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Title: Text-book of forensic medicine and toxicology
Author: R. J. M. Buchanan
Release date: November 27, 2024 [eBook #74804]
Language: English
Original publication: New York: William Wood
Credits: Richard Tonsing and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)
*** START OF THE PROJECT GUTENBERG EBOOK TEXT-BOOK OF FORENSIC MEDICINE AND TOXICOLOGY ***
Transcriber’s Notes:
Underscores “_” before and after a word or phrase indicate _italics_
in the original text.
Equal signs “=” before and after a word or phrase indicate =bold= in
the original text.
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Typographical and punctuation errors have been silently corrected.
TEXT-BOOK OF
FORENSIC MEDICINE AND
TOXICOLOGY
BY
R. J. M. BUCHANAN, M.D., F.R.C.P.LOND., &c.
PROFESSOR IN FORENSIC MEDICINE AND TOXICOLOGY,
UNIVERSITY OF LIVERPOOL;
HONORARY PHYSICIAN, ROYAL INFIRMARY,
LIVERPOOL;
FORMERLY HONORARY PHYSICIAN,
STANLEY HOSPITAL;
ASSISTANT HONORARY PHYSICIAN,
LIVERPOOL CHEST HOSPITAL, ETC.
EIGHTH EDITION, REVISED AND ENLARGED
NEW YORK
WILLIAM WOOD AND COMPANY
MDCCCCXV
PRINTED IN GREAT BRITAIN
PREFACE
The present edition of _Forensic Medicine, Toxicology, and Public
Health_ has been issued in two volumes; the first, on _Public Health_,
written by Professor Hope, has been already published separately.
Hitherto the subjects have been dealt with in a single volume under
the title of Husband‘s _Forensic Medicine_, but as they are now being
taught by different lecturers and in separate classes in most of the
medical schools, it has been thought advisable to issue the work in
two parts. This volume on _Forensic Medicine and Toxicology_ has been
revised throughout, and certain alterations and additions have been
made, whilst at the same time the view that the work is intended for
students and junior practitioners has not been lost sight of.
The author expresses his indebtedness to Dr. M‘Fall, Demonstrator
of Toxicology in the University of Liverpool, for his assistance in
revising the section on “Toxicology,” and also to the publishers for
the compilation of the index.
Apart from the general bibliography mentioned in the text, the works
of Taylor and Stevenson, Dickson, Mann, Glaister, Petersen and Haynes,
have been consulted.
A plate, showing the centre of ossification in the lower epiphysis of
the femur in a full time fœtus, has been introduced at the last moment,
and will be found opposite page 64. References to the subject may also
be found on pages 33 and 174.
CONTENTS
SECTION I
FORENSIC MEDICINE
CHAP. PAGE
Introduction 1
I. Legal Criminal Procedure 2
II. Medical Evidence Generally, Identity 11
III. Modes of Dying, Sudden Death, Signs of Death 38
IV. Post-mortem Examinations and Exhumations, Instructions
of the Crown Office in Scotland 56
V. Assaults, Homicide, and Wounds 68
VI. Blood Stains, Spectra, and Biological Tests 89
VII. Burns and Scalds, Contusions and Bruises 110
VIII. Suffocation, Hanging, Strangling, and Throttling 118
IX. Drowning 127
X. Death from Starvation, Cold and Heat, Lightning and
Electricity 132
XI. Offences against Chastity 140
XII. Pregnancy and Delivery 150
XIII. Fœticide, or Criminal Abortion 159
XIV. Infanticide, Live Birth, Cause of Death to the Fœtus 165
XV. Inheritance, Legitimacy, Impotence and Sterility,
Survivorship, Malpraxis and Neglect of Duty,
Feigned Diseases, Exemption from Public Duties,
Wills 184
XVI. Mental unsoundness, General Symptoms of Insanity,
Mania, Melancholia, Dementia, Restraint of the
Insane, Forms of Medical Certificates,
Testamentary Capacity 192
SECTION II
TOXICOLOGY
I. Definition of a Poison, Sale of Poisons, Classification
of Poisons, Action of Poisons, General Evidence of
Poisoning, General Treatment in Cases of Poisoning,
General Methods of Examination for Poison 227
II. Division 1: Chemical--Corrosive Poisons 246
III. Division 2: Vital--Metalloid Irritants 267
IV. Metallic Irritants 274
V. Vegetable and Animal Irritants 317
VI. Food Poisoning (Bromatotoxismus) 328
VII. Vegetable Alkaloids 335
VIII. Narcotic Poisons 343
IX. Deliriant Poisons 349
X. Inebriant Poisons 354
XI. Sedative Poisons 364
XII. Cerebral Poisons 377
XIII. Neural Poisons 385
XIV. Excitomotory Poisons 388
XV. Irrespirable Gases 397
INDEX 405
LIST OF ILLUSTRATIONS
SECTION I
FORENSIC MEDICINE
Plate showing Centre of Ossification in the Lower Epiphysis PAGE
of Femur in full time Fœtus _To face_ 64
FIG.
1. Finger Prints 24
2. Finger Prints 25
3. Photo-micrograph of transverse section of Normal Hair
Follicle 27
4. Photo-micrograph of Wool Fibres 90
5. Photo-micrograph of Flax Fibres 91
6. Photo-micrograph of Silk Fibres 92
7. Photo-micrograph of Cotton Fibres 93
8. Measurement of Blood Corpuscles (human) 97
9. Measurement of Blood Corpuscles (sheep) 97
10. Photo-micrograph of Red Blood Corpuscles from Domestic Fowl 99
11. Photo-micrograph of Blood Corpuscles of Fish 99
12. Photo-micrograph of Blood Corpuscles from a Dried Stain of
the Blood of a Cod-fish 100
13. Photo-micrograph of a Frog‘s Blood showing oval nucleated
Red Corpuscles 101
14. Photo-micrograph of Crystals of Hæmin 102
15. Blood Spectra 104
16. }
17. }Pulse Tracings before and after Execution _opposite_ 121
18. }
19. Hymen of Child of Four Years--Annular Type 144
20. Virgin Hymen, with Central Slit 144
21. Photo-micrograph of Human Spermatozoa 147
22. Deflorated Hymen, after Parturition, in Adult Woman 149
23. Abortion at Fourth Week 159
24. Abortion between Sixth and Eighth Week 160
25. Abortion at Tenth Week 160
26. Photo-micrograph of Human Milk 177
27. Photo-micrograph of Starch Granules 179
SECTION II
TOXICOLOGY
28. Photo-micrograph of Crystals of Oxalic Acid 258
29. Photo-micrograph of Crystals of Oxalic Acid 259
30. Photo-micrograph of Sublimate of Arsenious Acid obtained
by Reinsch‘s Process 284
31. Dowzard‘s Apparatus for Gutzeit‘s Test for Arsenic 285
32. Photo-micrograph of Crystals of Tartarated Antimony 292
33. Photo-micrograph of Crystals of Tartarated Antimony 293
34. Photo-micrograph of Crystals of Corrosive Sublimate 298
35. Photo-micrograph of Globules of Mercury obtained by
Reinsch‘s Process 303
36. Photo-micrograph of Crystals of Hydrochloride of Morphine 339
37. Photo-micrograph of Meconic Acid crystallised from Aqueous
Solution 340
38. Photo-micrograph of Meconic Acid crystallised from an
Alcoholic Solution 340
39. Photo-micrograph of Crystals of Cyanide of Silver obtained
by the Vapour Test 372
40. Photo-micrograph of Crystals of Strychnine Sulphate from
an Aqueous Solution 389
41. Photo-micrograph of Crystal of Strychnine Sulphate from
Aqueous Solution 389
42. Photo-micrograph of Strychnine Sulphate, Film Preparation
from Chloroform Solution 391
43. Photo-micrograph of Chromate of Strychnine 391
44. Photo-micrograph of Sulphocyanate of Strychnine 392
45. Photo-micrograph of Crystals of Brucine Sulphate 395
46. Photo-micrograph of Crystals of Brucine Sulphate 395
=FORENSIC MEDICINE AND= =TOXICOLOGY=
SECTION I
FORENSIC MEDICINE
INTRODUCTION
Medical Jurisprudence, Forensic Medicine, or Legal Medicine are terms
for that science which teaches the application of the knowledge of all
branches of medical and surgical science and art to the solution of
every question connected with the conservation of the species and the
administration of Justice. We find traces of this science in the Jewish
law; among the Egyptians, according to Plutarch; and even among the
Romans as early as the times of Numa Pompilius. Among German writers
the term State Medicine includes both Medical Jurisprudence and Medical
Police, Public Health, or Sanitary Science.
The special knowledge requisite to the Medical Jurist differs in many
ways from that requisite for the art of healing the sick. The majority
of medical students and practitioners may consider a simple exercise
of common sense in the application of their general professional
knowledge to the elucidation of problems of medico-legal import all
that is requisite, and that no special training is necessary for the
purpose. They may hope that it may never fall to their lot to be
called upon to act in the capacity of medical jurists. It may occur,
however, to any medical practitioner at any time of his professional
career that his services be requisitioned by law for the purpose of
elucidating problems of such a nature as will demand from him thought
and judgment quite apart from those he exercises in the ordinary course
of his medical and surgical practice. From such a requisition he has
no escape; he cannot shift his responsibility to another, and it
behoves him, therefore, to acquire a knowledge of Forensic Medicine,
in order to guide him, when so called upon, to give such evidence
as will enable a judge and jury to arrive at a just conclusion. The
relations of all medical practitioners to the State are twofold--first,
as healers of disease, and secondly, both as guardians of the innocent
against unfounded criminal charges and aids towards the detection and
punishment of crime.
CHAPTER I
LEGAL CRIMINAL PROCEDURE
ENGLAND AND IRELAND
=The Coroner‘s Court.=--The office of coroner is mentioned in a charter
in 925. Coroners were formerly chosen for life by the freeholders of
the district, but their election is now in the hands of the County
Councils. Their duties were first clearly pointed out by the Act 4 Edw.
I. c. 2, 1275 (_De officio coronatoris_).
At the present time the duties of the coroner are chiefly to hold
inquiry into the cause of death when there is any reason to doubt that
death resulted from natural causes.
When death results from natural causes, and under ordinary conditions,
the medical attendant is bound, under a penalty of forty shillings,
to certify as to the cause. The registrar of deaths accepts such a
certificate when accompanied by oral testimony given by a person who
was present at the time of death, and issues a certificate accordingly,
authorising the interment of the deceased.
Should conditions obtain to prevent the medical attendant from forming
an opinion as to the cause of death, or which would lead him to infer
that death did not take place from natural causes, he should notify the
matter to the coroner. Such would be necessary if death were directly
or indirectly due to accident, or if death occurred within a reasonable
time after an accident, although due to some other cause, or if an
accident happened to deceased during the course of a chronic illness,
the accident, however, not being in itself necessarily fatal.
It would be necessary also to notify the coroner if the death took
place under circumstances which, to the medical attendant, appeared
suspicious, such as might arise from culpable neglect or cruelty on
the part of persons in charge of the deceased. The same would apply to
cases in which the cause of death was unknown. A great responsibility
rests on the medical practitioner, in that he is compelled under a
penalty to certify as to the cause of death; while if he do so without
due consideration, or carelessly, he renders himself liable to censure
or legal proceedings.
It may happen that in certain cases--for example, where an accident
befell the deceased during the course of a lingering illness, and which
in itself had no causal relations to the death--the doctor may be prone
to certify the death as from the illness alone, taking no note of the
accident; and pressure may be brought to bear upon him by the relations
of the deceased to so certify and save them the trouble and publicity
of an inquest. It should be remembered, however, that although the
certificate be accepted by the registrar, and interment take place, the
coroner, if informed of the matter, may order the body to be exhumed
for the purposes of inquest.
There are coroners who, on receipt of information of death from
uncertain causes, may elect, on evidence obtained apart from the
medical practitioner, to notify the registrar authorising the interment
without holding an inquest. The law, however, states that, “except upon
holding an inquest, no order, warrant, or other document for the burial
of the body shall be given by the coroner” (50 and 51 Vict.).
The Coroners Act (50 and 51 Vict.) provides that, when a coroner is
informed that the dead body is lying within his jurisdiction, and there
is reasonable cause to suspect that such person has died a violent or
unnatural death, or a sudden death, of which the cause is unknown, or
died in prison, he shall summon a jury of not less than twelve, or more
than twenty-three, men to inquire touching the death of such person
aforesaid.
If the deceased were attended at his death, or during his last illness,
by a legally qualified medical practitioner, the coroner may summon
such practitioner as a witness. If the deceased were not so attended in
his last illness, the coroner may summon any legally qualified medical
practitioner in actual practice, in or near the place where the death
happened, to give evidence as to the cause of death. In either case
the coroner may require the medical witness to make a _post-mortem_
examination of the body, with or without analysis of the contents of
the stomach or intestines.
Should a statement on oath be made by any one before the coroner, that
in his belief the death of the deceased was caused partly or entirely
by the improper or negligent treatment of a medical practitioner, such
medical practitioner shall not make or assist at the _post-mortem_
examination.
If a majority of the jury are not satisfied with the medical evidence,
they may require the coroner, in writing, to summon another legally
qualified practitioner, named by them, to make a _post-mortem_
examination, with or without analysis of the contents of the stomach
and intestines, and give evidence as to the cause of death. A medical
practitioner who fails to obey the summons of a coroner, issued in
pursuance of the Coroners Act, is liable to a penalty not exceeding
five pounds, unless he shows good and sufficient cause for not having
so done. When evidence has been given before a coroner or magistrate,
and the case is afterwards sent for trial, copies of the medical report
and depositions are given to the judge and counsel, so that evidence
given at the trial is compared in detail with that given before the
coroner or magistrate. In view of this, it is imperative on the part of
medical witnesses to carefully consider their evidence before giving it.
The object of a coroner‘s inquest is to ascertain whether the death of
the person, over whose body the inquest is held, was due to natural
causes or not.
The proceedings are not directed against any one, they do not
constitute a trial, and hearsay evidence is admissible. The coroner
and jury alone have the right to interrogate the witnesses. Counsel
may be present in the interest of persons concerned with the inquest
who may desire such assistance, but counsel may not cross-examine any
witnesses, and may only question them by permission of and subject to
the decision of the coroner.
Witnesses are examined on oath, their evidence is taken down, and
should the case be transferred to a superior court, they are bound
under a penalty to appear and give evidence. The coroner may adjourn
an inquest for the purpose of obtaining further evidence, if he should
deem it necessary.
Should the verdict of the jury charge a person with murder, the coroner
issues a warrant for the arrest of the person, unless the person be
already in custody. In the case of manslaughter the coroner may accept
bail. According to the Act 4 Edw. I. c. 2, the coroner and jurors must
_view_ the body, this being _absolutely necessary_ to give jurisdiction
to him, and he has the power, within a convenient time after the death,
to order a dead body to be disinterred for this purpose.
Order of Summons from the Coroner to a
Legally Qualified Medical Practitioner
=_“London._=
_To wit_--_To_ ____________________ Esq., Surgeon.
“Sir--By virtue of this my Order as one of His
Majesty‘s Coroners for the _County of London_ you are
hereby required to be and appear before me and the jury on
______ day, the ______ day of ______ at ______ o‘clock in the
______ noon, at ______ in the Parish of ______, then and there
to give evidence on His Majesty‘s behalf touching the death
of ____________, and to make or assist in making a _post-mortem_
examination of the Viscera of the Head, Chest, and Abdomen of
the body of the said ____________ with ______ an analysis and
report thereon at the said Inquest. And herein fail not at your
peril.
Dated the ______ day of ____________ 19.”
(Signature of Coroner.)
=Prosecution.=--There was no Public Prosecutor in England until some
years ago, when an Act was passed authorising the appointment of such
an official, who should undertake the duty of prosecuting in certain
and specific cases of public importance, and in districts where the
appointment might be agreed upon. In ordinary circumstances it has
usually been left to the person against whom a crime has been committed
to prosecute the offender.
=Magistrates‘ Court.=--In the Magistrates‘ Court of Petty Sessions, the
proceedings are for the purpose of investigating as to the culpability
or non-culpability of a person accused of some criminal act, or
criminal negligence.
In this Court the accused person must be present, as the inquiry is
relative to his guilt or innocence. Witnesses in this Court may be
examined and cross-examined by counsel. A magisterial investigation
cannot take place if no arrest have been made. The magistrate may
deal summarily with cases of simple assault and such-like of minor
import, but when the case is of a more serious nature, and in suspected
manslaughter or murder, the accused person is committed to a superior
Court for trial, such as the Court of Quarter Sessions, the Assize
Court or, in London, the Central Criminal Court, all witnesses, medical
or lay, being bound over to appear and give evidence. The summons to
the Assizes is called a _subpœna_, and all witnesses receiving the
same, when accompanied with reasonable travelling expenses, are bound
to obey it.
=Assizes.=--The Assizes comprise two Courts, the Crown Court and the
Civil Court. A separate judge presides over each. In the former only
cases of a criminal nature are tried; in the latter suits are tried
between two parties. Medical practitioners may be called upon to give
evidence in either Court, according to the nature of the case in which
they are directly concerned.
Prior to a case being investigated by a judge and petty jury, it has
to come before the grand jury. This jury decides whether the case is a
proper one to proceed to trial.
The grand jury hear the evidence of such witnesses as they think fit,
apart from counsel. Should the grand jury consider the case one for
trial, they return a “true bill,” and it goes before the judge and
petty jury; if not, they “cut the bill,” and the accused is discharged.
Medical witnesses may be called upon, when under subpœna, to give
evidence before the grand jury.
The Crown Court of Assize consists of a judge and a sworn jury of
twelve men, called the petty jury. The latter hear the evidence of
witnesses, and are guided by the summing up of the judge. They deliver
a verdict after consideration of the evidence by which the accused
person is found guilty or not guilty. The judge, after receiving the
verdict, allots such punishment as he considers just. In certain cases
the prisoner when convicted may appeal to the Court of Criminal Appeal.
In the Assize Courts only barristers can plead; in the Magistrates‘
Courts of Petty Sessions, solicitors or barristers may plead.
In the Courts of Assize the witnesses are subject to the following
routine of examination. First, _Examination-in-chief_: this the witness
undergoes at the hands of the barrister who is pleading on behalf of
the party by whom the witness is called. In this examination such
questions are put to the witness as may elicit answers conveying to the
judge and jury a clear account of all the witness knows with regard to
the case. After the examination-in-chief, the counsel of the opposite
side subjects the witness to _cross-examination_, in such a way as to
shake the evidence given by the witness during his examination in chief
in points which would weigh against the prospects of his client. _It is
during cross-examination that a medical witness may be subjected to
questions which suggest answers capable of a different interpretation
from those he had previously given._ After cross-examination, the
counsel for the party upon whose side the witness appears subjects the
latter to _re-examination_, if he consider it necessary, during which
he endeavours to clear up any doubtful points in the evidence given by
the witness during cross-examination, with the purpose of eliciting an
explanation of their meaning.
The judge and members of the jury may put such questions to the witness
as they may consider necessary.
The same method of procedure applies to the higher Courts.
SCOTLAND
In Scotland public prosecutors are appointed by the Crown. The
chief public prosecutor is the Lord-Advocate; next in rank come
the Deputy-Advocates and Procurator-Fiscal. The Lord-Advocate and
Deputies take charge of cases in the High Courts of Justiciary, the
Procurator-Fiscal in the lower Courts.
The duties of the public prosecutor are to bring all accused persons
to a bar of justice; and in addition he acts as the coroner does
in England. Any person who is supposed to know anything about the
case is interrogated by the Procurator-Fiscal, or is _precognosced_.
The examination is made on oath; the written evidence constitutes
the _precognitions_. Counsel for the accused or for the Crown may
precognosce witnesses.
The preliminary examination of the accused takes place before the
Sheriff or Justice, and he may commit the person for trial or liberate
him, according to the evidence.
The precognitions, in cases of committal, are forwarded to the Crown
Counsel in Edinburgh, who may stop the proceedings, or send the accused
before the High Court, Circuit Court of Justiciary, or Sheriff, with
or without a jury. The Justiciary Courts correspond to the Courts of
Assize in England. Should the case be so transferred for trial, the
witnesses are summoned by writ. A penalty of £5 may be imposed for
disobedience to such writ, or imprisonment pending expression of regret
before the Court, and tendering bail for appearance.
Common witnesses and medical witnesses to fact are not allowed in
Court except when giving evidence. Expert witnesses may be allowed to
remain in Court by mutual consent of counsel. When one expert witness
is giving evidence, other experts are required to leave the Court, and
no expert witness who may have been present during the examination of
common witnesses is allowed to give evidence as to facts.
The verdicts of “Guilty” or “Not guilty” are similar to those given in
England, but in addition a verdict of “Not proven” may be given, and
all are final. In the case of the last two the accused cannot be tried
again.
In Scotland the verdict of a bare majority of the jury holds
good, whereas in England the decision must be unanimous. In the
case of a suspicious death, or a dead body being discovered, the
Procurator-Fiscal, acting as a coroner does in England, but without
a jury, may direct a medical man to examine the body and send in a
report; but all reports must be certified _on soul and conscience_,
without which they are of no value. Should the medical examiner be
satisfied without making an internal examination, he may certify to the
Procurator-Fiscal on the result of his external examination.
Should the Procurator-Fiscal consider it requisite to have a complete
examination, he issues a warrant to that effect to the medical
practitioner who has seen the case, and usually associates with him the
most skilled practitioner available in the neighbourhood. The warrant
consists of a petition by the Procurator-Fiscal, addressed to the
local judge, setting forth the grounds of his application, and craving
warrant to the inspectors named to make the necessary examination. This
is signed by the Procurator-Fiscal, and countersigned by the Sheriff or
local judge, if granted. The receivers of this warrant are empowered
to take full custody of the body, and they should be _careful to carry
the warrant with them_, or they may be refused admission pending its
production, which may result in great waste of time, and end in a
miscarriage of justice. The Procurator-Fiscal may supply to the medical
inspectors portions of the precognitions likely to bear on the medical
part of the inquiry. Medical men ought to be on their guard against
performing dissections in cases evidently judicial without previously
warning the proper law authorities, or without a warrant; for instances
have occurred where, owing to the want of proper support, obstructions
were thrown in the way which might have proved fatal to the value
of the investigation; and, besides, the premature disclosure of the
results of the inspection might frustrate other important steps of the
precognition.
The medical men so engaged will, as a rule, find it to their interest
to exclude all visitors, whether lay or professional, from the room
during the dissection. The regulations issued by the Crown Office,
Edinburgh, direct that no one should be allowed to be present at
the examination out of mere curiosity, and recommend that any one
not engaged in the inspection, but who is in attendance to give
information, or for any other purpose, and who may afterwards become
a witness, should remain in an adjoining room. The medical inspection
often furnishes good tests of the value of other evidence in the case;
therefore, it is desirable that the general witnesses should not have
an opportunity of knowing what is observed in the dissection of the
body. The notes of a case should be made at the time of inspection or
immediately afterwards. In the case of _post-mortem_ examinations it
is better that while one inspector conducts the practical details of
the examination, the other should take notes of its successive steps,
indicating all the points inquired into, with the observations made,
the appearances presented, negative as well as positive, stating simple
facts alone, without either generalisations or opinions. These notes
should be looked over by both inspectors before the body is sewn up, so
that omissions in the notes, or in the inspection itself, may be then
supplied.
Citation of Witnesses--Subpœna
In England, except upon a subpœna, a medical man is not bound to attend
as a witness at a trial, and then it should be served a reasonable time
before the trial, in order that he may make proper arrangements for
the carrying on of his business during his absence. In civil cases his
reasonable expenses should be tendered to him at the time the subpœna
is served, or within a reasonable time of the trial; and he may refuse
to give evidence unless his charges are paid, provided his objection be
stated _before he has been sworn_. A witness may be summoned from any
part of the United Kingdom.
The question has been raised, whether a _scientific witness_ was bound
to attend when subpœnaed. The law on the point is enveloped in some
obscurity; the better course is therefore to attend.
No tender of fees is necessary in criminal cases, “except in the case
of witnesses living in one distinct part of the United Kingdom being
required to attend subpœnas directing their attendance in another, who
are not liable to punishment for disobedience of the process, unless
at the time of service a reasonable and sufficient sum of money, to
defray their expenses in coming, attending, and returning, have been
tendered to them.” When summoned to two cases, the one civil, the other
criminal, the witness must attend the criminal; or when both cases are
the same, the one to which he first received the subpœna--notifying,
however, to the counsel engaged on the other case his unavoidable
absence, and giving the reasons which prevent his attendance.
In Scotland, witnesses are summoned by a writ or citation, which
must be delivered at the residence of the witness a reasonable time
before the trial. Delivery to a member of the family, or a servant
not within the house, will not do. If access cannot be gained, the
copy is fastened to the most patent door of the house. If the witness
do not appear, and it be clearly shown that he was duly cited, a
warrant for his apprehension may be issued, and he becomes liable to
be incarcerated till he finds “caution” for his due attendance at the
trial. His non-attendance may also, unless good excuse be forthcoming,
render him liable to a fine, or unlaw, of a hundred merks Scots--about
£5.
=Form of Subpœna in England.=--Where a medical witness has given
evidence in a case in which the accused person has been committed for
trial to a superior Court, he is summoned to give evidence at such
Court in the following terms:
[Sidenote: L.S.]
“George, by the grace of God, of the United Kingdom of
Great Britain and Ireland, King, Defender of the Faith,
To ______________________ Greeting: We command you, and every
of you, that all business being laid aside, and all excuses
ceasing, you do in your proper persons appear before our
Court of Quarter Sessions of the Peace (or other Court),
assigned to keep the peace in the City (or Borough) of
__________________________, and also to hear and determine
divers Felonies, Trespasses, and other Misdemeanours in our
said City (or Borough) committed, to be holden within the
_______________________, in the said City (or Borough),
on ____________________ the _______ day of _________________
now next ensuing, at the hour of ten o‘clock in the forenoon
of the same day, to testify the truth and give evidence,
on our behalf, against __________________ in a case of
_____________; and this and every of you are in no wise to
omit, under the Penalty of Twenty Pounds for you and every
of you. Witness, ___________________, Esq., our Recorder at
____________ aforesaid, the ________ day of ____________ in
the ________ year of our reign.”
“(Signed)
“Clerk of the Peace.”
In =Scotland= the following is the form of summons to appear before the
High Court of Justiciary, and at an inquiry into a fatal accident:
(I.)
“_To_ __________________________________________________
“You are hereby lawfully cited to attend a sitting of
the High Court of Justiciary within the Criminal Court
__________, upon the ___________ day of _________ Nineteen
hundred __________ years, at ______ o‘clock _______ noon,
as a witness in the case against _______________________,
prisoner in the Prison of _______________, and that under
the pain of One Hundred Merks Scots.
“(Signed)
“Sheriff-Officer.
“_Note._--Any witness failing to appear in terms
of citation not only forfeits the penalty, but
is liable to be apprehended and imprisoned.
“(Preserve and bring this Copy with you.)”
FEES ALLOWED TO MEDICAL WITNESSES
=Coroner‘s Court.=--The Coroners Act states that fees for medical
witnesses attending an inquest shall be, for attending to give evidence
at an inquest whereat no _post-mortem_ examination has been made by
the witness, one guinea. For making a _post-mortem_ examination and
attending to give evidence, two guineas. No fee can be obtained for
making a _post-mortem_ examination by a medical practitioner, unless it
be made by order of the coroner. Extra fees are not provided for when
the inquest is adjourned. For an inquest held over the body of a person
who has died in a lunatic asylum, public hospital, infirmary, workhouse
infirmary, or other medical institution, whether endowed or supported
by voluntary contributions, the medical officer of such institution
shall not be entitled to a fee. Should the dead body of a person be
taken to such an institution, the medical officer, if summoned to give
evidence, is entitled to the usual fee. Such fees are paid at the
termination of the inquest.
=Magistrates‘ Court.=--If the witness reside within two miles of the
Court, the fee is ten shillings and sixpence; beyond two miles, one
guinea.
=Courts of Quarter Sessions=, and =Central Criminal Court of
London=.--One guinea per day, and two shillings a night away from home,
with threepence per mile each way travelling expenses.
=Assize Court.=--One guinea per day, with two shillings a night away
from home, and a reasonable and sufficient amount for travelling
expenses. If there be no railway, threepence a mile each way. Sundays
are not included.
=Court of Probate and Divorce.=--One guinea per day within five miles
of the General Post Office. If beyond, two or three guineas a day, with
expenses out of pocket for coming and returning.
=Court of Appeal.=--One guinea a day if resident in London; two or
three guineas, with travelling expenses, if from a distance.
=County Court.=--From fifteen shillings as an ordinary witness, with
one guinea per day expenses if from home, to one to three guineas for
qualifying as an expert witness. With attendance at Court one to two
guineas and expenses one to three guineas per day.
=In Civil Cases.=--An arrangement is usually made with the solicitor
for a fee; this should be made before accepting the subpœna. A written
undertaking for payment, and properly stamped, should be obtained from
the solicitor before giving evidence; in default of this, the witness
should appeal to the judge from the witness-box before being sworn.
After taking the oath a witness is bound to give evidence, and the
solicitor may refer him to his client for the fee, which may lead to
disappointment.
IN SCOTLAND
The fee for attendance at High Courts of Justiciary or the Sheriff
Criminal Court is one guinea per day, if the Court be held in the town
in which the medical witness lives. For a post-mortem examination
and report, two guineas. For an analysis of blood or other stains on
clothing, two to four guineas, depending upon the amount of work done.
If the witness come from a distance, he is allowed two guineas per day,
both for the actual attendance at Court and also for each day occupied
in travelling to and fro, with a guinea a day for travelling expenses.
CHAPTER II
MEDICAL EVIDENCE GENERALLY
On the subject of evidence it is necessary to say a few words, for
it must be remembered that that which may be held to be evidence in
logic may not be so in law. Nothing in law is intuitive--nothing is
self-evident; everything must go through the process of proof by
testimony.
Legal evidence is therefore composed of testimony, but all testimony
is not necessarily evidence in law. Thus, if a witness declare that he
saw a certain act committed, his testimony may be accepted as evidence;
but if he state that his knowledge of a fact is obtained from another
person, such information, although it contain an absolutely true
description of what actually occurred, will not be received. In this
case his testimony is simply hearsay, and as such is not admissible,
except in the case of dying declarations, and in one or two other
instances which do not, however, concern us.
Medical evidence may be divided under the following heads: (1)
Documentary; (2) Oral or Parol; (3) Experimental.
1. DOCUMENTARY
Under this head are included Medical Certificates, Written Opinions,
Medical Reports, and Dying Declarations.
=Medical Certificates.=--Certificates generally refer to death, to
vaccination, to notification of infectious and industrial diseases, and
in districts which have adopted it, the notification of births; to the
state of health of an individual, &c. For those which have respect to
the health or to the illness of an individual there is no particular
legal form, as a certificate is merely a simple statement of a fact.
The only essential condition is that it contains the exact truth,
and any departure from this will entail heavy penalties. A statement
signed by a registered medical practitioner, distinctly describing the
condition of A or B, is all that is necessary as far as the law in
England is concerned. In Scotland the law is somewhat different, for
“A certificate of bad health by a physician or surgeon must bear to be
_on soul and conscience_.” ... “In cases of homicide, and other crimes
against the person, medical certificates produced respecting the nature
of the injuries must be verified on oath by the medical persons who
granted them” (_Dictionary Scot. Law_). In Scotland, the omission of
the words “on soul and conscience” invalidates a certificate.
Certificates of death, of vaccination, of notification of infectious
diseases, tuberculosis, industrial diseases, and births, and of
insanity can be procured already printed in the forms prescribed by the
law.
=Certificates of the Cause of Death.=--A medical practitioner who has
been in attendance during the last illness of a person is legally
bound to give a certificate stating, “to the best of his knowledge and
belief, the cause of death.” If he be unaware of the cause of death,
or have reason to believe that death was not due to natural causes, or
the result of violence, he may refuse the certificate. In such a case
it is customary and desirable for the medical man to notify the Coroner
of the circumstance as soon as possible. If he have no reasonable cause
to prevent him supplying the certificate, he is liable to a penalty
not exceeding forty shillings. In England and Ireland it is given to
a relative of the deceased or legally authorised person, who must
deliver it to the Registrar. In Scotland the doctor sends it to the
Registrar direct. Not more than one certificate should be given. No fee
is chargeable. The information on the certificate should be as clear,
complete, and accurate as possible.
=Notification of Births.=--When the authorities of any district have
adopted the Notification of Births Act of 1907, it is the duty of any
person who has been in attendance on the mother at the time, or within
six hours after the birth, to give notice of the birth in writing
to the Medical Officer of Health of the district in which the child
is born. The necessary certificate must be filled in and posted to
the Medical Officer of Health within thirty-six hours of the time of
birth. The certificate applies to any child dead or alive born after
the twenty-eighth week of pregnancy. Should the relatives of, or other
attendant upon the mother, fail to notify the birth, it is the duty
of the medical attendant to do so, failing which he may be fined not
exceeding twenty shillings.
=Notification of Infectious Diseases.=--By the Act of Parliament
1889, every medical practitioner attending on or called in to visit
the patient, shall forthwith, on becoming aware that the patient is
suffering from an infectious disease to which the Act applies, send to
the Medical Officer of Health of the district a certificate stating the
name of the patient, the situation of the building, and the infectious
disease from which in the opinion of such medical practitioner the
patient is suffering.
The notifiable diseases are: smallpox, cholera, diphtheria, membranous
croup, erysipelas, scarlatina or scarlet fever, typhus, typhoid,
enteric, relapsing, continued and puerperal fever.
By consent of the Local Government Board the Health Authorities may add
other diseases as occasion may require for a time or permanently. Of
these due notice is given to medical men. Tuberculosis and ophthalmia
neonatorum are now notifiable. The fee for the certificate in private
practice is 2_s._ 6_d._, if in a public institution, 1_s._ Failure to
certify renders the medical man liable to a penalty of 40_s._
=Notification of Tuberculosis.=--As mentioned previously, tuberculosis
is now a disease notification of which is compulsory. Special forms are
provided for the purpose.
=Notification of Industrial Diseases.=--Under the Factory and Workshop
Act, 1901, every case of lead, phosphorus, arsenical, or mercurial
poisoning, or anthrax, if contracted in a factory or workshop must be
notified by the practitioner in attendance on the case. The certificate
must be sent to the Chief Inspector of Factories at the Home Office,
London. The fee for notification is 2_s._ 6_d._ Other diseases may be
added to the list by special order of the Home Office.
=Written Opinions.=--These generally refer to civil questions.
=The Medical Report.=--A _Report_ is a document given in obedience to a
demand by the public authorities in Scotland, and has reference chiefly
to criminal cases. Medical Reports are sworn to as true by those who
draw them up. According to Alison, it is not a sufficient objection
that a Medical Report was made up at an interval after the occurrence
of the circumstances to which it refers. The same high authority also
states that should the writer of a Medical Report die before the trial,
his Report may be used in evidence,--this may be doubted.
The necessity for simplicity in the arrangement and in the wording of
their Reports cannot be too strongly urged on medical men. “A medical
witness will do well to remember, also, that copies of his Report and
depositions, either before a coroner or a magistrate, are usually
placed in the hands of counsel as well as of the Court; and that his
evidence, as it is given at the trial, is compared word for word with
that which has already been put on record.” All hearsay statements and
irrelevant matter should not be inserted in a Report; and the reporter
should be particularly careful not to add any comments to his simple
narration of facts. The use of superlatives is also very objectionable,
as it partakes somewhat of exaggeration. All technical words or phrases
should be as much as possible avoided; and where they are absolutely
necessary, they should be briefly explained.
As a case in point, showing the necessity for care in the use of words,
is the following from a published Paper by the late Sir R. Christison:
“Some years ago, on an important trial in the High Court of Justiciary
for assault, the public prosecutor attempted to prove that the person
assailed had been wounded to the effusion of blood; which is held in
law to be an aggravation of guilt in such cases. When the principal
medical witness was examined as to the injuries inflicted, he was asked
whether any blood had been effused; and he replied that a good deal
must have been effused. But he meant that there was effusion of blood
under the skin, constituting the contusion he had described; while the
counsel and the Court at first received his answer as implying that
there had been considerable loss of blood from a wound. The latter view
was on the point of passing to the jury as a fact, when one of the
judges detected the equivoque, and set the matter to rights.”[1]
[1] _Monthly Journal of Medical Science_, 1851.
In Scotland a medical practitioner may be called upon by the
authorities to grant reports as to dead bodies, without performing a
_post-mortem_ examination.
In the first case, where a death has occurred unaccompanied by any
suspicious circumstances, or where the evidence of suicide or death
from accidental injury is apparent from a simple examination of the
body, a certificate “on soul and conscience,” stating the probable
cause of death, is considered sufficient by the authorities, and a
_post-mortem_ is dispensed with. It is not necessary that the deceased
be seen by the medical practitioner before death, “yet, from the
suddenness of the death, the age of the deceased, and the symptoms
spoken to by the friends, he may still be enabled, satisfactorily to
himself, to certify the cause of death.” In England, such a case would
be the subject of a coroner‘s inquest.
In the second case, he may be summoned by a constable to inspect a body
found on the public road, or in any other unusual situation. In this
case he is called not only to certify the fact, but also the probable
_cause_ of death. He may, under these circumstances, give a report of
the external examination of the body, at the same time suggesting the
necessity for further and more careful examination by dissection, &c.,
and this is considered the proper course for him to take. In England,
in this case also, an inquest would be necessary. In all cases medical
men will consult their own interests in giving these Reports.
A Medical Report consists of two parts--the _Minute of the
Examination_, and the _Reasoned Opinion_ on the first portion of the
Report. In the case where the Report is made by two or more persons
appointed for the purpose, the latter portion is written in the plural,
and signed by each of the parties certifying.
The following is an outline of a Medical Report, which may be more or
less modified to suit the requirements of the case:
FORM OF MEDICAL REPORT
(_Date._) (_Place of Examination._)
(_Names of those who can speak to the Identity of the Body._)
I. MINUTE OF THE EXAMINATION
1. External Inspection
1. General Condition of the Body.--(_a_) _Well or ill
nourished._ (_b_) _General colour._ (_c_) _Marks and
scars._ (_d_) _Products of disease--Ulcers, hernia,
&c._ (_e_) _Injuries._
Caution.--There may be no external marks of injury,
and yet death may be due to violence. Extreme difficulty
in deciding if injury be inflicted before or after death.
2. Height.--_Determined by measurement._
3. Age.--_This can only be approximately guessed._
4. Sex.--_This is, of course, only difficult when
putrefaction is far advanced. Hair found only on the_
MONS VENERIS or PUBES _is characteristic
of the female, but if it extend upwards on the abdomen,
equally so of the male. No sex can be distinguished in the
embryo before the third month of intra-uterine life._
5. Colour of the Eyes.--_Difficult of determination._
Why? (_a_) _Disagreement of observers._ (_b_)
_Presence of putrefaction._
6. Colour of the Hair.--_This is necessary, in order to
compare hair of deceased with that found on suspected party._
7. Position of the Tongue.--_Normal or abnormal, injured
or uninjured._
8. Condition and Number of the Teeth.--(_a_)
_Complete._ (_b_) _Incomplete._ (_c_) _Any
peculiarity as regards size or form, in order to
compare with mark or bite on suspected party, &c._
9. Signs of Death.--_Presence or absence of the_ rigor
mortis _or supervening putrefaction_.
10. Condition and Contents of the Hands and
Nails.--(_a_) _In the drowned: weeds, sand, and
signs of long immersion._ (_b_) _In those shot:
scorching or blackening of the hand from powder, or
injury from recoil of the weapon._ _Is the weapon
grasped firmly in the hand?_ _Cadaveric spasm?_
_Cadaveric rigidity?_
11. Condition of the Natural Openings of the
Body--Nose, Mouth, &c.--(_a_) _Presence of sand or
weeds in mouth of those found in the water._ (_b_)
_Presence of marks of corrosive poisons._ (_c_)
_Presence or absence of the signs of virginity, or
of recent injury about the parts._
12. Condition of the Neck.--(_a_) _Presence of marks
of strangulation._ (_b_) _Condition of the upper
cervical vertebræ._ (_c_) _Dangers to be avoided
in determining the fracture or dislocation of the
cervical vertebræ. Great mobility of neck, sometimes
present, not due to injury of the bone._
2. Internal Inspection
_A. Cranial Cavity._
1. Condition of the bones of the skull.
2. Condition of the membranes and sinuses of the brain.
3. Condition and appearances of the brain substance.
4. Contents of the lateral ventricles.
_B. Thoracic Cavity._
1. Position of the organs on opening the chest.
2. Condition of the heart, large blood-vessels, and
pericardium.
3. Condition of the larynx, trachea, lungs, pleura, pharynx,
tongue, and gullet.
_C. Abdominal Cavity._
1. Position of the abdominal organs.
2. Healthy or diseased condition of the liver, spleen,
stomach, intestines, pancreas, bladder and ureters,
prostate, kidneys and supra-renal glands, uterus and
ovaries, blood-vessels and peritoneum.
3. Contents of the stomach and bladder.--_Should it
be necessary to remove the stomach and intestines, two
ligatures should be placed at the cardiac extremity of the
stomach and also at the pyloric end, and cut between the two
ligatures, then the stomach may be removed intact; and other
ligatures at the end of small intestines, also the rectum,
and the bowels then removed as conditions demand._
4. Condition of the blood-vessels.
5. Condition of bones and joints.
II. THE REASONED OPINION
In this portion of the Report the inspectors state the
nature of the conclusion at which they have arrived, and
their reasons.
_Recapitulation of the foregoing Rules._--It may be
of advantage here to restate, in a tabular form, a few
suggestions as to the composition of the Report:
_N.B._--1. Let the Report be as short as possible, but
state your views with clearness and distinctness. After
stating the nature of the disease in any organ, report
“all other organs healthy,” if they have been found so. To
specify some organs, omitting others, may lead to a pressing
inquiry from counsel as to the condition of the supra-renal
capsules, or some other organ, and an unfounded doubt cast
on the Report of the examiner.
2. Always avoid the use of technical terms as far as
possible, so that you may be saved the annoyance of having
to explain your meaning in the witness-box.
3. Express all dates and numbers in writing. Measure all
marks, and describe their size and appearance in writing.
Carefully write all names of persons to whom reference
is made. Take accurate notes, and from them compose your
report. Make a list of all articles submitted for inspection
and analysis, and label them.
4. State all facts clearly and chronologically. A
_fact_ is what is known directly and personally to
witness, and not what has been repeated by some
other person. Do not report hearsay testimony as
matters of fact.
5. Every report should be written under the impression that
it may come into court to be read.
6. Always avoid superlatives and all epithets of feeling or
impressions on the mind.
7. Always avoid speculative opinions and reference to moral
circumstances, unless specially required to do so.
8. State your conclusions at the end of the Report in as few
sentences as possible.
9. Keep a rough draft of all your Reports, for future
reference.
10. Transmit Report, signed and dated, without unnecessary
delay, to the proper authorities.
=Dying Declarations.=--The principle on which these are accepted is
founded, partly on the awful situation of the dying person, and partly
on the absence of interested motives in one on the brink of eternity,
and which is supposed to obviate the necessity of a cross-examination.
The law presumes that any one cognisant of impending death will tell
the truth, and such declarations are equal to evidence on oath. The
greatest care must be taken by the medical man who is called in to see
a person supposed to be dying, with regard to any declaration he or
she may wish to make. He must be satisfied as to the mental condition
of the person. The medical attendant should simply take the statement
as it is made, writing it down on the spot, or as soon after as
possible. The identical words used should be committed to paper, and
no suggestions or interpretations of his own should be made. Leading
questions should never be put, nor any attempt made to induce the
patient to make any statement. When we consider the condition of the
patient, the possibility of delirium induced by the severity of the
injury, together with the dread of death, it is, to say the least,
injudicious to introduce the suspected party into the room for the
purpose of identification, though this procedure has been suggested
by some writers. In every case, however, it is advisable for the
medical attendant, as soon as he sees that the case must end fatally,
to acquaint the patient in the presence of others of the fact, when
any statements made may then be taken. It is preferable that such
statements be made before a magistrate if time will allow. It should
also be borne in mind by those receiving dying declarations, that in
England “it must be shown that the deceased, at the time he made the
statement, was under the impression that death was impending; not
merely that he had received an injury from which death must ensue,
but that, as the popular phrase goes, ‘he then believed he was on the
point of death’” (R. _v._ Forester). In one case (R. _v._ Fagent, 7 C.
& P. 238) it was held that a declaration was inadmissible, because the
person making it asked some one near her whether he thought she would
“rise again”; and it was held that this showed such a hope of recovery
as rendered the previous declaration inadmissible. The declaration
should be signed by the person making it, and witnessed by some one
present at the time.
In the case of Reg. _v._ Whitmarsh (Central Criminal Court, Sept.
19, 20, 21, 1896), 62 J.P. 680. Upon an indictment for the murder of
a woman, who died as the result of the prisoner having used certain
instruments or other means upon her with the intent to procure her
miscarriage, it was shown that an inspector of police had seen her at
Charing Cross Hospital. He asked her questions, and from her answers
he wrote down a statement. The woman signed it. On July 7 the woman
appeared to be in a dying condition, and was aware of it. She said she
feared she must die, and asked to see her mother and a clergyman. The
doctor told her that he had given up all hope, and that she might not
live to see her mother. A magistrate saw her shortly afterwards, and
read over to her the statement she made on June 29, and he affixed to
it the following note, “This statement was read over to Alice Bayley
by me, and is referred to in her dying declaration,” and signed.
_Held_ (Darling, J.), that though this statement might be admissible,
it had better not be admitted in evidence. On the same day the woman
had also made a statement to the magistrate, of which he had taken
note, but before it was finished she became exhausted. The magistrate
then took the statement of June 29, repeated portions of it to her in
his own words, wrote these down, and asked her if it was correct. He
then read the whole statement to her and she signed it. The statement
commenced, “Having the fear of death before me, and being without hope
of recovery”--concluding with the words, “And the statement I made on
the 29th of June, and have now heard read over, is true.”
Justice Darling held this statement was admissible as a dying
declaration.
In the case of Rex _v._ Smith, 65 J.P. 426 (Bruce, J., Central Criminal
Court). A magistrate and a doctor visited a dying woman for the purpose
of taking her statement. In reply to a question put to her by one of
them, she said, “I am aware that I am seriously ill.” The magistrate
asked her questions and the doctor wrote down the answers. At the trial
the statement was objected to as inadmissible as a dying declaration
on two grounds: Firstly, that the statement consists only of answers
to questions put to her by the magistrate, and so comes within the
ruling of Cave, J., in Reg. _v._ Mitchell, 17 Cox C.C. 503, that “a
declaration should be taken down in the exact words which the person
who makes it uses, in order that it may be possible from those words
to arrive precisely at what the person meant. When a statement is not
the _ipsissima verba_ of the person making it, but is composed of a
mixture of questions and answers, there are several objections open to
its reception in evidence.... In the first place, the questions may
be leading questions, and in the condition of a person making a dying
declaration there is always very great danger of leading questions
being answered without their force and effect being fully comprehended.”
Secondly, the prosecution had not shown that at the time the woman made
the statement she was in expectation of immediate death.
The judge held (1) That the prosecution had not proved that in her own
opinion the woman was beyond all hope of recovery, and that therefore
the statement was inadmissible; (2) That such a statement--the
magistrate asking her questions and the doctor taking down only her
answers in writing--was not admissible as a dying declaration.
In the case of Rex _v._ Holloway, 65 J.P. 712 (Wills, J., Central
Criminal Court). The prisoner threw a burning lamp at his stepson and
set fire to his stepdaughter, who succumbed to the burns she received.
A deposition of the deceased girl was taken down by a magistrate. At
the time it was taken it was intended that it should be in accordance
with the provisions of the 1867 Act. The accused was present and had
full opportunity of cross-examining the witness. The deposition was
read over to the girl, and she assented to it, but could not sign it
because of the injuries to her hands. The magistrate who took the
deposition signed it. It was held that the deposition had been taken in
accordance with the provisions of the Indictable Offences Act, 1848,
sec. 17, and was admissible though it had not been signed by the girl.
The validity of a dying declaration has been called in question when
made by a person who has suffered a severe concussion of the brain,
and then recovered his sensibility. It is well known that under such
circumstances the recollection of what took place before or after the
injury is in many cases very imperfect, and the injured party may thus
draw unintentionally upon his imagination for his facts. In Scotland,
“the written deposition of a person who is dead is admissible, whether
the person were the party injured or not, if he would have been a
competent witness. It is not necessary that the deceased believe
himself to be dying when he emits the deposition, for his consciousness
of approaching death may be inferred from the nature of the wound,
or the state of illness or other circumstances of the case. Such
depositions are generally taken by a magistrate, but a declaration
deliberately made, though without an oath, and taken down ‘by a
creditable person,’ is admissible” (Macdonald, _Scottish Criminal Law_,
p. 512).
2. ORAL OR PAROL
A medical man may be called as a _common witness_, or as an _expert_
witness. In the _first_ case, he has only to state, as any other
witness might do, the facts that have fallen under his observation; in
the _second_, he has to interpret the facts he has himself observed, or
to give his opinion on facts noticed by others. In stating his opinion,
a medical witness must be prepared to back up his opinion by such
reasons as may be satisfactory to the understanding of his hearers,
“and this is the principal qualification of a medical witness, that
he make himself _intelligible to ordinary comprehensions_.” No man is
bound to give any testimony by which he may render himself liable to
any criminal prosecution. (See the ruling of Bailie, J., in the case of
Mr. George Patmore, tried for the murder of John Scott in a duel.)
At the trial, the witness is first examined by the party who calls him:
this is the examination-in-chief. He is then cross-examined by the
opposite party; and, lastly, re-examined by the former party, when he
is offered the privilege of explaining any discrepancies between his
examination-in-chief and cross-examination, but he must not introduce
any new matter, for by so doing he renders himself liable to be
cross-examined on it.
=The Use of Notes.=--All notes should contain a plain statement of the
facts, and, to render them admissible as evidence, they must be taken
_at the time_, and duly attested. From the notes prepared as before
mentioned a witness may refresh his memory, but they are not accepted
in its place. A witness may not read his notes as evidence, nor may
he refresh his memory by documents not his own and not produced, but
he may refresh his memory by looking at a document received from the
accused at the time of the offence, and kept by him (Geo. Wilson, jun.,
Aberdeen, May 1, 1861; 4 Irv. 42).
=The Use of Books.=--No witness is allowed to quote from books, or
to quote the opinion of other medical men on the subject, but he
may refer to facts. Sir Henry Littlejohn, in his papers on Medical
Jurisprudence,[2] gives some useful hints on this subject. It appears
that a medical witness, in an unguarded moment, stated that his opinion
was corroborated by a distinguished member of the medical profession
not engaged on the trial. The judge informed the witness that it was
most irregular to have other medical men present at the dissection than
those mentioned in the warrant, and that, if the witness did not feel
qualified for conducting such dissections, he had better resign the
post of medical inspector.
[2] _Edinburgh Medical Journal_, February 1876.
In England, at the request of both parties, the medical and scientific
witnesses may be excluded from the Court, but as a general rule they
are allowed to be in Court, and hear the whole of the evidence of
the case. In Scotland they are always excluded, although, by mutual
consent, “experts” may remain to hear the general evidence on which
they are to express their opinions, but when an expert is giving his
opinion the others must leave the Court. In the latter country also, a
medical witness who has been in Court cannot be examined on the facts
of the case, but only on matters of opinion. A medical man is, however,
sometimes allowed, on a special motion, to remain, although he is to
be examined as to facts, and withdrawn when other witnesses are to
be examined as to facts to which he is to speak. (See case of E. W.
Pritchard, H.C. 1865; 5 Irv. 88.)
In giving evidence the witness should--(1) Speak loudly and distinctly.
(2) Answer questions categorically--Yes or no. (3) Never use
superlatives. (4) Give answers irrespective of results of trial. (5)
Express no opinion as to guilt of prisoner; state facts only. (6)
Avoid using technical terms. (7) Avoid long discussions, especially
theoretical arguments.
When a quotation is made from a book by the examining counsel, the
medical witness, before replying to a question based on it, should see
that the quotation has been fairly and fully given, due regard being
paid to the context. Neglect of this precaution may lead him into
considerable difficulty.
A medical witness should remember that he is not retained for a party,
but in the cause of justice. He must, therefore, be candid in his
manner and simple in his language. Mr. Haslam remarks that, however
dexterous a witness may show himself in fencing with the advocate, he
should be aware that his evidence ought to impress the judge, and be
convincing to the jury. Their belief must be the test by which his
scientific opinion is to be established. That which may be deemed by
the medical evidence clear and unequivocal, may not impress the judge,
nor carry conviction to the jury.
The advice given by Sir W. Blizard may not be out of place here: “Be
the plainest man in the world in a Court of Justice; never harbour a
thought that if you do not appear positive, you must appear little
and mean for ever after; many old practitioners have erred in this
respect. Give your evidence in as concise, plain, and yet clear manner
as possible; be intelligent, candid, open, and just, never aiming at
appearing unnecessarily scientific. State all the sources by which
you have gained your information. If you can, make your evidence a
self-evident truth: thus, though the Court may at the time have too
good or too mean an opinion of your judgment, yet they must deem you an
honest man. Never, then, be dogmatic, or set yourself up for judge and
jury; take no side whatever, be impartial, and you will be honest. In
Courts of Judicature you will frequently hear the counsellors complain
when a surgeon gives his opinion with any of the least kind of doubt,
that he does not speak clearly; but if he is loud and positive, if he
is technical and dogmatic, then he is allowed to be clear and right. I
am sorry to have to observe that this is too frequently the case.”
=Liability of Medical Men to reveal Professional Secrets.=--The
question has arisen how far a medical man is bound to reveal the
secrets confided to him in his professional capacity as medical
attendant. This question was raised by Mr. Cæsar Hawkins in the trial
of the Duchess of Kingston (11 Harg. St. Tri. 243), before the House
of Peers, and decided by Lord Mansfield thus: “Mr. Hawkins will
understand that it is your (the other Peers) judgment and opinion that
a surgeon has no privilege, where it is a material question in a civil
or criminal course to know whether parties were married or whether a
child was born, to say that his introduction to the parties was in the
course of his profession, and in that way he came to the knowledge of
it. I take it for granted, that if Mr. Hawkins understands that, it is
a satisfaction to him and a clear justification to all the world. If a
surgeon was voluntarily to reveal these secrets, to be sure he would be
guilty of a breach of honour, and of great indiscretion; but, to give
that information in a Court of Justice, which, by the law of the land,
he is bound to do, will never be imputed to him as any indiscretion
whatever.” However objectionable it may be to the medical witness, and
be considered by him a breach of professional confidence, to reveal in
a Court of Law secrets known but to himself and patient, and regarded
as sacred, he has no privilege but to reveal them if demanded as
evidence, unless the evidence be such as might incriminate himself.
This is not the ruling in most Continental countries, where the medical
man claims the same privileges of secrecy as the priest in confessional.
3. EXPERIMENTAL
Under this head will be treated Identity and the examination of
the Living and the Dead, Real and Apparent Death, Cause of Death,
Exhumations, and Autopsies.
Identity
Examination of the Living.--With regard to the identification of the
living, the presence of a medical man is seldom required, but there are
many occasions when his opinion may be sought. Thus, under the Factory
Acts, he may have to examine children about whose age doubts may have
arisen. The Table on p. 33, giving the periods at which the teeth
appear, will assist him. A medical man may also be requested to give an
opinion as to the mental soundness or unsoundness of an individual. He
may also be consulted in cases where questions have arisen as to the
existence and character of certain marks on the body--of deformities,
either congenital or produced subsequent to birth, or of doubtful sex.
The marks which most frequently give rise to differences of opinion are
_nævi materni_, _scars_, and _tattoo marks_. In cases of doubtful sex,
the male organs may resemble the female, the female the male, or they
may be blended together in about equal proportions.
In all cases where an examination of a living person is required, the
consent of the person must be obtained, the nature of the examination
explained, and that any facts recorded will be used as evidence if
required. If the person refuse to be examined then it must not be
carried out.
Cicatrices.--The following questions may be put to the medical
expert--(1) Do scars ever disappear? (2) Can the age of a scar be
definitely stated?
In reply to the first and second questions, I shall quote the words
of the late Professor Casper: “Consequently the scars occasioned by
actual loss of substance, or by a wound healed by granulation, never
disappear, and are always to be seen upon the body; but the scars of
leech bites, or lancet wounds, or of cupping instruments, may disappear
after a lapse of time that cannot be more distinctly specified, and may
therefore cease to be visible upon the body. It is extremely difficult,
or impossible, to give any certain or positive opinion as to the age of
a scar.”
All cicatrices should be examined with oblique light and the aid of
a lens. In the early stages a cicatrix is of a red colour, changes
to brown, and later to white, and the surface glistens. In the
intermediate stages one could not give any positive evidence of the age
of a cicatrix. The probability is that a red cicatrix is a recent one,
a white cicatrix is not recent.
I have seen well-defined cicatrices upon the back of a Russian, after
incisions made by the blades of a cupping instrument fourteen years
previously, and in an Englishman after twenty-five years (R. J. M.
Buchanan).
Devergie states that where the brand of a galley-slave has vanished,
it may be recalled by slapping its usual position with the palm of the
hand. The scar remains white, while the skin round it is reddened. A
change of temperature to the part will sometimes cause the reappearance
of a vanished scar. Washing may also help to reproduce scars.
Cicatrices produced in childhood may grow with the ordinary growth of
the individual. The shape of a cicatrix will depend upon the character
of the wound which produced it; on the nature of the healing process;
on the elasticity or tension of the skin; on the convexity of the part;
and on the looseness of the subcutaneous cellular tissue. An incised
wound healing by the “first intention” will most probably leave a white
linear cicatrix; on the other hand, a wound healing by granulation will
leave a more or less irregular scar. The position of a wound on the
body also modifies the subsequent cicatrix; thus a linear cicatrix is
produced when the wound is in the long diameter of the limb, a more
or less oval one when across the limb. The retraction of the skin in
the latter case tends to draw the skin at right angles to the line of
incision, thus approximating the extremities of the cut, increasing
it in breadth and lessening it in length. Owing to one or more of the
above-mentioned conditions the typical cicatrix of an incised wound
is elliptical, tending, however, in some cases to assume a circular
form. Linear cicatrices are found chiefly between the fingers and
toes, and where the cutaneous surfaces are concave. In gunshot wounds
the resulting cicatrix is depressed and disc-shaped, and more or less
adherent in the centre to the subcutaneous tissues, and if the weapon
be fired close to the surface of the body, grains of unburnt powder
may be seen in the surrounding skin. Cicatrices from burns are, as a
rule, large, irregular, and superficial, and frequently give rise to
deformity. A scar left by caustics is circumscribed, deep and depressed
in the centre. Cicatrices in the groins are probably venereal; those in
the neck and under the jaw, strumous. Scars from operation incisions
are much less evident now than when wounds were more likely to
suppurate and heal by granulation. It is remarkable, after an incision
made with aseptic precautions and healing by first intent, as time
progresses the cicatrix becomes less and less noticeable, but they
can be detected by methods described above. Fine punctures and stitch
cicatrices may eventually leave little or no trace.
Dupuytren and Delpech state that the tissue formed in a cicatrix is
never converted into true skin--the _rete mucosum_ when once destroyed
never being re-formed. It contains no sebaceous glands, sweat glands,
or hair follicles, and is but slightly vascular. This may account
for the white colour of ordinary cicatrices, but even to this rule
exceptions may be taken, and dark brown patches of pigment have
been known to mark the situation of old lacerated wounds. It must
be remembered also that in irregular wounds and in incised wounds
which may heal with an uneven joint, that portions of skin may become
embedded or grow into the scar tissue and give rise to difficulty in
forming an opinion. I have seen a well-defined dark coloration of the
skin continue for three months after the application of a mustard
plaster, followed at the time by desquamation.
Tattoo Marks.--With regard to tattoo marks, the question of their
disappearance gave rise to considerable discussion in the celebrated
Tichborne case. On this subject the experiments of Hutin, Tardieu,
and Casper appear to point to the fact “_that tattoo marks may become
perfectly effaced during life_,” but that after death the colouring
matter with which the marks were made may be found in the lymphatic
glands. This is especially the case when vermilion is used. The most
permanent marks are made with Indian ink, powdered charcoal, gunpowder,
washing blue or ink, and vermilion. These are given in the order of
their permanency. Hutin found that in 506 men who had been formerly
tattooed, the marks had disappeared from 47 of the number. Not only
does permanency depend upon the colouring matter used, but also upon
the depth to which it has penetrated. If superficial, it may gradually
become effaced. If the material be carried down to the papillæ, it will
remain permanent, and can only be removed in such a way as to leave a
scar. But besides the spontaneous disappearance of tattoo marks from
the lapse of time, these marks may be artificially removed, and in such
a manner as to prevent the possibility of a definite opinion being
given as to their primary character. The presence of a scar in the
situation of a well-known tattoo mark is suspicious. Thus, the Claimant
had a scar on a part where it was sworn that Arthur Orton had been
tattooed. The application of strong acetic acid, potash, hydrochloric
acid and glycerole of papain appears to be the means adopted for the
removal of tattoo marks. Efforts are made to remove superficial tattoo
marks by removing the particles with needles. Tattoo marks according to
their position and design are useful evidence of identification.
Birth Marks.--The presence and characters of birth marks should be
noted for purposes of identification. Their removal may be possible,
but, except in such as are small and superficial, the process used
for removal leaves traces behind in the form of cicatrices or
irregularities of surface, which may generally be detected in oblique
light and with the aid of a good lens. Large moles or _nævi_ may he
excised, but a cicatrix will remain, which will differ in shape from
the original mark.
Congenital Deformities.--These offer no difficulty and are in many
cases permanent, such as intra-uterine amputations, constrictions,
abnormality of limbs, &c. Such conditions as hare-lip, cleft-palate,
herniæ;, &c., may be altered by surgical procedure, but leave permanent
records of this. Peculiarities in twins are interesting as to their
being of the “mirror image” or “identical” type.
Anthropometry.--This is principally used for the identity of habitual
criminals. The Bertillon method is based upon certain measurements of
the body, the principal of which are (1) the length of the head, (2)
width of head, (3) length of body, (4) length of trunk while sitting,
(5) distance between tips of mid-fingers with arms outstretched, (6)
length of left forearm, left middle finger, and left foot, (7) length
and width of right ear, (8) colour of irides. These measurements place
the person in one or other class, according to the special system of
classification.
[Illustration: Fig. 1.--First line (from left to right), plain
impressions of whorl (thumb), arch (second finger), radial loop
(forefinger).
Second line, rolled impressions of whorl (thumb), ulnar loop (fourth
finger).]
Finger Prints.--These are largely used as a means of identification
in criminal cases, either by prints left upon articles, or by
prints definitely made by the police authorities as a record for
identification purposes.
On articles, the finger prints may be rendered more visible by dusting
with some finely powdered material of dark colour which will adhere to
the impression, which may then be photographed and enlarged.
For purposes of record, the impressions are taken directly upon a
suitable surface of the bulbs of the fingers and thumbs after having
coated them with printer‘s ink. The impressions thus made show
individual peculiarities in the distribution and arrangement of the
ridges of the skin; and the chances of the markings of two individuals
being alike is about one in sixty-four millions. By means of the
pattern of these ridges, prints may be classified under the headings
of arches, whorls, and loops, with certain recognised modifications of
these. (See Figs. 1 and 2.)
[Illustration: Fig. 2.--First line (from left to right), plain
impressions of whorl (forefinger), ulnar loop (thumb), arch (second
finger).
Second line, rolled impressions of whorl (thumb), ulnar loop (third
finger).]
Eyes and Veins.--The angle of the eyes to the middle line of the face
is an aid to identity; this will show whether the equator of the eye
is on a plane at a right angle to the middle line, or above or below
it. Tamassia lays much stress upon the arrangement of the veins on the
back of the hands, which is an individual characteristic and one which
is not easily altered or likely to be. By compressing the arms with a
ligature the veins are made to stand out in relief and the backs of the
hands are photographed.
Other Peculiarities.--The identity of the accused may be further
proved by the absence or malformation of the =teeth= corresponding
with a bite on the party assaulted, or the impression of the teeth on
soft articles like cheese. Peculiarities of dentistry may be useful
in identification. Or it may be proved that the wound inflicted could
only have been made by a left-handed person, or in a manner peculiar to
those engaged in the slaughtering of animals--_e.g._ is the cut from
within outwards, as employed by butchers? The correspondence in the
size and peculiarities of the foot of the prisoner and the =footprints=
found in the vicinity of the crime is important as evidence. There
is considerable difference of opinion as to the size of a footprint
on the ground, Mascar of Belgium asserting that it is _smaller_ than
the foot that made it, Caussè, on the contrary, that it is usually
_larger_. It should be borne in mind that the size of the footprint
varies in running, walking, and standing, being smallest in running
and largest when the individual is standing, which may account for the
difference of opinion of the two observers just mentioned. This fact
should always be borne in mind when an examination is required to be
made of the footprints in the neighbourhood of the crime. A mark in the
footprint showing that the sole of the boot had been patched, or in
the case of the naked foot that there was some deformity of the toes,
would of necessity be important. The mark of the naked foot smeared
with blood has, in several cases, led to the identification of the
culprit. Photographs may be used as a means of identification. Casts of
footprints may be taken by smearing the print carefully with oil, and
pouring in liquid plaster of Paris, or by dusting it over with powdered
paraffin wax, and then melting it by holding a hot iron over the print;
this may be repeated until a sufficiently thick cast is obtained. Hot
solution of gelatine in water, mixed with oxide of zinc and glycerine
to the requisite consistence, may be used for the purpose.
Dyeing of Hair.--As a means of disguise the hair may be dyed, or the
colour may be changed from dark to light. For darkening the hair,
preparations containing permanganate of potash, or the acetate of lead,
bismuth, or nitrate of silver, are most frequently employed. Sticks of
nitrate of silver or lunar caustic are used for darkening eyebrows and
moustachios. A wash containing sulphide of potassium is used before
the application of the lead solution. This removes the grease, and
helps the rapid formation of the black sulphide of lead. Preparations
of henna are fashionable for the production of shades of copper to
rich brown. To detect fraud, some of the suspected hair should be
steeped in dilute nitric acid, the acid driven off by gentle heat,
and the nitrate dissolved in distilled water, and then sulphuretted
hydrogen passed through the solution, the result being the formation
of the black sulphide of lead. If silver be present, the addition of
hydrochloric acid will throw down the insoluble chloride of silver. If
careful examination be made of dyed hair, it will be found that the dye
is irregularly taken by the hair; the hair loses lustre, and I have
not unfrequently seen the hair close to the scalp white, or at least
several shades lighter than the rest. The scalp may also be seen more
or less discoloured, especially when nitrate of silver is used and
applied by the individual himself.
For lightening the natural colour, solutions of chlorine, of peroxide
of hydrogen, nitric and nitro-hydrochloric acids, of varying strengths,
are used. It must be remembered that the action of chlorine is by no
means uniform. The hair retains the odour of chlorine for some time,
even after repeated washing, and is hard, stiff, and brittle. Devergie
states that he has not succeeded in producing a perfect whitening of
the hair in less than from twelve to twenty hours. It must be borne in
mind that, under certain circumstances, dark hair may become suddenly
white. I have seen large patches of grey hair over the head, the result
of repeated attacks of neuralgia.
In the examination of persons whose hair is alleged to have been
dyed, it is necessary to compare the dyed hair with that from other
parts of the body, _e.g._ the pubes, or axilla, to wait and watch for
irregularities of colour as the hair grows, new growth being free from
dye, and if necessary to shave the part and compare the new growth with
other hair, also to examine carefully the skin in the position where
the dye has been applied. In one case which I noted, a man had been in
the habit of touching the moustachios and eyebrows with lunar caustic,
having previously damped it with his tongue; in time it produced
argyria which coloured the whole of his face, the body generally, but
most noticeable on the face.
[Illustration: Fig. 3.--Photo-micrograph of transverse section of
normal hair follicle, × 250. (R. J. M. Buchanan.)]
Examination of a Person said to have been Assaulted
Carefully examine the bruises, wounds, &c., to see if they could have
been inflicted as described. Ask no questions that may suggest an
answer. Examine all weapons said to have been used, and hand them over
to the police. In all cases where danger to life is imminent, send
for the Authorities, and take dying declarations, as these may become
evidence of vast importance, and, if properly taken, are as valid as if
given on oath.
Identity of the Dead
Much of what has been said under the heading of identity of the living
is applicable in examinations to establish identity of the dead.
The latter requires certain special details of examination owing to
the peculiar circumstances which may be present demanding them. The
material subject to examination may be incomplete, and difficulties
arise, so that it is essential to record every minute detail which may
be of value as evidence.
The purposes of examination under this heading are mainly related to
the questions of stature, age, sex, and special peculiarities of the
body.
It will be useful here to emphasize the importance of making a detailed
examination of the body. The examination, particularly the external
inspection, should be made in daylight.
If the body be seen where first discovered, note should be taken of the
exact position and attitude, of any signs of a struggle, of footprints
to or from the body; of bottles, medicines, vomit, or excreta near
the body, and which should be collected and retained. The expression
and colour of the face, the condition of the hands, the condition of
the dress as to tears and stains, the heat, amount of rigidity or
putrefaction, the presence of wounds and vital reaction in them.
If the body has been removed from the place where found, make similar
notes, remove the clothes, and compare any cuts if present in the
clothes with those on the body. Record for identification--nævi, moles,
tattoos, scars, hare-lip, cleft-palate, the mammæ, abnormalities of
fingers, teeth, bones, limbs, joints, &c.
An examination of the mouth, for the presence or absence of false
teeth, or of any peculiar formation of the jaw, may lead to the
identification of the body. In the case of Dr. Parkman, the
recognition by a dentist of the false teeth worn by the deceased led
to identification of the remains, and also to the discovery of his
murderer. The presence of an ununited fracture, as in the case of
Livingstone, may lead to the identification of the body. In one case
where a man was said to have died from a fracture of the ribs recently
caused by a blow, it was found on examination that the bones were
united by a firm callus, clearly showing that the skeleton produced
could not be that of the man alleged to have been murdered.
Record the height and if possible the weight. Note the sex, the
probable age, nutrition, and cleanliness or otherwise. Examine all
wounds, bruises, and describe them carefully, and marks, _e.g._
strangulation or throttling. Examine the hands carefully and describe
their peculiarities, also the colour of hair and eyes. Examine all the
apertures of the body for foreign bodies, or abnormal conditions, and,
in females, record carefully the condition of the external genitalia
and the presence or absence of the hymen.
Although a more detailed account of the method of carrying out
post-mortem examinations is given later on, it will not be out of place
here to point out briefly the steps of examination. I would again
emphasize the importance of making a thorough and complete internal
examination, leaving no organ unexamined. If there be no call for
special examination of the thorax or abdomen first, commence with
the examination of the surface of the brain, then proceed downwards.
Note the direction of any wounds and their depth. Examine all organs
for morbid changes, and in females, the vagina and uterus. Examine
the larynx and œsophagus. Remove injured bones and examine joints.
Remove the spinal cord. Always remember to note the contents of the
stomach and bladder in reference to the period at which death may
have occurred. Weigh all organs. Always remember the probability of
poisoning, and make your examination accordingly.
All fragments or injured parts of a body or its organs should be
preserved, and photographs taken of them.
It is better for two medical men to conduct the examination together.
Do not make the examination without an order from the coroner. A
medical man who is alleged as implicated in the cause of death should
not be present.
Identification of the dead may present special difficulties where
mutilation of the body has taken place, or where the body has been
severely burnt, or is disfigured as in cases of explosions or advanced
putrefaction. In such cases, fragments of clothes, ornaments, and
dental work may afford valuable evidence.
Occupation Marks.--As an aid to identification, it is important to
remember that certain trades leave marks by which those engaged in them
may be identified.
Thus, in shoemakers there may be more or less depression of the lower
portion of the sternum, due to constant pressure of the last against
the bone.
Tailors work sitting, with the legs crossed and the body bent forward.
The body is thus cramped, and the abdomen drawn in, and the thorax
projects over it, due to the manner of sitting. They frequently have a
soft red tumour on the external malleolus. A like tumour, but not so
large, may also be found on the external edge of the foot, and a corn
on the little toe.
Photographers have their fingers blackened by nitrate of silver,
pyrogallic acid and other developers, or stained yellow with bichromate
of potash.
Seamstresses have the index finger of the left hand roughened by the
constant pricking of the needle.
Copyists have on the little finger of the right hand, near its
extremity, a corn, and at the end of the middle finger a hard groove
made by the pen.
Violinists have corns on the tips of the fingers of the left hand,
harpists on both hands.
In smokers of pipes the incisors and canines are more or less worn by
the mouthpiece, but sometimes the groove is between the canines and
bicuspids. In cigarette smokers, the forefinger and thumb are stained
with tobacco juice, also between the index and middle fingers, on the
dorsum.
In coachmen, corns may be formed between the thumb and index finger,
and between the index and the second finger of the left hand, from the
pressure of the reins, and between the thumb and index finger of the
right hand, from the pressure of the whip.
In bricklayers, from the constant action of picking up bricks, the
flattening of the tip of the thumb and index finger of the left hand is
not uncommon.
Plasterers have corns on the external surfaces of the thumb and index
finger, due to grasping the “hawk” on which the plaster is placed
during their work.
Joiners and carpenters have callosities on the palm of the right hand
from grasping their tools, and between the thumb and index finger of
the right hand, also over the first interphalangeal joint of the right
index finger. The right shoulder is lower than the left.
The finger-ends of turners and coppersmiths are also more or less
flattened; in the latter, a deposit of the metal may take place.
=To ascertain the time which may have elapsed since death.=--This can
scarcely be determined with precision, as so much depends upon the
conditions under which the body may have been placed. The subject
under consideration is, therefore, beset with difficulties, and its
elucidation will require the greatest care on the part of the medical
expert. A careful attention, however, to the subjects treated in the
following pages will help to clear up many a doubtful point.
COOLING OF THE BODY
{ Covered by bed-clothes, or otherwise
(1) External { unexposed, when cooling will be dry
circumstances. { slower than in cold air quickly moving.
(2) Condition of the }
body itself. } Slow, if fat.
{ 1. Wasting diseases. Quick.
{ 2. Suffocation. Slow.
(3) Kind of death. { 3. Cholera, yellow fever, } Increase
{ rheumatic fever, and } of heat
cerebro-spinal meningitis. } after death.
The following circumstances must also be taken into consideration:
(1) Age. (2) Air--(_a_) moving; and (_b_) at rest. (3) Moisture. (4)
Warmth. (5) Nature of the supposed cause of death, as affecting cooling
of the body, and promoting the rapid advance of putrefaction. (6)
Presence or absence of the _rigor mortis_. Bodies may be preserved for
months if exposed to intense cold.
The following Table, compiled from the experiments of Devergie, may
be of use in aiding the expert to form his opinion, but it must be
borne in mind that, from the great difficulties which surround the
subject, the statements made are only approximately correct. The table
is divided into four stages or periods, the last being that in which
putrefaction commences:--
First.--_From a few minutes to twenty hours after
death_--Animal heat more or less present, but seldom
continuing longer than ten or twelve hours. Muscles
contract on the application of galvanic stimuli, and
in the earlier stage to blows.
Second.--_From ten hours to three days_--Body quite cold and
_rigor mortis_ well marked; muscles do not contract on
the application of stimuli. The age, mode of death,
and other collateral circumstances must, more or less,
be taken into consideration before an opinion can be
given.
Third.--_From three to eight days_--The body is quite cold,
and cadaveric rigidity has passed off. The muscles no
longer respond to any galvanic or mechanical stimulus.
The stage is modified and somewhat shortened in summer.
Fourth.--_From six to twelve days_--Commencement of
putrefaction. Putrefaction may, however, take place
on the first or second day after death; so that, as
before stated, care must be taken before any positive
decision can be given.
Stature.--As a general rule the length of the body is equal to
the distance between the tips of the middle fingers with the arms
outstretched. If an arm be missing, the length of the remaining one
multiplied by two, with the addition of 6 inches for each clavicle
and 1½ inches for the width of the sternum, will give the approximate
height. The femur is said to be equal to .275 of the body height. If
the skeleton be entire, the addition of 1½ inches for the soft parts
should be made.
Where only a limb or long bone or part of one be available, it is not
possible to give anything more than an approximate opinion of the
height.
Sex.--When mutilation, putrefaction, or charring has taken place,
by which the genitalia have been demolished, it may be difficult to
determine the sex. Evidence will be afforded by the distribution of the
pubic hair, which in the male reaches as high as the umbilicus, but is
horizontal with few exceptions in the female. Males have more hair on
the body generally.
The presence of moustachios and beard and the length of the hair on the
head will assist in sex determination.
The breasts if present will denote the sex, also the uterus, which
withstands putrefaction and burning to a marked degree.
Remains of clothing and ornaments will indicate the sex of the wearer.
Lineæ albicantes on the abdomen, buttocks, and breasts indicate the
female sex, and the probable occurrence of previous pregnancies. It
must, however, be remembered that lineæ albicantes occur in males who
have been stout or had the abdomen distended by disease.
The Skeleton in Relation to Identification.--When a complete skeleton
is submitted for examination, the chief points to elucidate are the age
and sex. These will be noted further on. It may happen that a single
bone, separate bones, or only a part of one is obtainable, when there
may be considerable difficulty in expressing a definite opinion. The
questions to be answered are: Are they human or belonging to the lower
animals? When the bones are entire the answer is not very difficult to
settle; but when parts of bones have to be dealt with, one has to be
very careful in forming conclusions, and the fragments may have to be
submitted, to a skilled anatomist. One may not be able to express an
opinion about bones of the lower animals, other than to state they are
not human. The services of a skilled Comparative Osteologist may be
necessary to decide the nature of the animal.
When fragments resembling bone have to be examined, the microscope
will be necessary to determine their osseous structure. When several
bones have to be examined it may be possible to build up part or the
whole of a skeleton. Duplicate bones will indicate remains of more than
one creature. All fragments and bones should be carefully described,
measured, and photographed.
By the character of the bones one may be able to determine the sex to
which they belong and the approximate age. As a general rule the bones
of the female are smaller, lighter, and less marked by muscular and
other attachments.
The thorax in the female is deeper than in the male, the sternum
shorter and more convex, the ensiform cartilage thinner and ossified
later in life. The cartilages of the ribs are larger and the ribs
smaller than in the male. The ribs are more oblique and may show the
results of long corset pressure. The body of the sternum is over twice
the length of the manubrium in the male, less than this in the female.
The length of the twelfth rib in the male averages 103 mm., in the
female 83.8 mm. The pelvis exhibits marked differences. The sacrum of
the male is more curved than that of the female, which is straighter in
the upper half and more curved in the lower. The male pelvis is more
compact, deeper, rougher, and narrower. The pubic angle is smaller, the
obturator foramen is oval, and the ischia incurved. The female pelvis
is more open, shallower, wider, not so rough, a wider pubic angle, and
shallower and broader symphysis, the ischia are everted, wider apart
and flatter, and the obturator foramen triangular. The inlet of the
female pelvis is greater in all its diameters.
The skull in the male is heavier and larger, the markings and ridges
being more pronounced, the mastoid processes, occipital protuberance,
zygomatic and superciliary ridges are more prominent, and the capacity
greater than in the female.
In the female the jaw is less prominent and has a wider angle.
The lumbar curve is longer in the female, and the lumbo-sacral angle
greater than in the male.
The angle made by the neck of the femur with the shaft is about a right
angle in the female, more obtuse in the male. It must be remembered
that these differences between the sexes are not present to the same
degree before puberty, so that prior to it the examination offers
little evidence as to sex.
When examining bones any injuries to their structure or other
abnormalities should be noted. The skull must be carefully examined
for fractures, especially the base, which may be easily overlooked.
Injuries to vertebræ should be looked for. The presence of callus will
indicate that fracture has occurred at a period before death long
enough for its formation.
Age.--There are several data which enable one to form a fairly accurate
opinion as to the age of a body, these are especially useful in earlier
years and intra-uterine life.
The more general are the size, height, development, the presence or
absence of signs of puberty, the state of dentition, the greyness of
the hair; in the female the atrophic condition of the uterus after the
menopause, and the character of the lower jaw.
In addition are the time of life at which centres of ossification
appear and the union of epiphyses to the shafts of bones and bones with
each other.
In intra-uterine life centres of ossification appear by the end of the
sixth month in the os calcis, manubrium, and the bodies and laminas of
the sacral vertebræ; by the seventh, in the first piece of the body of
the sternum and the astragalus; by the eighth, in the second piece of
the body of the sternum; at full term in the cuboid, third piece of the
sternal body, first coccygeal vertebra, and the lower epiphysis of the
femur.
All traces of the fontanelles have disappeared by the end of the
fourth year. The angle of the jaw in infants and young children is
obtuse; as dentition proceeds, the body becomes deeper and the angle
alters so that towards adult life it approaches a right angle, the
ramus is longer and the body has become well developed with a mental
foramen midway between upper and lower borders. In the new-born, the
mental foramen is low down as the body of the jaw is practically all
alveolar. In old people the angle again becomes obtuse and the alveolus
disappears as the teeth are shed, and the mental foramen is at the
upper border.
Table of the Eruption of the Teeth
Age--Eruption of teeth.
Lower central incisors, 7 months. }
Upper “ “ 8 “ }
“ lateral incisors, 7-10 “ }
Lower “ “ 10-12 “ } Temporary.
First molars, 12-14 “ }
Canine teeth, 18 “ }
Second molars, 22-24 “ }
First molars, 6 years. }
Middle incisors, 7 “ }
Lateral incisors, 8 “ }
First bicuspids, 9 “ }
Second bicuspids, 10 “ } Permanent.
Canines, 11-12 “ }
Second molars, 12-13 “ }
Wisdom teeth, 18-25 “ }
Examine the lower jaw. The ramus forms an obtuse
angle in full-grown fœtus, a right angle in adult
life, obtuse in old age from loss of teeth.
Table showing the Periods at which Points of
Ossification appear after Birth
Years of Life. Bones in which Centres of Ossification appear.
1. Fourth piece of the body of the sternum; coracoid process
of scapula; head of humerus; os magnum (carpus);
head of femur; upper end of tibia; external cuneiform
(tarsus).
2. Lower end of radius; unciform (carpus); lower end of tibia;
lower end of fibula.
3. Great tuberosity of humerus; patella; internal cuneiform
(tarsus).
3-4. Upper end of fibula.
4. Great trochanter (femur); middle cuneiform (tarsus).
4-5. Scaphoid (tarsus); lower end of ulna.
5. Lesser tuberosity (humerus); internal condyle (humerus);
trapezium and semi-lunar (carpus).
5-6. Upper end of radius.
6. Scaphoid (carpus).
7. Trapezoid (carpus).
10. Upper end of ulna.
12. Pisiform (carpus).
13-14. External condyle (humerus); small trochanter (femur).
Periods of Union of Epiphyses with the Shafts of Bones,
and of Bones with each other
Years of Life.
1-2. Symphysis of lower jaw.
2. Frontal suture; unites from below upwards; it may persist.
Anterior fontanelle filled up.
7-8. Rami of ischium and pubes.
17. Epiphyses of upper end of ulna; small trochanter (femur).
17-18. Epiphyses of condyles (humerus); upper end of radius.
18. Epiphyses of great trochanter of femur; lower end of tibia;
lower sacral vertebræ; portions of acetabulum united.
19. Epiphyses of the head of the femur.
20. Epiphyses of the head of the humerus; lower end of radius
and ulna.
21. Epiphyses of the upper end of tibia; lower end of fibula.
24. Epiphyses of upper end of fibula.
25. Second and third pieces of sternum; first and second sacral
vertebræ; epiphyses of clavicle, lower end of femur.
40. Manubrium, with body of sternum.
Table showing the Development of the Embryo
according to the Lunar Months
----------+----------+------------+----------------------------------
Month. | Length. | Weight. | Observations.
----------+----------+------------+----------------------------------
_First_. | | |
(3rd or | Four to | Twenty |The embryo is curved; the mouth on
4th week.)|six lines.| grains. |the cephalic extremity appears as
| | |a cleft, and the eyes as two
| | |black points. Nipple-like
| | |protuberances mark the position of
| | |the extremities. The heart can be
| | |seen, and the liver is
| | |disproportionably large.
----------+----------+------------+----------------------------------
_Second_. | | |
(End of |Fifteen to| Two to |The head disproportionably large.
8th week.)| eighteen | five |Nose, lips, and external parts of
| lines. | drachms. |generation visible, but sex
| | |doubtful. Anus appears as a dark
| | |point. Abdomen encloses the
| | |internal organs. Extremities
| | |project slightly from the trunk.
| | |_Ossification_ in _clavicle_ and
| | |_lower jaw_ about end of_ seventh
| | |week_; in _frontal bone_ and
| | |_ribs_ towards end of _eighth
| | |week_.
----------+----------+------------+----------------------------------
_Third_. | | |
(End of | Two to |One to two |Eyes and mouth closed. Fingers well
12th week.)| two and | ounces. |separated; nails recognisable. The
| a half | |sex can be detected by the aid of
| inches. | |a lens. Suprarenal capsules and
| | |thymus gland are formed. The
| | |cavities of the heart and divisions
| | |of the brain distinct. The placenta
| | |isolated; the umbilical vesicle,
| | |allantois, &c., have disappeared.
----------+----------+------------+----------------------------------
_Fourth_. | | |
(End of | Five to | Two and |The skin rosy and tolerably dense.
16th week.)| six | a half |Sex seen without aid from lens.
| inches. | to three |The mouth is large and open; the
| | ounces. |umbilicus is near the pubes.
| | |Meconium of a greyish-white
| | |colour in the large intestines.
----------+----------+------------+----------------------------------
_Fifth_. | | |
(End of | Ten to | Seven |From the fifth month the length of
20th week.)| eleven | to ten |the fœtus in inches is almost
| inches. | ounces. |_exactly double the number of the
| |varying in |lunar months_. The nails are
| |individuals.|distinct. The head, liver, heart,
| | |and kidneys are disproportionately
| | |large. The hair appears as a light
| | |down. The meconium is of a
| | |yellowish-green colour. Points of
| | |ossification, pubes and os calcis.
----------+----------+------------+----------------------------------
_Sixth_. | | |
(End of |Twelve to | One to two |Down and sebaceous matter cover
24th week.)| thirteen | pounds. |the skin. The colour of the body
| inches. | |is a cinnabar-red, and the
| | |umbilicus is farther from the
| | |pubes. The meconium is darker
| | |in colour; and the scrotum is
| | |empty, the testes being close
| | |to the kidneys. The pupillary
| | |membrane is still present.
----------+----------+------------+----------------------------------
_Seventh_. | | |
(End of | Fourteen | Three or |The skin is of a dirty-red colour;
28th week.)|to fifteen|four pounds.|the hair about half an inch long,
| inches . | |and plentiful. Membrana pupillaris
| | |disappearing; eyelids non-adherent.
| | |The large intestine quite full of
| | |dark olive-green meconium.
| | |Fontanelles distinctly felt.
| | |Liver still large, of a
| | |dark-brownish colour.
----------+----------+------------+----------------------------------
_Eighth_ | | |
(End of |Fifteen |Three to |The skin, covered with soft hair,
32nd week.)|to sixteen|five pounds.|is more of a rosy flesh-colour.
|inches. | |Disappearance of the pupillary
| | |membrane, and descent of the
| | |testicles into the scrotum. The
| | |open vulva exposes the clitoris to
| | |view. The nails almost reach the
| | |tips of the fingers.
----------+----------+------------+----------------------------------
_Ninth_. | | |
(End of |Sixteen to|Six pounds. |The head covered with hair;
36th week.)| eighteen | |the down on the body closing.
|inches. | |
----------+----------+------------+----------------------------------
_Tenth_. | | |
(End of | Eighteen | Seven to | Well-known signs of maturity.
40th week.)|to twenty | nine |
| inches. | pounds. |
----------+----------+------------+---------------------------------------------------------------------
Table giving the Measurements, according to the Months, of the
Extremities of the Fœtus in the Order of their Development
+-------+-----------+----------+------------+---------+------------+
| | Third. | Fourth. | Fifth. | Sixth. | Seventh. |
+-------+-----------+----------+------------+---------+------------+
|Humerus| 3½ lines.| 8 lines.|13-15 lines.|16 lines.|20-22 lines.|
|Radius | 2½ “ | 8 “ | 12 “ |16 “ | 17 “ |
|Ulna | 3 “ | 8 “ | 13 “ |17 “ | 18 “ |
|Femur |2-3 “ |4-5 “ | 12 “ |17 “ |19-21 “ |
|Tibia |2-3 “ |4-5 “ | 12 “ |17 “ |19-21 “ |
|Fibula | 2½ “ | . . . | 12 “ |17 “ |19-21 “ |
+-------+-----------+----------+------------+---------+------------+
+-------+------------+------------------+
| | Eighth. | Full Period. |
+-------+------------+------------------+
|Humerus|23-24 lines.|3 inches. |
|Radius |18-19 “ |2 “ 8 lines.|
|Ulna |22-23 “ |2 “ 10 “ |
|Femur | 24 “ |3 “ 6 “ |
|Tibia |21-23 “ |3 “ 2 “ |
|Fibula |21-23 “ |3 “ 1 “ |
+-------+------------+------------------+
Table showing the Maximum and Minimum Dimensions of the Osseous
Nucleus of the Inferior Femoral Epiphysis from the Seventh Month of
Intra-Uterine Life to Two Years after Birth
+------------+-------------+------+-----------------------------------------+
| |INTRA-UTERINE| | EXTRA-UTERINE. |
| | | | +-------------------+ |
| | | | | | |
| | | | Days. Months. |
| +-------+-----+ +-----------------+-----------------------+
| |Seventh|Ninth|Mature| 1-8 9-15 16-28| 1 3-6 7-12 12-24|
| +-------+-----+------+-----+-----+-----+-----+-----+-----+-----+
| | |lines| lines|lines|lines|lines|lines|lines|lines|lines|
+------------+-------+-----+------+-----+-----+-----+-----+-----+-----+-----+
|Maximum | | 2 | 4 | 3½ | 3½ | 2½ | 5 | 4 | 8 | 7 |
|Minimum | | “ | ¾ | 1 | ¾ | 1½ | 2 | 2 | 3 | 5 |
| | | | | | | | | | | |
| No. of } | | | | | | | | | | |
|Children}125| 31 | 9 | 52 | 8 | 3 | 2 | 9 | 3 | 6 | 2 |
|examined} | | | | | | | | | | |
+------------+-------+-----+------+-----+-----+-----+-----+-----+-----+-----+
CHAPTER III
MODES OF DYING, SUDDEN DEATH, SIGNS OF DEATH
MODES OF DYING
Syncope--death beginning at the heart.
Asphyxia--death beginning at the lungs.
Coma--death beginning at the brain.
=Syncope.=--From δνγκοπτω, _I strike down_. Sudden arrest of the action
of the heart.
This condition may be brought about by
1. Deficiency of blood due to hæmorrhage--_death by anæmia_.
2. Effect of certain diseases and poisons, &c.--_death by asthenia_.
Causes--_Heart Disease._--Aortic regurgitation, fatty degeneration, &c.
_Hæmorrhages_ from wounds of blood-vessels or the heart, profuse
hæmoptysis or hæmatemesis, uterine hæmorrhage, bursting of varicose
veins, bursting of aneurysms.
_Shock._--Emotion; blows on the head or epigastrium; sudden evacuation
of fluids from the body, as in emptying an over-distended bladder,
tapping a hydrocele, ascites, or a pleural effusion. Extensive
injuries to the body (railway and machinery accidents). Drinking large
quantities of cold water when heated.
_Exhaustive diseases_, chronic or infective.
Symptoms.--Pallor of the face and mucous membranes, dimness of vision,
cold perspirations, sense of impending death, restlessness, air hunger
and gasping for breath, nausea, and, maybe, vomiting, noises in the
ears, passing delirium, quick, feeble, and fluttering pulse, or the
latter may be imperceptible at the wrist, insensibility, convulsions.
In ordinary fainting attacks many of the above symptoms are absent;
such as are present are temporary. In collapse, consciousness is
retained.
Post-mortem Signs.--The cavities of the heart contain a normal quantity
of blood in death by asthenia, but may be almost empty when death
is due to anæmia. The blood in asthenic death is simply arrested in
its course; blood is, therefore, found in the large veins and in the
arteries. The brain and the lungs are not engorged with blood.
=Asphyxia.=--From ἀ priv. et δφνξιϛ, pulse. Apnœa is the better
term--ἀ priv. et πνεω, I _respire_; but this word is now used by
physiologists to denote a cessation of the respiratory movements due
to artificially oxygenated blood. Blood in this condition fails to
excite the respiratory centre in the medulla, and respiration ceases.
To avoid confusion the term asphyxia had better be retained, especially
as it is most commonly used and generally understood. Asphyxia, or
death from defect in the quality of the blood, is brought about when
any impediment is placed on the healthy action of the lungs. Experiment
has shown that for a short time after respiration has ceased, the
heart still continues to act, and that if the impediment to the proper
aeration of the air by the lungs be removed, life may be prolonged.
Taking therefore the primary meaning of the terms asphyxia and apnœa
into consideration, it may be remarked that the latter precedes the
former in point of time--asphyxia marking the period at which the
action of the heart ceases, apnœa the cessation of the respiratory
functions.
_Causes of Asphyxia._--1. Mechanical obstruction to the air passages:
foreign bodies, exudations, tumours, suffocation, strangulation,
drowning, hanging, spasm of glottis from mechanical irritation, or
irritant gases.
2. Interference with the action of the respiratory muscles: exhaustion
of the muscles from cold; paralysis of muscles from injury to or
disease of respiratory centre; poisons acting on the centre; continued
pressure on walls of the chest; fixation of muscles from tetanus or
strychnine poisoning.
3. Diseases of and injuries to the lungs: pleurisy with effusion, acute
pneumonia, empyema, pneumothorax, pyopneumothorax, pulmonary apoplexy,
embolism of pulmonary artery.
4. Inhalation of air deficient in oxygen.
_Symptoms of Asphyxia._--Divided into three stages. _First stage_:
deep, frequent, and laboured respiration; the extraordinary muscles
of respiration are called into play. _Second stage_: the inspiratory
muscles are less active than expiratory, convulsions of nearly all the
muscles of the body occur. _Third stage_: paralysis of respiratory
centres, dilated pupils, loss of consciousness, absence of reflexes.
Gasping inspirations with prolonged intervals precede dissolution.
_Post-mortem Signs._--Engorgement of the pulmonary artery, the right
cavities of the heart, and vent cavæ; but on the left side of the heart
the cavities, together with the aorta and pulmonary veins, are either
empty or contain but little blood. It must be remembered, however, that
cases of asphyxia do sometimes occur where the cavities on each side of
the heart are _empty, or nearly so_. This is the case in the syncopal
asphyxia of some writers. If also the obstruction to respiration be
imperfect, the circulation may be continued for some time, congestion
of one or more of the internal organs being the result. The blood
is dark-coloured, contains much CO₂, and the hæmoglobin is almost
completely reduced. The blood coagulates slowly.
=Coma.=--Insensibility ending in death. _Causes._--Concussion of the
brain, cerebral hæmorrhage, embolism, thrombosis, tumour, depressed
fracture of skull, meningitis, and serous effusions; effects of
poisons such as opium, alcohol, ptomaines, arsenic, barium, oxalic
and carbolic acids; in certain diseases of kidneys and liver, uræmia,
cholæmia, acetonæmia, profound anæmia, _e.g._ pernicious, and as a
terminal stage to acute or chronic diseases.
_Symptoms of Coma._--Coma is generally preceded by stupor, from which
the patient may be roused to a certain extent, but only temporarily.
The reflexes in this stage may be exaggerated, and the power of
swallowing fluids may be retained. When coma is present there is
complete abolition of consciousness, sweating, the patient is
powerless, the breathing stertorous. The temperature may vary according
to the cause; normal or subnormal generally, it may rise in lesions
of the pons Varolii. The pulse is generally full and bounding, the
pupils dilated or contracted and insensitive to light, the conjunctival
reflex absent. Mucus collects in the air-passages and causes “the
death rattle,” and the breathing becomes more and more embarrassed and
irregular. The reflexes are lost, and the sphincters relaxed.
_Post-mortem Appearances._--Causal lesions are found in the brain or
other organs; there is usually hyperæmia of the brain and spinal cord
and their membranes, unless there be profound anæmia preceding death.
The condition of the heart and lungs is not constant; the general
appearances resemble those in death from asphyxia.
Table giving the Diagnosis of Several Forms of Insensibility
Injury to the Head--_Concussion of the Brain._--The symptoms are very
similar to those of shock, with unconsciousness, but it may be possible
to rouse the person. The pupils are equal and dilated or contracted,
and react sluggishly to light. The breathing is shallow and slow with
sighing, the pulse feeble. The muscles are relaxed but not paralysed.
Vomiting and involuntary micturition and defæcation may occur. The
temperature is usually subnormal.
Cerebral Compression.--This, when due to injury, is usually associated
with fracture of the skull and hæmorrhage. Insensibility is complete,
the person cannot be roused. The pupils may be unequal, contracted or
dilated, and may not react to light. The breathing is slow, stertorous,
and may be irregular, or Cheyne-Stokes in type. The pulse is full
and bounding, the cheeks are blown out during expiration. Paralysis,
rigidity, or convulsions may be present on one side of the body. There
may be retention of urine, with overflow incontinence.
In cases associated with severe fracture or hæmorrhage within the
skull, the conjunctivæ may be chemosed, or there may be hæmorrhage from
the nose or ear; and a flow of cerebro-spinal fluid may take place from
the nose.
Alcohol.--In coma due to alcohol, there will be an alcoholic odour of
the breath, alcohol in the stomach contents, and it can be detected
in the urine. The odour of alcohol in the breath may be due to the
administration of alcohol by an outsider at the onset of the symptoms
which have ended in the coma. The pupils are equal, contracted, the
conjunctival reflex present, and the pupil dilates on pinching the
skin of the neck. The pulse is rapid, at first strong it becomes
feeble, the respirations snoring. If the coma be not complete, muscular
inco-ordination may be noticed. The person can usually be aroused by
stimulation.
In pure alcoholic coma the presence of the special features of coma
from other causes will be absent. It must be remembered, however, that
alcoholic coma may be combined with other kinds, and the more serious
form should be kept in mind. Where there is the slightest doubt in the
diagnosis, one‘s procedure should be ruled by the possibility of the
graver cause.
Opium or Narcotic Poisoning.--The skin is usually perspiring freely,
moist and cold; the countenance placid, pale and ghastly, the lips
livid. The eyes are heavy, and the pupils contracted to a pin-head and
equal, the conjunctival reflex usually present. There is the odour of
opium in the breath. The pulse is slow, and the respiration stertorous
and slow. There is no paralysis, and the person can be momentarily
roused by a sharp question or blow.
Apoplexy.--The person is with difficulty, if ever, temporarily aroused.
The face is red and bloated. Respiration suspirious and stertorous,
and there is often Cheyne-Stokes breathing. The pupils are dilated or
irregular; in pontine hæmorrhage, contracted. The temperature may at
first be subnormal but gradually rises.
There may be rigidity of the limbs, or hemiplegia. The pulse is full
and bounding, often of high tension with hardened arteries.
Albuminuria may be present.
Uræmia.--This is less profound than in cerebral hæmorrhage; the
patient may be temporarily aroused; the onset is usually gradual.
There is albuminuria with casts; albuminuric retinitis may be present.
The pupils may be contracted or dilated. The breath has a peculiar
so-called “uræmic odour.” The pulse is generally slow, the tension
high, and the heart enlarged. The respirations are slow and sighing,
and may be Cheyne-Stokes in type. There is no paralysis. There may
have been preceding convulsions, and the coma may alternate with these
attacks.
Anasarca may be present.
Diabetic Coma.--This may come on suddenly, and may occur unexpectedly
in a person in whom diabetes has not been discovered up to the time of
coma. There is sighing respiration, “air hunger.” The odour of acetone
in the breath is present, and sugar in the urine.
Epilepsy.--Unconsciousness is profound, and comes on immediately with
rigidity, followed by convulsions, unilateral, limited to the side of
the face, jaws, head and neck or arm, or generalised. Bloody froth
exudes from the mouth, the tongue being bitten. The eyes are wide open,
the pupils dilated and insensible to light. Micturition may occur.
After the convulsive attack has passed off, post-epileptic coma may
remain, though usually for a short time only.
Syncope.--This has been described under modes of dying (p. 38).
In all cases of coma when first seen examine the head for signs of
injury, note the odour of the breath, observe the state of the pupils
and their reactions, examine the limbs for paralysis, count the pulse
and note its character, and the state of the arteries, note the size of
the heart and auscultate it at each area. Count and note the character
of the respirations, take the temperature, examine the urine, take note
of the person‘s age, and inquire into the previous history.
SUDDEN DEATH
Sudden death may proceed from natural or violent causes. From the
former, death may occur unexpectedly and very rapidly, but as a rule
the period of time occupied by the phenomena of “dying” is measurable,
though inconstant. Should such period of time be immeasurable, death
may be considered as instantaneous.
Apart from sudden death resulting from violence or poisoning, the
common causes are as follows:--
1. Diseases of the heart: angina pectoris, valvular diseases with
failure of compensation, especially aortic regurgitation, degeneration
of the heart muscle, rupture of the heart, heart failure from
diphtheria or toxic diseases.
2. Diseases of the blood-vessels: rupture of aneurysms or varicose
veins, thrombosis, embolism.
3. Cerebral hæmorrhage, especially when in the region of the pons
Varolii or cerebellum.
4. Lesions of the respiratory system: œdema or spasm of the glottis,
membranous deposit or foreign bodies in the larynx or trachea, foreign
bodies in the pharynx, tumours, whooping-cough, asthma, embolism
of the pulmonary artery, air embolism, fat embolism, rupture of a
vessel or aneurysm into the air-passages, as in phthisical cavities,
pneumothorax, hæmothorax, pleuritic effusion, and in acute pneumonia.
5. Rupture of a gastric ulcer or ulcer of some other part of the
alimentary tract.
6. Sudden hæmorrhage into the peritoneal cavity from ruptured uterus,
ectopic gestation, &c.
7. Rupture of internal organs: distended bladder, spleen, pregnant
uterus, or other abdominal viscus.
8. Hæmorrhage into the pancreas.
9. Conditions associated with the nervous system: mental emotions,
epilepsy, uræmia, laryngismus stridulus in children.
10. Sudden death has occurred in Addison‘s disease, in diabetes, in
cases of lymphatism or status lymphaticus in young people, during the
early stage of chloroform anæsthesia, during simple vaginal examination
in women, during the injection of fluids into the vagina or uterus.
Bouvalat (_Annales d‘Hygiène_, 1892) relates a case in which, as the
cannula of a syringe was being introduced into the os uteri of a woman
with the object of criminal abortion, she fell back before any fluid
was injected, and died in a few minutes.
A similar case came under my notice, in which death took place while
the husband of the woman was attempting to introduce a solution of 20
minims of tincture of iodine, mixed with water to measure two drachms,
into her uterus through a No. 3 catheter.
SIGNS OF DEATH
Real or Apparent Death
It will be unnecessary here to discuss any of the theories put forward
with regard to cases of apparent death or prolonged trance, but simply
to note in the order of their occurrence the phenomena which attend
real death.
Real Death
Under this heading it is important to draw a distinction between
“Somatic death” and “Molecular death.” “Somatic death” is defined as
“the cessation of the vital functions and of the general renewal of
tissue consequent on that cessation”; “Molecular death” is the death of
the tissues themselves.
The signs of death occur as follows:--
1. _Entire and continuous cessation of the respiration and circulation;
no sounds heard on auscultation._ The absence of the heart sounds is
the most important sign of death, for even in the severest forms of
syncope the cardiac pulsations, as shown by M. Bouchet, can with care
be heard.
=Tests for cessation of respiration:--=
(_a_) Auscultation. (_b_) Placing a cold hand-mirror or empty
drinking-glass over the mouth or nostrils, or a light feather, and
noting the presence or absence of bedewing or movement. (_c_) Placing
a shallow vessel, such as a saucer, full of water on the chest or
abdomen, and observing the presence or absence of rippling of the fluid
(Winslow‘s test).
=Tests for cessation of the circulation:--=
(_a_) Auscultation.
(_b_) Manual exploration of the principal arteries for pulsation or
thrill.
(_c_) Magnus‘s test, applying a ligature tightly round a finger,
sufficient to stop the venous but not the arterial circulation, and
noticing whether or not a bloodless ring forms at the seat of ligature,
and a zone of livid redness on the distal side of the ligature, the
part becoming first red, then purple.
(_d_) Applying pressure to the finger-nail, and noticing whether the
colour disappears on pressure, and a pink tinge appears after relaxing
the pressure.
(_e_) Applying heat, such as dropping melted sealing-wax on the skin,
and noting whether or not redness or vesication ensues.
(_f_) Holding the hand, with the fingers abducted, against a strong
fight, and observing whether or not the web of the fingers is
translucent.
(_g_) Inserting a brightly polished needle into a fleshy part of the
body, allowing it to remain for ten seconds or so _in situ_, and
noticing whether it is tarnished or not on withdrawing it.
(_h_) Injecting hypodermically a solution of fluorescin
(resorcin-phthalein and sodium bicarbonate, a gramme of each dissolved
in 8 c.c. of water). No local discoloration of the skin takes place if
the circulation has ceased, but if not, a yellowish-green coloration
of the skin occurs round the seat of injection, and the substance may
be detected in the blood at a part some distance from the seat of
injection. By immersing some white silk threads in the blood drawn
at a distance from the prick, then boiling them in distilled water,
the latter will have a greenish colour if the fluorescin has been
circulated (Icard‘s test).
These tests will detect whether the circulation has ceased or not, and
so differentiate suspended animation from real death.
2. The _lustre of the eye_ is lost immediately after death. It has,
however, been stated that the iris will respond to the action of
atropine and eserine for some hours after death, and that the action of
the latter is always more marked than that of the former. The fundus
as seen by ophthalmoscopic examination is altered, the normal redness
changes to a yellowish-white, the vessels in the disc and just around
it become empty, and the veins appear to contain bubbles of gas and the
column of blood is broken up (Bouchet). A blackish round or oval stain
has been described by M. Larcher on the sclerotic coat on the outer
side, which he calls _l‘imbibition cadavérique du fond de l‘œil_. It is
probably due to thinning of the sclerotic from evaporation, enabling
the choroid to be seen through it. The spot precedes rigidity and is a
forerunner of putrefaction.
3. The _most powerful stimulus applied to the body does not cause any
reaction_. The muscles _may_, however, be made to contract shortly
after death by the stimulus of a slight blow, or by galvanism.
4. _The surface of the body becomes of an ashy-white colour._
Exceptions.
(1) Persons of florid complexion retain this on the malar
prominence for some time after death.
(2) The red or livid edges of ulcers.
(3) Blue, black, or red tattoo marks, if not effaced during
life, do not disappear.--Ecchymoses retain the hue they
had at the time of death.
(4) An “icteric” coloration existing at death, as in
jaundice, never becomes white.
(5) A rosy tint of the skin on those poisoned by carbon
monoxide.
(6) Dusky-red patches in those frozen to death.
(7) In certain cases of drowning, a rosy colour may be
observed on the lips and malar prominences.
5. The _temperature of the body_ at the time of death is retained
for some time. As a sign of death the fall of temperature must be
progressively continuous. Cooling will depend on the medium in which
the body is placed, and mere coldness of the body is not a sign of
death.
(1) Fat persons retain the heat longer than lean ones;
adults longer than children or old persons. Bodies are
cooled by--1. Radiation. 2. Conduction. 3. Convection.
(2) Bodies immersed in water cool more rapidly than in air.
This fact may be of importance in determining survivorship
in a case of drowning.
(3) Bodies in bed and covered by the clothes, or in
cesspools and in dung-heaps, cool less rapidly than when
exposed.
(4) Persons killed by lightning may keep warm longer than
others.
(5) Death by suffocation retards the process of cooling.
(6) The body may be cold externally, but possesses a
considerable amount of heat when the internal organs are
exposed. Persons who have died of cholera, yellow fever,
or suddenly of some acute disease--rheumatism--may retain
for some hours a considerable amount of heat. It has
even been asserted that in some diseases--cholera--there
is an increase of temperature soon after death
(Laycock), also after death due to some diseases
of the nervous system as in pontine hæmorrhage and
cerebro-spinal meningitis, and following prolonged muscular
spasm as in tetanus.
(7) Most bodies, under ordinary circumstances, are, as a
rule, quite cold in from eight to twelve hours after death.
The rate of loss of temperature depends upon the difference
between that of the body and its surroundings; it lessens
as the body cools. It takes at least twenty-four hours for
it to fall to the heat of the surrounding atmosphere.
6. _Relaxation, primary flaccidity, more or less general, of the
muscular system takes place._
_“If the above signs are alone present, death must have taken place
in from ten to twelve hours at the longest”_ (Casper). _Exception:
cadaveric spasm._
7. _Want of elasticity in the eyeball: flaccidity of the iris._ This
condition invariably occurs in from twelve to eighteen hours after
death.
8. _Flattening of the muscles_ of those parts on which the body rests,
due probably to loss of vital turgidity.
9. _Hypostasis._--Suggillation, or _post-mortem_ staining, is due to
the gravitation of the blood to the most dependent parts of the body
not subject to direct pressure. The hypostatic marks begin to form
in from eight to twelve hours after death, and increase in size till
putrefaction sets in. They alter their position with changes in the
position of the body so long as the blood remains fluid, but when it
has coagulated they remain permanent. Hypostasis may be mistaken for an
ecchymosis or a bruise, and in the lungs for congestion, inflammation,
&c. Errors may also occur with regard to the brain, stomach, kidneys,
and intestines: in the last, the redness of inflammation is seen all
over the parts, whereas the coloration of hypostasis is interrupted,
and this is best shown by drawing out the convolutions. The heart is
an exception to the rule, but it may contain clots varying in size
and colour. These are _post-mortem_ formations. The use of the word
suggillation is objectionable, as it has been used in opposite senses
by Continental and British authors--some writers restricting the term
to ecchymosis proper, others using it as synonymous with cadaveric
lividity or external hypostasis.
Cutaneous Hypostasis
(1) _Meaning of the expression._--The gravitation of
the blood in the capillaries after death, in obedience
to the laws of inert matter.
(2) _On what parts of the body usually seen?_--On the
most dependent parts of the body; on the whole of the
back of the body, if the body be supine. The patches are
irregular and slashed, terminate abruptly, and do not
fade gradually into the surrounding colourless skin.
(3) _At what period after death first observed?_--In
from eight to twelve hours, gradually extending in size
till putrefaction sets in.
(4) _Whether or not affected by death from
hæmorrhage?_--Formed after every kind of death, even
after death due to hæmorrhage, although the coloration
may not be quite so marked.
(5) _Hypostasis is liable to be mistaken for
ecchymosis--the result of injury._--Hypostasis must
also not be confounded with the livid patches seen on
the legs and feet of aged persons and on those who have
died from typhus, chronic renal and cardiac disease, &c.
The rose patches--“frost erythems”--seen on those who
have died from exposure to cold, must not be mistaken
for ecchymosis. The above patches are as frequently on
the upper surfaces of the body as on the lower, and are
not so extended as cadaveric lividities; the blood,
moreover, which gives rise to them is diffused through
the areolar tissue, and not incorporated with the true
skin.
(6) _How distinguished from ecchymosis?_--Effused or
coagulated blood is found when an incision is made
in a _true_ ecchymosis, however small, whereas
a few bloody points are alone seen on a slight or
deep incision into a _post-mortem_ stain or true
hypostasis. The seat of hypostasis is the superficial
layer of the true skin. Hypostases are never raised
above the surface, as ecchymoses sometimes are. In
describing these two conditions, “ecchymosis” and
“hypostasis,” it is preferable to describe the former as
“discoloration from extravasated blood,” and the latter
as “lividity after death.”
10. _Cadaveric rigidity._--From the moment of death till the time when
putrefaction sets in, the muscular structures of the body may be said
to pass through three stages:--
(1) _Muscular Irritability._--The muscles flaccid,
but still possessing the power of contractility on the
application of certain stimuli. Parts contracted during
the act of dying--cadaveric spasm--as the muscles of the
hand grasping a knife or other weapon, may continue so
for some time after death.
(2) _Cadaveric rigidity._--A state of rigidity, the
power of contractility absent.
(3) _Commencement of Putrefaction and Chemical
Change._--Relaxation again present; all power of
contraction lost, not to be regained.
Cadaveric rigidity, or _rigor mortis_, is a purely muscular phenomenon,
and is not dependent on the nervous system, as it is not prevented,
though it may be delayed, by division of the nerves, and is as well
marked in paralysed as in non-paralysed limbs. Cadaveric rigidity,
which occurs early in the heart, must not be mistaken for hypertrophy,
or its absence for dilatation. In every case the _rigor mortis_
precedes putrefaction, and consists in a shortening and thickening
of certain muscles, chiefly the flexor and adductor muscles of the
extremities, and also the elevators of the lower jaw.
This condition commences in the involuntary muscles, and in the heart
may simulate hypertrophy of that organ, then passes into the voluntary
muscles of the back of the neck and lower jaw, and then into the
muscles of the face, front of the neck, chest, and upper extremities,
and then into the trunk muscles, and last of all, into those of the
lower extremities. In most cases it passes off in the same order, the
body becoming quite flaccid, the _rigor mortis_ never returning. These
phenomena occur whilst the body is cooling. The muscle becoming rigid
is dying, the rigid muscle is dead. The cause of the _rigor mortis_ is
held to be due to the coagulation of the myosin. The reaction is acid
from the presence of sarcolactic acid, but becomes alkaline during
putrefaction.
If fresh difibrinated blood be passed through the rigid muscle, it will
become flaccid, and respond by contraction to electric stimulation.
Cadaveric rigidity generally supervenes from _eight_ to _twenty_ hours
after death, and may continue from a few hours to four or nine days.
The sooner rigidity comes on after death the sooner will it pass away,
and the later the onset the longer it will last. It is a general rule
that whatever exhausts the muscular irritability before death causes
the early appearance and the more rapid disappearance of _rigor mortis_.
Conditions which modify the onset and duration of _rigor mortis_:--
(1) _Age._--Transitory _rigor mortis_ may appear
in the immature fœtus according to the state of its
muscular development.
It is feeble and disappears quickly in infants and young
children.
It is usually well marked in adolescents and healthy
adults, but feeble in old people.
(2) _The Degree of Muscular Development of the
Body._--Other things being equal, the greater the
muscular development and muscular strength at the
time of death, the slower is the onset of _rigor
mortis_, and the longer its duration; the more feeble
or exhausted the muscular condition, the more rapid the
onset and the shorter its duration.
(3) _The Temperature of the Environment of the
Body._--In temperate and colder climates _rigor
mortis_ follows the usual course. A low temperature,
below freezing-point, will retard the onset and favour
the duration of _rigor mortis_, but if the body be
suddenly thawed before _rigor mortis_ has set in,
it will appear rapidly and disappear more quickly than
if it had not been subjected to the process of thawing.
If a body already in a condition of early rigidity be
exposed to a temperature of 75° C., the rigidity becomes
more marked, since albuminates in the muscles, other
than the myosin, become coagulated in addition. This
phenomenon has been called _heat stiffening_.
(4) _Mode of Death._--After all exhausting diseases
of long or short duration, rigor mortis appears early
and passes off quickly, as in death from phthisis,
cholera, typhus fever, typhoid, hydrophobia, scurvy, and
occasionally in chronic Bright‘s disease.
Death during alcoholic intoxication favours the duration of _rigor
mortis_. After violent muscular exercise death is quickly followed by
rigidity. Animals that have been hunted for some time before death
stiffen very rapidly. When convulsions precede death, _rigor mortis_
sets in early as a rule, but in certain cases, where death has been
preceded by strong convulsions, rigidity may appear quickly, but last
for some days, as in some cases of poisoning by strychnine.
Conditions which simulate _rigor mortis_:--
(1) _Stiffening by Catalepsy._--In this condition
the temperature of the body will remain at a degree
compatible with life over a period incompatible
with real death. If a limb be extended and rigid in
catalepsy, after passive flexion of it, it will return
to its former state.
(2) _Rigidity from the Body being Frozen._--In this
condition passive movement of the joints is accompanied
by crackling due to fracture of their frozen contents.
(3) _Heat Stiffening._--Is seen in the bodies of
persons who have been suddenly immersed in boiling
fluids; also to a certain degree in bodies of persons
who have met their death by burning from paraffin lamp
accidents.
_Cadaveric Spasm or Instantaneous Rigor._--“When this phenomenon occurs
the last act of life is crystallised in death.” It is a prolongation of
the last vital contraction of the muscles into the rigidity of death.
Cadaveric rigidity of the muscles must be distinguished from _muscular
spasm_ occurring at the moment of death.
They may thus he distinguished: In cadaveric rigidity any object
placed in the hand prior to the onset of _rigor mortis_ can be readily
removed, even if the precaution be taken of binding it in the hand
prior to the accession of _rigor mortis_.
In the case of _muscular spasm_ the object is found grasped in the
hand, and can only be with difficulty removed.
The difficulty experienced in removing a pistol or other weapon from
the hand may point to suicide; its easy removal to homicide, the weapon
having been placed there after death.
No adequate explanation of this phenomenon has yet been made. It is not
an unusually early onset of _rigor mortis_ in the muscles affected,
because they do not share in the initial relaxation that precedes
it, or the weapon would fall from the hand, and the bodies would not
retain the peculiar attitudes which have been described in different
instances. Nothing can simulate cadaveric spasm and it cannot be
produced in any way after death. Instantaneous rigor only occurs in
cases in which there has been great mental tension and nerve excitation
before death. It is a continuation of probably the very last voluntary
act of life.
_A body showing the signs of death before mentioned_ (Nos. 1 to 10)
_may be held to be that of a person who has been dead from two to three
days at the longest_ (Casper).
Muscular states of the body between the period of somatic and molecular
death:--
(1) _Primary Flaccidity._--The muscles respond to
electrical stimuli; the chemical reaction of the muscles
is either neutral or faintly alkaline.
(2) _Cadaveric Rigidity_ or _Rigor
Mortis_.--During this condition molecular death takes
place; the muscles do not respond to stimuli, but fresh
defibrinated blood passed through the muscles will
restore the response to stimulation, and their reaction
is markedly acid.
(3) _Secondary Flaccidity._--Disintegration of the
muscular elements takes place, no stimuli will provoke
response, and the reaction again becomes alkaline.
Table showing the principal points to be noted in the period of
accession of Cadaveric Rigidity and the causes which retard or hasten
its appearance, or modify its duration:--
_In what does it consist?_--In a shortening and
thickening of the muscles, particularly the flexors and
adductors of the extremities, and elevators of the lower
jaw.
_Period of Invasion._--Generally in from eight to
twenty hours after death. It has been known, however, to
supervene within three minutes of death, but it may be
delayed for sixteen or seventeen hours.
_Period of Duration._--From one to nine days. Three
weeks (Taylor).
_Order in which the Muscles are affected._--Involuntary
muscles, back of neck and lower jaw, muscles of the
face, front of the neck, chest, upper extremities and
then the lower extremities.
_Order in which it disappears._--Back of neck, lower
jaw, &c., following the course of its accession.
_Effects of Exposure to Cold._--Prolonged by dry cold
air, and by cold water.
_Effects of Enfeebling Disease prior to Death._--Rapid
in its invasion, and passing off rapidly.
_Effect of a Robust Frame at Period of Death._--The
accession may be prolonged; but, other things being
equal, it is more strongly manifested, and continues
longer.
_Effects of Violent Exercise prior to Death._--Rapidly
supervenes and rapidly disappears, as in soldiers killed
at the end of a battle.
_Effects of Poison._--Poisons which cause violent
contractions for some time prior to death--strychnine,
&c.--influence the rapid invasion of the _rigor
mortis_, its short duration, rapidly followed by
putrefaction. Where death in poisoning by strychnine is
almost instantaneous, with a short convulsive stage,
_rigor mortis_ comes on _rapidly_ and remains
a _long_ time.
11. _Putrefaction_.--the last of the phenomena which follow death--is
the resolution of the organised tissues of the body to the inorganic
state. It is a gradual process, and is the result of the action of
_micro-organisms, aided by moisture, air, and warmth_.
Putrefaction is the only absolute sign of death having taken place.
The _conditions which modify putrefaction_ are as follows:--
_External Conditions._--1. Micro-organisms; 2. Air; 3. Moisture; 4.
Warmth.
_Internal Conditions._--1. Age; 2. Sex; 3. Condition of the body--(_a_)
_Constitutional peculiarity_; (_b_) State of the body. 4. Kind of
death--(_a_) _The result of disease_; (_b_) _The result of poisons_.
External Conditions Which Modify Putrefaction
1. _Micro-organisms._--A fauna and flora of decomposition has been
described in a paper by Hough on “The Fauna of Dead Bodies,” _B. M.
J._, vol. ii. 1897, p. 1853, to which the reader is referred.
