Aids to Forensic Medicine and Toxicology
by W. G. Aitchison Robertson · English · Gutenberg #19019 · 312,720 chars · public domain (US)
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Title: Aids to Forensic Medicine and Toxicology
Author: W. G. Aitchison Robertson
Release date: August 10, 2006 [eBook #19019]
Language: English
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*** START OF THE PROJECT GUTENBERG EBOOK AIDS TO FORENSIC MEDICINE AND TOXICOLOGY ***
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AIDS
TO
FORENSIC MEDICINE AND TOXICOLOGY
BY
W.G. AITCHISON ROBERTSON
M.D., D.Sc., F.R.C.P.E.
LECTURER ON FORENSIC MEDICINE, SCHOOL OF MEDICINE, EDINBURGH; LATE
EXAMINER IN THE UNIVERSITIES OF EDINBURGH AND ST. ANDREWS; FOR THE
TRIPLE BOARD; DIPLOMA IN PUBLIC HEALTH, ETC.
NINTH EDITION
TWENTIETH THOUSAND
LONDON
BAILLIÈRE, TINDALL AND COX
8, HENRIETTA STREET, COVENT GARDEN
1922
PREFACE TO NINTH EDITION
I trust that, having thoroughly revised the "Aids to Forensic Medicine,"
it may prove as useful to students preparing for examination in the
future as it has been in the past.
W.G. AITCHISON ROBERTSON.
SURGEONS' HALL,
EDINBURGH,
_November_, 1921.
PREFACE TO EIGHTH EDITION
This work of the late Dr. William Murrell having met with such a large
measure of success, the publishers thought it would be well to bring out
a new edition, and invited me to revise the last impression.
This I have done, and while retaining Dr. Murrell's text closely, I have
made large additions, in order to bring the "Aids" up to present
requirements. I have also rearranged the matter with the object of
making the various sections more consecutive than they were previously.
W.G. AITCHISON ROBERTSON.
SURGEONS' HALL,
EDINBURGH,
_June_, 1914.
CONTENTS
PART I
FORENSIC MEDICINE
PAGE
I. Crimes 1
II. Medical Evidence 2
III. Personal Identity 10
IV. Examination of Persons found Dead 12
V. Modes of Sudden Death 13
VI. Signs of Death 16
VII. Death from Anæsthetics, etc. 19
VIII. Presumption of Death; Survivorship 20
IX. Assaults, Murder, Manslaughter, etc. 21
X. Wounds and Mechanical Injuries 21
XI. Contused Wounds, etc. 22
XII. Incised Wounds 23
XIII. Gunshot Wounds 24
XIV. Wounds of Various Parts of the Body 26
XV. Detection of Blood-Stains, etc. 30
XVI. Death by Suffocation 34
XVII. Death by Hanging 35
XVIII. Death by Strangulation 35
XIX. Death by Drowning 36
XX. Death from Starvation 38
XXI. Death from Lightning and Electricity 38
XXII. Death from Cold or Heat 39
XXIII. Pregnancy 40
XXIV. Delivery 41
XXV. Foeticide or Criminal Abortion 42
XXVI. Infanticide 44
XXVII. Evidences of Live-Birth 46
XXVIII. Cause of Death in the Foetus 50
XXIX. Duration of Pregnancy 50
XXX. Viability of Children 51
XXXI. Legitimacy 52
XXXII. Superfoetation 53
XXXIII. Inheritance 54
XXXIV. Impotence and Sterility 54
XXXV. Rape 55
XXXVI. Unnatural Offences 59
XXXVII. Blackmailing 60
XXXVIII. Marriage and Divorce 60
XXXIX. Feigned Diseases 63
XL. Mental Unsoundness 67
XLI. Idiocy, Imbecility, Cretinism 68
XLII. Dementia 70
XLIII. Mania, Lucid Intervals, Undue Influence, Responsibility,
etc. 71
XLIV. Examination of Persons of Unsound Mind 76
XLV. Inebriates Acts 78
PART II
TOXICOLOGY
I. Definition of a Poison 80
II. Scheduled Poisons 80
III. Classification of Poisons 83
IV. Evidence of Poisoning 85
V. Symptoms and Post-Mortem Appearances of Different Classes
of Poisons 86
VI. Duty of Practitioner in Supposed Case of Poisoning 89
VII. Treatment of Poisoning 90
VIII. Detection of Poison 91
IX. The Mineral Acids 94
X. Sulphuric Acid 95
XI. Nitric Acid 97
XII. Hydrochloric Acid 98
XIII. Oxalic Acid 98
XIV. Carbolic Acid 100
XV. Potash, Soda, and Ammonia 101
XVI. Potassium Salts, etc. 103
XVII. Nitrate of Potassium, etc. 103
XVIII. Barium Salts 104
XIX. Iodine--Iodide of Potassium 104
XX. Phosphorus 105
XXI. Arsenic and its Preparations 107
XXII. Antimony and its Preparations 112
XXIII. Mercury and its Preparations 113
XXIV. Lead and its Preparations 116
XXV. Copper and its Preparations 117
XXVI. Zinc, Silver, Bismuth, and Chromium 118
XXVII. Gaseous Poisons 120
XXVIII. Vegetable Irritants 123
XXIX. Opium and Morphine 124
XXX. Belladonna, Hyoscyamus, and Stramonium 127
XXXI. Cocaine 128
XXXII. Camphor 129
XXXIII. Tetrachlorethane 129
XXXIV. Alcohol, Ether, and Chloroform 130
XXXV. Chloral Hydrate 134
XXXVI. Petroleum and Paraffin Oil 134
XXXVII. Antipyrine, Antefebrin, Phenacetin, and Aniline 135
XXXVIII. Sulphonal, Trional, Tetronal, Veronal, Paraldehyde 137
XXXIX. Conium and Calabar Bean 138
XL. Tobacco and Lobelia 139
XLI. Hydrocyanic Acid 140
XLII. Aconite 143
XLIII. Digitalis 144
XLIV. Nux Vomica, Strychnine, and Brucine 145
XLV. Cantharides 146
XLVI. Abortifacients 147
XLVII. Poisonous Fungi and Toxic Foods 148
XLVIII. Ptomaines or Cadaveric Alkaloids 150
Index 152
AIDS TO FORENSIC MEDICINE AND TOXICOLOGY
PART I
FORENSIC MEDICINE
I.--CRIMES
Forensic medicine is also called Medical Jurisprudence or Legal
Medicine, and includes all questions which bring medical matters into
relation with the law. It deals, therefore, with (1) crimes and (2)
civil injuries.
1. A _crime_ is the voluntary act of a person of sound mind harmful to
others and also unjust. No act is a crime unless it is plainly forbidden
by law. To constitute a crime, two circumstances are necessary to be
proved--(a) that the act has been committed, (b) that a guilty mind or
malice was present. The act may be one of omission or of commission.
Every person who commits a crime may be punished, unless he is under the
age of seven years, is insane, or has been made to commit it under
compulsion.
Crimes are divided into _misdemeanours_ and _felonies_. The distinction
is not very definite, but, as a rule, the former are less serious forms
of crime, and are punishable with a term of imprisonment, generally
under two years; while felonies comprise the more serious charges, as
murder, manslaughter, rape, which involve the capital sentence or long
terms of imprisonment.
An _offence_ is a trivial breach of the criminal law, and is punishable
on summary conviction before a magistrate or justices only, while the
more serious crimes (_indictable offences_) must be tried before a jury.
2. _Civil injuries_ differ from crimes in that the former are
compensated by damages awarded, while the latter are punished; any
person, whether injured or not, may prosecute for a crime, while only
the sufferer can sue for a civil injury. The Crown may remit punishment
for a crime, but not for a civil injury.
II.--MEDICAL EVIDENCE
On being called, the medical witness enters the witness-box and takes
the oath. This is very generally done by uplifting the right hand and
repeating the oath (Scottish form), or by kissing the Bible, or by
making a solemn affirmation.
1. He may be called to give _ordinary evidence_ as a _common witness_.
Thus he may be asked to detail the facts of an accident which he has
observed, and of the inferences he has deduced. This evidence is what
any lay observer might be asked.
2. _Expert Witness._--On the other hand, he may be examined on matters
of a technical or professional character. The medical man then gives
evidence of a skilled or expert nature. He may be asked his opinion on
certain facts narrated--_e.g._, if a certain wound would be immediately
fatal. Again, he may be asked whether he concurs with opinions held by
other medical authorities.
In important cases specialists are often called to give evidence of a
skilled nature. Thus the hospital surgeon, the nerve specialist, or the
mental consultant may be served with a subpoena to appear at court on a
certain date to give evidence. The evidence of such skilled observers
will, it is supposed, carry greater weight with the jury than would the
evidence of an ordinary practitioner.
Skilled witnesses may hear the evidence of ordinary witnesses in regard
to the case in which they are to give evidence, and it is, indeed,
better that they should understand the case thoroughly, but they are not
usually allowed to hear the evidence of other expert witnesses.
In civil cases the medical witness should, previous to the trial, make
an agreement with the solicitor who has called him with reference to the
fee he is to receive. Before consenting to appear as a witness the
practitioner should insist on having all the facts of the case put
before him in writing. In this way only can he decide as to whether in
his opinion the plaintiff or defendant is right as regards the medical
evidence. If summoned by the side on which he thinks the medical
testimony is correct, then it is his duty to consent to appear. If,
however, he is of opinion that the medical evidence is clearly and
correctly on the opposite side, then he ought to refuse to appear and
give evidence; and, indeed, the lawyer would not desire his presence in
the witness-box unless he could uphold the case.
Whether an expert witness who has no personal knowledge of the facts is
bound to attend on a subpoena is a moot point. It would be safer for him
to do so, and to explain to the judge before taking the oath that his
memory has not been sufficiently 'refreshed.' The solicitor, if he
desires his evidence, will probably see that the fee is forthcoming.
A witness may be subjected to _three_ examinations: first, by the party
on whose side he is engaged, which is called the 'examination in chief,'
and in which he affords the basis for the next examination or
'cross-examination' by the opposite side. The third is the
're-examination' by his own side. In the first he merely gives a clear
statement of facts or of his opinions. In the next his testimony is
subjected to rigid examination in order to weaken his previous
statements. In the third he is allowed to clear up any discrepancies in
the cross-examination, but he must not introduce any new matter which
would render him liable to another cross-examination.
The medical witness should answer questions put to him as clearly and as
concisely as possible. He should make his statements in plain and simple
language, avoiding as much as possible technical terms and figurative
expressions, and should not quote authorities in support of his
opinions.
An expert witness when giving evidence may refer to notes for the
purpose of refreshing his memory, but only if the notes were taken by
him at the time when the observations were made, or as soon after as
practicable.
There are various _courts_ in which a medical witness may be called on
to give evidence:
1. =The Coroner's Court.=--When a coroner is informed that the dead body
of a person is lying within his jurisdiction, and that there is
reasonable cause to suspect that such person died either a violent or
unnatural death, or died a sudden death of which the cause is unknown,
he must summon a jury of not less than twelve men to investigate the
matter--in other words, hold an inquest--and if the deceased had
received medical treatment, the coroner may summon the medical attendant
to give evidence. By the Coroners (Emergency Provisions) Act of 1917,
the number of the jury has been cut down to a minimum of seven and a
maximum of eleven men. By the Juries Act of 1918, the coroner has the
power of holding a court without a jury if, in his discretion, it
appears to be unnecessary. In charges of murder, manslaughter, deaths of
prisoners in prison, inmates of asylums or inebriates' homes, or of
infants in nursing homes, he must summon a jury. The coroner may be
satisfied with the evidence as to the cause of a person's death, and may
dispense with an inquest and grant a burial certificate.
Cases are notified to the coroner by the police, parish officer, any
medical practitioner, registrar of deaths, or by any private individual.
Witnesses, having been cited to appear, are examined on oath by the
coroner, who must, in criminal cases at least, take down the evidence in
writing. This is then read over to each witness, who signs it, and this
forms his _deposition_. At the end of each case the coroner sums up, and
the jury return their verdict or _inquisition_, either unanimously or by
a majority.
If this charges any person with murder or manslaughter, he is committed
by the coroner to prison to await trial, or, if not present, the coroner
may issue a warrant for his arrest.
A chemical analysis of the contents of the stomach, etc., in suspected
cases of poisoning is usually done by a special analyst named by the
coroner. If any witness disobeys the summons to attend the inquest, he
renders himself liable to a fine not exceeding £2 2s., but in addition
the coroner may commit him to prison for contempt of court. In criminal
cases the witnesses are bound over to appear at the assizes to give
evidence there. The coroner may give an order for the exhumation of a
body if he thinks the evidence warrants a post-mortem examination.
Coroners' inquests are held in all cases of sudden or violent death,
where the cause of death is not clear; in cases of assault, where death
has taken place immediately or some time afterwards; in cases of
homicide or suicide; where the medical attendant refuses to give a
certificate of death; where the attendants on the deceased have been
culpably negligent; or in certain cases of uncertified deaths.
The medical witness should be very careful in giving evidence before a
coroner. Even though the inquest be held in a coach-house or barn, yet
it has to be remembered it is a court of law. If the case goes on for
trial before a superior court, your deposition made to the coroner forms
the basis of your examination. Any misstatements or discrepancies in
your evidence will be carefully inquired into, and you will make a bad
impression on judge and jury if you modify, retract, or explain away
your evidence as given to the coroner. You had your opportunity of
making any amendments on your evidence when the coroner read over to you
your deposition before you signed it as true.
By the Licensing Act of 1902, an inquest may not be held in any premises
licensed for the sale of intoxicating liquor if other suitable premises
have been provided.
The duties of the coroner are based partly on Common Law, and are also
defined by statute, principally by the Coroners Act of 1887 (50 and 51
Vict. c. 71). They have been modified, however, by subsequent
Acts--_e.g._, the Act of 1892, the Coroners (Emergency Provisions) Act,
1917, and the Juries Act of 1918.
The fee payable to a medical witness for giving evidence at an inquest
is one guinea, with an extra guinea for making a post-mortem examination
and report (in the metropolitan area these fees are doubled). The
coroner must sign the order authorizing the payment, and should an
inquest be adjourned to a later day, no further fee is payable. If the
deceased died in a hospital, infirmary, or lunatic asylum, the medical
witness is not paid any fee. Should a medical witness neglect to make
the post-mortem examination after receiving the order to do so, he is
liable to a fine of £5.
In Scotland the Procurator Fiscal fulfils many of the duties of the
coroner, but he cannot hold a public inquiry. He interrogates the
witnesses privately, and these questions with the answers form the
_precognition_. More serious cases are dealt with by the Sheriff of each
county, and capital charges must be dealt with by the High Court of
Justiciary. In Scotland the verdicts of the jury may be 'guilty,' 'not
guilty,' or 'not proven.'
2. =The Magistrate's Court or Petty Sessions= is also a court of
preliminary inquiry. The prisoner may be dealt with summarily, as, for
example, in minor assault cases, or, if the case is of sufficient
gravity, and the evidence justifies such a course, may be committed for
trial. The fee for a medical witness who resides within three miles of
the court is ten shillings and sixpence; if at a greater distance, one
guinea.
In the Metropolis the prisoner in the first instance is brought before a
magistrate, technically known as the 'beak,' who, in addition to being a
person of great acumen, is a stipendiary, and thus occupies a superior
position to the ordinary 'J.P.,' who is one of the great unpaid. In the
City of London is the Mansion House Justice-Room, presided over by the
Lord Mayor or one of the Aldermen. The prisoner may ultimately be sent
for trial to the Central Criminal Court, known as the Old Bailey, or
elsewhere.
3. =Quarter Sessions.=--These are held every quarter by Justices of the
Peace. All cases can be tried before the sessions except felonies or
cases which involve difficult legal questions. In London this court is
known as the Central Criminal Court, and it also acts as the Assize
Court. In Borough Sessions a barrister known as the _Recorder_ is
appointed as sole judge.
4. =The Assizes= deal with both criminal and civil cases. There is the
_Crown Court_, where criminal cases are tried, and there is the _Civil
Court_, where civil cases are heard. Before a case sent up by a lower
court can be tried by the judge and petty jury, it is investigated by
the _grand jury_, which is composed of superior individuals. If they
find a 'true bill,' the case goes on; but if they 'throw it out,' the
accused is at liberty to take his departure. At the Court of Assize the
prisoner is tried by a jury of twelve. In bringing in the verdict the
jury must be unanimous. If they cannot agree, the case must be retried
before a new jury. At the Assize Court the medical witness gets a guinea
a day, with two shillings extra to pay for his bed and board for every
night he is away from home, with his second-class railway fare, if there
is a second class on the railway by which he travels. If there is no
railway, and he has to walk, he is entitled to threepence a mile for
refreshments both ways.
5. =Court of Criminal Appeal.=--This was established in 1908, and
consists of three judges. A right of appeal may be based (1) solely on a
question of law; (2) on certificate from the judge who tried the
prisoner; (3) on mitigation of sentence.
Speaking generally, in the Superior Courts the fees which may be claimed
by medical men called on to give evidence are a guinea a day if resident
in the town in which the case is tried, and from two to three guineas a
day if resident at a distance from the place of trial, this to include
everything except travelling expenses. The medical witness also receives
a reasonable allowance for hotel and travelling expenses.
If a witness is summoned to appear before two courts at the same time,
he must obey the summons of the higher court. Criminal cases take
precedence of civil.
A medical man has no right to claim privilege as an excuse for not
divulging professional secrets in a court of law, and the less he talks
about professional etiquette the better. Still, in a civil case, if he
were to make an emphatic protest, the matter in all probability would
not be pressed. In a criminal case he would promptly be reminded of the
nature of his oath.
A medical man may be required to furnish a _formal written report_. It
may be the history of a fatal illness or the result of a post-mortem
examination. These reports must be drawn up very carefully, and no
technical terms should be employed.
No witness on being sworn can be compelled to 'kiss the book.' The Oaths
Act (51 and 52 Vict., c. 46, § 5) declares, without any qualification,
that 'if any person to whom an oath is administered desires to swear
with uplifted hand, in the form and manner in which an oath is usually
administered in Scotland, he shall be permitted to do so, and the oath
shall be administered to him in such form and manner without further
question.' The witness takes the oath standing, with the bare right hand
uplifted above the head, the formula being: 'I swear by Almighty God
that I will speak the truth, the whole truth, and nothing but the
truth.' The presiding judge should say the words, and the witness should
repeat them after him. There is no kissing of the book, and the words
'So help me, God,' which occur in the English form, are not employed. It
will be noted that the Scotch form constitutes an oath, and is not an
affirmation. The judge has no right to ask if you object on religious
grounds, or to put any question. He is bound by the provisions of the
Act, and the enactment applies not only to all forms of the witness
oath, whether in civil or criminal courts, or before coroners, but to
every oath which may be lawfully administered either in Great Britain or
Ireland.
A witness engaged to give expert evidence should demand his fee before
going into court, or, at all events, before being sworn.
With regard to notes, these should be made at the time, on the spot, and
may be used by the witness in court as a refresher to the memory, though
not altogether to supply its place. All evidence is made up of
testimony, but all testimony is not evidence. The witness must not
introduce hearsay testimony. In one case only is hearsay evidence
admissible, and that is in the case of a _dying declaration_. This is a
statement made by a dying person as to how his injuries were inflicted.
These declarations are accepted because the law presumes that a dying
man is anxious to speak the truth. But the person must believe that he
is _actually_ on the point of death, with _absolutely_ no hope of
recovery. A statement was rejected because the dying person, in using
the expression 'I have no hope of recovery,' requested that the words
'at present' should be added. If after making the statement the patient
were to say, 'I hope now I shall get better,' it would invalidate the
declaration. To make the declaration admissible as evidence, death must
ensue. If possible, a magistrate should take the dying declaration; but
if he is not available, the medical man, without any suggestions or
comments of his own, should write down the statements made by the dying
person, and see them signed and witnessed. It must be made clear to the
court that at the time of making his statement the witness was under the
full conviction of approaching or impending death.
III.--PERSONAL IDENTITY
It is but seldom that medical evidence is required with regard to the
identification of the living, though it may sometimes be so, as in the
celebrated Tichborne case. The medical man may in such cases be
consulted as to family resemblance, marks on the body, nævi materni,
scars and tattoo marks, or with regard to the organs of generation in
cases of doubtful sex. Tattoo marks may disappear during life; the
brighter colours, as vermilion, as a rule, more readily than those made
with carbon, as Indian ink; after death the colouring-matter may be
found in the proximal glands. If the tattooing is superficial (merely
underneath the cuticle) the marks may possibly be removed by acetic
acid or cantharides, or even by picking out the colouring-matter with a
fine needle. With regard to scars and their permanence, it will be
remembered that scars occasioned by actual loss of substance, or by
wounds healed by granulation, never disappear. The scars of leech-bites,
lancet-wounds, or cupping instruments, may disappear after a lapse of
time. It is difficult, if not impossible, to give any certain or
positive opinion as to the age of a scar; recent scars are pink in
colour; old scars are white and glistening. The cicatrix resulting from
a wound depends upon its situation. Of incised wounds an elliptical
cicatrix is typical, linear being chiefly found between the fingers and
toes. By way of disguise the hair may be dyed black with lead acetate or
nitrate of silver; detected by allowing the hair to grow, or by steeping
some of it in dilute nitric acid, and testing with iodide of potassium
for lead, and hydrochloric acid for silver. The hair may be bleached
with chlorine or peroxide of hydrogen, detected by letting the hair grow
and by its unnatural feeling and the irregularity of the bleaching.
