WHARTON AND STILLE’S MEDICAL JURISPRUDENCE. THIRD EDITION VOL. II. PART FIRST. PHILADELPHIA: KAY & BROTHER, 17 AND 19 SOUTH SIXTH STREET. 1873. Entered according to Act of Congress, in the year 1855, by KAY & BROTHER, in the office of the Clerk of the District Court of the United States in and for the Eastern District of Pennsylvania. Entered according to the Act of Congress, in the year 1860, by KAY & BROTHER, in the Clerk’s Office of the District Court of the United States in and for the • Eastern District of Pennsylvania. Entered according to Act of Congress, in the year 1873, by KAY & BROTHER, in the Office of the Librarian of Congress, at Washington. PHILADELPHIA : COLLINS, PRINTER, 7O5 JAYNE STREET. PREFACE. The Editors of the second volume of the present edition are as follows:— Of the Chapters Relative to the Fcetus and New- Born Child, and to the Difference of Sex : Samuel Ashhurst, M.D., of Philadelphia; Of the Chapters on Poisons : Robert Amort, M.D., of Brookline, Massachusetts; Of the Chapters on Wounds and Signs of Death : Wharton Sinkler, M.D., of Philadelphia; Of the remaining Chapters, and of Certain Psycholo- gical and Legal Notes elsewhere appearing: Francis Wharton, LL.D. May 1, 1873. TABLE OF CASES. [The numbers refer to sections.] A. Abbott, People v. 277 Abrams v. Foster 1201 Allen, R. v. 280 Anderson v. Whitaker 49 Angus, It. v. 1214 B. Bangs, Com. v. 1201 Barker, R. v. 277 Beale, Com. v. 245, 266 Beckett, R. v. 1137 Bellinger v. Craigue 1091 Benton, State v. 1101 Bocarm6’s Case, 612 Bodine, People v. 1245 Boom’s Case 1115 Bowler v. Bingham 40 Bournan v. Woods 1089 Brain, R. v. 1209 Brauer v. State 283 Briggs, R. v. 1139 Brinkley, R. v. 1233 Britton, R. v. 1187 Brown, Com. v. 1202 Burke, Com. v. 264, 270 ,C. Camplin, R. v. 264 Campo v. State 277 Carawan’s Case 1192 Carpenter v. Blake 1087, 1088, 1090, 1091 Case, R. v. 273, 1200 Chamberlain, R. v. 1081 Chauncey, Corn. v. 1101 Clarke, R. v. 277 Clewes, R. v. 1237 Coale’s Case 447 Conner, R. v. 1101, 1168 Cook v. State 1245 Cooper, State v. 1101,1201 Corsi v. Maretzek 1089 Cottrill v. My rick 1247 Coye v. Leach 1039 Craig v. Chambers 1091 Crompton, R. v. 1168 Croswell, People v. 271 D. Davidson, R. v. 1208 Demain, Com. v. 1201 Donellan’s Case 584, 1161 Drake, People v. 631 Dwight v. County 1248 E. Enoch, R. v. 1209 F. Fairlee v. People 1084 Farr, State v. 270, 284 Fletcher, R. v. 271 Folkes v. Chadd 1247 Forshner, State v. 277 Fritz, Com. v. 43 Fulkerson, State v. 1101 G. Gammon, R. v. 278, 280 Gardner Peerage Case 49 Gonzales, People v. 1157 Goodrich v. People 1006 VII TABLE OF CASES. Gordon, People v. 1234 Gray, State v. 282 Green, Com. v. 267 Gronnell, R. v. 1208 H. Hargrave, State v. 282 Harman, Com. v. 1212 Hatfield v. Gano 1201 Hay, R. v. 1034 Hays, People v. 270, 1200 Heath v. Com. 1161 Heath v. Glison 1087 Hendrickson, People v. 629 Hinkle, State v. 1006 Holroyd’s Case 1164 Holmes v. State 1085 Hood v. Grimes 1088 How’s Case 1197 Howard, State v. 1201 Hughes, R. v. 281 J. Jackson, R. v. 275 Jumpertz, People v. 1182 Jordan, R. v. 280 Johnson v. State • 1161 Jones, R. v. 276 K. Kennedy v. People 1154, 1245 King v. Com. 1101 Knights, State v. 1006 L. La Coste’s Case 1124 Lacy v. State 278 Leblanc, R. v. Leak, State v. 1100 Leighton v. Sargent 1087, 1090 Leitga, People v. 902 Lewis, State v. 278 Lidwell, R. v. 280 Lines, R. v. 281, 284 Long, R. v. 1080 Long v. Morrison 1091 Lorkey, State v. 1L01 Lynch v. Davis 1064 M. McCann, State v. 1154 McCann, People v. 1006 McCandless v. McWha 1080, 1090 McCarty, Com. v. 44, 45, 66 McCombe, State v. ‘I'i'l McCraney, People v. 329, 1119 McDonald v. Snelling 1082 McLaughlin, R. v. 1137 McRue, R. v. 281 Markuss, R. v. 1081 Martin, R. v. 277 Mawgridge, R. v. 1101 Mertz v. Detweiler 1087 Metcalf, People v. 275 Mills, Com. v. 1201 Mitchell, Com. v. 1101 Moehring v. Mitchell 1040 Moore, State v. 1101 Moore v. State 283 Morea, State v. 1168 Murrow, R. v. 1138 N. Noakes, R. v. 1082 Norket, R. v. 1187 P. Parker, Com. v. 1201 Patten v. Wiggin 1091 Pell v. Ball 1035 Penns, v. Sullivan 282 Porter v. Poquannoc 1246 Poulton, R. v. 1209 Pratt, State v. 277 Pressy, R. v. 271 Q- Quin, People v. 266 R. Rash, State v. 1161 Reed, State v. 277 Reeves, R. v. 1209 Regan, Com. v. 277 Rice v. State, 1085 Ruddock v. Lowe 1087, 1088 VIII TABLE OF CASES. u. Underwood v. Wing 1040 V. Van Butchell, R. v. 1065 Vendine v. Burpee 1247 Vincent, State v. 1240 Voke, States. 1161 W. Walker v. Boston 1248 Watkins, State v. 1161 Walter, People v. 274 Walters, R. v. 1211 Warman, R. v. 1139 Webb, R. v. 1081 Webster’s Case 1220, 1223, 1235 Wentz, Com. v. 40 West, R. v. 93 West, Com. v. 1207 Wharton, State v. 328, 495 Williamson, R. v. 1064 Williams, State v. 1118 Wilmot v. Howard 1091 Wing v. Angrave 1044 Wiltberger, U. S. v. 1107 Wood, Com. v. 1201, 1206 Wood, R. v. 1138 Wood v. Clapp 1091 Wright,'R. v. 276, 1209 Z. Zephon’s Case 1164 Rudland, R. v. 276 Russen, R. v. 280 Rutherford, State v. 1107 S. Saunders, R. v. 275 Seare v. Prentice 1087 Selfridge’s Case 1101 Senior, R. v. 1200, 1207 Spear v. Richardson 1248 Shepard, State v. 275 Sherman, State v. 435 Shreeve’s Case 1115 Simonds v. Henry 1087, 1091 Simpson, R. v. 1062, 1088, 1208 Slater v. Baker 1087 Smith v. Croom 1043 Smith v. State 1101 Smith, R. v. 1137 Spencer, R. v. 1082 Spiller, R. v. 1081 Spilling. R. v. 1081 Stanton, R. v. 273 Stegall v. Stegall 40 Stevens, R. v. 1138 Stoyell, State v. 264 Strieker, Com. v. 40 Stroud, Com. v. 282 Swan v. County 1248 T. Thomas, Com. v. 282, 1084 Thomas v. Winchester 1082 Tichborne Case 1219 Trailor’s Case 1115 Trilloe, R. v. 1209 IX CONTEXTS OF TOL. II. BOOK II. QUESTIONS RELATIVE TO THE FOETUS AND NEW-BORN CHILD. CHAPTER I. Signs of pregnancy. 1st. Suppression of the menses, § 1. 2d. Enlargement of the abdomen, § 3. 3d. Changes in the mouth and neck of the womb, § 6. 4th. Quickening, § 7. 5tli. Sympathetic phenomena, § 12. 6th. Pulsation of the foetal heart, § 19. 7th. Other sounds indicative of pregnancy, § 20. 8th. Kiestein in the urine, § 22. CHAPTER II. Delivery. 1st. Signs of recent delivery, § 23. 2d. Signs of delivery in the dead, § 28. 3d. Corpus luteum, § 29. 4tli. Feigned delivery, § 37. CHAPTER III. Duration of pregnancy. 1st. Presumption that the child born in wedlock is legitimate, § 40. 2d. Protracted gestation, § 41. (1) Usual duration of pregnancy, § 41. (2) Mode of reckoning duration of pregnancy, § 43. («) Cause of conception, § 44. (6) Cessation of the catamenia, § 46. (c) Arrest of monthly discharge, § 47. (d) Statistical results, § 50. 3d. Legal decisions, § 66. 4th. Early viability, § 67. XI CONTENTS OF VOL. II. CHAPTER IY. Superfcetation. 1st. Twin pregnancies in which the children have had different fathers, § 73. 2d. Parturition of children at the same time, but of different degrees of development, § 77. 3d. Short intervals between births of equally mature children, § 77. CHAPTER Y. Abortion and fceticide. 1st. Natural causes, § 84. 2d. Drugs as means of producing abortion, § 85. (1) Ergot, § 85. (2) Savin and oil of tansy, § 86. 3d. Venesection, § 91. 4th. Mechanical means, § 92. (1) Legitimate medical practice as inducing premature labor, § 96. (2) Blows upon the abdomen, g 97. 5th. Signs of abortion, § 98. (1) From an examination of the body expelled, § 98. (2) From an examination of the female, g 107. CHAPTER YI. Infanticide. 1st. Characteristics of stillborn and living children, § 108. 2d. Tests of live birth, g 128. (1) Hydrostatic lung test, g 132. (2) Static tests, g 144. 3d. Causes of death in the new-born child, g 149. (1) Causes of death before or during birth, g 150. (а) Compression of, and by, the umbilical cord, g 150. (б) Protracted delivery, g 155. (c) Debility, g 156. (d) Hemorrhage from the umbilical cord, g 157. (e) Length of the umbilical cord, g 160. (/) Fracture of the skull, g 161. (2) Causes of death after birth, g 165. (a) Exposure, g 166. (5) Suffocation, g 168. (c) Strangling, g 170. (d) Drowning, g 172. () Brit. Med. Journ., 1864, i. 181. ($0 Loud. Med. Review, February, March, and April, 1862. 14 BOOK II.] SYMPATHETIC PHENOMENA. [§ 18 color of the areola) is of most importance in primiparse, and in the latter months of gestation. 7. Elevation of the areola above the surrounding skin is most frequently found in the primiparous woman, and when found may be regarded as cha- racteristic of pregnancy. 8. A shiny mahogany-colored areola is a very valuable indication, and, 9, secondary areola, occur- ring most frequently in primiparse, is conclusive. 10. The presence of branny scales has some value, which is much increased if any fluid can be expressed from the nipple. 11. The presence of sebaceous follicles is conclusive, and is the most important of the mammary signs in the early months of multiparous women, while, 12, a raised areola and the presence of milk possess the highest value in the case of a woman carrying her first child. 18. The age of the foetus cannot be arrived at by an examination of the breasts. Eive kinds of follicles are enumerated by the author as existing in the areola, three of which, containing subaceous material, present evidence of pregnancy. § 16. A bluish or dusky color of the vagina, produced by venous congestion, was originally declared by Jacquemin to be an almost certain sign of pregnancy in females who are not subject to hemorrhoids. This statement has been confirmed by Kluge, Parent-Duchatelet, Kilian, Wistrand, and Montgomery, the last of whom says, “ In every instance, without a single exception, in which I have found this appearance distinctly marked, pregnancy coexisted.”(A) It should, however, be re- membered that pregnancy may exist, although this sign may not be visible. § 17. A very high authority, Dr. Robert Barnes,^1) says that a reliable sign of pregnancy in the early months is a flat- tening of the upper wall of the vagina, which is caused by enlargement of the womb with anteversion, which carries the os backwards and necessarily makes the superior wall of the vagina tense. § 18. The more or less distinct presence of several phe- nomena, which have been now considered, independently of (7i) Signs and Symptoms of Pregnancy, 2d ed. p. 245. (A1) Brit. Med. Journ., 1368. 15 § 18a] [book II. SIGNS OF PREGNANCY. the existence of any product of conception, characterizes the cases known as those of spurious pregnancy. They might be expected to be met with most frequently in women who have never borne children, and are, therefore, unacquainted with the sensations and conditions peculiar to pregnancy. But such is not the case. The most numerous examples of this delusion are presented by mothers approaching the period when the menses cease, and which is usually marked by uterine dis- orders of various kinds. Yet many are met with in the first year after marriage; and in such the source of the delusion is an instinctive longing for becoming a mother. To this power- ful instinct must be attributed the occurrence of many phe- nomena of pregnancy in unmarried and pure women, associated with evidences of a hysterical or a highly nervous tempera- ment, and the periodical cestus which often precedes and accom- panies the catamenia. It is impossible to determine accurately whether the delusion has a mental or a physical origin, or in what degree either cause predominates; but it is probable that a state of excitement of the reproductive organs occasions impressions, if not sensations, which awaken corresponding ideas in the mind, and that these in their turn render the various physical phenomena more intense. The vivid descrip- tions of their sensations, therefore, given by the subjects of these various cases, are not necessarily to be taxed as inven- tions, nor are the physical phenomena which they display to be regarded always as cunning tricks intended to deceive. They represent convictions as profound and distinct as those of the monomaniac, and are often as difficult to eradicate. § 18a. All of the signs which have now been referred to are uncertain in their nature, and various objections may be urged against each of them, but, if a majority of the more im- portant exist, the presumption of pregnancy is necessarily very strong, although certainty cannot be obtainable from them. The same objection cannot be made against the signs which we have designated as certain, from the fact that when found they indicate the presence of a foetus infallibly; although it cannot, indeed, always be inferred from their absence that pregnancy does not exist. This class of signs demonstrates, therefore, the presence of a foetus in the womb, and are ob- 16 BOOK II.] [§ 18c SYMPATHETIC PHENOMENA. tained by physical methods of exploration, inspection, touch, auscultation, etc. § 186. The 'passive movements of the child are obtained by the manoeuvre termed ballotternent by the French. The female being in a standing posture, the finger is introduced into the vagina, up to the mouth of the uterus, while the other hand is placed upon the abdomen. The womb is suddenly raised up by an abrupt movement of the finger, and, falling again upon it with a slight shock, communicates the sensation of sudden displacement of a body contained in a liquid. This test is seldom applicable before the fifth month, and sometimes not after the eighth, owing either to the position of the child or the small amount of anmiotic fluid present. In competent hands the test is a safe one; but it can give evidence only of the presence of a foetus—whether this be living or dead must be ascertained by other means. Another mode of performing ballotternent, but which is inferior to that just described, con- sists in giving sudden movements to the uterus by the hand, placed upon opposite sides of the abdomen while the woman is in erect posture or lying upon her side. § 18c. The active movements of the child become perceptible for the first time usually in the fourth month. They are at first extremely feeble, and in some cases remain so during the whole period of gestation. There are some rare cases in which no movement whatever has been felt by the mother throughout pregnancy; and, on the other hand, in some instances of spu- rious pregnancy the movements attributed to the child are described as violent. In the majority of cases, however, they are very distinct in the latter half of pregnancy. They are perceived by laying the hand upon the abdomen, and making gentle pressure upon it, or after dipping the hand in cold water before touching the skin. Sometimes an escape of gas from one portion of the intestine to another, or even the involuntary contraction of the abdominal muscles or of the uterus itself, may momentarily deceive the examiner, but a little attention will prevent all chance of mistake from these sources. The child may not always be made to execute move- ments; hence, both the woman may be pregnant and the child YOL. II.—2 17 § 2°] SIGNS OF PREGNANCY. [book ir. alive, without its being revealed at the time by this mode of physical examination of the abdomen.(i) § 19. 6th. Pulsation of the fatal heart.—The pulsation of the foetal heart resembles the ticking of a watch, and is discover- able at different portions of the uterus, according to the period of pregnancy at which the observation is made. These sounds cannot be mistaken for any other heard in the abdomen, since the pulsation is a double one, and not isochronous with the maternal pulse, being generally about 130 beats in the minute, varying, however, considerably in frequency, and becoming less frequent as pregnancy advances. These pulsations are first distinctly audible about the middle of the fifth month ; but M. Depaul says that it is possible to hear them one month earlier than this period, he having succeeded in perceiving them, with great distinctness, by depressing strongly the ab- dominal walls, and placing the stethoscope upon the fundus of the uterus. This manoeuvre would evidently succeed only in very thin persons, and when employed by a practised auscul- tator. The sounds may be more audible at one examination than at another; indeed, to an inexperienced auscultator, they may frequently be inaudible. It is extremely rare, however, not to find them in the last three months of pregnancy, except when the foetus is dead. Of 906 women examined at this period of pregnancy, says M. Ddpaul, the sounds were absent in 8 only. Yet in some rare cases they have been inaudible throughout pregnancy. The auscultation of the foetal heart is, therefore, a test of the existence of a foetus far more reliable than any other sign or combination of signs. It is easy of application, can be employed at a comparatively early period, and can hardly ever fail of being discovered when pregnancy really exists. § 20. 7tli. Other sounds.—There are two other sounds indi- cative of pregnancy, which are ascertained by auscultation, but neither of which can afford the same positive proof as the pulsation of the foetal heart. These are the uterine and the umbilical souffle. The first is a peculiar blowing, cooing, or whistling sound, audible over a greater or less extent of the (.«') Depaul, Traite Theorique et Pratique d’Auscultation Obstetricale. 18 BOOK II.] KIESTEIN IN URINE. r§ 22 uterine tumor, sometimes confined to one spot, and generally most audible in the lower and lateral portions of the uterus. It is said to be caused by the passage of the blood through the uterine arteries. It is isochronous with the pulse of the mother. It has been perceived as early as the tenth week, but most generally cannot be discovered until a later period. Its intensity increases up to the end of the seventh month (Depaul). Of 807 women who had passed the fifth month, this author observed the uterine souffle in 295. M. II. F. jSTagele(F) found it absent in only 20 cases out of 600. In affixing a value to this phenomenon, as a sign of pregnancy, the observations of M. Depaul render it positive that a* souffle perfectly similar to this is heard when the uterus is developed from any other cause than pregnancy. lie relates a number of cases which show conclusively that such is the case; in some of them, post-mortem examination disclosed fibrous and carcinomatous tumors imbedded in the walls of the uterus.(7) If, however, a certainty can be obtained that the development of the uterus is not due to this cause, the sign is hardly less characteristic than the foetal cardiac pulsation. § 21. The sound discovered and described by Dr. Evory Ken- nedy, and called by him the umbilical sound (from the suppo- sition that it proceeds from the umbilical vessels), is of trivial importance in the diagnosis of pregnancy. It is not audible in the majority of cases, requires an experienced ear, and, when found, is a superfluous sign, because the pulsation of the foetal heart and the uterine souffle will be also perceptible at the same time, and are not open to the same objections as is the one in question. § 22. 8th. Kiestein in the urine.—Very little need be said of this substance as a test or sign of pregnancy. The name of kiestein is applied to a substance which occurs at first as a fleecy cloud, and afterwards as a fatty pellicle or scum, in the urine of pregnant women, after it has been allowed to stand for a (ft) Die geburtsliulfliehe Auscultation, Mainz. 1838. (Z) The same opinion is held by Kiwiscli, whose opportunities for verifying the accuracy of his views are very extensive, and whose critical acumen and sound judgment have gained him a wide reputation.—Vid. Klinische Vor- traege. Bd. 2, p. 5G1. Prag. 1849. 19 §22] [BOOK II. SIGNS OF PREGNANCY. few days. Dr. J. Braxton Ilicks^1) recommends the addition of two teaspoonfuls of rennet to three iluidounces of urine to hasten the formation of the pellicle. Its nature is not very well understood, but Dr. Golding Bird supposed it to contain the caseous elements of milk mixed with the earthy phosphates. There is, however, considerable discrepancy of opinion respect- ing its constitution, while at present few are disposed to look upon it as of any value as a sign of pregnancy. Among the later observations are those of Dr. Yeit, who comes to the con- clusion that the so-called pellicle of kiestein is no peculiar matter at all, and is not of the slightest value as a sign of pregnancy. In urine of both non-pregnant and pregnant women pellicles are formed, containing vibriones and fre- quently the triple phosphate ; the chief difference between the respective urines being, that in that of pregnant women, alka- line, and in that of non-pregnant women, acid reaction more frequently manifests itself. This may depend, perhaps, upon the greater concentration of the urine in pregnancy, and the larger portion of mucus mixed with it.(m) Tanner, however, treats of the presence of this substance among the minor signs of pregnancy as tending to strengthen other evidence.^1) Montgomery, after reviewing all the evidence which has been published upon this subject, and comparing with it his own experience, concludes that we should be very slow to place any confidence in the sign in question, except as a “ corrobo- rative indication.”(a) Dr. G. T. Elliot, who conducted his investigations at the Bellevue Hospital, Hew York, concludes that there is nothing positive to be learned from the urine in regard to the existence of pregnancy, and that its appearances can scarcely even be called corroborative.(i) In conclusion, we draw attention to the fact, that, as the re- sult of his vast experience, Casper says that disputed preg- nancy is of much more rare occurrence inforo than is generally believed to be the case.(Y) (?') Lancet, Sept. 17, 1859. (to) Am. Journ. Med. Sci., Jan. 1852, p. 259. (to1) Op. cit. p. 186. (a) Op. cit. p. 307. (6) New York Journ. of Med., Sept. 1856, p. 181. (£') Forensic Medicine, New Sydenham Society’s Translation, vol. iii. p. 349. 20 BOOK II.] SIGNS OF RECENT DELIVERY. [§ 23 CHAPTER II. DELIVERY. § 23. 1st. Signs of recent delivery.—Within a week or ten days after delivery at term, the following signs are more dis- tinct and well marked the earlier the examination is made. The countenance of the female is pale, her skin warm and moist, the body languid, and the mind and feelings very im- pressionable. The breasts are more or less distended, and their veins very distinct upon the surface. They are increased in weight, and the knotty masses of lactiferous tubes and glands are very easily felt. The nipples are prominent, and watery milk spontaneously or by pressure exudes from them. The integuments of the abdomen are loose, lying in folds, marked with livid lines, which at a later period become whiter than the surrounding skin, and resemble scars; the uterus can be felt behind the pubis, like a large firm hall; the external organs of generation are moist, relaxed, and swollen, and the vagina, both at its entrance and throughout, is very capacious, and free from folds. The mouth of the womb is low, open about three-quarters of an inch, its margins very soft and relaxed, and sometimes slightly lacerated. A sanguinolent mucus exudes from the internal organs of generation. This discharge is known under the name of the lochia; its odor is peculiar, and easily recognized by those who have once per- ceived it. Such are the principal signs of delivery, and in their combination they present a characteristic picture which can leave no room for doubt of a recent confinement. Taken separately, however, there is hardly any one which is not liable to exceptions. Thus milk may be secreted independently either of pregnancy or delivery, as has been shown in the chapter on the “ Signs of Pregnancy.” Yet the manner in which the secretion takes place after delivery, with the atten- dant warmth of the skin, the turgescence of the glandular 21 §26] DELIVERY. [BOOK II. structure of the breast, and a certain amount of constitutional sympathy, called “ milk fever,” can rarely, especially during the first few days, allow one to be in doubt of its cause. There are, indeed, numerous cases in which no milk is secreted, and although even in these a certain degree of turgor and warmth may generally be observed, yet an opinion must be based upon a further examination. § 24. A microscopic examination of the milk may sometimes contribute to prove the recent occurrence of parturition. This solved all doubt in a case reported by Mr. Mercer Adam. The body of a new-born child, much decomposed, was found in a moss in the South of Scotland; it appeared to have been dead four or five weeks. Suspicion having fallen upon a young woman who was supposed to have been delivered secretly about that time, she was arrested, and acknowledged that she had borne a child about a year and a half before, which she had nursed until within three months of her apprehension, but firmly denied having been recently delivered. No feasible plan of deciding the question appearing, some one suggested that her milk should be examined by the microscope. This wras done, and it was found to abound in colostric globules. “This showed parturition to have lately occurred.” The girl finally confessed that she had recently given birth to a still- born child.(n) § 25. A case is reported by Rothame^n1) in which stains of milk, vernix caseosa, and meconium were analyzed, and evi- dence thereby obtained of a concealed birth and child murder. The presence of milk, possessing the peculiarities belonging to that fluid soon after delivery, was considered to be proven by finding fat, sugar of milk, caseine, potash, lime, and magnesia, with hydrochloric, sulphuric, and phosphoric acids. Vernix caseosa was evidenced by fat, mucus, and carbonate of lime, while meconium appeared to be indicated by fat, cliolesterine, mucus, fatty coloring matter, with the absence of biliary coloring material and bile acids. § 26. The condition, as above described, in which the genital (n) Edinburgh Monthly Journal of Medical Science, May, 1853. (n]) Henke, vol. xxxix. part I. 22 BOOK II.] SIGNS OF DELIVERY IN THE DEAD. [§ 28 organs, after delivery, are found, is one which it is entirely impossible to mistake for the result of disease, accident, or intentional injury. The only difficulty in ascertaining the fact of delivery having taken place arises in those cases where an examination has not been made at a sufficiently early period. After the establishment of the flow of the milk, and the disappearance of the relaxed and tumid condition of the genital organs, there remain hardly any other signs than the whitish streaks before referred to, indicative of the previous distension of the abdomen, and, in addition, the state of the os uteri. If it can be shown that abdominal dropsy or tumors have not been present, then the white lines, being usually per- manent, afford good evidence of the woman having borne one or more children, but allow no inference as to the date of delivery, except that it has not been recent. The os uteri, in a woman who has been delivered once or more than once, differs from its virgin state, in being more open, and having its margins irregularly notched, or even torn. Occasional ex- ceptions to this statement are met with. § 27. In conclusion, it may be stated that the medical proof of recent delivery, from an examination of the living woman, cannot be established with perfect certainty after the lapse of a week or ten days, if the female have already borne children ; if it, however, have been a first labor, the existence of the whitish streaks upon the abdomen, and the altered condition of the mouth of the womb, will afford strong suspicion of delivery having taken place at some former period, which cannot be more nearly determined. § 28. 2d. Signs of delivery in the dead.—These are extremely easy of recognition. It is evident that, in addition to the dilated and relaxed state of the vagina and vulva, the volume and capacity of the uterus, the thickness of its walls, the blood upon its inner surface, and the lacerated appearance of that portion of it to which the placenta was attached, are unmis- takable signs of recent delivery. The uterus, after delivery, does not return to its former size until after the expiration of eight or twelve weeks, but will be found during this period still larger than before pregnancy, its walls thick and firm, but not vascular, although traversed by dilated veins, and the 23 §31] DELIVERY. [book ii. mucous membrane of the os tineas softened, as if excoriated, vascular, and covered with mucus. The appendages of the uterus partake of the vascularity which characterizes it at the epoch of delivery, but they soon regain their ordinary aspect. The rate of return of the uterus to its normal size after parturition is irregular, depending upon its energy during labor, the period of pregnancy at which this process occurs, the occurrence of hemorrhage, etc., and consequently any attempt to infer from its condition the precise date of delivery must prove deceptive. § 29. 3d. Corpus luteum.—It has been supposed that the finding of a corpus luteum, or trace of a ruptured Graafian vesicle in the ovary, was introvertible proof of the previous existence of pregnancy. This opinion can no longer be main- tained. The body which is found in the ovary, as the result of the rupture of a Graafian vesicle, indicates the escape of an ovum, but not necessarily the occurrence of impregnation. It has, indeed, been supposed that if a corpus luteum were formed in the ovary, this would be a reliable proof that fecundation must have occurred. This view is, however, not supported by the later investigations into the physiology of menstruation and reproduction. § 30. The fact is now, perhaps, universally admitted, that the maturation and expulsion of ova, probably at the menstrual period, or immediately after it, take place independently of all sexual intercourse. The act of expulsion or discharge neces- sarily involves a rupture of one of the Graafian follicles, and the locality is indicated by a corpus luteum and a cicatrix. § 31. The following is a description, by Dr. Dalton, of the corpus luteum found in the ovary of a girl who destroyed her- self with oil of tansy, in the fourth month of pregnancy. The foetus was found in the womb. “The left ovaiy, which hung down a little lower than the right, had near its external extremity a small conical prominence, where the fibrous coat was wanting, and its place occupied by peritoneum alone. There was a very slight appearance here of a cicatrix, visible only on close inspection. There was no unusual vascularity here or at any other part of the ovary. Beneath this promi- nence the corpus luteum could be felt through the ovarian 24 BOOK II.] CORPUS LUTEUM. [§ 32 tissue, tolerably firm and well defined, showing the form of a sphere compressed laterally, much like that of the crystalline lens. On dividing the ovary longitudinally through the promi- nence, the corpus luteum was exposed. It presented nearly a circular section, measuring seven-eighths of an inch in its long diameter, and tliree-fourths of an inch in its short. It con- sisted externally of a convoluted wall of a dull yellow color, measuring at its deepest part a little over three-sixteenths of an inch in thickness. The space inclosed by the yellow wall W’as occupied by a colorless, reticulated, fibrous coagulum, which possessed a few minute vessels. This central coagulum was much compressed laterally, so that, although it presented a cut surface of about half an inch in diameter, it had hardly more than one line in thickness. There was no cavity or fluid any- where. Both ovaries were carefully divided in every direction, but only one other body was found having any resemblance to a corpus luteum, and that was so small and imperfect as to be hardly recognizable. There were many Graafian vesicles in the interior of each ovary, varying in diameter from three- sixteenths of an inch downward, but none at all prominent on the surface. Both ovaries were quite healthy.”(o) § 32. The question of practical interest in inquiries relative to the fact of impregnation or delivery having occurred, is whether there is a sufficient distinction possible between the corpora lutea of simple menstruation and those of pregnancy to enable us to declare with positiveness to which cause it may be properly ascribed. It would certainly be a gratifying result of scientific observation, if this question could be answered in the affirmative.(p) (o) American Journal of the Medical Sciences, January, 1852. (p) M. Coste, in his splendid work upon Embryology, says, that, during the first eight or ten days after the escape of the ovum, it is impossible to find any difference between the corpus luteum of menstruation and of pregnancy ; after this period the first assumes a retrograde course, while the latter, attain- ing a larger size than the other ever reaches, and becoming in every way more developed, remains stationary until about the end of the third month, at which time it begins to decline, and between the sixth and the ninth month has lost at least two-thirds of its volume ; still occasionally it is completely absorbed before delivery. During the period of decadence, it is difficult to distinguish the corpus luteum of pregnancy from that of menstruation. M. 25 § 34] [book ir. DELIVERY. § 33. M. gives a concise and satisfactory descrip- tion. He says: uWe must distinguish two kinds of corpora lutea—those which result from the cicatrization of a follicle, after the spontaneous expulsion of an ovum, without any sub- sequent conception; and those which are produced by the same process, after the expulsion of an ovum followed by conception, and especially by gestation. Those belonging to the first class rapidly pass through their different stages, never attain a high degree of development, are much inferior to the others in size, rapidly assume a yellow coloration, fade again in a few days, and in the course of one or two months become retracted and completely concealed in the ovarian tissue. The second species of corpora lutea, participating in the congestion and functional activity, which are established in all the sexual organs during gestation, attain a size sometimes greater than that of the ovary itself, and pass so slowly through the different stages of their development and atrophy, that they are still perceptible at the termination of pregnancy; they gradually diminish in size, in proportion to the growth of the foetus, and the approach of the end of gestation.” § 34. Dr. Dalton,(r) in his valuable monograph on this sub- ject, says: “There can be no doubt that in the first periods, the corpus luteum follows the same course of development, whether the discharged ovum becomes impregnated or not. Together with the rupture of the vesicle the same effusion of blood takes place in either case, followed by a gradual absorption of the coloring matter of the clot, with hypertrophy and folding up of the membrane of the vesicle. When, however, the ovum becomes impregnated, and continues its growth in the uterus, the corpus luteum, instead of reaching its maximum of devel- Coste differs from Raciborski, Pouchet, and most other physiologists who have made researches upon this subject, in regard to the cause of the color of these bodies, believing it not to be due to an extravasation of the coloring matter of the blood, but to other causes which the reader will find fully ex- plained in his wmrk.—Histoire generate et particuli'ere du Developpement dcs Corps organises. Paris, 1147. (q) Plxysiologie. Paris, 1850, vol. ii. p. 88. O) Prize Essay on the Corpus Luteum of Menstruation and Pregnancy, by Jno. C. Dalton, Jr., M. D., published in the Trans, of the Am. Med. Assoc., vol. iv. 1851. 26 BOOK II.] CORPUS LUTEUM. [§ 36 opment at the end of three weeks, and afterwards undergoing a rapid process of atrophy, continues to develop itself for a con- siderable period, and does not, in fact, become very decidedly retrograde until after the termination of pregnancy.” lie states, moreover, that the yellow color of the corpus luteum of pregnancy fades more rapidly than that of menstruation in proportion to its size and the activity of the changes it under- goes. § 35. Bischoff,(s) in a paper upon this subject, which with him was one of close investigation for many years, states that he had the opportunity of examining the ovaries in thirteen women who died while menstruating or in the pregnant con- dition. The results he obtained confirm the truth of the theory, that, at every menstrual period, a Graafian follicle ripens, swells, and hursts, and that, the ovum escaping, a corpus luteum is formed. Still, in ordinary menstruation, it never attains the full development which characterizes it when preg- nancy exists. It rapidly becomes contracted, and at the suc- ceeding menstrual period is already indistinct, and becomes gradually more and more so, the color changing from yellow to brown and black, and a puckered cicatrix on the surface of the ovary is soon the only trace of its existence. The corpus luteum of pregnancy, on the other hand, progresses steadily in its development, and attains a size never reached by that of menstruation. It lasts through the whole period of pregnancy, although diminished in size after the sixth or seventh month, and disappears after delivery. In the early periods, therefore, the difference between the two bodies is too slight to be relied upon; after delivery it is still difficult to distinguish that of pregnancy from those of fourteen days’ or three weeks’ stand- ins;, resulting; from menstruation. § 36. It is hence very plain, that, in the many cases in which the fact of impregnation having taken place is important to be known, we cannot rely with confidence upon the evidence derivable from the corpus luteum. TV"e doubt, moreover, whether, in view of the still very conflicting opinions among (, < a> M- Mcllvaine. P CtQ JD to O & -7 : v_li—t-x: i_ip. : . : : : : : : : : : ; : Montgomery. h~L Desormeaux. P CO CO Merriman. h-L »-*• Skey. M- Anderson v. Whittaker. h-*- Lee. M- Dewees. Of Of OSfcOI-*F-*->fi.tOl©fcOl005M.®tOSOCltaiOl>OfcOt-itOI-llOH-i|-i Total for each date. () Syst. of Midwifery, p. 279. See also Shapter, Proy. Med. Journ., April, 1844. 68 BOOK II.] SAVIN. TANSY. [§ 87 bitter for promoting the appetite. We think, however, that the administration of either of these drugs to pregnant women should always be looked upon with suspicion, for we cannot imagine any condition which, at this time, would require or justify their employment. In a case in which probably from one to two ounces of the oil of savin had been swallowed, a most violent inflammation of the stomach was excited, fol- lowed by softening and perforation of this organ, peritonitis, and death. The uterus was empty; it was of the size usual at the third or fourth month of gestation, and, judging from the state of the parts and the lochial discharge, the foetus had been expelled, it was supposed, from two to three days. Morphia and chloroform had both been taken by the unhappy woman, but the violent inflammatory results found at the post-mortem examination were, no doubt, properly ascribed to the action of the savin.(g) § 87. Dr. Lee states that he has known an instance where sixty drops of the oil of savin were taken every morning for a week, for the purpose of procuring abortion, in the sixth month of pregnancy. It brought on violent pain in the abdomen and region of the uterus, and the woman died on the third day after the delivery of a still-born foetus; on dissection, the ute- rine organs as well as the pelvic viscera generally were found to be in a state of high inflammation. Another case is men- tioned in which an infusion of savin was taken for a similar purpose. It brought on violent and incessant vomiting, ex- treme pain and uterine hemorrhage, and death in a few days.(r) Dr. Taylor met with a case in which death was caused by powdered savin—abortion having first taken place. Eight ounces of green liquid were found in the stomach, which, with the (esophagus and the small intestines, was highly inflamed. The poison was identified by observing the minute portions of the leaves under the microscope.(s) (q) Am. Journ. Med. Sci., April, 1851, p. 529. Communicated to Dr. T. R. Beck by James H. Salisbury, M. D., of Albany, N. Y. (r) Copland’s Med. Diet., Am. ed., art. “Abortion.” (s) Med. Gaz. xxxvi. 646. 69 §91] ABOETION AND FCETICIDE. [book ii. § 88. A case of poisoning with oil of tansy is reported by Dr. Dalton, of Boston, in which death, after the most violent con- vulsions, took place at the end of three hours and a half; the quantity swallowed was more than an ounce. The uterus con- tained a well-formed foetus about four months old, and there was not the least appearance anywhere of the foetus or mem- branes having suffered any In another fatal case of poisoning with this oil, reported by Dr. Hildreth, the quantity taken was half an ounce, and death followed in less than two hours. Pregnancy of a few weeks’ standing existed, and the drug was, as in the former case, undoubtedly taken for the purpose of producing abortion, but nothing of the kind took place.