Many different forms of micro-organisms combine in the production of
putrefaction, and the result of their action is inevitable, unless the
body be guarded against their invasion by special means, or the tissues
be rendered unfit for their use.
2. _Air._--Exposure in the open air has a marked effect in promoting
putrefaction; but garments fitting close to the body, and thus
excluding air, have a contrary effect. Dry air, or air in motion,
by assisting evaporation from the corpse, acts as a preservative.
The composition of the soil in which the body is placed has also a
more or less modifying effect. In light, porous soil, allowing of
the free ingress of air, decomposition is more rapid than in close,
compact soil, as clay; but in this we have to contend with another
agent--moisture--which more or less counteracts the protective virtue
of the closer earth.
3. _Moisture._--Putrefaction cannot proceed without moisture. The body,
however, contains sufficient water to enable this process to commence
spontaneously. Organic substances artificially deprived of water do not
putrefy. Cold and heat possess marked antiseptic properties--the former
by freezing the fluids in the body, the latter by drying them up.
4. _Warmth._--A temperature between 70° and 100° F. is found most
favourable to decomposition. The effect of cold is shown by the fact
that a body immersed in water during winter, at a temperature between
36° and 45° F., may be so well preserved as to present, ten or twelve
days after death, well-marked signs of violence, which would in summer
have been utterly obliterated in five or seven days. The preservative
influence of cold water will, however, depend greatly on the depth
at which the body has been submerged. Bodies so submerged, and then
exposed to the air, putrefy with such rapidity that exposure for one
day is said to work a greater change than three or four days longer
retention of the body in the water. As an instance of the preservative
power of cold, may be mentioned the mammoth found in Siberia embedded
in a block of ice.
Internal Conditions Which Modify Putrefaction
1. _Age._--The bodies of young children, other things being equal,
are said to putrefy rapidly. It should be remembered, however, that
clothing possesses considerable power in retarding putrefaction, and
that, in the hurry and anxiety to get rid of the infants, they are
oftener exposed naked than clothed, which may, in some measure, account
for their more rapid decomposition.
2. _Sex._--Sex, it would appear, has little or no influence either to
retard or hasten putrefaction; but it has been remarked that females
dying during or soon after child-birth, irrespectively of the cause of
death, putrefy rapidly.
3. _Condition of the Body._
(_a_) _Constitutional Peculiarity._--It is generally admitted that
persons of the same age and sex, dying similar deaths, and subjected
to like conditions as to exposure to the air and interment in the same
soil, exhibit marked differences as regards the accession and rapidity
of putrefaction. The explanation may be difficult, but the fact still
remains.
(_b_) _State of the Body._--Fat and flabby corpses putrefy more rapidly
than the lean and emaciated. Hence old people, who are generally thin,
keep fresh for a comparatively long time. Bodies, also, which are
much mutilated rapidly decompose--decomposition setting in first at
the parts injured. In examining wounds and bruises said to have been
inflicted during life, it is well to remember that the tendency of
putrefaction is to make them appear more severe.
4. _Kind of Death._
(_a_) _Effect of Disease._--Healthy persons dying suddenly, other
things being equal, are said to decompose more slowly than those
who have died from exhausting diseases, as in the case of typhoid,
phthisis, and dropsy, following organic disease, or of those diseases
attended with more or less putridity of the fluids.
(_b_) _Effects of Poisons._--Putrefaction rapidly supervenes in
those who have died suffocated by smoke, by carbonic oxide, and by
sulphuretted hydrogen. Narcotic poisoning is stated to accelerate this
condition; but in poisoning by phosphorus or alcohol, and in cases
of death from sulphuric acid, the putrefactive changes are greatly
retarded. Arsenic, chloride of zinc, and antimony are reputed to
possess antiseptic properties. The manner in which death takes place
from the action of the poison greatly hastens or retards putrefaction.
Thus, in the case of poisoning by strychnine, it is found that
when death has occurred rapidly, without much muscular exhaustion,
putrefaction sets in slowly; but that, when the muscular irritability
has been greatly exhausted by successive fits, the contrary is the
result.
THE PHENOMENA OF PUTRESCENCE IN THEIR CHRONOLOGICAL ORDER
1. =External=
_One to Three Days._--Greenish coloration of the abdominal walls. Odour
of putrescence is gradually developed, and, concurrently with this, the
eyeball becomes soft and yielding to pressure.
_Three to Five Days._--The green colour, of a deeper shade, has
now passed over the abdomen, extending also to the genital organs.
Patches of this green coloration also make their appearance somewhat
irregularly on other parts of the body, such as the neck, back, chest,
and lower extremities. A dark reddish frothy fluid about this time
wells up from the mouth.
_Eight to Ten Days._--The patches of green colour have now coalesced,
so that the whole body is discoloured. On some parts of the body the
colour is of a reddish-green, due to the presence of decomposed blood
in the cellular tissue. The abdomen is now distended with gases, the
products of decomposition. In India this distension has been known to
occur in less than six hours, the average period being a little over
eighteen hours. Much depends upon the season of the year. The colour of
the eyes has not disappeared, but the cornea have fallen in. Relaxation
of the sphincter ani takes place, and the superficial veins appear like
reddish-brown cords. The nails still remain firm.
_Fourteen to Twenty Days._--The colour of the surface is now bright
green, with here and there patches of a blood and brown colour. The
epidermal layer of the skin is raised in bullæ of varying size, in
some places the skin being more or less stripped off. The nails are
detached, and can be easily removed. The hair can be pulled from the
scalp with ease. The body is now greatly distended with gases, and
the features cannot be recognised, owing to the swollen condition of
the face. The body is generally covered with vermin. In determining
the time at which death occurred, it will be necessary to take into
consideration the season of the year, as it is found that an advanced
stage of decomposition may be present in from eight to ten days, with
the thermometer ranging between 68° and 77° F., which in winter, with a
temperature of from 32° to 50° F., would require twenty to thirty days.
“_Bodies green from putridity, blown up and excoriated, at the expiry
of one month, or from three to five months after death (cæt. par.),
cannot with any certainty be distinguished from one another_” (Casper).
_Three to Six Months._--During the above period the stage of
colliquative putrefaction has set in. The thoracic and abdominal
cavities, due to the increased formation of gas, have burst. The bones
of the cranium have more or less separated, allowing the brain to
escape. The soft parts are more or less absorbed, and no recognition
of the features is possible. The sex can only be positively made out
by the presence of a uterus, or by the peculiar growth of hair on the
pubes, which in woman only covers the pubes, but in man extends upwards
to the navel.
_Saponification._--Bodies exposed to the action of water, or buried in
damp, moist soil, are apt to undergo certain changes, in the course of
which they become saponified, and the formation of a substance known
as _adipocere_ is the result. Adipocere--_adeps_, lard, and _cera_,
wax--is chiefly composed of margarate of ammonia, together with lime,
oxide of iron, potash, certain fatty acids, and a yellow-coloured
odorous matter. The melting-point is 126.5° F. Adipocere has a fatty,
unctuous feel, is either pure white or of a pale yellowish colour,
and with the odour of decayed cheese. It is highly resistant to
putrefactive organisms, and is generally free from them. The formation
of this substance “to any considerable extent is not likely to occur
in less than three to four months in water, or six months in moist
earth, though its commencement may take place at a much earlier
period” (Casper). The above-quoted authority mentions a case in “which
the remains of a fœtus were found imbedded in adipocere, and which
fœtus was proved to have been buried in a garden exactly six months
and three-quarters.” Taylor also records the case of a bankrupt who
committed suicide by drowning, in which the muscles of the buttocks
were found converted into adipocere in five weeks and four days at the
longest.
Although the above statements may be accepted with regard to the
formation of adipocere as far as European countries are concerned,
they do not seem to be applicable to India, where the change appears
to be more rapid. Dr. S. Coull Mackenzie, in his valuable book on
_Medico-Legal Experiences in Calcutta_, records a case of a young
man whose body, recovered after seven days‘ immersion in the river
Hooghly, “was found to be in an advanced state of saponification,” and
the fleshy portions of undigested food in the stomach were converted
entirely into adipocere. “Lastly,” he writes, “in the hot, steamy,
rainy months of September and October, in three of the cases above
mentioned, saponification was found in bodies immersed in water, both
externally and internally, in from two days to eight days ten hours. In
the soft and porous soil of Lower Bengal during the rainy seasons, even
in a wooden coffin, the change is very rapid--three or four days.”
To explain the formation of adipocere, it has been supposed to be due
to the decomposition of the muscular structures of the body, by which
hydrogen and nitrogen are evolved, these combining to form ammonia, and
this, coming in contact with the fatty acids of the fat, forms a soap.
The process of saponification takes place most rapidly in young fat
persons; next, in those adults who abound in fat, and in those whose
bodies have been exposed to the soil of water-closets; more rapidly
in running than in stagnant water; and lastly, in those who have been
buried in moist, damp soil, especially if the bodies have been piled
one on the top of the other, the lowest being first saponified. The
muscular tissue appears to be the first to undergo this change. In
water the process is said to be completed in about five months, but in
soil a period of two or three years appears necessary.
_Mummification_ is of no medico-legal interest, as the causes which
produce it are unknown, and no reliable data can be obtained as to the
period of its accession, or the time required for its production.
2. =Internal=
Table showing the order in which the Internal Organs undergo
Putrefaction:
1. The Trachea.
2. The Brain of Infants.
3. The Stomach.
4. The Intestines.
5. The Spleen.
6. The Omentum and Mesentery.
7. The Liver.
8. The Adult Brain.
9. The Heart.
10. The Lungs.
11. The Kidneys.
12. The Bladder.
13. The Gullet.
14. The Pancreas.
15. The Diaphragm.
16. The Blood-vessels.
17. The Uterus.
Organs which Putrefy Early
1. _The Trachea, including the Larynx._--The rapid change in the
trachea must be borne in mind, in order to avoid the error of
attributing death to suffocation or drowning. An examination of the
trachea should never be omitted.
2. _The Brain of Infants up to the First Year._
3. _The Stomach._--The first traces of putrefaction are seen in
from four to six days after death. All the coats of the stomach are
softened, but there is no excoriation, as is the case when corrosive
poisons are taken. Emphysematous separation of the mucous coat may be
present, but must not be confounded with the excoriation just mentioned.
4. _The Intestines._--Casper declares that he does not remember any
case in the course of his experience where the intestines were “found
earlier putrefied than the stomach.” In the course of putrefaction
they become of a dark brown colour, bursting, and allowing an escape
of their contents; and they ultimately become changed into a dark
pultaceous mass.
5. _The Spleen._--This organ in some cases putrefies before the stomach
and intestines; but, as a rule, it resists decomposition longer.
6. _The Omentum and Mesentery._
7. _The Liver._--This organ is not unfrequently found firm and dense
some weeks after death. It putrefies earlier in new-born children than
in adults. The convex surface first shows signs of putrefaction. The
gall-bladder also remains for some time recognisable.
8. _The Adult Brain._--The brain of newly-born children, as mentioned
before, soon putrefies. This is not the case in the adult brain.
Putrefaction sets in not on the surface, but at the base of the brain.
A wound of the brain causes it to putrefy more rapidly than if no
injury be present.
Organs which Putrefy Late
9. _The Heart._
10. _The Lungs._--Contemporaneously with the appearance of
decomposition in the heart, the lungs also begin to show signs of
putrefaction, though this condition may take place earlier.
11. _The Kidneys._--These organs are long in yielding to the
putrefactive process.
12. _The Bladder._--Nearly all the other organs of the body are in a
state of decomposition before this viscus becomes materially affected.
13. _The Gullet._--This long remains firm, even after the stomach and
intestines fail to be recognised.
14. _The Pancreas._--The body must be far advanced in putrefaction
before this gland becomes affected.
15. _The Diaphragm._--This may be distinguished after the lapse of four
to six months.
16. _The Blood-vessels._--The aorta may be recognised after the body
has been interred for fourteen months.
17. _The Uterus._--Of all the organs of the body, the uterus resists
the putrefactive changes longer than any other organ.
Table showing some important Facts to be noticed with regard To
Putrefaction:
1. Earliest external indication of it.
(1) _In a Body exposed to Air._--Greenish coloration of the
abdominal coverings.
(2) _In a Body immersed in Water._--Face, head, and ears,
gradually extending from above downwards.
2. Earliest internal indication.--Found in the trachea, including
the larynx.
3. Advanced putrefactive appearances to be expected in a body
exposed to air, say from fourteen to twenty days at mean
temperature, as regards--
(1) _Epidermis._--Raised here and there in blisters about
the size of a walnut, in some places the size of a dinner
plate, and quite stripped off.
(2) _True Skin._--Maggots cover the body, chiefly in the
folds of the skin.
(3) _Cellular Tissue._--Blown up with gas.
4. Comparative time required to produce equal extent of putrefaction
in a body--
(1) _In Air._--One week. One month.
(2) _In Water._--Two weeks. Two months.
(3) _In Earth._--Eight weeks. Eight months.
_Does Lime hasten Putrefaction?_--It is a very general opinion that it
does. Careful experiment has, however, proved that lime neither retards
nor hastens putrefaction, but that it prevents the escape of the gases
produced during the process by absorbing them; it is, therefore, a good
and safe deodoriser, and in this property its true value lies.
CHAPTER IV
POST-MORTEM EXAMINATIONS AND EXHUMATIONS
The following are some of the Instructions issued to Medical Inspectors
by the Crown Office in Scotland, slightly modified:
I. Part of General Directions
13. When any portions of the body, or any substances found in or near
it, are to be preserved for further examination, they ought never
to be put out of the custody of the inspectors, or of a special law
officer. They must be locked up in the absence of the person who keeps
them. When they are to be transmitted to a distance, they should be
labelled, and the labels signed by the inspectors; and after being
properly secured and sealed, they should be delivered by the inspectors
themselves, or the special law officer whose duty it is to see them
delivered into the hands of the parties for whom they are intended.
II. Necessary Implements
14. Besides the ordinary instruments used in common dissections, the
inspector should be provided with a foot-rule for measuring distances,
and a glass measure graduated to drachms, for measuring the quantities
of fluids, two or three stoneware jars of medium size, or when these
cannot be had, a few clean bladders, for carrying away any parts of the
body which it may be necessary to preserve for future examination, and
in cases of possible poisoning, three or four bottles of eight, twelve,
and sixteen ounces, with glass stoppers or clean corks, for preserving
fluids to be analysed. The common square green glass pickle bottles are
very suitable, and can generally be obtained. No bottle or jar should
be used until it has been thoroughly washed under the supervision of
one of the inspectors. In cases of infanticide a balance, having a flat
scale-pan with a foot-rule painted on it, is of great use; on it the
infant may be stretched, weighed, and measured at one operation. Paper,
pens, ink, and sealing-wax should also be provided.
15. All distances, lengths, surfaces, and the like, whose extent may
require to be described, ought to be accurately measured; and the
same rule ought to be followed in ascertaining the volume of fluids.
When large quantities of fluids are to be measured, any convenient
vessel may be used, whose capacity is previously ascertained by the
inspectors. Conjectural estimates and comparisons, however common, even
in medico-legal inspections, are quite inadmissible.
III. External Aspect, and Examination of the Body
16. The importance of the external examination, and the particulars to
be chiefly attended to in performing it, will vary in different cases
with the probable cause of death. It comprehends an examination--(1)
Of the position of the body when found, as well as of all external
injuries or marks presented by it. (2) Of the vicinity of the body,
with a view to discover the objects on which it rested, or from or
upon which it may have fallen, marks of a struggle, signs of the
presence of a second party about the time of death or after it, weapons
or other objects the property or not the property of the deceased, the
remains of poisons, marks of vomiting; and where marks of blood are of
importance, and doubts may arise as to their really being blood, the
articles presenting them must be preserved for further examination. (3)
Of the dress, its nature and condition, stains on it of mud, sand, and
the like, of blood, of vomit, of acids, or other corrosive substances,
marks of injuries, such as rents or incisions; where injuries have been
inflicted on the body, care should be taken to compare the relative
position of those on the body and those on the clothes; and where
stains, apparently from poison, are seen, the stained parts are to
be preserved for analysis. (4) Ligatures, their material and kind,
as throwing light on the trade of the person who applied them; the
possibility, or impossibility, of the deceased having applied them
himself; their sufficiency for accomplishing their apparent purpose, &c.
17. The inspectors will commence the examination of the body itself by
surveying the external surface and openings. Before cleaning it they
will examine it on all sides, not neglecting the back, as is often
done, and look for marks of mud, blood, ligatures, injuries, stains
from acids, and the like; foreign bodies, or injuries within the
natural openings of the body, viz. the mouth, nostrils, ears, anus,
vagina, and urethra. If there are impressions of finger marks, they
will consider which hand produced them. If there be any doubt about
stains being blood, the skin presenting them must be preserved for
analysis. If there be acid stains, or other probable remains of poison,
or any foreign matter, the nature of which may require to be determined
by analysis, these must also be preserved. The ordinary places for the
impressions of ligatures are the neck, the wrists, the ankles, and the
waist. The degree of warmth of the trunk and extremities, the presence
or absence of cadaveric rigidity, and whether it exists equally in the
upper or the lower extremities, should be noted in this stage of the
proceedings; in other cases the progress of putrefaction, as indicated
by the odour of the body, the looseness of the cuticle, the colour of
the skin, and formation of dark vesicles on it, the evolution of air in
the cellular tissue, the alteration of the features, the softness of
the muscles, the shrivelling of the eyes, the looseness of the hair and
nails.
18. In this part of the examination it will sometimes be necessary to
observe the particulars by which the body may be identified. These are
numerous. But the most important are the stature, the age and sex,
the degree of plumpness, the size and form of the nose and mouth, the
colour of the eyes and hair, the state of the teeth, warts, nævi,
deformities, scars of old abscesses, ulcers, and wounds, and, if a
woman, marks of her having had one or more children.
19. The body is next to be washed, if necessary, and the hair of the
head shaved, or at least closely cut; and a thorough examination of
the whole integuments is to be made. At this stage the inspectors will
look particularly for the appearance of lividity, noting its chief
seat and its relation to the posture in which the body was found--for
impressions on the skin of objects on which it had rested--for marks of
injuries, more especially contusions, taking care to ascertain their
real nature by making incisions through the skin--for marks of disease,
such as eruptions, ulcers, and the like--for marks of burning--for
marks of concealed punctures in the nostrils, mouth, external openings
of the ears, the eyes, the nape of the neck, the arm-pits, the anus,
the vagina, and beneath the mammæ or scrotum; in infants, also in the
fontanelles and the whole course of the spine. At this stage, wounds
and other injuries should be carefully examined according to the
directions given in Division V. (_infra_). Where the injury may have
caused loss of blood, the presence or absence of pallor of the skin,
lining membrane of the mouth, and the gums ought to be noted.
IV. Dissection, or Internal Examination of the Body
20. In commencing the dissection of the body, it must be laid down as
an invariable rule that all the great cavities should be examined, and
also every important organ in each, however distinctly the cause of
death may seem to be indicated in one of them. It is right to examine
the cavity of the spine, and at all events its upper portion, in any
case where an unequivocal cause of death has not been discovered
elsewhere.
21. In examining the organs situated in the several cavities of the
body the inspectors must be guided in a great measure by their ordinary
anatomical and pathological knowledge.
22. The inspectors should begin with that cavity over which there is
a wound or other mark of injury. Or, if there be an injury on the
extremities, the dissection ought to commence there. In the absence
of any such guide, that cavity should be taken first where the
circumstances of death, so far as they are ascertained, may lead the
inspectors to expect unusual appearances. In other cases, the abdomen
should be first opened but not dissected, and a general survey made of
the parts exposed, without disturbing them materially, the position
of the diaphragm being determined by examining it with the hand; then
the thorax is immediately to be examined, unless there is good reason
for doing otherwise. The reasons for this method of procedure are as
follow: If the abdominal organs are removed, and the veins cut, the
blood in the heart may drain away through the venæ cavæ, and error
result. If, on the other hand, the thorax be first opened, the relation
of the abdominal organs to each other cannot be clearly made, owing to
the relaxation of the diaphragm, due to the severing of its thoracic
connections. Again, if the thorax be first opened, the position of the
diaphragm cannot be determined. The inspectors may begin with the head,
which may be examined thoroughly in the first instance, afterwards the
chest and belly, as above described; the spine being reserved till the
conclusion. Wherever unusual appearances are discovered in the first
cursory survey, the anatomical examination ought in general to be begun
there.
23. In examining the several regions of the body it is to be observed
that wherever a wound, or other obvious injury of the external parts,
lies in the way of the ordinary incisions, that part must be avoided,
so as to leave the external injury unaltered.
24. The most approved mode of opening the head in medico-legal cases
is, after dividing the integuments from ear to ear, and reflecting
the scalp over the forehead and occiput, to make the usual circular
incision through the skull, about an inch above the orbits in front,
and over the occipital protuberance behind, using the saw lightly
and carefully after the outer table of the skull has been divided,
so as to avoid injuring the membranes of the brain; and to raise the
skull-cap from before backwards, taking care to detach the dura mater
from the skull with the handle of the scalpel or a spatula where it
adheres firmly. The chisel and mallet should never be used where there
is any chance of finding a fracture of the skull; for how could it be
distinguished from a fracture made with the mallet? Should the dura
mater be firmly adherent to the skull-cap, the better practice is to
divide it carefully, so as to remove both at the same time. Tearing the
membrane and crushing the brain substance are thus avoided. In infants
and young children this mode of procedure is most necessary, as in them
the dura mater is, as a rule, adherent.
25. The ordinary mode of examining the membranes of the brain, and the
brain itself, answers well in medico-legal dissections. Effusions of
fluid within the skull should always be measured. After the brain is
removed, the dura mater ought to be stripped from the base of the skull
to facilitate the search for fractures there, which will, of course,
indicate external violence. After the removal of the brain, the upper
part of the spinal canal should be examined through the foramen magnum
before any part of its course be laid open; and search should be
particularly made for dislocation or other injury in the region of
the atlas and dentata. In cases of fatal fractures of the head, the
strength of the bones should be attended to. In cases of extravasation
within the head, the state of the coats of the cerebral arteries should
be examined.
26. The best mode of opening the spine is, after having finished the
examination of the brain, to cut through the integuments from the
occiput to the coccyx--to lay the vertebræ thoroughly bare on each
side by cutting away the muscles--to make an incision with the saw
on each side of the skull, from the postero-inferior angle of the
parietal bones into the lateral edge of the occipital hole--to remove
the triangular portion of the occipital bone thus detached, and then
to cut the rings of the vertebræ on each side with the bone-nippers or
spine-knife, beginning with the atlas. In these cases preference should
be given to the saw, by which the operation is not only more easily
accomplished, but there is no risk of confounding previous fracture
with that made in dissecting. Where there is reason to think that the
bones are injured, the laying open of the canal should stop at the
distance of two or three vertebræ from the injury, and the injured
bones, with two or three adjacent vertebræ on each side, should be
removed entire before the examination is extended farther down the
spine.
27. The organs of the throat may be examined, either by dividing the
lower jaw-bone at the chin, cutting the soft parts close to the inner
surface of each half of the bone backwards, and then turning the two
segments outwards; or by freely reflecting the skin of the throat,
separating the soft parts from the inside of the lower jaw, the knife
being carried parallel with and close to the bone, drawing the tongue
out below the chin, and then continuing the dissection backwards.
28. The best mode of examining the organs situated in the throat is,
after detaching the soft parts from the lower jaw, as advised in Sect.
27, to dissect the soft palate from the bone, and proceeding backwards,
to detach the whole soft parts from the base of the skull and vertebræ
down to the sternum, leaving them connected with the organs in the
chest. Besides the ordinary points to be attended to in this part of
the examination, the presence of venereal or other ulcerations is a
matter requiring attention in some cases.
29. It is necessary to examine the pharynx and gullet, the larynx,
trachea, and its greater ramifications, the lungs, the heart, and the
great vessels with particular care, because here are most frequently
found the causes of sudden natural death. In examining the heart each
auricle and each ventricle ought to be laid open by an independent
incision of its parietes; and this should not intersect any of the
valvular openings or the septum cordis.
30. For laying open the chest and abdomen, the most convenient method
is to make an incision down the fore part of the neck, chest, and
abdomen to the pubes; then cutting from the peritoneum upwards, to
dissect back the integuments and muscles of the chest, and examine the
abdomen, as in Sect. 22; next, divide the cartilages of the ribs, and,
cutting upwards, close under them, to raise the cartilages along with
the sternum. In separating the sternum from the clavicles, care must be
taken not to wound the subjacent vessels; and this may be avoided by
the dissector moving each shoulder so as to show the exact position of
the sterno-clavicular joints, and then dividing both joints cautiously.
In dividing the cartilages of the ribs, the saw is sometimes necessary.
The cartilages should be cut as far from the sternum as possible, to
give free space for the subsequent examination.
31. In inspecting the organs in the chest, a cursory examination
should be first made by turning them over, ascertaining the nature and
measuring the quantity of effused fluids, feeling for fractures of
the ribs, tumours, or other diseases, and opening the pericardium to
obtain a view of the heart. The most convenient course to pursue next
is, without moving the heart from its place, to lay open its several
cavities, in order to judge of the quantity and state of the blood in
both sides of that organ. For this purpose the following incisions
should be made: The _first_, beginning close to the base, is carried
along the right border of the heart directly into the right ventricle
towards the apex, care being taken not to cut the septum. This lays
open the right ventricle. The _second_ incision, opening up the right
auricle, begins midway between the entrances of the venæ cavæ, ending
just in front of the base. The _third_, for exposing the left auricle,
commences at the left superior pulmonary vein, and ends just in front
of the base, close to the coronary vein, care being taken not to wound
it. The _fourth_, displaying the left ventricle, commences behind the
base, and ends close to the apex. If the blood is in a fluid state,
the quantity contained in the right auricle may be materially affected
by the head being examined previously, as the blood may have escaped
from the heart by the jugular veins. The whole of the organs in the
chest--the lungs, heart, and gullet--together with the parts dissected
downwards from the throat, should now be removed in one mass, in order
to examine them in detail on a table. But previously two ligatures
should be applied on the gullet, just above the cardiac orifice of the
stomach, and the division made between them.
32. The organs in the abdomen ought to be turned over, like those of
the chest, before any one of them is minutely examined, but before the
thorax is opened, for the reasons given in Sect. 22. In the subsequent
examination, that organ is to be first proceeded with in which there
may appear to be disease.
V. Examination in Cases of Wounds and Contusions
33. In a _post-mortem_ examination, the most approved mode of examining
these injuries is, if they be situated over great cavities, to expose
the successive structures in the manner of an ordinary dissection,
observing carefully what injuries have been sustained by the parts
successively exposed before they are divided. Wounds ought not to be
probed, especially if situated over any of the great cavities. The
depth of a wound is best ascertained by careful dissection and exposure
of the parts involved; but after this is done, the thickness of the
tissues penetrated may be measured by the probe.
34. The seat of the wounds must be described by actual measurement from
known points, their figure and nature also carefully noted, and their
direction ascertained with exactness.
35. Before altering by incisions the external appearances of injuries,
which should never, if possible, be done, care must be taken to
consider what weapon might have produced them, and if a particular
weapon be suspected, it should be compared with them. The wounded parts
should be cut out entire, and carefully preserved.
36. Apparent contusions must be examined by making incisions through
them; and the inspectors will note whether there is a swelling or
puckering of the skin; whether the substance of the true skin be
black through a part or the whole of its thickness; whether there be
extravasation below the skin or in the deeper textures, and whether the
blood be fluid or coagulated, generally or partially; whether the soft
parts below be lacerated, or subjacent bones injured; and whether there
be blood in contact with the lacerated surfaces. By these means the
question may be settled whether the contusions were inflicted before or
after death.
37. In the cases of wounds, too, the signs of vital action must be
attended to, especially the retraction of the edges, adhesion of blood
to their surfaces, or the injection of blood into the cellular tissue
around, or the presence of the signs or sequelæ of inflammation.
Hypostasis must not be mistaken for vascular injection.
38. When large arteries or veins are found divided, care must be taken
to corroborate the presumption thus arising by ascertaining, in the
subsequent dissection, whether the great vessels, lungs, liver, and
membranous viscera of the abdomen be unusually free of blood.
39. In the course of the dissection of wounds, a careful search must
be made for foreign bodies in them. When firearms have occasioned
them, the examination should not be ended before discovering the
bullet, wadding, or other article, if any, lodged in the body; and
whatever is found must be preserved. When the article discharged from
firearms, or when any other weapon had passed through and through a
part of the body, the two wounds must be carefully distinguished by
their respective characters, especially as regards their comparative
size, inversion or eversion, smoothness or laceration, of their edges,
their roundness or angularity, and the comparative amount of bleeding
from each. In gunshot injuries, the presence or absence of marks of
gunpowder should be noted.
40. When wounds are situated over any of the great cavities, they ought
not to be particularly examined until the cavity is laid open; and in
laying open the cavity, the external incisions should be kept clear of
the wounds.
41. When the discoloured state of a portion of the skin is such as to
render it doubtful whether it is due to injury or to changes after
death, an incision should be made to ascertain whether there is blood
effused into the textures, constituting true ecchymosis, or merely
gorging of the vessels of the skin, or discoloration from infiltration
of the colouring matter of the blood, which takes place in depending
parts of a dead body. The term suggillation should be avoided, as it
has been used in opposite senses by Continental and British authors.
The respective expressions, “discoloration from extravasated blood,”
and “lividity after death,” are preferable.
VI. Examination in Cases of Poisoning
42. In examining a body in a case of suspected poisoning, the
inspectors should begin with the alimentary canal, first tying two
ligatures round the gullet, above the cardiac orifice of the stomach,
two round its pyloric end, and a third at the sigmoid flexure of the
colon, then removing the stomach and entire intestines; next dissecting
out the parts in the mouth, throat, neck, and chest in one mass; and,
finally, dissecting the gullet, with the parts about the throat, from
the other organs of the chest. The several portions of the alimentary
canal may then be examined in succession.
43. Previous to commencing the dissection in cases of supposed
poisoning, the inspectors should make such inquiries as may enable them
to form an opinion as to the class of poison to which the death may be
traceable, and thus to guide them as to the conclusions to be come to
from the presence, or it may be the complete absence, of any marked
appearance explaining the cause of death.
44. The medical inspectors may afford most important aid to the law
officers in investigating the history of cases of supposed poisoning.
For this purpose minute inquiry should be made into the symptoms during
life their nature, their precise date, especially in relation to meals
or the taking of any suspicious article, their progressive development,
and the treatment pursued. It is impossible to be too cautious in
collecting such information, and, in particular, great care must be
taken to fix the precise date of the first invasion of the symptoms,
and the hours of the previous meals. The same care is required in
tracing the early history of the case, where the inspector happens
to visit the individual before death; and if suspicions should not
arise till his attendance has been going on for some time, he ought,
subsequently to such suspicions, to review and correct the information
gathered at first, especially as to dates. All facts thus obtained
should be immediately committed to writing.
45. Besides inspecting the body and ascertaining the history of the
case, the inspectors may afford valuable assistance to the law officers
in searching for suspicious articles in the house of the deceased.
These are--suspected articles of food, drink, or medicine; the vessels
in which they have been prepared or afterwards contained; the family
stores of the articles with which suspected food, &c., appears to have
been made. All such articles must be secured, according to the rules
in Sect. 13, for preserving their identity. In this examination the
body-clothes, bed-clothes, floor, and hearth should not be neglected,
as they may present traces of vomited matter, acids spurted out or
spilled, and the like.
46. When a medical man is called to a case during life, where poisoning
is suspected, he ought as soon as possible to follow the instructions
laid down for securing articles in which poison may have been
administered.
47. In the same circumstances, it is his duty to observe the conduct of
any suspected individual, were it for no other reason than to prevent
the remains of poisoned articles from being put out of the way, and to
protect his patient against further attempts.
48. The whole organs of the abdomen must be surveyed, and particularly
the stomach and whole tract of the intestines, the liver, spleen, and
kidneys, the bladder; and in the female, the uterus and its appendages.
The intestines should in general be split up throughout their whole
length; and it should be remembered that the most frequent seat of
natural disease of their mucous membrane is in the neighbourhood
of the ileo-cæcal valve, and that, next to the stomach, the parts
most generally presenting appearances in cases of poisoning are the
duodenum, upper part of jejunum, lower part of ileum, and rectum.
49. In cases where the possibility of poisoning must be kept in view,
and where matters may require to be procured for chemical analysis, it
is essential to be sure that all instruments, vessels, and bladders
used are scrupulously clean.
50. When any unusual odour is perceived, either in the blood in the
course of making the dissection, or in the stomach when opened, it
ought to be carefully observed, and if possible identified by all the
medical men present. In this way alcohol, opium, prussic acid, oil of
bitter almonds, and other odorous poisons may be recognised. The smell
of the contents of the stomach ought always to be noted whenever it is
opened, as the smell often alters rapidly.
51. The stomach and intestines should be taken out entire, and their
contents emptied into separate bottles. If the stomach or part of
the intestines present any remarkable appearance, examination may
be reserved, if convenient, till a future opportunity; but in every
circumstance it must be preserved and carried away, as it may itself
be an important article for analysis. The throat and gullet may
be examined at once, and preserved with their contents, which, if
abundant, may be kept apart in a bottle. In addition to the alimentary
canal and its various contents, portions of the solid organs of the
body ought to be secured for analysis. The most important are the
liver, spleen, and kidneys. A part of the liver, at least a fourth
part, should be secured in every case of supposed poisoning; and in
cases where the fatal illness has been of long duration, and therefore
only traces of the poison may remain in the body, the whole of the
liver, the spleen, and both kidneys should be secured. A portion of the
blood, especially when the odour of any volatile poison is perceived,
should be at once put into a bottle, closed by a good cork or stopper.
52. No person ought to undertake an analysis in a case of suspected
poisoning unless he be either familiar with chemical researches, or
have previously analysed with success a mixture of organic substances,
containing a small proportion of the poison suspected.
53. All persons undertaking an analysis should bear in mind that the
opinion of some other person practised in toxicological researches may
be required; and they should therefore take care, when practicable, to
use only a portion of the several articles preserved for analysis. The
identity of the subjects for analysis must be secured by the rules in
Sect. 13.
VII. Examination in Cases of Suffocation
54. In cases of suspected drowning, the inspectors will observe
particularly whether grass, mud, or other objects be clutched by the
hands, or contained under the nails; whether the tongue be protruded or
not between the teeth; state of the penis; whether any fluid, froth,
or foreign substances be contained in the mouth, nostrils, trachea,
or bronchial ramifications; whether the stomach contains much water;
whether the blood in the great vessels be fluid. Careful pressure
should be made upon the lungs; any fluid contained in them in thus
forced into the bronchial tubes and trachea, and its nature observed.
When water with particles of vegetable matter or mud is found within
the body, these must be compared with what may exist in the water in
which the body was discovered, and should be preserved for further
scientific investigation, if requisite. Marks of injuries must be
compared diligently with objects both in the water and on the banks
near it, and especial attention given to the question--whether any
observed injuries had been sustained by the body before or after death.
55. In cases of suspected death by hanging, strangling, or smothering,
it is important to attend particularly to the state of the face
as to lividity, compared with the rest of the body; the state of
the conjunctiva of the eyes as to vascularity; of the tongue as to
position; of the throat, chin, and lips as to marks of the nails,
scratches, ruffling of the scarf-skin, or small contusions; the
state of the blood as to colour and fluidity; the state of the
heart as regards the amount of blood in its several cavities; the
state of the trunk and branches of the vena cava in the abdomen as
regards distension with blood; and the state of the lungs as regards
congestion, rupture of any of the air cells, and small ecchymoses under
the pleura, or the pericardium. The mark of a cord or other ligature
round the neck must be attentively examined; and here it requires to
be mentioned that the mark is often not distinct till seven or eight
hours after death, and that it is seldom a dark livid mark, as is very
commonly supposed, but a pale greenish-brown streak, presenting no
ecchymosis, but the thinnest possible line of bright redness at each
edge, where it is conterminous with the sound skin. Nevertheless,
effusions of blood and lacerations should be also looked for under and
around the mark, in the skin, cellular tissue, muscles, cartilages, and
lining membrane of the larynx and trachea. Accessory injuries on other
parts of the body, more especially on the chest, back, and arms, must
also be looked for, as likewise the appearance of blood having flowed
from the nostrils or ears, and the discharge of fæces, urine or semen.
In cases where death may be due to the emanations from burning fuel or
other poisonous vapours, a small phial should be filled with the fresh
blood, and securely corked for further investigation, if requisite.
VIII. Examination in Cases of Burning
56. In supposed death by burning, the skin at the edge of the burns
should be carefully examined for redness, or the appearance of vesicles
containing fluids.
IX. Examination in Cases of Criminal Abortion
57. In suspected criminal abortion, when the woman survives, the chief
points for inquiry are: The proofs of recent delivery, the ascertaining
of facts tending to show that she has been subjected to manœuvres with
instruments, and the occurrence of symptoms traceable to the action of
any of the drugs reputed as capable of causing abortion.
When the woman has died, the points requiring special attention at the
dissection are: The state of the womb, as regards its size and the
condition of its lining membrane, in reference to the probable period
of delivery; the condition of the intestinal canal, in reference to the
action of irritant drugs; of the mucous membrane of the bladder, in
reference to the action of cantharides; close inspection of the womb
and vagina, in reference to mechanical injuries, especially punctured
wounds; and any appearances that the death may have been caused by
inflammation in the organs of the pelvis, or by bleeding from the wound.
X. Examination in Cases of Infanticide
58. In cases of suspected infanticide, certain specialities must be
borne in mind. The cavity of the head should be laid open with a pair
of scissors. In opening the abdomen, the navel should be avoided, so
that the state of the vessels of the navel-string may be examined
correctly. This is done by carrying two incisions from the ensiform
cartilage to each of the anterior superior spines of the ilia, and by
deflecting downwards the triangular flap thus formed.
59. The inquiry in cases of infanticide should be conducted with
reference to the five following distinct questions: (1) The probable
degree of maturity of the child? (2) How long it has been dead? (3)
Whether it died before, during, or after delivery, and how long after?
(4) Whether death arose from natural causes, neglect, or violence? and
(5) Whether a suspected female be the mother of the child?
60. The points to be attended to for ascertaining the probable degree
of maturity of the child are: The general appearance and development,
the state of the skin, its secretions, and its appendages; the hair and
nails; the presence or absence of the pupillary membrane; the length
and weight of the whole body; whether the navel corresponds or not with
the middle of the length of the body; the situation of the meconium in
the intestines; the size of the testicles in the case of males, and in
either sex the size of the point of ossification in the lower epiphysis
of the thigh-bone. This is easily observed by making an incision
across the front of the knee into the joint, pushing the end of the
thigh-bone through the cut, slicing off the cartilaginous texture
carefully until a coloured point is observed in the section, and then,
by successive very fine slices, ascertaining the greatest diameter of
the bony nucleus. This does not exist previous to the thirty-sixth week
of gestation, and in a mature child is about one-fourth of an inch in
diameter. Has the infant been washed? Absence or presence of vernix
caseosa. Nature and character of the wrappings, if any, found on the
child.
61. The points of chief importance in reference to the period which
has elapsed after death are those specified in the last clause of
Sect. 17--it being borne in mind that the bodies of infants are often
concealed in ash-pits and dunghills, and that in these circumstances
putrefaction is very rapid.
[Illustration: Plate.--Section through the epiphysis of the lower end
of the femur showing ossification centre, in a full-term fœtus.]
62. The circumstances which indicate whether the child died before,
during, or after parturition, and how long after it, are the signs
of its having undergone putrefaction within the womb; the marks on
the crown, feet, buttocks, shoulders, &c., indicating presumptively
the kind of labour, and whether it was likely to have proved fatal to
the child; the state of the lungs, heart, and great vessels, showing
whether or not it had breathed; the nature of the contents of the
stomach and of the intestines; the presence of foreign matters in the
windpipe; the state of the umbilical cord, or of the navel itself, if
the cord be detached.
63. In order to examine properly the state of the lungs, heart, and
great vessels, with a view to determine whether or not the child had
breathed, the inspection should be made in the following order: Attend,
first, to the situation of the lungs; how far they rise along the sides
of the heart; to their colour and texture; whether they crepitate or
not. Then secure a ligature round the great vessels at the root of the
neck, and another round the vena cava above the diaphragm. Cut both
sets of vessels beyond the ligatures, and remove the heart and lungs
in one mass, which must be weighed and put into water, to ascertain
whether the lungs, with the heart attached, sink or swim. In the next
place, put a ligature round the pulmonary vessels, close to the lungs,
and cut away the heart by an incision between it and the ligature.
Lastly, ascertain the weight of the lungs; whether they sink or swim
in water; whether blood issues freely or sparingly when they are cut
into; whether any fragments swim in the instances where the entire
lungs sink; and in every instance of buoyancy whether fragments of them
continue to swim after being well squeezed in a cloth.
64. The general question to be considered in relation to the cause
of death is, whether the appearances are such as to be traceable to
the act of parturition, or whether they indicate some form of violent
death. The directions given in Divisions V., VI., and VII. apply to
infants as well as adults; but the following points are specially to be
noticed in cases of supposed infanticide:
In relation to wounds and contusions, the possibility of
minute punctured wounds of the brain or other vital
organs; in reference to injuries of the head, the
effusion of blood under the scalp, not in the situation
where it could have been produced during labour, or
fracture of the bones not producible by compression
of the head during labour, and not connected with
defective ossification of the skull; in reference to
the allegation that the head was injured by the child
suddenly dropping from the mother, when not recumbent,
the presence of sand or other foreign matters on the
contused scalp, and the existence of more than one
injury of the head; in relation to suffocation, the
external and internal signs of this form of death--marks
of compression of the mouth, and nose, and throat, and
the presence of foreign matters in the mouth and throat,
air-passages, gullet, or stomach, especially if the
body be found in contact with similar substances; in
reference to bleeding from the navel-string, a bloodless
state of the body, without any wound to account for
it; in reference to poisons, most commonly narcotics,
the absence of any of the above appearances, with an
otherwise healthy state of the body; in reference to
starvation and exposure, emaciation of the body, absence
of food from the stomach, and an empty, contracted
condition of the intestines; in reference to the
possibility of the child having been suddenly expelled,
and having fallen on the floor or into privies, &c., the
state of the navel-string is to be noted--whether long
or short, whether remaining attached to the child and
connected with the after-birth, indicating rapid labour,
or, if divided, whether it had been cut or torn across.
Nature of the ligature used, if any.
65. The circumstances noticed in Sects. 60, 61, 62, 63, 64, compared
with the signs of recent delivery in the female, will lead to the
decision of the question whether the suspected female be the mother of
the child. These circumstances may be shortly recapitulated as being
the signs of the degree of maturity of the child--the signs on the body
of the kind of labour, the signs which indicate the date of its death,
and the interval which elapsed both between its birth and death, and
between its death and the inspection.
EXHUMATIONS
It becomes necessary sometimes to exhume the bodies of persons who have
been buried. The cases which generally call for this always unpleasant
proceeding are those where a suspicion of poisoning or violence has
arisen some little time after the burial of the supposed victim. Or
the necessity may arise to show that the body buried is that of a
person whose death it is absolutely necessary to prove. In the case of
Livingstone, though this can scarcely be called a case of exhumation,
yet an examination some months after death of the arm of the corpse
alleged to be that of Livingstone, proved the existence of a badly
united fracture which the deceased was known to have had.
In conducting the exhumation, it is necessary that the medical experts
should be present to see the body removed from the coffin, and also
any person or persons who may be in a position to speak as to the
identity of the corpse--as, for instance, those who dressed it and
prepared it for burial. The person who made the coffin may also be of
assistance to speak as to its identity. As soon as the medical men are
armed with the proper authority, no time should be lost in order to
get the body as fresh as possible, and at once prove or disprove the
accusation of the crime, which, in the case of innocent persons, cannot
be too quickly removed. The best time to take up the body, if in the
summer, is early in the morning; and, in all cases, the examination,
if possible, should be made during daylight. Everything necessary for
making a medical inspection should be taken, and also a table on which
to place the body. Rubber gloves should be worn. A pail containing a
solution of some disinfectant, for the inspectors to wash their hands
after the exhumation is finished, should be close at hand. And it is as
well to expose the body for a short time to the air before beginning
the inspection. There is seldom any risk to health in removing a single
body, yet certain precautions are necessary; thus it is as well to
stand on the windward side of the corpse. Vaults should not be entered
as soon as they are opened, but time allowed for their ventilation.
Carefully note the amount of preservation of the coffin, and, if
broken, if any of the surrounding earth is in contact with the body.
This precaution is necessary in cases of suspected mineral poisoning
(as in arsenic, &c.), and it is as well also to save one or two pounds
of the earth immediately above the coffin for analysis. The body may
then be examined externally, any hair left on head or face preserved
for identification; and then an inspection of all the cavities made,
the contents of the stomach and bowels being placed in dry earthenware
jars or glass bottles, corked and capped with thin indiarubber skin,
and so tied and sealed that the string must be cut or the seals broken
in order to open them. The ends of the string should be sealed in the
presence of the authorities. In the examination, the instructions
previously given should be carefully followed. All injured or diseased
parts should be removed and preserved whenever this is practicable.
Soft parts not intended for analysis may be preserved in a concentrated
solution of salt.
=Beyond what Period is it useless to Exhume a Corpse=?--There is no
scientific limit, for even the bones may show that violence has been
used, or may point to the identity of a corpse, as in the case of
Livingstone just mentioned. Pregnancy may be detected. The medical
inspectors must proceed with the inspection unless they can positively
say that the progress of decay is such as to render the examination
nugatory in relation to its special objects. Casper mentions the case
of a man whose body was three times exhumed for different purposes. In
Scotland the law imposes a limit of twenty years, but in England the
law is silent on the point; in France a limit of ten years from the
date of the supposed crime; and in Germany, the limit is thirty years,
if the offence is that punishable with death, the time varying from
three to thirty years with the nature of the crime.
CHAPTER V
ASSAULTS, HOMICIDE, AND WOUNDS
=Assault.=--Every act of attack upon the person of another is an
assault in law, whether it injure or not; nor is it necessary that the
act done take effect. Spitting on anyone is an assault. No provocation
by word, whether written or spoken, can justify an assault, though it
may mitigate the offence. If a medical man unnecessarily strip a female
patient naked, under pretence that he cannot otherwise judge of her
illness, it is an assault if he himself take off her clothes (R. _v._
Rosinski, 1 Mood C.C. 12). So, where a medical man had connection with
a girl fourteen years of age, under the pretence that he was thereby
treating her medically for the complaint for which he was attending
her, she making no resistance solely from the _bona fide_ belief that
such was the case, this was held to be certainly an assault, and
probably a rape (R. _v._ Case, 1 Den. 580; 19 L.J. [M.C.] 174). Such an
act is now held to constitute a rape.
=Battery.=--This includes beating or wounding. A touch of the finger,
however slight, is included under this term.
=Homicide.=--In Scotch law homicide is held to be committed only where
a distinctly self-existent human life has been destroyed. Destruction
of an unborn child, however short a time before delivery, may be
criminal, but is not homicidal. In the same country criminal homicide
is divided into two classes:
(1) Murder. (2) Culpable Homicide.
1. _Murder_ is constituted in law by any wilful act causing the
destruction of human life, whether plainly intended to kill, or
displaying such utter and wicked recklessness as to imply a disposition
depraved enough to be wholly regardless of the consequences. Murder may
be the result of personal violence, poison, or by the committal of some
other serious crime, as where anyone causes the death of a woman in the
attempt to procure criminal abortion, rape, or by the exposure of an
infant which results in its death. The use of weapons is not essential.
2. _Culpable Homicide._--The name applied in law to cases where the
death of a person is caused or materially accelerated by improper
conduct of another, and where the guilt does not come up to the crime
of murder:
(_a_) Intentional killing of another in circumstances
implying neither murder on the one hand, nor justifiable
homicide on the other--_e.g._ if a person exceed
moderation in retaliation for an injury, or kill another
when the danger to which he was exposed is passed.
_Every charge of murder is held to conclude a charge of
culpable homicide, and the jury, if they see cause, may
find that culpable homicide only has been committed._
(_b_) Homicide, by the doing of any unlawful, or any
rash and careless act, from which death results, though
not foreseen as probable--_e.g._ using firearms in
a public street, &c.
(_c_) Homicide, resulting from negligence or rashness
in the performance of a lawful duty--_e.g._ a
signalman on a railway forgetting to alter the points,
and thus causing a collision, and loss of life. In
England this would amount to manslaughter.
=Justifiable Homicide.=--Self-defence; hanging a prisoner properly
sentenced to death; killing another to prevent murder, if prevention
can avail in no other way. In self-defence, the person killing must be
in _reasonable dread_ of death at the hand of his adversary.
In England there is--1. Murder; 2. Manslaughter; 3. Justifiable
Homicide.
Murder, according to Lord Coke (3 Inst. 47), is constituted “where
a person of sound memory and discretion unlawfully killeth any
reasonable creature in being, and under the King‘s peace, with malice
aforethought, either expressed or implied.”
In England the killing must be committed with malice aforethought.
Malice may be expressed or implied.
In Scotland malice aforethought is not necessary (5 Irv. 525, and 40
S.J. 92, and 5 S.L.R. 20).
The law in both countries appears to differ more in terms than in
practice. In England, if an injured party live for one year and a day,
and then die, death is not attributed to the injury; but in Scotland,
although no definite time is fixed, yet no case would I believe
be entertained at any lengthened period after the commission of a
homicidal act. The longest interval, according to Taylor, at which
conviction has taken place from indirectly fatal consequences was _nine
months_.
In the United States, as a rule, the crime of murder admits of two
degrees: in the _first_, where the act is intentional or is the result
of an attempt at burglary, rape, arson, or by poison; otherwise the
crime falls under the _second_ degree.
WOUNDS
=Legal Definition.=--According to the statute (24 and 25 Vict. c. 100,
sec. 18), the word “wound” includes incised, punctured, lacerated,
contused, and gunshot wounds. But to constitute a wound within the
meaning of the statute, the _whole skin_, not the mere _cuticle_, or
upper skin, must be divided (R. _v._ M‘Laughlin, 8 C. & P. 635). But
a division of the _internal_ skin, _e.g._ within the cheek or lip, is
sufficient to constitute a wound within the statute (R. _v._ Warman,
1 Den. C.C. 183). If the skin be broken, the nature of the instrument
with which the injury is inflicted is immaterial, for the present
statute extends to wounding, &c., “_by any means whatsoever_.” A wound
from a kick with a boot is within the statute (R. _v._ Briggs, 1 Mood
C.C. 318). Injuries, burns, and scalds--which, in accordance with the
above definition of a wound, are not wounds--are provided for under
the clause, “or cause any grievous bodily harm to any person.”
Casper defines “an injury” to be “every alteration of the structure
or function of any part of the body produced by any external cause.”
Taylor proposed the following as the best definition which can be given
to the word “wound,” whether in a medical or legal sense, viz. that
it is “a breach of continuity in the structures of the body, whether
external or internal, suddenly occasioned by mechanical violence.”
This would include dislocations, fractures, either simple or compound,
injury to the skin or mucous membrane, and to internal organs. Burns
and injuries due to the action of corrosives are excluded from the
category of wounds.
=Concerning Wounds in general.=--Great care must be taken to ascertain
the exact site and course of the injury on the body, as this precaution
will greatly assist in answering the questions: _Is the wound dangerous
to life?_ _Does it cause grievous bodily harm?_ _Is it suicidal, that
is, inflicted by the person on himself; or homicidal, inflicted by
another?_ The solution of the question of the dangerous character of
the wound is left to the professional knowledge of the witness, who may
be required to state his reasons for considering the wound dangerous
to life. His mere assertion will not be accepted. “The safest course,”
says Elwell, “for the witness, in regard to all these questions, is to
give a true and plain account of the wound, describing it minutely,
and the probable consequences that may attend it.” In relation to
their danger to life (apart from so-called “simple” wounds which are
not usually extensive, heal easily, and cause little trouble in their
course), wounds may be considered dangerous to life when they are so
extensive, or on account of their position and relation to important
structures when they would prove fatal without the intervention
of surgical skill; and when the danger is _imminent_. A _mortal_
wound is one which is rapidly followed by death. Wounds, however,
which in themselves could not be regarded as dangerous to life, may
become so by intercurrent complications, such as erysipelas or other
infective process. As a general rule, only those wounds in which the
danger to life is _imminent_ should be stated as dangerous to life.
Compound fracture of the bones of the cranium, injury to any large
arterial trunk, or to any of the internal organs, may be considered as
“dangerous to life”; but where the danger is more remote, as in the
probable supervention of tetanus, erysipelas, &c., the medical opinion
must be more guarded. But the medical witness should always bear in
mind that death may follow the slightest injury. A case is recorded of
death in forty-eight hours after extraction of a tooth. The contrary
also holds good, for the most fearful injuries have been followed with
recovery.
The following suggestions may help the practitioner in the formation of
his opinion as to the probable danger of a wound:
1. The extent of the injury. 2. The character of the
instrument used in the infliction of the wound. 3. The
violence suffered by the parts. 4. The size and importance
of the blood-vessels and nerves injured. 5. Is the wound
healing or likely to heal well, and is the constitutional
disturbance severe or slight? 6. Age of the sufferer. 7.
Is there any constitutional taint likely to render even a
slight wound more severe, or even dangerous to life? 8. Has
the previous medical treatment been skilful or otherwise?
Should the injured party be found dead, a careful _post-mortem_
examination will alone determine the probable part the injury bore in
the production of the fatal result.
Points of Importance to be Noticed in Examination of a Dead Body found
Wounded.
1. Note situation, extent, depth, breadth, length, and direction of
wound. Take careful measurements, in order to determine the character
of the weapon, and the organs of the body injured.
2. Is there any appearance of ecchymosis, or is the effused blood
liquid or coagulated?
3. Examine wound as to presence of pus, adhesive inflammation,
gangrene, or foreign bodies.
_Why?_ Presence of pus, &c., will show that death must
have taken place some time after the wound was inflicted.
4. In all examinations of wounds, be careful to disturb as little as
possible their outward appearance, in order to compare the wound with
the suspected weapon.
5. All notes should be taken during such examination, or _immediately_
after.
6. Make a careful examination of all the important organs of the body.
_Why?_ In order to disprove the suggestion that death
was due to other causes--poison, disease, &c. This is
important, as in the case of a girl who, dreading a
whipping, swallowed some arsenic, from which she died,
yet her father was tried for causing her death by the
severity of his punishment.
7. Only facts should be stated in the Report; _no inferences_ should be
drawn or suggested.
8. In describing the appearance of wounds use _simple untechnical
language_, and avoid superlatives and high-flown words to describe and
explain simple facts.
9. In gunshot wounds, note position of body, state and contents of the
hands, and the direction of the wound in relation to external objects.
Note also in all kinds of wounds the relationship of the wound to cuts
or rents in the clothes of the deceased.
INJURIES OF SPECIAL REGIONS
Injuries of the Head and Spine
These may be either _external_, affecting the integuments; or
_internal_, affecting the brain substance, &c. In the latter, as a
rule, there are signs of external violence. An ecchymosed tumour of
the scalp may impart a _sensation of crepitation_ to the finger, and
may thus be mistaken for a fracture of the skull. The tumour may also
pulsate if any large vessel be near it, giving one the idea that
the pulsations are due to the movements of the brain. A large wound
without fracture points to a more or less oblique blow, a small wound
to direct violence. A blow with a heavy blunt weapon may make a clean
incised wound, and often in these cases the seat of the bruise does not
correspond with the centre of the cut. Dr. Ogston mentions the case
of a young lady on whom a cricket ball inflicted a wound across the
forehead, immediately above, and of the length of, one of the eyebrows,
which he could not distinguish from a wound by a cutting instrument.
All injuries to the head are more or less severe and dangerous, and
great care is required in forming a prognosis with regard to the
ultimate effect of an injury to the head. Inflammation of the brain
does not, as a rule, supervene for about a week after the accident, and
patients should not be considered safe from danger till two or three
weeks after. Be it remembered also that in some cases the inflammatory
action may proceed insidiously for some months without giving any
distinct evidence of its presence till close upon a fatal termination.
Scalp wounds are dangerous, from erysipelas, &c. They should be
examined as to their extent, form, depth, and position.
_Concussion_ of the brain may arise from falls on the nates, or from
blows on the head. The face becomes pale, the pupils contracted, the
pulse weak and small, the extremities cold, the respiration scarcely
perceptible, and the sphincters relaxed. The tendency to death is from
syncope. Reaction may then occur: the pulse quickens; the skin is hot
and dry; there is great confusion of thought, from which the patient
ultimately recovers; vomiting is present in most cases. Concussion
often passes into compression, due to hæmorrhage from the lacerated
cerebral vessels. Concussion and compression differ in this: in the
former, the effects are instantaneous; in the latter, a short time
elapses before the symptoms make their appearance; and these become
more and more marked, whereas in concussion they gradually pass
off. It is often a difficult matter to distinguish the effects of
compression from those common to drunkenness or narcotic poisoning.
The odour of the breath and the history of the case will assist in
forming an opinion. Concussion of the brain may prove fatal without
either fracture of the skull, effusion of blood within the cranium, or
any other change being observed on dissection, death being caused by
the shock given to the whole nervous organ, which, being unrelieved,
speedily lapses into annihilation of function.
_The symptoms of compression_--a full, strong, and often irregular or
slow pulse; normal heat of surface; muscular relaxation; dilatation,
contraction, or inequality of the pupils; stertorous breathing, and
paralysis--are not unfrequently retarded, and this consideration should
render the opinion very guarded. Bryant records a case (_Surgery_,
vol. i. p. 216) in which a man was thrown out of a gig on to his head.
After a short period of insensibility he walked for half an hour,
and then gradually again became insensible, and ultimately died. A
large clot was found over the left cerebral hemisphere, the blood
evidently having flowed from the middle meningeal artery. The short
period of insensibility probably arrested the flow of blood from the
artery, which recurred on the sufferer walking. The structural form
of the cranium may have much to do with the danger to be expected
from blows--some skulls being thinner than others--and in a few rare
instances the fontanelles may not have become ossified during life.
The possibility of an unhealthy condition--atheroma--of the arteries of
the brain, or of disease of the heart, must be taken into consideration
before venturing an opinion as to the tendency or ultimate cause of
death.
It may be stated that the patient died of apoplexy. Apoplexy is a
disease of old age, and seldom occurs in the young, although it is
just possible it _might_ occur. The arteries should, in every case,
be examined for the presence or absence of disease. When violence is
used, the effusion of blood is, as a general rule, on _the surface_ of
the brain; but two cases are given by Dr. Abercrombie of spontaneous
bursting of a blood-vessel within the head, followed by effusion of
blood _upon the surface_ of the brain. “An external injury, coexisting
with an extravasation of blood into the cerebral substance, does not
necessarily imply cause and effect. The previous condition of the
brain, or the outpouring of blood from diseased vessels, may, in fact,
have been the cause of the accident” (Hewett). When, however, blood is
found effused on the surface of the brain, especially between the dura
mater and the skull, either beneath or opposite to an external wound,
we may reasonably infer that the hæmorrhage is due to a direct blow.
Hæmorrhage so severe as to produce dangerous pressure on the brain, as
a rule, comes from a rupture of the middle meningeal artery.
Husband relates a case in the Edinburgh Infirmary in which there was
a large clot over the left frontal lobes, accompanied with aphasia
and right hemiplegia, with no rupture of the middle meningeal artery,
or any signs of external injury. The man had just left the cells on a
charge of drunkenness. The source of the hæmorrhage was not clearly
made out, but it seemed to be due to the rupture of an artery in
a pachy-meningitic patch. Blood may be found in the cavity of the
arachnoid in the great majority of severe injuries to the head, and
even in trifling cases where least expected. Rupture of the venous
sinuses may take place without fracture of the skull. I have met with
this in a fatality during a boxing match; a large effusion over the
brain, and especially in the temperosphenoidal fossa, taking place from
rupture of the left lateral sinus at the junction with the superior
petrosal; there was also a vertical hæmorrhage into the pons. The
effused blood may, after a time, become changed, and form a false
membrane on the _parietal_ arachnoid, seldom on the _visceral_ surface.
Blood cysts may even be formed, in the course of time, having all the
appearances of a serous membrane. The blood may spread to parts remote
from the seat of injury, and the extravasation does not always occur
at the exact spot of the application of the blow, but often at a spot
directly opposite. Two extravasations may be the result of one blow.
Fits of passion have been advanced as a cause of apoplexy, but
this cause is rare. _Fracture of the cranial_ bones may be due to
counter-stroke--_contre-coup_--or to falls on the nates, &c. Fractures
of the skull are divided into two groups (Körber): (1) those produced
by _bilateral_ compression of the skull; and (2) those resulting from
violence applied to _one side_ only. _In both groups the line of
fracture runs parallel with the axis of compression._ Fissures of the
base from bilateral compression of the skull are always transverse.
Punctured wounds of the cranium are always dangerous, but the patient
may survive many days. Dr. Bigelow, Professor of Surgery in Harvard
University, U.S.A., relates a case in which an iron bar, weighing
thirteen and a quarter pounds, three feet seven inches in length, and
one inch thick, was driven through the head, followed by recovery, the
patient only losing the use of the injured eye.
Contusion and laceration of the brain may occur from injuries to the
head, either at the seat of injury or by contre-coup at some other
part. The contused area may exhibit local extravasation of blood,
or in the diffuse form, extravasations may be multiple and also on
the surface. The symptoms are those of cerebral irritation, coma,
or restlessness, paralysis, tonic or clonic spasms. In slight cases
recovery may follow, in others some degree of loss of mentality and
paralysis may remain.
There is great danger of inflammatory complications. I have met with a
case of severe comminuted fracture of the skull with laceration of the
brain, the latter substance appearing on the surface of the scalp, with
loss of brain substance, in a boy who made a complete recovery without
any loss of intelligence or power following the injury.
For the detection of brain substance on weapons the microscope is alone
reliable, and then only the cellular portion of the brain is of any use.
_Injuries to the spinal cord_ may cause immediate death; cases,
however, occur of life being prolonged for some days, or even longer,
after injury to the cord. The symptoms are progressive paraplegia and
paralysis of the bladder and rectum, ending in death. Bedsores and
septic infection of the bladder and kidneys are complications which
add to the gravity of the condition. Spicula of bone in the cord,
dislocation of the vertebræ, or extravasation of blood in the membranes
of the cord, may be found after death. The presence of blood upon the
spinal cord is not necessarily the result of violence, as hæmorrhage
may take place spontaneously. The spine should be examined in all fatal
cases of supposed injury. Concussion of the spinal cord is a fertile
source of differences of opinion in railway cases. In no case should a
hasty decision be given as to the probable future result to the patient
from the injury.
Wounds of the _face_ are not generally dangerous, unless they penetrate
the brain. There is always the possibility of injury to the eye causing
detachment of the retina, or inflammation leading to blindness.
Punctured wounds in the neighbourhood of the orbit may become septic
and lead to secondary meningitis.
Wounds of the Throat and Chest
Wounds of the _throat_ are more or less dangerous, due to the
possibility of severe hæmorrhage, emphysema, and bronchitis.
Wounds of the _chest_ are dangerous, on account of the amount of the
hæmorrhage which may take place, and the importance of the organs
which may be injured. Death may result more from the mechanical action
of the blood effused than from the depressing effect of the quantity
evacuated. Penetrating wounds of the thorax injuring the lungs cause
emphysema, pneumo-, pyo-, or hæmothorax, any of which may prove fatal;
pleurisy and pneumonia may occur. A fracture of the ribs may give rise
to injury of the lung substance or to inflammation of its coverings.
Laceration of the lungs may take place without fracture of the ribs.
The ventricles of the heart may be pierced, and yet life may be
prolonged for one or two months, permitting of considerable locomotion
during that period (Briand et Chaudé, _Med. Leg._, vol. i. p. 511).
Wounds of the heart, however, are, as a rule, rapidly fatal. Rupture
of valves may follow blows on the chest, and rupture of the heart may
occur from crushes or violent blows. Rupture of the heart has taken
place during violent exertion, and this is more likely to occur when
the muscle is diseased. It is often difficult to make out the direction
of the wound, as the lungs change their position during respiration.
Injuries of the Abdomen
Wounds of the _abdomen_, penetrating the intestines, although not
necessarily fatal, may cause death from peritonitis, due to the escape
of the intestinal fluids. Rupture of the intestine may follow blows or
crushing; it is generally fatal from peritonitis unless early surgical
treatment is carried out. Hernia may also follow wounds of the abdomen.
Rupture of the liver is not of infrequent occurrence, and may occur
without any external signs of the injury. The rupture is, as a rule,
longitudinal, transverse lacerations being rare. It is often followed
by pneumonia if not rapidly fatal. The cœliac plexus may be much
damaged by a blow or kick on the stomach, especially if this organ be
distended with food, and death may result without leaving any trace of
the injury externally or internally. The bladder may be ruptured and
death result from extravasated urine. Rupture of the bladder may occur
from fracture of the pelvis without sign of external injury. Rupture of
the _kidney_ may be recovered from if slight, but when severe is fatal.
Rupture of the spleen is usually fatal, and is more likely to occur
when enlarged from any cause. Coagulable lymph, the effect of a wound
of a serous membrane, may be thrown out in twelve hours or less.
Injuries to the abdomen may cause death by--
1. Shock; without lesion of the internal organs,
inflammation, or external signs of injury.
2. Hæmorrhage.
3. Lesion of the internal organs, but without inflammation.
Death in these cases seems to be due to depression of the
nervous system due to the intense pain following these
injuries.
4. By inflammation without lesion of internal organs.
5. Inflammation from lesion of internal organs.
6. Destruction of the natural functions of the organs, and,
as a result, malnutrition of the body.
Except in the first case, when death is instantaneous,
wounds of the abdomen are not as a rule immediately fatal.
Wounds of the _genital organs_ of the female may cause fatal
hæmorrhage, which takes place from the plexus of veins which, in these
parts, are devoid of valves. A kick from behind whilst the woman is
stooping or kneeling may rupture the labial vessels and death supervene.
Blows and kicks upon the abdomen do not often injure the non-gravid
uterus, but during gestation may produce abortion and hæmorrhage. If
the pregnancy be advanced the uterus may be ruptured or the placenta
separated. Penetrating wounds either through the abdominal wall, or
per vaginam in the attempt to procure abortion, cause hæmorrhage and
peritonitis with septic infection.
FRACTURES OF BONES
Unless they implicate some special structure, such as the brain and
medulla, simple fractures are not considered dangerous to life. When
compound, they may be complicated with hæmorrhage and infective
processes.
Certain pathological conditions favour the spontaneous fracture of
bones, or this occurrence with such slight violence as would not cause
fracture in the normal may take place.
In old people bones are more liable to fracture from their brittle
condition. Liability to easy fracture occurs in the insane, in nervous
lesions as locomotor ataxia and general paralysis of the insane,
when the bones are the seat of new growths, in fragillitas ossium,
osteopsathyrosis; in the latter disease I have seen the femur fracture
by the weight of the leg while resting the foot on a cushion. The
liability to fracture depends upon the proportion of organic and
inorganic constituents. In disease, the latter may be reduced and
predispose to fracture; in the young, the bones are more liable to
greenstick or incomplete fracture; and in the old, from excess of
inorganic constituents causing brittleness.
A medical man may be required to express an opinion as to whether or
not fractures are the result of direct violence, and especially when
allegations have been made against attendants on the senile or insane.
The previous predisposing pathological conditions must always be taken
into account, and also the amount, if any, of repair that has followed
in relation to the time the alleged violence took place.
As the condition of a fracture of the bone of a limb may become a
question of considerable importance in medico-legal investigations,
the following brief account of the process of repair in fractures is
given:
_From the First to the Third Day._--The period of
inflammation and exudation. Ordinary signs of inflammation
and laceration of the parts. Blood will be found
extravasated round the fracture, also in the medullary canal
mixed up with the fat.
_From the Third to the Fourteenth Day._--Gradual
subsidence of inflammatory action and growth of the soft
provisional callus from the periosteum and surrounding
structures, and internally in the medulla, forming a
fusiform mass holding the broken ends of the bones together
with some degree of firmness. This becomes firmer and almost
cartilaginous in density. When the bones are kept immovable,
or are impacted, the provisional callus may not be formed.
In the case of the ribs the provisional callus is always
formed, and Dupuytren‘s “ring of provisional callus” is
constant. This may also occur in fractures of the clavicle.
_From the Fourteenth Day to the Fifth
Week._--Ossification of the provisional callus. The bone
is first soft and spongy till the conversion of the soft
callus is complete.
_From the Fifth Week to some Months after the
Injury._--Complete bony union of the fracture and
absorption of the provisional callus.
Although the blood clot completely disappears from the immediate
neighbourhood of the fracture at an early period, yet layers of dark
coagulum may often be found beneath the superficial fascia for four
weeks or more after the accident (Erichsen).
It may be of importance to remember this in medico-legal inquiries.
The presence or absence of the signs of vital reaction will help to
distinguish fractures caused before or after death.
A fracture taking place immediately after death cannot be distinguished
from one immediately before death, but if a few hours after death, the
differences are easily recognised, blood is not effused round the ends
of the bones unless a large vessel be torn.
In the examination of bones for fracture in the living it is the duty
of the examiner to have an X-ray plate taken of the injured bone,
especially if the seat of injury is in close vicinity to a joint.
Previous fractures are easily recognisable after death even when the
bone does not show manifestations externally; on longitudinal section
the seat of fracture is rendered evident.
Is the Wound Suicidal, Homicidal, or Accidental?
An attempt is made to answer this question by a consideration of the
wounds in reference to their _position_, _nature_, _extent_, and
_direction_.
In reference to their _position_ it has to be borne in mind that one
person may wound any part of the body of another, but that to the
suicide certain parts only are accessible, and they have a predilection
for wounding themselves in favoured regions; the front of the body
and vital parts are chosen by the suicide, while wounds on the back
point to homicide. Suicidal wounds on the head are generally in front
or lateral, and on the neck in front or to one side, in cutting the
throat. Accidental head injuries are more often on the vertex, and
when there may be no history of a fall on the occiput, wounds in this
situation indicate homicide.
Suicides may choose unusual regions, such as cutting of a large vessel
as the femoral artery in Scarpa‘s triangle, or by a limited incision,
the carotid in the neck, the injury may be about the genitals, and the
penis and scrotum have been amputated.
Accidental injuries may occur on any part of the body, but most
commonly on exposed parts.
The _nature_ and _extent_ of the wounds does not afford much
assistance; with the exception of contused wounds which are usually
homicidal or accidental, any other form of wound, particularly incised
or punctured wounds, may be suicidal or homicidal, and with regard to
gunshot wounds, much depends upon their position and extent. As a rule,
the suicide does not make several wounds, and the homicide may not only
inflict several but of a greater severity than are necessary to carry
out his purpose.
Suicides, especially when insane, may wound themselves severely
and cause great injuries by leaping from buildings or similar high
positions. In some cases suicides have inflicted several and varied
wounds on their bodies.
The _direction_ of suicidal wounds, when the person is right-handed,
is generally from above downwards and inwards on the chest, and on the
left side. An upward direction points rather to homicide.
=Cut throat wounds=, when suicidal and inflicted by the right hand, are
generally oblique from left to right, beginning higher up than they
end. They generally cross the thyroid cartilage, and the larger vessels
may escape; if made below the thyroid cartilage they are generally
smaller and horizontal. The skin is the last structure divided, and
there may be several so-called “tentative cuts.” It has been held
that when the large vessels are cut the suicide stops, but this is
incorrect, as in some cases the wound has reached the spine and the
vessels been quite severed. Suicides may try to decapitate themselves
from behind, and failing this stab themselves. A homicidal cut throat
wound, when made from the front with the right hand, commences on the
right side and is carried to the left; they are often deep incisions to
the vertebræ and the tissues “undercut” at the ends. A homicidal cut
throat wound when made from behind the victim resembles a suicidal one.
When wounds are present on the forearms, hands, and fingers, and if
there are injuries on other parts of the body also, the inference would
be that the hand wounds were received in guarding the throat or other
efforts at defence from a homicidal attack.
=Wounds produced by Firearms.=--To distinguish between suicidal,
homicidal, and accidental wounds is far from easy. If the weapon be
held hard up or close to the body, as in suicide, the skin and hair
would be scorched and blackened, as would probably the hand that held
the weapon, but this has not occurred in every case. The grasping
of the firearm by the hand in cadaveric spasm is certain evidence
of suicide, as this cannot be simulated by an assailant placing the
weapon in the hand after death. Full investigation should be made by
noting the bullet track and surrounding objects which may have been
grazed in its course, in order to form a probable estimate of the
direction from whence it came. Bullet wounds in the back are usually
homicidal.
Duties of a Medical Man When Called to Examine a Wounded Person
The surgeon should at once visit the wounded party, and proceed to
examine the injury, for if this be done before swelling occurs, he will
be better able to form an opinion of its nature, extent, and severity.
If the wound has been dressed, he should, if possible, obtain the
attendance of the person who applied the dressings, and who would be
able to describe their nature, and the dangers to be avoided in their
removal, should that be deemed necessary. In no case should a surgeon
remove the dressings applied by a professional brother without his
presence and assistance. The condition of the injured party should be
carefully noted, and a minute description of the wound written down at
the time. The statements of the bystanders are also useful and should
be noted. The procedure in the examination of the dead body has been
previously described (p. 60).
An important question here arises. Have the wounds found on the
body been produced during life or after death? The answer is beset
with difficulties, and considerable caution will be necessary, but
tables will be given under the different kinds of wounds to assist
the diagnosis. Signs of vital reaction are important, as showing
the _ante-mortem_ infliction of the wound; but these may, to some
extent, be removed by the action of water, as in cases where the body
is found in a pond. Under these circumstances the evident signs of
drowning--water in the stomach, &c.--will assist the diagnosis. The
presence of putrefaction also greatly obscures the diagnosis. The
presence of coagulated blood between the edges of the wound is not a
trustworthy indication of the _ante-mortem_ infliction of the wound, as
experiment has shown that as long as the body remains warm coagulation
may take place. Coagulation even in contused wounds, effected before
death, may be retarded from various unknown causes--disease, _e.g._
scurvy; mode of death, _e.g._ asphyxia. The amount of hæmorrhage on
or around the body is, other things being equal, a safe criterion as
to the time when the wound was inflicted; if in considerable amount,
arterial blood points to _ante-mortem_ injury; the presence of venous
points blood to _post-mortem_ injury.
Care should be taken to record and photograph the body in position
where found, and its relation to surrounding objects. Careful note
should be made of the surroundings and the character and presence
of any blood-stains, footprints, &c. The question may have to be
considered as to whether the body is in the place it was when the
wounds were inflicted. Blood in any quantity in one place, and the
body found in another so seriously injured that locomotion would be
impossible, point to the body having been removed.
Signs of a struggle, if any, should be recorded. If a weapon be found
near to the body, its position should be noted, and if in the hand,
the firmness of the grasp--cadaveric spasm--should be recorded. All
clothing should be carefully examined, and the relation of cuts and
body wounds noted. All blood-stains on the clothing should be examined
and described.
Multiple bullet wounds denote homicide, but suicides have been known
to inflict more than one wound. It is strong evidence of suicide if
the gun or pistol has burst by the explosion, as suicides have a
predilection for overloading the weapon employed.
PRETENDED ASSAULT
How may wounds, alleged to have been the result of an assault, be shown
to have been self-inflicted? This has to be done by considering:
(1) The character of the wounds: in these cases they are generally
slight, and may consist in a series of small, superficial wounds.
(2) The parts of the body where they are, and those from which they are
absent. They are never found on vital parts, but always where there
is little danger of doing harm. They are present on parts accessible
to the individual. The hands are seldom wounded, and if they be, not
severely.
(3) The clothing may not be cut, and if it be, the cuts may not go
right through, and if they do, they may not coincide with the position
of the wounds. The person should be clothed in order to determine
this. Blood-stains on the cuts in the clothing may be erratic in
distribution, some being on the inner layer only, some on the outer,
and rarely soaking through all, pointing to the probability of its
having been artificially applied.
Such self-inflicted wounds are usually produced for the purpose of
bringing a fictitious charge of assault, feigning self-defence or
provocation on the part of the assailant when accused; and in order
to divert suspicion, as in the case of a person who alleges he has
received the injuries by an assailant who was committing robbery while
he himself is guilty of it.
THE CAUSES OF DEATH FROM WOUNDS
Wounds may prove fatal from results which are (1) =directly=
due to injury--_hæmorrhage_, _shock_, or _mechanical injury
to some vital organ_, _e.g._ the heart or lung; or (2) =indirectly=
from _complications_ which may supervene such as infective
processes--erysipelas, tetanus, septic infections,
gangrene,--exhaustion, or the effects of surgical operations; or (3)
_malum regimen_ (_a_) on the part of the patient, (_b_) on the part of
the medical attendant.
1. Direct
Hæmorrhage.--Hæmorrhage may be profuse and cause rapid death if a
large blood-vessel, more especially an artery, has been injured.
The hæmorrhage may take place internally, in which case it need not
necessarily be profuse; it will depend upon the position; a small
hæmorrhage into the pericardium or in the brain may prove rapidly fatal.
Shock.--Death from shock is generally associated with severe injury,
either a single one, or from several smaller injuries, any of which
alone would not be expected to prove fatal. Death may occur from shock
when the visible injury may be slight, as in blows over the heart
and abdomen, the latter causing fatal syncope from dilatation of the
splanchnic vessels. Repeated lesser injuries as in flogging may cause
death through shock; and fatal psychical shock may be caused by mental
excitement, as, for instance, in an encounter when no physical injuries
have been received.
Mechanical Injury to Viscera.--This causes rapid death, more especially
when the viscus injured, as the heart or medulla, is necessary for
the immediate functions of life; injuries to other organs may not be
followed by immediate death unless very severe and with great shock. A
wound of the lung may not be followed by death for some time.
In a healthy person the violence necessary to prove fatal ought to
be greater than in one diseased, and pathological conditions may be
found _post-mortem_, which were pre-existent to the injury, _e.g._
degeneration of blood-vessels, aneurysm, valvular disease of the heart,
phthisical cavities which may have bled, gastric ulcer which may have
ruptured. Such conditions might influence the findings of a jury, as,
for example, it is not always possible to form the opinion that death
has been directly due to violence when signs of injury are slight; a
man may receive a blow on the head while in the act of falling in a
fight, and _post-mortem_ a cerebral hæmorrhage be found with diseased
vessels, when it would be difficult to say with certainty that the
hæmorrhage was directly caused by the blow or preceded it.
2. Indirect
Fatal Complications.--In English law if death follow injury inflicted
by a person within a year and a day, the assailant may be tried and
punished; beyond that time the person is not held responsible for the
death. The infective processes mentioned above may supervene at any
time during the course of wounds with fatal result. Further, as a
result of altered conditions left by injuries which in themselves have
not proved fatal, and from the immediate effects of which the person
has recovered, fatal complications may follow, _e.g._ a person may have
received an abdominal wound which after healing may become the seat of
hernia which may strangulate; or an injury to the spinal cord, which
may cause death at a late date from bedsores and exhaustion.
Septic Processes.--These may cause death at an early date according to
their nature and virulence and the power of resistance of the person.
In such cases the original injury need not have been dangerous to life.
In other cases the infection may persist after the wound has healed, as
infective endocarditis might conceivably do.
Surgical Operations.--Should a surgical operation be considered
necessary for the treatment of the injury or in order to save life, and
the person dies after it, the prisoner will be held responsible for the
death. This holds good if the operation has been done in good faith and
performed with reasonable skill and care. If, however, it can be shown
that the operation was unnecessary, or performed unskilfully and death
resulted, the prisoner would not be held responsible unless it can
be proved that the injury apart from the operation could have caused
death, when the jury might convict.
Where from improper treatment of an injury an operation is called for
because of the improper treatment and the person dies, the prisoner
would not be held responsible. The main points to be considered in
reference to surgical operations for criminal injuries are:
(1) The operation must be absolutely necessary.
(2) The operator must have acted with reasonable skill and care.
(3) That the wound was dangerous to life, and without operation
would most probably have proved fatal.
3. Malum regimen
(_a_) On the part of the Person Injured.--If the wound is not in itself
sufficient to cause death, but by negligence in the care of it by
the injured person, complications arise which cause death, then the
punishment would probably be mitigated; but in law a person accused
of criminally injuring another is held responsible for the immediate
and remote results. “No man is authorised to place another in such a
predicament as to make the preservation of his life depend merely on
his own prudence.” If, however, it can be proved that death was largely
due to the imprudence or recklessness of the deceased, it is probable
that this would lessen the punishment.
(_b_) On the part of the Doctor.--A person accused of criminally
injuring another being held responsible for the results immediate and
remote, may plead that the latter, _i.e._ complications, or the death
itself are not due to the injury directly, and endeavour to throw the
responsibility on someone else, either the injured person through
negligence, or on the doctor for unskilful treatment. In reference to
the complications, the medical witness may be asked for his opinion as
to the cause and effect of the complication, and how it might have been
avoided. Having considered all the facts laid before him and made his
deductions, he must give his opinion fairly, and leave it to the Court
to decide in what way his opinion may influence its judgment and the
amount of punishment for the offence.
When there is an allegation that the treatment has been unskilful or
negligent, and contributory to complications and death, and a defence
raised accordingly, the prisoner has to prove this to the satisfaction
of the Court in order to mitigate the offence and punishment. The
medical man is expected to have exercised reasonable skill. If the
person treating the injury is a registered medical practitioner, and
has applied his treatment in good faith and for cure, even if the
treatment were improper, the assailant would be held responsible.
The care which the medical man ought to exercise is that which everyone
ought to exercise who has received the statutory education and passed
the statutory examinations.
THE SEVERAL KINDS OF WOUNDS
(1) Incised; (2) Punctured; (3) Lacerated and Contused; and (4) Gunshot.
1. Incised Wounds
Made by sharp instruments.
_General Characters._--Incised wounds are somewhat spindle-shaped,
their superficial extent being greater than their depth; the edges are
smooth and slightly everted, and the wounds are always larger than the
weapon which inflicted them--due to retraction of the divided tissues.
If a wound be in a line with the fibres of a muscle, there will be
less “gaping” than when the wound is directly or obliquely across the
muscle. From muscular contraction, or the elasticity of the skin, an
incised wound may assume a crescentic form. The cellular tissue is
infiltrated with blood, and coagula are found at the bottom and between
the edges of the cut. It must be borne in mind that a wound with smooth
edges may be made by a _blunt_ weapon over bones near the surface,
as on the scalp and over the tibia or shin, but a certain amount of
contusion may, in most cases, be detected by careful inspection a short
time after the receipt of the injury.
It is often of importance to distinguish where the weapon entered, and
where it was drawn out. The end where the weapon entered is usually
more abrupt than the other, which is naturally more drawn out. But in
some cases I have seen, when the weapon was simply drawn across the
part, both ends of the wound alike.
2. Punctured Wounds
The orifice is generally a little smaller than the weapon.
A stab may sometimes present the appearance of an incised wound; the
depth will, however, help to distinguish the one from the other. The
wound may not at all correspond with the shape of the weapon, and the
same pointed instrument may produce very different-shaped wounds in
different parts of the body. Much depends upon the movement of the
instrument in the action of puncturing; in the case of a double-edged
instrument the wound will most probably be fusiform or diamond-shaped.
When made with a knife the wound may be wedge-shaped if the knife have
a thick back. A circular weapon splits the skin and leaves a slit;
broken glass and pottery act in a similar way, but the wounds may
have jagged edges and show signs of contusion in them. On dissection,
two or more punctures may be found in the soft parts, with only one
external orifice; these are due to the weapon being only partially
withdrawn at each stab. Punctured wounds are always more dangerous
than incised. They cause little, if any, hæmorrhage externally, unless
a large vessel, such as the femoral artery, be injured, but they may
cause internal hæmorrhage or penetrate a viscus, _e.g._ the lung or
heart. These wounds generally heal by suppuration, and not infrequently
an abscess is formed in and around the track of the wound. Perforating
wounds generally have a large entrance wound with inverted edges, and a
small exit with everted edges; if the weapon be rough, the reverse may
be the case.
3. Lacerated and Contused Wounds
The edges of these wounds are never smooth, and generally do not
correspond at all with the weapon. A considerable amount of contusion
or bruising surrounds the solution of continuity of the part.
Hæmorrhage from these wounds is usually slight. A point of considerable
interest may arise in connection with this class of wounds; the defence
may declare that the injury was the result of a fall, and not due to
a blow. The history of the case, and the presence of a bruise where
no theory of a fall can explain its existence, will often afford the
only solution of the difficulty. Lacerated wounds heal by suppuration,
generally with more or less sloughing, and leave a permanent scar.
Scratches with the finger-nails may be considered as lacerated wounds,
but the skin is merely abraded, not divided. They are never important
as wounds, but often as a proof of a struggle in cases of rape, &e.
Bites are also lacerated wounds. The diagnosis of lacerated and
punctured wounds, whether inflicted before or after death, will depend
on much the same grounds as those of incised wounds, hæmorrhage, vital
reaction, &c.
Table of Differentiation Between Ante-mortem and Post-mortem Wounds:
---------------------------------------------------------------------
Incised Wounds.
-----------------------------------+---------------------------------
IN THE LIVING. | IN THE DEAD.
|
1. Edges sharply cut and everted, | 1. Edges close, and not everted.
the skin and muscles being |
retracted. |
|
2. Bleeding copious, and generally | 2. Bleeding absent or scanty.
arterial. |
|
3. There are clots. | 3. There are no clots in most
| cases; sometimes a few strial
| clots.
|
4. There is a good deal of staining| 4. There is little or no staining
or diffusion of blood in the | or diffusion of blood in the
muscular and connective tissues.| tissues of the wound.
|
5. After some hours or days | 5. There will be no attempt at
there will be signs of repair or| repair, and no signs of
inflammation. | inflammation. There may be
| signs of putrefaction.
-----------------------------------+----------------------------------
Lacerated Wounds.
-----------------------------------+----------------------------------
|
1. There will be more hæmorrhage | 1. There is hardly any hæmorrhage
and staining from the blood at | or staining unless large veins
first | are torn across.
|
2. After a few hours, or days, | 2. No evidence of repair, or
there will be suppuration or | inflammation, or gangrene can
other sign of repair; | be detected.
inflammation or gangrene may |
also supervene as in incised |
wounds. |
-----------------------------------+---------------------------------
Contused Wounds.
-----------------------------------+---------------------------------
|
1. There is swelling, and, after | 1. There is little swelling or
a few hours or a few days, if | change of colour.
deep-seated, the skin changes |
colour, particularly at the |
edges. |
|
2. There is effusion of liquid | 2. Very little blood is effused.
blood and lymph in the deeper | There are hardly any clots.
parts, and coagula form. |
|
|
3. The swelling subsides and the | 3. There are no rainbow-like or
colours fade after some days, | prismatic changes of colour.
or, in some cases, weeks. |
|
|
4. Abscesses may form, or | 4. No abscesses form, and no
ulceration, sloughing, | erysipelas or dangerous
or erysipelas set in. | changes are met with.
-----------------------------------+---------------------------------
4. Gunshot Wounds
The appearance which gunshot wounds present will to a great extent
depend upon the form of the projectile, and the distance at which the
firearm was discharged. Round halls make a larger opening than conical.
Small-shot, fired within a short distance of the body, make one large
ragged opening. The scattering of the shot depends on the calibre of
the gun, on the charge of powder, and essentially on the distance.
A charge of ordinary (No. 5) shot, to make a single hole, must have
been fired at less than _one foot_; but experiments should always be
made with the alleged weapon. A patent cartridge would make a single
hole at a considerable distance--five or six yards. Round bullets may
split, but the conical ones seldom do. The edges of wounds produced
by the discharge of firearms are always more or less ecchymosed; this
condition appears in about an hour after the infliction of the injury.
If the ball strikes obliquely, the edges of the wound may be much
lacerated, or the opening may be valvular and of small size, if the
skin over the part be in any way tightened, or if a conical ball has
been used. The injury to bones is greater from conical than from round
balls. The old round balls were easily deflected; the conical are not
so easily turned aside. The track of the ball _widens as it deepens._
This is the reverse of an ordinary punctured wound. The ball may either
lodge in a part, or perforate it. Should it have lodged, it must be
preserved and compared with the alleged firearm. Bits of clothing or
wadding may be carried into the wound. The latter should be carefully
kept, as they may prove important as a means of identification.
The aperture of entrance and exit must, if possible, be determined. On
this point there is much difference of opinion. The wound of _exit_
is always _smaller_ than the wound of _entrance_ (Casper). In this
opinion Casper agrees with M. Malle, Olliver d‘Angers, and M. Huguier,
but is opposed by Taylor, M. Matthysens, and others. “The characters
of a gunshot wound,” says Assistant-Surgeon Neill, “are those of a
contusion and laceration of all the tissues. Sometimes they are so
simple as to bear resemblance to a punctured wound, particularly if a
rifle-ball (conoidal), revolving on its long axis, has passed through
the soft parts at a great speed, but within a few hours it resembles
a contusion. The wound of entrance, as it has been termed, bears no
comparison in size or shape to that of the exit when a rifle-ball has
caused the injury. In the former you see the edges of the wound curving
inwards, and the circumference small, with little or no hæmorrhage.
In the latter, the wound is large, with torn and irregular edges
projecting outwards, and perhaps only slight oozing of blood. In a
short time, averaging an hour, round the entrance wound slight redness
begins, gradually extending to about two inches round its orifice.
Again, this colour changes to a blue- or greenish-black, and you see
all the appearances of a severe bruise, with a small wound of the skin,
its edges still curved inwards. In the exit wound the discoloration of
the skin is not apparent.” The probable reason for the discrepancies in
the statements of observers, as to the characters of entrance and exit
wounds, may be found in the fact that experiments have been conducted
with different-sized balls, different kinds of weapons, with varying
quantities and qualities of the powder used, the character of the wads,
and with varying velocities and distances. As pointed out by M. Roux,
the two openings may be equal if the ball preserves the same velocity
through the tissues as it possessed before entrance; the _entrance_
hole is smaller than the _exit_, when the ball has lost much of its
trajectile force, and enters the softer parts of the body first; the
_entrance_ is larger than the _exit_, when the ball first enters
through the denser tissues of the body, and leaves through the softer.
The opening of entrance made by the ball has generally, but by no means
always, inverted edges. The edges of the exit opening are everted,
bloody, and raw; but both the entrance and exit wounds may be everted
in fat persons, due to the protrusion of the fat; and this eversion
may also result from the expansive power of the gases generated during
putrefaction, should this condition be present. Wounds made by _double
shots_, as from double-barrelled guns, or pistols, or from slugs fired
from one barrel, diverge after their entrance into the body.
Observations during the war in South Africa threw fresh light upon the
results of gunshot wounds produced by modern projectiles. Of wounds
produced by the Mauser bullet, one correspondent (_The Physician and
Surgeon_, 1900, p. 49) states that “the aperture of entrance seldom
shows any bruising of surrounding tissue; frequently it has been
difficult to locate it, for where the skin is dense and elastic, there
is seldom any bleeding. There is never any inversion of the edges,
which are sometimes circular in form, and sometimes triangular like
a leech-bite. The aperture of exit, where the bullet has not been
distorted, is seldom any larger than that of entrance; there is no
bruising of surrounding tissue, and no eversion of the edges; bleeding
varies, of course, in accordance with the proximity of large, medium,
or small blood-vessels in the track, but in the vast majority of cases
it is slight.”
The late Sir William MacCormac, quoted by Sir William Stokes (_B. M.
J._, vol. i., 1900, p. 1453), says: “I saw a large number of injuries
inflicted by the Mauser bullet, which is remarkable for the small
wound it produces. In three-fourths, if not a larger proportion, it
was impossible to tell the exit from the entrance wound, they were so
similar in appearance.”
In the examination of gunshot wounds we have to consider--
1. _Direction in which the Gun was fired._--The track and position of
the ball in the body, coupled with the relative position of the body
to a window or door through which the gun may have been discharged,
and the place where the ball is found, should it have passed through
the body, may assist us in forming an opinion. It is often impossible
to trace the course of the ball through the cavities of the body,
but through the muscles and denser structures this is more easily
accomplished. The effects of the ball on surrounding objects may assist
very much in finding the direction of its course. Sir Astley Cooper,
by a careful consideration of the above suggestions, once correctly
determined that a left-handed man had fired the fatal shot.
2. _Distance at which the Charge was fired._--In the case of wounds
inflicted by a small shot, the scattering of the shot must be our
guide. Dupuytren has related a case in which a fowling-piece charged
with powder alone and fired at a distance of two or three feet from
the abdomen made a round hole in it and killed the man. If the weapon
be fired a short distance, _e.g._ a few inches from the body, the skin
will be scorched, smoke-blackened, and tatooed with powder, the flame
may singe the hair or clothing. If discharged quite hard up to the
body, the edges of the wound are freely lacerated, ecchymosed, and
burnt. Smokeless powder will not cause blackening of the skin. The
absence of scorching, or marks made round the wound by the half-burnt
powder, allows of the assumption that the shot must have come from
some distance--rather more than four feet. The absence of any of the
above, however, is not an absolute proof that the shot has come from a
distance.
There is no means of deciding, from an examination of a pistol or
gun, when the weapon was last used. In all cases, medical men, unless
sportsmen and familiar with firearms, should hand over the weapon to a
gamekeeper or gunsmith, and not attempt to give an opinion on matters
about which they know nothing. The following may be of use to students
for examination purposes, but for nothing else: Among the products
formed when gunpowder is exploded is the sulphide of potassium, but if
exposed to the air some portion of this substance is converted into
the sulphate of potash. If, then, the gun-barrel be washed out with
distilled water, and the washings filtered, and, on the addition of a
solution of acetate of lead, a black precipitate of sulphide of lead be
formed, this is supposed to point to recent use; if, on the other hand,
a white precipitate of sulphate of lead forms, to the use of the weapon
at some more distant date than the period alleged.
CHAPTER VI
BLOOD-STAINS
It is important in medico-legal investigations to determine the nature
of stains found on clothes, weapons, articles of furniture, &c. In the
case of blood-stains note should be made of their incidence upon the
body or in its vicinity. Blood-stains may vary in their character,
incidence, and magnitude, as sprays, spirts, or jets, smears of various
forms, or pools of blood.
Notes should be made of the relation of the direction of a spray
of blood to the position of a wounded body when found. A plan with
the position of the stains should be sketched upon the spot, and
measurements taken carefully.
In the examination of blood-stains the purpose of the medico-jurist is
not to demonstrate all the properties of blood, but to identify it.
There is not much difficulty in ascertaining whether stains are due
to blood or not; but when the question arises as to whether the blood
be human or that of some other animal, the identification is more
difficult and less certain.
Blood-stains vary in colour, according to the age of the stain, the
quantity of blood in it--the thicker the stain the darker--and the
nature and colour of the material upon which it is. Recent stains are
reddish in colour, old stains brownish. This change of colour depends
upon the free access of air and the presence or absence of chemical
substances in the air, so that it is almost impossible to infer the
age of a blood-stain by its colour. On dark-coloured materials the
stains are rendered more visible by the aid of artificial light, such
as candle-light; on light-coloured materials, on leather, wood, iron,
and stone, they are more visible in good daylight. By reason of the
coagulation and the albuminous composition of blood, dry stains stiffen
the fabric when thin, and on thicker woollen materials the fine fibres
become matted. On metals, such as iron or steel, they appear as dark
shiny spots or smears, and when dried are often fissured or cracked.
Rust may so alter blood as to produce a difference between the stains
on the blade and handle of a knife. In quite recent blood-stains
the general appearances are sufficient to give rise to a conclusion
as to their nature, especially if the stains are large. The general
features as seen by the naked eye are such that one may often recognise
blood-stains as arterial by the _comet shape_ they retain when falling
slantwise on an object. Venous blood is not spurted in small jets like
arterial, but blood from veins may become splashed upon objects and
assume shapes similar to those produced from an arterial jet.
EXAMINATION OF BLOOD-STAINS
The examination of blood-stains should be carried out in the following
way:
Physical Examination
1. Examine the stains carefully with a good pocket lens or a low
power microscope lens. A fabric will show matting of its fibres, red
filaments, and minute coagula in its meshes. In old blood-stains
coagula may be absent and the fabric appear as if dyed. The characters
of any fibres or hairs adhering to the stain and the nature of the
substance upon which the stain is should be noted.
[Illustration: Fig. 4.--Photo-micrograph of wool fibres, × 250. (R. J.
M. Buchanan.)]
2. Make accurate notes of the position and shape of the stains on the
material examined.
3. Take one stain, if there are several, or part if single, and note
the solubility of it in water, or in a mixture of water and some other
substance. The solubility of the colouring matter is greater if the
stain be recent than if it be old. The older the stain the less soluble
it becomes, as the hæmoglobin is gradually changed in course of time to
insoluble hæmatin.
An endeavour should be made to obtain a solution for microscopical,
chemical, and spectroscopical examination. The solvent, in order to
obtain the blood corpuscles in as natural a form as possible, should
approach in its specific gravity the _liquor sanguinis._
The following solvents fulfil this purpose:
(_a_) Glycerine and water, 1 to 7 (sp. gr. 1030).
(_b_) Pacini‘s solution of chloral hydrate in water (1 in 10).
(_c_) Normal saline solution.
(_d_) Roussin‘s solution of glycerine 3 parts, sulphuric acid
1 part (by weight), and water so that the mixture shall
have a sp. gr. of 1028.
(_e_) Saturated solution of borax in distilled water.
If distilled water alone be used, the red corpuscles lose their
hæmoglobin and become “laked” or “phantom” corpuscles; if the solution
be of higher sp. gr. than _liquor sanguinis_, then the corpuscles
become crenated and irregular in shape.
[Illustration: Fig. 5.--Photo-micrograph of flax fibres, × 250. (R. J.
M. Buchanan.)]
The technique of examination has to be varied in certain details,
according to the material upon which the stain is. Stains may have to
be examined upon cloth-fabrics, wood, plaster, metal, or leather. These
will be taken separately, and the methods of examination described
which will prove most reliable in each case.
1. _Cloth-fabrics._--Cut out a stain, or part of one, and macerate it
in a quantity of one of the solvents mentioned above, sufficient for
the purpose. If the stain be very small, squeeze with fine forceps
one or more drops upon microscope slides for microscopic, and keep
the remainder of the solution for spectroscopic, examination. In dyed
fabrics, which have been mordanted, the mordant may fix the blood-stain
so as to prevent solution, and especially so when the attempts have
been made to wash out the stain with soap and water.
To make a solution of the stain in such cases it is best to use
distilled water to which a small quantity of ammonia or citric acid has
been added; in one or other of these the colouring matter will dissolve.
2. _Wood._--Note the kind of wood, cut off a thin shaving and treat
with one of the solvents mentioned above. If on wood containing tannic
acid, such as oak or elm, the best solvent is a two per cent. solution
of hydrochloric acid.
3. _Plaster._--Scrape off some of the stained plaster, and treat as for
cloth or wood.
4. _Metal._--If the stain be upon a clean and unrusted metal, _e.g._
the clean blade of a knife, then gently heat the metal on the side
opposite to the stain, when the latter, if recent, will peel off or can
be easily detached. This requires some care and dexterity. It is easy,
however, to scrape the stain off into a watch-glass, and this procedure
is necessary when the metal is rusted and the stain mixed with the
rust, or when the stain is thin.
[Illustration: Fig. 6.--Photo-micrograph of silk fibres, × 250. (R. J.
M. Buchanan.)]
If on iron and mixed with rust the borax solution may be used, with
a drop or two of solution of ammonia; use a fine camel-hair pencil
dipped in the solution, and brush the stain off into a watch-glass.
Becker advises that stains mixed with rust should be digested with a
weak solution of ammonia and common salt for a few hours; decant the
solution and evaporate it upon a microscope slide to dryness, then test
the residue by the “hæmin test.”
Ganttner‘s test should be used to a portion of a stain upon metal when
thin or mixed with rust. It may be carried out upon the metal itself
or upon a scraping of the stain in a watch-glass resting upon a black
surface. Moisten the scraping in a watch-glass with a drop or two of
distilled water rendered feebly alkaline, then add a minute drop of
hydrogen peroxide. Wherever blood is present bubbles of gas develop,
which give the material a white beaded appearance. The froth develops
from the outside of the drop towards the centre when the stain is
mainly composed of blood. In a scraping consisting of mixed particles
of rust and blood, the reaction only appears upon the particles of
blood, and rust to which blood adheres; it does not take place on
those particles of rust free from blood. Before adding the peroxide of
hydrogen it may be necessary to dissipate any air-bubbles which may
cling to the scraping in the alkaline water by gentle agitation with
the point of a fine glass rod. Should the above reaction with peroxide
of hydrogen not take place, then one can rest assured that no blood is
present. The test, however, is a negative one; it is not a positive
test for blood only; other fluids and exudations from the body, such as
saliva and pus, give the reaction. The reaction will take place with
blood-stains of any age.
[Illustration: Fig. 7.--Photo-micrograph of cotton fibres, × 250. (R.
J. M. Buchanan.)]
In examining a clasp-knife or any hinged weapon for blood-stains, the
instrument should be taken to pieces and all the hinges and recesses
carefully examined, for in these places blood may be found, although
the weapon had previously been wiped clean, and appear free from stains.
5. _On Leather._--The tannic acid in leather forms a compound with
blood which is insoluble in the solvents generally used. A thin shaving
of the stained portion should be taken and folded, with the stained
surface outwards, in the form of a loop. If the outer surface of the
loop with the stain be made to touch the surface of the glycerine and
water solution, at the same time taking care that the leather itself
be not moistened, a recent stain may yield a sufficient quantity of
colouring matter for the purposes of examination. Failing this, the
shaving should be digested in a small quantity of a two per cent.
solution of hydrochloric acid in distilled water (Sorby).
Microscopical Examination
The microscopical examination of blood-stains, for the purpose of
identifying the presence of the red blood corpuscles, is especially
applicable to recent stains. In these the corpuscles may retain, to a
great extent, their normal characters; but their condition varies with
the age of the stain; they become altered in appearance and irregular
in shape with increasing age, until a stage is reached when they
become completely disintegrated and unrecognisable. Having obtained
a solution of a stain by one of the methods recommended, a few drops
should be placed upon a clean microscope slide and covered with a No. 1
cover-glass. In a recent stain, where minute coagula are present, one
may be placed on a microscope slide and moistened by breathing upon it
several times, and then covering it with a No. 1 slip, or a drop of the
glycerine solution may be allowed to act upon it on the slide until
it be sufficiently moistened, when it should be covered in the same
way. The preparation should be examined through the microscope with a
good lens (preferably a ¹/₁₂th oil immersion), magnifying 300 to 400
diameters, and if any corpuscles be found, their characters should be
carefully observed and noted.
All such specimens should be carefully preserved and labelled with
a description of the method of preparation, the case to which they
belong, the date of preparation, and the signature of the individual
who has made and examined them. It is essential that the preparation
and examination of the specimen should be made by the same individual.
In certain cases the conditions may be sufficiently favourable to allow
of the production of stained specimens, which can be mounted so as
to retain their original characters permanently. In every case it is
advisable to pursue the investigation with this object in view.
This process is especially applicable to recent blood-stains, in which,
from preliminary examination, the presence of blood corpuscles has been
determined; where complete disintegration of the blood corpuscles has
taken place it would not be of any value.
It may so happen that by means of stained specimens the identity of
blood corpuscles may be more easily established, when the result of
examination is uncertain in a specimen not so prepared.
By the action of certain dyes upon the corpuscles their special
features are rendered easier of recognition. Any of the approved
methods of preparing blood films for general clinical purposes, which
will suit the circumstances, may be employed. An easy and reliable
method is as follows. A drop of the solution of the blood-stain
properly prepared as previously recommended, or if obtainable a small
coagulum moistened with normal saline solution, is placed on a clean
coverslip and spread evenly over its surface with the aid of a fine
glass rod. The film is allowed to dry in the air, covered with a
watch-glass for protection against dust. When dry it is passed three
times through the flame of a Bunsen burner, or placed in a mixture of
equal parts of absolute alcohol and ether, to fix it. After fixation it
should be placed for a minute or more in an aqueous solution of eosin.
Any excess of stain should be removed by washing in distilled water,
and the specimen allowed to drain by standing it on edge upon a
piece of filter paper; it should then be allowed to dry, and then
counterstained with a freshly prepared aqueous solution of methylene
blue, hæmatoxylin solution, or other nuclear dye. Wash again in
distilled water, allow to dry, and mount in Canada balsam. By this
method the corpuscle will be stained pink, and if nucleated, the
nucleus will be stained by the methylene blue, hæmatoxylin, or other
nuclear stain which may have been used.
Leishman‘s stain may be used. This stain being a methyl-alcohol
solution is used for fixing and staining at the same time. A few
drops of the stain is placed on the dried film; after standing until
evaporation is almost complete, distilled water is dropped on to the
slide, and left to stand for two or three minutes, it is then drained
off, and a few more drops of distilled water added until the film is
pink in colour, then dried with filter paper. Red corpuscles are tinted
red with the eosin, and nuclei of leucocytes or nucleated red cells
violet or deep blue. The specimen may be examined direct with the oil
immersion or mounted in Canada balsam.
When examining specimens prepared from blood-stains, it is necessary
to search carefully for other cellular structures such as epithelial
cells, spermatozoa, or fragments of hair.
It may be advisable, in certain cases where the amount of material
submitted for examination is small, to centrifugalise some of the
solution in a fine glass tube, in order to determine any cellular
elements present to one spot. By making use of this concentrated
portion containing the cellular elements for the preparation of a
microscopic specimen, one not only facilitates the microscopical
examination, but is able to place more reliance upon the results
obtained.
The Results of Microscopical Examination of Blood-Stains in their
Medico-Legal Relations.
As previously stated, the examination of alleged blood-stains from
a medico-legal standpoint is pursued essentially for the purpose of
testifying as to whether they have been produced by blood or not.
Where the examination yields a negative result, further procedure is
necessary with a view of identifying the true nature of the stain.
Should, however, the result be positive, the question arises as to
the possibility of distinguishing between human blood and the blood
of other animals, and determining the exact animal from which the
blood has been derived. Such an examination should be pursued in full
recognition of its importance as a factor towards the establishment of
truth essential to the administration of justice.
To fulfil this obligation the methods employed should be so selected as
to produce results bearing testimony free from any possibility of doubt.
Certain differences exist, and may be detected by microscopical
examination, between the red corpuscles of human blood and those of
some other animals sufficiently well marked to render differentiation
possible. The differences are those of form and structure.
(1) In _man_ the red corpuscles appear as _circular_
biconcave discs, averaging ¹/₃₅₀₀ of an inch in diameter,
and are non-nucleated.
The red corpuscles of mammals present the same features, with the
exception of the
(2) _Camel_ tribe, in which the corpuscles are _oval_ in
form, but non-nucleated.
(3) In _birds_, _fishes_, _reptiles_, and _amphibians_ the
red corpuscles are oval in shape, and possess a nucleus.
Guided by the above facts, one is able to testify whether or not the
corpuscles exhibit the characters of mammalian blood.
Many attempts have been made with a view to establishing a reliable
means of differentiation between the red blood corpuscles of man and
other mammals (the camel excepted), and with a certain degree of
success, such as might be expected, under select conditions favourable
to histological research, but which do not obtain in medico-legal
practice. Differences in size of the red corpuscles, as revealed by
micrometric measurement, have been suggested as a possible means of
distinguishing between the blood of different mammals. Of the common
animals, the red blood corpuscles of the sheep present the most marked
difference in size compared with those of man. The following table of
the dimensions of red blood corpuscles is derived from measurements
made by Treadwell, and quoted by White (_The Medico-Legal Journal_, New
York, 1895):
μ.
Human 7.940
Dog 6.918
Rabbit 6.365
Ass 6.293
Pig 6.101
Horse 5.503
Cat 5.463
Ox 5.436
Sheep 4.745
_Menstrual blood_ contains no fibrin, has an acid reaction due to the
vaginal mucus which keeps it fluid, and contains squamous epithelial
cells. None of these characters can be differentiated on fabrics,
especially when contaminated with urinary stains in addition. Hence, in
cases of alleged rape, no distinction can be drawn between blood-stains
on the underclothing of the female, which may have arisen from
hæmorrhage the result of violence to the sexual parts, and those which
might have arisen from the ordinary menstrual flow or metrorrhagia. The
detection of spermatozoa, however, would add considerable value to the
observation.
[Illustration: Fig. 8.--Measurement of Blood Corpuscles.
Photo-micrograph of human red blood corpuscles, × 800. Each corpuscle
in diameter covers two divisions of the scale. Compare with sheep‘s
blood, Fig. 9. (R. J. M. Buchanan.)]
[Illustration: Fig. 9.--Measurement of Blood Corpuscles.
Photo-micrograph of red blood corpuscles from the sheep, × 800. The
diameter of the corpuscle covers one division of the scale. Compare
with human blood, Fig. 8. (R. J. M. Buchanan.)]
=Blood Crystals.=--Professor Preyer of Jena pointed out many years ago
that the hæmoglobin crystals from the blood of some animals differed in
shape from those of man, and this fact has given rise to many attempts
to trace the identity of the blood to the animal from which it has been
derived. The results have not been of sufficient value to establish it
as trustworthy for medico-legal purposes. Dr. Monckton Copeman (_B. M.
J._, vol. ii. p. 190, 1889) has carefully investigated the subject, and
his researches, partly confirmed by Professor Glaister of Glasgow, show
that from the guinea-pig, rat, and squirrel, crystals of hæmoglobin may
be easily obtained, but the solubility of human hæmoglobin renders it
much more difficult to crystallise. Crystals may, however, be obtained
in the following ways:
(_a_) By feeding leeches on human blood, crystals may
be found, after some weeks, in the gastric dilatation of
the alimentary canal.
(_b_) By diluting human blood with the fluid from
hydrocele, ascites, or pleurisy when they have undergone
decomposition.
(_c_) By adding crystals of glycocholate or
taurocholate of soda to human blood.
(_d_) By adding a drop of cat‘s bile to human blood
on a microscope slide, but the crystals are those of
reduced hæmoglobin.
Crystals of human hæmoglobin appear in the form of rectangular plates,
with a greenish or pale claret colour. On spectroscopic examination
they exhibit the characters of reduced hæmoglobin, in contradistinction
to the crystals derived from the lower animals, which produce the
spectrum of oxyhæmoglobin.
The blood of the bullock, sheep, and pig is very difficult to
crystallise. By the method adopted by Gamgee of adding to defibrinated
blood one-sixteenth its volume of ether, shaking until the mixture
becomes transparent, and allowing to stand in an ordinary temperature
for 48 hours, crystals may be obtained from the blood of the following
animals:
1. Horse.
2. Bullock.
3. Sheep.
4. Pig.
5. Dog.
6. Cat.
7. Rabbit.
8. Squirrel.
9. Guinea-pig.
10. Rat.
11. Mouse.
12. Chicken.
13. Pigeon.
Crystals from human blood are not easily obtainable by this process,
but when they are, they always give the spectrum of reduced hæmoglobin,
whereas those from the animals mentioned above give the spectrum of
oxyhæmoglobin.
Chemical Examination
Having obtained a coloured solution from a supposed blood-stain, if
sufficient in quantity, apply the following chemical tests to separate
portions:
1. Add a few drops of a weak solution of ammonia in distilled
water. The colour may remain unchanged, or, at the most, a _slight_
heightening may take place, if it be due to blood. If the solution
of ammonia be too strong, a brown colour may be produced if blood be
present.
2. Heat to boiling, when the following changes take place if blood be
present:
(_a_) The colour may disappear.
(_b_) Coagulation follows.
(_c_) A precipitate falls, dirty grey or brown in colour,
depending upon the amount of colouring matter present.
On adding caustic potash to the precipitate it
will dissolve, and the solution formed will
appear greenish by transmitted and red by
reflected light. This phenomenon is called the
_dichroism_ of blood. Authorities differ
in opinion as to whether the colour is green by
transmitted and red by reflected light, or _vice
versa_. “As a matter of fact, the phenomenon
is chameleon-like as regards colour, so that both
sets of observers may be considered right or
wrong” (Glaister).
[Illustration: Fig. 10.--Photo-micrograph of red blood corpuscles from
domestic fowl, × 250. (R. J. M. Buchanan.)]
[Illustration: Fig. 11.--Photo-micrograph of blood corpuscles of fish,
× 250. (R. J. M. Buchanan.)]
[Illustration: Fig. 12.--Photo-micrograph of blood corpuscles from a
dried stain of the blood of a codfish, × 250. (R. J. M. Buchanan.)]
3. Add tincture of guaiacum, freshly prepared: an opaque,
cream-coloured precipitate of the guaiac resin will form in the aqueous
solution. On the addition of ozonic ether, turpentine, or peroxide of
hydrogen, a blue colour will be produced at the junction of the fluids:
proportionate to the amount of blood-colouring matter present, the blue
colour will vary in intensity.
This test, known as Day‘s or Schönbein‘s, is extremely delicate, and
_reacts to no coloured substance except blood_.
In cases where the blood-stain is small, the test may be applied as
follows. Moisten a pure white filter paper with a drop of distilled
water, or one of the solutions recommended in the section on physical
examination, and touch the stain with the moistened portion. On adding
a drop of tincture of guaiacum followed by a drop of ozonic ether
to the wet filter paper the blue colour will be produced and easily
recognised on the white surface.
The guaiacum test, although extremely delicate, can only be accepted as
providing negative evidence. The absence of reaction proves the absence
of blood, except in _very old_ blood-stains, which may not respond to
the test. The blue colour produced indicates that the substance _may_
be blood, but it cannot be accepted without corroboration. Gluten, raw
potato, milk, bile, sweat (Ogston), and other oxidising substances give
a blue colour with guaiacum and ozonic ether; some substances give the
blue colour with guaiacum alone.
With blood, however, the test is sufficiently delicate to detect one
drop in six ounces of water.
4. _Nitric acid_ added to a portion of the solution of blood in
distilled water produces a whitish-grey precipitate.
[Illustration: Fig. 13.--Photo-micrograph of frog‘s blood showing oval
nucleated red corpuscles, × 250. (R. J. M. Buchanan.)]
5. _Hæmin Crystals._--Concentrate a portion of the solution upon a
microscope slide, add to it a minute crystal of chloride of sodium and
a few drops of glacial acetic acid. Heat gently to dryness or to a
lesser degree under a coverslip; examine with the microscope; if blood
be present, crystals of hæmin, or the hydrochloride of hæmatin, will
be found. They are of a yellowish-red to brownish-black colour with
a metallic lustre. They occur in rhomboidal prisms, or six-sided in
shape, or in the form of “whetstones,” often in clusters; many of the
crystals exhibit a lipped projection on one side. They are known as
Teichmann‘s crystals. It is well to verify their origin from blood by
placing upon them a drop of hydrogen peroxide, when they will give off
bubbles of oxygen gas.
They are insoluble in water, alcohol, and dilute acetic and
hydrochloric acids. They dissolve in boiling acetic or hydrochloric
acids, and the caustic alkalies. They respond to the guaiacum test, and
the ash produced by incineration shows the presence of iron by the red
colour produced on the addition of a drop of hydrochloric acid and a
solution of potassium sulphocyanide.
The production, by the methods described, of such crystals affords
conclusive proof of the presence of blood.
Spectroscopic Examination
To a portion of the coloured solution, filtered if necessary, the
spectroscopic tests should be applied. The following points must be
remembered in carrying out a spectroscopic examination:
(_a_) The colouring matter of fresh blood is hæmoglobin, and it may
exist in two states, according to the degree of its combination with
oxygen.
In arterial blood it is present as oxidised hæmoglobin, and the same
obtains in blood which has been exposed to the air under certain
conditions and for a varying period of time.
[Illustration: Fig. 14.--Photo-micrograph of crystals of hæmin, × 250.
(R. J. M. Buchanan.)]
In venous blood, especially when obtained under conditions preventing
oxidation, as from the heart cavity of an animal newly asphyxiated, it
is present as deoxidised hæmoglobin.
(_b_) In dry stains, especially if they have been subjected to the
action of impure air containing the products of coal-combustion, the
colouring matter becomes changed into _methæmoglobin_, or hæmoglobin
in which its combination with oxygen has been altered in such a way
that a current of a neutral gas, such as hydrogen or nitrogen, will
not dissociate it, as it does with oxyhæmoglobin. Such stains have a
brownish colour, and may give an acid reaction.
(_c_) In stains which have retained moisture, from having lain in damp
places, the hæmoglobin becomes converted into _hæmatin_. The same
change takes place in dry stains after a longer period of time.
On examining the solution of the colouring matter from a blood-stain
with the spectroscope, the spectrum will vary according to its
condition and the nature of the solvent used.
The spectra of hæmoglobin and its derivatives are characteristic, and
afford conclusive evidence of the presence of blood. The spectra must
be recognised, however, in more than one condition. Other substances
may yield spectra very similar to that of oxyhæmoglobin, but when
subjected to certain tests they do not alter in the same way. They
cannot be made to give the spectra of reduced hæmoglobin and reduced
hæmatin, and any colouring matter which may be made to yield the
spectra of reduced hæmoglobin and reduced hæmatin is derived from blood.
Blood Spectra
1. _Oxidised hæmoglobin_ (O₂Hb) is characterised by the presence in
its solar spectrum of two absorption bands between the D and E lines.
The first band commences at the D line and extends a short distance
towards the E. The second commences at a little distance from it, and
terminates at the E line; it is about twice the breadth of the first.
The band at D is more defined than the other (Fig. 15, 1).
2. _Deoxidised_ or _reduced hæmoglobin_ presents one broad band
occupying almost the whole of the space between D and E slightly to the
left of these lines (Fig. 15, 2).
3. _Methæmoglobin_ presents two bands between D and E, in the same
position as those of O₂Hb, but in addition a third band between C and D
and near to the former (Fig. 15, 3).
A solution of oxyhæmoglobin or methæmoglobin may be reduced by the
addition of a reducing agent, such as Stokes‘ reagent, consisting of
ferrous sulphate with a small quantity of tartaric acid dissolved in
water and rendered alkaline at the time of using with ammonia, or,
better still, by the addition of ammonium sulphide. The spectrum will
change to that of reduced hæmoglobin.
4. _Acid hæmatin_ presents a spectrum with a band between D and E,
commencing at a little distance from D and ending at E, also a narrower
band between C and D and commencing at C. It is a difficult spectrum to
obtain.
5. _Alkaline hæmatin_ presents a spectrum with a single band between
C and D near to the D line. It is more difficult to obtain than the
spectrum of acid hæmatin.
It is not necessary, however, to obtain these spectra, viz. 5 and 6,
but it is necessary to reduce solutions of either acid or alkaline
hæmatin in order to obtain the spectrum of _reduced hæmatin_. To do
so proceed as follows. To some of the solution of colouring matter
obtained from the stain add a small quantity of a 20 per cent. solution
of sodium hydrate; the solution will alter in colour, and the spectrum
of O₂Hb or MetHb will disappear. On adding to this solution of alkaline
hæmatin a few drops of ammonium sulphide, or Stokes‘ fluid, it becomes
claret-coloured, and on examination with the spectroscope the spectrum
of _reduced hæmatin_ will be seen. This is the most pronounced of all
blood spectra. Its production can be hastened by gently warming the
solution.
If the stain be old and already changed into hæmatin, its solution
will yield the spectrum of acid hæmatin, and will give the spectrum of
_reduced hæmatin_ on the addition of ammonium sulphide or Stokes‘ fluid
without previous alkalisation.
6. _Reduced hæmatin_ presents a spectrum with a dark band about midway
between D and E, and a broad but paler band commences near the E line
and extends to the _b_ line (Fig. 15, 4).
[Illustration: Fig. 15.--Blood Spectra.
1. Oxyhæmoglobin. 3. Methæmoglobin. 5. CO hæmoglobin.
2. Reduced hæmoglobin. 4. Reduced hæmatin. 6. CO hæmoglobin and
reduced hæmoglobin.]
In cases of death by asphyxia, in which the hæmoglobin is in
combination with CO₂, the blood, if removed and examined immediately
after death, gives a spectrum of reduced hæmoglobin, but on exposure
to the air it rapidly changes to oxyhæmoglobin. The period after death
at which blood is usually submitted for medico-legal examination
is sufficiently late to allow of this change, and so prevents the
possibility of determining death by asphyxia by spectroscopic
examination of the blood. Where death has been caused by the action
of _carbon monoxide_, the blood is of a _cherry-red colour_, and
it will retain this colour unchanged for a long time, in fact for
years, due to a stable combination of the CO and hæmoglobin, called
carboxyhæmoglobin. Such blood yields a very characteristic spectrum,
with two bands similar to those of O₂Hb, but nearer to the violet end
(Fig. 15, 6). Their position should be assured by accurate measurement
and comparison with a spectrum of O₂Hb. The CO hæmoglobin, however,
cannot be reduced; on the addition of ammonium sulphide or Stokes‘
fluid the bands remain unaltered.
