned from
the hornbooks of a profession to which the gleaners did not belono-." 
LEGAL TESTS.
791
  The  same eminent judge, in the case of  Com. v. Mosler, 4 Barr
266, admitted that moral insanity, if established, Avould relieve the
defendant from criminal responsibility.  " There may be," said he,
in his  charge  to the jury, "an  unseen ligament pressing  on the
mind, drawing it to consequences Avhich it sees but cannot avoid, and
placing it under a coercion, which, Avhile its results are clearly per-
ceived, is incapable of resistance. The doctrine which acknowledges
this mania is dangerous in its relations, and  can be recognized only
in the clearest cases.  It ought to have been shown to have been
habitual, or at least to have evinced  itself in more than a single in-
stance.  It is seldom directed against a particular individual; but
that it may be so, is proved by the case of  the young woman avIio
was deluded by an irresistible impulse to destroy her  child, though
aware of the heinous nature of the act.   The frequency of this con-
stitutional malady is fortunately small, and  it is better to confine  it
Avithin the strictest limits.  If juries Avere  to allow it as a general
motive, operating  in cases of this character, its recognition Avould
destroy social order as well as personal safety-.   To establish it as a
justification in  any particular case, it  is necessary either to show,
by clear proofs,  its  contemporaneous existence, evinced by present
circumstances, or the existence of  an habitual tendency developed
in previous cases, becoming in itself a second nature." The defence
was not established in this case, and the prisoner was convicted.
  The objection to adhering to the old decisions with reference  to
the test of criminal  responsibility, in the face of the  great advance
which has taken place in the last fifty years in the scientific know-
ledge of the subject of insanity, is that juries rather  than suffer an
insane criminal, Avhose unsoundness does not  come up to the anti-
quated standard, to be punished in the same  manner as if he Avere
sane, acquit him altogether. He is thus turned loose:  if his insanity
has not been real, a criminal escapes ; if it has, then society is again
exposed to the dangerous freaks of a madman.   Even if  they con-
vict, notwithstanding the  actual  existence of  moral insanity, the
lunatic is restrained only during the period of his sentence, and the
same result ensues.  If judges, instead of " moving in the ruts"  of
their predecessors, would, as it is the boast of the common law they
do, keep pace  with the advance of science; if juries Avere required,
as they are in some States, to find the fact of insanity whenever they
acquit on this ground ; or, if, what Avould perhaps be still better, the
jury, as it has been suggested (Whart. & Stille, " Med. Jur.," § 277),
were permitted simply to pass upon the mere fact of the commission
of the act, leaving the consideration of the prisoner's  sanity for a
commission or jury of scientific men, competent to decide so difficult
a question; if whenever the prisoner is acquitted because of insanity,
the court should in all cases commit him to a proper asylum, there
to remain until  proved before the same tribunal to be entirely restored;
the plea would be much'less frequently set  up, and would be much
more apt to be properly decided, if it should be.  Criminals would
thus be surer of punishment, the really insane have-an opportunity
of beino- restored by proper treatment, and  society have the  protec- 
792
MEDICAL TESTS.
tion w-hich, under the " right and wrong" test, it so often loses.
Where the offence is homicide, as Dr. Taylor very properly remarks,
the confinement of the prisoner  acquitted on the ground of moral
insanity, should, for the reasons  he mentions, be for life.—P.]
  Medieal  tests.—The tests  Avhich have  been  proposed by medical
jurists for detecting cases of homicidal mania are as follows:—
  1. The  acts of  homicide have  generally been preceded by other
striking  peculiarities  of conduct  in  the person—often by  a total
change of character.
  2. Those persons who are affected with it have in many instances
previously or subsequently attempted  suicide—they have expressed
a wish to die or to be executed  as criminals.  These supposed cri-
teria when tendered as medical proofs of insanity in courts  of law,
have been repeatedly, and very properly rejected.   They are of too
vague a  nature for practical use, and apply as much to cases of
moral depravity- as of actual  insanity; in  short, if these Avere ad-
mitted as proofs, they Avould serve as a convenient shelter  from pun-
ishment for many sane criminals.
  3. Motive for crime.—The acts are without  motive ; they  are in
opposition to all human motives. A man known to have been ten-
derly attached to his  wife and children  murders them—a fond
mother destroys her infant.  It  is hereby assumed, or implied that
persons Avho are sane never commit a crime Avithout an apparent
motive, and that in the perpetration of a criminal act an insane per-
son either never has a motive, or has one of a delusive nature only.
If these propositions Avere true,  it would be easy- to distinguish a
sane from an insane criminal; but the rule wholly  fails in practice.
In the first place, the non-discovery is here taken as a proof of the
non-existence of a motive ; while it is undoubted that motives may
exist for many atrocious criminal acts without our being able to dis-
cover them—a fact proved by the numerous recorded confessions of
criminals before execution, in cases in Avhich, until these confessions
were made, no motive for the perpetration of the crime had appeared
to the acutest minds.   [Com. v. Mosler, 4 Barr 266.—P.]
  4. Confessions.—The subsequent conduct of the person; he seeks
no escape, delivers himself up to justice, and acknowledges the crime
laid to his charge.  This is commonly characteristic of homicidal
mania; for by the sane criminal every attempt is generally made to
conceal all traces of the crime, and he denies it to the last, or until
he sees that denial can be no longer serviceable to him.
  5. Accomplices.—The  sane murderer has generally accomplices in
vice or crime; the homicidal monomaniac has not.   Upon this it
may be observed that some  of  the most  atrocious  murders com-
mitted in modern times have been proved  to be the acts of  persons
who had neither accomplices, nor any assignable inducements lead-
ing to the commission of the crimes.  It is, how-ever, a fact so far
in favor of the existence of homicidal insanity, that the insane never
have accomplices in the acts which they perpetrate.  These criteria
can hardly be  described as medical; they are circumstances upon 
MEDICAL TESTS — SUMMARY.
793
which a non-professional man may form just as safe a judgment as
one who has made insanity a special study.
  6. Delusion in the act.—The presence of delusion has been said to
characterize an act of homicidal monomania, while premeditation,
precaution, and concealment have been considered  to  be the essen-
tial features of the act of the sane criminal. Some medical men think,
if they discover anything resembling a delusion in the mind of an
accused person, that he is  necessarily irresponsible for the act, but
the theory of the law, as laid down by the judges in M'Naughten's
case, is that notwithstanding a person labors under a delusion, ifhe
commits an act Avhich he knows to be contrary to laAV he is liable
to punishment; if the delusion be partial, the party accused is still
responsible; and if the crime were committed for an imaginary in-
jury, he would be held equally responsible.  (See ante, p.  789.)
Much stress Avas formerly laid upon the delusion being connected with
the act in cases of alleged insanity ; but it must be remembered that,
except by- the confessions of insane  persons during convalescence,
it is not easy  for a sane mind to connect the most simple acts of a
lunatic  Avith the delusion  under which he labors.  Every act of
homicide  pierpetrated by a  really insane  person is doubtless  con-
nected with some delusion  Avith Avhich he is affected ; but it is  not
to be supposed that one Avho is sane  can always make out this con-
nection.
  It may be further observed that  premeditation, precaution, con-
cealment, and flight are met with in crimes committed by both sane
and insane criminals, although these acts are certainly strong char-
acteristics of sanity.   It should be  a question  for a jury whether,
when they are proved to have existed  in any  criminal act, there
might not have been such a power of self-control in the person, al-
though  in some degree insane, as to  justify a conviction.  It is not
the presence of a slight degree of mental aberration which necessa-
rily indicates a loss of power of controlling actions.  Are such per-
sons less beyond the influence of example than  one half of the sane
criminals  who are punished ?
  7. A number of murders perpetrated at  once.—In the acts of sane
criminals  one person, or at the most  two, may be destroyed; but, in
cases of homicidal mania, it is not unusual to find a Avife and several
children killed by the husband, or four or five children at once de-
stroyed  by7 the wife.   In these cases, no  motive but that which is
based on some insane delusion can be suggested for such a series of
murders.  Thus, four infants may be found murdered  by a mother,
who admits the act but endeavors to account for it by asserting that
she wished to convert them into angels, or to save them from desti-
tution and exposure to worldly  temptations.  It would be wrong,
however, to infer from this statement that, because a man has heaped
crime upon crime, he is therefore insane.  This would be equal to
making the atrocity of the crime or crimes a test of insanity.
  Summary.__The foregoing considerations lead to the inference
that there are no certain legal, or medical tests whereby homicidal
mania can be demonstrated  to exist.   Each case must be determined 
794
SUMMARY — INCONSISTENCIES.
by the circumstances attending it; but the true criterion of irrespon-
sibility, in all ambiguous  cases, appears to be whether the person,
at the time of the commission of the crime, had, or had not a sufficient
power of self-control to govern his actions ; or, in other words, Avhether
he knew the act was wrong, and could avoid the perpetration of it.
This involves the consideration, not  only whether insanity existed
in the accused, but whether it had reached a degree to destroy, not
merely a consciousness of  the  nature of the act, but volition—the
Avill to do, or not to do it.  If, from circumstances, it can be inferred
that an accused person had this power, whether his case falls within
the above rules or not, he  should be made responsible and rendered
liable to punishment.  If, hoAvever, he was led  to the perpetration
of the act by an insane impulse, or, in other words, by an impulse
which his mental condition did not allow him to control (lesion de
volonte, Esquirol), he is entitled to an acquittal  as an irresponsible
agent.   The power of  controlling an  act appears to me to imply
the existence of such a state  of sanity as  to  render the party re-
sponsible :  and when there is this want of control, it may be fairly
concluded  that there is no sane intention, and  that the person is
irresponsible. A test somewhat similar to this is constantly applied
by juries,  under the directions of our judges, to distinguish murder
from manslaughter: and it is quite certain that sanity and homi-
cidal mania are not more  nicely blended than those shades of guilt
whereby manslaughter passes into murder.  The  manner and  cir-
cumstances under Avhich  a crime is committed will often allow a
fair inference to be drawn as to how far a power of self-control ex-
isted or was exercised.  A man in a violent fit of mania or delirium
rushes with a drawn sword  into an open street, and stabs the first
person whom he meets; another, worn out by poverty and destitu-
tion, destroys his wife and children to  prevent them  from starving,
and then probably attempts to murder himself: these are cases in
which there is a fair ground to entertain a plea  of irresponsibility.
But when we find a man  not showing any previous  intellectual
disturbance, lurking for many days in  a particular locality, having
about him a  loaded weapon—watching a particular  person who
frequents  that locality—not facing the individual and shooting
him, but coolly w-aiting until he has an opportunity  of discharging
the weapon unobserved by his victim or others—the circumstances
appear to  show  such a perfect adaptation of means to ends,  and
such a poAver of controlling actions, that it is difficult to understand
on what principle an acquittal on the ground of insanity could have
been allowed.  I refer here to the case of MNaughten, tried for
the murder of 31r. Drummond, January, 1843.   The  acquittal in
this case was the more remarkable because  there was  no proof of
general  insanity, and  the crime was committed for a  supposed
injury.  According  to the  rules  laid  down  by  the  fifteen judges,
from questions submitted  to them in connection  with this case,  this
man should certainly have been convicted.  These acquittals on the
ground  of insanity,  contrary  to public opinion, are often errone-
ously ascribed to the crotchets of medical experts.    They are, I 
       ACQUITTALS  ON  THE  GROUND  OF INSANITY.    795

believe, more commonly  due to  the poAverful and impassioned
addresses of counsel, aa-Iio in civil  as well as in criminal cases simply
fight for victory, Avholly irrespective of any abstract ideas of truth
or justice.  Medical opinions are  brought  forward, or suppressed
in order to complete a sensational picture", which is intended to show
to an ignorant jury,  either that a lunatic is perfectly sane, or that
a sane man Avho has committed a deliberate act of murder, is beyond
any reasonable doubt insane. Every  artifice or argument  which
may raise a doubt in the minds of the jury is resorted to on these
occasions, and the last words of the last eloquent speaker have a far
greater influence on the verdict than the opinions of " mad doctors"
in the witness box.  These  admit of being misrepresented  and
turned into ridicule without any power of reply  on the part of
those  who  gave them.   [Dr. Bucknill (Criminal Lunacy, 98,  99)
mentions the  case of Margaret Garrety, who was tried in 1851, at
NeAvark, NeAv Jersey (see "Am. Journ. Ins.," January,  1852)  for
" the assassination  with a carving-knife, of a young man Avho had
seduced her and afterwards married another woman.  This trial,"
he says, " presents a remarkable  instance of perversion of the plea
by the jury, in order to avoid the condemnation and execution of
an ill-used Avoman.   The jury were sixty-two hours in deliberation ;
their verdict of 'not guilty on the ground of insanity,' Avas greeted
Avith applause in the court-house, and with universal congratulation
and  rejoicing in the  city.  The  celebrated Hampshire verdict,
'  Served  him  right,' would pjerhaps have been more consistent, if
not with the facts of the case, at least Avith the temper of the pub-
lic.  After the trial, the  court appointed a commission consisting
of six physicians, to examine her case, and decide Avhether she should
he sent to the asylum or set at liberty.   They unanimously reported,
that after careful investigation, they found existing no evidence of
unsound  mind."—P.]
  In cases of alleged homicidal  mania, very vague meanings have
been sometimes assigned to the  term delusion.  In  Reg.  v. Burton
(Maidstone Lent  Assizes, 1863), the prisoner, a youth of 18, was
indicted  for the murder of a boy at Chatham.  There was no mo-
tive; but it Avas argued by his counsel in defence, that he labored
at the  time under  a delusion—the delusion being a desire to be
hanged.  Mr. Joj-, the surgeon of the prison, stated that he had had
frequent  opportunities of examining the  prisoner  while in gaol,
and in his opinion  he AA7as perfectly sane;  so far as Avitness could
judge, he was under no delusion.   The jury returned a verdict of
"guilty."  If the youth had believed that  he had been  already
hanged  for murder, this might  have  been considered a  delusion;
but a desire to be  hanged, or to die from any violent cause cannot
be so regarded.  The remarks of the learned judge (the  late  Mr.
Justice 'Wio-htman) upon  this kind of defence contain all that is
necessary to show  its fallacy.  In  passing  sentence upon the pri-
soner he said: " It is stated that you labored under a morbid desire
to die by the hands  of justice, and that for this purpose you com-
mitted the murder.   This morbid desire to part  with your own 
796    ACQUITTALS ON THE GROUND OF INSANITY.

life can hardly be called a delusion:  and, indeed, the consciousness
on your part that you could effect your purpose by designedly de-
priving another of life (for AA-hich you would have to suffer, as you
knew-, the  punishment due to the  greatest of crimes) shoAvs that
you w-ere perfectly able to understand the nature and  consequences
of the act which  you were committing, and that you kneAv it was
a crime for which by law the penalty Avas capital.   This Avas, in
truth, a further, and I may say a deeper, aggravation of  the crime;
for  you designedly intended to compass your oavh  death by the
murder of  another."
  It has been a disputed  question Avhether a medical witness on a
trial in w-hich a defence of insanity is raised, can be asked his opin-
ion from the evidence, respecting the state of a prisoner's mind at
the time of the commission  of the alleged crime, i. e., whether the
accused was conscious at the time of doing the act that he was doing
something  contrary to law, or whether he Avas then laboring under
any and what delusion.  It has been  decided, by fourteen judges
out of fifteen,  that facts tending to lead to a strong suspicion of in-
sanity must be proved and admitted, before the opinion of a medical
witness can be received on these points.  (See " Med. Gaz.," vol. 46,
p. 240.)
  In forming a judgment of the mental condition of an accused
person, it  is no  part  of  the province of a  witness to  modify his
opinion according  to the punishment which  may  follow if the
plea be rejected, but simply according to the medical facts of the
case.   The legislature only is responsible for the punishment ad-
judged to crimes.   Dr. Mayo has justly observed, that a  medical
Avitness is  summoned to a  court of justice in order to enable the
judge  and  jury  to arrive  at certain  practical conclusions.   The
question proposed to him involves a simple fact, and  not its conse-
quences; and if the latter consideration  be entertained  by him, it
will be liable to bias his evidence on the fact, which is his legiti-
mate topic.  The definition of insanity becomes very expansive
when its expansion may become protective to a criminal Avith whom
we may happen to sympathize.  The question whether the accused
is a responsible agent is of a judical nature: our evidence should be
confined to the question whether the accused is insane in a certain
sense or meaning in which it is understood and defined  by law.
("Medical  Testimony and Evidence in Cases of Lunacy," 1854, p.
9.)   A medical witness in these cases generally moulds his evidence
to a foregone conclusion  on the criminal responsibility of the ac-
cused, and  he  thus lays himself open to a remark from the judge
that he must not encroach on the functions of the jury.   It is cer-
tainly a great evil that, under the  present  mode of laying this
question before a jury, the laAV operates unequally.   One case be-
comes a subject of prominent public  interest, and every exertion is
made to construe  the most trivial eccentricities of character into
proofs of insanity, and  to magnify the effects of an  hereditary
tendency by proving that a maternal grandmother's sister or some
remote relative had been confined as a lunatic: an acquittal follows. 
THE DEFENCE OF  INSANITY.
797
Another case may excite no interest—it is left to itself; the accused
is convicted, and either executed, or otherwise  punished, although
the evidence of insanity, had it been as carefully sought for and
brought out, would have been perhaps stronger  in this, than in the
former instance.
  Probably no case in modern times has produced greater  excite-
ment in the public mind, or so  strongly directed attention  to the
modern defence of  insanity in trials for murder, as that of  George
Victor  Townley, who was charged Avith the murder of a young lady
to whom he  Avas engaged to be married (Reg. v. Townley, Derby
AVinter Assizes, 1863).  In this case there w-as a clear and distinct
motive; there was  a full consciousness  of the nature of the act and
of its penal consequences, as well as an  absence  of  any delusion or
of anything indicative of intellectual insanity in the conduct of the
prisoner up to within a short time of the act, or in the numerous
letters  Avhich he wrote.  There was no  proof that he had lost self-
control, or that he  AA7as fettered in  his  actions.  The prisoner had
entered into  an  engagement w7ith the deceased  (Miss Goodwin).
Shortly before the murder she had written to him, requesting to be
released from her engagement;  she candidly told him that she had
formed an attachment to another man.   In his correspondence Avith
her, he requested a last intervieAV,  to hear (as he said) her determi-
nation  from her oavh lips.   The prisoner wrent to her house  on the
21st August, 1863, induced the deceased to take a  walk with him;
and in about an hour she was found bleeding from severe wounds
in the  throat, from the effects of which  she soon  died.  No sane
murderer intending to destroy another would have pursued a dif-
ferent course.  Towmley, it is true, made no attempit to  escape: he
admitted that he had stabbed her, and assisted in carrying her dead
body to WigAvell Hall, Avhere she resided.  At the trial there Avas
no answer to the charge of murder, except  that the prisoner Avas
insane  when  he perpetrated the act; that he was maddened  partly
by the refusal of  the  deceased to marry him, and  partly- by the
know-ledge that she was engaged and Avould probably- be married to
another man. This theory found some  medical  support, but the
jury returned a verdict of guilty.  An attempt  was  afterAvards
made to rescue this criminal  from punishment, but it  failed.  He
w7as condemned to penal  servitude, and subsequently destroyed
himself.
  Tested by the rules respecting criminal responsibility assigned by
Mr. Fitzjames Stepihen, the evidence in Townley's  case shoAved
clearly intention, will, and malice.   There was  an  absence of proof
of delusion,  and the allegation that the act* arose from an irre-
sistible impulse was a  mere  assumption, without  any fact  in the
previous or subsequent  conduct of the prisoner to give to it sup-
port.   It may well be inquired of those who adopt the theory- of
irresponsibility in  this case—If this is insanity,  Avhat is crime ?  If
ToAvnley was irresponsible for an act  thus  coolly perpetrated, in
which  the motive Avas so clear,  no  person should hereafter be con-
victed of murder who stabbed a woman from jealousy, revenge, or 
798         IRRESISTIBLE  IMPULSES TO  CRIME.
mortified pride.  There was no  doubt that Townley had  a con-
sciousness of right and wrong—that he kneAv the act Avas illegal and
punishable by the law of the land;  but his guilt did not rest upon
these judicial tests of criminal responsibility.  He had this knowl-
edge in common with all sane, and some really insane persons.  In
his case, hoAvever, insanity AA-as neither proved  nor rendered even
probable, w7hile it Avas disproved by his conduct and all the circum-
stances connected Avith  the act of murder.   It  may be  w7rong to
convict all men w7ho come  up to this judicial standard, i. e., who
know  right  from wrong, because insanity may  coexist with such
knoAvledge: but it would be a red.uctio ad. absurdum to contend that,
in the  absence  of any clear proof's of insanity, a man is to be ac-
quitted of crime when he knew that the  act Avas w7rong, and had
well calculated the  legal consequences.  One medical defender of
ToAvnley, in order to account for the absence of symptoms of insan-
ity, suggested that the duration of the homicidal impulse was short,
and did not extend  beyond the  period of the commission of the act
to which it impelled!  There would be no difficulty on  these prin-
ciples in making  out  that  every act of murder was the  result of
impulsive insanity,  and that  all murderers  while  stabbing  others
are morally insane,  and therefore, although they may show sanity
afterAvards, they are irresponsible for their acts!   The legal test of
a consciousness of right and wrong is much  complained of, but in
practiceit certainly cannot be said to err on the  side of harshness
or severity; for it is much more common  to find that sane persons
are acquitted on the ground of insanity, than that one who is really
insane  is convicted  and  punished as a sane criminal.  But the med-
ical assumption here suggested to extenuate Townley's crime w-ould
go far to exculpate every criminal who committed murder.
  The  doctrine of "irresistible  impulse" and the theory of impul-
sive insanity, have  been strained in recent  times to such a degree
as to create in the public mind a justifiable distrust of medical
evidence on  these  occasions.  It is obviously easy to convert  this
into a plea for  the  extenuation of  all kinds of crimes for which
motives are not at once  apparent, and thus medical Avitnesses often
expose themselves to severe rebuke.  They are certainly- not justi-
fied in  setting up such a defence, unless they are prepared to draw
a clear and common-sense  distinction betAveen impulses which are
" unresisted" and those  which are irresistible.  As a learned judge
once remarked in his address to a jury:  "  What  is the  meaning of
not being able to resist an impulse ?   Every crime is committed
under  an impulse, and  the object of the law is to compel persons
to control or resist these impulses.  If it is made an excuse for a
person  who  has committed a crime, that he was goaded to it by
some impulse Avhich medical men might choose to say he could not
control, such a doctrine would  be fraught with very sreat dane-er
to society."                                      J s        6
  While the truth of these  remarks is  obvious, it must be ad-
mitted that the ordinary legal  test  for  responsibility is not satis-
factory.  In  addressing the jury in Reg. v. Cockcroft, involving a 
IRRESISTIBLE  IMPULSES TO  CRIME.         799
trial for murder (Leeds Autumn Assizes, 1866), Mr. Justice Mellor
made the following observations on the defence of insanity Avhich
had been set up :  "It w-ould be dangerous if the idea Avent abroad
that persons committing crime under  sudden impulses were there-
fore to be excused.  At the same time, he thought that the defini-
tion of insanity which would excuse  from criminal responsibilitv,
its given in M'Naughten's case, hardly went  far enough.  He was
of opinion that a man might  knoAv that he AA-as doing an act which
was Avrong, and still he might be laboring under such disease of the
mind as not to be able to restrain his impulse to do that act, and
he should therefore not be  amenable to the criminal law.   The
mere fact, however, of the prisoner being ignorant, and of a Ioav
type of mind w7ould be no excuse.   If the jury thought that the
prisoner knew at the time w7hen  he committed the act that he
was doing wrong, and Avas not laboring under such a disease of the
mind as incapacitated him for controlling his impulses, he was not
entitled  to acquittal on the  ground of insanity.   The doctrine of
uncontrollable impulse, as  laid  down by some Avriters, was a very
dangerous one, and required  to be Avatched  with the utmost care.
Passion arising from provocation, however trivial, offered to a mind
however ill regulated, did  not relieve the person from criminal re-
sponsibility."
  Hence it  foliow-s that  a man might  knoAv  that he was doing
Avrong and  committing an act against  the laAV of God and man,
yet if with this consciousness of the illegality of the act, there w-as a
diseased condition of the mind  which prevented him from control-
ling his actions, he will be entitled to  an acquittal on the ground of
insanity.  With this admission, it appears  to me unnecessary7 to
occupy space with metaphysical discussions  regarding criminal re-
sponsibility ; for however objectionable the theory—if the practice
of the law be in any one case in conformity with  that Avhich has
been advised by writers on the  Medical Jurisprudence of Insanity,
although it may be even adverse to the  theory on Avhich  it is pro-
fessedly based, this is all with which  we have to concern ourselves:
the principle is admitted.  The great defect in the English laAV is,
not that it will not go even to  the full extent of exculpjating a per-
son avIio has committed a crime Avith the full knowledge of its ille-
gality, and under what is called an " uncontrollable impulse," or an
impulse which owing to mental disease his reason Avas  not sufficient
to control, but the uncertainty of its application.  There are many
cases reported which shoAV that an acquittal on the ground of in-
sanity is frequently a mere matter of accident. 
800
SUICIDAL MONOMANIA.
                   CHAPTER LXYI.

SUICIDAL MANIA.—SUICIDE NOT  NECESSARILY AN INDICATION OF IN-
  SANITY.—SUICIDE  A FELONY.--IN RELATION  TO LIFE-INSURANCE.—
  HEREDITARY TAINT.—EROTOMANIA.—PUERPERAL MANIA.—PYROMAN1A.
  —KLEPTOMANIA.--DIPSOMANIA.—RESPONSIBILITY OF DRUNKARDS.—
  DELIRIUM TREMENS.--SOMNAMBULISM.—DEAFNESS AND DUMBNESS.

  Suicidal monomania, or suicidal mania, is the name given to that
form of insanity which  is marked by the prominent  idea of self-
destruction.  Its approach is insidious: it is  foreshadoAved by im-
paired appetite and  sleeplessness arising from  some cause of mental
anxiety too trivial  to create alarm.  It may proceed either from
sudden  impulse  or,  be the result of long deliberation; it may be
committed with, or without, apparent motive; it may proceed either
from a delusive or a real apprehension of poverty, disgrace or ruin.
Suieide from  sudden impulse is  not uncommon ; persons have been
knoAvn  to destroy themselves who had  not previously manifested
any symptoms of intellectual disorder.  Sir Charles Bell relates that
one of the surgeons of the Middlesex Hospital was in the habit of
going every morning to be shaved by a barber in the neighborhood,
who w-as known as a steady- industrious man.   One morning the
surgeon was conversing with the barber about an attempt at suicide
which had recently occurred, and the surgeon observed that the man
had not cut his throat in the right place.  The  barber then inquired,
casually, where the cut should have been made  ; the surgeon pointed
on his neck to the situation of the carotid artery,   The barber in a
few minutes retired  to the back  of his shop, and there cut his throat
with the razor with which he had been shaving the surgeon; he had
wounded the  carotid artery in the place  indicated  by the  surgeon,
and died before any  assistance could be rendered to him.  Although
this act was quite sudden and unexpected, it  may  have been only
the final result of a delusion which had long existed, concealed from
others, in the mind  of this man—just as the sight  of a weapon has
often  led to its use for the purpose of suicide.
  Dr.  Forbes  Winslow- remarks " that a person is often impelled to
self-destruction by the overpowering and crushing influence of a
latent delusion that has for weeks, and perhaps months, been pressing
like an incubus on his imagination. Patients sometimes confess that
they have been under the influence of  monomaniacal ideas  and
terrible hallucinations for a long period without their existence
being  suspected even by their most intimate associates.   " For six
months," writes one patient, " I have never had the idea of suicide,
night  or day, out of my mind.  Wherever I  go an unseen demon 
SUICIDAL MONOMANIA.
801
pursues me, impelling me to self-destruction I My wife, friends, and
children observe my listlessness and perceive my despondency, but
they knoAv nothing of the worm that is gnawing within.   Is this
not a type of cases more generally prevalent  than Ave imagine ?"
(" Obscure Diseases of the Brain," p. 265.)  The Avant of power to
shake off this  delusion shoAvs clearly that  the mind is  not in  a
healthy state—that the person is not sane.
  Men who are thus mentally affected generally retain a  certain
control over their actions;  thus they will voluntarily give up pistols,
razors, or other w-eapons by Avhich suicide might be perpetrated.  A
friend suffering from an attack of suicidal mania, while residing with
me in Paris in 1830, delh7ered to me one night his razors,  with  a
request that I would lock them up and keep them out of his sight,
as otherwise he feared that he might destroy himself at any moment.
Although he recovered from this attack, he had a relapse, and sub-
sequently destroyed himself by taking prussic acid.   Persons labor-
ing under this form of monomania, may go to bed perfectly collected,
and suddenly awake in the night and destroy themselves by hanging,
drowning, or precipitating  themselves from   a windoAV.   These
cases probably depend on the persistence of sonje horrible halluci-
nation which may have occurred in dreaming,  and in the reality of
Avhich they cannot at the time disbelieve.   Some years ago  I saAv a
case of this kind in a man Avho Avas a patient at  Guy's Hospital.
The man attempted to strangle himself in the  dusk of the evening
with the cord of his bed ; he was fortunately saved, and he recovered
after having been nearly strangled.   On asking him what led him
to the attempt, he told me that he suddenly saAv a large black figure
round his bed (the devil), which by signs and words compelled him
to try and hang himself.   It appeared that this man had previously
shown symptoms of suicidal monomania.
  When the impulse to suicide is checked by any great moral shock,
it may suddenly disappear.   My friend, to whose case I have aboA7e
referred, recovered under the shock from the sudden outbreak of the
French Revolution in 1830.   The danger to which he was exposed,
while residing with me in Paris in the early days of the revolution,
for a time at least dispelled the idea of self-destruction.  Pinel men-
tions the case of  a man avIio while  hurrying to one of the  bridges
of Paris to throw himself into the river, was suddenly attacked by
robbers ; he made a desperate resistance, and  escaped from them.
He could not then account for his being where he was, and  quietly
walked home,- having abandoned the intention of destroying him-
self.  There is but little doubt that many acts of suicide would be
prevented if circumstances only gave a slight opportunity for re-
flection ; the mind would then be diverted from  the dominating
idea of self-destruction.
  Suicidal mania is susceptible of being spread by imitation, espe-
cially when  the mode of self-destruction adopted is accompanied by
circumstances of a horrible kind, or by such as excite great notoriety.
The sight of a particular spot where an act of suicide has  been al-
ready committed will often induce a person, who may hitherto have
       51 
802         IS SUICIDE  A PROOF  OF INSANITY?
 been unsuspected of any such disposition, at once to destroy himself.
 Thus, a second and a third suicide took place from the Monument
 near London Bridge, soon after  the  first  had  occurred.  Acts of
 incendiarism have been also observed to lead to arson in the same,
 or in a neighboring district: but there is here a criminal as Avell as
 a monomaniacal imitation, and experience  has clearly shown  that
 there is no check so effectual for this as the rigorous application of
 the law.
  Does  the act of suicide necessarily indicate  the  existence of insanity?
 —Suicide is often set doAvn as furnishing  positive evidence of in-
 sanity ; a doctrine which commonly finds expression in the verdicts
 of coroners' juries—not so much from the fact of insanity being
 thereby established,as thatany verdict but this would Aveigh heavily,
 not on the deceased, but on his surviving relations and friends.
  In the opinion of Dr. Davey, the suicidal propensity is, in all cases
 and  under all circumstances, a positive sign or symptom of disor-
 dered mind (insanity).  ("Journal of Mental Science," April, 1861,
 p>. 110.)  This, however, is not in accordance with the views of many
 psychologists.  In one case, a person will fancy  that he is constantly
 Avatched—that he is oppressed and  persecuted by all around him,
 and  that his prospects in life are ruined Avhen, on the contrary, his
 affairs are known to be flourishing;  he destroys himself under this
 delusion, in order to avoid imaginary evils.   In  cases of this descrip-
 tion, w7hether arising from a momentary  insane  impulse, or from
 delusive reasoning, there cannot be a  doubt that  the act is  one of
 insanity.   It is very  different,  however,  when  a real motive is
 obviously present—as when  a  person destroys himself  to avoid
 actual disgrace or  impending ruin.  The motive is here based on a
 reality—on  a  real estimate of the man's position; the results are
 clearly foreseen, and the suicide calculates that the  loss of life would
 be to him a smaller evil than the loss of honor and fortune.  It may
 be urged that a motive of this kind is itself delusive, and will appear
 insufficient to the minds of most men ; but what  known motive is
 there sufficient to account for parricide,  infanticide, or any other
 crime of the like horrible nature ? It appears to me, we must allow
 either that all crime is  the offspring of insanity, or that suicide, like
 infanticide, may be the deliberate act  of a sane person.  To affirm
 that suicide is always per se  evidence of insanity is  to affirm, sub-
 stantially, that there is no criminality in self-murder; for it is im-
 possible  to regard that act as a crime Avhich is committed under a
 really insane delusion.  (See "Ann. d'Hyg.,"  1831, vol. i.  p. 225 ;
 for some additional remarks on this subject  see Lectures bv Dr.
 Jamieson, " Med. Gaz.," vol. 46, p. 523, and " Jour. Psychol. Med.,"
 1850, p. 19.)
  The law of England very properly treats suicide as a felony; those
 who have attempted and  failed in its perpetration are held to be
 sane and responsible agents, unless there should be clear evidence of
 their (intellectual) insanity from other circumstances ; and it is cer-
tain, that the evidence required to establish  this  must be much
stronger than that sometimes admitted in cases of homicide. 
            IS SUICIDE A  PROOF  OF INSANITY ?         803

  Some singular medico-legal cases have occurred, involving the
question Iioav far the act of attempting suicide is indicative of in-
sanity.  In the case of the  Queen v. Rumball (Cent. Crim. Court,
May, 1843), a Avoman w-as  charged Avith attempting to droAvn her
child.   It appeared in  evidence that  she had fastened her child to
her dress, and thrown herself into a canal with the  intention of de-
stroying herself.  She was  rescued, and Avas subsequently tried and
convicted of the felony of attempting to murder her  child by drown-
ing.  Had she not been rescued, and  had she succeeded in her pur-
pose of self-destruction, it  is probable that  the verdict of a jury
Avould have been, as it so frequently is on these occasions—"Tempo-
rary insanity."  In Reg. v. Furley (Cent. Crim. Court, April, 1844),
the prisoner Avas convicted of murder under  similar circumstances,
but the sentence Avas subsequently commuted. In Reg. v. Gathercole
(1839), a man was charged  Avith manslaughter, under the folloAving
singular circumstances: The prisoner threw- himself into  a canal
for the purpose of drowning himself; the deceased, who Avas passing;,
jumped in  and rescued him, but by some accident  he was  himself
drowned in the humane attempt.  The defence Avas, that the prisoner
was at the time insane, and therefore not resp©nsible for the death
of the person who attempted to save him ;  but this was negatived,
and the prisoner Avas convicted.   So  if a man intending to shoot
himself fails, and by accident shoots a bystander,  he will  be held
responsible, unless there be a clear proof of intellectual insanity;
the act—the attempt  itself, taken alone, will  not  be admitted as
evidence.
  If two persons agree to commit suicide, and one only dies, the
survivor is guilty of murder.  In Reg. v.  Fisher (Taunton Spring
Assizes, 1865), the prisoner Avas indicted for the murder of his Avife
by poison.   It appeared from the evidence that they had been  mar-
ried fourteen years, and had lived happily together.  The man was
well-conducted and industrious ; but  he fell into a desponding  state-
of mind, and thought that by the introduction of machinery into his
trade of a shoemaker, he and his wife would be reduced to poverty..
He communicated this  feeling to his Avife;  they pondered over it
together, and  they  both agreed to destroy themselves.  The man,
procured a quantity of laudanum, and shared  it Avith his Avife; they
took about an ounce each.  The Avife died, but owing to early  vom-
iting the prisoner recovered.  It  Avas proved  that before marriage
the prisoner had been confined  in a  lunatic  asylum;  still  he had
perfectly recovered, and just before this occurrence  it was observed
that both  husband and wife were low and dispirited.  There was
then no indication of intellectual insanity about him :  and the only
delusion appeared  to be that machinery would ruin his trade. In
answer to the charge  he said, "According to my notion I  am not
guilty of murder."   The ease is like  that of  many  others—of two
poor, weak-minded, infatuated people agreeing to commit suicide.
Under the direction of the judge, the  jury  returned  a A-erdict of
guilty. 
804     SUICIDE IN  RELATION TO LIFE-INSURANCE.

  Suicide in relation to  life-insurance.—It is well knoAvn that ac-
cording to  the  rules of  some English offices, a policy of life-insur-
ance is forfeited by- the  act  of suicide; but supposing  it to have
been really an act of insanity,  it has been doubted  Avhether  the
policy would be legally  forfeited.  In an equitable view the policy
should not be forfeited  under these  circumstances, any more than
if the party had died accidentally by his own hands.  The condi-
tion equitably implies that the assurred party puts himself to death
deliberately and not unconsciously through a delusion as a result of
a fit  of delirium  or  an attack of  insanity.   This  question was
raised in the case of Borradaile  v. Hunter (Dec. 1841).  An action
was brought to recover  the amount of a policy of iusurance effected
on  the  life of a  clergyman who threw  himself  into  the Thames
from  Vauxhall Bridge,  and was drowned.  The whole case turned
upon the legal meaning of the words udie by his own hands," which
formed  the exception in the proviso  to the payment of the policy.
At the trial of the case, Erskine, J., directed" the jury,  that if the
deceased threw himself into the river  knowing that he should
destroy himself, and intending to do so, the policy would be void;
they had further to consider Avhether the deceased Avas at the time
capable of distinguishing betAveen  right and wrong, or in  other
words, whether he had  sufficient knowledge of the consequences of
the act  to make him a felo-de-se.  The jury found  that the deceased
threw himself into the water intending to  destroy himself, and
that  previously to this act  there was no evidence  of insanity.
They Avere then directed to take the act itself with  the previous
conduct of the deceased into consideration, and say whether they
thought he was.at the time capable of knowing right from Avrong.
They then  found that he  threw himself  from the bridge Avith the
intention of destroying himself, but  that he was not then capable
of judging betAveen right and  wrong.  The jury Avere here evi-
dently perplexed with the strict meaning of  the words right and
wrong; the first part of the verdict made the case one of felo-de-se,
the last part made it one of  insanity.  The verdict was entered for
the defendants, i. e., that the diseased was a felo-de-se, and that the
policy was therefore void.
  This case was subsequently argued before the four judges in the
Common Pleas (May, 1843).   It was then contended for the plain-
tiff, that according to the terms of the policy there must have been
an intention by the  party assured to  " die by his own  hand," and
that an insane person could  have no controllable intention.  The
judges differed ; three thought there was  no ground for saying that
the deceased was  affected by an uncontrollable impulse; on the
contrary, the jury had found that he threw himself into the river
knowing that he should  destroy himself, and intending to do so.
In their opinion the act was  one of felo-de-se, and the policy was
void.   Tindal, C. J., considered, that the verdict  should be for the
plaintiff, thereby leading  to  the inference that the act of suicide
was in this case the result of  insanity, and not of a  felonious kill-
ing,  to  which  alone  he considered  the  exception in the proviso 
        SUICIDE  IN  RELATION TO LIFE-INSURANCE.     805

should apply.   It  is probable if the term " suicide " had  been in-
serted  in the  policy, instead of the Avords " die by his own hands,"
that the decision would have  been  in favor of the  plaintiffs; for
to vitiate a policy from an accidental result depending on an attack
of insanity 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 sound and equitable vieAv of  the ques-
tion, so important to the interests of those who have insured their
lives.  It is impossible for  a man to enter into a contract against an
attack of insanity, any more than against an attack of apoplexy!  The
jury found that the deceased Avas irresponsible for the act, and it is
clear that the  insurers and insured intended no more by using the
terms " die by his  oavii hands," than the act of suicide.   By this
decision, therefore, the insurers received the benefit  of  a  wider in-
terpretation of the terms than that which either party  could have
foreseen or contemplated.
  The  question Avas again raised in the case of Schwabe v. Clift,
Liverpool Summer Assizes,  1845.  ("Med.  Gaz.," vol.  36, p. 826.)
The deceased, whose life w7as insured, destroyed himself by taking
sulphuric acid : there  w7as clear evidence of his being at  the time in
a state of insanity.  The jury  bere,  under  the  direction of Cres-
Avell, J., returned a verdict for the plaintiffs, thereby deciding that
the policy was not vitiated by the mere act of suicide. The learned
judge held that to  bring the case within the terms of the exception,
the party taking his own  life  must  have been, at the time of the
act, an accountable moral  agent and  able to  distinguish  right from
wrong.  In this instance the term  used in the policy Avas " suicide,"
Avhich  according to the learned judge meant " a felonious killing."
Supposing thatthe insured party  was killed by voluntarily precipi-
tating  himself from a  Avindow while in a fit of delirium  from fever,
this would be an act of suicide, or dying by his oavii hand; but it
surely  cannot  be equitably contended that his  heirs should lose the
benefit of the insurance in consequence of an event depending on
an accidental  attack of a disease, which no one could have foreseen,
and against Avhich no one could  guard !  If  this  principle be not
admitted, the  decision Avhich must necessarily folloAV 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  w7ho would benefit by the policy.
  On an appeal, the judgment  in this case Avas  hoAvever reversed,
the judges again differing. It Avas argued for the insurers, that if a
man retained  just enough  of intelligence to produce death by com-
petent  means, but was deprived of all moral sense, the  policy- Avas
void.  Against this vieAV it was urged by one of the judges, that
Avhether the intellect was  destroyed altogether, or only partially, it
could make no difference.  If death Avas the result of disease, Avhether
by affecting the senses, or  by  affecting the  reason (thus leading to
suicide), the insurance office Avas liable under the policy.  If the act
Avas not the aet of a sane and reasonable creature, it Avas not an act
of suicide within  the  meaning of the proviso.  Those judges who 
806     SUICIDE IN  RELATION  TO LIFE-INSURANCE.

adopted the opposite view held  that the meaning of the words, as
introduced into the exception, was—if the party should kill himself
intentionally: the Avords were considered to include all cases of vol-
untary self-destruction.  If a party voluntarily killed himself, it Avas
of no consequence Avhether he Avas sane or not.  The majority of the
court held this view, and a new trial was granted.  Had  all the
judges been present to give their opinions, the decision might have
been different; for five had  expressed  themselves at various times
in favor of the vieAv that the term suicide in policies applies, as it
ought to do, only in cases in Avhich there is no evidence of insanity;
Avhile four had declared their opinion to be, that it includes all cases
of " intentional" self-killing, Avhether the person be sane or insane.
It is difficult to understand howa man in a fit of delirium or insanity
can be said to kill himself voluntarily or  intentionally.  Will and
intention  imply the judgment of a sane man  in regard  to civil and
criminal acts, but a delirious or really insane  person acts  under a
delusion ; and as the law would hold him irresponsible  in regard to
others, his representatives should not suffer for an act which he Avas
himself incapable of controlling. (See " LaAV Times," July 18,1846,
p. 342.)
   The decision in this case is of great importance to persons Avhose
lives are insured, for it may be made to govern others ;  and on this
principle, a man attacked Avith delirium, and who during the fit pre-
cipitated himself from a window and was killed, would be declared
a suicide Avithin the meaning of the proviso, and a policy of insur-
ance on his life w-ould be  ipso facto void.  It  will be perceived that
the laAV, as interpreted by a majority of the judges, is that whenever
a person destroys himself intentionally, whatever may be the state of
his mind, the policy becomes void.  It also appears that, according
to this  legal view of  the question, a pierson may haA7e and exercise
his intention, although undoubtedly insane.  Whether he has been
found so  under a commission,  or a verdict to this effect has been
returned by a coroner's jury, is therefore unimportant.  It must be
proved  by those  Avho wrould benefit by the policy, that  the party
died  from his own act Avithout  intending to destroy himself.  If a
man take poison, or shoot himself, or commit any other act  leading
to his own death, it must be shown that it Avas the result of accident,
and not of design on his own  part.   Some Insurance offices now
insert in  the contract a  proviso by which, whether the person be
found felo-de-se or not, the policy shall be forfeited ; but they reserve
to themselves the poAver of returning a part or the whole value of
the policy, calculated up to the day of death.  In the mean time they
have the  power  of taking the  full benefit arising from an act of
suicide  committed during a fit of delirium or insanity, in Avhich, as
medical men  know, there can  exist  no controllable intention, no
freedom of judgment,  and no real  exercise of  will.   (See  case
" Prov.  Med. Journ.," Aug. 9, 1818, p. 428.)   [See chap, on Life
Insurance, post.]
   There is a form of suicide not unlikely to  present itself for con-
sideration, namely, Avhere a man, in  the habit of using a poAverful 
PUERPERAL  INSANITY.
807
drug  for medicinal purposes, takes a  large dose while in a state of
intoxication, and dies.  In May, 1857, a 31r. George Fife died from
an overdose of morphia, and it was proved to the satisfaction of the
jury that this must have been  taken while he Avas intoxicated.  In
such a case, a man may have no sane intention of destroying himself,
yet he dies by his own hands.  As drunkenness does  not excuse or
justify any act of homicide, so it would not probably be alloAved to
affect the question of suicide; and death under such circumstances
Avould probably be held to be a felonious killing.
  From these cases one fact  is clear—the act of suicide is not treated
by the law as a necessary proof of insanity ; and therefore  the in-
genious arguments Avhich have been held on this subject have  but
little interest for a medical  jurist, in a practical view.  It has been
elsewhere stated  that acts of suicide have been mistaken for homi-
cide,  merely  because the deceased had expressed no intention of
.destroying himself, and had manifested no disposition to  the act
by his previous  conduct.    This, hoAvever, is a fallacious  view of
the subject,  since suicide from  sudden impulse  is  by  no means
unfrcquent;  and  even when the act bears about it marks of delib-
eration, it  is  not to  be expected that a  person should previously
announce his intention, for this would be a sure way of defeating
his object.
  If, as it is alleged, the act of suicide Avas in all cases the offspring
of insanity, suicide should  be frequent among the insane.   Experi-
ence, however, is not in favor of this assumption.  The Report of
the Commissioners of Lunacy for 1850 sIioavs that there were then
confined as lunatics 15,079 persons, Avhile the suicides for  the year
among this large number amounted to only eight, of which^six Avere
perpetrated by strangulation.  As mechanical  restraint  is either
abolished, or considerably diminished in most asylums, lunatics have
now much more liberty than formerly, and yet suicides among them
are comparatively rare.   This favorable result must be in part as-
cribed to active superintendence  and watching.
  The tendency  to suicide seems to be in some  cases hereditary.
Dr. Burrows relates an instance in which this propensity  declared
itself through three generations : in the first, the grandfather hanged
himself; he  left  four sons: one  hanged himself, another cut his
throat, and a  third drowned  himself in an extraordinary  manner,
after having  been some months  insane: the fourth died a natural
death,—AA-hich, from  his eccentricity and irregularity of mind,  was
scarcely to be expected.  Two of these sons had large families:  one
child of  the third son died  insane, tAvo others drowned themselves,
another became insane, and  made  the most determined attempts on
his life.  Several of the progeny of this  family, being the fourth
generation, when, they  had arrived at puberty, showed a tendency
to the same fatal propensity.

  Puerperal  insanity.—Mania  may present  itself in  other forms
than  those hitherto considered.   Women who have  been  recently
delivered are liable to sudden attacks, in which a disposition to 
808                PUERPERAL INSANITY.
murder their offspring  is the most marked symptom.   This has
been long known and recognized by physicians as " puerperal mania."
The disorder seldom attacks a woman before  the third day—often
not for a fortnight, and in some instances not until several weeks
after delivery.  Out of ninety-two cases, Dr. Simpson observed that
the attack occurred in twenty-one, between the fifth and the fifteenth
clay.  ("Med. Times and  Gaz.," Sept. 1, I860, p. 201.)  The most
frequent period is at or about the commencement of lactation, and
betAveen that and the cessation  of the uterine discharges (lochia).
According to Esquirol, it  is generally preceded or attended by a
suppression of the lochia and milk.  The late Dr. Ashwell remarked
that undue  lactation  might give rise to an attack of mania under
which the murder of the offspring might be perpetrated.   (" Diseases
of Women," p. 732.  See the case of Reg. v. Lacey,  Nottingham
Summer Assizes, 1858.)  It may  also come on after forced, or volun-
tary w-eaning.
  The symptoms do not differ from those of mania generally but it
may assume any of the other forms of insanity: and in one-half of
the cases, it may be  traced  to  hereditary tendency.   There is  a
childish disposition for harmless  mischief.   The woman  is gay and
joyous,  laughing, singing, loquacious, inclined to talk obscenely,
and careless of everything around.   She imagines that her  food is
poisoned; she may conceal the suspicion, and merely avoid taking
what  is offered  to her.   She can  recognize  persons and things; and
can, though perhaps she will not, answer  direct questions.  Occa-
sionally there is great depression of spirits with melancholia. These
facts are of some  importance in reference to cases of alleged child-
murder.  This state may last a few hours, or for some days or Aveeks.
The murder of  the  child is generally either the result of a  sudden
fit of  delirium,  or a sudden impulse, with a full knowledge of the
wickedness and illegality of the act;  so that the legal  test of re-
sponsibility  of a knowledge of right and wrong cannot be applied
to such cases, except on the assumption that insanity already exists,
and taints the consciousness of the individual,  (p. 789.)  A woman
has been knoAvn to request her attendants to remove the child, but
she has afterwards taken an opportunity- to destroy it.   Such cases
are commonly distinguished from deliberate child-murder by there
being no motive,  no attempt at concealment, nor any denial of the
crime on detection.  There is in general a full consciousness of the
illegality of the act, but apparently an entire want of power to con-
trol the murderous feeling.
  Women in the pregnant state have been known to  perpetrate
murder apparently from some sudden perversion of their moral
feelings: there  has been probably latent  intellectual  disturbance,
but not sufficient  to attract the notice of friends.   There is a great
sympathy betAveen  the uterine organs and the brain, which may
account for  the occurrence of such cases; but I am not aware that
irresponsibility on the ground of insanity has been admitted in this
country, under these circumstances. 
PYR0 MANIA — KLEPTOMANIA.
809
  J'yroiianiia.   Propensity to incendiarism.—This  is described  as a
variety of monomania in Avhich there is a morbid  disposition of
mind  leading  to  impulsive  acts of incendiarism Avithout any- mo-
tive.  It is a condition not specially recognized by English jurists
or in English courts of justice.  It has been said to occur in  girls
about the age  of puberty, and  is  supposed to be connected  Avith
disordered menstruation.  The case of Jonathan  31artin has  been
frequently quoted as an instance of pyromania.  He had, however,
merely a delusion that he w-as deputed by God to burn down the
Cathedral of York, in order to do away Avith the  heresies which he
supposed to exist in the Church.  There was no doubt of his in-
sanity ;  he had been already twice confined in an asylum.  Never-
theless,  as the late Baron Alderson (who was counsel for the prose-
cution)  remarked, the act was perpetrated with much method.  It
seems that Martin remained behind after the afternoon service  in
the cathedral, and when left alone he Avent up into the belfry, cut
off  about eighty or ninety  feet in length of the prayer-bell  rope,
which, being usually rung  from beloAv, had been draAvn  up and
coiled up to that length there.   With this rope he succeeded  in
knotting a sort of ladder, and throAving  it over the iron gates  of
the choir, he climbed over by means of the knots.  Being  in the
choir, he struck a light Avith a flint and  his razor, lighted a candle
Avhich he had brought, collected the prayer-books, and set  fire  to
the paper, close to the carved work  at the archbishop's throne, in
two piles.   He then cut away a  silk curtain, gold fringe, etc., which
he stole ; and getting back by his rope-ladder into the body of the
cathedral, he escaped through a Avindow on  the north side,—the
most unfrequented part.  He had provided himself Avith a pair of
pincers, by Avhich he forced  the AvindoAV, and let himself out by his
rope-ladder  to  the ground.  A sane criminal could  hardly  have
devised a better method of perpetrating the act, or of escaping  after
its perpetration.   The defence, as  in most of  these cases, Avas in-
sanity at the time of perpetrating the act, and not specially Pyro-
mania.

  Kleptomania.   Propensity for thieving.—This term has been ap-
plied bv Marc to that form of monomania AA7hich is said to manifest
itself  by a propensity to acts of theft.   It is alleged by him and
others that  this propensity has often shoAvn itself in females labor-
ing under  disordered menstruation, or among those avIio were far
advanced in pregnancy—the motive being the mere  wish of posses-
sion.  Pregnancy, according to  him, should be a  good exculpatory
plea AA-hen a Avell-educated woman, of strictly moral  conduct, steals
some unimportant article of no value compared with her worldly
means and position in society.  There are several instances on re-
cord showing that well-educated persons moving in a respectable
sphere of society  have been guilty of petty acts of theft.  The arti-
cles taken have been valueless compared with their means. Instances
of this kind have been brought before our Police-courts, and this
motiveless  impulse to theft has been occasionally pleaded; but in 
810             EROTOMANIA — DIPSOMANIA.
most of them the folloAving facts have been clearly established by
evidence:  1. A perfect consciousness of the act and of its illegal-
ity.  2. The article, though of trifling value, has still been of some
use to the person—thus Avomen have stolen articles either adapted
to female use, or on Avhich  money could be raised.  3. There have
been art and  precaution in  endeavoring to conceal the theft; and 4,
either a denial of the act when  detected, or some evasive excuse.
When  circumstances  of this kind are proved, either the parties
should be made responsible, or theft  should be openly- tolerated.
The evidence of a disordered state of mind should not be allo\A7ed
to depend on the nature of the act, or every morally depraved per-
son might bring forward a  plea of insanity for any crime or offence.
When  the  plea  of insanity is raised in respect  to other cases of
stealing, the rule appears to be (per Tindal, C. J.), that there should
be proof that the  prisoner was incompetent to knoAv that the par-
ticular act  in question was a wrong one.  (Reg. v. Vaughan, Mon-
mouth Sum.  Ass.,  1844.)