Finger-print impressions are the most trustworthy of all means of
identification. Such a print is obtained by rubbing the pulp of the
finger in lampblack, and then impressing it on a glazed card. The
impression reveals the fine lines which exist at the tips of the
fingers. The arrangement of these lines is special to each person, and
cannot be changed. Hence this method is employed by the police in the
identification of prisoners.
In the determination of cases of doubtful sex in the living, the
following points should be noticed: the size of the penis or clitoris,
and whether perforate or not, the form of the prepuce, the presence or
absence of nymphæ and of testicles or ovaries. Openings must be
carefully sounded as to their communication with bladder or uterus.
After puberty, inquiry should be made as to menstrual or vicarious
discharges, the general development of the body, the growth of hair,
the tone of voice, and the behaviour of the individual towards either
sex.
With regard to the identification of the dead in cases of death by
accident or violence, the medical man's assistance may be called. The
sex of the skeleton, if that only be found, may be judged from the bones
of the female generally being smaller and more slender than those of the
male, by the female thorax being deeper, the costal cartilages longer,
the ilia more expanded, the sacrum flatter and broader, the coccyx
movable and turned back, the tuberosities of the ischia wider apart, the
pubes shallow, and the whole pelvis shallower and with larger outlets.
But of all these signs the only one of any real value is the roundness
of the pubic arch in the female, as compared with the pointed arch in
the male. Before puberty the sex cannot be determined from an
examination of the bones.
Age may be calculated from the presence, nature and number of the
erupted teeth; from the cartilages of the ribs, which gradually ossify
as age advances; from the angle formed by the ramus of the lower jaw
with its body (obtuse in infancy, a right angle in the adult, and again
obtuse in the aged from loss of the teeth); and in the young from the
condition of the epiphyses with regard to their attachment to their
respective shafts.
To determine stature, the whole skeleton should be laid out and
measured, 1-1/2 to 2 inches being allowed for the soft parts.
IV.--EXAMINATION OF PERSONS FOUND DEAD
When a medical man is called to a case of sudden death, he should
carefully note anything likely to throw any light on the cause of death.
He should notice the place where the body was found, the position and
attitude of the body, the soil or surface on which the body lies, the
position of surrounding objects, and the condition of the clothes. He
should also notice if there are any signs of a struggle having taken
place, if the hands are clenched, if the face is distorted, if there has
been foaming at the mouth, and if urine or fæces have been passed
involuntarily. Urine may be drawn off with a catheter and tested for
albumin and sugar.
If required to make a post-mortem examination, every cavity and
important organ of the body must be carefully and minutely examined, the
seat of injury being inspected first.
V.--MODES OF SUDDEN DEATH
There are three modes in which death may occur: (1) Syncope; (2)
asphyxia; (3) coma.
1. =Syncope= is death beginning at the heart--in other words, failure of
circulation. It may arise from--(1) _Anæmia_, or deficiency of blood due
to hæmorrhage, such as occurs in injuries, or from bleeding from the
lungs, stomach, uterus, or other internal organs. (2) _Asthenia_, or
failure of the heart's action, met with in starvation, in exhausting
diseases, such as phthisis, cancer, pernicious anæmia, and Bright's
disease, and in some cases of poisoning--for example, aconite.
The symptoms of syncope are faintness, giddiness, pallor, slow, weak,
and irregular pulse, sighing respiration, insensibility, dilated pupils,
and convulsions.
Post mortem the heart is found empty and contracted. When, however,
there is sudden stoppage of the heart, the right and left cavities
contain blood in the normal quantities, and blood is found in the venæ
cavæ and in the arterial trunks. There is no engorgement of either lungs
or brain.
2. =Asphyxia=, or death beginning at the lungs, may be due to
obstruction of the air-passages from foreign bodies in the larynx,
drowning, suffocation, strangling, and hanging; from injury to the
cervical cord; effusion into the pleuræ, with consequent pressure on the
lungs; embolism of the pulmonary artery; and from spasmodic contraction
of the thoracic and abdominal muscles in strychnine-poisoning.
The symptoms of this condition are fighting for breath, giddiness,
relaxation of the sphincters, and convulsions.
Post mortem, cadaveric lividity is well marked, especially in nose,
lips, ears, etc.; the right cavities of the heart and the venæ cavæ are
found gorged with dark fluid blood. The pulmonary veins, the left
cavities of the heart, and the aorta, are either empty or contain but
little blood. The lungs are dark and engorged with blood, and the lining
of the air-tubes is bright red in colour. Much bloody froth escapes on
cutting into the lungs. Numerous small hæmorrhages (Tardieu's spots) are
found on the surface and in the substance of the internal organs, as
well as in the skin of the neck and face.
3. =Coma=, or death beginning at the brain, may arise from concussion;
compression; cerebral pressure from hæmorrhage and other forms of
apoplexy; blocking of a cerebral artery from embolism; dietetic and
uræmic conditions; and from opium and other narcotic poisons.
The symptoms of this condition are stupor, loss of consciousness, and
stertorous breathing.
The post-mortem signs are congestion of the substance of the brain and
its membranes, with accumulation of the blood in the cavities of the
heart, more on the right side than on the left.
It must be remembered that, owing to the interdependence of all the
vital functions, there is no line of demarcation between the various
modes of death. In all cases of sudden death think of angina pectoris
and the rupture of an aneurism.
The following is a list of some of the commoner causes of sudden death:
(a) =Instantaneously Sudden Death=--
1. Syncope (by far the commonest cause).
2. Aortic incompetence.
3. Rupture of heart.
4. Rupture of a valve.
5. Rupture of aortic aneurism.
6. Embolism of coronary artery.
7. Angina pectoris.
(b) =Less Sudden but Unexpected Death=--
1. Cerebral hæmorrhage or embolism.
2. Mitral and tricuspid valvular lesions if the patient exerts himself.
3. Rupture of a gastric or duodenal ulcer; rupture of liver, spleen, or
extra-uterine gestation, or abdominal aneurism.
4. Suffocation during an epileptic fit; vomited matter or other material
drawn into the trachea or air-passages; croup.
5. Arterio-sclerosis may lead to thrombosis, embolism, or aneurism.
6. Poisoning, as by hydrocyanic acid, cyanide of potassium, inhalation
of carbonic acid or coal gas, oedema of glottis following inhalation of
ammonia.
7. Rapid onset of some acute specific disease, such as pneumonia or
diphtheria; collapse from cholera.
8. Heat-stroke, lightning, shocks of electricity of high tension.
9. Mental or physical shock.
10. Exertion while the stomach is overloaded.
11. Diabetic coma; uræmia.
12. _Status lymphaticus._ This is a general hyperplastic condition of
the lymphatic structures in the body, and is seen in enlargement of
tonsils, thymus, spleen, as well as of Peyer's patches and mesenteric
glands. It is a frequent cause of death during chloroform anæsthesia for
slight operations in young people.
In addition, it may be as well to remember that death sometimes occurs
suddenly in exophthalmic goitre, hypertrophy of the thymus, and in
Addison's disease.
In some cases of sudden death nothing has been found post mortem, even
when the autopsy has been made by skilled observers, and the brain and
cord have been submitted to microscopical examination.
VI.--SIGNS OF DEATH
(1) Cadaveric appearance; ashy white colour. (2) Cessation of the
circulation and respiration, no sound being heard by the stethoscope.
Cessation of the circulation may be determined by (a) placing a ligature
round the base of a finger (Magnus' test); (b) injecting a solution of
fluorescin (Icard's test); (c) looking through the web of the fingers at
a bright light (diaphanous test); (d) the dulling of a steel needle when
thrust into the living body; (e) the clear outline of the dead heart
when viewed in the fluorescent screen. (3) The state of the eye; the
tension is at once lost; iris insensible to light, fundus yellow in
colour; cornea dull and sunken. (4) The state of the skin; pale, livid,
with loss of elasticity. (5) Extinction of muscular irritability. The
above signs afford no means of determining how long life has been
extinct. The following, however, do:
=Cooling of the Body.=--The average internal temperature of the body is
from 98° to 100° F. The time taken in cooling is from fifteen to twenty
hours, but it may be modified by the kind of death, the age of the
person, the presence or absence of clothing on the body, the surrounding
temperature, and the stillness or otherwise of the air about the body.
Still, the body, other things being equal, may be said to be _quite
cold_ in about _twelve hours_.
=Hypostasis= or =post-mortem staining= is due to the settling down of
the blood in the most dependent parts of the body while the body is
cooling. It is a sure sign of death, and occurs in all forms of death,
even in that due to hæmorrhage, although not so marked in degree.
Post-mortem staining (_cadaveric lividity_) begins to appear in from
eight to twelve hours after death, and its position on the body will
help to determine the length of time the body has lain in the position
in which it was found. The staining is of a dull red or slaty blue
colour. It must be distinguished from ecchymosis the result of a bruise,
by making an incision into the part; in the case of hypostasis a few
small bloody points of divided arteries will be seen, in the case of
ecchymosis the subcutaneous tissues are infiltrated with blood-clot.
Internally, hypostasis must not be mistaken for congestion of the brain
or lungs, or the results of inflammation of the intestines. If the
intestine is pulled straight, inflammatory redness is continuous,
hypostasis is disconnected. About the neck hypostasis must not be
mistaken for the mark of a cord or other ligature. When the blood is of
a bright red colour after death (as happens in poisoning by CO or HCN,
or in death from cold), the hypostasis is bright red also.
=Cadaveric Rigidity--Rigor Mortis.=--For some time after death the
muscles continue to contract under stimuli. When this irritability
ceases--and it seldom exceeds two hours--rigidity and hardening sets in,
and in _all_ cases precedes putrefaction. It is caused by the
coagulation of the muscle plasma. It commences in the muscles of the
back of the neck and lower jaw, and then passes into the muscles of the
face, front of the neck, chest, upper extremities, and lastly to the
lower extremities.
It has been noticed in the new-born infant, as well as in the foetus. It
lasts from sixteen to twenty hours or more. In lingering diseases, after
violent exertion, and in warm climates, it sets in quickly, and
disappears in two or three hours; in those who are in perfect health and
die from accident or asphyxia, it may not come on until from ten to
twenty-four hours, and may last three or four days. After death from
convulsions or strychnine-poisoning, the body may pass at once into
rigor mortis. Rigor mortis must be distinguished from _cadaveric spasm_
or the _death clutch_; in the former, articles in the hands are readily
removable, in the latter this is not the case. In tetanic spasm the
limbs when bent return to their former position; not so in rigor mortis.
=Putrefaction= appears in from one to three days after death, as a
greenish-blue discoloration of the abdomen; in the drowned, over the
head and face. This increases, becomes darker and more general, a strong
putrefactive odour is developed, the thorax and abdomen become distended
with gas, and the epidermis peels off. The muscles then become pulpy,
and assume a dark greenish colour, the whole body at length becoming
changed into a soft, semi-fluid mass. The organ first showing the
putrefactive change is the trachea; that which resists putrefaction
longest is the uterus. These putrefactive changes are modified by the
fat or lean condition of the body, the temperature (putrefaction taking
place more rapidly in summer than in winter), access of air, the period,
place, mode of interment, age, etc. Bodies which remain in water putrefy
more slowly than those in air.
=Saponification.=--In bodies which are very fat and have lain in water
or moist soil for from one to three years this process takes place, the
fat uniting with the ammonia given off by the decomposition to form
_adipocere_. This consists of a margarate or stearate of ammonium with
lime, oxide of iron, potash, certain fatty acids, and a yellowish
odorous matter. It has a fatty, unctuous feel, is either pure white or
pale yellow, with an odour of decayed cheese. Small portions of the body
may show signs of this change in six weeks.
=Post-Mortem Examination.=--Never make an autopsy in criminal cases
without a written order from the coroner or Procurator Fiscal. If
authorized, however, first have the body identified, then photographed
if it has not been identified. A medical man representing the accused
may be present, but only by consent of the Crown authorities or of the
Sheriff. Clothing should be examined for blood-stains, cuts, etc.
Examine external surface of body and take accurate measurements of
wounds, marks, deformities, tattooings; note degree and distribution of
post-mortem staining, rigidity, etc.
Examine brain by making incision from ear to ear across vertex, reflect
scalp forwards and backwards, and saw off calvarium. Examine brain
carefully externally and on section.
Examine organs of chest and abdomen through an incision made from
symphysis menti to pubis, reflecting tissues from chest wall and cutting
through costal cartilages.
In cases of suspected poisoning have several clean jars into which you
place the stomach with contents, intestines with contents, piece of
liver, kidney, spleen, etc., and seal each up carefully, attaching label
with name of deceased, date, and contained organs, and transmit these
personally to the analyst.
=Exhumation.=--A body which has been buried cannot be exhumed without an
order from a coroner, fiscal, or from the Home Secretary. There is no
legal limit in England as to when a body may be exhumed; in Scotland,
however, if an interval of twenty years has elapsed, an accused person
cannot be prosecuted (_prescription of crime_).
VII.--DEATH FROM ANÆSTHETICS, ETC.
The coroner in England and Wales and Ireland must inquire into every
case of death during the administration of an anæsthetic. The
anæsthetist has to appear at the inquest, and must answer a long series
of questions relative to the administration of the drug.
Before, therefore, giving an anæsthetic, and so as to furnish yourself
with a proper defence in the event of death occurring, you ought to
examine the heart, lungs, and kidneys of the patient to see if they are
healthy. Should a fatal result follow, the anæsthetist will require to
prove that it was necessary to give the anæsthetic, that the one
employed was the most suitable, that the patient was in a fit state of
health to have it administered, that it was given skilfully and in
moderate amount, that he had the usual remedies at hand in case of
failure of the heart or lungs, and that he employed every means in his
power to resuscitate the patient.
The condition of the lungs is of more importance than the state of the
heart.
The chloroformist ought always to use the best chloroform.
An anæsthetic should never be administered except in the presence of a
_third person_. This applies especially to dentists who give gas to
females.
=Malpractice.=--In every case where a medical man attends a patient, he
must give him that amount of care, skill, knowledge, or judgment, that
the law expects of him. If he does not, then the charge of malpractice
may be brought against him. It is most frequently alleged in connection
with surgical affections--_e.g._, overlooking a fracture or dislocation.
Before a major operation is performed, it is well to get a written
agreement.
VIII.--PRESUMPTION OF DEATH; SURVIVORSHIP
=Presumption of Death.=--If a person be unheard of for seven years, the
court may, on application by the nearest relative, presume death to have
taken place. If, however, it can be shown that in all probability death
had occurred in a certain accident or shipwreck, the decree may be made
much earlier.
=Presumption of Survivorship.=--When two or more related persons perish
in a common accident, it may be necessary, in order to decide questions
of succession, to determine which of them died first. It is generally
accepted that the stronger and more vigorous will survive longest.
IX.--ASSAULT, MURDER, MANSLAUGHTER, ETC.
=Assault.=--This is an attempt or offer to do violence to another
person; it is not necessary that actual injury has been done, but evil
intention must be proved. When a corporal hurt has been sustained, then
_assault and battery_ has been committed. The assault may be aggravated
by the use of weapons, etc.
=Homicide= may be _justifiable_, as in the case of judicial execution,
or _excusable_, as in defence of one's family or property.
_Felonious homicide_ is murder. This means that a human being has been
killed by another maliciously and deliberately or with reckless
disregard of consequences.
=Manslaughter= or =Culpable Homicide= (Scotland) is the unlawful killing
of a human being without malice--as homicide after great provocation;
signalman who allows a train to pass, and so collide with another in
front.
X.--WOUNDS AND MECHANICAL INJURIES
A wound may be defined as a 'breach of continuity in the structures of
the body, whether external or internal, suddenly occasioned by
mechanical violence.' The law does not define 'a wound,' but the _true
skin must be broken_. Wounds are dangerous from shock, hæmorrhage, from
the supervention of crysipelas or pyæmia, and from _malum regimen_ on
the part of the patient or surgeon. _Is the wound dangerous to life?_
This question can only be answered by a full consideration of all the
circumstances of the case; a guarded prognosis is wise in all cases.
=Burns= are caused by flames, highly heated solids, or very cold solids,
as solid carbonic acid; scalds, by steam or hot fluids. Burns may cause
death from shock, suffocation, oedema glottidis, inflammation of serous
surfaces, bronchitis, pneumonia, duodenal ulcer, coma, or exhaustion. A
burn of the skin inflicted during life is followed by a bleb containing
serum; the edges of this blister are bright red, and the base, seen
after removing the cuticle, is red and inflamed; if sustained after
death, a bleb, if present, contains but little fluid, and there are no
signs of vital reaction. There are six degrees of burns: (1) Superficial
inflammation; (2) formation of vesicles; (3) destruction of superficial
layer of skin; (4) destruction of cellular tissue; (5) deep parts
charred; (6) carbonization of bones.
The larger the area of skin burnt, the more grave is the prognosis.
Burns of the abdomen and genital organs are especially dangerous. Young
children are specially liable to die after burns.
XI.--CONTUSED WOUNDS AND INJURIES UNACCOMPANIED BY SOLUTION OF
CONTINUITY
If a blow be inflicted with a blunt instrument, there is produced a
bruise, or _ecchymosis_, of which it is unnecessary here to describe the
appearance and progress. A bruise may be distinguished from a
post-mortem stain by the cuticle in the former often being abraded and
raised. When an incision is made into the bruise, the whole of the
subcutaneous tissues are found to be infiltrated with blood-clot, and
there is no clear margin. In the case of a post-mortem stain the edges
are sharply defined, not raised, and, on section, mere bloody points
are seen which are the cut ends of the divided blood vessels.
XII.--INCISED WOUNDS AND THOSE ACCOMPANIED BY SOLUTION OF CONTINUITY
These comprise incised, punctured, and lacerated wounds. In a recent
incised wound inflicted during life there is copious hæmorrhage, the
cellular tissue is filled with blood, the edges of the wound gape and
are everted, and the cavity of the wound is filled with coagula.
Lacerated wounds combine the characters of incised and contused wounds.
They are caused by falls, being ridden over, machinery crushes, bites,
blows from blunt weapons, etc. The wounds heal by suppuration.
_Punctured wounds_ come intermediate between incised and lacerated. They
are greater in depth than in length, being caused by sword or rapier
thrusts. They cause little hæmorrhage externally, but death may be due
to internal hæmorrhage. They may be complicated by (1) the introduction
of septic material adhering to the instrument; (2) the entrance of
foreign bodies which lodge in the wound, not only carrying in septic
matter, but acting as mechanical irritants; (3) injury to deeper parts,
which may at the time be difficult to detect.
An apparently _incised wound_ may be produced by a hard, blunt weapon
over a bone--_e.g._, shin or cranium. It is often difficult to
distinguish between a wound of the scalp inflicted with a knife and one
made by a blow with a stick. A puncture with a sharp-edged, pointed
knife leaves a fusiform or spindle-shaped wound. A wound from a blow
with a stick might be of this character, or it might present a jagged,
swollen appearance at the margin, with much contusion of the surrounding
tissues. If the wound is seen soon after it is inflicted, examination
with a lens may disclose irregularities of the margins, or little
bridges of connective tissue or vessels running across the wound, and
so be inconsistent with its production by a cutting instrument.
_Lacerated wounds_ as a rule bleed less freely than those which are
incised. Symptoms of concussion would favour the theory of the injury
having been inflicted by a heavy instrument. Again, it is often
difficult to decide whether the injury which caused death was the result
of a blow or a fall. A heavy blow with a stick may at once cause fatal
effusion of blood, but this might equally result from fracture of the
skull resulting from a fall. The wound should be carefully examined for
foreign bodies, such as grit, dirt, or sand. The distinction between
incised wounds inflicted during life and after death is found in the
fact that a wound inflicted during life presents the appearances already
described, whereas in a post-mortem incised wound only a small quantity
of liquid venous blood is effused; the edges are close, yielding,
inelastic; the blood is not effused into the cellular tissue, and there
are no signs of vital reaction. The presence of inflammatory reaction or
pus shows that the wound must have been inflicted some time before
death, probably two or three days.
_Self-inflicted wounds_ are made by the person himself in order to
divert suspicion, or in order to bring accusation against another. Such
wounds are always in front, not over vital organs, and superficial in
character. Note the condition of the clothes in such cases.