In cases where the amount of fluid obtainable for examination is very
small, recourse must be had to the micro-spectroscope, using a Sorby‘s
cell to hold the fluid, and substituting for the eye-piece of the
microscope a specially constructed spectroscope arranged so as to throw
the spectrum of a known solution of blood-colouring matter alongside of
that yielded by the solution under examination. Artificial light should
be used, and the D line located by placing in the flame a platinum wire
carrying a salt of sodium.
Biological Tests for Blood
The results of the experimental investigations of Friedenthal,[3]
Deutsch,[4] Uhlenhuth,[5] Wasserman and Schutze,[6] Nuttall,[7]
Tarchetti,[8] Grünbaum,[9] Metchnikoff,[10] and M‘Weeney[11] into
“blood relationships” have led to the suggestion of a new method--the
“biological test,” by which different kinds of mammalian blood may
be distinguished one from the other. Their experiments show in a
general way that the “serum from an animal which has been injected
intraperitoneally with any given organic fluid will, if mixed in small
quantity with a dilute solution of the fluid used for the injection,
produce a more or less definite precipitate.” If human defibrinated
blood be injected into the peritoneal cavity of a rabbit, the serum
obtained from the rabbit‘s blood, when mixed with a clear solution of
the blood of man or ape, will produce a precipitate, and agglutinate
the red blood corpuscles if present: the same reaction will not follow
if such serum be added to a solution of the blood of any other animal.
[3] Friedenthal, _Archiv für Anatomie und Physiologie_, 1900, p. 494.
[4] Deutsch, _Bulletin Medical_, Sept. 8, 1900; and _Centralblatt für
Bakteriologie_, Band xxix. p. 661.
[5] Uhlenhuth, _Deutsch Medicinische Wochenschrift_, 1901, Nos. 6, 17,
45.
[6] Wasserman and Schutze, _Berlin Klin. Wochenschr._, Feb. 21, 1901.
[7] Nuttall, _Jour. Hygiene_, vol. i., 1901, p. 367; _B. M. J._, vol.
i., 1901, p. 669.
[8] Tarchetti, _Gazz. degli Osped._, May 19, 1901; _B. M. J._, vol. i.,
1901.
[9] Grünbaum, _Lancet_, Jan. 18, 1902.
[10] Metchnikoff, _Centralblatt für Bakteriologie_, April 18, 1901.
[11] M‘Weeney, _Jour. State Med._, vol. ix. No. 7, p. 378. _Lancet_,
June 18, 1910.
The introduction of substances of albuminous or proteid nature into
the body of an animal, and which can be taken up by its cells as a
food, produces in the body of the animal a series of substances called
antibodies, of which one is designated _precipitin_ from its power of
producing a precipitate with the substance introduced. The organic
substance introduced capable of producing antibodies is called the
_antigen_. The precipitin is formed and present in the blood serum of
the inoculated animal.
Metallic poisons, alkaloids and carbohydrates, do not produce
antibodies; some vegetable proteids do.
The serum containing the precipitin is called the _antiserum_.
The precipitin in the antiserum is specific, and produces the effect
only with its own antigen, not with that derived from another species
of animal, but will act with one derived from a closely allied species,
_e.g._ man and the higher apes, sheep, and goat.
In order to eliminate this the antigen should be diluted to 1:1000.
The blood used as antigen may be dried and sterilised, thus it may be
kept for a long time, and when required for use dissolved in normal
saline.
The most convenient human antigen for general use is ascitic or
pleuritic fluid, and may be kept in good condition when mixed with a
small quantity of chloroform.
To produce the antiserum 3 to 10 c.c. of the antigen serum is injected
into a vein or the peritoneal cavity of a rabbit, and repeated at an
interval of four or five days until 25 c.c. have been injected. The
serum of the rabbit is then tested with the antigen diluted 1:100.
The injections are then continued until 70 to 80 c.c. have been
administered. The animal is then killed, the blood collected, and
stood in a refrigerator for the serum to separate. This is then drawn
into sterile pipettes, sealed, and kept in the cold. For purposes of
preservation one-tenth its volume of 5 per cent. phenol may be added
before pipetting. The antiserum may be dried on slips of black paper
for future use.
For medico-legal purposes, the antiserum should always be tested with
its antigen to be sure of its efficacy.
The antigen to be tested should be diluted 1:1000 at least, as potent
antisera may give reactions with strong solutions of antigens derived
from other species of animals. Various antisera may be made by
inoculating rabbits with the serum of different animals.
Metchnikoff has shown that intraperitoneal injection is not absolutely
necessary in order to produce an antiserum, feeding a rabbit on the
blood will act in the same way.
The procedure for testing a stain is as follows. First of all the stain
must be proved to be blood by the usual methods; this because the
antiserum will give reactions with other albuminous substances, _e.g._
mucus, pus, semen, milk, or albuminous urine derived from the animal
providing the antigen.
Having proved the stain to be blood, a solution of it should be made
in normal saline, sufficiently strong to give the HNO₃ reaction for
albumin, or to foam when shaken up. If the amount of solution be small,
the tests can be carried out in capillary tubes or pipettes. The
solution of the stain must be cleared by filtration or the centrifuge.
The tests must be controlled by comparison with known human blood,
and blood from several domestic animals. For this purpose the various
antisera should be kept in stock.
Two sets, A and B, of six small tubes are used, into each of A is
placed 0.05 c.c. of human antiserum from a sensitised rabbit. Into each
tube of Set A is then added double the amount of diluted antigen, as
follows:
{ 1. Receives extract of known human blood-stain.
{ 2. “ “ “ ox “ “
{ 3. “ “ “ horse “ “
Set A { 4. “ “ “ sheep “ “
{ 5. “ “ “ pig “ “
{ 6. “ “ “ stain under observation.
Set B is now charged as follows:
{ 1. Receives normal rabbit serum 0.05 c.c.
{ 2. “ human antiserum 0.05 “
{ 3. “ ox “ 0.05 “
Set B { 4. “ horse “ 0.05 “
{ 5. “ sheep “ 0.05 “
{ 6. “ pig “ 0.05 “
To each tube in Set B is now added about 0.1 c.c. of the extract of the
suspected stain.
It will thus be seen that in Set A known antigen is added to known
precipitin, with the exception of tube 6, which receives suspected
antigen, while in Set B the suspected antigen is added to known
antisera, with the exception of No. 1, which contains normal rabbit
serum.
The tubes are observed in an hour and the results noted. Should the
stain be human blood, positive reactions will be present in tubes 1 and
6 of stand A, and tube 2 of B.
The negative reactions in the other tubes in stand A prove that the
antiserum used is specific, and will only react with its own antigen;
in stand B that the stain is composed of specific human antigen,
reacting only with its own antiserum.
Should the stain suspected be other than human, and derived from one
of the other animals used for antiserum in stand B, then the positive
reaction will occur in the particular tube.[12] The test is now
recognised as very sensitive and reliable, and is also applicable to
the detection of the flesh or fluids of animals, and has thus been used
for the detection of meat stuffs.
[12] M‘Weeney, _Lancet_, June 18, 1910.
Tarchetti advises the following procedure in the examination of
blood-stains: Dissolve the stain in a few drops of a 0.9 per cent.
aqueous solution of sodium chloride, filter, and divide the filtrate
into two portions; to one (_a_) add 0.5 c.c. of the prepared rabbit
serum (the so-called antiserum); to the other (_b_) serum from a rabbit
which has not been injected with human blood. Both are to be placed in
an incubator at 37° C. for an hour. By this time, if the solution of
the stain be of human or anthropoid origin, the contents of the tube
(_a_) will have become turbid, the contents of tube (_b_) will remain
clear. From a series of experiments with blood-stains of man and other
animals on a variety of materials, Tarchetti states that this method is
reliable. Prepared rabbit “human antiserum” has been shown to have no
such reaction with the blood of the pig, ox, calf, mouse, or rat.
From the result of his investigations Grünbaum points out that these
reactions must be looked upon rather as “special” than “specific,” in
view of the fact that his “chimpanzee antiserum” gave a _slight_ but
distinct turbidity after a few hours with horse blood. He also suggests
a method for the microscopical application of the “biological test,” by
using a 1 per cent. blood solution with a drop of “antiserum.” This
method has enabled him to distinguish between human and anthropoid
blood, the reaction occurring earlier and being more complete when the
“antiserum” is used on its own blood.
Vegetable and other Stains which resemble Blood
Certain vegetable colouring matters give spectra which may be mistaken
for blood, from their close similarity. Of these cochineal dissolved in
a solution of alum gives two bands similar to O₂Hb. On the addition of
boric acid the bands move to the violet end of the spectrum, but they
are unaffected if the colouring matter be blood. Lac-dye, alkanet root,
madder, and others also give spectra resembling O₂Hb, but they are
changed or disappear on adding ammonia or sulphite of potassium, while
the spectrum of blood remains unaltered.
As stated previously, spectra of colouring matters other than blood
are not capable of being altered by reducing agents, so that, however
similar they may be to O₂Hb, they cannot be accepted as derived from
blood unless the spectra of reduced Hb and reduced hæmatin can be
obtained in the way described.
Cochineal, colours of certain roots and wood, turn crimson on the
addition of ammonia, logwood bluish-black.
The colour of the rose and certain flowers turn green on adding ammonia.
Fruit-stains from mulberry, currants, gooseberries, &c., turn
bluish-green with ammonia.
Vegetable stains have their colour heightened by the action of dilute
acids.
Chlorine bleaches fruit-stains, but turns the colour of blood-stains to
an olive-green.
Red dyes fixed by a mordant are not influenced by ammonia.
Iron stains are usually blackened by ammonium sulphide.
Red paint may contain red oxide of iron; digest with hydrochloric acid
and test for iron, by adding ferrocyanide of potassium to obtain the
Prussian blue. Iron stains may be of a reddish-brown or orange colour,
and insoluble in water, so that HCl is used to dissolve them.
_Citrate and malate of iron_ stains are soluble in water; the addition
of ammonia to an aqueous solution produces no change; guaiacum will
give a blue reaction if a persalt of iron be present. The addition of
hydrochloric acid and ferrocyanide of potassium will give the Prussian
blue reaction. A drop of nitric acid added to the solution will oxidise
the iron to the ferric state, and on the addition of a few drops of
fresh-made aqueous solution of sulphocyanide of potassium the port-wine
colour of sulphocyanide of iron will be produced.
A control test must be made with distilled water to prove the purity of
the reagents, and the two results compared with each other.
Aniline stains resembling blood are changed to greenish-yellow or
yellow on the addition of dilute nitric acid. Eosin stains produce
a fluorescent solution when dissolved in water. Grease, tar, pitch,
snuff, and paint may be mistaken for blood, especially on dark fabrics.
They may be detected by two methods:
(_a_) =The Wet Method.=--Having failed to obtain a solution by the aid
of the ordinary solvents for blood, other solvents must be used; ether
or benzene for grease, paint, or tar. The solution obtained must be
examined with the spectroscope.
(_b_) =The Dry Method.=--Place the cloth or other fabric stain down
upon a clean white filter paper; then on pressing the cloth with a hot
laundry iron, grease, tar, or pitch will stain the paper, paint or
snuff will not.
CHAPTER VII
BURNS AND SCALDS, CONTUSIONS AND BRUISES
BURNS AND SCALDS
Burns and Scalds are lesions characterised by a more or less marked
destruction of the tissues of the body, caused by the action upon its
internal or external surfaces of a temperature higher than that of the
body itself, or by the action of corrosive chemical substances.
=Burns= are produced in the following ways:
By exposure to radiant heat.
By the direct application of flame.
By contact with heated solids.
By contact with solid bodies which have become liquefied
by heat, such as metals in a state of fusion.
By friction.
By lightning, electricity, and X-rays.
By contact with corrosive chemical substances,
solid or liquid.
=Scalds= are produced by the application of heated liquids, at or near
their boiling-points, or in a gaseous form--as _steam_.
The injuries produced will depend upon the degree of temperature, the
period of exposure to its action, and the extent of surface involved.
The danger to life depends more on the extent of surface injured
than the intensity of the burn or scald upon a limited area, unless
the position of the burn render it peculiarly dangerous. Even though
the injuries be comparatively superficial, if they involve one-third
or one half of the surface of the body they must be regarded as
fatal. They may prove fatal by shock, by asphyxia, by constant and
profuse discharge from the injured surface, from absorption of septic
matter, from secondary inflammations of internal organs and serous
membranes--pleurisy, peritonitis, meningitis, perforating ulcer of
the duodenum. Children succumb more quickly than adults to burns and
scalds--the simplest, in their case, often proving fatal.
The cause of early death from burns and scalds is looked upon as a
disorder of the blood following injury to the red corpuscles by the
heat, and that this is more easily brought about in children, because
of the thinness of the skin, and the red corpuscles being less capable
of resistance.
The following table gives the different degrees of burns:
1. Superficial inflammation, characterised by redness without
blistering.
2. Acute inflammation, the epidermis raised, forming vesicles
containing serum.
3. Destruction of the superficial layers of the true skin.
4. Destruction of the true skin and subcutaneous cellular
tissues.
5. The superficial and deep parts converted into a charred mass.
6. Entire carbonisation of the parts.
(Dupuytren.)
Post-mortem Appearances
These will vary according to the extent of the injuries, the length of
time the individual lived after receiving them, and the causative agent.
=External Appearances.=--1. _Burns._--Radiant heat whitens the skin,
flames blacken it, from deposit of carbonaceous material. The hair
and clothing of the body are singed. Blisters may be present on
various parts, and roasted patches of the skin or deeper parts may
be present. The flame of an explosive, such as a mixture of coal gas
and air, scorches and mummifies the skin. The skin is blackened by
the explosion of gunpowder, and particles of the powder may be driven
into it; similar results follow explosions in coal mines, but to a
greater degree. Burns caused by red-hot solids or molten metals vary
in appearance according to the length of time they have remained in
contact with the surface: if short, there may be injury to the skin
only, with blistering; if for a longer period, there will be roasting
or charring of the part, and blisters may not be present.
All stages of burns may be present.
The uncovered parts of the body, as a rule, are more affected than the
clothed, unless the clothes become ignited, when the converse would
hold good. In cases where the clothes have been saturated with an
inflammable oil like petroleum the burns are much more severe.
2. _Scalds._--The appearances produced and the severity of the result
will vary directly with the boiling-point of the liquid. Boiling water
and steam produce vesication; the hairs are not affected. If the steam
be superheated, blistering may be absent, and the skin appear sodden
and devoid of elasticity. If the person survive the injuries for some
days, the skin will present appearances of reaction. After exposure
to great heat the bodies of the victims are usually contorted, with
the limbs flexed and the arms fixed in a defensive attitude--the
“pugilistic attitude.” This condition is due to _heat rigidity_.
=Internal Appearances.=--The brain is shrunk, usually without any
alteration in form, the lungs also shrunk, and the larynx, trachea,
and bronchi may contain carbonaceous material; their membranes may
be injected and covered with frothy mucus. The kidneys may present
reddish-brown markings from altered blood, and degeneration of the
epithelium of the tubules and Malpighian bodies.
There may be a reddened appearance of the mucous membrane of the
stomach and intestines, and in a certain number of cases, where death
has occurred some time after the injuries, ulcers may be present in the
duodenum.
The uterus and testicles resist the action of fire in a marked degree,
and may be changed but slightly, although the rest of the body has been
almost consumed.
The blood of persons who have been exposed to the action of CO during a
fire will present the usual cherry-red colour and the spectrum of COHb.
A similar cherry-red colour of the blood is found in bodies of persons
burnt to death which is not due to the action of CO. The cause is a
physical one, the alteration in colour being due to the coagulation of
the albumin in microscopical particles by the heat. In this condition
the spectrum is that of O₂Hb, and can be reduced in the usual way. The
same peculiar condition of the blood may be produced in corpses by
exposure to a sufficiently high temperature.
If on the examination of the blood COHb is detected, it indicates that
the person in whose body it is found was alive during the progress of
the fire.
_Corrosives._--The appearances produced by the application of corrosive
chemical substances are peculiar to them, and depend upon their special
actions upon the tissues. Sulphuric acid acts by rapidly extracting
water from the tissues and producing local rise of temperature; nitric
acid combines with the tissues to form picric acid; nitrate of silver
acts upon the tissue by hyperoxidation, and combines to form albuminate
of silver, nitric acid being liberated. A solution of phosphorus in
carbon disulphide, known as Greek fire, by the rapid oxidation and
burning of the phosphorus produces combustion of the tissues.
The diagnosis of lesions produced by corrosives from those by fire
or heated fluid or steam rests upon the absence of vesication, the
presence of the stains on the skin or clothing which they produce, and
the chemical analysis of the stains. Sulphuric acid produces a grey
or brownish-black eschar on the body; hydrochloric acid may leave a
whitish-grey stain; nitric acid produces a yellow stain on the skin,
and may produce sloughing.
=Was the burn inflicted before or after death?=--The answer to this
question depends upon careful consideration of all the evidences
afforded by the external and internal appearances, and upon the
presence or absence of _vital reaction_ in the lesions found.
Two characteristic appearances--redness and vesication--are present in
burns inflicted during life when the surface of the body is not charred
and the tissues destroyed. The redness affects the surface and entire
substance of the true skin, which is dotted by the deep red openings
of the sudoriferous and sebaceous ducts. This appearance cannot be
produced after death. Blisters are formed by a temperature somewhat
less than that of boiling water. Vesication, according to Orfila,
is characteristic of a burn inflicted during life, and the late Sir
Robert Christison found that in burns caused before and after death the
vesicles in the former contained serum, the latter air. In anasarcous
subjects, however, serous blisters may be formed, especially if the
heat employed be not too severe. A case is recorded by Taylor in which
vesicles containing bloody serum were formed on the body of a man who
had just been drowned and who had been put into a hot bath.
Ante-mortem vesicles in which vital reaction has taken place present
the following characteristics:
(_a_) They contain serous fluid in which albumin and
chlorides can be detected.
(_b_) An inflammatory red bounding line round the
circumference.
(_c_) Inflammatory redness of the base, and the papillæ
of the skin.
(_d_) The presence of pus, which would indicate that
the person had lived at least thirty-six hours after
the burn had taken place.
In burns produced after death, the surface and substance of the skin is
of a dull white colour, dotted with grey openings of the sudoriferous
and sebaceous ducts, and the subcutaneous tissues are uninjected.
Vesicles produced by burns may have to be distinguished from the
phlyctænæ, the result of advanced putrefaction. The latter possesses
none of the characteristics of the former.
If a vesicle present the following characteristics it may be accepted
as a post-mortem origin without doubt: if it be small and its contents
scanty, if the fluid it contain be free from albumin and chlorides, if
it contain air, and if there be no signs of inflammatory reaction.
=Was the burning homicidal, suicidal, or accidental?=--No general rules
for guidance can be here laid down. In most cases the conditions under
which the body is found will point less to suicide than to homicide or
accident. In cases of murder, the body is often burnt in the attempt
to destroy all traces of the crime. It must, however, be borne in mind
that intense heat applied to the body may give rise to a wound on the
surface like that caused by a cutting instrument. Casper mentions
such a case, in which a wound was found over the liver, due to the
application of intense heat to the body. The conjunction of robbery
will greatly assist in helping to solve the difficulty. It may be very
confidently stated that to dispose of a body by burning is no easy
matter.
Preternatural Combustibility
The possibility of “spontaneous combustion” occurring in bodies
during life has been mentioned in the earlier writings on medical
jurisprudence, and cases have been recorded in which it has been
alleged to have taken place. Up to the present time no undoubted case
of “spontaneous combustion” during life has been seen. On the other
hand, the possibility of its occurrence is contra-indicated by the
following facts: that the human body must consist of 75 per cent. of
its weight of water, to be compatible with life, and that a dead body
steeped in methylated spirit for many months or even years will never
be consumed, if set on fire, in the rapid and complete manner alleged
as occurring in cases of so-called “spontaneous combustion.”
A case is recorded by Beatson (_B. M. J._, vol. i., 1886, p. 295) of
a man, subject to foul eructations from the stomach, who got out of
bed during the night and struck a match to see the time; while blowing
out the light his breath took fire, producing an explosive noise
sufficiently loud to awaken his wife. Such cases are very rare.
It is a fact that by the action of certain micro-organisms upon organic
matter inflammable gases are produced. That such an occurrence is
possible, in the dead human body, is supported by cases recorded by
Gull (_Med. Times and Gazette_, 1885) and Reynolds (_Med. Chron._,
1891). In Gull‘s case inflammable gases escaped through punctures made
into the abdomen, and they burned spontaneously on contact with the
air. In Reynold‘s case no flames were seen, but extensive and deep
marks of burning were present, especially on the trunk and thighs. It
has been suggested that the habitual use of alcohol in excess during
life renders the tissues of the body more inflammable, but the matter
is not yet decided. Tissues steeped in alcohol are not rendered more
inflammable.
Dr. Ogston, who cautiously avoids committing himself to the belief in
“spontaneous combustion,” yet thinks that the subject of _preternatural
combustibility_ in certain conditions of the body may perhaps, to say
the least of it, be set down as one still _sub judice_. “There is no
evidence to justify the use of the word ‘spontaneous,’ but there can be
no doubt that an extraordinarily high degree of combustibility occurs
in rare instances, to which the term _preternatural_ combustibility
would more correctly apply” (J. Dixon Mann).
Burns due to X-Rays
Over-exposure to the action of X-rays produces burns of a peculiar
character, and in cases of unprotected skin exposed to the action
of the rays in those who are constantly working with them, forms
of dermatitis have arisen which are intractable and tend to become
epitheliomatous in character.
The results of slight over-exposure, or repeated short exposures vary
from a simple redness of the skin to severe dermatitis, the hair of the
part being shed. When the over-exposure or dosage has been severe, the
skin may vesicate and ulcerate. I have seen this in cases where the
rays have been used for reduction of the spleen in leukæmia and Banti‘s
disease. The burns heal with cicatrisation of radiate shape, the skin
around the scar being permeated with numerous capillary vessels which
produce the appearance of capillary nævi, and in other instances
large stellate superficial vessels are formed. In addition, marked
pigmentation of the skin may follow the burn. X-ray burns which have
produced vesication and ulceration or sloughing take a long time to
heal in comparison with ordinary burns.
In repeated exposure to the rays, even when little redness has been
noticed at the time, the formation of capillary vessels may become
evident some time after the exposures have been stopped. This may
cause disfigurement, by the formation of telangiectasis, especially
if they appear on the face or neck. The falling out of the hair is
produced by X-rays as a therapeutic measure in cases of ringworm, and
due precaution must be taken to limit the effect and area of exposure
by proper screening. The same precaution should be used to protect
parts of the body other than the part which requires treatment or
examination in other conditions.
With increasing knowledge of the effects of X-ray exposures, special
precautions have been devised to prevent untoward effects, so that
burns from over-exposure, and dermatitis amongst X-ray workers are
prevented.
CONTUSIONS AND BRUISES
In the living these injuries are accompanied with swelling, pain, and
more or less discoloration of the part affected. Among malingerers it
is not an uncommon practice to bruise the body to imitate the spots
of purpura and scurvy. In scurvy, the condition of the gums common to
that disease, and the state of the general health, will point to the
true nature of the spots. The diagnosis of purpura will be assisted
by noting the diffusion of the spots over the body. In old people
purpuric spots frequently extend round the limbs, chiefly on one of the
lower extremities. Many blood diseases are associated with ecchymoses
and purpuric eruptions. Some persons are very easily bruised, and a
pinch, by no means severe, will cause on their arms a severe bruise.
Discoloration--ecchymosis--may take place in the skin, cellular tissue,
muscles, or internal organs as a result of external injury, or it may
be due to sudden and powerful contraction of a muscle or group of
muscles. Not infrequently the discoloration does not appear over the
seat of injury, but at some distance from it; and when the effusion
is deep-seated, days may elapse before any discoloration of the skin
takes place, and then it is not blue, as in superficial parts, but
of a violet, greenish, or yellowish hue. A deep-seated ecchymosis
may give no external sign of its presence; hence in all cases deep
incisions should be made before an opinion is ventured as to the
entire absence of this occurrence. This is very noticeable among the
deep-seated muscles of a limb. In these cases, forty or fifty days
may elapse before the deep-seated bruise shows its existence on the
surface, and then only as irregular, yellowish, green, or bluish spots
over the part. A very slight contusion, as a sprain of the ankle, may
give rise to extended discoloration of the leg. An ecchymosis is not
necessarily situated directly under the seat of injury. A blow given
during life may not appear as an ecchymosis till _after death_. The
change of colour in bruises begins at the circumference, and travels
inwards. During the first three days the colour of the bruise is blue,
bluish-black, or black; greenish on the fifth or sixth day; and yellow
from the seventh to the twelfth. The extent of an ecchymosis depends
greatly on the looseness of the cellular tissue. A slight contusion
causes a slight redness and swelling, and may leave no mark on the dead
body, unless death has taken place within thirty-six hours. Injuries of
this kind sometimes leave a parchment-like hardness and discoloration
of the skin. The part looks slightly depressed, due probably to the
epidermis having been partly rubbed off, and the skin then drying.
Similar marks are sometimes made by blisters. These marks may be
produced on the dead body by friction and exposure to the air.
The diagnosis of ecchymosis from hypostasis has been given (see p.
46). A tolerably severe blow after death would be necessary to produce
appearances similar to those produced by a slight one during life.
In scourging, there are parallel ecchymosed lines, of small spots
resembling petechiæ. An internal organ may be ruptured, and yet there
may be no appearance of injury externally. The liver is the organ most
commonly ruptured. The rupture is almost always longitudinal, and in
some cases a portion of the gland is more or less detached. The spleen
is also not infrequently ruptured; and this occurs most frequently in
countries where ague prevails. Rupture of the lungs and brain is rare.
When the pelvis is fractured, the bladder is frequently found ruptured.
Death in most cases is due to internal hæmorrhage or shock, when any of
the internal organs are ruptured.
=Can the appearance of a bruise be produced after death?=--It is
possible that the appearance of a bruise inflicted during life may be
produced within two hours after death, and in some rare cases even
after the lapse of three hours and a quarter (Christison); but these
ecchymoses are limited in extent, and when large are due to a rupture
in a vein which can be readily ascertained. The experiments of the
late Sir Robert Christison, relating to this question, are detailed in
the _Edinburgh Medical and Surgical Journal_, vol. xxxi. The amount
of violence required after death to produce appearances like those
made before death is such as would seldom, if ever, be inflicted on a
corpse, and, therefore, where we find a well-marked bruise we ought to
infer that it was made before death.
The following table, compiled from the experiments of Christison, may
assist the diagnosis:
--------------------------------+---------------------------------
During Life. | After Death.
--------------------------------+---------------------------------
1. Swelling of the part. | 1. No swelling.
|
2. Coagulation of the blood | 2. No such appearance, unless
effused into the adjacent | there is a rupture of a large
cellular tissue, with or | vessel in the neighbourhood
without tumefaction. | of loose cellular tissue.
|
3. Incorporation of blood | 3. No such appearance produced
with the whole thickness | by a blow after death.
of the true skin, rendering |
it black instead of white. |
--------------------------------+---------------------------------
_N.B._--Extensive effusion may occur without affecting the skin,
but when the skin is so affected Christison thought it decisive of
_ante-mortem_ injury.
The Size and Form of a Bruise should be noted.
Why?
1. _In Hanging and Strangulation._--The mark due to pressure of
the cord on the neck in hanging runs obliquely round the neck; in
strangulation, the mark encircles the neck. The mark is frequently
interrupted, and may present very varied appearances in different parts
of the neck. The mark of the knot may be found under the chin.
2. _In Throttling._--The pressure exerted on the throat of the deceased
by the fingers of his assailant may leave marks which may point to the
means used to cause death.
3. _In other Cases of Death by Violence._--The impression made by the
weapon used may lead to the identification of the murderer. The marks
left by the wards of a large door-key once led to the identification of
the assailant.
CHAPTER VIII
SUFFOCATION, HANGING, STRANGLING, AND THROTTLING
SUFFOCATION
Death from suffocation is said to result from any impediment to the
respiration which does not act by compressing the larynx or trachea.
Suffocation may therefore be caused by pressure on the chest, as in
persons crushed in a crowd. It may also be due to the respiration of
certain gases, or to the presence of pulverulent substances in the air,
which act by choking up the air-passages. Imprisonment in any confined
space may cause death from suffocation, and abscesses bursting into
the trachea, or vomiting matters in drunken persons lodging in the
windpipe, may be attended with a like result. Pressure on the umbilical
cord whilst the child is in the maternal passages causes death from
suffocation.
=Signs of Death by Suffocation.=--The first effect of arrest to the
passage of air into the lungs is the stagnation of blood in the
capillaries of the lungs. Non-arterial blood then goes to the brain and
consciousness is soon lost. The respiratory sensation is then arrested
by the circulation of venous blood. The left side of the heart becomes
emptied, and then weak; the right side full and engorged. The great
venous trunks are also more or less full, and the abdominal viscera,
liver, spleen, and kidneys congested. The arrest of the heart‘s action
is a secondary effect; the right side is paralysed by being too full,
the left by being empty. These signs may be said to be typical, or,
rather, are to be expected in death due to suffocation, but it must
be distinctly stated that they are not always present. The right side
of the heart is not in all cases engorged with blood; and Christison
warns medical men against expecting “strongly marked appearances in
every case of death from suffocation.” The heart, moreover, continues
to contract after the lungs have ceased to perform their duty. Death
is thus due to apnœa--that is, death beginning at the lungs--and not
to syncope. Death in some cases is from neuro-paralysis or nervous
apoplexy. In death by shock, which in most cases is instantaneous, both
sides of the heart are equally filled. Death, the result of disease,
may present all the signs of death from suffocation, and no suspicion
may be aroused as to the cause of death from the _post-mortem_
appearances, especially if putrefaction have set in.
The following table is given as an aid to diagnosis in this form of
death:
Points to be noticed in forming a Diagnosis of Death by Suffocation
1. _The Blood._--There is _unusual fluidity_ of the blood found in
death by suffocation, however produced. This condition is sometimes
present in deaths due to certain diseases, fevers, &c., and in cases of
narcotic poisoning. Even with the blood in this condition, the presence
of coagula in the cavities of the heart is not infrequent. The colour
of the blood is changed to a dark purple, but in suffocation by carbon
monoxide it is red.
2. _Animal Heat._--In persons who have died from suffocation the animal
heat is long retained.
3. _Cadaveric Rigidity._--Other things being equal, the _rigor mortis_
is as well marked in this kind as in other forms of death.
4. _The Lungs._--Hyperæmia of the lungs is rarely absent. In
most cases both lungs are engorged in about equal proportions.
Hypostasis--_post-mortem stains_--must not be mistaken for capillary
engorgement.
5. _The Heart._--Engorgement of the right side of the heart, the left
being empty, or nearly so. It is advisable always to examine the heart
first, and then the lungs. The pulmonary artery is also much congested.
6. _Capillary Ecchymoses._--These appear as purplish-red spots on the
pulmonary pleuræ, on the surface of the heart, aorta, in the thymus,
and on the diaphragm. They may appear on the above-mentioned parts in a
fœtus suffocated _in utero_ by pressure on the cord. These ecchymoses
are rarely seen on adults, most frequently on infants, due probably
to the thinness of the coats of the capillaries, which are ruptured
in the efforts made to breathe. They are not a positive sign of death
from suffocation, as they have been seen in death due to cholera,
typhus, and other diseases. They are present also where death is due to
hanging, drowning, &c.
7. _Condition and Appearance of the Trachea._--The mucous membrane of
the trachea is injected, and appears of a cinnabar-red colour. This
is present in every case of death by suffocation, and must not be
confounded with the dirty cherry-red or brownish-red coloration due
to putrefaction. Remember also that the trachea putrefies early. If
suffocation be slowly produced, a quantity of frothy mucus may be found
in the windpipe, and also in the smaller tubes of the lungs. Always
examine, especially in cases of supposed infanticide, the trachea for
foreign bodies, the presence of soot, &c. The presence of sand, ashes,
&c., in the œsophagus and stomach in persons buried in these materials,
is presumptive of the person having been placed in them prior to death.
8. _Kidneys, Vena Cava, &c._--The quantity of blood in the kidneys
is always considerable. The abdominal veins are all more or less
congested, and the external surface of the intestines presents numerous
traces of venous congestion.
9. _The Brain._--Apoplexy of the brain, as secondary to the pulmonary
apoplexy, may be more or less present, attended by its well-known
appearances.
10. _Face, Tongue, and Mouth._--The expression of the face is not
characteristic of death by suffocation, and differs in no particular
from that common to other forms of death, being more frequently pale
than turgid; and the starting of the eyes, popularly ascribed to
this form of death, is not often seen. The tongue may or may not be
protruded beyond the teeth. The presence of _froth_ about the mouth is
not constant, and is of common occurrence in those dying from natural
causes. The tympanum may be ruptured.
=Was the suffocation homicidal, suicidal, or accidental?=--Suffocation
may occur accidentally during the act of swallowing, and by foreign
bodies placed carelessly in the mouth and then drawn suddenly into the
windpipe, or by blocking the pharynx or œsophagus, also from being
smothered by sinking into sand, grain, mud, and such-like, or by the
bed-clothes in cases of epilepsy during a fit. Examine the lips for
the presence of ecchymosis and other marks of violence. A man, some
years ago, was accused of having caused the death of his wife by
strangulation, for which he was indicted, and tried before the High
Court of Justiciary in Scotland. The _post-mortem_ examination revealed
the cause of death as due to suffocation, and the following injuries
were found on dividing the windpipe, which contained a quantity of
frothy mucus: in the interior of the larynx there was a considerable
extravasation of blood lying beneath the investing membrane, and
passing up on both sides and behind, as far as the chink of the
glottis, and above that opening into the ventricles of the larynx.
There was here, also, a fracture of the right wing of the thyroid
cartilage, by which its lowest horn was wholly detached, and the
cricoid cartilage was broken in two places at opposite sides of its
ring. The defence was that she had fallen accidentally while in a state
of drunkenness, and had thus produced the fatal injuries.
The man was acquitted, the legal opinion in favour outweighing the
medical opinion against the theory of accident. The above case created
some discussion at the time, and induced Dr. Keiller to make several
experiments as to the possibility of fracturing the cartilages of the
larynx. The following are his conclusions:
1. That _ordinary_ falls on the human larynx are
apparently not capable of producing fractures of its
cartilages, and even _falls from a height with superadded
force_ appear to be unlikely to do so.
2. That _severe pressure applied from before
backwards_, so as strongly to compress the larynx against
the vertebral column, or _violent blows inflicted over the
larynx by means of a heavy body_, are sufficient to cause
fractures of the larynx. Fractures so produced, however,
will be most discernible on the _internal_ surface, and
generally _in or near the mesial line_.
3. _Violent compression_ applied to the _sides of
the larynx_ (as in ordinary _manual throttling or
strangulation by grasping_), is, of all applied forces,
the most likely to produce fractures of the alæ of the
thyroid cartilage, or even of the cricoid cartilage, and
fractures so produced are most perceptible, as well as most
extensive, on the _external_ surface of the larynx. By
this _lateral_ mode of applying force, the _hyoid
bone_ is almost most readily broken.
4. That the condition of the larynx in regard to the absence
or presence of ossific deposit materially influences
its liability to fracture from external violence. If
altogether cartilaginous, partial slits or splittings may
be produced. If partly ossified, fractures may be produced
by a comparatively moderate degree of applied violence,
and if extensively or entirely ossified, extreme violence
will generally be required to produce laryngeal fracture
(_Edinburgh Medical Journal_, 1855-56).
Homicidal suffocation may be due to forcibly introducing foreign bodies
into the air-passages, especially in children; adults suffocated thus
are generally under the influence of alcohol or drugs, or enfeebled
from disease. Suicidal suffocation by these means is generally limited
to lunatics.
[Illustration:
Fig. 16.--The pulse in this case became slower than
normal. Five minutes after the drop the type reached
that of bradycardia, then recovered itself, and even
14½ minutes after the drop was beating with normal
frequency, but in the meantime had become very feeble.
1. The day before execution, 102 per minute.
2. 5 minutes after the drop, 54 per minute.
3. 7 minutes, 102 per minute.
4. 10 minutes, 96 per minute.
5. 13 minutes, 66 per minute.
6. 14½ minutes, 72 per minute.]
[Illustration:
Fig. 17.--The pulse in this case became accelerated
and then fell again, but was feeble throughout.
1. The day before execution, 84 per minute.
2. 3½ minutes after the drop, 162 per minute.
3. 4 minutes, 156 per minute.
4. 5½ minutes, 132 per minute.
5. 6½ minutes, 102 per minute.
6. 9 minutes, 84 per minute.
7. 11½ minutes, 78 per minute.
8. 12½ minutes, 78 per minute.]
[Illustration:
Fig. 18.--In this case the pulse rate increased,
and then fell to 72 per minute towards the end.
1. 1 week before execution, 60 per minute.
2. 2½ minutes after the drop, 162 per minute.
3. 3 minutes, 138 per minute.
4. 3½ minutes, 132 per minute.
5. 4½ minutes.
6. 5¼ minutes, 168? per minute.
7. 5¾ minutes, 108 per minute.
8. 7 minutes.
9. 8½ minutes.
10. 10 minutes, 72 per minute.
11. 12 minutes.]
Homicidal suffocation by compression of the chest has been effected
in infants; in adults it is combined with the covering of the nose
and mouth. The victims are generally old or enfeebled. Suffocation of
infants may be homicidal, or accidental, due to “overlaying”; in the
latter the greatest mortality is amongst the youngest infants. A child
ten months old may struggle and free itself or awaken the mother.
In France a favourite mode of committing suicide by suffocation is the
use of irrespirable gases--carbonic acid, carbon monoxide, and the
like. Collateral circumstances must be taken into consideration, and
will more or less help to point to the true cause of death.
The cause and nature of the death in all of its forms just mentioned
are in general the same. Pressure on the trachea--thus arresting
respiration--and also on the important vessels and nerves of the neck,
results in death, which may be brought about in four different ways:
1. Cerebral congestion, or apoplexy.
2. Congestion of the lungs and heart--apnœa or asphyxia.
3. Combination of above--apoplexy and asphyxia or apnœa.
4. Neuro-paralysis--nervous apoplexy, or syncope.
The following table will show the relative frequency of each form of
death:
Remer. Casper.
Apoplexy 9 9
Asphyxia 6 14
Mixed 68 62
-- --
83 85
-- --
=Traumatic asphyxia= occurs when a heavy weight such as a fall of
earth or masonry compresses the chest, and thoracic respiration is
impossible. The head and neck appear ecchymosed, the purplish-blue
lividity generally ending abruptly at the lower part of the neck
or upper part of the thorax, about the level of the clavicles.
The conjunctivæ are ecchymosed, and there may be epistaxis. This
discoloration does not disappear on pressure by the finger, indicating
its petechial character. If the person survive long enough, the
discoloration gradually disappears, passing through the colour changes
of an ordinary ecchymosis.
The effects on the eyes may be such as to be followed by changes in the
retina, and optic atrophy leading to loss of vision.
Parts of the neck pressed upon by clothing may escape ecchymosis, and
present a white mark of almost normal skin.
HANGING
Death by hanging is caused by the more or less perfect suspension of
the body by a cord applied around the neck, the weight of the body
acting as the constricting force.
The body need not hang completely, partial suspension is sufficient
to cause death. The ligature surrounds the neck above the thyroid
cartilage, the epiglottis is pushed against the back of the pharynx,
the base of the tongue and the soft parts are pressed into the cavity
of the pharynx, so that the obliteration of the naso-pharyngeal and
the laryngeal passages is complete. Death is due to asphyxia and
pressure on the cervical blood-vessels, even if the air-passages be
not completely occluded; stoppage of the cerebral circulation being
sufficient to cause death; in such a case the signs of asphyxia are
absent.
Consciousness is quickly lost, due to pressure on the vessels, and, for
this reason, in accidental or suicidal hanging the person is prevented
from making any effort to save himself.
=Post-mortem Appearances.=--The _external appearances_ are more or less
those described under “Death from suffocation.” In the greater number
of cases the face bears a quiet, placid expression, no turgidity or
lividity being noticeable. The eyes are usually half open, but not
protruded, and the condition of the pupils variable. The tongue may be
protruded, but just as often not. The face may be pale or livid, and
a bluish colour present on the free border of the lips. Cyanosis and
swelling of the face are only present when the death agony has been
long; they soon disappear.
Ecchymosis of the conjunctiva, and on the outer surfaces of the lids
may be present. The escape of urine, fæces, and semen may take place,
but are not characteristic, and are extremely rare.
Casper states that in not one of the many cases he had examined of
persons hanged has he ever “found an erection of the male organ,”
and he also asserts that the emission of semen is extremely rare.
Seminal emissions take place more frequently in persons who have been
shot, and also in those who have been poisoned by irrespirable gases
or by hydrocyanic acid. As a test of strangulation, it is therefore
worthless. Tardieu, however, only noticed the escape of urine and fæces
in two out of forty-one cases; it is by no means a test of hanging, as
it may occur after death if the body is shaken in a cart, or roughly
used when first found. A fat person dying of apoplexy may have a mark
round the neck as if strangled. Injury to the spinal cord due to
fracture or dislocation of the cervical vertebræ is rare in suicidal
hanging. Fracture of the spinal ligaments and of the hyoid bone is also
rare. Rupture of the internal and middle coats of the carotid arteries
sometimes occurs. But it appears that considerable damage is done to
the soft parts of the neck by the present judicial mode of hanging with
the “long drop.”
Dr. Dyer has recorded (_New York Medical Journal_, vol. iii., 1866)
some experiments he made on the eyes of a man and some dogs killed by
hanging. He found certain transverse fissures across the lens, which he
is inclined to think are characteristic of this mode of death. Dr. R.
F. Hutchinson states that an invariable sign of death from hanging is
_the flow of saliva out of the mouth, down the chin, and straight down
the chest_. The appearance is unmistakable and invariable, and _could
not occur in a body hung up after death_, the secretion of saliva being
a living act (Chevers). Death from hanging may take place although the
toes or other parts of the body rest on the ground. Death is complete
in four or five minutes.
=Marks of the Cord, &c.=--The mark of the cord is nearly always
present. It varies with the breadth and hardness of the ligature, but
is often interrupted. Its irregularities are reproduced on the skin.
It is sometimes only seen on one side. In strangling, the mark is low
down, most frequently encircling the neck; in hanging, the mark is
generally above or on the thyroid cartilage, and carried obliquely
upwards. The mark of the cord may be of a dirty yellowish-brown colour,
and, when cut into, feels more or less hard and leathery. In general
appearance it is not unlike the mark left by mustard-plasters or
blisters applied within a short time of death. This effect is probably
produced by the rubbing off of the epidermis, and subsequent drying up
of the cutis on exposure to the air. At other times the mark may be of
a dirty reddish or bright blue colour; or, lastly, there may be little
or no mark present, or the edges may assume a livid red coloration,
being nothing more or less than a _post-mortem_ stain.
=May the mark of the cord be produced after death?=--On this point
Casper says: “That any ligature with which any body may be suspended
or strangled, not only within a few hours, but even days after death,
especially if the body be forcibly pulled downwards, may produce a mark
precisely similar to that which is observed in most of those hanged
while alive.” And the same authority also adds that “the mark of the
cord is a purely cadaveric phenomenon.”
=Accidental= hanging is rare, and generally happens with children
while playing at hanging, or by accidentally becoming entangled in a
window-blind cord or swing rope, or by the neck-band of an article of
clothing by which they may become accidentally suspended from the spike
of a railing.
=Homicidal= hanging is rare, but the body may be suspended after death
from violence, to simulate suicide; and it may have to be decided
whether the hanging took place during life or after death.
The mark of the cord is of no assistance, rents in the carotids with
extravasation into the coats of the vessels indicate _ante-mortem_
suspension. The flow of saliva down the chin to the body indicates
suspension before death. It is important to examine the body for
injuries which could not be self-inflicted, and to remember the
possibility of poison having been administered with suspension after
death.
=Suicidal= hanging is the most common, as it is a favourite mode of
death with suicides. The absence of marks of injury on the body found
suspended, and the want of evidence as to a previous struggle having
taken place, all point to suicide. The fact that the feet are found in
contact with the ground does not militate against the probability of
suicidal hanging; and it appears that in India the natives seldom hang
themselves from any height, and are most frequently found with their
feet on the ground. A person may take poison first, and hang himself
before the poison has had time to prove fatal.
STRANGLING
Death is due to pressure made on the neck by any form of ligature
carried circularly round the neck, without suspension. The cord in
hanging is, as a rule, placed more obliquely than in strangling.
The mode of death is the same as in hanging. The _post-mortem_
appearances are similar to those of hanging, practically those of
asphyxia. The mark on the neck is the principal feature. In position
it is generally horizontal and situated below or on a level with the
thyroid cartilage. It more completely encircles the neck. It may be
interrupted in places if an irregular ligature has been used, causing
irregular pressure. Its character depends largely upon the nature
of the ligature. If the constriction has been uniform a continuous
depression is produced which may be marked by ecchymosis. If the skin
has been abraded, the line dries, and has a brownish, parchment-like
appearance and feeling. If the ligature has been removed before life
is quite extinct, the depressed line may disappear or be but slightly
evident.
A soft, broad ligature may leave no mark on the neck, if not applied
too tightly, or for too long a time. Should the victim have been
strangled in the recumbent posture, and dragged upwards and backwards
by the ligature, the mark will be on a slant as in hanging. According
to the amount of violence used injuries may be caused to the deeper
structures of the neck, such as effusion of blood into muscles,
fractures of the thyroid or cricoid cartilage; rupture of the tympanum
and epistaxis may take place.
=Accidental= strangulation may occur when a cord suspending a weight on
the back and passing across the chest slips and encircles or compresses
the neck.
Falling out of bed, with entanglement in the clothes or nightdress, may
cause strangling by tightening of the neck-band round the neck.
=Homicidal= strangling is as common as homicidal hanging is rare.
It is difficult to hang a man, but easy to strangle him, because
consciousness is rapidly lost, and the victim is unable to offer any
resistance once the cord is tightened round the neck. In homicidal
strangling the murderer generally uses a great deal more violence than
is necessary, and so there is found after death much more local injury
in such cases.
Severe local injuries, such as fracture of the laryngeal cartilages or
hyoid bone, denote homicide, as they are rarely noticed in suicidal
strangulation.
There may also be signs of general violence about the face, neck,
chest, or other parts of the body. The position of the knot affords
no material help, as the murderer may tie it in any position, but
more than one knot, especially if in different positions, points to
homicide. It must be remembered that finger-nails or other marks in
the vicinity of the ligature may be present in cases of suicides, from
the slipping of the cord or the determined attempts of the suicide
to carry out the act, or plucking at the cord involuntarily. When a
person is first strangled, then hung, there would be two marks--one
probably horizontal, the other slanting.
=Suicidal= strangulation is rare. The knot is generally adjusted at
the front or side of the neck, the cord may encircle the neck several
times. Injuries to the deep structures of the neck are absent. Signs of
general violence are not necessarily present.
If there be two marks upon the neck, one due to an attempt at
strangulation, the other to suspension, in a suicide, the first would
be the less marked, the latter more pronounced, whereas in homicide the
strangulation mark would be most distinct.
THROTTLING
Throttling is strangling by means of the hand or hands alone, and is
due to constant pressure of the fingers upon the throat. Very little
pressure is required to occlude the glottis; it can be done with
slight pressure of the thumb and forefinger on the side of the thyroid
cartilage.
The impression of the fingers and thumb upon the throat have
characteristic marks. They are usually to be seen on both sides of the
throat. The thumb mark is on one side, and the marks of the fingers,
separated from one another or clustered together, are on the other,
the thumb mark being the highest. When grasped from the front by the
right hand, the thumb mark will be on the right side of the throat.
If the victim be throttled by the two hands at the same time, as when
on the ground, the thumb marks are on the same side. If the assailant
be left-handed, and has used this hand to grip the throat, the thumb
mark will be on the left side of the victim. The finger marks are one
above the other. The marks may appear as ecchymoses if the examination
be made soon after death; if later, they may appear and feel like
parchment, and of a brownish colour. Crescentic marks of finger-nails
may be present, also other scratches in the vicinity. Other marks of
general violence may be present, and should the victim have fallen
to the ground, the head may be injured. Much blood is effused in the
tissues of the neck and the laryngeal cartilages, and the hyoid may be
found fractured; the carotids may escape injury, but not always.
The mucous membrane of the cheeks may be found lacerated. Where the
victim is thrown to the ground and knelt upon, fracture of the ribs and
ecchymosis of the chest wall may occur.
In a case examined by me of combined strangling and throttling, marks
of the ligature and fingers were both present, and on the clavicles
separate marks produced by the knuckles while tying the cord. These
knuckle marks did not show up till some time after death. Effusions
of blood were present in the tissues of the neck on each side of the
larynx, and amongst the muscles on both sides, and in the sheath of the
left carotid artery.
The hyoid bone was fractured in two places in its left half. The
thyroid cartilage was fractured vertically on each side of the middle
line into three pieces, the central portion having fallen behind the
other two into the cavity of the larynx. The right wing of the thyroid
was comminuted. The cornua were fractured. The cricoid cartilage was
also fractured posteriorly, and into three pieces in front. Effusions
of blood in the fractured areas had formed beneath the mucous membrane.
Effusion of blood was present on the front wall of the pharynx and the
upper part of the œsophagus. The right carotid artery was atheromatous,
and linear and star-shaped fissures were present, the latter surrounded
by a ring of sub-intimal effusion of blood.
On the right side of the thorax the fifth rib was fractured at the
junction with its cartilage, and on the left side the second, third,
fourth, fifth, and sixth ribs were fractured close to their cartilages,
and again from three to five inches further back. Blood effusions in
the tissues of the chest wall and under the pleuræ were present in the
region of the fractures.
A handkerchief was found tight on the neck and tied with two knots
both fastened securely. It was probable that the handkerchief had been
tied on after the throttling, as the knot ends were too short to allow
a sufficient pull on them to cause the injuries. Throttling may be
regarded as a homicidal act; although one or two instances of suicidal
throttling have been recorded in the insane.
=Judicial Hanging.=--In judicial hanging the prisoner is suspended by a
rope with a running noose around the neck, after a sudden drop of from
six to eight feet according to the weight of the body. The noose may be
arranged with the knot or slip-ring fixed at the side below the ear, or
in front so as to jerk the head backwards. The sudden and severe strain
upon the neck produces fracture or dislocation of the spinal column
at the second or third cervical vertebra, with rupture of the spinal
cord. Other local injuries occur, such as rupture of cervical muscles,
fracture of the larynx, and even lacerated wounds of the neck. The head
has even been severed completely from the body, and the deep structures
of the neck have even been so lacerated that the body has hung by skin
only, stretched to the thickness of two or three fingers. Death is said
to take place from shock, pressure on the vagi, and asphyxia, probably
also cerebral apoplexy. When death is instantaneous, the body hangs
motionless, the head fallen over the side opposite the knot, and the
neck stretched.
The heart may, however, continue to beat for a varying period after
apparent death--in some cases even as long as 14½ minutes. The
following interesting series of pulse tracings were taken by Dr.
Llewellyn Morgan, of Liverpool, and kindly placed at my disposal. In
No. 1 the heart beats could be recorded at the wrist for 14½ minutes
after the drop; in No. 2 for 12½ minutes; and in No. 3 for 12 minutes.
The frequency and character of the beat is variable, but in each case
shows a practically normal rate towards the end. (See Figs. 16, 17, 18.)
Apart from the local injuries to the neck, the external appearances in
judicial hanging are similar to those in other forms.
CHAPTER IX
DROWNING
Death by drowning occurs when the breathing is arrested by watery or
semi-fluid substances, blood, urine, or the muddy semi-fluid matter
found in cesspools and marshes. It is not necessary for the whole body
to be submerged. Death may result if the face alone be immersed, as in
the case of a man in a fit of drunkenness being drowned in the water
contained in the imprint of a horse‘s hoof left in the mud.
In addition to the changes in the internal organs, identical with those
present in persons who have died from suffocation or hanging, water is
found in the lungs or stomach.
Death may be due to--
(_a_) Apoplexy.
(_b_) Asphyxia.
(_c_) A combination of the two.
(_d_) Neuro-paralysis.
Death from pure apoplexy is rare; and it may be affirmed that death
from syncope never occurs in the drowned without leaving some signs of
asphyxia.
It is more difficult to restore the drowned than those dying from mere
stoppage of air from entering the lungs. Few if any persons recover who
have been submerged four minutes, and even in cases where this time has
been exceeded, followed by recovery, this result is probably due to the
person fainting before entering the water.
In death from drowning, the lungs are distended and overlap the heart,
and have a peculiar spongy feeling. They also contain a quantity of
frothy fluid, which cannot be produced in the dead body, as it is
the result of the violent efforts made by the individual to breathe
in the act of dying. This frothy condition of the fluid in the lungs
is an important sign of death by drowning, especially if the fluid
corresponds with that in which the individual is said to have perished.
It is just _possible_, however, that the person may have been first
suffocated, and then thrown into the water, froth in the trachea being
found in those suffocated; but in this case the froth is small in
quantity, and not watery. The froth in the drowned is like that made
with soap and water, and is not viscid, thus differing from bronchitic
exudation. Water in the stomach is an important indication of death
from drowning, especially if the water contained in the stomach can
be shown to possess the same characters as that in which the body was
found. Water in the intestines is still more important. In a great
number of cases this, however, must be next to impossible; when it can
be identified, the value of this sign is enhanced by the fact that
water does not enter the stomach in those submerged after death, unless
putrefaction be far advanced, or the body has lain in very deep water.
Casper concluded that a person had been drowned, by finding a small
quantity of mud in the stomach after putrefaction had set in. Water,
however, may be absent from the stomach if the person fall into the
water in a state of syncope, and it may be present if the person has
taken a draught of water before submersion.
The effect of season on putrefaction in water is shown in the following
table:
Summer. Winter.
5 to 8 hours produce as much change as 3 to 5 days.
24 “ “ “ 4 to 8 “
4 days “ “ 15 “
10 to 12 “ “ “ 28 to 42 “
(Devergie.)
Of the external signs, the presence of sand, gravel, or mud under
the nails may or may not be an important sign, for sand or mud may
collect under the nails during the efforts to drag the body from the
water; but weeds, &c., grasped in the hands show that there has been a
struggle, and point to death from drowning. The _cutis anserina_--goose
skin--present generally on the anterior surface of the body, and not,
however, peculiar to death from drowning, is important as a sign of
recent vitality. The face of those who have been drowned, and then
quickly removed from the water, is pale, and in most cases not swollen;
the eyes may or may not be closed; and not infrequently round the mouth
there is more or less froth, especially when death is due to apnœa. In
summer, however, after two or three days, and longer in winter, the
face assumes a reddish or bluish-red coloration, putrefaction taking
place about the head and upper extremities earlier than in other forms
of death. The _contraction or retraction of the penis_ is a well-marked
sign of death by drowning, and Casper asserts that he has “not observed
anything similar so constantly after any other kind of death.” Ogston
states that he has met with two cases of erection of the penis in the
drowned.
The question as to how long a body may remain in the water before it
floats has given rise to considerable discussion, without, however,
arriving at any very definite conclusion. It may be stated in general
terms that, as floating depends to some extent on the rapidity in which
putrefaction supervenes on submersion, bodies float earlier in summer
than in winter, in salt than fresh water, clothed than naked. In India
bodies have floated in twenty-four hours after immersion. Females and
children float more readily than males. A body from various causes may
float within a few hours of its submersion, especially if the body be
that of a female, fat and clothed. The old idea that the body of a
person thrown into water during life sinks, but that a dead body under
like conditions floats, is a fiction now exploded.
=Suicide or Homicide?=--Homicide by drowning is rare, except in
children. Accidental and suicidal drowning are common enough.
The signs to be sought for in the drowned are--(1) Absence of any
injury. (2) _Cutis anserina_ and retracted penis. (3) Water and mud in
the stomach. (4) Froth in the air-passages. (5) Distended lungs. (6)
General signs of death by asphyxia.
It should be remembered that the fact of the hands being tied together,
or to the feet, does not militate against suicide by drowning.
If wounds and other injuries be found on the body, the question
arises as to whether the injuries were sufficient in themselves to
cause death, and then as to whether they were caused during life.
A person jumping from a height into the water may sustain severe
injuries--dislocation of both arms, fracture of the skull and of
the vertebræ, or even lacerated wounds of more or less severity.
The absence of the signs proper to death by drowning, coupled with
the presence of external injuries, would point to death by violence
prior to immersion. The presence of signs of drowning, and injuries,
sufficient to have caused death in themselves, would indicate that they
had occurred after death.
The following considerations may assist in forming an opinion:
1. Previous history of person found in the water.
(_a_) Any history of suicidal tendency.
(_b_) Any motive that would render suicide probable.
2. Height from which the person fell.
3. Absence or presence of signs of death by drowning.
4. Absence of stakes or other objects in the water that might
have caused injuries to anyone falling against them.
The time required to cause death by drowning is so short that persons
seldom recover after submersion for three or four minutes; but the
cessation of respiration is no guide to the extinction of life, and an
attempt at resuscitation should always be made, for if the respiration
be fairly restored the heart will soon act. Nay more, as pointed out
before, in cases of so-called asphyxia, the heart may continue to act
for several minutes after the entrance of air to the lungs has been
arrested, and in judicial hanging it frequently happens that the pulse
at the wrist can be felt for ten or twelve minutes after suspension.
(See Figs. 16, 17, 18.)
Recapitulation of the Post-mortem Appearances in the Drowned
I. External
1. _In the Skin._--Rose-coloured patches may be present on the face
and neck. The condition of _goose skin_--_cutis anserina_--is hardly
ever absent even in summer. The _cutis anserina_ is not, however,
characteristic of drowning, as it may be present in other forms of
violent death, and also in some persons during life. It is a vital act,
the result of nervous shock, and does not depend upon the temperature
of the water for its production; still, it points to recent vitality.
2. _The Tongue._--The tongue is just as often found behind the jaws as
between them (Casper).
3. _The Hands and Feet._--The hands and feet acquire a greyish-blue
colour when the body has lain in the water from twelve to twenty-four
hours. The skin also becomes corrugated in longitudinal folds. The
greyish-blue condition of the hand is known as the “cholera hand.”
The nails may contain particles of sand and weeds. “No corrugation or
discoloration of the skin of the hands or feet is ever observed on
the body of anyone drowned who has been taken out of the water within
half an hour, within two, six, or even eight hours” (Casper). The same
authority states he has produced these effects by laying the hands
after death in water, or wrapping them in cloths kept constantly wet
for a few days.
4. _The Genitals._--Contraction of the penis and dartos is an almost
constant symptom, and Casper has “not observed anything similar so
constantly after any other kind of death.” It is due, probably, to
the same cause as the _cutis anserina_, which Brettner attributes to
“bundles of unstriped muscular fibres, lying in the upper stratum of
the true skin, surrounding the sebaceous glands, and forcing them
forwards by their contraction, thus making the _cutis anserina_.
Precisely similar unstriped muscles are found in the subcutaneous
cellular tissue of the penis; they run principally parallel to the long
axis of the member, but very often large bundles run across it.” The
action of cold and fright is to induce contraction of these cutaneous
muscles, with a resulting contraction of the penis.
II. Internal
1. _The Brain._--Cerebral hyperæmia is _most_ rare in the drowned, but
cerebral hypostasis is not infrequently mistaken for it.
2. _The Trachea._--The mucous membrane of the trachea and larynx is
always more or less injected, and is of a cinnabar-red, which must
not be mistaken for the dirty, brownish-red colour, the result of
putrefaction. A white froth, but seldom bloody, is also found in
varying quantity in the trachea, and is a most important sign of vital
reaction, but its diagnostic value is destroyed by putrefaction.
Sometimes a portion of the contents of the stomach may be found in the
trachea. When this occurs it is due to the act of coughing, induced by
the admission of water into the lungs. The contents of the stomach are
forced into the mouth, and then drawn into the lungs during the next
attempt at inspiration. This indicates that the person entered the
water during life. In cases where death has taken place from syncope
little or no froth may be found in the trachea.
3. _The Lungs._--The lungs are completely distended, almost entirely
overlapping the heart, and pressing close to the ribs. They are spongy
to the feel, and when cut into, a considerable quantity of bloody froth
escapes. The _froth_ found in the lungs is the result of the powerful
attempts to breathe, and cannot be produced by artificial means. It
adheres not to the sides of the bronchial tubes, as does the exudation
of bronchitis or pneumonia. The distension of the lungs is due partly
to an actual hyperæmia, and partly to inhaled fluid. Water is present
in the pleural cavities.
4. _The Heart and Great Vessels._--As is common to other forms of
asphyxia, the left side of the heart is entirely, or almost entirely,
empty; the right, on the contrary, is engorged. This condition of the
heart is, therefore, not a diagnostic sign of drowning, and is absent
in the drowned when death takes place by neuro-paralysis; in fact, in
some cases of undoubted drowning, both sides have been found empty,
probably, however, the result of putrefaction (Ogston). The same may be
said of the accompanying congestion of the pulmonary artery.
5. _The Blood._--As is common in all forms of death where respiration
has been arrested, the blood is found to be remarkably _fluid_, and of
a cherry-juice colour. M. Faure in his monograph on asphyxia states
that he has found large and firm clots in the right side of the heart
in the drowned who have not remained long under water. The blood is
diluted with water, most marked in the left side of the heart. The
amount of dilution is greater in slow drowning.
6. _The Stomach._--Casper considers that the presence of fluid in the
stomach, corresponding to that in which the body is found, is “an
irrefragable proof of the actual occurrence of death from drowning,”
and that the swallowing of it must have been a vital act of the
individual dying in the water. The absence of water from the stomach
does not negative death from drowning. Water is not always present. It
is possible for it to reach the stomach of a submerged body after death.
Water in the intestines is a more reliable sign of death from drowning,
and indicates submersion during life. It is only after very long
submersion and under great pressure that water finds its way into the
intestines after death.
_N.B._--Putrefaction in the drowned in most cases
commences in the upper part of the body, and extends
downwards. The face, head, and neck are first attacked.
This is the reverse of putrefaction in air.
CHAPTER X
DEATH FROM STARVATION, COLD, HEAT, BY LIGHTNING AND ELECTRICITY
DEATH FROM STARVATION
Death from starvation may be due to the total withdrawal of food, to
prolonged insufficiency, defective quality, inability to swallow it,
and inability to retain it.
Death from starvation may occur during famines, amongst ship-wrecked
sailors, and persons entombed in mines or pits, and is due to sheer
privation. It may follow criminal starvation, wilful refusal to take
food as a form of suicide, and it has been noted in cases of hysteria
and lunacy.
It may result from mechanical hindrance to the entrance of food
into the body from ankylosis of the jaws, or its passage through
the alimentary tract from stricture of the œsophagus or stomach,
from cancer or cicatrisation after injury from swallowing corrosive
substances. Amongst other diseases, tuberculosis, malignant disease,
and diabetes mellitus are the chief which produce external appearances
of starvation.
In the withdrawal or deprivation of food for criminal purposes the
victims are usually old, helpless, or feeble-minded persons, or young
children.
Symptoms.--These depend on the previous state of nutrition. Starvation
may be regarded as acute when death occurs within fourteen days from
the withdrawal of food, chronic when at a longer period.
The symptoms of hunger vary: they are said to pass off in forty-eight
hours, but may last for several days acutely.
The body temperature falls below normal, and the fall may be two
or three degrees before death. The pulse gradually increases in
frequency day by day. The chief sign is loss of body weight. Chossat‘s
experiments on pigeons showed that when they were totally deprived
of food, the surplus fat of the body was lost first, then the fatty
coverings of internal organs, the interstitial fat of muscles last of
all; the muscles themselves also wasted. A peculiar odour like acetone
emanates from those who have been starved, and towards and after death
the odour is putrescent.
In addition to the above signs, there are anæmia, sunken, glistening
eyes with dilated pupils, prominence of bony projections, pale and dry
lips and tongue, parched mouth and throat, weakness of the voice,
sunken abdomen, wasted limbs, constipated bowels, urine scanty and
turbid. There are pains in the abdomen, relieved by pressure; great
thirst, a dusky, dry skin, occasionally purpuric eruptions, exhaustion,
ultimately delirium ending in death.
=Post-mortem Appearances.=--There is emaciation of the whole body, dry,
wrinkled skin of a brown colour; the muscles are flabby and wasted, the
abdomen sunken, the eyes red and open; this appearance is not common in
death from other causes. The mouth and throat are dry even to aridity.
The heart, lungs, and blood-vessels are collapsed, and contain but
little blood. The abdominal viscera are shrunken and without enveloping
fat. The omentum is devoid of fat, and clear; the gall bladder is full
of dark bile; the urinary bladder may be quite empty. The stomach
and intestines are collapsed, contracted, and empty, and the walls
extremely thinned.
=Diagnosis.=--The absence of any other cause of death--such as cancer
of the stomach, stricture of the œsophagus, &c.--and the previous
history of the case will assist in forming an opinion, care being
taken not to confound the results of wasting disease with those due to
starvation.
=Legal Relations.=--The question of death from starvation may be
raised in a case of infanticide by omission. Although rare as an act
of homicide, it must be remembered that the law does not require the
absolute deprivation of food to be proved, but only that the necessary
quantity and quality of food has been withheld; but malice at the same
time must be proved. In cases of infanticide by starvation, the mother
and not the father is responsible for the proper feeding of the child;
but in the case of an apprentice, the master and not his wife is bound
to supply proper food to such apprentice.
In questions of survivorship, and in criminal cases, the medical
witness may be asked how long a person may survive after complete
withdrawal of food. Little is known as to the length of time required
to cause death by starvation, but it is certain that life may be
prolonged for some time without food, if water be allowed. Starvation
is less rapid in its effects if the body be kept warm. In a case
recorded in the _Lancet_, a man who had been shut up in a coal-mine
for twenty-three days, with only a little dirty water to drink, lived
three days after his liberation, and then died of exhaustion. In adults
the average is from seven to ten days without water. Tidy (_Legal
Medicine_, vol. i. p. 392) is of the opinion that the young die first,
then adults, and the aged last. Taking into account the enfeebled
vitality of the aged, it is more probable that the young or middle-aged
adult would survive the longest. Where water is freely obtainable, life
may be prolonged to the fifty-eighth day (_Foderé_, vol. ii. p. 276) or
even more.
Apart from age, account must be taken of the condition of the person in
reference to bodily health prior to the withdrawal of food.
The following tables, showing the average weight and height of
children up to twelve years of age, are from the Report of the British
Anthropometric Committee (1883):
Male Children
+------------+-----------+
| Age. | Weight in |
| | Pounds. |
+------------+-----------+
| At birth | 6.8 |
| One month | 7.4 |
| Two months | 8.4 |
| Three “ | 9.6 |
| Four “ | 10.8 |
| Five “ | 11.8 |
| Six “ | 12.4 |
| Seven “ | 13.4 |
| Eight “ | 14.4 |
| Nine “ | 15.8 |
| Ten “ | 16.8 |
| Eleven “ | 17.8 |
| Twelve “ | 18.8 |
+------------+-----------+
+------------+-------------------+-------------------+
| | Height in Inches. | Weight in Pounds. |
| Age. +----------+--------+---------+---------+
| | Female. | Male. | Female. | Male. |
+------------+----------+--------+---------+---------+
| One year | 27.5 | 33.50 | .... | 18.8 |
| Two years | 32.33 | 33.70 | 25.3 | 32.5 |
| Three “ | 36.23 | 36.82 | 31.6 | 34.0 |
| Four “ | 38.26 | 38.46 | 36.1 | 37.3 |
| Five “ | 40.55 | 41.03 | 39.2 | 39.9 |
| Six “ | 42.88 | 44.00 | 41.7 | 44.4 |
| Seven “ | 44.45 | 45.97 | 47.5 | 49.7 |
| Eight “ | 46.60 | 47.05 | 52.1 | 54.9 |
| Nine “ | 48.73 | 49.70 | 55.5 | 60.4 |
| Ten “ | 51.05 | 51.84 | 62.0 | 67.5 |
| Eleven “ | 53.10 | 53.50 | 68.1 | 72.0 |
| Twelve “ | 55.66 | 54.59 | 76.4 | 76.7 |
+------------+----------+--------+---------+---------+
Table of Ages, Heights, and Weights of Males and Females
from 13 to 30-35 Years of Age
+---------------+------------------------+-----------------------+
| | Males. | Females. |
| +------------+-----------+-----------+-----------+
| Years of Age. | Height in | Weight in | Height in | Weight in |
| | Inches. | Pounds. | Inches. | Pounds. |
+---------------+------------+-----------+-----------+-----------+
| 13 | 56.91 | 82.6 | 57.77 | 87.2 |
| 14 | 59.33 | 92.0 | 59.80 | 96.7 |
| 15 | 62.24 | 102.7 | 60.93 | 106.3 |
| 16 | 64.31 | 119.0 | 61.75 | 113.1 |
| 17 | 66.24 | 130.9 | 62.52 | 115.5 |
| 18 | 66.96 | 137.4 | 62.44 | 121.1 |
| 19 | 67.29 | 139.6 | 62.75 | 123.8 |
| 20 | 67.52 | 143.3 | 62.98 | 123.4 |
| 21 | 67.63 | 145.2 | 63.03 | 121.8 |
| 22 | 67.68 | 146.9 | 62.87 | 123.4 |
| 23 | 67.48 | 147.8 | 63.01 | 124.1 |
| 24 | 67.73 | 148.0 | 62.70 | 120.8 |
| 25-30 | 67.80 | 152.3 | 62.02 | 120.0 |
| 30-35 | 68.00 | 159.8 | 61.15 | 120.8 |
+---------------+------------+-----------+-----------+-----------+
Recapitulation of the Post-mortem Appearances of Death by Starvation
1. _In the Body generally._--Marked general emaciation of the body.
The skin is dry and shrivelled, sometimes more or less covered with
unhealthy-looking pimples, the muscles soft, reduced in size, and free
from fat. A peculiar fœtid acrid odour is given off from the body.
2. _In the Solid Viscera of the Thorax and Abdomen._--The liver is
small, the gall-bladder distended with bile, and the heart and kidneys
deprived of any surrounding fat. All the internal organs are shrivelled
and bloodless.
3. _In the Stomach and Intestines._--The stomach in some cases is quite
healthy, but more or less stained with bile; in others it is found
collapsed, contracted, empty, and the mucous membrane more or less
ulcerated. The intestines are thin, contracted, empty, and so shrunken
that the canal is almost obliterated. According to the late Dr. Duncan,
the intestines are frequently found inflamed and ulcerated.
DEATH FROM COLD
This form of death is rare in England, but is more common in countries
where the winters are severe. Anything that depresses the vital powers
renders the individual more or less susceptible to cold; such, for
instance, as drunkenness, previous illness, or deficiency in the amount
of food. The following _post-mortem_ appearances are given by Ogston,
who holds that they point, in the absence of any other obvious cause of
death, “if not with absolute certainty, yet with high probability,” to
death caused by cold:
1. An arterial hue of the blood generally, except when
viewed in mass within the heart; the presence of this
coloration not having been noted in two instances.
2. An unusual accumulation of blood, as in Quelmalz and
Cappel‘s cases, on both sides of the heart, and in the
larger blood-vessels of the chest, arterial and venous.
3. Pallor of the general surface of the body, and anæmia of
the viscera most largely supplied with blood. The only
exceptions to this were moderate congestion of the brain
in three cases, and of the liver in seven of them.
4. Irregular and diffused dusky-red patches--“frost
erythems”--on limited portions of the exterior of the
bodies, encountered in non-dependent parts, these
patches contrasting forcibly with the pallor of the skin
and general surface.
These signs are not so well marked in children as in adults. The late
Sir Benjamin Brodie considered that the effect of cold is to destroy
the principle of vitality equally in every part, and that it does not
exclusively disturb the functions of any particular organ. The fact of
a body being found frozen is no proof that death has been brought about
by cold.
Symptoms.--Exposure to severe cold produces loss of energy, lethargy,
followed by drowsiness, with an intense desire to sleep, which, if
gratified, passes on to stupor and coma. There may be delusions before
the coma. The primary cause of death is attributed to the lessened
dissociation of oxygen from the hæmoglobin to the tissues, and a
lessened power of the latter to utilise it.
=Diagnosis.=--The general appearance of the deceased, and the absence
of any other cause of death, together with the appearances just
mentioned, will assist in forming an opinion on this difficult subject.
The body lies as if in a deep and calm, sleep, without any external
appearance to guide us as to the cause of death, except perhaps a
swelling of the extremities, which has come on prior to death. If a
body be found buried in snow, and putrefaction present, death did not
in all probability take place from cold, provided that the cold has
been severe and continuous. Death from cold is generally accidental,
except in newly-born children, when it may be either accidental or
homicidal, according to circumstances.
When freezing of the body has taken place prior to the onset of _rigor
mortis_, the latter comes on after the body thaws. This, combined with
the other _post-mortem_ signs given above, affords evidence of the
strong probability that death had resulted from exposure to cold. In
view of the red colour of the skin being similar to that caused by
poisoning with CO, a spectroscopic examination of the blood should be
made.
DEATH FROM EXPOSURE TO HEAT
The results from exposure to excessive heat manifest themselves in
various ways. Any condition which may lessen the resistance of the
body to external heat predisposes to heat-stroke; such as privation,
fatigue, mental emotions, alcohol, over-eating, and especially previous
attacks of the disease.
=Sunstroke= occurs in those who work under the direct rays of the sun,
when the air is hot, still, and humid.
=Heat-stroke= or thermic fever affects those working in places which
are excessively hot and confined, as in glass-works, foundries,
stoke-holds, boiler-houses, sugar-refineries, paper-mills, &c.
=Heat exhaustion= and prostration are brought about in a similar
manner, but the effects are not the same, and usually transient and
less severe.
Sunstroke or heat-stroke may occur in two forms, the _asphyxial_ or
_apoplectic_, and the _hyperpyrexial_; it is also classified as sthenic
or asphyxial, and asthenic or syncopal.
_Asphyxial_ sunstroke or _heat apoplexy_ is probably the least
frequent; prodromal symptoms are headache, vertigo, disturbances of
vision, dyspnœa, and dry skin. In some cases sudden unconsciousness,
with or without convulsions, may occur, and death rapidly follows.
The coma may not be profound; there may be nausea and vomiting of dark
material, bounding pulse, stertorous breathing, contracted pupils, and
frequent micturition. The body exhales a “mousey odour.” There may be
involuntary dejection, with the same pungent odour, and very watery.
Delirium is present in some cases. The temperature may be subnormal,
or rise to 102° F., occasionally even to 106° F. When fatal, the coma
deepens, the pulse becomes rapid and feeble, and there is Cheyne-Stokes
respiration.
In _Hyperpyrexial_ cases the symptoms are similar to the asphyxial, but
the temperature may reach 110-115° F., and in profound coma death takes
place from asphyxia. A subconscious or automatic state, in which the
person may go on working, may precede the “stroke.”
In cases which are not so rapid, pneumonia, meningitis, cardiac and
respiratory paralysis may occur and prove fatal.
_Heat exhaustion_ may be more gradual in its onset, or come on
suddenly. Prodromal dizziness, faintness, nausea, headache, drowsiness,
epigastric and lumbar pains may precede the prostration and muscular
weakness. Fever supervenes, a rapid pulse, and in severe cases
collapse. Consciousness is seldom completely lost, and in favourable
cases is quickly regained. When there is marked prostration the heart
may fail.
The condition known as _heat prostration_ is a milder form, in which
there is little or no fever, and the circulation remains good.
After suffering from an attack of heat-stroke certain sequelæ have
been noted. The patients are rendered sensitive to slight elevations
of temperature, and, during warm weather, experience chromatopsia,
headaches, irritability, irascibility, and even delirium. Epilepsy
and insanity may persist during life. Fiske from his investigations
concludes that the habits of those working in hot atmospheres, and the
degree of temperature, are not nearly so important as the absence of
thorough ventilation as causative factors in the disease.
=Post-mortem Appearances.=--_Rigor mortis_ comes on early, and is
pronounced and disappears quickly. Putrefaction is early in onset. The
brain and cord, the lungs and spleen and splanchnic area exhibit venous
engorgement.
The blood is fluid, and the red corpuscles crenated. Extravasations of
blood may be present in the skin, the serous membranes, and cavities,
the superior sympathetic ganglia, and the vagi and phrenics. The left
ventricle is markedly contracted, the right dilated and filled with
blood.
Van Gieson records acute parenchymatous degeneration of the whole of
the cerebro-spinal nervous system, with chromatolysis of the cells.
Parenchymatous changes may be present in the liver and kidneys.
DEATH BY LIGHTNING AND ELECTRICITY
LIGHTNING
Death is not always immediate. Sometimes the clothes have been torn
off the body with scarcely any personal injury. _Metallic articles,
especially steel, worn or carried about the person become magnetic_ and
may be fused. The lesions which may be met with after lightning-stroke
are varied, and may comprise wounds of almost any description;
simple, compound, or comminuted fractures of bones; burns in the form
of streaks, patches, lines, or arborescent markings; ecchymoses;
singeing of the hair; impressions of metallic articles on the skin.
Apart from the lesions noted above, the following symptoms may be
present: deafness, blindness, paralysis, loss of memory, delirium,
and convulsions. Not infrequently those killed by lightning are found
in the same position that they occupied during life. The question may
arise as to whether the deceased died by lightning or violence. The
presence of a storm at the time when death is stated to have occurred,
and other attendant circumstances, will in most cases point to the true
cause of death. Metallic articles should be examined with regard to
their electric state. Dr. Honiball tenders this caution: “Be not too
sure that in every body found dead after a thunderstorm, and where no
marks upon it are found, that death was due to lightning-stroke, for it
may happen that death was due solely to cardiac syncope owing to sudden
and startling fright.”
=Post-mortem Appearances.=--Apart from the external injuries, when
present, _post-mortem_ rigidity comes on early. The head and neck
may be purplish in colour, the eyes partially open and suffused,
with variable pupils. The internal signs are not characteristic. The
membranes and vessels of the brain may be hyperæmic. The blood has been
said to be very fluid, but it may be coagulated. The internal organs
may be torn, bones may be fractured, and blood-vessels ruptured.
Industrial Electricity
With the increased use of electricity for motive power and illumination
instances of injury and even death have occurred, and probably will
become more frequent. One of the most important safeguards of the body
against the effects of electricity is its high degree of resistance,
especially if the body surface be dry. Moisture of the body surface
lessens the resistance and increases the liability to injurious effects.
The body is a bad conductor; it is said to be three million times less
than mercury, and fifteen million times less than copper; the nerves
conduct like metals. The danger of electric shocks depends upon the
amount of current passing through the body, the kind of contact, and
the insulation of the body at the time. Moisture of the body or clothes
will increase the effects of the shock. Much depends upon the quality,
duration, strength, and density of the current, and the direction in
which it passes.
The continuous current is less severe than the interrupted, and the
alternating is the most powerful in its effects. An alternating current
of 300 volts has caused death, and one of 1500 volts would certainly
prove fatal, whereas for the continuous current it would take 3000
volts to prove fatal.[13] Cases are recorded when with good contact
even so low as 65 volts has proved fatal. The Board of Trade forbids
the introduction into dwelling-houses of currents of more than 250
volts, unless for special purposes and with special permission.
[13] Cunningham, _New York Med. Journ._, 1890, p. 287.
As the current enters or leaves the body it may cause local injury.
Tetanic muscular contractions with pain, and pain from stimulation of
nerve endings in the skin with erythema may occur. Burns produced by
electricity may be accompanied by much local destruction of tissue and
slow healing.
There may be ascending neuritis from injury to nerves.
The shock may cause insensibility with pallor and stertorous breathing;
the skin is moist, the eyes suffused, and the pupils dilated.
Death is due to (1) inhibition of the medulla oblongata, or (2) direct
action on the heart muscle. According to the researches of Cunningham,
currents which traverse the whole body transversely or longitudinally
produce fibrillary contraction of the heart muscle. When the current
passes through the brain, medulla, and upper cord it may cause death
by respiratory paralysis. Those who have recovered from severe shock
describe the sensation as peculiar rather than painful.
_Post-mortem Appearances._--These include the local injury, if any,
at the point or points of contact, some hyperæmia of the internal
organs, œdema of the lungs, and fluidity of the blood. The general
appearances are those of asphyxia. Kratter considers that external
burns in association with subpericardial and subpleural ecchymoses, and
especially subendocardial petechiæ, also the presence of congestion of
the bronchi, strongly indicate death from electricity.
Minute hæmorrhages may occur in the meninges, and in the fourth and
other ventricles. Changes have also been described in the cells of the
central nervous system in experiments upon animals.
_Treatment._--The current should be switched off at once; the patient
should be removed from the conductor, the rescuer being protected with
some insulating material, the attempt should not be made bare-handed.
Stimulation, warmth, and artificial respiration should be resorted
to. After respiration has been re-established, friction should be
applied to the body. The treatment should be persevered in for several
hours. Signs of life may not be seen for two hours. Venesection may be
desirable.
CHAPTER XI
OFFENCES AGAINST CHASTITY
RAPE
According to the Statute 24 and 25 Vict. c. 100, sec. 48, rape in
England is defined as the “carnal knowledge of a woman against her
will.” In Scotland rape is held to be “the carnal knowledge of a woman
forcibly, and against her will, or of a girl below twelve years of age,
whether by force or not” (Hume, i. 303). An Act passed in 1885 (48 and
49 Vict. c. 69) has materially affected the law on this subject as
regards the age of females. To constitute the offence of rape, there
must be _penetration_, but proof of the actual emission of semen is
not now necessary. Before the Statute 9 Geo. IV. c. 31, sec. 18, it
was also necessary to prove emission, which might be proved either
positively by the evidence of the woman that she felt it, or it might
be presumed from circumstances; as, for instance, that the defendant,
after connection with the prosecutrix, arose from her voluntarily
without being interrupted in the act. The slightest penetration of the
male organ within the vulva will be sufficient, and the hymen need not
be ruptured (R. _v._ Russen, 1 East P.C. 438, 439). The resistance of
the woman must be to the utmost of her power. If, however, the woman
yield through fear or duress, it is still rape; but of course much
will depend upon the previous character of the woman, and her conduct
subsequent to the alleged outrage. The party ravished is a competent
witness to prove this and every other part of the case; but the
credibility of her testimony must be left to the jury. The defendant
may produce evidence of the woman‘s notoriously bad character for want
of chastity or common decency, or that she had before been connected
with the prisoner himself; but he cannot give evidence of any other
particular facts to impeach her chastity (R. _v._ Hodgson, R. & R.
211). She may be asked if she has had connection with other men, but
she need not answer (R. _v._ Cockcroft, 11 Cox, 410, per Willis, J.).
If she deny connection with the men named to her, they cannot be called
to contradict her (R. _v._ Holmes, L.R. 1 C.C.R. 334).
A rape, according to Scottish law, may be committed on a common
strumpet; and in England the law goes even further, and admits the
possibility of rape on the concubine of the ravisher (1 Hale, 729),
“although such circumstances should certainly operate strongly with
the jury as to the probability of the fact that connection was had
with a woman against her will.” A husband may be guilty of rape on his
wife if he hold her while another violates her, as in the case of the
Earl of Castlehaven, tried in 1637. Carnal knowledge of a woman by
fraud, which induces her to suppose it is her husband, now constitutes
a rape by the 48 and 49 Vict c. 69, which enacts that “whereas doubts
have been entertained whether a man who induces a married woman to
permit him to have connection with her by personating her husband, is
or is not guilty of rape, it is hereby enacted and declared that every
such offender shall be deemed to be guilty of rape.” It has also been
decided that if a man get into bed with a woman while she is asleep,
and he know she is asleep, and he have connection with her while in
that state, he is guilty of rape (R. _v._ Mayers, 12 Cox, 311, per
Lush, J.). The offence of rape is not triable at quarter sessions.
Upon an indictment for rape, there must be some evidence that the act
was without the consent of the woman, even when she is an idiot. In
such a case, where there was no appearance of force having been used to
the woman, and the only evidence of the connection was the prisoner‘s
own admission, coupled with the statement that it was done with her
consent, the Court held that there was no evidence for the jury (R.
_v._ Fletcher, L.R. 1 C.C.R. 39).
In another case, where the prisoner was caught in the act by the father
of an idiot girl, the learned judge told the jury that if the prisoner
had connection with the prosecutrix by force, and if she was in such
an idiotic state that she did not know what the prisoner was doing,
and if the prisoner was aware of her being in that state, they might
find him guilty of rape; but if, from animal instinct, she yielded to
the prisoner without resistance, or if the prisoner, from her state
and condition, had reason to believe she was consenting, they ought to
acquit him. The jury found that he was guilty of an attempt at rape (R.
_v._ Barrat, L.R. 2 C.C. 81).
Where the prosecutrix, an apparent idiot, proved that the prisoner had
had connection with her, but it appeared from her examination that
though she knew he was doing wrong, she made no resistance, and the
prisoner, on being apprehended and charged with committing a rape upon
the prosecutrix “against her will,” said “Yes, I did, and I‘m very
sorry for it,” it was held that there was evidence to go to the jury of
a rape (R. _v._ Pressy, 10 Cox, 635).
In Scotland, in the case of Hugh M‘Namara (H.C. July 24, 1848, Ark.
521), where the woman was only one degree removed from idiocy, it was
laid down that “if she had shown any physical resistance, to however
small an extent, the offence would be complete, in consequence of her
inability to give a mental consent.”
In future cases the above decisions will probably be set aside in the
light of the present enactment.
In the case also of a quack doctor, who, under the pretext of
performing a surgical operation on a young girl of nineteen years of
age, had connection with her, she at the time resisting, but believing
that she was undergoing an operation, it was held, on appeal, that he
was guilty of the crime of rape, and the former conviction confirmed
(R. _v._ Hattery, C.C.).
In England, and in Ireland, and also in Scotland, unlawfully and
carnally knowing a girl under thirteen years of age constitutes
a felony--the attempt in the former countries constitutes a
misdemeanour; in Scotland, a “crime and offence.” The child may be a
witness if she understands the nature of an oath or understands the
duty of speaking the truth, but her evidence must be corroborated
by some other material evidence in support thereof, implicating the
accused. The carnal knowledge of a girl above thirteen and under
sixteen, or of any female idiot or imbecile woman or girl, under
circumstances which do not amount to rape, but which prove that the
offender knew at the time of the commission of the offence that the
woman or girl was an idiot or imbecile, constitutes a misdemeanour.
Above sixteen consent does away with the crime; and it shall be a
sufficient defence for the accused to show that he had reasonable cause
to believe that the girl was of or above the age of sixteen years. This
defence does not apply to female idiots or imbeciles.
A boy under the age of fourteen was formerly in England presumed by law
incapable of committing a rape (R. _v._ Groombridge, 7 C. & P. 582);
but in Scotland there was no such provision, and a boy thirteen and a
half years of age was committed for rape (Rob. Fulton, jun., Ayr, Sept.
20, 1841).
The recent Act before quoted provides that, instead of imprisonment,
the offender, if _under_ sixteen, may be whipped and sent to a
reformatory school for not less than two or more than five years.
Evidently age cannot now be pleaded as an incapability.
The crime of rape appears to be most frequently perpetrated against
children, probably due to the popular idea that an attack of gonorrhœa
may be cured by connection being had with a virgin or healthy female.
The following Table from Casper gives the result of his examination of
one hundred and thirty-six cases of rape:
From 2½(!) to 12 years old 99
“ 12 “ 14 “ 20
“ 15 “ 18 “ 8
“ 19 “ 25 “ 7
47 “ 1
68 “ 1
---
136
In examination of a case of alleged rape, several points of interest
will have to be considered, which, for the sake of convenience, will be
placed in a tabular form:
1. _An examination of the parts of generation._
(_a_) Inflammatory redness and abrasion of the parts.
(_b_) A muco-purulent secretion.
(_c_) Hæmorrhage or dried blood about the genital organs.
(_d_) Destruction of the hymen.
(_e_) Dilatation of the vagina.
(_f_) General signs of rape.
2. _An examination of the body and limbs of the female._
3. _Examination of the linen worn by the female and the male for_
(_a_) Marks of semen.
(_b_) Marks of blood.
(_c_) Marks of other discharges, gonorrhœa, &c.
1. =An Examination of the Parts of Generation.=
(_a_) More or less inflammatory _redness_ and _abrasion_ of the mucous
membrane lining the parts, which is never absent in children, and
may last for some weeks. “In adults, virgins up to the time of the
commission of the crime, this appearance is either not found at all or
only faint traces of it. In those previously deflowered it is never
observed.” In the case of young children the genitals may be so injured
as to cause death in a few hours. The parts may therefore present all
varieties of injury, from slight bruising and redness to the most
fearful lacerations.
_Caution._--Inflammatory irritation due to catarrh
_may_ occur, and be apt to mislead.
(_b_) A _muco-purulent secretion_, from the mucous membrane lining the
vagina, of a greenish-yellow colour, more or less viscid, and soiling
the linen of the girl. This secretion, in colour and consistence,
cannot be distinguished from that the result of gonorrhœa. The usual
period of incubation of gonorrhœa is from three to eight days; among
young girls, however, this period may be shortened. The incubatory
stage of soft chancre is from three to five days (Diday); that of
hard chancre somewhat longer, varying from fifteen to twenty days.
Enlargement of the inguinal glands and the persistence of the discharge
after the use of simple treatment will tend greatly to confirm the
suspicion of venereal disease. The genital organs of the male may have
to be examined as to the presence of gonorrhœa or syphilis. Syringing
the urethra may remove for a time the gonorrhœal discharge; care must
therefore be taken in forming an opinion.
_Caution._--Unhealthy children, and those recovering
from some debilitating diseases--fever, &c.,--may suffer
from purulent discharges from the vagina. Small ulcers
may also be present, and may be mistaken for syphilitic
ulceration Infantile leucorrhœa is not uncommon.
(Percival‘s _Medical Ethics_.)
(_c_) _Hæmorrhage or Dried Blood about the Genital Organs._--(1)
Frequently absent in young children. (2) Always found in adults,
virgins at the time the rape was committed, when the vessels of the
hymen are ruptured.
(_d_) _Destruction of the Hymen._--Most frequently, and especially in
young girls, one or more _lacerations_ of the hymen may be seen. These
lacerations must be looked for within five or six days of the alleged
rape, as they soon heal up, and then no certain opinion can be given
as to the date of their infliction. They may also be produced by any
foreign body to substantiate a charge of rape.
(_e_) _Dilatation of the Vagina._--This condition may be produced by
the passage of hard bodies in order to substantiate a false charge of
rape. Casper once examined a girl, only ten years of age, whose mother
had gradually dilated her vagina with her fingers, in order to fit her
for sexual intercourse with men.
(_f_) _General Signs of Rape._--To the above are added certain general
signs, as a _difficulty in walking_, attended with an involuntary
separation of the thighs, common to both children and adults; _pain is
also not infrequently present in passing water_, and when _the bowels
are relieved_. In determining the truthfulness of the statements made
as to an alleged rape, the character of the woman, and the obvious
inconsistencies of her statements must be taken into consideration.
Moreover, if, in addition to the injuries found on the external
genitals, spermatozoa be detected in the vagina, a presumption in
favour of the injuries being due to sexual intercourse will be clearly
made out, but the presence of spermatozoa in the vagina of a woman
is no evidence of rape. Care, however, must be taken not to confound
with spermatozoa an animalcule--_Trichomonas vaginæ_--described by M.
Donné as being sometimes found in the vaginal mucus. The head of the
animalcule is larger than that of a spermatozoon, and is surrounded by
a row of cilia.
[Illustration:
Fig. 19.--Hymen of child of four years--annular type. The illustration
also shows the prominence of the urinary portion of the genitals.
(Glaister.)]
In the case of young children, the anxiety on the part of the parents
of the child to push the charge, and the story of the child and
that of the parent heard apart, may assist in guiding the opinion.
The lesson-like way in which the child tells her story, even to the
minutest details, is always suspicious. The proof of a previous
defloration negatives the pretended loss of virginity at the time of
the commission of the deed for which the accused is being tried. In
most cases, it is best to let the patient tell her own tale, and then
cross-examine. An injudicious question may put her on her guard.
=2. Examination of the Limbs and Body of the Female for Bruises,
&c.=--Little value is to be placed on injuries said to be inflicted
on the person of a female the result of a struggle, as these may be
produced by the woman on herself in order to substantiate her story. In
children, for obvious reasons, they do not occur.
[Illustration: Fig. 20.--Virgin hymen, with central slit.
(Glaister.)]
=3. Examination of the Linen.=--In all cases a careful examination
of the body linen of both parties should be made. With regard to the
position of the stains on the chemise of the woman, M. Devergie insists
that the stains on the front of the chemise are seminal, those on the
back are due to blood. This distinction is too arbitrary to meet all
the facts of these cases, for the position of the spots necessarily
depends on the respective positions of the parties at the moment of
ejaculation; and, moreover, the woman is more likely to wipe the parts
with the front than the back of her chemise. Mistakes may arise from--
1. The garments being intentionally soiled with blood. This is not
infrequently done in cases of false accusations.
2. The menstrual discharge may be readily mistaken for that due to
violence, as the two kinds of blood cannot be distinguished.
3. The red juice of fruits and grease spots have been mistaken for
marks of blood and seminal stains on linen.
The identification of blood-stains is not difficult when the stain
occurs on pieces of white linen; but when, as it not infrequently
happens, they have to be detected on the coarse, dirty, often stinking
linen of the poor, the task becomes somewhat more difficult. The same
may be said with regard to seminal spots. As a means of diagnosis in
stains due to semen, the appearance and smell of the stains are of no
assistance whatever. The microscope will alone give any trustworthy
evidence as to the nature of the stain; and even here a caution must be
added--for the fact is beyond doubt that the semen even of a healthy
young man varies much, and is scarcely ever twice alike, so that the
absence of spermatozoa is no proof that the spot is not seminal in its
origin.
The following are the tests used for the detection of semen:
1. _Characteristic smell when the spot is
moistened._--This test is of no use, for the reasons
before stated.
2. _Appearance when held to the light._--As uncertain
as the preceding.
3. _Doubtful spots upon cotton or linen_--not upon
_wool_, which usually contains sulphur--should be
cut out and moistened with a few drops of oxide of lead,
dissolved in liquor potassæ, and then dried at a temperature
of 68° F. The stain in a few minutes becomes of a dirty
yellow or sulphur-yellow colour. This change in colour
proves that the mark _is not_ a seminal stain. Semen
does not contain albumen. This test only shows that the
stain is not caused by albuminous compounds, which contain
sulphur; but it does not follow therefore that the spot must
be seminal, for marks made by gum, dextrine, and some other
substances of a like nature are not changed in colour.
4. _The Microscope._--This is by far the most reliable
test, but care is required in its manipulation.
(_a_) The cloth must not be rubbed between the fingers,
as the spermatozoa may be damaged by the operation.
(_b_) The suspicious spot on the linen should be
carefully cut out and placed in a clean watch-glass or small
porcelain vessel, and then moistened with a small quantity
of distilled water. The cloth may be gently moved about in
the water with a glass rod, and gentle pressure made so as
to thoroughly wet the cloth, which, in most cases, will be
accomplished in about a quarter of an hour. A single drop
should now, by gentle pressure with the fingers, be squeezed
on to a clean slide, and then placed under the microscope.
(_c_) Another method may be adopted. First determine
the side of the cloth on which the stain is present, and
cut out the stain, leaving a small strip of cloth attached
to the main portion. Place the end of the strip in a little
water in a watch-glass, so that the water by capillary
attraction may permeate the entire stain. With a thin-bladed
knife gently remove the moistened stain and place it on a
microscopic slide, and examine as before.
_Fixing and Staining._--A drop of the watery extract of
the stain may be placed on a microscope slide and allowed to
dry in the air, covered to protect it from dust, and then
fixed by heating the slide over a spirit or Bunsen flame or
by the use of absolute alcohol. When fixed, the preparation
can be stained with eosin and methylene blue, methylene
violet, or other nuclear dye. The film may also be fixed and
stained with Leishman‘s solution in one procedure, or fixed
by heat first and then stained with Leishman. The procedure
is the same as for blood, viz. to cover the film with a
few drops of Leishman‘s stain, let stand for two or three
minutes, then add a few drops of distilled water, in two
or three minutes wash in distilled water, dry with filter
paper, and examine with the oil immersion. The preparation
may be mounted in Canada balsam and preserved for further
reference. The head of the spermatazoon takes the nuclear
dyes in ordinary use. The spermatazoa are best found in
the centre of the stain. If the stain be small the watery
extract may be centrifuged.
_Florence‘s Reaction._--A useful chemical reaction has
been introduced by Dr. Florence of Lyons. It depends upon
the reaction between a concentrated solution of iodine in
potassium iodide and human semen. A watery extract of the
stain is made, and a drop placed on a microscope slide, by
Potassium iodide 1.65 grms.
Iodine 2.54 “
Distilled water 30 c.c.
The drops are covered with a cover glass and examined; where
the two drops unite, a precipitate is formed which consists
of brown crystals, very similar to hæmin crystals. If there
be sufficient material the precipitate may be obtained
in a test tube. This test is extremely delicate, and is
analogous in value to the guaiacum reaction for blood. A
positive reaction does not absolutely prove that the stain
is seminal, but a negative reaction proves that it is not.
Dr. Florence holds the reaction is specific for human semen,
as he has failed to obtain it with the seminal fluid of any
other animal, or other fluids or tissues. He considers it
due to the presence of an alkaloidal body in human semen,
which he calls virispermin.
The crystals are said by Dr. Max Richter to form on the
addition of the iodine solution to decomposition products of
lecithin.
The author has found this reaction extremely delicate, even
with minute traces. The crystals form rapidly and are easily
recognisable. They, however, are evanescent and disappear on
standing, so that they cannot be preserved as microscopic
specimens.
_The biological test._--This is carried out in the same
way as the biological test for blood. Dr. C. G. Farnum, who
proposed this test, uses semen or testicular emulsion for
antigen, injecting 5 to 10 c.c. into the peritoneal cavity
of a rabbit at intervals of from two to six days, on five
or eight occasions. The antiserum is diluted from twelve
to eighteen times with normal saline, and the semen four
to twenty-five times. Human antiserum gives a precipitin
reaction with the watery extract of human seminal stain, but
not with testicular emulsions of the bull, dog, or goat, or
with human blood serum.[14]
[14] _Journ. Amer. Med. Assoc._, 1901, p. 1721.
=Can a Rape be committed by one man on a healthy, vigorous woman?=--The
answer to the question will, to a great extent, depend on the relative
strength of the conflicting parties. Every case of rape has to be
judged on its own merits. In any case, the medical jurist has simply
to state, from the examination of the parties, that sexual intercourse
has taken place, leaving the jury to decide whether a rape or not has
been perpetrated. A case is mentioned by Casper where a healthy, strong
adult of twenty-five years old was violated by a single man.
=Can a Woman be Violated during Sleep?=--By this is intended natural
healthy sleep, and not that induced by narcotics. In natural sleep,
rape is scarcely possible in a virgin, especially if the hymen be found
recently ruptured, though it _may_ be possible in a woman accustomed to
sexual intercourse.
[Illustration: Fig. 21.--Photo-micrograph of human spermatozoa, × 1000.
(R. J. M. Buchanan.)]
=Can a Woman become Pregnant by an act of Rape?=--The answer to this
question is most decidedly in the affirmative. It is not necessary for
a woman to experience any sexual pleasure during connection in order
that she may conceive. A woman may become pregnant if fresh semen be
injected into the vagina with a glass syringe.
=Signs of Rape in the Dead.=--In the case of a woman found dead, the
question may arise as to her having been violated prior to death.
The reply to the question is by no means easy. Severe injury to the
genitals is a presumption in favour of rape, but cases are by no means
rare in which men failing to accomplish coïtus have injured the parts
with their fingers. The presence of spermatozoa in the vaginal mucus is
good evidence of a recent coïtus, but is no direct evidence of a rape.
Collateral evidence will in most cases decide the point.
Physical Signs of Rape in Adult and in Child
----------------------------------+----------------------------------
In the Adult. | In the Child.
----------------------------------+----------------------------------
1. If examined soon after the | 1. There may not be sufficient
commission of the offence, the | penetration to rupture the hymen,
hymen of the adult virgin may | consequently there will be
be ruptured, and the fourchette | no hæmorrhage. In other cases
may be lacerated, and the parts | the external organs will be
covered with blood. | bruised, and in many cases
| severely lacerated, the
| lacerations depending on the
| amount of penetration and force
| used.
|
2. Difficulty in walking, in | 2. Same as in the adult, but
passing water, and sometimes | lasting for a longer time--from
when the bowels are relieved. | eight to fourteen days.
These signs in the adult pass |
off in a day or two. |
|
3. Injuries on the person abused,| 3. For obvious reasons these
such as scratches and ecchymoses,| do not occur on children.
may be present as the result of a|
struggle. These may be |
self-inflicted. |
----------------------------------+----------------------------------
Directions as to manner of making a Medico-Legal Examination in a Case
of Alleged Rape.
1. Be careful to note everything, for it is in such cases as the one
under discussion where apparently unimportant signs may become of the
greatest moment.
2. Give the female no time for preparation, but make your visit, and
at once proceed to an examination. The visit to be of any practical
service should not be delayed beyond the third or fourth day after the
alleged offence, “by which time the lacerations will have healed, the
cicatrices disappeared, and the torn hymen be in such a state as to
make it difficult to say whether it had been divided recently or at
an earlier period.” But remember that you _are not justified in using
force_; and in this, as in cases of suspected pregnancy, if you examine
a woman against her will you render yourself liable for an action for
assault, and may have to pay heavily for your enthusiasm.
(_a_) Note time of a visit.
(_b_) Note time of alleged offence. _Why?_ May
prove the accused party innocent by an _alibi_.
(_c_) Avoid leading questions.
3. Age, strength, and condition of the health of the complainant.
Examine the wounds asserted to have been inflicted, and see if they
correspond with the history given of their infliction.
4. Examine organs of generation.
(_a_) Any recent signs of violence--blood, abrasions,
ulcerations, &c.
(_b_) Condition of hymen, and of the _carunculæ
myrtiformes_.
(_c_) Was the woman menstruating at the time? Signs
modified or obliterated by menstruation.
5. Preserve any spots on linen, &c., for future examination.
6. In case of death after violence--
(_a_) Examine mouth for foreign bodies, &c.
(_b_) Fractures or bruises on the body.
7. Examine spot where the crime is stated to have taken place.
8. Examine person of the accused.
(_a_) Muscular development and strength.
(_b_) Any abrasion about the penis, size of penis,
rupture of the frænum, &c.
(_c_) On linen, blood-stains, seminal spots, &c.
(_d_) Marks on his body, scratches, &c., as evidence
of resistance.
_N.B._--The lapse of a few days may be sufficient to
remove all traces of the violence done to the parts; and
in most cases days, weeks, and even months may elapse
before an examination is made of the alleged victim.
VIRGINITY
[Illustration: Fig. 22.--Deflorated hymen, after parturition, in adult
woman.
(Glaister.)]
There is no one sign which may be considered as an absolute test for
virginity. The presence or absence of the hymen is of no probative
value one way or the other. Its very existence has been denied by Paré,
Buffon, and others. It may be absent as the result of disease, or as
the result of a surgical operation to allow of the free discharge of
the menstrual flow. Its presence is no bar to conception; and cases
are on record where it has been found necessary to incise it, to
allow of the passage of the fœtus into the world. In fact, women who
have been prostitutes for years have possessed to the last uninjured
hymens. The changes in the breasts which proceed from impregnation do
not occur where only defloration has taken place. The rugose condition
of the vagina is only affected by the first birth, and not by sexual
intercourse.
What has been said of the above signs as tests for virginity may be
said of a host of others which from time to time have, with varying
success, been advanced as aids to the diagnosis. Casper, however,
considers “that where a forensic physician FINDS A HYMEN STILL
PRESERVED, EVEN ITS EDGES NOT BEING TORN, AND ALONG WITH IT--in young
persons--A VIRGIN CONDITION OF THE BREASTS AND EXTERNAL GENITALS, HE
IS THEN JUSTIFIED IN GIVING A POSITIVE OPINION AS TO THE EXISTENCE OF
VIRGINITY, and _vice versa_.”
CHAPTER XII
PREGNANCY
It not infrequently happens that a medical man is called upon to make
an examination of a woman for legal purposes, in order to decide--(_a_)
The existence of an alleged pregnancy. (_b_) The possibility of a
previous pregnancy. (_c_) As to the existence of concealed pregnancy.
The following are some of the reasons why pregnancy may be feigned:
1. _By a married woman, to gratify the desire of her
husband for issue._
2. _To influence the jury in a case of breach of promise
of marriage as to the assessment of the damages._
3. _To extort money from a seducer or paramour._
4. _To produce a spurious heir to property._
5. _By a single or married woman, to stay the infliction
of capital punishment._
Pregnancy may be concealed--(_a_) In order to procure abortion. (_b_)
In order to commit infanticide. (_c_) In the married and the unmarried,
to avoid disgrace.
Besides the above, other important questions may arise with regard to
this state:
1. _Is pregnancy possible as the result of coïtus in a state of
unconsciousness?_--There appears no reason for doubting the possibility
of this occurrence.
2. _Can pregnancy occur before the appearance of the catamenia?_--That
pregnancy may occur before menstruation is undoubted; and it appears
probable that the changes in the ovaries and uterus may go on at
the regular monthly periods, and yet there may be no discharge of
blood from the uterus, which, as pointed out by Bischoff, is only a
symptomatic though usual occurrence. Hence, pregnancy is possible prior
to menstruation.
3. _What is the earliest and latest age at which pregnancy is
possible?_--In our climate (Britain), the earliest age at which
pregnancy may occur is about the eleventh or twelfth year; but the
youngest age at which this condition is reported to have occurred is
_nine_ years (Meyer). In hot climates--as in Bengal--mothers under
twelve years of age are by no means rare. Cohabitation in marriage
takes place much earlier in India than in Europe, but Chevers doubts
if menstruation naturally occurs much sooner there than elsewhere, and
Baboo Modusoodun Gupta believes that the catamenia appear sooner or
later, according to the mode of living of the females, and the sexual
excitement to which they may be subjected. Thomas mentions the case of
a girl who menstruated regularly from the age of twenty-one months, and
also of another at eight months. The limit to child-bearing appears
to be between the fiftieth and fifty-second years; but even here
considerable variation has been recorded, and women have been delivered
of children at the age of sixty. Haller even reports one at seventy. As
long as menstruation continues a woman may become pregnant; but even
the cessation of this flow for some months is no bar to conception.
4. _Is it possible for a woman to become pregnant eight weeks after
her last confinement?_--This is undoubtedly possible, but it is of rare
occurrence. It is also probable that a woman may abort at the end of
the time above mentioned. Husband knew a woman, who for several years
bore a child every ten months.
At _common law_, in cases of disputed inheritance, the following may
occur, and give rise to the necessity for medical evidence on the
subject: A woman who has just lost her husband may disappoint the
expectant heirs to an estate by alleging that she is pregnant.
At _criminal law_, pregnancy may be used as a stay to the infliction of
capital punishment.
In the first case, a jury of matrons is impanelled by a writ _de ventre
inspiciendo_, to decide the existence of pregnancy, and if the fact be
proved, to watch till such time as she be delivered.
In the second case, in England, the pregnancy must be proved, and also
whether she be _quick with child_. In Scotland the pregnancy must be
proved, but without reference to _quickening_, and the jury of matrons
is unknown in that country. In the same country, if it can be shown
that a woman is pregnant, and that her life or that of the child is
endangered by her imprisonment, she may be admitted to bail till after
delivery. A pregnant female also cannot be compelled to appear and give
evidence, if on competent authority it be shown that her delivery will
probably take place at the time fixed for the trial.
Signs of Pregnancy
The diagnosis of early pregnancy in ordinary cases is by no means easy,
especially before the third or fourth month of gestation; but to the
medical jurist it is still more difficult, as he has to deal with cases
where he can scarcely expect much candour. No opinion should, however,
be given without taking into consideration the collective value of the
signs, as no one sign will afford sufficient data on which to base an
opinion. The signs furnished by auscultation are the most reliable, but
the position of the fœtus may render the sounds of the fœtal heart and
placental souffle difficult to detect.
The following may be taken as among the most important signs of
pregnancy, given in the usual order of their occurrence:
Uncertain or Accessory Signs
1. Cessation of menstruation First month.
2. Morning sickness Second month.
3. Salivation Variable.
4. Mammary sympathies Third month.
5. Enlargement of the abdomen Fourth month.
6. Quickening Fourth month.
7. Kiesteine Variable.
8. Jacquemier‘s Test Third month.
Certain or Essential Signs
1. Ballottement Fourth month.
2. Uterine souffle Second month.
3. Pulsation of the fœtal heart Fourth month.
Uncertain Signs
1. _Cessation of Menstruation._--The non-appearance of the catamenia,
though a most valuable sign, is by no means a conclusive one, as
menstruation may be arrested by diseases of various kinds; while, on
the other hand, there are many well-recorded cases of women who have
menstruated regularly during the whole period of their pregnancy.
There have been also cases in which the menses only occurred during
pregnancy; and in a few still more curious cases, women who have never
menstruated have been known to have borne several children. In cases
of concealed pregnancy, the woman may smear her linen with blood to
imitate the menstrual flow.
2. _Morning Sickness._--Nausea, often ending in vomiting, generally
occurs soon after rising in the morning, and may commence almost
immediately, but more frequently not till the expiration of the fifth
or sixth week after conception. It is not a reliable sign, and is often
very irregular in its occurrence. When present, it varies in degree,
from a feeling of nausea to the most violent vomiting, very distressing
to the patient.
3. _Salivation._--The excessive secretion of the salivary glands,
due to the irritation caused by pregnancy, was first mentioned by
Hippocrates as a sign of this condition. “It is to be distinguished
from ptyalism induced by mercury, by the absence of sponginess and
soreness of the gums, and of the peculiar fœtor, and by the presence of
pregnancy.” It is oftener absent than present.
4. _Mammary Sympathies._--As the breasts may enlarge from various
causes--such, for instance, as the distension of the uterus from
hydatids, or, as is the case with some women at each menstrual period,
when the catamenia are suspended, or after they have ceased--this is
by no means a sign on which much reliance should be placed. The change
in the colour of the nipple and areola, more apparent in women of dark
complexions, is more to be relied on as a diagnostic sign of pregnancy.
The first observable alteration, which occurs about two months after
conception, is “a soft and moist state of the integument, which appears
raised, and in a state of turgescence, giving one the idea that, if
touched by the point of the finger, it would be found emphysematous.
This state appears, however, to be caused by infiltration of the
subjacent cellular tissue, which, together with its altered colour,
gives us the idea of a part in which there is going forward a greater
degree of vital action than is in operation around it; and we not
infrequently find that the little glandular follicles, or tubercles as
they are called by Morgagni, are bedewed with a secretion sufficient to
damp and colour the woman‘s dress.”
During the progress of the next two months, the changes in the areola
are in general perfected, or nearly so, and then it presents the
following characteristics: “A circle round the nipple, whose colour
varies in intensity according to the particular complexion of the
individual, being usually much darker in persons with black hair, dark
eyes, and sallow skin, than in those of fair hair, light-coloured
eyes, and delicate complexion. The extent of the circle varies in
diameter from an inch to an inch and a half, and increases in most
persons as pregnancy advances, as does also the depth of colour. In
the centre of the coloured circle, the nipple is observed partaking of
the altered colour of the part, and appearing turgid and prominent,
while the surface of the areola, especially that part which lies
more immediately around the base of the nipple, is studded over and
rendered unequal by the prominence of the glandicular follicles, which,
varying in number from twelve to twenty, project from the sixteenth to
the eighth of an inch; and, lastly, the integument covering the part
appears turgescent, softer, and more moist than that which surrounds
it; while on both there are to be observed at this period, especially
in women with dark hair and eyes, numerous round spots or small
mottled patches of a whitish colour, scattered over the outer part of
the areola, and for about an inch or more all around, presenting an
appearance as if the colour had been discharged by a shower of drops
falling on the part.” The value of the above changes in the nipple
and areola as a diagnostic sign of pregnancy is greatly lessened by a
previous pregnancy. It should also be remembered that milk may occur in
the breasts of women who are not pregnant.
5. _Enlargement of the Abdomen._--For the first four months of
pregnancy the entire uterus is contained in the cavity of the pelvis;
it then gradually rises, so that at about the fifth month it is midway
between the pubes and umbilicus, which latter it reaches at the end
of the sixth month; during the seventh month it may be felt half-way
between the umbilicus and ensiform cartilage; at the end of the
eighth month it is level with the cartilage, now quite filling the
abdomen. Still increasing in size during the ninth month it does not
ascend higher, the abdominal walls yielding to its increased weight,
allowing it to fall somewhat forward. A caution is necessary with
regard to this sign. The abdomen may enlarge from causes other than
pregnancy. Pregnancy and ascites, or ovarian dropsy, may coexist in
the same patient, and the diagnosis be rendered anything but easy. The
enlargement of the abdomen may lead to unfounded suspicions detrimental
to the happiness and health of the unfortunate object of them.
6. _Condition of the Cervix Uteri._--The cervix softens during
pregnancy, and the softening is present as early as the second or third
week. It is an important sign. Hejar‘s sign or the softening at the
junction of cervix and body and the lower uterine segment is valuable,
but not always easily elicited. It is of most value from the second
to the fifth months. At the sixth month it loses one-fourth of its
length; at the seventh it is only half of its original length; at the
eighth it loses another quarter; and at the ninth the neck is entirely
obliterated. This shortening is more apparent than real, and its
occurrence is denied by the late Dr. J. M. Duncan, except during the
last few days of pregnancy.
7. _Quickening._--The period at which quickening occurs varies from
the fourth to the fifth month; and the term is understood to imply the
first perception of the movements of the fœtus experienced by the
mother. Nervous women, anxious to have children, sometimes complain of
sensations which they ascribe to quickening, pregnancy being absent.
Pregnancy may occur without quickening.
8. _Kiesteine._--This is no test of pregnancy, as it may be found in
women not pregnant.
9. _Jacquemier‘s Test._--A violet or port-wine colour of the vagina and
inner surface of the vulva, due to venous congestion of the parts from
pressure of the gravid uterus.
A flattening of the upper wall of the vagina, produced by the
enlargement and anteversion of the uterus, which, forcing the os
towards the sacrum, makes the anterior wall of the vagina tense, has
been added by Dr. Barnes as a sign of pregnancy.
Certain Signs
1. _Ballottement._--This test of pregnancy is applied by causing the
patient to stand upright; the finger of the right hand is then passed
into the vagina and placed in the anterior fornix, the other hand
being placed lightly over the abdomen in order to steady the uterine
tumour. If the finger be now jerked upwards against the head of the
child, it will be felt to float upwards in the liquor amnii, and then
by its own weight gradually to return to its former position. Tumours
in the uterus, attached to its walls by a pedicle, may give the same
sensation. Scanty supply of liquor amnii, or malposition of the child,
may sometimes prevent the adoption of the test.
2. _Uterine Souffle._--Under this head are included the placental
bruit, and the pulsations of the umbilical cord. Both these sounds
require a skilled auscultator to detect them. The uterine murmur, or
_bruit placentaire_, is heard best at the lower and lateral portions
of the uterus, just above Poupart‘s ligament. It is isochronous with
the pulse of the mother, and is heard most distinctly about the fourth
or fifth month of utero-gestation; in some cases, however, it may be
heard as early as the tenth week. The sound is intermittent, and varies
in character, being sometimes hissing, whirring, or cooing, at others
rasping.
3. _Pulsation of the Fœtal Heart._--The sounds of the fœtal heart
were first noticed by Mayar in 1818, and those of the placenta,
or _placental souffle_, by Kergaradec in 1822. The sound of the
fœtal heart is composed of a rapid succession of short, regular
double pulsations, differing from that of the adult heart in rhythm
and frequency. It can be heard more or less over the whole of the
abdomen about the middle of the fourth month, and is not unlike the
muffled ticking of a watch. In frequency it varies from 100 to 140.
The auscultator should be careful not to hang his head down, or he
may be apt to mistake the throbbing of his own arteries for sounds
communicated from the patient.
4. _Intermittent Contraction of the Uterus._--From the fourth to the
tenth month of pregnancy, the uterus may be felt by the palpating
hand to alternately contract and relax; the period of contraction and
relaxation varies. It is present in pregnancy whether the fœtus be
alive or dead.
Pregnancy may be simulated by ascites, by fibrous tumours of the
uterus, by ovarian dropsy, and by enlargement of the uterus from
retention of the catamenia due to an imperforate hymen, &c. The breasts
may also become affected by uterine tumours.
Diagnosis of Pregnancy
1. _Pseudo-Pregnancy._--In the examination of cases of alleged
pregnancy, the medical jurist should bear in mind the possibility of
enlargement of the uterus and abdomen from the presence of tumours. The
probable occurrence of _pseudo-pregnancy_ should also be considered.
Tumours and pseudo-pregnancy may occur in the married and unmarried;
and as the latter is not infrequently accompanied with many of the
signs and symptoms of pregnancy, an early diagnosis is of the utmost
importance.
The diagnosis will consist in--
(_a_) A careful examination of all the symptoms
present, when, in most cases, a break in their order of
sequence may be observed, or certain signs may be added
which do not occur in true pregnancy.
(_b_) Presence or absence of the hymen.
(_c_) If the patient be placed well under the
influence of chloroform, the tumour, if the result of
pseudo-pregnancy, will subside, gradually returning
as the effects of the anæsthetic pass off. Whilst the
patient is under the influence of the anæsthetic, the
hand may be pressed on the abdomen at each expiration,
and there retained, the pressure being continued during
the inspirations.
2. _Dropsy._--Use of the stethoscope; examination of the breasts for
milk, and the urine for albumen.
3. _Fibrous Tumours._--Absence of fœtal movements and other signs of
pregnancy.
4. _Ovarian Dropsy._--Tumour on one side of the abdomen; breasts
unaffected, and auscultation giving negative results.
5. _Retention of the Catamenia._--On examination, the hymen found
perfect and bulging. This condition cured by a crucial incision.
DELIVERY
This subject is best discussed under three heads: (1) Signs of Recent
Delivery in the Living. (2) Signs of Recent Delivery in the Dead. (3)
Signs of Previous Delivery.
1. Signs of Recent Delivery in the Living
(_a_) Transitory Signs; (_b_) Persistent Signs of Delivery
(_a_) Transitory Signs of Delivery
1. _General Indisposition._--The face is pale or flushed; the eyes
sunken, and surrounded by a dark areola; there is considerable
debility, and a tendency to faint; the skin is warm and moist, and the
pulse quick. It must be borne in mind that a woman who is anxious to
conceal her recent delivery may, by an effort of the will, to a great
extent hide her real condition.
2. _The Breasts._--The breasts feel firm and “knotty,” and on
pressure yield a small quantity of _colostrum_ or milk, which may be
distinguished by the aid of a microscope.
3. _The Abdomen._--The skin of the abdomen shows signs of recent
distension; it is relaxed, and more or less thrown into folds, the
lower part marked by irregular broken streaks of a pinkish tint,
becoming white and silvery as time goes on.
4. _The Lochia, or the “Cleansings.”_--These consist in a discharge
from the uterus, which, for the first three or four days after
delivery, is more or less bloody. During the succeeding four or five
days it acquires a dirty-greenish colour--“green waters,” with a
peculiar sour, rancid odour. In a few days this is succeeded by a
yellowish, milky-looking mucous discharge, which may continue for four
or five weeks.
5. _External Parts of Generation._--The labia and vagina bear distinct
marks of injury and distension.
6. _The Uterus._--The uterus is enlarged, and may be felt by the hand
for two or three days after delivery, as a round ball, just above
the pubes. The orifice of the uterus, if examined a few hours after
delivery, appears as a continuation of the vagina. This condition
completely disappears in about a week after delivery.
7. _After-pains._--These are of no use from a diagnostic point of view,
as we have no means of testing their presence or absence.
(_b_) Persistent Signs of Delivery
1. _Entire obliteration of the hymen._--This is no proof of actual
delivery.
2. _Destruction of the fourchette._
3. _The vagina dilated, and free from rugæ._
4. _Dark colour of the areola round the nipples._--This varies among
women; and cases are known where there was no areola either during
pregnancy or after delivery.
5. _Skin of Abdomen._--Due to the great distension of the abdomen, the
skin appears streaked with silvery lines varying in breadth. These
markings in some cases may be scarcely perceptible, especially if the
female has worn a tight abdominal belt during her pregnancy. The same
appearance may be produced by dropsy, or the prolonged distension of
the abdominal walls, the result of other causes. Attention to the other
signs present will assist the diagnosis. After the lapse of seven to
ten days the recent delivery of a woman cannot be certainly proved by
an examination of the living woman, especially if it be known that she
had previously borne children. In primiparæ the pink-coloured streaks
on the abdomen, and the transverse condition of the os uteri, may
strongly point to recent delivery.
2. Signs of Recent Delivery in the Dead
Should the woman die immediately after delivery, the external parts
will present the same appearance as just described in the living. On
opening the abdomen, the uterus will be found fat and flabby, between
nine and twelve inches long, and with the os uteri wide open. The
cavity of the uterus may contain large bloody coagula, and its inner
surface be lined by the decidua. The attachment of the placenta is
easily detected by its dark colour, and by the semi-lunar openings of
the arteries and veins on the surface of the uterus.