(w) § 89. The leaves and unripe fruit of the common rue, most probably, act like the foregoing drugs, solely by their irritant properties, which have been used with the hope of procuring abortion. The only cases which we have met with, where this was successfully induced, are those reported by Dr. Helie. The constitutional symptoms were, in them, very alarming, resem- bling such as are produced by poisons of a narcotico-acrid character.(v) § 90. Powerful purgative medicines, such as aloes, jalap, croton oil, and elaterium, given repeatedly, or in doses capable of setting up violent action of the lower bowels, may produce abortion by a secondary action upon the uterus. The same may be said of cantharides and turpentine. All of these drugs are capable of producing a great degree of active congestion and inflammation in the pelvic viscera, and hence the uterus is not always exempt from their action. At the same time, they can hardly produce this result without seriously endangering the mother’s life. It is certain that in the greater number of cases, where abortives are criminally employed, the life of the mother is more readily sacrificed than that of her offspring. § 91. 3d. Venesection has seldom a tendency to produce abor- tion. On the contrary, there is no remedy more in vogue for warding off a threatened abortion than this, and numerous (t) Am. Journ. Med. Sci., Jan. 1852, p. 140. (u) Ibid., May, 1835. (v) Ann. d’Hyg. Pub., vol. xx. p. 120. 70 BOOK II.] MECHANICAL MEANS. [§ 92 authors testify that pregnant women have been bled many times in succession without this result ensuing. Nevertheless, when pushed to the extent of causing syncope it may have that effect. M. Depaul(w) relates an instance in his own practice, where a woman, apparently suffering with severe headache, in two successive pregnancies, applied to him for the purpose of being bled. He afterwards discovered that the bleedings in these and on one previous occasion had de- stroyed the foetus, and that he thus had ignorantly seconded the intentions of the mother. Suction of the nipples by the mouth or by cupping glasses has occasionally been resorted to for the production of premature labor.(a) § 92. 4th. Mechanical means.—In some instances the woman seeks to rid herself of her burden, by making use of violent exertion, by direct injury to the abdomen, or by the introduc- tion of instruments into the womb. These attempts are often unsuccessful when made by the female herself, and even by an ignorant accomplice. A tailor’s apprentice attempted to pro- duce abortion in his mistress, by thrusting into her vagina the large scissors, used in his trade, and cutting with them. He wounded the vagina, but failed in his purpose.(6) Although the use of instruments generally indicates the intervention of another person, yet cases are known in which the woman has herself succeeded in introducing them. Thus, in a case in this country, a female brought on abortion by “ probing herself with a piece of whalebone,” and she declared that she had miscarried five times previously by the use of drugs.(z) More frequently, however, the abortion is accomplished through the culpable assistance of persons who make a trade of this nefarious prac- tice. While, for the most part, the persons who are ready to degrade their humanity to this occupation are exceedingly ignorant and wholly unskilled in medical knowledge, it cannot be denied that occasionally medical men lend their skill to the accomplishment of the woman’s purpose. Such conduct can- not be too strongly condemned, and is the more deserving of (w) Traite d’Auscultation Obstetricale, p. 270. (a) Scanzoni, Med. Times and Gaz., Oct. 1853. (5) Casper’s Gericht. Med. ii. 251. (x) New York Journ. of Med., yol. yii. p. 199. 71 §92] ABORTION AND FOETICIDE. [book it. receiving the punishment awarded for the criminal offence in question than are the blundering and reckless attempts of those less skilled, and who may, in many instances, be scarcely aware of the probable results of the operation to the mother.(y) In (y) “We blush, while we record the fact, that in this country, in our cities and towns, in this city, where literature, science, morality, and Christianity are supposed to have so much influence; where all the domestic and social virtues are reported as being in full and delightful exercise ; even here indi- viduals, male and female, exist, who are continually imbruing their hands and consciences in the blood of unborn infants; yea, even medical men are to be found, who, for some trifling pecuniary recompense, will poison the fountains of life, or forcibly induce labor, to the certain destruction of the foetus, and not unfrequently of its parent. “ So low, gentlemen, is the moral sense of the community on this subject, so ignorant are the greater number of individuals, that even mothers, in many instances, shrink not from the commission of this crime, but will voluntarily destroy their own progeny, in violation of every natural sentiment, and in opposition to the laws of God and man. Perhaps there are few individuals, in extensive practice as obstetricians, who have not had frequent applica- tions made to them by the fathers or mothers of unborn children (respectable and polite in their general appearance and manners), to destroy the fruit of illicit pleasure, under the vain hope of preserving their reputation by this unnatural and guilty sacrifice. “Married women, also, from the fear of labor, from indisposition to have the care, the expense, or the trouble of children, or some other motive equally trifling and degrading, have solicited that the embryo should be destroyed by their medical attendant. And when such individuals are informed of the nature of the transaction, there is an expression of real or pretended surprise that any one should deem the act improper, much more guilty ; yea, in spite even of the solemn warning of the physician, they will resort to the debased and murderous charlatan, who, for a piece of silver, will annihilate the life of the foetus, and endanger even that of its ignorant or guilty mother. “ This low estimate of the importance of foetal life is by no means restricted to the ignorant, or to the lower classes of society. Educated, refined, and fashionable women—yea, in many instances, women whose moral character is in other respects without reproach, mothers who are devoted, with an ardent and self-denying affection, to the children who already constitute their family —are perfectly indifferent respecting the foetus in utero. They seem not to realize that the being within them is indeed animate—that it is, in verity, a human being, body and spirit; that it is of importance; that its value is inestimable, having reference to this world and the next. Hence, they in every way neglect its interests. They eat and drink ; they walk and ride ; they will practise no self-restraint, but will indulge every caprice, every pas- sion, utterly regardless of the unseen and unloved embryo. They act with as much indifference as if the living, intelligent, immortal existence lodged within their organs were of no more value than the bread eaten, or the com- 72 BOOK II.] CRIMINAL ABORTION. [§ 92 the one case, the practice may be carried on for a considerable time with impunity, and hence a larger number of children be mon excretions of the system. Even in cases where mothers have suffered from repeated abortions, where foetus after foetus has perished through their neglect or carelessness, and where even their own health is involved in the issue, even in such cases every obstetrician can bear testimony to the great difficulty of inducing our wayward patients to forego certain gratifications, to practise certain self-denials, and to adopt efficient means for the salvation of the child. “This is not all. We can bear testimony that in some instances the woman who has been well educated, wTho occupies high stations in society, whose influence over others is great, and whose character has not been impugned, will deliberately resort to any and every measure which may effectually destroy her unborn offspring. Ashamed, or afraid, to apply to the charlatan, who sustains his existence by the price of blood, dreading, it may be, publicity, she recklessly and boldly adopts measures, however severe and dangerous, for the accomplishment of her unnatural, her guilty purpose. She will make extra-muscular efforts by long, fatiguing walks, by dancing, running, jump- ing, kept up as long as possible ; she will swallow the most nauseous, irri- tating, and poisonous drugs ; and, in some instances, will actually arm herself with the surgeon’s instrument, and operate upon her own body, that she may be delivered of an embryo, for which she has no desire, and whose birth and appearance she dreads. “These facts are horrible, but they are too frequent and too true. Often, very often, must all the eloquence and all the authority of the practitioner be employed; often he must, as it were, grasp the conscience of his weak and erring patient, and let her know, in language not to be misunderstood, that she is responsible to her Creator for the life of the being within her.”—On Criminal Abortion ; a Lecture introductory to the Course on Obstetrics, etc., in the University of Pennsylvania, by Hugh L. Hodge, M.D. Philadel- phia, 1854. In an article upon this subject (Annales d’Hygiene, 1856, v. 121), M. Tardieu, after referring to the crime as one allowed to go unpunished, and as a source of wealth to more than one midwife in New York, says (p. 125): “ In common with the magistrates and the mortality inspectors of Paris and its environs, I am convinced that criminal abortion constitutes a trade as free as it is immoral. So well is this fact known, that houses are openly shown where women may be sure of meeting with the wicked accomplices they re- quire, and which are notorious even beyond the frontiers. ” Statistical reports, analyzed by Dr. H. R. Storer (N. Amer. Med. and Surg. Journ., 1859), render it probable that the prevalence of this crime in the United States and in Europe is greater than those who have not examined the subject could conceive to be possible. Dr. Walter Channing, of Massachusetts, refers to the difficulty of obtaining a conviction for abortion, and adds : “I believe there has never been one in this State, this moral State by eminence, and per- haps in none is this crime more rife.” (Boston Med. and Surg. Journ., April, 1859, p. 135.) 73 §94] ABORTION AND FOETICIDE. [BOOK II. secretly sacrificed ; in the other, the career is usually short or interrupted, for its murderous consequences become too soon apparent. § 93. It is not necessary to describe the manner in which the operation is performed. The deplorable results of the clumsy manoeuvres usually practised are sometimes, though rarely, brought to light. An inquest was held at Nottingham in a case of abortion which had been produced by the intro- duction of a wooden skewer into the uterus. The child’s head had been perforated by this instrument; it was four and a half months old. A verdict was rendered, in accordance with the surgical evidence, that the woman had died of peritonitis, caused—by the rupture of an abscess in the ovary ! (z) A female, a single woman, went to the house of the prisoner, and, having informed her of her pregnancy, underwent an operation, as described by witness, of having a pin thrust up into the womb. This was repeated for several days, and it ended in the delivery of a male child of about six months’ development. The child was born alive, but died about five hours after- Dr. Channing relates the case of a woman who, believing herself to be pregnant, attempted to produce abortion by introducing into the womb a piece of soft wire bent upon itself for an inch or more at the further end. She succeeded in thrusting the wire into the uterus, but was unable to with- draw it, and, after suffering severe pain, she called in medical aid, but the wire could not be removed. Her attending phy- sician then cut it off as high up as possible, and six years after- wards the wire was still there. In this case the female was not pregnant.(a1) § 94. Zuchmeister(a2) says that he was called upon to remove a foreign body from the vagina, which had pierced one lip of the os uteri. Upon examination it proved to be a twig of the prunus spinosa, which is said by the reporter to be much used in Essen by those practising this detestable trade. (a) Lond. Med. Gazette, xlv. (a) Am. Journal, April, 1851, p. 526, from The Queen v. West, Carrington and Kirwan’s Nisi Prius Reports, vol. ii. p. 784. (a1) Boston Med. and Surg. Journal, April, 1859, p. 137. (a2) Allg. Wien. Med. Zeit., 1864, p. 81. 74 BOOK II.] MECHANICAL MEANS. [§ 95 § 94a. The operation required is one of an exceedingly deli- cate and difficult nature, and even those who are conversant with the anatomical arrangement of the parts interested re- quire to be careful in their manipulations. The operation ot inducing premature labor in this way has been sometimes at- tended with accidents. Thus, Dr. J. B. S. Jackson reports an instance in which the internal iliac artery was opened by an instrument introduced for the purpose of expediting labor.(6) A similar case is recorded, in which the left common iliac was punctured. In this case, which was brought to trial, the jury returned a verdict that the woman had died of a spontaneous rupture of the artery.(c) In France an attempt was made recently to produce abortion by the injection of a corrosive and irritating substance into the vagina. § 95. It is evident that in all these cases of local violence, should death result, a careful anatomical inspection would reveal the crime. In case, however, the woman survive the operation, a medical examination would probably he super- fluous. We do not recollect to have met with any case of criminal abortion more horrible than that reported in one of the Eng- lish medical journals.^) A man named Asher, known as an “herb doctor,” undertook, for the sum of two sovereigns, to procure abortion upon the person of a woman named Elizabeth Fletcher, who, in the absence of her husband, had become pregnant. The operation was performed upon the woman at his own house, and from that moment she began to suffer pain, which increased, and she became seriously ill. Asher being called upon to see her, “ introduced his hand and arm into the vagina, and kept them there from five to ten minutes, during the wdiole of which time the woman was in frightful agony.” From this time the pain increased greatly in severity, and vomiting commenced. Her death ensued in less than a week from the operation. An ex- amination of the body was instituted. There were marks of contusions extending from about two inches below the umbili- (&) Dublin Med. Press, Aug. 1848. (c) Ibid, (d) Med. Times and Gazette, March, 1835. 75 §96] ABOKTION AND FOETICIDE. [BOOK II. cus, on either side, to the symphysis pubis. The muscles of the abdomen, at this part, were infiltrated with pus, and co- agulated blood was found between them. Recent adhesions united the omentum to the surface of the intestines, and blood was extravasated in the vicinity of the uterus and bladder. The bladder was almost black, and in a state of gangrene. In its posterior wall was a large lacerated opening, and an aperture of considerable size in the corresponding part of the anterior wall of the neck of the uterus; two-thirds of the neck of the uterus were detached from the body of the organ. Through these openings the foetus had escaped from the uterus into the bladder, in which latter viscus it was found, together with some coagu- lated blood. This criminal, who is described as a “ gray-headed old man, upwards of sixty years old,” and who appears to have had much experience in performing those iniquitous operations, was sentenced to transportation for fourteen years only. § 96. (1) Premature labor is frequently induced in legitimate medical practice, for the purpose of avoiding the risks which in some cases attend parturition at term. The pelvis is some- times so much deformed, that a mature child cannot possibly be born alive. The choice, in such cases, lies between the Caesarean operation and an artificial premature birth. The proportion of children born at seven months that live, is, of course, smaller than if they were carried to the end of gesta- tion, and could be delivered; but as, in the cases of deformity alluded to, the child’s life must inevitably be sacrificed by birth through the natural passages, it becomes a vital question how its life may be preserved with the least risk to the mother. The statistics of the results of the Csesarean operation give no cheering view of its value; the danger to the mother’s life is infinitely greater than in the induction of artificial labor, which, in fact, in competent hands is a trifling operation. The average number of children saved by this means is rather more than one-half of the cases operated upon. The practice which, when first proposed, awakened some doubts as to its morality, has now received the sanction of the highest medical authori- ties, and is universally regarded as justifiable and beneficent. Although deformity of the pelvis is usually the motive for the operation, it may be properly employed in other cases, as, for 76 BOOK II.] [§ 98 SIGNS OF ABORTION. example, in women whose children habitually die before the term of gestation is reached, or who are suffering from diseases the danger of which is much heightened by the continuance of pregnancy. Yet the propriety of its employment in the latter case must be admitted with some reserve; the sym- pathetic phenomena of pregnancy are often far more alarming in appearance than in reality, and will rarely justify any inter- ference with the natural progress of gestation. In all cases, the physician should consult with one or more of his colleagues before inducing premature labor; in this manner, his humane intentions will not expose him, in case of failure, to reproach, suspicion, or prosecution. § 97. (2) Blows upon the abdomen are often designedly given with the view of causing a woman to miscarry. It is impos- sible to define the degree or mode of violence required to effect this purpose. Where uterine hemorrhage occurs shortly after ill-usage of this nature, it is reasonable to attribute it, and the abortion which follows, to the violence used. Great circum- spection is, however, necessary in giving a positive opinion when the hemorrhage preceding the miscarriage is not the im- mediate consequence of the injuries received, since a woman may happen to abort from other causes, or she may be near her confinement. In such a case, it may be necessary to de- termine whether labor has been spontaneous, or been provoked by the ill treatment. Ordinary labor does not commence with free hemorrhage (except in the case of placenta praevia), while, on the contrary, that which is brought on by blows upon the abdomen does so because the placenta becomes, by this violence, partly or wholly detached from the uterus. If the violence has, however, been inflicted upon other parts than the abdomen and loins, this criterion cannot be safely relied upon, and the dependence of the premature labor upon the injury must be established by other means. § 98. 5th. Signs of abortion.—The signs of abortion having taken place are obtained—(1) From an examination of the object expelled. This is necessary, in order to determine its human character and its probable age. Other bodies are expelled from the womb which bear a greater or less resemblance to the human embryo, but are not always the products of conception. 77 §100] ABORTION AND FCETICIDE. [book ii. Most frequently, however, they are the products of conception, but in a diseased condition. § 99. The substances called moles, which are not unfre- quently met with, fall under this denomination. The fleshy mole (also called “ false germ”) is composed of layers of fibrous matter inclosing a central cavity, in which sometimes frag- ments of the embryo can be recognized, but in others it ap- pears to have been dissolved in the amniotic liquor. This body is supposed to be a hypertrophy of the placental surface of the chorion. The hydatid mole, or mole vesiculaire, is cer- tainly a morbid alteration of the placental surface of the chorion. Velpeau and Mad. Boivin(e) have given so clear and accurate a description of the real character of this pathological product, that there remains but little of the mystery which formerly enveloped it. It consists of a dilatation of the cellular spongioles of the chorion. These increase, until they form a mass inclosing the ovum more or less completely. The remains of the foetus are sometimes found;(/) at others,again, the disease would seem to have originated at so early a period, that the embryo has become dissolved in the amniotic fluid. In this case, a trace of umbilical cord is sometimes found. These hydatids may remain in the uterus a much longer time than the usual duration of pregnancy ; and hence, as they are the result of conception, an opinion as to their probable age should be given with great caution, lest unjust aspersions should be thrown upon the character of the woman. The principal obstetrical authorities relate instances of the expul- sion of hydatids from the uterus at ten, eleven, and fourteen months after conception, and some agree in admitting that they may be retained many years. Dr. Montgomery says, that he has not met with any instance of such long retention.^) § 100. In cases of difficult menstruation, there are sometimes expelled substances which by some persons might be mistaken (e) Nouvelles Reclierclies sur l’Origine, la Nature, etc., de la mole vesicu- laire. (/) Dr. J. B. S. Jackson exhibited to the Society for Medical Improve- ment in Boston, a specimen, showing uterine hydatids connected with the membranes-of a four months1 foetus. Am. Journ. Med. Sci., April, 1850, p. 859. (jr) Pregnancy, etc., 2d ed., p. 267. 78 BOOK II.] MEMBRANOUS CONCRETIONS. [§ 102 for an early ovum. These are in some cases, false membranes, occasionally discharged entire,(h) preserving the shape of the uterine cavity ; in others, again, they are membranous concre- tions, originating from coagula of blood. The first variety is distinguished from the ovum by the absence of the flocculi of the chorion, to which the outer surface of the menstrual mem- brane, however rough it may be, bears no resemblance.(i) In the other, the central cavity is wanting, and no trace of um- bilical cord or placental surface can be found; besides this, it differs from the ovum in shape, being longer, thick in the middle, and pointed at either end. Of these productions, Dr. Denman says: “As the first cases in which this membrane was discharged were those of married women, a doubt arose in my mind wdiether it was not really a consequence of early concep- tion, hut I have lately had the most undoubted proofs that it is sometimes discharged by unmarried women, and may be found previous to and without connubial communication; and that the uterus has occasionally, or constantly, in some women, the property of forming it at or in the interval between the periods of the menstrual discharges. It seems particularly necessary to establish this fact, as the appearance of this mem- brane has more than once given rise to erroneous opinions and unjust aspersions.”(J) In examining doubtful masses expelled from the womb, they should be carefully cleansed and mace- rated in water, to dissolve the coagula. § 101. In conclusion, it may be mentioned that there can be no danger of mistaking for ova the polypi which are sometimes discharged from the uterus, since these are easily recognized by the remains of the pedicle, as well as by their structure. §102. The brief description given above of the various substances which may be discharged from the uterus, will suflice, we hope, to show that those which are called moles and hydatids are diseases of the appendages of the embryo, and that, even if no trace of the latter remain, yet the existence of (A) Dubois, of Neufchatel, gives the case of a girl who, at every menstrual period, expelled a hollow membranous body corresponding exactly with the shape of the uterus. Gaz. Med., 1847, p. 729. (t) Churchill, Dis. of Females, p. 103. (j) Introduct. to Midwifery, p. 161. 79 § 104] ABORTION AND FOETICIDE. [book II. these peculiar degenerations places the fact of impregnation beyond question; while, on the other hand, the products of a disordered menstrual function are so different in character as to be recognized as such without difficulty. § 103. The probable age of the ovum, or of the foetus, is ascertained from a consideration of the degree of its develop- ment. It is impossible to declare with positive accuracy the dimensions, weight, and degree of development of the foetus at any given period of its intra-uterine life. The date of con- ception can never be known with certainty, and even if it could, and the age of the foetus be ascertained, yet the weight and length, as well as the development, depend upon individual peculiarities. The same variety that is found in the bodily proportions of adults must prevail in the foetus. Hence, the statements which follow must be looked upon as averages only. § 104. At the earliest period at which the human embryo can be recognized, it is of a somewhat crescentic shape, with the cephalic extremity large and rounded; it is a semi-transparent viscid mass, and from the lower portion of its concave side the umbilical cord takes its origin. The vdiole ovum presents a loose, shaggy appearance, arising from the tufts of the chorion. A few weeks later, this is confined to only a portion of the surface of the ovum, from which the placenta becomes after- wards developed. In the course of the fourth and ffth week, the rudiments of the several parts of the foetus become distinct. The mouth is the first feature which is observed, and is very large, and of a triangular shape; the eyes are like two black specks, and the liver occupies the whole of the abdomen. A moving point can be seen where the heart is afterwards developed, but the blood is not yet of a red color. By the sixth week the forearm and leg are distinct, and the former is detached from the side, to which it was bound. The 7 # / rudiments of fingers and toes can be discerned. At the eighth week the head forms more than one-third of the body, the features are more distinct, but the sex is not yet manifest. Red blood is found in the vessels of the cord. At three months the foetus has attained the length of two to 80 BOOK II.] SIGNS OP MATURITY AND IMMATURITY. [§ 104 two and a half inches (Devergie), and the size of the whole ovum is about that of a goose’s egg. The fingers are separated, the toes are connected together by a soft substance, the soles of the feet are turned inwards, and the genital organs are quite dis- tinct, having indeed a size and prominence disproportioned to their subsequent development. At four months, the length is from five to six inches (Devergie, Velpeau), and the weight, as given by the best authorities, is very various, ranging from two and a half to eight ounces. At this time the pupillary membrane is more distinct than before, the skin is rosy but very delicate, and covered with a fine down, while the hair of the head is short, and of a silvery-white appearance. At five months, the foetus is from six to seven inches long, and Aveighs from five to seven ounces (Devergie). The head forms one-fourth of the body. The large intestines contain meconium in their upper portion. Quickening takes place usually at the beginning of the fifth month. In case of abor- tion at this period, the foetus usually escapes first through the ruptured membranes, these, with the placenta, following it. At six months, the head is no longer so disproportioned to the size of the body, and the umbilical cord arises a little above the pubis. The length is from nine to ten inches, and the weight one pound (Devergie). Fat is found in small quantity under the skin; the latter is of a purplish color, espe- cially in the palms of the hands and soles of the feet, as well as in the lips and ears. The scrotum, hoA\rever, is of a reddish color; the testicles are still in the abdomen. In females, the external labia project, but do not conceal the clitoris, which is large and prominent. The pupillary membrane is distinct and firm. The nails look like folds of skin. The hair is still scanty and short, and of a silvery-white color. At seven months, the foetus is found to have increased in all its proportions. It measures in length from twelve to fourteen inches, and weighs from two to three pounds. The bones ot the head are still yielding on pressure ; the frontal bone con- sists still of two parts; the ears lie close to the head; the arms and legs are bent in the position which they had in the uterus, if the child be born alive. At the eighth month, the length is vol. ii.—6 81 §106] ABORTION AND FOETICIDE. [book ii. from sixteen to eighteen inches, and the weight three or four pounds. The skin, in color aud thickness, is more like that of a child at term; it is covered with a fine short hair, and the hair of the head is of a darker color. Sometimes one of the testicles (generally the left) has descended into the scrotum; usually, however, they have not passed the abdominal ring. The pupillary membrane begins to disappear towards the close of the month. During the ninth month the foetus gradu- ally increases its length, until it attains from eighteen to twenty-two inches, and in weight on an average about seven pounds. The characteristic marks of maturity are considered to be the following:— § 105. The average length of a healthy, mature child is about eighteen inches, and its weight from six to seven pounds. Its skin is of a reddish-white color; the hair is pretty thick and strong; the nails of the fingers perfect, and the ears cartila- ginous. The limbs are firm and rdunded, and the testicles of the males usually are found in the scrotum. According to Moreau, the navel string is inserted a few lines below the centre of the body—a statement which is confirmed by the observations of Drs. Taylor,(A*) Ollivier, and Elsasser, although opposed to the opinion formerly held, that its point of attach- ment at the end of gestation was exactly the centre of the body. It is, moreover, firm and elastic. The child breathes and cries immediately after birth unless the third stage of labor has been protracted; is able to take the breast and swal- low, and within a few hours passes its urine and meconium. The meconium, however, is often not passed for two or three days; and in some cases is voided unobserved during birth. The presence of the vernix caseosa, a sebaceous secretion upon the skin, is found, according to Elsasser, upon about one-half of newly-born children. § 106. The several signs of immaturity may be thus stated in (k) Med. Jur.,p. 285, Am. ed. Diet. des. Sci. Med., Art. CEuf. Henke’s Zeitschrift, Bd. 42, p. 256. Dr. Elsasser also states, that in the well-propor- tioned adult, the middle of the body is not at the navel, but at the rising point of the mons veneris; a fact, which, he says, is generally received by artists and confirmed by a measurement of the best antiques.—S. Tabelle fiir bildende Kunstler von Joseph Mattersberger (nach Antiken), 1805. 82 BOOK II.] [§107 EXAMINATION OF THE FEMALE. general terms. The body is small, lean, and flaccid; the skin tender, wrinkled, red, and upon the palms and soles, purple; and the lips, ears, and genitals bleed very easily. The head is out of all proportion to the body, as is also the skull to the face; the bones of the skull are widely separated by membranous sutures, and very movable; the hair of the head is scanty, short, and silvery; the eyelids and lashes are downy. The face has an old and painful look; the pupillary membrane is present, and the ears are thin and membranous. The navel string is attached near the pubes ; the scrotum is very red, and not much wrinkled; the testicles are still in the abdomen; the lips of the vulva stand apart from each other, and the dis- proportionate clitoris protrudes between them.(T) The imma- ture child, moreover, breathes with difficulty; its voice is weak and whimpering ; it sleeps continually, cannot suck, and shows no desire for food. § 107. (2) The signs of abortion, as obtained by an examina- tion of the female, are not very certain in their character. It is seldom, indeed, that an examination of the living female is had, and especially at a period early enough to afford any valuable indications. When abortion occurs in the early months, it leaves but slight and evanescent traces behind it- A relaxed condition of the parts, which at the same time are covered with blood proceeding from the womb, resembles so closely the condition present during the catamenial flow that, practically, they could hardly be distinguished. The open state of the mouth of the womb may, in some cases, throw light upon the question. All these signs are, however, more distinct in the latter half of pregnancy, and, as the term of gestation approaches, closely resemble the signs of “ delivery.” (See § 23.) We also refer the reader for a consideration of the value of the corpora lutea, as indicative of pregnancy, to the chapter on the Signs of Delivery. We would merely repeat here, that although there is, in our opinion, sufficient evidence of a marked difference between the corpora lutea of pregnancy and those of menstruation, it requires more general assent and (Z) Bock, loc. cit., p. 241. 83 §108] INFANTICIDE. [book ii. more complete substantiation to allow positive inferences from their discovery to be put forward in criminal, or other import- ant cases, without reserve. For the latest views upon the corpus luteum vide Waldey- er’s article upon the Ovary and Parovarium, in A Manual of Human and Comparative Histology, by Strieker. H. Syd. Soc. Trans., Yol. II., p. 203. CHAPTER YI. INFANTICIDE. § 108. 1st. Characteristics of stillborn and living children.—• In the following considerations upon this subject, we shall restrict our remarks to the medical testimony required in the determination of questions arising out of the doubtful causes of death in new-born children. By this phrase we propose to designate those cases in which doubts concerning live birth may fairly be entertained. Those which do not require the solution of this question as preliminary to a judgment upon the fact or the manner of criminal interference, cannot, with strict propriety, be classified under the head of Infanticide. The degree of criminality of the offence is determined by the period at which it was committed, whether before or after birth; but manifestly this point is, at a certain period after birth, no longer subject to doubt. The mode of death at this time, whether criminal or otherwise, will be determined by the same general rules that are applicable in adult life. Hence the first purpose of medical investigation in cases of alleged infanticide, is to ascertain whether the child was born alive. The evidences of the child having; died before birth have been sought in the cessation of the intra-uterine movements and the sounds of the foetal heart, and in certain changes in the mother, such as a tendency to fainting, nausea and vomit- ing, loss of appetite and foul breath, a dull, pale, and dejected look, a sense of pressure upon the bladder and rectum, or of the falling of the contents of the womb from side to side, or, 84 BOOK. II.] INFANTICIDE. [§ 110 finally, the discharge of meconium or blood or the protrusion of the umbilical cord. But however probable these phenomena may render the death of the child, they do not demonstrate it. More certain signs are furnished by the condition of a child born dead, provided its birth have taken place three days or more previous to its expulsion from the womb. These will be described in another place.(^) § 109, In order that the reader may have a clear view of the evidence required to establish the fact that a child was born alive, it will be necessary to prefix to it a comparative sketch of the stillborn child and that which is born living. The visceral and other changes which indicate that a child has survived its birth, derive all their importance, as evidence, from a contrast with the condition and peculiarities of the same organs in the foetus: and the degree to wrhich the change has been accomplished, corresponds in general with the energy and extent of the new functions. Hence, before we can safely determine that a new-born child has been criminally destroyed, we must be prepared to show, as a necessary preliminary, and beyond the shadow of a doubt, that the essential foetal charac- teristics no longer exist. § 110. A child which is born dead, having perished immedi- ately before its birth, will be usually found, in medico-legal cases, owing to the hurry of concealment, to be still covered with the sebaceous secretion called vernix caseosa. Its hair is closely agglutinated; its ears lie closely to the head; the eyes are closed, and the eyelids when raised do not remain open. The mouth also is closed, and a drop of wuitery blood is often seen trickling from the nostril. The thorax, being unexpanded by respiration, appears flat and contracted, and the remnant of the umbilical cord has a fresher look than in a child which has lived for a few hours. The trachea is flattened, and often contains a viscid mucous secretion. The lungs lie in the poste- rior part of the thorax, and the rest of this cavity is often filled with a yellowish fluid of a slightly glutinous consistence. They are of a brownish-red color, more or less spotted in some cases, have a granular structure, and do not crepitate upon (Z1) See title “Abortion,” in index. 85 §1121 [book ii. INFANTICIDE. incision. Their length is greater than their breadth, and their edges are rounded. Their absolute weight is less than after respiration has occurred, since upon their expansion by this process, an active circulation of blood takes place through them; but their specific gravity is greater, their vesicular structure being undistended with air. § 111. A child which has been born alive presents the follow- ing characteristics; the period of survivance, the mode of death, and the time after it, at which the examination is made, have of course a considerable influence upon these. As a general rule, however, if the body be fresh, the remains of the vernix caseosa will be found under the armpits, behind the ears, etc., the hair will be dry and clean, the ears not so closely ap- plied to the head as in the stillborn child, and the eyes remain half open, in spite of all efforts to close them. The swelling upon the back of the head which is common in new-born chil- dren (caput succedaneum), in whom the head has been the pre- senting part, is far more marked in the child which is born alive than in the stillborn ; provided death has occurred before the expulsive pains of labor have begun. In the one case, it also contains a glutinous bloody serum, while in the other, the small quantity of liquid effused is colorless. The thorax is higher and more arched than in the foetus, and the diaphragm is depressed in a corresponding degree by the expansion of the lungs. As a general rule, according to Casper, the highest level of the diaphragm will be found between the fourth and fifth ribs in stillborn infants, and between the sixth and seventh in the living. § 112. The umbilical cord affords more valuable proof of extra-uterine life, as well as of the period of its duration, than any other of the external marks. It is generally of a bluish pearly-white color, of the thickness of a finger, and within twelve to twenty-four hours after birth, loses its polish and becomes dry and flaccid. The process of desiccation begins at the severed end, and in the course of twenty-four hours reaches to within half an inch of the navel; this portion of it still remaining pulpy and of an amber color. About this time the skin of the abdomen, around the attachments of the cord, becomes red and swollen, and is pushed up around it in the 86 BOOK II.] [§ 113 UMBILICAL CORD. shape of an inverted cone. During the second and third days the cord dries gradually away, becomes twisted and flattened like a ribbon, while the preparatory stage of separation is seen in the suppurative process which attacks the still moist portion by which it remains attached to the navel. On the fourth day, the cord is found to have acquired a yellowish-brown or black color, and in those parts of it not traversed by the umbilical vessels has the transparency and appearance of glue. The separation takes place more frequently on this than on the third day, but the time of its falling oft* is subject to great variation. According to the observations of Dr. Elsasser,(m) out of one hundred and thirty cases, it occurred— On the 4th day in 10 cases, on the 7th day in 16 oases, on the 10th day in 1 case. “ 5th “ 40 “ “ 8th “ 5 “ “ 6th “ 55 “ “ 9th “ 3 “ Cicatrization of the navel is generally complete by the four- teenth day. § 113. The process of desiccation above described is not inva- riable. Occasionally where the navel string is thick and pulpy, instead of withering and drying away, it will putrefy, even in the healthiest children. Elsasser has often made this observa- tion in his hospital at Stuttgart, and the fact is fully confirmed by the observations of Sommering and Osiander.