XIII.--GUNSHOT WOUNDS
These may be punctured, contused, or lacerated. Round balls make a
larger opening than those which are conical. Small shot fired at a short
distance make one large ragged opening; while at distances greater than
3 feet the shot scatter and there is no central opening. The Lee-Metford
bullet is more destructive than the Mauser. The former is the larger,
but the difference in size is not great. The Martini-Henry bullet
weighs 480 grains, the Lee-Metford 215, and the Mauser 173. Speaking
generally, a gunshot wound, unlike a punctured wound, becomes larger as
it increases in depth; the aperture of entrance is round, clean, with
inverted edges, and that of exit larger, less regular than that of
entrance, and with everted edges.
In the case of high-velocity bullets from smooth-bore rifles, including
the Mauser and Lee-Metford, the aperture of entry is small; the aperture
of exit is slightly larger, and tends to be more slit-like. There is but
little tendency to carry in portions of clothing or septic material, and
the wound heals by first intention, if reasonable precautions be taken.
The external cicatrices finally look very similar to those produced by
bad acne pustules.
The contents of all gunshot wounds should be preserved, as they may be
useful in evidence. A pocket revolver, as a rule, leaves the bullet in
the body.
Wounds inflicted by firearms may be due to accident, homicide, or
suicide. Blackening of the wound, singeing of the hair, scorching of the
skin and clothing, show that the weapon was fired at close quarters,
whilst blackening of the hand points to suicide. Even when the weapon is
fired quite close there may be no blackening of the skin, and the hand
is not always blackened in cases of suicide. Smokeless powder does not
blacken the skin. Wounds on the back of the body are not usually
self-inflicted, but a suicide may elect to blow off the back of his
head. A wound in the back may be met with in a sportsman who indulges in
the careless habit of dragging a loaded gun after him. If a revolver is
found tightly grasped in the hand it is probably a case of suicide,
whilst if it lies lightly in the hand it may be suicide or homicide. If
no weapon is found near the body, it is not conclusive proof that it is
not suicide, for it may have been thrown into a river or pond, or to
some distance and picked up by a passer-by.
A bullet penetrating the skull even from a distance of 3,000 yards may
act as an explosive, scattering the contents in all directions; but the
bullet from a revolver will usually be found in the cranium.
The prognosis depends partly on the extent of the injury and the parts
involved, but there is also risk from secondary hæmorrhage, and from
such complications as pleurisy, pericarditis, and peritonitis. Death may
result from shock, hæmorrhage, injury to brain or important nervous
structures.
XIV.--WOUNDS OF VARIOUS PARTS OF THE BODY
1. =Of the Head.=--Wounds of the scalp are likely to be followed by (1)
erysipelatous inflammation; (2) inflammation of the tendinous
structures, with or without suppuration. A severe blow on the vertex may
cause fracture of the base of the skull. Injuries of the brain include
concussion, compression, wounds, contusion, and inflammation. Concussion
is a common effect of blows or violent shocks, and the symptoms follow
immediately on the accident, death sometimes taking place without
reaction. Compression may be caused by depressed bone or effused blood
(rupture of middle meningeal artery) and serum. The symptoms may come on
suddenly or gradually. Wounds of the brain present very great
difficulties, and vary greatly in their effect, very slight wounds
producing severe symptoms, and _vice versâ_. A person may receive an
injury to the head, recover from the first effects, and then die with
all the symptoms of compression from internal hæmorrhage. This is due to
the fact that the primary syncope arrests the hæmorrhage, which returns
during the subsequent reaction, or on the occurrence of any excitement.
Inflammation of the meninges or brain may follow injuries, not only to
the brain itself, but to the scalp and adjacent parts, as the orbit and
ear. Inflammation does not usually come on at once, but after variable
periods.
2. =Injuries to the Spinal Cord= may be due to concussion, compression
(fracture-dislocation), or wounds. That the wound has penetrated the
meninges is shown by the escape of cerebro-spinal fluid. The cord and
nerves may be injured (1) by the puncture; (2) by extravasation of blood
and the formation of a clot; and (3) by subsequent septic inflammation.
Division or complete compression of the cord at or above the level of
the fourth cervical vertebra is immediately fatal (as happens in
judicial hanging). When the injury is below the fourth, the diaphragm
continues forcibly in action, but the lungs are imperfectly expanded,
and life will not be maintained for more than a day or two. When the
injury is in the dorsal region, there is paralysis of the legs and of
the sphincters of the bladder and rectum, but power is retained in the
arms and the upper intercostal muscles act, the extent of paralysis
depending on the level of the lesion. In injuries to the lumbar region
the legs may be partly paralysed, and the rectal and bladder sphincters
may be involved.
_Railway spine_, or traumatic neurasthenia, may be set up by concussion
of the cord as a result of blows or falls. Passengers after railway
accidents, or miners, often suffer from this affection.
3. =Of the Face.=--These produce great disfigurement and inconvenience,
and there is a risk of injury to the brain. The seventh nerve may be
involved, giving rise to facial paralysis. Punctured wounds of the orbit
are especially dangerous. Wounds apparently confined to the external
parts often conceal deep-seated mischief.
4. =Of the Eye.=--The iris may be injured by sharp blows, as from the
cork of a soda-water bottle. It is usually followed by hæmorrhage into
the anterior chamber, and there may be separation of the iris from its
ciliary border. Wounds at the edge of the cornea are often followed by
prolapse of the iris. Acute traumatic iritis or irido-cyclitis may
supervene four or five days after the injury. The lens is frequently
wounded in addition to the cornea and iris. In dislocation of the lens
into the anterior chamber as the result of a blow, the lens appears like
a large drop of oil lying at the back of the cornea, the margin
exhibiting a brilliant yellow reflex. Partial dislocations of the lens
as the result of severe blows generally terminate in cataract.
5. =Of the Throat.=--Very frequently inflicted by suicides. Division of
the carotid artery is fatal, and of the internal jugular vein very
dangerous on account of entrance of air. Wounds of the larynx and
trachea are not necessarily or immediately dangerous, but septic
pneumonia is very apt to follow. Wounds of the throat inflicted by
suicides are commonly situated at the upper part, involving the hyoid
bone and the thyroid and cricoid cartilages. The larynx is opened, but
the large vessels often escape. In most suicidal wounds of the throat
the direction is from left to right, the incision being slightly
inclined from above downwards. At the termination of a suicidal
cut-throat the skin is the last structure divided, the wound being
shallower as it reaches its termination; the wounds often show
parallelism. The weapon is often firmly grasped in the hand. Inquiry
should be made as to whether the patient is right or left handed, or
ambidextrous.
Homicidal cut throat is usually very severe and situated low down in the
neck or far to the side.
6. =Of the Chest.=--Incised wounds of the walls are not of necessity
dangerous; but severe blows, by causing fracture of the bones and
internal injuries, are often fatal. The symptoms of penetrating wounds
of the chest are--(1) The passage of blood and air through the wound;
(2) hæmoptysis; (3) pneumothorax; and (4) protrusion of the lung forming
a tumour covered with pleura. Fracture of the ribs may be due to direct
violence, as from a blow, when the ends are driven inwards, or to
indirect violence, as from a squeeze in a crowd, when the ends are
driven outwards.
7. =Of the Lungs.=--These usually cause hæmorrhage, and are frequently
followed by pleurisy, either dry or with effusion, and by pneumonia.
8. =Of the Heart.=--Penetrating wounds are fatal from hæmorrhage, of the
base more speedily than of the apex; but life may be prolonged for some
time even after a severe wound to the heart. Injury to the right
ventricle is the most fatal injury and the most frequent. Rupture from
disease usually occurs in the left ventricle; rupture from a crush is
usually towards the base and on the right side.
9. =Of the Aorta and Pulmonary Artery.=--Fatal.
10. =Of the Diaphragm.=--Generally fatal, owing to the severe injury of
the other abdominal organs. If the diaphragm be ruptured, hernia of the
organs may result.
11. =Of the Abdomen.=--Of the walls, may be dangerous from division of
the epigastric artery; ventral hernia may follow, internal hæmorrhage,
etc. Blows on the abdomen are prone to cause death from cardiac
inhibition.
12. =Of the Liver.=--May divide the large vessels. Venous blood flows
profusely from a punctured wound of the liver. Wounds of the
gall-bladder cause effusion of bile and peritoneal inflammation.
Laceration of the liver may result from external violence without
leaving any outward sign of the injury; it is commonly fatal. There is
rapid and acute anæmia from the pouring out of blood into the abdominal
cavity. This may also occur with injuries of other organs in the
abdomen.
13. =Of the Spleen.=--Fatal hæmorrhage may result from penetrating
wounds or from rupture due to kicks, blows, crushes, especially if the
spleen be enlarged.
14. =Of the Stomach.=--May be fatal from shock, from hæmorrhage, from
extravasation of contents, or from inflammation. The danger is
materially lessened by prompt surgical intervention.
15. =Of the Intestines.=--May be fatal in the same way as those of the
stomach. More dangerous in the small than in the large intestines.
16. =Of the Kidneys.=--May prove fatal from hæmorrhage, extravasation of
urine, or inflammation.
17. =Of the Bladder.=--Dangerous from extravasation of urine. In
fracture of the pelvis the bladder is often injured, and extraperitoneal
infiltration of urine occurs, with frequently a fatal issue.
18. =Of Genital Organs.=--Incised wounds of penis may produce fatal
hæmorrhage. Removal of testicles may prove fatal from shock to nervous
system. Wounds of the spermatic cord may be dangerous from hæmorrhage.
Wounds to the vulva are dangerous, owing to hæmorrhage from the large
plexus of veins without valves.
XV.--DETECTION OF BLOOD-STAINS, ETC.
Stains may require detection on clothing, on cutting instruments, on
floors and furniture, etc. The following are the distinctive characters
of blood-stains:
(a) =Ocular Inspection.=--Blood-stains on dark-coloured materials, which
in daylight might be easily overlooked, may be readily detected by the
use of artificial light, as that of a candle, brought near the cloth.
Blood-spots when recent are of a bright red colour if arterial, of a
purple hue if venous, the latter becoming brighter on exposure to the
air. After a few hours blood-stains assume a reddish-brown or chocolate
tint, which they maintain for years. This change is due to the
conversion of hæmoglobin into methæmoglobin, and finally into hæmatin.
The change of colour in warm weather usually occurs in less than
twenty-four hours. The colour is determined, not entirely by the age of
the stain, but is influenced by the presence or absence of impurities
in the air, such as the vapours of sulphurous, sulphuric, and
hydrochloric acids. If recent, a jelly-like material may be seen by the
aid of a magnifying-glass lying between the fibres. If old, a
cinnabar-red streak is seen on drawing a needle across the stain.
(b) =Microscopic Demonstration.=--With the aid of the microscope, blood
may be detected by the presence of the characteristic blood-corpuscles.
The human blood-corpuscle is a non-nucleated, biconcave disc, having a
diameter of about 1/3500 of an inch. All mammalian red corpuscles have
the same shape, except those of the camel, which are oval. The
corpuscles of birds, fishes, reptiles, and amphibians, are oval and
nucleated. The corpuscles of most mammals are smaller than those of man,
but the size of a corpuscle is affected by various circumstances, such
as drying or moisture, so that the medical witness is rarely justified
in going farther than stating whether the stain is that of the blood of
a mammal or not. Unfortunately, the corpuscles are usually so dried that
little information regarding their size can be given.
(c) =Action of Water.=--Water has a solvent action on blood, fresh
stains rapidly dissolving when the material on which they occur is
placed in cold distilled water, forming a bright red solution. The
hæmatin of old stains dissolves very slowly, so employ a weak solution
of ammonia, and this will give a solution of alkaline hæmatin. Rust is
not soluble in water.
(d) =Action of Heat.=--Blood-stains on knives may be removed by heating
the metal, when the blood will peel off, at once distinguishing it from
rust. Should the blood-stain on the metal be long exposed to the air,
rust may be mixed with the blood, when the test will fail. The solution
obtained in water is coagulated by heat, the colour entirely destroyed,
and a flocculent muddy-brown precipitate formed.
(e) =Action of Caustic Potash.=--The solution of blood obtained in water
is boiled, when a coagulum is formed soluble in hot caustic potash, the
solution formed being greenish by transmitted and red by reflected
light.
(f) =Action of Nitric Acid.=--Nitric acid added to a watery solution
produces a whitish-grey precipitate.
(g) =Action of Guaiacum.=--Tincture of guaiacum produces in the watery
solution a reddish-white precipitate of the resin, but on addition of an
aqueous solution of peroxide of hydrogen, or of an ethereal solution of
the same substance (known as _ozonic ether_), a blue or bluish-green
colour is developed. This test is delicate, and succeeds best in dilute
solutions. It is not absolutely indicative of the presence of blood, for
tincture of guaiacum is coloured blue by milk, saliva, and pus.
(h) =Hæmin Crystals (Teichman's Crystals).=--These are produced by
heating a drop of blood, or a watery solution of it, with a minute
crystal of sodium chloride on a glass slide and evaporating to dryness.
A cover-glass is placed over this, and a drop of glacial acetic acid
allowed to run in. It is again heated until bubbles appear. Crystals of
hæmin may now be detected by the microscope. They are dark brown or
yellow rhombic prisms.
An improvement on this test is the use of formic acid alone; on slowly
evaporating it, numerous very small dark crystals are visible if
hæmoglobin has been present (Whitney's test).
(i) =Spectroscopic Appearances.=--If a solution of a recent stain be
examined by the spectroscope, we get two absorption bands situated
between the lines D and E, the one nearer E being doubly as broad as the
other. These bands indicate _oxyhæmoglobin_.
If we now add a little ammonium sulphide to this solution, we get the
spectrum of _reduced hæmoglobin_, which is a single broad absorption
band situated in the interval between the preceding oxyhæmoglobin
bands. By shaking the solution, oxyhæmoglobin is again reproduced, and
gives its special absorption bands.
If ammonia be added to the original solution, _alkaline hæmatin_ is
produced, or if acetic acid be chosen, _acid hæmatin_ is produced, and
each gives its appropriate absorption bands.
_Methæmoglobin_ is formed in stains which have been exposed to the air
for a few days, and _hæmatin_ is found in old stains. _Hæmochromogen_
gives a very characteristic spectrum, and is obtained by reducing
alkaline hæmatin by ammonium sulphide. _Carbon monoxide hæmoglobin_
gives a spectrum which resembles that of oxyhæmoglobin, but it is not
reduced by ammonium sulphide.
(j) =Precipitin Test.=--This allows us to tell whether the blood is from
a human being or not. A specific serum must be obtained from a rabbit
which is sensitized as follows: 10 c.c. of human blood is injected into
its peritoneal cavity at intervals, until from three to five injections
have been given. The serum of this animal's blood will then give a white
precipitate only when brought into contact with dilute solutions of
human blood, but with the blood of no other animal. This is known also
as the 'biologic,' or Uhlenhuth's test.
=Rust Stains.=--These are yellowish-red in colour, and do not stiffen
the cloth. The iron may be dissolved by placing the stain in a dilute
solution of hydrochloric acid, when, on adding ferrocyanide of
potassium, Prussian blue is produced.
=Fruit Stains= are seldom so dark as blood-stains. Solutions of these do
not change colour or coagulate on boiling; ammonia changes the colour to
blue or green; acid brightens the original colour, while chlorine
bleaches it.
=Hairs.=--Human hairs must be identified and distinguished from those of
the lower mammals. If the hair has been pulled out from the root, the
microscope will show that the bulbous root has a concave surface which
fitted over the hair papilla, or that the root is encased in a fatty
sheath.
=Fibres of Clothing.=--Microscopically, wool fibres are coarse, curly,
and striated transversely; cotton fibres appear as flattened bands
twisted into spirals; linen fibres are round, jointed at frequent
intervals, with small root-like filaments; silk fibres are solid,
continuous, and highly glistening.
XVI.--DEATH BY SUFFOCATION
_Signs and Symptoms._--There are usually three stages:
1. Exaggerated respiratory activity; air hunger; anxiety; congested
appearance of face; ringing in ears.
2. Loss of consciousness; convulsions; relaxation of sphincters.
3. Respirations feeble and gasping, and soon cease; convulsions of
stretching character; heart continues to beat for three to four minutes
after breathing ceases.
_Post-Mortem Appearances--External._--Cadaveric lividity well marked;
nose, lips, ears, finger-tips almost black in colour; appearance may be
placid or, if asphyxia has been sudden, the tongue may be protruded and
eyeballs prominent, with much bloody mucus escaping from mouth and nose.
_Internal._--The blood is dark and remains fluid; great engorgement of
venous system, right side of heart, great veins of thorax and abdomen,
liver, spleen, etc. Lungs dark purple in colour; much bloody froth
escapes on squeezing them; mucous lining of trachea and bronchi
congested and bright red in colour; air-cells distended or ruptured;
many small hæmorrhages on surface of lungs and other organs, as well as
in their substance (_Tardieu's spots_), due to rupture of venous
capillaries from increased vascular pressure.
XVII.--DEATH BY HANGING
In hanging, death occurs by asphyxia, as in drowning. Sensibility is
soon lost, and death takes place in four or five minutes. The eyes in
some cases are brilliant and staring, tongue swollen and livid, blood or
bloody froth is found about the mouth and nostrils, and the hands are
clenched. In other cases the countenance is placid, with an almost
entire absence of the signs just given. The mark on the neck, which may
be more or less interrupted by the beard, shows the course of the cord,
which in hanging is obliquely round the neck following the line of the
jaw, but straight round in strangulation. In judicial hanging, death is
not due to asphyxiation, but, owing to the long drop, the cervical
vertebræ are dislocated, and the spinal cord injured so high up that
almost instant death takes place. On dissection the muscles and
ligaments of the windpipe may be found stretched, bruised, or torn, and
the inner coats of the carotid arteries are sometimes found divided. In
ordinary suicidal hanging there may be entire absence of injury to the
soft parts about the neck, the length of the drop modifying these
appearances. The mark of the cord is not a sign of hanging, is a purely
cadaveric phenomenon, and may be produced some hours after death.
XVIII.--DEATH BY STRANGULATION
This differs from hanging in that the body is not suspended. It may be
effected by a ligature round the neck, or by direct pressure on the
windpipe with the hand, in which case death is said to be caused by
_throttling_. Strangulation is frequently suicidal, but may be
accidental. When homicidal, much injury is done to the neck, owing to
the force with which the ligature is drawn. In throttling, the marks of
the finger-nails are found on the neck.
XIX.--DEATH BY DROWNING
Death by drowning occurs when breathing is arrested by watery or
semi-fluid substances--blood, urine, etc. The fluid acts mechanically by
entering the air-cells of the lung and preventing the due oxidation of
the blood. The post-mortem appearances include those usually present in
death by asphyxia, together with the following, peculiar to death by
drowning: Excoriations of the fingers, with sand or mud under the nails;
fragments of plants grasped in the hand; water in the stomach (this is a
vital act, and shows that the person fell into the water alive); fine
froth at the mouth and nostrils; cutis anserina; retraction of penis and
scrotum. On post-mortem examination, the lungs are found to be increased
in size ('ballooned'); on section, froth, water mud, sand, in air-tubes.
The presence of this fine (often blood-stained) froth is the most
characteristic sign of drowning. Froth like that of soap-suds in the
trachea is an indication of a vital act, and must not be mistaken for
the tenacious mucus of bronchitis. The presence of vomited matters in
the trachea and bronchi is a valuable sign of drowning. The blood
collects in the venous system, and is dark and fluid. Tardieu's spots
are not so frequently met with in cases of drowning as in other forms of
asphyxia. The other signs of death by asphyxia are present. Wounds may
be present on the body, due to falling on stakes, injuries from passing
vessels, etc.
The methods of performing artificial respiration in the case of the
apparently drowned are the following (the best and most easily performed
is Schäfer's prone pressure method):
1. _Schäfer's._--Place the patient on his face, with a folded coat under
the lower part of the chest. Unfasten the collar and neckband. Go to
work at once. Kneel over him athwart or on one side facing his head.
Place your hands flat over the lower part of his back, and make
pressure on his ribs on both sides, and throw the weight of your body on
to them so as to squeeze out the air from his chest. Get back into
position at once, but leave your hands as they were. Do this every five
seconds, and get someone to time you with a watch. Keep this going for
half an hour, and when you are tired get someone to relieve you.
Other people may apply hot flannels to the limbs and hot water to the
feet. Hypodermic injections of 1/50 grain of atropine, suprarenal or
pituitary extracts, may be found useful.
2. _Silvester's._--In this method the capacity of the chest is increased
by raising the arms above the head, holding them by the elbows, and thus
dragging upon and elevating the ribs, the chest being emptied by
lowering the arms against the sides of the chest and exerting lateral
pressure on the thorax. The patient is in the supine position--but first
the water must have been drained from the mouth and nose by keeping the
body in the prone position. The tongue must be kept forward by
transfixing with a pin.
3. _Marshall Hall's._--This consists in placing the patient in the prone
position, with a folded coat under the chest, and rolling the body
alternately into the lateral and prone positions.