Of course all the appearances just described will be greatly modified
by the time that has elapsed between delivery and death.
_Delivery after Death._--The fœtus has been known to have been expelled
from the uterus by the force of the gases generated by putrefaction.
Dr. Aveling, in a paper published in the _Obstetric Transactions_,
1873, arrives at the conclusion that _post-mortem_ delivery is possible
even where no symptoms of parturition were noticed before death. He
also thinks that the child may live _in utero_ for some hours after the
death of the mother.
Table showing the Size of the Uterus at Different
Periods after Delivery
_Two to Three Days._--7 inches long and 4 inches wide.
_Seven Days._--Between 5 and 6 inches long and 2 inches wide.
_Fourteen Days._--From 4 to 5 inches long and 1½ inches wide.
_End of Second Month._--Normal size. 2½ inches long and about
2 inches broad at the fundus.
Table giving Weight of the Uterus after Delivery
Immediately after Delivery 22 to 24 ounces.
Within a Week 18 to 21 “
End of Second Week 10 to 11 “
End of Third Week 5 to 7 “
End of Second Month normal, 9 to 10 drachms.
(Heschl.)
3. Signs of a Previous Delivery
1. _Marks on the abdomen_, consisting in shining silvery lines, due to
the distension of the skin. These may result from distension other than
that the result of pregnancy--tumours, dropsy, &c.
2. _Marks on the breasts_, similar to those appearing on the abdomen.
These, in conjunction with the above, are important.
3. _Peculiar jagged condition of the os uteri_, felt by the finger. The
condition may be the result of disease.
4. _Marks of rupture of the fourchette or perinæum._
5. _Dark colour of the areola round the nipple._
6. _Negative evidence_, from absence of any of the above.
=Can a Woman be delivered unconsciously?=--This question may arise in
cases of infanticide. Setting aside cases of epilepsy (in a fit of
which disease Husband once attended a woman who was confined during
the fit without being aware that she had been delivered), cases of
apoplexy, coma, and narcosis from chloroform, opium, &c., it may be
stated that delivery is possible during profound sleep. Husband once
attended a woman who informed him that “she always had her pains during
her sleep,” and only woke up just as the head came into the world. When
it is borne in mind how easily some women pass through labour, it is
quite possible that, after a busy day, sleep may be so profound as not
to be disturbed by the pains of labour. In primiparæ the occurrence
is more problematical. Women have often declared that they have been
unconsciously delivered whilst at stool. This is also possible, but the
circumstances of the case must be severely sifted.
CHAPTER XIII
FŒTICIDE, OR CRIMINAL ABORTION
[“_Every woman, being with child, who, with
intent to procure her own miscarriage, shall unlawfully
administer to herself any poison or other noxious
thing, or shall unlawfully use any instrument, or other
means whatsoever, with the like intent: and whosoever,
with intent to procure the miscarriage of any woman,
whether she be or be not with child, shall unlawfully
administer to her, or cause to be taken by her, any
poison or other noxious thing, or shall unlawfully
use any instrument, or other means whatsoever, with
the like intent, shall be guilty of felony, and being
convicted thereof shall be liable, at the discretion
of the Court, to be kept in penal servitude for life,
or for any term not less than five years, or to be
imprisoned for any term not exceeding two years, with
or without hard labour, and with or without solitary
confinement._”--Statute 24 and 25 Vict. c. 100,
sec. 58.]
The 59th section of the same Statute also takes into consideration
the unlawfully supplying or procuring any poison, or other noxious
thing, or instrument, or thing whatsoever for a woman, for the purpose
of inducing abortion. The person so doing shall be guilty of a
misdemeanour, and be kept in penal servitude for a term of five years,
or be imprisoned for any term not exceeding two years, with or without
hard labour.
It will be seen from the passages above quoted that there is no
distinction between a woman _quick_ or not _quick_ with child. “The
offence is to procure the miscarriage of _any woman, whether she be or
be not with child_” (R. _v._ Goodhall, 1 Din. 187; 2 C. & K. 293). But
although the law does not regard “quickening” in cases of abortion, yet
the fact of having “quickened” may be pleaded as a bar to immediate
capital punishment.
[Illustration: Fig. 23.--Abortion at fourth week.
(Glaister.)]
It has been decided in Scotland that drugging or operating to procure
abortion is criminal, though unsuccessful, but it is not certain
whether the woman alone can be charged with taking drugs to procure
abortion. Both in England and in Scotland, to make the procuring of
abortion criminal, “there must be felonious intent,” for it may be
necessary to cause abortion. It must be borne in mind that the law
allows no discretionary power on the part of medical practitioners
who, to save the life of the mother, may deem it advisable to induce
premature delivery. This being the case, no medical man should attempt
to induce premature labour without the consent of the relatives of the
woman, and the sanction of a medical colleague after consultation.
This precaution is the more necessary as several medical men have
been prosecuted, an event which would not have taken place had the
precaution above suggested been observed. A medical man should also
be very careful never to give any medicine “to bring on the courses”
if he has the slightest suspicion of pregnancy, even as a “placebo”
to satisfy an importunate patient, for should abortion be otherwise
procured, his really harmless medicine may be accused with the result,
and a grave suspicion be raised against him, to say the least.
The term _abortion_ is understood in _medicine_ to mean the expulsion
of the contents of the fœcundated uterus before the sixth month of
pregnancy, that is, before the child is considered viable. After this
period it is said to be a premature labour.
_In law_, however, no distinction is made and the expulsion of
the contents of the uterus at _any_ period before the full time
of pregnancy is considered an _abortion_; in popular language, a
_miscarriage_.
[Illustration: Fig. 24.--Abortion between sixth and eighth week.
(Glaister.)]
[Illustration: Fig. 25.--Abortion at tenth week.
(Glaister.)]
Abortion, when not produced by criminal means, generally occurs at
or a little before the _third month_ of utero-gestation, and then
usually in first pregnancies, or during the latter part of the period
of child-bearing. It is also more frequent among the rich than among
the poor. Of the two thousand cases of pregnant women examined by Dr.
Whitehead of Manchester, the sum of whose pregnancies was 8681, or 4.38
for each, rather less than 1 in 7 had aborted.
When abortion is criminally induced, it generally takes place between
the _fourth and fifth months_, that is, about the time the woman
becomes certain of her condition.
The Causes of Abortion are--
1. Natural or Accidental.--(_a_) Maternal--belonging to the
mother; (_b_) Fœtal--belonging to the ovum.
2. Violent.--(_a_) Mechanical; (_b_) Medicinal.
1. Natural or Accidental
(_a_) =Maternal.=--Among the maternal causes may be mentioned excessive
lactation; any irritation of the rectum or bladder; loss of blood,
which, by increasing the amount of carbonic acid in the blood,
acts as an excitant to the spinal cord; excessive irritability and
excitability of the uterus, &c. Certain states of the system conduce
to abortion--albuminuria, syphilis, certain fevers, scarlet fever,
smallpox, &c. Abortion may become habitual in some women. Great joy or
sudden sorrow have not infrequently been the cause of abortion. The
tendency to abortion is greatest at the menstrual periods, that is, at
the time when, had not the woman become pregnant, menstruation would
have taken place. Slight causes acting at these times are very liable
to produce abortion.
(_b_) =Fœtal.=--The death of the ovum, or a diseased condition of its
uterine coverings, or of the placenta, probably of an inflammatory
nature.
2. Violent
(_a_) =Mechanical.=--Under this head may be mentioned the passage of
certain instruments into the cavity of the womb, and the rupture by
violence of the membranes which surround the fœtus; also the injection
of fluids into the uterus. A medical man practising in Yorkshire
informed Husband that so great was the dread of large families, that
he knew of several ladies who, if they went a day over their monthly
period, passed a catheter into the uterus, with the desired result.
“It was wonderful,” he added, “how clever they were.” In India a twig
of the _Euphorbium nivulia_, anointed with assafœtida, is used for the
same purpose. “The fœtus is never delivered alive, but there is said
to be no great danger to the woman” (Chevers). Women may use hairpins,
knitting-needles, and the idea is to pass the instrument “until blood
comes,” which is accepted as a sign that abortion will be sure to
follow. In some cases it is by no means easy to procure abortion, and
women have been known to undergo a considerable amount of violence
without abortion taking place. In some women, however, on the other
hand, the slightest violence--such, for instance, as slipping from a
step or low chair--will cause them to abort.
(_b_) =Medicinal.=--Certain drugs, among which may be mentioned ergot,
savin, pennyroyal, rue, tansy, saffron, perchloride of iron, diachylon
which contains lead, and others, have been used for the induction
of abortion. In India unripe pineapple has a great reputation as an
abortive (_Medical Jurisprudence for India_, Chevers). It is scarcely
necessary to mention each drug individually, but it must be remembered
that there is _not one single internal medicament_ of which it can be
consistently with experience asserted that, even when an abortion has
followed its use, it must have produced this abortion, and that cause
and effect are in such a case “indirect and necessary connection.” All
the so-called abortives are most uncertain in their action, and their
use is attended with considerable risk to the woman. In the case of
diachylon profound lead poisoning may be the result. Be this as it
may, they are more frequently used to induce abortion than mechanical
procedure, from the fact that the latter requires some amount of
anatomical knowledge and manipulative skill.
The dangers of abortion from any cause are hæmorrhage, sepsis, and
peritonitis. In mechanical interference, especially where proper
precautions have not been taken to prevent them, sepsis and peritonitis
from local injury and perforation are prone to occur.
A medical man may be required to--(1) Examine into the nature and
characters of the substances expelled from the womb; (2) Examine the
woman stated to have aborted.
1. =Examination of the Substances expelled from the Womb.=--The
substances expelled from the womb often become the subject of judicial
inquiry, and the medical man may be required to give his opinion as to
their probable nature.
Dr. Gallard has called attention to the following:
1. During the last six months of pregnancy, abortion, even when it
occurs spontaneously, goes through the two stages as at full time,
_i.e._ the expulsion of the products of conception is, as a rule,
preceded by rupture of the membranes, followed after a time by the
expulsion of the placenta.
2. In the first three months this order of things is absent, for it is
the rule to see the fœtus expelled entire _en bloc_ without rupture of
the membranes.
3. If, then, we find during the first three months of pregnancy the
products of an abortion in which the membranes have been ruptured and
the embryo expelled alone, we must look for a pathological cause for
this infraction of a general rule; and if no disease of the embryo or
of the mother is found, we are justified in attributing the abortion
to mechanical means used directly against the products of conception.
Charpentier has shown that this rupture of the membranes is not
an absolute proof of criminal abortion; but in eighteen cases of
spontaneous abortion M. Leblond only found rupture of the membranes in
one, and in this the membranes presented an abnormal friability.
The questions may be asked--(1) Is it a fœtus?--(2) Is it a mole? If
so, is a mole also a fœtus?--(3) Is it merely the coats of the uterus,
and unconnected with pregnancy?
1. _Is it a Fœtus?_--The development of the fœtus is given on pp. 35,
36 _et seq._
2. _Is it a Mole?_--This question gives rise to another: Is a mole a
fœtus? To this the answer must be in the affirmative. Moles, being the
diseased appendages of the fœtus, vary in character, and have been
described by obstetrical writers under the following heads: (_a_)
Hydatiginous; (_b_) Carneous; (_c_) Fatty Moles.
(_a_) _Hydatiginous Moles_ are a result of a
diseased condition of the villi of the chorion. The
villi become dropsical, and hang in masses like a bunch
of grapes.
(_b_) _Carneous Moles._--These are the result
of hæmorrhage into the chorion. The blood becomes
organised, and a fleshy mass is formed, to which in some
cases a withered fœtus is attached.
(_c_) _Fatty Moles._--Death of the fœtus and fatty
degeneration of the placenta, or fatty degeneration
of the placenta and death of the fœtus, produces this
variety of mole. A withered fœtus with a mass of fatty
placenta are expelled.
3. _Is it merely the Coats of the Uterus, and unconnected with
Pregnancy?_--Fleshy masses may be expelled from the womb, which may
not be the result of sexual intercourse. The description just given of
true moles will, it is hoped, assist in forming a correct diagnosis.
Considerable care will be required, for the honour of the woman accused
depends upon the opinion given as to the nature of the substances
submitted for examination. It must also not be forgotten that moles may
be retained for many months in the uterus and be then expelled. The
knowledge of this fact may rebut an accusation of infidelity against
a wife. Polypi may be discharged from the womb; the presence of a
pedicle will point to their true character. All substances expelled
from the uterus should be carefully washed in water, and all clots
removed. The examination of the woman may also help in the formation
of the diagnosis. The absence of the signs of defloration or of recent
delivery will be in her favour.
2. =Examination of a Woman stated to have aborted.=--This subject may
be divided under two heads--(1) Has the woman been recently delivered?
(2) What were the means used to procure the abortion?
It is by no means easy to answer the question whether an alleged
abortion has really taken place or not. The signs of recent delivery
are in most cases absent, for the woman can better hide her condition
during the earlier than during the later months of utero-gestation;
consequently suspicion may not have been aroused against her for some
weeks or months after the event. The history of the case, with other
attendant circumstances--milk in the breasts, change in the colour of
the areola round the nipples, severe flooding, absence of the hymen,
injuries to the os uteri, transverse condition of the os uteri in
contradistinction to its circular form after delivery, &c.--will, in
most cases, assist in forming a correct diagnosis; but it must be again
repeated that few of the signs applicable to delivery at the full time
are here available.
In all doubtful cases--
1. Examine into the general and present state of the
health of the woman.
2. Find out if there are any reasons which would
occasion a pretext to use drugs which are not usually
given to women during pregnancy.
3. Learn if menstruation is regular and easy, or if
the woman is in the habitual use of emmenagogues, for,
if so accustomed, she may have used them ignorant of
pregnancy.
4. If a woman ascribes her abortion to a fall, to an
accident, or to violence used against her, carefully
examine into the nature of these.
5. Examine into the general causes of abortion, and
also inspect the expelled substances.
Where death is supposed to have followed the use of abortives, the
alimentary canal must be examined for the signs of the action of
irritants, or the presence of disease in the internal organs; but when
death has resulted from an attempt to procure abortion by instrumental
means, the neck of the womb is most frequently found covered by a
number of small more or less irregular wounds, which may penetrate into
the womb or lose themselves in the walls of the organ. Their course
is indicated by infiltration, or a small extravasation of coagulated
blood, the exact condition of which must, if possible, be ascertained,
so as to decide when the wound was inflicted.
The examiner must not forget that the wounds may extend to the fundus
of the uterus, and in this case the autopsy shows that a blunt
instrument, as a catheter or uterine sound, introduced through the
os uteri into the retroverted uterus, glides by its own weight into
the rent. The seat of the tear leads one to think that pregnancy was
not far advanced when the attempt was made, and in fact the accident
most frequently occurs in cases of suspected pregnancy. It must be
remembered that the uterus is often punctured by the injudicious use
of the uterine sound, but without any immediate dangerous symptoms.
Wounds in the walls of the vagina indicate the use of instruments by
an inexperienced hand; in the fundus of the uterus, to one at least
accustomed to the introduction of instruments. Spontaneous rupture of
the uterus is impossible during the early periods of pregnancy, just
when the attempts at abortion are usually made. Rupture due to external
violence is, as a rule, accompanied with outward signs of the violence
used.
In all cases a careful examination of the structure of the uterus
should be made. An examination of the ovaries for _false_ or _true
corpora lutea_ should be made. The opinions on the character and
differences of these bodies are so discordant as to destroy all
confidence in their value as proof of conception or the reverse.
Taylor says: “The discovery of the _ovum_ in the uterus _in process
of development_ could alone, in the present state of our knowledge,
warrant an affirmative opinion on this point in a Court of Law, and
this I believe to be the safest view at present of this much-contested
question. On the other hand, the absence of a corpus luteum from the
ovary would not in all cases warrant an opinion that conception had not
taken place.”
Examine carefully for local sepsis and signs of inflammation of the
uterus and its surrounding structures.
Recapitulation
In Medicine, Abortion occurs before the sixth month of
pregnancy--premature labour after that period.
In Law, Abortion may take place any time before the full period of
utero-gestation.
Abortion may be due to--
1. _Natural or Unavoidable Causes._
(_a_) Maternal. (_b_) Fœtal.
2. _Violence, with Criminal Intent._
(_a_) Mechanical. (_b_) Medicinal.
CHAPTER XIV
INFANTICIDE
According to the present state of English law, infanticide--murder of a
_new-born_ child--is not regarded as a specific crime, but is treated
and tried by those rules of evidence which are applicable in cases of
felonious homicide, but with this difference, that the law requires
proof that the child was born alive. An old Statute (21 Jac. I. c.
27) made the concealment of the birth of a bastard child conclusive
evidence of murder. As far as the legal estimation of the crime is
concerned, it matters not whether the child was killed immediately
on its entrance into the world, or within a few days afterwards. A
fœtus not bigger than a man‘s finger, but having the shape of a child,
is a child within the Statute (R. _v._ Colmer, 9 Cox, 506; R. _v._
Hewitt, 4 F. & F. 1101). An English judge, at a late trial, stated
that if the jury were of the opinion that the prisoner had strangled
her child before being wholly born, she must be acquitted of murder.
The law also, on the score of humanity, presumes that every child is
born dead until direct evidence to the contrary, from medical or other
sources, is given. The onus of the proof of live birth, therefore,
devolves on the prosecution. It may also be difficult to decide as to
the maternity, and the woman accused will have to be examined as to the
possibility of her recent delivery.
Here let me repeat the advice given on page 148 as to the examination
of a woman. Your duty is to request the woman to allow of the necessary
examination, giving her the warning which every magistrate or coroner
is bound to give to any person charged with a crime, before requiring
an answer to a question which may be used in evidence against her at
the subsequent trial. The innocent and the guilty may alike object to
an examination, but the presumption is against the party declining,
if several have voluntarily submitted. A young lady committed suicide
rather than submit to an examination by two medical men under an order
from the coroner. The medical men were guilty of a grave indiscretion,
and both they and the coroner were acting _ultra vires_ in attempting
to force a woman to obtain evidence against herself (Taylor, vol. ii.
p. 431).
The decision as to recent delivery will, to a great extent, rest on the
condition of the mother, and the apparent age of the child found dead.
The discovery of the body of the child is not necessary to conviction,
but the medical evidence as to the signs of respiration, of course,
depends on the body being found and examined. In most cases of alleged
infanticide tried in England, juries appear more inclined to fall back
on the minor offence--_concealment of birth_--than to convict of the
capital offence; and this appears to be the only alternative if the
body cannot be found, for, as we have just said, in law every child is
held to be born dead. It must of course be shown that the woman has
been recently delivered. In case of failure to prove the murder of the
child, the Act (24 and 25 Vict. c. 100, sec. 60) enacts that “if any
woman shall be delivered of a child, every person who shall, by any
secret disposition of the dead body of the said child, whether such
child died before, at, or after its birth, endeavour to conceal the
birth thereof, shall be guilty of a misdemeanour.” The mere avowal of
the birth is not sufficient to convict her; she must be proved to have
done some act of disposal of the body after the child was dead (R. _v._
Turner, 8 C. & P. 755).
In Scotland, _concealment of pregnancy_ is a statutory crime,
chargeable when the child born is found dead or is not found at all,
and there is no proof of its having been murdered. Pregnancy, up to
a period when a child might be born alive, must be proved, and the
words “during the whole period of her pregnancy” do not imply that the
pregnancy must have continued for the full period of nine months. All
that is necessary is that there should be such proof of duration of
pregnancy as made a living birth possible. If the accused can bring
forward a witness to whom she communicated her pregnancy, or called for
assistance at the birth, or (it is believed) can prove that the child
was born dead, she is entitled to an acquittal.
It has also been said that a woman ought not to be convicted of
“concealment of pregnancy,” if at the time of delivery the fœtus
do not appear to have reached the seventh month of intra-uterine
existence. The birth of a “child,” whether dead or alive, is essential;
therefore, if the woman accused “can prove that that which she brought
forth was not a ‘child,’ but an abortion, or a _fœtus_, which, from
some accident, was in such a condition that, though there had been
assistance, it could not have been in a condition to be called ‘a
child,’ then the case is out of the Statute.” The Scotch Statute
differs from the English on the “concealment of birth” in this, that so
long as the woman makes known her pregnancy, the motive for doing so is
not considered. Thus, if she make arrangements with anyone to conceal
the birth, “the Statute is eluded by that very circumstance” (Alison).
The Statute applies to married as well as to single women; but, in
the former case, the penalty is seldom enforced unless foul play is
suspected.
DEFINITION OF THE TERM “LIVE BIRTH” IN CRIMINAL CASES
“The entire delivery of a child.” There must be an independent
circulation in the child before it can be accounted alive (R. _v._
Enoch, 5 C. & P. 539). The entire child must be actually born into the
world in a living state (R. _v._ Poulton, 5 C. & P. 329). But the fact
of the child being still connected with the mother by the umbilical
cord will not prevent the killing from being murder (R. _v._ Reeves, 9
C. & P. 25). To kill a child in its mother‘s womb is no murder, because
the person killed must be “a reasonable creature in being, and under
the King‘s peace.” But if the child be injured in the womb, and yet be
born alive, and then die as a result of such injuries, it may be murder
in the person who inflicted them (R. _v._ Senior, 1 Mood. C. C. 346).
A distinction must be drawn between _medical_ or _physiological life_
and _legal life_. A child may have breathed, as it not infrequently
does, _before_ it is completely born into the world; and this might, in
a medical point of view, be considered as a live child, but it is not
one legally. The entire delivery of the child is necessary in law; and
“it must also be proved that the entire child has actually been born
into the world in a living state, and the fact of its having breathed
is not a conclusive proof thereof.” The inference unfortunately follows
from this ruling, that a mother may kill her child without fear of
punishment, if she do so before the entire body has slipped from her.
DEFINITION OF THE TERM “LIVE BIRTH” IN CIVIL CASES
The evidence of live birth in civil is somewhat different from that
required in criminal cases. The viability of the child is determined in
Scotland by its _crying_; in France, by its respiration; in Germany,
“the LIVE BIRTH of a child is to be held proven when it has been
heard to cry by witnesses of unimpeachable veracity present at its
birth”; but in England, the pulsation of the child‘s heart, or any
tremulous motion of the muscles, however slight, has been considered as
satisfactory proof of live birth.[15]
[15] Fyshe or Fisher _v._ Palmer, in 1806.
According to Blackstone, “crying, indeed, is the strongest evidence,
but it is not the _only_ evidence”; and Coke remarks, “If it be born
alive, it is sufficient though it be not heard to cry, for peradventure
it may be born dumb.”
=Signs of Live Birth prior to Respiration, and independent of it.=--(1)
Negative.--Signs of intra-uterine death, _i.e._ putrefaction, or
“intra-uterine maceration,” or of such imperfect development that it
could not have been born alive. (2) Positive.--Injuries to the child
showing that it must have been born alive.
1. Negative.--_Intra-uterine Putrefaction._--This condition differs in
some remarkable points from putrefaction in air.
The body is extremely flaccid and flattened, the bones of the cranium
moving easily on one another. The skin of the hands and other parts of
the body bear the evidence of prolonged soaking in fluid. In parts,
the skin is whitish, or of a reddish-brown or coppery-red colour,
without any trace of green, which is always present when putrefaction
takes place in the air. The cuticle may be raised in blisters, and be
easily detached from the true skin. The denuded patches are moist and
greasy, and exude a stinking, reddish-coloured serous fluid. The face
is flattened, and the features distorted. In one case that Husband
attended of intra-uterine death of the fœtus in a primipara, and where
putrefaction was far advanced, the scalp burst during delivery, and
the brain was poured out. Should, however, the child be exposed to
the air, it may soon acquire the appearances proper to putrefaction
in that medium. If the child, immediately after birth, be thrown into
water, the putrefactive changes would be like those of intra-uterine
decomposition. In this case the lungs must be examined for the evidence
of death by drowning.
2. Positive.--Evidence that injuries found on the body could not have
been inflicted during birth, or accidentally after birth. On this
subject it is scarcely possible to give an opinion one way or the
other. All the medical witness can fairly state is, that, from the
condition of the lungs, respiration has or has not taken place; that,
in the former case, it is not easy to state whether the injuries were
the cause of death or inflicted after death.
=Appearances showing that a New-Born Child has breathed.=--1. Walls
of the Chest.--“The vaulting of the thorax is not of the slightest
diagnostic value.” Casper quotes from Elsässer the following remarks:
“It is irrefutable that the variations in the circumference of the
thorax (and, of course, in its diameters) are so considerable that no
certain normal mean for a thorax that has breathed, and for one that
has not breathed, can be laid down. In most cases the measurements
of the thorax are incapable of determining whether the lungs contain
air or not. The reasons for these variations is, without doubt, to be
referred to the congenital differences in the volume of the osseous
thorax; partly, also, to the thickness of the soft parts, particularly
of the subcutaneous fat and the thoracic muscles; partly, also, to the
differences in the degree and amount of the dilatation of the thorax by
respiration, with which the distension of the lungs also corresponds,”
&c.
2. Diaphragm.--The position of the diaphragm may be considered as a
good diagnostic sign; for it is found that, in children born dead,
the highest point of the concavity is between the fourth and fifth
ribs, whereas in those born alive it is between the fifth and sixth.
The position of the diaphragm may be affected by the gases produced
during putrefaction, and also, in children who have _breathed_, from
distension of the stomach and intestines with gas.
3. Stomach and Intestines.--With regard to the stomach, Tardieu has
suggested that the presence of air-bubbles in the glairy mucus usually
found in that organ is a sign of live birth, as it can only have arisen
from the swallowing of saliva and mucus, aerated by repeated attempts
at respiration, probably lasting from five to fifteen minutes. Air
in the duodenum is strong evidence of live birth. Breslau of Prague,
who has further investigated this subject, states that, in children
born dead, or who have undergone prolonged intra-uterine putrefaction,
there is never any accumulation of gas in the stomach or intestines,
and that the presence of gas in these organs is contemporaneous
with respiration, and is independent of the ingestion of food.
The intestines of newly-born children do not float in water, but
rapidly sink in that fluid. As respiration proceeds, the coils of the
intestines become distended with gas.
4. Kidneys and Bladder.--The presence of crystals of uric acid in the
pelvis of the kidneys and even in the bladder has been suggested as
a sign of live birth. Uric acid infarction, as it has been called,
usually occurs in from two to ten days after birth, at a period when
there are more important signs of live birth than this, even if
infarction did not occur, as it does, in still-born infants.
5. Lungs.
(_a_) _Size._--In the fœtus, prior to respiration, the lungs do not
fill the cavity of the chest, and the left lung is never found even
partially covering the heart.
After respiration they fill the thorax more or less completely, the
amount of distension depending, of course, upon the completeness of the
respiratory acts on the part of the child.
(_b_) _Consistence._--Before respiration has taken place, the lungs
feel firm, compact, and resistant, and are of the consistency of liver.
After respiration they are spongy, crepitant, and yielding when pressed
between the fingers. They also present a marbled appearance. These
signs of respiration are more or less modified by disease, and the
_atelectasis pulmonum_ of Jörg, jun.
Casper denies the existence of _atelectasis pulmonum_ as a distinct
disease of newly-born children, and considers that “it is nothing
else than the original fœtal condition, from which it differs in no
anatomical respect”--an opinion supported by Meigs, who says “it, in
fact, resembles exactly the fœtal lung.” It is simply the result of the
child dying from some cause before respiration has had time to become
fully established, and has possibly been confounded with hepatisation.
It must also be remembered that cases are on record of infants having
lived for some hours, and then died, yet the lungs sank as a whole, and
when cut in pieces.
(_c_) _Colour._--The colour of the fœtal lungs is “exceedingly
various,” and it is by no means easy to convey the idea of colour by
words. Speaking in general terms, the lungs of children who have _not_
breathed are of a reddish-brown liver colour, this colour changing
to a brighter red at their margins. In children who _have_ breathed,
the lungs are of a slaty-blue colour, more or less mottled with
circumscribed red patches. This circumscribed mottling is _never_ found
in perfectly fœtal lungs. When the lungs are inflated artificially,
they swell up and present a uniform cinnabar-red colour, destitute of
insular marbling. The insular marbling of the lungs is characteristic
of lungs that have breathed, and is due to the presence of blood in the
arteries and veins surrounding the inflated lung tissue.
(_d_) _Buoyancy in Water._--Lungs which have respired float in water.
But the objection may be raised that lungs that have _not_ respired may
yet float from--
1. The result of artificial respiration.
2. The result of putrefaction.
The value of these objections will be discussed in the following pages.
The following table is given by Tidy:
--------------------------------+-----------------------------------
Lungs that have not Breathed. | Lungs that have Breathed.
--------------------------------+-----------------------------------
1. Dark in colour (black-blue,| 1. Light in colour (rose-pink,
maroon, or purple), resembling | pale pink, light red, or crimson),
liver. No mottling. | mottled.
|
2. Air-vesicles not visible | 2. Air-vesicles distinctly
to the naked eye. | visible to the naked eye, or a
| lens of low power (say a two-inch,
| or even a common reading-glass).
|
3. When squeezed or cut, do | 3. Crepitate or crackle freely.
not crepitate or crackle. |
|
4. Contain but little blood, | 4. Contain a good deal of blood,
therefore little escapes on | which escapes freely on section.
section. |
|
5. The blood present is not | 5. The blood present is freely
frothy, unless there be | mixed with air, and therefore
putrefaction. | appears frothy.
|
6. Sink in water, unless | 6. Float in water; or, at all
putrid, and often not then. | events, the parts which have been
| expanded, or have breathed, float.
| If fully expanded, they will buoy
| up the heart.
|
7. Bubbles of gas arising | 7. The air cannot be squeezed
from putrefaction may be | out by pressure.
squeezed out, and as they |
escape are usually noted to |
be of large size. |
--------------------------------+-----------------------------------
Hydrostatic Lung Test
(_Docimasia pulmonum hydrostatica_)
The value of this test, which is a test of respiration and not of live
birth, is founded on the supposition that a lung in which respiration
has taken place will float if placed in water, and that when this has
not occurred it will sink. Admitting that a lung floats as a result of
respiration, it has been objected that this is no proof of live birth,
for respiration may take place in:
1. The womb, _vagitus uterinus_.
2. The maternal passages, _vagitus vaginalis_.
3. Cases when the head protrudes, the body not yet being born.
With regard to the two first objections, it will be sufficient to say
that, in all the cases of so-called intra-uterine respiration, the
respiratory acts have occurred in difficult or instrumental labours,
where it is justifiable to suppose that, in the endeavour to remove the
child, a certain amount of air may have been unavoidably admitted into
the maternal passages. But the cases with which the medical jurist has
to deal cannot be classed with these, for in all those brought under
his notice delivery has been more or less rapid and unassisted.
To the last objection the same reply may be given, that rapid delivery
in doubtful cases must be considered as the rule, and that the time
which elapses between the birth of the head of the child and its
complete delivery is so short as not to lead to any great error in
diagnosis. It is true that the woman may faint with the child half
born, and that respiration may thus take place; and it has not yet been
decided how many inspirations a child must make to entirely inflate its
lungs, or the length of time required to do so.
_N.B._--Any pressure exerted on the umbilical cord during the process
of delivery gives rise to respiratory acts on the part of the fœtus.
The presence of what Casper calls _petechial ecchymoses_ beneath the
pleuræ, upon the aorta, and even on the heart, are, as a rule, a proof
that attempts at respiration have been made. These petechial ecchymoses
are sometimes found on the same parts in the drowned. (See “Drowning.”)
How is the Hydrostatic Lung Test performed? and What are the Objections
to its Use?
As this test was first used, it consisted in placing the lungs, with
or without the heart, in water, and then noting whether they sank or
floated. A glass vessel, eighteen inches high and twelve in diameter,
half filled with distilled water at 60° F., should be used. In summer,
water at the ordinary temperature of the room will answer the purpose.
To this rough test pressure is now added; the lung, or portions of it,
are greatly compressed in a linen cloth, and then thrown into water as
before. If the lungs thus compressed float, respiration is held to have
taken place; should they sink, the contrary is presumed.
Pressure is used for the following reason: The air generated by
putrefaction, and which may cause the lungs to float, is removed by
pressure, but no amount of pressure, short of entirely destroying
the lung tissue, will remove that which is the result of respiration
or inflation; and between these the medical expert must decide from
collateral evidence.
In performing the test: (1) Try if the lungs will float with the heart
and thymus gland attached to them. (2) If they will float without the
heart, &c. (3) Try if portions will float with or without pressure.
The following are the Objections to this Test:
1. The lungs may sink as a result of disease.
2. Respiration, even in healthy lungs, may be so
imperfect that they may sink.
3. Emphysema pulmonum neonatorum.
4. Putrefaction.
5. Artificial inflation.
1. That in consequence of disease the entire lungs, or portions of
them, may sink, and yet respiration may have taken place. Disease of
the lung may occur previously to birth or soon afterwards, but it is
scarcely probable that the disease would attack every portion of the
lung. Parts, doubtless, small in proportion to the diseased part, may
yet have been sufficiently inflated to float. The presence of disease
is also not difficult of detection.
2. That respiration, even in healthy lungs, may be so imperfect that
they may sink. This objection can scarcely be considered valid against
the general application of the test, for in these cases there is no
known test by which respiration or its absence can be determined. They
are, therefore, out of the pale of the test, as they are out of every
other mode of investigation.
3. _Emphysema pulmonum neonatorum._--Emphysema is generally the result
of excessive dilatation of the air cells of the lung, rupture of the
cell walls, and infiltration of the intra-lobular areola tissue. This
condition may be brought about by:
(_a_) Respiration. (_b_) Inflation.
The fact of the matter is simply this, that the so-called _emphysema
pulmonum neonatorum_, or emphysema of new-born children, is nothing
more or less than incipient putrefaction, induced by certain
unascertained conditions.
Casper sums up his conclusions on this subject in the following words:
“That not one single well-observed and incontestable case of emphysema,
developing itself spontaneously within the lungs of a fœtus born
without artificial assistance, is known; and it is not, therefore,
permissible in forensic practice to ascribe the buoyancy of the lungs
of new-born children, brought forth in secrecy and without artificial
assistance, to this cause.”
4. _Putrefaction._--It must be admitted as proved that the lungs of
new-born children in a state of decomposition will float in water.
But this admission does not render the test valueless, for it must be
remembered:
(_a_) That air generated by putrefaction is found in bubbles
_under_ the pleuræ, or in the fissures between the
_lobuli_ of the lungs, and _not in the air cells_ of
the lungs.
(_b_) That gas as a result of putrefaction can easily be
removed by compressing the lungs, or portions of them.
(_c_) That crepitation in putrefied lungs is absent, owing
to the fact stated under (_a_).
(_d_) That the lungs are among those organs which putrefy
late.
(_e_) That negative evidence may be obtained, if the lungs,
in a highly putrescent body, sink in water. The
tendency of putrefaction, as above stated, is to cause
them to float.
5. _Inflation._--In the first place, it is to be remarked that to
inflate the lungs is by no means an easy task. Elsässer states “that
in forty-five experiments performed on children born dead, without
opening their thorax and abdomen, only _one_ was attended with complete
success, thirty-four with partial success, and ten with none whatever;
and it must also be remembered that these experiments were conducted
without disturbance, and with the greatest care.” Professor Gross
states his opinion on this subject thus: “We are decidedly of opinion
that artificial inflation of the lungs is a very difficult matter; and
we believe that the complete distension of these organs can only be
effected where a tube is introduced into the mouth of the larynx.” In
the cases that come before the medical expert, the question naturally
arises, Who would inflate the lungs? Surely not the mother. If not the
mother, who else? It has been suggested that some malicious person
might inflate them to sustain a charge of infanticide. Is this probable?
The following points may be noticed on this subject:
(_a_) Known difficulty in inflating the lungs.
(_b_) Absence on the part of the mother of any preparation to
save the life of her child.
(_c_) Presence of air in the stomach and intestines, the result
of attempted inflation.
(_d_) Bright cinnabar-red colour of the lungs, without trace
of mottling.
(_e_) Absence of frothy blood when the lungs are cut into.
(_f_) When, therefore, we observe the following
phenomena, a sound of crepitation without any escape
of blood-froth on incision, _laceration_ of the
pulmonary cells with hyperæmia, bright cinnabar-red
colour of the lungs _without any marbling_, and
perhaps _air_ in the (artificially inflated)
stomach and intestines, we may with certainty conclude
that the _lungs have been artificially inflated_.
It may be further noted that natural respiration is accompanied with,
first, the distension of the air cells of the lungs with air; and,
second, with an increased flow of blood into the organs, beyond that
necessary for their nourishment and growth. They thus increase in
absolute weight, while their specific gravity is lessened.
The objections just mentioned apply to the hydrostatic test as
originally employed. It will now be necessary to notice those against
the same test when modified by pressure. These are two in number:
1. That no amount of pressure, short of entirely destroying the lung
tissue, can expel the air from a lung that has been inflated, or from
one in which respiration has taken place.
2. Pressure is, therefore, no test of natural respiration or of
artificial inflation.
In answer to the above, it will only be necessary to refer to what has
been already said with regard to the difficulty of inflation, and the
more probable event of the condition of the lungs being the result of
respiration.
Casper thus sums up the result of his views with regard to the
probative value of the _docimasia pulmonaris_:
“=That a child has certainly lived during and after its birth=--
“1. When the diaphragm stands between the fifth and sixth ribs.
“2. When the lungs more or less completely occupy the thorax, or at
least do not require to be sought for by artificial separation of the
walls when cut through.
“3. When the ground colour of the lungs is broken by insular marblings.
“4. When the lungs are found by careful experiment to be capable of
floating.
“5. When a bloody froth flows from the cut surface of the lung on
slight pressure.”
=The Lung Test is unnecessary when=--
1. The umbilical cord has dropped off, and cicatrisation has followed.
2. Where food is found in the stomach.
3. Where there are evident signs of putrefaction _in utero_.
4. Also in the case of the birth of monsters, or where, from congenital
malformation, the possibility of live birth is excluded.
Besides the hydrostatic test, the following have been proposed:
Ploucquet‘s Test.--This test is based on the relative weight of the
lungs, before and after respiration, to that of the entire body of the
child. The variations found in practice between the relative weights
render the test worse than useless.
Absolute Weight of the Lungs.--This test consists in a comparison
of the weight of the lungs before and after respiration, and it may
be stated here that the lungs, prior to respiration, vary in weight
from about 400 to 650 grains; but so much depends on the maturity or
immaturity of the child, and degree of respiration, that, like the
last, the test is unworthy of confidence.
Wredin‘s Test.--Dr. Wredin, of Petrograd, states that the gelatinous
substance found in the middle ear of infants before birth, gradually
disappears, to be replaced by air on the subsequent establishment of
respiration. Wendt, of Leipzig, from an examination of 300 cases,
declares that the gelatinous substance can only be expelled by the
establishment of full respiration. The value of this test has been
questioned, as some observers have found that in different cases
intervals of from a few hours to five weeks have occurred, before the
replacement of the gelatinous material by air.
Table Showing the Signs of Maturity of Child At Birth
As regards:
1. _Average Length of Body._--Nineteen inches.
2. _Average Weight of Body._--About seven pounds.
3. _Eyes._--The pupillary membrane is not found in the
mature child.
4. _Navel._--Said to be exactly midway between the
pubes and the ensiform cartilage.
5. _External Genitals._--Testicles found in the
scrotum, and the labia majora cover the vagina and
clitoris.
6. _Os Femoris._--Ossification of the inferior
femoral epiphysis. The osseous nucleus measures from
three-quarters of a line to three lines in diameter.
CAUSE OF DEATH TO THE FŒTUS
Death may be due to--
I. Immaturity on the part of the fœtus.
II. Complications occurring during or immediately after birth.
III. Congenital disease in one or more of the fœtal organs.
IV. Neglect or exposure, constituting “Infanticide by Omission.”
I. Immaturity on the part of Fœtus.-From some cause or another, the
child may die immediately after birth, in spite of every attempt to
save it. In many of these cases no disease adequate to account for
death can be detected.
II. Complications occurring during or immediately after Birth.--(1)
Unavoidable or inherent in the process of parturition. (2) Induced with
criminal intent, constituting “infanticide by commission.”
1. _Unavoidable or Inherent in the Process of Parturition._--The
immediate cause of death may be either maternal or fœtal. In the
former, the presence of tumours in the pelvic passages, or disease
of the bones, causing a narrowing of the canal, may lead to fatal
compression of the head of the child. Death may also be due to
protracted labour from debility on the part of the mother, or she may
suddenly faint after delivery. A congested state of the brain may
be present in these cases. In the latter (fœtal), pressure on the
umbilical cord from malposition of the child during labour, or an
abnormal increase in the size of the head, may cause death. There is
also a greater mortality, both during and after delivery, among male
than female children. The child may be also accidentally suffocated in
the fæces of the mother, or in the fold of her dress; or it may be born
while the woman is straining at stool, and be drowned in the contents
of the pan. Husband once met with a case of accidental death of a
child from suffocation in the drawers of the mother, who persisted,
from motives of delicacy, in wearing those articles of dress during
her confinement. Death may also result from strangulation, occasioned
by the pressure of the funis round the child‘s neck. The death in this
case can scarcely be considered as due to strangulation, as the child
had never breathed, but it is probably the result of the arrest of the
flow of blood along the cord, from the tightness of the folds round the
neck. Some congestion of the brain may, however, be found resulting
from the pressure on the vessels of the neck. Lastly, death may
ensue from a fall on the floor in cases of sudden and quick labours,
especially if the woman be in the erect posture at the time of delivery.
2. _Induced with Criminal Intent._--Infanticide by commission: was
the death due to violence? The answer to this question is by no means
easy. In all doubtful cases the attendant circumstances must be taken
into consideration. A woman may unintentionally injure her child in her
efforts to drag it from her. The presence of respiration, more or less
complete, is strongly presumptive against the death being the result
of accident. But even here considerable caution is necessary, for the
injury may not be immediately fatal, although accidentally inflicted,
sufficient time elapsing between its infliction and the death of the
child to allow of respiration. Foreign bodies found in the mouth and
fauces are also corroborative of death by violence. A case is recorded
in which the child‘s fauces, upper portion of the œsophagus, the
larynx, and the trachea were closely packed with a coarse green sand,
and yet the lungs sank when the hydrostatic test was applied to them.
There was nothing to show when the packing of the fauces was effected.
Strangulation may be produced by the constriction of the umbilical
cord round the neck, and for this reason marks round the child‘s
neck cannot always be ascribed to intentional violence. Of 327 cases
collected by Elsässer, in which the cord was from one to four times
round the children‘s necks, there was not in a single instance any
mark of the cord perceptible, even though in some cases the cord had
to be cut to permit the completion of labour. With regard to marks
round the neck of a new-born child, Casper remarks that it is possible
“to mistake the folds of the skin, produced by the movements of the
head, and which remain strongly marked in the solidified fat, and are
very prominent, particularly in short necks, for the marks of the
cord.” The _mark_ left by the _funis_ is broad, corresponds with the
breadth of the cord, runs without interruption round the neck, and is
everywhere quite soft, and never excoriated. Ecchymoses may be present,
irregularly following the line made by the cord. On the other hand,
“a mummified, parchment-like, unecchymosed depression points in every
case to strangulation by a hard, rough body,” and this more especially
if there be any abrasion of the cuticle or laceration of the skin.
Death, sometimes ascribed to strangulation, is probably the result
of suffocation, and happens thus: any pressure exerted on the cord
cuts off the blood from the placenta to the fœtus, and gives rise to
respiratory attempts on the part of the child, the child dying from
suffocation, or from the engorgement of the lungs with liquor amnii
drawn into them at every effort to breathe. An infant may be poisoned.
This cause of death is very rare, but deaths have resulted from the
use of poisonous gases. While on this subject it may be advisable
to state here that ulcerations have been found in the stomach and
intestines more or less accompanied with a collection of dark brown or
black bloody fluid, which have given rise to suspicions of poisoning
in infants to all outward appearances quite healthy. An infant may be
thrown into water and drowned. No traces of this mode of death would
be discoverable in the infant unless respiration had taken place prior
to its immersion. The plea of accidental drowning in a cesspool or
water-closet pan may be put forward; it is therefore well to examine
the cord. Has a ligature been placed upon it? Has it been cut by a
sharp instrument? The nature and character of the fluid found in the
stomach should be noted.
Fractures of the skull may happen--
1. _In the Womb._--The parturient female may fall from a considerable
height, and thus cause injury to her child. These cases are of no
judicial importance, as the presence of intra-uterine putrefaction or
an examination of the lungs will at once show that the child has not
breathed. It must be borne in mind, however, that dislocations may take
place in the womb, and this fact may be brought forward in defence. The
history of the case, and the absence of any other signs of violence,
will decide the truth or falsity of the plea.
2. _During Labour._--Fracture of the cranial bones during labour
generally occurs in difficult and protracted labours, which, from
this very cause, seldom become the subject of judicial inquiry. In
some cases the defective ossification of the bones of the skull may
give rise to fractures, which may lead to dangerous mistakes. This
deficiency, in the process of ossification is thus described by Casper:
“If the bone in question is held up to the light, this is seen to shine
through the opening, which is closed only by the pericranium. When the
periosteal membrane is removed, the deficiency in the ossification
is seen in the form of a round or irregularly circular opening, not
often more than three lines in diameter, though frequently less; its
edges are irregular and serrated: these edges are _never depressed,
as is the case in fractures_; and neither they nor the parts in their
neighbourhood are ever observed to be ecchymosed.” The child in these
cases may breathe for a short time, and then die without any apparent
cause.
[Illustration: Fig. 26.--Photo-micrograph of human milk, × 250.
(R. J. M. Buchanan.)]
3. _By Falls._--It is beyond doubt possible for a child to be born so
precipitately as to fall on the floor and be severely injured, and that
even fatally. In cases of alleged precipitate birth, to account for
injuries found on the child, the following points should be remembered,
and will assist in forming a diagnosis:
1. In Favour of Precipitate Birth and Accidental Injury
(_a_) Rupture of the umbilical cord. In all cases it would be advisable
to measure the length of the cord, and then the distance of the vulva
from the ground, allowing of course for the woman not being quite
erect at the time of delivery owing to a separation of the legs. A
disproportion between the two measurements may or may not account for
the rupture of the cord. The following measurements may be taken: usual
length of cord, eighteen to twenty inches; distance of vulva from the
ground, twenty-six inches, but allowing for stooping, two-thirds of the
above. To the length of the cord must be added about nine inches, the
distance from the navel to the top of the head of the child. Thus, a
fall of about thirty inches will put no strain on the cord. A case is
on record of a rupture of the cord taking place while the woman was in
a _recumbent_ position, but in that case the labour was precipitate,
and the cord very short and small.
(_b_) Placenta not detached from the child.
(_c_) Fracture of the parietal bones; the fracture radiating into the
frontal and squamous portion of the temporal bone. In experiments
on twenty-five children dropped from a height of thirty inches, one
parietal bone was found fractured in sixteen of the cases; both
parietals, in six cases. The fractures in most cases occurred about the
parietal protuberances. It must be remembered that the children were
dead, and that it is easier to fracture the skull of a live infant than
that of a dead one.
(_d_) Imperfect ossification of the bones of the skull.
(_e_) Absence of other injuries.
2. In Favour of Criminal Violence
(_a_) The fact of the umbilical cord being divided by some sharp
instrument and not torn. A caution must be here inserted, for Taylor
mentions a case where rupture of the cord occurred in such a manner
that it could not be decided whether it had been intentionally cut or
torn.
(_b_) Extensive fracture of one or more of the bones of the cranium.
(_c_) Fracture and dislocation of the neck.
(_d_) Presence of incised wounds, and other evidence of violence.
_N.B._--In all doubtful cases, a guarded opinion should
be given, stating simply that the dissection does not
reveal anything contrary to the statements offered as to
the cause of death.
III. Congenital Disease in one or more of the Fœtal Organs.--In all
cases the presence of congenital disease must be sought for.
IV. Neglect or Exposure, constituting “Infanticide by Omission.”--Under
this head may be mentioned the following:
(_a_) Neglecting to place the child in such a position that it may
breathe freely.
(_b_) Neglecting to protect the child from extremes of cold or heat.
(_c_) Neglecting to feed it with the food appropriate to its age. (See
Signs of Death from Starvation, pp. 132 _et seq._)
(_d_) Neglecting to tie the umbilical cord.
To give answers to these questions will in many cases be impossible,
and each must be decided by such circumstances as present themselves
in each individual case. For instance, if the body be found stiff,
blanched, naked or nearly so, lying on the ground, the vessels of
the interior gorged with blood, whilst the superficial vessels are
contracted and can be seen only with difficulty; at the same time,
the hydrostatic test shows that respiration has taken place, and in
the absence of all external or internal causes--the probability is in
favour of death by cold. In close relation with the present subject is
the question--
=Has the Infant bled to Death?=--Fatal hæmorrhage from the cord may
occur, especially if it be divided by a sharp instrument close to the
body of the child. As a rule, hæmorrhage does not occur from a ruptured
cord. (The signs of death from hæmorrhage have been noticed, page 81.)
=How Long did the Child survive its Birth?=--The answer to this
question is by no means easy, and the data on which a decision can
be based are not very reliable. The presence or absence of the
_vernix caseosa_ should be noticed. In still-born children the closed
eyelids, when raised, do not remain open; in the live-born, on the
other hand, the eyes remain half open even after repeated attempts to
close them. Another guide to the determination of the length of time
the child survived its birth may be found in the absence or presence
of the meconium in the intestines. The meconium--so-called from its
resemblance to inspissated poppy juice--is found in the large intestine
as a dark-greenish pasty mass, more or less filling that portion of
the bowel. In the upper portions of the intestines it varies from a
light-yellowish or greyish to a greenish-brown colour, till in the
large intestine it assumes the colour and consistence above mentioned.
It is generally discharged by the infant in from four or five to
forty-eight hours after birth. In breech presentations it may be passed
during the process of delivery, although the child be still-born; but
its entire absence from the intestines is presumptive of existence for
some days after birth.
[Illustration: Fig. 27.--Photo-micrograph of starch granules, × 250
(potato). (R. J. M. Buchanan.)]
The following are some of the points to be considered in forming a
diagnosis: (1) Changes in the skin. (2) Changes in the umbilical cord.
(3) Changes in the circulatory system.
Table showing how long a New-born Child has Lived.
---------+-----------------+----------------+-------------------
| At Birth, | |
| but before | From | From
| Respiration. | 1 to 24 Hours. | 2 to 3 Days.
---------+-----------------+----------------+-------------------
_Skin_. |As a rule, |The skin is |The skin assumes
| very red, soft, |firmer and rosy,|a yellowish
|smooth, and |and the vernix |tint. Sometimes
|covered with |caseosa not so |on the
|a whitish, fatty,|white. |abdomen and
|sticky coat | |base of the chest,
|(vernix caseosa).| |the epidermis
| | |shows signs of
| | |approaching
| | |exfoliation.
---------+-----------------+----------------+-------------------
_Head_. |Presence of caput| |The caput
|succedaneum. | |succedaneum has
| | |disappeared,
| | |leaving only a
| | |slight ecchymosis.
---------+-----------------+----------------+-------------------
_Umbilical_|Is fresh, firm, |The umbilical |The cord is
_Cord_. |bluish, roundish,|cord is |brown from its
|more or less |withering, and |extremity to its
|spongy. |the calibre of |base, is less
|The ductus |the arteries is |moist, and already
|arteriosus is |beginning to |shows signs of
|four to six |diminish from |mummification. The
|long. Its |the thickening |vessels are not
|lines diameter |of their walls. |easily made out,
|is double | |being flattened,
|that of each of | |and contain a
|the branches of | |fine clot more or
|the pulmonory | |less contracted.
|artery. | |
---------+-----------------+----------------+-------------------
_The_ |The large |The meconium |The green mucus
_Large_ |intestine |is discharged, |which covered the
_Intestine_.|contains |but the large |intestine is
|meconium. |intestine still |detached in
| |contains thick |places.
| |greenish mucus. |
---------+-----------------+----------------+-------------------
---------+--------------------+------------------+---------------
| From | From | From
| 3 to 4 Days. | 4 to 6 Days. | 6 to 12 Days.
---------+--------------------+------------------+---------------
_Skin_. |The icteric |The exfoliation |The exfoliation
|colour of the |of the skin |of the skin
|skin is more |extends from the |has extended to
|marked. Exfoliation |groins to the |the extremities.
|of the skin |axillæ and between|
|has begun over |the shoulders. |
|belly and base of |The epidermis |
|the chest. |is detached in |
| |strips, in scales,|
| |or as a firm |
| |powder. |
---------+--------------------+------------------+---------------
_Head_. | | |
---------+--------------------+------------------+---------------
_Umbilical_|The cord is of |The cord is |If the cord was
_Cord_. |a brownish-red |detached from |thin, cicatris-
|colour, flattened |the abdomen, the |ation is complete
|and distorted. |membranes first, |before the
|The vessels are |then the arteries,|tenth day. The
|twisted like a |and last, the |arteries, the
|gimlet. The arteries|vein. The arteries|vein, and other
|are in great |and the vein are |fœtal canals are
|part obliterated, |quite obliterated.|obliterated. If
|the calibre of the |The ductus |the cord was
|vein and ductus |arteriosus and |thick, a
|venosus is |foramen ovale |sero-purulent
|diminished, but they|diminished in size|discharge may
|and the foramen |are still open. |continue to the
|ovale are still | |twenty-fifth or
|open. The | |thirtieth day.
|circumference of | |
|the ring is injected| |
|and begins | |
|to show signs | |
|of inflammation, | |
|with the discharge | |
|of a sero-purulent | |
|fluid at | |
|the base of the | |
|cord. | |
---------+--------------------+------------------+---------------
_The_ |The green |The green mucus |
_Large_ |mucus almost |quite absent. |
_Intestine_.|absent. | |
---------+--------------------+------------------+---------------
1. _Changes in the Skin._--Exfoliation of the cuticle. The time
at which this occurs is so variable as to be of little value in a
medico-legal inquiry.
2. _Changes in the Umbilical Cord._--Mummification of the cord is
not of the slightest value as a proof of extra-uterine life; but the
separation of the cord which occurs between the fourth and seventh day,
especially when cicatrisation has taken place, is a sure sign that the
child must have lived four or five days at least. Two other appearances
of some value may also be noted, namely:
(_a_) In fresh bodies, the appearance of a bright red ring about a line
in breadth, which surrounds the insertion of the cord, and which is
formed within the uterus.
(_b_) A similar red ring, about two lines broad, around the insertion
of the cord, accompanied with “_thickening, inflammatory swelling of
the portion of the skin affected, and slight purulent secretion from
the umbilical ring itself_.” This latter condition Casper considers as
affording “_irrefragable proof of the extra-uterine life of the child_.”
3. _Changes in the Circulatory System._
(_a_) Ductus Arteriosus.--Arterial duct. A contracted condition of this
duct is of no value as a proof that a child has survived its birth; for
the duct is liable to become contracted, and even obliterated, before
the birth of the child.
(_b_) Ductus Venosus.--Nothing certain is known as to the exact time
when this duct closes; the condition of the vessel is, therefore, of no
assistance in determining the possibility of the child having survived
its birth. The duct has been found closed in a still-born child; and
in one child, which lived for a quarter of an hour, both the _ductus
arteriosus_ and the _foramen ovale_ were found closed. Cases are also
on record in which these fœtal channels were found open after thirty
days of extra-uterine life.
(_c_) Foramen Ovale.--What has been said of the preceding may be said
with regard to the foramen ovale.
_N.B._--To sum up, therefore, in the fewest words,
any attempt at forming an opinion on the _docimasia
circulationis_ may result in a fatal error on the
part of the medical witness, as it is impossible to
determine with any accuracy by days the period of their
closure. As a general statement, however, the following,
according to Bernt and Orfila, is the order in which
obliteration of the fœtal vessels takes place: (1) The
umbilical arteries. (2) Ductus venosus. (3) Ductus
arteriosus. (4) Foramen ovale.
Synopsis
1. Infanticide is not regarded as a specific crime.
2. To be tried by the same rules of evidence as apply to murder.
3. The law presumes that every child is born dead, till proof to the
contrary is given.
4. Onus of proving live birth devolves on the prosecution.
5. The body need not be found in order to obtain conviction of the
suspected party, if not of infanticide, at least of concealment of
birth.
The medical evidence, however, depends on the body being found and
examined.
The medical witness may be examined on one or more of the following
points:
(1) The recent delivery of the accused.
(For “Signs of Recent Delivery,” see page 155 et seq.)
(2) Maturity of the child found.
(3) Was the child still-born or live-born?
(4) Cause of death.
(5) Lastly, as to the mental condition of the mother.
Puerperal mania, &c.
6. In absence of proof of infanticide, the woman, in England, may be
tried for _concealment of birth_, that is, disposing secretly of the
body, whether the child be born dead or alive.
7. In Scotland, a woman may be tried for _concealment of pregnancy_
when the child is dead or missing, if she do not call for or make use
of help or assistance in the birth; but the case is quashed, if the
child be shown alive by the mother to others.
CHAPTER XV
INHERITANCE--LEGITIMACY--IMPOTENCE AND STERILITY
--SURVIVORSHIP--MALPRAXIS AND NEGLECT OF DUTY
--FEIGNED DISEASES--EXEMPTION FROM PUBLIC DUTIES
--WILLS
INHERITANCE
This subject will be discussed under the following heads: (1) The child
must be born alive. (2) The child must be born during the lifetime
of the mother. (3) The child must be born capable of inheriting. (4)
Tenancy by courtesy, and _possessio patris_.
=1. The Child must be born alive.=--This has been discussed in the
preceding section.
=2. The Child must be born during the lifetime of the Mother.=--Death
terminates the marriage contract. Would a child born after the death of
the mother, and therefore not during marriage, be entitled to inherit?
On this point Lord Coke writes:--“If a woman, seised of lands in fee,
taketh husband, and by him is bigge with childe, and in her travell
dyeth, and the childe is ripped out of her body alive, yet shall he
not be tenant by the curtesie, because the child was not born during
the marriage nor in the life of the wife; but in the meantime her land
descended.”
It appears from this that the husband is not entitled to the life-rent.
=3. The Child must be born capable of inheriting.=--Monsters cannot
inherit according to law. Blackstone says: “A monster which hath not
the shape of mankind hath no inheritable blood,” and cannot, therefore,
inherit; but, “if it hath human shape, it may be an heir.”
Buffon classes monsters under three divisions: (_a_) Monsters by excess
of organs. (_b_) Monsters by defect of organs. (_c_) Monsters by
alteration or wrong position of parts.
A hermaphrodite inherits, or not, property according to the prevailing
sex.
=4. Tenancy by Courtesy and Possessio Patris.=--“When a man marries a
woman seised of an estate of inheritance, and has by her issue _born
alive_, which was 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.”
There is yet another case bearing closely on this subject, known in law
as _possessio fratris_. On this subject Mr. Amos writes: “In the event
of a man twice married dying, and leaving a daughter by each marriage,
his estate would be equally shared by the daughters of the two
marriages; but if we suppose that there is also a son by the second
marriage, born in a doubtful state, the legal effect of his momentarily
surviving birth would be to disinherit the daughter of the first
marriage entirely, and transfer the whole of the estate to the daughter
of the second marriage, she being sister to the male heir, while the
daughter of the first marriage is only half-blood.”
In both of these cases proof of live birth, as before mentioned, is of
the slenderest kind.
A fœtus in the womb (_en ventre sa mère_) may--(_a_) Have a legacy
or estate made over to it. (_b_) A guardian assigned to it. That
these conditions may take effect, it must be born alive. (_c_) Be an
executor. To exercise this _post partum_ function, the child must in
England have attained the age of twenty-one.
LEGITIMACY
Every child born in wedlock is presumed to have the husband of the
woman as its father; but this presumption may be denied for the
following reasons:
1. Absence or death of the reputed father.
2. Impotence or disease in the reputed father, preventing
matrimonial intercourse.
3. In the case of a premature delivery in a newly-married woman.
4. Want of access.
5. The paternity of the child may be disputed when the woman
marries immediately after the death of her husband.
In Scotland, a child is held to be legitimate if born ten lunar months
after the death or absence of its alleged father; and the absence of
the supposed father must continue till within six lunar months of the
birth of the child, to prove its illegitimacy.
In the same country, a child born before marriage is rendered
legitimate by the subsequent marriage of the parents. This is not the
case in England.
A child born during wedlock is legitimate, although the date of
conception may be before marriage. A child born after the death of its
mother is held to be legitimate. A child may, as Taylor remarks, be
conceived before marriage, and born after the death of the mother, and
yet be legitimate, though neither conceived nor born in wedlock.
The Code Napoleon prohibits the contraction of a second marriage until
ten months after the death of the first husband; and this is also the
case in Germany. The Anglo-Saxon law prohibits remarriage for twelve
months. In Britain no time is fixed by law.
=Duration of Pregnancy.=--The consideration of this subject is of
importance in its relation to the legitimacy of a child.
The natural period of human gestation is usually stated at forty weeks,
ten lunar or nine calendar months, or 280 days. In Prussia, the period
is extended to 302 days, and in the Code Napoleon to 300; in Scotland,
ten months is held as the limit.
The duration of human gestation is subject to considerable variation;
in some females it is always protracted; in others, always premature.
Several modes of calculation are adopted by women:
1. Ascertained date of impregnation from one coïtus.
2. Supposed sensations of female at time of conception.
3. Suppression of the catamenia. This is open to the
objection, that causes other than that of impregnation
may arrest them. The catamenia may be stopped by cold or
other causes for two or three months, and then, before
their return, pregnancy may occur, thus upsetting all
calculations. The usual mode of calculation is from two
weeks after the last menstruation, and the period so fixed
is corrected by the time at which quickening occurs.
4. Period of quickening. (_a_) Quickening supposed when pregnancy
is absent. (_b_) Pregnancy without quickening.
(_c_) Variations in the time of its occurrence.
Whichever may be the mode of calculation adopted, it may be stated
that, as a rule, the period of human gestation is from 275 to 280 days,
and that cases of alleged pregnancy beyond 300 days must be received
with considerable caution.
The pregnancy of the Countess of Gloucester was held, in the reign of
Edward II., to be legitimate, although her husband had been dead one
year and seven months at the date of the application.
=Premature Births.=--The question may be asked, At what period of
gestation may a child be born viable--that is, capable of living and
attaining to maturity? Seven months, or 210 days, is considered as the
limit; but cases have been recorded of children born at six months
being reared. The Roman law admitted the legitimacy of seven-months’
children. (For the Signs of Immaturity, see “Table of the Development
of the Embryo,” pp. 35, 36.)
=Superfœtation.=--The term is used to imply the conception of a second
embryo in a woman already pregnant, and the birth of two children at
one time, differing considerably in their maturity, or of two births, a
considerable period of time elapsing between each. The possibility of
this occurrence has been doubted.
Churchill, in his work on Midwifery, writing on this subject says:
“In conclusion, I would say--(1) That the theory of superfœtation is
_unnecessary_ to explain the birth of a mature fœtus and a blighted
ovum, of a mature and immature fœtus born together or within a month
of each other, or of fœtuses of different colours, as they may
reasonably be supposed to be the product of one act of generation, or
of two nearly contemporaneous. (2) That, in cases of double uterus,
it is possible for a second conception to take place, and--judging
from the subsequent birth of the second child in the only case on
record--at a later period than the first. (3) That, in the remaining
cases, where one mature child succeeded the birth of another after a
considerable interval, we have no proof of a double uterus in any,
and positive proof that in one case it was single; and that to the
explanation of these cases no theory as yet advanced is adequate, that
of superfœtation being opposed by physical difficulties which are
unsurmountable in the present state of our knowledge.”
The late Dr. Matthews Duncan has, however, shown that the mouth of the
womb is not completely closed by conception, and the communication
between the vagina and ovary is not destroyed for some months after
impregnation, and that there is no impediment to the ascent of the
spermatozoa. Galabin[16] records an instance of extra-uterine and
uterine pregnancy occurring at the same time, the extra-uterine fœtus
being advanced in development as compared with that in the uterus, and
regards the condition as one of superfœtation.
[16] _Manual of Midwifery_, 1886.
The late Dr. Milne, while admitting this form of pregnancy as possible,
though very rare, remarks: “This variety we should not think due so
much to mechanical hindrances as to the absence of proper ovules. It
would imply extraordinary vigour were perfect ovulation to be achieved
for any length of time after impregnation.”
IMPOTENCE AND STERILITY
Evidence in relation to the above subjects may be required in actions
for nullity of marriage, divorce, legitimacy, inheritance, pregnancy,
and criminal assault.
=Impotence.=--By impotence is meant the incapacity for sexual
intercourse, and applies both to the male and female; but the term is
more especially used in reference to the former.
=Sterility.=--Sterility denotes the incapacity for procreation of
children; is also applicable to both sexes, but more usually in
reference to the female. A person may be impotent without being
sterile, although the former is usually regarded as implying the
latter. On the other hand, a person may be sterile without being
impotent, the former not necessarily denoting the latter. In reference
to nullity of marriage, if natural sexual relations are not and cannot
be consummated, the marriage will be declared null and void, provided
that such inability of consummation was unknown to the person bringing
the action for nullity before marriage. Impotence is sufficient ground
for bringing an action for nullity, provided it was present at the date
of the marriage, that it is irremediable, and that the person bringing
the action was not informed of it previously. Should, however, the
marriage have been consummated and impotence develop later, there will
be no grounds for such an action.
=Impotence and Sterility in the Male.=--This may arise from some
_organic defect_ of the organs or _functional disorder_. In reference
to the former there are certain abnormalities of the male organs which
have to be considered. Monorchids, men in whom one testis is absent
from the scrotum, are not necessarily impotent or sterile; nor are
cryptorchids, where both testes are undescended. In many of these
cases spermatozoa are absent from the seminal fluid with consequent
sterility; on the other hand, procreation has taken place, proving that
cryptorchids are not necessarily sterile.
Absence of the penis may be the result of want of development, injury,
disease, or operation. The penis may be present but attached in its
whole length to the scrotum; this may be remedied by operation.
Epispadias, so often associated with ectopion vesicæ, as a rule renders
an individual impotent and sterile. On the other hand, hypospadias
does not necessarily bar procreation; it will depend largely upon the
position of the urethral opening, and the possibility of its being
remedied by operation.
Removal or destruction of both testes renders a man sterile eventually,
but not necessarily impotent.
Functional disorder due to disease may give rise to impotence,
although the organs may remain anatomically perfect. Diseases such as
diabetes and influenza, neurasthenia, tabes dorsalis, myelitis, mumps,
and orchitis, and injuries to the head may be causative factors in
impotence.
The capacity for sexual intercourse is influenced to a varying degree
by age. Sexual capacity is regarded as coincident with puberty. In
judging the sexual capacity of a youth, age is of less moment than the
degree of physical development. I have seen a male child of five years
of age with as complete development of the sexual organs as an adult,
and with a deep voice. At the other extreme of life it is impossible to
lay down any definite limit to sexual capacity. Although it is regarded
as diminishing with age, yet there are many instances of procreative
power in men of an advanced age.
The principal points for consideration in reference to impotence
and sterility in the male are: (_a_) Does the condition prevent the
secretion of semen? (_b_) Does it prevent the conveyance of semen to
the vagina?
=Impotence and Sterility in the Female.=--As in the male, these may be
associated with organic defect or functional disorder. The external
organs may be absent, with or without the internal. The vagina may
be wanting through lack of development, or it may be obstructed by
mal-development or the result of disease. Again, the external organs
may be present, but the internal absent in whole or part. The hymen
may be imperforate, or unusually tough. Diseases of the uterus often
give rise to sterility. Vaginismus, in which attempts at coïtus cause
painful spasm, may prevent intercourse. In reference to functional
disorders are to be noted extreme debility, constant leucorrhœa,
dysmenorrhœa, menorrhagia, and amenorrhœa, all of which may be
associated with or causative factors in sterility. Emotional psychical
conditions may prevent sexual intercourse in women. General diseases,
however, do not necessarily prevent intercourse, as the woman may
remain a passive agent, neither is bodily deformity always a barrier to
the act.
The advent of sexual capacity in women is regarded as coincident with
the onset of the menses, about fourteen years of age, but pregnancy has
been known to take place prior to the first menstrual period. The age
at which the menses first appear varies in no small degree. It has been
known to occur during the first year of life, and pregnancy has been
known to occur as early as the eighth year. The menopause in women is
regarded as coincident with loss of procreative power. Women as a rule
cease to menstruate at forty-five years of age, but in not a few the
function persists until fifty, in exceptional cases to a more advanced
age. It is rare for a woman to bear children after the menopause, but
exceptions have been known to take place.
In the case of a husband seeking a nullity of marriage on the grounds
of impotence or sterility in his wife, the question at issue is not
whether she can bear children, but can she permit sexual intercourse?
Many conditions which cause sterility in the woman need not render her
impotent, and unless the latter obtains a nullity of marriage would not
be allowed. Further, the conditions which render the woman impotent
must be permanent and irremediable.
SURVIVORSHIP
The question of survivorship is not infrequently raised when a mother
and her new-born infant are found dead, or where several persons
have perished by a common accident. In the first case the mother is
generally presumed to have lived longest; and this presumption may be
borne out by the fact of the delivery being premature, or if there
be considerable disproportion between the size of the child and the
maternal passages. As pointed out before, important civil rights may
depend upon the question as to the live birth of an infant; and the
husband‘s rights to be _tenant to the courtesy_ will, of course, depend
upon the view taken as to the probable survivorship or not of the child.
With regard to the second question, much will depend upon the relative
ages and strength of the individuals. Sex will also have to be taken
into consideration. In the case of one or more persons found dead,
either from wounds or other causes, the fact of some being warm and
others cold, the presence of the _rigor mortis_ in one and absence in
the other, will point to the probable survivorship. The severity of the
wounds and injuries to large arterial trunks must also be considered.
(See test case, Underwood _v._ Wing, 1 Jur. N.S. 169.) In this case a
man, his wife, and three children were washed overboard and drowned,
one child, however, being seen alive a few minutes after the others
were submerged. The question at issue was, Did the husband survive the
wife, or the wife the husband? and on this Wightman, J., in summing
up, said: “We may guess, or imagine, or fancy, but the law of England
requires evidence, and we are of opinion that there is no evidence upon
which we can give a judicial opinion that either survived the other;
in fact, we think it unlikely that both did die at the same moment of
time, but there is no evidence to show who was the survivor.” Verdict
for the plaintiff.
MALPRAXIS AND NEGLECT OF DUTY
A medical man is liable to a civil action for damages who, by a
culpable want of care and attention, or by the absence of a competent
degree of skill and knowledge, causes injury to a patient. And it is
not necessary that the patient should have employed or was to have
paid him, provided always that there be no negligence or carelessness
on the part of the patient. Lord Chief-Justice Tindall remarks: “Every
person who enters into a learned profession undertakes to bring to the
exercise of it a reasonably fair and competent degree of skill.” It
has also been decided that if the defendant acted honestly, and used
his best skill to cure, and it does not appear that he thrust himself
in the place of a competent person, it makes no difference whether he
was at the time a regular physician or surgeon or not (R. _v._ Van
Butchell; R. _v._ Williamson, &c.). A surgeon does not undertake to
perform a cure, nor does he profess to bring the highest professional
skill into the consideration of the case; but he does undertake to
bring a fair and reasonable amount. The degree of skill required by law
is good common sense, or such knowledge as the operator had, joined
with a good purpose to help the afflicted, even if such interference
rendered the patient a cripple for life. “It would be dreadful,” says
Hullock, B., “if every time an operation was performed an individual
was liable to have his practice questioned.” “So, if a physician or
surgeon give his patient a potion or plaster to cure him, which,
contrary to expectation, kills him, this also is neither murder nor
manslaughter, but misadventure.” A medical man is only liable for gross
negligence, not for every slip he may make; but the distinction between
criminal and actionable negligence cannot be defined; but it appears
that the negligence must be so gross as to come under the legal meaning
of the word “felonious.” (See p. 82.)
FEIGNED DISEASES--MALINGERING
Human ingenuity is not wanting among those who, for private ends,
pretend to be suffering from disease. The soldier or sailor, anxious to
escape the dangers of active service, finds a ready means of evading
his duties by shamming; the prisoner, in order to lighten the burden of
his punishment, does the same. A man declares himself impotent to save
the expense of keeping an alleged bastard child, or to avoid punishment
for rape. Beggars appeal to the public by feigning some painful
disease, and incautious benevolence becomes the dupe of the clever
impostor.
Any attempt at classification is here out of the question, nor does
it appear necessary to give a long list of diseases which have been
feigned, or the means that have been employed by artists in deception.
To give some general hints for guidance is all that will be attempted
here, leaving matters of detail to the acumen of the medical examiner,
who, if in active practice, will have many opportunities of testing his
powers of discernment:
1. Never be satisfied with one visit, but pay a second at a
short interval, and unannounced.
2. Have the patient carefully watched in the interval of
your visits.
3. Examine each organ of the body separately, carefully
comparing the state of each with the symptoms described
by the patient.
4. Note the discrepancies in the statements of the patient
as to his symptoms and their known occurrence in real
disease.
5. Sometimes ask questions the reverse of his statements,
or take his statements for granted, when in all
probability he will contradict himself.
6. Remove all bandages and other dressings.
7. The administration of sham physic, or the suggestion of
some heroic mode of treatment; the application of the
actual cautery may have a beneficial effect.
8. Pay little attention to the reports of bystanders, or of
the culprit‘s fellow-prisoners.
9. Anæsthetics may be employed, if necessary, for the
purpose of detection.
10. The motives of deception should be inquired into, and
borne in mind, in the examination of all cases.
EXEMPTION FROM PUBLIC DUTIES
The existence of certain diseases may be claimed as a bar to active
service, both in a civil and in a military capacity; and the opinion
of a medical man may be required as to the fitness or unfitness of the
individual for the service from which he claims exemption. In giving
certificates of this nature, the medical practitioner cannot be too
guarded in wording them; and each case must be treated on its merits,
so that strict justice may be done.
Among the diseases which may incapacitate a man for active employment
may be mentioned--syphilis; hernia; phthisis; affections of the eyes,
attended with dimness of vision, or colour blindness; varicose veins;
and some other diseases.
WILLS
Although a medical man, as a rule, should refuse to draw up a will,
still there are occasions when his doing so may save much litigation
and expense. The following directions may therefore be of use:
1. Let the wishes of the testator be expressed in the plainest and
simplest words, avoiding all expressions that seem to admit of another
meaning than the one intended.
2. All alterations in the will should be initialled.
3. Do not scratch out a word with a knife, and no alteration must be
made after the will is _executed_.
4. Two witnesses are necessary, who must both be present and sign the
following attestation at the end of the will, or on each sheet if more
than one sheet of paper be used: “Signed by the testator (or testatrix,
as the case may be) in the joint presence of us, who thereupon signed
our names in his (or her) and each other‘s presence.”
5. Add address of witnesses.
6. A clause appointing an executor should be inserted thus: “And I
appoint J. B. executor of this my will.”
7. Begin, “This is the last will of me, W. B. of S.”; and end, “and I
revoke all former wills and codicils.” Dated this ___________ day of
______________ one thousand, &c.
CHAPTER XVI
MENTAL UNSOUNDNESS
In the whole range of medical jurisprudence there is no subject more
interesting, more difficult, or more important than the diagnosis
of insanity, and its relation to the criminal responsibility of
individuals. It is impossible, in the short space at our disposal, to
do more than to offer a few remarks which may assist the student in the
elucidation of some of the most important cases which may engage his
attention.
=Legal Definitions.=--Three forms of mental disorder are recognised in
law:
1. _A nativitate, vel dementia naturalis_--idiocy or imbecility.
2. _Dementia accidentalis, vel adventitia_--acquired general
insanity, either temporary or permanent, lunacy.
3. _Dementia affectata_, acquired madness from intoxication, &c.
(See “Delirium Tremens,” p. 205.)
Under the term lunacy are included the mania, monomania, and dementia
of medical writers. Another term frequently used in legal proceedings,
the meaning of which it is not easy to give, is “_non compos mentis_,”
_unsoundness of mind_. According to the late Forbes Winslow,
“unsoundness of mind is not lunacy” in the legal acceptance of the
phrase. This term was first used in a Statute passed in the reign of
Henry VIII., relating to the punishment of treasonable offences, and
is defined by the early law text-books to be strictly one who _gaudet
lucidis intervallis_--a definition not psychologically exact. The
phrase “unsoundness of mind” was first used by the late Lord Eldon to
designate a state of mind not exactly idiotic, and not lunatic with
delusions, but a condition of intellect occupying a place between the
two extremes, and unfitting the person for the government of himself
and the management of his affairs.
The above definition has been acted upon by other judges--Lyndhurst,
Brougham, &c. As a rule, a medical witness will consult his own
interest in not attempting to define insanity, bearing in mind the
philosophic caution of Polonius, who, when addressing Hamlet‘s mother,
says--
“Your noble son is mad:
Mad call I it; for, to define true madness,
What is‘t but to be nothing else but mad?”
To the legal mind, the chief character of insanity is the presence of
_delusion_; but this view is far too restricted. It was first advanced
by Erskine in the trial of Hadfield. Before that trial the doctrine
was that every man was responsible for his acts, unless he was totally
deprived of his understanding and memory, and did not know what he was
doing, “no more than an infant, than a brute, or a wild beast” (R.
_v._ Arnold). In the case of Bellingham, the knowledge of “right” and
“wrong” in the abstract was the test of mental unsoundness; and, as in
the opinion of the judge and jury he was held to be capable of solving
this metaphysical problem, Bellingham was duly hanged.
Since the trial and acquittal of MacNaughton on the ground of insanity,
the doctrine of the knowledge of abstract right and wrong has been
changed to a knowledge of right and wrong in relation to the particular
act of which the person is accused, and also at the time of committing
it.
It has also been held that, on the assumption that a person labours
under partial delusion only, and is not in other respects insane, he
must be considered in the same situation as to responsibility as if
the facts, with respect to which the delusion exists, were real. For
example, if, under the influence of delusion, he supposes another man
to be in the act of attempting to take his life, and he kills that man,
as he supposes, in self-defence, he would be exempt from punishment.
If his delusion were that the deceased had inflicted a serious injury
on his character and fortune, and he killed him in revenge for such
supposed injury, he would be liable to punishment. “Here,” says
Maudsley, “is an unhesitating assumption that a man, having an insane
delusion, has the power to think and act in regard to it _reasonably_,
... that he is, in fact, bound to be reasonable in his unreason, sane
in his insanity.” Yet this was the doctrine laid down by the judges
in answer to certain questions propounded by the House of Lords after
the acquittal of MacNaughton (see Maudsley‘s _Responsibility in Mental
Disease_, pp. 88 _et seq._).
As laid down by English lawyers, madness absolves from all guilt in
criminal cases. Where the deprivation of the understanding and memory
is total, fixed, and permanent, it excuses all acts; so, likewise,
a man labouring under adventitious insanity is, during the frenzy,
entitled to the same indulgence, in the same degree, as one whose
disorder is fixed and permanent (Beverley‘s Case, Co. 125, Co. Litt.
247, 1 Hale 31). “But the difficulty in these cases is to distinguish
between a total aberration of intellect and a partial or temporary
delusion merely, notwithstanding which the patient may be capable of
discerning right from wrong; in which case he will be guilty in the eye
of the law, and amenable to punishment.”[17]
[17] Archbold‘s _Criminal Cases_.
Lord Hale, who first pointed out the distinction to be drawn between
total and partial insanity, offered the following as the best test
he could suggest: “Such a person, as labouring under melancholy
distempers, hath yet as great understanding as ordinarily a child of
fourteen years hath, is such a person as can be guilty of felony.” (On
this subject, see R. _v_. Ld. Ferrers, 19 St. Tr. 333; R. _v_. Arnold,
16 St. Tr. 764, &c.)
To excuse a man from punishment on the ground of insanity, it
appears that it must be distinctly proved that he was not capable of
distinguishing right from wrong, and that he did not know, at the time
of committing the crime, that the offence was against the laws of _God_
and _nature_ (R. _v_. Offord, 5 C. & P. 186).
I shall here quote from Macdonald‘s _Criminal Law of Scotland_:
“Insanity or idiocy exempts from prosecution. But there must be an
alienation of reason such as misleads the judgment, so that the person
does not know ‘the nature of the quality of the act’ he is doing, or if
he does know it, that he does not know he is doing what is wrong. If
there be this alienation, as connected with the act committed, he is
not liable to punishment, though his conduct may be otherwise rational.
For example, if he kill another when under an insane delusion as to
the conduct and character of the person--_e.g._ believing that he is
about to murder him, or is an evil spirit,--then it matters not that he
has a general notion of right and wrong. For, in such a case, ‘as well
might he be utterly ignorant of the quality of murder.’ He does the
deed, knowing murder to be wrong, but his delusion makes him believe he
is acting in self-defence, or against a spirit. Nor does it alter the
effect of the fact of insanity at the time, that the person afterwards
recovers.... But the alienation of reason must be substantial. Oddness
or eccentricity, however marked, or even weakness of mind, will not
avail as a defence. Even monomania may be insufficient as a defence,
where the delusion and the crime committed have no connection, or where
the person, though having delusions, was yet aware that what he did was
illegal.”
Mere moral insanity--where the intellectual faculties are sound, and
the person knows what he is doing, and that he is doing wrong, but has
no control over himself, and acts under an uncontrollable impulse--does
not render him irresponsible (R. _v_. Burton, 3 F. & F. 772). Some
medical writers contend that there are two forms of insanity--moral and
intellectual. The law only recognises the latter, owing probably to
the difficulty of distinguishing between so-called moral insanity and
moral depravity. Taylor says: “Further, until medical men can produce
a clear and well-defined distinction between moral depravity and moral
insanity, such a doctrine, employed as it has been for the exculpation
of persons charged with crime, should be rejected as inadmissible.”
The day may not be far distant when the term “moral depravity” will
be unknown, and future generations, ceasing to believe in absurd
superstitions, will come to look on crime as the result of disease
of the brain, and learn to treat, instead of to punish, the morally
diseased. (For a full discussion of this subject the reader is referred
to the works of Dr. Henry Maudsley.)
The fact of the sanity or insanity of the prisoner at the time the
crime was committed is left to the jury to decide, guided by the
previous and contemporaneous acts of the party; and it has been laid
down by Lord Moncreiff in Scotland, and Lord Westbury in England,
that the mental soundness or unsoundness of any individual is to be
decided by the jury on the ordinary rules of every-day life, and that
on these principles they are as good judges as medical men. The whole
tendency of legal practice, when dealing with the plea of insanity, is
to entirely ignore the medical evidence. On the question of medical
evidence in cases of insanity, Doe J., of New Hampshire, remarks: “At
present, precedents require the jury to be instructed by experts in
new medical theories, and by judges in old medical theories,” and that
in this “the legal profession were invading the province of medicine,
and attempting to install old exploded medical theories in the place
of facts established in the progress of scientific knowledge. If the
tests of insanity are matters of law, the practice of allowing experts
to testify what they are should be discontinued; if they are matters
of fact, the judge should no longer testify without being sworn as a
witness, and showing himself qualified to testify as an expert.”
=Lunacy--What Constitutes?= (8 and 9 Vict. c. 100, secs. 90 and
114).--Imbecility and loss of mental power, whether arising from
natural decay, or from paralysis, softening of the brain, or other
natural cause, and although unaccompanied with frenzy or delusion of
any kind, constitute unsoundness of mind, amounting to lunacy within
the meaning of 8 and 9 Vict. c. 100 (R. _v_. Shaw, 1 C.C. 145).
The above is the last definition of lunacy up to 1875; but as the law
on this subject is so constantly changing, the student will find it
best to consult the _Law Reports_ from time to time. (See the account
in the case of R. _v_. Treadaway, _Law Reports_. Also the _Lancet_, on
the same case, vol. i. 1877.)
For some valuable remarks on the subject of the irresponsibility of
madmen, the student is referred to the works of Maudsley, Pritchard,
Ray, Hoffbauer, Georget, and others.
The following suggestions are offered for consideration on this subject:
1. Was the act an isolated event in the life of the culprit? Has it the
appearance of spontaneity, or was it the culminating point of a life
spent in so-called criminal acts?
2. _Absence of a motive for the committal of the deed._--The absence
of an _apparent_ motive is no proof of an unsound mind; the moving
principle may be _“the conscious impulse to the illegal gratification
of a selfish desire_.”
3. _The presence or absence of a well-concerted plan of action is
a diagnostic sign of little value._--Casper remarks that “only in
one case can the examination of the systematic planning of the deed
afford any information, and that is when these plans and preparations
themselves evince the stamp of a confused intellect, and betray the
hazy consciousness, the mental darkness, in which the culprit was
involved.”
4. _A dominant delusion may be so concealed as to be for a time
undiscoverable._--The case of the man who gave no indication of his
madness till he was asked to sign the order for his release, when
he signed _Christ_, is an example how carefully a delusion may be
concealed even during a most careful examination. Questions directed to
this point showed that he laboured under all the errors which such a
delusion might suggest.
5. It may “easily be conceived that insane persons, whose unreason
affects only one train of thought more or less restricted, yet labour
in other respects under disorders of feeling which influence their
conduct and their actions and behaviour without materially affecting
their judgment: and that many of such deranged persons, who often
conduct themselves tolerably well in a lunatic asylum, and while living
among strangers with whom they have no relations, and against whom
they have no prejudices or imaginary reason of complaint; subjected,
besides, to the rules of the house and to an authority that nobody
attempts to dispute; would, nevertheless, if restored to liberty
and residing in the midst of their families, become insupportable,
irritable at the slightest contradiction, abusive, impatient of the
least remark on their conduct, and liable to be provoked by trifles to
the most dangerous acts of violence. If, under such circumstances, a
lunatic should commit any act of injury or serious damage to another,
would it be just to punish him; because it cannot be made apparent that
the action has any reference to, or connection with, the principal
delusion which is known to cloud his judgment, it being apparent that
his moral faculties have undergone a total morbid perversion?”
6. _Insanity with Lucid Intervals._--Haslam, Ray, and others appear
to deny the possibility of lucid intervals; but M. Esquirol, on the
other hand, fully recognises the existence of this form of insanity.
In a legal sense, a temporary cessation of the insanity constitutes
a lucid interval, but the cessation must be complete, and not merely
a remission of the symptoms. The interval must be of some duration;
and when continuous insanity has been proved, the onus of proving a
lucid interval in civil cases rests with the party trying to support
the validity of a deed executed during the alleged interval. “If
you can establish,” says Sir W. Wynne, “that the party afflicted
habitually by a malady of the mind has intermissions, and if there was
an intermission of the disorder at the time of the act, that being
proved is sufficient, and the general habitual insanity will not affect
it, but the effect of it is this--it inverts the order of proof and
presumption; for, until proof of habitual insanity, the presumption
is that the party agent, like all human creatures, was rational; but
when an habitual insanity in the mind of the person who does the act is
established, then the party who would take advantage of the fact of an
interval of reason must prove it.” In civil cases the law recognises
the validity of wills made during lucid intervals, and has even taken
the reasonableness of a will as a proof of a lucid interval.
7. Have measures been taken by the culprit to escape punishment?
The classification of insanity adopted here is that given by Ray, and
is sufficient for all practical purposes:
{ 1. Resulting from
{ congenital defect.
{ 2. Resulting from an
{ obstacle to the
{ Defective { _Idiocy_ { development of the
{ development { { faculties supervening
{ of the { { in infancy.
{ faculties. {
{ { { 1. Resulting from
{ { { congenital defect.
{ { { 2. Resulting from an
{ { _Imbecility_ { obstacle to the
{ { { development of the
{ { { faculties supervening
{ { { in infancy.
INSANITY. {
{ Lesion of { { 1. Intellectual--
{ the faculties { { (_a_) General.
{ subsequent { _Mania_ { (_b_) Partial.
{ to their { { 2. Affective--
{ development. { { (_a_) General.
{ { { (_b_) Partial.
{ {
{ { { 1. Consecutive to mania,
{ { { or injuries of
{ { _Dementia_ { the brain.
{ { { 2. Senile, peculiar to
{ { { old age.
DEFECTIVE DEVELOPMENT OF THE FACULTIES
Under this heading may be included idiocy, cretinism, imbecility,
feeble-mindedness, and moral imbecility.
=Idiocy= is congenital, and was defined by Esquirol thus: Idiocy is
not a disease, but a condition in which the intellectual faculties are
never manifested, or have never been developed sufficiently to enable
the idiot to acquire such an amount of knowledge as persons of his own
age, and placed in similar circumstances with himself, are capable of
receiving. Idiocy commences with life, or at an age which precedes
the development of the intellectual and affective faculties, which
are from the first what they are doomed to be during the whole period
of existence. Since the days of Esquirol, much improvement has been
made in the care and treatment of the idiot; and it appears that he is
capable of some, though in most cases slight, mental culture. The cases
in which improvement takes place probably belong to imbecility, leaving
the _idiot_ in the same condition as described by Esquirol.
=Cretinism= differs from idiocy in being endemic; it is also more
curable, or at least more susceptible of improvement, than the latter.
In the idiot the malady is congenital; the cretin, on the other hand,
may to all appearances be free from disease for a time. “Every cretin
is an idiot, but every idiot is not a cretin; idiocy is the more
comprehensive term, cretinism is a special kind of it.” The enlarged
thyroid gland, high-arched palate, and brown or yellow colour of the
skin, are characteristic of the cretin. Local causes are at work in the
production of cretinism; _e.g._ defective function of the thyroid gland.
The idiot is usually cunning, mischievous, and dirty in his habits.
The derivation of the word idiot, from the Greek, ἰδιώτης --_a private
person_, or _an ill-informed ordinary fellow_--is peculiar. A person
suffering from any form of mental unsoundness, and thereby rendered
incapable of taking care of himself or of his property, was formerly
called by English law “an idiot,” and this word was not infrequently
joined with “fatuus” in old writs.
=Imbecility.=--This is a minor form of idiocy, and may or may not be
congenital. It admits of considerable degrees of intensity. Imbeciles
exhibit mental defection, rendering them incapable of managing
themselves or their affairs, and imbecile children are incapable of
being taught to do so.
=Feeble-mindedness= is a lesser degree of mental defection than
imbecility. It may exist from birth or an early age. Such persons
require care and control for the protection of themselves and others.
They may be incapacitated from acquiring the knowledge imparted in
ordinary schools.
=Moral imbeciles= exhibit moral defects which render them vicious in
behaviour, and they often exhibit criminal tendencies, which are not
affected by punishment.
CARE OF MENTALLY DEFECTIVE PERSONS
The Mental Deficiency Act of 1913 provides for their care. Such a
person may be either sent to an institution or placed under special
guardianship by the parent or guardian, if an idiot or imbecile;
or by the parent when, though not an idiot or imbecile, the person
affected be under the age of twenty-one years. If in addition to being
a defective, the person is neglected, abandoned, or without means of
support; or cruelly treated, guilty of a criminal offence, or liable to
be sent to an industrial school, or under imprisonment, detained in an
industrial school, inebriate reformatory, or institution for lunatics,
or habitual drunkard within the meaning of the Inebriates Act; or
in whose case proper notice has been given by the Local Education
Authority; or who is in receipt of relief at the time of giving birth
to an illegitimate child, or pregnant of such child.
=Certificates required.=--In the case of a parent or guardian who
desires to place a mentally defective person under guardianship, _two
medical certificates_ are necessary, one of which must be from a
medical man approved by the Local Authority or Board. If the person be
not an idiot or imbecile, the certificates must be signed by a Judicial
Authority, after such inquiry as he thinks fit. A defective to be
dealt with otherwise than by parent or guardian, is so under an order
by a _Judicial Authority_ on a petition presented under the Act, an
order of a _Court_ if guilty of a criminal offence, or an order of the
Secretary of State if detained in prison, a criminal lunatic asylum, or
reformatory.
The order of a Judicial Authority may be obtained by petition of any
relative or friend, or an officer of the Local Authority authorised
under the Act for the purpose. Two medical certificates must accompany
the petitions, one of which must be signed by a medical man approved
by the Local Authority or Board; or, when a medical examination cannot
be carried out, a certificate to that effect must be presented, and
a statutory declaration made by the petitioner and one other person,
who may be one of the medical certifiers, stating the class to which
the defective belongs. Upon receiving the certificates the Judicial
Authority interviews the defective. When the petition is presented by
a parent or guardian, the Judicial Authority, if satisfied, may issue
an order for the defective to be placed in an institution or appoint
a guardian. If the petitioner be not parent or guardian, consent in
writing of one or other must be obtained, without which the order must
not be made, unless the parent or guardian withhold their consent
unreasonably or are not to be found. If the Judicial Authority be not
satisfied, he may postpone the order, or refuse it.
When the order is made by a Court, the Court must be satisfied, on
medical evidence, that the person is a defective.
Two medical certificates are necessary when the Secretary of State
makes an order.
The order remains in force for a year, may be renewed for a second
year, and then for periods of five years.
GENERAL SYMPTOMS OF INSANITY
The onset of insanity may be gradual or sudden. More commonly the onset
is gradual, and manifested by alterations of emotion and conduct, which
may for a considerable period precede any impairment of intelligence.
Periods of depression may alternate with periods of excitement.
Irritability and instability of temper manifest themselves, and lead
relatives and friends to become suspicious of the change that is the
herald of serious mental impairment. Lack of interest in environment,
business, or the usual pleasurable pursuits, also a tendency to
personal seclusion manifest themselves, and changeability of the
affections, more often to those nearly related, are not uncommon.
Sooner or later the capacity to conduct business and allied pursuits
becomes enfeebled, and the power of judgment lessened; depression
begets apprehension and a dread of impending ruin in this world or
in the world to come. Marked indecision and vacillation of action is
quite common. Delusions follow, mostly of persecution, in the form of
attempts to cause ruin or poisoning. Delusions associated with the
special senses are common, particularly of hearing, supposed voices
urging the committal of certain actions, or expressive of derision; of
vision, by which objects are seen which are non-existent; of taste,
imparting the idea of poisoning; of touch and pain, invoking peculiar
sensations; of smell, conveying the idea that food, the body, &c.,
exhale disgusting odours.
Associated with the onset of insanity, and remaining permanently,
are three special distortions of perceptions--viz. _illusions_,
_hallucinations_, and _delusions_. So long as the first two can be
reasoned upon and rejected, judgment remains. At one or other time
the afflicted person becomes so affected by them that they become
realities, and are accepted as true and existent; then the judgment is
perverted, and the person is said to suffer from a delusion.
_Illusions._--An illusion is a false perception, a perversion of
the senses, a mockery, false show, counterfeit appearance. The false
perception is, however, invoked by some external appearance.
_Hallucinations._--Hallucinations are perverted sensations and
perceptions, for the production of which no external impulse is
present. The person may complain of seeing horrible reptiles around,
which are not present. So long as the reasoning faculties are capable
of dispelling the alleged reality of the hallucination and rejecting
it, it remains but an hallucination.
If, however, it becomes accepted as a reality and the person becomes
obsessed thereby, it becomes a delusion.
_Delusions._--A delusion is a chimerical thought, an affection of the
mind. It implies a disordered intellect. Delusions generally concern
the insane person, his power, soul, &c. A delusion is a perverted
idea of the mind in which there is belief in non-existent things or
occurrences. Delusions may be based upon previous hallucinations, or
arise out of erroneous conceptions.
MANIA
=Mania= is the result of a morbid condition of the brain, and to
express which “the term raving madness may be used with propriety,
as an English synonym for mania. All maniacs display this symptom
occasionally, if not constantly, and in greater or less degree.” Like
other diseases, mania observes the same pathological laws. There is a
period of incubation, during which the true state of the patient is in
most cases misunderstood, or not appreciated. Mental exaltation may
exist from the first onset of the disease, or the attack may be ushered
in by a stage of gloom or despondency. The general health shows signs
of impairment, the liver becoming sluggish, and the bowels confined or
relaxed. In some cases a febrile condition of the system is among the
premonitory symptoms of an attack of mania. The physical health is not
usually much affected during the paroxysm.
Dr. Conolly remarks that “even acute mania is not always accompanied
by the ordinary external signs of excitement. It would seem as if we
had yet to learn the real symptoms of cerebral irritation. Certainly,
in recent cases of mania--cases which have lasted more than six weeks,
and in young persons in whom I have seen the maniacal attack pass
into dementia--I have known the most acute paroxysms of mania exist,
rapid and violent talking, continual motion, inability to recognise
surrounding persons and objects, a disposition to tear and destroy
clothes and bedding, without any heat of the scalp or of the surface,
without either flushing or paleness of the face, with a clean and
natural appearance of the tongue, and a pulse no more than eighty or
eighty-five.”
This may occur in some cases, but in the majority there is always some
amount of physical derangement; the system, however, gradually becoming
tolerant of the undue excitement to which it is subjected.
Following the classification adopted, Intellectual Mania will now be
briefly considered under its two divisions--_General_ and _Partial_.
=General Intellectual Mania.=--By many medical writers general
intellectual mania is divided into mania and melancholia. The mind
in the former type of the disease is involved in the most chaotic
confusion possible, and there is also considerable bodily derangement.
The moral faculties become more or less affected, and the patient‘s
social and domestic relations are greatly altered. At one time he
is subject to violent fits of immoderate laughter, at another he is
gloomy and taciturn; sometimes quiet and tractable, at others wild
and excited, necessitating close confinement. He is haunted by wild
delusions, which at times take entire possession of him, and under
the influence of which he acts in the most extraordinary manner. In
the latter--melancholia, or mania with depression--delusion may be
absent, or, rather, for a time undetectable. The sufferer is gloomy,
and troubled with unhappy thoughts, which sometimes lead him to
self-destruction. He is sleepless, and rejects his food as unnecessary.
He may be aroused for a short time by questions addressed to him,
his replies to which are usually given correctly, most frequently in
monosyllables; but the moment his questioner leaves him he relapses
into his former gloomy state.
=Partial Intellectual Mania.=--The term _monomania_, first suggested
by Esquirol, is now generally given to this variety of insanity. The
patient, in the simplest form of this disorder, becomes possessed of
some single notion, which is alike contradictory to common sense and
to his own experience. Thus, he may fancy himself made of glass; and
influenced by this idea, he walks with care, and in dread of being
broken by contact with other bodies. In the case of an inmate at
the City of London Asylum, the presence of a weasel in the stomach
was stated by one woman. Esquirol mentions the case of a woman with
hydatids in her womb, who believed that she was pregnant with the
devil. Most of these strange fancies appear to be dependent on errors
of sensation.
Monomaniacs are ready enough to declare their predominant idea; yet
at times, and that without the occurrence of a lucid interval, they
will as carefully conceal it. “In the simplest form of monomania, the
understanding appears to be, and probably is, perfectly sound on all
subjects but those connected with the hallucination. When, however, the
disorder is more complicated, involving a longer train of morbid ideas,
we have the high authority of Georget for believing that, though the
patient may reason on many subjects unconnected with the particular
illusion on which the insanity turns, the understanding is more
extensively deranged than is generally suspected.”
MORAL MANIA
Pinel first drew attention to this form of madness. Pritchard defines
it as “consisting in a morbid perversion of the natural feelings,
affections, inclinations, temper, habits, and moral dispositions,
without any notable lesion of the intellect or knowing and reasoning
faculties, and particularly without any maniacal hallucinations.”
It is divided into--_General_ Moral Mania. _Partial_ Moral Mania.
=General Moral Mania.=--“There are many individuals,” says Pritchard,
“living at large, and not entirely separated from society, who are
affected in a certain degree with this modification of insanity. They
are reputed persons of a singular, wayward, and eccentric character. An
attentive observer will often recognise something remarkable in their
manners and habits, which may lead him to entertain doubts as to their
entire sanity; while circumstances are sometimes discovered on inquiry
which add strength to this suspicion. In many instances it has been
found that a hereditary tendency to madness has existed in the family,
or that several relatives of the person affected have laboured under
other diseases of the brain. The individual himself has been discovered
to have suffered, in a former period of life, an attack of madness
of a decided character. His temper and disposition are found to have
undergone a change, or to be not what they were previously to a certain
time; he has become an altered man, and the difference has perhaps
been noted from the period when he sustained some reverse of fortune
which deeply affected him, or the loss of some beloved relative. In
other instances, an alteration in the character of the individual has
ensued immediately on some severe shock which his bodily constitution
has undergone. This has been either a disorder affecting the head, a
slight attack of paralysis, or some febrile or inflammatory complaint,
which has produced a perceptible change in the habitual state of his
constitution. In some cases, the alteration in temper and habits has
been gradual and imperceptible; and it seems only to have consisted in
an exaltation and increase of peculiarities which were always more or
less natural and habitual. Persons labouring under this disorder are
capable of reasoning, or supporting an argument upon any subject within
their sphere of knowledge that may be presented to them; and they often
display great ingenuity in giving reasons for the eccentricities of
their conduct, and in accounting for, and justifying, the state of
moral feeling under which they appear to exist. In one sense, indeed,
their intellectual faculties may be termed unsound--they think and act
under the influence of strongly excited feelings; and persons accounted
sane are, under such circumstances, proverbially liable to error,
both in judgment and conduct.” (For interesting cases of this form of
madness, see Ray‘s _Jurisprudence of Insanity_.)
=Partial Moral Mania.=--In the case of the unfortunate sufferers from
this malady, one or two only of the moral powers are perverted.
This division admits of several subdivisions:--
_Kleptomania._--A marked propensity to theft. “There are persons,”
says Rush, “who are moral to the highest degree as to certain duties,
but who, nevertheless, lie under the influence of some vice. In one
instance, a woman was exemplary in her obedience to every command of
the moral law except one--she could not refrain from stealing. What
made this vice more remarkable was, that she was in easy circumstances,
and not addicted to extravagance in anything. Such was the propensity
to this vice that, when she could lay her hands on nothing more
valuable, she would often, at the table of a friend, fill her pockets
secretly with bread. She both confessed and lamented her crime.”
_Pyromania._--This consists in an insane impulse to set fire to
everything--houses, churches, and property of every kind and
description.
_Erotomania and Nymphomania._--This is known as amorous madness,
and consists in an inordinate and uncontrollable desire for sexual
intercourse. The unfortunate victims of this disease often express the
greatest disgust and repugnance for their conduct.
_Homicidal Mania_--In this form of madness the propensity to homicide
is very great, and in most cases uncontrollable. In the case of the
notorious Deeming, hanged in Australia in 1892 for the murder of his
wife, an appeal was made from the finding of the Colonial Court by
which he was tried to the Privy Council, on the ground of his being
affected with homicidal mania. The plea was not sustained. (See the
case of Henrietta Cornier, given by Pritchard, Ray, and others.)
The following suggestions may be of assistance in forming a diagnosis
as to the existence or non-existence of this form of madness:--
1. Previous history of the individual.--_Melancholy,
eccentric, morose, &c._
2. Absence of motive.--_Gain, jealousy, revenge, hatred, &c._
3. A number of victims are often sacrificed at one
time.--_The murderer, on the other hand, seldom sheds
more blood than is necessary for his success._
4. Proceedings of the murderer before and after the
crime.--_Absence of attempts at concealment or escape
on the part of the madman._
5. Character of the victims.--_Not infrequently, in the
case of madmen, their victims are those whom, when sane,
they loved most, and to whom they were most attached._
_Suicidal Monomania, or the Propensity to Suicide._--Much discussion
has arisen on this subject. Suicide is not always the result of
unsoundness of mind. Some, like M. Esquirol, are inclined to consider
suicide as always a manifestation of insanity. In the present day, the
dislike of coroners‘ juries to bring in any other verdict but that of
“suicide whilst in a state of unsound mind” is proverbial.
MELANCHOLIA
This condition is associated with mental depression and delusions.
In its simple form, marked depression of spirits, apprehension of
evil, sleeplessness, loss of appetite, and impaired alimentation with
constipation are evident.
Delusions of ruin, of the committal of acts contrary to the laws of
God and man--“_the unpardonable sin_”--a marked inaptitude to carry on
the ordinary duties of life, indecision, and often unutterable misery,
are commonly exhibited. The delusions are fixed and may be multiple.
They may comprise persecution, by friends or others; that things are
happening which powerfully influence the person‘s life and body, or,
as is often the case, concern religious matters, and everlasting
punishment.
Suicidal tendencies are often present, and depend largely upon the
misery associated with the condition. Melancholics often conceal this
tendency, or may exhibit it in varied ways so as to hide the method
which has been definitely decided upon. Thus a person so afflicted may
be found in possession of poison at one time, a pistol at another, a
knife at another, when the real intention is that of drowning. Thus
it is necessary to keep an extremely careful watch on melancholics.
Homicidal tendencies are not common. In some cases the melancholia is
combined with _marked agitation._ The face depicts misery, the eyebrows
raised, and the person moves about incessantly, picking up objects and
replacing them, moaning and uttering the same phrases expressive of
misery and hopelessness, wringing the hands, and rocking the body to
and fro.
In other cases _stupor_ is predominant, and the person sits in silence
and in the same attitude. Some resent interference, others are easily
persuaded by their attendants to do certain acts, but when done relapse
again into stupor. They manifest extreme apathy. Suicidal tendencies
are a pronounced feature of such cases.
Melancholia and mania may alternate periodically, with lucid intervals
intervening. The term _circular insanity_ has been applied to this
alternate character of the disease.
DEMENTIA OR FATUITY
=Dementia= consists in a failure of the mental faculties, not
congenital, but coming on during life. “A man,” says Esquirol, “in a
state of dementia is deprived of advantages which he formerly enjoyed.
He was a rich man who has become poor. The idiot, on the contrary,
has always been in a state of want and misery.” In this state there
is always more or less coherence, and maniacal paroxysms are not
infrequent. In mania, incoherence may be present, but then it is
characterised by sustained and violent excitement. In dementia, on
the other hand, there is apparent torpor and exhaustion of the mental
faculties. Closely allied to this form of mental unsoundness is that
interesting disease known as “=general paralysis of the insane=,” or
perhaps a better term, _progressive paralysis of the insane._ It is
considered by some to precede the psychical derangement, a contrary
opinion being held by others. General paralysis may accompany any of
the forms of mental derangement, but it is generally preceded by a
stage of melancholy. As the paralytic affection becomes more marked,
there is a concurrent loss of memory and incapability of mental
association, and all sense of duty is lost; the patient becomes
careless as to his person, and dirty in his habits. He expresses
himself as possessed of great property, and boasts of the wonderful
deeds that he can or has accomplished. Gradually he sinks into a state
of complete mental and physical decay. He cannot give expression to
his thoughts, and has to be fed, the food being pushed into his mouth.
The symptom which first attracts the attention, and which is perhaps
the first order of sequence, is a modification in the articulation.
“This is neither stammering nor hesitation of speech. It more closely
resembles the thickness of speech observable in a drunken man. It
depends upon loss of power over the co-ordinate action of the muscles
of vocal articulation.” If the tongue be now examined, it will be
found that when it is protruded it is not inclined to one side, but
that it is tremulous, and is protruded and withdrawn in a convulsive
manner. Griesinger was the first to call attention to the fact, and his
statement has since been confirmed, “that this motory disorder is at
the commencement not so much paralytic as convulsive in its nature.”
The gait becomes unsteady, the patient walks stiffly, and stumbles
over the slightest unevenness in the floor. Step by step the paralysis
progresses, till at last the unfortunate sufferer takes to his bed, on
which he may lie for months. Sometimes, especially during the earlier
stages, he may suffer from terrible delusions, from maniacal paroxysms,
or from epileptic fits, the latter possessing certain peculiarities.
The tongue during the fit is seldom bitten, which is so commonly the
case in epilepsy; and the convulsions are not so general, being limited
more to one side than to the other. It is also remarkable that each fit
is in most cases followed by an increase of the mental derangement.
Pritchard recognises four stages of dementia or fatuity:--
_First Stage._--Forgetfulness and impaired memory. This is common
to old age. In most cases passing events produce little, if any,
impression, whilst the past is remembered with tolerable freshness.
_Second Stage._--Incoherence and unreason, characterised by a total
loss of the reasoning faculty.
_Third Stage._--Incomprehension. The person so affected is quite
incapable of comprehending the meaning of the simplest question; and
should he attempt to reply, his answer is generally remote from the
subject.
_Fourth Stage._--Inappetency. The animal instincts are lost. The
unfortunate sufferer lives, and that is all, being scarcely conscious
of life. Organic life is all that is left.
DELIRIUM TREMENS. SIMPLE DELIRIUM. SOMNAMBULISM. SLEEP-DRUNKENNESS.
=Delirium Tremens.=--A temporary form of insanity, the result of
excessive indulgence in spirituous liquors. The drunkard, under the
effects of intoxication, “can derive no privilege from a madness
voluntarily contracted, but is answerable to the law equally as if he
had been in full possession of his faculties at the time” (1 Hale 32;
Co. Litt. 247). The intoxication of the defendant may be taken as a
mitigating circumstance, showing that the deed was unpremeditated. A
person rendered incapable of using his reason by intoxication brought
about by others, is not liable for his actions.
=Simple Delirium.=--Acts performed during attacks of certain
diseases--fever, sunstroke, &c.--accompanied with delirium, do not
render the individual liable to punishment; and wills made during the
continuance of the disorder, if they contain no statement inconsistent
with the known wishes and desires of the party during health, are
valid, the law looking more to the good sense of the will as a proof of
a lucid interval, than to the proved existence of such lucid interval.
=Somnambulist, &c.=--This is an abnormal mental state, closely
allied to that artificially produced and known under the names of
mesmerism, hypnotism, electro-biology, &c. It is commonly known as
“sleep-walking.” In this condition the mind appears to become enslaved
by one train of ideas to the exclusion of all others; the somnambulist,
thus deeply bent on the accomplishment of a definite end, takes no heed
of those objects which are in no way connected with the dominant ideas
in his mind. Hence, he walks safely past dangers which, when awake,
would disconcert his judgment and weaken his will. Somnambulism appears
also to be closely connected with epilepsy. In 1878, a man named
Fraser was tried in Glasgow for the murder of his child by beating it
against the wall. He was acquitted on the ground of being unconscious
of the nature of his act by reason of somnambulism. He had sprung
from an epileptic and insane stock; his mother died in an epileptic
fit, and some of his other relatives were insane. Thus it appears,
if the somnambulism be proved, the accused is exonerated from any
responsibility connected with the act for which he is being tried. So
also, if a person be suddenly aroused from a deep sleep--_somnolentia_
or _sleep-drunkenness_--the question may be raised as to his
responsibility for an act committed at the moment of awakening (R. _v._
Milligan). There cannot be a doubt but that if a person be suddenly
aroused whilst dreaming, he may unconsciously commit acts, the outcome
of his dream, which, unless the possibility of this condition be
recognised, may entail severe punishment on him. This state is closely
allied to that mental condition which sometimes occurs in epileptics
immediately after a fit. But in this, as in cases of somnambulism, the
facts of the case would have to be most carefully scrutinised.
The following hints may be of use as a guide in determining the
responsibility or not of the accused:--
1. The person must be shown to have a general tendency to
deep and heavy sleep, out of which he can only be aroused
by a violent and convulsive effort.
2. Are there any circumstances which, happening before
the individual went to sleep, would produce a train of
disturbed thought not entirely composed by sleep?
3. Did the act occur during the usual hours for sleep?
4. Was the cause of the awakening sudden, and does the act
bear throughout the character of unconsciousness?
5. What were the subsequent acts of the accused in relation
to the deed? Did he try to evade responsibility? This
must not have too much stress laid upon it, for the
wretchedness of the sudden discovery may so overcome him,
that he may seek to shelter himself from the consequences
of an act for which he is legally but not morally
responsible.
THE RESTRAINT OF THE INSANE AND DIRECTIONS FOR SIGNING MEDICAL
CERTIFICATES.
No person can be put under restraint unless the conditions required by
the Lunacy Acts are fulfilled. The Acts of Parliament for this purpose
are the Lunacy Act of 1890 (53 Vict. c. 53) and that of 1891 (54 and
55 Vict. c. 65). Lunatics may be put under restraint by the following
procedures, according to the particular case:--
Reception Order on Petition.
Urgency Order.
Order after Inquisition.
Summary Reception Order.
Order for Lunatics Wandering at Large, and for Pauper Lunatics.
Reception Order by Two Commissioners.
=Reception Order on Petition.=--This is usually the procedure for
private patients. The order for petition may be obtained from a
specially appointed Justice of the Peace, Judge of County Courts, or
Magistrate. A petition for the order must be presented to the Judicial
Authority by the husband, wife, or relative of the alleged lunatic;
if any other person apply, the reasons for this must be given. A
petitioner must be twenty-one years of age or over, and must have seen
the alleged lunatic _within fourteen days_ before its presentation. A
_statement of particulars_ and two medical certificates must accompany
the petition. The proceedings are private, and no one except the
petitioner, the alleged lunatic, and any one person appointed by
him, and the two medical men who have signed the certificates, may
be present, unless by permission of the Judicial Authority. If the
Judicial Authority be satisfied, he may make the order at once, even
without seeing the patient, or he may appoint a time within seven days
for inquiries and consideration. He may visit the alleged lunatic.
At the time of consideration of the petition he may adjourn it for not
more than fourteen days, or he may make the order at the time. He may
summon further witnesses, or dismiss the petition, giving his reasons
for so doing in writing.
A reception order is valid for seven days from its date, unless the
lunatic is certified by a medical man to be unfit for removal, when the
order is extended until a medical certificate of fitness for removal is
obtained, which is valid for three days.
The medical men signing the certificates must not be in partnership,
as principal and assistant, or have any direct or indirect interest in
the patient or his keeping (16 and 17 Vict. c. 96, sec. 4). They must
make separate visits at different times for the purpose of examination.
Each medical man must have examined the person within seven clear days
before the presentation of the petition.
Each medical man must write clearly and in the proper place on the
certificate: (1) The facts observed by himself as evidence of insanity,
and (2) the facts observed by others as evidence of insanity. The name
of his informant must be given.
One of the certificates should, whenever practicable, be under the hand
of the usual medical attendant (if any) of the alleged lunatic. If not
practicable, the reason must be given by the petitioner to the Judicial
Authority.
Neither of the certifying medical practitioners may be the father or
father-in-law, brother or brother-in-law, sister or sister-in-law,
partner or assistant of the other of them.
Great care should be taken to follow carefully the marginal directions
on the certificate form. The most trivial omission will invalidate the
certificate. The omission of the name of the street and number of the
house is sufficient to set it aside. A medical man should remember
that, although his certificate may have passed the scrutiny of the
Commissioners, it is liable to be made the subject of discussion in
a Court of law, and in cross-examination he will have to support the
statements therein made.
The following certificate properly filled up by Dr. Millar of Bethnal
House Asylum, is given in his book on _Hints on Insanity_, and may be
taken as an example of a correct certificate at that time, the present
form being slightly different:--
MEDICAL CERTIFICATE PROPERLY FILLED UP
1. _Here set forth the_ I, the undersigned,
_qualification entitling the_ _John Millar_, being a (¹)
_person certifying to practise_ _Licentiate of the_
as a physician, surgeon, _or_ _Royal College of Physicians_,
apothecary. _Edinburgh_,
2. Physician, surgeon, _or_ and being in actual practice as
apothecary, _as the case_ a (²) _Physician_, hereby certify
_may be_. that I, on the _third_ day of
_November, One thousand eight
hundred and eighty-eight_,
at (³) 600 _Cambridge Road_,
3. _Here insert the street and_ _Bethnal Green_, in the county of
_number of the house (if any_), _Middlesex_, separately from any
or other like particular. other medical practitioner,
personally examined
_James Thompson, sen._, of
4. _Insert residence, and_ (⁴) 600 _Cambridge Road_,
_profession or occupation_ _Bethnal Green_, _gentleman_,
_(if any)._ and that the said _James Thompson,
sen._, is a person (⁵) _of unsound
5. Lunatic, _or_ an idiot, mind_, and a proper person to be
_or_ a person of unsound mind. taken charge of, and detained
under care and treatment; and that
I have formed this opinion upon
the following grounds, viz.:--
6. _Here state the facts._ 1. Facts indicating insanity
observed by myself (⁶)--
_He is incoherent in his
conversation, violent in his
conduct, and quite unable to
take care of himself_.
7. _Here state the information,_ 2. Other facts (if any)
_and from whom._ indicating insanity
communicated to me by
others (⁷)--
_His son, James Thompson, jun_.,
_informs me that he has_
_threatened to commit suicide_,
_and has twice attempted it_
_with a razor._
(Signed) Name--_JOHN MILLAR_.
Place of abode--_Bethnal House_, _Bethnal Green_.
Dated this _third_ day of _November_,
_One thousand eight hundred and eighty-eight_.
Table relating to “Facts” of Insanity,
(compiled from Millar.)
+----------------------------------------------+
| Facts offering no Evidence of Insanity. |
+----------------------------------------------+
| 1. Refuses to take her medicine and resists |
| in every way; closes her teeth; threatens |
| to strike every one near her; obliged to |
| use the strait-waistcoat. |
| |
| 2. Violent in her temper, and very abusive. |
| |
| 3. Moody and irritable temperament, and of |
| weak memory in many particulars. |
| |
| 4. General restlessness of manner; considers |
| himself heavily involved in debt to many |
| thousand pounds; says he has been ruined |
| by the Government, and that he intends |
| prosecuting the Admiralty for £5000 damages. |
+----------------------------------------------+
| Vague and Irrelevant Facts. |
+----------------------------------------------+
| 1. She is suspicious of her husband; says he |
| keeps bad company; she is most irritable and |
| jealous, and takes stimulating drinks to a |
| dangerous and exciting extent. |
| |
| 2. Obstinate; has the manner and appearance |
| of an insane person; complained of her head; |
| refused her food, and would not go |
| downstairs; melancholy. |
| |
| 3. He has imperfect sight; good hearing and |
| taste; he is unable to speak; his gait is |
| ape-like, and the skull-bones seem to have |
| fallen together from the want of cerebral |
| development. He will occasionally slap his |
| face and strike his hands; sometimes makes |
| a howling noise. |
| |
| 4. She is very good-tempered; but day and |
| night she talks almost incessantly; |
| occasionally sings. She says she comes from |
| Otaheite, and relates stories of those |
| around her doing absurd things. |
+----------------------------------------------+
| Good Facts. |
+----------------------------------------------+
| 1. She states that she is a lost person and |
| without hope of forgiveness; that she will |
| be taken to prison, and die a miserable |
| death; that the devil whispers in her ear |
| that she has committed the unpardonable sin. |
| |
| 2. Great taciturnity; complete seclusion |
| from society; aversion to cleanliness; |
| wandering about the streets at improper |
| hours. |
| |
| 3. He states that he is a Prince of France; |
| that he possesses a palace, and has recently |
| had two fortunes left him (he cannot tell by |
| whom)--one of £400,000, the other of |
| £600,000; that he is going to Liverpool, a |
| distance of 150 miles, with a horse and |
| cart, which will take him four hours to go, |
| and eight to return. |
| |
| 4. Inability to hold any rational |
| conversation; her manner and conduct are |
| totally at variance with her usual habits. |
+----------------------------------------------+
The following are examples of “Facts” sent back to be amended by the
Commissioners--the emendations in italics:--
1. Incoherence, perversion of facts, delusion. _Fancies
that he possesses large amounts of money which people
have secreted from him._
2. Says her sister lives in Chiselhurst, and she fears she
is dying. She took great notice of my feet, and remarked
that they were very large. Query by Commissioner--Are
these delusions? _Her sister does not live at Chiselhurst,
and is perfectly well; my feet are not large._
3. General restlessness of manner; considers himself heavily
involved in debt to many thousands of pounds, _whereas
his debts do not amount to a few hundreds_; says he
has been ruined by the Government, _whereas he has
only been dismissed from his appointment on account
of his incapacity_; and he intends prosecuting the
Admiralty for £5000 damages, _he having no real ground
of action_. (This was twice sent back for correction,
the first correction being--_By these statements I
was satisfied that the patient was of unsound mind, and
by his general conduct during examination._ Finally
amended as given above.)
[Sidenote:
(_a_)--a Justice of the Peace for ____, _or_ His Honour the Judge of
the County Court of ____, _or_ ____ Stipendiary Magistrate for ____.
(_b_) Full postal address and rank, profession, or occupation.
(_c_) At least twenty-one.
(_g_) Some day within 14 days before the date of the presentation of
the petition.
(_h_) Here state the connection or relationship with the patient.
(_k_) Full Christian and surname.]
53 Vict. c. 5.--Sched. 2, Form 1.
PETITION FOR AN ORDER FOR RECEPTION OF
A PRIVATE PATIENT
In the Matter of_______________________________
a person alleged to be of unsound mind.
_To_ (_a_)____________________________________
____________________________________
____________________________________
The Petition of_________________________________________
of (_b_)_________________________________________
_________________________________________
in the County of________________________________________
1. I am___________(_c_) years of age.
2. I desire to obtain an Order for the Reception of
________________________________________________
as a person of unsound mind, in the Haydock Lodge Licensed House,
situate at Newton-le-Willows, Lancashire.