(w) Moreover, the process of desiccation is not confined to the cord of living children alone. In two stillborn children, Elsasser found the cord still remaining on the fifteenth and twenty-eighth day respectively after birth. It had undergone complete desicca- tion into a horny substance, while the bodies of the children were at the same time considerably advanced in putrefaction. Pieces of umbilical cord cut off and exposed to the open air, at 40° to 60° Fahrenheit, underwent the same withering and desiccating process as in the living child, and without the least foul smell. These observations may appear to invalidate the statement of Billard, which has been generally accepted as correct, viz., that the desiccation of the cord is an act of vitality, and consequently cannot and does not occur in the stillborn child. That they do not, however, materially affect (to) Henke’s Zeitschrift, 1852, 4 Heft. p. 262. (») Uber die Nabelbriiche. Lekrbuck fiir Ilabammen. 87 §115] INFANTICIDE. [book ii. its truth is evident, when we reflect that the process in the living child commences immediately after birth, and is completed generally within three or four days, whereas, in these observations, actual desiccation did not commence until much later, in one case on the ninth day, and in the other as late as the twentieth day. Furthermore, in neither case %vas there any indication of the cord becoming detached, a process which is alone of no trifling significance, both as evidence of life and of its duration. Hence, the withering and desiccation of the cord give a fair presumption that the child has lived and the degree to which the process has advanced, a valuable indication of the length of time it has survived its birth. § 114. Several other subordinate signs of live birth may be alluded to before we consider those derived from the condition of the lungs. One of these is suggillation, or a discoloration resembling a bruise, and which has been held to be a proof that respiration occurred. But it is now admitted to furnish no reliable evidence of life after birth. The same remark is applicable to the difference of color, which, it is said, theoreti- cally, must be presented by the blood in the opposite cavities of the heart. The absolute or relative weight of the liver is also a fallible test. For although it is true that this organ di- minishes in size in proportion as the lungs assume their function, yet it is impossible by its means to determine in any particular case in what degree, if at all, the lungs have ex- panded, because the degree of contraction of the liver, not being referable to any fixed standard, can neither be measured nor estimated. The discharge of meconium, or of urine, as tests of breathing are also unreliable. § 115. Of late years great importance has been attached to the condition of the centre of ossification in the lower end of the thigh-bone, which, it is claimed by Casper and other autho- rities, presents a very reliable criterion of the age of the new- born child. \ The value of this sign was first pointed out by Beclard, Ollivier, and Mildner. Casper gives a table of one hundred and twenty-five cases in which he investigated the condition of the osseous nucleus, and as the result of these observations says:— “ a. "When there is yet no visible trace of the centre of ossi- 88 BOOK II.] [§ 116 LUNGS. fication in the inferior femoral epiphysis, then the foetus can be no more than from thirty-six to thirty-seven weeks old. “ b. The commencement of this osseous nucleus, which is at first about the size of a hempseed or the head of an ordinary fly (half a line), indicates a foetal age of from thirty-seven to thirty-eight weeks, supposing the child to have been stillborn; in the opposite case the child may have been born alive before this time, without any osseous nucleus, which then becomes developed during its extra-uterine life. In rare instances of unusually retarded development, a foetus of forty weeks may exhibit only a trifling commencement of this nucleus. “ c. When this osseous nucleus possesses a diameter of from three-quarters to three lines, it indicates that the foetus must have attained a uterine age of forty weeks, always supposing of course that the child has been stillborn. In one instance of unusually retarded development, with defective ossification of the skull, of a girl born perfectly mature, we found no osseous nucleus. “ d. We may conclude that the child has lived after its birth, when the osseous nucleus measures more than three lines. But, on the other hand, an osseous nucleus of less than three lines does not prove that the child has not lived.”(o) This symptom is only regarded as confirmatory by Casper, and as possessing especial value from the fact of the resistance it offers to putrefactive change. Voltolini (o1) reports an instance of exception to this rule where the nucleus measured four and a half lines, but in which the child died immediately after birth. § 116. The lungs are the source from which the most reliable proof of live-birth is derived. In the child which has per- fectly respired, the lungs occupy a larger space in the thorax than in the stillborn foetus. They fill up, in general, its cavity completely, and partly cover and conceal the pericardium. Their color is of a pale red, shading into blue on the posterior surface, and becoming brighter upon exposure to the air, or else irregular light-red spots appear upon a bluish-red ground. (a) Casper’s Forensic Medicine. New Syd. Soc. Trans., vol. iii. p. 27. (o') Casper, vol. xvi. Part I. 89 § 117] INFANTICIDE. [book ir. This gives them a marbled appearance, a peculiarity which cannot be given to foetal lungs by inflation. Their edges are sharp, here and there curved inwards or projecting in tongue- like processes. They feel tough but not solid when handled, and retain slightly the impression of the finger. They crepi- tate also when pressed or cut, and upon incision yield a small quantity of frothy blood. They are heavier than the foetal lungs, but specifically lighter than water, floating upon it both with the heart and thymus gland attached, and also when cut to pieces. When pressed between the fingers under water, air bubbles rise from them to the surface. The thorax is wider and more arched than in the foetus, and the diaphragm is lower than before respiration, its convexity not reaching above the seventh or eighth rib. As the conditions thus described belong to lungs wdiich have fully respired, a less perfect degree of them may be expected to be found when the respiration has been incomplete, and cases may even occur in which very small por- tions only of the pulmonary tissue have been penetrated by air, and consequently are capable of floating when subjected to the hydrostatic test. The condition of the larynx before and after breathing is not the same. In the former case it is narrower, is occupied by mucus, and is closely in apposition with the epiglottis; but in the latter this covering no longer closes the opening to the larynx. None of these conditions, it will be observed, affect the question when the child breathed? They are equally con- sistent with breathing before and after birth. § 117. Certain changes take place in the foetal channels for the circulation of the blood, upon the occurrence of respira- tion. As, however, these changes are gradual in their nature, they can hardly with propriety be enumerated among the signs of live-birth. They are only considered in this place from the fact that they commence at birth, although not perfected until a later period. From the cases reported by Elsasser,(o2) it will be seen that the obliteration of the foetal channels occurs in a very indeterminate manner. In forty-eight out of fifty-two mature stillborn children they were all open except in four, in (o2) Henke’s Zeitsch.., 1841 and 1852. 90 BOOK II.] FCETAL CHANNELS. r§ ns which the foramen ovale was closed. In ninety-two who died in the first month, they remained open in two-thirds. Later researches on a still more extensive scale by the same indefati- gable author, prove, as the result of the examination of three hundred and seventy cases, the little reliance which can be placed on so variable a test. In illustration of this fact, we may remark that in one stillborn child the ductus venosus was found closed, and in a child which lived only a quarter of an hour, the foramen ovale and ductus arteriosus were both closed. On the other hand, in a child thirty-nine days old, he found all the foetal channels remaining open. Dr. Horman Chevers(p) substantiates this statement by the facts which he has collected respecting the frequent contraction and obliteration of the foramen ovale and the ductus arteriosus before birth. It is evident that if but one authentic case exists in which any of the foetal channels have been found closed at birth, it is enough to throw doubt upon any case in which its closure is assigned as a proof that the child must have survived its birth. More- over, the continued patency of these channels is of still less importance in a medico-legal sense than their closure, since the foramen ovale and ductus arteriosus are found open in certain cases in adult life. We have ourselves elsewhere brought abundant proof of this fact.(g) § 118. Professor Bernt,(r) of Vienna, has endeavored to de- termine, by means of the progressive closure of the foramen ovale and ductus arteriosus, the period during which the new- born child has survived, and his views have heretofore met with considerable attention, and been adduced as authority. He says: “1. If the child has lived only a few seconds, the aortal end of the duct appears contracted, and the vessel, in- stead of being cylindrical throughout, acquires the form of a truncated cone. 2. If the child has lived for several hours or a whole day, the duct becomes again cylindrical, although short- ened and contracted in diameter. Its size is about equal to ( p) Med. Gaz. xxxv. and xxxyi. () One of these occurred to Dr. Falkenbach, who, during the operation for turning for a cross birth, and while the child was undoubtedly within the uterus, heard it cry loudly several times, as did other persons in the room. The other case is of still more importance, and occurred also during an attempt at version. The tone of voice was like that of a new-born child, only dull, as if it came from a cellar. It continued crying at intervals for two or three minutes. After this, delivery progressed rapidly, until the shoulders arrived in the pelvis, which was rather narrow, while the child was a large one. The child was born dead, beyond recovery. Its cries, while in the womb, were heard by three other people in the room, as well as by the midwife, who was hard of hear- (w) Brit, and For. Med. Cliir. Rev., Jan. 1850, from Med. Zeitung, Nos. 20 and 80. Another case lias been still more recently reported by Dr. Knuppel. In consequence of a cross position, the child was turned, during which operation vagitus was distinctly heard. It was, however, horn dead. The lungs were of a pale red color, filled the chest completely, crepitated on incision, and swam in water. Canstatt’s Jaliresbericlit fur 1853. VII. Bd. p. 19. vol. ii.—7 97 §126] INFANTICIDE. [book ii. ing. 'The chest was examined twenty-four hours afterwards, and was found to be well expanded. The lungs partly covered the pericardium. They were removed, in connection with the heart and thymus gland, and being placed in a basin of cold water, swam completely. The lungs were of a bright-red color, with bluish spots here and there. They crepitated on incision, and some foam and a little blood flowed out. When cut under water, large air-bubbles rose to the surface: not the smallest portion of the structure sank. This last case is, ex- cept that in note (w>), we believe, the only one in which the lungs, in a case of uterine vagitus, have been submitted to the hydrostatic test; and hence, from it, we have undoubted proof of the possible occurrence of uterine respiration, and an increased probability of the observations in the previously related cases having been accurate. Two cases are related by Kirbyand another by Kristeller.(tt?2) In the latter, resuscitation was accomplished after apparent death. § 125. We have assumed that uterine respiration must be imperfect, a position which seems to be contradicted by this case ; but we find it stated by the author that “ the air cells of the periphery had not become completely filled with air,” a fact which we will not undertake to reconcile with the state- ment that no part of the lungs sank in water. § 126. The extreme rarity of uterine and vaginal respiration and vagitus is evident from the few authentic cases upon record, as well as from the incredulity with which the fact has been received by some authors. Moreover, certain obstetricians of most extensive experience state that they have never wit- nessed this phenomenon, and Baudelocque and Capuron declare that even in cases where the face and mouth of the child pre- sented at the vulva, giving a favorable opportunity for the access of air, they have never observed it. We are not able to define the causes which favor its occurrence in some cases and not in others, nor explain how the air could gain access to the lungs in cases like those above narrated, and in others which might be referred to. All that can be safely asserted is, that (w’) Bayer, Austzl. Intell. Bl., 1865. («?2) Prag. Yjhrsschrft, 88, p. 121. 98 BOOK II.] VAGINAL RESPIRATION. [§ 127 this phenomenon never occurs before the rupture of the mem- branes and the dilatation of the mouth of the womb, and that it has been observed, as yet, only in tedious labors, or when the hand of the accoucheur has been introduced to assist the de- livery. Dr. Beck relates two cases in which it was distinctly perceived under this latter contingency. It is not, however, a necessary element for its production. As vagitus uterinus has only been noticed in lingering and assisted labors, which characters hardly ever pertain to concealed deliveries, Casper thinks that this disputed physiological rarity need not enter into the question which a medical expert is called upon to answer. § 127. Another, and in its practical bearings more important condition, under which imperfect respiration may take place before birth, is after the delivery of the head, while the body yet remains in the vagina and the womb. It is undeniable that in this position the child often breathes and cries. The delivery of the body may be retarded by various circumstances, the principal of which are a too great size of the shoulders, a sudden cessation of the expulsive pains, and compression of the neck of the child by the umbilical cord. The fact, as above stated, is beyond all cavil, and Ritgen, a German ob- stetrician of high standing, from the frequency with which he has observed it, considers it not even exceptional. It will be readily seen how much doubt this fact may cast upon the question, whether the child has been born alive. It may breathe before it is fully born, and yet, as it is not accounted by the law to be born until fully expelled from the mother, fatal violence exercised upon it in this situation has been ad- judged not to constitute the crime of infanticide. We shall allude more in detail to this fact under “ Causes of death in new-born children.” (w3) In the same place will be found an account of those causes of imperfect respiration which act after birth. It sometimes happens that after the delivery of the head of the child, and after it has breathed and cried, its res- piration is impeded, and may be arrested by the pressure of the umbilical cord encircling the neck. The cord may be wound (w>3) § 149 et seq. 99 § 128] INFANTICIDE. [book ii. several times around the neck, so tightly as to render its dis- engagement without severing it, impossible, and hence, after the delivery the child may he incapable of resuscitation, and, in some rare cases, even bear upon its neck the marks of stran- gulation, and in its lungs the evident signs of its having re- spired. If, under such circumstances, the birth is not witnessed by a competent person, suspicions of having inflicted a violent death upon her offspring may unjustly attach to the mother.(w;4) § 128. 2d. Tests of live birth. — The most important of the proofs of live birth, which, from their general application, have been called “ tests,” are derived from an examination of the absolute and the specific weight of the lungs. Although the data yielded by them are said to prove life, they do so only in- cidentally, by proving respiration; and although, in criminal practice, it is requisite that the fact of respiration should be established, yet it is important to bear in mind that there may be life without respiration. The circulation may go on, and the child may make various muscular movements, after it is sepa- rated from the mother, without respiring. Sometimes, owing to congenital feebleness, or to its being in an asphyxiated con- dition, it makes no effort to breathe; and again, all its efforts may be fruitless, from the obstruction of the fauces and larynx with viscid mucus. Hence, paradoxical as it may seem, a child may live and die without having breathed. In such a case, the lungs will, of course, reveal no trace of respired The attempt too strictly to define the essential conditions of life has led to some absurd conclusions. In Germany, a distinct vocal sound is required by law as the evidence of life. But this ap- pears to be modified in practice by the substitution of breathing for vocal sound, and the doctrine is accepted that respiration and (w4) Vide infra, § 150. (*) This fact Avas urged as an objection to the hydrostatic test by th( Wittemberg Faculty (Valentin’s Pand. Med. Leg., p. ii. sec. vii. chap. 12, p. 583, ed. 1701), at the very beginning of its application to medical jurispru dence. We have ventured to depart from the custom of medical writers or this subject in treating of it under this head, because the object of the hydro static test is to ascertain whether the child has breathed, and not to deter- mine the fact of its having lived without respiration. 100 BOOK II.] TESTS OF LIVE BIRTH. [§ 129 life are reciprocally evidences of one another. According to this doctrine, intra-uterine life is not life in the sense of life after breathing. Plants, and those animals which breathe by the skin or by gills, do not, according to it, really breathe. But if we admit that breathing essentially consists in the act or acts by which the effete circulating fluids of a living creature are renovated, we shall see that life is consistent, not only with very dissimilar modes, but also with very irregular degrees of that renovation. The foetus in utero, while still inclosed in its membranes, has its blood renovated by juxtaposition with that contained in the maternal bloodvessels, and thus, indirectly but substantially, it breathes through the lungs of its mother. Although the mechanism of its respiration is different from that which will exist after birth, its essence and effect are the same. Again, even in the adult, examples are constantly met with of life without perceptible breathing, as in syncope and trance, states in which it is true that life is probably sustained by the exchange of the foul air in the lungs with the pure external air, under those laws which regulate the diffusion of gases. Yet in the popular sense there is no respiration, although there is life, and a life which, indeed, is generally manifested by the sound, however feeble, of the heart’s pulsation. The new-born child, therefore, although it presents the aspect of death, is not necessarily dead; its near approach to lifelessness may even become the means of saving its life under circumstances which would infallibly have pro- duced suffocation and death, had respiration been complete. § 129. The following may serve as illustrations of the state- ment just made. Weese reports the case of a female who was rapidly delivered of a child in a tub, and, believing it to be dead, buried it in a sand-pit, where it remained for half an hour, but was then disinterred and restored to life. In another case, at Berlin, the child, supposed to have been born dead, was buried for the space of an hour, but was resuscitated. In a third instance, a child apparently born dead, and so considered after an hour vainly spent in efforts to resuscitate it, was then abandoned for several hours, after which it was inclosed in a coffin and placed in a cold chamber (it was the month of Jan- 101 [book ii. §130] INFANTICIDE. nary), near an open window. Twenty-three hours after its birth the body was quite cold, but free from discoloration or stiffness. Owing to the latter circumstance the heart was ex- amined, and, being heard to pulsate, renewed attempts at re- suscitation were made. But finally all signs of life ceased. On dissection the lungs sank in water both in mass and in fragments. Another instance is still more remarkable, from its result. A woman buried her illegitimate child, which she supposed to be stillborn, nine inches under ground, and with the face downwards. It remained thus between four and five hours, when it was exhumed, resuscitated, and lived three days.(y) A case nearly identical with this is referred to by Briand, who, however, states that the life of the child was It is, then, quite possible that life may have existed in spite of every reasonable presumption of its absence, founded upon an inspection of the child both before and after its certain death. § 130. If the argument should ever be used in any case of infanticide, that the violence was inflicted upon a child which had lived without breathing, it would have to be sustained by other testimony or evidence than that of a medical expert; since there is no medical proof of extra-uterine life, independent of respiration. Hence, the commission of infanticide, by sub- merging a child in water before it has breathed, or the exclu- sion of air from it in any other way in which no external mark is left, deprives the medical examiner of the means of deciding whether the act was committed upon a living child; because, we repeat, the lungs remain in the same condition after as before birth, provided respiration has not taken place, and, in the short interval of existence possible under such cir- cumstances, no other change could occur which could be relied upon as an indication of life.(u) It would appear that the effort to breathe, although unsuccessful in inflating the lungs, may, nevertheless, modify the circulation of the blood so as to leave certain proofs of the fact. These, which (;y) Maschka, Prager Vierteljalirs., 1854, iii. s. (z) Medecine Legale, Geme ed., p. 209. («) Henke’s Lelirbucli, 12tli ed., p. 841. 102 BOOK II.] TESTS OF LIVE BIRTH. [§ 131 were first pointed out by Tardieu,(6) are what Casper lias de- nominated petechial suggillations, and which he describes as capillary extravasations of blood beneath the pleura and the lining membrane of the aorta and the heart. § 131. Liman describes these ecchymoses under the pleurae and other serous investments, as varying in size from that of a pin’s head to that of a liempseed ; they remain attached to the serous membrane when it is stripped oft*, nor can they be re- moved by washing. Liman does not think, with Tardieu, that they are a certain sign of asphyxia, and, though most common in suffocation, they furnish no clue as to the mode of its pro- duction. Their occurrence is accounted for by the theory that the powerful inspirations overcome the resistance of the cap- illaries. While their presence is an important sign of death from suffocation, their absence does not furnish equally strong proof that death has not occurred in this way.(^) In a case quoted from Hecker, there was prolapse of the cord, and, the introduction of the hand to effect version of the child having necessarily compressed the cord, and thereby sus- pended the circulation through it, several inspiratory move- ments of the child could be distinctly felt. It was not, how- ever, born alive, and extravasations like those just described were discovered on dissection. Similar observations have been made by Hohl, in cases of foot and breast presentation when the head was detained in the uterus or vagina; the inspiratory movements of the chest were frequent and vigorous, the children nevertheless were born dead, and the pleura and heart presented the ecchymoses referred to, and the lungs sank when placed in water.(c) It may naturally be inferred from what has now been stated, that, if any cause interrupts the fcetal circulation during labor, an inspiratory effort will be made, and, if the mouth and nose of the child are still immersed in liquor amnii, this fluid will tend to enter the respiratory pass- ages. Dr. Briesky has published four cases,(d) in which the heart of the foetus was heard during labor, but life was extinct at birth. In all of them the air-passages were filled with (5) Annales d’Hygiene, 2eme ser., iv. 379. (¥) Casper, yoI. xix. p. 73. (c) Gericht. Med., i. 706. (d) Prager Vierteljahrs, 1859, iii. 175. 103 §132] INFANTICIDE. [book ii. liquor amnii more or less tinged with meconium. In the first case the cord had prolapsed, as in the example already cited, and had been subjected to pressure, so as to favor the inspira- tion of the liquid; in the remaining three an analogous cause within the uterus may be surmised to have existed, but could not be demonstrated. In all of these cases extra-uterine life was rendered impossible by a physical obstacle in the lungs preventing the access of air to these organs. § 132. (1) Hydrostatic lung test (Docimasia pulmonum hydro- statica).—This is an experiment in which the lungs of a new- born child are placed in a vessel containing water, in order to judge from their specific gravity whether or not the child has breathed.(e) Its first application in medical jurisprudence was made by Dr. Schreyer, of Zeitz, although the principle was known, it is said, by Galen. The experiment is conducted in the following manner. The lungs are carefully removed from the chest, with the heart attached or not, but always in con- nection with the trachea. They are then placed upon the surface of pure water. If they float, the evidence is very clear that they contain air, and the higher they float the more per- fect has their expansion been. If, on the contrary, they sink to the bottom, the evidence is equally plain that they contain air to a very imperfect extent, if at all. In order, however, to judge fairly of their degree of buoyancy, and to ascertain how much and what parts of the organs contain air, a further investigation is required. The thymus gland, with the heart and pericardium, should be removed with care, to avoid in- juring the pulmonary tissue, after which the lungs should be again put in the water. Each lung should then be tried sepa- rately, and finally divided into small pieces, and each of these thrown by itself into the water, before and after compression between the fingers. By carefully observing the results elicited by this experiment, satisfactory proof of the presence or absence of air in the lungs may be acquired. At this stage of the in- quiry no further inference is allowable; we can neither say that the child has lived and breathed, because its lungs float (e) Valentin, Pand. Med. Leg., Par. ii. sec. vii. p. 502. “ De infanticidio per-pulmonum in aquam project, subsident. elidendo.” 104 BOOK II.] [§ 134 PUTREFACTION. on the water, nor deny that it has lived if they sink to the bottom of the vessel. And yet this experiment must always retain its great importance in cases of presumed infanticide. Restricted within its proper limits and sources of error pro- perly guarded against, there is no medical test so simple and conclusive.(/) As Dr. Taylor remarks, “ the law holds, under the decisions of its expounders, that respiration is only one, and not an exclusive proof of life.”(a) § 133. The objections made to the hydrostatic test are founded upon two facts:— 1st. That the air which gives buoyancy to the lungs may have been derived from other sources than natural respiration; and, 2d. That notwithstanding the absence of demonstrable air from these organs, the child may have lived. The sources from which the air may have been derived are, Putrefaction, Emphysema, and Artificial Inflation. Putrefaction.—At an undetermined stage of the putrefactive process, gas is disengaged by the decomposition of the blood contained in the lungs, and sometimes in sufficient quantity to give buoyancy to the whole or a portion of them. The air thus evolved is, however, not contained in the pulmonary vesicles, but in the cellular tissue, and chiefly between the lobes and on their margins. Here it is seen collected in rows of bubbles, much larger than the air-vesicles, prominent, and easily disappearing under slight pressure. At the same time, the lungs present other signs of the putrefactive process, in their greenish color, diminished consistence, and fetid odor. The period at which the putrefactive vesicles are developed is not accurately known, and is influenced by circumstances, as, indeed, are all the other incidents of putrefaction. § 134. It is a fact, however, worthy of remark, that this pro- cess is set up later in the lungs than in most of the other organs of the child. This fact is attested by many writers, and particu- lar stress is laid upon it by Dr. Casper. In four cases examined by this author, where the child’s body was already greatly (/) De usu partium corp. human., lib. xy. cap. 6. (a) Med. Jurisp., 6th ed., p. 451. 105 106 INFANTICIDE. [book ii. decomposed, the lungs retained their firmness and dark-brown color, and sank in water. In one case the heart and liver were both covered with putrefactive vesicles, and swam upon the surface of the water, while the lungs, which were firm and brown, sank to the bottom.(6) I have, myself, frequently found the lungs of new-born children entirely unchanged in color, consistence, and appropriate hydrostatic relations, when at the same time the brain was reduced to a mere pulp, the abdomen thoroughly putrescent, and the epidermis peeling from the whole body. The striking changes which attend the commencement of decomposition in the lungs cannot permit an error on the part of the examiner. Should the buoyancy ofi the lungs be due to putrefaction, by the development of spurious air-vesicles upon the pulmonary tissue, the fact may be easily recognized, and ascribed to its real cause. Should, however, no signs of putrefaction in the lungs be found, and yet these organs float, the objection is theoretical merely, and not at all pertinent. The obvious inference is, that the objec- tion cannot be urged, when there is no proof of its applies bility to the case in hand. It is not unnecessary to press these apparently simple truths upon the attention of the reader, for every day’s experience in forsenic medicine attests the false im- portance attached to irrelevant objections. "When the above- mentioned changes have supervened in the lungs, they can no longer be used in evidence, since the buoyancy of these organs may be due to air derived either from decomposition or from respiration. A discrimination between the two at this period is manifestly impossible. § 135. Emphysema was formerly distinguished from putre- faction, as a condition giving buoyancy to foetal lungs. It may safely be asserted that no such condition is found in lungs which have not respired. It is probable that the older authors mistook for it the appearances presented by putrefaction. Drs. Cummin and Lecieux(c) speak of a “ sort of contusion suffered (5) Casper’s ger. Leicli. off. 1 and 2 Hundert, Falle 67, 68 ; 65, 66. (c) The Proofs of Infanticide, by Wm. Cummin, M.D., p. 61. Consid. Med. Leg. sur 1’Infanticide par Lecieux ; vide also, Schmitt, loc. cit.; Ver- such 32 ; S. 41 and 212. 106 BOOK II.] [§ 136 EMPHYSEMA. by the lungs in difficult labors, to which they attribute the development of air in large vesicles on their surface,” while the lungs presented at the time no signs of putrefaction ; but these observations have not been confirmed by others. Mr. Taylor(d’) says, that in examining the bodies of many stillborn children, he has never met with any appearance resembling what has been described as a state of emphysema, indepen- dently of respiration and putrefaction. Toulmouche(cP) regards the occurrence of emphysema as very rare, and says, that when present, it is never sufficient to give buoyancy to the lungs of a foetus which has not breathed. Casper is equally decided, saying, “ that as yet, not one sin- gle well-observed and incontestable case of emphysema, devel- oping itself spontaneously within the foetal lungs, is known, and it is, therefore, not permissible in forensic practice to as- cribe the buoyancy of the lungs of new-born children to this cause.”() Henke’s Zeitsch. 1835. Uber Umsclilingimgen der Nabelsclmur nm den Hals der Kinder bie der Geburt, in forensisclier Hinsicbt. Also, Henke’s Zeitsch. 31 Erg. H. 1842. 121 §153] INFANTICIDE. [book 11. the authority of Carus, Wildberg, Mende, Albert, and other obstetricians. The marks are described as very various in their character; sometimes being merely furrows in the skin, with- out color, and sometimes red or blue stripes crossing each other and occasionally extending a short distance over the breast or back. Mr. Foster(_p) reports a case in which the child was born dead, the labor being very tedious. The um- bilical cord was twisted around the neck, leaving three parallel colored depressions. Dr. examined a new-born child found dead, in which the navel cord was coiled twice around the thigh, passed across the front of the body, and crossing the shoulder-blades, formed a tight loop around the neck. On the left side of the neck, beginning at the ear, there was a purple discoloration of the skin in two directions, viz.: towards the nape of the neck and towards the breast, corresponding to the parts which were pressed upon by the cord. There was no indentation nor ecchymosis, and the death of the child was found, upon examination, to be due to violence. Two cases are given in the same journal by Dr. Albert(r) in which the cord left a groove upon the neck, three or four lines wide, and of a dark blue color. The face in both cases was livid and turgid; and in one, in which the child had partially breathed, the eyes and tongue protruded, the latter being blue and swollen. § 153. A real ecchymosis, or extravasation of blood under the skin, has probably been observed but seldom in accidental strangulation by the umbilical cord.(5) A livid mark does not always indicate an effusion of blood, but is frequently caused by simple congestion—a fact which is proved by its rapid disappearance if the child survives.(0 It would not be safe to assume that the existence of ecchymosis disproves the possibility of this accident, because, in addition to the possible occasional occurrence of extravasation, it must be remembered i that the marks remaining after intentional strangulation are ([p) Med. Gaz. xxx. vi. 485. (9) Henke’s Zeitsch. Erg. H. 23, p. 29. (?*) Ibid. Bd. 42, p. 207. («) Elsasser, loc. cit. 1842, p. 7. (0 Windel, Henke’s Zeitsch. Jahrg., 1836, 1 Heft. ; Heyfelder, Med. Annal., Heidelberg, 1838, S. 258; Eichorn, Med. Cor. Bl. bayer, Aertze, 1840, Aug. 8. 122 BOOK II.] STRANGULATION BY THE UMBILICAL CORD. [§ 154 not always accompanied by it. Even in hanged persons, an extravasation of blood under the mark of the cord is not always found. Nevertheless, if ecchymosis be found under a deep and discolored mark upon the neck, and at the same time there is abrasion of the cuticle or laceration of the skin, such an injury cannot possibly be attributed to the umbilical cord. This opinion is held by Dr. A. S. Taylor,(u) and is fully sub- stantiated by a large number of recorded cases. In order that the reader may form an approximate estimate of the pro- portion of children born dead, in consequence of strangulation by the umbilical cord, we may state that Elsasser reports, that, out of 318 children born with the cord around the neck, three died, or one in 106 ; Carus found one in 43 ; and Siebold, one in 61 cases. Two points, however, must not be forgotten in connection with these data, viz., that they were all cases of labor where the best assistance was at hand, and that a certain number of the children were born apparently dead, but revived under the use of proper restoratives. The mortality in con- cealed and unassisted deliveries would certainly be much greater. Hence a woman, secretly delivered, may be unjustly accused of infanticide whose child has perished from a purely accidental, and by her, irremediable cause. In fact, the cord may be twisted around the child’s neck or body during preg- nancy, and its death is thus sometimes accomplished before the occurrence of labor.(?;) § 154. The child is not unfrequently wilfully strangled before it is completely born. When a ligature is found upon its neck, there can of course be no longer a question whether the impressions made were due to the umbilical cord. The defence is usually that the ligature was placed upon the neck by the woman herself, with the object of assisting her delivery. No medical evidence can disprove such a statement. If, how- ever, the child has been strangled by the hand, whether wil- fully or by accident, in attempts at self-delivery, the impressions left will be of a different character from those produced by (u) Med. Jur., p. 343. (w) Daubert, dissertat. de funiculo umb. foetu circumyoluto. Gotting. 1808. Preyer, de partu diflic, propter funic, uinbil. foetus collum obstringentem. Halle, 1765. 123 § 156] INFANTICIDE. [book ii. the constriction by the umbilical cord. A consideration of these will be found under the head of Strangulation after birth. We may, however, mention in this place, as thg chief charac- teristic, that the indenture or discoloration made by the um- bilical cord surrounds the neck entirely, which is never the case in death from hanging. The mark made by the umbilical cord is moreover broad, the depression is cylindrical, and its edges are soft, and it is not excoriated as when a string or other hard substance has been used. Moreover, this depression is rarely single, as in cases of violence, but oftener double, and occasionally triple, nor is it, as in the other case, hardened at the edges, or accompanied by subcutaneous ecchymosis.(a) It may be sometimes important to remember that, in fat children especially, if the neck be short and the body have been kept or found in a cold place, the fat, becoming con- gealed in the folds of the skin upon the neck, will give rise to furrows, which, to those who may disregard the other signs of strangulation, may suggest the suspicion of a ligature having been used.(6) § 155. (b) Protracted delivery.—The child frequently dies solely in consequence of the protraction of the labor, and this is especially the case in first labors, or where the membranes have broken early in the first stage. In such cases, death takes place usually from congestion of the brain, in consequence of the compression it suffers. After such tedious labors, the head becomes apparently elongated, and over the occiput a tumor forms, often called caput succedaneum, caused by a con- gestion of the vessels of the scalp and an exudation of bloody serum into the cellular tissue under it. § 156. (c) Debility.—The child may die, also, from consti- tutional feebleness, inherited from its parents, or produced by causes acting upon it during its intra-uterine existence. It may survive its birth a few hours or days, and then perish (а) Casper, op. cit., i. 804. (б) Tlie degree of pressure which the cord may exert during foetal life is illustrated by those cases in whifli deep impressions and consequent mal- formations of limbs have resulted from this cause. Even the amputation of a limb has been observed as an effect. Such a case is recorded in Virchow’s Archiv, x. 110, by Dr. Frickhoeffer, who also cites three analogous instances. 124 [§ 157 BOOK II.] HEMORRHAGE FROM THE CORD. from inherent debility or the neglect of some trifling pre- caution, which in a healthy child would be of little importance. The inspection of the body will often warrant this judgment when there is no other evidence to show the cause of death. § 157. (d) Hemorrhage from the umbilical cord.