4. _Howard's._--This consists in emptying the thorax by forcibly
compressing the lower part of the chest; on relaxing the pressure the
chest again fills with air. Here the patient is placed in the supine
position.
The objections to the supine position are that the tongue falls back,
and not only blocks the entrance of air, but prevents the escape of
water, mucus, and froth from the air-passages.
5. _Laborde's Method._--This consists in holding the tongue by means of
a handkerchief, and rhythmically drawing it out fully at the rate of
fifteen times per minute. This excites the respiratory centre, and this
method may be employed along with any of the other methods.
XX.--DEATH FROM STARVATION
The post-mortem appearances in death from starvation are as follows:
There is marked general emaciation; the skin is dry, shrivelled, and
covered with a brown, bad-smelling excretion; the muscles soft,
atrophied, and free from fat; the liver is small, but the gall-bladder
is distended with bile. The heart, lungs, and internal organs are
shrivelled and bloodless. The stomach is sometimes quite healthy; in
other cases it may be collapsed, empty, and ulcerated. The intestines
are also contracted, empty, and translucent.
In the absence of any disease productive of extreme emaciation (_e.g._,
tuberculosis, stricture of oesophagus, diabetes, Addison's disease),
such a state of body will furnish a strong presumption of death by
starvation.
In the case of children there is not always absolute deprivation of
food, but what is supplied is insufficient in quantity or of improper
quality. The defence commonly set up is that the child died either of
marasmus or of tuberculosis.
In cases where it is alleged that a child has been starved and ill-used,
one must examine the body for signs of neglect--_e.g._, dirtiness of
skin and hair, presence of vermin, bruises or skin eruptions. Compare
its weight with a normal child of the same age and sex. If the
disproportion be great and signs of neglect present, then the
probability is great (provided there be no actual disease present) that
the child has been starved.
XXI.--DEATH FROM LIGHTNING AND ELECTRICITY
The signs of death from lightning vary greatly. In some cases there are
no signs; in others the body may be most curiously marked. Wounds of
various characters--contused, lacerated, and punctured--may be
produced. There may be burns, vesications, and ecchymoses; arborescent
markings are not uncommon. The hair may be singed or burnt and the
clothing damaged. Rigor mortis is very rapid in its onset and transient.
Post mortem there are no characteristic signs, but the blood may be dark
in colour and fluid. The presence or absence of a storm may assist the
diagnosis.
Injuries by electrical currents of high pressure are not uncommon;
speaking generally, 1,000 to 2,000 volts will kill. In America, where
electricity is adopted as the official means of destroying criminals,
1,500 volts is regarded as the lethal dose, but there are many instances
of persons having been exposed to higher voltages without bad effects.
The alternating current is supposed to be more fatal than the
continuous. Much depends on whether the contact is good (perspiring
hands or damp clothes). Death has been attributed in these cases to
respiratory arrest or sudden cessation of the heart's action. The best
treatment is artificial respiration, but the inhalation of nitrite of
amyl may prove useful. Rescuers must be careful that they, also, do not
receive a shock. The patient should be handled with india-rubber gloves
or through a blanket thrown over him.
XXII.--DEATH FROM COLD OR HEAT
=Cold.=--The weak, aged, or infants, readily succumb to low
temperatures. The symptoms are increasing lassitude, drowsiness, coma,
with sometimes illusions of sight. Post mortem, bright red patches are
found on the skin surface, and the blood remains fluid for long.
=Heat.=--Death may result from syncope, the result of exposure to great
heat.
=Sunstroke.=--The person loses consciousness and falls down insensible;
the body temperature may be 112° F., the pulse is full, and a peculiar
pungent odour is given off from the skin. Coma, convulsions with
(rarely) delirium, may precede death. _Treatment_ consists in lowering
the body temperature by application of cold cloths, stimulants,
strychnine or digitalin hypodermically.
XXIII.--PREGNANCY
The signs of the existence of pregnancy are of two kinds, uncertain and
certain, or maternal and foetal. Amongst the former class are
included--Cessation of menstruation (which may occur without pregnancy);
morning vomiting; salivation; enlargement of the breasts and of the
abdomen; quickening. It must be borne in mind that every woman with a
big abdomen is not necessarily pregnant. The tests which afford
conclusive evidence of the existence of a foetus in the uterus
are--Ballottement, the uterine souffle, intermittent uterine
contractions, foetal movements, and, above all, the pulsation of the
foetal heart. The uterine souffle is synchronous with the maternal
pulse; the foetal heart is not, being about 120 beats per minute.
Evidence of pregnancy may also be afforded by the discharge from the
uterus of an early ovum, of moles, hydatids, etc. Disease of the uterus
and ovarian dropsy may be mistaken for pregnancy. Careful examination is
necessary to determine the nature of the condition present. Pregnancy
may be pleaded in bar of immediate capital punishment, in which case the
woman must be shown to be 'quick with child.' A woman may also plead
pregnancy to delay her trial in Scotland, and both in England and
Scotland, in civil cases, to produce a successor to estates, to increase
damages for seduction, in compensation cases where a husband has been
killed, to obtain increased damages, etc. A woman may become pregnant
within a month of her last delivery.
In cases of rape and suspected pregnancy, it must be borne in mind that
a medical man who examines a woman under any circumstances against her
will renders himself liable to heavy damages, and that the law will not
support him in so doing. If, on being requested to permit an
examination, the woman refuse, such refusal may go against her, but of
this she is the best judge. The duty of the medical man ends on making
the suggestion.
XXIV.--DELIVERY
The signs of recent delivery are as follows: The face is pale, with dark
circles round the eyes; the pulse quickened; the skin soft, warm, and
covered with a peculiar sweat; the breasts full, tense, and knotty; the
abdomen distended, its integuments relaxed, with irregular light pink
streaks on the lower part. The labia and vagina show signs of distension
and injury. For the first three or four days there is a discharge from
the uterus more or less sanguineous in character, consisting of blood,
mucus, epithelium, and shreds of membrane. During the next four or five
days it becomes of a dirty green colour, and in a few days more of a
yellowish, milky, mucous character, continuing for two to three weeks.
The change in character of the lochial discharge is due to the quantity
of blood decreasing and its place being taken by fatty granules and
leucocytes. The os uteri is soft, patulous, and its edges are torn. The
uterus may be felt for two or three hours above the pubis as a hard
round ball, regaining its normal size in about eight weeks after
delivery. Most of these signs disappear about the tenth day, after which
it becomes impossible to fix the date of delivery.
In the dead the external parts have the same appearance as given above.
The uterus will vary in appearance according to the time elapsed since
delivery. If death occurred immediately after delivery, the uterus will
be wide open, about 9 or 10 inches long, with clots of blood inside, and
the inner surface lined by decidua.
The signs of a previous delivery consist in silvery streaks in the skin
of the abdomen, which, however, may be due to distension from other
causes; similar marks on the breast; circular and jagged condition of
the os uteri (the virgin os being oval and smooth); marks of rupture of
the perineum or fourchette; absence of the vaginal rugæ; dark-coloured
areola round the nipples, etc. The difference between the virgin _corpus
luteum_ and that of recent pregnancy is not so marked as to justify a
confident use of it for medico-legal purposes.
XXV.--FOETICIDE, OR CRIMINAL ABORTION
This consists in giving to any woman, or causing to be taken by her,
with intent to procure her miscarriage, any poison or other noxious
thing, or using for the same purpose any instruments or other means
whatsoever. It is a felony to procure or attempt to procure the
miscarriage of a woman, whether she be pregnant or not, and it is a
felony for the woman, if pregnant, to attempt to procure her own
miscarriage. It is a misdemeanour for any person or persons to procure
drugs or instruments for a like purpose. It is not necessary that the
woman be _quick_ with child. The offence is the intent to procure the
miscarriage of any woman, _whether she be or be not with child_. When
from any causes it is necessary to procure abortion, a medical man
should do so only after consultation with a brother practitioner. Even
in these cases there is no exemption legally. Any medical man who gives
even the most harmless medicine where he suspects the possibility of
pregnancy may render himself liable to grave suspicion should the woman
abort.
In medicine, an _abortion_ is said to occur when the foetus is expelled
before the sixth month; after that it is _premature birth_. In law,
however, any expulsion of the contents of the uterus before the full
time is an _abortion_ or _miscarriage_.
In deciding whether any substance expelled from the uterus is really a
foetus or a mole, and therefore the result of conception, or the coat of
the uterus, and unconnected with pregnancy, the examination of the
substances expelled must be carefully made. Moles are blighted foetuses.
An examination of the woman will be necessary, though it is not easy
during the early months of pregnancy, and especially in those who have
borne children, to say whether abortion has taken place or not. The
history must be inquired into; the regular or exceptional use of drugs
to promote menstruation is important, for in the former case no criminal
intent may exist, although pregnancy be present. The state of the
breasts, the hymen, and the os uteri, should all be carefully examined.
Putting a few apparently unimportant questions as to the frequent use of
purgatives, the presence or absence of constipation, will often assist
the diagnosis as showing that the woman has acted in an unusual manner.
Abortion may be procured by the introduction of instruments, by falls,
violent exercise, blows on the abdomen, etc. In the hands of ignorant
persons the use of instruments (sounds, bougies, skewers, etc.) is
attended with great danger. Perforation of the vaginal walls, bladder,
cervix, or uterus, may follow their use. Septic pelvic peritonitis may
ensue, and the woman may lose her life. The person who has employed such
means for inducing abortion is liable to be charged with the crime of
murder. There is no evidence to show that ergot, savin, bitter-apple,
pennyroyal, or any other drug administered internally, will cause a
woman to abort, except when taken in such large doses that actual
poisoning results, with inflammation of the contents of the true
pelvis. In such cases reflex uterine contractions may be set up, and
abortion may follow. Diachylon pills are largely employed to induce
abortion, and very often the woman taking them suffers severely from
lead-poisoning.
XXVI.--INFANTICIDE
Infanticide, or the murder of a new-born child, is not treated as a
specific crime, but is tried by the same rules as in cases of felonious
homicide. The term is applied technically to those cases in which the
mother kills her child at, or soon after, its birth. She is often in
such a condition of mental anxiety as not to be responsible for her
actions. It is usually committed with the object of concealing delivery,
and to hide the fact that the girl has, in popular language, 'strayed
from the paths of virtue.' The child must have had a separate existence.
To constitute 'live birth,' the child must have been alive after its
body was entirely born--that is, entirely outside the maternal
passages--and it must have had an independent circulation, though this
does not imply the severance of the umbilical cord. Every child is held
in law to be born dead until it has been shown to have been born alive.
Killing a child in the act of birth and before it is fully born is not
infanticide, but if before birth injuries are inflicted which result in
death after birth, it is murder. Medical evidence will be called to show
that the child was born alive.
The methods of death usually employed are--(1) Suffocation by the hand
or a cloth. (2) Strangulation with the hands, by a tape or ribbon, or by
the umbilical cord itself. (3) Blows on the head, or dashing the child
against the wall. (4) Drowning by putting it in the privy or in a bucket
of water. (5) Omission: by neglecting to do what is absolutely necessary
for the newly-born child--_e.g._, not separating the cord; allowing it
to lie under the bed-clothes and be suffocated.
With regard to the question of the maturity of a child, the differences
between a child of six or seven months and one at full term may be
stated as follows:
Between the sixth and seventh month, length of child 10 to 14
inches--that is, the length of the child after the fifth month is about
double the lunar months--weight 1 to 3 pounds; skin, dusky red, covered
with downy hair (lanugo) and sebaceous matter; membrana pupillaris
disappearing; nails not reaching to ends of fingers; meconium at upper
part of large intestine; testes near kidneys; no appearance of
convolutions in brain; points of ossification in four divisions of
sternum.
At nine months, length of child 18 to 22 inches; weight, 7 to 8 pounds;
skin rosy; lanugo only about shoulders; sebaceous matter on the body;
hair on head about an inch long; testes past inguinal ring; clitoris
covered by the labia; membrana pupillaris disappeared; nails reach to
ends of fingers; meconium at termination of large intestine; points of
ossification in centre of cartilage at lower end of femur, about 1-1/2
to 2-1/2 lines in diameter; umbilicus midway between the ensiform
cartilage and pubis.
Owing to the difficulty of proving that the crime of infanticide has
been committed, the woman may in England be tried for _concealment of
birth_, and in Scotland for _concealment of pregnancy_, if she conceal
her pregnancy during the whole time and fail to call for assistance in
the birth. Either of these charges would only be brought against a woman
who had obviously been pregnant, and now the child is missing or its
dead body has been found. It is expected that every pregnant woman
should make provision for the child about to be born, and so should have
talked about it or have made clothes, etc., for it. The punishment for
concealment is imprisonment for any term not exceeding two years. The
charge of concealment is very often alternative to infanticide. To
substantiate the charge, however, it must be proved that there had been
a _secret disposition of the dead body_ of the infant, as well as an
endeavour to conceal its birth.
A woman may be delivered of a child unconsciously, for the contractile
power of the womb is independent of volition. Under an anæsthetic the
uterus acts as energetically as if the patient were in the full
possession of her senses.
Nowadays a woman is rarely hanged for infanticide, and it is a mere
travesty of justice to pass on her the death sentence, well knowing that
it will never be executed.
XXVII.--EVIDENCES OF LIVE BIRTH
The signs of live birth prior to respiration are negative and positive.
A negative opinion may be formed when evidence is found of the child
having undergone intra-uterine maceration. In this case the body will be
flaccid and flattened; the ilia prominent; the head soft and yielding;
the cuticle more or less detached, and raised into large bullæ; the skin
of a red or brownish-red colour; the cavities filled with abundant
bloody serum; the umbilical cord straight and flaccid.
A positive opinion is justified when such injuries are found on the body
as could not have been inflicted during birth, and are attended with
such hæmorrhage as could only have occurred while the blood was
circulating. Fractures of the cranium from accidental falls (precipitate
labour) are as a rule stellate, and are situated on the vertex or in the
parietal protuberance. The fractures from violence are more extensive,
usually depressed, and accompanied by laceration of the scalp.
The evidences of live birth after respiration has taken place are
usually deduced from the condition of the lungs, though indications are
also found in other organs. The diaphragm is more arched before than
after respiration, and rises higher in the thorax in the former case
than in the latter. The lungs before respiration are situated in the
back of the thorax, and do not fill that cavity; they are of a dark,
red-brown colour and of the consistence of liver, without mottling.
After respiration they expand and occupy the whole thorax, and closely
surround the heart and thymus gland. The portions containing air are of
a light brick-red colour, and crepitate under the finger. The lungs are
mottled from the presence of islands of aerated tissue, surrounded by
arteries and veins. The weight of the lungs before respiration is about
550 grains, after an hour's respiration 900 grains; but this test is of
little value. The ratio of the weight of the lungs to that of the body
(Ploucquet's test), which is also unreliable, is, before respiration,
about 1 to 70; after, 1 to 35. Lungs in which respiration has taken
place float in water; those in which it has not, sink. There are
exceptions to this rule, on which, however, is founded the _hydrostatic
test_. As originally performed, this test consisted merely in placing
the lungs, with or without the heart, in water, and noticing whether
they sank or floated. The test is now modified by squeezing, and by
cutting the lungs up into pieces.
The objections to the test as originally performed are--(1) That the
lungs may sink as the result of disease--_e.g._, double pneumonia. (2)
That respiration may have been so limited in extent that the lungs may
sink, owing to large portions of lung tissue remaining unexpanded
(_atelectasis_). (3) Putrefaction may cause the lungs to float when
respiration has not taken place. (4) The lungs may have been inflated
artificially. Few of these objections apply, however, when the
hydrostatic test, modified by pressure, is employed. To take these
objections in detail, it may be stated: (1) If the lungs sink from
disease, the question of live birth is answered. (2) This objection is
too refined for practical use. The lungs sink, there is an absence of
any of the signs of suffocation, and the matter ends. The examiner has
only to describe the conditions which he finds, and is not required to
indulge in conjectures as to the amount of respiration which may or may
not have taken place. (3) Gas due to putrefaction collects under the
pleural membrane, and can be expelled by pressure, and is not found in
the air cells. The lungs decompose late, hence in a fresh body
putrefaction of the lungs is absent; in a putrefied child, if the lungs
sink, it must have been stillborn. The so-called _emphysema pulmonum
neonatorum_ is simply incipient putrefaction.
The lung test simply shows that the child has breathed, but affords no
proof that the child has been born alive. The child may have breathed as
soon as its head protruded, the rest of the body being in the maternal
passages. The child is not born alive until it has been completely
expelled, although it is not necessary that the umbilical cord should
have been cut.
In addition to these tests, live birth may be suspected from the
following conditions: The _stomach_ may contain milk or food, recognized
by the microscope and by Trommer's test for sugar; the _large
intestines_ in stillborn children are filled with meconium, in those
born alive they are usually empty; the _bladder_ is generally emptied
soon after birth; the _skin_ is in a condition of exfoliation soon after
birth. The _organs of circulation_ undergo the following changes after
birth, and the extent to which these changes have advanced will give an
idea of how long the child has lived: The _ductus arteriosus_ begins to
contract within a few seconds of birth; at the end of a week it is about
the size of a crow quill, and about the tenth day is obliterated. The
_umbilical arteries and vein_: the arteries are remarkably diminished in
calibre at the end of twenty-four hours, and obliterated almost up to
the iliacs in three days; the umbilical vein and the ductus venosus are
generally completely contracted by the fifth day. The _foramen ovale_
becomes obliterated at extremely variable periods, and may continue open
even in the adult.
Importance of late has been attached to the _stomach-bowel test_. If the
stomach and duodenum contain air, and consequently float in water, the
chances are that the child did not die immediately after birth; this is
known as Breslau's second life test, and the lower the air in the
intestinal canal, the greater is the probability that the child survived
birth.
The umbilical cord in a new-born child is fresh, firm, round, and bluish
in colour; blood is contained in its vessels. The cord may be ruptured
by the child falling from the maternal parts in a precipitate labour,
and the ruptured parts present ragged ends. It is seldom that a child
bleeds to death from an untied or cut umbilical cord, and the chances in
a torn cord are still more remote. The changes in the cord are as
follows: First it shrinks from the ligature towards the navel; this
change may begin early, and is rarely delayed beyond thirty hours; the
cord becomes flabby, and there is a distinct inflammatory circle round
its insertion. The next change is that of desiccation or mummification;
the cord becomes reddish-brown, then flattened and shrivelled, then
translucent and of the colour of parchment, and falls off about the
fifth day. The third stage, that of cicatrization, then ensues about the
tenth to the twelfth day. The bright red rim round the insertion of the
cord, with inflammatory thickening and slight purulent secretion, may be
considered as evidence of live birth, and the stage at which the
separation of the cord by ulcerative process has arrived will point to
the probable duration of time the child has existed after birth.
There are many fallacies in the application of any of these tests, and
the whole subject bristles with difficulties. The medical witness would
do well to exhibit a cautious reserve, for if the child dies immediately
after birth it is almost impossible to prove that it was born alive.
XXVIII.--CAUSE OF DEATH IN THE FOETUS
The death of the foetus may be due to--(1) Immaturity or intra-uterine
malnutrition, or simply from deficient vitality; (2) complications
occurring during or immediately after birth, which may either be
unavoidable or inherent in the process of parturition, or may be induced
with criminal intent.
In the latter category come such accidents as the pressure of tumours in
the pelvic passages, or disease of the bones in the mother, or pressure
on the cord from malposition of the child during labour, asphyxiation
from the funis being twisted tightly round the neck or limbs, or from
injuries due to falls on the floor in sudden labours. Where the death of
the foetus has been induced with criminal intent, it may be due to
punctured wounds of the fontanelles, orbits, heart, or spinal marrow;
dislocation of the neck; separation of the head from the body; fracture
of the bones of the head and face; strangulation; suffocation; drowning
in the closet pan or privy, or from being thrown into water.
Under the head of infanticide by _commission_, we have injuries of all
kinds; under infanticide by _omission_, neglecting to tie the cord,
allowing it to be suffocated by discharges in the bed, neglect to
provide food, clothes, and warmth, for the new-born child.
XXIX.--DURATION OF PREGNANCY
The natural period of gestation is considered as forty weeks, ten lunar
months, or 280 days. A medical witness would have to admit the
possibility of gestation being prolonged to 300 days, and if this time
were not very materially exceeded it would be well to give the woman
the benefit of the doubt. It may be mentioned that 300 days is the
extreme limit fixed by the French and Scottish law. No fixed period is
assigned in English or American law to the duration of pregnancy, though
it is allowed that utero-gestation may be greatly prolonged. In a recent
case decided, the Lord Chancellor accepted a case where it was alleged
pregnancy had extended to 331 days. A child only five months old may
live, for a short time at all events. There is considerable difficulty
in many cases in fixing the date of conception. The data from which it
is calculated are the following: (1) _Peculiar sensations attending
conception_, which are not sufficiently defined to be recognized by
those conceiving for the first time. (2) _Cessation of the catamenia._
Other causes may, however, cause this; and, on the other hand, a woman
may menstruate during the whole period of her pregnancy. This datum also
gives a variable period, and may involve an error of several days or a
month, for the menses may be arrested by cold, etc., at one monthly
period, and the woman become pregnant before the next. (3) _The period
of quickening._ This, when perceived (which is not always the case),
also occurs at variable periods from the tenth to the twenty-sixth week.
