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PRINCIPLES

FORENSIC MEDICINE,

I -^^\j-J(^'J>£ ^/6'APJS/J:r2i^.-4

PRINCIPLES /<P<$<^

FOEENSIC MEDICINE.

WILLIAM A. GUY, M.B. Cantab.

FELLOW OF THE KOYAL COLLEGE OF PHYSICIANS;

PROFESSOR OF FORENSIC MEDICINE, KING'S COLLEGE, LONDON ;

PHYSICIAN TO king's COLLEGE HOSPITAL;

MEDICAL SUPERINTENDENT OF MILLBANK PRISON,

ETC. ETC.

SECOND EDITION.
WITH NUMEROUS ILLUSTRATIONS ON WOOD.

LONDON:
HENRY EENSHAW, 356, STRAND.

MDCCCLXI.

[r/ie right of Translation reserved.']

LOKDOK: PKINTED BV W. CLOWES AND SONS, STAMFOKD STREET.

PREFACE

SECOND EDITION.

»5^'

The original motive of the Author in undertaking t)i^/\t
work was to furnish the members of his class wit];i>a.€yfitfem' .^
of Forensic Medicine, in which the several subject^ 'should he
arranged in the same order, and treated in thelisftnle way, as
in his lectures.

This object has been kept in view in preparing the second
edition for the press.

The no less important object of condensation has been
attained by the abbreviation or omission of the greater
number of the illustrative cases quoted in the first edition,
and of some of the tables, on which much labour had been
expended. The references have also been curtailed, and
authors' names have been occasionally substituted for a more
exact reference to their works.

The space thus gained has allowed of the introduction into
this edition of several new subjects, and of a considerable

y\ PREFACE.

number of illustrative woodcuts, by which, it is believed, the
value of the work has been much enhanced.

In introducing this new feature, the author has merely
given greater development to a practice now becoming com-
mon, of illustrating medico-legal papers, and especially those
on Toxicology, by wood-cuts. A page of engravings illus-
trative of chemical apparatus has always formed a part of
Dr. Christison's work on Poisons ; wood engravings are very
largely used in the works on Materia Medica of Pereira and
Royle ; and Casper's * Handbuch der Gerichtlichen Medicin '
has an atlas of coloured prints.

The wood engravings, with the exception of those which
show th^ appearance of the subhmates of arsenic, have been
done expressly for this work ; and the greater number of
them are not to be met with in any shape elsewhere. They
were drawn and engraved under the author's direction, chiefly
from coloured drawings, preparations, and microscopic spe-
cimens in his own possession. The anatomical and patho-'
logical subjects, some of the crystals, some of the roots and
most of the seeds, were drawn by Dr. Westmacott, the re-
mainder by Mr. Hart, by whom all the engravings were
executed.

As a general rule the more important subjects, such as
Infanticide and Unsoundness of Mind in the first part, and
Poisoning by Arsenic, Opium, and Strychnia in the third
jiart, are the most fully treated and most largely illustrated ;
but the space devoted to each subject has been determined

PREFACE.

less by its importance than by the length of the descriptions
and discussions necessary to render it intelligible. It may be
well to add that, while the entire work has been revised, and
most parts of it condensed, many portions of it have been
wholly rewritten.

It is in the third part of the work, or that which treats of
Toxicology, that the largest additions and alterations have
been made ; so that the 165 pages devoted to this subject in
the first edition have been extended to 237 in the present one.
It is in this part, too, that the wood engravings will be found
most numerous.

In treating this important group of subjects, an attempt
has been made to render the tests for the poisons more easy
of comprehension, and to impress them more eflfectually on
the memory, by distinguishing between the properties of the
several poisons and their tests, and by arranging the tests, as
much as possible, in the order in which they would be ap-
plied, on the supposition that the substance submitted to
analysis was unknown, the most characteristic reactions being
added. Some of the properties and tests of the alkaloids and
other active principles of the animal and vegetable kingdoms
are stated as results of an inquiry still in progress. The
portion of the work relating to the properties and tests of
arsenic and arsenious acid has been remodelled in con-
sequence of the unexpected discovery of the globular form
of metallic arsenic, as deposited from its vapour. In the case
of some of the more important poisons, the value of individual

Vlll PREFACE.

symptoms, and the duration of the poisoning, have been de-
duced from an extensive and careful analysis of cases.

In the preface to the first edition the author had to ac-
knowledge his obligations, in a special manner, to Beck's
learned and elaborate Elements of Medical Jurisprudence;
to Ray's Medical Jurisprudence of Insanity ; to Dr. Gavin's
work on Feigned Diseases; to the Elements of Medical
Jurisprudence of Dr. A. Taylor; to Watson's Medico- legal
Treatise on Homicide ; and to the standard work on Poisons
of Dr. Christison ; as well as to several foreign monographs
and systematic works.

To this list must be added, as works of constant and neces-
sary reference, the learned treatises on Medical Jurisprudence
and on Poisons, as well as the valuable toxicological Essays
of Dr. Taylor, the Elements of Materia Medica of Dr. Pereira,
and the Elements of Chemistry of Dr. Miller. The author has
also much pleasure in recording his obligations to his friend
Dr. John Harley, Medical Tutor of King's College, for his
assistance in revising the press, as well as for his faithful
drawings of some microscopic objects, and his useful and
valuable suggestions.

26 Gordon Street,
January, 18GI.

CONTENTS.

Page
Introduction (including the subject of Medical evidence) . xv

PART I.

CHAPTER I.
Personal Identity — Age — Sex ...... 1

CHAPTER II.
Impotence — Rape — Pregnancy —Delivery, . . . .24

CHAPTER III.
Foeticide — Infanticide — Legitimacy , . . . .63

CHAPTER IV.
Life-assurance — Feigned Diseases 129

CHAPTER V.
Unsoundness of Mind ........ 149

CONTENTS.

PART II.

CHAPTER I. Page

Persons found dead — Real and Apparent Death — Sudden Death
— Survivorship 202

CHAPTER II.
Drowning — Hanging — Strangulation — Suffocation . . . 230

CHAPTER III.
Wounds and Mechanical Injuries » 255

CHAPTER IV.

Death by Fire — Spontaneous Combustion — Death by Lightning —
By Cold— By Starvation 285

PART III.

Toxicology.

CHAPTER I.
On Poisons in General 293

CHAPTER II.
Irritant Poisons 316

CHAPTER HI.
Mineral Acids — Sulphuric Acid — Nitric Acid — Hydrochloric Acid 325

CHAPTER IV.

The Alkalis and their Carbonates — Potash — Soda — Ammonia —
and their Carbonates 340

CHAPTER V.

The. Vegetable Acids — Oxalic Acid, and Binoxalate of Potash —
Tartaric Acid, and Bitartrate of Potash — Citric Acid . . 344

CONTENTS. XI

CHAPTER VI. Page

Salts of the Alkalis and Earths — The Nitrate and Sulphate of
Potash — the Sulphate of Alumina and Potash — the Sulphuret
of Potassium — the Chloride of Sodium — the Chlorides of Lime,
Soda, and Potash — and the Salts of Baryta .... 351

CHAPTER VII.

Vegetable Irritants — Purgative Medicines — Savin — Yew — Meze-
reon — Arum — Colchicum — Veratrum album — Helleborus
niger — and Diseased and Decayed Vegetable Matters . . 355

CHAPTER Vni.

Animal Irritants — Cantharides — Poisonous Fish — and Diseased
and Decayed Animal Matters . . . . . ,360

CHAPTER IX.

Irritant Gases — Nitrous Acid Gas — Sulphurous Acid Gas — Hydro-
chloric Acid Gas — Chlorine — and Ammonia . . .363

CHAPTER X.

Specific Irritans — Phosphorus — Iodine — and Iodide of Potassium 364

CHAPTER XI.

Arsenic and its Preparations — Antimony and its Preparations —
Mercury and its Preparations — Lead and its Preparations —
Copper and its Preparations — Zinc, Tin, Silver, Iron, Bismuth,
Chrome, and their Preparations 367

CHAPTER Xn.
Narcotic Poisons 435

CHAPTER XIII.
Opium and its Preparations — Morphia and its Salts . . . 439

CHAPTER XIV.

Hydrocyanic Acid — and the Cyanides — Oil of Bitter Almonds —
Laurel Water . . . . . . . . . 450

CHAPTER XV.
Poisoning by Alcohol, ^Ether, and Chloroform .... 469

Xll CONTENTS.

CHAPTER XVI. Page

Poisoning by Narcotic Gases — Carbonic Acid — Sulphuretted Hy-
drogen— and Carburetted Hydrogen 475

CHAPTER XVn.
Narcotico-acrid Poisons 485

CHAPTER XVni.
Nux Vomica — Strychnia — Brucia 488

CHAPTER XIX.

Belladonna — Hyoscyamus — Stramonium— Camphor — (Enanthe
Crocata — Cocculus Indicus — Lolium temulentuni — Poisonous
Mushrooms ......... 502

CHAPTER XX.
Aconite — Digitalis — Tobacco — Lobelia Inflata — Conium . .512

CHAPTER XXI.

Ergot of Rye — Cicuta Virosa — Phellandrium Aquaticum —
/Ethusa Cynapium — Cytisus Laburnum — Solanum Nigrum . 526

CHAPTER XXII.
Oil of Turpentine— on of Tar — Kreasote— Oil of Dippel . .529

LIST OF WOOD ENGRAVINGS.

Fig. Page

1. The jaw-bone in old age 16

2. Male and female pelvis . . . . . . .21

3. Spermatozoa 41

4. Trichomonas vagince ....... 42

5. Developed air-cells ....... 79

6. Air-cells and air vesicles in foetal lungs . . . .80

7. Diagram of foetal circulation 98

8. Foramen ovale ........ 99

9. Human blood-corpuscles ....... 264

10. Crystals of hsemine ....... 266

11. Blood-corpuscles in man and animals .... 268
12 & 13. The gullet in poisoning by hydrochloric acid . . 338

14. The stomach in poisoning by hydrochloric acid . . . 338

15. Seeds of colchicum 357

15*. Globules of metallic arsenic ...... 369

16. Reduction tube 371

17. Reduction tube (new form) 372

18&19. The regular octahedron 372

20. Appearances of the opaque octahedron .... 373

21. Appearances of the transparent octahedron . . . 373

22. The lengthened octahedron 373

23. Trefoil-variety of the octahedron 374

24. The half octahedron 374

25. Appearances of the half octahedron 374

26. Twin crystals 374

27. Group of crystals of arsenious acid sublimed . . . 375

28. Reduction tube with arsenical crust 375

29 & 30. Mixed crusts of arsenic and arsenious acid by reflected

light 377

31. Mixed crust of arsenic and arsenious acid (by transmitted

light), showing globules of the metal .... 377

32. Crust of pure metallic arsenic, showing globules . , 377

33. Apparatus for transferring stains of arsenic from an opaque

to a transparent surface . . . . . .378

34. Capillary reduction tube 378

35. Capillary tube mounted for the microscope , . , 379

36. Drop bottle . . : 380

Xiv LIST OF WOOD ENGRAVINGS.

Fig. Page

37 it 38. Original forms of Marsh's apparatus . . . 382

39. Modern form of the same 382

40. Crust of arsenic in horizontal tubt» 384

41. Crust of antimony in horizontal tube .... 384

42. Form of apparatus for reducing arsenic by electrolysis . 387
43 & 44. The tetrahedron 401 •

45. Cube with the edges replaced by planes . . . .401

46. Microscopic forms of crystals of tartar emetic . . . 401
47 & 48. Crystals of corrosive sublimate (sublimed) . . 409

49. Globules of mercury 410

50. Globules of mercury and arsenic 411

49*. Lead tree 421

50*. Tin tree 433

51. Silver tree 433

52. Seeds of papaver somniferum 440

53. Form of crystals of morphia ...... 441

54. 55, & 56. Seed of the nux vomica 489

57. Microscopic appearance of the powder of nux vomica . . 490

58. Form of crystals of strychnia ...... 491

59 & 60. Microscopic crystals of strychnia . . . .491

61. Microscopic crystals of strychnia from its solution in chloro-

form 494

62. Crystals of strychnia with acetic acid, carbazotic acid, and

corrosive sublimate ....... 494

63. Seeds of belladonna 503

64. Seeds of hyoscyamus ....... 506

65. Seeds of stramonium ....... 508

66. Seeds of cocculus indicus 512

67 &; 68. Seeds of aconitum napellus 513

69 & 70. Roots of aconitum napellus 514

71. Root of the horse-radish ....... 514

72. Seeds of digitalis 518

73. Seeds of lobelia inflata 523

74 & 75. Seeds of conium maculatum .... 523-4

PRINCIPLES OF FORENSIC MEDICINE.

INTRODUCTION.

The state avails itself of the knowledge, experience, and skill of the
medical man for three distinct purposes : — 1 . For the care and treat-
ment of soldiers and sailors, prisoners, convicts, paupers, and lunatics,
and other classes of persons for whose safety governments make them-
selves responsible ; 2. As officers of health ; and 3. As skilled wit-
nesses in courts of law.

The duties which the medical man is called upon to perform in the
first of these three capacities do not differ materially from those which
devolve upon him in the ordinary practice of his profession, except
that he is expected to give at least as much attention to the prevention
as to the cui-e of disease, and to add to his medical and surgical skill a
fair share of administrative talent.

But as officers of health, and as witnesses iu courts of law, medical
men are required to perform important and responsible duties for
which the ordinary practice of their profession affords no adequate
preparation, medical education, till of late years, no proper training,
and medical literature no sufficient guidance.

A consciousness of the distinctness, importance, and difficulty of the
duties required of the medical man in these two capacities led at
length to the establishment of a new and distinct science, taught in
separate courses of lectures, treated of in separate works, and engaging
the attention of many distinguished men more or less completely sepa-
rated and set apart for the practice of the corresponding art.

This new science and art was either made to embrace the whole of
the duties which the medical man may be called upon to perform on
behalf of the state, in which case it received the name of Political
Medicine, or State-Medicine ; or it was divided into two sciences, the
one under the title of Hygiene or Public Health, the other known
indifferently as Forensic Medicine, Juridical Medicine, Legal Medicine,
or Medical Jurisprudence.

XVI INTRODUCTION.

As the term Forensic Medicine expresses at least as clearly as
any of the other terms the application of medical knowledge to legal
purposes, it is employed in the title of this work. It is scarcely
necessary to add that the term medico-legal is in common use, as in
the phi-ases " medico-legal knowledge," " medico-legal experience,"
" medico-legal skill."

The history of the science of Forensic Medicine resembles closely
that of most other sciences. Necessity or convenience first gives birth
to an art practised by individuals more or less skilful without any
guidance from general principles ; the impoi-tance of the art, and the
responsibility attached to the practice of it, soon create a demand for
instruction, oral and wiitten, which instruction gradually assumes a
systematic form ; and that which was so lately an art is universally
recognized as a science. Thus the science of astronomy sprang from
a rude art of navigation, and the science of medicine from an empirical
art of healing. The science of Forensic Medicine, in like manner,
took its rise in the necessity of bringing medical knowledge to bear
on legal inquiries relating to personal injuries or loss of life ; the
medical witness being at first without guide or instruction in the per-
formance of his duty, and so continuing till a growing sense of the
importance of his evidence, to society on the one hand, and to his own
reputation on the other, created a demand for instruction which could
not fail of being supplied. Cases were accordingly collected, arranged,
and commented upon, illustrative facts were sought after, special experi-
ments were devised and performed, till at length the medical witness
received in books and lectures the same distinct instruction as the
physician or surgeon at the bed-side had already derived from written
or oral teaching in the theory and piactice of medicine, or of surgery.

But the importance of medical testimony received an earlier recog-
nition from some of the continental governments than from the public
or the medical profession j for the appearance of the first medico-legal
treatise (1597) was anticipated by nearly a century by the earliest
state recognition (1507) of the necessity of medical evidence, and was
followed within a few years by the appointment of medical men for the
performance of medico-legal duties.*

The history of Forensic Medicine as a science in England is of com-
paratively recent date. It cannot be carried further back than the
publication, in 1788, of Dr. Samuel Farr's Elements of Medical

• The following dates have an historical interest. 'I'he penal code of tlie
Bishop of Bamberg, proclaimed 1507. A uniform penal code adopted by tl>e
Diet of Katisbon, 1532. The Covstitutio Crimmalis Carolina, publislied 1553.
Presentation by Henry IV. of France of letters patent to his first physician, em-
powering him to appoint two surgeons in every city and large town to ex-
amine and report upon wounded or murdered persons, 1603. Publication at
Frankfort of tlie Meihodus Testificandi of Condronchus, 1597, and of the works
of Fortunatus Fidelis and Paul Zacchias in 1598 and 1621. First course of
lectures on Forensic Medicine given by Micliaelis at Leipzig, about 1650. For a
learned history of legal medicine, see Traill's Outlines of Medical Jurisprudence.

IKTEODUCTION. XVll

Juvisprudence ; and the science was first taught in lectures at the
University of Edinburgh, in 1801, by Dr. Duncan, sen., the first pro-
fessorship having been conferred by government on his sou in 1803.
Since that date the science has made great and rapid progress; its
importance is fully recognized by most of the examining bodies ; it is
taught in all our medical schools ; its principles are being constantly
applied in our courts of law ; and England is contributing her fair
share of practiavl observation and original research towards its exten-
sion and improvement.

The application of the principles of the science to actual practice,
or, in other words, the practice of Forensic Medicine as an art,
devolves, for the most part, on the great body of medical practitioners.
It is only in comparatively rare instances that those who have devoted
special attention to the entire subject, or to important constituent paiis
of it, such as Toxicology, or who have attained to eminence in special,
branches of medical practice, such as midwifeiy and the treatment of
the insane, are summoned to give evidence. in our courts of law.

There are many reasons why the medical man should approach the
performance of this class of duties with apprehension. He is conscious
of the importance which attaches to his evidence ; he is wanting in
that confidence which a more frequent appearance in the character of
a witness would impart ; he is painfully alive to the unstable founda-
tion upon which many medical opinions rest ; he knows that it is not
easy in practice to observe the rules of evidence with which in theory
he may have made himself acquainted ; and, above all, he shrinks from
that publicity which attends all our legal proceedings, and from the
unreasonable license allowed to counsel engaged not to discover truth
but to achieve a victory for a client. Sympathizing in these reason-
able apprehensions of the medical witness, some medical writers of
eminence and most authors on Forensic Medicine have endeavoured to
prepare him for the performance of his duties by setting forth the
precautions he should observe both prior to and during his attendance
in court. Information respecting the best mode of conducting pre-
liminary medico-legal inquiries is generally to be found under the
heads of " Post-mortem inspection," " General evidence of poisoning,'
" Unsoundness of mind," or other subject to which the inquiry specially
refers : the precautions to be observed, when he makes his appearance
in the witness-box, are commonly treated of in a distinct Chapter
under the title of Medical Evidence. This distinction is observed
in these pages.

Before proceeding to treat of the duties of the medical witness, it
may be well to give some idea of the number of cases occurring year
by year in England and Wales of a class to give rise to inedico-legal
inquiries. Taking the year 1856 as the year concerning v/hich we
have the most recent exact information, the Nineteenth Annual Repoit
of the Kegistrar-General records the following figures : —

XVin INTRODUCTION.

Sudden deaths (causes unascertained) . . 3,474

Intemperance, privation, neglect, and cold . . ],123

Poison 432

External violence 13,352

Alalforinations, premature birth and debility, and

atrophy 32,709

Totol . . . 51,095

The mixed class of deaths by external violence comprises 6,438 deaths
by fractures and contusions, wounds, and other violence; 2,919 by
burns and scalds; 2,681 by drowning (exclusive of deaths at sea) ; and
1,314 by hanging and sutibcation.

The number of inquests to which these premature, sudden, and
violent deatlis occurring in 1856 gave rise, was 21,801: and as the
number of qualified practitioners in England and Wales falls far short
of this number, it follows that, if the duty of attending at inquests
were distributed equally, each member of the profession would attend
at least one inquest every year.

The committals for trial arising out of these 2 1 ,801 inquests amounted
to 476, of which 205 were for murder, and 271 for manslaughter;
and of this number 265 took their trial. In 1314 instances the death
was returned as suicidal.

The total number of cases requiring medical evidence in our higher
courts of law may be judged of approximatively fi-om the printed
returns of commitments for trial for offences against the person. In
the year 1854 these commitments amounted to 1,849, and comprised
76 commitments for murder and attempts to murder attended with
dangerous bodily injury ; various attempts to maim and injure, 159 ;
assaults, and inflicting bodily harm, 276 ; manslaughter, 231; attempts
to procure abortion, 5; concealment of birth, 61 ; rape, assaults with
intent, &c., 268; unnatural offences, and assault with intent, 107.
If we add 1 5 other cases of injury to the person not comprised in the
printed returns under the head of " Offences against the Person," we
have a total of nearly 1,200 cases on which it is highly probable that
the evidence of medical men was required. If we add to these cases
nearly 22,000 inquests, the civil cases in uhich skilled medical evidence
is requiied, and proceedings in respect of lunatics, the occasions on
which medical men are summoned to the service of the state will
appear very consideiable — certainly numerous enough, and important
enough in themselves to justify all the attempts which have been made
to construct a science of Forensic Medicine, to teach it systematically in
books and lectures, and to draw up a code of instructions for the guid-
ance of the medical witness in the performance of his duties.

INTROLUCTIOX.

MEDICAL EVIDENCE.

The duties which the medical man may be required to perform when
summoned as a witness are twofold. He may have to state facts, and
l>e may have to interpret them ; in other words, he may be, in the
language of jurisprudence, both a common witness and a skilled witness.
In some cases he is a common witness, in others a skilled witness ; and
in others, again (and these are the majority of cases), he acts in both
capacities.

As a common witness, his duty is to state facts ; as a s^jtV^c? witness,
to express his opinions. If he is examined as to facts which he has
himself witnessed, he is also questioned as to his interpretation of them,
and then he performs the double duty of a common and a skilled wit-
ness ; but if summoned to state his opinion of the bearing and value
of facts deposed to by others, he acts the part merely of a skilled
witness.

This distinction, between the duties of a common witness and of
a skilled witness, has not always been recognized; and some medical
men have fallen into the error of supposing that they were not required
to express opinions, but merely to state facts. The law on this point
is, however, quite plain. " The general rule is, that a witness must
not be examined as to his opinion, for his testimony must be confined
to evidence of facts. But in questions of skill and judgment, men of
science or experience are allowed to give evidence of their opinion."
" In criminal cases, the opinions of medical men of science are very
frequently employed as evidence. A physician who has not seen the
patient, may, after hearing the evidence of others, be called to prove,
on his oath, the general eflect of the disease described by them, and its
probable consequences in the particular case. So in prosecutions for
murder medical men have constantly been allowed to state their
opinion, whether the wounds described by witnesses were likely to be
the cause of death."*

In stating facts, and in drawing inferences from them, or from the
evidence of other witnesses, there are certain precautions which the
witness ought to observe, and certain legal requirements of which hb
should not be ignorant.

In the first place, he should approach the performance of his duties
in a proper frame of mind. He should " use his best endeavours that
his mind be clear and collected, unawed by fear, and uninfluenced by
favour or enmity." (Percival.) The witness will find it difficult lo
maintain this impartial frame of mind when the crime alleged is one of
unusual enormity, when popular feeling runs high either for or against
an accused person, or in times of public agitation, when a popular
movement may seem to be endangered by evidence given in favour of
an individual,' or when he is engaged distinctly for the prosecution or
for the defence. In this latter case, he must not deem himself free
* Burn's Justice, Title, Evidence.

XX INTRODUCTION.

from the risk of partiality, even though, after hearing all the facts
upon which his opinion must be formed, and making i)roper personal
inquiries, he feels that he can conscientiously give his evidence in favour
of the party for whom he is retained.

The medical witness requires to be specially cautioned against ex-
pressing an opinion on the general merits of the case under inquiry,
thus offending against an admitted principle of English law, that " when
scientiHc men are called as witnesses, they are not entitled to give their
opinion as to the merits of the ccise, but only as to the facts proved on
the trial." Against this rule many eminent members of the medical
profession have offended, and been reprimanded accordingly.

A special caution is also required against a feeling of misplaced
humanity, or an equally misplaced condemnation of the law on the
score of undue severity. It was under the influence of both these feel-
ings that the late Mr. Abernethy,* when speaking of the necessity for
examining the lungs in all cases of suspected infanticide, gave express-
si on to the unsound sentiment — " It is your duty, I think, to try to
weaken the effect of your testimony on this point." This was a great
error; for if there is one thing more essential for the medical witness
to remember than another, it is, that he has nothing whatever to do
with the consequences to which his opinions may lead, provided always
that they are the result of cautious inquiry and due reflection. " The
dread of innocent blood being brought upon us by explicit and honest
testimony, is one of those superstitions which the nurse has taught, and
which a liberal education ought to purge from the mind; and if, in the
performance of our duty, innocence should unfortunately be involved in
the punishment of guilt, we shall assuredly stand acquitted before God
and our own consciences." (Percival.)

The medical witness approaching his duties with a mind thus free
from bias, requires some instruction as to the mode in which his evi-
dence should be given.

Bearing in mind the distinction already laid down between the
duties of a common witness and of a skilled witness, he should be
cautious not to obtrude his opinions when facts only are required of
him, nor dogmatically to assert as facts things which are merely
matters of opinion. He should answer the questions put to him,
whether by the counsel, the court, or the jury, clearly and concisely,
and if none of these elicit the whole truth, it is his duty to supply what
is wanting. Such additions are always gratefully received by the
court.

The statements which the witness has to make, and the opinions he
expresses, should be couched in the plainest and simplest language ;
and he should avoid as much as possible all technical terms, and when
it is absolutely necessary to use them, explain them in the clearest and
simplest way. It is scarcely necessary to add, that he should care-
fully avoid all figurative and metaphorical expressions.
* Lectures, ' Lancet,' vol. xii. p. 227.

INTRODUCTION. XXI

The medical witness ought also to understand that he is not allowed
to quote authorities in support of his opinions. The rejection of such
appeals to authority has been unjustly stigmatized as " a compromise
of the rights and dignity of the profession,"* and the rule of exclu-
sion has not always been rigidly acted on. There can be no doubt,
however, that the common usage of our courts of law is to disallow
these appeals to authority.

This exclusion of all appeals to authority is not attended with any
bad effect, inasmuch as the medical witness is supposed to have made
himself master of the opinions of the most eminent writers on the
subject-matter of his evidence, and to have employed these opinions as
the basis of his own inquiries and experience, so as to embody in his
own evidence the opinions of the lending authorities of his profession.

But though the medical witness is precluded from citing authorities,
he may be made the medium of bringing them into play ; for he may
be asked whether A or B is an esteemed authority with his profession,
and whether he (the witness) coincides with some opinion expressed in
his works. If the witness answers in the affirmative, he becomes the
exponent of the opinion to which he has thus given his assent.

The suggestions now made as to the mode in which the medical
man ought to give his evidence will be of little use to him, unless he
have previously prepared himself with care for the duty which he is
about to discharge. It will contribute greatly to the right performance
of this duty if he avail himself of the assistance and advice of other
members of the profession, more especially of such as have devoted
some attention to medico-legal inquiries. It has been recommended,
too, that the medical witnesses about to be examined should first meet
together and agree on the opinions which they shall express.

The foregoing observations relate chiefly to the mode in which the
medical witness should give his evidence ; the precautions to be taken
in order that his evidence may be admissible still remain to be con-
sidered. These precautions may be treated under the heads of Notes,
Confessions, and Death-bed declarations.

Notes. — When observing any facts which, at a future time, may
become the subject-matter for legal inquiry, the medical man should
not trust to his memory, but commit the facts to writing. This
should be done, either on the spot, or as soon as possible after the
transaction to which they relate. If, as in performing a post-mortem
examination, it is necessary to resort to dictation, the notes of the
amanuensis should be immediately examined and corrected.

These notes may afterwards be used by the witness in court to
refresh h.\?, memory, but not to supply its place. If the facts were
not committed to writing till some time after the events to which they
refer, or if, having been made at the proper time, they have been entirely
forgotten, the notes will be of no use to him.

Confessions. — The medical man may receive confessions of guilt
* Smith, 'Analysis of Medical Evidence,' p. 128.

XXll INTRODUCTION.

from those whom he is called upon to attend professionally, and it is
important that he should know under what conditions these are admis-
sible in a court of law.

" A confession, in order to be admissible, must be free and volun-
tary, that is, must not be extracted by any sort of threats or violence,
nor obtained by any direct or implied promises, however slight, nor by
the exertion of any improper influence." The duty of the medical man
with regard to confessions is, therefore, clear. If called upon to receive
a confession, he must take care not to hold out any sort of inducement
to make it ; he must avoid suggesting matter for the confession by lead-
ing questions ; he must receive what is said to him without comment,
reduce it to writing as soon as possible, read it over to the person con-
fessing, obtain his signature to it, and countersign it himself.

The "medical man should also be careful to ascertain the state of
bodily health and of the mind of the party making the confession. The
necessity of this caution is well illustrated by cases quoted by Dr.
Southwood Smith,* in which the mind was affected either by disease,
or the chronic influence of hardships and exposure.

To these examples might be added other confessions of murders never
committed, and self-accusations of impossible crimes, such as witch-
craft.

Dying Declarations. — Dying declarations are admitted as evidence in
cases of homicide, where the death of the deceased is the subject of the
charge, and the circumstances of the death the subject of the declaration.
They form an exception to the rule that all evidence in criminal cases
must be given on oath ; and they are admitted on the principle that
the party being at the point of death, and without hope of recovery, is
induced to speak the truth by considerations as powerful as an oath
administered in a court of justice. It follows, therefore, that a decla-
ration, though proved to have been made by a person in a dying state,
is not admissible unless it also appear that the deceased apprehended him-
self to be in such a state as would oblige him soon to answer before his
Maker for the truth or falsehood of his assertions. It is not necessary,
however, that the deceased should express his apprehensions. His con-
sciousness of approaching death may be inferred from the nature of the
wound, or illness, or from other circumstances of the case. But if any
hope whatever be entertained, whether spontaneously or on the sugges-
tion of others, or even if it be inferred to exist, death-bed declarations
cannot be leceived in evidence.

" As the declarations of a dying man are admitted, on a supposition
that in his awful situation, on the confines of a future world, he had
no motives to misrepresent, but, on the contrary, the strongest motives
to speak without disguise and without malice, it necessarily follows,
that the party against whom they are produced as evidence may enter
into the particulars of his state of mind and of his behaviour in his
last moments, or may be allowed to show that the deceased was not
• Lectures on Forensic Medicine, ' Med. Gazette,' vol. xxi. p. 628.

INTRODUCTION. XXlll

of such a character as was likely to be impressed by a religious sense
of his approaching dissolution."

Having thus stated the law respecting dying declaratic us, it will not
be difficult to prescribe the course which the medical man ought to
adopt when called upon to receive such declarations. As dying declara-
tions are but confessions, made under a more solemn and binding sanc-
tion, all that has been said on the subject of confessions is applicable
here. The medical man should merely receive the declaration, with-
out putting any leading questions, but confining himself to such inqui-
ries as may be necessary to clear up any ambiguity in the dying man's
statements. He should record the very words used, and, if there be
time for it, he should commit the declaration to writing, read it to the
dying man, and obtain his signature to it. If the declarant's death
take place so suddenly that there is no time for this, he should make
a memorandum of the conversation at once, while it is Iresh in his me-
mory, and before the words used have escaped him. To this docu-
ment the witness will be allowed to refer to refresh his memory when
he gives his evidence. Another essential part of the medical man's
duty is to ascertain the exact state of the declarant's mind, whether
he is calm and collected, or otherwise, and whether he is under the
infiuence of any particular bias, or undue feeling of resentment.

It is scarcely necessary to remark that the medical witness may be
examined as to conversations which may have taken place in the pre-
sence of an accused party, with a view to ascertain his bearing and
demeanour. When in attendance therefore on cases likely to become
the subject of inquiry in a court of law, the medical man should be
attentive to the words of speakers and the demeanour of listeners.

It ought, however, to be understood that hearsay is not admissible
as evidence unless it form pait of the res gesta. A medical witness,
therefore, would not be allowed to cite a case of his own observing
in support of his opinions if the case consisted in part, as it must
needs do, of statements made by the patient, his friends, or attendants.

It still remains to state the usage of our courts of law with regard
to secrets confided to the medical man in the course of his professional
attendance. " It was solemnly decided, in the case of the Duchess of
Kingston, that in a court of justice medical men are bound to divulge
these secrets when required to do so." " If a medical man," said
Lord Mansfield on that occasion, *' 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 which by the law of
the land he is bound to do, will never be imputed to him as any indis-
cretion whatever."

It may be necessary to wam the medical man against taking part
in duels, even though his object in being present at them is to save iile,
and not to destroy it. He should also understand that a witness is not
obliged to give evidence which may tend to criminate himself.

The following is a summary of the principal contents of this chapter.

1. As regards the state of the witness's mind. He should never

XXIV INTRODUCTION.

consider the general merits of the case, nor allow his mind to he swayed
hy prejudice of any sort. He should guard most carefully against
any biiis in favour of or against an accused party.

2. As to the mode of giving his evidence. He should not be forward
to state facts or express opinions which are not actually called for; but,
at the same time, he should withhold no statement which is essential
to the information of the jury. He should use the plainest and the
simplest language, avoiding, as much as possible, technical terms, and
all metaphorical expressions. He should quote no authorities, bat
merely state his own judgment. In cases of difficulty, he should, if
practicable, provide the assistance of other medical men.

3. Circumstances affecting the admissibility of his evidence. In
matters of importance, he should never trust to memory, but take
notes ; at the time if possible, but if not, as soon as may be after the "
facts or occurrences to which they refer. If he employs an amanu-
ensis, he should examine and correct the notes at once. These notes
may be used to refresh the memory, but not to supply its place.
When called upon to receive a confession, he must take care to hold
out no promise or threat of any sort. He must receive it without
comm£7it, reduce it to wi'iting on the spot, read it over to the person
making it, obtain his signature to it, and countersign it himself. In
doing so, he must not omit to ascertain, to the best of his ability, the
state of mind of the party making the confession. Similar rules apply
to death-bed declarations. Such inquiries only should be made as are
necessary to clear up any ambiguity in the dying man's statements.
The very words used should be taken down ; and if there is time for it,
they should be read to him, and his signature obtained. If the death
take place so suddenly, that there is no time for this, a memorandum
of the conversation should be made while the very words used by the
dying man are fresh in the memory. In this case, as in that of con-
fessions, every endeavour should be used to ascertain the state of the
declarant's mind. The witness should also be attentive to the conver-
sations held in cases likely to become the subject of judicial inquiry,
and to the demeanour of the persons present at them or taking part in
them. But he should bear in mind that Hearsay is only admissible as
evidence when it forms part of the res gesta.

4. The medical man should further understand that he may be re-
quired in a court of law to divulge the secrets confided to him by
patients; that he may expose himself to a criminal prosecution for
taking any part in duels ; and that he is not obliged to give evidence
which would have the effect of criminating himself.

Consult on the subject of this Chapter, Philips and Starkie on
Evidence ; An Analysis of Medical Evidence, by John Gordon Smith,
M.D. ; Amos's Lectures in the 7th Volume of the Medical Gazette ;
Percival's Medical Ethics ; Archbold's Summary of the Law relative
to Pleading and Evidence in Criminal Cases. Also Burn's Justice, by
E. V. Williams, title Evidence.

FOEENSIC MEDICINE.

PART I.

CHAPTER I.

PERSONAL IDENTITY. AGE. SEX.

TfiESE three subjects are thrown into one group, because they have
u close connection with each other. Thus, the body or remains of some
unknown person may be found, and it may be necessary to ascertain
first the sex, then the age, and afterwards to identify the individual by
means of peculiar and characteristic marks. In other instances these
questions are raised separately. The three subjects are arranged in
this Chapter in the order which appeared most convenient, the subject
of sex occupying the last place, from its connection with the topics con-
tained in tlie next Chapter.

PERS6nAL IDENTITY.

Questions of Identity are of frequent occurrence in our courts of
law. A child claims an inheritance : is he the person he pretends to
be? A man who has been robbed is required to identify the thief; and
a witness may be examined as to the identity of a party with whom he
is acquainted. There is one instance, also, in which a jury may be
impannelled for the sole purpose of trying the question of identity, viz.,
where a prisoner after conviction makes his escape and is retaken. The
question of identity may also be raised as to persons found dead ; and
in coroners' inquests the very first step taken is to identify the body or
any remains of it that may be found.

The subject of personal identity, then, divides itself into 1, The
Tdentity of the Living, and 2, The Identity of the Dead.

B

PERSONAL IDENTITY.

1. IDENTITY OF THE LIVING.

In identifying living pereons the aid of a medical man is rarely
required, unless in the case of deformities or injuries, the nature or
effects of which he may be called upon to explain ; or where changes
have l)een produced in the external appearance by the application of
colouring ingredients to the skin or hair. But in order to give com-
pleteness to the present subject, some questions will be briefly noticed
which do not require medical evidence for their solution.

In the case of parties claiming inheritance, much stress has been
laid on family resemblance as a means of identification. Thus, in the
celebrated Douglas case. Lord Mansfield said, " I have always considered
likeness as an argument of a child's being the son of a parent. A man
may survey ten thousand people before he sees two faces perfectly alike,
and in an army of one hundred thousand men every one may be known
from another. If there should be a likeness of feature, there may be
a discriminancy of voice, a difference in the gestures, the smile, and
various other things ; whereas, a family likeness runs generally through
all these, for in everything there is a resemblance, as of features, size,
attitude, and action." This case was decided in favour of the claimant,
Archibald Douglas, in consequence of his proAX'd resemblance to Colonel
Stewart, his father. The twin brother, Sholto, who died young, was
proved to have equally resembled Mrs. Stewart, the mother.

On the other hand, it ought not to be forgotten that persons
having no connection by relationship or descent may bear the closest
resemblance to each other, as in the following remarkable example.

In the year 1772, one Mall, a barber's apprentice, was tried at the
Old Bailey for robbing a Mrs. Ryan of Portland Street. The witnesses
swore positively to the identity of the lad, and the whole court
imagined him guilty. But he succeeded in proving his innocence
by reference to the books of the court ; from which it appeared that on
the day and hour when the robbery was committed the lad was on
his trial at the bar where he then stood for another robbery, in which
he was likewise unfortunate enough to be mistaken for the person who
committed it.

lu this same class of cases the question of identity may resolve itself
into a consideration of the change which the lapse of time, coupled with
fatigue, hardship, and privations, may produce in the personal appearance
of the claimant.

This question was raised in the case of Cassali, a noble Bolognese,
who left his country at an early age, and was supposed to have lost his
life in battle; but, after an absence of thirty years, returned and
claimed his property, which his heirs had appropriated. The change in
his appearance was so great that he was treiited as an impostor, and
thrown into prison. The judges, being in doubt, consulted Zacchias,
who in his consultation mentioned several causes which might produce
such a change, as age, change of climate, diet, mode of life, and disease.

IDENTITY OF THE LIVING. -3

Cassali had left home in the bloom of youth, had been exposed to the
hardships of a military life, and if the claimant's account of himself
might be believed, he had languished for years in prison. As the heirs
could not prove the death of Cassali, the judges, influenced by the
opinion of Zacchias, decreed that his estates should be restored to
him.

The question of identity assumes a more complicated form when
some person more or less closely resembling the true claimant is brought
forward, or presents himself, to contest the claimant's right. The reader
will lind illustrations of both these frauds in the cases of Baronet and
Martin Guerre, which, with that of Cassali already cited, and other
leading cases from the ' Causes Celebres,' are quoted and criticised by
Fodere in the second chapter of his ' Traite de Medecine Legale.' They
will also be found in an English dress in Beck's ' jMedical Jurisprudence,'
in the Chapter on Age and Identity.

In many cases of disputed identity the difficulty has been solved by
means of peculiar personal marks, upon which the medical man has been
required to state his opinion. These marks are either nsevi materni, or
moles, or defoi-mities, or the scars of foregone disease or injury. Even
these personal marks, however, have been found, by a strange coinci-
dence, to be present in two individuals otherwise closely resembling each
other. Thus, Joseph Parker, who was tried at New York in 1804, on
a charge of bigamy, not only closely resembled one Thomas Hoag, for
whom he was mistaken, in general appeai-ance, but had in common
with him a scar on the forehead, a small mark on the neck, and a lisp
in his speech ; but, unlike Hoag, he had no scar on his foot. That he
was Joseph Parker, and not Thomas Hoag, was also proved to the
satisfaction of the jury by an alibi. (Beck, Chapter on Age and
Identity.)

In a Belgian case reported in one of the French Journals for 1847, a
question of identity turned in some degree on the possibility of the
removal of scars. The medical man, M. Vandelaei-, stated that scars
might be removed by time or by artificial means, and the physicians
of the pi-isons of Valvorde and Ghent confirmed this opinion by stating
that prisoners are in the habit of effacing scars by applying a salted
herring to them. MM. Lebeau and Limanges, on the other hand,
contended that scars could not be removed. This latter opinion is
doubtless the correct one ; though it must be admitted that scars grow
less distinct with the lapse of time, and may also be rendered less dis-
tinct by friction or the use of stimulants. The belief that they may
entirely disappear is probably founded on the very slight marks often
left by very extensive wounds when they heal by what is technically
called the "first intention." Thus, in the case of a maniac who had
completely removed the parts of generation, the situation of the wound
was marked by so faint a white line that it might be overlooked by a
casual observer ; and a severe flogging which has left the back quite
raw at the time is traceable after an interval of some years only by

4 PERSONAL IDENTITY.

very fine white lines upon the back and sides, and, where the knots
had fiiUen, by little round pits resembling small white circles neatly cut
out by a punch. In one case in which the author was consulted, the
entire absence of both kinds of mark enabled him to state with confidence
that the man coulil not have been, as it was alleged he had been, very
severely flogged. The same remarks that apply to ordinary scars may
be extended to the blue and red discolorations of the skin produced by
the process of tattooing. They admit of removal only by the de-
struction of the portion of skin in which they are seated,

From what hcvs been just stated it will be infei-red that the exact
shape and position of a s<xjr may often prove of the utmost importance
in detei-mining a question of identity. Thus the operations of bleeding,
cupping, and vaccination, like the punishment of the lash, leave appear-
ances difficult to confound with those due to any other cause. So also
with scars left by scrofulous ulcers on the neck, and by lupus on the face,
by small-pox on every part of the body, and by burns and caustic.

Identification is sometimes effected, as in the following instance, by
comparing a recent wound with the part of the body detached from it.

In January, 1846, a robbery was committed at fctigny, in a house
inhabited by two old men. The next morning, when the robbery was
discovered, several spots of blood were found on the floor on the left of
a chest of drawers which the lobbers had forced. Other spots of
blood, rendered apparent by a fall of snow which had taken place the
preceding night, were found following the direction taken by the robbers
when they quitted the house. In every case the blood was on the left-
hand side of the footsteps. A shred of membrane was also found on the
road, which on examination was found to be a portion of skin. On
searching the neighbourhood, a man was found with his hand wounded.
Dr. Lemoine and JVl. Cceurderoi were appointed to examine him ; and
they both agreed that the wound, which was on the left hand, was
probably inflicted about the date of the robbery, and that the piece ol'
skin, judging from its dimensions and shajje, had formerly covered the
injured part. The accused confessed the crime. (Annales d'Hygiene,
Janvier, 1847.)

Fraudulent discoloration of the Hair. — The question whether it is
possible to change the colour of the hair from dark to light was raised
in a case which occurred in Paris in the year 1832. A man named
Be'noit, suspected of having committed murder, was tried before the
Court of Assizes of ihe Seine. Cei-tain witnesses deposed to having
seen him in Paris at two in the afternoon with black hair ; while
others declared that they saw him at "Versailles, at five or six o'clock
the same evening, with fair hair. The man's hair wa.s naturally jet
black, and it does not appear that he wore a wig. The tribunal
summoned Orfila, and Michalon, one of the first hair-dressers of Paris,
to solve the following question: Is it possible to change the colour of
the hair from dark to light ? Michalon replied in the negative ; but
Orfila, on the contrary, declared that it was possible, and that twenty-

FKAUDULENT DISCOLORATION OF THE HAIR. 0

six years before (March 3rd, 1806), Vauquelin had read at the Insti-
tute a me'moire on the property which chlorine possesses of giving to
black hair all the lighter colours, and even of changing it to white.

This case led to some careful experiments by Ortila, and subse-
quently by Devergie, in order to ascertain what changes in the colour
of the hair might be effected by chemical means. Orfila examined the
mode of effecting the change from light to dark, from dark to light,
and from light red or chestnut to other shades of colour. Devergie
limited himself to the verification of Orfila's experiments on the effect
of chlorine in changing the hair from dark to light.

1. Modes of changing the hair from light to dark.

One method is by a mixture of charcoal and grease. This is easily
detected by its soiling the fingers for days after its application, and
by placing a lock of the hair in boiling water : the grease swims on the
surface, and the charcoal falls to the bottom of the vessel.

A second method is to moisten hair, previously freed from its oil by
liquor ammonise, with a solution of nitrate of bismuth. The hair, on
being allowed to dry, is covered with the crystallized salt of bismuth.
This is removed with distilled water, and the hair is again allowed to
dry. Hair thus prepared, on being steeped for a quarter of an horn-
in a solution of sulphuretted hydrogen, was uniformly changed to
black without being rendered brittle. When the oily matter of the
hair was not previously removed, the change of colour was less com-
plete.

The source of the change of colour in this case may be easily de-
tected by treating the hair with dilute hydrochloric acid, or by a weak
solution of chlorine. The hair is restored to its original colour, and
the resulting liquid yields on evaporation a white residue, which, on
being dissolved in distilled water, has all the characters of a salt of
bismuth.

The acetate of lead employed in exactly the same way yielded
similar, but less perfect results. The metal may be detected by the
same means as in the case of the bismuth.

A mixture of litharge, chalk, and fresh lime, in the proportion of
3 parts litharge, 3 parts chalk, and 2 or 3 parts lime, was found still
more effectual. This being dissolved in water, the hair is kept moist
with it for three or four hours, and then allowed to dry. The chalk
and oxide of lead attached to the hair are next removed with dilute
acetic acid, and, lastly, the hair is rubbed with yelk of egg. The
colour of the hair is thus effectually changed without any injury to its
texture. These ingredients in variable proportions, according to the
degree of change which it is desired to effect, compose the Tinctura
Pompeiana of the shops. The cause of the change of colour can be
detected by steeping the hair in dilute nitric acid, which dissolves all
the ingredients with effervescence, leaving the nitrates of lead and lime
in solution.

Similar results were obtained by means of the plombite of lime,

G PERSONAL IDENTITY. — DEGREE AND DURATION

formed, by boilinij, during an hour and a quarter, 4 parts of sulphate
of lead, 5 parts of hydrate of lime, and 30 parts of water. The change
of colour is not produced by this agent unless the hair be kept
moistened with it for some hours.

Nitrate of silver gave to light hair a violet hue, which became
darker by exposure to light. This agent was easily detected by the
colour of the hair, and by steeping it in a solution of 1 part of chlorine
to 4 of water. A clotted chloride of silver is thus formed, which may
be identified by its appropriate tests.*

A mixture of sulphate of mercury and oxide of copper dissolved in
dilute acetic acid answei-ed less perfectly than the preparations of lead.

2. Mode of changing the hair from dark to light.

The results of numerous experiments performed by Orfila and De-
vergie with solutions of chlorine of different degrees of strength, mav
be thus summed up. Black hair may be changed to various lighter
shades; as dark and light chestnut, dark and light blond, yellow, and
yellowish white, by being steeped or washed a longer or shorter time
in solutions of chlorine of different strengths. Hair combed with a
solution of chlorine is but slightly changed even after many repetitions
of the pi-ocess ; and there is reason to believe that Orfila erred in sup-
posing that it would be possible to obtain the marked effects produced
by soaking the hair in a solution of chlorine if it were merely combed
with that fluid for many hours. The chlorine is readily detected by
its odour, even after washing the hair as many as fifty times with
water ; the colour of the hair is j^eculiar, by no means uniforai, and
not easily confounded with any natural colour ; and the hair itself is
hard, stiff, and brittle. These results are in strict accordance with
those of my own experiments. Specimens of dark hair treated Avith
chlorine, and of light hair treated with the Tinctura Pompeiana, are
preserved in the jMuseum of King's College.

All these processes for changing the colour of the hair occupy some
time, and, with due care, it is easy to detect the fraud that has been
practised. If the question were actually raised in a couit of law, the
hair might be allowed to grow, taking cai-e that the suspected person
had no access to any dye ; or the shorter process of analysis might at
once be used.

It may be well to state in this place that the hair sometimes under-
goes a very marked change of colour in the course of some processes of
manufacture. In turning rulers, for instance, out of the wood known as
*' gi'een ebony," light hair is permanently changed to a green, and a
similar change of colour results from working in an atmosphere con-
taining copper in fine division.

The effect of sudden and violent emotion in turning the hair gray is
well known. Such quick change of colour is also known to be

• A more natural colour may be imparted to the hair by the production of a
sulphide of silver ; or of some of the compounds developed in the practice of
photography.

OF LIGHT NECESSARY FOR IDENTIFICATION. i

occasionally due to disease and to other obscure causes. One remark-
able case of a complete change of colour in the hair of the whole body-
is related by Dr. Gordon Smith. The change took place in a girl
thirteen years of age in a single night, and was not immediately pre-
ceded by any indisposition or by any emotion which could account for
it. The change thus produced is sometimes permanent ; but in some
cases the natural colour of the hair has been restored.

One other question relating to the identity of the Living remains to
be examined, viz.. What degree and duration of light are necessary
to enable an observer to distinguish the features, so that the person may
be afterwards identified ? That a very short duration of a brilliant light
is sufficient for this purpose will appear from a case related to Dr. Mont-
gomery by one of his patients. A lady, on her passage from India,
awoke in "the middle of the night, and heard some one stirring in her
cabin, but could see nothing, it being quite dark ; when suddenly the
cabin was so completely illuminated by a flash of lightning, that she
could see distinctly a man rummaging one of her trunks, and discerned
his features so accurately that she identified him next morning : some
of the stolen things were found upon him, and he subsequently acknow-
ledged the fact.*

in a case which occuiTed in France about half a century ago, the
question was raised whether the light produced by the flash of a pistol
was sufficient to discover the face of the person firing.

The Sieur Labbe, Mayor of the commune of Foulanges, in the depart-
ment of the Calvados, on a dark night in the month of May, 1808,
was passing on horseback along the highway with the widow Beaujean,
when his servant, who was on foot, was fired at with a gun through a
hedge bordered by a ditch, and wounded in the hand. Both Labbe
and his servant swore that they recognized the assassin by the light of
the discharge. One of the accused was arrested, tried, and condemned
to death ; but an appeal being taken to the Court of Cassation,
M. Lefevre Gineau, Member of the Institute, and Professor of Experi-
mental Physics in the Imperial College of France, was consulted as to
the possibility of an identification in the manner described. Accordingly,
Gineau, his son, Professors Dupuis and Caussin, and several others,
retired into a dark room, where several primings were fired, the
spectators being stationed at different distances, to witness the effect.
The light produced was strong, but fuliginous, and so rapidly
extinguished, that it was impossible to distinguish the individual
firing. *' It was scarcely possible to see distinctly the form of a head,
and that of the face could not be recognized." The experiments were
then repeated in the court-yard of the college, the gun being loaded
with powder, but with the same results. The sentence was reversed. f

These experiments do not appear to have convinced Fodere', who
thought that if the night were dark, and the persons within six, eight,

* ' Cyclopaedia of Pract. Med.,' art. Identity,
t Quoted by Beck from the ' Causes Celebres.'

8 PERSONAL IDENTITY.

;)!• ten feet of each other, such events as those now related are possible ;
and the results arrived at by the French experimenters are certainly at
variance with the opinions of persons accustomed to the use of fire-
arms, as well as with some experiments made by the author, who
repeatedly recognized the face of a person with which he was familial-
by the discharge, in the dark, of a gun close at hand. It may also be
reasonably contended, that under the influence of strong excitement the
perceptions are uncommonly acute, as the actions are unusually rapid.
It might happen, therefore, that a person exposed to danger would
have a quicker and more distinct perception than an experimenter. The
question, therefore, is one which admits of satisfactory solution only
by collecting cases occurring under circumstances of intense excitement.

The following case, which occurred in England in 1799, is of this
nature : — " A man named Haines was indicted for maliciously and
feloniously shooting at Edwards, Jones, and Dowson, Bow Street
officers, on the highway. Edwards deposed that, in consequence of
several robberies near Hounslow, he, together with Jones and Dowson,
was employed to scour that neighbourhood ; and that they accordingly
set oft in a post-chaise on an evening in November, when they were
attacked near Bedfont by two persons on horseback, one of whom
stationed himself at the head of the horses, and the other went to the
side of the chaise. The night was dark ; but he swore that from the
flash of the pistols he could distinctly see that the man rode a dark-
brown horse, between thirteen and fourteen hands high, and of a very
remarkable shape, having a square head, and very thick shoulders, and
altogether such that he could pick him out of fifty horses: he had
afterwards recognized the horse. He also perceived by the same flash
of light that the man at the chaise-door had on a rough shag-brown
gi'eatcoat." *

The reader will find a French case in confirmation of the foregoing in
the Introduction to Fodere*s ' Treatise' (note, p. 28).

2. IDENTITY OF THE DEAD.

In cases of death by accident or violence, and in cases of exhumation,
the medical man may be required to identify the dead. Sometimes
he is called upon to assist in identifying the entire body, or one which
has been mutilated, but, in other cases, to examine with the same
object the skeleton, or such parts of it as may be found, with a view
of deteimining the set, age, and probable stature of the person to
whom the fragments belong.

When the entii'e body is the subject of examination, the same mis-
takes may be committed as in the case of the living. It may be sup-
posed to be that of some person actually living at the time ; of which
eiTor there is more than one instance on record.

• Montgomery : ' Cyclop, of Piact. Med.,' art. Identity.

IDENTIFICATION OF THE DEAD. i)

There are many successful cases of identification upon record, of
which the following are examples: —

In the year 1814, Dupuytren identified the person of a murdered
man chiefly by means of a malformation of the hip-joint. The ex-
istence of a similar deformity enabled MM. Laurent, Noble, and
Vitry, in 1828, to identify a man who had been buried in a cellar
at Versailles three years. The body of Maria Martin was identified
eleven months after her death by the absence of cei-tain teeth from the
upper and lower jaw, and by signs of inflammation, with extensive
adhesions of the pleura, answering to an attack of inflammation of the
chest, from which she was proved to have suffered shortly before her
mysterious disappearance. A doubtful case, tried at Edinburgh, was
decided by a dentist, who produced a cast of the gums which he had
taken before death. The scanty remains of the body of the Marchioness
of Salisbury, discovered among the ruins of Hatfield House, were also
identified by the jaw-bone having gold appendages for artificial teeth ;
and the identification of the body of Dr. Parkman, murdered by Dr.
Webster, the American chemist, was greatly assisted by the very pe-
culiar formation of the jaw, and the correspondence of a portion of it
with a cast taken by a dentist.

In some remarkable instances the work of identification has consisted
in discovering, after a considerable period of interment, the bodies of
celebrated personages about whose real burial-place a doubt had been
raised. In other instances the body has been completely identified by
the close resemblance of the face of the corpse to extant pictures, or by
other similar means. The identification of the remains of Henry IV.
in Canterbury Cathedral, after the lapse of nearly four centuries and a
half, is an example of the first class of cases ; the identification of the
remains of Charles I., of the second class. The remains of Charles I.
were completely identified by the striking resemblance of the counte-
nance, notwithstanding its disfigurement, to his portrait on coins, busts,
and paintings. The fourth cervical vertebra was also found divided
ti-ansversely, the corresponding surfaces being smooth, showing that
they had been separated by a heavy, sharp instrument. An interesting
narrative of this exhumation was published by Sir Henry Halford, and
a detailed account of the search after the body of Henry IV., in Felix
Summerley's ' Handbook for Canterbury.'

The cases of mistaken identity in the living have their parallels in
the dead, as the following case wnll show: —

A resurrection-man was tried for raising the body of a young woman
from the churchyard of Stirling, nine weeks after death. The body
was identified by all the relations, not only by the features, but by the
left leg being shorter than the right. The jury was convinced that the
libel was proven, and gave a verdict accordingly. " Now I am certain
that this was not the body of the woman who was taken from the
churchyard of Stirling, but one that, at least six weeks after the time
libelled, was buried in the churchyard of Falkirk, from which she was

10

PERSONAL IDENTITY.

taken by this man, who also took the other for which he was tried ;
she also was lame of the left leg : thus, though guilty of the offence
laid to his charge, he was found guilty by a mistake of the corpus de-
licti."— (Dunlop, note to Beck's * Medical Jurisprudence.')

Cases illustrative of the possibility of dead persons being mistaken
for living ones, not merely by acquaintances and friends, but by parents
and near relations, are recorded by Smith, and by Di-. Cummin in his
lectures. (' Medical Gtizette,' vol. xix.)

Calculation of the Stature from the length of a part of the body. —
Attempts were made by M. Sue as much as a century ago, to furnish
data for calculating the stature from the length of the extremities.* He
measured subjects of medium height, chosen from appearing to him
well proportioned. Some of the numbers are averages ; others the
result of only one measurement. The following table presents these
measurements reduced to English feet, inches, and lines ; —

Age.

Body.

Trunk.

Upper

Extremity.

Lower
Extremity.

1 year .

3 years .
10 years .
14 years

(average)
20-25 yean

(average)

}

Ft. In. Lin.
2 0 0

2 11 3

3 11 0

4 10 8

5 8 2

Ft. In. Lin.
1 2 5

1 8 4

2 1 7

2 5 11
2 10 1

Ft. In. Lin.

0 9 7

1 3 0

1 8 4

2 4 1
2 8 0

Ft. In. Lin.

0 9 7

1 3 0

1 9 11

2 4 10
2 10 1

M. Sue states, that towards the 20th, and from that to the 25th
year, the superior border of the symphysis pubis forms the exact centre
of the body, and that this centre continues constant for more advanced
ages, except that in old age the spine becomes curved. Before the
adult age, the centre of the body varies according to the age.

These measurements of M. Sue have been repeated by Orfila, both
for the subject and for the skeleton ;f with the result of showing that
the statements of M. Sue must be received with caution. Thus of
44 males, who with 4 exceptions were adults, there were only 7 in
whom the length from the vertex to the pubes was exactly equal to the
length from the pubes to the sole of the foot ; whilst in 23 instances,
the former measurement exceeded the latter ; and in 14 fell short of it.
The greatest difference on either side was 2\ inches English. Again,
out of 7 females submitted to measurement, there was not one in whom

* • Sur les Proportions dn Squelette de 1' Homme.
I'Acaderaie Royale des Sciences, torn. ii. 1755.
f 'Traits de Medecine Legale,' tom. i, p. 105.

Memoires presentes

MEANS OF CALCULATING THE STATURE OF THE BODY.

11

the above measurements were equal, and the tipper half of the body
was longest in 6 and shortest in one. The males on an average were
longer from the vertex to the pubes by more than ^ inch, the females
by 1^ inch. On pursuing the examination of the tables still further,
and bringing together the instances in which the length from the vertex
to the pubes happens to be the same, a considerable difference is found
to exist in the length from the pubes to the sole of the foot. Thus of
fifteen males measuring 2 feet 9 inches or 2 feet 9^ inches from the
vertex to the pubes, one measm-ed as little as 2 feet 7 inches from the
pubes to the sole of the foot, while another measured 2 feet 11| inches
— a difference of 4^ inches. Again, of five females, in whom the upper
measurement was 2 feet 6f inches to 2 feet 7 inches, one measured
little more than 2 feet 4 inches, the other little less than 2 feet 8 inches
— being a difference of nearly 4 inches.

So that in making use of Orfila's measurements for the pui-pose of
determining the stature of the body, we might be in error to the extent
of from 4 to 4^ inches. On turning to Oi fila's table of measurements
of the skeleton, we encounter still more remarkable deviations from the
rule laid down ; for in one instance in which the upper part of the
body measures 3 feet 1|- inch, the lower part measures only 2 feet
8 inches, being a difference of 5^ inches ; and, in another instance, in
which the upper measurement was 2 feet 5^ inches, the lower mea-
surement was 2 feet 11 1 inches, being a difference in the opposite
direction of 6 inches. It follows, then, that the statements of M. Sue
are much too general to be used for purposes of great accuracy ; and
that in making use of the more exact measurements of Orfila, as means
of determining the stature of the body, we might commit very serious
errors.

M. Orfila's measurements of the several cylindrical bones, from
which he proposes to calculate the stature of the skeleton and of the
living body, also yield, as the subjoined table will show, veiy unsatis-
factory results : —

Stature of the Skeleton calculated from the Length of the
Cylindrical Bones. — (From Orfila's second table.)

Humerus 6 obs.
Ulna 7 „
Femur 7 „
Tibia 7 „

Ft. In. Lin.
1 1 0

0 10 8

1 6 1
1 3 0

STATUEE,

Max.
Ft. In. Lin.
6 1 3
6 1 3
6 0 0
5 10 6

Min.
Ft. In. Lin.
5 9 9
5 5 0
5 7 0
5 5 0'

Difference.
In. Lin.
3 6
8 3
5 0
5 6

12

PERSONAL IDENTITY.

Stature of the Body, calculated from the same data.
(From Orfila's first table.)

Humerus 19 obs.
Ulna 14 „
Femur 12 „
Tibia 11 „

Ft. In. Lin.

1 2 6

0 10 8

1 5 9
1 2 5

STATUKE.

Max.
Ft. In. Lin.
5 8 1
5 10 10
5 9 8
5 9 8

Min.
Ft. In. Lin.
5 4 6
5 5 8
5 4 6
5 4 6

Difference
In. Lin.
3 7
5 2
5 2
5 2

It would appear, then, that for the same length of cylindrical bone,
we may have a variation in the length of the skeleton of from 3| to
85 inches ; and in the length of the body of from more than 3 J to more
than 5 inches.

This minute analysis of the tables of M. Orfila has been rendered
necessary by the undue importance which he himself attached to them;
for he says, " we are certain that it will be possible in the greater
number of cases, on consulting these tables, and on having regard
especially to the lengths of the femur and humerus, to arrive suffi-
ciently near the truth." This excess of confidence on the part of
M. Orfila arose from his not havincr really examined his own figures.
Such an examination was the more desirable, as the high authority of
M. Orfila has led to the use of his figures for practical purposes. Thus,
Dr. Henri Bayard, in three instances, in which the only portions of the
body left were the bones, applied Orfila's data ; in two unsuccessfully,
but in the third case with a success which is obviously attributable
only to a happy coincidence. The following are the particulars of this
case. The stature of the body, calculated fi-om the measurement of the
long bones of the upper and lower extremities, was 1 mfetre 54 centi-
metres. It was highly probable from the circumstantial evidence that
the skeleton belonged to one Adnet, who had disappeared two years
previously. Adnet's wife stated that her husband was as nearly as
possible of her own height, and that he could wear her shoes. She
measured 1 m^tre 52 centimetres. A certificate under the hand of the
mayor of the commune in which Adnet resided, gave as his height,
determined for the purposes of the conscription, I m^tre 53 centi-
metres. So that the calculated stature (1 metre 54 centimetres)
corresponded very closely with the ascertained stature. (* Annales
d'Hygiene,' April, 1845, p. 379, and ' Kanking's Retrospect,' vol. ii.,
p. 422.)

The following table presents the average measurements in English
feet, inches, and lines, obtained from forty-four male and seven female
subjects.

AGE.

13

Male.
Female

2.

II

i.'

2 3=-

III

a

r^

i

n

a

i

2

5

5 6 6
5 1 0

2 9 6

2 7 1

2 9 0
2 5 11

2 5 6

2 2 8

15 8
1 4 6

1 1 9

12 2
1 1 5

10 5
OUT

0 9 5

0 8 8

0 10 2
0 9 9

AGE.

The law makes many distinctions in regard to Age, and defines with
much minuteness the privileges, immunities, and responsibilities which
belong to the several periods of life. It rarely happens, however,
that the medical man is required to give evidence on this point ; and
the occasions on which his opinion may be required will become less
numerous as our system of registration of births comes into more com-
plete operation.

It is chiefly as a preliminary means of identification that the ques-
tion of age is important, and, like the general question of identity, it
divides itself into two parts. 1, The Age of the Living ; and 2, The
Age of the Dead.

1. MEANS OP DETERMmiNG THE AGE OF THE LIVING.

Many attempts have been made to give to this subject an air of im-
portance, and much learning has been expended upon it. The arbi-
trary division of human life into several periods, the equally arbitrary
assumption of certain ages as periods of unusual importance and danger
(the climacterics), and the laboured general description of the changes
which take place in the external appearance of the body and in the
faculties of the mind — all these are wanting in the precision necessary
for medico-legal purposes ; and the same remark applies to the calcu-
lations of M. Quetelet, based upon the ascertained stature and weight
of the body at different periods of life.

The same objection applies to the position of the centre of the body as
a test of age. It may be stated, in general terms, that the centre of the
body at birth is at the umbilicus ; in the adult, at the pubes ; for the
intermediate ages, at intermediate points, nearer to the umbilicus in
the infant, and to the pubes in those approaching the adult age; and
that in the female, in consequence of the lower extremities, but
especially the thigh bones, being shorter than jn the male, the centre of
the body is above the pubes.

The facts collected in illustration of the period of puberty in the two
sexes, and of the change of life in the female, also show the little
dependence that can be placed on these occurrences as indications of
age. The extremes are so far apart in all observations belonging to

14

AGE.

this class, that it would be unsafe to apply the average results to indi-
\'idual cases.

During the periods of childhood and boyhood we possess more pre-
cise, though still very imperfect, means of ascertaining the age in the
successive appearance of the teeth both of the first and second dentition.

The following is the order and probable period of the appearance of
the first set or milk-teeth.

Central incisors .

. 5—7 months

Lateral incisors .

.6-9 „

First molars

. 8-15 „

Canine teeth

. 15—18 „

Second molars .

. 18—24 „

The milk-teeth, then, make their appearance at different times in
different children. Some are bom with the incisors above the gums ;
others have no teeth till the end of the second year ; and others, again,
live many years without having a single tooth. Too much reliance,
therefore, must not be placed on this test of age.

The following table presents the order and probable time of the
appearance of the permanent set of teeth, with the number of teeth
existins at each age.

AGE.

INCrSORS.

BICUSPIDS,

MOLARS.

Central.

Lateral.

Anter.

Poster.

Anter.

Second.

Poster.

7 years .

8 years .

9 yeare .

10 years .

11 years .
12—12^.
121—14.
18 -25.

4
4
4
.4
4
4
4

4
4
4
4
4
4

4
4
4

4
4
4
4
4

4
4
4
4

4
4
4

4

4
4
4

I

1

4

As it was impoi'tant to ascertain how far this table might be em-
ploved as a standard of comparison in determining the age of children,
es])ecially of those employed in factories, Mr. Saunders* selected the
two periods of 9 and 13 years, observed the number of teeth existing at
those periods in many hundred children, and obtained the following
results : —

Out of 457 boys 9 years of age, 219, or nearly one-half, had the
number of teeth stated in the foregoing table ; namely, 4 central in-
cisors, 4 lateral incisors, and 4 anterior molars. Of 251 girls, of the
same age, 168, or considerably more than one-half, had the same num-

* ' The Teeth a Test of Age.' By Edwin Saunders.

THE TEETH AS A TEST OF AGE. 15

bev of teeth. Taking the two sexes together, 387 out of 708 had the
full complement of teeth. The remainder in both sexes consisted of
children who in place of the full number of 4 of each kind of teeth, had
a smaller number of one or the other. Thus in a large proportion of
the children, one, two, or three, out of the four lateral incisors were
wanting, and so of the other teeth. In 52 cases only the lateral
incisors were entirely wanting.

If, then, in each column of the foregoing table, opposite the age of
9 years, we substitute for the number 4, the numbers 1,2,3, or 4,
and assert that wherever any of those numbers of teeth are found to
exist, there we may assume that the child is in its 9th year, our as-
sertion will be borne out in 656 out of 708 cases, or in about 13 in
every 14 cases. In the remaining cases, 52 in number, a child of
8 years might, by the use of the foregoing table, be mistaken for one
of 9 years old.

The following are the results of the inquiry respecting children who
had attained the age of 13 years: —

Rather less than half the boy.-, and more than half the girls, and as
nearly as possible half of the two sexes taken together, had the full
complement of teeth entered in the table as belonging to children of
12^ to 14 years of age: by far the majority of both sexes had one or
more of the several orders of teeth: and in 11 instances only wei'e
some or other of the teeth entirely wanting. In three cases a child of
13 might have been mistaken for one of 12 to 12|- years; in one
instance for one of 11, and in one instance for one of 10. In a vast
majority of instances, however, we should be justified in stating that a
child having one or more of the several teeth indicated in the table
opposite to the period of 12^ to 14 years had completed its 13th year.*

The permanent set of teeth is not complete till the denies sapientioi
have made their appearance. This usually happens from the J 8th to
the 25th year, but it sometimes takes place much later; and one case
is recorded by Dr. Hamilton of a man of 80 who died from the irrita-
tion produced by cutting his wisdom-tooth.

Among the signs of age on which some stress has been laid is the
white line around the margin of the iris, — the arcus senilis. As the
author has seen this circle completely formed in one man of 42, and in
another of 39, and absent in a man of 79, and in another of 85 ; and
as the cause of the arcus has been proved to be a deposit of oil-globules
in the iris, which may take place from causes other than advancing age,
this appearance must be rejected as a test of age.

All other indications of age in the Living, such as grayness or bald-
ness of the hair, and the loss of teeth, are deceptive. Cases of prema-
ture old age, of unusual vigour at advanced periods of life, and of resto-
ration in the aged of some of the structures and functions proper to an
early period of life {e.g. the cutting of teeth and the growth of coloured

* The results here stated in general terms were given in the first edition of
this work in a tabular form.

16 AGE.

hair ; tlie secretion of millc, and the persistence or return of the men-
strual discharge), will sometimes prevent us from even guessing at the
age with any accuracy. On the other hand, the early occurrence of
the marks of puberty in both sexes, and the premature or very late
appeai-ance of the menses in the female, create difficulties in rightly
estimating the age at an earlier period of life.

2. MEANS OF DETERMINING THE AGE OF THE DEAD.

In examining the bodies of persons recently dead, we have the same
means of estimating the age which we possess in the case of the living.
There are instances, too, in which we may derive some advantage from
the dissection of the body. Bony deposits in the heart and arteries
would affoid a strong probability that the subject had reached at least
a mature, and probably an advanced period of life.

The state of the osseous system will also furnish some clue to the
age, both at the earlier and later periods of life. The imperfect ossifi-
cation of the bones, and of their processes and epiph3^ses, and the con-
dition of the cartilages of the larynx and ribs, will afford us some
assistance in infancy, childhood, and youth.* At the other extreme of
life, marked changes in the osseous system also take place. The in-
tenial cavities of the bones increase, from the absoi-ption of the osseous
matter, and the bones from the same cause become lighter. The bones
of the head are solidly united, but, on account of the absorption of
their diploe, become thin. The spinal column is curved. The car-
tilages of the larynx and ribs are completely ossified. The osseous
tissue generally is more dense, dry, and fragile, and abounds in earthy
materials. In very old persons the appearance of the lower jaw is
highly characteristic. The body is very shallow, owing to the absorp-
tion of the alveolar border, and the angle is obtuse, as in childhood.
This appearance of the jaw in extreme old age is shown in tho annexed
engravincr.

* TTie reader will find very minute details of the proRrcss of ossification in
its relation to age in Orfila's treatise (vol. i., p. 106) ; in B^cliard's ' Anatomie
G^nerale,* p. 495 ; and at p. 31 of the first edition of this work.

DOUBTFUL SEX. ANDROGYNI. 17

SEX.

This subject, like the foregoing, divides itself into two parts. 1, The
means of ascertaining the Sex of the Living ; and 2, The means of
determinino- the Sex of the Dead.

1. SEX OF THE LIVING, INCLUDING THE SUBJECT OF
DOUBTFUL SEX.

The question of sex may be submitted to the medical man in refer-
ence both to infants and adults. In the case of a new-born child, the
issue of parents possessed of real or landed property, the right of suc-
cession, and should it die, the disposal of the property, must depend on
the determination of the sex. If a wife, being tenant in tail-male, is
delivered of a son born alive, the husband's right is secured ; but the
property passes from him if she gives birth to a daughter. This form
of succession is termed ' tenancy by the courtesy.'

It may be necessary also not merely to ascertain the sex, where that
can be done, but in doubtful cases, to determine which sex most
predominates ; for it appears, on the authority of Coke upon Littleton,
that " an hermaphrodite, which is also called Androgynous, shall be
heire, either as male or female, according to that kind of the sexe
which doth prevail, and accordingly it ought to be baptized."

The question of sex may also arise at a later period of life, as in
the case quoted by Beck of a young nobleman of doubtful sex, whose
parents consulted a medical man whether he should be educated as a
male or female.

There are three different conditions of the organs of generation
whicli may present difficulties to the medical examiner.

1. The male organs may resemble the female.

2. The female organs may resemble the male.

8. The organs of the two sexes may be blended, some one or more
organs of the one sex being superadded to, or substituted for, those of
the other.

1. The male organs may resemble the female. (Androgyni.) The
most common maltbrmation of this sort consists of a small, imperfect,
and imperforate penis, a short canal beneath it, and a cleft scrotum,
these parts bearing respectively some resemblance to the clitoris,
vagina, and labia of the female. Each section of the scrotum some-
times contains a testicle, but in other instances those organs, one or
both, are situated behind the external ring. The short canal, or cul de
sac, which replaces the urethra, and is found to communicate with the
bladder, opens at the base of the penis, or in the perineum, neai- the
anus. It is often enlarged at its commencement, so as to resemble the
vagina ; and instances have occun-ed in which sexual intercourse has
taken place through this enlarged canal of the urethra. From tlie

C

18 SEX.

jx)sition of the opening of the urethra beneath the imperforate penis,
these pereons are called hypospadians.

The existence of the testicles in the folds resembling the labia, or in
the groin, the communication of the opening beneath the imperforate
penis or in the perineum with the bladder, the absence of any organ
corresponding to the uterus, and, in the adult, the absence of menstru-
ation,— will enable us at once to distinguish the sex. In most of these
cases the conformation of the body nearly approaches that of the male.
The development of the muscles, the tone of the voice, the tastes and
habits, are more those of a man than of a woman. Nevertheless there
are cases in which an enlargement of the breasts, coupled with a
preference for the society of the male, might lend us into error in the
absence of a careful examination of the organs of generation. In other
instances the sexual passion is absent. Several cases answering to this
description have been put on record ;* and there are preparations illus-
trative of these malformations in most of our museums. A single
case, published by Mr. W. Loney in the ' Lancet,* May 7, 1856, will

suffice for the purpose of illustration. " Jane W , 28 years of age,

was admitted into the lunatic ward of the Macclesfield workhouse.
Her unwillingness to be washed excited suspicion, and led to lier being
examined ; when it was found that she had a penis two inches long, and
the same in circumference, placed on the pubes, just above and between
the external labia; it had a well-defined prepuce, which could be
moved at pleasure, causing a slight erection. The opening into the
vagina, which was just below, was so small as to admit the little finger
with difficulty ; and a ligamentous band could be felt at about three
inches distance from its mouth. The urethra could not be seen, but a
catheter was passed into the bladder through the vagina. There was
no opening in the penis. The hair of the head was short and curly,
like a man's ; the limbs very muscular and hairy ; and the voice ex-
ceedingly rough and masculine. The mammas were entirely absent, and
there was more hair than usual about the pubes. She had never men-
struated. Her taste was very depraved, as she would eat old poultices
with great delight. She was strong and healthy, and annoyed the
young women in the same ward by the display of her amatory pro-
pensities."

Sometimes the penis, whether well or ill formed, is found confined
to the scrotum by a particular formation of the integuments/ This
malfonnation, with the other deviations from the noimal structure just
described, occun'ed in two cases, one a negi'o, the other a European,
of which Cheselden gives engravings ; and in the case of a child baptized
and brought up as a girl, Mr. Brand by a slight incision liberated the
restricted parts, and proved to the parents that they hai mistaken the
sex of their child.

Another malformation belonging to this division, and which might

* See Beck's ' Elements of Medical Jurisprudence,' vol, i. p. 1T2,

DOUBTFUL SEX. ANDROGYNE. 19

possibly give rise to doubt as to the sex, consists in a deficiency of the
anterior wall of the urinary bladder, and of the lower and anterior
portion of the abdominal parietes, their place being occupied by a red
and sensitive mass of an irregular form, with the ureters opening upon
it. The penis is short, imperfectly formed, and imperforate. The
vesiculse seminales open near the red and sensitive surface just described,
or in a small tubercle at the root of the penis. The testicles are gene-
rally well formed, sometimes contained in the scrotum, sometimes to be
felt in the groin, or they have not descended. The sexual appetite in
some of these individuals is weak ; in others strong ; in others alto-
gether wanting. The persons who have this malformation are called
Epispadians.

2. 'i"he female organs may resemble the male. (Androgynae.) Ail
enlarged clitoris is the most common form of malformation belonging
to this class. None of the recorded cases presented any real difficulty,
though some have excited great interest. The absence of testicles from
the labia, the presence of a vagina and uterus, the occurrence of men-
struation, either of these singly or all combined, render the distinction
easy.*

A prolapsus uteri has more than once given rise to a question of sex.
Sir Everard Home mentions the case of a Frenchwoman suffering from
this disease who laid claim to the male sex, and was shown as a curi-
osity. The prolapsus was evident on inspection. And Mahon relates
the case of one Margaret Malaure, who came to Paris in 1693, dressed
as a man. She alleged that she possessed and could use the organs of
both sexes. She, too, was exhibited ; and several physicians and sur-
geons gave certificates that she was an hermaphrodite. But Saviard,
an eminent surgeon, was inci'edulous. He examined her in the presence
of his brother practitioners, and found that she had a prolapsus uteri,
which he reduced.

3. The organs of the two sexes may be blended, some one or more
organs of the one sex being superadded to, or substituted for, those of
the other.

Many cases of this imperfect approach to the true hermaphrodite are
on record. In some instances an ovary has been found on the left side,
and a testis on the right ; in others the position of these two organs
has been reversed ; and in a third class of cases the external organs have
approximated closely to the female type, and the internal to the male,
or the reverse.!

It is unnecessary to add that no case of real hermaphroditism, in
other words, of a blending of the organs of the two sexes in a state of
perfect development in the same person, is on record.

* See the cases illustrative of this malformation detailed at length in 'Cyc.of
Anatomy and Physiology,' art. Hermaphroditism.

t See the case of Durrje or Derrier in Cummin's Lectures, 'Med. Gaz.,' vol.
xix. : and for cases of the last-named malformation, occurring both in man and
animals, see the very complete and learned paper on Hermaphroditism by
Dr. Simpson, in the ' Cyclopsedia of Anatomy and Physiology.'

20 SEX.

In examining cases ot doubtful sex, the following points must be
taken into consideration : — The size of the organ corresponding to the
penis or clitoris, and whether it is perforate or imperforate ; the form
and mode of attachment of the prepuce ; the presence or absence of
parts corresponding to the nymphoe ; the presence or absence of the
testicles. The openings which exist must be carefully examined with
a sound, to ascertain whether they communicate with the bladder or
uterus, or are merely culs de sac ; and inquiry should be made re-
sjiecting the existence of the menstrual discharge, or of vicarious dis-
charges. The character of the voice should be observed, and the con-
duct and feeling of the person under examination towards either sex
should be ascertained. The general conformation and appearance of the
body should also be observed, including the growth of the beard,* and
of hair on different paiis of the body ; the formation of the shoulders
and hips ; the development of the breasts ; and the fulness of the
thighs.

2. SEX OF THE DEAD.

When the entire body is submitted to our inspection, we shall find
no difficulty in detennining the sex, except in those rare instances in
which the chai-acters of the two sexes are blended. In some of these
cases dissection will enable us to ascertain the sex where it would
scarcely be possible to come to any decision during life.

But when the question of sex is raised after death, it is generally in
reference to the skeleton or some part of the osseous system, in which
the following differences are observable : —

The horns of the female are lighter, more cellular, less marked
by asperities, and less cun-ed by muscular action, than those of the
male : the processes are less strongly marked, and the joints smaller.
The skull of the female is smaller, more oblong, less depressed at the
sides, and of greater length behind the foramen magnum ; the face is
more oval, the frontal sinuses less strongly marked, the nostrils more
delicate, the jaws and t«eth smaller, and the chin less prominent.
The chest of the female is deeper than that of the male ; the sternum
is shorter and more convex ; the ensitonn cartilage thinner, and ossified
later in life ; the ribs smaller, and their cartilages longer. The verte-
bral colamn is longer, and the bodies of the veilebrae are deeper in the
female than in the male. The pelvis, however, of the two sexes
pi-esents the most striking contrast. The ossa ilia are more expanded and
horizontal in the female ; the sacnim more concave ; the pubes more
shallow ; the angle formed by the descending rami more obtuse ; the
pubic arch wider ; the tuberosities of the ischia more largely separated ;

* The curious case published by Dr. Cliowne of an otherwise well-developed
female with a copious beard and whiskers, supplies us with a cauiion not to
attach too much importance to any one of the signs detailed in the text. For
the case itself, and a learned history of similar instances, see ' Lancet,' for 1852,
vol. i. p. 421.

SEX OF THE SKELETON. 21

the foramen ovale larger, more triangular, and more oblique; the
acetabula wider apart; the entire pelvis more shallow, but larger in its
outlets than in the male. These differences between the pelves of the
two sexes is shown in the annexed engravings, in which A repre-
sents the male, and B the female pelvis.

The difference between the male and female skeleton is less slrongly
marked before the age of puberty.

A well-formed adult female pelvis measures at the brim about 4^
inches from before to behind ; about 5 inches fi'om side to side ; and
about 5^ inches obliquely. At the outlet it measures 4 inches from
before to behind, and the same from side to side.

This group of subjects — identity, age, and sex — cannot be better
brought to a close than by a case in which the question of identity
was involved, and the distinctions just laid down in respect to age and
sex practically applied.

Case of the icidow Houet. — In this case, which occurred in Paris, proof
of identity was successfully deduced from the remains of a female who
had been interred eleven years. The official report was drawn up by
MM. Orfila, Chevallier, Barruel, and Boys de Loury.*

In the year 1821, a widow lady of the name of Houet, residing
in the city of Paris, disappeared ; and certain persons, Bastien,
Robert, and Robert's wife, were suspected of having made away with
her. A judicial inquiry was pending for some time in the Court of
Assize; but the accused, for want of evidence, had been set at liberty.
Some information, however, was subsequently obtained touching a body
said to have been buried for about eleven years in a particular garden ;
and by means of a patient and ably directed research, such satisfac-
tory evidence was procured of the identity of the remains, and of

* For a very full account of this case, refer to Cummin's Lectures, ' Medical
Gazette,' vol. xix.

22 SEX.

the manner of the death,, that the prisoners were convicted and
punished.

Tlie first part of the inquiry — the juridical exhumation — was con-
ducted by M. Boys de Loury. After excavating different parts of the
garden for about five houivs, one of the worlimen hit upon a hollowed
spot, which, on being carefully opened, was found to contain the
remains of a human body, reduced almost to a skeleton. A drawing
was made of the parts in situ. The figure lay on the left side, with
the head bent forward upon the neck, the vertebral column curved,
the right fore-arm raised, so that the bones of the hand nearly touched
those of the face. The pelvis was turned obliquely upwards, resting
on the left haunch. The thigh-bones were raised considerably, and
the legs were crossed beneath them. The prevailing colour of the
remains was between an ochre and a brown, but the parts in contact
with some of the long bones were of a deep-red tint.

The bones were small and delicMe : those of the extremities were
not at all curved by muscular motion, the marks of the insertion
of the muscles were few and faint. Among the bones of the left hand
was found a gold ring, of small diameter, carved in facettes ; 'and
several small well-formed finger-nails were also discovered. The
cranium was small, and oblong from front to rear ; the parietal bones
were very yielding; the sutures were well-knit; the teeth were white
and well preserved, but three molars were wanting, and one of the
incisors was carious. A small quantity of light-coloured, or ruddy
hair was found, having some gray hairs mixed with it. The ossa
innominata were- largely spread out ; the cavity of the pelvis not deep ;
the anterior part of the sacrum concave ; the sub-pubic holes triangular ;
the cotyloid cavities wide asunder : finally, the upper opening of the
pelvis presented exactly the diameters usually found in well -shaped
females. So that, putting all these chai-acters together, there cannot be
a doubt but that this was the skeleton of a woman.

The state of the neck was particulai'ly striking. Tlie third, fourth,
fifth, aiid sixth cervical vertebrae, as well as the right clavicle, were
held together by a blackish mass, surrounded at its lower part by
several twists of a cord two lines in diameter ; the cord was in a very
decayed condition, and no knot could be found upon it. Minute atten-
tion was subsequently given to this piece de conviction, and the obvious
inference, that the deceased had been strangled, was fully borne out
by all the direct and collateral circumstances.

Several elaborate documents were drawn up by the reporters ; of the
first of which the following is a resume: —

" From the preceding facts, we feel ourselves justified in concluding,

" 1. That these bones are those of a human skeleton.

" 2. That the skeleton is that of a female.

" 3. That this female had attained the a{je of from 60 to 70.

" 4. That her stature was about 4 feet 8 or 9 inches (nearly 5 feet
Eng.).

ILLUSTRATIVE CASE. 23

" 5. That the hair of the female, which ^as of a bright blond colour
in youth, was mixed with gray at the time of her death.

" 6. That the hands were small.

" 7. That during life the bones had never suffered any injury.

" 8. That this woman died of strangulation, and that the act was, to
all appearance, homicidal ; and

" 9. That the body must have lain for several years in the earth."

The prisoners, who had been long suspected, were brought to trial,
condemned, and sentenced to forced labour for the remainder of their
lives.

24

CHAPTER II.

IMPOTENCE. RAPE. PREGNANCY. DELIVERY.

In the last chapter the subject of sex was examined as a means of
identification ; in this it is considered in relation to the genemtive
function, and comprises the subjects at the head of the chapter.

IMPOTENCE.

The medical man may be required to ascertain whether or not a
roan is impotent, or incapable of sexual intercourse. 1 . In suits for
divorce. 2. In cases of contested legitimacy; and 3. In accusations
of rape. The question of incapacity for sexual intercourse has been so
rarely raised in the case of females, that the term impotence, though
equally applicable to women and men, has been used only in reference to
the latter. As, however, there is an obvious distinction between im-
potence and steiility in women as in men, the meaning of the word im-
potence is here extended so as to embrace both sexes.

MaiTiage, regarded as a contract entered into by two parties, pre-
supposes, as do all other contracts, a free exercise of the will, and
ability to fulfil the terms of the contract.

The first condition, the free exercise of the will, comes into question
in those cases in which marriages have been brought about by the
exercise of undue influence upon either party to the contract, and it is
alleged that the person so influenced was of weak or unsound intellect.
The consideration of this class of cases belongs to the subject of un-
soundness of mind.

Before proceeding to consider the second condition — ability to fulfil
the terms of the contract — it may be well to premise that, in order to
establish a ground for divorce, corporeal imbecility must not only be
proved to have existed before the marriage, but to be irremediable. In
most suits of divorce, the medical man is called upon to examine the
person of the husband ; but if the husband is not Ibrthcoming, he may
be required to examine the wife, in order to find confinnation of the
alleged impotency of the husband. This course seems to have been
pursued in a suit of nullity referred to by Mr. Chitty. A certificate
was produced twelve years after the marriage, to the effect that the
wife was virgo intacta, although apta viro ; and this, coupled with two
several confessions by the husband of his incapacity, and with proof
that the woman's health had suffered, though the husband had not

IMPOTENCE IN THE MALE. 25

given in his answer, and that he had removed into France, and had
refused to undergo surgical examination, was holden sufficient in the
ecclesiastical court.

It appeai-s, then, that in suits of nullity of marriage the medical
man will have to examine, not merely into the fact of impotence, but
to determine whether or not it existed at the period of the marriage,
and whether or not it admits of remedy.

This subject of impotence will have to be considered under the two
heads of — 1. Impotence in the Male, and 2. Impotence in the Female.

1. IMPOTENCE IN THE MALE.

The causes of impotence may be divided into two classes —
1. Physical, and 2. Moral or Mental.

1. The Physical Causes of Impotence are — a. Too tender or too
advanced an Age. h. Malformation or defect of the penis, c. Defect
or disease of the testicles, d. Constitutional disease or debility.

a. Age. — The earliest age recognized by law for the formation of
the marriage contract is 14 in the male, and 12 in the female. " But
the ecclesiastical courts look rather to the habit, strength, and consti-
tution of the parties ; they only inquire whether they be habiles ad
matrimonium, and not how many years they may have numbered ;
and, indeed, the common law will hold infantile marriages, solemnized
with due formality, valid, when the parties on reaching the ages just
stated do not demur to the contract."

The age at which puberty occurs in the male, no less than in the
female, is subject to very great variation. It is usual to recognize
14 years of age as the earliest advent of puberty in the male ; but the
signs of puberty may first show themselves much later than this; and
many examples of large development of the sexual organs in childhood
are on record. The signs of puberty are to be sought for in the general
conformation of the body, the character of the voice, the growth of
hair on the pubes, and the development of the organs of generation
themselves. If the genital organs are found to have the usual manly
development, there is a presumption in favour of the seminal secretion
having the elements necessary to impregnation.

But impotence may arise from the infirmity of age as well as from
immaturity ; and the question arises, At what age do the powers of
procreation cease ?

This question has acquired an unusual interest in consequence of
the celebrated Banbury Peerage Case, which was brought before the
House of Lords, and decided in the year 1813. The principal "argu-
ment urged against the claimant was, that the ancestor under whom
he claimed could not have been the son of Lord Banbury, because
that nobleman was eighty years old when the child was born. In
reference to this question of age. Sir Samuel Romilly expressed him-
self as follows : " The objection to the age of Lord Banbury may at

26 IMPOTENCE.

once be dismissed. The law of England admits of no age at which a
man may not become a father ; and many medical authorities may be
cited to show that this rule is founded on reason. Dr. Gregory, of
Edinburgh, whose name must be familiar to all admirers of science,
says upon this subject, — ' Magna autem de his rebus differentia ;
decantantur enim exempla senum in castris Veneris strenue merentium,
postquam centum annos compleverant ; neque sane dubium, aut adeo
rarum octogenarium patrem fieri.' Haller likewise pronounces a man
of ninety to be capable of procreating. Parr became a father in his
one hundred and fortieth year. In short, the liberality of the law on
this subject is excessive ; for theie is no age, from seven upwards, at
which a man is denied the privilege of having children." Lord
Erskine, following on the same side, cited the case of Sir Stephen Fox,
who married at the age of seventy-seven, and had four children ; the
first child was born when the father was seventy-eight, the second and
third were twins in the following year, and the fourth was born when
the father was eighty-one. The Attorney-General, Sir Vicary Gibbs,
who opposed the claimant's title, evidently felt the objection on the
score of age to be far from valid, for he shifts his argument as rapidly
a^ possible from it to more secure ground. He says : " Age may not be
a proof of impotency, but it is evidence of it. The probability of the
earl's begetting a child at eighty is very slight, and it is not increased
by the appearance of another child two years later. Instances have
been adduced of these extraordinary births, but none have been cited
in which a man at eighty-two, having begotten a son, had concealed
the birth of such son." With regard to age, then, it is clear that no
limit is fixed by law, or can be assigned by science, at which the power
of procreation ceases. Old age, provided it be a robust old age, is
obviously no impediment to procreation. In the case of Lord Banbury,
there is ample evidence of his having been capable of strong exercise
until within a short period of his death.*

b. Malformation or defect of the penis. — The experiments of Spal-
lanzani and Rossi have shown that in animals complete sexual inter-
course is not necessary to impregnation ; but that the injection of semen
by a syringe will suffice for that purpose, the animal being in heat. John
Hunter's ingenious expedient, recommended in a case of fistula in perineo,
further proves that in the human subject the semen may be introduced
in the same manner during the existence of the venereal orgasm with
the same result. But the cases to be cited under the head of Pregnancy
must be admitted to prove more than this. They show that a female
may become pregnant in consequence of intercourse taking place in a
state of unconsciousness, and accompanied by so little injury to the
parts of generation as to attract no attention afterwards. Cases of
pregnancy occurring in women in whom the hymen is intact may also
be adduced in confirmation of the same view. So that it would seem

* See Sir Harris Nicolas's treatise on the Law of Adulterine Bastardy.

PHYSICAL CAUSES OF IMPOTENCE. 27

that neither the introduction of the male organ nor the venereal orgasm,
are necessary to impregnation. It follows, then, from these considera-
tions, that small size or partial mutilation of the penis is not to be ac-
counted a cause of impotence. Provided that what exists or remains of
the penis is sufficiently large to admit of introduction within the orifice
of the vagina, and there be no impediment to the emission of semen,
fruitful intercourse may take place. Thus, the removal of the glans
penis ; of the corpora cavernosa (as in a case quoted by Paris, from
Piazzoni) ; of a very considerable portion of the organ (as in the case
of a soldier quoted by Frank, in whom a large part of the penis was
carried away by a musket-ball) ; did not occasion impotence. A still
more extreme case is on record,* in which, in consequence of disease
followed by amputation, there was only a very small protrusion of the
organ on pressure, and yet the patient after the amputation became the
father of two children. An amputation of the penis close to its root
would in all probability cause impotence, though, for the reasons
already assigned, fruitful intercourse is perhaps not altogether
impossible.

The opposite malformation, viz., an excessive development of the
penis, whether normal or as a consequence of disease, can also scarcely
be regarded as a cause of impotence ; for though intercourse, in the
ordinary sense of the term, were impossible, still impregnation might
take place.

The same remark applies with equal force to a malformation of the
penis, in which the ui-ethra opens upon the organ itself, though not in
the usual situation.

Several such cases not resulting in impotence have been placed on
record, and are the more conclusive, inasmuch as the malformation
was transmitted from pai-ent to child, and in one instance, reported by
Frank, through three generations.

When the opening of the urethra, instead of being upol! the penis,
is in the perineum, fruitful sexual intercourse cannot take place unless
the semen be artificially introduced into the vagina, as in the case ot
fistula in perineo just referred to. As in all cases of this class, it is
possible that, either intentionally or accidentally, semen ejected from
an opening remote from the penis may be introduced into the vagina,
and thus cause impregnation, it would be unsafe to pronounce any per-
son subject to such malformation to be incapable of fruitful sexual
intercourse.

Persons subject to the malformations described at pages 18 and 19
under the names of hypospadia and epispadia, must also be accounted
impotent, unless artificial means be resorted to.f

Congenital phymosis, and a confinement of the penis to the scrotum
by a peculiar formation of the integuments, have also been mentioned
among the causes of impotence ; but both these malformations admit

* Mr. Hurd in ' London Med. and Surg. Journal,' vol. iv.
t 'fid. Med. and Surg. Journal,' vol. 1. pp. 43, 132.

28 IMPOTENCE.

of cure. Severe strictures, and extensive disease of the prostate
gland, which act by preventing the expulsion of the semen, and
paralysis of the muscles of the penis, complete the list of the causes of
impotence which have their seat in the penis.

c. Defect or Disease of the Testicles. — The excision of both testicles
early in life ocaisions impotence ; but when they are removed after
puberty, the power of complete sexual intercourse may continue for a
time, and a person so mutilated may even become a fathei-, through
the semen contained in the vesiculae seminales. That sexual intercourse
may take place for a considerable period after the removal of both
testicles is proved by a case related by Sir Astley Cooper.* For about
twelve months after the loss of the second testicle there were emissions
in coitu ; after that period coitus took place at distant intervals, but
without emission. Sexual intercourse becoming less and less frequent,
ceased entirely at the end of ten years. The possibility of fruitful
sexual intercourse taking place after castration, rests upon the discovery
of apparently good semen in the vesicular seminales at a considerable
interval after the removal of the testicles, as in a case cited by Otto ;
on the analogy of animals ; and on at least one instance in the human
subject. Sedillot cites a case on the authority of Boyer, in which,
after the removal of both testicles, a man became a father.f

There has been much unnecessary discussion as to the possibility of a
man having only one testicle being capable of fruitful intercourse, and
as to the impotence of men in whom the testicles have not yet de-
scended, As impregnation cannot be supposed to depend upon the
quantity of semen introduced into the vagina, we may safely affirm
that one sound testicle is to the full as efficient as two ; and as the
position of the testicles cannot be supposed to alter their functions, it
is unnecessary to inquire whether men in whom the testicles are
situate in the abdomen or in the inguinal canal are capable of pro-
creating thAr species. If healthy and well-formed testicles can be dis-
covered either in the scrotum or in the groin, we may safely decide
that the parties are not impotent. If the testicles are to be found
neither in the groin nor in the scrotum, our opinion must be founded
on the sound of the voice, the growth of the hair, the development of
the penis, and the general appearance of the body.

The question of impotence has sometimes been raised in cases in
which the testicles are unusually small. This circumstance is not in
itself a sufficient ground for inferring impotence ; for though cases are
on record in which a small size of the testicles coincided with a total
absence of sexual desire, a case recorded by Mr. Wilson, shows that a
person in whom both the penis and testicles are originally of very
small size may have sexual desires, may experience erections with
emissions, and may become a father of a family ; those parts which
were so small gradually increasing till they attain the size usual in

* • Med. Chir. Rev.,' vol. xviii. p. 390. + Sedillot's ' Manual,' p. 17.

PHYSICAL CAUSES OP IMPOTENCE. 29

the adult.* The sufficiency of even a single testicle of small size is
shown by the case of John Bury, which occurred in the reign of Queen
Elizabeth. His first wife, Willimet, alleged that he was impotent ;
and it appeared on the inspection of two physicians, that he had but
one testicle of the size of a small bean, and that she was a virgin. On
this and other circumstantial evidence, the ecclesiastical court annulled
the marriage. But John Bury took a second wife, by whom he had
a sou. The legitimacy of this son being called in question, the com-
mon lawyers were unanimously of opinion that the ecclesiastical
court had been misled, and pronounced the first raai-riage valid not-
withstanding.!

Of the diseases which affect the testicles, and occasion impotence,
the wasting of those organs which sometimes follows on attacks of
cynanche parotidea is the most important. Fodere witnessed several
cases of this kind in deserters condemned to labour on the canal at
Aries ; and Larrey, in many soldiers of the army of Egypt. The
testes lose their sensibility, become soft, and diminish in size until they
are no larger than a white French bean. When both testes are affected,
the patient becomes impotent — the beard grows thin, and the intellect
weak. Larrey states that the disease could not be traced to previous
attacks of gonorrhoea, but attributes it to the use of the brandy of dates.

Elephantiasis is another alleged cause of degeneration of the testicle
leading to impotence, and malignant diseases of the testicle, such as
scirrhus and medullary sarcoma, may lead to the same result; but we
cannot safely pronounce the subjects of these diseases to be impotent
unless the entire structure of both testicles is affected.

Congenital scrotal hernia, or inguinal hernia of long standing, or
other tumours of large size involving the genital organs, or occupying
the lower part of the abdomen or upper part of the thighs, may occasion
impotence by rendering sexual intercourse impossible.

d. Constitutional disease or debility. — Diseases which occasion ex-
treme debility may become causes of impotence (temporary or per-
manent), through the weakness to which they give rise. There
must always, however, be great difficulty in determining on the
degree of debility or exhaustion from disease which entails impo-
tence ; and the same remark applies with equal force to the weak-
ness brought on by age and natural decay.

But the diseases most likely to occasion impotence are those which
affect tlie nervous centres, more especially diseases of the spine,
whether arising from internal causes or from mechanical injury.
Hemiplegia, from disease of the brain, and paraplegia, from disease or
iujuryof the spinal cord, might be supposed to give rise to impotence;
but that fruitful sexual intercourse may take place within a few
weeks of a well-marked attack of hemiplegia is proved by the cases

* • Lectures on the Urinary and Genital Organs,' p. 424.
f Hargi-ave's ' State 'JYials,' Appendix, vol. x. p. 24.

30 IMPOTENCE.

adduced on the occasion of the trial of Legge v. Edmonds. After
partial recovery from paraplegia, also, the power of fruitful sexual
intercourse does not appear to be lost.*

Case of Lcgge v. Edmonds. — The following is a careful summary of
those facts of this case which are interesting in a medico-legal point of
view. Mr. Legge, of Newent, married August 25, 1835, and died
June 24, 1844. His wife was delivered of a daughter March 23, 1837,
and again of a daughter October 80, 1844, being four months after the
death of Mr. Legge. The first child attained the age of two years ;
the second survived four years. The legitimacy of the second child
was called in question, partly on account of the state of health of Mr.
Legge at the date of the conception, and partly in consequence of the
alleged adultery of Mrs. Legge with the defendant, to whom she was
subsequently married, and by whom she had children. Mr. Lcgge
was an athletic man, and a free liver, occasionally drinking to excess,
but not an habitual drunkard. On November 4th, 1843, when about
thirty-five or thirty-six years of age, he had a well-marked apoplectic
seizure, with loss of speech and hemiplegia of the right side, for which
he was actively treated, and was so far recovered by November 27th,
being little more than three weeks from the date of the attack, as to
cease to take medicine. The hired nui"se left him at the end of five
weeks. After the lapse of a week his speech was partially restored ;
he left his bed at the end of a fortnight ; came down stairs as early as
the end of the third week ; by the end of the fourth week he was
walking in the town, and drank tea out. At or about this period he
was seen walking about by more than one witness. On December 7th
(little more than a month after the attack), he went to Ledbury in a
gig, driving himself part of the way, and signed his name at the bank,
taking his hand out of a sling for the pui-pose. On December 27th
he transacted business as usual, and wrote his name. He dined out
near Newent before Christmas-day, and rode on hoi-seback before the
end of the year. On January 6th he visited Gloucester, and had
transactions with several tradesmen. Before the end of January he
supped at Gloucester, and opened oysters, and on the 31st of the month
attended a meeting, at which he took off his coat and challenged one
of the company to fight. Evidence of the most conclusive kind was
brought forward to prove that between the end of November, 1843,
and the end of January, 1 844, he had repeatedly transacted business and
written his name, walked about without support, driven himself in a gig,
ridden on horseback and leaped hurdles, gone out shooting, and killed
game. It is also proved by the testimony of several witnesses that he
had so far recovered before the end of January as to seem to be in perfect
health. He had no new attack of illness till February 28th. The
cause of his death in the June following seems to have been disease of
the liver and dropsy, attended by a general break up of the system.

* See a case cjuoted from M. Brachet by Curling on ' Diseases of the Testes,'
2ndedit. p. 371.

PHYSICAL CAUSES OF IMPOTENCE. 31

From the foregoing statement, carefully compiled from the notes of
Mr. Chai-les Jones, the solicitor for the defence, it appears that there
were no medical grounds for assuming an incapacity for fruitful sexual
intercourse at the end of January, the presumed date of the conception
of the daughter whose legitimacy was contested. The adverse opinion
of Drs. Taylor and Carpenter was based upon other than medical con-
siderations. The inquiry, commenced at Cheltenham, was afterwards
continued in London, when, in addition to a contirmation of the opinion
previously expressed by Dr. Semple, Mr. Walsh, and the author, by
Drs. Frederic Bird and Blundell, the following facts were given in
evidence : — 1. E. K., in his fifty-eighth year, when ast, thirty-three,
had a well-marked attack of hemiplegia of the right side, which has
left him lame, and with his speech slightly affected. He alleges that
he had connection with his wife within a week of his seizure, that his
sexual powers have not been impaired, and that since the attack he has
had three children always considered as his own. His wife gives three
weeks as tlie extreme limit of time after the attack at which connec-
tion took place. The facts of this case were confirmed by Mr. Wether-
field, of Covent Garden, who added that he had known other cases of
hemiplegic patients begetting children. 2. W. D., set. thirty-two, had
an attack of hemiplegia of the right side when only twenty-six years
of age, and a second attack when twenty-eight years old. Intercourse
took place within a fortnight of the first attack ; and there have been
three children, of which the first was born in about eighteen months
from the first seizure. Neither husband nor wife had any doubt that
the children were their own.

In both these instances the recovery was less complete than in the
case of Mr. Legge. The reader will find a full account of this case,
differing in some material points from the preceding, in Taylor's
' Medical Jurisprudence,' sixth edition, p. 675. Tlie cases of E. K. and
W. D. are not comprised in his review of the case.

There are certain drugs, again, which taken in single large doses, or
used habitually in excess for considerable periods of time, may give rise
to impotence. Opium, spirituous liquors, and tobacco, and other
substances of less power, such as camphor, coffee, and nitre, have
been mentioned as causing impotence, but with what justice it is
difficult to say.

Masturbation and early and excessive sexual indulgence are also
among the acknowledged causes of impotence.

2. Moral or Mental Causes of Impotence. — Excessive passion,
timidity, apprehension, superstition, fear, aversion, and disgust, have
been known to occasion impotence. With the exception of the last-
named emotions — aversion and disgust — the remainder are transitory,
and cm-able. That impotence with one female is not inconsistent with
sexual ability in respect of others is proved by the case of John Bury,
already referred to, as well as by that of the Earl of Essex, who

32 IMPOTENCE.

admitted his inability to know the Countess of Essex, but denied his
impotence as to other females.*

2. IMPOTENCE IN THE FEMALE.

The causes which prevent sexual intercourse in the female are,
1. — Narrowness of the vagina, existing in all subjects before the age of
puberty ; and in rare instances in the full-grown adult. In the latter,
this defect admits of remedy by the continued use of emollients, and by
careful dilatation.

2. Adhesion of the labia, the result of inflammation ; and oblitera-
tion of the vagina from the same cause.

3. Absence of the vagina, accompanied in some cases by absence of
the uterus.

4. Imperforate hymen. As this impediment may be removed by
the knife, it belongs to the class of curable causes.

5. Tumours occupying the vagina, such as polypi, scirrhous forma-
tions, prolapsus uteri, and prolapsus vesica?.

In addition to these mechanical causes of impotence, there are othei's
which, without positively preventing sexual intercourse, render it so
difficult or painful, that they deserve mention in connection with the
subject of impotence. Of these the more important are — Unusual
shortness of the vagina; inflammatory or malignant diseases of the
vagina or uterus ; extreme sensibility of the pai'ts ; a fistulous com-
munication between the vagina and rectum ; and internal piles. Some
of these are obviously curable, others admit of no relief.

Sterility. — Those permanent causes of sterility which are not at the
same time causes of impotence (such as absence of the uterus, the rest
of the genital organs being well formed, and closure of the Fallopian
tubes, or of the neck of the uterus), are for the most part of such a cha-
racter as not to be discoverable during life. Besides these, there are
curable causes of sterility, as of impotence, such as profuse discharges,
menorrhagia and leucorrhoea, and alterations in the character of the se-
cretions of the vagina and uterus. f There are also other causes of
sterility little understood, as is proved by the possibility of females
sterile with one husband becoming fruitful with another. Promiscuous
intercourse is one of the acknowledged causes of sterility; but it is of
a temporary nature, as is shown by the fruitfulness of married convicts
who had been previously prostitutes.

The subject of sterility is of little importance in a medico-legal point
of view, as the question of sterility, apart from that of impotence, is
very unlikely to be mooted in a court of law.

A few directions as to the mode of conducting examinations in cases
of alleged impotence will conclude this subject.

* See Hargrave's ' State Trials,' vol. i. p. 315 ; or abstract by Beck, p. 54.
t M. Donn6 has shown that these secretions, in females apparently in good
health, are sometimes such as instantly to destroy the seminal animalcules.

LEGAL DEFINITION OF RAPE. 33

1. Note the age, general appearance, habit of body, and state of
health, of the person complained of, and ascertain what diseases he or
she may have previously laboured under.

2. The sexual parts should be carefully examined, and their degree
of development ascertained. The nature and extent of such canals as
may be discovered, and the parts with which they communicate, should
be ascertained by the sound or catheter. The urethra of the male
should be explored, and the state of the prostate ascertained.

3. Ko manipulations of a gross or indelicate kind should be practised,
as they are both unnecessary and inconclusive ; and no artificial sti-
mulus should be employed ; though the use of cantharides and other
provocatives has been recommended on high authority.

4. These examinations can only be safely intrusted to skilful and
experienced medical men. The examination of females should be con-
ducted by accoucheurs. The jury of matrons is now justly regarded
as incompetent.

RAPE.

Rape was formerly punished as a capital offence, as was the carnal
knowledge of a female under ten years of age. The carnal knowledge
of a female between ten and twelve years was punished by imprison-
ment, with or without hard labour.

The statute, 4th and 5th Vict., chap, 56, substitutes transportation
for life for the punishment of death ; but leaves the subject in other
respects in much the same state as befoi-e.

The legal definition of a rape is, " the carnal knowledge of a woman
forcibly and against her will."

As the law makes no distinction between the maiTied and the single,
the chaste and the unchaste, and as it does not limit the time after the
alleged commission of the offence at which an accusation may be pre-
ferred, the medical man may have to make his examination of the female
under very different circumstances in different cases.

Rape being defined as " the carnal knowledge of a woman forcibly
and against her will," a question has arisen as to the meaning of the
term carnal knowledge, and a doubt has been raised whether it implies
penetration and emission, or penetration only. Though this difficulty
might be supposed to have been set at rest by the 9th of Geo. IV.,
chap. 31, which distinctly provides that neither in cases of rape, nor
in offences contra naturam, shall it be necessary to prove the actual
emission of seed; but that the carnal knowledge shall be deemed com-
plete upon proof of penetration only, much difference of opinion con-
tinued to exist among legal writers, and conflicting decisions were
given from the bench, till at length it came to be understood and uni-
versally admitted that proof of emission is not required. A question
was next raised as to the meaning of the word " penetration," and it

D

34 RAPE.

was at length decided, after further difference of legal opinions and
decisions, that any introduction of the male organ within the vulva
constitutes penetration.*

The least possible introduction, then, of the male organ within the
vulva, even short of the rupture of the hymen, and without the
emission of semen, constitutes a rape, provided it be done forcibly and
against the will of the female.

In order, therefore, to obtain a conviction in a case of alleged rape, it
is necessary to prove, 1, Forcible penetration, in this limited sense of the
terra ; and, 2. In the case of females above twelve years of age, that the
force was used against the will of the complainant. The subject, there-
fore, divides itself into two parts — the question of penetration, or, in
other words, the physical signs of rape, and the question of consent.
On the first question the medical man is required to give evidence ; on
the second the court decides on the evidence of other witnesses.

PHYSICAL SIGNS OF RAPE.

Though, after the explanation already given of the meaning of the
tenn penetration, it is not necessary to prove the existence of any
definite amount of injury (as, for instance, the rupture of the hymen
in those who have not had previous sexual intercourse), it is incumbent
on the medical man to make a minute and careful examination of the
parts of generation, so as to be able to give a clear description of the
amount of injury they have sustained. And though it is not necessary
to prove the fi\ct of emission, the discovery of semen on the person of
the female, or on her dress, must obviously be of very great import-
ance.

The duty of the medical man when called on to examine the person
of a female said to have been violated will therefore consist — 1. In an
examination of the parts of generation, with a view to an exact desciip-
tion of the amount of injury they have sustained. 2. In an examina-
tion of the body and limbs of the female, with a view to discover
bruises, scratches, or other evidences of resistance to the alleged
violence. 3. In an examination of the linen worn by the female at
the time of the alleged rape, with a view to the discovery of spots of
semen or of blood, and, in some cases, of other discharges. It may
also be necessary to examine the person and linen of the accused.

1. Examination of the parts of generation. — Before proceeding to,
consider the injuries which these parts may sustain in cases of rape, it
will be necessary to institute a preliminary inquiry respecting the valiie
of the hymen, and of other alleged signs of virginity ; for, in the greater
number of instances, the crime of rape is committed on the person of
a female who has not pieviously had sexual intercourse; and it is usual,

* See the cases quoted In Archbold's ' Pleading and Evidence in Criminal
Cases,' and in the lirst edition of this work.

PHYSICAL SIGNS OF RAPE. THE HYMEN. 35

in the case of adult females, to endeavour to rebut the charge of rape
by alleging previous unchastity — a question on which the medical
examiner may be required to express an opinion.

The Hymen. — Strange as it may appear, there has been much differ-
ence of opinion among authors as to the very existence of this mem-
brane. Male, Beck, and Devergie, give long lists of those who affirm
and of those wlio deny its existence ; but it must be admitted that the
former have the advantage, both in numbers and authority.

Orfila examined more than 200 subjects, and never found it wanting,
Gavard found it in the foetus, in the new-born infant, in young women
from 23 to 25 years of age, and in one of 50 years old. Bennach, of
Marseilles, saw it in a woman of 60. Devergie himself has found it
invariably present in new-born infants, and has met with it in women
of different ages exposed at the Morgue, of whom one was 65 and
another 72 years old. The same author has twice observed the labia
minora united through the whole extent of their free edge, leaving
above a small aperture corresponding to the meatus urinarius. In
another case the vagina was closed by a false membrane within .the
labia minora, having a perfect hymen behind it. Devergie concludes,
from a careful review of all his authorities, that the hymen is an almost
constant formation, recognizable by marked characters in 99 cases out
of 100 ; and that the differences of opinion which have existed in
former times have arisen from the great varieties discoverable in its
form and size.*

The most usual form of the hymen is that of a semilunar fold, con-
cave, before and convex behind, bounding the entrance of the vagina
below, the extremities losing themselves behind the labia minora in the
circunaference of the. aperture of the vagina. Another foi-m is that of
a circular membrane, perforated in the centre, and adhering by its
entire circumference to the opening of the vagina. A third form
consists of a membrane filling up the entire orifice of the vagina, with
the exception of a small opening above, corresponding to the meatus
urinarius. Lastly, the most unusual form is that of filaments of
mucous membrane uniting the caruncula^ rayrtiforraes.

At birth the hymen is limited in extent ; but little by little, and
especially during the period which precedes puberty, it increases in
size. Its free edge then becomes relaxed and thrown into folds, and it
is believed that when the rupture takes place it is chiefly in these folds,
and that in this way those small pyramidal tubercles, three, four,
five, or six in number, known as the carunculaj myrtiformes, are
formed. These small bodies, being the remains of the hymen, are
looked upon as evidence of the previous existence of that membrane.

There can be little doubt, then, of the existence of the hymen, in the
great majority of females in some one of the forms just described.
The medical examiner should, therefore, ascertain whether it is present

* Consult Devergie, • Des Attentats a la Pudenr.'

36 RAPE.

or absent. Its recent destruction .affords conclusive evidence of the
recent employment of force, and if there are other marks of violence
on the parts of generation and on the person of the female, there can
be no reasonable doubt of the commission of a rape, as far as that
crime admits of being proved by physical signs.

But the medical examiner, in place of the hymen, may find only the
carunculaj myrtiformes, resulting from the destruction of the membrane
at some earlier period. Would this ascertained absence of the hymen
justify the assertion that the female had had previous sexual intei-
course ? The answer to this question is obvious. The hymen may
be destroyed otherwise than by sexual intercourse: from within, if the
aperture be small, by the first menstrual flux, or by the accumulation
of other discharges ; from without, by accident, or by the intentional
introduction of foreign bodies for lascivious purposes. The mem-
bi-ane may also be destroyed by disease ; or it may be originally
wanting, as in a case related by Capuron. The absence of the
hymen, therefore, is no proof that a female has had previous sexual
intercourse.

On the other hand, the piesence of the hymen must not be accounted
a certain sign of chastity ; for after sexual intercourse the membrane
has remained intact, and even after the birth of children. Ambrose
Pare, Ruisch, Capuron, and Baudelocque give cases of mothers in
whom the membrane was either ruptured by the child, or purposely
divided by the knife; and Tolberg, on the authority of the elder
Meckel, cites the case of a woman in whom the hymen was pre-
served circular and tense after the birth of a foetus of five months,
enveloped in all its membranes.

This occasional persistence of the hymen in mariied and pregnant
females will occasion less surprise if we bear in mind the very great
difieren ce which exists in the size of the parts of generation in different
females, and the effect of habitual discharges in causing a relaxed state
of the parts.

The presence of the hymen, then, is not conclusive proof of chastity,
noi' its absence of the reverse.

Besides the intact condition of the hymen, or its recent rupture,
other signs of virginity have been enumerated of which the most
important are the fresh colour, fiimness, and elasticity of the labia,
the entire state of the fourchette, the narrowness and lugose state
of the vagina, and a plump and elastic condition of the breasts.
The difficulty and pain attending intercourse, and the flow of blood,
have also been mentioned as signs of previous virginity. All these
signs are fallacious. The condition of the labia just described is not
always destroyed by repeated acts of intercourse, and in the state of
the breasts many widows and mothers may compare with undoubted
virgins. The fourchette may remain uni-uptured after repeated inter-
course, and even after child-beaiing ; and the narrow and constricted
state of the vagina is not only not peculiar to virgins, but it may be

FALLACY OF THE SIGNS OF VIRGINITY. 37

artificially imitated by the use of astringents, whilst the opposite state
is naturally present during the menstrual period, and may be induced
by the leucorrhceal discharge, or by profuse menstruation. The pain
attending a first connection, and the show of blood, are still more
fallacious, as both may occur from relative disproportion.

The difficulty of ascertaining the fact of previous sexual intercourse,
and the possibility of the usual signs of virginity remaining after long
habits of unchastity, is well illustrated by the following case.*

" Several years ago, two young women of genteel appearance were
attacked in the public streets by some young men, who called them
gross and oppi'obrious names, and told the passers-by that they were
nothing better than common prostitutes. Some good-natured persons
resented this conduct, and took the girls' part. A complaint was
lodged on their behalf against their defamers, and the latter were
summoned to appear before a magistrate. The defendants pleaded a
justification, while the females, on the contrary, stoutly insisted on
their purity ; they even otiered to submit to a personal inspection by
a medical examiner, — which the opposite party dared them to do.
A sworn inspector, a clever and conscientious m.an, was appointed by
the magistrate, and the result of his investigation was this, — That
it was totally out of his power to say anything certain in regard to
one of the females ; she might or she might not be a virgin ; but for
the other, she probably had had some intercourse with men, but he
could not assert the fact positively. The issue of the dispute 1 know
not; but this is certain, that it subsequently came out that these
same young women had actually been for some time entered on the
registers of the police, and one proof of their being anything but virgins
was, that they had both been, on several occasions, affected with the
venereal disease."

The physical signs of rape consist in marks of Adolence on the organs
of generation, proportioned to the force employed, the resistance
offei'ed, and the relative disproportion of the parts. If the sufferer has
not previously had sexual intercourse, there may be, in addition to
marks of injury on the labia, rupture of the hymen and fourchette.
If the injury be recent, the parts will be found lacerated, abraded, and
covered with blood ; if of some standing, there will be signs of recent
inflammation, with increased heat and swelling of the genitals, and
profuse mucous discharge, at first tinged with blood.

These appearances will present themselves if the parts are inspected
soon after the commission of the crime ; but at the end of three or
four days the inflammation will liave subsided, the parts may be en-
tirely healed, and nothing may remain to point out the injury which
has been inflicted.

In women who have had sexual intercourse, and in those who have
borne children, the marks of violence will be, cceteris paribus, less

* Parent Duchatelet, ' La Prostitution dans la Ville de Paris.'

38 RAPE.

distinct, and the resulting inflammation less intense. The marks of
injury would also be less distinct if the offence were committed during
the menstrual pei'iod, when the parts are dilated and relaxed, or in
the case of a woman sufi'ering from any profuse dischai-ge.

It is scarcely necessary to state that all these marks of injury to
the parts of generation may exist, and yet no rape have been com-
mitted; for a first intercourse, with full consent, would give rise to
the same appearances, as would a great disproportion of parts in the
case of a woman accustomed to sexual intercourse.

The possibility of marks of injury to the oi-gans of generation being
self-inflicted, or otherwise fraudulently produced, in order to support
a charge of rape, must also be borne in mind. In a case related by
Fodere an appearance of injury to the parts of generation of a child was
produced by the pressure of a piece of money.

Appearances on the paits of generation, similar to those due to
violence, may also be occasioned by disease. We owe our first
knowledge of this important fact to Dr. Percival. " Jane Hampson,
set. 4r, was admitted aft out-patient of the Manchester Infirmary,
February 11, 1791. The parts of generation were highly inflamed,
sore, and painful ; and it was stated by the mother, that the child
had been as well as usual till the preceding day, when she complained
of pain in making water. This induced the mother to examine the
parts affected, when she was surprised to find the appearances above
described. The child had slept two or three nights in the same
bed with a boy fourteen years old, and had complained of being very
much hurt by him during the night. Leeches and other external ap-
plications, together with appropriate internal remedies were pre-
scribed; but the debility increased, and on the 20th of February
the child died. A coroner's inquest was held ; previous to which
the body was inspected, and the abdominal and thoracic viscera
found free from disease. From these circumstances, Mr. Ward, the
surgeon attending the case, was induced to give it as his opinion
that the child's death was caused by external violence ; and a ver-
dict of murder was accordingly returned against the bov with whom
she had slept. Not many weeks elapsed, however, before several
similar c;ises occurred, in which there was no reason to suspect
that external violence had been offered, and some in which it was
absolutely certain that no such injury could have taken place. A
few of these patients died. Mr. Ward was now convinced that he
was under a mistake in attributing the death of Jane Hampson to
external violence, and informed the coroner of the reasons which
induced this change of opinion. Accordingly, when the boy was
called to the bar at Lancaster, the judge informed the jury that the
evidence adduced was not sufficient to convict ; that it would give
rise to much indelicate discussion if they proceeded to the trial, and
that he hoped, therefore, they would acquit him without calling wit-
nesses. With this request the jury immediately complied. The

MARKS OF VIOLENCE. DISEASE IN CHILDREN. 39

disorder in these cases, says Dr. Percival, had been a typhus fever,
accompanied with a mortification of the pudenda."*

A complaint nearly resembling that observed by Dr. Percival
has been described by Mr. Kinder Wood. It is preceded by all the
ordinary symptoms of fever for about three days.. The attention of
parents is then called to the seat of the disease, by complaints in
voiding the urine. When the genital organs are examined, one or
both labia are found enlarged and inflamed. The inflammation is of a
dark tint, and soon extends internally over the clitoi'is, nymphse, and
hymen. Ulceration succeeds, an^the external organs of generation
are progressively destroyed. The affection proved very fatal. It
seemed to be a peculiar kind of eruptive fever.f

Mr. Lawrence % also describes a peculiar kind of inflammation inci-
dental to the external organs of children, which is not only a serious
affection in itself, but has often been confounded with syphilitic affec-
tions, so as to give rise to the suspicion that the children had been
ill-used, and had thus caught the disease. In some instances judicial
trials of a serious nature have been the result. It occurs in young
subjects of from four or five to eight or ten years of age : it consists
of inflammation of the labia and tlie external organs generally ; which
assume a deep, dusky red colour, and in- which foul ulcerations form
with a tawny gray, and sometimes an actual sloughing surface. They
are very painful, attended with a thin fetid discharge, and sometimes
extend so as to occupy a considerable portion of the surface of the
external organs of generation, with feverishness, restlessness, great
pain, and very considerable disturbance of the health of the child.
This disease differs widely from syphilis. It commences with " an
excessively deep-coloured inflammation," with great disturbance of the
health, the inflammation being followed by foul and sloughing ulcers,
" of a tawny colour, totally different fiom the characters of any primary
venereal sore." Mr. Lawrence gives the case of a child suffering from
this affection, who, in consequence of previous professional opinions that
it was the venereal disease, was questioned and interrogated until she
gave in to the idea that had been suggested and strongly entertained by
the parents, and said that a certain youth had done something or other
to her. The suspected individual was taken to Bow Street, examined
there, and tried at the Old Bailey on a capital charge of violating this
young person : on that trial Mr. Lawi-ence gave evidence, and he states
that this is not the only instance in which a circumstance of this kind
has taken place.

Mr. Wilde of Dublin describes a similar affection of the parts of
generation of young children in connection with leucorrhceal oph-
thalmia, and he adduces facts to prove that both affections are con-

* • Medical Ethics,' pp. 103 and 231.

t 'Med. Chir. Trans.,' vol. viii. p. 84. See also Beck's 'Medical Juris-
prudence,' art. Rape, for further references to authors.
X Surgical Lectures, ' Lancet.'

40 RAPE.

tagious. (See * Medical Times and Gazette/ Jau. 17, 1857. See also
Mr. Kesteven in same journal, April, 1859.)

I have seen several ciises of this deep-coloured inflammation of the
genitals with profuse discharge, but not proceeding to ulceration ; and
have generally found the friends suspicious of violence.

It appeal's, then, that disease may give rise to appearances on the
parts of generation closely resembling the effects of violence. But it
is important to bear in mind, that such disease attacks only young
children, and that in some instances the same disorder prevails at the
same time, in the same place.

2. The evidence afforded by the discovery of marks of violence on
the parts of generation may derive important confirmation from the
results of an examination of the person of the female. If great vio-
lence has been used, and much resistance offered, the traces of the
struggle will be found in the shape of bruises and scratches, espe-
cially on the groins, thighs, and knees, and on the arms and chest.
The clothes may also l)e torn in the struggle.

Marks of violence, then, on the parts of generation, corroborated by
bruises and scratches on other parts of the person, form the principal
physical signs of rape.

3. Examination of the linen. — Very important information may be
derived from a careful examination of the linen worn by the female at
the time of the alleged rape. Such an examination may furnish
valuable negative evidence, or it may issue in the discovery of spots or
stains of blood, of menstrual fluid, of semen, or of other discharges.

Sp'ts of blood. — When the injury is recent, we shall expect to find
spots of pure blood on the linen ; spots presenting a uniform red
colour throughout. When the injury has been some little time in-
flicted, and the first haemorrhage has ceased, there will be a muco-
sanguinolent discharge, which will stain the linen less deeply and
unifoniily, presenting spots of a lighter colour, reddish, or of a yellow-
ish red, lighter in the centre, and bounded at the circumference by a
circle of a deeper colour than the rest of the spot.

The coexistence of these spots of blood, or of bloody mucus, with
marks of violence, forms a strong corroboration of a charge of rape ;
but the absence of marks of violence would justify a suspicion of fraud.

For the chemical tests and microscopic characters of spots of blood,
the reader is referred to the chapter on wounds.

The menstrual fluid. — It is necessaiy to be on our guard against con-
founding blood-stains with the stains produced by the menstrual dis-
charge. The menstrual fluid is secreted by the lining membrane of the
uterus. It resembles venous blood in colour, but it is not brightened
by contact with the air ; and it differs both from ai-t<;rial and venous
blood in containing a very small quantity of fibrine, and not being
coagulable. It has a characteristic sour odour, and an acid reaction,
due to the piesence of free phosphoric and lactic acids. It is
also blended with mucus and epithelial scales ; and is sometimes

SEMEN AND SEMINAL SPOTS. 41

discharged in union with clots of blood. These properties of the
menstrual fluid are so well marked that there ought to be no diffi-
culty in distinguishing it from blood when presented in any quantity
in its pure unmixed state. But the appearances presented by spots or
stains of menstrual fluid and blood respectively are not so distinct. A
stain, as distinguished from an undisturbed spot of blood, may closely
resemble a stain or spot due to the menstrual dischaige. Should the
examination in a case of rape be instituted soon after the commission
of the offence, the presence of the menses might be ascertained by
introducing a plug into the vagina. If the coloured fluid were found
to flow from the upper part of the vagina, we should be justified in
inferring that it was the menstrual fluid.

If the menses were flowing at the time of an alleged rape, blood
would be mixed with the discharge. But this could give rise to no
difficulty, as some of the stains, presenting all the characters of blood,
would correspond with marks of violence on the parts of generation.

This coincidence took place in the case of Mary Ashford, which
occurred in 1817, and excited much interest at the time.

In this case it was proved that the menses were fiowing at the
time of the alleged rape, and coagulated blood was found at the spot
where connection took place, and in the middle of the impression of a
figure on the grass. The parts of generation were lacerated, and
covered with coagulated blood. The shirt and pantaloons of the
accused were also bloody. Abraham Thornton, the accused, confessed
the connection, but said that it was with consent. The dead body of
Mary Ashford was found the next morning in a pool of water.*

Semen, and seminal spots. — When called upon to examine the person
of a female soon after the violence has been committed, semen may
sometimes be discovered at the orifice of the vagina, or on the other
parts of generation. In other instances, we may find seminal spots on
the gai'ments of the female. If a fluid is found having the general
appearance of semen, its real character may be determined by examina-
tion under the microscope, which reveals the presence of certain minute
bodies of a very characteristic appearance, and variously designated as
spermatozoa^ zoosperms, seminal animalcules, and cercaria seminis.
These bodies have been proved to exist in the semen of all male animals
which have reached the age of puberty. When
examined by a powerful glass they present the
appearance depicted in the annexed woodcut. They
consist of a slender filament surmounted by an oval
or pear-shaped head. They are diffused through
the semen in large numbers, mixed with granular
or corpuscles of much larger size. They are very
minute, their entire length not exceeding the 50th

* See this case given at length in Cummin's Lectures, 'Med. Gaz.,' vol, xxi.
p. 386.

42 RAPE.

of a line, and the head varying in width from the 600th to the 800th
of a line ; or about half the diameter of the human red blood-corpuscles.
For several hours after the death of the animal to which they belong they
are in motion, the filament having a peculiar lashing, undulating, or
vibrating movement. But when they have ceased to move, they may still
be detected by their peculiar shape. This shape they retain even when
dry, and they may be discovered in dried semen if carefully moistened.
Orfila discovered them in semen which had been kept for eighteen
years on glass plates. These bodies also resist putrefaction in a re-
markable degree, so that Dr. John Dewy observed them in putrid
semen which had been kept for ten weeks.* They have also been
repeatedly detected by several observers in the liquid obtained by
steeping seminal stains on linen in a small quantity of distilled water.
Devergie found them in stains which had been dried ten months, and
M. Bayard discovered complete animalcules in seminal stains two
months, a year, and even three years old.

An instructive case of rape, by Dr. Henry Munroe, accompanied
by an engraving showing the spermatozoa, the blood globules, the
epithelial scales of the menstrual discharge, and the mucous bodies in
the liquid obtained by steeping the stains on linen in distilled water,
will be found in Beale's * Archives of Medicine,' vol. i. p. 139.