  Erotomania.   Aidoiomania.—Erotomania has been  described by
M.  Esquirol as a chronic affection of the brain leading to mental
disorder, in Avhich  amorous ideas are as predominant and as uncon-
trollable as religious ideas in some cases  of religious melancholia.
It occurs in both sexes, and in his opinion it differs from  nympho-
mania  and  satyriasis in the fact, that it has its origin in a primary
disturbance of the functions of the brain from disease.  In nympho-
mania, however, the female sexual organs, and in satyriasis the male
sexual  organs, are  at fault.  These twro  mental conditions he re-
gards as depending on morbid  changes in the sexual organs.  Dr.
Marc has suggested that the term aidoiomania (from aiboiov, puden-
dum) is more appropriate ;  it signifies furor genitalis, and includes
both nymphomania and satyriasis.  (" De la Folie," vol. 2, p.  182.)
  It cannot be denied that,  from sympathy between the genital
organs and the brain, mania may sometimes shoAV itself  by exces-
sive sexual  desires leading to  attempts by one on  the other sex.
This is the very difficulty to the admission of such a defence.  Ex-
cessive amorous propensities may exist  in  sane and responsible
persons, and if unresisted by due moral control, they may in a cer-
tain sense be described as irresistible; but this Avill hardly satisfy a
court of law that  a man could not help  perpetrating a rape Avhen
time and circumstances were especially favorable for such an assault
on a woman.  The sane ravisher will  generally seek his opportu-
nity—the maniac  will attack any woman opjenly and indiscrimi-
nately.   Such a defence is rarely set up in a case of rape, for  the
reason, no doubt, that all the circumstances  of the case Avould  be
adverse to it.

  Dipsomania.   Drunkenness.  Civil responsibility of drunkards.—
This state, w7hich  is called in law frenzy or " dementia affectata,"
is regarded as a temporary  form of insanity.  Jurists and legislators
have differed Avidely respecting  the degree to which drunkards 
        CRIMINAL RESPONSIBILITY OF DRUNKARDS.     811

should be made responsible for their acts.  When the mind of a
man is completely Aveakened by habitual drunkenness, the laAV infers
irresponsibility, unless it plainly appears that the person Avas  at the
time of the act, Avhether of a civil or of a criminal nature, endoAved
with  full consciousness and  reason  to know7 its good or evil tend-
ency.^  Any deed or agreement made by a party Aviien  drunk  is not
invalidated  by our law, except in a case in which the intoxication
has proceeded so far as to deprive him of all consciousness of what
he is doing;  and a court of equity will not interfere in other cases,
unless the drunkenuess was the result of collusion by others for the
purposes of  fraud.  When the  drunkenness has occasioned a tem-
porary  loss of the reasoning powers, the person  is  incapable of
giving a valid consent, and therefore cannot enter into a contract
or agreement; for this implies aggregatio mentium, i. e.,  a mutual
assent of the parties.   Partial drunkenness therefore, provided the
person knew Avhat he  was about,  does not vitiate a contract or
agreement into Avhich he may have entered.  Thus the law appears
to define two states in drunkenness:  one in which it  has proceeded
to but a slight extent, and it is considered that there is still a  poAver
of rational consent; another in which it has proceeded so far that
the person has no consciousness of the transaction,  and therefore
can give no rational consent. The proof of the existence of this last
state  Avould render all the civil acts of a person  void.  A confession
made by a man while in a state of drunkenness  is legally admissible
as evidence against him and  others,  provided it be corroborated by
circumstances.  In a case tried a few years since the prisoner con-
fessed, Avhile drunk, that he had committed a  robbery and murder
which had taken place some time before, but of which he had not
been  suspiected.  He  mentioned a spot AA-here  the property of the
murdered person  had been concealed  by him, and the whole  of the
circumstances of  the murder.  The property was found as he had
described it, and the case Avas clearly brought home to him, chiefly
by collateral evidence from his oavii  confession.  He Avas convicted.
Iu a  case tried at the Central Criminal Court, in October, 1849, a
man pleaded his drunkenness at the time of his first marriage as a
defence to a charge of bigamy.   There was some evidence to shoAV
that he Avas partly- intoxicated  when  the ceremony- AA-as performed:
it Avas proved, hoAvever, that he AA-as sufficiently conscious of the
whole of the proceedings, and he Avas convicted. (" Med. Gaz.," vol.
44, p. 762.)
  Criminal responsibility of drunkards.—When homicide is committed
by a man in a state of drunkenness, that is held to be no excuse for
the crime.   If  voluntarily induced, whatever may  be its degree, it
is not admitted as  a  ground of irresponsibility, even although the
party might  not have contemplated the crime when sober.  (Reg. v.
Reeves, Derby Winter Assizes, 1844.)  Thus it appears that  when
the state of drunkenness is such that any civil act Avould be void, a
person mav still be held legally responsible for a crime like mur-
der.   Some  judges have admitted a plea of exculpation when the
crime has been committed in a  state  of frenzy arising from habitual 
812 ,    CRIMINAL RESPONSIBILITY  OF  DRUNKARDS.

drunkenness ; but even this  is not general.  The question Avhether
the person was or AA7as not drunk at the time of committing a crime
may be, however, occasionally of  some importance.  It was held by
Patteson, J., that  although  drunkenness is no excuse for any crime
whatever, yet it is of very great importance in cases in which there
is a question of intention. A person may be so drunk as to be utterly
unable to form  any intention at all, and yet he may be guilty of
very great violence.  (Reg. v. Cruse, 8 C. & P. p. 546.)  If the drunk-
enness has produced a diseased state of the mind, then a criminal
act perpetrated by the person, might admit of exculpation either on
the ground of insanity, or of the  want of sane consciousness at the
time of the act; but the difficulty is to prove in such cases the ex-
istence of actual disease  to  a sufficient degree to render the person
irresponsible in  a legal sense.  When it  is a question Avhether the
accused was actuated by malice or not,  a jury may under certain
circumstances be required to take the fact of drunkenness into their
consideration, and this may  have some influence upon their verdict.
While, then, drunkenness does not furnish any excuse for a crime,
it may become material Avith reference to the intent Avith Avhich an
act has been  perpetrated.   ("Law Times," Sept. 27, 1845, p. 542.)
It is obvious that if drunkenness were to be readily admitted as a
defence, three-fourths  of the crimes committed  in this country
would go unpunished!.
  In cases in which  the head has sustained any physical injury, as
among  soldiers  and sailors, drunkenness, even Avhen existing to a
slight extent, produces sometimes a fit of temporary insanity, leav-
ing the  mind clear when the drunken fit is over.  The huv makes
no distinction between this state and ordinary drunkenness, although
juries occasionally show by their verdicts that some difference ought
to be made.  (See  cases in Alison, p. 653.)
  Hallucinations and illusions are a common effect of drunkenness,
and may lead to the commission of criminal acts.  Marc relates a
case Avhere tAvo  friends being intoxicated, the one killed the other
under  an illusion that  he was an evil spirit.   The drunkenness of
the accused Avas held  to have been voluntary ; and  he  Avas con-
demned to ten years' imprisonment w7ith hard labor.  A case of this
description (Reg. v. Pcdteson) Avas tried at  the Norfolk Lent Assizes,
1840.  A man while intoxicated killed his friend, Avho Avas also in-
toxicated, under the illusion that he was some other pierson who had
come  to attack him.  It is  reported that the guilt of the prisoner
w7as  made  to rest upon the fact, whether, had be  been  sober,  he
would have  perpetrated the act  under a similar illusion !  As  he
had voluntarily brought himself into a  state of intoxication, this
w7as no justification ; he Avas found guilty of manslaughter, and sen-
tenced to two months' imprisonment.
  The proof of drunkenness may fail, but still, if the person charged
with the death acted under an illusion, he will be acquitted. In Reg.
v. Price (Maidstone  Summer Assizes, 1846), it was proved that the
prisoner, Avho had been on friendly terms with deceased, w-as going
home at night, having previously been in company Avith deceased at 
CRIMINAL  RESPONSIBILITY OF DRUNKARDS.   . 813
a public house.  According to the prisoner's statement, a man sprang
upon him from the hedge by the roadside, and demanded his money
and his watch,  or else he said he would have his life; the prisoner
closed with, and beat him severely, inflicting such injuries  that he
died shortly afterAvards.  The supposed robber turned out to be his
friend, and it was believed that he had made an attempt to rob the
prisoner jokingly; the result, however, Avas  that  the attempt had
ended in this fatal manner.  The prisoner throughout told the same
story, and there did not appiear to be the slightest ground  for sug-
gesting that it was untrue.   Coltman, J., after hearing the evidence
of the witnesses, said it appeared to be quite clear that the prisoner
had acted under an impression  that  he was protecting his OAvn life
from the attack of a  robber, and under such circumstances he could
not be held to be criminally responsible.  The  jury accordingly
returned a verdict of not guilty, and the prisoner Avas discharged.
  An  excessive indulgence  in  the habits of drinking does  not
necessarily derange the mind,  but it  practically renders a person
unfit for the control  of himself and  the management of his  pro-
perty.  It is therefore a question whether it Avould  not be for the
benefit of such persons and of those dependent on them, if  the laAV
interfered and placed them under the same restraint as those Avhose
minds had been actually rendered unsound by this pernicious habit.
[The  laAV does so interfere in Pennsylvania—vide  note to p. 769
ante.—P.]
  Intoxication  is simply poisoning by alcohol, a light form of nar-
cotic poisoning. A medico-legal question may arise in reference to
the responsibility of persons for  acts  pjerpetrated Avhile they are
under the  influence of other narcotics of a  more poAverful^ kind.
Thus, a person  may  have lost  his self-control from the effects of
opium or any of its preparations—Indian hemp, datura, chloroform,
or substances  of  the  like  nature.   If we  except  Indian hemp
(bhang or  gunja)  and  datura (in which muscular power may be
excited), the general effect of other  narcotics is to produce only a
short  stage  of excitement, which is speedily followed  by drowsi-
ness, stupor and muscular weakness.  As a result of  taking  any
of these drugs, a man may have halluciations or illusions, and in
this state commit  murder like an insane person, w7ho may fancy
that he sees a hideous  spectre,  or  the  devil  before him.  Dr.  Che-
vers, in his " Medical Jurisprudence for India,"  describes several
instances in which murders have been perpetrated by persons  Avho
had taken preparations of hemp (op. cit. pp. 541 et seq.).  The legal
test of irresponsibility for such  acts  he states as follows:   " No
person can  be acquitted unless  it can be proved that, by reason of
unsoundness of mind not  wilfully  caused  by himself, he  was uncon-
scious, and incapable of knowing, in  doing  the act, that he  was
doing an act forbidden by the  law of the land" (p. 566).   Persons
who voluntarily  place themselves in such  a  condition as to be
deprived of all self-control  are therefore  held responsible;  and
whether the druo- be alcohol, opium, or Indian hemp is immaterial.
  Restraint   Interdiction.—Drunkenness, even when  habitual, is 
814     CRIMINAL RESPONSIBILITY  OF  DRUNKARDS.

not a sufficient ground for the imposition of restraint or interdic-
tion,  in the English  law.  Thus, on a Commission in November,
1836 (Re Holden), the jury returned that the party  Avas of Aveak
mind and given  to habits of drunkenness,  but that he A\-as not of
unsound mind.  On application, the Lord  Chancellor refused  to
interfere.  This part of our law requires revision.

  Delirium tremens.—This is a disordered state of mind Avhich pro-
ceeds from an abuse of intoxicating  liquors.  Habitual drunken-
ness appears to be the predisposing, Avhile abstinence from drink is
the immediately exciting  cause.  Thus, the disorder frequently
does not show itself until the accustomed stimulus  has been with-
drawn for a certain  period.    It  commences Avith tremors of the
hands, by wdiich it is known  from ordinary delirium and restless-
ness ; and the individual is subject to hallucinations and illusions,
sometimes of a horrible kind, referring to past occupations or events.
The patients are often violent,  and prone to commit suicide  or
murder—more commonly the former;  hence they require close
watching.  Persons  laboring under  this disorder are incompetent
to the performance of any civil  act,  unless the mind  should clear
up before death; they are not  responsible  for criminal acts com-
mitted Avhile they are laboring under an attack.  Acquittals have
even taken pjlace on charges of murder,  when there Avas delibera-
tion as Avell as an apparent motive for the act.  Thus then, although
the disorder may  have been voluntarily brought  on by habitual
drunkenness, the law admits it as a  sufficient plea for irresponsi-
bility, while in a case of confirmed drunkenness it rejects the plea.
In delirium there is a formed  disease of the brain, Avhile  volun-
tary drunkenness merely produces a temporary disturbance of its
functions.  In one  trial the  evidence showed that homicide had
been committed by the accused while he Avas laboring under an attack
of delirium tremens.  (Reg. v. Simpson, Appleby7 Summer Assizes,
1845.)  The prisoner's mind had become unsettled from this dis-
order, brought on  by habitual  drunkenness.  In another case the
plea Avas also admitted by the jury, although it  was  scarcely sup-
ported by the medical evidence.  (Reg. v.  Watson, York Winter
Assizes, 1845.)
  [Many of the States of the Union have statutes defining murder,
and dividing it into degrees.  Where this is the case the existence
of intoxication and its  effect upon the  mind of one charged Avith
homicide, becomes of much importance,  upon the  question of in-
tent and premeditation.  The " American Law  Journal," for Oc-
tober, 1848 (p. 145), contains the following  admirable article upon
this subject.
  " The mental status produced  by drunkenness is frequently deter-
mined by the testimony of physicians.  But the  effect of that state
of mind, voluntarily produced,  in relieving from  responsibility- for
crime, is to be determined by the courts.  Sir William Blackstoue
quotes the language  of  Sir EdAvard Coke, who declares that  ' a
drunkard who is voluntarius daemon, hath no privilege thereby; but 
       CRIMINAL RESPONSIBILITY  OF  DRUNKARDS.    815

what hurt or ill soever he doth, his drunkenness doth aggravate it.'
And Sir William adds, that ' the  common  laAV of England, con-
sidering Iioav easy it is to counterfeit this excuse, and Iioav Aveak an
excuse it is, though real, will not suft'er any man thus to privilege
one crime  by  another.'  (PIoav.  19, 4  Bl." 26, 1 Inst. 247.)  The
effect  of this severe  rule of the  common law  is frequently to fix
upon the accused the legal guilt of a crime of much greater enormity
than he ever intended to commit. But the great value of the com-
mon law is that  it  is  founded upon far-reaching vieAvs of  policy,
which look beyond the justice of the  particular case, for the pur-
pose of protecting the higher interests of society.  It seems to be
conceded as a principle  of the  common laAV  that a man  wlio Avil-
fully perpetrates  an  unlaAvful  act is responsible for all  its conse-
quences.   Hence, a man who  accidentally kills  another by dis-
charging a gun at a  sheep, or a domestic foAvl, for  the  purpose  of
stealing it, is guilty of murder at common laAV, although  his mind
neA7er in fact assented to the enormity of  taking the life of a fel-
low being.   On the same principle,  it Avould seem that a man who
voluntarily puts himself in  a state of mind which causes  him to
take the life of another is guilty, by construction, of the common
laAV crime of murder.
  "The hardship of this rule has sometimes caused the scales of
justice to vibrate in its application to capital cases.  In 1819, Mr.
Justice  Holroyd, in  Rex v.  Grindley, under the influence  of his
feelings, held that' though  voluntary drunkenness cannot  excuse
from  the  commission  of crime,  yet where, as upon a charge of
murder, the material question is Avhether the act was premeditated,
or done only Avith a sudden  heat  and impulse, the fact of the party
being intoxicated  is  a circumstance proper to be  taken into con-
sideration.  (Lewis's Crim. L. 602 ;  1 Spear's 384.)  This decision
has doubtless had its influence  elseAvhere.  The error of Mr. Justice
Holroyd consisted in supposing that at common law it AA-as  ahvays
'a material question' in murder 'whether the act was, premeditated'
or not.  We have seen  that premeditated  killing Avas not  ahvays
essential to constitute  the  crime;  otherwise it never  could have
been held murder to kill a  human  being  accidentally in the pre
meditated perpetration of larceny.  There is some reason to  believe
that subsequent reflection brought  the mind of that enlightened
judge to an acknowledgment of his error.  In 1835, in the  case  of
Rex v. Carroll, Mr. Justice  Parke, after citing the case of  Rex v.
Grindley, decided by Mr. Justice Holroyd, remarked that '  highly
as I respect that  late excellent judge, I differ  from him, and my
brother Littledale agrees Avith  me.   He once acted upon that case,
but afterAvards retracted his opinion, and there is no  doubt that
case is not laAV.   I think that there Avould be no safety for human
life if it were  to be considered  as law.'  (7 Car. and Payne, 145 ;
32 Eii". Com.  LaAV, 471; Lewis's Crim. LaAV, 602, note.) _
  " Mr Justice Story, in the United States v. Drew, took a distinction
on the effect of intoxication which, on account of its humanity, has
received general commendation.  That learned judge held that in- 
816         DECISIONS IN  THE UNITED STATES.
sanity, of which  the  remote cause is habitual drunkenness, is  an
excuse for an aet  done by the party while so insane, but not at  the
time under the influence, of liquor.  The crime (to be punishable) must
take place during a fit of intoxication, and be the immediate result
of it, and not a remote consequence superinduced  by the antecedent
drunkenness of the party.  In cases therefore of delirium tremens or
mania a potu, the insanity excuses the act, if the party be not intoxi-
cated when it is committed.   (5  Mason, 28 ; Am. Jurist, vol. 3, p. 5
to 30 ;  Burnet v.  The State, Martin & Yerger, 133 ;  Cornwell v. The
State, ib. 147 ;  LeAvis's Criminal Law, 602, note.)
  "In Virginia, where there is a statute dividing murder into de-
grees, like that of Pennsylvania, it is believed that a similar view
of the laAV prevails.   (Com. v. Jones, 1 Leigh, 612.)
  " In Tennessee, Mr. Justice Reese, in 1843, in delivering the opin-
ion of the Supreme Court upon a similar statute,  has explained
the law on this interesting question in  language  so  clear and for-
cible as neither to be misunderstood or  refuted.  In the case  of
Swan v.  The State, 4 Humphreys, 136, the judge  makes the  follow-
ing remarks:—
  " The characteristic quality of murder of the first degree, and
that which distinguishes it from murder in the second degree or any
other homicide, is the existence at the time of the death of  the as-
saulted, of a  settled purpose and  a fixed deliberate design on the
part of the assailant  that his assault should produce death.  The
length of time  which  the assailant deliberates on his intention is
not material.   Drunkenness is no  excuse for or justification  of
crime.   But although drunkenness in point of law  constitutes no
excuse or justification for crime, still, when the nature and essence
of a crime is made by law to depend upon the peculiar state and
condition of the criminal's mind at the  time, and with reference to
the act done, drunkenness as a  matter of fact affecting such state
and condition of the mind, is a  proper subject for consideration and
inquiry by the  jury.   The question  in  such  a case is, what is the
mental status?  Is it one of  self-possession, favorable to the  forma-
tion of a fixed purpose by deliberation or premeditation ? or did the
act spring from existing passion, excited by inadequate provocation,
acting  it may be on a peculiar temperament, or upon one already
excited by ardent spirits ?  In such  case  it  matters not that the
provocation Avas inadequate, or the spirits voluntarily drank.  The
question is, did the act proceed from sudden passion, or from delib-
eration and premeditation ?   To regard the fact  of intoxication as
meriting consideration in such  a case, is not to be held that  drunk-
enness will excuse  crime, but to inquire whether  the very crime
which the laAV defines and punishes has  in fact been committed.  If
the mental state required by law to constitute the crime be one of
deliberation and  premeditation, and drunkenness  or other cause
excludes the existence of such mental state, then the  crime is not
excused by drunkenness, or  such other cause, but has not  in fact
been committed."
  Of course it  is  not to be understood from the foregoing article 
SOMNAMBULISM.
817
that drunkenness is any defence to the factum of guilt.   It  is only
with reference to the question of intent, and Avith the view to reduce
the degree of guilt from murder in the first degree, which in most
of the States is punishable Avith death, to murder of  the  second
degree or to manslaughter, the punishment  of which  is only im-
prisonment more or less extended, that evidence of intoxication is
receivable.  Commonwealth v. Kilpatrick, 7 Casey, 203; Com. v. Miller.
17 Legal Intel. 276 (Ludlow, J.).
  Nor will  it be sufficient even for this purpose, unless the intoxi-
cation be so great as to render  the prisoner unable to form a Avilful,
deliberate, and  premeditated design to kill, or incapable of judging
of his acts and  their legitimate consequences.  (Keenan  v. Common-
wealth, 8 Wright 55 ;  Com. v. 31iller, Ib. v. Kilpatrick, supra).—P.]

  Somnambulism.—This term  applies  to  sleep-walking;  but the
medico-legal facts are chiefly confined to acts of violence  perpetrated
unconsciously during  the state of sleep, in which it is presumed
that malice  and intention, the chief  ingredients of crime, are want-
ing.  It has been a contested question among medical jurists, how
far a person should be held responsible for a criminal act  perpetrated
in that half-conscious state which exists when he is suddenly roused
from sleep.  There is no doubt  that the mind is at this time subject
to hallucinations and illusions, which may be more active and per-
sistent in some persons than in others ;  but it is difficult to suppose,
unless Ave imagine there is a sudden access of insanity, that a person
should  not recover from the delusion before he could perpetrate an
act like murder.  A remarkable case of this description, that of
Bernard Schedmaizig, will be found reported by Marc. (Op. cit. vol
1, p. 56.)  This man  suddenly awoke at midnight, and saAv, as he
believed, a frightful phantom.  He tw7ice called out, "Who is that?"
and receiving no  answer, and  imagining  that the phantom  was
advancing upon him, he seized a hatchet  which was beside  him,
attacked the supposed spiectre, and it Avas found that he had mur-
dered his wife.   He Avas charged with the murder, but pronounced
" not guilty" on the ground that he Avas not at the time conscious
of his actions.  A trial involving this question occurred in England.
A peddler in the habit of Avalking about the country armed with a
sword-stick, Avhile lying asleep on the high road, was roused by  a
man accidentally passing, Avho seized and shook him by the shoulders.
The peddler suddenly aAVoke, dreAv his SAvord and stabbed the man,
who soon afterwards died.  The peddler was tried for manslaughter.
His irresponsibility was strongly urged by his counsel, on the ground
that he could  not haA7e been conscious of an act thus perpetrated
while in a half-waking state; and this defence Avas supported by the
opinion of a medical witness.   The prisoner Avas, however, found
guilty.  Under such  circumstances, it  Avas not  unlikely that an
idea had  arisen in the prisoner's mind that he had been attacked
by robbers and therefore had stabbed the man in self-defence.  (Rex
v.  31illigan, Lincoln  Autumn  Assizes, 1836.)  In Reg. v. Byron
(Winchester  Winter  Assizes,  1863), it Avas proved that  a bloAV
      52 
818     RESPONSIBILITY OF THE DEAF  AND DUMB.

struck by a drunken  person during sleep had  caused death.  The
man was charged with manslaughter under  the  folloAving circum-
stances :  The prisoner and deceased were soldiers in the same regi-
ment, at Aldershot.   The prisoner  Avas in  the  street  drunk, and
deceased seeing this, took him in to prevent his being arrested for
drunkenness, and placed him  on his bed.   In this state he lay for
some time quite drunk and insensible.  In the course of the after-
noon, deceased went up stairs to see him; he tried to awaken him,
when the prisoner suddenly kicked out, and his boot came violently
against  the lower part of the abdomen of deceased.  The prisoner
did not awake, but appeared then to be quite insensible.  The de-
ceased died, and it was found  that the blow had caused rupture of
the intestines.  As in  order to constitute the crime of manslaughter,
it must be shown that  the person charged did something knowingly,
and the prisoner was not in  a state to have known anything, it
w7as held that there was no case against him, and he was acquitted.
The act was committed during sleep, but the sleep appears to have
been the sleep of drunkenness.
  Somnambulism may become a subject of discussion under a con-
tested policy of life-insurance, in which it may be provided that it
shall be vitiated by suicide.  If  a man falls from a height and is
killed while in a state of somnambulism, would  this be  considered
an act of suicide Avithin the meaning of  the policy ?  The proviso
against  suicide has been held to include only intentional killing (case
of Borradailev. Hunter, "Med. Gaz.," vol. 36, p. 826), and in death
under these circumstances the killing cannot be said to be inten-
tional ; it can only be  regarded as an accident—therefore it is rea-
sonable to infer that the policy would not be void.  It is impossible,
however, to  lay down any general  rules relative to cases  of this
description ;  since the circumstances attending each case will suffi-
ciently  explain how  far the act of murder or suicide  had been
committed during a state of somnambulism, or under an illusion
continuing from a state of sleep.

                      THE DEAF AND DUMB.

  It was formerly laid down in the old law-books, that a person born
deaf and dumb was by presumption of law an idiot, but in modern
practice, Avant of speech and hearing does not imply want of capacity
either in the understanding or memory, but  only a difficulty in the
means of communicating  knowledge; and when it can be shown
that such a person has understanding, which many in this condition
reveal by signs, he may be tried and'suffer judgment and execution.
(Archbold.)  A deaf and dumb person is not incompetent  to give
evidence, unless he is also blind; he may be examined through the
medium of a sworn interpreter  who understands his signs.  .This
condition does not justify restraint or interdiction, unless there'is at
the same time mental deficiency. A deaf and dumb person who has
never been instructed, is altogether irresponsible for any action, civil
or criminal.  Such a person cannot even be called on to plead to a 
           FEIGNED DEAFNESS AND  DUMBNESS.        819

charge, when there is reason to suppose that he cannot understand
the nature of the proceedings.  A deaf and dumb woman Avas charged
with cutting off the head of her child.  By signs she pleaded "not
guilty," but she could not be made to understand the nature of the
other proceedings against her.  Upon this she Avas discharged, and
subsequently confined as a criminal lunatic.  In Reg. v. Goodman
(Stafford Summer Assizes, 1841), a deaf and  dumb man was con-
victed of theft  and  sentenced  to  imprisonment.  He was made to
comprehend the proceedings by signs and talking with the fingers.
In Reg. v. Brook (Buckingham Summer Assizes, 1842), the prisoner
could read and write well.  He was charged with  feloniously cutting
and  stabbing.  The proceedings were reported  to him in writing.
He w7as convicted, and the judge(Alderson, B.) having sentenced him
to a year's imprisonment, handed doAvn  his judgment in Avriting,
which  he recommended him to read  and  ponder  over in prison!
In Reg. v. Jackson (Bedford Summer Assizes, 1844),  Alderson, B.,
held that before  the evidence of a dumb Avitness can be received,
the court must  be satisfied that he understands the obligation of an
oath.
  It has been decided in the ecclesiastical courts that the consent of
a deaf  and dumb  person given by signs, renders a matrimonial con-
tract valid, provided the person has a full and proper understanding
of their meaning.  An incompetency to enter into  contracts  or un-
soundness of  mind,  must not be inferred to exist merely in  conse-
quence of a person being deaf and dumb.  In the  case of Harrod
v. Harrod.  (Vice-Chancellor's Court, June, 1854), an  attempt was
made to deprive the plaintiff' of his rights on the  ground that he
was an illegitimate child.  The marriage of his parents took place
thirty  years previously, but the marriage was said to be void by
reason  of the alleged incapacity of his mother to enter into the con-
tract ;  the mother Avas deaf and dumb, and of more than ordinarily
dull intellect.  Sir W. P. Wood  said there was an important  differ-
ence between " unsoundness  of mind" and " dulness of intellect."
The presumption in such cases was always in favor of sanity, and
the fact of a person being deaf and dumb did not raise a presump-
tion the other way.  Experience  in asylums showed, that the deaf
and dumb were not necessarily of unsound mind.  The Avoman had
assented to the marriage in form and substance, and with a perfect
knoAvledge of what she was doing.  In the ceremony of marriage
it had never been  held that the repetition of the words Avas necessary.
The woman conducted herself with great propriety before and after
the marriage, and a child Avas born in due course.  There was no
ground for an issue.
   Feigned deafness and dumbness.—From these statements it will be
perceived that  medical evidence is of but little importance in rela-
tion to the deaf and dumb.   Indeed,  there are only two  cases in
which this kind  of evidence is likely to be called for—1st, when
there is  accompanying mental deficiency,  in which case the general
rules elsewhere  given are applicable;  and 2dly, when there is  a 
820        FEIGNED  DEAFNESS AND  DUMBNESS.
suspicion that the deafness and dumbness are feigned. _ There will
be no great difficulty in detecting an imposition of this kind.  It
may be found that the alleged deafness and dumbness did not come
on until a motive existed, and that there was  no apparent cause
but the very-  suspicious one of evading responsibility for some of-
fence committed.  The use of ether or chloroform-vapor may be
occasionally resorted to Avith advantage  for the detection of such
an imposition.  In one instance, a strong shock  of the induced cur-
rent from a large magneto-electrical apparatus, by means of moist-
ened conductors applied over the larynx, brought out after  a few
minutes the power of speech in a lad who had successfully imposed
on many  persons.  ("Med. Times  and Gaz.,"  March 30, 1861, p.
339.)  It requires great skill to maintain an imposture of this kind.
Such persons are immediately thrown off their guard by addressing
them in a voice a little above, or a little below the common conver-
sational tone ; a change in the eye or the features will at once indi-
cate  that  they hear and understand what is said.  An  ignorant
impostor may be dealt with on  the principle of " artis est  celare
artcrn," by seriously proposing in a low voice to a medical friend
Avho may be present, the necessity for the performance  of some
formidable surgical operation.   The  production  of amputating
instruments has been known to have a Avonderful effect!
  In Reg. v.  Yaquierdo (Herts Summer Assizes,  1854) the prisoner,
who w7as charged w7ith wilful murder, w7as found by the jury to be
wilfully mute.  The man refused to plead, although it was obvious
that he was  well aware of the nature of the proceedings.  No
counsel could be assigned to him, as this could not be done  without
the prisoner's consent.  He Avas convicted  and sentenced.
  Dr. Wilson mentions the case of an  impostor  w7ho had succeeded
in convincing all around him that he was completely deaf.  His
medical attendant prescribed for him  daily- extra wine and  other
articles of diet, but in reality he ordered that none of them were
to be supplied.  The consequence was that while the patient was
nominally living  on the fat^ of the  land, he was actually suffering
from hunger.   At last the surgeon remarked  aloud that he  could
not understand why the patient seemed to be losing flesh with such
a diet.  This proved too much, and the pretended deaf man, in an
unguarded moment, indignantly exclaimed to the nurse, "You know
I have never  had any of those good things."  (" Lancet," 1872,1, p.
93.)   On one occasion, a pauper  feigning  deafness and dumbness,
was detected  by the production  of a case  of  surgical instruments
during a consultation between tAvo surgeons as to the performance
of an operation upon him at once.
  If the impostor can  write, he  may-  perhaps  be detected by the
ingenious plan adopted by the AbbC Sicard.   When the deaf and
dumb are taught to write they are taught  by the eye. The letters
are only known to them by their form, and their value in any word
can be understood only by their  relative position Avith respect to
each  other.   A half-educated impostor will spell his words, or di- 
           FEIGNED DEAFNESS  AND DUMBNESS.        821

vide them incorrectly: and the errors in spelling will always have
reference to sound—thereby indicating that  his knowledge has
been acquired through the ear, and  not alone through the eye.  A
man Avho had defied  all other means  of  detection wrote down
several sentences, in which  the misspelling Avas obviously due to
errors  produced by the sound of the words, thereby showing that
he must  have heard them pronounced.  The Abbe concluded that
the man was an impostor without seeing him, and he subsequently
confessed the imposition. 
822          PRINCIPLES  OF LIFE INSURANCE.
LIFE  INSURANCE.
                  CHAPTER  LXVII.

PRINCIPLES OF LIFE INSURANCE.—QUESTIONS TO  PERSONS  AVHO INSURE
  THEIR  LIVES.—MEDICAL QUESTIONS.--WHAT  DISEASES  HAVE  AND
  WHAT DISEASES HAVE NOT A TENDENCY  TO  SHORTEN LIFE?—LEGAL
  DECISIONS RESPECTING THE MEANING OF THESE WORDS.--CONCEALMENT
  OF DISEASES.—AVHAT IS MATERIAL CONCEALMENT?--CONCEALMENT OF
  HABITS.—WHAT IS INTEMPERANCE?—PROXIMATE AND  REMOTE  EF-
  FECTS.—DELIRIUM TREMENS.--EPILEPSY.—PHTHISIS.--ABSTINENCE.—
  VEGETARIANISM.--OPIUM-EATING. — INVETERATE SMOKING. —INSAN-
  ITY.—VOIDANCE OF POLICIES BY SUICIDE.:—SECRET POISONING OF PER-
  SONS AVHOSE LIVES ARE INSURED.

  The subject of Life Insurance in a medico-legal view is almost
peculiar to the medical jurisprudence of Great Britain.   This arises
from the extent to AA-hich insurances on  lives are effected in this
country, and from the peculiar nature of the provisions which regu-
late contracts of this description.
  The insurance of a life is  a contract  whereby the insurer, in con-
sideration of  a certain sum of money, called a premium, either in a
gross sum or in periodical payments—proportioned to the age, sex,
profession, health, and other circumstances of the person whose life
is insured—undertakes to pay to the person for Avhose benefit the in-
surance is made, a stipulated sum or an  equivalent annuity, upon
the death of the individual whose life  is  insured, whenever this
event shall happen, if the insurance be for the whole life; or, in case
this shall  happen within a certain period, if the insurance be for a
limited time.
  The  deed by which this contract is made is called a policy, and it
is concerning the stipulations of  the policy, and the meaning to be
put upon certain medical terms used in it, that litigation commonly
arises.  The amount of premium payable will be regulated by the
mean expectation or duration  of life of the  individual; and this it is
Avell known is not only different at different ages, but is greater at
certain periods of life in women than  in  men.  One fact, however,
is certain,—the most successful Insurance Offices have considerably
underrated the probability of expectation of  life among adults, and
thus have derived enormous  profits by demanding higher premiums
on the insured than a fair view of the  rate of  mortality Avould jus- 
PRESUMPTION  OF  DEATH.
823
tify.   The  calculations of some of the older offices Avere based on
Avhat is called the Northampton Table, which represents in an ex-
aggerated degree the mortality7 not only of the class of persons avIio
commonly  effect insurances,  but  of the entire  population.  This
table has been thus improperly applied to determine the mortality
of men in  the middle classes, holding the most durable tenure of
life.  Besides this, as Mr. Edmunds has shown, some of  the offices
have entirely excluded from insurance the sick class, out of which
the greater part of the mortality indicated in the table  necessarily
takes place.  By excluding the sick, and requiring strong medical
certificates  respecting the condition of healthy- applicants, it follows
that  the mortality among the insured falls immeasurably short of
that  which is  indicated by the ordinary Tables of  Mortality, from
which  the amount of premium is really calculated.
  The  sum for Avhich a person's life has been insured cannot be re-
covered until after the death of the  person, and distinct proof of
death.   Those who w-ould benefit by the death must prove the fact
of death, when this is open to doubt.   A case is reported in which
a claim was  made on an  insurance company- for the amount of a
policy  on the life of a man Avho suddenly disappeared, Avhile at
Brighton, within a Aveek after the insurance of his life had been
effected.  The man's clothes were found on the beach, and the jury
AA7ere asked to infer from this fact that the man was drowned, and
that his  body had  been carried out to sea.  No one had seen him
go into the water.  The jury Avere discharged  without a verdict.
It w7as quite possible that the clothes had  been designedly placed
there, and that the man had gone off in another direction, and Avas
still  living.
   [A case is mentioned in Angell on " Fire and Life Insurance," p.
379, note 4, where the defence of want of proof of death  Avas set
up, but  not  successfully.  In the  Avinter of 1848, Rev.  Thomas
Waring very mysteriously disappeared near Elizabethtown, Hardin
Co.,  Kentucky, and was then, and still believed by his relatives and
friends to  have been  murdered.  Some years before his death he
had  effected  an  insurance on his life, in  favor  of  his wife, in the
Nautilus Mutual Life Insurance Co. of New York, for  $5000.  In
January, 1853, suit Avas  instituted in Jefferson Circuit Court by
Mrs.  Waring, for the recovery  of the sum  named.  One of the
points  relied  upon by the defence Avas that he Avas not dead, but
had  absconded.  The Avhole case turned upon this.   The case was
submitted  to the jury upon the evidence, and a verdict rendered for
plaintiff for the amount of the policy Avith interest.
  The law applicable to  such cases is thus stated by Mr. Angell
("Fire and Life  Insurance," § 351): "In order to render the in-
surers  upon  a life liable, the event of death may (must) happen
within the time prescribed by the policy, and as a  doubt may exist
whether the pierson upon whose death the liability- depends is dead,
a question  of fact may be raised to be determined by the jury.  All
the authorities concur in stating the rule of the common law to be
that the  presumption of life  with respect  to persons of Avhoni no 
824
PRESUMPTION  OF  DEATH.
 account can be given, ends at the expiration of seven years from the
 time they were" last known to be living; and that, after such a
 period of time,  the burden of proof is devolved on the party insur-
 ing the life of the individual in question.  The  issue in such case
 being an issue  of fact, the jury- are  at liberty to find the fact of
 death within the period of seven years, upon the  circumstances
 proved in the case.   The circumstances which  have  been stated to
 be material to  this issue, are the age of the  party, his situation,
 habits, employment, state  of  health,  physical  constitution,  the
 place or climate of the country, whether  he went by sea or land,
 the facilities of communication  betAveen  that  country  and his
 former home, his habit of correspondence with  his relatives, the
 terms of intercourse upon which he lived with them, in short, any
 circumstances tending to aid the jury in finding the fact of life or
 death—all these circumstances have been stated by Prof. Greenleaf
 as material.  There must also be evidence, that learned author pro-
 ceeds  to say, of diligent inquiry at the place of the person's last
 residence in this country, and among his  relatives, and any others
 who would have probably heard from him, if living; and also at
 the place of his  fixed  foreign residence, if he was known to have
 any.   In Loring v.  Steinman, 1  Met. (Mass.) R. 204, Shaw, C. J.,
 in giving the judgment of the court, says: "It is  a well settled
 rule, that upon a person's leaving his  usual home and place of resi-
 dence for temporary  purposes of business or pleasure,  and not being
 heard  of, or  known  to be living, for the  term of seven years, the
 presumption of  life then ceases, and that of his death arises.   The
 presumption is greatly strengthened when the departure of an indi-
 vidual was from his  native place, the  seat of his ancestors, and the
 home of his brothers and sisters, and family- connections; and still
 further Avhen it  was  to enter upon the perilous employment of a
 seafaring life."
  Upon this subject, see also Best on Presump., 59-61;  Whiteside's
 Ap., 11 Harris 114;  Campbell v. Read, 12 Ib. 498 ; Holmes v. John-
 son, 6  Wright 159;  Windship v. Conner, 42 N. H. 341.
  When the person whose  life  is in question has gone  to sea, the
 presumption  of  death may arise  much sooner than seven years.
 Thus in Patterson v. Black, Park on Ins. 433-34 (2  Am. Ed.) the
 question was whether  the  assured died before the 30th January,
 1778.  It appeared that about the 20th November, 1777, he sailed
 from the Cape of Good Hope, in the  sloop of war Sw-allow, which
 ship, not being afterwards heard of, was supposed to have been lost
 in a storm off the Western  Islands.   The plaintiff proved the de-
 parture, and also called several captains who sailed at the same time
 who swore that the vessel must have been  as forward  in her course
 as they were on the  13th or 14th of January, the period of a most
 violent storm, in which she was probably lost; and that the SAvallow
 was much smaller than their vessels, Avhich with difficulty weathered
 the storm.   Lord Mansfield, Avho tried the cause, left it to the jury-
 to say whether,  under  all the circumstances, they thought the evi-
dence sufficient to convince them that the assured died" before the 
SURVIVORSHIP.
825
time limited ;  adding, that if they thought it so doubtful as not to
be able to form an opinion, the defendants should have their ver-
dict.  They found for the plaintiff.
  The rule is stated to be that where a vessel is missing and no in-
telligence of her has been received within a reasonable time after she
sailed, it is presumed that she foundered at sea.  Thus, Avhere a ship
was insured in 1739, from North Carolina to London, an action was
brought against the underwriters.  The only evidence was that she
had sailed on her intended voyage, and had never since been heard
from.  The defendant objected  that as captures  and seizures were
excepted by the policy, it lay in the assured to prove a loss by sink-
ing, etc.  The Chief Justice (Lee), however, said that it would be
unreasonable to expect evidence of that, for as everybody on board
was presumed  to be droAvned, the plaintiff had given the best proof
the nature of the case admitted of.  The case being left to the jury,
they found for the plaintiff.   Green v. Brown, 2  Strange 1199.
  In order to raise this presumption, hoAvever, it  must be distinctly
shoAvn that the ship left the port bound on her intended voyage;
and although  her  not being heard of for many months or years,
raises a presumption of her crew having  perished, it affords none as
to the precise time of the death of any person on board.   This must
be collected bv the jury from the circumstances of the case.  Watson
v. King, 1 Stark.  R. 121; Sillick v. Booth, 1 Y. & C. N.  C. 117;
Best on Presump. 145-6.
  Where tAvo or more  persons perish by the same  calamity, the
question sometimes arises, when the circumstances of their deaths
are unknown,  which one is to be presumed to be survivor.   By the
Roman law, if it were the case of father and son, where the latter
was under the age of puberty, he was presumed to have died first;
but if above that age, the presumption was the other Avay.   By the
French code, if the persons perishing are under the age of fifteen, the
eldest is presumed to have survived ; if  above the age of sixty, the
youngest.  If  betAveen those ages and of different sexes, the male is
presumed to have survived; if of the same sex the presumption is
in favor of the younger.   (Greenleaf's Ev. vol. 1, § 29.)
  But in the common laAV, no rule on the subject has been laid down;
and the better opinion is that the presumption is that all perished
together.  Ib.  § 30.   However, in the case of Moehling v. 31itchell,
1 Barb. Ch. (N. Y.) 264,  w-here  a married woman  procured an in-
surance on the life of her husband, for her oavii use, the money to
be iiaid to her, unless she died before him, and in that case to her
child, pursuant to the act of 1840 (2 R. S.  3 ed. 207, §§ 60,  61), and
sailed with her husband and child in a ship which was never heard
of again ;  held, there being no presumption that the child survived
her or that she survived  her husband,  that the case did  not fall
within the act, and that  the insurance money was part of the per-
sonal estate of the husband.
  " If any circumstances of the death of either party can be proved,
there can be no inconvenience in submitting the question to a jury,
to Avhose province it properly belongs."  1 Greenl. Ev. § 30.  Thus 
826
EXPECTATION  OF  LIFE.
in the case cited by Blackstone, from Cro. Eliz. 503 (2 Black. Com.
132), upon the  question of what constituted a sufficient seisin on
the part of the husband to entitle the wife to dower, where a father
and son Avere both hanged in one cart, but the son Avas supposed to
have survived the father by appearing to struggle longest; the jury
found that he was the survivor, whereby he  became seized of an
estate in  fee by survivorship, in consequence of which seisin  his
widow had a verdict for her dower.   See also upon this  subject,
Best on Presump. 190-202.—P.]
  Different rules have been given by actuaries for calculating the
expectation or duration of life at different ages.  It is difficult to test
their accuracy, except in reference to large numbers of persons liv-
ing under similar circumstances, and for these groups of the popu-
lation statistics do not fairly- provide.  Age is the point from which
nearly all the Tables of Mortality start, without reference to health,
trade, occupation, or social position. One of the most simple of these
rules for calculating the duration of life from 5 to 60 years has been
given by Willich; lie  considers  it to be equal to tAvo-thirds of the
difference betAveen the age and 80.  Thus, in a man 20 years of age
the difference is equal to 60, and two-thirds of this are equal to 40,
the probable duration of life  for  a person of average  health at  20.
Each office has its own rules for calculating the amount of premium
to be paid by the person who effects an insurance.  As insurance
offices are very numerous and their profits are large, it is obvious
that their calculations must be very much in their own favor.  The
expectation of life in the insured is ordinarily much greater than
they assign to it; at the same time, the amount payable in the form
of premium is kept down by competition.
  With respect to the influence of profession, a higher premium is
demanded by some offices for the insurance of the lives of persons
whose occupiations expose them  to great risk—as, for instance, of
persons actually engaged  in  military or naval service.  The rule
adopted with respect to professions in one of the best London offices
is as follows:  "No  extra premium is required from any person  in
the army or navy unless on actual service, but  the assurance will
be void if the  party whose  life is assured enter  into any naval or
military service whatever, unless  by consent  of  the Directors, en-
dorsed on the policy."
  Above all other conditions, the general state of health of the person
is likely to have a most important influence on the mean duration
of life; and it is here that medical science lends its aid—1st, by
showing how far a contract may be safely  entered into when  the
person is affected with disease;  and, 2dly, by showing Avhether a
diseased state  of  the  body  really existed  in the person  insured,
although at the time of insurance it may have been alleged that he
wras healthy, and free from disease.
  By improved methods of diagnosis, the existence of disease under
a proper  examination is easily  made known, or it may be at once
inferred  from  symptoms described  by  non-professional  persons.
Then, again, the influence of particular diseases in shortening  life 
      QUESTIONS  CONNECTED WITH  LIFE  INSURANCE.   827

are now so much better understood than former!}7, that the numer-
ous offices have  of late years been especially established for the in-
surance of diseased, as well as of healthy lives, the amount of pre-
mium being of course regulated by the nature of the disease, and
the degree to which it may have advanced.  In these cases, lives are
insured as  if the persons had  reached a greater age, the amount
paid  being calculated on the theory that the person is ten, fifteen,
or twenty years  older than he is.
  As in the case of all civil contracts, the law requires that  there
should be a strict compliance with the conditions by each party,  it
follow that, if any fraud has been committed by the insured—if he,
or those to Avhom  he trusted  in his dealings with the office, have
concealed from the insurers the existence of any disease under which
he was at the time laboring, or any symptoms indicative  of a pro-
bable attack of  disease; or if he or they have knowingly and wil-
fully misrepresented or  misdescribed  his  actual bodily condition,
then the  contract will be  void, and the amount of the premiums
forfeited.   This forfeiture is a usual condition in the  policy.   Ac-
tions on policies of life insurance are not unfrequent; and, unfortu-
nately, the medical evidence given on these occasions, as in cases  of
insanity, is of a very conflicting character.  This  is by  no means
creditable to the profession, for it either proves the existence  of
great bias in the witnesses, or that medical rules are  devoid  of all
certainty, and are therefore practically useless.   A Avriter, in com-
menting upon these professional conflicts, says: "One of the  most
unsatisfactory parts of our law of evidence is that Avhich relates  to
the  testimony of experts.  It  is impossible to shut  out such evi-
dence altogether, but there is nothing Avhich brings more discredit
upon the administration of justice.  There is one consequence of its
admission AA-hich is common to all cases in AA-hich it occurs.   It  is,
that no difficulty has ever been found in  obtaining any amount of
evidence of this description  on either side of any point  a,t issue."
It will be, therefore, necessary to enter into an examination of the
circumstances under which medical men are called upon  to appear.
An  action  is never  likely to  be brought for the recovery of the
amount of a policy, except in those cases  w7here there  is  reason  to
suspect that a  Avilful fraud has  existed in  the contract.  Juries
always regard such actions with disfavor;  and Avhile judges  inter-
pret the laAV strictly, the onus of proof is entirely- throAvn upon the
offices.  Hence  the insured are placed in a very advantageous posi-
tion.  These actions, in nine cases out of ten, depend upon the con-
struction put on the medical terms of the  contract; hence, it  is our
duty to see how7 medical defects are likely to arise in reference to
the  policy.  The conditions of insurance vary in  different offices.
The following are taken from  the papers issued by one of the prin-
cipal London offices:—
   Questions.—The name,  residence,  and  profession of  the  party
whoselife is to be assured? Place of birth ? Date of birth? The
_ day of —. Age next birth  day — years'?  (Proof should be fur-
nished.)   Married  or  single?  Sum to be  assured, £ —.  Term for 
828  QUESTIONS  PROPOSED TO  THE MEDICAL  ATTENDANT.

which  the assurance is required?  Have you ever been afflicted
with gout, rupture, asthma,  fit  or fits, spitting of blood, or any
other disease or disorder Avhich tends  to shorten life?  Have you
had the smallpox, or been vaccinated?  Have any of your relatives
died of consumption ?   Are you  now,  and  have you always been,
of temperate habits of  life?   Are you employed in any naval  or
military service ? State if there be any other material circumstance
touching your past or present state of health or habits of life  to
which  the foregoing questions  do not extend?  Name and resi-
dence of your usual medical attendant?  Has attended me — years.
Name, residence, and profession of two friends AA-ell acquainted with
your health and habits of living?  Has known  me — years.  Has
known me — years.  Has a proposal ever been made on your life
at any other office or offices?  If  so, where?  Was it accepted at the
ordinary premium ? or at an increased premium ?  or declined ?  I, the
above named----, do hereby declare that the foregoing statements,
and the answers and replies made by7 me to  the  several above-men-
tioned questions and requisitions, and each and every of them, is and
are true in substance and matter of fact. And that I have not omit-
ted or concealed any fact, matter, or thing in anyAvise touching  or
affecting my state of health, constitution, or habits of life.  And I
also  declare, that it is expressly understood  and agreed between
myself and the Company, that the foregoing particulars, statements,
and this declaration are to be considered and taken as  the basis  of
the contract of assurance between  me and the Company, for this
assurance.  And in case the foregoing  particulars,  statements, and
declaration be  untrue, or contain any untrue averment, the policy
of assurance effected in pursuance thereof shall, in any or either of
such cases, be absolutely null and void, and the  premiums paid
thereon shall become and be absolutely forfeited to the Company,
and  not be receivable or recoverable by me or by my representa-
tives.  Dated the — day of —, 186-.   Signature of the person.
   [Statements in an application for life insurance, "upon the faith
of which the piolicy is expressed to be made, with a stipulation that,
if they shall be found  in any respect  untrue, the  policy shall  be
void," are warranties, and'if untrue, even in a point immaterial to
the risk, avoid the policy.  Miles v. Connecticut Mutual Co., 3 Gray
(Mass.)  580; Cazenove v. Ins. Co., 6 C. B. (N.  S.) 437.—P.]
   The following questions are submitted to the usual medical atten-
dant of the person whose life is proposed for insurance:  1. How
long have you known him ?   2.  Are  you his usual medical atten-
dant? and have you seen him  with  reference  to  this report?  3.
When was he last ill ? and what  have been the nature and duration
of the complaints for which you have attended him?  4. Has  he
to your knowledge, or have you  reason to believe that he has had,
any giddiness, or  affection of the head, or any  particular determi-
nation of blood  to the head; or has he  suffered from apoplexy,
palsy, epileptic or other fits, or other disease of the brain, or from
insanity?  5. Has he ever suffered from pulmonary disease? from
habitual cough, shortness of breath, spitting  of blood, asthma,  in- 
REFEREES.
829
flammation, or other disease of the lungs, or  from disease of the
heart?  6.  Has he ever had dropsy, inflammation, or severe disease
of the boAvels, disease of the liver, of the kidneys, or other urinary
organs, or any affection of the alimentary canal ?   7. Has  he had
gout or rheumatism?   If so, in what  form? and have the  attacks
been frequent?  8.  Has he ever been  affected with  hernia?  If so,
in Avhat situation?  Is it reducible? And does he wear a truss?   9.
Has he had any serious Avound, hurt, or other accident, causing any
bodily infirmity?  10. Do you consider he is iioav in perfect health?
11. Has he been, and  is he noAv, habitually sober  and temperate?
12. Is he of active or sedentary habits ?   13. Does his occupation
expose him to the chances of disease ?  14. Have his  parents been
healthy  and long-lived, or  othenvise?  15.  Have  any of his near
relatives died of consumption or any hereditary disease ? 16.  State
any material circumstance  touching his health or habits, to which
the foregoing  questions do not extend, which may affect  the eli-
gibility  for life assurance?  Dated this — day of —, 186-   Signed

  In order to show the searching nature of these inquiries, and how
one set of answers is made to act as  a check upon another, it is only
necessary to refer to the following list of  queries which are put  to
private individuals acquainted with the person.   This paper is to  be
filled up and transmitted with a proposal for life-insurance:—
  State  whether you have  been acquainted with the person whose
life is proposed to be  insured,  and how long.  Whether you have
ever heard or known of his being  ill, and,  if so, state the time of
the illness and nature  of the complaint.  Whether he is at this time
to the best of your knoAvledge and belief, in perfect health. Whether
his habits and manner of living are temperate and  regular.   (You
will be pleased to direct your particular attention to this subject of
inquiry.)  Whether his appearance indicates health and a good con-
stitution.   Whether there  is any, and what, apparent defect in the
formation of his person.  When you last saAv him.  Whether he is
in person thin or middle-sized, stout or bloated.   Whether his com-
plexion  is pale, sallow, broAvn or florid.  Whether  he is married  or
single.  Whether he has had any brothers or sisters.  If so, how
many; the number now7 living; the ages  at which the others have
died, and the cause of their decease.  Ascertain and state Avhether
his parents are living, and if not, the  age at Avhich they have died,
and the causes of their death ; communicate all the information you
can acquire as to the health and longevity of his other relatives;
also Avhether any of them have died of consumption,  or have been
subject to fits or  mental derangement.  Whether the persons referred
to, respecting  the  life to be insured, are worthy of  credit; and
whether the medical referee is the  usual  medical attendant of the
party.  Whether you consider the life  in question in all respects safe
and proper to  be insured by the company upon ordinary- terms, and
Avhether you recommend the same to the Directors as such.  Ascer-
tain  if  the life has  been  proposed in any other office, and  if so,
whether declined or  taken.  If the insurance is proposed by one 
830                 MEDICAL  REFEREES.
party on the life of another, endeavor to learn and state the object
for Avhich it is intended.
  No one can  blame insurance offices for acting thus rigorously.
Frauds of the worst description have been frequently attempted upon
them, and it is only by the adoption of  a system of this kind that
they can protect themselves.
  The chapter on  life-insurance in the first edition of this work has
been translated  by M. Tardieu with numerous editions.   ("Ann.
d'Hyg." 1866, 1, 383, and 2, pp. 120 and  382.)  Among  them he
gives copies of the questions to which answers are required  by many
French,  German,  and Spanish offices.   They  do not materially
differ from those above given, but the more recent offices have evi-
dently profited in  this respect by the experience of the older insti-
tutions in Great Britain.  Dr. Gmelin, of Stuttgart, has  collected
the formularies of questions put by fifteen dift'erent offices, chiefly
German, to the  medical attendant of the intending insurer.   He
finds that they vary from a minimum of  ten to a maximum of
thirty-two questions.   He divides them into superfluous, indiscreet,
irrelevant, and misleading.  (Eulenberg, "Vierteljahrs." 1872,1, 271.)
From the minuteness of  some of these  inquiries it appears that  a
much more difficult duty is thrown upon German than upon English
medical practitioners.   According to  M. Tardieu, some French
companies act upon a much more reasonable plan, and leave the
medical attendant perfectly free to draw up a certificate according
to his oavii views.  ("Ann.  d'Hyg." loc.  cit.)
   The relations  of medical  men with  insurance offices—Medical re-
sponsibility.—The practice Avith some offices in obtaining a certificate
gratuitously from the medical attendant of the person proposing to
insure his life is one great source of litigation.  The responsibility- of
causing the life to be accepted or rejected is thus throAvn entirely upon
the  usual medical attendant of  the person; for, as we shall see
hereafter, an application for a certificate from a medical practitioner
who is a stranger, is very likely to be treated as a fraud, and to lead
to the disputing of the policy.  The medical attendant of the person,
it is true, is the only individual who can properly certify- to the real
state of health, and therefore to him  an application is  generally
made.  He is sometimes expected to furnish an important certificate
of this kind gratuitously;  and should it happen to be unfavorable,
he is exposed to the risk of losing what may probably be a lucrative
portion of his practice: for I shall not  sup>pose that any member of
the profession would certify- to Avhat he  knew to be untrue, in order
to retain a patient.  The question is, whether an insurance office has
a right to place a medical man in such a responsible position as this.
In the issuing  of a policy, the insurers and insured are equally
benefited, for the contract w7ould certainly not be made except upion
a supposition of reciprocal  benefit.  The medical attendant, without
whose sanction  the policy could not be properly effected, not only
derives  no benefit, but is  actually exposed to the risk of loss for
performing in an  honorable and conscientious manner an invidious
duty thus forced upon him.  Such a state of things ought not to be. 
MEDICAL  REFEREES.
831
Many actions for the recovery of disputed policies have shown most
clearly that the practice leads to great carelessness and indifference
on the part of medical men in draAving up these certificates; and
this produces, in  the end, a more serious loss to the representatives
of the insured, than if the life  had not been accepted.  It must be
remembered that the  insurers  do not suffer by any  misconduct on
the piart of a medical man who signs such a certificate, but the repre-
sentatives of the insured ; hence, the offices show no disposition to
amend this vicious system.  It is always professed that such com-
munications are confidential; but in more than one instance medical
men have found that the  contents of  their certificates have become
known to  their  patients, and have even been publicly used as evi-
dence in courts of law.  A partial remedy Avould be, that the medical
attendant of the party- should not be called upon to sign a certificate
at all, but that this should be done only by a medical referee of the
office, after a regular  professional consultation with the medical
attendant, and a proper examination of the person.  If the life Avere
rejected, the onus of rejection would  be on the proper person—the
appointed  referee; and  if  accepted, he w-ould be properly made
responsible to the office for any gross  negligence in the performance
of his duties.  It is true that there are few insurance offices which
have not consulting physicians and surgeons attached to them; but
the weight of responsibility in contested  suits does not rest with
these officers so much as with the medical attendants of the insured.
In the event of a medical practitioner being called upon to sign  a
certificate of this kind, it appears to me  that the safe plan to  be
adopted would be that he should decline the proposal, except upon
a professional consultation with the medical officers appointed by
the  insurers.  If, however, from  private considerations, he is com-
pelled to sign the certificate, it is his duty to use the greatest caution,
not merely in returning answers to the formal questions on the paper,
but in detailing all particulars known to him respecting the state of health
of the person.  In acting otherwise, he would be  doing the greatest
possible injury to the representatives of the insured, and probably
damage his own reputation.  There  is no intermediate course ;  the
duty must either be performed carefully, conscientiously, and hono-
rably, or it must be declined altogether.  [The practice of  sending
blank certificates to be  filled up by the regular medical attendant
of the applicant, gratuitously,  has become as great a nuisance in the
United States as in Great Britain.   We are clearly of the  opin-
ion that it is not the physician's duty to comply Avith such requests;
it is optional with him  to  do it, or not.  In the  first  place,  the
company has no right to the service without an adequate compen-
sation ; and secondly, there may be cases  in which the family  phy-
sician w-ould have serious doubts as to the propriety of divulging
professional secrets connected with his patient's former^health,e.g.,
in the case of syphilis; or of certain  habits, as of occasional drunk-
enness or opium eating.  Of course,  all such points must be known
to the applicant himself, and on him  alone must devolve the risk of
any concealment.—R.] 
832        DISEASES  TENDING TO  SHORTEN  LIFE.