(4) _A single coitus._ This does not, however, correspond to the time of
fertilization. Several days may elapse before the spermatozoa meet with
an ovum and fertilize it.
In Scotland a child born six months after marriage is legitimate, which
is allowing an ample margin.
XXX.--VIABILITY OF CHILDREN
A child may be born alive, but may not be viable, by which is meant that
it is not endowed with a capacity of maintaining its life. Speaking
generally, 180 days represents the lowest limit at which a child is
viable, but prolonged survival under these circumstances is the
exception. Many cases, however, have been recorded in which children
born at six months have been reared. The signs of immaturity and
maturity may be thus tabulated:
IMMATURITY. MATURITY.
Centre of body high; head Strong movements and cries as soon
disproportionate in size; membrana as born; body clear, red colour,
pupillaris present; testicles coated with sebaceous matter; mouth,
undescended; deep red colour of nostrils, eyelids, and ears, open;
parts of generation; intense red skull somewhat firm, and fontanelles
colour, mottled appearance, and not far apart; hair, eyebrows, and
downy covering, of skin; nails not nails, perfectly developed;
formed; feeble movements; testicles descended; free discharge
inability to suck; necessity for of urine and meconium; power of
artificial heat; almost unbroken suction, indicated by seizure on the
sleep; rare and imperfect nipple or a finger placed in the
discharges of urine and meconium; mouth.
closed state of mouth, eyelids,
and nostrils.
XXXI.--LEGITIMACY
A child born in wedlock is presumed to have the mother's husband for its
father. This may, however, be open to question upon the following
grounds: Absence or death of the reputed father; impotence or disease in
the husband preventing matrimonial intercourse; premature delivery in a
newly-married woman; want of access; and the marriage of the woman again
immediately on the death of her husband. In the last case, where either
husband might have been the father, the child at the age of twenty-one
is at liberty to select its father from the possible pair.
A child born of parents before marriage is in Scotland rendered
legitimate by their subsequent marriage, but in England the offspring
remains illegitimate whether the parents marry or not after its birth.
The offspring of voidable or invalid marriages may be made legitimate
by application to the courts.
There is a difference between being legitimate and lawfully begotten. A
child born in wedlock is legitimate, but if the parents were married
only a week previously it could not have been lawfully begotten.
The Acts and rulings relating to Marriage and Legitimacy are extremely
complicated. It is not putting it too strongly to say that a very large
number of people in this country who believe themselves to be legally
married are not married at all, and that thousands of children who have
not the slightest doubt as to their legitimacy are in the eyes of the
law bastards.
XXXII.--SUPERFOETATION
By superfoetation is meant the conception, by a woman already pregnant,
of a second embryo, resulting in the birth of two children at the same
time, differing much in their degree of maturity, or in two separate
births, with a considerable interval between. The possibility of the
occurrence of superfoetation has been doubted, but there are
well-authenticated cases which countenance the theory of a double
conception. It has been shown that the os uteri is not closed, as was
once supposed, immediately _on conception_. Should an ovum escape into
the uterus, it may become impregnated a month or so after a previous
conception. The most probable explanation is that the case has been one
of twins, one being born prematurely; or, on the other hand, the uterus
may have been double, and conception may have taken place in one cornu
at a later period than in the other cornu.
XXXIII.--INHERITANCE
In order to inherit, the child must be born alive, must be born during
the lifetime of the mother, and must be born capable of inheriting--that
is to say, monsters are incapable of inheriting. There is a mode of
inheritance called 'tenancy by courtesy.' When a man marries a woman
possessed of an estate or inheritance, and has, by her, issue born alive
in her lifetime capable of inheriting her estate, in this case he shall,
on the death of his wife, hold the lands for his life as tenant by the
courtesy of England. The meaning of the words 'born alive' in this
instance is not the same as in cases of infanticide. In Civil law any
motion of the child's body, however slight, or the fact of it having
been heard to cry by witnesses, is held to be sufficient proof of the
child having been born alive. It may die immediately afterwards, and it
is not necessary that the child be viable.
XXXIV.--IMPOTENCE AND STERILITY
In the male, impotence may arise from physical or mental causes. The
physical causes may be--too great or too tender an age; malformation of
the genital organs; _crypsorchides_, defect or disease in the testicles;
constitutional disease (diabetes, neurasthenia, etc.); or debility from
acute disease, as mumps. Masturbation, and early and excessive sexual
indulgence, are also causes. The mental causes include--passion,
timidity, apprehension, aversion, and disgust. The case will be
remembered of the man who was impotent unless the lady were attired in a
black silk dress and high-heeled French kid boots.
If a man is impotent when he marries, the marriage may be set aside on
the ground that it had never been consummated. The law requires that the
impotency should have existed _ab initio_--that is, before
marriage--and should be of a permanent or incurable nature; marriage,
as far as the law goes, being regarded as a contract in which it is
presupposed that both the contracting parties are capable of fulfilling
all the objects of marriage. In the case of the Earl of Essex the
defendant admitted the charge as regards the Countess, but pleaded that
he was not impotent with others, as many of her waiting-maids could
testify. When a man becomes impotent _after_ marriage, his wife must
accept the situation, and has no redress. A man may be _sterile_ without
being impotent, but the law will not take cognizance of that. The wife
may be practically impotent, but the law will not assist the husband. He
must continue to do his best under difficult circumstances. In former
times in case of doubt a husband was permitted to demonstrate his
competency in open court, but this custom is no longer regarded with
favour by the judges.
The removal of the testicles does not of necessity render a man
impotent, although it deprives him of his procreative power. Eunuchs are
capable of affording illicit pleasure, whilst the male sopranos, or
_castrati_, are often utilized for that purpose.
In the female, impotence may be caused by the narrowness of the vagina,
adhesion of the vulva, absence of vagina, imperforate hymen, and tumours
of the vagina.
Sterility in women may occur from the above-named causes of impotence,
together with absence of the uterus and ovaries, or from great debility,
syphilis, constant amenorrhoea, dysmenorrhoea, or menorrhagia.
XXXV.--RAPE
Rape is the carnal knowledge of a woman by force and against her will.
The resistance of the woman _must be_ to the utmost of her power, but if
she yield through fear or duress it is still rape. The woman is a
competent witness, but her statements may be impugned on the ground of
her previous bad character, and evidence may be called to substantiate
the charge. The perpetrator must be above the age of fourteen years.
The definition of rape which we have given is not altogether
satisfactory. Take, for example, the case of a woman who goes to bed
expecting her husband to return at a certain hour. The lodger, let us
say, takes advantage of this fact, and, getting into bed, has connection
with her, she not resisting, assuming all the while that it is her
husband. This is rape, but it is not 'by force,' and it is not 'against
her will,' but it is 'without her consent,' as she has not been fully
informed as to all the circumstances of the case.
In all cases of rape in which there is no actual resistance or
objection, consent may be assumed. It is not essential that the woman
should state in so many words that she does not object. The force used
may be moral and not physical--_e.g._, threats, fear, horror, syncope.
By 48 and 49 Vict., c. 49, the carnal knowledge of a girl under thirteen
is technically rape. The consent of the girl makes no difference, since
she is not of an age to become a consenting party.
An attempt at carnal knowledge of a girl under thirteen is a
misdemeanour. Her consent makes no difference, and even the solicitation
of the act on the part of the child will not exonerate the accused.
Intercourse with a girl between thirteen and sixteen, even with her
consent, is a misdemeanour.
This Act is a favourite with the blackmailer. The child is sent out to
solicit, dressed like a woman, but appears in the witness-box in a much
more juvenile costume.
To constitute rape there must be _penetration_, but this may be of the
slightest. There may be a sufficient degree of penetration to constitute
rape without rupturing the hymen. Proof of actual emission is now
unnecessary.
The subject of carnal knowledge (C.K.) or its attempt may be summed up
as follows:
Under thirteen C.K. Felony.
Under thirteen Attempt Misdemeanour.
Consent no defence.
From thirteen to sixteen C.K. Misdemeanour.
From thirteen to sixteen Attempt Misdemeanour.
Consent and even solicitation no defence.
Reasonable cause to believe the girl over sixteen is a good defence.
Charge must be brought within three months.
Over sixteen C.K. with consent Nil.
Subject to civil action for loss of girl's services by father.
Idiot or imbecile C.K. with violence Rape.
Idiot or imbecile C.K. without violence Misdemeanour.
Personation of husband Rape.
Tacit consent no defence, for obtained by fraud.
Married woman C.K. with consent Adultery.
Mother, sister, daughter, C.K. consent immaterial; Incest.
grand-daughter born in wedlock or not
Females Indecent assaults Misdemeanour.
It is a misdemeanour to give to a woman any drug so as to stupefy her,
and so enable any person to have unlawful connection with her.
False charges of rape are very often made. The motive may be to extort
blackmail, revenge, or mere delusion. On examining such cases bruises
are seldom found, but scratches which the woman has made on the front of
her body may be discovered, and the local injuries to the generative
organs are slight, if present at all.
_Physical Signs._--In the adult the hymen may be ruptured, the
fourchette lacerated, and blood found on the parts, together with
scratches and other marks and signs of a struggle. In the child there
may be no hæmorrhage, but there will be indications of bruising on the
external organs, with probably considerable laceration of the hymen, the
laceration in some cases extending into the rectum. Severe hæmorrhage,
and even death, may follow the rape of a young child. The patient will
have difficulty in walking, and in passing water and fæces. After some
hours the parts are very tender and swollen, and a sticky
greenish-yellow discharge is present. These signs last longer in
children than in adults; but as a rule--in the adult, at least--all
signs of rape disappear in three or four days. Young and delicate
children may suffer from a vaginal discharge, with swelling of the
external genitals, simulating an attempt at rape. Infantile leucorrhoea
is common, and many innocent people have been exposed to danger from
false charges of rape on children, instituted as a means of levying
blackmail. A knowledge of these facts suggests the necessity of giving a
guarded opinion when children are brought for examination in suspected
cases. Pregnancy may follow rape.
_Seminal stains_ render the clothing stiff and greyish-yellow in colour,
with translucent edges. On being moistened they give the characteristic
seminal odour.
Semen may be found on the linen of the woman and man, and will be
recognized under the microscope by the presence in it of spermatozoa,
minute filamentary bodies with a pear-shaped head; but it must not be
forgotten that the non-detection of spermatozoa is no proof of absence
of sexual intercourse, for these bodies are not always present in the
semen of even healthy adult young men. Spermatozoa must not be mistaken
for the _Trichomonas vaginæ_ found in the vaginæ of some women. The
latter have cilia surrounding the head, which is globular.
_Florence's Micro-Chemical Test for Spermatic Fluid._--If a drop of the
fluid obtained by wetting a supposed spermatic stain be mixed with a
drop of the following solution (KI, parts 1.65; pure iodine, 2.54;
distilled water, 30) in a watch-glass, brownish-red pointed crystals
resembling hæmin crystals are obtained.
_Barberio's Test._--Mix a drop of the spermatic stain with a drop of a
saturated solution of picric acid, when needle-shaped yellow rhombic
crystals are formed.
_Gonorrhoeal Stains._--A cover-glass preparation stained with methylene
blue reveals the gonococci lying in pairs within the leucocytes.
XXXVI.--UNNATURAL OFFENCES
Trials for =sodomy= and =bestiality= are common at the assizes, but, as
they are rarely reported, they fail to attract attention. Sodomy is a
crime both in the active and passive agent, unless the latter is a
non-consenting party. The evidence of either associated may be received
as against his colleague. If the crime is committed on a boy under
fourteen, it is a felony in the active agent only. As in cases of rape,
emission is not essential, and penetration, however slight, answers all
practical purposes.
There can be no doubt that in the majority of these cases there exists a
congenitally abnormal condition of the sexual instinct, these
individuals from their childhood manifesting a perverted sexual
instinct. The man is physically a man, but psychically a woman, and
_vice versâ_. The tendency nowadays is not to charge these people with
the more serious offence, but to deal with them under Section 11 of the
Criminal Law Amendment Act, 1885 (48 and 49 Vict., c. 69). This section,
which is sufficiently comprehensive, runs as follows: 'Any male person
who in public or private commits or is a party to the commission, or
attempts to procure the commission by any male person, of any act of
gross indecency with another male person, shall be guilty of a
misdemeanour.' The penalty is imprisonment for two years, with or
without hard labour. It is provided by Section 4 of the same Act that a
boy under sixteen may be whipped.
=Incest.=--This crime is dealt with under the Punishment of Incest Act,
1908 (8 Edward VII., c. 45). Carnal knowledge with mother, sister,
daughter, or grand-daughter, is a misdemeanour, provided the
relationship is known. It also applies to the half-brother and
half-sister. It is equally an offence whether the relationship can or
cannot be traced through lawful wedlock. Consent is no defence. A woman
may be charged under the Act if she, being above the age of sixteen,
with consent permits her grandfather, father, brother, or son, to have
carnal knowledge of her.
XXXVII.--BLACKMAILING
There are in London and every large city scores of men and women who
live by blackmailing or chantage. There are many different forms of this
industry. There is the man who knows something about your past life,
which he threatens to reveal to your friends or colleagues unless you
buy him off. There is the breach-of-promise blackmailer, and there is
the female patient, who threatens to charge you with improper conduct or
indecent assault. Medical men from their position are often selected as
victims. The introduction of corridor carriages on many of our railways
has done much to stamp out one particular form of blackmailing, but
public urinals are still a source of danger.
It is the worst possible policy to temporize with a blackmailer. If you
give him a single penny, you are his for life. It is as well to remember
that it is just as criminal to attempt to extract money from a guilty as
from an innocent person. It is of no use attempting to deal with these
cases single-handed. You must not only deny the allegation, but 'spurn
the allegator.' Put the matter into the hands of a good sharp criminal
solicitor, and instruct him to rid you of the nuisance by taking
criminal proceedings.
XXXVIII.--MARRIAGE AND DIVORCE
Marriage may be accomplished in many ways: (1) By the publication of
banns; (2) by an ordinary licence; (3) by a special licence; (4) by the
Superintendent-Registrar's licence; (5) by a special licence granted by
the Archbishop of Canterbury in consideration of the payment of the sum
of £25. Then, for persons having a domicile in Scotland, there is the
marriage by repute. The consent of the parties, which is the essence of
the contract, may be expressed before witnesses, and it is not requisite
that a clergyman should assist, but it is essential that the expressions
of consent must be for a matrimonial intent. 'Habit and repute'
constitute good evidence, but the repute must be the general, constant,
and unvarying belief of friends and neighbours. The cohabitation must be
in Scotland.
Any irregularity in the marriage ceremony or the non-observance of any
formality will not invalidate the marriage, unless it were known to both
the contracting parties. If a man were married in a wrong name the
contract would still be valid if the wife were unacquainted with the
deception at the time. If the person who officiated were a bogus
clergyman, the marriage would hold good if the contracting parties
supposed him to be a properly ordained priest. In a case in which a
marriage was solemnized in a building near the church at a time when the
church was undergoing repairs, and where during such alterations Divine
service had been performed, it was held that the ceremony was good. To
all intents and purposes marriage comes under the 'Law of Contract' (see
Anson, W.R., Bart.), and the law looks to the _intention_ rather than to
the actual details. All marriages between persons within the prohibited
degrees of consanguinity or affinity are null and void. This prohibition
extends both to the illegitimate as well as the legitimate children of
the late wife's or husband's parents. A marriage with a deceased wife's
sister is now legal in Great Britain and the Colonies, and is recognized
in most foreign countries. A common device with people within the
prohibited degrees is to get married abroad, but such marriage is
strictly speaking inoperative, and the children of such union are
illegitimate. Practically, however, it is a matter of no importance, for
when people live together and say they are married, they are accepted at
their own estimate.
A man can obtain a divorce from his wife if he can prove that she has
been guilty of adultery since her marriage. This may be established by
inference. Obviously, it is difficult in the majority of cases to
establish by ocular demonstration that adultery has been committed. But
given evidence of familiarity and affection with opportunity and
suspicious conduct, a jury will commonly infer it.
A woman cannot obtain a divorce from her husband for adultery alone. She
must prove adultery plus cruelty, or adultery plus desertion without
reasonable cause. Failing this, she may be able to prove either bigamy
or incestuous adultery. Legal cruelty is a very comprehensive term, and
does not of necessity mean physical violence. If the husband as the
result of his infidelity were to give his wife a contagious disease,
that would constitute cruelty. Taking a more extreme case, if a husband
were to have connection in her house with his wife's maid, that would
probably be held to constitute cruelty, as it would tend to lower her in
the eyes of her servants.
A wife can obtain a judicial separation if she can prove (1) adultery,
(2) cruelty, or (3) desertion without reasonable cause for two years. If
a husband is away on his business, as, for example, the case of an
officer ordered abroad, that is not desertion. For a woman to get a
judicial separation, it is sufficient if she can prove one variety of
matrimonial offence, but for a divorce she requires more than one.
The jury may find that Mrs. A. has committed adultery with Mr. B., but
that Mr. B. has not committed adultery with Mrs. A. The explanation is,
that a wife's confession is evidence against herself, but not against
another person. You can confess your own sins, but not another's.
The Divorce Law of Scotland differs materially from that of England. In
Scotland there is no decree nisi, no decree absolute, and no
intervention by the King's Proctor. Instead there is a single and final
judgment, and when a decree of divorce is pronounced the successful
litigant at once succeeds to all rights, legal and conventional, that
would have come to him or her on the death of the losing party. If the
husband is the offender, the wife in such circumstances may claim her
right to one-third of his real estate; and if there are children, to
one-third of his personal property, and to one-half if there are none.
=Voidable Marriages.=--If a man and woman go through the marriage
ceremony, such a contract is null and void under the following
circumstances: (1) Where bigamy has been committed; (2) if one of the
parties were insane at the time of marriage; (3) where the plaintiff is
under sixteen years of age; (4) when the marriage has not been
consummated or followed by cohabitation; (5) when one of the parties was
incapable of performing the marital act (impotent, and such not known by
the other at the time); (6) when drunkenness had been induced so as to
obtain consent; (7) concealment of pregnancy at the time of marriage.
XXXIX.--FEIGNED DISEASES
Malingering in its various forms is by no means uncommon, and by many is
regarded as a disease in itself. It is necessary, however, to
distinguish between those cases in which it is feigned for some definite
purpose--for example, to escape punishment or avoid public service--and
those in which there is adequate motive, and the patient shams simply
with the view of exciting sympathy, or from the mere delight of giving
trouble. It is not uncommon for individuals summoned on a jury, or to
give evidence in the law courts, to apply to their doctor for a
certificate, assigning as a cause of exemption neuralgia, or some
similar complaint unattended with objective symptoms. In such cases it
is well to remind the patient that in most courts such certificates are
received with suspicion, and are often rejected, and that the personal
attendance of the medical man is required to endorse his certificate on
oath.
Malingering has become much more common since the National Health
Insurance Act has been passed. The possibility of obtaining a fair sum
each week without the necessity of working for it induces many persons
either to feign disease or to make recovery from actual disease or
accident much more tedious than it ought really to be.
The feasibility of successfully malingering is greatly enhanced by the
possession of some chronic organic disease. An old mitral regurgitant
murmur is useful for this purpose.
It is not flattering to one's vanity to overlook a case of malingering,
but should this occur little harm is done. It is a much more serious
matter to accuse a person of malingering when in reality he may be
suffering from an organic disease.
Here are some of the diseases which are most frequently feigned:
=Nervous Diseases=, as headache, vertigo, paralysis of limbs, vomiting,
sciatica, or incontinence or suppression of urine, spitting of blood;
others, again, simulate hysteria, epilepsy, or insanity.
On the other hand, the malingerer may actually produce injuries on his
person either to excite commiseration or to escape from work. Thus, the
beggar produces ulcers on his legs by binding a penny-piece tightly on
for some days; the hospital patient, in order to escape discharge,
produces factitious skin diseases by the application of irritants or
caustics.
It is much more difficult to decide whether certain symptoms are due to
a real disease which is present, or whether they are merely
exaggerations of slight symptoms or simulations of past ones. The miner,
after an injury to his back, recovers very slowly, if at all. He is
suffering from 'traumatic neurasthenia'--a condition only too often
simulated, and a disease very difficult to diagnose accurately. The
miner takes advantage of our ignorance, and continues to draw his
compensation. A workman during his work receives a fracture; instead of
being able to resume work in six weeks, he asserts that the pain and
stiffness prevent him, and this disability may persist for months. Such
cases as these frequently come before the courts when the employer has
discontinued to pay the weekly compensation for the injury. Medical men
are called to give evidence for or against the injured workman.