—If the body of a new-born child present the evidence, in its blanched and waxy hue, and in the paleness and dryness of the internal organs, particularly of the heart and lungs, of a great loss of blood, the hemorrhage will have proceeded, when no wounds are found which will otherwise account for it, from the um- bilical cord. This rule, which is generally admitted, is, how- ever, not applicable when the body of the child is already decomposed ; since, during the putrefactive process, according to Casper, the body parts with a considerable portion of its blood. The hemorrhage may have been accidental,( he can seldom decide with certainty how they were made, and much less whether before or after complete birth and respira- tion. It is sometimes necessary to know whether the marks of strangulation could not have been produced after death. This, upon good authority,(u) may be answered in the affirma- tive, if the body be still warm when the constricting force is applied. The question as to whether the umbilical cord had been severed before the strangling was attempted, is of no im- portance in a medical point of view, since this circumstance will not in any manner affect the signs of the mode of death, and respiration may have been perfectly well established long before the cord is cut. A case is related in the Lancet,(v) where a child, with the placenta attached to it, was buried in the ground, and covered one inch and a half deep with earth. It was found that at least half an hour had elapsed since the earth had covered the child, and yet, when it was taken up, respiration was still going on. § 171. Maschka relates a case(y) where a child was found in a privy. The heart and lungs floated, apparently from decom- position, for after pricking the bullae and compressing the lungs they sank, yet faeces and sand pervaded the smaller bron- («) Casper’s Wocliensckrift, 1837; Ollivier (d’Angers) Ann. d’Hyg., vol. xxix. p. 149. (v) Am. edit., 1850, p. 513. (y1) Yiertel. f. Ger. Med., 1865, N. F. Band II. p. 87. 139 §173] [book ii. INFANTICIDE. chial tubules. The decision given by Maschka was that the child had been dropped into the privy alive, and had there attempted to breathe. The mother stated that it was expelled from her while she was at stool. § 172. (d) Drowning.—The signs of death by drowning, in the new-born child, do not differ from those found in the adult, and are elsewhere fully considered. Generally, however, children which are found dead in the water have been thrown into it, for the purpose of concealing the body, after they have already perished by natural or criminal means. Hence it is not often that the peculiar signs of death by drowning will be met with, but, in all cases where children are found dead in the water, search should be made for traces of other violent injury, and it should be especially noted whether respiration has occurred. If marks of violence are found upon the body, particularly fractures, they must be carefully examined for the purpose of ascertaining, if possible, whether they could have been accidentally produced by substances in the water, or whether they were not rather due to criminal violence, and in- flicted during life. Such a question will very naturally arise, when, for instance, a large stone is found in the bag in which the child has been thrown into the water. A case of this kind has been reported in Henke’s Zeitsclirift. The general rules elsewhere detailed, by which a distinction may be made be- tween wounds inflicted before or after death, are applicable here. These signs will not be affected by the submersion un- less putrefaction has taken place. §173. (e) Wounds.—The general distinctions between wounds inflicted before and after death are considered in the chapter on Wounds, Book V., Part II. The remarks there made are equally applicable in the case of new-born children.(v2) (®2) Wounds found upon a child may have been inflicted in utero, just as the fractures are which have already been referred to. Mr. Lynch (Brit. Med. Journ. and Abeille Med., xv. 95) reports the case of a child horn dead at the eighth month with a contused wound of the back, looking as if the skin and muscles had been violently torn from the occiput to the sacrum, and also as if the part had begun to heal. A week before the mother had met Avith a fall upon a piece of wood. In another case, reported by Dr. Finnell, there existed a penetrating wound of the leg which he attributed to a stab in 140 BOOK II.] WOUNDS IN THE NEW-BORN CHILD. [§ 173 Wounds inflicted upon them being very rapidly fatal, the signs which show that they were made during life, drawn from the ensuing inflammation, rarely come under notice. The cha- racter of the blood effused is, however, a diagnostic sign of great value. If this is found coagulated, there can be little doubt that the child was living when it received the injury; hut if, on the contrary, blood be found extravasated under the wound, or effused around it, and still remaining liquid, we may be equally sure that the wound was made shortly after death, and while the body was still warm. A recent observation by Ollivier d’Angers will illustrate this fact. In this case the child was murdered before it had breathed, but while the cir- culation was still going on, as was proved by the examination of numerous wounds made by a cutting instrument in the back of the throat, as well as of other injuries. Coagula were found upon the orifices of the wounds. An incised wound may be accidentally inflicted upon a child by the knife or scissors, in severing the umbilical cord. When this happens, it will generally be found that the fingers or toes, or some part of the limbs, which have been suddenly elevated by the child at the moment of the incision, are injured. Where there is any suspicion of the wound having been produced in this way, the physician must carefully examine the situation, extent, and shape of it, and assure himself that the cord has really been cut, before assenting to the probability of this explana- tion. A peculiar mode by which the new-born child is often destroyed, is the introduction of pointed instruments, such as pins or knitting-needles, into the fontanelles, the ears, the nose, and between the vertebrae. In a superficial examination, these injuries may be overlooked. Hence, in doubtful cases, atten- tion should be carefully given to this point. By dissecting out the suspected portion of skin, and stretching it against the abdomen below the umbilicus, received by the mother a week before her confinement, which was brought on by her injury. Immediately after the infliction of the wound, a gush of water followed by blood had taken place from the uterus. (New York Journ. of Med., Jan. 1860, p. 99.) A very remarkable case of fcetal wound is published in Med.-Chir. Trans, xxxii. 59, and several others of extreme interest are referred to by Dr. Montgomery, Signs and Symptoms of Pregnancy, 2d ed. p. 684. 141 §173] INFANTICIDE. [book ii. the light, the finest puncture can be detected. Sometimes a multiplicity of wounds is inflicted. The following cases will serve as examples. A young woman, becoming pregnant, con- cealed her situation with great care. Her parents could not prevail upon her to acknowledge it, but it was finally ascer- tained by a midwife. She was confined alone. She seized a pocket-knife, thrust the blade into the child’s head, back, ab- domen, and limbs, cut off its head, and concealed the bleeding fragments under her paillasse. She was soon discovered, and at first denied the crime. Afterwards she brought the knife to the mayor, and made no attempt to escape, but confessed the act, and ascribed it to despair at having been abandoned by her lover.(w;) A still more inhuman example of infanticide is reported by Prof. It was proved that Severine L had borne an illegitimate child, of which no traces could be found. The girl, who at first obstinately denied the charge, finally confessed the crime, and indicated to the medical officers the place where she had concealed its remains. She said that she had been delivered at night, had suffocated her child, then cut it into pieces, the better to conceal it in the chamber vessel, which she than carried into the garden, and threw the con- tents into a dung-heap. With some difficulty the fragments were nearly all recovered, and placed in apposition. The head, thorax, and abdomen had been all separated from each other by a cutting instrument. The head was dreadfully mangled, the arms were cut off from the chest, and the forearms from them again, and many of the fingers also were separated. In like manner, the lower extremities were dissevered. The genital organs were separated completely. The lungs were of a rosy color, crepitant, and weighed two and a half ounces, with the heart and thymus attached. Being put into water, they floated, even after being subjected to enormous pressure. A portion, after being placed under a weight of 60 kilo- grammes (132 lbs.), still swam. The heart and the blood- vessels were entirely empty of blood, and the substance of the former was very pale. From these, and the signs which indi- («) Ann. d’Hyg., July, 1853. (w) Ann. d’Hyg., 1851. 142 BOOK II.] UNCONSCIOUS DELIVERY. [§175 cated the maturity of the child, it was justly concluded that it was at term, had lived and breathed, and that its death was caused by the wounds inflicted upon it by a cutting instru- ment. Siebold(y) also witnessed a case somewhat like the foregoing, in which the mother, actuated by the usual motive, viz., fear of abandonment, destroyed her new-born child by cutting off its head. In this case, also, the hydrostatic test clearly proved that the child had fully breathed. § 174. (/) Dislocation.—There have been examples of infanti- cide by dislocation of the neck. The discovery of the luxation requires no unusual skill in post-mortem As the existence of other dislocations in children found dead may give rise to a suspicion of criminal violence, it should be known that intra-uterine dislocations are occasionally met with. Dr. J. B. S. Jackson has described a complete upward dislocation of the head of the thigh-bone, and a partial dislocation of the knee-joint, in an acephalous foetus weighing two pounds and two ounces.^1) § 175. (y) Unconscious delivery.—It is frequently alleged, in defence of women charged with infanticide, that the rapidity of their labor, and the sensations attending it, were such, that they were not sufficiently conscious, at the moment of the ex- pulsion of the child, to save it from danger. This defence is often made in those cases where the dead body of the child is found in a privy-well, or water-closet. Although, in many cases, the proof of delivery having taken place in the manner described, depends upon other evidence than that required of the physician, yet there are questions which he will be called upon to answer, relative to the probability of the occurrence, which will demand very careful reflection. At first sight, the fact may appear highly improbable, that a woman should pos- sibly mistake the convulsive pains of labor for the ordinary sensation of a call to stool, or that any labor, however easy or rapid, could be accomplished without her being fully conscious of it. With due allowance for cases of wilful deception and (y) Henke’s Zeitscli., 1845, p. 157. (2) For a case in point see Orfila, Med. Leg., vol. ii. p. 109. (21) Boston Med. and Surg. Journ., March, 1860, p. 127. 143 §175] INFANTICIDE. [book ii. of purposed wrong to the child, there remains sufficient evi- dence to show the possibility of unconscious delivery in this sense. As the child’s head descends into the pelvis, the mother is often seized with an irrepressible desire to evacuate the bowels, and nothing is more common than for this evacuation to take place, in spite of all efforts to restrain it, at the very moment that the child is expelled. Hence, it is quite intelli- gible, that a woman in labor, in the absence of proper advice, may seat herself upon the privy hole, or night-stool, at pre- cisely the most critical moment for the child. By a forcible pain, favored by a very yielding condition of the parts, the head may be abruptly expelled; the cord may break with the fall of the child, which may perish miserably, either by the injury received in its fall, or stifled with the filth into which it is plunged. The mother, exhausted and terrified, may be unable to prevent this catastrophe. Cases of this kind are related, of married women and of others, where there was no attempt to conceal the birth, and no suspicion of criminal intentions.(a) An English lady in India was pregnant at full term with her second child. She experienced a very slight sensation as if her bowels were about to be relieved ; a feeling as if some- thing had touched her body followed, and caused her to ask the attendant to lift the bedclothes, when, to the surprise and alarm of both, the child was found entirely extruded. It was but slightly undersized.^1) An equally striking case, in which the escape of the child from the maternal parts was mistaken for an evacuation of the bowels, is reported by Ammeuille.(6) While a want-of knowledge of the phenomena of labor may plausibly account for the event in a woman with her first child, yet the greater rigidity of the parts, and the slower progress of the delivery in this case, render its occurrence far more unlikely than in those who have already borne children. It («) For cases illustrative of this fact, vide Henke’s Abhandlungen, Bd. i. S. 40 if. 2te Aufl.; Dr. Sclmitzer (Med. Zietung d. ver. f. Heilk. in Preussen, 1839); Fleischmann (Henke’s Zeitsck. 1839, 2 H.); Dr. Beck (Ed. Med. Jur., p. 317, note); Ricker (Henke’s Zeitscli. 1843, 3 H. p. 197). Also note to § 164. (a1) Dr. G. Smith, Brit, and For. Med.-Chir. Rev., Oct. 1857, p. 554. (b) L’Union Med.; and Phila. Med. and Surg. Reporter, March, 1860, p. 501. 144 ROOK II.] RAPID DELIVERY. [§175 is said, that, if the cord be found broken, instead of cut, it will confirm the story; but this circumstance is not conclusive, since it may have been broken by the hands of the mother, and the child afterwards thrown into the privy for conceal- ment. In most cases, our opinion can be founded only upon the traces of blood at and near the alleged scene of labor, and upon the absence of conflicting testimony. The concealment of the fact of having given birth to a child will throw just doubt upon the woman’s veracity, since, if the delivery were accidental, the natural presumption is, that the mother would have sought for immediate assistance. Other forms of unconscious delivery do not possess the same practical interest as the foregoing. Women may be delivered in a state of insensibility, and, according to Dr. Montgomery, even during deep natural sleep: in such cases, the child may perish from want of attention, and in some one of the various ways before alluded to.(/f) Delivery may also be so rapid, although the mother is aware of being in labor, that she is unable to guard against an acci- dent to the child. Mrs. B., of Quebec, aged thirty, married, and pregnant with her first child, was seized during the night with labor-pains. After bearing them for a long while, she requested a woman to give her some warm water to “ set over,” to relieve what she described as a great pressure at the lower part of her bowels. She had hardly seated herself upon the edge of a rather high chair, when a severe bearing-down pain seized her, and before any assistance could be afforded (although one or two women were in the room), the child was forcibly expelled, and fell, head foremost, on the floor, being killed on the spot. When the physician arrived, about twenty minutes after delivery, the child, although dead, was still attached by the cord to the placenta, which came away shortly after the infant. In another instance, the wife of a clergyman, in labor with her second child, but not suffering from any pain, was suddenly seized with a strong bearing-down pain, and got up with the intention of walking into an adjoining room. Before she had proceeded more than a few yards, another pain threw (61) See Kawson, Lancet, 1841; Scliultze Ann. d’Hyg., y. 38, p. 216. vol II.—10 145 § 176] INFANTICIDE. [book ii. the infant upon the carpet. The cord was ruptured near the umbilicus, but fortunately did not bleed from the foetal portion. The child was not injured. A similar case is related by Dr. Larkin, of Wrentham, Mass., except that the cord was so long, that it was not broken. The mother broke it in two, and suc- ceeded in reaching her bed-room, although much exhausted from hemorrhage. Both mother and child recovered.(c) § 176. (A) Poisoning.—This form of infanticide is extremely rare. Dr. Taylor states, that the earliest stage at which he has known a trial to take place for the murder of a child by poison, was two months. In this case, a quantity of arsenic was given to the child, and it died in three hours and a quarter after its administration.^ More recently, a woman destroyed her child, which was only one day old, by arsenic. She was tried, and acquitted upon the plea of 'puerperal insanity, although the evidence certainly did not warrant such a verdict. Mr. Justice Cress- well, at the close of his charge to the jury, “read the whole of the evidence, and at the close remarked that he was bound to tell them that there was undoubtedly no direct proof that the prisoner was otherwise than in her perfect senses, as no person saw her laboring under delusion or insanity.”(e) The defence in this case should suggest to the medical ex- pert the reflection, that, however palpable the fact of criminal agency may, in a case of infanticide, appear to him, and how- ever complete may be the proof of the child having both lived and breathed, he can never be exempt from the mortifi- cation of hearing objections urged, entirely foreign to the case, and a defence set up which has merely an imaginary basis. Luschka(/) draws attention to the fact that on the lips of new-born children there is an outer smooth zone and an inner villous one with a marked furrow between, looking when the mouth is gently closed like a double lip. The villous zone disappears with advancing age ; but, should death occur before (c) Am. Journ. Med. Sci., Jan. 1846, quoted from various sources. (d) R. v. South, Norf. Aut. Circ., 1834. (e) Ed. Monthly Journ., Sept. 1852. (/) Henle, Zeitschrft. f. Nat. Med., xviii. p. 88. 146 BOOK II.] 147 POISONING. it has done so, it dries even down to the submucous tissue, and looks much like an eschar, which, unless understood, might readily be taken for the effect of a corrosive poison. § 177. Some valuable experiments and conclusions by Casper, contained in his Vierteljahrschrift, 1863, Heft I. p. 1, are here added as being perhaps the most appropriate place. From the fact that one-fourth of all the medico-legal inspections annu- ally ordered in Berlin are upon the persons of new-born children, Casper was led to believe that the attempts made to conceal the bodies often occasioned such injuries as caused a legal investigation to be instituted. As a contribution to the elucidation of this point, twenty-five experiments were made upon the bodies of newly-born children. From a height of thirty inches, ten infants were dropped upon an asphaltum and fifteen upon a stone pavement. There were no visible injuries to the surface produced, but in twenty-four cases frac- tures of the skull were found. The fractures were distributed as follows: one parietal, sixteen times; both parietals, six times; once the parietal and frontal of the same side ; once the frontals of both sides; and once the occipital had sustained a fracture. Numerous fractures were not found. The peculiar form of injury is also worthy of notice. Almost always one, two, or three fissures extended from the parietal protuberance to the margin of the bone, and sometimes extending across the sagittal suture to the parietal of the opposite side; twice a small portion of bone was broken off Twice, when the body was allowed to fall from the table, fracture of the parietal resulted. When the head was trodden upon by a heel, frac- tures were always produced, not only in the parietal touched, but in the opposite bone, which looked much as if done in life. Extensive injuries were produced by striking the head against a table or wall. Four bodies were placed two or three inches under ground which was then stamped level; in three of the cases fractures resulted. No result was obtained by compress- ing the head with the hands, or by falling suddenly upon the child placed upon a hard surface. Compressing the head into a narrow box was attended with no result in two cases, but in a third a slight cleft extended from the lambdoidal suture 147 § 179] INFANTICIDE. [book ii. into the left parietal bone, while the coronal suture was some- what separated. Extensive injuries were easily produced by blows with a mallet or hammer. In all the cases the fractures were like cracks in glass. In five only, out of sixty fractures, were serrations present. Detachment of dura mater, separa- tion of sutures, extravasations of blood beneath the pericra- nium, and coagulations at the seat of fracture are not peculiar to the living. More or less coagulated extravasations were pretty constantly found, and the other appearances mentioned were not infrequent. In conclusion, we are warned that the foetal skull, like that of the adult, may be more resistant after death than it is during life. The cases are perhaps too few to establish laws, but coming as they do from so high an au- thority, are worthy of the most careful consideration. § 178. 4th. General considerations.—The reader will not fail to perceive, that in the considerations upon infanticide now presented, the author has not taken up all the objections which are usually urged against the various points in the medical evidence; to have done so, would not merely have unduly lengthened the chapter, but have presented the subject under an aspect of obscurity and difficulty which it really does not in itself possess. It has appeared to him that the simplest and most perspicuous mode of presenting the subject was one in which it should be entirely divested of the trivial and irre- levant objections which are often thrown around it, and which are by no means essential for a correct understanding of it. § 179. The discussion on this subject may be appropriately concluded by some general considerations. In every case of suspected infanticide the following questions, says Bo'cker, arise:— 1. Did the death occur in a natural manner? 2. Could it have been prevented by proper precautions ? 3. Is the mother guilty of not having employed them ? 4. Was it caused by violence on the part of the mother? 5. If traces of violence exist upon the child, did the mother inflict them ? It must be admitted, however, that medical testimony alone is not competent in all cases to solve these questions, which 148 BOOK II.] CONCLUSION. [§ 180 can only be answered by a careful comparison of all the cir- cumstances of each case. § 180. It is a fundamental principle laid down by Henke that death by violence is by no means to be inferred from the fact that the child was born alive. Even where marks of death by violence exist, it does not follow that the child was murdered. In the former case it may have perished in conse- quence of some disease incompatible with its life, or have been suffocated by the caul upon its face, or by its lying in a pool of blood and water, or in a mass of feces, or under a limb of the mother while in a state of exhaustion or unconsciousness ; or, in consequence of there being no help at hand, or of the unwillingness of the mother to betray her condition, the child may be suffocated, or may perish from exposure to cold, etc. "While, says Casper, we refuse to be imposed upon by the “ im- pudent lies” which women do not hesitate to tell to conceal their guilt, we should not forget that the dangers to new-born children are very numerous, and that, without any criminal intent upon the mother’s part, the child may perish from any of the causes just mentioned, from an injury to the head, from constriction of the navel-cord or hemorrhage following its rupture, from falling into the privy or a close stool, etc. Even apparent marks of violence must be cautiously inter- preted. Prints of finger-nails upon the head and face of the child may have been made by the efforts of the mother to extract the child after the birth of its head, and even a dis- location of the neck, under the circumstances, must be regarded as within the limits of possibility. But if the marks referred to should be accompanied by others which can only be ex- plained by intentional violence, then the former must be more seriously interpreted. Yet it must not be forgotten that many marks of accidental injury are with difficulty to be dis- tinguished from such as are feloniously inflicted. Care should also be taken not to confound these with marks which may have been made after death in recovering the body from cess- pools, privies, and similar places, or which are merely signs of the voracity of fishes, hog3, rats, etc. In fine, the duty of the medical jurist, called upon to investigate cases like those 149 §180] INFANTICIDE. [book ii. under consideration, should be to preserve the strictest im- partiality, to avoid being biassed by bis sympathy with the misfortunes of the accused, upon the one hand, or, on the other, by his abhorrence of her imputed crime, and to endeavor to give its just weight, and no more, to every circumstance which the investigation brings to light. 150 BOOK III. QUESTIONS ARISING OUT OF THE DIFFERENCE OF SEX. ANALYTICAL TABLE. CHAPTER I. DOUBTFUL SEX. 1st. Male hermaphrodites, § 181. 2d. Female hermaphrodites, § 184. 3d. Real hermaphrodites, § 185. 4th. Absence of sexual organs, § 188. CHAPTER II. SEXUAL DISABILITY. 1st. Sterility, § 191. (1) Removable causes of sterility, § 191. (2) Incurable causes of sterility, § 192. 2d. Impotence, § 201. (1) Congenital absence of the testes, § 202. (2) Castration, § 203. (3) Diseases of the testes, § 205. (4) Defect in size and malformation of the penis, § 206. (5) Obstruction from large hydroceles or hernite, § 207. (6) Local relaxation, § 208. (7) Causes of a psychical character, § 209. (8) Want of age, § 210. CHAPTER III. RAPE. 1st. Rape upon children, § 213. 2d. Rape upon adult females, § 233. 3d. Rape upon persons under the influence of ether or chloro FORM, § 245. 151 § 182] DOUBTFUL SEX. [BOOK III. 4th. Physical evidence of rape, § 249. (1) Condition of the hymen, § 250. (а) It is not always destroyed by the first connection, § 251. (б) It may be lost from other causes than coition, § 252. (2) Seminal stains, § 253. (a) Microscopical examination of semen, § 254. (5) Chemical relations of semen, § 258. 5th. Feigned rape, § 259. 6th. Rape by females, § 260. 7tli. Pederasty—Sodomy, § 261. 8th. Legal relations of rape, § 263. CHAPTER I. DOUBTFUL SEX. § 181. The word hermaphroditism, which at one time was used to describe the union of the organs of both sexes in o.ne individual, is now generally applied to all those cases in which doubts exist concerning the real sex, in consequence of some aberration from the normal type of the genital organs. The word can no longer be used in its original acceptation, for most certainly there is no authentic case of self-impregnation recorded, nor even of the association of the generative functions of both sexes in one person. The cause of these deviations from the usual form may be found in the earlier stages of embryonic development; but an exposition of the present state of medical knowledge relative to the processes of faulty evolution would here be out of place. § 182. The practical question which we have to determine is, how far is it possible to discriminate the true sex of a living person ? The solution of it is attended with no little difficulty, and in some cases is indeed impossible. The physician will be chiefly embarrassed in the case of children, since the im- portant indications derivable from the general as well as local sexual development will be wanting. It should not be for- gotten that even after death a positive opinion is, in some cases of hermaphroditism, hardly warranted by the most care- 152 BOOK III.] [§ 18B FALSE HERMAPHRODITISM—MALE. ful anatomical inspection. The male ancl female sexual organs, imperfect in development although distinctive in character, may be so evenly distributed that it will not be possible to know which predominate. Or, on the other hand, the traces of sexual organs may be so indistinct, that we can give them no appropriate sexual name. Hence the reader will perceive how much more excusable is reserve in pronouncing an opinion upon the sex of a living person, the essential generative organs being concealed from our observation. We can only hope to approximate to the truth, by observing whether there is not some regularity in the freaks of nature, and thus discover, if possible, some uniform correspondence between the visible deviations and those which are hidden from our view. With this object, the cases of hermaphroditism may be divided into the apparent and real, besides which there is a certain number in which literally no sexual organs exist. In the cases of appa- rent or false hermaphroditism, either male or female character predominates, but the former much more frequently. § 183. 1st. Male hermaphrodites.—In these the only anomaly is external, the internal organs having their natural conforma- tion and development. The penis exists, more or less developed, with an urethra either normal or opening at variable distances between the glans and the pubis—a condition which is called hypospadias. The scrotum is divided or cleft, and thus pre- sents a resemblance to the vulva, but neither nymphse nor va- gina are found, although not unfrequently there is a shallow depression or cul-de-sac between these false labia, which is lined with a delicate skin and bears no very distant resemblance to the vaginal entrance. The testes are found on each side of the divided scrotum. The history of a supposed female named Marie Rosine G-ottliche is related, who had been in the practice of cohabitation with the male sex. Iler genital organs were formed in the manner here described.(a) Eagele gives a case of twins who were considered as female until their seven- teenth year. At this time it was discovered that they were male, the penis being imperforate, and the divided scrotum re- (a) Casper’s "Wochensclirift, 1833, No. 3. 153 § 184] DOUBTFUL SEX. [book III. sembling a vulva, but containing a testis on each side.(6) The case of Adelaide Prdville, who lived in the married state for a long time and on good terms with her husband, is related in full by St. Hilaire, with a number of other cases which will also fall under the above general description.(c) Persons with these malformations are not necessarily impotent, except where the urethra opens at or near the base of the penis. In conse- quence of the position of this orifice, the semen cannot be ejaculated into the vagina, but escapes along the sides of the cleft in the scrotum. Impregnation may, however, take place, if the urethra opens far enough forward to allow of the inclu- sion of its orifice within the vagina, and instances of impreg- nation by persons affected with a considerable degree of hy- pospadias are upon record. Sometimes the only deficiency observable in this class is the absence of the testes from their usual location. This condition is liable to be mistaken for another, but far more important deviation from the natural type in the internal organs of generation (mentioned further on), since in both, the scrotum is empty. Put, in this case, the testes are not really deficient, but have remained in the ab- domen, instead of descending as is usual in the ninth month of foetal existence. In the case of persons in this condition, the power of procreation is unaffected, provided the testes are healthy.^1) This anatomical defect is very rare. Siebold states that of 37,000 recruits in Wurtemberg, only twenty-four were found in whom the testes had not descended.(d) § 184. 2d. Female hermaphrodites.—By far the greater number of these owe the doubts concerning their sex to an unusual size of the clitoris. Commonly associated with this circumstance, are an unfeminine appearance, more or less beard, and a rough and masculine voice and manner: although the sexual desires of these persons are violent, they are usually barren. The usual length of the clitoris in the adult female is about half an inch, but Berner mentions having seen a clitoris an inch long in a girl seven years of age, and IIome,(e) one of (5) Siebold’s Ilandbuch, p. 95. (c) Hist, des Anomalies, t. ii. p. 53. (c1) See § 201. (d) Handbuch, p. 82. (e) Philos. Trans., 1799, p. 1G3. 154 BOOK III.] FALSE HERMAPHRODITISM—FEMALE. [§ 134 two inches long and as thick as the thumb, in a negress twenty- years years old. In addition to this hypertrophied condition of the clitoris, an imperfect urethra with one or more openings is often found, and, at the same time, a constriction of the vagina to such a degree that it becomes almost imperforate. Such was the anatomical condition in Marie Lefort; she had menstruated regularly from the age of eight years until her death at thirty; the existence of a uterus was clearly esta- blished. Her voice was masculine, and she had a thick and strong beard.(/) Sir Astley Cooper examined the body of a charwoman, aged eighty-six years, wdio presented these devia- tions. He says, she differed from other women in the magni- tude and length of the clitoris, in the absence of the external orifice of the vagina, which began in the urethra itself, and in the imperfect development of the ovaries.(y) A woman twenty-five years of age, on account of her notorious com- merce with both sexes, was placed under strict police super- vision. Resorting to masturbation, her health became so much impaired that she died in the course of sixteen months. The external genitals were found to have their natural conforma- tion, with the exception of the clitoris, which was three and a half inches long and three inches in circumference, and imper- forate, except at the base. The uterus and one ovary wTere rudimentary, and the general conformation of the breasts was masculine, although, owing to the occurrence of a trilling peri- odical discharge, she was considered to be a woman. It was proved that this person had been guilty of the most astonish- ing and unnatural excesses with young people of both sexes.(A) A child described by Mr. E. Smith may be placed in the same class, as all the female organs were complete; the only anomaly being that the urethra opened in two places, and the clitoris bore some resemblance to the penis.(z) In a black female sub- ject, dissected by Hr. Jno. Heill, the clitoris was five inches long and one inch in diameter, and resembled a penis, except (/) St. Hiliare, Hist, des Anomalies, t. ii. p. 74. (g) History of a supposed Hermaphrodite, by Robert Merry, Surgeon. Guy’s Hosp. Rep., Oct. 1840. (A) Henke’s Zeitschrift, Bd. 44, S. 183, by Albert, of Euerdorf. (i) Lond. Med. Gaz., yol. xxxiii. 155 §184] DOUBTFUL SEX. [book hi. that it was not traversed by a perfect urethra. The perineal opening was not larger in diameter than a catheter of average size, and the vagina was extremely narrow. On one side of the penis existed what appeared to be a scrotum, but which contained an irreducible omental hernia. This gave the feel of a testicle, but no true glandular structure or excretory tube could be detected. The internal organs were completely female, although not completely developed. The general habitus was feminine.(J) A very similar case is reported by Dr. F. L. Parker.(&) The subject of it was of the negro race, was re- garded as a man, bred as a cooper, and had been married as a man. The genital organs were exclusively those of a female, except the clitoris, which measured, after death, an inch and three-quarters externally, and in its entire length five inches. A perfectly analogous example in which the clitoris was from two to three inches in length, is reported by Dr. J. Mason "Warren. The subject was of Irish birth, bore a man’s name, and had a masculine appearance.(a) Dr. Cambridge has re- ported the case of a female whose clitoris was five inches in length and of the diameter of the quiescent penis of an adult. This malformation was discovered while the woman was in labor.(6) Mr. Wells has described the case of the person in whom the general external organs were those of a hypospadic male; but there were no testes, and a small uterus and one ovary existed.(c) The case related by Dr. Mayer, of Bonn, which gave rise to much discussion, and which is usually classed among the cases of mixed sex, may with more reason, we think, be placed under this head. The only male organs were a (so called) penis, which was only two inches long, im- perforate, and partly concealed under the mons veneris. On the other hand, the orifice of the urethra was situated as in the female, there was a large vagina, a uterus with its appen- dages, and a defective ovarium on one side, and (what is called) (j) Quarterly Summary of Trans. Coll. Pliys. Philada., N. S., vol. i. No. 3. (&) Charleston Med. Journ., Jan. 1859, p. 57. (a) Am. Journ. Med. Sci., Jan. 1860, p. 123. (5) Lond. Times and Gaz., Jau. 1860, p. 45. (c) Ibid., Feb. 1860, p. 177. 156 BOOK III.] REAL HERMAPHRODITES. [§ 185 a withered testis on the other. We cannot avoid holding some doubts concerning this last-mentioned organ. From the absence of any account of the seminal tubes, deferent vessels, or seminal vesicles, and the evidently rudimentary nature of this body, it might as properly have been termed an ovary. This suppo- sition would, moreover, have been favored by its position. However this may be, it is evident that the female character greatly predominated. When twenty years of age, this person menstruated on three different occasions. A certain number of cases are recorded in which a prolapsed uterus or an extror verted bladder has grossly imitated the male organ, but these cases are so easy of detection, and have so little claim to be classified with permanent anomalies of evolution in the sex- ual organs, that it is not necessary to dwell upon them^e?) § 185. 3d. Beal hermaphrodites.—Hot a few authors have doubted the existence of persons entitled to this designation, but there can, at the present day, be no question of the fact. It is, of course, not meant that the union of the f unctions of both sexes in one individual ever occurs, but merely that the essential gen- erative organs of both may coexist.^1) It will be seen from the following cases that this abnormal condition is found in different degrees.(e) The first we will mention is the case observed by Petit, and communicated to the French Academy in 1820. The subject was a soldier who died of a wound at the age of twenty-two years. The penis was normal, the scrotum empty, the testes small and soft, occupying the position of the ovaries, but provided with epididymis and vasa clefe- rentia. The seminal vesicles and prostate gland likewise were present. The uterus opened into the urethra at the neck of the bladder; the vagina was absent. It is stated that the Fallopian tubes were found, but they were probably in an im- perfect condition. (d) For cases exemplifying these deceptions, vide Saviard (Rec. d’Obs. Chirurg., p. 150). Home (Philos. Trans, for 1799). (Ed. Med. and Surg, Journ., vol. i. p. 54.) St. Hillaire (Hist, des Anomal., t. i. pp. 272-277). (d1) There is, however, no case recorded in which two testicles, and two ovaries, the essential indices of sexuality, existed in the same persons. (e) A very remarkable case occurring in the 17th century is recorded by Dr. Thomas Allen (Philos. Trans. Abr. i. 24), and another, scarcely less so, is that of Hubert, who died 17G7 (Diet, de Med., xxi. 104). 157 § 186] DOUBTFUL SEX. [book hi. § 186. A more recent case, described by two of the most emi- nent pathologists of Germany, Ixiwisch and Kolliker, is of great interest. The individual died at the age of 33 years. The external genitals were, a perfectly normal penis, with a rugose but empty scrotum. The uterus was perfect, somewhat longer than usual, but in its ordinary position. The vagina was ru- dimentary, and opened into the prostatic portion of the urethra. The Fallopian tubes were 3f inches long, with imperfectly de- veloped fimbriae. The round ligaments had their usual position and attachments. In place of the ovaries were found testes, provided each with an epididymis and a deferent duct which led to the inguinal ring, and, turning to the uterus, followed its sides and finally opened into the prostate gland. This latter body was of normal size ; on each side of it were vesiculos seminales.(7) MM. Bouillaud and Manec have reported a case in which the person attained the age of sixty-two years, and had lived and been married as a man. The general appearance was feminine, with the exception of the beard. The external organs consisted only of a penis with the orifice of the urethra at the base of the gland. A loose fold of skin occupied the place of the scrotum. The internal organs were, however, completely feminine, with the exception of the prostate gland, which occupied its usual position. The vagina opened into the membranous portion of the urethra. It is not stated whether the menstrual function was performed.