Till a recent period, these bodies were the only ones found on the
person or on the hnen of the female which possessed motion, or consisted
of the two constituent parts — an oval head and a filamentous tail. But
M. Donne has described and depicted an animalcule occasionally en-
countered in vaginal mucus, and especially in the discharges of females
p. . careless of personal cleanliness, to which he gives

the name of Trichomonas vagina;. It is found
mixed with granular bodies of larger size than
those of semen, and having the shape depicted
in the annexed engraving. The head of the tri-
chomonas is three times the size of that of the
spermatozoa ; it has several granules in its interior,
and a row of from four to six short cilia springing
from its circumference.

But besides the discovery of the seminal animalcules, there are other
means of identifying seminal spots. They are of a grayish colour, which
is best seen by placing the linen between the eye and the light. They
are stiff, as if starched ; inodorous, but when moistened give out the
well-known seminal odour. Held near the fire — taking care at the
same time not to scorch the linen — the spots become of a yellow fawn
colour, and several small whitish spots, which were not previously
perceived, make their appeaiance. According to Orfila, this effect of
heat on the seminal spots is characteristic: it does not take place with
any other healthy or morbid discharge ; neither with the vaginal

* Ed. ' Med. and Surg. Joum,,' vol. Iv. p. 15.

EXAMINATION OF THE ACCUSED. 43

mucus and the lochia ; nor with the gonorrhceal discharge and fluor
albus.

Pure and concentrated nitric acid gives to the solution of the semen
in water a slight yellowish tinge, though it were colourless before, but
causes no precipitate.

The change of colour which the spot undergoes on being held near
the fire, and the peculiar odour of the solution, are highly characteristic.
The absence of precipitate with nitric acid is less conclusive. The dis-
covery of perfect spermatozoa places the nature of the spot beyond
doubt.*

Other discharges. — In addition to the physical signs of rape already
mentioned, it sometimes happens that there are traces of the venereal
disease, and a question may arise as to the value to be attached to the
presence of that disease. As the earliest period after connection at
which the disease occurs is about three days, if it should be present in
a female examined soon after the alleged violence, the circumstance
could have no influence on the decision of the case, except in as far as
it would prove the female unchaste. If on an examination at a later
period the disease should be found present, it would prove the female
unchaste if the disease were absent in the accused, but would form a
strong corroboration of the charge if present. As we have no means
of distinguishing the discharge in gonorrhoea from the purulent or
muco-purulent discharge from the vagina of children, or from the
more highly coloured leucoi-rhceal discharges of the adult, it will be
necessary to be very cautious in forming an opinion as to the nature of
any existing discharge.

In cases of accusation of rape based upon the existence of a purulent
or muco-purulent discharge in young females, the ascertained ab-
sence of gonorrhoea in the accused, coupled with evidence of the
frequency of such discharges in children, is of the utmost importance
to the defence.

The inferences drawn from an examination of the parts of generation
and person of the female, and of the state of the linen, admit of being
strengthened by an

Examination of the accused. — The person of the accused, if ex-
amined soon after the commission of the offence, may bear distinct
marks of the resistance which was offered, and the linen worn at the
time may be found soiled with blood and semen. In some instances,
too, the force used is such as to rupture the f'roenum. On the other
hand, the result of the examination may be such as to negative the
supposition of rape ; for the accused may prove too weak, or of too
tender, or too advanced an age to be justly chargeable with rape ; or
it may happen that he is impotent, in which case the charge must at
once fall to the ground.

Some confirmation of the statements of the female may sometimes

* Orfila: 'Traite deMedocine Legale,' vol.^i. pp. 156 et seq.

44 RAPE.

be derived from an inspection of the spot upon which the offence was
alleged to have been committed. It may bear distinct traces of a
struggle, and be found covered with blood.

In case of death following rape, a post-mortem examination may be
required. No particular directions are necessary in this case. The
parts of generation, and the surface of the body, would have to be
carefully inspected ; and the mouth should be especially examined, as
foreign bodies are sometimes introduced in order to stop the cries of the
female.

Though the medical examiner may be in a condition to prove, by an
inspection of the persons of the complainant and of the accused, that
an act of forcible sexual intercourse has taken place, the proof of rape
may still be incomplete ; for the female may have consented after
offering a certain amount of resistance. The sufficiency of the re-
sistance, and the question of consent generally, must be reserved for the
jury, who will be guided by the following considerations: — The
previous character of the female, and her relations with the accused ;
the motives by which she may be actuated in bringing the accusation ;
the place and circumstances in which the offence was alleged to have
been committed; the time which elapsed before complaint was made;
whether, if other persons were near at hand at the time of the alleged
violence, her cries were heard ; and whether, if they were discovered,
she made resistance, and cried out before the discovery. The question
of consent has of course no place in the case of children imder ten years
of age, of idiots, or of females in a state of unconsciousness, however
produced.

This question of consent has sometimes been summarily answered
in the case of the adult female, by alleging the utter impossibility of
committing the crime on af female in full possession of her senses, and
of an ordinary degree of strength. Of the difficulty of completing the
offence, in the sense which was formerly attached to the term penetra-
tion, there can be little doubt, but as that term is now understood,
the offence must be admitted to be possible, especially where there is
great disparity of strength. The female, too, may faint from terror, or
yield to threats of worse violence.

Two questions connected with this subject still remain to be dis-
cussed. 1. Can a female be violated during sleep without her know-
ledge ? and, 2. Does pregnancy ever follow rape ?

1. Can a female he violated during sleep without her knovcledgei —
That a female may be violated during stupor produced by narcotics,
there is no doubt ; that a female, accustomed to sexual intercourse,
may he violated during profound sleep, is also highly probable;* but

* In the year 1840, 1 was consulted by a poor woman, who, after mentioning
other complaints of little importance, stated that she was somewhat alarmed by
the fact of her sleep being so heavy that she was with difficulty aroused. She
added, by way of illustration, that her husband had assured her that he had
frequently had connection with her during sleep.

DIEECTIONS FOR MEDICO-LEGAL EXAMINATION. 45

that a virgin should be violated during sleep may be held to be in the
very highest degree improbable. In the absence of facts this is all that
can be said on the subject ; but that it may be a matter of doubt, is
proved by the fact that the medical faculty of Leipsic, in 1669,
answered the question in the affirmative, and the juridical faculty of
Jena, in the negative. Violation is here used in the sense of sexual
connection accompanied by a certain degree of force: but when discussing
the question of pregnancy, cases will be cited which go to prove the
possibility of sexual intercourse which has taken place during sleep
being followed by pregnancy, which event has come upon the female
by surprise — a proof that connection was not accompanied by violence.

2. I)oes pregnancy ever follow rape ? — The facts just referi-ed to
prove that pregnancy may follow unconscious connection, hence the
venereal orgasm is not a sine qua non of conception. It is also ad-
T;iitted that pregnancy may follow a first intercourse with consent ;
hence there is nothing in the nature of a first connection to prevent
conception. It is, therefore, in the highest degree improbable that an
event which may follow an act unconsciously performed, and in spite of
the suffering attending a first intercourse, should be prevented by the
repugnance which a female feels to the party offering her violence.

It now only remains to give some short directions for performing
medico-legal examinations in cases of alleged rape.

1. Let no time be lost in making a personal inspection of the female,
and let a note be taken of the time at which the inspection is made,
and of that at which the offence is stated to have been committed.

2. Observe the age, strength, and state of health of the complainant ;
examine any injuries that may exist, or may be alleged to exist, on her
person, and see whether they correspond with the cause by which they
are said to have been inflicted.

3. Examine the organs of generation, noticing the exact state of the
parts; whether they are bloody, swollen, inflamed, abraded, or ulcerated ;
whether there is any discharge, and from what part it flows ; whether
the hymen and fourchette are entire or injured, and if injured, whether
recently, and whether the carunculas myrtiformes are present ; ascertain
the date and origin of such marks of violence as exist, and determine
whether they might not have been produced by other than the alleged
cause, as, for instance, by foreign bodies, purposely applied to, or
introduced into, the parts. Inquire, also, whether the alleged violation
took place during the menstrual period, or while the female was labour-
ing under any debilitating discharge.

4. Let any existing discharge be carefully observed, collected, and
examined ; and let any spots of blood or semen on the person or clothes
be also reserved for examination.

5. If death have taken place, the body must be inspected, and search
be made for bruises, fractures, or dislocations ; and for foreign bodies
thrust into the mouth. The internal viscera must also be examined.

6. Examine the spot on which the offence was committed.

46 PREGNANCY.

Lastly. Examine the person of the accused ; his bodily strength
and development ; the parts of generation, with a view to discover
whether he be impotent, or capable of producing the existing amount
of injury, whether he have the venereal disease, or any recent abrasion,
or rupture of the franum. Examine his person also, with a view to
discover bruises, scratches, or other marks of resistance ; and his linen
for spots of blood or semen.

If the joint examination of the complainant and accused does not
support the charge of rape, it may justify a charge of assault with
intent to commit it; and it is usual, when the capital charge fails, for
another indictment to be preferred, charging the prisoner with the mis-
demeanour.

PREGNANCY.

The medical man may be requii-ed to ascertain the existence or non-
existence of pregnancy, for legal purposes, not only in cases where it
is truly alleged to exist, but where it is feigned or concealed.

Pregnancy may be feigned by the unmarried female with a view to
extort money, or to induce a paramour or seducer to marry her ; or
she may bring an action for breach of promise of marriage, and allege
pregnancy as a means of influencing the jury in the assessment of
damages. It may be pretended by the married, to gratify the wishes
of a husband, or to produce a supposititious heir to an estate ; and it is
pleaded both by married and single women to stay the execution of
capital punishment.

Pregnancy may be concealed both by the married and unmarried, to
avoid disgrace, or with a view of procuring abortion or committing
infanticide.

The two cases in which an examination of women alleged to be preg-
nant is most likely to be required for medico-legal purposes are — 1. A
case at common law, where a widow upon the death of her husband
alleges that she is with child, which allegation if true would disappoint
the heirs to the estate ; and — 2. A case in criminal law, where a female
condemned to death pleads pregnancy in stay of execution.

The legal mode of putting the first of these allegations to the test is
by the issue of a writ de Ventre inspiciendo, the examination being in-
trusted to a jury of matrons, or discreet women, generally twelve in
number, who are charged with the duty of ascertaining the fact of the
pregnancy, and of narrowly watching the female till her delivery. In
the second case, the duty of the jury is to ascertain, not only whether
the female is pregnant, but also whether she is quick with child.

The jury of matrons has not always been constituted in the same
manner ; and it is now a common practice to require the aid of one or
more skilled medical examiners. Thus in the case of Mrs. Fox,* two

* ' London Med. Gaz.,' vol. xvi. p. 697 ; vol. xvli. p. I9i.

SIGNS OF PREGNANCY — HOW ASCERTAINED. 47

medical mea and two matrons were appointed to visit her once a fort-
night. In a recent criminal case (case of Mary Weeks, indicted for
the wilful murder of George Weel?:s, Western Circuit, March 20,
1856), the counsel for the defence moved for a stay of execution, as
the prisoner was quick with child. The doors of the court were
ordered to be locked, and a jury of matrons were called into the box
and sworn, and charged to inquire into the fact, whether or not the
prisoner was so. Two medical men were also sworn to examine the
prisoner, and give evidence before the jury of matrons. The jury
retired for a short time, and on returning into court found that the
prisoner was so. Sentence was accordingly respited until by due
coui'se of nature the prisoner should be delivered.

Another case in which a court of law has interfered on proof of the
existence of pregnancy is when a female in this situation is imprisoned,
and application is made to admit her to bail, A case for a medical
examination may also arise under the act 1 Gul. IV., chap, 22, which
provides that the deposition of a witness may be read in evidence in
place of a personal appearance where it can be shown to the satisfaction
of the judge that the witness is unable, from permanent sickness or
other infirmity, to attend the trial. It has been ruled that imminent
delivery is a cause for examination under this act.

As the subject of pregnancy is one which involves a great number
of details, the several parts of which it consists will be examined in
the following order. 1. The signs and symptoms of pregnancy during
life ; including questions raised by the expulsion of various substances
from the womb. 2. Examination of tiie uterus and its appendages
after death, with a view to the discovery of proofs of an existing or
previous pregnancy ; and 3. Questions of a medico-legal nature con-
nected with pregnancy.

• 1. SIGNS OP PREGNANCY.

The leading Signs of Pregnancy are here briefly described, the
reader being referred for more accurate information to works on mid-
wifery, or to monographs treating expressly on this subject.*

Tke Constitutional Signs or Symptoms of Pregnancy are : — an
irritable and capricious temper, melancholy, languor ; a worn and
dejected expression of countenance, and emaciation ; nausea, heartburn,
loathing of food, a capricious, variable, or depraved appetite ; vomit-
ing, especially in the morning, and a costive state of bowels ; fever-
ishness, determination of blood to the head, with eruptions on the
face ; and in some cases salivation, and pains of the face and teeth.

* Consult Montgomery, ' Cyclo. of Pract. Med.,' art. Pregnancy, and his work
on the ' Signs of Pregnancy.' See also Dr. Tanner's recent work on the same
subject.

48 PREGNANCY.

These symptoms, taken separately, have little or no value, and even
when several of them coexist, they are far from conclusive.

The Breasts. — The changes which take place in the breasts in con-
sequence of pregnancy consist, (a) in increased size and firmness ; (6)
in the formation around the nipple of a moist dai'k circle, or areola,
studded with mucous follicles ; and (c) in the secretion of lymph (a
mixture of milk and serum), which flows from the nipple.

Sifjns referable to the Uterus. — These are, a. changes in the size
and shape of the abdomen ; b. quickening ; c. suppression of the ctita-
menia ; d. changes in the neck and orifice of the uterus ; e. increased
size of the uterus ; /. ballottement ; g. discoloration of the mucous
membrane of the vagina ; h. sounds heard on the application of the
stethoscope to the abdomen.

a. The Changes in the Size and Shape of the Abdomen — consist
in a imiform enlargement, first perceptible about the end of the third
month, and progi-essively increasing up to the period of delivery.
Before the third month the uterus sinking into the pelvis causes the
abdomen to appear flattened, and the umbilicus depressed.

6. Quickening — is vulgarly attributed to the movements of the
child, but more correctly to a sudden change in the position of the
uterus, which takes place, for the most part, between the 14th and
18th weeks, but sometimes as early as the 12th week. It is a very
fallacious sign ; for these movements are sometimes not perceived at
all, at others confounded with the motions of flatus, with changes in
the position of the viscera, or with sudden contractions of the abdominal
muscles.

c. Suppression of the Catamenia. — The menses may be suppressed
for long periods, from causes other than pregnancy ; or they may be
present for one or two periods after conception, or during the whole
course of gestation ; or, again, they may be absent at all other times,
and make their appearance only after conception. Moreover, the sign is
wanting in females who have become pregnant without having men-
struated. A female who is really pregnant may also conceal the fact
from her friends, by pretending that she is regular, and imitating the
catamenia by blood.

d. The Changes in the Neck and Orifice of the Uterus. — The neck of
the impregnated womb is fuller, rounder, softer, and more elastic ; the
margins, or lips, lose their well-defined edge, and become soft, swollen,
and indistinct ; the orifice, instead of being tiansverse, becomes circular,
and admits the point of the finger more readily, and to a greater depth ;
and in advanced periods of pregnancy the neck becomes shorter, and is
at length no longer to be felt. The position of the womb also changes
as pregnancy advances. The organ i-ises higher, the fundus is tilted
forward and the neck backward.

e. Increased Size of the Uterus. — During the first three months,
the uterus not having yet risen out of the pelvis, no increase of size

SIGNS OF PREGNANCY. 49

can be discovered, either by external examination or by examination
per vaginam ; but at the end of the fourth month it may sometimes be
felt above the pubes ; and during the fifth, it may be felt both
externally and per vaginam.

As this enlargement of the uterus may be due to any cause gradually
distending its cavity, too much reliance must not be placed upon it as
a sign of pregnancy.

/. Ballottement. — This name has been given to the sensation pro-
duced by the fall of the fcetus after it has been jerked upwards by a
brisk movement of the finger. It is not available till after the end of
the fourth month, and rarely much beyond the completion of the
sixth. Its application, therefore, is limited, and in resorting to it much
practice and some precautions are required. In practised hands it is a
sign of great value.

g. Discoloration of the Mucous Membrane of the Vagina. — M. Jacque-
min states that during pregnancy the entire mucous membrane of the
vagina has a deep violet tint, like that of lees of wine, and that this
change of colour constitutes an infallible sign of pregnancy. This
statement has been confirmed by more than one competent observer ;
but the test does not admit of frequent application in this country.

A. Application of the Stethoscope. — Two sounds may be heard on
applying the stethoscope over the region of the uterus in a pregnant
female ; the pulsations of the foetal heart, and the uterine murmur.

The Foetal Pulse. — The pulsations of the foetal heart vary from 1 20
to 160 in a minute, and bear no relation to the pulse of the mother.
Each pulse is double, and resembles the tick of a watch heard through
the pillow. It is not always heard in the same position, but generally
on one side, at a point nearly midway between the umbilicus and the
anterior superior spine of the ilium. It is als* occasionally inaudible.
Once heard, it is a sure sign of pregnancy. It fails in the case of a
dead fcetus, and it is also inapplicable at an early period of utero-
gestation.

The Uterine Murmur, — This is a low murmuring, or cooing sound,
resembling that made by blowing gently over the lip of a wide-mouthed
phial. It is synchronous with the pulse of the mother, and its relative
situation remains the same during the whole period of gestation. It
may generally be detected in the lateral or anterior parts of the uterus,
and is first distinctly audible about the end of the fourth month.

Condition of the Urine. — The urine of a pregnant woman, after
standing one or two days, becomes turbid, and numerous fatty globules
rise to the surface, and form an opaque, creamy pellicle, with adherent
caseous matter, not unlike that which forms on the surface of cold
mutton broth. This crust swims on the surface for three or four,
days, but breaks iip and disappears with advancing putrefaction.
To this fatty pellicle the name of Kyestein has been given. It has
also been recently shown that the urine of pregnant women contains
grape-sugar.

50 PREGNANCY.

Of the foi'egoing signs of pregnancy, there are very few which can
be deemed conclusive when taken by themselves ; while many of them
are extremely fallacious, and are liable to be simulated by various
diseased conditions, or to be obscured by coexisting diseases of the
uterus itself, or of the abdominal viscera. Some of the most valuable
of these signs can only be duly appreciated by experienced persons, to
whom alone this class of inquiries should be intrusted.

The evidence of pregnancy afforded by substances expelled from the
womb has not a very frequent medico-legal application, and may be
very briefly discussed.

The chief of these substances are, 1. An early ovum, 2. Moles.
3. Hydatids. 4. False membranes.

1. An Early Ovum. — We may recognize an early ovum either by
the characters of the contained foetus, or by that of the surrounding
membranes. The appearances presented by the foetus itself during the
early stages of its development will be examined in the next chapter.
The membranes of the ovum present highly characteristic appeai"auces.
The decidua is characterized by its soft, rich, pulpy appearance and
strong red colour, by its rough external surface perforated by small
foramina, and its smooth internal surface. The inner decidua is known
by its smooth outer surface, audits internal one covered with filaments,
which receive the arboi-escent villi from the surface of the chorion.
These appearances are never assumed by any product of disease.

2. Moles. — Some authors have regarded these bodies as products of
conception, and some as occurring independent of sexual intercourse.
If products of conception, they will be identified as such by the dis-
covery of some parts belonging unequivocally to an ovum ; but if no
such parts can be discovered, we are bound not to assume that the sub-
stance under examination was due to impregnation.

3. Hydatids. — There is a decided balance of opinion in favour of
Hydatids being in all cases the product of conception ; hence they form
an exception to the rule just laid down with regard to moles, and it is
not necessary to discover traces of an ovum in order to form a decided
opinion. It must be recollected, however, that Hydatids may spring
from portions of retained membrane, and may not be expelled for
several months, so that, though furnishing proof of pregnancy, they
would not serve to fix its date.

4. False Membranes. — False Membranes are often expelled in dys-
menorrhoea ; and a superficial and careless observer might pronounce
them to be the product of conception. The general rule already laid
down, that no substance expelled from the uterus should be regarded
as a product of conception, unless it contain well-marked traces of
some part or other of an ovum, must be observed also m this case.

2. Examination of the Uterus and its Appendages after death.

The examination of the uterus and ovaries after death may become
necessary, with a view of determining the existence, or previous oc-

POST-MORTEM EXAMINATION. 51

currence, of pregnancy ; a fact of much importance in certain medico-
legal cases.

The uterus itself, by presenting the small size of the virgin state,
may at once negative the supposition of pregnancy. Or it may be
found enlarged, but empty, and marked by some of the changes
which accompany gestation. In this case we should not be justified
in asserting that pregnancy had existed, because these appearances
may be due to any tumour which had distended the organ, and
at the same time formed a vascular connection with its internal
surface. If, instead of being empty, the womb should be found to
contain any substance, it must be carefully examined, and if traces of
an ovum should be discovered, the fact of previous impregnation
v/ould be made out.

Much importance was formerly attached to certain appearances in
the ovaries, as signs of pregnancy ; and on the trial of Mr. Agnus of
Liverpool for the murder of Miss Burns, the discovery of a corpus
luteum in the ovary of Miss Burns was held to prove the fact of
recent pregnancy, in the face of much difference of opinion as to the
conclusions to be drawn from the appearance of the uterus itself.

The value of the corpus luteum as a sign of previous impregnation
has been a subject of lively discussion, and the characters by which the
true corpus luteum, the product of conception, may be distinguished
from the false corpus luteum, found in virgins, have been very mi-
nutely described. It results from this discussion, that the distinction
between the true and the false corpus luteum is not of so marked and
decisive a character as to justify us in making use of it for medico-
legal purposes.*

3. Questions of a Medico-legal Nature connected with Pregnancy.

These questions are — 1. What are the limits of child-bearing? 2.
Can a woman conceive while in a state of unconsciousness ? 3. Can
a woman remain ignorant of her pregnancy up to the time of delivery ?
4. Does the presence of the hymen rebut the supposition of preg-
nancy? And 5. Is superfoetation possible ?

1. What are the limits of child-hearing'^ — Cases of early fruitful-
ness are related by high authorities. Thus, Montgomery delivered a
female of twins before the completion of her 15th year ; La Motte
and Sir E. Home give instances of pregnancy in the 13th year; the
last-named author another in the 12th ; and Bruce, in Abyssinia, and
Dunlop, in Bengal, met with mothers of 11 years. Mr. Roberton

* " The fact that a structure, in its essential characters similar to, though
smaller than, a corpus luteum, observed during pregnancy, is formed in the
human subject independent of impregnation or of sexual union, coupled with
the varieties in size of corpora lutea formed during pregnancy, necessarily
renders unsafe all evidence of previous impregnation founded on the existence
of a corpus luteum In the ovary."— Kirke's ' Physiology,' 1st Edit. p. 606.

52 PREGNANCY.

gives the case of a factory girl delivered of a still-born child when she
had barely completed her 11th year. Blumenbach gives an instance
of pregnancy in a Swiss girl in her 9th year (Male, p. 176), and
Joubert and Schurigius cases at the same early age (Smith, p. 496).

On the other hand, cases are recorded of pregnancy at very ad-
vanced jieriods of life. Bartholomew Mosse mentions four cases of
women pregnant in their 51st year, and Dr. Labatt of Dublin one ;
Knebel, La Motte, and Roberton, each one in the 52nd year; Koberton
one in the 53rd year ; Bartholomew Mosse, Knebel, and Roberton
each one in the 54th year; a case of pregnancy at the same age (that
of Mrs. Ashley) is also related in the ' Edinburgh Annual Register ' for
1816. In a French case, in which the succession to an estate was
disputed on the ground of the mother being 58 years old when the
child was born, a decision was given in favour of the fact. Pliny,
Valescus de Tarenta, and Marra of Venice, record cases of pregnancy
at 60. The Countess de Taxis is stated to have borne a healthy child
at the age of 62 (Smith, p. 496). Capuron states that a woman of 63
was generally believed in Paris to have given birth to a daughter ;
and, lastly. Beck quotes a case from the ' Boston Medical and Surgical
Journal,' of a woman at Whitehall (State of New York) becoming a
mother at 64.

It will be observed that at each age from the age of 51 to the age
of 54 inclusive, instances of pregnancy are recorded on undoubted
authority. After this age there is a break in the chain of evidence,
the earliest of the more remarkable instances having occurred at 58,
and the latest at 64 years of age.

As the first and last appearance of the menses are usually supposed
to fix the limits of possible fruitfulness, and as the coincidence of
such early and late occurrence of menstruation does certainly lend
support to the cases of early and late pregnancy, it may be well to-
state that menstruation at nine years of age is not an uncommon
occurrence either in England or on the Continent ; that the author, out
of 1,500 cases to which he directed his inquiries, found one of men-
struation beibre the completion of the eighth year, and that Male met
with two instances of regular return of the catamenia and partial
development of the breasts at six years of age. In one French case,
menstruation is recorded at five years. The occunence of the
menstrual discharge, even in the first year of life, rests on good au-
thority.

On the other hand, the author has known the function of men-
struation to continue uninterruptedly so late as the 57th year ; and
Dr. James Reid has recorded instances of menstruation for every year
from that age up to the 69th, inclusive. Cases of menstruation
recurring, after inteiTuption, at a still more advanced age are also on
record.

As the age at which the menses first make their appearance admits
occasionally of medico-legal application, it may be well to state that

CONCEPTION FROM UNCONSCIOUS INTERCOUESE. 53

the 14th and 15th years are the most common epoch of their com-
mencement, then the 16th, then the 17th and 13th, then the 18th
and 12th, and the other ages in the following order: — the llth,
the 19th, the 20th, the 10th, the 21st, the 22nd, the 9th, and the
23rd.

The most common period for the disappearance of the menses
would seem to be from the 45th to the 50th year, inclusive ; but the
instances before 40 and after 50 are numerous.

2. Can a woman conceive while in a state of unconsciousness^ —
The answer to this question must be in the affirmative. Capuron
says, " It is a fact, which experience has more than once confirmed,
that a woman may become with child while in a state of hysteria,
under the influence of narcotics, during asphyxia, drunkenness, or
deejy sleep, and consequently without being conscious of it, or sharing
the enjoyment of the man who dishonours her." This statement is
fully borne out by a case given by Capuron himself, in which the un-
conscious intercourse took place during a profound sleep produced by
punch ; by a case cited by Beck, Art. Pregnancy, in which the same
result was brought about by wine ; and by a third case communicated
to Fodei'e' by Desgranges, in which opium was administered with
the same intent.

As examples of conception taking place from intercourse during pro-
found sleep, two cases may be cited, the one on the authority of
Dr. Gooch, the other on that of Dr. Cusack. Of unconscious intercourse
followed by pregnancy during a prolonged fainting fit, an instance was
communicated to the author by Mr. Hewett of Berkshire ; and of
violation with the same result during a state of asphyxia, or apparent
death, an instance is cited by Fodere (vol. i., p. 500) from the
' Causes Celebres.'

It appears, then, that there are various states of system accompanied
by insensibility, during which connection may take place followed by
conception, the female being unconscious of the occurrence, and not
suspecting it afterwards.

3. Can a Woman remain ignorant of her Pregnancy up to the time of
Delivery ? — it is obvious that in the cases just referi'ed to this is quite
possible. A woman who is not conscious of having exposed herself to
the risk of becoming a mother, would naturally attribute her enlarge-
ment, and all the symptoms of pregnancy accompanying it, to any
cause but the true one. There is another case in which such ignorance
is possible ; and that is where the female has yielded to the solicita-
tions of a lover in consequence o-f solemn assurances that, under cer-
tain circumstances, connection may take place without danger. Thus
Fodere cites a case on the authority of M. Desgranges, in which a
young girl, after resisting the repeated solicitations of her lover,
yielded to his desires in a bath, under the assurance that in that
situation she could not conceive. She became a mother, however, but
appeared to remain ignorant of her situation till the last. M. Des-

54 . PREGNANCY.

gi-anges states that she always affirmed to him that the circumstance
of the connection having taken place in the water had removed all idea
of pregnancy.* There is also an opinion prevailing that a single act
of intercourse is unattended with danger ; and another popular preju-
dice, that provided the act of intercourse is incomplete, and the hymen
remains uninjured, impregnation is impossible. Fodere states that
many cases have occurred of females asserting that they were not
pregnant up to the last, on the strength of the precautions which they
had taken.

Now in all such cases it is obviously possible that the female may
attribute the symptoms of pregnancy to disease, and really believe what
she so much desires should be true. But it is in the highest degree im-
probable that a woman who has had connection under any circum-
stances should not have serious misgivings as to the real cause of her
altered state, and as to the infallibility of the popular belief on which
she had acted. In this, as in other things, the wish is father to the
thought, and as the maraed woman, anxious for offspring, construes
every unusual sensation into a sign of pregnancy, and makes serious
preparations for the important event which is to crown her wishes, so
the single woman, whose wishes all tend the other way, may sincerely
attribute to any cause but the true one, every symptom of an event
which threatens her with shame.

4. Does the presence of the Hymen rebut the supposition of
Pregnancy ? — This question is easily answered, for it has already been
shown (p. 36) that the hymen may exist in spite of repeated inter-
course, and that it may not be destroyed even by delivery. Its
presence, therefore, does not negative the supposition of pregnancy.

5. Is Superfcetation possible ? — As this question has an important
bearing upon legitimacy, it demands a careful examination. Superfceta-
tion is defined as the conception of a second embryo during the gesta-
tion of the first, the products of the two distinct conceptions being
born either at the same or at different times. Some light is thrown
upon this question by more than one well -authenticated case in which
a woman has been delivered of twins of different colours, and both of
them fully formed. The two following are taken from many similar
ones quoted or referred to by Beck ".f " A female at Charleston, in
South Carolina, was delivered in 1714 of twins, within a very short
time of each other. One was found to be black, and the other white.
This variety of colour led to an investigation; and the female con-
fessed that on a particular day, immediately after her husband had
left his bed, a negro entered her room, and by threatening to murder

• Fodere, vol. i, pp. 496-7. Beck quotes this case as an illustration of the
position that ignorance of pregnancy may exist " when the female is an idiot."
This case does not appear to be in point, for though M. Desgranges describes
the girl as "assez niaise," there seems no good reason to regard her as an
idiot.

f ' Medical Jurisprudence,' Art. Pregnancy.

SUPERFCETATION. 55

her if she did not consent, had connection with her." This case is
related on the authority of Buffon. The following case is mentioned
by Dr. Moseley as occurring within his time at Shortwood estate, in
the island of Jamaica : " A negro woman brought forth two children
at a birth, both of a size ; one of which was a negro, and the other a
mulatto. On being interrogated upon the occasion of their dissimili-
tude, she said she perfectly well knew the cause of it; which was,
that a white man belonging to the estate came to her hut one morning
before she was up, and she suffered his embraces almost instantly after
her black husband had quitted her." A case still more remarkable
than either of the foregoing, and scarcely credible, is quoted from
the Rev. Dr. Walsh's Notices of Brazil. " It was communicated to
me," says Dr. Walsh, " by the Sargente' Mor of the San Jose gold
district (Brazil). A Creole woman with whom he was acquainted
in the neighbourhood had three children at a birth, of three different
colours, white, brown, and black, with all the features of the respec-
tive classes.

In the first two cases there is nothing very remarkable. It is easy
to imagine conception taking place in the same ovary or in different
ovaries, from the nearly simultaneous application of semen, whether of
the same man or of different men.

Now these are cases in which the two children are of the full size,
and differ in nothing but colour from children of one father and one
conception. There is another class of cases equally easy to believe
and to understand, in which the birth of two children is separated by a
short interval, or by an interval closely corresponding to their relative
size and degree of development, on the supposition of their being twins.
Of the former class of cases the following, cited by Beck, from
the Consilia of Zacchias, is an example : — *' J. N. Sobrejus lost his life
in a quarrel, leaving his wife pregnant. Eight months after his death
she was delivered of a deformed child, which died in the birth. Her
abdomen remained large, and it was suspected that a second infant was
contained in it, but all efforts to procure its delivery proved fruitless.
One month and a day thereafter, the widow was again taken in labour,
and brought forth a perfect living child. The relations of the husband
contested its legitimacy, on the ground that it was the fruit of a
superfffitation, and Zacchias was consulted on the subject. He agreed
that the two infants could not have been the product of one conception,
since the interval between their birth was so great : but advanced it as
his opinion, that the first was the product of a superfoetation, and con-
ceived a month after the other. This he strengthened by the fact
that the husband died suddenly while in a state of perfect health.
His opinion preserved the character of the mother, and also gave her
those legal rights to which her situation entitled her." Zacchias
seems, in this case, to have chosen the most improbable of two sup-
positions. It is certainly more easy to suppose that the birth of
twins, the product of the same conception, may take place at two

50 PREGNANCY.

different times, than that they should be the products of two different
conceptions ; and it is by no means easy to understand on what data
Zaccliias could found his opinion that the child first born was the last
conceived. In a question of so much difficulty, the wisest course seems
to be to prefer that interpretation which involves the least difficulty,
and which is most consistent with experience. Now the expulsion of
twins at different times is allowed to be a common event, of which
examples are to be found in most works on midwifery. The most
feasible opinion, then, seems to be, that this was a case of twins con-
ceived at the same time, but of which one was discharged before the
other.

But there are cases on record which do not admit of so easy an
explanation, and which certainly countenance the theory of a double
conception.

The wife of Raymond Villard, of Lyons, married at the age of
twenty-two, and became pregnant after an interval of five years, but
had an abortion at the seventh month, on the 20th of May, 1779.
She conceived again within a month ; and on the 20th of January,
1780, eight months after her delivery, and seven months from her
second conception, she was suddenly delivered of a daughter. This
delivery was not, however, followed by the usual symptoms — no milk
appeared, the lochia were wanting, and the abdomen did not diminish
in size. It was accordingly found necessaiy to procure a nurse for
the child.

Two surgeons who visited the female were at a loss with respect
to her situation, and called Ur. Desgranges in consultation, who
declared that she had a second child in the womb. Three weeks
after her delivery she again felt the motions of a foetus ; the abdomen
again increased in size, and on the 6th of July, of the same year, 1780
(five months and sixteen days after the first birth), she was again
delivered of a living daughter. The milk now appeared, and she
was enabled to nurse the child.

Dr. Desgranges, after stating his firm conviction that these two
children were conceived at an interval of some months, adds, that
this second child could not have been conceived after the delivery of
the first, inasmuch as no sexual intercourse took place between the
husband and wife till twenty days after, which would have made
the age of the second child only four months twenty-seven days.

On the 19th of January, •1782, the mother presented the two
children, with extracts from »the baptismal register, before two
notaries of Lyons, in order to attest the facts above stated.*

Assuming that the facts of this case are correctly stated, it must be
admitted to be nearly conclusive as to the possibility of superfoetation ;
for if we deny this, and assume both children to have been the pro-
duct of a simultaneous conception, and the last child to have been at

* Fodere, vol. i. p. 485,

SUPERFCETATION. 57

full tei*m, the first child, which, be it observed, in common with
the other survived its birth between one and two years at the least,
must have been born alive at three months and a half ; or, if the first
child be admitted to be seven months old, the second must have been
born alive at six weeks, which is obviously absurd. The alternative
supposition, that the second child was the fruit of sexual intercourse
taking place subsequent to the delivery of the first, as stated by
Dr. Desgranges himself, is also in the highest degree improbable, for
it supposes a child, born before the completion of the fifth month, to
be reared ! This improbability is increased by the absence of all
allusion to any peculiar difficulty in rearing the child. The only re-
maining supposition, namely, that the second child was a twin born
after a gestation of twelve months and a half, presents similar difficulties.

Dr. Maton has also related a well-authenticated case, in which two
male children (both of which were "born perfect") were brought
forth at an interval of nearly three calendar months. If this had been
a case of simultaneous conception, the one would have been six months
or less, the other nine months or less.

Additional cases are referred to by Beck, in three of which there
was an interval of one month, in two an interval of two months, and
in one an interval of four months.

In deciding this question, those cases only must be admitted to have
any weight in which the interval between the births is considerable ;
for, where the interval is short, if we suppose the child last born to
be mature, the first may have been eight or seven months old, which
is quite reconcilable with the supposition of its being reared. When,
however, the interval is one of four months, if we assume, as before,
that the child last born is mature, the first cannot be more than five
months old, an age-at which it is highly improbable that a child could
be reared.

In any cases that may hereafter occur, it will be important to
observe the size and degree of development of the children, as this
must always be an essential element of the inquiry. But it must not
be forgotten that even the products of the same conception may differ
greatly in size, and yet both be healthy children.

This fact is well illustrated by a case brought under the notice of
the author by Mr. Streeter, in which female twins, five and a quarter
months old, were born enveloped in a common chorion. The one was
more than twice the size of the other, But the smaller foetus alone had
made successful efforts to respire.

If the single case of the wife of Raymond Villard be allowed to be
correctly stated, the doctrine of superfoetation must be admitted to be
highly probable ; but, as there may still be room for doubt, it may be
useful to subjoin the chief arguments employed by the advocates and
opponents of that doctrine.

The opponents of superfoetation allege that the occurrence is im-
possible, because 1, shortly after conception the os tincse, as well as

58 ■ . PREGNANCY.

the internal apertui'es of the Fallopian tubes, are closed by a thick
tenacious mucus. 2. The membrana decidua, which is also fbnned
soon after conception, lines the uterus, and aids in obliterating the
openings into its cavity. 3. That when the uterus is impregnated, the
Fallopian tubes, instead of running horizontally to the ovaria, li.
parallel to the sides, so that if a second embryo were formed within
the ovarium, the tubes could not embrace it in order to convey it to
the uterus. And 4, that the arrival of a new embryo in the uterus
would prove destructive to the first.

The last objection is founded upon a bare assumption, and may
therefore be summarily dismissed. The third objection, if valid, must
prove fatal to the doctrine of superfoetation ; but though this obstacle
may exist in the fully developed uterus, the ovary and Fallopian tubes
ai'e not more prevented from coming into contact with each other in
the early stage of utero-gestation, at which alone superfoetation is
alleged to take place, than in the unimpregnated state. The answer
to the first two objections is an obvious one. Neither the tenacious
mucus nor the newly-formed decidua, though in contact with the
orifices and cells of the uterus, adheres so firmly to it as not to admit
the passage of the semen. The fact of menstruation in numerous cases
occurring during a part or the whole of pregnancy seems to prove, that
the adhesion of this tenacious mucus and of the decidua is by no means
so firm as to forbid the passage of fluid ; and this argument is strength-
ened by the frequent occurrence of haemorrhage in the advanced stages
of pregnancy in consequence of partial detachment of the placenta.
The arguments advanced against the doctrine of superfoetation are cer-
tainly not of sufl[icient weight to counterbalance the improbabilities
set forth in the case of Raymond Villard ; and unless that case can be
shown to be untrustworthy, there seems to be no alternative but to
admit the truth of the doctrine.

If, then, we admit the possibility of superfoetation, the question
arises, Can we explain this occurrence in such a manner as to avoid the
objections of its opponents ? The existence of double uteri, and more
rarely of double vaginse also, suggests the required explanation ; and as
the recorded cases of this malformation are much more numerous than
those of superfoetation, it is quite possible that some of the latter may
be explained by the malformation in question.*

That this malfoi-mation does really explain some cases of superfoeta-
tion is proved by a case related by Sch eider of a woman who, six weeks
after maiTiage, bore a four months* child, and forty weeks after mar-
riage mature twins. On examination, the uterus and vagina were both
found double, and each vagina had a separate orifice.f

* Dr. Cassan (' Recherches sur les Cas d'Utdrus Double, et de Superfoetation ')
has collected forty-one cases, in three of which both uterus and vagina were
double ; and Beck has added eleven others, in three of which the vagina was
double.

f Miiller'a 'Archives,' 1836, and ' London Med. Gaz.,' vol. xx. p. 408.

SIGNS OF RECENT DELIVERY. 59

DELIVERY.

Delivery, like pregnancy, may be either concealed or pretended ; —
concealed, with a view either of hiding shame, or of effecting the de-
struction of the child ; and pretended, in order to produce a supposi-
titious heir to an estate, to influence the feelings of a paramour with
a view to marriage, or to satisfy the wishes or appease the anger of a
husband.

The medical man, then, may be called upon for medico-legal pur-
poses to ascertain the existence of delivery in concealed cases, and its
non-existence in pretended cases. The latter class of cases is com-
paratively rare ; but the former is of frequent occurrence, especially in
accusations of infanticide, when we are called upon to examine the
suspected mother, with a view to determine whether she has been re-
cently delivered. A similar inquiry may have to be instituted in the
dead. The medical man may also be called upon to determine whether
a female has borne children at a former period. He may further be
questioned (especially in trials for infanticide) as to the possibility of
a female being delivered in a state of unconsciousness, or in such a
position and in such circumstances as, without any criminal act of her
own, to endanger the life of her offspring.

This subject, therefore, medico-legally considered, resolves itself into
four heads or divisions : — 1. The signs of recent Delivery in the
Living. 2. The signs of recent Delivery in the Dead. 3. The signs
of Delivery at a forjner and more remote period. 4. Other medico-
legal questions connected with Delivery.

1. Signs of recent Delivery in the Living. — When an examination
is made within a few days after delivery, the following appearances are
present : — •

1. The countenance is pale, resembling that of a person recovering
from a slight illness, and the eye is sunken and surrounded by a
dark cii'cle. The pulse is increased in frequency, and the skin is soft
and wai-m, and moistened with a perspiration of a peculiar and un-
pleasant odour.

2. The breasts, especially if examined on the third or fourth day
after delivery, are found full, tense, and knotty, and when pressed or
drawn yield a milky fluid. The nipples are turgid, and the areola
presents the appearances proper to the state of Pregnancy.

3. The abdomen is distended, its integuments relaxed and thrown
into folds, and its lower part, from the pubes to the umbilicus, marked
by light-coloured broken streaks or cracks. On pressing the hand
firmly over the pubic region, we feel the tumour produced by the im-
perfectly contracted uterus, about the size of the head of a new-born
child, rising three or four inches above the brim of the pelvis, and in-
clining more to one side than the other.

4. The external parts of generation bear distinct marks of the dis-

60 DELIVERY.

tension and injuiy which they ha\e recently undergone. They are
swollen and relaxed, and not uncommonly bruised and torn, especially
after a first labour. In first deliveries, also, the fourchette is often
ruptured, and the injury sometimes extends deep into the perineum.

5. On examination per vaginam we discover the uterus enlarged,
and con-esponding with the external tumour, the os uteri gaping, so as
to admit two or three fingers, and its margins relaxed, flabby, and
fissured. If the examination is made within a few hours after delivery,
the orifice is so open that its margins cannot be distinguished, and it
seems to be a continuation of the vagina. The vagina itself is also
dilated and relaxed, and its internal surface is smooth from the oblite-
ration of the rugaj.

6. The lochia. From the time of delivery and for the first two or
three days, but in some instances much longer, a sangixineous discharge
flows from the genitals. It then becomes nearly colourless, or acquires
a light brown or dirty greenish hue, whence the vulgar name *' green
waters." This discharge has a peculiar, sour odour, resembling that
offish-oil — an odour very difficult to conceal or destroy.

The value of these signs of recent delivery depends upon their being
found in combination ; the uterus and vagina may be enlarged, and
the external parts injured by a tumour of any kind recently expelled,
and this may be followed by a discharge from the genitals. The
breasts, moreover, may enlarge and secrete milk, from sympathy with
the distended uterus ; and the abdomen may display all the marks of
recent distension.

It is of the first importance that the examination should be made
without delay ; for even in cases in which the signs of delivery are
most strongly marked, they may disappear before the tenth day ; and
as a general rule it may be stated that after that date no satisfactory
results are to be expected. In many cases it will be diflScult to give
a decided opinion even before this period has elapsed. Much depends
on the relative size of the foetus, and on the constitution of the
mother.

In cases of abortion occurring in the early months, the appearances
would be slight and evanescent, and before the end of the second
month it is generally admitted that no evidence of recent abortion
would be discoverable. All these circumstances must be taken into
account in forming our decision.

2. Signs of recent Delivery in the Dead. — The external parts
present the same appearance in the dead as in the living. On opening
the cavity of the abdomen, the uterus is found to present different
appearances, according to the time which has elapsed between delivery
and death. If death has taken place immediately after parturition,
the uterus will be found flat and flabby, from 9 to 12 inches long, the
OS uteri wide open, its cavity containing large coagula of blood, and
the internal surface lined by the soft and pulpy remains of the decidua.
The attachment of the placenta is distinctly visible, characterized by

SIGNS OF A FORMER DELIVERY. 61

its darker colour, the small number of flocculi, and the semilunar
openings upon its surface.

The size of the uterus at periods more remote from delivery varies
with the degree of contraction which has taken place. In the first two
or three days after delivery of a mature child, it may be stated to be
about seven inches long by four broad ; its external surface is vascular,
and marked by purple patches ; when divided it is found to be from an
inch to an inch and a half in thickness, of the colour and consistence of
firm muscular fibre. Its internal surface retains the appearances just
described. At the end of a week, the length of the uterus is between
five and six inches. It is now about an inch in thickness ; less vas-
cular, but more firm in texture. The inner surface is still bloody, and
partially covered by decidua. At the end of a fortnight the length of
the uterus does not exceed five inches, and after the laj)se of a month,
it has resumed its original size, but the os uteri never closes so com-
pletely as in the virgin state.

The Fallopian tubes and one or both of the ovaries are found
turgid and vascular, and on -being cut into present one or more cor-
pora lutea.

3. Signs of Delivery at a former and more remote period. — The
external marks consist of silvery lines, or " shining broiien streaks,
like the remains of cracks," on the skin of the breasts and abdomen.
These marks are often absent, and when present they furnish proof
merely of great previous distension from whatever cause, followed by
sudden subsidence. The marks on the abdomen are, for obvious
reasons, the most farllacious ; but those on the breasts are extremely
unlikely to be caused by any other form of distension. When the
two are found in combination, they furnish strong evidence either of a
former delivery, or of some distension of the uterus producing sym-
pathetic enlargement of the breasts. An experienced hand will detect
in the os uteri a peculiar, jagged. condition, on which much stress has
been laid as evidence of a former delivery. The marks of a previous
rupture of the fourchette or perineum will also tend to confirm the
evidence derived from the external examination of the abdomen and
breasts. On the other hand, we may find negative evidence of a still
more satisfactory character ; as, for instance, a state of imperforation
or narrowness of the parts quite inconsistent with the idea either of
pregnancy or delivery. A perfect hymen would also afford a pre-
sumption against a previous delivery. (See p. 36.) The following
case will serve to illustrate the difficulty which may exist of proving
the fact of a previous delivery : — " We very lately examined a patient
who had borne five children, and nursed three of them, the youngest
being now five years old ; the breasts were small, but neither flaccid
nor pendulous ; the nipples short, with not the least shade of brown
colour in the areolae, which exhibited only the delicate rose colour so
often observed on that part of the virgin breast; there were neither
lines nor spots of any kind on the abdomen; the os uteri was small

62 DELIVERY.

and natural ; the vagina contracted, and the fourchette perfectly entire.
It should be mentioned that this lady never carried her children
beyond the end of the eighth month."*

4. Other Medico-legal Questions connected with Delivery. — Two
questions connected with the subject of delivery still remain to be
examined. 1. Can a woman be delivered in a state of unconscious-
ness ? 2. Can a woman, if alone and without assistance, prevent her
child from perishing after delivery? The first of these questions alone
will be examined in this place; the second belongs more pi-operly to
the subject of Infanticide.

Can a woman be delivered in a state of unconsciousness ? This ques-
tion can be answered in the affirmative. The event may happen
under the influence of narcotics or ardent spirits ; during coma, deli-
rium, or puerperal convulsions ; during an attack of apoplexy ; during
deep sleep ; and during suspended animation. Cases of imconscious
delivery are of rare occurrence, and not very likely to happen in a
female pregnant for the first time. In women, however, who have
borne many children, and who have natuially easy deliveries, such an
event is more probable.

* Mdhlgomery : 'Cycle. Pract. Med.,' vol. iv. p. 504.

( 63 )

CHAPTER III.

FCETIGIDE. INFANTICIDE. LEGITIMACY.

These subjects cannot be understood witbout a preliminary knowledge
of the growth and development of the Embryo and Foetus.

ON THE GROWTH AND DEVELOPMENT OP THE FCETUS.

It is commonly asserted that no distinct ovum containing a defined
embrvo can be discovered in the uterus before the 20th or 22nd day ;
but Velpeau* has seen three ova which were not more than twelve days
old, and Sir E. Home found an ovum of a very minute size in the
uterus only eight days after impregnation.! The following account of
the development of the embryo is based chiefly on the description of
Devergie,i taken conjointly with the estimates of length and weight
given by Hamilton, Burns, Capuron, Chaussier, Maygrier, Fodere,
Orfila, Devergie, and Velpeau, together with Bichard's measurement of
the foetal skeleton ; and reduced, in the case of the French authorities,
to the English standards. The embryo at 14 days measures about
one-twelfth of an inch, and at three weeks about one-tenth.

Embryo, Three to Four Weeks. — Length, B to 5 lines. Weight,
about 20 grains. Size, that of a large ant, a house-fly, or a barley-
corn. Form, that of a serpent, the head indicated by a swelling, the
caudal extremity slender, and terminating in the umbilical cord ; the
mouth indicated by a cleft ; the eyes by two black points ; the mem-
bers beginning to appear as nipple-like protuberances. The chorion
villous ; but the villosities uniformly diffused over the surface.

Embryo of Six Weeks. — Length, fiom 7 to 10 lines. Weight, from
40 to 75 grains. The face distinct from the cranium ; the apertures
of the nose, mouth, eyes, and ears perceptible ; the head distinct from
the thorax ; the hands and forearms in the middle of the length, and
the fingers distinct ; the legs and feet situate near the anus ; there is a
distinct umbilicus for the attachment of the cord, which consists of
the ornphalo-mesenteric vessels, of a portion of the urachus, of a part
of the intestinal tube, and of filaments which represent the umbilical
vessels. The placenta begins to be formed ; the chorion and amnion
are still separated ; the umbilical vesicle is very large. Points of ossi-
fication in the clavicle atid maxillary bone.

* ' Embryologie,' p. 50. f Gooch's ' Midwifery,' p. 88.

; ' Mddecine Legale,' art. Infanticide.

()4 F(ETICIDE.

Embryo of Two Months. — Length, variously stated at from 1^
inches to 4 inches. Weight, 2 to 5 drachms. Hudiments of the nose
and lips ; palpebral circle beginning to appear ; the arms and legs
detached from the trunk ; clitoris or penis apparent ; anus marked by
a dark spot ; rudiments of lungs, spleen, and supra-renal capsules ;
cacum placed behind the umbilicus ; digestive canal withdrawn into
the abdomen ; urachus visible ; chorion beginning to touch the amnion
at the point opposite the insertion of the placenta ; placenta beginning
to assume its regular form ; umbilical vessels becoming twisted.
Points of ossification in the frontal bone and in the ribs.

Embryo of Three Months. — Length, variously stated at from 2
inches to 6 inches. Weight, from 1 ounce to 3 ounces. The
head voluminous ; the free margins of the eyelids in contact ; mem-
brana pupillaris visible ; mouth closed ; fingers completely separated ;
inferior extremities of greater length than the rudimentary tail ;
clitoris or penis very long; thymus as well as supra-renal capsules
present ; the two ventricles of the heart distinct. The decidua uterina
and decidua reflexa in contact ; the funis containing umbilical vessels
and a little of the gelatine of Warthon ; placenta completely isolated ;
the umbilical vesicle, allantois, and omphalo-mesenteric vessels have
disappeared.

Foetus of Four Months. — Length, variously stated at from 4J inches
to 8^ inches. Weight, 2^ or 3 ounces to 7 or 8 ounces. Skin rosy,
and tolerably dense ; mouth very large and open ; membrana pupillaris
very evident ; nails beginning to appear ; genital organs and sex dis-
tinct; gall-bladder appearing; meconium in duodenum; caecal valve
visible : umbilicus placed near the pubes. Complete contact of chorion
and amnion ; membrane forming at point of attachment of the placenta
to the uterus. Points of ossification in the inferior part of the sacrum ;
ossicula auditoria ossified.

Fo&tus of Five Months. — Length, variously stated at from 6 to 10^
inches (a still-born male 13 inches, still -bom female 13^ inches ; male
bom alive 9 niches, female born alive 10 inches). Weight, 5 or 7
ounces to 1 pound 1 ounce, (In one still-born male reported by
Schmitt, 1 pound 13 ounces ; in one still-born twin female weighed by
the author, 1 pound 6 ounces, and in the other 11 ounces.) The volume
of the head still comparatively great ; nails veiy distinct ; hair be-
ginning to appear ; skin without sebaceous covering ; heart and kidneys
very voluminous ; gall-bladder distinct ; meconium of a yellowish-
green tint occupying commencement of large intestines. Points of
ossification in pubes and os calcis ; germs of the permanent teeth.

Foetus of Six Months. — Length, variously stated at from 8 inches
to 13^ inches. Weight, 1 lb. to 2 lbs. 2 oz. Skin presents some
appearance of fibrous structure ; eyelids still agglutinated : membrana
pupillaris still existing ; the funis inserted a little above the pubes ;
lace of a purplish red ; hair white or silvery ; sebaceous covering
beginning to appear ; meconium in the upper part of the large intes-

OF THE FCETUS. 65

tines; liver of dark-red colour; gall-bladder contains insipid serous
fluid ; testes near kidneys. Points of ossification in the four divisions
of the sternum. Middle point of the body at the lower end. of the
sternum.

Fcetus of Seven Months. — Length, variously stated at from 11 inches
to 16 inches. Weight, 2 lbs. to 4 lbs. 5 oz. Skin of rosy hue, thick and
fibrous, and covered with sebaceous matter ; nails not reaching to the
ends of the fingers ; eyelids no longer adhering ; membrana pupillaris
disappearing ; meconium occupying nearly the whole of the large
intestine ; left lobe of liver almost as large as the right ; gall-bladder
containing bile ; brain firmer ; testicles more distant from kidneys.
Faint of ossification in the astragalus. Middle point of the body a
little below the end of the sternum.

Fcetus of Eight Months. — Length, from 14 inches to 18 inches.
Weight, 3 lbs. 4 oz. to 5 lbs. 7 oz. Skin paler, covered with fine short
hairs, and with a well-marked sebaceous envelope ; nails reaching to
the extremities of the fingers ; membrana pupillaris disappears ;
testicles descend into the internal ring. A point of ossification in the
last vertebra of the sacrum. The middle point of the body nearer the
umbilicus than the sternum.

Fostus at Nine Months, or Full Term. — Length, 16 to 20 inches.
Weight, 4 lbs. 5 oz, to_7lbs. The head covered with hair from f inch to
1 inch long ; skin covered with sebaceous matter ; membrana pupillaris
absent : testes have passed inguinal ring, and are frequently found in
scrotum ; meconium at termination of large intestine. Point of
ossification in the centre of the cartilage at the lower end of the
femur ; os hyoides not yet ossified ; four portions of occipital bone
remain distinct ; external auditory meatus still cartilaginous.

As the growth and development of the foetus has an important bear-
ing on the subjects of this chapter, and the estimates just given are
obviously too general to be of much use in the decision of medico-
legal questions, I have prepared two tables founded upon the accurate
observations of different authors, and presenting not only the average
weights and measures but the two extremes; for it is obvious that
the extreme values which have hitherto been so much neglected in all
numerical investigations, are often those which are most required.

Of the following tables, ih^ first* presents the ascertained weight
of the fcetus at the several ages specified, and the second f the ascer-
tained length, and in both cases the still-born are distinguished from
those born alive : amongst the latter those only being included who
had survived their birth one week or less. The foreign weights and
measures have been carefully reduced to the English standard, frac-
tional parts of an ounce being omitted in the table of weights. The
number of observations has been stated, in order that the value of the
several results may be better appreciated, and that fresh observations
may at any time be added.

* See page 66. t See page 67.

F

66

GROWTH AND DEVELOPMENT OF THE FCETUS.

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68 F(ETICIDE.

The weight of the foetus at full term has been made the subject of
many investigations, and as this point is of importance in itself, and
interesting as throwing light upon the probable limits of variation at
earlier periods of utero-gestation, the results, as deduced from upwards
of 20,000 observations, by Quetelet, Camus, Le'cieux, and Baudelocque,
and by Drs. Macaulay and Clark, including the facts in the preceding
table, are subjoined : —

Gi'eatest weight .... 14 lbs.

Least weight .... 2 lbs. 6 oz.

Average weight .... 6 lbs. 11 oz.

Instances are on record of weights greatly exceeding even the
maximum now stated. Dr. Merriman records one exceeding 14 lbs.
Sir Richard Croft one, and Dewees two, of 15 lbs., Dr. Kamsbotham
senior, and Dr. Moore, of New York, instances of 16^ lbs,, and Mr.
Owens, of Ludlow, one of 17 lbs. 12 oz. Even this great weight is
said to have been exceeded.

It is only necessary to add that, as a general rule, still-bom children
are heavier than those born alive, males than females, single children,
ceteris paribus, than twins, and twins than triplets.

The length of the fa?tus at full term, as given by different English
and French authors, is shown in the subjoined statement : —

Greatest length . . . . 2fi inches.

Least length . . . . 17 „

Average length . . . . 19 „

Cases are recorded in which the length has exceeded even this maxi-
mum. Dewees, for instance, met with a length of 27 inches.

The length, like the weight, is greater in males than in females, in
still-born than in those born alive, and in single children than in twins,
triplets, &c.

The signs of maturity or immaturity will be gleaned from the
history of the development of the foetus ; and they will be stated more
at length under the head of legitimacy, on which question they have an
important bearing.

FCETICIDE, OR CRIMINAL ABORTION.

The crime of abortion consists (see 1 Vic. cap. 85) in unlawfully
administering to any woman, or causing to be taken by her, with
intent to procure her miscarriage, any poison or other noxious thing,
or in unlawfully using for the same purpose any instrument or other
means whatsoever.

If the words of the statute were taken literally it would not be
necessary to prove that the woman to whom the poison or noxious
thing had been given, or force in any way applied, with a view to pro-

CAUSES OP ABOETION. 69

cure abortion, was really pregnant, or that abortion had followed the
use of these means. The judges, however, have generally held the
proof of pregnancy to be necessary. It will also be observed that the
statute is silent as to the distinction between women quick and not
quick with child.

In trials for abortion, the first duty of the medical man will be to
establish the fact of abortion by an examination of any substances
which may have been discharged from the womb. Having ascer-
tained that the substances submitted to his inspection are the products
of conception, he may be required to determine wliether the abortion
was due to natural causes, to the use of drugs, or to violence. For
this purpose he will have to form an opinion as to the sufficiency of
any means which may have been used to procure the miscarriage. In
rare instances, also, he may have to examine the female to whom the
corpus delicti is stated to belong, in order to determine whether or not
she has been recently delivered. Three different examinations there-
fore may be required.

1. An examination of substances expelled from the womb.

2. An inquiry intq the cause of the abortion : and

3. An examination of the female supposed to have miscarried.

1. Examination of Substances expelled from the Womb. — It is only
in the early periods of gestation that this examination will offer any
difficulty. When the embryo has attained a certain degree of develop-
ment, it will be impossible to confound it with any other substance
expelled from the uterus. The rule already laid down (p. 50), in
speaking of moles and false membranes as signs of pregnancy, must be
observed in cases of alleged abortion, viz. to admit no substance to be
a product of conception in which distinct traces of an ovum cannot be
recognized. To this rule hydatids form a solitary exception.

Having ascertained that the substance submitted to our inspection is
really a product of conception, we must next determine its age ; and
this will be done by comparing it with the description already given
of the growth and development of the embryo and foetus, p. 63,
et seq.

2. Cause of the Abortion. — In considering the cause of an abortion
attributed to the administration of drugs or the use of force, it is neces-
sary to be armed with some preliminary knowledge respecting the
occurrence of abortion from natural causes. This is known to be a very
common event, especially in the early months of pregnancy, and it has
been variously stated as occurring in 1 out of 12, or even (Dr. Granville)
1 in 3 of the total number of conceptions. Accoucheurs who have had
to deal chiefly with women in more advanced periods of pregnancy
have estimated the proportion much lower {e. g., 1 in 188, Madame
La Chapelle). The causes which occasion this high proportion of mis-
carriages will be conveniently coasidered under the title of

Natural Causes of Abortion. — These are either (a) predisposing, or
(6) exciting, a. The predisposing causes may affect either the female

70 F(ETICIDE.

hereelf or the ovum. The females most liable to abortion are the
plethoric, the irritable, the nervous, the lymphatic, the feeble, and the
ailing. Excessive or irregular menstruation and leucorrhoea are also
among the predisposing causes. Females attacked by syphilis, scurvy,
asthma, and dropsy, and those affected with malignant diseases, are
peculiarly liable to miscarry. Malformations of the pelvis, the small
size of the pelvis in those who marry very early, tight lacing, and all
diseases of the uterus or its appendages which tend to prevent the
complete development of the organ, may be mentioned among the pre-
disposing causes of abortion. To these may be added, a rigidity of the
womb, as in those who are pregnant for the first time at a compara-
tively advanced age, and a relaxed condition of the neck of that organ.
Occasionally, abortion has been epidemic, depending upon some pecu-
liar condition of atmosphere.*

The predisposing causes of abortion dependent upon the condition of
the ovum are very numerous, especially in the early months. Velpeau
states that of upwards of 200 embryos expelled before the end of the
third month, at least one half were diseased. The disease may exist in
any part of the ovum — in the membranes, in the placenta, or in the
foetus itself. The different forms of disease which may attack these
several parts are too numerous to specify in this place ; suiKce it to
observe, that where we can discover any marked disease of the foetus,
or its annexes, we are justified in regarding such disease as affording
a strong probability in favour of the abortion having been due to
natural causes.

A woman who has once miscarried is likely to miscarry again from
the same cause, and at or about the same period of gestation ; and it is
also usual to attribute a certain effect to the mere force of habit. In the
woman, for instance, whom Heberden (' Commentaries,' p. 15), mentions
as having miscarried 35 times, it is reasonable to attribute the later
abortions in part to the force of habit.

h. The occasional, or exciting causes of abortion, are not less numer-
ous than the predisposing. Among them may be mentioned all strong
and sudden actions of the muscles of the abdomen, in the stronger
efforts of expiration, as in coughing, straining efforts to void the urine
or faeces, &c. ; violent exercise, as in dancing ; profuse discharges from
the bowels or from the womb itself; undue excitement of the genital
organs ; blows, and various forms of mechanical injury.

All these occasional or exciting causes will fail of producing abortion
when the ovum is sound, and the female healthy ; while, on the other
hand, the most careful abstinence from all the exciting causes will
not prevent abortion when the predisposition from either cause is
strong.

The criminal means resorted to with a view of destroying the foetus
are best divided into two classes, general and local ; the first acting

* See references to these epidemics in Velpeau's ' Art des Accouchemens,'
art. Avortement.

CONSTITUTIONAL MEANS. VENiESECTION, ETC. 71

through the constitution of the mother; the second by immediate
application to the abdomen or uterus.

1. Constitutional Means. VencBsection. — The confidence placed by
the vulgar in this remedy comes, like many other popular fallacies,
from high medical authority — that of Hippocrates. But it is merely
a vulgar error. It is a notorious fact that pregnant women bear blood-
letting well, and that it is often the best means of averting a threatened
abortion. The assumption that blood-letting promotes abortion is
moreover rebutted by facts adduced by several high authorities. Cases
are recorded of women bled 48, 80, and 87 times in the course of their
pregnancies, and yet without occasioning miscarriage ; and Dr. Rush,
who bled very freely in the yellow fever of 1793, asserts that not one
pregnant woman to whom he prescribed bleeding died or miscarried.

The popular belief in the efficacy of the abstraction of blood from
the foot seems to rest on no better foundation, nor does the removal of
blood by leeches applied to the anus or vulva — a practice much less
frequently resorted to in this country than in France — appear to pos-
sess any peculiar efficacy.

Emetics. — It is well known that during the early months of preg-
nancy, and even in some instances throughout the entire duration of it,
severe and distressing vomiting occurs, but without producing abor-
tion. This fact affords some presumption against the efficacy of
emetics — a presumption strengthened by the failure of several active
irritant poisons productive of violent vomiting in bringing about
miscarriage. In females strongly predisposed to abortion emetics
would, however, be likely to occasion it.

Cathartics. — These remedies, too, may be given repeatedly, and in
very large doses, without producing abortion. Dr. Rush's experience
in the yellow fever of 1793 is conclusive on this point.* But it is
not to be doubted that hypercatharsis, but especially that resulting
from remedies acting chiefly on the rectum, is not without danger to
the life of the foetus, when there is a decided predisposition to abortion.

Diuretics. — These remedies are mentioned as calculated to produce
abortion, but without sufficient reason. Irritant poisons, which act
in moderate doses as diuretics (e. g., nitre), may occasion abortion ;
but not simply by their diuretic action.

One of the iri'itant poisons which powerfully affects the urinary
organs is specially deserving of notice in this place : namely, cantharides.
This active substance combines the effect of a violent emetic, a strong
purgative, and a most effective diuretic, and acts violently on the
organs in the immediate neighbourhood of the uterus, viz., the bladder
and the rectum, occasioning also intense fever and great debility ; and
yet even this drug given in full doses may fail (as in a case related by
Mr. Lucas, of Leeds) in producing abortion. The occasional and even
frequent failure of such active poisons renders the efficacy of less

* 'Med. Observations and Inquiries,' vol. iii. p. 249.

72 FffiTICIDE.

powerful remedies extremely doubtful, unless there is in the female a
very decided predisposition to miscarry.

Emmenagogues. — Under this name avast number of active and inert
remedies are classed, by far the majority of which have as little effect
on the uterine system as they have on other parts of the body. The
medicines which Beck notices under this head are savin, mercury,
snakeroot, and pennyroyal.

Snakeroot and pennyroyal do not appear to be very efficacious ; nor
does mercury in the solid form, or in its preparations, even wheh
given in very full doses, and to the extent of causing profuse
salivation, appear to be attended with any risk of abortion ; but the
Juniperus sabina has some pretensions to be considered a dangerous
drug : for, in common with other irritant poisons, it has undoubtedly
occasioned abortion in more than one instance, though it has failed in
others, and in others, again, has sacrificed the life both of mother and
child.

Closely allied to the so-called emmenagogues is the secale cornutum,
or ergot of rye, a medicine which possesses the remarkable property of
exciting the muscular fibi-es of the uterus to contraction, and is in
much too frequent use for that purpose. Concerning the efficacy of
this remedy, much difference of opinion exists.

Some authors have supposed that the power of the ergot is limited
to the period of delivery, and to the state of full expansion and deve-
lopment of the uterus. This opinion seems highly improbable, and
cases are certainly recorded in which this active agent produced abor-
tion at an earlier period of gestation ; and experiments on animals
have shown that it is capable of producing abortion at any period.
On the other hand, several cases are recorded both by l5r. Condie and
by Dr. Beck, in which considerable doses of the ergot, often repeated,
failed in producing abortion.

The root of a plant called the Actea ramosa has the reputation of
being nearly as active as the ergot.

Digitalis has been named among the substances capable of producing
abortion, on the authority of a case related by Dr. Campbell. The
digitalis was given for dropsy; the child was still-born, and the
mother died soon after, Mr. W. H. Dickinson (' Med, Chir. Trans.,'
vol. xxxiv. p. 1) has shown that digitalis in such doses as from ^fs.
to ^ifs. of the infusion, and TT\^xx. to TTT^xl. of the tincture, has a spe-
cific action on the uterus ; and its power of producing abortion, though
not proved, is to be inferred from the facts stated.

It results from all these observations on the power of medicines to
produce abortion : — That there is no one medicine which can be
depended on as a means of procuring abortion in women not strongly
pi-edisposed to miscarry ; that, if given in doses short of those which
would risk the life of the mother, they would almost certainly fail of
accomplishing their pui-pose ; that, where they do succeed, they
place the life of the mother in jeopardy, and often sacrifice it ; and

MECHANICAL MEANS. 73

that, for every case in which the mother escapes, there is prohably
one at least in which the mother and her offspring both fall a sacrifice,
and one in which the mother dies, the child remaining uninjured in the
womb. The fact is, that none but poisons, or medicines administered
in poisonous doses, can be expected to produce abortion in any case
unless the predisposition to abortion is already very strong ; when
such predisposition does not exist, the mother is much more likely to
fall a sacrifice, whilst the child remains intact in the womb, or is even
born alive, than the child to be expelled and the mother to survive ;
in other cases both the mother and offspring will perish.

Mechanical means. — These consist either of external violence
applied to the abdomen or loins, or of instruments introduced into the
riterus.

External violence applied to the abdomen or loins is a sufficient
cause of abortion, and cases enough are on record to prove that it is
so. But it would appear that unless the degree of violence is such as
to endanger the life of the mother, it is not likely to occasion abortion.
"In 1811 a man was executed at Stafford for the murder of his wife.
She was in the pregnant state, and he had attempted to induce abor-
tion in the most violent manner, as by elbowing her in bed, rolling
over her, &c., in which he succeeded — not only procuring abortion,
but along with it the death of the unfortunate woman."' * "A
female in the last month of her pregnancy was struck on the abdomen
by her husband. An extensive detachment of the placenta caused the
immediate death of the foetus, and that of the mother in fifty-one
hours afterwards." f

Severe injuries not directly inflicted on the abdomen often fail of
occasioning abortion. Thus, Madame La Chapel le mentions the case
of a young midwife, who was pregnant and had a narrow pelvis ; and
who, with a view to procure abortion and avoid the Caesarian section,
threw herself from a height. She died in consequence of her wounds,
but she did not miscarry. Mauriceau also gives the case of a preg-
nant female seven months gone, who to escape from a fire in her room
slid down from the third story, but losing her hold from fright, fell
upon the stones and fractured her forearm ; but there was no abortion.

The same remarks apply to the introduction of instruments into the
womb, as to the causes of abortion which have been already mentioned.
In some instances abortion has been procured ; in others, though con-
siderable injury has been inflicted, the child has been born alive ; and
in all of them the mother's life has been endangered or sacrificed. In
attempting to puncture the membranes, especially at the early periods
of gestation, the uterus has generally been seriously, and often fatally,
injured.

Sulphuric acid^ in one extraordinary case, has been injected into the
vagina with a view of producing abortion. The result was the most

* Smith's ' Forensic Medicine,' p. 305. f Campbell, op. cit. p. 131.

74 FCETICIDE.

violent inflammation of the parts, and adhesion of the os tincoe, with
the formation of a dense membrane over it. After attempting delivery
by incisions into the neck of the uterus, it was found necessary to per-
form the Caesarian operation — and both the mother and the child died.*

The following case which occurred in the practice of Dr. Wagner, of
Berlin, illustrates so forcibly the difficulty of procuring abortion in
women not predisposed to miscarry, whether by medicines or by
mechanical means, that it will form a very fitting conclusion to this
subject.

•'A young woman, seven months with child, had employed savin
and other drugs with a view to produce miscarriage. As these had
not the desired effect, a strong leathern strap (the thong of a skate)
was tightly bound round her body. This too aA-ailing nothing, her
paramour (according to his own confession) knelt upon her, and com-
pressed the abdomen with all his strength : yet neither did this effect
the desired object. The man now trampled on the girl's person while
she lay on her back ; and, as this also failed, he took a sharp-pointed
pair of scissors, and proceeded to perfoi-ate the uterus thiough the
vagina. Much pain and haemorrhage ensued, but did not last long.
The woman's health did not suffer in the least ; and, pretty much
about the regular time, a living child was brought into the world
without any marks of external injury upon it."

Examination of the Female. — In cases of abortion we may be re-
quired to examine the person of the suspected female. We should be
guided in such an examination by the signs already laid down at
p. 59 ; bearing in mind that these signs will of course be less strongly
developed in the early than in the later months. Before two months
little dependence can be placed on these signs.

If the female dies, we may be required to examine the body, and
must be guided by the same signs that exist in delivery at the full
period, but which are less distinct as the period of utero-gestation is
earlier.

The following is a summary of the chief points to be attended to in
cases of abortion : The supposed product of conception must be sub-
mitted to minute and careful examination. If a foetus has been ex-
pelled, its age must be determined by the rules already laid down.

The reputed mother, whether alive or dead, must then be examined ;
- — if alive, we must endeavour to ascertain whether there was or was
not such a predisposition to abortion as to account for its having taken
place, without attributing any great efficacy to the means employed.
With a view of determining whether or not such a predisposition exists,
we must inquire into the general state of health of the mother before
the abortion took place, and especially whether she has had previous
abortions — and if so, whether they occurred at or about the same
period of gestation. If the female died from the means employed, we

* This case is given in the report of M. Guerin to the Academie Natiouale of
Paris, and is cited in the ' Lancet/ voL viii. p. 38.

SUMMARY. / O

must use the same caro in examining the state of the uterus, and must
observe the rules hereafter to be laid down for conducting post-mortem
examinations.

Some questions of medical ethics mix themselves up with the
question of abortion, as

Under what circumstances, and by what means, is it morally and
legally proper to induce premature delivery % and what circumstances
will justify the Ccesarian operation ?

Such questions as these are easily ai^wered. The medical man is
clearly justified in resorting to any measures which promise to pre-
serve the life of mother and child when both are threatened ; and
where one only can by any possibility be preserved, the female herself
may use her right of self-preservation, and choose whether her own
life or that of her child shall fall a sacrifice to the means recommended
to be used.

INFANTICIDE.

There is no crime which meets with so much public sympathy as
Infanticide, and this feeling has been largely shared by members both
of the medical and legal profession. The medical man hcis conse-
quently been led to take the part of an advocate where he should have
been mei-ely the man of science ; while the lawyer has equally for-
saken his proper sphere by setting himself up as a judge of matters
with which he could have but a slender acquaintance.

This misplaced humanity, added to learning equally misplaced, has
encumbered with objections, and overlaid with refined subtleties, a
subject necessarily complicated.

The public sympathy for the child-murderer arose out of the ex-
treme harshness and cruelty of a former statute (21 Jac. I. cap. 27),
which virtually visited the concealment of shame with the punishment
of murder. Dr. William Hunter, under the influence of that injus-
tice, wrote, in 1783, his celebrated essay ' On the Uncertainty of the
Signs of Murder in the Case of Bastard Children.' About a quarter
of a century later (1803) an act was passed decreeing that women
accused of infanticide should be tried by the same rules of evidence as
obtain in other trials for murder ; but that the prisoner, if acquitted,
may be put on her trial! for concealment of the birth, and, if found
guilty, punished by imprisonment for a term not exceeding two years.

The provisions of this statute were confirmed by an act passed in
June, 1828 (9 Geo. IV. cap, 31), which act also provides that it shall
not be necessary to prove whether the child died before, at, or after its
birth ; but that if any woman tried for the murder of her child shall
be acquitted, she may be tried for the concealment of the birth, and
punished as if she had been originally put upon her trial for the con-
cealment of the birth.

Questions of infanticide are necessarily more complicated than those

76 INFANTICIDE.

of homicide in general ; for, previous to the inquiry into the means by
which a child has come by its death, it is necessary to show that it
has been born alive. The medical man may, moreover, be required to
examine the female suspected of being the mother of the child, in order
to determine whether or not she has been recently delivered.

Two classes of questions, then, may be raised in cases of infanticide ;
the one relating to the child ; the other to the mother.

QUESTIONS RELATING TO THE CHILD.

These are the following : —

1. What is the degree of maturity of the child ?

2. Was the child bora alive ?

3. If born alive, how long did it survive its birth ?

4. How long has the child been dead ?

5. What was the cause of death ?

1. THE DEGREE OF MATURITY OF THE CHILD.

This question will be answered by employing the data contained in
the introduction to this Chapter, viz., the length and weight, the
position of the centre of the body, the proportional development of
the several parts, the growth of the hair and nails, the condition of
the skin, the presence or absence of the membrana pupillaris ; in the
male, the descent or non-descent of the testicles, &c.*

2. WAS THE CHILD BORN ALIVE?

This question involves a great number of details, and depends on the
determination of many difficult and delicate points.

First, as to the legal meaning of the term bom alive. It has been
decided in more than one case, that to constitute live-birth the child
must be alive after the whole body has been brought into the world;
that it must have an independent circulation ; but that to constitute
such independent circulation, it is not necessaiy that the umbilical
cord should be severed.

In examining the body of a child with a view to determine whether
or not it was born alive, the chief point to be attended to is the state
of the lungs. If we can discover in these organs signs of respiration,
we establish a probability in favour of live-birth ; but if there are no
signs of respiration in the lungs, there is an equally strong probability
that the child was still-born. But in the absence of all signs of respira-
tion thei'e may still be sufficient proof that a child has or has not
been born alive. Hence the present inquiry consists of two parts.
1. The evidence of live- birth, independent of, and prior to, respira-

* See ante, p. 63 et seq.

INTRA-UTERINE MACERATION. 77

tion. 2. The evidence of live-birth deduced from, and subsequent to,
respiration.

The evidence of live-birth prior to respiration is either negative or
positive, — negative when we discover signs of previous death within
the womb ; and positive when we discover injuries upon the body of
the child which must have been inflicted while the blood was still cir-
culating, and of such extent and severity that they could not have
happened accidentally or been inflicted during the birth.

Intra-uterine maceration. — The appearances presented by a child
which has died in the womb, and has there undergone maceration, are
the following : — The body is shrunken and flaccid in every part, the
chest and abdomen flattened, the ribs distinctly visible through the
skin, the ilia prominent, the extremities attenuated. The head is soft
and yielding, so that it falls flat in whatever position it may be placed.
The cuticle is more or less extensively detached, and is everywhere
easily separated from the true skin. On the hands and feet the cuticle
is white, thickened, and wrinkled, as if from the application of a
poultice. The true skin itself is moi'e or less extensively discoloured.
The abdomen, which is the first part to exhibit the change of colour,
presents a mottled appearance, blending a rose and ash colour. Else-
where the skin assumes a brownish red, without any admixture of
green. The parts of generation have a deep-red coloui", as have also,
in a less degree, the head and face. The umbilical cord is straight and
flaccid. The entire surface of the skin is covered with a soapy fluid,
so that the body, when handled, slips from the grasp. On cutting into
the cellular membrane it is found to be infiltrated with serum reddened
by the colouring matter of the blood, and to contain in parts, especially
in the scalp, a substance which Oi-fila has aptly compared to gooseberry
jelly. The periosteum is easily detached from the bones of the cranium,
which are loosely united, and move easily the one upon the other. The
several cavities are filled with an abundant sero-sanguinolent fluid ;
and the viscera are tinged throughout of a reddish-brown colour, at
the same time that their minute structure is very distinctly dis-
played.

These appearances are more or less strongly marked, as the child
has lain a longer or shorter time dead within the womb. They are
quite distinct from the effects of putrefaction, whether in air or water,
and the odour of putrefaction is entirely wanting. When developed in
a marked degree it is impossible to mistake them for those due to any
other cause ; but if the death of the child took place only a short time
before its expulsion from the womb they would not be present. In
such a case the absence of all traces of respiration on the one hand, and
of marks of violence accompanied with copious effusion of blood, on
the other, would prove that the child was still-born.

The single case in which, anterior to, and independent of, the es-
tablishment of respiration, we may state that a child has been bora
alive, is, when we find marks of violence on the body so severe that

78 INFANTICIDE.

they could not have been inflicted during the birth, and attended with
haemorrhage so considerable that it could only have occurred while the
blood was still circulating. Thus Devergie relates a case of the
mui-der of an infant that had not respired, which was proved by the
existence of extensive wounds and marks of great violence on the
head, with copious effusion of blood.* To justify a positive opinion
in such a case, the loss of blood must be large ; for a severe wound in-
flicted On a plethoric infant after the circulation had ceased, might be
attended with considerable haemorrhage.

There are two cases, then, in which, independent of, and anterior
to, respiration, we may decide the question, ** was the child born
alive?" in the one negatively when we find the marks of intra-uterine
maceration, in the other affirmatively, when we discover injuries
Avhich, from their extent and severity, must have been inflicted after
the birth of the child, and while the blood was still circulating.

But the cases in which we can obtain evidence of live-birth before
respiration must be extremely rare, as few children in whom the
blood is still circulating are born without respiring, at least im-
perfectly.

In the great majority of cases, therefore, the evidence of live-birth
must be sought for in the lungs, proof of respiration being the first
link in the chain of evidence that the child was born alive.

In order to prove that a child was born alive we must first show
that respiration has taken place ; and then that the child breathed
after the birth. For in order to prove that the child has been horn
alive, it will not suffice to prove that it has breathed, for it may have
breathed during the birth and yet have perished before the delivery
was complete.

HAS RESPIRATION TAKEN PLACE ?

The best evidence of respiration is the change which it produces in
the external appearance of the lungs ; and, were it not that inflation
gives rise to the same change, a mere inspection of the lungs would
supersede all other tests. As it is, it serves to establish the alternative
of respiration or inflation when all other means fail.

Lungs which have neither respired nor been inflated, are of a
uniform texture throughout, and resemble both in colour and con-
sistence the adult liver. Their surface is marked by slight furrows,
which obscurely denote the division of the lobules. When the lungs
are full of blood, these slight furi-ows are scarcely, if at all, visible ;
but when those organs are comparatively empty, the furrows are
more distinct, and are still more strongly marked in the lungs of the
foetus which has undergone intra-uterine maceration. The lungs are
also sometimes found studded with small circular melanotic spots.

The effect of respiration or inflation varies according to the degree
of either. The smallest quantity of air serves to develop some of the

• ' Annales d'Hygiene,' May, 1837.

DEVELOPED AIR-CELLS. 79

air-cells on the surface of the lungs ; and these developed air-cells form
the best proof of the admission of air in one of these two ways. The
right lung, and especially the edges and concave surface of its upper
lobe, admit the air most readily : it is here, therefoi-e, that the first
effects of inflation or respiration must be looked for.

The aii--cells thus developed present a highly characteristic appeai-
ance. If the lungs are fresh and tilled with blood, their jjosition is
marked by briUiant vermilion spots ; if the lungs contain less blood,
or if they are examined some days after the death of the child, the
spots are of a lighter colour ; and in children who have survived their
birth some days, they have very nearly the colour of the healthy adult
lung.

The form and arrangement of the cells are not less characteristic
than their colour: they are angular in shape, are not perceptibly
raised above the surface, and are obviously situated in the substance,
though near the surface, of the lung. The grouping of the cells is
generally irregular, but occasionally, as Devergie Fig. 5.
observes, they are found in groups of four, arranged
in a perfectly regular and symmetrical manner. The
ordinary appearance and grouping of the cells is
represented in the annexed wood-cut taken from a
coloured drawing of foetal lungs in which respiration
had been imperfectly set up.

Another appearance which I have once seen the air-cells pi esent, is
that of a group of small globules, like millet seeds, arranged closely
side by side, and on the same level.

The only appearances on the surface of the lungs with which these
developed air-cells might by possibility be confounded, are, 1, the
small circular melanotic spots already mentioned ; 2, small round spots
"of blood thrown out upon the surface ; and, 3, air-bubbles, the product
of putrefaction. The first two appearances may be at once distin-
guished by the perfect roundness of the spots, the entire absence in
them of anything resembling a developed texture, and their character-
istic colour, the melanotic spots being black, and the spots of blood
deviating very slightly in colour from that of the surrounding portions
of lung. These spots, therefore, can occasion no difficulty.

The appearance of the air-bubbles produced by putrefaction is, if
possible, still more characteristic. The air collects on the surface, and
between the lobes of the lungs, either in detached globules, the size of
peas, rising above the level of the surrounding lung, or as a string of
minute vesicles not unlike a fine mercurial injection beneath tissue-
paper. The air is evidently contained in the cellular membrane con-
necting the pleura with the surface of the lung, and its true situation
is often pointed out by a small globule seated upon a larger one. If
these appearances were not sufficient to distinguish air, the product of
putrefaction, from air contained within the air-cells, it would suffice to
pass the finger over the surface of the lung. The air follows the

80 INFANTICIDE.

pressure of tlie finger, and is dispersed, and a little stronger pressure
effaces the bubbles, and will even break down the larger globules. No
amount of pressure so applied will force the air out of the air-cells, or
in any way alter their appearance.

Some authors, as will be presently more fully stated, have spoken of
an emphysema of the foetal lungs, as giving rise to some difficulty in
applying the hydrostatic test ; but it will be shown that this so-called
emphysema is merely an incipient process of putrefaction, giving rise
to precisely the same appearances, and admitting of the same ready
pjg_ Q discrimination, as the more ordinary results of putre-

faction. The subjoined engraving is as faithful a
representation as it is possible to give, without colour,
of the several appearances described in the text. With
the exception of the large air-bubbles, which are
taken from another subject, all the appearances were
present on the same limited space of the surface of
the lungs. The air-cells are recognized by their
peculiar shape and grouping; the round dark spots are melanotic,
the fainter spots are effused blood ; the string of small light round
dots, and the two large circular spots, are air-bubbles.

It can scarcely be necessary to offer a caution against confounding
with the developed air-cells that change of colour which takes place
on the surface of fresh foetal lungs from the contact of air. The
change of colour is the same in both cases, but the mere contact of
air with the surface of the lungs does not alter the texture of the organ
in any way.

The appeai-ance of the developed air-cells is, therefore, quite charac-
teristic. It furnishes undeniable proof either of respiration or of
inflation, and is the only lung-test to which no serious objection can be
offered.

Considered as a test, or sign, of the admission of air into the lungs
in one of these two ways, it is also as delicate as it is simple ; for it
detects the smallest possible quantity of air introduced into the lungs,
a quantity much too small to have any appreciable effect on the specific
gravity either of the entire lung, or of the portion of the lung into
which it has been introduced. I have repeatedly detected at a glance
the existence, in the superficial air-cells, of a quantity of air which
was insufficient to render the smallest fragment of the lung buoyant ;
and I have never found these signs of respiration absent in any case in
which a child was stated to have breathed, though for the shortest
space of time. In one case in which it was reported that the child had
given only three distinct gasps, the effect of respiration was obvious,
at the first glance, in the bright vermilion-coloured groups of developed
air-cells scattered over the surface of the right lung. This sign, there-
fore, succeeds where the hydrostatic test fails.

If a different appearance were produced in the air-cells by respira-
tion and inflation respectively, and we could infallibly distinguish the

DEVELOPED AIB-CELLS. 81

one from the other, there would be no need of any other lung-test ;
and if it could be made to appear that all the other tests which have
been proposed fail in effecting this most desirable object, then all those
tests would cease to have any claims upon our attention.

Devergie,* after stating, correctly enough, that an attentive examina-
tion of the bodies of several infants had enabled him to distinguish,
d priori, and without any other research, lungs belonging to a still-
born infant from those of an infant which had breathed ; and also to
determine whether the air had dilated all parts of the lungs, or merely
certain portions of those organs, adds, that " in many cases he could
determine whether the distension of the lungs with air was the effect
of respiration or of insufflation." In the case of air introduced by
respiration, Devergie states that there is a minute injection of capillary
vessels on the surface of the air-cells, which injection does not take
place in the case of inflation. This distinction may be well founded,
but it deals with parts so extremely minute, and, according to the
author's own statement, is to be relied on only in ma7iy, but not in
all cases, that it may be fairly set down as unfit for medico-legal use.
I have not myself observed such, a difference between the effects of in-
flation and respiration as to pretend to be able in this way to distinguish
the one from the other.

Developed air-cells, then, form the best, and the only necessary proof,
of the admission of air into the lungs ; and they are to be found in
every case of respiration or inflation, however limited in extent, or
slight in degree. t

The number of the air-cells, and the degree to which they are developed,
is, moreover, a measure of the extent to which these processes have been
carried. When respiration is complete, the lungs present the spongy,
crepitant character of adult lungs, and differ from them only in having
a more rosy colour.

Before proceeding to the consideration of the other lung-tests, it is
necessary to premise that respiration is not a sudden, but a gradual
process ; that it is rarely, perhaps never, completed in a few respira-
tions; that it very often remains incomplete and partial after many
hours, days, or even weeks ; and that in some grown-up persons
portions of the lungs are even believed to remain permanently in their
fcetal state. In by far the majority of cases of infanticide, therefore,
we shall have to deal with lungs in which the process of respiration
has been very incompletely set up. This fact increases the importance
of a sign which stands us in stead where, as will be presently shown,
every other test may fail.

But the admission of air into the air-cells of the lungs is not the
only efl'ect of respiration. As a general rule, this change is accom-

* ' Medecine Legale,' vol. i. art. Infanticide.

t It is strange that this simple sign of respiration should have been so often
overlooked. Cruveilhier, in his ' i^Jorbid Anatomy/ depicts the bright ver-
milion air-cells as a disease of the foetal lungs.

G

82

INFANTICIDE.

panied by an increased afBux of blood, leading, as a natui-al conse-
quence, to an increase of weight in the lungs themselves, and an in-
crease in their weight as compared with that of the body. This increase of
weight, absolute and relative, has been made the basis of two lung-tests.

The absolute Weight of the Lungs. — This test of respiration rests
upon the supposition that " the arteries and veins of the lungs of a
foetus, which have not respired, are empty, and in a state of collapse,"
whilst after respiration they become more or less filled with blood.
This erroneous statement of Fodere has been corrected by Orfila and
Devergie. That it is a gross mistake, I have had many opportuni-
ties of proving ; for I have examined lungs which had breathed, and
found them almost destitute of blood ; and have repeatedly met with
lungs that have never admitted air, or which presented only a few
groups of developed air-cells, but yet were gorged with blood in eveiy
part.

The received estimates of the weight ot the lungs before and after
respiration were in accordance with these erroneous assumptions. The
lungs of mature children before respiration were stated to weigh one
ounce, or 480 grains, and after respiration two ounces, or 960 grains.
How remote these estimates were from the truth, the following
averages, founded upon upwards of 400 observations on mature children,
will serve to show : — Still-born, 874 grains ; children who had survived
their birth one month or less, 1072 grains. The observed weight,
therefore, in still-born children is nearly double the rude estimate of
authors, and the increase after respiration, instead of being equal to
the original weight, is less than one-fourth. These averages differ too
little from each other to admit of practical application in a court of
law : the extreme figures are still more conclusive, as the comparison
instituted in the following table will show.*

Before

After

Before

After

Respiration.

Respiration.

Respiration.

Respiration

510

510

694

—

520

—

703

—

550

546

713

726

562

744

746

586

590

—

774

630 (two)

—

—

861

632

—

920

640

—

1054

1000

647

—

—

1173

658

—

—

1189

666

—

—

1203

683

675

1480

687

—

1950t

—

* For the particulars of these observations, which are all taken from English
sources, see ' Lancet,' Oct. 1, 1842. The case marked f has been subsequently
added. It is given on the authority of Dr. A. Taylor.

r

STATIC

TESTS.

ABSOLUTE WEIGHT OF TH]

Before

After

Eespiration.

Respiration.

Maximum

. 1950

1203

Minimum

510

510

Mean

. 769

820

83

This table speaks for itself: it shows in a striking manner the
limited application of the absolute weight of the lungs as a test; for,
out of 34 cases, there is not a single one in which we could have stated,
by means of this test alone, that respiration had, or had not, taken
place ; while, in two instances, the great weight of the lungs would
have led us to infer respiration, though the children were still-born.

As in the great majority of cases of alleged infanticide the lungs of
the child, if it has breathed at all, are found to contain but little air,
it is important to determine the effect of imperfect respiration in in-
creasing the weight of the lungs. The following is the average result
of a considerable number of facts : — Still-born, 874 grains ; imperfect
respiration, 988 grains; perfect respiration, 1195 grains.

The effect of imperfect respiration, then, is to increase the weight of
the lungs by about 100 grains, or one-eighth of their original weight.

The mean weight of the lungs after different durations of respiration
is as follows : — Still-born, 874 grains; less than one hour, 918 grains ;
twelve hours, 853 grains; one day, 1000 grains ; one month and less,
1072 grains.

Hence the duration of lespiration for one hour adds less than
50 grains to the weight of the lungs, which is increased by only
126 grains when respiration has lasted one day. If additional evidence
were required of the uselessness of this test, it might be found in a
comparison of the weight of the lungs in two children born alive in
whom the weight of the body was the same. In the one case the lungs
weighed 1544 grains, and in the other 494, the one being more than
three times as great as the other.

It appears, then, that the difference between the absolute weight of the
lungs before and after respiration, and especially after imperfect respi-
ration, or respiration lasting only for a short time, is much too slight
to be used as a test ; and that the inference drawn from a comparison
of average weights is fully confirmed by a comparison of the extremes.

This test, moreover, is rendered unnecessary by the mere inspection
of the lungs ; unless, indeed, it could be shown that the absolute weight
of the lungs promises to assist us in distinguishing respiration from
inflation. This, though it has been recommended for that purpose, it
does not do; for as it fails in distinguishing the lungs of the still-born
from those which have respired, it must also fail in distinguishing
lungs that have breathed from those that have been inflated: for
inflated lungs are, as to the blood which they contain, in the condition
of foetal lungs.

Ploiccquet's Test, or the ratio of the weight of the lungs to that of
the body. — Before entering upon an examination of this test it is ne-

84

INFANTICIDE.

cessary to premise, that the bodies of still-born children are heavier by
about one-third than the bodies of children born alive ; that the body
of the male is heavier than that of the female ; that the proportion
which the weight of the lungs bears to that of the body decreases as
the weight of the body increases ; and that the weight of the lungs is
subject to much greater variation than that of the body.

This test is a good example of the futility of all conclusions drawn
from a small number of facts. Ploucquet himself making use of three
facts, only two of which were strictly comparable, obtained the propor-
tion before respiration, of 1 to 70 ; after respiration, of 1 to 35. The
moie numerous facts collected by subsequent observers have gi-eatly
modified these proportions, and the following statements will, it may
be hoped, serve to consign the test to oblivion. The averages drawn
from more than 400 observations on mature children are as follow : —
Still-born 1:57, instead of 1:70 ; children who have lived one month or
less 1:38 instead of 1:35. The extremes, which, as before observed,
are the values really required for practical purposes, are shown in the
following table.

Before After

Before

After

espiration. Respiration

.

Eespiration.

Respiration.

1:91 —

1:54

1:55

1:82 —

1:51

(two)

1:52

1:74 —

1:49

1:49

1:71 (two) —

—

1:48

1:70 —

—

1:46

1:67 1:65

1:45

1:45

1:61 1:61

—

1:44 (two)

1:60 —

—

1:41

1:59 1:59

—

1:39

1:57 (three) 1:56

1:21

Before

After

Eespiration

. Respiration

Maximum

. 1:21

1:39

Minimum

. 1:91

1:65

Mean

. 1

:60

1:50

The results of this table differ somewhat from those already obtained
in the case of the absolute weight of the lungs; for iii 7 cases out of 33
there is certainly a probability, derived from the low ratio obtained,
that respiration had not taken place ; but, on the other hand, there is
one case in which, relying upon this test, we should have mistaken a
still-born child for one that had breathed. The value of our conclusion
must, moreover, depend, as in the case of the absolute weight of the
lungs, upon an assumption that we have found the true limits both
before and after respiration.

HYDROSTATIC TEST. 85

The following are the mean proportions after different durations of
respiration: — ytill-born, 1:57; less than one hour, 1:51; 12 hours,
1:53; 1 day, 1:48 ; 1 month, or less, 1:38.

The difference between the several proportions is here extremely-
small ; certainly much too small to justify the employment of the
test in cases of imperfect respiration, in which alone such a test can be
required.

If further proof were required of the futility of this test, it might be
found by comparing the ratio of the lungs to the body in two cases in
which the weight of the body was precisely the same. Thus, to take
only one instance : the weight of the body being in each of two children
born alive 32,436 grains, the lungs bore to the body in the one case
the proportion of 1 to 21, in the other of 1 to 66 ; the one ratio being
more tlian three times as great as the other. Precisely the same re-
marks, too, apply to this test as to the absolute weight of the lungs.
Simple inspection would render it superfluous even if it were useful ;
and it cannot serve to distinguish inflation from respiration.

Both the static lung-tests should, therefore, be allowed to fall into
disuse as alike unsafe and unnecessary.

The Hydrostatic Test. — This is without exception the most interest-
ing and important test ever proposed for the determination of a medico-
legal question ; interesting from the many controversies to which it
has given rise, and important on account of the purpose to which it is
applied, and the high value formerly assigned to it.

That this test may be understood, it must be premised, that though,
when first proposed, it was erroneously considered a test of live or still-
birth, it is merely a test of respiration; the question, when or where
did respiration take place, being consequent on the determination of
the fact of respiration. It is necessary further to premise that the
Hydrostatic Test has undergone several modifications since it was first
proposed towards the end of the seventeenth century. Originally, and
till a comparatively recent period, it consisted in placing the lungs,
with or without the heart attached, entire in a vessel of pure water of
the temperature of about 60°. This rough test was first modified
to the extent of dividing the lungs into several pieces and experimenting
with those pieces as with the entire lungs. The test, as now performed,
consists in first immersing the several portions of the lungs in water,
and then applying to them the subsidiary test of pressure. It will be
presently seen that the objections urged against the hydrostatic test
apply chiefly to the test as originally performed ; and that this addi-
tional test of pressure removes at least one objection, though it leaA'es
others in full force, and opens an important inquiry as to the distinction
between the effects of respiration and inflation.

In examining the hydrostatic test, it will be convenient to consider,
in the first place, the value of the test as originally performed, in-
cluding the addition subsequently made of dividing the lungs into
several portions, but without submitting them to pressure ; and with

86 INFANTICIDE.

the distinct understanding that it can in no case be a test of live-birth,
but only of respiration. A supporter of the hydrostatic test would
assert on its belialf, that, if the lungs, whether entire or divided into
portions, when placed in a vessel of water sink to the bottom, respira-
tion lias not taken place.

To this assertion there are two objections. 1. That respiration
may have taken place, and yet the entire limgs, as well as the several
parts into which they have been divided, may sink in consequence of
disease. 2. That respiration may have taken place, but to so limited
an extent, or in so imperfect a manner, that both the entire lungs and
every portion of them, though perfectly healthy, containing only the
ordinary quantity of blood, and presenting no unusual appearance, may
nevertheless sink.

Now, in examining the first objection, it must be borne in mind
that disease may exist before respiration or supervene after it. If a
disease existing before biith affect the whole of both lungs, it is
obvious that respiration cannot take place ; but if it affect only certain
parts of the lungs, there is nothing to prevent the healthy portions
from receiving air, and those portions of the lungs would float, pro-
vided the quantity of air admitted into them were sufficient to render
them buoyant, if, on the other hand, the disease supervene after
respiration, it is not probable that it would proceed to such an extent
as to consolidate the whole of both lungs. Hence some portions would
be found to float. On either of the foregoing suppositions, that is to
say, whether the disease occurred before respiration or supervened
upon it, the cases must be extremely rare in which the objection on the
score of disease would be valid.

Without having recourse to authorities, it may be safely stated,
that disease occurring after respiration rarely, if ever, affects the
whole of both lungs ; certain portions, therefore, will remain free from
disease, and, provided respiration has been completely performed in
those portions, they will, by their buoyancy, at once remove the
objection. It will not, perhaps, be safe to deny the possibility of the
lungs being so extensively affected by pneumonia as that no part of
them shall remain buoyant ; but the event must be of extremely rare
occurrence, and the objection will almost never find place. When the
disease is partial, whether it occur before birth or after respiration, the
objection can hold good only in those cases in which respiration has
been so imperfectly established in the healthy portions of the lung as
not to render any one of those portions buoyant. In such cases the
first objection merges in the second ; for if lungs healthy in all their
parts may respire without becoming buoyant, it follows that lungs
which have only certain parts of their structure in a sound state may
receive air into those parts in a quantity too small to cause them to
float. If it can be shown that lungs healthy in all their parts may,
in spite of respiration, sink when placed in water, it will follow
that lungs which are only,' partially healthy may also sink, though

HYDROSTATIC TEST. OBJECTIONS. 87

respiration have taken place. This leads to the second objection,
viz. : —

That respiration may have taken place, but to so limited an extent,
or in so imperfect a manner, that neither the entire lungs, nor any
portion of them, though perfectly healthy, containing only the usual
quantity of blood, and presenting no unusual appearance, shall float.
A single case, reported by Dr. Alfred Taylor,* will suffice to prove
the validity of this objection. The child was a female twin, weighing
little short of five pounds and probably nearly mature. " The
substance of the lungs was healthy, of a deep Modena-red colour,
with here and there patches of a somewhat lighter hue. There was
no crepitation under the knife, nor was there any mai-k of congestion ;
for no more blood followed the incisions than is ordinarily witnessed
in dividing the lungs of the foetus." " The lungs were separately
placed in water ; but they both sank with equal rapidity. Each
lung was then cut into fifteen pieces." " The pieces of the two lungs
having been kept apart, were placed in water separately ; and it was
remarked that every portion sank rapidly to the bottom : and on com-
pression below the surface of water, no bubbles of air escaped." This
child had survived its birth twenty-four hours.

This single case is sufficient to establish the validity of the objection
now under consideration ; but it is by no means unique^ for similar
instances have been reported by Bernt, Remer, Orfila, Daniel, Schenk,
and Osiander, which cases are quoted in the Essay from which the
foregoing fact is taken. Billard meeting with some of these cases was
led into the strange error of supposing, that children may survive
their birth for hours, and even days, without breathing. f I have
myself repeatedly examined lungs in which the process of respiration
had been very imperfectly set up in several portions of one or both
lungs, and yet only one or two of the several parts into which the
lungs were divided floated when placed in water ; but I have not met
with any instance in which every portion of both lungs sank.

The objection, then, to the statement that the sinking of the lungs,
whether entire or divided into several portions, is a proof that respira-
tion has not taken place, is a sound and valid objection to the
hydrostatic test in its original form ; and the objection of course applies
equally to lungs healthy in all their parts, and to those which have
only some portions of their structure fi-ee from disease.

Let it now be supposed that the entire lungs, or any one of the
several portions into which they have been divided, float when placed
in water ; and that this buoyancy of the whole lung, or of its parts, is
asserted to be a proof that respiration has taken place. This assertion
would be met by three distinct objections. The buoyancy may be due,
not to respiration, but 1. to Emphysema ; 2. to Putrefaction ; or,
3. to Inflation. The first objection, that the lungs may float in con-

* ' Guy's Hospital Reports,' No. v. case 4.
■f • Maladies des Enfans,' title Viabilite'.

88 INFANTICIDE.

sequence of emphysema is easily disposed of. The term emphysema,
in its usual acceptation, means an enlargement or rupture of the air-
cells, which enlargement or rupture can only be produced by air in-
troduced through the air-tubes in the process of respiration, or by
inflation. Now, air so introduced into the lungs will expand the
air-cells so as to furnish, independent of the emphysema itself, distinct
proof that the child has breathed. On the other hand, if the emphy-
sema were caused by inflation, the first objection would become
identical with the third. But the emphysema spoken of as an objec-
tion to the hydrostatic test, is an emphysema of a different kind, and
is alleged to be caused by air generated in the lung by some peculiar
action of its tissues. Dr. Cummin* says : " It sometimes happens that
infants sufler violence in the birth ; the labour, perhaps, being tedious,
and the mother malformed. The sides of the chest may be so pressed
against the substance of the lungs as to do those organs injury ; they
become inflamed and puffy, containing air in large vesicles on their
surface, and this is what some authors call emphysema." Lecieux also
states that in extracting an infant by the feet, he often found that a
part of the lungs floated, though the child had certainly not breathed,
and even died in the course of the delivery. He could not attribute
this accidental buoyancy of the lungs to putrefaction, because the
infant did not present the characters of putrefaction, and he examined
the body a short time after the extraction ; but as we sometimes see a
wound or a bruise, especially on the head, accompanied by an emphy-
sematous swelling, it appeared to him that in this case, during the
extraction of the foetus, the lungs suffered a sort of contusion ; that an
effusion of blood took place into their tissue, which by undergoing
a change gave rise to the formation of some bubbles of air, and in this
way produced the buoyancy of a part of the lungs. This e?:planation
appeared to him the more probable, inasmuch as the lungs had a
brownish violet tint.f

That it is not necessary to I'esort to this explanation of the forma-
tion of gas in the lungs, the following fact will suffice to prove.

Duinng the winter of 1840, I examined the body of a mature
still-born foetus, within forty-eight hours after its extraction by
instruments. There was not the slightest trace of putrefaction in
the lungs or in any other part of the body ; there was no change of
colour, no softening of tissues, no putrefactive odour, and, with the
exception of a vesicle the size of a pea on the surface of one of the
lungs, no formation of gas. The lungs, which were gorged with
blood, were extracted, put into a gallipot, and carried in the pocket
about two hours ; at the end of which time their entire surface was
found studded with vesicles, some of them as large as a pea, and others
smaller than a pin's head.

Here, then, in the course of two hours a very large quantity of gas

* • The Proofs of Infanticide Considered,' by William Cummin, M,D. p. 61.
f Lecieux, ' Considerations Medico-l^gales sur I'Jnianticide.'

HYDROSTATIC TEST. OBJECTIONS. 89

was developed, though the lungs had certainly undergone no injury in
the birth, and no single sign of putrefaction could be detected.

This incipient process of putrefaction, for it is nothing less, is not
limited to the lungs, but may occur in effusions of blood on the brain
(of which I have seen two examples) and in other parts of the
body, especially in parts containing an unusual quantity of blood.
When it occurs in the lungs they are usually congested, or the seat of
pulmonary apoplexy which is apt to occur in children delivered after
tedious labours, or extracted by instruments.

The considerations now advanced seem, therefore, to justify the
opinion that this so-called emphysema is nothing more than' an
incipient process of putrefaction. Hence the first objection to the
floating of the lungs as a test of respiration merges in the second ;
and instead of three objections we have only two ; the formation of air
in the cellular tissue inconsequence of incipient or advanced putrefac-
tion ; and Inflation.

1. Of the formation of air in the cellular tissue of the lungs in con-
sequence of putrefaction. The possibility of the lungs floating in
water in consequence of putrefaction has been called in question ; but
there is no sufficient reason to doubt that the lungs may become
buoyant from this cause.

Some experiments which I made during the winter of 1839, will
serve to illustrate the origin of the opinion that putrefaction will
not cause the lungs to float. In some instances the lungs of still-born
children, when placed in water, as soon as they began to give out a
putrefactive odour, gradually rose to the surface, where they remained
for many days, and then slowly sank to the bottom. In other in-
stances, large air-vesicles were formed on the surface of the lungs, but
not in sufficient number to render them buoyant ; whilst in others,
again, though the lungs gave out a strong putrefactive odour, there
was no development of air-vesicles, and no tendency to rise to the
surface; nor did they ever become buoyant either in the water in
which they had stood, or in clear water. This remarkable difference
may perhaps be explained by the quantity of blood contained in the
lungs, putrefaction being more readily set up when the quantity is
considerable.

There is no longer, therefore, any room to doubt that gases de-
veloped in the various stages of the putrefactive process may cause
lungs which have not breathed to float. This objection to the hydro-
static test, as originally performed, is, therefore, a valid objection.

2. Of Inflation. The objection that the lungs may be rendered
buoyant by inflation, is also valid, as the possibility of inflation being
effectually performed to the extent of causing the lungs to float is
universally admitted.

From what has been stated, it follows that to the Hydrostatic Test,
as originally and till a comparatively recent period performed, and
used merely as a test of respiration, there are four valid objections,

90 INFANTICIDE

that is to say, two to the sinking of the lungs as a sign that respiration
has not taken place, and two to the floating of the lungs as a proof
that it has. To the sinking of the lungs as a proof of still-birth there
are the objections of disease and imperfect respiration, and to the
floating of the lungs as a proof of respiration there are the objections
of putrefaction (in its several degrees and stages) and inflation.

Such is the value of the hydrostiitic test, in the sense in which that
term was used up to the pei'iod of the introduction of pressure as an
auxiliary test.

The Hydrostatic Test as modified by the addition of Pressure. —
The mode of applying pressure is not very material, provided
it be not carried to the extent of destroying the texture of the
lung. For some purposes the pressure of the finger and thumb under
water is sufficient ; but if stronger pressure be required it is best effected
by placing the fragment of lung in a clean cloth, and, by the aid of an
assistant, twisting the two ends of the cloth opposite ways. It can
rarely be necessary to carry the pressure beyond this point, though in
some experiments to which allusion will presently be made, the frag-
ments of the lungs were submitted to strong ])ressure by treading the
cloth which contained them under foot.*

A supporter of the hydrostatic test, in this its modern signification,
would assert, on its behalf, that if the lungs, both entire and divided
into several portions, when placed in water, sink, both before and after
being submitted to pressure, fyL respiration has not taken place. The
objections to this assertion are the same which apply to the earlier
test, viz., disease and imperfect respiration, with this difference, how-
ever, that portions of lung containing a large quantity of blood and
too little air to render them buoyant, might possibly become buoyant
in consequence of a portion of the blood being forced out by the
pressure. Hence the sinking of the lungs after the application of
pressure affords a stronger reason for supposing that respiration has
not taken place.

On the other hand, supposing the several portions into which the
lungs have been divided, to float both before and after being sub-
mitted to pressure, and it is asserted that this buoyancy of the
lung is a proof of respiration, do the two objections urged with
success against the earlier test, viz., putrefaction and inflation, hold
good here also ?

The objection on the score of putrefaction falls at once to the
ground ; for very moderate pressure of the fingers will expel the
air generated by putrefaction, and cause the lungs to sink. It only
remains, therefore, to consider the force of the objection, that inflation
may cause the lungs to float.

* Mr. Jennings of Leamington, after applying pressure in the manner now
recommended, and subsequently by means of weights, kneaded the several
portions of lung in the palm of the left hand with the thumb of the right.
• Transactions of the Provincial Medical and Surgical Association, 1834.'

HYDROSTATIC TEST. PRESSURE. 91

That air artificially introduced into the lungs will render them
buoyant, there can be no doubt ; but whether the application of
pi-essure will serve to distinguish the buoyancy which is due to
respiration from that due to inflation is a question that demands
very careful consideration.

The addition of pressure to the old form of hydrostatic test was
first proposed by Beclard, and was introduced into practice in this
country by Dr. Alfred Taylor,* and Mr. Jennings,t both of whom
employed it as a diagnostic mark. The former concludes from re-
peated experiments, " that air, introduced by artificial inflation, may,
under all circumstances, be expelled by compression, if the experiment
be pz'operly performed, and the pressure continued a sufficient length
of time. "I Mr. Jennings states, that " air introduced into the lungs,
by artificial inflation, may be expelled by pressure, so that the lungs
will sink in water," and on the other hand, that " after respiration,
the air cannot be expelled from the lungs without completely breaking
down the structure of every part of the organ. Any part, however
small, not thus broken down, will continue to float."

The A^alue of this test can be decided only by an appeal to facts.
Now it is admitted by Dr. Taylor, on the authority of Case III.
in the J]ssay already cited,§ " that air, from respiration," (imperfect
respiration,) "may, by very moderate pressure, be forced out from
divided portions of the organs ;" and, on the authority of Case II.,
" that there are no satisfactory means of distinguishing artificial
inflation from feeble respiration." Schmitt also reports a case in
which the middle lobe of the right lung alone floated, and that
imperfectly, but it sank again when forcibly compressed. The child
had lived twenty-four hours, and artificial inflation had not been used.||

This test of pressure, then, does not distinguish imperfect respira-
tion from imperfect inflation. On the other hand, some experiments
which I made in the year 1841 prove that lungs completely dis-
tended by inflation cannot be made to sink by a degree of pressure
short of that which destroys the texture of the lung ; and that lungs
so distended with air differ from those which have breathed completely
only by requiring somewhat more pressure to make them sink.

As this statement is important, an account of one of these experi-
ments, in the very words in which it was described from notes made
at the time, is subjoined.

" I took the lungs of a chfld two months old who had died of
marasmus, and the lungs of a foetus, still-born, at eight months.
I inflated the foetal lungs completely, and in doing so ruptured the
air-cells, and produced emphysema over the entire surface, so that

* • London Med. and Phys. Journal,' Nov. 1832, and Jan. and May, 1833.

t ' Trans, of Prov. Med. and Surg. Association for 1833.'

j 'Guy's Hospital Reports,' No. V,

$ The child survived six hours, and breathed very imperfectly.

II Schmitt, ' Neue Versuche,' &c. 93rd observation, p. 21t.

92

INFANTICIDE.

when I ceased to inflate them the lungs rapidly collapsed. I then
took one lobe from the lung of either body, and, placing them together
in a cloth, submitted them, by means of an assistant, to strong
pressui-e. Both portions still retained their buoyancy. I next stood
with my whole weight on the cloth which contained them, and
repeatedly stamped upon them, but still both floated though their
structure was almost destroyed. I then took a portion from the lungs
of both children, distinguishing the lung which had breathed by the
darker colour of its central portion, placed them both together in the
same cloth, and proceeded as before. After applying pressure by
twisting the cloth strongly, both pieces continued to float; they
retained their buoyancy even after they were trodden upon, and
it was not till they were pounded with the heel, and their structure
thoroughly broken up, that the inflated portion sank: the portion
of the lungs which had breathed still floated, though imperfectly.
On pounding this portion of lung a second time, this likewise sank
to the bottom. A second and a third experiment led to the same
result, the inflated portion of lung sinking after a less degi'ee of
pressure than the portion which had breathed, but the structure
being in both portions broken up before their buoyancy was de-
stroyed." Another series of experiments was attended with the
same result.

If, in these experiments, it had happened that a degree of pressure,
short of that required to break down the structure of the lung, had
caused the inflated portions to sink, while it was necessary to destroy
the structui-e of the portions which had breathed before they could
be made to sink, we could understand how pressure might become a
means of diagnosis : but as the only difference is the degi-ee in which
the structure of the lung is broken up, and as, in any given case, we
shall have to examine a portion of lung separately, and not side by
side with one which we can take as a standard of comparison, it is
obvious that this test of pressure is not applicable to medico-legal
purposes.

It has been objected to these experiments that, having been made
upon lungs inflated out of the body, their results do not admit of
application to lungs inflated within the body. This objection, of
which it is difficult to see the force or validity, has happily been
obviated by experiments upon lungs successfully inflated within the
body. Two such cases, of which one was reported in the ' Medical
Times,' November 30, 1844, were communicated to the author by
Dr. Henry Browne, of Manchester, and two similar cases by Dr. F. J.
Hensley, were published in the ' Medical Times,' February 8, 1845.
In all these cases the children were still-born, and the lungs were
extensively inflated ; but they could not be made to sink by pressure
till their structure was broken up. The report of Dr. Hensley's
cases is enriched by some valuable practical comments by Dr. Arthur
Farre, with directions for inflating the lungs of still-born children.

HYDROSTATIC TEST. PRESSURE. OTHER TESTS. 93

The only objections, then, to the value of the hydrostatic test as
perfected by the addition of pressure, are three : — 1. The lungs may
sink, and yet the child to whom they belong have breathed, inasmuch
as respiration may have been too imperfect to render any portion of
the lungs buoyant. 2. The lungs may sink though respiration have
taken place, inasmuch as disease may have rendered them specifically
heavier than water. 3. The lungs may float, and yet the child may
not have breathed, inasmuch as inflation may render them buoyant,
and pressure may fail to distinguish this effect of inflation from that of
respiration.

In addition to the static and hydrostatic lung-tests, the following
tests of respiration have been proposed.

Changes in the Size and Shape of the Chest. — The chest- before
respiration is stated to be small, narrow, and flattened ; after respira-
tion larger, and rounder. This test is not wanted in cases of com-
plete respiration, while in imperfect respiration the presumed changes
do not occur. It is unnecessary in the one case and useless in the
other.

C/iange in the Position of Diaphragm. — The diaphragm, before
respiration, is stated to be arched and to rise high in the chest ; after
respiration, to be flattened and depressed. This sign is open to the
same objection as the foregoing.

Changes in the Volume of the Lungs. — The lungs are stated to be
larger after respiration than before ; this increase of size being de-
pendent partly on afflux of blood, and partly on the admission of air.
The uselessness of this test will be inferred from what has been already
said of the static lung-tests. It also is not wanted when respiration
is perfect or extensive, and it is useless in that imperfect respiration
by which, as has been already shown, the lungs are not materially
increased in size either by the afflux of blood or the admission of
air.

Changes in the Position of the Lungs. — Before respiration the lungs
lie far back in the chest, leaving the thymus and pericardium un-
covei'ed, and presenting sharp edges ; after respiration they project
forwards, seeming to fill the chest, nearly covering the thymus and
pericardium, and having their edges rounded. This is a description of
foetal lungs and of those which have fully respired ; but the descrip-
tion is not applicable to cases of imperfect respiration ; for, in all the
points now specified, foetal lungs closely resemble those that have
breathed imperfectly.

Changes in the Consistency of the Lungs. — Before respiration the
lungs are as dense as liver ; after respiration, spongy and crepitous.
When the lungs are found spongy and crepitous, the}'- have, of
course, received air; but that air may have been either inflated
or respirefl. In cases of extremely imperfect respiration, there is
no change in the lungs in this respect beyond the limits of the
developed* air-cells.

94 IXFANTICIDE.

Weight of the Liver compared with the Weight of the Body. —
After respiration a part of the blood which liad circulated through the
liver is diverted to the lungs. The liver, therefore, loses weight.
Professor Berat, of Vienna, availed himself of this fact to encumber
the subject of infanticide with another useless test. All the objections
already advanced against the static lung-tests, and all that might be
urged against any test whatever, apply to this. Orfila took the pains
to submit the value of the test to experiment, and found that the ratio
of the liver to the body before respiration was 1 to 19 ; after im-
perfect respiration, when alone, if ever, such a test is wanted, 1 to
19| ; after complete respiration 1 to 17§.

To all the foregoing tests, then, there is one simple objection, —
when respiration is complete they are unnecessary, and, when re-
spiration is imperfect, useless ; and they do not distinguish inflation
from respiration, which is the only distinction really required beyond
that obtained by the first glance at the surface of the lungs.

The refinements which some German authors have endeavoured
to introduce into the hydrostatic test, by means of balances and
graduated jars, like the tests now mentioned, may be safely consigned
to oblivion.

A careful examination of the lungs themselves is the best, and
only necessary means of determining whether or not the lungs have
received air through the air-passages. If the air-cells aie found
developed we have certain proof of respiration or inflation, and the
number of cells so developed is the best measure of the extent to
which those processes have been carried. The eye will detect
these signs of the admission of air into the lungs where the quan-
tity admitted is too small to render any portion of their texture
buoyant. This sign, therefore, succeeds when the hydrostatic test
fails.

The practical directions necessary for determining the question of
respiration are, therefore, very simple. Proceed at once to extract the
lungs, taking care merely not to injure their texture, or that of the
surrounding organs : examine carefully the surface of the lungs, and
if that surface is found of a uniform colour, and the substance of a
uniform firm texture like that of the adult liver, respiration has not
taken place ; but if the surface is found mottled with spots of a bright
vermilion, or of a rose colour, and these spots contain developed air-
cells, then respiration or inflation has taken place.

It appears, then, that the only real difficulty which we encounter in
ascertaining whether a new-born child has, or has not, breathed arises
out of the resemblance of the effects of inflation to those of respiration.
This difficulty, though it cannot be overcome by the use of any lung-
test, may be materially lessened by some very obvious considerations.

It is now^ generally admitted that the lungs of an infant may be
inflated through the mouth, without having recourse to any instru-
ment. All that is necessary is to secure the nostrils, te force the

DISTINCTION BETWEEN RESPIRATION AND INFLATION. 95

larynx back upon the oesophagus, and to imitate the movements of
respiration by the alternate compression and non-compression of the
chest. Four instances of such successful inflation are referred to at
p. 92 of this work. Schmitt succeeded in more than one instance *
in completely inflating the lungs in this way : in two cases so perfectly,
" that not even a single point was to be found in either lung into
which the air had not penetrated." f Such a complete inflation of the
lungs is not readily effected even out of the body ; for I have re-
peatedly removed the lungs, and inflated them by the blowpipe, and
in no case have I been able to expand the entire texture of the lung
without rupturing some of the superficial air-cells, and producing
emphysema. There is reason, therefore, to believe that it is not easy,
even for an instructed and skilful person, to effect a complete expansion
of the lungs by inflation ; and it may be safely affirmed that such com-
plete inflation could not be practised by an unskilful person. If, then,
it were urged on a trial for infanticide, that the mother had resorted to
inflation with a view of preserving the life of her child (for the sup-
position that it might be put in practice by a malicious person with a
view of criminating the mother is too absurd to be seriously entei'-
tained), and it appeared in evidence that the lungs were completely
expanded with air, the objection must fall to the ground. But even if
the lungs were found very imperfectly distended with air, it would
admit of grave doubt whether even this slight degree of distension
could be effected by an uninstructed and unpractised female recently
delivered of a child.

This is a case, too, in which circumstantial evidence would come to
our aid ; for to render the plea of inflation by the mother at all feasi-
ble, she must have shown in other ways her anxiety to preserve the
life of her offspring. She must have made some preparations for her
delivery, and must have prepared clothes for her child. In by far the
majority of cases of alleged infanticide, no such preparations have been
made ; and when they have been omitted, it is not likely that the plea
of inflation would make any impression on the jury. It would be still
less effectual in that large class of cases in which there is not merely
no evidence of due preparation, but the body of the child bears marks
of violence.

Authors have laid down more than one distinction between the
effects of inflation and respiration. Metzger, indeed, gives no less than
four diagnostic marks. He states that inflation is distinguished by
incomplete distension of the lungs, by flatness of the chest, by the want
of crepitation when incisions are made into the lungs, but chiefly by the
bloodless condition of the lungs, such bloodless condition not being
accounted for by previous haemorrhage. All these distinctions are
unfounded ; respiration also produces incomplete distension of the
lungs, accompanied by perfect flatness of the chest, absence of crepita-

* Op. cit. Experiments, Ixxx. and xcviii,, also x. xliii. and xlix.
t Page 189.

96 INFANTICIDE.

tion, and a comparatively bloodless state of the lungs. The static
lung-tests have also been employed as a means of diagnosis, on the
well-founded assumption that inflation does not affect the weight of
the lungs. Now as the static lung-tests do not serve to distinguish
respiration from non-respiration, and the inflated lungs are, as far as
the blood they contain is concerned, in the condition of lungs which
have not breathed, it follows that the static lung- tests cannot dis-
tinguish respiration from inflation.

There is fortunately one available distinction on which but little
stress has been laid. In all unskilful attempts to inflate the lungs of a
child through the mouth, air is introduced in considerable quantity
into the stomach. The absence of air, therefore, from the stomach
would go far to prove that inflation had not been practised.

Assuming that, by a careful inspection of the lungs, we have con-
vinced ourselves that either respiration has taken place or inflation
been practised ; and further, that the body of the infant has marks of
violence upon it, that the stomach does not contain air, and that the
circumstantial evidence, strengthened by the general considerations
respecting the difficulty of inflating the lungs, convince us that the
alternative of inflation is untenable ; but that the infant must have
breathed, a further inquiry is still needed before we can determine the
question of live-birth, in the sense which the law attaches to that
term. The question still to be answered is : — Did respiration occur
before, during, or after birth ?

Respiration may take place before complete delivery, a. in the
passages ; 6. in the womb ; and c. after the delivery of the head of the
child, the body still remaining in the passages.

a. Respiration may take place in the womb in cases of face-presenta-
tion. Such an event, however, must be extremely rare, for face pre-
sentations occur once only in 280 deliveries, (1 in 279f, Churchill).
In this position, too, respiration would probably be extremely im-
perfect, so that the complete expansion of the lungs would at once
negative the supposition of the child having breathed within the
womb, and perished before complete delivery.

h. Respiration may also occur during the passage of the child
through the vagina ; and it is of frequent occurrence during the intro-
duction of the hand to facilitate tedious labour, or to effect a change in
the position of the child. It must also be admitted to be possible in
cases where no manual assistance is given, provided the parts of the
mother are capacious. In this class of cases, too, it is probable that
respiration would be very imperfectly established, so that the complete
distension of the lungs would negative the supposition of respiration
having occurred only in the vagina.

c. Respiration after the delivery of the head of the child, and before
the complete separation of the body from the parts of the mother, is a
common event. In such a case no serious impediment is likely to be
offered to the complete deliveiy of the child. Schmitt relates no less

CONTENTS OF THE STOMACH AND INTESTINES. 97

than nine cases of this kind which occurred in his own practice, and in
all of them the child was safely delivered. On the other hand, a few
cases are recorded in which children, having breathed in this situation,
perished before the completion of the labour ; and the same fatal
result may happen to children who have breathed in the womb or in
the passages.

The possibility of respiration taking place before the complete sepa-
ration of the child from the mother is thus placed beyond a doubt ;
and it must be evident that the mere inspection of the lungs will not
enable the medical man to assert positively that respiration took place
before, during, or after the birth. If respiration has taken place to
a very limited extent, it may have occurred before birth ; but if the
lungs are found fully distended with air we should be justified in
assuming that the child was born alive.

The examination of the lungs, with a view to ascertain whether
respiration has or has not taken place, is not the only means we possess
of solving the question of live-birth. We may succeed in obtaining
better evidence than the state of the lungs can afford that a child has
been born alive, by a careful examination of other parts of the body : —
of the stomach, intestines, and bladder ; and of the organs of circula-
tion, the umbilical cord, and the skin.

The changes in the organs of circulation, in the umbilical cord, and
in the skin, at the same time that they are proofs of live-birth, are
also means of determining how long a child has survived its birth.
The more minute examination of these points will, therefore, be re-
served till the indications to be derived from the state of the internal
viscera have been considered.

The stomach may contain milk, or farinaceous food, proving that
the child was born alive, and had survived its birth long enough to
have been fed. Milk is readily identified by its physical characters,
and by Trommer's test, as used for detecting the presence of sugar
in urine.* The farinaceous food may be identified by means of the
starch it contains, which strikes with iodine-water a characteristic blue
colour ; and by means of the sugar which it contains, if it have been
sweetened, the sugar yielding characteristic results when treated by
Trommer's test. The presence of blood in the stomach also affords
a probability of live-birth, for it is more likely to have been swallowed
than to have been poured out as the result of disease.

The examination of the intestines may sometimes throw light on the
question under consideration. In mature still-born children, the large
intestines are found filled with meconium ; and although this may be

* Trommer's test. Add to the liquid to be examined a few drops of a weak
solution of sulphate of copper, and an 'excess of caustic potass, and apply the
heat of a spirit-lamp. The liquid assumes a deep violet tint, and on being
heated lets fall a deposit of the red sub-oxide of copper. This test gives cha-
racteristic results with the whey and curd of milk, as well as with liquids
containing sugar.

II

98 INFANTICIDE.

partially expelled during labour, a considerable quantity of it will remain
in the large intestines in all cases of still-birth. The complete expul-
sion of the meconium, therefore, will furnish a strong probability
that a child has survived its birth. But, on the other hand, the pre-
sence of a considerable quantity of meconium in the intestines must
not be taken to prove that the child was not born alive, as its expul-
sion is sometimes delayed for some hours or days.

Some stress has been laid on the state of the bladder as a sign of live-
birth. As this viscus is commonly emptied of its contents soon after
birth, its being found empty has been regarded as a pioof that the child
was born alive. This sign is not to be depended ui>on, as there is no
doubt that the bladder may be emptied of its contents during labour.

3. HOW LONG DID THE CHILD SURVIVE ITS BIRTH?

Our means of answering this question are less precise than could be
desired. The extent to which res])iration has taken place cannot be
depended upon for this purpose ; and recent observations have tended

HOW LOXG DID THE CHILD SURVIVE ITS BIRTH?

greatly to impair the value of at least one of the three signs just referred
to, namely— a. The changes in the organs of circulation; b. The
state of the umbilical cord ; and c. The state of the skin.

a. Changes in the Organs of Circulation. — There exist in the fcetus
certain temporary additions to those organs of circulation which are
destined for extra-uterine life. These additions consist of the umbi-
lical arteries (a a), which return the blood of the foetus to the mother ;
the umbilical vein (6), which conveys the blood of the mother, through
the intervention of the placenta, to
the fcetus ; the ductus venosus, (c),
which conveys part of the mother's
blood direct to (/j), the ascending
cava ; the ductus arteriosus, (d),
which conveys the blood destined
after birth to circulate through the
pulmonary arteries {kk), direct into
(/) the descending aorta ; and the
foramen ovale (a Fig. 8), situated at
(e), which, by establishing a commu-
nication between the right and lett
auricle, makes the double heart of
the future breathing animal, a single
one during the hfe in the womb. All
these parts, being unnecessary to extra-
uterine life, are closed after birth.*

The Umbilical Arteries and Vein. — The obliteration of the arteries
takes place much more speedily than that of the vein. At the end of
the tirst twenty-four hours they present a marked diminution in their
calibre, and an increase in the thickness of their coats near the umbi-
licus. At the end of two days the contraction extends through a
great part of their length, and at the end of the thii'd day reaches
nearly to their termination in the ilie^. The changes which occur in
the umbilical vein and in the ductus venosus take place much more
slowly. During the first three days a slight contraction only takes
place ; on the fourth day this contraction is more marked, and on the
fifth it is, with few exceptions, complete.

The changes that take place in the ductus arteriosus have been
minutely described by Bernt of Vienna, and constitute the Vienna test.
This vessel is about an inch in length, imiformly cylindrical, and about
the size of the pulmonary artery. After a few respirations the vessel
contracts towards the aorta ; but after some hours or days, it resumes
its cylindrical shape by becoming uniformly contracted throughout.
At the end of a week it has diminished from the size of a goose-quill
to that of a crow-quill. On the eighth day the duct is obliterated in
half the children, and about the ninth or tenth in all of them.

* In the diagram referred to in the text, g g represent the iliac arteries, i the
descending cava, and I the vessels of the portal system, derived from the um-
bilical vein.

100 INFANTICIDE.

The period of obliteration of the foramen ovale is extremely
variable. Thus Billard found the foramen ovale obliterated in 1 out of
18 infants of a day old ; in 4 out of 22 children of two days old ; in 8
out of 22 children of three days old ; and 2 in 27 of four days old. De-
vergie confiims these observations as to the uncertain period at which
the foramen ovale is closed. No precise period can, indeed, be fixed for
the obliteration of this aperture ; it often continues open even in the
adult, and, in some cases, without producing any dangerous conse-
quences.

Bernt enters into some minute details respecting the situation of the
opening of the fossa ovalis at different intervals after birth ; but these
details have no practical value. Indeed, the confidence formerly
placed in the closure of the several foetal vessels and of the foramen
ovale, as signs of live-birth, and in the order and progress of the pro-
cess of obliteration in those parts respectively, as means of determin-
ing, with some approach to accuracy, how long a child had survived
its birth, has been lately rudely shaken ; for it has been shown that,
on the one hand, all the vessels and the foramen ovale may remain
open in children who have survived their birth several days; and, on
the other hand, that the two parts on the obliteration of which the
greatest reliance has been placed (the ductus arteriosus and the fora-
men ovale) may be closed within a few minutes after birth, or even, in
rare instances, previous to the birth.