=Epilepsy= is often simulated. The foaming at the mouth is produced by a
piece of soap between the gums and the cheek. The true epileptic,
especially if he suspects that a fit is imminent, takes his walks abroad
in some secluded spot, whilst the impostor selects a crowded locality
for his exertions. The epileptic often injures himself in falling, his
imitator never; one bites his tongue, but the other carefully refrains
from doing so. The skin of an epileptic during an attack is cold and
pallid, but that of the exhibitor is covered with sweat as the result of
his exertions. In epilepsy the urine and fæces are passed involuntarily,
but his colleague rarely considers it necessary to carry his deception
to this extent. In true epilepsy the eyes are partly open, with the
eyeballs rolling and distorted, whilst the pupils are dilated and do not
contract to light; the impostor keeps his eyes closed, and he cannot
prevent the iris from contracting when a bicycle-lamp is flashed across
his face. A useful test is to give the impostor a pinch of snuff, which
promptly brings the entertainment to an end.
=Lumbago= is often feigned, and the imposture should be suspected when
there is a motive, and when physical signs, such as nodes and tender
spots, are absent. A simple test is to inadvertently drop a shilling in
front of him, when he will promptly stoop and pick it up. The same
principles apply to spurious sciatica.
=Hæmorrhages= purporting to come from the lungs, stomach, or bowels,
rarely present much difficulty. The microscope is of use in all cases of
bleeding. Possibly the gums or the inside of the cheeks may have been
scratched or abraded with a pin.
=Skin Diseases= are excited artificially, especially those which may be
produced by mechanical and chemical irritants. The most commonly
employed are vinegar, acetic acid, carbolic acid, nitric acid, and
carbonate of sodium; but tramps frequently use sorrel and various
species of ranunculus. The lesions simulated are usually inflammatory in
character, such as erythema, vesicular and bullous eruptions, and
ulceration of the skin. They may be complicated by the presence of
pediculi and other animal and vegetable parasites. Chromidrosis of the
lower eyelids in young women often owes its origin to a box of paints.
Factitious skin diseases are seen most commonly on the face and
extremities, especially on the left side--in other words, on the most
accessible parts of the body.
Feigned menstruation, pregnancy, abortion, and recent delivery are
common, and should give rise to no difficulty. The same may be said of
feigned insanity, aphonia, deaf-mutism, and loss of memory.
The following hints may be useful to a medical man when called to a
supposed case of malingering: Do not be satisfied with one visit, but go
again and unexpectedly; see that the patient is watched between the
visits; make an objective examination, compare the indications with the
statements of the patient, noting especially any discrepancies between
his account of his symptoms and the real symptoms of disease; ask
questions the reverse of the patient's statements, or take them for
granted, and he will often be found to contradict himself; have all
dressings and bandages removed; suggest, in the hearing of the patient,
some heroic methods of treatment--the actual cautery, or severe surgical
operation, for example; finally, chloroform will be found of great use
in the detection of many sham diseases.
XL.--MENTAL UNSOUNDNESS
The presumption in law is in favour of a person's sanity, even though he
may be deaf, dumb, or blind.
The terms 'insanity,' 'lunacy,' 'unsoundness of mind,' 'mental
derangement,' 'madness,' and 'mental alienation or aberration,' are
indifferently applied to those states of disordered mind in which the
person loses the power of regulating his actions and conduct according
to the ordinary rules of society. The reasoning power is lost or
perverted, and he is no longer fitted to discharge those duties which
his social position demands. In some cases of insanity, as in confirmed
idiocy, there is no evidence of the exercise of the intellectual
faculties. It is probable that no standard of sanity as fixed by nature
can be said to exist. The medical witness should decline to commit
himself to any definition of insanity. There is no practical advantage
in attempting to classify the different forms of insanity.
According to English law, madness absolves from all guilt, but in order
to excuse from punishment on this ground it must be proved that the
individual was not capable of distinguishing right from wrong in
relation to the particular act of which he is accused, and that he did
not know at the time of committing the crime that the offence was
against the laws of _God_ and _nature_.
Lunatics are competent witnesses in relation to testimony, as in
relation to crime, if they understand the nature of an oath and the
character of the proceedings in which they are engaged. The judge, as in
the case of children, examines the lunatic tendered as a witness as to
his knowledge of the nature and obligation of an oath, and, if
satisfied, he allows him to be sworn.
A person, if suffering from such a state of mental unsoundness as to be
unable to take care of his property, may be placed under the care of the
Court of Chancery. The Court then administers his property, and
otherwise allows him entire freedom of action.
With regard to the care of lunatics, no person is allowed to receive
more than one lunatic into his house unless such house is licensed and
the proper certificates have been signed. One patient may be taken
without the house being licensed, but the usual certificates must in all
cases be signed, and the Lunacy Commissioners communicated with. If a
person receives another not of unsound mind into his house, and such
person becomes subsequently insane, the person so keeping him renders
himself liable to heavy penalties, unless the legal certificates are at
once procured and the Commissioners of Lunacy communicated with.
At common law it appears that a lunatic cannot be placed in an asylum
unless dangerous to himself or to others, but under the Lunacy Acts the
placing of a madman in an asylum is considered as a part of the
treatment with a view to the cure of the patient.
XLI.--IDIOCY, IMBECILITY, CRETINISM
=Idiocy= is not a disease, but a congenital condition in which the
intellectual faculties are either never manifested or have not been
sufficiently developed to enable the idiot to acquire an amount of
knowledge equal to that acquired by other persons of his own age and in
similar circumstances with himself. Idiots, as a rule, are deformed in
body as well as deficient in mind. Their heads are generally small and
badly-shaped, and their features ill-formed and distorted. The teeth are
few in number and very irregular. The hard palate has a very deep arch,
or may even be cleft. The complexion is sallow and unhealthy, the limbs
imperfectly developed, and the gait is awkward, shambling, and unsteady.
In his legal relations an absolute idiot is civilly disabled and
irresponsible, but in regard to crime, or as a witness, see remarks made
above.
=Imbecility= is a form of mental defect not usually congenital, but
commencing in infancy or in early life. The line of demarcation between
the imbecile and the idiot may be found in the possession by the former
of the faculty of speech, in distinction from the mere parrot-like
utterance of a few words which can be taught the idiot. Imbecility may
be intellectual, moral, or general. Questions frequently arise as to
their responsibility for actions done by them, or as to their ability to
manage their own affairs.
=Cretinism= is a form of amentia, which is endemic in certain districts,
especially in some of the valleys of Switzerland, Savoy, and France. The
malady is not congenital, but its symptoms usually appear within a few
months of birth. The characteristics of this form of idiocy are an
enlarged thyroid gland constituting a goitre or bronchocele, a
high-arched palate, dwarfed stature, squinting eyes, sallow complexion,
small legs, conical head, large mouth, and indistinct speech.
=Feeble-Minded.=--These are persons who are capable of earning a living
under favourable circumstances, but are incapable, from mental defect
which has existed from birth or from an early age, of (a) competing on
equal terms with their normal fellows, or (b) of managing themselves
and their affairs with ordinary prudence. Feeble-mindedness may affect
the moral nature only, rendering the person selfish, untruthful,
obscene, or unemployable. The Act of 1899 controls feeble-minded
children; many such become paupers, criminals, prostitutes, etc.
=Mental Deficiency and Lunacy Act, 1913.=--Those included under this Act
are idiots, imbeciles, feeble-minded persons, and moral imbeciles. The
parents or guardians of such children between the ages of five and
sixteen years must provide for them education and proper care. If they
are unable to do so, the School Boards or Parish Councils must do so.
XLII.--DEMENTIA: ACUTE, CHRONIC, SENILE, AND PARALYTIC
In dementia the mental aberration does not occur until the mind has
become fully developed, thus differing from amentia, which is congenital
or comes on very early in life.
=Acute Dementia.=--This is a condition of profound melancholy or stupor,
which arises from sudden mental shock, the mind being, as it were,
arrested and fixed in abstraction on the event.
=Chronic Dementia= is generally caused by the gradual action on the mind
of grief or anxiety, by severe pain, mania, apoplexy, paralysis, or
repeated attacks of epilepsy.
=Senile Dementia= is a form which is incidental to aged persons, and
commences gradually with such symptoms as loss of memory for recent
events, dulness of perception, and inability to fix the attention. Later
on the reasoning powers begin to fail, and finally, memory, reason, and
power of attention, are quite lost, the muscular power and force
remaining intact. In the last stage there is simply bare physical
existence.
=General Paralysis of the Insane, Paralytic Dementia.=--This is a most
interesting form of dementia. It is closely allied to, if not identical
with, locomotor ataxy. Its most prominent and characteristic symptom
consists in delusions of great power, exalted position, and unlimited
wealth--megalomania. The exaltation is universal, and the patient may
maintain at one and the same time that he is running a theatrical
company, that he is the Prince of Wales, and that he is the Almighty.
Moral perversion is a common symptom, and the patient is often guilty of
criminal assaults, indecent exposures, bigamous marriages, and the like.
It is accompanied with progressive bodily and mental decay. Women are
comparatively rarely affected by it, and it generally commences in men
about middle age, and its duration is from a few months to three years.
It is commonly parasyphilitic in origin. Paralytic symptoms first appear
in the tongue, lips, and face; the speech becomes thick and hesitating.
The paralytic symptoms gradually go on increasing, the sphincters refuse
to act, and death may occur from suffocation and choking. Sometimes,
during the earlier stages especially, there may be maniacal paroxysms or
epileptic fits. The delusions remain the same throughout, the patient
always expresses himself as being happy, and his last words will
probably have reference to money and other absurd delusions.
When a person of hitherto blameless life is charged with an act of
indecency, he should be examined for G.P.I. The condition of his
prostate should also be investigated. He may be suffering from either
mental or physical disease, or both (see p. 59).
XLIII.--MANIA
Under the term 'mania' are included all those forms of mental
unsoundness in which there is undue excitement. It is divided into
general, intellectual, and moral, and each of the two latter classes
again into general and partial.
=General Mania= affects the intellect as well as the passions and
emotions. Mania is usually preceded by an incubative period in which the
patient's general health is affected. The duration of this period may
vary from a few days to fifteen or twenty years. When the disease is
established, the patient has paroxysms of violence directed against
himself as well as others. He tears his clothes to pieces, either
abstains from food and drink or eats voraciously, and sustains immense
muscular exertion without apparent fatigue. The face becomes flushed,
the eye wild and sparkling; there is pain, weight, and giddiness in the
head, with restlessness.
=General Intellectual Mania=, attacking the intellect alone, is rare;
but some one emotion or passion, as pride, vanity, or love of gain, may
obtain ascendancy, and fill the mind with intellectual delusions.
A _delusion_ may be defined as a perversion of the judgment, a
chimerical thought; an _illusion_, an incorrect impression of the
senses, counterfeit appearances; hence we speak of a delusion of the
mind, an illusion of the senses. Lawyers lay great stress on the
presence of delusions as indicative of insanity. An _hallucination_ is a
sensation which is supposed by the patient to be produced by external
impressions, although no material object acts upon his senses at the
time.
=Partial Intellectual Mania=, or =Monomania=, also called =Melancholia=,
is a form of the disease in which the patient becomes possessed of some
single notion, contradictory alike to common-sense and his own
experience.
=General Moral Mania.=--This is a morbid perversion of the natural
feelings, affections, inclinations, temper, habits, moral dispositions,
and natural impulses, without any remarkable disorder or defect of the
intellect, or knowing and reasoning faculties, and particularly without
any insane illusion or hallucination. It is often difficult to
distinguish this form of mania from the moral depravity which we
associate with the criminal classes.
=Partial Moral Mania--Paranoia--Delusional Insanity.=--In this form one
or two only of the moral powers are perverted. Delusions are always
present, and very frequently are those of persecution. The patient's
conduct is dominated by his delusion; thus murder and suicide may be
committed. There are several forms:
_Kleptomania_, a propensity to theft; common in women in easy
circumstances. _Dipsomania_, or _Oinomania_, an insatiable desire for
drink. _Morphinomania_, a craving for morphine or its preparations.
_Erotomania_, or amorous madness. When occurring in women this is also
called _Nymphomania_, and in men _Satyriasis_. It consists in an
uncontrollable desire for sexual intercourse. _Pyromania_, an insane
impulse to set fire to everything. _Homicidal mania_, a propensity to
murder. _Suicidal mania_, a propensity to self-destruction. Some
consider suicide as always a manifestation of insanity.
=Insanity of Pregnancy.=--This may show itself after the third month of
pregnancy in the form of melancholia. It is not recovered from until
after delivery.
=Puerperal Mania.=--This form of mania attacks women soon after
childbirth. There is in many cases a strong homicidal tendency against
the child.
=Insanity of Lactation= comes on four to eight months after parturition,
either as mania or melancholia. The mother may repeatedly attempt
suicide.
=Mania with Lucid Intervals.=--In many cases mania is intermittent or
recurrent in its nature, the patient in the interval being in his right
mind. The question of the presence or absence of a lucid interval
frequently occurs where attempts are made to set aside wills made by
persons having property. In these cases the law, from the reasonableness
of the provisions of the will, may assume the existence of the lucid
interval. A will made during a lucid interval is valid. When an attempt
is made to set aside the provisions of a will on the ground of insanity
in a person not previously judged insane, the plaintiff must show that
the testator was mad; when the provisions of the will of a lunatic are
attempted to be upheld, the plaintiff must show that the will was made
during a lucid interval.
A testator is capable of making a valid will when he has (1) a knowledge
of his property and of his kindred; (2) memory sufficient to recognize
his proper relations to those about him; (3) freedom from delusions
affecting his property and his friends; and (4) sufficient physical and
mental power to resist undue influence. The fact of a man being subject
to delusions may not affect his testamentary capacity. He may believe
himself to be a tea-kettle, and yet be sufficiently sound mentally to
make a valid will.
=Undue Influence.=--Persons of weak mind or those suffering from senile
dementia are often said to have been unduly influenced in making their
wills, and subsequently their dispositions are disputed in court. Before
witnessing the will made by such a person, the medical man should
satisfy himself that the testator is of a 'sound disposing mind.' This
he will do by questioning, and his knowledge of the home-life of the
patient will either confirm or set aside the idea of influence.
A person who is aphasic may be competent to make a will. He may not be
able to speak, but may understand what is said to him, and may be able
to indicate his wishes by nods and shakes of the head. Ask him if he
wishes to make a will, then inquire if he has £10,000 to leave, then if
he has £100, and in this way arrive approximately at the sum. Then ask
him if he wishes to leave it all to one person. If he nods assent, ask
if it be to his wife or some other likely person. If he wishes to divide
it, ascertain his intention by definite questions, and, having
ascertained his views, commit them to writing, read the document over to
him, and ask if it expresses his intentions. That being settled, a mark
which he acknowledges in the presence of two witnesses, preferably men
of standing, will constitute a valid document.
In certain forms of neurasthenia, the 'phobias' are common, but must not
be regarded as evidence of insanity. 'Agoraphobia' is the fear of
crossing an open space, 'batophobia' is the fear that high things will
fall, 'siderophobia' is the fear of thunder and lightning, 'pathophobia'
is the fear of disease, whilst 'pantophobia' is the fear of everything
and everybody.
=Epilepsy in Relation to Insanity.=--The subjects of this disease are
often subject to sudden fits of uncontrollable passion; their conduct is
sometimes brutal, ferocious, and often very immoral. As the fits
increase in number, the intellect deteriorates and chronic dementia or
delusional insanity may supervene. (1) Before a fit the patient may
develop paroxysms of rage with brutal impulses (_preparoxysmal
insanity_), and may commit crimes such as rape or murder. (2) Instead of
the usual epileptic fit, the patient may have a violent maniacal attack
(_masked epilepsy_, _epileptic equivalent_, _psychic form of epilepsy_).
(3) After the fit the patient may perform various automatic actions
(_post-epileptic automatism_) of which he has no subsequent
recollection. Thus the patient may urinate or undress in a public place,
and may be arrested for indecent exposure. Epileptics who suffer from
both petit and grand mal attacks are specially liable to maniacal
attacks. Such insanity differs from ordinary insanity in its sudden
onset, intensity of symptoms, short duration and abrupt ending. To
establish a plea of epilepsy in cases of crime, one must show that the
individual really did suffer from true epilepsy, and that the crime was
committed at a period having a definite relation to the epileptic
seizure.
=Alcoholic Insanity.=--This may occur in three forms:
1. _Acute Alcoholic Delirium_ (_mania a potu_), due to excessive amount
of alcohol consumed.
2. _Delirium Tremens_, due to long-continued over-drinking. The patient
suffers from horrible dreams, illusions, and suspicions, which may lead
him to attack people or commit suicide.
3. _Chronic Alcoholic Insanity._ Loss of memory is the chief symptom,
with paralysis of motion, hallucinations and delusions of persecution.
=Responsibility for Criminal Acts.=--To establish a defence on the
ground of insanity, it must be proved that the prisoner at the time when
the crime was committed did not know the nature and quality of the act
he was committing, and did not know that it was wrong. At the present
time, however, the _power of controlling his actions_ is usually made
the test.
The plea of insanity is brought forward, as a rule, only in capital
charges, so that the prisoner, if found guilty, will escape hanging. If
proved 'guilty, but insane,' the person is sentenced to be kept in a
criminal lunatic asylum 'during His Majesty's pleasure.'
XLIV.--EXAMINATION OF PERSONS OF UNSOUND MIND
The following hints with regard to the examination of patients supposed
to be insane will be useful: The general appearance and shape of head,
complexion, and expression of countenance, gait, movements, and speech,
should be noted; the state of the general health, appetite, bowels,
tongue, skin, and pulse, should be inquired into; and in women the state
of the menstrual function should be ascertained. The family history must
be traced out, and the personal history taken with care, especially as
to whether the unsoundness came on late in life or followed any physical
cause. Ascertain whether it is a first attack, whether the patient has
suffered from epilepsy, has squandered his money, grown restless, has
absurd delusions, etc. In order to ascertain the capacity of the mind,
questions should be asked with regard to age, birthplace, profession,
number of family, and common events, such as the day of week, month, and
year. The power of performing simple arithmetical operations may be
tested. It may be necessary to pay more than one visit. The examiner
should be careful to ask questions adapted to the station of life of the
supposed lunatic; a man is not necessarily mad because he cannot perform
simple arithmetical operations, or does not know about things with which
his questioner is well acquainted. The opinion of a supposed lunatic
that his examiner's feet _were large_ was not considered by the
Commissioners among the facts indicating insanity, yet statements quite
as absurd are made by medical men as 'facts of insanity' observed by
themselves. 'Reads his Bible and is anxious about the salvation of his
soul' is another example of a bad certificate. Some well-marked delusion
should be recorded.
For a lunacy certificate (_Reception Order on Petition_ or _Judicial
Reception Order_), except in the case of a pauper patient, there are
required the signatures of two independent medical men and of a relation
or friend. The medical men must not be in partnership or in any way
interested in the patient; they must make separate visits at different
times, and write on the proper forms the facts observed by themselves
and those observed by others, giving the name of the informer. A
certificate is valid only for seven days. In very urgent non-pauper
cases the signature of one medical man is sufficient, but such
certificate (_Emergency Certificate_ or _Urgency Order_) is only valid
for two days, and, as the patient can only be detained in the asylum
under this order for seven days in England or three in Scotland, it must
be supplemented by another signed as above directed. The medical
certificate must contain a statement that it is expedient for the
alleged lunatic to be placed forthwith under care, with reasons for
making such statement. The certifying medical practitioner must have
personally examined the patient not more than two clear days before his
reception. In London and other large towns, where an expert opinion is
readily obtainable, it is not expedient to resort to such urgency
orders. Medical men should be careful how they sign certificates of
insanity. No medical man is bound to certify, but if he does so he must
be prepared to take the responsibility of his acts. There must be no
reasonable ground for alleging want of 'good faith' or 'reasonable
care.' The practitioner must exercise that amount of care and skill
which he may reasonably be expected to possess.
XLV.--THE INEBRIATES ACTS
It is somewhat difficult to define an inebriate, but for the moment the
following will suffice, and will ultimately, in all probability, be
officially adopted:
An inebriate is a person who habitually takes or uses any intoxicating
thing or things, and while under the influence of such thing or things,
or in consequence of the effects thereof, is--(a) dangerous to himself
or others; or (b) a cause of harm or serious annoyance to his family or
others; or (c) incapable of managing himself or his affairs, or of
ordinary proper conduct.
Under the provisions of the Habitual Drunkards Acts (42 and 43 Vict., c.