3. I last saw the said__________________________________
at______________________________________________________
on the (_g_)_______day of________________ 19_______
4. I am (_h_)_______________________________ of the
said____________________________________________________
(or if the Petitioner is _not connected_ with or related
to the or Patient, _state as follows_:)
I am not related to or connected with the said__________
________________________________________________________
The reasons why this Petition is not presented by a relation
or connection are as follows:
The circumstances under which this Petition is presented by
me are as follows:--
5. I am not related to or connected with either of the persons
signing the certificates which accompany this petition as (_where
the petitioner is a man_) husband, father, father-in-law, son,
son-in-law, brother, brother-in-law, partner, or assistant (_or
where the petitioner is a woman_) wife, mother, mother-in-law,
daughter, daughter-in-law, sister, sister-in-law, partner,
or assistant.
6. I undertake to visit the said________________________
__________________________personally, or by some one specially
appointed by me, at least once in every six months while under
care and treatment under the order to be made on this petition.
7. A statement of particulars relating to the said_____________
______________________________________accompanies this petition.
_If it is the fact, add_: 8. The said_____________________
has been received in the Haydock Lodge Licensed House,
Newton-le-Willows, under an Urgency Order dated the____________
_______________________________________________________________
The petitioner therefore prays that an order may be made in
accordance with the foregoing statement.
=Signed= (_k_)_______________________________________
Date of Presentation of the Petition, this____________
day of___________________ 19_________
[Sidenote: (_a_) Name of Patient.
(_b_) To be signed by the petitioner.]
53 Vict. c. 5, s. 31.
When neither Certificate is signed by the Usual Medical
Attendant.
I, the undersigned, hereby state that it is not practicable to
obtain a Certificate from the usual Medical attendant of (_a_)
__________________________________________________________________
for the following reason, viz.:--
(=Signed=) (_b_)______________________________
_______________ 19____________
Form 2.
STATEMENT OF PARTICULARS REFERRED TO IN THE
ANNEXED PETITION
_If any particulars are not known the fact is to be so stated._
[Where the patient is in the petition or order described as an idiot,
omit the particulars marked ►]
The following is a Statement of Particulars } __________________
relating to the said } __________________
Name of patient, with Christian name at } __________________
length } __________________
Sex and Age __________________
► Married, single, or widowed __________________
► Rank, profession, or previous occupation } __________________
(if any) } __________________
► Religious persuasion __________________
Residence at or immediately previous to } __________________
the date hereof } __________________
► Whether first attack __________________
Age on first attack __________________
When and where previously under care } __________________
and treatment as a lunatic, idiot, or } __________________
person of unsound mind } __________________
► Duration of existing attack __________________
Supposed cause __________________
Whether subject to epilepsy __________________
Whether suicidal __________________
Whether dangerous to others, and in } __________________
what way } __________________
Whether any near relative has been } __________________
afflicted with insanity } __________________
Names, Christian names, and full postal } __________________
addresses, of one or more relatives }
of the patient } __________________
Name of the person to whom notice of } __________________
death to be sent, and full postal } __________________
address, if not already given } __________________
‡Name and full Postal Address of the } __________________
usual Medical Attendant of the Patient } __________________
‡When the Certificate is not signed by
the usual Medical Attendant, the Certificate
on the other side must be filled out.
[Sidenote: (_a_) _When the petitioner or person signing an urgency
order is not the person who signs the statement, add the following
particulars concerning the person who signs the statement._]
Signed (_a_)
_Name, with Christian
Name at length_________________________________
_Rank, Profession or
Occupation_ (_if any_)____________________
_How related to, or
otherwise connected
with the Patient_______________________________
53 Vict. c. 5. s. 7 (4).
=When a previous Petition has been dismissed=.
[Sidenote: (_a_) Name of Patient.
(_b_) Name of asylum, hospital, licensed house, or single charge.
(_c_) Justice of the Peace for ———, or Judge of County Court of ——, or
Stipendiary Magistrate for ———]
I, the undersigned, hereby state that a former Petition for
Reception of (_a_)___________________________________________
into (_b_)___________________________________________________
was presented to__________________________________________________
(_c_)________________________________________________________
in the month of________________ 19_______, and dismissed.
Herewith is a copy (furnished by the Commissioners in Lunacy)
of the statement sent to them of the reasons for its dismissal.
Signed________________________________________
________________ 19________
Note.--_This Copy is to be obtained from the Commissioners
in Lunacy by the Petitioner at his own expense._
An Order for Reception of a Lunatic is to be obtained upon a private
application by Petition to a Judge of County Courts, or Stipendiary
Magistrate, or Metropolitan Police Magistrate, or specially appointed
Justice of the Peace. The petition is to be presented, if possible,
by the husband or wife, or by a relative (_i.e._ a lineal ancestor
or lineal descendant, or lineal descendant of an ancestor not more
remote than great-grandfather or great-grandmother) of the Lunatic,
and is to be accompanied by a Statement of Particulars and two
Medical Certificates on separate sheets of paper. One of the Medical
Certificates accompanying the Petition must, if practicable, be by the
usual Medical Attendant of the Lunatic; if not by him, the reason must
be stated (see Form above). If a previous Petition has at any time been
dismissed, the facts relating to its dismissal are to be stated in the
fresh Petition (see Form above); and the Petitioner must obtain from
the Commissioners in Lunacy a Copy of the Statement sent to them of the
reasons for its dismissal, and present this copy with his Petition. The
Reception Order (which will not remain in force for more than seven
days after its date), the Petition, the Statement of Particulars,
and the Medical Certificates must be sent to the Superintendent or
Proprietor of the Asylum, Hospital, or House where the Patient is to be
received.
[Sidenote: (_a_) _Insert residence of patient._
(_b_) County, city, _or_ borough, _as the case may be._
(_c_) _Insert profession or occupation, if any._
(_d_) _Insert the place of examination, giving the name of the street
with number or name of house, or should there be no number, the
Christian and surname of occupier._
(_e_) County, city, _or_ borough, _as the case may be._
(_f_) _Omit this where only one certificate is required._
(_g_) A lunatic _or_ an idiot, _or_ a person of unsound mind.
(_h_) _If the same or other facts were observed previous to the time
of the examination, the certifier is at liberty to subjoin them in a
separate paragraph._
(_i_) _The names and Christian names (if known) of informants to be
given, with their addresses and descriptions._
(_k_) _Strike out this clause in case of a patient whose removal is not
proposed._
(_l_) _Insert full postal address._]
53 Vict. c. 5.--Sched. 2, Form 8.
CERTIFICATE OF MEDICAL PRACTITIONER
In the Matter of_________________________________________
of (_a_)_____________________________________________________
in the (_b_)_____________________ of_________________________
(_c_) _______________________________________________________
_______________________________________an alleged lunatic.
I, the undersigned, ______________________________________________
do hereby certify as follows:
1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.
2. On the_______________________ day of ________________ 19__
at (_d_) _______________________________________________
in the (_e_)___________________ of _____________________
_________________(separately from any other practitioner) (_f_)
I personally examined the said ___________________________________
and came to the conclusion that ____ he is (_g_) ____________
and a proper person to be taken charge of and detained under
care and treatment.
3. I formed this conclusion on the following grounds, viz.:--
(_a_) Facts indicating insanity observed by myself at the
time of examination (_h_), viz.:--
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
(_b_) Facts communicated by others (_i_), viz.:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
4. The said __________________________________________________
appeared to me to be[18]..................in a fit condition of
bodily health to be removed to an asylum, hospital, or licensed
house (_k_).
5. I give this certificate having first read the section of the
Act of Parliament printed below.
=Signed=____________________________________
of (_l_)_____________________________
=Dated= this __________ day of ________ 19__
[18] _Or_ not to be.
[Sidenote: Lunacy 8.
53 Vict. c. 5, ss. 4, 11, 16, 28, 29.]
_Extract from section 317 of the Lunacy Act, 1890._
Any person who makes a wilful misstatement of any material
fact in any medical or other certificate or in any statement or
report of bodily or mental condition under this Act, shall be
guilty of a misdemeanour.
[Sidenote: (_a_) A Justice for --, specially appointed under the
Lunacy Act, 1890, _or_ the Judge of the County Court of --, _or_ the
Stipendiary Magistrate for--
(_b_) _Address and occupation._
(_d_) _Name of petitioner._]
53 Vict. c. 5.--Sched. 2, Form 3.
ORDER FOR RECEPTION OF A PRIVATE PATIENT, TO BE MADE
BY A JUSTICE APPOINTED UNDER THE LUNACY ACT, 1890,
JUDGE OF COUNTY COURTS, OR STIPENDIARY MAGISTRATE
I, the undersigned _______________________________________________
being (_a_) _________________________________________________
__________________________________________________________________
upon the petition of _____________________________________________
of (_b_) ____________________________________________________
in the Matter of _________________________________________________
a person of unsound mind, accompanied by the Medical Certificates
of _______________________________________________________________
and ______________________________________________________________
hereto annexed, and upon the undertaking of the said (_d_)
__________________________________________________________________
to visit the said ________________________________________________
personally or by some one specially appointed by the said (_d_)
__________________________________________________________________
once at least in every six months while under care and treatment
under this Order, hereby authorise you to receive the
said _____________________________________________________________
as a patient into your Licensed House (_e_).
=And= I declare that I have [_or_ have not] personally
seen the said ____________________________________________________
before making this Order.
=Dated= this __________________ day of ________________ 19___
=Signed= (_a_) _________________________
_A Justice for _________________________________
appointed under the above-mentioned Act [or the
Judge of the County Court of_____________________
or a Stipendiary Magistrate_].
=Urgency Orders.=--Where it is urgent that an alleged lunatic (not
a pauper) must be put under restraint as soon as possible, he may
be received upon an _urgency order_, without petitioning a Judicial
Authority, accompanied by a _statement of particulars_ and _one
medical certificate_. The order should be made by the husband, wife,
or a relative of the alleged lunatic; if this be not possible, the
reasons must be stated. It may be signed before or after the medical
certificate, and before or after a petition order has been made.
If before, it must be noted in the petition; if after, a copy must
accompany the petition. No person may sign an urgency order if under
twenty-one years of age, and must have seen the alleged lunatic within
two days before the date of the order.
The urgency order remains in force seven days from its date, during
which period the procedure for a “Judicial Order on Petition” is
carried out. If the petition has been presented and the order is for
some reason or other deferred, then the urgency order remains in
force. The medical examination for certification must have been made
not more than two days before reception, and reasons must be given why
“it is expedient” that the alleged lunatic should be put under control
“forthwith.”
[Sidenote: (_a_) House, _or_ hospital, _or_ asylum, _or_ as a single
patient.
(_b_) _Name of Patient._
(_c_) Lunatic, _or_ an idiot, _or_ a person of unsound mind.
(_d_) _Some day within two days before the date of the order._
(_e_) Husband, wife, father, father-in-law, mother, mother-in-law, son,
son-in-law, daughter, daughter-in-law, brother, brother-in-law, sister,
sister-in-law, partner, or assistant.
(_If not the husband or wife, or a relative of the patient, the person
signing to state as briefly as possible_--1. _Why the order is not
signed by the husband or wife, or a relative of the patient._ 2. _His
or her connection with the patient, and the circumstances under which
he or she signs._)
(_f_) Superintendent of ____ the ____ asylum, ____ hospital _or_
resident licensee of the ____ house (_describing the asylum, hospital,
or house by situation and name_.)
Lunacy, Nos. 4 & 2.
(33 Vict. c. 5, s. 11.)]
53 Vict. c. 5.--Sched. 2.
FORM OF URGENCY ORDER FOR THE RECEPTION OF A
PRIVATE PATIENT, WITH MEDICAL CERTIFICATE
AND STATEMENT ACCOMPANYING URGENCY ORDER
Forms 4, 2, 8 and 9.
I, the undersigned, being a Person Twenty-one years of age,
hereby authorise you to receive as a Patient into your (_a_)
House (_b_) _________________________________________________
__________________________________________________________________
as a (_c_) __________________________________whom I last saw at
____________________________________________________________________
on the (_d_) __________________ day of_______________ 19____
I am not related to or connected with the Person signing
the Certificate which accompanies this Order in any of the
ways mentioned in the Margin. (_e_) Subjoined (_or_ annexed)
hereto is a Statement of Particulars relating to the said __________
(=Signed=) _____________________________________
_Name and Christian Name_ } _______________________________
_at Length_ } _______________________________
_Rank, Profession, or Occupation_ } _______________________
_(if any)_ } _______________________
_Full Postal Address_ _____________________________________
_How related to or connected_ } ___________________________
_with the patient_ } ___________________________
=Dated= this _______________ day of __________ 19____
STATEMENT OF PARTICULARS REFERRED TO IN THE
ANNEXED ORDER
_If any Particulars are not known,
the Fact is to be so stated._
(Where the patient is in the petition or order described
as an idiot, omit the particulars marked ►.)
The following is a Statement of Particulars } ____________________
relating to the said } ____________________
Name of Patient, with Christian Name } ___________________________
at length } ___________________________
Sex and Age __________________________
Married, Single, or Widowed ______________________________________
► Rank, Profession, or previous Occupation } _____________________
(if any) } _____________________
► Religious Persuasion ___________________________
Residence at or immediately previous } ___________________________
to the date hereof } ___________________________
► Whether First Attack ________________
Age on First Attack ________________
When and where previously under Care } ________________________
and Treatment as a Lunatic, Idiot, or } ________________________
Person of Unsound Mind } ________________________
► Duration of existing Attack ____________________________________
Supposed Cause ___________________________________________________
Whether subject to Epilepsy ______________________________________
Whether Suicidal _________________________________________________
Whether dangerous to Others, and in } ____________________________
what way } ____________________________
Whether any near Relative has been } _____________________________
afflicted with Insanity ... ... } _____________________________
Names, Christian Names, and full Postal } ________________________
Addresses of one or more Relatives } ________________________
of the Patient } ________________________
Name of the Person to whom Notice } _________________________
of Death to be sent, and full Postal } _________________________
Address, if not already given } _________________________
Name and full Postal Address of the } __________________________
usual Medical Attendant of the } __________________________
Patient } __________________________
=Signed= _________________________________________
When the Petitioner or person signing an Urgency Order is =NOT=
the person who signs the Statement, add the following particulars
concerning the person who signs the Statement.
Name, with Christian name at length ______________________________
Rank, profession, or occupation (if any) _________________________
How related to or otherwise connected } __________________________
with the patient } __________________________
[Sidenote: (_a_) _Insert residence of patient._
(_b_) County, city, _or_ borough, _as the case may be._
(_c_) _Insert profession or occupation, if any._
(_d_) _Insert the place of examination, giving the name of the street,
with number or name of house, or should there be no number, the
Christian and surname of occupier._
(_e_) County, city, _or_ borough, _as the case may be._
(_f_) _A lunatic_, an idiot, _or_ a person of unsound mind.
(_g_) _If the same or other facts were observed previous to the time
of the examination, the certifier is at liberty to subjoin them in a
separate paragraph._
(_h_) _The names and Christian names (if known) of informants to be
given, with their addresses and descriptions._
Lunacy, Nos. 8 & 9.
(53 Vict. c. 5, ss. 11, 28, 29, 32 and 33.)]
53 Vict. c. 5.--Sched. 2, Form 8.
CERTIFICATE OF MEDICAL PRACTITIONER
In the Matter of _________________________________________________
of (_a_) ____________________________________________________
in the (_b_)________________________ of _____________________
(_c_) _______________________________________________________
an alleged lunatic.
I, the undersigned _______________________________________________
do hereby certify as follows:--
1. I am a person registered under the Medical Act, 1858,
and I am in the actual practice of the medical profession.
2. On the ________________ day of ___________________ 19 ______
at (_d_) ______________________________________________
in the (_e_) ________________ of ______________________
I personally examined the said _____________________________
and came to the conclusion that ____ he is (_f_)_______
and a proper person to be taken charge of and detained under
care and treatment.
3. I formed this conclusion on the following grounds, viz.:--
(_a_) Facts indicating Insanity observed by myself
at the time of examination (_g_), viz.:--
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(_b_) Facts communicated by others (_h_), viz:--
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
[Sidenote: (_i_) _If an urgency certificate is required, it must be
added here.--Form No. 9._
(_k_) _Strike out this clause in case of a private patient whose
removal is not proposed._
(_l_) _Insert full postal address._
53 Vict. c. 5.--Form 9.]
(_i_) STATEMENT ACCOMPANYING URGENCY ORDER
I certify that it is expedient for the welfare of the said ________
_______________________ (_or_ for the public safety, _as the
case may be_) that the said ____________________________________
should be forthwith placed under care and treatment.
My reasons for this conclusion are as follows: ____________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
4. The said _______________________________________________________
appeared to me to be [‡ _____________] in a fit condition of bodily
health to be removed to an asylum, hospital, or licensed house
(_k_). (‡) Or not to be.
5. I give this certificate having first read the section of the Act
of Parliament printed below.
=Dated= this ________________ day of _________________________
One thousand nine hundred and ______________
(=Signed=) _____________________________
of (_l_) _____________________________
_Extract from section 317 of the Lunacy Act, 1890._
Any person who makes a wilful misstatement of any
material fact in any medical or other certificate,
or in any statement or report of bodily or mental
condition under this Act, shall be guilty of a
misdemeanour.
=Orders after Inquisition.=--This constitutes a legal investigation
as to whether or not a person is capable of managing his or her own
affairs, and whether restraint is necessary. It is conducted before a
judge, with a jury if the alleged lunatic demand one, unless the judge
is satisfied by personal examination that the lunatic is not mentally
competent to understand the demand for a jury. In such a case the
medical man is only concerned as a witness.
According to circumstances the alleged lunatic may be kept under
restraint, or remain at liberty with the control of his or her affairs
under a “Committee of Estate”; or, if declared sane, set free and with
control of his estate.
=Summary Reception Orders.=--When a lunatic is not under proper
control, and if without relations or friends, and there be no one who
will sign a petition for detention, or when a lunatic is uncared for,
cruelly treated, and is found so by a medical practitioner, his duty
is to inform a constable, relieving officer, or overseer of the parish
of the fact. The official will then make a statement on oath to a
Judicial Authority, who will direct two medical practitioners to make
the necessary examinations, and if satisfied he will issue an order for
the removal of the individual to an asylum. The procedure followed will
then be the same as for a “petition for reception.” Under a summary
reception order the Judicial Authority may place the person under the
care of a relation or friend, or the visitors of the asylum in which
the person is intended to be, or is placed.
=Lunatics Wandering at Large.=--Every constable, relieving officer,
or overseer of a parish who knows of a person, whether pauper or not,
who is deemed to be a lunatic and wandering at large, shall apprehend
and take such person before a Justice, or if the Justice receive
information on oath, he may have the person apprehended and brought
before him. The Justice has the person medically examined, and if
certified a lunatic to the satisfaction of the Justice, he may issue an
order for detention; if the medical man certify that the person is not
fit for removal, the removal is postponed until the person is certified
fit for it.
The above proceedings are not necessary if it be considered a matter of
public safety and for the good of the alleged lunatic that immediate
detention be carried out. The constable, relieving officer, or overseer
of the parish may remove such person to the workhouse of the union
in which the person is, and detain him for not more than three days.
Before the expiration of that time the necessary proceedings under the
Lunacy Act must be taken.
=Reception Order by two Commissioners.=--Any two or more Commissioners
in Lunacy may visit a pauper lunatic or an alleged lunatic not detained
in a workhouse or lunatic asylum, and if satisfied after certification
by a medical man that the person is a lunatic, order removal to an
asylum.
=Pauper Lunatics.=--A medical officer of a Poor Law Union who has
knowledge that a pauper within his district is alleged to be a
lunatic, shall notify the relieving officer or overseer of the parish
where the pauper resides of the fact, who within three days shall
notify a Justice, who will interview the alleged lunatic and call
in a medical practitioner to examine and certify. If the Justice be
satisfied that the person be a lunatic, he makes an order for removal
to an asylum. One medical certificate only is necessary.
=Escape of Lunatics.=--An escaped lunatic may be retaken at any time
within fourteen days without a fresh order.
=Discharge of Lunatics.=--The reception order remains in force for
periods of one, two, and three years, and then for periods of five
years. At the end of any of these periods the Lunacy Commissioners may
continue the detention of the lunatic, if satisfied by certification
from the medical man of the institution, or the usual medical attendant
of the lunatic, that the patient remains of unsound mind and further
detention is necessary.
The petitioner of the reception order may request the discharge of a
patient. The discharge may be refused if the medical man in charge
certifies the lunatic dangerous and unfit to be at large, unless two of
the visitors to the asylum or the Commissioners visiting the asylum or
house give their consent in writing.
Two Commissioners--one medical, the other legal--may order the
discharge of any patient.
When a patient recovers, the medical attendant of the institution
notifies this to the petitioner or person responsible for the payment
on account of the patient. Should the patient not be removed within
seven days of such notice, the patient may be discharged “forthwith.”
PROCEDURE IN SCOTLAND
Idiots and imbeciles under eighteen years of age may be received into
training schools without the legal procedure which obtains in England
and Wales. They are sent to these institutions as lunatics, however,
under the usual legalities, in order that the Government grant may be
obtained. When over eighteen years of age, if sent to institutions
other than training schools, they are classed as lunatics, and the
necessary legal procedure is followed.
=Insane persons whose malady is not confirmed= may be cared for
privately for a period not exceeding six months. The certificate of one
medical practitioner only is required.
_Insane persons_, pauper or not, can be placed in an asylum by order of
the Sheriff, by petition and two medical certificates. The inspector of
the poor acts as petitioner for paupers.
In cases of urgency a _certificate of emergency_ from one medical
practitioner is required, along with a request from the petitioner, to
the superintendent of the asylum.
A person who is _prodigal_ or _facile_ can be restrained from
alienating his property by guardians appointed by the Court.
When a lunatic is found to be incapable of administering his or her
estate, the Court appoints a Committee of Estate.
PROCEDURE IN IRELAND
The procedure differs in pauper and private cases.
=Pauper patients, not dangerous.=--In order to detain such a pauper
there must be a declaration of insanity and destitution, with the names
and addresses and descriptions of two relatives of the person, given
before a magistrate. A magistrate and a clergyman or poor-law guardian
must certify that they have personally inquired into the case. One
medical certificate is necessary. The applicant must remove the patient
when called upon.
=Paying patients who are not dangerous=, for admission to a district
asylum, are under more stringent regulations. A declaration that they
are unable to pay the expenses necessary for support in a licensed
house must be made before a magistrate; further, that there is no
friend who can undertake this; and a statement of the length of time
the patient has resided in the country. A magistrate and clergyman must
certify that they have investigated the case. One medical certificate
must be signed by two practitioners. A guarantee for the payment must
be given, and also to remove the patient when called upon. The sanction
of an inspector of lunatics must be given.
For admission into licensed houses, charitable institutions, and single
care, an order by a relative or connection of the lunatic is required
with two medical certificates, unless urgent, when one is sufficient,
but a second must follow within fourteen days.
LIABILITIES OF PERSONS SIGNING LUNACY CERTIFICATES
A medical practitioner is bound to certify as to the sanity of a
person. If, however, he undertakes to fill up the certificates
necessary for the detention of an alleged lunatic, he becomes
responsible to the authorities for the correctness of the certificates,
and if he make a wilful misstatement of facts he is guilty of a
misdemeanour. The medical practitioner may have an action brought
against him by the lunatic when recovered or discharged. The most
vindictive feelings may be entertained against the medical man. In such
a case, if the medical man proves his “good faith” and the exercise of
“reasonable care” in his examination and certification, he receives the
protection of the Court.
LIABILITIES OF PERSONS RECEIVING INSANE PATIENTS
In the case of Nottidge _v._ Ripley and Nottidge, the Lord Chief Baron
having been understood to intimate an opinion that no person ought
to be so confined unless he is dangerous to himself or others, the
Commissioners pointed out that the scope of the Lunacy Acts is not thus
limited. They said:
“The object of these Acts is not, as your Lordship is aware, so much
to confine lunatics, as to restore to a healthy state of mind such of
them as are curable, and to afford comfort and protection to the rest.
Moreover, the difficulty of ascertaining whether one who is insane be
dangerous or not is exceedingly great, and in some cases can only be
determined after minute observation for a considerable time.
“It is of vital importance that no mistake or misconception should
exist, and that every medical man who may be applied to for advice on
the subject of lunacy, and every relative and friend of any lunatic,
as well as every magistrate and parish officer (each of whom may be
called upon to act in cases of this sort), should know and be well
assured that, according to law, any person of unsound mind, whether he
be pronounced dangerous or not, may legally and properly be placed in a
county asylum, lunatic hospital, or licensed house, on the authority of
the preliminary order and certificates prescribed by the Acts.
“Upon the whole, it appears that the power to restrain and confine
a lunatic is limited at common law to cases in which it would be
dangerous, either as regards others or himself, for the lunatic to
be at large; but that the power to place and detain a lunatic in a
registered hospital or licensed or other house, under an order and
medical certificates duly made and obtained in accordance with the
Lunacy Acts, is not so limited.”
The terms of the Lunacy Act, 1890, are as follows:
“Subject to the exceptions in this Act mentioned a person
shall not be received or detained as a lunatic, as a single
patient, unless under a reception order by a judicial
authority.” “Every person who, except under the provisions
of the Act, receives or detains a lunatic or an alleged
lunatic in an institution for lunatics, or for payment takes
charge of, receives to board or lodge, or detains a lunatic
or alleged lunatic in an unlicensed house, shall be guilty
of a misdemeanour, and in the latter case shall also be
liable to a penalty not exceeding fifty pounds.” “Except
under the provisions of this Act, it shall not be lawful for
any person to receive or detain two or more lunatics in any
house, unless the house is an institution for lunatics or a
workhouse.” “Any person who receives or detains two or more
lunatics in any house except as aforesaid shall be guilty of
a misdemeanour.”
It is therefore unlawful to receive a lunatic or alleged lunatic except
by reception order. Only one can be received into a private house, and
a reception order is required. No medical man should receive a lunatic
into residence without the necessary reception order. All the statutory
regulations are demanded for a single case, and the private house is
subject to visitation and inspection.
It is also important to remember that if any one receive a person not
insane at the time, but who subsequently becomes insane, he renders
himself liable to prosecution, unless he procure the necessary medical
certificates and order (R. _v._ Wilkins).
=Is a Lunatic a competent Witness?=--Mr. Fitzjames Stephen maintains
(_Criminal Law_) that madmen 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,
they are competent witnesses whatever be the nature or degree of their
mental disorder. An idiot shall not be allowed to give evidence (Co.
Litt. 6 b; Gilb. Ev. 144); a lunatic during a lucid interval may do so
(_Id. Com. Dig. Testm._ {A}). When a lunatic is tendered as a witness,
it is for the judge to examine and ascertain whether he is of competent
understanding to give evidence, and is aware of the nature and
obligation of an oath; if satisfied that he is, the judge should allow
him to be sworn and examined (R. _v._ Hill, 2 Den. 255; 20 L.J. [M.C.]
222).
=The Civil Rights of Lunatics.=--If an individual be suffering from
such mental disease as to render him incompetent to manage his own
affairs, the law steps in to protect him and his property from injury.
But the power so used does not necessarily imply that he is deprived of
his personal freedom, but merely such restraint as is necessary for his
protection.
Many lunatics, under the protection of the Court, live in their own
houses with large establishments. A person so protected by the law is
said to be subject to an “interdiction.” In these cases a commission is
usually granted by the Court of Chancery, and a writ known under the
name of “_de lunatico inquirendo_” issued, after certain legal matters
of detail are settled, and affidavits from medical men certifying to
the insanity of the party have been filed.
The tests of insanity in these cases differ from those required in
criminal cases, where the knowledge of right from wrong is imperatively
demanded. The mental defect must not be the result of ignorance or want
of education, and at one time commissions were only issued when it was
shown that lunacy and idiocy alone existed, imbecility or mere weakness
of mind not being deemed sufficient to deprive a man of his civil
rights, or to place him under the protection of the Court.
To so great an absurdity did this lead, that the man suffering
from a delusion sufficient to be comprehended under the legal term
“lunacy” was protected, whereas the feeble-minded were left without
interference, though needing it more. The cost of these commissions
sometimes reached almost fabulous sums. The expense has been somewhat
lessened by recent enactments, and the process simplified--the Lord
Chancellor having it in his power to direct an inquiry before two
Commissioners, thus dispensing with a jury. (See the 16 and 17 Vict. c.
70, and 25 and 26 Vict. c. 86.)
In Scotland, however, the law is far more simple. The cognition
proceeds on a _brieve_ or writ addressed to the Lord President of the
Court of Session, and directs him to inquire “whether the person sought
to be cognosced is insane, who is his nearest agnate, and whether such
agnate is of lawful age.” “And such person shall be deemed insane if
he be furious or fatuous, or labours under such unsoundness of mind as
to render him incapable of managing his affairs.” “The trial is before
a judge of the Supreme Court and a special jury. If the insanity be
proved, the nearest agnate--relation by the father‘s side--is by law
entitled to the guardianship.” No one not a near relative can institute
these proceedings.
In Scotland also, the trial by jury may be avoided by applying by
petition to the Court of Session for the appointment of a judicial
factor or _curator bonis_. Of this appointment the alleged lunatic
is informed, which, if he please, he may oppose; medical evidence is
received, and on this the Court rests its decision--the usual course
being to remit the case to some competent person to make inquiry, take
evidence, and report. The Commissioner is usually the Sheriff.
=Examination of the Insane.=--A few words of caution need here be
said. Medical men will consult their own dignity and that of their
profession by remembering that in cases of alleged insanity, as in
fact in all other cases when their opinion is sought, they are not
justified in taking sides. Their evidence will be the more valuable in
proportion to the care they take in examining into the facts of the
case, and the good sense and judgment shown in their examination of the
patient. To distinguish between the mistakes, the result of ignorance
and want of education, and those the result of a feeble mind, is of
primary importance. It is no sign of insanity in an uneducated farmer
that he knows not the _pons asinorum_. All cases should be tested by
considering the surroundings and possible degree of culture of a person
placed under like conditions as the party under examination. Has he
shown himself capable of an average amount of culture? or is his mental
condition inferior to what one might legitimately expect under the
influences to which he has been subjected? The medical examiner should
also direct his attention to this important point, setting aside all
legal and medical theories of insanity, viz.--“Is the case of _such
mental disorder_ as to create _an incapacity for managing affairs_.”
TESTAMENTARY CAPACITY
A medical practitioner may be called upon to give evidence as to
the capacity of a testator to make a valid will. An ordinary person
witnessing a will does so to fact only, but if a medical man do so it
implies that he was of the opinion that the testator was fit to make
a will and of a sound and disposing mind. In making an examination of
a person for fitness to make a will, the medical man must endeavour
to find out if the testator understands the nature of his action, and
all the details associated with it; also if he knows the nature and
amount of his property, and the claims or otherwise of those who may
become beneficiaries under it. Further, has he such a delusion as may
influence his will in disposing of his property, and bring about a
disposal of it which, if the mind had been sound, would not have been
made.
A person may have a delusion or delusions without interfering with the
making of a will. If the “disposing mind” be left intact, testamentary
capacity is upheld. In severe illness and old age the mind may be
so disturbed, without true insanity being present, that a person is
rendered incapable of making a will. In all such cases the medical man
should be sure of his ground before granting, if requested, that the
patient is capable or otherwise. It is a good plan, when examining a
patient as to testamentary capacity, to have the will produced, and
privately read it out to the person and ask if it be correct, then to
have the person repeat the dispositions of the will, and see if they
coincide with the contents of the document.
People who are aphasic may make wills which are valid. Difficulties
arise in cases of sensory aphasia.
RESTRAINT OF HABITUAL DRUNKARDS
An habitual drunkard, as defined by law, is “a person who, not being
amenable to any jurisdiction in lunacy, is notwithstanding, by reason
of habitual intemperate drinking of intoxicating liquor, at times
dangerous to himself or herself, or to others, or incapable of managing
himself or herself or his or her own affairs.”
Before placing such a person under restraint in a licensed retreat the
person‘s consent must be obtained. The patient must make an application
to a Justice of the Peace, and supported by a declaration from two
persons stating that the applicant is an habitual drunkard within
the meaning of the Act. If the justice be satisfied, he can make out
an order for detention. The order is valid for any time mentioned in
the application not exceeding two years. The patient can be detained,
forcibly if necessary, and if escaped may be arrested and taken back.
SECTION II
TOXICOLOGY
CHAPTER I
DEFINITION OF A POISON--SALE OF POISONS--CLASSIFICATION
OF POISONS--ACTION OF POISONS--GENERAL EVIDENCE
OF POISONING--GENERAL TREATMENT IN CASES OF POISONING
--GENERAL METHODS OF EXAMINATION FOR POISON
Toxicology is that division of Forensic Medicine which takes into
consideration the modes and actions of poisons upon the living body,
the treatment of their effects upon the body, and the methods of
detecting them when occasion requires.
=Definition of a Poison.=--Neither the law nor medicine defines a
poison. The popular definition is to be avoided, viz., that, a poison
is a substance capable of acting injuriously on the body when taken or
administered in a small dose.
Husband defined a poison as “_any substance which, introduced into the
system or applied to the body, is injurious to health and destroys
life, irrespective of temperature or mechanical means_.”
Taylor and Stevenson define a poison as “_a substance which when
absorbed into the blood is, by its direct action, capable of seriously
affecting health or destroying life_.”
There are substances, however, which do not require absorption into
the blood in order to exert their deleterious action, _e.g._ the
corrosive acids and alkalies; but, although the chief action is a local
one in most cases, some absorption does take place and is evidenced
in systemic effects, and are so classified as poisons differing from
powdered glass, which acts mechanically only and is not a poison in the
true sense of the word.
Winter Blyth considers that “_a substance of definite chemical
composition, whether mineral or organic, may be called a poison if it
is capable of being taken into any living organism, and causes, by its
own inherent chemical nature, impairment or destruction of function_.”
According to Luff a poison is “_a substance which, either by its direct
action upon the skin or mucous membranes, or after its absorption into
the blood, is capable of injuriously affecting health or destroying
life_.”
Letheby defines a poison as “_anything which otherwise than by the
agency of heat or electricity is capable of destroying life, either by
chemical action on the tissues of the living body, or by physiological
action from absorption into the system_.”
The law does not recognise the manner in which the substance acts, nor
the result; the legal standpoint is the _intent_ of the administrator
qua administrator. The law is as follows: “_Whosoever shall administer
or cause to be administered or taken by any person any poison or other
destructive thing with intent to commit murder shall be guilty of a
felony_” (24 and 25 Vict. c. 100, sec. 11).
Section 22. “_Whosoever shall unlawfully apply or administer to or
cause to be taken by, or attempt to apply or administer to, or attempt
to cause to be administered to or taken by, any person, any chloroform,
laudanum, or other stupefying or overpowering drug, matter, or thing,
with intent, in any of such cases, thereby to enable himself or any
other person to commit, or with intent, &c., to assist any other person
in committing any indictable offence, shall be guilty of felony._”
Section 23 enacts that, “_Whosoever shall unlawfully administer to, or
cause to be administered to, or taken by any other person, any poison
or other destructive or noxious thing so as thereby to endanger the
life of such person, or so as thereby to inflict upon such person any
grievous bodily harm, shall be guilty of a felony_.”
Section 24. “_Whosoever shall unlawfully or maliciously administer to
or cause to be administered to or taken by any other person any poison
or other destructive or noxious thing with intent to injure or aggrieve
or annoy such person shall be guilty of a misdemeanour._”
Section 25. “_If upon the trial of any person charged with the felony
above mentioned the jury shall not be satisfied that such person
is guilty thereof, but shall be satisfied that he is guilty of the
misdemeanour above mentioned, then, and in every such case, the jury
may acquit the accused for such felony and find him guilty of a
misdemeanour._”
=Administration of Noxious Drugs.=--The law throws on the medical
witness the responsibility of the definition of a _noxious thing_, and
whether it was given in excess, or liable to cause annoyance or injury
to health. At a Bodmin Assize, Lord Chief-Justice Cockburn, after
consultation with Mr. Justice Hawkins, delivered an important judgment
on the subject. A man was charged with having administered cantharides
with criminal intent. The judges ruled that there must not only be
an administration of a noxious drug with a guilty intent, but the
drug must have been administered in such quantities as to be noxious,
whereas the dose here given was too small to be seriously deleterious.
Distinction was drawn between a drug like cantharides, which is only
noxious when given in excess, and strychnine, a well-established
poison. Acquittal was therefore directed. In the case of R. _v._ Cramp,
the prisoner was charged with having administered half an ounce of
oil of juniper with intent to procure abortion. He was convicted, but
appealed on the legal ground that the substance must be noxious in
itself, and not only when given in excess. Lord Coleridge ruled that
“if a person administers with intent to produce miscarriage something
which _as administered_ is ‘noxious,’ he administers a ‘noxious thing.’”
=The Sale of Poisons.=--The law, by the Pharmacy Act, 1868, and its
amendments, restricts the sale of poisons to pharmaceutical chemists,
chemists and druggists, and registered medical practitioners. The Acts
define and indicate by schedule “Poisons within the meaning of the
Act.” The Schedule of Poisons, as amended in the “Poisons and Pharmacy
Act, 1908,” and “Additions to Schedule 1913,” is:
SCHEDULE OF POISONS
[_As amended by Orders in Council_]
Part I
Arsenic, and its medicinal preparations.
Aconite, aconitine, and their preparations.
Alkaloids.--All poisonous vegetable alkaloids not specifically named
in this schedule, and their salts, and all poisonous
derivatives of vegetable alkaloids.
Atropine, and its salts, and their preparations.
Belladonna, and all preparations or admixtures (except belladonna
plasters) containing 0.1 or more per cent. of belladonna
alkaloids.
Cantharides, and its poisonous derivatives.
Coca, any preparation or admixture of, containing 1 or more
per cent. of coca alkaloids.
Corrosive sublimate.
Cyanide of potassium, and all poisonous cyanides and their
preparations.
Emetic tartar, and all preparations or admixtures containing 1 or
more per cent. of emetic tartar.
Ergot of rye, and preparations of ergots.
Nux vomica, and all preparations or admixtures containing 0.2 or
more per cent. of strychnine.
Opium, and all preparations or admixtures containing 1 or more
per cent. of morphine.
Picrotoxin.
Prussic acid, and all preparations or admixtures containing 0.1 or
more per cent. of prussic acid.
Savin, and its oil, and all preparations or admixtures containing
savin or its oil.
Part II
Almonds, essential oil of (unless deprived of prussic acid).
Antimonial wine.
Cantharides, tincture and all vesicating liquid preparations or
admixtures of.
Carbolic acid, and liquid preparations of carbolic acid,
and its homologues containing more than 3 per cent.
of those substances, except preparations for use as
sheep wash or for any other purpose in connection with
agriculture or horticulture, contained in a closed
vessel distinctly labelled with the word “poisonous,”
the name and address of the seller, and a notice of
the special purposes for which the preparations are
intended.
Chloral hydrate.
Chloroform, and all preparations or admixtures containing more
than 20 per cent. of chloroform.
Coca, any preparation or admixture of, containing more than 0.1
per cent. but less than 1 per cent. of coca alkaloids.
Diethyl-barbituric acid, and other alkyl, aryl, or metallic
derivatives of barbituric acid, whether described
as veronal, proponal, medinal, or by any other
trade name, mark, or designation; and all poisonous
urethanes and ureides. [_Added March 12, 1913._]
Digitalis.
Mercuric iodide.
Mercuric sulphocyanide.
Oxalic acid.
Poppies, all preparations of, excepting red poppy petals and syrup
of red poppies (_Papaver rhœas_).
Precipitate, red, and all oxides of mercury.
Precipitate, white.
Strophanthus.
Sulphonal, and its homologues, whether described as trional,
tetronal, or by any other trade name, mark, or
designation. [_Added March 12, 1913._]
All preparations or admixtures which are not included in
Part I. of this schedule, and contain a poison within
the meaning of the Pharmacy Acts, except preparations
or admixtures the exclusion of which from this
schedule is indicated by the words therein relating to
carbolic acid, chloroform, and coca, and except such
substances as come within the provisions of Section 5
of this Act.
Memorandum.--Special importance attaches to the last paragraph of Part
II. of the schedule, as the effect of that paragraph is to include in
Part II. many preparations and admixtures of vegetable drugs which
contain poisonous alkaloids, although the drugs containing them are not
specified in the schedule.
With those in Part I. a registration of the sale is compulsory, the
purchaser must be known to or introduced by some person known to the
vendor, and the purpose for which the poison is required, the date,
the name and amount of the poison sold, the name and address of the
buyer, and the entry must be signed by the purchaser and introducer.
All substances in Parts I. and II. must be labelled by the vendor
with a label bearing the name of the poison, the name and address
of the seller, and the word “Poison”; but with those in Part II. no
registration as in Part I. is required. In the sale of arsenic both
the seller and purchaser must sign the entry, and the introducer must
witness it. No arsenic can be legally sold to a person under the age of
twenty-one years; nor may it be sold in quantities of less than 10 lbs.
unless mixed with soot or indigo--one ounce of the former, or half an
ounce of the latter, to each pound of arsenic. If quantities of over 10
lbs. be sold, and the soot or indigo would render it unfit for use in
the way desired, then they may be omitted (_Arsenic Act_, 1851).
=Classification of Poisons.=--A good and scientific classification
of poisons is still wanted. The following simple general division,
depending upon the chief effect, may be taken as guides by the student:
(a) _Corrosives_--Local corrosion.
(b) _Irritants_--Gastro-intestinal irritation.
(c) _Neurotics_--Altered action of the nervous system.
1. INORGANIC
_Corrosive_--Sulphuric acid, &c.
_Irritant_--Arsenic, &c.
2. ORGANIC
_Irritant_--Savin, Cantharides.
_Affecting Brain_--Opium.
_Affecting Spinal Cord_--Strychnia.
_Affecting Heart_--Digitalis.
_Affecting Lungs_--Carbonic acid.
(Guy.)
IRRITANTS
{ Acid poisons--Sulphuric acid, &c.
_Mineral_ { Alkaline poisons--Caustic soda, &c.
{ Non-metallic--Phosphorus, Iodine, &c.
{ Metallic--Arsenic, Antimony, &c.
_Vegetable_--Savin, Elaterium, &c.
_Animal_--Cantharides.
NEUROTICS
_Cerebral_--Opium, Hydrocyanic acid, Alcohol.
_Spinal_--Strychnia, Nux vomica.
_Cerebro-spinal_--Conium, Belladonna, Aconite.
_Cerebro-cardiac_--Calabar bean, Digitalis.
(Taylor.)
The subjoined classification is based upon that adopted by the late
Professor Sir Douglas Maclagan. Where the poison acts in such a manner
as to place it in two or more groups, I have fully described it in one,
merely drawing attention to it under the others:
DIVISION I
CHEMICAL
{ Acids.
_Corrosive_, { Alkalies.
{ Caustic salts.
_Vulnerant_, Glass, Needles.
DIVISION II
VITAL
_Irritant_, Metalloid, Phosphorus, Iodine.
“ Metallic, Arsenic, Antimony, Mercury, &c.
“ Vegetable, Gamboge, Elaterium, Colchicum, Squill.
“ Animal, Cantharides, Ptomaines.
_Narcotic_, Somniferous, Opium.
“ Deliriant, Hyoscyamus, Belladonna.
“ Inebriant, Alcohol, Cocculus Indicus, Chloroform,
Ether, Cannabis Indica.
_Sedative_, Cardiac, Digitalis, Aconite, &c.
“ Cerebral, Ether, Chloroform, Hydrocyanic acid.
“ Neural, Conium, Aconite.
_Excitomotory_, Strychnia, Ergot.
_Irrespirable Gases_, Carbonic acid, Carbon monoxide,
Coal gas, Chlorine.
_Toxicohæmic or Septic_, Snake venom, Ptomaines, “Toxins.”
=Action of Poisons.=--Amid the difficulties which surround this
subject, three points appear to have been clearly made out: (1) That it
is necessary for all poisons to enter the blood before their specific
action can be produced. (2) That poisons possess an elective affinity
for certain tissues and organs. Thus, arsenic, however introduced
into the system, as a rule attacks the stomach; and this peculiarity
of action closely allies it to the poisons of typhoid, scarlet fever,
smallpox, &c., which appear to have, respectively, an elective affinity
for the glands of the intestines, the throat, and the skin. (3) That
the habitual use of a poison in medicinal doses does not ensure a
perfect toleration on the part of the system with regard to the action
of the poison, for sooner or later a complete cachexia is produced,
showing that the poisonous effect of the drug is not arrested.
Besides the above, there are also certain conditions connected with
the action of poisons: (1) The poison is absorbed and distributed by
the blood. (2) A portion is eliminated by the fluid secretions and
excretions. (3) Another portion is for a time deposited in the tissues
and organs of the body. These processes are of necessity simultaneous.
The channels of entrance and exit are as follows: Of entrance we
have--(1) _The blood-vessels as a result of wounds_--more important
in a physiological than a medico-legal question. (2) _The skin and
cellular membrane._--Absorption by the skin is modified by the
condition of the part, and also by the form in which the drug is
applied. Thus the skin of the arm-pits and groins is more absorbent
than the palms of the hands. Watery solutions are not so effective
as oily preparations, and the application of the drug in fine powder
is more effectual than a watery solution of it. This is explained
by the presence of a natural oily, unctuous substance on the skin,
which prevents the direct contact of the watery solution, but if the
solution be allowed to evaporate on the part, the substance thus left
in minute division is then readily absorbed. The danger of allowing
strong solutions of corrosive sublimate to evaporate on the head in the
treatment of certain skin eruptions is thus explained. (3) _The lungs
and air-passages._--Absorption by these organs is most active, hence
the intense rapidity in the action of aerial poisons. (4) _The stomach
and intestines._--Poisons introduced into the stomach or intestines
take longer to arrive at the special organs on which they act than by
the other channels of entrance. They are absorbed by the capillaries
into the mesenteric veins, and before passing to the heart, by which
they enter the general circulation, they pass through the liver, where
they are in part excreted in the bile or deposited in the gland. The
absorbing power of the stomach is modified by its fulness or emptiness,
and poisons not soluble in water may be rendered so by the gastric
secretion.
The avenue of entrance may materially modify the action, and some
poisons which act rapidly when entering by a wound, are inert when
taken into the stomach. Snake poisons when given by the mouth are
entirely harmless. Hydrogen sulphide is more toxic when inhaled
than when taken in solution. This, though true in some cases, does
not always occur; and the inertness of these poisons, it has been
suggested, may be due to the elimination of them being as rapid
as their absorption, so that a poisonous dose never enters the
circulation. The intestines absorb more rapidly than the stomach, and
this must be borne in mind when administering powerful drugs _per anum_.
Of the channels of exit we have: (1) _The kidneys._ (2) _The lungs._
(3) _The bile._ (4) _The milk._ (5) _The saliva._ (6) _Mucous
membrane._ (7) _The skin._
We know not the cause, but certain poisons appear to select a
particular route for their exit--thus iodide of potassium leaves by
the urine; mercury and its salts by the saliva; arsenic and eserine,
the active principle of the Calabar bean, in small quantities, by the
stomach, &c. We are, however, prepared to show that all poisons must
enter the blood before they produce their effects, and that almost
simultaneously with the entrance of the poison into the blood a process
of elimination begins, and that fatal effects depend upon absorption
taking place more rapidly than elimination. On the amount also of the
poison absorbed do its fatal effects depend, and not on the quantity
actually taken. Whilst absorption and elimination are both going on,
some of the poison is being deposited in the organs and tissues of the
body. As proofs of these statements it has been shown that poisons
have been detected in the blood, and that urine, saliva, and milk,
fluids secreted from it, may contain portions of the poison taken, and
produce dangerous symptoms when given to other animals. Poisons applied
to the brain tissue, or to nerve trunks, do not produce symptoms,
and the action of a poison may be arrested for a time by compressing
by a ligature the main vessels of the limb under the skin of which
the poison has been injected. After death no trace of the poison may
be detected, the quantity taken being just sufficient to produce a
fatal result, or elimination may be so rapid that, although death was
directly due to the poison, any remains of its existence cannot be
made out. This occurred in the case of Dr. Alexander, who died from
an accidental dose of arsenic, all the arsenic being eliminated in
_seventeen_ days--in another fatal case, in _seven_ days. (Taylor)
As evidence of the diffusion of poisons the following table may be of
use:
{ Dilatation of the pupil in poisoning by
Physiological. { belladonna, hyoscyamus, &c.
{ Contraction of the pupil in poisoning by opium,
{ Calabar bean.
{ _Taste._--Bitter taste of the secretions. Strychnia,
{ picrotoxin. The milk of animals fed on wormwood
{ may become bitter; on colchicum,
Physical. { poisonous.
{
{ _Smell._--Prussic acid, tobacco, conium, &c.
{
{ _Colour._--Skin blackened by nitrate of silver,
{ given internally.
_N.B._--By the aid of the spectroscope the salts of lithium
and thalium have been detected in the liver and
other tissues.
Recapitulation of the Mode of Action of Poisons, and the Causes which
Modify their Action.
MODE OF ACTION
I. LOCAL
1. Corrosion of the part }
to which the poison } Strong acid, alkali, &c.
is applied. }
2. Inflammation as the }
result of irritants } Arsenic, cantharides, &c.
applied to a part. }
3. Effects on the nerves } Dilatation of the pupil by belladonna,
of motion and sensation. } tingling of the tongue and skin by
} aconite, paralysis by conium.
II. REMOTE
1. Common--not to be distinguished from the effects of injury or
disease.
2. Specific--peculiar to the poison itself.
(1) General--affecting the whole system.--Antimony.
(2) Partial--acting on a particular organ.--Antimony.
MODIFYING CAUSES
{ 1. Quantity of the poison increases its rapidly
{ fatal action.
{
1. Quantity. { 2. Action changed by the size of the dose. Thus,
{ oxalic acid in large doses acts as a corrosive;
{ in small doses on the heart, brain, or spinal
{ cord.
{ _Solubility_ increases the activity of poisons.
{ _Chemical Combinations._--Baryta is poisonous,
2. Form. { sulphate of baryta is inert.
{ _Mixture._--Dilution may retard or accelerate
{ the action of a poison.[19]
3. Point of application--Skin, lungs, mucous and serous membranes.
{ _Habit_--generally lessens the action of
{ poisons, e.g. _arsenic-eater, morphine-taker_.
4. Condition of { _Idiosyncrasy_--increases or may lessen the
the body. { action of poisons.
{ _Disease_--generally lessens, but in some cases
{ increases the action of poisons.
[19] Dilution lessens the activity of some poisons, by prolonging
the time necessary for their absorption; but in the case of powerful
irritants, which act through the blood, moderate dilution increases
their activity, by enabling them to enter the vessels more easily.
Oxalic acid is an example of the effect of dilution as a modifying
agent in its action. A small concentrated dose acts as an irritant;
diluted, it is soon absorbed, and quickly causes death.
GENERAL EVIDENCE AND DIAGNOSIS OF POISONING
It will now be necessary to consider briefly the general evidences of
poisoning, in order to determine whether a death alleged to be due
to poison is not really the result of disease. For convenience of
description, this subject will be divided into five sections:
1. Evidence from the Symptoms.
2. Evidence from the _Post-mortem_ Appearances.
3. Evidence from Chemical Analysis.
4. Evidence from Experiments on Animals.
5. Moral Evidence.
1. =Evidence from the Symptoms.=--As a general rule the symptoms come
on suddenly while the person is in apparent health, except in cases of
slow poisoning, when the poison may be so administered by frequently
repeated and small doses as to simulate disease, and the physician is
more easily misled than when a single large dose is given. In cases of
suspected homicide this suddenness in the accession of the symptoms
is particularly to be noticed, and we may have to decide as to the
probabilities of accident, suicide, or homicide. Here collateral
evidence must be our guide. The slowness, obscurity, and irregularity
of the symptoms are more in favour of homicide than either accident or
suicide. But it must also be borne in mind that the invasion of many
diseases is sudden, as is the case with cholera, gastritis, and some
others.
Certain conditions of the system more or less modify the effects of
some poisons. Thus, sleep delays the action of arsenic; and this may
also be the case with other poisons. Intoxication has also been said
to exert a retarding power over the action of certain poisons. This is
probably more apparent than real, the fact being that the symptoms in
the cases observed are masked.
Much more important, however, is the influence of disease. Large doses
of opium are well borne in mania, delirium tremens, dysentery, and
tetanus; whereas it is well known that even small doses of mercury in
cases of Bright‘s disease of the kidney, or in children recovering from
any of the eruptive fevers, have produced dangerous salivation.
The symptoms of poisoning go on from bad to worse in a steady course;
but there may be remissions, followed, under treatment, by their
entire disappearance, no ill effect remaining. Remissions are most
likely to occur in slow poisoning with the metallic irritants, from
fear of detection or cunning on the part of the poisoner to imitate
the progress of disease. In nervous affections, all the symptoms must
be taken into consideration, and these will be found to differ from
those of any known poison. The history of the case should also have due
attention paid to it.
In poisoning, the symptoms appear soon after food or drink has been
taken. This is open to the objection that apoplexy has occurred
immediately after a meal. The probative value of the above statement
is, however, increased if several persons have been similarly affected
after partaking of the same dish, especially if the symptoms followed
within a short time--under four hours--of the meal. But it must also be
remembered that all persons are not affected alike by the same poison.
Again, the diagnostic value is weakened if it can be proved that the
person or persons affected have taken nothing in the way of food for
two or three hours previously.
_The flesh of animals poisoned by accident, or intentionally, may
seriously affect those who eat it._--As a case in point may be
mentioned the injurious effects produced in some persons who had
partaken of the Canadian partridges imported to this country some years
ago, and which had probably eaten some poisonous berries during the
severe winter of that year.
Poisons may be introduced into the system otherwise than by the mouth;
that is, they may be placed in the vagina or rectum, or inhaled when
volatile poisons are used. Sometimes a poison has been introduced
into the medicine, or a poisonous draught substituted for the one
prescribed. In any case, where suspicious symptoms suddenly occur, the
poison has most probably been taken in from half an hour to an hour
previously, and it is of special importance to note the period of time
that may have elapsed between the accession of the symptoms and the
last meal, or administration of medicine.
When called in to a case of suspected poisoning, and in many cases
where no suspicion at the time arises, the medical attendant should pay
attention to the following points:
1. The time of the occurrence of the symptoms, and their
character.
2. The time that has elapsed between their commencement and
the last meal, dose of medicine, &c.
3. Have the symptoms continued without intermission or
remission, and in an aggravated form, till death?
4. The order of their occurrence.
5. The previous health or illness of the patient.
6. Have the symptoms any relation to a particular meal or
article of food, &c.?
7. If patient has vomited, have the vomited matters,
especially the first, been carefully preserved?
8. Preserve all vomited matters, food, medicines, &c.
9. How many were at the meal, and was what was taken common
to all, or only taken by a few?
2. =Evidence from= _Post-mortem_ =Appearances=.--The morbid
appearances found in cases of poisoning will be treated more in
detail when each poison, or group of poisons, comes to be separately
considered. A caution may be given here against allowing the
_post-mortem_ signs of disease or external injury to exclude the
idea of poisoning; for death may to all appearance be the result
of disease or injury, and yet be caused by poison. An attention to
the _post-mortem_ appearances is important in all cases; for in
many instances, where the symptoms were unknown to the experts at
the time the inspection was made, they were subsequently found to
correspond with the morbid changes which the autopsy revealed. The
normal appearance of the stomach is white or nearly so, except during
digestion, when it is reddened; yet we may sometimes come across cases
in which the mucous membrane of this organ may be found so reddened as
to lead to a suspicion of poisoning. The knowledge of this fact, and
the absence of symptoms, will prevent an error in diagnosis. Ulceration
from disease and from irritant poisoning must be distinguished. In
that due to disease, the ulcers formed are, as a rule, small and
circumscribed; in those from poison, there is diffused inflammatory
redness over other parts of the stomach, and even in the intestines;
and the poison, as in the case of arsenic, may be found adhering to the
sides of the ulcer. Ulceration is more frequently the result of disease
than of the action of poisons. Perforation of the stomach or intestines
may be due to ulceration or to corrosion. The condition of the mouth
and gullet will help the diagnosis. The appearance of the ulcer and
the parts around it, together with the hints just given, must guide
the diagnosis. Of _post-mortem_ softening little need be said, beyond
stating that it very rarely occurs, and is of course not preceded
by symptoms. (For the diagnosis between inflammatory redness of the
intestines and _post-mortem_ staining, see page 45.)
3. =Evidence from Chemical Analysis.=--The objects of a chemical
analysis are to determine: (1) The presence and nature of the poison.
(2) The proportion or quantity of the poison taken. (3) The solution of
certain questions connected with the administration of the poison.
The detection of poison in the body is of course the most important
proof of poisoning; but it may be suggested that the poison was
introduced after death, which, to say the least, is a most ingenious
line of defence, but which, at the same time, must be held to be highly
improbable, and impossible if found deposited in one or more of the
solid organs. Again, granting that poison has been taken, is it the
cause of death? This question may arise when injuries are found on the
body, and it then becomes a matter of importance to know something of
the symptoms which preceded death, and the morbid appearances found
after death. The case of the girl who took arsenic to escape a beating
by her father is a case in point. The father was tried for causing the
death of the girl by undue severity, but it was subsequently shown
that arsenic self-administered was the true cause of death. The poison
may disappear from the body. This disappearance may be effected by
vomiting, purging, or by the urine, or the poison may become absorbed
and decomposed. The person poisoned may live sufficiently long to allow
of the entire elimination of the poison, and yet die of the induced
exhaustion. (See case of Dr. Alexander, _ante_.)
Some poisons, especially those which are sparingly soluble, are with
difficulty removed from the stomach, even by the most incessant and
violent vomiting. This is notably the case with arsenic, which adheres
to the mucous coat of the stomach with considerable tenacity. But
even after all traces of the poison have left the stomach, it may be
detected in the solid viscera.
Temporary deposit of poison in the organs or tissues (Taylor): (1) The
Liver. (2) The Kidneys. (3) The Spleen. (4) The Heart. (5) The Lungs.
(6) The Muscles. (7) The Brain. (8) The Fat. (9) The Bones.
With regard to arsenic, the following table, taken from Taylor, is of
importance, as showing the amount of the poison which may be found in
the liver at certain intervals:
After taking the Poison. Total Weight of Arsenic.
In 5½ to 7 hours 0.8 grains.
8¾ hours 1.2
15 hours 2.0
17 to 20 hours 1.3
10½ days 1.5
14 days 0.17
17 days _nil_
Is it necessary that the poison should be found in the body or in the
evacuations to lead to a conviction for poisoning? On this point,
Christison was of opinion that if the symptoms, _post-mortem_,
appearances, and moral evidence are very strong, it is not necessary
that the poison be found in order to establish a charge of poisoning.
This opinion was also supported by the late Dr. Geoghehan, Professor
of Medical Jurisprudence in the Royal College of Surgeons, Ireland,
and was also virtually acted upon in the case of Palmer, where the
non-detection of strychnia was strongly dwelt upon by the counsel for
the defence, but without success. Many of the vegetable poisons almost
defy detection, except by the symptoms, _post-mortem_ appearances, and
some experiments on animals of doubtful value. The detection of poison
in the food taken, or in the vomited matters, is of great importance;
but it is of still greater importance if it can be found in the
urine, drawn from the bladder, this being a proof that it has passed
through the system. Here again a caution is necessary--for it must be
remembered that poisoning may be _feigned_ or _imputed_--the poison
being mixed with the food and evacuations, and an innocent person
accused.
The following suggestions should be carefully considered by every
analyst when substances are sent to him for examination:
He should carefully note when and from whom the substances were
received; in what state they were received--secured, or exposed--the
number of articles, and whether properly labelled. He must make the
analysis himself, and state where it was made. The character and
nature of the substances examined should be noted, and he must be
prepared to give an outline of the methods or processes used for their
determination. He must also be able to guarantee the purity of his
reagents, and be prepared to answer the following questions:
1. Is the poison free or combined?
2. What is the strength and quantity found?
3. Could the poisonous substance exist naturally?
4. How much of the poison found is a fatal dose?
5. If no poison is found, is there anything noxious
or injurious to health?
The analyst may have the following submitted to him for examination:
(1) Substances found on the accused, or in the room, or on the person
of the deceased. (2) Articles of food. (3) Vomited matters, urine, &c.
(4) Contents of the stomach. (5) Solid organs of the body.
He may also have his results called in question for the following
reasons: (1) Purity of his reagents. (2) Faulty processes. (3) Hasty
conclusions. (4) Experiments on animals.
Death may undoubtedly be due to the action of a poison, and yet its
presence may fail to be detected, due to--(1) The nature of the
poison-strychnia, hydrocyanic acid, &c. (2) Vomiting and purging. (3)
Absorption and elimination. (4) Decomposition--phosphorus, chloral
hydrate, chloroform. (5) Smallness of the dose.
(For directions for conducting a _post-mortem_ examination in cases of
poisoning, see page 61.)
=4. Evidence from Experiments on Animals.=--The evidence derived from
experiments on animals with the contents of the stomach and vomited
matters must not be too implicitly trusted, as these may give rise to
vomiting and other symptoms when no poison is present. All animals are
not alike affected with man by the same poisons; and it appears that
the dog and the cat are the only animals that at all approach man with
regard to the effects produced. Experiments on the lower animals are
useless to decide--(1) The fatal dose of any poison. (2) The rate of
absorption, deposition, or elimination of poisons. (3) The rapidity of
the action of certain poisons.
In the case, however, of some vegetable poisons, the effects produced
on animals by a portion of the substance taken by the person
suspected of having been poisoned, may afford corroborative evidence
of poisoning. In the case of Lamson, executed for poisoning his
brother-in-law with aconite, experiments on animals formed the chief
evidence against the accused.
=5. Moral Evidence.=--The moral evidence of poisoning is generally
furnished by the common witnesses of the Crown; but the value of this
kind of evidence, in many cases, can only be fully appreciated by a
medical witness. To render this part of the subject as complete as
possible, a few remarks may not be out of place. The suspicious conduct
of the prisoner before and after the event, the recent purchase of
poison, the mode of administration, the object of the prisoner in
getting rid of his supposed victim, and the fact of several persons
being alike affected, should be carefully noted down. The anxiety
evinced during the illness of the deceased, and the hurry in the
funeral arrangements, showing an over-anxiety to remove all traces of
his guilt, are suspicious. The probability of suicide is weakened by
the state of the mind and the nature of the dying declarations of the
deceased. In the case of a person indicted for poisoning, evidence to
show motive in another case is admissible. (R. _v._ Geering, 18 L.J.
[M.C.] 215; R. _v._ Heeson or Johnson; R. _v._ Garner, 3 F. & F. 681.)
Lastly, it remains to be considered--
_What is the duty of a Medical Man who suspects the Action of Poison in
a Patient on whom he is in attendance?_
In the case of R. _v._ Wooler, Baron Martin, who tried the case, in
his charge to the jury, stated that, in his opinion, the medical men
in attendance ought, “when the idea of poisoning struck them, to have
communicated their suspicion to the husband, if they did not suspect
him; and if they did suspect him, they ought to have gone before a
magistrate.” Suppose they had acted as the learned judge suggested,
and spoken to the husband, who, had he been guilty, would in all
probability have desisted from his terrible design for a time, then
a great criminal would have been let loose on society, and without
punishment. Then, again, had they applied to the magistrates, the delay
caused by the indecision of the magistrates how to act in so delicate
a case would have allowed the criminal to remove all traces of his
design, and the means of testing their suspicions would have been lost;
and, along with this, would have been lost the professional character
and fortunes of the authors of the investigation. “There is a third
course,” said the late Sir R. Christison, “and in my opinion it is the
fittest of all: When the medical attendant is satisfied of the fact of
poisoning, he should communicate his conviction to the patient himself.
His predicament, in every other way, is so embarrassing, that he ought
not to be deterred by the chance of injury to his patient from making
so dreadful a disclosure.” (See an account of the same course being
adopted in the case of Mr. Blandy by his physician, Dr. Addington,
reported in Howell‘s _State Trials_, vol. xviii.)
Table giving the names of Diseases, the Symptoms
of which resemble those the result of Irritant Poisons,
together with such points of difference as may assist in
distinguishing the one from the other:
Irritant Poison.--Symptoms of violent irritation in one or more
portions of the alimentary canal. Pricking and burning of the tongue
and mouth, and intense thirst, frequently accompanied with great
constriction in the throat. Great abdominal pain and tenderness.
Vomiting and purging are also usually present. The skin is hot and
cold at intervals; the pulse small, frequent, and irregular. In the
last stage the skin may become icy cold. _An acrid, metallic, or
burning taste in the mouth precedes the vomiting._ The vomit and alvine
discharges are generally mixed with _blood_. Death occurs in from six
hours to two days and a half.
Cholera.--Extreme and sudden prostration. The breath is cold to the
hand in the last stages. The body is cold, shrivelled, and livid, or
of a leaden hue. Vomiting and purging are present; the former is never
bloody, the latter resembling rice-water. The thirst is intense, and in
this particular alone resembles the effects of irritant poison. Death
in from one to two days, or even less.
Summary of the General Evidence of Poisoning,
in a Tabular Form
----------------------------------+----------------------------------
Poison. | Natural Causes.
----------------------------------+----------------------------------
1. The symptoms come on suddenly,| 1. Many diseases come on
and rapidly progress. | suddenly--cholera, gastritis,
| &c--and run a rapid course to
| a fatal termination.
|
2. The symptoms begin while | 2. Some acute diseases begin
the person is in sound health.| under like circumstances.
|
3. The symptoms of poisoning | 3. This is also the case with
go on from bad to worse in a | many common diseases.
steady increase. |
|
4. Uniformity in the nature of | 4. The uniformity of the symptoms
the symptoms. | is common to many diseases;
| but in some cases the absence
| of uniformity may be a proof
| of disease.
|
5. The symptoms come on | 5. Apoplexy, colic, cholera, and
immediately after a meal. | some other diseases may follow
| a meal. But the fact that some
| hours have elapsed since the
| last meal is against the
| probability of poisoning.
|
6. Several persons are attacked, | 6. As a general principle it may
after partaking of the same | be stated that there is no
meal, with the same symptoms. | disease likely to attack
| several persons at once, but
| there are cases on record of
| this having occurred.
|
7. Poison found in the food, | 7. Poison may be mixed with food,
vomited matters, urine, &c. | &c, in cases of imputed
| poisoning.
----------------------------------+----------------------------------
English Cholera.--In this disease all the symptoms of irritant
poisoning are present. Pain in the belly, and vomiting. But in this
disease the vomit and alvine discharges are _never_ bloody, most
frequently bilious. _An acrid taste in the mouth and throat succeeds
the vomiting._ This is due to the acrid nature of the vomited matters.
The stools contain bile in English cholera; in irritant poisoning,
sometimes blood. Death is rare within three days.
Gastritis.--Acute idiopathic gastritis is so rare in this country as
scarcely to need description. Most of the cases recorded of acute
gastritis have been found to be due to irritants. We must, therefore,
consider the period and order of the occurrence of the symptoms in
relation to the last meal. Costiveness of the bowels would point to the
presence of gastritis or enteritis, violent purging and vomiting to
irritant poisoning.
Enteritis.--Though more common than gastritis, enteritis is a rare
disease. The bowels are generally _confined_. Tubercular and aphthous
inflammation of the intestines may simulate irritant poisoning,
especially chronic poisoning by arsenic. The _post-mortem_ and a
chemical analysis will reveal the true cause of death.
Peritonitis.--In the early stages of the disease vomiting is rare,
and constipation is the rule, with marked tenderness over the whole
abdomen. The morbid appearances in the peritoneum are seldom caused by
irritants.
Perforation of the Stomach.--The symptoms supervene immediately after
a meal; the pain, which is very acute, gradually extending over
the abdomen. In most cases the patient has suffered for some time
previously from dyspepsia.
Hernia.--Examine the seat of pain, the cause will be soon detected.
But an omental hernia may be present, giving rise to twisting pain at
umbilicus.
Intussusception of the Bowels.--Pain, sudden and confined to one
spot below the stomach. Vomiting is present _without_ purging, thus
differing from diarrhœa and cholera. After a time the vomit becomes
fæcal.
Colic.--May be confounded with poisoning by the salts of lead. If lead
be taken in large doses, it produces the symptoms common to irritant
poisons added to those of colic. In chronic lead poisoning, the blue
line round the gums, the aspect of the patient, and history of the
case, will point to the true cause of the symptoms. Lead colic is also
generally accompanied with extreme depression of spirits.
Rupture of Internal Organs.--Rupture of the stomach, duodenum,
gall-bladder, and impregnated uterus, is of rare occurrence. The
autopsy will show the true cause of death.
Table giving the names of Diseases the Symptoms of which
resemble those the result of Narcotic Poisoning, together with
such points of difference as may assist in distinguishing the
one from the other:
Narcotic Poisoning.--Giddiness, headache, drowsiness, and considerable
difficulty in keeping awake. Paralysis of the muscles, convulsions,
ending in profound coma and death. The symptoms of narcotic poisoning
begin not later than an hour, or at most two hours, after the poison
is taken, except in the case of poisonous fungi and spurred rye, when
a day or two may elapse. The symptoms of narcotic poisoning advance
gradually. The person may, in _most_ cases, be roused from the deepest
lethargy. The pupil in opium poisoning is, as a rule, _contracted_.
Recovery seldom occurs after twelve hours; in most cases, death takes
place in six or eight hours--the shortest time being three hours.
Apoplexy.--In some cases apoplexy is preceded by warning
symptoms--headache and giddiness. As a rule apoplexy is a disease of
old age, and of stout, plethoric people. If the symptoms do not come
on for some hours after food or drink has been taken, this disease is
to be suspected; but it may occur _at_ or _immediately_ after a meal,
too soon to be the result of the action of narcotics--ten to thirty
minutes always elapsing before these poisons act. Apoplexy generally
comes on suddenly, coma at once present. It is seldom possible to rouse
the person when the sopor of apoplexy is fully developed. The pupils in
apoplexy are _usually unequal or dilated_; but should the effusion of
blood take place into the pons Varolii, the pupils may be contracted,
hence closely simulating opium poisoning. Apoplexy may last for days,
or death may occur in an hour.
Epilepsy.--Loss of consciousness and presence of convulsions mark this
disease; and in these it resembles poisoning by prussic acid. Epilepsy
is in most cases a chronic disease. Warnings--_aura epileptica_--are
often present. The fit begins violently and abruptly. The paroxysm
generally lasts for some time, and death rarely occurs during the first
attack.
Table showing Points of Difference in the Action of
Corrosive and Irritant Poisons
------------------------------------+------------------------------
Corrosives. | Irritants.
------------------------------------+------------------------------
1. Destruction of the parts to | 1. Irritation of the parts
which they are applied. No | to which they are applied
remote action on the system. | producing inflammation.
| Remote action present in
| most of the irritants.
|
2. Symptoms supervene immediately | 2. Symptoms may rapidly
they are swallowed, and consist | supervene after they are
of a burning, scalding pain | taken, or some delay may
felt in the mouth, gullet, and | occur, due to the state of
stomach. | concentration or dilution
| of the poison. Pain in
| the stomach and bowels,
| more or less severe, is
| always present with the
| other signs of irritation.
|
3. Death may result from-- | 3. Death may result from--
(1) Shock. | (1) Shock.
(2) Extensive destruction | (2) Irritation, causing
of the parts touched. | convulsions.
(3) Starvation. | (3) Protracted suffering.
(4) Suffocation, the result | (4) Starvation.
of œdema, or spasms due |
to acid in larynx. |
4. _Post-mortem_ appearances: | 4. _Post-mortem_
corrosion and extensive | appearances: irritation
destruction of tissue. | and signs of inflammation,
| ulceration, &c.
------------------------------------+------------------------------
GENERAL TREATMENT OF CASES OF POISONING
The principal modes of procedure are as follows:
1. To remove the poison from the digestive tract, or neutralise it or
render it insoluble by the administration of suitable antidotes.
2. To overcome the effects of that which has been absorbed.
3. To promote its elimination.
4. To alleviate dangerous symptoms, and endeavour to keep the patient
alive until the effects of the poison have passed off.
To forcibly empty the stomach, emetics may be administered or other
means used to induce vomiting, or the stomach pump or tube may be
employed.
Suitable emetics are sulphate of zinc in thirty-grain doses dissolved
in warm water, a dessert-spoonful of mustard in half a pint of warm
water, ipecacuanha wine in tablespoonful doses, copious draughts of hot
water. Tartar emetic and sulphate of copper should be avoided, except
in cases of phosphorus poisoning, when the latter may be used. The
hypodermic injection of ⅒ grain of apomorphine is a very useful emetic,
especially in cases of narcotic poisoning. Irritation of the fauces
with the finger or a feather promotes vomiting, and may be useful in
the absence of an emetic.
The stomach tube or pump is most useful in that it is under the
control of the operator and enables him to thoroughly wash out the
stomach. After passing the tube, previously lubricated with vaseline
or glycerine, through the œsophagus down to the stomach, a pint of warm
water should be first injected before withdrawing any of the contents.
By alternate injection of water and its withdrawal, the stomach may
be efficiently cleansed, and at the same time solutions of suitable
antidotes may be passed into it. It must be remembered that neither
the stomach pump, syphon tube, nor emetics, are to be used in cases of
poisoning with corrosives, with the exception of carbolic acid. The
tube should be used with great caution in cases of irritant poisoning.
Antidotes are remedies which counteract the effects of poisons. They
act mechanically, _e.g._ flour and water, chalk mixture; chemically,
as magnesia and chalk in mineral acid poisoning, alkaline sulphates in
lead and barium poisoning; and physiologically, as antagonists, such
as morphine and atropine, atropine and physostigmine, strychnine and
chloral hydrate.
To counteract the effects of the portion of the poison absorbed,
special treatment is necessary: purges and diuretics may be called for;
artificial respiration may be necessary; cardiac depressants require
cardiac stimulants; the cold douche as a restorative and external
warmth are desirable in certain cases. Sedatives may be administered
to alleviate convulsive seizures. Tracheotomy may be required in cases
with laryngeal complications; and pain, exhaustion, excessive vomiting
or purging are to be treated by appropriate remedies.
EXAMINATION OF THE CONTENTS OF THE STOMACH, VISCERA, ETC., FOR POISON
The number and condition of the vessels received should be noted and
copies made of any affixed labels.
The appearance, smell, colour, and reaction to test paper of the
contents should be noted, and their weights and volumes determined.
All jars, wrappers, labels, and seals should be preserved for future
reference.
The stomach contents should be carefully examined in reference to their
nature, colour, and smell, and the presence or absence of any abnormal
constituents. The mucous membrane of the stomach should be examined
with the naked eye and by the aid of a lens, the surface washed with
distilled water, and the washings added to the contents.
There is often some clue as to the nature of the poison afforded, and
the investigation should be made for it first; the presence or absence
of other poisons, however, must be determined. If there be no clue,
then a systematic examination must be carried out. The poison must be
looked for not only in the contents of the stomach, but in the viscera
as well; it must be remembered that poison may be introduced into the
stomach after death.
Volatile poisons, such as alcohol, chloroform, prussic acid, may be
separated by distillation after acidulation with tartaric acid. Arsenic
is best separated by drying the organic material, and distilling after
adding strong hydrochloric acid.
Other metallic poisons may be tested for, with or without destruction
of organic matter. To destroy the organic matter, the _moist method_
is the one in general use: After reducing the contents of the stomach
or the viscus to a pulp, they are mixed with distilled water to the
consistency of thin gruel, and placed in a flask with some crystals
of potassium chlorate--half an ounce to each pound of the liquid.
Pure hydrochloric acid is added, and the flask gently heated on a
water bath, a mixture of chlorine and oxides of chlorine is given off
and gradually breaks up the organic matter, converting at the same
time any mineral poison present into the chloride. This procedure is
followed until the material becomes quite limpid, more chlorate or
hydrochloric acid may be added if necessary. It is then transferred to
an evaporating dish and heated on the water bath until the smell of
chlorine disappears. It is then filtered while hot, to allow chloride
if present to pass through; a stream of sulphur dioxide is passed
through the filtrate when cold, to reduce any metals present to a lower
state of oxidation. Silver chloride will not pass through the filter in
this process, so it has to be dealt with in a special manner.
In making a systematic analysis, volatile poisons must be tested for
first, then ascertain the presence or absence of alkaloids, after which
the inorganic poisons must be dealt with.
CHAPTER II
DIVISION I.--CHEMICAL
CORROSIVE POISONS
THE MINERAL ACIDS
_General Characters._--The mineral acids have no remote effects on the
system; their action is purely local. They are seldom used for the
purpose of homicide, except in the case of young children. By suicides
they are more frequently employed.
The _Symptoms_ common to the action of these acids supervene
_immediately_ the acid is swallowed, and consist in a sensation of
burning in the mouth and gullet. Dreadful pain is felt in the stomach,
attended with constant eructations, and vomiting of a brownish or
blackish matter, mixed with blood. Mucus, together with, in severe
cases, portions of the mucous membrane of the stomach, may be detected
in the vomited matters, which have an intensely acid reaction, changing
the colour and destroying the texture of cloth or other material on
which they may fall. The act of swallowing is attended with intense
pain, and not infrequently is rendered quite impossible. The thirst
is intense, the bowels are confined, and the urine is diminished
in quantity. The pulse is small and weak, and the skin clammy and
cold. Respiration is performed with difficulty, and the countenance
expresses the most intense anxiety. Sometimes, when the upper part of
the windpipe is implicated, there is more or less cough and difficulty
of speech. Death may even result from suffocation--the skin, in this
case, presenting a cyanosed appearance. The mouth is excoriated, the
lips shrivelled and blistered. In children, when the acid has been
poured far back into the mouth, by forcing the bottle backwards before
emptying it of its contents, the mouth may more or less escape injury,
and the signs in it of corrosive poisoning be absent. The teeth may
become loose, and fall out of the mouth. The mental faculties remain
clear, death generally coming on suddenly, the patient dying convulsed
or suffocated. The period at which death ensues is very variable, and
considerable power for locomotion may be retained by the sufferer,
though, as a rule, he is found writhing in exquisite agony on the floor
or elsewhere. Some cases recover, leaving the coats of the stomach more
or less injured, and the general health greatly impaired.
_Post-mortem Appearances._--The body externally is healthy. The lips
and external parts of the body, which have come in contact with the
acid, are charred. The mucous membrane of the mouth, shrivelled and
eroded, is whitish, yellowish, or brownish, sometimes appearing “as
if it had been smeared with white paint” or thin arrowroot. Many of
the appearances above described will depend upon the rapidity with
which death has followed the swallowing of the poison. The mouth,
gullet, and trachea may alone show any signs of the corrosive action of
the poison, and it is important to remember that death may be due to
sulphuric acid, and yet the acid may never have reached the stomach.
In one or two cases where the poison was poured into the mouth during
sleep, and in the case of children in whom the mouth was held open,
there were no signs of the poison on the lips, and the mouth even
escaped in one or two cases. The stomach, in some cases more or less
contracted and perforated by the corroding action of the acid, may
contain a dark grumous liquid, the acidity of which will depend upon
the treatment adopted, or the length of time that may have elapsed from
the swallowing of the acid to the fatal termination. The stomach also
appears as if carbonised, this being due to the action of the acid on
the effused blood; no such appearance being produced when sulphuric
acid is poured into the dead stomach. Corrosive action may be found in
the duodenum. In cases where the patient has survived from sixteen to
twenty hours, the small intestines have been found inflamed. The blood,
Casper states, is never fluid in acute poisoning by sulphuric acid,
but always “syrupy at least, and sometimes ropy; it has a cherry-red
colour, and acid reaction.” Sulphuric acid is also said to possess
powerful antiseptic properties, and that bodies of those who have died
from its effects remain long fresh.
There are two things which may render the diagnosis difficult--(1)
Gastric ulcer. (2) _Post-mortem_ digestion of the stomach.
Gastric ulcers vary in size from that of a threepenny-piece to that
of a florin, or larger. In shape they are round or oval, and present
the appearance of shallow but level pits, with sharp, smooth, vertical
edges--appearing as if they had been punched out. The peritoneal
opening is smaller than that on the internal surface of the stomach.
The absence of injury to the mouth and gullet will distinguish gastric
ulcer and _post-mortem_ softening from the action of corrosive poisons.
_General Treatment._--Chalk, carbonate of magnesia, bicarbonate of
soda, the plaster from the walls or ceiling of the apartment stirred in
water, and followed by diluent drinks--barley water, linseed tea, &c.
The use of the stomach pump is contra-indicated.
SULPHURIC ACID
_Forms._--Sulphuric acid occurs in two forms--_concentrated_ and
_diluted_.
_Characters._--Concentrated sulphuric acid or oil of vitriol (specific
gravity, 1.800 to 1.845), as it is found in commerce, is a heavy, oily,
colourless, or slightly brownish-coloured liquid, not fuming when
exposed to the atmosphere; but, when added to water, causing a rapid
increase of temperature, which may crack the glass vessel in which
the mixture is made. Sulphuric acid chars and destroys the texture of
organic bodies placed in it. _Dilute sulphuric acid_ is a colourless,
strongly acid liquid, reddening litmus, and charring paper dipped into
it when subsequently dried, care being taken not to scorch the paper.
_Symptoms, &c._--The symptoms and _post-mortem_ signs have been already
described, p. 246.
_Chemical Analysis and Tests._--The acid will have to be examined under
the following heads: (1) Simple, concentrated acid. (2) Dilute acid.
(3) Mixed with organic liquids, food, vomit, &c. (4) On the clothes of
the person injured.
I. Concentrated Acid
1. _Chars Organic Matter._--A piece of wood or paper placed in the
strong acid rapidly becomes blackened.
2. _Heat when added to Water._--Equal quantities of acid and water
added together produce intense heat.
3. _Evolution of Sulphurous Acid._--When boiled with chips of wood,
copper cuttings, or mercury, fumes of sulphurous acid are evolved,
detected by their sulphur-like odour, and by their power of first
bluing and then bleaching starched paper dipped in iodic acid.
II. Dilute Acid
1. _Chars Paper._--This only occurs when the paper is dried by the aid
of heat, subsequently to moistening it in the dilute acid.
2. _Precipitation of Sulphate of Barium._--A solution of the nitrate or
of the chloride of barium is precipitated by sulphuric acid in the form
of a white insoluble powder, unaffected by nitric or hydrochloric acid,
even when heat is applied. This test is so delicate, that a liquid
containing ¹/₂₅₀₀₀th part by weight of the acid is precipitated by
either of the test solutions.
3. _Action of Heat._--The dilute acid is entirely volatilised by heat.
III. Mixed with Organic Liquids, &c.
In tea, coffee, or beer the mode of applying the tests are the same,
the mixture being previously filtered, or the acid separated from the
organic mixture by dialysis, or the following cautions are necessary:
_Objection A._--Alum, or any acid sulphate, would give all the
reactions with the nitrate and chloride of barium.
_Answer A._--Evaporate a portion of the doubtful liquid; if pure acid,
there will be no residue, sometimes only the _slightest trace_ of
sulphate of lead.
_Objection B._--Erroneous estimation of free sulphuric acid, in
consequence of the presence of some saline or neutral sulphates.
_Answer B._--Evaporate as before. The free sulphuric acid separated
by warming the liquid is then added to a known weight of powdered
carbonate of baryta until effervescence ceases. The resulting
precipitate when weighed, represents the free sulphuric acid present.
Calculate in the following manner--
BaCO₃ + H₂SO₄ = BaSO₄ + H₂O + CO₂.
BaCO₃ = 197.
H₂SO₄ = 98.
CO₂ = 44.
In the above equation, 98 parts of H₂SO₄ take the place of 44 parts of
CO₂. If, therefore, 100 grains of BaCO₃ renders the liquid neutral,
the amount of free SO₄ present will be represented by the increased
weight of the precipitate in the proportion of 54 to 98, the difference
between 44 and 98 the equivalent of CO₂ + SO₄.
To extract the acid from organic mixtures, digestion with alcohol is
required: filter and neutralise the filtrate with caustic potash,
evaporate to dryness, and dissolve the residue in distilled water
acidulated with hydrochloric acid; the previous tests may then be
applied. Extraction with alcohol leaves behind combined acid in the
form of sulphates. The presence of free acid in the filtrate or
original mixture may be detected by the change of tropæolin solution
from yellow to crimson or ruby colour when added to it; or on adding a
few drops of the mixture or filtrate to a solution of potassio-tartrate
of iron B.P. in water, so as to make it of a yellow tinge, and to which
potassium sulphocyanide has been added, the liquid changes from a
yellow to a port-wine colour.
IV. Stains on the Clothes, &c.
1. The strong acid changes the colour of black woollen cloth to a dirty
brown, the edges of the spots assuming a reddish tint after a few days.
The dilute acid on the same cloth produces a red stain, which in time
becomes brown.
2. The spots made by the strong acid remain damp for some time--strong
sulphuric acid, having a great affinity for water, continually absorbs
moisture from the atmosphere.
3. The spot should be cut out, boiled in distilled water, or digested
with alcohol, filtered and tested for free sulphuric acid.
4. A portion of the cloth not touched by the acid should be tested, in
order to show that the sulphuric acid found is not due to sulphates
present in the cloth.
5. An acid sulphate--bisulphate of potash--gives a reddish stain to
black cloth like that produced by the dilute acid. Test for this salt
by incineration.
_Fatal Period._--Average time before death ensues is from two to
twenty-four hours. The shortest time was one hour, but in children
death may be instantaneous. Life, however, may be prolonged for some
weeks, or even months.
_Fatal Dose._--One drachm in a healthy adult has proved fatal; on the
other hand, however, four ounces have been swallowed without being
fatal.
_Treatment._--As before mentioned.
_N.B._--This acid in past years has given rise to several actions, it
having been employed to disfigure the person by throwing it in the
face.
NITRIC ACID
_Forms._--Strong nitric acid, and dilute nitric acid.
_Characters._--This acid is commonly known as _aqua fortis_, or red
spirit of nitre. It is seldom used as a poison.
The _strong acid_ varies in colour from a pale yellow to a deep
orange. The colour is due to admixture with peroxide of nitrogen. On
_cloth_ and _articles of dress_ it produces _yellow stains_, which are
darkened by the application of an alkali. If poured on copper cuttings,
reddish fumes of nitrous acid are given off. _Dilute nitric acid_ is
a colourless acid liquid, not precipitated by nitrate of barium or
nitrate of silver, showing absence of sulphuric and hydrochloric acids.
All its alkaline salts are soluble in water.
_Symptoms._--The symptoms have been before described, and are similar
to those produced by sulphuric acid, though not quite so severe. The
_vapour_ of this acid has caused death in eleven hours by congestion of
the bronchial tubes and lungs; care should, therefore, always be taken
not to inhale the fumes given off by the acid in the manufacture of
gun-cotton, &c.
_Post-mortem Appearances._--Same as the mineral acids generally, but
the tissues touched are turned yellow, and if bile be in the stomach it
is turned green. The stomach is rarely perforated.
_Chemical Analysis._--Nitric, like sulphuric, acid will be examined
under four heads; but being a volatile acid, easily decomposed, and
also having its nature changed by contact with organic substances, its
presence on clothes may fail to be detected after a few weeks. The
colour of the stain on cloth may also remain, although the acid has
been entirely removed by washing. 1. Strong, concentrated acid. 2.
Dilute acid. 3. Mixed with organic liquids, &c. 4. On the clothes of
the person injured.
I. Concentrated Acid
1. _Volatility._--When exposed to the atmosphere, strong nitric acid
gives off colourless or orange-coloured acid fumes. Heated in a
watch-glass, it is evaporated without residue.
2. _Action on Organic Matter._--The acid leaves on woollen clothes
a _yellow-coloured stain_, which is darkened by the addition of an
alkali. The colour of the stain is due to the formation of picric acid.
3. _Action on Metals._--Gently heated in a test tube with copper
filings, orange-coloured fumes are given off, which redden but do not
bleach litmus paper. Starch paper treated with iodide of potassium
becomes purple.
4. _Solution of Gold._--If a small portion of gold leaf be put into
the acid, no effect is produced; but on the addition of concentrated
hydrochloric acid, the metal is rapidly dissolved.
II. Dilute Acid
1. Absence of sulphuric and hydrochloric acids, proved by no
precipitate being formed with nitrate of barium and nitrate of silver.
2. It does not char paper when the paper is heated, as is the case with
sulphuric and hydrochloric acids.
3. If a piece of filtering paper be dipped into a solution of the acid
saturated with carbonate of potash, dried and ignited, it will burn
like touch-paper.
4. The acid liquid, saturated with carbonate of potash and evaporated,
deposits _fluted_ prisms which do not effloresce or deliquesce on
exposure. Neutralised with soda, the crystals are of a _rhombic_ form.
5. A crystal, so formed, moistened with distilled water on a plate, and
then heated with strong sulphuric acid and allowed to cool, gives with--
(1) A piece of _green sulphate of iron_--a dark green
ring round the crystal.
(2) A small portion of _morphia_--a rich orange colour,
a yellow liquid being formed.
(3) A small portion of _brucine_--a blood-red colour.
6. If an aqueous solution of diphenylamine be added to a solution
containing nitric acid, in a test tube, and pure sulphuric acid be
poured down the side of the tube to form a layer at the bottom, a blue
colour forms at the junction of the two liquids.
III. Mixed with Organic Liquids, &c.
Due to the measures employed by way of treatment the vomited matters
may be neutral and yet nitric acid be present. The method adopted
with viscid and turbid organic mixtures is to dilute them with pure
water, and then filter. If the filtrate be acid, it is neutralised with
carbonate of potash, evaporated, and then set aside to crystallise,
and the crystals purified by digesting them in ether or alcohol. The
crystals are again dissolved and re-crystallised. The tests just
mentioned should then be employed. It should be remembered that nitric
acid has a strong tendency to combine with solid organic structures,
and to become decomposed. The parts of the body stained by the acid
should, therefore, be digested in water at a gentle heat, the liquid
cooled, filtered, and neutralised with carbonate of potash, and then
examined for nitre.
IV. Stains on the Clothes, &c.
Macerate the piece of cloth in distilled water by the aid of heat. If
the solution be acid, neutralise with carbonate of potash, and filter.
Test the solution as before mentioned.
The action of the dilute solution of caustic potash on the following
stains on cloth is characteristic: Nitric acid stain becomes of a clear
orange tint. Iodine stain disappears. Bile stain remains unchanged.
_Fatal Period._--Death may take place in an hour and a half, or life
may be prolonged for some months.
_Fatal Dose._--Two drachms; recovery has taken place after half a fluid
ounce of the strong acid has been taken.
_Treatment._--As before mentioned when speaking of the acids generally.
HYDROCHLORIC ACID
_Forms._--Strong and the dilute acid. It is known as muriatic acid, or
spirits of salts.
_Characters._--_Strong hydrochloric acid_ is either colourless or has
a bright yellow tint, due to the presence of the perchloride of iron.
It fumes in the air, and gives rise to dense white fumes when a glass
rod moistened with ammonia is held over the surface of the acid. The
_dilute acid_ is colourless.
_Symptoms._--Poisoning with muriatic acid is so rare that the symptoms
have not been well studied, but they do not appear to differ much from
those produced by the action of the other acids. It does not stain the
skin, but may darken the mucous membranes. The fumes are apt to attack
the air-passages.
_Chemical Analysis._--The acid will have to be examined under the
following heads: 1. Simple, concentrated acid. 2. Dilute acid. 3. Mixed
with organic liquids, food, &c. 4. On the clothes of the person injured.
I. Concentrated Acid
1. _Action on Organic Matter._--The strong acid tinges most organic
tissues, when immersed in it, a _yellow colour_. The stains on black
cloth are at first distinctly _red_, becoming reddish-brown after a few
days.
2. _Action on Metals._--This acid does not act on copper or mercury,
even when boiled with them, and this distinguishes it from the other
acids.
3. Hydrochloric acid, added to peroxide of manganese and then warmed,
gives off chlorine gas, detected by its greenish-yellow colour and
suffocating odour. The vapour thus produced bleaches litmus paper,
and causes a blue coloration on starch paper moistened with iodide of
potassium.
II. Dilute Acid
1. Decomposes alkaline carbonates, chlorides being formed which, when
heated in the solid state with strong sulphuric acid and peroxide of
manganese, evolve chlorine gas, known by the before-mentioned tests.
2. _Precipitation of Chloride of Silver._--A white curdled precipitate
of chloride of silver is thrown down when a solution of nitrate of
silver is added to hydrochloric acid. This precipitate becomes grey
on exposure to light. If a portion of the precipitate be added to
ammonia it will dissolve; another portion, when boiled with nitric
acid, is unaffected; and a third portion, ignited in a capsule, becomes
converted into a horny mass.
In any case where there is a doubt as to whether the hydrochloric
acid exists in the free state, or is only present in the form of
chlorides, the following test should be resorted to, which will not
only discriminate between the two forms, but give the relative amount
of each present:
Take two equal measures of the acid liquid. Precipitate one with
nitrate of silver, after the addition of nitric acid, and weigh the
precipitate. Evaporate the second portion of the acid liquid to
dryness, and dry the residue in a water bath; dissolve this residue
in distilled water, and treat the solution with nitrate of silver as
before, weighing any precipitate which occurs. The weight of chloride
of silver obtained from the first portion of the liquid will give
all the hydrochloric acid present, both in the free state and in
combination; while the weight of the silver precipitate in the second
portion of liquid only gives the chlorides, all free--hydrochloric acid
having passed off during the process of evaporation.
III. Mixed with Organic Liquids, &c.
The suspected acid liquid should be filtered, and then distilled
almost to dryness. The portion of the distillate which comes over at
first may be thrown away; but the latter portion will give all the
reactions before described for hydrochloric acid, if that be present.
Distillation is adopted in the case of this acid, as it is more
volatile than either sulphuric or nitric acid. It may be objected that
the acid found in the vomited matters is from the gastric juice. In
answer to this, it may be stated that the free hydrochloric acid in
normal gastric juice is only about five grains in sixteen ounces, an
amount which would give but slight reaction with the tests.
IV. Stains on the Clothes, &c.
The spots produced by the action of the acid on black cloth are at
first of a _bright red_ colour, changing in ten or twelve days to
reddish-brown. These spots may be cut out and macerated in warm water;
the liquid thus obtained then tested by nitrate of silver and the other
tests before noticed. Another portion of the cloth should be treated
in the same manner, and the resulting liquid tested, as a control
against the objection that the acid might have been present in the
cloth. Hydrochloric acid has been used to erase writing from paper in
attempts at forgery, &c. The paper must be treated in the same manner
as mentioned for the cloth, and the tests used. Sometimes oxalic acid
is employed for a like purpose, in which case the nitrate of silver
will give a precipitate; but the oxalate of silver is soluble in nitric
acid; the chloride is not soluble even when boiled.
_Fatal Period._--From two or five hours to thirty hours or more.
_Fatal Dose._--One fluid drachm to one ounce; recovery has taken place
after swallowing two fluid ounces.
_Treatment._--The same as for the other acids.
Table showing the Colour produced by the Action of
the Mineral Acids on the Skin and on Cloth
+-------------+----------------------+--------------------------+
| | Skin. | Cloth. |
+-------------+----------------------+--------------------------+
|Sulphuric |Brown colour. |Dirty-brown edges becoming|
| acid. | | red after a |
| | | few days from absorption|
| | | of moisture. |
| | | |
|Nitric acid. |Bright yellow, due to |Yellow, orange-red, or |
| | the formation of | brown. |
| | picric acid. Colour | |
| | heightened by | |
| | alkalies. | |
| | | |
|Hydrochloric |Greyish-white. |Bright red changing |
| acid. | | after some days to |
| | | reddish-brown. |
| | | |
+-------------+----------------------+--------------------------+
SULPHATE OF INDIGO
A dark blue liquid formed by dissolving indigo in strong sulphuric
acid. Used as a dye. The symptoms are much the same as those detailed
under sulphuric acid, with the additional bluing of the mouth and lips.
It may be detected with the tests given under sulphuric acid, the blue
colour being first discharged by boiling it with nitric acid.
CARBOLIC ACID
Phenol. Phenic Acid. Coal-tar Creosote. Oil of Tar
Carbolic acid is obtained in the dry distillation of coal, and forms
the acid portion of coal-tar oil, from which it is subsequently
extracted by shaking the crude coal-tar oil with a mixture of slaked
lime and water. After allowing the mixture to stand for some time,
the watery portion is separated from the undissolved oil, the former
treated with hydrochloric acid, and the resulting oily fluid purified
by careful distillation. Up to the year 1900 no restrictions were
put upon the sale of carbolic acid, but owing to the large number
of suicidal and accidental deaths from its use, it was by Act of
Parliament scheduled as a poison, and all preparations containing more
than 3 per cent. of it, cresylic acid, or their homologues, must be
sold as poisons.
Pure carbolic acid forms long, colourless, prismatic needles, which
melt at 35° C. into an oily liquid. It boils at 180° C., and greatly
resembles creosote, for which it is very frequently substituted in
commerce, but from which it differs in the following characters:
It does not affect polarised light as creosote does; it forms a
jelly-like mass with collodion, and is soluble in a solution of
potash, whereas creosote is unaffected by collodion, and is insoluble
in a solution of potash. It possesses a penetrating, characteristic
odour; burning taste; is slightly soluble in water, but freely so in
glycerine, ether, and alcohol; and gives no acid reaction to test
paper. When undiluted, it attacks the skin, which it shrivels up.
Creosote is obtained from wood-tar, which imparts to it its caustic
properties.
Carbolic acid acts as a corrosive and anæsthetic on the skin and mucous
membranes, and as a narcotic on the brain. Its poisonous properties
are exerted whether it be swallowed or merely applied to the skin,
especially if a wound be present.
_Effects on the Skin, &c._--Strong carbolic acid, when applied to the
skin, corrugates, hardens, and destroys its sensibility, and is said
to whiten it; though in one case, in which the crude acid had been
taken with a suicidal intent, there was after death a dark brownish
ring about half an inch wide surrounding the mouth; and in another,
that of a child who, in climbing to a shelf, poured over its face and
neck about half a saucerful of diluted acid, the colour of the skin
touched by the acid was yellowish-white and yellowish-brown, dry and
parchment-like. The action of the acid on the mucous membranes is
similar to that on the skin, but the corrugation is more marked, and
considerable softening and peeling may also take place.
_Effects on the Nervous System._--Rapidly supervening stupor, total
muscular relaxation, anæsthesia, and stertorous breathing are among
the most prominent symptoms. Nearly all the sufferers die comatose.
Carbolic acid appears to act principally on the central nervous ganglia
at the base of the brain and on the spinal cord. The evidence is more
in favour of its action on the brain than on the spinal cord, and not
at all on the periphery of the nerves. The muscles contract vigorously
after death, in response to galvanic stimulation applied either to the
nerves or to the muscles themselves.
_Effects on the Circulation._--The action of carbolic acid on the
circulation has not yet been fully worked out, but it appears to be a
cardiac depressant, the heart being arrested in diastole.
_General Symptoms._--As soon as the acid is swallowed, the patient
complains of intense burning pain in the mouth, throat, and stomach,
the pupils are contracted, the conjunctiva insensible to touch, the
skin cold and clammy, the temperature rapidly falls, and the pulse
becomes weaker and weaker, till it is almost imperceptible. The
breathing is laboured, and, as the fatal issue approaches, becomes
stertorous; vomiting of frothy mucus occurs in some cases. The invasion
of the symptoms is most rapid, and many of the patients have been
in an insensible condition when found. The above symptoms have even
supervened when the strong acid has been used for dressing wounds.
Dr. J. Hamilton records a case where the acid was used as an
application to a wound four inches long, in a child four and a half
years of age. Direct contact of the acid with the wound was prevented.
About an hour after the dressing was applied he saw the patient, who
was then supposed to be suffering from the effects of chloroform
used during the operation on the child‘s arm. She was suffering from
symptoms like those before described. On removing the dressing, some
of the carbolic acid, it was found, had melted and run into the wound,
and to this Dr. Hamilton attributed the symptoms. The child ultimately
died. (See _British Medical Journal_, 1873, vol. i. p. 226.)
The urine and fæces, when passed, are of a dark colour, and it has
been frequently noticed that the urine passed by the assistants in
surgical hospitals, who, under the antiseptic methods adopted, are
constantly washing their hands in solutions of carbolic acid, is of
an olive-green colour. This shows that absorption takes place readily
through the skin. Bilroth, in his work on _Clinical Surgery_, gives
several instances of absorption in this way. Nephritis with casts in
the urine may occur. The hypodermic administration of carbolic acid,
twelve to twenty-four grains in a day, has failed in five cases under
my observation to be followed by carboluria.
_Post-mortem Appearances._--If the poison has been drunk, a dark
brownish horny rim may be found soon after death round the lips; the
mucous membrane of the mouth and stomach is whitened, corrugated, and
softened, and looks as if smeared with white lead--in some cases, horny
in patches; inflammatory signs being absent or only slightly visible.
The blood is uniformly fluid, becoming a bright red on exposure. The
smell of carbolic acid is detected in the stomach, and sometimes in
the small intestine, and even in the spleen, liver, and kidneys. In
Dr. Ferrier‘s case, the urine found in the bladder after death had a
slight olive-greenish tint with a peculiar mixed odour, which gave the
usual reactions to the tests for carbolic acid. The dark colour of the
urine is not due to the presence of hæmin, as the urine, in poisoning
by carbolic acid, does not contain more than a normal amount of iron;
the colour is, therefore, probably due to some product formed by the
partial oxidation of the acid as hydroquinone. Signs of nephritis may
be present. The left ventricle of the heart is, in most cases, found
contracted, the right flaccid. The lungs are congested, and this may
also be the case with the vessels of the brain; but there may be an
entire absence of any _post-mortem signs_ to point to the probable
cause of death, where the poison has gained entrance through a wound
when the acid has been used as a surgical dressing.
_Chemical Analysis._--Carbolic acid may be separated from mixture
with organic substances by distillation with dilute sulphuric acid,
from urine by agitation with ether. Bromine water, as recommended
by Landolt, gives a bulky yellowish precipitate of tribromo-phenol.
The precipitate should then be collected, well washed, and gently
warmed in a test tube with sodium-amalgam and water. The liquid poured
into a dish and acidulated, will, if phenol be present, give the
characteristic odour of that substance, and it may be seen floating
in the liquid as an oily fluid. By this test, one part of phenol in
43,700 of water may be detected. It must be remembered that, according
to Landolt, carbolic acid is normally present in the urine, but
Hoppe Seyler contends that it is not originally present in urine,
but is formed by the action of sulphuric acid, probably from indican.
Carbolic acid urine, treated with nitric acid, and then with potassæ,
and concentrated, becomes blood-red, brown-red, and then changes from
pea-green to violet. Carbolic acid mixed with urine does not give the
above reactions (Schmidt‘s _Jahrbücher_, Bd. clxiv. p. 144).
A solution of carbolic acid, mixed with one-fourth of its volume of
ammonia and a few drops of bleaching powder solution (1 in 20 of
water), and then warmed, but not boiled, assumes a blue colour (green
in very dilute solutions), becoming red on the addition of sulphuric or
hydrochloric acid. The perchloride of iron gives a violet colour with
carbolic acid.
_Fatal Period._--Death has occurred in three minutes; also delayed to
sixty hours; usually three to four hours.
_Fatal Dose._--One drachm has caused death in twelve hours. A child
six months old died from the effects of a quarter of a teaspoonful of
a solution of one part of the acid to five of glycerine. Recovery has
taken place after an ounce of 90 per cent. strength liquefied acid,
also after four ounces of the crude acid; after six ounces of the crude
acid, 14 per cent. strength; and in a child of two after half an ounce
of crude acid of 30 per cent. strength.
_Treatment._--Stomach pump. Wash out the stomach with equal quantities
of alcohol and water mixed--whisky, brandy, gin, or rum will do until
absolute alcohol or rectified spirit be obtained. The washing should be
repeated every 5 to 15 minutes from four to eight times; apomorphine
hydrochlorate gr. ⅒ should be given hypodermically at the commencement,
and the administration of demulcent drinks. Emetics are of little
or no use, owing to the anæsthesia of the mucous membrane of the
stomach. The sulphate of soda, Glauber salts, has been proposed as an
antidote. Any soluble sulphate may be tried. Oil or vinegar is the best
outward application to the skin, after washing with spirit of wine or
methylated spirits.
OXALIC ACID
This is a powerful corrosive and cardiac poison, but on account of its
strongly acid taste it is ill-adapted for the purposes of the murderer.
Deaths have not infrequently followed the accidental substitution of
this substance for Epsom salts--sulphate of magnesia--which it somewhat
closely resembles.
The ordinary crystals of oxalic acid are in the form of four-sided
prisms, colourless, transparent, odourless, or with a slight acid
smell, very acid taste, and not deliquescent in the air. It is
largely used in the arts, by brass-polishers, straw-bonnet makers,
book-binders, and others. The acid is also used to remove writing-ink
from parchment, paper, &c., for the purposes of forgery, &c.
_Symptoms._--These present many strange anomalies. In a large dose--an
ounce or more--oxalic acid acts as a corrosive; in a smaller, as
an irritant; and in a still smaller dose, as a cardiac sedative.
Death has been known to occur so rapidly as to prevent any attempt
at treatment. When the dose is large, an acid taste is experienced
during swallowing, followed by burning pain in the throat and stomach.
Vomiting then sets in, and in most cases continues till death, which
may, however, occur when this symptom has existed from the first.
The vomited matters may be simply mucus, mucus and blood, or dark
coffee-grounds-looking matter. Unless the case is protracted, the
bowels are rarely much affected, though purging and tenesmus have been
noticed. Occult blood may be present in the fæces. Collapse now sets
in; the pulse becomes feeble and scarcely perceptible, the skin cold
and clammy, showing the action of the poison on the heart probably
through the central nervous, as well as through the intra-cardiac
ganglia. Should the treatment adopted prove successful, and life be
prolonged, the patient complains of tenderness of the mouth, soreness
of the throat, and painful deglutition. Pressure over the abdomen
causes pain. Vomiting and purging are also frequently present; and if
recovery takes place, convalescence is generally very gradual. The
urine may contain a large quantity of albumen, casts are numerous, and
oxalates in crystal form are present.
[Illustration: Fig. 28.--Photo-micrograph of crystals of oxalic acid, ×
50. (R. J. M. Buchanan.)]
Oxalic acid acts as a poison when applied to a wound in any part of the
body; and although this substance undoubtedly acts on the brain through
the medium of the blood, it is a remarkable fact that _it cannot be
detected in that fluid_, even when injected into the femoral vein of
an animal which died in thirty seconds (Christison). Leeches, it is
recorded, have been poisoned by the blood drawn by them from persons
suffering from oxalic acid poisoning. The blood does not appear to
undergo any physical change. Unlike the mineral acids, oxalic acid is
still poisonous even when its corrosive and irritant properties have
been destroyed by dilution.
_Post-mortem Appearances._--The mucous membrane of the mouth, tongue,
and throat is corrugated, white, and softened. The tongue is sometimes
of a brownish colour, and sordes appear on the teeth. The stomach is in
some cases pale, soft, and very brittle, and contains a dark, grumous,
acid liquid; at other times it presents several semi-gelatinous spots,
looking as if they had been boiled. Enlarged blood-vessels filled
with dark-coloured blood are also seen ramifying over the internal
surface of the organ. Perforation is of rare occurrence. The intestines
generally escape with some slight inflammatory redness, unless the case
is unusually prolonged. In some cases the stomach is quite healthy, no
morbid appearance being found in any portion of the alimentary canal.
[Illustration: Fig. 29.--Photo-micrograph of crystals of oxalic acid, ×
50. (R. J. M. Buchanan.)]
_Chemical Analysis._--From organic mixtures the acid may be separated
by dialysis, and the tests applied, or it may be obtained in crystals
by precipitating it from the boiled and filtered organic mixture
with acetate of lead. The precipitate washed is then decomposed by
sulphuretted hydrogen and filtered, the filtrate concentrated to drive
off excess of sulphuretted hydrogen, and then set aside to crystallise,
which, if the acid be present, it does in slender prisms. From the
contents of the stomach the acid may be separated by partial drying
over a water bath, extraction with hot alcohol acidulated with a little
hydrochloric acid, filtering the alcoholic solution, evaporating to
dryness, and dissolving the residue in water. Should, owing to the
treatment adopted, oxalate of lime in white chalky masses be found in
the stomach, these should be washed and then boiled with pure carbonate
of potash. A partial decomposition takes place, insoluble carbonate of
lime and soluble oxalate of potash are present in the liquid, which,
when filtered and neutralised with nitric acid, may be tested with the
following reagents:
1. _Nitrate of silver_ gives a white precipitate, _soluble_ in _cold_
nitric acid; the precipitate dried and heated on platinum foil is
dissipated in a white vapour with slight detonation.
2. _Calcium chloride or sulphate_ produces a white precipitate with
oxalic acid; the test is more delicate if the acid be first neutralised
with ammonia. The precipitate is immediately dissolved by hydrochloric
or nitric acid, but not dissolved by oxalic, tartaric, acetic, or other
vegetable acid. Lime-water should not be used as a test, as it gives
precipitates with other acids; the sulphate largely diluted is not open
to this objection.
3. _Lead acetate_ gives a white precipitate soluble in nitric acid. On
clothes, parchment, &c., the spot or spots must be well boiled, and
the above tests applied to the solution. The stains may vary from a
brownish-red to orange-red colour.
_Fatal Dose._--Three drachms have caused death in one hour; sixty
grains caused the death of a boy sixteen years of age, but recoveries
have been known to take place after an ounce and an ounce and a half
had been swallowed.
_Fatal Period._--Death has resulted in _ten minutes_ from a dose of
_one ounce_. The shortest period has been three minutes. The time
varies with individuals, even when the same quantity is taken. In the
case of two girls who each swallowed _an ounce_ of oxalic acid, one
died in _ten minutes_, and the other in _thirty minutes_. Death usually
takes place within from half an hour to an hour, although it has been
delayed for five days.
_Treatment._--Water should not be given, as it increases the solubility
of the acid, and thus assists in the more extensive absorption and
diffusion of the poison. The carbonates of potash and soda should be
avoided, as the oxalates of these alkalies _are themselves_ poisonous.
The stomach tube should not be used. Lime is the best antidote, as the
oxalate of lime is insoluble, and may be given in the form of common
_whiting_; a pint of saccharated lime water may be given. Vomiting
should be promoted. In the stage of collapse the case must be treated
on general principles.
Essential Salt of Lemons
The binoxalate of potash or salt of sorrel, or, as it is more commonly
known, salt of lemons, occurs as a constituent of many plants. The
common sorrel--_Rumex acetosa_--contains it in large quantities.
_Symptoms._--Those of poisoning by oxalic acid, on which its poisonous
properties depend.
_Post-mortem Appearances._--Inflammation of the stomach and intestines.
Other appearances as in oxalic acid.
_Chemical Analysis._--See oxalic acid. The incinerated salt leaves a
white residue of potassium carbonate; oxalic acid leaves no residue.
_Fatal Period._--_Eight minutes_ in the case of a lady recently
confined, who took half an ounce of the salt by mistake for cream of
tartar.
_Fatal Dose._--Half an ounce.
_Treatment._--The same as recommended for poisoning by oxalic acid.
Table showing Symptoms, Post-mortem Appearances, Fatal Dose,
Period of Death, and Treatment of Poisoning by
+-------------------------+-----------------------------------+
| | Sulphuric Acid. |
+-------------------------+-----------------------------------+
| _Symptoms_ |Burning pain in the mouth, |
| |throat, and gullet. Constant |
| |vomiting of brownish or blackish |
| |matter containing blood. |
| |The lips shrivelled, blistered, |
| |and excoriated; and the corners |
| |of the mouth show signs |
| |of the corrosive action of the |
| |poison. Collapse and death. |
| | |
| _Post-mortem_ |Presence of the signs of powerful |
| _Appearances_ |corrosion; perforation of |
| |the stomach, which is blackened |
| |and softened. |
| | |
| _Fatal Dose_ |One drachm. |
| | |
| _Fatal Period_ |One hour. Average about ten |
| |hours. |
| | |
| _Treatment_ |Magnesia, chalk, whiting, soap |
| |suds, milk, and mucilaginous |
| |drinks. |
+-------------------------+-----------------------------------+
| | Hydrocyanic Acid. |
+-------------------------+-----------------------------------+
| _Symptoms_ |Giddiness, insensibility, difficult|
| |respiration, dilated pupil, |
| |tetanic spasms, and convulsions. |
| |In acute cases, death |
| |by shock; in those more prolonged, |
| |suffocation ends the |
| |scene. |
| | |
| _Post-mortem_ |Face pale and countenance composed;|
| _Appearances_ |congestion of the brain, |
| |and traces of inflammation in |
| |the stomach and bowels. |
| |Odour of prussic acid may be |
| |detected in most cases in the |
| |stomach and other parts of the |
| |body. |
| | |
| _Fatal Dose_ |About 45 minims of the Pharmacopœia|
| |acid. |
| | |
| _Fatal Period_ |Two to five minutes. |
| | |
| | |
| _Treatment_ |Chlorine in vapour and in water, |
| |and the mixed oxides of iron. |
| |Cold affusion to the head and |
| |face, galvanism, artificial |
| | respiration, &c. |
+-------------------------+-----------------------------------+
| | Oxalic Acid. |
+-------------------------+-----------------------------------+
| _Symptoms_ |Burning pain in the mouth and |
| |throat, vomiting of greenish-brown |
| |or grumous matter. |
| |Collapse sets in; skin cold and |
| |clammy; frequent pulse, and |
| |respiration hurried. Delirium |
| |and convulsions end in death. |
| |Effects depend on size of dose. |
| |Well diluted, it acts on brain, |
| |spine, and heart. |
| | |
| _Post-mortem_ |Lining membrane of mouth and |
| _Appearances_ |fauces white, shrivelled, and |
| |easily removed. Perforation |
| |of stomach rare. The _post-mortem_ |
| |appearances depend on |
| |dilution of acid. |
| | |
| _Fatal Dose_ |One drachm in a boy; in another |
| |case, half an ounce. |
| | |
| _Fatal Period_ |Less than ten minutes. |
| | |
| _Treatment_ |Chalk and water. Promote |
| |vomiting. Magnesia, lime |
| |water, and oil. Mucilaginous |
| |drinks. |
+-------------------------+-----------------------------------+
ACETIC ACID
In the glacial form this acid acts as a corrosive, the dilute acid as
an irritant. Cases have been recorded of poisoning by the glacial acid.
_Symptoms._--The parts with which the acid has come in contact are
softened and rendered yellowish-white in colour. The larynx is commonly
affected by the acid, as it is very volatile.
_Post-mortem Appearances_ are those of corrosive poisoning with
inflammatory action in the upper air-passages.
_Fatal Period_ is variable but rapid.
_Fatal Dose._--One drachm caused death in a child, but recovery has
taken place in an adult after taking six fluid ounces.
_Chemical Analysis._--Separate the free acid from organic matter by
distillation, if in combination it should be liberated by adding
phosphoric acid. With ferric chloride and ammonia to neutralisation a
red colour is produced, turned yellow by hydrochloric acid.
_Treatment._--Magnesia should be given to neutralise the acid and
vomiting produced. The laryngeal symptoms will require treating on
general principles; tracheotomy may be necessary.
THE ALKALIES
POTASH. SODA. AMMONIA
Poisoning by the use of the alkalies is very rare. For the sake of
convenience, and as the symptoms produced by the caustic preparations
of soda and potash, taken in large doses, do not greatly differ, one
description will do for both:
=Potash= is found in commerce as (1) caustic potash, either solid or in
solution; (2) carbonate and bicarbonate; (3) pearl-ash and soap-lees.
=Soda= is found as (1) caustic soda; (2) carbonate (washing soda) and
bicarbonate; (3) soap-lees, carbonate of soda mixed with caustic alkali.
_General Characters._--Like the inorganic acids, the alkalies destroy
the animal tissues with which they come in contact. Their action is
local, no specific remote effects being produced. They are seldom, if
ever, used for the purpose of homicide; the deaths caused by them are
in most cases the result of accident or suicide. When injected directly
into the veins of animals, the toxic action of potash and soda appears
to differ, the former arresting the action of the heart in diastole,
whereas the latter, according to Podocaepow and Guttman, does not, even
in large doses, affect the heart or temperature--Guttman, moreover,
asserting that soda has no influence upon the nerve centres, the
peripheral nerves, or the muscles. It is difficult to understand how,
with this asserted negative action, soda, like potash, causes death.
_Symptoms._--During the act of swallowing, the patient complains of a
caustic taste, accompanied with a sensation of burning in the mouth and
throat, extending into the stomach. Vomiting may or may not be present;
but in severe cases, when it does occur, the vomited matters may be
mixed with blood. The surface of the body is cold, and bathed in a cold
sweat. Purging is generally present, accompanied with intense pain and
straining. The pulse is weak and quick, and the countenance anxious.
The _post-mortem_ appearances are inflammation and softening of the
mucous membrane of the mouth, gullet, and stomach, which may also be
covered with chocolate-coloured or black spots. When life has been
prolonged for some months the stomach may become contracted, the
pyloric orifice scarcely admitting the passage of a fine probe.
_Chemical Analysis._--The caustic alkalies are known from their
carbonates by giving a brown precipitate with nitrate of silver;
whereas their carbonates give a white, and also effervesce on the
addition of an acid.
The following table will show the reaction of these alkalies with
reagents:
To distinguish Caustic Potash from Caustic Soda
+--------------------+--------------------------+-----------------+
| | Potash. | Soda. |
+--------------------+--------------------------+-----------------+
| Bichloride of | A canary-coloured | No precipitate. |
| platinum. | precipitate | |
| | in solutions | |
| | acidulated with | |
| | hydrochloric acid. | |
| | | |
| Strong solution of | Precipitate in granular | No precipitate. |
| tartaric acid. | white crystals. | |
| | | |
| Colour given to | Rose or lilac tint. | Yellow tint. |
| flame. | | |
| | | |
| Neutralised with | Crystallises in long, | Crystallises in |
| nitric acid. | slender, fluted prisms.| rhombic plates.|
+--------------------+--------------------------+-----------------+
_In Organic Mixtures._--If the mixture be strongly alkaline, filter and
test as above.
_Fatal Period._--From three hours to as many years.
_Fatal Dose._--About half an ounce of the caustic alkali. The smallest
fatal dose recorded of caustic potash is forty grains.
_Treatment._--Water freely; drinks containing citric or acetic acid,
vinegar, lemon juice, oil, linseed tea, and other demulcent drinks. The
stomach tube should be avoided.
AMMONIA
In vapour, in solution, or solid.
_Symptoms._--The vapour may cause death by producing inflammation of
the larynx and lungs. The symptoms to which it gives rise are a feeling
of choking, and a suspension of the power of breathing. Intense heat
and pain are felt in the throat, which may remain for some time. When
ammonia is swallowed in solution, the symptoms produced are not unlike
those the result of the action of soda or potash, only more intense.
Dr. Patterson records the history of a case of a poor man who drank
about an ounce of the liquid ammonia. When seen, his lips were livid,
breathing stridulous, aspect anxious, extremities cold, pulse 100;
inside of mouth, tongue, fauces, as far as visible, red, raw, and
fiery-looking. He died suddenly, nineteen days after the accident, of
laryngeal spasm. Albuminuria occurred in one case.
The _post-mortem_ appearances are those found in most cases of
poisoning by corrosives.
_Chemical Analysis._--Ammonia can be separated from organic mixture by
distillation. Putrefaction must not have taken place. The vapour of
ammonia is easily set free and recognised by its pungent odour. The
carbonate effervesces when an acid is added to it, and gives a white
precipitate with salts of lime. Dense white fumes are given off in the
presence of hydrochloric acid. Nessler‘s reagent gives a reddish-brown
colour or precipitate.
_Fatal Period._--Death has been known to occur in _four minutes_, but
life may be prolonged for some time, the person dying of some thoracic
trouble.
_Fatal Dose._--A teaspoonful of the strong solution.
_Treatment._--Vinegar and water, lime-juice and oil, and leeches to
the throat if the inflammatory symptoms be severe. The rest of the
treatment will depend upon the symptoms present. Tracheotomy may be
necessary.
CAUSTIC SALTS
CHLORIDE OF ANTIMONY
Chloride of antimony (butter of antimony) is a corrosive liquid. The
colour varies from a light yellow to a dark red. Though a powerful
poison, it is seldom taken for that purpose. It has been taken
by mistake for ginger beer. On the addition of water, the white
oxychloride is precipitated.
_Symptoms._--The symptoms produced by swallowing this substance are
those of corrosive poisoning. The mouth and throat are excoriated, the
skin cold and clammy, and the pulse feeble and quick. Severe pain is
felt in the stomach, and vomiting is incessant.
_Post-mortem Appearances._--Those found after corrosive poisoning.
_Chemical Analysis._--When poured into water, the chloride is
precipitated; the precipitate, soluble in tartaric acid, becomes
orange-red on the addition of hydrogen sulphide. The supernatant liquid
will give a white precipitate with nitrate of silver, showing the
presence of hydrochloric acid. The salts of bismuth are precipitated by
the addition of water, but the precipitate is, unlike the antimonial,
insoluble in tartaric acid, and is blackened by hydrogen sulphide.