  Diseases tending to shorten life.—Let us take the case, however,
that this preliminary duty has been properly performed ; important
medical questions may arise respecting the alleged infringement of
the conditions of the  policy.   The list of diseases specified com-
prises a great variety—affections of the head, apoplexy, palsy, epi-
leptic or  other fits, disease of the brain,  insanity, disease  of the
lungs, spitting of blood, asthma, inflammation, disease of the heart,
dropsy, diseases of the bowels, liver, kidneys, or urinary organs, gout,
rheumatism, hernia, phthisis, or any hereditary disease.  In the
proposals of some offices, the mysterious word " fits " occupies a very
prominent position, but it is difficult  to say what this word thus
isolated actually means.  It appears to have  been borrowed from
the vocabulary of the ancient searchers under the bills of mortality
in the reign of Charles II.   Thus  it may comprise, apoplexy, epi-
lepsy, paralysis,  syncope, convulsions from any cause,  and even
asphyxia.  The word is too indefinite for a certificate, and should
be expunged.  In the mean time, a court of law will not allow in-
surers to benefit by the use of ambiguous terms in the contract,
and it has therefore  commonly restricted the meaning of the Avord
"fits," to attacks of epilepsy.  The main  condition, however, is in-
volved in  the terms—" any other disease or disorder tending to shorten
life."  Upon the  meaning  of these  words litigation commonly
turns, and the opinions of medical experts are required.
  It is  impossible to lay doAvn any general rules for determining
what diseases have, and what diseases have  not  a  tendency to
shorten  life.  Any deviation from  health  might be so interpreted;
but the law puts  a proper limitation here upon the meaning of the
words, considering them to apply to those diseases only Avhich, in a
medical view, are regarded as  of a serious nature, and, as a general
rule, are  likely either  directly or  indirectly to affect the duration
of life  of any person  laboring under them.  This question w-as
brought to an issue in  the case of Watson v. Mainwaring, in which
payment of the amount  of a  policy was  refused, because the  in-
sured had labored at the time under what was called organic dyspep-
sia ; and  this fact  was kept concealed from the insurers.  It w-as
left as a  question of fact to the jury, whether the malady with
Avhich the deceased was afflicted, and  of which he ultimately died,
Avas  an  ordinary  or organic dyspepsia at the time of the insurance.
The judge (Chambre)  in charging the jury said : " All disorders
have more or less a tendency to shorten life, even the most trifling;
as, for instance, corns may end in mortification; but that is not the
meaning of the clause.   If dyspepsia were a disorder tending to
shorten  life within this exception, the lives of half the members of
the profession of  the law would be  uninsurable."  We learn then,
from this  case, that a person may die  from a disease under Avhich
he was laboring at the  time of  insurance; and yet if it be not the
common course of that disease to  shorten  life, the  representatives
may recover the amount of the policy.  This is an equitable inter-
pretation of the terms; for the insurers  have no right to give a
forced meaning to the words of the policy, and to take advantage 
INFLUENCE OF GOUT.                833
 of what must be  regarded as an  accidental result.   From other
 decisions Ave learn that, in order to render a policy valid, these words
 do not  imply that  the insured must have been at the time entirely
 free from all the seeds of disorder or latent  disease.   Such a condi-
 tion is impossible.  A man may be  laboring under  some insidious
 disease—ulceration of the stomach or intestines, for instance—lead-
 ing to perforation ; but if this be, as it commonly is, unknown both
 to himself and  his medical attendant, the insurers are bound to
 take the risk.  Lord Mansfield in the case of Sir James Ross, held
 that the warranty Avas sufficiently true, if  the person were  at the
 time in a reasonable good state of health.   A life may be a good
 life, although the person may be at the time  laboring under  some
 bodily infirmity.
  _ [The assured, who effected a policy on his life in February, 1855,
 signed a declaration stating, among other things, that he was then
 in good health, and did ordinarily'enjoy good  health; and that he
 was not aAvare of any disorder or circumstance tending to shorten
 his life, or .to render an insurance on his life more than usually haz-
 ardous, unless anything stated in ansAver to  certain questions Avhich
 preceded the'declaration might  be so considered.  In an action upon
 the policy, it appeared that in 1853 and 1854, the deceased had had
 two severe bilious attacks.   Medical men  had  expressed different
 opinions as to the effects of these attacks upon his health;  but it
 did not appear that the unfavorable opinions had ever been com-
 municated to the.assured. ' It was  held that  it AA7as proper to  in-
 struct the jury that " if the assured honestly believed at the time
 he made the declaration, that the bilious attacks had no effect upon
 his health, and did not tend to shorten his life, or render an insur-
 ance upon it more hazardous, the fact that he was  aware that he
 had had these attacks, even though (without his knowledge) they
 had such a tendency, would not defeat the policy."—Jones v. Pro-
 vincial Ins.  Co., 3 C. B. (N.  S.) 65.—P.]
  On the other hand, a disease tending to shorten life must not be
 taken to signify  only one of those maladies which have commonly
 a rapid  and fatal course—as phthisis and scirrhus; it may apply to
 dropsj-, gout, asthma, insanity, and  many diseases of a chronic cha-
 racter.   When the existence of these diseases, or even a well-marked
 tendency to them, is concealed from the insurers, or omitted to  be
 stated  through  mistake, even  without fraudulent  intention, the
 piolicy in the event of death  becomes void, because the risk incurred
 is really different from the risk understood and intended at the time
 of the agreement.  Such diseases are not necessarily fatal, but this
 is not the question; their tendency \s to diminish the expectation of
 life, and if medical evidence establish this with regard to any dis-
 order intentionally  concealed, whether chronic or acute, the contract
 is at an end.
  Gout.__In December, 1862, a case was tried in which it was alleged
that there had been concealment of the existence of gout. (Excrs. of
Fowkes v. The 31anchester and London Assurance Company.)  The
deceased, Fowkes, a commercial traveller, aged 49, in the year 1860
      53 
834
CONCEALMENT OF HABITS.
effected a policy on his life for 1000J.  He died in June, 1861.  Pay-
ment was refused on the ground that  the answers of deceased were
untrue, and that there had been suppression of a material fact.  It
seems he Avas asked whether he had ever been afflicted with gout, and
he  answered "No."  He Avas asked Avhether the life  had been
offered  at  any other office, and, if so, whether it  Avas  accepted ;
and he answered  that it had been proposed, and had been accepted
at the ordinary rate.  These Ave re the  ansAvers Avhich it was alleged
were  false.  On  the part of the company, a surgeon stated that in
May, 1858, deceased was suffering from suppressed gout.  He had
an " extremely slight  attack," which  lasted only about forty-eight
hours; he did not tell the deceased that  it was gout;  he believed
that  he died of  suppressed gout in an aggravated form.  A  pro-
posal  of the deceased to  another company, Avhich had been declined,
was put in evidence.  On  the part of the plaintiffs it was contended
that there was no evidence that deceased had ever been  " afflicted
Avith  gout."  The Lord Chief Justice left  it  to  the  jury—first,
w-hether the ansAvers of the insured Avere untrue ; and next, Avhether
they7 were false to his knowledge.  First, had he been  "afflicted
with  gout?"  The question  must  be  considered with some reason-
able latitude, and it Avas  not  because a person had some passing
symptoms which  a far-seeing  medical man might ascribe to the
presence of suppressed gout in the system, but Avhether  there was
gout  in a  sensible appreciable form? This certainly was stated
before the  proposal, to  have been  " the slightest, possible case" of
gout,  according to the medical evidence.   As to the other question
—whether the life had been proposed at any office and accepted or
declined—it appeared that the life had been proposed at two offices,
and accepted by one, but  declined by the other.  Had the assured
answered  truly- in simply saying that he had proposed  and been
accepted ?  The question no doubt was not  in the most compre-
hensive form, but was it  ansAvered fully and fairly, and  according
to its obvious meaning and effect, by saying nothing of the proposal
which had been declined ?  He thought not; but left it to the jury.
He, however, thought further that it Avas not strictly true that the
life had been " accepted" in the sense in w-hich the word was used—
for it  had not been accepted by any office on a proposal for assurance,
but merely- approved by the medical  man.  It Avas for the  jury to
say whether either of the answers was untrue, and, if so, whether
either was untrue to the knowledge of the assured.  The jury found
that the assured had not been  afflicted with gout at the time of the
proposal;  also that the ansAver to the other question was  untrue,
but not to his knowledge.  The Lord Chief Justice directed a ver-
dict for the plaintiff, subject to  a point reserved for  the court
whether the knoAvledge  of the untruth was material.

  Habits.—Again, a person may be laboring under no actual disease
at the time of affecting the insurance, but his habits may be such as
to produce general injury to  health, and to  have a tendency to
shorten life.  Concealment of habits, the effect of which  on health 
CONCEALMENT OF HABITS.
835
must, or ought to be knoAvn to all medical men, may be just as fatal
to a policy as the concealment of a serious disease.  Although they
may not  ahvays be included in the questions put by the office, yet
the laAV will equitably hold that the insurers should be made ac-
quainted  Avith all circumstances Avhich might reasonably affect the
risk.   Concealed habits of drunkenness have thus given rise to
medical questions of considerable importance; and in one remarkable
instance Avhich Avill be mentioned hereafter, a question arose as to
whether  the  practice of opium-eating, which  had been concealed
from the insurers, had or had not a tendency to shorten life.
  Some recent exposures, partly of a civil, and partly of a criminal
nature, have rendered insurance offices much more strict in  their in-
quiries.  In the rules already quoted, special  information  is de-
manded upon the existence of material circumstances touching health
or habits of life, and Avhether the person is, or is not of temperate
habits.   Any facts  bearing upon these questions, if known to the
medical attendant, must of  course be stated.  The existence of such
habits must be known  to  the person himself, and the declaration
Avhich he signs is so explicit that,  if intentionally concealed by him,
no individual can reasonably complain of  the voidance of the policy
and the forfeiture of the premiums.
  The case of Von Lindenau v. Desborough, tried in the Court of
King's Bench before Lord Tenterden  in  October, 1828, shows that
medical men are bound, at the risk of invalidating the policy, to
state the exact bodily condition, so far as it can be obtained by ob-
servation, of  the  person  whose life it is proposed to insure.  It
appears that on the 16th June, 1824, a policy for 3208J. Avas  effected,
in the Atlas office, on the life of  the Duke of Saxe  Gotha,  at the
time he Avas residing abroad.   The Duke died on the 17th Febru-
ary, 1825, within nine months of the time of effecting the insur-
ance ; and the payment of the amount of  the policy was refused on
account of a material concealment of the exact condition of the
insured from the insurers.  It appeared  in evidence that for some
time  prior to the insurance, the Duke  bad been an invalid, and
that at the time it was effected he was childish, and had not spoken
for two years.  He had  labored under some affection of the brain,
did not improve in health after the insurance, and ultimately died
from an  attack  of  paralysis.  The certificate upon Avhich the in-
surance was granted had been  signed by tAvo German physicians,
Drs.  Dorl and Ziegler.  It was to the effect that the  general health
of the Duke Avas°good; but that he was "hindered," (gehindert,
had an impediment) in his speech, and had an affection in his left
eye.   It was also stated  that he was perfectly free from disease, or
symptoms of disease.  On inspection of the head, a tumor  of  large
size connected with the  inner table of the skull was found pressing
upon the brain.   This tumor was evidently of long standing, and
had  probably been  the  cause of the symptoms and death,  len
ounces of serum Avere found effused in the brain.
  It appears that before the insurance  was effected, an  agent in
Germany- had informed the insurers that  the Duke had led a disso- 
836
MATERIAL  CONCEALMENT.
lute life, by which he had lost the use of his speech, and, accord-
ing to some, of his  mental faculties  also; and on this  the Office
required a payment of nearly double the  usual premium.  The
case of the insurers was that there had been material concealment
•of the Duke's real condition at the time of effecting the insurance.
The late Mr. J. H. Green, who apipeared as a witness for the plain-
tiff, the claimant under the policy, considered,  from  the history of
the case, that there Avere no symptoms of organic disease, although
the symptoms mentioned Avould lead to a  suspicion of disease in
the head.  In reply to a question by Lord Tenterden, he said if, as
a medical man, he had been asked by an Insurance Company con-
cerning the state of a  man's health, who Avas  uiiAvilling to move,
who was subject to control and influence,  and who had lost his
speech, he would have considered  it his duty to mention these cir-
cumstances.  Lord Tenterden  then left it to the jury- whether there
had been any concealment of material  facts  relative to the Duke's
health.  The plaintiff was nonsuited, and a new trial subsequently
refused.
  There can be no doubt that  the ansAver here  given  by  Mr. Green
was such as every conscientious man must  have  given  under the
circumstances.   A medical  expert appears in  court to  speak the
whole truth, to the best of his judgment, and not to make out rightly
or wrongly the particular case of the  person  who summons him.
On the other hand,  it is obvious that Drs. Dorl and Ziegler gave a
most impropier certificate.   They might not have been  able to ex-
press any opinion respecting the existence of a tumor in the brain,
but they were wrong in suppressing the real  state of the Duke.  If
they knew7 his actual condition, their  conduct was censurable;  if
they did not know it, they were not justified  in signing a certificate
at all.   Because a man  may enjoy at  the  time tolerable  bodily
health, facts of this  nature, shoAving great disease of the nervous
system, ought not to be kept from the knowledge of the  insurers.
Imbecility, depending on Avhatever cause, should always  be men-
tioned.

  Material concealment.—Some medical practitioners entertain the
opinion  that, provided they can certify that the  person is in good
health at or about the time of  the insurance, that is all that the
insurers  need  know.  The same opinion is  commonly entertained
by the insured;  and the latter, after having been attended by one
medical  man for an illness, will  apply to another, a comparative
stranger, to certify to his condition of health  for insurance.  We
must not lend ourselves to this system, which is based  sometimes
upon a mistake,  at others upon fraud.   If medical men wrould de-
cline signing the papiers under such circumstances, they  would not
only save themselves from  censure, but be actually conferring a
benefit upon the applicant, by preventing him from obtaining a
policy upon terms which on  his death  may render  it invalid, and
entail a forfeiture of the premiums.  From Avhat has already7 been
said, it will be understood that the exact state  of health of the per- 
MATERIAL CONCEALMENT.
837
son at the time of the insurance does not represent the whole of the
risk incurred by the Office.  The restoration to health, as in a case
of diseased lungs, may be only temporary;  it may be speedily fol-
lowed by phthisis, and the insurers therefore ought to be informed
of the previous condition, as Avell as present state of the applicant.
The conditions in the declarations are so explicit upon this point,
as to render it scarcely necessary to refer to the propriety of making
this addition to the  certificate.   The disease under which  the  in-
sured had labored may have been of a trivial kind, and not likely
to affect the risk  ; nevertheless  the safest plan is to state it.  The
option  will then lie with  those Avho are to incur  the  risk.  When
facts of this  kind are either concealed, or  not plainly stated, the
question of how far the}7 were or w-ere not material to  be laid before
the insurers is ahvays left to the jury, who are guided in their ver-
dict by their own. common-sense, as well as by  medical opinions.
It Avould appear, also, from a decision of the House of  Lords in
Anderson v. Fitzgerald, that the truth of the ansAvers given, and not
their materiality, should  govern the verdict of a jury.   In a case
tried in December, 1856, Lord Campbell held that a suppression of
the truth on  the  part of the person whose life was insured, would
not avoid the policj7, if the party effecting the insurance Avas inno-
cent and ignorant of the  suppression.
   Some medical men have adopted the plan of signing certificates,
but have  declined to make any Avritten reply to certain queries:
as, for  instance, the general query—Can you give any, and what
information respecting the habits of the applicant ?   If nothing be
knoAvn  concerning these, it should be so stated ; if, hoAvever, the
existence  of  any habits affecting health be knoAvn to us, Ave_shall
do an  injury to  the applicant and ourselves by withholding infor-
mation  on the subject.  It  may be the means of causing a  heavier
premium  to  be  demanded for insurance than  if the facts  were
knoAvn ; and if this should not  happen, the omission  is very likely
to give  rise to future litigation.   Thus,  in the case of the Earl of
31a r, the  payment of the policy Avas refused on the ground that
the Earl had been addicted to  opium-eating.  His medical referee
replied  favorably to  the special questions in  regard  to  habits,
whether sedentary  or active, temperate or intemperate;_ but he
neglected to reply to the general question regardiug habits;  and
on&the Earl's death  it w7as found that he had been an opium-eater
for many years  before effecting the insurance.  ^ This fact might
not have been knoAvn to the medical referee, but  it is  ahvays better
to fill in the  reply either affirmatively or negatively,  if the certifi-
cate be signed at all, than to leave the Office to draAV an unfavor-
able inference, or to render the policy afterwards open to dispute.
   In the  case  of a 31rs.  Elgie payment of the amount of a policy
was refused  under the following circumstances: The insured had
been for some time prior  to the insurance in  a delicate  state of
health  and  in the  year  1821 it Avas thought that the symptoms
were those of phthisis.  In October, 1822, she was twice alarmingly
ill  In December of that year, wishing to insure  her life, she called 
838
CONCEALMENT OF PHTHISIS.
in a medical friend, who had not been in attendance upon her, to
examine her and certify as to her state of health.  It appears he
examined particularly the state of her lungs and liver, and finding
them, as he thought, sound, certified that the ordinary state of her
health was  good.   On  the 19th March,  1823, he gave  another
certificate to the same effect, upon Avhich the insurance was effected
in April, 1823.   Mrs. Elgie died of disease of the lungs in April,
1824.  Payment Avas  refused, on  the ground that there  had been
concealment of material facts as  to the  state of health of the in-
sured.   It appears that, unknoAvn to the medical gentleman who
had given the  certificate, the insured had been attended between
December, 1822, and the 19th March 1823 (the date of the certifi-
cate), by a medical practitioner residing  in her neighborhood  for a
cough, and that she had become much emaciated.  This gentleman,
however, thought that there Avas no structural disease—an opinion
confirmed by the examination made for the certificate in March.
The fact  of the deceased  having labored under this illness was,
however, concealed  from  the  insurers.   The jury thought  that,
although  there had  been concealment, it was not material, and a
verdict was returned against the defendants.  A new  trial  was
granted, but a  verdict was  again  returned against them.   The
truth is, it is not the concealment of eveiy slight attack of illness
that will vitiate a policy; although the  contract being one, as it is
termed, uberrima?, fidei, it is in  the highest degree unwise either in
the insured, or, if it be known to him, in the medical man signing
the certificate,  to conceal from the insurers any previous illness or
medical attendance from another  quarter.  It may always  be fairly
urged that a knoAvledge of the facts might have led to the  rejection
of the life, or have made a difference in the amount of the annual
premiums.  One part of our duty therefore, if we sign a certificate
upon a careful examination, is to ascertain whether the applicant
has, or has not been previously- attended by another medical practi-
tioner.
   A case was tried at the  Wanvick Summer Assizes, 1844 (Geach
v. Ingall), in which  it was alleged that  the existence of phthisis
(pulmonary consumption),  or phthisical symptoms, had been  con-
cealed from the office.   On  the  side of the  plaintiff, the medical
attendant of the insured was called, and he certified that in  May,
1840, when  the policy was  issued, he considered the deceased to be
in good health, and an insurable  life.  A  physician Avho examined
the deceased in February of that year  stated his belief  that the'
chest of the deceased Avas  souud, and he considered  him to  be a
very good life.  For the defence two medical men Avere called, who
deposed  that deceased had had spitting  of blood before effecting
the insurance, and that he had labored under decided symptoms of
consumption in 1840, which  it was inferred  must have existed at
the time of the insurance.   There Avas  evidence of a general  con-
sumptive tendency in the family ; the father died of  it, and there
was no doubt \A7hatever that the insured had died of it in December,
1843, three and-a-half years after the policy Avas issued.  The medi- 
CONCEALMENT  OF HERNIA.
839
cal evidence AA-as conflicting, but the existence of the disease at the
time of the insurance rested upon presumption and not upon proof;
hence the jury returned a verdict for the plaintiff.  A second and
a third trial were had upon this case, on the ground of misdirection
by the learned judges; but verdicts were again returned on both
these occasions in the  plaintiff's  favor.   It is most probable that
the seeds of consumption  existed in the  insured; but, unless there
is some plain and certain evidence from symptoms, proof of this
Avill amount to nothing.   If inferential proof of this kind Avere
sufficient to avoid a policy, the pjayment  of most policies might be
easily and successfully disputed.  Had the deceased died soon after
the insurance, there might have been greater probability in favor
of the view adopted  by the office; but he  lived nearly four years
afterAArards ; hence, if the sympitoms had  existed in  a confirmed
state at the time of the insurance, of Avhich there Avas no direct
evidence, as  the  medical  officer of the  company had certified in
favor of the life, the case must have been of an unusually protracted
kind.
  In a case in which strangulated hernia was the cause of death, the
deceased had insured his life upon his own declaration and a medi-
cal  certificate.  In  about  thirteen months afterAvards he died from
the effects of an operation for strangulated hernia.   The medical
Avitness who signed the certificate stated  at the trial that the de-
ceased had never  had hernia, and that he had not attended him for
that disease.  A  letter w-as produced, hoAvever,  in which he (the
Avitness) had admitted the existence of hernia in the deceased four
months before his death.   He denied the truth of this statement,
and said the tumor  Avhich he had reduced by manipulation was
varicocele.  The  question was, whether hernia had  or  had  not
existed, and had been concealed from the insurers at the time when
the  insurance Avas  effected.   The admission in the  letter carried
the period of the alleged  existence of hernia to five  months  after
the  certificate was  granted,  Avhilst the deceased had positively-
stated in  his declaration, that he  Avas  not, and had never been
affected Avith rupture, and the medical certificate Avas  to the same
effect.  One medical witness  deposed that he had been consulted
by the deceased, and had found him laboring under irreducible
hernia five months before he proposed to  insure his life !   This
gentleman stated that he then informed the deceased he had in-
guinal hernia ; he tried to reduce it, but could not succeed.  These
facts it Avas alleo-ed, Avere not stated to  the insurers at the time of
the insurance, as°they certainly ought to have been.  On the other
side tAvo  medical Avitnesses, including the operator, thought that
the 'hernia Avas quite recent.  The operator found no adhesions,
and there Avas nothing to induce him to suppose that the hernia
Avas of fourteen  months' standing.  Evidence Avas also  given to
shoAV that the Avitness Avho  deposed to  the existence of inguinal
hernia  before  the insurance  might have been mistaken in his
di-io-nosis and  have  confounded a hydrocele or a A7ancocele with a
hernia- but admitting this to be true, the existence of a tumor of 
840
CONCEALMENT OF DISEASE.
any kind in such a situation should not have been kept concealed
from the company or their medical referee.  The jury returned a
verdict  that there was  no fraud, but  that  the deceased had had
hernia at the time of effecting the insurance.   A second trial was
granted, and a verdict was then returned in favor of the plaintiffs.
  If, under any circumstances, a jury should find that the conceal-
ment is material, the legal consequence is that the p>olicy  is void.
It is not at all necessary that  the person should die of the disease
concealed.   This rule was laid dow-n by the late Lord Tenterden in
the case of a Colonel Lyon.   The Colonel  insured  his life by two
policies in May and June, 1823, and  died of a bilious remittent
fever in October of that year.  Payment Avas refused on the ground
of misrepresentation and concealment.   Colonel Lyon referred the
office for a certificate of his health to a gentleman who had not at-
tended him for three years previously.   His ansAvers to the  printed
questions were  that  he had had no other medical attendant, and
that he never had  "a serious illness."   The medical gentleman to
whom he referred certified that his life Avas insurable, and the
policy was issued.   It appeared in evidence, hoAvever, that  the  de-
ceased had been attended by two other medical practitioners from
February to April, 1823, for hep>atitis, fever, and a determination
of blood to the head.   One of these employed very active treatment:
he considered him  to be in a dangerous state,  and Avould not have
certified him  to be in health  until the end  of May, 1823.  All
agreed that the deceased did not die  of the disease for which he
had  been  thus  attended.  Lord Tenterden  stated it to  be  his
opinion, that  if a man referred  to one practitioner,  because he
could spieak well of his  health, and  thought that if he referred to
other medical men  they would  not  so certify, although  the in-
sured did not die of  the disease with which he was then afflicted,
the policy would be void.  A verdict  Avas accordingly given  for
the defendants.  The practice of referring to medical men avIio
have been only recently consulted is not infrequent.  The  opinion
of the usual medical  attendant might be unfavorable, or he might
report on the existence of habits which Avould  render the life unin-
surable, or insurable only- at a high premium.  This want  of fair-
dealing, however, commonly defeats its object.  There is expensive
litigation, and the policy- is pironounced to be void.  The case of Wil-
shere v.  Brown, tried before Lord  Abinger in the Exchequer in De-
cember, 1842, and of  Palmer and. Fish v. Irving, tried at the NorAvich
Summer Assizes, furnish illustrations of this.  In the latter case the
deceased had returned that he had never had  a medical attendant.
His life was insured  for a large sum on the 21st November, 1842,
and he died on the 5th December folloAving.  There AA-as reason to
believe that he had died from  inflammation of the  lungs; but it
Avas proved that he had labored under symptoms of pulmonary con-
sumption, and had been  attended  by  three medical men  shortly
before he  effected the  insurance.   This was concealed, and  the
policy AA-as set aside on the ground of fraud.
  A singular case  Avas tried at Glasgow in 1837, in Avhich the pro- 
INTEMPERATE HABITS.
841
ceedings were inverted, compared with the usual English practice
in such cases.  An Insurance Company brought an action against
the representatives of the insured, on  the issue Avhether the policy
had  not been  obtained  by misrepresentation and undue conceal-
ment.   An insurance Avas effected on the life of a 3Irs. Rcdston, on
the 10th December, 1833.  Her own declaration was  that she was
in good health, and that she Avas  not  afflicted Avith any disease or
disorder tending to shorten life.   She referred to her usual medical
attendant, who certified that he had known her for ten years, and
had  been in the habit of attending her professionally; that she was
last  ill in the month of September, 1833 ; " that her  indisposition
Avas  acidity- of  the stomach;"  that she had not,  to his knowledge,
been affected with any illness of such  a nature as to  influence  her
general health; that she Avas then (30th No\-ember, 1833) in perfect
health, and was not subject to fits or any affection of  the head, but
occasionally to slight headache from acidity- in  the stomach.   He
knew of no circumstance in her business or habits of living tending
to impair  her  health or shorten her life.   The deceased died of
apoplexy on the 3d September, 1834, within nine months from  the
issuing of the policy.  The Insurance Company were about to pay
the amount, when an action AA-as brought by the medical attendant
against the executors of the deceased for payment of 1621. for med-
ical  attendance, etc., on Mrs. RaAvlston, from  the 15th  September,
1833 (tAA-o months pulor to the date of the policy) to the 4th June,
1834.  The referees aAvarded 145£. to the plaintiff.  His books were
given  in evidence, and  it then appeared that  between the 19th
September and 3d December, 1833, (the date of the proposal for in-
surance) he  had paid her  thirty-five professional visits, most of
these of long duration.   It further appeared  from  the  diary that
she had been frequently  bled; her head had been shaved and blis-
tered, and leeches had been applied to  her  temples.   She had  also
had  constant attendance after the insurance, and in the early part
of 1834 had had several fits of epilepsy.  Three medical Avitnesses
deposed that the declaration of  deceased and the certificates giA7en
by her medical attendant did not set forth  her true condition; and
that  there had  been misrepresentation  and concealment of material
facts.  This was also the opinion  of the judge, and a verdict  Avas
returned for the office.  Although the illness, prior to the insurance,
might  have had no connection Avith  the death from apoplexy, it
AvaS held that the insurers ought to  have  been made  acquainted
with it.
  Aniono- the diseases upon the concealment of which  policies have
been most  frequently disputed, may be enumerated gout, dropsy,
paralysis, epilepsy,hsenioptysis, incipient phthisis, delirium tremens;
and to  this list  may be added drunkenness, intemperance, irregular
habits, prostatic disease, and laceration of the perineum in women,
as a consequence of delivery.

  Intemperate habits.—In a large  number of cases the payment of
policies is resisted on the ground of concealed drunkenness and gene- 
842
INTEMPERATE  HABITS.
ral habits of intemperance.   There is some difficulty in these cases,
because medical men may entertain different opinions respecting the
effect of  such  habits upon  the general health, and the  degree to
which they may be safely carried.  There is one thing hoAvever
certain—whatever may be our opinion of their effect on health, Ave
are  bound to state, if knoAvn to us, that they exist, and thus put
it out of the power of a company to dispute a policy upon such a
ground.  From the frequent concealment of habits of this kind,
some offices iioav adopt the practice of making it a special question,
to Avhich a plain negative or affirmative ansAver should ahvays be
given: "Are you  now, and have  you alwavs  been  of temperate
habits of life?"
  When intemperance is alleged, we find not only7 conflicting medi-
cal evidence, but much cross-swearing among the witnesses.  It be-
comes a  question: What is  intemperance?  and this  is  answered
according to the peculiar vieAVS of a Avitness.  A case was tried at
the Exeter  Spring Assizes in 1842 (Southcomb v. Merriman), which
will shoAV  the difficulty of getting at the truth.  Payment of a
policy Avas  disputed by the office  on  the ground of  concealed in-
temperate habits.  At the trial the representatives of the insured
called tAvelve witnesses to prove that the deceased Avas a very  tem-
perate man, Avhile the office called twenty-one to show that  he Avas
habitually intemperate!   One of the temperance witnesses (for the
plaintiff) defined  drunkenness to  be  "Avhen a man has lost his
reason, could not give a piroper ansAver, was not able to do business,
had  lost his legs, and Avas obliged to be carried home."  He ad-
mitted that the deceased had occasionally- continued drinking for
three or four  days together, but  that was a very rare  occurrence.
The medical attendant who  gave the certificate said that the de-
ceased's was a  perfectly good life, and he considered him to  be a
person of sober and temperate habits:  he had not thought it requi-
site to inform  the office of occasional outbreaks, because he did not
think that  drinking had  any effect upon his health.   Several Avit-
nesses proved that deceased  was in the habit of drinking enormous
quantities of beer, and that it required  a great deal to make him
ramble.  The  insurance was effected in October, 1839, and the de-
ceased died in April, 1841,  from inflammation of the lungs; but,
in the opinion of the medical Avitnesses, this had not arisen from
excessive drinking.  Notwithstanding  the concealment of these
facts, the jury  returned a verdict for the full amount claimed ; but
a rule for a new trial was afterAvards obtained.  This  case shows
what fallacious vieAvs are entertained on the medical questions of
life-insurance.   In a case like this, it Avas  clearly- the duty of a
medical man to describe the habits of the deceased.   He might, if
he pleased, have appended  to the certificate that in his judgment
they had not affected the health of the person, but the defendants
who were to take the risk should have been placed in a positiou to
form a judgment for themselves.
  In the case of the Hon. II. G. Talbot (Craig v. Fenn, December,
1841), Avhere no ansAver  Avas returned to the question Avhether the 
          CONCEALED HABITS OF INTEMPERANCE.      843

deceased Avas of temperate  and moderate habits of life, and the
company actually charged  a higher premium in consequence, the
jury returned a verdict in their favor, the real condition of the in-
sured not having been made known to them at the time the insu-
rance Avas effected.
  [Where the representation Avas made that the insured was of sober
and temperate habits and in good health; if the representation Avas
true at the time it was made, the subsequent habits of the insured
Avould be no bar to a recovery  upon the policy.  (Reichard v. 31an-
hattan Life  Insurance  Company, 31 Missouri R. 515.)  And if the
party insuring is not called upon by any general or special question,
he need make no statement as  to any particular habit, as intempe-
rance, though such  habit may be prejudicial to his health.   Rawls
v. Life Ins.  Co., 36  Barb. (N. Y.) 357.   Where the insurance is by
a creditor upon the life of his debtor, declarations of the latter as
to his habits, or as to the  fact of suppression  of information are
mere hearsay and inadmissible as evidence.  Ib.—P.]

  Concealed habits of intemperance.—In Hutton v.  Waterloo Life As-
sociation (Q. B. December, 1859), an action was brought by a Avidow
for the recovery- of  2500(?. upon a policy effected  in April, 1854, on
the life of her husband.  Payment was refused on the ground that
the written  ansAvers made by deceased to questions proposed  by the
company were false, and therefore  that  the contract Avhich Avas
based upon  them  was void.   One question was Avhether he Avas
subject  to delirium tremens or any disease calculated to shorten life,
Avhich he answ-ered in  the negative; a second was, wdiether he AA-as
of tempjerate and sober habits, Avhich he answered in the affirma-
tive; and the third was as to the name and residence of his "ordi-
nary  medical attendant, to  be referred to as to present and general
state of health," to Avhich he ansAvered, "Dr. Cobb."  The inquiry
now- Avas whether these ansAvers were true.  The action had already
been  once tried, Avhen the  plaintiff obtained a  verdict; but the
court granted a new trial upon the ground that there was no find-
ing by the jury.
  The evidence in the  case,  medical  and general, showed that the
deceased Avas of intemperate habits, and that in May, 1854, he had
suffered  from delirium tremens, of which disease he died in  1856;
further, that Dr. Cobb, to Avhom he referred as  his  usual medical
attendant, had not attended him since 1851, and that from this date
until the date of the insurance he  had been attended by another
medical man, to Avhom he had  given no reference, although he Avas
his usual medical attendant.  The jury- found for the defendants on
the main issues.  This case presented tAvo curious features: 1st,
the medical evidence proved  that the first attack of delirium tremens
came on on May 11, after the insurance had been effected ; and 2dly,
the medical  attendant  of the deceased and the medical officer of the
company differed greatly about the deceased's state of health at or
about the time the  insurance Avas effected.  The  medical attendant
of the deceased  who was a  Avitness for the company, deposed that 
844       CONCEALED HABITS  OF  INTEMPERANCE.

he attended him for an attack of delirium tremens on May 11, and
again on May 28,1854—both attacks being the results of excessive
drinking.  The report to the company, made by their oavii medical
officer, dated May 22, 1854, gave, however, a most flattering account
of deceased's health, and  described him as a " first-class life."  In
his evidence at the  trial this gentleman said that he  then observed
no indication of delirium tremens nor of drunken habits ; the de-
ceased was the picture of health.  This serious  discrepancy could
not be reconciled by a re-examination of the witnesses.   The con-
cealment of intemperate habits Avas clearly proved, and on this pro-
bably the verdict of the jury chiefly turned.
  Questions of a similar kind Avere raised in Wheelton v. Hurdisty
(Q. B. Dec. 1856). An insurance had been effected to a large amount
on the life of a Mr. Jodrell, and the payment of the policy was dis-
puted on the ground that there had  been concealment of intempe-
rate habits, and of the existence of delirium tremens at the time the
insurance was effected.  The jury  found that  there had been mis-
representation and concealment.
  One of  the most singular cases of this description, in reference to
conflicting medical evidence, Avas that of Rawlings v. Desborough,
tried by Lord Denman in December, 1837.   The main question Avas,
Avhether a Mr. John Cochrane, Avhose life had  been insured, Avas or
was not a person of intemperate habits at, or before the time of in-
surance.   A medical certificate had  been given  to  the effect that
his habits Avere not intemperate.   The AA-eight of the evidence, how-
ever, general and medical, tended to show that he  Avas a thorough
drunkard.  One of the witnesses for the plaintiff  said, the deceased
" never appeared to me to take anything to hurt  a  man ; I never
saAv him drink more than the rest of the company ; I only saAv him
intoxicated fifty or sixty times in  four years !  His health did not
seem to be impaired by Avhat he drank."  His groom stated that he
had seen his master " tipsy a hundred times, perhaps, but not beastly
drunk."  The late Mr. Travers examined the deceased for one office,
and from Avhat he saw, advised that his life should  not be accepted.
He considered the man to be laboring under delirium tremens.  One
observation made by- this witness is worthy of remembrance Avhen
a medical practitioner is engaged  in  examining a person for a life-
insurance—i. e., a man may have pursued an intemperate course for
some time, and yet his appearance at  the time may be such as to
lead a common observer to imagine he Avas in the plenitude of health
when he is liable  to  become the subject of an immediate attack.
NotAvithstanding the strong evidence of  habits of  intemperance
from a period anterior to  the date of the insurance, the jury7 re-
turned a verdict for  the  plaintiffs, but a  motion  for a new trial
was  soon afterwards made.   Lord  Denman  observed  upon  this
occasion, in respect to what was matericd concealment, that he did
not conceive the true  meaning to be, that the party whose life Avas
to be insured was bound to volunteer a statement of  every circum-
stance  that anybody might afterwards  think  Avas likely to affect
the risk of his life.   The real intention Avas, that he should submit 
          CONCEALED  HABITS  OF  INTEMPERANCE.       845

himself to a full examination and inquiry, that he is bound to state
nothing  untruly, and that  he is  bound  to ansAver all  questions
truly.   If he decline to ansAver, the office may  act upon his refusal,
and if he ansAver untruly, he shall  gain no benefit from such false
statement.
   In  February, 1840, a trial took place before  Tindal, C. J. (Pole v.
Rogers) relative to a policy on the life of Mr. Peter Cochrane, brother
of this Mr. John Cochrane.  The insurance was  effected  in 1834.
The insured died the following year of hydrothorax, brought on, as
it was alleged by defendants, by very intemperate habits, the exist-
ence of which was concealed from them.  The  evidence, both medi-
cal and general, AA-as just as conflicting as in the former case, and it
became rather a question of credibility. The jury returned a verdict
for the plaintiffs, thereby either denying  the existence of intempe-
rance, or considering that the concealment of  it, if it existed, Avas
not material.
   This case is Avorthy of note in one point of view, as it involved a
neAV question in medical jurisprudence—namely, whether Ave are
to regard the immediate or remote effects on the body  produced by
intemperate habits ?  The Solicitor-General, avIio  appeared for the
plaintiffs  (the representatives of the insured), argued that the terms
"habits prejudicial to health" w7ere too indefinite.  Was it to be
regarded as an abstract, or relative proposition ? He appeared to rest
his case upon an admission that there was intemperance to a certain
degree, but he contended that habits which Avere not at all prejudi-
cial to the health of one man might absolutely  kill another.  There
was a very common habit of keeping late hours; this might be ut-
terly  destructive to the health of some persons, but not to that of
others.  This sort of condition Avas so vague that it left it open to
an insurance office  to resist  the payment of any policy, unless the
meaning of the words w7as brought Avithin some reasonable and Avell-
defined limits.  The jury A\-ere  bound to see whether  the alleged
intemperate habits had been indulged in for a long time Avithout
injury; they must  look to all the habits of the person taken to-
gether, and see Avhether one habit was not counteracted in its effects
bv another.   The insured Avas a man of very active  habits,  and
therefore  excessive drinking would not affect him as it  would others
who led a sedentary life.
   This ingenious but sopdiistical reasoning involves an important
medical question.   It is well known that intemperance is a relative
term, and  may be  differently construed by different medical  wit-
nesses.  The real question, however,  divested of its  sophistry, is
this:   Can any person indulge  in an excessive  use  of alcoholic
liquids Avithout this  practice sooner or later leading to an impair-
ment of health, by producing disorder of the stomach and liver, and
remotely affecting different organs ? The effects of such habits may
not show themselves immediately, but the office requires to be in-
formed of their  existence or non-existence, and not of the period
when they are likely to affect health visibly, or to engender a fatal
disease   To assert that a man can be addicted to excessive drink- 
 846       CONCEALED HABITS OF INTEMPERANCE.

 ing Avithout impairing his  health  is  contrary to all  experience.
 There is no such compensation, or balance of  habits as that Avhich
 the Solicitor-General supposed to exist in this case.  Habit  may
 accustom  a man  to intemperance—it  may enable him to drink  a
 large  quantity  of alcoholic  liquid without being apparently  inju-
 riously influenced by it at the time ; but a deranged state of system
 will sooner or  later follow, and  delirium tremens or dropsy will
 probably  supiervene.  A good natural constitution  may  enable  a
 man to resist the pernicious effects for a certain  period, but  ulti-
 mately they Avill show7  themseh-es in some form of disease; and in
 the case of these two brothers, the result of their intemperance was
 made apparent in  the very early deaths of both.  It  is unfortunate
 that no light is permitted to  be thrown on such cases by pathology.
 Post-mortem examinations are not ahvays made in these cases ; for
 the death being, as it is called, natural, it is not commonly thought
 necessary to inspect the body, although as in the above instances,
 the condition of the liver and other organs might  at  once  have
 removed a difficulty which arose  from the conflicting evidence on
 the habits of the deceased.
   In all cases of a contested  policy, one important principle is  uni-
 formly acted upon ; those Avho resist the payment are bound to prove
 Avhat they allege by conclusive and satisfactory evidence.  A court
 Avill not receive probability  or conjecture—the evidence  must be
 certain. Hence many suits  fail from the medical evidence going
 no further than to  shoAV that  a particular disease or habit had proba-
 bly existed at the  time of insurance.  If the  disease or habits be
 shown to have certainly existed, the evidence may still fail to prove
 satisfactorily that  the concealment w-as either wilful or material.
   Contested cases  of life-insurance are very instructive:  they often
 sIioav the imperfect manner in which medical observations respecting
 health or disease are made, and that the medical treatment of  per-
 sons wdiose lives are insured may become a material question in the
 event of a policy being  disputed.  In the case of Chattock v. Shawe,
 in reference to  an insurance  on the  life  of a Colonel Greswold, a
 question arose not only respecting the concealment of intemperate
 habits,  but as to the concealed  existence of delirium tremens, from
 the  examination of handwriting, as well  as from the description
 given  by  non-professional Avitnesses.  It was  here even  doubtful
 AA-hat had  caused  the  death of the  deceased.   According to  one
 medical Avitness, it Avas  a curious combination of Asiatic cholera,
 phrenitis, and epilepsy !  It w-as proved that, more than three years
 before  the insurance Avas effected, this gentleman had met Avith a
 fall, and he Avas afterAvards  seized with a fit, described  by some
 Avitnesses  as epileptic, by others as arising from concussion of the
 brain.   The existence  of intemperance and epilepsy prior to  the
 insurance Avas not  made out to the satisfaction of the jury, and they
 returned a verdict for the representatives of the insured.
  In Walters v.  Barker, tried at  the  Monmouth Summer Assizes,
1844, the  deceased, at the age of  sixty, insured his life on the 4th
May, 1841, and  he died in the August folloAving.  It was alleo-ed 
ABSTPNENCE.—OPIUM-EATING.
847
by the office that the cause of death Avas an attack of paredysis,
Avhich it Avas pretended had existed from a A-ery early period of his
life.   No  medical evidence Avas given on either side;  there  Avas
merely  a  presumption that death might have taken place  from
paralysis ;  hence the verdict was for the plaintiffs.

  Abstinence.   The vegetarian system.—We have already- considered
the effects of habits of intemperance, and the necessity for stating
in a certificate the existence of them Avhen knoAvn ; but other habits
may exist Avhich have a tendency to shorten life, although in a less
obvious manner. What are called temperance  principles are, or Avere
very prevalent.   There are many persons Avho have been full lh7ers,
and ha\7e afterAvards taken up the notion that  Avater and a vegetable
diet Avere  all  that  Avas  necessary  to  support  life.   This sudden
change, especially in pjersons advanced  in life, is very likely to affect
the constitution seriously, and, if not to create disease, so to weaken
the vital powers as to render  any slight illness or accident  serious.
I kneAv one  instance in  Avhich a gentleman Avho  had been in the
habit of living on a full diet, Avith a  moderate use of alcoholic
liquids, suddenly adopted the plan of living on Avater and vegetable
food; he  oliA-iously fell  off in strength, and lost  his  previously
healthy- condition.   About a year afterwards he met Avith a slight
sprain to the ankle-joint; inflammation  ensued, Avhich, in spite of
the best treatment, assumed an unhealthy character; suppuration of
the joint  folloAved;  amputation of the leg Avas performed, but, in
spite of an improved diet, the piOAvers of life  never rallied. There
was  no attempt at union  in the flap, and  he finally died exhausted.
There can be no doubt  that these sudden changes in the mode of
living are liable to lead  to impairment of health,  and to affect
materially the expectation of life.  Hence it is our duty to inquire
and report upion facts of this kind Avhen they  become known to us.
  In Huntley v. The St. George Insurance Company (NeAvcastle Au-
tumn Assizes, 1858), a medical man insured his life for 2000/.; and
although certified to be in good health, and  to all appearance he
was so^ he died from Blight's disease within three months after he
had effected the insurance.  There Avas  also  disease  of the heart.
The questions Avhether he had either of these  diseases at  the  time
of the insurance were answered  by him  in the negative.  It was
contended  that, as  a medical man, he must have known that he
Avas suffering from these  diseases, and had Avilfully concealed them.
It appeared from the evidence that the deceased had taken  to a
vegetable  diet, and it Avas considered that this Avas the cause of the
rapid failing 'of his health.  The jury returned  a verdict for the
plaintiff's, and the Chief Baron suggested that in  future Insurance
Companies should put among their questions  to insurers, "Are you
a vegetarian?"