19, and 51 and 52 Vict., c. 19), any habitual drunkard may voluntarily
place himself under restraint. He must make an application to the owner
of a licensed retreat, stating the time during which he undertakes to
remain. His application must be accompanied by a statutory declaration
of two persons stating that they knew the applicant to be a confirmed
drunkard. Without this testimony as to moral character his application
cannot be entertained. His signature must also be attested by two
justices, who must state that he understands the effect of his
application, and that it has been explained to him. The limit to the
term of restraint is twelve months, after which he must resume his
former habits if he wishes to qualify for another period. The Act works
automatically, and, when it has been set for a certain time, the patient
cannot release himself until the period has expired. The Inebriates'
Retreat must be duly licensed, and the licensee incurs distinct
obligation in return for the powers entrusted to him. It is an offence
against the Act to assist any habitual drunkard to escape from his
retreat, and should he succeed in effecting his escape he may be
arrested on a warrant. A drunkard who does not obey orders and conform
to the rules of the establishment may be sent to prison for seven days.
It may be as well to mention that it is an offence to supply any
drunkard under the Act with any intoxicating drink or sedative or
stimulant drug without authority, and that the penalty is a fine of £20
or three months' imprisonment. The Act is a good one, but might be
carried farther with advantage. It has been ruled that a crime committed
during drunkenness is as much a crime as if committed during sobriety. A
person is supposed to know the effect of drink, and if he takes away his
senses by drink it is no excuse. He is held answerable both for being
under the influence of alcohol or of any other drug, and for the acts
such influence induces.
=Inebriates Act= (1898-1900).--If an habitual drunkard be sentenced to
imprisonment or penal servitude for an offence committed during
drunkenness, or if he has been convicted four times in one year, the
court may order him to be detained for a term not exceeding three years
in an inebriate reformatory.
PART II
TOXICOLOGY
I.--DEFINITION OF A POISON
Though the law does not define in definite terms what a poison really
is, it lays stress on the _malicious intention_ in giving a drug or
other substance to an individual. It is a _felony_ to administer, or
cause to be administered, any poison or other destructive thing with
intent to murder, or with the intention of stupefying or overpowering an
individual so that any indictable offence may be committed. It is a
_misdemeanour_ to administer any poison, or destructive or noxious
thing, merely to aggrieve, injure, or annoy an individual. For a working
_definition_ we may state that a poison is a substance which, when
introduced into or applied to the body, is capable of injuring health or
destroying life. A poison may therefore be swallowed, applied to the
skin, injected into the tissues, or introduced into any orifice of the
body.
II.--SALE OF POISONS; SCHEDULED POISONS
The sale of poisons is regulated by various Acts, but chiefly by the
Pharmacy Act, 1868, and by the Poisons and Pharmacy Act, 1908. Only
registered medical practitioners and legally qualified druggists are
permitted to dispense and sell scheduled poisons. They are responsible
for any errors which may be committed in the sale of poisons. If a
druggist knows that a drug in a prescription is to be used for an
improper purpose, he may refuse to dispense it. The practitioner who
carelessly prescribes a drug in a poisonous dose is not held
responsible, but the dispenser would be if he dispensed it and harmful
or fatal consequences followed on its being swallowed. When a dispenser
finds an error in a prescription, it is his duty to communicate with the
prescriber privately pointing out the mistake.
A great responsibility rests on the medical man who does his own
dispensing, as there is no one to check his work.
If a doctor prescribes a drug with the intention of curing or preventing
a disease, but that, contrary to expectation and general experience, it
causes illness or even death, no responsibility can rest with the
prescriber. It has to be proved that actual injury has been sustained by
the complainant before an action for damages can be commenced, and that
the plaintiff was free from all contributory negligence.
=Scheduled Poisons.=--By the Pharmacy Act of 1868 two groups of poisons
are scheduled. Part I. contains a list of those which are considered
very active poisons--_e.g._, arsenic, alkaloids, belladonna,
cantharides, coca (if containing more than 1 per cent. alkaloids),
corrosive sublimate, diachylon, cyanides, tartar emetic, ergot, nux
vomica, laudanum, opium, savin, picrotoxin, veronal and all poisonous
urethanes, prussic acid, vermin killers, etc. Such poisons must not be
sold to strangers, but only to persons known to or introduced by someone
known to the druggist. If sold, the latter must enter into the 'Poison
Register' the name of the poison, the name of the person to whom it is
sold, the quantity and purpose for which it is to be used, and date of
sale. The entry must be signed by the purchaser and by the introducer.
The word 'Poison' must be affixed to the bottle or package, and also
the name and address of the seller.
Part II. contains a list of poisons supposed to be less active. These
may only be sold if on the bottle, box, or package there is affixed a
label with the name of the article, the word 'Poison,' and the name and
address of the seller. It is not necessary to enter the transaction in a
register.
Chemists are required to keep poisons in specially distinguishable
bottles, and these in a special room or locked cupboard.
=Dangerous Drugs Act, 1920.=--The regulations restrict the manufacture
and sale of opium, morphine, cocaine, and heroin so as to prevent their
abuse. Preparations containing less than 1/5 per cent. of the first two
or less than 1/10 per cent. of the last two are excluded. Prescriptions
containing the above drugs must be dated and signed with the full name
and address of the prescriber, and must have also those of the patient.
The total amount of the drug to be supplied must be stated, and it must
not be dispensed more than once; the dispenser retains the prescription.
Special books must be kept recording the purchase and sale of these
drugs.
=Proprietary Medicines Bill= (introduced in 1920, and likely soon to
become law).--The sale of any unregistered proprietary medicine
purporting to cure certain diseases or produce abortion is made an
offence. A register of proprietary medicines, etc., is established. The
object is to protect the public against quack remedies.
=Notification of Poisoning.=--Every case of poisoning which occurs in
any industry (lead, arsenic, anthrax, etc.) must be notified by the
medical attendant to the Chief Inspector of Factories (Factory and
Workshops Act, 1895).
III.--ACTION OF POISONS; CLASSIFICATION OF POISONS
=Action of Poisons.=--They may act either locally or only after
absorption into the system.
1. _Local Action_, as seen in (a) corrosive poisons; (b) irritant
poisons, causing congestion and inflammation of the mucous
membranes--_e.g._, metallic and vegetable irritants; (c) stimulants or
sedatives to the nerve endings, as aconite, conium, cocaine.
2. _Remote Action._--This may be of reflex character, as seen in the
shock produced by the pain caused by corrosive poisons, or the poison
may exert a special action on certain structures, as belladonna on the
cells of the brain, strychnine on the motor nerve cells of the spinal
cord.
3. _In Both Ways._--Certain poisons, as carbolic or oxalic acids, act in
this way.
Age, idiosyncrasy, tolerance, and disease, all exert modifying
influences on the action of a poison. The form in which the poison is
swallowed and the quantity also determine its action. In the gaseous
form, poisons act most rapidly and fatally. When in solution and
injected hypodermically, they also act very rapidly. In the solid form
they act as a rule slowly, and may even set up vomiting, and so may be
entirely ejected by vomiting. Poisons act most energetically when the
stomach is empty. If taken when the stomach already contains food,
solution and absorption may be greatly delayed.
Some poisons are cumulative in their action, and thus, even if
infinitesimal doses be swallowed each day, there is a certain amount of
storage in the tissues (though a certain percentage of the poison is
being constantly eliminated), and at last symptoms of poisoning show
themselves.
=Classification of Poisons.=--As an aid to memory, the following
classification is perhaps the best:
I. _Inorganic._
1. Corrosive acids and alkalies, and caustic salts (carbolic and
oxalic acids also).
2. Irritant--practically all the metals and the metalloids (I. Cl.
Br. P.).
II. _Organic._
{ Animal--venomous bites, food poisoning, cantharides.
1. Irritant { Vegetable--all strong purgatives, hellebores, savin,
{ yew, ergot, hemlock, laburnum, bryony, etc.
2. Neuronic.
(a) Somniferous--opium and its alkaloids.
(b) Deliriant--belladonna, hyoscyamus, stramonium, cannabis,
cocaine, cocculus, camphor, fungi.
(c) Inebriants--alcohol, ether, chloral, carbolic acid (weak),
benzol, aniline, nitro-glycerine.
3. Sedative or depressant.
(a) Neural--conium, lobelia, tobacco, physostigma.
(b) Cerebral--hydrocyanic acid.
(c) Cardiac--aconite, digitalis, colchicum, veratrum.
4. Excito-motory or convulsives--nux vomica, strychnine.
5. Vulnerants--powdered glass.
III. _Asphyxiants._
Poisonous and irrespirable gases.
IV.--EVIDENCE OF POISONING
It may be inferred that poison has been taken from consideration of the
following factors: Symptoms and post-mortem appearances, experiments on
animals, chemical analysis, and the conduct of suspected persons.
1. _Symptoms_ in poisoning usually come on suddenly, when the patient is
in good health, and soon after taking a meal, drink, or medicine. Many
diseases, however, come on suddenly, and in cases of slow poisoning the
invasion of the symptoms may be gradual.
2. _Post-Mortem Appearances._--These in many poisons and classes of
poisons are characteristic and unmistakable. The post-mortem appearances
peculiar to the various poisons will be described in due course.
3. _Experiments on Animals._--These may be of value, but are not always
conclusive.
4. _Chemical Analysis._--This is one of the most important forms of
evidence, as a demonstration of the actual presence of a poison in the
body carries immense weight. The poison may be discovered in the living
person by testing the urine, the blood abstracted by bleeding, or the
serum of a blister. In the dead body it may be found in the blood,
muscles, viscera--especially the liver--and secretions. Its discovery in
these cases must be taken as conclusive evidence of administration. If,
however, it be found only in substances rejected or voided from the
body, the evidence is not so conclusive, as it may be contended that the
poison was introduced into or formed in the material examined after its
rejection from the body, or if the quantity be very minute it will be
argued that it is not sufficient to cause death. A poison may not be
detected in the body, owing to defective methods, smallness of the dose
required to cause death, or to its ejection by vomiting or its
elimination by the excretions.
5. _Conduct of Suspected Persons._--A prisoner may be proved to have
purchased poison, to have made a study of the properties and effects of
poison, to have concocted medicines or prepared food for the deceased,
to have made himself the sole attendant of the deceased, to have placed
obstacles in the way of obtaining proper medical assistance, or to have
removed substances which might have been examined.
V.--SYMPTOMS AND POST-MORTEM APPEARANCES OF DIFFERENT CLASSES OF POISONS
Whilst recognizing the fact that toxic agents cannot be accurately
classified, the following grouping may for descriptive purposes be
admitted with the view of saving needless repetition:
1. =Corrosives.=--Characterized by their destructive action on tissues
with which they come in contact. The principal inorganic corrosives are
the mineral acids, the caustic alkalies, and their carbonates; the
organic are carbolic acid, strong solutions of oxalic acid, and acetic
acid.
_Symptoms._--Burning pain in mouth, throat, and gullet, strong acid,
metallic or alkaline taste; retching and vomiting, the discharged
matters containing shreds of mucus, blood, and the lining membrane of
the passages. Inside of mouth corroded. There are also dysphagia,
thirst, dyspnoea, small and frequent pulse, anxious expression, shock.
Death may result from shock, destruction of the parts--_e.g._,
perforation of stomach or duodenum, suffocation; or some weeks
subsequently death may be due to cicatricial contraction of the gullet,
stomach, or pylorus.
_Post-Mortem Appearances._--Those of corrosion, with corrugation from
strong contraction of muscular fibres, and followed by inflammation and
its consequences. The mouth, gullet, and stomach, and in some cases the
intestines, may be white, yellow, or brown, shrivelled and corroded. The
corrosions may be small, or may extend over a very large surface.
Sometimes considerable portions of the lining membrane of the gullet or
stomach may be discharged by vomiting or by stool. Beyond the corroded
parts the textures are acutely inflamed. The stomach is filled with a
yellow, brown, or black gelatinous liquid or black blood, and may in
rare cases be perforated.
2. =Irritants.=--These are substances which inflame parts to which they
are applied. The class includes mineral, animal, and vegetable
substances, and contains a larger number of poisons than all the other
classes together. Irritants may be divided into two groups: (1) Those
which destroy life by the irritation they set up in the parts to which
they are applied; (2) those which add to local irritation peculiar or
specific remote effects. The first group includes the principal
vegetable irritants, some alkaline salts, some metallic poisons, etc.;
and the second comprises the metallic irritants, the metalloids
(phosphorus and iodine), and one animal substance, cantharides.
_Symptoms._--Burning pain and constriction in throat and gullet, pain
and tenderness of stomach and bowels, intense thirst, nausea, vomiting,
purging and tenesmus, with bloody stools, dysuria, cold skin, and feeble
and irregular pulse. The vomit consists at first of the food, then it
becomes bile-stained, and later dark coffee-grounds in appearance, due
to extravasation of blood from the over-distended vessels in the gastric
mucous membrane. Death may occur from shock, convulsions, collapse,
exhaustion, or from starvation on account of chronic inflammation of the
gastro-intestinal mucous membrane.
_Post-Mortem Appearances._--Those of inflammation and its consequences.
Coats of stomach, fauces, gullet, and duodenum, may be thickened,
black, ulcerated, gangrenous, or sloughing. Vessels filled with dark
blood ramify over the surface. Acute inflammation is often found in the
small intestines, with ulceration and softening of mucous membrane. The
rectum is frequently the seat of marked ulceration.
3. =Poisons Acting on the Brain.=--Three classes: The opium group,
producing sleep; the belladonna group, producing delirium and illusions;
and the alcohol group, causing exhilaration, followed by delirium or
sleep.
_Symptoms._--Of the opium group, giddiness, headache, dimness of sight,
contraction of the pupils, noises in the ears, drowsiness and confusion,
passing into insensibility. Of the belladonna group, delirium, illusions
of sight, dilated pupils, dry mouth, thirst, redness of skin, coma. Of
the alcohol group, excitement of circulation and of cerebral functions,
want of power of co-ordination and of muscular movement, double vision,
mania, followed by profound sleep and coma. In the chronic form,
delirium tremens.
_Post-Mortem Appearances._--In the opium group, fulness of the sinuses
and veins of the brain, with effusion of serum into the ventricles and
beneath the membranes. In the belladonna group, nil. In the alcohol
group, signs of inflammation, congestion of brain and membranes,
fluidity of blood, long-continued rigor mortis.
4. =Poisons Acting on the Spinal Cord.=--Strychnine, brucine, thebaïne.
The leading symptom is tetanic spasm.
5. =Poisons Affecting the Heart.=--These kill by sudden shock, syncope,
or collapse. They comprise prussic acid, dilute solution of oxalic acid
and oxalates, aconite, digitalis, strophanthus, convallaria, and
tobacco.
6. =Poisons Acting on the Lungs.=--These have for their type carbonic
acid gas and coal gas. The fumes of ammonia are intensely irritating,
and may give rise to laryngitis, bronchitis, and even pneumonia. Nitric
acid fumes sometimes produce no serious symptoms for an hour or more,
but there may then be coughing, difficulty of breathing, and tightness
in the lower part of the throat, followed by capillary bronchitis (see
p. 120).
VI.--DUTY OF PRACTITIONER IN SUPPOSED CASE OF POISONING
If called to a case supposed or suspected to be one of poisoning, the
medical man has two duties to perform: To save the patient's life, and
to place himself in a position to give evidence if called on to do so.
If life is extinct, his duty is a simple one. He should make inquiries
as to symptoms, and time at which food or medicine was last taken. He
should take possession of any food, medicine, vomited matter, urine, or
fæces, in the room, and should seal them up in clean vessels for
examination. He should notice the position and temperature of the body,
the condition of rigor mortis, marks of violence, appearance of lips and
mouth. He should not make a post-mortem examination without an order in
writing from the coroner. In making a post-mortem examination, the
alimentary canal should be removed and preserved for further
investigation. A double ligature should be passed round the oesophagus,
and also round the duodenum a few inches below the pylorus. The gut and
the gullet being cut across between these ligatures, the stomach may be
removed entire without spilling its contents. The intestines may be
removed in a similar way, and the whole or a portion of the liver should
be preserved. These should all be put in separate jars without any
preservative fluid, tied up, sealed, labelled, and initialled. All
observations should be at once committed to writing, or they will not be
admitted by the court for the purpose of refreshing the memory whilst
giving evidence. If the medical practitioner is in doubt on any point,
he should obtain technical assistance from someone who has paid
attention to the subject.
In a case of attempted suicide by poisoning, is it the duty of the
doctor to inform the police? He would be unwise to do so. He had much
better stick to his own business, and not act as an amateur detective.
VII.--TREATMENT OF POISONING
The modes of treatment may be ranged under three heads: (1) To eliminate
the poison; (2) to antagonize its action; (3) to avert the tendency to
death.
1. The first indication is met by the administration of emetics, to
produce vomiting, or by the application of the stomach-tube. The best
emetic is that which is at hand. If there is a choice, give apomorphine
hypodermically. The dose for an adult is 10 minims. It may be given in
the form of the injection of the Pharmacopoeia, or preferably as a
tablet dissolved in water. Apomorphine is not allied in physiological
action to morphine, and may be given in cases of narcotic poisoning.
Sulphate of zinc, salt-and-water, ipecacuanha, and mustard, are all
useful as emetics. Tickling the fauces with a feather may excite
vomiting.
In using the elastic stomach-tube, some fluid should be introduced into
the stomach before attempting to empty it, or a portion of the mucous
membrane may be sucked into the aperture. The tube should be examined to
see that it is not broken or cracked, as accidents have happened from
neglecting this precaution. The bowels and kidneys must also be
stimulated to activity, to help in the elimination of the poison.
2. The second indication is met by the administration of the appropriate
antidote. Antidotes are usually given hypodermically, or, if by mouth,
in the form of tablets. In the absence of a hypodermic syringe, the
remedy may be given by the rectum. In the selection of the appropriate
antidote, a knowledge of pharmacology is required, especially of the
physiological antagonism of drugs. Antidotes may act (1) chemically, by
forming harmless compounds, as lime in oxalic acid poisoning; (2)
physiologically, the drug which is administered neutralizing more or
less completely the poison which has been absorbed; (3) physically, as
charcoal. Every doctor should provide himself with an antidote case. The
various antidotes will be mentioned under their respective poisons.
3. To avert the tendency to death, we must endeavour to palliate the
symptoms and neutralize the effects of the poison. Pain must be relieved
by the use of morphine; inflamed mucous membrane soothed by such
_demulcents_ as oils, milk, starch; stimulants to overcome collapse;
saline infusions in shock, etc. In the case of narcotics and depressing
agents, stimulants, electricity, and cold affusions, may be found
useful. We should endeavour to promote the elimination of the poison
from the body by stimulating the secretions.
VIII.--DETECTION OF POISONS
Notice the smell, colour, and general appearance, of the matter
submitted for examination. The odour may show the presence of prussic
acid, alcohol, opium, or phosphorus. The colour may indicate salts of
copper, cantharides, etc. Seeds of plants may be found.
This examination having been made, the contents of the alimentary canal,
and any other substances to be examined, must be submitted to chemical
processes.
Simple filtration will sometimes suffice to separate the required
substance; in other cases dialysis will be necessary, in order that
crystalloid substances may be separated from colloid bodies.
In the case of volatile substances distillation will be required. The
poisons thus sought for are alcohol, phosphorus, iodine, chloral,
ether, hydrocyanic acid, carbolic acid, nitro-benzol, chloroform, and
anilin. The organic matters are placed in a flask, diluted with
distilled water if necessary, and acidulated with tartaric acid. The
flask is heated in a water-bath, and the vapours condensed by a Liebig's
condenser. In the case of phosphorus the condenser should be of glass,
and the process of distillation conducted in the dark, so that the
luminosity of the phosphorus may be noted.
For the separation of an alkaloid, the following is the process of
Stas-Otto. This process is based upon the principle that the salts of
the alkaloids are _soluble in alcohol and water_, and _insoluble in
ether_. The pure alkaloids, with the exception of morphine in its
crystalline form, are _soluble_ in ether. Make a solution of the
contents of the stomach or solid organs minced very fine by digesting
them with acidulated alcohol or water and filtering. The filtrate is
shaken with ether to remove fat, etc., the ether separated, the watery
solution neutralized with soda, and then shaken with ether, which
removes the alkaloid in a more or less impure condition. The knowledge
of these facts will help to explain the following details, which may be
modified to suit individual cases: (1) Treat the organic matter, after
distillation for the volatile substances just mentioned, with twice its
weight of absolute alcohol, free from fusel oil, to which from 10 to 30
grains of tartaric or oxalic acid have been added, and subject to a
gentle heat. (2) Cool the mixture and filter; wash the residue with
strong alcohol, and mix the filtrates. _The residue may be set aside for
the detection of the metallic poisons, if suspected._ Expel the alcohol
by careful evaporation. On the evaporation of the alcohol the resinous
and fatty matters separate. Filter through a filter moistened with
water. Evaporate the filtrate to a syrup, and extract with successive
portions of absolute alcohol. Filter through a filter moistened with
alcohol. Evaporate filtrate to dryness, and dissolve residue in water,
the solution being made distinctly acid. Now shake watery solution with
ether. (3) Ether from the acid solution dissolves out _colchicin_,
_digitalin_, _cantharidin_, and _picrotoxin_, and traces of _veratrine_
and _atropine_. Separate the ethereal solution and evaporate. Hot water
will now dissolve out _picrotoxin_, _colchicin_, and _digitalin_, but
not cantharidin. (4) The remaining acid watery liquid, holding the other
alkaloids in solution or suspension, is made strongly alkaline with
soda, mixed with four or five times its bulk of ether, chloroform, or
benzole, briskly shaken, and left to rest. The ether floats on the
surface, holding the alkaloids, except morphine, in solution. (5) A part
of this ethereal solution is poured into a watch-glass and allowed to
evaporate. If the alkaloid is volatile, oily streaks appear on the
glass; if not volatile, crystalline traces will be visible. If a
volatile alkaloid, add a few pieces of calcium chloride to ethereal
solution to absorb the water; draw off the ethereal solution with a
pipette, allow it to evaporate, and test the residue for the alkaloids,
conine and nicotine.