(m) A curious and well-described case is that of Ackermann :(ji) An imper- forate penis, a vulva containing a normal testis on each side, a (/) Kiwiscli (Klinisclie Vortraege Abth. II. Prag. 1849). This thoroughly authenticated fact of the coexistence of the prostate and uterus in one indi- vidual, is a serious blow to the cultivators of transcendental anatomy, who have maintained its impossibility. Weber, Leuckardt, and many other authors consider the prostate gland to be a rudimentary uterus, or rather the analogue of this organ in the female. Another example of the coexistence of these two organs, in a person 60 years of age, is furnished by Lauger. The uterus was attached to the upper part of the prostate gland, and there were two testicles (Archives Gen. de Med., Seme ser. vii. 720). An equally marked case (Hemaphroditismus lateralis) of the coexistence of an ovary and a tes- ticle in a new-born child is recorded by Meyer, of Zurich (Virchow’s Archiv, xi. 420). i Cm) Journ. univ. et hebdom. de Med., t. x. p. 467. (ft) Infantis Androgyni historia et iconograpliia. Jena, 1805. 158 BOOK III.] REAL HERMAPHRODITES. [§ 186 common vagino-urethral canal, and vasa deferentia opening on either side of the os uteri, blit entering the walls of the uterus at the points whence usually spring the Fallopian tubes. Per- haps the most remarkable case of double sex is that examined by Dr. Horace A. Ackley, Professor of Surgery in the Cleve- land Medical College, and reported by Dr. George Blackman.(0) The person from whom the parts were removed was about twenty-six years of age, and had been employed as a servant. “ The history of this individual, as furnished by Prof. Ackley, is briefly as follows: Stature large; external conformation, with the exception of the hips, male; beard moderate ; habits solitary, and had a dislike to women; menstruation per penis, monthly; this was always attended with much suffering, and during one of these menstrual periods he died from cerebral congestion. After death, the body found its way to the Cleve- land Medical College.” .Upon dissection the disposition of the sexual organs was the following: “The penis was large, the scrotum empty, a perfect uterus with pervious Fallopian tubes and ovaries, testes on each side above the ovaries and excretory ducts leading from them, a vagina opening into the neck of the bladder, and a prostate gland.” The inner surface of the vagina was reddened, and its cavity contained what was sup- posed to be menstrual blood.(p) This statement was after- (o) Am. Journ. Med. Sci., July, 1853, p. 63. Another singular case, ex- emplifying the condition called lateral hermaphroditism, has been reported by Dr. Banon. The penis was of the usual size in the adult, and imperforate, although subject to erections. Beneath were the external female parts nearly perfect; the orifice of the urethra was placed as in the female, the vagina was rudimentary, but was provided with a hymen, the prostate was absent ; the uterus was small, but well formed. There was one testis and one ovary, the vas deferens opened into the uterus. This individual had never men- struated, preferred manly exercises, and in conformation presented a curious intermingling of the characteristics of both sexes. Am. Journ. Med. Sci., July, 1852, from Dublin Med. Press; or fuller, Dublin Quart. Journ., Aug. 1852, p. 66. The somewhat similar case of Angelique Courtois, Follin. Gaz. des Hop., Dec. 1851, is more particularly interesting, from the fact that the single, well-formed, and undoubted testis had no excretory duct, but lay under a pervious and fimbriated Fallopian tube. There were no ovaries, semi- nal vesicles, or prostate. (p) Other cases of menstruation through the penis, or from an orifice at its base when imperforate, are on record. One is reported by Dr. Harris, of 159 § 187] DOUBTFUL SEX. [book nr. wards supported by an examination of the parts made by Dr. W. L. Burnett, of Boston. § 187. The necessity, however, of the most minute and con- scientious examination of such remarkable cases as this has since become apparent, for we find that the internal sexual organs were not so distinctive as represented. Dr. J. B. S. Jackson, of Boston, in addressing the Society for Medical Im- provement on this subject, stated that he had been permitted by Prof. Ackley to examine the specimen. He found no trace of the os tincfe, but the uterus passed insensibly into the vagina. This last was extremely small, measuring in the smallest part, on the inner surface, not more than four or five lines in circumference. Dr. J. found some thickening of the tissues about where the ovaries should be, but it was ill-defined and slight; “ and it would not have been thought of, except in connection with the present question.” Upon one side an incision was made into this questionable part; but nothing like a Graafian vesicle was seen, nothing but a loose cellular, Virginia, and another by Dr. Barry, of Connecticut, in which it was neces- sary to determine the sex on account of a denial of the person’s right to vote. (Am. Journ. Med. Sci., 1847, July.) Prof. Simpson, of Edinburgh, states, that he has been informed, on credible authority, of two instances where, in males, (?) the menstrual discharge was perfectly regular in its occurrence and considerable in quantity. One of these persons was seventeen years of age, the other had been married for several years, and his wife had no children. (Art. Hermaphroditism, Cyc. of Anat. and Physiol.) Dr. Blackman saw in the Northern Hospital at Liverpool, a sailor from the American merchant- man Rappahannock. He says : “ This person was about thirty years of age, and, with the exception of the breasts, which were large, had the general ap- pearance of a male. The penis, however, was short, and the scrotum some- what cleft, so as to resemble in some respects the external labia of the female. At the time of my examination menstrual blood was passing through the penis, and we believe this was a regular monthly occurrence.” (Am. Journ. Med. Sci., July, 1853.) A case apparently similar in anatomical conditions to that of Suydam, above referred to, is reported by Dr. Coste, of Marseilles. His patient was 21 years of age, the penis was of the size of a boy’s of 12 or 14 years, it was imperforate, and the urethra opened at its base. The menses flowed from this orifice at regular periods. There was no external orifice of the vagina, the perineum was covered with hair, the labia majora were rudi- mentary, and on the right side there was a body like a testicle. The habitus was feminine, and there was no beard. An operation was performed to make an artificial vagina, and eight months afterwards she was married. (Med. Zeitsclirift fur Geburtzkunde von Busch, etc., 1836, Bd. 4, H. 2, p. 267.) 160 BOOK III.] [§ 189 ABSENCE OF SEXUAL ORGANS, ETC. or fibro-cellular, tissue. Tlie size and structure of the testicles, so far as examined, were quite normal, and, it is said, that there was an epididymis, although the existence of a vas deferens was not clearly ascertained. The vesiculee seminales were not found, and the prostate gland, Dr. Jackson says, had not been demonstrated.^) § 188. 4th. Absence of sexual organs.—Siebold states that he has in his museum a child with no external genitals. Not- withstanding this, two testicles were found in the abdomen. This case is related in full in Faber’s “Duorum monstrorum humanorum descriptio anatomical He also refers to another case of a child, three years old, in whom no internal gene- rative organs were found, and externally only an urethral oritice.(r) § 189. The foregoing enumeration of anomalous conditions of the sexual organs will suffice, we think, to convince the reader, upon careful examination, that the determination of sex in a living person presenting any of those which are ex- ternal, is attended with much difficulty, in consequence of the absence of a uniform correspondence between the outward and inward defects. It will also be seen from some of the cases, that reliance cannot be placed upon the general conformation of the individual nor upon the tastes and habits, since expe- rience shows that the indications derived from them are often fallacious. Practically, therefore, the question must often remain unresolved, or be determined solely by the sexual pre- dominance in the external organs alone. It may be observed, however, that the rarity of real duplicity of sex, or of the complete absence of the sexual organs, compared with the (arotiddea, or mumps, and waste away in consequence. Atrophy of the testicle, and impotence, may sometimes be produced by mechanical injury to the spine, or to the occiput. Both Larrey and Ilennen mention cases in which, from blows with a sabre upon the occipital protuber- ance, impotence resulted. Dr. Fisher,(r) of Boston, had a case in which the loss of virile power was only temporary, after an injury of a similar character. Larrey states that many of the 172 (r) Am. Journ. Med. Sci., yol. xxiii. BOOK III.] MALFORMATION OF THE PENIS. [§ 206 soldiers in the French expedition to Egypt became impotent from atrophy of the testes, which he ascribed to the use of date-brandy sophisticated with solarium capsicum or pseudo eapsicum. § 206. In some cases, the inability to procreate arises from some defect in the copulative organ. (4) Defect in size and malformation of the penis.—The gene- ral rule may be laid down, that, if the organ he of sufficient size to be introduced within the entrance of the vaerina, fecun- dation may be the result. Hence, except the penis he con- genitally absent, or have been removed close to the pubis, the person is not necessarily incapable. In case of hypospadias or epispadias, i. e., where the orifice of the urethra is either below or above the organ, at some point of its length, the individual may become a father, if the orifice can be brought within the female parts. Cases proving this fact satisfactorily are re- ported by Fodere, Belloc, Kopp, and others ;(s) in some of which instances the malformation was transmitted to the children. A very interesting case of this nature is reported by Traxel^s1) An unmarried woman, at her confinement, deposed that for three years she had not cohabited with a man, but only with a female whose sexual organs bore some re- semblance to those of the male. On examination, this person was found to present the following peculiarities. A scrotum was divided in the middle, and on either side contained a testicle. Between its two halves there was a fissure lined with a mucous membrane, and presenting at its upper angle and below the penis the orifice of the urethra. The penis was short, thick, and imperforate, and along its under surface, in the natural position of the urethra, was a deep furrow extend- ing from its root to its extremity. The new-born child pre- sented the same malformation precisely. In this case it is evident that during coition the open urethral furrow was transformed into a canal by the apposition of the vaginal membrane, and conveyed the semen to the uterus. The person hitherto regarded as a woman was judicially ordered to assume (s) Beck’s Med. Jur., vol. i. (s1) Prager Yierteljalirs., 1856, 4tes Bd. Anal., p. 103. 173 [book nr. § 208] SEXUAL DISABILITY. man’s clothing, provide for the support of the child, and de- clared capable of contracting marriage. This defect is also in some cases curable by an operation. Examples of bifid penis,(t) and cases in which this organ had an unnatural attach- ment to the abdomen (u) and to the scrotum,(v) are to be re- garded rather as medical curiosities, than as likely to give rise to practical difficulty in legal relations. The same may be said of an excessive size of the penis. § 207. (5) Obstruction from, large hydroceles, or hemice.—This is sometimes an effectual hindrance to copulation, if volumi- nous. A case is related where a man of fifty-one years of age, who had been affected with a scrotal hernia for nine years, was nevertheless able to beget children, since, in the horizontal position, the tumor became a third smaller, and allowed the protrusion of the penis.(zp) An interesting case is related in Henke’s Zeitsclirift, in which the paternity of a child was attributed by the mother to a married man of sixty years of age. It was represented, in his defence, that he was affected with a double scrotal hernia of ten years’ standing, which rendered the sexual act impossible, since the penis was almost entirely concealed by the immense tumor, measuring in cir- cumference 18f inches. A very careful examination and report was made by the official surgeons ; they declared that this state of the parts did not hinder the act of coition, since the tumor was of such a yielding nature as to allow, by proper manipulation, of the sufficient protrusion of the organ.(x) § 208. (6) Local relaxation.—Constitutional causes often im- pair the sexual power, not only by rendering the seminal secretion inactive, but by destroying the ability to copulate. Excessive abuse of venery, and the vice of masturbation, are the most frequent causes of that local relaxation which often (t) Ephem. Nat. Curios. Dec. 1, Ann. 1, Obs. 110, Dec. 3, Obs. 77; Sixtus D. de diffusione genitalium, singular! penis bifidi observatione illustrat; Kopp. Jalirbucb, vii. p. 38G. Tlie preparation is in the Anatomical Cabinet in W iirzburg. (u) Schurig, Spermatologie, p. 184. (®) Clieselden’s Anatomy, p. 314 ; Brand. Ed. Encycloped. Art. Her- maphrodites. (w>) Pyl’s Aufsatze, Sammlung viii. s. 204. (x) Band 44, s. 379. 174 BOOK III.] [§ 210 WANT OF AGE. constitutes an insuperable obstacle to sexual intercourse. If impotence be ever caused by the use of colcliicum, nitre, cam- phor, dulcamara, and other drugs, as is alleged, the defect will be, most probably, only of a temporary nature. § 209. (7) Psychical causes.—These are, in some cases, hardly explicable by the individual himself. Cases are on record in which, notwithstanding the existence of proper sexual feelings on the part of the husband, he has been unable to accomplish that part of the act which is essential to impregnation. De- vergie relates a case of this kind.(y) Another one is given by Dr. Strecker.(y) In both cases, the husbands had the sensation and the knowledge of emission with other women. In one of these cases, this circumstance was attributable to indifference on the part of the female. Generally, where relative impo- tence exists, it will depend, in the absence of physical causes, upon some prejudice or passion. Excessive sexual desire will sometimes defeat its own end; and, on the other hand, too great timidity, or disgust and aversion, may prove causes of impotence. "We need hardly add, that they are often but temporary in their nature. § 210. (8) Want of age.—The seminal secretion is established at the age of puberty, which is about the fifteenth year in temperate climates, and ceases at no determinate period. The establishment of this secretion is marked by familiar changes, both local and general. The genital organs become developed, hair appears upon the pubes and under the axillae, the beard becomes apparent, the voice more grave, and the muscular system developed. Curious instances have been reported, in which there has been unusual sexual precocity. The- most astonishing of these is one related by Professor Stone, of Washington.(a) The child was only four years old ; he was four feet and a quarter of an inch in height, and weighed nearly seventy pounds. His bones and muscles were developed in an extraordinary degree, his voice was grave, and the pubes was covered with a luxuriant growth of hair. The penis (y) Mt'd. Legale, Nullite de Mariage. (s) Henke’s Zeitschrift, 1840, 1 H. p. 223. (a) Am. Journ. of Med. Sci., Oct. 1852. 175 §211] [BOOK III. SEXUAL DISABILITY. measured, in a semi-flaccid state, four and a quarter inches in length, and when perfectly flaccid three and a half inches. The prepuce was short, leaving exposed a perfectly formed glans penis. The papillae of the corona glandis were salient, and exquisitely sensitive. In the scrotum wTere two firm, appa- rently well-developed testicles, perhaps rather under the average size of those organs in the adult. The spermatic cords were distinct, and, under the finger, gave the impression of perfect organs. His father having observed “ during the night, when he had slept with him for the first time, a constant erection of the penis, accompanied by a nickering, like an excited stallion,” consulted Hr. Stone concerning him. The boy was said to be extremely fond of embracing the opposite sex, and on one oc- casion, when in bed with a near relative, a married lady, the latter was aroused by finding him closely clasped to her back, and her night-dress saturated with a glutinous material— very different from that she expected, as she supposed he had emptied his bladder upon her. The reporter had no opportu- nity of examining the secretion with the microscope. Hr. Riittel observed a case in which a girl of fourteen be- came pregnant by a boy of the same age. Mr. Ruelle, of Cambria, has recorded an example of pre- cocious virility. A child three and a half years of age, mus- cular and strong as one of eight, had all his male organs of the full adult size, with long black hair on the pubes, and, under excitement, discharged semen four or five times daily. He had also a full male voice, and dark short hair on the cheek and upper lip.(6) § 211. Old age is usually attended with impotence, hut there is no fixed period at which, either medically or legally, a man must cease to be capable of begetting children. Mr. Curling has found the spermatozoa in the semen of men at sixty, seventy, and even eighty-seven years of age, and Casper in a man of sixty-nine. Parr is said to have become a father at the age of 140 years; and quite a sufficient number of instances are known, to determine the fact of the occasional retention of virility much beyond the age of sixty years. The preserva- (6) Brit, and For. Med. Rev., Jan. 1844, p. 277. 176 BOOK III.] RAPE. [§ 212 tion of this faculty coincides with a vigor and haleness of constitution which is the lot of but few aged men. Curling has shown(61) that there may be perfect virility without the presence of spermatozoa, in which case, of course, the ability to propagate is absent; and Mr. C. thinks that, where this condition is known to exist, it presents a bar to marriage, but is insufficient ground for a divorce. Delpech says,(62) that workmen engaged in making red toy balloons, in which process sulphide of carbon is extensively used, at first pass through a stage of excitement with inten- sified sexual desires, but finally lose all such inclination; it is even stated that the testicles of boys engaged in this work never develop, and that analogous effects are produced in women, who eventually become sterile after passing through a period of venereal excitement. These statements would certainly seem to require further and confirmatory observations before a judicial decision could be based upon them. It should also be borne in mind that a single microscopic examination is not sufficient, as Casper has shown that sper- matozoa may be absent at one time and present at another. CHAPTER III. RAPE. § 212. Medical evidence in cases of rape is seriously affected by circumstances over which the physician can have no con- trol. One of the most important of these is the want of an examination at a sufficiently early 'period to afford useful results. In genuine cases, where rape has been really attempted, the local marks of violence are often extremely insignificant, and consequently soon disappear. A slight contusion of the geni- tals, a laceration of the hymen, or a trifling discharge of blood, (5’) Lancet, vol. ii. 1863, p. 11. (52) Ann. d’Hygiene, Jan. 1863, p. 65. VOL. II.—12 177 §213] RAPE. [book hi. are the sole indications of the transaction, and may, within forty-eight hours, be no longer present. Hence, it is seldom possible for the medical examiner to make any useful note of “ the marks of violence upon the person, the disorder of the clothing,” etc., which are usually prescribed by authors. The dress has been smoothed or changed, the marks of injury have disappeared, and all that remains is perhaps a suspicious stain upon a chemise, alleged to have been worn at the time of the assault. It is stated by a celebrated author, who has had much experience in such cases (Casper), that in fifty-eight cases which he had been required to examine, the time that had elapsed from the alleged commission of the rape varied from three weeks to one year. In connection with the injuries above alluded to, the victim of rape, particularly if young and a virgin, often manifests by her manner of walking, i. e. by keeping the limbs separated, that she suffers pain in the genitals. She is also apt to complain of pain in passing her urine or in going to stool. These signs are naturally most conspicuous immediately after the act of violence, and, apart from aggra- vating causes, may be expected to decline from day to day. § 213. 1st. Rape upon children.—We propose in the present article to refer a good deal to the experience of Casper, be- lieving that the subject will be more profitably illustrated by authentic cases, than by theoretical discussions. There is no subject upon which it is more necessary for the physician to be guarded in his opinion than this, since he may be designedly entrapped into an admission entirely at variance with his real view of the case. Thus—a tradesman of irreproachable character was accused by a woman of having violated her daughter, who was but eleven years of age, and of having communicated to her a gonorrhoea. The child was of a very scrofulous constitution. The labia majora were separated and flaccid, the clitoris un- usually developed, the entrance of the vagina inflamed, and painful to the touch, and the hymen obviously stretched. There was also a copious urethral discharge. The opinion given by Dr. Casper was, that a complete penetration had not taken place, but efforts by the male organ, affected with gonorrhoea, had been made to effect it. The further pro- 178 BOOK III.] [§ 216 RAPE UPON CHILDREN. gress of the case showed the truth of this opinion but not of the accusation, for the defendant was found perfectly free from disease, and the cross-examination developed the fact, that the mother, after having fruitlessly endeavored to extort money from the tradesman, had delivered the child to her own paramour, a journeyman living in the same house, whom she knew to be affected with gonorrhoea. She then threatened to denounce the tradesman, unless he gave her money. § 214. In thirteen cases of alleged rape on children from two and a half years to fourteen,he found, upon examination, nothing whatever to support the accusation, as the sexual parts were in a perfectly natural condition. Yet many of these cases had been previously examined by physicians, and were provided with certificates attesting various degrees of injury. In two cases the accused parties were also said to exhibit unmistakable traces of the previous existence of chancres. Dr. Casper as- certained that the children were wholly uninjured, and that the presumed venereal cicatrices were perfectly natural ap- pearances. § 215. It is also important to know, that it is by no means easy to ascertain the condition of the hymen, especially in children, who present a majority of the cases. There are two reasons for this. 1st. Where the outrage has been really com- mitted, the tender parts of the child become so sensitive, in consequence of their inflamed and swollen condition, that they will not bear the slightest touch, much less a separation of the labia; the child becomes so uncontrollable, that it is often necessary to give up entirely the examination without attain- ing the desired end, and this repeatedly, if the physician happen to be inexperienced, or unless an anaesthetic is ad- ministered. § 216. The second reason is based upon the variety of struc- ture presented by the hymen. It is not always crescentic, but frequently is attached all round to the vagina, having a circu- lar hole in the centre. This free edge is sometimes swollen and loose, and is then particularly deceptive. It varies a great deal in thickness and firmness. Its place of insertion also varies, it being sometimes attached near the entrance of the 179 § 217] rape. [book hi. vagina, and at others so far back that it is found with diffi- culty, especially under the circumstances before referred to. “ For these reasons,” says Casper, “ the cases are explicable, which I have so frequently met with, where a previous medi- cal or surgical examiner had certified that the hymen was absent, when I myself have afterwards found it entire and un- injured.”^) In order to have a clear understanding of medical evidence in cases of rape, the subject may properly be considered under the divisions of, 1st. Rape upon Children. 2d. Rape upon Adults. We here refer, however, only to the outrage upon persons of the female sex ; the crime in a contrary sense will be considered hereafter. § 217. 1st. The frequency of attempted rape upon children has been lately shown by Casper. Of one hundred and eleven cases which he had examined up to the close of 1856, seventy- eight were children under twelve years of age, and seventeen between the ages of twelve and fourteen. It is probable that very nearly the same proportion might be observed in other places if proper statistical inquiry were made. This frequency may be accounted for by the comparative ease with which a child’s resistance may be overcome, and by its entire ignorance of the nature and consequence of the sexual act. We may also mention here, that the author above quoted refers it, as well as the superadded disgrace and misery of venereal infec- tion, to the prevalent superstition among the lower classes in his country, that connection with a pure virgin will cure a person affected with this disease, and hence, for the sake of certainty, the youngest children are chosen as victims of this revolting crime.(d) Casper found syphilitic gonorrhoea in tliir- (c) Casper, loc. cit. (d) The supposition exists in other countries. Mr. Wilde, of Dublin (Med. Times and Gaz. Sept. 10, 1853), says: “ A delusion prevails very extensively among the lower orders in Ireland, to the effect that a man can get rid of an obstinate gonorrhoea, which has ‘foiled the doctors,’ by having connection with a virgin, and, as the easiest mode of effecting that object, a child of tender years is selected.” He states also that he had been informed by Dr. Montgomery that he knew a case in which a servant woman, affected with gonorrhoea, induced a child to have connection with her, in the hope of thus curing herself. From the work of Duchesne on the prostitution of 180 BOOK III.] [§ 219 MARKS OP VIOLENCE. teen girls from five to fourteen years of age. One of them, aged only five years, had moreover venereal warts, and in a child of three years of age he found a primary chancre. § 218. The traces left after an attempt at sexual connection by an adult with a girl under the age of puberty vary some- what with the age, but more still with the degree of violence and the frequency of its repetition. A full and complete con- nection between an adult male and a child under twelve years of age is, on the first attempt, manifestly impossible ; repeated efforts, however, will produce such a dilatation of the parts as to render it finally practicable. A case, where the vagina of a child seven years of age became by degrees sufficiently dilated to admit the adult male organ completely, is men- tioned in Canstatt’s Jahresbericlit for 1851. But in the ma- jority of cases the penetration is hut partial, and in some cases the chief injury has been inflicted by the use of the finger. The truth of this statement is shown by the frequently unin- jured condition of the hymen. In fifty-one cases of rape upon children, many of them under fourteen, complicated with syphilis, Casper found the hymen destroyed only seven times in those between nine and fourteen years, and twice slightly torn in children of nine and ten years of age. In all the re- maining cases, viz.,four-fifths of the whole number ft was entirely uninjured. § 219. The usual marks of violence left after the attempt upon children are a swollen condition of the labia majora, together with an inflamed and painful state of the vaginal entrance, and a secretion from these parts of a muco-purulent discharge. There is also pain in urination and defecation. This condition may be illustrated by a case where a child ten years of age was assaulted by a man aged thirty-eight; the following signs were found immediately afterwards. The nymphse swollen, of a dark red color, and very painful, the hymen torn into three parts, the vaginal entrance free, but of a deep red color as far as the attachment of the hymen. The Algiers, we learn that “the Arabs believe that the syphilis may be trans- mitted to a negro female, the individual thus transmitting it becoming free from the disease.” 181 § 220] RAPE. [book ill. child was feverish and had pain in and after urination. Spots of blood were found on the under-garment. In the course of a week the hymen was healed, but not united, the swelling subsided, but there remained a muco-purulent discharge for about two weeks, (e) A yet fuller illustration is presented by the case of a child under seven years of age ravished by an adult. It is reported by Dr. McKinlay.(ex) At the upper part of the cleft of the buttocks, behind and above the anus, the skin was besmeared with dried blood. The vagina was lacerated in various directions. One laceration extended down to the verge of the anus, laying bare the rectum, and others upwards and laterally. In the cavity produced by the lacera- tion was some fecal matter which had escaped from the rectum through an opening an inch in length, and situated three- quarters of an inch from the verge of the anus. The child gradually recovered in spite of these frightful injuries. If gonorrhoea or syphilis have been communicated, there may be, in addition to these marks of injury, an urethral dis- charge, chancres, condylomata, and, if sufficient time have elapsed, buboes and constitutional symptoms. We subjoin here a few cases, showing the appearances we may expect to find in children upon whotn rape has been attempted. § 220. X., a man of leisure, was accused of having repeatedly misused three sisters, Agnes, aged 12, Clara, 11, and Antonia, 8. In all three the hymen was destroyed; in the two elder, the vaginal canal was uncommonly widened for their age, but not in the youngest. The opinion given was, therefore, that all three of the children had been deflowered, but that it was pro- bable that the youngest had been masturbated with the finger. The evidence of the children, and some witnesses, gave all the details of this filthy transaction. Several more cases of an exactly similar character are given ; we will, therefore, not re- peat them. In the following case the whole proceeding was seen. Ottilia, aged ten years, still retained her hymen, although this was inflamed and relaxed. The vaginal ent rance was dilated, (e) Keller. Casper’s Vierteljalirsclirift. Y. Band. 1 H. 1854. (e1) Br. and For. Med.-Cliir. Rev., Oct. 1859, p. 535. A very similar case, which ended fatally, is reported by Mr. Colles, Med. Times and Gaz., June, 1860, p. 560. 182 BOOK III.] MAllKS OF VIOLENCE. [§ 220 irritated, and very sensitive. An old man of not less than sixty- five years had, it was said, often abused the child, having first enticed her by the present of a silver penny. On the last occa- sion, when he was discovered, the act took place in a barn, and a witness observed it through the chinks of the wall. The opinion of Dr. Casper, founded merely upon the condition of the child, was that a complete penetration had not taken place. A journeyman baker, affected with gonorrhoea, was accused of rape upon a child seven years of age, of healthy constitution. The child, examined one month afterwards, was found to have the hymen uninjured, hut had gonorrhoea, and the mucous membrane of the vaginal entrance in an inflamed condition. Hence the opinion was given that the condition of the child was due to an attempted, but not completed, coition by a man affected with gonorrhoea. Eight other similar cases are given. Another instructive case is the following. The girl was four- teen years of age. The labia majora were relaxed and inelas- tic, and did not cover the vaginal entrance as they do in the virgin state. The orifice of the vagina was dilated, particu- larly in the lower portion. The opening of the hymen, which was itself not destroyed, was unusually large, and the vaginal mucous membrane very red and inflamed. The hymen and clitoris were swollen, and there was also gonorrhoea. The defendant, a bookbinder, who was charged with having fre- quently had connection with the young girl, as well as others who visited his shop to buy writing materials, represented that he had merely used manipulations with his hand. Dr. Casper, in reply to the question put by the judge, stated that “ it was improbable that the defendant had merely manipu- lated with the hand, since the dilation of the vagina was ad- verse to this opinion, and that masturbation merely could not induce so much inflammation, nor the urethral gonorrhoea which was present. Hence it was to be presumed that the defendant had at least endeavored to introduce his organ into the vagina.” A case happened in London in 1858, and is related by Dr. Taylor,(/) of a girl of seven years, violated by a boy under seventeen years of age. There was complete de- (/) Med. Jurisp., 6th ed. p. 697. 183 § 222] RAPE. [book III. struction of the hymen, and slight laceration of the perineum hut no other marks of violence. Very profuse bleeding had saturated the girl’s clothing, but no trace of blood was found upon the boy’s clothes or person ; and it was inferred, there- fore, that the bleeding was an after effect, and a result of oozing from small bloodvessels. Had not the proof of the crime been complete on other grounds, this circumstance would have rendered its commission by the accused improbable. Idascher^1) relates a sickening case of a child eight months of age, violated by a boy eighteen years old. Upon examina- tion there were found redness, swelling, and great tenderness of the labia minora and parts in the neighborhood of the urethra, with rupture of the hymen, freenum, and perineum, together with laceration of the posterior wall of the vagina. § 221. A case of genuine rape, with syphilitic infection, gave rise to an indictment against a journeymen hatter, who had abused his master’s daughter in the most shameful man- ner. “ The girl was only eight years of age, her private parts were very much dilated, and the mucous membrane, particu- larly at the entrance, very red and painful to the touch. The hymen was destroyed, and she had a virulent gonorrhoea.” Dr. Casper gave his opinion, “that there was no room for doubt that an impure coition had taken place, and been really consummated.” It was afterwards discovered that the accused was affected with gonorrhoea. But on account of his obstinate denial of the charge, and his endeavor to escape conviction by assigning other reasons for the infection, the judge proposed the question, if the common use of an unclean chamber utensil could possibly be the means of conveying the gonorrhoeal dis- ease. The answer was, that this was possible, but that such an origin of the disease could not properly be assumed in this case, on account of the destruction of the hymen, and the dilatation of the vaginal canal. § 222. There can be no doubt of the occasional transmission of gonorrhoea by other means than sexual intercourse ; but it is important for the physician to keep in mind the fact, that, in the case of children at least, the presumption is entirely in 184 (/') Oest. Zeitsch., xxxii. 33. BOOK III.] CASES. [§ 223 favor of the ordinary mode of infection, unless the signs of violence before enumerated do not exist. Dr. Ryan,() Ilandbuch, p. 102. 217 § 253] RAPE. [book hi. is sometimes destroyed by riding on horseback, by ulceration, by the first eruption of the menses, and by self-abuse. From a consideration of these circumstances it follows, that, while the hymen is far from being good proof of chastity, it may be lost and the female still be pure. Perhaps the only exception to this remark will be found in cases where the traces of its de- struction are recent. Here, of course, the presumption will be, that its laceration is due to sexual connection, unless other means are apparent. Where the female supposed to be viola- ted does not deny having previously had carnal intercourse, the signs from the presence or absence of the hymen do not come under consideration. The other traces of sexual intercourse, such as turgescence and bruising of the parts, with heat and moisture, may, where opportunity for an early examination is given, be of some weight wThen taken in connection with other evidence. An interesting case of 'post-mortem examination, in which these signs were of value, may be found in Henke’s Zeitschrift, vol. xlvi. p. 41. The external genitals were found swollen and red, the clitoris in a state of partial erection, and the vagina turgescent and very moist. The mucous membrane of the uterus was highly injected, and the mouth of the womb open. In its cavity there was found a yellowish-white liquid of gela- tinous consistence, and which, from its smell and other pecu- liarities by chemical reagents, was evidently semen. The dead body of the woman had been found lying near a public road, with the clothes thrown up over the face, exposing the lower parts of the body, and the thighs stretched widely apart. Other marks of violence were found upon the body, but the cause of death was forcible suffocation. This opinion, given by the official surgeon, was confirmed by the subsequent con- fession of the criminal, that, while violating the person of the deceased, he had endeavored to stifle her cries by forcing the clothes over her face. § 253. (2) Seminal stains upon the clothing of the female form, however, the most reliable medical evidence in rape either upon children or adults. It is of course evident that they will not always be present, since none of the semen may have been shed outwardly. On the other hand, the mere pre- 218 BOOK III.] [§ 254 SEMINAL SPOTS. sence of seminal stains upon the female’s clothing is, of itself, no proof at all that violence was attempted, and still less that penetration was effected. Moreover, all that constitutes the crime of rape, including penetration, may have been com- pleted without the occurrence of seminal emission. The de- tection of semen upon the female’s clothing must, therefore, be regarded only as corroborative of the signs derived from the condition of the genital organs and other parts of the complainant’s body, as well as from other circumstantial evi- dence. Practically there is considerable difficulty in ascer- taining the presence of seminal spots; in illustration of this remark, we cannot do better than quote the words of the acute Dr. Casper, than whom there is, perhaps, no better authority.(w) He says: “In all the numerous cases which have come under my observation, I have never omitted, even when several months have elapsed since the alleged rape, to direct my attention to the chemise. Put this is not the white, fine, and frequently changed garment of the upper classes of society, but almost without exception of coarse material, ragged, and not washed for weeks or months; the lower half presenting two large, disgusting stains, made up of a com- pound of menstrual blood, dirt, excrement, urine, gonorrhoeal matter, etc. etc. Nothing is said of this ‘in the books;’ and hence the possibility of recognizing traces of semen in such a mixture is out of the question. But we have in the micro- scope, which, as well as I am aware, Rudolph Wagner first used for this purpose, an excellent means of diagnosis.” § 254. (a) The microscopical characters of semen can be recog- nized equally in the dried spot and in the recent secretion. In the former, however, the spermatic animalcules will most pro- bably be dead, and in a fragmentary condition. M. Bayard(z) has been able to recognize them in spots as much as six years old. The following directions for preparing the spots for microscopical examinations are given by M. Bayard: “ The tissues covered by the stain should be allowed to macerate in lukewarm water for several hours. The liquid should then (w) Vierteljalirschrift fur ger. u off. Medecin., Bd. 1, H. 1. (%) Ann. d’Hyg., t. xxii. 219 § 255] [book III. RAPE. be filtered, and if the spots have not entirely disappeared, the tissue should be placed in a porcelain cup with a little distilled water, and heated over an alcoholic lamp to 176° F. If any glutinous matter still remain upon the filter, it should be again macerated in water, to which a sixth part of ether or ammonia has been added. All the resulting liquids should then be poured upon the same filter. The point of this, be- ing carefully cut and reversed upon a glass slide, should be moistened with ammonia to dissolve the fatty matters, and the paper then removed, leaving the matter to be examined upon the glass.” This method is objectionable because the degree of heat and the various successive manipulations must tend to disintegrate the animalcules. Schmidt, in his valuable paper,(y) recommends the following simple plan, which has, moreover, the advantage that the spot need not be cut out. The inner surface of the spot, which is known by a slight shining prominence in the centre, and easy to find by the light of a candle, should be turned outward, and the tissue so folded that the middle of the spot shall form the apex of a funnel-shaped bag, which should dip in a watch-glass half filled with water. After three or four hours, warm the water in the watch-glass over an alcohol lamp, after the addition of a drop of ammonia. A drop of the water may then be examined for spermatozoa, and, being dried upon a glass plate, kept for future reference. Koblanck recommends the still simpler method of cutting out the suspected portion of linen, macerating it for five or ten minutes in a few drops of distilled water, and pressing it with a glass rod.fy1) Dr. J. G. Richard- son (y2) says that the use of high powers of the microscope (1200-2800 diameters) enables us to detect spermatozoa with increased certainty, and that their appearance under a high ob- jective is so characteristic, that we can easily pronounce the stain to be seminal, even if we find only imperfect specimens of spermatozoa in which the greater part of the tail has been lost. § 255. Spermatic animalcules exist in all animals capable of (y) Die Diagnostik verdachtiger Flecke in Criminalf alien. (yx) Canstatt’s Jahresbericlit, 1853, vii. 15. (y2) Handbook of Medical Microscopy, Pliila. 