Of the patency of the foetal vessels after live-birth a good example
is given by Mr. Henry Lee, in his ' Pathological and Surgical Observa-
"tions,' p. 116. The umbilical vein, the ductus venosus, the ductus
arteriosus, and the left umbilical artery, were all open ; the right
umbilical artery being closed only near the umbilicus, and yet the child
from which the preparation was taken died from umbilical haemor-
rhage when a fortnight old, and six days after the separation of the
funis. Similar cases have been reported by Jorg and others. That
the foramen ovale may remain open at very advanced periods of life is
a fact too generally admitted to require proof. On the other hand, the
little importance to be attached to the closure of the foetal vessels and
foramen ovale is shown by a cafe reported by Dr. Norman Chevers,
and illustrated by a preparation exhibited at the Pathological Society,
January, 1847. The child had survived its birth only fifteen
minutes, and yet the ductus arteriosus was found unilbnnly contracted
and so nearly closed as only to admit the shank of a large pin, while
its coats exceeded in thickness those of any other of the large vessels.
Dr. Chevers was of opinion that in this case the contraction of the
vessel took place before birth ; but it is scarcely necessary to resort to
this supposition, though the anomalies occasionally met with, and
among others the absence of the duct, certainly give some counte-
nance to this opinion. Of the very early closure of the foramen
ovale, a remarkable case was reported by Mr. Smith, at a later meet-
ing of the Pathological Society (December 7, 1847). The child
lived sixteen hours and died comatose. Upon examining the body,

CHANGES IN THE UMBILICAL CORD. 101

the foramen ovale was found closed bv a strong reticulated membrane
firmly attached to its distinct annulus, impervious, and pouched.
Dr. Chevers was inclined to the opinion that in this case, also, the
closure had taken place before birth.

It appears, then, that the fact of the foetal vessels and foramen OA'ale
being open is no proof that the child was still-born ; and, on the other
hand, that the contraction of the ductus arteriosus and closure of the
foramen ovale are quite consistent with a verv short peiiod of survivor-
ship. The medico-legal value, therefore, of these tests of live-birth
and survivorship is nearly on a par with the static lung-tests. The
open state of the vessels will furnish merely a probability of still-birth,
and the contraction or closure of one or more of the vessels merely a
probability of live-birth. The length of time that the child has sur-
vived its birth could certainly not be safely inferred from an examina-
tion of the foetal vessels.

6. Changes in the Umbilical Cord. — In a new-born child the umbi-
lical cord is fresh, firm, round, and of a bluish colour ; its vessels still
contain blood, and its size varies according to the quantity of gelatinous
fluid which it contains. The shrinking or withering of the cord is the
first change that takes place: it commences at the ligature, and gra-
dually extends to the umbilicus. In some cases it begins directly
after birth ; in others, not till some hours have elapsed ; it is rarely
delayed longer than thirty hours or two days, and never longer than
three. The cord is now flabby, and sometimes a distinct redness is
perceptible around the umbilical ring. The second change which
takes place is the desiccation of the cord. It first assumes a reddish-
brown colour, and becomes semi-transparent ; it is then flattened and
shrivelled ; and when the process is still more advanced it becomes
quite transparent, and of the colour of parchment. The umbilical
vessels are distinctly seen contracted, and containing clotted blood,
and are sometimps completely obliterated. The commencement of
this process of desiccation dates from one or two to four days after
birth. The period at which the process is complete varies from one
to five days, but the most usual period is three days. The next stage
of the process is the falling off of the cord ; this usually happens on
the fifth day. Cicatrization of the umbilicus is the last change
which occurs, and this takes place about the tenth to the twelfth day.
This description is based on the observations of Billard.

The changes which take place in the cord of a child born dead, are
merely the common consequences of putrefaction. The phenomena of
desiccation do not show themselves in the cord of a dead child till
after the latest period at which desiccation takes place in the cord of a
living child ; and the cord of a dead child does not separate, though
the cuticle can be readily peeled off.

c. Change in the Skin. — This consists in an exfoliation of the epider-
mis, beginning on the abdomen, and extending successively to the
chest, groins, axillae, interscapular space and limbs, and, lastly, to the

102

INFANTICIDE.

hands and feet. Sometimes the skin comes off in layers or scales, and
sometimes in the form of a dust. This process of exfoliation, or des-
quamation, of the cuticle, sometimes begins when the child is a day
old, sometimes it is delayed till the third or fourth day. It lasts, also,
a variable period, — sometimes of thirty days, and sometimes of two
months. It continues longest in feeble and delicate children.

This, too, is a vital process differing essentially from that separation
of the cuticle which takes place in consequence of putrefaction. Al-
though the pei-iod of its occurrence is variable, its existence will aflford
ciear proof that the child has survived its birth.*

The following table, based upon the observations of Billard, pre-
sent, at one view, the principal changes just described, with the pro-
bable date of their occurrence, and the proportion of cases in which
the foramen ovale and ductus arteriosus have been observed to re-
main open.

Table combining the Changes which take place in the Umbilical Coi-d,
with the date of the Obliteration of the several Openings.

Days.

Umbilical
Cord.

Foramen
Ovale.

Ductus
Arteri-
osus.

Umbilical
Arteries.

Umbilical
Vein.

Ductus
Venosus.

1

Withering.

Open
per cent.

74

Open

per cent.

68

Open.

Open.

Open.

2

68

59

Obliteration
advanced.

Open.

Open.

3

Desiccating.

64

68

Obliterated.

Open.

Open.

4

Beginning to
separate. ,

63

63

Contracted.

Contracted.

5

Separation
usually
complete.

45

52

• •

Obliterated.

Obliterated.

8

Separation
complete.

25

15

10

Cicatrization

to

commencing.

12

Cicatrization
complete.

Mucous
Exudation.

Assuming the two questions — •!. Was the child born alive ? afad,
2. If born alive, how long has it survived its birth ? to have been
answered in the affirmative, we may have next to inquire,

* Billard, ' Maladies des Enfans,' pp. 13-24.

WHAT WAS THE CAUSE OF DEATH? 103

HOW LONG HAS THE CHILD BEEN DEAD?

The process of putrefaction differs in no material respect in the adult
and in the infant. The same changes occur in the same order. The
animal heat is first extinguished, rigidity then comes on, and putre-
faction follows. The body of the new-born infant parts with its heat
very quickly ; the rigidity is as great, and lasts as long in the infant
as in the adult ; and putrefaction, according to Devergie, goes on more
rapidly. These facts must be borne in mind when we are deciding
the question before us. With the exception of the time required, the
principles that will guide us in our decision will be the same at all
ages. These will be the subject of a future cha{>ter. The effects of
intra-uterine maceration, described at p. 77, must not be confounded
with those of putrefaction. The absence of the putrefactive odour will
supply a sufficient diagnostic mark.

WHAT WAS THE CAUSE OF DEATH .''

There are several ways in which the life of a child which has been
born alive may be sacrificed, within a short period of its birth,
without any violence being used on the part of the mother, a. It may
be so immature or so feeble as to be unable to maintain an independent
existence ; h. it may encounter accidental obstacles to the continuance
of the respiration ; or, c. it may labour under a congenital disease
which will effectually prevent the establishment or continuance of the
several vital functions.

a. The death of an infant after a few respirations, in spite of the
most skilful and persevering attempts to restore animation, is an event
too well known to every accoucheur to require proof or illustration in
this place ; and such an event must be of more common occurrence in
the case of children born under circumstances which preclude any
effectual assistance. Among the more common causes of the early
death of the infant may be mentioned a long and tedious labour,
haemorrhage, and continued interruption to the circulation through the
cord; to which may be added the immaturity or feebleness of the
infant itself. It ought also to be understood that the same causes
which occasion still-birth promote the early death of children bom
alive. Thus large children more frequently perish in the birth, or
die soon afterwards, than small ones, and male children (as being
laiger) more frequently than female children. Again, the danger to
the child is greater in a first pregnancy than in subsequent ones. It
is probable, too, that in the absence of violence, or even of intentional
neglect on the part of the mother, many more illegitimate children
would be still-born or die soon after birth than legitimate children.
The reports of obstetric practitioners have shown that, while the mor-
tahty of legitimate children is about 1 in 20, that of the illegitimate is

104 INFANTICIDE.

about 1 in 10 ; while the deaths of males are to those of females as
about 7 to 5.

b. Among the accidental obstacles to the continuance of respiration
may be mentioned, such a position of the infant as shall cause the
mouth to be applied to some soft and yielding object, or to be im-
mersed in blood, in the discharges, or in water ; and the accumulation
of mucus in the mouth, nostrils, and air-passages. It may also be
added that there are cases in which respiration is altogethei- prevented,
as when the child is born in the membranes.

c. The congenital diseases which may prevent the establishment of
the several vital processes, or render their continuance for any length of
time impossible, have their seat in the three organs most essential to
life ; — the heart, the lungs, and the brain.

Diseases of the heart and large vessels. — These diseases are rare
in infancy ; but malformations accompanied by contraction or early
closure of the foetal vessels have an important medico-legal bearing,
as affording a presumption in favour of death from natural causes.

The diseases of the lungs are more important in relation to the pre-
sent question. They are six in number, — 1. Hepatization (red and
grey), the consequence of pneumonia occurring before birth. 2. Pul-
monary apoplexy. 3. Pulmonary tubercles. 4. (Edema. 5. A disease
described by Devergie, under the name of osdema lardaciforme, which
seems to be quite as nearly allied to schirrus as to oedema. It affects
the thymus as well as the lungs. And, 6. A condition of lung known
as atelectasis pulmonum.

These diseases of the lungs may affect either their entire structure
or a part only. Where the whole lung is involved, it is clear that
respiration cannot be perfectly established, and the child cannot long
survive its birth ; where, however, the disease is partial, the medical
man must state, to the best of his judgment, whether it is extensive
enough to prevent the continuance of life.

The condition of the lungs to which Dr. Jorg of Leipsig has given
the name of atelectasis pulmonum, or imperfect expansion of the
lungs, is not, strictly speaking, a disease, but merely an absence of
respiration and a persistence of the foetal condition, which is found in
by far the majority of new-born children, and may even continue for
days or weeks. The substance of the lungs in the unexpanded parts is
perfectly healthy, the want of expansion depending probably upon some
defect of innervation.

The chief diseases which affect the brain and spinal marrow are
apoplexy, and accumulations of fluid and morbid softening. The
apoplexy of the foetus and new-born infant differ in no respect from
the apoplexy of the adult. M. Lasserre (Banking's * Retrospect,'
vol. iii. p. 342) gives a case of meningeal apoplexy, a second of
effusion of blood into the ventricles, and a third into the posterior
part of the left hemisphere. When serum exists to a limited extent
either between the membranes or in the ventricles of the brain, life is

I DEATH FROM VIOLENCE. 105

not necessarily compromised, at least not within a short period of
birth; when, however, the accumulation ot' serum is considerable, it
may materially interfere with the functions of" life, and would afford a
sufficient explanation of the premature death of the child. The same
remark applies to morbid softening of the brain and spinal cord. It
must be borne in mind, however, that the brain of the foetus is natu-
rally softer and much more vascular than that of the adult.

The same remark applies to all the diseases just specified, viz. that
they are not of frequent occurrence ; and that when they are present,
it is rarely to such a degree as to account for the speedy death of the
child, or to have any important bearing on the question of infanticide.

It is only when proofs of respiration are present that these signs of
death from natural causes have any value ; and in the case of children
who have survived their birth but a short time, it may be laid down
as a general rule, that the absence of marks of violence affords a fair
presumption that death has been due to natural causes. It is true
that, in such a case, the child may have been the victim of intentional
neglect, and may have died from the want of those simple aids by
which the lives of children in more favourable circumstances are pre-
served ; or it may have been prevented from continuing to breathe by
simply closing the mouth and nostrils ; but the medical man has no
means of detecting these causes of death, and the accused must have
the benefit of the doubt which attaches to the case.

Was the Death due to Violence. — In answering this question we
shall have to consider whether the injury which the child has sustained
might have been the result of accident.

In some cases the traces of injury are so marked and of so undoubted
a character, that we may decide without hesitation that they are due
to murderous violence. Punctured wounds of the fontanelles, orbits,
heart, or spinal marrow, dislocation of the neck, separation of the
head from the body, extensive fracture of the bones of the head and
face, suffocation by plugging the fauces, or strangulation effected with
unusual force, tell their own tale.

But there are cases in which the nature and cause of the injury are-
only to be determined by reference to obstetric experience and medico-
legal experiments, illustrating the mechanical injuries which the child
may sustain during and immediately after the birth.

Suffocation. — Respiration, as has been already stated, is sometimes
prevented or arrested by purely accidental causes which leave no mark
of injury on the child ; so that the medical witness has no means of
stating whether the child fell into the position of danger, or was
intentionally placed in it, or was allowed to remain in it when it
might have been rescued from it. This difficulty presents itself in a
case of not uncommon occurrence. A child is found in a privy, and
the question arises whether it was suffocated by being thrown into it,
or expelled while the mother was there for a natural purpose. In
such a case, if respiration is found to have taken place extensively or

106 INFANTICIDE.

completely there would be a strong presumption against accident.
On the other hand, very imperfect respiration would affbid an equally
strong probability the other way, provided it can be shown that such
sudden and unexpected deliveries do take place.

Many cases of sudden parturition in such situations are on record,
Thus, J org relates the case of a pregnant woman who " on account
of a de.sii-e to evacuate the bowels, went to the night-stool, and
brought forth sitting on this, without any pain or bearing down, a
large boy, who first struck the edge of the night-stool with his head,
and then fell on the ground."* 'I'here was in this case an extravasa-
tion of blood on the left parietal bone. Mr. Tatham also mentions the
case of a married lady delivered of twins on the night-stool. Jt was
not her first labour, but probably her second. Both the children
died.t

JSuch cases of sudden parturition, though not of very uncommon
occurrence, are rare in women who have not previously borne children.
It must be admitted, then, as possible, that a foetus found dead in a
privy may have been discharged in the course of a sudden delivery, and
have died suffocated. Sometimes the child so expelled falls into water
instead of into night-soil. In this case, and generally where the body
of an infant is found in water, a question will arise whether the child
died by drowning, or was placed in the water to conceal some other
mode of death.

Suffocation by the introduction of foreign substances, such as mud,
straw, feathers, wool, and wet linen into the mouth is not an un-
common cause of death. In such cases the question arises whether the
foreign substcince could have been drawn into the mouth by the act of
inspiration, or whether it must have been forcibly and intentionally
introduced. No general rules can be laid down for the decision of this
question. When a plug of wet linen or other similar material is
employed, the mucous membrane is stated to be congested anterior to
the situation of the plug, and pale where the greatest pressure has
been exerted.

Another mode of effecting suffocation is by rolling the tongue back
into the throat. As the tongue would probably lesume its original
situation, it is not likely that this cause of death would be detected.

Strangulation. — A child may be strangled by the application of a
cord, and yet no marks of violence appear on the neck. But even
where marks of violence do show themselves by a discoloured depres-
sion round the neck ; — is it certain that this has been done by the
mother ? Might not this appearance aiise from the twisting of the
cord around the neck, or by the pressure of the neck of the womb ?
Klein, an eminent German authority, has examined this point with
great care. He says : " I have never met with an instance of marks of
injury of the kind supposed — ecchymoses or suggillations — produced

* 'Die GeburtshUmiche Exploration,' p. 116.

t * London Medical Repository,' vol. i. part iv. New Series.

DEATH FROM VIOLENCE. 107

by the orifice of the uterus, or by the umbilical cord, although I have
known a great number of cases in which the neck of the infant had
been strongly girded by the funis once or twice twisted round it,
strangulation having been either actually produced, or rendered most
palpably imminent." He then goes on to speak quite as decidedly
regarding the pressure of the neck of the uterus ; not a bruise, as he
tells us, nor mark of any kind being left on the infant which has
perished in this way. A case mentioned by Jorg shows that the ex-
perience of Klein is not to be implicitly trusted : — " The navel string
had been twisted five times round the neck, and had left five tolerably
deep red impressions." Taufflieb also has reported cases of the same
kind,* and there are several English cases on record to the same
effect.

The presumption in favour of strangulation by the umbilical cord
admits of being rebutted in those cases in which the cord is unusually
short. It may be stated in this place that the length of the cord is
subject to great variety. Though its most common length is 18
inches, it may be as short as 4J inches and as long as 69 inches*
(Churchill's 'Midwifery,' 3rd edition, p. 108.)

Marks of pressure on the neck, therefore, cannot always be attri-
buted to intentional violence ; but as, in most instances, a murderer
uses more force than is necessary, it will often happen, in cases of in-
fanticide, that the marks are too distinct to be accounted for by the
accidental twisting of the umbilical cord round the neck. Moreover,
if respiration is found to have been completely established, there will
be the strongest presumption against the strangulation having been
produced by a cause acting during the birth. On the other hand, the
absence from the lungs of all signs of respiration will afford a pre-
sumption in favour of the constriction having been due to the um-
bilical cord.

Strangulation may also be effected by the pressure of the fingers on
the throat, in which case ecchymoses may be found corresponding with
the cause.

Drowning. — The signs of this form of death are the same in the
infant and in the adult. These signs will be described in a future
chapter. "

Fracture of the Skull. — This may happen in three ways: — 1.- In
the course of labour. 2. By falls on tihe floor. 3. By intentional
violence.

1. The possibility of fracture of the bones of the skull being pro-
duced during labour, is proved by more than one well-authenticated
fact. Siobold relates a case in which a female with a very narrow
pelvis was delivered, by the efforts of nature alone, of a well-formed
still-born female child. On examining the head, a great quantity of
blood was found extravasated upon the surface of the cranium, and
there were three fissures in the left parietal bone, and one in the left
* ' Annales d'Hygiene,' vol. xiv. p. 340.

108 INFANTICIDE.

frontal bone. INIichaelis of Keil also reports the case of a woman with
a well-formed pelvis, who was delivered of her first child after a natural
labour. The child breathed both during and immediately after birth,
but then died. The head was much disfigured; and on examination,
the right parietal bone, which during birth had been directed under
the promontoiy of the sacrum, was covered anteriorly and above
with effused blood, and on the leraoval of the periosteum was found
fractured in five places. The whole of this bone was uncommonly thin.
On opening the skull there was found no extravasation beneath the
fissures, but the longitudinal sinus was ruptured, and there was an
extensive coagulum on the cerebrum on both sides, under the dura
mater, and on the tentorium.* These two cases will show the great
amount of injury which the head may sustain during birth.

Seeing, then, that fracture of the skull during labour is possible,
what is the difference between fiactures thus produced, and those the
result of intentional violence ? There is no essential difference between
the two foi-ms of injury, except in those cases in which unusual violence
has been used, the fracture being minutely comminuted and accom-
panied by depression ; or the fracture not being limited, as it commonly
is when caused by pressure of the womb, to the parietil and frontal
bones, but extending to other bones of the skull, and even to the bones
of the face.

2. On the subject of fractures of the skull caused by falls on the floor,
Chaussier has made some intei'esting experiments. Fifteen still-born
children were allowed to fall perpendicularly, and head foremost, from
a height of 18 inches on a stone floor. In 12 of them one or other of
the parietal bones was broken. When the height was 3 feet and
upwards the fractures were proportionably greater. Fractures were
also produced by strong pressm-e and by blows.f

But Dr. Klein has adduced facts which seem to render it doubtful
whether fracture ever occurs in sudden labours from falls on the floor.
He availed himself of the opportunities he possessed, by his official
station in the kingdom of Wiirtemberg, to procure returns of all
such labours occuiTing within his jurisdiction. The result was 183
well-authenticated cases, in 150 of which the mothers were suddenly
delivered standing ; yet there was not a single case of death among
them, nor of fracture of the skull, or other mischief happening to the
infant ; though some of the children had fallen on bare boards, and
some on the pavement. The reason of the difference between the ex-
periments and those cases occurring naturally is supposed to be that,
in the latter, the direction in which the body of the infant is projected
is oblique, and the fall is not so instantaneous as in the experimental
essay.

The truth would appear to lie between these experiments of

• These cases are quoted by Eeck, Art. Infanticide.

t ' Conside'rations Mddico-l^gales sur 1' Infanticide,' par Lecieux.

DEATH FKOM VIOLENCE. 109

Chaussier and the facts collected by Klein ; for Dr. Cohen von Baren
has succeeded in bringing together several instances of fracture of the
skull from falls in cases of sudden delivery. Out of 50 cases reported
by him, 30 children were boi-n while the mother was standing, 17
while stooping or sitting, and 3 while kneeling. Of the 50, 32 were
first-born, and 42 were at full term. Of the 19 infants born while
the mother was standing, one only had fracture of the skull, and the
cause of this was doubtful. But it appears that out of 25 cases in
which the cord was ruptured, 5 presented fractui-es of the skull.
These fractures of the skull occasioned by falls can also be distinguished
from those due to intentional violence only by the comparatively slight
injuries sustained in the one case contrasted with the extensive injury
commonly inflicted in the other.

In cases of fracture of the skull due to a fall during sudden delivery,
the umbilical cord is liable to be torn through, especially if it does not
exceed, or falls short of, the usual length. The seat of the rupture is
usually within one or two inches of the navel. If the umbilical cord,
instead of being torn, should be found divided by a cutting instrument,
it might be inferred that the injuries to the head were due to accident.
In any case, the state of the cord ought to be ascertained.

Fracture and Dislocation of the Neck. — These injuries are never
present before birth ; and as they are not caused by falls on the
floor, they may be taken as sure signs of criminal violence.

Contusions. — In examining bruises on the head it is necessary to
bear in mind, that tumours commonly result from compression of this
part during labour : a mere swelling on the head must not, therefore,
be taken for a mark of criminal violence.

Incised and Punctured Wounds. — There is nothing peculiar in
these wounds as inflicted on the new-born infant. For the distinction
between these and other wounds inflicted during life and after death,
the reader is referred to the subject of Wounds.

Poisoning. — The rules for the examination of the stomach and in-
testines, and of the substances contained within them, are the same
for the infant and the adult; they will therefore be treated of under
the general head of Poisoning. This form of death is rare in the ci\^(i
of the new-born child ; but several cases of poisoning by the mineral
acids characterized by the same appearances on the body of the infant
and on the clothes as mark the action of those acids on the adult, have
lately occurred. In all these instances the crime was committed at a
considerable interval after the birth of the child. In determining
whether an infant has fallen a victim to poison, it should be borne
in mind that the alimentary canal, in common with other important
oi'gans of the economy, is subject to disease. Sometimes the lining mem-
brane of the oesophagus presents a marked injection, in the form of
spots, longitudinal lines, or ramifications. These may happen to be
arranged transversely and may be mistaken for the effects of a ligature
applied to the neck. The stomach, moreover, may be the seat of

110 INFANTICIDE.

ulcerations with a sanguinolent, dark-coloured discharge ; and the same
changes may be found in the rest of the alimentary canal.

Infanticide by Omission. — The omission to tie the umbilical cord
sometimes proves fatal ; and there can be no doubt that that omission
is in some instances a criminal one. Some authors have doubted the
correctness of the general opinion of the necessity for tying the cord,
and have adduced arguments in favour of their own view of tlie case.
There are, however, facts enough on record to show that such an
omission may be attended with danger. Fodere' relates one case in
which the child perished in consequence of the ligature becoming
loose;* and Dr. Campbell two fatal cases, one from the accidental,
the other from the intentional, removal of the cord.f

It is probable that fatal haemorrhage would very rarely follow a
rupture of the cord, and this probability is strengthened by the testi-
mony of Klein. Such a rupture of the cord is not necessarily the act
of the mother, for it may occur in cases of sudden delivery taking
place in the erect posture.

The signs of death from haemorrhage are the paleness of eveiy part
of the body, and the small quantity of blood contained in the heart
and large vessels. In the absence of wounds to account for the
haemorrhage, such a bloodless state of the body may be regarded
as in all probability the effect of haemorrhage from the cord.

The child may perish by other acts of omission. The mother may
have failed to provide proper clothing or food, to remove it from a
position of danger, to clear the mouth of mucus, or other accidental
impediments to breathing. Supposing it to have been previously
shown that the child had survived its birth for some days, death from
want of food would betray itself by the great emaciation of the whole
frame, and the empty state of the alimentary canal. In these cases
the child is at the same time often exposed to the action of cold, which
form of death is characterized by pallor of the surfiice, with congestion
of the internal parts.

Such cases of infanticide by omission being difficult of proof are
never punished with death, but the mother is convicted of the lesser
crime of concealing tne birth ; and even when marks of violence
are found on the body, the inquiry generally assumes so complicated
a shape, that the jury cannot be induced to return a verdict of wilful
murder.

EXAMINATION OF THE MOTHER.

The fii"st inquiry with reference to the female suspected of having
given birth to the child is, — Whether she has been recently delivei(;d.
and if so, whether the period of her delivery corresponds with the

• Vol. iv. p. 515

• vol. IV. p. 515.

f 'Introduction to the Study and Tractico of Midwifery,' p. 151.

DIRECTIONS FOR MEDICO-LEGAL EXAMINATION. Ill

time at which the child is supposed to have been born. This part of
the inquiry belongs to the subject of delivery (p. 59).

Another inquiry may be necessary in certain cases ; and that is into
the state of the mother's mind. Puerperal insanity is by no means a
rare disease, and there is no doubt that it sometimes takes the form
of homicidal mania, threatening the life of the child. An interesting
case of this kind is quoted by Paris and Fonblanque.* It was that
of a married woman, of good reputation, who being delivered of a
child, and not having slept many nights, fell into a temporary frenzy,
and whilst alone killed her infant; but company coming in, she told
them that she had killed it, and there it lay. The good reputation
which the woman had previously borne, the long want of sleep, and
the entire absence of the usual motives to the commission of such a
crime, added to " many circumstances of insanity appearing," led to
her acquittal. Dr. Paris observes, in reference to this case, that " had
this woman been of doubtful character, though innocent, she might
have been executed for want of medical evidence to prove the nature
and frequency of puerperal insanity."

A question of some importance in its bearing on infanticide, and
having reference to the mother, relates to the strength which a female
recently delivered possesses. There is no doubt, that, as a general
rule, a woman recently delivered possesses the strength requisite for
the destruction of her child's life. Thus, Fodere relates the case of a
French widow, who being seized with labour pains while receiving a
visit from eight of her neighbours, complained of colic, and seating
herself on a bucket in bed, as soon as the child's head passed the
vagina, squeezed it flat by compressing it with her thighs. That a
woman has strength enough to move about and exert herself after her
delivery, is proved by the successful concealment of the fact of de-
livery and of the dead infant in the large majority of cases brought to
trial, as well as by well-authenticated instances of females walking
several miles, or resuming laborious occupations on the very day of
their delivery.

This subject of infanticide will be best brought to a conclusion by
the following summary of the chief points to be attended to in cases
of infanticide.

1. Examine the body of the child in order to determine its degree
of maturity ; for this purpose, weigh and measure it, ascertain the
position of the centre of the body, and attend to the several points
comprised in the description of the growth and development of the
foetus (p. 63). Note also any malformation which may be present.

2. Note the several circumstances by which the time that has
elapsed since the death of the child may be determined, such as the
presence or absence of animal heat and rigidity, the existence or non-
existence of putrefaction, and, if putrefaction be present, the degree to
which it has advanced.

* ' Medical Jurisprudence,' vol. iii. p. 129.

112 INFANTICIDE.

3. Examine the entire surface of the body with a view to ascertain
the presence of marks of violence, and, if any be present, determine
whether they might have been produced during birth, or by accidental
causes acting after birth. Examine the mouth for foreign bodies intro-
duced into it, and the fontanelles, orbits, heart, and nucha?, in search
of wounds inflicted by pointed instruments. Note the state of the
umbilical cord, measure it, and ascert'iin whether it has been torn or
cut ; and observe the condition of the skin.

4. Open the chest, and remove the heart, lungs, and thymus gland.
Separate the lungs, and carefully inspect their surface. Observe
whether they are of a uniform liver-colour and compact consistence
throughout, or uniformly spongy like the adult lung, or mottled with
developed air-cells, as in imperfect respiration. If there are any parts
of a lighter colour than the rest, observe whether the structure of the
lung itself is developed in those parts, and distinguish the developed
air-cells from air contained beneath the pleura, the result of incipient
or advanced putrefaction, by applying gentle pressure with the finger.
In lungs which are free from putrefaction, the hydrostatic test may be
resorted to, to ascertain the degree of buoyancy of the lungs, as a
measure of the quantity of air which they contain.

o. Examine the heart and blood-vessels ; the foramen ovale, the
ductus arteriosus, the ductus venosus, and the umbilical arteries and
vein. Observe whether these several parts are contracted or obli-
terated, and to what extent and degree ; and whether they contain
much or little blood.

6. Examine the stomach to ascertain whether the child has been
fed, using for this purpose the tests for sugar, milk, and starch ; if
there is any appearance of inflammation in the alimentary canal, test
its contents with a view to the discovery of poison. Note whether
the intestines contain meconium and in what quantity, and whether
the urinary bladder contains urine.

7. Examine the bones of the skull both at the vertex and base,
in search of fractures. Inspect the brain and its membranes, and
note any effusion of blood or serum. Examine the spine and spinal
cord with a view to the discovery of dislocation or fracture of the'
vertebrae.

8. Examine the suspected female in order to ascertain whether she
has been recently delivered, and how long. It may be necessaiy, also,
in certain cases, to inquire into the state of the woman's mind.

It is notorious that the law, as it now stands, is altogether in-
operative, and that the only punishment really awarded to the child-
murderer is the two years' imprisonment with which it visits the
concealment of the birth. This impunity is due to the unnece!>sary
refinement of the law, which requires at the hands of the medical
man a distinction that, in most cases, it is out of his power to
make. The child must be bom alive, and unless the medical witness
can prove that it has been bom alive, it may bear on its body the

SUGGESTIONS. 113

clearest marks of murderous violence, and yet the murderer may
escape unpunished.

In most instances, the crime of infanticide is committed so soon
after the birth of the child, that the only proof of its having been
born alive is that furnished by the presence of the signs of respira-
tion. But it has been already shown that respiration may take
place before and during the birth, as well as after it ; and, in by
far the majority of cases, all that the medical man can succeed in
proving is, tliat the child has or has not breathed. It is not in the
nature of things possible that he should say whether respiration, if it
have taken place, occurred before or after the birth. Now, it may be
fairly asked. Why require proof of live-birth at all ? for it is notorious
that this question does not lead to the punishment, but to the escape,
of guilty persons.

The suggestion which we would make is this: Let the law be
so framed as to exclude as much as possible all appeal to scientific
authority. If the child-murderer is to be punished, all question as to
the child being horn alive must be done away with ; and whenever
there are found on the body of an infant marks of violence sufficient
to account for its death, which marks of violence could not be pro-
duced in the natural progress of the labour, or by any accident
occurring afterwards, let the female be punished as guilty of murder.
Medical evidence would thus be restricted to the question of the
true cause of the injuries found on the child. There would be no
injustice in such an enactment, for the same injuries which would
destroy the life of a child that had already breathed, would effec-
tually cut off all chance of the preservation of a child in whom the
act of respiration had not yet taken place ; and it is in the highest
degree improbable that a female would inflict such injuries on a child
that did not show some signs of life.

On the other hand, as, in the absence of all external injury, it is
impossible to prove that a child has been murdered ; and yet it may
be easy to show that the female has been guilty of criminal neg-
ligence ; let that criminal negligence be punished according to its
degree. The law, as it now stands, contemplates only one degree
of criminal negligence, viz., the concealment of the birth ; and the
concealment of the birth, except in as far as the life and well-being
of the child are thereby affected, is but the concealment of shame.
The concealment of the birth is criminal, inasmuch as such con-
cealment presupposes the want of that assistance which all women
know to be necessary to the well-being of the new-born child.
Let the concealment of the birth, then, be punished as now, by
imprisonment for such a time as the law sees fit. Another omission,
— that of providing proper clothing and shelter for the child — at
present escapes punishment altogether, and certainly demands a
separate enactment.

114 LEGITIMACY.

LEGITIMACY.

The law always supposes that a child born in wedlock has the
mother's husband for its father ; but this presumption may be rebutted
by evidence of non-access on the part of the husband, or impotence, or
any other cause which makes it impossible that the reputed should be
the real father.

There are several circumstances out of which the question of
leo-itimacy may spring. A woman may bear a child after her
husband has been absent from her more than nine calendar months ;
nnd in this case the question arises. Does the period of utero -gestation
admit of being extended beyond this the usitatum tempus pariendii
On the other hand, a woman within an unusually short period of her
marriage may bring forth a child capable of being reared, and here the
question may arise, what is the earliest period at which a viable child
may be born. Again, a woman before the expiration of the full terra
of nine calendar months from the date of her marriage, say in the
7th or 8th month, may be delivered of a child having the size and
general appearance of one at full term ; and it may become a question
whether a child of such a size, and apparently so mature, could have
been of the supposed age. Here an accurate knowledge of the growth
and development of the foetus will be necessary.

Lastly, a woman may give birth to a child during the life-time, or
after the death, of her husband, he having been at the time of the
conception of the child in such a state of feebleness or disease, or
imperfect convalescence from some severe malady, as to give rise to
the question whether he could have been the father of the child.
A question of paternity may also arise, where there is no doubt of
the legitimacy of the child, in consequence of the marriage of the
mother to a second husband immediately after the death of the first.
Some cases of disputed legitimacy turn on the alleged impotence of the
husband. (See the Chapter on Impotence.) The questions which
fall to be examined in this place are chiefly — 1. The Duration of Preg-
nancy, and 2. The Viability of Children.

1. DURATION OF PREGNANCY.

This is a question to be decided by medical evidence ; for, though
the practice of our courts of law is to consider forty weeks as the
more usual time, medical men are allowed to give evidence as to the
possibility of that period being extended.

The general belief among medical men, as well as among the vulgar,
is, that the period of utero-gestation in the human subject is 9 calendar
months, 10 lunar months, 40 weeks, or 280 days ; and we often meet
v,rith the less definite expression " 9 months, or 40 weeks." Now, it
is important to understand that there is a material difference between
9 calendar months on the one hand, and 10 lunar months, 40 weeks,

DURATION OP PREGNANCY. 115

or 280 days, on the other ; for nine calendar months may consist
either of 273, 274, 275, or 276 days, falling short of 280 by from
4 to 7 days.

This want of precision in estimating the duration of pregnancy
arises in part from the inadequacy of the means we possess of deter-
mining the duration of pregnancy in particular cases. These means
are four in number.

1. Peculiar Sensations at or about the time of conception. 2. Ces-
sation of the Catamenia. 3. The Period of Quickening : and 4. A
single Coitus.

1. Peculiar Sensations felt at, or soon after, Conception. — This
mode of reckoning is inaccurate, inasmuch as these sensations are not
defined so as to be recognized by those who conceive for the first time;
they are not constant in their occurrence in the same female ; and they
do not take place at any particular period.

2. The Cessation of the Catamenia. — There are also great objections
to this mode of reckoning, for the catamenia may cease from causes
other than conception. Hence the following case is a possible one : a
woman, from some cause quite independent of conception, ceases to
menstruate, and immediately before or after the next suppressed period
she conceives, but she dates the conception from the first suppressed
period. As the cases of protracted gestation are not very numerous,
a part of them may perhaps be explained in this way. On the
other hand, a female may menstruate once, or more than once,
after conception, in which cases her reckoning will fall short of the
real duration of pregnancy.

But, eyen allowing the cessation of the catamenia to be a sound
starting-point, it can give only an approximative result; for as in
most women 28 days (according to the best authorities) intervene be-
tween the commencement of one menstrual period and the commence-
ment of another, there may be an interval between the termination of
one menstrual period and the beginning of the next of nearly 28 days;
say 25 days. If conception be assumed to take place on the first day
after the cessation of thti. menstrual discharge, and we reckon from the
first suppressed period, the calculated duration of pregnancy would fall
short of the real duration by 25 days. If, on the other hand, we
assume conception to take place on the day preceding the suppression,
and we calculate from the last appearance of the menses, the calcu-
lated duration of pregnancy would exceed the real duration by the
same period of 25 days.

To avoid this possible error of 25 days, accoucheurs have adopted
the expedient of dividing the interval between the two periods into
two parts, and reckoning from the division. In this way the possible
error is reduced to twelve or thirteen days.

Our estimates would differ less widely from the truth in those
cases in which the interval is greatly contracted, either by the menses
continuing for several days or recurring more frequently than usual,

116 LEGITIMACY.

as every three weeks, or every fortnight : they would, on the other
hand, be more remote from the truth in those instances in which the
interval is prolonged to five or six weeks, or even two months.

3. The Period of Quickening. — The inadequacy of this event as a
starting-point from which to reckon the duration of pregnancy will be
inferred from what has been already stated in speaking of the signs of
Pregnancy, viz. that quickening, where it is perceived, occurs at very
variable periods, having a range, according to the best authorities, of
six weeks (from the 12th to the 18th), and, if we combine the state-
ments of several authors, of sixteen weeks, namely, from the 10th to
the 26th week.

4. A single Coitus. — This is the only accurate mode of reckoning ;
and a sufficient number of well-attested facts of this class have now
been collected to prove that the duration of pregnancy is subject to
considerable variation, as well as to a marked excess above 280 days.

The following table embodies the results of 14 cases in which the
duration of pregnancy was determined by a single coitus.

Aveiage of the 14 cases . . . 284 days.

Minimum . . ♦^ . . . 270 „

Maximum . . ... 293 „

Range 23 „

Excess above 280 days . , . . 13 „

Excess above 9 calendar months . 17 to 20 „

The inferences to be drawn from cases in which the duration of
pregnancy was fixed by a single coitus, admit of being strengthened by
cases of an analogous kind, in which the sudden death of a husband, or
the date of his separation from his wife, is used to determine not the
exact duration of pregnancy, but its minimum duration, for in using
this mode of reckoning it is commonly assumed that the pregnancy
dated from the very day of death or departure.

The following table gives the results of 27 cases in which the exact
duration of pregnancy, or the mininum duration, was determined either
by a single coitus, or by the sudden death of the husband, or by his
separation from his wife.*

Average of the 27 cases

. 284 days

Minimum .

. 260 „

Maximum .

. 308 „

Range

. 48 „

Excess above 280 days .

. 28 „

Excess above 9 calendar

months

32 to 35 „

The results of these cases, then, furnish the strongest possible reason
for regarding the period of utero-gestation as variable and not fixed,

* The author is indebted for the case of 308 days to Mr. Hewitt, a former
pupil of King's College. The duration was ascertained by the sudden death
of the husband. Cases of less than 260 days are excluded.

DURATION OF PREGNANCY IN ANIMALS. 117

and as so great an amount of variation is shown to exist in so small a
number of cases, we may fairly expect a still greater difference from the
collection of a greater number of similar facts.

The inference drawn from these facts derives the strongest conlirma-
tion from the analogy of animals.

Formerly the period of gestation in animals, like that in the human
species, was held to be a fixed period. For instance, the duration of
pregnancy in the mare was fixed at 11 months, and in the cow at 9
calendar months. Subsequent observations have shown that, in those
animals, the period is far from being a fixed one, and has thus fur-
nished a strong argument to the advocates of a variable period in the
human species.

The well-known observations of M. Tessier, which extended to
102 mares and 160 cows, give the following striking results: —

In the Mare.

In the Cow

Shortest period .

,

. 311

days.

241

days.

Longest period .

.

. 394

J)

308

j»

Range

,

. 83

„

67

„

Excess above the stated

period

57 or 60

?>

32

or 35

,,

Average period .

11

mths. 10

„ 9mtl

IS. 10

3'

The difference observed in the case of both these animals is very
remarkable, and certainly much greater than might have been antici-
pated. The excess above the assumed period is also very great in
both instances.

Earl Spencer has made a still more extensive series of observations
on the period of gestation in the cow.*

His lordship's observations were made on 764 cows, and the results
may be briefly stated thus : —

Shortest pei'iod of gestation, a live calf I ^^. ,

being produced j ^^'

Shortest period of gestation, when the calf ^ ^ ,^

was reared / "

Longest period of gestation . . . 313 „

Range (greatest) , . . . . 93 „

Range in the case of a viable calf . . 71 ,,
Excess beyond 260 days, before which period t

his lordship considers a calf decidedly > 53 „

immature )

Excess above 9 calendar months . 37 or 40 „

Excess above 10 lunar months . . 33 „

Average duration . . , 284 or 285 „

It appears also to be well made out, from his lordship's observations,
that by far the majority of instances of gestation protracted beyond

* See the 'British and Foreign Medical Review' for Jan. 1841.

118 LEGITIMACY.

the average period, occurred in the case of bull-calves, the numbers
being, of cow-calves 90, of bull-calves, 152.

These observations of Lord Spencer, added to those of M. Tessier,
establish beyond a doubt the fact, that the period of utero-gostation
in the cow and horse, which, like that of the human subject, was for-
merly regarded as fixed, is not only variable, but that the extremes
are widely separated from each other, and the longest period in
excess by considerably more than a calendar month of the average
duration.

The case in favour of a vaiiable period in the human subject admits
of being strengthened by other arguments.

All the functions of the human body which have been carefully
examined, such as the pulse, the respiration, the secretion of urine,
and the cutting of the teeth, are found not only to be variable, but to
vary within wide limits. So also with those functions which have a
close connection with pregnancy : for instance, the catamenia. They
make their first appearance at any age, from 9 years up to 23 or 24-
(and even earlier and later than those ages), and they continue up to
any age from 35 to 55, or even later. In some women they recur at
intervals of a month, in others of six weeks, in others of a fortnight,
and each period may comprise a variable number of days. Then, again,
the period of quickening varies from the 10th or 12th to the 18th or
20th week, or even later; and child-bearing, which in the majority
of cases ceases at 45, may occur as late as 54, and possibly at a still
more advanced age.

Another argument of no slight force in favour of a variable period,
and of the possible extension of pregnancy beyond the usually assigned
limit, is to be found in the fact that the advocates of a fixed period are
by no means agreed among themselves as to what that fixed period is
to be. Thus of the seventeen medical men examined in the Gardner
Peerage case, five advocated a fixed period, and were opposed to the
idea of protracted gestation, but all of them stated the duration of
pregnancy differently, and, with the exception of Sir Charles Clarke,
who fixed it at 40 weeks or 280 days, were forced to admit a greater
or less deviation from an absolutely fixed period. Dr. Gooch, for
instance, stated it at from a day or two before to a day or two after
9 calendar months, and Dr, Davis at a day or two under 9 calendar
months ; while Dr. Blegborough allowed an interval of from 39 to 40
weeks; and Mr. Pennington of from 37 to 40 weeks.

If the advocates of a fixed period, all of them men of acknowledged
eminence and experience, could differ thus widely in their estimates,
they might differ as widely from nature herself.

Bnt while five of the seventeen medical men examined in the Gardner
Peerage case thus supported the opinion that the period of gestation
was fixed, or nearly so, twelve believed that it might be protracted to
9^, 10, or 11 calendar months, or (288—290) (304—306) (334—337)
days.

THE GARDNER PEERAGE CASE. 119

The balance of authority, both ancient and modern, may be also
adduced in support of the theory of a variable period and of possible
extension of pregnancy beyond the usual period of about 280 days.
Among modern authors of note may be citwl the names of Hunter,
P'odere, Gardien, Velpeau, Capuron, Desormeaux, Richerand, Dewees,
Hamilton, Burns, Denman, and Montgomery.*

To the foregoing arguments may be added the fiict, that legal
decisions in this country have been favourable to protracted gestation,
and that the same may be said of the decisions and even of the laws of
other countries. Thus, the law of France does not allow the legitimacy
of a child born after a gestation of 300 days to be disputed, and admits
evidence as to more lengthened gestation.

The arguments in favour of a variable period and the possible pro-
traction of gestation, then, are

1. The strong analogy of animals, whose period of gestation, like
that of the human female, was originally supposed to be fixed, but
which is now proved, by careful and extensive observation, to be
subject to great variety, and to be much protracted beyond the
assumed limit,

2. The analogy of other functions of the human body, and especially
of menstruation and child-bearing, all of which present wide limits of
variation in time and degree.

3. The absence of any exact conformity in the statements of those
who advocate a fixed period, and deny the possibility of its extension.

4. The balance of authority, both ancient and modern, in favour of
its possible extension.

5. The legal decisions and laws of our own and other countries.

6. (and this is the most conclusive). The facts founded on accurate
observation in cases of a single coitus, or of sudden death, or separa-
tion.

These arguments must be admitted to have far greater weight than
the general impression in favour of a fixed period. But, though they
render it in the highest degree probable that the period of utero-ges-
tation may fall shoit of, and extend beyond, 280 days, the degree to
which it may be lengthened out must still remain a subject of dis-
cussion;

This question, of the extent to which the period of utero-gestation
may be protracted, assumed a definite shape in the celebrated Gardner
Peerage Case, of which the following is a brief outline.

In the month of March 1796, Alan Hide Gardner, afterwards Lord
Gardner, then a captain in the navy, was married to Miss Adderley.
They cohabited together as man and wife from the time of their mar-
riage until the month of January J 802 (except during the occasional

* For the precise statements of these authorities, see the article Succession,
by Dr. Montgomery, himself a firm believer in protracted gestation, in the
•Cyclopaedia of Practical Medicine ;' and for the opinions of older authorities,
see Beck's ' Medical Jurisprudence,' article Legitimacy.

120 LEGITIMACY.

absence of the husband). On or about the 30th of January, Alan
Hide Gardner took leave of his wife, and sailed a few days afterwards
for the West Indies, and did not return to England until the 10th day
of July in the same year, his wife remaining in England during the
whole of that period. Towards the end of the year 1801, when Alan
Hide Gardner was absent on his Majesty's service, his wife entered into
an adulterous conversation with Henry Jadis, Esq., which Alan Hide
Gardner did not discover until the month of June 1803; after which
time he did not live or cohabit or have any intercourse whatever with
his said wife. On the 8th of December, 1802, she was, without the
knowledge of Alan Hide Gardner, delivered of a male child, which was
afterwards baptized by the name of Henry Fen ton Gardner. In
Easter Term, 1804, Alan Hide Gardner brought his action in the Court
of King's Bench against Henry Jadis, for criminal intercourse with
Maria Elizabeth Gardner, and in that action obtained a verdict against
Henry Jadis for 1000^. damages. He also obtained a sentence of
divorce in the Conssistory Court, and the marriage was subsequently
dissolved by Act of Parliament. Alan Gardner, Baron Gardner, died
on the 30th of December, 1808, leaving Alan Hide Gardner his eldest
son and heir, who thereupon succeeded to the barony, and became the
second Baron Gardner. On the 10th of April, 1809, Alan Hide, Lord
Gardner, was married to the Honourable Charlotte Smith, daughter of
the Right Honourable Robert Lord Carrington, and by her had issue
Alan Legge Gardner, his only son, who was born on the 29th of
January, 1810, and one daughter. Alan Hide Lord Gardner died on
the 22nd of December, 1815, leaving Alan Legge Gardner his only
surviving son, who succeeded to the title. Henry Fenton Gardner
attained the age of twenty-one years in the month of December, 1823.
Alan Legge Gardner, being an infant of the age of fourteen years or
thereabouts, petitioned his Majesty for a recognition of his right to the
title by letters patent, or by ordering his name to be entered on the
Parliament Roll as a minor peer.*

It was proved on the trial that there was a possibility of access on
the 30th of January, from that date to the 7th of February, and on or
after the 11th of July. Hence the three questions proposed to the
medical witnesses : —

1. Could a child born on the 8th of December have been the result
of sexual intercourse either on the 30th of January, or anterior to it,
being 311 days?

2. Could a child born on the 8th of December have been the result
of sexual intercourse on the 7th of February, or anterior to it, being
304 days ?

3. Could a child born on the 8th of December, and living to man-
hood, have been the result of sexual intercourse on or after the 11th

* This account is taken, with alterations, from Le Marchant's history of the
case.

CASE OF THE REV. FERGUS JARDINE. 121

of July, a period of 150 days, or two or three days short of five
calendar months ?

The first two of these questions may be reduced to one, and we
shall have the following alternative : — if the child were legitimate, he
must have been either a five months' child, or, to speak more correctly,
a 150 days* child, or a 304 or 311 days' child (one calendar month
and two or nine days beyond the usitatum tempus pariendi).

The latter alternative, viz., gestation protracted to the 304 or 311
days, was the one chiefly insisted upon in this celebrated trial.

Of the medical witnesses who were examined, the majority gave
their evidence in favour of protracted gestation ; a small number of
influential names was ranged on the side of a fixed period. As the
opinions of these latter authors have been already stated, and the sub-
ject of protracted gestation has been discussed at as great length as is
consistent with the limits of this work, the reader is referred for fur-
ther particulars to Dr. Lyall's pamphlet.* The decision of the case
did not turn upon the medical evidence, but upon the adultery of
the mother of Henry Fenton Jadis. The claim of the petitioner, Alan
Legge Gardner, was allowed.

2. VIABILITY OF CHILDREN.

The question, What is the shortest period of gestation at which a
viable child may be born ? was raised in the Jardine case, which,
though less known than the Gardner Peerage case, is equally interest-
ing, as no less than 14 medical men, and a still greater number of
non-professional witnesses gave their evidence. In this case, too,
there was great difference of opinion among the medical witnesses.
The evidence of Drs. Alison and Christison was admitted, simply
because as Lecturers on Forensic Medicine, their attention had been
directed to the question involved ; and it may be safely affirmed, that
the evidence of the last-named witness. Dr. Christison, threw more
light upon the case than 1;hat of all the other witnesses put together.

The following is a short abstract of this case : —

The defendant was married on the 3rd of March, 1835 ; and on the
24th of August following, his wife was delivered of a girl. Supposing
this child to have been the ffuit of sexual intercourse on the day of the
marriage, it was only 174 days, or five calendar months and twenty-
one days old. The infant, which was undoubtedly immature, though
the degree of immaturity could not be ascertained or determined, died
on the 20th of March, 1836, having survived, as nearly as possible,
seven months.

The libel charged the defendant with having committed fornication

* ' Medical Evidence relative to the Duration of Human Pregnancy, as given
on the Gardner Peerage Case.'

122 LEGITIMACY.

with his wife before mairiage. A great many witnesses were called,
some to estiiblish the possibility of sexual intercourse before marriage
others to show that the child, though small and feeble, was not
immature, or at least not so immature as the date of the marriage,
would make it ; and others to speak to the impossibility or improba-
bility of a child surviving at that early period. The extent to which
the allegations of the libel were made good, and the vague nature of
the evidence adtluced in their support, will be best seen by the follow-
ing extract from the decision of the Presbytery, November 7, 1838:
" That the testimony of the several witnesses, both with respect to
matters of fact, viz., the appearance of the child at birth, &c., and also
with respect to the opinions of medical men regarding the viability
of such a premature child as the child in question is said to be, is of
such an opposite and contradictory nature, that the Presbytery, with
their present light, have great difficulty in coming to any decision on
these points. The Presbytery, therefore, agreeably to a common
maxim of law, Satius est impunitum reliiiqui f acinus nocentis quam
innocentem damnan, find the libel not proven." *

The principal points established by the general and medical evidence
in relatiou to Mrs. Jardine and her infant were, that she had men-
struated as usual the week previous to her marriage; that she was,
both before and after her marriage, in a very weak state of health ;
that she was herself a seven months' child ; that she had a second
child, a daughter, which she believed to have been born "just about
the commencement of the eighth month of her pi'egnancy," and that she
had not provided baby-linen for this child. As regards the infant,
the evidence, though contradictory on many points, showed that it was
small (it weighed three pounds when born), very feeble, and decidedly
immature, though no data were adduced to show the degree of the
immaturity. It required to be nursed with care, but none of those
precautions for preserving the child's warmth, such as wrapping
it in wool, causing an adult female constantly to sleep with it, or to
keep it in her arms, were taken, which seem to have been absolutely
necessary in the cases of Drs. Rodman and Outrepont, presently to be
described.

The special question raised in the Jardine case was this — Could a
child born 174 days, or five calendar months and twenty-one days
after marriage, be reared to the age of seven months ? and the more
general question which the case suggests is — What is"^the earliest
period of gestation at which a viable child may be born ? or, in other
words, what is the earliest period of gestation at which a child has
been born, and has survived its birth so long as to prove that there
was no physical obstacle to its attaining the adult age?

* ' Record of the Proceedings in the reference by the Synod of Fife, to the
Venerable the Greneral Assembly of the Church of Scotland, in May, 1839, of
the Case of Mr. Thomas Barclay, Town Clerk, and Nine of the Parishioners of
Kinghorn, against the Reverend Fergus Jardine.' Edinburgh, 1839.

QUESTION OF EARLY VIABILITY.

123

Now it is universally admitted that a child may he born and reared
to manhood at the seventh and eighth, as well as at the ninth month.
All authorities are agreed as to the possibility of a child of seven calendar
months living to manhood ; it is only, therefore, with regard to
periods anterior to this that any doubt exists. On the other hand, in
spite of the case of Fortunio Liceti, said to be born at four and a half
months, and to have lived to 80, we may pretty safely affirm that a
viable child cannot be born before five calendar months, or 150 days.
Our attention, then, will have to be directed to the periods of five and
six months, and it may be useful, in this place, to give a short tabular
summary of the leading particulars of the cases which are best attested,
and most worthy of confidence. In the cases of Outrepont and
Belloc, the age stated is that at which the children were last seen
alive by the reporters.

Table showing the Lengths and Weights of Children reported to have
been born during the 5th and 6th Months of Gestation, with the
assumed Age and the probable Age, according to the Estimates and
Observations given at pages 66, 67.

Author.

Length.

Weight.

Survived

its

Birth.

lb. oz.
1 13

1 yr. 9 m.

U 0

8 years.

••

17 years.

U 0

2 days.

2 0

Ai days.

1 5

8 days.

1 1

Si hours.

1 8i

3i hours.

Asserted
Age.

Age

according to

Estimates

and

Observations,

Rodman

Outrepont
Belloc .

Bucholtz*
Koppf .
Fleischmann +

Christison J

Mr. Thomson I

Inches.

13 at

3 weeks.

13*

121

14

12i

lU

13

I2i

Days.
133

175 or 189
6 months.

189 days.

182

168

167

5 months.

Possibly

5 months.

6 months.

Possibly

5 months.

6 months.

6 months.

Possibly
5 months.

Possibly
5 months.

5 months.

This table is certainly confirmatory of the views of the reporters of
the several cases : there is not one of the cases in which the asserted
age does not correspond pretty closely with the estimates and measures

* Beitrage, ii. 104.

f Jahrbuch, iii. 128.

J Henke's ' Zeitschrift,' vi.

$ Evidence in the Jardine case.
II Of Alva, Stirlingshire, quoted by
Beck, p. 212. .

124 LEGITIMACY.

already given, and, in some cases, the observed weights and measures
might have belonged to an earlier period of gestation.

if now we revert to the Jardine case, we find a weight of 3 lbs.
stated to belong to a child born at 174 days, or before the completion
of the 6th month, which weight is a pound in excess of any of the
weights given in the table. It also exceeds the weights given at p. GG,
with the exception of the very doubtful instance of 3 lbs. 13 oz.

Though the lengths and weights contained in the above table afford
a strong probability that the estimated periods of gestation in some, at
least, of the cases is the true one, that probability requires to be con-
firmed, by contrasting the other particulars of their histories with the
acknowledged signs of immaturity.

The following are the signs of maturity and immaturity, according
to Fodere and Capuron.

The signs of maturity are the following :

The ability to cry as soon as the child reaches the atmospheric air,
or shortly thereafter, and also to move its limbs with facility and more
or less strength ; the body being of a clear red colour ; the mouth,
nostrils, eyelids, and ears perfectly open ; the bones of the cranium
possessing some solidity, and the fontanelles not far apart ; the hair,
eyebrows, and nails perfectly developed ; the free discharge of the
urine and meconium, a few hours after birth ; and, finally, the power
of swallowing and digesting, indicated by its seizing the nipple, or a
finger placed in its mouth.

The signs of immaturity, on the other hand, are the following:

The length and volume of the infant much less than those of an
infant at full term ; it does not move its members, and makes only
feeble motions ; it seems unable to suck, and has to be fed artifi-
cially; its skin is of an intense red colour, and traversed by numerous
bluish vessels ; the head is covered with a down, and the nails are
not formed ; the bones of the head are soft, and the fontanelles
widely separated ; the eyelids, mouth, and nostrils closed ; it sleeps
continually, and must be preserved by artificial heat ; and, lastly, it
discharges its urine and meconium imperfectly, and often after a long
interval.

The presence of the membrana pupillaris, the high position of the
centre of the body, the non-descent of the testicles, the large size of
the head as compared with the body, the great prominence and deep
red colour of the parts of generation, and the absence or scanty deposit
of sebaceous matter on the skin, may be mentioned as additional signs
of immaturity.

By comparing this description with some of the more remarkable
recorded cases, it will be seen what degiee of probability attaches to
the estimates of authors. Only two of these cases are here selected
for consideration, viz., those related by Dr. Rodman of Paisley, and
Dr. Outrepont.

Dr. Rodman's case is as follows :

DR. Rodman's case. 125

After describing the mother as " more cautious in her decisions,
accurate in her observations, and steady in her deportment, than what
is usually met with in society," and stating that she had borne five
children, and " was confident that the period of her gestation was less
than nineteen weeks," Dr. Rodman says, that premature labour came
on in consequence of fatiguing exertions, and she was delivered of a
living male infant.

" Not daring to allow the washing of the infant's body, he was
speedily wiped and wrapped in flannel, with only an opening in the
dress around his mouth for the admission of air ; and by the time the
dressing was over, the mother was ready to take him into the warm
bed with herself. It is common, if there be much apparent weak-
ness, to feed a child the first twelve hours after birth very frequently,
yet, in this instance, although the child was weak, no feeding was
attempted till beyond that time ; the nourishing heat with the mother
in bed was relied on. On ihe following day, the head, body, and
extremities of the child were surrounded with fine cotton-wool, pressed
to appear like cloth, to the thickness of two or three folds, and over
that the flannel as before ; and again the child was given to the
mother in bed. His vital energy was so deficient, that even with
this dress, of himself he was unable to support the degree of warmth
which was necessary to his existence. The heat of a fire was evi-
dently injurious, as he soon became weaker when exposed to it,
whilst the warmth of the mother in bed enlivened and strengthened
him. Too much heat induced a sickly paleness of his face, with an
obvious expression of uneasiness in his countenance ; and the abstrac-
tion of heat, even by tardily undressing his head, brought on a
nervous affection, or starting of the muscles all over his body. From
seeing how these morbid affections were induced, the child was kej)t
regularly and comfortably warm, by the mother and two other females
alternately lying in bed with him for more than two mouths. After
this he could be left alone from time to time, but was still undressed
very cautiously and only partially at any one time. It was not till
the child was three weeks old that the length, or weight of the body
could be ascertained. The length was found to be 13 inches, the weight
1 lb. 13 oz. avoirdupois. It was extremely difficult to get the child to
swallow nourishment the first week ; the yellow gum soon came on,
and the thrush seized him severely on the eighth day, and was not
cured till the end of the third week. During the first week he was
fed with toasted loaf bread boiled with water, sweetened and strained
through fine linen ; in the second week twenty drops of beef-tea were
added to the two or three teaspoonfuls which he took of this nourish-
ment, and small doses of castor-oil were administered. At the end of
three weeks he began to swallow teaspoonfuls of his mother's milk,
and in two days afterwards he made exertions to suck. His mother's
milk was gradually substituted, at least in part for the panada, though
this was still continued occasionally with a few drops of port wine.

126 LEGirraACY.

Under this careful management he attained the age of four months,
at which time his health and excretory functions were peculiarly
regular."

Five months after this, as we find from a second paper by Dr.
Rodman,* this little child was still doing well. In this paper he
confirms what he had stated in the first : he describes the mother as
tall, robust, and healthy, and states that she had a peculiarly accurate
knowledge of the time of her previous gestations, and does not hesitate
still to aflfirm, that the period in this instance was rather under
nineteen weeks. f

Dr. James Hamilton, in his evidence given in the Jardine case, states
that this infant lived a year and nine months, and consequently was a
viable infant ; but that from the facts of the case, and some circum-
stances communicated in a correspondence with Dr. Rodman and
himself, he had always been impressed with the belief that theie was
some mistake in the woman's reckoning, and that the infant was a
dwarf. Dr. Hamilton adds that the infant was considerably smaller
than those puny infants born within the six months, whom he had seen
drag on a miserable existence for four or five days.

It must be admitted at once that, in this instance, an extremely
feeble and immature child was reared by very judicious treatment.
It cannot be denied, too, that the estimate of the child's age, formed
by the mother, was at least as likely to be correct as such estimates
ever can be, and the degree of doubt which attaches to the case
is only such as attaches to a mother's estimate of the age of a child.
The length and weight of the child, too, are in keeping with the other
lengths and weights given in the table at p. 123, and they will be
found to coincide with the extreme weight and length of the tables at
pp. 66, 67. The absence of any description of the appearances presented by
the child prevents us from determining, with any approach to accuracy,
its degree of immaturity. It might have been a' five months' child, but
there is no ground for supposing it to have been born before the com-
pletion of the fifth month.

The case related by Dr. Outrepont, of Bamberg, is a very valuable
one, for it is the only quite unequivocal instance hitherto published,
of the rearing of a six months' child. The particulars are given so
fully, and with such precision, that even Hencke, who previously
denied the possibility of such an incident, has candidly admitted that
Outrepont's case is an unequivocal example. J The evidence is as
complete as it is possible to be in any case of the kind. It is complete
both as derived from the date of the mother's impregnation, and as
drawn from the structure and history of the child. The mother, a

* 'Ed. Med. and Surg. Journal,' vol. xii.

f Case of a child born between the fourth and fifth month, and brought up.
By John Rodman, M.D., Paisley, 'Ed. Med. and Surg. Journal/ vol. xi. p. 445^
The facts of this case were attested by Mr. White of Paisley.

X ' Zeitschrif t,' vi. 27.

outrepont's case. 127

young woman, whose catamenia had always been perfectly regular,
menstruated as usual ten days after her marriage, and subsequently
to this time was repeatedly connected with her husband. About
a fortnight after this menstruation, she underwent a general change
in appearance, and began to have frequent attacks of vomit-
ing and fainting, symptoms which she never had in her life
before. These symptoms continuing the catamenia did not return :
and about twenty weeks after their last appearance, she felt the first
movements of the child. Five weeks after this, and twenty-seven
weeks (twenty -five?) after the last appearance of the catamenia, she
was seized with labour-pains, and uterine hsemorrhage ; upon which
Dr. Outrepont having discovered that the hemorrhage proceeded from
the placenta being attached over the os uteri, encouraged the labour,
and brought it forthwith to a prosperous conclusion. Here the evi-
dence of the child being not more than twenty-five weeks old, is as
strong as in the nature of things it is reasonable to expect. The
state of the child at birth is still more unequivocal. It was a boy,
and breathed immediately on being born. It measured thirteen and
a half inches, and weighed one pound and a half. Its skin was
covered with smooth lank down, and was much wrinkled. The
whole extremities were extremely small in proportion to the trunk,
and were kept constantly bent over the body, as during the existence
of the foetus in the womb. The nails of the fingers and toes were
like mere white folds of skin, the testicles were still within the belly,
and the pupillary membrane was entire. The child whined, but could
not cry— slept almost constantly — awoke only once a day — seldom
opened its eyelids, and was obviously insensible both to light and
sound. The first excretion of urine took place on the seventh day,
and the first evacuation of the bowels on the ninth. Subsequently the
urine was voided once in forty-eight hours, and the faeces every two
or three days. It was placed in a basket filled with wool, kept in a
uniform temperature, and moved with great care. For some time it
was fed with the spoon on diluted milk and sugar. In four weeks
the down began to drop off from the skin. In fifteen weeks it had
made very little progress in any respect. The wiinkles had disap-
peared, however, from the skin, and the length was increased an inch
and three quarters. But from this time, which corresponded with the
fortieth or forty-second week after impregnation, — that is with the
full period of utero-gestation, — it made rapid advances; sleeping less,
eating more, crying strongly, and becoming evidently sensible to
sound, and pleased with the light. When fourteen months old, it
was of the weight and stature of a child born at full term. In the
eighteenth month, the testicles descended into the scrotum, without
causing him any annoyance. In like manner, the teeth began to
appear early in his third year. He did not begin to walk till half a
year later ; and at that time differed from other children of the
same age, not only in littleness, but likewise in the singularly old

128 LEGITIMACY.

expression of his countenance. When Dr. Outrepont saw him in 1816,
he was eleven years of age, was as big as a boy of seven or eight, and
had just begun to read and write.*

The length and weight in this case are also in keeping with the
lengths and weights in the table at p. 123, and are much within the
extremes given in the tables at pp. 66, 67. The signs of immaturity
are also so well marked and so minutely described as to be decisive of
the possibility of rearing a child born at the end of the sixth solar
month, or about twenty-six weeks.

Having discussed at length the two great questions connected with
the subject of legitimacy, it will be necessary to say only a few words
on some questions of less interest and importance.

The question of paternity, as has been already stated, may arise
where a woman, soon after the death of her husband, marries a second
time. Sometimes this question assumes the shape of the one last dis-
cussed. A child is born within five months, or thereabouts, of the
death of the first husband, and the question of paternity becomes one
of viability. Where the child is of such an age as that it might have
had either husband for its father, the question of paternity must be
decided by a reference to the state of health of the deceased husband
dt the presumed time of conception.

Another class of questions, of little importance and rare occurrence
in this country, may arise in slave-holding states, where the reputed
parents of a child are of different colours, and the offspring differs in
appearance from the majority of children of mixed marriages.

Some discussion has taken place as to the kind and degree of
evidence of live-birth which may be necessary to establish a right of
inheritance under the tenure known as ' tenancy by the curtesy.'
'' 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 curtesy of England." It appears that the
meaning of the expression born alice, is not the same in this case as in
cases of infanticide. It has been decided that in questions of tenancy by
the curtesy, any kind of motion is evidence of live-birth. Thus, in the
case of Fish v. Palmer, tried in 1806, " a twitching and tremulous
motion of the lips" was held to be sufficient evidence of live-birth.

The question, how far monsters are capable of inheriting, has been
raised, and answered by Blackstone, who states that " a monster
which hath not the shape of mankind," " hath no inheritable blood ;"
but if, in spite of deformity, " it hath human shape it may be an heir."

* This case is taken from Dr. Christison's evidence on the Jardine case, with
alterations and additions suggested by the perusal of the case in the 'Zeitschrilt,
liir die Staatsarz,' vi. 19. It may be well to state that Dr. Christison admitted
the possibility of a child bom after 174 days being reared.

129

CHAPTER IV.

LIFE-ASSURANCE. FEIGNED DISEASES.
LIFE-ASSURANCE.

The medical man performs many important functions in relation to
life-assurance. With the exception of the simple facts which the
actuary obtains from mortuary registers as his materials for cal-
culating common average risks, almost all his information respecting
special risks, and the influence of particular diseases on the duration
of human life must be drawn from medical sources.

Every well-conducted assurance office, moreover, employs a medical
man to examine and report upon the state of health of all persons
making personal application to the office, and, in other cases, intrusts
the duty to some medical man chosen for the purpose. The ordinary
medical attendant of the applicant is also consulted respecting his
state of health and the diseases from which he may have sxiffered.

The services of the medical man are still more indispensable in the
case of those offices which undertake the insurance of unsound lives.
He is also employed by benefit societies to ascertain the state of health
of persons applying for admission into them.

Similar services to these have also to be occasionally performed in
examining emigrants and recruits.

The insurance offices generally provide the medical examiner with a
printed list of questions, prepared under medical advice, or suggested
by their own experience, relating to the state of health of the applicant,
his family and personal history, his occupation and habits, the diseases
which he has suffered, and such other particulars as are presumed to
afi^ect the probable duration of his life. Similar questions are drawn
up for the guidance of the medical referee.

From this brief statement it will be seen that the duty of the
medical examiner resolves itself into a work of inquiry and a work of
personal inspection and examination, respecting both of which a few
practical suggestions may be offered with advantage.

The inquiries which the medical examiner is expected to make relate
partly to the family history and partly to the personal history of the
applicant. The importance of the first class of inquiries rests upon the
ascertained prevalence of hereditary predisposition whether of a favour-
able or unfavourable character. As a general rule, the children of
those who have died at an advanced age themselves live to be old,
while, on the contrary, the children of parents who have died young
are likely to be short lived. Moreover, a considerable number of dis-
eases which sensibly affect the duration of human life are transmitted

* K

130 LIFE-ASSURANCE.

from parent to oflsi)ring, or, passing over one generation, fi-om grand-
sire to grandson. The medical examiner should, therefore, begin by
ascei-taining whether the parents of the applicant are living or dead ;
and, if living, what age they have attained, if dead, at what age they
died. This inquiry should be extendefl to the brothers and sisters, and
in some instances to the uncles and aunts of the applicant. As a
general rule it will not be necessary to extend the inquiry beyond the
father and mother and the brothers and sisters of the applicant, if the
answers respecting them prove favourable ; but if these near relations
have died early, or if they appear to be subject to some hereditary
malady seriously affecting the duration of life, it may be necessary to
include in the inquiiy a larger circle of relationship. Having ascer-
tained the ages of the living and deceased members of the applicant's
family, the medical examiner should next inquire into the causes of
death in the case of those deceased members of the family who have
not died of old age. If one or more should be found to have died of
pulmonary consumption, asthma, insanity, gout, or disease of the heart ;
or of apoplexy or dropsy at an early age ; the fact would have to be
noted as more or less seriously affecting the value of the life under
examination ; and similar importance would attach to the ascertained
prevalence of any of these diseases among the living members of the
applicant's family.

From the family history of the applicant the examiner would pass
to his personal history, which would comprise his age, his social relation
(whether mamed or single), his occupation, place of residence, and
habits of life, and the diseases to which he has been subject, not for-
getting to ascertain whether he has had small-pox, or been vaccinated.
Among the diseases or symptoms of disease to which the gi-eatest im-
portance attaches may be mentioned spitting of blood (as affording a
strong probability of consumption) ; gout, acute rheumatism, and
asthma (as both liable to recur and as laying a foundation for serious
organic changes) ; dropsy (as a common result and indication of severe
organic mischief); inffammation of the lungs (as leaving behind it
some unfavourable change in those organs, or as being the direct
consequence of tubercular deposit) ; fits (as betraying serious lesion
of the nei-vous system); rupture (as involving danger of strangula-
tion) ; and calculous disorder (as obviously tending to shorten life).

The personal examination will have to be conducted with gi-eater or
less care and minuteness as the family and personal history have
proved favourable or otherwise. A favourable personal and family
history will justify a cursory inspection and examination. If the
person is well formed ; the complexion healthy ; the pulse regular and
equal, of fair force, and not exceeding 70 or 75, or falling much
below 60 (in the female not more than 80) ; and if the breathing
is free and tranquil, further inquiry will be unnecessary. If, on the
contraiy, the family or personal history is unsatisfactory; if the
person is ill formed or disproportioned, if the pulse is ii-equent or

EFFECT OF LOCALITY AND CLIMATE. 131

otherwise abnormal, and the respiration unnatural, and especially
if the applicant has been attacked by any serious disease, a more
minute examination directed to the condition of the nervous system,
of the lungs, or of the heart, will be required. In the examination of
the chest, percussion and auscultation should be employed, and in exa-
mining the lungs the spirometer of Dr. Hutchinson may be used with
advantage.*

To these general observations on the duties of the medical examiner
such short statements as are consistent with the narrow limits of this
work respecting the influence on longevity of place of residence, change
of climate, occupation, and habits of life, of peculiarity of constitution,
of hereditary predispositions, and of pre-existing disease, may be added
with advantage.

Place of Residence. — The principal facts which have been ascer-
tained respecting the place of residence of persons living within the
limits of their native country are the following : — That the inhabitants
of the rural districts are longer lived than the inhabitants of towns.
2. That large cities are more fatal to life than small ones. 3. That
marshes, and the low-lying districts on the banks of rivers, are less
healthy than more elevated spots. 4. That of two districts of equal
elevation that which has a sandy or gravelly soil is healthier than
that which consists of clay or rich alluvium. 5. That close, damp,
and ill-drained houses are peculiarly fatal to life. Such considera-
tions as these ought, in extreme cases, to influence the medical examiner
in selecting lives for assurance. It is obvious that the inhabitant of
Glasgow or Liverpool has not so good an expectation of life as the
inhabitant of London, and a much worse expectation than a resident in
the country ; that a residence in London on the south side of the
Thames entails greater risks than a residence on the north side ;t and
that the tenant of a close, damp house is not so good a life for assurance
as a man who occupies a spacious, dry, and well-built residence.

Change of Climate. — The removal from a temperate or a cold
climate to a hot one, or the reverse, affects the duration of life much
more seriously than any change of residence from one part of a man's
native country to another. Our insurance offices, accordingly, either
lefuse to insure lives at all in extreme cases, or demand additions
to the usual rate of premium, varying with the ascertained or esti-
mated increase of risk. The most precise information Vhich we
possess in reference to this subject is drawn from the reports of the
mortality of our troops and seamen employed in different parts of the
world ; from which it appears that while the difference between low

* For a description of this instrument, with directions for Its use, tables of
reference, and the indications which it affords, the reader may be referred to
Hoopers ' Physician's Vade Mecum,' 5th edition, p. 162.

t The deaths in London per million inhabitants, on an average of fifteen
years, have been as follows :— West districts, 3,676 ; Central Districts, 4,402 ;
Xorth districts, 4,670; East districts, 5,435 ; South districts, 6,535.

132 Line- ASSURANCE.

and damp situations and dry and elevated ones prevails in every part
of the world, the risk to life increases with the temperature, attaining
its maximum within the tropics, and falling to the standard of Eng-
land, or even below it, in cold or temperate regions. Some assurance
offices, acting upon this general principle, allow the assured to reside
without extra charge in any part of the woild lying beyond thirty
degrees from the equator, requiring from those who take up their
abode within these limits an extra payment roughly proportioned to
the additional risk.

Occupation. — The occupations which have been pioved to affect
injuriously the duration of human life are those which lead to ex-
cessive indulgence in spirituous liquors, those which combine sedentary
habits, or a minimum of exertion, with exposure to a close and heated
atmosphere, those which entail undue exposure to the weather with
hardships and privations, those which require long hours of work, and
a sacrifice of natural rest, those which are carried on in clouds of dust,
and those which bring men in constant contact with poisonous sub-
stances. The employments which demand special mention, as belong-
ing to these several heads, are licensed victuallers, potboys, and brewers'
draymen ; compositors, tailors, and drapers' assistants ; soldiers and
sailors during active warfare; bakers; knife and needle grinders;
house-painters, manufacturers of cards enamelled with lead, and men
who work with mercury, phosphorus, or the salts of arsenic. One
occupation not easily brought under any of these heads has been shown
to shorten life without causing an undue amount of sickness, namely,
the employment of the butcher.

The most important of the above employments, in its bearing on
life-assurance, is that of the licensed victualler, whose life is very
generally looked upon with suspicion, and even deemed uninsurable in
the absence of very distinct proof of temperate habits.

Habits of Life. — Luxury, sloth, dissipation, and intemperance, are
all of them very fatal to human life ; but the last is the only one of
which it is easy to obtain distinct proof. When the fact of intempe-
rance is clearly established it aflbi ds groi'.nd for fhe peremptory rejec-
tion of the life. It is also well ascertained that unusual risk attends
the assurance of the lives of persons living in a continual state of pecu-
niary difficulty and embarrassment.

Peculiarity of Constitution. — Under this head it will suffice to
notice the scrofulous constitution ; the long neck and narrow chest so
common in consumptive patients; and the short neck, florid complexion,
large chest, and tendency to corpulency of the victims of apoplexy.

Hereditary Predisposition. — 'The most important of hereditary pre-
dispositions in relation to life-assurance is pulmouaiy consumption, a
disease which destroys one in seven of the entire English population,
and more than one in four of the adult population of the metropolis,
being peculiarly fatal to men following sedentaiy occupations, and to
persons of dissipated and intemperate habits. The inquiries of the

PEE-EXISTING DISEASE. 133

medical examiner should be especially directed to discover traces of
this disease in the family history, and great importance should be
attached to the occurrence of several deaths from this cause among
the nearest relatives. Insanity, gout, asthma, urinary calculus, disease
of the heart, dropsy, and apoplexy, especially when they appear to
have caused the death of more than one member of the family at a
comparatively .early age, are also deserving of the serious attention of
the examiner.

Pre-existing Disease. — The medical examiner will have to form his
own estimate of the influence which previous attacks of disease may
have had upon the health of the applicant and the value of his life.
As a general rule, it may be stated that the febrile exanthemata which
make their attacks chiefly in childhood, and the typhus or typhoid
fever of the adult, do not permanently affect the value of life. Attacks
of erysipelas must be viewed differently, as this is a disease very apt
to recur. The same remark applies to attacks of gout, acute iheu-
matism, and asthma, and in a very peculiar manner to attacks of pul-
monary consumption, a disease which often proves fatal after several
distinct attacks. The importance of the symptom of spitting of
blood, as affording a probability of a previous attack of consumption,
has been already insisted upon. But the medical examiner ought to
bear in mind that vomiting of blood from the stomach may have been
confounded with spitting of blood from the lungs ; and that even where
there is no room to doubt that the blood was brought up by an effort
of coughing, it may have come from the throat, or from some slight
abrasion of the lining membrane of the windpipe. Even when the
blood is shown to have come from the lungs it may have been the
result of some great exertion immediately preceding it, or, in the
absence of such explanation, it may have accompanied the formation of
bronchial polypus, or resulted from the discharge of an aneurism into
the air-passages. In this latter case, the symptom would be still
more formidable than if it had resulted from tubercular disease of the
lung itself. The quantity and colour of the blood alleged to have
been discharged by coughing are points of the utmost importance.
The expectoration of a considerable quantity of vermilion-coloured
blood would always constitute a sufficient ground for the rejection of
a life ; but a scanty expectoration of blood, whether light or dark
coloured, should always lead to a minute and careful examination of
the chest. If inflammation of the lungs, or other severe disease of
those organs, or repeated attacks of bronchitis, figure in the previous
history of the applicant, there would be the same reason for submitting
the chest to careful examination ; for these diseases are not only im-
portant in themselves, but may be the result of tubercular deposit, on
the one hand, or may lay the foundation for mortal diseases of the
heart on the other. Repeated attacks of bronchitis, for instance, may
be expected to occasion emphysema, and to be followed by hypertrophy
of the heart.

134 LIFE-ASSURANCE.

If the medical examination into the applicant's family and personal
history, and into his existing state of health, should prove favourable,
his life would naturally be recommended for assurance on ordinary
terms ; but if unfavourable, the somewhat difficult question arises
whether the life should be altogether rejected or accepted on condition
of a more or less considerable addition to the ordinary premium, or
(what amounts to the same thing) on payment of the premium re-
quired for a healthy person of a more advanced age. Such adjustments
can only be safely made by a medical man of sound experience and
large medical knowledge ; and it would be useless to attempt to lay
down for the guidance of the examiner in this matter any rules, how-
ever general.

But the medical examiner may not only be required to give his
advice in cases of insurance for the whole of life, he may also be
required to determine the propriety of insurances on unsound lives for
short periods, and to suggest the teims upon which they ought to be
effected. Cases are of common occurrence in which it is of the utmost
importance to effect an insurance for a short term, as of one or two
years, upon a life which must be rejected if offered for the whole of
life. A young person, for instance, who has already had symptoms of
pulmonary consumption, and whose chest has been ascertained to be
unsound, may desire to effect an insurance on his life for one year, and
the medical examiner may have to report on the expediency of under-
taking the risk. The considerations which would guide him in his
decision are obvious. Pulmonary consumption may prove fatal in any
one of a considerable series of years, and the chances against an attack
of the disease falling in any particular year are considerable ; and even
on the assumption of its occurring in the year covered by the assurance,
there is the favourable chance of its commencing its attack at a late
period of the year, and either not proving fatal in that attack, or (as
the disease in its fatal attack has an average duration of nearly two
years) not having a fatal issue till long after the period covered by the
assurance has run out. Similar reasonings apply to other severe dis-
eases, and, with little modification, to the assurance of unsound lives.
On this branch of the subject, too, it is not possible to lay down any
precise rules. For forming a right decision upon this class of cases
large professional knowledge must be combined with sound judgment.

On the purely legal bearings of the subject of life assurance little
need be said. It is obvious that the contract entered into in a policy
of insurance may be rendered Void by any intentional concealment or
omission of such particulars of the previous health or habits of the
applicant as, if known, must have caused the life to be rejected, or ac-
cepted only on more onerous terms : also by omitting to name the medical
men who have attended him in any serious illnesses. But even where
there has been no fraudulent concealment, questions have been raised
as to the tendency of particular diseases, such as indigestion, gout, or
mental unsoundness, of accidental injuries, such as fractuies, and of

FEIGNED DISEASES. 135

particular habits, such as smolving and opium-eating, to shorten life.
On all such questions there i-; much room for difference of opinion
among even well-informed medical men.

The definite questions now commonly prepared for the guidance of
the medical examiner, and the experience of insurance offices of the
difficulty of obtaining a verdict in their favour, except in cases of
undoubted fraud, tend greatly to limit the number of actions at law,
and to deprive this subject of some of the legal interest which it for-
merly possessed. But the importance of the subject in every other
point of view, and the value of the services of the medical examiner
and referee, is on the increase as the value of the assurance of life and
health becomes more fully appreciated, and the practice of insurance
proportionally extended.

FEIGNED DISEASES.

Though feigned diseases are not of very great importance in a legal
point of view, and though cases of imposition rarely occupy the atten-
tion of our higher courts of law, the subject is one which very pro-
perly finds a place in a medico-legal treatise.

Diseases and disabilities are feigned from a great variety of motives.
The soldier or sailor pretends to be ill to escape from duty, or to ob-
tain his discharge from the service, and the mendicant to avoid labour.

Sickness is often feigned to obtain parochial relief, or to impose on
private benevolence ; to defraud benefit societies ; to procure the
comforts of an hospital ; to obtain compensation for some pretended
injury; to procure a release from confinement, or exemption from
punishment : and there are many persons, particularly young and un-
married females, who, without hope of gain, feign diseases in order to
excite public interest and curiosity, or private sympathy.

The persons most prone to feign diseases are those who congregate
most ; as soldiers, sailors, prisoners, beggars, and school boys and
girls. But the best school for feigned diseases is the army, especially
in countries where the conscription is in force. Thus Fodere, speaking
of the time when the conscription was in full force in France, says
that malingering " was brought to such perfection, as to render it as
difficult to detect a feigned disease, as to cure a real one."

In treating the subject of feigned diseases a classified list will first
be given of the principal diseases and defects which have been feigned;
and this will be followed by rules for their detection.

Classified List of Feigned Diseases and Defects,

It is difficult to form any classification of feigned diseases which
shall be free from many objections. The most natural is into, 1. Dis-
seases obvious to the senses; 2. Diseases and defects of a simple kind,
not obvious to the senses, but depending upon the description of the
impostor ; and, 3. Diseases of a more complicated nature.

136 FEIGNED DISEASES.

1. Diseases obvious to the Senses,

This class contains the following subdivisions. a. Increased and
diminished size of parts. 6. Malformations, c. Wounds, ulcers, and
superficial inflammations, d. Discharges, e. Spasmodic affections.
/. Paralytic affections.

a. Increased and diminished Size of Farts. — Tumours. A fa-
vourite mode of producing tumours is by injecting air beneath the
cellular membrane — beneath the skin of the abdomen to imitate ascites,
into that of the scrotum to imitate hydrocele and hernia, under the
scalp to give the appearance of hydrocephalus, into various parts of
the limbs, with the assistance of ligatures, to imitate local swellings.
This imposition may be detected by the touch, and by uncovering the
tumour and searching for the aperture through which the air has l»een
introduced, which aperture is generally found covered by a small piece
of plaster. Tumours are also produced by pressure. Swellings on
various parts of the limbs, anasarca, varicose veins, and an appearance
resembling elephantiasis, have been produced by ligatures ; and
oedema of the upper extremity by hanging the limb over the back of a
chair previous to the medical visits. In such cases marks of the pressure
will be discovered on careful search. Tympanites has been imitated
by swallowing air, or drinking large quantities of chalk and vinegar.
In such cases, a solution of Glauber's salts with weak tobacco-water
has proved very efficacious in the hands of Dr. O'Hara. The appear-
ance of an abdominal tumour has also been produced by forcibly
elevating the spine at the loins whilst lying on the back. Tumours
have also been imitated by the use of substances extraneous to the
body, as polypus of the nose, by means of the testes of a cock, or the
kidneys of a rabbit retained in the nostril, and sometimes impregnated
with foetid juices. Strong sternutatories will assist us in unmasking
these cases. Hcem^rrhoids have been imitated by the bladders of rats
or small fish partly introduced into the rectum ; Prolapsus ani by
the gut of an ox or of a sheep, or by the everted anal extremity of the
bowel of a colt or hog. In one case mentioned by Percy and Laurent,
prolapsus ani was actually produced by passing into the anus the
bladder of a sheep, distending it with air, and forcibly retracting it.
Prolapsus uteri has been imitated by similar means ; Hydatids of the
uterus by vesicles prepared from the intestines of a pig ; malignant
tumours by a sponge soaked in various colouring matters ; and Hernia
has been feigned by the injection of air, or by the forcible retraction of
the testicles towards the rings. Cancer has been imitated by a cow's
spleen, and by a sponge moistened with milk, and fixed under the
armpit. Swellings of tlie Joints, intended to represent white swellings,
have been produced by various acrid plants, as the ranunculus acris
and ranunculus sceleratus, applied to the part. Enlargement of the
abdomen in the female has been simulated by a pad. Partial Atrophy
may be produced by pressure.

DISEASES OBVIOUS TO THE SENSES. 137

The frauds contained under this head only require, for their detection,
a careful examination of the part itself, by the eye and by the touch.

b. Malformations. — Lateral curvature of the spine has been imi-
tated. This simulated deformity is always in the dorso-lumbar
region ; the curve always single ; the convex side not gibbous ; there
are folds of skin, generally two in number, on the concave side ; and
the haunch of that side is raised so as to give to the extremity the
appearance of being shortened. In morbid deviations, on the contrary,
the seat of curvature is variable ; there is more than one curvature ;
the convex side is gibbous ; the folds of skin, if present, are very
slightly marked, and there is little or no inclination of the trunk, or
elevation of the haunch. Gibbosity, or elevation of the shoulders, wry
neck, hip-disease, and various contractions of the limbs or joints, are
imitated by obstinate and long-continued flexion of the part, aided by
inaction and the use of tight bandages. Sometimes the contraction is
attributed to a burn or previous injury, in which case a wound is
made to bear out the assertion. More commonly these contractions
are attributed to a previous attack of rheumatism. In these cases
there is generally ground for suspicion when there is no cicatrix, and
no atrophy of the limb, but on the contrary, tension, hai-dness, and
swelling of the contracted muscles. Many means have been proposed
for the detection of this class of impositions ; such as compressing by
a tourniquet the nerves supplying the contracted muscles ; applying a
wet bandage tightly round the limb, which, when dry, may so com-
press the muscles as to prevent the continuance of their contraction ;
endeavouring to move the limb during natural sleep, or during that
produced by narcotics ; the examination of the limb during the sick-
ness and weakness produced by an emetic, or by intoxication, or,
better still, by chloroform ; the electric shock; gradual and repeated
tension of the contracted limb by means of a pulley or weights ; making
a sudden extension whilst the attention is engaged ; applying the
actual cautery should that remedy be indicated in the real disease ; or
recommending the warm climate of the coast of Africa as a cure. In
some cases the most effectual method ©f all is to treat the deformity
as a matter of no importance, not requiring surgical treatment.
Dislocations may be effected intentionally. Those of the shoulder-
joint and patella are the most easily accomplished. Fractures, when
real, are often prevented from healing by frequent motion, leading to
the formation of false joints.

c. Wounds, Ulcers, and Superficial Inflammations. — Mutilation is
a very common practice in the army, and especially in regiments sub-
mitted to very strict and harassing duties. In countries in which the
conscription is in force, the practice is carried to an extraordinary
extent. This is the case in France, and to a still greater extent in
Egypt, in which unhappy country, it is stated to be difficult to meet
with a single unmutilated male adult. Wounds. — The distinction be-
tween wounds self-inflicted and inflicted by others, or taking place

138 FEIGNED DISEASES.

accidentally, will be considered under the head of wounds. Bruises
have been imitated by colouring materials, but not being true to nature
they are easily detected by the expeiienced eye. Ulcers are among
the most common of feigned diseases, and when they exist naturally
they are often intentionally increased. The means most commonly
resorted to are corrosive acids and alkalies, caustics, corrosive subli-
mate, arsenic and its sulphuret, copper wii'e, acetate of copper, blis-
tering plaster, quicklime, the flame of burning bodies, the ashes and
chewed leaves of tobacco, the vegetable acrids, especially the ranunculus
acris and sceleratus, the mezereon or spurge-laurel, the euphorbium,
the arum maculatum, and the juniper. Ulcers are also excited by
mechanical means, as by pressure and friction — pressure by pieces of
copper coin, and friction by sand. Occasionally in place of being
produced or increased by the use of irritants, ulcers are imitated by
gluing a portion of a spleen or the skin of a frog on the pai-t, the
surface being kept moist by a sponge dipped in blood and water. The
most common situation of these factitious ulcers is the lower extre-
mities. Factitious ulcers may often be detected by simple inspection
of the surface and dressings, or by a closer examination with the lens.
The sudden increase of inflammation on and about the ulcer will
naturally excite a suspicion of the use of irritants; and the healthy
appearance of the impostor will often be found at variance with the
extent of ulceration. In hospitals, when there is ground for suspicion
that an ulcer is prevented from healing by the use of irritants, a wooden
box completely enclosing the leg has been used with the best effect.
Fistula in Ano and in Perineo have been imitated by a punctured
wound into which a tent covered with some irritating substance, or
made of the root of the milk thistle, or of white hellebore, is intro-
duced. A variety of cutaneous diseases have been feigned, or inten-
tionally produced, as lupus by the application of pounded garlic, and
the juice of the euphorbium ; erysipelas by a short application of
blisters ; urticaria, by eating shell-fish ; psoriasis and impetigo, by
the use of strong rubefacients ; pompjiolyx, by blistering plaster ;
scabieSf by punctures irritated with gunpowder; porrigo, by nitric
acid dropped upon the hand, and by othe)- irritants ; as also by a paste
composed of rancid butter, honey, sulphur, and a small quantity of the
powder of cantharides ; baldness has been effected by the use of nitric
acid. Variola in its eruptive stage has been imitated by punctures
into which bay-salt and gunpowder were afterwards rubbed. The
discolouration of the skin in jaundice has been imitated by a variety of
colouring materials.

To this division belong certain affections of the eyes, which are ob-
vious to the senses. Ophthalmia has been purposely produced by
gonorrhceal matter, nitric acid, corrosive sublimate, sulphate of
copper, nitrate of silver, lime, pepper, snuff, the smoke and juice of
tobacco, salt, alum, the powdered root of euphorbium, a blast of cold
air, cantharides, friction, and the introduction of fragments of cloth or

DISEASES OBVIOUS TO THE SENSES. DISCHARGES. 139

muslin. The counterfeit disease is generally confined to one eye, and
that the right : its progress is veiy rapid, the swelling and inflamma-
tion are chiefly in the conjunctiva, and cease when tlie vision becomes
imperfect. The eye is rarely so much disorganized as in the real
ophthalmia. Factitious ophthalmia, when it occurs in the army, is
apt to attack only the privates and non-commissioned officers. The
use of irritants in the form of powder can often be detected, as in the
case of ulcers, by simple inspection. Ophthalmia tarsi has been
simulated by the use of strong irritants, or by the extraction of the
eyelashes. A healthy aspect of countenance would lead us to suspect
the fraud which had been practised, as ophthalmia tarsi rarely occurs
in any but the scrofulous and cachectic. Opacity of the cornea has
been caused by dropping strong acid into the eye, or by introducing a
fragment of lime or of some other strong irritant. Cataract, too, has
been produced by the introduction of a fine needle through the cornea
to the lens.

d. Discharges. Vomiting is a frequent factitious symptom of
disease. It is effected by pressing on the pit of the stomach, by swal-
lowing air, by a strong and sudden action of the abdominal muscles
assisted by tickling the fauces, and by the use of emetics. The matters
rejected from the stomach are common water, urine, and even faeces,
all of which had been previously swallowed. The larva of insects
have also been mixed with substances stated to have been vomited.
Factitious vomiting is generally unaccompanied by emaciation, and the
fraud is often readily detected by the absence of the other concomitants
of those diseases of which vomiting is a symptom. Diarrhoea and
dysentery, too, are often feigned or produced at will ; feigned, by
breaking down an ordinary evacuation and mixing it with urine ;
produced, by a mixture of vinegar and burnt cork, by a solution of
the sulphate of iron, by drastic purgatives, or by the introduction of
irritating substances into the rectum. The evacuations are sometimes
tinged with blood procured by puncture, laceration, or strong suction
of the gums, or they are coloured of a dark red by logwood, green by
senna, and black by deep-coloured wines. A careful examination of
the evacuations, the use of a separate close-stool, the inspection of the
linen, and a comparison of the symptoms present with those of the
simulated disease, will assist in discovering the fraud. Ascarides have
been clumsily imitated, as in an out-patient of King's College
Hospital, by pieces of thread, one of which was red. A species of
lizard was placed in the evacuations, in a case related by Dr. Spence.
Alterations in the secretion of urine belong to this division. Alleged
urinary concretions have been found to consist of sand, pebbles, and
pieces of quartz and flint. Fragments of brick or slate, and small
pebbles, have been introduced into the urethra to bear out the alleged
existence of urinary calculus ; and calcined bricks, coals, and fragments
of bone have been introduced into the vagina with the like intention.-
Mere inspection assisted, in some cases, by chemical tests, will serve to

140 FEIGNED DISEASES.

unmask such impositions. Hematuria has been simulated by the use
of beet-voot, maddei", cochineal, the Indian fig, the fruit of the prickly
pear, and logwood ; blood has also been injected into tlie bladder,
or mixed with the urine after it has been passed, or it has been
obtained from the mucous membrane of the urethra by scratching.
Haematuria may also be caused by substances taken internally, as
savin, cantharides, and turpentine. The urine may be tinged of dif-
ferent colours by substances taken internally, such as madder, log-
wood, indigo, rhubarb, black cherries, the whortle-berry, the pulp of
cassia fistula, elder rob, and ferrocyanate of potass, or of iron. Milk
has been added to the urine to give it a white colour. In all suspicious
cases, the patient should be made to pass urine in the presence of the
medical man. The absence of the local and constitutional symptoms
attending the more severe affections of the kidney and bladder would
naturally excite suspicion, and assist the diagnosis. Gonorrhoea has
been imitated by the use of caustics ; the menstrual discharge by
staining the linen with bullock's blood ; and Epistaxis has been pro-
duced by incisions. Hcemoptysis is a favourite factitious disease. It
is imitated by holding in the mouth a sponge filled with blood, by
incisions on the inside of the mouth or back of the throat, by pricking
the gums, or by blood sucked from other parts of the body ; or pastilles
coloured with carmine, Armenian bole, brickdust, or vermilion, have
been used for the same purpose. In suspicious cases, the mouth should
be carefully examined, and rinsed out with water, the rejected fluid
inspected, and, if necessary, analyzed : the chest also should be examined.
Hoematernesis is simulated by swallowing the blood of some animal.
OtorrJicea is simulated by honey, pus, rancid tallow^ asafoetida, or old
cheese, introduced into the meatus : it has been excited by cantharides,
or by irritating liquids. Ozoena has been imitated and excited by
similar means. Foetid breath and perspiration have been produced
by oil of dippel, asafoetida, old cheese, putrifying fish, and the rancid
oil from a cart wheel. Emetics in the one case, and ablutions in the
other, with careful watching, will serve to detect the imposture.

e. Spasmodic affections. This class of diseases is frequently and
successfully feigned. Epilepsy is the disease generally chosen for
imitation, as it has the peculiar recommendation of being assumed
at such times as suit the impostor's convenience. In addition to the
violent struggles which form the prominent feature of the true disease,
impostors have contrived to inflict bruises upon different parts of their
persons as evidence of former attacks, to vomit blood previously
swallowed, to imitate the foam at the mouth by chewing soap, and to
discharge the urine as if involuntarily. As in the true epileptic seizure
there is an entire absence of sensibility, the feigned disease is readily
detected by any harmless infliction of pain, or by the use of some
powerful stimulant. The stimulants commonly recommended for
this purpose are, the vapours of hartshorn, or of sulphur, snuff,
pepper, or asafoetida, applied to the nostril ; a few drops of alcohol

SPASMODIC AFFECTIONS. 141

or tui'pentine poured into the eye ; a solution of aloes and salt, mustard,
or common salt, placed in the mouth ; hot water, or actual flame
applied to the slvin. Sharp-pointed instruments have sometimes been
introduced into the flesh, but without detecting the imposition.
The mechanical stimulus least objectionable, and most likely to be
effectual, is the flecking of the naked feet with a wet towel or hand-
kerchief. Other diagnostic marks between the true and the fictitious
epileptic seizure might be mentioned; but they are of little value in
comparison with these direct tests. Convulsions. These irregular
actions of the muscles have been rife in all ages, partly as the i-esult
of involuntary imitation, and partly as the consequence of imposition.
They are most frequent in females ; but are by no means confined to
that sex. The chief difference between real and feigned convulsions is
that the real may be continued for a long time with comparatively little
exhaustion, while the factitious soon occasion fatigue. To discover the
fraud "it is sufficient to act with force on the antagonist muscles."
(Orfila.) The impostor may also be tired out by long watching. Two
cases of pretended local convulsive movements have come under the
notice of the author. In one case the muscles of the abdomen were the
seat of the contortions; in the other the muscles of the shoulders. Chorea.
This, like other forms of convulsion, has often been the offspring of
fanaticism, of involuntary imitation, and of voluntary deception. It
is more easily feigned than epilepsy. When skilfully imitated the
diagnosis is not easy, and many of the distinctions laid down in books
are without foundation. Cold affusions and electricity, which may be
used with propriety in true chorea, are not pleasant remedies for im-
postors, and are therefore greatly to be commended. Hysteria. It is
of little consequence whether an attack of hysteria be feigned or not :
cold affusion, which is the best remedy for the real disease, is not a
pleasant application in feigned attacks. Whether it cures the real
disease or leads to the fictitious one being laid aside is a matter of
little moment. Catalepsy is a very rare disease, and its existence,
especially in a male, may fairly justify some degree of suspicion.
Powerful stimulants, the proposal of the actual cautery while the
finger is on the pulse, appending a weight to the extended limb and
cutting the string suddenly, have been recommended and practised
with effect in feigned cases. Attempts have been made to feign te-
tanus and hydrophobia but they were unsuccessful. The fingers have
been forcibly contracted, and the nails driven into the palm of the hand.
By wearying the muscles with a conical piece of wood the imposition is
readily detected. Stammering is often feigned. The best distinction
is founded on the fact, that true stammerers hesitate little or not at all
in repeating what they know by heart, and in singing. Strabismus,
Nictitation, and Blepharospasmus are unimportant and easily pre-
tended. Dysphagia, when feigned, may be cured by the persevering
use of the probang. , The suspected person should be narrowly
watched. Stricture of the urethra has been feigned, but as the treat-

142 FEIGNED DISEASES.

ment of the real disease is not agreeable, the imposition is not likely
to be persevered in.

/. Paralytic Affections (Hemiplegia, Paraplegia, and Local Para-
lysis). In true paralysis, the parts affected are relaxed and emaciated,
and their tempeiature is lowered. In paraplegia, the urine generally
undergoes a maiked change. These characters are not piesent in the
fictitious malady. Every form of partial paralysis has been feigned.
In paralysis of the fore-arm and hand, and more rarely of the entire
upper or lower extremity, the discovery of a blue line on the gums
would give good grounds for believing the paralysis real. Paralysis
agitaiis. In attempting to imitate this disease the impostor generally
overdoes his part. It is considered characteristic of the real disease
that the patient in attempting to walk "is impelled unwillingly to
adopt a running pace." The pretender, on the other hand, is apt to
hesitate in his movements and to advance with difficulty. It happens
fortunately in this, as in most diseases of this class, that the remedies
proper for the disease are not agreeable ones ; and where there is a good
ground for suspicion, low diet will be found a useful auxiliary. Ptosis.
The impostor generally makes attempts to prevent the raising of the
eyelid, and this leads to detection. Insensibility, when feigned, may
be detected by the use of stimulants, and the imposition will often be
discovered by inconsistent statements as to the cause. Coma and
Lethargy have been very successfully feigned, and in one or two
instances the impostor has resisted every stimulant that could be
thought of: in one case the operation of trephining caused merely
a single groan. The treatment which we should be justified in
resorting to if the complaint were real would prove a trying discipline
to most impostors. Syncope. This scarcely admits of being feigned,
for if the impostor can contrive to grow pale, he can scarcely control
the action of the heart and arteries. More than one case, howeA''ei-,
of a voluntary control over the circulation is on record, of which the
best authenticated — that of Colonel Townshend — will be found in the
chapter on Real and Apparent Death. Death itself has been feigned,
and in one or two cases with such success as to deceive the common
observer ; and, in the solitary case of Colonel Townshend, so as to
deceive medical men themselves. Poisoning has been feigned in some
instances and imputed in others. The same rules apply to the detec-
tion of the first class of cases as to the detection of a feigned disease.
We must compare the symptoms present with the known symptoms of
poisoning generally, or of special poisons. Cases will also be given,
under the heads of hanging and drowning, of the fraudulent disposal of
a dead body so as that death may appear to have been due to those
causes. Among prisoners unreal attempts at suicide by suspension or
strangulation are very common. The attempt is usually made when
assistance is known to be at hand. The feigned' insensibility which
follows is best unmasked by the electric shock.

DIMINISHED SENSATION. 148

2. Diseases and defects of a simple kind not obvious to the senses,
but depending chiefly upon the description of the impostor.

The principal diseases belonging to this class consist in, a, increased
and b, diminished sensation.

a. Increased Sensation. — Pain. This common symptom of disease
is easy to assume and difficult to detect. External pain, such as tic-
douloureux, often occurs in persons other wise, to all appearance, healthy ;
and there are many pains of a severe character, of which the cause is
extremely obscure. Many cases are also on record in which severe pain
has arisen from a cause that has escaped observation, and the sufferers
have been treated as if the pain were pretended. The nature of the
pain, the appearance of the patient, the presence of the symptoms of
disease with which it is ordinarily associated, and the consistent ac-
count given of its origin and progress, will assist us in distinguishing
real from pretended suffering. But great caution and patience are
necessary. Remarkable cases are recorded of submission to the most
severe and trying remedies, and even to the removal of the breasts
and limbs for simulated neuralgic affections. Fain in the head, and
the giddiness which often accompanies it, are also easily feigned, and
not easily proved to be so. No certain rules of diagnosis can be laid
down in this class of cases ; and in the case of pains in the head, as in
pains in other parts of the body, real sufferings have been mistaken for
pretended ones. Rheumatic pains in various parts of the body, es-
pecially in the loins and thighs, are often feigned ; and, as they are not
accompanied by any change in the parts affected, or by any well-marked
constitutional symptom, with success. In many works on feigned dis-
eases, long rules are given for detecting feigned pain, and the symptoms
of almost every disease accompanied by pain are detailed with a minute-
ness as unnecessary as it is useless ; for it may be stated as a general
rule that feigned diseases of the more obscure class can be detected only
by those who have extensive experience of real ones.

6. Diminished Sensation. — A diminution or entire absence of sensa-
tion is frequently pietended. Amaurosis is a favourite feigned disease,
and is often produced intentionally. The substances employed for this
purpose are the juice or extract of belladonna or hyoscyamus, the dis-
tilled water of the spurge laurel, and snuff moistened with a decoction
of belladonna. The amaurosis produced by these means is not at first
distinguishable from the real ; but it disappears if the impostor be
carefully isolated and watched. Of the perseverance with which the
pretence of blindness is sometimes carried out, a case related by Mahon
affords a good illustration. A recruit feigned blindness, and, after all
other means had been tried without success, he was placed on the bank
of a river, and ordered to walk forward, which he did. He afterwards
confessed the imposture. Myopia. — Short-sightedness being a disability
in the army is often feigned. It may be detected by placing an open

144 FEIGNED DI8EASE8.

book close to the face, or by requiring the suspected person to read
print at some distance by the aid of glasses for the near-sighted. If
the individual cannot read the book when thus placed, or when such
glasses are used, we may be sure that the defect is feigned. Presbyopia
is i-arely feigned. The mode of detection is the converse of the pre-
ceding. ' Ambli/opia, or weakness of sight, is also rarely pretended. In
the army, the surest way to put a stop to these pretended defects, is to
employ the subjects of them in some service for which the real defect
would"^ not unfit them. Nyctalopia. — Night-blindness. This disease
is peculiar to warm climates, in which the sun's rays have great power.
There are no satisfactoi7 means of distinguishing the true from the
feigned disease, as opposite states of pupil may exist in different cases.
Here, too, it is useful to find for the real or pretended nyctalope some
employment for which the affection, if real, does not incapacitate him.
Ifemeralopia, or day-blindness. This disease is not of much imjx)rt-
ance. It sometimes ocdurs for a short time as a symptom of worms,
or of other intestinal irritation. The diagnosis will depend upon our
knowledge of the disease of which it is 3 symptom. Deafness. — As
this may occur without any change in the appearance of the external
ear, it is a favourite imposition, the modes of detecting it are obvious.
A watch should be set on the suspected person day and night, and things
calculated to excite interest or apprehension should be said in his pre-
sence, and the effect be carefully watched. It has been recommended
to place the hand on the pulse while any bad news, or threat of punish-
ment, is being uttered. He should be called sharply or unexpectedly
by name, or in a whisper, or he should be roused from sleep and spoken
to, or a piece of money should be let fall close to him. All these, and
similar tests, have often been applied in vain ; sometimes, too, the
loudest noises have not produced any apparent effect. In one case,
related by Dunlop, a pistol was fired off close to the ear without efl'ect ;
but upon the man bemg sent to sleep by opium, the imposition was
detected on the repetition of the firing. Dumbness. — This is sometimes
assumed with great perseverance. As a general rule it may be stated,
that if a man not deaf can move his tongue he is not dumb. Nothing
but complete paralysis can account for his being dumb. Some mutes
add to pretended dumbness a feigned mutilation of the organ, which
they effect by rolling the tongue back into the throat, and scratching
it so as to make it bleed. A relative of the author's detected such an
imposition in the case of a man who, by means of a written paper
describing his captivity among the Algerines and his mutilation by
them, had excited great commiseration. Pretending to give entire
credence to the man's tale, and taking a half-crown out of his pocket,
he requested the man to show him his tongue once more, upon which
he thrust his finger suddenly against the root, and the tongue rolled
out. Dcaf-dii.mbness. — The combination of deafness and dumbness,
though never occurring in a person previously in possession of both
these faculties, is sometimes obstinately pretended. The impostor is

FEVER. 145

best made to lay aside his imposture by solitary confinement and low
diet. In one or two remarkable instances, men who have pretended
that they were born deaf and dumb, have resisted every test, and
have been discovered only by those having personal experience of the
really deaf and dumb.

3. Diseases of a more complicated kind.

In the two foregoing divisions those impositions have been considered
which consist of a single appearance or outward manifestation, tangible
or visible to the senses ; or of a single alleged symptom or defect, not
necessarily combined with other symptoms, or which, if sometimes
forming part of a disease, deserve separate consideration. It now re-
mains to speak of instances in which whole trains of symptoms proper
to certain diseases have been assumed, with more or less success. This
division consists of two classes : a. Diseases of the body. 6. Diseases
of the mind.

a. Diseases of the Body. — Fever may be either feigned or purposely
excited. Fodere states, that he has often seen impostors produce an
extraordinary frequency of pulse, accompanied with chattering of the
teeth and profound sighs. Febrile symptoms may be excited by strong
stimulants, such as wine, brandy, cantharides ; and by the internal use
of tobacco, which drug has a remarkable effect on the pulse ; also by
the introduction of a clove of garlic into the rectum. Violent exercise,
or strong contraction of the limbs, or a heap of blankets, has been
resorted to as a means of imitating fever. The tongue has been
whitened by chalk, pipeclay, soap, flour, or whiting ; and tinged
brown by tobacco, brick-dust, liquorice, or gingerbread. Pallor of the
skin has been imitated by the use of emetics, by smoking, by digitalis, or
by drinking an infusion of cumin seeds. A flush, on the other hand,
is produced by friction. The detection of cases of simulated fever is
easy. The effects are always ephemeral, and all that is necessary is to
have the patient watched for a few hours. Ague is often feigned, but
not with much success. The effort necessary to imitate the rigors
throws the impostor into a perspiration, which leads to detection. The
shivering fit is not followed by the other stages. Bheumatism. — The
acute form is not easily feigned ; but the chronic form consisting chiefly
in pain, and having no strongly-marked accompanying symptoms, has
often been, as already stated, imitated with success. Various affections
of the chest are assumed by impostors. Pneumonia. — In one instance
mentioned by Dr. Gavin this disease was assumed, but not very
successfully. The stethoscope would serve at once to prove its non-
existence. Phthisis. — It would be diflicult to deceive a careful ob-
server, or one skilled in the use of the stethoscope ; but many symp-
toms of the disease have been successfully assumed. Heemoptysis and
mucous expectoration have been imitated in the manner already de-
scribed. Emaciation may be produced by abstinence, by drinking

L

146 FEIGNED DISEASES.

vinegar, or by sucking a copper coin ; febrile symptoms by the means
just pointed out. Asthma, also, has been imitated, but here the
stethoscope will assist in the detection of the imposition. Apoplexy
cannot be successfully feigned. The fraud is easily detected by ster-
nutatories, or by strong stimulants. Dyspepsia. — This disease is
often feigned, and sometimes with success. Vomiting, gastralgia,
pyrosis, and in fact all the symptoms of dyspepsia have been assumed,
and the imposition has been detected only by careful watching. Gas-
tritis, or acute dyspepsia, has also been assumed, but it is difficult to
imitate it with success. Constant vomiting is not easily feigned, nor
is the bright-red tongue, often present in acute gastritis. Peritonitis,
too, has been imitated, but rarely with much success. In one case in
which there was a pretence of great pain increased by pressure, a dose
of opium was given, and the man bore very strong pressure without
being roused from sleep. Hepatitis in its chronic form is a favourite
feigned disease, as it is very prevalent in hot climates, and is supposed
to be of very frequent occurrence in this coimtry. The dull heavy
pain in the right side is easily assumed, and the pain in the shoulder,
but the discoloured eye and skin, the unhealthy aspect of the counte-
nance, and the mental depression and listlessness not so readily.
Jaundice has been imitated by staining the skin with an infusion of
the root of curcuma longa, or of saffron, with tincture of rhubarb, the
bruised seeds of the broom, or the stamens of the iris. Clay-coloured
stools have been produced by taking a small quantity of muriatic acid,
and the colour of the urine has been heightened by rhubarb. Attempts
have also been made to pass off pebbles for gall-stones. It is notreasy
to tinge the conjunctiva yellow, nor to produce at one and the same
time the yellow skin, the pale stools, and the highrcoloured urine. It
must be borne in mind, however, that in the real disease the fseces are
not always pale, but that occasionally they contain an excess of bile.
Scurvy. — One prominent symptom of this affection is often imitated,
viz., the spongy and bleeding gums. For this purpose, various irri-
tating substances are used, or the gums are punctured previously to
the visit. As this is but one symptom, and the otheis are not easily
feigned, this imposition will present but little difficulty. Nephritis. —
The pain which accompanies this disease has been assumed, and the
assertion has been borae out by the exhibition of pebbles or fragments
of brick. It is scarcely necessary to state that it is almost impossible
for an impostor to assume all the symptoms of nephritis.

Much more might be said on this division of feigned diseases, and
minute rules for diagnosis might be laid down : but want of space, and
the assurance that it is not by descriptions of diseases, but by actual
experience of them, that the true are to be distinguished from the false,
has led to the subject being thus briefly handled. Those who are
familiar with treatises on this subject will know how much of false
diagnosis they contain. In doubtful cases, a reference to the best
description of the disease supposed to be assumed is strongly recom-

RULES FOR THEIR DETECTION. 147

mended, but it must be borne in mind that symptoms commonly con-
sidered as of high diagnostic value may be absent in the real affection,
and may lead to unjust suspicions.

h. Mental Disorders. — Feigned insanity is of so much importance
that it will be treated in the next chapter under the head of unsound-
ness of mind.

The following general rules may render some assistance in distin-
guishing a feigned disease from a real one.

RULES FOR THE DETECTION OF FEIGNED AND FACTITIOUS
DISEASES.

1. Inquire, in all cases, into the existence of motives for deception.
Will the suspected person, by imposition, gain anything he desires, or
escape anything he dreads ? It should, however, be borne in mind
that both men and women feign diseases from other motives than
those of gain ; and occasionally there is so complete an absence of all
discoverable motive, that we are forced to believe in the existence of a
moral insanity displaying itself in this way.

2. Inquire into the previous history of the patient, and the character
he bears among his comrades or companions. It often happens that
the impostor has been previously noted for dishonesty, and for prac-
tices similar to those of which he is suspected. But, in other instances,
men of the best character, who have for years conducted themselves
with propriety, have been convicted of malingering.

3. In the case of external diseases obvious to the senses, make a
minute and careful inspection of the part itself, and examine it by the
eye and by the touch. When there is a suspicion of the use of irri-
tating substances, inspect the part narrowly with the aid of the lens,
and search the pockets, boxes, or bed of the suspected party, and if
necessary isolate him so as to deprive him of the assistance of others,
and of his means of deception. Use equal care in inspecting substances
alleged to have been discharged, and examine them, if necessary, by the
microscope or by chemical tests. In cases of rigidity, anchylosis, or
deformity, examine the suspected person when under the influence of
chloroform.

4. When some defect, or disability not obvious to the senses, but
depending entirely upon the assertion of the person himself, as pain,
deafness, &c., is supposed to be assumed, we must endeavour to take
him by surprise. In the case of pretended deafness, for instance, we
must try to discover the imposition by sudden and unexpected noises,
by speaking to the suspected person immediately on his being roused
from sleep, or when his power of self-control has been impaired by
opium or chloroform.

5. In cases of feigned diseases, properly so called, we must examine
minutely into the history and alleged causes of the disease ; compare
the age, temperament, and mode of life of the suspected person with

148 FEIGNED DISEASES.

the symptoms present ; watch narrowly the course of the symptoms,
and contrast it with the known march of the disease itself.

6. The suspected peison should be visited at all hours of the day,
and at times at which he does not expect to be seen ; and he should be
watched by those whom he is not likely to suspect.

7. The questions addressed to a suspected person should be of a
nature to mislead him : they should be so framed as to lead him into
the assumption of symptoms foreign to the malady which he is simu-
lating. By concealing the suspicions really entertained, and foretelling,
in the hearing of the suspected person, the advent of symptoms which
do not belong to the assumed disease, the malingerer may often be made
to betray himself.

8. Observe whether the suspected person is willing to make use of
the medicines and measures prescribed for his relief. The impostor is
generally less disposed to resort to the necessary means than he who is
really ill.

9. Great caution is necessary in the treatment of suspicious cases.
As a general rule, no measures ought to be employed which would not
be justifiable on the supposition of the disease being real. But when
thei e seems to be strong ground for suspicion, low diet, isolation, and
nauseous medicines may be fairly resorted to. When the disease sup-
posed to be assumed is one which does not affect life (such as spasmodic
twitchings of the muscles), it will often suffice to treat it with indif-
ference, and to dissuade the suspected person from having recourse to
medical treatment. Persons who wantonly abstain from food will
generally desist if allusion is made in their hearing to cases of pro-
longed abstinence; and those who refuse to take exercise may be
influenced by being placed on a lower diet.

Closely connected with the subject of feigned diseases is that of
disqualifying diseases. It is chiefly interesting to military and naval
surgeons; but cases occasionally occur in civil life in which the
medical man is required to state his opinion.. He may be directed
to ascertain whether an individual is fit to serve on a jury ; whether
he is able to attend as a witness ; whether he is competent to take on
him certain offices or duties ; or whether he can bear hard labour, or
other severe punishment, which he may be sentenced to undergo.
The medical man may also be called upon to ascertain the state of
health of persons wishing to effect insurances upon their lives, and
of children presenting themselves for admission into some of our
public schools. The subject of exemption on the gi-ound of disquali-
fication in civil and criminal cases scarcely requires, or admits of, any
precise rules ; and disqualification for military service is a subject of
too great extent to be treated of usefully in this place. There is the
less necessity for its introduction here, inasmuch as the military surgeon
is required to possess some work on his recruiting duties. The foregoing
obsei-vations on feigned and factitious maladies apply equally to malin-
gerers in the army and skulkers in the navy as to impostors in civil life.

149

CHAPTER V.

UNSOUNDNESS OF MIND.

The occasions on which the medical man may be required to give
evidence as to the condition of the mind are very numerous. A man
makes a will, and his relations dispute its validity : was the testator,
at the time of making the will, in full possession of his faculties ? A
man squanders his property, or is accused of so doing : is he competent
to manage his affairs? A man or woman contracts an unsuitable
marriage : was the party possessed of such an amount of intellect, or
in such a state of mind, as to give a valid consent to the contract ?
A criminal, or a person under accusation, makes a confession: was he
in a sound state of mind when he made it ? An act of great atrocity
is committed : is the man who committed it in such a state of mind as
to make him responsible for his act ? A criminal is supposed to feign
insanity in order to escape from the consequences of his crime : is he
really of unsound mind ? That these questions are of frequent occur-
rence may be inferred from the fact that the ascertained number of
persons of unsound mind in England and Wales does not fall much
short of 35,000. The medical man may be summoned to give evidence
on the state of a person's mind before any of our courts of law, civil,
criminal, or ecclesiastical ; before commissions technically designated
de lunaticQ inquirendo ; and in the case of pauper lunatics, before the
magistrate. He may also be called upon to sign certificates of unsound-
ness, at the instance of private persons, with a view to provide for the
safe custody of those who are either unable to take care of themselves,
or so afflicted as to be dangerous to society.

All inquiries into the state of the mind are surrounded by peculiar
difficulties — difficulties partly inherent in the subject itself, partly due
to the requirements of the law. The difficulties inherent in the subject
itself arise, in part, out of the great original differences between mind
and mind, the various degrees of development which they derive from
education, and the equally various degrees of restraint to which they
are subject in each period of life. Other sources of difficulty are to be
found in the purely inferential character of our knowledge of the
human mind, in the inapplicability to it of the method of experiment,
in the want of any recognized standard of sanity, and in the necessity
under which we are all placed of erecting our own mental experience
into^, standard to which to refer the operation of other minds. Minds
thus different in original power, and in acquired habits, are known to
be variously afi'ected by the same physical and moral causes, and to be

150 UNSOUNDNESS OF MIND.

subject to many distinct forms of disease displaying themselves in lan-
guage and acts of the most vaiious character. J^ome part of the difficulty
which surrounds this subject is also to be attributed to the undue
importance formerly given, in works on the human mind, to one or
two of its higher faculties. The reason and the imagination were put
so prominently forward, and the emotions and passions were made
to play so subordinate a part, that soundness and unsoundness of mind
came to be regarded as almost synonymous with a sound or erring
reason ; imagination had to bear all the blame of misleading the judg-
ment ; and delusion became the favourite test of insanity.

A more simple and practical theory of the human mind, recognizing
the existence of several distinct faculties, has now taken the place of
the narrow speculations of the older metaphysicians ; and this theory
of separate faculties, originally of different power in dilTerent persons,
more or less improved by education and habit, under greater or less
restraint fiom without or within, subject to different degrees of excite-
ment ; from causes acting within the body itself or from without,
som'^times alone and sometimes in combination, is the theory which
best agrees with reason and experience, offers the readiest explanation
of the almost infinite variety of character, the endless diversities of
opinion, and the strange eccentricities of conduct prevailing among
mankind, and is most in harmony with what we know of the unsound
mind.

The difficulties due to the requirements of the law originate in part
from the lawyer's necessary ignorance of the unsound mind, the narrow
views which have been handed down to him upon the subject, and the
arbitrary selection of tests difficult, if not impossible, of application.
The medical witness is accordingly often asked to define that which is
properly a subject of description, and is tortured with questions which
if he ventures to answer according to his belief, he lays himself open to
the charge of presumption, if not of impiety.

In discussing the subject of unsoundness of mind, it is important to
premise that it is not possible to frame a single definition of that state,
nor to present a just view of it in a single description. For mental
unsoundness assumes many shapes, and admits of many divisions and
subdivisions, with a coi'responding nomenclature. In searching after a
just classification and an appropriate nomenclature, it is desirable to
adopt, as far as practicable, the divisions and names sanctioned by legal
usage. Wherever, then, the law defines with precision the meaning of
the terms it uses, those terms will be preferred ; and where no fitting
word has been provided characteristic of a given state of the unsound
mind, that will be employed which is in most common use by the best
medical authorities.

In searching for a term proper to designate all departures from the
more usual state of the mind, we necessaiily encounter the woids
*' mad" and " insane," descriptive of the person affected, " madness"
and " insanity," descriptive of the state of the sufferer. These terms

ITS VARIETIES. 151

might be adopted at once if they were commonly employed as the
exact opposites, respectively, of the words " sane" and " sanity."
But they are generally used in a restricted sense, as applied chiefly to
those deviations from the healthy condition of the mind which consist
in excessive and disproportioned activity, and are rarely, if ever, applied
to those states of mind characterized by deficient energy of action,
whether original or acquired. It is necessary, therefore, to make
choice of terms which, being in less common use, may be more easily
restricted in their meaning. Such are the terms " Unsoundness of
mind" applied to the condition of the mind itself, and " Non compos
mentis" applied to the person whose mind is affected.

But even these two terms are not free from objection, for the term
"Unsoundness of mind" has not been always employed by legal
authorities in a strict and limited sense. In the Portsmouth case, for
instance. Lord Eldon spoke of unsoundness of mind as a state re-
quiring to be distinguished both from idiocy and lunacy, and in many
statutes it is found associated with the words Idiot and Lunatic.

The term " Unsoundness of mind," then, which seemed so simple
and intelligible, is open to serious objection : but as it is to be preferred
to the term Insanity, or to any other in common use, it has been
placed at the head of this chapter.

The other term, " Non compos mentis," applied to persons who
are of unsound mind, has been used by legal authorities with much
greater consistency, and should be employed in preference to all others.

Having thus made choice of a term comprehensive enough to include
all deviations from a sound condition of the mind, we have next to
inquire what the law includes under this term, non compos mentis,
what forms of unsoundness it recognizes, and how far it may be con-
sistent with our knowledge as medical men to adopt a subdivision in
accordance with the legal terms in most common use.

The common law of England originally included under this term
only two forms of unsoundness, viz.. Idiocy and Lunacy, but the
highest legal authorities have acknowledged the necessity of more
minute subdivisions. Thus Lord Coke recognizes four sorts of non
compos mentis. — " 1. Idiota, which from his nativitv by a perpetual
infirmity is non compos mentis. 2. He that by sickness, grief, or other
accident wholly loseth his memory and understanding. 3. A lunatic
that hath sometime his understanding, and sometime not, aliquando
gaudet lucidis intervallis, and therefore he is called non compos mentis,
so long as he hath not understanding. Lastly, he that by his own
vicious act for a time depriveth himself of his memory and under-
standing, as he that is drunken."

We have here distinctly recognized three forms of unsoundness of
mind, Idiocy, Dementia, and Lunacy, of which the first two alone are
sufficiently well defined and understood to admit of being employed
both by lawyers and physicians as part of a classification of the forms
of mental unsoundness. The term lunacy is objectionable, inasmuch

152

UNSOUNDNESS OP MIND.

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SPECTRAL ILLUSIONS. 153

As the subject of unsoundness of mind is one of vast extent, and
embraces a great amount of details, a methodical arrangement of it is
absolutely requisite. It is proposed to treat it under the following
heads: — 1st. Of certain unusual conditions of the mind not included
under the general term mental unsoundness, and of the phenomena
of dreaming. 2. Of certain condftions of tlie mind allied to mental
unsoundness, but produced by temporary causes, viz. delirium, de-
lirium tremens, drunkenness, and the effects of certain poisons.
3. Of the several forms of unsound mind, treated in the order in
which they stand in the foregoing table. 4. Of some of the more
important chai-acters of the unsound mind, and of the medical and
legal tests of that unsoundness. 5. Of feigned unsoundness of mind.
And, lastly. Rules for the examination of persons supposed to be of
unsound mind.

1. OP CERTAIN UNUSUAL CONDITIONS OF THE MIND NOT IN-
CLUDED UNDER THE GENERAL TERM MENTAL UNSOUNDNESS.

The subjects included under this head have a close connection with,
and direct bearing upon, unsoundness of mind. Dreaming is very
generally recognized as an analogue of insanity. Spectral and other
illusions exist in most forms of mental unsoundness ; and the acts of
the somnambulist are occasionally such as to originate questions of a
medico-legal nature.

Spectnil illusions. — Some individuals have possessed the power of
recalling at will impressions made on the senses, so as to place the
objects before them afresh ; others have enjoyed a still more enviable
power of converting thoughts into sensations, if such an expression
may be allowed ; and others again, in moments of intense excitement,
or under the influence of slight derangements of their health, have
seemed to see or hear things which had no real existence.*

Spectral illusions, as has been just stated, are of common occurrence
in some fonns of mental unsoundness, and their presence serves to
explain, at least in part, the obstinate belief by which the mind, in
such cases, is possessed. Thus the author of a curious and interesting
autobiography, f which receives strong confirmation from the state-
ments of persons who have been similarly afflicted, says in reference to
one of his many spectral illusions : '* I imagined I was really present to
them ; and that my not acknowledging it was a delusion, an obstinate
resistance of the Divine will on my part. That of the two, the
appearance of the bed, walls, and furniture, was false, not my preter-
natural impressions."!

* For examples, see Sir David Brewster's ' Letters on Natural Magic,' Sir
Walter Scott's ' Demoriology and Witchcraft,' and Brierre de Boismont ' On Hal-
lucinatioiis.'

f ' A Narrative of the Treatment experienced by a Gentlemen during a state
of Mental Derangement,' page 63.

154 UNSOUNDNESS OF MIND.

Spectral illusions, then, are common to men of sound and of unsound
mind, the diH'erence being, that the former do not believe in their
reality, the latter do. The sane man corrects these false impressions
by the use of the other senses, or by some effort of comparison, while
the man of unsound mind neglects these simple means of undeceiving
himself, or cannot use them ; or if he is led to entertain any doubt, he
dispels it by the help of his delusion. Thus, the author of the auto-
biography, whose unsoundness of mind took a strong religious turn,
thought it impious to doubt.

The subject of illusions of the senses came into discussion in the
recent case of Buranelli, and questions were put to the medical
witnesses as to the proper definition of the terms illusion and delusion.
The difference between them is best shown by the addition of three
words to each : — an illusion of the senses, a delusion of the mind. It
may be well to add that an illusion of the senses, if believed to be a
reality, becomes a delusion of the mind. The term spectral illusicm
is synonymous with the word phantasm. The term hallucination
might be dispensed with altogether. It is not needed ; and as it means
an erroi-, blunder, or mistake, it has no proper place in descriptions of
mental unsoundness. An illusion means a mockery, false show, or
counterfeit appearance ; and a delusion a chimerical thought. The
word illusion may be applied, with equal propriety, to a sensation
without corresponding object, to a transformed appearance of a real
object, or to an internal sensation exaggerated or misinterpreted. But
M. Brierre de Boismont uses the term hallucination to designate an
unreal sensation wholly due to the action of the brain, and illusion to
designate a real sensation exaggerated or distorted by the same opera-
tion. The single term illusion ought to suffice for both purposes.

Dreaming. — The phenomena of dreaming have a striking analogy
to those of some forms of unsound mind. The external world being
shut out, and the higher faculties of the mind being in a state of com-
parative inaction, illusions have all the vivid impress of reality, and the
thoughts which pass through the mind produce the same impression as
in our waking state. They also follow each other according to asso-
ciations over which we have no control.

Many dreams are directly traceable to bodily conditions which are
recognized in the waking state as productive of pain or uneasiness,
such as an oppression at the stomach, a distension of the bladder, or an
inflammation or irritation of the skin. Sometimes this uneasy
sensation is distinctly perceived by the sleeper, but attributed to a
wrong cause, and associated with imaginary events. Thus Dr, Reid
relates of himself, that "the dressing applied after .a blister on his
head, having become ruffled so as to produce considerable uneasiness,
he dreamt of falling into the hands of savages, and being scalped by
them."

In other instances, the uneasy sensation gives rise to a dream which
has no other relation to the sensation itself than that of being painful

PHENOMENA OF DREAMING. 155

or disagreeable. The most distressing dreams of this class are known
as nightmares.

In another class of cases, the bodily uneasiness seems to have no
other effect than that of bringing the mind into a condition favourable
to the blending together of disconnected occurrences, sometimes recent
sometimes remote, having nothing in common but the feeling of
annoyance or discomfort.

We hear, perhaps, of a distressing accident; we have received some
unpleasant news of an absent friend ; and we have been concerned in
some business which gave rise to anxiety : a dieam takes place in
which all these are combined together; we are ourselves connected
with the accident; the absent friend is in our company; and the
person with whom the business is transacted also appears on the
scene.*

A curious fact has been observed with regard to dreams excited by
one class of bodily sensations, viz., that the same sound which awakes
the sleeper, occasions a dream that appears to occupy a considerable
time. Thus, " a gentleman dreamed that he had enlisted as a soldier,
joined his regiment, deserted, was apprehended, carried back, tried,
condemned to be shot, and at last led out for execution. After all the
usual preparations, a gun was fired ; he awoke with the report, and
found that a noise in an adjoining room had both produced the dream
and awakened him."

The strong analogy which exists between the phenomena of dream-
ing, and of certain forms of unsound mind, is shown in the examples
cited at p. 181.

The remarkable analogy between dreaming and insanity, and the way
in which the one may pass into the other, is well illustrated by the
case of a maniac, mentioned by Dr. Gregory, who for a week after his
recovery was harassed, during his dreams, by the same rapid and
tumultuous thoughts, and the same violent passions, by which he had
been agitated during his insanity. The case of M'N'aughton may
perhaps be cited as bearing a close resemblance to one class of dreams.
The refusal of his father to take him into partnership originated in
his mind a sense of hardship and injury : the Roman Catholics, the
Police, and the Tories, being successively the theme of newspaper abuse,
and being also represented as guilty of acts of injustice, impressed his
mind with the same feeling. Hence the long dream of years, in which
the sense of public injury was transferred to himself, till he became the
fancied object of political persecution.