  Opium-eating.__There is another habit said to be common, the
concealment of which gave rise to an important  trial some years
since: I allude to the practice of opium-eating.  In 1826 the Earl of 
848
OPIUM-EATING.
31ar effected an insurance on his life, and tAvo years afterwards, i. e.,
in 1828, he died of jaundice and drop>sy at the age of fifty-seven.
The Insurance Company declined paying the amount of the policy,
on the ground that the Earl Avas, at the time of the insurance, and
had  been for some time previously, an opium-eater.  This practice
was concealed  from  the  insurers;  and it Avas further alleged that
it had a tendency to  shorten life.  It Avas clearly proved in evidence
that the Earl had been a confirmed opium-eater up to the time of
his death.   According to Dr. Christison, the  deceased had taken
laudanum for thirty  years, at times to the amount of tAvo or  three
ounces daily—a tablespoonful for a dose.  He was a martyr to rheu-
matism, and, besides, lived rather freely.  Many persons who Avere
constantly about him, and many intimate friends, deposed that until
1826 (the year of the insurance) he was of a cheerful  disposition,
and  clear in his intellects.  Some of them admitted that they then
pierceived a  change in his habits, AA-hich they attributed to the ad-
verse circumstances in  w7hich he was  compelled to live.  In 1825,
Dr. Abercrombie found him enfeebled and broken-down  in con-
stitution, but Avithout any- definite complaint.  The main question
at the trial  Avas, Avhether opium-eating had a tendency to shorten
life—for on  this the  issue turned—whether  the  concealment from
or the non-communication of this practice to the office was, or AA-as
not material.
  Drs. Christison, Alison, Abercrombie, and Duncan were exam-
ined on the  part of the insurers; and although they entertained the
opinion that the habit had  a  tendency to shorten life, they Avere
unable to adduce any cases in  supqiort of it.  Their opinion was
based not on personal experience, but on the  general effects of
opium as manifested  by its action on  the brain—by its producing
disorder of the  digestive organs, and giving  to the  person  a  worn
and emaciated appearance.  In most of the instances collected, there
Avas  no evidence that life had been shortened by the practice.  On
the contrary, some of the individuals had carried it on  for years,
and  had attained a good old age.   The jury returned a verdict for
the plaintiff's, not on  the ground that the practice was innoxious
and  its concealment immaterial, so much as on the technical  point
that the insurers had not made the usual and careful inquiries into
the habits of the deceased; and they-  were therefore considered as
having taken upon themselves the risk from their own laches.  It
appears that the general question  wnth respect to habits w7as not
answered by the  medical referee,  and it Avas, therefore, considered
that the office had waived the  knoAvledge of  them.  A  new trial
Avas  granted, on the  ground of misdirection, but the suit was com-
promised.
  Hence it will be seen that no decision w-as come to in this case on
an important question, which is very- likely- to arise again.  It will
be desirable, therefore, to examine  some of the facts connected Avith
opium-eating, in order, if possible,  to see how far it really tends to
shorten life.  In the  case of the Earl  of Mar, it apipeared to be  a
fair inference that the habit did not shorten his life, for he is repre- 
         EFFECTS OF OPIUM-EATING  ON  HEALTH.      849

sented to have indulged in it for thirty years; and for tAventy-eight
years, according to the statements of his friends, no injurious effects
had followed.  Dr. Christison subsequently collected from numerous
sources no fewer than tAventy-five cases, from which we learn that
opium has been taken  in large quantities for forty years together,
Avithout producing any marked injury to health.  At the London
Medical  Society, the late  Dr. Clutterbuck related the case of a
Avoman who for seven years had taken tAvo scruples (forty grains) of
solid opium daily.  She Avas fifty-four, had led an irregular life,
and had first taken opium to relieve the pains of rheumatism.  The
dose Avas not increased, and the usual ill-effects of opium Avere absent
—such as constipation, nausea and loss of appetite.  Although she
did not increase the dose, the effects of the diminution of a single
grain of her usual quantity were most marked, and she felt them
immediately.  ■ Many cases of this description are recorded by medi-
cal authorities; they  appear  to s1ioav that opium-eating has not
necessarily that tendency to shorten life which it has hitherto been
supposed to have. There is, however, sufficient evidence to prove
that the practice  gives rise to  prejudicial eff'ects on the  system and
tends to impair health.  It  may not  have  this effect in all cases,
except on the withdraAA-al of the stimulus;  but this is not the ques-
tion.   It might  be  on this principle argued that the drinking  of
alcoholic liquids has  no  tendency to shorten life,  because  some
hundreds of cases may be adduced in Avhich the persons have been
addicted to intemperate habits for years, and have  still appeared
to suffer but little in bodily health.   They who have witnessed the
effects of opium-eating in Turkey and China agree that  the practice
leads  to the  speedy  destruction  of  health.  Dr. Oppenheim,  in
writing on the state of medicine in Turkey, says: " The  habitual
opium-eater is readily recognized by his appearance.  A  total
attenuation of body, a withered yelloAv countenance, a lame gait,
a bending of the spine (frequently to such a degree as  to cause the
body to assume a semicircular form),  and glassy deep sunken eyes,
betray him at the first glance.  The digestive organs are much
deranged ; the sufferer eats scarcely anything, and has  hardly one
evacuation in  a week; his mental and bodily powers are destroyed.
As the habit becomes more confirmed, his  strength continues  de-
creasing, the  craving for the stimulus becomes greater, and  in
order to produce the desired effect the dose must be constantly aug-
mented.    After long  indulgence, the  opium-eater suffers from
neuralgic pains,  to  which opium itself brings  no  relief.  These
persons seldom attain the age of forty- if they have begun to take
opium early."  This description  of the effects is exactly what Ave
should expect from  physiological and pathological reasoning.  Dr.
Christison states  he has ascertained that  constipation is by  no
means a general  consequence of the continued use of opium; but
this may be simply an exception to the rule.  It is believed by some
that the action of the drug may be different in different countries,
and that the description of the effects produced by the use of opium
in Turkey cannot be applied to the English opium-eater.  The fol-
       54 
850      EFFECTS OF  OPIUM-EATING ON HEALTH.

lowing case, however, which occurred to Dr. A. Thomson at Uni-
versity College Hospital, shows that climate has little influence on
the effects of this drug:—
  E. M., aged  35, was admitted May 26, 1835.  About seventeen
years ago she  began to suffer from a pain in the right iliac region,
for which a medical gentleman  ordered  her to take ten drops of
laudanum, night and morning.   This Avas gradually increased, the
pain continuing, until at last she took three teaspoonfuls every four
hours, day and night.   At first the ten drops relieved the pain, but
it was found necessary to  increase the dose to  produce the same
effect, so that  three teaspoonfuls at last did not produce so much
relief as the ten  drops at  first.  The effect of the small doses was
simply to ptroduce a relief from pain, without  othenvise affecting
the body or mind.  As the dose was increased, hoAvever, she found
it to produce  a comfortable condition of the mind : she felt lively
and cheerful, and was capable of doing any amount of  work ;  it also
caused a sense of warmth over the Avhole body.  She had  severe
family afflictions, but  w7hile under the influence of opium was not
at all distressed by them, although she felt them severely- at other
times.  If  she passed  over the usual time for taking a dose, she had
the most distressing sensations  about the joints, not of  pain, but
such as she was unable to describe.  She suffered from involuntary
motions of the arms, fingers, and toes; numbness in the limbs and
body generally; profuse perspiration, nausea, vomiting, and  loss of
appetite; a saline taste in the saliva, and a bad taste in the mouth;
trembling of the  limbs, great  debility, and a feeling  of  lassitude.
The memory  and mental  poAvers generally became impaired, and
there w7as a great depression of the spirits.   These symptoms Avere
all relieved by a repetition of  the dose.   The opium also produced
constipation—not more than one motion occurring in a w7eek; and
she does not .recollect whether that was  produced by  medicine or
not.  If the dose was deferred, she had ahvays suffered from severe
headache.  Her sense  of smell was so much  impaired that she could
perceive no pungency in snuff"; her taste was so much lost that she
could not distinguish pepper or  mustard  ; and  her hearing was so
defective that she could hardly detect the  voice of any one Avho
spoke; yet her own voice sounded most disagreeably loud to her.
Her touch was so much affected that she  could not execute any
needleAvork.   The acuteness of all her senses w7as, however, restored
by the usual dose, the want of  which Avas indicated by flushing and
heat of the face.  During the  period of taking the opium she had
very little sleep, and in the intervals she did not attempt to sleep
from want of  the desire, so that she  generally worked all  night.
What sleep she had  Avas, generally, during the day, but this was
much confused and easily broken.  About five or six years ago, her
resources being exhausted, she obtained admission into the hospital.
The laudanum was here discontinued for the first three days, and
all the above symptoms were present; she  now7 for the first time
appeared to see the most frightful spectres of animals and other ob-
jects in the ward.  The symptoms were again relieved by the usual 
          EFFECTS  OF  OPIUM-EATING ON HEALTH.      851

doses.  The doses of laudanum were decreased during the whole
time; and Avhen she left the hospital, she took a teaspoouful only in
the course of the day.   On returning home, as she AA-as dependent
on her friends, she was  obliged to discontinue the laudanum and
Avine, and Avas unable to get  beer; she was now more miserable than
before, all the symptoms returning with increased  severity, and for
the first  six  months she Avas almost entirely helpless.   There Avas
pain in the chest with a cough, which had continued ever since. She
Avas twelve months at home before the above distressing symptoms
disappeared.   The consequences of her opium-eating then observed
were a much impaired taste, numbness of the limbs, coldness of the
feet, inability to Avalk far without aching pains in  the limbs, and a
general sense of lassitude.
  There is abundant evidence that this drug, as it  has been admin-
istered to  children in  the  factory-districts, has produced serious
injury to health and great  mortality.   In the late Mr. Grainger's
report on the Children's Employment Commission, it is stated "that
laudanum  and other preparations of  opium are  given to young
children in gradually-increased doses, until the child will bear from
fifteen to twenty drops of laudanum at a time.  The child becomes
pale and w-an, with a peculiar sharpness of features,  and  rapidly
Avastes aAvay.  The majority of these children die  by the time they
are two years old.  These facts appear to show that climate does
not at all  affect  the action of the drug in the earl}7 periods of life;
and the  observations yet made are not sufficiently  numerous to
justify us in affirming the existence of this  influence  with respect
to adults.   Dr. Christison has remarked that many-  persons probably
die young  from the effects  of this habit without  the  secret  being
discovered ; for even the medical attendant, as well  as intimate
friends, may be kept in complete ignorance of the person indulging
in it.  On  the whole, Ave are bound to conclude that  the  habit of
opium-eating  is injurious to health, and is therefore calculated to
shorten life.   In any proposal  for life-insurance the insurers ought
to be informed of this habit where it  exists, and  no medical man
should sanction its concealment merely because many persons ad-
dicted to it have lived for years in apparently tolerable health.  One
of the questions put to a medical man is, whether he knoAvs any-
material circumstance touching the health or habits of the person to
which the other inquiries in  the certificate do not extend; and if so,
he is required to state them. Noav, without going the length of say-
ino- that the life of an opium-eater is uninsurable upon a common risk,
the habit is itself sufficiently material  to require that it should be
declared in reply to such a question as this. The practice may be, and
often is concealed from a medical attendant; then the insured, if not
candid in avowing its existence, must expose his representatives to
the risk of losing all benefit under the policy. Independently of
medical facts, which appear to favor both  sides of this question, a
jury would probably be guided to a verdict by the eff'ect actually
produced on  the constitution of a person who has  been addicted to
the practice.   If it has continued many years, and  there is no proof 
852
TOBACCO-SMOKING — INSANITY.
of his health having in consequence  undergone any  remarkable
change, this might be regarded  by the jury as the best possible
evidence in favor of the concealment not being in such a case ma-
terial.   The insurers could not equitably complain of  the  verdict
in the Earl of Mar's case; for as he began opium-eating at twenty-
seven, and died at fifty-seven without any obviously injurious effects
being produced  by the use of the drug, it could  not be said that,
in his case at least, the practice had  shortened  life.  It is rarely
in our power to apply any better or more practical test than this,
under  circumstances in Avhich  medical facts appear to bear both
ways.  The case is very different from intemperance  in the use
of alcoholic liquids: no one can doubt  that in this form the results
must be inevitably to impair health and to shorten life.   The facts
here bear one way; and  if instances of longevity can  be adduced
among spirit-drinkers, they are well known and generally admitted
to be exceptions to the rule.   The queries put by Insurance Offices
are now so explicit, that they must  be  considered as  including
the habit of opium-eating;  and  there does not appear to  be any
just  pretence  for evading  the admission  of the practice, either
on the part of the insured, or (if known to him) of his medical at-
tendant.

   Tobacco-smoking.—I am not aware that  the  prevalent habit of
smoking tobacco has ever been regarded in relation to life-insurance.
Although inveterate smokers are liable to attacks of dyspepsia, loss
of muscular and nervous poAver, weakness, and other derangements
of the system, there is not, so far as I know, any  evidence to show
that the practice has a tendency to shorten life.  Should the  habit
be stated in a certificate ?  I think it should, if known to the medi-
cal referee, and where it is of a most inveterate kind.  This would
at least prevent objections on the part of a captious company. There
is no rule of law on this point, if we except a dictum of Lord Mans-
field : " The insured need  not mention what  the insurer ought to
know, what he  takes upon himself the knowledge of, or what he
waives being  informed of:  the insurer need not be told  general
topics of speculation."

   Insanity.—When we are called upon to say w-hat diseases have a
tendency to shorten life, there is commonly no difficulty in giving
a reply, since the name of the disease—its  knoAvn effects upon  the
body—the degree of mortality produced by it, and its intractable-
ness, are data upon which a medical opinion may be easily expressed.
There are some diseases, however, respecting w7hich it is not so easy
to return an answer; and among these may be mentioned insanity,
which has already given rise to discussion in a court of law.  The
treatment of this malady falls out of the usual line of piractice; and
there are comparatively few in the profession Avho have made  them-
selves  acquainted with statistical details respecting it.   This may
account for the decision in the following case:—
   In 1835, a trial took place at  the York Assizes, in w7hich  the 
INFLUENCE OF  INSANITY.
853
 question  was, whether  insanity had, or had not, a tendency to
 shorten me.   The representatives of a clergyman brought an action
 against the 1 rovidence Insurance Company, to recover the  amount
 of a policy effected on the life of a gentleman;  but the office refused
 to pay 011 account of the person having been  insane, and this fact
 having been kept from their  knowledge when the insurance was
 effected. ^ Several medical Avitnesses gave evidence on the occasion.
 One considered that insanity had a tendency  to shorten life ;  ano-
 ther, that it had not; a third, who admitted that the deceased was
 laboring under insanity, did  not consider that his mental state was
 such as had a tendency to shorten life.  The judge charged the jury
 that the question for them to consider was, whether insanity had a
 tendency to shorten life, as, if so, this would make  the concealment
 of it material.  If insanity  had such a tendency, they must find
 for the defendant; if not, for the plaintiff.  The jury found for the
 plaintiff, on the ground  that insanity had no tendency to shorten
 life, and that therefore the concealment was not material.
  There is probably no case which more strongly  shoAvs the neces-
 sity for proper medical evidence on these occasions.   The finding of
 the  jury  was  contrary to all  good medical  experience, and was
 founded on a complete mistake.  The researches of Esquirol, Farre,
 and others, shoAV that  insanity has a decided tendency to shorten
 life.  So well  aware are the insurance offices  of this, that  the ex-
 istence, or non-existence of insanity or mental derangement is now
 made a special question,  to which an ansAver must be given in the
 declaration.  The contrary opinion appears to have arisen from the
 hypothesis that insanity is not  a bodily disease, and in no Avay con-
 nected with physical changes in the structure of the brain.  Admit-
 ting this statement to be true, experience is decidedly against  the
 inference based on it, when Ave look at insanity in  the aggregate of
 cases.
  There was formerly an erroneous notion that insanity had a tend-
 ency to prolong life; but more correct statistical  researches  have
 shoAvn that the insane are more liable than the sane to various dis-
 eases, and that when attacked  they sink more easily under them;
 hence the mortality of the insane  is, cceteris paribus, much above
 the  average of that of  the  sane population.   Among  other fatal
 diseases, the insane are especially liable to attacks of paralysis and
 epilepsy;  and  paralysis,  hoAvever  slight, is commonly the  fore-
 runner of death in these cases.  In private asylums, the mortality
 is ahvays less than in public  hospitals; but recent researches have
 shoAvn that the mortality of  the insane has been much reduced by
 the introduction of an improved system of management and treat-
 ment.
  Accurate observations have shown that the mortality among
 male is greater than among female lunatics, and the more advanced
 the age the greater the proportionate rate of mortality.  The con-
cealment  of insanity in any of its forms, or even  of a  knoAvn
hereditary tendency to this malady-, would be considered material, 
854
ACCIDENTAL CAUSES OF DEATH.
inasmuch as either condition forms a special question to which an
answer should be returned.

  Accidental causes of  death.  Death from sunstroke.—There are
several offices Avhich now insure persons against accidents occurring
on sea or land, and it would seem at first sight that there w-ould be
less room for litigation under such circumstances.  The proof of the
accident and the amount of injury done, or (if fatal) the cause of
death, would appear to be a simple matter.  But the question arises
— What  is an accidental as distinguished from a natural cause of
death?  With our ideas of an accident,  we generally associate
physical  injury or violence done to the person ; and if a man dies
from  any- other cause, his death cannot be said to be accidental.
This question  came before the Court of Queen's Bench, in January,
1861  (Sinclair v. The Maritime Insurance  Company), and the Lord
Chief Justice delivered the judgment of the court.  The action was
brought  by the administratrix of a pjerson named Laurence, avIio,
being about to proceed on a voyage as a master of a vessel, insured
himself against any personal  injury  from any "accident" which
might happen to him upon  any ocean, sea, river, or lake.   The
assured being  with his ship in the Cochin  River, on the southwest
coast of India, and  being on duty on -board his ship, Avas, in the
language of the special case, "struck doAvn by sunstroke," from the
eff'ects of which he died in the course of the same day.   The ques-
tion was, Avhether the death arose from " accident" within the mean-
ing of the policy, and the opinion of the court was that it did not.
It was difficult to draw a line between a death from "accident" in a
policy of this nature and a death from natural causes, such as should
be of universal application.  But  the court might safely assume
that in an " accident" some violence, casualty, or vis major Avas neces-
sarily involved, and that a death from a known natural cause could
not be considered as accidental.  Disease  or death engendered by
exposure to heat, cold, damp, and the vicissitudes of climate or at-
mospheric  influences, could not properly be said  to be accidental;
at all events, not unless the exposure was brought about by circum-
stances of an accidental character.   Thus, if a mariner in the ordi-
nary discharge of his duty caught cold and died, his death would
not be accidental, though it might be so if by reason of shipwreck
he was compelled to take to the boat, and died from exposure to wet
and  cold.  In one sense the death was accidental, for the  effect was
uncertain beforehand; but it must  be considered as the eff'ect of
natural causes, and not accidental.  Sunstroke, so far as the  court
was  informed of it,  Avas  an inflammatory disease  of the  brain,
brought on by exposure to the intense heat of the sun's  rays.  To
that disease persons exposing themselves to the sun in tropical cli-
mates were more or less liable, just as persons exposing themselves
to natural causes of a different kind were liable to diseases conse-
quent therefrom.  Death from "sunstroke" must therefore be con-
sidered as  arising from natural causes, and not from accident, and
judgment will be given in favor of the defendants. 
            LIFE INSURANCE—ALLEGED SUICIDE.        855

 ^  Iii the case of a person being killed  by lightning whose life was
 insured against accidental death, the question might arise Avhether
 such a mode of death Avas  accidental or not.   Death by lio-htnino-
 is certainly not a natural cause of death, and in common  language
 any person killed by lightning is said to have died accidentally. °
   [Where a death takes place in such manner that it may  have
 happened from natural causes, the assured are not  liable unless it is
 proved to have been caused by accident.   Trew v. Ins. Co., 5 Hurls.
 & Norm. 211.
   A clause in  a life-insurance policy provided  in case "of a bodily
 injury to the  insured of so serious a  nature as to wholly disable
 him from following his usual business, occupation, or pursuits," for
 the payment  of £5 per Aveek during  the continuance of  such dis-
 ability.   The  insured, a solicitor and registrar  of a county court,
 was confined to his  bedroom for several weeks by a sprained ankle,
 and was consequently unable to attend to his business.  It Avas held
 that he Avas "wholly disabled" within the meaning of the policy,
 and therefore entitled  to recover.  Hooper v. Accidental Ins.  Co., 5
 Hurls. & Norm. 546.—P.]

   Suicide.—Among the conditions in policies of insurance, there is
 generally a stipulation  in the contract that the policy shall be void
 if the person who insures his life commits suicide.   Thus  a medi-
 cal question may arise as to whether suicide AA-as, or Avas not, com-
 mitted in a particular case.   A person ma}7 die from poison, Avounds,
 droAvning, or other forms of asphyxia; and  it may be difficult to
 say in certain cases Avhether the death arose from accident, suicide,
 or from violence inflicted by another.   Such cases are often left in
 great uncertainty at coroner's inquests—the evidence received being
 imperfect or insufficient; because in cases of sudden deatli, provided
 there be no suspicion of murder, it is  considered of little  moment
 to make a strict  inquiry.  If the life of the deceased should happen
 to  be insured  under a piolicy containing this condition respecting
 suicide, the question may become of great moment to the interest
 of. the insurers, and they will require clear evidence that the death
 Avas natural or accidental, and not suicidal, before paying the amount
 of the  policy.   The cause of death should in all cases of violence
 be determined  by a medical  man: this will put an end to  any dis-
 pute concerning  the payment of the policy, and relieve the repre-
 sentatives from the trouble and expense of litigation.  If the death
 be sudden, and any suspicious circumstances  are left unexplained,
 it  is  certain that a civil action will follow.   We are not therefore
 safe if, at a coroner's inquest, we suppose that we have only to satisfy
 a common jury by a hasty opinion expressed from an external view
 of the body, or an ill-conducted inspection, merely because it  may
 appear to us quite certain  that the deceased could not have been
 murdered.  Should the deceased happen to be one of that  class  of
persons on Avhose lives insurances are commonly effected, the Avhole
of the circumstances connected Avith the examination of the body,
and the medical opinion of the cause of death, must come to light, 
856       LIFE INSURANCE — SUICIDE  BY  POISON.

and if carelessly performed will probably be made the subject of a
severe cross-examination. I have known several instances in which
there have been painful exposures of this kind, because the medical
witness thought any kind of evidence would serve the purpose of a
coroner's jury.   The verdict of a jury at an inquest is not binding
on a company:  they have not  only a right, but often good reason to
dispute it, and they frequently exercise this  privilege.  The In-
surance Companies are exposed to all  kinds of frauds, some of them
of a most fearful kind, actually leading, as in  the case of burial-
clubs (a kind of life-insurance), to the  perpetration of murder for
the sake of the small amount insured.
  A case of some interest in reference to the question of suicide by
poison, on the part of a person AA-hose  life had been only recently
insured for a very large sum, was tried before Lord Tenterden  in
1832 (Kinnear v.  The Rock Insurance  Company); the late Mr. J. H.
Green, Mr. Key, and myself  Avere called upon  to give evidence on
the part of the  defendants.  This trial would not have occurred but
that the medical inspection of the body for the inquest tAvo  years
previously had been most improperly conducted, and no satisfactory
evidence of the cause of death assigned.  As a sum of 10,000^.
rested upon the issue, the insurers felt that they bad a right to de-
mand a full and perfect inquiry.  The  depositions taken at the in-
quest on decease Avere sent to  me for  examination, and from these
it appeared that the person Avhose life Avas insured died tAvo years
before the action Avas brought;  the body was  carelessly inspected
for a coroner's  inquest, and the contents of the stomach, without
being subjected to any chemical analysis, had  been thrown aAvay.
These circumstances placed great difficulty in  the  way of produc-
ing proof, and in fact so far as medical evidence was concerned they
left the question almost a mere matter of opinion.   An application
was made to me on  the part  of the Insurance Company, to know
whether the exhumation of the body and any  further processes of
analysis w-ould be attended with any benefit,  but  an answer Avas
returned in the negative.  From the manner in which  the first
examination had been conducted—also from the fact that, as the
symptoms under which the deceased had died could only have been
presumptively those of narcotic poisoning, it Avas altogether impro-
bable that, after tw-o years' interment, any trace of narcotic poison
would be discovered  in the remains.
  The deceased—who, according to the evidence given at the trial,
had been  for some time in a Ioav state of  mind—returned to his
house, in  the Regent's Park,  on the  evening of the 19th October,
1830.  The house was then undergoing repair; his family were in
the country, and the only person residing Avith him at the time was
a man-servant.   The account  given  by this person was  that the
deceased returned home about  ten o'clock in the evening, apparently
in his usual health:  he ordered him to place a decanter of w7ine, a
tumbler, and a wineglass on the library table adjoining his bed-room;
told him that he was going to take a composing draught, and desired
that he  might not be called on the following morning, saying that 
VITIATION OF POLICIES  BY SUICIDE.        857
he would ring his bell if he wanted anything.  The deceased Avent
to bed, but about tAvelve o'clock the servant was awakened  by a
noise, as if the bar of the library-shutters had fallen.   On getting
up, he saw his master, without a light, in the act of returning from
the library to his bedroom, Avhich adjoined it; he took a light from
Avitness, and again went to  bed.  On going up stairs ten minutes
afterwards, Avitness found the light extinguished, and the door of
the deceased's bedroom fastened.  On the next morning, at  9.30,
witness Avent to deceased's bedroom, and knocked at the door as
usual, but received no answer; he Avent again at ten o'clock, but
the door was still fastened, and the deceased did not answer when
he knocked.  The  Avorkmen  Avho  were employed in the house
alarmed witness, about twelve o'clock, by telling him that they had
heard his  master moaning or  groaning.  A ladder was then  pro-
cured, and the room was entered by the Avindow.  The decased was
in bed, and appeared to  have just died as the witnesses entered.  A
surgeon Avas immediately sent for, who on his arrival examined and
tasted some liquid  which was found in a tumbler  on the table.
Search Avas made for a phial, but none could be found; hoAvever, it
Avas proved that there were on the library table a piece of blue and
a piece of red  paper, evidently the cover and wrapper of a phial,
Avhich Avere not there previously. It was also deposed that a  cork
and string were found in the fireplace.   The Avindow of the  library
was open, the shutters having  been unfastened.
   The surgeon, who was called, stated that the body wras lying in a
composed state, the countenance being somewhat pale.  There was
perspiration on  the skin, with  patches of a livid  color here and
there distributed over it.  The body Avas inspected for the coroner's
inquest by tAvo pihysicians and two surgeons.  An accumulation of
putrid blood is said to have been found in the stomach, Avith an
eff'usion on either side of the chest.   The vessels of  the brain  were
someAvhat turgid, but there Avas no extravasation.   The contents of
the stomach were  throAvn  aAvay without  any chemical analysis
having been made.  It  appears that  the only approach to analysis
Avas  the  draAving of a  stick of nitrate of silver across the mucous
membrane of the'stomach at the time of the inspection.  The cause
of death assigned by these witnesses Avas the rupture of a blood-
vessel in the stomach.   A verdict of " Death from natural causes"
Avas returned; the body was buried, and it was supposed that  all
inquiry had ceased.                                      .
  The cause of death assigned by the witnesses being considered
altocrether inadequate to account for this event  under the circum-
stances—the suddenness of death in a person who was  in  perfect
health the evening before—the absence of any sign of effusion of
blood in  the brain, so frequently met with in sudden death  from
aDonlexy—together Avith the  circumstantial evidence that some
liquid  had  been taken  by  deceased, and  the  phial  disposed  of,
afforded a strong ground for suspicion.  The insurers refused pay-
ment of the amount of  the policy, and demanded an inquiry.
  The circumstantial evidence not being of itself sufficient to  esta- 
858       LIFE-INSURANCE — SUICIDE BY POISON.

blish  the fact of poisoning, additional  evidence Avas required to
determine—1. Whether the  cause of death assigned by  the wit-
nesses at the inquest Avas adequate to account for it; and 2. Whether,
if not, the facts  proved relative to the death of the deceased were
consistent Avith  narcotic poisoning—whether, in short, death by
poison was, or Avas not probable.
   Mr. Green, Mr. Key, and myself Avere requested to give an opinion
on these points.  With regard to the  first, we said  the cause of
death assigned by the witnesses was inadequate and unsatisfactory.
The blood found in the stomach Avas loosely described as half-putrid
and not coagulated :  so far from its being proved that it had been
effused during life, it was not improbable, from the careless manner
in Avhich the inspection Avas made, that it had proceeded from some
vessels divided  by  the examiners.   Admitting that it had been
effused during life, it did not furnish a satisfactory explanation of
the cause of death, since the  quantity was small.  That it was  not
satisfactory to the inspectors themselves appeared certain  from  the
fact that they- examined the stomach for some  kind  of pioison by
the rough experiment  of drawing a stick of nitrate of silver over
the mucous membrane!   Further, gastric hemorrhage rarely  de-
stroys life on a first attack, and is generally accompanied by vomit-
ing of blood; but the  deceased had  never been subject to hsema-
temesis,  and there had been no bloody vomiting.
   With  regard to the  second question, the facts proved might be
explained by supposing that the deceased had  taken a prisonous
dose of laudanum, or of some preparation of  opium: it might be
contended that no opiate AA-as present in the stomach, but it did not
ap>pear that any analysis had been made.  The  deceased  had died
in about the period  at which this pioison operates fatally, and it
Avas for the jury to determine from the circumstantial evidence, as
the medical evidence Avholly failed to throAv light upon the subject,
hoAv far this Avas likely.  We all agreed that narcotic poisoning in
the deceased's case was, so far as we could speak in the absence of
an analysis, probable, inasmuch as the facts proved respecting his
death agreed Avith this view, and the results of the medical inspection
so far as they went were quite consistent with  it.  On the  other
hand, the question might arise whether there Avere no natural causes
which would have destroyed life within tAvelve hours in  the same
tranquil  manner in Avhich the deceased was supposed to have died.
To this it may be replied, that apoplexy and other diseases might
also have accounted for death; but there was no evidence  from  the
inspection to establish the existence of these, and death from a
narcotic poison was, medically speaking, just as pirobable.   In short,
as the evidence was essentially of a negative kind, and  there were
tAvo ways of accounting for death, either of them consistent with
the medical facts, it remained for  the jury to decide from the Avhole
of the circumstances which was  the  more probable.  The cause of
death was entirely a matter  of medical presumption.  It was  im-
possible  to swear that the  deceased could  not have  died  from
apoplexy, or from the  effects of a large dose of an opiate.  As the 
VITIATION OF POLICIES  BY  SUICIDE.        859
case Avas only one of suspicion, and not of actual  proof, a verdict
Avas returned for the plaintiff'.
  There can be no doubt of the propriety of the verdict, since the
law always justly insists upon what the circumstantial evidence,
combined Avith medical opinions, was here incapable of affording—
namely, direct and not inferential proof of death from poison.  The
insurers had alleged suicide  by poison—this they Avere bound to
prove by clear and distinct evidence ; the plaintiff AA-as not required
to show that the death was natural. If, besides the paper-wrappers,
string, and cork, a phial Avhich had evidently contained laudanum
had been found, or the  liquid in  the tumbler, instead of being
merely  tasted  or smelt by the medical gentleman and then thrown
aAvay, had been carefully analyzed, or had the same cautious pro-
ceedings been adopted with regard to the contents of the stomach,
clear evidence might have been adduced which would have satisfied
the jury that the deceased had died from narcotic poison.  In sup-
posing that the deceased took a fatal  dose of an opiate, it Avas as-
sumed that he had disposed of the bottle by throAving it out of the
library-Avindow, Avhich was found open after the shutters had been
fastened : no traces of the composing draught Avhich he had told his
servant he should take Avere found—not even the phial—and the
colored wrappers of paper, cork, and string found in the bedroom
were not accounted  for.
   The  only point that  went against  the presumption  of narcotic
poisoning was this: the servant SAvore on the trial that his master's
bell rang about nine o'clock.   If this were true, the deceased could
not then have been under the influence of a narcotic poison, as he
must have walked across the room to have rung the  bell.  This
Avould  have given  but three hours for the fatal  operation  of the
poison, while most cases of  pioisoning by opium have  not  proved
fatal in less than from six to twelve hours.  Still, opium has been
knoAVii to cause death  within a short  p>eriod.  Sir R. Christison
met Avith a case where the person died in three hours, and Dr. Beck
another w-here death  occurred  in  two hours and a  half.  But on
compearing the evidence of this Avitness at the inquest and the trial,
there Avas^a great discrepancy.  He said  nothing of  a bell ringing
when examined at the inquest recently after his master's death (i. e.
tAvo years  before the  trial), when  it might be supposed  that the
whole of the circumstances Avere fresh in his mind.
   Anion«■ the medico-legal questions connected with this subject is .
the following: Does the proviso in the policy respecting suicide in-
clude  all acts of self-destruction, or is it restricted only to those
cases in Avhich either a sane or a piartially insane person consciously
destroys himself?   This question  has been elsewhere  considered
(Chap.  fit)).   The  act  of suicide does not  necessarily indicate in-
sanity; but even if it  did, the rule  of law, as settled by a majority
of  the  iudo-es in reference to this proviso in cases of life-insurance,
is that  whenever an insured  person destroys himself intentionally,
whatever may be the state  of his  mind, the policy is void.  If a
person  whether sane  or insane, kills  himself unintentionally, then 
860        VITIATION OF POLICIES  BY  SUICIDE.

the insurers are liable;  but the onus of proof in this case lies npion
the plaintiffs, i. e., those who would benefit by the policy.   Accord-
ing to the practice of some offices, the act of suicide does not  ren-
der a policy void.
  [The leading English cases on this subject are Borradalc v. Hun-
ter, 5 Mann. &  Grang. R.  639, and  Cleft  v.  Schwaibe, 3  Mann.,
Grang. & Scott R. 437.   In the former case, the provision was that
the policy should be void if the assured "should die by his OAvn
hands."  The  assured  threw himself into  the  Thames and  Avas
droAvned.   The jury found, hoAvever, that though  this was clone
voluntarily, and with intent to destroy life, the  assured  " Avas not
capable of judging  betAveen right and  wrong."   The majority of
the court held the policy to  be avoided.   Chief Justice Tindal
dissented, delivering a  very able opinion sustaining his views.
  In the other case, the policy provided that it should become void
if the assured "committed suicide."  He did, in a fit of insanity,
commit suicide by taking  sulpliuric acid.   Creswell, J., directed
the jury that  they  must find for the plaintiff, unless the assured,
when he died  by his own voluntary act, "was able  to distinguish
betAveen right and wrong, and to appreciate the nature and quality
of the act that he w7as doing, so as to be a responsible moral agent."
Upon a bill of exceptions, this instruction was held to be erroneous,
the majority of the court being of opinion that it was immaterial
under the terms of the policy, Avhether the assured was, or was not
at the time a responsible, moral agent.  Chief Baron  Pollock and
Justice Wightman  dissented, on   the  ground that  as  "soon as
it is ascertained that a person has lost his sense of right and Avrong,
it matters not Avhat else of the human faculties  or capacities remain,
and that he can no  more commit suicide than  he can commit mur-
der."
  The same question arose in Breasted v. Farmers' Loan and Trust
Co., 4 Hill (N. Y.) R. 73; affirmed in 4  Seld.  299.  The policy in
that case provided that it should  become void in case the assured
should " die by his  own hand."  He committed  suicide by drow-n-
ing himself iu  the  Hudson River, being at  the time  of "unsound
mind, and wholly unconscious of  the act."   The case came before
the court upon a demurrer.   Nelson, C. J., delivered the opinion of
the court, giving judgment for  plaintiff.
  A similar decision has recently been made by the Supreme Court
of Maine upon an  insurance effected by Joseph Esterbrook,  who
afterwards became  deranged, and committed  suicide by shooting
himself.  (Legal and Insurance Reporter, Sept. 1866, p. 281.)
  As to the construction of the Avords " die by his own hand," see
Hartman v. Keystone Ins Co., 9  Harris (Penna.) 466.—P.]
  M. Brierre de Boismont reports a case which  is also instructive
in reference to this difficult question.   On the 12th of October,
1840, a man was found dead, apparently strangled, on the road to
Stettin.  His  affairs were found to be in an unsettled state, and it
was supposed he had  destroyed himself; but the position of the
body, and  the condition in AA-hich it was  found, were apparently 
VITIATION OF POLICIES  BY  SUICIDE.        861
not consistent Avith this theory.  The hands were tied behind the
back, and there were the appearances of a robbery.  As all the cir-
cumstances pointed to a violent death  at the hands of another, a
judical inquiry Avas made, Avhich, from Avant of evidence, led to no
important result.   The deceased, who w-as a merchant, had recently
effected an insurance on  his life for the amount of 40,000 francs,
Avhich was to be piaid to his family on his death, except in case of
his committing suicide.  This sum was paid into  court, and AA7as
subsequently reclaimed  by the  office on the ground  that the  de-
ceased had destroyed himself.   A Avitness had come fonvard Avith
an autograph letter of the deceased, in which he had described the
motiA.es that had led  him to perpetrate the act, and the  mode in
Avhich he had carried out his design.   This document clearly proved
that he had sacrificed his own life for the  sake of his family, in
order to preserve  them from impending  ruin.  According to the
private letter to his friend, which had every appearance of authen-
ticity, he  had  suspended  himself to a beam, from  Avhich a friend,
according to a previous arrangement, had cut him  down, and had
then disposed his body on the high road, under such circumstances
as to  give  the impression  that he had been the victim of a murder-
ous  assault.  ("Ann. d'Hyg.," 1866, 2,  397.)  The  attempt thus
made to defraud the  Insurance Company  by hastening the term at
Avhich the insurance Avould fall in, and by falsifying the conditions
of the policy, Avas defeated by the production of a private letter.
   There is another kind  of fraud Avhich perhaps is more  common,
namely, that in which the insured simulates death in order that his
relatives or  creditors may receive the amount of the insurance.
Tavo  instances  of this kind of fraud have been related in a former
part  of this work.   In one,  the insurer endeavored to make it
appear  that he lost  his  life while  bathing  on the sea-shore, his
clothes being  found on  the steps  of a bathing-machine;  in  the
other, the case of a fraudulent bankrupt, the  man registered his
oavii alleged death, and folloAved his oavii coffin to the grave in a
country churchyard!  In both cases the fraud Avas detected, and
the offices were saved from a heavy- loss.
   It is naturally supposed that a man has a direct  interest in pre-
serving his  own life, but this of course will not prevent him from
falling a victim to the criminal designs of a another. The insurable
interest of a person in the life of another became an important
question in January, 1863, in Hebdon v. West.   The plaintiff, a clerk
in a banking-firm, had effected an insurance on the life of one Ped-
der  Avho was a member of the  firm.  Plaintiff became indebted to
the'firm for  a sum of 5000?., and Pedder having informed the plain-
tiff that ho should not be troubled with any demand for repayment
durino- his (Pedder's) life, the plaintiff"  insured Pedder's life in the
defendant's company for the sum of 2500?.  It was  the payment of
this sum to the plaintiff that was now in dispute, the defendant con-
tending that plaintiff had no insurable interest in the life of Pedder.
The case was argued, and the court put to counsel  the cases which
had been  already decided, of a father insuring his son's life or a 
862
INSURANCE MURDERS.
husband his Avife's.  It had been held that in these cases there was
no  insurable interest.  Hence, w-hen a husband desired to make a
provision for his wife, he  insured his own life—she did not  insure
his.   Further, they instanced the remarkable case of  Wainwright
(p. 863), in which  that  person induced  his  sister-in-laAV  to  insure
her life, and then poisoned her, in order, as next of kin, to get hold
of the sum assured.   That case shoAved the immense importance of
the law requiring a real interest in the life of a person Avhose life
was insured.  The result of the argument Avas that the court re-
served its judgment; but  there appeared to be no agreement con-
cerning Avhat was  a legal insurable interest in the life of another.
[See Reese v. Mutual Ins.  Co., 23 N. Y.  (9 Smith) 516;  Rawls v.
Insurance Co., 36 Barb.  (N. Y.) 337.  In the  latter case it was held
that a creditor's insurance upon the life of his debtor was not  in-
validated  by the running of the statute of limitations against the
debt before death.—P.]

  Insurance murders.—The insurance of lives has been considered
to be objectionable, on the ground that it tends to create an interest
in the death of another, and thus to lead to  secret acts of murder.
The 14th George  III. c.  48, expressly enacts that  no insurance
on  life shall be valid unless the person insuring has a direct  legiti-
mate  interest in the person whose life is insured.   This statute was
enacted for the purpose  of  preventing gambling in policies, and to
guard society against the  risk of persons  insuring contriving the
death of the insured for the sake of the payments to be made under
the policy ; but its effect is simply to render the policy void ; it does
not require that  the premiums shall  be refunded, nor"does it award
any penalty on the offenders.  As policies of life-insurance may be
bought and sold like other property, they may fall into the  hands
of persons who ha\-e no  other interest in  them than the desire that
such  policies should speedily become claims by the  death of the
insured.  The interest of such holders, it has been justly observed,
lies in the death and not in the life of the insured.
  [In  a recent  case in Pennsylvania, Elliott's Executor's Ap., 14
Wright 75, it was decided  that the  assignment of policies of life in-
surance by a debtor who was insolvent Avhen insured, in trust  for
the benefit of his wife,  is  fraudulent and void as against creditors.
But that policies effected without fraud directly and on their face for
the benefit of the w-ife and payable to her, are not fraudulent as to
creditors.—P.]
  A case  is related in which a man was found dead at St. Fergus,
in Scotland, from a pistol-shot wound under very suspicious circum-
stances. The medical  and moral facts were not consistent with the
theory of suicide; on the contrary, they all  pointed to a cool and
deliberate act of murder.. A medical man was placed on his trial
for this alleged crime, and  the motive assigned for the act Avas that
the  prisoner had  recently effected insurances in three  dift'erent
offices to the amount of about 2000?., upon the life of  the deceased
—a poor man, in whose life it was proved he could have  had no 
INSURANCE MURDERS.
863
laAA-ful pecuniary  interest.   The  insurances were only for short
periods, and as in the Scotch offices the policies are  not rendered
void  by  suicide,  the amounts could be  claimed even assuming
that the deceased had destroyed himself.  The body, Aveapon, and
other  objects had, it was supposed, been arranged w-ith a vieAv to
make it  appear that the act was suicidal.  It is a significant fact,
hoAvever, as a key  to explain the death of the deceased and the mo-
tive of the  accused, that the risk connected with the largest in-
surance (1000?.) commenced  on the 24th November, 1852, and ter-
minated  on the 24th November, 1853.  Only one premium to the
amount of about eleven  pounds had  been paid, and this payment
w-as proved to have been  made  by the prisoner.  The deceased Avas
found dead on the 20th November, 1853 ; i. e., only four days before
the date  at which the policy of insurance on his life would haA7e
lapsed.   The evidence went to show  that the accused had the mo-
tive, means, and opportunity of committing this crime ; but as there
were  no circumstances which could directly- fix it  upon him, he AA-as
acquitted of the charge.
   A remarkable case was tried in this country in 1835 (Wainxvright
v. Bland, Exchequer, 29th June, 1835),  in  Avhich  the amount of a
policy of insurance effected for tAvo  years on the life of a 31iss
Abercromby was sought to be recovered.   The action Avas brought
against the Directors of the  Imperial Assurance Company, and Avas
resisted by  them on the grounds that the lady had been destroyed
by p»oison, and that the plaintiff Wainwright had  no lawful pecuni-
ary interest in her life.  As there is strong reason to believe that
thisAvas one of the first murders brought about by the use of strych-
nia in this country, it may- be considered as the type of those Avhich
twenty-one years afterAvards were for a time successfully perpetrated
by the criminal William Palmer.  Strychnia had been  discovered
only twelve years previously, and it was then but  little known <as a
poison either in England or France.   The history of the case is re-
markable, as the  real cause of death was completely  overlooked.
Tavo  fine-looking  young Avomen of the name of  Abercromby, the
daughters of a deceased  officer, with  no other property than pen-
sions  of  ten pounds a year from government, lived a few miles out
of town with a man of the  name of Wainwright and his wife, who
Avere  also in reduced circumstances. They came to London in 1830,
as the winter was setting in, and took lodgings.  The elder girl,
having just attained her twenty-first year, was sent, sometimes alone
and sometimes Avith her sister, tonofeAver than eight or ten insurance
offices to eff'ect insurances at each on her own life.  Being in full and
vigorous  health, she met Avith a favorable reception from several
offices, although 'she could assign no other reason for wishing to in-
sure her life than that she AA-as told it was right  for her to do so.
Five  offices granted policies in her own name, some for two, others
for three years, for no  less a sum than 16,000?.  Among them the
Imperial  in October, 1830, accepted an insurance on her life for two
years for'3000?.   On the  13th of the following December, when in
perfectly good health, she made her will, and assigned this and other 
864
INSURANCE MURDERS.
policies to the plaintiff Wainwright and his wife.  On the evening
of this day the whole p>arty w7ent to a public theatre, and on their
return had a  supper of oysters and porter.  On this occasion Miss
Abercromby was first  taken ill; it was said she suffered from an
hysterical attack, but there is no clear account of her illness at this
time.  It was not until the 16th that  she was seen by a physician,
but her illness was not such as to excite alarm; it was supposed to
be hysterical.  On the 21st this physician was called suddenly to
her, and he then found her in \7i0lent tetanic convulsions, resembling
those which are sometimes the effects of a Avound, i. e., tetanus.  She
said she Avas sure she should die, and she suddenly went  off into a
fit of convulsions.  The physician  left the house, returned in about
an hour, and she was then just dead.  The appearances  presented
by the body are imperfectly reported; there was an eft'usion of serum
at the base of the brain, and to this death was referred.   There
Avas  no analysis of the contents of the stomach ; it is said  they were
minutely examined, and that there was no appearance of  anything
sufficient to account for death ;  but the person to whom this ex-
amination AAras intrusted was not called to the  trial.
  Wainwright,  as executor  and trustee, applied for payment of
two  of the policies which had been assigned to him, but this was
refused.  He then went to France  with  his family, and  five years
afterwards (in 1835), through an agent, brought an action against
the  Imperial  Assurance Company.   On this occasion  the jury
could not agree in a verdict.  (" Med. Gaz.," vol. 16, p. 606.)   An-
other action was afterAvards brought against the company, and the
facts above stated came out at the trial.  The Attorney-General
said  that the plaintiff had left the country, and there  Avas good
reason to believe that he Avould never again return to it.  The judge
charged the jury that, whether murder had been committed or not,
the executors  could recover, provided the insurance had been ef-
fected bond fide on behalf of the deceased.   His lordship directed
their attention to the extraordinary fact of this young lady, the
deceased, having effected these large insurances for only two years;
of her sudden illness and death in convulsions soon after the assign-
ment of the policy;  and reminded them that no proof  had been
adduced to substantiate the reasons she  had given to the various
offices for effecting the insurances on her life.  By the Avill  and
assignment made to the plaintiff and his wife, these persons were
placed in a situation in which the law would not alloAV any one to
stand—namely, that of having a strong  interest in procuring the
deatli of a fellow-creature by unlawful means.   The jury returned
a verdict for the insurers, on the  ground  of misrepresentation and
want of interest.
  There  can  be no doubt  that  this y-oung Avoman died from the
effects of a dose of strychnia, administered to her shortly  before
she was seen by the physician on the afternoon of the 21st Decem-
ber.  Tetanus, as it is produced by this poison, is rapidly fatal; but
as it arises from wounds, it comes on slowly, and is only fatal after
some days; and there Avas no Avound, or other natural cause to ac- 
INSURANCE MURDERS.
865
count for its occurrence.  Waimvright w-as subsequently tried, con-
victed of forgery, and transported.  He died many years afterAvards
in one of our penal settlements, and, before his death, it is reported
that he substantially admitted that he destroyed Miss Abercromby
and several other persons by strychnia.
  Some of the  poisonings which took place at Rugeley in 1855-6,
and which culminated in the conviction and execution of the noto-
rious William Palmer for the murder  of J. P. Cook, originated in
the easy system of raising money by the insurance of lives.  The
body of Ann Palmer, the wife of the prisoner, had  been lying fif-
teen months in the grave, under a professional burial certificate of
deatli from bilious cholera, when the sudden death of Cook and the
detection of antimony in  his  body, led to the exhumation of the
body of this lady.  It was then found that  she had died from the
effects of antimony-, which was detected by Dr. Rees and myself in
all parts of the body, even  in  the ovaries.   When  the  history of
the illness which preceded death was  gone into, it was found that
the symptoms w-ere consistent  with  the  effects of tartarized anti-
mony, but not  with  those of bilious cholera, or any other disease.
Antimony  had not been  prescribed for  the deceased during her
illness, and it was therefore  clear that it must have been adminis-
tered to her by some one, up to Avithin a short period of her death.
With an actual life interest  in his wife's property to the extent of
only 3000?., and within the short period of nine months of her death,
 William Palmer made, or caused to be made, proposals for insuring
her life in eight different  offices for an aggregate sum of 33,000?.
Three of these proposals made by himself—to the Norwich Union
in December, 1853, for 3,000?.; to the Scottish Equitable in Janu-
ary, 1854, for 5,000?.; and to  the  Sun in February, 1854, also for
5,000?.—were accepted by these offices.   He  thus contrived in less
than three months to effect a total insurance of 13,000?. to cover a
life-interest of  3,000?. on his wife's property I  The other proposals,
to the amount  of about  20,000?., AA7ere declined by- the offices to
which he applied.   The  total  premiums paid by Palmer on the
three policies amounted to 388?.; and he Avas at the time  so pressed
for money, that  he drew a bill which Avas actually discounted on
the  security of the  policies, so that he  contrived  to make the
policies pay for themselves.   As he  Avas in embarrassed circum-
stances, and unable  to meet bills of  this kind without  becoming
still more deeply involved in debt, the realization of the policies
bv the  death  of his  wife became to him a matter of  necessity.
Within little  more  than six months after effecting the insurance
on her life  the wife died from pioison, under his immediate superin-
tendence ' On her death, these large sums were claimed by Palmer,
and were paid  to him by the  offices.  Although there was at the
time some suspicion that the wife had died from poison,  there was
no inquest or inspection, and the body was  hastily buried.  These
facts only came to light more  than a year afterwards, during the
investigation of another murder in 1855.  It seems that the general
respectability of  Palmer, his social and  professional position,  to-
       55 
866
INSURANCE MURDERS.
gether with the tAvo medical certificates of the cause of the death
of the wife, checked any intention  which  might have existed on
the part of these offices to resist the  payment of the policies.  117?-
liam Palmer, hoAvever, carried his life-insurance speculations much
further than this.  Having no pecuniary interest whatever in the
life of his brother, Walter Palmer, he either made or induced him
to make proposals for the insurance  of bis life, in various offices, to
the amount of 82,000?.   The Prince of Wales office accepted the
proposals to the extent of 13,000?. under certain  limitations.  On
the 16th August, 1855, Walter  Palmer died  suddenly, in the pre-
sence of his brother and another man  of doubtful character, Avith
Avhom he had recently placed him as a  lodger; and it Avas rendered
highly probable, if not proved, that  the  prisoner  William had
shortly before purchased  at a  druggist's a bottle of prussic acid.
The policy had been previously assigned by7 Walter to William, for
a nominal consideration ; but Avhen  William Palmer made applica-
tion for the amount after the death of his brother, the office refused
payment; and, for very good reasons,  Palmer failed to enforce it.
He subsequently tried, but ineffectually, to insure, to the extent of
25,000?., the life of his groom, George  Bates,  described  by him in
his proposal as a  "gentleman"  of  independent means;  and  he
advised a man named Cheshire, the postmaster of Rugeley, also
to make proposals on  his life  to the  extent of  5000?. and assign
the policies to him.  But for the revelation of  facts connected with
the death of Cook, these tAvo piersons on Avhose heads a heavy- life-
insurance value had thus been  set,  would have been the next vic-
tims.  Thuggism, as formerly pierpetrated in India by a certain class
of Hindoos, might be regarded  as a venial offence compared with
this professional mode of raising large  sums of money upon human
life.
   It is now the custom  of Offices to require a statement  whether
the life has been already proposed to other Offices, and whether the
proposal  has, or has not been accepted.  But  this is only a partial
method of checking such  nefarious  speculations.  In France and
most Continental  States insurances of this  kind are said to be
strictly forbidden, not for  the  prevention of gambling (Avhich  is
rather encouraged), but in order to guard  society against  the risk
of the persons insuring contriving the death of the insured.  That
these regulations are. not sufficient to guard against secret  murder
and speculation in human life is, how7ever, clearly established by
the  case of Dr. De la Pommerais,  who, in May, 1864, Avas con-
victed in Paris of the murder of  a woman  named PauAv.   The
reader will find an account of the medical circumstances connected
with this act of murder, Avhich equals, if it  does not  surpass  in
atrocity, the murders perpetrated by William Palmer on his wife
and  brother, in vol. 2, p. 438, of "The Principles and Practice  of
Medical Jurisprudence," 1873.
  De la Pommerais had first cohabited Avith the deceased.   Having
thrown her off, he married, in August, 1861, a lady of some fortune^
Madlle. Dubizy.  Some time after the marriage, the mother of this 
INSURANCE MURDERS.
867
lady died under very suspicious circumstances, as it was supposed,
from poison administered by the prisoner.  In June, 1863, he sud-
denly, and without any7 apparent cause, reneAved his intimacy Avith
the deceased Pauw, who w-as living in great  poverty Avith several
of her children.  Having advanced  to her small sums  of money,
amounting on the Avhole to about 27?., he inducecl her to insure her
life in various Insurance Offices  for the sum of 22,000?., and after-
Avards to assign the policies to him.   The  reasons which  he gave
for effecting these insurances Avere—parti}7  that  he had advanced
to the deceased  large sums of money (4000?.), and partly that, in
the event of her  death, he wished to provide for  his illegitimate
children.  The first  statement Avas proved to be  untrue, and the
second  was inconsistent with the claims which  he subsequently
made on  the Offices.  The Avoman was examined, found  to be in
good health, and insurances on her  life Avere effected  for tAvO or
three years, to the large amount  above stated.   La Pommerais paid
the first premiums, amounting to 600?.  He had thus entered into
engagements for three years to  pay in premiums a sum of about
800?. per annum, when his practice did not bring in more than 400?.
per annum, and he had no other resources.   He  induced the de-
ceased to feign that  she Avas ill and had met with an accident; but
the surgeons and physicians Avhom she consulted found, on exami-
nation, that there Avas nothing the matter with her, Avith the excep-
tion of a feAV attacks of vomiting.  She continued well up  to the
16th of November, wlien the  prisoner visited her, and  passed the
evening with  her.   She avus tak;en very ill  that  night, and after
violent vomiting and convulsions, with fainting, she died on the
morning  of the  17th, and it Avas proved, from  the effects of digi-
taline,—a large quantity of which the prisoner had purchased some
time before, and of the disposal  of which he could give no satisfac-
tory  account.  He found no difficulty, however, in procuring a
medical certificate to the effect that deceased had died from gas-
tritis and perforation  of the stomach.  The policies of assurance
had been assigned to him by the deceased shortly before her  death;
and it was the early claim which he put in for the payment of them
that first led to suspicion.  There was no answer to the charge of
murder by the administration of digitaline, and the  prisoner Avas
convicted and executed.
   The proper method to stop  this secret system of murder Avould
be by placing severe legal restrictions on the  sale or assignment of
policies, and&by preventing the  purchase of them by strangers, who
can only  have an interest in the death of the  insured at  the earliest
possible period.  The burial-club murders are  said to have been
much checked by a  regulation which prohibited, a person  from re-
covering under  this species of insurance  more than the amount
proved °to have been actually  paid  for the  funeral.   It  would be
well if this principle were universally carried  out, but  from  the
evidence given at the trial of Mary Ann Cotton (Reg.  v. Cotton,
Durham  Lent Assizes, 1*73),  there is reason  to believe that in-
surances  on lives are still secretly effected simply for the purposes 
868
INSURANCE MURDERS.
of murder.   The prisoner Avas indicted for the murder by poison of
her stepson, Avho  died  in  July, 1872.  The body of the deceased
was exhumed, and arsenic AA-as detected in it.  This was the sole
cause of deatli.   This  woman, it was stated upon well-ascertained
facts, had at different  times killed  by poison her mother, fifteen
children, three husbands and a lodger—making altogether twenty
persons; and the lives of most, if not all, of them were insured.  In
some of these cases she had claimed, and received  from the In-
surance Offices, the premiums oh these deaths.  One of her  three
husbands thus disposed of and four of her children, were insured
in the British and Prudential Insurance Office.  They died rather
rapidly one after the other, and the medical man assigned gastric
fever as the cause of death, when the symptoms were not consistent
Avith this cause.   The prisoner obtained from  the Office a sum of
thirty-five pounds by the death of this husband, and  some smaller
amounts from burial-clubs, by the deaths of the children!  She then
married a man with a family of children, and was very anxious to
have his life  and the lives  of his children insured.   One day he
found her at an Office trying to procure an insurance  on his life.
He  left her, and his life was thereby saved.  This woman was very
properly convicted and executed.   No toxicomania was pleaded in
defence!  It is clear from  the evidence in this and other cases, that
some of the Insurance  Offices AA-hich  find clients among the  poor,
furnish great facilities  for such murders, and that  the managers are
not sufficiently careful  in making inquiry- into the means, motives,
and objects Avhich induce persons  in  this class of life to effect in-
surances on the lives of others.
  The  trial and  conviction of this  criminal  for these insurance
murders brought to light another fact, namely, the great insecurity
of life in this country, owing to the  perfunctory manner in Avhich
medical men discharge an important  duty in filling up certificates
of the causes of death.   With fully-marked symptoms of arsenical
poisoning, these sudden and violent deaths were registered, one after
the other, as gastric fever.  A public writer, commenting on  these
cases,justly observes: "Arethe  symptoms of arsenical poisoning so
subtle that trained doctors cannot  be  expected to  notice them ? Is
it creditable to medical science that a man should be alloAved to die
with a fatal quantity of arsenic in his stomach without foul play
being suspected?  But perhaps the greatest Avonder is, that a Avoman
could successfully practice for so  man}7 years a system of  pjoison-
ing, without betraying her dreadful secret, or awakening  more
than once material distrust among her neighbors."  The success of
this criminal depended, first, on  the facilities for  insuring the
lives of others in a Ioav class of Insurance Offices, and, secondly,
on  the carelessness with Avhich  causes of death are certified. 
INDEX.
   ABDOMEN, wounds of the, 357
     Abortion, 526
     causes of, 527
     from drugs, 530
     from injections, 538
     signs of in the living and dead, 538
     feigned,  540
     law relative to, 540
     medical  responsibility in cases of, 545
     proofs required, 546
 Abortives,  specific, 531
 Abstinence, effects of, 487
 Accidental wounds, 275, 279
 Acetate of lead, 170
     of  copper, 173
     of  morphia, 208
 Acetic acid, 126
 Acid, sulphuric, 110
     nitric, 115
     hydrochloric,  119
     oxalic, 120
     acetic, 126
     arsenious, 140
     arsenic,  159
     carbolic, 191
     prussic, 212
     carbonic, 447
     sulphurous, 456
     tartaric,  125
     hydrosulphuric, 466
 Acid poisons,  110
 Aconitina, 248
 Aconite, poisoning with, 245
     root mistaken for horseradish, 247
     leaves  and seeds of, 247
 Aconitum napellus, 245
 Adipocere, 75
 iEthusa cynapium, 244
 Affiliation, evidence in cases of, 660, 683
 Age, medical questions concerning, 636
     for procreative power, 681
     impotency depending on, 682
     of the new-born child, rules for determin-
      ing,  550
 Aidoiomania, 810
 Air, in  veins, a  cause of death, 356
     confined, suffocation from, 458
     of drains and sewers, composition of, 471
Alcohol, poisoning with, 222
Algaroth, powder of, 180
Alienation, mental   (See Insanity.)
Alkalies, poisoning with, 127
Allotropic phosphorus, action of, 138
Almond-flavor, 218
Almonds, bitter, essential oil of, ^lo
Aloes, noxious effects of, 186
Ambidextrous persons, wounds by, 280
Amenorrhoea, 494
    a cause of insanity, 692
Amentia, 742
Ammonia, poisoning by, 129
Ammoniated mercury, 167
Arnrnonio-chloride of mercury,  167
Amnii, liquor, stains  of,  546
Amorphous phosphorus, 138
Analysis, articles preserved for, 27
    fallacies connected with, 28
Anamirta cocculos, 229
Androgyni and androgynae, 668
Animal irritants, 192
Antimony, tartarized, poisoning by, 176
    chronic poisoning by, 179
    chloride of,  182
Apnoea, death from, 384
Aqua-fortis, 115
Areolae of the breast, state of, in pregnancy,
  496
Arrowroot, detection of, 583
Arsenates, alkaline, poisoning by the, 159
Arsenic, 140
    eating, 85
    symptoms caused by, 140
    post-mortem appearances, 142
    death from external application, 143
    analysis as a solid, 144
    in solution,  146
    Marsh's process for, 147
    Reinsch's process for, 148, 154
    detection of, in organic mixtures, 149
    sulphides of, 159
    acid, 159
Arsenious acid (see Arsenic), 140
Arsenites, alkaline, poisoning by, 156
Arsenite of copper, 157
    in paper-hangings, 157
Arsenuretted hydrogen,  fatal effects of, 159
    tests for, 147
Arteries, wounds of, 354
Arterial and venous blood,  298
Artificial inflation of the  lungs, 569
Asphyxia, death from, 58
    various forms of, 384
    from mechanical causes, 443
    from gases, 446
Assizes, trial at the, 39
Atelectasis of the lungs,  564
Atelectasis a cause of still-birth, 59
Atropa belladonna, 249
Atropia,  251
Attesting witnesses, 779 
870                                  INDEX.
   BACON, 196
     Ballottement in pregnanoy, 500
Balls, apertures produced by, 369
    deflection of, 370
Barber's poisoned wheat, 230
Barium, chloride of, 132
Baryta, poisoning by, 132
Bastardy, adulterine, 639
Battle's vermin killer, 236
Bearsfoot (Hellebore), 188
Belladonna, 249
Bestiality, 724
Bichloride of mercury, 160
Binoxalate of potash, 125
Birth,  concealment of,  524
    proofs of, in criminal law, 554
    date of, 620
    partial and entire, 620
    proof of, in civil law, 622
    plural, 639
    monstrous, 634
Births,  premature, 645
    protracted, 650
    posthumous,  662
Bismuth, subnitrate, 184
    arsenic in,  185
Bitter almonds, essential oil of, 218
Black hellebore, 188
Bladder, rupture of the, 360
Blistering-fly, poisoning by, 192
Blood on weapons, 235, 297
    on clothing and furniture, 288. 292
    marks of, in death from wounds, 289
    tests for, 291
    arterial and venous, 298
    corpuscles  of, 303
    on  linen, 292
    human and animal,  305
    optical examination of, 301
    loss of, a cause of death, 311
    extravasation of, on the brain, 343
    in cases of abortion, 546
    in stomachs of new-born children,  585
    menstrual,  723
Blood-crystals,  307
Blood-stains, examination of, 291
    on linen, 292
    date of, 292, 302
    distinguished from  rust and fruit  stains,
      295
    microscopical examination of,  303
    spectral examination of, 301
    guaiacum process, 300
    in cases of abortion, 546
    of rape, 723
Blows or falls, injuries produced by, 266
Blue vitriol, 173
    rocket, 245
Body, cooling of the, in  death, 62
    destruction of the, by fire, 380
    specific gravity of the,  398
    inspection  of the, in cases of poisoning,