1871, pp. 299 and 302. 220 BOOK III.] SEMINAL SPOTS. [§ 257 procreation, and are found in the semen of man from the age of puberty to quite an advanced period of life. “They are extremely small, scarcely surpassing the one-fiftieth, and at the very most the one-fortieth, of a line in length. The little, oval, somewhat flattened, almond-shaped, and perfectly trans- parent body seldom exceeds from the one six-hundredth to the one eight-hundredth of a line in length; the filiform tail at the top is thickish, and so strong, that the double contours are plainly visible, but towards the end it becomes so fine, that it cannot be followed even with the highest powers to the point; so that it is possible the delicate extremity proceeds further than it can be traced, and that the animalcule is actually longer than it can be determined to be by micrometric It is hardly possible for one accustomed to microscopic examinations to confound spermatozoa with other objects, unless they should be all in a fragmentary con- dition. In such case, an opinion should be given and received cautiously. When any are found entire, we do not think that there is any other microscopic animalcule which a practised observer can mistake for them. It is important to bear in mind that the absence of spermatozoa from the suspected stains is not conclusive of their not being seminal. For it is certain that, after debilitating sickness or excessive venery, and also in old men, the seminal liquor often contains but few if any animalcules. In a case reported by Dr. Beale^1) fibrillae were found in the urine bearing a certain resemblance to spermatozoa, but which were concluded to be forms of fungi. § 256. Casper says, that, “ though stains are proved to be of seminal origin when these specific zoosperms are found in them, yet the absence of spermatozoa does not prove that these stains have not been caused by human semen,” and gives the result of numerous observations in support of his statement.^2) § 257. It was formerly supposed that spermatozoa were the only bodies ever found in this connection that had motion and (s) Wagner’s Physiology, translated by Dr. Willis. London, 1841, p. 9. (z1) Archives of Medicine, No. iii. p. 251. (g2) For. Med., vol. iii. 296. 221 § 259] RAPE. [book hi. consisted of a head and tail, but M. Donnd has of late described an animalcule, sometimes found in the vaginal mucus of females careless of cleanliness, which he has termed tricho- monas vaginee. It is found mixed with granular bodies larger than those often found with spermatozoa. The head of a trichomonas is three times the size of that of a spermatozoa, and has upon its circumference a row of from four to six short cilia.(z3) § 258. (6) "With respect to the chemical relations of semen, we think little need be said. The spots are usually of a slightly yellow color, somewhat stiff, as if the tissue were starched, and give out the peculiar odor of semen when moistened. They become of a deeper color by being held near the fire, and small whitish specks become visible in them—an effect which is said not to occur with stains from other discharges. Devergie first showed that spermatic stains on linen, when held near the fire, assume a deep nankin-yellow tint, while albuminous spots remain unaltered. This method has proved successful even when the matter of a suspected stain upon some dark-colored stuff1 has been soaked out of it and transferred to white linen. M. Lassaigne informs us that a similar color is developed in albuminous stains when they are heated after having been moistened with a solution of plumbate of potassa, but this effect is not produced in spermatic stains, nor in those produced by gelatin, starch, gum, or dextrine.(a) Semen is alkaline, glutinous, and but slowly soluble in water. When seminal stains are not mixed with any other matter, they may be recognized by the following properties, in addition to those just mentioned. The solution obtained by macerating the stain in distilled water is not limpid, is not coagulable by heat, gives a characteristic odor on evaporation, and, when the latter is complete, there is left a shining transparent substance, sparingly soluble in water, but yielding a glutinous solution with potash. Pure nitric acid causes no precipitate.^1) § 259. 5th. Feigned rajge.—The following singular case oc- (23) Guy’s Forensic Medicine. London, 1868, p. 46. (a) Annals d’Hygiene, 2eme ser., x. 405. (a1) For evidences derivable from traces of blood, vide Blood-Stains. 222 BOOK III.] RAPE BY FEMALES. [§ 260 curred in France. Marie V , aged twenty-eight years, was seen to fall down, apparently in a faint, near the house of her uncle, the district schoolmaster, at the entrance of a field adjoin- ing the public road. Her hands were found fastened by a cord, her handkerchief was tied over her mouth, her hood (capote) was drawn over the upper part of her face and fastened by pins in front of the eyes, leaving, however, a sufficient interval for the use of sight; her clothes were soiled with mud at the lower part only, and her camisole was laced. She did not apparently regain consciousness for several hours; she then related, with circumstantial detail, that she had been assaulted by four young men who had endeavored, though unsuccessfully, to violate her person. A medical examination being ordered, a vast number of superficial linear incisions were found, made ap- parently with the point of a knife or scissors; there were no contusions or marks of recent violence on the genital organs or their vicinity. Her clothes were not torn or crushed, and m her pockets a penknife and scissors were found, on the points of which there were slight traces of blood. The girl at last, after much hesitation, confessed that she had not been the victim of any assault, hut that in a paroxysm of hysteria, without any reason to account for the strange idea which took possession of her mind, she had herself inflicted these wounds with scissors on the parts of her body which she had been able to reach. The legal proceedings were consequently stopped, (b) § 260. 6th. Rape by females.—An instance of this kind is related by Casper, in which a child only six years of age received a gonorrhoea from his governess, with whom he slept. In another and far more horrible case, a mother satiated her unnatural lust with her own son nine years of age, upon whose body, however, no traces of the crime were perceptible.^1) Two cases have occurred in France, in one of which a female of eighteen years obliged a boy under fifteen years to com- ply with her wishes ; and in another a girl of eighteen was (5) Lond. and Ed. Monthly Journ., Dec. 1853, p.* 550; from Gaz. des Hop., Oct. 30. (61) Gericht. Med., ii. 129. 223 §261] RAPE. [book III. charged with rape on two children, the one of thirteen, and the other only eleven years of age. She was affected with syphilis, which she communicated to the children. It is stated also, that, from a narrowness of the vagina, she was unable to gratify her propensities with adults. The only means by which the rape can be established through medical evidence is where gonorrhoea or syphilis has been thus communicated. § 261. 7th. Paederasty.—This unnatural crime demands but little notice from us. It has been customary for authors, in describing the physical results of this vice, to enumerate vari- ous local injuries, such as laceration and a patulous condition of the sphincter ani, prolapsus of the rectum, and ulcerations, together with constitutional effects, as consumption, dropsy, etc., as the inevitable results by which the commission of it could be ascertained. Tardieu,(c) speaking of the recent signs of unnatural violence, says that they are found to differ with the amount of force employed, the size of the organs, the youth of the victim, and his freedom from previous pollution of the same kind. In different cases they vary from redness, excoriation, and painful heat in the anus, and difficulty in walking, to fissures, lacerations, extravasation of blood, and inflammation of the mucous membrane and its subjacent cellular tissue. The observations of Parent-Duchatelet,(V) and of Casper,(d) show, however, that such consequences are far from being even the common effect of this disgusting vice. The former of these authors speaks from a long experience; he says that he has never observed the results above enumerated. Dr. Casper, in a valuable monograph on this subject, in which he communicates a number of cases which fell under his notice, says, that none of the signs enumerated by authors are to be depended upon. In one case, however, mentioned by him, (c) Attentats aux mceurs, p. 123. (c1) De la prostitution dans la ville de Paris, vol. i. p. 225. (d) Vierteljahrsclirift fur ger. u. off., Med., Bd. i. H. 1. Also Ibid. Bd. vii. H 2. For an historical accouut of the vice, see “Geschichte der Lust- seuche im Alterthume nebst ausfiihrliclien Untersuchungen iiber den Venus und Phalluscultus, Bordelle, Noua-of Wxeia der Skythen, Poderastie und andere geschlechtliclien Ausschweifungen der Alten, etc.” By Dr. Julius Rosen- baum. Halle, 1845. 8vo. 224 BOOK III.] PiEDERASTY. [§ 262 in which a medical examination was obtained immediately after the commission of the crime, the sphincter ani was lacerated to the depth of two lines, and the parts irritated and painful. The most frequent result which he witnessed may be described in the words of Zacchias, strangely heretofore overlooked: “ Multo magis frequentem tam nefandi coitus usum significare poterit ipsius podicis eonstitutio, qui cum ex natura rugosus existat, ex hujusmodi congressu leevis ac planus efficitur, ob- literantur enim rugse illse in ani curriculo existentes ob as- siduam membri attritionem.” He also describes a funnel- shaped depression of the nates, as a frequent result. It should be remembered, however, that these observations were made upon persons whose lives had been spent in the practice of this degrading vice, or who had been for a considerable time in the practice of it. Syphilitic ulcerations or growths, in these parts, although of suspicious origin, may be really due to other causes than a direct transmission by unnatural connec- tion. Marks of violence may be naturally expected in young persons. § 262. The frequency of this crime is probably much greater than the statements above quoted from Parent-Huchatelet and Casper would seem to indicate. Tardieu states that on two occasions the sudden descent of the Parisian police upon cer- tain dens of vice resulted in the capture of eighty-seven in the one, and of fifty-two in the other, persons found flagrante delicto. From these in part he obtained the perfect confirma- tion of the description of Zacchias in regard to the signs of this vice when habitually indulged in. In two hundred and five cases of avowed criminality, these indications were want- ing only fourteen times. In addition to the details already given, he describes relaxation of the sphincter ani, dilatation of the anus, incontinence of feces, ulcers, piles, fissures, fistulse, etc., as consequences of this detestable crime. It is unfortunate that there is no medical evidence by which the crime can be be brought home to the active transgressor; Tardieu, however, describes as effects of habitual indulgence in it, a tapering form of the whole penis, when this organ is slender, and when it is of large dimensions, a similar shape of the glans alone. YOL. II.—15 225 § 264] RAPE. [book hi. Legal relations of rape. § 263. 8th. The points to which medical testimony is most likely to be invited, in prosecutions for rape, are the follow- ing :— 1st. Submission of prosecutrix, § 264. (a) From artificial stupefaction, § 264. (ib) From ignorance of the nature of the act, § 269. (c) From mistake of person, § 275. (d) From fear, § 276. 2d. Prior want of character of prosecutrix, § 277. 3d. Subsequent suppression of the fact by prosecutrix, § 279. 4th. Extent to which coition was carried, § 280. 5th. "Want of age of defendant, § 285. 6th. Want of sexual capacity of defendant, § 286. The law on each of these points will be now briefly con- sidered. 1st. Submission of prosecutrix.—This may happen from either of the following causes:— § 264. (a) From artificial stupefactionfa)—It makes no matter whether the drug was given for the purpose of producing stupefaction, in order that the rape might be effected on the female thus made unconscious, or whether it was administered for the purpose of causing sexual excitement, and thereby leading to a voluntary submission. It is rape in either case; the law being, that the overcoming of chastity, and the de- stroying of resistance by artificial means, is rape, when the offence is consummated. If the result of the dose be stupe- faction, and if, on the woman thus become insensible, carnal intercourse be effected, it is rape, though the intention was merely to excite. Thus, where the prosecutrix was made drunk by the prisoner, who then violated her person, it was held in England, where, from the offence being capital, it is 226 (a) See the medical relations of tliis point, ante, § 242. [§ 265 BOOK III.] LEGAL RELATIONS OF RAPE. kept within its strict, common law limits, that the crime was rape, though the jury expressly found that the liquor was given with the intent of exciting, not stupefying.(b) And in this case it was held, that where the insensibility is the defendant’s act, and where the defendant knows that “ the act was against the prosecutrix’s consent at the last moment she was capable of exercising her will,” it is rape. On this point agreed all the ten judges of England, constituting the final Court of Re- vision in criminal causes; and it was not required by the exi- gencies of the case that they should go further. Several, how- ever, thought—and this view is in accordance with the analogous cases to be hereafter noticed—that the crime was consummated by the mere act of knowingly violating an in- sensible woman, whether the insensibility was produced by the defendant himself or not. § 265. In a case of subsequent date in Hew York, the in- dictment charged that the defendants committed a rape upon one Mary A. Williams, also counts for assault with intent to commit a rape, and for simple assault and battery. The evi- dence showed that the defendants got the girl intoxicated, and then, it seems, two of them raped her, the others being present at the time. The girl was proved to be a common prostitute. The defendants were found guilty on the second count. The case came before the Supreme Court on excep- tions to the judge’s charge. In delivering the opinion of the court, Judge Johnson said, “ The judge, among other things, charged the jury, that, if they should find, from the evidence, that the girl and the defendants were drinking together vol- untarily, and afterwards went out together, without any assig- nation having been made, or any consent on her part to have sexual intercourse with them, and she became insensible from the liquor thus drank, and while in such condition the de- fendants violated her person, they would be guilty of rape'.” “It has, I think, never yet been held that merely having carnal knowledge of a woman while deprived, by voluntary intoxication or otherwise, of all reason and volition, without (6) E. v. Camplin, 1 Car. & K. 746; 1 Den. C. C. 89 ; Wh. Cr. Law, § 1140 ; and see Com. v. Burke, 105 Mass. 376 ; State v. Stoyell, 54 Maine 24.. 227 § 267] RAPE. [book III. her consent, and by such force only as was necessary to accom- plish the act under such circumstances, was a rape.” The point, however, on which the court relied in granting a new trial was, that, in New York, carnal intercourse with an intoxi- cated woman is by statute an independent offence, and not rape.(c) § 266. In the prosecution of Dr. Beale, in Philadelphia, in 1854, which has been noticed above,(d) the point was not made, and it was assumed by both sides, that carnal intercourse with a woman who was stupefied by chloroform was rape, though the chloroform was administered, at her request, for the purpose of facilitating the extracting a tooth. And if this be the law —and the cases to be subsequently noticed unite with the reason of the case in indicating that it is—it goes to establish the broad position, that rape is sexual intercourse with a woman, not against—as has been formerly said—her will, but without it. § 267. In January term, 1860, Dr. Davis Green was tried before the Common Pleas of Mercer County, Ohio, for a rape on Jane Gray. According to the statement before us, which was prepared by the defendant’s counsel for the Western Law Monthly,(e) the prosecutrix was a “truthful, virtuous girl, robust and healthy, of limited education and intelligence, though of good natural sense, aged seventeen years on the 21st of August, 1857.” The evidence, according to the same state- ment, was that “on the night of the 23d of June, 1857, she lodged in bed with a daughter of defendant of about the same age, in the northeast corner room of a village hotel, in Mercer County; that in the adjoining room, south, there lodged a man and his wife, and in the adjoining room, west, with an un- fastened door between them, there lodged the defendant, and other persons in other beds; that the prosecutrix and her bed companion retired about 10 P. M., and after talking a short time fell asleep ; that during the night, the first thing remem- bered by the prosecutrix was that the defendant had her by the arms, pulling her out of bed ; that he said he was Dr. (c) People v. Quin, 50 Barbour 128 ; Wh. C. L., § 1128. (d) See ante, § 245. (0) April, I860, p. 183. 228 BOOK III.] [§ 267 LEGAL RELATIONS OF RAPE. Green, and he had come to have sexual intercourse with her ; that he placed her in a position with her feet touching the floor, and her weight partially resting on them and on the pillows; that in that position he had complete sexual inter- course with her; that she experienced the pain of rupture of the hymen, but experienced upon her clitoris a pleasurable sensation from the coition ; that the act lasted but a few min- utes ; that upon leaving her the defendant said to her she must never tell it, that it would not hurt her; that he held his hand upon her mouth, and she felt a rag between his hand and her mouth ; that she heard what was said, was conscious of all that occurred; that she tried to speak, but felt so weak and scared that she could not, or would not speak aloud, and did not say but a word or two—said, ‘ Go away ; oh dear!’ that she tried to force him away, but could not; that she ex- perienced a ringing sensation in the head, felt weak, drowsy or sleepy, but did not sleep any more that night; that she re- mained in bed until morning, made no outcry, and told no one of the occurrence until about the last of December, 1857 ; that next morning she felt unwell, and presented a sad and gloomy countenance, and for a week or two was nervous and easily alarmed; that the ringing in the head lasted a day or two; for three or four days she could not sit up for any considerable time; the symptoms of the weakness lasted two weeks; that this time, 23d June, was the usual period for the return of the menstrual discharge, and symptoms of it were felt, but no actual discharge had yet occurred ; that on the morning of the 24th she observed a spot, as of blood, on her chemise, the only night dress she wore, which she supposed was a slight menstrual discharge, but that no discharge followed at any time thereafter ; that she conceived and gave birth to a child on the 26th March, 1858 ; that after retiring to her room on the 23d June, before going to bed, her nose bled ; that she never saw chloroform before, but smelled it on trial, and be- lieve the smell to be like that she experienced on night of 23d June ; that she first thought defendant had intercourse with her twice that night, and told others so, but, on reflection, was sure it was only once ; that she saw him with shirt and drawers on, but had no other clothing ; that she made an 229 § 267] RAPE. [book nr. effort twice with both hands to resist him, but could do no- thing; she weighed 130 pounds; was in good health, and had always enjoyed good health ; did not smell medicine when first awoke, but did after defendant left her room, in about six minutes; the effect was unpleasant, cannot say painful; that her mind was clear from the time she awoke, and she knew everything; her feet were about six inches ; more than half her weight on her feet, the rest thrown back on the upper part of the bed ; the rail of the bed came in contact with the middle of her thighs; she made no effort to awaken the daugh- ter of defendant, though her hand was near or touching hers ; did not halloo nor call any body ; her hands were not restrained at any time; defendant only touched her with one of his hands; is sure she remembers everything that occurred accurately.” The defendant was a physician. A large amount of evi- dence was offered to prove or disprove the offence. The defen- dant’s daughter, a highly intelligent young lady, testified that she was not disturbed, perceived no odor of medicine in the room, and noticed nothing unusual in the appearance of prose- cutrix the next morning. The defendant was just recovering from a long and severe attack of phlegmonous erysipelas. The left hand very sore; poulticed ; the neck very stiff and sore, and the right hand also sore and in ulcers. No one about the house heard any noise or disturbance during the night, after parties had retired. The partitions between the rooms were of boards ; had stood twenty years ; had shrunk so that there were cracks between them nearly an inch in width. The boards were an inch in thickness. The bed of ordinary size. It was also testified, as we learn from the judge’s notes, that the defendant, before retiring to bed, took a vial from his pill- bags, which he said contained a weak solution of chloroform ; that he bathed the court-plaster on his hand with it, saying that it relieved pain; that he took this vial up to bed with him, saying that he might need it in the night, if his hand became painful; that when he retired he asked which room the girls were in, and selected a bed near the door of their room, saying that he could be near the girls and could wake them early; that he rose before them next morning, and they were called to breakfast by other persons. 230 BOOK III.] LEGAL RELATIONS OF RAPE. [§ 267 He offered no evidence as to his character. He is a married man, age over forty years. A witness swore (without objection) that he once, under the influence of chloroform, had a tooth which the surgeon en- deavored to pull, but it broke off, when an effort was made to extract the root with a screw ; that he saw, heard, and knew all, but his volition was overcome—had no inclination to re- sist. The court (Lawrence, J.), in charging the jury, adopted substantially the views in the text. The defendant was con- victed, and a motion for a new trial refused. But to this de- cision the same objection applies as that heretofore urged to the conviction in Com. v. Beale, i. e., that it is unsafe to con- vict when the sole proof of the corpus delicti rests on the evi- dence of a witness who, at the time of the alleged act, was under the influence of a stimulant which it is admitted is apt to work erotic imaginations. In the case immediately before us, it is true, there was subsequent pregnancy, which was not shown in Com. v. Beale. But in neither case was there any medical examination showing sexual intercourse to have been at the time consummated; and in the present case, there was no complaint made by the prosecutrix until months after the alleged rape, at a time when she found herself pregnant. Tes- timony of witnesses as to what took place when they were under the influence of chloroform, should be subjected to the same tests as those applied to insane witnesses. Such testi- mony cannot be safely excluded.(/) But there should be always in such cases proof of the corpus delicti aliunde.(f1) (/) See vol. I. § 242. (/') From the judge’s charge we extract the following :— “ When the will acquiesces in coition, there cannot, as a general rule, be any rape. But the acquiescence which defeats a prosecution for rape is that of a will so far under the enlightened guidance and control of the other faculties, that the mind can fairly comprehend the nature, and judge of the consequences of the act, unless, as before stated, the defect of capacity is un- known to the accused. (The judge, in a previous part of the charge, had said, that, if the prosecutrix had the capacity to understand the nature and judge of the consequences of sexual intercourse, and the power to resist it by act or word, and neither such capacity nor power was overcome by force, fear, or chloroform, her acquiescence in the act would defeat a prosecution 231 § 268] RAPE. [book hi. § 268. The subject of tlie criminal employment of chloro- form is hereafter separately considered.(y) for rape.) If the faculties have been, to some extent, suspended by chloro- form, but enough remain to reasonably comprehend the nature, and judge of the consequences, of the act, their acquiescence in coition will defeat a pi’ose- cution for rape. “ But if, through the influence of chloroform, either directly upon the will, or the consciousness, or other faculties of the mind or the sexual feelings and emotions, the mental capacity is so benumbed, suspended, or perverted as to be unable reasonably to comprehend the nature and judge of the conse- quences of coition, and by reason of such condition, known to the defend- ant, the act is acquiesced in or consented to, such acquiescence or consent will not alone defeat a prosecution for rape. Rape may exist with such ac- quiescence, thus knowingly obtained. “It is of the utmost importance that you should ascertain whether chloro- form was administered ; and if so, whether it deprived the prosecutrix of mental and physical powers. “If it be assumed (and whether it be, is for the jury to say) that there is evidence tending to show that chloroform was administered to the prosecutrix while asleep; that sexual intercourse was had with her ; that she partially or wholly awoke before it commenced ; that she was conscious of it, and all the movements attending it; that she could and did hear and understand words spoken in a low tone ; that the intercourse produced upon her clitoris a pleasurable sensation ; that this wras preceded by the pain of a ruptured hymen ; that she did not speak ; that she felt a desire to resist physically, en- deavored to do so, but could not; that the act was followed by pregnancy, and the birth of a child in 276*days; that she was a vigorous girl, in her seventeenth year, virtuous, truthful, of limited education and intel- ligence ; that the act wTas at the proper time for the return of the men- strual period, but before any actual discharge ; it will be important to ascer- tain whether there is any stage in the effect of chloroform upon the human system where these facts can exist consistently wTith the idea that such inter- course could be had without her consent. “ The inquiry maybe assisted by ascertaining whether the various powers of the mind and body fade away under the influence of chloroform, gradually and coequally, and return in like manner, as the influence passes off; or whether some—and if so, what ones—precede others in thus fading away and being restored, and the order thereof, in all the various stages of the in- fluence ; and whether some—and if so, what—faculties are retained, and the extent and capacity of them. “ In the case which I have assumed, where the sense of hearing remained, and the sensations of pain and pleasure were felt in a greater or less degree, these facts would tend to show that the stage or condition of anaesthesia had either not been reached, or was past; and, if so, it might be much more pro- 232 (g) See post, title “ Chloroform.” BOOK III.] LEGAL RELATIONS OF RAPE. [§ 269 § 269. (b) From ignorance of the nature of the act.—A striking instance of this is to be found in the case of the imbecile girl bable that memory would retain its power than if the facts were otherwise. And if the capacity to remember existed, statements made by its aid might be reliable. But as failure to resist by icord and act, haying the capacity to do so, would be strong if not sufficient evidence of acquiescence in the coition, it would at once become necessary to determine if the faculties of hearing and feeling could coexist in a sound body, without either the capacity to speak or make forcible resistance. If that be not possible, then due weight should be given to such consideration, in determining whether she acquiesced in the coition. But if the capacity to hear, feel, and remember be consistent with incapacity to speak or forcibly resist, then the evidence of guilt may thereby be enhanced. What may be the truth, you will determine from the evidence in the case. “ But if the prosecutrix had the capacity to hear, feel, and remember, and a capacity to speak and forcibly resist, but the inclination to do so was lost, the will overcome by the action of chloroform, either operating upon the will faculty, or the judgment and reflective faculties (or sexual emotions), so that the mind was thereby incapable of fairly comprehending the nature and consequences of sexual intercourse, and the defendant, knowing these facts, had unlawful carnal knowledge of her, forcibly, that would be a rape. And it would in such case be wholly immaterial whether the entire mind was disordered and overthrown, or only such faculties thereof as are rendered incapable of having just conceptions, and drawing therefrom correct conclusions, in relation to the alleged rape. “ Whether the physical or mental capacities I have named could operate normally while other faculties of the mind—as the judgment, the under- standing, the reflective and reasoning faculties—were so deranged or over- thrown as to destroy the capacity to comprehend the nature and consequences of coition, is a question of fact for the jury to determine, upon all the evi- dence in the case. “But if the prosecutrix had the capacity to hear, feel, remember, speak, and to resist, or in any event, it should not be presumed her will was over- come, without proof of that fact beyond a reasonable doubt. “If chloroform may produce delusion in the mind of its subject in any one of its stages, you will inquire if it existed in this case ; whether its existence is consistent with the other mental and physical phenomena which you may find to have existed; and you will give due effect to your conclusions on this subject. “ With these principles as to what are necessary to constitute a rape, the jury will proceed to inquire into the prominent points of controversy, and ascertain if it is proved that the defendant forcibly had unlawful knowledge of Jane Gray ; and if so, was it against her will ?” (The judge then read to the jury section 212 of 3 Greenl. Ev., and section 4C8 of Wharton and Stifle’s Med. Jur., and called the attention of the jury to the prominent points of evidence relied upon to prove and disprove the fact of sexual intercourse, and upon the subject of acquiescence.) 233 § 270] [book III. RAPE. already mentioned, who had no notion of what the sexual act consisted, and who was totally unable to account for her preg- nancy, except by the statement that her cousin had played with her on the sofa.(A) § 270. It is no defence, therefore, that the party ravished gave consent, or even aided in the commission of the offence, when from her very tender years she is to be presumed incapable of knowing the nature of the act.(i) From the same reasoning it results that it is a rape to have carnal intercourse with an idiotic, imbecile, or insane woman, even though without dissent, she being incapable of intelligent submission.^') The defendant was convicted, and a motion for a new trial refused. The result has been commented on in the text. Of the fact there stated, that under certain stimulants erotic imaginations are engendered, the following illustration may be given, from the Providence Journal, of August 13,1872:— “A very singular and remarkable case of hallucination induced by the use of a cosmetic, has lately occurred in Methuen. A young woman living in that town went to Lawrence on Saturday evening last, and on her return to her home, late at night, reported that she had been cruelly assaulted by three men, about twenty rods from her father’s house, and that she was left insen- sible and badly hurt. Physicians have examined the case, and find that several days ago this girl purchased a bottle of preparation kept at the apothe- caries’, known as “Soule’s Infallible Moth, Tan, and Freckle Eradicator.” This preparation she used for four days, applying it externally upon her face and profusely upon her forehead. On Thursday, the fifth day after com- mencing its use, she was taken with sickness at the stomach and a feeling of general debility of the entire system. She was obliged to leave her work at the mill and go home, and remained quite ill from this time till Saturday evening, at the time of this occurrence. The physicians say no such assault has been made as she alleges, and they are of the opinion that the girl was laboring under an hallucination, which might have been caused from the use of this preparation, as one prominent ingredient of it is corrosive sublimate, which is a poison, and its application upon the brain externally would have a tendency to produce a sort of insanity.” (h) Ante, § 248. (i) Hays v. People, 1 Hill, N. Y. R. 351. (j) State v. Farr, 28 Iowa 397. See Com. v. Burke, 105 Mass. 376. In an Ohio case the defendant was indicted—1. For having committed a rape on the person of Louisa Dowler ; 2. For an assault with the intent to commit a rape on said Louisa ; and, 3. For having carnal knowledge, she, the said Louisa, being an insane woman, and he, said defendant, knowing her to be such. The defendant pleaded not guilty, and the cause was tried by a jury at the March Term of the Court of Common Pleas. The evidence on the 234 BOOK III.] LEGAL RELATIONS OF RAPE. [§ 271 § 271. In England the rule is, there must be some evidence that the act was without the consent of the woman, even where trial proved that the said Louisa Dowler was of unsound mind, and had been so from her nativity: though she was not so absolutely destitute of mind that she did not perform the necessary functions and calls of humanity ; but that she had not mind enough to testify as a witness or to be held legally responsi- ble for her acts, whether civil or criminal. The words of the statute are: That if any male person, 17 years old and upwards, shall have carnal knowl- edge of any other woman than his wife, such woman being insane, he know- ing her to be such, every person so offending shall be deemed guilty of a misdemeanor, and upon conviction thereof, shall be imprisoned in the peni- tentiary and kept at hard labor not more than ten nor less than three years. Mr. Knowles for the State, Messrs. Nye and Jewett for defendant, claimed that the said Louisa, being an idiot, had no will, and therefore thkt a rape could not be committed on her person against her will: it was further claimed that the word insane, in the 6th section of the act, did not embrace an idiot, and hence the defendant could not be convicted of either of the charges em- braced in the indictment. Mr. Justice Nash.—It is claimed, first, that a fe- male idiot is not the subject of a rape ; that she has no will, and hence an act cannot be done to her person against her will. No authorities are cited for this startling position. On looking into the books I can find no such distinc- tion intimated; and if such was the law, it is singular that so important a qualification of the crime of rape should not have been noticed hitherto in any treatise on this subject. Rape is defined to be, the having carnal knowledge of a female forcibly and against her will. There is here no limit to the use of the word female ; nothing said as to the soundness or unsoundness of her mind as to idiocy or insanity. In this respect our statute follows the common law, and must therefore be construed as the same words were construed in the definition of the crime at common law. There is another consideration not to be overlooked. The section providing for punishing assaults with a criminal intent, declares that an assault committed on another with the intent to commit a rape, shall be criminal. Now, if a rape cannot be committed on the person of an idiot, then it is no crime to assault her person with such an intent. The same question applies also to assaults committed on an insane person; since this argument places them without the protection of the law punishing the crime of rape. Nor are insane persons protected under the 6th section, since the crime there described is committed only when the per- petrator knows the woman to be insane. Indeed, that section is clearly limited to the case of a male person’s knowingly having sexual knowledge of an in- sane female without resistance on her part, and with her acquiescence. Hence this section cannot be made to embrace the case of one having such sexual intercourse forcibly and against the will or resistance of such insane female. It is further claimed that an idiot is not an insane person under the meaning of that term in the 6th section. The result, then, follows, that a female idiot is left wholly unprotected against this class of crimes. A person cannot be punished for having carnal knowledge of her person forcibly and against her 235 §271] [book III. RAPE. she is an idiot. In such a case, where there were no appear- ances of force having been used to the woman, and the only will, as she has no will to overcome; she is not an insane person, and so not under the protection of the 6th section, and neither an idiot nor an insane female is protected against assaults with intent to commit a rape, since a rape cannot be committed on the person of either. It must require some very co- gent reasoning, or some very convincing authorities, before the court could be induced to give a construction to a statute which must lead to such results. But here is no such authority ; no such decision has been found. Is there any mbre force in this reasoning ? Let us examine it for a moment. In the first place, where the carnal knowledge is had by force, it must be against the will of the female. Nor need there be any direct evidence of this action of the will; the law implies the want of consent from the force itself. It is the consent of the female which takes away all criminality from this connection; it is this want of consent which renders this connection, obtained by force, criminal. Hence if an idiot has no will to be overcome, she has none to con- sent, and then the law implies that the act being accomplished by force is done against her will. But is it true that an idiot or insane person has no will ? What is the definition of these two words ? Do they imply a loss of will or a mere unsoundness of mind ? These words are thus defined by Web- ster : “ Idiot—a natural fool, a fool from birth ; a human being in form, but destitute of reason or the ordinary intellectual powers of man. Insane—un- sound in mind or intellect; mad ; deranged in mind and one of the words used to define insanely, is foolishly. Fool is defined to be one who is destitute of reason or the common powers of understanding ; an idiot. Some persons are born fools, and are called natural fools; others may become fools by some injury done to the brain. In Chitty’s Medical Jurisprudence, p. 348, an idiot is defined to be “a person who has been defective in intellectual powers, from the instant of his birth, or at least before his mind had received the im- pression of any idea.” Again, Chitty says “that idiocy consists in a defect or sterility of the intellectual powers; but it may be induced in after life ; while lunacy or madness consists in a perversion of intellect.” All these definitions imply either a weakness or perversion of the mind or its powers, not their destruction. The powers are still all present but in an impaired and weakened state. Hence an idiot cannot be said to have no will, but a will weakened and impaired—a will acting, but not acting in conformity to those rules, and motives, and views which control the action of the will in persons of sound mind. Indeed, in an insane person the will is too often fearfully active, and wholly uncontrollable by reason or persuasion. There is here no lack of will, but simply a perversion of it. Nor is this the most conclu- sive answer to this argument. If there is no will, how are voluntary actions continued? Not only actions which, like respiration, are instinctive, and independent of the will; but eating and numerous other acts which necessa- rily imply the exercise of the will are performed by idiots and insane persons ; and their exercise demonstrates the existence of a will—of a will which can assent to, or dissent from, what are clearly voluntary acts. I have therefore 236 BOOK III.] LEGAL RELATIONS OF RAPE. [§ 271 evidence of the connection was the prisoner’s own admission, coupled with the statement that it was done with her consent, it was held, that there was no evidence for the jury.