From _organic_ liquids, the antimony may be obtained by boiling them
with tartaric acid, filtering, and then applying the tests for antimony.
_Treatment_.--Milk, magnesia, and infusions containing tannin.
CHLORIDE OF ZINC
This substance is a powerful corrosive. It is employed as a
disinfectant, and is sold to the public under the name of “Sir W.
Burnett‘s Fluid.” This preparation, which is a strong solution of
the chloride of zinc, has caused death by being mistaken for “fluid
magnesia,” for “pale ale,” and in one case, on board one of the
American steamers, for “mineral water.” Chloride of zinc is also used
in the treatment of cancer and other tumours as an external application.
_Symptoms._--The symptoms come on immediately after the poison is
swallowed. Chloride of zinc acts as a powerful corrosive, accompanied
with all the symptoms which have been before described when speaking
under the head of corrosive poisons. The nervous system is also
powerfully affected.
_Post-mortem Appearances._--Those of corrosive poisoning in its most
violent form. The mouth, throat, stomach, and intestines are often
found hardened, white, opaque, and corrugated.
_Chemical Analysis._--Ammonium sulphide gives a white precipitate,
which is insoluble in caustic alkalies. Hydrogen sulphide gives a
white precipitate in neutral solutions, but no precipitate when the
free mineral acids are present. Potassium ferrocyanide gives a white
precipitate. Test for chlorine with nitrate of silver.
_Treatment._--White of eggs, emetics, followed by demulcent drinks.
CHLORIDES OF TIN
This metal requires but little notice; but the two
chlorides--protochloride and the perchloride--form a mixture used in
the arts, and known as _Dyer‘s Mixture_. They act as irritant poisons,
but are seldom used as such.
NITRATE OF SILVER
The only preparation of silver requiring notice is the nitrate--_lunar
caustic_, or _lapis infernalis_. It acts as a powerful corrosive.
If administered for some time in small doses it is deposited in the
skin, which acquires a permanent dark colour. It does not appear to
be eliminated by the urine, and has been discovered in the liver five
months after its administration was discontinued.
The symptoms come on immediately, the vomited matters becoming
blackened on exposure to light. The dark spots on the skin will also
help to point to the nature of the poison. A dose of salt and water may
be given by way of treatment.
VULNERANT
GLASS, ENAMEL, AND NEEDLES
None of the above can be considered as poisons; but should they be
taken, they give rise in most cases to irritation of the stomach and
bowels. Pins and needles have been swallowed without doing much harm.
Mixing ground-glass in food is a favourite mode of killing adopted by
the West Indian negroes.
CHAPTER III
DIVISION II.--VITAL
METALLOID IRRITANTS
PHOSPHORUS
Poisoning by this substance is more common in France than in England.
In England, the deaths due to this poison are more frequently the
result of accident, from the incautious use of phosphorus paste for the
destruction of vermin. These pastes generally contain from 3 to 4 per
cent. of phosphorus. Children have also been poisoned by sucking the
heads of lucifer matches. In one case, that of a child, death followed
from sucking about forty matches. It has most frequently been employed
as a means of suicide, but seldom for the purpose of homicide. One
case, however, occurred at the Bodmin Assizes in 1857. Kopf relates a
case of a young woman, aged twenty-four, who died on the fourth day
after swallowing the heads of six packets of lucifers (_Allg. Wien.
Med. Ztg._, No. 47, 1819; Schmidt, vol. cv. p. 296). The size of the
packets is not stated. In this case the bowels were confined, and the
_post-mortem_ revealed only the redness of inflammation in the stomach
and bowels. Death has followed inunction of phosphorus paste.
_General Characters._--There are two kinds--ordinary waxy, crystalline
phosphorus, and a peculiar form known as red allotropic or amorphous
phosphorus, prepared by heating waxy phosphorus to a temperature
of 240° C., in an atmosphere free from oxygen. The ordinary yellow
phosphorus is poisonous, the red or amorphous non-poisonous. As
found in the shops, phosphorus is preserved in water in the form
of translucent white or slightly yellow-coloured cylinders. It is
sparingly soluble in oil, alcohol, and other hydrocarbons, but greatly
so in bisulphide of carbon. White vapours are given off when it is
exposed to the air, these consisting of phosphorus and phosphoric acids.
_Symptoms._--Phosphorus acts as an irritant poison, but some days may
elapse after the poison is taken before the injurious effects become
apparent. The symptoms occur in three stages.
_First stage:_ The patient complains of a garlic-like taste in the
mouth, peculiar to poisoning by this substance. This is followed by a
burning sensation in the throat, accompanied with severe pain in the
stomach, and intense thirst. The belly becomes swollen, and there is
vomiting, in some cases, of blood from the stomach, which may continue
till death. The vomited matters are of a dark green or black colour,
with an odour of garlic, and sometimes appearing phosphorescent in the
dark. This condition may also be observed in the motions passed. There
is intense thirst. The pulse is feeble, the countenance anxious, and
the surface of the body bathed in a cold sweat. In males, priapism is
not infrequent. The nervous and muscular debility is intense, and the
patient may die in a state of collapse or during a fit of convulsions.
_Second stage:_ This is a stage of intermission of the symptoms which
may last for three days or more, the patient seems as if going to
recover, and only suffers from general malaise. A case is recorded
where the intermission lasted nine weeks. In cases proceeding to a
fatal termination the intermission is followed by the third stage.
_Third stage:_ Jaundice is the most notable symptom and rapidly
increases; the liver becomes much enlarged and the abdomen distended;
epigastric pain is severe and there is vomiting of grumous black
material consisting of altered blood; purging may be present and the
motions contain blood. There is a marked tendency for hæmorrhages to
occur from the mucous membranes and subcutaneously, producing purpuric
spots. The urine is diminished, high coloured, contains bile pigments,
albumen, blood, and casts. There are great prostration, a quick weak
pulse, sleeplessness, coldness of the surface, gradually increasing
weakness, apathy, convulsions, and coma, followed by death about the
fifth or sixth day.
The liver may diminish in size before death. It is rare for recovery
to take place after enlargement of the liver and jaundice have
supervened. It is by no means always easy to diagnose acute yellow
atrophy of the liver or malignant jaundice from phosphorus poisoning.
In phosphorus poisoning, the early symptoms, those of acute gastritis,
are more severe, are developed more rapidly, and run their course more
quickly than in acute atrophy, and there is a marked interval between
these and the appearance of the jaundice; in acute yellow atrophy
this interval is wanting, and from the beginning, on the contrary,
there are gradual malaise, slight gastric catarrh, and jaundice. The
jaundice and suffering, together with the increased action of the heart
in phosphorus poisoning, are wanting in malignant jaundice, but the
cerebral symptoms are more marked in the latter than in the former.
Acute yellow atrophy most frequently occurs in women, especially during
pregnancy. In acute atrophy leucin and tyrosin are present in the
urine; in phosphorus poisoning they may occur, but generally in the
urine voided just before death.
Chronic poisoning, accompanied with all the symptoms just mentioned,
may result from the action of the vapour on those engaged in the
manufacture of phosphorus or of lucifer matches. In persons thus
employed, necrosis of the jaws and caries of the teeth are not of
infrequent occurrence. The lower jaw is more commonly affected. Mr.
Lyons states that this form of necrosis cannot attack persons who have
perfectly sound teeth, but only those whose teeth are carious (_St.
Bartholomew‘s Hospital Report_, vol. xii.).
_Post-mortem Appearances._--Those of acute irritant poisoning,
including extensive destruction of the coats of the stomach, by
softening, ulceration, and perforation, terminating in gangrene.
The stomach may contain a quantity of white vapour, having a strong
smell of garlic. This white vapour has been noticed to pass from the
vagina and anus of those poisoned by phosphorus. The blood appears
to be thoroughly disorganised; the blood-cells are colourless and
transparent, their colouring matter being dissolved in the uncoagulated
liquor sanguinis; hæmorrhages may be present beneath the serous
membranes and in the pleural and pericardial cavities, and thromboses
are frequently present, due to a tendency for the blood-cells to
agglutinate. In a case recorded in the _British Medical Journal_, 1873,
fatty degeneration of the liver and kidneys was found a week after
the poison was taken. In phosphorus poisoning, the liver is enlarged,
of a dull appearance, doughy, uniformly yellow, with the acini well
marked; in acute atrophy, the liver is diminished in size, greasy on
the surface, leathery, of a dirty yellow colour, with traces only of
the obliterated acini. In the former, also, the hepatic cells are
either filled with oil globules or entirely replaced by them; in the
latter, the cells are filled with a fine granular detritus, and their
structure replaced by newly-formed connective tissue. Putrefaction
rapidly supervenes on death. Hæmorrhages may be found on the surface of
the brain and spinal cord, and the grey matter of the cortex and basal
ganglia rose-pink in colour. Fatty changes have been found in the walls
of the capillaries and the large cortical cells.
_Chemical Analysis._--The smell of phosphorus is characteristic, as is
also its luminosity when exposed in the dark. The following process,
suggested by Mitscherlich, may be adopted for its detection:
To render the suspected matter quite fluid water is added, previously
acidulated with sulphuric acid, in order to neutralise any ammonia
present. The liquid is then transferred to a glass retort, fitted with
a long condensing tube passing into a receiver containing solution of
nitrate of silver. Distillation is conducted in the dark, when the
minutest trace of phosphorus may be detected by the luminous appearance
of the vapour during condensation. Other modifications of this process
have been suggested, in order to increase the space occupied by the
phosphorescence.
By the above process, one part of phosphorus may be detected in 100,000
parts of substance. Another method for the detection of this poison in
very minute quantities is that proposed by Dussart (_Compt. Rend._,
xliii. 1126), and modified by Blondlot (_Compt. Rend._, lii. 1197).
The test is based on the fact that when phosphorus is exposed to the
action of _nascent hydrogen_ in a Marsh‘s apparatus, it burns with an
emerald-green flame. In order to avoid the yellow colouring of the
flame produced by the sodium in glass, Blondlot recommends the use of
a platinum jet. As the green colour is more or less interfered with by
the presence of organic matters, he passes the gas through a solution
of nitrate of silver; the resulting precipitate is then placed in
another hydrogen apparatus, as just mentioned, and the colour of the
flame of the issuing gas noted. Phosphorus may become decomposed in
the body; and as phosphoric acid is taken in most articles of food,
the only satisfactory evidence of phosphorus having been taken is to
produce it in its free state, or at least to exhibit its luminosity.
The detection of the colouring matter of lucifer matches in the stomach
or vomited matters will point to the probable nature of the poison, and
whence it was derived.
_Scherer‘s Test_ is based on the reducing action of phosphorus on
nitrate of silver, which it blackens. The suspected material should be
placed in a flask or in a Dowzard‘s apparatus for Gutzeit‘s test for
arsenic, lead acetate is added to the material to fix the H₂S, and some
lead acetate solution placed in each cell. A little ether is added to
the mixture, and the flask or top of the apparatus capped with paper
moistened with nitrate of silver, and set aside for some hours in a
dark place. If phosphorus be present the paper will be blackened from
deposition of metallic silver.
_Fatal Period._--From half an hour to twenty days or more.
_Fatal Dose._--One grain and a half. The smallest fatal dose recorded
for an adult is one-eighth of a grain. An infant five weeks old died
from sucking a single match head, which probably contained one-fiftieth
of a grain of phosphorus. Recovery has taken place after four and six
grains have been taken.
_Treatment._--The stomach pump or syphon tube should be used as soon as
possible, and the stomach well washed out with warm water containing
a drachm of old oil of turpentine to the pint. If the turpentine be
not readily obtained, “sanitas” should be used with the water, or a
1 per cent. solution of permanganate of potash. After washing the
stomach, the old oil of turpentine, or the French oil of turpentine, or
“sanitas” may be administered in half to one drachm doses in mucilage
and water every fifteen minutes for several doses, and afterwards three
or four times daily. The 1 per cent. solution of potassium permanganate
may be administered in copious drinks.
According to some observers, turpentine is said to be of no value;
but this failure in the use of turpentine has been shown to be due to
the employment of different varieties of oil. The crude acid French
oil, of the three kinds met with in commerce, appears to be the only
one that acts as described below. With turpentine, phosphorus forms a
spermaceti-like mass consisting of _turpentine phosphorus acid_. It
has an acid reaction, and is converted, on exposure to the air, into a
resinous substance smelling like pine-resin. With earths and metallic
oxides it forms insoluble salts. The acid is not poisonous; doses of
0.03 to 0.3 gram may be given to dogs and rabbits without any other
effect than that of lowering of the body temperature. To the formation
of this compound, the antidotal properties of turpentine in phosphorus
poisoning are attributed (_Kohler a. Schempf Dingl._, pol. Jcxcix.).
Turpentine is said by some to be valueless if not given within twelve
hours. Emetics of sulphate of copper may be administered, but the salt
is liable to cause severe gastro-enteritis. Further treatment may
consist of mucilaginous drinks containing magnesia and opium to relieve
pain. Oils or fats should not be given because of their solvent action
upon phosphorus.
=Synopsis of the Effects due to Poisoning by Phosphorus=
1. Which variety of phosphorus is poisonous?--The ordinary yellow
phosphorus usually kept in water. The allotropic form is inert.
2. What quantity is sufficient to kill an adult?--One grain and a half.
3. Symptoms as regards--
(1) _Alimentary Canal._--Pain in the stomach and belly,
eructation of gas smelling like garlic, vomiting, and
sometimes purging, with other signs of irritation.
(2) _Circulatory System._--Tendency to hæmorrhage from
the mouth, stomach, lungs, bladder, &c. Petechiæ and
ecchymoses may occur on all parts of the body. If the
case be prolonged, anæmia may be present. Pulse small,
weak, and scarcely perceptible.
(3) _Nervous System._--Cramps, creeping sensations in
the limbs, delirium, convulsions, paralysis, and extreme
nervous prostration.
(4) _Period of Invasion of the Symptoms._--Obscure and
insidious; some hours or even days may elapse before the
appearance of the symptoms.
(5) _Period of Fatal Termination._--In some cases as
short as four hours.
4. _Post-mortem_ Appearances--
(1) _Alimentary Canal._--Signs of irritation and
inflammation in the stomach and intestines. Gangrene and
perforation have been noticed. Strong smell of garlic
when the abdomen is laid open. Appearances not unlike
scurvy may be found.
(2) _Cellular Tissue._--Ecchymoses may be present in
the cellular tissue of the abdomen, chest, and other
parts of the body.
(3) _Muscular Tissue._--Fatty degeneration in the heart
and other organs of the body has been noticed in several cases.
(4) _Liver._--Fatty degeneration of the gland.
(5) Blood entirely disorganised, the cells transparent,
and their contents dissolved in the uncoagulated liquor
sanguinis. The colour, cherry-red.
5. _Name_ special affection produced by phosphorus in lucifer match
makers--Necrosis of the jaws, usually of the lower jaw. The disease
begins in a decayed tooth.
6. _Name_ a natural disease which phosphorous poisoning has been
supposed to resemble--Acute yellow atrophy of the liver.
IODINE
Iodine is seldom used as a poison, owing to the difficulty experienced
in disguising its colour. In the form of a strong solution it has been,
however, employed for throwing on the person with intent to cause
grievous bodily harm, as in this form it is corrosive, and destroys the
part which it touches.
_General Characters._--Iodine is a dark grey solid, with a bright
metallic lustre. It melts at 107° F., boils at 175° F., and gives off
at the ordinary temperature a faint odour not unlike chlorine. But
slightly soluble in pure water, it is, however, readily dissolved when
a soluble iodide is added to the water.
_Symptoms._--Those produced by irritant poisons generally; the severity
of the symptoms being increased by the strength of the solution, iodine
possessing corrosive as well as irritant properties. The vomited matter
will be stained with the iodine, and starchy material turned blue or
black.
_Post-mortem Appearances._--Those the result of acute irritant
poisoning.
_Fatal Period._--Two days.
_Fatal Dose._--One fluid drachm of the tincture has proved fatal;
recovery has taken place after taking one fluid ounce of the tincture.
_Treatment._--The stomach should be emptied by the aid of the stomach
pump, and then diluent drinks--arrowroot and barley water--may be given.
_Chemical Analysis._--Add bisulphide of carbon to the suspected
mixture, and shake them together. The sulphide will dissolve out
the iodine, which may be obtained on evaporation and sublimed. The
characteristic reaction of iodine, the development of a blue colour on
the addition of a small quantity of starch, will be conclusive evidence
of its presence. If chloroform be added to iodine in aqueous solution
and shaken up, the chloroform is coloured crimson by the iodine, and
falls to the bottom as the mixture is allowed to settle.
IODIDE OF POTASSIUM
This salt is largely used in medicine; and though poisonous effects may
be produced, due probably to some constitutional idiosyncrasy, it has
seldom been used as a poison. It must, however, be placed among noxious
irritant substances.
_General Characters._--Iodide of potassium--hydriodate of
potash--occurs in cubical crystals of a white or faint yellow colour,
very slightly deliquescent when pure, and with a feeble odour of iodine.
_Symptoms._--Iodide of potassium acts as an irritant in large doses,
producing also many of the symptoms which attend a violent catarrh,
with profuse discharge from the nose, lachrymation, and swelling
of the eyelids, also pustular eruptions like acne on the face and
body generally. Small doses--three to five grains--have produced in
some persons most unpleasant and even alarming symptoms. In chronic
poisoning, certain glands, the mammary and testicles, are said to
waste away. Salivation is not infrequently present. I have seen the
administration of the salt produce a severe bullous and hæmorrhagic
eruption, simulating hæmorrhagic smallpox, with sloughing. (See also
the account in _British Medical Journal_, 1878, of a case of purpura in
a child five months old, after a dose of two and a half grains of the
salt.)
_Treatment._--The use of emetics and the stomach pump, starch, &c.
_Chemical Analysis._--In solution, iodide of potash gives the following
characteristic reactions:
1. With a salt of lead Bright yellow precipitate.
2. With corrosive sublimate Bright scarlet precipitate.
3. With strong nitric acid and starch A blue colour.
In organic mixtures the mode of detecting it is more complicated.
Sulphuretted hydrogen should be first passed through the mixture in
order to convert any free iodine into hydriodic acid. The excess of the
gas is then driven off by the application of heat, and potash added,
the resulting liquor filtered, and the filtrate evaporated to dryness.
To get rid of any organic matter, the residue left after evaporation is
charred at a low red heat, reduced to powder, and dissolved in water.
This solution is then concentrated, and strong nitric acid and solution
of starch added, when, if iodine be present, the blue colour will be
developed.
CHAPTER IV
METALLIC IRRITANTS
ARSENIC
Arsenic is found as metallic arsenic, as arsenious acid, in the form of
two sulphides--realgar and orpiment, and as a constituent of several
ores--iron, copper, &c.
Metallic arsenic is of a steel-grey colour, brittle, and sublimes at
a temperature a little below 400° F., without, however, previously
fusing. The vapour of the metal has a peculiar garlic-like odour, which
is not possessed by any of its compounds.
Arsenious Acid
Arsenious anhydride--white arsenic--the most important of all the
compounds of arsenic, is colourless, odourless, and almost devoid of
taste. As found in commerce, it occurs under two forms--as a white
powder, and as a solid cake, which is at first nearly transparent, but
soon becomes opaque, and then resembles white enamel. At a temperature
of about 380° F. it sublimes, but is again deposited on cool surfaces
in the form of octahedral crystals. It is but slightly soluble in cold
water, only about half a grain to a grain being taken up by an ounce of
water. Stirred in boiling water, and then allowed to cool, from a grain
to a grain and a quarter is dissolved in the same quantity of water;
but when it is boiled for an hour, about twelve grains are dissolved
in the ounce of water. This solubility is, however, diminished by the
presence of any organic matter in the liquid. It is therefore less
soluble in infusions of tea or coffee than in pure water. A teaspoonful
of powdered arsenic is said to weigh 150 grains, and a pinch 17 grains.
Arsenious acid is used in the arts in the manufacture of certain green
colours, in dyeing, and in calico printing. A weak solution is employed
in medicine in the treatment of certain diseases of the skin, in ague,
and in other diseases.
It has been proposed to use arsenious acid, on account of its caustic
properties, as an application for cancerous tumours. The employment of
this substance for this purpose is by no means new; but its use has
been revived from time to time by the charlatan. In the year 1844, a
man was tried at the Chester Winter Sessions (R. _v._ Port) for the
murder of a woman whom he pretended to cure of a cancer by the use of
an arsenical plaster. In another case, recorded by M. Flandin, where
death occurred, the quack declared that he had not applied more than
_four_ or _five_ grains to the woman‘s breast. The powder used for this
purpose is generally composed of arsenious acid, realgar, and oxide of
iron. The above cases, to which many more might be added, attest to the
danger which attends the application of arsenic to the surface of the
body; it should, therefore, never be used, especially as a more safe
and potent caustic for this purpose is found in the chloride of zinc.
Some years ago, in London, several cases of severe arsenical poisoning
were due to the presence of arsenic in some cheap violet powder. In one
case the navel and scrotum of a baby were fearfully excoriated, due to
the use of this powder.
Farmers employ arsenious acid (white arsenic) for destroying vermin:
for steeping corn in order to destroy any spores of fungi; and it
also forms an ingredient in the wash for sheep. Injurious effects
have followed the accidental use of the corn thus treated, and those
employed in washing the sheep have suffered more or less severely.
By an Act of Parliament (14 Vict. cap. xiii. sec. 3), it is ordered
that if sold in small quantities, it must be mixed with the sixteenth
part of its weight of soot, or the thirty-second part of its weight
of indigo, ten pounds being the smallest quantity allowed to be sold
unmixed.
The presence of this admixture must be remembered, as a medical man
may be led into an error when the vomited matters are coloured blue,
black, or green, from the mixture of bile with the indigo. Arsenic is
not, as a rule, a corrosive poison. One case is, however, on record
where it acted as a corrosive, but the purity of the arsenic in that
case has been questioned. Its action is that of an irritant, causing
inflammation in the stomach and bowels of those who have taken it;
and it appears that fatal effects are produced whether the poison be
swallowed or introduced into the system in any other way--_e.g._ by
injection into the rectum or vagina, or applied to the surface of the
body.
Some observers hold that arsenic cannot be considered in the light
of an accumulative poison, others that it is so to a certain extent,
and that its elimination is not so rapid as was previously thought.
Given in medicinal doses, it is eliminated in from fifteen to twenty
days. Hence, in cases which have survived the immediate action of the
drug, no arsenic may be found in the body fifteen days after its fatal
administration. This is a fact of considerable importance. In the
case of Pierre Emile L‘Angelier, for whose murder Madeline Smith was
tried, Dr. Penny found 88 grains in the stomach, although the deceased
survived eight or ten hours after the probable period of taking the
poison, and vomited repeatedly during that time. At the above trial,
the question was suddenly raised, that if such a large quantity was
found after death in the stomach, it was scarcely possible to infer
the administration of a much larger quantity; and thus, that the
quantity must have been larger than another party could have secretly
administered, or naturally would attempt to administer. Drs. Mackinlay
and Wylie, of Paisley, obtained 60 grains, and Sir R. Christison 30
grains more, from the stomach of a man poisoned by arsenic administered
in whisky-punch sweetened, the arsenic being kept in suspension by
constant stirring.
Symptoms of Arsenical Poisoning
_Acute._--The rapidity and virulence of the symptoms are more or less
modified by the form (_e.g._ solution) and the dose taken. From half
an hour to an hour is the usual time which elapses before the symptoms
of poisoning present themselves. In one case, in which the poison was
in solution, the symptoms came on immediately after it was swallowed;
in another, after the lapse of ten hours. The patient first complains
of a feeling of faintness and depression, followed by intense burning
pain in the stomach, increased by the slightest pressure. Nausea and
vomiting, the latter increased by the act of swallowing, now occur. The
vomited matters may be dark brown, black, or bilious; or they may be
greenish from the indigo mixed with the arsenic coming in contact with
the yellow colouring matter of the bile. Blood may also be vomited.
Purging, accompanied with straining at stool, and cramps in the calves
of the legs may occur--the purging, like the vomiting, being incessant,
and affording no relief to the sufferer; the stools may contain blood,
or resemble those of cholera. The thirst is intense, and there may
be a feeling of throat irritation, the pulse feeble and irregular,
and the skin cold and clammy. The urine may or may not be suppressed.
As a rule, the symptoms in this form of poisoning are _continuous_;
but cases occur in which there are distinct _remissions_, and even
_intermissions_. Coma, paralysis, or tetanic convulsions may supervene
before death closes the scene.
_Certain anomalies may occur._--The pain may be absent or but slight.
Vomiting and purging do not occur in all cases, nor is thirst, a
most common and persistent symptom, always present. In some cases
the symptoms resemble those which accompany an attack of cholera. In
others, signs of collapse first make their appearance, from which the
patient may rally, or he may die outright. These variations in the
symptoms do not appear to be due to the _form_ or _quantity_ of the
poison taken. It should also be remembered that arsenic may produce
symptoms closely resembling those the result of _narcotic poisoning_.
_Chronic._--In whatever way the poison be exhibited in small and
repeated doses, there follows a peculiar and characteristic train of
symptoms, associated with (_a_) the general nutrition of the body,
(_b_) the facial appearance, (_c_) irritative disturbance of the
alimentary canal, (_d_) skin eruptions, and (_e_) implication of the
nervous system.
(_a_) The nutrition of the body is altered, there is gradual loss of
flesh with ragged growth of the finger-nails and falling out of the
hair. There may be œdema and jaundice in some cases.
(_b_) The face presents a peculiar appearance, the eyes are inflamed
and watery, the conjunctivæ reddened and congested, there is excessive
secretion from the nose resembling coryza.
(_c_) The disturbance of the digestive organs is revealed by the
dryness of the mouth and occasional excoriation of the tongue, which
may be reddened or covered with white fur and silvery in appearance;
salivation may be present instead of dryness of the mouth; there may
also be irritation of the throat; symptoms of gastro-enteritis, _e.g._
nausea and vomiting, anorexia, diarrhœa, or alternating diarrhœa and
constipation.
(_d_) The skin eruptions are of various kinds, and comprise eczema,
herpes, urticaria, erythema, keratosis, marked pigmentation and
exfoliation.
(_e_) The nervous symptoms are those of peripheral neuritis, numbness,
formication, hyperæsthesia, and tenderness, especially of the soles
of the feet, the latter presenting appearances of erythro-melalgia;
there is some amount of paresis, in some cases amounting to absolute
paralysis of the limbs affected. The hands may be anæsthetic, while
the feet are hyperæsthetic and hyperalgesic, and the perspiration much
increased. Mental symptoms are not common, but there may be hebetude,
or delusions.
In the Maybrick case, tried at the Liverpool Assizes in 1889, the
following symptoms arose from repeated administration of arsenic during
a period of probably about fourteen days. On April 27 Mr. Maybrick was
seized with vomiting after taking tea. On the next day the vomiting
continued, with foulness of the tongue, and he complained of stiffness
in the lower limbs. On May 1 he complained of feeling unwell after
taking luncheon, and he was sick on the following three days, and
complained of a tickling sensation in the throat, with retching. On May
7 he was still suffering from vomiting, diarrhœa had commenced, and the
throat was very dry and inflamed. On May 8 the diarrhœa was accompanied
by tenesmus. On May 9 the tenesmus was distressing, and he died on May
11.
Dr. Prosper de Pietra Santa describes a disease to which workers in
manufactories of paper coloured with Schweinfurt-green are liable,
characterised by the appearance of vesicles, pustules, _plaques
muqueuses_, and ulcerations on the exposed parts of the body,
fingers, toes, and scrotum. Arsenical poisoning has been mistaken
for nettle-rash, scarlet fever, and Addison‘s disease. In cases of
slow poisoning the symptoms resemble very much those of gastritis and
ulcer of the stomach, and death due to the action of arsenic has been
referred to “spontaneous inflammation of the bowels.”
It must be remembered that in some cases of acute arsenical poisoning,
when the acute symptoms have passed away, the nervous system exhibits
its effects at a later period; in one case paresis came on on the
fifth day, in another at the end of a week, and in a case recorded by
Seeligmüller four weeks elapsed before the onset of nervous symptoms.
_Post-mortem Appearances._--The appearances found after death depend
upon the quantity of the dose and the length of time which supervenes
between the taking of the poison and death. Inflammation of the stomach
is a marked effect of the action of this substance on the system;
and this condition is in most cases present whether the poison be
swallowed, sprinkled on an ulcerated surface, or rubbed into the skin.
The inflammatory redness, which may assume the appearance of _crimson
velvet_, may be found in cases where death has taken place in _two_
hours. It is sometimes found spreading over the entire surface of
the stomach; at others, at the cardiac end only. The red colour is
increased on exposing the stomach to the air. When the poison has
been swallowed, the stomach may be found covered with white patches
of arsenic, embedded in dark-coloured thick mucus, mixed with blood.
Dr. Paterson thus describes the condition of a stomach he examined:
Its lining membrane was generally very red and injected; but in
addition there were very numerous stellated patches of vivid red,
leading to a darker tint; in the centre of some of them was noticed a
minute clot of blood; in others, an exceedingly rough particle of a
crystalline substance, which was afterwards found to be arsenious acid.
Perforation of the stomach is extremely rare, if it has ever occurred,
but ulceration of the same organ has been observed in a person who
died from the effects of arsenic in _five_ hours (Christison, on
_Poisons_, p. 340). In opposition to all the statements just made it
has been shown that arsenic may prove fatal without leaving any sign of
inflammatory action (R. _v._ M‘Cracken; R. _v._ Newton).
The mouth, pharynx, and gullet are generally found free from any
inflammatory action. The small intestines may or may not be affected:
in most cases the duodenum alone shows any signs of irritation. The
rectum is that part of the large intestine most prone to inflammation.
I have seen marked ulceration of the colon after death from inhalation
of arseniuretted hydrogen. The other internal organs--the liver,
spleen, and kidneys--do not appear to be appreciably affected by
arsenic.
Due probably to the antiseptic properties of arsenic, the stomach and
intestines retain for a long period after death the appearances of
irritant poisoning. In two cases, this was so well marked as to be
visible--in the one case, _twelve_ months, and in the other, _nineteen_
months after interment. In suspected cases portions of the liver should
always be preserved and examined for arsenic.
=The Period after Death when Arsenic may be Detected=
Arsenic is an indestructible poison, and may be found in the body after
many years. In one case it was detected after the lapse of fourteen
years. Arsenic has the power, to a certain extent, of arresting
putrefactive changes; the stomach may, therefore, be found well
preserved, and with the signs of inflammatory action present after the
lapse of many months, and after putrefaction has far advanced in other
parts of the body. When a person is suspected of having been poisoned
with arsenic, and nothing but the skeleton is left for investigation,
the arsenic should be looked for specially in the bones of the pelvis
and the neighbouring vertebræ (_Watt‘s Dictionary of Chemistry_, Sup.).
In reference to the preservative action of arsenic upon the tissues of
those poisoned by it, the appearances of the bodies of the victims of
Flannagan and Higgins, recorded by Whitford (_B. M. J._, 1884, vol. i.
p. 504), are interesting. Arsenical poisoning having been established
in one of three victims, the bodies of two others, Mary Higgins, aged
ten years, and John Flannagan, aged twenty-four years, were exhumed
and examined. The abdominal viscera of Mary Higgins yielded one grain
of arsenious acid, and although the body had been interred for about
thirteen and a half months, it was well preserved. A remarkable
state of preservation obtained in the body of John Flannagan, who
had been interred for thirty-seven and a half months; the face and
body generally could be easily identified. Three and a half grains of
arsenious acid were found in the abdominal viscera. In these cases a
peculiar appearance was found in the stomach and intestines, consisting
of a golden-yellow pigment or coating of the mucous membrane of the
parts. It was thought by some observers to be composed of arsenic
sulphide, but Campbell-Brown, and Davies of Liverpool, as a result of
their analysis of it, found that it did not contain any appreciable
amount of arsenic, but consisted mainly of bile pigment.
In trials for arsenical poisoning, where an exhumation has been made,
the question may arise whether the arsenic found in the body has been
carried into it from the earth surrounding the coffin.
In reply, the following points must be kept in mind:
1. Arsenic may occur in certain calcareous and ochrey soils.
2. In these soils no arsenical compound _soluble in
water_ has been found.
3. The arsenic of these soils is dissolved out by
hydrochloric acid, proving their previous insolubility.
4. The arsenic is, therefore, probably in the form of an
arsenite or arseniate of iron, lime, &c.
5. Careful experiments have rendered it evident that even
“under the most favourable circumstances the dead human
body does not acquire an impregnation of arsenic from
contact with arsenical earth” (Taylor).
6. It has been suggested that the arsenical compound in the
soil may be rendered soluble by the ammonia formed during
putrefaction.
This last suggestion is negatived by the following facts:
1. The production of ammonia ceases before the body arrives at that
stage of decomposition when it is at all likely to be exposed to the
action of the soil of the cemetery.
2. The production of hydrosulphuret of ammonia during decomposition
would tend to the production of sulphuret of arsenic forming yellow
patches in the substance of the organs, thus rather fixing the arsenic
on particular parts than allowing it to percolate through the tissues
of the body from external application.
_Analysis of the Suspected Earth._--About two pounds of the earth
should be boiled for some time in water; supernatant liquid should then
be poured off from the insoluble residue, and filtered. The filtered
liquid, after concentration, may then be examined by the tests about to
be described. If no arsenic be found, the earth may now be boiled with
dilute hydrochloric acid, filtered, concentrated, and then tested as
before. The first process shows that no compound of arsenic soluble in
water is present; the second shows that the arsenic is in a state of
combination, and therefore not likely to impregnate the body.
=The Detection of Arsenic=
_General Directions._--In cases of suspected poisoning by arsenic or
antimony, the contents of the stomach should be mixed with distilled
water acidulated with hydrochloric acid and filtered, and the filtrate
placed in a stoppered bottle lettered or numbered “A” or “1.” The
liver should be cut into pieces, some of which should be bruised in a
mortar with distilled water acidulated as above mentioned, pressed and
filtered, and the filtrate placed in a bottle marked “B” or “2.”
The kidneys and portions of the other solid organs may also be treated
as above. Each solution so obtained may be then tested by the processes
about to be described. By these means the amount of poison in each
organ may be estimated.
Before subjecting the organic mixture to Marsh‘s or Reinsch‘s
processes, Brande and Taylor strongly recommend a modified course of
procedure.
The contents of the stomach, vomited matters, &c., and the solid
organs, finely divided, must each be separated and _thoroughly_ dried
in a water bath, then mixed with an excess of _strong_ hydrochloric
acid in a flask, and slowly distilled by means of a sand bath, the
distillate carried into a receiver containing a little pure distilled
water, and the process continued nearly to dryness.
If arsenic be present, the distillate contains the arsenic as
chloride, and can be at once subjected with great facility to the
usual tests for the presence of that metal. This mode of proceeding
both facilitates and expedites the ordinary methods of testing, as it
separates the arsenic present from the complex organic mixtures with
which it is associated, and presents it in a comparatively pure form
for identification. The process also admits of the residue left in the
retort being examined for lead and the other metallic poisons.
Before the following processes are applied, some of the sediment from
the contents of the stomach, or the vomited matters, may be collected
and well washed. If this is boiled in distilled water and filtered,
the following tests, known as “the liquid tests for arsenic,” may be
applied to the filtrate:
1. _Ammonia Nitrate of Silver_, prepared by adding
a weak solution of ammonia to a strong solution of nitrate
of silver, gives with arsenic a yellow precipitate of
_arsenite of silver_ soluble in nitric, citric, acetic,
and tartaric acids, and ammonia.
2. _Ammonia-Sulphate of Copper_, prepared by
adding ammonia to a dilute solution of sulphate of copper,
gives with arsenic a green precipitate of _arsenite of
copper_. This precipitate is soluble in the mineral and
vegetable acids and ammonia, but is not affected by soda or
potash. The precipitate, dried and heated in a reduction
tube, yields octahedral crystals of arsenious acid.
3. _Sulphuretted Hydrogen._--The suspected liquid
should be first slightly acidulated with _pure_
hydrochloric acid _before_ the sulphuretted hydrogen
gas is passed into it, when, if arsenic be present, a yellow
precipitate is formed, known to be such by the following
tests:
(1) Insoluble in water, ether, alcohol, the vegetable acids,
and dilute hydrochloric acid, but decomposed by strong
nitric and nitro-hydrochloric acids.
(2) Dissolved, if no organic matter present, forming a
colourless solution, when potash, soda, or ammonia is
added.
(3) The yellow precipitate dried and heated with soda and
cyanide of potassium yields a sublimate of metallic
arsenic.
_N.B._--None of the above tests should be
applied in the presence of organic matter. The
soluble salts of cadmium and per-salts of tin give
yellow-coloured precipitates with sulphuretted
hydrogen.
(4) If stannous chloride dissolved in strong hydrochloric
acid be added to a solution of arsenic in hydrochloric
acid, metallic arsenic is thrown down as a precipitate.
This is a fairly delicate test.
The following Table gives the differences between
the Yellow Precipitates formed with Sulphuretted Hydrogen
and Arsenic, Cadmium, and Per-Salts of Tin:
+------------------+-----------------+------------+--------------+
| | | | Per-Salts |
| | Arsenic. | Cadmium. | of Tin. |
+------------------+-----------------+------------+--------------+
|Colour. |Yellow. |Yellow. | Dirty yellow.|
| | | | |
|Action of ammonia.|Soluble. |Insoluble. | Insoluble. |
| | | | |
|Action of |Insoluble. |Soluble. | |
|hydrochloric acid.| | | |
| | | | |
|With cyanide |Sublimes as |Sublimes as | No sublimate.|
|flux. |metallic arsenic.|brown oxide.| |
+------------------+-----------------+------------+--------------+
_Marsh‘s Process._--This method for the detection of arsenic is
founded on the fact that the several compounds of arsenic, except the
sulphide and metallic arsenic itself, form a gaseous compound with
nascent hydrogen, from which it may be readily separated by appropriate
treatment. The solution to be tested should, therefore, be prepared as
proposed by Brande and Taylor, given on a preceding page.
_Precautions._--(1) Absolute purity of reagents. (2) The sulphuric acid
should be diluted with five times its weight of water, and allowed to
cool. (3) The suspected fluid should be added gradually. (4) Generate
the gas regularly. (5) If no stain be at once produced, keep a portion
of the exit tube red-hot for at least one hour.
The usual form of the apparatus is that of a =U=-shaped glass tube,
about one inch in diameter and eight inches high, supported in a
vertical position on a wooden stand. One end of the tube is fitted with
a tap, and terminates in a glass tube drawn to a fine point; the other
end is closed with a cork.
The apparatus is used as follows: A piece of pure zinc is dropped into
the tube, and shaken into such a position that it occupies the bottom
of that limb of the tube which is furnished with the tap. Water is
then added, and subsequently sufficient pure sulphuric acid to cause
a moderately brisk evolution of hydrogen. The production of hydrogen
gas from pure zinc and pure sulphuric acid is sometimes slow, and may
be facilitated by adding a few drops of platinic chloride solution to
the contents of the flask previous to the addition of the sulphuric
acid. The gas being allowed to accumulate for a short time, the tap
is then partially turned on, and the gas ignited; if, on depressing
a piece of white porcelain momentarily in the flame, no deposit or
discoloration occur, the reagents used may be taken as pure. By the
use of Thorpe‘s apparatus for Marsh‘s test, in which the hydrogen is
obtained by the electrolysis of water, the absence of arsenic in the
reagents and apparatus is ensured. The tap is now connected with a tube
of thin, hard glass, drawn out to a fine point at the end and having a
constriction in the middle. The liquid to be tested being now placed in
the apparatus, the gas is again ignited, and a piece of white porcelain
momentarily depressed in the flame, when, if arsenic be present, a
black, circular, metallic-looking stain will appear, which has the
following composition. In the centre is the unoxidised metal, round
this is a mixed deposit, and outside this the zone of arsenious acid.
While the gas is passing, the exit tube should be heated to redness a
little behind the constricted part, when a dark ring will appear if
arsenic be present. The black deposit on the porcelain may be either
arsenic or antimony, but may be distinguished as follows:
--------------------+---------------------------+--------------------
| Arsenic. | Antimony.
--------------------+---------------------------+--------------------
Nature of the stain.|Metallic brilliancy. |Absence of metallic
| |lustre.
| |
Effect of heat. |Volatile. |Non-volatile.
| |
Heated with a little|Dissolves. |Oxidises to a white
nitric acid. | |insoluble powder.
| |
Warmed with a strong|Dissolves immediately. |Slowly dissolved.
solution of chloride| |
of lime. | |
| |
Treated with |Detached but not dissolved,|Soluble: on
bisulphide |but if heated |evaporation,
of ammonium. |to drive off ammonia |_orange-yellow_
|_yellow sulphide_ |sulphide formed.
|formed. |
| |
The nitric acid |A brick-red precipitate |No reaction, but if
solution |soluble in ammonia. |ammonia and potash
evaporated to | |are added, a black
dryness gives with | |precipitate is
nitrate of silver. | |ultimately formed.
--------------------+---------------------------+--------------------
The portion of the tube on which the dark ring has been deposited is
now cut off, broken into fragments, and heated in a small, hard glass
tube--when, if arsenic be present, a white sublimate will be obtained
of well-defined octahedral crystals. If the sublimate be treated with
sulphide of ammonium, it is detached but not perfectly dissolved,
and on evaporation of the solution to dryness, a residue of the
yellow sulphide of arsenic will remain, which, if heated with strong
nitric acid, and evaporated again to dryness, will give a brick-red
precipitate with nitrate of silver solution, soluble in ammonia. The
process of Marsh may be used quantitatively by passing the issuing
gas through a glass tube, dipping into a strong solution of argentic
nitrate. A portion of the tube is kept at a red heat, when, if arsenic
be present, it is deposited in the metallic form in the cool portion.
The glass tube containing the stain is cut with a file and weighed.
The stain is then removed by strong nitric acid, the tube dried and
weighed: the difference in weight equals the amount of metallic
arsenic. The nitrate of silver solution is now treated with pure
hydrochloric acid, filtered, and the filtrate neutralised with sodium
carbonate, titrated with standard solution of iodine. By dipping the
end of the issuing tube into a fresh solution of argentic nitrate, the
absence of colour will show that all the arsenic has been obtained.
Instead of the =U=-shaped tube a Wolff‘s bottle or Erlenmeyer‘s flask
may be used, and the exit tube carrying off the gas bent twice upon
itself and connected with a glass bulb containing calcium chloride.
From this bulb the long, hard glass tube proceeds, pointed at the end
to form a gas jet; the gas is lighted at the end, and if a Bunsen flame
be applied at a short distance from the end, a deposit of the arsenic,
if present, will form on the distal side of the point at which the
flame is applied.
_Reinsch‘s Process._--First obtain a clear solution by filtration or
otherwise, and then proceed as follows: Strongly acidify the liquid
with hydrochloric acid, introduce some pieces of copper foil, and
heat to near the boiling-point of the liquid. Both the acid and metal
must be previously tested to ensure their freedom from arsenic. Any
arsenic present will then be deposited on the copper in the metallic
state, either in the form of a black lustrous deposit when the arsenic
is present in any quantity, or else as a steel-grey coating when a
minute quantity only is present. In either case, the copper foil, after
remaining for some time in the suspected fluid, is taken out, cut
into small pieces, introduced into the bottom of a hard glass tube,
and heated to low redness, when the arsenic will sublime as arsenious
acid in octahedral crystals, forming a ring in the cooler portion of
the tube. The deposit is identified as arsenious acid by the form of
the crystals, and by its deportment with the various reagents, as in
the treatment of similar sublimates mentioned under _Marsh‘s Process_.
Two precautions have to be taken in applying this test: do not use too
large a portion of copper foil at first, and do not remove the copper
too quickly from the boiling fluid. A solution containing arsenic acid
or an alkaline arsenite, mixed with sulphuric acid, does not produce
any deposit on metallic copper even after long boiling, unless the
quantity of the arsenic present be considerable; the deposition may,
however, be ensured by adding sulphurous acid or a sulphite, whereby
the arsenic is reduced to arsenious acid (G. Werther, _J. Pr. Chem._,
lxxxii. 286; _Jahresb._, 1861, p. 851).
_Objections to Reinsch‘s Process._--The chief objection to Reinsch‘s
process is the possible impurity of the reagents used--both these
reagents, even when supplied as pure, being liable to contain traces of
arsenic. As met with in commerce, both hydrochloric acid and metallic
copper invariably contain minute quantities of arsenic, the former
generally containing the larger quantity of that impurity. Although,
by purchasing the purest possible reagents, specially prepared for
analysis, it may be possible to ensure their freedom from arsenic,
yet in all cases they should be tested before using them. Some of the
hydrochloric acid should be diluted with distilled water, and gently
heated with the copper foil. If no tarnishing or deposit of any kind
occur on the metal after a lapse of several hours, the reagents may be
taken as pure and the trial of the suspected substance at once made.
Professor Abel has proposed the following process to ensure the
purity of the copper and acid: Boil together equal portions of strong
hydrochloric acid and a solution of perchloride of iron. While the
mixture is boiling immerse the copper foil, which, if pure, will be
merely brightened in colour; if impure, a black deposit on the metal is
formed.
[Illustration: Fig. 30.--Photo-micrograph of sublimate of arsenious
acid obtained by Reinsch‘s process, × 250. (R. J. M. Buchanan.)]
_Bloxam‘s Method for the Detection of Arsenic._--The late Professor
Bloxam suggested an admirable and delicate process for the detection of
small quantities of arsenic. The method is, like that of Marsh, founded
on the property possessed by nascent hydrogen of forming a gaseous
compound with arsenic; but, instead of the hydrogen being generated by
the action of dilute sulphuric acid on zinc, Bloxam generates the gas
by an electric current.
The wires from the extremities of a battery terminate in small plates
of platinum foil, which are plunged into the liquid to be tested, the
apparatus being so arranged that the hydrogen gas evolved from the
negative pole is collected. The issuing gas is tested in a similar
manner to that obtained in Marsh‘s process.
This method of Bloxam‘s is exceedingly delicate, and possesses one
great advantage, that no zinc being used, there is no danger of
contamination by the use of impure metal; while, as nothing foreign is
introduced during the process of testing, the liquid under examination
is left pure for the application of other tests if necessary.
[Illustration: Fig. 31.--Dowzard‘s apparatus for Gutzeit‘s test for
arsenic. A and B indicate glass cells or traps which contain solutions
of lead acetate and copper chloride for the purpose of fixing H₂S and
PH₃ which otherwise would react upon the mercuric chloride spot on the
filter-cap. The cells are fitted into one another, as shown in the
figure.]
_Gutzeit‘s Test._--This test is more sensitive to the presence of
minute quantities of arsenic than that of either Reinsch or Marsh. The
apparatus devised by Dowzard should be used (_Journ. Chem. Soc._, vols.
lxxix. and lxxx. 463, p. 715), which consists of an Erlenmeyer‘s flask
fitted with superimposed cells, containing solutions which will wash or
neutralise those gases which would interfere with the accuracy of the
result. The following is Dowzard‘s description of the method of using
the apparatus:
“A weighed or measured portion of the sample is mixed with 5 c.c. of
pure HCl (if the sample is alkaline it must be neutralised first), four
drops of a 15 per cent. solution of cuprous chloride in hydrochloric
acid are then added, and the mixture made up to 30 c.c. with water; if
it is not convenient to work with such a small bulk as 30 c.c. this
quantity may be doubled or trebled, but the same proportion of acid
should be used. A rod of pure zinc, 3 cm. long and 5 mm. in diameter,
is first placed in the flask, the above mixture is then introduced and
the first cell placed in position; lead acetate solution 5 per cent. is
now poured into the cell until it is about half full. The second and
third cells are filled in a similar manner; a small tuft of cotton wool
is introduced into the neck of the top cell, and its mouth capped with
mercuric chloride paper, which may be held in position by an elastic
band or a glass collar made from a piece of glass tubing. After forty
minutes or more the cap is removed and examined in full daylight. A
minute trace of arsenic is indicated by a lemon-yellow spot, which
varies in tint according to the amount present; and a heavy trace by an
orange-brown spot. The mercuric chloride paper is prepared as follows:
one drop of a 5 per cent. solution of mercuric chloride is allowed to
fall on the centre of a piece (4 cm. square) of thin Swedish filtering
paper, such as Muncktell‘s No. 1 F.; the paper is dried before using.”
The lead acetate in the cells absorbs any H₂S gas given off, and if
additional cells contain a 15 per cent. solution of cuprous chloride
in hydrochloric acid, PH₃ is also prevented from passing and causing a
stain. By this method arsenic can be detected in the presence of 2500
times its weight of antimony. The presence of selenium and tellurium
compounds does not interfere with the usefulness of this method.
_Fleitmann‘s Test._--Detects arsenic in the presence of antimony,
but does not detect arsenic as arsenic acid. When zinc or aluminium
is heated with excess of potassium or sodium hydroxide in a mixture
containing arsenious anhydride, arseniuretted hydrogen is evolved. The
gas may be led into 4 per cent. nitrate of silver solution, or a test
tube the top of which is covered with filter paper wet with nitrate of
silver. The gas reduces the silver salt, and a black precipitate is
produced in the solution, or a black spot on the paper.
_Fatal Dose._--Two grains in solution have been known to cause death.
Recoveries have, however, occurred after an ounce or more of the poison
has been taken. Much will depend upon the fulness or emptiness of the
stomach at the time the poison is taken, and also upon the vehicle in
which the poison is administered. Vomiting and purging are more urgent
when the dose is large, probably assisting to get rid of the arsenic
before its fatal action is produced.
_Fatal Period._--From twenty minutes to two or three weeks, and even
later from the secondary effects of the poison. Any thick medium, cocoa
or soup, will of course delay the action of the poison.
_Treatment._--Vomiting should be promoted, and diluent drinks largely
given. The stomach pump, if it can be procured without much delay,
should also be employed to empty the stomach. Emetics of sulphate of
zinc should be given without delay--followed by the administration of
milk, lime-water, and albumen. Symptoms as they occur must be treated
on general principles.
The hydrated sesquioxide of iron, the hydrated oxide of magnesia,
and animal charcoal have been proposed and used as antidotes. The
sesquioxide of iron can be prepared ready to hand by saturating
the tincture _ferri perchloridi_ with ammonia or washing soda. It
should be given freely. Drachm doses of dialysed iron in water may
be administered. Reputed antidotes are useless when the poison is in
the solid state. The diarrhœa, tenesmus, collapse, pain, and nervous
symptoms should be treated on general principles.
=Other Poisonous Compounds of Arsenic=
=Arsenical Vapour.=--The vapour from the flues of the copper and
arsenic smelting-works in Cornwall, escaping into the air, may cause
death to cattle, and the destruction of vegetation. The workmen in
these works not infrequently suffer from eruptions on the skin, and
from great constitutional derangement; but, on the whole, taking into
consideration the dangerous nature of their employment, the men appear
to enjoy average health. Actions for damage and nuisance have resulted
from the escape of this vapour from the factories.
=Arsenite of Potash.=--A solution of arsenite of potash, mixed with
the tincture of red lavender (the solution contains four grains of
arsenious acid in one ounce)--better known as Fowler‘s Solution, or
as Fowler‘s Mineral Solution or Tasteless Ague Drop. It is probably
a solution of arsenious acid in carbonate of potash, and not a true
arsenite of potash. This preparation has been much used as a domestic
remedy for ague in the Fens of Cambridgeshire. Death from its use is
rare; but it is, nevertheless, too dangerous a medicine to be used
recklessly. Idiosyncrasy has much to do with the action of the drug,
some persons taking even large doses with impunity, whilst, in others,
the smallest medicinal dose has produced alarming symptoms. It is
stated that the Styrian arsenic-eating peasant is capable of taking
without injury five grains of arsenious acid for a dose; and in one
case of suspected murder in Styria, the prisoner was acquitted as the
deceased was known to be an arsenic-eater.
_Donovan‘s Solution._--A solution of hydriodate of arsenic and mercury.
Now officinal, and much used by many practitioners.
_Sheep Dip._--The mixture used for washing sheep, composed of
tar-water, soft soap, and arsenic, has caused death in twenty-four
hours. The men engaged in dipping the sheep may suffer both locally and
constitutionally from the effects of the arsenic in the solution.
_Treatment._--As before described.
_Analysis._--See p. 280 _et seq._
=Arsenite of Copper.=--Scheele‘s green, and the aceto-arsenite of
copper, Schweinfurt-green, are met with in commerce and the arts
as green pigments. Among workmen they are familiarly known as
emerald-green, Brunswick-green, or Vienna-green. In France, the term
_vert Anglais_ or English green has been given to them. Scheele‘s
green contains about 55 per cent. of pure arsenious acid; the other,
Schweinfurt-green, about 58 per cent.
These colours are employed for various purposes, among which the
following may be mentioned:
1. Artificial flowers and other articles of dress.
2. Confectionery, pastry ornaments, and toys.
3. As green paint for the insides of houses.
4. In the green colour for wall-papers.
5. In the green-coloured paper lining boxes, &c.
6. Green-coloured tapers used for artificial lighting.
The employment of emerald-green in the colouring of wall-papers is
so extensive, that in the year 1860 an English paper-stainer stated
that he used two tons of arsenic weekly. In 1862 the amount of this
colour manufactured during the year was from 500 to 700 tons. Numerous
cases of chronic arsenical poisoning have resulted from the presence
of arsenic in the form of Scheele‘s green and Schweinfurt-green in
wall-papers and other articles. As the colour is only loosely applied
to the surface by means of a weak solution of size, it is easily
brushed off, and may so impregnate the air of a room as to produce
injurious effects on those who inhabit the apartment. By fermentation
of the starch paste used for fastening the paper to the walls,
nascent hydrogen is liberated, and, combining with the arsenic to
form arseniuretted hydrogen, passes into the air of the room and is
inhaled. This gas is extremely poisonous, and small quantities suffice
to produce serious results. Certain moulds are endowed with the power
of living in materials containing arsenic, and of decomposing arsenious
acid or its salts into the gaseous form known as _diethylarsine_; there
are altogether ten such moulds, and the most active is the _Penicillium
brevicaule_.
In the case of ladies‘ dresses, the following method is adopted:
The colouring material is made by thoroughly stirring
together a mixture containing, in definite proportions, the
green pigment, cold water, starch, and gum arabic, or some
similar substance which shall give the colour consistence
and adhesiveness. Not infrequently in this process the hand
and forearm are freely used in the liquid to expedite the
work. Of this mixture, properly prepared, the workman takes
a quantity in his fingers and roughly spreads it over the
muslin or fine calico. The fabric is then beaten and kneaded
between the hands until it is uniformly coloured. The longer
this process is continued, the more perfect is the result.
The cloth is now fastened to a frame for drying. In all this
process of colouring, the hands, forearms, and frequently
also the face of the operative must become soiled with the
green colour. It will be also observed that the colour is
but loosely applied, _no mordant being used_, as in
calico printing, to fix the pigment in the texture of the
cloth.
_Symptoms._--All the effects produced by arsenic may result from the
use of articles coloured with these pigments. Chronic inflammation of
the stomach and bowels, and irritation of the eyes, accompanied in
some cases with extreme nervous debility and prostration, are by no
means uncommon in those employed in the manufacture of this “cheerful,”
but poisonous colour. The skin of the hands, arms, and scalp is often
attacked by a vesicular eruption or an erythema. When it is borne in
mind that, according to the analysis of Hoffman, a single twig of
twelve artificial leaves may contain as much as ten grains of pure
arsenic, it is not to be wondered at that the most serious results have
occurred from the reckless use of these colours. In Prussia and France
the use of the arsenical colours is prohibited.
_Analysis._--Scheele‘s green is insoluble in water, but is soluble in
ammonia, the solution having a blue colour, from the separation of the
arsenious acid from the oxide of copper. If a few drops of the blue
ammoniacal solution be poured on some crystals of nitrate of silver,
the yellow arsenite of silver is formed. The blue ammoniacal solution,
if acidified with HCl and boiled with pure copper foil, deposits
arsenic on the copper, which, if cut into strips and placed in a small
reduction tube and heated, sublimes and is deposited in octahedral
crystals on the cold portion of the tube. The tests before described
are applicable for the detection of this substance.
=Orpiment=
Orpiment, or yellow arsenic, one of the sulphurets of arsenic, has
been used occasionally as a poison. It is also largely employed in the
arts for paper-staining and for colouring toys. In cases of arsenical
poisoning, it is this compound that is commonly found adhering to the
stomach and intestines. It is formed by the sulphuretted hydrogen, the
result of decomposition, acting on the white arsenic swallowed.
=Realgar=
Realgar, or red arsenic, is another of the sulphurets of arsenic, and,
like orpiment, is largely used in the arts as a colour. It is also
employed, like orpiment, as a depilatory, fatal results having followed
its use for this purpose. The colour of this substance prohibits its
frequent use as a poison.
Both of these compounds owe their poisonous properties to the amount of
free arsenious acid which they contain, and which may be as much as 30
per cent.
_Symptoms._--The symptoms produced by these substances are similar to
those caused by arsenic. The fatal dose will depend on the amount of
free arsenious acid which they may each contain.
_Treatment._--Emetics and demulcent drinks.
=Metallic Arsenic, &c.=
Metallic arsenic, fly powder, arsenic acid, largely used in the
manufacture of magenta, aniline red, or fuchsine, and the arseniates
of potash and soda, are all poisonous. The _papier moure_ of the shops
consists of blotting-paper steeped in a solution of arseniate of
potash. Macquer‘s neutral arsenical salt is the binarsenate of potash.
_Symptoms._--The symptoms are those of arsenical poisoning.
_Treatment._--When metallic arsenic has been taken, vomiting must be
promoted by the use of proper emetics. Tartar emetic should never be
used. In the treatment for poisoning with arsenic acid, or of the
arseniates of potash and soda, the hydrated oxide of iron, or of the
acetate of iron, should be used, as the arseniates are precipitated by
the iron.
=Arsenic Acid=
No case of poisoning by this substance has been recorded, for, although
poisonous, it is better known in the laboratory than in the shops.
It differs from arsenious acid in being only partially volatilised
by heat, in its solubility in water, and in being precipitated of a
brick-red colour by nitrate of silver. With sulphuretted hydrogen a
yellow precipitate is slowly formed, insoluble in hydrochloric acid.
=Arseniuretted Hydrogen=
This gas has proved fatal in several cases. It is generated in the
process known as Marsh‘s process for arsenic, and is so poisonous that
a very small quantity, not sufficient to be detected by its odour, has
caused death. In most cases death has been the result of accident.
_Symptoms._--Giddiness, fainting, constant vomiting, pain in stomach,
and suppression of urine, with rapid destruction of the red blood
corpuscles, associated with hæmorrhages from all the mucous membranes
and jaundice, are among the most prominent symptoms.
The _post-mortem_ appearances are inflammation of the stomach, with
softening of its coats. The liver and kidneys are also more or less
affected, and have been found of a deep indigo colour.
_Analysis._--This has been described when speaking of Marsh‘s process
for arsenic.
=Cacodylic Acid=
Cacodylic acid and the cacodylates are poisonous. The acid dissolves
easily in water and alcohol, and it unites with many metals and
organic substances to form salts. Although it is held by some to be
non-poisonous, Murrell asserts that the administration of cacodylate of
sodium produces symptoms “far more severe than those which follow the
exhibition of arsenic in its ordinary forms” (_B. M. J._, 1900, vol.
ii. p. 1823; 1901, vol. i. p. 120).
Professor Fraser of Edinburgh, on the other hand, from clinical
observation and chemical tests, affirms that cacodylic acid and the
cacodylates are extremely stable bodies, and the arsenic in them is
with such great difficulty set free that it passes through the body in
combination as an inert substance (_B. M. J._, 1902, vol. i. p. 713).
=Arsenical Contamination of Food Stuffs=
Arsenic is found associated with many other substances in nature,
particularly copper and pyrites. Arsenic is commonly present in
commercial sulphuric acid manufactured from pyrites containing the
metal, and when such acid is used with common salt for the production
of hydrochloric acid, the latter also becomes contaminated. It may be
safely stated that commercial sulphuric acid, hydrochloric acid, copper
and zinc, free from arsenic, do not exist in the market. Hence in the
detection of arsenic by the toxicologist the absolute purity of these
reagents, which he uses, must be established.
In the manufacture of glucose, arseniferous sulphuric acid has been
the means of contaminating it. Ritter and Blyth pointed out the
danger, by this means, of conveying arsenic into beer, confectionery,
syrup, and other food stuffs. Glucose made with such acid, and used
in the manufacture of beer, was the cause, in the year 1900, of a
widespread and serious epidemic of arsenical poisoning in Manchester
and Liverpool, in which several thousand persons suffered. Arsenic may
also contaminate grain during malting by the use of anthracite coal or
sulphur bar in the kilns.
Recapitulation of the Leading Facts with regard to
Poisoning with Arsenic
--------------------------+------------------------------------------
ACUTE POISONING.--SYMPTOMS, ETC.
--------------------------+------------------------------------------
Action on alimentary | Intense irritation of the stomach, upper
canal | part of small intestine, and lower part
| of the large. The inflamed condition of
| the stomach occurs even if arsenic be
| absorbed by the skin. Not present in
| all cases.
|
Circulation | The heart weakened, with a consequent
| reduction in force and frequency of
| pulse.
|
The brain and nervous | In some cases the action upon the brain
system. | is that of a narcotic, and the
| paralysis sometimes seen appears to be
| due to a direct action of the drug on
| the cord.
|
The urinary organs | Arrest of the action of the kidneys is
| not uncommon. Stranguary.
|
Fatal dose | Two grains.
|
Average period of the | From half an hour to an hour after the
commencement | poison is taken.
of the symptoms. |
|
Average period before | Ten to twenty-four hours.
death. |
--------------------------+------------------------------------------
CHRONIC POISONING.--SYMPTOMS, ETC.
--------------------------+------------------------------------------
The eyes, nose, and mouth| Irritation and redness of the eyes and
| nostrils. Dryness of the mouth and
| throat.
|
The stomach and bowels | Loss of appetite, colicky pains, cramps,
| irritability of bowels, mucous
| discharges.
|
Nervous system | Depression and irritability of spirits,
| sleeplessness, giddiness, convulsions,
| vertigo, paralysis, etc.
|
Cutaneous surface | Brown pigment deposit in the skin of the
| face. “Eczema arsenicale,” etc.
|
Means of diagnosis in | Examine the urine unostentatiously.
suspected cases. | Remove patient from present abode.
| Examine wall-paper, etc., for arsenic.
|
The probable | Signs of irritation, slight or absent,
_post-mortem_ | in stomach and bowels.
if death is due |
to this poison. |
|
Organs most important to | Liver, stomach, kidney.
secure for analysis. |
|
Circumstances under | Green wall-papers, coloured toys and
which it may occur | sweets, green tarlatan dresses, etc.
independently of |
criminal administration.|
--------------------------+------------------------------------------
ANTIMONY
Antimony, the Stibium of the ancients, is obtained from the native
sulphide. Metallic antimony is of a bluish-white colour, crystalline
and brittle. It melts at about 840° F., and is slowly volatilised at a
white heat.
Two compounds of antimony--tartar emetic and chloride of antimony--are
alone of any toxicological interest.
[Illustration: Fig. 32.--Photo-micrograph of crystals of tartarated
antimony, × 50.
(R. J. M. Buchanan.)]
=Tartar Emetic=
=Antimonium Tartaratum. Tartarated Antimony=
Tartar emetic occurs as a white powder; sometimes, however, with a
yellowish tint. It is soluble in about three parts of boiling water and
fifteen of cold, and insoluble in alcohol.
The _vinum antimoniale_ of the Pharmacopœia contains two grains of the
salt in an ounce of wine.
Before 1856 poisoning by antimony was of rare occurrence, but since
that year several cases of chronic poisoning have occurred, giving to
this substance considerable importance.
Symptoms of Antimonial Poisoning
_Acute._--Tartar emetic is an irritant poison, but possesses slight
corrosive properties. When taken in large doses, two or three drachms,
it gives rise to a metallic taste in the mouth, which is not easily
removed. In most cases, violent vomiting follows immediately after the
poison is swallowed, the vomiting continuing even after the stomach
is emptied of its contents. In a few cases, however, even when a
large dose has been taken, vomiting may be absent. Burning pain is
felt at the pit of the stomach, accompanied with cramps in the belly
and purging. There is considerable difficulty in swallowing, and the
patient complains of tightness and constriction in the throat. The
mouth and throat in some cases are excoriated, or covered with whitish
aphthous-looking spots, which ultimately become brown or black. In some
cases the thirst is intense; in others, absent or nearly so. Cramps
in the lower extremities, almost amounting in some cases to tetanic
spasms, followed by extreme depression, are generally the precursor of
a fatal termination. The urine may be suppressed, as is the case in
arsenical poisoning; in some cases it has even been increased. On this
point, however, the statements of observers differ. Trousseau says that
the urine is suppressed; Huseman that it is _never_ suppressed. The
skin is in some cases covered by a pustular eruption, not unlike that
of smallpox. Dobie has recorded a case of poisoning by tartar emetic in
which a comatose condition was present. In antimonial poisoning, even
in the most desperate cases, there is always greater hope of recovery
than in arsenical poisoning.
[Illustration: Fig. 33.--Photo-micrograph of crystals of tartarated
antimony, × 50.
(R. J. M. Buchanan.)]
_Chronic._--The symptoms which mark the chronic form of poisoning
differ chiefly in being less intense and less rapid than in the acute.
Chronic poisoning by small repeated doses is that form of poisoning
which appears most in vogue of late years--as certain diseases,
enteritis, etc., can be simulated by the administration of repeated
small doses. The unfortunate victim complains of constant nausea and
retching, with great depression. Food is objected to, as it only
increases the vomiting. The matters vomited are at first merely mucus,
but after a time they become mixed with bile. Each time the poison is
repeated, the symptoms become aggravated. Emaciation gradually sets in,
and the person dies from complete exhaustion, or from the effects of
a larger dose than usual. Chronic poisoning has given rise to several
errors in diagnosis, and the histories of recorded cases should put
medical men on their guard. In all doubtful cases examine the urine.
_Post-mortem Appearances._--The mucous membrane of the throat, gullet,
and stomach is inflamed, and in some places softened and corroded.
Aphthous-looking spots are not infrequently found on the mucous
membrane of the stomach, and these may also be observed on the throat
and on the small intestines. The liver has been found in some cases of
chronic poisoning, where the fatal termination has been for some time
retarded, enlarged, and its structure so soft as to be easily broken
down. Fatty degeneration of the internal organs has been found after
protracted fatal administration of the drug. It is stated that in
Brunswick the fatty livers of the geese are produced by the judicious
administration of antimony. The appearances above detailed may be more
or less absent or present, according to the time that may have elapsed
from the swallowing of the poison to the time at which death has
occurred.
At the _post-mortem_ examination on the body of Mr. Bravo, poisoned
with tartar emetic in 1876, the mucous surfaces of the stomach and
duodenum were found pale and yellowish. Ulcers were present in the
cæcum, and the rest of the large intestine blood-stained, but not
ulcerated. Stevenson records the _post-mortem_ appearances of the
bodies of three women poisoned by tartar emetic (_B. M. J._, 1903,
vol. i. p. 873). They are of peculiar interest in reference to the
preservative action of antimony upon the bodies of those poisoned by
it. In the case of M. E. Marsh, upon whose body the examination was
made eight days after death, there was no odour of putrefaction, the
bowels were in a condition of acute catarrh and streaky congestion
without ulceration.
The body of Bessie Taylor had been buried for twenty-one months;
ordinary putrefactive changes were absent, and with the exception of
the integuments, it was in a remarkably good state of preservation.
The alimentary canal showed acute non-ulcerative gastro-enteritis, the
stomach and duodenum were of a cinnabar-red colour, the jejunum also
in patches. The ileum was covered with orange-red mucus in its lower
portion, and there was an orange-coloured patch twelve inches above
the ileo-cæcal valve. The patch on analysis was proved to contain
antimonious sulphide. Similar orange patches were present in the colon
and upper portion of the rectum. There were no ulcerations, but the
mucous membrane of the intestines was of a dull cinnabar-red colour.
The body of Mary J. Spink was exhumed five years after burial, and
presented a life-like aspect; there was no putrefactive odour, and
no larvæ present. The stomach and intestines were of a cinnabar-red
colour; there were no ulcerations; the intestines contained
orange-coloured mucus.
Elimination of Antimony from the System
Antimony, taken in a large dose, or in small doses frequently repeated,
appears to be rapidly absorbed, and then eliminated from the system by
the kidneys. Dating from the time at which the poison was swallowed, it
will be found in the organs of the body in the following order:--
1. Stomach and bowels, but slightly in the liver.
2. Absent from the stomach, but present in the liver,
spleen, and kidneys--traces in the blood.
3. Present in the fat and bones, with traces in the liver,
fæces, and urine.
4. The period required for its complete elimination from the
vital organs varies from fifteen to thirty days.
In other words, the presence of antimony in the stomach and intestines
points to the recent administration of the poison; and its absence
from those organs, and presence in the others above mentioned, to a
more remote period of administration. It has been suggested that in
some cases the poison may be eliminated by the mucous membrane of the
stomach. This assumption has been proved to be correct, for it has been
shown that antimony may be found in the stomach after the inhalation of
antimoniuretted hydrogen.
_Fatal Dose._--It is impossible to state with certainty the exact
amount of antimony--tartar emetic--which may prove fatal, as recoveries
have taken place even after an ounce had been taken. Large doses are
uncertain in their effects, as the severe vomiting which they produce
generally helps to get rid of the poison. In small doses, death may
result from the depressing action which it exerts over the heart.
_Fatal Period._--From a few hours to several weeks, and even months.
_Treatment._--Promote vomiting by the administration of warm water,
or warm greasy water, or the stomach may be washed out with a syphon
tube, unless the chloride of antimony is the poison, and then give
tannic acid in drachm doses in warm water, or any vegetable infusion
containing tannin--viz., tea, oak bark, or cinchona bark. Demulcent
drinks may be administered, and warmth applied. Opium may be given to
relieve pain, and stimulants for the depression.
The Detection of Antimony
Prepare the solutions of the liver and other solid organs, and also the
contents of the stomach, as described under the detection of arsenic,
using tartaric acid instead of hydrochloric acid. Through a portion
of one of the solutions, obtained by filtration or dialysis, pass a
current of sulphuretted hydrogen, which will produce, if antimony be
present, an orange-coloured precipitate of the sulphide of antimony.
The precipitated sulphide is dissolved by hot hydrochloric acid with
the evolution of sulphuretted hydrogen; and if the resulting solution
be poured into water, a white precipitate is formed of oxychloride of
antimony, soluble in tartaric acid. Chloride of bismuth is precipitated
when poured into water, but the precipitate is turned black by sulphide
of ammonium, the antimonial orange-red; the precipitate of bismuth is
not soluble in tartaric acid, the antimonial is soluble.
Marsh‘s and Reinsch‘s processes may also be used for the detection of
antimony. The former is, however, open to the objection that antimony,
when present in any quantity, rapidly precipitates on the zinc in the
form of a flocculent black deposit, while the issuing gas is found to
contain only traces of the metal.
Reinsch‘s process is, however, very delicate, and its application is in
every respect similar to that in use for the detection of arsenic. The
acid liquid should, however, be boiled down to a small bulk with the
copper, before a conclusion is drawn as to the entire absence of the
metal.
Table giving the Characteristic Reactions of Antimonial
and Arsenical Deposits on Copper.
--------------------+----------------------------+----------------
| Antimony. | Arsenic.
--------------------+----------------------------+----------------
The colour of the | Lustrous, with a violet | Dark steel-grey
deposit on copper| hue. | colour, and
by Reinsch‘s | | lustrous.
process is-- | |
| |
The coated copper | No effect, or only a | Well-marked
heated in the end| trifling white sublimate,| sublimate of
of a small tube. | non-crystalline, | octahedral
| non-volatile. If the | crystals; is
| sublimate be dissolved | readily
| in solution of tartaric | volatile.
| acid and sulphuretted |
| hydrogen passed |
| through the solution, |
| the orange antimonious |
| sulphide is thrown |
| down. |
--------------------+----------------------------+----------------
It may be noted that mercury likewise yields a deposit on copper with
Reinsch‘s process; but the coating is in this case either of a grey
colour or white, and silvery on the application of friction. When
the coated copper is heated in a glass tube, there is a sublimate of
metallic mercury readily aggregating into globules on being rubbed with
a glass rod. If the deposit is trifling in quantity, a magnifying-glass
should be used to identify the metallic globules. This test at once
distinguishes a deposit on copper due to mercury from that produced
under similar conditions by arsenic or antimony.
_Quantitative Analysis._--Take a measured quantity of the suspected
liquid and precipitate thoroughly with sulphuretted hydrogen. Wash,
dry, and weigh precipitate. One hundred parts equal 202.78 parts of
crystallised tartar emetic.
Recapitulation of the Leading Facts with regard to
Poisoning with Antimony.
---------------------------------------------------------------------
ACUTE POISONING.--SYMPTOMS, ETC.
-------------------------+-------------------------------------------
Action on alimentary | Intense irritation of the stomach and
canal. | bowels, constant vomiting, and
| frequently purging. Eliminated by the
| stomach when absorbed by the skin, or as
| antimoniuretted hydrogen by the lungs.
| Presence, in some cases absence, of
| signs of inflammation in intestinal
| canal.
|
Circulation | The cardiac contractions are lessened in
| frequency and force, the heart being
| finally arrested in diastole.
|
Brain and nervous | Sometimes delirium, paralysis of sensation
system. | and motion, and diminution of reflex
| action.
|
Urinary organs | Secretion of the kidneys, as a rule, not
| arrested; sometimes increased.
|
Fatal dose | Two grains.
|
Average period of | A very short time after the poison is
commencement of | taken. Almost immediately.
symptoms. |
|
Average period before | Various. Ten to twenty hours.
death. |
-------------------------+-------------------------------------------
CHRONIC POISONING.--SYMPTOMS, ETC.
-------------------------+-------------------------------------------
Mouth | Aphthous spots on mouth, metallic taste.
|
The stomach and bowels | Constant irritation, nausea, sinking at
| the stomach, symptoms of enteritis or
| cholera, purging, tenesmus, etc.
|
Nervous system | Malaise, low spirits, giddiness, delirium.
|
Cutaneous surface | Pustular eruption like smallpox, sweating,
| decrease in temperature.
|
Means of diagnosis in | Same as for arsenic.
suspected cases. |
|
The probable post-mortem| Much the same as in arsenic poisoning.
if death is due to |
this poison. |
|
Organs most important to| Liver, stomach, and kidneys.
secure for analysis. |
-------------------------+-------------------------------------------
MERCURY
Metallic mercury possesses no toxicological interest, as it appears to
be almost inert, even in very large doses. If applied to the skin in a
finely-divided state, as in mercurial ointment, or internally, as blue
pill, its toxic effects may be produced. The vapour given off from the
metal is highly poisonous, producing salivation, emaciation, and death.
A singular accident of poisoning by mercurial vapour occurred on board
H.M.S. _Triumph_ in 1810, owing to the bursting of bladders containing
large quantities of the metal; in three weeks 200 men were affected
with salivation, etc., nearly all the cattle on board died, as well as
the mice, a dog, and a canary-bird.
[Illustration: Fig. 34.--Photo-micrograph of crystals of corrosive
sublimate, × 50. (R. J. M. Buchanan.)]
Corrosive Sublimate
This is the most important of the preparations of mercury. It occurs
either in crystalline masses of prismatic crystals or as a white
powder. It is now known among chemists as the perchloride, though it
is frequently spoken of as the bichloride, chloride, and oxymuriate of
mercury. It has a powerful metallic and styptic taste, and is soluble
in about sixteen parts of cold water and three of boiling water.
Alcohol and ether readily dissolve it, the _latter having the power of
abstracting it from its solution in water_. This property of ether is
of importance as a means of separating corrosive sublimate from its
solution in other liquids. It is important to remember that corrosive
sublimate is soluble in alcohol (R. _v._ Walsh). The liquor hydrargyri
perchloridi of the Pharmacopœia contains half a grain of the salt to a
fluid ounce of water. Half a grain of the muriate of ammonia is added
to increase the solubility of the mercurial salt. Applied externally
to the unbroken skin, corrosive sublimate has caused death in several
cases, the symptoms being almost identical with those which follow the
entrance of the poison into the stomach. Toxic symptoms have followed
intra-uterine or vaginal injections of solution of perchloride of
mercury, also when it has been used to wash out abscess cavities.
Acute poisoning, in some cases fatal, has resulted from the external
application of corrosive sublimate to ulcers and tumours.
Symptoms of Poisoning by Corrosive Sublimate
_Acute._--The symptoms come on almost immediately the poison is
swallowed. A strong metallic coppery taste in the mouth is experienced,
and a choking sensation in the throat. Pain of a burning character
is felt, extending from the mouth to the stomach, followed by nausea
and vomiting of stringent mucus, more or less tinged with blood, and
violent purging, the evacuations being also mixed with blood and mucus.
The pulse is feeble, quick, and irregular; the countenance flushed
or pale, and the tongue white and shrivelled. This appearance of the
tongue is not present in all cases. Broncho pneumonia may occur. The
skin is cold and clammy, and the functions of the kidneys are altered
and albuminuria present, there being in many cases complete suppression
of urine. As is the case with other irritant poisons, the symptoms and
effects produced admit of considerable variation. Thus, there may be
no pain in the stomach, and no purging. Salivation is present in some
cases, but chiefly in those in whom the fatal termination is somewhat
prolonged. This sign is not infrequently absent. Poisoning with
corrosive sublimate differs from arsenical poisoning in the following
particulars:--Corrosive sublimate has a distinct metallic taste,
arsenic is almost tasteless; the symptoms in the former supervene
immediately the poison is swallowed, in the latter there is a short
delay. The discharges in corrosive sublimate are more frequently bloody
than in arsenic poisoning.
_Chronic._--The symptoms present in this form of poisoning are
modified by the size of the dose, and the interval allowed to elapse
between each dose. Nausea, followed by occasional vomiting, and pains
in the stomach, are complained of by the patient. There is general
constitutional disturbance, with anæmia and cachexia, and consequent
mental depression. Salivation, as might be expected, is a more
prominent symptom than in acute poisoning; but the salivation may be
intermittent--that is, it may cease and then reappear, even after the
lapse of months, without an additional dose of mercury having been
given in the interval. Salivation may also come on in the course of
certain diseases, attacking the salivary glands, and it may also be
produced by other causes--pregnancy, etc. The glands of the mouth
become swollen and painful, the gums tender, and the teeth loosened
fall out of the mouth. Periostitis of the jaw may occur. The breath
has a peculiar, offensive smell, the bowels are irritable, and
diarrhœa is not infrequently present. It must be borne in mind that
in certain diseases--granular disease of the kidney--the smallest
dose of any mercurial preparation may produce profuse ptyalism. And
the toxicologist must be careful not to mistake the affection known
as _cancrum oris_, or “the canker,” most common in delicate, ill-fed
children and adults, for the effects of mercury. The nervous system
is more or less affected, neuralgic pains and mercurial tremors
being present in many cases. The tremors commence in the tongue and
face and spread to the arms and legs--they are similar to those of
paralysis agitans; at first they are invoked by exertion, finally they
become continuous; they cease during sleep. Paralysis may also occur,
especially in those exposed to the vapour of mercury. Habit appears to
exert some influence on the action of corrosive sublimate, if we may
accept the story of the old man of Constantinople, who for thirty years
took large doses till his daily allowance was a drachm, and then died
at the respectable age of one hundred years.
_Post-mortem Appearances._--The morbid appearances are chiefly
confined, as is the case with arsenic, to the stomach and bowels;
but the corrosive action of the mercurial sublimate is more marked.
Inflammation more or less intense is always present in the stomach, the
mucous membrane of which may be found of a slate-grey colour, corroded,
and so soft as to scarcely admit of the removal of the organ without
tearing it. The cæcum and rectum are also sometimes found inflamed,
and the mucous membrane softened. Perforation of the stomach is very
rare, only one case having been recorded in which this was present. The
mouth, throat, and gullet may also present signs of the action of the
poison similar to those just described as seen in the stomach. Patches
of pneumonia are present in the lungs of some cases, and the kidneys
show coagulative and desquamative nephritis.
_Fatal Dose._--The smallest dose was _two grains_ in the case of a
child, but the exact amount to cause death in an adult has not been
accurately determined. Recovery has taken place after one hundred
grains has been taken.
_Fatal Period._--From half an hour to five days. No exact time can
be stated. In one case death took place on the twelfth day after
swallowing seventy grains of the perchloride.
_Treatment._--Vomiting, if present, must be encouraged; if absent, it
must be produced by emetics--zinc sulphate or cupric sulphate, followed
by copious draughts of warm water. The hypodermic injection of ¹/₂₀ to
⅒ grain of apomorphine may also be used to produce vomiting. Albumen,
the white of egg, or vegetable gluten produced from flour by washing it
in a muslin bag, should be given. The albuminate of mercury so formed
should be quickly removed by an emetic or lavage by means of a soft
tube and funnel in mild cases, as it is soluble in excess of albumen,
and may be digested or absorbed. The rapid removal of the poison from
the stomach, however, is the end to which all our exertions must tend.
The forcible use of the stomach pump should not be employed if it
can possibly be avoided, as it may greatly injure the softened mucous
membrane of the gullet and stomach. Opium may be given to relieve pain,
and opium enemata to relieve purging and tenesmus.
=Calomel=
Calomel, or the subchloride of mercury, is not used as a poison.
In large doses it may act as an irritant poison, and death has not
infrequently occurred even from comparatively small doses. Profuse
salivation and gangrene of the mouth have resulted from its use,
and cases are recorded of death resulting from these. In many
cases idiosyncrasy appears to modify, more or less, the action of
this preparation of mercury. The poisonous effect of calomel has
been attributed to--(1) Adulteration with corrosive sublimate. (2)
Conversion of the calomel into corrosive sublimate by the action of the
hydrochloric acid of the gastric juice.
_N.B._--The free acid of the gastric juice is probably in too small a
quantity to materially alter the composition of the calomel.
=Ammonio-Chloride of Mercury=
White precipitate may, if taken in large doses, produce alarming
effects, but it cannot be regarded as an active poison. Pavy‘s
experiments on rabbits indicate that it is a more powerful poison than
was formerly thought to be the case. Its action is that of an irritant,
accompanied with, in some cases, severe salivation.
=Red Precipitate=
Red oxide of mercury possesses poisonous properties, but it is
seldom employed as a poison. The symptoms most frequently present
are vomiting, coldness of the surface of the body, stupor, pain in
the abdomen, and cramps of the muscles of the lower extremities. The
vomited matters are generally mixed with some of the red oxide.
=Cinnabar. Vermilion=
A compound of sulphur and mercury in the form of a dark red crystalline
mass is known as cinnabar; and to the same substance reduced to a fine
powder the name vermilion has been given. It is used as a red pigment.
It can scarcely be considered as a poison, Orfila asserting that it
is not poisonous. The vapour of this substance appears, however, to
be capable of producing severe symptoms, and in one case, profuse
salivation resulted from the application of the vapour to the body.
=Cyanide of Mercury=
This substance, though an active poison little inferior to corrosive
sublimate, is seldom used as such, probably from its being better known
to chemists than to the general public. It differs from corrosive
sublimate in having no local corrosive action. It has been supposed,
but proof is wanting, that its injurious effects are due to its
decomposition by the acids of the stomach and the formation of prussic
acid. Death has occurred in nine days from a dose of ten grains. It
acts as an irritant. The sulphocyanide of mercury is used in the
manufacture of the toy known as Pharaoh‘s serpents.
=Turbith Mineral=
A powerful irritant poison, but seldom used. A drachm has caused death
in a boy sixteen years of age. Coldness of the surface, burning pain in
the stomach and bowels, with other symptoms of irritant poisoning, were
present. After death, the mucous membranes of the throat, stomach, and
bowels were found considerably inflamed.
=Nitrates of Mercury=
These substances--the nitrate and sub-nitrate--are used in the arts for
various purposes. They act as powerful irritant poisons, with symptoms
and _post-mortem_ appearances not unlike those before described when
speaking of corrosive sublimate and other irritants.
_Chemical Analysis_:
Table showing the Reaction of Mercuric and
Mercurous Salts with Reagents
-------------------------------+------------------------------------
Mercuric Salts
-------------------------------+------------------------------------
1. With solution of iodide of | 1. Bright scarlet precipitate,
potassium. | soluble in excess.
|
2. With potash solution. | 2. Bright yellow precipitate.
|
3. With hydrosulphuret of | 3. First a yellowish and then a
ammonia. | black precipitate is produced.
|
4. Heated in a reduction tube.| 4. It melts, boils, is volatilised,
| and forms a white crystalline
| sublimate.
|
5. With ether. | 5. It is freely soluble in ether;
| and the ethereal solution, when
| allowed to evaporate
| spontaneously, deposits the salt
| in white prismatic crystals.
|
6. Heated with carbonate of | 6. Globules of metallic mercury
soda in a reduction tube. | are produced.
-------------------------------+------------------------------------
Mercurous Salts
-------------------------------+------------------------------------
1. Hydrochloric acid. | 1. A white precipitate of calomel,
| blackened on addition of ammonia.
|
2. Potassium iodide solution. | 2. Green precipitate.
|
3. Caustic potash or soda | 3. Black precipitate of mercurous
solution. | oxide.
-------------------------------+------------------------------------
=Detection of Mercury in the Tissues and in the Contents of the
Stomach.=
Mercury is particularly liable to be absorbed by the tissues; it also
readily combines with various organic substances, gelatine, albumin, &c.
[Illustration: Fig. 35.--Photo-micrograph of globules of mercury
obtained by Reinsch‘s process, × 50. (R. J. M. Buchanan.)]
_A._--If the contents of the stomach are under examination, they should
be diluted with distilled water, filtered, and the residue pressed and
reserved for further examination.
The liquid thus obtained may be concentrated, and, while still warm,
slightly acidified with hydrochloric acid. A slip of zinc foil, with
a piece of gold foil twisted round it, is then introduced. If mercury
be present, the gold will, sooner or later, lose its yellow colour,
and its surface become white and silvery, while the zinc is wholly or
partially dissolved. The gold being removed, separated from the zinc,
washed first with water and then with ether, is divided into two equal
parts. One half may be heated in a reduction tube, when it will yield a
sublimate of metallic mercury, identified by the spherical form of the
globules under a magnifying-glass, and their metallic reflection and
complete opacity. The other half of the gold may be treated with nitric
acid and heated, which will dissolve off the mercury. The resulting
solution, after expelling the excess of acid by evaporation, will give
a scarlet precipitate with iodide of potassium soluble in excess; and,
with protochloride of tin, a black precipitate of metallic mercury.
_B._--For the detection of mercury in the insoluble form, the residue
from _A_ is dried; or, if the tissues are under examination, they
should be finely divided, and freed from superfluous moisture. In
either case, the substance is boiled in moderately strong nitric or
hydrochloric acid (about one part of acid to four of water). After
digestion for some time, the liquid is filtered, concentrated, and
tested as in _A_. When there is reason to infer the presence of
corrosive sublimate in considerable quantity in an organic liquid,
advantage may be taken of the solubility of the salt in ether, and
the power possessed by this liquid of abstracting it from its aqueous
solutions. The liquid is agitated with an equal volume of ether, the
ethereal solution poured off and allowed to spontaneously evaporate,
when the corrosive sublimate will be left in white silky prisms,
yielding all the characteristic reactions of the salt. In obscure cases
of salivation, the saliva should be examined as follows: Take about
two drachms of the saliva, acidulate with pure hydrochloric acid, and
immerse in the mixture a very small piece of copper gauze attached
to a platinum wire, and set aside in a warm place for some hours. If
mercury be present, the copper will be covered with a white coating;
this should be washed and heated in a reduction tube, when globules of
mercury will be formed, and examined with a lens.
_C._--Mercury in solution may be detected by Reinsch‘s process. On
boiling with pure copper foil after acidifying the solution with
hydrochloric acid, the mercury is deposited on the copper in the
metallic state, as a whitish silvery film, which can be polished
to a silvery mirror surface. On washing the film in water, ether,
and absolute alcohol and allowing it to dry, then subliming it in a
reduction tube by the aid of heat, the mercury deposits on the cool
part of the tube in the form of minute globules, which may be easily
recognised through the microscope. If a small crystal of iodine be now
placed in the tube and gently warmed so as to volatilise it, but not
the mercury, and the tube be left to stand for a short time, the iodine
combines with the mercury to form the scarlet iodide, the colour of
which renders it easy of recognition.
According to Bonnewyn, the presence of an extremely small quantity of
corrosive sublimate (¹/₅₀₀₀₀) in calomel may be detected by immersing
a clean knife blade, moistened with alcohol or ether, in the suspected
calomel. A black spot is formed on the steel very difficult of removal.
No spot is formed when the calomel is pure.
LEAD
Metallic lead is not poisonous; but it appears probable that when it
is acted upon by the acids of the intestinal secretions, it may become
so changed as to produce unpleasant symptoms. Any salt of lead is
poisonous when in a condition to be absorbed into the system.
Sugar of lead and white lead are alone important, and will therefore be
briefly considered.
=Sugar of Lead=
Acetate of Lead. Subacetate. Goulard‘s Extract
_General Character._--The acetate of lead, better known as sugar
of lead, is not unlike loaf-sugar in its general appearance. It is
usually met with in the form of solid crystalline masses of a white or
brownish-white colour. To the taste it is sweet, a metallic astringent
taste being left in the mouth. Acetate of lead is soluble in water and
in alcohol. The subacetate is a more active poison than the neutral
acetate. Sugar of lead is popularly considered as an active poison, but
this does not appear to be the case. Sir R. Christison gave eighteen
grains daily in divided doses for eight or ten days with no other
unpleasant symptoms than slight colicky pains in the abdomen. Lead is
probably eliminated from the system by the urine, and also by the milk;
but there is reason to believe that when once deposited in the body,
some considerable time is required for its complete elimination. Dr.
Wilson is of opinion that in chronic lead poisoning the lead is more
largely deposited in the spleen than in any other organ of the body.
This organ should therefore always be carefully examined in suspected
cases of poisoning by this metal.
_Goulard‘s Extract_ is a solution of the subacetate of lead. It may be
of a reddish colour, from the employment of common vinegar in the place
of pure acetic acid in the manufacture.
_Goulard‘s Lotion_ is the extract diluted with water.
=White Lead=
White lead, carbonate of lead, ceruse, or kremser white, is used as a
pigment. It is generally in the form of white, heavy chalky masses,
insoluble in water, and, when taken in large doses, poisonous. It is
this substance which, in the majority of cases, causes chronic lead
poisoning, or _painter‘s colic_.
The _chloride_ and _nitrate_, the oxides, _litharge_ and _red
lead_, are all poisonous; but the _sulphate_, due probably to its
insolubility, appears to be inert.
Lead poisoning may result from--
1. Constant contact with lead and its salts in manufactories.
2. Its use in the arts and as a pigment. The injurious effects of
this substance are strikingly seen among painters, the makers of
glazed cards, and the workmen engaged in preparing Brussels lace--this
material being whitened by beating white lead into it. All thus
employed are liable to suffer more or less from chronic poisoning.
3. Its application to the surface of the body in the form of ointment,
plasters, cosmetics, and hair-dyes.
4. Drinking water impregnated with lead, from being stored in leaden
cisterns or conveyed in leaden pipes.
“The action of water upon lead is much modified by the presence of
saline substances. It is increased by chlorides and nitrates, and
diminished by carbonates, sulphates, and phosphates, and especially
by carbonate of lime, which, held in solution by excess of carbonic
acid, is a frequent ingredient of spring and river water. But water
highly charged with carbonic acid may become dangerously impregnated
with lead, in the absence of any protecting salt, in consequence of
its solvent power over carbonate of lead. In general, water which is
not discoloured by sulphuretted hydrogen may be considered as free
from lead; but there are few waters which have passed through leaden
pipes, or have been retained in leaden cisterns, in which a minute
analysis will not detect a trace of the metal; and were it not for the
great convenience of lead, iron pipes and slate cisterns would, from a
sanitary point of view, be in all cases preferable.
“Another case of contamination by lead may arise from electric action,
as where iron, copper, or tin is in contact with or soldered into lead;
and in these cases, owing to the action of alkaline bases as well as
of acids upon the lead, danger may occur when it is thrown into an
electro-negative as well as into an electro-positive state.
“Cisterns are sometimes corroded and their bottoms are perforated by
pieces of mortar having dropped into them, the lime of which has caused
the oxidation of the metal and a solution of the oxide.”
5. Lead may also find its way into the system by means of the food.
Farinaceous foods, chocolate, and tea may become contaminated if lead
wrappers be used; and confectionery from the use of lead chromate as a
colouring agent. The use of leaden vessels in the manufacture of cider
is attended with danger, and also the keeping of pickles in glazed
earthenware jars. The celebrated “Devonshire Colic” was the result
of cider-making in leaden vats. Beer may be contaminated with lead
if allowed to stand in leaden pipes overnight. Rum has been known to
have been dangerously impregnated with lead, leaden worms having been
used attached to the stills. Many tobacconists are in the habit of
using lead foil to wrap up their tobacco and snuff; this practice has
resulted in several cases of chronic lead poisoning. Soda and Seltzer
waters may contain lead when kept in syphons with leaden caps or valves.
6. Acute and subacute cases of poisoning occur from the taking of lead
in the form of diachylon pills to procure abortion.
=Symptoms of Poisoning by Lead=
_Acute._--A metallic taste in the mouth, accompanied with dryness in
the throat and intense thirst, is experienced by the patient soon after
the poison is swallowed. In some cases, however, _two or more hours_
may elapse before the effects of the poison begin to show themselves.
Vomiting may or may not be present. Twisting colicky pains are felt
in the abdomen, relieved in some cases by pressure. The paroxysms
of pain may be separated by intervals of ease. The bowels are, as a
rule, obstinately confined, and the fæces are of a dark colour, from
the formation of the sulphuret of lead. The skin is cold, the pulse
quick and weak, and there is considerable prostration of strength. In
some cases the patient suffers from cramps of the calves of the legs,
and sometimes, in protracted cases, paralysis of one or more of the
extremities may supervene. The effect on the nervous system, headache,
temporary blindness, is marked by giddiness, and stupor, in some
cases delirium even resembling acute mania, terminating in coma, or
convulsions and death. Albuminuria may occur.
_Chronic._--This form of poisoning generally occurs among painters,
manufacturers of white lead, pewterers, and others. The early symptoms
are those of ordinary colic, only more severe. The patient generally
complains, in the first instance, of feeling unwell, and of general
debility. He then suffers from pain of a twisting, grinding nature,
felt in the region of the navel, the abdomen being retracted and hard.
The bowels are obstinately confined. The appetite becomes capricious,
and may be entirely lost. The mouth is parched, the breath fœtid, the
countenance sallow, the skin dry, and general emaciation sets in. A
nasty sweetish metallic taste in the mouth is present in most cases.
Not infrequently the subjects of lead poisoning experience a peculiar
form of paralysis of the upper extremities, well known as “dropped
hand.” It appears that this condition is the result of paralysis of
the extensor muscles of the wrist, the long supinator escaping. In
other cases the muscles of the shoulder girdle or pelvic girdle and
legs may be affected. Acute general paralysis has occurred in workers
with lead, and may prove fatal. Optic neuritis and optic atrophy occur
in some cases. Persistent headache may be present in others. The
muscles undergo a form of fatty degeneration. The lead appears to act
primarily on the muscles, then on the nerves, and lastly on the nerve
centres. The absorption of lead causes marked anæmia with degeneration
of the red corpuscles, which show marked punctate basophilia. One
other symptom of importance has yet to be noticed. The gums, at their
margins where they join the teeth, present a _well-marked blue line,
absent where a tooth has been removed_. This is not present in all
cases, but it should be looked for. Chronic lead absorption produces
cardiovascular changes with arterio-sclerosis, valvular degeneration,
cardiac hypertrophy, and chronic renal changes with albuminuria.
Closely associated with these conditions are saturnine arthritis
and gout. The effects upon the vessels may predispose to cerebral
hæmorrhage or lead encephalopathy. Cicconardi suggests as a method of
diagnosis in lead poisoning, where the cause of the colic is uncertain,
to paint the skin with a 6 per cent. solution of sodium sulphite. If
lead be the cause the painted part will become darkened in colour.
_N.B._--The symptoms produced by white lead--carbonate
of lead--are those of _colica pictonum_, or _painter‘s colic_,
described under the head of Chronic Lead Poisoning.
_Post-mortem Appearances._--In acute poisoning the mucous membrane of
the stomach and intestines is inflamed, and is in some cases covered by
layers of white or whitish-yellow mucus, more or less impregnated with
the salt of lead swallowed. Corrosion of the mucous membrane may occur
if the dose be large, and this condition is more frequently present
when the neutral salt is taken.
In chronic poisoning there are no constant _post-mortem_ appearances.
The muscles of the paralysed extremity are usually found flaccid, of a
cream colour, and the subject of fatty degeneration.
_Fatal Dose._--Sugar of lead is not an active poison, recovery having
taken place after one ounce had been swallowed.
_Fatal Period._--Uncertain.
_Treatment._--The stomach should be emptied by means of the pump or
syphon tube, followed by the free administration of the sulphates of
soda and magnesia. The carbonates should not be given, the carbonate
of lead being poisonous. Vomiting should be promoted, and a powerful
cathartic administered. Albumen and milk should also be given, as these
precipitate the oxide. In the chronic form of poisoning, the iodide
of potash and aperients, notably the sulphate of magnesia, should be
administered. Dixon Mann does not consider that iodide of potash is
of any value as an eliminator of lead, as the latter forms a stable
compound with the tissues. Sulphur baths are also useful in removing
the lead from the system. Lately the galvanic bath has been tried
with great success. By way of _prophylaxis_, it has been recommended
that all those engaged in lead manufactories, or who are obliged to
handle this metal frequently, should partake largely of lemonade made
with sulphuric acid, should not take their meals in the factories, or
without well washing the hands.
_Chemical Analysis_.--When the solid acetate is heated on platinum
foil, it melts, then solidifies, becomes dark in colour, and gives off
fumes of acetic acid.
The following are the liquid tests for lead in solution:
1. Dilute sulphuric acid gives a white precipitate of the sulphate,
which is insoluble in nitric, but soluble in hydrochloric acid, in
excess of caustic potash solution, and in ammonium acetate solution.
2. Solution of potassium iodide gives a yellow precipitate, soluble in
boiling water and caustic potash solution.
3. Sulphuretted hydrogen, or ammonium sulphide, gives a black
precipitate.
4. Potassium bichromate a yellow precipitate.
=Detection of Lead in Organic Mixtures=
The contents of the stomach or vomited matters must be diluted
with water and filtered. The residue left on the filter, washed
with distilled water, should be set aside for further examination;
the filtrate and washings acidified with nitric acid. A current of
sulphuretted hydrogen passed through the solution will then throw down
the whole of the lead, should any of that metal be present, in the
form of a brownish-black sulphide, which may be collected on a small
filter and dried. The sulphide, boiled with dilute nitric acid, is
partly converted into insoluble sulphate, and in part dissolved as
nitrate. The carefully neutralised solution may be either tested at
once or carefully concentrated. In either case, the production of a
bright yellow precipitate, with a solution of bichromate of potash, and
a similar one with a solution of iodide of potassium, may be taken as
conclusive of the presence of lead. The portion of lead deposited as
sulphate will be found to be soluble in a solution of pure potash, the
resulting liquid giving a brown-black precipitate on the addition of
sulphide of ammonium.
The insoluble residue left on the filter should be incinerated in a
porcelain crucible, either with or without nitric acid, care being
taken not to raise the temperature more than is necessary to produce
the desired effect: the carbonised mass boiled with dilute nitric
acid evaporated to dryness, extracted with distilled water, and
then filtered, the filtrate tested as before mentioned. It is often
useful, as a preliminary test for the presence of lead in a soluble
form, to dip a piece of bibulous paper into the clear liquid obtained
by submitting the contents of the stomach or vomited matters to
filtration, and then exposing the paper to the action of a current of
sulphuretted hydrogen. If lead be present, blackening of the paper will
take place.
To detect the lead in the urine and fæces, Dixon Mann advised the urine
to be evaporated to the consistency of gruel, and the fæces to be mixed
with distilled water to a similar consistence; the organic matters are
then to be destroyed with hydrochloric acid and chlorate of potash
with the aid of heat, and the solution filtered. The filtrate is then
placed in a cell with a parchment bottom, and this into another cell
containing distilled water acidulated with sulphuric acid. Two pieces
of platinum foil are now placed in the inner and outer cells, separated
by the parchment; that in the inner cell is connected with the cathode,
that in the outer with the anode of four Grove cells, and the current
closed for several hours. The lead, if present, is deposited on the
platinum connected with the cathode.
The magnesium method (Marsden & Abram) is useful. A strip of pure
magnesium is placed in the urine, to which has previously been added
ammonium oxalate, about 1 gramme to 150 c.c. Lead, if present, is
deposited on the magnesium in about half an hour, but it may take some
hours. The strip is washed in distilled water and dried--warmed with a
crystal of iodine the yellow iodide will form; or the deposit may be
dissolved in HNO₃ and tested in the usual way.
Goadby recommends inoculating the urine with bacillus coli, which
during its growth produces H₂S; this precipitates any lead as sulphide.
After filtering, the filtrate is dissolved in a small quantity of 10
per cent. nitric acid and tested by the usual methods.
Recapitulation of the Leading Facts with regard to
Poisoning by Lead
--------------------+-------------------------------------------
ACUTE POISONING.--SYMPTOMS, ETC.
--------------------+-------------------------------------------
Action on alimentary| Sweet metallic taste in mouth. Vomiting,
canal. | constipation, burning twisting pain in
| the belly. Inflammation of canal.
|
|
|
Circulation. | The pulse lowered, and tendency to death
| from syncope. Anæmia.
|
Nervous system. | Neuralgic pain, convulsions, cramps,
| paralysis, &c.
--------------------+-------------------------------------------
CHRONIC POISONING.--SYMPTOMS, ETC.
--------------------+-------------------------------------------
Mouth and alimentary| Sweet metallic taste; blue line at margins
canal. | of gums; breath fœtid. Colic,
| constipation.
|
Nervous and muscular| Headache, delirium, stupor, amaurosis,
symptoms. | paralysis of the extensor muscles of the
| wrist, anæsthesia of the affected part.
| Fatty degeneration of the muscles.
|
Circumstances under | Certain trades, as painters, plumbers,
which it may occur. | type-founders, &c. Action of drinking
| water on lead. Hair-dyes, food in leaden
| utensils, &c.
|
Prophylaxis | Grinding lead colours in oil or water.
| Cleanliness in factories. Slate cisterns
| for water. Dilute sulphuric acid
| lemonade.
|
Medical treatment | Epsom salts, iodide of potassium, galvanic
| baths, &c.
--------------------+-------------------------------------------
COPPER
Metallic copper, like metallic lead, is not poisonous, but its oxides
are; it should, therefore, not be swallowed, as it is rapidly acted on
by the intestinal secretions and poisonous compounds formed. An alloy
of copper is used for ornamenting ginger-bread, &c. All the salts of
copper are poisonous. The most important are, however, the _sulphate_,
_blue-stone_, or _blue vitriol_, and the _subacetate_ or _verdigris_.
Copper is eliminated to a slight extent by the urine. It has been
found in the stomach, liver, and intestines eight months after its
administration had been discontinued. It has also been detected more
readily in the bronchial secretion than in the urine.
=Symptoms of Poisoning by Copper=
_Acute._--The primary action of the sulphate of copper in from five- to
fifteen-grain doses is that of a quick emetic; in larger doses, a
powerful irritant; but when absorbed, it appears to act chiefly on the
brain and nervous system. Its irritant action is marked by nausea,
vomiting, griping pain in the belly, which is greatly distended,
and increased flow of saliva. The vomited matters are of a bluish
or greenish colour, and the discharges from the bowels greenish and
containing blood. The vomited matters become blue on the addition of
ammonia. The above-mentioned symptoms usually follow immediately after
the poison is swallowed, and rapidly increase in severity. After a
time, the remote effects supervene, marked by headache, giddiness,
laboured breathing, quick irregular pulse, coma or convulsions,
paralysis, and death.
In poisoning by this substance, the convulsions are most violent, and
wild incoherent delirium not infrequent.
The subacetate of copper or verdigris produces symptoms not unlike
those just described. Jaundice and suppression of urine may result when
either this or the sulphate is taken.
_Chronic._--Constant and troublesome irritation of the stomach and
bowels; vomiting and purging, attended with considerable straining
at stool; loss of appetite, loss of power, and general emaciation
set in. The patient is subject to frequent trembling of the limbs,
which may end in paralysis. The mouth is unpleasant, and a coppery,
metallic taste is experienced. Cramps or colicky pains in the belly are
not infrequently present. Jaundice is sometimes present. The vomited
matters are greenish; but the practitioner must not be led away, and
thus mistake the colour of the vomited matters which occur in some
morbid states of the bile, for the result of poisoning by a salt of
copper. A form of chronic poisoning affecting workers in this metal
has been described by some French pathologists as “copper-colic.” A
cachectic condition of the system, accompanied with one or more of the
symptoms already detailed, marks this form of poisoning. _A purple_
line along the margins of the gums is present in some cases.
Copper poisoning may result from--
1. Its introduction into the system by using, for culinary purposes,
copper vessels not properly tinned. An interesting account of poisoning
from this source may be found in the second volume of the _Medical
Observations and Inquiries by a Society of Physicians in London_,
published 1764. The cases there recorded occurred on board ship, with
most alarming symptoms.
2. By constant application of the metal to the surface of the body,
necessitated by certain processes in its manufacture and in its
application for industrial purposes. M. Michel Levy, however, says
in his work, _Traité d‘Hygiène, Publique et Privée_, that workmen
in copper may pass green-coloured urine and yet be as robust and as
long-lived as other workmen.
3. The use of certain preparations of this metal as pigment.
4. The use of German silver--an alloy of copper, zinc, and nickel--may
be rendered dangerous by the action of acid food upon the compound.
5. The use of a salt of copper to give a green fresh colour to certain
tinned vegetables and fruits, peas, &c., now introduced into this
country from France.
_Post-mortem Appearances._--The mucous membrane of the stomach is
inflamed, the inflammation extending sometimes into the gullet. The
intestines may be found perforated. The lining membrane of the whole
alimentary canal presents a deep green colour, distinguished from that
the result of a morbid condition of the bile by being turned blue on
the addition of ammonia.
_Fatal Dose._--Nothing certain is known as to the exact quantity that
may prove fatal, as the evidence of the poisonous action of copper is
somewhat contradictory. It appears to be more dangerous in small doses
than in large ones. Half an ounce of verdigris or subacetate has proved
fatal to an adult.
_Fatal Period._--The shortest time on record is four hours.
_Treatment._--Induce vomiting, and assist the emetic action of the
copper salts by the free use of warm water, milk, or any demulcent
drink. The stomach tube may be used if vomiting does not occur. As an
antidote, large quantities of albumen and iron filings have been given,
of which the former appears to be most efficacious.
_Chemical Analysis._--The following are the liquid tests for copper in
solution:--
1. Ammonia gives a bluish-white precipitate soluble in excess, forming
a blue solution.
2. Sulphuretted hydrogen and ammonium sulphide give a
chocolate-coloured precipitate.
3. Ferrocyanide of potassium gives a port-wine colour, or reddish-brown
precipitate.
4. If a bright steel needle be introduced into an acid solution of
copper, the metal is deposited on the needle.
5. If a piece of zinc bound with platinum wire be placed in a solution
of a copper salt, the metal is deposited on the platinum; it is turned
violet on exposure to the vapour from sulphuric acid mixed with
potassium bromide.
=Detection of Copper in Organic Liquids=
_A._--The finely-divided tissue, or the contents of the stomach,
diluted with water, are thrown on a filter, and the insoluble portion
set aside for further treatment. (See _B._)
The filtrate and washings may now be concentrated, acidified with
sulphuric acid, and a polished needle inserted in the liquid; and
should no immediate deposition of metallic copper occur, it may be
allowed to remain for several hours. The colour of the metallic deposit
is highly characteristic of copper. As a corroborative proof, the
concentrated liquid may be placed in a platinum capsule with some
fragments of zinc, when the copper will be deposited on the platinum
capsule at the parts in contact with the zinc; the liquid poured off,
and the excess of zinc adhering to the platinum removed by dilute
hydrochloric acid. The copper may now be dissolved off the platinum by
nitric acid, the excess of acid driven off by heat, and the solution
subjected to the wet tests given above.
_B._--The insoluble portion from _A_ is incinerated in a porcelain
crucible. The ash thus obtained is digested in hydrochloric acid
with the aid of heat, and evaporated nearly to dryness. The residue,
dissolved in distilled water, may be tested as under ‘_A_.’
ZINC
The sulphate and the chloride of zinc are alone important. Poisoning by
the chloride of zinc has been described (p. 265).
=Sulphate of Zinc=
White vitriol or white copperas.
_Symptoms._--The sulphate of zinc acts as a pure irritant. Violent
vomiting, accompanied with pain in the abdomen, and purging, are the
symptoms which first make their appearance. These may be followed by
symptoms which betoken collapse, viz. coldness of the limbs, paleness
of the face, irregular pulse, and fainting.
_Post-mortem Appearances._--Presence of inflammatory action.
_Fatal Dose._--Uncertain.
_Fatal Period._--Death has occurred in four hours.
_Chemical Analysis._--Distinguished from oxalic acid by remaining fixed
when heated on platinum foil.
In Solution:
1. _Ammonia_ gives a white precipitate soluble in excess.
2. _Ferrocyanide of Potassium_, a white precipitate.
3. _Sulphuretted Hydrogen or Ammonium Sulphide_, a milky-white
precipitate in a neutral pure solution.
4. _Nitrate of Baryta_, a white precipitate showing the presence of
sulphuric acid.
5. _Caustic potash_ or _soda_, a white precipitate soluble in excess.
In Organic Mixtures pass sulphuretted hydrogen, collect the sulphuret,
and decompose it with boiling hydrochloric acid, then test for zinc.
_Treatment._--Tea, coffee, milk, warm water, albumen, and in some cases
enemata of gruel and other emollients.
IRON
The preparations of iron which are of importance are the sulphate and
the muriate.
Sulphate of Iron
_Copperas_ or _Green Vitriol_--has been administered as a poison, but
more frequently to procure abortion. An ounce has been taken with no
other serious effect than the production of violent pain, purging,
and vomiting. Constant application of this substance to the body
has produced vomiting, pains in the belly and limbs. These symptoms
disappear on treatment.
_Chemical Analysis._--(1) Hydrosulphuret of ammonia gives a black
precipitate. (2) Ferrocyanide of potassium added to it, in solution,
gives rise to a greenish-blue precipitate, becoming dark blue on
exposure. (3) Chloride of barium will point to the nature of the acid
present.
=Muriate of Iron=
Better known as the _Tincture of Sesquichloride of Iron_, or the
_Tinctura Ferri Perchloridi_.--The tincture acts as a corrosive and
irritant poison, death having followed in five weeks after an ounce and
a half had been swallowed. It is sometimes used as an abortifacient.
Recovery has, however, taken place after three ounces had been
swallowed. The symptoms present in most cases observed were those of a
corrosive and irritant.
_Chemical Analysis._--(1) The addition of nitrate of silver, causing
a white precipitate insoluble in nitric acid, points to the presence
of chlorine. (2) The peroxide of iron, indicated by the formation of
Prussian blue on adding a solution of the ferrocyanide of potassium.
BISMUTH
The preparations of this metal act as irritant poisons, death having
occurred from a dose of two drachms of the sub-nitrate. Dr. Trail
(_Outlines of Medical Jurisprudence_, p. 116) mentions the ease of a
patient of his who took _six drachms_ in three days in divided doses.
The symptoms were vomiting, extreme pain in the abdomen and throat,
a weak, feeble pulse, and much anxiety about the præcordia. Recovery
took place. A case of severe vomiting during pregnancy, ending fatally,
was mistaken for arsenic poisoning. The error arose from mistaking a
greyish powder on the walls of the stomach for arsenic. It turned out
on further inquiry that it was bismuth, given medicinally to prevent
the vomiting. Bismuth carbonate mixed with gruel or bread and milk
is given in large quantities for the purposes of radiography of the
alimentary canal without any untoward effects.
POTASSIUM
=Nitrate of Potash=
This substance is well known as nitre, saltpetre, and sal prunella. In
large doses it acts as an irritant, and cases are recorded in which it
has been used to poison children. In one case, the presence of crystals
of the salt in some of the dried vomited matter on the child‘s shoe,
led to an explanation of the cause of death.
_Symptoms._--Those of a pure irritant, to which death must be referred,
and not to any constitutional action of the drug. The nervous symptoms,
which are sometimes very marked, are, as is well known, common to the
action of many pure irritants. In some cases there is suppression of
urine.
_Post-mortem Appearances._--Those produced by irritants generally.
_Chemical Analysis._--Separate the poison by dialysis, evaporate, and
test the crystals as directed under nitric acid.
_Fatal Dose._--About an ounce.
_Fatal Period._--Two hours.
_Treatment._--The same as for other irritants; demulcent drinks.
Promote vomiting.
=Sulphate of Potash=
_Sal Polychrist_, _Sal de Duobus_, or sulphate of potash, acts as an
irritant poison, being largely used in France as an abortive. The
symptoms and the _post-mortem_ appearances are much the same as those
produced by the nitrate. A like treatment may also be adopted. In the
detection of this substance, the nitrate of baryta will point to the
acid present, and bichloride of platinum to the presence of potash.
=Chlorate of Potash=
This salt acts as a poison when taken in large doses, producing
symptoms which might be mistaken for poisoning with arseniuretted
hydrogen, or for such diseases as hæmoglobinuric fever.
_Symptoms._--These comprise pain in the stomach and bowels with
vomiting, collapse and stupor, cyanosis, jaundice; diminution of the
urine, which contains hæmoglobin, casts, and albumen. It is a question
whether the jaundice is hæmatogenous or hepatogenous. Chlorate of
potash destroys the red corpuscles, the hæmoglobin is dissolved out and
is set free in the liquor sanguinis.
_Fatal Dose._--45-50 grains proved fatal to a child three years old.
For an adult 390 grains to an ounce and a half.
_Fatal Period._--From five hours to several days.
_Treatment._--The stomach should be washed out through the syphon tube.
Venæsection may be useful, with subsequent transfusion of fresh blood.
The nephritis and other symptoms must be treated generally.
_Post-mortem Appearances._--The mucous membrane of the stomach may be
inflamed and submucous hæmorrhages may be found. The blood is chocolate
in colour and gives the spectrum of methæmoglobin. The spleen is
enlarged and chocolate-coloured, and the kidneys acutely inflamed.
_Chemical Analysis._--Chlorate of potash may be separated from organic
material by dialysis.
1. If to a solution of the salt a few drops of indigo sulphate be
added, and then a few drops of strong sulphuric acid, the indigo-blue
is bleached.
2. If a small crystal of the chlorate be heated in a test tube with a
drop of strong sulphuric acid, it explodes with detonation.
BARIUM
The chloride, nitrate, and carbonate of barium are all irritant
poisons. But besides their irritant action, the salts of barium also
appear to act on the nervous system and the heart, arresting its action
in systole. The symptoms, post-mortem appearances, and treatment are
the same as for the other irritant poisons. Sulphate of magnesia, or
other soluble sulphate, should be given to form an insoluble sulphate
of baryta. Sulphate of barium is also used like bismuth carbonate for
radiography.
_Chemical Analysis._--Sulphuric acid or alkaline sulphate gives a
white precipitate with solution of chloride of baryta, insoluble in
nitric acid. The salts impart to flame a greenish-yellow colour. The
chlorine is detected by nitrate of silver. Dissolve the carbonate in
hydrochloric acid, and test as above.
CHROMIUM
Two compounds of this metal are largely used in the arts for dyeing
purposes--the neutral chromate and the acid bichromate of potash. The
bichromate of potash is a powerful poison, and death may occur from its
direct action on the nervous system, without the development of any of
the signs of irritation; in other cases, however, well-marked irritant
symptoms have been present. Applied externally, it produces deep
fistulous sores, especially on the mucous membrane of the septum of the
nose, in the workmen who are engaged in its manufacture. These sores
are prevented to some extent by taking snuff. Dyers not infrequently
suffer severely on their arms when using it in the course of their
trade. Death has resulted in _four hours_ after its administration.
_Chemical Analysis._--A solution of the bichromate of potash, added to
a solution of acetate of lead, gives a yellow precipitate; with nitrate
of silver, a red. The salt boiled with hydrochloric or sulphuric acid
and alcohol, gives a green liquid.
_Treatment._--Emetics, magnesia, chalk, demulcent drinks, &c.
CHAPTER V
VEGETABLE AND ANIMAL IRRITANTS
=Mode of Action.=--The general effects produced by the somewhat large
class of vegetable irritants are--
1. Severe abdominal pain, accompanied with vomiting and purging.
2. Absence in most cases of any cerebral or nervous symptoms.
3. The irritant properties appear to reside in an acrid oil or resin.
In colchicum, stavesacre, and some others, the presence of an alkaloid
may account for their active properties.
4. In medicinal doses, the vegetable irritants act as safe purgatives.
5. The _post-mortem_ appearances found in the alimentary canal betoken
inflammation, the result of irritation.
6. Applied externally, they produce inflammation, pustular eruptions,
and sometimes unhealthy callous sores.
SAVIN
The leaves and tops of this plant, _Juniperus Sabina_ (_N.O.
Coniferæ_), yield an acrid volatile oil, to the presence of which the
poisonous properties are due. The oil is colourless or pale yellow,
with a peculiar terebinthinate odour. It is used in medicine both
internally and externally, and is supposed to possess emmenagogue
properties. The dried powder is less active than the fresh tops. Savin
is seldom used as a poison, more frequently to procure abortion. Its
use for this purpose is mentioned in the old ballad of “Marie Hamilton”:
“The King has gane to the Abbey garden,
And pu‘d the savin tree,
To scale the babe from Marie‘s heart;
But the thing it wadna be.”
_Symptoms._--Those of irritant poisoning. Violent pain in the abdomen,
followed by vomiting, and in some cases salivation and strangury.
Purging is not always present. When taken to procure abortion, death
often takes place before the object for which it was taken is attained.
_Post-mortem Appearances._--The stomach, gullet, and intestines are
found congested and inflamed. The stomach may in places be seen
corroded, and a green powder adherent to its coats. The powder washed
and dried, and then rubbed, gives off the odour of savin.
_Chemical Analysis._--When an infusion or decoction of the leaves
has been taken, chemical analysis is of no assistance. The oil may
be separated from the contents of the stomach by subjecting them to
distillation, and then shaking the distillate with ether, when the oil
is dissolved out. On the evaporation of the ether, the oil is left for
examination. When the powder is taken the contents of the stomach are
not unlike green pea-soup. If a small portion of the green liquid be
taken, and diluted with water, the green chlorophyll, being insoluble,
will sink; but if the colour be due to bile, the liquid will remain of
a uniform green colour. If a portion of the green matter be collected,
dried, and then rubbed in a mortar, the characteristic odour of savin
will be given off. The microscope may detect bits of the twigs.
The oil, on the addition of strong sulphuric acid, gives a brown
colour. On diluting the coloured liquid with water, a dense white
precipitate forms.
CROTON OIL
The oil expressed from the seeds of _Croton tiglium_ (_N.O.
Euphorbiaceæ_).
The seeds, when taken, produce violent pains in the stomach and
purging. Pereira has described the case of a man who suffered severely
from inhaling the dust of the seeds. The dose of the oil is from half
a minim to a minim. Dr. Trail mentions the case of a delicate lady
patient who took three drops for a dose without inconvenience. Dr. Adam
records a case (_Edinburgh Medical Journal_, 1856) of a man who, in
mistake, drank three drachms of a liniment containing about fifty drops
of croton oil. After the most alarming symptoms, the patient ultimately
recovered. Two drachms and a half have caused death (_Journal de Clinic
Médicale_, 1839, p. 509). The poisonous properties depend upon the
presence of a fatty acid.
A medical friend informed Husband that in Shetland six drops in as many
colocynth pills have, in cases there, only produced “a comfortable
‘_aisement_’ of the bowels.” This is attributed to the _dura ilia_,
resulting from a constant fish diet.
_Symptoms._--Pain in the abdomen, vomiting, and purging, followed by
exhaustion and collapse. In some cases, when the dose is large, the
pain is hot and burning, and may be felt from the mouth downward.
_Chemical Analysis._--Separate the oil from the contents of the stomach
by means of ether, and then drive off the ether by means of heat. The
oil then warmed with nitric acid becomes of a brown colour, and nitrous
acid vapours are given off.
COLCHICUM
The poisonous properties of _Colchicum autumnale_, Meadow Saffron
(_N.O. Melanthaceæ_) reside in an alkaloid _Colchicine_, chiefly found
in the corms, but also present in other parts of the plant. The seeds
have caused death.
In June 1875 an epidemic of gastric irritation among the inhabitants
of Rione Boego was traced to the use of the milk of goats which had
accidentally eaten the leaves of colchicum.