    position  of the, in  death from wounds,
      283
    position of the, in  death from hanging,
      418
Bones, fractures of the, 363
Books, quotations from,  48
Born  alive, signification of, in  criminal  and
  civil law, 554, 629
Brain, wounds  of the, 348
Breasts, changes in pregnancy, 496
Brick-kilns, vapor of, 457
Broom-tops as an abortive, 530
Brucia, effects of, 239
Buoyancy of the body, living and dead, 395
Burnett's fluid, poisoning with, 183
Burning, homicidal, 380
Burns and Scalds, 375
    on the living and dead body, 375
    the result of accident,  homicide or sui-
      cide, 375
    by corrosive liquids,  381
    from lightning, 479
Butler's vermin killer, 236
Butter of antimony, 182
pADAVERIC rigidity, 63
\)  Caesarean extraction, 631
Calabar bean, poisoning by, 230
Camphor, poisoning with, 227
Canalis venosus, closure of the, 582
Cantharides,  effects of, 192
    detection of, 193
Cantharidine, 193
Capacity, testamentary, 774
    test of, 774
Carbonates of potash and soda, 128
    of ammonia, 130
    of baryta, 133
    of lead, 172
Carbolic acid, 191
Carbonic Acid, suffocation by, 447
    symptoms caused  by, 449
    appearances in death from, 456
    analysis, 450
    combustion in mixtures of, 451
    of lime and brick-kilns, 457
Carbonic oxide, 455
Carburetted hydrogen, suffocation by, 459
Carnal knowledge, 699
Carotid arteries, wounds of the, 355
Catamenia (see Menstruation), 494
Caustic alkalies, poisoning with, 127
Cement-kilns, vapors of, 457
Cerebral  or narcotic poisons,  86, 205
Cerebro-spinal poisons, 86
Certificates of insanity, rules  regarding, 752
Ceruse, poisoning by,  172
Cesspools, effluvia of, 469
Charcoal vapor, effects of, 452
Chest,  wounds of the, 351
    changes produced in the, by respiration,
      558
Child-murder, 548.  (See Infanticide.)
Child, legal detention of a, 575
    new-born, age and maturity of,  from  the
      sixth to the  ninth month, 550
    evidence from  development of, 646
    inspection of the body of, 553
    changes  in the body of the,  after  birth,
      579
Children, supposititious, 666
Chloride  of barium, 132
    of mercury, 160
    of antimony, 182
    of zinc, 183
    of iron, 184
Chloroform, poisoning with, 224
Cholera mistaken for poisoning, 94
Cholesterine, 588
Chronic poisoning,  100 
INDEX.
871
Chronic Poisoning by phosphorus, 135
     by arsenic, 141
     by mercury, 161
     by lead, 172
     by antimony, 179
Chronic insanity, 747
Cicatrization of wounds, 336
Cicatrices, 337
     colored, 339
Cicuta virosa, 242
Cider  poisoned with lead, 173
Circulation, cessation of the, in death, 57
Circulation, foetal changes in the, 580
Circumstantial evidence, in  wounds, 282
Citrate of iron mistaken for blood,  297
Classification of poisons, 86
Coal-vapor, effects of, 452
     gas, suffocation by, 459
Cocculus indicus, poisoning with, 229
Coke-vapor, effects of, 452
Colchicina,  188
Colchicum,  poisoning with,  187
Cold, death from, 483
     infanticide by, 601
Coldness of the body in death, 62
Colic,  painter's,  172
Colica pictonum, 172
Colocynth, effects of, 186
Color-test, influence of morphia in disguising,
  in strychnia, 239
Colostrum of milk, 584
Coma, or  death by the brain,  59
Combustion, human, alleged,  380
     in carbonic acid  and air,  451
Commissions of lunacy, 760, 769
Compression of the brain, 343
Concealment of pregnancy,  504
     of delivery, 508
     of birth, 524
     of sex,  678
Conception, date of, 641
Concussion of the brain, 341
     and intoxication, 342
Concussion of the spinal marrow, 349
Confessions  in  drunkenness, 811
Confined air, effects of,  458
Congenital diseases in new-born children, 593
Conia, 241
Conium maculatum, poisoning with, 240
Contracts of lunatics, 771
Contused wounds, 268
Contusions on the living and dead,  262
Cooling of the  body after death, 62
Copper, arsenite of, 157
     poisoning by salts, 173
     in articles  of food,  175
Copperas, poisoning with, 184
Cord, umbilical, death from laceration of, 591
    length of the, 606
    strangulation by the, 609
Cord, mark of  the, in hanging, 409
     in strangulation, 423
Coroner's  inquests, 37
Corpora lutea,  517
Corrosion  distinguished from ulceration, 104
Corrosive  liquids, burns from, 381
Corrosive  poisons, 87
Corrosive  Sublimate, symptoms  of  poison-
       ing with, 160
    post-mortem appearances, 162
    tests for, 163
    in organic  liquids,  164
Counsel, license of. 42
    privileges of, 47
Courtesy, tenancy by, 628
Cranium, fractures of the, 269, 347
    accidental in the new-born child, 603
Cretins, 742
Criminal abortion, 526.   (See  Abortion.)
Criminal responsibility in insanity, 781
    in drunkenness, 810
    somnambulism, 818
    in deafness and dumbness, 818
Croton oil,  poisoning with,  187
Crying, evidence of live birth, 624
Crypsorchides, virility  of, 685
Cuts and stabs, 271
Cyanide of silver,  214
    of potassium,  217
   DALBYS carminative, 207
     Date of birth, 620
    of conception, 641
Datura stramonium,  255
Daturia,  256
Dead, wounds and contusions on the, 261
Dead body,  examination of the, 22
    burning of the,  380
Deadly nightshade, 249
Deaf and dumb, 818
Deafness and dumbness, feigned, 819
Death, signs of, 60
    causes of sudden, 57
    muscular irritability after, 64, 66
    reality  of, 65
    apparent in new-born children, 365
    acceleration of, in personal injuries, 320
    from surgical operations on wounded per-
      son,  329
    proof of in cases of life insurance, 823
    presumption of,  824
Debility, death of a new-born child from, 591
Decay, food rendered poisonous by, 203
Declarations of dying person, 33
Defloration, signs of, 710
Deformities, evidence from, 659
Deformities, sexual, 668
    of the face from wounds, 349
Delirium mistaken for insanity, 738
Delirium tremens,  following wounds, 329
    in reference to insanity, 752
    in drunkards,  814
Delivery, 507
    in the living, 508
    at a remote period, 510
    feigned  and unconscious, 511
    during sleep, 512
    signs of, in the dead, 575
    protracted, death of the child from, 591
    sudden, in the erect posture, 605
    violence inflicted on the child during, 607,
      611
    locomotion and exertion after, 607
Delusion in insanity, 734
    in reference to testamentary capacity, 773
De lunntico  inquirendo, 760
Dementia, 741
    senile, 744
Dementia naturalis, accidentalis, 733
Derangement, mental, 729
Destructive  things, 81, 83
Development of child, evidence from, 623.646
De ventre inspiciendo, writ of, 502 
872
IND
EX.
Diaphragm, wounds of the, 356
Digitalis, poisoning with, 254
Digitaline, 255, 867
Dipsomania, 810
Direction of wounds, 278
Discharge of lunatics, 758
Diseased flesh, poisonous, 193
Disease, influence of, on poisons, 90
Dislocations, 366
Divorce, medical evidence in suits of, 696
Docimasia pulmonaris, 563
    circulationis, 580, 582
Doubtful sex, 668
Drains and sewers, noxious gases of, 469
Dress, examination of the, in wounds, 272
Drowning, cause of death from, 384
    death from secondary causes in, 388
    appearances in, 386
    medical proofs of, 393
    buoyanoy of the body in, 397
    marks of violence in cases of, 399
    homicidal or suicidal, 401
    from partial immersion, 402
    a cause of death in new-born children, 598
Drugs used as abortives, 530
Drunkards, restraint of, 769, 813
Drunkenness, responsibility in cases of, 810
    interdiction in cases of habitual, 769, 813
    as affecting degree of guilt in homicide,
      815
Ductus arteriosus, closure  of, 581
Dumb, responsibility of the, 818
Dyes, red, mistaken for blood, 295
Dying declarations, rules respecting, 22, 23
  EARTHENWARE, wounds from, 268
    Eccentricity mistaken for insanity, 740
      in wills, 775
Ecchymosis, from violence, 262
    changes of color in, 263
    production of,  after death, 264
    not always a result of violence, 265
    in hanging, 409
    in strangulation of the umbilical cord, 611
    natural marks resembling, 613
    caused by lightning, 481
Eclampsia, 512
Eczema from arsenic, 142
Effusion of blood (see Extravasation), 279
Effluvia of drains and sewers, 469
Electric  fluid,  action  of, 475.  (See Light-
  ning.)
Embryo, examination of the,  520
Emerald green, poisoning with, 158
Emetic, tartar, poisoning with, 176
Epispadias, 639
Epithelial scales, 584
Ergotin, 534
Ergot of rye as an abortive, 531
Erotomania, 810
Erysipelas following wounds,  329
Essence of mirbane, 219
Essential oil of almonds, 218
Ether, poisoning with, 224
Evidence and testimony, 54
Evidence, medical, 41
    rules  for the delivery of, 53
Evidence of poisoning in the living, 89
    in the dead, 98
    notes, when and how used in, 28
    circumstantial, in wounds, 282
Examination in chief, 46
    cross, 46
Examination of wounds, 260
    of weapons,  267, 271
    of fire-arms, 375
    the female in child-murder,  617
    of lunatics,  762
Excitement a cause of extravasation, 346
Exhaustion,  death from, 311
Exhumation of bodies, 25
Extent of wounds, 276
Extract, Goulard's, poisoning with, 172
Extravasation of blood on the brain, 343
    date of, 347
  FACE, wounds of, 349
    Facts, specification of, in insanity, 753
Family likeness, evidence from, 657
Fasting, long, effects of, 487
Fatuity, 741
Fat poisoned  by lead glaze, 173
Features, evidence from the, 657
Fecundity in  women, 695
Feigned poisoning, 76
    wounds,  273
    strangulation, 434
    pregnancy, 501
    menstruation, 495
    delivery, 511
    abortion, 540
    insanity, 746
    deafness  and dumbness, 819
Fern, decoction of, as an abortive, 530
Fever, death  from,  after wounds and opera-
  tions, 331
Fire-arms, examination of, 375
Fish,  poisonous, 194
Flagellation,  death from, 315
Fleming's tincture of aconite, 246
Fish,  diseased, poisoning by,  194
Flogging,  military,  death from, 315
Flour, accidental poisoning of, 173
Fly-paper, 157
Fly-water, death from, 157
Fcetal circulation, changes  in the, caused by
  respiration, 580
Fcetal stomach, contents of the, 582
Foetal heart,  sounds of the, 499
    changes in the, after breathing, 580
Foeticide.   (See Abortion.)
Foetus, characters of the, from conception to
      the sixth month, 520
    from the sixth to the ninth month, 552
Pood, poisonous, 193
    putrescent, 203
    death from privation of, 486
Fool's parsley, poisoning with, 244
Foramen ovale, closure of the, 581
Fowler's mineral solution, 157
Foxglove, poisoning with, 254
Fractures, 363
    accidental, in the  drowned, 401
    in new-born children, 603
Fragilitas ossium, 364
Fruit-stains resembling blood, 295
Fungi, poisoning with,  231
H ALL-BLADDER, wounds of the, 359
\J  Gamboge, effects of, 186
Game, poisoned, 203 
INDEX.                                 S73
Gardner peerage case, 656
Garotte robberies, 431
Gaseous poisons, 446
Gelatinized perforation of the stomach, 106
Gelseminum, 190
Genitals, wounds of the,  362
Gestation, natural period of, 641
    duration of, from one intercourse, 642
    short periods of, 645
    protracted, 650
    mistakes in  the mode of  computation of,
      653
    period of, not fixed by law, 655
Glass, wounds caused by, 268
    powdered, effects of, 83
Godfrey's cordial, 207
Gonorrhoea, in rape, 708
Goulard's extract, 172
Goulard-water, 172
Green vitriol, 184
Green hellebore, 188
Grievous bodily harm, 259
Guaiacum process, for blood,  300
Gunpowder, wounds from,  372
Gunshot wounds, nature of, 368
     near or distant, 368
     accidental,  homicidal, or suicidal, 370
   HABIT, its influence on poisons, 84
     intemperate, in cases  of life insurance,
       741
Haematin, properties of,  291
    crystals of, 307
Hair, evidence from, on  weapons, 285
    the color of, in paternity, 660
Hallucinations in insanity, 734
    in  drunkenness, 812
    in  sleep, 817
Hanging, death from, 404
    appearances in death from, 406
    evidence of, from mark  of the cord, 409,
      411
    of  the dead body, 413
    marks of violence on the body in, 414
    homicidal, 416
    circumstantial evidence in cases of, 417
    evidence from  position of the body in, 418
    fracture of crystalline  lens, a result of,
      420
Hartshorn, poisoning with, 129
Head,  wounds of the, 340
    injuries to the, in new-born children, oOd
Heart,  wounds of the, 352
Heat, excessive, death from, 486
Hellebore, poisoning with, 188
Hemlock, poisoning with, 240
    water-dropwort, 243
Hemorrhage, death from, 311
    internal, death from, 313
    death of the new-born  child from,  591
Henbane, poisoning with, 232
Hepatization of the lungs 564
Hereditary transmission of insanity  744, 807
Hermaphrodites, legal rights of,  b!6
Hermaphroditism, 668
Hernia, phrenic, 356
Hierapicra,  186
    in abortion, 530
Homicidal  Monomania, 784
    symptoms of, 785
     legal tests, 789
Homicidal Monomania, varieties of, 787
    medical tests of, 792
    medical evidence in cases of, 796
Homicidal wounds, characters of, 275
    burning, mistaken for spontaneous, 380
Horseradish mistaken for aconite, 247
Hunger, death from.  (See Starvation.)
Hydrate of chloral, 226
Hydrochloric acid, 119
Hydrocyanic acid.   (See Prussic Acid.)
Hydrogen,  test for arsenic, 147
Hydrostatic Test, 563
    objections  to  the,  from  sinking  of the
      lungs, 564
    erroneous inferences from, 566
    effects  of putrefaction on the, 568
    artificial inflation, 569
    general  conclusions respecting the em-
      ployment of, 574
Hydrosulphate of ammonia, 461
Hydrosulphuric acid, poisoning with, 466
Hymen, evidence derived from the, in rape,
      703
    as a sign of virginity, 711
Hyoscyamus, poisoning with, 232
Hypospadias, 689
TDENTITY of substances,  26
1   Identity from the flash of gunpowder, 374
Idiocy, 742
Idiosyncrasy in poisoning, 85
Idiots, rape on, 715
Illusions in insanity, 734
    in drunkenness, 812
Imbecility, 742
    senile, 744
Immaturity of the foetus, or venter, 619
    of the partus,  in cases of legitimacy, 647
    death of  the child from, 591
Impediments,  canonical, to marriage, 697
Impotency, causes of, 680
    from age, 682
    from local disease and  malformation, 685
    from general disease, 689
    as a ground for divorce, 696
Impulse to crime,  794, 800
Imputed poisoning, 95
    wounds, 273
    strangulation, 434
Inanition, death from, 489
Incapacity, sexual.  (See Impotency.)
Incendiarism, propensity to, 809
Incised wounds, 268
Incoherency,  743
Incompetency, mental, medical tests of, 762
Indian tobacco,  253
Indigo, sulphate of, 111
Infanticide, 548
    inspection of the body in, 553
    proofs of life before respiration in, 554
    after respiration, 557
    static test in,  560
Ploucquet's test in, 562
    proofs of  live  birth in,  575
    natural causes of death in, 591
    violent causes of death in, 594
    summary of medical proofs in,  608, 618
    proposed  changes in the law of, 675
Infant in law, 519
Infantile leucorrhcea, 705
Infants, action of opium on, 205 
871                                  ini


Inflation, artificial of the lungs,  569
Influence of morphia in disguising the color
     test of strychnia, 239
Inheritance, questions relating to, 620
Inquests, coroners', 37
Insane, responsibility of the, 771. 781
Insanity, medical definitions of, 729
     moral, 731
     legal definitions of, 733
     early symptoms of,  734
     hallucinations and illusions in, 734
     lucid intervals in, 735
     various forms of, 737
     hereditary trrnsmission of, 744, 807
     feigned, 746
     post-mortem  appearances in,  747
     rules for applying restraint in, 749
     signing certificates of, 752
     interdiction in cases of, 759
     evidence of from written  documents, 766
     plea of, in criminal cases, 781
     homicidal, 784
     puerperal, 807
Insect-powders, 235
Insemination, 641
Inspection of the body,  in poisoning, 23
     in wounds, 283
     in child-murder, 553
     for coroners'  inquests, 25
Insurance, life, 822
Intellectual insanity, 731
Intemperate habits as affecting life insurance,
  841
Intercourse, duration of gestation after, 644
     carnal,  legal  proofs of, 701
Interdiction in  insanity,  749
Intervals, lucid, in insanity,  735
    validity of  acts performed during,  735
Intestines, ruptures of the, 360
Intoxication mistaken for concussion, 342
Iodine, 138
Iron, salts of, poisoning with, 184
Iron moulds mistaken for blood stains, 295,
  297
Iron filings, 83
Iron, muriate of,  184, 530
Irritant poisons, general  effects of, 87
Irritants, mechanical, 83
    mineral, 110
    vegetable, 186
    animal,  192
  JALAP, effects of. 186
    Juniperus Sabina, poisoning with, 187
Jury of matrons, 502
T7IDXEYS, ruptures of the, 360
i\  King's yellow, 159
Kleptomania, 809
   LABOR, premature, induction of,  545
     Laburnum, poisoning with, 257
Lacerated wounds, 268
Lactation a cause of puerperal insanity, 808
Latent disease, death from, in wounds, 326
Laudanum, poisoning by, 207
Lead, poisoning by acetate, 769
    tests for the salts of, 170
    chronic poisoning by, 172
EX.


 Lead-glaze, poisonous effects of, 172
 Lead palsy, 172
 Legal tests of insanity, 789
 Legitimacy, legal presumption of, 639
     period of gestation in reference to, 641
     disputed, from shortness of gestation, 645
     viability in reference to, 647
     proofs of, from the state of the offspring,
       646
     disputed from long periods of gestation,
       650
     in what cases admitted, 654
     inferred from paternal likeness, 659
 Leucorrhoea, infantile, 705
 Levant-nut, 229
 License of counsel, 42
 Life, legal and medical, 532
 Life Insurance, 822
     principles of, 822
     proof of death, 823
     suicide in relation to, 804
     questions connected with proposals for, 827
     policies vitiated by fraud,  834
     policies vitiated by concealment of habits,
       834
     policies vitiated  by concealment of  dis-
       ease, 836
     acts of murder in connection with, 864
Lightning, death from, 475
     post-mortem appearances, 476
     action for damages from. 482
Likeness, parental evidence from,  657
Limekilns, vapors of,  457
Liquids,  corrosive, burns by, 381
Liquor amnii, 546
Liquor arsenicalis,  156
Litharge, poisoning with,  173
Live birth in civil suits, 619
     proofs of, in child murder, 554
     Scotch law concerning, 624
    summary regarding, 678
Liver, ruptures and wounds of the, 359
Lobelia,  poisoning with, 253
Lochia, evidence of delivery from  the, 509
Lockjaw, death from,  in wounds, 328
Long fasting, effects of, 487
Lucid intervals,  735
Lucifer-matches,  poisoning with, 134
Lunacy,  343
    commissions of, 760
Lunacy acts, legal provisions of the, 754
    breaches of  the, 755
Lunatics, wounds inflicted by, 226
    restraint applied  to, 749
    discharge of, 758
    civil responsibility of, 771
    contracts of, 771
    marriage of,  771
    testamentary capacity of, 774
    interdiction of, 759, 769
    examination of alleged, 762
    wills by, 774
Lungs, wounds and ruptures of the, 352
    examination of the, in new-born children,
      558
    specific gravity of, 562
    atelectasis of the, 564
    variably affected  by respiration, 567
    putrefaction of, 568
    artificial inflation of, 569
Lung-tests, 559
Lypemania, 740 
INDEX.                                  875
    MAGNETIC sleep, rape during, 717
      Majority, questions relative to, 636
     when attained, 637
 Malapraxis, 367
 Malformation, death of the child from, 592
     sexual, 668
 Mania, 737
     suicidal, 800
     homicidal, 784
     puerperal, 807
 Mania sine delirio, 731
 Marriage, impediments to, 696
     of lunatics,  void, 771
 Marsh's process for arsenic, 147
 Matrons, jury of, 502
 Maturity of the  new-born child, signs of, 551
 Meadow-saffron.   (See Colchicum.)
 Meat, unwholesome, 196
 Meconic acid, tests for, 210
 Meconium, 585
     microscopical characters of, 588
 Mechanical injury, death from, 314
 Mechanical irritants, 83
 Medical evidence, 17
 Medical witnesses, 41
 Medical jurisprudence defined, 17
 Medical jurists,  duties of, 18
 Medical witnesses act, 38
■ Medical privilege, 43
 Medical etiquette, 44
 Medical responsibility, in wounds. 334
     in cases of insanity,  749
     in delivery, 545
 Medico-legal reports, 29
     for coroners' inquests, 32
 Melted metals, burns from, 376
 Melancholia, 740
 Menses,  suppression of, in pregnancy, 494
 Menses (see Menstruation), 494
 Menstrual blood, character of, 723
 Menstrual climacteric, 694
 Menstruation, suppression of, a sign of preg-
        nancy, 494
     feigned, 495
     appearances of, after death, 539
     relation of gestation to, 643
     fallacies in  calculating pregnancy, 651
     age  at which it appears, 653
     pregnancy before. 474, 692
     appearance  of, in infants, 693
     age  at which  it ceases, 694
     absence of,  a cause of sterility, 692
     in hermaphrodites, 669
 Mental alienation, 729
 Mercurius Vita1, 180
 Mercuric methide, 168
 Mercury, poisoning by the salts of,  160
     chronic poisoning by, 161
     ammonia-chloride of,  or  white precipi-
        tate, 167
     oxide of, 168
     sulphates and nitrates of, 168
     methide of, 168
 Metallic irritants, 140
 Methide, mercuric,  168
 Microscopical evidence,  107, 303, 71 J, 7JJ
 Milk, detection  of, in the stomach, o84
 Mind, unsoundness of, 733
 Mineral green, poisoning with, 157
     solution, Fowler's, 156
 Minium, poisoning with, 173
 Minor. (See Minority.)
Minority, questions relating to, 636
Mirbane, essence of, 219
Miscarriage, legal meaning of, 526, 540
Mole-pregnancy, 521
Moles, nature of,  521
    abortion of, 521
Monkshood, poisoning with, 245
Monomania, 739
    suicidal, 741
    homicidal,  784
Monorchides, virility  of, 685
Monsters, abortion  of, 546, 592
    legal definition of, 635
    do not inherit,  635
    sexual, 586, 668
Monsters, destruction of, not permitted, 593
Monstrosity, death  of the child from, 592
Monstrosity, sexual, 668, 688
Moral insanity, 731, 783
Morphia and its salts, poisoning with, 208
    influence of, in  the color-test, 239
    tests for, 209
Mortality of wounds,  310
Motives for crime, 792
Muco-purulent  discharges, 710
Mucous discharges, characters of, 704
Muriate  of iron, 184,  530
    of morphia, 209
Muriatic  Acid, poisoning with, 119
Mushrooms, poisoning with, 231
Mussels, poisoning with, 194
   NiEVI mistaken for marks of violence, 615
     Narcotic poisons, 88, 205
Narcotico-irritants, effects of, 88
Navel-string   (See Umbilical cord.)
Neck, twisting of the, in  the new-born, 607
Needles and pins, actions of, 83
Neurotic poisons, 87, 205
New-born child,  legal meaning of, 549
Nicotina, poisoning with, 227
Nightshade.  (See Belladonna.)
Nitrate of potash, 130
Nitre, death from,  131
Nitric Acid, poisoning with,  115
    vapor of 115
    analysis, 117
Nitrobenzole, 219
Noma pudendi, 704
Non compos mentis, 733
Notes,  use of, in evidence, 28
Noxious substances, legal meaning of, 82, 541
    animal food, 193
Nux vomica, poisoning with,  194
rPDEMA of the lungs, 564
UJ   ffinanthe crocata, 243
Oil of vitriol, poisoning with.   (See Sulphu-
      ric Acid.)
    croton,  187
    of bitter almonds, 218
    of savin, 187, 535
    of tansy, 536
Operations, surgical, death from, 329
Operation, Caesarean, 631
Opium, syniptoms caused by, 205
    appearances in  death from, 206
    process  for detecting, 208, 211
Orbit, wounds of the, 349
Orpiment, poisoning by,  159 
876
IND
EX.
Ovum, examination of the, 520
Oxalate of potash, acid,  125
Oxalic  Acid,  symptoms  and  appearances
  caused by,  120
   PAINTER'S colic, 172
     Palsy from lead, 172
Paper hangings, arsenic in, 157
Papier Moure,  157
Paraplegia,  virility in cases of, 690
Paregoric elixir, 208
Parental likeness, 657
Parturition.   (See Delivery.)
Partus,  the new-born child, 549
Paternity, questions on, 657
Peach-nut oil, 219
Pearlash, poisoning with, 127
Pearl white, 184
Perforation of the stomach  from poison, 104
    spontaneous, 105
Personal injuries, 258
    death from slight, 320
Phosphorus, poisoning by, 133
    red or amorphous, action of, 138
Phrenic hernia, 356
Phrenitis, 738
Picrotoxine, effects of, 230
Pins and needles, administration of, 83
Ploucquet's  test, 562
Plural births, 639
Poison, definition of a. 79
    law respecting the administration of, 81
    influence of habit on, 84
      of idiosyncrasy, 85
    irritant and corrosive,  87
    narcotic and narcotico-irritant, 86
    effects modified by disease, 90
    slow and rapid death from, 98
    gaseous, 446
Poisoned game, 204
Poisoned grain, 230
Poisoning, evidence of,  in the living, 89
    disease mistaken for, 94
    feigned  and imputed, 95
    evidence in the dead, 101
    chronic, 100
    ulceration, corrosion, and  softening, 103
    rules for investigating  cases of, 30, 96
    infanticide by,  616
Poisonous food, 193
    gases, 446
    fungi or mushrooms, 231
Poppies, syrup of, 207
Pork, diseased, poisoning with, 196
Porphyridium cruentum taken for blood, 305
Posthumous children, 662
Potash and its carbonates, poisoning with, 127
    oxalate  of, 125
    nitrate of, 130
    sulphate of, 131
    arsenite of, 156
    arsenate of, 159
Potassium, cyanide of, 217
Precipitate,  white and red,  167, 168
Pregnancy, signs of, 494
    feigned, 501
    plea of,  in bar of execution, 502
    concealment of, 504
    unconscious, 505
    in the dead, 506
    proof of, in cases of abortion, 540
Pregnancy, longest duration of, 642
    before menstruation, 692
    crimes perpetrated during, 818
    earliest age for, 692
    latest age for, 694
    following rape, 718
Premature births,  645
    labor,  induction of, 545
Presumption of death, 823
    of survivorship, 825
Procreative power, age for, in the male, 681
    in the  female, 691
Projectiles, 369
Protracted births,  650
    gestation, 653
Prussic Acid, symptoms caused by, 212
    fatal doses of, 213
    analysis, 213
    detection of, in the tissues, 217
Ptyalism, mercurial.  (See Salivation.)
Puberty in males,  681
    in females, 691
    premature, 693
Puerperal mania, 807
Pulmonary tests, 559
Punctured  wounds, 268
Purulent discharges  in  alleged  rape,  705,
  710
Putrefaction, effects of, 70
    of the  lungs, 568
Putrescent food, 203
Pyaemia a cause of death in wounds, 333
Pyromania, 809
QUICKENING a sign of pregnancy, 497
  Quicksilver.  (See Mercury.)
   RAPE, definition of, 699
     proofs  of, in  children  under  puberty,
      700
    vulval and vaginal, 702
    evidence from marks of violence in,  702
    loss of physical evidence in, 703, 718
    false charges of, 704
    gonorrhceal discharge in, 706
    on girls after puberty. 709
    on adults, 713
    under narcotics, 715
    on idiots, 715
    during sleep, 716
    from mistake of person,  716
    pregnancy following,  718
    microscopical evidence in, 722
    evidence of, in the dead  body, 723
    by females on males, 724
Red lead in  snuff, 173
Red phosphorus, 138
Red precipitate, 168
Redness of the stomach in poisoning, 102
Re-examination, 47
Reinsch's process for arsenic, 148, 154
Reports, medico-legal,  29
Respiration, cessation of the, in death, 60
    signs of, in the new-born child, 563
    imperfect,  565
    before birth, 573
Responsibility, medical, 334, 545, 757
Restraint in insanity, 749
Rigidity, cadaveric, 63
Rigor mortis, 63 
INDEX.
877
Rules for the delivery of evidence, 53
Rust, stains of, mistaken for blood, 295
Rye, ergot of, action of, 533
  SAFFRON as an abortive, 537
    Salivation, arsenical, 142
      mercurial,  162
Salt of sorrel,  125
Saltpetre, action of, 131
Sal volatile, 130
Sanguineous tumors in the new-born, 603
Sausage poison, 196
Savin, poisoning with, 187
    as an abortive, 537
Scalding,  homicidal, 379
Scalds and burns,  375
Scalp, wounds of the, 340
    tumor in new-born children, 603
Scammony, 186
Scheele's  green, 157
    prussicacid, 212
Scirrhus of the lungs, 564
Secale cornutum, 533
Self-delivery, violence in, 607
Self-inflicted wounds, 273
Senile dementia, 743
Sewer gases, noxious  effects of, 469
Sex,  concealed, 678
    distinction of, 668
    destruction of by an operation, 676
    mixed and doubtful cases of, 671
    civil rights depending on, 673
Sexual malformation, varieties of,  668
    influence of, on electoral rights, 675
    a cause of impotency, 689
Shellfish,  poisoning by, 194
Shock, death from, 314
Shot, wounds from, 371
Skull, fractures of the, 344, 604
    accidental fracture of, in parturition, 604
Sleep, delivery during, 511
    rape  during, 716
    homicide during, 817
Slow  poisoning, 100
Small-shot, wounds produced by, 371
Smothering, death from, 444
    accidental, cases of, 445
Snuff, poisoned with lead, 173
Soap-lees, poisoning by, 127
Soda and its carbonate, poisoning by,  128
Sodomy, 724
Softening of the stomach from poison,  104
Somnambulism, responsibility in cases of, 816
Sorrel, salt of, 125
Spanish flies, poisoning with, 192
Spasm, cadaveric, 67
Specific gravity of the human body, 398
Spectral analysis of blood, 301
Spermatorrhoea a cause of impotency,  688
Spermatozoa, age at which they appear, 682
    examination of stains for, 720
Sphacelia segetum (see Ergot),  534
Spinal marrow, injuries to the, 349
    poisons, 88
Spine, concussion of the, 349
    fractures of the, 349
Spirits, poisoning with (see Alcohol),  III
Spirits of hartshorn, death from, 129
Spirit of salt, 119.   (See Muriatic Acid.)
Spleen, ruptures of the, 360
Spontaneous oombustion, alleged, 380
Spontaneous perforation of the stomach, 104
Stabs and cuts, 271
Stains, acid, on clothing, 114, 118
    of blood on linen and weapons, 292, 297
    of meconium, 587
    of amniotic liquid, 546
    in cases of rape, 719
Starch, detection of, 583
Starvation,  death  from, 487
    appearances in  death from, 489
    infanticide by,  601
Stas's process for strychnia, 238
Static test, the, in  infanticide, 560
Sterility  in males and females, 681, 691
    causes of, 688, 696
Stibiated tartar, 176
Stillbirths, 554
Stomach, redness of the, 102
    softening of, 104
    perforation of the, 104
    wounds and ruptures of the, 360
    foetal, contents of the,  582
Stramonium, poisoning with, 255
Strangulation, causes of death, 421
    post-mortem appearances in, 422
    accidental and  suicidal, 429
    homicidal, 430
    evidence of, from marks of violence, 432
    imputed  homicidal, 434
    destruction of new-born child by, 609
    accidental, by umbilical cord, 609
    marks on child resembling, 613
Strychnia, poisoning with, 233
    symptoms and appearances, 234
    analysis, 236
    in organic mixtures, 238
    influence of  morphia  in  disguising the
       usual color test of, 239
Subacetate of lead, 172
    of copper, 173
Sublimate, corrosive, poisoning with, 160
Subpoenas, rules respecting, 39
Sudden death, 57
Suffocation, causes of death in, 439
    post-mortem appearances, 440
    evidence of death  from, 442
    accidental cases of, 442
    of children, 443
    from gases, 446
    by carbonio acid, 447
    by charcoal vapor, 452
    by carbonic oxide, 455
    coal vapor, 456
    by vapors of lime  and brickkilns, 457
    confined air, 458
    by coal-gas, 459
    nitrous oxide, 462
    sulphuretted hydrogen, 466
    by sewer gases, 469
    of new-born children, 595
Sugar, detection of, in the fcetal   stomach,
       583
    of lead,  poisoning with, 169
Saggillation  (Ecchymosis),.73, 263
Suicidal  wounds, characters of, 279
    mania, 741, 800
Suicide and insanity, 800
Suicide, 800
     not  necessarily from insanity, 802,  807
     a felony, 802
     in relation to life insurance, 806, 855
     hereditary tendency to, 807 
878
IND
EX.
Sulphate of indigo,  111
    of potash, 131
    of copper, 173
    of zinc, 183
Sulphate of iron,  184
Sulphide of ammonium, 469
Sulphuretted Hydrogen, effects, 466
    appearance in death from, 467
    detection of, 471
Sulphuric Acid, symptoms, 110
    analysis,  112
    burns from, 381
Sulphurous acid, action of, 456
Sunstroke, death from, 486
Superconception,  662
Superfoetation, 662
Supposititious children,  666
Surgical operations, responsibility for, 334
Survivorship, 825
Syncopal asphyxia,  58
Syncope, death from, 57
Syphilis in case of rape, 708
Syrup of poppies, 207
rpANSY, oil of,  536
1  Tartar Emetic, poisoning with, 176
    tests for, 178
Tartarated antimony, 176
Tartaric acid, 125
Tartnrized antimony, 176
Technical terms, 31,  56
Tenancy by courtesy, 628
Teratology (see Monsters), 635
Testamentary capacity,  774
Testicles, period at which  they descend, 551
    non-descent of the,  685
Testimonial competency from age, 636
Tetanus from wounds, 328
Theft, insane propensity to, 809
Thornapple, poisoning with, 253
Throat, wounds of the, 277
Thugs, murder by, 255,  431
Tobacco, poisoning with, 227
    Indian, 253
Toucher in pregnancy, 500
Trial at the Assizes, 39
Trichiniasis, 198
Trichomonas, 722
Tumors, sanguineous, 603
   ULCERATION distinguished from corrosion,
     104
Umbilical cord, evidence of live birth, 579
    laceration of the, 591
    death from compression of the,  591
    strangulation by the, 609
Unconsciousness, acts in a state of, 817
Unconscious pregnancy, 504
    delivery, 511
    intercourse, 715
Unnatural offences, 724
Unsoundness of mind,  733
Uterine age of foetus, 550
Uterus, changes in the, from pregnancy, 500
VAGINA, wounds of the, 363, 703
 V     purulent discharges from, 705
Vaginitis in infants, 705
Vagitus uterinus, 573, 628
Vapors, of charcoal, effects of, 452
    of coal and coke,  456
    of lime, brick, and cement kilns, 457
    rape under narcotic, 715
A7egetable irritant poisons, 186
A7eins, wounds of, 355
    death from entrance of air into, 356
Venereal disease in  cases of rape, 708
Venter, 520.   fSeeOvum or Embryo.)
Ventre, de, inspiciendo, writ of, 502
Veratria, 189
A'erdigris, 173
Veratrum viride,  188
Vermin powder, or killer, 236
Vertebrae, fractures of the, 349
    in drowning,  401
    injuries to the,  in hanging, 405, 417
    in cases of child-murder,  607
Vesications from burns and scalds, 377
A7esicuhir mole, 522
Viability, in  monstrosity, 635
    in legitimacy, 647
    in concealments of birth,  524
Violation.   (See Rape.)
Violence in self-delivery, 607
Virgo intacta, 712
Virginity, signs of,  710
Virility, proofs of, 581
\7iscera, preservation  of the, 25
Vitriol, oil of,  poisoning by (see Sulphuric
      Acid), 110
    blue, poisoning  by,  157
    white,  183
Vitriol, green, 134
Vomica, nux, poisoning with, 233
    WADDING, wounds from, 372
      Wall-papers, arsenical, effects of, 157
AVater-hemlock, 242
AVaters, potable, poisoned with lead, 172
Weapons, used in producing wounds, 267, 271
    evidence from, 284
    found in the hands after death, 284
    blood and other substances on, 285
Wheat, poisoned, 230
White precipitate, poisoning with,  167
    lead,  172
AVhite vitriol, 183
    hellebore, 188
Wills  of the insane, law regasding, 774
Wills, proofs of eccentricity in, 775
    burden of proof in alleging insanity, 779
    in senile dementia and in extremis, 777
    attesting witnesses to, 780
    made in drunkenness, 811
Wine  of colchicum, 187
Witnesses, medical, 41
    admitted in court, 49
    rules respecting the examination of, 50
AVolfsbane, poisoning by, 245
Wood, smouldering, death from, 454
Wounds, medico-legal definition of, 258
    producing grievous bodily harm, 259
    examination of 260
    vital and post-mortem, 261
    without hemorrhage, 262
    produced by weapons, 267
    incised, lacerated, and contused, 268
    from glass or earthenware, 268
    self-inflicted or imputed, 273
    evidence from situation, 275 
INI)
EX.
S79
Wounds, nature and extent of, 276
    direction and shape of, 278
    suicidal and accidental, 279
    by right or left hand,  279
    circumstantial evidence in, 282, 290
    in what position inflicted, 283
    direct cause of death, 311
    fatal from hemorrhage, 311
    fatal from mechanical injury, 314
    from shock, 314
    from erysipelas, 329
    from delirium tremens, 329
    mortality of, 310
    death from latent disease in cases of, 319
    which of two caused death, 319       •
    death from slight wounds, 320
    fatal after long periods, 321
    secondary causes of death from, 322
    fatal from unskilful treatment,  324
    fatal from imprudence, 324
    from unhealthy state of body, 326
    acceleration of death  from, 327
    fatal from abnormal conditions, 327
    tetanus following, 328
    fatal from surgical operations, 329
    fatal from pyaemia, 333
Wounds of the head, 340
    struggling after severe, 355
    of the face, 349
    of the spine and spinal marrow,  349
    of the chest, 351
    of the lungs and heart, 352
    of the arteries and veins, 354
    of the diaphragm, 356
    of the abdomen, 357
    of the liver, spleen, and kidneys,  359, 360
    of the intestines and stomach, 360
    of the urinary bladder, 360
    of the genitals, 362
    gunshot,  368
    from gunpowder, 372
    caused by lightning, 477
    on the new-born child in infanticide, 602
   YELLOAV arsenic, poisoning with, 159
     Yellow jessamine, 190
Yew, poisoning with, 257
ZINC, poisoning by the salts of, 183
  Zoosperms (see Spermatozoa), 682
THE  END. 
 
HENRY    C.    LE_A.'S
                         (late lea k blanchard's)
OLASSIFIED   O^T^I_iOG TTIE
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Henry C. Lea's Publications—(Dictionaries).
 TyUNGLISON (ROBLEF), M.D.,
         Professor of Institutes of Medicine in Jefferson Medical College, Philadelphia.

    MEDICAL  LEXICON; A Dictionary  op  Medical  Science:  Con-
      taining a concise explanation of the various Subjects and Terms of Anatomy, Physiology,
      Pathology, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical
      Jurisprudence, and Dentistry.  Notices of Climate and of  Mineral Waters;  Formulae for
      Officinal, Empirical, and Dietetic  Preparations;  with the Accentuation and Etymology of
      the Terms, and the French and other Synonymes; so as to constitute a French as well as
      English Medical  Lexicon.   A New Edition.   Thoroughly Revised, and very greatly Mod-
      ified and Augmented   In  one very large  and handsome royal octavo volume of over 1100
      pages.   (Nearly  Ready.)
  The object of the  author from  the outset has not been  to make the work a mere lexicon or
dictionary of terms,  but to afford, under each, a condensed  view of its various medical relation's,
and thus to render the work an epitome of the existing condition of medical  science.  Starting
with this view, the immense demand which has existed for the work has enabled him,  in repeated
revisions, to augment its completeness and usefulness, until at length it has attained the position
of a recognized and  standard  authority wherever the language is spoken.  The mechanical exe-
cution of this edition will be found greatly superior to that of previous impressions.  By enlarging
the size of the volume to a royal octavo, and by the employment  of a  small but clear type, on
extra fine paper, the additions have been incorporated without materially increasing the bulk ol
the volume, and the matter of two or three  ordinary octavos has been compressed into the space
of one not unhandy  for consultation and reference.
                                                It is undoubtedly the  most complete and  useful
  It would be a work of supererogation to bestow a
word of praise upon this Lexicon.  We can only
wonder at the labor expended, for whenever we refer
to Its  pages for  information we are seldom disap-
pointed in  finding all we desire, whether it be in ac-
centuation, etymology,  or definition of terms.—New
York Medical Journal, November, 1S65.
  It would be mere waste of words in us to express
our admiration of a work which is so universally
and deservedly  appreciated.  The most admirable
work of its kind  in the English language.  As a book
of reference it is invaluable to  the medical  practi-
tioner,  and in every instance that we have  turned
over its pageB for information we have been charmed
by the clearness of language and the  accuracy of
detail with which each  abounds.  We can most cor-
dially and  confidently commend it to our readers.—
Qlag'gow Medical Journal, January, 186(5.
  A work to which there is  no ej^al in the English
language.—Edinburgh Medical jlsurnal.
  It is something more  than a dictionary, and some-
thing less than an encyclopaedia.  This edition of the
well-known work is a great improvement on its pre-
decessors.  The book is  one of the very few of which
It may be  said with truth that  every medical man
should possess it.—London Medical Times, Aug. 26,
1*65.
  Few works of the class exhibit a grander monument
cof patient research and  of scientific lore.  The extent
of the sale of this lexicon is sufficient to testify to its
nsefulness, and to the great service conferred by Dr.
Bobley Dunglison on the profession, and  indeed on
•thers, by its issue.—London Lancet, May 13, 1865.
  The old  edition, which is now superseded by the
aew, has been universally looked upon by  the medi-
cal profession as a work of immense research and
great value.  The new has increased usefulness; for
medicine, in all its branches, has been making such
progress that many new terms and subjects have re-
cently been introduced : all of which may be found
fully defined in the present edition.  We know of no
other  dictionary in the English language that can
bear a comparison with it in point of completeness of
subjects and  accuracy  of statement.—N.  Y. Drug-
gists' Circular, 1865.
  For many years Dunglison's Dictionary has been
the standard book of reference with most practition-
ers in  this country, and we can certainly commend
'.his work  to the renewed confidence and  regard of
oar readers.—Cincinnati Lancet, April, 1865.
medical dictionary hitherto published in this country.
—Chicago Med*Examiner,|Tebruary, 1S65.
  What we take to be decidedly the best medical dic-
tionary in the English language.  The present edition
is brought fully up to the advanced state of science,*;
For many a long year "Dunglison " has been at on" !
elbow,  a  constant companion and  friend, and w
greet him in his replenished and improved form wiaal
especial satisfaction.—Pacific Med. and Surg. Jou\.
nal, June 27, 1865.                            ^L
  This is, perhaps, the book of all others which th/  t
physician or surgeon should have on his shelves.  J?8  I
is more needed at the present day than a few year««  I
back.—Canada Med. Journal, July, 1865.         ?
  It deservedly stands  at the head, and cannot  he
surpassed in excellence.—Buffalo  Med. and Surg.
Journal, April, 1865.
  We can sincerely  commend  Dr. Dunglison's work
as most thorough, scientific, and accurate.  We have
tested it by searching its pages for new terms, which
have abounded so much  of late in  medical nomen-
clature, and our search has  been successful in every
instance.  We have  been particularly struck with the
fulness of the synonymy and the accuracy of the de-
rivation of words.  It is as necessary a work to every
enlightened  physician  as Worcester's English Dic-
tionary is to every one who would keep up his knowl-
edge of the English tongue to the  standard of the
present day.  It is, to our mind, the most complete
work of the kind with which we are  acquainted.— t
Boston Med. and Sxirg. Journal, June 22, 1865.     I
  We are free to confess that we know of no medical
dictionary more complete; no one better,  if so well
adapted for the use  of the student; no one that may
be consulted with more  satisfaction by the medical.
practitioner.—Am. Jour. Med. Sciences, April, 1865. *'
  The value of the present edition has been greatly j
enhanced by the introduction of new subjects an| i
terms, and a more complete etymology and accentna
tion, which renders the work not only satisfactor
and desirable, but indispensable to the physician
Chicago Med. Journal, April, 1865.
  No intelligent member of the profession can or wil
be withtfut it.—St.  Louis Med. and Surg. Journal
April, 1865.
  It has the  rare merit that it certainly has no riva
in the  English language  for accuracy and extent
references.—London Medical Gazette.
 TJOBLYN {RICHARD  D.), M.D.


    A  DICTIONARY  OF THE  TERMS  USED IN MEDICINE AND
      THE COLLATERAL SCIENCES.  Revised, with numerous additions, by Isaac  Hats
      M.D., Editor of the "American Journal of the Medical  Sciences."  In one large rovtv)
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  Ttisthe best book of definitions we have, and ought always to  be aponthe atudect't table.__Bouthem
Med. and Surg- Journal 
Hbnry  C Lea's Publications—(Manuals).
flfEILL  (JOHN),  M.D.,   and   &MITH [FRANCIS O.), M.D.,
                                            Prof.of the Institutes of Medicine in the Uniti. of Penna.
    AN  ANALYTICAL  COMPENDIUM  OF  THE  VARIOUS
      BRANCHES  OF  MEDICAL SCIENCE;  for the Use  and Examination of Students.   A
      new edition, revised and improved.  In one very large and handsomely printed royal 12mo.
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 The Compend of Drs Neilland Smith is incompara-
bly the most valuable work of its class ever published
In this country  Attempts have been made in various
quarters to» squeeze Anatomy, Physiology, Surgery,
the Practice of Medicine, Obstetrics, Materia Medica,
and Chemistry into a single manual; but the opera-
tion has signally failed in the hands of all up to the
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t miracle of success.  The outlines of the  whole are
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are eminently entitled to the grateful  consideration
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 There are but few students or practitioners of me-
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unassuming though highly  instructive work.  The
whole science of medicine appears to have been sifted,
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ern Lancet.
  In the rapid course of lectures, where work for the
students is heavy, and review necessary for an exa-
mination, 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.  Of course it is useless
for us to recommend it to all last course students, but
there is a class to whom we very sincerely commend
this cheap book as worth its weight iu silver—thst
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.
 TJARTSHORNE (HENRY), M. D.,
          Professor of Hygiene in the University of Pennsylvania.

    A  CONSPECTUS   OF   THE  MEDICAL  SCIENCES;  containing
      Handbooks on  Anatomy,  Physiology, Chemistry,  Materia Medica  Practical  Medicine,
      Surgery, and Obstetrics.   In one large royal  12mo. volume of 1000 closely printed pages,
      with over 300 illustrations on wood,  extra cloth,  $4 50;  leather, raised bands, $5 25.
      (Lately Published.)
  The ability of the  author,  and his practical skill in condensation, give  assurance that thii
work will prove valuable not only to the student preparing for examination, but also to the prac-
titioner  desirous of obtaining within  a moderate compass,  a view of the existing condition of the
various  departments of science connected with medicine.
  This work is a remarkably complete one In its way,
and comes nearer to our idea of what a Conspectus
should be than any we  have yet seen.  Prof. Harts-
horne, with a commendable forethought, intrusted
the preparation of many of the chapters on special
•ubjects to experts, reserving only anatomy, physio-
logy, and practice of medicine to himself.  As a result
we have every department worked up to the latest
date and in a refreshingly concise and lucid manner.
There are an immense amount of illustrations scat-
tered throughout the work, and although they have
often been seen before in the various works upon gen-
eral and special subjects, yet they will be none the
less valuable to the beginner.  Every medical student
who desires a reliable refresher to his memory when
the pressure of lectures and other college work crowds
to prevent him from hairing an opportunity to drink
deeper in the larger works, will find this one of th«
greatest utility.  It  is thoroughly trustworthy from
beginning to end; and as we have before intimated,
a remarkably truthful outline sketch of the present
state of medical science.   We could hardly expect it
should be otherwise, however, under the charge of
such a thorough medical scholar as the author has
already proved himself to be.—N. York Med. Record,
March 15, 1869.
 T UDLO W (J. L.),  M. D.

   A  MANUAL  OF  EXAMINATIONS  upon Anatomy, Physiology,
      Surgery, Practice  of Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy, and
      Therapeutics.  To which is added a Medical Formulary.   Third edition, thoroughly revised
      and greatly extended and enlarged.   With  370 illustrations.    In one handsome  royal
      12mo. volume of 816 large pages,  extra cloth; $3 25; leather, $3 75.
  The arrangement of this volume in the form of question and  answer renders it especially suit-
able for the office examination of students, and for those preparing for graduation.

 rfANNER  (THOMAS HA WKES), M. D.,  frc.

 1  A MANUAL OF CLINICAL  MEDICINE  AND PHYSICAL DIAG-
      NOSIS.  Third American from the Second London Edition.   Revised and  Enlarged by
      Tilbury Fox, M. D.,  Physician to the Skin  Department in University College Hospital,
      &c.  In one neat volume small 12mo., of about 375 pages, extra cloth. $150.  (Just Issued.)
  *  * Bv reference to the " Prospectus of Journal" on page 3, it will be seen that this work i9
offered as a premium for procuring new subscribers to the "American Journal of the Medical
Sciences."
                                                The objections commonly, and justly, urged against
                                               the general run of "compends," "conspectuses," and
                                               other aids to indolence, are not applicable to this little
                                               volume, which contains in concise phrase just those
                                               practical details that are of most use in daily diag-
                                               nosis,  but which the yonng practitioner finds it diffi-
                                               cult to carry always  in  his memory without some
                                               quickly accessible means of reference.  Altogether,
                                               the book is one which we can heartily commend to
                                               those who have not opportunity for extensive read-
                                               ing, or who, having read much, still wish an occa-
                                               sional practical reminder.—N. Y. Med. Gazette, Nov.
                                               10, 1870.
  Taken as a whole, it is the most compact vade me-
cum for the use of the advanced student^and junior
practitioner with which we are acquamted.-iJorton
Med. and Surg. Journal, Sept. 22, 187U.
  It contains so much that is valuable, presented in
so attractive a form, that it can hardly be spare*
even inthe presence of more fall and complete work..
The additions """>«  t0 the volume by M5' F°u T*
materially enhance its value, and almost make it a
Slw work   Its convenient size makes it  a valuable
^rapanion to the  country practitioner and if con-
^Jntlv carried by  him, wonld often render hitu good
!lr* c'e and relieve many a doubt  and perplexity.-
£eaven'worth Med. Herald, July, 1870. 
6                  Henry C. Lea's Publications—(Anatomy).
 QRAY  (HENRY), F.R.S.,
         Lecturer on Anatomy at St. George's Hospital, London.