The difference between dreaming and insanity is, that in the one,
the senses are closed to outward objects ; in the other, the evidence of

* ' Inquiries concerning the Intellectual Powers, and the Investigation of
Truth.' By John Abercrombie, M.l>. The reader is referred to this work for
many instructive anecdotes referring to this subject; and for more full informa-
tion on the physiology of the human mind, to the chapter on Mental Physio-
logy and Pathology in the author's edition of. Hooper's ' Physician" s Vade

156 UNSOUNDNESS OF MIND.

sense is disregarded, or the senses merely suggest trains of wild and
fanciful association, objects truly perceived being perverted and mis-
interpreted by the help of the prevailing delusion. In dreaming, as
soon as the pei-son is roused from sleep, and the external world is again
brought before him, all his illusions and delusions vanish; but the
madman is in a waking dream, from which he is not to be roused.

Legal relations of Dreaming. — A question of criminal responsibility
arises in those rare cases in which a man suddenly aroused from sleep
kills another. Such was the case of Bernard Schedmaizig, who
suddenly awaking at midnight thought he saw a frightful phantom,
and receiving no answer to his challenge twice repeated, but imagining
that the phantom was advancing upon him, and having altogether lost
his self-possession, raised a hatchet which was beside him and attacked
the spectre. It was found that he had murdered his wife. Kay
also relates the case of two men, who being out over night in a place
infested with robbers, engaged that one should watch while the other
slept ; but the former failing asleep, and dreaming of being pursued,
shot his friend through the heart. A pedlar, who was rudely aroused
from sleep by a passer-by, ran him through the body with the sword of
a sword stick. He was found guilty.* In all such cases, the con-
fused state of the mind on being suddenly aroused from sleep ought
certainly to be considered'as a mitigating circumstance.

Somnambulism. — This is a form of dreaming in which the senses
and voluntary muscles participate ; the one exercised with extraordi-
nary acuteness on the subject-matter of the dream, the other obeying
the mandates of the sleeper's will with unwonted precision. The
somnambulist's mind during the dream is so concentrated upon one
object, that his reason or fancy will accomplish that to which it was
unequal during his waking hours. It is this complete attention to
one object, too, which probably accounts for that extraordinary acute-
ness of the senses, that precision of movement, and that total absence
of fear which marks the most astonishing feats of the somnambulist ;
such as walking on the edge of a precipice, swimming a rapid stream,
or riding at full gallop. Sometimes the sleep-walker performs, at each
recurrence of the fit, with all the precision of his waking hours, some
routine duty.

Objects of sense presented to the sleep-walker, either produce no
effect, or they are mixed up indistinctly with the dream which he is
acting. In some cases, so complete is the mind's abstraction, that the
loudest noises are unheeded ; in others, those things only are attended
to which haimonize with the existing train of thought. The somnam-
bulist is either unconscious of what has occurred, or he remembers it
as a dream. In some cases, that which has transpired in one fit of

• The first ami last of these cases are quoted by Dr. Forbes Winslow in his
• Plea of insanity in Criminal Cases,' the first from Dr. Pagan, the last from
the • British and Foreign Medical Review.'

SOMNAMBULISM. 157

sleep-walking is distinctly remembered in subsequent ones, but quite
forijotten in the intervals.

The analogy already pointed out as existing between dreaming and
insanity may be extended so as to embrace some cases, at least, of som-
nambulism; for in certain forms of both these ali'ections there is a
remarkable increase of talent ; in both there may be a complete
change of character ; and it would not be incorrect to state, that there
is an intellectual and moral somnambulism, as there is an intellectual
and moral insanity.

The following cases may be adduced in support of this view. A
Carthusian monk who, while awake, was remarkable for his simplicity,
candour, and probity, walked almost every night in his sleep, and was
a thief, and a plunderer of the dead. A pious clergyman, in his fits
of somnambulism, would steal and secrete whatever he could lay his
hands upon, and on one occasion he even plundered his own church. In
one case the somnambulism took the form of suicidal mania. The
paroxysms occurred every night, and watchers were required, as if
for a patient labouring under an acute disease. He always attempted
to escape ; and one night having succeeded, he was found suspended
by the feet, from the limb of a high tree.* The following case of
homicidal somnambulism is quoted by Georget from an anonymous
work. A monk late one evening entered the foom of the prior of the
convent, his eyes open but fixed, his features contracted into a frown,
and with a knife in his hand. He walked straight up to the bed, as if
to ascertain if the prior were there, and then gave three stabs, which
penetrated the bed-clothes and a mat, which served the purpose of a
mattress. He then returned with his features relaxed, and an air of
satisfaction on his countenance. The next day, on being questioned,
he confessed, that having dreamed that his mother had been murdered
by the prior, and that her spirit had appeared to him and cried for
vengeance, he was transported with fury at the sight, and ran
directly to Stab her assassin. Shortly after he awoke, covered with
perspiration, and rejoiced to find that it was only a dream. f

Legal Relations of Somnambulism. — A question has been raised as
to the responsibility of the somnambulist for acts committed during the
paroxysm, and it has been attempted to be shown that, as that which
is done during the fit is often only the accomplishment of a project
formed while the party was awake, he ought to be held responsible.
If this improbable assumption were true, the somnambulist would not
be responsibile unless it could be shown that he was voluntarily accom-
plishing in the fit that which he had previously thought about ; in other
words, that he became a sleep-walker at will, which is an absurd sup-
position. If the question of responsibility should arise it should be
shown that the sleep-walking was real and not feigned, and also that
the accused was subject to these fits.

* • A Treatise on the Medical Jurisprudence of Insanity.' By J. Ray, M.D.
f Georget, 'Des Maladies Mentales,' p. 127.

158 UNSOUNDNESS OF MIND.

Ecstasis, or cataleptic sotnnambulism, which is nearly allied to hys-
teria, and almost invariably occui"s in females, may be noticed in this
place. For some interesting cases of it, the reader is referred to Dr.
Abercrombie's work on the Intellectual Powers.

2. OF CERTAIN CONDITIONS OF THE MIND, ALLIED TO MENTAL
UNSOUNDNESS, AND CAUSED BY DISEASE, OR BY THE OPERA-
TION OF CERTAIN POISONS: NAMELY, DELIRIUM, DELIRIUM
TREMENS, AND DRUNKENNESS.

Delirium. — This state of noind supervenes in the course of almost all
severe febrile and inflammatory diseases, and especially of those which
attack the internal viscera. It is a common sequence of severe acci-
dents, and of surgical operations ; and it often ushers in the fatal
termination of chronic disorders.

The delirium of fever is generally preceded by pain and throbbing
in the head, heat of the scalp, and flushing of the cheeks ; but it some-
times makes its attack suddenly, without previous warning. In the
first class of cases delii-ium is often preceded by dreaming. The
patient talks in his sleep, and wakes up confused and forgetful ; but
when fully roused, he is collected, and so remains till the next slumber.
By degrees this disturbed sleep passes into waking delirium. The
patient lies on his back, dull and listless, with eyes half open, mutter-
ing to himself, unconscious of persons or things around him, and when
roused scarcely recognizing them. As the disorder inci'eases and the
strength fails, the voice becomes more indistinct, the fingers are con-
stantly picking at the bed-clothes, the evacuations are passed uncon-
sciously, and the patient can no longer be roused to any effort of attention.

If delirium occurs at an earlier stage of the disease, or before the
strength of the patient has been much impaired, the symptoms are
somewhat modified. The eyes are bloodshot, and intently fixed as if
on some object really present. The patient talks loudly and earnestly,
tosses restlessly about in bed, and makes repeated attempts to leave it,
sometimes escaping from the custody of attendants, displaying gi-eat
strength and activity, and even committing acts of fatal violence.

In some cases, during attacks of delirium, the memory of things
long past becomes wonderfully active, and languages which were quite
forgotten are recollected and spoken with perfect fluency.

In fatal cases, delirium usually passes into coma, but occasionally it
disappears some hours or days before death, and leaves the patient in
full possession of his faculties.

Delirium is a leading and almost constant symptom of poisoning by
belladonna, henbane, and stramonium; a frequent result of poisoning
by other members of the class of narcotico-acrids ; an occasional one in
poisoning by the pure narcotics, and it may even occur from the opera-
tion of poisons belonging to the class of irritants.

Delirium bears a close resemblance to that form of unsound mind

DELIRIUM TREMENS. 159

which goes by the name of incoherence ; and the distinction between
the two is not always easily made, without some inquiry into the
history of the case. Delirium, when not caused by poison, is a symp-
tom of some well-marked bodily disease, while unsoundness of mind
is rarely accompanied by bodily disorder, till it has lasted so long as
to become associated with paralysis.

Legal Relations of Delirium. — Civil acts performed during an access
of delirium are necessarily void, and criminal acts entail no responsi-
bility. In determining the validity of wills made by patients labour-
ing under diseases attended with delirium, the law has regard less to the
proved existence of a lucid interval, than to the character of the will
itself. If it be in keeping with the patient's known character, and in
harmony with intentions expressed or instructions given when he was
sound in mind and body ; if the several parts of the will are consistent
with each other ; if no improper influence was brought to bear upon
him ; the will would be declared valid, even though the medical evi-
dence threw doubts on the testator's capacity. On the other hand, in
the absence of these conditions, the will would generally be declared
invalid, in spite of the strongest evidence of the testator's capacity.

It is important to distinguish delirium, with intervals of perfect con-
sciousness, from the calmness of demeanour sometimes assumed by
patients labouring under strange delusions, the result of unsoundness
of mind showing itself in the first stage of convalescence from fever
or other acute disease ; or as part of delirium tremens brought on by
drinking. The distinction is et\sily made, when it is borne in mind that
in the one case (delirium) the mind wanders during sleep, in the other
case while the patient is evidently wide awake.

Delirium Tremens. — The delirium of drunkards is easily recognized
by the peculiar foi-m which the mental unsoundness assumes, and by
the equally characteristic bodily symptoms, aided by the previous
history of the patient ; and, in most cases, by the prompt cure effected
by the proper remedies — stimulants and opiates.

A patient suffering from delirium tremens is restless, sleepless, timid,
suspicious, and cunning. He is subject to illusions of the senses, and
fancies himself surrounded by hideous and loathsome objects, such as
toads, serpents, and scorpions, and that he is persecuted by strange
sounds and threatening voices; or he thinks that thieves or evil spirits
are breaking into the house. When under treatment, he is suspicious
of the persons in attendance, and is constantly endeavouiing to make
his escape ; and, if not properly watched, may do violence to himself or
others. Some patients display a painful eagerness to go somewhere, or
do something upon which their minds are bent. The bodily symptoms
consist of the tremor from which the disease derives its name, with a
pale, cold, clammy skin, a moist, white, tremulous tongue, and a small
weak pulse. The history of the case is that of a course of intemperance
terminated by a short supply of spirituous liquor, or by some exhaust-
ing disease or surgical injury.

160 UNSOUNDNESS OF MIND.

In the milder forms of the affection, the patient goes about as usual,
answers questions collectedly, and converses rationally ; but when left
to himself, he is as one in a waking dream, speaking of things calcu-
lated strongly to excite the feelings and passions with a manner per-
fectly free from excitement.

Some cases of delirium tremens, however, are accompanied by strong
excitement, so as to present the closest resemblance to cases of moral
mania, the patient being impelled to acts of violence against himself
and others by the most unfounded delusions.

This class of cases is most commonly brought about by a few days
or weeks of continuous hard drinking ; or they occur, as the result of a
single debauch in men who have had previous attacks of mania, or of
inflammation of the brain, or who have suffered from severe falls or
blows on the head. Such cases as these while they last are not to be
distinguished from cases of mania.

Prolonged abstinence, too close attention to study or business, and
solitary confinement, sometimes bring on a state of mind closely allied
to delirium tremens, and characterized like it by illusions of the senses
of sight and hearing.

Legal Relations of Delirium Tremens. — As delirium tremens is a
temporary form of unsoundness of mind produced by a peculiar exciting
cause, its legal relations must be those of insanity, unless the nature of
the exciting cause constitutes it an exception to the general rule. This
it does not appear to do ; for, though drunkenness has little effect on
civil or criminal acts, delirium tremens is allowed to have the same
eflfect as insanity itself.

Drunkenness. — The excitement which, in persons of sound mind,
attends the indulgence in alcoholic liquors, is converted, in persons of
unsound mind, into maniacal incoherence, not to be distinguished from
mania arising from other causes, except by the history of the case and
the evidence of the sense of smell. A craving after spirituous liquors
constitutes, in some persons, a form of unsoundness of mind (dipso-
mania) ; while in other persons it is merely one of the leading symp-
toms of an existing mental unsoundness. In some cases the craving
after alcoholic liquors assumes an intermittent character, showing itself
only at intervals.

Legal Relations of Dnmkenness. — Drunkenness has no legal effect
on any offence to which it leads. It neither increases nor mitigates the
penalties which attach to it. Drunkenness has even been deemed an
aggravation of the offence. A drunkard's acts are therefore valid,
luiless it can be shown that the drunkenness was procured by another
person with a view to an unfair advantage. The question of the
responsibility of persons suffering from the disease now recognized as
dipsomania must be decided by the same tests as are applicable in
other forms of unsoundness of mind.

AMENTIA. 161

3. OF THE SEVERAL FORMS OF UNSOUND MIND.

On referring to the table at p. 152, it will be seen that the several
forms of unsound mind resolve themselves into three leading classes —
Amentia, Dementia, and Mania.

This form of unsoundness of mind comprises the two species, idiocy
and imbecility, as well as those cases of originally defective intellect
which are traceable to local causes and are known as cretinism.

Idiocy. — The best legal and medical writers agree in defining idiocy
as a congenital malady, and the idiot as one " who from his nativity by
a perpetual infirmity is non compos mentis" But some writers of
both professions have used the term with less precision, evidently con-
founding the idiot with the victim of dementia, or even of mania. The
time for such confusion of terms is now past, and there is a clear under-
standing that idiocy is a congenital absence or serious defect of all the
faculties of the mind ; but a state admitting of degrees, and, like other
forms of unsoundness of mind, not allowing of strict definition.

Idiocy, in its lowest form, combines the extreme of bodily deformity
with an existence purely vegetative. Such idiots seem devoid even of
sensation, and would perish if not closely attended to. In a somewhat
higher form there are sensations of heat and cold, of hunger and thirst,
and just intelligence enough to indicate the commonest wants by signs.
But these are equally helpless with the first class. A still higher class
consists of those idiots who have sensation and consciousness, recognize
familiar persons and objects, are susceptible of attachment, can move
from place to place, are able to make known their wants by gestures
and sounds, or even by words imperfectly articulated, can be made to
acquire habits of decency, can learn to hum or sing, or even to perform
the simpler operations of arithmetic, and are susceptible of a certain
limited improvement of their bodily and mental condition under
careful, assiduous, and skilful teachers.

As a general rule, idiots are deformed in body as well as stunted in
intellect. They have small and misshapen heads, squinting eyes, large
gaping mouths with thick lips, and other features ill formed and dis-
torted. The limbs and trunk are also imperfectly developed, and
their gait is awkward and unsteady. Their complexion is generally
sallow and unhealthy. Some of their senses are altogether wanting,
and others very imperfect. In a few exceptional cases, the head is of
ordinary size and well formed, and the body is not distorted, but the
expression of the face is that of complete vacuity.

Idiots who reach the age of puberty often display the sexual passion
by offensive gestures and disgusting habits, and they are also subject
to violent fits of passion, and sometimes commit acts of atrocious
cruelty.

162 UNSOUKDNESS OF MIND.

Tlie Legal Relations of Idiocy, in the restricted sense here assigned
to the term, are very obvious. The persons now described labour under
complete civil disability, and are irresponsible.

Im^jecility. — This term is here used to designate unsoundness of
mind occurring in early childhood, as contradistinguished from that
which is congenital. This distinction is in accordance with the legal
definition of idiocy ; and it has the advantage of separating the idiot
who has no use of speech, in consequence of his brain at birth being so
defective a.s to prevent him from being taught even to this limited extent,
from those who, being born with a better conformation of brain, are
able to acquire the use of speech. A distinguished writer on Mental
Unsoundness, M. Georget, recognizing this distinction, describes the
imbecile as persons who have some use of speech, and who display some
indications of mind, of intellectual faculties, and of feelings and affec-
tions.

In strict propriety of language, perhaps, idiocy and imbecility should
be equally characterized as congenital defects, of which the more marked
(idiocy) makes itself soonest known, while imbecility is not recognized
till the faculties have been tested by education and found wanting. It
is also obvious that it is not possible to draw a sharp line of distinction
between the idiot and the imbecile. The fainter shades of imbecility
pass into the lighter tints of idiocy. But the possession or otherwise
of the faculty of speech is the best distinction of which the nature of the
case adm.its.

The majoi'ity of imbeciles exhibit intellectual as well as moral
deficiency. They cannot acquire or retain knowledge ; they cannot
understand or appreciate the customs of society and laws human and
divine; they cannot bring their emotions and passions under control,
as men of sound mind are able to do. But there is a small exceptional
class which exhibits intellectual deficiency without seriously offending
against morality, and a larger class which combines the highest intel-
lectual endowments with utter incapacity in the conduct of life. There
is, therefore, an intellectual, a moral, and a general imbecility, as there
is an intellectual, moral, and general mania.

The form of imbecility which is most common and most important
in a medico-legal point of view is that which aflfects the intellect, the
morals, and the prudential conduct of life. Persons who exhibit this
threefold deficiency profit by education, so as to foi-m and express
simple ideas ; to read, write, and count ; and to become musicians,
draughtsmen, or mechanics. They may even attain to proficiency in
some one branch of knowledge, or some one accomplishment. But
they do not profit by the opportunities afforded them in the same
degree as their neighbours. They present great varieties of character.
Some are fickle and changeable, and incapable of fixing their attention ;
others are methodical and persevering. Some of them are found fit
only for the coarsest and rudest labours, while others are equal, with
the assistance and guidance of otbei-s, to the conduct of business and

IMBECILITY. 163

tlie management of pi-operty. Others know the value of money, and can
give infoiination on the matters with which they are conversant, but
they are unequal to emergencies, and unable to sustain close conver-
sation or argument. They are thoughtless, improvident, uneasy, and
restless, and generally incapable of strong and steady attachment.
Imbeciles are very common among the lower orders of society. They
are found following occupations requiring little sense or skill. Their
neighbours look upon them as weak and singular persons, and tease
and torment them accordingly. Many of them become lazy, drunken,
and dissipated; and some, under slight temptation, and very in-
iidequate motives, break out into fits of ungovernable passion, and
commit acts of theft, arson, rape, or murder. " They steal adroitly,
and hence are considered as very intelligent : they recommence their
offences the moment they are released from confinement, and thus are
believed to be obstinately perverse." " They have no idea, or a very
imperfect one, of society, laws, morality, courts, and trials ; and though
they may have the idea of property, they have no conception of the con-
sequences of theft. They may have been taught to refrain from injuring
others, but they are ignorant of what would be done to them if guilty
of incendiarism or murder." " Their conduct is actuated solely by the
fear of punishment, when capable of experiencing that sentiment, and
by their own desires. Others have some notions of property, but
neither a sense of morality, nor a fear of punishment furnishes motives
sufiiciently powerful to prevent them from stealing." Georget, from
whose work, ' Sur la Folic,' these passages are quoted, says that
" these beings of limited capacity furnish to the courts of justice, to
prisons and scaffolds, moi'e subjects than is generally supposed."

Imbecility, as has been already pointed out, is not necessarily of this
general character, displaying itself at the same time in the intellect,
morals, and conduct. It is sometimes partial, affecting only or chiefly
either the intellectual or the moral character. There may be, on the
one hand, an inability to acquire and apply knowledge in persons who
have a due sense of right, act with integrity, and perform every social
duty ; and, on the other hand, an unusual power of acquiring know-
ledge, with judgment, fancy, and refined taste, but combined with
feebleness of purpose, want of self control, inaptitude for business,
disregard of duty, and want of common honesty. Such persons are
known in society as weak, soft, easy, good-natured, well-meaning, good
sort of people, and if possessed of brilliant talents, as having every
sense but common sense. They are too easy to be just ; too thought-
less to be honest. They have an instinctive horror of business, an
aversion to their regular occupations, and a distaste for everything that
wears the shape of a duty. They are utterly ignorant of the value of
money, and the last use they make of it is to pay their debts. Each
man among them has his own favourite form of extravagance, and his
own mode of ruining himself. One calls an architect to his assistance ;
another an upholsterer ; a third collects useful things which he never

164 UNSOUNDNESS OF MIND.

uses, or displays a curious taste in worthless trifles. They aie always
forming acquaintances with unworthy persons, who find it worth their
while to know and to flatter them. With all their easiness of dis-
position they have much warmth of temper and strength of passion.
They are bad children, husbands, and fathers, because in these relations
of life they have duties to perform. Throughout life they are weak,
wavering, fickle, and self-willed, as children ; the soun^e of constant
anxiety and misery to their families ; the prey of designing knaves ; the
expected inmates of gaols, workhouses, and lunatic asylums.

These moral imbeciles remain at large, because the intellect being
unaffected, they have no distinct delusions, and there is nothing appa-
rently to prevent them fiom becoming, at any moment, useful members
of society. As weakness of intellect is a necessary ingredient in the
legal idea of imbecility, the attempt to prove such persons of unsound
mind, in a court of law, must necessarily fail. That absence of moral
sense, and corresponding want of self-control which is the essence of
their mental malady, is to be proved only by the history of their
daily life.

Imbeciles are sometimes as much under the dominion of childish
fancies as maniacs are of delusions. A few years since a commission of
lunacy was granted in the case of a young gentleman, aged 20, who
was the slave of a childish fancy for windmills, with an aversion
equally strong to watermills. Having been jjlaced under control in a
place where there were no windmills, he cut the calves of a child's legs
through to the bone, and stated that he should have taken away its
life, that he might be tried for his act, and removed from a place
where there were no windmills. He had always been violent when
thwarted in his fancy, had threatened his keeper and members of his
family, and had more than once made preparations for committing
murder. ^In this instance, childishness of fancy, insufficiency of
motive, absurdity of act, and ignorance of legal consequences were
strikingly combined.

Legal Relations of Imbecility. — In respect to this foi-m of mental
unsoundness, two distinct orders of questions may arise — questions of
competency, and questions of responsibility. •

The competency of imbeciles to form contracts, and the validity of
them when formed, has, in more than one instance, engaged the atten-
tion of our courts of law. Persons of weak mind have been brought
by improper influence to ally themselves in marriage, and the validity
of such marriages has been successfully disputed, as in the case of
Portsmouth v. Portsmouth, in which, as in other instances that might
be cited, the proof of imbecility was not drawn from a few isolated
facts, but from an investigation of the whole life, conduct, and cha-
racter of the party.

The competency of imbeciles to manage themselves and their affairs
is often called in question. As the conduct of life is partly dependent
on a knowledge of such simple mattei-s as the value of money, and

IMBECILITY. 165

partly on judgment and discretion, inquiries of this class sometimes
assume a very simple, and at other times a very complicated shape.

la rare instances men have been pronounced incapable of managing
their affairs, on the ground not so much of general weakness of in-
tellect, as of a defective knowledge of numbers and of the value of
money. Two such cases are related by Dr. Abercrorabie, in one of
which the most prominent character was a " total inability to perform
the most simple process of arithmetic," and in the other *' a total want
of the power of tracing relations both as to time and numbers." In
the face of evidence showing that they had made much progress in
their education, both were pronounced incapable of managing their
affairs.

In a case of imbecility on which the author was called to give evi-
dence, the patient did not know how many pence there were in sixpence
or a shilling, or how many shillings in a sovereign ; could not
perform the most ordinary operation of arithmetic ; was ignorant of
the date, the month, and the year ; did not know the name of the
reigning monarch ; could not recognize persons whom he had seen and
conversed with only four days previously. His attention was aroused
with the utmost difficulty, and could not be fixed to any one subject.
His look was vacant, his dress peculiar, his gait awkward, his motions
grotesque, his speech slow and hesitating. He used the same words
and expressions again and again, repeated imperfectly the tasks and
prayers of his childhood, and imitated the contortions of persons, like
himself, subject to fits. Such a case could present no difticulty either
to the medical witness or to the jury.

The more complicated and difficult class of cases arise in respect of
persons who though they display many marks of imbecility, in childish
ways, eccentric habits, violent passions, and cruel dispositions, are yet
able to perform the simple operations of arithmetic, know the value of
money, and can comprehend such statements and suggestions with
respect to their affaii's as may be submitted to them. In some of these
cases, a successful appeal has been made to the efficient manner in
which the party has actually conducted his own affairs.

The proof of imbecility, combined with undue influence, has, in
numerous instances, been held to invalidate a will ; but, in the absence
of such influence, all that is required to establish the wills of people of
weak understanding is, that they should have been capable of compre-
hending their nature and effect.

The question of responsibility for crimes, such as arson and murder,
can also only be answered by an appeal to all the circumstances of the
act, the motives by which it was instigated, and the whole life and
character of the accused. This subject of responsibility in criminal
cases will be more fully considered when all the forms of unsound mind
have been passed in review.

Several interesting and instructive cases of imbeciles concerning whom
the two questions of competency and responsibility have been raised.

It'G UNSOUNDNESS OF MIND.

are given in detail, and made the subject of judicious commentary in
Dr. Kay's * Treatise on the Medical Jurisprudence of Insanity.'

Cretinism. — In many parts of the continent of Europe, especially in
valleys lying among hills, but occasionally in unhealthy rural and urban
districts in every part of the world, a disease prevails which combines
the extreme of bodily deformity and degeneracy with deficiency of in-
tellect. In Switzerland and Savoy persons so afflicted are called cretins,
and in France cagots. The morbid feature by which they are chiefly
distinguished is the enlargement of the throat, known as goitre or bron-
chocele ; but to this several bodily defects and deformities are super-
added. The stature is dwarfed, the belly large, the legs small, the head
conical, the arch of the palate high and narrow, the teeth irregular,
the mouth large, the lips thick, the complexion sallow, the voice harsh
and shrill, the speech thick and indistinct, the eyes squinting, the gait
feeble and unsteady, the sexual power weak, or wanting.

The best authorities agree in representing this physical degeneracy,
with the coexisting mental deficiency, as commonly dating from a
period subsequent to birth. About the fifth or sixth month, the
healthy bodily development seems to be checked. The child looks
unhealthy and seems weak ; the head is large, and the bones widely
separated ; the belly swells and the limbs shrink ; teething goes on very
slowly, and the child cannot stand or speak till its fifth or sixth year.
Some cases are complicated with spinal distortion, some with hydro-
cephalus. In rare instances the physical and mental deficiency dates
from birth.

It is usual to divide the victims of this singular affection into three
classes — cretins, semi-cretins, and the cretinous, or cretins of the
third degree. The first class answer to the description of idiocy already
given, with the addition of the peculiar deformity of the throat.
Their life is automatic; they have no trace of intelligence; their senses
are dull, or wholly wanting ; they are unable to speak ; their time is
spent in basking in the sun or sitting by the fire ; and nothing but the
most urgent calls of nature rouses their attention. They do not
possess the power of reproduction.

The next class, or semi-cretins, show a higher degree of intelligence.
They may be taught to read and to repeat prayers, but without under-
standing what they leam ; they have no idea of numbers ; they note
what passes aroimd them, and use language to express their wants ;
they remember common events, understand what is said to them, and
speak intelligibly on common subjects.

Cretins of the third degree show glimpses of a higher nature, and are
capable of attaining a certain degree of proficiency in mechanical em-
ployments and contrivances, in drawing, painting, and music; but
arithmetic is a very rare acquirement. They are said to be acutely
alive to their own interest, extremely litigious, unable to manage
themselves or their affairs, but obstinate and unwilling to be advised.

Cretins of the second and third degrees, if remeved from the place of

DEMENTIA. 167

their birth and placed under judicious superintendence early in life,
are cjipable of considerable improvement both of body and mind, and
may be made useful members of society.

DEMENTIA.

This form of mental unsoundness is to be carefully distinguished
from the two forms of amentia just described. In idiocy the deficiency
is congenital ; in imbecility it shows itself in early life ; in dementia,
on the contrary, it supervenes slowly or suddenly in a mind already
fully developed. Dementia differs from mania, on the other hand,
inasmuch as the one arises out of the exhaustion and torpor of the
faculties, the other from their iindue excitement.

The state of the mind in dementia is best described by the word
incoherence. There is also a form of mania equally well described by
the same word ; but the incoherence of dementia is marked by languor,
that of mania by excitement. It must, however, be understood that
patients suffering from dementia are liable to maniacal paroxysms, and
maniacs to remissions of comparatively tranquil incoherence.

Dementia is divided into acute and chronic, of which the first form
is rare, and consists in a condition of profound melancholy or stupor ;
tlie second of very common occurrence, and characterized by inco-
herence.

There are also degrees or stages of dementia, which Prichard indi-
cated by the words forgetfulne.ss, irrationality, incomprehension, and
inappetency. A patient suffering from dementia, and passing from bad
to worse, would first exhibit want of memory, then loss of reasoning
power, then inability to compi'ehend, and, lastly, an abolition of the
common instincts and of volition.

Dementia may occur at any period of life after the development of
the mental faculties — in childhood, manhood, or old age. When it
occurs in aged persons it is known as senile dementia.

The chaKicters of dementia differ with its cause and mode of com-
mencement. That form of it which arises from sudden mental shocks
often presents a distinct and very peculiar feature. — The mind is, as it
were, arrested and fixed for the remainder of life in sad abstraction on
the one event which had occasioned it. In other instances, the shock
destroys the power of the mind, and reduces it to a state of imbecility
or idiocy.

During the earthquake panic of 1843, the author had an opportunity
of seeing a case of dementia in a lad of twelve years of age, brought on
by the conversation of a knot of Irishmen in the dusk of the evening,
concerning the expected visitation. The poor boy seemed deprived of
all his faculties, was dull and listless, and answered every inquiry by a
vacant smile. He occasionally had an access of terror and excitement,
but soon relapsed into his state of stupor.

The prolonged action of apprehension or grief is another cause of
dementia. Dementia also follows upon severe attacks of fever, and

168 UNSOUNDNESS OF MIND.

upon mania, melancholia, apoplexy, paralysis, or repeated attacks of
epilepsy. In all these cases it may depend on softening or other chronic
disease of the brain.

Senile Dementia, or that which is jncidental to persons in advanced
age, is the most simple and well-marked form of that variety of de-
mentia which arises from causes acting slowly and gradually. The
first symptom of approaching senile dementia is loss of the memory of
recent events, with dulness of perception and apprehension, and an
inability to fix the attention, or to follow any train of thought. The
things which were heard five minutes since, are forgotten, and the
same question is repeated over and over again. Hence, the transaction
of business requii-ing sustained attention becomes impossible. The
power of attention, and the control of the will over the thoughts,
becoming more and more enfeebled, the reasoning powers suffer ; for
scarcely are the premisses laid down before they are forgotten, so that
the act of comparison by which the conclusion is arrived at cannot be
performed. Hence, after pursuing the same topic of conversation
through part of a sentence, some accidental suggestion turns the ideas
aside. Persons so aiFected know their attendants and recognize their
friends, but they seldom display signs of emotion on seeing them ; and
they can still employ themselves mechanically, — men in writing, and
women in knitting and sewing. The next phase of the malady is one
of complete incomprehension. Memory, reason, and the power of at-
tention are entirely lost ; but the muscular force remains intact, and
displays itself in perpetual activity, in jumping or running to and fro,
or walking round in a circle, or rocking backwards and forwards in a
chair, dancing, singing, and shouting, or in talking or muttering in-
cessantly. Many, however, sit silent and tranquil, or with a vacant
unmeaning stare, for weeks, months, or even years. A few remain
crouched in one uneasy posture, or they stand erect with the neck
rigidly fixed at right angles to the body. In the last stage of all,
even the animal instincts are lost ; there is neither sensation, nor
memory, nor thought, nor reason, but bare physical existence ; with
occasionally, at distant intervals, a short resuscitation of some of the
mental powers. Paralysis of the limbs, more or less extensive and
complete, is also a common occurrence in this advanced stage of the
malady.

Legal Relations of Dementia. — The questions most commonly raised
respecting this form of unsoundness of mind relate to the validity of
wills made or altered by aged persons £tlleged to be suffering from senile
dementia. The inquiry is generally one of considerable difficulty ;
inasmuch as patients suffering from senile dementia vary greatly from
day to day, and present themselves to different pei-sons in different
lights. Accordingly there is room for very conflicting testimony, and
wide divergences of opinion, both among unskilled and skilled wit-
nesses; and the legal decision ultimately turns much more on the
character of the will itself and its consonancy, or otherwise, with the

MANIA. 169

known intentions and views of the testator at an earlier period of his
life, and with the natural feelings of persons of sound intellect, than
on the medical or other evidence respecting his mental condition.

MANIA.

This term includes all those forms of unsoundness of mind which
are characterized by undue excitement of the faculties. It differs
therefore in a marked manner from those already described, both
in its legal relations, and in the tests by which its existence is ascer-
tained. There is no legal term in common use which properly charac-
terizes this state ; and one of its most important forms, moral insanity,
is as yet unrecognized by the law. The only legal term employed
in a sense analogous to that of mania is lunacy, which, as has been
remarked, is objectionable from being founded on a variable feature of
the disease.

Mania is divided in the table at p. 152 into three classes: General,
Intellectual, and Moral ; and each of these latter into two subdivisions —
General and Partial.

General Mania. — There is a form of mania which affects both the
intellect and the passions, and throws the whole mind into a state of
mingled excitement and confusion. It is the counterpart of the inco-
herent stage of dementia, and the form which, in some cases, mania
assumes from the very first. It would be correctly designated by the
phrase " raging incoherence." There is another form of mania which
is apt to be confounded with the foregoing variety, on the one hand,
and with monomania on the other, but which, when carefully examined,
will be found to be a general unsoundness, accompanied with undue
excitement of the mind, the predominant feeUng or passion merely
taking the lead in the unsound, as it had previously done in the sound
mind. Both of these forms will be treated under the general term,
Mania.

Mania, under whatever form it may appear, except when it is the
immediate consequence of injuries, moral shocks, intoxication, poison-
ing, or acute disease, is preceded by important bodily and mental
changes. The period during which these changes are taking place
is termed the period of incubation, which sometimes embraces a pei'iod
of fifteen to twenty years. It is described by Georget in terms of which
the following is an abbreviation : —

Sometimes the cause acts strongly and rapidly; at other times,
slowly and with less force. In the first case, madness breaks out at
the end of some hours or days after a state of anxiety and uneasiness,
with headache, sleeplessness, excitement, or depression. The patient
begins to babble, cry, and sing, becomes wild and agitated, and has the
appearance of a person in a state of intoxication. In the second case,
the mind is affected gradually and often very slowly. The patient is
generally conscious of some disorder in his intellectual faculties ; he is

170 UNSOUNDNESS OF MIND.

beset by new and odd notions, and bj' unusual inclinations ; he feels
himself changing in his affections; but, at the same time, he preserves
a consciousness of his condition, is vexed at it, and tries to conceal it ;
he continues his occupations as much as he can ; and like a man in the
first stage of intoxication, he makes every effort to appear reasonable.
Meantime his health gives way. He either sleeps less or not at all ;
his appetite is impaired or lost ; he suffers from indigestion and consti-
pation ; he grows thin, and the features alter. (In females the monthly
discharge becomes irregular and scanty, and at last is altogether sus-
pended.) At the same time a great change takes place in the tastes,
habits, affections, and character of the patient, and in his aptitude for
business ; if he was gay, communicative, and social, he becomes sad,
morose, and averse to society; if he was open and candid, he becomes
suspicious and jealous ; if he was moderate in his political and religious
opinions, he passes to an extreme exaggeration in both ; if he was affec-
tionately attached to wife, children, or relations, he regards them with
indifl^erence or dislike ; tears and laughter succeed each other without
apparent cause ; if he was orderly and economical, he becomes confused
and prodigal ; if he has been coiTect in his conversation, he indulges in
violent and obscene language ; if he had long abstained from the plea-
sures of love, he becomes the victim of insatiable desires, and either
seeks to associate with the other sex, or has recourse to disgraceful
practices.

If this is the first attack, the persons by whom he is surrounded do
not suspect the nature of the ailment which torments him ; they put
questions to him which lead to no result, except that of fatiguing and
giving him pain ; or they indulge in offensive insinuations, and charge
him with frivolous accusations ; and when, at length, he breaks out
into furious mania, the attack is attributed to some slight contradiction
or some cause equally inadequate to produce it.

When the period of incubation has passed, and the disease is fully
established, the mental and physical phenomena undergo a change.
The disorder of the cerebral functions assumes a more positive cha-
racter, the patient believes in the reality of his delusions, and instead
of concealing his thoughts, openly and strenuously avows them, except
when induced by powerful motives to pursue a contrary course. When
thwarted and opposed he makes use of the most violent and insulting
language, and often gives utterance to the most obscene expressions.
In many cases, too, his violence does not spend itself in words, but he
tears his clothes and bedding to pieces, and inflicts bodily injury on
himself and those about him. The physical derangement displays itself
in febrile excitement, an accelerated pulse, and a wild and sparkling
eye, pain, weight and giddiness in the head, ringing in the ears, and
restlessness and sleeplessness. The patient is also singularly insensible
to cold and heat, and he either abstains from food and drink for long in*
tervals of time, or eats voraciously. The muscular power is inordinately
developed, and the patient sustains for a long time, without sleep, a

INTELLECTUAL MANIA, GENERAL AND PARTIAL. 171

succession of efforts which would soon utterly exhaust a healthy pei'son.
The habits of the patient are often most disgusting and offensive.

General Intellectual Mania. — The opinion is gaining ground that
mania is in all cases primarily an emotional disease, and that the
alfection of the intellect is only secondary. But there is certainly a
class of cases in which the disease appears to be almost limited to the
intellectual faculties, which are in a highly excited state, while the
moral faculties are little if at all affected. But it would probably be
more correct to say that, in certain cases, some strong emotion or
passion, such as pride, vanity, or ambition, displays itself chiefly
by its effect upon the intellect. Thus Dr. Keid, in his work
on Insanity, tells us of a vain young medical student, who, in the
expectation of realizing a fortune by attaining academical honours,
entered himself at Cambridge, and so injured his health by fruitless
application to study, as at length to fall into a state of decided de-
rangement. This young man stated that he was the Farnese Her-
cules; that he had written Dr. Clarke's Travels in Russia; that he
had composed the ^neid of Virgil ; had painted one of the master-
pieces of Kaffaelle ; and that he knew everything.

Dr. Henry Johnson, in his work on the arrangement and nomen-
clature of Mental Disorders, also gives the highly characteristic letter
of an ambitious patient who contrived to confer upon himself the some-
what incongruous titles of champion and king of England, and heir
presumptive to the crown, and at the same time to monopolize all the
principal offices of state.

A highly instructive autobiography of a gentleman who had re-
covered from an attack of mania, shows how general was the dis-
turbance of the whole intellectual and moral being, though the pre-
dominant emotion was of a religious character, and it would have been
quite possible to describe the case as one of religious monomania.

General intellectual mania is, therefore, in very many cases, to be
regarded as the violent disturbance of all the intellectual faculties
brought about by the over-excitement of some leading emotion or
passion.

Partial Intellectual Mania. — This was formerly called melancholia,
from the mistaken notion that such partial affections of the intellect
are always of a gloomy character. Esquirol showed that this view of
the case was incorrect, inasmuch as the ideas of such persons are not
always gloomy, but, on the contrary, oftentimes extremely gay and
pleasant; and he substituted the term monomania, which is now
generally received.

The most simple form of this disorder is that in which the patient
takes up some single notion opposed to common sense, and pei'sonal
experience ; such as, that he is secretary to the moon, the Crystal
Palace, a grain of wheat, a goose-pie, a pitcher of oil, a wolf, a dog, or
a cat.

In many cases, this single delusive idea relates to, or is occasioned

172 UNSOUNDNESS OF MIND.

by, some bodily sensation or disease, which the monomaniac, like the
dreamer, associates with imaginary accompaniments, and interprets by
the aid of his delusion. Thus, Esquirol tells us of a woman suffering
from hydatids in the womb, who insisted that she was pregnant with
the devil ; of another, whQ having adhesions of the intestines from
chronic peritonitis, imagined that a regiment of soldiers lay concealed
in her belly, and that she could feel them struggling and fighting with
each other ; and of a third, who, sufl'eiing from the same morbid con-
dition, believed that the apostles and evangelists had taken up their
abode in her bowels, and were occasionally visited by the pope and the
patriarchs of the Old Testament.

But such delusions as these, though perhaps originally founded upon
real sensations, may continue after the sensations themselves have
passed away, as is proved by the cures that have been effected by a
very laudable species of deception. Thus, a patient, after thinking
himself cured of a serpent in his bowels by means of a pretended
surgical operation, suddenly took up the idea, that the creature had
left its ova behind, ready to be hatched into a brood of young ones ;
but was reassured by the dexterous reply, that the snake was a male.

It must not be supposed that such cases of partial intellectual mania
comprise all the cases designated as monomania. In most instances
the affection of the mind doubtless goes beyond a single insane idea,
and influences more or less extensively the thoughts and the conduct,
being marked by other intellectual and moral inconsistencies: and
there is reason to believe, that many cases of so-called monomania are
examples of general mania, characterized by the immoderate activity of
some one faculty.

Moral Mania. — It was Pinel who first directed the attention of the
profession to moral insanity. Previous to his time, insanity was
generally considered as either exclusively, or chiefly, a malady of the
reasoning faculties. Participating in the common belief of the suffi-
ciency of a few faculties to explain all the phenomena of the sound and
unsound mind, and doubtless influenced by the prevalent metaphysical
doctrines of his time, he found, to his great sui-prise, that there were at
the Bicetre many maniacs " who betrayed no lesion whatever of the
understanding, but were under the dominion of instinctive and ab-
stract fury, as if the affective faculties alone had sustained injury.''
He called this fonn of mental disorder manie sans delire. Since his
time the reality and great importance of this distinction between
intellectual and moral mania have been recognized by practical ob-
servers, amongst whom are to be found the well-known names of
Esquirol, Georget, Gall, Rush, Keil, Heinroth, Hoffbauer, Cox,
Andrew Combe, Abercrombie, ConoUy, Pri^chard, and Ray. Pn\
chard, who has treated this subject with great ability, and has clearly
made out that moral generally precedes intellectual insanity, defines
moral mania as " consisting in a morbid perversion of the natural feel-
ings, affections, inclinations, temper, habits, and moral dispositions,

GENERAL MORAL MANIA. 173

Without any notable lesion of the intellect, or knowing and reasoning
faculties, and particularly without any maniacal hallucination."

Moral mania, like intellectual mania, admits of being distinguished
as general and partial.

General Moral Mania. — Pn\chard observes that there are many
individuals living at large in society, who are reputed persons of a
singular, waywai'd, and eccentric character. An attentive observer
will often recognize something remarkable in their manners and habits,
which may lead him to entertain doubts as to their sanity ; and on
inquiry his suspicions are often strengthened by finding that an
hereditary tendency to madness has existed in the family, that several
of the relations have laboured under other diseases of the brain, or that
the individual himself, in a former pei'iod of his life, has had a decided
attack of madness. His temper and disposition are found to have
undergone a change ; 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, or some
severe shock to his constitution, — some febrile or inflammatory dis-
order affecting the brain, a slight attack of paralysis, or a fit of epilepsy.
In some cases, the alteration in temper and habits has been gradual and
imperceptible, and seems to have consisted only in an exaltation or in-
crease of peculiarities which were always more or less natural and
habitual. Persons labouring under this disorder are capable of reason-
ing, or supporting an argument, upon any subject within their sphere
of knowledge, and they often display great ingenuity in giving reasons
for the eccentricities of their conduct, and in accounting for and justify-
ing their existing state of moral feeling. 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 judg-
ment and conduct.

Hoffbauer, who has written very ably on the subject of insanity, re-
cognizes this form of mental unsoundness.

*' It is clear," he says, " that mania may exist uncomplicated with'
mental delusion ; it is, in fact, only a kind of mental exaltation {toll-
heit), a state in which the reason has lost its empire over the passions
and the actions by which they are manifested, to such a degree, that
the individual can neither repi-ess the former, nor abstain from the
lattex". It does not follow that he may not be in possession of his
senses, and even of his usual intelligence, since, in order to resist the
impulses of the passions, it is not sufficient that the reason should
impart its counsels, — we must have the necessary power to obey them.
The maniac may judge correctly of his actions without being in a con-
dition to repress his passions, and to abstain from the acts of violence
to which they impel him." He subsequently observes, that when
mania proceeds from inordinate passions, " its more immediate cause

174: UNSOUNDNESS OF MIND.

lies in the physical temperament, or in certain moral affections which
induce frequent occasions of anger. In every other respect, the maniac
may be master of his propensities, and the actions to which they lead ;
he may judge and act rationally. He is irrational only in his paroxysms
of fury, and then his errors of judgment are rather the effect than the
cause of his furious transports."

This form of mental unsoundness is illustrated in the works of
Pi'r^chard and Pay, by a large number of cases, which may be con-
sulted with advantage. Of these, the most remarkable is that of
Frederick William of Prussia, father of Frederick the Great, a drink-
ing and smoking hypochondriac, and the strange, waywai-d, and
cruel tyrant of his family and household. His religious austerities,
his disgusting and brutal behaviour to his children, his unfounded
hatred of his own son, and repeated attempts upon his life, his solitary
attempt upon his own life, his course of steady and unswerving per-
secution of the innocent objects of his suspicion and dislike, without
any delusion beyond that which might fairly be regarded as the
offspring of his hate — present a striking picture of general moral
mania.

Partial Moral Mania. — This consists in an exorbitant activity of
some one passion or propensity, and its predominance or complete
mastery over every other. The persons thus affected are generally
perfectly conscious of their condition, and they either evince the
utmost horror at the enormity of the conduct to which their ruling
passion would impel them, and with difficulty restrain themselves, or
they give way, as if in desperation, to the impulse which urges
them on.

There is not one of the stronger impulses of our nature that may
not be thus placed, by morbid excitement, beyond the restraint of
reason and conscience. The following varieties are now generally
recognized, and described under distinct names : — Kleptomania, Eroto-
mania, Pyroraania, Dipsomania, Suicidal Mania, Homicidal Mania.
In addition to these forms of partial moral mania, which are of special
interest to the public and the legislature, there are many other distinct
vaiieties, some marked by extreme depression, and others by great
excitement, which have been classed under the two heads of Melancholia
and Exaltation, of which the first comprises the three species, hypo-
chondriasis, nostalgia, and religious despair ; and the second excessive
pride, vanity, or ambition.

Cleptomania, or propensity to theft. — This form of partial moral
mania is of very common occurrence in persons of both sexes, placed
by their wealth beyond the reach of vulgar temptation. It is more
common in women than in men. A propensity to theft is also a
common feature of imbecility and of mania, and has been known to
accompany maniacal paroxysms. Pri)|chard mentions the curious
case of a lunatic who would never eat his food unless he had pre-
viously stolen it.

SUICIDAL MONOMANIA. 175

Erotomania, or amorous madness. — This disease is otherwise known
as Satyriasis when it attacks men, and Nymphomania when it occurs
in women. It sometimes attacks virtuous females, who view their
excited passions with horror and remorse.

Pyromania, or propensity to incendiarism. — This propensity, in
common with Kleptomania, is more common in women than in men.
It occurs most frequently in young women subject to menstrual sup-
pression or disturbance, and in imbeciles of the other sex.

Dipsomania. — A propensity to excessive indulgence in spirituous
liquors is a well-recognized form of unsoundness of mind. In some
persons the desire for drink is continuous ; in others intermittent. In
some the desire is but part of a more general unsoundness ; in
others it is the true source of all the manifestations of unsoundness
which the patient makes. In other words, he is perfectly rational
when not under the influence of drink.

Suicidal Monomania. — Much difference of opinion has existed as to
the real state of mind of self-murderers. The fact of suicide having
been generally practised and sanctioned by philosophers and lawgivers
of past times, and of its still being in common use in nations which
have attained in many respects a high civilization, such as China and
Japan, has led some to the belief that it is not always the result of an
insane impulse. The calm and deliberate manner in which the crime
is often perpetrated, and the apparent soundness of the reasons alleged
in its favour, have been somewhat strangely used as arguments against
the opinion of those who attribute suicide in all cases to insanity. A
better reason for believing it to be, occasionally at least, altogether in-
dependent of insanity is, that in France two persons often combine for
the purpose of self-destruction ; such union of purpose being extremely
rare in the case of the insane.

The argument drawn from national usage in ancient and modern
times cannot be allowed much weight, for who would hesitate to cha-
racterize an English widow who should burn herself on the death of
her husband, as insane? and yet such self-sacrifice was until recently
both a virtue and a custom in India. Some savage nations, again, eat
human flesh ; but in a case of infanticide which occurred in France,
the fact that the mother cooked a portion of her child, and ate of it,
and then offered the dish to her husband, was justly regarded as a
strong evidence of insanity.

A careful consideration of recorded cases of suicide cannot but lead
to the conclusion, that a considerable number are the result of insane
impulse ; and this conclusion is strengthened by the frequent attempts
at self-destruction made by the acknowledgedly insane. The extraor-
dinary modes of death sometimes selected might also be urged as an
additional argument in favour of the insane origin of suicide. It may
be added, that some of our highest authorities, as Fodere and Esquirol,
have strongly maintained the necessary dependence of suicide on in-
sanity.

176 UNSOUNDNESS OF MIND.

Homicidal Mania. — The most distinguished authors, botli at lionie
and abroad, have recoc;nized this form of mental unsoundness, as having
an existence independent of delusion. The cases on record are now
very numerous, and comprise instances of successful resistance to the
impulse in some instances, of voluntary submission to restraint in
others, and examples of failure in a third class.

Women seem to have been more frequently than men the victims of
this propensity to destroy, and sometimes this excited feeling has led
to the commission of infanticide (see p. 111). Females suffering from
grief, or anxiety, from habitual discharges, at the menstrual period, at
the change of life, and soon after delivery, are thrown into a peculiar
nervous state, known as mimosis inqnieta, which is sometimes accom-
panied by a strong impulse to crime, with an overwhelming fear of
giving way to it. Cases of this kind frequently present themselves
among the out-patients of our hospitals.

Melancholia. — There are, as has just been stated, three principal
forms of melancholia, all of which are characterized by profound
sadness. The first, hi/pochondriasis, consists in a melancholy and
desponding view of the condition of the body and of the health, often,
but not always, based upon uneasy bodily sensations and disorders of
the organs of digestion: the second, nostalgia, consists in an intense
longing for country and home in those who are exiled : the third,
religious despair.

Exaltation. — This is a state of mind the opposite of melancholia,
which prevails in those who exult in the belief that they are possessed
of great personal attrjiction, great power, great dignity, great inven-
tive faculties, or great projects of benevolence.

It would also be quite possible to select cases from all large col-
lections of insane persons, which would warrant the use of a larger
vocabulary of terms — cases, for instance, in which a lying or begging
propensity is quite as clearly marked as a thieving propensity in
those designated as Cleptomaniacs. Nor is it possible to omit the
remarkable cases of lycanthrophy which are on record, and one of
which Cthat of the soldier Bertrand) has, within a few years of this
time, occurred in France. In this instance, the violation of the grave
was an intermittent insane passion, which no sense of personal danger
was allowed to disappoint.

Of Mania with Lucid intervals. -^'Mdima., in a considerable number
of cases, assumes a recurrent or intermittent form, the patient in the
interval being in his right mind. The proportion which such cases
bear to those of complete recovery has been variously stated at from
one in six to one in ten. The interval is various. Esquirol has seen
cases assume the quotidian, tertian, and quartan type ; or the interval
has been that of a month, or it has recurred with the same season of
the year. More frequently the attacks occur at uncertain intervals,
and are of uncertain duration. This recurrent mania, with intervals
of complete sanity, must not be confounded with those periods of

CHARACTERS OF AMENTIA AND DEMENTIA. 177

comparative tranquillity which, like lulls in a storm, occur in most
cases of mania. With regard to such intervals of comparative repose,
Haslam remarks that, " as a constant observer of this disease for
more than twenty-five years, he cannot affirm that the lunatics, with
whom he had daily intercourse, have manifested alternations of in-
sanity and reason. They may at intervals become more tranquil, and
less disposed to obtrude their distempered fancies into notice. For a
time their minds may be less active, and the succession of their
thoughts consequently more deliberate ; they may endeavour to effect
some desirable purpose, and artfully c mceal their real opinions ; but
they have not abandoned or renounced their distempered notions."

The legal relations of mania with lucid intervals are important.
The law generally views civil acts done in lucid intervals as if they
were performed by a person in a permanently sound state of mind ; it
admits the validity of wills made during such intervals, and has on
more than one occasion admitted the I'easonableness of the will as
proof of a lucid interval. With regard to criminal acts, it makes a
reasonable distinction ; for it justly regards the condition of unsound-
ness as one readily reproduced by provocation or excitement. The
legal relations of the other forms of mania will be considered in the
following division.

4. OF SOME OF THE MORE IMPORTANT CHARACTERS OF THE UN-
SOUND MIND, AND OF THE LEGAL AND MEDICAL TESTS OF THAT
UNSOUNDNESS.

A knowledge of the individual characters of mental unsoundness is
of the first importance both to the lawyer and to the ])hysician.
Without a resume' of its characteristics, a mere description of its
several forms would present but an imperfect view of the subject. It
is proposed, therefore, to establish, by appeal to facts, some, of the
more remarkable phenomena of mental unsoundness, as a preliminary
to the discussion of the chief legal questions which arise out of that
state, and to prescribe, for the guidance of the medical witness, such
rules as these phenomena shall be found to suggest for recognizing it,
and for distinguishing it from its counterfeit.

Of the Characters of Unsoundness of Mind from Defective Development
or Diminished Activity of the Faculties.

There is a simplicity about this division of the subject which does
not belong to the other, and the principal characters are more easily
deduced from the foregoing descriptions. The law, in reference to
this form of unsoundness, moreovei', is more simple and more in ac-
cordance with medical experience ; and its decisions have been more
uniform.

178 UNSOUNDNESS OF MIND.

The appearance of the idiot or imbecile is in itself almost decisive,
and scarcely requires confirmation from an actual inquiry into his
mental condition. Difficulty of arousing and fixing the attention ;
slowness and weakness of comprehension ; forgetfulness of recent oc-
currences ; ignorance of social relations ; unconsciousness of familiar
things, even of such as immediately concern a man's self, as his age,
the place in which he lives, and the mode in which he passes his
time, the year, the month, and date of the month ; ignorance of
those public persons and events which are the most frequent topics of
conversation, and most familiar to those who take an interest in the
common affairs of life, as the name of the reigning monarch, of the
prime minister, &c. ; a scanty knowledge of arithmetic and of the
value of money ; an imperfect knowledge of right and wrong, and of the
state of the law in regard to the most common and familiar crimes ; —
may be mentioned among the characters of the several forms of un-
soundness from defective development.

In ordinary and extreme cases of imbecility there can be no diffi-
culty in forming a decision as to the competency of the iq^dividual to
take care of himself and his affairs, to form contracts, to devise i)ro-
perty, &c. ; but where the imbecility exists in a less degree, the
question is by no means of this simple nature, and cases have occurred
in which there has been room for much difference of opinion. In this
class of cases it generally happens that the individual in question has
for some part of his life been at liberty, and entrusted with the
management of his affairs. Hence an invaluable tost is provided in a
comparison of his existing with his former state of mind. This
simple and obvious test seems to have been strangely overlooked by
medical men, till the interesting case of Mr. Edward Davies gave
Dr. Gooch the opportunity of pointing it out, and insisting upon its
importance. (See ' Quarterly Review,' 1830, and the fiist edition of
this work.)

The tests of capacity usually recommended in the case of imbeciles
are obviously insufficient to determine whether or not a man is (^-
pable of managing his own property. The arithmetical test, on which
authors have laid so much stress, is merely a test of knowledge, not of
power. A man may be the best accountant in the world, but he may
labour under a moral imbecility, and have so mean a sense of right, so
childish a fancy, and so weak a will, that from infancy to age he may
yield to every impulse, and gratify every whim without once counting
the cost. In a case that lately came under the author's notice, the
individual owed pence as a child, and pounds as a boy, and added
debt to debt with each year that passed over his head, till at length
a severe disappointment brought on a distinct attack of mania, of
which a benevolent but extravagant mission, violent outbursts of
passion, and fierce hatreds, arrangements to spend a year's income in a
week, and the unfounded expectation of an immense fortune on the
morrow, were constituent parts. He became the inmate of an asylum.

CHARACTERS OF MANIA. 179

with delusions enough to furnish a dozen madmen, settling down at
last into the conviction that he was the Saviour of mankind, in which
conviction he died. In this case, there was the cultivated and refined
intellect of a man with more than the weakness of a child ; but no
test could have served to prove him incapable of managing himself and
his affiiirs, save only the history of his life.

The criminal acts of persons of weak intellect are as strongly
marked by folly as their daily words and actions. They have no other
characters, and consequently we have no better test. In the case of
imbeciles, as in that of maniacs, the law lays down the test of a
knowledge of right and wrong. This is as insufficient a test in
criminal, as the arithmetical test in civil cases. It is a test of know-
ledge, and not of power ; and the knowledge of right, and the power to
act right, are as distinct as science and art. This subject will be pre-
sently examined more at length.

Of the Characters of Unsoundness of Mind from Excessive Activity of
the Faculties.

In tracing some of the more prominent characters of this division, or,
in other words, of mania, it is proposed to use the term in its most
extended sense as applied to those cases (and they are the great
majority) in which the intellect, the affections, and the passions, are
jointly implicated, whether there be a single delusion or several de-
lusions, or merely some one excited emotion or passion, the source of
a thousand changing fancies. This inquiry will prepare the way for
an examination ol" the plea of insanity in criminal cases — a subject of
great interest and importance.

1. In Mania, consciousness, memory, and reason may remain
intact, and that even in the midst of the most violent paroxysms. The
opinion, to which reference has just been made, that mania is in all
cases primarily an emotional disease is quite consistent with this pro-
position. It is quite conceivable that the emotions and passions may
be under constant or intermittent excitement of the most violent cha-
racter, and yet that there shall be a perfect consciousness on the part
of the patient of all the relations in which he stands towards others, a
fi'ee use of reason, and a perfect recollection of every occurrence in
which he has borne a part. It is true that in the actual paroxysm of
maniacal excitement, there may be neither time nor place for acts of
comparison or processes of reasoning, and that even conscience may
lose all restraining power ; but that memory does remain intact, even
in the most violent maniacal outbursts, there is no room to doubt.
The author was consulted in the case of a lady who had been suffer-
ing from mania for a long term of years, and who was subject to
paroxysms of extreme violence. In one of these paroxysms she had
destroyed some valuable papers belonging to her husband ; and yet
after the lapse of twenty years, during an interval of tranquillity, she

180 UNSOUNDNESS OF MIND.

leverted to the occurrence, and expressed her regi'ot at what had
happened. Similar evidence of accurate recollection is to be found in
the autobiographies and viva-voce histories of persons who have re-
covered from mania.

Of the intact condition of the higher feculties of the mind in the
maniac's more tranquil moments no medical evidence need be adduced.
It will snlfice to quote the words of Mr. (afterwards Lord) Erskine,
used at the trial of Hadfield for shooting at George III, in Drury Lane
Theatre, in 1800. " In all the cases," he says, "which have filled
Westminster Hall with the most complicated considerations, the luna-
tics, and other insane persons who have been the subjects of them, have
not only had memory in my sense of the expression, — they have not
only had the most perfect knowledge and recollection of all the relations
they stood in towards others, and of the acts and circumstances of
their lives, but have, in general, been remarkable for subtlety and
acuteness. Defects in their reasonings have seldom been traceable, —
the disease consisting in the delusive sources of thought, — all their de-
ductions, within the scope of their malady, being founded on the im-
moveable assumptions of matters as realities, either without any
foundation whatever, or so distorted and disfigured by fancy, as to be
nearly the same thing as their creation."

The madman, then, reasons like other men, with this difference,
that his delusions being stronger than the imaginations of a sane man,
and his passions more violent, reason is more readily made the advo-
cate of the one and the slave of the other. The same observations
which apply to the reason apply to the other faculties of the mind.
The senses are most apt to rebel ; but even they are unsuccessful in
their revolt- The delusion is too sti'ong even for them.

2. The senses are deceived and conf<junded. The author of the
interesting autobiography referred to at p. 153, says: " My senses were
all mocked at and deceived. In reading, my eyes saw words on the
paper, which, when I looked again, were not. The forms of those
aroimd me, and their features, changed even as I looked on them."
'* 1 heard the voices of invisible agenis, and notes so divine, so pure,
so holy, that they alone, perhaps, might recompense me for many
sufferings. My sense of feeling was not the same ; my smell, my
taste, gone or confounded." The conversion of familiar sounds, such
as the lowing of cattle, the falling of water, the grating of a chain, the
noise of footsteps, &c., into articulate speech, is not the least remark-
able feature of this disorder of the mind. It is scarcely necessary to
add, that illusions of sight and hearing are almost universal accom-
paniments of mania.

3, The persons with whom the madman associates derive their cha-
racters from his delusion. In the eyes of the author of the autobio-
graphy the inmates of the asylum and his keepers were supernatural
beings. There was a maniac there whom his spirits called the Lord
Jehovah, supremely omnipotent, the Trinity in unity ; and one of the

CHARACTERS OF MANIA- 181

keepers was supposed by him to be the Saviour of maukind. At other
times these same persons assumed other shapes, and according to the
state of his mind, were either fiends or angels. His delusion could
give to any object any shape it pleased.

4. Real impressions on the organs of sense become, as in dreams, the
materials of imaginary scenes. This curious phenomenon, also, is
strikingly illustrated in this autobiography. When the cold air blows
upon the patient as he is trying to suffocate himself, in obedience to the
spirits which speak within him, he imagines the spirits of his sisters
to be breathing on him to cool him and encourage him to go through
with his task. The familiar sensation of water trickling down the
back is converted into the crystal tears of his father, whose venei-able
countenance he sees bending over him. His shaven head suggests the
painful notion that he has received the tonsure of the Roman Catholic
priesthood, a mark of the beast. The jets of gas in the fire become the
utterance of his father's spirit, continually striving within him to save
him, and continually obliged to return to be purified in hell-tire, in
consequence of the contamination it received from his foul thoughts.
The lowing of the cattle conveys to him articulate sounds and sentences,
and the grating of the chair against the wall speaks to him in his
father's voice.

5. The strange antics of the madman are the effects of his delusion.
The following passages from the autobiography fully establish this
proposition : " I expected to be guided to prayer ; but a spirit guided
me, and placed me in a. chair, in a constrained position, with my head
turned to look at the clock, the hand of which I saw proceeding to the
first quarter ; I understood I was to leave the position when it came to
the quarter." *' Another delusion I laboured under was, that I should
keep my head and heart together, and so serve the Lord, by throwing
myself head over heels over every stile or gate 1 came to ; the con-
dition here was, as before, on its being done in precision and decision."
On one occasion a keepei*, in struggling with a patient, throws him
down and nearly strangles him. " When I saw his bloated and in-
flamed cheeks, and the eyes starting out of the sockets, I offered to do
anything to rescue him. My spii-its desired me to whirl myself round
and round as fast as I could, which 1 did till I staggered against the
wall, and nearly fell on the stone pavement." This last quotation
suggests the corollary that

6. The acts of the madman, the results of his delusions, are often
such as no sane man would believe fitted- to compass the object in
view.

7. The violence of the madman is often the effect not of mere
passion but of his delusions. " I knew no malice," says the author of
the autobiography, " no vice. I imagined that they (the keepers)
loved me, and were all deeply interested in the salvation of my soul,
and I imagined, too, that I loved them deaily. Yet I wrestled with
the keepers, and offered to do so with others, and struck many hard

182 UNSOUNDNESS OF MIND.

blows ; sometimes, as one informed me, making it difficult for three
strong men to control me ; yet whenever I did this, I was commanded,
that they wished me to do so, to prove my faith and courage, but that
they were commanded to prove both till they were satisfied of my sin-
cerity." "It was always a great delight to me to get my hand at
liberty, even for a moment, and the first use I usually made of it was
to strike the keeper who untied me ; directed by my spirits to do so,
as the return he desired above all things else, because he knew I was
proving my gratitude to the Lord Jehovah at the risk of being struck
myself." Doubtless the keepers regarded this as mere senseless and
motiveless violence. Do we not equally misunderstand the criminal
acts of the lunatic?*

8. The Maniac, if naturally of a reserved disposition, or when im-
pelled by a strong motive, has the power to conceal his delusion. The
proof of this proposition may be found in evei y work on insanity ; and
a remarkable illustration of it was given by Erskine in his defence
of Hadfield. A person who had been confined in a lunatic asylum pro-
secuted his brother and the keeper of the asylum for imprisonment and
false duress: Erskine was informed that the man was undoubtedly
insane ; but he was not told of the particular form which the malady
assumed. The prosecutor, himself a witness in support of the indict-
ment, was put into the witness-box and examined ; and when Erskine
came to cross-examine him, he found his evidence clear, distinct, col-
lected, and rational. He tried to discover some lurking alienation of
mind ; but during a cross-examination, conducted with all the skill
and sagacity of which he was master, for nearly an hour, he was com-
pletely foiled: the answers were perfectly rational — theie was not the
slightest appearance of mental alienation. A gentleman, however, who
had been accidentally detained, came into court, and whispered in
Erskine's ear that the witness thought he was the Saviour of mankind.
On receiving the hint, Erskine made a low bow to the witness, ad-
di essed him in terms of great reverence, respectfully begged to apologize
for the unceremonious manner in which he had treated a person of his
sacred character, and called him by the name of Christ. The man
immediately said, " Thou hast spoken truly : I am the Christ !" Pinel
relates a similar case. A commission appointed to visit the prison of
the Bicetre, examined one particular patient repeatedly upon many
successive days; but all their endeavours to prove the man insane
failed. They accordingly ordered a certificate to be prepared for his
liberation. It was necessary, before the man was released, that he
should himself sign the certiticate. It was placed before him, and he
signed ** .Jesus Christ." In a case to which the author has already
referred, he has reason to believe that more than one of the patient's
delusions was never mentioned to any one but himself, and that only

* These statements, like others In this instructive autobiography, are sin-
gularly in keeping with those of a recovered religious maniac who was for a
long period under the authors observation.

CHARACTERS OF MANIA. 183

once ; nor could he be induced by long conversations framed for the
purpose to give the slightest indication of tliem to third parties.

9. The acts of the Maniac often evince the same forethought and
preparation as those of the sane. This fact is well illustrated by the
following case : A patient who was confined in the Manchester Lunatic
Asylum, had been cruelly treated, and in revenge killed the person who
had charge of him. He related, with great calmness and self-possession,
the particulars of the transaction to Dr. Haslam. He said : *' The man
whom I stabbed richly deserved it. He behaved to me with great
violence and cruelty ; he degraded my nature as a human being ; he
tied me down, handcuffed me, and confined my hands much higher than
my head, with a leathern thong ; he stretched me on the bed of tor-
ture ; after some days he released me. I gave him warning ; for I
told his wife 1 would have justice of him. On her communicating
this to him, he came to me in a furious passion, threw me down,
dragged me through the court-yard, thumped me on my breast, and
confined me in a dark and damp cell. Not liking this situation, I was
induced to play the hypocrite. I pretended extreme sorrow for having
threatened him, and, by an affectation of repentance, prevailed on him
to release rae. For several days I paid him great attention, and lent
him every assistance. He seemed much j)leased with the flattery, and
became very friendly in his behaviour towards me. Going one day into
the kitchen, where his wife was busied, I saw a knife ; this was too
great a temptation to be resisted : I concealed it about my person, and
carried it with me. For some time afterwards, the same friendly inter-
course was maintiiined between us; but, as he was one day unlocking
his garden door, 1 seized the opportunity, and plunged the knife up to
the hilt in his back."

10. The Maniac, in spite of his proverbial cunning, is easily imposed
upon. This characteristic forms the great safeguard of the sane in
their dealings with maniacs. A good illustration of it is contained in
Lockhart's ' Life of Sir Walter Scott.' Henry Weber, Scott's protege and
amanuensis, had been reproved by him for indulging in habits of intoxi-
cation, which injured his health and interfered with his literary pur-
suits. On the evening after his return from Edinburgh, the author
observed Weber's eye fixed upon him with an unusual solemnity of
expression. On inquiring after his health, Weber rose and said :
'• Mr. Scott, you have long insulted me, and I can bear it no longer.
I have brought a pair of pistols with me, and must insist on your
taking one of them instantly ;'' and with that he produced the weapons,
which had been deposited under his chair, and laid one of them on
Scott's manuscript. " You are mistaken, I think," said Scott, " in
your way of setting about this affair — but no matter. It can, how-
ever, be no part of your object to annoy Mrs. Scott and the children ;
therefore, if you please, we will put the pistols into the drawer till
after dinner, and then arrange to go out together like gentlemen."
Weber answered with equal coolness, " 1 believe that will be better,"

184 UNSOUNDNESS OF MIND.

and laid the second pistol also on the table. Scott locked them both
in his desk, and said : " I am glad you have felt the propriety of what
I suggested — let me only request further that nothing may occur
while we are at dinner to give my wife any suspicion of what has
been passing." Weber again assented, and Scott withdrew to his
dressino--room, from which he immediately despatched a message to
one of Weber's intimate companions. The maniac was secured and
placed in confinement.

11. Maniacs in confinement are often conscious of their state, and
know the legal relations in which it places them. An intriguing, un-
ruly, vicious madman was detected with a piece of iron, which he had
contrived to shape like a dagger, and fix into a handle. When the
weapon was taken away from him, he became excessively abusive, and
had to be placed under restraint. In the fit of fury which followed,
he uttered the most revolting imprecations, and exclaimed to the
keeper, " Pll murder you yet : T am a madman, and they cannot
hang me for it." When Martin set fire to York Minster, the inmates
of a neighbouring madhouse discussed the question whether Martin
would suffer the extreme penalty of the law. Various opinions were
expressed; but in the midst of the conversation, one patient, ap-
parently as mad as the rest, exclaimed, " He (Martin) will not be
hanged — of course he will escape." " For what reason ?" asked
several voices. *' They cannot hang him," replied the lunatic, " be-
cause he is mad, — he is one of ourselves !"* It is important to under-
stand that this consciousness of their state occurs only in the case of
madmen surrounded by madmen in lunatic asylums, or in the case of
those who have been under treatment.

The foregoing are some of the more prominent of those characters
of mania which bear on the decision of medico-legal questions.
They serve to throw light upon the phenomena of insanity, and
to answer son\e of the arguments advanced by persons ignorant
of the real nature of this strange condition of mind.f To those
who are better informed, they may be useful by setting forth more
clearly than any general description can do, the conti-adictions of
which the madman is the sport.

It is probably beyond the power of the sane mind to conceive the
confusion which reigns in the mind of the madman. A series of de-
lusions, the offspring of some one excited passion or emotion, or one
single delusion, the work of fancy, the interpreter of every sensation,
the source of every thought, the mainspring of every action ; holding
every faculty in stern subjection, making the senses its dupes, the
reason its advocate, the fancy its sport, and the will its slave ; now
whispering in the ear things unspoken, now painting on the eye things
unseen; changing human beings at will into fiends or angels : convert-

* Winslow's 'Plea of Insanity in Criminal Cases,' pp. 16, 11.
f For a very able exposition of some of the characters of mania, see Aber-
crombie, ♦ On tbe Intellectual Powere,' 9tli edition, pp. 315 and 326.

LEGAL RELATIONS OF MANIA. 185

ing every sensation into a vision, every sound into articulate speech ;
the unreal world v^ithiu in constant conflict with the real world with-
out ; understood ot no one, yet believing himself to be comprehended
by all ; punished for the very actions which he supposes his tyrants to
have commanded, controlled in everything which he thinks it his duty
to perform. There is no wish however presumptuous, no fancy how-
ever monstrous, no action however absurd, no crime however heinous,
that his delusion cannot create, prompt, and justify. That a sane
man might form a conception, however faint, of the distraction of such
a state as this, it would be necessary to combine into one whole the
strange confusion of a dream, and the sleeper's entire belief in its
reality, the varying impressions and changing scenes of his waking
hours, and the conduct, to him wholly unintelligible, of those about
him.

The degree of confusion existing in the mind of the madman will,
of course, vary with the nature and extent of his delusions. When
several delusions spring from one excited emotion or passion, such
as pride, vanity, or religious veneration, the distraction may be ex-
pected to be greater than when one single delusion takes possession of
the mind. But in this latter case, though the confusion will be less,
and there may be many and long intervals of apparent sanity, the
patient's mind will be as abject a slave to the one delusion as to the
many.

Lc'jal relations of Mania. There is a difference worthy of note
between the effect of mania on civil and criminal acts. In civil cases,
if a man can be shown " to be non compos mentis, the law avoids his
act, though it cannot be traced to, or connected with, the morbid
imagination which constitutes his disease, and which may be ex-
tremely partial in its influence on conduct." * But in criminal
cases, it is not enough to prove a man non compos : it must be shown
that at the time he committed the act he did not know right fi-om
wrong. It is not easy to understand the gi'ound of the distinction
thus established between civil and criminal acts. If it be just to
deprive a man of the management of his property on account of a
delusion which has no immediate connexion with the affairs of business,
ought not the same delusion which renders him incapable of civil acts,
to render him also incapable of crimes ? Do not the same faculties
concur in civil as in criminal acts ? Is there not in both some wish or
emotion or passion to originate the act, reason, or instinctive cunning, to
plan it, and will to execute it ? The civil acts of a maniac are not void
on account of the direct effect of his delusion upon them, but because
there is no security that the influence of the delusion may not at any
moment extend beyond its usual sphere of action. It is just so with
his criminal acts. The delusion which ordinarily affects only the intel-
lect, or shows itself in harmless peculiarities of conduct, may lead to

* Erskine, in Ms defence of Hadfleld.

186 UNSOUNDNESS OF MIND.

acts of atrocious violence ; and it is reasonable to suppose that the
mind which is in such an excited or perverted state that it can
oppose no effect'ial check to delusive ideas, is also in such a state as to
be able to offer no effectual resistance to a criminal impulse. The im-
portance of this subject will justify a more lengthened examination
of it.

The plea of Insanity in criminal cases. — It is necessary to piemise
that the plea of insanity may be raised in respect of several criminal
offences, such as homicide, arson, and theft ; but as the large ma-
jority of cases in which the plea has been sot up have been cases of
homicide, and all the legal discussions of importance have arisen out
of such cases, the remarks which follow must be understood to relate
primarily to them. It ought also to be borne in mind that though
the plea of insanity may be set up in reference to homicidal acts
committed in a maniacal paroxysm, and by persons otheiwise rational
alleged to be seized with an uncontrollable impulse, the cases which
have been brought under discussion belong to the class of mania with
delusion in which the homicidal act has been carefully planned, and
carried deliberately into effect.

Our earliest legal authorities evidently confounded mania with idiocy,
for Bracton defines a madman as one who " does not understand what
he is doing, and, wanting mind and reason, differs little from brutes ;"
and when the attorney-general, on the trial of Hadfield, in the first
year of this century, laid down the law, " that to protect a man from
criminal responsibility there must be a total deprivation of memory
and understanding," Erskine admitted this to be '* the very expression
used both by Lord Coke and by Lord Hale."

This total insanity Lord Hale was the first to distinguish from
partial insanity, and he first laid down the principle, that partial
insanity is no excuse in the commission of any capital of!'ence. The
same authority suggests as a measure of responsibility, *' that 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 treason and felony."

The practice of our courts of law was for a long time in strict con-
foi-mity with the principle thus laid down by Lord Hale. Thus,
Mr. Justice Tiacy, in the trial of Arnold in 1723, for shooting at
Lord Onslow, obseiTed : " It is not every kind of frantic humour, or
something unaccountable in a man's actions, that points him out to be
such a madman as is exempted from puni^^hment : it must be a man
that is totally deprived of his understanding and memory, and doth
not know what he is doing, no more than an infant, than a brute, or
a wild beast: such a one is never the object of punishment."

The trial of Hadfield gave the death-blow to the doctrines of Lord
Hale, and established delusion as the true test of intellectual mania.
In conducting the defence, Erskine showed that what the law had
styled madness was idiocy — the idiocy a nativitate vel dementia

PLEA OF INSANITY IN CRIMINAL CASES. 187

»
natiiralis of Lord Hale himself — and that no such madness as that
imagined by the older writers had " ever existed in the world." He
then succeeded in showing that "delusion, when there is no frenzy or
raving madness, is the true character of insanity," but added the very
questionable proviso that in order to render the madman irresponsible
for crime, it must be shown, that the act in question was the imme-
diate unqualified offspring of the disease.

These new doctrines, though always quoted with approbation, were
soon lost sight of, and in place of the test of delusion, sprang up that
of " right and wrong." Thus, in the case of Bellingham tried at the
Old Bailey for the murder of Mr. Perceval, May 15, 1812, Mansfield,
C. J., is reported to have told the jury, that they must be satisfied,
in order to acquit, that the prisoner was incapable of judging between
right and wrong, and that at the time of committing the atrocious act
with which he stood charged, he' did not consider that murder was a
crime against the laws of God and Nature. In a case which occurred
only two months later (that of Bowler for shooting Mr. Burrowes),
Mr' Justice Le Blanc left it to the jury to determine whether the
prisoner, when he committed the offence, was incapable of distinguish-
ing between right and wrong, or whether he was under any illusion in
respect to the pei-son he shot, which rendered his mind at the time
insensible to the nature of the act he was about to commit ; since in
that case he would not be legally responsible for his conduct. In a
still more recent case (Rex v. Offord), Lord Lyndhurst told the jury
to acquit, if they were satisfied that the prisoner did not consider his
act any crime against the laws of God and Nature. A similar prin-
ciple with slight and unimportant verbal variations was affirmed in
the trial of Oxford for firing at the Queen, in the recent case of
M'>saughton, in the able exposition of the law by the lord chancellor
before the House of Lords, by the law lords who spoke on that oc-
casion, and, lastly, by all the judges to whom this grave question was
referred.

There can be no doubt, then, that the legal test at present received
is the power of distinguishing right from wrong. But the difficulty
of applying this test in practice is so great that judges ©ften, and juries
always, prefer a more easy and reasonable mode of procedure. Thus,
in the case of Hadfield, Lord Kenyon, with the concurrence of the rest
of the judges of the Queen's Bench, inteiTupted the defence, and said
that " with regard to the law, as it had been laid down, there could
be no doubt whatever. If a man be in a deranged state of mind at the
time of committing an act, he is not criminally answerable ; the
material part of the case is whether, at the very time, his mind was
sane. His insanity must be made out to the satisfaction of a moral
man meeting the case with fortitude of mind, and knowing the
anxious duty he has to discharge." Here, then, the distinction between
right and wrong is altogether lost sight of, and the simple practical
question of the insanity of the accused is made to take its place. As

188 UNSOUNDNESS OF MIND.

a general rule, however, the theory and practice of the law have been
so far consistent, that though the verdict of the jury has been couched
in general terms, the test of right and wrong hiis been distinctly pro-
pounded from the bench. In the case of M'Naughton, for instance,
the jury brought in a verdict of " not guilty, on the ground of in-
sanity," after Chief Justice Tindal had in his charge strongly and
clearly laid down the distinction of right and wrong.

The state of the law up to a recent date, and, indeed, up to the
present time, may be inferred from the answers of the fifteen judges to
the questions suggested by the trial of M'Naughton. These questions
were submitted by the judges to the House of Lords, and the answers,
in which the whole bench, with the exception of Mr. Justice Maule,
concuiTed, were read to the house by Lord Chief Justice Tindal on the
19th June, 1843. From these questions and answers given in extenso
at the foot of this page,* the present state of the law in respect of

* Question I. What is the law respecting alleged crimes committed by
persons afflicted with insane delusion, in respect of one or more particular 8ui>
jects or persons : as, for instance, when at the time of the commission of ilie
alleged crime the accused knew he was acting contrary to law, but did the
act complained of wiih the view, under tlie influence of some insane delusion,
of redressing or avenging some sujyposed grievance or injurj'-, or of producing
some supposed public l)eneflt?- Answer. Tlie opinion of the judges was, that,
not uithstav ding the party committed a icrong act, while labouring under the
idea that fie was redressing a supposed grievance or injury, or under the im-
pression of obtaining some public or private benefit, he was liable to punish-
ment.

Question IL What are the proper questions to be submitted to the jury,
when a person alleged to be ahected with insane delusion, respecting one or
more particular subjects or persons, is charged with the commission of a crime
(murder, for example) and insanity is set up as a defence?— Answer. The jury
ought in all cases to be told that every man should be considered of sane mind
until the contraiy were clearly proved in evidence. That before a plea of in-
sanity should be allowed, undoubted evidence ought to be adduced tliat the
accused was of diseased mind, and that at the time he committed the act he
vias not conscious of right and vyrovg. This opinion related to every case in
which a party was charged with an illegal act, and a plea of insanity was set up.
Every person was supposed to know what the lav) was, and therefore nothing
could justify a wrong act except it was clearly pi-oied that the party did not
know right from wrong. If that was not salistactoriiy proved, the accused
was liable to punfthraent ; and it was the duty of the Judge so to tell the jury
when summing up the evidence, accompanied by those remarks and observa-
tions which the nature and peculiarities of each case might suggest and require.

Question 111. In what terms ought the question to be left to the jury as to
the prisoner's state of miud at the time when the act was conmiitted ? No
answer.

Question IV. If a person, under an insane delusion as to existing facts, com-
mits an offence in consequence thereof, is he hereby excused ?— Answer. If the
delusion were only partial, the party accused was equally liable with a person
of sane mind. If the accused killed amther in self-defence, he would be en-
titled to an acquittal ; but if the crime were committed for any supposed injury,
he uould then be liable to the punishment awarded by the laws to his crime.

Question V. Can a medical man, conversant with the disease of Insanity,
who never saw the prisoner previously to the trial, but who was present during
the whole trial and the examination of all the witnesses, be asked his opinion as
to the state of the prisoner's miud at the time of the commission of the alleged

yi.. .,:-./,

PLEA OF INSANITY IN CRIMINAL CASES. 189

homicidal acts, committed by persons afflicted with mania accompanied
by delusions, may be inferred to be as follows : — That a person who
commits an act under the influence of an insane delusion, with a
view of avenging some supposed injury, redressing some supposed
grievance, or producing some supposed public benefit, is liable to
punishment, if, at the time of committing the act, he knows that it is
contraiy to law ; and that if the delusion is only partial, the respon-
sibility incurred is equal to that attaching to a person of sound mind.
It further appears that before the plea of insanity can be allowed, it must
be proved in evidence that the accused was of diseased mind, and that
at the time of committing the act he was not conscious of right and
wrong. He is assumed to know what the law is, and is only held
irresponsible for his act if his mind can be shown to be so unconscious
of right and wrong that he is incapable of appreciating the law and
its requirements. This is the only reasonable interpretation which
can be given to the doctrine of the judges. " Every person was
supposed to know what the law was, and therefore nothing could
justify a wrong act, except it was clearly proved that the party did
not know right from wrong."

Four distinct questions are suggested by this brief summary of the
decisions of the fifteen judges. 1. Are the class of maniacs now
under consideration (namely, those who commit acts of violence under
the influence of delusions, and with premeditation) cognizant of the
law ? 2. Can they distinguish right from wrong ? 3. Do the
answers to these questions apply to persons subject to partial
delusions? 4. Are these legal and moral tests of any practical
utility?

1 . Are maniacs, who commit premeditated acts of violence under the
influence of delusions, cognizant of the law ? The answer to this
question is easy. There is every reason to believe that these persons
possess the intelligence and consciousness requisite to the knowledge
and appreciation of the law. They have been shown to be as a class by
no means wanting in memory, observation, or reasoning power. Some
of them have committed murder that they might suffer the penalty of
the law ; those who, from being placed under restraint, have grown
conscious of their infirmity, know or believe that they are by that in-
firmity rendered irresponsible, and it is in the last degree improbable

crime, or his opinion whether the prisoner was conscious, at the time of doing
the act, that he was acting contrary to law ? or whether he was labouring
under any, and what delusion at the time ? — Answer. The question could not
be put in the precise form stated above, for by doing so it would be assumed
that the facts had been proved. When the facts were proved and admitted,
then the question as one of science would be generally put to a witness under
the circumstances stated in the interrogatory.

Mr. Justice Maule dissented from the answer to this last question. In his
opinion such questions might be at once put to medical men without reference
to the facts proved ; and he considered that this had been done, and the legality
of the practice thereby confirmed on the trial of M'Naughtou.

190 UNSOUNDNESS OF MIND.

that monomaniacs whose intellects appear to be so little affected that
they are allowed to mingle in society like other men, should be igno-
rant of a law with which ft-om their earliest years they have been
familiar, and of which we are all, unfortunately, too often reminded.
The knowledge and consciousness of this law may be fairly expected to
be the very last of which madness would deprive a man.

2. Can they distinguish right from wrong'? There is reason to
believe that the class of maniacs now under consideration are conscious
of the difference between right and wrong, and if asked whether
murder is an offence against law, divine and human, would answer
unhesitatingly in the affirmative. But there is equally reason to
believe that if a maniac subject to delusions were to conceive the
desire to commit murder, he would be as incapable of resisting that
desire as he had already proved himself incapable of resisting his
delusions. There is a fair and reasonable analogy between the insane
thought and the insane wish. His delusions have already defied the
evidence of his own senses, the efforts of his own reason, the tes-
timony of his sane neighbouis, and the remonstiances of his friends ;
and his impulses will ])robabIy prove as irresistible when confronted
with his knowledge ot the distinction between right and wrong and
the remonstrances of his conscience.

3. Of partial deltisions. It is natural to suppose that a maniac
subject to a great number of delusions would be less able to control
his irregular impulses than one who has but one or two delusions.
A multitude of delusions naturally implies more confusion and more
excitement. A single delusion may be supposed to be moie compatible
with self-restraint. Single delusions are, however, of rare occurrence,
and do not oft«n figure in couits of law. Partial delusions are much
more common, but when they are closely examined they are found to
be the offspring and natural expression of some one excited feeling or
passion, which, having had strength enough to create illusions of the
senses and delusions of the mind, may be expected to give rise to insane
impulses of great power.

The excited feelings or passions which, having first destroyed the
integrity of the senses and mental faculties, proceed to instigate acts of
violence and ciuelty, are religious excitement or despondency, and
jealousy. Domestic anxieties exaggerated into fear of starvation, and
discontent transformed into an insane belief in persecution, are also fruit-
ful sources of illusions, delusions, and acts of violence. Now the acts of
violence which ultimately flow from these excited feelings or passions,
after they have given rise to a series of delusive ideas, ought to be judged
by the same rules which apply to the delusions themselves. The acts
are probably as little subject to resti-aint as the delusions to conection.

If the four most common sources of homicidal acts — religious excite-
ment or despondency, jealousy, domestic anxiety, and discontent — are
submitted to further analysis, the objection to the plea of insanity will
be found to be narrowed to a small number of cases.

PLEA OF INSANITY IN CRIMINAL CASES. 191

Maniacs under the influence of religions excitement or despondency
are subject to illusions and delusions of a very singular kind. They
frequently transform the persons with whom they are associated into
supernatural beings, endowed with authority or power not to be ques-
tioned or resisted, and they convert common and familiar sounds into the
articulate language of temptation or command. One religious maniac,
therefore, kills a relative or a keeper, imagining him to be a beast, or
a fiend ; another has an honest conviction that he is above the law.
Perhaps he believes himself to be the Deity, or that he is commissioned
by him to fulfil some mission of wrath or extirpation. In cases of
religious mania, then, we can never confidently affirm that the criminal
act was not the natural consequence of a delusion which placed the
maniac, in his own sincere conviction, beyond and above the operation
of human laws ; or of a command which he would deem it impious
to resist.

Of homicidal acts instigated by jealousy shaping itself into a distinct
delusion it will suffice to observe that they are such acts as if com-
mitted by sane men on the evidence of their senses, would be punished
as manslaughter and not as murder.

Of the infanticides committed by fathers and mothers under the pres-
sure of domestic anxiety culminating in an insane dread of starvation, it
may be observed that they are the acts of parents generally remarkable
for their domestic virtues and devoted attachment to their victims, and
that between them and ordinary murderers there is no single point of
resemblance.

Discontent, transformed into an insane belief in persecution, presents
greater difficulties. The case against the insane believer in persecution
is generally put in a form which seems to preclude a satisfactory answer.
A maniac believes himself to have been injured by another, and he
takes away his life. If the injury were real instead of imaginary, the
murderer would be responsible for his act, and so, it is contended,
ought the madman to be. This argument would be valid if all the
concomitants in the two cases were the same ; but, in reality, they have
nothing in common but the act itself. The imaginary offence has
iraaginaiy accompaniments, and every thought connected with it is one
of confusion. The supposition that the mind which can imagine an
impossible offence is sound in all other respects is opposed to the strong
conviction of all men of experience among the insane. They all with one
consent repudiate the notion of a mind subject to such a delusion being
sound, and free to act as it will, beyond tlie sphere of its influence.

The more closely the subject of this partial delusion is observed, the
more extensive is found to be the disorder of his intellect. Those
actions which are not directly prompted by his delusion are more
strange, and his passions are more excitable than those of other men.
The theory of a single insane idea springing up in the mind, unaccom-
panied by any other disordered action of the faculty from which it takes
its rise» having no effect upon the remaining faculties, and showing

192 UNSOITNDNESS OF MIND.

itself simply by prompting an action, which, when once suggested,
is carried out with the complete consciousness of its real nature which
exists in the mind of a sane man acting under the suggestion of a cor-
responding reality, is too absurd to be for one moment entertained.
Even in this case, therefore, the question of responsibility cannot be
decided by the simple test of a knowledge of right and wrong.

But there is another case allied to the one now under consideration
which presents still greater difficulties. A man receives a real injury,
and he avenges himself; but it is alleged that he was not of sound
mind when he committed the act. The unsoundness of his mind is
admitted, but he is deemed responsible as committing murder under
the instigation of the common motive of revenge. On the other hand,
it is reasonable to allege that the real injury has been by his insane
mind magnified to an undue importance, and then acted upon just as if
it had been altogether imaginary ; that he is therefore neither more
nor less responsible for his act than the man whose motive was from
the fust purely imaginative. In this case, too, an inquiry into the
state of mind, extending much beyond the legal test, will be necessary,
and cannot be refused ; and this very inquiry, once granted, must
result in showing the insufficiency of the test. Even in those cases
where the criminal act cannot be traced to any delusion of which it is
the legitimate offspring, but it is simply alleged in defence that the
party is of unsound mind, the very fact of the unsoundness becomes an
irresistible plea in mitigation. It would be strange, indeed, if the case
of the unhappy maniac under the accusation of crime were the only
one in which such a plea is ignored and refused.

4. Are these legal arid moral tests of any practical utility ? If the
utility of a test is to be measured by the facility of its application,
this test of a knowledge of right or wrong Will certainly be condemned.
It fails in the hands of the medical witness, it is often practically set
aside by our judges, and it is never really applied by our juries, as the
very form of their verdict shows. In most cases it is comparatively
]- easy to ascertain the fact of unsoundness of mind, but it is impossible
to determine the precise effect of that unconsciousness upon the mad-
man's acts. But it is eminently absurd to credit a mind which is
already occupied by delusions with an otherwise efficient state of its
faculties. It is in the highest degree improbable that a mind so pos-
sessed is able, beyond the sphere of its delusions, to think, feel, and act
with the clearness, force, and freedom of the sane.

Some writers, under a strong sense of the failure of the legal test of
a knowledge of right and wrong, have sought to set up in its place the
power of control or restraint. The test has been thus transferred from
the intellect to the will— from the knowledge of right to the power
of acting aright. But this is a mere shifting of the difficulty. It is
obviously quite as easy to ascertain a man's abstract knowledge of
right and wrong, lawful and unlawful, as the exact amount of self-
restraint which he possesses.

PLEA OF INSANITY IN CRIMINAL CASES. 193

This test appears to have one advantage over the knowledge of
right and wrong. Jt is thought that the mode of accomplishing
the homicidal act will itself throw light on the amount of restraint
or self-control which the maniac is able to exert. If he watches his
opportunity, bides his time, prepares a fitting instrument, and uses it
in the ordinary way, it is infeiTed that he possessed such an amount
of self-control as ought to have prevented the murderous act. The
objection to this test is obvious. It is drawn from the analogy of the
madman's sensations and thoughts. If he could not prevent the senses
from being the sport of illusions, and was unable to root out delusions
from his mind, it is not to be supposed that he can control the irregular
impulses and passions which are to the will what illusions are to the
senses or delusions to the intellect. And if it is alleged that the skill
evinced in planning the homicidal act, and the patience shown in wait-
ing for a favourable opportunity, ought to be taken as evidence of
adequate self-control, appeal may again be made to analogy. The
acts of the maniac are in strict keeping with his thoughts. His
delusions, even when they are most distinctly present to his mind, are
quite compatible with the exercise of all his faculties. If they are
attacked, he defends them acutely and justifies them plausibly. They
have not destroyed his faculties, they have merely perverted them to a
wrong use. So is it with his homicidal act. The impulse which
seizes upon his unsound mind does not destroy his powers, it merely
perverts them. Accordingly, if a maniac is under the delusion that
his keeper is a fiend, or if he believes that the Deity has commissioned
him to take away the keeper's life, he will load a pistol, watch his
opportunity, and act in every respect as a sane criminal would do.
And, if prevented on one occasion, he will wait for a more favourable
opportunity. Nay, the merest imbecile knows that a knife or a pistol
is a common instrument of death ; and weak as his mind may be,
he conceals his weapon, not because he is conscious of guilt, but because
he knows that, if it were openly displayed, the action he contemplates
would be prevented. The fact is, that in proposing this test, as in
the general discussion of this question, two distinct things have been
confounded, —the act itself, which is the result of the delusion, and
the mode of accomplishing it. It is the delusion which distinguishes
the madman and not the mode in which the delusive impulse is
carried into effect. This test, then, is open to the same objections
which lie against the legal tests : it seems reasonable, but it is not
practical.

The difficulty of devising a test which shall not be open to the
most serious objections has led some persons to devise an easy method
of escape by depriving persons of unsound mind of what is called the
privilege of insanity, or, in other words, refusing to entertain the ques-
tion of the state of the mind at all. This suggestion may have the
merit of simplicity, but it is open to the very serious objection that it
could be acted upon only once. The spectacle of a madman on the

o

194 UKSOUXDNESS OF MIKD.

scaflFold would be simply intolerable. No jury conld be found to con-
vict ; and the indiscriminating statute would prove as complete a dead
letter as the statute which awards the punishment of flogging to
assaults upon the Queen did, when it was to be applied to the person
of poor Lieutenant Pate. The idea of hanging and flogging madmen
is utterly repulsive, and must be given up.

Anothei- theory entertained by some writers of eminence is, that as
madmen are, like other men, influenced by fear, the punishment of
death, as the consequence of murder, should be kept before their eyes.
This theory may be said to have broken down in the case of Lieutenant
Pate, just referred to. It is most probable that this poor imbecile was
cognizant of the degrading punishment awarded by a recent statute to
persons who should assault the sovereign ; but the thieat had no effiect
upon him. By parity of reasoning, it seems most probable that the
threatened punishment of death would prove equally ineffectual in
every class of madmen. But, in reality, the restraining influence ot"
the punishment of death is already brought to bear upon persons of
unsound mind ; for it should be borne in mind that men who have not
been certified as insane, and confined in lunatic asylums, do not believe
themselves to be mad. They are, in their own sight, sane men. It
is only after men have been taught, by confinement as madmen, that
they are insane, or are believed to be so, that the terror of the
gallows is replaced by the alternative terror of perpetual imprison-
ment.

Those who maintain the theory now under examination are apt to
defend it by comparing persons of unsound mind with the lower
animals, alleging that, as dogs can be weaned by punishment fi-om
practices distasteful to their masters, so madmen can be deterred from
crime by fear of death. In putting forward this argument from
analogy two facts are overlooked — the fact that the animal has been
punished, and has a distinct recollection of the pain inflicted upon
him, while the madman has been merely threatened ; and the fact
that there are many dogs who cannot be weaned from bad habits
by the frequent repetition of the most severe chastisement.

In the case, then, of the class of maniacs now under consideration,
who, being subject to delusion, commit their acts of violence with pre-
meditation, it is submitted that all the legal and moral tests are
inapplicable and useless ; and that the law of England ought to be as-
similated to that of France — " II n'y a ni crime ni de'lit lorsque le
pre'venu e'tait en etat de demence au temps de Paction."

It may be objected that under such a law, unless the most rigid
proof of insanity were required, some men would escape who ought to
suffer the punishment of death : but, on the other hand, none who did
not deserve death would be executed; and it is a generally acknow-
ledged principle, that it is better that many guilty persons should
escape than that one innocent man should suffer. Moreover, a verdict
of acquittal, on the giound of insanity, bi'ings with it, as a necessary

PLEA OF INSANITY IN CRIMINAL CASES. 195

consequence, confinement for life, which, were it inflicted as a punish-
ment, would hardly be second in severity even to death itself.

Nor is there any good reason to fear that, ])y exempting the madman
from the punishment of death, we shall weaken the hold which the
law has on the man of sound mind ; for, in order that he may escape
death, he must successfully feign insanity — a task of no ordinary
difficulty — and, if he succeed, a perpetual sacrifice of liberty awaits
him. It is not likely, therefore, that society will suffer any injury
from the adoption of the course here advocated ; and we may peihaps
find that it gains something by openly attributing to disease some of the
most revolting crimes which degrade and debase our common nature.

In respect to the responsibility of madmen, then, the law seems to
be in this dilemma: — it must either insist upon a test which it is
impossible to apply, or it must uniformly refuse or admit the plea of
insanity. If it hold to a test, its decisions will want that uniformity
which ought to belong to them, and their soundness will be constantly
liable to be called in question ; if it reject the plea of insanity it ought
forthwith to do away with all other pleas in mitigation.

The foregoing observations apply to those cases only in which dis-
tinct proof has been obtained of unsoundness of mind, existing pre-
viously, as well as at the very time of the criminal act, and not to that
instinctive madness which is altogether independent of the intellect,
and consists merely in uncontrollable impulse. This form of madness
is now generally recognized by medical men, and has on more than
one occasion led to the acquittal of an accused party. The criminal
acts committed under its influence have most or all of the following
characters : —

They are without discoverable motive, or in opposition to all known
motives. A man kills his wife to whom he is tenderly attached, a
brother his sister, a mother her infant ; or the victim is one whom the
madman never saw before in the course of his life, and against whom
it is impossible that he can bear any malice. After the commission of
the act, he does not seek to escape ; he often publishes what he has
done ; does not conceal the body from view, but openly exposes it ;
delivers himself up to justice ; describes the state of mind which led
to the act, and either remains stupid and indifferent, or is overwhelmed
by remorse. He has no accomplices, has made no preparations, and
takes nothing from his victim. Sometimes he has previously spoken
of his strong temptation, and begged to be prevented from doing
mischief.

These homicidal acts are generally preceded by a striking change
of conduct and character, and, on inquiry, the accused is often found
to have an hereditary tendency to insanity, to have attempted suicide,
to have expressed a wish for death, or to be executed as a criminal.

In this class of cases it is most important that all the circumstances
should be duly weighed, and that careful search should be made after
those motives which most frequently actuate the criminal. It is in

196 UNSOUNDNESS OF MIND.

such difficult cases, too, that a caution is especially necessary against
basing a decision upon one or two alleged characteristics. All the cir-
cumstances of the act ought to be duly weighed, in the spirit of the
words of Lord Hale : " lest, on the one side, there be a kind of inhu-
manity towards the defects of human nature, or, on the other side,
too great an indulgence given to great crimes."

This instinctive madness is no doubt sometimes associated with
delusion, the criminal act itself being the result of strong excite-
ment of the passions, while the delusion suggests the motive. To
this class probably belong those cases of wholesale murder in which
the father of a family destroys his wife and children, to prevent them
from falling victims to stai^vation, and then puts an end to his own
life : the idea that such an evil threatens them being insane, no less
than the impulse which prompts such a mode of escape.

In order to complete this inquiry into the plea of insanity in criminal
cases, it would be necessary to enter into minute details respecting
the different aspects given to criminal acts by tiie several varieties of
unsound mind. The want of space for so full a discussion of the
subject leads me to substitute the following brief summary : — An
imbecile has a confused and imperfect notion of crimes, laws, and
punishments ; and his acts are as foolish as his thoughts. The case
referred to at p. 164 is a good example of crimes committed by this
class. A monomaniac fancies himself an object of persecution, and
he murders one of his imaginary tormentors. His act is as mad as
his thought. He destroys one of his supposed enemies, and hopes
thereby to rid himself -of all. Such was M'Naughton. Another
having betrayed decided symptoms of madness, receives a real injury,
and murders the person who has injured him. Such was Lord
FeiTcrs. A third, oppressed with melancholy fears, kills those to
whom he is most attached, to save them from some imaginary fate.
Such was the female already referred to, who, under the fear of
starvation arising out of temporary difficulties, murdered her child,
cooked it, ate of it, and offered the dish to her husband. Lastly, we
have the so-called instinctive madness, of which the case of William
Brown, given at length in Kay's 'Medical Jurisprudence of Insanity,'
affords a good example.

FEIGNED UNSOUNDNESS OF MIND.

Men feign insanity from the same motives which lead to the simu-
lation of other diseases. Of this class of feigned diseases, too, as of
those already noticed at greater length at p. 145, it may be stated
that it is only by actual experience of the real disease that the counter-
feit can be detected. Indeed, this remark is generally acknowledged to
be peculiarly applicable to feigned insanity.

• . Idiocy. — This form of mental unsoundness is rarely assumed, and,
when feigned, is easy of detection. The idiot has almost always a

FEIGNED MANIA. 197

peculiar form of head, accompanied in most instances by other de-
formities ; and it must always be practicable to learn so much of an
impostor's history as that he was not always in the condition which he
has assumed.

Imbecility. — In this case, too, the history, where it can be obtained,
will assist in unmasking the imposition ; and where the previous
history is unknown, the patient, by assigning his unsoundness to some
inadequate cause, may assist us in our diagnosis. The peculiar cast of
countenance of the imbecile is extremely dilficult to imitate. The dull,
stupid, vacant, and wandering look, corresponding with the unsettled
and uneasy manner, the disconnected and evanescent ideas, the variable
temper and spirits, the sudden and transient gusts of passion, and the
foolish acts utterly unsnited to bring about the objects he professes to
have in view, are, collectively, very difficult to assume. In the less
strongly-marked forms of real imbecility, folly and acuteness are dis-
played indifferently on all subjects ; but the impostor is shrewd on
those which involve his interest or the success of his scheme, and dis-
plays his stupidity only in matters of indifference.

This class of cases, however, piesents unusual difficulty of diagnosis,
and gives rise to great differences of opinion among medical men.
Several cases have come under the notice of the author of imbeciles
certified as insane by the medical officers of prisons, and returned from
the asylums as impostors ; and other cases in which, after long and
careful observation under the most favourable circumstances, two
equally competent observers have not been able to agree in their
opinion. Unsettled habits, wandering and disconnected thoughts,
sudden bursts of passion, unprovoked acts of violence, imsuccessful
attempts at suicide, transient and half-formed delusions, short fits of
industry, handywork displaying much skill and ingenuity, make up a
combination which it would be in the power of a good actor to
assume. But imbeciles of this order possess sufficient shrewdness
and self-control to conceal and moderate their eccentricities when
they have an object to accomplish. So that it is quite possible for a
real imbecile in prison to seem an impostor in an asylum.

Dementia. — This form of unsoundness is rarely imitated. That
torpor of all the faculties which belongs to the true disease is not
readily put on and sustained ; and we shall be much assisted in our
diagnosis by bearing in mind the fact that dementia, where it is not
the result of a sudden and severe mental shock, is the consequence of a
disease of the brain, which, sooner or later, reveals itself in paralysis.

Mania. — As it is more easy to assume the violence of mania than
the more subdued characters of the foregoing forms of unsoundness,
mania is more frequently feigned. The distinction between the fic-
titious and the true disease, though occasionally requiring time and
continued observation, is not difficult; but in this, as in other feigned
diseases, the impostor often obstinately resists the efforts of the medical
man to obtain a confession of his fraud.

198 UNSOUNDNESS OF MIND.

The peculiar intense expression of the countenance, the marked al-
teration of the features, and the wildness of the eye, which belong to
real mania, can scarcely be successfully assumed. The vehement ex-
citement, the loud shouts, the strong struggles, and violent convulsive
movements of the paroxysms also scarcely admit of imitation, and
cannot be supported for any length of time.

'i'he real maniac will continue without sleep for days, and even
weeks, or, if he sleep at all, his rest will be disturbed and agitated;
but the impostor can scarcely keep himself awake beyond one or two
days, and a dose of opium, which would produce no effect whatever
upon the madman, would infallibly send the impostor to sleep. The
same remark applies to other remedies, such as emetics and purgatives.
The madman will also go without food for days together with impunity,
and with little loss of strength. Another character of true mania is
insensibility to external impressions. The maniac will also bear the
most intense cold, and gaze without being dazzled on the strong light
of the sun.

Other symptoms of less importance have been insisted on, such as
the torpid state of the bowels, the moderate or low temperature of the
trunk and limbs, a peculiar odour of the skin, and a frequent pulse.*

To this account of the physical signs of mania it may be added that
the impostor is apt to overact his part during such times as he is
watched ; that instead of becoming more quiet and reserved on the
approach of the physician, his violence increases ; that he assumes a
want of intelligence instead of that perversion of reason which is so
characteristic of the real affection ; that he obtrudes instead of conceal-
ing his thoughts ; that he pretends a defect of memory and appre-
hension which does not belong to real insanity, gives false answers to
questions, and affects not to recognize persons whom he knows; that
he does not recur constantly to the leading idea ; that he betrays hesi-
tation in the midst of his assumed violence ; that he has not the steady
gaze of the madman ; that his fits occur suddenly and at irregular and
convenient intervals, instead of having the periodicity of intermittent
attacks of mania. Il^may be added, that instead of having the long
period of incubation so general in true mania, the first attack of his
disorder is sudden. That perversion of the moral feelings which causes
the madman to dislike every person to whom he was previously at-
tached, being a symptom little known to the vulgar, is also not assumed
by the impostor.

Besides the diagnostic marks to be gleaned from the foi'egoing
description, and the precautions already mentioned under the head
of feigned diseases, some special tests have been recommended ; such
as repeating to the suspected person a series of ideas recently uttered

* In the first edition of this work I adduced facts to show that the value of
the pulse as a diagnostic mark had probably been exaggerated. All, perhaps,
that can be safely afHrmed is that an Infrequent pulse, which often exists in
healthy persons, would scarcely be compatible with mania.

FEIGNED MANIA. 199

when the real maniac will introduce new ideas, but the impostor will
deem it expedient to repeat the same words. The use of the whirling
chair is also recommended, as producing giddiness and nausea in the
impostor.

Partial Intellectual Mania. — Monomania . — Melancholia. — These
partial forms of mania are less frequently feigned than general mania,
and rarely with success. Many of the characters of mania already
described are present in cases of intellectual mania springing out of
some excited motion, sucli as pride or vanity. There is the same
irritability of temper, the same violent prejudices, the same unfounded
aversions and equally unfounded attachments, the same sleeplessness,
the same insensibility to impressions, and to the operation of medicines.
The pretended monomaniac makes a more open display of his assumed
delusion than the real monomaniac, who rarely solicits attention. The
true monomaniac is generally reserved, taciturn, and indifferent, but
is easily excited and angered by opposition and argument. When hard-
pressed men generally take refuge in violence and women in tears.

The forms of intellectual insanity most commonly assumed, and
most difficult to distinguish, are those which consist in the assumption
of a single delusion, or of profound melancholy ; and it is obviously
difficult to lay down any diagnostic mai'ks by which the real disease
can be distinguished from the false. The difficulty of diagnosis is
seriously enhanced when, as sometimes happens, the malingerer is a
good actor, and makes a faithful copy of the words and acts of a
madman with whom he has been brought in contact.

Moral Mania, general and partial. — As the character of the act
or acts committed is the chief ground for believing in the existence of
this form of unsoundness, there is no certain means of distinguishing
the real from the feigned disease. It is, however, so unlikely that n
sane man would commit a murder, for which no motive could be dis-
covered, with the certainty of being hanged if found sane, and im-
prisoned for life if pronounced mad, that we may fairly assume a
homicide, accompanied by all or many of the characters already pointed
out, to have been the result of real moral insanity. The personal and
family history of the accused would also afford some presumptions in
favour of or against the theory of insanity. Of general moral Insanity
it may suffice to state that the strange combination of foolish, obscene,
and cruel acts which make up the history of the true disease, places
a serious difficulty in the way of the impostor.

Concealed Insanity. — The power of concealing his delusions, under
the influence of a sufficiently strong motive, has already been shown
to belong to the madman ; and long-continued observation, repeated
interrogations, and careful inquiry into the patient's previous history
may be necessary to bring the delusions to light.

200 RULES FOR THE EXAMINATION OF PERSONS

RULES FOR THE EXAMINATION OF PERSONS SUPPOSED TO BE
OF UNSOUND MIND.

Under this head it is proposed to give a few simple directions as to
the chief points to be attended to in the several examinations which
the medical man may be required to institute.

1. Observe the general appearance of the individual, the shape of
the head, the conformation of the body, the expression of the counte-
nance, the gait and movements, and the speech.

2. Ascertain the state of the general health, and note whether the
complexion is pale or florid, and the skin moist or dry. Inquire into
the state of the digestion, whether the appetite is good, bad, or
variable, an<l the bowels costive or loose, the tongue fuiTed or clean.
Ascertain whether the individual is restless or tranquil, whether the
sleep is sound and continuous or disturbed and broken ; whether he is
susceptible of heat and cold, or the reverse. In females the state of
the menstrual functions should be ascertained,

3. Inquire into the history of the person's family, with a view
especially to ascertain whether he has any hereditary predisposition to
insanity, whether any members of his family have been subject to fits,
or have betrayed any marked eccentricity of behaviour.

4. If the mind appear unsound, ascertain whether the unsoundness
dates from birth, or from infancy, or from what time. If the un-
soundness has supervened later in life, did it follow any severe bodily
illness, any accident, any mental shock, or long-continued anxiety of
mind, or repeated epileptic fits? Have the habits of life been regular
or the reverse, temperate or intemperate ?

5. Does the present state of mind differ materially from that which
existed when the party was reputed of sound mind ? Have his
feelings, affections, and domestic habits undergone any marked change ?

6. When the inquiry is directed to ascertain the capacity of the
mind, inquire as to the person's knowledge of his birth-place, of the
profession or occupation of his parents, the number of his brothers,
sisters, and near relations ; as to his recollection of persons and events
remote and recent. Bbes he know his own age? Is he conscious of
the lapse of time, and can he name the month, the year, and the day of
the week? Does he know the name of the reigning monarch, and of
those persons who are most frequently subjects of conversation ? Can
he perform the simple operations of arithmetic, and does he know the
value of money ? Can he repeat those simple forms of words which
are in general use, such as the Lord's Prayer? Note his power
of attention, and distinguish carefully between mere negative or affir-
mative answers to leading questions, and such as indicate judgment
and reflection. If the inquiry relate not to the capacity of the mind,
but to its soundness in other respects, we should endeavour to discover
the existence of delusion by conversation directed to those topics which
are most likely to interest and excite the mind. If the unsoundness

SUPPOSED TO BE OF UNSOUND MIND. 201

affects the moral feelings rather than the intellect, the relations and
friends of the individual should be made the subject of conversation.
In cases of supposed moial insanity, inquiry should be made into the
motives which may have led to the commission of the act of which the
party is accused.

7. When undergoing examination in a court of law, the medical
witness should carefully avoid all definitions of insanity, on the plea
that mental, like bodily diseases, do not admit of definition, but are
subjects for description ; and that diagnosis in most cases must depend
upon a comparison of several combined symptoms. The medical man
should also insist on having sufficient opportunity of forming his
opinion. He should rarely content himself with a single visit, and in
eases of difficulty should require the party to be placed for some time
under his observation.

8. When required to sign certificates of lunacy, the medical man
should bear in mind that he is required to visit the patient by himself,
to sign the certificate at the time of the visit, and to assign the reasons
which have influenced him in attaching his signature.

202

PART 11.

CHAPTER I.

PERSONS FOUND DEAD. — REAL AND APPARENT DEATH. —
SUDDEN DEATH. — SURVIVORSHIP.

Under the title of Persons found Dead it is proposed to consider
those general precautions which should be observed in conducting
inquiries concerning persons whose mode of death is unknown. As
the first question which would naturally be raised is as to the reality
of death, the subject of Real and Apparent Death follows in order ;
then Sudden Death, in which some of the more common modes of dis-
solution are briefly considered ; and, lastly, Survioorship.

PERSONS FOUND DEAD.

In treating of Medical Evidence instructions were given as to the
best mode of stating facts and opinions in a court of law, so as to
give them their full force, and to render them admissible as evidence.
In this place, some brief directions will be given for observing and
collecting that important class of facts which refers to persons found
dead.

In almost all medico-legal cases, but especially in those refen-ing
to persons found dead, the two functions of a common and of a skilled
witness, are combined. The medical man is cognizant of two orders
of facts, those which require no interpretation from him, and those
from which he is expected to draw his own inferences. If sent for
to a dying man, or to one already dead, and subsequently required
by the coroner to make an examination of the body, he must of neces-
sity observe many things connected with the body itself, such as the
position in which it is placed, and the objects by which it is sur-
rounded, which might just as well be observed and stated in evidence
by any other person ; but the postrmortem inspection must be intrusted
to himself or to some other skilled member of the profession. Hence
the present inquiry branches off into two divisions. 1. The relation
of the body to surrounding objects. 2. Directions for the perfonnance

PLACE IN WHICH THE BODY IS FOUND. 203

of post-mortem inspections for legal purposes : in other words, direc-
tions as to the best mode of performing the duties of a common witness
and of a skilled witness respectively.

1. RELATION OF THE BODY TO SURROUNDING OBJECTS.

The medical man is summoned to most cases of severe illness or
sudden death, and thus becomes one of the iirst witnesses of those
simple facts, which, in criminal cases, constitute the presumptive or
circumstantial evidence. He is also, in most cases, by far the best
educated and most intelligent witness. Whenever, then, he is called
to visit the dying or the dead, under circumstances of suspicion, he
should be alive to all that is passing around him, that no object,
however trifling, which may possibly throw light on the cause of
death, may be overlooked. The following are some of the principal
points to which his attention should be directed : —

The place in which the body is found. — The place in which a body
is discovered is not always that in which death actually took place ;
for, in suicidal as well as homicidal cases, persons severely wounded
may be able to move to some distance from the spot on which their
injuries were received, and the murderer sometimes tries to conceal
his crime by carrying the body to a place remote from the scene of
violence.

The position of the body. — The position of the body does not always
correspond with the cause of death. Thus the body of a man killed
by a blow on the head was found in an upright position, supported
by a wooden fence. Murderers often dispose of the bodies of their
victims in such a way as to make it appear that they died by their
own hands. Thus, persons who have been poisoned have been
suspended by the neck, or thrown into the water; and the body of
Sir Edmundbury Godfrey, who had been violently strangled, and which
bore distinct marks of that mode of death, was found lying in a ditch,
pierced with his own sword, and with his clothes so arranged as to
create the belief that he had died by his own hand.

The spot on which the body is found. — It is often highly important
to examine carefully the spot on which a body lies. In the case of
fatal injury to the head, it is usual to allege that the death was
caused by a fall on some hard, resisting body ; an allegation only to be
rebutted by an examination of the spot. Thus, the death of a man
found lying in a field with a severe bruise on the head, having been
attributed to a fall on a stone, or fragment of wood, the field was
carefully searched, and no such object could be found near the spot on
which the body lay. In another case, a small wound in the head,
which had penetrated to the brain, and had been received during a
murderous struggle, was attributed to a fall on a sharp object,'such as
a nail fixed in the floor ; but the floor having been examined, and no
such object found, it followed that the wound had been inflicted by

204 PERSONS FOUND DEAD.

some small pointed instrument. The murderer after his acquittal,
which was due to defective medical evidence, confessed that he had
struck his victim with the point of a pair ot snufl'ers.

The soil or surface on which the hodij lies. — It rarely happens that
a struggle takes place without leaving on the spot itself some traces
which may be compared with the clothes of the suspected murderer or
of his victim. Foot-prints on the soil, for instance, have often furnished
important evidence. Thus Sir Walter Scott gives an account of a
murder discovered by the print of the murderer's foot left on the clay
floor of a cottage in the death-struggle. The measure of the foot, the
tread, and the mode in which the sole of one of the shoes had been
patched, corresponded most closely with the foot-mark ; and this was
the first link in the chain of evidence which led to the conviction of
the murderer. Cases of murder, followed by the suicide of the mur-
derer, are of occasional occurrence. When the two crimes have been
committed in the same room important light has been sometimes
thrown on the transaction by finding stains of blood on the floor and
on the sole of the foot of the perpetrator of the double crime.

Position of surrounding objects. — In suicidal cases the instrument
of death is generally found lymg near the body ; in homicidal cases it
is often removed and concealed. In cases of death by the more
active poisons, the poison is often found on, or close to, the person.
The close correspondence of wounds or bruises found on a dead body
with the objects immediately surrounding it sometimes throws great
light on the cause of death. Thus, in the case of the Prince de Conde,
who was found suspended by the neck in his bed-room, the corre-
spondence of certain abrasions found on the legs with a heavy chair
placed close to them, and of others on the shoulder with a projecting
part of the window to which he was suspended, harmonized with the
struggles of a man suspended during life, and gave strong confirmation
to the opinion of those who attributed the death to suicide.

The Clothes. — Having noted the place and spot on which the body
lies, the position of the body, and the objects by which it is suiTounded,
a more close inspection should be made of the body itself. The clothes
may be covered with mud, or corroded by an acid, or stained by blood,
or some animal secretion ; or they may be torn or cut. The cha-
racter and position of the stains, and the direction of the rents or cuts,
should be carefully noted.

The cuts should be examined to see whether their size, shape, and
direction coincide in the several garments, and whether they correspond
with wounds found on the body itself; for it may happen that a
mui-derer tries to conceal his crime by cutting the (dothes after he has
wounded the body, and that the wounds and incisions do not coincide.

It is scarcely necessary to state that crimes have often been dis-
covered in consequence of the close con-espondence of things found in
the possession of an accused person with things used in the perpetra-
tion of the crimes themselves.

POST-MORTEM INSPECTION. 205

The hearing and conduct of the parties in attendance on sick,
dying, or dead persons should not be overlooked ; and it is especially-
important to notice it in cases of suspected secret poisoning.

The foregoing are some of the points to be attended to in respect of
persons found dead ; but neither examples nor rules can do more than
suggest the sort of inquiries which may be necessary. There must always
be great scope for individual judgment, foresight, and decision. To the
correctness of a good observer the medical witness must add the in-
telligence and invention of an acute experimenter. The service which
an intelligent medical witness may have it in his power to render to
the cause of justice cannot be better illustrated than by a case, for
which the author is indebted to the late Dr. James Reid. It is given,
as nearly as possible, in his own words : —

" I was sent for one day to a man and his wife, whom I found
lying in the same room with their throats cut. The woman lay on the
floor with her right arm extended under the bed, and a razor close to
her right hand. Her throat was deeply cut from ear to ear, and she
lay in a complete pool of blood. The husband, who was in bed, had
received a wound in the throat, which had merely divided the trachea
without wounding any important blood-vessel, and without causing
any great loss of blood. When questioned, he gave the following
account : — In the middle of the night he was roused from sleep by
receiving a wound in the throat from the hand of his wife. The
shock, the wound, and the loss of blood together, had prevented him
from making any resistance or giving any alarm. My suspicions were
roused, partly by the man's manner, and partly by observing the
water in a basin standing in the room slightly tinged with blood. In
endeavouring to find some confirmation of my suspicions, a thought
struck me. / turned up the bed-clothes, and found the sole of the foot
covered with dried blood. I stated this fact to the jury at the coroner's
inquest : a verdict of guilty was immediately returned, but the man
died almost at the moment that the sentence was passed."

2. EXAMINATION OF THE BODY. — POST-MORTEM INSPECTION.

The medical man having discharged the duty of a common witness
by noting all those points of presumptive or circumstantial evidence
which may throw light on the mode and cause of death, proceeds to the
examination of the body itself. When the body is that of some person
unknown, those characteristics which may lead to its identification
should be noted down, in accordance with the instructions given at
p. 8. Those appearances which serve to denote how long the party
has been dead (see the next chapter) should next be observed, and then
the external injuries which the body may have received.

If any wounds, contusions, or excoriations exist, their nature must
be specified, and their extent determined by exact measurement. The
neck, back, and limbs should be examined, with a view to ascertain

206 PERSONS FOUND DEAD.

whether any dislocation or fracture exists ; the chest compressed, to
ascertain whether blood or any fluid mixed with air or gas escapes
from the mouth or nostrils; the cavity of the mouth inspected, in
search of foreign bodies or stains of corrosive poisons ; and the anus
for poisons introduced into the body by that opening. In new-born
children the orbits, fontanelles, and nucha; should be inspected in search
of minute wounds inflicted by pointed instruments. In women the
points of junction of the breasts, especially on the left side, with the
skin of the chest, should be examined, in search of minute wounds.
The female organs of generation should also be examined in search of
poisons, corrosive acids, or wounds.

Post-mortem Inspection. — The great rule to be observed in conduct-
ing post-mortem inspections for medico-legal puri)0ses is to examine
every cavity and important organ of the body. Even when the cause
of death is quite obvious, it is well to observe this caution ; for if any
part of the body have been left unexamined, the objection may be
made that the cause of death might have been found there, or some
disease which would have given a mortal character to an injury not
otherwise fatal.

The order in which the great cavities of the body are examined must
depend, in part, on the supposed cause of death. As a general rule the
seat of injury should be inspected first, before the contents of the blood-
vessels have been disturbed by the examination of other parts.

Chaussier and other French authors have given unnecessarily minute
directions for performing post-mortem examinations for legal purposes.
Such examinations are not likely to be perforaied in a hasty or slovenly
manner.

Specific directions for post-mortem examinations in cases of rape,
delivery, poisoning, infanticide, &c., are given under those heads.

REAL AND APPARENT DEATH.

The subject of real and apparent death has never attracted much
attention in England, and no jnedical author of reputation has treated
it at any length.

In earlier peiiods of our history persons ran some risk of being
buried alive, but this risk has now disappeared, and is not likely to
recur unless in the impiobable event of some fatal epidemic malady
rendering speedy interment expedient. But the question of real or
apparent death may assume a practical importance long before the
usual period of interment arrives. In cases of suspended animation,
the adoption, neglect, or speedy abandonment of the measures usually
resorted to with a view of restoring life, must depend on the previous
answer to the question — Is life really extinct?

On the Continent, and especially in France, this subject of real and
apparent death is treated with greater respect, and has employed the
pens of such distinguished modico-legal writers as Winslow, Bruhier, and

EEAL AND APPARENT DEATH. 207

Louis, and has received some attention at the hands of Mahon, Fodere',
and Orfila.

The greater importance attached to the subject abroad is accounted
for by the practice of early interment, and by . the Roman Catholic
rite of extreme unction, which raises a serious impediment to the use of
means for restoring animation.

There are three forms of suspended animation which may be mis-
taken for real death — syncope, asphyxia, and trance.

1. Syncope. — There is good reason for believing that, in the ma-
jority of instances, the apparent death, about which so much has been
said and written, was merely a state of prolonged syncope. The
success attending the accidental employment of the veiy means that
are found most efficacious in restoring those who have fainted, namely,
cold water and fresh air, seems to prove this. The efficacy of cold
water is attested by Hippocrates in the case of a woman apparently
dead from fever, and by John Howard, who bears his personal testi-
mony to the restoration of persons supposed to be dead of the gaol
fever, and brought out for burial, on being washed with cold water !

The efficacy of pure and cold air in producing the same result rests
on the authority of Diemerbrock and Zacchias in cases of plague ; and
well-authenticated instances of similar recovery after small-pox are on
record. One of these occurred in the person of an infant daughter of
Henry Laurens, the first President of the American Congress. She
had the small-pox, and was laid out as dead ; but the window of the
apartment that had been carefully closed during the progress of the
disease being thrown open, the fresh air revived the supposed corpse,
and restored her to her family.

Such cases as these were not of infrequent occurrence before the
time of Sydenham, who abolished the stifling system of treating
eruptive diseases, especially small-pox. The acknowledged existence
of cases of prolonged syncope after febrile and eruptive diseases gives
probability to cases in which recovery from a state of apparent death
is alleged to have occurred at the touch of the scalpel, or, in ancient
times, under the flame of the funeral pyre.

2. Asphyxia. — This is a form of suspended animation of very fre-
quent occurrence. It is being continually mistaken for real death, and
can be distinguished from it only by the result of the means employed
for the recovery of the patient.

y. Trance. — Cases of suspended animation, not answering exactly
to the description of syncope or asphyxia, occasionally occur in females.
The motionless and insensible state of the frame, the coldness of the
surface, and the suspension of the functions of respiration and circula-
tion, combine to produce a semblance of death, and to create tem-
porary difficulty even for the medical man.

The subject of real and apparent death would be incomplete if some
notice were not taken of those cases in which a state of apparent death
has been brought about by an effort cf the will. The occasional

208 PERSONS FOUND DEAD.

9ccurrence of such cases has heen placed beyond the reach of doubt ;
and a minutely-described and well-authenticated instance of this kind,
that of the Honourable Colonel Townshend, is related by Cheyne in
his * English Malady.'

" He told lis, he had sent for us to give him some account of an odd
sensation he had for some time observed and felt in himself; which
was, that composing himself, he could die or expire when he pleased,
and yet, by an effort, or somehow, he could come to life again : which,
it seems, he had sometimes tried before he had sent for us. We all
three felt his pulse first : it was distinct, though small and thi-eady,
and his heart had its usual beating. He composed himself on his
back, and lay in a still posture some time ; while I held his right
hand, Dr. Baynard laid his hand on his heart, and Mr. Skrine held a
clean looking-glass to his mouth. I found his pulse sink gradually,
till at last I could not feel any by the most exact and nice touch. Dr.
Baynard could not feel the least motion in his heart, nor Mr. Skrine
discern the least soil of breath on the bright mirror he held to his
mouth. Then each of us by turns examined his arm, heart, and breath,
but could not by the nicest scrutiny discover the least symptom of life
in him. This continued about half an hour. As we were going away
(thinking him dead) we observed some motion about the body, and
upon examination found his pulse and the motion of his heart gradually
returning ; he began to breathe gently, and speak softly." This ex-
periment was made in the morning, and he died in the evening. On
opening the body nothing was discovered but disease of the kidney, for
which he had long been under medical treatment, all the other viscera
being perfectly sound.

This case of Colonel Townshend is not only curious but instructive,
as it renders it in the highest degree probable, that there may be stfites
of system so nearly resembling death as even to deceive medical men,
and distinguishable from real death only by the continuance of animal
heat and the absence of rigidity, and by the success of the means of
restoration.

The fact that there are certain states of the living system which may
for considerable periods closely simulate death admits of important
practical application. It teaches us that we should not hastily
abandon the attempt to resuscitate persons who have appeared to
perish by syncope or asphyxia, or in whom life seems to have in any
way become extinct. This caution is especially needed in cases of
apparent death from haemorrhage, shock, sun-stroke, drowning, and
the several forms of suffocation.

Signs of Death. — Of the signs of death insisted upon by authors some
are trivial and inconclusive, others of considerable importance, both as
signs and as means of forming a judgment of the time that life has
become extinct. To the first class belong the Cessation of the Circulation
and Respiration ; the absence of sense and motion ; the Facies Hippo-
cratica ; the State of the Eye ; the State of the Skin ; and the Extinc-

SIGNS OF DEATH. 209

tiori of Muscular Irritability. To the latter class belong the Extinction
of Animal Heat; Cadaveric Rigidity; and Putrefaction.

The Cessation of the Circulation. — If no pulse can be felt on apply-
ing the finger to the wrist, and the beat of the heart can neither be
felt nor heard, it is fair to assume that the circulation of the blood has
ceased. It is possible, indeed, that very feeble movements of the heart
might escape observation ; but whether the heart cease to beat alto-
gether, or contract so feebly as not to make itself jierceptible to the
hand or ear, is of little consequence, as the fact of life having been
restored after its contractions had been apparently suspended for a
time, as in the remarliable case of Colonel Townshend, is enough to
deprive the test of all practical value.

The Cessation of the Respiration. — The two functions of circulation
and respiration are so closely connected, that what is true of the one is
likely to be true of the other. The tests of respiration — the looking-
glass, the feather, and the cup of water placed on the chest or abdomen
— are at least as delicate as those by which we seek to determine the
continuance of the heart's action. It is scarcely possible that respira-
tion should take place in any degree, and yet escape detection by such
means ; and yet in the case of Colonel Townshend, the looking-glass
remained for a long period unsoiled, and no trace of respiration could be
detected. The suspension of the respiration, therefore, like the cessation
of the circulation, is not to be I'egarded as a sure sign of death.

The same remai'ks apply to the joint cessation of the respiration and
circulation as to the cessation of either separately. .

The Absence of Sense and Motion. — As these negative states are
present in all cases of suspended animation, they are not to be con-
sidered as signs of death. The combined loss of voluntary motion an<i
sensibility is not of rare occurrence in hysteric females, and it is present
in the mesmeric slumber ; but in these cases the functions of circula-
tion and respiration go on uninterruptedly, and a careful observer will
sometimes detect a vibrating movement of the eyelid, which forms an
exception to the general rule of immobility.

The Fades Hippocratica. — This shrunk and sharp expression of
countenance, combining the sunken eye, the sharp nose, the pointed
chin, the hollow temple, the prominent cheek-bone, the projecting
ear, the wrinkled brow, the dry livid skin, and the white powdered
hair of the nostrils and eyebrows, is a trivial and unsafe sign of
death, open to the serious objections : —

That it is nearly always absent in cases of sudden death, and in the
victims of acute disease.

That it is present in the dying as well as in the dead, and has been
observed where recovery has taken place.

That it may be brought about by a strong impression of danger, the
apprehension of a dreadful punishment, or the anticipation of certain
death ; and that where it exists, it does not long survive the extinction
of life.