(/c) no hesitation in holding, that both idiots and insane persons are possessed of a will, so that it may be legally and metaphysically said, that a carnal knowl- edge may be had of their persons forcibly and against their will. The next inquiry is, what is the proper construction to be given to the word insane ? In the 6th section of the act for the punishment of crimes, Curren’s Re- vised Statutes, p. 184, that section provides: “That, if any male person seventeen years old and upward shall have carnal knowledge of any woman other than his wife, such woman being insane, he, knowing her to be such, shall be deemed guilty,” etc. It is claimed that this word insane does not embrace a female who is an idiot. We have already seen that idiocy may be induced after infancy, as wTell as be congenital, Chitty’s Med. Jurisp. p. 347, and that both terms are defined by the same words, unsoundness of mind. In the one case this unsoundness of mind develops its existence in want of capacity to reason at all; or, at least, in a much less degree than the gene- rality of mankind ; while in the other there is, perhaps, greater acuteness, though upon false and fancied hypotheses. (Chitty’s Med. Jurisprudence, p. 348.) Still, in both cases, unsoundness of mind is the cause. The very ori- gin of the word insane demonstrates this ; in its Latin origin, it is a word simply meaning unsoundness and nothing more ; and in the popular language it is used in this sense to this day, whatever may be the specific meaning at- tached to it by writers on mental diseases. If, then, the object and policy of this statute embraces idiots as well as lunatics, there is nothing in the use of the word insane which absolutely precludes us from giving that elementary meaning to the word in this statute. The reason of this provision clearly applies to idiots as well as to lunatics; if there is any reason in the case of female lunatics, why sexual intercourse with them should be prohibited, equally strong is the reason why it should not be permitted with female idiots. If the offspring in one case might be affected with insanity, so in the other it might with idiocy. Whatever reason, therefore, can be found to so declare the law in relation to female lunatics will apply equally forcibly to idiots. If the one class ought to be protected, equally so ought the other. Such, then, being the manifest scope of the law, I can have no hesitation in concluding that such was the intention of the legislature; that this word insane was used in its elementary and popular meaning, as descriptive of that unsound- ness of mind, which renders individuals civilly and criminally irresponsible for their acts, whether the unsoundness uncloses itself in idiocy or lunacy. In accordance with these views I hold that a female idiot, or an insane female, is the subject of rape, and hence of an assault with the intent to commit that crime; and that a male person, of proper age, who shall have carnal knowledge of a female idiot, knowing her to be such, is guilty, under the (*) R. v. Fletcher, 1 L. R., C. C. 39 ; 12 Jur., N. S. 535 ; 35 L. J., M. C. 172; 14 L. T., N. S. 573. 237 § 273] RAPE. [book hi. In a prior case the prisoner was convicted of a rape upon the prosecutrix, who was an apparent idiot. She proved the act done, and said that it was wrong, but that she said nothing to the prisoner, and that she did not do anything to him, and that she did not like to hurt nobody. The constable told the prisoner that he was charged with committing a rape upon the prosecutrix, and against her will. The prisoner, in answer to that, said, “ Yes, I did ; and I’m very sorry for it.” It was held, that there was evidence to sustain the conviction.(7) But the present (1872) English rule undoubtedly is, that, while, if there is actual incapacity to assent, and force is used, the offence is rape,(m) yet there must be some evidence, in all cases, to disprove assent, and, if there be not, a conviction should not be sustained.^1) § 272. Somewhat in the same sense the law is expressed in a late (1865) able opinion of the Supreme Court of Michigan. Rape at the common law or under the statute of Michigan, it was held, is not committed upon the person of a woman over ten years of age, where no circumstance of either force or fraud accompanies the carnal knowledge. "Where, therefore, a man had criminal connection with a woman of mature age, of good size and strength, hut who was shown by the testi- mony to be in a state of dementia—not idiotic, but approach- ing towards it; and it appeared that no fraud or force was used by him, it was held as not constituting a rape.(n) § 273. But suppose the woman was mentally sound, and an adult, but submitted from ignorance as to the sexual character of the act ? In England this point received a judicial decision on the trial of a physician, who had sexual connection with a young 6th section, of having carnal knowledge of an insane woman, knowing her to be such. The jury were so charged, and they returned a verdict of guilty of an assault with an intent to commit a rape, and not guilty on the other two counts. And sentence was passed on the prisoner.—State v. Crow, Common Pleas of Athens County, Ohio.— Western Laic Journal, vol. x. pp. 501-5. (0 R. v. Pressy, 17 L. T., N. S. 295 ; 16 W. R. 142 ; 10 Cox., C. C. 635. (to) R. v. Fletcher, Bell C. C. 63 ; 8 Cox C. C. * (to1) R. v. Fletcher, 1 L. R. C. C. 39 ut supra. * (n) Crosswell v. People, 13 Mich. 427. 238 BOOK III.] [§ 275 LEGAL RELATIONS OF RAPE. girl, who made no resistance, solely from a belief that the de- fendant was, as he represented, treating her medically. All the judges held the case was rape.(o) And it was said in another case, where the patient was directed to lean forward, for the purpose of receiving an injection, and where sexual intercourse was then attempted, that the defendent was guilty of an assault.(p) § 274. In a more recent casein New York,the prisoner was indicted for a rape upon Lucy S. Jones, and was convicted in the court below. The facts of the case are sufficiently stated in the opinion of the court, which was given by Gilbert, J “ The plaintiff in error is a physician. The prosecutrix is a single woman, thirty years of age. The commission of the offence rests upon her testimony alone. Her evidence, briefly stated, is, that the plaintiff* in error, while attending her in a professional capacity, told her that she had a disease of the womb, and that a physical examination was necessary; that she submitted with much reluctance; that he had carnal con- nection with her on two occasions, while professing to be making such examination; that this occurred in the parlor of her brother’s house, while the wife of her brother was in an adjoining room ; that she made no outcry.” “ No one, we think, would seriously contend that such a statement, made by a female of mature age, and possessing any intellectual capacity, ought to be allowed to become the basis of judicial action.” The court below charged the jury that, in a case like this, “ the force used in ordinary sexual intercourse is sufficient to constitute a rape.” In the Supreme Court this was held to be error, (q) § 275. (c) From mistake of person.—Very early in the ju- dicial history of this country, a conviction of rape was sus- tained in New York by a very eminent judge—Thompson, C. J.—upon evidence showing that the prosecutrix mistook the defendant for her husband, and permitted his embraces, (o) R. v. Case, 19 L. J., M. C. 174, 1 Den., C. C. 580 ; 4 Cox, C. C. 220 ; Wh. Cr. Law, § 1143. (p) R. v. Stanton, 1 Car. & Kir. 415. () R. ®. Barrow, 38 L. J., M. C. 20; 1 L. R., C. C. 156 ; 19 L. T., N. S. 293 ; 11 Cox, C. C. 191. (a) Ibid. (y) Wharton’s C. L. § 1142. See also Lewis c. State, 30 Ala. 54. (z) Wrh. C. L. § 1142 ; R. ®. Rudland 4 F. & F. 495 ; R. «. Jones, 4 L. T., N. S. 154; R. ®. Wright, 4 F. & F. 967. (a) R. ®. Jones, 4 L. T., N. S. 154. 240 BOOK III.] LEGAL RELATIONS OF RAPE. [§ 278 that she was the defendant’s mistress, the question of prior chastity is always a material one to be considered by the med- ical examiner, since unchastity can be shown by the defendant, not as an excuse or justification, but as a fact throwing much light on the value of her testimony. Thus it has been ex- pressly decided, that it is competent for the defendant to show that the prosecutrix’s previous character for chastity was bad,(b) and that she had before been connected with himself; though the general opinion in England has been, that he cannot show particular acts of unchastity except those committed with him- But, even in England, a wider range seems now to be encouraged, it having been held admissible to ask the prosecu- trix “ whether she was not, on the Friday last, walking on the high-street to look out for men,” and, upon her denying this, to call witnesses to contradict her.(rf) And it has been in some States ruled that the prosecutrix may be asked whether she had not had previous connection with other men ; and that, in such case, she is not privileged from answering.(e) § 278. The object of such testimony is twofold: 1st, in making the fact of coercion less likely, and, 2d, in diminishing the witness’s weight as respects credibility generally. It is less likely that a strumpet, or one holding herself out as sub- mitting to illicit intercourse, though on special inducements or occasions alone, would resist to the extremity which a prosecution for rape requires, than would a chaste woman. And although, under ordinary circumstances, it is inadmissible to impeach veracity by attacking chastity, yet, in such an issue as the present, this seems but proper. Such being the case, it will be seen that medical testimony as to the prosecutrix’s prior condition is of peculiar value. Evidence of any prior venereal complaints, or of any other facts tending to prove (b) See Pratt 0. State, 19 Ohio St. 277. (c) R. v. Hodgson, R. & R. 2; R. v. Clarke, 211 Stark. 243 ; R. v. Barker, C. & P. 589; R. v. Martin, G C. & P. 5G2. See People 0. Abbott, 19 Wend. 192 ; Campo 0. State, 3 Kelley, 417. Whar. C. L. §§ 1149-51. (d) R. ». Barker, 3 C. & P. 589 ; R. 0. Robins, 2 M. & R. 512. (e) People 0. Abbott, 19 Wend. 192 ; State 0. Reed, 39 Yt. 417 ; State 0. Murray, 63 N. C. 31 ; State 0. Forshner, 43 N. H. 89. Contra, McCombe 0. State, 8 Ohio St. 643 ; Com. 0. Regan, 105 Mass. 593. See Pratt 0. State, 19 Ohio St. 277 ; Wh. C. L. § 1151. YOL. II.—16 241 § 280] [book hi. RAPE. previous illicit intercourse, it is always proper, under such cir- cumstances, to receive. § 279. 3d. Subsequent suppression of the fact by prosecutrix.— It is here that the presence or absence of a medical examina- tion tells most forcibly. The omission of the friends of the injured party to obtain an instantaneous medical inspection may be their misfortune, arising from ignorance or false shame; but it is better that they should suffer from it, in the acquittal of the offender, than that the stimulus to supposititious prose- cutions be given, which will always result from dispensing with this most salutary check. It is not, of course, pretended that the want of immediate medical inspection is a legal bar. This it is not; for no matter how suspicious the omission may be, it is for the court to leave the whole question of the reality of the alleged rape to the jury alone. But it is maintained that it is a salutary rule of policy, which juries should them- selves enforce, in no case to sustain a prosecution for rape un- less the prosecutrix’s evidence is corroborated by the testimony of experienced persons, medical or otherwise, who were called in to inspect her person as soon after the occurrence as the circumstances of the case would allow. And such seems to he the case in England, where the courts agree in telling the jury that, unless there be positive medical evidence of some sort of violence to the person, there is not sufficient proof of penetration to constitute the offence.(/) The nature and character of the testimony so to be obtained have been already discussed. Under this head it is enough to say that in all cases the results of, as well as the fact of, an examination are admissible evidence. It is admissible, also, for the prosecutrix to prove that she made a complaint, though she cannot put in evidence what were the particulars of her statement, (y) § 280. 4th. Extent to which coition was carried.—The English law, as to the extent to which the act must have been con- summated, has undergone much fluctuation. Thus it was at first held that emission must be proved. Great difficulty was (/) R. v. Gammon, 5 C. & P. 821. See ante, § 267. (fir) Wharton’s C. L. § 1150. See Lacy v. State, 45 Ala. 80. 242 BOOK III.] LEGAL RELATIONS OF RAPE. [§ 280 thus produced, which was obviated by the statute of 9 Geo. IV. c. 31, which dispensed with proof of emission. Then the question arose as to the degree to which penetration must be shown to have taken place. In Ireland it was said, somewhat loosely, by Lord Carlton, C. J., in 1800,(A) that it was enough if the prosecutrix swore to “ carnal knowledge of her person.” But in England it has always been held that the entrance of the private parts of the man within the private parts of the woman must be specifically proved. The first case tried on this point laid down a rule which, though once or twice subsequently departed from, may now be considered as the settled law, viz., that, though it is not necessary to prove the hymen to have been ruptured, yet the evidence of penetration must be positive.(z) The only point in which this rule has fluctuated has been in respect to the necessity of a rupture of the hymen. Thus, in 1832, in a case before Mr. Baron Gur- ney, that learned judge said, that, “if the hymen is not rup- tured, there is not a sufficient penetration to constitute the offence.”(J) In 1839, however, Chief Justice Tindal declared the only question for the jury to he, whether the private parts of the man did or did not enter into the person of the woman; and that, therefore, though it appear from the evidence, beyond all possibility of doubt, that the party was disturbed imme- diately after penetration, and before the completion of his purpose, yet he must be found guilty of having committed the complete offence of rape.(A) In the same year a boy named John Jordan was indicted for carnally knowing a girl under ten }rears; and, there being no evidence of a rupture of the hymen, it was insisted by the prisoner’s counsel, on the au- thority of Gammon’s case, just cited, that the offence had not been completed. The defendant was acquitted on other grounds; but Mr. Justice Williams told the jury, “ I am of opinion, as matter of law, that it is not essential that the hymen should be ruptured. In the case of Rex v. Gammon it was proved that (A) R. v. Lidwell, 1 McNally’s Evicl. 606. (i) R. v. Russen, 1 East, P. C. 438, 439. (j) R. v. Gammon, 5 C. & P. 321. (k) R. v. Allen, 9 C. & P. 31. 243 §281] RAPE. [book III. the hymen was ruptured, and the point was, therefore, not necessary to the decision of that case. I also think that it is impossible to lay down any express rule as to what constitutes penetration. All J can say is, that the parts of the male must be inserted in those of the female, but I cannot suggest any rule as to the extent.”^) § 281. Shortly previous to this, though not reported until afterwards, was a trial before Mr. Justice Bosanquet, in which Mr. Justice Coleridge and Mr. Justice Coltman concurred with that learned judge in saying that it “is not necessary, in order to complete the offence, that the hymen should be ruptured; but that, where that which is so very near the entrance has not been ruptured, it is very difficult to come to the conclu- sion that there has been penetration so as to sustain a charge of rape.” In consequence of this charge, the defendant was acquitted of the rape, and convicted of the assault, although there was evidence from the surgeon who attended the injured party that her private parts internally were very much in- flamed, but that, in consequence, he could not tell whether the hymen was ruptured or not.(m) In 1841, however, the ques- tion was put to rest by a case which came before the twelve judges, in which the early decision of It. v. Russen was finally reviewed and sustained. The prisoner was charged with hav- ing feloniously ravished Mary Ann Wesley; and it was very clearly proved by her—she being a girl between eleven and twelve years of age—as well as by a woman who detected the prisoner in the act, that carnal intercourse had been attempted. With respect to penetration, a surgeon was called, who de- posed to the appearances in and about the child’s private parts, and stated his belief that penetration had taken place, but that the hymen, which in the prosecutrix was placed at the usual distance from the opening, had not been ruptured. The jury returned a verdict of guilty, finding “that there had been penetration, but that the penetration had not poceeded to the rupture of the hymen.” On this finding the prisoner was sentenced, and the judgment sustained by all the judges.(?i) (?) R. v. Jordan, 9 C. & P. 118. (n) R. v. Hughes, 8 C. & P. 752. (m) R. v. M’Rue, 8 C. & P. 641. 244 BOOK III.] [§ 282 LEGAL RELATIONS OF RAPE. In accordance with this result, in a case tried in 1844, where the surgeon deposed that “ the hymen of the child was not ruptured, hut that upon the hymen was a venereal sore, which must have arisen from actual contact with the virile member of a man,” Mr. Baron Parke left it to the jury to say “whether, at any time, any part of the virile member of the man was within the labia of the pudendum of the prosecutrix; for if ever it was (no matter how little), that will be sufficient to constitute a penetration, and the jury ought to convict the prisoner of the complete offence.” The verdict was, not guilty.(o) § 282. In this country, the rule thus laid down—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.(p) Perhaps the furthest limit to which it has reached is in a remarkable case in Philadelphia, where, though there was no medical examina- tion, it was held that proof by the prosecutrix of pain in the sexual organ, and of the juxtaposition at the time of the defend- ant’s face to her own—she at the time being in a dentist’s chair, under the influence of ether—was enough to justify a jury in presuming that there was penetration, and that the penetration was sexual. The general result of both medical and legal opinion, however, is, that, while the learned and able judge who tried the case properly left it to the jury as a ques- tion of fact, as he was obliged to do, to determine whether penetration had taken place, the verdict was not sustained by the evidence, and forms an unsafe precedent for the future.^) In North Carolina, it was decided in 1860 that emission was necessary.(r) By the act of February 29,1861, it was provided that “ proof of penetration only” should establish the offence. Under this act it was held in 1871, that the slightest penetra- tion, without rupture of the hymen, was enough.(s) (o) R. v. Lines, 1 C. & K. 393. (p) State v. Leblanc, 3 Brevard 339; Penns, v. Sullivan, Add. 143 ; Stroud v. Com., 11 S. & R. 177; Com. v. Thomas, 1 Yirg. Cases 307. See Wh. C. L. § 1137. Cq) Com. v. Beale, Phil., 1854. See ante, § 245 et seq. (r) State v. Gray, 8 Jones 180. (s) State v. Hargrave, 65 N. Car. 467. 245 § 286] RAPE. [BOOK III. § 283. In Ohio, in 1867, in a case of rape on a child seven years old, a physician testified that he found marks of violence and evidence of disease, but as a matter of science he had no means of determining whether the disease was gonor- rhoea or vaginitis, the evidences of both diseases being indis- tinguishable. He then was permitted by the court to express his opinion to the jury that the disease was gonorrhoea, his opinion being founded mainly on the fact that he found evi- dences of that disease on the person charged with the rape. It was held by the Supreme Court that the expression of this opinion under such circumstances ought not to have been permitted.(0 § 284. Penetration may be inferred by circumstances, and may not be specially eo nomine proved.(w) § 285. 5th. Want of age of defendant.—There is an absolute rule, in this respect, at common law, viz., that an infant under fourteen is to be presumed positively incapable of committing a rape, though he may be convicted of an assault with an intent to ravish.(v) Over fourteen, this question resolves itself into the ordinary one of capacity. § 286. 6th. Want of sexual capacity of defendant.—This is purely a medical question, which has been examined under another head.(w) (0 Moore v. State, 17 Ohio St. 521. (w) Brauer v. State, 25 Wise. 413. See R. v Lines, 1 C. & K. 393; State v. Farr, 28 Iowa 397. (®) Wh. C. L., § 1134, and also ante, § 210. (w) Ante, § 201. 246 BOOK IV. QUESTIONS RELATIVE TO IDENTITY. ANALYTICAL TABLE. CHAPTER 1. IDENTIFICATION OF THE LIVING OR DEAD 1st. Cases of doubtful identity, § 287. 2d. Means of identification, § 289. (1) Establishing age from the skeleton, § 289-290. (2) By means of the teeth, § 292. (3) Determination of sex from inspection of the skeleton, § 296. (4) Fractures, deformities, and peculiarities in the dead body, § 298. (5) Cicatrices, § 300. (6) Hair, § 303. (7) The length of time that has elapsed since death, § 304. (a) Heat as influencing decomposition, § 305. (5) Air as influencing decomposition, § 308. (c) Water as influencing decomposition, § 309. (cZ) Dryness and moisture of the soil as influencing decom- position, § 310. (8) Putrefaction in the foetus, § 319. (9) Influence of lime on the putrefactive process, § 320. § 287. 1st. Cases of doubtful identity.—Many curious cases of doubtful or disputed identity might be cited to illustrate the singular fortuitous resemblance between individuals, not only in their general personal appearance, but also in accidental marks. Other cases also might be related, in which long ab- sence and various circumstances have so changed a person, that his nearest relatives have not been able to recognize him. Usually, in cases of disputed identity, whether of the dead or living, a scar, a deformity, or some congenital or indelible 247 § 288] IDENTIFICATION OF THE LIVING OR DEAD. [BOOK IV. mark, as a nsevus maternus, or mother’s mark, a mole, tattoo- ing, etc., has proved the only means of recognition. Salomd Muller sued for her liberty before the courts of Louisiana, alleging that she was a white woman, and had come over from Germany with her parents, at the age of three years. Since that time she had been held in slavery. She was recognized by her resemblance to her family, and further iden- tified by the existence of two small ncevi materni upon the inside of each thigh, which were correctly described by the midwife who assisted at her birth, and the woman who took care of her upon the Atlantic passage, after the death of her mother.(a) Even more remarkable is the conflict as to identity in the Tichborne case, in which, after a trial of weeks, the plaintiff, who sued as Sir Roger Tichborne, claiming as such possession to large English estates, broke down in his case, and a verdict was taken against him without hearing the defendants. An in- dictment was then found against him for perjury, but, as this has not yet (1872) been tried, comments are reserved to a future edition. § 288. Usually, medical testimony can hardly be required respecting the identity of the living. In disputed cases, it may become necessary for the physician to give his opinion respecting the permanence of scars, tattoo marks, and con- genital or acquired deformities. But more frequently he is called upon to assist in the identification of the dead, or to state after how long a period of time and under what circum- stances such identification is possible. Kriigelstein says that he assisted at the inquest upon the body of a man found dead in a morass. The body was recognized by a number of persons present, as well as by the wife of the deceased, who, however, remarked that her husband when he had left her wore a dif- ferent jacket from the one on the body. Some time after- wards, however, the man who was supposed to have been dead came home again, and upon investigation it was finally dis- covered that the deceased was a person belonging to a neigh- (a) Beck, vol. ii. p. 664, from the Monthly Law Reporter, Boston, 1845, Wli. C. L. (2d ed.) 337 ; and see article in Albany Law Journal for Sept. 28, 1872, p. 239. 248 BOOK IV.] CASES OF DOUBTFUL IDENTITY. [§ 288 boring village, who had left his home at an early age, and upon his return was recognized by no one. The likeness between the two men, it is stated, was most Dr. Kinlock, of Drumoak, Aberdeenshire, relates a case of mistaken identity under extraordinary circumstances. The body of a man between sixty and seventy years of age, was found slightly imbedded in sand, on the bank of a river ; both eyes had been picked out by hooded crows, but decom- position had made no progress. The left ear and the first finger of the left hand were wanting, having the appearance of having been lost in early life. The body was conveyed to a suitable place, and persons were requested by advertisements to come and identify it. After some time, two young women claimed it as the body of their father, who, they stated, was a lawyer; that he was in the habit of leaving home for two or three weeks at a time, without informing them where he went, and that he had lost the left ear, and first finger of his left hand. They apparently recognized the clothes and the body, and gave vent to expressions of grief on the event. Subse- quent doubts in the mind of one sister were overruled by the confident affirmations of the other. The funeral took place accordingly, and was attended by the daughters and friends ol the supposed deceased lawyer. Returning from the funeral, the boatman of the ferry which they had to cross asked them for whom they were in mourning, and, upon receiving their answer, laughingly informed them that he had, only half an hour before, ferried their father over alive and well, and directed them where they would find him. This, to their great joy, proved true. Whose was the body they had buried in the churchyard at Drumoak remained undiscovered.(c) (5) Henke’s Zeitschrift, 1850, 4 H. (c) Ed. Monthly Journ., Feb. 1854. The following curious case occurred in Boston : It was said that, upon the testimony of the captain of a vessel and six of his crew, a man named James Guard had been arrested by the police on the charge of attempting to rob a vessel, but was afterwards released on its appearing that he could not be the man, as on the night of the robbery he was safely slumbering in the watchhouse of the North End, whither he had repaired for lodging. It was also stated, that on Monday night a body was found in the water at the end of Commercial Wharf, which an officer of the north station testified before a coroner’s jury was the body of the unfortunate 249 § 289] IDENTIFICATION OF THE LIVING OR DEAD. [BOOK IV. Cases might be indefinitely multiplied by citations from the annals of criminal procedure, to show that nothing is more common than the failure of the nearest friends to identify the body of a deceased person, or than the most positive judicial testimony in regard to the identity of persons found dead, but which subsequent events have proved to be utterly erroneous. ■ § 289. 2d. Means of identification.—The means of recognizing from the skeleton the age of the deceased, are found chiefly in an observation of the degree of ossification. A brief description of this process at different ages up to the time at which it is completed, will enable us to determine the question in an ap- propriate manner. One of the most reliable indications of age in the skeleton of a supposed new-born child, will be found in the osseous point in the cartilaginous epiphysis of the lower extremity of the femur. Its importance in this relation was first pointed out by Beclard, but has lately been further sub- stantiated by the observations of Ollivier and Mildner.(d) At James Guard, who, but a night previous, had been so falsely charged with crime, but who, nevertheless, appeared to have rather suddenly come to a tragic end. The coroner’s jury had no doubt, from the testimony of the officer, that the body was really that of James Guard, and they returned a verdict in accord- ance thereto, stating that “ James Guard came to his death by accidental drowning.” Thus the matter was deemed and considered to be settled, when —so runs the report—last night, as the aforesaid officer sat meditating in his office, at the station house, upon matters connected, no doubt, with the city’s welfare, the door slowly opened, and what appeared to be the body of James Guard entered. In these days, a police officer is not apt to be a believer in ghosts, but, for a moment, thoughts of that character flitted through his brain. A request for lodgings, uttered in no ghostly tones, awakened him to a sense of reality, and an explanation ensued, when it appeared that James Guard, who had been once charged with robbery, and on the oath of a coroner’s jury with having been picked up drowned, was in reality alive and kicking, with sufficient love of the things of this world to receive with gratitude the gift of a soup ticket, presented to him by the penitent police officer. Thus the body now lying in the dead-house is not that of James Guard, but of some one who so closely resembled him as to have been mistaken for him by a dozen per- sons. It is probably fortunate for the living, that this “ Dromio,” who might have continued to work mischief for him, has really deceased. It is, certainly, a strong case of personal resemblance. (Boston Law Reporter, vol. viii. No. 1, page 55, etc.) (d) Prag. Vierteljahrschrift, 4, 1850. 250 BOOK IV.] AGE. [§ 290 the commencement of the last month of intra-uterine existence, there may be seen, upon a transverse section of this epiphysis, a spot which is more vascular and darker than the surrounding structure, in the midst of which a body of the size of a poppy seed or the head of a fly may be recognized, which, upon drying, will be found to be of newly formed bony matter. At the time of birth, this osseous point has attained the size of a pea or lentil, is hollow and incloses a porous and vascular substance ; the shell itself being of a firm, bony nature. From the obser- vations of the above-mentioned authors, it results that, 1st. If this osseous point be wanting, the skeleton is that of a foetus of not more than eight months; 2d. When it has attained the size of a poppy seed or the head of a fly, the foetus is probably in the last month of gestation; 3d. When it has acquired a diameter of one and a quarter lines, the full period has been reached; and, 4th. If the point of ossification be three lines, or more, it may be assumed that the child has lived after its birth. These statements have been verified by their authors, but, it is needless to say, that, having so important a bearing upon questions of infanticide, as well as upon other questions not less vital in their character, much additional confirmation is required to entitle them to our unreserved confidence. § 290. The length of the skeleton of a new-born, mature child is between fifteen and sixteen inches. At the end of the first year, the two sides of the frontal bone are united in half their length, the fontanelles diminish in size, the temporal bone is still composed of four pieces, and the four incisor teeth have appeared. Points of ossification are found in the coracoid process of the scapula, in the ensiform cartilage, and in the patella. At the end of the second year, the length is about thirty-two inches; the four portions of the temporal bone form but one piece; the anterior fontanelle is usually closed, and both halves of the os frontis are united. Two canine and four molar teeth have made their appearance. The pelvic bones, which are afterwards consolidated in the aceta- bulum, touch each other; the epiphyses of the metatarsal and metacarpal bones are ossified, and points of ossification are seen in the lower end of the tibia and fibula. At the expira- tion of the third year, the sutures of the bones of the head have a 251 § 290] IDENTIFICATION OF TIIE LIVING OR DEAD. [BOOK IV. zigzag appearance; all the first set of teeth are fully extruded; the odontoid process of the second vertebra is firmly united with the body; the spinous processes of the vertebrae ossify, as do the trochanter major, the patella, and the cuneiform bones. At the end of the fourth year, the child is about three feet long, the styloid process of temporal bone is formed, and the pro- cess of ossification continues in the parts mentioned. In the fifth and sixth year, no further trace of the division of the os frontis is found; the sutures unite, the arches of the vertebrae become united with the bodies and the lower extremity of the ulna, and the pisiform bones are ossified. In the seventh and eighth year, the second set of teeth replace the first. If the eight permanent incisors are present, the age is probably at least nine years. The canine and molar teeth make their appearance between the tenth and twelfth year, with the exception of the last molar, which is very irregular in the period of its extrusion. Orfila describes the ossification at this period as follows : At eight years, the upper extremity of the radius; at nine, the navicular bone of the carpus ; at twelve, the trochlea of the os humeri; from thirteen to fourteen, the trochanter minor and the three parts of the os inno- minatum, which last is sometimes delayed till the fifteenth year; and at fifteen, the sacral vertebrae, are united together. From this period up to the age of twenty-five, the same author observes that the process of ossification is most noticeable in the following points: from fifteen to sixteen, the coracoid process of the scapula is united with the body of the bone, and the acro- mion contains an ossific point; from fifteen to eighteen, an osseous point in the sternal end of the clavicle; from fifteen to twenty, ossification of the last bone of the coccyx. At six- teen years, an osseous point is seen in the head and tubercles of the ribs; at seventeen, bony union of the epiphyses of the phalanges; and at eighteen, of the head and trochanter of the femur. From eighteen to twenty-five, union of the sphenoid and occipital bone of the three parts of the tibia; and from twenty to twenty-five, of the first piece of the sternum to the rest of the bone. Between twenty-five and thirty years, occurs the complete union of the first to the second bone of the sacrum; from forty to fifty, of the ensiform cartilage to the lower extremity of the 252 BOOK IV.] STATURE. [§ 291 sternum ; and between this and the sixtieth year, the union of the sacrum and coccyx. In advanced life, the bones lose their density ; the earthy matter predominates, and they hence be- come more brittle. According to Sommering, they lose nearly a fourth part of their weight. They are yellower than in the previous years of life ; the diploe in the flat bones disappears, so that the two plates of bone touch each other, are thin and sometimes lose their substance in this part, forming an open- ing. The sutures in the bones of the skull become indistinct, and generally first on the inside of the cranium. The inter- vertebral substance loses its thickness, and the borders of the cervical vertebrae are smaller before than behinjl. If the teeth have been lost, the alveolar processes become absorbed, but if they remain, they bear unmistakable signs of age in their yellow color and worn appearance. The ensiform cartilage is completely ossified, as well as those of the ribs. There are, however, no such alterations in the condition of the skeleton as would give more than an approximate appreciation of the exact age at this period of life.(e) § 291. Stature.—AVhen the whole skeleton has been pre- served, and the articulating ends of the long bones have not been wasted by decay, the height of the individual can be ob- tained by adding from one and a half to two inches to the length of the skeleton. Should, however, the bony remains be in a fragmentary condition, an accurate estimate of the height of the living person cannot be made. Orfila and Sue have, indeed, by assuming the superior border of the pubes to form the exact centre of the body (as it should do in a well- formed adult), considered it possible to calculate the height. The tables prepared by M. Orfila comprise, moreover, measure- ments of the several cylindrical bones, from which he proposes to calculate the stature of the skeleton and of the living body.(/) Dr. Guy has found, however, upon a careful exami- nation of these tables, that they cannot be relied upon as (e) The foregoing statements have been taken chiefly from the works of Mende, Nicholai, and Friedreich, who have devoted particular attention to the subject; also from Dr. J. Miller, Das Knochengeriiste des Menschen, etc., in Henke’s Zeitschrift for 1852, 3 H. p. 62. (/) Traite de Med. L6g., 4th ed. 253 § 292] IDENTIFICATION OF THE LIVING OR DEAD. [BOOK IV. accurate, since in one instance the upper half of the body ex- ceeded in length the lower by five and a half inches, and in another the excess was six inches in a contrary direction. By taking the average of all the measurements, this author states that we may be in error to the extent of two and a quarter inches; and in the table of the measurements of the cylindrical bones we may be led into error in calculating from them the height of the skeleton, to the extent of more than four inches, and in no case of less than one and three-quarter Hence, owing to the false inferences (which occasionally may be of serious importance) to which these calculations may lead, the physician should use great reserve in giving an opinion as to the stature of the body, from the inspection of merely a por- tion of the skeleton. § 292. (2) Teeth.—The most striking part of the evidence by which the identification of the remains of the murdered Dr. Parkman was secured was that given by the dentist, Dr. Keep. He testified that about three years previously he had made and fitted a set of teeth for Dr. Parkman, a set for each jaw, consisting of manufactured artificial teeth, formed in combinations of three blocks to each jaw, and set upon gold plates fitted and adjusted thereto. He stated that several natural teeth and stumps remained, to which, as well as to the natural shape and peculiarities of the jaws, it was necessary that the plates should be adjusted. An attempt having been made to consume the head by fire, in an assay furnace, the gold had melted away, but the mineral teeth, being composed of an infusible material, remained, preserving more or less of their original shape. Dr. Keep recognized the blocks of mine- ral teeth as of his own manufacture, and as having been made for Dr. P., and showed that they could have belonged to no one else, from their correspondence with the trial-plate and the mould of the jaw of the deceased, which had been carefully preserved and marked with his name. In addition, the lower jaw had a certain peculiarity of natural formation which served to distinguish it from others, and render the correspond- (g) Forensic Medicine, p. 24. 