   ANATOMY,  DESCRIPTIVE  AND   SURGICAL.   The  Drawings  uy
       H. V. Carter, M. D., late Demonstrator on Anatomy at St. George's Hospital;  the Dissec-
       tion? jointly by the Author and Dr. Carter.  A new American, from the fifth  enlarged
       and improved London edition.  In one magnificent imperial octavo volume, of nearly V'lt)
       pages, with 465 large and elaborate engravings on wood.   Price in extra cloth, $6 00;
       leather, raised bands, $7 00.   (Just Issued.)
  The author has endeavored in this work to cover a more extended range of subjects than is cus-
 tomary in the ordinary text-books, by giving not only the details necessary for the student, but
 also the application of those details in the practice of medicine and surgery, thus rendering it both
 a guide for the learner, and an admirable work of reference for the  active practitioner  The en
 gravings form a special feature in the work, many of them  being  the size of nature, nearly all
 original, and having the names of the various parts printed  on the body of the cut,  in place of
 figures of reference, with descriptions at the foot.  They thus  form a complete and splendid series,
 which will greatly assist the student  in obtaining a clear idea of Anatomy, and will also serve to
 refresh the memory of those who may find in the exigencies of practice the  necessity of recalling
 the details of the dissecting room; while combining, as it does, a complete Atlas of Anatomy, with
 a thorough treatise on systematic, descriptive, and applied Anatomy, the work will be found of
 essential use to all physicians who receive students in  their offices,  relieving both preceptor and
 pupil of much labor in laying the groundwork of a thorough medical education.
  Notwithstanding the enlargement of this edition, it has been kept at its former very moderate
price, rendering it one of the cheapest works now before the profession.
 The illustrations are beautifully executed, and ren- I   From time to time, as successive editions have ap-
der this work an indispensable adjunct to the library  peared, we have had much  pleasure in expressing
of the surgeon. This remark applies with great force  the general judgment of the wonderful excellence >'.
to those surgeons practising at a distance from our
large cities, as the opportunity of refreshing their
memory by actual dissection is not always attain-
able.— Canada Med Journal, Aug. 1870.
  The work is too well known and appreciated by the
profession to need any comment. No medical man
can afford to be without it, if its only merit were to
serve as a reminder of that which so  soon becomes
forgotten, when not called into frequent use, viz , the
relations and names of the complex organism of the
human body. The present edition is much improved.
—California Med. Gazette, July, 1870.
  Gray's Anatomy has been so long the standard of
perfection with every student of anatomy, that we
need do no mure than call attention  to the improve-
ment in the present edition.—Detroit Review of Med.
and Pharm., Aug. 1870.
Gray's Anatomy.—Cincinnati Lancet, July, 1870.
  Altogether, it is unquestionably the most complete
and serviceable text-book in anatomy that has er=i
been presented to the student, and forms a striking
contrast to the dry and perplexing volumes on  tho
same subject through which their predecessors strug-
gled in days gone by.—N. Y. Med. Record, June 15,
1870.
  To commend Gray's Anatomy to the medical pro-
fession is almost as much a work of supererogation
as it would be to give a favorable notice of the Bible
in the religious press.  To say that it is the most
complete and conveniently arranged text book of its
kind, is to repeat what each generation of students
has learned  as a tradition of the elders, and verified
by personal experience.—N.  Y. Med. Gazette, De<\
17,1870.
 CfMITH (HENR Y H.), M.D.,     and  JJORNER (WILLIAM E.), M.D.,
   Prof, of Surgery in the Univ. of Penna., Ac.          LateProf. of Anatomy in the Univ. of Penna., Ac.

   AN   ANATOMICAL  ATLAS,  illustrative  of  the  Structure   of  the
       Human Body.  In one volume, large imperial octavo, extra cloth, with about six hundred
       and fifty beautiful figures.  $4  50.
  The plan of this AtlaB, which renders it so pecu-1 the kind that has yet appeared; and we must add,
liarly convenient for the student, and its superb ar- | the very beautiful manner in which it is "got up,"
tistical execution, have been already pointed out. We  is so creditable to the country as to be flattering to
must congratulate the student upon the completion  our national pride.—American Medical Journal.
of this Atlas, as it is the most convenient work of I
 CjHARPEY ( WILLIAM), M.D.,   and    Q VAIN (JONES fr RICHARD).

   HUMAN  ANATOMY.  Revised, with Notes and Additions, by Joseph
      Leidv,' M. D., Professor of Anatomy in the University of Pennsylvania.  Complete in two
      large octavo volumes, of about 1300 pages, with 511 illustrations; extra cloth, $6  00.
  The very low price of this standard work, and its completeness in all departments of the subject.
should command for it a place in the library of all anatomical students.
 ffODGES, (RICHARD M.), M.D.,
 •*-*     Latt Demonstrator of Anatomy in the Medical Department of Harvard University

   PRACTICAL  DISSECTIONS.   Second Edition,  thoroughly revised.   1l
       one neat royal 12mo. volume, half-bound, $2 00.
  The object of this work is to present to the anatomical student a clear and concise description
 of that which he is expected  to  observe in an ordinary couise of dissections.   The author  has
 endeavored to omit unnecessary details, and to present the subject in the form which many years'
 experience has shown him to be the most convenient and intelligible to the  student.  In  the
revision of the present edition, he has sedulously labored  to render the volume more worthy ci
the favor with which it has heretofore  been received. 
Henry  C. Lea's Publications—(Anatomy).
 ftlLSON (ERASMUS), F.R.S.

     A  SYSTEM OF HUMAN ANATOMY, General  and Special.   Edited
      by W. H. Gobrkcht, M. D., Professor of Generaland Surgical Anatomy in the Medical Col-
      lege of Ohio.   Illustrated with  three hundred and ninety-seven engravings  on wood,  in
      one large and handsome octavo volume, 61' over 600  large pages;  extra cloth, $4  00; lea-
      ther, $3 00.
  The  publisher trusts that  the well-earned reputation of this long-established favorite will be
more than maintained by the present edition.   Besides a very thorough revision by  the author, it
has been most carefully examined by the editor, and the efforts of both have  been directed to in-
troducing everything which increased  experience in its use  has suggested as desirable to render it
a complete text-book for those seeking to obtain or to renew an acquaintance with Human Ana-
tomy.   The amount of additions which it has thus received may be estimated from the fact that
th« present edition contains  over one-fourth  more matter than the last,  rendering  a smaller type
and an enlarged page requisite to keep the voluure within a convenient size.  The author has  not
only thus added largely to the work, but he has also made alterations  throughout, wherever there
appeared the opportunity of improving the arrangement or  style, so us to present every fact in its
most appropriate manner, and  to render the wjiole as clear and intelligible as  possible. The editoi
has exercised the  utmost caution to obtain entire accuracy in the text, and has largely increased
the number of illustrations, of which  there are about one  hundred and  fifty more  in this edition
than in the last, thus  bringing distinctly before the  eye of the student everything of interest oi
importance.

  UEATH  (CHRISTOPHER), F.R. C.S.,
 ■*•*■     Teacher of Operative Surgery in University College, London.

    PRACTICAL ANATOMY:  A  Manual of Dissections.   From  the
       Second revised and improved London edition.  Edited, with additions, by  W.  W. Keen,
       M. D.,  Lecturer on Pathological Anatomy in  the Jefferson Medical College,  Philadelphia.
       In one handsome royal 12mo.  volume of 578 pages, with 247  illustrations.   Extra cioth,
       $3 50; leather, $4 00.  (Lately Published.)
   Dr. Eeen, the American editor of this work, in his
 preface, says: "In  presenting  this American edition
 of 'Heath's Practical Anatomy,' I  feel that  I have
 been instrumental in supplying a want long felt for
a real dissector's manual," and this assertion of its
editor we deem is fully justified, after an examina-
tion of its contents, for it is really an excellent work.
Indeed, we do not hesitate to say, the best of its class
with which we are acquainted ; resembling Wilson
In terse and clear description, excelling most of the
so-called practical anatomical dissectors iu the scope
of the subject and practical selected matter.  . .  .
In leading this woik, one is forcibly impressed with
the great pains the author takes to impress  the sub-
ject upon the mind of  the student,  lie is full of rare
and pleasing little devices to aid memory in  main-
taining its  hold upon the slippery slopes of anatomy.
—St. Louis Med. and Surg. Journal, Mar. 10, 1871.

  It appears to us certain  that, as a guide in dissec-
tion, and as  a work containing facts ol anatomy in
brief  and  easily understood form, this manual  is
complete.  This work contains,  also,  very perfect
Illustrations of parts which can thus be more easily
understood and studied; iu this respect it compares
favorably  with works of  much greater pretension.
Such manuals of anatomy are always favorite works
with medical students.   We would earnestly recom-
mend this one to their attention; it has excellences
which make it valuable as a guide iu dissecting, as
well as in studying anatomy.—Buffalo Medical and
Surgical Journal, Jan. 1871.
  The fii st English edition was issued about six years
ago, and was favorably received not only on account
of the great reputation of its author, but also from
its great value aud excellence  as a guide-book to the
practical anatomist.  The American edition has un-
dergone some alterations and additions which will
no doubt enhance its value materially,  The conve-
nience of the student has been carefully consulted in
the arrangement of the text, and the directions giveu
for the prosecution of certain dissections will be duly
appreciated.—Canada Lancet, Feb. 1871.
  This is an excellent Dissector's Manual; one which
is not merely a descriptive manual of anatomy, but
a guide to the student at the dissecting table, enabling
him, though a beginner, to prosecute his work intel-
ligently, and without assistance.  The American edi-
tor has made many valuable alterations and addi-
tions to the original work.—Am. Jour a. ofObtttlrics,
Feb. 1871.
 MACLISE  (JOSEPH).

    SURGICAL  ANATOMY.    By  Joseph  Maclise, Surgeon.   In  one
      volume  very large  imperial quarto;  with 68 large and splendid plates, drawn in the best
      style and beautifully colored, containing 190 figures, many ol them the size ol life; togethei
      with copious explanatory letter-press.  Strongly and handsomely bound in extra cloth.

  As no complete work of  the  kind has heretofore  been published in the English language, the
Dresent volume 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 reler to ascc-
tain the exact relative positions of the various portions of the human frame towards each  otner
and to the surlace, as well at, their abnormal deviations.  Notwithstanding the large size, oeauty
ana finish ot the very numerous illustrations, it will be observed  that the price is so low  as  to
place it within the reach ot all members ot the profession.
  w»  unnw of no work  on surgical anatomy which  refreshed  by  those clear and distinct  dissections,
  we  unuw ui «     ,,,,,..,.                     which every one uiust appreciate who has a panicle
can compete with it.—i-uwce*.        ,„„,.„, tha  ot enthusiasm.  The English meiical press has quue
  The work of Maclise on surgical anatomy is of the  __u....._,.,------^„ ... ......„„ .........."..----Ji_<4..
nlanest  value.  In some respects it is the best publi-
cation of «» ^nd we have seen, and is  worthy of a
DUce  in the lib.aryol any medical man, wuile the
student could ..caicly make a better investment than
this —The M astern Journal ofMedicine and Surgery

  No such  lithographic  illustrations of surgical re-
 ."   n»ve hitherto, we think,  been given.  While
r*° .maratoi' is ehowu every  vessel and nerve where
»h« operato'
   ol>e»'»lIon lB contemplated, the exaci anatomist it

a ,HNtK •*> SPECIAL A.N ATOMY AND HISTOLOGY. |   In 2 vols.
 K rfbtu eaiuou, extensively revised and iiiudmed. 1   SOU wood
exhausted the words of praise, in recommending this
admirable treatise.  Those who have any curiosny
to gratify, in reference to the perfectibility of tne
lithographic art in delineating the complex mechan-
ism ol the human body, are invited to examine our
specimen copy.   If anything will induce surgeons
and oLudents to patronize a book of such rare value
and everyday importance 10 them, it will tie a survey
of the ariistical oiill exhibited in tnese lac-fUnute of
nature.—bunion Med. and Surg. Journal.

  In 2 vols. 8vo., of  over 1000 pages, with mo-re than
cuts ,' extra cloth, $t> 90. 
8
Henry C. Lea's  Publications—(Physiology).
 llfARSHALL  (JOHN),  F. R. S.,
JXL     Professor of Surgery in University College, London, Ac.
    OUTLINES OF  PHYSIOLOGY, HUMAN AND COMPARATIVE.
      With Additions by Francis Gurnet Smith, M. D., Professor  of the Institutes of Medi-
      cine in the University of Pennsylvania, Ac.  With numerous illustrations.  In one  large
      and  handsome octavo volume,  of 1026 pages, extra cloth,  $6  50;  leather, raised band?,
      $7 50.
  In fact, in every respect, Mr. Marshall has present-
ed us with a most complete, reliable, and scientific
work, and we  feel  that it is worthy  our warmest
commendation.—St. Louis Med. Reporter, Jan. 1869.

  We doubt if there is in the English language any
compend of physiology more useful to the 6tudent
than this work.—St. Louis Med. and Surg. Journal,
Jan. 1869.
  It quite fulfils, in our opinion, the author's design
of making it truly educational in its character—which
Is, perhaps, the highest commendation that can he
asked.—Am. Journ. Med. Sciences, Jan. 1869.

  We may now congratulate him on  having com-
pleted the latest as well as the best summary of mod-
ern physiological science, both human and compara-
tive, with which we are acquainted.  To speak o(
this work in the terms ordinarily used on such occa-
sions would not be agreeable to ourselves, and would
fail to do justice to its author.  To write such a bonk
requires a varied and wide range of knowledge, con-
siderable power of analysis, correct judgment, skill
in arrangement, and conscientious spirit.—London
Lancet, Feb. 22, 1868.
  There are few, if any, more accomplished anatomists
and physiologists thau the distinguished professor of
surgery at University College ; and at has long en-
joyed the highest reputation as a teache) of physiol-
ogy, possessing remarkable powers otcleai exposition
and graphic illustration. We have rarelj the plea-
sure of being able to recommend a text-book so unre-
servedly as this.—British Med. Journal, Jan 2j,186S.
 /CARPENTER  (WILLIAM B.), M.D.,  F.R.S.,
 v/      Examiner, in Physiology and Comparative Anatomy in the University of London.

     PRINCIPLES OF HUMAN PHYSIOLOGY;  with their chief appli-
      cations to Psychology, Pathology, Therapeutics, Hygiene and Forensic Medicine.   A nen
      American from the last and revised London edition. With nearly three hundred illustrations.
      Edited, with additions, by Francis  Gtjrney Smith, M. D., Professor of the Institutes of
      Medicine in the University of Pennsylvania, Ac.   In one very large and beautiful  octavo
      volume, of about 900 large pages, handsomely printed;  extra cloth, $5 50 ; leather, raised
      bands, $6 50.

  With Dr. Smith, we confidently believe "that the
present will more than sustain the enviable reputa-
tion already attained by former editions, of being
one of the fullest and most complete treatises on the
subject in the English language."  We know of none
from the pages  of which a satisfactory knowledge of
the physiology of the human organism can be as well
obtained, none better adapted for the use of such as
take up the study of physiology in  its reference to
the institates and practice of medicine.—Am. Jour.
Med. Sciences.
  We doubt not it is destined to retain a strong hold
on public favor, and remain the favorite text-book in
our colleges.— Virginia Medical Journal.

  The above is thetitle of what is emphatically the
great work on physiology; and we are conscious that
it would be a useless effort to attempt to add any-
thing to the reputation of this invaluable work, and
cas only say to all with whom our opinion has any
influence, that it is our authority.—Atlanta  Med.
Journal.
 T>Y THE SAME AUTHOR.
     PRINCIPLES OF  COMPARATIYE PHYSIOLOGY.  New Ameri-
       can, from the Fourth  and Revised London Edition-.   In one large and handsome octavo
       volume, with over three hundred beautiful illustrations.  Pp.752.  Extra cloth, $5 00.
m  As a complete and condensed treatise on its extended and important subject, this work becomes
a necessity to students of natural science, while the very low price at which it is offered places it
within the reach of all.
JTIRKES (WILLIAM SENHOUSE), M.D.

    A MANUAL OF  PHYSIOLOGY.   Edited  by W. Morrant Baker,
      M.D., F.R.CS.   A new American from the eighth  and improved London edition.  With
      about two hundred and fifty illustrations.  In one large and  handsome royal 12mo. vol-
      ume.  Cloth, $3 25;'leather, $3 75.   (Now Ready.)

  Kirkes' Physiology has long been  known as a concise and exceedingly convenient text-book,
presenting within a narrow compass all that is important  for the student.   The rapidity with
which successive editions have followed each other in England has enabled the editor to keep it
thoroughly on a level with  the changes and new discoveries made  in the science, and the eighth
edition, of which the present is a reprint, has appeared so recently that it may be regarded as
the latest accessible exposition of the subject.

                                              of the physiological text-books in use in this conn-
                                              try.  It represents more accurately than the  works
                                              of  Dalton or Flint, the  preeent state  of our knowl-
                                              edge of most  physiological  questions,  while it is
                                              much less bulky and far more readable than the lar-
                                              ger text-books of Carpenter or Marshall. The book
                                              is admirably adapted to be placed in the hands of
                                              students.—Boston Med.  and Surg. Journ., April Jy
                                              1&73.                                        '
  On  the whole, there is very little in the book
which either the student or practitioner will not find
of practical value and consistent with our present
knowledge of this rapidly changing science ; and we
have no hesitation in expressing our opinion that
this eighth edition is one of the best handbooks on
physiology which we have in our language.—N. Y.
Med. Record, April 15, 1873.
  Thib volume might well be  used to replace many 
He wry C. Lea's Publications—(Physiology).
J) ALTON (J.  C.), M.D.,
         Professor of Physiology in the. College of Physicians and Surgeons, New York, Ac.

    A  TREATISE OX  HUMAN  PHYSIOLOGY.  Designed for the  use
      of Students and  Practitioners of Medicine.  Fifth edition, revised, with nearly three hun-
      dred illustrations on wood.  In one very beautiful oetavo volume, of over 700 pages, extra
      cloth, $5 25 ;  leather, $6 25.  (Just Issued.)
                                Preface to the Fifth Edition.
  In preparing the present edition of this work, the general plan and arrangement of the previous
editions have been retained, so far as they have been found useful and adapted to the  purposes of
a text-book for students of medicine.  The  incessant advance of all the  natural  and physical
sciences, never more nctive than within the last five years, has furnished many valuable aids to
the special  investigations of the physiologist; and the progress of physiological  research,  during
the same period, has required a careful revision  of the entire work, and the modification or re-
arrangement of many of its parts.   At this day, nothing is regarded a=  of any  value in natural
science which is not  based  upon direct and intelligible observation or experiment; and, accord-
ingly, the discussion of doubtful or theoretical qirestions has been avoided, as a general rule, in
the present volume, while new  facts, from whatever source, if fully established,  have  been added
and incorporated with  the  results of previous investigation.  A number of  new illustrations have
been introduced, and  a few of the older ones, which seemed to  be no longer useful, have been
omitted. In all the changes and additions thus made, it has been the aim of the writer to make the
book, in its present form, a faithful exponent of the actual conditions of physiological science.
    New York, October, 1871.
  In this, the standard text-book on Physiology, all that is needed to maintain the favor with which
it is regarded by  the profession, is the author's assurance that it has been thoroughly  revised and
brought up to a level with the advanced science  of the day.  To accomplish this has required
some enlargement of the work, but no advance has been made in the price.
  The fifth edition of this truly valuable work on
Human Physiology comes to us with many valuable
Improvements and  additions.  As  a text-book of
physiology the work of Prof. Dalton has long been
well known as one of the best which could be placed
in the hands of student or practitioner. Prof. Dalton
has, in the several  editions of his work heretofore
published, lahored to keep step with the advancement
in science and thela^t edition showsby itsimprove-
ments on former ones that he is determined to main-
tain the high standard of his work.   We predict for
the  present edition increased favor, though this work
has long been the favorite standard.—Buffalo Med.
and Surg. Journal, April, 1872.
  An extended notice of a work so generally and fa-
vorably known as this is unnecessary. It is justly
regarded as one of the most valuable text-book* on
the  subject in the English language.—St. Louit Med.
Archives, May,  1872.
  We know no treatise in physiology so clear, com-
plete, well  assimilated,  and perfectly digested, as
D:ilton's. He never writes cloudily or dubiously, or
in mere quotation.   He assimilates all his material,
and from it  constructs a homogeneous transparent
argument, which is always houestaud well informed,
and hides neither trutb, ignorance, uor doubt, so far
as either belongs to  the subject in hand.—Brit. Med.
Journal, March 23, 1672.
  Dr. Dalton's treatise is well known, and by many
highly esteemed in this country. It is, indeed, a good
elementary  treatise on the subject it professes to
teach, and may safely be put into  the hands of Eng-
lish studeats.  It has one great merit—it is clear, and,
on the whole, admirably illustrated. The part we
have always esteemed  most highly is that relating
to Embryology.  The diagrams given of the various
stages of development give a clearer view of the sub-
ject than do those in general use in this country; aud
the text  may be said to be, upon the whole, equally
clear.—London Med. Times and Gatette, March 23,
1872.
  Dalton's Physiology is  already, and deservedly,
the favorite text-book of the majority of American
medical  str,.louts.  Treating a most  interesting de-
partment .if science in his own peculiarly lively aod
fascinating*style, Dr. Dalton carries his reader along
without effort, and at the  same time  impresses upon
his mind the truths taught much  more successfully
than if they were buried beueath  a multitude of
words.—Kansas City Med. Journal, April, 1872.

  Professor  Dalton is regarded justly  as the authority
in this country on physiological subjects, and the
fifth editiou of his valuable work fully justifies the
exalted opinion the medical world has of his labors.
This last edition is greatly enlarged.— Virginia Clin-
ical Record, April, 1872.
D UNGPWfe^?orNof S«2« J Medicine in Jefferson Medical College, Philadelphia.
    HUMVN  PHYSIOLOGY.   Eighth edition.   Thoroughly revised and
        S   -i    ~Am*A or.fl pnlirffed with five hundred and thirty-two illustrations.   In two
      ieaXrgenand LnSS^^rinted o^avo volumes of about 1500 pages, extra cloth.  $7 00.


 T EHMANN (C.  O.).
    PHYSIOLOGICAL CHEMISTRY.  Translated from the second edi-
      f    h  George E  Day  M. D., F. R. S., Ac, edited by R. E. Rogers, M. D., Professor of
      rv!«roUtrv in the Medical Department of the University of  Pennsylvania, with illustrations
        1   tedfrom Funke's Atlas of Physiological Chemistry, and an Appendix of plates.  Com-
      plete in two large and handsome octavo volumes, containing  1200  pages, with nearly two
      hundred illustrations, extra cloth.   $6 00.
B
Y THE SAME AUTHOR
MANUAL  OF  CHEMICAL  PHYSIOLOGY.   Translated from the
  German, with Notes and Additions, by J. Cheston  Morris, M.D., with an Introductory
  Essay on Vital Force, by Professor Samuel Jackson, M. D., of the University of Pennsyl-
  vania.  With illustrations on wood.   In one very handsome octavo volume of 336  pages,
  extra cloth.  $2 25. 
10
Henry C. Lea's Publications—(Chemistry).
  A TTFIELD  (JOHN),  Ph. D.,    '
"^     Professor of Prartiral Chemistry to the Pharmaceutical Society of Great Britain, Ac.
   CHEMISTRY,  GENERAL, MEDICAL,  AND PHARMACEUTICAL;
      including the Chemistry of the U. S. Pharmacopoeia.  A Manual of the General Principles
      of the Science, and their Application  to Medicine  and Pharmacy.  Fifth Edition, revised
      by  the  author.   In one handsome royal  12mo. volume ;  cloth, $2 75; leather, $3 75.
      (Just Ready.)
  We commend the work heartily as one of the best
text-books extant for the medical student.—Detroit
Rev. of Med. and Pharm., Feb  1872.
  The best work of the kind In the English language.
—N. Y. Psychological Journal, Jan. 1872.
  The work is constructed with direct reference to
the wants of medical and pharmaceutical students;
Rnd, although an English work, the points of differ-
ence between the British and United States Pharma-
copoeia* are indicated, making it as useful here as in
England   Altogether, the book  is one  we can heart-
ily recommend to practitioners  as well as students.
—N. Y. Med. Journal, Dec. 1871.
  It differs from other text-books in  the following
particulars: first, in the exclusion of matter relating
to compounds which, at present, are only of interest
to the scientific chemist; secondly, in containing the
chemistry  of every substance recognized officially or
in general, as  a remedial agent.  It will be found a
most valuable book for pupils, assistants, and others
eogaged in medicine and pharmacy, and we heartily
commend it to our readers.—Canada Lancet, Oct.
1871.
  When the original English edition of  this work was
published, we had occasion to express our high ap-
preciation  of its worth, and h1«o to review, in con-
siderable detail, the main  features of the book.  As
the arrangement of subjects, and the main part of
the text of the present edition are similar to the for-
mer publication, it will be  needlesR for us to go over
the ground a second time ;  we may. however, call at-
tention to a marked advantage po-sessed by the Ame-
rican  work—we allude  to the introduction of the
chemistry  of the preparations of the United States
Pharmacopoeia  as well as that relating to the British
authority. — Canadian  Pharmaceutical  Journal,
Nov. 1871.

  Chemistry has borne the  name of being ahard sub-
ject to master _by  the  student of  medicine, and
chiefly because so much of it consists of compounds
only of interest to the scientific chemist; in this work
Buch portions are modified  or altogether left out, and
in the arrangement of the subject matterof the work,
practical utility is sought after,  and we think fully
attained   We commend it for its clearness and order
to both teacher and  pupil.—Oregon Med. and Surg.
Reporter, Oct. 1871.
0
 DLINO (WILLIAM),
      Lecturer on Chemistry at St. Bartholomew's Hospital, Ac.
A  COURSE OF  PRACTICAL  CHEMISTRY, arranged for the Use
    of Medical Students.  With Illustrations.  From the Fourth and Revised London Edition.
    In one neat royal 12mo. volume, extra cloth.  $2.   (Lately Issued.)
  As a work for the practitioner it cannot be excelled
It is written plainly and concisely, and gives in a very
small compass the information required by the busy
practitioner.  It is essentially a work for the physi-
cian, and no one who purchases it will ever regret the
outlay   In addition to all that  is usually given in
connection with inorganic chemistry, there are most
valuable contributions to toxicology, aninral and or-
ganic chemistry, etc.  The portions devoted to a dis-
cussion of these subjects  are very excellent.  In no
work can the physician find more that is valuable
and reliable in regard to urine, bile, milk, bone, uri-
nary calculi, tissue composition, etc.  The work is
small,  reasonable in price, and well published.—
Richmond and Louisville Med. Journal, Dec. 1869.
 (CALLOWAY (ROBERT),  F.C.S.,
 \JT     Prof, of Applied Chemistry in  the Royal College of Science for Ireland, Ac.

   A MANUAL OF QUALITATIVE  ANALYSIS.   From the Fifth Lon-
      don Edition. In one neat royal 12mo. volume, with illustrations; extra cloth, $2 50.  (Just
      Issued.)
  The success which has carried this work through repeated editions in England, and its adoption
as a text-book in several of the leading institutions in this country, show that the author has suc-
ceeded in the endeavor to produce a  sound practical manual and book of reference for the che-
mical student.
  Prof  Galloway's books are  deservedly in high
esteem, and this American reprint of the fifth edition
(1R69) of his Manual of Qualitative Analysis, will be
acceptable to many American students to whom the
English edition is not accessible.—Am. Jour, of Sci-
ence and Arts, Sept. 1872.
  We regard this volume as a valuable addition  to
the chemical text-books, and as particularly calcu-
lated to instruct the student in analytical researches
of the inorganic compounds, the important vegetable
acids, and of compounds and various secretion* aud
excretions of animal origin.—Am. Journ. of Pharm.,
Sept. 1872.
 J^LOXAM (C. L.\
J-*      Professor of Chemistry in King's College. London.

   CHEMISTRY,  INORGANIC AND  ORGANIC.   From the Second Lon-
      don Edition.  In one very handsome octavo volume,  of 700 pages, with about 300 illustra-
      tions.   Cloth, $4 50 ;  leather, $5 50.  (Just Ready.)
  It has been the author's endeavor to produce a Treatise on Chemistry sufficiently comprehen-
sive for those  studying the science as a branch of general education, and one which a student
may use with advantage in pursuing his chemical studies at one of the colleges or medical schools.
The special attention devoted to Metallurgy and some other branches of Applied Chemistry renders
the work especially useful to those who are being educated for employment in manufacture.
  Pofessor Bloxam has given us a most excellent I ... It is astonishinghow much information he often
and useful practical trettise.   His 666  pages ar« | convey* in a f>>w paragraphs.   Wo might quote fifty
crowded with facts and experiments, nearly nil well I instances of this.—Chemical Hews.
chosen, and mauy quite new, even to scientific men. | 
         henry u.  LEA'S ruBLiCATioNH—(Chemistry, Pharmacy, d-c).     11

pHANDLER  (CHARLES F.).   and   /^HANDLER (WILLIAM H.),
^     Prof of Chemistry in the N.  Y. Coll. of       ^     Prof of Chemistry in the Lehigh
          Pharmacy.                                       University.
   THE   AMERICAN  CHEMIST:  A Monthly  Journal of Theoretical,
      Analytical, and Technical Chemistry.  Each number averaging forty large double  col-
      umned pages of reading matter. Price $5  per annum in advance.  Single numbers, 50  cts.
 [L#"~  Specimen numbers to parties proposing to subscribe will be sent to any address on receipt
of  25 cents.
  *#* Subscriptions can begin with any number.
  The  rapid growth of the Science of Chemistry and its infinite applications to other sciences
and arts render a journal  specially devoted to the subject a necessity to those whose pursuits
require familiarity with the details of the science. It has been the aim of the conductors of "TaE
American  Chemist"  to supply this want  in  its broadest sense, and the reputation which  the
periodical has already attained is a sufficient evidence of the  zeal and ability with which they
have discharged their task.
  Assisted by an able body of collaborators, their aim is to present, within a moderate compass,
an abstract of the progress of the science in all its.departments, scientific and technical.  Import-
ant original communications and selected papers  are given in full, and the standing of the " Chem-
ist" is such as to secure the contributions of leading uir- . in all portions of the country.  Besides
this, over one hundred journals and transactions of learned societies in America, Great Britain,
France, Belgium, Italy, Russia, and Germany are  carefully scrutinized, and whatever they offer
of interest is condensed and presented to. the reader.  In this work, which forms a special feature
of the "Chemist," the editors have the assistance of M. Alsberg, Ph.D., Prof. G. F.  Barker, T.
M. Blossom, E.M., H. C. Bolton, Ph.D., Prof. T. Egleston, E.M  , H. Endemann, Ph.D., Prof. C.
A. Goessmann,  Ph.D.,S. A. Goldschmidt, A.M., E.M., E.  J.  Hallock, Prof.  C. A. Joy, Ph D.,
J. P.  Kimball,  Ph.D., 0.  G. Mason, H.  Newton,  E.M., Prof.  Frederick Prime, Jr.,  Prof. Paul
Schweitzer, PhD , Waldron Shapleigh, Romyn  Hitchcock, and Elwyn Waller, E.M.   From the
thoroughness and completeness with which this  department is conducted, it is believed that no
periodical  in either hemisphere more faithfully reflects the progress of the science,  or presents a
larger  or more carefully garnered store of information to its readers.

 ETOWNES (GEORGE),  Ph.D.

    A  MANUAL  OF ELEMENTARY CHEMISTRY;  Theoretical and
       Practical. With one hundred and ninety-seven  illustrations.  A new American, from the
       tenth and revised  London  edition.  Edited by Robert  Bridges, M. D.   In one large
       royal 12mo. volume, of about 850 pp., extra cloth, $2 75 ; leather, S3 25. (Lately Issued.)
  This work is so well known that it seems almost other work that has greater claims on the physician,
superfluous  for us to speak about it.  It has been a pharmaceutist, or student, than this.  We cheerfully
favorite text-book with medical students for years, i recommend  it  as the best text-book on elementary
and its popularity has  in  no respect diminished, j chemistry, and bespeak for it the careful attention
Whenever we have been consulted by medical stu- if students of pharmacy.—Chicago Pharmacist, Aug.
dents, as has frequently occurred, what treatise on 1869.
chemistry they should procure, we have always re-I               ....   _.... .„„ ,,„_ i„„„„„f/,i,0j
*„mm«„A.,A  vi„r,o„>  f£ w*  ,Ja»rA»A  u ,.« thP b«Kt  I  Here is a new edition which has been long watched
Perspicuous  diction! contains 'all  the most recent  ".old place as the most ^cessful ol
discoveries,  and  is of moderate pric*.-Cincinnati i *nd™n Medical Gazette, Jan. 1, 1869.
Med. Repertory, Aug. 1869.                      I   it wni continue, as heretofore, to hold the first rank
  Large additions have been made, especially In the  is a  text-book for students of medicine.—Chicago
department of organic chemistry, and we know of no  Med.  Examiner, Aug. 1869.
w
  IVOHLER  AND FIT TIG.
      OUTLINES  OF  ORGANIC  CHEMISTRY.   Translated  with  Ad-
      ditions from  the Eighth German Edition.   By Ira  Remsen, M.D., Ph.D., Professor of
      Chemistry and Physics in Williams College, Mass.  In one handsome volume, royal 12mo.
      of 550 pp. extra cloth, $3.  (Just Ready.)
  As the numerous editions of the original attest, this work is the leading text-book and standard
authority throughout Germany on its important and intricate subject—a position won for it by
the clearness and conciseness which are its distinguishing characteristics.  The translation has
been executed with the approbation of Profs. Wbhler and Fittig,  and numerous additions and
alterations  have been  introduced, so as to render  it in every respect on a level with the most
advanced condition  of the science.  ___________________

 T>OWMAN (JOHN E.),M. D.
    PRACTICAL  HANDBOOK OF MEDICAL  CHEMISTRY,   Edited
      bv C  L  Bloxam,  Professor  of  Practical Chemistry  in King's  College,  London.   Fifth
      American, from the fourth and revised English Edition.   In one neat volume, royal 12mo.,
      pp. 351, with numerous illustrations, extra cloth.  $2 25.
 T>Y THE SAME AUTHOR.                  ----
   INTRODUCTION  TO PRACTICAL  CHEMISTRY,  INCLUDING
      ANALYSIS.   Fifth American, from the fifth and revised London edition.  With numer-
      ous illustrations. In one neat vol., royal 12mo., extra cloth.  $2 25.

  M Pp,8 TECHNOLOGY- or Chemistry A ppliod to I  very handsome  octavo volumes, with  800 wo. d
  the Arts  and  t- Manufactures.  With American   engravings, extra cloth, $6 00
  additions, by i*rof. Waltkr E. Johsbon.  In two I 
12     Henry C. Lea's Publications—(Mat. Med. and Therapeutics).
 pARRISH  (ED WARD),
         Professor of Materia Medica in the Philadelphia College of Pharmacy.

   A TREATISE  ON  PHARMACY.   Designed as a Text-Book  for the
      Student, and as a Guide for the Physician and Pharmaceutist.  With many Formulae and
      Prescriptions.  Fourth  Edition,  thoroughly revised, by Thomas S.  Wiegand.   In one
      handsome octavo volume, with several hundred illustrations.   (In Press.)
  The immense amount of practical information condensed in this volume may be estimated from
the fact that the Index contains about 4700 items.    Under the head of Acids there are 312 refer-
ences; under Emplastrum, 36; Extracts, 159; Lozenges,  25; Mixtures, 55;  Pills, 56;  Syrups,
131;  Tinctures, 138; Unguentum, 57, &o.
  We have examined this large volume with a good
deal of care, and find that the author has completely
exhausted the subject upon which he treats ; a more
complete work, we think, it would be  impossible  to
find.  To the student of pharmacy the  work is indis-
pensable ; indeed, so far as we know, it is the only one
of its kind in existence, and even to the physician  or
medical student who can spare five dollars to pur-
chase it, we  feel  sure the practical information he
will obtain will more than compensate him for the
outlay.—Canada  Med. Journal, Nov. 1864.
  The medical student and the  practising physician
will find the volume of inestimable worth for study
and reference.—San Francisco Med.  Press, July,
1864.
  When we say that this book is  in  some respects
the  best which has been published on  the subject  in
the  English language for a great many years, we do
not wish it to be understood as very extravagant
praise.  In truth, it is not so much the best as the
>aXj book.—The London Chemical News.

  An attempt to furnish anything like an analysis ol
Parrish's very valuable and elaborate Treatise on
Practical Pharmacy would require more space than
we have at our disposal.  This, however, is not bo
much a matter of regret, inasmuch as it would be
difficult to think of any point, however minute and
apparently trivial, connected with the  manipulation
if pharmaceutic substances or appliances which ha*
not been clearly and carefully discussed in this vol-
ume.  Want of space prevents our enlarging further
on this valuable work, and we must conclude by a
simple expression of our hearty appreciation of its
merits.—Dublin Quarterly Jour, of Medical Science,
August, 1864.
8
 TILLE  (ALFRED),  M.D.,
     Professor of Theory and Practice of Medicine in the University of Penna.

THERAPEUTICS AND  MATERIA MEDICA; a Systematic Treatise
    on  the  Action and Uses of Medicinal Agents, including their Description  and History
    Fourth edition, revised and enlarged.  In two large and  handsome octavo volumes.  (Pre-
   faring.)
                                            abroad its reputation as a standard treatise on Materia
                                            Medica  is securely established   It is second to no
                                            work on the subject in the English tongue, and, in-
                                            deed, is decidedly superior, in some respects, to any
                                            other.—Pacific Med. and Surg  Journal, July, 1868.
                                              8till6's Therapeutics is incomparably the best work
                                            on the subject.— N. Y.  Med. Gazette, Sept. 26, 1868.
                                              Dr. Still^'s work is becoming the best known of any
                                            of our treatises on Materia Medica. .  . . One of the
                                            most valuable works in the language  on the subject!
                                            of which it treats.—N. Y. Med. Journal, Oct. 1868.
                                              The rapid exhaustion of two editions of Prof. Stillest
                                            scholarly work, and the consequent  neces^ty for a
                                            third edition, 16 sufficient evidence of the high  esti-
                                            mate placed upon it by the profession. It is do exag-
                                            geration to say that there is no superior work upon
                                            the subject in the English language.  The present
                                            edition  is fully up to the most recent  advance in the
                                            science  and art of therapeutics.—Leavenworth Medi-
                                            cal Herald, Aug. 1868.
  Dr. Stille'b splendid work on therapeutics and ma-
teria medica.—London Med. Times, April 8,1865.
  Dr. Still6 stands to-day one of the best and most
honored representatives at home and abroad, of Ame-
rican medicine; and these volumes, a library in them-
selves, a treasure-house for every studious physician,
assure his fame even had he done nothing more.—The
Western Journal of Medicine, Dec. 1868.
  We  regard  this work  as the  best one on Materia
Medica in the English language, and as such it de-
serves the favor it has received.—Am. Journ. Medi-
cal Sciences, July 1868.
  We need not dwell on the merits of the third  edition
of this luagaificently conceived work.  It is the work
ou Materia Medica, in which Therapeutics are prima-
rily considered—the mere natural history of drugs
being  briefly disposed of.  To medical practitioners
thin is a very valuable conception. It is wonderful
how much of the riches  of the  literature of Materia
Medica has been condensed into this book. The refer-
ences alone would make it worth possessing.  But it
is cot a  mere compilation.   The writer exercises a
good judgment of his own on the great doctrines and
points of Therapeutics.  For purposes  of practice,
8till6's book is almost unique as a repertory of in-
formation, empirical and scientific, on the actions and
uses of medicines.—London Lancet, Oct. 31, 1868.
  Through the former editions, the professional world
Is well acquainted  with this work.  At home and
  The work of Prof. Still6 has rapidly taken a high
place in professional esteem, and to say that a third
edition is demanded and now appears before us, suffi-
ciently attests the firm position this treatise has made
for itself.   As a work of great research, and scholar-
ship, it is safe to say we have nothing superior.  It U
exceedingly full, and the busy practitioner will find
ample suggestions upon almost every important point
of therapeutics.—Cincinnati Lancet, Aug. 1868.
 QRIFFITH (ROBERT E.), M.D.

    A  UNIVERSAL  FORMULARY,  Containing  the  Methods of Pre-
      paring and Administering Officinal and other Medicines.  The whole adapted to Physiciani
      and Pharmaceutists.  Second edition, thoroughly  revised, with numerous additions, by
      Robert P. Thomas, M.D., Professor of Materia Medica  in the Philadelphia College of
      Pharmacy.  In one large and  handsome octavo volume  of 650 pages, double-columns.
      Extra cloth, $4 00; leather, $5 00.                                °

  Three complete and extended Indexes render the work especially adapted for immediate consul-
tation.  One, of Diseases  and their Remedies, presents under the head of each disease the
remedial agents which have been usefully exhibited in it, with reference to the formulas containing
them—while another of Pharmaceutical and Botanical Names, and a very thorough General
Index  afford the means of obtaining at once any information desired.   The  Formulary itself ia
arranged alphabetically, under the heads of the  leading constituents of the prescriptions.
  We know of none iu our language, or any other, so comprehensive in its details.— London Lancet
  One of the most complete works of the kind in any language.—Edinburgh Med. Journal.
  We are not cognizant of the existence of a parallel work.—London Med. Gaeette. 
— _JiENRY C. Lea's Publications—(Mat. Med. and Taera/jr/uucs).     13

jPEREIRA (JONA THAN),  M.D., F. R.S. and L.S.

    MATERIA  MEDICA  AND  THERAPEUTICS;  being an Abridg-
      ment of the late Dr. Pereira's Elements of Materia Medica, arranged in conformity witt
e British Pharmacopoeia, and adapted to the use of Medical Practitione
ty with
                                                                          mu Botany
      Pharmaceutical Society of Great Britain; and by Robert Warington  F R S  Chemical

      nn!iaI°Q,t0/heBSK0Ciety °f APot?ec"ies-  With numerous additions and references to tlTe
      United  States Pharmacopoeia, by Horatio  C.  Wood,  M.D., Professor  of Botany in the
      University of Pennsylvania.   In one large and handsome octavo volume of 1040 closely
      printed pages, with 236  illustrations, extra cloth, $7  00;  leather, raised bands, $8 00
  The task of the American editor has evidently been
■o sinecure, for not only has he  given to us all that
is contained in the abridgment  nseful for our pur-
poses, but by a careful and judicious embodiment of
over a hundred new remedies has increased the size
of the former work fully one-third, besides adding
many new illustrations, some of which are original.
We unhesitatingly Ray that by so doing be has  pro-
portionately increased the value, not only of the  con-
densed edition, but has extended the applicability of
the great original, aud has placed his medical coun-
trymen under lasting obligations to him.  The Ame-
rican physician  now nas all that is needed in the
shape of a complete treatise on  materia medica, and
the medical student has a text-book which, for prac-
tical utility and intrinsic worth, stands unparalleled.
Although of considerable size, it is none too large for
[Im purposes for which it has been intended, and every
co-diral man should, in justice to himself, spare a
place for it upon his book-shelf, resting assured  that
the more he consults it the better he will be satisfied
jf its excellence.—N. Y.  Med. Record, Nov. 15, 1866.
  It will fill a place which no other work can occupy
iu the library of the physician, otudeut, and apothe-
cary.—Boston Med. and Surg. Journal, Nov. 8, 1866.
  Of the many works on  Materia Medica which have
appeared since the issuing of the British Pharmaco-
poeia, none will be more acceptable to the student
and practitioner than the present.  Pereira's Materia
Medica had long ago asserted for itself the position of
being the must complete work on the subject iu the
English language.   But its very completeness stood
in the way of its success.  Except in the way of refer-
ence, or to those who made a special study of Materia
Medica, Dr. Pereira's work was too full, and its pe-
rusal required an amount of time which few  had at
their disposal.  Dr. Fane h.is very judiciously availed
himself of the opportunity of the publication of the
new Pharmacopoeia, bybrinsring out an abridged edi-
tion of the great'work.  This edition of Pereira is by
no means a mere abridged re-issue, butcontains many
improvements, both in the descriptive and thera-
peutical departments.  We cau recommend  it  as a
very excellent and reliable text-book.—Edinburgh
Med. Journal, February, 1866.
  The reader cannot fail to be impressed, at a glance,
with the exceeding value of this work as a conipeud
of nearly all useful knowledge on the materia medica.
We are greatly indebted to Professor Wood for his
adaptation of it to our meridian.  Without his emen-
dations and additions it would lose much of its vhIua
to the American student. With them it is an Ameri-
can book. — Pacific Medical and Surgical Journal,
December, 1S66.
 fjLLIS (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. Together with the usual Dietetic Preparations and Antidotes for Poisons.  The
      whole aecompfinied with a few brief Pharmaceutic and Medical Observations.  Twelfth edi-
      tion, carefully revised and much improved by  Albert H. Smith, M. D.  In one volume8v.».
      of 376 pages, extra cloth, $3  00.   (Lately Published.)
  This work has remained  for some  time out of print,  owing to the anxious care with which the
Editor has sought to  render the  present edition worthy a continuance of the very remarkable
favor which has carried the volume to the unusual honor of a Twelfth Edition.   He has sedu-
lously endeavored to introduce in it all new preparations and combinations deserving of confidence,
besides adding two new classes, Antemetics and Disinfectants, with brief references to the inhalation
of atomized fluids, the nasal douche of Thudichuni, suggestions upon the method of hypodermic
injection, the administration of anaesthetics, &c. &c.  To accommodate these numerous additions,
he ha3 omitted much which the advance of science has rendered obsolete or of minor importance,
notwithstanding which the volume has been increased by more than thirty pages.  A new feature
will be found  in  a copious  Index of Diseases and  their remedies, which cannot but increase the
value of the work as a suggestive book of reference for the working practitioner.  Every precaution
has been taken to secure the'typographical accuracy so necessary in a work of this nature, and it
is  hoped that the new edition  will  fully maintain the position which "  Ellis' Formulary" has
long occupied.

 flARSON (JOSEPH), M.D.,
 \j      Profensor of Mutrriii Medica and Pharmacy in the University of Pennsylvania, Ac.

   SYNOPSIS  OF  THE  COURSE  OF  LECTURES   ON  MATERIA
      MEDICA  AND PHARMACY, delivered in  the University of Pennsylvania.   With three
      Lectures on the Modus  Operandi of Medicines.  Fourth and revised  edition, extra cloth,
      $3 00.                        ___________________

DUNGLISON'S  NEW REMEDIES, WITH FORMULAE
  FOR THEIR PREPARATION AND ADMINISTRA-
  TION   Seventh edition, with extensive additions.
  One vol. Svo , pp. 770; extra cloth.  *1 00.
ROTLE'S  MATERIA MEDICA AND THERAPEtT-
  ticb.  Edited by Joseph  Carson, M. D.   With
  ninety-eight illustrations.  1 vol. Svo., pp. 700, ex-
  tra cloth. $3 00.
CHRISTISON'S DISPENSATORY.  With copious ad-
  ditions, and  213  large wood-engravings.   By R.
  Eolksfeld Grifpith, M. D. One vol. 8vo., pp. 1000;
  extra cloth.  $4 00.
CARPENTER'S PRIZE  ESSAY ON THE USE OF
  Alcoholic Liquors in Health and Disease.  New
  edition, with a Preface by D. F. Condie, M.D., and
  explanations of scientific words.  In one neat 12iuo.
  volume, pp. 178, extra cloth.  60 cents.
De JON<;H ON THE THREE KIND*; OF COD-LIVEE
  Oil, with their Chemical  and  Therapeutic Pro-
  perties.  1 vol. 12ino., cloth.  75 cents. 
14             Henry C. Lea's Publications—(Pathology, &c.)
 JPENW1CK (SAMUEL),  M.D.,
         Assistant Physician to the London Hospital.
   THE  STUDENT'S GUIDE  TO  MEDICAL DIAGNOSIS.   From  the
      Third Revised and Enlarged English Edition   With  eighty-four illustrations on wood.
      In one very handsome volume, royal 12mo.  (Nearly Ready.)
  The very great success which this work has obtained in England, shows that it has supplied an
 admitted want among elementary books for the guidance of students and junior practitioners.
 Taking up in order  each portion of the body or  class of disease, the author has endeavored to
 present  in simple language the value of symptoms, so as to lead the student to a correct appreci-
 ation of the pathological  changes  indicated by them.   The latent investigations have  been care-
 fully introduced into the present  edition, so that it may fairly be considered as on a level with
 the most advanced condition of medical science. The arrangement adopted may be seen from the
 subjoined
            COTSTT3E3STSEI3  STJ]Vri«IA.Tl-^r OF  CONTENTS.
  Chapter I. Introductory.  II. Diseases of the Heart and Pericardium.  III. Diienses of the
 Lungs.  IV. Diseases of the Throat and Larynx.  V. Diseases of the Kidneys.   VI. Diseases of
 the Liver.  VII.  Diseases of the Stomach.  VIII.  Diseases of the Peritoneum and Intestines.
IX. Abdominal Tumors.  X. Diseases of the Brain.  XI. Fevers.   XII. Rheumatism and Goul.
XIII. Diseases of the Skin.
QREEN (T.  HENR Y),, M. D.,
        Lecturer on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School.

    PATHOLOGY  AND  MORBID ANATOxMY.  With numerous Illus-
     trations on Wood.   In one very handsome octavo volume of over 250 pages, extra cloth,
     $2 50.  (Lately. Published.)
 We have been very much pleased by our perusal of : thology and morbid anatomy. The author shows that
               It is the only one of the kind with I he has been not only a student of the teachings of his
                                            confreres iu this branch of science, but a practical
                                            and conscientious laborer in the post-mortem cham-
                                            ber.   The work will prove a useful one to the great
                                            mass of students and practitioners whose time for de-
                                            votion to this class of studies is limited.—Ant Journ.
                                            of Syphilagriiphy, April, 1872.
this little volume
which we are acquainted, and practitioners as well
as students will find it a very useful guide; for the
information is up to the day, well and compactly ar-
rauged, without being at all scanty.—London Lan
cet, Oct. 7, 1871.
  It embodies in a comparatively small space a clear
statement of the present state of our knowledge of pa-
GLITGE S ATLAS OF PATHOLOGICAL HISTOLOGY.
  Translated, with  Notes and Additions, by Joseph
  Leidy, M. D.  In  one volume, very large  imperial
  quarto, with  320 copper-plate figures, plain and
  pxlored, extra cloth.  #4 00.
SIMON'S GBNERAL PATHOLOGY, as conducive t<
  the Establishment of Ratioual Principles for tht
  Prevention  and Cure of Disease.   In one octavo
  volume of 212 pages, extra cloth.  $1 25.
BOLLY ON THE HUMAN BRAIN ; its Structure, Phy-
  siology, and Diseases.  From the Second and much
  eulaiged London edition.  In one octavo volume of
  .">O0p.,ges,with \2'>wood-cnts: extra cloth. $2 50.
LA ROCHE ON YELLOW FEVER, considered in its
  Historical, Pathological, Etiological, and Therapeu-
  tical Relations. In two large and handsome octavo
  volumes of nearly loOO pages, extra cloth. $7 00.

HOLLAND'S MEDICAL  NOTES  AND  REFLEC-
  TIONS.   1 vol. 8vo., pp. 500, extra cloth.  $3 50.

W H AT TO OBSERVE AT THE BEDSI DE AND AFTER
  Death  in Medical Cases.  Published under the
  authority of the London Society for Medical Obser-
  vation  From the second London edition. 1 vol.
  royal 12mo., extra cloth.  $1 00.

LAYCOCK'S  LECTURES  ON  THE PRINCIPLES
  and Methods op  Medical Observation  and  Re-
  search. For the  use of advanced students and
  junior practitioners.  In one very neat royal 12m o.
  volume, extra cloth.  $1 00.
S1ROSS (SAMUEL D.),  M. D.,
*-*      Professor of Surgery in the Jefferson Medical College of Philadelphia.
  ELEMENT^   OF  PATHOLOGICAL  ANATOMY.   Third  edition,
     thoroughly revised and greatly improved.   In one large and very handsome octavo volume
     of nearly 800 pages, with about three hundred a,nd fifty beautiful illustrations, of which a
     large number are from original drawings ; extra cloth.  $4 00.
J
    ONES (C. HANDFIELD),F.R.S.,and  SI EV EKING (ED. H), M.D.,
        Assistant Physicians and Lecturers in St. Mary's Hospital.

   A  MANUAL  OF  PATHOLOGICAL ANATOMY.   First American
       edition, revised.  With three hundred and ninety-seven  handsome wood engravings.  In
       one large and beautifully printed octavo volume of nearly 750 page?, extra cloth, $3 50.

 VTURGES (OCTA VIUS), M.D., Cavtab.
 KJ     Fellow ofthe Royal Vollepe of Physicians, Ac. Ac.

   AN  INTRODUCTION*  TO   THE   STUDY  OF  CLINICAL  MED-
       ICINE.  Being a Guide to-the Investigation of Disease,  for the Use  of Students.   In one
       handsome 12mo. volume, extra cloth, >t>l  25.  (Now Ready.)
  Table op Contents.   I. The  Sort of Help needed  by the Student at  the Bedside.  II. Some
 General Rules with Reference to  the Examination  of Patients   III. The Family and Personal
 History of the Patient.  IV. Examination of the Functions.   V. Examination of the Phenomena
connected with the Brain and Cord  VI. The Physical Examination of the Chest, its Inspection
and Palpation.  VII.  Percussion Applied  to the Heart and Lungs.   VII[.  Auscultation  of the
Chest.   IX. Examination of the Abdomen and of the  Secretions.   X. The Diagnosis.  XI. The
Treatment. 
Henry C  Lea's publications—(Practice of M<3diri>u>).
15
 WLINT (A USTIN),  M. D.,
         Professor of the Principles and Practice of Medicine in BeUevue Med. College, N. Y.

   A  TREATISE   ON   THE   PRINCIPLES  AND  PRACTICE  OF
      MEDICINE ;  designed for the use of Students and Practitioners of Medicine.   Fourth
      edition, revised and enlarged.   In one large and closely printed octavo volume of about 1100
      popes; handsome extra cloth, $6 00; or strongly bound in leather, with raised bands, $7 00.
      (Just Ready.)