If a fixed alkaloid, treat the acid solution with soda or potash and
ether, evaporate ethereal solution after separation, when the solid
alkaloid will be left in an impure state. To purify it, add a small
quantity of dilute sulphuric acid, and, after evaporating to
three-quarters of its bulk, add a saturated solution of carbonate of
potash or soda. Absolute alcohol will then dissolve out the alkaloid,
and leave it on evaporation in a crystalline form.
_General Reactions for Alkaloids._--(1) Wagner's reagent (iodine
dissolved in a solution of potassium iodide) yields a reddish-brown
precipitate; (2) Mayer's reagent (potassio-mercuric iodide) gives a
yellowish-white precipitate; (3) phospho-molybdic acid gives a yellow
precipitate; (4) platinic chloride, a brown precipitate; (5) tannic
acid, etc.
In order to isolate an inorganic substance from organic matter,
Fresenius's method is adopted. Boil the finely divided substance with
about one-eighth its bulk of pure hydrochloric acid; add from time to
time potassic chlorate until the solids are reduced to a straw-yellow
fluid. Treat this with excess of bisulphate of sodium, then saturate
with sulphuretted hydrogen until metals are thrown down as sulphides.
These may be collected and tested. From the acid solution, hydrogen
sulphide precipitates copper, lead, and mercury, _dark_; arsenic,
antimony, and tin, _yellowish_. If no precipitate, add ammonia and
ammonium sulphide, iron, _black_, zinc, _white_, chromium, _green_,
manganese, _pink_. The residue of the material after digestion with
hydrochloric acid and potassium chlorate may have to be examined for
silver, lead, and barium.
For the detection of minute quantities, the microscope must be used, and
Guy's and Helwig's method of sublimation will be found advantageous.
Crystalline poisons may be recognized by their characteristic forms.
IX.--THE MINERAL ACIDS
These are sulphuric, nitric, and hydrochloric acids.
_Symptoms of Poisoning by the Mineral Acids._--Acid taste in the mouth,
with violent burning pain extending into the oesophagus and stomach, and
commencing immediately on the poison being swallowed; eructations,
constant retching, and vomiting of brown, black, or yellow matter
containing blood, coagulated mucus, epithelium, or portions of the
lining membrane of the gullet and stomach. The vomited matters are
strongly acid in reaction, and stain articles of clothing on which they
may fall. There is intense thirst and constipation, with scanty or
suppressed urine, tenesmus, and small and frequent pulse; the lips,
tongue, and inside of the mouth, are shrivelled and corroded. Exhaustion
succeeds, and the patient dies either collapsed, convulsed, or
suffocated, the intellect remaining clear to the last. After recovering
from the acute form of poisoning, the patient may ultimately die from
starvation, due to stricture of the oesophagus, stomach, etc.
_Post-Mortem Appearances Common to the Mineral Acids._--Stains and
corrosions about the mouth, chin, and fingers, or wherever the acid has
come in contact. The inside of the mouth, fauces, and oesophagus, is
white and corroded, yellow or dark brown, and shrivelled. Epiglottis
contracted or swollen. Stomach filled with brown, yellow, or black
glutinous liquid; its lining membrane is charred or inflamed, and the
vessels are injected. Pylorus contracted. Perforation, when it takes
place, is on the posterior aspect; the apertures are circular, and
surrounded by inflammation and black extravasation. The blood in the
large vessels may be coagulated.
Avoid mistaking gastric or duodenal ulcer, with or without perforation,
for the effects of a corrosive poison.
_Treatment._--Calcined magnesia or the carbonate or bicarbonate of
sodium, mixed with milk or some mucilaginous liquid, are the best
antidotes. In the absence of these, chalk, whiting, milk, oil,
soap-suds, etc., will be found of service. The stomach-pump should not
be used. If the breathing is impeded, tracheotomy may be necessary.
Injuries of external parts by the acid must be treated as burns.
X.--SULPHURIC ACID
=Sulphuric Acid=, or oil of vitriol, may be concentrated or diluted. It
is frequently thrown over the person to disfigure the features or
destroy the clothes. Parts of the body touched by it are stained, first
white, and then dark brown or black. The presence of corrosion of the
mouth is as important as the chemical tests. Black woollen cloths are
turned to a dirty brown, the edges of the spots becoming red in a few
days, due to the dilution of the acid from the absorption of moisture;
the stains remain damp for long, owing to the hygroscopic property of
the acid.
_Method of Extraction from the Stomach._--The contents of the stomach or
vomited matter should, if necessary, be diluted with pure distilled
water and filtered. The stomach should be cut up into small pieces and
boiled for some time in water. The solution, filtered and concentrated,
is now ready for testing. Blood, milk, etc., may be separated by
dialysis, and the fluid so obtained tested. A sulphate may be present.
Take a portion of the liquid, evaporate to dryness, and incinerate; a
sulphate, if present, will be obtained, and may be tested.
_Caution._--Sulphuric acid may not be found even after large doses, due
to treatment, vomiting, or survival for several days. In all cases every
organ should be examined. Vomited matters and contents of stomach should
not be mixed, but each _separately_ examined. This rule holds good for
all poisons. On _cloth_ the stain may be cut out, boiled in water, the
solution filtered, and tested with blue litmus and other tests.
_Post-Mortem Appearances._--Where the acid has come in contact with the
mucous membranes there are dark brown or black patches. The stomach is
greatly contracted, the summits of the mucous membrane ridges being
charred and the furrows greatly inflamed; the contents are black or
brown.
_Tests._--Concentrated acid chars organic matter; evolves heat when
added to water, and sulphurous fumes when boiled with chips of wood,
copper cuttings, or mercury. Dilute acid chars paper when the paper is
heated; gives a white precipitate with nitrate or chloride of barium,
and is entirely volatilized by heat. Dilute solutions give a white
precipitate with barium nitrate, insoluble in hydrochloric acid even on
boiling.
_Fatal Dose._--In an adult, 1 drachm.
_Fatal Period._--Shortest, three-quarters of an hour; average period
from onset of primary effects, eighteen to twenty-four hours.
XI.--NITRIC ACID
=Nitric Acid=, or aqua fortis, is less frequently used as a poison than
sulphuric acid. The fumes from nitric acid have caused death from
pneumonia in ten or twelve hours.
_Method of Extraction from the Stomach._--The same as for sulphuric
acid. In beer, etc., the mixture may be neutralized with carbonate of
potassium, dialyzed, the fluid concentrated and allowed to crystallize,
when crystals of nitrate of potassium may be recognized.
_Post-Mortem Appearance._--The mucous membranes are rendered yellow or
greenish if bile be present; they are also thickened and hardened.
_Tests._--Concentrated acid gives off irritating orange-coloured fumes
of nitric acid gas. When poured on copper, it gives off red fumes and
leaves a green solution of nitrate of copper. It gives a red colour with
brucine, turns the green sulphate of iron black, and with hydrochloric
acid dissolves gold. A delicate test for the acid, free or in
combination, is to dissolve in the suspected fluid some crystals of
ferrous sulphate, and then to gently pour down the test-tube some strong
sulphuric acid. Where the two liquids meet, if nitric acid be present, a
reddish-brown ring will be formed. It turns the skin bright yellow, and
does the same with woollen clothes, from the formation of _picric_ acid.
_Fatal Dose._--Two drachms.
_Fatal Period._--Shortest, one hour and three-quarters in an adult; in
infants in a few minutes, from suffocation.
XII.--HYDROCHLORIC ACID
=Hydrochloric Acid=, muriatic acid, or spirit of salt, is not uncommonly
used for suicidal purposes, being fifth in the list.
_Method of Extraction from the Stomach._--The same as for sulphuric
acid. As hydrochloric acid is a constituent of the gastric juice, the
signs of the acid must be looked for.
_Post-Mortem Appearances._--The mucous membranes are dry, white, and
shrivelled, and often eroded.
_Tests._--The concentrated acid yields dense white fumes with ammonia.
When warmed with black oxide of manganese and strong sulphuric acid it
gives off chlorine, recognized by its smell and bleaching properties.
Diluted it gives with nitrate of silver, a white precipitate, which is
insoluble in nitric acid and in caustic potash, but is soluble in
ammonia, and when dried and heated melts, and forms a horny mass. Stains
on clothing are reddish-brown in colour.
_Fatal Dose._--Half an ounce.
_Fatal Period._--Shortest, two hours; average, twenty-four hours. Death
may occur after an interval of some weeks from destruction of the
gastric glands and inability to digest food.
XIII.--OXALIC ACID
=Oxalic Acid= is used by suicides, though not often by murderers. The
crystals closely resemble those of Epsom salts or sulphate of zinc;
oxalic acid has been taken in mistake for the former. It is in common
use for cleansing brass, in laundry work, for dyeing purposes, and
especially for bleaching straw hats.
_Symptoms._--If a concentrated solution be taken, it acts as a
corrosive, causing a burning acid, intensely sour taste, which comes on
immediately, great pain and tenderness and burning at pit of stomach,
pain and tightness in throat. Vomiting of mucus, bloody or dark
coffee-ground matters, purging and tenesmus, followed by collapse,
feeble pulse, cyanosis and pallor of the skin; also swelling of tongue,
with dysphagia. In some cases cramps and numbness in limbs, pain in head
and back, delirium and convulsions. May be tetanus or coma. If taken
freely diluted, the nervous symptoms predominate, and may resemble
narcotic poisoning. Sometimes almost instant death.
_Post-Mortem Appearances._--Mucous membrane of mouth, throat, and
gullet, white and softened, as if they had been boiled; there are often
black or brown streaks in it. Stomach contains dark, grumous matter, and
is soft, pale, and brittle. Intestines slightly inflamed, stomach
sometimes quite healthy.
_Treatment._--Warm water, then chalk, carbonate of magnesium, or
lime-water, freely. Not alkalies, as the oxalates of the alkalies are
soluble and poisonous. Castor-oil. Emetics, but not stomach-pump.
_Fatal Dose._--One drachm is the smallest, but half an ounce is usually
fatal.
_Method of Extraction from the Stomach._--Mince up the coats of the
stomach and boil them in water, or boil the contents of the stomach and
subject them to dialysis. Concentrate the distilled water outside the
tube containing the vomited matters, etc., and apply tests.
_Tests._--White precipitate with nitrate of silver, soluble in nitric
acid and ammonia. When the precipitate is dried and heated on
platinum-foil, it disperses as white vapour with slight detonation.
Sulphate of lime in excess gives a white precipitate, soluble in nitric
or hydrochloric acid, but insoluble in oxalic, tartaric, acetic, or any
vegetable acid.
=Oxalate or Binoxalate of Potash= (salts of sorrel or salts of lemon) is
almost as poisonous as the acid itself.
XIV.--CARBOLIC ACID
=Carbolic Acid, Phenic Acid, or Phenol=, is largely employed as a
disinfectant, and is often supplied in ordinary beer-bottles without
labels.
_Symptoms._--An intense burning pain extending from the mouth to the
stomach and intestines. Indications of collapse soon supervene. The skin
is cold and clammy, and the lips, eyelids, and ears, are livid. This is
followed by insensibility, coma, stertorous breathing, abolition of
reflex movements, hurried and shallowed respiration, and death. The
pupils are usually contracted, and the urine, if not suppressed, is dark
in colour, or even black. Patients often improve for a time, and then
die suddenly from collapse. When the poison has been absorbed through
the skin or mucous membranes, a mild form of delirium, with great
weakness and lividity, are the first signs.
_Post-Mortem._--If strong acid has been swallowed, the lips and mucous
membranes are hardened, whitened, and corrugated. In the stomach the
tops of the folds are whitened and eroded, while the furrows are
intensely inflamed.
_Treatment._--Soluble sulphates which form harmless sulpho-carbolates in
the blood should be administered at once. An ounce of Epsom salts or of
Glauber's salts dissolved in a pint of water will answer the purpose
admirably. After this an emetic of sulphate of zinc may be given. White
of egg and water or olive-oil may prove useful. Warmth should be applied
to the body.
_Fatal Dose._--One drachm, but recovery has taken place after much
larger quantities, if well diluted or taken after a meal.
_Tests_ are not necessary, as the smell of carbolic acid is
characteristic.
_Local action_ of carbolic acid produces anæsthesia and necrosis.
Accidents sometimes happen from too strong lotions applied as surgical
dressings.
=Lysol= is a compound of cresol and linseed-oil soap, and is much less
toxic than carbolic acid.
XV.--POTASH, SODA, AND AMMONIA
=Caustic Potash= occurs in cylindrical sticks, is soapy to the touch,
has an acrid taste, is deliquescent, fusible by heat, soluble in water.
=Liquor Potassæ= is a strong solution of caustic potash, and has a
similar reaction. =Carbonate of Potassium=, also known as potash,
pearlash, salt of tartar, is a white crystalline powder, alkaline and
caustic in taste, and very deliquescent. The bicarbonate is in
colourless prisms, which have a saline, feebly alkaline taste, and are
not deliquescent.
_Symptoms._--Acrid soapy taste in mouth, burning in throat and gullet,
acute pain at pit of stomach, vomiting of bloody or brown mucus, colicky
pains, bloody stools, surface cold, pulse weak. These preparations are
not volatile, so that there is not much fear of lung trouble. In chronic
cases death occurs from stricture of the oesophagus causing starvation.
_Post-Mortem Appearances._--Soapy feeling, softening, inflammation, and
corrosion of mucous membrane of mouth, pharynx, oesophagus, stomach, and
intestines. Inflammation may have extended to larynx.
_Method of Extraction from the Stomach._--If the contents of the stomach
have a strong alkaline action, dilute with water, filter, and apply
tests.
_Tests._--The carbonates effervesce with an acid. The salts give a
yellow precipitate with platinum chloride, and a white precipitate with
tartaric acid. They are not dissipated by heat, and give a violet colour
to the deoxidizing flame of the blowpipe. Stains on dark clothing are
red or brown.
_Treatment._--Vinegar and water, lemon-juice and water, acidulated
stimulant drinks, oil, linseed-tea, opium to relieve pain, stimulants in
collapse. Do not use the stomach-tube. The glottis may be inflamed, and
if there is danger of asphyxia, tracheotomy may have to be performed.
=Carbonate of Sodium= occurs as _soda_ and _best soda_, the former in
dirty crystalline masses, the latter of a purer white colour. It is also
found as 'washing soda.'
_Symptoms, Post-Mortem Appearances, Treatment, and Extraction from the
Stomach._--As for potash.
_Tests._--Alkaline reaction, effervesces and evolves carbonic acid when
treated with an acid; crystallizes, gives yellow tinge to blowpipe
flame. No precipitate with tartaric acid, nor with bichloride of
platinum.
=Ammonia= may be taken as _liquor ammoniæ_ (harts-horn), as carbonate of
ammonium, as 'Cleansel,' or as 'Scrubb's Cloudy Ammonia.'
_Symptoms._--Being volatile, it attacks the air-passages, nose, eyes and
lungs, being immediately affected; profuse salivation; lips and tongue
swollen, red, and glazed. The urgent symptoms are those of suffocation.
Inhalation of the fumes of strong ammonia may lead to death from
capillary bronchitis or broncho-pneumonia. Death may result from
inflammation of the larynx and lungs. When swallowed in solution, the
symptoms are similar to those of soda and potash.
_Post-Mortem Appearances._--Similar to other corrosives.
_Method of Extraction from the Stomach._--The contents of the stomach,
etc., must be first distilled, the gas being conveyed into water free
from ammonia.
_Tests._--Nessler's reagent is the most delicate, a reddish-brown colour
or precipitate being produced, but ammonia may be recognized by its
pungent odour, dense fumes given off with hydrochloric acid, and strong
alkaline reaction.
_Treatment._--Vinegar and water. Other treatment according to symptoms.
_Fatal Dose._--One drachm of strong solution.
_Fatal Period (Shortest)._--Four minutes.
XVI.--INORGANIC IRRITANTS
=Nitrate of Potassium (Nitre, Saltpetre)--Bitartrate of Potassium (Cream
of Tartar)--Alum (Double Sulphate of Alumina and Potassium)--Chlorides
of Lime, Sodium, and Potassium.=--All these are irritant drugs, and give
the usual symptoms.
XVII.--CHLORATE OF POTASSIUM, ETC.
=Chlorate of Potassium= produces irritation of stomach and bowels;
hæmaturia; melæna; cyanosis, weakness, delirium, and coma.
_Post-Mortem._--Blood is chocolate-brown in colour, and so are all the
internal organs; gastro-enteritis; nephritis.
_Tests._--Spectroscope shows blood contains methæmoglobin; the drug
discharges the colour of indigo in acid solution with SO_{2}.
_Treatment._--Transfusion of blood or saline fluid; stimulants.
=Sulphuret of Potassium= (liver of sulphur) occurs in mass or powder of
a dirty green colour; has a strong smell of sulphuretted hydrogen.
_Symptoms._--Of acute irritant poisoning, with stupor or convulsions.
Excreta smell of sulphuretted hydrogen.
_Post-Mortem Appearances._--Stomach and duodenum reddened, with deposits
of sulphur. Lungs congested.
_Treatment._--Chloride of sodium or lime in dilute solution, and
ordinary treatment for irritant poisoning.
_Fatal Period (Shortest)._--Fifteen minutes.
XVIII.--BARIUM SALTS
=Chloride of Barium= occurs crystallized in irregular plates, like
magnesium sulphate, soluble in water and bitter in taste. =Carbonate of
Barium= is found in shops as a fine powder, tasteless and colourless,
insoluble in water, but effervescing with dilute acids, and readily
decomposed by the free acids of the stomach. =Nitrate of Barium= occurs
in octahedral crystals, soluble in water.
_Method of Extraction from the Stomach._--Dialysis as for other soluble
poisons.
_Tests._--Precipitated from its solutions by potassium carbonate or
sulphuric acid. Burnt on platinum-foil, it gives a green colour to the
flame.
_Symptoms._--Besides those of irritants generally, violent cramps and
convulsions, headache, debility, dimness of sight, double vision, noises
in the ears, and beating at the heart. The salts of barium are also
cardiac poisons.
_Post-Mortem Appearances._--As of irritants generally. Stomach may be
perforated.
_Treatment._--Wash out stomach with a solution of sodium or magnesium
sulphate, or of alum, and give stimulants by the mouth and
hypodermically.
XIX.--IODINE--IODIDE OF POTASSIUM
=Iodine= occurs in scales of a dark bluish-black colour. It strikes blue
with solution of starch, and stains the skin and intestines
yellowish-brown. Liquid preparations, as the liniment or tincture, may
be taken accidentally or suicidally.
_Symptoms._--Acrid taste, tightness of throat, epigastric pain, and then
symptoms of irritant poisons generally. Chronic poisoning (iodism) is
characterized by coryza, salivation, and lachrymation, frontal headache,
loss of appetite, marked mental depression, acne of the face and chest,
and a petechial eruption on the limbs.
_Post-Mortem Appearances._--Those of irritant poisoning with corrosion,
and staining of a dark brown or yellow colour.
_Treatment._--Stomach-pump and emetics, carbonate of sodium, amylaceous
fluids, gruel, arrowroot, starch, etc.
_Analysis of Organic Mixture containing Iodine._--Add bisulphide of
carbon, and shake. The iodine may be obtained on evaporation as a
sublimate. It will be recognized by the blue colour which it gives with
starch.
=Iodide of Potassium.=--Colourless, generally opaque, cubic crystals,
soluble in less than their weight of cold water.
_Symptoms._--Not an active poison, but even small doses sometimes
produce the effects of a common cold, including those symptoms already
mentioned as occurring with iodine.
_Analysis._--Iodide of potassium in solution gives a bright yellow
precipitate with lead salts; a bright scarlet with corrosive sublimate;
and a blue colour with sulphuric or nitric acid and starch.
XX.--PHOSPHORUS
=Phosphorus= is usually found in small, waxy-looking cylinders, which
are kept in water to prevent oxidation. It may also occur as the
amorphous non-poisonous variety, a red opaque infusible substance,
insoluble in carbon disulphide. Ordinary phosphorus is soluble in oil,
alcohol, ether, chloroform, and carbon disulphide; insoluble in water.
It is much used in rat poisons, made into a paste with flou
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