254 BOOK IV.] [§ 294 TEETH. .ence of the block of mineral teeth with it more significant than it might otherwise have been. § 293. Dr. Guy states that a doubtful case of identity, in Edin- burgh, was decided by a dentist, who produced a cast of the gums which he had taken before death. So also the remains of the Marchioness of Salisbury, discovered among the ruins of Hatfield House, were identified by the jaw-bone having gold appendages for artificial teeth.(A) § 294. In Mr. Sargent’s history of Braddock’s expedition(z) is narrated a very interesting instance of identification by means of an artificial tooth. Sir Peter Halket, in 1758, after the reduction of Fort Du Q.uesne, proceeded to the spot of Braddoek’s defeat for the purpose of discovering, if possible, the remains of his father, who was there killed. “In reply to his anxious questions,” we are told, “one of his tawny guides had already told Halket that he recollected, during the combat, to have seen an officer fall beneath such a remarkable tree as he should have no difficulty in recognizing; and, at the same moment, another, rushing to his side, was instantly shot down, and fell across his comrade’s body. As they drew near the spot, the detachment wras halted, and the Indians peered about through the trees to recall their memories of the scene. With speaking gesture, they briefly discoursed in their own tongue. Suddenly, and with a shrill cry, the Indian of whom we have spoken sprang to the well-remembered tree. While the troops rested on their arms in a circle around, he and his companions searched among the thick fallen leaves. In a moment, two gaunt skeletons were exposed lying together, the one upon the other, as they had died. The hand that tore away their scalps had not disturbed their position; but no si) Ibid. 1842. (*) Lond. Med. Repos., yol. iii. p. 380. 326 BOOK V.] OXALIC ACID. [§ 369 not the ordinary result. According to Dr. Geoghegan, who examined the stomachs of three persons poisoned with thi3 acid, the mucous membrane of the stomach was softened, with various shades of brown discoloration, and erosion or gelatini- zation ; there was a brownish-black ramiform vascularity of the submucous tissue, and the contents of the stomach were of the color of coffee-grounds, owing to the action of the acid upon the mucus and coloring matter of the blood. In Dr. Jackson’s case small ulcerations and thickening of the mucous membrane were observed, together with permanent redness. Hence the action of the acid may be chiefly expended upon the mucous coat of the stomach, no actual corrosion being ob- served. -In an instance reported by Mr. Letheby, the coats of the stomach were so softened that it could scarcely be handled without lacerating it, and in another, referred to by Dr. Christison, it is said that this organ was perforated, (y) In sortie of these cases, however, it is evident that the conditions spoken of may have resulted from the long contact of the acid with the coats of the stomach after death, since even so feeble an acid as that naturally contained in the stomach is capable of produciug similar results. It is certainly not the ordinary effect of oxalic acid. The oesophagus is also in many cases found altered, having a scalded or boiled appearance. It is pale, brittle, corrugated, and abraded in some places. More recently a case has been reported by Dr. A. Wood, in which the stomach presented a large irregular aperture. As sufficient details of the dissection are not given, and the viscera do not appear to have been examined in situ, it is possible that this hole may have been artificially produced. The autopsy was made thirty-five hours after death.(z) § 369. A case of suspected poisoning by this acid was re- in detail by Dr. J. C. White, of Boston, to the Society of Medical Science. The post-mortem appearances were as follows:— Twenty-four hours after death the stomach, intestines, spleen, (y) Med. Gaz., yol. xxxv. p. 49 ; Lond. Med. Repos., vol. xi. p. 20. (z) Edinburgh Monthly Journal, March, 1852. (a) Boston Med. and Surg. Journ., Jan. 27, 1870, p. 57. 327 § 369] IRRITANT POISONS. [book v. kidneys, liver, and part of the pancreas were removed from the body and brought to Dr. White for examination, and forty-eight hours after death appeared as follows:— The stomach which, with six inches of oesophagus attached, was tied at both extremities, contained ten or twelve ounces of grayish fluid of the consistence of gruel, with an acid smell and reaction. It was marked externally by dark streaks corresponding to the position of the bloodvessels, and by large stains of a scorched appearance near the oesophagus. Within, its lining membrane, for an inch or more surrounding the oesophageal opening, was of the same black color as that tube, and the bloodvessels in the depending portions filled with black blood were visible through it. Elsewhere, and generally, the mucous membrane was of its natural color or paler than usual. The structure of the mucous membrane and other tissues was unchanged except in the lower portions where it was soft and thin (probably a cadaveric change). There was more or less mucus attached to its inner surface. The oesophagus exteriorly was of an uniform deep slate color. Its interior surface was stained of a deep black, the same color penetrating in parts to and through the muscular tissue. The lining membrane was not materially softened nor easily separated from the tissues beneath. In the intestinal canal there was nothing unnatural besides the usual cadaveric softening of the mucous membrane and the reddened patches. All the other organs were apparently healthy; the blood con- tained within them being generally bright red. Christison states that after concentrated doses the “ stomach is found to contain black extravasated blood, exactly like blood acted upon by oxalic acid out of the body.” In order to test further this action of oxalic acid upon the tissues of the stomach and oesophagus, the following experi- ments were made. A healthy stomach was removed at an autopsy, and on the following day a solution of the acid (3ss to ,?j of water) was poured into it and into the oesophagus, which was shut off from the stomach by a ligature. The next day the vessels of the stomach were seen externally to be blackened and the 328 BOOK V.] OXALIC ACID. [§ 369 organs darkened, the oesophagus being much darker than the stomach. The fourth day they were opened. The lining membrane of the oesophagus was much darker than that of the stomach. The mucous membrane was everywhere white, but the coats beneath were dark and had a scorched look in places. On subsequent exposure the whole internal surface of the stomach blackened at the tips of the rugae. This latter circumstance is interesting in connection with the fact that the towels and sheet spoken of, in parts where stained by the discharges from the deceased, gradually turned to a dark brown on drying, on the tops of the folds exposed to the air. (This experiment was repeated subsequently with a similar result.) Half an ounce of oxalic acid in one ounce of water was injected by a tube into the empty stomach of a large and healthy pup, six weeks old. In a few minutes vomiting began, and was repeated several times. There was no purging. Six hours afterwards there were remaining no symptoms of illness. Section in twenty-four hours after killing showed the stomach and oesophagus pale and healthy ; there was nowhere any red- dening or blackening of the tissues visible. At the same time a pup of the same litter, also strong and healthy, and in a fasting condition, had injected into the stomach the same quantity of the same solution, the oesopha- gus being tied just below the pharynx. Immediate attempts to vomit followed, which continued for some time. Death took place in two to four hours. Section in twenty-four hours afterwards. The stomach was found inflated with gas. Ex- ternally it was reddened in parts, and the bloodvessels of the cardiac portion were visible and of a black color. It contained a dark-colored liquid and mucus. The lining membrane was reddened in parts and covered writh a dark-colored mucus easily removed by the finger. Hear the cardiac orifice it had a dark brown, scorched appearance, not to be wiped away. The interior of the oesophagus was pale and generally stained of a dark-blackish color. These appearances resemble those pre- sented in the stomach and oesophagus in this case. Oxalic acid cannot be detected in the blood, and if injected into a vessel 329 §371] IRRITANT POISONS. [book v. it is so readily decomposed that it cannot be recognized even after a few minutes. § 370. 5th. Chemical examination.—The crystals of oxalic acid resemble, at first sight, those of sulphate of magnesia (Epsom salts), and the former substance has hence often been taken in mistake for the latter. They are permanent, flat- tened, transparent, four-sided prisms, soluble in water and alcohol. They are also entirely volatilized by heat, which is not the case with sulphate of magnesia. [This is an important method of distinguishing oxalic acid from other similar crys- tals.] The usual tests for oxalic acid are lime-water and the soluble salts of lime, and nitrate of silver. With lime-water, or even with a solution of the sulphate of lime, a white pre- cipitate is obtained, nearly insoluble in an excess of oxalic acid, or in acetic acid, but readily dissolved by nitric acid. With nitrate of silver a copious white precipitate of oxalate of silver is obtained, soluble in nitric acid or in ammonia. If the precipitate be dried, and heated on the point of a knife over the flame of a spirit-lamp, it becomes brown on the edge, detonates feebly, and is entirely dissipated in a white vapor. In this manner it is distinguished from other white salts of silver, which give off white fumes, but leave a residue. § 371. In liquids containing organic matter, as in matters vomited or in the contents of the stomach, the preliminary steps of diluting, filtering, and concentrating are required. The liquid should be acidulated with acetic acid, and the acetate of lead added till the precipitate is no longer formed, for the purpose of separating the oxalic acid. If the resulting oxalate of lead be now diffused through distilled water, and a current of sulphuretted hydrogen be passed for a long time, (and until no more black precipitate is formed), through the liquid, a sulphuret of lead will be formed, and the acid re- main in solution. It can then be examined by the tests already mentioned; and a portion of the liquid may be evapo- rated to form crystals of the acid. If, however, antidotes have been administered, such as chalk or magnesia, the super- natant liquid, after standing some time, may, if not acid, be thrown away, and the inorganic residue, after being suspended in distilled water, be mixed with a twentieth part of carbonate 330 BOOK V.] TARTARIC ACID. [§ 373 of potash, and boiled for two hours. Thus oxalate of potash will be formed, which should be filtered and then neutralized with diluted nitric acid. Add the solution of acetate of lead as long as any precipitate falls. Separate the oxalic acid by means of sulphuretted hydrogen passed through the mixture of oxalate of lead, and test its presence as before. If the acid have not been entirely neutralized by the antidotes admin- istered, the supernatant liquid and the insoluble residue must be separately examined.(b) It must be remembered that if lime or magnesia has been given as an antidote, the contents of the stomach may have a neutral reaction, and the poison be contained in an insoluble oxalate; in such an instance the local effects of the acid may not be so prominent, while enough of the acid may have been absorbed to cause death. § 372. The tests for binoxalate of potash in solution are the same as for oxalic acid. The crystals differ from those of oxalic acid in having a feathery appearance. They may be distinguished, also, by the action of heat, not being entirely dissipated like those of oxalic acid, but leaving an ash of car- bonate of potash. Both the quadroxalate and the binoxalate of potassa are kept in the shops under the names of salt of sorrel and essential salt of lemons, and are employed for re- moving iron mould and ink stains from linen. V. Tartaric Acid. § 373. The only case in which this substance incontestably proved poisonous is related in the Lancet, Jan. 2, 1845. A man took, by mistake for Epsom salts, an ounce of tartaric acid dissolved in half a pint of warm water. He immediately exclaimed that he was poisoned, and complained of a violent burning pain in his throat and stomach. Obstinate vomiting continued for nine days, when he died. Nearly the whole of the alimentary canal was found highly inflamed. Tartaric (5) For some remarks on the facility of detecting oxalic acid by means of the microscope, see report of a lecture on the Application of the Microscope to Toxicology, by Geo. W. Birkett, M.D., Med. Times and Gazette, April, 1855. 331 § 375] IRRITANT POISONS. [book v. acid was detected in the dregs of the cup, and the druggist admitted that he had made a mistake. Another case is re- ported by Devergie, but the accuracy of his opinion and analysis is contested by Orfila. Christison mentions an instance in which six drachms of tartaric acid were taken in twenty-four hours, without the least inconvenience, and both he and Coindet administered it to cats without observing any inju- rious effect. An instance is on record in which the bitartrate of potash proved fatal by excessive purging, but the quantity swallowed, or rather eaten, is said to have been more than a quarter of a pound.(c) VI. Acetic Acid. § 374. This acid in a concentrated form is highly irritant and corrosive. Only one fatal case of poisoning by it is re- ported. The liquid was swallowed by a young girl, and in a few hours afterwards she died in great agony. The post-mortem appearances resembled somewhat those produced by sulphuric acid, the surface of the tongue being brown and leathery, the mucous membrane of the oesophagus of a blackish-brown color, and large black elevations marked the lining membrane of the stomach, the rest of the organs appearing inflamed. Eight ounces of a thick, blackish fluid were found in the stomach. In case of an investigation to detect this acid in the contents of the stomach, it must be remembered, that it is contained in the natural secretions of this organ; hence, to be of any value, the chemical evidence must detect a considerable quantity of it. Also, as Christison suggests, vinegar is a common remedy with the vulgar for many diseases, and especially for poisoning. § 375. Vinegar.—Dr. David, of Montreal, met with an in- stance in which a woman endeavored to destroy herself by drinking a quantity of common vinegar. When seen, three hours afterwards, her countenance was wild and the pupils dilated, the body was covered with a cold perspiration, and the breathing was laborious and hurried. Her tongue was dry and cold, the abdomen distended, and she had acute pain in the 332 (c) Loud. Med. Gaz., 1837-38, i. 177. BOOK V.] POTASH, SODA, ETC. [§ 376 epigastrium, which was increased by pressure. She was, more- over, delirious. She soon recovered after the administration of an emetic of sulphate of zinc.(d) CHAPTER III. Alkaline. IRRITANT POISONS (e)—(Continued.) Potash and soda, § 376. Post-mortem appearances, § 377. Bleaching solution containing, § 378. Ammonia, and salts, § 379. Baryta, § 383. I. Potash, Soda, etc. § 376. These two alkalies may be treated together, since their poisonous effects are similar. Our notice of them will be brief, as they seldom occasion poisoning, and, when they do, it is almost necessarily accidental, and its cause is readily known. They may prove fatal either by their immediate action or by their remote influence upon the system. When swallowed in large quantity and in a concentrated solution, the taste is ex- ceedingly nauseous and acrid, and a sensation of burning heat and constriction in the throat, oesophagus, and stomach is ex- (d) Amer. Journ. Med. Sci., Oct. 1848, p. 303. (e) Nearly all of the substances belonging to this class produce very dif- ferent effects when they operate for a long time in minute quantities, and when they are taken in large doses at once. It is only in the latter case that the term irritant is strictly applicable to them. In the former mode of action they gradually undermine the health, and may ultimately destroy life by in- terfering with the nutrition of the body. This effect may result either from their deleterious action upon the digestive organs, or upon the composition of the blood, or finally upon an impairment of that action of the tissues by which they appropriate for their own nutrition the organic elements contained in the blood. Arsenic and most of the salts of mercury are actively irritant when applied to the tissues in a concentrated form ; but in minute quantities, and largely diluted, they slowly but surely sap the foundations of life, by wearing away old structures and preventing the substitution of sound mate- rials for their repair. 333 § 376] IRRITANT POISONS. [book v. cited. When a considerable portion of the solution has reached the stomach, there is great pain and tenderness in the abdomen, vomiting of mucus and altered blood, inability to swallow, copious diarrhoea, and general collapse. If the patient survive a few days, the inside of the mouth is seen to be greatly inflamed, sloughs become detached from the throat, vomiting continues, there is a dysenteric condition of the bowels, and the patient dies from marasmus. Life may be, however, prolonged even for months and years, and the person finally die from the impairment of his diges- tive powers or from a stricture of the oesophagus which pre- vents the swallowing of food in sufficient quantity to sustain life. A case is related by Dr. Barham, in which a caustic solution of impure carbonate of soda (soap lees) was swallowed by mistake, and the patient died two years and three months afterwards of stricture of the oesophagus caused by it.(/) Several other instances of a similar kind are recorded, and Sir Charles Bell relates one in which death did not take place until twenty years after the accident. A more recent ex- ample is one furnished by Dr. Deutsch.(y) The quantity drunk was a “ portion of a glass,” and was estimated to contain half an ounce of caustic potassa. The early symptoms were such as those described above, but recovery from them took place. Gradually, however, swallowing became difficult, and death took place in twenty-eight weeks after the accident. The lower part of the oesophagus was found enormously thickened, so that its canal was nearly obliterated near the stomach. The increased thickness was entirely confined to the mucous membrane, the muscular coat, on the other hand, having nearly disappeared. II. Nitrate of Potassa. (Saltpetre.) “ A German, who spoke English imperfectly, went into a store, and asked for ‘ bitter salt,’ meaning sulphate of magnesia (bitter Salz). The attendant supposed he meant saltpetre, and gave him half a pound. The man took three ounces and a half (/) Lancet, 1850, vol. ii. (g) Times and Gaz., May, 1858, p. 537. 334 BOOK V.] NITRATE OF POTASSA. [§ 377 at one dose. His bowels were opened three times within three or four hours. He complained of a slight sense of heat in the epigastrium, and drank a good deal of water. About five hours after having taken the saltpetre, he suddenly fell out of his chair and died. “ The marked peculiarity, in this case, was the absence of the painful symptoms which usually follow the ingestion of irritant poisons; and the question arises, how was death pro- duced? Certainly not by inflammation of the stomach, for he complained of nothing but a slight sense of heat in the stomach. The poison must have acted by destroying the vitality of the blood. There was no post-mortem examination. The rigor mortis was very imperfect, the lips of almost a natural pink hue, and the appearance of the countenance so life-like, that some persons who were present doubted the propriety of inter- ment on the third day.”(A) This is the largest dose of nitre which we find recorded as having been taken, and its symptoms were, on that account probably, peculiar. There are numerous instances of death occasioned by an ounce or an ounce and a half of this salt, and in which the symptoms were those of a violent local irritant and a depressor, at the same time, of nervous power. Death may occur within two hours. On the other hand, recovery has taken place after doses of nitre varying from half an ounce to two ounces. The symptoms are vomiting, with extreme burning pain in the throat and abdomen, followed by coldness and collapse, and subsequently by bloody stools. In one case bloody vomiting is noted.(z) Nervous symptoms, such as tremor, spasm, and hallucinations, have been observed. Re- covery is slow, and the digestive function remains feeble or deranged. § 377. Post-mortem appearances.—The mucous membrane of the stomach will, in recent cases, be found more or less acted upon by the salt. Thus it may be seen in some parts inflamed, and in others covered with brown sloughs of partially detached membrane. Perforation has even been observed. In chronic (7i) New Jersey Medical Reporter, Jan. 1855. CO Journ. f. Pliarmakodynamik, ii. 178. 335 § 379] IRRITANT POISONS. [book v. cases, the smooth and condensed structure peculiar to the cicatrization of mucous membranes will be easily recognized. III. Bleaching Solutions, etc. § 378. Chloride of potash or of soda is frequently employed by washerwomen or laundresses, and hence, according to Tar- dieu,(/) quite a number of suicides and accidents have been caused by the swallowing of a liquid called Veau de Javelle (chlorinated potassa), which is commonly used on account of its strong bleaching power on linens. In the dose of five to eight ounces this preparation can cause fatal results in an adult. Chemical examination.—In seeking for the presence of these alkalies in the tissues there are two important considerations to be remembered: 1st. The rapid transformation of soda and potassa into carbonates when in contact with the air, the car- bonic acid of which is absorbed and fixed by its oxides. 2d. The presence in the living organism of a certain number of salts of soda and of potassa which properly are contained in the secreting glands and other tissues. Up to this time no reliable means have been furnished for determining the pre- sence of potassa and of soda in cases of poisoning by these alkalies. Tardieu gives(&) the details of six different, cases of poison- ing by these caustic alkalies, in two of which Veau de Javelle was the agent employed. IY. Ammonia and Sesquicarbonate of Ammonia. § 379. This alkali has occasionally been used with homicidal purpose, but, in general, cases of poisoning by it are the result of accident. The vapor of strong ammonia has destroyed life, when respired too long a time by a person in a state of tem- porary insensibility. The effects produced by swallowing a strong solution of ammonia are somewhat similar, though more intense, than those of the other alkalies. Plenck relates that a man who had been bitten by a mad dog had admin is- O') Op. cit., p. 255. 336 (&) Op. cit., p. 261, etseq. BOOK V.J AMMONIA AND SESQUICARBONATE OF AMMONIA. [§379 tered to him a glassful of ammonia. His lips, tongue, and gums turned black immediately, and lie died within four minutes.(7) In another case, strong ammonia was taken with suicidal intent. The symptoms were collapse, serous and bloody diarrhoea, and bloody vomiting, excruciating pain in the abdomen, and death in six hours. The mind remained clear till the last.(m) Two cases are reported in the same paragraph of children who were killed by accidentally swal- lowing a mixture of hartshorn and sweet oil.(n) A little boy, two years of age, took about half an ounce of very pungent spirits of hartshorn from a bottle. He immediately screamed and was very sick, bringing up at first stringy mucus of a light color, and then some more which was dark. The lips were swollen, the breathing was harsh, hurried, and somewhat obstructed, and afterwards became somewhat croupy. There was no insensibility nor any diarrhoea. He recovered.(o) In another case, reported in the same journal, an ounce was taken in milk, by a man who supposed it to be castor oil, having poured it out in the dark. He took immediately copious draughts of warm water, and vomited a quantity of matter like soapsuds. The inside of the mouth, upper lip, tongue, and fauces were white, and other parts excoriated; there was great difficulty in swallowing. He said he felt as if he was on fire from his stomach to his mouth ; his voice was husky, pulse small and frequent, and the surface cold. He was ordered dilute acetic acid and demulcent remedies, under which he soon recovered. There was no diarrhoea throughout the case.(_p) A woman took a wineglassful of strong liquor of ammonia by mistake for the acetate, yet in a fortnight she was Hr. W. Reed has reported the case of a man who swallowed by mistake three drachms of the strong solu- tion of ammonia, and as much of the sesquicarbonate dissolved in two ounces of oil. The symptoms resembled those above (l) Mitsclierlich, Lebrbucb, ii. 277. (m) Annales de Therapeut., iii. 443. (to) Times and Gaz., June, 1855, p. 353. () The following facts are recited by this experimenter.(wj) “ The influence of conium appears to be in proportion, not to the muscular strength of the individual, but to his motor activity. “ 1. The operation of hemlock in the same individual varies in degree according to his motor activity. A dose of conium, which in the ordinary condition of the patient shall be just sufficient to produce the peculiar effects of the plant in a mild degree, will, during the exhaustion following a profuse seminal discharge for example, operate much more decidedly and in- tensely. Again, the effect will be found to vary in proportion as the activity of the patient varies. Thus, in those whose bodily vigor declines as the day wears away, a dose which will be followed by no appreciable effect in the early morning will produce decided effects in the evening, and vice versa. “ 2. Those leading a sendentary, inactive life are more readily affected by conium than those of active habits. A delicate person of active habits will, therefore, bear a larger dose of hemlock than one possessing abundance of strength with but little energy. “3. An active restless child will often take, with scarcely any appreciable effect, a dose sufficient to paralyze an adult of indolent habits; and such as would reduce a powerful muscu- lar man to a tottering condition, and force him to assume a (w) Cliristison. (v) The Old Vegetable Neurotics, the Gulstonian Lectures of 1868. Mac- millan & Co., London, 1869. (w) Quoted from p. 12. 567 § 620] NARCOTIC POISONS. [book v. recumbent position, and retain it for a quarter of an hour or more. (See cases.) “ 4. The same rule applies to children themselves; to pro- duce a given effect, a dull inactive child requires only one-half the quantity that a lively active one does. “Upon the cerebrum hemlock is powerless. I have induced its full physiological action again and again hundreds of times, in at least a hundred different individuals of all ages, and have never been able to recognize the least narcotic, nor di- rectly hypnotic, effects. If sleep followed- complete repose of the muscular system as a necessary consequence, then there would be no more powerful or direct hypnotic than hemlock. But other conditions over which this drug has no direct con- trol are required to procure sleep. Under the influence of an effectual dose a child often presents the aspect of sleep. * * * But such an event will rarely happen to an adult. Ilis mind will continue during the whole action of the hemlock as calm and active as was Socrates’ when he said to his friend, ‘ Crito, we owe HCsculapius a cock; pay the debt, and do not forget it.’ And he will tell us that he feels a strong desire to keep the eyes closed and remain quiet and undisturbed. “ In poisonous doses the eyes will be completely fixed and the pupils dilated ; articulation and deglutition impossible ; ex- pression and all other power of motion gone, and yet, while there is every appearance of the most profound coma, the per- ceptive faculties and reasoning powers may be as acute as ever. Such a condition is, I believe, not an uncommon one in other states than that produced by hemlock. * * * “ I have observed that persons who use tobacco freely, usually require a large dose of conium to produce its physiological effects; and the reverse, that those cannot tolerate tobacco who are readily influenced by comparatively small doses of hemlock.” § 620. The following plan is recommended by Orfila for its detection in food and other organic matters. The parts cut into small pieces should be placed in water acidulated with sulphuric acid, filtered, and evaporated by a gentle heat, after cooling, agitated with twice their volume of strong alcohol, then again filtered and evaporated until all the alcohol has 568 BOOK V.] CONIUM MACULATUM. [§ 620 been dissipated. The fluid should, after cooling, be neutral- ized or rather rendered alkaline by soda, when the character- istic, mousy smell of conicine will be perceived. Being now agitated with sulphuric ether, and decanted, the conicine is left behind by the spontaneous evaporation of the ether, and may be distilled over chloride of calcium. Heated in a capsule it forms white vapors, having a strong smell of celery and the urine of mice. The following process has been employed by Dr. Harley (V) for the recovery and detection of very small quantities of conia when mixed with organic matters. “ The substance known or suspected to contain conia is comminuted and ex- hausted, after a few days’ maceration in a percolator, by water acidulated with one-fiftieth of its bulk of sulphuric acid; the filtrate is spread out in a thin layer upon flat dishes, and allowed to evaporate to the consistence of a thin syrup in a warm, dry room, or at the distance of three or four feet before a fire; the residue is mixed with an equal bulk of strong solution of caustic potassa (one part to three of water), trans- ferred to a long tube, and agitated with its bulk of ether several times during twenty-four hours. The ether is then decanted,.and the alkaline mixture washed again and again with fresh portions of ether, until the conia is completely removed. Two, or at most three, washings are sufficient for this purpose. On distillation of the ethereal solution, the conia, more or less pure, remains. The impure conia is next shaken with a small quantity of dilute sulphuric acid, which separates the alkaloid from oily or resinous impurities. From this solution of sulphate of conia the base is separated in the usual way, viz., evaporation to a syrupy consistence, mixture with caustic potassa, washing the mixture with ether, evaporation of the ether, and finally distillation of the conia in a current of hydrogen, which may of course be omitted when we only want to determine the presence of conia. If spirit be used in the exhausting process, the ethereal extract will be contaminated by much fatty and resinous matters ; hence the advantage of using a watery solution. In searching (x) Op. cit., p. 80. 569 § 620] NARCOTIC POISONS. [book v. for conia in organic mixtures the same process may be adopted. The contents of the stomach may be digested for a few days with a sufficiently large quantity of sulphuric or oxalic acid, to prevent decomposition, then strained, evaporated sponta- neously, and treated as above. Before we conclude that conia is present, we must isolate an oily matter which possesses, in addition to a conia odor, an intensely sharp biting taste, and which dissolves readily, with loss of odor, in a drop of dilute sulphuric acid. We must pour off this drop into a clean tube, and redevelop from it a strong conia odor by the addition of a little of a strong solution of caustic potassa. If we depend upon the odor alone we may fall into error. Dr. Harley (y) relates a case in which it was impossible for him to distinguish in urine from patients, who had not taken conium, an ethereal extract treated with potassa from an aque- ous solution of conia which he used for comparison. He mentions this fallacy in order to show, “ that, in examining the animal fluids or tissues for conia, we must bear in mind that the addition of caustic potash to them will often develop an odor indistinguishable from conia, and that nothing short of the isolation of the principle itself should satisfy us.” Detection of conia in urine.{z)—About one part of a saturated solution of oxalic acid is added to four parts of the wTarm urine, and the mixture allowed to evaporate spontaneously. The brown syrupy residue should be separated from the crys- talline matter, and both separately treated with excess of caustic potassa and then washed with ether. These methods for the detection and recovery of conia were compared many times by Dr. Harley, and found to be quite reliable. (30 Op. cit., p. 18. (s) Harley, op. cit., p. 19. 570 BOOK V.] MISCELLANEOUS POISONS. CHAPTER X. MISCELLANEOUS POISONS Nux vomica and strychnine or strychnia, § C21. Symptoms, § 622. Fatal dose, § 623. Compared with tetanus, § 624. Post-mortem appearances, § 625. Chemical examination, § 626. Aconite, § 627. Symptoms, § 628. Post-mortem appearances, § 629. Lobelia inflata (Indian tobacco), § 630. Lobelina, chemical character, § 631. Cedar oil, § 632. Savin, § 633. Post-mortem appearances, § 634. Detection, § 635. Taxus baccata (Yew), § 636. Tansy, oil of, § 637. Cocculus Indicus. Symptoms, § 639. Results of experiments, § 642. Post-mortem appearances, § 643. In adulteration of liquors, § 644. Detection, § 645. Atropa belladonna (Deadly nightshade), § 646. Atropia or atropine, § 647. Post-mortem appearances, § 648. Mode of recovery from organic mixtures, § 649. Digitalis purpurea (Foxglove), § 650. Digitaline, § 651. Cinchona. Quinia or quinine, § 653. Daphne mezereum, § 654. Chloral-hydrate, § 655. Fatal dose, § 656. Symptoms, § 657. Chemical characters of chloral, § 658. Chloral-hydrate, § 659. Its recovery, § 660. 571 § 622] MISCELLANEOUS POISONS. [book V. Veratrum, § GG1. Album, § 6G3. Viride, § 6G3. Veratria, and other alkaloids of, § G64. Differential table of symptoms of, compai'ed with strychnia, § 6G5. § 621. Nux vomica. 1st. Qualities.—Hux vomica and its chief poisonous alkaloidal principle may be conveniently treated of together. Nux vomica is a round flat seed about three-quarters of an inch in diameter, and two lines in thickness. It is covered with fine, silky, gray hairs, and is hard and difficult to pulverize. The powder is of a yellowish-gray color, and has an intensely bitter taste. Strychnia is usually seen as a grayisli-white powder, inodorous, but excessively bitter. This property is so distinct that it is said that it may be perceived when only one part of strychnia is present in 30,000, or as others assert, in 600,000 parts of water. It is very sparingly soluble in water, but is easily dissolved by ordinary alcohol when boiling. It is deposited, however, upon cooling. § 622. 2d. The symptoms produced by strychnia or by nux vomica in poisonous doses are the following: The most pro- minent are spasmodic muscular contractions, which the slightest cause, such as a noise in the room, the contact of a person, or the attempt to introduce liquids into the mouth, is sufficient to excite. During these convulsions the limbs become per- fectly rigid, the muscles tremble, the respiration is suspended, and the lips, tongue, and fingers become blue. The intellect is not affected, this drug seeming to exercise its influence upon the nervous centres, from the medulla oblongata dowirwards, alone. The fits succeed each other at short intervals, and death usually takes place during one of them, although it may occur after their cessation, from mere exhaustion. A well described case of accidental poisoning with strychnia, by Mr. Bennett,(a) would answer almost equally well for a picture of hydrophobia. The quantity taken was about a grain and a half in solution. The patient, when first seen, which was about an hour after the poison had been taken, was in a rigid and trembling state and the face almost maniacal in its expres- (a) Lancet, 1850, Yol. ii. p. 462. 572 BOOK V.] NUX VOMICA. [§ 622 sion. This was soon followed by a violent tetanic convulsion. Between the fits she did not utter any expression of alarm, but would occasionally request a little cold water. The mus- cles of the jaws remained so rigid between the spasms that the attempt to introduce the stomach pump was unsuccessful, and although some strong emetics were got down, it repeatedly happened that the attempt of the patient to take liquids was followed by so violent a spasmodic fit as to prevent her swal- lowing them, and to give that apparent dread of water so well marked in cases of hydrophobia. During the tetanic fits the whole was stiffened and straightened ; the neck violently drawn back, the chest fixed, the eyes protruding from their sockets in a horrible manner, the legs pushed out and widely separated, the muscles of the face convulsed, pulse impercepti- ble, and no breathing could be perceived; the face was livid? more particularly the lips, and froth issued from the mouth. The pupil was also dilated during the paroxysm. It was im- possible to produce any relaxation of the body during a fit, and if moved the whole body maintained its rigid condition. As soon as death had taken place, which was in an hour and a half, the limbs relaxed, the face and lips gradually lost their livid hue and became, as well as the body, extremely pallid. In this case alarming symptoms did not arise until about an hour after the poison had been taken, and numerous cases might be referred to in which an interval of an hour or two occurred. The poisonous effects of strychnia are more rapidly developed than those of nux vomica. But usually the former supervene very speedily, being seldom delayed more than fifteen minutes. Death may occur in fifteen minutes, as in the case of Dr. Warner, who was supposed to have taken only half a grain,(b) or in half an hour, as in a case reported by Dr. Theinhart, where thirty grains of strychnia were swallowed, and seldom is postponed for more than two hours, if no measures for the removal of the poison have been taken.(c) In a case that occurred near London, a prescription was improperly prepared, so that the young man, for whom it was directed, took a grain (6) Phila. Med. Exam., Oct. 1847, p. 809. (c) Am. Journ. of Med. Sci., Jan. 1848, p. 303, from Gaz. Medicale. 573 § 628] MISCELLANEOUS POISONS. [book v. and a half of mix vomica, and the same quantity of strychnia. It is stated that “he soon afterwards complained of some ex- traordinary sensations, and almost immediately expired. ”(/) § 623. 3d. Power.—The smallest quantity of nux vomica which is known to have caused death, is said to be three grains of the alcoholic extract, but it is quite uncertain to how much of the powder this corresponds. Hoffmann (quoted by Chris- tison) states, that two doses of the powder, of fifteen grains each, proved fatal, and other cases are related in which fifty and sixty grains produced death. The smallest quantity of strychnia which has proved fatal appears to be one grain.(e) In Mr. Bennett’s case, above quoted, about one grain and a half was taken. Recovery occasionally is observed, even after very large doses. Dr. Thomas Anderson records a case in which seven grains of strychnia were taken without producing fatal conse- The comparative mildness of the symptoms and the recovery throw some doubt upon the purity of the strych- nia which was used. Dr. Dresbach, of Ohio, attended a man who drank, by mistake, three ounces of a solution of strychnia, containing one grain to the ounce. When seen by Dr. D., about twenty minutes afterwards, he was in the following condition: The whole muscular system rigid, the muscles of the back and legs so rigidly contracted, that it was with ex- treme difficulty the man was able to walk, face drawn awry and articulation impeded, a sense of burning about the stomach, tightness about the chest, vertigo and dimness of vision, lower extremities cold, and perspiration abundant. Chloroform being the only article at hand which seemed likely to be useful, Dr. D. gave the patient at once two drachms, and in less than fifteen minutes, the relief, Dr. D. says, was complete^g) A case, in which a man recovered after swallowing a grain and a half, is reported by Mr. Foster.(A) In another case, a girl (d) Am. Journ. of Med. Sci., April, 1854, p. 537, from Pliarm. Joiiru., July, 1852. (e) Med. Times and Gaz., April, 1855. (/) Am. Journ. of Med. Sci., April, 1848, p. 562. (