   By common consent of the English and American medical press, this work has been assigned
to the highest position as  a complete and compendious text-book on the most advanced condition
of medical science.  At the very moderate price at which it is offered it will be found one of the
oheapest volumes now before the profession.
  Admirable and unequalled. — Western Journal of
Medicine, Nov. 1869.
  Dr. Flint's work, thougb claiming no higher title
than that of a text-book, is really more.  He is a man
of large clinical experience, and his book is full of
•uch masterly descriptions of disease as can only be
drawn  by a man intimaiely acquainted with their
various  forms.  It  is not so long since we had  the
pleasure of reviewing his first edition, and we recog-
nize a great improvement, especially in  the general
part of the work. It is a work which we can cordially
recommend to our readers as fully abreast of the  sci-
»nce of the day.—Edinburgh Med. Journal, Oct.  '69.
  One of the best works of  the kind for the  practi-
tioner, and the most convenient of all for the student.
—Am. Journ. Med. Sciences, Jan. 1S89.
  This work, which stands  pre-eminently as  the ad-
vance standard of medical science  up to the present
time in  the practice of medicine, has for its  author
one who is well and  widely known as one of the
leading practitioners of this continent.   In fact, it is
seldom that any work is ever issued from the press
more  deserving of universal recommendation.—Do-
minion Med Journal, May, 1869.
  The third edition of this most excellent book scarce-
ly needs any commendation from  us.  The volume,
is it stands now, is really a marvel: first of all, it is
excellently printed and bound—and we encounter
that luxury of America, the ready-cut pages, which
:he Yankees are 'cute enough to insist upon—nor are
these by any means trifles ; but the contents of the
book are astonishing.  Not only is it wonderful that
my one man can have grasped in his mind the whole
icope of medicine with that vigor which Dr. Flint
■ihows, but the condensed  yet clear way in which
this is done is a perfect literary triumph   Dr. Flint
;s pre-eminently one of the  strong men, whose right
'.o do this kind of thing is well admitted ; and we say
10 more than the  truth  when we affirm that he is
very nearly the only living man that oould do it with
mch results as the volume before us.—The London
Practitioner, March, 1869.

  This is in some respects the best text-book of medi-
:ine in our language, and it is highly appreciated on
:he  other side of the  Atlantic, inasmuch  as the first
sditiou was exhausted in a  fev months.   The second
sdition was little more than a reprint, but the present
iias, as the author says, been thoroughly revised.
Vluch valuable matter has been added, and  by mak-
ing  the type smaller, the bulk of the volume is not
much increased. The weak point in many American
works is pathology, but Dr. Flint has taken peculiar
pains on this poiut, greatly to the value of the book.
—London Med. Times and Gazette, Feb.  6, 1869.
BARLOWS MANUAL OF THE  PRACTICE  OF I TODD'S CLINICAL LECTURES ON CERTAIN ACUTE
  MEDICINE.   With Additions  by D. F. Cohdie,    Diseases. In one neat octavo volume, of 320 pages,
  M D.  1 vol. 8vo., pp. 600, cloth.  $2 50.         I   extra cloth. *2 60.
 T>AVY(F.W.),M.D.,F.R.S.,
■i-         Senior Asst. Physician to and Lecturer on Physiology, at Guy s Hospital, Ac.
   A TREATISE  ON  THE  FUNCTION  OF  DIGESTION;  its Disor-
      ders and  their Treatment.   From the second London edition.   In one handsome volume,
      small octavo, extra cloth, $2 00.  (Lately Published.)
  The work before us is one which deserves a wide treatise, and_ sufficiently exhaustive for all practical
circulation. We know of no better guide to the study
of digestion and its disorders—St. Louis Med. and
Burg. Journal, July 10, 1869.
  A thoroughly good book, being a careful systematic
purposes.—Leavenworth Med. Herald, July, 1669.
  A very valuable work on the subject of which  t
treats.  Small, yet it is full of valuable information.
—Cincinnati Med. Repertory, June, 1869.
 DRINTON (WILLIAM), M.D., F.R.S.
^LECTURES ON  THE  DISEASES  OF  THE  STOMACH;  with an
      Introduction on  its Anatomy and Physiology.   From the second and enlarged London edi-
      tion.   With illustrations on wood.   In one handsome octavo volume of about 300 pag^s,
      extra cloth.   $3 25.           ___________________

 rfHAMBERS (T. K.), M. D.,
 \J      Consulting Physician to St. Mary's Hospital, London, Ac.
   THE INDIGESTIONS;  or, Diseases of the Digestive Organs Functionally
      Treated.  Third and revised Edition.  In one handsome octavo volume of 333 pages, extTa
      cloth.   $3 00.   (Lately Published.)
  So verv large a proportion of the patients applying
to every general practitioner suffer from some form
       jstion. that whatever aid* him in their man-
                'put.- money iu his purse,  °
of indigest
agement directly "put.- money iu his purse,  auu >n-
dfrectly does.m're than anything else to advance his
reputafion with the public.  From this  pure y mate-
rial pout of view, setting aside iU h.gher claims to
merit, we know of no more desirable acquisition to
a pliy.-iciau's library than the book before us.  He
who should commit its contents to his memory would
dud its price an investment of capital that returned
him a most usurious rate of interest.—N. Y. Medical
Gazette, Jan. 28, 1871.
B
Y THE SAME AUTHOR.  (Lately Published)

RESTORATIVE  MEDICINE.  An  Harveian Annual  Oration,  deliv-
   ered at the Royal College of Physicians, London, on June 24. 1871.  With  Two Sequels.
   In one very handsome volume, small  12mo., extra cloth, $1 00. 
16        Henry C. Lea's Publications—(Practice of Medicine).
 LJA R TSHORNE  (HENR Y), M. D.,
■*■■*-     Professor of Hygiene in the University of Pennsylvania.

   ESSENTIALS OF THE  PRINCIPLES  AND  PRACTICE OF MEDI-
      CINE.   A handy-book for Students and Practitioners.   Third edition, revised and  im-
      proved.  In one handsome royal 12mo. volume of 487 pages, clearly printed on small type,
      cloth, $2 38;  half bound, $2*63.   (Just  Issued.)
  The very  remarkable favor which has been bestowed upon this work, as manifested in the ex-
haustion of  two large editions within  four years,  shows that it  has successfully  supplied a want
felt by both student  and practitioner of a volume which at a moderate price and in a convenient
size should afford a  clear and compact view  of the most modern teachings in medical practice.
In preparing the work for a third edition, the author has sought to maintain its character by very
numerous additions, bringing it fully up to the science of the day, but so concisely framed that
the size of the volume is increased only by thirty or forty pages.  The extent of the new informa-
tion thus introduced may be estimated by the fact that there have been two hundred and  sixty
separate additions made to the text,  containing references to one hundred and eighty new authors.
  This little epitome of medical kuowledge lias  al-  mulas are appended, intended as examples merely,
rea'ly  been noticed  by us. It is a vade  mecum of | not as guides for unthinking practitioners.  A com-
value, including in a short space most of what is  es- \ plete index facilitates the use of this little volume, in
sential in the science and practice of medicine.  The j which all important remedies lately introduced, such
third edition is well up to the present day in the
modern methods of treatment, aud iu the use of newly
di-overed drugs.—Boston Med. and Surg. Journal,
Oct. 19, 1871.
  Certainly very few volumes contain  so much pre-
cise information within so small a  compass.—N. Y.
Med. Journal, Nov.  1871.
  The diseases are conveniently classified; symptoms,
causation,  diagnosis, prognosis, and treatment are
carefully  considered, the whole being marked by < demand
briefness, but clearness of expression.  Over 250 for
as chloral hydrate and carbolic acid, have received
their full share of attention.—Am. Journ. of Pharm.,
Nov. 1871.

  It is an epitome of the whole science and practice
of medicine, and will be found most valuable to the
practitioner for easy reference, and especially to the
student in attendance upon lectures, whose time  is
too much occupied with many studies, to consult the
larger works.  Such a work must always be in great
         Cincinnati Med. Repertory, Nov. 1871.
 \KTA TSON (THOMAS),  M. D., fi-c.    *

     LECTURES   ON   THE   PRINCIPLES  AND  PRACTICE  OF
       PHYSIC.   Delivered  at  King's College, London.   A new American, from the Fifth  re-
       vised and  enlarged  English edition.  Edited, with additions, and  several hundred illus-
       trations, by Henry Hartshorne, M.D., Professor of Hygiene in the University of Penn-
       sylvania.  In two large and handsome 8vo. vols. Cloth, $9 00; leather, $11 00.  (Just Issued.)
  At length, after many months of expectation, we | advantages of great culture and a ripe experience
have the satisfaction of finding ourselves this weekiu  combined  with  the soundest  judgment  and  sin-
pu-session  of a revised and enlarged edition of Sir I c*rity of purpose.  The author's  rare combiuntion
                                              of great scientific attainments combined with won-
                                              derful forensic eloquence has exerted extraordinary
                                              influence over the last two generations of physicians.
                                              His clinical descriptions of most diseases have never
                                              been equalled ; and on this score  at least his work
                                              will live  long in the future.  The work  will be
                                              sought by all who appreciate a  great book.—Amer.
                                              Journal of Syphilography, July,  1S72. •
                                                We are exceedingly gratified at the reception of
                                              this new edition of Watson, pre-eminently the prince
                                              of English authors, on  "Practice."  We, who read
                                              the first edition as it came to us tardily and in frag-
                                              ments through the  "Medical  News  and Library,"
                                              shall never forget the great pleasure and profit we
                                              derived from  its graphic delineations of disease, its
                                              vigorous  style and splendid  Euglish. Maturity of
                                              years,  extensive  observation,  profound research,
                                              and  yet continuous enthusiasm, have combined to
                                              give us in this latest edition a model of professional
                                              excellence in teaching with rare beauty iu the mode
                                              of communication.  But this classic needs no eulo-
                                              gium of ours.—Chicago Med. Journ., July, 1872.
Tliomas Watson's celebrated Lectures.  It is a sub
ject for congratulation and for thankfulness that Sir
Thomas Watson, during a period of comparative lei-
sure, after a long, laborious, and most honorable pro-
fessional career, while retaining full possession of his
high mental faculties, should have employed the  op-
portunity to submit his Lectures to a more thorough
revision than was  possible during the earlier and
busier period of his  life.  Carefully passing in review
some of the most intricate and important pathological
ami practical questions, the results of his clear insight
and hiscalm judgment are now recorded for the bene-
fit of mankind, in language which, for precision, vigor,
and classical elegance, has rarely been equalled, and
never surpassed  The  revision has evidently been
most carefully done, and the results appear iu almost
every page.—Brit. Med. Journ., Oct. 14, 1871.
  The lectures are  so  well  known  and  so justly
appreciated, that it is  scarcely ut'c<j«sary  to  do
more than call attention to the special advantages
of the  last  over previous editions.   In.the revi-
sion, the author has displayed all the charms and
D
     UNGLISON,  FORBES,  TWEEDIE,  AND CONOLLY.

    THE  CYCLOPAEDIA OF  PRACTICAL MEDICINE:  comprising
      Treatises on the Nature and Treatment  of Diseases, Materia  Medica and Therapeutics,
      Diseases of Women and Children, Medical Jurisprudence, &c. Ac.  In four large super-royal
      octavo volumes, of 3254 double-columned pages, strongly and handsomely bound in leather
      $15 ;  extra cloth.  $11.
  *** This work contains no less than four hundred and eighteen  distinct treatises, contributed
   sixty-eight distinguished physicians.

 POX (WILSON), M.D.,
-*-       Holme Prof, of Clinical Med., University Coll.,  London.

    THE  DISEASES  OF  THE  STOMACH: Being  the  Third Edition  of
      the "Diagnosis  and  Treatment of the Varieties  of  Dyspepsia."  Revised and Enlarged.
      With  illustrations.  In one handsome octavo volume.
  *,* Publishing in the " Medical News and Library" for 1873.
  The present edition of Dr. Wilson Fox's very ad mi- I   Dr. Fox has put forth a volume  of uncommon ex-
rable work differs from the preceding in that it deals . celleuce, which  we feel verv sure will take a hi«h
with other maladies thau dyspepsia ouly.— London I rank among works  that treat of the btoinach —Am.
Met. Times, Feb. 8, 1873.                        | Practitioner, March, 1873.                 ' 
Henry  C. Lea's Publications—(Diseases of Lungs and Heart).    H
JpLlNT (A US TIN), M.D.,
         Professor of the Principles and Practice of Medicine in Bellevue Hospital M<d. College, A". Y.

   A PRACTICAL TREATISE ON THE  DIAGNOSIS, PATHOLOGY,
      AND TREATMENT OF DISEASES OF  THE HEART.   Second  revised and  enlarged
      edition.   In one octavo volume of 550 pages, with a plate, extra cloth, $4.  (Just Issued.)
  The author has sedulously improved the opportunity afforded him of revising this work.  Portions
of it have been rewritten, and the whole brought up to a level with the most advanced condition of
science.  It must therefore continue to maintain its position as the standard treatise on the subject.
  I^r; Flint chose a difficult subject for his researches, | able for purposes  of illustration, in connection with
and has shown remarkable powers of observation
and reflection, as well as great industry, in his treat-
ment of it.  His book must be considered  the fullest
and clearest practical treatise on those subjects, and
should  be in the bands of all practitioners and stu-
dents.  It is a credit to American medical  literature.
—Amer. Journ. of the Med. Sciences, July, 1860.
  We question the fact of any recent American author
in our profession being more  extensively  known, or
more deservedly esteemed in this country than  Dr.
                                               cases which have been reported by other trustworthy
                                               observers.—Brit, and For. Med.'-Chirurg. Review.

                                                 In  regard to the  merits of the work, we  have no
                                               hesitation in pronouncing it full, accurate, and judi-
                                               cious.  Considering the present state of science, such
                                               a work was much needed. It should be in the hands
                                               of every practitioner.—Chicago Med. Journ.

                                                 With more than pleasure do we hail the advent of
                                               this work, for it fills a wide gap  on the list of text-
Flint. We willingly acknowledge his success, more ' books for our schools, and is, for the practitioner, the
particularly in the' volume on diseases of the heart, i most  valuable practical work of its kind.—j.V. 0. Med.
In making an extended personal clinical study avail- I News.
B
Y THE SAME AUTHOR.
A  PRACTICAL  TREATISE  ON   TnE  PHYSICAL  EXPLORA-
   TION OF THE  CHEST AND THE DIAGNOSIS OF DISEASES  AFFECTING THE
   RESPIRATORY ORGANS. Second and revised edition. In one handsome octavo volume
   of 595 pages, extra cloth, $4 50.
                                            which pervades his whole work  lend an additional
                                            force to its thoroughly practical character,  which
                                            cannot fail to obtain for it a place as a standard work
                                            on  diseases of the respiratory system.—London
                                            Lancet, Jan. 19, 1867.
                                              This is an admirable book.  Excellent in detail and
                                            execution, nothing better could  be desired by the
                                            practitioner.   Dr. Flint  enriches his subject with
                                            much  solid and not a little original observation.—
                                            Ranking's Abstract, Jan. 1867.
  Dr Flint's treatise is one of the most trustworthy
fuid»s which he can consult.   The style is clear and
distinct, and is also concise, beingfree from that tend-
ency to over-refinement and unnecessary minuteness
which characterizes many works on the  same sub-
ject.— Dublin Medical Press,  Feb. 6, 1867.
  The chapter on Phthisis is replete with interest;
and his remarks on the diagnosis, especially in  the
early stages, are remarkable for their acumen and
great practical  value.  Dr. Flint's style is ciear and
elegant, and the tone of freshness and originality
 PULLER (HENRY WILLIAM), M. D.,
■*■       Physician to St  George's Hospital, London.

   ON  DISEASES  OF   THE  LUNGS  AND  AIR-PASSAGES.   Their
      Pathology, Physical Diagnosis,  Symptoms, and Treatment.   From the second and revised
      English edition.   In one handsome  octavo volume of about 500 pages, extra cloth, $3 50.
  Dr. Fuller's work on diseases of the chest was so  accordingly we have what might be with perfect jus-
favorably received, that to mauy  who did not know  tice styled an entirely new work  from his pen, the
the extent of his engagements, it was a matter of won- ; portion of the work treating of the heart  and great
der that it should be allowed to remain  three years | vessels being excluded. Nevertheless, this volume is
out of print.  Determined, however, to improve it, | of almost equal size with the first.—London Medical
Dr Fuller would  not consent to a mere reprint, and i Times and Gazette, July 2C, 1867.
W'

W
 1LLIAMS (C.J.B.), if.D.,
      Senior Consulting Physician to the Hospital'for Consumption, Brompton, and
 1LLIAMS (CHARLES  T), M.D.,
      Physician to the Hospital for Consumption.
PULMONARY  CONSUMPTION;  Its Nature,  Varieties,  and  Treat-
  ment.  With an Analysis of One Thousand cases to exemplify its duration.  In one neat
  octavo volume of about 350 pages, extra cloth.   (Just Issued.)   $2 50.
  He can still speak from a more enormous experi-1
ence and a closer study of the morbid processes in-
volved in tuberculosis, than most liviug men.  He j
owed it to himself, and to the importance of the sub- j
ject, to embody his views in  a separate work and
we  are glad that he  has accomplished this duty.
After alL the grand teaching which Dr Williams has |
for the profession is to be found in his therapeutical
chapters, and in the history of individual cases ex-
tended, by dint of care^ver ten, twenty, thirty, and
even forty years.—London Lancet, Oct.  21, 1871.
  His  results are more favorable than those of any ]
previous author; but probably there is no malady,
the treatment of which has beeu so  much improved
within the last twenty years as pulmonary consump-
tion. To ourselves, Dr. Williams's chapters on Treat-
ment are amongst the most valuable and attractive in
the book, and would alone render it a standard work
of reference. In conclusion, we would  record our
opinion that Dr.  Williams's  great reputation is fully
maintained by this book.  It is undoubtedly one of
the most valuable works in the language upon  any
special disease.—Lond. Med. Times  and  Gaz., Nov.
I, luJl.
r a  wfirTTTf ON PNEUMONIA  1 vol. Svo., extra SMITH ON CONSUMPTION; ITS EARLY ANDRE-
  cloth  of 500 pages  Price WOO.                   MEDIABLE STAGES.  1 vol. Svo, pp. 254.  $2 25.
BUCKLER  O.N  FIBRO-BRONCHITIS AND  RHED- : SALTER ON ASTHMA.   1 vol. Svo.  $2 50.
  MATIC PNEUMONIA.  1vol.8vo.  *125.         WALSHE ON THE DISEASES OF THE HEART AND
S>ISKE FUND PRIZE ESSAYS ON CONSUMPTION.   GREAT VESSELS.  Third American edition.  la
  1 vol Svo,, extra cloth.  «1  00.                 '   1 vol. 8vc. 420 pp., cloth.
*3 00. 
18        Henry C. Lea's Publications—(Practice of Medinne).
ROBERTS ( WILLIAM), M. D..

Lecturer on Medicine in the. Manchester School of Medicine, Ac.
   A PRACTICAL  TREATISE  ON URINARY AND   RENAL  DIS-
      EASES, including Urinary Deposits.  Illustrated by numerous cases and engravings.  Sec-
      ond American, from the Second  Revised and Enlarged London Edition.  In  one large
      and handsome octavo volume of 616 pages, with a colored plate ; extra cloth, $4 50.  (Just
      Issued.)

  The author has subjected this work to a very thorough revision, and has sought to embody in
it the results of the latest  experience and investigations.  Although every  effort has been made
to  keep it within the  limits of its former  size, it has been enlarged by a hundred pages, many
new wood-cuts have been introduced, and also a colored plate representing the appearance of the
different  varieties of urine, while the price has been retained at the former very moderate rate.
In every  respect it is therefore presented as worthy to maintain  the position which it has acquired
as  a leading authority on  a large,  important, and perplexing class of affections.  A few notices
of the first edition are appended.
 The plan, it will thus be seen, is very complete, [ diseases we have examined  It is peculiarly adapted
an 1 the manner in which it  has been  carried out is ] to the wants  of the majority of American practltion-
in  the highest degree satisfactory.  The characters  ers from its clearness and simple announcementof the
of the different deposits are very well described, and I facts in relation to diagnosis and treatment of urinary
the microscopic appearances  they present are illus-  disorders, and contains in condensed form the investi-
trated by  numerous well executed engravings  It ' gations of Bence Jones, Bird, Beale, Hassall, Prout,
only  remains to us to strongly  recommend  to our | and a host of other  well-known writers upon this sub-
readers Dr. Roberts's work, as containing an admira- I ject. The characters of urine, physiological  and pa-
ble rCsume" of the present state of knowledge of uri- | thological, as indicated to the naked eye as well as by
nary diseases, and as a safe and reliable guide to the  I microscopical and  chemical investigations, are con-
clinical observer.—Edin. Med. Jour.                cisely represented  both by description and by well
  The most complete and practical treatise upon renal' executed engravings.—Cincinnati Journ. of Med.
 T>ASHAM (W.R.),  M.D.,
•*-'      Senior Physician to the Westminster Hospital, Ac.

   RENAL DISEASES: a Clinical Guide to their Diagnosis and Treatment.
      With illustrations.  In one neat royal 12mo. volume of 304 pages. $2 00.  (Jusi Issued.)
  The chapters on diagnosis and treatment are very
good, and the student and  young  practitioner will
find them full of valuable practical  hints.  The third
purt, on the  urine, is excellent, and we eordially
recommend its perusal.  The author has arranged
his matter in  a somewhat novel, and, we think, use-
ful form.  Here everything can be easily found, and,
what is more important, easily read, for all the dry
details  of larger  books here acquire a new interest
from the author's arrangement.  This part of the
book is full of good work.—Brit, and For. Medico-
Chirurgicrd Review, July, 1870.

  The easy descriptions and compact modes of state-
ment render the book pleasingand convenient.—Am.
Journ. Med. Sciences, July, 1870.
  A book that we believe will be found a valuable
assistant to the practitioner and guide to the student.
—Baltimore Med. Journal, July, 1870.
  The treatise of Dr. Basham differs from the rest in
its special adaptation to clinical study, and its con-
densed and almost aphorismal style, which makes it
easily read  and easily understood.   Besides, the
author expresses some  new views, which are well
worthy of consideration. The volume is a valuable
addition to this department of knowledge.—Pacific
Med. and Surg. Journal, July, 1870.
MORLAND ON RETENTION IN THE BLOOD OF THE ELEMENTS OF THE URINARY SECRETION.
   1 vol. 8vo., extra cloth.  75 cents.

  TONES (C.  HANDFIELD), M. D.,
U      Physician to St. Mary's Hospital, Ac.                                           ,

   CLINICAL  OBSERYATIONS
      DISORDERS.  Second American Edition.
      extra cloth, $3 25.

  Taken as a whole, the work before us furnishes a ]
short but reliable account of the pathology and treat- I
ment of a class of very common but certainly highly
obscure disorders.  The advanced student will find it
a rich mine of valuable facts,  while the medical prac-
titioner will derive  from it many a suggestive hint to
aid him iu the diagnosis of "nervous cases," and in
determining the true indications for their ameliora- I
tion or cure.—Amer. Journ. Med. Sci., Jan. 1867.    I
  ON  FUNCTIONAL   NERYOUS
  In one handsome octavo volume of 348 pages,


  We must cordially recommend it to the profession
of this country as supplying, in a great measure, a
deficiency which  exists in the  medical literature of
the English language.—New York Med. Journ., April,
1867.

  The volume is a most admirable one—full of hints
and practical suggestions. — Canada Med. Journal,
April, 1867.
0
s
Y DISEASES OF THE SPIXAL  COLUMN AND OF THE NERVES.
   By C. B. Radcliff, M. D., and others.   1 vol. 8vo., extra cloth, $1 50.
LADE  (D. D.),  M.D.

DIPHTHERIA;  its Nature and Treatment, with an account of the His-
   tory of its Prevalence  in various Countries.  Second and revised edition.  In  one neat
   royal 12mo. volume, extra cloth.  $125.
H°-
   DSON(A.), M. D., M. R. I. A.,
    Physician to the Veath Hospital.

LECTURES ON  THE  STUDY  OF  FEVER.
   Cloth, $2 50.
In  one vol.  8vo.,  extra
JjYONS (ROBERT D.),  K.C.C.

   A  TREATISE  ON FEVER; or, Selections from a Course of Lectures
      on Fever.  Being part of a Course of Theory and Practice of Medicine.  In one neat ootavo
      volume, of 362 pages, extra cloth.  $2  25. 
Henry  C. Lea's Publications—(Venereal Diseases, etc.).
19
 T3UMSTEAD  (FREEMAN J.),  M.D.,
■"-'    Professor of Venereal Diseases at the Col. of Phys and Surg., New York, Ac.

   THE  PATHOLOGY  AND  TREATMENT   OF  VENEREAL  DIS-
       EASES.   Including the results- of recent investigations upon the subject.   Third edition,
       revised and enlarged,  with illustrations.  In  one large and handsome octavo volume ot
       over 700 pages, extra cloth, $5 00 ;  leather,  $6 00.  (Just Issued.)
   In preparing  this standard work again for the  press, the  author has subjected it to a  very
thorough revision.   Many portions have been rewritten,  and much new matter added, in order to
bring it completely on a level with the most advanced condition of syphilography,  but by careful
compression of the text of previous editions, the work has been increased by only sixty-four pages.
The labor thus bestowed upon it, it is hoped, will insure for it a continuance of its position as a
complete and trustworthy guide for  the praetitioner.
                                               much special commendation as if its predecessors had
                                               not been published.  As a thoroughly practical book
                                               on a class  of diseases which form a large share d
                                               nearly every physician's practice, the volume before
                                               us is bv far the best of which we have knowledge.—
                                               N. Y. Medical Gazette, Jan. 28, 1871.
                                                  It  is rare  in the history of medicine to find any one
  It is the most complete book with which we are ac-
quainted in the language.  The latest views  of the
best authorities are put forward, and the information
is well arranged—a great point for  the student, and
still more for the practitioner. The subjects of vis-
ceral syphilis,  syphilitic affections of the  eyes, and
the treatment of syphilis by repeated inoculations, are
very fully discussed.—London Lancet, Jan. 7, 1871.
  Dr.  Bumstead's  work  is already so  universally
known as the best treatise in the English language on
book which contains all that a practitioner needs to
know; while the possessor of "Bumstead on Vene-
real" has no occasion to look outside of its covers for
veuereal diseases, that it may seem almost superflu- < anything practical connected with the diagnosis, his-
ous to say more of it than that a new edition has been toiy, or treatment of these affections.—N. Y. Medical
Issued.  But the author's industry has rendered this i Journal, March, 1871.
new edition virtually a new work, and so merits as <
flULLERIER (A.)
\S      Surgton to the Hb%
and
Hdpital du Midi.
 J? UMSTEA D  {FREE MA N J),
■*-*    Professor of Venereal Disi rises in the I
         Physicians and Surgeons, N. I
College of
   AN  ATLAS OF VENEREAL DISEASES.   Translated and  Edited  by
    Freeman J. Bumstead.   In one large imperial 4to. volume of 328 pages, double-columns,
    with  26  plates, containing about  150  figures, beautifully colored, many of them the size of
    life; strongly bound in extra cloth, $17 00; also, in five parts, stout wrappers for mailing, at
    $3 per part.   (Lately Published.)
  Anticipating a very large sale for this work, it is offered at  the very low price of Three Dol-
lars  a Part, thus placing it within the reach of all who  are interested in this department of prac-
tice.  Gentlemen desiring early impressions of the plates would do well to order it without delay.
  A specimen of the plates and text sent free by mail, on receipt of 25 cents.
  We wish for once that our province was not restrict-
 ed to methods of treatment, that we might say some-
 tiling of the exquisite colored plates in  this volume.
 — London Practitioner, May, 1869.
  As a whole,  it teaches all  that can be  taught by
 means of plates and print.—London  Lancet, March
 1.. 1869.
  superior to anything of the kind ever before issued
 on this continent.—Canada Mni. Journal, March, '69.
  The practitioner who desires to understand  this
 binnch of medicine thoroughly should obtain this,
 the most complete and best work ever  published.—
 Dominion Med. Journal, May, 1869.
  This is a work of master hands on both sides.  M.
Cul lerier is scarcely second to, we think we may truly
sav is a peer of the illustrious and venerable Ricord,
while in this country we do not hesitate to say  that
Dr  Bumstead,  as  an authority, Is without a rival
Assuring our readers that these illustrations tell the
whole history of venereal disease, from its inception
to its end, we do not know a single  medical work,
which for its kind is more necessary for them to have.
—California Med. Gazette, March, 1869.
  The most splendidly illustrated work in the lan-
guage, and in  our opinion  far more useful than the
French original.—Am. Journ. Mr.d. Sciences, Jan.'69,
  The fifth and concluding number of this magnificent
work has reached  us, and  we have no hesitation in
saying that its illu-trations surpass those of previous
numbers.—Boston Med. and Surg. Journal, Jan. U,
1869.
  Other writers besides M.  Cullerier have given ns a
good account of the diseases of which he treats, but
no one has furnished us with such a  complete series
of illustrations of the venereal diseases. There is,
however, an additional interest and value possessed
by the volume before us ; for it is an American reprint
and  translatiou of  M. Oulierier's work,  with  Inci-
dental remarks by one of the most eminent American
syphilographers,  Mr. Bumstead. —Brit, and  For.
Medico-Chir. Review, July, 1869.
//
ILL (BERKELEY"),
         Surgeon to the Lock Hospital, London.

ON  SYPHILIS  AND  LOCAL  CONTAGIOUS  DISORDERS.   In
  one handsome octavo volume ; extra cloth, $3 25.   (Lately Published.)
                                           to whom we would  most earnestly recommend  its
                                           study; while it is no less useful to the practitioner.—
                                           fit. Louis Med. and Surg. Journal, May, 1869.
   Bringing, as it dots, the entire literature of the dis-
 e -se down to the present day, and  giving with great
 ability the results of modern research, it is in every
 respect a most desirable work, and  one which should
 find a place in the library of every surgeon.—Cali-
fornia Med. Gazette, June, 1869
   lonsidering the scope of the book  and the careful
   ention to the manifold aspects and details  of its
sibject, it is wonderfully concise.  All these qualities
render it an especially valuable book to the beginner,
 ■ C
atte
  The most convenient and ready book of reference
-we have met with.— N. Y. Med. Record, May 1,1869.

  Most admirably arranged for both student and prac-
titioner, no other work on the subject equals it; it is
more simple, more easily studied.—Buffalo Med. and
Surg. Journal, March, 1869.
 r/EISSL  (//.), MD.
^   A  COMPLETE  TREATISE ON  VENEREAL DISEASES.  Trans-
      lated from the Second Enlarged German Edition, by Frederic R. Stukgis, M.D.   In one
      octavo  volume, with illustrations.   (Preparing.)
1 
20
Henry C. Lea's Publications—(Disease* of the Stein).
TH~ILSON (ERASMUS), F.R.S.
    ON  DISEASES OF THE  SKIN.   With Illustrations on wood.  Sev-
      enth American, from the sixth and enlarged English edition.  In onelarge octavo volume
      of over 800 pages, $5.
  A SERIES OF  PLATES   ILLUSTRATING  "WILSON  ON DIS-
     EASES OF THE SKIN;" consisting of twenty beautifully executed plates,  of which thir-
     teen are exquisitely colored, presenting the Normal Anatomy and Pathology of the Skia,
     and embracing accurate representations of about one hundred varieties of disease, most ol
     them the size of nature.  Price, in extra cloth, $5 50.
 Also, the Text and Plates, bound in one handsome volume.  Extra cloth, $10.
 Such a work as the one before us is a most capital |   Ne one treating skin diseases  should be without
and acceptable help. Mr. Wilson has long been held
as high authority in this department of medicine, and
his  book on diseases of the skin has long been re-
garded as one or the best text-books extant on the
subject.  The present edition  is carefully prepared,
and brought up in its revision to the present time In
this edition we have also included the beautiful series
of plates Illustrative of the text, and in the last edi-
tion published separately. There are twenty of these
plates, nearly all of them colored to nature, and ex-
hibiting  with  great fidelity  the various groups of
diseases.—Cineinnati  Lancet.
a, copy of this  standard work.— Canada Lancet,
August, 1863.
  We can safely recommend it to the profession <ta
the best work on the subject  now in  existence in
the English  language.—Medical Times and Gazette.

  Mr. Wilson's volume is an excellent digest of the
actual amount of knowledge of cutaneous  diseases;
it includes almost every fact or opinion of importance
connected with  the anatomy and  pathology of the
skin.—British and Foreign Medical Review.
>Y THE SAME AUTHOR.                  ----
 THE  STUDENT'S  BOOK  OF  CUTANEOUS MEDICINE  and Dis-
    eases of the skin.  In one very handsome royal 12mo. volume. $3 50.  (Lately Issvsd.)
XTELIGAN (J.MOORE), M.D.,M.R.I.A.

   A  PRACTICAL  TREATISE  ON   DISEASES  OF  THE  SKIN.
      Fifth American, from the second and enlarged Dublin edition by T. W. Belcher, M. D.
      In one neat royal 12mo. volume of 462 pages, extra cloth.  $2 25.
                                             heir value justly estimated; in a word, the work is
                                            fully up to the times, and is thoroughly stocked with
                                            most valuable information.—New York Med. Record,
Jan. 15, 1867.
  The most convenient manual of diseases of the
skin that can be procured by the student.—Chicago
Med. Journal, Dec. 1866.
  Fully equal to ail the requirements of students and
young practitioners.—Dublin Med. Press.
  Of the remainder of the work we have nothing be-
yond unqualified commendation to offer.  It is so far
the most complete one of its size that has appeared,
and for the student there can be none which cat com-
pare with it in practical value. All  the late disco-
veries in Dermatology  have  been duly noticed, and |
jftY THE SAME AUTHOR.                 ----

   ATLAS  OF   CUTANEOUS  DISEASES.    In  one  beautiful  quarto
      volume,  with exquisitely colored  plates, Ac, presenting about one hundred varieties of
               Extra cloth, $5 50.
                                             inclined to consider it a very superior work, com-
                                             bining accurate verbal description with sound views
                                             of the pathology and treatment of eruptive diseases.
                                             —Glasgow Med. Journal.
                                               A compend which will very much aid the practi-
                                             tioner in this difficult branch of diagnosis  Takin
                                             with the beautiful plates of the Atlas, which are re-
                                             markable for their accuracy and beauty of coloring,
                                             it constitutes a very valuable addition to the library
                                             of a i)ractical*man.—Buffalo Med. Journal.
  The diaguosis of eruptive disease, however, under
all circumstances, is very difficult. Nevertheless,
Dr. Neligan has certainly, ''as far as possible," given
a faithful and accurate representation of this class of
diseases, and there can be no doubt that these plates
will be of great use to the student and practitioner in
drawing a diagnosis as to the class, order, and species
to which the particular case may belong.   While
looking over the "Atlas" we have been induced to
examine also the "Practical Treatise." and we are
 TJILLIER (THOMAS), M.D.,
■*--*-      Physician to the Skin Department of University College Hospital, Ac.

   HAND-BOOK  OF  SKIN  DISEASES,  for Students and Practitioners.
      Second American Edition.   In one royal 12mo.  volume of 358  pp.  With Illustrations.
      Extra cloth, $2 25.
  We can conscientiously recommend it to the stu-1   It is a concise, plain, practical treatise on the vari-
dent;  the style is  clear and pleasant to read, the  ous diseases of the skin ; just such a work, indeed,
matter is good, and the descriptions of disease, with  as was much needed, both by medical students and
the modes of treatment recommeuded, are frequently  practitioners. — Chicago Medical Examiner,  May,
Illustrated with well-recorded cases.—Loudon Med.  1865.
Times and Gazette, April 1, 1865.                I
 ANDERSON (Mr.CALL),  M.D.,
*£*-      Physician to the Dis-pensa.ry for Skin Diseases, Glasgow, 4c.

   ON THE  TREATMENT  OF DISEASES OF THE  SKIN.   With an
      Analysis of Eleven Thousand Consecutive Cases.  In one vol. 8vo.  $1.  (Just Ready.)
  The very practical  character of this work and the extensive experience of the author,  cannot
fail to render it acceptable to the subscribers of the "American  Journ'al of the  Medicu.
Sciences."   When completed in the "News and  Library," it will be issued separately iu &
neat octavo volume.
• 
         henry C Lea's Publications—(Diseases of Children).         21

JgMlTH (J. LE WIS), M. D.,
           Profuisor of Morbid Anatomy in the Bellevue Hospital Med. College, N. Y.
    A COMPLETE PRACTICAL TREATISE ON THE DISEASES OF
      CHILDREN.  Second Edition, revised and greatly enlarged.   In one handsome octavo
      volume  of 742 pages, extra cloth, $5; leather, $6.   (Just Issued.)
                       From the Preface to the Second Editiox.
  In presenting to the profession the second edition of his work, the author gratefully acknow-
ledges the favorable reception accorded  to the first.   He has endeavored to merit a continuance
of this approbation by rendering the volume much more complete than before.  Nearly twenty
additional diseases have been treated of, among which may be named Diseases  Incidental to
Birth, Rachitis, Tuberculosis, Scrofula, Intermittent,  Remittent, and Typhoid Fevers, Chorea,
and the various forms of  Paralysis. Many new formulae,  which  experience has shown  to be
useful, have been introduced, portions of the text of a  less  practical nature have  been con-
densed,  and other portions,  especially those  relating to  pathological  histology,  have  been
rewritten to correspond with recent discoveries.  Every effort has been made,  however, to avoid
an undue enlargement of  the volume, but, notwithstanding this, and an  increase in  the size of
the page, the number of pages has been enlarged by more than one hundred.
  227 West 49th Street, New York,  April, 1872.
  The work will be found to contain nearly one-third more matter than the previous edition, and
it is confidently presented as in every respect worthy to  be  received as the standard American
text-book on the subject.
  Emineutly  practical as well as judicious in its
teachings.—Cincinnati Lancet and Obs., July, 1S72.
  A standard  work that leaves little to be desired.—
Indiana Journal of Medicine, July, 1872.
  We kuow of no book on this subject that we can
more cordially  recommend to the medical student
and the practitioner.—Cincinnati Clinic, J une29, '72.
  We regard it as superior to any other single work
on the diseases of iut'ancy aud childhood.—Detroit
Rev. of Med. and Pharmacy, Aug. 1S72.

  We confess to increased enthusiasm in recommend-
ing this second edition.—St  Louis Mtd. and Surg.
Journal, Aug. 1S72.
(10NDIE (D. FRANCIS), M. D.

   A PRACTICAL TREATISE ON THE DISEASES OF CHILDREN.
      Sixth edition, revised and augmented.   In one large octavo volume of nearly 800 closely-
      printed pages, extra cloth, $5 25; leather, $6 25.   (Lately Issued.)
                                            teachers.  As a whole, however, the work is the best
                                            American one that we have, and in it» special adapta-
                                            tion to American practitioners it certainly has no
                                            aqual. — New York Med. Record, March 2, 1S68.
 The present edition, which is the sixth, is fully up
to the times in the discussion of all those points in the
pathology and treatment of infantile diseases which
have been brought forward by the German and French
 \T7~EST  (CHARLES), M.D.,
  ' '      Physician to the Hospital for Sick Children, Ac.
   LECTURES  ON  THE  DISEASES  OF  INFANCY  AND  CHILD-
      HOOD.   Fourth American from the fifth revised and enlarged English edition.   In one
      large  and handsome octavo volume of 656 closely-printed pages.  Extra cloth,  $4 50;
      leather, $5 50.
  Of all the English writers on the diseases of chil- I living authorities in the difficult department of medi-
dren, there is no one so entirely satisfactory to us as | cal science in which he is most widely known.—
Dr. West.  For years we have held his opinion as I Boston Med. and Surg. Journal, April 26, 1866.
judicial, and have regarded him as one of the highest |

 1DY THE SAME AUTHOR.  (LatelyIssued.)

   ON SOME DISORDERS OF  THE NERVOUS SYSTEM TN  CHILD-
      HOOD; being the Lumleian Lectures delivered at the Royal College of Physicians of Lon-
      don  in  March, 1871.  In one volume, small 12nio., extra cloth, $1 00.

 03UTH(EUSTACE), M. D.,
^         Physician to the Northwest London Free Dispensary for Sick Children.
    A  PRACTICAL  TREATISE ON  THE  WASTING DISEASES OF
      INFANCY AND CHILDHOOD.  Second American, from the second revised and enlarged
      English edition.  In one handsome octavo volume, extra cloth, $2  50.  (Lately Issued.)
  This is iu  every way an  admirable book.   The  scribed as a practical  handbook of the common dis-
modest title which the author haschosen foritscarce-  eases of children, so numerous are the affectione c.m-
lvconvevs an adequate idea of the  many tubjects  sidered either collaterally or  directly.  We are
tit) a which it treats  Wasting is so constant an at-  acquainted with uo safer guide to the  treatment of
tendant noon the maladies of childhood, that a trea-  children's diseases, and few works give the insight
fci«e uDonthe wasting diseasesof children must neces  into the physiological and other peculiarities of chil-
k« HI v embrace the consideration of many affections  dren that Dr. Smith's book does.—Brit. Med. Journ.,
of which i t is a symptom ; and this is excellently well  April 8, 1871.
done by Dr.  Smith   The book might fairly be de-__________
G
    UERSANT  (P.),M.D.,
       Honorary Surgeon to the Hospital for Sick Children, Paris.
    SURGICAL  DISEASES OF  INFANTS AND  CHILDREN.   Trans-
      lated bv R  J. Dunglison, M. D.  In one neat octavo volume, extra cloth, $2 50.   (Now
      Ready.)                       __________________
OKWEES ON THE  PHYSICAL AND MEDICAL TREATMENT OF CHILDREN. Eleventh edition.  1 vol-
   Svo. of 618 pages. $2 80. 
22          Henry C. Lea's  Publications—(Diseases of Women).
  A VELING  (JAMES H.),           and  WILTSHIRE (ALFRED), M.D.,
•*■■*•     Physician to the Hospital for Women and     rr      Assistant Physi"ian-AccoucheurtoSt.
              Children.                                          Mary's Hospital.

    THE  OBSTETRICAL  JOURNAL  of Great  Britain  and  Ireland;
      Including  Midwifery, and the Diseases of AVomen and Infants.  With an American
      Supplement, edited by William F.  Jenks, M.D.   A monthly of about 80 octavo pages,
      very handsomely printed.  Subscription, Five Dollars per annum.   Single Numbers, 50
      cents each.
  Commencing with  April, 1873, the Obstetrical Journal  will consist of Original Papers by Brit-
ish and  Foreign Contributors ; Transactions of the Obstetrical Societies in Kngland and abroad;
Reports of Hospital Practice; Reviews and Bibliographical Notices; Articles and Notes, Edito-
rial, Historical, Forensic, and  Miscellaneous; Selections from  Journals; Correspondence, Ac.
Collecting together the vast amount of material daily accumulating in this important and ra-
pidly improving department of medical science, the value of the information which it will pre-
sent to the subscriber may be estimated from  the character of the gentlemen who have already
promised their support, including such names as those of Drs. Atthill, Robert Barnes, Henry
Bennet, Thomas Chambers, Fleetwood Churchill, Matthews  Duncan, Graily  Hewitt,
Braxton Hicks,  Alfred Meadows, W. Leishman,  Alex. Simpson, Tyler Smith, Edward J.
Tilt, Spencer Wells, Ac. Ac. ; in short, the representative men  of British Obstetrics and Gyna-
cology.
  In order to  render the Obstetrical  Journal fully adequate to the wants of the American
profession, each number will contain a Supplement devoted to the advances made in Obstetrics
and Gynaecology  on  this side  of the Atlantic.   This portion of  the  Journal will be under the
editorial charge of Dr. William  F. Jenks, to whom editorial communications, exchanges, books
for review, Ac, may  be addressed, to the care of the publisher.
  *** Gentlemen desiring complete sets will do well to forward their orders without delay.
 /THOMAS  (T.GAILLARD),M.D.,
 •*■      Professor of Obstetrics, <fee., in the College of Physicians and Surgeons, N. Y., Ac.

   A PRACTICAL TREATISE ON THE DISEASES OF WOMEN.  Third
       edition, enlarged and  thoroughly revised.   In one large and handsome  octavo volume of
       784 pages, with 246 illustrations.  Cloth, $5 00;  leather, $6 00.  (Just Issued.)
   The author has taken advantage of the opportunity afforded by the call for another edition of
 this work to render it worthy a continuance of the very remarkable favor with which it has been
 received.  Every portion  has been subjected  to a  conscientious revision, several new chapters
 have been added, and no  labor spared to make it a complete treatise on the most advanced  con-
 dition of its important subject.   The present edition therefore contains  about one-third  more
 matter than the previous one, notwithstanding which the price has been maintained at the former
 very moderate rate, rendering this one of the  cheapest volumes accessible to the profession.
  As compared  with the first edition, five new chap- i   We are free to say that we  regard Dr Thomas the
 ters  on  dysmenorrhcea,  peri-uterine fluid  tumors, I best American authority on diseases of women. Seve-
 composite tumors of the ovary, solid tumors of the : ral others have written, and written well, but  none
 ovary, and chlorosis,  have been added.  Twenty-| have so clearly and carefully arranged their text and
 seven additional wood-cuts have been  introduced,  instruction as Dr. Thomas.—Cincinnati Lancet and
 many subjects have been subdivided, and all have  Observer, May, 1872.
 Z^hL^lTZ?1 !nte,r,StUial infease A In fa?!' t,he ,  We deem it scarcely necessary to recommend this
 cTaseT\^££  ^V™™**' ^t V  J     work t0 Physicians as it is  now widely known, and
 of no book which ™Tly'i ,",   y b7y th" T ka°W  most °f them *lready possess  it, or will certain y do
 eVnte the  nrl«n^ ta ™mPlete'y  a?d concisely repre-  80   To gtndents we ^hesitatingly recommend  it as
   rrilK.? r fvnfCOl0?y> none *0™* I the besttext-book on diseases  of females extant.-*.
 besnelkl  fn »,f,h^ rCllaWe> .teachm« • ,non« w£lch ! Louis Med. Reporter,  June, 1869.
 Despeaks  an author more apt in research and abnn-
 dant in resources.—N. Y Med. Record, May 1,1872. '  Of all the army ef books that have appeared of late
  W
 did
 book,

 onThe subject w^po:^?nouHaln^uageU "w^ave" ! "l™' ** ^ *«**-<**V°»«« *«*■ *«"«VJune,
 no hesitation in recommending Dr. Thomas's work as I
 one of the most complete of its kind ever published. I  ^ not 'be best work extant on the subject of which
 It should be in  the possession of every practitioner  " treats, it is  certainly second to none other.   So
for reference and for study.—London Lancet, April  short a  time has elapsed since the medical press
27, 1S72.                                        teemed with commendatory notices of the first edition,
  Our author is not one of those whose views "never I 'J?8,1 ' VTV1- be suPerfl,uon* *0«iveJan  fended re-
 hange."  On the contrary, they have been modified l JUT^Zhaft~n0Wfi,rm>r estabhehed antte American
in many particulars to accord with the progress made
in this departmentof medical science: hence it has the
freshness of an entirely new work. No general prac-
titioner can afford to be without it.—*. Louis Med.
and Surg  Journal, May, 1872.
  Its able author need not fear comparison between  „
it and any similar work in the English language- ' 8eC0I>d edition makes its appearance, shows that the
                                            '  general judgment of the profession has largely con-
                                                                    ) at that time.—Cincinnati
text-book of Gynaecology.— N. Y. Med. Gazette, July
17, 1869.
  This is a new and revised edition of a work which
we recently noticed at some length, and earnestly
commended to the favorable attention of our readers.
The fact that, in  the short space of one year,  this
  Its able author need not fear comparison between
  and any similar work in  the English language:
nay more, as a text book for students and as a guide  *cuel*'J augment or tne p
f.r practitioners, we believe it is unequalled. *In the I «rm«"VhAe "P1"10^ we«^e
liberies  of reading  physicians  we meet with  it  Lnncu-' Au«- 18b9-
of eaerthan any other treatise on diseases of women. I  It is so short a time since we gave a full review of
We■•oncludeourbrlefreviewbyrepeatingthenearty I the first edition of this book, that we deem it only
™lf? ■, ^1°f '. *, vo,ume 6lvea "^en we com-  necessary now to call attention to the second appear-
menced : if either student or practitioner cangetbut I ance of the work.  Its success has been remarkable
ouebookondise^es of women that book should be | and we can only congratulate  the  author on the
iJro mas' ~Amtr-  Jour.  Med.  Sciences,  April, I brilliant reception his book has received.— N Y  Med.
187J-                                         | Journal, April, 1869. 
Henry  C. Lea's Publications—(Diseases of Women).         23
 TJODGE  (HUGH L.). M.D.,
■*"*•      Emeritus Pnfmsor of Obstetrics, Ac, in the University nf Pennftylmnia.

    ON  DISEASES PECULIAR  TO WOMEN; including Displacements
       of the Uterus.  With original  illustrations.   Second  edition, revised  and enlarged.  In
       one beautifully printed octavo volume of 531 pages, extra cloth.   $4 50.  (Lately Issu-ed.)
  In the preparation of this edition the author has spared no pains to improve it with the results
of his observation and study  during the interval which has elapsed since the first appearance of
the work.  Considerable additions  have thus been made  to it, which have been pnrtially accom-
modated by an enlargement in the  size of the page, to avoid increasing  unduly the bulk  of the
volume.
  From Prop. W. H. Btford, of the Rush Medical
                College, Chicago.
  The book bears the impress of a master hand, and
must, as its predecessor, prove acceptable to the pro-
fession.  In diseases of women  Dr. Hodge has estab-
lished a school of treatment that has become world-
wide in fame.
  Professor Hodge's work Is truly an original one
from beginning to end, consequently no one can pe-
ruse ite pages without learning something new.  The
book, which is by no means a large one, is divided into
two grand sections,  so to speak: first, that treating of
the nervous sympathies of the uterus, and, secondly,
that which speaks of the mechanical treatment of dis-
placements of that organ  He is disposed, aR a non-
believer in the frequency of inflammations  of the '
uterus, to take strong ground against many of the
highest authorities in this branch of medicine, and
the arguments which he offers in support of his posi-
tion are. to say the least, well put.  Numerous wood-
cuts adorn this portion of the work, and add incalcu-
lably  to the proper  appreciation of the variously
shaped instruments referred to by our author.  As a
contribution to the study of women's diseases, it is of
great value, and is abundantly able to st^nd on its
own merits—N. Y. Medical Record, Sept. 15,  1868.

  In this point of view,  the treatise of Professor
Hodge will  be indispensable to  every student In its
department.  The large, fair type and general  perfec-
tion of workmanship will render it doubly welcome.
—Pacific Med. and Surg. Journal, Oct. 1868.
 VfTEST (CHARLES), MD.

     LECTURES  ON  THE DISEASES OF WOMEN.   Third American,
      from  the Third London edition.  In one neat octavo volume of about 550 pages, extra
      cloth, $3 75; leather, $4 75.
  The reputation which this volume has acquired  as a standard* book of reference in its depart-
ment, renders it only necessary to say  that the present edition has received  a careful revision at
the hands of the author, resulting in a considerable increase of size.  A few notices of previous
editions are subjoined.
   The manner of the author Is excellent, his descrip-
 tions graphic and perspicuous, and his treatment up
 to the level of the time—clear, precise, definite, and
 marked by  strong common sense. — Chicago Med.
 Journal, Dec. 1861.
   We cannot too highly recommend this, the second
 edition of Dr. West's excellent lectures on the dis-
 eases of females.  We know of no other book on this
 subject from which we have derived as much pleasure
 and instruction.  Every page gives evidence of the
 honest, earnest, and diligent searcher after truth.  He
 Is not the mere compiler of other men's ideas, but his
 lectures are the result often years' patient investiga-
 tion in one of the widest fields for women's diseases—
 St. Bartholomew's Hospital.  As a teacher, Dr. West
 Is simple and earnest in his language, clear and com-
 prehensive in his  perceptions, and logical in his de-
 ductions—Cincinnati Lancet, Jan. 1862.
  We return the author our grateful thanks for the
 vast amount of instruction he has afforded us.  His
 valuable treatise needs no e Uogy on our part.  His
 graphic diction  and  truthful pictures of disease all
 speak for themselves.—Mtdico-Chirurg. Review.
  Most justly esteemed a standard work.....It
 bears evidence of having been carefully revised, and
is well worthy of the fame it has already obtained.
—Dub. Med.  Quar. Jour.
  As a writer. Dr. West stands, in our opinion, se-
 cond only to Watson, the "Macaulay of Medicine;"
 he possesses that happy faculty of clothing instruc-
 tion in  easy  garments;  combining pleasure with
 profit, he leads his pupils, in spite of the ancient pro-
 verb, alone a royal road to learning. His work is one
 which will not satisfy the extreme on either side, but
 it is one that will please the great majority who are
 seeking truth, and one that will convince the student
 that he has committed himself to a candid, safe, and
 valuable guide.—N. A. Med.-Chirurg Review.

  We must now conclude this hastily written sketch
 with the confident assurance to our readers that the
 work will well repay perusal.  The  conscientious,
 painstaking, practical physician Is apparent on every
 page.—N. Y. Journal of Medicine.

  We have to say of it,"briefly and decidedly, that it
 is the best work on the subject in any language, and
 that it stamps Dr.  West as the facile  princfps of
 British obstetric authors.—Edinburgh Med. Journal.

  We gladly recommend his lectures as in the highest
 degree instructive to all who are interested in ob-
stetric practice.—London. Lancet.

  We know of no treatise  of the kind so complete,
and yet so compact.—Chicago Med. Journal.
 TfARNES  (ROBERT), M. D.,  F. R. C. P.,
JL)     Obstetric Physician t« St. Thomas's Hospital, Ac.

   A  CLINICAL  EXPOSITION  OF  THE  MEDICAL  AND  SURGI-
       CAL DISEASES OF  WOMEN.  In one handsome octavo volume with illustrations.  (Pre-
       paring.)

HHURCHILL  ON THE  PUERPERAL  FEVER AND
  OTHER DISEASES PECULIAR TO WOMEN.  1 vol.
  Svo  pp. 4oO, extra cloth.  $2 30.
DEWEES'S TREATISE ON THE DISEASES  OF FE-
  MALES   With illustrations.   Eleventh Edition,
  with  the Author's last improvements and correc
  tione.  In  one octavo volume of 536 pages, with
  plates, extra cloth. $3 00.
WESTS ENQl'IRY  INTO  THE  PATHOLOGICAL
  IMPORTANCE  OF ULCERATION  OF THE  OS
  UTERI.  1 vol  ,Svo., extra cloth. $125.
MEIGS ON WOMAN: HER DISEASES AND THEIR
  REMEDIES  A Series of Lectures to his Class.
  Fourth aud Improved Edition.  1 vol. 8vo., over
  700 pages, extra cloth, 95 00 ;  leather, *6  00.
MEIGS O.V  THE NATURE,  SIGNS,  AND TREAT-
  MENT OF CHILDBED FEVER.  1  vol. 8vo., pp.
  36:1,  extra cloth.  >_' 00.
ASHWELI. s PRACTICAL TREATISE ONTHE DIS-
  EASK-. PECULIAR TO WOMEN.  Third American,
  from the Third and revised Loudon edition.  1 vol.
  Svo., pp. J2S, extra cloth.  $3 50. 
24               Henry C. Lea's Publications—(Midurifery).
 TJODGE  (HUGH L.), M.D.,
■*■-*-      Emeritus Professor of Midwifery, Ac , in the University of Pennsylvania, Ac.
   THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRICS.    Illus-
      trated with large lithographic  plates containing one hundred and fifty-nine figures from
      original photographs, and with numerous wood-cuts.   In one large and beautifully printed
      quarto volume of 550 double-columned pages, strongly bound in extra cloth, $14
  We have examined Professor Hodge's work with
great  satisfaction; every topic is elaborated  most
fully.  The views of the author are comprehensive,
and concisely stated.   The rules of practice are judi-
cious, and will enable the practitioner to meet eveiy
emergency of obstetric complication with confidence.
—Chicago Med. Journal, Aug. 1864.
  The work of Dr. Hodge is something more than a
simple presentation of his particular views in the de-
partment of Obstetrics; it is something more than an
ordinary treatise on midwifery; it is, in fact, a cyclo-
paedia of midwifery.   He has aimed to embody in a
single volume the whole science and art of Obstetrics.
An elaborate text is combined with accurate and va-
ried pictorial illustrations, so that no fact or principle
Is left unstated or unexplained.—Am. Med.  Times,
Sept. 3, 1864.
  We should like to analyze  the remainder of this
excellent work, but already has this review extended
beyond our limited space.  We cannot conclude this
notice without referring to the excellent finish of the
work.  In typography it is not to be excelled ; the
paper is superior to what is usually afforded by our
American cousins, quite equal to'the best of English
books.  The engravings  and  lithographs are most
beautifully executed.  The  work recommends itself
for its originality, and is in every way a  most vain-
able  addition to those on the subject of obstetrics.—
Canada Med. Journal, Oct. 1864.
  It is very large, profusely and elegantly illustrated,
and is fitted to take its place near the works of great
obstetricians. Of the American works on  the subject
it is decidedly the best.—Edinb. Med. Jour., Dec. '64.
  #*#  Specimens of the  plates and letter-press will be  forwarded to any address, free by mail,
en receipt of six cents in  postage stamps.