_Symptoms._--Colchicum, in medicinal doses, increases the activity of
the liver, and bile is freely secreted. The action of the kidneys and
of the skin is also increased. The heart is more or less affected, and
its frequency diminished. In large doses, all the symptoms of irritant
poisoning are present, and in some cases have been likened to those
observed in Asiatic cholera.
_Post-mortem Appearances._--Death may result from its use without
leaving any morbid appearances. In other cases, however, the usual
signs of inflammation were present. Casper describes the colour
and condition of the blood in those poisoned by colchicum as dark
cherry-red, with the consistency of treacle. A marked congestion of the
vena cava may also be present.
_Chemical Analysis._--Colchicine, obtained by Stas process, added to
concentrated nitric acid, becomes of a violet colour, changing to
blue and brown. The violet solution changes to yellow on dilution
with water, then to red on adding caustic soda. Tincture of iodine
precipitates colchicine of a kermes brown colour, platinum bichloride
yellow, and tannic acid white, the precipitate being soluble in
alcohol, acetic acid, and alkaline carbonates. Strong sulphuric acid
gives a yellow colour with colchicine, which changes to green, violet,
and reddish-brown on the addition of nitric acid.
_Fatal Dose._--One ounce of the tincture.
_Treatment._--Stimulants and opium should be given to counteract its
depressing effects. Tannin is said to be an antidote.
ERGOT
Like savin, ergot is more frequently used to procure abortion than as a
poison. When taken in a large dose it causes vomiting, purging, intense
thirst, hurried breathing, and irregularity of the heart‘s action.
Ergot appears to act powerfully on non-striated muscular fibre wherever
it exists in the body; hence the vessels contract powerfully, and the
peristaltic action of the intestinal canal is greatly increased. On the
pregnant uterus its action is uncertain, as it does not appear to have
any marked power in inducing labour, but on the parturient uterus its
effects are most marked. A case is recorded in the _Lancet_ (vol. ii.
1882) in which ergot had been taken for some time to procure abortion,
but this end not being accomplished, the patient took “two hands full”
of the powdered ergot to expedite matters, which caused the following
fatal symptoms: There was some amount of jaundice, and the expression
of the face was anxious. Occasionally fits of stupor occurred, and the
general condition of the patient was maudlin, but there was no smell
of alcohol in the breath; but during the course of the case, which
ended fatally, a distinct etherish smell could be perceived. The pulse
was so quick that it could not be counted, and it had also a peculiar
jerky feeling under the finger. Attempts were made to induce labour
by passing a _bougie-a-boule_, but the patient died collapsed before
delivery could be effected.
Where the drug has been taken for some time in the form of rye-bread
made from the diseased grain, the symptoms in some cases are referable
to the nervous system; in others, the blood appears to undergo
certain changes; and hæmorrhages into the internal organs, as in the
case just mentioned, have been frequently noticed. Gangrene of one
or more of the extremities has also been known to occur. To chronic
poisoning by this drug the term _Ergotism_ has been applied, and may
occur under two forms--the spasmodic and the gangrenous; the former
marked by convulsions, giddiness, delirium, dimness of vision, and
tetanic spasms; the latter, as a rule, by dry gangrene of the nose or
extremities.
_Chemical Analysis._--Ergot has a peculiar, slightly fishy odour, which
is increased by rubbing up the powder with liquor potassæ and heating
the mixture. At the same time it turns a reddish colour. The production
of this odour, and the appearance under the microscope, are the only
tests yet known for this substance in powder. From organic mixture it
may be extracted with hot alcohol acidulated with sulphuric acid. The
solution is red in colour, and shows two bands in the spectrum, one in
the green, and a second, broader and more marked, in the blue.
_Treatment._--Wash out the stomach, and give inhalations of amyl
nitrite.
BLACK HELLEBORE
This plant, _Helleborus niger_--Black Hellebore--(_N.O. Ranunculaceæ_),
known as the Christmas rose, is the melampodium of the old
pharmacopœias. All parts of the plant are poisonous.
_Symptoms._--Purging, vomiting, pain in the bowels, and cold sweats.
Death is generally preceded by convulsions and insensibility.
_Post-mortem Appearances._--Those common to the action of other
irritants.
WHITE HELLEBORE
White Hellebore, _Veratrum album_ (_N.O. Melanthaceæ_), acts very much
in the same manner as the black hellebore, but is more powerful. The
powder causes violent sneezing. The alkaloid _Veratria_ appears to be
the active principle. The symptoms and _post-mortem_ appearances are
analogous to those produced by black hellebore.
GAMBOGE
Gamboge is the gum resin of _Garcinia Morella_. It is an active
ingredient in certain quack “vegetable pills.” One drachm has caused
death by its irritant action. Owing to the imperfect pulverisation of
gamboge in quack pills, they have caused violent irritation of the
bowels, straining at stool, and prolapsus uteri, due to the irritating
action of small pieces of this substance.
JALAP
Jalap, the powder obtained from the tubers of _Exogonium Purga_. The
active properties of the drug reside in a resin. It is a drastic
purgative; twelve grains have killed a dog.
SCAMMONY
Scammony is obtained from the dry root of _Convolvulus Scammonia_. Like
the last mentioned, it is a powerful purgative, and may cause death if
given in large doses to debilitated individuals.
CASTOR-OIL
The oil expressed, with or without the aid of heat, from the seeds of
_Ricinus communis_. A girl, eighteen years of age, died in Liverpool in
1837 from eating a few of the castor-oil seeds.
ARUM MACULATUM
Cuckoo-pint, Wake-robin, or Lords and Ladies, is one of the most acrid
of indigenous vegetables. The active property of the plant appears to
be lost by drying, and by distillation in water. Children have been
poisoned by its leaves.
YEW
The twigs and fruit of _Taxus baccata_ act as irritant poisons,
producing also symptoms which point to cerebro-spinal mischief. A case
is recorded of poisoning by yew leaves, in which only five grains of
the leaves were found in the stomach; yet death took place within an
hour from the time the symptoms commenced (_British Medical Journal_,
1876, vol. ii. p. 392). In the above-mentioned case, vomiting and other
signs of gastric irritation were absent. The chief symptoms present
were--pallor of the face, faintness, an almost imperceptible pulse,
facial convulsions, foaming at the mouth, stertorous breathing, loss
of consciousness, ending in death. The symptoms are due to an alkaloid
toxin. Several children have died after eating the fruit. _Post-mortem_
signs of irritation of the alimentary canal.
LABURNUM
_Cytisus Laburnum_, or common Laburnum, the seeds, bark, and wood of
which are poisonous. They contain a narcotico-acrid, crystallisable
alkaloid--_Cytisine_--producing vomiting, foaming at the mouth,
convulsions, and insensibility. Recovery took place in two cases
mentioned by Trail, from the use of emetics and ammonia.
FOOL‘S PARSLEY
_Æthusa Cynapium_ has been mistaken for parsley. Nausea, vomiting,
giddiness, and severe abdominal pains are among the most common
symptoms of poisoning by this plant.
BRYONY
Two plants are included under this name, _Bryonia dioica_, white
bryony (_N.O. Cucurbitaceæ_), the only indigenous cucurbitaceous
plant, and the _Tamus communis_, black bryony _(N.O. Dioscoreaceæ_).
Both the bryonia dioica and the tamus communis possess active irritant
properties. They are of importance from the fact of their growing wild,
and the possibility of the fruit being eaten by children.
ELATERIUM
Elaterium, the inspissated juice of _Ecballium officinarum_, or
Squirting Cucumber. It is a powerful drastic purgative, one grain
having given rise to alarming symptoms in man.
ANIMAL IRRITANTS
CANTHARIDES
Cantharides--_Cantharis vesicatoria_ (_N.O. Coleoptera_)--is seldom
given as a poison, but is most frequently employed to procure abortion,
or for its supposed aphrodisiac properties.
Cantharides is a pure irritant. Applied externally, it produces
vesication; and if absorbed, strangury.
Cantharidine--the active principle of Cantharides--is insoluble in
water and bisulphide of carbon. It is but slightly soluble in alcohol,
but it is dissolved by chloroform, ether, and some oils. Four parts of
cantharidine have been procured from a thousand parts of the flies.
_Symptoms_.--An acrid taste is first experienced in the mouth,
followed by a burning heat in the throat, stomach, and abdomen. There
is constant vomiting of bloody mucus, and the stools also contain
blood. The patient complains of intense thirst, pains in the loins,
and an incessant desire to void urine, which is frequently mixed with
blood. Salivation in some cases is a prominent symptom. Strangury may
result from the external application of cantharides as a blister, &c.
Priapism is often obstinate and painful, and the fatal termination is
generally ushered in by violent convulsions and delirium. In pregnant
women, abortion may take place as a result of the general irritation
and disturbance of the system, there being no proof that the uterus
is particularly affected by the drug. The vomited matters may contain
shining green particles, the presence of which indicates the nature of
the poison taken. The invasion of the symptoms may in some cases be
retarded.
_Post-mortem Appearances_.--Those of powerful irritation. The mucous
membrane of the whole alimentary canal, from the mouth to the rectum,
has been found in a state of acute inflammation. The uterus, kidneys,
and internal organs of generation share also in the general irritation,
ulceration of the bladder having been met with in some cases. Portions
of the wings and elytra are sometimes found adhering to the coats of
the stomach.
_Fatal Dose_.--One ounce of the tincture has caused death in fourteen
days. This is perhaps the smallest fatal dose on record. Six ounces
have been stated to have produced no dangerous symptoms. The
worthlessness of the preparation may account for this result.
_Treatment_.--Vomiting should be promoted and warm mucilaginous drinks
given. If vomiting be absent, emetics should be administered. Oil
should not be given, as it dissolves out the active principle. Opium
may be given with advantage.
_Chemical Analysis_.--The contents of the stomach should be
concentrated and then treated with chloroform, filtered, and the
filtrate allowed to spontaneously evaporate. A portion of the residue
should then be placed on the skin, and the presence or absence of
vesication noticed. Examined under the microscope, portions of
the wing-cases may be detected. No change of colour is produced
in cantharidine by the action of sulphuric or nitric acid, thus
distinguishing this substance from any of the vegetable alkaloids.
PUTREFACTIVE OR BACTERIAL ALKALOIDS
The processes by which complex and highly organised substances are
broken up into their primary elements are largely synthetical. The
putrefactive processes brought about by the action of bacteria result
in the formation of special products, some of which combine with
certain mineral and vegetable acids to form definite chemical salts;
in this respect they correspond with inorganic and organic bases.
These products are called ptomaines, a name suggested by an Italian
toxicologist, Selmi, and it is derived from the Greek word πτῶμα, a
cadaver or corpse.
On account of their basic properties, resembling the vegetable
alkaloids, they are called putrefactive or bacterial alkaloids. They
have been called animal alkaloids, but some ptomaines may be produced
by the action of bacteria upon vegetable proteids; so this term is not
strictly applicable, and should be restricted to those basic bodies
or “_leucomaines_” that result from metabolism of the tissues in the
animal body.
The essential element of their basic nature is nitrogen, and in this
they resemble the vegetable alkaloids. Some contain oxygen, like the
fixed alkaloids, while others do not, like the volatile alkaloids
nicotine and conine. The kind of ptomaine formed depends upon the
nature of the bacterium, the material upon which, and the conditions
under which, it grows; the amount of oxygen present; the temperature
and the period of growth. All ptomaines are not necessarily poisonous.
Albumin is the origin from which all alkaloids, vegetable or animal,
are derived. The following is a list of the principal ptomaines:
_Methylamine_, CH₃NH₂.--Found in herring brine
and decomposing fish--non-poisonous.
_Dimethylamine_, (CH₃)₂NH₂.--From putrefying
gelatine, yeast, fish, and sausage--non-poisonous.
_Trimethylamine_, (CH₃)₃N.--Various decomposing animal
and vegetable tissues, ergot--poisonous in large
quantities.
_Ethylamine_, C₂H₅NH₂.--Beet-sugar,
wheat-flour--non-poisonous.
_Diethylamine_, (C₂H₅)₂NH₂.--Putrid fish and
sausage--non-poisonous.
_Triethylamine_, (C₂H₅)₃N.--Putrid fish and
sausage--non-poisonous.
_Propylamine_, C₃H₇NH₂.--From cultures of bacteria of
fæces--non-poisonous.
_Butylamine_, C₄H₁₁N.--From cod-liver oil. Diaphoretic
and diuretic--in large doses causes vomiting and stupor.
_Iso-amylamine_, (CH₃)₂·CH·CH₂CH₂NH₂.--Decomposing
yeast and cod-liver oil--active poison, causes
convulsions and death.
_Caproylamine_, C₆H₁₅N.--Called septicin by Hager.
_Collodine_, C₈H₁₁N.--The first ptomaine obtained in
a chemically pure condition--from putrid horse flesh,
pancreas, gelatine, and mackerel.
_Hydrocollodine_, C₈H₁₃N.--Putrefying horse flesh and
mackerel--highly poisonous.
_Parvoline_, C₉H₁₃N.--Putrid horse flesh and mackerel.
_Unnamed base_, C₁₀H₁₅N.--From decomposing fibrin and
jelly-fish. Like curare in its action.
_Putrescine_, C₄H₁₂N₁₂.--From human corpses--feebly poisonous.
_Cadaverine_, C₅H₁₆N₂.--From human corpses--causes suppuration.
_Neuridine_, C₅H₁₄N₂.--Common product of putrefaction--quite inert.
_Neurine_, C₅H₁₃NO.--From human corpses, intensely
poisonous--resembles muscarin in its action.
_Choline_, C₅H₁₅NO₂.--From putrefying animal and
vegetable substances--feebly poisonous; by giving up one
molecule of water it changes to neurine--this may be
brought about by bacteria or chemical agencies.
_Muscarine_, C₅H₁₃NO₂.--From putrid fish and horse
flesh. The active principle of poisonous mushroom.
_Gadinine_, C₇H₁₆NO₂.--From putrefying codfish,
haddock, and gelatine, in pure cultures of proteus
vulgaris--poisonous in large quantities.
_A Base_ (_?_), C₇H₁₇NO₂.--From decomposing
horse flesh--its action is like curare: causes loss of
temperature, rigors, convulsions, and general paralysis:
the heart stops in diastole.
_Mydaleine._--Composition not determined--from human
corpses--actively poisonous.
Even after prolonged periods and with access of air, any putrefactive
alkaloids which may form do so in very small quantities, and they are
very unstable. In their chemical reactions they respond to many of the
group-tests used for alkaloids, but they differ in their reaction to
the special tests used for vegetable alkaloids. There is no test that
will differentiate between putrefactive and vegetable alkaloids, as a
class; at the same time no putrefactive alkaloid will give the same
chemical reactions, and have the same physiological properties, as any
one of the vegetable alkaloids.
_Neurine_ was first obtained by Liebreich by boiling protagon with
concentrated baryta. Since then it has been extracted from putrefying
animal tissues. The free base is strongly alkaline, and gives a white
cloud with the vapour of hydrochloric acid. It is intensely poisonous,
resembling muscarine in its action. Very small quantities cause
complete paralysis in frogs. Respiration ceases first, and the heart
beats become more and more feeble, until it stops in diastole. If
atropine be now injected the heart begins to beat again.
As a defence set up in cases of poisoning, when one or other of the
rarer alkaloids has been used, it has been suggested that the poison
discovered in the body of the deceased was due to the processes of
putrefaction of the tissues themselves. In view of this it is important
to know the toxic power of such putrefactive alkaloids as may be found
in the human cadaver.
Two only of these are actively poisonous--_neurine_ and _mydaleine_;
others are toxic in so small a degree that large amounts would be
required to produce lethal effects, far more in proportion to the body
weight than any vegetable alkaloid for which it may be alleged they
have been mistaken.
_Neurine_ does not appear before the fifth or sixth day after death,
_mydaleine_ not until the seventh day, and only in traces; it does not
appear in amount sufficient for quantitative analysis until the end of
the second or third week.
At the period after death when a medico-legal analysis has generally to
be made, _choline_ is the only alkaloid present, and it is but feebly
poisonous.
In rabbits _neurine_ causes marked salivation and increased flow
of secretion from the eyes and nose. The heart beats more quickly
at first, but gradually slows down and stops in diastole. There is
increased peristalsis of the intestines with profuse diarrhœa. There
is narrowing of the pupil both after injection or local installation.
Clonic spasms and violent convulsions occur, and are followed by
paralysis first of the hind then of the fore legs, ending in death. The
symptoms are prevented or relieved by atropine.
If atropine be injected first the poisonous effects of the _neurine_ do
not show themselves.
_Mydaleine_ was discovered by Brieger in putrefying cadaveric organs.
Small doses injected into guinea-pigs cause profuse lachrymation and
coryza.
The pupils dilate and then become motionless. The temperature rises
from 1° to 2° Centigrade. There is somnolence at this stage, with
increased intestinal peristalsis. The pulse and respirations are
quickened; later these with the temperature return to the normal, and
the animal recovers. Large doses cause death with the heart in diastole
and the intestines contracted.
Clonic spasms and stupor precede death.
_The Extraction of putrefactive alkaloids_ from organic matters may be
carried out by the process for alkaloid extraction (_vide_ p. 335 _et
seq._).
Amongst the attempts made to distinguish the putrefactive from
vegetable alkaloids by chemical reactions one method was based on the
rapid reduction of potassium ferricyanide to the ferrocyanide. After
converting the alkaloid to a sulphate, a solution of it is mixed with
a drop of potassium ferricyanide and a drop of ferric chloride added:
the deep blue colour of Prussian blue is produced if reduction to the
ferrocyanide has taken place. However, certain vegetable alkaloids,
viz. morphine, aconitine, eserine, and hyoscyamine act rapidly as
reducing agents upon the ferricyanide. Emetine, igasurine, nicotine,
colchicine act less rapidly. Brieger considers that when the reaction
occurs with putrefactive alkaloids it is due to impurities present in
them. Brouardel and Boutmy have suggested making use of the action
of alkaloids upon photographic silver bromide paper as a means of
distinction. The paper is written upon with a solution of the alkaloid
and kept light free for half an hour; it is then fixed in a solution
of sodium hyposulphite and washed in water. The putrefactive alkaloids
are said to reduce and blacken the silver compound, while the vegetable
alkaloids do not. Neither of these processes is to be relied upon for
medico-legal purposes.
LEUCOMAINES OR ANIMAL ALKALOIDS
_Leucomaines_ or _animal alkaloids_ are basic substances which
originate from the metabolic processes taking place in the animal body.
They closely resemble the vegetable alkaloids, and some are found in
plants as well as animals. It is probable that some of them may have
originated primarily from the putrefactive processes in the intestines
and been absorbed into the system. The following is a list of the
principal leucomaines resulting from the metabolism of the tissues of
the animal body:
_Adenin_, C₅H₅N₅.--From thymus gland, from all tissues
animal or vegetable which are rich in nucleinic
acid--poisonous in large doses.
_Sarkine_ or _hypoxanthine_, C₅H₄N₄O.--From urine and
flesh--causes increased reflex excitability and
convulsive seizures.
_Guanine_, C₅H₅N₅O.--From flesh and guano--it is inert.
_Xanthine_, C₅H₅N₄O₂.--From flesh and urine--acts as a
muscle stimulant.
_Heteroxanthine_, C₆H₆N₄O₃.--From urine.
_Methylxanthine_, C₆H₆N₄O₂.--From urine.
_Paraxanthine_, C₇H₈N₄O₂.--From urine--destroys
spontaneous muscular action, lessens reflex excitability.
_Carnine_, C₇H₈N₄O₃.--From fresh meat.
_Gerotine_, C₅H₁₄N₂.--From liver and kidneys, an isomer
of cadaverine--exerts a paralysing action upon the nerve
centres and cardiac ganglia.
_Spermin_, C₂H₅N.--From semen, testicles, ovaries,
breast, thyroid, pancreas, and spleen, normal bone
marrow. Poehl states that it has a tonic effect on the
nervous system.
_Creatinine_, C₄H₇N₃O.--From urine.
_Crusocreatinine_, C₅H₈N₄O.--From fresh meat.
_Xanthocreatinine_, C₅H₁₀N₄O.--From fresh meat--causes
depression, fatigue, somnolence, defæcation, and
vomiting.
_Betaine_, C₅H₁₁NO₂.--From urine.
_Mytilotoxine_, C₆H₁₅NO₂.--From poisonous mussels.
=The Relation of Leucomaines to Disease=
It will be necessary in considering the relation of leucomaines to
disease to give the term a wider significance than that relative to
the chemistry of these bodies. Autogenous diseases may be looked upon
as having their origin in altered metabolism of the tissue cells,
apart from the introduction of foreign cells or poisons. “It is
certainly true that if we should drink only chemically pure water, take
only that food which is free from all adulteration and infection,
and breathe the purest air free from all organic matter living and
dead, yet our excretions would contain poisons. It is true that the
excretions of all living things, plants, and animals contain substances
which are poisonous to the organisms excreting them” (Vaughan).
Bouchard estimates that the amount of a certain poison formed in
the intestines of a healthy man in twenty-four hours, if absorbed,
would prove fatal. Unless free elimination takes place, elevation of
temperature may follow.
The products of imperfect digestion, if absorbed, may give rise to
serious disturbances. Hildebrandt has shown by his experiments that
subcutaneous injection of pepsin into dogs is followed by elevation
of body temperature, which he calls “ferment fever.” The fever
reaches a maximum within a few hours and may last several days.
Rigors are frequent. The animals suffer from trembling in the limbs,
uncertainty of gait, vomiting, dyspnœa, and coma followed by death. On
_post-mortem_ examination there are found degeneration of the heart,
muscles, liver, and kidneys, abundant hæmorrhages into the intestine,
Peyer‘s patches, the mesenteric glands, and occasionally into the
lungs. The blood is at first lessened in coagulability, afterwards
increased, and thrombi formed which have been found in the lungs and
kidneys.
Excessive formation of these poisonous substances within the body
or insufficient elimination of them produces serious disturbances.
Fatigue fever is an example. A considerable rise of temperature may
follow excessive and prolonged exercise, the appetite is impaired,
and insomnia is present from excitation of the brain and the senses
being rendered more acute. There may be rigors simulating malaria.
This fatigue fever occurs particularly amongst recruits in armies
subjected to prolonged marching. From his observations of this disease
in the Italian army, Mosso states that it is due to the absorption
of poisonous substances into the blood from the tissues, which, if
injected into the circulation of healthy animals, produces symptoms
of exhaustion. The fever of prostration or exhaustion is similar but
less in degree, it is more likely to be produced by prolonged exertion
with insufficient food, it may resemble typhus fever, delirium may
be present, and loss of muscular control over the bowels; death may
result. In non-fatal cases weeks may elapse before recovery takes place.
Rachford has pointed out that an excess of paraxanthine in the blood
is followed by migraine, and it may give rise to epileptic seizures,
gastric neurosis, and asthma; and by injecting paraxanthine into the
blood of mice and rats he has produced symptoms of certain forms of
epilepsy, and others similar to the nervous symptoms of chronic lead
poisoning.
CHAPTER VI
FOOD POISONING (BROMATOTOXISMUS)
Instances have occurred from time to time of serious illness attacking
individuals either separately or collectively shortly after the
ingestion of food. The food may be rendered poisonous in the following
ways:
1. A poisonous substance may have been added to it, intentionally or
accidentally.
2. Grain may become infected with poisonous fungi, _e.g._ ergot.
3. Plants or animals may feed upon materials harmless to them, but
which render them poisonous to man--birds that have fed on mountain
laurel are said to have proved poisonous to man.
4. During periods of physiological activity of certain of their glands,
the flesh of some animals becomes poisonous to man; some fish, for
example, are poisonous during the spawning season.
5. Food may carry infection by contamination with germs, _e.g._ typhoid
bacilli in milk.
6. The animal may suffer from a specific disease, and it may be
transmitted to man, _e.g._ tuberculosis.
7. Foods may be contaminated with bacteria which produce poisons either
before or after the food has been eaten.
8. The food may be infected with parasites or their ova, and which
develop in the individual who partakes of it, _e.g._ trichiniasis.
In cases in which the poison has been added or preformed, the symptoms
of poisoning come on almost immediately or within a short space of
time; there may, however, in the latter, be a delay in the appearance
of the symptoms in instances where the bacterial poison is formed
subsequent to the ingestion of the food. This delay is bordering on the
nature of a true infection. In those cases when the bacteria have been
present in the animal before, or develop in it subsequent to its death,
and which develop in the person who eats it as food, symptoms may not
come on for some time; the condition is a true infection, and there may
be an incubation period over six or seven days.
Meat Poisoning (Kreotoxismus)
Apart from those cases of poisoning following the ingestion of food
to which poison has been added, or from meat affected by parasitic
disease, there have occurred outbreaks of serious illness following
the partaking of meat. Vaughan, in the _Twentieth Century Practice of
Medicine_, vol. xiii. p. 20, holds that “there can scarcely be any
difference of opinion on the following points: (1) With fresh food to
act upon and with normal gastric juice to act, the process of peptic
digestion proceeds without the formation of any harmful substance. (2)
With putrid food, containing poisons to start with, the most active
digestion does not guarantee the destruction of those poisons. (3)
With even the best of food, peptic digestion may proceed so slowly and
imperfectly that during the process poisons may be formed by bacterial
agencies.” During the process of decomposition of meat and other
albuminous foods by bacterial agency, certain poisonous substances are
formed prior to the production of the ptomaines or bacterial alkaloids.
These are known as toxalbumoses and enzymes; they are unstable bodies,
they cannot be obtained in a crystalline form, and their composition
is not fully understood. They give certain reactions with a few group
reagents, but they are recognised only by their effects upon living
animals. As decomposition advances the more stable alkaloids are
formed, but those which are poisonous, like the toxalbumoses, are
readily converted by further processes of putrefaction or by chemical
means into innocuous bodies. Toxins is the general term used in
toxicology for these poisonous substances formed from animal tissues.
It is not necessary that complete putrefaction should have taken place
for meat to prove poisonous. In fact many of the severest cases are
those in which it has not fully putrefied. The most poisonous toxins
are present during the early stages of decomposition, and the changes
are not recognisable by the senses--smell or taste--which would ensure
the rejection of the meat as food.
The poisonous effects are rarely due to the ingestion of bacterial
products alone; those cases in which no bacteriological investigation
of the food has been made cannot be taken into consideration. The
toxalbumoses are destroyed by a few minutes‘ exposure to a temperature
at boiling-point, 212° F. (Durham, _B. M. J._, 1898, vol. ii. p. 797).
In reference to the toxic action of the alkaloids, these have been
noted only from the results following subcutaneous injection; their
effects when taken per orem have not been established by experiment.
In all instances where the necessary bacteriological investigation has
been properly carried out a true infection has been proved to have
taken place.
In cases of meat poisoning the principal bacteria concerned are not the
ordinary putrefactive organisms. The Bacillus enteritidis of Gärtner,
which has been found associated with twelve epidemics, and the Bacillus
botulinus of Ermengem are the most important causative agents.
The Bacillus enteritidis is killed by proper cooking. It is destroyed
in one minute at a temperature of 180° F. At 41° F. it will not grow,
but, in meat kept at 68° F. for seventy-two hours, it flourishes
abundantly. Freezing will not kill it. In meat which has been infected
with the bacilli _post-mortem_ they do not penetrate the meat more
than 1 cm. in ten days. Roasting or boiling will sterilise it. In those
instances in which poisoning has taken place after cooking, the bacilli
have either been present in the meat beforehand, and the temperature
has not been sufficiently high or the cooking sufficiently prolonged,
to ensure their destruction in the deepest portions; or the meat after
cooking has become contaminated, and been insufficiently warmed up
again after keeping it for a day or so. Exposure to sewer gas will not
affect meat and contaminate it with the Bacillus enteritidis. The chief
symptoms due to the Bacillus enteritidis are vomiting and diarrhœa,
herpes labialis, rashes on the skin followed by desquamation in about
fourteen days, jaundice, and great thirst. The onset is sudden, with
nausea, headache, pains in the back and limbs, rigors, fever lasting a
few days, general weakness, and, in cases which recover, convalescence
extending over a period of from three to six weeks.
The symptoms of botulismus, due to the Bacillus botulinus of Ermengem,
and associated with sausage poisoning, are, as a rule, dryness of
the mouth, constriction of the fauces, nausea, vomiting, purgation,
vertigo, dilatation of the pupils, with dimness of vision and diplopia,
and a sense of suffocation. Marked muscular weakness and nervous
prostration are prominent symptoms. In fatal cases there is weakness of
the pulse and cyanosis, with coldness of the surface and perspiration.
The temperature is raised at first and may reach 103° F., but
ultimately falls below normal. Delirium comes on late, followed by coma
and death.
In dangerous cases obstinate constipation may follow after a few hours
of watery stools.
On _post-mortem_ examination of the bodies in fatal cases the following
appearances have been noted: a white, dried, parchment condition of the
mouth, fauces, throat, and gullet; hyperæmia of the mucous membrane of
the stomach and intestines with submucous extravasations of blood. The
abdominal and thoracic viscera have been found engorged with blood,
with enlargement of the spleen; the former are due to failure of the
heart, and cannot be regarded as characteristic of sausage poisoning.
Some stress has been laid on the observation that putrefaction is
unusually delayed, but Müller has shown that no reliance can be placed
upon it; he says that in forty-eight autopsies it has been noted that
in eleven of them putrefaction had developed rapidly.
The symptoms of meat poisoning are grouped by Dixon Mann into two
divisions: (1) those due to a true infection, (2) those due to simple
poisoning.
In (1) the symptoms are those of an infectious disease--they include
headache, anorexia, rigors, constipation followed by diarrhœa, pains in
the back and limbs, photophobia, delirium, skin eruptions, meteorism,
and enlargement of the spleen. The _post-mortem appearances_ greatly
resemble those of enterica--infiltration, ulceration, and sloughing of
Peyer‘s patches; hæmorrhage into the bowels, enlargement of the spleen,
with possibly some pus depots.
In (2) the symptoms are those of acute gastro-enteritis--violent
vomiting, purging, prostration, cramps in the legs, and collapse;
the temperature is generally subnormal, but may be elevated. The
_post-mortem appearances_ are those produced by gastro-enteritis,
with hæmorrhages into the intestinal mucous membrane; the spleen is
frequently enlarged, and Peyer‘s patches may be infiltrated.
Meat poisoning has usually been most frequently associated with the
ingestion of pork, veal, beef, meat pies, potted meat, tinned meat,
sausages, and brawn. The more finely divided the meat, the more
easily and completely it may become infected and poisonous. Cases of
poisoning from the ingestion of canned meats are not uncommon. In some
instances they may be due to metallic poisoning, in the great majority
they are due to putrefactive changes having taken place in the meat.
Ungefug reports a case confirmed by the celebrated chemist Heinrich
Rose, in which sulphate of zinc had been used as a preservative
instead of saltpetre. In some the canning may have been imperfect,
and putrefaction taken place before reaching the consumer; in others
decomposition may have begun after opening the can. The meat may have
been taken from diseased animals, or decomposed prior to canning.
Poisoning by tinned provisions with the metal used for tinning is more
likely to occur with fruits than meat. The malic acid of the juice
probably dissolves the solder and forms a malate of tin. Cherries,
apples, pineapples, and tomatoes are the most likely to do this.
In 1890 Luff investigated four cases of tin poisoning due to the
consumption of tinned cherries. Some of the material left was analysed,
and the juice contained malate of tin in solution equivalent to two
grains of the higher oxide of tin per fluid ounce. It was estimated
that the symptoms were produced by doses of two to four grains of
malate of tin. Two of the patients nearly died from the diarrhœa and
collapse.
Sulphate of copper is used to give a full green colour to peas, olives,
and pickles, or it may contaminate preserved fruits if they be left in
copper vessels. The copper combines with the phyllocyanic acid of the
chlorophyll, and although insoluble in the surrounding liquor, is set
free and absorbed by the process of digestion.
Fish Poisoning (Ichthyotoxismus)
Fish may cause poisoning in two ways: in one the poison is a
physiological product of certain glands of the animal, and is quite
independent of bacteria; the other is due to the poisonous products
of bacterial growth. The fish that are inherently poisonous as a rule
occupy tropical waters: several of them exist in Japanese waters.
Mackerel, carp, barbel, and herrings may become poisonous at times;
some of these, especially mackerel, may rapidly become unfit for food
after they are dead. Caviare and the roe of herrings have caused
poisoning. Shell-fish, especially mussels, also may prove poisonous.
The symptoms of fish and shell-fish poisoning are variable. In some
cases disturbance of the nervous system predominates, with delirium,
convulsions, and paralysis. There may be dryness and constriction
of the throat, dyspnœa, disturbed vision, vertigo, jerky speech or
aphonia, rapid pulse, loss of co-ordination, numbness, formication,
coldness of the limbs, dilated pupils, paralysis, and collapse,
followed by death in a few hours. Other cases exhibit symptoms of
severe gastro-intestinal irritation, with nausea, vomiting, pain,
tenesmus, mucous and bloody stools; in the most dangerous cases the
bowels are constipated. Cases exhibiting the nervous type of symptoms
resemble poisoning by atropine, and an alkaloid--ptomatropine--is
regarded as the cause. It has never been obtained in the pure state,
and nothing is known of its composition. It must not be mistaken, in
toxicological examination, for atropine; its presence can only be
recognised by its action on the pupil.
Many cases of fish poisoning are accompanied by erythema, urticaria,
and severe itching of the skin. In probably all cases there is an
elevation of the body temperature.
Tinned fish has caused poisoning on many occasions. In one case of
tinned salmon poisoning, which proved fatal, parts of the stomach
and intestines were almost gangrenous from the intensity of the
inflammation.
Stevenson (_Brit. Med. Journ._, 1892) records a case of sardine
poisoning which proved fatal, and in which the tissues _post-mortem_
were found to be emphysematous. He extracted an alkaloid from some of
the sardines, and the stomach contents; it was highly toxic and proved
fatal to rats.
It is most probable in poisoning by tinned fish that the contents of
the tins have become contaminated with bacteria before being sealed up.
_Shell-fish_ may become contaminated with bacteria and cause true
infections in people who eat them. Typhoid fever has been carried
in this way by oysters, and probably cockles. The fish may develop
toxins and prove poisonous, and as an example of this mussels produce
a powerful toxin--_mytilotoxine_--while they are alive, which gives
rise to a serious illness termed mytilotoxismus. There are three quite
different classes of symptoms induced by poisonous mussels. In one the
symptoms are principally those of acute gastro-enteritis; in another
skin eruptions are the principal feature; and the third is known as
mytilotoxismus paralyticus, in which there is great disturbance of the
cerebro-spinal nervous system, with paralysis. The two former groups
of symptoms are due to putrefactive processes in the mussels, but the
third or paralytic group is due to the alkaloid _mytilotoxine_, which
is not a product of putrefaction, as it is not found in mussels that
have been allowed to decay.
There is nothing to evidence the idea that mussels absorb metallic
poisons--_e.g._ copper--from the bottoms of vessels.
Poisoning by Milk and Milk Products
The term milk poisoning or galactotoxismus is used here to indicate
the results following the drinking of milk infected with saprophytic
toxicogenic bacteria, and which are mainly responsible for the high
mortality from “summer diarrhœas” of artificially-fed infants. One of
the products of these bacterial infections of milk is the alkaloid
_tyrotoxicon_. It has been isolated by Vaughan from cheese, and has
also been found in ice-cream, frozen custards, and cream puffs.
Vaughan, however, asserts that it is not the one most frequently
present, nor is it the most actively poisonous. There are others which
he considers are poisonous albumins (Vaughan, _Twentieth Cent. Pract.
Med._, vol. xiii.).
The symptoms of poisoning by tyrotoxicon are mainly those of acute
gastro-enteritis, and comprise constriction of the fauces, nausea
and vomiting, sharp griping intestinal pains, headache, thoracic
oppression, chilliness, dizziness, and purging. In severe forms
exhaustion, subnormal temperature, coma, collapse, and death may follow.
TRICHINIASIS
This disease is due to the introduction of the _Trichina spiralis_
into the human body. The encysted worm is found embedded in the
fibres of all the striped muscles of the trunk and limbs, and even
in the heart, where it appears in the form of white ovoid bodies or
capsules, the capsules being sometimes calcareous. The worm passes the
greater part of its existence in the chrysalis state in the muscular
system of one animal, and only reaches its mature condition in the
stomach of another. Virchow and Zenker assert that the trichina not
only frequently presents itself in the human organism, but that this
organism is most favourable for its full development. Once in the
stomach, the period of incubation is about three to eight days, and
then propagation rapidly begins and continues, so that Dr. Kellen
estimates that in about seven days after the ingestion of half a pound
of meat the stomach and intestines may contain thirty millions of the
worms. The worms when introduced into the stomach leave their capsules,
become free, produce young, and these leave the stomach through its
coats for the muscles, where they become encysted. The trichina is most
frequently found in pork, seldom in sheep, horses, or oxen--the last
being the most free.
_Symptoms._--Intestinal irritation, loss of appetite, sickness,
malaise, general weakness of the limbs, and diarrhœa. The eyelids swell
as well as the joints, the skin is bathed in cold, clammy sweat, and a
low form of fever sets in. Death may be due to peritonitis, paralysis
of the muscles--the result of their destruction--or to irritative
fever. During the perforation of the coats of the stomach and bowels by
the worms, the mucous membrane becomes inflamed, pus is formed on the
surface, and the stools become bloody.
TOXICOHÆMIC, SNAKE POISONS, ETC.
Under this head may be classed all those effects produced by the sting
or bite of various insects and reptiles, and also by the bite of the
mad dog and wolf.
No medico-legal question is likely to be raised on this subject, at
least in this country, where, with the exception of the common viper or
adder, all our reptiles are harmless enough.
CHAPTER VII
THE VEGETABLE ALKALOIDS
Vegetable alkaloids may be classified in three groups: (1) derivatives
of pyridine, _e.g._ atropine, conine; (2) derivatives of quinoline,
_e.g._ cinchonine, narcotine; (3) substituted amines and amides. The
majority of the vegetable alkaloids belong to the first two groups.
They are for the most part solid, crystalline, and colourless; a few,
such as conine, nicotine, and pilocarpin, are liquid. They combine with
acids to form salts, and the salts are more soluble in water than the
free alkaloid. Alkaloids possess certain properties in common, amongst
which is that of being precipitated from their solutions by certain
reagents, which are called alkaloidal grouping reagents. Some are
precipitated by all the group reagents, others only by a few.
Alkaloidal Group Reagents
1. _Iodine dissolved in solution of Potassium Iodide_--_Wagner‘s
reagent_.--Gives a reddish-brown precipitate with most alkaloids.
2. _Phosphomolybdic Acid_--_Sonnenschein‘s reagent_.--Made by
dissolving phosphomolybdate of soda in water containing one-tenth its
volume of strong nitric acid. It gives a yellow precipitate with most
of the alkaloids; it also precipitates ammonium salts and ammonia
derivatives, also salts of lead, silver, and mercury unless there be
sufficient acid to keep them in solution.
3. _Potassio-mercuric Iodide_--_Mayer‘s reagent_.--Made by adding a
solution of potassium iodide to one of mercuric chloride until the red
precipitate first formed be just dissolved. This solution precipitates
most of the alkaloids. The solution to be tested must contain acetic
acid.
4. _Phosphotungstic Acid_--_Scheibler‘s reagent_.--This acts in a
manner very similar to phosphomolybdic acid.
Methods for detecting Vegetable Alkaloids
There are several methods recommended for the isolation and detection
of the vegetable alkaloids, and their separation from the contents of
the stomach or from the membranes and tissues of the body. The process,
however, most generally pursued is that of Stas, which may be briefly
described as follows:
(_a_) The substance to be examined is mixed with twice its weight of
absolute alcohol, to which from ten to thirty grains of tartaric or
oxalic acid--preferably the former--have been added, and the mixture
subjected to gentle heat in a flask, 70° to 75° C., or 158° to 167° F.
(_b_) If the membranes or organs have to be examined, they are finely
divided, treated with absolute alcohol, squeezed, and again treated
with fresh alcohol as in (_a_).
In either case, the mixture, when quite cold, is filtered, and the
alcoholic solution is concentrated by evaporation, either _in vacuo_ or
in a current of air not exceeding 95° F. or 35° C.
The liquid residue is now passed through a moistened filter, which
separates the fat and other insoluble matters. The filtrate is
evaporated to dryness over sulphuric acid or _in vacuo_, and the acid
residue of this evaporation dissolved in the smallest possible quantity
of distilled water. The acid liquid is then _gradually_ neutralised
with the bicarbonate of potash or soda until effervescence ceases, and
afterwards shaken in a flask with four or five times its bulk of pure
ether, and allowed to settle. When the ether has become quite clear, a
small portion of it is decanted into a small glass capsule, and allowed
to spontaneously evaporate in a dry place. If during evaporation
streaks of liquid appear on the side of the capsule, running together
at the bottom, a liquid volatile alkaloid is probably present. If none
of these manifestations occur, the alkaloid is in all probability solid
and non-volatile.
----------------------------------------+-----------------------------------
_The Alkaloid is Volatile_. | _The Alkaloid is Non-Volatile_.
----------------------------------------+-----------------------------------
To the original mixture in a flask | To the original mixture in a
add a moderate quantity of a strong | flask add strong caustic potash or
solution of caustic potash or soda, | soda solution, and agitate with
mixed with ether; agitate, and allow | successive portions of pure ether
the mixture to settle. Pour off | allowing it to completely settle
the ethereal solution, and re-shake | each time. The ethereal solutions,
residue with a fresh quantity of | being mixed, are evaporated, leaving
ether; decant, and mix both solutions. | the alkaloid in an impure state.
The ethereal solution is | To purify it, the solid residue left
now shaken with a mixture of four | on evaporation is treated with a
parts of water and one of sulphuric | small quantity of dilute sulphuric
acid, which withdraws the alkaloid | acid, which dissolves the alkaloid,
from its solution, leaving any fatty | leaving any fatty impurities behind.
matter dissolved in the ether. The | The acid liquid is evaporated
acid solution is now mixed with | to three-quarters of its bulk over
strong potash or soda solution in | strong sulphuric acid, and then a
excess,[20] agitated with ether, the | saturated solution of carbonate of
ether poured off, and then evaporated | potash or soda added. The absolute
at as low a temperature as | alcohol will then dissolve out the
possible,[21] leaving the pure alkaloid| pure alkaloid, giving it, on
with all its characteristic chemical | in the crystalline form, and in
and physical properties. | evaporation, a state to show its
| characteristic reactions.
----------------------------------------+-----------------------------------
[20] The sulphates of alkaloids are insoluble in ether; hence they must
be decomposed by an alkali.
[21] The temperature should be low, or the greater part of the conine
will be evaporated with the ether.
If morphine has to be sought for, the liquid should be shaken with
ether immediately after being neutralised with carbonate of sodium,
and the ether poured off as quickly as possible; for if the alkaloid
have time to separate in the crystalline form, scarcely any of it is
dissolved by the ether (Otto).
The method of Stas is based upon the fact that the salts of the
alkaloids, as a class, are soluble in water and alcohol, but are
insoluble in ether; and that these salts when in solution are readily
decomposed by the mineral alkalies with the elimination of the
alkaloids, which, in their free and uncombined state, are more or less
readily soluble in ether.
Otto‘s Method.--Otto‘s modification of Stas‘s process is simpler, and
at the same time equally accurate. Instead of numerous treatments and
evaporations which have to be gone through in the original process,
Otto converts the alkaloid into a salt, such as the sulphate, by the
addition of acid, and after solution in a small quantity of water,
agitates with successive quantities of ether, which remove all foreign
fatty matters, leaving the solution of the alkaloid comparatively
pure, and from which the alkaloid may be obtained in a state of great
purity, by first rendering the solution alkaline and then using ether
to dissolve the alkaloid.
R. Wagner‘s Method.--The presence of alkaloids in organic
liquids--strychnia in beer, for example--may, according to R. Wagner
(_Zeitschr. Anal. Chem._, vol. iv. p. 387), be detected by mixing the
liquid, diluted with two vols. water (½ to 1 litre), with about 5 c.c.
of a solution of iodine in potassium iodide (12.7 grains iodine to the
litre) and a few drops of sulphuric acid. The precipitate separated
from the supernatant liquid is dissolved in a dilute solution of sodium
hyposulphite, and again precipitated by means of the iodine solution.
If this new precipitate be now dissolved in aqueous sulphurous acid,
the solution will leave, on evaporation, the pure sulphate of the base.
Dragendorff‘s Method.--This is intended for the purpose of separating
alkaloids from each other when more than one are in aqueous solution,
by using different solvents in sequence. Some solvents take up
certain alkaloids to the exclusion of others. The process consists of
extracting the aqueous acid solution of the alkaloids successively
with petroleum spirit, benzene, chloroform, and amyl-alcohol, then
alkalising it and repeating with the same solvents.
1. From the _acid_ solution _benzene_ removes caffeine, colchicine,
santonin, digitalin, cantharidin. _Chloroform_ removes papaverine,
colchicine, narceine, picrotoxin.
2. From the _alkaline_ solution _petroleum ether_ removes strychnine,
brucine, aconitine, veratrine, conine, nicotine, lobeline, emetine,
and aniline. _Benzene_ removes atropine, hyoscyamine, physostigmine,
codeine, narcotine, and further quantities of strychnine, brucine,
aconitine, veratrine, and emetine. _Chloroform_ removes morphine,
narceine, papaverine, strychnine, and brucine. _Amyl-alcohol_ removes
morphine, solanine, and narceine.
The Stas process cannot be recommended for the detection of opium in
organic liquids, for two reasons. Firstly, that it altogether fails
to indicate the presence of meconic acid; and, secondly, because
morphine is almost insoluble in ether. Dragendorff recommends the
use of _benzole_ for separating the alkaloids, but in this substance
morphia is nearly insoluble. It is, however, applicable to strychnine,
aconitine, conine, and atropine; but for the two last, on account of
their volatility, ether is preferable.
Rodger‘s and Girdwood‘s Method.--Extraction with dilute hydrochloric
acid and the use of chloroform instead of ether. Chloroform is a much
better solvent of most alkaloids than ether. Particularly useful for
the isolation of strychnine and for most alkaloids, but there is a
little danger of hydrolysis of the alkaloid in the use of a mineral
acid, _e.g._ hyoscine.
Stevenson‘s Modification of the Otto-Stas Process.--The material to be
examined, if solid, is finely divided, and digested for twenty-four
hours with twice its weight of rectified spirit at 35° C.; if fluid,
with twice its volume. The clear liquid is decanted and the residue
again digested with fresh spirit; this is again decanted, and mixed
with the first alcoholic solution. The residue is now digested with
spirit faintly acidified with acetic acid; this is decanted, and the
residue digested with two or three lots of unacidified alcohol. The
alcoholic extracts obtained before acidification are mixed together and
rapidly raised to 70° C. for a moment or two. They are quickly cooled
and filtered, and the filter washed with spirit. The acidified extract
and those after it are mixed and treated in the same way. The extracts
are then separately evaporated at a temperature not above 35° C. to the
consistency of a syrup, the excess of acid being neutralised with soda;
these are extracted with absolute alcohol, and the extracts evaporated
to a syrup as before. The syrupy extracts are now diluted with a small
quantity of water, filtered, the filters washed with water, and the
filtrates mixed. The liquid will contain the whole of the alkaloids,
and will be free from albuminoids, which have been coagulated while
the extracts were at 70° C. The liquid containing the alkaloids is
extracted several times with washed ether, which removes fatty acids or
oils, but does not remove alkaloidal salts. The ether should be washed
with water to which a few drops of sulphuric acid has been added, and
the water kept: this has to be done because some alkaloidal salts are
slightly soluble in ether. The acid liquid and the acidified aqueous
washings of the ether are mixed together, rendered alkaline with sodium
carbonate, and exhausted firstly with a mixture of one volume of
chloroform to three of ether, and lastly three or four times with ether
alone.
The alkalisation with sodium carbonate liberates the alkaloids from
their salts, and these are soluble in the chloroform-ether and ether.
These ethereal extracts are then washed with water acidified with
sulphuric acid, and water alone, and the washings mixed. The water
acidulated with sulphuric acid converts them into sulphates, which are
insoluble in the ether and chloroform, and are removed by the acidified
water, while impurities are left behind. The mixed aqueous and acid
extracts are again washed with ether, the ether removed, and the
liquid re-alkalised with sodium carbonate and then re-extracted with
chloroform-ether and ether.
The ethereal solutions are removed and are washed with water slightly
alkalised with sodium carbonate. The ethereal solution is filtered
through a dry filter, the filtrate evaporated to dryness first at 35°
C. then at 100° C., and cooled over sulphuric acid. The residue is
weighed and represents the weight of the alkaloids. A test quantity
should be evaporated to see if there be any oily odorous residue,
_i.e._ a volatile alkaloid, nicotine or conine. If so, the chloroform
and ether extracts should be mixed with a little pure ether and strong
hydrochloric acid; the alkaloids are thus changed into non-volatile
hydrochlorides, which are left behind after evaporation of the
chloroform and ether. Any alkaloid found should be converted into the
hydrochloride, dissolved, and tested by special tests. Morphine cannot
be extracted except in very minute amounts by this method. To obtain
it, the first alkaline solution from which the other alkaloids have
been removed should be extracted with acetic ether and ether, in which
morphine is soluble.
[Illustration: Fig. 36.--Photo-micrograph of crystals of hydrochloride
of morphine, × 50.
(R. J. M. Buchanan.)]
Taylor‘s method for the extraction of morphine may be briefly described
as follows:
The liquid--porter, &c.--to be examined is acidified with acetic acid;
or, if a solid organ is to be tested, it must be cut into thin slices
and placed in distilled water acidified in a similar way. In either
case the liquid is digested for one or two hours at a gentle heat,
and filtered. Acetate of lead is now added to the filtrate until no
further precipitation occurs; the liquid is then boiled and filtered.
The meconic acid remains on the filter as meconate of lead, while
the filtrate contains the morphine as acetate. The liquid is freed
from excess of lead by passing through it a current of sulphuretted
hydrogen, filtered to remove the precipitated sulphide of lead, and
the resulting liquid evaporated to an extract on a water bath, and
treated with alcohol. The alcoholic solution on evaporation gives
acetate of morphine, which may then be tested.
[Illustration: Fig. 37.--Photo-micrograph of meconic acid crystallised
from aqueous solution, × 50. (R. J. M. Buchanan.)]
[Illustration: Fig. 38.--Photo-micrograph of meconic acid crystallised
from an alcoholic solution, × 50. (R. J. M. Buchanan.)]
The meconate of lead which remains on the filter is decomposed by
treating it with dilute sulphuric acid, and gently boiling the mixture.
The filtered liquid should be neutralised before the tests for the
presence of meconic acid are applied.
The reactions of both morphine and meconic acid are best seen from the
following Table:--
Morphine--Solid
--------------------------------+---------------------------------
Treated with strong nitric acid.| Dissolves with effervescence and
| the production of ruddy fumes,
| forming a rich orange-coloured
| solution not changed by the
| addition of stannous chloride.
|
Mixed with a little iodic acid | A blue colour, due to the
and starch paste. | liberation of iodine.
|
Dissolved in cold strong | Bright-green colour.
sulphuric acid, and a drop of|
strong solution of bichromate|
of potash added. |
|
Rubbed with sulphomolybdic acid| A violet colour changing to
(Frohde‘s reagent). | green, and then sapphire-blue.
--------------------------------+---------------------------------
Morphine and Meconic Acid in Solution
---------------------+------------------------+----------------------
| Morphine. | Meconic Acid.
---------------------+------------------------+----------------------
Tested with litmus | Slightly alkaline. | Very distinctly acid.
paper. | |
| |
A little perchloride| An inky-blue colour, | Deep red colour, not
of iron, rendered | destroyed and changed| easily destroyed by
of nearly neutral | to orange-red by | a solution of
as possible. | nitric acid. | corrosive sublimate
| | or dilute mineral
| | acids.
---------------------+------------------------+----------------------
The characteristic tests for morphine are its reactions with nitric
acid, iodic acid and starch, and perchloride of iron. The reaction with
the perchloride of iron is also characteristic of meconic acid. This
last-mentioned test is a very conclusive one for meconic acid, when
certain precautions are taken; for the property of striking a deep red
with a persalt of iron is shared equally by sulphocyanides and alkaline
acetates. The colour produced by sulphocyanic acid _is instantly
bleached_ on the addition of _corrosive sublimate_. The question thus
lies between acetic and meconic acid. To distinguish the one from
the other, the solution to be tested should be boiled for a short
time after the addition of a few drops of sulphuric acid. Any acetate
present is decomposed and the acetic acid is expelled by the boiling;
so that if, after allowing the solution to cool, it still gives the
red colour with perchloride of iron, the reaction may be taken as
conclusive of meconic acid. By these means morphine and meconic acid
may be detected in porter and other liquids.
Table showing the Characters and Tests of the
Following Poisons
------------------------------+-------------------------------
Morphine. | Strychnine.
------------------------------+-------------------------------
1. Crystallises in colourless| 1. Crystallises in white
transparent prisms, belonging| four-sided prisms, terminated
to the trimetric | by four-sided pyramids.
system. |
|
2. Sulphuric acid and | 2. Treated with cold sulphuric
bichromate of potash give | acid, no reaction; on
a bright-green coloration. | the addition of a crystal of
| potassium bichromate, an
| intense purple colour is
| produced, becoming crimson
| and then light red.
|
3. Strong colourless nitric | 3. Strong nitric acid usually
acid, added freely to a cold | produces a yellow or
solution, produces a deep | yellow-brown colour.
orange-red coloration, not |
changed by stannous chloride.|
------------------------------+-----------------------------------
Brucine. | Narcotine.
------------------------------+---------------------------------
1. Crystallises in oblique | 1. Crystallises in right
rhomboidal prisms, sometimes | rhombic prisms, or in needles
agglomerated mushroom-like | grouped in bundles.
heads. |
|
2. Sulphuric acid gives a | 2. Sulphuric acid a bright
rich rose-pink tint; on the | sulphur-yellow colour, potassium
addition of potassium | bichromate added a
bichromate, none of the | green colour as with morphine,
reactions of strychnine | but slower in production.
are observed. |
|
3. Strong nitric acid | 3. Strong nitric acid forms
produces a blood-red | a colourless fluid, becoming
colour, changed after | yellow on heating.
warming and diluting with |
distilled water to purple |
by stannous chloride; |
ammonium sulphide gives |
a similar but less marked |
reaction. Excess of |
stannous chloride |
discharges the blood-red |
colour in the cold. |
------------------------------+---------------------------------
CHAPTER VIII
NARCOTIC POISONS
Somniferous
OPIUM
Opium is the inspissated juice of the _Papaver somniferum_, the garden
or opium poppy. The plant is a native of Egypt and Syria, cultivated in
England.
Opium is sometimes taken in its crude state as a poison, but more
frequently one of its preparations is thus employed--notably the
tincture, better known as laudanum.
The poisonous properties of this drug reside in an alkaloid,
_morphine_--in combination with an acid, _meconic acid_. The several
varieties of opium vary considerably in the quantity of morphine which
they contain, the amount varying from 2 to 9 per cent.
Opium, or its alkaloid, morphine, forms an important ingredient in
_Dalby‘s Carminative_, _Winslow‘s Soothing Syrup_, _Godfrey‘s Cordial_,
_Chlorodyne_, _Nepenthe_, &c.
Of all forms of poisoning, that by opium and its preparations is the
most frequent; and it is stated that three-fourths of all the deaths
from opium occur among children _under five years of age_.
_Symptoms._--The rapidity with which the symptoms of poisoning by opium
make their appearance will depend upon the form in which the poison
is taken--solution, of course, increasing the activity of the drug.
In most cases, an interval of from half an hour to an hour elapses
after the poison has been swallowed before any evil effects become
apparent. Christison, however, mentions a case in which stupor did not
show itself for eighteen hours. During the first stage of poisoning
by opium, the patient may become slightly excited; this state is,
however, soon followed by giddiness and drowsiness. The eyes are kept
open with difficulty. Stupor and insensibility now supervene, from
which he may, in most cases, be temporarily aroused by a loud noise or
a smart blow. As the case progresses, coma and stertorous breathing
occur, and it becomes almost impossible to rouse him at all. The pulse,
at first small, quick, and irregular, becomes slow and full as the
coma increases. The breathing, hurried in the early stages, is now
slow and stertorous. The pupils are contracted in the early stages,
and may be in the later stages dilated; the former condition is most
frequently present, together with insensibility to light. The pupils
may be contracted in cases of _hæmorrhage into the pons Varolii_, and
this disease has been mistaken for opium poisoning. In uræmic coma,
coming on in the course of Bright‘s disease, the pupils may also be
contracted; the nature of the case will be explained by the history
and presence of dropsy. All the secretions, except that of the skin,
are suspended, and the bowels are usually obstinately confined. The
breath may be impregnated with the odour of opium. Certain anomalies
in the symptoms may occur; thus, there may be vomiting and purging,
convulsions (the last most frequent in children), delirium, tetanic
spasms, one pupil dilated and the other contracted, paralysis, and
anæsthesia. It must be borne in mind that remissions sometimes occur in
the symptoms, the patient dying after an attempt at recovery.
A question of some importance may arise as to the amount of volition
and power of locomotion which may exist for some time after a poisonous
dose has been taken. Death may be due to causes other than the effect
of poison. It must, at least, be admitted as possible, that a person,
after swallowing a quantity of opium sufficient to cause death, may yet
be able to walk and move about for one or two hours.
_Opium-eating._--If opium be taken for some time in small doses, the
system becomes tolerant of it, so that a dose which would be poisonous
to most people only produces a slight and pleasurable excitement. De
Quincey was in the habit of taking daily nine ounces of laudanum.
The habitual opium-eater generally suffers from disorders of the
digestive organs, dyspepsia and its train of unpleasant symptoms; the
body becomes thin, the countenance attenuated, the eyes sunken and
glassy, the gait halting, and the body bent. The craving for the drug,
which becomes greater and greater, is only temporarily satisfied by
larger and larger doses. The opium-eater seldom attains a great age,
usually dying before forty. This is perhaps a somewhat exaggerated
picture of the ill effects of opium-eating. Christison, after quoting
the results of his observations in twenty-five cases of confirmed
opium-eaters, concludes as follows: “These facts tend on the whole
rather to show that the practice of eating opium is not so injurious,
and an opium-eater‘s life is not uninsurable, as is commonly thought,
and that an insured person, who did not make known his habit, could
scarcely be considered guilty of concealment to the effect of voiding
his insurance. But I am far from thinking (as several represent who
have quoted this work) that what has now been stated can with justice
be held to establish such important inferences; for there is an obvious
reason why, in an inquiry of this kind, those instances chiefly should
come under notice where the constitution has escaped injury--cases
fatal in early life being more apt to be lost sight of, or more likely
to be concealed.”
_Effects of External Application._--The application of opium to the
surface of the body is not usually attended with dangerous symptoms;
but, in a few cases, due probably to some idiosyncrasy, alarming
effects, or even death, have resulted from the external application of
the drug. Orfila has tried to show that opium is readily absorbed by
the coats of the rectum, and that it acts more rapidly than when taken
into the stomach. This statement does not appear to be correct, for the
dose administered by enema is usually twice that given by the mouth.
_Post-mortem Appearances._--As might be expected, the appearances found
after death are not very characteristic. The vessels of the brain
are congested, and serous effusions in the ventricles or between the
membranes are not uncommon. Engorgement of the lungs is most frequently
present in those cases in which convulsions have occurred. The stomach
is in most cases found quite healthy. The bladder may be full of urine,
due probably to the person being unable to empty it from loss of
consciousness.
_Fatal Period._--From three-quarters of an hour and upwards.
_Fatal Dose._--Four grains is about the smallest fatal dose of opium
in an adult; but cases of recovery, where an ounce or more of laudanum
has been taken, are not very rare. Children are very susceptible to
opium. The smallest dose of morphine that has proved fatal to an infant
is one-twelfth of a grain of the hydrochloride. Half a grain of the
acetate has proved fatal to an adult, one grain of morphine or its
salts has proved fatal on several occasions. With prompt treatment
recovery has taken place after much larger doses, even as much as
seventy-five grains.
_Chemical Analysis and Tests._--These have been described on p. 339 _et
seq._
_Treatment._--The stomach pump should be used without delay, and the
stomach thoroughly washed out. The washing water should contain about
ten to fifteen grains of permanganate of potash to the pint, and the
washing repeated at short intervals, as the permanganate destroys the
morphine. If the stomach tube be not at hand, the patient should be
made to drink the permanganate solution if possible. This treatment
should be carried out even when morphine has been administered
hypodermically, as it is excreted by the stomach. Emetics should also
be given if the patient can swallow; if unable to do so, a hypodermic
of ⅒ grain of apomorphine may be given. The administration of strong
coffee or tea, the application of ammonia to the nostrils, flagellation
of the soles of the feet, and keeping the patient constantly walking
about (a procedure of doubtful value) are among the measures usually
adopted by way of treatment. Galvanism and artificial inflation of
the lungs have done good service even in the most hopeless cases. The
student is referred to some important cases recorded by Dr. Burgess
and others in the _Medical Press and Circular_, vol. i. p. 369, for
the year 1892. Dr. Burgess strongly recommends prolonged artificial
respiration, the interrupted current, and the administration of
stimulants, externally, internally, and hypodermically. Dr. Finny is of
opinion that, while opium may be useful in cases of atropine poisoning,
atropine is of little use in opium poisoning; in this opinion Dr.
Burgess concurred. The state of the respiration is a better test than
the condition of the pupil when atropine is used as an antidote. If
the administration of atropine does not quicken the respiration it
should be discontinued, and other methods tried. Vinegar should not
be given, as it dissolves the morphine and renders it more easy of
absorption. Death is rare in those cases in which proper remedies have
been resorted to before the stage of stupor has commenced.
=Synopsis of the Effects of Opium upon the System=
1. _The Mental Faculties._--The first effect noticed when opium is
taken in small doses is a primary exaltation of the mental faculties;
the imagination is rendered brilliant, and the passions exalted; after
a time drowsiness supervenes, followed by deep sleep. A dose of thirty
drops of the tincture caused in one experimenter an exhilaration of the
mental faculties, and an aptitude for study; the subsequent drowsiness
being removed by a dose of a hundred drops or more, when the greatest
mental excitement was the result.
2. _The Respiration._--The frequency of the respiration is diminished,
and the oxidation of the blood impaired.
3. _The Pulse._--The first effect on the circulatory system is that of
a stimulant, and then sedative. By the administration of repeated small
doses, the force of the circulation may be maintained for some time.
4. _The Eyes and Countenance._--The pupils, when the patient is
powerfully under the influence of opium, are contracted even to a
point. Dilatation, has, however, been noticed in some cases, especially
when death approaches. In apoplexy of the pons Varolii, the pupils are
contracted. The countenance is placid, pale, and ghastly; the eyes
heavy, and the lips livid.
5. _The Cutaneous System._--The skin, although cold, is not
infrequently bathed in profuse perspiration.
6. _The Alimentary Canal._--Sometimes there is vomiting and even
purging; but, as a rule, the secretions along the whole alimentary
canal are diminished, and constipation is the result. According to Dr.
Walter Smith, of Dublin, morphine is mainly excreted into the stomach
and bowels, and so cast out in the fæces. Very little goes out in the
urine.
7. _The Average Commencement of Symptoms._--Much depends upon the
size and form of the dose. In most cases the first appearance of the
symptoms is seldom delayed beyond an hour after the poison is taken.
8. _The Average Period of Death._--Seven to twelve hours.
Table showing some of the Symptoms and Effects of
Opium and Belladonna
---------------------------------+-----------------------------------
Opium. | Belladonna.
---------------------------------+-----------------------------------
1. Slight excitement, coma, | 1. Active, busy delirium preceding
lethargy, and no return of the | the coma, followed by delirium,
excitement should the patient | if recovery takes place.
recover. |
|
2. Coma is of shorter duration | 2. Coma is of longer duration
than in poisoning by belladonna.| than in poisoning by opium.
|
3. Pupils contracted. | 3. Pupils dilated.
|
4. Local application to the eye | 4. Dropped into the eye, the
does not affect the pupil. | pupils are dilated.
|
5. Bowels as a rule confined. | 5. Bowels not affected.
|
6. Acts powerfully on children. | 6. Well borne by children.
---------------------------------+-----------------------------------
Table showing the Points of Distinction between
Apoplexy and Narcotic Poisoning
------------------------------------+--------------------------------
Apoplexy. | Narcotic Poisoning.
------------------------------------+--------------------------------
1. Apoplexy _may_ be preceded by | 1. No premonitory symptoms,
premonitory symptoms, as giddiness,| except by fortuitous
headache, noises in the ears, | combination.
and partial paralysis. |
|
2. Apoplexy chiefly attacks the | 2. More frequently in the
old, and is very rare in young | young, especially of the
people. | female sex.
|
3. Most frequently among fat | 3. In fat or thin people.
people. |
|
4. Symptoms may come on during | 4. An interval of from ten to
the meal or _immediately_ after. | thirty minutes always occurs,
| even in the case of opium, the
| commonest of narcotic poisons.
|
5. The symptoms commence abruptly, | 5. The symptoms advance
sometimes with deep stupor. | gradually.
|
6. Patient is with difficulty, if | 6. Patient may be roused from
ever, temporarily aroused. | the deepest lethargy if shaken
Convulsions common. Face bloated. | or spoken to in a loud voice.
Pupils _dilated_, or irregular. | Convulsions rare in opium
| poisoning. Face seldom bloated.
| Pupils _contracted_.
|
7. Life may be prolonged for a | 7. Life is seldom prolonged
day or more. Apoplexy _may_, | beyond six or eight hours.
however, kill in an hour. | Shortest time in which opium
| has caused death, _three_
| hours.
|
8. No response when the forehead | 8. Patient may be roused by
is smartly tapped with the | tapping the forehead, &c.
finger-nails, or when water is |
injected into the ear. |
------------------------------------+--------------------------------
Table showing the Condition of the Pupils in--
-----------------------+---------------------------------------------
Ordinary sleep |The eyes turned upwards; pupils contracted.
|
Chloroform narcosis |When the _liquid_ is taken, coma; pupils
|dilated; eyes suffused or glistening, and
|turned upwards. When the _vapour_ is
|inhaled, pupils first contracted; when
|coma supervenes, dilated.
|
Apoplexy |Pupils dilated; insensible to light.
|Sometimes unequal. Apoplexy of pons
|Varolii, pupils contracted.
|
Alcoholic coma |The pupils dilated or variable, and not
|affected by a bright light placed before
|them.
|
Poisoning by opium |Contracted in some cases to a pin‘s head;
|as death approaches, the pupils dilate.
|
Carbolic acid |Contracted and insensible to light.
|
Calabar bean |Powerful contraction of the pupils.
|
Hyoscyamus or atropine |Dilatation of the pupils.
|
Strychnine |In some cases the pupils, during the
|paroxysms, are dilated, and contracted
|during the intermissions.
|
Aconite |Sometimes contracted; but in 17 out of 20
|cases recorded by Dr. Tucker, dilatation
|was present.
-----------------------+---------------------------------------------
CHAPTER IX
DELIRIANT POISONS
Under this head will be noticed those poisons whose action on the
animal economy is characterised by _delirium_, illusion of the
senses, and marked _dilatation_ of the pupil. In some cases there is
considerable irritation of the digestive organs, accompanied with a
difficulty in passing water, sometimes ending in complete suppression
of urine. The mydriatic alkaloids atropine, hyoscine, hyoscyamine,
daturine, duboisine, scopolamine, are practically identical in chemical
composition and action, and produce similar symptoms.
The following are among the most important poisons of this group:--
1. Belladonna.
2. Hyoscyamus.
3. Stramonium.
4. Solanum Dulcamara.
5. Solanum Nigrum.
6. Solanum Tuberosum.
Those of less importance are _Œnanthe crocata_ or Dropwort, Camphor,
Salicylic Acid, and Yew--the last already described among the Vegetable
Irritants.
BELLADONNA
_Symptoms._--Taken internally or applied externally, belladonna,
_Atropa Belladonna_ (_N. O. Solanacea_), or its alkaloid atropine,
causes dryness of the mouth and throat, with intense thirst. Nausea and
vomiting are present in most cases, accompanied with giddiness, double
or indistinct vision, active delirium, convulsions, ending in stupor
and coma. In the majority of cases an erythematous rash appears on the
skin, with elevation of temperature resembling scarlet fever. A very
marked characteristic of poisoning by solanaceous plants is _dilatation
of the pupil_, the iris in some cases being reduced to a mere line
round the pupil. The symptoms in some cases which have been recorded
are almost identical with those of delirium tremens. In other instances
there has been little or no delirium, the patient at once passing
into fatal lethargy. Alarming symptoms have followed from drinking a
decoction of belladonna leaves, which were mistaken and supplied for
those of the ash. Accidental poisoning has also frequently occurred
among children from their eating the ripe berries of the belladonna
plant. Slight symptoms of poisoning are sometimes met with from the
use of belladonna plasters to remove the milk from the breasts of
women delivered of still-born children, or in cases where the child has
died soon after birth. In these cases the patients complain of intense
dryness of the mouth, dimness of vision, and itching of the skin. The
removal of the plasters will at once arrest the unpleasant symptoms.
In the _Gazette des Hôpitaux_, July 1859, a case is recorded of
poisoning by the outward application of belladonna in the form of the
following liniment: Camphorated oil of henbane, ten ounces; extract of
belladonna, four scruples. The patient was seriously ill for some days,
but ultimately recovered.
Poisoning has also resulted from the use of a solution of atropine
(four grains to one ounce) dropped into the eye in the treatment of
iritis. (See _British Medical Journal_, 1876, vol. i.)
_Post-mortem Appearances._--Congestion of the vessels of the brain,
sometimes with fluid blood, at other times with thick black blood.
The stomach may or may not be congested; but in cases where the ripe
berries have been taken, the mucous lining may be seen deeply dyed by
the juice of the berries. The pupils are usually found dilated.
_Fatal Dose._--One teaspoonful of belladonna liniment and one drachm
of tincture have proved fatal. Recovery has taken place after half an
ounce of liniment and extract. Children are less affected than adults.
Of atropine half a grain has proved fatal. Recovery has taken place
after five grains of the sulphate.
_Fatal Period._--Twelve hours to several days.
_Chemical Analysis._--From organic mixtures the alkaloid may be
obtained by Stas‘s process, and treated according to Vitali with a
little fuming nitric acid, and then dried in a water bath: when cold,
it must be moistened with a drop of potassæ dissolved in absolute
alcohol. A violet colour changing to red is produced, the violet being
characteristic, as strychnia when treated as above gives a red colour.
The physiological action on the pupil must also be noted. When the
berries are taken, the mucous membrane of the stomach may be found
dyed of a purple colour, turned green by alkalies and red by acids.
Fragments of the berries may also be found in the stomach.
To a small quantity of solid atropine add a drop or two of strong
sulphuric acid, then a crystal of sodium nitrite; a yellow colour is
produced, which alcoholic solution of potash changes to reddish-violet
and then pale rose.
Free atropine gives a red colour with phenolpthalein; the colour is
discharged with alcohol, but reappears on evaporating it.
_Gerrard‘s Test._--Mercuric chloride dissolved in alcohol gives a red
colour.
_Blyth‘s Test._--To the solid alkaloid add strong solution of baryta,
evaporate, to dryness, and heat the residue, when the smell of hawthorn
blossom is given off.
_Wormley‘s Test._--An alcoholic solution of bromine gives a crystalline
yellow precipitate.
_Treatment._--Wash out the stomach and give hypodermic injections
of one-third of a grain of pilocarpine, which is the best antidote.
Emetics and purgatives, castor-oil and animal charcoal may be
administered. The symptoms as they present themselves must be treated
on general principles.
_N.B._--Belladonna has been stated to act in
antagonism to opium, and its administration
recommended in poisoning by that drug.
HYOSCYAMUS
Hyoscyamus, _Hyoscyamus niger_, or henbane (_N.O. Solanaceæ_),
alkaloids hyoscine, hyoscyamine, taken in large doses, produces
symptoms not unlike those due to belladonna. There is the same
affection of sight--double vision; the same dilatation of the pupils,
delirium, confusion of thought, insensibility, and coma. Hyoscine has
a hypnotic effect in comparison to the deliriant action of belladonna.
But its action varies very much on different people. A form of mania,
with wild hallucinations, has sometimes been observed to follow the
administration of this drug.
The peculiar property of henbane is marked by its tendency to produce
a general paralysis of the nervous system. The root has been eaten by
mistake for parsnips, when all the foregoing symptoms were present. The
seeds are more poisonous than the roots, the leaves being the least
poisonous part of the plant.
_Post-mortem Appearances._--The morbid appearances are not unlike those
which result from poisoning with belladonna.
_Fatal Dose._--Nothing certain can be stated as to the amount required
to cause death. Alarming symptoms are said to have followed the
administration of ten minims of the tincture, repeated every six hours.
Twenty of the _seeds_ have caused active delirium. Idiosyncrasy may
have something to do with this result. Half a drachm of the tincture
is often given to an adult, and repeated every four hours, without any
unpleasant result.
_Treatment._--As for belladonna, emetics and purgatives, to expel the
poison from the system.
STRAMONIUM
The Thorn Apple, _Datura Stramonium_ (_N.O. Solanaceæ_), possesses
powerful poisonous properties. These are marked by the production of
giddiness, impairment of vision, and syncope. Furious delirium is not
infrequent; and in one case where this state was present there was
loss of speech. The face is usually flushed, the eyes glistening and
restless, and the pupils dilated; in short, the countenance is that
of one intoxicated. Taken together, the symptoms are not unlike those
produced by belladonna.
Poisoning by stramonium seeds is a favourite mode of procedure among
the Hindoos; but as the poison is most frequently given to facilitate
robbery, death seldom results from its use. In India, the seeds are
mixed with the boiled rice so commonly eaten there, and as they closely
resemble the seeds of the common capsicum, the dangerous nature of
the mixture is not readily detected. The seeds of the datura can be
distinguished by the taste, which is slightly bitter, whereas that of
the capsicum is hot and pungent. The outward application of the leaves
may give rise to all the appearances of poisoning.
The active principle of stramonium is the alkaloid _Daturine_, which
crystallises in colourless quadrangular prisms, with a bitter acrid
taste. It resembles atropine and hyoscyamine in chemical properties.
_Post-mortem Appearances._--Congestion of the vessels of the brain and
its membranes, with some slight gastric irritation.
_Treatment._--As for belladonna, emetics and purgatives, to get rid of
the portions of the plant swallowed.
Some other solanaceous plants--_Solanum Dulcamara_, Bittersweet or
Woody Nightshade, _Solanum nigrum_, or Garden Nightshade, and the
_Solanum tuberosum_, or Potato--possess poisonous properties. They,
like the other members of the order to which they belong, give rise to
symptoms characterised by giddiness, dimness of sight, trembling of the
limbs, and delirium. The water in which the potato has been boiled is
sometimes used by the vulgar as an application to favus of the scalp.
The active principle of these plants resides in an alkaloid,
_Solanine_, which is not a very powerful poison. A rabbit has been
killed in a few hours by two grains of the sulphate of solanine.
ŒNANTHE CROCATA
Hemlock-Dropwort, or Dead-tongue, is a poisonous indigenous,
umbelliferous plant.
Accidental poisoning by this plant has occurred, the root having been
mistaken for parsnip. The symptoms in one of the cases which have been
recorded were those of _delirium tremens_; in another, which terminated
fatally, vomiting of blood was followed by convulsions. First
contraction and then dilatation of the pupil, spasmodic respiration,
and an almost imperceptible pulse were the effects noticed. Death may
take place in a few hours.
_Post-mortem Appearances._--Congestion of the vessels of the brain, and
gastric irritation. The face has sometimes a bloated expression, and
blood may escape from the ears and mouth.
_Treatment._--Purgatives and emetics, to evacuate the bowel and
stomach, and thus get rid of the poison.
CAMPHOR
Camphor is a concrete vegetable oil obtained from _Camphora
officinarum_ (_N.O. Lauraceæ_). Its employment for the purpose of
homicide is rare, but several cases of accidental poisoning from the
use of the homœopathic solution have been recorded (_British Medical
Journal_, 1873, vol. ii. p. 617).
The symptoms are--languor, giddiness, delirium, foaming at the mouth,
vomiting of blood-tinged fluid, convulsions, gastric irritation, and
great abdominal pain. In one case--that of a young lady aged twenty,
who took twenty-five drops of “Epps‘ Concentrated Solution of Camphor”
for a sore throat--all the above-mentioned symptoms were present; she
was also unconscious for several hours, and partially paralysed for
several days--perfect recovery from the nervous symptoms not taking
place for more than six months.
The homœopathic solution (Rubini‘s) is stronger than that of the
British Pharmacopœia in the proportion of 7.2 to 1. For its detection
in organic fluids, it may be removed by chloroform; and from fixed
oils, by distillation. Water precipitates it from its alcoholic
solution.
_Post-mortem Appearances._--Those produced by irritants.
_Treatment._--Purgation and emetics, to empty the bowel and stomach.
SALICYLIC ACID
This substance, prepared by acting on a mixture of carbolic acid and
sodium with carbonic acid at a moderate heat, is used largely for
acute rheumatism. In some cases premonitory symptoms of poisoning have
demanded a cessation in the administration of the drug. The most usual
of these are noises in the ears, difficulty of hearing, amblyopia,
delirium, and profuse perspiration. There may be hæmorrhages from the
mucous membranes, and into the retina. When the drug is discontinued
the symptoms pass off. The symptoms are held by some observers to be
due to the artificial and not the natural acid.
CHAPTER X
INEBRIANT POISONS
The poisons grouped under this head are characterised by causing
delirium, followed by narcotism. Recovery is not infrequently slow, the
system suffering more or less severely from the effects of the poison.
In the case of alcohol, loss of appetite, accompanied with considerable
gastric irritation, are among the after-effects of the poison.
The chief of this group are--Alcohol, Cocculus Indicus, Poisonous
Fungi, Nitro-Benzene.
Others of less importance will be briefly considered.
ALCOHOL
It will be necessary to consider poisoning by this substance under two
forms--acute and chronic. So many anomalies present themselves that it
is difficult to give a clear outline of the symptoms.
_Acute._--In most cases the symptoms come on within a few minutes
after the poison is swallowed. Giddiness, confusion of ideas, and a
difficulty in walking straight are among the first effects produced,
these being followed by stupor and coma. Nausea and vomiting are the
early signs of recovery. In some cases there may be _no_ premonitory
symptoms, sudden and complete stupor supervening some time after a
large dose of alcohol has been taken.
The patient not infrequently recovers from the first symptoms. A
relapse takes place; he becomes insensible, and dies convulsed. The
countenance wears a vacant expression, the face flushed and bloated,
the lips livid, and the pupils dilated and insensible to light. The
pupils may be contracted, but dilate on irritating the skin by a
pin-prick or pinch. The sensibility of the pupil to the action of
light should be regarded as a favourable symptom. The rapidity with
which alcohol acts is not so great as to prevent the individual from
walking some distance and performing certain acts of volition. The
rapidity with which the symptoms show themselves will depend upon the
previous habits of the individual, and the strength and quantity of the
alcohol taken. Alcohol, when diluted, induces a preliminary stage of
excitement, followed by stupor; but when concentrated, stupor may come
on almost immediately after the spirit is swallowed.
The vapour of alcohol may act as a poison, giving rise to the symptoms
above mentioned.
Congestion of the lungs or brain, or both together, is in most cases
the cause of death in acute poisoning by alcohol.
_Chronic._--The habitual dram-drinker suffers from many diseases. The
appetite becomes impaired; there is considerable irritation of the
stomach and bowels, marked by vomiting and purging. Then follows a long
list of organic diseases. The structure of the liver becomes changed;
it may increase in size, become lighter in colour and cirrhotic,
being then known as “hobnailed” or _dram-drinker‘s liver_. Jaundice
and dropsy may be present as the result of this altered condition of
the gland. The kidneys also suffer from granular degeneration. Then
follow a long series of nervous complaints: congestion of the brain,
paralysis, _delirium tremens_, and insanity. Sudden death by coma not
infrequently ends the career of the drunkard.
_Delirium tremens_ is one of the most common results of the habit of
drinking; and this affection, it is stated, may be induced by the
sudden discontinuance of alcohol in those who are habitually given to
its use.
_Post-mortem Appearances._--The stomach may present the usual signs of
inflammation, due to the irritant action of alcohol. The colour of the
mucous membrane of the stomach may be bright red, dark red, brown, or
quite pale. The brain and its membranes are sometimes congested, and
the intracranial vessels gorged with blood. The odour of alcohol may
be present in the contents of the stomach; and alcohol may, in some
cases, be detected in the lungs, brain, and other organs of the body.
The lungs are not infrequently found congested, and the right cavities
of the heart full of dark-coloured blood. Casper examined a case in
which the cavities of the heart were empty. The blood is remarkably
fluid, and of a dark colour. “Lymphatic exudation between the cerebral
meninges, so that the pia mater upon the cerebral hemispheres is seen
here and there whitish as if varnished, is not a result of death from
drinking, but is the result of the chronic irritation of the brain by
habitual drunkenness, and is therefore a very common appearance in the
bodies of all drunkards, from whatever cause they have died.” One other
condition occurring in those dying from the effects of alcohol, is the
remarkably long continued presence of the _rigor mortis_, and perfect
freedom from putrefaction, even up to the ninth day, in an atmosphere
by no means unfavourable to early decomposition. A condition of the
skin known as _cutis anserina_, or “goose skin,” was present in some of
the cases examined by Casper.
_Absorption and Elimination._--From experiments on animals, it has been
shown that alcohol is rapidly absorbed, and then eliminated from the
system, and that all traces of alcohol may disappear in a few hours,
and yet death be the result of its action. Alcohol is supposed to be
decomposed in the body, but the exact changes it undergoes do not
appear to be very clearly made out.
_Fatal Period._--Death has occurred in a few minutes after a large
dose of alcohol had been swallowed. The average fatal period is about
twenty-four hours. Death may also be an indirect result of the action
of alcohol on the system.
_Fatal Dose._--Uncertain. The age and habits of the individual must be
considered. Between three and four ounces proved fatal to a boy seven
years of age.
Table showing the Points of Distinction between Concussion
of the Brain, Alcoholic Poisoning, and
Poisoning by Opium.
-----------------------+---------------------+---------------------
Concussion of the Brain.|Alcoholic Poisoning. | Poisoning by Opium.
-----------------------+---------------------+---------------------
1. Marks of violence | 1. The absence of | 1. Same as under
on the head. |marks of violence, |alcohol.
|unless the person has|
|fallen on the ground.|
|The history of the |
|case will help in |
|forming an opinion. |
| |
2. Stupor comes on | 2. Excitement | 2. The symptoms
suddenly. |previous to the |slow in appearing;
|stupor, which comes |drowsiness, stupor,
|on suddenly. |lethargy. Muscles
| |relaxed, and loco-
| |motion impossible.
| |The patient may be
| |roused by a sharp
| |question.
| |
3. Face pale and | 3. Face flushed; | 3. The face pale,
cold; the pupils |and pupils generally |pupils contracted.
sluggish and insensible|dilated. |
to light, sometimes | |
dilated | |
| |
4. Remissions are | 4. Partial recovery| 4. Remissions are,
rare, the patient |may take place, |as a rule, rare in
recovering slowly, |followed by death |this form of
and with some |after the lapse |poisoning.
confusion of ideas. |of some hours. |
| |
5. Absence of the | 5. Presence of the| 5. Odour of opium
odour of alcohol in |odour of alcohol in |in the breath.
breath; if present, |the breath. |
it is probably due | |
to the treatment of | |
bystanders. | |
| |
-----------------------+---------------------+---------------------
_Chemical Analysis._--Tests for Alcohol:
1. Characteristic smell.
2. It dissolves camphor.
3. Treated with dilute sulphuric acid and a strong solution
of bichromate of potash, the green oxide of chromium
is set free, and the vapour of _aldehyde_ may be
detected by the smell.
4. Burnt under the mouth of a test tube, moistened with
solution of baryta or lime-water, a deposit is formed in
the tube of carbonate of baryta or lime.
5. If a few drops of a solution of iodine in iodide of
potassium be added to alcohol, and then sufficient
caustic potash be added to decolourise it, a crystalline
precipitate of iodoform with its characteristic odour
will be formed.
6. If copper turnings be added to a solution containing
alcohol, then some strong nitric and sulphuric acid, and
the mixture warmed, the odour of sweet spirit of nitre
will be given off.
7. On warming with sodium or lead acetate and sulphuric acid
the odour of acetic ether is evolved.
_Alcohol in the Contents of the Stomach or in the Tissues._--The
contents of the stomach, or the tissues bruised and macerated in
distilled water, should be carefully distilled in a water bath. It
will be necessary to neutralise the liquid prior to distillation.
The distillate should be mixed with chloride of calcium or anhydrous
sulphate of copper, and re-distilled. The liquid thus obtained is
shaken with dry carbonate of potash, and allowed to settle. The alcohol
rises to the top of the mixture, whence it may be removed by the aid of
a pipette, and tested as before mentioned.
_Treatment._--Immediate use of the stomach pump and emetics; to empty
the stomach a hypodermic injection of apomorphine may be given.
Affusion of cold water to the head, or the injection of cold water
into the ears, may be tried. The administration of ammonia, and the
employment of galvanism, have been of service in some cases.
COCAINE
Cocaine is an alkaloid obtained from the _Erythroxylon Coca_. It
produces a paralysing effect upon the endings of sensory nerves, and is
used as a local anæsthetic. When absorbed into the blood it paralyses
the vagus and causes increased rapidity of the pulse. Applied to the
eye it causes dilatation of the pupil. It first has a stimulating
action on the centres of the brain and spinal cord, finally paralysing
them. It produces death by paralysis of respiration, according to
Mosso, by causing tetanus of the respiratory muscles.
_Symptoms._--The symptoms produced are pallor, cyanosis, faintness, and
cold sweats, pain in the precordial region, rapid pulse, intermittent
heart beat, laboured respiration. The pupils are dilated. Speech
becomes incoherent, there may be trismus of the jaws, the ideas are
confused, and there may be delirium. Tetanic spasms of muscles may
occur, and convulsions, also loss of consciousness.
Chronic poisoning, following the cocaine habit, produces a long
series of symptoms which are manifestations of mental and physical
degeneration, which in extreme cases may pass on to insanity, with
hallucinations and delusions.
_Fatal Dose._--Half a grain injected into the gum of an adult has
caused alarming symptoms, and two-thirds of a grain has caused death.
Recovery has taken place after forty-three grains were taken by the
mouth.
_Fatal Period._--Death has occurred in twenty minutes after three and a
half grains by hypodermic injection.
_Chemical Analysis._--The alkaloid may be separated from the stomach
contents or viscera by the usual procedure for extraction of alkaloids.
1. On the addition of strong nitric acid and evaporating to dryness,
the residue when treated with alcoholic solution of potash gives off an
odour like peppermint or meadow-sweet.
2. _Goeldner‘s Test._--Strong sulphuric acid and resorcin when mixed
with cocaine gives a blue colour, changing to rose-pink on addition of
caustic potash. Goeldner considers this a reaction peculiar to cocaine.
3. _Metzer‘s Test._--If a few drops of a 5 per cent. solution of
chromic acid in water be added to a solution of cocaine hydrochloride,
each drop gives a yellow precipitate which redissolves. The addition of
strong hydrochloric acid produces a yellow precipitate of chromate of
cocaine. Metzer considers this reaction peculiar to cocaine.
4. When applied to the tongue or lips a feeling of numbness is
produced; it is rendered more effectual if a solution of sodium
bicarbonate be first applied to the mucous membrane.
_Treatment._--Wash out the stomach and encourage vomiting. Stimulants
and ammonia should be given freely, and if convulsions occur chloroform
should be inhaled. Tannic acid or gallic acid in thirty-grain doses
have been recommended, also iodine one grain with potassium iodide ten
grains, in a wine-glassful of water between the stomach-washing or
emesis. Oxygen inhalations and artificial respiration may be resorted
to in failure of the respiration.
COCCULUS INDICUS
The fruit of Cocculus Indicus, _Anamirta paniculata_ (_N.O.
Menispermaceæ_), is poisonous, and is frequently used by poachers to
capture fish. The berries are ground to powder, mixed with bread,
and then thrown into the water. When taken by the fish, they become
stupefied, float to the surface, and are then taken.
The poisonous properties are due to a crystalline alkaloid,
_Picrotoxin_. Fraudulent publicans have used this drug for the
adulteration of beer. The strength of the beer is first reduced by the
addition of salt and water, and then the cocculus indicus is added,
to give to it an intoxicating property. The effect produced on the
unfortunate customers is a strong desire to sleep, with more or less
wakefulness. Loss of voluntary power is present, but consciousness
is not lost, the sufferer lying in a state bordering on nightmare.
Cocculus is not used in medicine or the arts, and yet a large quantity
is imported, and mysteriously disappears in this country.
_Symptoms._--The symptoms which have been noticed in poisoning by this
substance are--nausea, vomiting, severe abdominal pains, stupor, and
intoxication. Two deaths at least have been reported as resulting from
it. In the case of R. _v._ Cluderay, “the defendant administered to a
child two cocculus indicus berries, entire in the pod, with intent to
murder the child.” The kernel is a poison; the pod is not, and will
not dissolve in the stomach; and they were therefore harmless. This
was held to be administering poison with intent to murder, within the
section of the Statute.
_Picrotoxin_, the alkaloid, is in fine white crystals, intensely bitter
to the taste, soluble in boiling water, slightly so in cold. Alcohol
and ether readily dissolve it. Strong nitric acid dissolves it,
without change of colour; and sulphuric acid produces an orange-yellow
colour, changed to pale yellow by dilution. In organic liquids it
might be mistaken for sugar, or _vice versa_, as it precipitates the
oxide of copper when boiled with the sulphate of copper and potash. In
examining beer supposed to be adulterated with picrotoxin, the beer
should be acidulated with hydrochloric acid, and then shaken up with
ether. On spontaneous evaporation of the ether, the picrotoxin is left
in crystals.
_Treatment._--Stomach pump, emetics, apomorphine subcutaneously; then
chloral and the bromide of potassium. Chloroform may be inhaled.
Paraldehyde is said to be a specific antidote.
LOLIUM TEMULENTUM
The seeds of _Lolium temulentum_, or common darnel, are poisonous.
Cases of poisoning have occurred from these seeds being accidentally
ground with wheat or rye, and then made into bread.
_Symptoms._--Gastric irritation, nausea, and vomiting followed by
giddiness, deafness, loss of vision, and, in some cases, delirium. Not
infrequently the symptoms resemble those produced by ergot. No death
has been recorded as resulting from the use of these seeds. Three
ounces of paste made from darnel flour, given to a dog, did not cause
death.
POISONOUS FUNGI
Accidental poisoning by mushrooms is by no means rare. The _Agaricus
campestris_, and a few others, are edible; but it is a fact worthy
of notice that the poisonous properties of mushrooms are modified
by climate and the seasons of the year at which they are collected.
Idiosyncrasy may have something to do with the injurious effects
produced on some persons by the fungi.
The _Agaricus campestris_, or common mushroom of this country, is
sometimes poisonous; and in some countries--Italy and Hungary--it is
usually avoided. In Russia and in France certain fungi are eaten which
are regarded as poisonous by us.
Bentley gives, in his _Botany_, the following table, by which edible
and poisonous mushrooms may be known:
-----------------------------------+---------------------------------
Edible. | Poisonous.
-----------------------------------+---------------------------------
1. Grow solitary in dry airy | 1. Grow in clusters in woods
places. | and dark damp places.
|
2. Generally white or brownish. | 2. Usually with bright colours.
|
3. Have a compact, brittle | 3. The flesh tough, soft, and
flesh. | watery.
|
4. Do not change colour by the | 4. Acquire a brown, green, or
action of the air when cut. | blue tint when cut and
| exposed to the air.
|
5. Juice watery. | 5. Juice often milky.
|
6. Odour agreeable. | 6. Odour commonly powerful and
| disagreeable.
|
7. Taste not bitter, acrid, | 7. Have an acrid, astringent,
salt, or astringent. | acid, salt, or bitter taste.
-----------------------------------+---------------------------------
_Symptoms._--Two sets of symptoms may follow the use of mushrooms as
food--those of irritant and those of narcotic poisoning. In the latter
class, giddiness, double vision, and even delirium, have been present.
Nausea, vomiting, purging, and convulsions characterise those of the
former class. In some cases the individual has presented all the
appearances of intoxication.
_Post-mortem Appearances._--These will depend to a great extent upon
the character of the symptoms prior to death. If signs of irritation
have been present, inflammation of the stomach and bowels will most
probably be found; but if, on the other hand, narcotic symptoms were
predominant, congestion of the vessels of the brain will most likely be
present. Arsenic and other poisons have been mixed with mushrooms with
intent to kill; the probability of this occurring should be borne in
mind, and a rigid examination of the contents of the stomach made in
all doubtful cases.
_Treatment._--Castor-oil and emetics, atropine hypodermically.
NITROBENZENE, OR ESSENCE OF MIRBANE
This substance, prepared by acting on benzene by nitric acid, is
largely used for flavouring sweets, &c. Nitrobenzene is a heavy,
yellow, oily substance with a strong odour of bitter-almond oil, from
which, however, it differs by undergoing no change of colour when
agitated with strong sulphuric acid. The natural oil acquires a fine
crimson colour when treated with strong sulphuric acid.
_Symptoms._--These may not make their appearance for three or four
hours after the poison is swallowed or inhaled. The vapour is more
powerful than the liquid. In some cases which have been described,
the patient has complained of feeling drunk, with pain in the head,
giddiness, faintness, distorted vision, drowsiness, ending in coma and
death. The face is flushed, the jaws sometimes spasmodically closed,
and the lips livid. Vomiting then supervenes, the vomited matters
having the odour of bitter almonds. Symptoms not unlike those produced
by prussic acid or the essential oil of bitter almonds have been
noticed in one or two cases; but, as a rule, the insensibility is not
immediate, as in prussic acid poisoning, and in this fact lies the
distinction between the two substances. Rapidly fatal cases might be
mistaken for apoplexy, but the odour betrays the cause of death.
_Post-mortem Appearances._--Nothing very characteristic is found after
death due to this poison. The blood is sometimes black and fluid and
gives the spectrum of acid hæmatin, the lungs congested, and the liver
of a purple colour. The blood, contents of the stomach, and even the
tissues, may smell strongly of this substance.
_Chemical Analysis._--Nitrobenzene may be separated by distilling the
organic mixture with sulphuric acid, when the distillate will contain
the poison if present. It is converted into aniline by heating it
with acetic acid and iron filings. (See test for aniline, _infra._)
On account of its odour, the only substance with which it can be
confounded is the essential oil of bitter almonds, which owes its
poisonous properties to the prussic acid it contains.
The following Table may assist in its Detection.
-----------------------+---------------------+-----------------------
| Nitrobenzene. | Oil of Bitter Almonds.
-----------------------+---------------------+-----------------------
Strong sulphuric acid.| No change of colour.| A rich crimson colour.
| |
Proto-sulphate and the| No blue colour. | Prussian blue.
persulphate of iron,| |
liquor potassæ, and | |
hydrochloric acid. | |
| |
Solution of sulphate | Insoluble. | Soluble.
of soda. | |
-----------------------+---------------------+-----------------------
_Treatment._--Stomach pump, emetics, stimulants, cold douche,
artificial respiration.
DINITROBENZENE
This substance is a solid of a yellow colour, and is used in the
manufacture of _roburite_, _bellite_, and _sicherite_, explosives used
in coal mines for blasting. Poisoning by it occurs amongst the workmen
who come in contact with it in factories where it is used, by inhaling
either the vapour or fine particles, and by handling it may become
absorbed through the skin.
_Symptoms._--In acute cases these are similar to poisoning by
nitrobenzene. In chronic poisoning there is a marked and peculiar
pallor of the face, with a livid blue colour of the ears, lips,
fingers, and toes. Nausea and vomiting occur, with weakness,
giddiness, and staggering. Amblyopia is a common symptom, with
concentric contraction of the visual field and central scotoma. The
blood resembles that of pernicious anæmia, and the urine is brown or
blackish, due to some pigments of the aromatic series.
_Post-mortem Appearances._--The blood has been found
chocolate-coloured, and ecchymoses have been noted in mucous membranes.
_Treatment._--As for nitrobenzene.
ANILINE
Aniline is a colourless oily liquid gradually changing to brown on
exposure to air. The various aniline dyes are obtained by oxidation
of aniline. Aniline is produced by reduction of nitrobenzene. It is
slightly soluble in water, freely so in alcohol or ether. It can be
absorbed through the unbroken skin as well as by the lungs and mucous
membranes. It is used in the manufacture of marking inks. It has very
toxic properties.
_Symptoms._--The symptoms come on rapidly--nausea and vomiting,
with giddiness and drowsiness; the lips, face, ears, fingers, toes,
conjunctivæ, and mucous membranes become cyanotic. The respirations
are slow and laboured. The pulse may be full and slow, or small and
irregular. The body surface is cold, the pupils react sluggishly
to light. The blood is chocolate-coloured, and is said to give the
spectrum of methæmoglobin. The blue colour is held to be due to pigment
changes, and not to true cyanosis. Convulsions and coma may come on in
fatal cases.
Buchanan met with a case of aniline poisoning in a man who by mistake
swallowed about half an ounce of marking ink. Vomiting came on early,
with giddiness and staggering gait. The body became changed in colour
very rapidly--the colour being between a slate and leaden hue. The
eyeballs were of the same colour but of a lighter shade, the mouth
and tongue exhibited the colour most markedly. The temperature was
subnormal, the pulse quick and feeble, and the breathing occasionally
interrupted with sighing respirations. The blood failed to give the
spectrum of methæmoglobin. The symptoms passed off within twenty-four
hours. During the illness, the man passed several green-coloured
motions. The vomit was of a purplish-black colour--from the marking
ink--and on analysis gave the reactions of aniline. Some of the ink was
procured, and on being analysed was found to consist of hydrochloride
of aniline and chloride of copper. The treatment consisted of stomach
lavage and inhalations of oxygen, which gave the patient much relief.
Cases have been recorded of aniline poisoning in infants from
absorption of the material from linen napkins, which were stamped
with marking ink. Buchanan has seen lividity arise from the dry
hydrochloride of aniline having been carried in a paper parcel in the
waistcoat pocket for two or three days.
_Post-mortem Appearances._--None characteristic.
_Fatal dose._--Six drachms have proved fatal, probably less might do so.
_Chemical Analysis._--Aniline may be separated from organic matter by
alkalising and distilling the mixture.
1. If chloride of lime (bleaching powder) be added slowly to an aqueous
solution of aniline, a deep purple colour is produced, which changes to
brownish-red.
2. If strong sulphuric acid be added to aniline in a porcelain capsule
it forms a dirty-white mass; on adding water and then potassium
bichromate a bronze-green colour is produced, which changes rapidly to
blue and then black.
3. If aniline be dissolved in excess of aqueous solution of phenol, and
bleaching powder dropped into the mixture, a yellow streak changing to
blue follows each drop.
4. Heated with corrosive sublimate a rich crimson colour is produced.
5. If aniline be mixed with a little chloroform and alcoholic solution
of potash and heated, the peculiar odour of phenyl-isocyanide is given
off.
_Treatment._--As for nitrobenzene.
Fusel-oil, Amylic Alcohol, Potato-Spirit.--Fusel-oil, also known as
amylic alcohol, is known by its unpleasant odour and burning taste; it
acts like alcohol as an inebriant, giving rise to headache, giddiness,
&c.
Nitro-glycerine.--In liquid or vapour, violent headache and throbbing
in the temples are produced by this substance, which is used in the
treatment of angina pectoris.
ACETANILIDE (ANTIFEBRIN), PHENAZONUM (ANTIPYRIN), AND PHENACETIN
These substances are used extensively as antipyretics. They have been
known to cause poisoning when administered in large doses.
_Symptoms._--The symptoms are principally those of depression,
impairment of sight, vertigo, sleepiness, and unconsciousness;
collapse, cyanosis, and loss of body temperature; the pulse and
respiration are lowered. Antipyrin causes tumultuous action of the
heart, and there may be erythematous or herpetic eruptions on the skin.
Aniline derivatives, like sulphonal and other synthetic drugs, tend
to destroy the red corpuscles of the blood, and decompose hæmaglobin,
producing hæmatoporphyrin which appears in the urine.
_Chemical Analysis._--Antifebrin may be extracted from an acid solution
by chloroform; for antipyrin the solution should be alkaline.
_Antifebrin_ gives the phenyl-isocyanide reaction on warming with
alcoholic solution of potash and chloroform. Bichromate of potassium
dissolved in strong sulphuric acid gives a red colour, changing to
brown and dirty green; sodium nitrite and strong hydrochloric acid give
a yellow colour, changing to green and blue; on evaporation the residue
is orange, and turns red on addition of ammonia.
_Antipyrin._--Heated with strong nitric acid and the liquid
allowed to cool, a purple colour is produced; if water be added a
violet precipitate is thrown down, and the filtered liquid will be
purplish-red. Ferric chloride gives a blood-red colour, destroyed by
a mineral acid. An aqueous solution of potassium nitrite and strong
sulphuric acid gives a green colour.
_Phenacetin_ is coloured yellow by nitric acid, the colour persisting
when heated. It dissolves in sulphuric acid without change of colour.
Boiled with hydrochloric acid, then diluted with water and chromic acid
solution added, gives a deep red solution.
CHAPTER XI
SEDATIVE POISONS
Cardiac
DIGITALIS
The common foxglove, _Digitalis purpurea_, (_N.O. Scrophulariaceæ_),
grows wild in the hedges in the South of England. All parts of the
plant are poisonous, from the presence of a glucoside _digitalin_, and
in addition it also contains the glucosides digitoxin, digitonin, and
digitalein; according to Kopp, digitoxin is six to ten times more toxic
than digitalin.
_Symptoms._--Nausea, salivation, vomiting, purging, and severe
abdominal pains are first noticed. The patient then complains of pain
in the head, giddiness, and a gradual loss of sight. The eyes protrude,
the pupils are dilated and insensible to light, and the sclerotics,
according to Tardieu, are of a characteristic blue colour; the pulse
weak, slow (forty in the minute) and jerky, sometimes intermittent. The
surface of the body is cold, and bathed in perspiration. An aggravation
in the symptoms takes place whenever the patient attempts to leave the
recumbent position; hence, in all cases of poisoning, and in those
where the therapeutical action of the drug is sought, the patient
should be warned of the danger of leaving the recumbent posture. A
marked depression in the action of the heart is a characteristic
effect of this poison. The effect on the heart may be divided into
three stages: (1) diminution in the frequency of the pulse, and rise
of arterial pressure; (2) both of these become abnormally low; (3)
frequency of pulse abnormally high, arterial pressure abnormally low.
Convulsions have sometimes been noticed, and syncope and stupor are not
uncommon.
_Post-mortem Appearances._--Congestion of the brain and its membranes,
and some inflammatory redness of the mucous membrane of the stomach.
The blood is fluid.
_Fatal Dose._--Uncertain. Large doses of the infusion and tincture have
been given without any untoward results. Thirty-eight grains of the
powdered leaves, and nine drachms of the tincture, have proved fatal.
One-quarter to half a grain of digitalin might prove fatal to an adult.
_Fatal Period._--From three-quarters of an hour to twenty-four hours.
_Chemical Analysis._--If the leaves in an infusion be taken, these must
be sought for and examined. The glucoside may be extracted by first
removing the impurities by means of petroleum ether, then acidifying
with acetic acid and extracting with chloroform.
The following are the tests for _digitalin_:
1. An almost amorphous, white, or fawn-coloured inodorous
substance.
2. Almost insoluble in water.
3. Decomposes nitric acid, with the evolution of nitrous
acid fumes. An orange-yellow-coloured solution is formed,
which, in a few days, assumes a golden-yellow tint.
4. Sulphuric acid dissolves it, changing it to a
reddish-brown colour, changed to violet by bromine vapour.
5. Hydrochloric acid with it at first forms a yellow
solution, which, when heated, changes to a bright green
colour.
The physiological test may be employed by injecting a solution of a
carefully prepared extract of the contents of the stomach or vomited
matters under the skin of a frog, dog, or rabbit.
_Treatment._--Purgatives and emetics should be given, followed by
infusions containing tannin, green tea, oak bark, galls, strong coffee,
and other stimulants. The patient should be kept in the recumbent
posture, and on no account allowed to sit up.
TOBACCO
The consumption of tobacco, _Nicotiana Tabacum_ (_N.O. Solanaceæ_),
has greatly increased of late years. In some countries its use was
prohibited by stringent laws. In Russia amputation of the nose was the
punishment. Several Popes have excommunicated those who smoked in St.
Peter‘s at Rome; and in some parts of Switzerland it was ranked on the
tables next to adultery. Amurath IV made smoking tobacco a capital
offence. Be this as it may, the moderate use of tobacco does not appear
to lead to injurious results; and it is found that workmen engaged in
the manufacture of tobacco do not suffer from any diseases other than
those affecting the generality of mankind.
_Nicotine_--the alkaloid--is a colourless or slightly amber-coloured,
oily, volatile liquid. It is to this principle that the poisonous
activity of the drug is due. It differs from the other oily alkaloid,
_conine_, in appearing of a green colour when a drop is placed on the
surface of white enamelled glass--conine having a _pink_ colour. They
both leave a greasy stain on paper. Nicotine has been detected by
Stas‘s process in the tongue, stomach, lungs, and liver. A ptomaine not
unlike nicotine has been discovered.
_Symptoms._--Symptoms of poisoning by tobacco are by no means uniform,
and have been variously described by observers. As a type of the
effects produced, the following may be noticed as occurring to the tyro
after his first or second “pipe”: The pulse is primarily quickened;
then follow nausea and faintness, accompanied with an intense feeling
of sinking. The face is blanched, the pulse slow; perspiration
stands on the forehead, and ultimately he vomits, and then gradually
recovers. Cold air blowing on the face, or sponging the face with
cold water, materially hastens a return to comfort. Sometimes, as
in the case related by Dr. Marshall Hall of a man who smoked two
“pipes,” nausea, vomiting, and syncope occurred, followed by stupor,
stertorous breathing, general spasms, and insensibility of the pupil.
After an interval of a few hours, the above symptoms again returned,
but from which the patient ultimately recovered. Death has resulted
as a sequence to excessive smoking. Gruelin records two cases--one
from seventeen, the other from eighteen, pipes smoked at a sitting.
The symptoms after taking nicotine are more acute, and are a burning
acrid taste in the mouth and throat, nausea, vomiting, unconsciousness,
shock, sighing respirations, delirium, convulsions; the pupils first
contracted then dilated.
The filthy habit of snuff-taking has also been accredited with one
or two deaths. Santeuil, the French poet, died in two days from the
effects of snuff mixed with his wine as a practical joke.
In animals, the symptoms are--nausea, vomiting, purging, convulsions,
stupor, and death. The heart becomes paralysed. One drop of the
empyreumatic oil on the tongue of a cat killed it in two minutes, the
animal dying in convulsions.
_Post-mortem Appearances._--These are by no means uniform or
characteristic. If much vomiting precedes death, the vessels of the
brain may be engorged with blood. Inflammation of the stomach and
intestines is also present in some cases. The odour of nicotine may be
detected in the vomit or the stomach contents.
_Fatal Period._--The symptoms soon make their appearance, and death has
occurred in three-quarters of an hour, or even less--in three minutes
after taking the nicotine, in fifteen minutes after enema of tobacco.
_Fatal Dose._--One to three drops of nicotine would probably kill an
adult in a few minutes; an enema containing half a drachm of the leaves
has proved fatal.
As an enema, tobacco should be used with extreme care.
_Chemical Analysis._--Nicotine obtained by the usual process for
alkaloid extraction, and mixed with water, may have the following tests
applied after solution in dilute hydrochloric acid:
1. Chloride of platinum gives an orange-yellow crystalline
precipitate.
2. Corrosive sublimate, a white crystalline precipitate.
3. Arsenio-nitrate of silver, a yellow precipitate.
4. Caustic potash added to the hydrochloride and warmed
causes a strong odour of tobacco.
5. Solution of iodine in ether added to ethereal solution
of nicotine is followed by the production of long needle
crystals after some hours.
_Treatment._--Promote vomiting, wash out the stomach, cold water
douches, and stimulants. Inject strychnine hypodermically.
LOBELIA
Lobelia, or Indian Tobacco, _Lobelia inflata_ (_N.O. Lobeliaceæ_),
is extensively employed in North America in the treatment of asthma.
The plant is officinal in the British Pharmacopœia. In small doses it
possesses expectorant properties.
_Symptoms._--Nausea, vomiting, giddiness, cold clammy sweats, and
great depression. The pulse becomes irregular, and very feeble. Taken
together, the symptoms are not unlike those produced by tobacco.
_Fatal Period._--One to two days, or more.
_Fatal Dose._--One drachm of the powder.
_Chemical Analysis._--The alkaloid is fluid and may be extracted like
nicotine; with it (1) strong sulphuric acid gives a red colour; (2)
sulphomolybdic acid gives a violet colour.
_Treatment._--The same as recommended under tobacco. Stimulants should
be given, ether hypodermically or alcohol _per rectum_.
VERATRINE
The alkaloid _Veratrine_ is obtained from the dried fruit of _Asagrœa
officinalis_ (_N.O. Melanthaceæ_).
The alkaloid is in the form of a white amorphous powder, bitter and
acrid to the taste. It acts as a powerful errhine, causing violent
sneezing. Insoluble in water, it is readily dissolved by alcohol,
ether, and chloroform. When gently heated on a plate with strong
sulphuric acid, it first turns yellow, then crimson. Veratrine is
entirely dissipated by heat.
Two grains of the alkaloid killed a cat in one minute; a dog being
destroyed in two hours by a dose of three grains. The one-sixteenth of
a grain (?) of veratrine in a pill caused alarming symptoms in an adult
woman, for whom it was ordered by a medical man.
_Symptoms._--Acrid burning sensation in the throat and down the
œsophagus to the stomach, vomiting, great thirst, diarrhœa may occur
with tenesmus. The pulse is feeble and respiration slow. The pupils may
be dilated or contracted. Collapse and twitching of muscles, loss of
consciousness and convulsions, or delirium and stupor may come on.
_Post-mortem Appearances._--Are the same as in poisoning by any of the
vegetable irritants.
_Treatment._--Stomach pump, and emetics. Astringent infusions should
be given, and alcohol and opium administered if the condition of the
patient seems to require them.
_Chemical Analysis._--Extract in the usual way for alkaloids.
1. Strong sulphuric acid produces a yellow colour, changing to red,
produced rapidly if heated.
2. Strong hydrochloric acid and heat produces a red colour.
3. Sulphomolybdic acid produces a reddish colour, changing to dirty
brown, greenish, and finally blue.
These tests should be done with the solid veratrine.
HYDROCYANIC ACID
Hydrocyanic acid is a compound of cyanogen and hydrogen. It was first
obtained by Scheele in 1782, but it was not until 1815 that Gay-Lussac
pointed out its real nature. Anhydrous hydrocyanic acid may be obtained
by passing over cyanide of mercury, gently heated, a stream of dry
sulphuretted hydrogen. It is now made by mixing ferrocyanide of
potassium with dilute sulphuric acid, and applying heat, when the acid
is distilled over and collected in a cooled receiver.
Dilute hydrocyanic acid, the only important form of the acid from a
toxicological point of view, is a colourless, feebly acid liquid,
with a peculiar odour, like that of bitter almonds or peach kernels
(specific gravity, 0.997). The Pharmacopœial acid contains 2 per cent.
of anhydrous acid; that of Scheele 5 per cent. According to Taylor,
however, the percentage of the acid varies from 1.3 to 6.5. Taking
into consideration the smallness of the dose, and the shortness of the
time before death occurs, it is the most deadly of all known poisons.
Prussic acid is not regarded as a cumulative poison--that is, it does
not gradually accumulate in the body and then break out with dangerous
or fatal violence.
_Symptoms._--These will be more or less modified by the quantity of
the dose, and in some cases closely resemble an attack of epilepsy. In
most cases, the symptoms of poisoning are seldom delayed beyond _one_
or _two_ minutes; and if the dose be large, the symptoms of poisoning
may come on while the person is drinking. Giddiness, followed by almost
complete insensibility, mark the accession of the symptoms. The eyes
are fixed, staring, and glassy; the pupils are dilated, and insensible
to light. The muscles of the extremities are relaxed, and the limbs
flaccid. A white or bloody froth surrounds the mouth, and the jaws
are fixed. The surface of the body is cold and clammy to the touch;
the respiration is sometimes long-drawn and spasmodic; and the pulse
so reduced as to be almost imperceptible. The breathing is sometimes
_stertorous_ in character. This is an important fact; for, in ignorance
of the occasional presence of this symptom, it was argued that Walter
Palmer, whose breathing was stertorous, died of apoplexy, and not from
prussic acid as was alleged. When the dose is small (between twenty
and thirty drops of the dilute acid), the patient complains of nausea,
giddiness, and a feeling of constriction round the head. The mind is
confused, the pulse hurried, and the breathing irregular. Salivation
may also be present. Tetanic spasms and involuntary evacuations precede
the fatal termination. When the dose is from ten to twenty drops, the
patient complains of nausea, giddiness, and a feeling of impending
suffocation. These symptoms under treatment may soon pass off, or
leave the patient more or less confused and listless. In most cases,
where the dose is very large, death takes place suddenly, without
convulsions; but the period of death does not appear to be as short in
man as in the lower animals.
_External Application._--Applied to the unbroken skin, prussic acid
does not appear to have caused any alarming symptoms; but it should
be used with the utmost caution where the skin is at all abraded or
ulcerated.
_Post-mortem Appearances._--In making an inspection, care should be
taken; for, if the dose be large, the vapour from the corpse on opening
it has been known to produce giddiness and fainting. Externally, the
skin is pale, livid, or of a violet colour. The hands are clenched,
and the nails blue. The jaws are firmly set, and there is usually some
froth around the mouth. The internal organs are greatly congested, and
the venous system gorged with fluid dark-coloured blood. The stomach
and intestines are sometimes inflamed, but in many cases they present
no material alteration in colour.
The appearances, when only a small dose has been taken, are not unlike
those of asphyxia. The detection of the odour of hydrocyanic acid in
the body is of importance; but this may be absent from the following
causes:
1. Smallness of the quantity of the acid present.
2. Volatilisation from exposure of the corpse to the air.
3. The smallness of the dose, and its absence the result
of absorption and elimination, if death has not rapidly
taken place.
4. The amount of dilution of the poison.
5. Concealed by other odorous substances.
In some cases, the smell may be detected in the stomach seven or
eight days after death. The viscera should, in all cases of suspected
poisoning, be placed in a glass-stoppered jar, and the stopper covered
by bladder and tinfoil. Hydrocyanic acid is so volatile that, unless
the greatest care be taken, all traces of it may vanish; and thus the
guilty person may be allowed to escape.
_Fatal Period._--From a few seconds to as many minutes. Under active
treatment, if a patient survive forty minutes, he will generally
recover.
_Fatal Dose._--Thirty minims of the dilute acid of the Pharmacopœia.
This contains six-tenths of a grain of the anhydrous acid. Recovery
has, however, taken place even after comparatively large doses. The
strength and age of the individual, and also the emptiness or fulness
of the stomach at the time the poison is swallowed, will materially
affect the issue.
Experiments on Animals
Numerous experiments on animals have been made to ascertain the
rapidity with which prussic acid kills. The late Sir R. Christison
found that three drops projected into the eye acted on a cat in twenty
seconds, and killed it in twenty more. The same quantity dropped on
a fresh wound in the loins acted in forty-five, and proved fatal in
one hundred and five seconds. In the cases where death did not occur
so rapidly, there were regular fits of violent tetanus; but in the
very rapid cases, the animals perished, just as the fit was ushered
in, with retraction of the head. In rabbits opisthotonos, in cats
emprosthotonos, were the chief tetanic symptoms.
As a proof that the acid acts equally on the brain and spinal cord, may
be noticed the presence of coma and tetanus in some cases of poisoning
by this substance.
In the experiments on animals certain effects were noticed, which are
as follows:
_Expulsion of the Fæces and Urine._--In some cases only the fæces, in
others the urine alone, was involuntarily expelled; and in some other
cases neither the one nor the other was present.
_The Shriek or Cry._--This cry, though a common, is by no means a
constant symptom.
_Convulsions._--These are sometimes present.
_Acts of Volition._--Only slight acts are possible; in the case of one
of the dogs experimented on by Mr. Nunneley, the animal “went down,
came up, and then went down again the whole flight of a steep, winding
staircase.”
The _Post-mortem Appearances_ were not well marked in the animals
subjected to experiment. In chronic cases, Mr. Nunneley states that
both sides of the heart were distended with black blood. The pure
acid is stated to completely destroy the irritability of the heart
and voluntary muscles, galvanism producing no effect whatever. “In
eight experiments on cats and rabbits with the pure acid, the heart
contracted spontaneously, as well as under stimuli, for some time after
death, except in the instance of the rabbit killed with twenty-five
minims, and one of the cats killed by three drops applied to the
tongue. In the last two the pulsation of the heart ceased with the
short fit of tetanus which preceded death; and in the rabbit, whose
chest was laid open instantly after death, the heart was gorged, and
its irritability utterly extinct.”
=Detection of Hydrocyanic Acid in Cases of Poisoning=
The “_Vapour Tests_” are those most readily applied to organic
mixtures; but in some cases it may be necessary to make a distillation
of the suspected substance, in order to isolate the poison.
The first point to be noticed is, whether any _odour_ of the acid can
be perceived in the substance under examination. In any case, the
contents of the stomach or finely-divided tissues should be mixed with
water, and examined as to the reaction with test paper. If the mixture
be found to be _alkaline_, it must be neutralised by the addition of
tartaric acid; if, on the contrary, it be _acid_, carbonate of soda
must be carefully added to neutralisation. A state of neutrality is
always necessary previous to distillation, for the following reasons:
An _alkaline_ state of the liquid would, on the one hand, prevent, or,
at all events, retard, the evolution of the hydrocyanic acid; whilst,
on the other, the existence of any _free acid_ would decompose any
cyanide which might be present, and thus give rise to an evolution of
hydrocyanic acid not existing as such in the mixture.
The organic mixture is then placed in a flask, and the contents
distilled at as low a temperature as possible by the aid of a water
bath.
Should hydrocyanic acid be present, the distillate will yield all the
characteristic reactions of the dilute acid.
1. Nitrate of silver will give a curdy-white precipitate, insoluble
in cold but soluble in boiling nitric acid. A portion of the
precipitate, on the addition of some liquor potassæ, sulphate of iron,
ferric chloride and hydrochloric acid, forms Prussian blue. In this
test, which may be taken as quite conclusive, the hydrochloric acid
decomposes the cyanide of silver; and on the addition of the sulphate
of iron, Prussian blue is formed.
2. If a portion of the dry precipitate formed by the nitrate of silver
be heated in a test tube, cyanogen gas will be evolved, known by its
characteristic odour of peach blossoms, and by its burning at the mouth
of the tube with a rose-coloured flame.
3. To the solution containing hydrocyanic acid add a few drops of
potassium nitrite, two or three drops of ferric chloride solution and
dilute sulphuric acid until a yellow tint is obtained; heat to boiling,
cool, precipitate excess of iron with ammonia, filter, and add one or
two drops of a very dilute solution of colourless ammonium sulphide.
A very minute quantity of hydrocyanic acid gives a violet-red colour,
changing to blue, green, and finally yellow.
4. If a solution of starch be tinged blue with iodine, the colour will
be discharged by a minute quantity of hydrocyanic acid.
=Vapour Tests.=--There are three tests for the presence of hydrocyanic
acid when present in organic mixtures, which have the advantage of
being applicable without the addition of anything extraneous to the
mixture to be tested. They are all dependent on the volatile nature of
hydrocyanic acid, and may be applied as follows, the suspected mixture
being divided into three portions:
1. _Iron or Prussian Blue Test._--The liquid mixture to be tested is
placed in a small beaker glass, and covered with a glass plate the
centre of which is smeared with a mixture of potash and proto-sulphate
of iron. The whole is now left undisturbed for some time. The glass is
eventually removed, and the mixture of potash and iron treated with
hydrochloric acid, which, should hydrocyanic acid be present, will
cause the development of Prussian blue.
2. _Sulphur Test, or Liebig‘s Test._--A second portion of the original
mixture is placed in a beaker, and a watch-glass containing a few drops
of bisulphide of ammonium is suspended over the liquid, the mouth
of the beaker being closed. A short time is allowed to elapse; the
watch-glass is then removed, and its contents evaporated to dryness
at a low temperature. A blood-red colour is developed on the addition
of a little perchloride of iron to the _dry_ residue. This effect is
due to the absorption of the hydrocyanic acid vapour by the bisulphide
of ammonium--sulphocyanide of ammonium being formed, which, on the
addition of perchloride of iron, gives the blood-red colour of the
sulphocyanide of iron, which is bleached by corrosive sublimate.