210 REAL AND APPARENT DEATH.

The State of the Eye. — The formation of a tenacious glairy mucus
on the conjunctiva, occasioning a loss of transparency in the eye and
a collapsed and wrinkled state of the cornea, are among the best and
earliest of the trivial signs of death. But they are not conclusive ; for,
on the one hand, the conjunctiva may be invested by a mucous film
and the cornea may lose its brilliancy in the living, and, on the other
hand, these appearances are absent in some forms of death. In death
from apoplexy, from carbonic acid, and from prussic acid, the eyes
may preserve their brilliancy and prominence for a long time. Putre-
faction, too, by distending the cavities of the body with gas, sends
blood to the head, and makes the eyes brilliant and pi-ominent; and
Nysten produced this state of the eyes in the dead body by introducing
substances in a state of fermentation into the stomach.

The State of the Skin. — Pallor of the skin, owing to the absence of
circulation ; livid discolourations, the result of the subsidence of the
blood ; and loss of elasticity, have been mentioned among the signs
of death. Pallors of the skin may exist during life, and it is not
present in several forms of death, especially in death from suffocation.
Livid discolourations, too, may exist in aged and feeble persons in de-
pending parts of the body. But loss of elasticity is a sign of con-
siderable value and very early developed.

The Extinction of Muscular Trritahility was recommended by
Nysten as a ceitain criterion of death. He proposed to lay bare a
muscle and test it by puncture or by the galvanic fluid. The absence
of contraction was justly assumed to be a sign of death, but its pre-
sence could only be taken to prove that the body was either alive or
recently dead.

Among the trivial signs of death, the flexure of the thumb across
the palm of the hand may be mentioned. The thumb assumes this
position before cadaveric rigidity comes on, but it is similarly con-
tracted during life in certain spasmodic affections.

The foregoing signs of death do not supply us with the means of
deteimining how long life has been extinct. But the extinction of
animal heat, rigidity, and putrefaction, being the only certain signs
of death, and also means of determining, with more or less precision
and certainty, the period at which death took place, are worthy of
being examined more closely.

SIGNS OF DEATH WHICH ARE ALSO MEANS OP DETERMINING HOW-
LONG LIFE HAS BEEN EXTINCT.

Extinction of Animal Heat. — The temperature of the body is
closely dependent on the circulation of the blood ; so that when this
ceases, in a part of the body or in the entire frame, that part, or the
whole body, soon becomes cold. Hence the extremities become cold
before death ; and as the circulation becomes more and more languid,
even the internal parts of the body cool down, as is shown by the low

SIGNS OF DEATH. EXTINCTION OF ANIMAL HEAT. RIGIDITY. 211

temperature of the breath as it issues from the lungs ; and at length,
when life is extinct, all the parts of the body become cold. But as,
on the one hand, great coldness of the body is often present during
life, and in cases of suspended animation, and, on the other hand, in
cases of sudden and violent death the body often parts with its heat
very slowly, the value of this sign of death is impaired. An
anomalous restoration of heat to the body, without any other sign of
life, has also been observed to take place after death by cholera.

Nor is the extinction of animal heat a very sure means of determin-
ing the period at which death tooiv place ; for the rate of cooling of
the body varies with the age and cause of death, the treatment of the
body itself, and the state of the atmosphere; so that the period of
cooling may vary from two or three hours to fifteen or twenty, and
may even extend to upwards of four days.

The body cools slowly when covered with clothing and exposed to a
warm, still atmosphere, quickly when exposed naked to a draft of cold
air. It parts with its heat more speedily in water than in air. Age,
emaciation, and death by haemorrhage or chronic disease favour the
cooling of the body ; youth and vigour, corpulence, and acute disease
or speedy death retard it. In persons falling victims to the same
disease, the extinction of animal heat is, cceteris paribus, as the rapidity
with which they prove fatal. In chronic diseases, the body parts with
much of its heat during life.

Cadaveric Rigidity. — For some time after life is, to all appearance,
extinct, the muscles continue to contract on the application of
stimuli. The extreme duration of this irritability, even in the muscles
of voluntary motion, does not exceed two hours ; and when it ceases,
cadaveric rigidity sets in.

This phenomenon occurs in all classes of animals alike, and is the
first certain evidence of death. It was originally supposed to com-
mence only with the complete extinction of the animal heat ; but it is
now known to rnake its appearance long before the body has cooled,
and to commence in those parts which lose their heat the latest. > It
is confined to the muscular system ; for so long as the muscles remain
entire, the limbs continue inflexible, unless great force be used ; but
when they are cut or torn, the rigidity ceases. It takes place in ail
positions of the body, and whether the limbs be flexed or extended,
and it does not change the positions which the several parts of the
body had at the time of death. It shows itself first in the muscles of
the trunk and neck, then in those of the upper extremity, then in
those of the lower ; and it disappears nearly in the same order ; the
muscles of the lower extremity often remaining rigid when those of the
trunk and upper extremity have resumed their state of relaxation. It
is entirely independent of the nervous system, for it makes its appear-
ance after the nerves have ceased to be excited by the galvanic
fluid. A division of the nerves, or even the removal of the entire
brain, does not prevent its occurrence ; and in death from apoplexy or

212 REAL AND APPARENT DEATH.

hemiplegia, the paralyzed limb is affected in the same way, and to the
same extent, as the sound one.

Cadaveric rigidity is strongly marked and persistent in muscular
subjects, and, as a general rule, it lasts long wlien it sets in late. In
death by lingering diseases, such as low fever, consumption, and scurvy,
and the diseases of old age, the rigidity sets in very speedily, and
disappears again in the course of one or two hours. On the other
hand, in death by acute inflammation of the stomach or viscera, by
irritant poisons, whether minei-al, vegetable, or aerial (provided they
exert no specific influence on the contractile powers of the muscles),
the rigidity is for the most part slow in making its appearance,
strongly developed, and lasts for a considerable time. After death
from spasmodic cholera it is said that rigidity has commenced very
early, and has not ceased till after the lapse of four or five days. It
is slow in showing itself in death from apoplexy, haemorrhage, wounds
of the heart, decapitation, injuiy of the spinal marrow, and asphyxia.
Its duration in poisoning by carbonic acid is very considerable, and in
one case Nysten found that it continued seven daj'^s. On the other hand,
in poisoning by sulphuretted hydrogen gas, rigidity does not occur.

Cadaveric rigidity cannot be mistaken for any other condition of the
dead body. The stiffness caused by intense cold would be readily
distinguished fi om it by the ease with which the limbs are moved.

The rigidity of the muscular system present during life in such
diseases as catalepsy and tetanus does not need to be distinguished
from cadaveric rigidity. If any distinction were necessary, it might
be drawn from the effect of bending an extremity forcibly: if the
rigidity were due to a vital contraction, the limb would be restored to
its position, whicli would not happen in the rigidity of death.

Rigidity, then, is a certain sign of death, and a state not to be con-
founded with any existing in the living body, or in any form of apparent
death. Supervening, too, as it does, after the extinction of muscular
irritability, it is a sure indication of the hopelessness of our attempts
at resuscitation.

Putrefaction. — This, too, is an infallible sign of death, not re-
quiring to be distinguished from any condition of the living body.

As the march of the putrefactive process affords some means of
judging of the period at which death took place, it will be necessary to
describe the changes which it occasions in the body with some degree
of minuteness.

In the intei-val which elapses between the extinction of life and
the commencement of the putrefactive process, the body falls more
and more under the influence of physical laws. The skin loses its
elasticity, and the flesh its firmness, and the blood, which was equally
distributed through the body by the action of the heart and the
elasticity of the arteries, now obeys the laws of gravity, and falls to
the most depending parts of the corpse. Hence the paleness of some
parts and the deep violet tint of others, the discolouration of the

SIGNS OF DEATH. CADAVERIC LIVIDITY. 213

occiput and back, of the depending parts of the intestines, and of the
posterior part of the lungs.

As the body is usually placed on the back, this cadaveric lividity
is found on the posterior parts of the body and of the internal organs ;
but if the body be placed on the face, it will occupy the anterior
part of the body and of the viscera. If again, after discolourations
have formed on the back, the body be turned while still warm, and
before the blood has coagulated, they will disappear. These discolour-
ations are often very extensive, and, if the body is placed on a -smooth
surface, uniform in tint ; but if the surface is uneven, the discolour-
ations are interrupted and irregular. The pressure of the clothes
produces the same effect ; so that a careless observer might mistake the
marks of clothes ftistened round the neck for the effect of strangulation,
or isolated patches for severe bruises.

The extent and amount of discolouration are pi'oportioned to the
quantity of the blood which the body contains ; the general prevalence,
therefore, of cadaveric lividity through the whole body indicates a
general fulness of the vascular system. On the other hand, its absence
shows that a small quantity of blood exists in the body. Sudden death
unattended by haemorrhage or effusion of blood, is characterized by ex-
tensive lividity ; but after death preceded or caused by hajmorrhage,
the skin is remarkably pale, and presents but faint traces of such dis-
colouration.

This subsidence of the blood explains a fact of some medico-legal
importance, namely, the diminished intensity of colour in parts which
had been the seat of the less severe and more diffuse forms of inflam-
mation. But the appearance produced by such acute inflammation
as follows burns and scalds, blisters, and strong friction on the surface,
and the action of the more violent irritant poisons on the internal
parts, are permanent, and quite distinct in the dead body.

Cadaveric lividity is said to be distinguished from the effect of
injuries inflicted during life by the seat of the discolouration being in
the rete mucosum and vascular membrane which lie exterior to the
true skin. The vessels of these parts are filled with dark blood, so
that the cut surface presents a black line from which the blood may
be expelled by pressure. The dermis or true skin is white. But in
the discolourations of the skin produced by the afflux of blood daring
life the tissue of the true skin is injected with blood, and exhibits when
divided a number of bloody points. This discolouration of the tissues
external to the true skin, is, however, not an invariable occurrence ;
for on comparing a vertical section of the integument from a part of
the back deeply discoloured by cadaveric lividity, with a similar
section from a highly inflamed portion of skin, the first was found to
be quite free from vascular injection, while the last presented a number
of red spots of extravasated blood. The two sections were mounted
side by side, treated in every way the same, and examined by the
same power of the microscope.

214 REAL AND APPARENT DEATH.

Besides these discolourations produced by the blood which follows
the course of the vessels, there are others due to the transudation of
the fluids. Thus the parts in immediate contact with the gall-bladder
are deeply tinged with bile ; and the aqueous humours of the eye
transuding, cause the dull and collapsed appearance of the cornea.

The subsidence of the blood and the transudation of the fluids partly
explain that relaxed and softened state of the tissues which is the first
of the series of changes usually attributed to putrefaction. These
fluids next undergo changes of colour, and tinge the several textures
with brown, blue, or green discolourations, according to the degree of
decomposition which they have undergone.

The exudation of fluids is followed by the development of gases in
the several cavities of the body, especially in the abdomen. This
takes place sometimes so rapidly, and to such an extent, as to change
the position of the body. In consequence of the resistance offered by the
walls of the abdomen and chest, the internal viscera and their contents
suffer displacement. The diaphragm is thrust upwards, the contents
of the large vessels are forced towards the head and neck, the face
swells, the eyes become prominent, and a mucous or bloody fluid flows
from the mouth and nostrils. In rare instances the contents of the
bowels are forced out. Blood also exudes from wounded or ruptured
vessels, leading to post-mortem haemorrhages and extravasations. Of old,
much importance was attached to this post-mortem bleeding of wounds,
and if it happened to coincide with the touch of the criminal supposed
to have inflicted them, he was summarily convicted of the murder.

There is reason to believe that the development of gas (probably
carbonic acid) in parts of the body filled with blood often precedes the
other common signs of putrefaction. I have seen this early foi-mation
of gas both in the lungs and beneath the membranes of the brain.
(See Infanticide, p. 89.)

As putrefaction advances, the cuticle becomes detached, the muscles
grow viscid and pulpy, assume a dark- greenish colour, and exhale a
highly offensive odour ; and at length the whole texture of the body
becomes changed into a soft semi-fluid mass, which gradually parts
with its moisture, dries up, and leaves a fibrous fatty residue, slowly
lost in the soil.

Sometimes these processes of putrefaction and decay go on very
rapidly, and are soon completed ; at other times they are extended
over many years, the rapidity with which they take place depending
greatly upon the circumstances in which the body is placed. When the
process of putrefaction is once established under favourable circum-
stances it goes on rapidly, the parts already decomposed acting as a
sort of leaven to the rest.

The conditions which affect the progress of putrefaction, and enable
us to form an opinion as to the time at which death took place, are
Temperature, Moisture, and Access of air. Period, Place, and Mode of
Interment, Age, Sex, Condition of the Body, and Cause of Death.

SIGNS OF DEATH. PUTKEFACTION. 215

Temperature. — Putrefaction is arrested by a temperature of 212°
and of 32° : in the former case the body is reduced to di-yness by the
evaporation of the fluids ; in the latter the fluids are congealed. The
most favourable temperature is one ranging from 70'-' to 100°. Putre-
laction, therefore, takes place more rapidly in summer than in vyinter,
and, other things being equal, varies with the temperature.

Moisture. — This is an essential condition, and without it putrefac-
tion cannot begin, or, having begun, cannot continue. The body
contains, in all its parts, moisture enough to insure decomposition ;
but those parts, such as the brain and eye, which contain the largest
quantity of fluid are most prone to putrefaction, and dropsical subjects
putrefy speedily.

Putrefaction commences soon, and runs a rapid course, in inflamed
parts, in bruises, and at the edges of wounds.

Bodies which have remained for some time in the water, and are
then exposed to the air, putrefy more rapidly than those which have
not been immersed; but in bodies which remain in the water putrefac-
tion goes on slowly, from the contact of air (another condition highly
favourable to putrefaction) being prevented.

On the other hand, dryness of the air retards or arrests putrefaction.
Hence the preservation of the bodies of travellers on sandy deserts.

A rapid current of air has the same effect as dry air, by causing
rapid evaporation. On the other hand, a moist and stagnant atmo-
sphere encourages putrefaction, by retarding evaporation no less than
by supplying moisture.

Access of Air. — That the presence of atmospheric air promotes
putrefaction is shown by the slow development of gas which takes
place when blood or flesh is introduced into a vessel through mercury,
so as to exclude all the air which does not attach to the substance
introduced : also, on the other hand, by the preservation of flesh in
atmospheres not containing oxygen, such as hydrogen and nitrogen ;
less completely in atmospheres in which oxygen is chemically combined
with some other gas, as in carbonic acid and nitrous acid ; also in at-
mospheres filled with vapours that absorb oxygen, such as turpentine.
The well-known antiseptic quality of the contents of common sewers
is explained partly by the exclusion of air, and partly by the presence
of gases not containing oxygen. Oxygen, when taken separately,
promotes putrefaction more than any other gas whatever, but when
combined with nitrogen, as in atmosphei'ic air, its activity is greatly
increased.

It appears, then, that heat, moisture, and the free access of air, are
the conditions most favourable to putrefaction. In judging, therefore,
vOf the period at. which death took place, we should consider well what
amount of influence each of these agents has brought to bear on the
result.

Period, Place, and Mode of Interment. — Period. — Bodies putrefy
much more speedily in air than in the ground. Hence the longer in-

216 REAIi AND APPARENT DEATH.

tennent is delayed, the greater the changes produced by putrefaction.
Thus, Orfila observes, that if, during the summer, a body be kept
exposed for five or six days, and then interred, it will be found, at
the end of a month, to have undergone as much change as it would
have . done at the end of seven months, if it had been interred at
once.

Site. — In dry elevated situations, putrefaction goes on slowly ; in
low swampy grounds, rapidly. Soil. A dry absorbent soil retards, a
moist one accelerates, putrefaction. In sand or gravel the change goes
on slowly, and adipocere is rarely met with. In marl or clay, and in
loose mould, especially that which is impregnated with animal or
vegetable matter, moie quickly (except peat, which cleai'ly retards
putrefaction). The deeper the grave, cocteris paribus^ the slower the
putrefaction. The more completely the body is defended from the air
by clothes or coffin, the more slowly does putrefaction go on. It is
rapid where the body is exposed to the soil, but very slow where it is
buried in a coffin hermetically sealed.

The several media retard putrefaction in the following order : —

1. Water of common sewers and cesspools. 2. Common water.
3. The earth (in different degrees according to the character of the
soil). 4. The air (in different degrees according to its temperature,
moisture, &c.).

Consult Orfila's * Traite des Exhumations Juridiques,' and De-
vergie's ' Me'decine Legale,' which contains the marrow of Orfila's
observations, with his own account of the changes produced by putre-
faction in the water. The process of putrefaction as it occurs in water
will have to be examined by itself

Age. — Other things being equal, the bodies of children putrefy more
speedily than those of adults and aged persons, and the bodies of old
persons undergo this change more rapidly than those of the adult.

Sex. — According to Orfila, putrefaction takes place more rapidly in
females than in males. He attributes this to the greater quantity of
adipose matter with which their cellular membrane is loaded. This
explanation, though not quite satisfactory, agrees with the fact, that
the bodies of fat persons undergo this change more readily than those
of the lean and emaciated.

Condition of the Body and Cause of Death. — Putrefaction takes
place more or less speedily in proportion as the body is more or less
filled with fluid. Accordingly, it is very rapid after sudden death, and
after death from acute disease ; more slow after death from haemor-
rhage, and from chronic disease, unless complicated with dropsy.
After death from inhaling carbonic acid (judging from three cases
mentioned by Devergie in the 17th vol. of the ' Annales d'Hygiene')
putrefaction is also greatly retarded.

The same observation applies to the parts of the body as to the entire
frame; for those parts which are filled with fluids at the tinie of
death, through inflammatign, congestion, or dropsy, or in consequence

SIGNS OF DEATH. PUTREFACTION IN WATER. 217

of wounds or bruises, putrefy more rapidly than healthy and entire
structures.

It was formerly believed that the bodies of persons destroyed by
poison putrefied very rapidly ; but it is now well known that arsenic,
and the other mineral poisons, act as powerful antiseptics. Animal and
vegetable poisons have probably no effect either way ; but persons
poisoned by them putrefy rapidly, as in other cases of speedy death.
There is reason to believe that putrefaction takes place with unusual
rapidity in animals di'iven soon after a meal and dying suddenly ; as
well as in men dying suddenly during violent exertion.

Putrefaction in Water. — More dependence is to be placed on the
criteria laid down for determining the period of death in those whose
bodies have remained in the water, than in those who have been ex-
posed to the air or interred, for the obvious reasons, that the tem-
perature of the water is more uniform, and the body, unless when it
rises to the surfece, is protected from the air. As Devergie, whose
official position at the Paris Morgue has given him unusual means of
observation, places much reliance on the signs by which the period of
death is determined in the drowned, the following account based upon
his description is subjoined.

The bodies of the drowned are subject, like those who perish by
other modes of death, to loss of heat and rigidity, and to putrefaction
in a modified form, accompanied by the formation of adipocere. One of
the first changes, which may be seen as early as the third or fourth day,
consists in a bleaching of the skin of the hands.

At the end of a week the body is found supple, and the skin of the
palms of the hands very white.

A week to twelve days of immersion bleaches the backs of the hands,
and softens and bleaches the face.

At the end of a fortnight the hands and feet are bleached and
wrinkled, the face slightly swollen with spots of red, and the middle
of the sternum has a greenish tint.

At the end of a month, the hands and feet are completely bleached
and wrinkled as if by a poultice, the eyelids and lips are green, the rest
of the face reddish-brown, and the front of the chest presents a large
patch of green with a reddish-brown spot in the centre.

At the end of two months, the face is swollen and brown, and the
hairs are but slightly adherent : much of the skin of the hands and
feet is detached, but the nails have not separated.

At two months and a half, the skin and nails of the hands are de-
tached, and the skin of the feet, but the toe-nails are still adherent. In
the female, reddish discolouration of the sub-cutaneous cellular tissue
of the neck, of that which surrounds the trachea, and of the organs
contained in the cavity of the chest ; partial saponification of the
cheeks and chin ; superficial saponification of the mammae, the axillge,
and the anterior part of the thighs.

At three months and a half. The skin and nails of the hands and

218 SUDDEN DEATH.

feet completely removed ; part of the hairy scalp, of the eyelids, and
of the nose, and the skin of many parts of the body destroyed ; and
the face and upper part of the neck and axillaj partially saponified.

At four mouths and a half. Nearly total saponification of the fat of
the face, of the neck, of the axillae, and of the anterior part of the
thighs ; commencing earthy incrustation of the thighs ; incipient sa-
ponification of the anterior pait of the brain ; opaline state of the
greater part of the skin ; almost entire separation and destruction of
the hairy scalp ; calvariura denuded and beginning to be very friable.

As to the more remote periods no accurate approximations can be
given ; but Devergie alleges that the above signs have been repeatedly
applied with complete success to bodies that have remained in the
water for periods unknown at the time of their examination.

The foregoing description applies to bodies immersed during winter
and spring. Bodies immersed in summer undergo the same changes
much more rapidly. Thus, 5 to 8 hours of immersion in summer
correspond to 3 to 5 days in winter ; 24 hours to 4 to 8 days ;
48 hours to 8 to 12 days ; 4 days to 15 days. Thus on the average
the same changes in summer take place from three to five or six times
as rapidly as in winter, or even more promptly than that. The changes
in spring and autumn are intermediate between those of winter and
summer.

This account of the changes which take place in the bodies of the
drowned would be incomplete without some further notice of that
development of gas within the body which causes it to rise to the
surface. This takes place slowly in winter, and the body rarely rises
to the surface in less than six weeks or two months. But the same
change takes place in summer from the 14th to the 16th day, or even
earlier. In some instances the body is found to float at a much earlier
period than either of those now indicated.

Frequent mention has been made of adipocere. This substance
derives its name from the resemblance it bears to a compound of wax
and fat. It is formed by the union of the margaric and oleic acids,
arising from the decomposition of the fat of the body, with the
ammonia generated during decomposition. It is, therefore, a sort of
animal soap.

Adipocere is formed in bodies which remain for a long time in water,
also in bodies buried in moist soils, and especially where a large number
of bodies 'have been interred in one common grave. A body must
remain about thi'ee years in the ground in order that it may be com-
pletely transfoi-med, but the change takes place much more rapidly
in water. In bodies which remain in the water the development of
adipocere may commence as early as the third or fourth week.

Adipocere is sometimes of a pure white colour, sometimes of a
yellowish or brownish white. Bodies wholly converted into this
substance have a ghastly bleached appearance, but retain their form,
so as to admit of identification.

Causes. 219

SUDDEN DEATH.

Under this title it is intended to point out some of the common
causes of sudden and speedy death, and to indicate those appearances in
the dead body which tiirow iight on the true cause of death in the
more obscure cases. That such cases are not of uncommon occurrence
will be inferred from the fact that no less than from 3,500 to 4,000
sudden deaths occur year by year in England and Wales from causes
not ascertained ; this number being over and above the 1 5,000 deaths
returned as due to violent causes, of which the greater number also
belong to the class of sudden or speedy deaths.

A temporary suspension of the heart's action constitutes the chief
sign and the essence of apparent death ; a total an-est of its contrac-
tions is real death. Some of the vital endowments of the blood and
muscles survive this cessation of the heart's action ; and the lingering
imtability of the heart itself, and especially of the right auricle, forms
our ground of hope in the use of means of resuscitation. This suspen-
sion or total arrest of the heart's action, or, in other words, apparent
or real death, may be brought about by different causes, of which some
act directly on the heart, and others indirectly through the medium of
the lungs.

The causes of sudden death which act directly on the heart are
either — I. Structural diseases of the heart itself, and of the large
vessels, or 2, Nervous shocks paralyzing its muscles, or 3, Causes
cutting ofiF the supply of blood to it, or 4, Causes destroying the
stimulant property of the blood.

1. The structural diseases of the heart and large vessels, such as
disease of the valves, hypertrophy, aneurism of the aorta, and ossifica-
tion of the heart, aorta, or coronary arteries, are readily discovered on
post-mortem examination. The only diseases of the heart which might
escape observation are atrophy and fatty degeneration of the muscular
tissue ; and there is reason to believe that both of these causes are
occasionally overlooked. In some instances, as in two cases related by
Mr. Paget, death really due to fatty degeneration was believed to have
been caused by poison.

2. The nervous shocks of sufficient force to paralyze the heart, and
to cause instant or speedy death, may be caused by strong and sudden
emotions of fear and joy, by the lightning and sun-strokes, by heavy
blows on the head or pit of the stomach, by violent exertion giving
rise to sudden effusion of blood on the brain (of which one case has
come under the notice of the author), by large drafts of cold water
swallowed when the body is heated, and by a few of the more active
poisons given in full doses.

3. The supply of blood necessary for the heart's action may be cut
off by profuse haemorrhage. It may also be kept from the left side of
the heart by the arrest of the circulation through the lungs in death
by apnoea. But this belongs to the class of indirect causes.

220 SUDDEN DEATH.

4. The proper constitution of the blood may be destroyed by the
mechanical admixture of air introduced into the veins during opera-
tions on the neck, shoulder, or axilla ; or it may be chemically de-
stroyed by poisons, directly introduced into the circulation. This
contamination of the blood plays an important part in death
by all the more active and deadly poisons, whether inhaled or
swallowed.

Of the causes of sudden or speedy death which act indirectly upon
the heart, the most common is that an-est of the circulation through
the lungs which attends the several forms of sufi'ocation. A similar
arrest of the pulmonary circulation constitutes the intermediate link
between the less severe shocks to the nervous system and the ultimate
arrest of the heart's action.

Seveial of the foregoing causes of sudden death are at once revealed
by a careful inspection of the body ; but those causes of death which
do not leave behind them any structural change may yet give rise to
such marked changes in the distribution of the blood through the body,
and in and about the heart, as to aid us very materially in our inquiries
into the true cause of death. Thus, death from the rapid loss of blood
would be indicated by pallor of the surface, and the empty and con-
tracted state of all the cavities of the heart ; death from shock sud-
denly arresting the circulation, by a distended state of all the cavities
of the heart; and death from suffocation by violet patches on the
surface of the body, and distension of the right side of the heart with
dark blood.

The causes of sudden death, and the post-mortem appearances by
which they are indicated, may be more fully discussed by adopting the
well-known classification of Bichat ; namely, death beginning at the
head, death beginning at the heart, and death beginning at the lungs.

Sudden Death commencing at the Heart. — Syncope. — The phe-
nomena which attend this form of death are : — Pallor of the face and
lips, cold sweats, dizziness, dimness of vision, dilated pupils, gasping
and sighing respiration, a slow, weak, and irregular pulse ; to which
are sometimes added nausea and vomiting, restlessness and tossing of
the limbs, transient delirium and convulsions.

On inspecting the body, the vessels generally are found to contain
but little blood, and the heart to he nearly or quite empty, and
contracted. This empty state of all the cavities of the heart contrasts
strongly with their distended state in the rare cases of death originating
in the brain, and acting directly upon the heart; and not less
strongly with the distended condition of the right side of the heart,
and empty state of the left, which occurs in death commencing in the
lungs.

Sudden Death commencing at the Head. — Injuries to the nervous
centres may act directly upon the heart, and put a stop to its contrac-
tions : or they may first afi'ect the fimction of respiration by paralyzing
the respiratory muscles. When the heart is directly affected, the

BEGINNING AT THE LUNGS. APN(EA. 221

circulation is, as it were, arrested and fixed in what may be termed its
normal state, each side of the heart containing its due proportion of
blood, and all the cavities being distended from the sudden loss of
power in the heart to propel its contents. This mode of death has
been designated asthenia. When, on the contrary, the muscles of
respiration are paralyzed, the post-mortem appearances will be those
presently to be described under the head of apnoea.

Sudden Death commencing at the Lungs : Apnoea {Asphyxia^. —
The sense now affixed to the term asphyxia departs strangely from the
original derivation of the word, which means pulselessness. It is now
understood to mean real or apparent death due to a suspension of the
function of respiration, — a mode of death much more aptly designated
by the term apnoea.

Apnoea may be produced by a great variety of causes, of which the
chief are : —

1. Cessation of the action of the muscles of Respiration, 2. Cessa-
tion of the action of the Lungs themselves. 3. Exclusion of the atmo-
spheric air from the Limgs.

1 . Cessation of the Action of the Muscles of Respiration may be due
to inertia of the muscles themselves, in consequence of cold or debility ;
to a loss of nervous influence supplied to the muscles, as fi'om division
of the upper portion of the spinal marrow, or of the pneumogastric and
phrenic nerves, from the lightning stroke and from apoplectic seizures ;
to mechanical restraint, as by pressure on the chest or abdomen ; or
to tonic spasm, as in death from Tetanus or Hydrophobia.

2. Cessation of the Action of the Lungs. — This may be due to a
division of the eighth pair of nerves ; or to a mechanical obstacle,
such as the admission of air into the pleura, or the entrance of the
viscera of the abdomen through a wound in the diaphragm.

3. The partial or complete Exclusion of Atmospheric Air from the
Lungs may be brouglit about by the entire absence of air, as in a
vacuum ; or by its extreme rarefaction, as on the top of very lofty
mountains. The air, again, may be mechanically excluded, as by a
foreign body introduced into the larynx, by submersion, by suffocation,
by strangulation, by suspension. Or lastly, the place of the atmo-
spheric air may be taken by a gas, such as nitrogen or hydrogen, which
cannot support respiration. Other gases seem to exercise a deleterious
influence on the economy, independent of the mere exclusion of the air.
Some of these are intensely irritating, as the sulphurous acid gas,
chlorine, and ammonia ; others, though less irritating, are not less
fatal in their effects, such as the carbonic acid, carbonic oxide, car-
buretted hydrogen, nitrous acid, hydrosulphuric acid, hydrosulphate
of ammonia, arseniuretted hydrogen, and the vapour of hydrocyanic
acid. Some of these, as well as the more simply irritant gases, may
act mechanically by producing a spasm of the glottis, and closing it
against the admission of air.

To this list of the causes of apnoea may be added certain diseases of

222 SUDDEN DEATH.

the lungs, as hepatization, oedema, or tubercular infiltration, which
prove fatal by filling the air-cells, and preventing the process of re-
spiration from being duly performed.

The symptoms of apnoea will be more or less strongly marked accord-
ing as the asphyxiating cause acts suddenly or slowly. If the at-
mospheric air is suddenly excluded from the lungs, as by mechanical
compression of the trachea, complete submersion, or the inhalation of a
gas which is so irritating as to cause spasmodic contraction of the
glottis, the symptoms are strongly marked, and run a rapid course.

The sufferer struggles violently for breath, and uses strong efforts to
remove the obstruction. The face at first flushes, but soon grows
turgid and livid ; the veins of the head and neck swell ; the eyeballs
start from their sockets ; and the swollen tongue protrudes between
the teeth. A short attack of giddiness, with bright spots before the
eyes, and ringing sounds in the eais, is followed by loss of conscious-,
ness, convulsive movements of the limbs, and relaxation of the
sphincters, with expulsion of the urine and faeces and more generally
of the prostatic fluid. In two or three minutes, if relief be not afforded,
life is extinct.

When the asphyxiating cause acts more slowly, the symptoms are
somewhat modified, and succeed each other at longer intervals.

There is a feeling of constriction in the chest, from which the
sufferer strives to free himself by strong voluntary efforts to inspire
air, or by the involuntary efforts of yawning or sighing. A dull heavy
pain in the head, especially over the forehead, with giddiness, dimness
of sight, and torpor of the intellectual faculties succeed, and gradual
loss of sensation and voluntary motion. Still, the functions of re-
spiration and circulation continue, as shown by almost imperceptible
movements of the walls of the chest, and pulsations of the heart
scarcely sensible to the hand. This imperfect state of respiration and
circulation is followed by the entire cessation of those functions, and
by complete loss of motion, voluntary and involuntary. At this
point of time the fulness of the capillary system begins to show itself,
by the injected state of the face, and by a deep violet discolouration of
that part, which also extends to the hands and feet. Some portions of
the trunk and extremities exhibit spots, more or less extensive, of the
same colour. At length, the capillary circulation ceases, and the state
of apnoea is complete.

In some cases the asphyxiating cause, acting more slowly still, seems
to induce a sleep which terminates, without suffering, in death ; in
other instances, the sensations are even pleasurable, consisting of a
display of beautiful colours or of pleasant landscapes before the
eyes. There is still another class of cases in which the sufferer,
suddenly roused from a state of torpor to a vivid and painful per-
ception of his state, makes an effort to escape from the death which
threatens him, but finds his muscular strength unequal to the accom-
plishment of his purpose, and falls to the ground.

THEORY OF APNCEA. 223

After death the body presents the following appearances : — Patches
of rosy, bright red, or violet, discolouration are seen on the face or on
other parts of the body, as much on the least as on the most depending
parts. The eyes are usually prominent, firm, and brilliant. The
mouth is sometimes expressive of calmness, at others of suffering.
Cadaveric rigidity is very marked, and continues for a long time.
The venous system of the brain is commonly full of blood, but its
substance presents, when divided, but few bloody points. Sometimes
the ventricles of the brain contain serum ; sometimes blood is effused
at the base in the substance or on the surface of the organ. The base
of the tongue is almost always injected, and its papillae strongly
developed. The lining membrane of the epiglottis, larynx, and
trachea, is of a deep red colour, and the colour increases in intensity
as we approach the last ramifications of the air-tubes. The air-pas-
sages often contain a frothy sanguinolent fluid. The lungs are so much
distended and increased in size as to project over and conceal the
pericardium. They are of a deep violet colour, and when cut into
and compressed, large drops of black, thick, liquid blood exude. The
liver, the spleen, and the kidneys, are also gorged with blood. The
veins of the heart are distinctly traced upon its surface, its right
cavities and the large venous trunks are gorged with black, thick,
liquid blood ; but the left cavities of the heart are found nearly or
quite empty.

Such are the appearances present in death by apnoea when it occurs
in its unmixed form : and they are those observed in the bodies of
persons who have perished by inhaling carbonic acid. But all these
appearances aie not present in every case, nor, if present, are they
equally marked in all.

Theory of Apnasa {Asphyxia). — When air is prevented from gaining
access to the lungs, the blood does not undergo its usual change from
venous to arterial, and venous blood does not minister to the support of
the vital functions of the several organs so completely as the arterial
blood does. Some, indeed, have supposed that venous blood is a
positive poison ; and that it is much worse for an organ to be supplied
exclusively with venous blood than to receive no blood at all.

On this assumption, the cessation of the heart's action may be ex-
plained in one of three ways. The heart may be paralyzed by the
circulation of the venous blood through the coronary arteries in place
of arterial blood ; or the venous blood may be unfitted to excite the
left cavities of the heart to contraction ; or, again, the nervous in-
fluence supplied to the heart from the nervous centres may be sust-
pended by the circulation of venous blood through the nervous
tissue.

But the assumption that venous blood is directly poisonous, and
worse than no blood at all, has been disproved, as far as it can be, by
experiment. Kay has shown that the venous blood exercises no dele-
terious influence on the muscles, by comparing the contractility of a

224 SUDDEN DEATH.

limb from which the supply of arterial blood has been cut off with
that of a limb supplied exclusively with venous blood ; and Edwards
found that a cold-blooded animal placed in an asphyxiating medium
lives longer than one whose heart and bulb of the aorta have b^en
excised.

Venous blood, therefore, is not positively, or to a great degree, in-
jurious ; its circulation is merely a negative injury, and destructive of
life by occupying the place of arterial blood and cutting off the supply
of that fluid to the economy. As the absence of all circulation through
the vessels of the heart, or through those of the brain, or through the
nerves supplying the heart with vital stimulus, would certainly and
speedily prove fatal to life, so would the mechanical exclusion of ar-
terial blood from the vessels of those parts, whether by warm water or
by venous blood. This theory of exclusion, then, is adequate to the
explanation of death by apncea. It has been shown, however, by
Dr. Kay, that neither this theory, nor the theory of poisoning by a
deteriorated blood, is the true one ; but that the essential character of
this form of death consists in the accumulation of blood in the lungs and
right cavities of the heart, and a diminished supply of that fluid to its
left cavities ; so that the quantity of blood sent out for the supply of the
system constantly diminishes, till at length the circulation is altogether
arrested. Hence in death by asphyxia the left ventricle is found
contracted, and nearly or altogether empty. It is of little consequence
to inquire into the proximate cause of this arrest of the circulation
through the lungs ; the fact is all with which, as medical jurists, we
have to do.

On contrasting the post-mortem appearances proper to the thi-ee
modes of death, syncope, asthenia, and apnrea (asphyxia), it will be
seen, that in the flrst, all the cavities of the heart are empty or contain
little blood ; in the second, all the cavities are full of blood ; and in
the third, the right side is gorged with blood, while the left ventricle
contains little or none.

It is most important, however, that the medical jurist should bear
in mind that the characteristic ai)pearances of sudden death, due pii-
marily to the heart, the lungs, or the brain, are not always equally
marked ; that they may be combined with each other in difierent pro-
portions ; and that a cause usually productive of the one may, in
certain circumstances, give rise to the other. Thus, a person may be
threatened with suffocation (one of the causes of apnoea), and appre-
hension may give rise to sudden syncope ; or a violent attempt to
escape the threatened injury may burst a blood-vessel in the brain,
and cause apoplexy. We must, therefore, bear m mind the possibility
of such combinations as these, in order that we may be prepared to
understand the different appearances presented by those who perish
from a common cause.

It may be useful to subjoin the following facts connected with
sudden death.

RELATIVE FREQUENCY OF ITS DIFFERENT FORMS. 225

From the 19th Annual Report of the Registrar-General, it appears
that of 416,470 deaths from all causes, occurring in England and
Wales, on the average of the five years 1852-56, 13,711, or about 1
in 30, were violent deaths, of which 3045 were due to various fonns of
chemical injury, 3826 to apnoea (asphyxia), and the remaining 6840
to various mechanical injuries. Of the 13,711 violent deaths, 10,057
occurred in males, and 3654 in females. The sudden deaths, for the
average of the same five years, are stated at 3843 or more than 1 per
cent. (1 in 109). They are distributed between males and females in
the proportion of about 3 to 2.

The suicides on the average of the same five years amounted to
1083, of which 777 in men and 306 in women. Of 1044 due to
ascertained causes, 642 were brought about by various forms of suffo-
cation, 111 by poison, 1 by burning, and the remainder by mechanical
injuries, among which 210 cut throats, 43 gun-shot wounds, 12 other
wounds, and 20 falls. The suicides by poison by men and women
respectively were as 6 to 5, by apncea as about 3 to 1, and by me-
chanical injuries at about 4 to 1. The greatest number of suicides in
both sexes occtfrred between the ages of 45 and 55. The relative fre-
quency of the several forms of sudden death appears, from a work of
Ferrario and Sormoni on sudden deaths occurring in Milan, to be as
follows :■ —

Head (including apoplexy, cerebral con-
cussion, vertigo, and coma) . . 879 or about 4 in 5.

Heart (including diseases of the heart,
angina pectoris, aneurism, and haa-
morrhage). .... 150 or about 1 in 7.

Lungs (including asphyxia, suffocative

catarrh, and pulmonary apoplexy) . 14 or about 1 in 75.

Difficult labours .... 5

Total . . . 1048

The relative frequency of the different forms of sudden death classi-
fied according to their proximate causes must, however, be understood to
differ at different periods of life. The proportions just stated are ob-
viously those which obtain chiefly among adults ; for sudden deaths in
infancy and childhood, if classed according to their causes, would re-
verse the order just stated. By ftir the most common cause of death
in infancy and childhood is to be found in the lungs, and the least
common in the brain, though the fact of convulsions being verv
common in early life might lead a superficial observer to attribute
the majority of sudden deaths to the brain and not to the lungs. The
diseases of the lungs which give rise to sudden or speedy death in
infants and young children are spasmodic croup or laryngismus
stridulus, to which Dr. West attributes three out of four of the sudden

Q

226 suiivivousHiP.

deaths of children under one year old, imperfect expansion of the lungs
at bii-th (atelectasis pulmonum), sudden collapse of the lung, consolida-
tion from pneumonia, and sudden serous effusion into the pleura, to
which ought to be added a disease not mentioned by Dr. West in the
paper now referred to, pulmonary apoplexy. A not uncommon cause
of sudden death among the children of the poor is suffocation, as a con-
sequence of drinking hot water from the spout of the kettle. Next to
diseases of the lungos, sudden death by exhaustion from insufficient
food, or chronic diarrhoea, is most common, while fatal disorders of the
brain are very rarely to be set down among the causes of sudden
death in infancy and childhood.

Of the sudden deaths entered in the tables of the Registrar- General
upwards of one-third occur in infancy.*

SURVIVORSHIP.

When two or more persons die by the same accident, a question
sometimes arises as to which died first ; for, in certain cases, the succes-
sion to property would be secured on proof of survivorship even for an
instant of time.

Hitherto little has been done towards establishing broad general
principles applicable to this class of inquiries : indeed, the materials for
the establishment of such principles are wanting. Some of the more
accurate results which have been attained will be found stated in the
following pages under the following heads: — 1. Of the probabilities
afforded by age and sex, irresi>ective of the mode of death. 2. Of the
degree in which such probability is atTected by the peculiar mode of
death.

1. Of the Probabilities afforded by Age and Sex.

Age. — As the body attains its full growth and strength at about 27
years of age, or from 25 to 30, and, in healthy persons, continues
strong and vigorous up to about 50, there will be no sufficient ground
for inferring survivorship in the case of adults of the same sex, whose
ages range between 25 and 45, or even betwe.en 20 and 50, provided
the form of death is one in which mere strength of frame and power of
endurance is concerned. Before and after the ages specified, the
strength and power of endurance will be less, but still within the
limits of puberty and old age (say 15 and 60 years) the difference
will probably be inconsiderable. The probability of survivorship, in
the case of a middle-aged adult perishing with one under puberty or
above 60, will be in favour of the adult. In the case of one under 15
and one above 60 perishing together, the French law assumes that the
former survived : when both are under 15, that the elder outlived the
younger. According to the civil law of England, if parent and

* See a Lecture by Dr. West, on Sudden Death in Infancy and Childhood in
tlie 'Medical Times and Gazette/ Nov. 26, 1859.

PROBABILITIES ESTABLISHED BY THE MODE OF DEATH. 227

child perish by a common death, the child shall be presumed to
have survived if above puberty, and' to have died first if under
puberty.

In the case of a mother and child both dying in childbed, without
assistance, the presumption is, that the mother survived, for there is a
chance of still birth, and a further probability that the child, if bom
alive, would die before the mother would be able to render the assist-
ance necessary for its preservation. A large child would be still move
likely to perish first, for it has been elsewhere stated (p. 84) that still-
born children greatly exceed in size and weight those born alive. If
the body of the child could be examined the presumption might be still
further strengthened by the external marks of a difficult labour, or the
absence of the signs of respiration. Legal decisions have not been
always in conformity with the principle here laid down.

Sex. — If one of either sex perish by a common accident, it may be
inferred that the male, being the stronger, is the survivor ; but this
rule applies only to modes of death in which strength and courage
give the best chance of safety. On the other hand, females being
subject to prolonged fainting in consequence of fright, may be, by that
very circumstance, incapacited from those struggles which in so many
foi-ms of death may be presumed to increase danger. When, then,
there is safety in exertion, the probability of survivorship will be
with the male ; where passive endurance or insensibility would tend
to lessen the danger, with the female.

2. Of the Degree in which the foregoing Probabilities are affected by
the Mode of Death.

Under this head it is proposed -to specify some of the more common
modes of death, and to endeavour to establish some general principles
with respect to them, assuming, as before, that the parties about whom
the question is raised are placed, as nearly as may be, in the same
circumstances.

Apncea {Asphyxia). — Women consume less oxygen than men ; the
same quantity of air, therefore, will last them for a longer time. Hence,
of adult males and females perishing together of apncea, the females
may be presumed to have survived. In poisoning by carbonic acid gas,
which is nearly allied to death by apnoea, the chances of survivorship
are with the female. This statement rests on the authority of a large
number of facts. In 19 out of 360 cases of poisoning by carbonic acid,
which took place in Paris during 1834 and 1835, a man and woman were
exposed to the fumes of charcoal together : of these three only were saved,
and these three were females. In solitary cases of the same form of death
the result is also favourable to the female ; for 1 8 out of 73 females were
restored, and only 19 out of 83 males, so that the chances for the
female and male respectively are nearly as 15 and 14 (instead of 5
and 4 as Devergie represents it). Single cases are in strict conformity

228 SURVIVORSHIP.

with this result. Thus, in a case quoted by Beck from the 'Transyl-
vania Journal/ a man and his wife were exposed in a small room to
the gas from live coals. The man was found dead, rigid, and con-
tracted, but the woman was still breathing and recovered. Again,
in a case reported by M. Sardaillon, a man, his wife, and their child
aged seven years were asphyxiated in a porter's lodge. The child
died, the father was very ill and with difficulty restored to life, while
the wife was well enough to call for help and to assist both husband
and child. In these cases it would be necessary to take into account
the position which the parties occupied in the room, whether on the
bed or on the floor, near to or remote from an open window, &c.

Drowning. — There are many complicated considerations connected
with this mode of death. In shipwrecks men are more likely to be in a
favom-able situation for saving themselves, as they are more on deck
than women ; they also in many instances are able to swim , or to
save themselves by clinging to portions of the wreck, and they are
less encumbered by clothing. When the comparison is between men
similarly exposed and capable of the same exertion, it may be necessaiy
to inquire whether one was more exposed to cold by having the body
half immersed, while the other was more under water. Search should
also be made for severe injuries which may have prevented the swimmer
from using his strength, or may have otherwise proved fatal. Apoplexy
is stated by Devergie to be sooner fatal than apncea, while in death by
syncope there is the best chance of recovery.

Suffocation. — In all cases of suffocation depending upon an insuffi-
cient quantity of air, or upon air rendered partially unfit for respira-
tion, it may be presumed that those who require least air live the
longest — women longer than men, children than adults. In suffocation
from the falling of houses or earth, or by mechanical means in general,
the stronger may be presumed to survive the weaker — men, women ;
adults, children and old persons.

Cold. — As young children bear cold worse than adults, the pro-
bability of survivorship in exposure to the same degree of cold is in
favour of the latter. Men bear cold better than women, adults better
than the aged. It is necessary also to take into account the clothing of
the persons exposed, and their state of health. Spirituous liquors in
excess increase the effect of cold ; in moderation they give increased to-
lerance of it.

Heat. — The young and old, as they suffer more from cold, so do
they bear heat better. " The relative tolerance of heat of the two sexes
is not well ascertained. Fodere relates the case of an Englishman and
his daughter aged seven years, who, in the year 1814, crossed the desert
of Syria to the Persian Gulf. Both rode on camels, and were placed in
precisely similar circumstances, but the father died, while the child
arrived in safety at its journey's end.

Hunger and Thirst. — Those who have not reached their full growth
require more nourishment than adults, and adults more than aged

HUNGER AND THIRST. 229

persons. The aged, then, if healthy and robust, may be presumed to
survive both, and the adult to live longer than the child. Corpulent
persons are thought to bear hunger better than the emaciated. In
death from starvation, those who have the freest access to water may
be presumed to live the longest. Those who use the greatest exertions
will suffer earliest in this as in the foregoing modes of death. Those
who possess most passive endurance may be expected to live the longest.

Such are some of the principal forms of death, in which the circum-
stances of the several victims are likely to be so similar as to admit of
the application of general rules. In other modes of death, and in
these under certain circumstances, there may be no points admitting
of strict comparison, and many things which may exercise a marked
influence on the result will have to be taken into the account. The
reader will find several such cases quoted in Beck's ' Medical Juris-
prudence ;' but as they throw little light upon the general question,
and establish no fixed principles, it would be useless to quote
them.

It has been suggested by more than one writer, that a distinct
enactment would be preferable to the present custom of deciding each
case on its own merits. Such an enactment, extending to that large
class of cases in which the circumstances of the death are but im-
perfectly known, and to those in which it is in the very nature of things
impossible to come to a correct decision, is certainly much to be de-
sired. On many points, as it has been seen, the opinions of medical
men can throw much light, and their researches lead to general princi-
ples admitting of tolerably safe application.

230

CHAPTER II.

DROWNING HANGING — STRANGULATION— SUFFOCATION.

These modes of death are brought together in the same chapter, as
they are all forms of apnoea, or sudden death beginning at the lungs.

DEATH BY DROWNING.

The medico-legal importance of this cause of death may be inferred
from the fact, that on an average of the five years 1852-56, 2352
deaths were caused by drowning, of which 1847 in males and 505 in
females. Of this number 164 (87 males and 77 females) were ascer-
tained acts of suicide.

Although death by drowning is commonly attributed to apnoea, it
is not always due to that cause. Hence this subject is not so simple
as at first sight it would appear to be. To make it intelligible it will
be necessary to describe the various modes in which a man found in
the water may liave come by his death, supposing him to have died in
the water.

When a man in perfect possession of all his faculties falls into the
water, he sinks to a greater or less depth, but immediately rises to
the surface again ; and, if he is a swimmer, makes efforts to save him-
self, till at length he is reduced to the condition of one who cannot
swim at all ; with this difference, that he has already exhausted the
strength which the other has in reserve for the death-struggles
common to both. These struggles consist of irregular movements of
the arms and legs, and graspings of the hand at all objects within
reach, whether floating in the water, fixed at the bottom of it, or
gi-owingon the banks. In the course of these irregular movements he
rises repeatedly to the surface, tries to breathe, and takes in air and
water. The contact of the water with the windpipe causes a cougl^
by which part of the fluid is rejected, antl with it some of the air
contained in the lungs. This occurs again and again, till the body no
longer rises to the surface ; water alone is received in the vain efl'orts
to respire, while forcible involuntary expirations continue to expel the
air from the lungs. At length all these efforts cease, the body sinks
to the bottom of the water, and bubbles of air are forced from the
chest by the elastic reaction of its parietes. The greater part of the
water which has been taken in finds its way iuto the stomach, and a
smaller portion into the lungs ; and this portion, mixed with the

DIFFERENT FORMS OF DEATH BY DROWNIKG. 231

secretions of the mouth and air-passages, and frothed by the air in-
spired and expired, forms the foam so constantly met with in persons
who have perished in this way.

In cases belonging to the class just described, we may expect to find
the a})pearances proper to death by apncea, coupled with those due to
the medium in which the death takes place. In the case of the swim-
mer death may take place from exhaustion, with only indistinct signs
of death by suH'ccatiou.

But death may take place in the water, and yet be caused neither
by apnoea nor by exhaustion. There may be a complete loss of con-
sciousness at the very moment of immersion. This may happen from
fright, from drunkenness, from an attack of hysteria, or of catalepsy
(of which latter the author has known one melancholy instance) ; and
in this case the body falls to the bottom of the water, rises again to
a certain height, and sinks without a struggle. In these cases death
is due to shock, or to syncope, and not to suffocation.

Again, a person may fall or throw himself into the water with the
head foremost, and, striking against a rock or fragment of wood, or
even against the surface of the water itself, perish by concussion ; or
the body falling or thiown from a height may strike the water w\th
the chest and pit of the stomach, so as to cause instant death from
shock. In these cases, also, death is due to causes other than apnoea.

Again, cold, excitement, or the first violent struggles, may occasion
apoplexy, or sudden death from disease of the heart. These sudden
deaths by diseases of the brain and heart are of occasional occurrence
in persons bathing in cold shallow water.

Death by drowning may also be of a mixed character. A man falls
into the water in the full possession of all his faculties ; he preserves them
for a time, till, struck with horror at the death which threatens him,
he faints, and thus perishes.

It appears, then, that death by drowning may be due to apnoea, to
exhaustion, to shock or syncope, and to apoplexy ; and, further, that
death may be brought about partly by apnoea and partly by one of
the other causes now specified. The cases in which marks of apnoea
more or less distinct are found in the body, either separately or
blended with those proper to some other form of death, fo]-m the great
majority, and cases in which the signs of apncea are wholly absent a
small minority, while cases of pure and rmmixcd apnoea occupy an
intermediate place. Devergie, whose opportunities of experience in
this class of cases have been already alluded to, estimates the cases of
unmixed apncea as one in four or two in eight of the whole, the cases
in which no traces of apnoea exist as one in eight of the whole, and the
mixed cases as five-eighths of the whole.

The appearances present in the body of the drowned must of neces-
sity vary with the manner and precise cause of death.

In those cases in which death has been due to apnoea, the post-
moitem appearances will be those proper to that mode of death

232 DEATH BY DROWNING.

(see p. 223), but blended with those due to the medium in which the
death happened, and modified by the time that the body has remained
in the water, as well as by the period of exposure to the air after
removal from the water.

Supposing the death to have been due to apnoea, and the examina-
tion of the body to be made soon after the death and removal from
the water, it may be expected to present the following appearances : —
The face and general surface of the body are either pale or slightly
livid, with occasional patches of a deeper tint. The expression of
the face is generally calm. The tongue is swollen, and closely applied
to the teeth, rarely protruded between the closed jaws, and still more
rarely wounded and bloody ; and there is a frothy foam at the mouth.
The air-passages also contain a froth, which is sometimes tinged with
blood ; and the trachea and larger bronchial tubes contain water
which sometimes penetrates to their most minute ramifications. Some-
times the water is in such quantity as to fill the whole of the air-
passages, and it occasionally carries with it portions of slime or mud,
or fragments of aquatic plants.

The lining membrane of the air-passages is sometimes found con-
gested ; the lungs contain a large quantity of black fluid blood ; the
vena; cavai and right cavities of the heart are distended with dark
blood, while the left cavities and aorta are comparatively empty. The
stomach almost always contains water, of which the quantity is some-
times very considerable. The intestines have a rosy colour ; the liver,
spleen, and kidneys are gorged with blood ; and the bladder sometimes
contains urine tinged with blood. The brain piesents the same ap-
pearances as in other cases of death by apnoea. Sand or mud are often
tound in the hollow of the nails, the fingers are sometimes abraded,
and portions of plants growing in the water, or on the banks of the
stream, are sometimes found grasped in the hands. Injuries received
in falling into the water during the death-struggles, or through the
violence of the stream, may also leave their marks upon the body.
These will presently be more minutely described.

In bodies which have remained in the water, or been exposed to the
air for some time, the pallid, or slightly livid hue of the features just
described may be exchanged for a bloated appearance, and large livid
spots may show themselves on different parts of the body, as in other
cases of death by apucea.

In death by shock, syncope, or exhaustion, there is little or no
water in the air-passages or in the stomach. The cavities of the heart
and large vessels are equally distended with blood, or are nearly
empty, and the brain and internal viscera are in their natural state.

Death by concussion or by apoplexy, or by disease of the heart, will
reveal itself by the usual post-mortem appearances.

In mixed cases the post-moi-tem appearances due to apnoea will be
less strongly marked. There will be less froth at the mouth, less
water and froth in the air-passages, and in the stomach ; and less

WAS DEATH CAUSED BY DROWNING? 233

congestion of the lungs, of the heart and great vessels, and of the
internal viscera.

Several medico-legal questions suggest theniselves in reference to a
body found in the water, of which the first in order is the following :
— Was death caused by drowning i In the case of a ' person found
dead in the water, the death may obviously have happened from natural
causes or from intentional violence prior to the immersion ; and in the
latter case the death may have been due to some cause producing
apncea, and giving rise to the characteristic appearances proper to that
mode of death. In other words, a person may be strangled or
suffocated, and then thrown into the water to conceal the true cause
of death. In forming a decision on a question of so much difficulty,
we shall have to consider the several post-mortem appearances alleged
to be characteristic of death by drowning, and to determine whether
they might have been occasioned by causes acting before immersion.
We must also determine whether, in the case of bodies remaining in
the water some time after death, the appearances usually attributed
to the mode of death may not be explained by the peculiar circum-
stances in which the body is placed.

Of the post-mortem appearances present in bodies found in the water,
some are common to death by drowning and to death by other forms
of apnoea, while others are peculiar to death by drowning. To the
first class belong the position and swollen state of the tongue ; the
pallor with rosy or violet discolorations of certain parts of the skin ;
the injected state of the brain ; the congestion of the internal viscera ;
the fulness of the right cavities of the heart, and emptiness of the
left ; the fluid state of the blood ; and the existence of bloody urine in the
bladder. To the second class belong : — excoriations of the fingers, with
sand or mud in the hollow of the nails ; fragments of plants grasped
in the hand ; water in the stomach ; froth at the mouth and nostrils ;
and froth, water, mud, or sand in the air-passages.

Of the post-mortem appearances belonging to the first class, it will
suffice to observe, that their presence in persons found dead in the
water is consistent with the supposition of death by drowning, but
that they might have been caused prior to immersion by any of the
modes of death which act by occasioning apncea. If the body is free
from marks of strangulation, death might still have been caused by
suifocation produced by forcible closure of the mouth and nostrils.

The post-mortem appearances alleged to be due to drowning, and
to be characteristic of that mode of death, must now be briefly con-
sidered.

Excoriations of the Fingers are much more frequently absent than
present ; but, when they exist, may be regarded as a probable, though
not certain sign of death by drowning. They might be caused previous
to forcible immersion, by the rubbing of the fingers against any hard
and rough body ; and possibly after death in running streams.

Sand or mud in the hollows of the nails, also, affords a probability

234 DEATH BY DROWNING.

of immersion during life, inasmuch as it implies, like the excoriations
of the fingers, that the drowning man grasps at the bed or banks. But
if the body remained long in the water, mud or sand might be deposited
in the hollow of the nails.

If the hands were found clenched and grasping weeds growing in the
stream or upon the banks, there would be the strongest probability in
favour of death by drowning.

Water in the Stomach. — The discoveiy of water in the stomach
affords another strong presumption in favour of death by drowning ;
especially if the water can be identified with that in which the body
was found by its containing leaves of plants growing on the banks or at
the bottom. Except in the cases presently to be mentioned, it presup-
poses acts of deglutition during efforts to breathe. It must, however,
be admitted to be possible, though very unlikely, that the water might
have been swallowed a very short time before submersion.

The quantity of water found in the stomach is very variable ; and
depends partly upon the number of efforts at respiration made during
the act of diowning, and partly on the depth of the water. In animals
that have been stunned befoi'e immersion, as well as in animals kept
under water from the first, and prevented from rising to the surface,
the stomach contains no water ; while in animals allowed to rise to the
surface, it is found to be in proportion to the number of times that the
animals so rise.

That the depth of the water also influences the quantity found in the
stomach is proved by the experiments of Dr. A. Taylor. The stomach
of a cat held two feet below the su?face of the Thames contained scarcely
any water ; but that of a cat lowered to the depth of fifty-five feet con-
tained a large quantity. The stomach of a third cat which was allowed
to rise repeatedly to the surface of the water, was distended, but not so
much as the one which had been lowered to the depth of fifty-five
feet.

The influence of the columnar pressure of the water is, therefore,
considerable ; and it is probable, that where the water is very deep
the pressure of the fluid may overcome the resistance offered by the
collapse of the oesophagus, even though the animal died previously to
submersion. It appeai-s, moreover, that water may enter the stomach
in consequence of putrefaction producing a general relaxation of the
tissues.

From what has just been stated, it is obvious that the discovery of
water in the stomach is not tn be considered as conclusive evidence of
death by drowning, when the water is of great depth, or when the
body is far advanced in putrefaction. It must also be admitted to be
possible that the water might have been swallowed immediately pre-
viously to immersion, and possible, also, though most improbable, that
it might, as suggested by Orfila, be maliciously injected after death.

But though the discovery of water in the stomach affords a pre-
sumption of death by drowning, its absence must not be taken as evl-

SIGNS OF DEATH BY DROWNING. 235

dence to the contrary ; for it is not present in cases of death by drown-
ing due to causes other than apnoea, such as shock, syncope, concussion,
or apoplexy. The tendency to swallow may also be voluntarily re-
sisted ; or the body may be, in some way or other, prevented from
rising to the surface.

On the other hand, water may have entered the stomach, and yet
not be found there after death ; for if the head be allowed to hang
below the rest of the body, the water will flow from the stomach.
This fact also has been proved by Dr. Taylor's experiments. If, more-
over, the body is long exposed after its removal from the water, the
fluid contained in the stomach may transude through its coats, and
disappear.

The absence of water from the stomach, therefore, is not conclusive
against death by drowning, for it may have gained access to the
stomach, and subsequently disappeared ; or it may never have entered
the stomach at all.

Froth, water, mud, or sand, in the Air-Passages. — Mucous froth. —
The experiments of Piorry and Orfila have clearly shown that the
presence of mucous froth in the air-passages is due to the body rising
repeatedly to the surface for air, and that it does not exist in animals
kept entirely under water.

This froth is also absent when the body remains in the water a long
time after death, or is subject to long exposure after its removal from
the water, or when the head is placed below the level of the body.
The value of this mucous froth as evidence of death by drowning is
also impaired by the fact that it exists not only in the several forms of
death by apnoea, but in death by apoplexy or epilepsy, and in catarrhal
and other affections of the lungs.

Water in the lungs. — That water generally enters the lungs in death
by drowning has been abundantly proved by experiments on animals,
and by cases in the human subject in which not water only, but sand
and mud, have entered the air-passages. By drowning rats in chalk
and water, with free access to the air, I have never failed to obtain
effervescence by means of acids in every part of the lungs.

But the value of this sign is impaired by the fact that water may
enter the lungs of those who have been thrown into the water after
death. Orfila and Piorry found, that the quantity which thus gained
admission to the lungs, varied according to the position of the body.
When it remained upright there vfas, a large quantity; less when
horizontal.

It has been suggested that water may be injected after death. This
is most improbable. But water is not always present in the lungs of
those who have died by drowning ; for, as in the case of the stomach,
if the head is left depending, the water flows out. Long exposure, too,
will cause it to transude and be lost.

Froth at the Mouth and Nostrils. — This, too, is a sign of death by
drowning ; but it is open to all the objections just stated in respect of

236 DEATH BY DROWNING.

froth in the air-passages. It depends, indeed, very closely on the
existence of froth in the air-passages, as well as on the development of
the putrefactive process, and the consequent generation of gas forcing the
froth in the larynx and trachea into the fauces. Hence it is more
frequently present in summer than in winter.

From this examination of the signs of death by drowning, it appears
that there is no single sign on which entire reliance can be placed.
When, however, several signs happen to coincide, the probability is
greatly strengthened. Like the symptoms of disease, they may be of
little value when taken separately, but when combined they enable us
to form a safe diagnosis. Some authors, and Orfila among the number,
have, indeed, thought that the question,^ Was death due to drowning?
admits of no decision ; but from this o'pinion Devergie very properly
dissents.

It is important to bear in mind, that the appearances characteristic
of death by drowning are not permanent. In winter they may con-
tinue after the body has lain from fifteen to eighteen days in the
water, while in summer they would disappear from the third to
the sixth or eighth day of immersion. The exposure of the body to
the air also causes them rapidly to disappear, and in che height of
summer a few hours would suffice to dissipate them. When putre-
faction has gone to any considerable extent, all the signs of death by
drowning are of course completely removed.

The time that the body has remained in the water will be deter-
mined approximately by the signs laid down at page 217.

The evidence derived from the signs of death by drowning already
discussed admits of being confirmed or invalidated by the condition of
the body in other respects, especially by the presence or absence of

Marks of Violence. — With regard to injuries discovered on the
bodies of persons found in the water, three questions arise : —

1 . Were they inflicted during life ?

2. If inflicted during life, are they of such a nature as to account
for death before submersion ?

3. Were the injuries accidental, suicidal, or homicidal?

The first question — whether the injuries were inflicted during life ?
— and the third question — were the injuries accidental, suicidal, or
homicidal ? are fully discussed under the head of wounds. The fact
of the body having been immersed in water will influence the decision
of this question, only in so far as the injuries are altered in appearance
by the continuance of the body in the water.

Are the Injuries of such a nature as to account for Death before
Submersion ?

There are five different ways in which a body taken from the water
may come to exhibit marks of violence. 1. A man may be murdered,
and, when dead, thrown into the water; 2. He may receive severe
injury from the hands of others or himself, and may then be thrown
(or throw himself) into the water while still alive. 3. The body may

MARKS OF VIOLENCE. 237

be bruised by the struggles which the drowning man makes to save
himself. 4. It may be borne by the violence of the stream against
some obstacle. 5. The body may sustain severe injury in the very
act of falling into the water.

1. On the supposition that a man has been murdered and thrown
into the water quite dead, we should expect to find an absence of all
the signs of death by drowning ; with the exception only of such as
may be present under certain circumstances already mentioned, such as
uncommon depth of water, or advanced states of putrefaction.

2. On the supposition, again, that a man found in the water had first
been severely injured and then thrown in whilst still alive, we might
ex])ect to find some at least of the signs ali-eady mentioned, and these
might be sufficiently marked to enable us to come to a decision ; but
this would, of course, depend on the strength still left to the drowning
man, after the violence inflicted upon him.

3. The injuries which the body might sustain through the struggles
of the drownmg man would not be such as to raise any question of the
true cause of death. They would consist of bruises more or less ex-
tensive and severe, but not so severe or extensive as to endanger life.

4. The injuries which may be inflicted on the body by the violence
of the stream would also consist of bruises more or less extensive. It
is very unlikely that such severe injuries as dislocations or fractures
could originate in this way.

5. Falling into the Water. — There is no doubt that considerable
injury may be inflicted if a person falls or throws himself from a con-
siderable height upon a hard bank or pier of a bridge. Fracture of the
skuii or limbs, extensive bruises, and severe lacerated wounds may be
readily accounted for by this cause.

Dislocation of the extremities is also a possible consequence of the
mechanical obstacle presented by the water to the body falling from a
great height. This accident happened many years since, as stated by
Dr. Gordon Smith, to a man who was in the habit of jumping from
the parapet of London Bridge into the Thames for a wager. He had
previously performed this feat with impunity, but the last time he sank
and was drowned. Both arms were found dislocated, in consequence,
it is thought, of his having fallen with them in the horizontal posi-
tion, instead of holding them close to his sides.

Two cases ai'e also recorded (South's edition of Chelius's Surgery,
vol. i. p, 532), the one of fracture of the body and arch of the fourth
cervical vertebra, the other of fracture of the body of the fifth cervical
vertebra, made in jumping into the water, due to the violent muscular
effort to avert collision with the bottom, by drawing back the head.

The medical man should, therefore, first ascertain whether the
drowned man fell from a height into the water, whether the stream is
rapid, and what obstacles present themselves ; and if on careful exami-
nation he finds that there are no such causes as these to account for the
violence which the party has sustained, he may fairly trace that vio-

238 DEATH BY DROWNING.

lence to some cause preceding the immersion. In bodies found in shal-
low still water, marks of violence afford strong presumption of homicide.

Having convinced ourselves, after a careful examination, that death
took place by drowning, another question arises —

Was the drowning the result of Accident, Suicide, or Homicide? —
This question is exceedingly difficult to answer. For if there are no
marks of violence on the body, it is not possible to say whether the
man fell in, or jumped in, or was pushed in. Again, in respect of
bodies found in running streams, it may not be possible to ascertain at
what point the body entered the water ; hence we are deprived of such
information as rpight have been obtained from a close examination of
the spot where the body is found.

Nor if we find the hands of the drowned man full of leaves or grass,
showing that he struggled hard whilst in the water, can we affirm that
he was thrown or pushed in by others ; for, if he fell in, he would do
precisely the same.

Nor again, does the fact of a man being drowned in a shallow stream
of water render the idea of homicide improbable ; for if a sti-ong man
were to hold the head of a weak or infirm one in a basin of water, he
might drown him just as effectually as in a deep stream. On the
other hand, it should be borne in mind that cases of suicidal drowning
in shallow water, or in very narrow spaces, such as small house-cisterns,
are by no means rare.

It is evident, from what has been stated, that where there are no
marks of violence on the body, we have no means of determining whe-
ther the drowning was the result of accident, suicide, or homicide.
Nor does the discovery of external injuries throw any light upon the
question, unless those injuries are of such a kind as that they could
not have been inflicted by the person himself previous to immeision,
or by the accidental striking of the body against an obstacle in entering
the water, during the death struggle.

There is one case which would at first sight seem conclusive as to
homicide, and that is where a body is found in the water, tied hand
and foot. Dr. Smith, however, relates the following case : — In July,
1816, the body of a gauging-instrument maker, who had been missing
for some days from his home, was discovered floating down the Thames.
On being taken out, his wrists were found tied together and made fast
to his knees, which were in like manner secured to each other. He
had been in a state of mental derangement for two years. The cord
with which he had tied himself was recognised as one that had hung
from the ceiling over his bed, and by which he used to raise himself
up, as he had been confined to bed for some weeks. He was a good
swimmer, and it was presumed he had taken the precaution to prevent
himself from employing that power. The verdict in this case was,
" Found drowned." Two other cases of a similar kind are on record,
one by Fodere', in which the hands and fingers were tied together
with a silk riband, in numerous folds: and another in the ninth

]

MEANS OF RESTORATION. 239

volume of the ' Anuales d'Hygifene,' in which the feet, wrists, and neck
were tied. Fodere' in the one case, and the medical examiners (Marc,
Guichard, &c.) in the other, gave their opinion in favour of suicide.
In such cases as these it would be necessary to determine whether the
knots or folds admitted of being made with the teeth, or by any move-
ments of the hands or limbs.

Treatment of the Drowned. — Before describing the proper treatment
of the drowned, it may be well to recall the fact that in the majority
of deaths by drowning the cause of death is apncea, simple or mixed ;
and that the means to be adopted are those which would be prescribed
in other cases of suffocation, with certain modifications obviously sug-
gested by the circumstance of the death having occurred in the water.
The contact of the v/ater, for instance, will account for a lower
temperature of the surface than would exist as a simple consequence of
death from apnoea. Hence the necessity for more prompt and sustained
attempts to restore the heat of the surface. Such provision as may
not be inconsistent with the use of other means of restoration should
also be made for relieving the lungs and stomach of the water which
had entered those organs.

The following rules for the treatment of the drowned are in accord-
ance with the improved method of the late Dr. Marshall Hall. Strip
the body, and carry it, resting on the belly with the face downwards,
at once to a house close at hand, or to a convenient spot in the open
air; and wipe the body and face dry. Raise the body into the sitting
posture, and endeavour to excite respiration by the use of smelling-
salts, by tickling the nostrils and throat with a feather, and by dashing
warm water on the face and chest. If these means of exciting respira-
tion happen to be at hand, use them promptly, and desist if they do
not produce an immediate effect: if not at hand, proceed at once to
replace the body on the face with the arms crossed under the forehead.
Then turn it to the side and back again to the face about fifteen times
in a minute. In the short intervals apply friction and pressure to the
ribs, and along the spine, and carry the hands with a firm pressure
along the extremities from below upwards. If warmed blankets can
be procured place them under and round the body, and rub the body
with hot towels. Persevere with this treatment, with the assistance
of other persons, for several hours, or until some of the more certain
signs of death have made their appearance. (See p, 208 et seq.)

DEATH BY HANGING.

Death by hanging is of common occurrence. In the five years
1852-56, 494 persons perished in this way, in England and Wales, of
whom 384 were males and 110 females. Of the 494 deaths by hang-
ing no fewer than 451 were ascertained suicidal acts, of which 349 were
by men and 102 by women. Judicial executions account for 7 of
the deaths, so that only 487 were voluntary acts, of which 451 were

240 DEATH BY HANGING.

suicidal. In the whole five years only one death of a child under five
yeare old was set down as an act of homicide. It is probable that
all the other cases were suicidal.

As the cause of death is the same in hanging, strangulation, and
Buftbcation, it may be well to make a fev/ preliminary observations on
these modes of death, before proceeding to examine them sepaiately.

Though, in common language, death from any of these three causes
is due to suffocation, the term suffocation has in medico-legal language
a meaning quite distinct from that of the other two. Whenever death
is produced by any impediment to the respiration, which does not act
by compressing the larynx or trachea, it is said to be due to suffocation.
Thus a man is said to be suffocated if his mouth and nostrils arc
closed, or if the action of the muscles of respiration is prevented by
mechanical pressure either on the chest or abdomen. Certain noxious
gases, too, are said to destroy life by producing suffocation. The subject
of suffocation, then, separates itself at once from those of suspension and
strangulation, inasmuch as it includes all those cases of violent death
in which the respiration is suspended, by causes other than pressure on
the throat. Our attention, therefore, must be directed, in the first
place, to death by suspension and strangulation, in both of which
pressure is exercised on the air-tube and throat.

This piessure may be applied to any part of the throat, and not only
so, but it may be applied to the .same part in different ways and
degrees. The most simple mode is by direct pressure on the trachea
with the fingers. Here the cause of death is obvious ; it is the same
as in many cases of drowning ; the same as in suffocation — viz. apnaa
(asphyxia). Death takes place in consequence of the mechanical
hindrance to the respiration. But the cause of death is not so clear
when the entire circumference of the neck is subject to compression ;
for in this case not only is the larynx or trachea subject to pressure but
the blood-vessels also suflfer. In some instances both the air-tubes
and the vessels are implicated ; in others the air-tubes suffer the chief
compression and the vessels escape ; in otheis, again, the air-tubes escape
and the vessels suflfer all the pressure. The respiration and circulation
are most completely impeded when a cord is fixed round the lower
part of the neck, so as to embrace the trachea, and the huge vessels at
their enti-ance into and exit fi-om the chest ; t)r when the cord is applied,
or drawn by the weight of the body, beneath the lower jaw. Both
functions are less interfered with when the cord is fixed directly over
the larynx, as the projections of the os hyoides and thyroid cartilage in
some degree defend the air-passage and blood-vessels from pressure.

Now this variation in the position of the ligature, and in the pressure
which it exercises on the organs of respiration and circulation respec-
tively, explains the difference in the length of time required to destroy
life in all those cases in which death does not take place instantaneously
from injuiy to the spinal cord. But the circumstance of the air-tubes
and blood-vessels being, in all other cases, compressed simultaneously

CAUSE OF DEATH. 241

gives rise to the question, whether the compression of the air-tube or
of the blood-vessels is the immediate cause of death. Is death, in other
words, produced by apnoea, or by apoplexy ?

It was formerly the general belief that death was produced by
apoplexy : and this opinion was not unreasonable ; for it is well
known that mere pressure with the fingers on the carotid arteries will
cause sleep, by checking the supply of blood to the brain, and apoplexy
is often brought on, in persons predisposed to that disease, by the
pressure of a cravat impeding the return of blood through the veins.
The possibility, therefore, of apoplexy being brought about by pressure
on the large blood-vessels is not to be doubted ; but the question still
recurs — in those cases of suspension or strangulation in which the
air-tube and blood-vessels are simultaneously compressed to which
of the two pressures is death to be attributed ? Both causes doubt-
less combine to produce the fatal result, but there is every reason to
regard the stoppage of the respiration as the essential cause ; for death
by apnoea would be much more speedily and certainly induced by
a complete or partial stoppage of the breathing, than fatal apoplexy
by the complete or partial arrest of the circulation. But an appeal
may be made to actual experiment for the decision of this question.
A dog was suspended by the neck with a cord, an opening having been
previously made in the trachea below the place where the cord was
applied. After hanging for about three quarters of an hour, during
which time the circulation and the breathing went on as usual, the
animal was cut down, and did not appear to have suffered materially.
The cord was then shifted from above to below the opening into the
trachea, so as to stop the ingress of air into the lungs ; and the
animal being again suspended, was in a few minutes completely dead.*
In this experiment the compression of the vessels was probably less
than it would be in many cases of death from hanging in the human
subject, in which the violence employed, the height of the fall, and the
weight of the body combine to tighten the cord, and thus exercise the
strongest pressure on the vessels as well as on the air-tube.

A similar operation on the human subject is described by Smith
(' Forensic Medicine,' Appendix, p. 561.)

" A man of the name of Gordon was executed at Tyburn, in April,
1733. Mr, Chovet having, by frequent experiments on dogs, dis-
covered that opening the windpipe would prevent the fatal conse-
quences of the halter, undertook to save Gordon, and accordingly
made an incision in his windpipe, the effect of which was, that when
Gordon stopped his mouth, nostrils, and ears, for some time, air enough
came through the opening to allow of the continuance of life. When
hanged, he was observed to be alive after all the rest were dead;
and when he had hung three quarters of an hour, being carried to a
house in the Tyburn road, he opened his mouth several times and

* ' CyclopEcdia of Practical Medicine,' Asphyxia.

R

242 DEATH BY HANGING.

groaned ; and a vein being opened he bled freely. No further attempts
succeeded in eliciting any other signs of life. The want of success
probably was to be attributed to the great weight of tlie man, by
which the compression of the vessels of the neck must have become
more effectual than in ordinary cases, and perhaps' at the same time
the opening into the trachea was not sufficiently free." It is obvious
that the same results would happen if for the compression of the neck
brought about in suspension by the weight of the body, an equal pres-
sure were exercised directly by strangulation.

It appears, then, that when the windpipe as well as the large blood-
vessels suffer compression, death may be attributed to apnoja ; when
the respiration is free, or but slightly affected, pressure on the vessels
may cause death by apoplexy, but more slowly ; and that when respi-
ration and circulation are both impeded, both may contribute to the
fatal result, though the stoppage of the respiration is the more
efficient.

It has been suggested that the immediate cause of death in hanging
and strangulation is pressure on the nerves which are subordinate to
the function of respiration ; but as such pressure does not prove fatal
till the lapse of many hours, this explanation may be rejected.

Having now examined the questions which are common to death by
hanging and by strangulation, the subject of death by hanging may be
resumed.

Death takes place very suddenly in certain cases of suspension.
This may arise from two causes : from fear producing syncope as in
some cases of drowning ; and from injury to the spinal cord by luxation
of the cervical vertebrae, fracture of the odontoid process, or rupture
of the intervertebral substance.

These injuries to the spine are caused either by the fall of the body
from a great height, or from a rotatory motion given to the body at the
moment of the fall.

Death after hanging takes place, then, in different ways and different
intervals of time. When it occurs most promptly it may be referred
to injury sustained by the spinal marrow above the origin of the nerves
of respiration, and more rarely to syncope from fright. Next in point
of rapidity will be the death from apnoea^ and the least rapid that by
apoplexy.

We are not without information as to the sensations that accompany
death by hanging. Suicides who have been saved from death, and
philosophers who have instituted experiments on themselves, have both
contributed something to our knowledge. It appears that these sen-
sations are not always the same ; and the difi'erence probably depends
on the various degrees in which the windpipe and blood-vessels are
compressed. Some have retained no recollection of what happened
to them ; others were conscious of sudden loss of sense and motion ;
in others a deep sleep was ushered in by flashes of light, by a bluish
flame, by brilliant circles of colours, or by oculai- illusions of a more

THE MARK OF THE CORD. 243

definite kind, accompanied by hissing or singing in the ears. In other
instances, again, the sensations are stated to have been extremely plea-
surable, though of short duration.

These sensations resemble those that occur in cases of disordered
cea'ebral circulation, and those that precede the fits in some cases of
epilepsy.

But it is only in cases of suicidal hanging that these pleasurable
sensations manifest themselves. In homicidal cases, when much vio-
lence is used, the countenance expresses suffering; the eyes are bril-
liant and staring, and seem to be bursting from their sockets ; and the
eyelids open and injected; the tongue, swollen and livid, is forced
against the teeth, or more or less protruded from the mouth, and
compressed or torn by the contracted jaws ; the lips are swollen and
the mouth distorted; and blood, or a bloody, froth, hangs about the
mouth and nostrils ; the upper extremities are stiff, the hands livid, and
the fingers so forcibly closed on the palm as to force the nails into the
flesh ; and the convulsions are so violent as even to cause the expulsion
of the contents of the bowels, and to produce erection of the penis,
with expulsion of the urine, semen, or prostatic fluid. The cir-
cumscribed rosy or violet discolourations on the trunk and extremities
common to all cases of death by apnoea are strongly developed ; the
course of the cord is distinctly indicated by some of the appearances
presently to be described, but generally assumes the form of a well-
marked bruise; and, on cutting through the skin, the muscles and
ligaments of the windpipe are found stretched, bruised, or torn.

The internal appearances are the same as in other forms of apnoea.
The lungs are said to be sometimes distended with air, sometimes
collapsed.

The great difference in the two forms of hanging (suicidal and homi-
cidal) is important ; for it explains the very different appearances dis-
covered after death in the two cases respectively.

Two principal medico-legal questions arise in regard to persons found
hanged. 1 . Did the suspension take place during life, or after death ?
and, 2, Was the hanging accidental, suicidal, or homicidal?

1 . Did the suspension take place during life, or after death ?

The points most worthy of attention as bearing on the solution of
this question are : — The mark of the cord ; The appearance of the
countenance ; The position and state of the tongue ; The condition of
the genital organs ; and the expulsion of the faeces.

The Mark of the Cord. — It is now well ascertained that the ap-
pearances on the neck due to suspension during life are by no means
uniform. In homicidal cases attended by violence, and involving
strong struggles, the neck sustains great injury, marked by the bruised
appearance of the skin, and the torn state of the subjacent parts ; but
in judicial and suicidal hanging much less injury is done both to the
surface and to the deeper-seated parts„

In those cases (both judicial and suicidal), in which the position of

244 DEATH BY HANGING.

the cord is mainly detentiined by the weight of the body, it follows
jiretty closely the line of the jaw-bone, and there is an oblique indented
mark, of the colour of a recent bruise, on the fore part of the neck,
and yellowish brown, as if from a superficial burn, towards the angle
of the jaw. Sometimes the bruise corresponds with the whole breadth
of the ligature ; at others there is a deep gi-oove, bordered by two dis-
coloured lines. The mark varies with the size of the cord and the
materials of which it consists, being less distinct when a soft material,
such as a handkerchief, is used, than when a hard ligature, such as a
rope, is employed. When the material is hard and resisting, the ap-
pearances on the neck indicate the number of times that the ligature has
been passed round it, and even the material of which it consists. But
in many cases of judicial and suicidal hanging, the mark of the rope
consists at first of a simple depression without any change of colour,
oblique if due to the weight of the body, horizontal if firmly fixed
round the neck. After the lapse of several hours, the rope-mark
assumes a light-brownish tint. If an incision be made into the skin
the cellular membiane is found strongly compressed, so as to form a
shining white band. Thfe appearances of a bruise are never developed
at all. The countenance, as will be presently more fully stated, is at
first pale and its expression natural, and it is not till several hours have
elapsed that it assumes a livid tint, and still longer before it wears a
bloated appearance.

In a case of judicial hanging, in which the cord was removed soon
after the body had been cut down, I observed merely a depressed
circle on the fore part of the neck, and a slight excoriation, with a
burnt appearance over the angle of the jaw. In a case of suicidal
hanging with a small rope tied firnily round the neck, which was re-
moved without delay, there was a white depressed line deeper at the
back of the neck than in front and assuming a dusky hue after the
lapse of several hours. The strands of the rope were distinctly
marked, but there was no ecchymosis on any part of the neck.

The appearances, then, produced by the cord in cases of hanging
during life are not the same in all instances : in some cases there is
the usual appearance of a bruise or ecchymosis ; in others there is
merely an indentation of the skin, without discolouration, and a con-
densed state of the subcutaneous tissues, resembling old parchment ;
and these appearances may be combined at the angle of the jaw, or in
other parts of the neck, with slight excoriations, or appearances like
those produced by superficial burns.

As the condensed, abraded, and burnt appearance of the skin may
obviously be produced after death as well as during life, there remains
only to consider as possible proof of death by hanging the value of the
biniise or ecchymosis present in a certain proportion of the cases.

The question, whether the appearances occasioned by the cord in an
individual suspended during life, can be produced after death ? has
been answered in the affirmative. In the chapter on Wounds and

STATE OF COUNTENANCE, TONGUE, GENITAL ORGANS. 245

Mechanical Injuries, it will be shown, when speaking of the distinction
between bruises inflicted during life and after death, that ecchymosis
may be produced for some time after life is extinct. The rule which
apphes to bruises in general will of course hold good with respect to
this jmrticular form of bruise ; and accordingly Orfila proved, by
experiments on the dead body, that, up to eighteen hours after death,
precisely the same appearances may be produced as in suspension
during life ; Devergie has produced the parchment-like condition of the
skin and subjacent cellular tissue, as well as the ecchymosed appearance
bounding the depression ; and Dr. Casper, of Berlin, succeeded up to
two hours after death in producing ecchymosis resembling that occurring
in hanging during life. It follows, then, that neither ecchymosis, nor
the peculiar parchment-like condensation of the skin is a sure sign of
suspension during life ; and that consequently the appearance of the
neck, taken alone, is not conclusive as to the question under con-
sideration. But a very considerable effusion of blood, a rupture of the
trachea, a separation of its cartilages, a dislocation of the spine, a
division of the coats of the vessels, or, indeed, any evidence of great
violence would furnish a strong probability of suspension during life,
or of suspension after strangulation, for it is highly improbable that
much force would be used in suspending a body which had been pre-
viously deprived of life by other means.

State of the Countenance. — In death by hanging, whether judicial or
suicidal, the countenance is usually pale, and the expression of the
features natural. But this pallor of the face is followed, after a few
hours, by a livid hue of the lips, eyelids, and face generally ; and, after
a still longer interval, by a marked congestion of the countenance.
There is nothing in the expression or colour of the face to show that
suspension took place during life or after death ; but if the vessels of
the head and face were found highly congested in a body recently cut
down, it would furnish a probability in favour of suspension during
life; for, suspension after death, though it might produce discolouration
of the neck itself, could not cause turgescence of the vessels of the
head and face.

Position and State of the Tongue. — The same injected state of the
base of the tongue, with swelling and protrusion of the organ, which
occurs in other forms of death by apnoea, occurs also in death by
hanging, and affords a strong probability of suspension during life.

State of the Genital Organs.- — The genital organs of both sexes are
affected in death by hanging. In the female, redness of the labia and
discharge of blood have been occasionally noted, and in the male a
more or less complete state of erection of the penis, with discharge of
urine, of mucus, or of the prostatic fluid, is a frequent occuirence. It
may be expected to be present in at least one case in three. But it
must be borne in mind, that these appearances in the genital organs,
when they do occur, are not characteristic of death by hanging or
strangulation, for they have been observed in other forms of violent

246 DEATH BY HANGING.

and sudden death, as in fatal gun-shot wounds of the brain, and of
the large vessels, and in poisoning by prussic acid. It is probable
that the fluid ejected from the urethra is not semen but mucus;
for, in the report of the case of a criminal executed in America,
(' American Journal of the Medical Sciences,' May 1840,) there was no
priapism, but a fluid was discharged which is stated not to have con''
tained any seminal animalcules.

This sign then, when present, is one of considerable importance, for
it is strictly vital, and affords a sure proof of violent and sudden
death ; and if combined with other exteraal signs of death by hanging,
and characteristic internal appearances, would be nearly conclusive. On
the other hand, the absence of erection and emission is no evidence that
death was not due to this cause.

Expulsion of the fwces. — The contents of the bowels are expelled in
about one fourth of the cases of death by hanging ; but as this also
happens in other forms of sudden or violent death, it is to be regarded
as evidence of such mode of death, but not of death by hanging
only.

2. Was the Hanging accidental, suicidal, or homicidal "? — Accidental
hanging is of rare occurrence. One case is given by Dr. Smith : it was
that of a girl who was swinging in a brewhouse, and near the rope
used by her for that purpose was another for drawing up slaughtered
sheep. In the course of the exercise her head got through a noose of
this second rope, by which she was pulled out of the swing, and kept
suspended at a considerable height, until she died. Dr. Taylor also
relates a case communicated to him by one of his pupils. A boy ten
years old had been amusing himself by fastening a piece of plaid
gown to a loop in a cord, which was suspended from a beam in the
room. In the act of swinging he raised himself, and gave himself a
turn, when the loop of rope suddenly caught him under the chin, and
suspended him until life was extinct. A playmate was witness of the
occurrence.

With the exception of a small number of cases of this class, in
which the mode of death is obvious, the question under consideration
is narrowed to this : Was the Hanging suicidal or homicidal ? The
figures given from the returns of the Kegistrar General show that the
probability is always strongly in favour of suicide ; and, for obvious
reasons, hanging is a mode of death which a murderer is little likely
to resort to. It presupposes a great disproportion of strength between
the murderer and his victim, or a combination of two or three persons
against one. In the figures just referred to, the solitary ascertained
case of homicide in the five years 1852 to 1856, was committed on the
person of an infant.

There would be nothing in the appearance of the body itself, beyond
the marks of a severe struggle, to distinguish the homicidal from the
suicidal act ; but if a man were found suspended at a height from the
ground which he could not by any possibility have reached,' and with

DEATH BY STRANGULATION. 247

no object near on which he could have mounted, we might reasonably
conclude that he was suspended by another.

It was once supposed that a man found with the feet or some part
of the body touching the ground was more likely to have been hanged
by another than by himself; but careful observation has shown this to
be an error, for suicides have been found in every imaginary position,
and very many in such a posture that death must have been produced
by strangulation, the suicide leaning forward so as to compress the
windpipe.

A great many cases, in which the bodies of suicides were found
placed in every possible attitude, are given, illustrated by engravings,
in an interesting paper in the fifth volume of the * Annales d'Hygiene.'

As in most of the cases in which the body touches the ground the
cord would not be so put on the stretch as to give it its usual oblique
position, there would be no difference between such cases and cases of
strangulation, except, perhaps, that in the latter the mark would be
more distinct, and would embrace a greater portion of the neck.

The marks of violent struggles on the clothes or person of the
deceased, or of severe injuries, would justify a suspicion of homicide;
but as severe and extensive injuries have been known to be produced
by a suicide, and slighter injuries may take place accidentally, this
criterion must be used with great caution.

It appears, then, that in death by hanging, the presumption is
always strongly in favour of suicide, but that we can rarely have the
means of converting this presumption into certainty, or even of adding
materially to its force.

It may be well to add that cases are on record in which persons
found suspended have been previously killed by strangulation or by
other violence, as well as cases in which the true cause of death was
poison.

^ DEATH BY STRANGULATION.

This mode of death is rare compared with death by hanging. It
accounts for fifty deaths in the year, of which thirty-seven in males
and thirteen in females. Only half of these deaths were ascertained to
be suicidal ; of which twenty in males and five in females. Homicide
by strangulation, though much more common than by suspension,
is of rare occurrence in grown-up persons, but common in infants.

Death by strangulation differs from death by hanging only in the
fact that the body is not suspended ; but some of the cases of suicidal
hanging in which the body touches the ground might with equal
propriety be set down to strangulation.

Strangulation may be effected either by the uniform pressure of a
ligature round the neck, or by direct pressure on the windpipe. In
rare instances the two are combined, some object being introduced into
the folds of the ligature, and placed immediately over the windpipe.

248 DEATH BY HANGING.

From this distinction between death by hanging and death by
strangulation, it follows that, as a general rule, the mark on the neck
will differ in the two cases ; being oblique and high in the neck in
death by hanging, circular and low down in death by strangulation.
From this general rule, however, those cases of hanging must be ex-
cepted in which tiie cord is firmly fixed round the ueck, and those in
which the body is not completely suspended, but touches the ground ;
and those rare cases of strangulation in which the ligature happens to
be fixed somewhat obliquely. The mark in hanging, therefore, may
happen to be circular, a;id that in strangulation more or less oblique.
The introduction of a foreign body into the folds of the ligature would
be indicated by the greater size and distinctness of the bruise over the
windpipe.

Another difference between strangulation and hanging is, that in
strangulation much more force is used ; hence the mark on the neck
will be more visible, and the injury to the subjacent parts more con-
siderable; and this will be especially the case in homicidal strangu-
lation, for the murderer generally uses more violence than is necessary
to effect his purpose.

The same questions arise in respect of strangulation, as of hanging
— viz., 1. Was death caused by strangulation ? 2. Was the stran-
gulation accidental, suicidal, or homicidal ?

1. Was Death caused by Strangulation'? — A cord applied a few
hours after death would not produce that degree of ecchymosis which
would result from the application of the cord during life ; and the
turgesceuce of the countenance, as well as the characteristic post-
mortem appearances, would be wanting. It is only, therefore, in
suicidal cases, and in the scarcely conceivable case of slight forc6 being
used by the murderer, or death taking place suddenly, from shock or
syncope, that the appearances produced by a cord applied during life
could resemble those due to its application after death. The same
observations apply to direct pressure on the windpipe. As, moreover,
hanging is known to be the more common suicidal gfct, the murderer
is not likely to hide the real mode of death by simulated strangulation.
It is much more probable that having strangled his victim, he should
endeavour to conceal the real mode of death, by suspending the body
or placing it in a position suggestive of suicide.

In the well-known case of Bartholomew Pourpre, the deceased was
first strangled and then suspended, and the mark of the cord was
found at the lower part of the neck, while the teeth knocked in, and
the bloody mouth, showed the foice which had been employed.

The murderers of Sir Edmondbury Godfrey, after strangling him
near Somerset House with a twisted handkerchief applied with great
force, concealed the body for a time, and then carried it to Islington,
where they threw it into a ditch, passed his own sword through him,
and laid his gloves and other articles of dress on the bank, so as to
excite the belief that he had committed suicide.

WAS THE STRANGULATION SUICIDAL OR HOMICIDAL ? 249

The absence of blood from the wound, though tlie sword had passed
through the heart, excited suspicion, which was fully confirmed by the
discovery of a bruise, an inch broad, extending round the neck ; and a
fracture of the cervical vertebrae, which rendered the neck so flexible
that it could be turned from one shoulder to the other. The face
which during life was remarkably pale, was livid and suffused, and the
eyes bloodshot.

2. Was the Strangulation accidental, suicidal, or homicidal'? —
That strangulation, like hanging, may take place accidentally, is
proved by the following cases.

An ingenious young man having nearly lost the use of his arms was
in the habit of moving a heavy weight by means of a cord attached to
it and passed round his neck. One morning, shortly after having
retired to his own room, his sister discovered him sitting in a chair
apparently lifeless. He was found to be quite dead, with the cord
twisted round his neck. On cutting the cord, the weight fell on the
floor. There was little doubt that the deceased had attempted to
move the weight in the usual way, but that it had slipped behind,
and had compressed the trachea so as to produce strangulation. (Dr.
Smith.)

In July, 1839, Elizabeth Kenchan, an extremely dissipated, drunken,
and disorderly woman, went to bed intoxicated, with her bonnet on,
and in the morning was found strangled in her bonnet strings. ' It
appears that she fell out of bed, that her bonnet became fastened
between the bedstead and the wall, and that she, being too drunk to
loosen the strings, was consequently strangled.

These rare cases of accident would be easily known to be such by
the position of the body and the circumstances of the case.

In a few cases, then, death by strangulation has been due to acci-
dent; but if we have convinced ourselves that death did not take
place in this way, the question is narrowed, and assumes this shape : —

Was the Strangulation suicidal or homicidal i — Strangulation
appears to be a suicidal act in about half the recorded cases. As it is
difficult for a man to strangle himself by the pressure of his hands
even with the aid of a ligature, some mechanical contrivance is usually
resorted to. A case is related by Orfila, of a suicide who was found
lying dead in his bed, with two cravats twisted several times round
his neck. Dunlop relates the case of a Malay who used a small stick
for the same purpose. In the year 1838 a Mr. Watson, aged 88,
strangled himself by placing a poker through the tie of his hand-
kerchief and twisting it round and round. In another instance, the
handle of a pot was employed, and several similar examples have been
put on record.

Strangulation by pressure of the hand on the trachea may be safely
assumed to be homicidal, as in the following case. A trial for murder
by strangulation took place at the Chester assizes, in April, 1835.
The prisoner, who was a robust man, upon some slight provocation,

250

DEATH BY HANGING.

seized the deceased by the cravat, and pressed him firmly by the neck
against a wall, until he was dead. On examining the body, the face
was found to be livid and swollen, and the features distorted. There
was also a considerable discolouration and depression on that part of
the neck to which the pressure had been applied. The prisoner was
seen to commit the crime, and the case was clearly proved against him,
but he was acquitted on the ground of insanity.

It has been alleged that fatal pressure with the fingers on the
windpipe might occur accidentally ; but this may be safely pronounced
to be impossible. An unsuccessful attempt to attribute death to this
cause was made in the well-known case of Beddingfield.

In 1763, a man named Beddingfield was found dead in his bed-
room, and the charge was laid against his wife and man-servant. The
medical testimony was very unsatisfactory, as no dissection had taken
place, but it was pi-oved that there were marks about the neck resem-
bling those of fingers. A contradictory account was, however, given of
the number : one surgeon said a thumb and three fingers ; the other,
a thumb and four fingers ; while another witness, who also saw the
marks, at the inquest spoke of two only, " which looked as if the
blood was set in the skin." The defence was, that the deceased had
fallen out of bed, and was found lying on the floor on his face, with
one hand round his neck. The discrepancies in the testimony, and the
omission of dissection, might, however, have led to subsequent doubts,
had not one of the condemned persons confessed that he had strangled
Beddingfield in his sleep, by seizing his throat with his left hand ; and
that though the deceased struggled violently and made some noise, yet
he soon accomplished his purpose.

The following is a case of homicidal strangulation by a foreign
body introduced into the ligature.

Dr. Clench, a London physician, was called out of bed by two
persons on the night of the 4th of January, 1692, to visit a sick friend.
He entered a hackney coach with them, and drove about several streets
in the city for an hour and a quarter. The two persons then left the
coach, and sent the driver on an errand. When the coachman
returned, he found Dr. Clench sitting on the bottom of the coach,
against the front seat, with his head on the cushion. Thinking him
in liquor, he shook him, but obtained no answer. He then called the
watch, and they found him strangled by a coal wrapped in a hand-
kerchief, and applied directly over the windpipe. The coachman had
heard no noise while driving the carnage.

The appearances present in the body in cases of forcible strangulation
may be inferred from the evidence of Mr. W. Wilson in the case of
Hector M' Donald, tried and convicted of the culpable homicide of his
wife, at Inverary, April 1857. There was an abrasion on each side of
the windpipe, five abrasions on the left arm, three on the right arm:
the skin on the front and sides of the neck, and on the upper part of
the chest was blackened. On the throat there were the marks of a

DEATH BY SUFFOCATION. 251

thumb and three fingers. The bruises were such as to justify the
belief that the throat had been grasped by the left hand, of which the
wrist was pressed upon the chest, and that the right hand had grasped
the left arm of the victim. The internal appearances were highly
characteristic of death by apnoea. The substance and membranes ot
the brain were injected ; the right side of the heart contained a
quantity of dark fluid blood : the left side was nearly empty. The
lungs also contained a quantity of dark fluid blood. All the internal
viscera were healthy.

DEATH BY SUFFOCATION.

Under this head are comprised all cases of apnoea, not produced by
direct pressure on the windpipe, with the exception of drowning,
which has already been treated separately.

On an average of the five years 1852 to 1856, 708 deaths by suffo-
cation occurred, of which 427 in males, and 281 in females. Of the
whole number, 106 were infants killed by overlying, and about 180,
also infants, were suffocated by bed-clothes. Fifty-seven, of whom the
majority were young children, were suffocated by their food, 38 by
gases, chiefly carbonic acid. Two suicides, five murders, and one
manslaughter by suffocation are reported to have happened annually.

Suffocation may take place in many ways.

The mouth and nostrils may he stopped by accident or by force,
A person in a state of helplessness, from whatever cause, may fall on
the face and be suffocated by water or loose earth ; and new-born
children by the discharges, by the bed-clothes, or by being overlaid in
bed. Murderers have also sometimes despatched their victims by this
means.

Mechanical Pressure on the Chest. — This may occur from accident,
as when a quantity of earth or rubbish falls upon a man ; or as a
homicidal act, combined with strangulation ; the murderer pressing
with his whole weight upon the body, and compressing the larynx or
trachea with the hand. Sometimes suffocation is effected, as by
Burke and Bishop, by compressing the chest and closing the mouth
and nostrils at the same time.

Suffocation by pressure on the chest was also resorted to in bar-
barous times as a torture, and constituted part of the peine forte et
dure of our ancient law.

A risk of accidental suffocation from pressure on the chest has
sometimes been incurred in taking casts with plaster of Paris.

Persons have also been pressed to death in a crowd. On the 14th
of June, 1837, no less than twenty-three persons lost their lives at
the Champs de Mars in this way, death being due partly to suffocation
and partly to severe injury to the chest.

Closure of the glottis. — This also may occur accidentally, as in the

252 DEATH BY SUFFOCATION.

57 cases mentioned above as having been suffocated by food. When
this happens in adults they are usually in a state of intoxication, or in
a fit. Thus Paris and Fonblanque quote the case of a patient who was
seized, after a heavy meal of pork, with an epileptic fit, during which
he died ; when, upon opening the trachea, it was found to contain a
quantity of animal matter, resembling the pork on which he had
recently dined.

Among familiar examples of accidental suffocation may be cited the
death of Anacreon, attributed to a grape-seed ; and of Gilbert the poet
from swallowing a piece of mutton. There is a case on recoid of
suffocation caused by swallowing a bee in some honey ; another in
which death was caused by slaked lime getting into the larynx, and
producing violent inflammation there. Tumours in the glottis have
led to the same result.

Examples of suicidal suffocation are afforded by slaves who, both
in ancient and modern times, are alleged to have swallowed their
tongues. In other instances, some article of dress, such as a hand-
kerchief has been swallowed, and one case of determined suicide was
brought about by swallowing a cork bristling with sharp pins. The
preparation is in the museum of King's College. ^

Suicidal suffocation by the vapours of charcoal «re not common in
England but very frequent in France.

Suffocation is not a mode of death frequently resorted to by mur-
derers. When the victims are young and vigorous adults, the force
required is such as to reveal the cause of death by external marks and
internal appearances; but where the body is very weak from any
cause, as in the new-born infant, the old man, or the intoxicated, suf-
focation is not very difficult to effect, and, if unaccompanied by
violence, might not betray itself by the state of the body externally or
internally.

The post-mortem appearances present in well-marked cases of death
by suffocation may be deduced from the account given by Dr. Ollivier
of Angers, of the persons suffocated in the Champs de Mars. In all
the twenty-three persons, without exception, the skin of the face and
neck was of a uniform violet tint, spotted with blackish ecchymoses.
In nine there was infiltration of blood under the conjunctiva of the
eye; in four, sero-sanguineous froth running from the mouth and
nostrils ; in four, blood running from the nostrils ; in three, blood
flowing from the ears ; in seven, fractures of the ribs ; in two, females,
fracture of the sternum. In sixteen bodies that were opened, the
blood was black, diffluent, and filling all the large veins at the right
side of the heart. The pulmonary tissue was mostly of a reddish
brown, and in three quarters of each lung, posteriorly, there was a
considerable accumulation of black and liquid blood ; but there was no
ecchymosis, either on the surface or in the substance of the lungs,
except in one case. In all the cases in which there was infiltration of
blood benea'th the conjunctiva, and in those in which blood flowed from

THE VICTIMS OF BURKE AND BISHOP. 253

the ears, the vessels of the pia mater and substance of the brain were
gorged with blood.

In consequence of the comparatively slight injuries caused by suffo-
cation, this mode of death was, previous to the passing of the Anatomy
Act, selected by the murderers Burke and Bishop. Burke, with his
female accomplice, Macdougall, was tried at Edinburgh in 1828, and
Bishop, with Williams and May, in London, in 1831.

Burke destroyed the deceased, Margery Campbell, by sitting on her
body, covering her mouth and nostrils with one hand, and applying
the other forcibly under the chin.

Fifty-nine hours after death, the eyes were closed ; the features were
found composed, as in deep sleep, red, and somewhat swollen ; the lips
of a dark colour; and the conjunctivae of the eyes much injected with
blood. There was a little fluid blood on the left cheek, apparently
from the nostrils; the tongue was not protruded or torn by the teeth,
but there was a slight laceration on the inside of the upper lip opposite
the left eye-tooth ; the cuticle under the chin was much ruffled, and the
surface of the true skin, when laid bare, was dry and biown ; but there
was no ecchymosis. The integuments, except on the face, were per-
fectly free from lividity. The joints were flaccid. There was no
effusion of blood or laceration of the paits around the windpipe, and
no injury of the cartilages, but the os hyoides and thyroid cartilage
were further apart than usual, in consequence of the stretching of the
interposed ligament. The following wei'e the internal appearances :
The membrane of the windpipe healthy, with here and there some
tough mucus, not frothy, and a few points of blood between it and the
membrane. The organs within the chest were'perfectly natural ; the
lungs remarkably so, and unusually free of infiltration. The blood
throughout the body was black and fluid, and accumulated in the large
veins, and in the right cavities of the heart. The abdominal viscera,
with the exception of incipient disease of the liver, were healthy. The
brain also was quite healthy, and presented a little more turgescence
of vessels than usual ; and there were three extravasations of blood iij
the scalp, but without corresponding external bruise. There were some
marks of violence on the limbs, considerable effusions of blood among
the muscles of the neck, back, and loins, and on the sheath of the spinal
cord. The posterior ligamentous connections between the third and
fourth cervical vertebrae were torn. These injuries to the back were
shown to have been occasioned after death by the forcible doubling up
of the body. It should be added that a ' handful ' of clotted blood was
found near the body.

In the case of Carlo Ferrari, the victim of Bisliop and Williams,
the appearances from which suffocation might have been inferred were
even less strongly marked. The face, it is true, was swollen and con-
gested ; the eyes blood-shot, and the hps tumid ; but the lungs were
quite healthy and not congested, the heart was contracted, and all its
cavities quite empty. But these exceptional appearances were explained,

254 DEATH BY SUFFOCATION.

by the fact, that the murderers, after stupefying their victim with
liquor, lowered his body into a well with the head downwards, taking
care to keep his mouth below the level of the water. In this case, too,
there was some extravasated blood under the scalp, among the muscles
of the neck, and on the spinal cord. The fresh state of the body, the
appearance of the countenance, and a wound upon the left temple com-
bined to excite suspicion, and led to the committal and conviction of
the murderers.

In both these cases death was certainly caused by suffocation, and
yet the appearance of the bodies was not such as to lead at once to the
conclusion that death had happened in this way. The medical exa-
miners, in both cases, were inclined to ascribe the deaths to the injury
done to the spine, which was afterwards proved to have been occasioned
after death by the forcible doubling up of the bodies in packing them.

In allusion to the opinion expressed by some medical men, that the
signs of suffocation are so strongly marked as of themselves to arrest at-
tention. Dr. Christison observes : — ** In the body of the woman Camp-
bell, no person of skill, whose attention was pointedly excited by being
told that from general circumstances murder was probable, but the
mahner of death unknown, could have failed to remark signs that
would raise a suspicion of suffocation. But if his attention had not
been roused ; if, for example, he had examined it in the anatomical
theatre of an hospital, without knowing that suspicions from general
circumstances were entertained regarding it, he might have inspected
it even mmutely, and yet neglected the appearances in question. Nay,
a person of skill and experience would have been more likely to do so
than another, because every one who is conversant with pathological
anatomy must be familiar with such or similar appearances, as arising
from various natural diseases." Dr. Christison then draws attention
to the close resemblance between the appearances present in the body
of Campbell and those observed in the body of a man who died of
dysentery, adding that the ' vascularity of the conjunctivae, and the
contusions on the legs made the only difference.' *

* ' Cases and Observations in Medical Jurisprudence, Ed. Med, and Surg.
Journal,' vol. xxxi, p. 243. (1829.)

255

CHAPTER III.

WOUNDS AND MECHANICAL INJURIES.

In this Chapter it is proposed to treat of all injuries inflicted on the
body by mechanical means, excepting the several forms of death by
suffocation treated of in previous chapters, and injuries by fire, and by
lightning, which are reserved for separate examination in succeeding
ones.

All injuries, therefore, which one man inflicts upon another, whether
by cutting or bruising instruments, by his own person, or by forcing
him against an obstacle, will have to be considered under this head.
Tor the punishment of all such injuries when maliciously inflicted, the
statute law makes provision, no less than for stabbing, cutting, shoot-
ing, drowning, strangling, and suffocating, by the insertion of the
words " or shall by any means whatever cause to any person any
bodily injury dangerous to life."

In examining so large a subject as this of wounds, or mechanical
injuries, methodical an-angement is especially necessary. The different
kinds of mechanical injury will have to be separately considered, the
questions common to all^ such injuries must be discussed, and the
peculiar way in which th'ey affect the more important organs of the
economy must receive due attention.

Three kinds of mechanical injury will have to be separately exa-
mined : — wounds in the common acceptation of the term, gunshot
wounds, and mechanical injuries not usually designated as " wounds."

The old surgical definition of a wound * makes it to consist in a
solution of continuity. Mechanical injuries, therefore, may be con-
veniently divided into such as are without solution of continuity and
such as are with solution of continuity. The first will include, con-
tusions, concussions, simple fractures, dislocations, and sprains. The
second comprises incisions, punctures, and lacerations, compound frac-
tures, and gun-shot wounds.

The two classes of injuries, whatever the parts which they affect.

* ' A wound is a solution of continuity in any part of the body suddenly
made, by anything that cuts or tears, with a division of the skin.' ' By the
word skin, I understand not only the external cutis, but also the inward mem-
branes of the gullet, ventricle, guts, bladder, urethra, and womb, all of which are
capable of wounds from sharp instruments, either swallowed or thrust into
them.' — Richard Wiseman's ' Chirurgical Treatises,' book v., chap, i.

256 WOUNDS.

have some points common to all the forms of violence included in the
class. Thus, almost all injuries affecting the deeper-seated parts of the
bodv are accompanied by external traces of the violence which pro-
duced them, whether that violence caused a solution of continuity
or not. Hence, in the greater number of cases we shall have traces
of the injury on the surface, and on this account it will be neces-
sary to examine minutely the subject of bruises and incisions involving
the external parts of the body.

The arrangement which it will be convenient to adopt has now been
sufficiently indicated. The whole subject will be best examined under
the following heads: — 1. The eharacters of contused wounds, and of
injuries unaccompanied by solution of continuity. 2. The characters
of incised wounds, and of those accompanied by a solution of con-
tinuity. . 3. The characters of gun-shot wounds. 4. The detection of
spots of blood on weapons and clothes. 5. The questions common to
all forms of mechanical injury. 6. Wounds as they affect the several
important organs of the economy.

1. THE CHARACTERS OF CONTUSED WOUNDS, AND OF INJURIES
UNACCOMPANIED BY SOLUTION OF CONTINUITY.

A blow with a blunt instrument gives rise to an appearance on the
surface familiarly known as a bruise, and, in scientific language, as an
ecchymosis.

A bruise consists in a discolouration of the skin ])roduced by extra-
vasation of blood into the cellular membrane. The blood may be
thrown out in the superficial or in the deep-seated parts. When
thrown out in the superficial parts, and especially in the lax and
yielding portions of the skin, the colour makes its appearance at once.
When the effusion is deeper seated, days may elapse before any dis-
colouration of the skin takes place, and then it is not blue, as in super-
ficial parts, but of a violet, greenish, or yellowish hue ; nor is it
always immediately over the eff'usion of blood.

The colour is not developed to its full extent at once ; but it con-
tinues to'deepen for five or six hours. When blood ceases to flow
from the broken vessels, serum is eff"used, and inflammation is set up,
and in this manner the extent of the bruise is iucreased. The colour of
the bruise also undergoes a change, and passes from deep blue through
shades of green, yellow, and lemon colour. After a further inten^al,
the effused fluids are absorbed, and the colours first fade and then
wholly disappear.

If the parts have received great injury, the inflammation runs on to
suppuration, and an abscess forms if the injury is deep, an ulcer if
superficial. The change of colour begins at the circumference of the
bruise, where the eff'used fluids are small in quantity, and travels in-
wards towards the centre, where the blood is in larger quantity, and
where the deep blue colour often remains after the rest of the bruise

CHARACTEKS OF CONTUSED WOUNDS. 257

has completely changed its appearance. In bruises of any extent, and
in those parts which contain much blood, coagula are formed.

The extent of the bruise, and the rapidity of the changes which it
undergoes, will depend on a variety of circumstances, such as the force
used, the size and character of the weapon, the age and constitution of
the sufferei-, the full or empty state of the vessels, and the tension or
laxity of the skin.

As the form of a bruise is mainly determined by the shape of the
weapon with which it is inflicted, it often furnishes of itself strong
presumptive evidence against an accused party. Thus Starkie, in his
* Law of Evidence,' instances an attempt at murder in which the
prosecutor, in his own defence, struck the assassin violently in the
face with the key of the house-door. The bruise which followed
corresponded precisely in shape to the wards of the key, and it was
chiefly through this very singukr and unexpected piece of evidence
that the assassin was afterwards identified and brought to trial. The
subjects of death by hanging, strangulation, and suffocation, furnish
familiar examples of the correspondence of bruises with the cause that
has produced them.

Though the seat of the discolourations which constitute a bi'uise, is,
as has been stated, the cellular membrane, it is not confined to this,
but involves more or less the substance of the true skin. Bruises are
thus distinguished from cadaveric lividity. (Seep. 213.) The amount
of injury, and consequent extent of bruise inflicted by a blow, will also
depend, as has just been stated, upon the condition of the parts involved
in the injury. A boxer in training Avould scarcely be marked by a
blow. which would disfigure a person in an ordinary state of health,
and in severe cases of scurvy the slightest touch will occasion a bruise
closely resembling that produced in healthy persons by greater degrees
of violence.

Blows, even when very severe, do not always produce marks of
injury on the surface. Thus blows on the abdomen, severe enough to
rupture the viscera, do not always bruise the skin, though they some-
times lead to the effusion of blood between the muscles. In order
that the appearance of a bruise may be produced, it is necessary
that there should be comparatively hard and unyielding parts beneath
the skin ; and, on the other hand, where we find severe injuries of the
hard parts, such as fractures of bones, without any trace of bruises on
the skin, we should be cautious how we attribute such injuries to the
blows.

Can the Appearance of a Bruise he 'produced after Death ?

This question is answered by the experiments of Dr. Christison.
from which it appears, that, up to two hours after death, and, in rare
cases, after three hours and a quarter, appearances may be produced
more or less closely resembling bruises inflicted during life ; blood is
effused into the cellular membrane, on the surface of the cutis, and
even into its substance ; and the blood thus effused is found to coagulate.

258 WOUNDS.

Means of dtstmjuishing Bniises inflicted during Life from those
inflicted after Death. — In certain cases this distinction is easy. If
there is much swelling, if there is any change of colour, or any sign of
inflammation, the bruise must have been inflicted during life.

If on cutting into the bruise, the effusion of blood is found to be
considerable, and the clots large, the presumption is strongly in favour
of the bruise having been inflicted during life. So also if the cutis is
discoloured from the effusion of blood into its texture. This is a
valuable diagnostic mark, except in the case of bruises inflicted within
a few minutes after death, when, judging from the analogy of incised
wounds, we may expect the same appearances as in those produced
during life.

The same cff'usion of blood, which, on the surface of the body, gives
rise to the appearance of a bruise, may occur in the internal parts as
the result of violence, and yet leave very slight traces on the surface,
or none at all ; and it is therefore important to ascertain whether such
effusions of blood in deep-seated parts may take place after death as
well as during life. This question may be safely answered in the
affirmative. In the body of Margery Campbell, the victim of Burke,
in addition to the signs of suffocation, described in the last chapter,
there were marks of severe injury to the back, to which Dr. Christison
was at first inclined to attribute her death. On examining the back,
blood in a semi-fluid state was found under the trapezius muscle, near
the inferior angle of the scapula, as also in the left lumbar region, but
there was no corresponding bruise on the integuments. Blood was
also found in the cervical and dorsal regions, especially in the former.
The ligaments connecting the vertebraj posteriorly were ruptured, but
there was no fracture. On the sheath of the spinal cord opposite to the
rupture, there was a mass of semi-fluid black blood, about the thickness
of a penny- piece, and one inch in diameter ; from this a thin layer of
the same kind of blood extended along the posterior surface of the
sheath, as far down as the lowest dorsal vertebrae. The spinal cord
was uninjured, and there was no blood under its sheath. Dr. Chris-
tison, by experiments on the dead body, was able to prove, that all
these marks of violence might be produced as much as seventeen hours
after death ; for he succeeded in producing them by bending the head
forcibly down upon the chest in a subject which was cold, and in which
all the joints were stiff. In the body of Carlo Ferrari, a similar
effusion of blood was discovered. Coagulated blood to the amount of
five or six ounces was found extravasated among the deep-seated
muscles of the neck, from the occiput to the last cervical vertebra. A
large quantity of fluid blood was also found both in the upper and
lower part of the spinal canal, exterior to the sheath of the cord.
There was no appearance of injury either to the vertebrae or their
ligaments; there was no blood within the sheath, and the cord was
healthy. The confession of the criminals themselves showed that these
injuries to the spine were produced after death. (Kefer to pp. 253-4.)

CHARACTERS OF INCISED WOUNDS. 259

The difficulty which in some cases exists in determining whether a
bruise was inflicted during life or soon after death, will be greatly in-
creased, it" the body we are called upon to examine is in a state of putre-
faction. For the effect of putrefaction is to exaggerate the appearances
of injury, and to produce alterations of consistence and colour, which
would make it very difficult indeed to answer this question satisfactorily.
It should also be borne in mind that when putrefaction sets in, the pres-
sure of the gases evolved in the putrefactive process on the large veins
of the body may cause copious outpourings of blood through ruptured
vessels. This was well shown in the body of a man who had died of
apoplexy. The veins of both arms had been opened, but no blood had
flowed during life. After death, however, an abundant outpouring of
blood took place from the wounded vessels.

In a case, however, which occurred at Paris, the effusion of blood
caused by strangulation was discovered as a black mass twenty years
after death. But the cord was found round the neck, and removed all
the difficulty which might otherwise have existed.

In respect to fractures the same observations apply, and in nearly
the same degree, as to contusions affecting the surface of the body.
There is every reason to believe, that a fracture produced within a
short period after death, and one produced during life, but speedily
followed by death, would present very nearly the same appearances.
A fracture produced some time before death would be readily distin-
guished by the inflammation set up about it.

Fractures, from the very nature of the parts injured, may be detected
long after death. Thus, in the body of Clarke, the victim of Eugene
Aram, the fracture and indentation of the temporal bone were plainly
distinguished on the exhumation of the skeleton after it had been buried
thirteen years.

2. CHARACTERS OP INCISED WOUNDS, AND THOSE ACCOMPANIED
WITH A SOLUTION OF CONTINUITY,

Under this head are comprised incised, punctured, and lacerated
wovinds. Gun-shot wounds will be treated of separately. It is to in-
cised wounds, as being of most frequent occurrence, that the following
observations chiefly apply.

The immediate and most obvious consequences of wounds with solu-
tion of continuity are haemorrhage, and retraction of the edges of the
wound: the more remote effect inflammation. In a recent incised
wound, inflicted during life, there is copious haemorrhage, the cellular
tissue is filled with blood, there are coagula between the lips of the
wound, and the edges are everted. After the lapse of from eighteen
to twenty-four hours there are the signs of inflammation, increased
redness, swelling, and effusion of coagulable lymph.

Copious haemorrhage affords of itself a strong presumption in favour
of a wound having been inflicted during life, especially if the body is

260 WOUNDS.

fresh. Scanty liaemorrhage, or the entire absence of it, as in the c^e
of Sir Edmun'dbury Godfrey (p. 248), supplies an equally strong reason
for attributing death to some other cause. Lacerated wounds, and
severe gun-shot wounds, however, form an exception to this rule. In
the well-known instance recorded by Cheselden of a man's arm torn off
by a windmill, and in a case more recently reported by Mr. Bransby
Cooper, there was little or no hemorrhage. On the other hand, a
very considerable amount of haemorrhage may take place after death,
and especially when putrefaction is set up, if any large vein happen to
be wounded.

In the case of incised, as of contused wounds, it is important to
determine whether the same appearances that exist in Avounds inflicted
during life may be produced after death.

Characters of Wounds produced after Death. — The experiments of
Orfila on the dog have shown, that the appearances proper to incised
wounds inflicted during life may be produced immediately after death ;
and the experiments of Dr. Alfred Taylor made on limbs recently
removed by amputation, show to what degree the resemblance may be
carried.

After ten minutes there was immediate considerable retraction of
the skin, with protrusion of the adipose substance, and the escape of a
small quantity of blood ; and after the lapse of twenty-four hours, the
edges were found red, bloody, and everted ; the skin somewhat flaccid ;
a small quantity of blood escaped on separating the edges ; no coagula
were found adhering to the muscles ; but at the bottom of the wound
there were several loose coagula readily broken down by the finger.

After the same interval of ten minutes a second experiment was
perfonned. In this instance the edges of the wound were but very
slightly evei'ted ; scarcely any blood escaped ; and twenty-four hours
afterwards the edges of the incision were pale and perfectly collapsed,
presenting none of the characters of a wound inflicted during life ;
and at the bottom of the wound there were a few coagula of blood.

Other experiments performed at a later period after the removal of
the limbs gave rise to appearances less distinctly marked. When the
wound was not made till two or three hours after the removal of the
limb, a small quantity of liquid blood was effused, and no clots were
found. The edges of an incised wound made twenty-four hours after
death were yielding, inelastic, in close approximation, and free from
any coagula of blood. Such are the characters of incised wounds inflicted
after death.

Lacerated wounds combine the characters of incised and contused
wounds, being accompanied with a less amount of ha;morrhage than
the foi-mer, and some degree of the discolouration attending the latter.
For these reasons the distinction between such wounds inflicted during
life and after death is less easily made.

Punctured wounds are intermediate between incised and lacerated
wounds, resembling the former when inflicted with a sharp instru-

CHARACTERS OF GUN-SHOT WOUNDS. 261

ment, and being accompanied by profuse haemorrhage ; but when made
with a blunt object, being more nearly allied to lacerated wounds, and
productive of but little loss of blood. Sword -wounds, traversing
the body, are marked by a large depressed orifice of entrance, and a
small and raised orifice of exit.

3. CHARACTERS OF GUN-SHOT WOUNDS.

Gun-shot wounds belong to the class of contused or lacerated
wounds ; of contused wounds when the shot does not penetrate, of
lacerated wounds when it enters or traverses the body. Such wounds,
as Wiseman observes, are " the most complicate sort of wounds ;" they
combine " contusion, attrition, and dilaceration " in a high degree ;
they occasion "all sorts of fractures;" they introduce extraneous
bodies ; and they give rise to haemorrhage, inflammation, erysipelas,
gangrene, and sphacelus. The lips of a gun-shot wound are " livid or
blackish ;" they become the seat of inflammation and swelling ; and
" blisters frequently rise about them," containing " matter of a fcetid
smell."

Gun-shot wounds produced by discharges close to the person are
" burnt by the flame," and they may contain particles of unconsumed
powder. If covered by clothes, the clothes also may be blackened oi-
burnt. As a general rule gun-shot wounds, unless they injure some
large vessel, do not give rise to much haemorrhage ; but the destruction
of parts occasioned by the sloughing and suppuration that follow upon
them often occasions profuse and fatal discharges of blood.

The bullet, shot, or wadding discharged from guns or pistols at
short distances sometimes lodge in the body ; in other cases they
traverse it. When they lodge in the body they often furnish very
conclusive evidence. The bullet may prove to have been cast in a
mould, or the wadding to be formed by printed paper or other ma-
terial, in the possession of the person who fired the shot. It may even
happen that the composition of the bullet, or the mode of making it, is
peculiar. In medico-legal cases, therefore, the contents of a gun-shot
wound should be carefully examined, and, if necessary, preserved. When
bullets discharged from fire-arms traverse the body, the apertures of
entrance and exit should be carefully examined. The aperture of
entrance is round and clean, that of exit less regular in shape and
jagged. On entering the body " the bullet forces the flesh in with it,
and the place by which it enters presently contracts closer ; but its
going out is more lax.'' The same difference of entrance and exit is
seen in the clothes covering the wounded part. Bullets which strike
the body obliquely produce a valvular wound.

Bullets which lodge in the body are often found to have been turned
out of their direct course by coming in contact with a bone, or other
firm resisting structure. Thus (to give examples occurring in the
practice of Richard Wiseman) a bullet which entered the cheek has

262 • wouKDS.

been cut out from the back of the neck ; a second, which entered the
outside of the small of the leg, was found on the inside of the thi^h
above the knee ; and a third, which entered the outside of the arm, was
cut out below the scapula. In some cases, the bullet has struck the
head or abdomen, and after traversing the half-circumference of the
part, has been found to be lodged, or to have passed out at, the opposite
point. But a bullet may not only be turned from its straight course
by encountering resistance, and being diverted into a less resisting
channel, but it may be split into two or more fragments by striking a
bone. These fragments may either traverse the body or lodge in it.
If they lodge, they may be found to have taken the same eccentric
course as the undivided bullet in the cases just cited : if they traverse
the body they may occasion more than one wound of exit resembling in
character wounds of exit caused by a single bullet.

When the bullet takes a direct course through the body (that is to
say, when it is not deflected) the character of the two apertures,
coupled "with the direction of the line which joins them, may furnish
important information as to the position of the body at the time the
wound was received. So also when a bullet, after traversing an
obstacle external to the body, such as wooden palings, or windows,
strikes a wall beyond, the line of flight, and spot from which the shot
was fired, may be readily determined.

Small shot discharged quite close to the body, and striking it at right
angles, may give rise to a round clean wound not easily distinguished
from one caused by a bullet ; but at the distance of a foot or more
the shot are found to scatter more or less, and to occasion an irregular
wound. At the distance of three feet the shot are so much scattered
that it is not possible to confound the injury with one caused by a
bullet. In this class of wounds, we may always expect some of the
shot to lodge in the body, and when fired close, or within a short dis-
tance, there will be the same marks of burning on the skin and
clothing.

Fire-arms loaded with wadding, and fired quite close to the body, or
within a few inches, may produce severe penetrating wounds, and
destroy life, and even at the distance of a foot may give rise to severe
and extensive superficial injuries. The unconsumed powder, when fire-
arms loaded only with powder are discharged close to the body, may
produce the same injuries as small shot.

From what has been said above of the complicated character of
gun-shot wounds, it is obvious that they are attended with great
danger to life. They may prove fatal, immediately, or within a short
interval, by shock or haemorrhage, and after a longer interval, by
secondary haemorrhage, by erysipelas, by tetanus, or by the inflamma-
tion and extensive suppuration following on the death of the injured
parts.

The usual medico-legal questions, such as the more or less danger-
ous character of the wound, the effect of the treatment adopted, and of

DETECTION OF SPOTS OF BLOOD. 268

the subsequent conduct of the wounded person, on the issue of the
injury, and the amount of locomotion possible after the injury, arise in
gun-shot as in other wounds.

The question whether the wound was the result of accident, suicide,
or homicide may also be raised respecting these in common with other
wounds. As a general rule, accidental wounds, whether inflicted by
the wounded person, in loading, or in the act of carrying a loaded piece,
or by another person pointing at him a piece supposed not to be
loaded, or walking or shooting in his company, have the characters of
wounds caused by discharges near the person ; but these characters
they have in common with suicidal wounds. But suicidal wounds
have the character which accidental wounds often, and homicidal
wounds, sometimes, lack of being inflicted in front on the head or
region of the heart. To this rule, however, some suicidal gun-shot
wounds form an exception, inasmuch as the weapon is directed to the
back of the head. As a general rule, too, the suicide fires only one
shot ; but to this rule, also, there are exceptions, for suicides have been
known to fire two pistols, and even to resort to flie-arms after the
failure of incised wounds. In some cases we are assisted by finding the
suicide in a I'oom secured from within, with the weapon still grasped
in the hand, and, when the priming was of powder, with the hand
stained by it.

Some advantage is occasionally derived from an examination of the
gun or pi?tol. In all cases where the combustion of the gunpowder is
imperfect, the finger introduced into the barrel is blackened by the
unconsumed charcoal ; and on examining the residue it is found to consist
of this unconsumed charcoal mixed with sulphuret of potassium. But
where the combustion is perfect the finger is not blackened, for the
residue is white and consists of the sulphate and carbonate of potash.
After an interval of some days, varying with the more or less amount
of moisture in the atmosphere, the mixed residue of charcoal and sul-
phuret of potassium becomes converted into sulphate of potash, which
after a still longer interval may be found blended with the rust of iron.

4. DETECTION OF SPOTS OF BLOOD.

The medical jurist may be required to examine red spots supposed
to be caused by blood on wearing apparel, on catting instruments, and
on wooden floors or furniture ; also, in some cases, to examine solu-
tions of blood in water. He may also be required to distinguish human
blood from the blood of animals.

Where spots of blood are recent, and the quantity of blood is con-
siderable, the appearances which they present are highly characteristic,
and there is no difficulty in obtaining a solution of a peculiar colour,
readily distinguished from all other red fluids by its chemical and
microscopical properties. But when the spots are not recent, and the
quantity of blood is inconsiderable, the work of identification is less easy.

®0

264 WOUNDS.

Blood is a compound fluid, consisting of fibrin, serum, and a colouring
matter known as hcematosine, which colouring matter is contained in

the circular discs or red corpuscles
figured in the annexed woodcut,
^ The fibrin coagulates spontane-

ously ; the serum is coagulated by
heat or acids ; the red corpuscles
are visible under the higher powers
<^ of the microscope ; and the colour-
[^^ ing matter has some peculiar and
characteristic chemical reactions.
Magnified 400 diameters. ^pj^e red corpuscles, or globules,

of the blood are seen under the
microscope as isolated discs, either a in plan, or b in profile ; or c aggre-
gated like piles of coin ; or d variously contracted and crimped by
the exudation of their contents.

The colouring matter of blood-stains is more or less completely dis-
solved out by cold water ; and the blood-solution thus obtained has a
vei-milion red colour. This colour is discharged, and the solution
changed to a dirty slate colour by boiling, at the same time that the
serum is coagulated, and thrown down. This coagulum, if collected,
dried, and boiled in liquor potasses is completely dissolved, forming
a dark-green solution. The blood-solution has also the characteristic
property of not being changed in colour by the addition of a small
quantity of liquor ammonia; . With infusion or tincture of galls the
blood-solution yields a red precipitate. These tests are quite chai"ac-
teristic. No other red solution has the same reactions. Those ob-^
tained from flowers and roots and the juices of fruits are changed to
green or violet by liquor ammoniae, and cochineal to crimson. The
solution of sulpho-cyanide of iron yields a precipitate of oxide of iron,
and is rendered colourless by zinc and sulphuric acid, and permanganate
of potash is changed from pink to blue ; and none of these colouring
matters are coagulated and changed by heat. Ked coloui-ing matters
due to the presence of salts of iron yield a dark-blue precipitate with
the infusion or tincture of galls.

Blood-stains on articles of dress may be recognized by their con-
sistence and colour, and more completely identified by microscopic
examination. A spot of blood not disturbed by contact or friction feels
like thick gum or starch. Small spots are circular, larger spots
approach the circular form, and large and small alike have a defined
and abrupt margin. Arterial blood has at first a rich red colour, and
venous blood a purple hue. Venous blood first grows brighter by ex-
posure to the air, but, after a time, in common with ai-terial blood,
assumes a venous tint. After the lapse of a few hours, the blood,
whether from an artery or vein, assumes a dusky blue colour, which
it retains without change for years. Blood-stains on white calico up-
wards of twenty years' old have undergone no perceptible change.