   BANNER (THOMAS i7.-), M. D.

   ON  THE  STGNS AND  DISEASES OF PREGNANCY.   First  American
      from the  Second and Enlarged English Edition.  With four colored plates and illustrations
  More time than we have had at our disposal since
we received the great work of Dr. Hodge is necessary
to do it justice.   It is undoubtedly by far tbe most
original, complete, and carefully composed treatise
on the principles and practice of Obstetrics which has
ever been issued  from the American press.—Pacific
Med. and Surg. Journal, July, 1864.

  We have read  Dr. Hodge's  book with great plea-
sure, and have much satisfaction in expressing our
commendation of it as a whole.  It is certainly highly
instructive, and in the main, we believe, correct.  The
great attention which the author has devoted to the
mechanism of parturition, taken along with the con-
clusions at which he has arrived, point, we think,
conclusively to the fact that, in Britain at least, the
doctrines of Naegele have been too blindly received.
—Glasgow Med. Journal, Oct. 1864.
T
     on wood.  In one handsome octavo volume of about 500 pages, extra cloth, $4 25.
The very thorough revision the work has undergone
has added greatly toils practical value, and increased
materially its efficiency as a guide to the student and
to  the young practitioner.—Am. Journ. Med. Sci.,
April, 1868.
  With the immense variety of subjects  treated of
and the ground which they are madeto cover, the im-
possibility of giving an extended review of this truly
remarkable work must be apparent.  We have not a
single fault to find with it, and  mo6t  heartily com-
mend it to the careful study of every physician who
would not only  always  be sure of his diagnosis of
pregnancy, but always ready to treat all  the nume-
rous ailments that are, unfortunately for the civilized
women of to-day, so commonly associated with the
function.—N.  Y. Med. Record, March 16 1868.
  We recommend obstetrical students, young and
old, to have this volume in their collections.  It con-
tains not onl J a fair statement of the signs, symptoms,
and disease* of pregnaucy, but comprises in addition
much interesting relative matter that is not to be
found in  anj  other work that we can name.—Edin-
burgh Med Journal, Jan. 1868.
 Q WAYNE  (JOSEPH GRIFFITHS), M.D.,
^--'     Physician-Accoucheur to the British General Hospital, Ac.

   OBSTETRIC APHORISMS FOR THE USE OF  STUDENTS COM
      MENCING MIDWIFERY PRACTICE.   Second American, from the Fifth and Revised
      London Edition,  with Additions by E. R.  Hutchins, M. D.  With Illustrations.  In one
      neat 12mo. volume.   Extra cloth, $1 25.  (Now  Ready.)
  *s* See p.  3  of this  Catalogue for  the terms  on which this work is  offered as a premium to
subscribers to the "American Journal op the Medical Sciences."
  It is really a capital little compendium of the sub-
ject, and we recommend young practitioners to buy it
and carry it with them when called to attend cases of
labor.  They can while away the otherwise tedious
hours of waiting, and thoroughly fix in their memo-
ries the most important practical suggestions it con-
tains.  The American editor has materially added by
his notes  and the,  concluding chapters to the com-
pleteness  and general value  of the book.—Chicago
Med. Journal, Feb. 1870.

  The manual before us containsin exceedingly small
compass—small enough to carry in the pocket—about
all there is of obstetrics, condensed into a nutshell of
Aphorisms.  The illustrations are well selected, and
serve as excellent reminders of the conduct of labor—
regular and difficult.—Cincinnati Lancet, Apftl, '70.
  ""'' '■'■» is a most.admira.ble little work, and completely
answers the purpose.  It Is not only valuable for
young beginners, but no one who is not a proficient
in the art of obstetrics should be without it, because
it condenses  all that is necessary to know for ordi-
nary midwifery practice.  We commend the  book
most favorably.—St. Louis Med. and Surg. Journal,
Sept. 10, 1870.

  A studied perusal of this little hook has satisfied
us of its eminently practical value.  The object of tbe
work, the author says, in his preface, is  to give the
student a few brief and practical directions respect-
ing the management of ordinary cases of labor ; and
also to poiut out to him in extraordinary cases when
and how he may act upon his own responsibility, and
when he ought to send for assistance.—N. Y. Medical
Journal, May, 1870.
1!
TINCKEL  (F.),
      Professor and Director of the Gynacological Clinic in the University of Rostock.

A COMPLETE  TREATISE ON THE PATHOLOGY AND TREAT-
  MENT OF CHILDBED, for Students and Practitioners.  Translated, with the consent of
  the author,  from the Second German Edition, by James Read Chadwick, M D.   In one
  octavo volume.   (Preparing.) 
Henry C. Lea's Publications—(Midwifery).              25
])£EIGS (CHARLES D.), M.D.,
         Lately Professor of Obstetrics, Ac, in the Jefferson Medical College, Philadelphia.
   OBSTETRICS:  THE  SCIENCE   AND THE  ART.   Fifth  edition,
      revised.  With one hundred and thirty illustrations.  In one beautifully printed octav*
      volume of 760 large pages.   Extra cloth, $5 50 ;  leather, $6 50.
J^EISHMAN (WILLIAM), M.D.,
        Rtgius Professor of Midwifery in the  University of Glasgow Ac

   A SYSTEM  OF  MIDWIFERY, INCLUDING THE  DISEASES  OF
      PREGNANCY AND THE PUERPERAL  STATE.  In one large and very handsome oc
      Read  ^^              PaS6S' WUh  °Ue hundred and e^y-two illustrations.   (Nea'rly
J^AMSBOTHAM (FRANCIS H.), M.D.

    THE PRINCIPLES AND  PRACTICE  OF  OBSTETRIC  MEDI-
      CINE AND SURGERY, in  reference to the Process of Parturition.  A new and enlarged
      edition,  thoroughly revised  by the author.  With additions by W. V.  Keating, M. D.,
      Professor of Obstetrics, Ac,  in the Jefferson Medical College, Philadelphia.  In one large
      and handsome imperial octavo volume of 650 pages, strongly bound in leather, with raised
      bands; with sixty-four beautiful plates, and numerous wood-cuts in the text, containing in
      all nearly 200 large and beautiful figures.  $7 00.
  We will only add that the student will learn from
It all he need to know, and  the practitioner will find
It, as a book of reference, surpassed by none other.—
Stethoscope.
  The  character  and merits of Dr. Ramsbotham's
work are so well  known and thoroughly established,
that comment is unnecessary and praise superfluous.
The illustrations, which are numerous and accurate,
are executed in the highest  style of art. We cannot
too highly recommend the work to our  readers.—St.
Louis Med. and  Surg. Journal.
  To the physician's library it is indispensable, while
to the student, as a text-book, from which to extract
the material for laying the foundation of an educatiou
on obstetrical science, it has no superior.—Ohio Med.
and Surg. Journal.
  When we  call to mind the  toil we underwent in
acquiring a knowledge of this subject, we cannot but
envy the student of the present day the aid which
this work will afford him..—Am. Jour, of the  Med.
Sciences.
 QHURCHILL (FLEETWOOD),  M.D.,  M.R.I.A.

   ON  THE THEORY AND  PRACTICE  OF  MIDWIFERY.   A new
      American from the fourth revised and enlarged London edition.  With notes and additions
    •  by D. Francis  Condie,  M. D., author of a "Practical Treatise on the Diseases of Chil-
      dren,'' &o.   With one hundred and ninety-four illustrations.  In one very handsome octavo
      volume of nearly 700 large pages.  Extra cloth, $4 00; leather, $5 00.
  In adapting this standard favorite to the wants of the profession in the United States, the editor
has endeavored  to insert everything that his experience has shown him would be desirable for the
American student, including a  large number of illustrations.  With  the  sanction of the author,
he has added, in the form of an  appendix, some chapters  from a little "Manual for Midwives and
Nurses," recently issued by Dr.  Churchill, believing that the details there presented can hardly
fail to prove of  advantage to the junior practitioner.   The result of all these additions is that the
work now contains fully one-half more matter than the  last American edition, with nearly one-
half more illustrations; so  that, notwithstanding the use of a smaller type, the volume  contains
almost two hundred pages more  than before.
  These additions render the work still  more com-
plete and acceptable than ever; and with the excel-
lent style in which the publishers have presented
this edition of Churchill, we can commend it to the
profession with great cordiality and pleasure.—Cin-
cinnati Lancet.
  Few works on this branch of medical  science are
equal to it, certainly none excel it, whether in regard
to theory or practice, and iu one respect it is superior
to all others, viz., in its statistical information, and
therefore, on these grounds a most valuable work for
the physician, student, or lecturer, all of  whom will
find in it the  information which they are seeking.—
Brit. Am. Journal.
  The  present treatise is very much enlarged and
amplified beyond the previous editions but nothing
has been added which could be well dispensed with.
An exaniination of the table of contents shows how
thoroughly the author has gone over the ground, and
the care be has taken in the text to present the sub-
jects in all their bearings, will render this new edition
even more necessary to the obstetric student than
were either of the former editions at the date of their
appearance.  No treatiseon obstetrics with which we
are acquainted can compare favorably with this, in
respect to the amount of material which has been
gathered from every source.—Boston Med. and Surg.
Journal.

  There is no better text-hook for students, or work
of reference and  study for the practising physician
than this. It should adorn and enrich every medica]
library.—Chicago Med. Journal.
M{
  ONTGOMERY (W.  F.), M.D.,
      Professor of Midwifery in the King's and Queen's College of Physicians in Ireland.

AN  EXPOSITION  OF  THE  SIGNS  AND SYMPTOMS OF  PREG-
   NANCY   With some other Papers on Subjects connected with Midwifery.  From the second
   and enlarged English edition.  With two exquisite colored plates, and numerous wood-cuts.
   In one very handsome octavo volume of nearly 600 pages, extra cloth..   $3 75.
RIGBT'S SYSTEM OF  MIDWIFBRY. With Notes
 and Additional Illustrations.  Second American
 edition. One volume ootavo, extra cloth, 422 pagee.
 $2 60.
DEWEES'S COMPREHENSIVE SYSTEM  OF MID-
  WIFERY. Twelfth edition, with the author's last
  improvements and corrections.  Iu one octavo vol-
  ume, extra cloth, of 600 pages. $8 6i\ 
26                Henry C. Lea's Publications—(Surgery).
   61 ROSS  (SAMUEL D.),  M.D.,
         Professor of Surgery in the Jefferson Medical College of Philadelphia.

   A  SYSTEM OF SURGERY:  Pathological,  Diagnostic, Therapeutic,
       and Operative.  Illustrated by upwards of Fourteen Hundred Engravings.   Fifth edition,
       carefully revised, and improved.  In two large and beautifully printed imperial octavo vol-
       umes ol about 2300 pages, strongly bound in leather, with raised bands, $15.  (Just Ready.)
  The continued favor, shown by t^ie exhaustion of successive  large editions of this great work,
proves that it has successfully supplied a want felt by American practitioners and students. In the
present revision no pains have been spared by the  author  to bring it in every respect fully  up to
the day.  To effect this a large part  of the work has  been  rewritten, and  the whole enlarged by
nearly one fourth, notwithstanding which  the  price has been  kept at its  former very moderate
rate.   By  the  use of a close, though very legible type, an, unusually large amount ol  matter is
condensed  in its  pages, the  two volumes containing  as much  as four or  five ordinary  octavos.
This, combined with the most careful mechanical execution, and its very durable binding, renders
it one of the cheapest works accessible to the profession.- Every subject properly belonging co the
domain of surgery is treated in  detail, so that the student who possesses this work may be said to
have in it a surgical library.
  It must long remain the most comprehensive work
 on this important part of medicine.—Boston Medical
 and Surgical Journal, March 23, 1865.

  We have compared it with most of our standard
 works, such as those of Erichseu, Miller, Feigusson,
 Syme, and  others, and we must, in justice  to our
 author, award it the pre-eminence.  As a work, com-
 plete in almost every detail, no matter how minute
 or trifling, and embracing every  subject  known in
 the principles and practice of surgery, we believe it
 stands without a rival. Dr Gross, in his preface, re-
 marks "my aim has  been  to embrace the whole do-
 main of surgery, and to allot to every subject its
 legitimate  claim to  notice;" and, we.assure our
 reader*, he  has kept his word.  It is a work  which
 we can most confidently recommend to our brethren,
 for its utility is becoming the more evident the longer
 it is upon the shelves of our library.—Canada Med.
 Journal, September, 1865.
  The first two editions of Professor Gross' System of
 Surgery are so well known to the profession,  and so
 highly prized, that it would be idle for us to speak in
 praise of this work.— Chicago   Medical Journal,
September, 1865.
  We gladly indorse the favorable recommendation
 of the work, both as regards matter and style, which
 we made when noticing its first appearance.—British
 and Foreign Medico-Chirurgical Review, Oct. 1865.
  The most complete work that has yet issued from
 the  press on the  science and practice of surgery.—
 London Lancet.
  This system of surgery is, we predict, destined to
 take a commanding position  in oui surgical  litera-
 ture, and be the crowning glory of the author's well
earned  fame.  As an authority on geueral surgical
subjects, this work is long to occupy a pre-eminent
place, not only at home, but abroad.  We have no
 hesitation In pronouncing it without a rival in our
 language, and equal to the best systems of surgeiy in
 any language.—N. Y. Med. Journal.
  Not only by far the best text-book on the subject,
 as a whole, within the reach of American students,
 but one which will be much more than ever likely
 to be  resorted to and regarded  as a high authority
 abroad.—Am. Journal Med. Sciences, Jan. 1865.
  The work contains everything, minor and major,
 operative and diagnostic, including mensuration and
 examination, venereal diseases, and uterine manipu-
 lations and operations.  It is a complete Thesaurus
 9f modern surgery, where the student and practi-
 tioner shall noi  seek in vain for wiiai they desire.—
 San Francisco Med. Press, Jan. 1865.  '
  Open it where  we may, we find sound practical in-
formation conveyed in plain language.   This book is
no mere provincial or even national system of sur-
gery, but a work which, while very largely indebted
to the  past, has a strong claim on tbe gratitude of ike
future of surgical science.—Edinburgh Med. Journal,
Jan. 1865.
  A glance at the work is  sufficient to show that the
author and publisher have spared no labor in making
it the most complete "System of Surgery'' ever pub*
lished in any country.—St. Louis Med. and Surg.
Journal, April, 1865.
  A system of surgery which we think unrivalled  in
our language, and which will indelibly associate bis
name with surgical science. And what, in our opin-
ion, enhances the value of the wora is that, while the
practising surgeon will find all that lie requires in it,
it is at the same time one of the  most valuable trea-
tises which can be put into the hands of the student
seeking to know  the principles  and practice of this
 oranch of  tbe profession which  he designs subse-
quently to follow.—Tlie Brit. Am. Journ., Montreal.
UY THE SAME AUTHOR.

  A  PRACTICAL  TREATISE  ON   FOREIGN   BODIES  IN  THE
      AIR-PASSAGES.   In 1 vol. 8vo. cloth, with illustrations^  pp. 468.   $2 75.
SKEY'S OPERATIVE SORGERY.   In 1 vol. 8vo.
  cloth, of over 650 pages ; with about 100 wood-cats.
  *M 25
COOPER'S LECTURES ON THE PRINCIPLES AND
  Practice of Sckoery In lvol. 8vo. cloth, 750 p 42.
 UiiJSON'b  INSTITUTES AND PRACTICE OF SUR-
  uery. Eighth edition, improved qnd altered.  With
  thirty-four plates.  In two handsome octavo v»l-
I  nines, abouilOOUpp..leather,raised bands. 4)6 50.
 MILLER  (JAMES),
■*•£*•     Late Professor of Surgery in the University of Edinburgh, Ac.

   PRINCIPLES OF  SURGERY.   Fourth American, from the third and
      revised Edinburgh edition.   In one large and very beautiful volume  of 700 pages, with
      two hundred and forty illustrations on wood, extra cloth.
DY THE SAME AUTHOR.
$3 75.
THE  PRACTICE  OF  SURGERY.   Fourth American, from the last
   Edinburgh edition.  Revised by the American editor.   Illustrated by three hundred and
   sixty-four engravings  on wood.  In one large octavo  volume of nearly 700 paces  extra
   cloth.   $3 75.
UARGENT (F.  W.), M.D.
ON BANDAGING AND OTHER OPERATIONS  OF MINOR  SUR-
    GERY.  New edition, with an additional chapter on Military Surgery.  Une nanasome royal
    I2mo. volume, ol nearly 400 pages, with lcs4 wood-cuts.   Extra cloth, ((1 76. 
Henry C. Lea's Publications—(Surgery).
27
J^SHHURST  (JOHN, Jr.), M.D.,
         Surgeon to the Episcopal Hsopital, Philadelphia.

    THE  PRINCIPLES  AND   PRACTICE  OF  SURGERY.   In  one
      very large and handsome octavo volume of about 1000 pages, with nearly 560 illustrations,
      extra cloth,  $6 50; leather, raised bands, $7 50.   (Just Issued.)
  The object  of the author has  been to  present, within as condensed a compass as possible, a
complete treatise on Surgery in all its branches, suitable both as a text-book for the student and
a work of reference for the practitioner.  So much has of late years been done for the advance-
ment of Surgical Art and Science, that there seemed to be a want of a work which should present
the latest aspects of every subject, and which, by its American character, should render accc.-si'ule
to the profession at large the experience of the practitioners of both hemispheres.  This has been
the aim of the author,  and it is hoped that the volume will be found to fulfil its purpose satisfac-
torily.   The plan and general outline of the work will be seen by the annexed

                        CONDENSED SUMMARY OF CONTENTS.
  Chapter I. Inflammation.   II.  Treatment of Inflammation.   III. Operations in general:
Anaesthetics.   IV. Minor Surgery.   V.  Amputations. . VI. Special Amputations.   VII. Effects
of Injuries in  General  : Wounds.  VIII.  Gunshot Wounds.   IX. Injuries of  Bloodvessels.   X.
Injuries of Nerves, Muscles and Tendons, Lymphatics, Bursae, Bones, and Joints.  XI. Fractures.
XII. Special  Fractures.  XIII. Dislocations.  XIV. Effects of Heat and Cold.  XV. Injuries
of the  Head.  XVI. Injuries  of the Back.   XVII. Injuries  of the Face  and Neck.  XVIII.
Injuries of the Chest.   XIX.  Injuries of the Abdomen and Pelvis.   XX. Diseases resulting from
Inflammation.  XXI.  Erysipelas.   XXII. Pyaemia   XXIII.  Diathetic Diseases :  Struma  (in-
cluding Tubercle and Scrofula); Rickets.  XXIV. Venereal Diseases ; Gonorrhoea and Chancroid.
XXV. Venereal Diseases continued  : Syphilis.  XXVI. Tumors.  XXVII.  Surgical Diseases of
Skin, Areolar Tissue,  Lymphatics,  Muscles,  Tendons, and Bursae.  XXVIII.  Surgical Disease
of Nervous System (including Tetanus).   XXIX. Surgical Diseases of Vascular System (includ-
ing Aneurism).   XXX.  Diseases of Bone.  XXXI.  Diseases  of  Joints.   XXXII.  Excisions.
XXXIII.  Orthopaedic Surgery.   XXXIV. Diseases ef Head and Spine.  XXXV. Diseases of the
Eye.  XXXVI.  Diseases of the Ear.  XXXVII. Diseases of the Face and Neck.   XXXVIII.
Diseases of the Mouth,  Jaws, and Throat.  XXXIX. Diseases of the Breast.  XL. Hernia.  XLI.
Special Herniae.    XLII. Diseases of Intestinal Canal.   XLIII. Diseases of Abdominal Organs,
and various operations on the Abdomen.   XLIV. Urinary Calculus.  LXV. Diseases of Bladder
and Prostate.   XLVI. Diseases of  Urethra.   XLVII. Diseases of Generative Organs.  iNpEX.
                                               Indeed, the work as a whole must be regarded as
                                              an  excellent and concise expouent of modern sur-
                                              gery, and as such it will be found a valuable text-
                                              book for the student, and a useful book of inference
                                              for the general practitioner.—N. Y. Med. Journal,
                                              Feb. 1S72.
                                               It gives us great pleasure to call the attention of the
                                              profession to this exirllent work.  Our knowledge of
                                              its talented and accomplished author led us to  expect
                                              from him a very valuable treatise upon subjects to
                                              which he has repeatedly giveu evideuce of having pro-
                                              fitably devoted much timn aud labor, aud we are in uo
                                              way disappointed.— Phila. Med. Times, Veto. 1, ln72.
  Its author has evidently tested the writings and
experiences of the past and present in the crucible
of a careful, analytic, aud honorable mind, aud faith-
fully endeavored to bring his work up to the level of
the highest standard of practical surgery   He is
frank and definite, and gives us opinions, and gene-
rally sound ones, instead  of a mere rwumf of the
opinions of others  He is conservative, but not hide-
bound by authority.   His style is clear, elegant, and
scholarly.  The wc rk is an admirable text book, and
a useful book of reference   It is a credit to Auieiicau
professional literature, and one of the first ripe fruits
of the soil fertilized by the blood of our late unhappy
war.—N. Y. Med. Record, Feb. 1, 1872.
 OIRRIE ( WILLIAM), F. R. S. E.,
J-       Professor of Surgery in the University of Aberdeen.
  THE  PRINCIPLES  AND PRACTICE  OF  SURGERY.   Edited by
      John Neill, M. D., Professor of Surgery in the Penna. Medical College, Surgeon to the
      Pennsylvania Hospital, Ac.  In one very handsome octavo volume of 780 pages, with 316
      illustrations, extra cloth.  $3 75._________________

JJAMILTON (FRANK H), M.D.,
"^     Professor of Fractures and Dislocations, Ac, in BelUvue Hosp. Med. College, New York.
  A  PRACTICAL TREATISE  ON  FRACTURES  AND  DISLOCA-
      TIONS   Fourth edition, thoroughly revised.  In one  large and handsome octavo volume
      of neariy 800 pages, with several hundred illustrations.  Extra cloth, $5 75; leather, $6 75.
      (Just Issued.)
  It is  not of course, our intention to review in ex-




               better than either ot its preaecee-
just out, and it is  better wan euue. ».
sors.—Cincinnati Clinic, Oct. 14, lb/i.
  Undoubtedly the best work on Fracture* and Viz-
locations in the English langiwge.-tinetiMiott Mea.
Repertory, Oct. 1871.
  We have once more before us Dr. Hamilton's admi-
rable treatise, which we have always considered the
most complete and reliable work on the subject.  As
a whole, the work is without an equal in the litera-
ture of  the profession.—Boston Med. and Surg.
Journ., Oct. 12, 1S71.
  It is unnecessary at this time to commend the hook,
except to such  as are beginners in the study of this
particular branch of surgery.  Every practical sur-
geon in this country and abroad knows of it as a most
trustworthy guide, and one which they, in  common
with us,  would unqualifiedly recommeud as the high-
est authority in auy language.—N. Y. Med. Record,
Oct. 16, 1871.
 MORLAND  (W. W.),  M.D.
IU. T)jsEASES OF  THE URINARY ORGANS; a Compendium of their
      Diaenosis Pathology and Treatment.   With illustrations   In one large and handsome
      octavo volume of »'  '-^«o-cM. extra cloth.  $3 50. 
28                Henry C.  Lea's Publications—(Surgery).
 PRICHSEN  (JOHN E.),
-*-*      Professor of Surgery in University College, London, etc.
   THE SCIENCE  AND ART OF SURGERY; being a Treatise on  Sur-
      gical  Injuries,  Diseases, and Operations.   Revised by the author from the Sixth and
      enlarged English Edition.  Illustrated by over seven hundred engravings on wood.  In
      two large and beautiful octavo volumes of over 1700 pages, extra cloth, $9 00 ; leather,
      $11 00.  (Just Ready.)

                      Author's Preface to the New American Edition.
  " The favorable reception with which the ' Science and Art of Surgery' has been honored by the
Surgical Profession in the United States of America has been  not only a source of deep gratifica-
tion and of just pride to  me, but has laid the foundation of many professional friendships that
are amongst the agreeable and valuer] recollections  of my life.
  "I have endeavored to make the present edition ofthis work more deserving than its predecessors
of the favor that has been accorded to them.  In consequence of delays  that have unavoidably
occurred in the publication of the Sixth British Edition, time has been afforded to me to add to this
one several paragraphs which I trust will be found to increase the practicaHvalue of the work."
   London, Oct. Ib72.
  On no former edition of this work has the author bestowed more pains to render it a complete and
satisfactory  exposition of British Surgery in its modern aspects.   Every portion has been  sedu-
lously revised, and a large number of new illustrations have been introduced.   In addition to the
material thus added to the English edition, the author has furnished for the American edition such
material as has accumulated since the passage of the sheets through the press in London, so that
the work as  now presented to the American profession,  contains his latest views and experience.
  The increase in the size of the work has seemed to render necessary its division into two vol-
umes.   Great care  has been exercised in its typographical execution, and it is confidently pre-
sented as in every respect worthy to maintain the high reputation which has rendered it a stand-
ard authority on this department of medical science.
  These are only a few of the  points in which the  states in his preface, they are not confined to any one
present edition of Mr. Erichsen's work surpasses its ; portion, but are distributed generally through the
predecessors.   Throughout there is evidence  of a  subjects of which the work treats.  Certainly  one of
laborious care aud solicitude in seizing the passing'  the most valuable sections of the book seems to us to
knowledge of the day,  which  reflects the greatest I be that which treats of the diseases of the arteries
credit on  the author, and much enhances the value ' and the operative proceedings which they necessitate.
of hiswork.   Wecanonly admirethe industry which i In few text-books is so much carefully arranged in-
has enabled Mr. Erichsen thus  to succeed, amid the | formation collected.—London Med. Times and Gaz.,
distractions of active practice, in produciug emphatic
ally the bjok of reference and study for British prac-
titioners of surgery.—London Lancet, Oct. 26, 1872.
  Considerable changes have been made in this edi-
tion, and  nearly a hundred  new illustrations have
been added.  Itis difficult in a small compass to point ' practitioner.—Dublin Quarterly Journal.
eut the alterations and additions; for, as the author
Oct. 26, 1872.
  The entire work, complete, as the great English
treatise on Surgery of our own time, is, we can assure
our readers, equally well adapted for the most junior
student, and, as a book of reference, for the advanced
D
Df THE SAME AUTHOR.  (JustIssued.)

  ON  RAILWAY,  AND  OTHER  INJURIES  OF  THE  NERYOUS
      SYSTEM.  In a small octavo volume.  Extra cloth, $1  00.

   R UITT (ROBERT),  M. R. C.S., £c.

   THE PRINCIPLES  AND  PRACTICE  OF MODERN  SURGERY.
      A new and revised  American, from the eighth enlarged and improved London edition  Illus-
      trated with four hundred and thirty-two wood engravings.  In  one very handsome octave
      volume, of nearly  700 large and closely printed pages. Extra cloth, $4 00;  leather, $5 00.
                                             perspicuously," as to elucidate every important topic.
                                             The fact that twelve editions have already been called
                                             for, in these days of active competition, would  of
                                             itself show it to possess marked  superiority.  We
                                             have examined  the hook most thoroughly, and can
                                             say that this success is well merited.   His book,
                                             moreover,  possesses the inestimable advantages  of
                                             having the subjects perfectly well arranged and clas-
                                             sified, and of being written in a style at once clear
                                             and succinct.—Am. Journal of Med. Sciences.
  All that the surgical student or practitioner could
desire.—Dublin Quarterly Journal.

  It is a most admirable book. We do not know
.when we have examined one with more pleasure.—
Boston Med. and Surg. Journal. ■

  In Mr. Druitt's book, though containing only some
seven hundred pages, both the principles and the
practice of surgery are  treated, and so clearly and

A^SHTON (T. J.).

 ON  THE  DISEASES, INJURIES,  AND  MALFORMATIONS  OF
     THE RECTUM AND ANUS; with remarks on Habitual Constipation.  Second American
     from the fourth and enlarged London edition.  With handsome illustrations.   In one very
     beautifully printed octavo volume of about 300 pages.  $3 25.
JflGELO W (HENR Y J.), M. D
      Professor of Surgery in the Massachusetts Med. College

ON  THE  MECHANISM  OF  DISLOCATION  AND  FRACTTTRTT
   OF THE  HIP.  With the Reduction of the Dislocation by the Flexion Method   With
   numerous original illustrations.   In one very handsome octavo volume.  Cloth  ' *2sn
   (Lately Issued.)                                                            '  ** *"'■ 
Henry C. Lea's Publications—(Suraerv).               29
JJRVANT (THOMAS), F.R.C.S.,
"*-"      Surgeon t<> Guys Hospital.

    THE  PRACTICE   OF  SURGERY.   With  over Five Hundred En-
      gravings on Wood.  In one large and very handsome octavo volume of nearly 1000 pages.
      extra cloth, $6 25 j leather, raised bands, $7 25.  (Just Ready.)
  The distinguished reputation of the author and the extended experience which he has enjoyed as
Burgeon to one of the largest of  the London hospitals, are an earnest of the value of his labors.
Though entitled a " Practice of Surgery," it will be seen by the subjoined summary of the contents
that it is by no means  confined  to operative surgery, but that it  presents  also a view of the prin-
ciples which should guide the  surgeon in his daily practice.  Nearly all of the very full series of
illustrations have  been prepared expressly for the work.

                        s.Tj'&a.-ss/i.AjEinz- or1  contents.
  Introduction.—r. On  Repair and Inflammation,  n.  On  Traumatic Fever. Septicaemia, and Py-
aemia,   in. On Trismus and Tetanus,  iv. Delirium Tremens, v. Contusions : Wounds of the Scalp,
Blood Tumors, Osteitis.   VI. Injuries of the Cranium,  vii. Concussion of the Brain,   vm. Injuries
of the Brain and  its Membranes,  complicating Fracture,  ix.  Compression of the Brain,  x. Re-
sults of Injuries to the Head.  xi. On Fractures of the  Skull,   xu. The Operation of Trephining.
xin. Diseases  of  the  Scalp and Cranium,  xiv. Spina Bifida,  xv.  Injuries of the Spine,  xvi.
Intra-Spinal Inflammation, Spinal Paralysis, Railway Concussion,   xvu.  Fractures, Dislocations,
and Wounds of the Spine, xviu. Curvature of the Spine,  xix. Injuries and Diseases of the Nerves.
xx. Surgical Affections of the Nose.  xxi. Surgical Affections of Larynx and Trachea,  xxti. Sur-
gery of the Chest,  xxm. Wounds of the Heart,  xxiv. Diseases  of the  Arteries,  xxv. Aneurism.
xxvi. Ligature of Arteries,  xxvn.  Injuries and Diseases of the Veins,  xxvm. Affections of  the
Lips, etc. xxix. Diseases of the  Jaws,  etc.   xxx. Affections  of  the  Pharynx,  xxxi. Injuries of
the Abdomen,   xxxn.  Hernia,  xxxm.  Varieties of Herniae.  xxxiv. Trusses,  xxxv. Surgery of
the Anus,  xxxvi.  Diseases of the Integuments : Wounds,  xxxvu. Poisoned Wounds,  xxxvm.
Burns,  xxxix. Skin Grafting,   xl. Boils, etc.  xli. Gangrene,  etc.  xlii. Ulcers,  xliii. Mor-
tification,   xliv.  Erysipelas,  xlv.  Diseases of the Lymphatics.   Xlvi. Diseases of the Kidney.
xlvii.  Diseases of the Bladder,  xlviii. Diseases of the  Prostate,   xlix. Urinary Deposits,  l.
Stone in the Bladder,  li. Lithotrity.  lii. Lithotomy,  liii. Stone in the Female Bladder, liv.
Stricture of the Urethra,   lv. Retention of Urine,  lvi. Affections of the Penis,  lvii. Haemato-
cele, etc.  lviii.  Diseases of the  Testicle.    lix. Sterility,  lx. Affections of the  Female  Geni-
tals,   lxi. Ovariotomy,   lxh. Venereal Disease,  lxiii. Syphilis,  lxiv. Tumors,  lxv. Anatomy
of Tumors,  lxvi. Tumors of the Breast, lxvii. Di-eases of the Thyroid Gland,  lxviii. Wounds
of the Joints,   lxix.  Dislocations,  lxx. Dislocations  of the Upper Extremity,   lxxi.  Disloca-
tions of the  Lower Extremity,   lxxii.  Pathology of Joint Diseases,  lxxiii.  Diseases of Special
Joints,  lxxiv. Treatment of Joint Disease,  i.xxv. Excision and Amputation in  Joint Disease.
lxxvi. Osteo-arthritis.  lxxvii. Diseases of the Bones,   lxx vm. Tumors of Bone,  lxxix.  Frac-
tures.   Lxxx.  Fractures of the  Upper Extremity.  lxxxi.  Fractures of the Lower Extremity.
lxxxii. Complicated Fractures,  lxxxiii. Gunshot Injuries, lxxxiv. Feigned and Hysterical Dis-
ease,  lxxxv. Affections of the  Muscles and Tendons,  lxxxvi. Ganglions,  lxxxvii. Orthopaedic
Surgery,  lxxxviii. Anaesthetics,  lxxxix.  Shock,   xc.  Amputation,  xci. Special Amputations.
xcn. Elephantiasis,  xcni. Affections of the External Ear. xciv. Parasites.
TXTELLS (J. SOELBERG),
''     Professor of Ophthalmology in King's College Hospital, Ac.
  A TREATISE  ON  DISEASES  OF THE  EYE.   Second  American,
     from the Third and  Revised London  Edition, with additions; illustrated with numerous
     engravings on wood, and six colored plates   Together with selections from the Test-types
     of Jaeger and  Snellen.   In one large and very handsome octavo volume of nearly 800
     pages.  (Nearly Heady.)
  In this respect the work before us is of much more
service to the general practitioner than those heavy
compilations which, in giving every person's views,
too often neglect to specify those which are most in
     lance with the author's opinions, or in geueral
accord—
acceptance.  We have no hesitation iu recommending
this treatise, as, on the whole, of all English works
on the subject, the one  best adapted to the wants of
the general pmclilioiier.- Ediiiburgh Med. Journal,
March,  1870.
  A treatise of rare merit.  It is practical, compre- .
hensive and yet concise Upon those subjects usually  the subject of which it treats, and is a necessary work
found difficult to the student, he has dwelt at  length  for every physician who attempts to treat diseases of
and entered into full explanation.  After a careful  the eye—Dominion Med. Journal, Sept. 1869.
perusal of its contents, we can unhesitatingly com-1
mend it to all who desire to consult a really good
work on ophthalmic science.  The American edition
of Mr.Wells' treatise was superintended in its passage
through the press  by Or. I.  Minis Hays,  who has
added some notes of his own where it seemed desira-
ble.  He has also introduced more than one hundred
nt'w additional wood-cuts, and added selections from
the test-types of Jaeger and of Snellen.—Leavenworth
Med. Herald, Jan. lhTU.
  Without doubt, one of the best works upon the sub-
ject which has ever been published ; it is complete on
 T A WSON (GEORGE), F.  R. C. S., Engl,
 / J     Assistant Surgeon to the Royal London Ophthalmic Hospital, Moorflelds, Ac.
   INJURIES OF  THE  EYE,  ORBIT, AND  EYELIDS:  their Imme-
     diate and Remote Effects.  With about one hundred illustrations.   In one very hand-
     some octavo volume, extra cloth, $3  50.
  It is an admirable practical book In the highest and beet sense of the phrase.—London Medical Timet
and Gazette, May 18, 1867. 
30
Henry C. Lea's Publications—(Surgery, 6c).
 J A URENCE (JOHN Z.), F. R. C. S.,
        Editor of the Ophthalmic Review, Ac
   A HAXDY-BOOK OF  OPHTHALMIC  SURGERY,  for  the  use  of
      Practitioners.   Second Edition, revised and enlarged.  With numerous illustrations.  In
      one very handsome octavo volume, extra cloth, $3 00.   (Lately Issued.)
  For those, however, who must assume the care of  tion of the optical defects of the eye, the publisher
diseases and injuries of the eye,  and  who are  too
much pressed for time to study the classic works on
the subject, or those recently published by Stellwag.
Wells, Bader, and others, Mr. Laurence will prove a"
Bate and trustworthy guide. He has described in this
edition those novelties which have secured the confi-
dence of the profession *iuce the appearance of his
last  To the portion of the book devoted to a descrip-
has given increased value by the addition of several
pages of Snellen's tes-t-types, so generally used to i est
the acuteness of vision, and which are difficult to ob-
tain in this country.  The volume has been conside-
rably enlarged and improved by the revision aud ad-
ditions  of its author, expressly for  the American
edition —Am. Journ. Med. Sciences, Jan. 1870.
TUALES (PHILIP S.), M. D., Surgeon U. S. N.

  MECHANICAL  THERAPEUTICS: a  Practical Treatise on Surgical
     Apparatus, Appliances, and  Elementary Operations: embracing  Minor Surgery, Band-
     aging, Orthopraxy, and the Treatment of Fractures and Dislocations.  With six hundred
     and forty-two illustrations on wood.   In one large and handsome octavo volume of about
     700 pages: extra cloth, $5 75; leather, $6 75.
 /THOMPSON(SIR HENRY),
 -*      Surgeon and Professor of Clinical Surgery to University College Hospital.
    LECTURES  ON  DISEASES  OF THE URINARY ORGANS.  With
      illustrations on  wood.   In one neat octavo volume, extra cloth.  $2 25.
  These lectures stand the severe test.  They are in- I Meal hints so useful for the student, and even more
structive without being tedious, and simple without  valuable to the young practitioner.—Edinburgh Mtd.
being diffuse; and they include many of those prac- | Journal, April, 1869.

 D7 THE SAME AUTHOR.

   ON  THE  PATHOLOGY AND TREATMENT  OF  STRICTURE OP
      THE  URETHBA  AND URINARY FISTULA.  With plates and wood-cuts.  From the
      third and revised English edition.  In one very handsome octavo volume, extra cloth, $3 50.
      (Lately Publislied.)                                        ,
  This classical work has so long been recognized as a standard authority on Us perplexing sub-
jects  that it should be rendered accessible  to  the American  profession.   Having enjoyed the
advantage of a revision at the hands of the author within a  few months, it will be found to present
his latest views and to be on a level with the most recent advances of surgical science.
  With a work accepted as the authority upon the I ably known by the profession as this before us, must
subjects of which it treats, an extended notice would | create a  demand for it from those who would keep
be a work of supererogation.  The simple announce- I themselves well up iu this department of surgery.—
ment of another edition of a work so well and favor- | St. Louis Med. Archives, Feb. 1870.
JJY THE SAME AUTHOR.  (Just Ready.)

    THE  DISEASES  OF  THE  PROSTATE, THEIR  PATHOLOGY
      AND TREATMENT.  Fourth Edition, Revised.   In one very handsome octavo volume of
      355 pages, with thirteen piates, plain and colored, and illustrations on wood.  Cloth, $3 75.
  This work is recognized in England as the leading authority on its subject, and in presenting
it to the American profession, it is hoped that it will be found a  trustworthy and  satisfactory
guide in the treatment of an obscure and important class of affections.
 /TAYLOR  (ALFRED S.), M.D.,
 ■*      Lecturer on Med. Jurisp. and Chemistry in Guy's Hospital.

   MEDICAL JURISPRUDENCE.  Seventh American Edition.   Edited
      by John J. Reese,  M.D., Prcf. of Med. Jurisp.  in the Univ.  of Penn.   In one large
      octavo volume.  Cloth, $5  00;  leather, $6 00.  (Just Ready.)
  The present edition of this valuable manual is a
great improvement on those which have preceded it.
It makes thus by far the best guide-book in this de-
partment of medicine for students and the general
practitioner in ourlaaguage.—Boston Med. and Surg.
Journal, Dec. 27, 1866.
■£> Y THE SA ME A UTHOR.  (Nearly Ready.)

   THE PRINCIPLES AND  PRACTICE OF  MEDICAL JURISPRU-
      DENCE.  Second Edition, Revised,  with  numerous Illustrations.  In  two very large
      octavo volumes.                                                                  °
  This great work is now recognized in England as the fullest and most authoritative treatise on
every department of its important subject.  In laying it, in its improved form, before the Ameri-
can profession, the publisher trusts that it will assume the ume position in this country. 
Henry C. Lea's Publications—(Psychological Medicine, &c).    31
rfUKE  (DANIEL  HACK), M.D.,
"*-      Joint author of " The Manual of Psychological Medicine" Ac.       '

   ILLUSTRATIONS  OF  THE INFLUENCE OF  THE MIND UPON
      THE BODY IN  HEALTH AND  DISEASE.  Designed  to illustrate the  Action of t e
       Imagination.  In one handsome octavo volume of 416 pages, extra  cloth,  $3  25.  (Now
      Ready.)

  The object of the author in this work has been to show not only the effect of the mind in caus-
ing and intensifying disease, but'also  its curative influence, and the use which may be made of
the imagination and the emotions as therapeutic agents.   Scattered facts bearing upon this sub-
ject have long been familiar to the profession, but no attempt has hitherto been made to collect
and systematize them so as to render them available to ths practitioner, by establishing the seve-
ral  phenomena  upon a scientific basis.  In the endeavor thus to  convert to the use of legitimate
medicine the means which have been employed so successfully in many systems of quackery, the
author has produced a work of the highest freshness and interest as well as of permanent value.

 DLANDFORD (G. FIELDING), M. D., F. R. C  P.,
J~*     Lecturer on Psychological Medicine at the School of St. George's Hospital, Ac.

   INSANITY AND ITS  TREATMENT:  Lectures on the  Treatment,
       Medical  and  Legal, of Insane  Patients.   With a  Summary of the Laws in force in the
       United States  on the Confinement of the Insane.   By Isaac Ray, M. D.  In one very
       handsome  octavo volume of 471 pages: extra cloth, $3 25.  (Just Issued.)
  This volume  is presented to meet the want, so frequently expressed, of a comprehensive trea-
tise, in moderate compass, on the pathology, diagnosis, and treatment  of insanity.  To render it of
more value to the practitioner in this country,  Dr.  Ray has added an appendix which affords  in-
formation, not  elsewhere to be found in so accessible a form, to physicians who may at any moment
be  called upon  to take action in relation to patients.
  It satisfies a want which must have been sorely
felt by the busy general practitioners of this country.
It takes the form of a manual of cliuical description
of the various forms of insanity, with a description
of the mode of examining persons suspected of in-
sanity.  We call particular attention to this feature
of the hook, as giving it a unique value  to the gene-
ral practitioner.  If we pass from theoretical conside-
rations to descriptions of the varieties of insanity as
actually seen in practice and the appropriate treat-
ment for them, we find in Dr. BlandfordV work  a
considerable advance  over previous writiugs on the
subject. His pictures of tbe various forms of mental
disease are so clear and good that no reader cau fail
to be struck with their superiority to those given in
ordinary manuals in the English language or (so far
as our own reading extends) in any other.—London
Practitioner, Feb. 1871.
w
    INSLOW (FORBES),  M.D., D.C.L.,ifc.

    ON OBSCURE  DISEASES  OF  THE BRAIN AND DISORDERS
     OF THE  MIND;  their incipient Symptoms, Pathology, Diagnosis, Treatment, and  Pro-
     phylaxis.  Second American, from the third and revised English edition.  In one handsome
     octavo volume of nearly 600 pages, extra cloth.  $4 25.

J EA  (HENRY  C).
   SUPERSTITION   AND  FORCE:   ESSAYS  ON  THE  WAGER  OF
     LAW, THE WAGER OF BATTLE, THE ORDEAL, AND TORTURE.   Second Edition,
     Enlarged.  In one handsome volume royal l2mo. of nearly 500 pages; extra cloth, $2 75.
      (Lately Published.)
  We know of no single work which contains, in so
■mall a compass, so much illustrativeof thestraugest
operations of the human mind.  Foot-notes give the
authority for each staieinemt, showing vast research
and wonderful industry.  We advise our  confreres
to read this book aud ponder its teachings.— Chicago
Med. Journal, Aug. 1870.
  As a work of curious inquiry on certain outlying
points of obsolete law, "Superstitiou aud Force"  is
one of the most remarkable books we have met with.
—London Athenaum, Nov. 3, 1866.
  He has thrown a great deal of light upon what must
be regarded  as one of the most instructive as well as
interesting phases of human society and progress.  . .
The fulness and breadth with which  he has carried
out his comparative survey of this repulsive held of
history [Torture], are such as to preclude our doiug
justice to the work within our present limits.  But
here, as throughout tbe volume, there will be found
a wealth  of illustration aud a critical grasp of the
philosophical import of facts which will  render Mr.
Lea's  labors of sterling value to  the historical stu-
dent.—London Saturday Review, Oct. 8,  1S70.

  As a hook of ready reference on  the subject, it is of
the highest value.— Westminster Review,  Oct. 1867.
 OF THE SAME AUTHOR.  (Late y Published.)
*  STUDIES  IN  CHURCH  HISTORY—THE  RISE  OF  THE  TEM-
      PORAL POWER—BENEFIT OF CLERUY—EXCOMMUNICATION.  In one large royal
      12mo. volume of 516 pp. extra cloth.   $2 75.
  Th« Rtorv was never told more  calmly or with  literary phenomenon that the head of one of the first
  »JTror inarniuc or wiser thought. We doubt, indeed,  American houses is also the writer of some of itsmost
greater learning or wiser
if auy other study of this field can be compared with
this tor clearness, accuracy, and power. — Chicago
Examiner, Dec. 1870.
  Mr Lea'slatestwork, "StudiesinChurch History,"
fully sustaius the promise of the first. It deals with
three  subjects—the  Temporal Power,  Benefit  of
Clergy, and Excommunication, the record of which
has a peculiar importance for the English student, aud
Is a chapter on Ancient Law likely to be regarded as
final.  We can hardly pass from our weutiou of such
works as these—with which  that on "SacPidotal j
Celibacy" should be iucluued—without  uouug  llie |
original books.—London Athenaum, Jan. 7, 1871.
  Mr. Lea has done great honor to himself and  this
country by the admirable works he has written on
ecclesiologicaland cognate subjects. We have already
had occasion to commend his "Superstition  aud
Force"  and his "History of tjacerdotal Celibacy."
The preseut volume is fully as admirable  iu its  me-
thod of dealing with topics and in the thoroughness—
a quality so frequently lacking in American author*—
with which they are investigated.—N. Y. Journal of
Psychol Medicine, July,  1870. 
32                         Henry  C. Lea's Publications.
INDEX  TO  CATALOGUE,
                                           page
 American Journal of the Medical Sciences     .   1
 American Chemist (The).....11
 Abstract, Half-Yearly, of the Med. Sciences    .   3
 Anatomical Atlas, by Smith and Horner   .    .   6
 Anderson on Diseases of the Skin     .    .    .20
 Ashton on the Rectum and Anus .    .    .    .28
 Attfield's Chemistry......10
 Ashwell on Diseases of Females .    .    .    .23
 Ashhurst's Surgery    ....'.  27
 Barnes on  Diseases of Women    ....  2:3
 Bryant'6 Practical Surgery.....29
 Bloxam's Chemistry   •                    .10
 Blandford on Insanity......31
 Basham on Renal Diseases.....18
 Brinton on the Stomach.....15
 Bigelow on the Hip    ....        .28
 Barlow's Practice of Medicine    .        .    .  15
 Bowman's (John E.) Practical Chemistry  .    .  11
 Bowman's (John E.) Medical Chemistry   .    #  II
 Buckler on Bronchitis......  17
 Bumstead on Venereal.....p  19
 Bumstead and Cullerier's Atlas of Venereal      19
 Carpenter's Human Physiology   .
 Carpenter's Comparative Physiology  .
 Carpenter on the Use and Abuse of Alcohol
 Carson's Synopsis of Materia Medica  .
 Chambers on the Indigestions
 Chambers's Restorative Medicine
 Christison and Griffith's Dispensatory
 Churchill's System of Midwifery .
 Churchill on  Puerperal Fever
 Condie on Diseases of Children   .
 Cooper's (B. B ) Lectures on Surgery  .
 Cullerier's Atlas of Venereal Diseases
 Cyclopedia of Practical Medicine .
 Dalton's Human Physiology .
 De Jongh on Cod-Liver Oil   .
 Dewees's System of Midwifery
 Dewees on Diseases of Females
 Dewees on Diseases of Children  .   .
 Druitt'a Modern  Surgery
 Dunglison's Medical Dictionary  .
 Dunglison's Human Physiology  .
 Dunglison on New Remedies
 Ellis's Medical Formulary, by Smith .
 Erichsen's System of Surgery
 Erichsen on Nervous Injuries
 Fenwick's Diagnosis    ....
 Flint on Respiratory Organs .
 Flint on the Heart.....
 Flint's Practice of Medicine  .
 E ownes's Elementary Chemistry .
 Fox on Diseases of the Stomach  .
 Fuller on the Lungs, &c.
 Green's Pathology and Morbid Anatomy
 Gibson's Surgery.....
 G luge's Pathological Histology, by Leidy
 Galloway's Qualitative Analysis .
 Gray's Anatomy.....
 Griffith's (R. E.) Universal Formulary
 Gross on Foreign Bodies in Air-Passages
 Gross's Principles and Practice of Surgery
 Gross's Pathological Anatomy
 Guersant on Surgical Diseases of Children
 Hartshorne's Essentials of Medicine  .
 Hartshorne's Conspectus of the Medical Sciences
 Hamilton on Dislocations and Fractures
 Heath's Practical Anatomy  .
 Hoblyn's Medical Dictionary
 Hodge on Women.....
 Hodge's Obstetrics.....
 Hodges' Practical Dissections
 Holland's Medical Notes and Reflections
 Horner's Anatomy and Histology
 Hudson on Fevers     ....
 Hill on Venereal  Diseases
 Hillier's Handbook of Skin Diseases
 Jhnes and Sieveking's Pathological Anatomy
 Jones (C. Handfield) on Nervous Disorders
 Kirkes' Physiology.....
Knapp's Chemical Technology
Lea's Superstition and Force
ery
vols
 Lea's Studies in Church History
 Leishman's Midwifery
 La Roche on Yellow Fever  .
 La Roche on Prfenmonia, &c.
 Laurence and Moon's Ophthalmic Surg
 Lawson on the Eye
 Laycock on Medical Observation .
 Lehmann's Physiological Chemistry, 2
 Lehmann's Chemical Physiology .
 Ludlow's Manual of  Examinations
 Lyons on Fever    ....
 Maclise's Surgical Anatomy .
 Marshall's Physiology .
 Medical News and Library  .
 Meigs's Obstetrics, the Science and the Art
 Meigs's Lectures on Diseases of Women
 Meigs on Puerperal Fever
 Miller's Practice of Surgery .
 Miller's Principles of Surgery
 Montgomery on Pregnancy  .
 Morland on Urinary Organs .
 Morland  on Uisemia
 Neill and Smith's Compendium of Med Science
 Neligan's Atlas of Diseases of the Skiu
 Neligan on Diseases of the Skin
 Obstetrical Journal
 Odling's  Practical Chemistry
 Pavy on Digestion
 Prize Essays on Consumption
 Parrish's Practical Pharmacy
 Pirrie's System of Surgery  .
 Pereira's Mat. Medica and Therapeutics, abridge
 Quain and Sharpey's Anatomy, by Leidy
 Ranking's Abstract     ....
 Radcliff and others on the Nerves, &c.
 Roberts on Urinary Diseases .
 Ramsbotham on Parturition .
 Rigby's Midwifery.....
 Royle's Materia Aledica and Therapeutics
 Salter on Asthma......
 Swayne's Obstetric Aphorisms
 Sargent's Minor Surgery
 Sharpey and Quain's Anatomy, by Leidy
 Simon's General Pathology  .
 Skey's Operative Surgery
 Slade on Diphtheria    ....
 Smith (J. L.) on Children
 Smith (H. H.) and Horner's Anatomical Atlas
 Smith (Edward) on Consumption .
 Smith on Wasting Diseases of Children
 Solly on Anatomy and Diseases of the Brai
 StiI16's Therapeutics    ....
 Sturges on Clinical Medicine
 Tanner's Manual of Clinical Medicine .
 Tanner on Pregnancy  ....
 Taylor's Medical Jurisprudence
 Taylor's Principles aud Practice of Med  Ju
 Tuke on the Influence of the -Mind
 Thomas on Diseases of Females  .
 Thompson on Urinary Organs
 Thompson on Stricture  ....
Thompson on the Prostate
 Todd on Acute Diseases ....
 Wales on Surgical Operations
 Walshe on the Heart   ....
 Watson's Practice of Physic .
 Wells on  the Eye.....
 West on Diseases of Females
 Weston Diseases of Children
 West on Nervous Disorders of Children
 West on Ulceration of Os  Uteri
 What to Observe in Medical  Cases
 Williams on Consumption  .
 Wilson's Human Anatomy  .
Wilson on Diseases of the Skin  .
Wilson's  Plates on Diseases of the Skin
 Wilson's Handbook of Cutaneous Medicine
Wilson on Spermatorrhoea
Winslow on Brain and Mind
 Wohler's Organic Chemistry
 Winckel on Childbed
 Zeissl on Venereal .
isp
For "The American Chemist"  Five Dollars a year, see  p. 11.
For "The Obsthtrioal Journal" Five Dollars a year,  see  p.  22. 
 
 
 
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