3. _Silver Test._--This is the most successful of the vapour tests,
a single apple pip yielding all the reactions. If a watch-glass
containing a few drops of nitrate of silver solution be suspended in
a beaker (as in 2), the silver solution will become white and opaque,
from the formation of cyanide of silver; examined under the microscope
it is seen to consist of small prismatic crystals. The cyanide as
formed, treated with hydrochloric acid, liquor potassæ, and sulphate of
iron, will give Prussian blue.
_The Quantitative Analysis._--Use the precipitate of cyanide of silver,
100 grains being equal to 20.33 of pure anhydrous acid.
=Treatment.=--The treatment of poisoning by prussic acid is now to be
considered. As part of the general treatment, the stomach pump should
be at once employed, and the stomach emptied and then washed out with
water.
_Ammonia._--The use of this substance was first advocated by Mr. John
Murray of London, and is no doubt a valuable remedy if given early.
Care should be taken that the mucous membrane of the air passages and
alimentary canal be not inflamed by using too strong a solution.
_Chlorine._--Recommended by Riauz in 1822. Water impregnated with the
vapour of chlorine may be given internally, and the gas may be breathed
under proper precautions.
_Cold Affusion._--First proposed by Dr. Herbst of Göttingen. Its
success is most to be looked for when it is employed before the
convulsive stage of the poisoning is over. The cold water should be
poured on the head and down the spine.
[Illustration: Fig. 39.--Photo-micrograph of crystals of cyanide of
silver obtained by the vapour test, × 50. (R. J. M. Buchanan.)]
_Bleeding from the Jugular Vein._--In one case treated by Magendie,
bleeding from the jugular vein was attended with success.
_Chemical Antidotes._--The administration of a solution of carbonate
of potash, followed by a solution of the mixed sulphates of iron, has
been suggested. The formation of Prussian blue is the result. The
only objection to this treatment is, that prussic acid is so rapidly
absorbed that death may result from the already absorbed acid before
the antidote can be given.
_Atropine._--This should be given hypodermically.
_Peroxide of hydrogen_ should be given freely by means of the stomach
tube.
_Cobalt_ nitrate 0.5 to 1 per cent. solution has been advocated
hypodermically.
_Sodium thiosulphate_, in 10 per cent. solution, repeated
hypodermically.
Cyanide of Potassium
This substance is used largely by photographers and electro-platers.
It acts as a poison in a similar manner to hydrocyanic acid, and the
symptoms are the same. As a commercial preparation it frequently
contains undecomposed potassium carbonate, and may exert a corrosive
action on the mucous membranes of the mouth and stomach, leading to the
production of blood-stained mucus in the stomach.
_Post-mortem Appearances._--These are the same as those described under
hydrocyanic acid, with the addition of the corrosive effects.
_Fatal Dose._--Five grains have proved fatal in a quarter of an hour;
recovery has taken place after forty grains.
_Chemical Analysis._--Same as for hydrocyanic acid.
_Treatment._--As for hydrocyanic acid.
PREPARATIONS CONTAINING HYDROCYANIC ACID
The following plants contain prussic acid, and are therefore more or
less poisonous in proportion to the quantity of the acid which they
severally contain:
Nat. Ord. Rosaceæ
_Amygdalus Communis._--The Almond and its varieties.
_Prunus Domestica._--The Plum and its varieties.
_Cerasus._--The Cherry and its varieties.
_Pyrus Aria_, or White Bean Tree.--The seeds are poisonous.
Nat. Ord. Euphorbiaceæ
_Jatropha Manihot_, or Bitter Cassava.
Bitter Almonds
The essential oil of bitter almonds is very poisonous. “The oil does
not, like common essential oils, exist ready formed in the almond,
but it is only produced when the almond pulp comes in contact with
water. It cannot be separated by any process whatever from the almond
without the co-operation of water--neither, for example, by pressing
out the fixed oil, nor by the action of ether, nor by the action of
absolute alcohol. After the almond is exhausted by ether, the remaining
pulp gives the essential oil as soon as it is moistened; but if it is
also exhausted by alcohol, the essential oil is entirely lost. The
reason is, that alcohol dissolves out a peculiar crystalline principle
named _Amygdalin_, which, with the co-operation of water, forms the
essential oil by reacting on a variety of the albuminous principle in
the almond, called _Emulsin_, or _Synaptase_.
The essential oil of bitter almonds may contain from 6.0 to 14.33 per
cent. of hydrocyanic acid. Deaths from the incautious use of this oil
for flavouring articles of confectionery are not infrequent. As the
flavour is not in the least injured, it has been suggested to subject
the oil to repeated distillation with caustic potassæ, by which means
the oil is purified from prussic acid.
_Symptoms in Man._--Nausea, vomiting, and diarrhœa, due to gastric
irritation, have occurred when the dose has been small, as is the case
when confectionery owes its flavour to the use of the essential oil.
Idiosyncrasy may have something to do with these effects, for cases
are on record where a single almond has produced a state resembling
intoxication, followed by an eruption not unlike urticaria or
nettle-rash. Taken in large doses, the symptoms produced are identical
with those described under poisoning by prussic acid. The breath is
usually strongly impregnated with the odour of bitter almonds.
_Symptoms in Animals._--Vomiting, trembling, weakness, paralysis,
tetanic convulsions, and coma.
_Post-mortem Appearances._--These are identical with those seen in
poisoning by the pure acid.
_Fatal Dose._--The essential oil is from four to eight times as strong
as the acid of the Pharmacopœia. From twenty to thirty drops have
proved fatal. Death may take place in half an hour or less.
_Treatment._--The same as that recommended under prussic acid.
Cherry-Laurel
The cherry-laurel, _Prunus Laurocerasus_--the leaves of which have
been used for flavouring custards, &c.--contains prussic acid, and is
therefore poisonous.
In the British Pharmacopœia there is an _Aqua Laurocerasi_--laurel
water--prepared from the leaves. It contains 0.1 per cent. of
hydrocyanic acid. It should be used with extreme caution, as the amount
of hydrocyanic acid contained in the leaves is uncertain. Death has
frequently resulted from its use. The most important case, however, is
that of Sir T. Broughton. His mother, who gave him his usual draught
on the morning of his death, observed that it had a strong smell of
bitter almonds. Two minutes after he took it she observed a rattling
or gurgling in his stomach; in ten minutes more he seemed inclined to
doze; and five minutes afterwards she found him quite insensible, with
the eyes fixed upwards, the teeth locked, froth running out of his
mouth, and a great heaving at his stomach, and gurgling in his throat.
He died within half an hour after swallowing the draught. No light was
thrown on the case by the carelessly conducted _post-mortem_; but the
suddenness of his death, the improbability of apoplexy occurring at so
early an age, and the odour of bitter almonds observed by his mother,
pointed out clearly enough the true cause of death.
ACONITE
All parts of this plant, the _Aconitum Napellus_ (_N.O. Ranunculaceæ_),
are poisonous. The poisonous properties depend upon the presence of an
alkaloid--_aconitine_--chiefly found in the root.
Poisoning by the alkaloid came before the public mind in the case of
Dr. Lamson, executed for the murder of his brother-in-law. The symptoms
noticed in that case were very much as detailed below. When any part
of the plant is chewed, a sensation of tingling is experienced in the
mouth, and burning in the throat. Many of the aconites are, however,
inert. The root, having been taken by mistake for horse-radish, has led
to several cases of accidental poisoning.
-------------------------------------+------------------------------
Aconite | Horse-Radish
-------------------------------------+------------------------------
_General Characteristics._-- | _General Characteristics._--
Root conical; dark brown externally,| Root cylindrical, of nearly
and with numerous twisted rootlets; | the same thickness down its
internally, the colour is whitish. | whole length. Externally,
| buff-coloured; internally,
| white.
|
_Taste._--Produces a tingling | _Taste._--Sweet and pungent.
and numbing sensation in the mouth. |
-------------------------------------+------------------------------
_Symptoms in Man._--The patient complains, within a short time after
the poison is taken, of dryness of the throat, accompanied with
tingling and numbness of the mouth and tongue. He then complains of
nausea, vomiting, pain in the epigastrium, and distressing dyspnœa,
of a sensation of formication or tingling, with numbness in his face
and limbs, which appear to him heavy and enlarged. In attempting to
walk he staggers, his limbs losing their power of supporting his
body. He becomes giddy, his pupils dilated, and his sight and hearing
imperfect; but he is seldom unconscious till near death. His pulse
irregular, gradually becomes weaker, and at last almost imperceptible;
his skin cold and clammy; his features pale and bloodless; and his mind
clear: then suddenly he dies, in some cases from shock, in others from
asphyxia; or he may die from syncope, especially after some exertion.
_Symptoms in Animals._--Weakness of the limbs and staggering, the
respiration slow and laboured, loss of sensation, paralysis, dimness of
vision, increasing difficulty in breathing, _convulsions_, and death by
_asphyxia_.
Delirium is present in some cases, and dilatation of the pupil has also
been noticed. In a case recorded in the _British Medical Journal_,
1877, vol. i. p. 258, two ounces of the tincture of aconite were drunk
in mistake for _Succus Limonis_; recovery took place, but not before
alarming symptoms had taken place, and death at one time appeared
imminent.
_Post-mortem Appearances._--General venous congestion. The brain and
its membranes are, in most cases, found congested and the stomach and
intestines inflamed.
_Fatal Period._--The symptoms may come on immediately, or may be
delayed for an hour or two. In the case mentioned in the _British
Medical Journal_ the patient walked about five miles after swallowing
two ounces of the tincture, which he drank at 11 o‘clock, returning
home at 2.30 P.M. An excise officer, who died in about four hours, was
able to walk from the Custom House over London Bridge. Death has taken
place in so short a time as one hour and a quarter.
_Fatal Dose._--About two grains of the extract, and one drachm of the
tincture. Much will depend upon the amount of the alkaloid present. One
drachm of the scraped root is said to have proved fatal. One-fifteenth
of a grain of aconitine has proved fatal.
_Chemical Analysis and Tests._--The alkaloid must be isolated from the
contents of the stomach by the process of Stas. The physiological test
consists in placing a small portion of the extract, or the alkaloid so
obtained, on the tongue or lip, and noting if tingling be produced.
To the pure alkaloid, nitric acid added produces no change of colour.
Officinal phosphoric acid added, and the mixture carefully evaporated,
a violet colour is produced; this reaction is due to impurities in the
aconitine.
_Kundrat‘s Test._--A solution of ammonium vanadate in strong sulphuric
acid produces a coffee colour with aconitine.
_Treatment._--Emetics, stomach lavage, castor-oil, and animal charcoal
should be given. The administration of digitalis in aconite poisoning
has been attended with good results. (See _British Medical Journal_,
11th December 1872.) The drug may be given hypodermically as an
antidote. Stimulants will be required; and friction down the spine,
together with galvanism and artificial respiration, may be tried.
=Synopsis of the Action of Aconite=
1. _On Nervous System._--Giddiness, numbness, and tingling in the limbs
is a primary effect, followed by gradually increasing paralysis of the
muscles, and insensibility of the surface of the body to pinching and
pricking. Dr. Fleming asserts that it produces a _powerful sedative
effect on the nervous system_. At any rate, it now seems to be proved
that aconite paralyses the sensory nerves, commencing at their
peripheral endings.
2. _On Vascular System._--Extreme depression of the circulation is
produced by doses large enough to cause death. The pulse may become
imperceptible at the wrist. In medicinal doses, aconite lowers the
heart‘s action; in poisonous doses, it causes fatal syncope.
3. _On Digestive System._--Some have denied the irritant action of
aconite on the alimentary canal, but Sir R. Christison states that he
was deterred from the use of aconite “by two patients being attacked
with severe vomiting, griping, and diarrhœa.”
CHAPTER XII
CEREBRAL POISONS
The symptom most characteristic of these poisons is the marked
anæsthesia which they produce when their vapours are inhaled. The
hydrate of chloral, though placed under the above heading, is more
closely allied in its action to opium than to ether or chloroform.
ETHER
Ether, when taken in its liquid form, produces symptoms and
_post-mortem_ appearances not unlike those caused by alcohol.
_Fatal Dose._--No death having been recorded, the fatal dose of this
substance is unknown.
=Ether Vapour.=--The vapour of ether has caused death. Entering the
blood through the lungs, it acts with great rapidity, a state of
lethargy being quickly induced.
The early symptoms are noticed in a modification of respiration, the
breathing becoming slow, prolonged, and stertorous. The face is pale,
the lips bluish, and the surface of the body cold and exsanguine. The
pulse, at first quickened, becomes slower, as the inhalation of the
vapour is continued. The pupils are dilated, and the eyes glassy and
fixed. The voluntary muscles of the body become flabby and relaxed,
the patient still, however, having the power to move the limbs. The
involuntary muscles are not affected; as an instance, the uterus
contracts and expels its contents with ease. If the inhalation of
the vapour be pushed too far, the pulse sinks, and coma ensues, from
which the patient can only with difficulty be aroused; but if in an
early stage the ether be discontinued, the patient quickly regains
consciousness, due to the rapid elimination of the ether by the
lungs. A marked peculiarity in this form of poisoning is the complete
anæsthesia or paralysis of the nerves of sensation.
_Post-mortem Appearances._--These are chiefly found in the brain and
lungs, which in most cases are greatly congested. The cavities of the
heart have been found full of dark-coloured liquid blood. A marked
effect noticed in poisoning by ether is the congestion of the vessels
of the upper portion of the spinal cord. The liver, kidneys, and spleen
are sometimes congested.
_Chemical Analysis._--The contents of the stomach and tissues must be
treated and distilled, as described under alcohol.
_Tests_:
1. The vapour passed into a solution of bichromate of
potash, and sulphuric acid added, gives the reactions of
alcohol.
2. The vapour burns with a smoky flame, depositing carbon on
any cool surface placed above the flame.
3. It is but sparingly soluble in water, on which liquid it
floats.
_Treatment._--When the pulse becomes weak, and the breathing laboured
and stertorous, the inhalation should be discontinued, and cold water
dashed in the face--free ventilation being also allowed. Galvanism and
artificial respiration should also be tried.
CHLOROFORM
The effects produced by chloroform when swallowed are not unlike those
occasioned by alcohol. Four ounces have been taken without causing
death; it is, therefore, not an active poison in this form.
=Chloroform Vapour.=--The symptoms occasioned by chloroform when
inhaled are not unlike those caused by ether, with this exception, that
insensibility and general relaxation of the muscles are more rapidly
produced.
_Symptoms._--The symptoms of poisoning when chloroform is taken by the
mouth are similar to those following inhalation, with irritation of
the mucous membrane of the stomach and intestines. Vomiting generally
occurs, the person becomes unconscious and comatose, the face cyanosed
and the skin moist. The pupils are dilated and insensitive to light.
The breathing is slow and stertorous, the pulse small and feeble.
Death is due to respiratory paralysis first, and paralysis of the
heart in addition, or the latter, according to some observers, may be
the primary cause. On recovery diarrhœa may follow, with occasionally
enlargement of the liver and jaundice.
_Post-mortem Appearances._--Congestion of the vessels of the brain, and
also of the lungs, is generally found. The cavities of the heart are
usually empty; but, in some cases, the right side of the heart is found
distended with dark-coloured fluid blood. Congestion of the spleen,
liver, and kidneys is not of infrequent occurrence.
_Fatal Period and Dose._--In one or two cases where the vapour was
inhaled, death took place in from one to two minutes. Thirty drops thus
taken destroyed life in one minute, and even fifteen drops have proved
speedily fatal. It has thus destroyed life in a smaller dose, and
more rapidly, than any other known poison. When swallowed, one fluid
drachm has proved fatal in a boy, about four fluid drachms in an adult.
Recovery has taken place after four fluid ounces. Three hours is the
shortest fatal period after swallowing chloroform.
_Chemical Analysis._--In searching for the presence of this substance
in the blood or tissues, the examination should be made as speedily as
possible, as chloroform is thought by some observers to have a great
tendency to pass into formic acid, and thus to escape recognition.
1. The substance to be examined should be placed in a flask, to which
is adapted a glass tube bent at right angles. A piece of blue litmus
paper, and another portion of paper moistened with iodide of potassium
and starch paste, are inserted into the end of the glass tube. The
flask and its contents should now be placed in a water bath heated to a
temperature of 161° F. (72° C.), and a portion of the glass tube just
past the bend heated to redness. Any chloroform vapour evolved from
the contents of the flask is decomposed during its passage through
the heated glass tube into free chlorine and hydrochloric acid, the
presence of the former being indicated by the starch paper becoming
blue; while at the same time the reddening of the litmus paper reveals
the presence of the acid. As a further corroboration, the exit tube may
be made to dip into nitrate of silver solution, when a precipitate of
the curdy-white chloride of silver will take place, insoluble in nitric
acid, but dissolving on the addition of ammonia. Every 100 parts of
chloride of silver formed, equals 27.758 of chloroform. By this process
chloroform has been detected four weeks after death in putrid organs.
2. Chloroform may be separated from organic mixtures by distillation.
If aniline and alcoholic solution of potash be added to chloroform and
heated, the peculiar odour of phenyl-isocyanide is given off.
3. A solution of β-naphthol dissolved in caustic potash, when added to
chloroform and heated, gives a blue colour.
4. Chloroform reduces Fehling‘s solution.
_Treatment._--The same as recommended with regard to ether. M. Nelaton
recommends inversion of the body, and ascribes the recovery of one
patient to his suddenly lifting him up and throwing him over his
shoulder with his head hanging down.
CARBON BISULPHIDE
This substance is largely used in certain industries, as it dissolves
oils, fats, caoutchouc, gutta percha, &c. It is very inflammable,
burns with a blue flame, evolving sulphur dioxide. The odour, when
this substance is impure, is very disagreeable. If taken internally,
it produces an intense burning sensation in the throat, headache, and
giddiness. In chronic poisoning from the vapour in manufactories where
it is used, there appear to be two stages--one of excitement, and
one of depression. In the former, there are more or less persistent
headache, irritability of temper, tinnitus aurium, and even mania;
in the latter, anæsthesia of the skin, even affecting the mucous
membranes, patients complaining that their tongues feel as if tied in
a cloth. Paralysis of the limbs has been noted in prolonged cases of
chronic poisoning. The _post-mortem_ appearances do not differ much
from those found after death from the inhalation of chloroform. Carbon
bisulphide may be separated from organic liquids by distillation, and
detected by its odour, and by a black precipitate of sulphide of lead
when heated with nitrate of lead and potash.
CHLORAL HYDRATE
This substance is prepared by acting on alcohol by chlorine. It is used
extensively as a hypnotic, and, owing to its indiscriminate use, many
fatal cases have been recorded. Care should be taken when large doses
are given not to repeat them too quickly, as there appears to be a
tendency to accumulation, and sudden and dangerous action of the drug.
_Symptoms._--Chloral, in moderate doses, acts on the brain as a
powerful hypnotic, the early symptoms being gradual drowsiness,
followed by deep sleep. With a dose of about 30 grains, the patient
can, however, by walking about, ward off sleep. In large doses the
narcosis becomes completely uncontrollable, and the poison then acts
as a depressant to the basal ganglia of the brain, and on the spinal
cord; and, as a result, there is weakness of the heart‘s action, with
ultimate diastolic arrest, slowing of the respiratory movements,
and general muscular weakness, with some anæsthesia. Under these
circumstances the patient has all the appearance of a drunken person,
the face is flushed, and the deep sleep may pass imperceptibly into
death without any marked change. In some cases delirium precedes the
condition of sleep. The pulse in some cases is quickened, and the
face flushed; but, in other cases, the pulse becomes slow and almost
imperceptible, the heart being ultimately arrested in diastole. In
these cases the face is pale, and the breathing performed at long
intervals. The motor paralysis present, when a poisonous dose is
taken, is due to the action of the drug on the spinal cord, and not
on the nerves. During the sleep produced by chloral, the pupils are
contracted, but dilate on the person awakening. In a case described by
Dr. Levinstein, and reported in the _Lancet_, 21st February 1874, the
patient took six drachms with intent to commit suicide. The face was
at first flushed, the veins swollen, and the pulse 160 per minute; he
then became livid, the pupils contracted, and at times the circulation
appeared to be entirely arrested. The temperature varied from 32.9°
C. to 38.7° C. (89.6° F. to 100.4° F.). This case recovered under
treatment by the subcutaneous injections of strychnine (.03 to .04
grain), and the use of faradisation in thirty-two hours after the
poison had been taken. Chronic chloral poisoning, “chloral-drinking,”
has unfortunately become far too common of late years, in which the
mental faculties suffer severely, so that in our asylums, cases of
mania and melancholia are rightly (or wrongly) attributed to the habit.
A peculiar eruption, not unlike that produced by shell-fish, and
followed by desquamation, sometimes occurs when this substance has been
given for some time in medicinal doses.
_Post-mortem Appearances._--These are not unlike those of asphyxia, the
vessels of the brain being engorged, and the ventricles containing an
abnormal quantity of fluid. The mucous membrane of the larynx may be
injected, and in some cases œdematous. The right side of the heart is
engorged and the left empty, together with congestion of the lungs.
Chloral is very little decomposed into chloroform by the blood. W. H.
Roberts has in several cases recovered it as chloral from the blood.
_Fatal Dose._--The fatal dose cannot be accurately stated, but
children, as in the case of belladonna, are said to bear the drug
better than adults. A child a year old died in ten hours from a dose of
three grains. Ten grains proved fatal to an old lady seventy years of
age. Twenty grains has caused death in an adult in half an hour, and in
one case thirty grains. As a rule, any quantity over two drachms may
be considered a dangerous, if not a fatal dose, although recovery has
been stated to have occurred after one ounce. Dr. Richardson considers
120 grains, distributed over twenty-four hours, as a safe dose for an
adult. Death may take place suddenly, or after the lapse of several
hours.
_Fatal Period._--From fifteen minutes, which is the shortest time on
record, to thirty-nine and a half hours, which is the longest period
recorded.
_Chemical Analysis._--Chloral may be extracted from the stomach
contents by digestion with absolute alcohol acidified by sulphuric
acid. The alcoholic extract is filtered and evaporated. The residue is
treated with petroleum ether to remove fatty substances, and finally
shaken with pure ether to remove the chloral. On evaporating the ether
the chloral hydrate is left. From urine it may be extracted by first
acidifying with sulphuric acid and then treating it with petroleum
ether and ether. Chloral hydrate in solution gives the following
reactions:--
1. On agitation with solution of caustic potash, and gently warmed if
necessary, chloroform is evolved, which can be detected by its odour.
From a strong solution the chloroform may separate in the form of
minute globules.
2. If one drop of ammonium sulphide be added to a solution of chloral
hydrate and gently heated, a peculiar opalescent milky reddish-yellow
precipitate forms. This test is extremely delicate, and differentiates
chloral hydrate from chloroform.
3. Alcoholic solution of potash and aniline when added to chloral
hydrate solution, shaken up and warmed, produces the peculiar odour of
phenyl-isocyanide. This is due to the formation of chloroform on the
addition of the caustic potash.
4. If β-naphthol dissolved in caustic potash solution be added to a
solution of chloral hydrate and the mixture warmed, a blue colour is
produced.
5. Chloral hydrate reduces Fehling‘s solution.
To separate chloroform in the stomach contents from chloral hydrate
they should be acidified with tartaric acid and distilled, when
the chloroform which was free in the stomach will pass over to the
receiver. If the residue be now rendered alkaline with caustic potash
and again distilled, any chloroform which then comes over must have
been derived from chloral hydrate in the stomach contents.
_Treatment._--The treatment consists in washing out the stomach, the
administration of emetics, or hypodermic injection of apomorphine,
in the use of galvanism, friction, mustard-plasters to the calves of
the legs, artificial respiration, and the hypodermic injection of a
solution of nitrate of strychnia or injection of atropine. The warmth
of the body must be carefully maintained in all cases by suitable
external applications. Oxygen inhalations are said to be beneficial.
SULPHONAL
Sulphonal is a product of the oxidation of mercaptol, obtained from
acetone and mercaptan; it occurs in tasteless, odourless, colourless
crystals or powder, was introduced into medical practice in 1888, and
has since caused many accidental deaths. The habit of taking it may
be acquired. It has a tendency to accumulative action when taken for
some time without interruption. A serious feature in most of the cases
of poisoning is that usually those taking it have been apparently
benefited by the drug up to the time of the appearance of toxic
symptoms.
_Symptoms._--In medicinal doses (15-30 grains) it has an action
similar to that of paraldehyde, it causes sleep with little depression
of the circulation and respiration. Larger doses produce variable
symptoms, mental confusion with nervous ataxic manifestations, stupor,
and insensibility; less frequently excitement and convulsions. Skin
eruptions may follow a large dose or from its long continued use. In
severe cases there is marked cyanosis, feeble pulse, and stertorous
and irregular breathing. Death usually results from failure of
respiration, or the urine may be suppressed and fatal coma supervene.
Albuminuria and hæmatoporphyrinuria are common features, especially
in chronic cases. The deep pink colour of the urine was attributed to
hæmatoporphyrin, and indicating extensive destruction of the red blood
corpuscles. It is a grave symptom. That the colour of the urine is due
to hæmatoporphyrin is questionable, for on removing the hæmatoporphyrin
the colour remains the same. The cumulative action is due to slow
elimination by the kidneys. A case published by Drs. Taylor and Sailer,
and reported in the _Lancet_, February 1900, was that of a woman aged
fifty-two years, unmarried, and presenting symptoms of hysteria. On
inquiry it was discovered that she had been in the habit of taking
sulphonal for some time, the dose being fifteen grains per diem.
She was informed of the evil results likely to follow the continued
use of the drug, and she discontinued its use for some weeks. After
this she resumed taking the drug, and began speedily to exhibit all
the symptoms of sulphonal poisoning: viz. mental confusion, marked
insomnia, difficulty of speech, and a peculiar sighing dyspnœa. The
urine was tinged a deep pink colour (hæmatoporphyrinuria), and a
stiffness and paralysis of both legs soon developed. The control of
the sphincters was lost. Cutaneous sensibility was not affected. The
paralysis spread rapidly upwards, and death resulted from cardiac
failure. Spectroscopic examination of both urine and blood disclosed
the presence of hæmatoporphyrin. At the necropsy the following
conditions were revealed: fatty degeneration was present in the heart,
liver, and kidneys. The spleen was filled with a greenish pigment, both
free and within the lymphoid corpuscles, the fibrous trabeculæ were
greatly increased in size, and the lymphoid follicles were extremely
well developed. Excessive pigmentation was found also in the lymphatic
glands of the body and in the lungs. No morbid changes could be found
in the spinal cord or brain.
_Fatal Dose._--This is very uncertain, depending upon idiosyncrasy.
Thirty grains has caused death in a woman in forty hours, while a
case is reported in the _Lancet_, January 1904, of recovery after the
taking of 365 grains. In many cases death has followed the daily use of
moderate doses (10-20 grains) for several months.
_Fatal Period._--May occur in a few hours, or days, or after months;
also after the use of the drug has been discontinued.
_Chemical Analysis._--Sulphonal is very stable, and is unaffected by
boiling alkalies or by concentrated nitric or sulphuric acids. From
its solution in concentrated sulphuric acid it may be recovered by
dilution. It is easily recovered from the body after death, as its
stability prevents its decomposition. It is isolated from organic
matter by treatment with alcohol, evaporation, and extraction of the
residue with hot water, evaporation and final extraction with ether.
_Tests._--1. Heated in a test tube with powdered charcoal, sulphonal
forms mercaptan, acetic acid, formic acid, and sulphur dioxide. The
offensive odour of mercaptan may be noted, and the vapours will change
blue litmus paper. Sulphur dioxide may be shown by its bleaching action
on a piece of filter paper moistened with blue starch iodide and
suspended in the mouth of the tube.
2. When melted with potassium cyanide, sulphonal develops a mercaptan
odour, and potassium sulphocyanate is formed at the same time. A
blood-red colour is therefore produced on the addition of ferric
chloride to a solution of the residue in water. Great care must be
exercised in the carrying out of this test, as it is somewhat dangerous
to the experimenter.
_Treatment._--The stomach should be washed out in order to remove any
drug unabsorbed. Diuretics, purgatives, and general stimulants given,
such as strychnine, hot coffee, &c.
TRIONAL AND TETRONAL
These compounds are very similar in both their chemical and
physiological properties to sulphonal, but both have a bitter taste.
Both have caused fatal poisoning, the symptoms being very similar to
those caused by sulphonal.
VERONAL
Veronal, a synthetic compound, is a white crystalline powder about four
times as powerful as sulphonal, very slightly soluble in water, more
soluble in hot water, and in alkaline solutions, and absorption takes
place from the intestine.
_Symptoms._--In moderate doses it produces sleep without subsequent
depression, and does not affect temperature or respiration. In larger
doses it may cause erythema and constipation, with alternating
semi-coma and delirium. During the last few years fatal cases of
poisoning have become rather frequent.
Details of a fatal case by Dr. Durrant reported in Taylor, p. 616, are,
briefly: A man aged thirty-three, a heavy drinker, to whom veronal
had been prescribed, in fifteen-grain doses, with chloral hydrate and
bromide of ammonium, had gradually increased the dose from 15 to 30
grains, or even 60 grains. Five weeks before death he had taken 100
grains, and had recovered in three days. Nine hours after taking 120
grains of veronal with 20 grains of chloral and 40 grains of ammonium
bromide he was found deeply comatose, with surface warm, respirations
32, pulse 102, pupils dilated, corneæ insensitive, reflexes absent.
Next day not so deeply comatose, he could be made to wince by slapping
the face, the pupils were still dilated, temperature 102° F., pulse
110, reflexes still absent. Later he was still constipated, and the
breathing impeded by mucus. On the third day he spoke when roused;
the temperature, bowels, and pupils the same. With slight remission
he became worse, and on the fourth day, in a comatose condition,
with muscular flaccidity and absence of reflexes, temperature 104°
F., respirations over 40, and the pulse 150, death took place.
_Post-mortem._--Nothing was found except intense congestion of the
lungs, liver, spleen, and brain, due, no doubt, to the asphyxial form
of death. The mucous membrane of the alimentary canal was congested,
but otherwise normal.
_Chemical Tests._--1. Heated dry with sodium carbonate, ammonia is
evolved. If held in the mouth of the tube red litmus paper turns blue,
turmeric paper brown.
2. A saturated solution acidified with nitric acid gives a white
precipitate with Millon‘s reagent soluble in excess.
_Treatment._--As for sulphonal.
CHAPTER XIII
NEURAL POISONS
CONIUM
The common or spotted hemlock, _Conium maculatum_ (_N. O.
Umbelliferæ_), is indigenous. It must be distinguished from the
_Myrrhis temulenta_, another indigenous, umbelliferous plant, which
has also a spotted stem, but which is covered with hairs--the stem of
the hemlock being smooth. Several cases of poisoning have occurred,
hemlock having been mistaken for parsley, fennel, asparagus, and
parsnip. The leaves of the plant have a peculiar mousy odour, which is
intensified when they are rubbed in a mortar with some caustic potash.
The poisonous properties reside in an alkaloid, _conine_. The activity
of the plant appears to depend upon the time of the year when it is
gathered, being most powerful in May. The ready decomposition of the
alkaloid by heat or age renders the extract of conium a very uncertain
preparation, the conine being converted into an inert resinoid matter.
_Conine_ the alkaloid is a colourless volatile oil, lighter than
water, with an odour of mice. It is strongly alkaline, soluble in
diluted acid, but its salts have not yet been crystallised. It has been
suggested that a ptomaine not unlike conine may be formed in the body
by the combination of one molecule of butyric acid and one molecule of
ammonia with separation of water, thus:
Butyric Acid. Ammonia. Conine.
2C₄H₈O₂ + NH₃ - 2H₂O = C₈H₁₅N
Conine is a deadly poison, killing all animals, death resulting from
asphyxia. Neutralised with an acid, its activity is increased, and it
becomes more soluble in water. Almost instant death resulted in a dog
from injecting two grains of conine, neutralised with hydrochloric
acid, into the femoral vein.
_Symptoms in Man._--The symptoms in some cases resemble those of
poisoning with opium; in others, the patient complains of dryness and
constriction of the throat, and drowsiness. There is dilatation of the
pupil, with closure of the eyes or ptosis, and loss of power in the
muscles of the extremities, so that the patient falls on attempting to
walk. The paralysis does not appear to be due to any direct influence
upon the muscles, but upon the motor nerves, and especially on their
extreme peripheral ends, and in this differs from Calabar bean, which
acts on the spinal cord. Gradual loss of power in the respiratory
muscles is the cause of death. Giddiness, coma, and convulsions were
the typical symptoms of two cases of accidental poisoning recorded by
Dr. Watson.
_Symptoms in Animals._--“Palsy, first of the voluntary muscles, next of
the chest, lastly of the diaphragm--asphyxia, in short, from paralysis,
without insensibility, and with slight occasional twitches only of the
limbs; and the heart was always found contracting vigorously for a long
time after death” (Christison).
_Post-mortem Appearances._--Congestion of the vessels of the brain and
lungs. The blood is very fluid, and of a dark colour, the fluidity due
probably to the mode of death--slowly induced asphyxia. There may be
some redness of the mucous membrane of the alimentary canal.
_Fatal Period._--The symptoms may come on in from ten minutes to an
hour, or more, after the poison has been taken. Death usually takes
place in about four hours.
_Fatal Dose._--Uncertain. Thirty grains of the extract carefully
prepared killed a rabbit in five minutes. A single drop of conine
dropped into the eye of a rabbit killed it in nine minutes.
_Chemical Analysis._--Conine may be extracted from organic mixture by
the general process for extracting alkaloids. The following tests may
then be applied:
1. The odour of conine, when diluted with water, resembles that of
mice. Harley states that a mixture of caustic potash with organic
substances may evolve a similar odour even when conine is absent.
2. On warming conine with sulphuric acid and potassium bichromate
butyric acid is produced, and can be recognised by its peculiar odour.
3. If conine be added to a solution of alloxan a reddish-purple colour
is produced in a few minutes, and white needle-shaped crystals form
on standing. These crystals if dissolved in caustic potash solution
produce a purple colour, and the odour of conine is given off.
_Treatment._--Emetics, stomach pump, castor-oil, followed by ammonia
and other diffusible stimulants. Artificial respiration should be
resorted to and kept up for a long time.
CALABAR BEAN
A strong emulsion of Calabar bean, _Physostigma venenosum_ (_N.O.
Leguminosæ_), is used on the West Coast of Africa as a test of
innocence in cases of suspected witchcraft. In 1864 some children in
Liverpool were poisoned by eating some of these beans, which had been
swept out of a ship from Africa on to a heap of rubbish. The poisonous
alkaloid is physostigmine or eserine.
_Symptoms._--Vomiting, giddiness, irregular action of the heart. The
mental faculties are unaffected. The eyes are bright and the pupils
_contracted_; in which latter it differs most strikingly from atropine,
hyoscyamine, and daturine, where dilatation of the pupil is the rule.
The late Sir R. Christison considered that its primary action is on
the heart, causing paralysis of that organ, and that the insensibility
and coma are only secondary. Dr. Harley considers that it is not a
cardiac, but a respiratory poison. Later experiments have shown that
the paralysis produced is due to the action of the drug on the spinal
cord and not on the nerve trunks. It appears also that death is due to
a failure of the respiration, for the heart in animals has been found
still beating for one and a half hours after death. The contraction
of the pupil, when locally applied, is probably brought about by its
paralytic action on the peripheral sympathetic nerve fibres of the
iris; and it is stated that when very large doses of physostigmine are
given, the pupils dilate, pointing to oculo-motor palsy. A few drops of
the extract placed in the eye cause powerful contraction of the pupil.
_Fatal Dose._--Six beans produced death in a boy six years of age.
_Chemical Analysis._--The alkaloid eserine should be extracted in the
usual way, benzene being used as a solvent in the place of chloroform
and ether.
Eserine gives the following chemical reactions:
1. If an aqueous solution of the salt be boiled and then strong nitric
acid added, the solution turns a yellowish-orange colour, changed to
violet on addition of caustic soda in excess; the violet is discharged
on acidulation, but returns on re-alkalising the solution.
2. A solution of eserine in ammonia solution gives a blue residue on
evaporation to dryness. Dilute acids produce a red-coloured solution
with it, which is fluorescent by reflected light.
3. Bromine water produces a red turbid solution with eserine, which
clears on heating.
4. The physiological test--eserine solution instilled into the eye of
an animal produces contraction of the pupil.
_Treatment._--The stomach should be emptied and washed out by means of
the syphon tube, or emetics administered. One-fiftieth to one thirtieth
of a grain of atropine sulphate should be administered hypodermically
and repeated until the pupils dilate. The tincture of belladonna may
be given by the mouth. Stimulants should be given and artificial
respiration carried out if required.
CHAPTER XIV
EXCITOMOTORY POISONS
NUX VOMICA STRYCHNINE
Some of the most poisonous known plants belong to the genus _Strychnos_
(_N.O. Loganiaceæ_).
The Java poison, Upas Tieuté, is a watery extract of _S. Tieuté_; the
basis of the poison used in Guiana, and known as Wourali, Ourari,
Urari, or Curare, is the juice of _S. toxifera_. _S. nux vomica_,
the Koochla tree, produces the nux vomica seeds of commerce; and the
bark of the tree has been accidentally substituted for cusparia, or
angustura bark, hence it is known as _false angustura_ bark. The
substitution is attended with considerable risk, on account of the
strychnine which the false bark contains. It may be known by its
being quilled, externally covered with white lichenous spots, and the
internal surface becoming _blood-red_ when touched with nitric acid.
This reaction, which depends upon the presence of an alkaloid, brucine,
_does not_ occur when true angustura bark is thus treated.
NUX VOMICA
_The Seeds of S. Nux Vomica_
The British Pharmacopœia contains an extract and a tincture. The
alkaloid strychnine is the active principle of the seeds and other
parts of the plant. Another alkaloid, brucine, is also found, and is
poisonous.
The symptoms and _post-mortem_ appearances and treatment will be
detailed under the head of strychnine. The brown powder of the seeds
may, in some cases, be seen adhering to the mucous membrane of the
stomach.
STRYCHNINE
Strychnine is very slightly soluble in cold water to the extent of one
part in 8300; in boiling water one part dissolves in about 2500. It is
more soluble in alcohol, and very soluble in chloroform or ether and
chloroform mixed.
It has a bitter taste, so intense, that one part in 70,000 of water
can be detected by the taste. Strychnine is not easily decomposed--it
resists the action of warm strong sulphuric acid, and is not altered by
putrefactive processes when present in viscera. It has been discovered
in the body 322 days after death in one case, 368 days in another.
[Illustration: Fig. 40.--Photo-micrograph of crystals of strychnine
sulphate from aqueous solution, × 50. (R. J. M. Buchanan.)]
[Illustration: Fig. 41.--Photo-micrograph of crystal of strychnine
sulphate from aqueous solution, × 50. (R. J. M. Buchanan.)]
Allen detected strychnine in the residue of some viscera from a person
who had died of strychnine poisoning, and which he had kept in a jar
for six years. Richter found the alkaloid at the end of eleven years in
putrid tissues which had been exposed to the air all that time in open
vessels.
_Symptoms._--Should the poison be in solution, the patient complains
of a hot and intensely bitter taste during swallowing. The effects of
the poison depending to a great extent on the mode of administration,
become manifest in from a few minutes to an hour or more after it
is taken. The earliest symptoms are a feeling of suffocation and
great difficulty of breathing. These come on suddenly, without any
premonitory warnings. Twitching of the muscles rapidly pass into
tetanic convulsions of nearly all the muscles of the body, which
are simultaneously affected. The head after several jerks becomes
stiffened; the neck rigid; the body curved forward, quite stiff, and
resting on the back of the head and heels. The face is congested, and
the countenance expresses intense anxiety; the eyes staring, the mouth
open, and the lips livid. The throat is dry, the thirst great; but
when an attempt is made to drink, the jaws are spasmodically closed,
and a piece of the vessel may be bitten out. During the intervals of
the paroxysms the intellect is usually clear, and the patient appears
conscious of his danger, frequently exclaiming, “I shall die!” He is
also conscious of the accession of the paroxysms, telling those around
him of their approach, and asking to be held. In the case of J. P.
Cook, poisoned by Palmer, those about him tried to raise him, but he
was so stiff that they found it impossible. He then said, “Turn me
over,” which they did, and he died in a few minutes. Intense pain is
felt, due to the powerful contractions of the muscles. After the lapse
of a minute or two, the spasms subside, a sudden lull takes place,
during which the patient feels exhausted and his skin is bathed in
sweat.
In poisoning by strychnine, the jaws are slightly, if at all, affected,
trismus is a late symptom, and occurs only during a convulsive seizure.
In tetanus the result of disease, the locking of the jaws is an early
and a marked symptom.
As death approaches the fits become more frequent, and the patient dies
from exhaustion or suffocation.
_Post-mortem Appearances._--There is no characteristic appearance found
after death. The blood is fluid, the heart empty, with some congestion
of the membranes of the brain. Absence of all cause for so violent and
sudden a death. _Rigor mortis_ is prolonged for some time.
_Fatal Period._--The rapidity in the accession of the symptoms and
fatal termination will, to some extent, depend upon the form in which
the poison is taken--_i.e._ in solution or in pill. In most cases the
symptoms appear in from three or four minutes to an hour or more after
the poison is swallowed, death following in from ten minutes to six
hours. As a rule, if the person lives for two hours after the onset of
symptoms recovery may be expected.
[Illustration: Fig. 42.--Photo-micrograph of strychnine sulphate, film
preparation from chloroform solution, × 50. (R. J. M. Buchanan.)]
[Illustration: Fig. 43.--Photo-micrograph of chromate of strychnine, ×
50.
(R. J. M. Buchanan.)]
_Fatal Dose._--A quarter to half a grain; but large doses have been
taken, followed by recovery.
[Illustration: Fig. 44.--Photo-micrograph of sulphocyanate of
strychnine, × 50.
(R. J. M. Buchanan.)]
_Chemical Analysis._--The poison may fail to be detected, and this
link in the scientific evidence may be wanting, as was the case in
Palmer‘s trial. In that case the strychnine had been administered in
_pills_; and when after death the stomach had been cut open, and the
contents lost, there was little hope of discovering the poison. The
non-discovery of the poison was made a strong point on the part of the
defence, ignoring at the same time the fact that the stomach had been
tampered with and the contents spilt. The alkaloid abstracted from the
tissues or contents of the stomach by the process generally used for
extraction of alkaloids, may have the following tests applied to it:
1. Scarcely soluble in water, but readily soluble in
acidulated water.
2. Intensely bitter taste.
3. Not affected by sulphuric acid; but when a little
peroxide of lead, or peroxide of manganese, or bichromate
of potash, or ferricyanide or permanganate of potassium
is added, a magnificent purple-blue colour, changing to
crimson, and finally to a light red tint, is the result. The
¹/₂₀₀₀₀ part of a grain of strychnine has been stated to
give this reaction.
4. The physiological test consists in introducing a small
quantity of the suspected substance under the skin of a
frog, and noting whether or not the animal suffers from
tetanic spasms.
5. _The Galvanic Test._--Place a solution of
strychnine, say one part of strychnine in 15,000 of water,
in a slight depression in a piece of platinum foil, and
allow the mixture to evaporate. When dry, moisten the spot
with sulphuric acid, connect the foil with a positive pole
of a single-cell Grove‘s battery, and then touch the acid
solution with the negative pole. A violet colour will be at
once produced, remaining permanent.
6. _Bloxam‘s Test._--To the solid alkaloid in a
porcelain dish a drop or two of strong nitric acid is added
and gently heated; on adding a small quantity of potassium
chlorate a scarlet colour is produced. Ammonia changes
this colour to brown and a brown precipitate falls. If the
mixture he evaporated to dryness it leaves a dark green
residue forming a green solution in water, changed to
orange-brown with caustic potash and green again with nitric
acid. This test distinguishes strychnine from any of the
alkaloids which commonly occur in cases of poisoning.
7. Potassium bichromate when added to a solution of a salt
of strychnine, produces a yellow crystalline precipitate
of chromate of strychnine: the reaction can be done on
a microscope slide and the crystals examined. On drying
the crystals and then touching them with a drop of strong
sulphuric acid, the purple colour changing through red to
green is produced.
8. Picric acid gives a yellow crystalline precipitate of the
picrate.
9. Ammonium or potassium sulphocyanate produces crystalline
precipitates.
10. Ferri-cyanide of potassium produces a crystalline
precipitate with solutions of salts of strychnine.
Strychnine may not be found in the body, even after death from
poisoning by it, for the following reasons:
1. Smallness of the quantity taken.
2. The time which has elapsed after taking the strychnine
until the symptoms commence.
3. If the careful preservation of the stomach and its
contents has been overlooked.
4. The alkaloid may have been eliminated from the body
before death.
_Treatment._--Evacuation of the stomach by emetics and the stomach
pump, under anæsthesia, and then the administration of animal charcoal,
iodide of potash, tannic acid, and tea; bromide of potassium in large
doses (half an ounce), and repeated in smaller doses. Chloral should be
given in five-grain doses hypodermically every ten minutes, until the
convulsions are subdued. Chloroform should be inhaled for some time.
Urethane is said by Anrep to be more useful than chloral, and should be
given in drachm doses.
BRUCINE
This alkaloid is present along with strychnine in Nux Vomica seeds
and the Ignatius bean. Cases of poisoning by it seldom occur, as the
alkaloid is but little known by the public.
_Symptoms._--It resembles strychnine in its action but is much
less poisonous. It produces death by convulsions when injected
subcutaneously, but according to Brunton does not so often produce
convulsions when taken into the stomach.
Differential Diagnosis of Strychnine Poisoning from
Tetanus, Hysteria, Epilepsy, and other
Poisons causing Tetanic Spasms.
+--------------------------------+------------------------------+
| Tetanus. | Tetanus from Strychnine. |
+--------------------------------+------------------------------+
| 1. The presence of a wound. | 1. Some solid or liquid |
| Symptoms have no connection | taken within a short time |
| with any liquid or solid | of commencement of symptoms. |
| swallowed. | Not connected with any |
| | peculiarity of constitution. |
| | |
| 2. Gradual accession and | 2. Symptoms sudden and |
| progress of the symptoms; | violent. All the muscles are |
| difficulty in swallowing; | affected at one and the same |
| stiffness of the jaws, neck, | time. Arms affected and |
| trunk, legs, and arms. The | hands clenched at the same |
| hands not generally affected. | time as the body and legs. |
| | Jaw only affected or fixed |
| | during efforts to swallow. |
| | |
| 3. Curving of the spine | 3. Opisthotonos an early |
| forwards not primarily | symptom, generally |
| present; generally comes on | appearing in a few minutes. |
| after some days of previous | |
| illness. | |
| | |
| 4. Symptoms may undergo | 4. Intervals of complete |
| abatement, but there is no | intermission. |
| perfect intermission. | |
| | |
| 5. Death after the lapse of | 5. Death usually occurs in |
| several hours or days. Direct | two hours, or even less |
| injury to spinal cord may give | than a quarter of an hour. |
| rise to tetanus and death in | Recovery in a few hours. |
| a few hours. Recovery slow. | |
+-------------------+------------+-------+----------------------+
| Hysteria. | Epilepsy. | Tetanus occurring |
| | | During the Action |
| | | of other Poisons. |
+-------------------+--------------------+----------------------+
| 1. Connected with | 1. Previous | 1. The presence of |
| a peculiar | history of | other symptoms of |
| constitution. | epilepsy. | poisoning peculiar |
| | | to certain poisons. |
+-------------------+--------------------+----------------------+
| 2. The presence of| 2. Presence of the | |
| known stigmata of | _aura epileptica._ | |
| hysteria. | The tongue bitten; | _Obs._--Arsenic, |
| | and insensibility | antimony, and |
| | lasting for | other irritant |
| | some time. | poisons may |
| | | sometimes cause |
| | | tetanic spasms; |
| | | but other symptoms |
| 3. The spasms | 3. Alternate | are present which |
| frequently | contraction and | point to the nature |
| convulsive, and | relaxation of | of the poison. |
| alternating with | the muscles. | |
| stiffness of the | | |
| muscles. Loss of | | |
| consciousness. | | |
+-------------------+--------------------+----------------------+
| 4. | | |
+-------------------+--------------------+----------------------+
| 5. Never fatal. | 5. Seldom fatal | |
| Recovery very | during first | |
| rapid. | attack. | |
+-------------------+--------------------+----------------------+
[Illustration: Fig. 45.--Photo-micrograph of crystals of brucine
sulphate, × 50.
(R. J. M. Buchanan.)]
[Illustration: Fig. 46.--Photo-micrograph of crystals of brucine
sulphate, × 50.
(R. J. M. Buchanan.)]
_Chemical Analysis._--The alkaloid may be extracted from organic
admixture by the usual methods. Its reactions to special tests are as
follows:
1. If nitric acid be added to the solid alkaloid, or in aqueous
solution, a bright red colour is produced which changes to yellow on
heating. The addition of stannous chloride or sulphide of ammonium to
the acid solution after cooling changes it to violet; the colour is
discharged by excess of the stannous chloride. If the red acid solution
be largely diluted with water, a yellow precipitate falls, soluble in
dilute hydrochloric acid. If the filtrate from the yellow precipitate
be neutralised by ammonia and calcium chloride added, a precipitate of
calcium oxalate forms, insoluble in acetic but soluble in hydrochloric
acid. This reaction is peculiar to brucine.
2. With sulphuric acid and potassium bichromate a deep orange-red
colour is produced.
3. Sulphomolybdic acid gives an orange-red or purplish-red colour,
changing to blue.
4. _Blyth‘s Test._--If methyl iodide be added to a solution of brucine
in strong alcohol, circular rosettes of crystals form in a few minutes.
Strychnine does not give this reaction.
_Treatment._--Same as for strychnine.
CHAPTER XV
IRRESPIRABLE GASES
CARBON DIOXIDE
_Circumstances under which it occurs accidentally._--Death may
result where several persons are sleeping in the same room, and the
ventilation is imperfect; from the admission of the vapour of charcoal
into a room from an adjoining vent; or from incautiously sleeping in a
brewery close to a vat in which fermentation is going on. Many deaths
have occurred from this gas, due to the incautious descent into wells.
It must also be borne in mind that death may result from the presence
of this gas in an atmosphere which will permit the combustion of a
candle. For a candle will burn in an atmosphere containing 25 per cent.
of CO₂, whereas 5 per cent. will cause death. The burning of a candle
is therefore no test of security from danger in an atmosphere where
the presence of carbonic acid is suspected. Carbonic acid does not, as
is generally supposed, sink to the lower portions of a room; and Dr.
Taylor, from his experiments, states “that in a small and close room
persons are liable to be suffocated at all levels, from the very equal
and rapid diffusion of carbonic acid during combustion.”
_Symptoms._--When the carbonic acid is pure, that is, unmixed with
other gases, spasm of the glottis at once occurs, and the sufferer
falls down insensible, and death is almost immediate. When the gas
is diluted the early symptoms are a feeling of weight and fulness
in the head, accompanied with giddiness, throbbing of the temporal
arteries, drowsiness, palpitation of the heart, gradually increasing
insensibility, stertorous breathing, ending in death from asphyxia or
apoplexy. Sometimes the victim dies convulsed, at other times a deep
sleep quietly merges into death. The symptoms will, of course, depend
upon the quantity and purity of the gas present in the apartment.
_Action on the Animal Economy._--The opinions of observers vary
greatly--Berzelius maintaining that an atmosphere containing 5 per
cent. was not injurious to life; Allen and Pepys, on the other hand,
stating that 10 per cent. of the gas would cause death. Bernard
considers that it is not poisonous, as it can be injected into the
bodies of animals without injury, and that its action is purely
negative; it is irrespirable in the same sense as pure hydrogen or
nitrogen is--simply, therefore, causing death by suffocation. Whatever
may be the true explanation of its action, it is enough for all
practical purposes to know that death follows when it is breathed, even
when mixed with a normal amount of oxygen.
_Post-mortem Appearances._--The face may be pale and composed, or
swollen and livid. The vessels of the brain are frequently greatly
congested, and the heart and great vessels gorged with black fluid
blood. The blood in some cases, however, is of a cherry-red colour.
This may probably be due to the presence of carbon monoxide, which
appears to have the power of preventing the change of arterial into
venous blood, the opposite effect to that of carbon dioxide. The tongue
may or may not be protruded beyond the teeth; in most instances the
latter is the case. Animal heat is long retained after death, and the
_rigor mortis_ occurs as in other forms of death.
_Treatment._--Bleeding from the arm, cupping from the nape of the neck,
and the employment of cold affusion to the head. The patient should
be removed without delay into the open air. Artificial respiration
and galvanism have been successfully employed in some cases, and
inhalations of oxygen should be used if possible.
_How the proportion of Carbon Dioxide may be estimated._--The air to
be examined is drawn into a vessel capable of holding one and a half
gallons, to which is added a clear solution of lime or baryta. The
vessel, after being well agitated, is allowed to remain untouched for
from eight to twenty-four hours. The carbonic acid is absorbed by
the lime or baryta, and the difference in the causticity of the lime
solution before and after it is placed in the vessel gives the amount
of carbonic acid present in the air. A simple method of collecting the
air in a mine is by lowering a bottle full of fine sand, so arranged
that at any depth it may be turned upside down, and the sand allowed to
run out, its place being taken by the air of the mine. The bottle may
now be quickly drawn up, corked, and reserved for examination.
_How may an Apartment, Well, or Mine be cleared of it?_--Free
ventilation in the first case. In the case of a well, a basket of
slaked lime may be let down; but in mines a steam fanner or a jet of
steam must be blown through the mine. No one, of course, should be
allowed to enter the well or mine until it has been cleared of the
carbonic acid.
CARBON MONOXIDE
This gas is formed in a variety of ways, one being the oxidation of
carbon at a very high temperature in a limited supply of oxygen. It
is given off by iron stoves at a red heat. It is one of the chief
ingredients of the vapour of burning charcoal.
To this gas is due the suffocating quality of air in which coke or
charcoal is burnt. It is inodorous, hence the dangerous insidiousness
with which it produces its fatal results. It is said that 0.5 per cent.
will cause death, and even 0.1 per cent. is injurious. The vapours from
brick kilns and “burnt ballast” heaps are injurious to health, and the
owners of them may be indicted for causing a nuisance.
The fumes from burning charcoal are taken advantage of for purposes of
suicide, a method frequently used on the Continent, but almost unheard
of in England. The suicide generally shuts himself up in a room, which
he has closed against any ventilation, and in which he has placed a
receptacle containing burning coke or charcoal.
Poisoning by carbon monoxide occurs in two forms--_acute_ and _chronic_.
_Symptoms_: _Acute._--The first symptoms may be those of excitation,
which are quickly followed by intense headache, giddiness, throbbing of
the temples, and nausea followed by vomiting. Muscular weakness occurs,
sensation and the reflexes are lost, drowsiness and coma follow, and
in fatal cases convulsions often come on before death. The pulse
becomes imperceptible at the wrist. The conjunctivæ become hyperæmic,
the eyes staring, the pupils dilated and insensible. The voluntary and
involuntary muscles are relaxed, the skin cold and cyanotic, and the
lips covered with froth.
_Chronic._--The symptoms are headache, neuralgic pains, anæmia,
shortness of breath, and wasting; when advanced they are those of
peripheral neuritis and mental disturbances.
The less severe symptoms of chronic carbon monoxide poisoning are not
uncommon, and occur in those who occupy small and badly ventilated
rooms, in which there may be a heating stove, gas stove, or imperfect
gas fittings; the last are especially dangerous when water gas is used
for illuminating purposes, as it contains a high percentage of carbon
monoxide.
It is a very powerful gas, speedily causing death by acting chiefly
on the nervous system, the symptoms being those produced by a pure
narcotic.
The _post-mortem_ signs are redness of the face, with reddish patches
on different parts of the body. The blood--and this is chiefly
characteristic of carbon monoxide poisoning--is cherry-red, due to a
chemical compound formed by the action of the gas on the colouring
matter of the blood, thus paralysing the oxygen-carrying power of the
blood corpuscles. The gas is supposed to combine with the hæmoglobin
forming a fixed compound, the spectroscopic examination showing the
two absorption bands of the hæmoglobin nearer to the violet end of the
spectrum than under normal conditions. (See Blood Spectra, p. 103.)
These bands resemble those of O₂Hb, so their position must be compared
with a spectrum of O₂Hb, the two spectra being side by side.
There is another important difference, however, determined by the
action of a reducing agent such as ammonium sulphide. The bands of COHb
are unaltered, while those of O₂Hb are reduced. Death frequently takes
place before all the Hb has been changed into COHb, so that the blood
contains a mixture of COHb and O₂Hb, and on the addition of a reducing
agent the spectrum is a composite one of COHb and reduced Hb. Only the
broad band of reduced Hb is to be seen if the amount of COHb present be
less than 28 per cent. In an atmosphere containing a large percentage
of carbon monoxide death may occur before the blood contains sufficient
COHb to give the characteristic spectrum.
The _treatment_ consists in the removal of the sufferer into the
fresh air, artificial respiration, venesection, and the transfusion of
arterialised defibrinated blood. Oxygen inhalations should be given. In
two cases subcutaneous injections of nitro-glycerine were followed by
recovery.
WATER GAS
This gas is prepared by passing steam through incandescent carbon, and
is a compound of nearly equal parts of carbonic oxide and hydrogen. It
owes its dangerous properties to the first-named gas. When water gas,
pure and simple, is supplied for heating purposes, its leakage cannot
be detected, as the gas possesses no odour. When used for lighting and
carburetted, its escape is more readily detected by the smell, but
even then it is more dangerous than coal gas as the proportion of CO
is higher. Several deaths have resulted from the use of water gas for
heating and lighting purposes, and also for steel smelting in Leeds.
The symptoms of poisoning are those of carbon monoxide.
SULPHURETTED HYDROGEN
Sulphuretted hydrogen is a gas possessing a powerful odour of rotten
eggs. It is largely used as a test for most of the metals; and its
presence may be detected by filter paper, moistened with a salt of
lead, becoming black.
_Symptoms._--When the gas is moderately diluted the symptoms produced
are giddiness, throbbing of the temples, pain and oppression of the
stomach, nausea, and vomiting; delirium and convulsions sometimes
occur, together with laborious respiration and an irregular pulse. When
the gas is but slightly diluted, the person becomes suddenly weak and
insensible, and rapidly dies.
_Post-mortem Appearances._--Fluidity and blackness of the blood, loss
of muscular contractility, and a tendency to rapid putrefaction. The
bronchial tubes are reddened, and the internal vascular organs may
appear almost black.
_Treatment._--This will consist in the immediate removal of the person
into fresh air, and the administration of stimulants, together with the
respiration of chlorine gas evolved from bleaching powder by the action
of an acid.
COAL GAS
Coal gas is composed of several hydrocarbons, the chief of which is
marsh gas, together with free hydrogen, carbon monoxide and carbon
dioxide, ammonia, hydrogen sulphide, and sulphides of carbon, which
give to it its peculiar odour. The poisonous properties of coal gas are
due to the carbon monoxide, 7.5 per cent. being present in ordinary
gas as supplied for illuminating purposes. It can be detected by
passing the coal gas through an acid solution of cuprous chloride,
which becomes black by the formation of a compound CuCOCl. A dangerous
explosive compound is formed when the gas reaches the proportion
of 1 in 10 of the atmosphere. Poisoning by this gas is, as a rule,
accidental.
_Symptoms._--Headache, nausea, vomiting, giddiness, ending in coma.
Stertorous breathing is noticed in some cases. Should the sufferer
be removed from the gas, the breath smells strongly of the gas. The
murderer Chantrelle tried to cover his crime by admitting gas into his
wife‘s bedroom, but the attempt failed. The pupils are, as a rule,
dilated before death.
_Post-mortem Appearances._--Cherry-red colour of the blood, redness of
the pulmonary tissue, and froth in the air-passages. The vessels of the
brain are engorged, and rose-coloured patches appear on the thighs.
_Treatment._--This consists in removing the patient into the fresh air,
artificial respiration, oxygen inhalations, &c., as in carbon monoxide.
COMBUSTION GASES
Toxic effects have been produced by inhalation of the gases caused by
explosives. The principal gases are carbon dioxide, carbon monoxide,
and nitrogen. Gunpowder yields a considerable amount of CO and
sulphuretted hydrogen. Nitro-glycerine, dynamite, and gun-cotton yield
a large amount of CO. Tonite yields very little CO, and roburite none.
Smokeless powders give off CO.
The manufacture of “roburite” and “sicherheit,” which contain
dinitro-benzine, is fraught with danger from this substance, causing,
in acute cases, cyanosis of the face or the whole body, headache,
vertigo, paresis, coldness, quick pulse, dyspnœa, shallow breathing
with long intervals, and coma. Vomiting may occur, and the blood
becomes a chocolate colour. A chronic form of poisoning produces
lividity and cyanosis, with gastritis, hepatic enlargement and
jaundice, paræsthesia, numbness, and cramps in the muscles, amblyopia
with concentric contraction of vision-fields, and central scotoma.
The blood is like that of pernicious anæmia, and the urine brown or
blackish.
ACETYLENE GAS
This gas has a peculiar odour of geranium. It is a product of the
incomplete combustion of hydrocarbons, and is formed when lamps or gas
jets are burned with insufficient air, _e.g._ a Bunsen burner which
has “lighted back,” also from the use of oil stoves, and gas cooking
and heating apparatus. It is used for illumination, and formed by
the action of water on calcium carbide. It forms a highly explosive
mixture with air. It is not a potent poison. Continued exposure to
it causes anæmia, malnutrition, and nervous symptoms. On animals it
produces narcosis. It does not combine with hæmoglobin, but acts as an
indifferent gas.
NITROGEN MONOXIDE, NITROUS OXIDE
This is known as laughing gas; it has a sweetish taste and smell.
When breathed in small quantities it produces tingling sensations and
induces laughter, hence its name. When breathed for anæsthetic purposes
the skin becomes livid, the blood pressure raised, and unconsciousness
follows. It acts first upon the higher nerve centres, then upon the
spinal cord, medulla, and heart. If pushed too far it causes death
by asphyxia. In ordinary use for anæsthesia, the latter is rapidly
produced, and recovery follows quickly when the administration is
stopped. It has peculiar effects upon certain people, who may not only
show the symptoms of hilarity, but, in some cases, become extremely
violent.
PETROL FUMES
Petrol fumes produce toxic effects upon those who breathe them,
comprising perverted taste, dysphagia, headache, giddiness, cyanosis,
insensibility, mania and imbecility. Maniacal outbreaks occur during
recovery. Peripheral neuritis may follow.
NAPHTHA, BENZOL OR BENZENE
This causes poisoning when swallowed or inhaled, _e.g._ glove cleaning,
waterproofing, &c. Death has taken place in either way.
_Symptoms._--In _acute_ poisoning there is excitement, flushing of the
face, cyanosis, dilated pupils, headache, slow breathing, stupor and
coma, with gastro-intestinal irritation.
Hallucinations and delirium may occur amongst workers in it;
idiosyncrasy plays a part. Women may become intoxicated, excited, and
hysterical. It may cause headache, vertigo, narcosis, and inability to
walk, with vomiting. Small hæmorrhages may occur. Rapid coma and death
may occur when the vapour is concentrated.
_Treatment._--When swallowed, the stomach tube should be used and ether
and strychnine given hypodermically. When overcome by vapour, removal
to the open air, artificial respiration, oxygen inhalations, and
restoratives are required.
SULPHUR DIOXIDE
This is an irrespirible gas with the odour of burning sulphur. It is a
preservative and bleaching agent, is used for disinfection, and occurs
in certain industries.
The inhalation of the fumes causes a feeling of suffocation, with spasm
of the glottis, and irritation of the nose, trachea, and bronchi,
producing sneezing and cough; opacity of the cornea, dyspnœa, cyanosis,
and convulsions may occur.
CHLORINE
The gas is used for disinfection and bleaching. In chemical works
chronic poisoning may occur causing anæmia, emaciation, gastritis,
dental caries, bronchitis, and emphysema. If concentrated, it causes
dyspnœa, violent cough, hæmoptysis, stupor, and syncope.
_Treatment._--Fresh air, steam inhalations, and the general treatment
of the lung conditions.
PHOSPHORETTED HYDROGEN
This is a very poisonous gas. Deaths have occurred on board ships
carrying cargoes of electrolytic ferrosilicate containing calcium
phosphide. It reduces the oxyhæmoglobin. It may produce rapid, followed
by slow and laboured breathing and convulsions.
INDEX
Abdomen, P.-M. exam., 58, 59;
enlargement of, 153;
in delivery, 156;
in pregnancy, 153;
in starvation, 132;
injuries of, 75
Abel, Prof., on arsenic, 284
Abercrombie, Dr., on apoplexy, 73
Abortion, criminal, 64, 76, 159 _et seq._;
causes of, 160, 161;
dangers of, 161;
definition of, 160, 164;
examination in, 162, 163;
in poisoning, 313, 317, 319, 322;
law of, 159;
R. _v._ Goodhall, 159
Abscess, in wounds, 84
Accident, death from, 2
Acetanilide (antifebrin), 363
Acetic acid, 262
Acetone, in starvation, 132
Acetylene gas, 401
Acid poisons, 231, 234, 246
Aconite and aconitine, 229, 234, 239, 348, 375, 376
Action (general) of poisons, 232-34
Acts of Parliament:--
_Arsenic Act_, 1851 (14 Vict. c. 13), 230, 275;
_Coroners Acts_, De Officio Coronatoris
(4 Edw. I, c. 2, 1275), 3, 4;
50 & 51 Vict., 1887, 3;
_Factory and Workshop Act_, 1901, 12;
_Fœticide_ (24 & 25 Vict. c. 100, sec. 58 and 59), 159;
_Habitual Drunkard‘s Act_, 226;
_Indictable Offences Act_, 1848 (sec. 17), 18;
_Infanticide_ (21 Jac. I. c. 27), 165;
(24 & 25 Vict. c. 100, sec. 60), 166;
_Lunacy Acts_ (8 & 9 Vict. c. 100, secs. 90 and 114), 195;
(16 & 17 Vict. c. 70), 224;
(16 & 17 Vict. c. 96, sec. 4), 207;
(25 & 26 Vict. c. 86), 224;
(53 Vict. c. 5, 1890), 210-219;
(53 Vict. c. 53), 207, 223;
(54 & 55 Vict. c. 65, 1891), 207, 223;
_Mental Deficiency Act_, 1913, 198;
_Notification of Births Act_, 1907, 12;
_Notification of Infectious Diseases_, 1889, 12;
_Pharmacy Act_, 1868, 228;
_Poisons Act_ (24 & 25 Vict. c. 100, secs. 11, 22-25), 228;
_Poisons and Pharmacy Act_, 1908, 229;
Additions to Schedule Order, 1913, 229;
_Rape_ (24 & 25 Vict. c. 100, sec. 48), 140;
(48 & 49 Vict. c. 69, 1885), 140, 141;
_Wounding_ (24 & 25 Vict. c. 100, sec. 18), 69
Adam, Dr., on croton oil, 318
Addington, on poisoning, 240
Adipocere, 52
After-pains, in delivery, 156
Age, ossification as a sign of, 33, 34, 174;
putrefaction, 50
Ague and arsenic, 274
Air and putrefaction, 50, 55
Albumen, as antidote, 300, 312;
in urine, 41, 258, 268, 307, 382
Alcohol, 40, 62, 114, 119, 120, 135, 226, 231,
232, 244, 348, 354 _et seq._;
amylic, 362
Alexander, on poisoning, 233, 238
Alimentary canal, 61, 271, 291, 297, 306, 310, 322, 346
Alison, on infanticide, 166
Alkalies, in poisoning, 231, 234, 262 _et seq._
Alkaloid poisons, 229;
mydriatic, 349 _et seq._;
putrefactive, 323 _et seq._;
vegetable, 335 _et seq._
Allen, Dr., on CO₂, 397
Almonds, bitter, 62, 229, 361, 373
Amenorrhœa, in sterility, 188
Ammonia, 264 _et seq._
Amos, on inheritance, 184
Anæmia, 132, 299, 307, 401, 403
Analysis, chem., in P.-M. exam., 57, 62
Anasarca, 41
Aneurysm, in death from wounds, 81
Aniline oil, 108, 361, 362
Animal poisons, 231, 322 _et seq._
Ante-mortem injuries, 79
Anthropometry, 24;
Commission on, 133
Antibodies, in blood tests, 105
Antidotes, in poisoning, 243
Antifebrin, 363
Antigen, in blood tests, 105
Antimony, 229, 234, 264 _et seq._, 280, 282, 292 _et seq._
Antiserum, in blood tests, 105, 106
Apes, in blood testing, 105, 107
Aphasia, 73, 226
Apnœa, 118, 121, 126, 128
Apomorphine, 243, 257, 300, 345
Apoplexy, 40, 73, 118, 121, 126, 136, 236, 241, 347, 397
Arborescent marks, 137
Areola, of nipple, 152, 156
Arterio-sclerosis, 307
Arthritis, in lead poisoning, 307
Asphyxia, 38, 39, 110, 121 _et seq._, 136, 139, 369,
375, 380, 397, 402
Assaults, 27, 68, 80;
Law cases of, R. _v._ Rosinski, 68;
R. _v._ Case, 68
Assize Courts, 5
Atelectasis pulmonum, 169
Atheroma, as cause of death, 73
Atrophy, acute yellow, of liver and phosphorus poisoning, 268
Atropine, 229, 244, 348, 349, 372
Auscultation, in pregnancy, 151
Aveling, Dr., on delivery, 157
Bacillus enteritidis, 329, 330;
botulinus, 329, 330;
typhosus, 328
Bacterial poisons, 323, 328 _et seq._
Bail, 4
Bailie, Justice, on medical evidence, 19
Ballottement, in pregnancy, 154
Banti‘s disease, and X-rays, 114
Barristers, 5
Baryta and barium salts, 234, 244, 248, 313, 315
Battery, 68
Beatson, on burns, 114
Becker, on blood-stains, 92
Beer and arsenic, 290;
and strychnine, 337
Belladonna, 229, 231 _et seq._, 349-351
Bentley, on fungi, 359
Benzene and benzole, and alkaloids, 337, 338, 402
Bernard, on CO₂, 397
Bertillon‘s method, 24
Berzelius, on CO₂, 397
Beverley case, 193
Bigelow, on wounds, 74
Bile, in poisoning, 233
Bilroth, on carbolic acid, 256
Biological tests, for blood, 105;
semen, 146
Birds, blood corpuscles, 96, 99
Birth--certificates, 12;
marks, 23;
precipitate, 177;
premature, 186
Bismuth, 314
Blackening, in wounds, 78, 87
Blackstone, on infanticide, 167;
on inheritance, 184
Bladder and putrefaction, 54;
in new born, 169;
in P.-M. exam., 62, 169
Blandy case, 240
Blisters, in burns, 112;
in infanticide, 167
Blizzard (Sir W.), on evidence, 20
Blondlot, on phosphorus, 269
Blood, corpuscles, 97 _et seq._;
crystals, 96-102;
cysts, 73;
films, 94;
in burning, 112;
cold, 135, 136;
drowning, 130;
heat-stroke, 137;
mammalian, 96, 105;
menstrual, 96;
P.-M., 62;
poisoning, 232, 247, 256, 267, 271, 319,
327, 355, 360, 362, 399, 401;
rape, 142, 143;
suffocation, 199;
stains, 79, 80, 89 _et seq._, 145;
vessels, 54, 81, 232
Bloxam, on arsenic, 284;
test, 393
Blue line, in lead poisoning, 307
Blyth, on poisons, 227;
tests, 350, 396
Board of Trade and electricity, 138
Body viewing, 4
Bones, epiphyses, 33, 34;
fractures, 56;
ossification, 33, 34;
poisoning, 238, 268, 271
Bonnewyn, on mercury poisoning, 304
Books, use of, in Court, 19
Borax, 91, 92
Bouchard, on leucomaines, 327
Bouchet, on signs of death, 33, 34
Boutmy, on alkaloids, 326
Bouvalat, on sudden death, 42
Bowels (_see_ Intestine)
Brain, 54, 58, 71 _et seq._;
in burns, 112;
cold, 130;
drowning, 130;
electricity, 138;
poisoning, 231, 233, 238, 256, 269, 291, 297, 345, 355,
356, 360, 364, 366, 375, 377, 378, 380, 384;
suffocation, 119
Brande and Taylor‘s method, in arsenic, 280, 281
Bravo case, 294
Breasts, in pregnancy, 152
Briand and Chaudé, on wounds, 75
Brieger, on alkaloids, 326
Bright‘s disease, and poisoning, 235, 244
Brodie (Sir B.), on cold, 135
Bromatotoximus, 328 _et seq._
Brouardel, on alkaloids, 326
Broughton (Sir T.), on poisoning, 374
Bruce, Justice, on dying declarations, 17
Brucine, 342, 388, 393, 396
Bruises, 115, 144
Brunton, Dr., on brucine, 394
Bryony, 322
Burgess, on opium, 345
Burnett‘s fluid, 165
Burns, 64, 110 _et seq._
Cachexia, in poisoning, 299
Cacodylic acid, 290
Cadaveric rigidity (rigor mortis), 46 _et seq._, 119;
spasm, 48, 78, 80
Cadmium, 281
Calabar bean, 231, 233, 348, 386, 387
Calcium chloride, 260
Callus, provisional, 77
Calomel, 301
Camel, blood corpuscles, 96
Camphor, 349, 352
Canadian partridges and poisoning, 236
Cancer and arsenic, 274
Cancrum oris and mercury, 300
Cannabis Indica, 232
Cantharidis, 229, 231, 234, 322
Caput succedaneum, 180
Carbolic Acid, 229, 231, 234, 254 _et seq._, 348
Carbon bisulphide, 112, 379;
dioxide, 231, 232, 397;
monoxide, 104, 112, 232, 398
Carunculæ myrtiformes, 148
Caspar, 21, 52, 70, 86, 113, 122, 123, 128, 130, 142,
149, 169, 170, 173, 177, 247, 319, 355
Castlehaven, Earl of, and rape, 140
Castor-oil, 321
Catalepsy, and rigor mortis, 48
Cat‘s bile, in blood testing, 98
Caustic salts, 231;
soda, 231, 262;
potash, 262
Cave, Justice, on dying declarations, 16, 17
Cell, Sorby‘s, 105
Central Criminal Court, 10
Cerebral concussion, 72, 356;
compression, 72;
poisons, 231, 377 _et seq._
Certificates of birth, &c., 11 _et seq._;
exemption, 191;
lunacy, 206 _et seq._
Cervix uteri, 153
Cessation of circulation and respiration, 43
Chalk, in poisoning, 244, 247
Chancery Court, 224
Chancre, soft, 143
Chantrelle, on coal gas, 401
Charcoal, in poisoning by CO₂, 121
Charpentier, on abortion, 162
Chastity, offences against, 140 _et seq._
Chemical exam., 98;
poisons, 231, 246
Cherry-laurel, 374
Chest, in infanticide, 168;
new born, 168;
P.-M. exam., 59
Chevers, on suffocation, 122
Cheyne-Stokes breathing, 41, 136
Children, weight and height of, 134
Chlorine, 232, 372, 403
Chloroform, 230, 232, 239, 244, 337, 348, 378, 393
Cholera, simulating poisoning, 241
Chossat‘s experiments, 132
Christison (Sir R.), 12, 112, 116, 118, 238, 240, 258,
275, 278, 305, 343, 344, 386
Chromium, 316
Churchill, on suffocation, 186
Cicatrices of wounds, 21 _et seq._
Cinnabar, 301
Circulation in poisoning, 255, 271, 291, 297, 309, 310
Cisterns, in lead poisoning, 305, 306
Citation of witnesses, 8 _et seq._
Civil rights in lunacy, 224
Climate, in putrefaction, 50
Clothes, cuts in, 71, 80;
in burning, 111;
stains on, 89, 91
Coagulation of blood, 78, 89, 112
Coal gas poisoning, 232, 400;
coal-tar, 254
Cobalt, in hydrocyanic acid, 373
Coca, 229, 230;
cocaine, 357, 358
Cocculus Indicus, 232, 354, 358
Cockburn, Lord, on poisons, 228
Code Napoleon, 185
Coke, Lord, on murder, 69;
on live birth, 167;
on inheritance, 184
Colchicum, 231, 234, 318
Cold, death from, 135, 136;
P.-M. appearances in, 135
Coleridge, Lord, on poisons, 228
Colic, in poisoning, 241, 242, 305, 306, 317
Collapse, in poisoning, 258, 268, 330, 333
Colostrum, in delivery, 156
Colour, in putrefaction, 51, 52
Coma, 39, 40, 135, 137;
in poisoning, 268, 276, 290, 310, 327, 333, 343,
349, 351, 354, 360, 377, 382, 399
Combustion gases, 401;
spontaneous, 113
Comminuted fractures, 74
Commissioners in lunacy, 208, 210, 213, 220, 221, 224
Committee of estate in lunacy, 220, 221, 224
Complications, in injuries, 81
Compression, cerebral, 40, 72
Concealment of birth and pregnancy, 166, 183
Concussion, cerebral, 72, 356
Confectionery and arsenic, 287, 290, 306
Congenital deformities, 23;
disease, 178
Conium, 231, 234, 385, 386;
conine, 385
Conolly, on mania, 200
Constitutional peculiarity, 51
Contre-coup in fracture of skull, 74
Contusions, 60, 61, 74, 84, 115
Convulsions, in poisoning, 268, 276, 293, 310, 327, 332, 343,
349, 351, 354, 360, 377, 382, 399
Cooling of body, 30, 45
Cooper (Sir A.), on gunshot wounds, 87
Copper, sulphate, 243, 280, 290, 300, 331, 332;
subacetate, 310 _et seq._
Cord, marks of, 123, 176;
spinal, injuries of, 74
Cornier, Henrietta, case, 203
Coroners, 2;
Act, 2-4;
Court, 2 _et seq._;
jury, 3
Corpus luteum, in abortion, 164
Corpuscles (_see_ Blood), 97 _et seq._
Corrosive poisons, 110, 112, 231, 234, 244, 246, 275;
sublimate, 229, 232, 341
Cotton fibres, 93
County Council, 2
Court of Criminal Appeal, 5;
Probate, 10;
Session, 10, 224
Cramps, in poisoning, 276, 293, 311, 401
Creosote, 254
Crepitation, in fracture, 71;
in lung, 170, 172
Cretinism, 197
Criminal abortion (_see_ Abortion);
procedure, 2 _et seq._
Cross-examination, 4, 5
Croton oil, 318
Crown Office instructions, 7, 56 _et seq._
Crying, in infanticide, 167
Cryptorchids, 187
Crystals, antimony, 292, 293;
arsenic, 282, 283;
blood, 96;
brucine, 395;
hæmin, 101, 102;
hæmoglobin, 96, 98;
meconic acid, 340;
mercury, 298;
morphine, 339;
seminal, 146;
strychnine, 389, 392;
Teichmann‘s, 101
Culpable homicide, 68
Cunningham, on electricity, 138, 139
Curator bonis, in lunacy, 225
“Cut the Bill”, 5
Cutis anserina, 128, 129, 355
Cyanide of mercury, 301;
potassium, 229 373
Cyanosis, 122, 361, 378, 401
Darling, Justice, on dying declarations, 17
Daturine, 349, 352
Day‘s test (blood), 100
Death, 43 _et seq._;
certificate of, 2;
from bruises, 116;
burns, 111;
suffocation, 108;
wounds, 80;
fœtus, 174;
sudden, 42
Deformities, 21, 24
Deeming case, 203
Degrees of burns, 110
Deliriant poisons, 231, 249 _et seq._
Delirium, 136, 205, 235, 320, 321, 330,
344, 349, 355, 366, 375, 380
Delivery, 64, 65, 155 _et seq._, 175
Delpach, on cicatrices, 23
Delusions in lunacy, 193, 196, 199, 200
Dementia in lunacy, 204, 205
Depositions, 18
De Quincey, on opium, 344
Deutsch, on blood, 105
Development of embryo, 35, 36
Devergie, on scars, 22;
on hair-dyeing, 26;
on putrefaction, 30, 128;
on rape, 144
Diabetes, sudden death, 41;
starvation, 132
Diachylon, in abortion, 161
Diagnosis of insensibility, 39
Diaphragm in new born, 168;
in putrefaction, 54
Diarrhœa, 277, 300, 325, 330, 333, 367, 374, 378
Dichroism of blood, 100
Diday, on chancre, 143
Diethylarzine, 288
Diethyl-barbituric acid, 230
Digitalis, 230, 232, 364 _et seq._;
Digitaline, 365
Dinitrobenzene, 361
Discharge of lunatics, 221
Dissection, P.-M., 58;
instruments, 56
Dobie, on antimony, 293
Docimasia pulmonum hydrostatica, 170;
pulmonaris, 173;
circulationis, 182
Doe, Justice, on insanity, 195
Donné, M., on rape, 144
Donovan‘s solution, 287
Dowzard‘s apparatus, 270, 285
Dragendorff‘s method (alkaloids), 337
Dropsy, 155, 355
Drop-wrist, 307
Drowning, 63, 127 _et seq._, 171, 176
Drunkenness, 72, 114, 135, 226, 235
Duboisine, 349
Ductus arteriosus and venosus, 182
Duncan, Mathews, on pregnancy, 153;
on superfœtation, 186
Dupuytren, M., on cicatrices, 23;
on fractures, 77, 87;
on burns, 111
Durrant, Dr., on veronal, 384
Dussant‘s method, 269
Duties of medical men, 79
Dyed fabrics, 91
Dyeing, of hair, 26;
and arsenic, 274
Dyer, Dr., on suffocation, 122;
mixture, 265
Dyes, in blood-stains, 108
Dying, declarations, 11, 16 _et seq._;
Law cases: Fagent, 17;
Forester, 17;
Holloway, 18;
Mitchell, 17;
Smith, 17;
Whitmarsh, 17;
modes of, 38 _et seq._
Dysentery, in poisoning, 235
Dysmenorrhœa, 188
Dyspnœa, 327, 375, 382, 403
Earth, poisoning, 279;
putrefaction, 55
Ecchymosis, 44, 63, 71, 115, 119, 122, 125, 137, 171, 176
Ectopion, vesicæ, 188
Elaterium, 231, 322
Eldon, Lord, on insanity, 192
Electricity, 110, 136 _et seq._
Elimination of poisons, 295, 327, 355
Elsässer, on inflation, 172, 176
Elwell, on wounds, 70
Embryo, 35, 36
Emetic tartar, 229, 243
Emetics, in poisoning, 243, 257, 270, 286,
289-300, 345, 365, 367
Emmenagogues, 163
Emphysema neonatorum, 171, 172
Enamel, as poison, 266
Enteritis, 241, 293
Enzemes, in poisoning, 329
Epilepsy, 41, 242, 327, 394
Epiphyses, 33;
table of, 34, 37
Epispadias, 188
Ergot, 229, 232, 319, 328
Erichson, on fracture, 77
Erlenmeyer‘s flask, 283
Erotomania, 203
Eruption of teeth, 33
Erysipelas, 70
Erythema, frost, 135
Eserine, 387
Esquirol, M., on insanity, 196, 197, 201, 203, 204
Ether, 232, 377, 402
Eversion of wounds, 86
Evidence, in Court, 4 _et seq._;
of poisoning, 235 _et seq._
Examination, in abortion, 162, 163;
Court, 4 _et seq._;
insanity, 225;
malingering, 190;
rape, 143, 148;
blood-stains, 89 _et seq._;
P.-M., 56 _et seq._;
stomach contents, 244
Excitomotory poisons, 388 _et seq._
Exemption certificates, 191
Exhumation, 3, 4, 56, 66;
period of, 66
Expenses, Court, 8
Exposure, in infanticide, 178
Extraction of alkaloids, 325, 335 _et seq._
Eyes, in drowning, 128;
hanging, 122;
identity, 25;
poisoning, 276, 291, 325, 343, 346, 348, 377, 385, 390;
starvation, 132
Face, in drowning, 127;
P.-M. exam., 63;
suffocation, 119;
in poisoning, 276;
wounds of, 74
Facts, in lunacy certificates, 209, 210
Falls, in fœticide, 177
Farnum, Dr., on rape, 146
Fat, in poisoning, 238
Fauvre, M., on asphyxia, 130
Feeble-mindedness, 198, 225
Fees, medical, 8-10
Feet, in drowning, 129
Feigned diseases, 190
Ferric chloride test (Hcy. acid), 371
Ferrier, Dr., on carbolic acid, 256
Ferrocyanide of potassium, 312, 313
Finger prints, 24, 25;
marks, 125;
nails, 124
Finny, Dr., on opium, 345
Firearm wounds, 78
Fishes, blood corpuscles, 96, 99, 100
Flaccidity, 49
Flannagan case, 278, 279
Flattening of muscles, in death, 45
Flaudin, M., on arsenic, 274
Flax fibres, 91
Fleitmann‘s test (arsenic), 286
Florence‘s reaction (semen), 146
Fluorescin test (death), 44
Fœticide, 159 _et seq._;
fœtal heart, 15, 154
Fœtus, 161, 166, 174, 185;
size of, 37
Fontanelles, 33
Food poisoning, 62, 290, 306, 328 _et seq._
Fool‘s parsley, 321
Foot-prints, 25, 26, 79
Foramen ovale, 182
Foreign bodies in trachea, 42, 61, 175
Forms of subpœna, 8, 9
Fowler‘s solution of arsenic, 286
Fractures, 74, 76, 77, 120, 129, 176
France, and CO₂ suicide, 121
Fraser, on cacodylates, 290
Friction, in burning, 110
Friedenthal, on blood tests, 105
Frohde‘s reagent (morphine), 341
Fruit-stains, 108
Fungi poisoning, 359
Fusel-oil, 362
Galabin, on superfœtation, 187
Gallard, on abortion, 162
Galvanic test (strych.), 392
Gamboge, 231, 320
Gamgee, on blood tests, 98
Gangrene in poisoning, 301, 320
Ganttner‘s test (blood), 92
Gases, irrespirable, 232, 397
Gastric inflammation, 241, 268, 277, 352, 374, 401;
ulcers, 274
Gay-Lussac, on hydrocyanic acid, 368
General paralysis, 204
Genital organs, 76, 130, 156
Geoghehan, on poisons, 238
Georget, M., on insanity, 195, 201
Gerrard‘s test (belladonna), 350
Gestation, 76
Glaister, Prof., on blood-stains, 96, 97, 100
Glass as vulnerant poison, 231, 265
Gloucester, Countess of, 186
Goadly, on lead poisoning, 309
Goeldner‘s test (cocaine), 357
Gonorrhœa, in rape, 142
Goulard‘s extract, 305
Grand Jury, 5
Gross, Prof., on lung inflation, 172
Grünbaum, on blood tests, 105, 107
Guaiacum test (blood), 100
Gull (Sir W.), on combustibility, 114
Gullet, 59, 247, 263, 278, 294, 301, 330
Gums, in lead poisoning, 307;
copper, 311
Gunshot wounds, 80, 85
Guttman, on caustic soda, 263
Gutzeit‘s test, 270, 285
Guy, on poisons, 231
Habit, in poisoning, 235
Habitual drunkards, 226
Hæmatin, 90, 103, 104, 360
Hæmatoporphyrin, 382
Hæmin, crystals, 101, 102, 256;
test, 92
Hæmoglobin, 91, 96, 98, 102, 103, 135, 315, 399, 403
Hæmorrhage, 38, 42, 73, 75, 80-84, 139, 143, 178, 268,
307, 320, 327, 330-332, 343, 353, 402
Hair, dyeing of, 26
Hale, on rape, 140
Hallucinations, 199, 200
Hamilton, on carbolic acid, 255
Hands, in drowning, 129
Hanging, 63, 117, 121 _et seq._;
accidental, 123;
homicidal, 123;
judicial, 126;
suicidal, 123, 124
Haslam, on evidence, 20
Hawkins, on secrecy, 20;
poisons, 228
Head, in new born, 180;
injuries of, 40, 72 _et seq._;
P.-M. exam. of, 58
Heart, disease, 42, 81;
drowning, 129, 130;
electricity, 139;
fœtal, 151, 154;
infanticide, 167;
poisoning, 231, 232, 256, 258, 263, 291, 325, 327, 355,
364, 366, 368, 377, 380, 382, 386, 397, 402;
P.-M. Exam., 60;
putrefaction, 54
Heat, death by, 136;
exhaustion, 136, 137;
prostration, 137;
stroke, 136
Hegar‘s sign, in pregnancy, 153
Hellebore, 320
Hemiplegia, 73
Hemlock, 385
Hernia, 75, 242
Hewett, on head injury, 73
Higgins‘ case, 278
High Court of Justiciary, 6
Hildebrandt, on leucomaines, 327
Hippocrates, on pregnancy, 152
Hoppé, Seyler, on carbolic acid, 256
Hume, on rape, 140
Husband, 73, 157, 175, 227
Husman, on antimony, 293
Hutchinson, on suffocation, 122
Hutin, on tattoo marks, 23
Hydrochloric acid, 252 _et seq._
Hydrocyanic acid, 229, 231, 232, 239, 261, 367 _et seq._;
Hydrogen peroxide, 90, 92, 101, 372;
sulphide, 233
Hymen, 28, 142, 143, 148, 155, 188
Hyoscyamus, 231, 348, 351;
hyoscyamine, 349; hyoscine, 349
Hysteria and tetanus, 394
Icard‘s (fluorescin) test, 44
Identity of the dead, 28, 66;
of the living, 21 _et seq._;
Law case: Parkman, 28
Idiocy and imbecility, 141, 142, 195, 197, 224
Immaturity, in fœtus, 175
Impotence, 187, 188
Incised wounds, 83
India, and drowning, 128
Indictable Offences Act, 18
Indigo, in arsenic, 275, 315;
sulphate, 254
Infanticide, 64, 133, 165 _et seq._;
Infanticide, Law cases in: Colmer, 165;
Enoch, 166;
Hewitt, 165;
Poulton, 166;
Reeves, 166;
Senior, 167;
Turner, 166;
Inflammation, 72, 110, 164;
in poisoning, 234, 237, 278, 300, 360
Inflation of lung, 121, 172;
and P.-M. staining, 45
Inheritance, 184, 185
Inorganic poisons, 231
Insanity, 129 _et seq._;
circular, 204;
classification, 197;
continuous, 196;
definition of, 192, 193;
delirium in, 205;
delusions in, 193, 196, 199, 200;
hallucinations, 200;
drunkenness in, 205;
moral, 194;
procedure in, 206-222
Insanity, Law cases in: Arnold, 193, 194;
Beverley, 193;
Ferrers, 194;
Hill, 224;
Nottidge _v._ Ripley, 222;
Offord, 194;
Shaw, 195;
Treadway, 195;
Wilkins, 223
Inspection, medical, 7, 56
Instantaneous rigor, 48
Instructions (P.-M.) of Crown Office, 7, 56 _et seq._;
Intestines, 54, 61, 176, 181, 232, 259, 275, 279, 291, 294, 297,
300, 306, 311, 325, 327, 330, 333, 360, 369, 375
Intoxication, 72, 114, 135, 226, 235
Intussusception, 241
Iodide of potassium, 272 _et seq._, 393
Iodine, 231, 271, 335, 371;
test for hydrocyanic acid, 371
Ipecacuanha, 243
Iron in arsenic poisoning, 289, 313;
in testing hydrocyanic acid, 371;
in morphine, 341;
muriate, 313;
sulphate, 313;
stains, 96, 108
Irrespirable gases, 121, 397
Irritant poisons, 231, 234, 240, 267, 317
Jacquemier‘s test (pregnancy), 154
Jalap, 321
Jaundice, 268, 311, 315, 319, 355, 378, 401
Jörg, M., on infanticide, 169
Judicial authority, 207, 215, 220;
factor, 224
Jury, coroner‘s, 3
Justiciary Court, 6
Justifiable homicide, 69
Keiller, on suffocation, 120
Kellen, on trichiniasis, 333
Kidney, in new born, 169;
poisoning, 233, 238, 256, 269, 278, 291, 297, 300,
319, 322, 327, 355, 378, 382, 383;
P.-M. exam., 62;
putrefaction, 54;
rupture of, 45, 75, 116;
in suffocation, 119
Kiesteine, on pregnancy, 154
Kingston, Duchess of, case, 20
Kleptomania, 202
Kopf, on phosphorus, 267
Körber, on fractures, 74
Kratter, on electricity, 139
Kundrat‘s test (aconite), 376
Labour and fœtal death, 176
Laburnum, 321
Lacerated wounds, 84
Lamson case, 239, 375
Landolt, on carbolic acid, 256
Larcher, on signs of death, 44
Larynx, in hanging, 120, 122;
poisoning, 262;
P.-M. exam., 59, 63;
strangling, 124;
throttling, 125
Law cases in--_abortion_ (crim.), Goodhall, 159:
_assault_, Case, 68;
Rosinski, 68:
_dying declarations_, Fagent, 17;
Forester, 17;
Holloway, 18;
Mitchell, 17;
Smith, 17;
Whitmarsh, 17:
_identity_, Parkman, 28:
_infanticide_, Colmer, 165;
Enoch, 166;
Hewitt, 165;
Poulton, 166;
Reeves, 166;
Senior, 167;
Turner, 166:
_insanity_, Arnold, 193;
Beverley, 193;
Ferrers, 194;
Hill, 224;
MacNaughton, 193;
Nottidge _v._ Ripley, 122;
Offord, 194;
Shaw, 195;
Treadaway, 195;
Wilkins, 223:
_malpraxis_, Butchell, 190;
Williamson, 190:
_medical evidence_, Patmore, 19:
_murder_, Cornier, 203;
Deeming, 203:
_poisoning_, Blandy, 240;
Cramp, 228;
Flannigan, 278;
Garner, 240;
Geering, 240;
Helson, 240;
Higgins, 278;
Lamson, 239;
M‘Cracken, 278;
Marsh, 294;
Maybrick, 277;
Newton, 278;
Palmer, 238, 390, 392;
Port, 274;
Pritchard, 19;
Spink, 294;
Wooler, 240:
_pregnancy_, Gloucester, 186;
_professional secrecy_, Kingston, 20;
_rape_, Barrett, 141;
Castlehaven, 140;
Cockcroft, 140;
Fletcher, 141;
Groombridge, 142;
Hattery, 141;
Hodgson, 140;
Holmes, 140;
Mayers, 141;
Pressy, 141;
Russen, 140;
_somnambulism_, Milligan, 206;
_survivorship_, Underwood _v._ Wing, 189;
_will case_, Tichborne, 23;
_wounds_, Briggs, 69;
M‘Laughlin, 69;
Warman, 69
Lead, 260, 304, 305 _et seq._
Leather, and blood stains, 93
Leblond, M., on abortion, 162
Legal criminal procedure, 2 _et seq._
Legitimacy, 185
Leishman‘s stain, 95, 146
Lemons, oil of, 260
Letheby, on poisons, 229
Leucomaines, 323, 326, 327
Levinstein, on chloral, 380
Levy, M., on copper, 311
Liability of medical men, 12, 20, 148, 222
Liebig‘s test (hydrocyanic acid), 371
Liebreich, on neurine, 324
Ligature, in infanticide, 65
Lightning, death by, 110, 137, 138
Lime, in putrefaction, 55
Lineæ albicantes, 31
Linen, in rape, 144
Littlejohn, on use of books, 19
Live birth, in infanticide, 166 _et seq._
Liver, in poisoning, 238, 256, 268-271, 278, 280, 291, 297,
310, 319, 327, 355, 365, 378, 383;
P.-M. exam, of, 62;
putrefaction, 54;
rupture of, 116
Livingstone, Dr. David, 28, 66
Lochia, in pregnancy, 156
Locomotor ataxia, 76
Lolium temulentum, 359
Lord-Advocate, 6
Lucid intervals, in insanity, 196
Luff, on poisoning, 229, 231
Lunacy, 291 _et seq._;
Acts, 206, 207, 223;
certificates, 206 _et seq._
Lungs in drowning, 130;
new born, 169, 174;
poisoning, 23, 233, 238, 256, 327, 345, 355, 365, 377, 378;
P.-M. exam, of, 63, 65;
putrefaction, 54
Lush, on rape, 141
Lustre of eye, in death, 43
MacCormac, on gunshot wounds, 87
Macdonald, criminal law, 18, 194
Mackenzie, Dr. C., on saponification, 53
Maclagan, Prof., on poisons, 231
MacNaughton case, 193
M‘Weeney, on blood tests, 107
Magnesium method (lead), 309
Magnus test (death), 43
Malignant disease, 132
Malpraxis, 82, 189;
law cases of, R. _v._ Van Butchell, 190;
R. _v._ Williamson, 190
Malum regimen, 82
Mammæ, in pregnancy, 152
Mammalian blood, 96, 105
Mania, 200 _et seq._, 235;
in poisoning, 379, 380, 402
Mann, Dixon, on combustibility, 114;
on lead poisoning, 308, 309;
on meat poisoning, 330
Mansfield, on prof. secrecy, 20
Manslaughter, 69
Marks of the cord, 123, 176
Marsh‘s test, 269, 280-84, 289, 296
Martin, on poisoning, 240
Matrons, jury of, 151
Maturity, of infant, 66, 174
Maudsley, on insanity, 193, 194, 195
Mauser bullet, 87
Maybrick case, 277
Mayer‘s reagent (alkaloids), 335
Measurement of fœtus, 36
Meat poisoning, 328
Meconic acid, 339-43
Meconium, 64, 179
Medical certificates, 11, 208 _et seq._;
evidence, 11 _et seq._;
liabilities, 12, 20, 148, 222;
report, 12
Medicines, in abortion, 171
Melancholia, 203, 204, 380
Meningitis, 110
Menopause, 189
Menorrhagia, 188
Menstruation, 152, 161, 189;
blood in, 96
Mental unsoundness, 192 _et seq._
Mercury, 230, 231, 235, 298 _et seq._;
salts of, 302 _et seq._
Mesentery, in putrefaction, 54
Metal, stains on, 92
Metallic poisons, 231, 245, 331
Metalloid poisons, 231, 267
Metchnikoff, on blood stains, 105, 106
Methæmoglobin, 102, 103
Metzer‘s test (cocaine), 358
Meyer, on pregnancy, 150, 154
Micro-organisms, 50
Microscope, 90, 94, 95, 145
Milk, human, 106, 177;
poisoning, 233, 333
Millar, Dr., on lunacy, 208, 209
Milne, Dr., on pregnancy, 187
Mineral acids, 246;
poisons, 231
Minute of P.-M. exam., 14
Miscarriage, 160
Mitscherlich‘s process (phosph.), 269
Modes of dying, 38 _et seq._
Modifying causes of poisoning, 234
Moisture, in putrefaction, 50
Molecular death, 43
Moles, in abortion, 162
Moncrieff, on insanity, 195
Monomania, 194, 201, 203
Monorchids, 187
Monsters, 184
Moral depravity, 194;
evidence, 239, 240;
mania, 194, 198, 201, 202
Morgan, Dr., on pulse tracings, 126
Morning sickness, in pregnancy, 152
Morphine, 244, 337, 339, 341-43
Mortal wounds, 70
Mosso, on leucomaines, 327
Mouth, in poisoning, 247, 259, 263, 278, 291, 293, 297,
299, 307, 311, 322, 330, 369, 375;
starvation, 132;
suffocation, 119
Mucous membrane, in poisoning, 233
Mummification, 53;
of cord, 182
Murder, 68, 69;
law cases: Cornier, 203;
Deeming, 203
Murrell, on cacodylates, 290
Muscles, in poisoning, 238, 310, 327, 390, 399
Muscular spasm, 47
Mushrooms, table of, 359
Mydaleine, 325
Mydriatic alkaloids, 349
Mytilotoxine, 332
Nævi materni, 21, 28
Naphtha, 402
Napoleon Code, 185
Narcotic poisons, 40, 72, 231, 242, 276, 343 _et seq._;
Nausea, in poisoning, 277, 293, 299, 330-33, 349,
360, 364, 374, 399
Navel, in infanticide, 64
Necrosis of jaw, 268
Needles, as vulnerant, 231, 265
Neglect of duty, 189
Neill, on gunshot wounds, 86
Nelaton, on chloroform, 378
Nervous system, in poisoning, 255, 263, 271, 276, 277, 286, 288,
297, 307, 310, 326, 349, 351, 376,
377-386, 399, 402
Nessler‘s reagent (ammonia), 264
Neural poisons, 231, 385 _et seq._
Neurine, 324
Neuritis, optic, 307;
peripheral, 277, 402
Nicotine, 365
Nipples, in pregnancy, 156
Nitric acid, 250 _et seq._
Nitrobenzene, 360, 361
Nitrogen monoxide, 402
Nitro-glycerine, 363
Normal saline solution, 90, 94, 106
Nose, in arsenic, 391
Notes, use of, 19
Notification of births, &c., 12
Nottidge _v._ Ripley (lunacy), 222
“Noxious thing”, 228
Numbness, in poisoning, 375, 401
Nunneley, on hydrocyanic acid, 370
Nuttall, on blood tests, 105
Nux vomica, 229, 388
Nymphomania, 203
Occupation marks, 29, 30
Œnanthe crocata, 352
Ogston, Prof., 72, 101, 114, 128, 130, 135
Oil of bitter almonds, 62, 373, 374;
lemons, 260
Omentum, in putrefaction, 54
Omission, in infanticide, 178
“On soul and conscience”, 7, 11
Opinion, reasoned, 13, 14;
written, 12
Opisthotonus in poisoning, 369, 390, 394
Opium, 41, 62, 229, 231, 235, 343 _et seq._, 356
Oral evidence, 18
Order, coroner‘s, 4;
lunacy, 207, 210-13, 215-20
Orfila, on vesication, 112;
on mercury, 301;
opium, 344
Organic poisons, 231
Organs, order of putrefaction, 52 _et seq._
Orpiment, 288
Ossification, 34, 64, 65, 174, 177
Otto‘s method (alkaloids), 337, 338
Oxalic acid, 229, 257 _et seq._
Oxygen, in poisoning, 398, 400, 402
Oxyhæmoglobin, 103
Pacini‘s solution (blood stains), 90
Paint stains, 108
Painter‘s colic, 305
Palmer case, 238, 390, 392
Pancreas, in putrefaction, 54
Paralysis, 72, 137, 138, 202, 204, 276, 306, 310,
330-33, 344, 351, 355, 378, 380, 382, 387
Parkman case, 28
Parol evidence, 18
Paterson, on ammonia, 264;
arsenic, 278
Patmore case, 19
Pauper lunatics, 220-22
Pavy, on mercury, 301
Penalties, 36, 11
Pencillium brevicaule, 288
Penetration, in rape, 140
Penis, absence of, 187;
erection of, 122, 128;
P.-M. exam. of, 63;
retraction of, 128, 130
Penny, on arsenic, 275
Perforation, in poisoning, 237, 242, 259, 278, 300, 333
Peritonitis, 110, 242
Peroxide of hydrogen, 92, 93, 101
Petition, in lunacy, 207, 210-13
Petty jury, 5
Peyer‘s patches, 327, 330, 331
Pharmacy Act, 228
Phenacetin, 363
Phenazonum, 363
Phenol, phenic acid, 254
Phlyctænæ, in putrefaction, 113
Phosphomobylic acid, 335
Phosphoretted hydrogen, 403
Phosphorus, 231, 239, 243, 267 _et seq._;
Phosphotungstic acid, 335
Physiological test (strych.), 392
Physostigmine, 244
Picrotoxin, 229, 234, 358
Pinel, on mania, 201
Placenta, in infanticide, 178;
souffle, 151, 154
Plaster, stains on, 92
Plouquet‘s test (lung), 174
Pneumonia, in poisoning, 299
Poisoning--law cases: Blandy, 240;
Cramp, 228;
Flannigan, 278;
Garner, 240;
Geering, 240;
Helson, 240;
Higgins, 278;
Lamson, 239;
M‘Cracken, 278;
Marsh, 294;
Maybrick, 277;
Newton, 278;
Palmer, 238, 390, 392;
Port, 274;
Pritchard, 19;
Spink, 294;
Smith, 275;
Wooler, 240
Poisons and poisoning, 51, 61, 62, 176, 227 _et seq._;
Acts, 228, 229;
action, 232, 234;
administration, 228;
chemical analysis, 237;
classification, 230 _et seq._;
definition, 227;
diagnosis, 235;
evidence, 235 _et seq._;
experiments, 239;
modifying causes, 234;
P.-M. appearance, 236;
sale of, 228;
schedules, 229, 230;
symptoms, 235
Polypus, in abortion, 163
Poppies, 230
Possessio fratris and patris, 184
Post-mortem examination, 3, 4, 7, 10, 45, 56 _et seq._;
Potash, caustic, 262, 263
Potassium salts, 314, 315, 325, 393
Precipitate, red and white, 230
Precipitins, in blood tests, 105
Precognitions, 6
Pregnancy, 67, 76, 150 _et seq._;
Diagnosis of, 155;
duration of, 185;
in poisoning, 229 _et seq._;
in rape, 147;
signs of, 151-54
Premature birth, 186
Preyer, on blood crystals, 96
Primary flaccidity, 45, 49
Pritchard case, 19
Pritchard, on insanity, 195, 201, 203, 205
Private patient, in lunacy, 210-13, 215-17, 220
Procurator-fiscal, 6
Professional privilege and secrecy, 20, 21
Prosecution, 4
Prosecutor, public, 4, 6
Prussian blue test (hydrocyanic), 371
Prussic acid, 62, 122, 239. (_See_ Hydrocyanic Acid.)
Ptomaines, 231, 232, 323-26, 365, 385
Ptomatropine, 332
Puberty, 188
Pugilistic attitude, in burning, 111
Pulse tracings (in hanging), 126
Punctured wounds, 74
Pupils, in brain injury, 72;
poisoning, 233, 234, 330, 343, 348-52, 364-68,
377, 378, 380, 384, 386, 399, 402
Purging, in poisoning, 242, 258, 263, 268, 276, 311, 313, 320,
330-33, 344, 355, 360, 364, 366, 367
Pus, 71, 93, 106, 113, 143
Putrefaction, 49 _et seq._;
in drowning, 128, 131;
infanticide, 167, 171, 172;
in poisoning, 269, 278, 294, 323, 330-33
Pyrites and arsenic, 290
Quarter Sessions, 5
Quickening, 151, 153, 186
Rabbit, in blood tests, 105, 106
Rachford, on leucomaines, 327
Rape, 140 _et seq._;
age at, 142;
definition of, 140;
in England and Ireland, 141;
examination for, 142;
in Scotland, 141;
signs of, 143, 148
Rape, law cases in: Barrett, 141;
Cockcroft, 140;
Fletcher, 141;
Groombridge, 142;
Hattery, 141;
Hodgson, 140;
Holmes, 140;
Mayers, 141;
Pressy, 141;
Russen, 140
Ray, on insanity, 195, 197, 202, 203
Realgar (red arsenic), 289
Reception order. (_See_ Order.)
Register of death, 2
Regulations of Crown Office, 7, 56
Reinche‘s test, 280, 283, 284, 296, 303, 304
Relaxation (flaccidity), 45, 49
Reptile blood, 96
Respiration, in infanticide, 167 _et seq._;
poisoning, 246
Rete mucosum, 23
Reynolds, on combustibility, 114
Richter, Max, on rape, 146
Rigidity, heat, 111
Rigor mortis, 46 _et seq._, 136-38, 390
Ritter, on arsenic, 290
Rodger and Girdwood‘s method, 338
Roman law, on legitimacy, 186
Roussin‘s solution (blood stains), 91
Roux, M., on gunshot wounds, 86
Rupture of organs, 242
Salicylic acid, 353
Saliva and salivation, 93;
in poisoning, 233, 235, 272, 276, 298, 299,
301, 304, 317, 322, 364;
in pregnancy, 152
Santa, Dr., on arsenic, 277
Saponification, 52, 53
Savin, 229, 231, 317
Scalds, 110 _et seq._
Scammony, 321
Scars, in identity, 21
Scheele‘s acid, 368;
green, 287, 288
Scherbler‘s reagent (alkaloids), 335
Scherer‘s test (phos.), 270
Schönbern‘s test (blood), 100
Schweinfurt‘s green, 287
Scopolamine, 349
Scorching, of wounds, 78, 87, 111
Scourging, marks of, 116
Scurvy, and contusions, 115
Secondary flaccidity, 49
Sedative poisons, 232, 364 _et seq._
Semen, 106, 122, 140 _et seq._
Sepsis and septic poisons, 74, 79, 80, 112, 164, 232, 323, 334
Sex, 31, 51
Sheep wash (arsenic), 275, 287
Shell-fish, poisoning, 332, 380
Shock, 38, 75, 81, 112, 139, 234, 366, 375
Sickness, morning, in pregnancy, 152
Signs of death, 43 _et seq._, 118, 127;
delivery, 155, 156;
pregnancy, 151 _et seq_.;
rape, 143, 148, 149
Silk fibres, 92
Silver nitrate, 260, 265, 280, 283, 288, 370;
test (hydrocyanic acid), 371
Skeleton, in identity, 31, 32
Skin, in burning, 111, 112, 115;
drowning, 129;
hanging, 123;
infanticide, 167, 179;
poisoning, 232, 233, 255, 274-77, 286, 288, 291, 293,
297, 306, 310, 330-32, 344, 349, 355, 368,
369, 374, 375-380, 382, 384, 399, 402;
putrefaction, 55;
strangling, 124;
throttling, 125
Skull, fracture of, 32, 176
Sleep, in insanity, 206;
poisoning, 235, 348;
rape, 147
Snake venom, 232-34
Sneezing, in poisoning, 320, 367
Snuff, in poisoning, 366
Smith, Madeline, case, 275
Smokeless powder, 87
Smothering, 63
Soda, caustic, 262, 263
Sodium theosulphate, 373
Solanine, 352
Solicitors, 5
Somatic death, 42
Somnambulism, 206
Somniferous poisons, 231, 343
Somnolentia, or sleep-drunkenness, 206;
law case: R. _v._ Milligan, 206
Sonnenschein‘s reagent, 335
Soot and arsenic, 275
Sorby, on blood stains, 93;
cell, 105
Souffle, placental, 151, 154;
uterine, 43, 151, 154
Spasms, in poisoning, 293, 320, 325, 344, 366
Spectra and spectroscope, 102, 103, 112, 136;
in poisoning, 234, 320, 360, 362, 382, 399
Spinal cord, 59, 74, 231
Spink case, 294
Spleen, 54, 62, 238, 278, 305, 330, 378
Spontaneous combustion, 113
Spermatozoa, 95, 144-47, 187
Squill, 231
Stains, acid, 249, 251-54;
blood, 79, 89 _et seq._, 145;
metallic, 108, 282;
seminal, 145, 146;
vegetable, &c., 108
Starch granules, 125, 179
Starvation, 132 _et seq._, 178, 243
Stas‘s process, 319, 335, 337, 350, 365, 376
Stature, in identity, 31
Steam, scalding by, 110
Stephen, Lord, on insanity, 223
Sterility, in female, 188; male, 187
Stertorous breathing, 368, 377, 397
Stevenson, on poisoning, 294, 332, 338
Stokes (Sir W.), on wounds, 87;
fluid, 103, 104
Stomach, in drowning, 127, 131;
infanticide, 168;
poisoning, 232, 233, 237, 242, 246, 256-59, 263, 268, 275,
278-80, 288, 291-95, 299-301, 350, 355, 366,
369, 375-78;
pump, 243, 244, 257, 269, 272, 286, 300, 307, 310,
322, 330-35, 345, 366, 386, 393, 402;
putrefaction, 54;
starvation, 135
Stramonium, 349, 351
Strangling, 63, 124 _et seq._, 176
Strangury, 322
Strophanthus, 230
Strychnine, 229, 231, 238, 244, 337, 342, 348, 380, 388 _et seq._, 402
Stupor, in melancholia, 204;
in poisoning, 319, 349, 354, 356, 364, 366, 402
Styrian arsenic eaters, 287
Subpœna, 8
Sudden death, causes of, 42 _et seq._
Suffocation, 63, 118 _et seq._;
infanticide, 176;
poisoning, 243, 246, 330, 368, 390, 402
Suggillation (_see_ Hypostasis), 45
Suicidal monomania, 203
Sulphonal, 230, 282
Sulphur, test in hcy. acid, 37;
dioxide, 402
Sulphuretted hydrogen, 273, 280, 285, 295, 308, 312, 400
Sulphuric acid, 231, 247 _et seq._, 261
Summons, Court. (_See_ Citation.)
Sunstroke, 136, 137
Superfœtation, 186
Surgical operations, 81
Survivorship, 133, 189
Symptoms, general, in poisoning, 235
Syncope, 38, 72, 118, 121, 127;
in poisoning, 364, 366, 375
Tables--_acids_, colour of stains from, 254;
symptoms of poisoning by, 261;
_aconite_ v. horse-radish, 375:
_alcohol_, brain concussion and opium,
distinctions between, 356:
_alkaloids_, characters of, 342:
_antimony_ and arsenic, reactions of, 296;
symptoms of, 297:
_arsenic_, in liver, 238;
precipitates (and of cadmium and tin), 281;
symptoms of, 291:
_bruises_, date of, 116:
_caustic potash, and soda_, distinctions between, 263:
_children_, height and weight of, 134;
maturity of, 174:
_corrosive and irritant poisons_, distinctions between, 234:
_dead body_, examination of, 71:
_diseases_, simulating irritant poisoning, 240-42;
narcotic, 243:
_embryo_, development of, 35, 36:
_epiphyses_, union of, 34:
_fœtus_, death of, 181;
measurements of, 37:
_insanity_, classification of, 197:
_lead_, symptoms of, 310:
_leucomaines_, 326:
_lunacy certificates_, 208-19:
_meconic acid_ (and morphine), reactions of, 341:
_mercuric_ and _mercurous salts_, reactions of, 302:
_mushrooms_, 359:
_new born_, age of, 180, 181;
respiration in, 170:
_ossification_, centres of, 34:
_osseous nucleus_, dimensions of, 37:
_poisoning_, evidences of, 241:
_poisons_, actions of, 234;
causes modifying, 234;
classification of, 231;
diffusion of, 233, 234;
schedules of, 229, 230:
_pregnancy_, signs of, 151:
_ptomaines_, 323, 324:
_putrefaction_, order of, 53, 54;
time and indications of, 55, 128:
_rape_, age in, 142;
examination in, 142;
signs of, 148:
_rigor mortis_, time and causes of, 49:
_suffocation_, death from, 121:
_teeth_, eruption of, 33:
_tetanus_, diagnosis of, 393:
_uterus_, size of, 157;
weight of, 157:
_wounds_, types of, 84, 85:
Tamassia, on veins, 25
Tannic acid and tannin, 93, 365, 393
Tar, oil of, 254
Tarchette, on blood stains, 105, 107
Tardieu, on digitalis, 364;
hanging, 122;
tattoo marks, 23
Tattoo marks, 21, 23
Taylor, 52, 69, 70, 113, 164, 165, 194, 227, 231,
233, 238, 339, 368, 382, 397
Taylor, Bessie, case, 294
Teeth, 25, 33, 246, 259, 268, 299
Telangiectasis, 115
Temperature, body, 30, 45, 50, 132
Tests: acetanilide, 363;
acetic acid, 262;
aconite, 376;
alcohol, 356;
alkaloids, 335 _et seq._;
ammonia, 264;
aniline, 362;
antimony, 295 _et seq._;
arsenic, 280 _et seq._;
barium, 315;
belladonna, 350;
blood, 90 _et seq._;
biological (blood), 105,
(semen), 146;
brucine, 393, 396;
carbolic acid, 256;
carbon disulphide, 380;
caustic alkalies, 363;
chloral, 381;
chloroform, 379;
chromium, 316;
cocaine, 357;
cocculus indicus, 358;
conine, 386;
copper, 312;
death, 43 _et seq._;
digitaline, 365;
eserine, 387;
ether, 378;
hydrochloric acid, 252;
hydrocyanic acid, 370;
iodine, 272;
iron, 314;
lead, 308 _et seq._;
lobelia, 367;
lung, 170 _et seq._;
meconic acid, 335, 341;
mercury, 302 _et seq._;
morphine, 335, 341;
nicotine, 366;
nitric acid, 250;
nitrobenzene, 360;
oxalic acid, 259;
phenacetin and phenazonum, 363;
phosphorus, 269;
potassium salts, 272, 314, 373;
semen, 145;
strychnine, 392;
sulphonal, 383;
sulphuric acid, 248;
veratrine, 367;
veronal, 384;
zinc, 265, 313
Testamentary capacity, 225
Testicles, in drowning, 112;
infanticide, 64
Teichmann‘s blood crystals, 101
Tetanus, 64, 70, 235, 390, 394
Tetronal, 383
Thorpe‘s apparatus, 282
Throat, 59, 132;
and poisoning, 232, 246, 259, 276, 293,
294, 306, 330, 332, 379
Throttling, 117, 125
Tichborne case, 23
Time of death, 30
Tidy, on infanticide, 170;
starvation, 123
Tin, chloride of, 265, 281;
tinned food, 331, 332
Tindall, on malpraxis, 190
Tobacco, 234, 365
Tongue, in drowning, 129;
poisoning, 259, 276, 299;
starvation, 123;
suffocation, 119
Toxalbumoses, 329
Toxicohæmic poisons, 232, 334
Toxicology, 227 _et seq._
Toxins, 232, 329
Trachea, in drowning, 130;
poisoning, 247, 402;
putrefaction, 54;
suffocation, 118;
tracheotomy, 244
Traill, on bismuth, 314;
croton oil, 318
Treatment (general) in poisoning, 243, 247
Trichiniasis, 328, 333
Trichomonas vaginæ, 144
Uhlenhuth, on blood tests, 105
Ulceration of bowel, 294
Umbilical cord, 174, 177, 180, 182
Underwood _v._ Wing (survivorship), 189
United States, and murder, 69
Unsound mind, 192 _et seq._ (_See_ Insanity.)
Uræmia, 40
Urethane, in strychnine, 393
Urine, in poisoning, 238, 239, 246, 256, 258, 276, 291, 293,
297, 305, 309, 311, 349, 370, 382, 401;
stains, 96, 106
Uterine souffle, 151, 154
Uterus, contraction of, 154;
double, 186;
in abortion, 76, 162, 164;
in burning, 112;
delivery, 156;
impotence and sterility, 188;
poisoning, 242, 319, 322, 377;
pregnancy, 76, 153;
injury to, 76;
P.-M. exam., 62, 65;
putrefaction, 54;
superfœtation, 186;
table of size, 157;
of weight, 157
Vagina, 142, 143, 156, 188
Vaginismus, 188
Vagitis uterinus, 170;
vaginalis, 170
Van Gieson, on heat-stroke, 137
Vapour, arsenical, 286, 301;
tests in hydrocyanic acid, 370, 371
Vaughan on, food poisons, 328, 333
Vegetable alkaloids, 335 _et seq._;
poisons, 231, 239, 317;
stains, 108
Venesection, in electricity, 139
Verdicts, 6 _et seq._
Vermilion, 301
Vermin-killers and arsenic, 275
Vernix caseosa, 64, 179
Veronal, 383
Vesicules, in burns, 110, 111, 113
Violence, in infanticide, 161, 178
Violet powder and arsenic, 275
Virchow and Zenker, on trichiniasis, 333
Virginity, signs of, 144, 149
Vital poisons, 231, 267;
reaction, 45, 61, 79, 112
Vitalli‘s test (belladonna), 350
Volatile poisons, 244
Vomiting, 241-244, 258, 263, 275, 276, 277, 280, 292, 293,
295, 297, 299, 300, 306-11, 313, 320, 330-33, 360,
361, 364-68, 374, 378, 399
Vulnerant poisons, 231, 266
Wagner‘s method, 337;
reagent, 335
Wall-papers and arsenic, 287
Warmth and putrefaction, 50
Warrant, coroner‘s, 4;
Procurator-Fiscal‘s, 7
Wash, sheep‘s (or dip), and arsenic, 255, 287
Wassermann, on blood tests, 105
Water, gas, 400;
lead in, 305, 306;
and putrefaction, 53-55
Watt, on arsenic, 278
Weed-killers and arsenic, 275
Weight of children, 137;
lungs, 174;
uterus, 157
Wendt, on infanticide, 174
Westbury, Lord, on insanity, 195
Whitehead, on abortion, 160
Wightman, on survivorship, 189
Wills, drawing of, 191
Wills, on dying declarations, 18
Wilson, on note-taking, 19;
lead poisoning, 305
Winslow, Forbes, on insanity, 192;
test of death, 43
Witnesses, 3, 6, 8, 18, 19, 223
Wolffe‘s bottle, 283
Womb, in infanticide, 176
Wood, blood stains on, 91
Wool fibres, 90
Wormley‘s test (belladonna), 350
Wounds, in abortion, 163, 164;
causes of death in, 80, 81;
definition of, 69;
in drowning, 129;
examination of, 60 _et seq._;
infanticide, 175 _et seq._;
varieties of, 70 _et seq._
Wounds--law cases: R. _v._ Briggs, 69;
M‘Laughlin, 69;
Warman, 69
Wredin‘s test (live birth), 174
Writ of Court, 8;
lunacy, 224
Wynne (Sir W.), on insanity, 196
X-rays, 77, 110, 114, 115
Yew, 321
Zinc, chloride, 265;
sulphate, 300, 313, 331
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