BLOOD-STAINS ON ARTICLES OF DEESS. 265

The colouring matter of these stains may be procured for examina-
tion in the following manner. The stained fragment of cloth is to be
cut out, placed in a test-tube with a small quantity of cold distilled
water, and shaken for a few minutes. A recent stain so treated may
yield a red, or reddish-brown solution, of a sufficient depth of colour
to give characteristic results with liq. ammouise and on boiling. But
older stains give up their colour very slowly and imperfectly, whether
suspended in distilled water, as usually recommended, or agitated with
water in a test-tube ; and the process is not much hastened by separat-
ing the fibres of the cloth. For these older stains, therefore, a different
process is required. The stain is to be moistened with a few drops of
distilled water, and scraped with a scalpel or sharp knife. To the
small quantity of coloured liquid thus obtained a drop or two of
glycerine or syrup is to be added. The resulting liquid, placed on a
glass slide and covered with a piece of microscopic glass, will be found
to contain the red corpuscles figured at p. 264, mixed with a few
fibres from the cloth. Stains on white calico upwards of twenty
years old have yielded highly characteristic results when treated m
this way.

Blood-stains on articles of linen or cotton may be shown to contain
animal matter by placing them in a reduction-tube, applying the flame
of a spirit-lamp, and exposing a moistened slip of turmeric paper to
the gases which issue from the tube. The presence of ammonia is
shown by the usual change of colour from yellow to brown. The
colour and appearance of the stain, confirmed by this test, leave no
room to doubt that the stain was^ caused by blood. This test is not
applicable to silken or woollen textures.

Another, and very ingenious, test for blood-stains has been suggested
and practised by my friend and colleague Professor Bloxam. It is
founded upon the well-known fact that coagulated albumen becomes
soluble in water at about the temperature of boiling oil (350"-* Fahr.).
The stain is introduced into a strong tube of green glass sealed at one
end, moistened by from half a drachm to a drachm of distilled water, and
secured by sealing the open end of the tube. The tube, so sealed at
either end as to bear strong pressure from within, is now placed in a
small iron saucepan containing oil, which is kept boiling for the space of
an hour, at the end of which time, the contents of the tube will be
found to have acquired a dirty slate colour, and the stain to have parted
with some of its colouring matter to the distilled water. The dis-
coloured water, on being tested with nitric acid, bichloride of mer-
cury, and ferrocyanidu of potassium, will yield the white precipitates
characteristic of the presence of albumen.

There is still another test for blood-stains recommended by Virchow
as " one of the surest tests " as. well as a most delicate one; and it is
one of which he has practical experience in medico-legal cases. It is
based on the production of minute crystals of Hcemine. The blood-
stain is to be covered with dry, crystalline, powdered common salt,

266

WOUNDS.

^^r

/

moistened with glacial acetic acid, and evaporated at a boiling heat.
'I'he dry residue contains crystals of haemine in large numbers. By
this method Virchow was able to pro-
•^'^' ^^" duce innumerable microscopic crystals

1 z from a blood-spot a line in dia-

I meter. These crystals are represented •
3^' in fig. 10. The larger ones (1) are
\//^ after Virchow, the smaller ones (2)
\ j) are copied from the result of an ex-
periment on aminute recent clot of

300 diameters. 150 diameters, sheep's blood. With blood-stains of
long standing this test fails, though
the stain on the glass is of a veiy characteristic colour.

Iron-moulds on linen have sometimes, as in a case lelated by Devergie,
been mistaken for spots of blood ; but the distinction is easily made.
Cold water dissolves out the colouring matter of blood more or less
quickly and completely ; but it does not affect the ii on-mould. Hydro-
chloric acid dissolves out the iron, which may be identified by its
characteristic tests.

Blood-stains on floors and furniture may be identified in the manner
just recommended. The stained portion of wood should be cut out,
moistened with distilled water and scraped ; or the small clot of blood
may be carefully detached and placed in distilled water.

Bloodstains on articles of steel and iron are readily identified when
they present themselves in the forai of clots on a clean bright surface
of metal. They are then of a clear red, or reddish-brown colour, are
easily detached, and scale off when the metal is exposed to a moderate
heat. The presence of animal matter in the spots is readily ascer-
tained by heating them with the spirit lamp in a reduction-tube.
Ammonia is given off, which is detected by its alkaline reaction on
turmeric paper. A small particle of blood-crust is sufficient for this
purpose. The crust placed in a iew drops of distilled water will, after
a time, yield a reddish-brown solution with the reactions already
described ; and if treated with syrup or glycerine, and placed under
the microscope, will be found to contain blood-globules.

If the blood is merely smeared upon the instrument it will not scale
off when heated ; but it will be necessary to moisten the stain with dis-
tilled water, and scrape it off carefully for examination by tests or the
microscope.

If the instrument has been for some time exposed to air and moisture,
spots of rust will be mixed with those of blood. In this case, too, the
stains are not detached by heat, and it will be necessary to scrape
them off, place them in distilled water, and separate the insoluble par-
ticles of rust by filtration. The resuUing coloured liquid will have the
chemical and microscopic characters of the blood solution.

Two other kinds of spots on articles of steel or irori have been
pointed out as liable to be mistaken for spot* of blood, namely, spots of

DIFFERENCE BETWEEN BLOOD OF MAN AND ANIMALS. 267

rust and spots produced by lemon-juice, vinegar, or other vegetable
acid.

Spots of Bust somewhat resemble blood-spots in colour, but they do
not scale off on the application of heat, and they are not solable in
water. If thick enough to be detached, they are readily separated by
filtration, leaving the water quite clear, and not atfected by the tests
for iron. A drop of hydrochloric acid placed on the spot of rust dis-
solves it, and leaves the metal clean, and on diluting the solution with
distilled v/ater, evidence of the existence of iron may be obtained by
appropriate tests.

Spots of Lemon-juice have b^n mistaken for those of blood. A
man, as in a case related by Orfila, was suspected of having murdered
another, and a knife, apparently covered with blood, was found in his
possession ; but on submitting the knife to examination, it was found
that the spots were due to citric acid. The instrument had been used
some days before for cutting a lemon, and had been put by w^ithout
being wiped.

The thinner spots produced in this way have a reddish-yellow
colour. The thicker spots have a reddish-brown colour, nearly re-
sembling that of blood, and they separate, like blood-spots, on the
application of a moderate heat. When heated in a tube they give off
a volatile matter, which has an acid reaction — spots of blood have an
alkaline reaction. The solution in distilled water is light yellow^- that
of blood is red ; it sometimes has an acid reaction — that of blood is
neutral, or faintly alkaline ; with infusion of galls it yields a black
precipitate, a blue with ferrocyanate of potash, and a rich cherry red
with the sulpho-cyanide of potassium. Blood yields a red precipitate
with the first test, and is unaffected by the others. The oxide of iron
is thrown down by alkalis.

Supposing it to be clearly made out that the stain we have been
examining is a blood-stain, two questions may arise: 1. Is it human
blood, or that of an animal ? 2. From what part of the body does the
blood flow ?

1. Difference between the blood of man and that of animals. — Two
means of diagnosis have been proposed, the one microscopic, the other
chemical.

Diagnosis by the microscope. — The only means of distinction under
the microscope is afforded by certain well-known differences in the shape
and size of the blood-corpuscles. The human blood-corpuscle, depicted
in fig. 9, p. 264, is a circular flattened disc ; and the blood corpuscle of
mammals, with a single unimportant exception, has the same form. The
only appreciable difference is in the size of the globules. In man they
measure on an average gJg^ of an inch ; in animals the diameters vary
from jJjjj to gj'gg. But these are only averages ; and the extreme
measurements which in man may be stated at ^uVo ^nd ^'^j, lie, in
some animals, still wider apart. When it is borne in mind that, in
most instances, we have to examine a blood-solution obtained from

268

WOUNDS.

dried blood, made to approximate to the average density of the blood
by the addition of syrup, glycerine, or a saline solution'; that the size
of the globules is materially affected by the density of the medium in
which they are seen ; and that in the blood itself the diameter of one
globule may be twice as great as that of ai\other, it is not to be ex-
pected that the most skilful and practised person should be able to
distinguish human blood from that of other mammals. But the
blood-corpuscles of birds, reptiles, and fishes differ so widely in size
and shape from those of man and animals, as to enable us to state
positively that the blood in a given case is either that of a mammal,
or belongs to one of the three classes of creatures just specified. The
differences of size and shape in the human blood (1), the blood of the
common fowl ; (2), the blood of the frog; (3), and the blood of a fish,
(4), are shown in the annexed engraving. The corpuscles are mag-
nified about four hundred diameters.

Fig. 11.

<^

(For some minute details of measurements in Mammalia, see 'Micro-
graphic Dictionary,' Art. Blood; also Plate 40.)

Chemical Diagnosis. — It was Barruel who first proposed to dis-
tinguish the blood of different animals by the characteristic odour
given off on the addition of sulphuric acid.

If sulphuric acid, diluted with half its bulk of water, is added to the
blood of an animal, an odour is instantly perceived which certainly
bears a close resemblance to the perspiration of the animal itself; and
it is probable that the majority of persons would recognize the odour if
informed of its existence. But it is certain that the majority would be
mistaken if asked to name the animal which had supplied the blood.

I make this statement as the result of experiments made with fresh
blood of different animals, in such quantity as one or two drac>.hms at a
time, in the class-room for several years in succession. The majority
have always been wrong in their guesses. At the same time it should
be stated, that, on one occasion, a member of my class was uniformly
right in his opinion of several specimens of blood, though the experi-
ment was so devised as to preclude mere guessing. As a means of
distinguishing spots of blood, or solutions obtained from them, this
test of odour must certainly be disallowed. It has also utterly failed
in the hands of very competent persons.

Source of the blood. — la some cases the spots of blood submitted for

QUESTIONS COMMON TO ALL WOUNDS. 269

examination are found blended with hair, skin, fragments of mucous
membrane, or epithelial cells ; or with other matters adhering to the
material upon which the blood has fallen. The discovery of such ad-
mixtures may often supply very important medico-legal information ;
but the subject is one of too great extent to be fully examined in this
place. Such examinations as these should always be intrusted to
persons having perfect knowledge of the microscope, and large experi-
ence in the use of the instrument.

5. THE QUESTIONS COMMON TO ALL FORMS OF MECHANICAL
INJURY.

There are three questions common to all forms of mechanical injury ;
namely, 1. Was the injury inflicted during life? 2. Was it the cause
of death? and 3. Was it accidental, suicidal, or homicidal ? The first
question has been already examined. The second and third questions
still remain to be discussed.

Was the Wound the cause of Death f — ^The answer to this question
i-arely presents any difficulty when a man in the enjoyment of perfect
health receives a severe injury, and dies soon after, before sufficient
time has elapsed for disease to set in, or neglect, or unskilful treatment
to prove injurious ; before, in fact, any event has supervened to com-
plicate the original question proposed. But when a considerable interval
elapses between the receipt of the injury and the fatal event, such com-
plications may arise, and render the answer to the question difficult.

The question — Was the wound the cause of death ? may have to be
decided in cases in which the fatal result follows soon after the receipt
of the injury, as well as in cases in which the death happens at ah in-
terval so remote as to admit of the supervention of extianeous causes.

To the first class of cases belong the abnormal formation of the parts
injured (as in the instance cited by Paris and Fonblanque, of the death
of a boy caught robbing an orchard, caused by a blow intended as a
simple chastisement on a skull preternaturally thin), and their ab-
normal situation (as in the familiar instances of an inguinal hernia,
injured by a kick ; of fatal haemorrhage caused by a blow on the loins
over the seat of a kidney containing a jagged calculus ; and of a large
abscess behind the ear ruptured by the same means).

To this class of cases also belong those sudden deaths which follow
falls or blows too slight to account for the fatal result by the direct
injury they occasion, death being really caused by the effusion of
blood upon the brain, or the rupture of an aneurism ; in both which
cases it is possible to atti-ibute the death to the excitement of the
struggle as well as to the fall or blow. Also those cases of latent
effusion on the brain or into the cavities of the chest which might
prove suddenly fatal even in the absence of violence, but which might
certainly cause death under the influence of excitement or shock.

270 WOUNDS.

In such cases as these the injury is inflicted in ignorance of the
existence of any cause by which that injuiy, though comparatively
slight, might be rendered mortal. To all other cases, such as those of
young, feeble, or aged persons, and pregnant women, the English law,
as laid down by Lord Hale, will apply : *' It is sufficient to prove
that the death of the party was accelerated by the malicious act of the
prisoner, although the foimer laboured under a. mortal disease at the
time of the accident."

The second class of cases, or those in which an interval elapses before
the wound proves mortal, comprises a greater number of special cases.
Before treating of these cases in detail, it is necessary to premise that
even when the interval between the injury and the fatal result is of
considerable duration, it may be quite possible to attribute the death
to the injury without any misgiving. The injury may be of such a
kind that no strength of constitution, and no exercise of care and skill,
could avert a fatal termination. In fractures or dislocations of the
spine, for instance, and in gun-shot wounds when the bullet lodges in
the body, however long the fatal result may be postponed, the death
is fairly attributable to the injury alone. But though, in cases of this
kind, no doubt can exist either respecting the true cause of death,
or the guilt attaching to the act of violence, the lapse of time has, in
most civilized countries, been taken into account, and by the common
law of England, if the injured party survive one year and one day,
the crime ceases to be murder, and English juries have sometimes
shown a disposition to shorten this period very considerably.

Within this long period of 366 days there is ample opportunity for
some of the circumstances now to be specified to come into play.

1. A trifling wound or injury may prove fatal, from the injured
part taking on an unhealthy character, such as scrofulous inflammation,
due to peculiarity of constitution, or from the supervention of some
disease not necessarily or usually resulting from it, such as eiysipelas.

2. To the same class of cases belong instances of fatal tetanus, or
of delirium tremens from slight injuries, as well as rare instances of
pyajmia from latent abscess brought into activity by a fall or blow, and
instances of fatal diseases of internal organs springing up independent
of the injury but soon after its occurrence.

3. Another circumstance bearing on the question, Was the wound
the cause of death ? is the improper management of the wounded party,
whether consisting in the neglect of medical assistance, or of medical
instructions, or in the resort to ignorant and unqualified practitioners,
or in irregularities, misgovemment, and reckless exposure to cold,
fatigue, or fiesh injury, or to intoxication, on the part of the patient
himself, or in mala praxis on the part of the medical attendant, being
a qualified practitioner.

Was the wound accidental, suicidal, or homicidal^ — Accidental
death is a common occurrence in crowds, and in wrestlings and
fights, when the deceased person falls, or is thrown or struck against,

NATURE OF THE WOUND. 271

hard resisting objects, in which case an examination of the spot on
which the party fell will help to determine the question.

There is always a probability of accident when a body is found in a
dangerous situation, as at the foot of a precipice, or in a river with
steep banks ; and the probability is increased when the deceased
person is proved to have been drinking previously. In all doubtful
cases the character of the injuries found on the body will go far to
detei'mine the class to which the death belongs. Bruises, fractures,
and dislocations, for instance, are more consistent with the theory of
death by accident than incised, punctured, or lacerated wounds.

If we suppose the alternative of accident to be excluded by the
nature of the case, the original question is narrowed to this, Was the
injury suicidal or homicidal ?

As suicides are much more common than homicides, there is always
a primd-facie probability in favour of suicide, especially in middle-
aged persons ; but this probability will be materially modified by such
considerations as, the place in which the body is found ; the nature,
situation, extent, and direction of the wound ; and the number of
wounds.

The Place where the Body is found. — If a corpse is found in a room
with the windows and doors fastened on the inside, the circumstances
are conclusive as to suicide. The absence of the instrument of death
would be conclusive as to murder. So also, if the blood from a
mortal wound has been washed from the body or floor, or the body
itself has been placed in a position inconsistent with the mode of
death, or covered, or buried.

The Nature of the Wound. — Contused wounds are rarely suicidal,
though attempts at self-destruction by knocking the head against the
wall are not uncommon. Severe contusions, therefore, are most pro-
bably homicidal, unless the body is lying near a height from which it
might have fallen accidentally, or from which the deceased might have
thrown himself. Incised wounds are as likely to be suicidal as homi-
cidal, and it is not often that the peculiarity of the wound affords us
any assistance in determining the class to which it ought to be re-
ferred. The cleanness and evenness of an incised wound have, indeed,
been mentioned as affording a probability in favour of homicide. It is
generally asserted, that a self-inflicted wound is likely to be jagged and
uneven ; but this assertion does not seem to be borne out by reason-
ing or by fact ; for a suicide who has made up his mind is less likely
to waver in his resolution than a man to remain still under the hands
of a murderer; and some of the deepest and cleanest wounds of the
throat are certainly suicidal.

But in some few instances the shape of an incised wound does afford
very important aid in determining the question of suicide or homicide,
by pointing out the kind of instrument with which the wound was
inflicted, and the occupation of the murderer. Thus, a man found
with his throat cut from within to without, as butchers slaughter

272 WOUNDS.

sheep, was found to have been murdered by a butcher. Orfila cites
the case of a murder traced to a butcher by the fact of the body being
found divided into two parts by a cutting instrument passed into the
fibro-cartilage uniting the third and fourth himbar vertebrae, and
dividing the articulating processes of the vertebraj transversely
through, as butchers ai'e accustomed to cut through the spines of
animals.

The Situation of the Wound. — It may be laid down as a general
rule, that if a wound is so situated that the instrument of death, when
placed in the hand of the deceased, cannot be made to reach it, whether
by the motion of the hand itself, or by that of the part injured, or by
both jointly, it was not self-inflicted. Wounds inflicted on concealed
y)arts of the person, as within the labia, and beneath the breast of the
female, are in all probability homicidal. It must, however, be borne
in mind that while murderers sometimes inflict injuries of a kind to
appear suicidal, many suicides are moved by very eccentric impulses.

The Extent of the Wound. — It has been thought that a suicide
would not have courage or strength to inflict a very extensive wound
upon himself; but eiq^erience is opposed to this view. Suicidal
wounds of the throat, for instance, are usually deep and extensive ;
and in newspaper accounts of cases of suicide nothing is more common
than to read of the head being nearly sevei-ed from the body. Super-
ficial wounds of the throat are, however, among the most common
forms of pretended suicide.

The Direction of the Wound. — Suicidal wounds generally pass from
left to right, and from above to below, such being the most natural
movement of the arm. In the case of left-handed persons, the direction
would be from right to left. Wounds of the throat, whether suicidal
or homicidal, are, however, generally transverse. When persons of
different statures fight together, it is natural to suppose, that a wound
inflicted by the taller man would pass from above downwards, and
the reverse if given by the shorter, supposing both combatants to be
in the erect posture. In wounds inflicted by a sword, or by fire-arms,
it is always important to notice both the direction of the wound, and
the orifices of entrance and exit.

The Number of Wounds. — The coexistence of several mortal wounds
affords a presumption against suicide, but only a presumption ; for
after inflicting on themselves wounds necessarily mortal, suicides have
retained strength and determination enough left to inflict others. Thus
Orfila relates the case of a gentleman at Rouen who was found dead in
his chamber, with two pistols lying in the room, one near the body .
the other on the bed, at some distance from it. The deceased had
shot himself in two places. One wound, apparently inflicted while he
was lying on the bed, had completely traversed the left side of the
chest, breaking a rib before and behind, perforating the lung through
its middle portion, and passing near to the roots of the pulmonary
veins. A very large quantity of blood was extravasated in the thorax.

IS THE WOUND DANGEROUS TO LIFE? 273

After inflicting on himself this serious injury, the deceased must have
risen from his bed, walked to a closet to procure another pistol, with
which he produced a second wound that must have proved instantly
mortal. Thi> ball had entered at the frontal bone, and, after tra-
versing the left hemisphere of the brain, had become lodged against
the OS occipitis. There was not the least doubt of this having been an
act of deliberate suicide.

Mr. Watson gives a case of suicide in which no less than ten wounds
were inflicted on the throat.

It is scarcely necessary to observe that most of the probabilities just
established are liable to lead to error if too implicitly relied upon.
In inquiring into the true manner of death in doubtful cases we have to
guard against false inferences from circumstances purely accidental as
well as from arrangements made to deceive us.

Nor will it always be safe to assume that a severe injury, actually
inflicted by another, is the real cause of death ; for as in a case
related by Wildberg, a death occurring during a chastisement may,
on examination, be found to have been due to poison.

The circumstantial evidence in death by wounds is of the first im-
portance. It has been already alluded to under the head of persons
found dead. Thus Sellis, a servant of the Duke of Cumberland, after-
wards King of Hanover, was found lying dead on his bed with his
throat cut, while his master was .under the care of Sir Everard Home
severely wounded in the head and hand. His Royal Highness stated
that he was roused from sleep by a blow on the head, followed by several
others, one of which caused an immense effusion of blood ; that he
leaped out of bed, and followed his assailant, who repeatedly struck at '
him, and would doubtless have murdered him, but that the doors pro-
tected his person from some of the blows. Every part of this statement
was confirmed by the circumstantial evidence. The coloured drapery
at the head of the duke's bed was sprinkled with blood ; there were
traces of blood on the passages and staircase, and on the doors of all
the state apartments ; and ISellis's coat was found hanging on a chair
out of reach of blood from his bed, but the sleeve was sprinkled from
the shoulder to the wrist " with blood, quite dry, and evidently from
a wounded artery."

When Lord William Russell, the victim of Courvoisier, was found
lying dead in his bed with his throat cut, the facts that the instrument
of death did not lie near the body, and that a napkin was placed over
the face, were in themselves conclusive as to the question of suicide or
homicide; and left no doubt whatever that he had been barbarously
murdered. Again, when a woman of the name of Norkott was found
dead in her bed with her throat cut, the fact that, on the left hand of
the deceased, there was a bloody mark of a left hand was conclusive
evidence of her having perished by the hand of another.

In addition to the questions already examined there are others
which may have to be considered. We may be asked whether a

T

274 WOUNDS.

given wound is dangerous to life, and of many wounds which was
mortal. Sometimes, too, it may be important to know how long the
wounded person survived the injury, and to fix the point of time at
which a wound was inflicted. These questions will now be briefly
discussed.

Ts the Wound dangerous to Life? — This question is easily answered
in the case of injuries to the large blood-vessels and important viscera
of the body, but less easily in the case of injuries which affect life
rather by their extent than by the importance ol the pai-ts implicated;
for while, on the one hand, slight injuries to parts altogether imim-
portant may, in peculiar states of constitution, prove fatal, on the
other hand, recovery may take place from injuries the most severe and
extensive, as was the case of Mr. Tipper, who was pinned against a
stable-door by the shaft of a gig traversing his chest.

The question of the danger attending wounds or injuries of the
several important parts of the body will be found discussed under the
next heading.

Of many Wounds which was mortal'? — It is easy to understand
how this question may become important in a medico-legal point of
view. A mortal struggle may begin with blows and end with the
use of a stabbing or cutting instrument, and the crime would have a
A'ei y different aspect, according as the death was attributable to the
blows or to the stabs or cuts. The question is of so general a nature
that it must suffice to indicate its importance.

How long did the wounded person survive'? — This question, too,
may evidently assume importance in a court of law, especially in con-
'nexion with the amount of exertion possible after severe injuries.
But the question, as one of detail, can be answered only as in the
next division.

■ When was the Wound inflicted ? — This question may arise either
during life or after death.

During life the question must be answered, in the case of contused
wounds, by the extent of the ecchymosis and the colours it assumes ;
in the cases of incised and punctured wounds, by the state of the
divided parts, whether they ai-e filled with exlravasated blood or
not; and whether the edges are swollen, and the surrounding skin
inflamed.

After death the question either resolves itself into the simple in-
quiry. How long has the deceased been dead ? or into the double question
of the date of the death and the length of time that the deceased sur-
vived the injury. The presence or absence of animal heat, of
cadaveric i-igidity and of putrefaction, and the progress which putre-
faction may have made, must be taken into account. These changes
in the condition of the dead body take place, as has been already
observed (p. 212), with very different degrees of rapidity in different
subjects ; so a? to oblige us to speak of the time occupied by them with
caution and reserve.

WOUNDS OF THE HEAD. 275

6. OF WOUNDS AS THEY AFFECT THE SEVERAL PARTS OF
THE BODY.

Some of the questions which have been merely indicated as im-
portant in the previous division, will he examined in detail in this.

Wounds of the Head. — Injuries to the saalp are of more import-
ance than those of the integuments of other parts of the body, partly
on account of the peculiar tendency of the skin itself to take on the
erysipelatous inflammation, partly from the quantity of loose areolar
tissue which intervenes between the tendon of the occipito frontalis
and the periosteum, and which is very liable to become the seat of
diffuse inflammation ; and partly from the relation of the tendon to
this lax tissue, preventing, as it does, the escape of the effused pro-
ducts. Punctured wounds of the scalp are dangerous on account of
the inflammation which they set up in this tissue, and the want of
free exit for the discharges. Contused wounds are also dangerous for
the same reasons. On the other hand, extensive lacerated wounds
which do not involve the periosteum are rarely productive of serious
consequences, inasmuch as they afford free passage to the products of
inflammation.

Fractures of the Skull are not more important than those of other
bones, unless they are accompanied by injury to the brain or its mem-
branes. But in this case, as in that of wounds of the scalp, a slight
injury may lead to fatal consequences, while complete recovery may
take place after very extensive injury. The force that occasions the
fracture may, at the same time, produce concussion, or other injury to
the brain. It is important also to understand, that a blow does not
always fracture the bone on which it alights, but that it may produce
a counter fracture at an opposite part of the skull. A severe blow on
the vertex of the head, for instance, will often occasion a fracture at
the base of the skull, especially when applied at once to a large surface,
as in a fall from a height.

,> In forming an estimate of the danger attending fractures of the
•skull, it is necessary to bear in mind the different thickness of its
several parts. Thus, a blow on the temple would be productive of
greater injury than one of equal force applied to other parts of the
cranium. The orbitar plate is another part which by its extreme
thinness exposes the brain to serious injury from thrusts with pointed
instruments. The cribriform plate of the ethmoid bone again would
be easily fractured, and the base of the brain be readily injured by a
sharp-pointed instrument thrust up the nostril.

Injuries of the Brain itself will have to be considered under the
distinct heads of concussion, compression, wounds, and inflammation.

Concussion of the Brain. — This is a common effect of severe blows
or violent shocks. The symptoms often follow immediately on the
accident, and death takes place without reaction, or any improvement

276 WOUNDS.

from the usual remedial means. In other cases the sj'mptoms of con -
cusslon and compression are combined, and in others, again, concussion
is followed by compression or inflammation.

Several cases of death by concussion are on record in which no lesion
of the brain could be discovered. Thus, Mr. Tiavers, in his work on
* Constitutional Irritation,' gives the case of a prize-fighter who was
taken off the ground insensible, and apparently apoplectic, and died in
eight hours ; yet no lesion or extravasation could be discovered on
careful inspection of the brain.

The interval which elapses between the receipt of this form of
injuiy, and the fatal termination is veiy various. It may prove fatal,
as in the case just quoted, in a few hours, or after the lapse of several
days, weeks, or even months. Thus Richard Wiseman, in his chapter
on Wounds of the Head, gives the case of a lady who received a blow
on the head while riding under a pent-house. The blow stunned her,
and she died after many months of suffering from the injury with
symptoms pointing to abscess of the brain.

It is a remarkable circumstance connected with this class of injuries,
that the patient sometimes seems to suffer little or no immediate incon-
venience ; but, after the lapse of some days, is seized with symptoms of
compression or of inflammation of the brain. Thus, Mr. Pott gires
the case of a woman who received an injury on the head, and remained
well for twelve days. She then fell ill, and died with symptoms of
compression of the brain. The ventricles were found to contain bloody
serum, and a small coagulum of blood. And Abercrombie gives the
case of a girl, aged thirteen, who fell from a swing, and struck her
head violently against the ground. For six weeks after the accident
she complained of headache, but was not otherwise ill. Feverish
symptoms then came on, followed by slight delirium and <;oma,
and she died two months alter the fall. The ventricles were
found distended with serous fluid, without any other morbid
appearance.

Compression of the Brain. — This may be caused by depressed bone,
or by the effusion of blood or serum. The symptoms come on suddenly
or gradually, according to the nature of the compressing cause, and
the fatal result follows in varying intervals of time. In cases of com-
pression produced by depressed bone, the cause of death is obvious,
and can give rise to little difficulty ; but when it arises from effusion
of blood or serum following an injury, it is easy to allege that the
effusion and consequent fatal result were due, not to the injury itself,
but to some concomitant circumstance. Thus, if in the course of a
struggle a man is thrown down or struck, and dies soon after, with
symptoms of compression, and it appears that an effusion of blood has
taken place, the effusion may be attributed to the excitement of the
contest, and not to the injury itself; and the question will be even
more difficult if the deceased was given to habits of intoxication, or
was of a plethoric habit, and apoplectic make, or of an advanced age.

WOUNDS OF THE BRAIN. 277

The inquiry will be still more difficult, if on dissection the vessels of
the brain are found in a diseased state ; but as effusion of blood rarely
takes place on the surface of the brain from disease, the difficulty will
only attach to effusions of blood at the base, in the ventricles, or into
the substance of the organ.

Wounds of the Brain. — This class of injuries presents considerable
difficulty in a medico-legal point of view — a difficulty which cannot be
better set forth than in the words of Richard Wiseman. He says that
" the greater symptoms that are usually said to attend the wounds of
the brain do show themselves more uncertainly than a speculative
chirurgeon would imagine ; and in cuts and wounds made by sharp
weapons or sudden strong force, more uncertainly than in contusions,
concussions, and depressions of the skull ; the highest of them,
viz., vomiting, stupor, loss of spirits, with a paralysis of legs and arms,
arising more suddenly in these latter cases than in the former."
" Nay, we see many die suddenly from a box on the ear, and from
small blows or wounds. In some whereof, upon opening the cranium,
there hath been much blood extravasated : in others none at all, or
aught else that may be thought to have killed the patient." " Others
I have been called on to see opened, when there had pi eceded only a
contusion of the calvaria, without any fissure, or more extravasated
blood than is usually seen in every opening on taking off the cranium :
yet the patient lay, as I am informed, under all those symptoms of
delirium, coma, &c. Then, again, I have drest many that had been
cut through the skull, the shivers of bones lying pasht with the flesh
and hair upon the dura mater : yet the patient hath been without any
symptoms of such a wound ; which I suppose happened by reason of
the bones lying loose upon the membrane."

Of severe symptoms speedily supervening from a slight injury the
following is an example. A young man received a blow on the fore-
head from a cudgel, soon took to his bed and became delirious : a
sopor followed, and after some days he died. A small hair-like fissure
was found running from the great canthus of the eye upward. On
removing the skull and dura mater but little blood was found extra-
vasated, and the pia mater little altered. Of comparatively slight
symptoms following very severe injuries, the following is an example
of the opposite kind from the same author : A soldier was shot in the
face by a case-shot, and had *' his face, with his eyes, nose, mouth,
and forepart of the jaws, with the chin shot away, and the remaining
parts of them driven in. One part of the jaw hung down by his
throat, and the other part pushed into it. I saw the brain working
out underneath the lacerated scalp on both sides between his eyes and
bix)ws." Yet this man, after being carried off as dead, was found next
morning knocking against the door of the r;jom in which he had been
placed, and was seen standing by the door. He was quite sensible,
implored help by signs, and assisted himself to drink. His
wounds were dressed, and he remained under Wiseman's care six or

278 WOUNDS.

seven days, beincj left alive at the end of that time. An equally re-
markable case, illustrating the power of locomotion that may remain
after very severe iiij ii'ies of the brain, is related in the voyages of the
great French surgeon, Ambrose Pare. ** A soldier in my presence
gave to one of his fellows a stroke with an halbard upon the head,
penetrating even to the left ventricle of the brain, without falling to
the ground." After being dressed by Pare " he letumed all alone to
his lodgings, which was at least 200 paces distant." The third day
he came staggering to Pare"s tent to be dressed, but died under his
hands in a convulsion. Pard says : " I have recited this history as a
monstrous thing, that the soldier fell not to the ground when he
had received this great stroke, and was in good senses even till
ileath."

Other remarkable cases of the same kind are to be found in the works
both of Pare' and Wiseman. Many modern cases might also be cited,
but the following will suffice. Thomas Fothergill was charged before
Mr. Justice Willes at Newcastle with the wilful murder of John Smith.
The prisoner struck the deceased on the head with a pickaxe. The
blow knocked him down, and then the prisoner struck him again with
the pickaxe on the body. The deceased was lifted up by a fellow-
workman, and after a time was able to walk to his lodgings, from
which he was conducted to the Newcastle Infirmary, where he died
ten days afterwards of the injuries he had received. On examination
it appeared that he had received a wound on the temporal bone, which
had driven it in and had lacerated the brain ; and the spleen was also
found to be torn by external injury. Either injury was sufficient to
cause death.

Inflammation of the Brain. — Inflammation of the brain may follow
upon injuries, not only to the organ itself, but to the scalp, and the
parts most nearly connected with the brain, such as the orbit and ear.
The severity of the inflammation is not always proportioned to the
injury received. A slight injury may give rise to very severe inflam-
mation, a severe injury to very slight effects. The period at which
inflammation sets in is also very variable. As a general rule, it does
not follow directly upon the injury, but several hours, some days, or
even weeks may elapse before it takes jjlace.

Injuries of the head, then, have this peculiarity, that at first they
often appear of little consequence, but after a considerable interval
dangerous symptoms may arise and prove fatal. Railway accidents
have more than once given rise to difficult questions relating to this
class of injuries. The symptoms of injury to the nervous system have
not shown themselves at once, but the following day, or after a still
longer interval, and much difficulty has been experienced by the jury
in awarding damages, in consequence of conflictiug medical opinions.
In the interval which elapses between the receipt of the injury and the
accession of dangerous symptoms, there is always room for neglect or
mismanagement, on the part of the patient, his friends, or the medical

WOUNDS OF THE THROAT. 279

attendant, which may materially affect the question, — Was the injury
the cause of death ? This question, therefore, has a peculiar application
to injuries of the head.

Injuries to the Spinal Cord. — The spinal cord, like the brain itself,
is subject to concussion ; to compression, from effusion of blood on its
surface or in its substance ; and to wounds from fractured vertebra^.
Concussion and compression may follow severe shocks, as in railway
accidents ; the more severe injuries arise from falls or blows, or
sudden twisting movements of the neck. Injuries to the substance of
the cord generally prove fatal, the interval varying according to the
degree of violence used and the part of the spine which has been
Avounded. Serious injury to the upper part of the cord proves imme-
diately or speedily fatal by paralyzing the muscles of respiration ;
injuries to the cord opposite the lower cervical vertebrai (the
fourth, fifth, sixth, and seventh) prove fatal in from four or five
hours to as many weeks or months : in rare instances not till the
lapse of years. In the case of John Carter of Coggeshill in Essex,
displacement of the last three vertebrae with pressure on the cord
opposite the seventh vertebra, did not prove fatal for fourteen
years. When the cord is injured in the dorsal or lumbar region
there is loss of power and sensation in the parts below the seat of
injury with retention of urine and loss of power in the sphincter
ani, requiiing constant medical aid and careful nursing. With these
aids life may be prolonged for years. Many injuries to the brain
principally affect its base, and by- causing pressure on the medulla
oblongata impair the functions of the nerves supplying the muscles
of respiration*

Wounds of the Face. — These injuries obviously produce great dis-
figurement, and, in consequence of the large distribution of important
nerves over the face, still more grave inconvenience. From the near
proximity of the principal features to the brain, there is also a risk of
injury to that organ, as well as of inflammation extending from the
seat of the wound. In this respect the wounds of the integuments of
the face rank next in importance to those affecting the scalp.

Wounds of the Throat. — These injuries are important from their
frequency. They are the chosen mode of death with a gieat majority
of suicides, and sometimes a murderer inflicts a wound on the same
part in the hope that his victim will be supposed to have committed
suicide. The degree of danger depends upon the position and the parts
implicated. Wounds of the anterior part of the throat are less dan-
gerous than those of the side of the neck ; those of the lower part of
the throat, less so than those of the upper part. A division of the
carotid artery is almost necessarily fatal, and that of the internal

* For a group of cases of injury to the cervical portion of the spinal cord-
consult 'lancet,' July 19, 1856, p. 85. See also 'On Concussion of the Spine,'
a clinical lecture by Mr. Skey, ' Lancet,' Jan. 10, 1857.

280 WOUNDS.

jugular vein is attended with great danger from haemorrhage, and from
the introduction of air into the circulation as well as from the risk of
phlebitis. Wounds of the larynx or trachea are attended with com-
paratively little danger, and those of the trachea are less important than
those of the larynx.

The question, Was the woimd the cause of death ? is easily answered,
but the question, Was the wound suicidal or homicidal? is less easy
of solution. There is also a question of considerable interest relating
to wounds of the throat, namely, What amount of voluntary motion is
possible after the receipt of a severe wound ?

The questions of suicide or homicide, and of the amount of voluntary
motion possible after a severe wound in the throat, were raised in the
case of Captain Wright, who shared the captivity of Sir Sidney Smith
in France, and his celebrated escape from the Temple, and who had
the misfortune to be taken a second time and imprisoned in the same
place. He was found dead in his bed with his throat cut, and the
razor closed in his right hand. There was an extensive transverse
wound on the anterior and superior parts of the throat, above the
bone of the windpipe, cutting through the skin, the muscles, the
windpipe, the oesophagus, and the blood-vessels, and penetrating to the
cervical vertebrae.

The circumstances of the case are involved in so much mystery that
it is impossible to determine by the evidence collected with great pains
by Sir Sidney Smith, whether Wright really committed suicide or not.
But it is easy to show that the mere fact of the deceased being found
with the razor closed in his hand does not militate very strongly against
the supposition of suicide ; for, in the case of the suicide of a military
officer, which occurred in September, 1838, the head was found
nearly severed from the body, and there was no room to doubt the fact
of suicide, yet the razor did not fall from the hand, but was placed
upon the dressing-table. In a more recent case, a madman, after in-
flicting a severe wound on his throat had time to struggle with the
maid-servant before he fell down dead. In October, 1833, a man cut
his throat with a razor while walking along Oxford Street. He
divided the carotid artery and several of its branches, the jugular
vein of one side, and the trachea; yet after inflicting the wound he
was seen to hold a handkerchief to his neck, and run forwards. He
fell dead on the pavement, about four yards fiom the spot where
he wouuded himself. The razor was found firmly grasped in his
hand.

In the remarkable case of Mary Green, who was murdered in 1832
by John Danks, the confession of the culprit, and the circumstantial
evidence coincided to prove that, after a wound which divided the
trunk of the carotid artery, and all the principal branches of the ex-
terrial carotid, with the jugulars, the female must have risen from the
ground, run a distance of twenty-three yards, and climbed over a low
gate. Fjom actual trial it appeared that it must have taken at least

WOUNDS OP THE LUNGS AND HEART. 281

from fifteea to twenty seconds to run from the spot on which the
murder was committei to that on which the body was found.*

Wounds of the Chest. — Incised wounds of the parietes of the chest
are not attended with any peculiar danger, but severe contused wounds
by causing fracture of the bones, and consequent injury of the internal
parts, often prove fatal. The fatal result is due either to extensive
rupture of the viscera, to haemorrhage, or to inflammation. Severe
contusions of the chest may also terminate fatally by the shock which
they occasion. This class ot' injuries is of common occurrence in prize-
fights, in falls from great heights, and from heavy objects crushing the
chest. Peneti-atiug wounds of the chest are dangerous, inasmuch as
they can scarcely fail to injure some important organ, occasionmg
thereby fatal haemorrhage or severe subsequent inflammation ; but
cases are recorded of sword and gun-shot wounds traversing the chest,
and yet occasioning no bad symptoms, and terminating favourably ; and
the majority of cases of injury to the chest which were under Wise-
man's care after the battle of Dunbar seem to have recovered.

Wounds of the Lungs. — Haemorrhage is the immediate consequence
of this class of injuries. The blood may be discharged by the wound,
or by expectoration, or it may accumulate in the cavity of the pleura,
causing great ditficulty of breathing. When the large vessels are
wounded the haemorrhage is copious and speedily fatal. An injury to
the substance of the lung itself is not necessarily fatal, for patients
have recovered after removal of a portion of the lung, and, in rare
instances, foreign bodies, such as bullets, have remained in the lung
for years, and have been inclosed in a cyst. Inflammation is a
common consequence of wounds of the lung, especially when a foreign
substance has been forced into the wound, as happens in injuries with
fire-arms. Cases of wounds of the lungs require careful management,
and long-continued rest, as without it injuries which have been re-
paired may be reproduced. Emphysema is a familiar effect of this
class of wounds. When judiciously treated it does not materially
increase the danger.

Wounds of the Heart. — Penetrating wounds of the heart are neces-
sarily speedily fatal from haemorrhage, unless they pass so obliquely
through the parietes that the flap aces like a valve, or a foreign body
happen to plug the oriflce. Death may be delayed, in these cases,
for some hours, or even days. The rapidity with which death takes
place will depend upon the situation of the wound. Thus wounds of
the base will pi'ove more speedily fatal than those of the apex, and
superficial wounds dividing the vessels of the heart less promptly than
those which penetrate its cavities. John Bell gives the case of a
soldier, in whom the apex of the heart was cut with the point of a
very long and slender sword, and this soldier lived twelve hours, during
which time, as appeared after his death, the heart had, at every stroke,

* See the case more at length in Dr. Taylor's ' Elements of Medical Juris-
prudence/ p. 442,

282 WOUNDS.

been losing a small quantity of blood, till, in twelve hours, it entirely
filled the chest, and the patient was suffocated and died. Another man
was wounded with a sword, the point of which cut the coronary artery,
which threw out its blood so slowly, that it was two hours before the
pericardium filled with blood, and then, after gi-eat anxiety, the patient
died.* In very rare instances, when the wound does not prove fatal
by hemorrhage, complete recovery has taken place. A case, for
instance, is related by Fournier, and authenticated by M. Mansen,
chief surgeon to the hospital at Orleans, of a patient, who not only
survived a wound of the heart, but may be said to have made a
perfect recovery from it, inasmuch as he died at the distance of six
years after the receipt of the injury, from disease unconnected with it,
and the ball was found embedded in the heart. MM. Ollivier and
Sanson have collected a number of cases of penetrating wounds of the
heart, with a view of determining the probable period at which these
injuries prove fatal. Out of twenty-nine cases of wounds of the
cavities of the heart only two proved fatal within forty-eight hours.
In the remaining cases, death took place in periods varying from four
to twenty-eight days.f

Wounds of the Aorta ayid Pulmonary Artery are necessarily fatal ;
but patients have been known to live a few days after small punctured
wounds even of the aorta.

Wounds of the (Esophagus and Thoracic Duct. — Such injuries are
necessarily rare from the great depth at which these parts lie. They
would be dangerous from the extravasation of their contents. Orfila,
however, mentions a case of recovery from a bayonet-wound of the
oesophagus.

Wounds of the Diaphragm. — Punctured wounds of the diaphragm
itself do not appear to be attended with great danger, but they are
rarely uncombined with injury to the parts above or below. Hernia of
the stomach has sometimes followed these injuries, and proved fatal.
Kupture of the diaphragm from severe blows or falls is not an un-
common occurrence. In the majority of cases the rupture is attended
by a fatal shock to the nervous system, and death is immediate.
In other instances it takes place after a longer interval, from the
protrusion of the viscera of the abdomen into the chest, and the
consequent disturbance of the functions of the organs contained in
one or both of those cavities.

Wounds of the Abdomen. — Wounds of the panetes' of the abdomen
may be attended with serious consequences. Death may take place in
incised wounds from a division of the epigastric artery. As in the
scalp, so here, there is additional danger from wounds of the tendons of
the muscles, and the consequent accumulation of matter beneath them.
Ventral hernia is a remote consequence of wounds of the parietes of
the abdomen. Contusions of the abdomen are generally attended with

* ' Principles of Surgery,' vol. i. p. 468.

t ' Diet, des Sciences M^dicales," art. Cos rarex.

WOUNDS OF THE VISCERA. 283

serious consequences. Sudden death from shock, haemorrhage from
rupture of the viscera, and inflammation, are the chief causes of death.
The liver and spleen are the organs most liable to suffer injury, and
rupture of their substance is not uncommon.

Wounds of the Liver. — Penetrating wounds of this organ, when
they extend to any depth, are apt to prove fatal by dividing some of
the large vessels. In other cases the danger arises from inflammation
of the organ. Wounds of the gall-bladder prove fatal by causing
effusion of bile, and consequent peritonaBal inflammation.

Wounds of the Spleen. — Deep wounds are fatal by haemorrhage ;
but recovery may take place from superficial wounds. Rupture of the
spleen from blows on the belly are not uncommon. They prove fatal,
according to the amount of injury in from a few hours to several days.
In a convalescent patient, a kick over an enlarged and extremely soft
spleen caused the effusion of several ounces of blood, and death in a
few minutes. (Dr. Robert Williams, ' Elements of Medicine,' vol. ii.
p. 470.)

Wounds of the Stomach. — These prove fatal by the shock to the
nervous system, by ha;morrhage, if the large vessels are divided, by the
extravasation of the contents and consequent peritonaeal inflammation,
and by inflammation of the viscus itself. Wounds of the stomach,
however, are not necessarily fatal, and many cases of recovery are
recorded, even when the wound was extensive, and the stomach dis-
tended with food at the time of the injury.

Wounds of the Intestines. — These injuries may prove fatal in the
same way as those of the stomach, viz., by haemorrhage, by effusion
of their contents, and consequent peritonaeal inflammation, or by
inflammation of the part itself. The danger is greater in the small
than in the large intestines, in consequence of tlie more fluid state
of their contents, and the greater risk of extravasation. For the
same reason, wounds of the duodenum are more dangerous than those
of the other small intestines. In the absence of extravasation, there
is a fair chance of recoveiy from wounds of the intestines by the
effusion and organization of coagulable lymph about the edges of
the incision.

Wounds of the Kidneys. — The kidneys are chiefly exposed to
injury from blows and stabs in the loins. Penetrating wounds of
these organs may prove fatal, in consequence of haemorrhage, ex-
travasation of urine, or inflammation. If means are taken to pre-
vent the urine from being effused into the peritonaeal cavity, recovery
may take place.

Wounds of the Bladder are chiefly dangerous from extravasation
of urine, which is, of couise, most apt to occur when the organ is
distended. In the absence of effusion they may prove fatal by the
inflammation to which they lead. Rupture of the bladder, though
ultimately fatal, does not destroy life rapidly; and the accident 'does
not immediately prevent the patient from walking about.

284 WOUNDS.

Wounds of the Genital Organs. — A removal of the penis, if not
fatal by haemorrhage, is not dangei'ous ; but an incised wound of the
urethra entails the risk of extravasation of urine into the cellular
membrane and fatal sloughing. The removal of the testicles is attended
with less danger than a contusion. This latter injury sometimes proves
fatal by the shock to the nervous system. Wounds of the spermatic
cord occasion dangerous haemorrhage. The complete removal of all the
parts of generation of the male has in many instances led to no bad
result. Deep wounds of the labia of the female are dangerous from
haemorrhage. Fatal injuries have been indicted on the uterus, bladder,
or rectum, or on the large vessels of the pelvis, by instruments intro-
duced into the vagina.

Consult Mr. Watson's * Medico-legal Treatise on Homicide.'

285

CHAPTER IV.

DEATH BY FIRE — SPONTANEOUS COMBUSTION — DEATH BY
LIGHTNING — BY COLD — BY STARVATION.

DEATH BY FIRE.

On the average of the five years 1852-56, no less than 2,623 deaths in
Englfind and Wales were attributed to the agency of heat. Of this
number 483 were burns, of which 436 by clothes catching fire, 15 by
conflagrations, 24 by gunpowder and fireworks, and 7 by explosive
gases. 1,548 deaths from the same causes were less accurately de-
fined, 46 deaths were caused by drinking hot water; and 541 death
by scalding liquids. In the whole five years 2 suicides, 1 murder, and
4 manslaughters were attributed to burning, and 2 manslaughters to
scalds.

The medico-legal questions that arise in reference to death by fire are
similar to those relating to other forms of external injury, except that
the alternatives of suicide and homicide very rarely present themselves.
The great majority of deaths by fire are accidental. In accidental
cases, and in the few cases of suicide and murder, the burning would
leave marks on the body showing that it was inflicted during life ; but
as it is known that the burning of the body after death is sometimes
resorted to by a murderer to conceal the real cause and mode of death,
it may be of the utmost importance to distinguish burns inflicted
during life from burns inflicted after death. Another medico-legal
question may arise when a body is found with marks of injury by
burning too extensive to be readily accounted for by the quantity
of fuel consumed. It may become a question whether the body so
injured was unusually combustible, or whether it might not even be
the subject of " spontaneous combustion," This second question will
be separately examined. The first question will be now considered.

Distinction between burns inflicted during life and after death. — We
owe the earliest experiments on this subject to Dr. Christison. But
the results which he arrived at have been somewhat modified by sub-
sequent experimental inquiries in France and Germany, but especially
by those of Champouillon and Chambert. The last-named author
seems to have exhausted the subject both by the number and accuracy
of his experiments, and we shall therefore adopt the conclusions at

286 DEATH BY FIRE.

which he has arrived, with some modifications suggested by the more
(^rtain of the results of the earlier writeis.

Bums inflicted during life by bodies not so highly heated as to char
and destroy the tissues, produce two characteristic appearances — redness
and vesication. The redness, more or less intense -according to the
temperature and the length of its application, affects the surface and
entire substance of the true skin, which is dotted by the deep led
openings of the sudoriferous and sebaceous ducts ; and it also extends
to the subcutaneous tissues. Blisters, more or less numeious and
extensive, also make their appearance under a temperature below that
of boiling water, and contain serum, which either coagulates in mass,
or yields an enormous piecipitate of albumen when heated, or treated
with nitric acid. The albumen is more abundant when wholly due to
vital action than when the burn, being inflicted at the point of death,
the vesicle forms after life is extinct. These appearances belong
equally to burns made at the point of death and to those made twenty
hours previously, but vesicles, though generally present, are sometimes
absent in burns whatever the period at which they were inflicted.

On the other hand, in burns inflicted after death, the surface and
substance of the true skin are of a dull white colour, dotted with grey
at the openings of the sudoriferous and sebaceous ducts, and the sub-
cutaneous tissues are uninjected. No vesicles aie produced by a tem-
perature below the boiling point ; and those occasioned by a higher
temperature either contain no fluid, or one which, as it contains little
albumen, merely becomes opaline or milky when treated by heat or
nitric acid. Po.st-mortem vesicles are most readily produced in ana-
sarcous suVvjects.

The appearances just described as caused by burns inflicted during
life, show themselves in all health^ subjects, and probably iu the large
majority of sick persons ; but the case of a consumptive patient re-
ported by M. Bouchut, shows that the application of heat to the skin
of a dying man may produce as little effect upon it as upon a corpse.*

It should be understood that the appearances just described as due to
the application of heat to the living body are common to all the more
intense inflammations of the skin, however produced ; to the application
of cantharides and other strong stimulants, to pressure and friction, and
even to idiopathic inflammations of the skin. I have seen, on the
ankles of a young man who had died of acute phthisis, two patches of
inflammation of a deep led colour not removable by pressure, and with
well-defined margins, on one of which were large vesicles containing
serum. In this case, I ascertained beyond doubt that the spots, which
had been observed during life, were not caused by the application of
any heated body. In all these cases of acute cutaneous inflammation,
a thin vertical section of the inflamed skin and underlying tissues
displays, even to the naked eye, distinct red patches, contrasting very

* This case is quoted by Chambert in an elaborate paper in the ' Annales
d' Hygiene,' April, 1859, to which the reader is referred.

SPONTANEOUS COMBUSTION. 287

strikingly with similar sections of skin discoloured by the mere sub-
sidence of the blood.

It is scarcely necessary to add that redness follows instantly on the
application of heat, and that vesicles show themselves after the interval
of a few seconds.

SPONTANEOUS COMBUSTION.

The following case, which rests on the authority of Le Cat, a firm
believer in the doctrine of spontaneous combustion, forms a fitting in-
troduction to this subject. It is said to have taken place in 1725.

A man of the name of Millet, living at Rheims, was charged with
the murder of his wife. It appears that the body of the deceased
was found lying in the kitchen of the house at a short distance from
the hearth, entirely consumed. A part of the head only, with a
portion of the lower extremities, and a few of the vertebrae, had
escaped combustion. The floor beneath the body was partially burnt.
The prisoner, in his defence, stated that he and his wife had retired to
rest the pievious evening, — that his wife, not being able to sleep,
got up and went into the kitchen, as he supposed to warm herself.
He was awakened by the smell of fire, and going down into the
kitchen, discovered the deceased lying near the hearth, in the manner
stated. The prisoner was condemned to death for the murder, but, on
appeal to a higher court, the sentence was revoked, and it was pro-
nounced to have been a case of spontaneous human combustion.

In this case the extent to which the body was consumed might lend
some support to the opinion, that it was more combustible than human
bodies in general, but it gives no countenance to the notion that the
fire originated in the body itself. It was certainly in the most favour-
able cii'cumstances for being set on fire ; and this is true of most of the
reported cases of alleged spontaneous combustion which have occurred
both in this country and abroad.

Orfila testifies his belief in spontaneous human combustion by thus
describing the phenomena which accompany it: — A light blue flame
appears over the part which is about to be attacked : this flame is not
readily extinguished by water, and indeed frequently the addition of
this liquid only serves to increase its activity. Deep eschars now
form in the part affected, accompanied by convulsions, delirium, vomit-
ing, and diarrhoea, followed by a peculiar state of putrefaction, and
death. The process is said to advance with extreme rapidity, but the
body is never entirely consumed : some parts are only half burnt,
while others are completely incinerated, a carbonaceous, fetid, unctuous
ash remaining. The hands and feet commonly escape destruction,
while the trunk is usually entirely dissipated. The wooden and other
combustible ai-ticles of furniture situated near the individual are either
uninjured, or but imperfectly consumed ; the clothes, however, cover-
ing the body are commonly destroyed. The walls and furniture of

288 DEATH BY LIGHTKING.

the apartment are covered with a thick greasy soot, and the air is itn-
pregnated with an offensive empyreumatic odour. This phenomenon is
stated to have been chiefly observed in corpulent females, advanced in
life, and especially in those subjects who had been long addicted to the
abuse of spirituous liquors.

It is, perhaps, practically of little consequence whether the doctrine
of spontaneous combustion be true or false. The cases on i-ecord may
be fairly allowed to prove an unusual degree of combustibility of the
human tody, occurring in rare instances and, for the most part, in
corpulent spirit-drinking females, merely requiring to be set on fire,
and needing no other fuel but their clothes, night-dress, or ordinary
bed-furniture. Till we possess cases better authenticated, and more
accurately reported, we must content ourselves with this amount of
knowledge.

The spontaneous combustion of inorganic substances is a subject of
much interest and importance, but it has no medico-legal bearing.

DEATH BY LIGHTNING.

From the Reports of the Registrar-General for the five years 1852-
56, it appears that about 21 deaths by lightning occur, one year with
another, in England and Wales; 18 in males and 3 in females. This
mode of death rarely gives rise to questions of a medico-legal nature ;
but inasmuch as the effects sometimes produced on the body, both
externally and internally, resemble those inflicted by mechanical vio-
lence, a question might possibly arise, whether a person found dead,
under unknown circumstances, had perished from the effects of lightning,
or had been murdered.

In the majority of cases we shall have a clue to the cause of death,
by knowing that a thunder-storm has taken place near the spot on
which a body is found. This fact being ascertained, we shall next
have to inquire what probability there was of the body having been
struck by lightning.

As a general rule it may be stated, that the electric fluid prefers and
seeks out good conductors ; and as the human body is a very good con-
ductor of electricity, it is as likely to be struck as any object similarly
situated, unless, perhaps, that object be of metal.

As a general rule, too, lofty objects are more likely to be struck
than low ones ; but this rule is subject to many exceptions, for persons
have been struck in the immediate neighbourhood of lofty trees which
have been uninjured.

The electric fluid is often conducted to the human body by lofty
objects in its proximity, such as trees, masts and rigging of ships, and
the moist strings of kites. The danger of remaining under a tree
during a storm is proverbial.

It has been thought that a person is tolerably safe m an open space
far from any object which could attract the electric fluid ; but this is

CAUSE OF DEATH. 289

an error. The human body may be, in these circumstances, the most
prominent object, and, at the same time, the best conductor.

It is now understood that death may be caused by an electric shock,
other than the lightning stroke. This takes place when a cloud, in
near proximity to the eartli, is negatively electrified, whilst the earth
is positive. The human body is heie made the conductor, by means of
which the equilibrium is restored. This is called the ascending or
returning stroke.

The violent effects produced by the electric discharge — the disruption
of the several parts of a building, and their forcible removal to a dis-
tance ; the separation of the good conductors from the bad ones; the
fusion of metallic substances ; the ignition of inflammable ones ; the
magnetic properties communicated to articles of iron and steel — are
familiarly known.

The Post-mortem appearances in the bodies of those who have been
struck by lightning are very various. Sometimes no marks of vio-
lence are found on the body, and this is said to occur most commonly
in cases of death produced by the returning stroke. At other times
the body presents marks of violence, such as contusion and laceration
about the spot where the electric fluid has entered ; occasionally there is
merely a small round hole at the point of exit ; at other times there is
an extensive ecchymosis, and this is most commonly found on the back,
the electric fluid appearing to prefer the track of the spinal marrow.
Fracture of the bones is a rare occurrence. They may occur, as
Ambrose Pare states, without external wound. One case of extensive
fracture of the bones of the skull is related by Pouillet. Marks of
burns are not fiequently met with, and probably never, except in cases
where the clothes have been set on fire.

The state of the blood, alleged by some authorities to be fluid, by
others to be coagulated ; the state of the limbs, asserted by some authors
not to grow rigid, but by other authors, with better reason, to be sub-
ject to rigidity, and sometimes even to become quickly and excessively
rigid ; and the putrefactive process, stated by Pare and others to be
retarded, but by other authorities to be hastened, — are trivial signs, of
little medico-legal importance. The state of the body in these respects
is worthy of note ; but even should it be clearly made out that the
blood is fluid, rigidity absent, and putrefaction hastened, these circum-
stances could not be considered peculiar to death by lightning, for there
is reason to believe that all of them may coincide in other modes of
sudden death.

In some cases the state of the objects found upon the person furnish
very complete evidence of the cause of death. The clothes may be
torn and burnt ; metallic bodies fused and forcibly carried to a distance
from the body ; and articles of iron or steel, such as the steel of the
stays, or the main-spring of a watch, rendered strongly magnetic.

Cause of Death. — The power of the electric fluid shows itself chiefly
through the nervous system. If death takes place, it is through the

U

290 DEATH FROM COLD.

shock sustained by it; or if a less degree of injury is inflicted, it is
manifested on the brain, spinal marrow, or nerves, in loss of sight, sen-
sation, or voluntary motion, temporax-y or permanent.

DEATH FItOM COLD.

Death from cold is an uncommon event in this country, though
death by cold and inanition combined is not of very rare occurrence in
severe winters.

The first effect of intense cold is a sensation of numbness and stiff-
ness in the muscles of the limbs and face. This is soon followed by
torpor and profound sleep, passing into coma and death.

The effects of cold are manifested partly on the general circulating
system, and partly on the circulation through the brain.

The effect on the circulating system generally is to drive the blood
fi-om the surface to the interior of the body, so as to gorge the spleen,
liver, lungs, and brain with blood. The genital oigans are similarly
affected, priapism sometimes resulting from congestion of the vessels
of the penis. The temperature of the blood itself is lowered ; the
heart contracts slowly and feebly, and the pulse becomes small and
thready.

The congestion of the nervous centres occasions numbness, torpor,
somnolency, giddiness, dimness of sight, tetanus, and paralysis ; and
the congestion of the brain sometimes occasions a species of delirium as
happened to Edward Jenner, or the appearance of intoxication, as wit-
nessed by Captain Parry and others in the expeditions to the North Pole.
The effect of cold varies in intensity in different persons according to
their sex, age, and strength: the young, the aged, the infirm, persons
worn out by disease or fatigue, and those addicted to the use of intoxi-
cating liquors perish most promptly. It would appear, too, that,
independent of these circumstances, some persons have a great advan-
tage over others in their power of resisting cold — a fact frequently
observed by voyagers and travellers in the Arctic regions.

The circumstances which cause the impression of cold on the body
to be severely felt, and which give rise to effects not indicated by the
height at which the thermometer stands will be understood from the
following considerations : —

The body is cooled in three ways — by cutaneous exhalation ; by
conduction from the direct contact of air ; and by radiation.

The cutaneous exhalation is increased by dry and diminished by
moist air. The body, therefore, parts with its heat more rapidly in a
dry atmosphere.

On the other hand the body is cooled by conduction, when the air is
moist ; so that the body is cooled alike by dry cold air and by cold
moist air.

Cold humid winds lower the temperature of the body in a very
striking degree.

DEATH FEOM STARVATION. 291

A rapid renewal of the air, as in a brisk cold wind, lowers the
temperature of the body by evaporation and by conduction at the same
time. The effect of a slight breeze in increasing the feeling of cold
was remarkably exhibited m the expeditions to the polar seas.

Post-mortem Appearances. — The surface of the body is pallid, and
the viscera of the head, chest, and abdomen are congested. There is
congestion of the vessels of the brain, but extravasation does not appear
to have been noticed, though the old opinion of the cause of death was
in favour of apoplexy. In two cases reported by Dr. Kellie, of Leith,
there was a large effusion of serum in the ventricles of the brain.
The blood in the aorta and left cavities of the heart is stated by
Dr. Paris, on the authority of Sir B. Brodie, to be florid. It will be
seen that none of these appearances are so characteristic as to be in
tliemselves conclusive as to the cause of death.

DEATH PROM STARVATION.

This is an extremely rare event ; but death from cold in persons in-
sufficiently nourished is not infrequent. Cases of homicide by the
deprivation of food, are of occasional occurrence, and insane persons,
and those who seek to avoid some greater calamity, such as capital
punishment, sometimes commit suicide by obstinately refusing to take
sustenance.

The Symptoms produced by protracted Abstinence are pain in the
epigastrium, relieved by pressure ; emaciation, the eyes and cheeks
sunken, the bones projecting, the face pale and ghastly, the eyes wild
and glistening, the breath hot, the mouth dry and parched, intolerable
thirst, delirium, extreme prostration of strength.

After a longer interval the body exhales a fetid odour, the mucous
membranes of the outlets become red and inflamed, and death takes
place in a fit of maniacal delirium, or in horrible convulsions.

The period required to produce fatal effects varies with the age, sex,
and strength, and with the amount of exertion ; and it also depends in
a great degree on the command of liquids, for the experiments of Redi
have shown, that animals live more than twice as long when they have
access to water as when they are kept without it.

Cases are on record in which life has been prolonged tinder volun-
tary starvation for a considerable period ; in one case (that of Viterbi),
twenty-one days, and in a still more remarkable one, fifty-eight days.
This, which occurred in the south of 'France, and was reported to the
Academy of Medicine, is as follows : —

GuillauEie Granet was a prisoner at Toulouse, and he resorted to
starvation to avoid punishment. For the first seven days the symp-
toms were not very remarkable ; his face was flushed, his b)eath foul,
and his pulse small and feeble. After this period he was compelled
to drink water occasionally, to relieve the excessive thirst which he
suffered, but in spite of the close watch which was kept over him, he

292 DEATH FROM STARVATION.

frequently drank his urine, or the water of the prison-kennel. His
strength did not appear to fail him during the greater ])art of the time,
and, with varying symptoms of constitutional distuibance and acute
sufferings, he lingered till the fifty-eighth day, when he expired, after
struggling for four hours in convulsions.*

Post-mortem Appearances. — The body is much emaciated, and exhalea
a fetid odour ; the eyes are red and open, the skin, mouth, and fauces
dry, the stomach and intestines empty and contracted ; the gall-
bladder is distended with bile ; the heart, lungs, and large vessels
collapsed, and destitute of blood ; and putrefaction runs a rapid course.
These appearances are not so characteristic as to be decisive of the
mode of death; but in the absence of any disease productive of ex-
treme emaciation, such a state of body will furnish a strong presump-
tion of death by starvation. It must be recollected, that there are
maladies such as stricture of the oesophagus, and organic disease of the
stomach, which prove fatal by starvation. Search should, therefore,
be m.ade for such causes of death.

The time that a person may reraain without food, or may support
life on a very scanty supply of it, may become a question of some im-
portance, as will appear Irom the case of Elizabeth Canning, quoted by
Dr. Cummin in his Lectures in the * Medical Gazette,' vol. xix. The
question raised in this case was, whether a girl of eighteen could be
confined, in the depth of winter, twenty-eight days, without fire, with
about a gallon of water in a pitcher, and with no food but some pieces
of bread, amounting altogether to about a quartern loaf, and a small
minced pie which she happened to have in her pocket, and at the expi-
ration of the period retain sufficient strength to break down a window-
shutter fastened with nails, get out of the window on to a sort of
pent-house, thence jump to the ground, nine or ten feet below ; and
finish by walking from Enfield Wash to Aldermanbury.

To this question we should be strongly inclined to return an answer
in the negative. The cases which have been alluded to, and especially
that of Guillaume Granet, give us good ground for believing, tiiat life
might have been prolonged for twenty-eight days, or even more, on
this scanty sup|)ly of nourishment ; but it is extremely improbable
that, at the end of this time, she would have had strength enough left
to effect her escape. This case is also curious in its bearing on the
question of identity.

The longest abstinence from food, with free access to water, of which
J have experience among prisoners is ten days. In two men and one
woman complete abstinence from food during this period was followed
by no bad symptom, and the ordinary prison diet was resunCM without
injury to health. The prisoners were weakened, but by no means
exhausted.

* Fodere', vol. ii. p. 276,

293

PAET III.

TOXICOLOGY.

The frequent occurrence of cases of real or supposed poisoning, and
the complicated nature of the questions to which they give rise, render
this the most important division of Forensic Medicine ; while the great
number of recognized poisonous agents causes it to occupy no incon-
siderable part of every medico-legal treatise.

The first suspicion of poisoning usually assumes a somewhat inde-
finite shape, and the question raised is not so much what poison has
been taken as whether any poison has been taken. In seeking a
solution of this question it is natural first to consider, to the operation
of what class of poisons the symptoms which have suggested the
suspicion bear the nearest I'esemblance ; and then to select from the
members of that class the individual poison of which the effects cor-
respond most closely with the symptoms in question. This, which is
the natural order of inquiry, is also the most convenient one. Accord-
ingly a distinct chapter will be devoted to the subject of Poisons in
General ; including the definition of the term poison, the mode of
action of poisons, the causes which modify their action, the evidence of
poisoning, and the classification of poisons.

This chapter will be followed by a series of chapters in which the
individual poisons will be grouped according to their analogies, and
separately examined.

CHAPTER I.
ON POISONS IN GENERAL.
DEFINITION OF A POISON.

The first question of a general nature which offers itself for solution
relates to the meaning of the word Poison.

The term poison does not admit of strict definition ; but the meaning
which ought to attach to it may be ascertained by a simple process of
exclusion. A substance which affects one person in consequence of

294 ON POISONS IN GENERAL.

some peculiarity of constitution, but has no effect upon other persons, is
not a poison : a substance which proves fatal in consequence of some
temporary condition of system, as cold water swallowed by a person
heated by exercise, is not a poison : substances which prove fatal
through the mechanical irritation they set up in the internal parts,
such as pins and needles, and particles of steel or glass, are not poisons:
again, hot water may prove fatal when swallowed, but water being
harmless in itself, and injurious only as a vehicle for conveying heat, is
not a poison. Substances, therefore, which owe their fatal effects to
some peculiarity of constitution, or to some unusual condition of the
body ; as well as mechanical irritants, and substances naturally harm-
less, but rendered injurious by extraneous causes, are not to be consi-
dered as poisons. The mode in which a substance is applied to the
body forms also no part of the definition of the term poison. It may
be applied to the skin, or inhaled, or swallowed, or introduced into the
anus or vagina, or into the ear, but it is still a poison. Again, the
quantity of a given substance which may prove fatal, or the time
during which it may continue to act before death takes place, cannot be
allowed to enter into the definition ; for in both these respects un-
doubted poisons differ widely from each other. These exclusions have
narrowed the possible definition of a poison ; and although from the
nature of things precision is impossible, the following may be adopted
as the nearest approach to a definition : — A poison is any substance
which, when applied to the body externally, or in any way introduced
into the system, without acting mechanically, but by its own inherent
qualities, is capable of destroying life.

In by far the greater number of medico-legal cases poisons are swal-
lowed. Hence the definition of a poison has been sometimes so framed
as to exclude all other modes of application ; and the words " admi-
nister," or '* cause to be taken by," which are used in the statute
1 Vict., cap. 85, would seem to imply this mode of introducing a
poison into the system.

The word poison is frequently qualified, in common conversation,
by such tei-ms as " active" " virulent," " deadly," and the last of
these terms is very generally used in indictments.

A " deadly poison " may mean a substance which proves fatal in a
small dose, or one which in a larger dose destroys life very rapidly, or
one which, irrespective of the dose, is more likely to prove fatal, or
more difficult to counteract, than others. Strychnia and oxalic acid,
for instance, are both " deadly poisons ;" but while less than a grain
of the one may destroy life, about half an ounce of the other is re-
quired for the same purpose ; yet a full dose of oxalic acid may prove
much more rapidly fatal than even a large dose of strychnia. On the
other hand, Epsom salts or sulphate of potash, in order that they may
destroy life, must be given in considerable quantity, and, even when
so given, do not prove certainly or rapidly fatal : so that it would
obviously be iucoiTect to designate these substances as ** deadly

MODE OF ACTION OF POISONS. 295

poisons." Nor would the term be correctly applied to such a sub-
stance as sulphate of zinc, which is often prescribed as an emetic in
doses of a scruple or half a drachm, or to the non-corrosive prepara-
tions of mercury, iron, or copper. In any case the term " deadly
poison" is open to the objection of raising an unnecessary vei'bal
question, and unless it is to be looked upon, when used in indictments,
as mere " legal surplusage," in accordance with the opinion lately
expressed by Mr. Justice Earle, it ought to be allowed to fall into
disuse.

" A destructive thing," is another phrase used in the statute just
referred to, and open to question. A destructive thing, if not a poison,
in the sense ordinarily attached to that term, must be some substance
which destroys life by a mechanical action on the internal parts, or
by some property not inherent in it, such as heat. Some substances, as
sponge, or plaster of Paris, may destroy life by presenting an obstacle to
the passage of the contents of the intestines ; others, as large particles
of glass or steel, by irritating the Iming membrane of the alimentary
canal ; and pins or needles, by wounding vital organs, or by setting up
inflammation in the less important parts which they traverse. Such
substances may be fairly regarded as " destructive things :" but
whether they have caused death in any particular instance can be
determined only by a post-mortem examination.

Having defined the term poison with sufficient precision to indicate
the class of substances which will have to be examined in the follow-
ing pages, certain general questions relating to poisons must next be
considered. These are, — Their mode of action, and The causes which
modify their action.

MODE OF ACTION OF POISONS.

The action of poisons is twofold, local and remote.

The local action of poisons may consist in con^osion, or chemical de-
composition, as when a concentrated mineral or vegetable acid, a pure
alkali, or a corrosive salt, is applied externally or taken internally : in
irritation or inflammation, in various- degrees, and followed by the
several terminations of adhesion, suppuration, ulceration, or gangrene,
as from the application of arsenic, tartar-emetic, or cantharides : and,
lastly, in an effect on the nerves of -sensation or motion ; as the numb-
ness and tingling of the lips and tongue, occasioned by chewing the
leaves, seeds, or root of monkshood, and the sharp pricking sensation in
the same parts, caused by the arum maculatum ; the loss of sensation
in the skin by the application of the vapour of prussic acid ; and the
dilatation of the pupil from the application of belladonna, to the eye.

The remote action of poisons is of two kinds, common and specific :
the first resembling the effect of othe)' forms of severe injury inflicted
on the same part, and varying in intensity with the amount of that
injury ; the last being peculiar to the poison itself. Thus, arsenic

296 ON POISONS IN GENERAL.

when swallowed, and applied to the raucous membrane of the ali-
mentai7 canal, gives rise to those severe cramps in the extremities
which are present in all acute inflammations of the lining membrane
of the stomach and bowels, however produced ; but the same poison,
inserted into a wound, applied to the skin, or inhaled by the lungs,
excites inflammation of the mucous surfaces with which it does not
come into immediate contact. This is its specific action. Again,
oxalic acid acts on the mucous membrane of the stomach and bowels as
a corrosive, and excites inflammation around the parts of the membrane
which it has destroyed ; and this destruction and consequent inflamma-
tion are attended with the same constitutional shock that accompanies
all severe local injuries; but it has also a remote specific effect on the
brain and spinal coi-d, and on the heart. The purest example of a
remote constitutional effect of a common kind is afforded by the
mineral acids, and by the pure alkalis and their carbonates, which, by
the local destruction they occasion, give rise to the common symptoms
of collapse — extreme debility, faintings, imperceptible pulse, cold ex-
tremities, and death. The absence of remote specific effects in the
case of these chemicals has led some authors to doubt the propriety of
classing them among the poisons.

The remote specific effects of poisons may also be distinguished as
constitutional or local ; that is to say, as producing a general effect on
the whole frame, or a partial effect on a particular organ. Tartar-
emetic, for instance, has a peculiar depressing effect upon the system,
and a peculiar local action on the lungs ; while arsenic acts as a stimu-
lant to the system, and exerts a local action on the mucous surfaces.

A knowledge of the specific remote action of poisons is of the first
importance, as it often enables us to judge of the particular poison
which has been taken, or of the class of poisons to which it belongs.
Thus the narcotic poisons, as a class, occasion stupor, the narcotico-
acrids, delirium. Nux vomica, and the several plants of which strychnia
is the active principle, affect the spinal cord, producing violent attacks
of tetanus ; conia, the active principle of hemlock, [paralyses the whole
muscular system ; arsenic, even when applied externally, causes in-
flammation of the mucous membrane of the alimentary canal ; mer-
cury attacks the salivary glands and mouth ; cantharides the urinary
system ; antimony the lungs ; manganese the liver (and this is an
effect of copper) ; chromate of potash the conjunctiva of the eyes ;
iodine the lymphatic glands ; lead the muscular system generally (and
this, too, is an occasional effect of arsenic) ; and spurred rye produces
gangrene of the limbs. Poisonous substances used in the arts also
reveal their effects upon the system through their specific actions.
Thus the dropped hand betrays the use of lead, paralysis agitans that
of mercury, gangrene of the jaws that of phosphorus, and a peculiar
rash, with the formation of small ulcers about the nostrils, ears, bends
of the arms, and scrotum, the employment of the arsenite of copper.

In the case of some of these poisons, one part or set of organs only is

MODE OF ACTION OF POISONS. 297

affected, but others attack almost every impoi-tant organ of the economy.
The most striking; example of this kind is arsenic, which, besides pro-
ducing inflammation in the parts with which it comes in contact, affects
all the mucous surfaces, as well as the organs of circulation, respiration,
and innervation ; and all these effects may be exhibited in the same
case. Oxalic acid and the salts of mercury produce similar complications.

in producing these remote specific efiects, poisons must either be
carried by the circulation to the parts affected, or their action on the
nerves of the part to which they are applied, must be propagated to
the nervous centres, and thence reflected to the organs remotely
affected. Now there is abundant proof of the absorption of poisons,
and their consequent circulation through the system. Experiments on
animals have shown that this takes place in whatever manner the
poison is applied to the body ; and the results of such experiments have
been confirmed by the analysis of the blood and secretions, and even of
the solid textures; the list of the poisons thus detected including
almost every substance which can be recognized by its odour or colour,
or which, not being decomposed by the animal fluids or textures, can
be submitted to chemical reagents. Hence the bare fact of the ab-
sorption of poisons is too generally known and admitted to require
additional proof or illustration; but the questions arise — Is it in con-
sequence of absorption that- poisons prove fatal ? Is their action
arrested or postponed by the arrest of the ciiculation ?

As the greater number of experiments which have been made in
illustration of these questions have consisted in the introduction of poisons
into wounds, it may be well to consider by themselves the arguments
derived from this mode of introduction. In the first place, it has
been satisfactorily shown, that poisons so introduced do not act directly
on the nerves of sensation or volition, for their action is not impaired
by the previous division of the nerves supplying the part into which
the poison is introduced, and they continue to take eflect even when,
as in Majendie's well-known experiment, the poisoned limb is con-
nected with the body only by quills introduced into its large vessels.
It is also clear that the great nervous trunks are not abJe to transmit
the poisonous influence, for poisons inserted into a limb do not produce
their effect when the limb is connected with the body by nerves only.
Again, a division of the. spinal marrow does not prevent the action of
those poisons which prove fatal by attacking that part, and the direct
contact of poisons with the substance of the brain itself has been found
to be unattended with their usual effect. This class of experiments,
therefore, affords a very strong presumption in favour of the necessity
of absorption to the action of poisons.

But the introduction of poisons into wounds is only one way in
which they may gain admission into the body. It is necessaiy to
inquire how poisons which have been swallowed produce their effects.
Is absorption necessary to their fatal action? An experiment per-
formed by Mr. Blake proves this necessity as strongly as in the case

ay» ON POISONS IN GENERAL.

of poison inserted into wounds. Prussic acid was introduced into the
stomach through an opening in its parietes ; it produced no effect, so
long as the vessels entering the liver were secured by a ligature, but
began to act within one minute after its removal.*

It appears, then, that poisons, whether inserted into wounds or in-
troduced into the stomach, produce their fatal effects in consequence of
absorption, and that, where absorption is altogether f)revented, these
effects do not occur. The question now arises — In what manner do
poisons, introduced into the blood and circulated through the system,
produce their fatal effects? On what part and on what tissue do they act ?

It is plain that all poisons do not destroy life in the same way.
Some paralyse the heart, others act directly upon the lungs, and give
rise to asphyxia; a third class attack the brain; a fourth tlie spinal
marrow ; and a fifth class appear to affect the entire capillary circula-
tion. This difference of action is displa)ed in a marked manner when
poisons are introduced, as in the ex})eriments of Mr. Blake, directly into
the current of the circulation. So introduced, the salts of magnesia,
lime, strontia, and baryta; of zinc, copper, lead, and silver; as well
as oxalic acid and digitalis, affect the heart ; the salts of soda, hydro-
cyanic acid, tobacco, and euphorbium attack the capillaries of the
lungs ; opium and its alkaloid, morphia, affect the brain ; while the
action of the salts of potash and ammonia seems to be limited to the
general capillary circulation,! These different modes of death can only
be accounted for in one of two ways, — the poison must be conveyed
with the blood to the organ affected, or some powerful influence must
be transferred to that organ from the nerves distributed to the coats of
the blood-vessels themselves. The latter supposition seems, in the
highest degree, improbable; for in a second experiment performed by
Mr. Blake, blood poisoned with woorara continued to traverse both
the arteries and veins of the abdominal viscera for several minutes
before any effect manifested itself. This experiment, taken by itself,
affords a sufficient refutation of the theory which the ingenious experi-
ments of Morgan and Addison were intended to establish. Considerable
and very important additions have been lately made to our knowledge
of the action of poisons, and of the proximate cause of death in poison-
ing, by M. Claude Bernard. He has shown by well-devised experiments
on animals that the more active poisons attack paiticular tissues or
organs essential to life — that woorara paralyses the motor nerves;
that strychnia attacks the sensitive portion of the nervous system, and
excites fatal reflex actions ; that digitalis, upas antiar, coiTowal, and
wao, veratrine, and several other poisons, act on the muscular tissue
throughout the body, and on the heart as a muscle.;};

* For minute particulars of this and of similar experiments see Mr. Blake's
Essay in the ' Edln. Med. and Surg. Journal,' vol lill. p. 45.

t ' Ed. Med. and Surg Journal.' vols. 11., llv., and Ivi.

% See his lectures in the ' Medical Times and Gazette,' vol. ii. 1860, Nos. 532.
533, 535.

MODE OF ACTION OF POISONS. 299

There remains, then, but one explanation of the action of poisons
when once. introduced into the blood-vessels, namely, that they aie car-
ried with the blood to the organs or tissues on which they act : some
by the coronary arteries to the heart, which they paralyse ; others to
the spinal marrow, exciting fatal tetanic spasms ; others to the brain,
proving fatal by an indirect action on the respiration ; and others,
again, to the lungs, causing an arrest of the capillary circulation, and
consequent asphyxia.

One difficulty which stood in the way of the reception of the theory
of the necessity of absorption to the action of poisons, namely, the
rapidity with which certain poisons, such as pr^issic acid, prove fatal,
has been removed by the ingeniously-contrived and carefuUy-pei'formed
experiments of Mr. Blake. Having provided a delicate measure of the
condition of the circulating system, by inserting into the femoral ar-
tery of the animal to be experimented on, the hsemadynamometer of
Poiseuille, he proceeded to ascertain the time required for the circula-
tion of poisons from one part of the system to the other. This he
effected chiefly by introducing various substances, previously known to
paralyse the heart, directly into the vessels, and, by means of the in-
strument, noting the instant of time at which the first effects of the
poison manifested themselves, and at which the heart ceased to beat.
Without entering into a minute account of the experiments themselves,
it may suffice to state, that, in the dog, the time required for a poison
to pass from the jugular vein to the lungs was four seconds, or from
four to six seconds ; from the jugular vein to the coronary arteries of
the heart seven seconds ; from the jugular vein to the carotid artery
five to seven seconds, and from the aoita to the capillaries, four se- '
conds. A poison introduced into the jugular vein was distributed
through the whole body in nine seconds. In the horse, the time re-
quired for the completion of the circulation was from twelve to twenty
seconds, or somewhat less^ than the time (twenty-five seconds) deduced
by Hering of Stuttgardt, from his experiment.

These experiments are in harmony with the more recent ones of
M. Claude Bei-nard. A saturated solution of sulphuretted hydrogen,
introduced into the jugular vein of a dog, began to be eliminated from
the lungs in three seconds ; and when injected into the femoral vein of
the same dog, in six seconds.

Assuming that the time required for the complete circulation of a
poison through the body of a dog is nine seconds, it follows that if it
can be shown, that poisons applied to the dog's tongue do not act in so
short a space of time, absorption may take place, and the blood may be
distributed to the organ on which it produces its fatal effects. Now,
in Mr. Blake's experiments, strong hydrocyanic acid applied to the
tongue of a dog did not begin to act till eleven seconds, and did not
prove fatal till thirty-three seconds; and when a tube was previously
introduced into the larynx, so as to prevent the vapour of the acid from
entering the lungs, the first appearance of the symptoms was after

300 ON POISONS IN GENERAL.

sixteen seconds, and death took place in forty-five seconds. In like
manner, nicotina, the essential principle of tobacco, applied to the
tongue of the same animal, did not prove fatal till twenty seconds.
These experiments afford very strong confirmation to the theory of the
necessity of absorption to the fktjil action of poisons, and must be
admitted to prove that necessity, at least in the great majority of cases.
Jf the theory of the fatal action of poisons by an effect produced on the
nerves of the part to which they ai'e applied be tenable, it must be in
those rare instances in which the fatal action of the poison is reported
to have been liteially instantaneous, or much more prompt than in any
of Mr. Blake's experii^ents. Such an experiment is reported by Dr.
Christison, who states, that in one instance an animal was killed out-
right by piussic acid in -four seconds ;* and cases are cited by the same
author, and by Dr. Taylor, f in which the same poison destroyed life in
three, and even in two, seconds ; and in the experiments of Sir Ben-
jamin Brodie, alcohol and the essential oil of bitter almonds seem to
have produced the same instantaneous effect.^

In the presence of these facts, and v^ith the knowledge we possess of
the instantaneous impi-ession produced upon the system by sudden and
extensive mechanical and chemical injuries, it would scarcely )je safe to
deny the possibility of the more active poisons when taken in large
doses pioving fatal by a sudden shock to the system.

A fact i-eported by Sir B. Biodie renders it probable that poisons
may act through continuity of tissue. A man was bitten in the hand
by a rattlesnake. There was inflammation, sloughing, and suppura-
tion of the cellular tissue of the arm, and copious and extensive extra-
vasation of blood beneath the integuments of the chest and back, limited
to the injured side of the body.

The theory of absorption finds a p'-actical application in the use of
ligatures and cupping-glasses for preventing the effects of poisons
inserted into wounds.

CAUSES WHICH MODIFY THE ACTION OF POISONS.

There are three ways in which the action of poisons may be modi-
fied. 1. By the quantity and form in which they are administered.
2. By the part of the body to which they are applied ; and 3. By the
condition of the body itself.

1. Quantity and Form of the Poison. — Quantity. As a general rule,
the larger the quantity of a poison introduced into the system the more
prompt and the more severe its effects; but in the case of poisons
which are swallowed, a large dose will sometimes be immediately and
completely discharged by vomiting, while a smaller dose will remain

* ' Treatise on Poisons,' p. T.

t ' Medical Jurisprudence,' 5th Edition, p. 160.

X Sir Benjamin Brodie's ' Pliysiological ilesearches,' p. J 39,

CAUSES WHICH MODIFY THE ACTION OF POISONS. 301

on the stomach, and prove fatal. Again, small doses of a poison often
repeated, will develop different symptoms from those caused by a single
large dose. The operation of some poisons also varies remarkably in
kind as well as in degree with the quantity taken. Thus oxalic acid in
a large dose may destroy life almost instantly by shock ; in a smaller
dose it may affect the heart in a less degree, but still prove fatal by its
action on that oi'gan; in a yet smaller dose it affects chiefly the spinal
cord ; and in a more minute dose still, the brain. Of the whole class
of uarcotico-acrid poisons, it may be affirmed, that when given in large
doses they act chiefly as narcotics, and in smaller doses chiefly as irri-
tants. Form. — Under this head will have to be considered, — a. The
State of Aggregation, b. The Chemical Comhination, and c. The
Effect of Mixture.

a. The State of Aggregation. — Poisons in solution act more ener-
getically than when in a solid form, partly because they are more
readily absorbed, and partly because they are brought into contact with
a larger surface. For the same reason soluble poisons are much more
active than those which are sparingly soluble, and the soluble salts of
a poison more active than the less soluble base. Poisons also act when
in a state of vapour, with great energy on the lungs and skin. But
poisons are not merely rendered more active by solution: their effects
are also modified by it. Of this oxalic acid is a remarkable example.

6. Chemical Combination. — As a general rule, substances which have
a purely chemical action, as the mineral acids and the alkalis, lose their
active properties when in combination. The resulting substance ob-
tains new properties, and. is more or less active as it is more or less
soluble. Acid poisons, in combining with bases, or basic poisons com-
bining with acids, become more or less active as the resulting com-
pounds are more or less soluble; and, as a general rule, those compounds
retain in their soluble combinations the specific characters of their
active ingredient. Thus all the soluble salts of morphia have the same
action, and all the soluble compounds of oxalic acid affect the system in
the same way. When two poisonous substances combine to form one
chemical compound (as arsenious acid with copper, or hydrocyanic acid
with mercury or silver), the resulting compound may give rise either
to the symptoms of the more active element, or to the mixed effects
of the two poisons ; or it may produce symptoms peculiar to itself.
Lastly, some poisons insoluble in water, as arsenite of copper, and car-
bonate of lead or baryta, may be rendered soluble anil active by the
juices of the stomach, or by the acid of the perspiration.

c. Mixture. — All admixtures which render a poison more soluble
render it more active. All other admixtures have a contrary effect.
Thus acids increase the activity of opium, and of the salts of coppei-,
and water of arsenic. Mucilaginous substances, on the other hand,
partly by protecting the coats of the stomach, and partly by involving
the poison, if in substance or in powder, retard or prevent its action.
Food taken before or with poison has the same effect. Hence the

302 ON POISONS IN GENERAL.

frequent escape of those who have taken very large doses of arsenic or
corrosive sublimate. Poison mixed with food is similarly affected by
the character of the food. Thus arsenic given in a solid dumpling
would manifest its effects much more slowly than if taken in porridge,
and in this latter case than if mixed with tea, beer, or water. So also
with the more deadly poisons when given in the form of medicine.
Thus sti-ychnia given in a pill acts more slowly than the same poison
administered in a draught or mixture. We avail ourselves of the pro-
tecting effect of admixture with mucilaginous substances in the treat-
ment of cases of poisoning, and we use substances possessed of little or
no power as antidotes, because they possess the property of withdrawing
and holding in suspension certain poisons. Powdered charcoal is the best
example of this class ; but magnesia and the sesquioxide of iron given
in poisoning by arsenic owe their repute chiefly to this power.

2. The Part to which the Poison is apj^lied. — The effect which the
same poison has on different parts of the body is directly as the ab-
sorbing power of those parts. Thus poisons act most promptly when
injected into a vein ; next in degree when introduced into a wound ;
the serous surfaces hold the next place ; then the stomach ; and, last
of all, the unbroken skin. Poisons introduced into the lungs, whether
in a fluid or a gaseous form, act with nearly as great rapidity as when
introduced directly into the circulation. The corrosive poisons and
stronger irritants produce an effect proportioned to the importance of
the part to which they are applied. Thus, the mineral acids prove
speedily fatal if they come into contact with the windpipe ; less speedily
by acting on the gullet and stomach, and they are still less active when
applied to the skin. It is a remarkable fact, that even those poisons
which most strikingly affect the nervous system do not act when
applied directly to the brain, spinal marrow, or trunks of the nerves.
Many animal poisons, which, as a- class, are readily decomposed, have,
as might be anticipated, no effect on the stomach, though the smallest
quantity introduced into the skin proves cei-tainly fatal. Thus the
poison of the viper or mad dog may be swallowed with impunity.

3. The Condition of the Body itself. — Under this head will have to
be considered, — a. Habit, b. Idiosyncrasy, c. Disease.

a. Habit. — It is not possible to lay down any bi-oad general rule in
reference to the influence of habit on the effect of poisons. For while
some poisons derived from the vegetable kingdom, and belonging to the
class of narcotic or of narcotico-acrid poisons, as opium, alcohol, and
tobacco, lose their effect by repetition, and may be taken at length in
doses which would poison a man not accustomed to their use, other
poisons belonging to the same classes, as digitalis and strychnia, have a
cumulative effect. Again, though the less deadly mineral poisons,
such as the common salts of zinc and iron, may be taken by healthy
persons in continually increasing doses, the more active poisons, such
as arsenic and meicury, seem to share with strychnia and digitalis a
cumulative property ; and when gradually introduced into the system

IDIOSYNCRASY. — DISEASE. 303

in their use in the arts, they certainly appear, like the carbonate of
lead, to be the more dangerous the longer they are used. Nor does
habit seem to render men who work with arsenite of copper more
tolerant of the poison. The same effects appear to be reproduced at
each resumption of their employment. The stomach may, however,
become accustomed to the local action of poisons, and grow nearly in-
sensible to them, as happens with the spirit-drinker ; and it is perhaps
possible that the stomach may become tolerant of increasing doses of
arsenic or corrosive sublimate. It must be borne in mind, however,
that even those substances to the action of which the system most
readily adapts itself, produce permanently injurious effects on the
system. Thus, alcohol causes disease of the lungs, liver, kidneys, and
brain; tobacco, however frequently repeated, still excites the circula-
tion ; and opium injures the digestion, emaciates the body, and enfeebles
the mind.

h. Idiosyncrasy. — There are three ways in which individuals differ
from each other, or from the majority of their fellows. 1. They
are affected in a greater or less degree than is usual by a substance
which produces the same effect in them as in other men. Thus, a few
grains of mercury shall salivate one man, but as many drachms or
ounces shall not affect another. The same remark applies to arsenic,
A child, too, shall bear a larger quantity of mercury than an adult ;
probably because his functions being more active, the substance is
sooner removed from the system by the secretions. 2. A substance
which, in the majority of persons, produces one given effect, shall in
an individual act in a very different manner. Thus, common Epsom
salts have been known to act like opium, and opium to have a purga-
tive effect. Lastly, a simple article of diet, which has no more efliect
on most men than any other food that they take, shall act like a poison
on the stomach of a few individuals. Thus, certain kinds of fish and
vegetables, and even common butcher's meat, act like irritimt poisons
on some persons. Even mutton has been known to act invariably in
this way.

c. Disease. — The general effect of a state of disease is to render the
body less susceptible of the action of poisons. Thus, persons in an
advanced stage of typhus fever, or otherwise reduced to extreme weak-
ness, are scarcely affected by stimulants which would overpower the
strong ; and this is seen even in healthy persons in the increased
tolerance of spirits towards the after-part of the day, when the body is
comparatively weak. In continued fever and in yellow fever there is
increased tolerance of mercury, but in paralytic affections, and in anaemic
states of system, an opposite condition prevails : in anaemia, large
doses of preparations of steel are readily borne ; in severe dysentery,
cholera, and haemorrhage, of opium ; in all the moi-e severe affections of
the nervous system, as tetanus, hydrophobia, delirium tremens, and
mania, every remedy, but especially the narcotic poisons, may be given
in greatly increased doses. Delirium tremens may be safely and sue-

304 ON POISONS IN GENEIIAL.

cessfuUy treated by half-ounce doses of tincture of digitalis, and opium
may be given in one form of mania in repeated doses of two scruples.
The only exception to the general rule here laid down is in the case of
poisons which tend to produce conditions of system similar to those
actually existing. Thus, the irritants would increase gastritis, diar-
rhoea, or dysentery; and the narcotics exasperate a determination of
blood to the brain.

Besides these three principal modifying causes, there is one condi-
tion of system which deserves mention as tending to diminish the
operation of poisons, viz. sleep. This is too obvious to require any
comment, as in this state all the functions are carried on more slowly,
and all effects on the system must of necessity be less severe. On the
same principle, substances which produce sleep being administered
with or before other poisons, must weaken or counteract their effects ;
opium, for example, when given with arsenic not only masks the
symptoms proper to that poison, but appears to retard its operation.

EVIDENCE OF POISONING.

Under this head it is proposed to examine very briefly the chief
circumstances which would lead us to believe that an illness or death,
accompanied or preceded by suspicious symptoms, was due to poison,
using the term poison in a general sense. There are five such cir-
cumstances. 1. The symptoms. 2. The post-mortem appearances.
3. The results of experiments on animals. 4. Chemical analysis.
5. The conduct of suspected persons.

1. The Symptoms. — In most cases of poisoning the symptoms appear
suddenly, in a person in good health, soon after the taking of food,
drink, or medicine, and they run a rapid course towards a fatal termi-
nation.

The sudden appearance of the symptoms affords a slight presumption
in favour of poisoning, fo)*, when administered, as poisons commonly are
in criminal cases, in huge doses, the symptoms soon show themselves.
But, on the other hand, when given in small and repeated doses, the
invasion of the symptoms is often gi-adual. It must also be recollected
that many diseases set in suddenly. This is true of many cases in
almost all severe epidemics, as in plague, cholera, and yellow fever ;
typhus fever also, and the febrile exanthemata — small-pox, scarlatina,
and measles — show themselves suddenly with severe symptoms of indis-
position. Many diseases of the more important organs also set ia sud-
denly ; such as perforation of the stomach or intestines, and rupture of
other important viscera, organic diseases of the heart, and apoplexy.

The occurrence of the symptoms in a person in good health, also
affords only a slight presumption in favour of poisoning ; for, on the
one hand, many acute diseases make their attack without any previous
impairment of health ; and, on the other, it is not unusual to administer
poison to a person already suffering from i lines?, or to give a deadly

SYMPTOMS. ■ 305

poison to a person whose health has been previously undermined by
the administration of a less-active substance {e g. acetate of morphi.a
or strychnia after tartar-emetic, as in Cook, the victim of Palmer).

The appearance of the symptoms soon after the taking of food,
drink, or medicine, affords a somewhat stronger presumption ; for all
the more active poisons when given in large doses, especially if the
poison be very soluble, act with great promptitude. On the other
hand, it must be borne in mind, that vomiting and other symptoms of
indisposition often manifest themselves after a meal containing no
unwholesome substance; that apoplexy may follow a full meal; that
rupture of the stomach, when its coats are softened by previous dis-
ease, would naturally take place while the organ was distended with
food ; that English cholera is often c:aused by unripe fruits, putrid meat,
or other unwholesome ingesta ; and that a large draught of cold water,
swallowed while the body is heated, may produce instant death.

The probability derived from the symptoms occurring soon after a
meal would be greatly strengthened if other persons partaking of the
same meal were similarly affected ; but, at the same time, too much
importance should not be attached to the absence of such effects; for
the person in whom the symptoms have manifested themselves may
have partaken of some dish or part of a dish, or of some wine or drink
which the others may not have tasted.

The attack of several persons by severe symptoms at or about the
same time, and soon after a meal of which all have partaken, may be
considered as the strongest possible presumption of poisoning either by
the food itself, or by some accidental or intentional admixture. If the
symptoms are those of simple irritant poison, it will not be possible to
determine by the symptoms alone which alternative is the true one ;
but they may happen to be so characteristic as at once to point to the
very poison which has been administered.

The value of this coincidence will be felt to be very considerable if
it is borne in mind that none but epidemic diseases of the more severe
kind are likely to attack seA^eral persons at the same time. It may be
doubted even whether Asiatic cholera, in any one instance, has seized
two or more members of a family so nearly at the same time, and at
the same interval after a meal of which they had all partaken, as to
give rise to a suspicion of poisoning. The only other diseases which
are known to occur simultaneously, or at about the same time in severel
persons, are imitative convulsive disorders; and these are generally
confined to females.

The simultaneous fatal attack of several persons in the same place,
or on the same mission, in the absence of any proof that they had par-
taken of the same food, would furnish a strong presumption of poison-
ing. Thus, the death in one night of four of the eight peers selected to
represent the Scottish nation at the nuptials of Queen Mary with the
Dauphin of France, in 1558 (Lord Fleming at Paris, Bishop Eeid, the
Earl of Rothes, and the Earl of Cassilis at Dieppe) very naturally gave

X

306 • EVIDENCE OF POISONING.

rise to a suspicion of poisoning ; especially as the refusal of the Scottish
deputies to grant the crown matrimonial to the bridegroom had given
great offence to the French court.*

A suspicion of poisoning is often successfully rebutted by reference
to the fact, that neither food, drink, nor medicine has been taken for
hours before the commencement of an illness, f It must not, how-
ever, be too hastily assumed that, because no food or medicine w^as
swallowed before the symptoms set in, those symptoms are not due
to poison ; for poisons have been introduced into the anus or vagina,
poured down the throat of a drunken or sleeping person, or inserted
into the external ear.

The rapid course of the symptoms towards a fatal termination is
also an extremely fallacious evidence of poisoning ; for many cases of
poisoning end fatally after a considerable interval, and many acute
diseases lun a very quick course.

All the characters now mentioned are, therefore, to be received with
caution, and cai-efully weighed against each other. The joint occur-
rence of two or more of them would strengthen the probability ; and
the coincidence of all of them, though not decisive, would justify a
strong suspicion. Thus, if a person in perfect health, soon after taking
food, were attacked with severe and continued vomiting and purging,
and died within twenty-four hours, a strong suspicion would naturally
arise that the food had contained some poisonous substance ; and the
suspicion would be greatly strengthened if other persons who had
partaken of the same food were similarly affected. The poison might
have been added to the food, or the food itself might have had poison-
ous properties ; but the probability of poisoning in one of these two
ways is very strong ; and the inference would be almost irresistible if
it could be shown that the person affected had never suffered in the
same way before, and that neither English nor Asiatic cholera was
prevailing at the time.

2. The Post-mortem Appearances. — The evidence from post-
mortem appearances is, as a general rule, even less decisive than
that afforded by the symptoms. It is true that there are poisons
which leave in the dead body unmistakeable signs of their action:
such as the mineral acids which stain and corrode the parts with
which they come into contact, and oxalic acid in strong solution
which corrodes the lining membrane of the gullet and stomach. Very
characteristic appearances are also sometimes produced by corrosive
sublimate, which, being decomposed by the secretions and membrane
of the stomach, leaves a slate-coloured deposit of finely divided mer-
cury ; and by arsenious acid, which is changed into the yellow sulphide
by contact with sulphuretted hydrogen, the product of putrefaction,
or clings as a white patch to the mucous membrane, Orpiment, and
Scheele's green, and the salts of copper, also leave characteristic stains.

♦ Sharpe's Peerage— Marquis of Allsa.

f For Illustrations see Christison ' On Poison/ p. 53.

POST-MOETEM APPEARANCES. " 307

Vegetable poisons are also sometimes identified by seeds, or fragments
of leaves left in the alimentary canal.

Other poisons, again, belonging both to the class of irritants and to
that of the narcotico-acrids, excite so intense an inflammation in the
mucous membrane of the stomach and intestines as to give rise to a
strong suspicion ; such intense inflammation being of rare occurrence in
disease. Less degrees of inflammation being of common occurrence in
persons who have died a natural death, would not of themselves justify
a suspicion of poisoning ; and the same remark applies to those appear-
ances of congestion in the brain which often result from the action of
the narcotics and narcotico-acrids, such congestion being of common
occurrence in simple apoplexy, in ursemia, and in many forms of death
not originating in the brain.

The negative evidence from post-mortem appearances has the same
force with the positive evidence. Thus the absence of corrosion in
alleged cases of poisoning by corrosives would serve to disprove the
charge ; the absence of inflammation, after the alleged administration
of an irritant or narcotico-irritant poison, to render the charge highly
improbable ; and the absence of congestion of the brain, in a case of
imputed narcotic poisoning, would afford a lower presumption against
the exhibition of such a poison.

Formerly undue importance was attached to an unusual blackness or
lividity of the skin as evidence of poisoning; and the same remark
applies to the early occurrence of putrefaction. There is no reason to
believe that either of these appearances is more common after death
from poisoning than after other forms of sudden death ; and it is
now well known that some of the mineral poisons, for instance arsenic
and corrosive sublimate, preserve the parts with which they are in
contact.

The discovery of post-mortem appearances similar to those produced
by poison, even thoug?i confirmed by the discovery of the poison itseltj
would not prove that death has been caused by poison, for death might
be produced by some other cause befoi'e the poison had had time to
prove fatal. On the other hand, in several instances on record, a dead
body has borne marks of severe external injury, or the internal organs
have been found very extensively diseased, and yet the real cause of
death was poison. This class of cases strongly enforces the caution
insisted on at page 205, under the head of post-mortem inspection,
viz., to submit every part of the body to careful examination.

The absence of characteristic post-mortem appearances might be-
come important in the very improbable event of poison being introduced
into the body after death, with a view to inculpate an innocent person.
The post-mortem appearances, then, do not furnish independent
evidence in the case of any considerable number of poisons ; but they
may serve to confirm, by their presence, the presumption drawn from
symptoms or from moral evidence, or by their absence they may in-
validate a charge prompted by malice.

308 EVIDENCE OF POISONIKG.

3. Experiments on animals. — There are many considerations which
affect the value of the evidence derived from this source. Poisons are
'alleged not to produce the same effect upon animals as upon the human
subject, and many examples of this difference have been put on record.
They also require to be given in quantities altogether disprojiortionate
to the difference of size. To this objection there is the obvious answer,
that the animals generally selected for experiment, especially the dog
and cat, have been proved to be similaily affected with man by all the
poisons in common use.

This observation obviously applies with equal force to that very
numerous class of cases in which the domestic animals and poultry have
partaken of poisoned food in common with man, or have eaten the
matters rejected from the human stomach.

It ought also to be borne in mind, that, in many instances of ex-
periments on animals with substances supposed to contain poison, the
speedy death of the animal, or its escape with impunity, affords suffi-
cient evidence in the affirmative or negative, without minutely examin-
ing the symptoms actually present.

In the case of some poisons also, as, for instance, of strychnia, the
effect is of that simple and marked kind, that it is likely to be present
in all animals alike.

In many cases again, both experimental and accidental, this objection
has been obviated by the poison having produced similar fatal eflects
upon more than one kind of animal, such as the dog, the cat, and the
domestic fowl.

Another objection to the evidence drawn from experiments on animals,
applies to those cases in which the substance administered has been pre-
viously rejected from the human stomach, or collected from the stomach
and intestines after death. It is alleged that the animal secretions
may be so vitiated as to prove poisonous, and the allegation is supported
by the well-known experiment of Morgagni, made with bile taken
from the stomach of a child who died in convulsions from tertian ague.
The bile mixed with bread and given to a cock caused convulsions and
death in a few minutes, and the same effect followed in two pigeons
inoculated with this same substance. It is obvious that such an ex-
periment as this made with the bile of a diseased subject can have no
proper application to cases in which food rejected from the stomach of a
healthy person under the influence of poison has been swallowed by
animals and proved fatal.

It is scarcely necessary to sta^ that experiments with substances re-
jected from the stomach, or found there after death, may fail in con-
sequence of the substances themselves not containing the poison, or
from the poison having been decomposed, or previously rejected.

In some cases of poisoning of animals by arsenic and by strychnia,
good evidence of poisoning has been afforded by the fatal effect pro-
duced on one animal by eating the flesh of another animal which had
been poisoned.

CHEMICAL ANALYSIS 309

When there is reason to believe that the quantity of poison contained
in tlie matters to be submitted to experiment is small, small animals,
such as rats or mice, should be chosen for the purpose ; and the frog
has been lately recommended as particularly adapted to experiments
with minute quantities of such poisons as strychnia. Leeches have
also been pointed out as applicable to the same purpose.

In experimenting on larger animals which vomit their food, it is ex-
pedient to guard against the rejection of the poison from the stomach
by securing the gullet with a ligature.

In the case of the greater number of poisons the necessity of experi-
ments on animals is altogether superseded by the much higher certainty
which attaches to chemical analysis ; bat as the tests for some of the
vegetable poisons are uncertain, such experiments, performed with
care, are valuable, and have been admitted as evidence.

Experiments on animals have also been resoi-ted to, in order to de-
termine some physiological questions raised in cases of poisoning ; such
as, the shortest time within which a dose of prussic acid may prove
fatal^ or the possible absence of marks of inflammation in the stomach
after poisoning by some substance, such as corrosive sublimate, which
usually occasions well-marked post-mortem appearances.

4. Chemical Analysis. — This form of evidence, though not abso-
lutely necessary when the symptoms, post-mortem appearances, and
circumstantial evidence confirm each other, is always of the first im-
portance. The poison may be discovered in the living person by tests
applied to the urine, to the blood abstracted by bleeding, cupping, or
leeches, or to the serum of a blistered surface ; or it may be detected in
the dead body in the blood, flesh, viscera, and secretions. In both these
cases the discovery of the poison affords conclusive evidence of its
administration. The discovery of a poison in the substances rejected
from the stomach or voided by the bowels, or in the contents of the
stomach and bowels after death, or in articles of food or medicine of
which the sufferer has partaken, is open to certain objections presently
to be mentioned.

Objections may be urged against the sufficiency of the evidence
drawn from chemical analysis on each of the three suppositions, that
poison has been detected, that it has not been detected, or that it has
been found in very small quantity.

On the supposition that a poison has been found in the matters dis-
charged during life, or found in the alimentary canal after death, or in
articles of food or medicine, there is the one objection, that it may
have been accidentally mixed with it, or fraudulently, in order to
inculpate an innocent party, in which case the evidence must be sup-
ported by proof that this could not have happened.

On the supposition that a poison has not been found in any of the
substances submitted to analysis, it does not follow that a poison has
not been taken ; for in the case of a meal actually containing poison,
and being followed by symptoms of poisoning, the articles submitted to

310 EVIDENCE OF POISONING.

analysis may not contain the poison, though some other portion of
the meal may have been adulterated with it. The poison may even be
so unequally distributed through a single dish that the part examined
may not contain any poison, though other parts of it do. Thus, the
poison may be in the gravy, and not in the meat itself, or it may be
sprinkled only on the outside of the joint. Again, when we are
seeking for a poison in the contents of the stomach and intestines, we
may fail to detect it because it had been rejected, or evacuated, ab-
sorbed, decomposed, or evaporated ; or because it belongs to that large
class of vegetable poisons which we have not yet found the means of
discovering with certainty. The poison is most likely to be rejected
or evacuated when it belongs to the class of irritants, absorbed when
it is in a fluid state or soluble, decomposed when it belongs to the
animal or vegetable kingdom. Insoluble substances, or those that are
sparingly soluble, such as arsenic, may often be detected in the stomach
and intestines after repeated vomiting and pui'ging, for they adhere as
powder to the mucous coat, and are enveloped by the tenacious secretion
thrown out about them in consequence of the inflammation to which
they give rise.

In cases of disinterment, poison, though it may have been the cause
of death, and may have existed in the body at the time of death,
may exude through the textures, or be evaporated, or so completely
decomposed, that no trace of it is to be found. This observation does
not apply to the mineral poisons, in a solid form, for though they may
undergo change in consequence of the decay of the textures, they are
merely transformed but not destroyed. Thus arsenious acid may
combine with the nascent sulphuretted hydrogen given off during
the decomposition of the stomach, and be converted into the yellow
sulphide of arsenic, and corrosive sublimate may by the mere contact
of the mucous membrane be converted into calomel, or pure finely
divided mercury. Among the animal poisons, cantharides, and, among
vegetable poisons, opium, may be mentioned as undergoing little change
from the decay of the textures.

It is scarcely necessary to add that cases are by no means of rare
occurrence in which malicious or mistaken imputations of poisoning are
cleared up by the non-discovery of poison in the matters supposed to
contain it.

When poison has been discovered in very small quantity, the objec-
tion is sure to be advanced that the quantity found was not suffi-
cient to account for death. To this objection there is the obvious
reply that the quantity of poison found must always fall short of the
quantity actually taken : for it is only a part of the matters vomited or
otherwise expelled from the body, of the contents of the alimentary
canal after death, or of the blood tissues or viscera of the body which is
submitted to analysis. The discovery, therefore, of a quantity of
poison insufficient to destroy life is scarcely even a presumption that the
substance was not administered in a poisonous dose ; but it is also

QUANTITATIVE ANALYSIS. 311

consistent with the supposition that the poison was given in a medicinal
dose or doses, for purely medical purposes.

But the value of chemical analysis as an evidence of poisoning is not
limited to the discovery of the poison in larger or smaller quantity in
some single substance submitted to examination ; for by the comparison
of one analysis with another, important light is sometimes thrown
upon the manner of administration, and means are afforded of demon-
strating the innocence or guilt of a suspected or accused party. An
interesting case given by Christison on the authority of Dr. Alison
will serve to illustrate this position. A bowl of porridge eaten by
the deceased female tor breakfast was found to contain arsenic. The
chemical analysis showed that the poison was not mixed with the store
of meal, but only with the portion of meal used in making the porridge.
As it appeared from other circumstances that the poison must have
been mixed with the meal in the morning before any stranger entered
the house, the husband (the only other inmate) was convicted of the
murder. An instance of an opposite kind is quoteid by the same
author from Barruel. The arsenic was found mixed with a large mass
of flour, as well as with the part used in making bread. As the
poison was not likely to have been mixed with a criminal intent, with
so large a portion of the flour, the admixture was inferred to have been
made with some innocent purpose. The wheat had probably been
intended for seed, was mixed with arsenic to destroy insects, and had
been sent, in mistake, to the mill.*

In several cases of poisoning by the corrosive acids, the examination
of the clothes of the suspected murderer conjointly with the body of his
victim has led to a conviction.

The cases just referred to are examples of qualitative analysis. The
two following cases illustrate, in an equally striking manner, the use
which may sometimes be made of two or more analyses directed to
determine the quantity of poison present in the several substances sub-
mitted to examination,

Mr. Hodgson, a surgeon, was tried at Durham Autumn Assizes, in
1824, for attempting to poison his wife. It was proved that he had
substituted corrosive sublimate for calomel and opium in pills pre-
scribed by her physician. This he attributed to a mistake committed
while he was intoxicated. It was further proved that a laudanum
draught, also ordered by her physician, contained corrosive sublimate.
This, too, the prisoner explained by alleging that he had mistaken for the
water-bottle an injection of corrosive sublimate which he had previously
prepared for a sailor. But on submitting the draught and the injec-
tion to chemical analysis, the former was found to contain fourteen
grains to the ounce, while the latter contained only five grains to the
ounce. t

* Christison ' Ou Poisons,' p. 15.

t For a full report of this interesting case see the • Edin, Med, and Surg.
Journal,' vol. xxii. p, 438,

312 RULES FOR MEDICO-LEGAL EXAMINATION.

Samuel Whalley was indicted at York Spring Assizes, in 1321, for
maliciously administering arsenic to Martha King, who was pregnant
by him. But it appeared that of the tarts in which the arsenic was
alleged to have been administered, the portions eaten could not have
contained more than ten gi-ains, while the matters alleged to have
been vomited, contained even after repeated attacks of vomiting, fifteen
grains.*

5. The conduct of suspected persons. — Great importance is very
properly attached, in trials for poisoning, to the conduct of the prisoner,
before, during, and after the illness of the deceased. The prisoner is
often proved to have become possessed, without adequate motive, of a
knowledge of poisons and their properties ; to have purchased poison
under false pretences ; to have compounded medicine, or prepared
food for the deceased ; to have sought opportunities of administering
medicine or food ; to have shown great haste in disposing of matters
which might have been exaniined ; to have placed obstacles in the way
of obtaining proper medical assistance ; to have made arrangements for
keeping near relatives, and other inconvenient witnesses at a distance ;
to have made huiTied arrangements for the funeral ; to have made
opposition to an examination of the body ; perhaps to have tampered
with the matters reserved for analysis. Such acts as these, some
of which are likely to fall under the notice of a medical attendant,
will have to be carefully weighed by the jury, together with such
other items of general or circumstantial evidence as the existence of an
obvious motive or inducement to the crime, and the previous state
of mind of the deceased as affording a probability, or the reverse, of
suicide.

This part of the subject of death by poison may be usefully brought
to a close by a summary of the leading precautions to be observed in
conducting medico-legal examinations in cases of suspected poisoning.

RULES FOR MEDICO-LEGAL EXAMINATION IN CASES OF POISONING.

The chief points to be attended to in cases of suspected poisoning
are the following :

1 . The state of the patient before the commencement of the symp-
toms, whether in good health or suffering from illness — the time at
which the symptoms began, and at what interval after a meal, or after
taking food, drink, or medicine — the nature of the symptoms, their
order and time of occurrence, and the period of the commencement of
any new symptom or train of symptoms ; whether the symptoms
increased steadily in severity, or alternated with intervals of ease, and
whether the exacerbations corresponded with a repetition of the food or
medicine, or followed the use of any new article of food or medicine —
also the character of any substances which may have been rejected from

* ' Edin, Med. and Surg. Journal,' vol. xxix. p. 19,

CLASSIFICATION OP POISONS. 313

the stomach, or have passed from the bowels. If the case terminated
fatally, the exact time of the death should be noted down, if the
person is found dead, the time at which he was last seen alive should
be ascertained.

2. When the symptoms of poisoning have shown themselves soon
after a meal, minute inquiries should be made as to the manner in
which the several dishes used at the meal have been prepared ; the
vessels used in the preparation of the food should be inspected, and
their contents, if necessary, be preserved ; suspicious powders or liquids
found in the house should also be sealed and kept. If several persons
have partaken of the same meal care should be taken to ascertain
what articles were taken by those who suffered, and by those who
escaped, and in what quantities, and whether the same articles of
food had been pi'eviously taken without any bad effect by the persons
attacked.

3. The vomited matters must be carefully collected, and removed
from clothing, furniture, &c., on which they may have been rejected ;
and portions of the dress, furniture, or flooring may, if necessary, be
reserved for examination.

4. In performing a post-mortem inspection, a note should be kept
of the time at which the inspection is made, and all the precautions
insisted on (p. 205) should be carefully observed. The state of all
the internal viscera must be noted, and especially of the mouth,
tongue, and fauces, of the larynx, oesophagus, stomach, and intestines.
In removing the viscera, care should be taken to place them on a clean
surface, and to preserve them in clean vessels, and the same caution
applies to the contents of the stomach and intestines. If the medical
man has occasion to transmit the contents of the stomach and bowels,
the blood, or other fluids of the body, or portions of the viscei-a, or
other substance supposed to contain poison, to a chemist for analysis, it
must be carefully sealed, so as to prevent the possibility of the substance
being tampered with during its transit.

5. In performing a chemical analysis, measures should be taken to
pi'eserve the identity of the substances submitted to examination.
While the analysis is going forward they must not be let out of the
sight and custody of the operator, and during his absence they should
be preserved under lock and key.

6. In conducting correspondence in reference to pending medico-
legal analyses, letters should be doubly secured first by wafer or gum,
and then by seal; and letters should be posted, if possible, by the
writer.

CLASSIFICATION OF POISONS.

There are only two principles of classification which commend them-
selves to the judgment of the toxicologist, as logically correct and
practically useful. The one arranges the several poisonous agents

314 CLASSIFICATION OF POISONS.

according to the source whence they are obtained ; the other, in ac-
cordance with their action on the system. When the first principle
of classification is adopted, poisons are arranged in three principal
classes — mineral, vegetable, and animal ; when the second is preferred,
they are also arranged in three leading classes — irritants, narcotics,
and narcotico-acrids. A classification based solely on the source from
which the poison is obtained is open to the very obvious objection
that though almost all the substances derived from the mineral and
animal kingdoms are irritants, those derived from the vegetable king-
dom comprise poisons belonging to each of the three classes, the
ii-ritant, narcotic, and narcotico-acrid. On the other hand, a classifica-
tion based on the mode in which poisons affect the system is subject
to the inconvenience of separating, in the case of the considerable class
of vegetable poisons, substances derived from the same kingdom of
nature, and distributing them through the three classes of irritants,
narcotics, and narcotico-acrids.

As, then, these two modes of classification are open to nearly equal
objection, on the ground of logical consistency, our choice will
naturally be determined by considerations of utility ; and it is obvious
that these greatly preponderate in favour of an arrangement which
places side by side those poisonous substances which produce a similar
effect upon the system.

The most useful classification of poisons, therefore, is that founded
on their mode of action, and this is the one now generally adopted.
According to the received classification, poisons may be distributed
into three principal classes — irritants, narcotics, and narcotico-irritants.
The poisons belonging to the first class excite inflammation in the
parts with which they come in contact, and give rise either to the
constitutional disturbance which attends on high inflammatory action,
or to the nervous symptoms attendant on severe and extensive injury
to impoi-tant organs of the economy ; those belonging to the second
class affect the nervous centres, producing coma, delirium, convulsions,
and other allied symptoms ; and those of the third class combine, in
varying degrees and proportions, the symptoms proper to the two
classes.

After a careful consideration of the many and conflicting difficulties
which surround the attempt at a classification of poisons, I see no
reason to depart from the division into irritants, narcotics, and nar-
cotico-acrids. Distinct chapters will be devoted to these three leading
classes, in which chapters the several poisons belonging to each class
will be distributed into sub-classes, in accordance chiefly with their
mode of action.

The lelative importance of the three classes of poisons may be
inferred from the number of cases in which, one year with another,
they prove fatal. In the five years, 1852 — 56, the number of deaths
by poison amounted, on an average, to 401, of which 133 were due to
poisons not distinctly specified. Of the remaining 268, 90 were

ORDER OF PRECEDENCE OF POISONS. 315

irritants, 175 narcotics, and 3 narcotico-acrids. 82 cases of suicidal
poisoning were distributed as follows : — Irritaut poisons, 27 ; narcotic
poisons, 54 ; narcotico-acrid poisons, 1. It appears, then, that two
deaths by narcotic poisons occur for one death by the irritants, while
deaths by narcotico-acrid poisons are of comparatively rare occurrence.
The principal poisons, arranged in the order of the frequency with
which they prove fatal, take rank as follows : — Laudanum, opium,
morphia, and Godfrey's cordial, 141 ; prussic acid, essential oil of
bitter almonds, and cyanide of potassium, 34 ; arsenic, 27 ; salts of
lead, 23; mineral acids, 15; oxalic acid, 13; mercury, 10; strychnia
and nux vomica, 2.*

* ' Nineteenth Annual Report of the Registrar-General,' p. 164,

316

CHAPTER II.

IRRITANT POISONS.

Substances which inflame the parts to which they are applied are
said to act as irritants to those parts ; and substances which, in
traversing the alimentary canal, inflame the organs with which they
(^ome in contact, are also termed irritants ; and, with the exception
indicated when defining the term poison, of hot and cold water, and
such articles as pins, needles, and powdered glass, may claim to be
admitted into the list of irritant poisons, if they prove in any instance
fatal to life, or productive of symptoms of great severity.

The class of irritants comprises animal, vegetable, and mineral
substances ; it contains a greater number of individual poisons than
the two other classes of narcotics and narcotico-acrids put together ;
and it also contributes largely to the list of cases of poisoning. It
accounts for one-third (90 in 268) of the annual deaths from ascer-
tained poisons; of which third more than two-thirds (61 in 90) were
metallic irritants, one-third (27 in 90) mineral and vegetable acids
(principally the sulphuric and oxalic), while all the remaining irritants
i'ormed but an insignificant fraction of the whole.

So considerable a class of poisons must needs comprise several sub-
classes. Three groups, at least, admit of distinction and separation.
There is the well-marked group of simple corrosive poisons, which
destroy life by a direct destructive action on the mucous membrane of
the alimentary canal ; the equally well-marked group which proves
fatal by the irritation occasioned in the same parts ; and a third group
which add to local destruction or irritation, peculiar remote effects not
due to the local injury they inflict. To the first group belong the
mineral acids, the caustic alkalis, and their carbonates, oxalic acid
when given in strong solution, and the more soluble salts of the
metallic poisons, mercury, antimony, zinc, and tin. To the second
group belong the principal vegetable irritants, some of the alkaline
salts used in medicine, and the less active metallic poisons. The third
group comprises oxalic acid and the soluble oxalates ; the metallic
irritants, arsenic, mercury, antimony, lead, and copper ; the metalloidal
elements, phosphorus, and iodine; and, as a product of the animal
kingdom, cantharides.

Any classification based solely upon the mode of action of these
poisons must recognize these three classes; but as great inconvenience
would arise from separating oxalic acid from the other vegetable acids,

SYMPTOMS. 317

or corrosive sublimate from the less soluble and non-corrosive salts
of mercury, a mixed arrangement, recognizing mode of action, on the
one hand, and similarity of composition and origin on the other, will
best meet the practical requirements of the case. Such a mixed
arrangement is given at the end of the present chapter.
• The symptoms caused by irritant poisons, as a class, are buniing pain
and constriction in the throat and gullet ; acute pain, increased by
pressure, in the pit of the stomach ; intense thirst ; nausea and
vomiting, followed by pain, tension and tenderness of the entire
abdomen ; and purging attended with tenesmus, and frequently with
dysuria. The constitutional symptoms vary with the intensity of the
irritation, and the interval which has elapsed since the administration
of the poison, being at one time those of collapse, at another of inflam-
matory fever. The mode of death also varies. The patient does
not rally from the first shock to the nervous system, or he dies in
strong convulsions, or he is worn out by protracted suffering, or he
is starved through the injury sustained by the gullet and stomach.

These symptoms A^ary in severity, and in the period and order of<
their occurrence, with the quantity of the poison, with its solubility,
and with the full or empty state of the stomach ; but In a more
marked manner, according as it is corrosive or simply irritant. When
the poison is sparingly soluble, as in the case of arsenious acid, the pain
in the several parts specified is not felt immediately on swallowing it,
but after an interval more or less considerable, and, occasionally, the
pain and sense of constriction in 'the throat and gullet are absent; or
they follow the other symptoms instead of preceding them, in conse-
quence partly of the frequent acts of vomiting, and partly of the
repeated contact of the vomited matters with the upper portions of the
tube ; but when the poison is corrosive, and very soluble, as is the
case with the mineral acids, oxalic acid, the pure alkalis, corrosive sub-
limate, and the chlorides of tin, zinc, and antimony, the pain is felt as
soon as the poison comes in contact with the paiis affected, and occurs
almost simultaneously in the throat, fauces, gullet, and stomach,
whence it extends rapidly to the entire abdomen, and is soon followed
by vomiting and purging. The action of the corrosive and more
soluble irritant poisons is also followed by copious vomiting and
purging of blood, which does not take place at all, or to a more
limited extent, in the case of the simple irritants. In poisoning by the
corrosives, also, the upper part of the windpipe is frequently attacked
with inflammation, giving rise to hoarseness, wheezing respiration, and
harassing cough, and often ending in suffocation.

The Morbid Appearances caused by the irritants are those of corro-
sion, followed by inflammation and its consequences, when the poison
is a corrosive, and those of inflammation and its consequences when
the poison is a simple irritant. The corrosions may be confined to small
spots, or they may extend over a large surface ; they may be limited
to a removal of portions, more or less considerable, of the lining mem-

318 IRRITANT POISONS.

brane of the gullet and stomach, or all the coats of those organs may
be destroyed. The parts injured may become the seat of perforations
of greater or less extent, and considerable portions of the organs them-
selves may even be discharged by vomiting or by stool.

The simple irritants, and the corrosives beyond the corroded part,
give rise to inflammation more or less severe, followed by its usual
consequences. In some cases there is merely increased vascularity, in
others deep redness ; the surfsice is covered with a tenacious secretion,
and the cavity filled with a glairy mucus. The coats are found thick-
ened with the intensity of the inflammation ; dark, as if gangrenous,
from the extravasation of blood into the mucous membrane and beneath
the submucous tissue ; softened; but occasionally hard and shrivelled.
Vessels filled with dark blood are sometimes found ramifying minutely
over the surface, which in other instances is studded with black points.
Sometimes the mucous membrane is found ulcerated, and more rarely
it is gangrenous. These appearances are not confined to the stomach,
but are found in the fauces, and oesophagus, and in the duodenum.
The appearances in the rest of the small intestines are those of acute
inflammation, with ulceration and softening of the mucous membrane ;
ulcers are also found in the large intestines, and excoriation of the anus.
In some cases there are traces of inflammation in the mucous membrane
of the larynx and air passages ; and the corrosive poisons often produce
in the gullet a peculiar wrinkled and worm-eaten appearance, due to the
contraction of the longitudinal and transverse fibres, and the removal
of patches of epithelium. (See figures 12, 13, and 14, p. 338.)

The treatment of poisoning by the irritants as a class consists
(irrespective of the administration of the appropriate antidote) in the
prompt use of the stomach-pump (if not contraindicated by extensive
destruction of the soft parts), or of emetics of ipecacuanha, common
salt, or mustard, assisted by copious draughts of warm water, and by
tickling the fauces ; and, when the poison is discharged, by the free
use of milk and water, or of oily and mucilaginous drinks. Castor-oil
mixed with milk is the best aperient. The after-treatment must be
determined by the state of the patient and the special symptoms present
in each case. Bleeding, if indicated by the state of the patient, is to
be commended as removing part of the poison absorbed into the blood.
Several of these symptoms and post-mortem appearances are not peculiar
to poisoning; and there are some common and familiar diseases, as English
and Asiatic cholera, acute inflammation of the stomach or intestines,
rupture of the stomach or intestines, or of other viscera of the abdomen,
in which one or more of the symptoms of irritant poisoning are present
in a marked form. They may also be produced by drinking hot or
cold water ; and authors have been at some pains to show that simple
distension of the stomach, vomiting and purging of blood, colic,
strangulated hernia, and obstruction of the bowels, diarrhoea, and
dysentery, have some symptoms in common with ordinaiy cases of
irritant poisoning, and may still more nearly resemble certain excep-

SIMILAR SYMPTOMS CAUSED BY DISEASE. 319

tional cases. Though the importance of the objections founded on
this possible resemblance of disease to poisoning has certainly been
exaggerated, it may be well to point out some of the leading features-
in which the diseases in question differ from the usual effects of irri-
tant poisons.

In English cholera, the evacuations very rarely contain blood, and
there is no pain and constriction in the throat, except occasionally as
the result of constant efforts to vomit. The disease prevails chiefly in
summer and autumn, and is rarely fatal. In Asiatic cholera, too, dis-
charge of blood is a very rare occurrence, though the evacuations
sometimes have a port- wine tint; and the pain and constriction
of the throat are wanting. In both diseases the purging follows the
vomiting much more rapidly than in cases of poisoning. The irritant
of which the operation most nearly resembles these diseases is arsenic ;
and during the prevalence of both forms of cholera the effects of
arsenic have been mistaken for disease, without seriously affecting
the reputation of the medical attendant. Acute inflammation of
the stomach, except as the result of drinking hot or cold water, or
as the effect of some irritant substance, is a very rare disease, and is
not accompanied either by pain and constriction in the throat, or by
diarrhea. Acute inflammation of the bowels affects their peritoneal
covering, and is attended with constipation. Distension of the stomxxch,
though an occasional cause of severe suffering and of sudden death,
does not admit of being mistaken for the effect of a class of poisons of
which vomiting is a leading symptom. A full stomach would, in
itself, furnish a strong pi-esumption against irritant poisoning. Rup-
ture of the stomach occurring, as it often does, during or directly after
a meal, and through an effort to vomit, followed by sudden and
violent pain, by collapse, and by death instantly, or in from four or
five to less than twenty-four hours, might naturally raise a sus-
picion of poisoning, which nothing short of a post-mortem examination
can set at rest. The same observation applies to a rupture of the
inner coat alone — a case of very rare occurrence — and to rupture of
the intestines, and of the other viscera of the abdomen. All these acci-
dents may be followed by vomiting, with excruciating pain, and extreme
tenderness of the abdomen, cold skin, feeble pulse, and symptoms of
collapse, with death within twenty-four hours. The effect of drink-
ing hot water differs from that produced by the simple corrosives,
chiefly in the absence of characteristic stains, and the negative
result of an analysis. The drinking of cold liquids sometimes causes
vomiting and purging, and other symptoms allied to those of irritant
poisoning ; and, in the absence of a complete history of the case, it
may be necessary to resort to the negative evidence afforded by the
result of an analysis.

Of vomiting and purging of blood it will be sufficient to remark that
they ai'e not accompanied by urgent symptoms suggestive of the action
of poison ; of diarrhcea and dysentery that, in by far the greater

320 IRRITANT rOISONS.

number of cases of poisoning discharges from the bowels are asso-
ciated with vomiting ; and of colic, strangulated hernia, and obstruc-
tion of the bowels, that they are attended l)y constipation, and that the
vomited matters are often feculent.

The post-rnortem appearances in cases of irritant poisoning are not
always characteristic ; and it is true of the more common appearances,
as of some of the more usual symptoms, that they might have been
occasioned by disease. The appearances in the stomach commonly
specified as answering to this description are — Redness of the Mucous
Membrane ; Gangrene and Lividity ; Softening ; Ulceration ; and Per-
foration.

Redness of the mucous membrane may be produced by colouring
matter ; but when it is due to blood contained in the vessels, it may
be traced to subsidence of the blood after death, or to the blood being
driven into the small vessels by the contraction of the arteries, or to
transudation through the peritoneal covering of the liver or spleen ;
or to congestion in cases of sudden death, especially in the various
forms of death from apnoea, when it often occurs in large bright
patches ; or lastly, it may be the result of thj^t flow of blood to the
mucous coat of the stomach which takes place during the process
of digestion. Sometimes, too, a remarkable redness of the stomach
is found after death without any symptoms occurring during life
to account for it. Hence, mere redness of the mucous coat of the
stomach, even when it does not occur on the most depending part, is
not to be regarded as a proof of inflammation. But when the redness
of the mucous membrane is combined with softening, putrefaction not
having set in ; when the membrane itself is covered with a thick and
tenacious mucus ; when it is opaque, so that dissected off and stretched
over the finger, the finger is not visible ; the redness may be certainly
attributed to inflammation, especially if it cannot be traced to mere
subsidence of blood, and the larger veins are not injected. The same
remarks apply also to the intestines.

Gangrene and Lividity . — Gangrene of the mucous membrane is of
very rare occurrence, except as the consequence of long-continued
pressure in cases of hernia. Gangrene of the mucous membrane from
acute inflammation has been described by authors of reputation ; but
there is no doubt that a dark appearance due to infiltration of blood
into its texture has been often confounded with it. This lividity of
the mucous membrane presents itself in as many shapes as the redness
just described ; in points, striae, ramifications, and patches of greater
or less extent. In some instances the vessels, to their smallest
branches, are filled with black blood ; in others, the mucous membiane
is thickly studded with black points ; and in others, again, thick coagu-
lated blood is poured out into the sub-mucous cellular membrane.
These appearances, but especially the latter, are most common in
poisoning by the mineral acids and by oxalic acid. There is reason to
believe that these appearances (with the exception of the injection of

ULCERATION. 321

the vessels with dark blood, which is sometimes seen in post-mortem
softening) are never found in the stomach as the result of disease, but
that they are always due to the action of violent irritants. They are,
however, sometimes met with in the intestines in acute dysentery and
enteritis. This livid colour of the mucous membrane is distinguished
from melanosis by the latter being arranged in regular well-defined
s[)0t5, without thickening of the mucous membrane, or signs of sur-
I'ounding inflammation.

Softening. — The mucous membrane is sometimes softened, some-
times hardened by the action of poisons. When softened, it is either
through the action of the con-osives, or it is the effect of inflammation
without corrosion. Softening is also one result of disease during
life, and of the action of the gastric juice after death. As the soft-
ening fiom coiTOsion is attended with more complete destruction of
surrounding parts, with characteristic changes of colour, and with
signs of acute inflammation, and as the softening due to the action of
the non-corrosive irritants is attended by mai'ks of acute inflammation,
the softening due to these two causes will be readily recognized ; and
the fact that the softening from disease is not preceded by any charac-
teristic symptoms will sometimes assist the diagnosis.

Ulceration. — Ulcers of the stomach may arise either from the action
of poison, or from disease. Those due to disease are either the result
of cancer of the stomach, which is readily recognized, or they occur
in stomachs which, in other parts, present a healthy appearance.
Open ulcers, or the scars of ulcers, are present in about one dead body
in ten. In about one-fifth of the cases there is more than one ulcer.
The ulcer is rarely much smaller than a fourpenny piece, or larger
than a crown-piece, but it may attain a diameter of five or six inches.
Its shape is usually round or oval ; and it presents the appearance of
a shallow but level pit, with a sharp, smooth, vertical edge, as though
it had been punched out ; and as the circular opening in the sub-
mucous areolar tissue is smaller", and the aperture in the pe)-itoneum,
if the ulcer perforates, still more minute, the ulcer has the appearance
of a cone, with the base directed inwards. The mucous membrane
and the areolar tissue are somewhat thickened by exudation of lymph ;
and it is not unusual to find adhesions to surrounding parts. In some
cases there is little or no appearance of inflammation in the parts sur-
rounding the ulcer ; in most instances the edges are thickened and
raised, and the thickening sometimes extends to a circle of half an inch
or an inch ; and occasionally the surrounding parts are described as
" a thick brawny mass," sometimes mistaken for cancer ; or they are
stated to be blackened. In more than a third of the cases the ulcer
occupies the posterior surface of the stomach, and more than three-
fourths of the ulcers occur on the posterior surface, on the lesser
curvature, or near the pylorus.* When due to poison the ulceration

* See Dr. Brinton, ' On the Pathology, SjTuptoms, and Treatment of Ulcer of
the Stomach,' p. 4.

Y

322 IRRITANT POISONS.

is the result of a more intense inflammation tlian that wliich attends
the more chronic ulceration of disease ; and the ulcer is often found
discoloured, as in the case of nitric acid and iodine, or covered with a
white powder, as in the case of arsenic, or coated with a substance
resulting from the decomposition of the poison, such as the black
powder (minutely divided mercury), formed by the decomposition of
corrosive sublimate, or the yellow sulphide of arsenic formed during
the process of putrefaction after death. Those occasional appear-
ances, added to the intensity of the inflammation, and the symp-
toms during life, will render the distinction between idiopathic
ulceration and that due to poisoning easy.

Perforation of the Stomach mny arise, 1, from corrosion; 2, from
inflammation, and consequent ulceration ; 3, from softening during
life ; and 4, from the action of the gastric juice after deatli,

1. Perforation from Corrosion. — It is impossible to confound a per-
foration due to the direct corrosive action of an irritant poison with
any perforation arising from natural causes, acting either during life
or after death. The state of the mouth, throat, and gullet, and often
of the skin and clothes of the deceased will rentier the distinction easy.
In many cases, too, the corrosive poison escaping into the cavity of the
abdomen leaves traces of its action on the other viscera.

2. Perforation from Ulceration is of very rare occurrence. When
caused by idiopathic inflammation, the surrounding mucous membrane
is less highly inflamed, and neither stained nor covered with deposit,
as in poisoning by the irritants.

3. Perforation from Softening of the coats of the stomach during
life is not of rare occurrence. It most frequently happens in young
females, from fifteen to twenty-five years of age, and often after slight
symptoms of indisposition. The rupture generally takes place soon
after a meal, more rarely as a consequence of strong sudden exertion,
and is immediately followed by acute pain of the abdomen, and symp-
toms of acute inflammation of the peritoneum. There is little vomit-
ing, and no purging, but the patient dies in a state of collapse in from
eighteen to thirty-six hours ; but in^some cases the fatal event is post-
poned in consequence of the escape of the contents of the stomach being
small in quantity, and the inflammation of the peritoneum limited in
extent, or subacute in character. The aperture in the peritoneum is
generally small, and the ulcer itself has the peculiar characters just
described. In one-third of the causes the seat of the perforation has
been the lesser curvature of the stomach ; in one-tenth, the pyloric
extremity ; in about one-twentieth the posterior surface ; in the same
number the cardiac extremity ; while in one-eighth of the cases there
are two ulcers opposite to each other on the anterior and posterior
surfaces of the organ, the first being the seat of the perforation.*

The absence of marks of acute inflammation, and, in many cases, of

* Consult Dr. Brinton's work just cited, and Dr. Taj'lor's essay in the ' Guy's
Hospital Reports,' No. 8.

CLASSIFICATION OF THE IRRITANT POISONS. 323

the discolourations characteristic of some of the irritant poisons ; the
non-detection of poison in the stomach itself, or in the contents of the
abdomen ; the sudden occurrence of pain ; the slight subsequent vomit-
ing; the absence of diarrhoea; and the early occurrence of death, as
compared with the period at which perforation following poison
generally proves fatal, will make the distinction between this form of
perforation and that due to poison easy.

4. Pei^foration from the action of the gastric juice after death has
boen the subject of much controversy ; but the fact of its sometimes
taking place has been placed beyond a doubt, by observations and
experiments made both on men and animals. The seat of the opening
is generally the posterior surface of the stomach, but it depends on the
position of the body. The aperture may be of any size, from that of a
shilling to that of the palm of the hand : and, in some instances, it has
been found to occupy one-half of the stomach. It may assume any
shape, and its edges are fringed, softened, and smeared with a dark
pulpy mass, and the vessels of the stomach are sometimes found in-
jected with dark blood. The viscera in contact with the opening
sometimes undergo a» similar change. Occasionally there is more
than one aperture. As there is no appearance of inflammation around
the opening, it is impossible to confound this post-mortem change with
the effect of an irritant poison.

Perforation of the stomach due to the action of irritant poisons "
would be attended by marks of acute inflammation, and by charac-
teristic stains and deposits.

Perforation of the intestines is of very rare occurrence in cases of
poisoning, and perforation of the gullet still less common. Both are
of occasional occurrence as the consequence of diseases not difficult to
recognize after death.

CLASSIFICATION OF THE IRRITANT POISONS.

The following classification, which comprises all the more important
divisions of irritant poisons, is in conformity with the principles
already laid down in this chapter. It recognizes three leading classes,
with numerous sub-classes — the leading classes being — 1. Simple Cor-
rosives. 2. Simple Irritants. 3. Specific Irritants.

1. The class of Simple Corrosives comprises two sub-classes : —
a. The mineral acids, h. The alkalis and their carbonates. These
simple corrosive poisons are treated in two distinct chapters.

2. The class of Simple Irritants comprises : — a. The vegetable
acids, of which the oxalic is the most important. This acid, though
belonging to the class of specific irritants, is most conveniently included
in the same chapter with the other vegetable acids, h. The salts of
the alkalis and earths, c. Vegetable irritants in common use as
purgatives, d. Other vegetable irritants not comprised in the fore-

324 CLASSIFICATION OF THE IIIUITANT TOISONS.

going sub-classes ; among which savin is the most important, e. Pro-
ducts of destructive distillation, such as dippels and fusel oil. /. Er-
got of rye, and other diseased or decayed vegetable matters, g. Animal
irritants, of which canthaiides is the most important, h. Irritant
gases.

3. The class of Specific Irritants contains — a. Metalloidal
poisons, iodine and its salts, and phosphorus, h. Metallic irritants,
among which arsenic, mercury, antimony, lead, and copper, with
their compounds and salts, are the most important.

25

CHAPTER III.

MINERAL ACIDS.

1. Sulphuric acid,

2. Nitric acid.

3. Muriatic acid,

4. Mixtures and compounds of these acids.

The mineral acids, as a sub-class of the large class of irritant poisons,
are distinguished from most irritants by their strong corrosive proper-
ties, and from all irritants except those of the next sub-class, alkalis and
their carbonates, by their remote symptoms being due entirely to their
energetic local action. They have no specific remote effects.

In the years 1837 and 1838 one in fifteen of the fatal cases of
poisoning were due to the mineral acids, pure or in a state of mixture.
The whole number was 36, of which 32 were from sulphuric acid, 2
from nitric acid, mixed in one instance with laudanum, in another with
aloes. The number of cases of poisoning by these acids has probably
decreased both absolutely and by comparison with other poisons ; for
in the five years 1852-1856, 77 cases only were registered, of which
73 were by sulphuric acid, 2 by nitric acid, and 2 by muriatic acid.

Though poisoning by the mineral acids is, for obvious reasons, not
likely to be a homicidal act, they are sometimes administered to adults
in place of medicine, or poured down the throat while they are asleep
or intoxicated : and more frequently to young children by their mothers
or nurses. In mfants the act is most probably homicidal, in children
either homicidal or accidental, in adults generally suicidal. The mineral
acids have also been administered otherwise than by the mouth. One
acid (the sulphuric) has been injected into the vagina, another (nitric
acid) has been poured into the ear.

The mineral acids, especially oil of vitriol, are also sometimes used to
disfigure the person, or destroy the clothes, or to imitate the destructive
action of moths.

The Mineral Acids have the following familiar properties in com-
mon:— they discolour, and, at the same time, corrode, or injure, the
texture of black cloth; and they redden vegetable blues, and alter or
discharge the colour of articles of dress.

The symptoms common to the mineral acids are the following : —

326 MINERAL ACIDS.

a burning pain in the mouth, throat, and gullet, occurring immediately
after swallowing the acid; followed by excruciating pain in the stomach,
eructations, constant retching, and vomiting of a brownish or blackish
matter containing blood, coagulated mucus, flakes of epithelium, or
portions of the mucous membrane of the stomach itself. The act of
swallowing is painful, or even impossible, and there is intense thii'st.
The bowels are costive, and the urine scanty or suppressed, and the
patient is troubled with constant tenesmus and dysuria. The pulse is
generally small and frequent, the respiration catching, and sometimes
laborious, and the countenance expressive of intense anxiety. In some
cases the acid passes into the windpipe, and causes a harassing cough,
with croupy respiration, the accumulation of tenacious mucus dis-
charged with difficulty, and a hoarse voice threatening instant suffoca-
tion. The lips are shrivelled and blistered, or excoriated, or they
present spots of the characteristic colour of the acid bordered with
red, or there are discoloured streaks extending from the angles of the
mouth to the chin. The inside of the mouth is white, shrivelled, and
corroded, and the teeth loose and discoloured. The tongue is some-
times white and polished, sometimes discoloured. The acid generally
leaves distinct marks on the cheeks, neck, or fingers, as well as on the
clothes; and the vomited matters, if rejected on a limestone pavement,
cause effei-vescence. In fatal cases death is generally preceded by
symptoms of collapse ; the intellectual faculties remaining clear to the
last. Sometimes the patient dies convulsed, sometimes suffocated.
Severe nervous symptoms, such as trismus, tetanus, epilepsy, and
delirium are occasionally present, and rashes sometimes appear on
the skin.

The period at which death happens is very variable : it may take
place as early as two hours, or at the end of days, weeks, or even
months. When the patient survives for some days, the symptoms are
somewhat modified. He is feverish ; has a dry skin and frequent pulse ;
occasionally vomits his food and drink, mixed with flakes of tena-
cious mucus, similar flakes being sometimes discharged from the
bowels ; and suffers from salivation with fcetor of the breath. The
belly is tense, the breathing short and difficult ; there are pains and
spasms of the limbs ; digestion is impaired, all the functions of the
body languish, the patient becomes extremely emaciated, and dies in a
period varying from a fortnight to some months.

Other patients recover imperfectly, to become dyspeptic, and valetu-
dinarians for life. Rather less than half the number of cases recover
completely.

In some instances the poison does not reach the stomach, but affects
the throat, gullet, and windpipe. In other cases the acid acts only on
the windpipe, causing death by suffocation.

The mineral acids have also proved fatal when introduced into the
body otherwise than by the mouth ; as when injected into the bowels
or womb, or poured into the ear.

POST-MORTEM APPEARANCES. 327

The post-mortem appearances, common to the mineral acids, are the
following : — The body externally has a healthy appearance. The lips,
chin, and other parts of the body are marked by the action of the acid
in the manner already described. The mucous membrane of the
mouth is white, yellowish, or brownish, shrivelled and corroded ;
and the same appeaiances extend into the throat. The epiglottis
is sometimes contracted, sometimes swollen, the rima glottidis con-
tracted, and the larynx inflamed. The gullet either presents the same
appearance as the mouth and fauces, or it is highly inflamed, and lined
with a coat of tenacious mucus, or its mucous coat is partially or
wholly stripped off. (See fig. 13, p. 338.) Sometimes it presents
the peculiar wrinkled and worm-eaten appearance shown in flg. 12.
Occasionally the gullet entirely escapes. In rare cases it becomes
the seat of ulceration, and is perforated. The stomach is usually
distended with gas, and filled with a yellowish, brownish, or blackish
glutinous secretion, which also extends into the oesophagus and
commencement of the small intestines. The mucous membrane is
highly inflamed, its vessels are minutely injected with black blood ;
see fig. 14, p. 338, in which the black grumous matter and the black
injected vessels are shown in a case of poisoning by hydrochloric acid,
or the black blood is extravasated into its substance ; the rugae are
softened, and extensive destruction of the coats of the stomach, ulcera-
tion, and perforation, are of frequent occurrence. The pylorus is com-
monly contracted. The duodenum presents similar appearances to
those found in the stomach. When perforation takes place, the aper-
tures are generally circular, situated at the posterior part of the organ,
and surrounded by inflammation and black extravasation. The peri-
toneal surface of the viscera, even when there is no perforation of the
stomach, is highly inflamed and coated with coagulable lymph. When
the contents of the stomach escape into the cavity of the abdomen they
act upon the surface of the viscera, and impart to it a peculiar unctuous
feel. The inflammation sometimes extends into the chest, so that the
thoracic surface of the diaphragm has been found coated with lymph.
The blood in the large vessels is often found firmly coagulated. The
urinary bladder is generally emjjty and conti-acted.

Exceptions to the general rule of the post-mortem appearances are
numerous, partly arising from the strength and quantity of the acid,
partly from the state of the stomach at the time, and partly from the
part of the alimentary canal which the poison reaches. It may not
pass beyond the mouth, it may not enter or pass the stomach, or its
action may be limited to the upper part of the windpipe.

The diagnosis of poisoning by the mineral acids is easy. The imme'
diate commencement of the symptoms, the extensive disorganization
produced in all the parts with which the acids come in contact, the
absence of diarrhoea, the stains on the skin of different parts of the
body and on the clothes, form a combination not attributable to any
other cause. In the great majority of cases, the symptoms on the

328 MINERAL ACIDS.

lx)st-raortem appearances are decisive of themselves, but when com-
bined they leave no room for doubt. In almost every instance ad-
ditional evidence is afforded by the chemical analysis.

Treatment. — The best antidote is calcined magnesia, finely powdered
and mixed with water, or milk and water. If this cannot be immedi-
ately procured, carbonate of magnesia, chalk, or whiting may be sub-
stituted ; and, if these should not happen to be at hand, oil or soap-
suds. The plaster from the ceiling or wall of an apartment, beaten
into a thin paste with water may be substituted. The pure alkalis
and their carbonates, being themselves corrosive poisons, should be
given only in weak solution. Previous to the preparation of the anti-
dote, and subsequently to it, milk, and mucilaginous and oily drinks
should be given frequently and in large quantity, and should be con-
tinued for many days.

The use of the stomach-pump is contra-indicated in the con-oded and
softened state of the parts : indeed, it has often been found impos-
sible to introduce it. U the patient is quite unable to swallow, a
cautious attempt may be made to int)oduce the tube into the oesophagus
beyond the obstruction. The subsequent treatment must depend on
the nature and severity of the symptoms. Leeches to the pit of the
stomach may be necessary, and sometimes blood will have to be taken
from the arm. The bowels must be kept open at first by injections of
thin giniel, and as soon as apeiients appear safe, by castor-oil, previously
mixed with about twice its quantity of hot milk. Excoriations on the
surface must be treated as burns.

. 1. SULPHURIC ACID. {Oil of Vitriol.)

Sulphuric acid was the cause of death in one-seventeenth of the
fatal cases of poisoning in 1837-38. It was the poison administered
in 32 out of the 36 cases of poisoning by the mineral acids; of which
32 cases, 21 were accidental, and 7 suicidal, and 4 of a doubtful cha-
racter. In the five years 1852-56 it is ci edited with 73 deaths, and
it takes the fifth rank among the poisons in order of frequency of
use.

The strong sulphuric acid is sold by druggists and oilmen as " oil
of vitriol" to blacking-makers; and the dilute acid as "vitriol,"
"spirit of vitriol,'' or "essence of vitriol," for cleaning utensils of
copper or brass, at the small charge of Id. for four ounces, or 2d, or
Sd. the pound. In medicine, the strong acid is used in the cure of
ringworm, and the- dilute acid is often prescribed as an internal
remedy. In the arts the acid is largely used for vaiious purposes, and,
among othei-s, for the manufacture of other chemicals ; and, as the
impure specimens of the acid sometimes contain large quantities of
arsenic, that poison is often found in drugs and chemicals as an
impurity.

SULPHURIC ACID. 329

For medico-legal purposes, we may have to examine, 1. The strong
acid. 2: The dilute acid. 3. The acid in stains on cloth, 4. The
acid in organic mixtures.

1. Strong Sulphuric Acid.

This is an oily liquid, heavier than water, without odoui", not
fuming, colourless when pure, but, as found in commei'ce, of a brown
tint. It corrodes animal matters, and chars vegetable substances, and
when added to water the mixture becomes hot. The charring pro-
perty of the acid may be tested by a piece of paper or wood.

2. Dilute Sulphuric Acid.

The liquid is known to contain an acid by reddening litmus : it is
probable that it contains either free sulphuric acid or free hydrochloric
acid, if it chars vegetable matters ;* and it is certain that it does so if,
on adding a few drops of nitric acid, and then a solution of nitrate of
baryta, a heavj- white precipitate (the sulphate of baryta) falls down.

The sulphate of baryta collected, washed, and dried, being mixed
with five times its weight of black flux, and heated on charcoal in the
reducing flame of the blowpipe, is converted into a sulphide, which,
on being placed in a test-tube, and moistened by dilute hydrochloric
acid, gives off sulphuretted hydrogen, which may be readily detected
by its odour, and by its effect on paper moistened with a solution of
acetate of lead, and held over the mouth of the tube. By this three-
fold process an acid liquid is proved to contain sulphuric acid ; but
not necessarily as free acid. It may be as a constituent of a supersul-
phate, such as alum; or the precipitate of sulphate of baryta may
have been obtained from a neutral sulpliate, such as Epsom salts, and
the acid reaction from some other free acid in excess. The presence of
a saline ingredient, or of a neutral salt, will be proved by the result of
evaporating the acid liquid ; and the volatile acids, such as the acetic
and hydi'ochloric acids, may be separated by distillation, and identified
by appropriate tests.

3. Stains on Cloth,

The strong acid stains black cloth brown, and corrodes it. The
stain continues moist for years, and has an unctuous feel. The dilute
acid pi-oduces the same change of colour ; but it is less corrosive, and
the spots are diy.

* The charring property of sulphuric acid is so remarkable as to constitute a
test. If a piece of filtering paper be dipped In a liquid formed by adding a
single minim of the strong acid to 800 minims of distilled water, and then dried
before a fire without scorching the dry portion of the paper, the part touched
by the acid becomes black and brittle. Hydrochloric acid has the same pro-
perty, though in a lower degree.

330 MINERAL ACIDS.

To detect the acid, the stained fragment of cloth must be digested
in a small quantity of warm distilled water for a few horns. The
liquid must then be filtered, and treated as dilute sulphuric acid. The
acid may be detected after the lapse of several years, Foi- medico-
legal purposes, an unstained portion of the same cloth should be exa-
mined in the same way.

Clean linen and cotton fabrics corroded by the acid may be sub-
mitted to destructive distillation in a reduction-tube, over the mouth
of which a slip of filtering paper, moistened with a solution of starch,
and sprinkled with iodic acid, is held. The sulphurous acid gas
combines with the oxygen of the iodic acid, and releases the iodine,
which reveals its presence by the bl ue iodide of farina. This process
is not appHcable to woollen textures, which contain sulphates, and the
results must, in any case, be compared with those of a parallel ex-
periment with an unstained portion of the same material. The process
is not applicable to the coats of the stomach, or to its contents.

4. Organic Mixtures.

Liquids containing organic matter, such as tea and coffee, beer and
porter, if thick or tui-bid, must first be boiled with distilled water ; if
clear, they may be filtered at once. The coloured precipitate thrown
down by nitric acid and nitrate of baryta is to be collected, and boiled
in strong nitric acid, to destroy the organic matter, and converted into
sulphide of barium, as above.

The contents of the stomach, or the matters rejected by vomiting,
will have a strong acid reaction if no antidote has been given ; but if
the case has received medical treatment, or the patient has survived
some time, they may be neutral, or even alkaline.

a. If they have an acid reaction, it is probable that they contain a
free acid, which may be sulphuric acid, or one of the two acids usually
found in the stomach, the acetic and hydrochloric. These acids may
be separated by distilling the filtered liquid by the chloride of calcium
bath (see hydrochloric acid), till it attains the consistence of a thin
syrup. If, on testing the result of the distillation for hydrochloric and
acetic acids, neither is present, the liquid in the retort must be diluted,
filtered, and tested for sulphuric acid. If, however, the fluid in the
leceiver contain either acetic or hydrochloric acid, we dilute the liquid
in the retort, and continue the distillation, adding fresh water as often
as necessary, till all trace of these acids disappear. The fluid remain-
ing in the retort is then to be tested for sulphuric acid.

If the fluid has an acid reaction, and also leaves a saline deposit on
evaporation ; and the result of distillation proves that the free acid is
the sulphuric, we are dealing either with a supersulphate, such as
alum, or with a sulphate, such as Epsom salts, in combination with
free sulphuric acid. In the latter case, we may want to ascertain the
quantity of the uncombined acid, which must be done by adding car-

SULPHURIC ACID. 331

bonate of baryta till eflfervescence ceases. The quantity of free acid
may be calculated from the weight of the resulting sulphate of baryta.

b. If the organic matters have an alkaline reaction, or are neutral,
they must be boiled in distilled water and filtered ; the tests being
applied to the filtered liquid.

If carbonate of lime has been given as an antidote, the resulting
sulphate of lime must be dissolved by boiling with nitric acid.

When the quantity of acid discovered by any of these processes is
very small, there is no proof that it has been swallowed; for the
secretions of the stomach always contain a small quantity of neutral
sulphates.

Nor does the discoveiy of a neutral sulphate, such as the sulphate
of magnesia, prove the administration of free sulphuric acid, for the
salt itself may have been given as an aperient.

The discovery of sulphate of lime, however, by proving the admini-
stration of sulphuric acid, and the subsequent use of chalk as an
antidote, would be as conclusive as the finding of the free acid.

But where the characteristic appearances of poisoning with sul-
phuric acid are present, chemical analysis becomes superfluous, except
in those rare cases in which the acid is taken in so dilute a form that
its more marked post-mortem effects are absent.

Sulphuric acid has been detected in parts of the body to which it
must have been conveyed by the blood. It has been found in the
contents of the peritoneum, pleura, heart, and bladder, and even in the
liquor amnii, and body of the foetus. (' Med. Gaz.,' vol. i., p. 710.) The
milk of nurses who were taking the acid has been found to produce
disordered bowels and convulsions in children whom they were
suckling ; and in one case (* Med. Gaz.,' vol. i., p. 756) the matters
voided from the bowels of the child were found to corrode the napkin.

Quantitative Analysis. — Use for this purpose the precipitated sul-
phate of baryta, previously boiled in pure nitric acid, and then care-
fully washed and dried. In 100 grains of the sulphate there are 41 ^
grains of the strong acid,

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — Those already described at p. 325 , but severe in pro-
portion to the strength and corrosive properties of the acid. Seveie
nervous symptoms are sometimes present, such as locked-jaw, rigid
spasms of the extremities, epilepsy, and delirium.

Diagnosis. — The dark-brown stains on the skin, and the moist bi'own
corroded stains on black cloth, are characteristic of this acid.

Post-mortem Appearances. — Those described at p. 327 ; but the
degree of disorganization greater, and perforation more frequent (about
two-thirds of the cases), than in poisoning by the other mineral acids.
The colour of the epithelium and mucous membrane dark-brown or
black, as if charred; while in cases of poisoning by nitric acid it is

332 MINERAL ACIDS.

more commonly yellow or green. When thickly coated with mucus,
the lining membrane of the mouth and of the sevei-al portions of the
alimentary canal acted on by the acid, has the appearance of being
coated with white paint. Dr. Chowne has shown that this is the
effect of sulphuric acid on the secretions of the alimentary canal after
death. On the mucous membrane itself after death, the local eil'ect of
the acid, as shown by Orfila, is to render the membrane yellowish and
brittle, to bleach the muscular and peritoneal coat, and to char the
blood in the vessels.

Smallest fatal dose. — In the adult, one drachm. A less quantity
in the infant. In one instance, half a teaspoonful of the dilute acid
proved fatal to an infant five weeks old. (' Med. Gaz.,' vol. xxii., p. 389.)
Two ounces have been swallowed by adults without fatal conse-
quences.

Shortest fatal period. — Two hours. In fatal cases, life may be
prolonged for several days, weeks, or even months.

Average Duration. — In cases which prove fatal within 24 hours,
about 10 hours.

Mortality. — Almost all infants and young children. In adults,
two-thirds of the cases.*

Treatment. — That already described at p. 328.

* The following are the general results of several cases reported in the
English and Foreign Journals : —

Of 36 cases (of which the majority occurred in females) — 26 were fatal (all
the children and 18 adults), and 10 recovered (all adults).

Of 31 cases — 20 were suicidal, 3 homicidal (all young children), and 8 acci-
dental (2 of them children).

Among adults, the recoveries were to the deaths, both in accidental and
suicidal poisoning, as 1 to 2.

Of the 26 fatal cases, 10 lasted a day or less ; 6 more than a day and less than
a week ; 3 less than a fortnight ; 1 from a fortnight to three weeks ; 1 more
than three weeks ; and 5 extended from live to forty-five weeks.

The following were the precise periods of death — in 5 children, 1 in 3i hours,
2 in 4i hours, 1 in 12 hours, and 1 in 3 days." In 20 adults— 1 in 3i hours, ] in
about 4 hours, 1 in 8 hours, and 1 in 12 hours; 2 in 1 day, 1 in 1^ day, 2 in
2 days, 1 in 4 days, 1 in 5 days, 1 in 8 days, 1 in 11, 15, 22, and 33 days respec-
tively, and 2 in 60 days: 1 in 26 weeks, and 1 in 45 weeks.

The average duration in all who survived a day or less was 10 hours— of all
surviving a week or less 32 hours.

The recoveries are stated to have taken place in 6, 7, 10, 11, 14, 18, and 23
days respectively.

Perforation of the stomach took place in 8 cases out of 21 in which the post-
mortem appearances are described.

The reader is referred to the following cases reported in English Journals, or
extracted from foreign publications : —

Ed. Med. and Surg. Journal— "Vol. x. p. 527. Vol. xxii. Vol. xxvi. Vol. xxxvi.
p. 99. Vol. liii. p. 406 et seq. (an interesting case by Dr. Craigie with many
valuable cases from foreign sources), and Vol. Ivi. p. 537. — Lancet, 1834-5,
1. p. 266. 1836—7, i. p. 195. 1837—8, 11. p. 782.— Medical Gazette, Vol. i. p. 127.
Vol. vii. p. 27. Vol. xxii. p. 76. Vol. xxv. p. 944. Vol. xxix. p. 147. Vol.
XXX. p. 352, — Medical and Physical Journal, Vol. i. p. 500.— Medical Repositorj",
Vol. xiv. p. ] 60.— Guy's Hospital Reports, Vol. iv. p. 297.— See also Dr.
Roupell's Illustrations of the effects of poisons.

NITKIC ACID. 333

Sulphuric acid has been introduced into the body in other ways
than by the mouth. It has been injected into the vagina to procure
abortion ; and into the rectum by mistake for a clyster ; and it is
sometimes used to disfigure the face and injure the dress. The local
treatment of parts thus injured will consist in the use of alkaline
lotions to neutralize the acid, followed by that appropriate to burns.

2. NITKIC ACID. {Aqua Fortis, Eed Spirit of Nitre.)

This acid is much less frequently used as a poison than sulphuric
acid, but moi'e frequently than hydrochloric acid. It was the cause of
four deaths in. 1837-38, two of which were from the unmixed acid;
and of two deaths only in the five years 1852-56.

The poison may present itself for analysis, 1, as the strong acid ; 2,
as the dilute acid ; 3, in stains on cloth ; and, 4, in organic mixtures.

1. Strong Nitric Acid.

This acid, as met with in commerce, varies in colour from a deep
orange to a light yellow ; gives out orange-coloured acid fumes ; pro-
duces dry yellow stains in black cloth, which it also coiTodes, though
in a less degree than sulphuric acid, and causes similar stains in other
articles of dress, and in the skin and other tissues of the body. These
stains become brighter when touched with an alkali. When poured on
coj^per, tin, lead, or mercury, ruddy, colourless fumes of binoxide of
nitrogen are given off, which immediately become ruddy on admixture
with air, a brisk effervescence takes place, and a greenish liquid remains.
With morphia and its salts, the acid strikes a rich orange colour.

2. Dilute Nitric Acid.

The liquid is proved to contain an acid by the effect on litmus
paper. The addition of a few drops of pure nitric acid and nitrate of
baryta, by the absence of precipitate, proves that sulphuric acid is not
present. The absence of precipitate on adding a solution of nitrate of
silver shows that it is not hydrochloric acid. If a mineral acid,
therefore, it is nitric acid ; and as most of the vegetable acids give a
precipitate with nitrate of silver, there is a strong presumption in
favour of the liquid containing nitric acid. This presumption is con-
verted into certainty by the following tests : — a. When boiled with
copper filings, provided the acid be not very dilute, the characteristic
orange fumes are given off. b. It' carbonate of potash is added to the
liquid till effervescence ceases, and a piece of filtering paper is dipped
into the liquid and dried, it burns like touch-paper, c. On slowly
evapoi'ating the liquid, it yields crystals of nitrate of potash.

The crystals of nitrate of potash obtained in this manner fromvthe
solution, yield further corroborative proofs of the nature of the acid,
by the following reactions: — a. The crystals are lengthened, fluted
prisms, permanent in the air. b. When ignited on charcoal, they burn

334 MINERAL ACIDS.

with deflagration, c. On the addition of strong sulphuric acid, a
colourless vapour with the peculiar odour of nitric acid is given off'.
(/. Place a fragment of the salt on a por<;elain slab, add one or two
•Irops of distilled water, and then a drop of strong sulphuric acid ; in
the resulting liquid place a fragment of morphia. The morphia will
assume a rich orange colour, and gradually impart to the liquid a deep
yellow tint. e. Substitute for the morphia a fragment of copper : the
ruddy fumes of nitrous acid will be given off. /. Place on a porcelain
slab a crystal of the salt, moisten it with distilled water, add a drop of
concentrated sulphuric acid, apply the heat of a spirit lamp, and, as
effervescence takes place, introduce into the liquid a crystal of the
green sulphate of iron ; a dark green ring, changing to brown, will
form round the crystal, g. Place a crystal of nitre on a porcelain
slab, moisten with distilled water, add a drop of strong sulphuric acid,
and one or two drops of strong hydrochloric acid : the resulting liquid
dissolves gold leaf.

3. Stains on Cloth.

Strong nitric acid injures the texture of black cloth, and produces
a dry stain, which is at first yellow, or orange, but grows darker
by the lapse of time. It is deepened in colour when touched by
an alkali. The process of analysis is very simple. The fragment
of cloth must be digested in a small quantity of warm distilled
water. The presence of an acid will be indicated by test paper ; and
the nature of the acid will be inferred from the appearance of the
stain. The acid is then to be neutralized with carbonate of potash,
and the solution filtered. The dry filter will burn like touch-paper.
Evaporate the liquid, collect the crystals, and apply the morphia test
on a surface of white porcelain ; and if possible apply the other tests
in succession. As nitric acid is less permanent than sulphuric acid, it
cannot be detected in stains on cloth after so long a period. But Dr.
O'Shaughnessy obtained satisfactoiy evidence of its presence in a
fragment of cloth from a coat which had been folded up " during the
previous summer ntionths." — ('Lancet,' August 1830.)

It may be necessary to distinguish stains produced by nitric acid
from those caused by iodine or by bile. The stains from nitric acid are
indelible, and when touched with a weak solution of caustic potash
become orange yellow. Those caused by iodine immediately disappear ;
the bile-stain undergoes no change. (Barruel.)

4. Organic Mixtures.

If the liquid is viscid, dilute with distilled water, boil, and filter.
If it has an acid reaction, neutralize with carbonate of potash, crys-
tallize, and apply the tests already described.

If antidotes, such as chalk or magnesia, have been given, the liquid,
instead of having an acid reaction, may be neutral or feebly alkaline

NITRIC ACID. 335

In this case, also, the filtered liquid is to be neutralized with carbonate
of potash ; soluble nitrate of potash will be formed, and insoluble
carbonate of lime or magnesia will be thrown down, which must be
separated by fresh filtration. The filtered liquid is then to be evapo-
rated, and the crystalline residue tested for nitrate of potash.

When the quantity of acid in the organic liquid is very small, it
has been recommended to filter the liquid from the vessel containing it
by means of a rough syphon formed of filtering paper. (Christison.)

Portions of mucous membrane acted upon by the acid may be treated
in the same manner as fragments of cloth.

In the case of nitric as of sulphuric acid, the post-mortem appear-
ances are so characteristic as to render chemical analysis unnecessary.

Quantitative analysis. — To the nitrate of potash add strong sul-
phuric acid ; dissolve the sulphate, calcine it, wash with alcohol to
remove free sulphuric acid, and evaporate to dryness. For one hun-
dred grains of the dry sulphate allow about eighty-two grains of liquid
nitric acid.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Si/mptoms. — Those already described (p. 325). A miliary rash,
attended with intolerable itching, was present in one case on the sixth
day.

Diagnosis. — The yellow stains on the skin, and the dry yellow
corrosions on the dress, are characteristic of this acid ; and the dis-
covery of these stains on the person and dress has often led to detection
in homicidal cases.

Post-mortem appearances.' — Those already described (p. 327). The
colour of the mucous membrane yellow or green in parts of the
stomach and intestines containing bile. The degree of corrosion less,
and perforation of rarer occurrence, than in poisoning with sulphuric
acid.

Smallest fatal dose. — Two drachms. (Taylor.) In infants less.
Recovery has taken place after half an ounce, or more.

The shoi^test fatal period. — In the adult one hour and three quar-
ters : in the infant a few minutes.

Average duration. — In the majority of fatal cases death takes place
within twenty-four hours ; but hfe may be prolonged to several days,
weeks, or months.

Treatment. — That pi'escribed for tlie mineral acids generally
(p. 328).

Nitric acid has been introduced into the body in other ways than by
the mouth. In one case it was poured into the ear, and caused in
succession sloughing, abundant haemorrhage, paralysis jactitans, ex-
treme debility, and death in about thirteen weeks. (* Med. Gaz.' March,
1830.)

The orange fumes given off when nitric acid is poured upon copper
or mercury (and which are commonly known as nitrous acid gas) are

336 MINERAL ACIDS.

produced in large quantity in some processes of the arts, such as water-
gilding and brass-button making. They irritate the eyes and lungs, and
give rise to a troublesome cough renewed by each repetition of the pro-
cess ; and at length becoming habitual. In more than one instance it
has proved fatal in periods vaiying from twenty-seven hours to two
days. The sipnptoms are a burning heat in the throat; tightness at
the chest and pit of the stomach ; extreme distension and acute pain
of the abdomen ; nausea and vomiting ; purging of a yellow matter ;
scanty secretion of urine and dysuria ; a cough at first dry, and then
attended by scanty orange expectoration, with extreme dyspnoea, and
feeling of impending suffocation ; transient delirium ; extreme debility ;
and inexpressible anxiety; and death after convuiaions. The post-
mortem appearances consist in signs of acute inflammation and its
consequences in the air-passages and lungs, and in the alimentary
canal, engorgement of the lungs and heart with black liquid blood,
distension of the stomach and intestines with gas, and a yellow colour
of the contents of the air-passages and alimentaiy canal. Manufac-
turers who produce these irritating fumes ought to be required to
conduct them into the nearest chimney.

The binoxide or deutoxide of nitrogen which, when mixed with air,
gives lise to these orange fumes, cannot be respired without producing
them by combining with the atmospheric air in the lungs. Hence it
cannot excite surprise that Sir H. Davy suffered very severely when
he tried to inhale the binoxide.

3. MURIATIC ACID. {Ili/drochlortc acid. Spirit of Salt.)

Though muriatic acid is somewhat largely employed in the art^, it is
not often used as a poison. No case of poisoning by it was leported in
the years 1837-38; only two cases in the five years 1852-56, and
less than half a dozen cases have occurred since that time. The poison
may have to be examined, 1. As the strong acid. 2. As the diluted
acid. 3. In stains on cloth. 4. In organic mixtures.

1. Strong Muriatic Acid.

The acid of commerce is of a yellow colour, fuming when highly
concentrated, and yielding dense white fumes with the vapour of
ammonia. It produces a green stain in black cloth, but does not
corrode it ; or the stain is first red and then green ; and it reddens
vegetable blues. It is distinguished from sulphuric acid by its colour,
and from nitric acid by the absence of orange fumes when poured on
metals. When boiled with black oxide of manganese, chlorine is given
off, which is known by its colour, odour, and bleaching properties,

2. Dilute Muriatic Acid.

Having ascertained that the liquid contains an acid by the use
of litmus paper, we first test it by nitric acid and nitrate of baryta ;

MURIATIC ACID. 337

if there is no precipitate it is probable that the acid is either nitric or
muriatic. If on testing it with a solution of nitrate of silver we
obtain a dense white precipitate, the probability is greatly strengthened ;
and if the precipitate is insoluble in nitric acid, and in caustic potash,
but very soluble in ammonia, and, when dried and heated fuses into
a horny mass, which may be cut with a knife, the acid is certainly
mm-iatic acid.

As a chloride (such as common salt) with a free acid would have
an acid reaction, and yield the same white precipitate with nitrate of
silver, a portion of the liquid should be evaporated, when, if there is a
crystalline residue, the acids should be distilled over and the crystal-
line residue examined.

3. Stains on Cloth.

Digest the stained cloth in warm distilled water, filter, test with
nitrate of silver, and identify the precipitate as above. Examine, at the
same time, an unstained portion of the same cloth.

4, Organic Mixtures.

Most organic liquids contain muriatic acid free or combined, and
most organic matters yield a precipitate with nitrate of silver. In
the contents of the stomach, the acid may either exist in the free state,
in which case the liquid will have a strong acid reaction, or it may be
combined with an antidote, in which case the liquid may be neutral.

If the liquid has a strong acid reaction, we submit it to distillation
at a low temperature, by immersing the retort in a boiling solution of
chloride of calcium (two parts of the salt to one of water), the distil-
lation being repeated by adding distilled water to the dry residue. The
liquid in the receiver may be ti-eated as pure diluted acid.

If by this means we detect free muriatic acid in the contents of the
stomach only in minute quantity, the proof of poisoning by this acid
will be incomplete, for the gastric juice itself contains a minute pro-
portion (one part in 1500) of free muriatic acid. But when the
acid is found in considerable quantity in the stomach of a person in
whom the symptoms during life and the post-mortem appearances
were those due to the action of a mineral acid, the cause of death will
be clearly proved.

If the organic liquid is neutral, it may either contain no muriatic
acid, or the acid may be combined with an antidote — magnesia, lime,
soda, or potash. In this case we evaporate to dryness and calcine,
dissolve the residue, and test the solution with nitrate of silver.

If the residue consists of common salt, it may have resulted from the
administration of carbonate of soda as an antidote, or the common salt
may have formed a part of the food. Here, again, the result of the
chemical analysis is worthless unless supported by the symptoms and
post-mortem appearances, and the stains which we may discover on
the clothes.

z

338

MINERAL ACIDS.

Quantitative Analysis. — Use for this purpose the dried precipitated
chloride of silver, of which 100 grains are equivalent to 69 grains of
liquid muriatic acid.

Symptoms. — Those already described (p. 325).

Post-mortem Appearances. — Those already described (p. 327). In
a suicidal case, in which a large quantity of the strong acid was taken,
and proved fatal in less than twenty-four hours, the epithelium of
the throat and gullet was destroyed in patches, and the stomach
contained a large quantity of black grumous matter, adhering to the
surface so as to admit of being preserved. The preparation, with a
drawing from the recent gullet and stomach, is in the Museum at King's
College. As the appearances in this case, especially^he shrivelled and
worm-eaten aspect of the gullet, bear a very near resemblance to those
present in cases of poisoning by sulphuric acid (see Roupell's Plates)
and to one case of poisoning by oxalic acid which came under my notice,
I append three woodcuts which, even in the absence of colours, convey
a very clear idea of the actual appearances. Fig. 12 shows the corrugated
and worm-eaten appearance of the gullet ; fig. 13 a portion of the
gullet from which a large patch of epithelium has been removed, and
fig. 14 the appearance of the stomach with its black grumous contents
and the vessels injected with black blood. The preparation was pre-
sented to the Museum by Mr. Bowman

FiR. 14.
Fig. 12. FiK. 13.

The mucous membrane of the stomach and intestines sometimes has
a yellow tint, or it is green from the action of the acid on the bile. No
case of perforation has yet been reported ; but in a case of poisoning by
a large dose of the dilute acid reported by Puchelt of Heidelberg, the
entire stomach is stated to have been destroyed, and rejected by vomiting.

Smallest fatal dose. — One ounce.

Shortest fatal period. — Five hours and a half.

Average period. — About twenty-four hours.

Treatment. — That of poisoning by the other mineral acids (p. 328).

MIXED ACIDS USED IN THE ARTS. 339

Nitric acid mixed with sulphuric, under the name of aqua regince,
and with muriatic acid, under the title of aqua regia, are used in the
aits, the one to separate silver from plated articles and in the manu-
facture of collodion, the other to dissolve gold and platinum.

The mineral acids have also been taken in a state of mixture with
other substances — nitric acid with laudanum, aloes, &c. ; and muriatic
acid, in combination with tincture of iron and corrosive sublimate, is in
common use for browning gun-bai-rels, and has been taken as a poison
in one case (' Medical Gazette,' November, 1839).

340

CHAPTER IV.
THE ALKALIS AND THEIR CARBONATES.

1. Potash and Carbonate of Potash.

2. Soda and Carbonate of Soda.

3. Ammonia and Carbonate of Amm^ia.

The alkalis and their carbonates share with the preceding sub-class
of initants, the mineral acids, the property of destroying the animal
tissues by the violence of their action, at the same time that they give
rise to no specific or peculiar remote efiiects. The corrosive property
of these poisons belongs to them only when swallowed in substance, or
in strong solution, as that of the mineral acids belongs to the concen-
trated acids or their less dilute mixtures.

The alkalis and their carbonates, in common with the alkaline
earths, are distinguished from one class of the metals, commonly so
called, by the negative eflect of sulphide of ammonium, from another
class by the negative effect both of hydro-sulphuric acid and sulphide
of ammonium. They resemble the alkaline earths in having an alka-
line reaction ; but they differ from them by yielding no precipitate with
carbonate of ammonia.

Though the alkalis and their carbonates are in very common use for
household purposes, or as medicines, they are very rarely administered,
or taken by accident, as poisons.

1. POTASH AND CARBONATE OF POTASH.

Caustic Potash, as used in the laboratory, is in the form of greyish
masses, which present when broken an imperfect crystalline texture,
are soapy to the touch, acrid to the taste, highly deliquescent, fusible
by heat, rapidly absorbing carbonic acid from the air, and very soluble
in water. When fused in small cylindrical ^moulds it is the potassa
fusa of the shops.

In solution (the liquor potassce of the shops and laboratory) it has
a strong alkaline reaction ; changes the colour of black cloth to brown ;
is not precipitated by carbonic or sulphuric acid, but yields with a
solution of bichloride of platinum a yellow precipitate.

The carbonate of potash, bicarbonate of potash, or salt of tartar,
is sold by oilmen in two forms. 1. As a mottled deliquescent mass —
yellow, grey, brown, and black — with a soapy feel, a urinous taste,
and a strong alkaline reaction. In this form it is known as Potash or

POTASH AND CARBONATE OF POTASH. 341

Potashes, and is used chiefly for cleaning oil lamps. 2. In small
white grains, or as a white semi-crystalline mass, having similar de-
tergent properties, and used for washing and other cleansing purposes.
In this form it is known as Pearlash.

We may have to examine and identify these salts. 1, In substance.
2. In solution. 3. In organic mixtures.

1. In Substance.

Potash (or potashes) is readily recognized by the physical properties
just described. The more pure form of carbonate of potash requires to
be distinguished from carbonate of soda, and from other white powders.
It has an alkaline reaction, effervesces and gives out carbonic acid
when treated by acids, and imparts a violet tint to the deoxidizing
flame of the blowpipe. It is very soluble, and has in a state of solution
the properties now to be described.

2. In Solution.

A solution of carbonate of potash when evaporated on platinum
foil leaves a white deposit not dissipated by heat, and is thus distin-
guished from the salts of ammonia : it has an alkaline reaction ; it
yields a yellow precipitate with a solution of bichloride of platinum,
in which respect it resembles the salts of ammonia, but differs from
those of soda ; it gives a colourless precipitate of bitartrate of potash
with a solution of tartaric acid, which precipitate is promoted by
agitation and by friction with a glass rod.

3. In Organic Mixtures.

If an organic liquid has a strong alkaline reaction, there is a pre-
sumption in favour of one of the substances contained in this chapter.
By diluting and filtering a small portion of the liquid, and applying
trial tests, it will be easy to ascertain which of the three alkalis is
present. The process for the carbonate of potash consists in evaporating
the organic matter to dryness, incinerating the residue, treating the
ash with distilled water, and applying to the solution the tests just
enumerated.

SVMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — When a strong solution of the poison is taken, an acrid
burning taste is perceived in the act of swallowing, followed imin>
diately by a burning sensation in the throat and gullet. This is soon
followed by acute pain in the pit of the stomach, with great tenderness
on pressure; frequent and violent vomiting of a tenacious bloody
mucus, of a brown grumous matter, or of flakes of epithelium.
Violent colic pains, with tension and tenderness of the abdomen, soon
supervene, and there is purging of stringy mucus mixed with blood.

342 THE ALKALIS AND THEIU CARBONATES.

Theie is much difficulty in swallowing, and sometimes hoai-seness of
the voice, and cough. In fatal cases, death either takes place with
symptoms of collapse, or after prolonged sufferings from increasing
difficulty in swallowing, constant vomiting of blood, bloody stools, and
tenesmus. In chronic cases the patient dies from starvation, through
the long-continued stricture of the oesophagus.

Post-mortem Appearances. — The lining membrane of the throat
and gullet is softened and corroded ; the oesophagus, stomach, and
intestines are inflamed, with abrasion and ulceration of the lining
membrane, and dark spots or patches caused by the extravasation of
blood. Sometimes the inflammation extends to the larynx. In chronic
cases, large portions of epithelium and mucous membrane are found
removed, and the gullet and stomach are contracted. Perforation has
not taken place in any of the recorded cases.

Smallest fatal quantity. — Half an ounce.

Shortest Jatal period. — Three hours.

Average fatal period.— In the majority of fatal cases death takes
place within twenty-four hours. In chronic cases, the fatal event
may be delayed for days, weeks, months, or tven years.

Treatment. — As an antidote, vinegar largely diluted with water or
lemon-juice and water. Acidulated demulcent drinks, and the juice of
oranges and ripe fruits may then be freely administered, and almond or
olive oil. Inflammatory symptoms must be combated with anti-
phlogistics, pain by preparations of opium, and collapse, if present,
by the usual stimulants. The stomach-pump should not be used.

2. SODA AND CARBONATE OF SODA.

Caustic soda has no medico-legal interestj Carbonate of soda is
sold by oilmen for cleansing purposes, in two forms, as soda and best
soda — the soda in a dirty crystalline mass, the best soda in masses of
a purer white. In common with potash, carbonate of soda may have
to be identified in substance, in solution, and in organic mixtures.

1. In Substance.

Carbonate of soda has an alkaline reaction ; it efiervesces and gives
oqt carbonic acid when treated with an acid ; it readily crystallizes,
and is efflorescent, and it imparts a yellow colour to the flame of the
blowpipe.

2. In Solution.

A solution of carbonate of soda dilTere from a solution of carbonate
f>f potash by yielding no precipitate with the bichloride of platinum, or
with tartaric acid ; while it gives with antimoniate of potash a white
ciystalliue precipitate. Further distinctions might, if necessary, be
founded on the form and character of the salts of the two alkalis ; but
this is unnecessary. It will suffice to state that when converted into

AMMONIA AND CARBONATE OF AMMONIA, 343

nitrates by adding dilute nitric acid, soda crystallizes as rhombic plates,
and potash as prisms.

3. In Organic Mixtures.

The process for organic liquids containing carbonate of soda is the
same as for those containing carbonate of potash.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — Those of poisoning by carbonate of potash, but of less
severity.

Post-mortem Appearances. — Those of poisoning by carbonate of
potash, though less marked.

Treatment. — That of poisoning by carbonate of potash.

3. AMMONIA AND CARBONATE OF AMMONIA.

Ammonia in the form of gas, or dissolved in water, as the liquor
ammonicB, or in combination with carbonic acid gas as the sesqui-
carbonate of ammonia, is largely used in medicine and the arts, and
is occasionally taken as a poison, generally by accident; but in rare
instances it is taken or given v/ith intent to destroy life. The in-
cautious use of the vapour of ammonia with a view to rouse patients
from syncope, or asphyxia, or as an antidote to prussic acid, has also
caused death by suffocation or inflammation of the air-passages.

The vapour of ammonia is readily recognized by its pungent odour,
and it is distinguished from the tixed alkalis by the change produced
in vegetable colours being dissipated by heat. The sesquicarbonate
(vulgarly known as hartshorn, volatile salt, or smelling salts) is recog-
nized by its pungent odour, and distinguished from the carbonates of
potash and soda by being completely dissipated when heated on pla-
tinum foil. It is distinguished from liquid ammonia by effervescing
with an acid, and yielding a white precipitate with the salts of lime.

Ammonia is set free from its salts when they are heated with liquor
potasssp in a test tube, the vapour of ammonia being identified by the
odour, by its alkaline leaction on turmei'ic or reddened litmus paper,
and by the dense fumes formed when brought into contact with hydro-
chloric acid. Ammonia in organic mixtures must first be separated by
distillation and then identified by its appiopriate tests.

Symptoms. — These, as far as they are due to actual contact, are the
same as those produced by potash and soda, and their carbonates ; but
from its extreme volatility it gains access to the air-passages, and has
thus proved fatal in so short a time as four minutes.

Post-mortem Appearances. — Signs of violent inflammation in the
alimentary canal with separation of the epithelium of the mouth, and
inflammatory appearances in the air-passages.

Trratment. — Vinegar and water as an antidote, and the after-treat-
ment proper to the class of irritants.

344

CHAPTER V.
THE VEGETABLE ACIDS.

1. Oxalic Acid (and the Binoxalate of Potash).

2. Tartaric Acid (and Bi tartrate of Potash).

1. OXALIC ACID {Acid of Sugar).

This substance is largely used in the arts, under the common name of
acid of sugar. It is in use among bookbinders, shoemakers, and
workers in leather, among straw-bonnet makers and workers in straw ;
and among workers in brass. It is also commonly employed to take
ink-stains out of linen. It is sold both by druggists and by persons
who supply the trades using it. Its cheapness (2d. per ounce),
common employment, and known activity, commend it to the suicide ;
its resemblance to Epsom salts leads to accidents ; while its strong
acid taste unfits it for the purpose of the murderer, unless mixed with
some strongly-flavoured liquoi', such as gin, brandy, or rum, or strong
tea or coffee.

Oxalic acid, for the reasons stated, is in common use as a poison,
taking the sixth place among the ascertained poisons. In the five
years, 1852-56, it was credited with 13 deaths per annum, or about
1 in 21 of the ascertained poisons. Of these 13 deaths, 4 occurred in
men and 9 in women, and 10 of the 13 were suicidal cases. Of the
19 cases traced to oxalic acid in the two years, 1837-8, 13 were
suicidal and 1 accidental ; while of 15 cases which I have collected
from 'different sources, 8 were suicidal, 5 accidental, and 2 unascer-
tained. Of the 15 cases 12 occurred in women and only 3 in men.

Tests.— OxbWc acid may have to be examined in substance, in solu-
tion, and in organic mixtures.

1. In- Substance.

The crystals are transparent, colourless or nearly so, permanent in
the air (unless containing nitric acid), very sour to the taste, soluble
in about their own weight of hot water, and in from eight to twelve
or fourteen times their weight of cold water. They are also soluble
in alcohol.

The crystals are four-sided prisms, with dihedral or tetrahedral
summits ; and they bear such a resemblance to the crystals of sulphate
of magnesia and sulphate of zinc, as to be occasionally confounded with
them. The distinction, howerer, is easy. Oxalic acid has an intensely

OXALIC ACID. 345

sour taste ; the other salts are bitter : the solution of oxalic acid has a
strong acid reaction ; that of the sulphate of magnesia is neutral, and
of the sulphate of zinc only slightly acid : oxalic acid is entirely dissi-
dated by heat, or, if impure, leaves only a scanty saline residue ; the
sulphates of magnesia and zinc are fixed : liquor potassaj added to a
solution of oxalic acid produces no change ; but it precipitates the
white oxides of the sulphates of magnesia and zinc ; oxalic acid effer-
vesces with solutions of the alkaline carbonates, but yields no precipi-
tate, while the sulphates of zinc and magnesia give a white precipitate,
without effervescence. Oxalic acid discharges the colour of ink ; the
other crystals produce no change in it.. Oxalic acid is sufficiently dis-
tinguished from the citric and tartaric acids by the defined shape of its
crystals.

2. In Solution.

The liquid is known to contain an acid by its action on litmus,
and a vegetable acid or acid salt if it yields crystals on evaporation.
Long slender prismatic crystals, dissipated by heat, afford a strong pro-
bability of the presence of oxalic acid. On the supposition that we are
ignorant of the nature of the acid, we acidulate with a few drops of
nitric acid and then add a solution of nitrate of baryta. The absence
of precipitate shows that it is not sulphuric acid. We then add to
another portion of the liquid a i%v{ drops of a solution of nitrate of
silver ; a white precipitate is thrown down, which will be identified as
oxalate of silver by the tests presently to be described.

If we have reason to believe that the acid liquor contains oxalic acid,
we may obtain more complete evidence by evaporating and obtaining
crystals, or by the addition of ammonia, which, if the solution contain
a large proportion of the acid, will produce a characteristic radiated
crystallization of oxalate of ammonia. The characteristic tests by
which the oxalic acid may be fully identified are the following :

1. Nitrate of Silver. — It throws down an abundant white precipitate
of oxalate of silver, soluble in nitric acid and ammonia ; and which,
when dried and heated on platinum foil, detonates, and is dispersed as
a white vapour, leaving a residue of metallic silver.

2. Sulphate of Lime. — The salts of lime give with oxalic acid a
white precipitate, the oxalate of lime, soluble in nitric and hydro-
chloric acids, but insoluble in the vegetable acids. The solution of
the sulphate of lime should be added in large quantity.

A solution of sulphate of copper is often mentioned as a test for
oxalic acid. It throws down a greenish-white precipitate of oxalate
of copper. The soluble salts of lead also give a white precipitate —
a fact of which we avail ourselves in the process for organic liquids.

3. In Organic Liquids.
As oxalic acid is not altered by contact with the animal textures or
with food, and it is not often that an antidote can be given, the process
for the free acid is comparatively simple.

346 THE VEGETABLE ACIDS.

The acid liquid if dilate may be filtered at once, but if not, we add
distilled water, allow the liquid to stand for a time, filter it, and con-
centrate by evaporation. To the resulting liquid we add acetate of
lead till a precipitate ceases to be formed. This precipitate, the oxalate
of lead, is then diffused through distilled water, and sulphuretted hy-
drogen gas transmitted for two hours through the mixture. Black
sulphuret of lead is thrown down, and oxalic acid is set free. The
sulphuret having been separated by filtration, the oxalic acid remains
in solution, and may be identified by the tests just described.

If carbonate of lime or of magnesia had been employed as an anti-
dote, we shall have to adopt a modified process by which the acid may
be detached from the base. The fragments of solid matter must first
be rubbed down, and the mixture must then be brought to the con-
sistence of a thin syrup by the addition, if necessary, of distilled water.
To this about a twentieth part of its bulk of cai'bonate of potash must
be a dded, and it must then be boiled for two hours. The resulting
liquid will contain soluble oxalate of potash, and insoluble carbonate of
lime or of magnesia. The insoluble matters being now separated by
filtration, the liquid which passes the filter will consist of oxalate of
potash in solution. The alkali is now to be neutralized with pure
nitric acid, and the solution of acetate of lead is to be added as long as
any precipitate falls. Collect, as before, the oxalate of lead, suspend it
in distilled water, separate the oxalic acid by sulphuretted hydrogen
gas, and identify the oxalic acid by the tests already described.

If the antidotes which have been administered have only partially
neutralized the oxalic acid, and the sepai-ated liquid has an acid reac-
tion, the process first described must be adopted for the liquid portion,
and the second process for the solid matters.

As oxalate of lime exists in large proportion, but in small absolute
quantity in rhubarb, it is always possible to attribute its detection,
when in small quantity, to rhubarb taken medicinally. The history of
the case, with the previous symptoms and post-mortem appearances,
will at once destroy this objection.

A strong solution of oxalic acid stains black cloth of a deep-biown
colour without corroding it, and reddens the vegetable blues. In
consequence of its lemoving the colour of ink, it has been used to
discharge writing.

Quantitative Analysis. — Use for this purpose the oxalate of lead.
Every hundred grains correspond to forty-two of the crystallized acid.

Experiments on Animals. — Large doses (such as ^ss.) in strong
solution cause symptoms of irritant poisoning, and death from collapse
in fi'om two to twenty minutes. Alter death, black extravasated blood
is found in the stomach,»and there are marks of acute inflammation,
with hardening or softening of the lining membrane. The diluted
acid in large doses kills by paralyzing the heart ; in lesser doses by
tetanic spasm of the muscles of respiration, and in still smaller ones
by coma.

OXALIC ACID. 347

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — The symptoms in man vary with the dose and the
degree of concentration of the poison. When the dose is large, and
the solution concentrated, the symptoms follow immediately on the
swallowing of the poison. An intensely sour taste is speedily followed
by a burning sensation in the pit of the stomach, increased by pressure,
and pain and constriction of the throat. The pain is soon succeeded by
vomiting, sometimes of blood, but generally of a greenish-brown or
black grumous matter. If the patient survive several hours, there is
purging of a similar matter, sometimes tinged with blood. The re-
maining symptoms are those of collapse, — extreme debility, pale and
anxious countenance, cold and clammy sliin, small and frequent pulse,
and hurried respiration. There are also soreness of the mouth, inflam-
mation and swelling of the tongue, constriction of the throat, painful
deglutition, intense thirst, restlessness, difficulty of breathing, and
harassing cough. Cramps and numbness of the legs and arms, acute
pain in the head and back, delirium and convulsions, are among the
nervous symptoms present in certain cases.

These symptoms are subject to many anomalies and exceptions.
Even pain and vomiting have been altogether absent, or vomiting did
not occur till emetics were administered. An eruption has in one case
appeared on the skin. From the speedy death of leeches applied to the
epigastrium in a case of poisoning by oxalic acid, it is inferred that the
blood is poisoned.

Fost-mo7'tem Appearances. — The external appearance of the body is
natural, and the countenance pale and composed. The lining mem-
brane of the mouth and fauces is generally white, shrivelled, and
easily detached ; and a similar appearance extends into the gullet,
which is contracted into folds both longitudinally and transversely,
while the epithelium is detached in small in-egular patches, leaving a
brown surface beneath. The tube sometimes closely resembles a piece
of worm-eaten wood. (See figures 12 and 13, p. 338.) The stomach
contains a dark-brown, or greenish-brown, grumous matter, in appear-
ance nearly resembling meconium, which also lines the oesophagus, and
extends into the duodenum. The mucous membrane is sometimes
quite pale, and free from rugae ; at others, the membrane is highly
inflamed, and the rugae strongly marked. It is easily stripped off, and
in some instances has been extensively detached. Its vessels are mi-
nutely injected with black blood. (See fig. 14, p. 338.) Perforation
is rare. In eases of some continuance, the small intestines present the
same appearances as the stomach. The peritoneum has been found
inflamed, and in one case the right pleura. The lungs are sometimes
greatly congested, and in one instance there were some traces of inflam-
mation in the brain.

In rare instances, the most charactei'istic post-mortem appearances,
like the symptoms during life, are absent.

348 THE VEGETABLE ACIDS.

As a general rule it may be stated that both the symptoms and
post-mortem appearances, in poisoning by oxalic acid, are highly cha-
racteristic. Christisou justly observes, " If a person, immediately
after swallowing a solution of a crystalline salt, which tasted purely
and strongly acid, is attacked with burning in the throat, then with
burning in the stomach, vomiting, particularly of bloody matter, im-
perceptible pulse, and excessive languor, and dies in half an hour, or,
still more, in twenty, fifteen, or ten minutes, I do not know any
fallacy which can interfere with the conclusion, that oxalic acid was
the cause of death. No parallel disease begins so abruptly, and ter-
minates so soon ; and no other crystalline poison has the same eftects."*
It may be added, that the post-mortem appearances, though not
equally characteristic, afford a strong probability. The wrinkled and
corroded gullet, the pale, shrivelled, and partially-detached mucous
membrane of the stomach, the dark veins ramifying on its surface, and
the dark-brown grumous matter which fills its cavity, point strongly
to the action of a powerful corrosive poison, while the absence of the
coloured spots on the skin would preclude the supposition of the
etfect being due to either of the mineral acids.

First appearance of the symptoms. — -When the quantity of the
poison is considerable, and the solution concentrated, the symptoms
begin immediately. If the quantity is small, and the solution weak,
they may be delayed for some hours.

Smallest fatal dose. — Less than Jtalf an cmnce has proved fatal ;
but a smaller quantity has produced severe symptoms, and, on the
other hand, recovery has taken place after the administration of two
or three times as much. When active treatment is immediately
adopted the patient often recovers.

Shortest fatal period. — Death has taken place in ten minutes,
the dose being one ounce. In one case, the subject of an inquest
held by Mr. Wakley, it must have been nearly instantaneous.
Death has taken place in one case at the end of twenty- three days, the
dose having been half an ounce.

Mortality. — The majority of cases prove fatal. A small number
are recovered by prompt treatment.

Treatment. — The proper antidote is chalk, suspended in water.
Magnesia or its carbonate may also be used : in the absence of these
the plaster of the apartment. Lime water and oil have been used

* Of 11 cases of poisoning by oxalic acid reported in the Journals, 5 were
accidental, and 6 suicidal. Of the accidental cases, 3 were by mistake for Epsom
salts. Of 13 cases, 6 recovered and 7 died. 3 occurred in males and 10 in
females. The duration of the fatal cases was as follows — 2 of a quarter of an
liour, 1 of twenty minutes, 1 of less than half an hour, and 1 of eight days.
The average duration of the first 4 cases was about twenty minutes.

The reader is referred to the following cases : — Med. Gazette, i. T57 : v. 704:
xxvii. 870: xxxi. 491. London Medical Reiwsltory, vi. 474: xi. 20; xil. 18.
lancet, Dec. 15, 1827 : vol. ix. : x. 512 : xxxli. 748, xxxlii. 29. Guy's Hospital
lieports, vil, 353. Edln. Med, and Surg. Journal, xxlv, 67,

TARTARIC ACID. 349

with advantage ; but the alkalis are inadmissible. Warm water may-
be given freely, after the use of the antidotes. If vomiting is not
present, emetics of sulphate of zinc may be employed. The stomach-
pump should either not be used, or it should be introduced with the
greatest caution.

BINOXALATE OF POTASH {Salt of Sorrel — Essential Salt of
Lemons).

This salt is a constituent of wood-sorrel and of other plants. Like
oxalic acid itself, it is used for bleaching straw and removing ink-
stains, for which purpose it, or a quadroxalate of potash, is sold under
the name of " essential salt of lemons," for three halfpence the
half ounce. As a poison it is scarcely inferior in activity to oxalic
acid. It has been taken by mistake for the bitartrate of potash, or
cream of tartar.

Tests. — The salt is found in the form of colourless rhombic prisms.
It has a sour taste, and strong acid reaction. It is much less soluble
in water than oxalic acid, requiring 40 parts of water for its solution.
It resembles oxalic acid in yielding a white precipitate with nitrate of
silver and sulphate of lime, and it has the same reactions with sulphate
of copper and the salts of lead.

When the crystals are heated, they leave a white ash of carbonate
of potash, which effervesces with nitric acid, forming nitrate of
potash.

Symptoms. — Those of poisoning by oxalic acid. In a case of re-
covery from poisoning by a quarter of a tea-spoonful of this substance,
lately reported by Dr. F. C. Webb, there was burning in the throat,
a red tongue, intense thirst, no abdominal pain, vomiting after the
lapse of two hours, severe pain in the loins, dysuria, great weakness of
the legs, pain in the head, and cramps in the hands and legs.

Fost-mortem, Appearances. — The same as in poisoning by oxalic
acid.

Treatment. — That of poisoning by oxalic acid.

Smallest fatal dose. — Half an ounce.

Shortest fatal period. — Eight minutes, in a lady recently de-
livered.

Mortality. — Like oxalic acid, it has proved fatal in the greater
number of cases.

2. Tartaric Acid.

This acid has been taken as a poison once in England and once in
France.

Tests. — This acid crystallizes in oblique rhombic prisms. It is
colourless, and has a pleasant taste ; is soluble in five or six times its
weight of water, and less soluble in alcohol. When heated, it first
fuses, and then burns with a light red flame, giving out a peculiar

350 THE VEGETABLE ACIDS.

odour, and leaving an abundant deposit of carbon. Carbon is also
deposited when it is heated with strong sulphuric acid.

The solution deposits feathery crystals; it yields no distinct pre-
cipitate with nitrate of silver ; and it gives a white granular precipi-
tate with the salts of potash. This precipitate (the bitartrate) is
promoted in dilute solutions by friction of the sides of the vessel with
a glass rod.

Experiments on Animals. — These prove that tartaric acid is much
less active than oxalic acid. In full doses it destroys life in less than
an hour, with marks of great weakness, and palsy of the limbs.

Symptoms. — In the large quantity of one ounce, dissolved in half a
pint of warm water, the poison has proved fatal to a young male
adult in nine days, with the ordinary symptoms of irritant poisoning.
There are no specific symptoms.

Post-mortem Appearances. — In the case just referred to, inflamma-
tion of the greater part of the alimentary canal.

Treatment. — By the same antidotes as oxalic acid, with the after-
treatment proper to the class of irritants. The soluble salts of potash
are not contra-indicated, as in poisoning by oxalic acid.

Bitartrate of Potash {Cream of Tartar, Argol). — In large doses,
such as two ounces and upwards, this salt is a decided poison. It has de-
stroyed the life of an adult male in forty-eight hours, with the symptoms
and post-mortem appearances of irritant poisoning. This substance is
generally found as a white powder, sparingly soluble in water, and the
solution has a feeble acid reaction. The powder when heated is con-
verted into carbon and carbonate of potash, which latter effervesces
with acids. The base may be identified by bichloride of platinum. It
may be obtained as a sediment from organic liquids. The treatment
is by copious demulcents, and by other remedies appropriate to the
condition of the system. A dilute solution of the bicarbonate of potash
may be given with advantage ; as it reduces the bitartrate to the con-
dition of a harmless purgative salt — the neutral tartrate.

3, Citric Acid.
Experiments on animals show that this acid is a more active poison
than the tartaric acid. If a case of poisoning should occur by it, the
treatment would be that of poisoning by oxalic or tartaric acid.

351

CHAPTER VI.

SALTS OF THE ALKALIS AND EARTHS.

The carbonates of potash, soda, and ammonia have been already exa-
mined (see p. 340), the bitartrate of potash at p. 350, and the bin-
oxalate of potash at p. 349 ; iodide of potassium will be treated of in
Chapter X. The poisons, therefore, which remain to be examined in this
chapter are : —

1. The Nitrate of Potash.

2. The Sulphate of Potash.

3. The Sulphate of Alumina and Potash.

4. The Sulphuret of Pot-assium.

5. The Chloride of Sodium.

6. The Chlorides of Lime, Soda, aud Potash.

7. The Salts of Baryta.

The nitrate and sulphate of potash, the sulphate of alumina and
potash, and the bitartrate of potash (p. 350), as also the chloride of
sodium, resemble each other in being weak poisons, that is to say, in
only acting as such in large doses. They are not generally considered
poisons, and more than one of them has consequently been taken to
discharge worms or to procure abortion. The sulphuret of potassium
is a more active and fatal poison, and combines the irritant action of
the base with the narcotic property of the sulphuretted hydrogen gas.

NITRATE OF POTASH {Nitre, Saltpetre, Salprunelle).

Poisoning with this substance is generally accidental, it being taken
by mistake for sulphate of soda or sulphate of magnesia.

Properties. — It is sold in two forms — in colourless or nearly colour-
less crystals, or in crystalline masses ; and in white spherical or cir-
cular cakes (salprunelle). It has a salt cool taste, and the familiar
property of causing matters with which it is mixed to burn with de-
flagration.

Tests.— ^QQ nitric acid (p. 333).

Symptoms. — It is only when given in large doses that nitre is in-
jurious. I have repeatedly given it medicinally in doses of a scruple,
and it has been administered in doses of two and three scruples, and
even to the extent of half an ounce in a dose, without injurious effects.
It has also been taken in doses of one or two ounces without pro-
ducing any more severe effect than- a strong emetic or purgative. But
several cases are on record in which doses of an ounce and upwards

352 SALTS OF TUE ALKALIS AND EARTHS.

have produced very severe effects. In such doses the sym}>toms are
those of acute irritant poisoning, with profuse discharges of blood by
A'omiting and purging, and bloody urine. There is extreme prostration
of strength, accompanied or followed in some instances by nervous
symptoms, such as convulsions, slight trismus, tetanus, and stupor,
loss of speech, sensation, and voluntary motion, and illusions of the
senses, in one case there was chorea of two months' duration.

Fatal Dose. — One ounce of the salt has proved fatal, and deatli has
taken place in tlirec hours. In such cases the fatal event is due to
collapse.

Post-mortem Appearances. — Marks of violent'inflammation in the
stomach and small intestines, with black patches in the stomach, re-
sembling gangrene. In one case there was a small aperture in the
stomach.

Treatment. — As there is no antidote, the treatment is that of the
irritants as a class (p. 318). Vomiting, if absent, should be promoted
by emetics, followed by the abundant use of diluents, or the stomach-
jmmp may be used. Antiphlogistic remedies may be required, to
combat high inflammatory action, sedatives if nervous symptoms are
present, and stimulants in case of collapse.

SULPHATE OF POTASH {Sal (le duohus, Sal Folychrest).

This salt has more than once proved fatal when administered in
large doses. In a French case, ten drachms given, in divided doses, to
a lady within a week of her confinement proved fatal in two hours,
with the symptoms and post-mortem appearances of irritant poisoning.
In a suicidal case, in which Dr. Letheby gave evidence, ^^iss of the
poison gave rise to marked appearances of irritation in the stomach
and small intestines.

Tests. — The salt is readily identified by the nitrate of baryta, as a
test for the acid, and the bichloride of platinum as a test for the base.

Treatment. — That of irritant poisoning (p. 318).

SULPHATE OF ALUMINA AND POTASH [Alum).

This substance has been very rarely taken as a poison.

Properties. — It is found in commoce as a colourless crystalline
mass, or in the calcined state as a white mass or powder. It is also
to be met with as iron-alum. It has a sour taste, and yields an acid
solution, which is readily distinguished from dilute free acids by
evaporation. If a drop of a solution of alum is placed on a slip of
glass, it commonly leaves on evaporation a beautiful compound
crystal, consisting of straight parallel columns crossed at right angles
by short lines, and surrounded by rectangular crystalline forms.
These compound crystals are blended w^ith right octahedra, more or
less perfectly formed. From saturated or strong solutions of alum the

CHLORIDES OF LIME, SODA, AND VOTASH. 353

crystals are deposited either as right octahedra or as cubes, and large
masses of crystals, consisting of piles of octahedra, either colourless or
coloured, are familiar objects in the shops.

Tests. — The sulphuric acid may be detected by the solution of
nitrate of baryta ; the alumina is thrown down by liq. potassae, as a
white precipitate, soluble in an excess of the precipitant ; and the
potash may be detected by the chloride of platinum.

Si/mptoms. — Those of simple irritant poisoning (p. 317).

Treatment. — That of simple irritant poisoning (p. 318). After
emptying the stomach by the stomach-pump or by emetics, lime-
water may be given with advantage.

SULPHURET OF PQTASSiUM {Liver of Sulphur).

The alkaline sulphurets are active poisons, containing an irritant
base with a nai'cotic gaseous acid.

Properties. — It is found in the shops in dirty green masses, or in
powder of the same colour. It yields a yellow solution, and has a
strong odour of sulphuretted hydrogen.

Tests. — On the addition of an acid the gas is disengaged, and pro-
duces its characteristic effect on paper moistened with acetate of lead.

Symptoms. — Those of acute irritant poisoning, with the addition of
convulsions, or of stupor. The breath, and the matters discharged from
the stomach and bowels, have the odour of sulphuretted hydrogen.
Death may occur in so short a time as a quarter of an hour.

Post-mortem Appearances. — Redness of the stomach and duodenum,
and deposit of sulphur on the mucous membrane. The surface of the
body very livid. The lungs gorged with dark blood.

Treatment. — Dilute solutions of chloride of soda or lime (bleaching
liquids) should be immediately administered. The remainder of the
treatment is that of irritant poisoning.

CHLORIDE OF SODIUM [Common Salt).

Properties and Tests. — The salt is soluble in water, and the solu-
tion on evaporation yields cubic crystals. The acid is detected by the
solution of nitrate of silver, which throws down the white chloride.
The base may be detected by the negative reaction with the bichloride
of platmum.

Symptoms. — Those of irritant poisoning (p. 317).

Treatment. — That of irritant poisoning (p. 318).

CHLORIDES OF LIME, SODA, AND POTASH {Bleackinj Powders
and Liquids).

The chloride of lime, hypochlorite of lime, or common bleaching
powder ; the chloride of soda, hypochlorite of soda (in solution),
* 2 A

354 SALTS OF THE ALKALIS AND EARTHS.

Labaraque's or Fincham's liquid ; and the chloride of potash, hypo-
chlorite of potash, or Eau de Javelle, are all poisonous.

Properties. — All these substances and solutions yield chlorine spon-
taneously or on the addition of an acid, and they have a strong odour
of the gas. The gas is readily identified both by its peculiar odour
and by its bleaching propei-ties.

The symptoms, post-mortem appearances, and treatment in poison-
ing by these substances would be those proper to the class of irri-
tants.

SALTS OF BARYTA.

The salts of baryta have been occasionally taken as poisons. The
muriate and the carbonate have both proved fatal. The nitrate and
acetate are also possessed of poisonous properties.

Properties. — The chloride of barium is found in commerce irregu-
larly crystallized in tables. It is permanent in the air and soluble in
water, and has an acrid taste. The carbonate is commonly found in
the shops as a fine white powder, insoluble in water, but soluble with
effervescence in dilute acids. Though insoluble in water, it is readily
decomposed by the free acids of the stomach.

Tests. — Baryta is piecipitated from its solutions as a white car-
bonate by carbonate of potash, and as an insoluble white sulphate by
sulphuric acid or the alkaline sulphates. Oxalic acid does not precipi-
tate baryta from dilute solutions. The acids in combination with the
base are easily distinguished : the carbonic acid by effervescing on the
addition of dilute mineral or vegetable acids ; the muriatic acid by
nitrate of silver ; the nitric acid by precipitating the base with sulphate
of potash, when nitrate of potash will remain in solution ; and acetic
acid by the odour of the vapour disengaged on adding dilute sulphuric
acid.

Symptoms, — Those of irritant poisoning (p. 317), with the addition
of nervous symptoms in a maiked form, such as violent cramps and
convulsions, headache, excessive debility, dimness of sight and double
vision, noises in the ears, and violent palpitation of the heart. The
occurrence of such symptoms would justify the removal of this poison
to the class of specific irritants.

Post-mortem Appearances. — Those of irritant poisoning (p. 317).
In one case, in which death took place in two hours, the stomach was
found perforated.

Treatment. — The free administration of the sulphate of soda or of-
magnesia as an antidote, with the use of emetics and the stomach-
pump. The after-treatment is that common to the whole class of irri-
tants. (See p. 318.)

355

CHAPTER YU.
VEGETABLE IRRITANTS.

1. Purgative medicines.

2. Juniperus sabina.

3. Taxiis baccata.

4. Daphne mezeveum.

5. Arum maculatum.

6. Colchicum autumnale.

7. Veratrum album (veratria).

8. Helleborus niger,

9. Diseased and decayed vegetable matters.

This group consists, 1. Of substances belonging to the class of pur-
gative medicines — Aloes, colocynth, gamboge, jalap, ^cammony,
castor-oil seeds, and croton seeds and oil. 2. Of other vegetable irri-
tants not commonly used as aperients — Savin, yew, mezereon, arum
maculatum, colchicum, and hellebore. 3. Diseased and decayed vege-
table matters.

1 . Of the first group, which comprises the more active purgatives, it
will suffice to state that when given in large doses, or to a pei'son
suffering from great debility, they may act as poisons. All those
enumerated above, given alone or in combination, have proved fatal.
They owe their poisonous property chiefly to the oily or resinous
matters which they contain. Two of the poisons in the second group
(colchicum and stavesacre) owe their irritant properties to alkaloids
(colchicina and delphinia) ; and the poisonous eiTects of another vegetable
irritant (hellebore) are said to be due to a neutral crystallizable principle
(helleborine).

The vegetable irritants are often identified in the contents of the
alimentary canal by fragments of their leaves, fruits, or seeds.

The symptoms produced by this class of poisons are those of irritation
of the alimentary canal — vomiting and purging, with pain in the abdo-
men, tenesmus, and strangury. The patient falls into a state of collapse,
attended occasionally with drowsiness and slight nervous symptoms.

The post-mortem appearances are those of inflammation of the ali-
mentary canal in various degrees and stages — redness, ulceration,
softening, and effusion of dark blood into the submucous tissue.

The treatment proper to the whole class of vegetable acrids consists
in the administration of emetics when vomiting is absent, followed by
the free use of diluents ; in local or general blood-letting when inflam-
matory symptoms run high, and in the use of stimulants or narcotics
if collapse or nervous symptoms are present.

356 VEGETABLE lERlTANTS.

2. Savin (Juniperus sabina). — This is a small indigenous bushy
shrub, yielding a round purple fruit about the size of a currant. It
has a peculiar strong odour, and an acrid taste ; and owes its irritant
properties chiefly to an essential oil readily obtained from the fresh tops
of the plant by distillation with water. This oil, and an ointment
made of the freshly-bruised plant, are in the London PhaiTnacopceia.

The leaves of the plant, in powder or infusion, and the oil, are often
given with a view to procure abortion ; but it has more frequently
proved fatal to the mother than effectual in destroying the child.
Savin in also in occasional use as a vermifuge.

Symptoms. — Those of irritation of the alimentary canal. There is
severe pain in the belly and vomiting, and sometimes strangury, but
diarrhoea is rare. Salivation and insensibility are among th^ occasional
symptoms.

Fost-mortem Appearances.— Those of acute inflammation of the
alimentary canal ; and the green powder is often found mixed with
the contents of the stomach and bowels. On drying and rubbing this
powder it gives out the peculiar odour of the plant, and the hard thick
parts of the twigs exhibit under the microscope the ordinary charac-
teristics of coniferous wood. Watery solutions of savin yield a deep-
green colour with the permuriate of iion.

The treatment of poisoning by savin is that proper to the whole
class of irritants (p. 318).

3. Yew (Taxus baccata). — The leaves and ben-ies of this tree are
poisonous. The leaves have proved fatal to animals, and the leaves
and berries to man. The leaves, in substance or in infusion, are
sometimes given as a vermifuge or abortive.

Symptoms. — Those of irritant poisoning, with the addition of ner-
vous symptoms, such as insensibility and convulsions, which may
perhaps justify us in classing the yew among the narcotico-acrids.
Death seems to take place from collapse, when it happens in a short time ;
but if at a later period, the cause of death appears to be inflammation
of the alimentary canal. The leaves have proved fatal to an adult in
fourteen hours, and the berries to a girl five years old in four hours.

Post-mortem Appearances. — Those of irritation of the alimen-
tary canal. The leaves or berries are generally found in the stomach,
and may be identified by their shape and appearance. The leaves are
lancet-shaped ; and the berries, which are about the size of a pea,
consist of a hard, brown, egg-shaped seed, surrounded by a colourless
viscid juice, enclosed in a light red covering. The juice has an acid
reaction and a nauseous taste.

4. Mezereon (Daphne mezereum). — This is a cultivated garden
shrub, yielding a bright red berry, possessing highly irritating properties,
and in large quantities acting as a poison. The berries, from their
beautiful colour, attract the notice of children, and have been mistaken
for currants. They contain a single ovate seed composed of two plano-
convex cotyledons enclosed within the coat. Five or six of the berries

ARUM. COLCHICUM. 357

are sufficient to produce serious effects. The bark of the root is an
ingredient in the compound decoction of sarsaparilia.

The sj/mptoms, post-mortem appearances, and treatment are those
of irritant poisoning,

5. Arum (Arum maculatum, lords and ladies, cuckoo-pint). — The
green spotted leaves of this plant, shaped like the head of an arrow,
appear early in spring in hedge-rows, woods, and shaded spots, the
green spathe, with its purple column enclosed, in May, and a cluster
of bright-red berries alone, towards the end of summer. The root is
tuberous and somewhat heart-shaped, and, in common with all other
parts of the plant, is highly acrid and irritating. The juice applied to
the tongue causes acute darting pain, as if it were pierced with sharp
needles ; and in the case of three children who ate of the leaves of
the plant, the tongues were so swollen as to render swallowing diffi-
cult. Two of the children died in twelve and sixteen days respectively.
The third recovered. The poisonous properties of the plant are
wholly dissipated by heat ; and the roots, first steeped in water, and
then baked and powdered, constitute the " Portland sago." The
symptoms, post-mortem appearances, and treatment are those proper
to irritant poisoning.

6, CoLCHiCUM (Colchicum autumnalc, Meadow saffron), — This plant
grows in moist meadows in every part of Europe, It flowers in
autumn, and throws out its leaves in spring; and it has a fibrous
root attached to the underside of an underground stem or corm. The
fruit, which ripens about midsummer, contains a number of round
seeds. The corm and seeds are used in making several preparations of
the Pharmacopoeia — the fresh corm for the extract, and acetic extract,
the dried corm for the vinegar and wine, and the seeds for the simple
and compound tinctures of colchicum. The corm has been taken by
mistake for onions, and the seeds, wine, and tincture have also been
taken in poisonous doses.

The symptoms are sometimes slow in showing themselves, even
when large doses of the wine or tincture are taken ; but in other
cases they begin almost immediately, and death may take place in as
short a time as seven hours. The symptoms are those pf irritation of
the alimentary canal, with collapse. Nervous symptoms are of rare
occurrence. The post'mortem appearances are those common to
simple irritant poisoning; and the treatment is that proper to poison-
ing by the irritants (p, 318), with the addition of the free use of
stimulants to counteract the extreme debility.

The seeds of colchicum are round in shape, brown Fig- 15.
in colour, hard, and shrivelled on the surface. They
are of the size figured in the annexed woodcut, and
weigh eight, ten, or twelve to the grain,

Colchicum owes its poisonous properties to an alka-
loid, allied to veratria, and named colchicina, of which
less than half a grain has proved fatal to an adult.

358 VEGETABLE IRRITANTS.

Hellebore. — There are several species of hellebore — the Helleborus
niger, viridis, and foetidiis, and the Veratrum album, or white helle-
bore. Two of these, the Veratrum album, and the Helleborus niger,
are of some importance as poisons.

7. Vkratrum album (White hellebore). — This plant is not
indigenous. Its rootstork and radicles are employed in making the
Vinum Veratri of the Pharmacopoeia. Every part of the plant is
poisonous ; but the powder of the root, or an infusion made from it,
is the preparation which has been most commonly taken as a poison.
This powder, which somewhat resembles powdered jalap in colour,
has an acrid, bitter taste, and strongly irritates the nostrils. It is,
accordingly, sometimes used, mixed with starch, as an errhine ; but
its principal use is to destroy vermin on the skin or hair.

The symptoms, post-mortem appearances, and treatment are those
proper to irritant poisoning (p. 317), with a tendency to death by
collapse. As little as 20 grains of the powder has destroyed life in
three hours. It owes its poisonous properties chiefly to the alkaloid
veratria.

Veratri A. — This alkaloid is contained in the seeds of the Asagraa
officinalis (Cebadilla), as well as in the rootstock of the Veratrum
album. It is prepared from the seeds of the Asagraa, and is in
the London Pharmacopoeia. It violently irritates the nostrils and skin,
and is applied externally iu small quantities, and given internally in
doses of -y'.j grain. Even in this small quantity it requires to be used
with caution. One-sixteenth of a grain is believed to have produced
a state of dangerous collapse (Taylor). The alkaloid veratria is sold
as a powder. It is not crystallizable. It burns away without residue,
is nearly insoluble in cold, and sparingly soluble in hot water, spar-
ingly soluble also in ethei-, but readily dissolved by alcohol. It has a
slight alkaline reaction, forms soluble salts with the acids, and is
slightly reddened by nitric acid, and changed to a deep crimson by sul-
phuric acid.

8. Helleborus niger (Black hellebore, Christmas rose). — This
plant derives its name from the dark or black colour of its root.
Hence, also, the name " Melampodium" of the old Pharmacopoeias.
It grows in shady woods, and flowers in January, as the * Christmas
rose.' The leaves and roots are both poisonous ; and the powdered
root is a brisk purgative, and, as well as the leaves, is a favourite
but dangerous worm-medicine with the vulgar. The tincture of helle-
bore is officinal.

The symptoms, post-mortem appearances^ and treatment are those
proper to irritant poisons generally (p 3 17), with violent action on the
bowels, and marked symptoms of collapse.

9. Diseased ami decayed vegetable matters. — A few cases have
occurred of poisoning by spoiled vegetables; and bread made of wheat,
rye, or barley, when spoiled or mouldy, has been known to act as an
irritant poison, causing flushed face, dry tongue, violent colic pains,

SUPPLEMENTAL LIST. 359

urgent thirst and headache, vomiting and diarrhoea, exhaustion and
drowsiness. The»e poisons are classed by Dr. Christison with the
narcotico-acrids, to which class tlie ergot of rye certainly belongs.

Besides the vegetable irritants briefly noticed in this chapter, there
are others of less importance, of which it must suffice to append a list.
Some of them have produced the effects of irritants in the human
subject, and have proved fatal, while others are inferred to be poisonous
from their effect upon animals, or from direct experiment. A
minute description of these poisons and of their effects must be sought
for in works on toxicology. Most of them will be found figured, with
brief descriptions of their effects, in Johnson's ' British Poisonous
Plants.' The following is the list in question : — Anemone pulsatilla,
or pasque flower, (also the A. nemorosa, A. hortensis, and A. coro-
naria, with other species,) ; Bryonia dioica, red-berried, common, or
white bryony ; Tamus communis, or black bryony ; Caltha palustris,
or marsh marigold ; Chelidonium majus, or celandine ; Daphne
laureola, or spurge laurel ; Euphorbia lathyris, or caper spurge (also
other species, as the E. peplus, and E. helioscopia) ; Helleborus
viridis, or green hellebore ; Hyacinthus nonscriptus, or wild hyacinth ;
Mercurialis perennis, or dog's mercury ; Narcissus poeticus, or nar-
cissus; Kanunculus acris, bulbosus, sceleratus, and other species of the
crowfoot, or buttercup ; and the Sambucus nigra, or elder.

Besides the foregoing, which are indigenous plants, the Jatropha
curcas, or physic nut of the West Indies; and the Hippomaue man-
cinella, or manchineel, with other species of the same (as the H.
figlandulosa, and H, spinosa), may be mentioned as possessed of highly
irritating properties. (See Christison, chapter on Vegetable Acrids.)

360

CHAPTER VIII.
ANIMAL IRRITANTS.

1. CANTHARIDES.

2. POISONOUS FISH.

3. DISEASED AND DECAYED ANIMAL MATTER.

Among the poisonous substances derived from the animal kingdom
some possess independent properties, others owe their poisonous effects
to a change wrought by putrefaction. Of the first class cantharides
is the principal member. Poisonous fish occupy a less important
position. To the second class belong the several kinds of diseased and
decayed animal matter.

I. Cantharides.

The Cantharis vesicatoria, Spanish fly, or blister beetle, distinguished
by the shining golden green colour of the head, legs, and wing-cases,
furnishes a very active irritant poison. It is the active ingredient of
several preparations of the London Pharmacopoeia — of the tincture
which is administered internally ; and of the acetum, ceratum, un-
guentum, and emplastum cantharidis, which are applied externally. It
is characterized by its energetic action on the urinary and generative
organs. The powder and tincture are given to procure abortion, for
lascivious purposes, or merely by way of a joke ; and both powder
and plaster have been taken by mistake. It has also produced severe
effects when applied externally.

When it has been administered in powder, the blistering fly may be
detected in the contents ot the stomach by the glistening golden or
green colour of some of the particles, which may be readily seen by
the lens or under the microscope ; or it may be dissolved in ether or
chloroform, evaporated to the thickness of an extract, and applied to
the skin, or to the lip. If a blister is raised, it gives convincing evi-
dence of the presence of cantharides. By these two tests Barruel
succeeded in detecting cantharides in some cakes of chocolate, of which
a part had been maliciously given to several persons.

The fly owes its poisonous property to an alkaloid, canthdradin, of
which one giain is afforded by half an ounce of the powder; and the
one-hundredth part of a grain will raise blisters on the lip. The
chemical properties of this principle are not characteristic.

Symptoms. — Soon after swallowing the poison, a burning pain and

POISONOUS FISH. 361

constriction of the throat, speedily followed by a similar burning pain
in the pit of the stomach, increased by pressure, and extending at
length over the whole abdomen, accompanied by excessive pain in
swallowing, dryness of the fauces, great thirst, copious discharge of
blood or bloody mucus from the stomach, mixed with shining, green
particles, and, in less quantity, from the bowels ; tenesmus, pain in
the loins, distressing strangury, bloody stools and urine, priapism, with
swelling, and inflammation of the genital organs. The patient is ex-
tremely restless, the breathing laborious, the pulse quick and hard.
Occasionally headache, delirium, and convulsions, and coma are super-
added.

Among the occasional symptoms recorded are blisters of the mouth,
salivation, vomiting of tenacious mucus taking the shape of the
gullet, or of the mucous membrane itself, redness of the eyes, and
lachrymation, nausea, and an albuminous state of the urine.

Wlien given as a medicine, in the form of tincture, small doses, such
as four or five drops, produce a marked effect on the urinary organs,
curing incontinence of urine, sometimes without causing pain. On the
other hand, very large quantities, as six ounces of the tincture, or two
drachms of the powder, have been taken without bad effect, a fact
only to be accounted for by the badness of the preparation.

The smallest quantity of the tincture which has proved fatal is one
ounce, and two doses of the powder of twenty-four grains each, taken
at an interval of a day, have destroyed life after producing abortion.

Post-mortem Appearances. — These correspond with the symptoms
just detailed. There are marks of inflammation in different degrees
and stages in the whole length of the alimentary canal, and in the
urinary and genital organs. The stomach is sometimes inflamed in
patches, where the powder has adhered. The brain has been found
gorged with blood. The powder may be found in the stomach for
long periods after death. According to Orfila and Leseur, it may be
found unchanged after an interment of nine months.

Treatment. — There is no antidote to this poison. Vomiting must
be excited and encouraged by emetics and warm liquids ; and the
poison must be removed from the bowels by full doses of castor oil.
The free use of diluents, with oily or demulcent injections into the
rectum and bladder, and leeches or bleeding, if the inflammatory
symptoms run high, constitute the remainder of the treatment,
fiaudanum may be advantageously added to the injections, or supposi-
tories of opium may be introduced into the rectum.

2. Poisonous Fish.

Several kinds of fish belong to the class of irritant poisons. Some of
these are constantly poisonous, others occasionally so, and others,
again, act injuriously on certain persons only.

The most important of these poisonous fish is the common mussel,
which becomes poisonous in certain circumstances not yet well under

362 ANIMAL IRRITANTS.

stood. The symjttoms generally come on after an interval of one or
two hours, with swelling and itching of the eyelids, and watering of
the eyes, and an eiiiption on the skin, in most cases closely resembling
common nettle i-ash, and attended with intense heat and itching.
Dyspnoea generally follows, but occasionally precedes these symptoms ;
there is extreme weakness ; and in fatal cases delirium, convulsions,
and coma have supervened. Symptoms of irritation of Ihe stomach
are not always present, but in some instances there have been nausea,
pain in the pit of the stomach, vomiting, and difficulty in swallowing.

The treatment will consist in the free use of emetics, purgatives,
and diluents. Ether may also be given with advantage.

Instances are on record in which oysters, eels, and salmon have
produced injurious effects. The richer fish also habitually disagree
with some persons. When fish owe their poisonous properties to
putrefaction, they belong to the next class of poisons.

3. Diseased and Decayed Animal Matter.

There is a disease prevalent among cattle on the Continent, but
less known in England, which consists in the formation of large boils
upon different jmrts of the body. The flesh of animals which have
died of this disease has often produced severe effects by contact with
the skin, and when eaten has destroyed life either by producing
violent cholera, or by creating a similar disease to that under which
the animal laboured. The glanders communicated to man from the
horse, and the diffuse inflammation excited by punctured wounds
inflicted in dissection, or in preparing meat for the table, are familiar
examples of the effect of diseased animal matter applied externally to
the human body.

Decayed Animal Matter is a common cause of severe and dangerous
symptoms allied to those of irritant poisoning. The articles of food
which have most frequently acted as poisons are sausages (especially
those made of liver and blood), bacon and ham, cheese, and goose

The symptoms raiely come on till the lapse of three or four hours.
Jn some instances the irritation oi the alimentary canal is accompanied
by symptoms of collapse, in others by narcotic symptoms, which would
perhaps entitle these poisons to a place among the narcotico-acrids.

It appears that the poisonous quality of the food is developed only
in the first stages of putrefaction, but disappears when that process is
far advanced.

The milk of cattle fed in particular pastures, containing poisonous
plants, is said to acquire poisonous properties, just as the honey of
bees, which feed on certain poisonous flowers, produces delirium and
symptoms of narcotic poisoning.

The treatment of these cases, after the removal of the poison from
tlie stomach, would be determined by the nature of the symptoms
present.

363

CHAPTER IX.
IRRITANT GASES.

1. Nitrous-acid Gas. (See p. 335.)

2. Sulphurous-acid Gas.

3. Hydrochloric-acid Gas.

4. Cihlorine.

5. Ammonia. (See p. 343.)

The irritant gases have the common property of irritating and in-
flaming the eyes, throat, and whole extent of the air-passages. In a
concentrated form they may produce fatal spasm of the glottis.

2. Sulphurous-acid Gas.

This gas^ possesses highly-irritating properties. It is one of the
products of the combustion of common coal, and contributes to the
fatal result when coal is burnt in close apartments. It is also the
chief cause of the irritating gusts which issue from the baker's oven,
and as such contributes to produce the diseases of the chest to which
the London bakers are peculiarly liable.

3. Hydrochloric-acid Gas.

From experiments made on plants by Drs. Turner and Christison,'
and from experiments on small animals by Messrs. Rogerson (see
chapter on Poisonous Gases in ' Christison on Poisons'), it is evident
that this gas is possessed of highly-irritating properties, and that if
inhaled by the human subject it would destroy life, as certainly as
any other of the irritating gases.

4. Chlorine.

This gas is largely used in bleaching, and, in the sick room, as a
disinfectant. It has highly-irritant properties, and produces violent
irritation in the eyes, nostrils, air-passages, and throat. In a case
cited by Christison, great relief was obtained by the inhalation of a
small quantity of sulphuretted hydrogen gas.

From information collected by Christison, it appears that men who
are in the habit of inhaling air impregnated with chlorine become
gradually accustomed to its use, though they suffer from dyspeptic
complaints and acidity, and lose flesh; but nevertheless many of them
attain to an advanced age.

3G4

CHAPTER X.
SPECIFIC IRRITANTS.

This group comprises the metalloidal poisons and their compounds,
and the preparations and compounds of most of the metallic poisons.
The salts of some of the metals, such as zinc, appear to be simple
irritants, and not to occasion any remote specific effects. But as they
belong to the class of metallic poisons, it has not been thought expedient
to separate them from the more important members of the same class.
The leading poisons belonging to this class are treated in separate
chapters. The metalloidal poisons, phosphorus and iodine, are treated
in the present chapter.

1. PHOSPHORUS.

Properties. — It is usually found in the shops as small cylinders,
preserved in water. It has the consistence and appearance of wax,
is insoluble in water, but soluble in oils, in alcohol, and in the ethers :
also remarkably soluble in the bisulphide of carbon. It burns at a low
temperature with yellow flame and dense white smoke, and is luminous
in the dark. A paste, consisting of flour, sugar, and phosphorus,
sometimes coloured with Prussian blue, is sold as a poison for rats.
Phosphorus has been given medicinally in over-doses, and is often
taken in France, and sometimes in England, as it exists on lucifer
matches ; but its property of shining in the dark, which it does not
lose by admixture with articles of food, and its peculiar odour and
taste, unfit it for the service of the murderer.

Symptoms. — Those of acute irritant poisoning (p. 317). The taste of
the poison resembles that of garlic, and the breath has an odour of the
same substance. The matters rejected from the stomach and bowels
have the same odour, and they are sometimes distinctly luminous in
the dark. In some cases the nervous system seems to be strongly
affected ; and, in one instance, the symptoms resembled those of hydro-
phobia. Irritation and excitement of the genital organs are among
its occasional effects.

Post-mortem Appearances. — Those of acute irritant poisoning, in-
cluding extensive destruction of the coats of the stomach, with softeu-
ing, ulceration, and perforation. The contents of the alimentary canal
are phosphorescent, and the effluvia from a body advanced in putre-
faction have been observed to have the same property.

Poisonous Dose. — From one to three grains.

Period of Death. — In acute cases, a few hours. In one instance,
four hours. In chronic cases life may be prolonged for seveial days.

Treatment. — After the stomach-pump or emetics, hydrate of mag-
nesia suspended in mucilagino'is drinks, followed by aperients of the

SPECIFIC IRRITANTS. 365

sulphate and carbonate of magnesia. The rest of the treatment is that
of irritant poisoning (p. 318).

In the chronic form of poisoning by phosphorus, the patient wastes
away under prolonged dyspepsia and diarrhoea, with hectic fever. Ex-
posure to the vapour of phosphorus, in the process of making lucifer
matches, causes severe irritation of the lining membrane of the air-
passages, and leads to caries of the teeth and necrosis of the jaw. The
discovery of the important fact that red, amorphous, or allotropic
phosphorus, though possessing the same chemical composition, is not
poisonous, may lead to the disuse of common phosphorus for manu-
facturing pui'poses. The substitution of chlorate of potash is, how-
ever, to be pieferred.

Phosphorus in Organic Mixtures. — Several methods for detecting
the poison have been proposed. Mitscherlich adds to the organic
matter water, and a small quantity of sulphuric acid, and distils it in
the dark from a flask, through a tube kept cool by a stream of water.
At each condensation of the vapours in the tube a luminous appear-
ance is perceived. Another plan consists in converting the phosphorus
into phosphoric acid, by boiling with nitric acid diluted with three
parts of water. A third plan, suggested by Dr. Taylor, consists in
digesting the organic matters in bisulphide of carbon, and allowing the
solution to evaporate spontaneously. The phosphorus remains in the
form of small globules, which sometimes take fire spontaneously. (' On
Poisons,' 2nd edit., p. 350.)

2. IODINE.

Properties. — This is a scaly substance, not unlike iron filings in
appearance, of a peculiar and disagreeable odour, giving off irritating
violet fumes when heated, striking a fine blue colour with a solution
of starch, and staining the skin and lining membrane of the intestinal
canal a yellowish brown, which stain is removed by liquor potassas. It
is found in the shops in substance, as a tincture, and as a compound
solution with iodide of potassium as a solvent. It is largely used in
medicine as an external application, and internally in combination with
potash, as iodide of potassium.

Symptoms. — A disagreeable acrid taste, with a sensation of heat,
dryness, and constriction in the thj-oat, in the act of swallowing, fol-
lowed by the symptoms of acute irritant poisoning (p. 317). The
discharges, of a deep yellow tint, are often mixed with blood.

In chronic poisoning, produced by the prolonged employment of
iodine or its preparations in medicinal doses, the symptoms, in addition
to those of irritation of the alimentary canal, are tremors, palpitation,
gradual absorption of the testicles, mamma;, and other glandular
structures, ptyalism, increase of almost all the secretions, priapism, and
enlargement and tenderness of the liver. These symptoms, which
are not present in all cases of iodism, have been more than once pro-
duced by small doses, administered for a few days at a time.

366 IODIDE OF POTASSIUM.

Post-mortem Appearances. — Those of acute irritant poisoning
(p. 317). Enlargement of the liver.

Treatment. — That of irritant poisoning (p. 318), including the free
use of a weak solution of carbonate of soda, and of diluents containing
starch, such as arrow-root.

3. IODIDE OF POTASSIUM (Ilydriodate of Potash).

Properties. — Iodide of potassium is a crystalline substance, having
a peculiar faint odour. Its ciystalline form is a cube. The crystals,
when pure, are white, permanent in the air, and very soluble in water and
alcohol ; but when impure, of a yellowish colour, and deliquescent.

Tests. — Strong nitric or sulphuric acid turns the crystals browu by
liberating the iodine, which on the application of heat lises in violet
vapours.

In Solution it has the following reactions: — corrosive sublimate
yields a fine carmine-red precipitate, the iodide of mercury ; acetate
of lead, the yellow iodide of lead ; the subnitrate of mercury, the
yellow subiodide of mercury, which gradually changes to a dirty
brown; sulphuric and nitric acids change the solution to a brown ;
and, on the addition of starch, to a characteristic blue. The base
may be detected by the bichloride of platinum.

In Organic Mixtures. — Transmit sulphuretted hydrogen through the
mixture to convert free iodine into hydriodic acid. Drive off the
excess of gas by a gentle heat, add potash in excess, filter, and evaporate
to dryness. Place the residue in a covered crucible and char it at a low
red heat ; reduce the charred mass to powder, treat it with distilled
water, and filter. Concentrate the liquid by evaporation, and apply
the test of starch and sulphuric acid. By this means very minute
quantities of the poison ma)' be detected.

Symptoms. — When given as a medicine, and in small doses, the
hydriodate of potash sometimes acts injuriously, in consequence of
peculiarity of constitution. Alai-ming symptoms have been produced
by two or three doses of two or three grains, or a single dose of five
grains ; but the medicine is being constantly given in five-grain doses
three times a day to large numbers of patients, without producing any
bad effects. The symptoms are vomiting and purging, severe griping
pains in the abdomen, watering at the nose and eyes, swelling of
the face, headache, dryness of the throat, intense thirst, difficulty of
breathing, frequent pulse, and great prostration of strength. In less
marked cases the symptoms resemble those of a severe cold. Ptyalism
is an occasional symptom. In one case, in which I ascertained that no
preparation of mercury had been given, all the characters of mercurial
salivation were present.

Treatment. — The poison should be promptly removed by the use of
emetics, or by the stomach-pump. The after-trpatment is by diluents,
with antiphlogistic remedies if necessary.

361

CHAPTER XI.

1. ARSENIC AND ITS PREPARATIONS.

2. ANTIMONY AND ITS PREPARATIONS.

3. MERCURY AND ITS PREPARATIONS.

4. LEAD AND ITS PREPARATIONS.

5. COPPER AND ITS PREPARATIONS.

6. ZINC, TIN, SILVER, IRON, BISMUTH, CHROME, AND

THEIR PREPARATIONS.

Aksenic is by far the most important of the metaUic poisons, whether
we measure its importance by the extent to which it is diffused, the
number and variety of its applications in medicine and the arts, or the
frequency of its use as a poison.

Arsenic and its compounds enter largely into the composition of the
earth's crust. It is found as metallic arsenic, as arsenious acid, in
the form of the two sulphides, realgar and orpiment, and as a con-
stituent of several ores of iron, copper, silver, tin, zinc, nictkel, and
cobalt. The greater part of the arsenious acid of commerce is pre-
pared from an arsenical sulphide of iron, known as mispickel, or
arsenical pyrites ; the remainder from the roasting of ores containing
arsenic, especially those of copper and cobalt.

The vapours of arsenious acid are diffused in the atmosphere, in
large quantities, in the neighbourhood of some smelting furnaces.
Arsenic has also been found in several soils, in plants grown upon
them, and in some mineral waters and running streams.

As the iron pyrites, or mundic, which is so largely employed in the
manufacture of oil of vitriol, contains arsenic as an impurity, much
of the sulphuric acid of commerce is tainted with arsenic ; and this
being, in its turn, very largely used in the manufacture of nitric,
hydrochloric, and other volatile acids, of sulphate of soda, as a pre-
liminary to the making of the carbonate of soda, and for other pur-
poses, many liquid and solid substances in common use in medicine
and the arts are impregnated with arsenic. In the application of the
tests presently to be described, the two metals, zinc and copper, the
two acids, the sulphuric and the hydrochloric, and the sulphuret of
iron have all been found to contain arsenic. Arsenic acid and the
alkaline arseniates are in use as mordants, and in some dye-works to
such an extent as to poison the waters of the streams into which they
discharge their refuse ; and even to taint the water-supply of towns.

Arsenious acid, the most important of the compounds of arsenic, is
very largely employed in the arts. It is used in the manufacture of
glass, to improve the quality of the " metal," and in the making of
white enamel. Farmers use it to preserve grain for seed, and many

368 ARSENIC AND ITS PREPARATIONS.

of the dipping compounds for sheep owe their efficacy to the large
quantity of arsenious acid which they contain. Grooms give it to
horses to improve their coats ; and there is no longer any doubt that
some Styrian peasants habitually take arsenious acid in quantities
exceeding the smallest poisonous dose,* Shipbuilders mix it with tar
to protect timber from worms. It is largely employed to kill rats
and vermin, flies, and moths. It has long been used in the manufac-
ture of composition candles, and recently to prevent the furring of
steam-boilers.

The metal arsenic is mixed with lead in small shot.

The preparations of arsenic have been mixed by accident, or in
ignorance, with articles of confectionary : arsenious acid with lozenges,
orpiment in Bath buns, and Scheele's green with blancmange. Scheele's
green is also very largely used in the manufacture of green papei-s.

Areenical preparations are administered internally, in Fowler's
solution, and the liq. arsenici chloridi, for the cure of ague and inter-
mittent disorders, and of obstinate skin diseases ; and white arsenic
mixed with large quantities of calomel, or otherwise minutely sub-
divided, is sometimes applied externally in lupus and cancer.

The preparations of aisenic which ai-e of most interest in a medico-
legal point of view are, the white oxide or arsenious acid, the yellow
sulphui-et or orpiment, the green arsenite of copper or Scheele's green,
and the arsenite of potash contained in Fowler's solution. Of these
the arsenious acid is by far the most important ; and it will have to
be examined, accordingly, with great care, and in much detail.

As all our processes of analysis include the production of the metal
arsenic as a means of identification, it will be expedient to preface the
examination of the several preparations of arsenic by some account of
the most important properties of the metal.

The metal arsenic sublimes at the low temperature of 356°
Fahr. When the sublimation is conducted in close vessels, it is
deposited on cooler surfaces unchanged ; but when heated in contact
with air it is deposited as the white oxide, or aisenious acid, or as a
mixture of the acid with the metal. The metal is also deposited un-
changed when it is sublimed in an atmosphere of carbonic acid. The
metal in subliming gives out the odour of garlic. It shares with
antimony the property of combining with nascent hydrogen, to, form
the arseniuretted hydrogen gas, which gas, when heated or burned,
gives up the pure metal to cool surfaces ; and it shares with several
other metals the property of being reduced and deposited on copf)er
boiled in an acid liquor containing any of its prepaiations.

All these properties of metallic arsenic are displayed in operations on
the small scale, in which we use the spirit-lamp and small reduction-

* Dr. Roscoe, in a paper read to the Manchester Philosophical Society, Oct
2c, 1860, brings forward conclusive evidence in support of this siatenient, and
adduces well-authenticated instances in which the poison was swallowed to the
amount of 43 and 5^ grains at a time.

AESEXIOUS ACID. 369

tube. The vapour of the metal has the garlic oJour : it is deposited
on cooled surfaces as arsenious acid, when the tube contains atmo-
spheric air ; and as pure metal when it is filled with carbonic acid gas :
it forms a shining metallic crust or stain on a surface of porcelain
when the burning jet of arseniuretted hydrogen is directed upon it
from Marsh's apparatus ; it leaves a similar stain in the tube through
which the gas is transmitted, when heated by the spirit
lamp ; and it forms a metallic coating to copper foil when -^^S- 15.
boiled in liquids containing it and acidulated with hydro- ^«
chloric acid, according to Remsch's process. The vapour of ®^«*®
the pure unmixed metal is deposited on cooled surfaces as ^ •••
minute globules, closely resembling those of mercury (fig. 9\ 9
15) ; but when air is present in such quantity as to oxidize
part of the vapour, the globules of metal are blended with the white
powder or transparent crystals of arsenious acid.*

ARSEXious ACID (Oxide of Arsenic, Sesquioxide of Arsenic, White
Oxide of Arsenic, White Arsenic, Arsenic'\).

In the two years 1837 and 1838, arsenious acid was the ascertained
cause of 185 deaths, being as many as those attributed to all the pre-
parations of opium, and considerably more than those caused by all
the other poisons. Of these 185 deaths, 112 were ascertained to have
been suicidal, 21 accidental, and 12 homicidal ; but the homicidal
deaths from this cause were probably much more numerous.

Since the act of 1851 (14 Vict., cap. xiii.), which restricted the
sale of arsenic, and prescribed its admixture with soot or indigo when
sold in small quantities, it is probable that cases of poisoning by
arsenious acid have become less numerous, both absolutely and re-
latively to other poisons. In the two years 1837, 1838, it was, as
has just been stated, the cause of 185 deaths. This was out of a total
for those years of 543 deaths by poison. But in the five years 1852-
56, it gave rise to 27 only of the annual average of 268 deaths by
ascertained poisons. In the first period, therefore, the proportion was
1 in 3, or 34 per cent., in the second period 1 in 10, or 10 per cent.
In France arsenious acid takes still higher rank as a poison.

The common use of arsenious acid as a poison will excite no sur-
prise when it is borne in mind that it is as white as flour, that it is
tasteless or nearly so, that it may be mixed with articles of food without
undergoing or causing any change, that it is very cheap, and that it is
in common use, as has just been stated, for a great variety of purposes.

Arsenious acid is found in commerce as a solid cake, and as a white
powder. The cake, when first sublimed, is nearly transparent, but

* Refer to a paper by the author, ' On the Production and Identification of
Crystals of Arsenious Acid and Crusts of Metallic Arsenic,' in Dr. Beale's
' Archives of Medicine,' No. Ill, 1858.

t In some country places it is known as " Mercury " !

2 B

370 ARSENIC AND ITS PREPARATIONS.

becomes opaque by keeping, and resembles white enamel, interspersed
with thin transparent striaj. It is the powder which is ordinai-ily used
as a poison. Arsenious acid, in either of these forms, has well-marked
physical properties, and may be readily identified by chemicjil tests.

Properties. — I. Arsenious acid is sparingly soluble in water, hot
or cold. 2. The solution has a very slight acid reaction. 3. In
substance it is tasteless, but its solution or vapour has a very faint
sweet taste. 4, The solution of the acid in boiling water, when
slowly evaporated, deposits well-formed octahedral crystals. 5. It is
very soluble in ammonia, in hydrochloric acid, and in carbonate of
potash ; and it is deposited; from its solutions in ammonia and hydro-
chloric acid, also as octahedra. 6. It combines with alkalis, forming
soluble arsenites.

Two of these properties, the solubility and the taste, require to be
more minutely examined.

Solubility of Arsenious Acid. — Cold water dissolves from half a
grain to a grain to the ounce; boiling water poured on the poison re-
tains on cooling one grain and a quarter to the ounce ; and water
boiled for an hour on the powder retains on cooling 12 grains to the
ounce. But the presence of organic matter renders the poison less
soluble. (Taylor.)

Taste of Arsenious Acid. — The poison was formerly described as
having an acrid taste, but this statement is now acknowledged to be
incorrect. The powder has scarcely any taste ; if any, a very faint
sweet taste. This sweetness is more perceptible in solution, and still
more so in vapour.*

Tests. — We may have to identify arsenious acid, 1. In substance
2. In solution. 3. In organic liquids; and, 4. In the fluids and solids
of the body.

1. Arsenious Acid in Substance.

a. When heated by the spirit lamp on platinum foil, it sublimes
unchanged, as a white vapour, b. When heated in a reduction-tube,
it is deposited either as an amorphous powder or as octahedral crystals.

c. When moistened by liquor potassas it undergoes no change of colour,

d. When moistened by sulphide of ammonium, no immediate change of
colour takes place ; but, after a time, when the excess of ammonia has
evaporated, a canary-yellow sulphide of arsenic is formed. This change
may be brought about directly by heat, or by the addition of acetic acid.

e. When the arsenious acid is mixed with charcoal and heated, the metal
is reduced and volatilized ; and if a reduction-tube be employed for this

* Otto Tachenius, in his Hippocrates Chemicus, says, " that after many sub-
limations of arsenic, on opening the vessel, he suclicd in so grateful and sweet a
vapour, that he greatly admired it, having never experienced the like before."
See Baker's ' Employment for the Microscope,' p. 133. The tastelessness of the
powder is proved by the case of a lad who took from the mouth of a bottle as
much arsenious acid as would cover a sixpence, and who told me that it tasted
like flour.

AR8ENI0US ACID. SUBLIMATION.

371

Fig, 16.

purpose, the metal is deposited on the cooled sides of the tube as a shining
metallic crust. /. The vapour has the characteristic garlic odour.

Of these tests there are two which require to be more exactly de-
scribed, and their results more minutely examined. These are the
test of sublimation and the test of reduction.

Sublimation. — It has just been stated that arsenious acid, when
heated by the flame of a spirit-lamp in a glass tube, is converted into
a white vapour ; and that this vapour is deposited on the sides of the
tube either as an amorphous powder, or as octahedral crystals. But
as it is the crystals which are characteristic of the poison, and not the
white amorphous deposit, it is necessary to explain by what mode of
manipulation the crystalline deposit may be obtained. Now experience
has proved that in order to the development of characteristic crystals
of arsenious acid the white vapour must be raceived on a heated
surface. On a cool surface it deposits itself as an amorphous powder.

The process of sublimation is usually performed in a reduction-tube
of green glass of about the size and length shown in fig. 16, After
drying the tube by passing it repeatedly through the flame of the spirit-
lamp, the arsenious acid is to be conducted to the sealed end through a
smaller glass tube, or by means of a gutter of paper, so as to avoid
soiling the sides of the tube. The
middle portion of the tube should
then be heated and the flame of the
lamp immediately transferred to the
sealed end. The vapours as they rise
will be deposited on the heated part of
the tube as crystals, and on the cooler
portion of the tube as an amorphous
powder.

One object contemplated by the pro-
cess just described is so to intro-
duce the arsenious acid as to keep the
sides of the tube clean. For this pur-
pose, as well as for obtaining well-
formed crystals, the following modified
process is to be commended : — Take
two small tubes of glass (green or white),
of which the one shall be large enough
to inclose the other. Shape the larger
into the reduction-tube, fig. 16, and the
smaller into the shorter tube, shown in
the same figure. Introduce the arsenious

acid into the short tube, and drop it into the reduction-tube. Apply
the flame of the spirit-lamp so as to envelope the lower third of the
tube. By the time that the temperature of the inner tube is so raised
as to sublime its contents, that of the outer tube will be favouiable
to the deposit of the vapour in the form of distinct crystals.

372-

ARSENIC AND ITS PREPARATIONS.

Fig. 17.

This method of sublimation, in common with all similar methods,
is open to the serious objection that the crystals cannot be conveniently
examined through the thick round sides of the tube by means of the
lens or microscope ; and this objection applies with great force to
minute crystals obtained from small quantities of the poison. To
obviate this objection I have proposed the
following method : — Take a small, clean,
dry specimen-tube, a, of white glass, of
about twice the length and size shown in
fig. 17, drop it into a hole in a slab of
porcelain or brass, b, and hold it in a verti-
cal position. Let the arsenious acid fall to
the bottom of the tube. Then hold a disc,
c, of thin crown glass of the size of a
crown-piece in the flame of the spirit-lamp
till it is quite dry and hot : place it at once
over the mouth of the tube, and imme-
diately apply the point of the flame of the lamp steadily to the bottom
of the tube, till the lower surface of the glass disc is covered with
glittering crystals. As soon as the crystals are seen to form on the
disc, withdraw the lamp. Repeat the operation with other discs.

By this method crystals may be obtained from the smallest visible
speck of arsenious acid, and, being upon a flat surface, may be con-
veniently examined by the lens or microscope. Excellent results of
extreme delicacy may also be obtained by a similar method 'of pro-
cedure presently to be described. (See flg. 33.)

The crystals of arsenious acid obtained by these methods of subli-
mation are also procured by oxidation of the metal arsenic, as a
constituent part of tests yet to be described ; and as the crystals, how-
ever procured, always furnish a very important means of identification,
their shape and characteristic properties ought to be well understood.
Crystals of Arsenious Acid. — These crystals are remarkable for their

brilliancy and permanence.
^'^- ^^- ^'g- 19- They are distinct and sepa-

rate, except when superim-
posed, very rarely foi-ming
compound crystals of any
definite shape. Their pre-
vailing form is the regular oc-
tahedron, consisting of eight
equilateral triangles joined
at their edges. A section
passing through four

and dividing the cryst:il into two equal parts gives a figure which is a
perfect square. The crystal is shown in outline in fig. 18, and as it is
occasionally seen under the microscope in fig. 19. But in every con-
siderable group of crystals there are many modified and imperfectly-

THE CRYSTALS OF AESENIOUS ACID.

373

formed octahedra, together with some prismatic and other forms, con-
cerning which it is necessary to give a few words of explanation.

The regular octahedron, it should be understood, presents itself to the
lens and microscope under many different aspects, according as the
crystal adheres by an angle, face, or edge, and according as the light
traverses the crystal or is reflected from it. When the crystals are
viewed by reflected light, or when the light passes through them so
as to render them practically opaque, they present either two, three,
or four sides, as in the annexed engraving (fig. 20), in which 1 repre-
sents a crystal resting on a face with an angle of the face pointing for-
ward ; 2, a crystal also resting on a face, but with the base of the
triangle forward ; 3, a crystal placed as 1, but differently viewed, and
4, a crystal attached by an angle, and with the opposite angle pro-
jecting forward. Fig. 20,

But when the light is transmitted through the crystals these forms

are modified and disguised by such shadows as those shown in fig. 21.

Fig. 21.

These shadows represent the remote inclined sides of the crystal, so
that crystal 3 of the series displays four sides, crystal 6 five sides,
and crystal 5 seven sides. It very rarely happens that the eight sides
of the crystals are distinctly visible, as in fig. 19, in which the two
equilateral tiiangles represent the parallel sides without shadow, and
the three receding triangles and three dark triangular shadows com-
plete the number.

Sometifnes, in consequence of the indistinctness of the shadows of
the receding sides, the crystal is seen as in 1, fig. 2.5,
under the simple form of an equilateral triangle.

Sometimes the octahedron, instead of being moulded
on a square, is built upon an oblong, so as to assume
the form shown in fig. 22.

In all groups of well-developed crystals most of
the forms just described and figured will be readily
seen ; but it should be understood, as has just been
stated, that the octahedron is not always perfect. The opposite angles

Fig. 22.

374

ARSENIC AND ITS PREPARATIONS.

are ofteu truncated, as in No. 4, fig. 21 ; sometimes one angle only ;

sometimes all the angles. Again, the sides of the crystals are

sometimes indented, and the angles rounded, as in fig. 23,

Fig. 23. so as to resemble a trefoil, and the crystal is sometimes

Vfi.\ed in such a position (2, fig. 21) as to be identified with
difficulty.
Sometimes, too, the crystals are not only truncated or
disguised by curtailment of their angles, sides, or edges,
but they are imperfectly built up, so as to present several
forms different from any of those figured above, but of very common
occurrence in all groups of crystals. One of the most common of
these forms is a black square without any
perceptible markings, which would result from
a half crystal attached by an angle, or possibly
from 4, fig. 20. Five or six other forms
frequently met with would result from a half
crystal divided by a plane parallel to two of its
faces, as in fig. 24. This half crystal yields
the forms depicted in fig. 25, namely, 1, a
simple equilateral triangle ; 2, an equilateral
triangle resting on half the adjoining triangle,
as a base ; 3, a simple hexagon ; 4, a hexagon
with thi-ee small equilateral triangles in
shadow; 5, a truncated equilateral triangle; 6, a figure having the
appearance of a triangular prism.

Fig. 25.

Fig. 24.

The twin crystals or macles (fig. 26) resulting from the juxta-
position of corresponding portions of the half ciystal, shown
Fig. 26. in 6, fig. 25, are also not uncommonj and it is not unusual
^xTn. for these twin crystals to assume forms very easily mis-
\^ ^y\ taken for cubes.

In one instance I have seen the crystals built, up into a
rectangular prism, with the ends shaped into a short four-
sided pyramid, and the length divided into two unequal
parts by a line at right angles to the axis.

Sometimes when the heat of the surface on which the
crystals are deposited is insufficient, all the crystals assume irregular
and confused forms.*

* Those who desire fully to understand, or clearly to explain, the microscopic
appearances of the crystals of arsenious acid should study those appearances on
the larger scale by means of octahedra of wood and glass, referring at the same
time to the • Mineralogy and Crystallography ' of Tennant and Mitchell.

ARSENIOUS ACID. REDUCTION.

375

Some of the many forms assumed by the crystals of arsenious acid,

Fig. 27.

as seen under the microscope by transmitted
light, are shown in fig. 27, as well as in
fig. 13, where they are mixed with scattered
globules of metallic arsenic ; also in figures
29 and 30, where they are viewed by re-
flected light in mixed crusts of arsenious acid
and metallic arsenic.

Reduction. — This process is commonly
eflfected in the tube of green glass repre-
sented in fig. 28. The arsenious acid, well
mixed with about four times its bulk of
finely powdered recently ignited charcoal,
is introduced into the tube at a, with the precautions just described in
speaking of the process of sublimation, with this difference only, that

Fig. 28.

it is not necessary to heat the middle portion of
the tube. On applying the heat of the spirit-
lamp steadily to the sealed end of the tube held
at an angle of 45°, the metal rises in vapour,
with the odour of garlic, and is deposited on the
sides of the tube from a quaiter to half an inch
above the mixture, as a dark brown or black
ring, h. As the vapour of the metal rapidly
attracts oxygen fiom the atmosphere, it is
readily reconverted into arsenious acid. Hence
the ring is always a mixture, in variable pro-
portions, of metallic arsenic and aisenious acid.
The lower portion of the ring consists chiefly of
metal, and has the appearance of a mirror; the
portion immediately above it contains a larger
admixture of arsenious acid, and the highest
portion may consist almost wholly of the acid.
By cautiously applying the flame of the lamp to
the lower portion cf the ring, it may be rendered
more compact and more distinctly metallic ;
and by driving the crust repeatedly up and down the tube, it may ba
wholly converted into arsenious acid, in the form of octahedral
crystals.

When this process of reduction is performed with proper precautions
(using a tube of green or German glass that the glimmer of lead
reduced in the glass itself may not be confounded with the crust of
metal ;* taking care that the mixture of arsenious acid and charcoal
and the sealed end of the tube itself are free from moisture, so that
the mixture may not be driven up into the tube ; taking equal care to

* The objection formerly advanced that the arsenious acid sometimes used
in the manufacture of glass might be reduced, so as to create a glimmer in the
glass, is now abandoned.

376 ARSENIC AND ITS PREPARATIONS.

introduce the mixture so as not to soil the tube ; and drying the tube
itself after its introduction) very satisfactory results are obtained. The
mixed crust thus procured cannot be mistaken for globules of mercury ;
nor can it be confounded with the crust obtained by the same process
from the white hydrated oxide of cadmium, as the anhydrous oxide of
cadmium blended with the crust has a brown, green, or yellow colour.

But as it may always be alleged that the metallic crust obtained by
this process of reduction does not present of itself such distinct cha-
racters as to justify a witness in affirming that it is due to arsenic and to
nothing else, it is always deemed necessary to submit the crust to further
manipulation. This is done in one of two ways. The sealed end of
the tube containing the residue of the charcoal is drawn off, and the
metallic crust driven up and down the tube till the metal is changed
into the oxide, and deposited as octahedral crystals on the side of the
tube ; or the sealed end of the tube, as well as the part of it containing
no deposit, are filed off, and the part containing the crust being folded
in paper, is broken into small fragments, which fragments are introduced
with like precautions into a second reduction-tube, and the metal con-
verted into arsenious acid by heat. In either of these ways the evidence
afforded by the reduction of the metal is confirmed by the production
of the characteristic crystals of arsenious acid.

But this method of procuring crusts of metallic arsenic from
arsenious acid and charcoal, and crystals of arsenious acid from the
metal, is open to two classes of objections. The method itself is want-
ing in delicacy, and encumbered by many precautions, and the results
present themselves in a form so unfavourable for examination that the
.more minute crusts and crystals cannot be identified with certainty.
The use of the lens and microscope is in all cases rendered difficult,
in some impossible. These consideiations have led me to recommend
the same simple apparatus for the reduction of the metal as that already
described for the sublimation of the oxide, and shown in fig. 17.

The mixture of arsenious acid and charcoal is first dropped into the
clean and dry specimen-tube (a) ; ' the disc of glass (c) is then held in the
flame of the spirit-lamp till the moisture is driven off, and when cool
is placed over the mouth of the tube. The point of the flame is then
steadily applied to the bottom of the tube. The vapours of the metal
when first disengaged from the mixture combine with the oxygen of
the air contained in the tube, and arsenious acid is re-formed, which
deposits itself on the under surface of the glass disc, as an amorphous
powder, or in glittering crystals, according to the temperature. The
after-deposit is in the metallic form.

The crust in this case, then, as in the usual process of reduction, is
a mixed crust of metallic arsenic and arsenious acid. This crust, when
examined by the lens, or under the microscope by reflected light, has
the appearance shown in fig. 29, where the sparkling triangular
facettes of the octahedral crystals of arsenious acid are shown project-
ing through a layer of metal ; or that depicted in fig. 30, where the

MIXED CEUSTS OF ARSENIC AND ARSENIOUS ACID. 377

distinct octahedral crystals or masses of crystals are more or less
thickly coated and obscured by a light brown or giay mefcillic deposit.

Fig. 20. FiK 30

A third form assumed by some of the thumei crusts, md b} the cir-
cumference of the thicker crusts, consists of cr^stds of arsenious acid
interspersed with distinct globules of metallic arsenic, as in fig. 31.
The thinnest crusts of all present an iridescent appearance, and may
be resolved, under the higher powers of the microscope, into aggregates
of small globules. Crusts of pure unmixed metal, presenting under
the microscope the appearances shown in fig. 32, may be readily ob-
Fig. 31. Fig. 32.

tained by covering the mixture of arsenious acid and charcoal with a
layer of dried bicarbonate of soda, so as to fill the tube with an atmo-
sphere of carbonic acid gas. See also fig. 15, p. 369.

The appearances presented by figures 29, 30, and 31, are quite decisive
of the presence of arsenic. Those presented by the unmixed metal in
fig. 32 are less conclusive, as the globules sometimes are not to be dis-
tinguished by their appearance from those of mercury. Hence it may be
necessary in the case of the purer crusts of arsenic, and expedient in other
cases, to confirm the evidence afforded by the microscopic characters of
the metallic or mixed crust, by converting the metal into arsenious acid.
With this view the portion of the glass bearing the crust must be cut
into narrow slips with a writing diamond. The slips must then be
introduced into a specimen-tube (fig. 17), and treated in the manner
just described. The glass disc will be covered with glittering crystals.

378 ARSENIC AND ITS PREPARATIONS.

or with a mist which can be resolved, under the higher powers of the
microscope, into gi-oups of well-formed octahedra.

It may be well to state that the metals cadmium, selenium, and
tellurium are, like the metal arsenic, sublimed by the heat of a spirit-
lamp; that selenium is also deposited as globules, and tellurium some-
times converted into cryst<ils of telluric acid. But crusts of selenium
have the colour of port wine, the crystals of telluric acid are needles,
and the metallic crusts of cadmium and tellurium do not consist of
globules. The mixed crusts of arsenic are not to be confounded with
any other result of sublimation, and are quite different in appeai-ance
from mixed crusts of cadmium obtained from a mixture of the white
hydrated oxide with charcoal.

There is still one method of procedure especially applicable to such
minute quantities of arsenious acid as the thousandth of a grain ; and
it is one that might without impropriety be comprised in the cutegory
of liquid tests. If on evaporating a drop of liquid supposed to hold
arsenious acid in solution, a white non-crystalline stain is left, we may
proceed to test it in one of two ways.

1. A drop of the liquid is to be evaporated on a porcelain slab a,

upon which a ring of glass

Fl8- 33. ft, such as is used for making

^ I — 1^ raised microscopic cells is

a I ~~^ placed, so as to enclose the

A stain. On this ring a glass

disc c, is to be placed to
receive the sublimed arseni-
ous acid. Having heated
this disc in the flame of the lamp, and placed it upon the glass ring,
the flame is to be steadily applied to the porcelain slab beneath the
stain, and withdrawn as soon as a mist appears on the disc. This
mist, if examined by the microscope, will be found to consist of crystals
of arsenious acid. In this way as small a quantity as the one-thou-
sandth of a grain of arsenious acid may be identified without difficulty,
and even the five-thousandth of a grain will be found to yield cha-
racteristic results.

2. But for combined delicacy and ease of application the following
method is to be preferred.

Take a fragment of microscopic glass, and mark It with a writing
diamond, so that when broken it may yield nai-row slips of glass.
Place a drop of the solution of arsenious acid on the glass, let it dry.

Fig. 34.

and then break the glass into slips. Draw out a small tube of green
glass a a into the form shown in fig. 34 ; dry the tube by passing it

REDUCTION OF SMALL QUANTITIES OF ARSENIOUS ACID. 379

repeatedly through the flame of the spirit-lamp. Introduce the slips of
glass into one of the open ends of the tube as at h. Seal the tube at a,
and shake the slips down to the sealed end. Place the tube in a good
side light, and, after heating the capillary portion of the tube, apply
the flame of the lamp steadily to the sealed end. When the vapours of
arsenious acid show themselves, move the flame cautiously towards the
capillary portion of the tube till a white mist or stain appears, as at e.
Now draw off and seal the capillary tube ai dd and mount it for the
microscope in the manner shown in fig. 35, which represents a card of
the size of the common microscope slide with a central aperture enlarged
by side cuts. The capillary tube c d, rests on a perforated label
gummed to the back of the card and is confined to its place by the slips

Fig. 35.

a\ I y, V,^ I «

of gummed paper a a. Write a memorandum of the date and circum-
stances of the reduction on the label. As the sides of the capillary tube
c d are exceedingly thin, they offer no impediment to an examination of
the stain 6, with the higher powers of the microscope ; and in this way
the thousandth and two-thousandth of a grain of arsenious acid may be
identified with certainty, and less quantities than the five-thousandth of
a grain when the reduction is carefully and skilfully performed.*

The same method of procedure is equally applicable to the reduction
of the metal. The only modification required consists in substituting
for a tube open at both ends a reduction-tube (fig. 16) sealed at one
end. The mixture of arsenious acid and charcoal having been intro-
duced into the small short tube shown in the figure, and this being
placed in the reduction-tube, this last is then to be drawn out into a
capillary tube, through which the sublimed arsenic is made to pass.
The first part of the crust will generally be found to consist of metallic
globules, the second of crystals of arsenious acid,

* To obtain these minute quantities proceed as follows : — Weigh a grain of
arsenious acid in an accurate balance. Dissolve it In a thousand minims of
distilled water. Take up the solution with a pipette, furnished with a small
opening, or use the stoppered drop bottle (fig. 36, p. 380), which I recommend
for all solutions and tests used In delicate chemical manipulations. Ascertain
how many drops from the point of the pipette are equivalent to a minim.
Say that there are three drops to a minim, then the stain left by the evapora-
tion of a single drop will consist of iJU grain arsenious acid.

380

ARSENIC AND ITS PREPARATIONS.

Fig, 36.

2. Arsenious Acid in Solution.

There are several tests for arsenious acid in solution. Of these
three are applied in a liquid form, and are known as liquid tests ; one
in the form of gas, and may be distinguished as the
gaseous test ; a fifth is the well-known Marslts test ;
and a sixth the now equally familiar test of lieinsch.
1. The Liquid Tests. — These are three in num-
ber:— the ammonio-nitrate of silver, the ammonio-
sulphate of copper, and sulphuretted hydrogen water.
a. The ammonio-nitrate of silver.* This throws
down a rich yellow arsenite of silver, which on ex-
posure to light, changes to a dingy brown, b. The
ammonio-sulphate of copperf causes a precipitate of
the bright green arsenite of copper, c. Sulphuretted
hydrogen water throws down in strong solution a
yellow precipitate of sulphide of arsenic. The sul-
phide of ammonium produces no immediate effect,
but after a long interval, or on the addition of a few
drops of acetic acid, causes the same precipitate.

These tests are supposed to be applied in succession
to a clear colourless liquid believed to contain arse-
nious acid, and so applied, are free from objection ;
but it should be understood that a solution of phos-
phoric acid yields with ammonio-nitrate of silver a
yellow precipitate, as an alkaline phosphate does with the simple
nitrate of silver ; and that a decoction of onions gives with the ammonio-
sulphate of copper a green precipitate. As these liquid tests are only
used as trial tests, or to prove that a white powder or crystals
obtained from the oxidation of a ring of metal really consist of
arsenious acid, these objections find no place.

The Gaseous Test. — This test, too, is supposed to be applied to a clear
colourless liquid. Having ascertained that the liquid does not possess
any decided acid or alkaline reaction, we transmit the sulphuretted
hydrogen gas through the liquid slightly acidulated with acetic acid.
If the liquid contains arsenious acid its colour is soon changed to a
rich golden yellow. If the quantity of the arsenious acid is consider-
able, a precipitate of the same colour is formed ; but if it is in small
^quantity, the precipitate is not formed until the excess of gas has been
expelled by heat, and the liquid has been left at rest for several hours.
The only other substances which yield with sulphuretted hydrogen a
yellow precipitate are the peroxide of tin and cadmium, the one of

* The ammonio-nitrate of silver Is formed by adding liquor ammoniae to a
strong solution of nitrate of silver, till the brown oxide of silver at first thrown
down is nearly redissolved.

t The ammonio-sulphate of copper Is formed in the same way by adding
liquor ammonia? to a solution of the sulphate of copper, till the bluish-white
Lydrated oxide of copper is nearly redissolved.

THE GASElOUS TEST. 381

rare, the other of extremely rare occurrence. The sulphuret of anti-
mony is orange-coloured. There is a strong presumption, therefore,
in favour of arsenic, which may be converted into certainty by collect-
ing and examining the precipitate, or by applying the ammonio-
nitrate of silver and the ammonio-sulphate of copper to other portions
of the same liquid.

The precipitated sulphide of arsenic having been allowed to subside,
is to be carefully collected, washed, and dried, and submitted to a
process of reduction similar to that already described when speaking
of arsenious acid ; and differing only in the substitution for char-
coal of a flux containing an alkali. That usually employed is the
black flux formed by incinerating a mixture of one part of nitrate of
potash with two of the bitartrate. But incinerated acetate of soda (as
recommended by Dr. Taylor) is to be preferred ; or a mixture of one
part of cyanide of potassium with three parts of carbonate of soda,
previously well dried. If this last flux is used it should be in the pro-
portion of 1 of the sulphide to 12 of the flux. The metallic
crust obtained by this process of reduction, like that obtained from
arsenious acid by charcoal, is a mixed crust, consisting of metallic
arsenic, arsenious acid, and undecomposed sulphide.

In dealing with minute quantities of the sulphide, the method of
reduction by the capillary tube (fig. 34, p 378) should be employed,
followed, if the quantity of the precipitate is sufficient, by the method
described at p. 372 (fig. 17).

The precipitated sulphide of arsenic is readily distinguished from the
sulphides of cadmium and tin, which it resembles in colour. The sul-
phide of arsenic is not precipitated by sulphide of ammonium till the
ammonia has been expelled or neutralized by an acid ; but the sul~
phides of cadmium and tin are thrown down immediately. The sul-
phide of arsenic is very soluble iu ammonia, while those of cadmium
and tin are insoluble in it. The sulphide of arsenic yields a distinct
metallic sublimate, while the sulphide of tin yields none, and the sul-
phide of cadmium gives a metallic sublimate with the characteristic
properties described at p. 376.

When the liquid from which the sulphide is precipitated is not wholly
free from colour or from organic matter, the precipitate should be dis-
solved in ammonia, and again thrown down by the addition of hydro-
chloric acid.

The gaseous test, then, applied with simple precautions, and fol-
lowed by the reduction of the metal from the sulphide, gives certain
evidence of arsenic. It is unnecessary, though for medico-legal pur-
poses desirable, to convert the sublimed metal into crystals of arse-
nious acid to dissolve the crystals, and to apply the liquid tests to the
solution.

Marsh's Test. — This ingenious and valuable test was proposed by
Mr. Marsh, of Woolwich, about the year 1835. He employed two
forms of apparatus ; the one (fig. 37) consisted of a tube bent in tlie

382

ARSENIC AND ITS PREPAUATIONS.

shape of the letter J, the long leg being twice the length of the shorter
one, and open, and the latter furnished with a stop-cock tei-minated by

a nozzle with a minute bore.

Fig. 37.

Fig. 38.

Hydrogen was generated in this
apparatus by pure zinc and dilute
sulphuric acid, to which a por-
tion of the liquid containing ar-
senic was added. When the
arseniuretted hydrogen had filled
the smaller leg of the tube the
stop-cock was opened, and the jet
of gas inflamed. On holding over
the flame a piece of glass or por-
celain, a distinct metallic ring
was deposited upon it. For larger
quantities of liquid Mr. Marsh
made use of the apparatus depicted
in fig. 3y.* Many alterations
and modifications of Marsh's
apparatus have been since sug-
gested, which it is unnecessary to describe. The subjoined engraving

Fig. 39.

represents the most convenient form. The apparatus consists of a
wide-mouthed bottle with a closely fitting coik, pierced for two tubes,
of which the one, furnished with a funnel, dips beneath the liquid,
and the other bent nearly at right angles, but sloping slightly towards
the bottle, descends but a short distance into the vessel. This tube is
furnished with a cork for the reception of a detached horizontal tube

* For an account of the apparatus employed by Mr. Marsh, and the results
which he obtained, refer to the 'Transactions of the Society of Arts,' vol. 11.,
Session 1835-6.

maksh's test. 383

of glass free from lead, and drawn out at its extremity into a point
with a small aperture.

In this apparatus hydrogen is generated by pure zinc and dilute
sulphui'ic acid, and the action is continued till the atmospheric air is
completely expelled, and all risk of an explosion is thereby avoided.
The flame of a spirit-lamp is then to be steadily applied for ten or
fifteen minutes consecutively to the horizontal tube. If there is no
deposit on the sides of the tube, we conclude that the zinc and sul-
phuric acid do not themselves contain arsenic. Having convinced
ourselves of the purity of these substances, we pour into the funnelled
tube a portion of the liquid supposed to contain arsenious acid, and
immediately reapply the spirit-lamp to the horizontal tube. If the
liquid contain arsenious acid, a metallic deposit will take place on the
tube at the distance of half an inch or more from the part to which the
flame is applied. The horizontal tube should be at least five or six
inches in length, so that we may obtain two such crusts at least.
Having procured these, we may inflame the hydrogen as it issues from
the end of the horizontal tube, and obtain one or two deposits on slips
of porcelain, and others on discs of crown glass. A very minute
quantity of arsenic will suffice for both these purposes. We may then
continue to apply the flame of the spirit-lamp to the horizontal tube,
until the absence of stain from a fragment of glass held before the jet
proves that the metal is exhausted. The spots thus obtained consist
either of arsenic or of antimony.

The evidence aflForded by the metallic stains thus obtained may be
confirmed by bending the horizontal tube at right angles and holding a
wide test-tube over the flame. The tube will be coated with arsenious
acid resulting from the oxidation of the metal. The contents of the
tube may be dissolved in a small quantity of distilled water and the
solution proved to contain arsenious acid by the liquid tests.

The round spots or stains on the flat surface of porcelain have the
following distinctive properties: —

a. The arsenical stain has every variety of metallic lustre from that
of copper to that of steel, but it never wears the sooty appearance which
belongs to the crusts of antimony, b. The arsenical stain is much
more readily dissipated by the heat of the spirit-lamp flame, and gives
out the garlic odour.* c. The two stains are characteristically affected
by several liquid and gaseous reagents, from which I select three, the
first two as tests by simple solution, the last as a test by solution
followed by a characteristic coloured deposit. Of these three tests the

* As this is a characteristic property of the arsenical stain, it may be applied
in practice as follows : — Procure a crust of arsenic and one of antimony on the
ends of two oblong porcelain slabs. Obtain two stains at the other ends of the
slabs from the liquid under examination ; apply the flame of the spirit-lamp
steadily to the centre of the porcelain between the two stains. If there is an
arsrnic stain at one end, and an antimony stain at the other, the first will soon
contract under the heat, and ultimately disappear, before the other shows any
signs of being affected by the heat.

384 ARSENIC AND ITS PREPARATIONS.

first was originally suggested by Bischoff, the second is now proposed
for the first time, and the third was suggested by the author in the
' Medical Times,' July, 1847.

1. The arsenical stain is rapidly dissolved by a solution of the
chloride of lime (bleaching liquid) which does not affect the anti-
monial stain. 2. The antimonial stain is less speedily, but at length
completely dissolved by a solution of the proto -chloride or perchloride
of tin, which does not dissolve the arsenical stain. 3. The anti-
monial stain is rapidly dissolved by the sulphide of ammonium ; the
arsenical stain slowly and imperfectly. The solution of the anti-
monial stain, when dry, leaves an orange-coloured spot of sulphide
of antimony, while the imperfectly-dissolved arsenical stain, when
dry, presents a light lemon-yellow spot of sulphide of ai-senic mixed
with portions of undissolved metal.

Several other modes of distinguishing these stains have been pro-
posed, such as the vapours of iodine and phosphorus, the tincture of
iodine, and nitro-muriatic acid followed by a solution of nitrate of silver
to the dried spot ; but the three tests of chloride of lime, protochloride
of tin, and sulphide of ammonium are sufficient for every practical
purpose. The last-named test has the peculiar advantage of leaving
behind highly characteristic and permanent appearances.

The larger and thicker stains of arsenic may also be readily identified
by the microscope. Globules of metallic arsenic may be seen by the
higher powers on the discs of glass; or they may be transferred from the
slab of porcelain to a disc of glass by the method described at p. 378,
and illustrated in fig. 33. The disc of glass, examined under the higher
powers of the microscope, will be found to be covered with octahedral
crystals ; or, if the cell is very shallow, with globules of the metal.

The stains of antimony and arsenic in the tube also present some re-
markable differences. The antimony is deposited close to the point of
the tube to which the heat is applied, and on both sides of the flame ;
the arsenic at some distance from it. This difference is shown in the
annexed woodcuts, of which A represents the arsenial stain and B the
Fig. 40. Fig. 41.

A B

antimonial stain. The antimony volatilizes very slowly, the arsenic
rapidly, on the application of heat ; the arsenic has often a nut-brown
colour nearly • resembling that of copper, the antimony more nearly
resembles tin. Of these properties the first and second are highly cha-

STAINS OF ARSENIC AND ANTIMONY. 385

ractei'istic, but the colour of the crusts is less constant; for though
antimony rarely presents the distinct copper colour of arsenic, nor
arsenic the tin-like lustre which belongs to most crusts of antimony,
it is possible to obtain crusts of antimony and aisenic very closely
resembling each other in colour, though not in shape or position.
The effect of heat is quite decisive ; for while the crust of antimony
moves slowly under the heat of the spirit lamp, and undergoes no
remarkable change, the crust of arsenic is easily dissipated, and
readily converted into characteristic crystals of arsenious acid. The
crusts of arsenic and antimony may also be readily distinguished
by detaching the horizontal tube, and transmitting a stream of dry
sulphuretted hydrogen gas through it, at the same time chasing
the metal, by the heat of the spirit lamp, in a direction opposite to the
stream of gas. The antimonial crust is made to change its place slowly
and with difficulty, and gradually assumes, but only in part, the cha-
racteristic orange hue of the sulphide of antimony; while the stain of
arsenic is readily driven from point to point as a light lemon-yellow
sulphide, forming a distinct crust, which disappears with the continued
application of heat.

Some precautions are necessary in the use of Marsh's test. To avoid
the risk of explosion, the gas should be generated freely at first, but
less briskly at the time of adding the suspected liquid ; for the smallest
addition of another metal occasions a violent extrication of gas. The
first violent action having subsided, the jet should be lighted to ascer-
tain that the risk of explosion has passed ; and the absence of arsenic
(in other words the purity of the zinc and sulphuric acid) ascertained
by repeatedly applying a clean suiface of porcelain to the jet, as well
as by steadily applying the flame of the spirit lamp to the horizontal
tube for several minutes. If there is no stain on the porcelain or on the
tube, the zinc and sulphuric acid may be assumed to be free from
arsenic ; and the suspected liquid may be added drop by drop, the
flame of the spirit lamp being kept all the time steadily applied to the
horizontal tube. A few stains should also be obtained on porcelain and
on glass. If there should happen to be much froth, a small quantity of
spirits of wine may be poured into the funnelled tube. By proceeding
in this manner all risk is avoided, and all objections are obviated.

Eeinsclis Test. — This test consists in adding to the liquid containing
arsenic, a i^vf drops of pure hydrochloric acid, introducing it into a
test tube with a narrow short slip of bright copper, and heating the
liquid to the boiling point. If the slip of copper is speedily tarnished
by the liquid, other slips may be introduced one by one, until the
copper retains its colour. The slips of copper are then to be removed
from the liquid, washed in distilled water, and dried at a low tem-
perature. The metal arsenic will be found to form an iron-grey
coating, adherent if in small quantity, but readily separating if more
abundant. A single slip of copper if thickly coated (or several slips if
merely stained) is then to be introduced into the capillary reduction-
tube (fig. 34), with the precautions described at p. 378. Arsenious

2c

386 ARSENIC AND ITS PREPARATIONS.

acid in the form of minute octahedral crystals, readily identified under
the microscope, will be found to line the capillary portion of the tube.
If characteristic results are obtained by this process, other slips may be
similarly treated in the simple mode described at p. 372, and illus-
trated in fig. 17, or by the method figured and described in fig. 33,
p. 378. The crystals of arsenious acid, being thus obtained on a flat
surface, are in a state very favourable for microscopic examination.

By any of these three methods satisfactory results should be obtained
with the thousandth of a grain of metallic arsenic, and in skilful and
practised hands with the five-thousandth of a grain.*

Certain precautions must be taken in employing this test. As the
hydrochloric acid may itself contain arsenic, its purity must be ascer-
tained by dilating with distilled water, and boiling in it a strip of clean
pure copper. And as it is now w^ell ascertained that almost all speci-
mens of copper, and even many specimens thrown down by the electro-
type process, contain arsenic, its purity must be previously ascertained.
If the copper, when boiled in the dilute hydrochloric acid, is untar-
nished, the acid may be considered pure; and if the copper itself, when
boiled in the acid liquor supposed to contain arsenic, is not dissolved,
and does not impart a green colour to the liquid, the copper may be
used with safety. It is only in those cases where the liquid which is
being tested dissolves the copper, that the impurity of the metal can
interfere with the result. In order, however, to guard against both
actual fallacies and speculative objections, a copper of ascertained
purity should be used.f

The process of reduction which constitutes the second part of the
test is rendered necessary by the iact, that other metals as well as
arsenic, when treated in the same way, also yield metallic deposits :
solutions containing mercury and silver without boiling, and those con-
taining antimony, bismuth, tin, and lead, on applying heat. Alkaline
sulphurets also tarnish the metal.

As the appearances presented by these metallic deposits, though
different, are not so different as to serve for tests, the process of reduc-
tion is absolutely necessary. The formation of octahedral crystals
effectually distinguishes the arsenical crust from all others ; and as
these crystals may be certainly obtained from less than a thousandth
of a grain of the metal, and readily identified by the higher powers of
the microscope (| or ^) , no other distinction can be required.

As it is very important that these and similar statements respecting
the detection of minute quantities of arsenic, or of other poisons, shouhl
not be discredited, a short digression on the divisibility of matter may

* To obtain these small quantities for purposes of experiment, prepare a
thousand small slips of copper, and boil ihcm in an ounce of distilled water
acidulated with hydrochloric acid, and holding In solution 1^ grain As 0.,.
The slips of copper will be distinctly coated with metal, and, if equally coated,
each would carry .^^ grain. Experiment successively with a slip, and with
fractional parts of a slip, up to a fifth, or less.

t Consult a paper by Dr. A. Taylor on 'Facts and Fallacies connected with
the research for Arsenic and Antimony, &c.,' in 'Guy's Hospital Reports,' I86(.'.

GALVANIC TEST.

587

be permitted. Some misapprehension certainly exists on this subject
in consequence of the bulk of matter represented by a grain being
undervalued. The best way to correct this misconception appeared to
be the counting out of the number of distinct particles of common
objects visible by the naked eye. I have caused this to be done in
the case of certain small seeds, and have found that the seeds of
digitalis number 1126 to the grain, and those of lobelia inftata 3176,
while the fern seeds of the shops can be counted to the number of
50,900 to the grain. When, therefore, we speak of the ready identifi-
cation of the thousandth of a grain of arsenic, and the possible recog-
nition of the five thousandth of a grain, we are still speaking of visible
particles. When, again, we speak of metallic crusts obtained by
Marsh's apparatus, from the half-millionth or millionth of a grain of
arsenic, or of a thousand fiagments of copper thickly coated by a grain
of arsenic according to Reinsch's method, it is only necessary to revert
to the fact, that a single grain of gold can be mechanically divided
into 490,000 visible pieces ; and into the almost incredible number
of 4,900,000,000 fragments visible by the microscope. (See Miller's
' Elements of Chemistry,' Part I. p. 4.)

Galvanic Test. — My colleague, Professor C. L. Bloxam, has lately
advocated the method of electrolysis as the best and least objectionable
means of generating arseniuretted hydrogen and procuring crusts of
metallic arsenic. He first made use of a simple modification of the
J-tube figured at p. 382, but afterwards preferred an apparatus of the
form shown in the annexed engraving, in which m is a two-ounce
nan'ow-mouthed bottle, the bottom (if which is replaced by a piece

Fig. 42.

of vegetable parchment 6, secured by thin platinum wire. The cork
a, carries a funnelled-tube c, a small tube d, bent at right angles,
and connected by a caoutchouc tube e, with a drawn-out reduction-
tube/; and it is pierced by a platinum wire A, suspending a plate of
platinum-foil I. The wire is connected with the negative pole of a
galvanic battery. This bottle is placed in a glass n, a little larger than

388 ARSENIC AKD ITS PREPARATIONS.

itself, and into which the positive plate i, attached to the wire h, of
the battery is introduced. The apparatus is pkced in a larger vessel,
o o, filled with cold water. An ounce of dilute sulphuric acid (1 acid
to 8 water) is then introduced into the bottle, the poles are connected
with the battery, and hydrogen gas is generated till all fear of an explo-
sion ceases. The shoulder of the reduction-tube at g, is then to be
heated to "redness during fifteen minutes, to ascertain the puiity of the
sulphuric acid. The liquid to be tested is then introduced through
the funnelled tube c. Frothing is prevented by adding a drachm of
alcohol. The metal arsenic is then reduced in the horizontal tube at g,
as in the modern form of Marsh's apparatus.

This method has the advantage of superseding the use of zinc in
generating the arseniuretted hydrogen, and thus excluding one possible
source of fallacy ; and it is very delicate. It was successively
applied in a series of experiments with quantities of arsenious acid
varying from the -^ij, to the -p^L^ grain, a characteristic arsenical mirror,
a shining ring of crystals of arsenious acid, and the alliaceous odour
being obtained in each instance. This method is applicable to the
detection of antimony, mercury, and of other metals.*

3. Arsenious Acid in Organic Liquids.

As arsenious acid is very insoluble in water, and still more so in
liquids containing organic matter, the poison may sometimes be ob-
tained in a solid form by diluting with distilled water, and allowing
the powder to subside. The poison may also be found adhering to the
mucous coat of the stomach, from which it may be detached. The
solid arsenious acid so obtained may be treated in the manner described
at p. 371.

If there is no solid arsenious acid in the organic liquid, the poison
may still be dijafused through it, or dissolved in it ; in which case the
liquid must be rendered slightly alkaline by liquor potassas, and then
carefully evaporated to dryness over a water-bath. By this means a
large portion of the organic matter is coagulated, so that by boiling the
I'esidue in distilled water, a liquid is obtained which will pass the
filter ; and may be treated as arsenious acid in solution by any of the
methods described at p. 380. This method of procedure is only
available where time is no object. In all other cases the process
presently to be described must be employed. The solid matters that
remain on the filter must be preserved, so that if we fail to procure
evidence of arsenic from the filtered liquid, this solid residue may be
treated by the methods now to be described as applicable to the solids
and fluids of the body.

* On the application of Electrolysis to the detection of the poisonous metals
in mixtures containing organic matters. (' Quarterly Journal of the Chemical
Society,' 1860.) For information concerning the fallacies which may attach to
the processes of Marsh and Reinsch, consult this valuable paper ; also a paper
by Wm. Odling, M.B., on some failures of Marsh's process for the detection of
arsenic, and Dr. Taylors ' Facts and Fallacies,' &c.. In the ' Guy's Hospital
Reports,' 1860.

PROCESS FOR ORGANIC SUBSTANCES. 389

4. Arsenious Acid in the Solids or Fluids of the Body.

As there are cases of poisoning by arsenic, in which the poison is
entirely expelled during life, so that no trace of it can be discovered
in the stomach after death, it is most important to be able to detect
the poison in the fluids or solids to which it has been conveyed by
absorption.

All the methods which have been at different times proposed for
eifecting this object consist of three essential parts: — The destruction
of the animal matter so as to obtain a liquid which will pass the filter ;
the reduction of the poison to the metallic state by Reinsch's or IMarsh's
method, or by the method of electrolysis advocated by Professor
Bloxam ; and the complete identification of the metal.

P^or the destruction of the animal matter four principal methods have
been proposed — one by nitrate of potash ; a second by nitric acid ; a
third by sulphuric acid ; and a fourth by hydrochloric acid. The last
of these methods is recommended by its simplicity, as well as by the
fact that the acid employed is the same that is used in Keinsch's test.

In the following process, proposed by Fresenius and recommended by
Professor Bloxam, hydrochloric acid is employed, with the addition
of chlorate of potasla, followed by the bisulphite of soda, which has
the great advantage of bringing back the poison to the convenient and
manageable form of arsenious acid.

If the organic matters are in a solid state, they must be reduced
to a fine state of division and be brought to the consistence of thick
gruel by mixture with water. If already in a liquid state, we pro-
ceed at once to digest them for an hour, in a porcelain dish over a
water-bath with about half an ounce of hydrochloric acid, adding
powdered chlorate of potash occasionally until the organic matters. are
disintegrated. The resulting liquid is then to be filtered off, and
evaporated over the water-bath to about an ounce. The coloured
fluid thus obtained is poured into a flask, and a few drops of a strong
solution of bisulphite of soda are added to it till it smells strongly of
sulphurous acid. The flask is then heated in a water-bath, until this
odour ceases. The resulting solution, mixed with at least an equal
bulk of water, maybe examined for arsenic by any or all of the methods
already described at p. 380,

Quantitative Analysis. — The quantity of arsenious acid contained in
a substance submitted to analysis is best determined by the use of the
pure sulphide of arsenic obtained from a measured portion of the
filtered liquid: iOO grains of the sulphide very nearly correspond to
80 grains of arsenious acid.

When the body of a person supposed to have been poisoned by ar-
senious acid, or by other preparations of arsenic, is disinterred for the
purpose of analysis, and the poison is detected in the stomach, in the
solid textures, or in the fluids of the body, it is sometimes alleged that
the arsenic contained in the surrounding soil was dissolved in water and

390 ARSENIC AND ITS PREPARATIONS.

conveyed into the body. To meet this allegation it is deemed necessary
to analyze a portion of the soil. One or two pounds of the soil ai'e
first treated with boiling water, and the filtered liquid i-educed by eva-
poration to a convenient quantity is tested by Reinsch's process. If this
gives no indication of the presence of arsenic, the soil is to be treated
with one part of hydrochloric acid to ten of water. The lime and iron
dissolved by this means are to be thrown down by adding bicarbonate
of potash in excess, and the resulting liquid filtered and reduced as
before, is to be examined by Reinsch's test.

The following facts bearing on the value to be attached to the de-
tection of arsenic in the dead body require to be borne in mind : —

a. Ai-senic may be detected in the dead body after such long intervals
of time as seven and ten years. Arsenious acid, which is usually found
attached to the coats of the recent stomach as a white powder or paste,
is converted into the yellow sulphide by the sulphuretted hydrogen
given out in the process of putrefaction.

h. Orfila affirmed that arsenic is a natural constituent of the body
itself; and that it may be discovered both in the fleshy parts of the body
and in the bones. But subsequent researches of himself and others have
shown that there was in his first experiments some source of fallacy.

c. Arsenic when contained in the soil of cemeteries is generally, if
not always, in an insoluble form, in combination with iron or lime.

d. Preparations of arsenic, whether taken in single large doses, or in
repeated small ones, are absorbed into the blood, and may be found in
the textures and secretions ; and they are only slowly eliminated from
the body. The limit usually stated for the complete elimination of
arsenic from the human body is three weeks ; but it has been extended
to a month by M. Bonjean. (See Ranking's retrospect, vol. iii., ' Report
on Forensic Medicine.')

e. Preparations of arsenic have a preservative effect on dead animal
matter.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — In most cases the symptoms set in within an hour of
the swallowing of the poison, with burning pain at the pit of the
stomach increased by pressure, nausea, and vomiting renewed by the
act of swallowing. The pain soon becomes more diffuse, and there is
swelling and tenderness of the belly, with diarrhoea, tenesmus, and
dysuria. After the setting in of vomiting, if not previously, there is
a sense of constriction in the throat, with intense thirst, inflammation
and smarting of the eyes, headache, violent beating of the heart,
frequent pulse, quick catching respiration, extreme restlessness, great
debility, cramps in the legs, and convulsive twitchings in the extremi-
ties. In the majority of cases the mind is intact. When the poison
proves rapidly fatal, death commonly takes place by collapse, or by
coma; in moie chronic cases, the patient dies exhausted by the
violence of the irritative fever, or after a long train of nervous

SYMPTOMS. 391

symptoms terminated by convulsions. Patients who recover are
either restored to perfect health, or they suffer from indigestion,
from prolonged weakness or palsy of the limbs, or from epileptic fats.

But cases of poisoning by arsenic present not only the greatest
possible variety in the character, combination, and severity of the
symptoms, but exceptions to general rules, and anomalies of the most
perplexing kind.

In one considerable class of cases, the symptoms are those just
detailed, but in a more aggravated form. The vomiting is incessant,
the pain in the pit of the stomach most acute, and increased by the
slightest pressure ; the mouth, tongue, and throat are red, hot, and
swollen; the eyes bloodshot; the countenance flushed; the thirst
excessive ; the diarrhoea profuse, and attended with tenesmus and
discharges of blood; the belly acutely painful and tender, and much
swollen ; the urine is suppressed or passed with pain and difficulty ;
the pulse is full, quick, and frequent ; and the respiration laborious
and painful ; there is a sense of fulness and oppression at the heart
V\'ith violent palpitation ; there is intense headache, with giddiness,
incessant restlessness, and severe cramps in the legs and arms, followed,
if life is prolonged, by convulsions, tetanic spasms, epileptic fits, de-
lirium, coma— a group of nervous symptoms varying with each case,
and terminating in various ways, and at various intervals, in recovery
or death.

In a second class of cases the symptoms are those of collapse. There
is little or no pain, vomiting, or diarrhoea, a cold and clammy skin,
extreme prostration of strength, the pulse vei-y frequent and almost
imperceptible, or so low as thirty or forty beats in the minute. The
mind, as in most cases of poisoning by arsenic, is unimpaired, but there
is some approach to coma, slight ci-amps or convulsions, and death
without reaction. Sometimes this state of collapse is accompanied by
constant vomiting and profuse purging. In this class of cases, death
often takes place in four or five hours, and it is rarely delayed beyond
twenty hours.

In a third class of cases, the patient falls into a profound sleep,
deepening into coma, and dies in a few hours without rallying. Such
a case is recorded by Mr, T. Wright, of Dublin. Death took place in
four hours, and followed upon sound sleep ; and after death there was
no trace of inflammation of the mucous membrane even in the spots
covered with arsenic. (' Lancet,' vol. xii., p. 194.)

In a fourth class of cases, the symptoms so closely resemble those of
a common attack of English cholera, as to have averted suspicion from
the minds of intelligent and well-informed physicians. Such was the
case of the Duke of Praslin.

All these varieties of cases develop themselves under large and small
doses of the poison ; and they are not to be accounted for by the form
or vehicle in which it is administered. The same dose administered in
the same way may give rise to prolonged vomiting and purging in one

392 ARSENIC AND ITS PREPARATIONS.

man, to collapse in a second, to coma in a third, to violent irritative
fever and severe nervous symptoms in a fourth ; and these leading
forms may even run into, and be blended with, each other.

Though these varieties do not admit of complete explanation they
become more intelligible when we reflect that the poison is an irritant
by contact with the alimentary canal, and, as such, gives rise to all
the symptoms, local and remote, which follow on such irritation, —
pain and tenderness, vomiting and purging, cramps and spasms ; that
it is absorbed into, and circulated with, the blood, developing in this
manner its specific symptoms on the whole course of the alimentary
mucous tract, and not only reinforcing the direct effect of the poison in
causing pain and tenderness, vomiting and purging, but superadding
redness and smarting of the conjunctiva, intense thirst, palpitotion and
rapid pulse ; that it affects the nervous system both by the direct
violence of its action on the parts with which it comes in contact, and
by being circulated with the blood through the nervous centres, hence
delirium, convulsions, tetanic spasms, epileptic fits, extreme weakness,
paralysis ; and that, lastly, it is in course of elimination from the
system through the secretions of the liver, kidneys, and skin, giving
rise in one person to jaundice, in another to dysuria, and even sup-
pression of urine with its natural consequence, blood tainted with
urea, and coma as a sequence, and in a third to painful cutaneous ei-up-
tions. Administered in large doses, or to feeble persons, the first
shock to the system might prove fatal, as in drinking cold water or in
blows on the stomach.

The great importance which attaches to the subject of poisoning by
arsenic, and the very variable character and grouping of the symptoms
in different cases, renders a more detailed account of symptoms and of
combinations of symptoms desirable. The following summary is based
chiefly on a careful analysis of a group of 25 cases.

Alimentary Canal. — Vomitimj was stated to be present in 23 cases,
but in one case not till artificially induced. In a few cases, this, in
common with every other marked symptom, has been wholly absent.
The vomited matters consisted, in 3 cases, of blood ; in 2, of mucus tinged
with blood ; in 1, of mucus only ; in 1, of water containing arsenic; in
1, of bile, and in 1, of bile and faeces. The vomited matters are some-
times described as yellow or brown. Diarrhcea was present in 11
cases, but absent in 4, out of 15 in which the symptom is mentioned ;
in 7 cases it was excessive. The matters passed bj/ ^tool consisted, in
3 cases of blood, and in 2 of a material closely resembling gieen paint.
Pain : Of 20 cases in which this symptom is mentioned, it was present
in 19, and altogether absent in 1 ; in 2 instances it subsided after a
short time, and it is stated not to have been increased by pressure in
2 instances. The tongue and throat are described as sore, con-
stricted, hot, painful, and tense, in 9 cases. Thirst: Of 17 cases in
which this symptom is mentioned, it was present in 15, and absent
in 2 ; in 13 it is described as intense. The countenance was flushed

SYMPTOMS. 393

and swollen, in 7 cases ; pale and anxious in 5 : the facies hippocratica
present in one. The eyes were inflamed, swollen, or smarting in
7 cases. The skin hot and dry in 6 cases ; covered with cold per-
spiration in 4 ; profuse perspiration with petechias in 3 ; universal
desquamation in 1 ; covered with an eczematous eruption in 1. Head-
ache in 9 cases, absent in 1 ; described as intense in 4. Violent palpi-
tation in 2 cases. Fulse generally very frequent, but of variable
character, ranging from 90 to 140, or more ; in one case 30 to 49.
Jaundice, suppression of urine, strangury, and salivation must be added
to this list of symptoms.

Some of the leading symptoms and groups of symptoms are deserv-
ing of special notice.

Nervous Symptoms. — These are not only of great severity in many
acute cases, but they have been of very long continuance. Thus,
Mr. Gadsden, one of the victims of Eliza Fenning, was seized with
epilepsy on the first day ; had four attacks on the second day, then a
fit every evening at the same hour, for fourteen successive evenings;
then an interval of seven or eight days, followed by another relapse,
and that by another interval of three weeks ; at the end of three
months the fit still recurred every twelve hours, or three or four times
in two days ; and he continued, even after the lapse of two years, to be
subject to frequent attacks. In the case of Helen Mitchell, there was
extreme debility of the limbs for three months.

A careful analysis of 25 cases of poisoning by arsenious acid yielded
the following results in respect of this class of symptoms. There was
extreme restlessness in 5 cases ; extreme debility in 10 cases ; com.a in
3 cases ; delirium in 3. The mind was stated to be unimpaired in
6 cases ; there were cramps in the legs in 9 cases, in 4 extending to the
arms ; convulsions in 6 cases ; paralysis of tongue and gullet in
3 cases ; tetanus in 2 cases ; chorea in 1 ; hysteria in 1 ; epilepsy
in 2 cases. Tetanus, coma, and delirium successively in 2 cases.
Death took place in 3 cases in the midst of convulsions, and in one
after a horrible fit of convulsive laughter followed by rigid spasm of
the whole body.

Locked jaw has been observed among the early symptoms — in one
case so early as three quarters of an hour. (Orfila.)*

Post-mortem Appearances. — The stomach is the seat of acute in-

* The reader is referred to the following cases:— the cases of the Messrs.
Turner, and Mr. Gadsden, poisoned by P^liza Fenning, in Mr. Marshall's Re-
marks on Arsenic; tliose of the Mitchells, reported by Mr. Alexander Murray,
in the Edin. Med. and Surg. Journal, vol. xviii. p. 167, and three cases given
by Mr. Alexander McLeod, in the same Journal, vol. xv. p. 553. 'I'hese cases
afford some of the best illustrations of the nervous symptoms which follow
poisoning by arsenic. Also Kd. Med. and Surg. Journal, v. 389 ; liv. 106, 262 ;
Ivi. 295; lix. 250. Lancet, July 21, 1827; Aug. 15, 1829; Oct. 31, 1829,
vii. 254; Oct. 6, 1838; Nov. 3, 1838; and Nov. 24, 1838. Medical Gazette,
V. 411 ; ix. 895; xiv. 62; xv. 828; xix. 238; xx. 309. London Medical Re-
view, iv. 188; xix. 288. Guy's Hospital Reports, No. iv. 68; and subsequent
volumes.

394 ABSEKIC AND ITS PREPARATIONS.

flammation, sometimes spreading over the entire surface, sometimes
confiin?d to the prominent folds of the membrane, sometimes existing
in well-defined patches. Sometimes, in lieu of the bright tint of in-
flammation the mucous membrane has the deep hue of congestion.
The most common and characteristic appearance is that of one or
more patches from the size of a shilling to that of a crown j)iece,
consisting of a tough white or yellowish paste of arsenious acid, mixed
with coagulable lymph, firmly adhering to the inflamed mucous mem-
brane, and forming so many centres of intense inflammation. White
spots of arsenious acid are also often found between the rugae.
Ulceration is comparatively rare, and perforation still less common.
Gangrene also is a rare occurrence; but the dark swollen appear-
ance produced by extravasation of blood beneath the mucous mem-
brane is often met witli. The stomach usually contains a brown
grumous matter, which is occasionally tinged with blood ; but some-
times the colour is yellow from the partial conversion of the poison
into sulphide ; and the mucous coat has been found smeared as with
yellow paint. The inflammiation generally extends to the duodenum
and commencement of the other snmll intestines, and occasionally
affects the whole length of the intestinal canal, being most conspicuous
in the lower bowel. The oesophagus, also, is sometimes the seat of
inflammation, and in rare instances the mouth, tongue, fauces, and
windpipe have been involved in the inflammatory action. The
peritoneal covering of the stomach or of the entire abdomen is some-
times found in a state of inflammation, and the intestinal glands are
swollen.

Among occasional post-mortem appearances may be mentioned, in-
flammation of the bladder, livid spots on the skin, and congestion
of the brain and serous effusion.

The most remarkable post-mortem appearance, however, is the
absence from the mucous membrane of the stomach of all traces of
inflammation, and of every other characteristic change. This anomaly
is not due to the death having taken place before there was time for
inflammation to be set up ; for well-marked inflammatory appearances
have been present in the most lapidly fatal cases.

It happens fortunately for the ends of justice that arsenic not only
preserves the stomach with which it is in contact when surrounding
parts are in a state of advanced decay, but that even the charac-
teristic appearances of inflammation are present after several months
of interment.

Fatal Dose. — The smallest fatal dose of arsenious acid on record is
two grains and a half. It was contained in two ounces of fly-water,
and proved fatal to a strong healthy girl, nineteen years of age, in
thirty-six hours (Dr. Letheby). Much smaller quantities have given
rise to alarming symptoms. On the other hand, recovery has taken
place from doses of half an ounce, an ounce, and even an ounce and a
half. The larger doses of the poison are often taken on a full stomach.

TREATMENT. 395

in substance, or in powder, and are promptly rejected with the food, or
earned away by the brisk action of the bowels.

Fatal Period. — The poison has proved fatal in as short a period as
two hours, in three or four instances (one by Mr. Foster, of Hunting-
don, and one by Mr. Macaulay, of Leicester).

On the other hand cases may prove fatal after three, four, five, six,
or seven days, or even as late as the second or third week. The average
duration of fatal cases is 20 houis, and that of all the cases which ter-
minate within 24 hours is less than 7 hours. As many as 85 in the
100 die within 24 hours. More than half the cases terminate within
6 hours, two-thirds within 8 hours, and more than three-fourths
within 12 hours.*

Fatality. — Fatal cases and cases of recovery are nearly equally
divided. The first class are to the second as 52 to 48.

Proportion of Suicidal, Homicidal, and Accidental Gases. — In 100
cases, about 46 are suicidal, 37 homicidal, and 8 accidental. This
statement is based on an analysis of 92 cases. The cases of suicide
were equally divided between men and women.

Commencement of Symptoms. — In some instances , the symptoms
have come on in ten minutes after taking the poison. They have even
been described as setting in immediately. But in other instances they
have not made their appearance for several hours, and have been even
delayed till ten hours. It is natural to suppose that sleep would have
the effect of delaying the operation of the poison.

Treatment. — As arsenious acid itself is a powei-ful emetic, it some-
times excites such effectual vomiting that it is completely rejected
from the stomach. This is most likely to happen when it is swal-
lowed with, or soon after a meal. In other cases on the exhibition of
an emetic, or the abundant use of diluents, the contents of the stomach
are rejected, and with them the poison. When, on the other hand,
the poison is swallowed on an empty stomach, it attaches itself to the
mucous coat, excites violent inflammation, and the formation of a
tenacious secretion, by which it is glued to its surface and protected
from the action both of emetics and antidotes. In the first class of
cases recovery is often attributed to some substance which is thought
to possess the virtues of an antidote. Arsenic, also, by its purgative
action sometimes occasions so free an evacuation of the bowels that
the poison is partly carried off by this channel.

The first step in the treatment consists in removing the poison as
promptly as possible from the stomach. If the stomach-pump is at
hand it should be used without delay. If not, and the poison itself is

* Out of 41 cases which proved fatal within a day, 3 were fatal in 2 hours ;
1 in 2 hours and a half ; 1 in 3 hours ; 2 in 3 hours and a half ; 8 in 4 hours ; 6
in 5 hours ; 6 in 6 hours ; 2 in 6 hours and a half ; 1 in 7 hours ; 2 in 8 hours ;
3 in 9 hours; 2 in 12 hours; 1 in 15 hours; 1 in 17 hours; 1 in 21 hours, and

1 in 24 hours. Of 7 which lasted more than one day, 1 was fatal in 36 hours;

2 in 48 hours ; 1 in 3 days and a half; 1 in 4 days and a half; 1 in 6 days, and
1 in 7 days.

396 ARSENIC AND ITS PREPARATIONS.

acting freely as an emetic, vomiting should be promoted by copious
draughts of warm milk and water, and tickling of the throat with a
feather. If the patient is not sick, emetics of ipec;iciianha, mustard,
or common salt, aided by similar copious draughts of waira milk and
water should be given. When the stomach has been emptied by
these means, milk, or milk beaten up with eggs, or a mixture of milk,
lime water, and white of egg, should be given freely at short intervals.

The rest of the treatment will be determined by the symptoms
which happen to be most urgent. If the inflammatory symptoms run
high blood may be taken from the arm, or by leeches from the pit of
the stomach. When coma threatens, blood may also be removed with
advantage. The state of collapse must be met by stimulants, and the
nervous symptoms by anodynes. Tetanic spasms would be best
relieved by chloroform. The intense thirst may be satiated with
small quantities of acid water ; the tenesmus and dysuria by injections
of gruel containing laudanum ; the diarrhoea, if ineffectual and painful,
by castor oil mixed with milk. Antimony ought not to be given as
an emetic, inasmuch as the resemblance of the crusts of antimony to
those of arsenic gives rise to an objection to the chemical evidence.
Sulphate of zinc, and antidotes containing iron ought perhaps also
to be avoided, lest it should be alleged that arsenic detected in the
stomach existed in them as an impurity.

Antidotes. — When arsenious acid has been given in solution, the
hydrated sesquioxide of iron, the acetate of the sesquioxide, the
hydrated persulphuret of iron, the hydrated oxide of magnesia, cal-
cined magnesia, or animal charcoal freely administered (from 15 to
20 times the bulk of the poison), might be attended with some
advantage. W^hen the poison is taken in the solid form these reputed
antidotes are quite useless. The hydrated oxide of magnesia preci-
pitated from a strong solution of the sulphate by liq. potassae, and
well washed, is to be preferred, as being equally effectual with the
others, and more free from objection should the patient succumb, and
an analysis of the contents of the stomach be required.

In conducting the treatment of a case of poisoning by arsenious
acid, or by other preparations of arsenic, it should be borne in mind
that evidence of poisoning may be obtained by examining the urine,
the serum from a blistered surface, or the blood drawn fiom the arm
or by leeches, as well as from the matters vomited or passed from the
bowels.

Arsenious acid has been intioduced into the body in other ways
than by the mouth. It has been inserted into the vagina, producing
intense locaf inflammation, and the characteristic general symptoms of
poisoning by arsenic. It has been applied to the skin in the form of a
mixed powder and of ointment, with similar local and constitutional
results ; and it has been inhaled in the fonri of vapour. Severe indis-
position has also been produced by the smoke of candles containing
arsenic.

ARSENITE OF COPPER. 397

OTHER PREPARATIONS OF ARSENIC.

Arsenite of Potash. — This is the active principle of Fowler's
solution, in which it is contained in the proportion of four grains to
the ounce. It may be readily detected by any of the methods de-
scribed for arsonions acid.

Arsenic Acid. — This acid, though a powerful poison, is of no medico-
legal interest except inasmuch as it is formed in the course of some of
the processes for detecting arsenious acid. It is a white deliquescent
solid. It resembles arsenious acid in yielding a metallic sublimate
when reduced with charcoal, and a metallic crust when treated by
Marsh's or Reinsch's method. It also gives a yellow precipitate with
sulphuretted hydrogen, on boiling. It differs from arsenious acid in
being very soluble in water, in having a strong acid reaction, and in
not being volatilized by the heat of a spirit-lamp. It is also preci-
pitated a brown red by nitrate of silver, and by the ammonio-nitiate,
while arsenious acid gives with the latter a yellow precipitate.

The combinations of arsenic acid are called arseniates, and have the
same properties.

Arsenite of Copper. Scheele's Green. — This is a fine green powder,
containing one part of arsenious acid to two parts of oxide of copper.
It is readily identified by yielding distinct crystals of arsenious acid
when heated, and a residue of oxide of copper ; and it is soluble both
in ammonia and in nitric acid.

Aceto- Arsenite of Copper. Emerald, mineral, Schweinfurth, Bruns-
wick, or Vienna Green. — This also is a fine green powder largely used
by paper-stainers, both for fancy-papers and for wall-papers, both alone
to impart a full green colour, and mixed with oxide of zinc, with
porcelain powder, or with whiting, to give more delicate tints of
green. It has also been used to give a green colour to sweetmeats
and confectionery, to wafers, to toys and cages, to cakes of water
colour, to oil colours, to articles of dress, and to papers used as wrappers
for fruits and sweetmeats. , -

Tests. — This poison is readily identified by giving off when heated
strong fumes of acetic acid and crystals of arsenious acid, with a residue
of oxide of copper.

Symptoms. — Those of the acute form of poisoning may be inferred
from the case of a prlnt-colourer admitted into King's College Hospital,
June 1858. Death took place from an ounce of the aceto-arsenite of
copper in seven hours, under symptoms belonging to the second class
of cases of arsenical poisoning described at p. 391. He did not vomit
till an emetic was administered, and diarrhoea did not form a pro-
minent symptom. He was pale, excited, faint, and anxious, with a
small feeble pulse, slight epigastric tenderness, intense thirst, profuse
cold sweats, severe cramps in the calves of the legs and in the hands,
with twitchings of the legs and arms. The patient never rallied, but
died exhausted. The tongue was tinged green, and the matters re-

398 ARSENIC AND ITS PREPAUATIONS.

jected from the stomach and bowels were of the same colour The
stomach-pump was used, and the hydrated sesquioxide of iron freely
administered. The post-mortem appearances were a dirty green
tongue, the stomach containing a large quantity of the antidote
speckled with green, congestion of its mucous coat, and of that of tlie
small intestines, deep chocolate colour of the folds of the stomach, and
dots of extra vasated blood over the surface, especially near the pylorus.
The lungs were greatly congested ; the brain and kidneys sound.

It may be stated generally that the symptoms, post-mortem appear-
ances, and treatment of poisoning by the arsenite of copper and by
tlie aceto-arsenite, are those of poisoning by arsenious acid.

Very severe symptoms of irritant poisoning have been induced by
eating various substances coloured with arsenite of copper. They
have been the usual symptoms of irritant poisoning. In one or two
instances it has proved fatal. In two cases the symptom of jaundice
showed itself as if the copper had proved active.

The symptoms of the chronic form of poisoning by the inhalation
and swallowing of the powder detached from the walls of rooms have
not been uniform. They have consisted of several of the following
symptoms variously grouped. Nausea and loss of appetite, depression
and weakness, colic, headache, dryness of the tongue and throat, thirst,
cough, and wateiy and inflamed eyes.

Arsenite of copper mixed with warm size is largely used in making
tinted papers and for paper-hatigings, and is so laid on as to come into
contact with the hands of the workmen. After working one or two
days the men begin to suffer, and are soon obliged to abandon their
employment. The first symptom pi'oduced is a papular rash, running
on to pustulation, about the root of the nostrils ; the back of the ears,
the bends of the elbow, and the inside of the thighs suffer in order,
and then the scrotum, which is often found sprinkled with superficial
circular ulcers from the size of a split pea to that of a fourpenny piece,
looking as if cut by a punch. Sometimes the fingers are inflamed,
and the nails drop off. The pulse is sometimes increased in frequency,
and occasionally the eyes smart and the epigastrium is tender. On
abandoning the employment, the effects soon pass away ; and they
might certainly be avoided by scrupulous cleanliness and simple pre-
cautions to avoid contact with the poison. Dr. Prosper de Pietra
Santa, in the ' Annales D'Hygifenc,* October 1858, p. 339, gives a
similar account of the effects of Schweinfurth gi-een as used in Paris.
Sea also an able paper by M. A. Chevallier in the same journal, July
1859.

The Arseniate and Binarseniate of Potash. — These are active
poisons little used in this country. The arseniate is a white, deli-
quescent, and very soluble substance, and has the reactions of " arsenic
acid." The binarseniate is known as *' Macquir's neutral arsenical
salt.'*

The Arseniate of Soda is used as a medicine in France. A grain

ARSENIURETTED HYDROGEN. 399

of the salt to an ounce of distilled water constitutes *' Pearson's
solution ;" and paper soaked in a solution of one pait of arseniate of
soda and two of sugar in twenty parts of water, and dried, is in use
for poisoning flies.

Sulphides of Arsenic. — Realgar, or red arsenic, and orpiment, or
yellow arsenic, and King's yellow, which consists chiefly of orpiment,
are largely used in tinting paper, and for other similar purposes. Both
orpiment and King's yellow contain arsenious acid, often in considerable
quantities. The yellow sulphide of arsenic is the precipitate thrown
down by sulphuretted hydrogen gas from liquids containing arsenious
or arsenic acid, and their compounds. It is also occasionally admini-
stered as a poison, and is sometimes found adhering to the coats of
the stomach after death, having been formed, as already stated, by
the union of arsenious acid with nascent sulphuretted hydrogen, given
out during the process of decomposition. In organic mixtures the
sulphides are detected by their characteristic colours. They are soluble
in ammonia, and thrown down from the ammoniacal solution, in a state
of sufficient purity, by muriatic acid.

The sulphides, when treated by black flux in the same manner that
arsenious acid is treated by charcoal, yield metallic sublimates. (See
p. 381.) When boiled with nitro-muriatic acid they are converted
into arsenic and sulphuric acids. The symptoms of poisoning by the
sulphides are those of poisoning by arsenious acid ; and the post-mortem
appearances are also the same, with the exception that the contents of
the alimentary canal have a yellow colour, and that the mucous
membrane is tinged of the same hue. The treatment is that of poison-
ing by arsenious acid.

Arseniuretted Hydrogen. — Several cases of poisoning by this gas,
which is very rich in arsenic (each cubic inch containing little short of
a grain of the metal), are on record. It has been more than once
generated instead of hydrogen by sulphuric acid containing arsenic, and
when inhaled has proved fatal. A very interesting series of cases
affecting a whole family, and due to the inhalation of that gas evolved
from decomposing arsenite of copper, have been related by Dr.
Elliotson. The symptoms were nausea, vomiting, thirst, watering of
the eyes, red and foul tongue; a rapid pulse, ranging from 120 to
160, and, after apparent recovery, pains in the limbs. The patients
derived much advantage from blood-letting.

The poison, though inhaled by the lungs, seems to be eliminated by
the kidney, in which organ it gives rise to severe irritation. In two
instances cited by Christison (' On Poisons,' 4th Edition, p. 326) and in
a third case by Vogel ('Brit, and For. Med. Chir. Review,' January
1854, p. 279) it gave rise to ha?maturia.

Compound cases of poisoning by arsenic are not of rare occurrence
that by arsenic and opium jointly being the most frequent. The
opium has the effect of masking the characteristic action of arsenic, so
that the case resembles very closely the rai-e instances of arsenical
poisoning, in which narcotic symptoms are very prominent. Such was

400 ARSENIC AND ITS PREPARATIONS.

the character of a case of poisoning by arsenic and laudanum, which
occurred some years since in King's College Hospital.

2. ANTIMONY AND ITS PREPARATIONS.

Until the last few years poisoning by antimony has been so rare an
occurrence that the jioison is not distinctly specified by the Registrar-
General in the list of substances which proved fatal in the five years
1852-56. But since the trials of Palmer, Dove, McMullen, and Snie-
thurst, of which the first three took place in the year 1856 and the
last in 1859, the subject of poisoning by antimony, and especially by
small repeated doses of tartar-emetic, has assumed great importance.

The preparations of antimony, which are important in a medico-
legal point of view, are tartar-emetic and chloride of antimony. The
precipitated sulphide of antimony is of interest from being developed
in testing for the poison.

The 7netal antimony shares with arsenic the property of combining
with nascent hydrogen, and of being di posited in the metallic form on
burning the jet of gas, or heating the glass tube through which it is
passing. It differs from arsenic in not being volatilized when in the
mass by the heat of the spirit-lamp, and with difficulty when in the
forni of thin films. In common with arsenic, mercury, and several
other metals, it is deposited in the metallic form on copper when its
solutions are treated after the method of Reinsch. The metal
antimony often contains a minute fraction of arsenic.

The precipitated sulphide formed by transmitting a stream of sul-
phuretted hydrogen through a solution of a salt of antimony, or by
treating metallic stains of antimony with the sulphide of ammonium, is of
a characteristic orange-red colour, and like the black prepared sulphuret
yields metallic antimony when heated in a current of hydrogen gas.

Tartar Emetic (Tartarised Antimonii, Stihiated Tartar y Potassio-
Tartrate of Antimony).

This substance is found in the shops as a white powder, or as
yellowish-white efflorescent crystals. This salt, as well as the anti-
monial wine and James's powdei-, may contain minute traces of
arsenic, derived either from the metal antimony, or from the sulphuric
acid used in its manufacture.

Properties. — Tartar emetic is very soluble in water, in about three
parts of boiling and fifteen of cold watei*, but insoluble in alcohol ;
and it has a sickly metallic taste, and faint acid reaction.

Tests. — It may be necessary to examine the poison in a solid
form, in solution, in organic mixtures, and in the fluids and tissues of
the body.

1. In Substance.

a. When heated by the flame of a spirit-lamp it decrepitates and
chars, and if the heat is increased by the use of the blowpipe, the

TARTAR EMETIC.

401

metal is reduced, but not sublimed. When treated with sulphuretted
hydrogen, or sulphide of ammonium, the characteristic orange-red
sulphide is formed.

2. In Solution,

a. A drop of a solution of tartar emetic evaporated on a slip of glass
leaves a crystalline deposit, b. This deposit, examined by the lens or
microscope, may contain well-formed crystals, which are either tetra-
hedra (figs. 41, 42), or cubes with the edges removed (fig. 43), or some
modification of the cube. Sometimes all the crystals assume the one
shape sometimes the other ; but in many cases both kinds of crystals
are to be found in the same specimen, as is shown in fig. 44 ; together

Fig. 41.

Fig. 42.

Fig. 43.

jAl

^

^

with the branched crystalline foi-ms so common in collections of crystals
obtained from solutions of salts. In fig. 41 the tetrahedron is shown,
in the usual manner, by outline; in fig. 42, as generally seen under the
lens or microscope.

c. The solution is proved to contain a salt of antimony by the orange
precipitate which it yields with sulphuretted hydrogen gas, or sulphide
of ammonium. The precipitated sulphide of antimony is soluble in
caustic potash, in a large excess of ammonia, and in strong hydrochloric
acid. The solution in hydrochloric acid has the characteristic property

Fijj. 44.

-^7.

of letting fall a white precipitate when largely diluted with water.
The sulphide is also decomposed when boiled in hydrochloric acid,
sulphuretted hydrogen being given off, and chloride of antimony re-
maining in solution ; and it may be reduced to the metallic state by

2 D

402 ANTIMONY AND ITS PREPARATIONS,

heating it in a current of hydrogen gas. The indication afforded by
this test is confirmed by the following tests: 1. The three dilute
mineral acids throw down a white precipitate, which is re-dissolved
by the acid in excens, and by a solution of taitaric acid. Of these
acids the nitric acid is least open to objection as a test, but the three
conjointly are conclusive as to the presence of antimony. 2. A strong
infusion of gall-nuts gives a dirty yellowisli-white precipitate. 3. Fer-
rocyanide of potassium causes no precipitate.

d. Introduce a portion of the solution into a Marsh's apparatus,
and proceed as ia the case of areenic (p. 383). The crusts obtained on
a slab of porcelain by inflaming the jet genei'ally possess a less distinct
metallic lustre, and a more smoky appearance than those of. arsenic,
but crusts are sometimes obtained which may be very readily mis-
taken for those of the latter metal. The crusts obtained by healing the
horizontal tube have a characteristic shape (fig. 41, p. 384) and tin-
like lustre. For the mode of distinguishing the crusts of the two
metals, see p. 384.

e. Treat the solution after the method of Reinsch (p. 385), taking
care to use a specimen of copper free from antimony as well as arsenic.
The antimony deposited on the copper is generally of a violet tint.
It may be dissolved off from the copper, either, 1, by boiling the metal
in a weak solution of permanganate of potash rendered slightly
alkaline by liquor potassas (Dr. Odling) ; or, 2, by a weak solution
of potash and the frequent exposure of the metal to the air (Mr.
Watson, of Bolton). If the first process is adopted, the solution of
antimony must be first freed from the brown deposit of the hydrated
peroxide of manganese by filtration, then slightly acidulated with
hydrochloric acid, and, lastly, treated with sulphuretted hydrogen
gas. If the second process is adopted, vhe solution of the metal is
first filtered, then acidulated with hydrochloric acid, and, lastly,
treated with sulphuretted hydrogen.

/. The metal may be separated from liquids containing it by the
process of electrolysis described at p. 387. The antimony is deposited
on the platinum plate connected with the negative pole of the battery,
and may be identified either by washing it with sulphide of ammonium,
and evaporating the solution, or by either of the methods just ,de-
scribed.

3. In Organic Liquids.

All vegetable substances containing tannin decompose the salts
of antimony. Several other vegetable substances affect the action
of the tests, and milk is coagulated by strong solutions of those salts.
Coloured fluids, though they modify the action of the other tests, have
little effect upon sulphuretted hydrogen, the precipitated sulphide
retaining its characteristic colour. If no antidote has been given,
and the poison has not been wholly rejected by vomiting, it may
remain in the stomach unchanged. In this case we dilute, filter,

EXPERIMENTS ON ANIMALS. 403

acidulate with tartaric acid, and transmit sulphuretted hydrogen gas
through the liquid. If antimony is present we obtain the charac-
teristic orange sulphide of antimony. If this process fails, we adopt
for the solid contents of the stomach and the coats of the viscus the
same method as for the organic tissues.

The discovery of antimony, by either method, in the contents of the
stomach proves that some preparation of antimony has been taken,
either as medicine, or as a poison. If the quantity discovered exceeds
that of an oidinary medicinal dose, there is a strong presumption of
poisoning; but when the quantity is small it will be impossible to
state that it has been administered as a poison, unless it can be dis-
tinctly shown that it was not given as a medicine. Antimonial
emetics ought never to be given in cases of poisoning, but the pos-
sibility of their being given should be borne in mind.

4. In the Tissues.

Antimony, like arsenic, is absorbed, and may be found in the secre-
tions, in the blood, and in the solid viscera of the body. The pi-ocess
for detecting the poison in the blood or solid viscera is that already
recommended for arsenic (p. 388). The resulting acid liquor may be
treated after the method of Reinsch (p. 385), or that of Marsh
(p. 381), or by electrolysis (p. 387). If by Reinsch's method the
metal must be identified by the method just described: if by Marsh's
method, by the characters described at p. 384.

Quantitative Analysis. — For this purpose use the precipitated
sulphide of antimony, carefully washed and dried. One hundred
parts correspond to 203 parts of crystallized tartar emetic.

Experiments on Animals.

Large doses of tartar emetic, such as half an ounce, may be given to
dogs with impunity if they are allowed to vomit ; but a few grains
prove fatal when the gullet is tied. When injected into the veins,
there is vomiting and purging, and marks of acute inflammation are
found after death in the alimentary canal and in the lungs. In some
instances of speedy death there was no inflammation in any organ of
the body.

An interesting series of experiments on slow poisoning by antimony
have been lately made by Dr. Nevins, of Liverpool (' Liverpool Medico-
Chirurgical Journal,' No. 1), in illustration of the case of McMullen,
whose death was attributed to the repeated administration of small
doses of tartar emetic by his wife. The animals selected for experi-
ment were rabbits, eleven in number, to which Dr. Nevins gave tartar
emetic in powdei-, four times a day, in doses of half a grain, a grain,
and two grains. The quantity required to destroy life was from
twelve grains in a feeble rabbit to seventy-two in the longest survivor.
Five of the rabbits died, the first after four, the last after seventeen
days. Three survived after taking the poison seventeen days ; and

404 ANTIMONY AND ITS PREPARATIONS.

three were killed, after one, three, and four days respectively, two
after an interval of fourteen days, and one thirty-one days after taking
the last dose of the poison.

The symptoms produced were loss of appetite, loss of spirit, and,
after the sixth day, great emaciation. None of the rabbits vomited ;
and diarrha;a was absent in five out of eight. There were no cramps ;
but three of the five that died of the poison were violently conmlsed
for a few minutes before death, and a fourth slightly so. Seveial of
the animals had ulceration of the mouth, wheie the powder came in
contiict with the lining membrane. One of the rabbits, being with
young, aborted.

The post-mortem appearances consisted in congestion of the liver in
all the rabbits, vivid redness of some part of the lining membiane of
the stomach in most instances, ulceration in two ; and cartilaginous
hardness of the pylorus in some instances. The small intestines in
some of the animals presented patches of inflammation throughout,
and, in two instances, the solitary glands, throughout the bowels,
were enlarged, prominent, of a bright-yellow colour, and loaded with
antimony. The colon and rectum were nearly always healthy. In
two instances the mucus of the stomach or bowels had a brownish
colour, attributed to the formation of the sulphide of antimony. The
kidneys were generally found more or less congested, and the bladder
more vascular than usual, and distended with urine. This was not the
case, however, in the animals that were killed after a few days, or
some time after the discontinuance of the poison. The hrain, heart,
and spleen were always healthy, but the lungs in many cases were
deeply congested, and in some acutely inflamed, sometimes hepatized,
and gorged with blood ; the air-tubes being of a bright-red colour.
Bloody extravasations (or exudations) were found in the cavities of the
chest and abdomen, and also between the muscular and raucous coat
of the caecum, in more than one instance.

The poison was found, by means of Reinsch's test, in every part of
the body — always in the liver, and in great abundance ; in smaller
quantity in the spleen; at a later period of the poisoning in the
kidneys ; at the earliest period in the tissues of the stomach, and later
in the ccecum. The faces always contained the poison — in one rabbit
killed fourteen days after the last dose, and in another twenty-one days
after the poison had been discontinued. Antimony was also found in
the lungs from an early period. Jn the muscles and in the blood it was
difficult to detect ; but it was found in the bo7ies on the fifteenth day,
and thirty-one days after the poison had been discontinued. The poison
was also found in the foetal rabbits, of which one of the poisoned
animals aborted.

The poison was being constantly eliminated by the kidneys. It was
discoverable in the urine after the twelfth dose; and in the urine
voided twenty-one days after the poison had been suspended. This
statement corresponds with, and confirms, what has been already stated

SYMPTOMS. 405

(p. 390), relatively to the slow elimination of arsenic from the system.
From these experiments Dr. Nevins arrives at the following genej-al
conclusions : " that tartar emetic is a deadly poison when repeated in
small doses for a sufficient length of time ; but that the total quantity
necessary for causing death, and also the length of time required, are
very variable in different cases ; that there is a considerable general
similarity in the symptoms and morbid appearances produced, but by
no means absolute uniformity ; that the poison permeates almost all
the tissues of the body, and even those of the unborn offspring, if its
administration is continued long enough, whilst, at the same time, it
is constantly being eliminated from the system by the kidneys and
bowels ; and lastly, that the fatal effects are often disproportionate to
the apparent changes found after death."

These conclusions of Dr. Nevins are generally in harmony with the
results of an experimental inquiry made by Messrs. Millon and
Lavran in 1846. (' Annales d'Hygiene,' vol. xxxvi. p. 221.)

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — The symptoms of acute poisoning in the human sub-
ject are : —A strong metallic taste perceived in the act of swallowing,
with heat, constriction and soreness of the mouth and throat, followed
by nausea, vomiting, pain and tenderness of the epigiistrium, extending
to the whole abdomen, soon followed by repeated and profuse diarrhoea,
with severe cramps of the extremities, and symptoms of collapse,
namely, cold skin, clammy sweats, a small quick pulse, and great
weakness. Death sometimes happens in this state of collapse ; but it
is sometimes preceded by severe nervous symptoms, such as convul-
sions, tetanic spasms, and delirium. Large doses of the preparations of
antimony sometimes occasion insensibility as one of their eai"liest
effects. In one instance the characteristic pustular rash was present on
the skin and in the throat. In some exceptional cases vomiting has
not been set up till other emetics have been administered.

Smallest Fatal Dose. — In an adult, two grains; in a child, | of a
grain. (Dr. A. Taylor, in 'Guy's Hospital Reports,' Oct. 1857.) In a
healthy adult 31 has destroyed life in ten hours, A gram and a half of
tartar emetic with fifteen grains of ipecacuanha repeated on two suc-
cessive days proved fatal with vomiting, purging, and prostration, in
the case of a healthy woman five days after her confinement. (' Med.
Times and Gaz.,' March 28, 1857.) Children have been killed by
ten grains in a few hours. On the other hand, such large doses as
^i of the poison have been frequently swallowed with impunity, in
consequence of its prompt rejection from the stomach. Very severe
effects have, however, been produced by so small a dose as six grains.
It has often been given in inflammation of the lungs, in doses of two
grains, repeated at short intervals, without producing any injurious
effects.

Shortest Fatal Period. — Tartar emetic, in a single large dose, may

406 ANTIMONY AND ITS PREPARATIONS.

destroy life in a few hours ; but, on the other hand, a patient survived
nearly five days after taking forty grains of the poison.

Tartar emetic applied externally in the form of lotion or ointment
excites inflammation of the skin and a crop of pustules, and, if con-
tinued, it may cause intense inflammation and sloughing. Nausea
and vomiting have sometimes attended this external use of the poison.

Post-mortem Appearances. — Inflammation of the mucous mem-
brane of the stomach extending sometimes to the small intestines, and
rarely to the throat and gullet. In some instances inflammation in
the lungs, and in the brain. In animals the lungs have been found
inflamed.

Treatment. — The best antidote is tincture of cinchona bark. When
this is not at hand, or cannot be immediately procured, the decoction
or powder may be substituted. Any decoction or infusion containing
tannin, such as tea, or decoction of oak bark, may also be used as an
antidote. In the absence of the antidote, or while it is being pre-
pared, vomiting should be promoted by warm water, milk, or muci-
laginous drinks, or the stomach-pump may be employed. The after-
treatment must be determined by the symptoms. General or local
bloodletting may be necessary, and opium may be prescribed with
advantage.

Chronic Poisoning. — The experiments of Dr. Nevins already de-
tailed have removed any doubt which may have attached to recent
medico-legal cases, as to the power of tartar emetic, in repeated small
doses, to destroy life. The symptoms produced by such small re-
peated doses are, nausea, vomiting, and purging, with extreme debi-
lity, and gradual exhaustion.

Chloride of Antimony (Butter of Antimony) .

This is a corrosive liquid of a light-yellow or dark-red colour, which
has been taken by mistake for ginger beer and antimonial wine.
When largely diluted with water the white oxychloride of antimony
falls down, and the clear liquid is proved to contain muriatic acid
by the addition of nitrate of silver. The subsidence of a white pre-
cipitate on the addition of water in excess is common to this substance
and the salts of bismuth, but the colour produced in the liquid by
sulphuretted hydrogen gas at once distinguishes the two bases. Bis-
muth yields a black, and antimony an orange-red precipitate.

Symptoms. — The action of the chloride of antimony is both prompt
and violent. In one case, which proved fatal, death took place in ten
hours and a half after swallowing between two and three ounces of the
liquid. Narcotic symptoms were added to those of violent irritation
of the alimentary canal, and after death the mucous membrane of the
entire canal presented a (charred appearance, and was softened and
abraded. Recovery has taken place after swallowing an ounce of the
poison.

COKEOHIVE SUBLIMATE. 407

Treatment. — That of poisoning by tartar emetic. Diluents should
be largely and promptly administered.

3. MERCURY AND ITS PREPARATIONS.

Mercury and its preparations are in common use in the arts and in
medicine, and they are occasionally used as poisons. They take the
seventh place among the ascertained causes of death by poison, coming
next after oxalic acid, and they are credited by the Kegistrar-General
with ten deaths a year, on the average of the five years 1852-56.
Corrosive sublimate, the preparation usually taken or given as a
poison, was the cause of twelve out of 543 deaths from poison in 1837
and 1838 ; of which twelve cases two were accidental, and nine
suicidal. Metallic mercury, as used in the arts, gives lise to severe
and well-defined maladies, and the preparations of mercury used as
mediciries occasionally prove fatal when given in an over dose, or in an
ordinary dose to persons very susceptible of their action. The metal
itself is inert, and may be given in very large doses without injury ;
but its oxide when diffused through the air, or brought into constant
contact with the skin, is well known to produce injurious effects.

One important property of metallic mercury requires to be noticed,
as it is made use of in medico-legal inquiries. It sublimes unchanged
at 660°, and if the sublimation is conducted in a glass tube, a ring of
small metallic globules forms on the cool part of the tube. In a still
more minute state of division it has the appearance of a black powder;
and it is in this form that the metal is thrown down from the solution
of its salts.

The most important salts and preparations of mercury are: — the
chloride or corrosive sublimate ; the sub-chloride, or calomel ; the
ammonio-chloride, or white precipitate ; the red oxide, nitric oxide,
or red precipitate ; the sulphide, cinnabar, or vermilion ; the sub-sul-
phate of the oxiile, or Turpeth mineral ; the bicyanide, or prussiate of
mercuiy ; and the two nitrates of mercury. The black sub-oxide,
and sub-sulphide are of less importance.

Of these preparations of mercury by far the most important is corro-
sive sublimate.

Corrosive Sublimate. — (Oxy-muriate, Corrosive Muriate,
Bichloride, more properly Chloride, of Mercury.)

This preparation of mercury is used for preserving the feathers of
birds and skins of animals from moth, also for destroying bugs and for kill-
ing lice and maggots in man and in animals ; and it is a favourite remedy,
when dissolved in spirits of sweet nitre, for gonorrhoea and syphilis.

Properties. — This poison is found as a very heavy crystalline mass,
or as a white powder, of a peculiarly nauseous styptic metallic taste,
permanent iu the air, but slowly decomposed in sunshine, an insoluble
grey powder being formed. It is soluble in twenty parts of tem-

408

MERCUBY AND ITS PREPARATIONS.

perate, and in two parts of boiling, water. It is more soluble in
alcohol and ether, for which reason ether is used to remove it from
its aqueous solution. Common salt, also, increases its solubility.

Tests. — We may have to examine the poison in substance, in solu-
tion, in organic liquids, and in the tissues and organs of the body.

1. In Substance.
On the supposition that we are ignorant of the nature of the sub-
stance submitted to analysis, we first test it by the heat of a spirit
lamp. It tirst melts in its water of ciystallization, and is then com-
pletely volatilized ; giving off white acrid irritating fumes. If heated
in a test tube, it deposits long silky crystals on the cool sides of the tube.
Collected on a flat surface of glass these crystals are arranged as in
fig. 45, or they assume the stellate form shown in fig. 46. As arse-
Fig, 45. Fig. 46.

nious acid treated in the same way yields octahedra, and calomel an
amorphous deposit, the twofold test of heat and crystallization, is
almost conclusive of the nature of the substance. The great solubility
of corrosive sublimate in water further distinguishes it from arsenic
and calomel. The addition of a few drops of liquor potassae places
the nature of the substance beyond a doubt. Corrosive sublimate
is changed to a yellow colour, while arsenic undergoes no change,
and calomel is blackened. We may obtain still further assurance
by the following tests : 1. Sulphide of ammonium blackens the powder.

2. A solution of iodide of potassium turns it to a bright scarlet.

3. Moisten a clean rag with dilute hydrochloric acid, sprinkle the
powder upon it, and rub it on a clean plate of copper. A silvery stain
is formed which is readily volatilized by heat. 4. Mix one part of the
poison with four parts of calcined carbonate of soda; place the mixture
in a reduction tube (fig. 16, p. 371), or in the short tube (fig. 17,
p. 372), and cautiously apply the heat of a spii-it lamp, having pre-
viously dried the upper part of the tube. A ring of globules will
be formed on the cool sides of the tube, or on the disc of glass placed
over its mouth.

2. In Solution,
a. On the supposition that we are ignorant of the contents of a
liquid submitted to analysis, we may ascertiiin that it contains a crystal-

CORROSIVE SUBLIMATE IN SOLUTION. 409

line salt by evaporating a portion of the liquid on a flat piece of glass,
and may examine the crystal, if necessary, under the microscope. Cor-
rosive sublimate is deposited, in part, in long smgle needles, branched
or stellate, as in figures 45, 4(i 6. Or we test for a base by sul-
phuretted hydrogen, which yields with corrosive sublimate a black pre-
cipitate, first giving a milky white appearance to the liquid, c. Sul-
phide of ammonium also gives a black precipitate, d. With liquor
ammonifc it yields, in common with lead and bismuth, a white preci-
pitiite, but with liquor potassae a yellow (thehydrated oxide). By this
we recognize a per-salt of mercury. The supernatant liquor contains
chloride of potassium, and if we add to it nitrate of silver we obtain
the white chloride of silver, which proves that the salt of mercury is a
chloride. The colour of the precipitate with liquor potassse shows that
it is a per-salt. e. This precipitate being collected, washed, and dried,
and heated in a reduction tube, gives a well-defined ring of mercury.
The sulphide precipitated by sulphuretted hydrogen, or by sulphide of
ammonium when dried and heated with bicarbonate of soda, also yields
a ring of mercury. By using either precipitate for that purpose we
obtain conclusive evidence of the presence of mercury.

The following are additional tests : 1. Protochloride of tin. A solu-
tion of this substance throws down a white precipitate, turning rapidly
to grey, and from grey to black. The black deposit is minutely divided
mercury. The supernatant liquor being decanted or separated by fil-
tration, and the deposit dried, the globules coalesce. 2. Metallic test.
Acidulate the liquid with a lew drops of hydrochloric acid, and intro-
duce into it a narrow slip of clean copper. A grey film will be formed
on the surface of the metal. This being carefully dried, introduced
into a reduction tube, and heated with the flame of a spirit lamp, vields
a ring of metallic globules deposited on the upper part of the tube.
Pure tin, zinc, or silver may be substituted for copper ; but the latter
is to be preferred. 3. Galvanic test. Take a narrow strip of zinc
foil, moisten it, and take up as much gold leaf as will adhere to it.
Introduce this into the solution slightly acidulated with hydrochloric
acid ; the gold will soon be covered with a grey film. Remove it from
the solution, dry it carefully, introduce the dried metal into a reduc-
tion tube, and apply the flame of a spirit lamp. A ring of metallic
globules will be formed. This test is extremely delicate, and it is
applicable to the discovery of very minute quantities of the poison.
The metallic deposit may be readily obtained by placing a drop of the
acidulated solution on a surface of clean copper or gold, and touching
the moistened metal with a fragment of zinc or iron. Dr. Wollaston
once employed a key and a sovereign for this purpose.

Mercury is one of the metals which is deposited on copper when
its solutions are treated after the method of Keinsch (p. 385). The
deposit is known as mercurial by drying the copper, and heating it
in a reduction tube, when a ring of metallic mercury will be formed.

The acid in combination with the mercury may be shown to be the

410 MERCURY AND ITS PREPARATIONS.

hydrochloric by testing the fluid from which the mercury has, by any
of the foregoing methods, been precipitated. On the addition of the
nitrate of silver we obtain a white precipit^ite of chloride of silver.

3. In Organic' Liquids.

Corrosive sublimate is sometimes swallowed in substance, or in a
stsite of imperfect solution ; and though it is very soluble, may be
found in the stomach in a solid form, and may be separated by merely
diluting the viscid liquid with distilled water, stirring it, allowing the
heavy corrosive sublimate to subside, and quickly pouring off the
supernatant liquor. More commonly the poison is given in solution in
water or in some liquid suited to disguise its taste ; and when so given
it may be decomposed by the contents of the stomach, or by the mucous
membrane itself. The poison may, therefore, exist in the stomach
partly in solution undecomposed, pirtly in combination with the con-
tents of the stomach, and partly in union with its coats.

If any portion of the poison exists in the free state, it may be readily
separated by diluting the contents of the stomach with distilled water,
obtaining a clear liquid by filtration, shaking it in a stoppered bottle,
with an equal bulk of ether, and drawing off the ethereal solution with
the pipette. If the ether has dissolved any of the coiTosive sublimate,
it will be readily identified by evaporating a portion of it on a surface
of glass. The crystals depicted at p, 408 will remain behind. They
may be dissolved in distilled water, and the solution tested by the
reagents already described.

The solid contents of the stomach may be conveniently examined by
the same method as for the organic tissues.

4. In the Organic Tissues. .

Bring the organic matters into a state to pass the filter by the
method described at p. 389 ; and test the liquid by the method of
Reinsch (p. 385). If the copper receives a grey coating, wash it in
distilled water, dry it, and heat it in a i eduction tube (fig. 16, p. 371).
Globules of metallic mercury will be deposited on the cool side of the
tube, or on the covering of thin glass (fig. 17, p. 372). When we have
to deal with small quantities of mercury, as will be the case in exa-
mining the tissues of the body, we should employ the form of reduc-

Flg. 47.

a

1

o

©*0e

■"-.V" :

tion tube figured at p. 378, in the manner described when speaking
of the detection of minute quantities of arsenic. This test is one of

GLOBULES OF MERCURY AND ARSENIC. 411

great delicacy. The five-thousandth pai-t of a grain can be readily
sublimed and identified. The appearance of a group of globules ob-
tained from this small quantity of the metal is shown in a fig. 47,
where they are magnified 70 diameters and measure ^^^ inch. Some-
times the metal is cxidised, and then presents the appearances depicted
in b fig. 47. Among spots of no very defined shape are to be found a
number of prismatic crystals, some scarcely longer than their breadth,
while others are long needles.

As arsenic, when deposited on copper by Reinsch's process, and then
sublimed in the same way as mercury, also yields distinct globules, it
will be necessary to distinguish the one from the other. The globules
of arsenic are sometimes quite as brilliant as those of mercury, and
are, therefore, not to be distinguished from them ; but generally they
do not present so smooth a surface. They are somewhat granular in
appearance, while the globules of mercury are quite smooth. The
difference between them, is such as is shown in fig. 48. But the

Fig, 48.
Arsenic. Mercury.

©•^O • @*.@

(Magnified 150 diameters.)

metallic lustre which belongs to the globules cannot be properly i-e-
presented by wood engraving. It would evidently be unsafe to rely
on this comparatively slight difference. The distinction, however, is
rendered easy by the fact that the globules of arsenic, as obtained by
this process, are always blended with the characteristic octahedral
crystals of arsenious acid, while those of mercury are either unmixed,
or blended with the small needles just described and figured. The
arsenical sublimate, when obtained in the presence of atmospheric air, is
either found to consist wholly of crystals, or the crust is compounded
of globules and crystals, the globules occupying the part of the tube
nearest the flame of the lamp, and the crystals the part more remote.
In the case of a liquid found in the stomach, or obtained by simple
boiling, yielding mercury by any of the processes now described, we
have evidence of a soluble salt of mercury, and a strong presumption
in favour of corrosive sublimate; but when the solid matters after
evaporation to dryness are treated with hydrochloric acid, w^e have
no evidence of a soluble salt, because even an insoluble salt, thus
treated, would be converted into corrosive sublimate. This process,
then, is open to the objection that the mercury which it is the means
of discovering may have been administered for medicinal purposes in

412 MERCURY AND ITS PREPARATIONS.

the form of calomel, blue pill, or grey powder. This objection could
only be answered by distinct evidence of such substances not having
been administered as medicine, or by the characteristic symptoms and
jxjst-mortem appearances due to corrosive sublimate being present.

Corrosive sublimate, like arsenic and other active poisons, may be
rejected fiom the stomach so as not be detected after death.

Quantitative Analysis. — Though the presence of mercury may be
ascertjiined by the methods already described, the quantity of the
poison is best detei-mined by means of the protochloride of tin. When
the poison is in solution, the protochloride of tin should be added so
long as any precipitate falls. The precipitate should then be washed,
dried, and weighed.

When there is reason to believe that the quantity of corrosive subli-
mate is considerable, we may follow with advantage the summaiy
process recommended by Dr. Christison. The solid matters are to be
triturated, without previous filtration, with protochloride of tin,
when the mixtuie u ill assume a slate-grey colour, and separate readily
into a liquid and coagulum. The liquid may be rejected, but the
coagulum, having been washed on a filter, must be carefully removed
and boiled in a moderately strong solution of caustic potash, until all
the lumps disappear. The oxide of tin with the animal and vegetable
matteis are thus dissolved, and the solution, on remaining at rest,
deposits a heavy grey powder, consisting chiefly of finely divided
mercury. To separate the mercury completely, the solution must
be allowed to remain at rest, at a temperature little short of boiling,
for about twenty minutes. The supernatant liquor may then be drawn
off, and the remaining black powder after repeated washings may be
removed, heated, and sublimed. This pro(;ess is a very delicate one.
Of the metallic mercury thrown down by the protochloride of tin, a
hundred giains correspond to one hundred and thirty-five grains of
corrosive sublimate.

Experiments on Animals.

The experiments of Sir Benjamin Brodie show that corrosive subli-
mate is a very active poison. Six grains dissolved in six drachms of
water killed a rabbit in 4^ minutes, and a scruple proved fatal to a
cat in twenty-five minutes. The rabbit became insensible in three
minutes, and was convulsed ; and on opening the chest the heart had
ceased to beat, and its left cavifies contained scarlet blood. The mucous
membrane in the cardiac portion of the stomach was of a dark-grey
colour, much softened and readily detached : but similar effects wei-e
produced by the action of the poison after death. Sir B. Brodie attri-
buted the fatal effect of the poison to this chemical action on the mucous
membrane. Dr. Bostock and other experimenters, by administering
smaller doses, produced the common symptoms of irritant poison, followed
by death after some hours ; and the appearances on dissection of active
irritation and inflammation of the mucous membrane of the stomach.

MERCURIAL SALIVATION. 413

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — Immediately, or within one or two minutes of swallow-
ing a substance or liquid of a peculiarly nauseous, metallic, and styptic
tast(!, there is a sense of tightness and burning in the throat and gullet,
greatly increased by pressure, and on every attempt to swallow, and
speedily followed by burning pain in the epigastrium, also increased on
pressure. Vomiting and purging of stringy mucus or of bilious
matter often containing blood ensue, and the entire abdomen becomes
distended and exquisitely painful. The face is generally flushed and
swollen and the eyes sparkling ; but in other cases the countenance is
pale and anxious, the lips white and shrivelled, and the eyes dull but
expressive of great anxiety. The diarrhoea is accompanied with tenes-
mus, and dysuria is often present, the secretion of urine being scanty or
altogether suppressed. The pulse is full, quick, and frequent, or
small, frequent, and intermittent, according as the symptoms are
those of high fever or of collapse, and the breathing is quick and catch-
ing. There are sometimes intervals of comparative ease, during which
the patient is drowsy; and this drowsiness sometimes amounis to coma.
Nervous symptoms, consisting of cramps, twitches, and convulsions of
the limbs, are often present from an early period ; and occasionally
there is paralysis. Death takes place during a fainting fit, in the
midst of strong convulsions, or during protracted insensibility. To
these symptoms, in most cases which do not prove rapidly fatal, sali-
vation is superadded, and the painful train of nervous symptoms
caused by the specific effect of mercury on the system. These charac-
teristic effects of the poison will be presently examined.

The symptoms of poisoning by corrosive sublimate are by no means
uniform, nor is the mode of death always the same. Three varieties
of cases at least may be recognized: — 1, Violent irritation of the
stomach and bowels, with collapse. 2. Salivation and other remote
effects, with little or no irritation of the alimentary canal. 3. Irrita-
tion of the stomach and bowels, followed by salivation and remote
constitutional effects.

Meixurial Salivation. — A coppery taste, a peculiar fetor of the
breath, tenderness and swelling of the mouth, inflammation swelling
and ulceration of the gums, and an increased flow of saliva, are the
familiar symptoms of mercurial salivation. These symptoms vary
greatly in severity in different cases. In the more severe forms the
salivation is profuse ; the face, neck, and tongue, swollen ; the inside
of the mouth ulcerated or gangrenous. These local affections are
preceded or accompanied by a frequent pulse and hot skin, and other
symptoms of fever.

Several interesting questions suggest themselves in connexion with
this symptom of mercurial poisoning, a. What is the smallest dose
which will occasion salivation? b. Can salivation be produced by
other causes, and if so, can we distinguish such salivation from the

414 MERCURY AND ITS PREPARATIONS.

effects of mercury ? c. What is the earliest period at which salivation
may occur? d. What is the duration of mercurial salvation? e. Can
salivation cease and recur without a renewed use of the mei-curial
preparation ? /. Is it possible to distinguish gangrene of the mouth,
the effect of mercury, from the same disease due to other causes?

a. Smallest dose required to occasion salivation. There is much
difference between different individuals, between persons of difl'erent
ages, and even in the same person at different times, in respect of the
quantity of mercury which they can bear. As a general rale, children
are less susceptible of the action of mercury than adults, the robust
than the delicate. The same female who in her ordinary state of
health is affected with difficulty, shall, when suffering from an;Emia, be
salivated with a few doses of blue pill. In affections of the nervous
system, also, very marked effects are often produced by small doses of
mercury.* Again, there are many persons peculiarly susceptible of
the action of mercury, and others whom the largest doses continued
for a considerable period will not affect. Many instances of severe
dnd even fiital effects produced by small doses are on record, in one
case given on the authority of Dr. Bright, five grains of calomel
placed on the tongue of an apoplectic patient produced in three hours
violent salivation, and such swelling of the tongue as to render scaii-
fications necessary. Three grains of corrosive sublimate in three doses
has caused violent ptyalism: three five-grain doses of blue pill, given
one every night, have proved fatal ; two grains of calomel have caused
ulceration of the throat, exfoliation of the jaw, and death ; and the
external application of three drachms of mercurial ointment has de-
stroyed life in eight days. (' Christison on Poisons,' p. 379.)

b. Can salivation be produced by other causes, and if so. can we dis-
tinguish such salivation from the effects of mercury ? Salivation may
occur spontaneously, so as to constitute a disease in itself, or it may be
due to the mere accumulation of saliva, in consequence of some disease
of the throat, such as quinsy, preventing deglutition. It may even be
occasioned by the influence of the imagination, as in a case related by
Christison (p. 382). Various preparations of gold, copper, lead,
arsenic, antimony, and bismuth, sulphuric acid, iodine, and iodide ot
potassium; several substances derived from the vegetable kingdom,
such as castor-oil, fox-glove, opium, and prussic acid, have also given
rise to salivation.

The distinction between mercurial salivation and that dependent
upon other causes is generally easy, in the first stage. ^Mercurial
salivation is preceded by the coppery taste and fetor of the breath,
and accompanied by redness, sponginess, and ulceration of the gums.
These are wanting in spontaneous salivation, and in that produced by

* In a case of paralysis of the facial nerve which came under my notice,
there was a distinct red line upon the gums of the paralyzed side, while the
other was quite free. The sensibility of the affected side was perfect, though
the patient complained of a sensation of tingling.

MERCURIAL SALIVATION. 4r5

most of the medicines just mentioned.* But the advanced stage of
mercurial salivation seems to differ less stril^ingly from some severe
aftections of the mouth due to other causes, and accompanied by
ptyaiism. Thus in a curious account of an epidemic salivation, form-
ing a part of a tertian fever, quoted from Mailer's Collections on the
authority of Quelmelz, it is stated that in one instance it was as great
as the most violent mercurial salivation, and was accompanied by
fetor, superficial ulceration of the mouth, pustules on the tongue, re-
laxation of the gums, and looseness of the teeth. (Christison, p. 382.)

c. What is the earliest period at which salivation may occur?
Mercurial salivation rarely sets in under twenty-four hours ; but in
Dr. Bright's case already cited, it appeared in three hours. In a case
of poisoning by two drachms of corrosive sublimate, it began in four
hours. (Taylor.) The shortest period, therefore, may probably be
stated at three hours.

d. What is the duration of mercurial salivation? The duration of
mercurial salivation is very variable, and may be very considerable.
It may continue for any period from a few days to as many years. In
one instance it is alleged to have lasted six years. (' Lancet,' No. 453.)

e. Can salivation cease and recur without the renewed use of the
mercurial preparation ? This question may be safely answered in the
affirmative. Dr. Robert Williams (' Elements of Medicine,' vol. ii.,
p. 523) gives a case on the authority of Dr. Daniel, in which salivation
was suspended for eight or nine days under an attack of remittent fever,
and then returned, though not a grain of mercury had been given after
the accession of the fever. Instances of recurrence of salivation after
three and even four months are on record ; but in one case at least
(Christison, p. 381) the recurrent salivation was unattended by fetor,
redness, ulceration, or sponginess of the gums. The possibility of re-
current mercurial salivation is also confirmed by analogy; Ibr in the
case referred to in the note at the foot of this page, the salivation is
proved to have taken place after the iodide of potassium had been
suspended for several weeks.

/. Can gangrene of the mouth, the effect of mercury, be distinguished
from the same disease due to other causes? We have no certain
diagnostic marks Cases of cancrum oris following debilitating dis-
eases, or occurring in children badly lodged and badly fed are not of
very rare occurrence. In such cases it very seldom happens that
mercury in some form has not been given. Hence, a difficult question
may arise as to the cause of the disease. In the absence of any exact
means of dis(Timination, it may be sufficient to state that extreme de-
bility, brought on by any of the causes just mentioned, is a sufficient

* A case now under my care seems to justify the cautious statement in the
text. All the symptoms of severe mercurial salivation are present as the
effect of a course of iodide of potassium, in the ascertained absence of mercurial
preparations, other than those given from time to time as aperients, such
aperients not having previously affected the system.

416 MERCURY AND ITS PREPARATIOKS.

cause of gangrene ; and that even if the mercury which may have
been given have contributed to the fatal lesult, the medical man is
not to be blamed for the use of a medicine of great value in the dis-
eases of children, and which less frequently causes salivation in them
than in adults. It is generally stated that gangrene, the effect of
mercury, may be distinguished by its beginning in the mucous mem-
brane of the mouth and throat, while the cancrura oris begins in the
skin of the cheek or chin. This statement is without foundation ; for
in a fatal case of mercurial salivation which occurred under the care of
Dr. John Bright, of the Westminster Hospital, the gangrene began as
a small black spot between the lower lip and chin. Other cases of the
same kind are on record.

Mercurial Tremors, Shaking Palsy, Tremhlement Metallique. —
This disease occurs in men whose work exposes them to the fumes of
mercury, or causes them to handle the oxide so as to absorb it by the
skin ; such as quicksilver miners, water gilders, minor silverers, and
barometer makers. It sometimes begins suddenly, sometimes comes on
gradually; and is sometimes attended by salivation, sometimes not.
The upper extremities are commonly first affected, and then, by degrees,
all the muscles of the body. In the more strongly-marked cases the
patient can neither speak, masticate, nor walk. The unsteadiness of the
aims prevents him from grasping any object, and the muscles of the
legs are so convulsed that he cannot plant his foot firmly on the ground,
and when he tries to walk, his gait soon becomes an unsteady dancing
trot. If the patient so affected does not give up his work, he loses his
memory, is unable to sleep, becomes delirious, and so dies. On leaving
off his work he geneially gets well, but the lecovery may occupy
some weeks or months. Sometimes the disease does not admit of cure.
The absorption of the poison is sometimes indicated by a blue mark on
the gums, as in lead poisoning, but more commonly by a dark red line ;
and a curious symptom not generally recognised, though very com-
monly present, is a brittle state of the teeth, causing them to chip.
The preventive treatment of this affection consists in cleanliness and
ventilation ; and the swallowing of white of egg in water three or four
times a day may be recommended.

Post-mortem Appearances. — Corrosive sublimate and the soluble
salts of mercury give rise to post-mortem appearances differing little
from those due to other con-osive poisons. The effects are intermediate
between those produced by the corrosive acid poisons and those caused
by the stronger non-corrosive in-itants, such as arsenic. Corrosion,
softening, and sloughing ulceration of the stomach and intestines are
of frequent occurrence, and the peritoneum is often found inflamed.
The sloughs have been found to yield mercury on analysis. Sometimes
the small intestines escape, and the poison acts only on the stomach and
on the rectum, or on the large intestines generally. The decomposition
of the salt by contact with the mucous membrane, or with the contents
of the stomach, or with antidotes, and the consequent deposition of

CORROSIVE SUBLIMATE. TREATMENT. 417

mercury in a state of minute division on the lining membrane, as a thin
slate-coloured covering, sometimes serves to identify the poison. When
the body is in a state of decay, a similar appearance of the mucous
membrane may be caused by the action of sulphuretted hydrogen, giving
rise to the formation of the black sulphuret. When mercurial salivation
has existed during life, we shall find the mucous membrane of the mouth
inflamed or sloughing.

One post-mortem appearance which has been more frequently en-
countered as the result of poisoning with corrosive sublimate than as
a consequence of poisoning with arsenic, is the highly inflamed state of
the urinary organs, and the contracted state of the bladder, correspond-
ing to the very scanty secretion of urine during life.

Corrosive sublimate applied to the mucous membrane after death
causes it to assume a white, wrinkled, and granulated appearance. It
is also harder than natural, and of a dead whiteness, with rose-coloured
vessels ramifying upon it. These appearances extend to the muscular
and peritoneal coats. They were found by M. Orfila, in the mucous
membrane of the rectum, with which corrosive sublimate in powder had
been brought in contact after death. In the expei-iments of Sir B.
Brodie the same effect was produced on the mucous membrane during
life and after death.

Smallest Fatal Dose. — Three giains have proved fatal in the case of a
child. Very large doses have been swallowed with impunity, having been
rejected by vomiting, or decomposed by the prompt use of antidotes.

Shortest Period. — Death may occur in two hours. The nitrate of
mercury has proved fatal in two hours and a half. In the case of this
poison, as in that of arsenic, the period is extremely variable.*

Treatment. —The antidotes to corrosive sublimate are albumen,
gluten, iron filings, a mixture of gold dust and iron filings suspended
in gum water, and the hydrated ])rotosulphuret of iron. The anti-
dotes most readily procured are the white of egg and gluten. The
white of egg should be given freely mixed with water, as long as urgent
symptoms are present, and accompanied, if necessary, by emetics and
diluents. If eggs cannot be procured, flour mixed with water, or milk,
may be substituted. White of egg has been proved to be an efficient
antidote in so many cases, that where it is at hand it is quite unnecessary
to resort to any other.

The rest of the treatment will not diffeir from that proper to poi-
soning by the irritants generally. Where salivation is present, cool
air, cold drinks, and gentle aperients, with gargles of alum or chloride

* The following periods are on record: — one of 2 hours; one of 2^ hours;
one of 3 hours ; one of 6 hours ; one of 1 1 hours ; and one of 3, 6, 8, and 1 1 days
respectively. Of these nine cases, tlien, about half the number died in less than
12 hours, and the remaining half in a period varying from 3 to 11 days.

The reader is referred to the following cases of poisoning by corrosive subli-
mate:— Medical Gazette, vii. 329; viii. 616; xxix. T97 ; xxxi. 5&o. Ed. Med.
and Surg. Journal (five cases by Mr. Valentine)j xiv. 46^ ; li. 114; liii. 404 ;
Iviii. 5i)5.

2 E

418 MERCURY AND ITS PREPARATIONS.

of sodium, must be used ; and in very severe cases, large doses of
acetate of lead. Occasionally, when the inflammatory symptoms run
high, local or general blood-letting may be resorted to.

Corrosive sublimate acts as an irritant poison, and produces its cha-
racteristic effects in whatever way it may be introduced into the system.

CALOMEL {Subchloride of Mercury, Protochloride of Afercury).

Properties. — Calomel is a heavy white or yellowish-white powder,
insoluble in water, and in alcohol and ether, but soluble in nitric and
hydrochloric acids.

Tests. — On the supposition that we are ignorant of the nature of the
powder, we first apply heat, which, as in the case of corrosive subli-
mate and arsenic, volatilizes it. If heated in a tube, it is deposited on
the cooled glass as an amorphous powder. Its insolubility in water at
once distinguishes it from corrosive sublimate, but not from arsenious
acid. It is turned black by sulphide of ammonium, liquor potassae,
and liquor ammoniaj. It resembles corrosive sublimate in the action of
protochloride of tin upon it : heated with carbonate of soda, it yields a
sublimate of metallic mercury, aud it gives a silvery stain when rubbed
with dilute muriatic acid on copper.

Calomel, though generally a safe medicine when given in moderate
doses, and administered in many di.-eases in large quantities often
repeated, sometimes produces very violent effects, acting either as an
irritant poison, or destroying life by producing gangrene of the mouth
and throat. Cases are on record of fatal results following a single
dose of a scruple, and quantities so small as fifteen, eight, and six
grains. On the other hand, doses of three drachms, and of one ounce
have been taken without fatal consequences. In the Asiatic cholera,
and in many of the severe fevers of hot climates, calomel in repeated
doses of one scruple has been found highly beneficial ; and in the case
of the cholera has rather allayed than increased the initation of the
alimentary canal.

The violent effects produced by calomel in exceptional cases have
been attributed to its partial conversion into conosive sublimate by
the free hydrochloric acid of the stomach, or by contact with some
chloride, as the chloride of sodium, or the muriate of ammonia. The
quantity of corrosive sublimate formed by the first of these reactions
must be extremely small, as free hydrochloric acid exists in the
stomach in very minute proportion. On the other hand, experiment
has shown that the quantity of corrosive sublimate formed by admix-
ture with chloride of sodium at the temperature of the stomach itself
is extremely small, and insufficient to account for the fatal result, A
minute quantity of corrosive sublimate is found mixed with calomel ;
but this, too, has been shown by Dr. Christison to be insufficient to
account for the occasional poisonous effects of calomel. In ten different
speciemns of calomel examined by him, the quantity of corrosive sub-
limate did not exceed a five hundiedth of its weight.

BICYANIDE OF MEKCURY. 419

The other compounds and preparations of mercury possess poisonous
properties ; but us these have been very rarely taken as poisons, a very
brief description of their properties will suffice.

Red Precipitate (red oxide of mercury). — This substance is largely
used, mixed with lard or grease, for destroying vermin. The crystals
of the red precipitate are small, brilliant, and of a scarlet or deep orange
colour; the powder is orange coloured. It is very heavy, insoluble in
water, but soluble in warm hydrochloric acid, which converts it into
corrosive sublimate. When heated in a small glass tube it is entirely
dissipated, metallic globules are sublimed, and oxygen gas is given oft".

Cinnabar, Vermilion (bisulphuret of mercury). — This substance is
found in commerce in the form of a dark red semi-crystalline mass, or
in that of a fine red powder. The former is cinnabar, the latter ver-
milion. When thrown down from a solution of a per-salt of mercury
by sulphuretted hydrogen, it is black ; but, when sublimed, becomes
red. It is heavy, insoluble in water and muriatic acid, entirely dis-
sipated by heat, but collects on the sides of the tube unchanged.
VVhen mixed with carbonate of soda, and heated in a reduction tube,
globules of metallic mercury are sublimed; and on adding a mineral
acid to the residue, sulphuretted hydrogen is given off, showing the
presence of sulphur.

White Precipitate (ammonio-chloride of mercury). — This is found
in the form of a White heavy powder, insoluble in water, and entirely
dissipated by heat. It yields with carbonate of soda a metallic subli-
mate. The ammonia may be detected by boiling the powder in liquor
potassae. The gas is given off, chloride of potassium is formed, which
may be detected by the nitrate of silver test, and the yellow peroxide
of mercury remains.

Turpeth Mineral (sulphate of the oxide of mercury). — This is a
heavy yellow powder, sparingly soluble in water, and yielding, when
heated in a glass tube, a metallic sublimate, with fumes of sulphurous
acid gas. When boiled in a solution of potash, the yellow peroxide is
thrown down, and a sulphate of potash is formed, the acid of which
may be identified by the nitrate of baryta test.

Nitrates of Mercury (nitrate and subnitrate) . — The nitrate of mer-
cury is found in the form of white crystals, which are very soluble
in water, the solution being highly acid and corrosive. When heated
in a tube, the crystals give off nitrous acid gas, and a ring of metiillic
globules is sublimed. When mixed with carbonate of soda and heated,
metallic mercury is sublimed. On adding liquor potassae to a solution
of the salt, a yellow precipitate is thrown down. The acid is readilv
detected by adding carbonate of potash till effervescence ceases, and
filtering the resulting liquid ; nitrate of potash remains in solution.

The subnitrate differs from the nitrate, inasmuch as liquor potassae
throws down a black precipitate from a solution of the former, and a
yellow precipitate from that of the latter,

Bicyanide of Mercury (prussiate of mercury). — This salt is in the

420 LEAD AND ITS PREPARATIONS.

form of white, heavy, inodorous crystals, which have a strong metallic
taste, are soluble in hot and cold water, and nearly insoluble in alcohol.
When heated, the crystals yield metallic mercury and cyanogen gas,
which is recognised by the characteristic purple colour of its flame.
When heated with hydrochloric acid, hydrocyanic acid is given off.
The solution yields with sulphuretted hydrogen, and sulphide of
ammonium, a black precipitate, but it is not precipitated by liquor
potassse.

All the foregoing preparations of mercury have, in rare instances,
been taken as poisons. Their activity is proportioned to their solu-
bility. Thus the soluble nitrates and the bicyanide of mercury even
in small doses are extremely active poisons, while the white and red
precipitate, the turpeth mineral, and vermilion act much less power-
fully. The soluble salts act as corrosive poisons, the insoluble com-
pounds simply as irritants. Both classes may produce the specific
effects of mercury. In poisoning by the bicyanide of mercury, the
symptoms are those of poisoning by a soluble salt of mercury. The
cyanogen, which is in combination with the mercury, does not seem to
modify the action in any material degree^

Two cases of poisoning by red precipitate occuiTed in the practice of
Mr. A. Prince, of the Harrow Road, and are reported in the * Medical
Times and Gazette,' November, 1859. In one of the cases, the symp-
toms of acute irritant poisoning, were followed, (the dose being two
drachms,) on the third day by violent salivation, with extensive destruc-
tion of the soft parts.

4. LEAD AND ITS PREPARATIONS.

Acute ]X)isoning with the salts of lead is an event of rare occurrence.
One case only of poisoning (by Goulard's extract) occurred in the two
years 1837-8 ; and although no less than twenty -three deaths from the
" salts of lead " are returned by the Registrar-General for the average
of the five years 1852-56, it is obvious that they are chronic cases. No
case of lead poisoning occurs in the five years in the lists of suicides,
murders, and manslaughters. From the great use made of lead in the
arts, its effects as a slow poison are familiar to every medical man.

The metal itself does not possess any poisonous properties ; but as it
is readily acted on by acids, jt may become poisonous by combining
with the contents of the stomach.

The preparations of lead which are used in medicine or the arts, are
the two oxides, the carbonate, the acetate and subacetate, the sulphate,
the chloride, and the nitrate. Of these, the carbonate and the acetate
are most important in a medico-legal point of view.

Tests for the Salts of Lead. — On the supposition that we are
ignorant of the nature of a base contained in a solution piesented for
analysis, we first transmit sulphuretted hydiogen through it, or add a
few drops of the sulphide of ammonium, head is one of those bases
which give with this leagent a black precipitate. Liquor ammonlae,

SALTS OF LEAD.

421

liquor potassne, and dilute sulphuric acid throw down a white preci-
pitate. By this succession of trial tests, the solution is known to con-
tain a salt of lead.

The base is still further identified by the following tests : 1. Chro-
mate of potash throws down a gamboge-yellow chromate of lead.

2. Iodide of potassium yields an iodide of lead of the same colour.

3. If a fragment of zinc the size of a pin's point be placed in a drop of
the solution, the lead is deposited in one of the annexed forms. The
leal tiee is developed very rapidly and should be examined under the

Fig. 49,

microscope before the form has become obscured by the formation of
the white cai-bonate. This test acts characteristically on one grain of
the acetate of lead in four ounces of distilled water.

These tests ai-e sufficient to identify the base, and may be applied to
any of the soluble salts of lead.

Oxides of Lead. — There are thi-ee oxides of lead : the protoxide, r-ed
lead, and the peroxide. The protoxide, in the form of a yellow
semi-crystalline glass, is the litharge of commerce ; in that of a fine
powder, it goes by the name of massicot, A combination of pi'o-
toxide and peroxide of lead is the minium, or red lead, of commerce.
The brown peroxide is little known out of the laboratory.

Litharge (protoxide of lead). — This is in common use by painters
and glaziei-s, and is used as a cheap glaze for the common kinds of
earthenware. Serious accidents have arisen fi'om this glaze being
acted upon by acids. Litharge has also been used to impart a sweet
taste to sour wines. As already stated (p. 5), it is a constituent of
the hair dyes in common use. It possesses the following properties :
it is found in the form of reddish or yellowish scales, which are volatile
at a red heat, insoluble in water, but pei-fectly soluble, when pure,
in nitric acid, the solution possessing the properties of niti'ate of lead,
and the base giving the reactions already described. When placed
on a piece of charcoal, it is readily reduced by the heat of the blow-pipe.

Minium or Red Lead. — This is the common colour-ing matter of the
r-ed wafers ; and it has been found mixed with snuff. It is in the form
of a rich red powder, insoluble in water, and but partially dissolved by
nitric acid. When heated, it gives off oxygen, and is reduced to the
orange-yellow protoxide of lead. It is readily reduced under the blow-

422 LEAD AND ITS PREPARATIONS.

pipe on a fragment of charcoal, and on burning the wafers which con-
t;iin it, little globules of lead will be observed to form on the edges,
mixed with the unreduced yellow protoxide.

White Lead (ceruse, carbonate of lead). — This is extensively used
in the arts, chieHy as the basis of colours, and for enamel cards, and, so
used, is among the most common causes of colica pictonum and of other
forms of chronic poisoning by lead. It is sold in white masses, or as a
heavy white powder, and possesses the following properties: When
heated to redness, it loses its carbonic acid, and is changed to the
yellow protoxide. It is insoluble in water, but soluble with efferves-
cence in nitric acid. If quite pure, it is completely soluble in the
acid; but as it is usually Ibund mixed with some sulphates, it is not
completely dissolved. In large doses it may act as a poison, though it
is very insoluble in water. It is, however, dissolved in considerable
quantity in water which contains free carbonic acid.

Sugar of Lead (acetate of lead). — This substance is sold in the
form either of a crystalline mass resembling lump sugar, or in that of
a glistening, heavy, white powder. It ^ very soluble in water, has a
slight odour of vinegar, and a sweetish astringent taste. When heated,
it first dissolves in its watei" of crystallization, then gives off a part of
its acid, chars, and is partly reduced to the metallic state. When
heated in the mouth of a glass tube under the blowpipe, distinct
globules of lead are formed. If boiled with dilute sulphuric acid,
acetic acid is given oft", which may be known by its odour. The
powder is also blackened by sulphide of ammonium, and changed
to a fine yellow colour by iodide of potassium and chromate of potash.
In a state of solution, it gives the characteristic reactions of all the
soluble salts of lead.

Goulard's Extract (subacetate of lead). — This is found in the shops
in the form of a whitish or yellowish-white solution. It has an
alkaline reaction, and is distinguished from a solution of the acetate
by the copious precipitate of carbonate of lead, formed by transmitting
a stream of carbonic acid gas through it. Goulard's extract is an active
poison, and has more than once proved fatal.

Sulphate of Lead. — This is a heavy white powder, insoluble in
water and in acids, and unchangel by heat. It is blackened by the
sulphide of ammonium. If it is suspended in water, and sulphuretted
hydrogen gas is transmitted through it, the black sulphuret of lead is
formed, the sulphuric acid remaining in the supernatant liquor, in
which it may be detected by the nitrate of baryta. This salt of lead, in
consequence of its extreme insolubility, is stated not to be poisonous ;
but it is possible that if given in a very large dose, it would not be
quite inactive.

Chloride of Lead. — This is in the form of a white powder, sparingly
soluble in cold, but more soluble in hot water, soluble in dilute nitric
acid, but insoluble in alcohol. It has a sweetish taste. At a heat
below redness, it fuses into a semi-transparent horny mass {plumbum

SYMPTOMS. 423

corneum), but is volatilized by an intense heat. Its solution has the
reactions of a salt of lead.

There is a yellow oxychloride of lead used as a pigment under the
name of mineral, or patent yellow, and Turner's yellow. Like the
chloride, it is fusible, and remains tixed when melted.

Nitrate of Lead. — This is found in the form of tetrahedral or octa-
hedral crystals, soluble in water. Filtering paper dipped in the solu-
tion and dried, burns like touch paper. When heated in a glass tube,
nitrous acid vapour is given off, and the yellow protoxide remains
behind. The solution gives the characteristic reactions of a salt of lead.

Salts of Lead in Organic Liquids. — Add to the suspected liquid
a little nitric acid; boil, and filter. Transmit sulphuretted hydrogen
gas through the filtered liquid. If a salt of lead be present, a black
precipitate will be formed.

If no precipitate falls when the liquid is treated in this manner,
collect the solid matters remaining on the filter, incinerate, dissolve the
ash in nitric acid, dilute and filter the resulting liquid, and transmit
the sulphuretted hydrogen gas as befoi-e.

If by either or both of thesfr processes a black precipitate is obtained,
it may be proved to contain lead in either of two ways. 1. By
placing the dried precipitate on a fragment of charcoal, and reducing
the metal by the blowpipe. Or, 2, By exposing the sulphuret to
a red heat in a tube open at both ends, to burn off the sulphur, treating
the residue with strong nitric acid, and diluting the resulting solution
with distilled water. The solution must then be filtered, evapoiated
to dryness, and gently heated to expel the excess of nitric acid. The
residue, being dissolved in distilled water, will give the characteristic
reactions of lead. Care must be taken in these experiments to avoid
the use of ordinary flint glass, which always contains lead.

If no lead should be obtained by either of the foregoing methods, the
stomach itself may be cut into fragments and incinerated.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — All the salts of lead, with the exception, perhaps, of
the sulphate, act as weak irritant poisons, differing from the other
irritants chiefly in the absence of diarrhoea, and the presence of the
opposite state — constipation. Even the most soluble preparations of
lead act feebly as compared with most of the metallic irritants, and
rarely proved fatal.

The usual symptoms produced by a large dose of a solut>le salt of
lead are a burning and pricking pain in the throat and gullet, thirst,
vomiting, colic pains, with tenderness of the belly, obstinate con-
stipation, cramps in the extremities, cold sweats, and, in fatal cases,
convulsions, and tetanic spasms. In one recorded cas^ the pulse fell
to 40.

The most important and interesting form of lead poisoning is that
which is induced slowly by the long-contixlued use of preparations of

424 LEAD AND ITS PREPARATIONS.

lead, whether as medicine, in the arts, or in consequence of the acci-
dental impregnation of water or articles of food. The form in which
the effects of the poison first show themselves is that of the painters'
colic ; its more remote effects are known as the lead pais)',

IVie Painters' Colic, or, as it is called from the place where it was
first observed, Colica Pictonum, is marked by excruciating pain of the
abdomen, especially in the pit of the stomach and around the navel.
This pain is almost always relieved by pressui-e. The belly is hard,
the muscles of the abdomen strongly contracted, and the navel drawn
inwards. The bowels are either obstinately confiueil or scanty motions
are passed with much suffering. Very rarely diarrhoea is present.
The urine is small in quantity, and passed with difficulty. The
countenance is dull and anxious, the skin bedewed with cold per-
spiration, the pulse commonly of the natural fiequency, but sometimes
accelerated, the breathing quick and catching. In rare instances
febrile symptoms are present.

The painters' colic sometimes comes on without previous symptoms
of disease, at others after long-continued indigestion and disorder of the
bowels. It may terminate either in complete recovery, or may pass
into the second form of chronic poisoning — lead palsy. In rare in-
stances it terminates in a species of apoplexy, which comes on with
giddiness, extreme weakness, and toi-por. As these symptoms increase,
the pains in the belly subside, and the patient at length dies convulsed
and comatose.

Lead Palsy. — This is sometimes the termination of a single attack
of colic, but more commonly it supervenes after repeated seizures. In
some cases, again, it comes on without any previous attacks of colic.
The disease chiefly affects the upper extrerriities, especially the muscles
of the hand and forearm, which Hrst lose their power and then gradu-
ally waste away. The loss of power is chiefly in the extensor muscles,
so that when the arm is raised, the hand falls by its own weight.
Hence the expression, ' dropped hand.' The patient generally raises one
hand by the aid of the opposite arm, which is very characteristic of
the loss of power in the muscles of the forearm and hand.

This affection is in all cases difficult of cure, and very apt to recur
on the renewed application of its cause. The persons most subject to
the action of lead are those employed at furnaces for smelting lead ore,
manufacturers of litharge, and of red and white lead, house-painters,
colour-makers, plumbers and workers in lead, glass-blowers, glaziers,
potters, and manufacturers of glazed cards. It occurs occasionally in
persons who make comparatively little use of lead, as in compositors
from the handling of the types, in fishmongers from the use of lead
counters covered with brine.* In other cases, where it cannot be
traced to the use of lead in any way, it is attributable to the drinking
of water contained in leaden pipes or cisterns, under the circumstances
presently to be mentioned.

* I have witnessed two or three cases among this class of tradesmen.

TEEATMENT. 425

In the course of the several employments just mentioned, lead finds
its way into the system either by the skin, the lungs, or the stomach.

The" chief practical rule for the prevention of disease consists in the
strict enforcement of cleanliness. A great amount of disease has been
prevented by the substitution of moist for dry grinding.

Animals are frequently poisoned by lead contained in the water
they drink, and sometimes by the use of utensils containing some
preparation of lead.

There is one symptom which has been pointed out as characteristic
of the action of lead on the system ; viz., a blue line on the gums
round the margin of the teeth. This is a valuable indication, and one
rarely absent where marked symptoms of lead poisoning are present.
It exists in many cases where it is not possible to prove the intro-
duction of lead into the system, and when it is necessary to assume
that it finds its way into the body through the water which the
patient drinks.

Fost-rnortem Appearances. — In one case of acute poisoning by
Goulard's extract, the morbid appearances were the following: —
The lower end of the gullet, the whole stomach and duodenum,
a part of the jejunum, and the ascending and transverse colon were
greatly inflamed, and the villous coat of the stomach appeared as if it
had been macerated. The stomach contained six ounces of a reddish-
brown fluid which had a sweetish, styptic, metallic taste, exhaled the
odour of vinegar while evaporating, and yielded globules of lead when the
dry residue was subjected to the process of reduction. (Christison.)

In colica pictonum there are no constant morbid appearances
beyond an unusual constriction of the large intestines. In lead palsy
the aftected muscles are found pale and flaccid, and when the disease
has been of long continuance they resemble white fibrous tissue.

Treatment. — The antidotes to the salts of lead are the soluble
alkaline or earthy sulphates — the sulphates of soda or magnesia.
These should be freely administered, dissolved, or suspended in water.
If vomiting is absent, it may be excited by emetics of sulphate of
zinc, and encouraged by copious draughts of warm water, or the
stomach-pump may be used. Milk and white of eggs may be given
with advantage. When the colic pains are severe, and the bowels
costive, opium may be administered in combination with aperients,
and copious injections of warm water may be given. The remainder
of the treatment is that proper to the irritant poisons.

In consequence of the extensive use of lead in pipes and cisterns for
conveying and holding water, and the ill effects which sometimes re-
sult from the action of the water upon it, it is important to examine
the circumstances under which that action takes place. This subject
has been carefully examined by Drs. Christison, Taylor, and Miller.
The principal results of their inquiries may be briefly stated as follows : —

The contact of air and water with the metal leads to the formation
of an oxide of lead, which is dissolved in the water. The solution

426 LEAD AND ITS PREPARATIONS.

absorbs carbonic acid from the air, and the resulting oxycarbonate is
deposited in silky scales. A fresh portion of oxide is formed and dis-
solved and a fresh crop of crystals deposited ; and in this way the
metal is rapidly corroded. The free access of atmospheric air is essential
to these changes, for distilled water deprived of its gases by boiling,
and excluded from the air, has no action on lead. The action of air and
water on lead is very rapid when the water is pure. Thus distilled
water, or very soft water, or rain water collected in the open country
left in contact with pure lead, with the free access of air, cause a very
rapid corrosion of the metal ; but the rain water collected from the
roofs of houses in large towns, in consequence of the impurities which
it dissolves, has little or no action on lead.

On the other hand, the action of water on lead is materially modified
by the presence of various saline substances, even in the small
quantity of three or four grains to the gallon. The chlorides and
nitrates increase the corrosion ; but the sulphates, phosphates, and
carbonates lessen it. Bicarbonate of lime is a very effectual preser-
vative, and to the presence of this substance many springs owe their
property of not acting on lead. Sulphate of lime also affords a very
complete protection, so small a quantity as one part in 5000 effectually
preventing the foranation of the carbonate. Some kinds of river water,
as that of the Thames and the water used in Edinburgh, contain saline
matters in sufficient proportion to render the use of lead perfectly
safe. The same remark applies to most spring waters. But the
waters of some rivers and springs are so destitute of saline matters
as to act powerfully on lead. It must, moreover, never be forgotten
that carbonic acid, if present in the water, will completely counteract
the preservative effect of the salts above mentioned. It is better,
therefore, to forego the use of lead for cisterns and water-pipes. Slate
should be used for cisterns, and iron, earthenware, or glass for pipes.

It may be stated, then, as a general result, that the action of water
on lead, and the consequent danger of conveying and preserving it in
pipes or cisterns made of that material varies directly as the purity
of the water. It follows that we may render the use of lead for such
purposes perfectly safe by the artificial admixture of saline matter
with the purer kinds of water. Sulphuric acid by forming an inso-
luble sulphate of lead is also an efficient protection. The use of lead
is attended with most danger when it is employed to collect or pre-
serve rain or snow-water, or spring water of unusual purity ; and the
danger is increased by the use of leaden lids to cisterns, the pure water
rising by a natural process of distillation, and collecting on the lid.

There is one cause which greatly facilitates the action of water on
lead, and which may act with sufficient energy to neutralize the pre-
servative effects of saline matter, and be even increased by its presence,
namely, the galvanic action excited by the contact of some other metal
with the lead, or of the solder used for joining the sheets of lead.

The vegetable acids and fatty substances have the property of dis-

COPPER AND ITS PREPARATIONS. 427

solving lead ; hence the danger of keeping asceseent fruits, or liquors,
or fatty matter, in vessels made of that material, or glazed with the
oxide. Sour milk, cider, wine, and rum, have obtained poisonous
properties in this way. Shot used for cleaning wine-bottles, and then
carelessly left in them, have impregnated the wine with lead.

The treatment which seems best suited to promote the elimination
of lead from the system consists in the administration of iodide of
potassium in doses of five or of ten grains three times a day.

5. COPPER AND IIS PREPARATIONS

Poisoning with the salts of copper is of very rare occurrence.
Among the 543 cases of poisoning occurring in England and Wales
in 1837-8, not one was due to this caui-e, nor is the poison specified in
the Registrar-General's list of the causes of violent death in the five
years 1852-56. In consequence of the marked colour of all the salts
of copper, they are not likely to be taken accidentally, and they are
ill adapted to the purposes of the murderer. They are, however,
occasionally used by the suicide. The use of copper utensils in cookery
sometimes leads to the accidental admixture of poisonous salts of
copper with food ; and the sulphate of copper has been improperly
employed to promote the fermentation of dough, to decolourize sugar,
and to give a green colour to pickles. The arsenite or aceto-arsenite
of copper is also largely used in the arts. See Arsenic (p. 397).

Metallic copper is not poisonous ; but in consequence of the readi-
ness with which it oxidates and combines with acids, it cannot be
swallowed with impunity. Very injurious consequences have been
known to be produced by sucking copper coin ; and in a state of minute
division, as used in the process of printing, it appears to act as a poison.

Copper in the form of hydrated oxide, and in combination with acids,
is in common use in the arts. It will be necessary to particularize
the following : the hydrated peroxide, the carbonate, the sulphate, and
the acetates.

The Hydrated Peroxide. — Copper exists in this shape under the
names of mineral green and verditer. Mineral green formerly con-
sisted of arsenite of copper, but is now formed by a combination of
the hydrated peroxide with pure lime or chalk, potash, and alumina.
Verditer consists of the same materials in a different proportion.

The anhydrous peroxide of copper is a brownish black powder,
which is readily dissolved by nitric acid, the solution assuming, on the
addition of ammonia in excess, a deep blue colour. The hydrated
peroxide of copper may be procured by adding liquor potassae to a so-
lution of any of the soluble salts of the metal.

As none of the salts of copper assume the importance of arsenious
acid or corrosive sublimate, it will suffice to consider the tests for
copper generally, and then to describe and distinguish from each other
those salts which are in common use.

Tests for the Salts of Copper. — All the salts of copper are either

428 COPPEIl AND ITS PREPARATIONS.

blue or green. Their colour, therefore, distinguishes them at once
from most other substances. The salts of nickel and the sulphate of
iron are also green, but the distinction between the green sails of
copper and these substances will be readily made by comparing them
in a state of solution. In very dilute solutions the colour of the salts
of copper disappears, or is so masked as to afford no clue to the
nature of the substance with which we have to deal : it will be
necessary, therefore, to suppose that substance to be unknown to
us. Acting on this supposition, we first test the liquid with sul-
phuietted hydrogen, when we obtain a deep brown or blatk pre-
cipitate. Sulphide of ammonium yields the same precipitate. On
the addition of liquor ammonia; the hydrated pei oxide is first thrown
down ; and this being dissolved, by the addition of ammonia in excess,
the chai'actftristic deep blue coloured solution of the hydrated per-
oxide is formed.

The salts of copper in solution may be further identified by the
following tests: 1. FeiTocyanide of potassium yields a fine hair-brown
gelatinous precipitate ; 2. Polished iron (a knife or a needle suspended
by a thread) placed in a solution of a salt of copper is speedily coated
with a thin film of the metal ; 3. A drop of the solution placed on
platinum foil, and slightly acidulated, when touched with a strip of
zinc, yields a similar metallic deposit ; 4. If a minute fragment of zinc
is placed in a drop of a solution of a salt of copper on a fiat surface of
glass, the copper is deposited in an arborescent form ; and is sufficiently
distinguished from other metals by its colour.

Some of the salts of copper possess peculiar properties, and may
have to be distinguished from each other.

Carbonate of Copper (natural verdigris). — This is the gi'eenish
coating formed on the surface of copper and its alloys by the action
of air and water. It is readily distinguished from the other salts of
copper by effervescing with acids. The reactions of the base are those
of other salts of copper.

Sulphate of Copper (blue vitriol, blue-stone, Roman vitriol). — The
base is detected by the tests already described. The salt is further
known by adding a few drops of liquor ammonias, and a solution of
arsenious acid. Green arsenite of copper is thrown down. The sul-
phuric acid in combination may be detected by the test of nitric acid
and nitrate of baryta.

Subacetate of Copper (artificial verdigris). — The term artificial ver-
digris is sometimes applied to the unmixed subacetate, and sometimes
to a combination of this with the neutral acetate and carbonate. Its
colour accordingly varies, being sometimes blue and sometimes green.
The subacetate is known by the effect of heat. When introduced into
a test tube, and heated by the flame of a spirit lamp, a jiortion of
acetic acid is given off; and another part being decomposed, leaves an
ash of carbon, which deoxidizes the copper, so that a thin film of metal
is left on the sides of the tube.

COPPER IN ORGANIC LIQUIDS. 429

Acetic acid is also given off on boiling the salt with dilute sulphuric
acid.

Nitrate of Copper. — This is in the form of deliquescent blue
crystals. The acid in combination may be detected by the absence
of a precipitate with nitrate of baryta, and with nitrate of silver ; and
by the ruddy furaes of nitrous acid gas evolved by boiling the crystals
with tin filings in a few drops of distilled water. By adding liquor
potassai to the solution, nitrate of potash is formed, which may be
identified by appropriate tests (p. 333).

Chloride of Copper. — There is a soluble chloride, and an insoluble
subchloride of copper. The chloride is of a bright-green colour, the
subchloride is white. An oxychloride is known in the shops as
Brunswick Green.

The chloride is deliquescent and very soluble in v/ater ; the sub-
chloride is insoluble in water, but soluble in acids. The tests for the
base are the same as for other salts of copper. The hydrochloric acid
in combination may be detected, in the case of the soluble chloride, by
the addition of nitrate of silver. The insoluble subchloride must be
convei-ted into a soluble salt for the purposes of examination.

Arsenite of Copper. — See the chapter on Arsenic (p. 397).

The several salts of copper are found in the shops, mixed in various
proportions and under different names, as pigments.

Copper in Organic Liquids. — Solutions of copper are decomposed by
several of the common contents of the stomach, — such as albumen, fibrin,
milk, tea, coffee, &c., and by the mucous membrane of the stomach,
the suboxide being thrown down. As the salt of copper is not always
completely decomposed, it may often be obtained in sufficient quantity
for analysis by simply boiling with distilled water and passing the
solution through a filter. The insoluble substances must be reserved
for further examination. The clear liquid which has passed the filter
may be tested by the reagents just described. By slightly acidulating
the liquid, and then passing through it a stream of sulphuretted hydro-
gen, the brownish-black sulphuret of copper is thrown down. This
must be carefully collected, and washed, and incinerated in a glass
tube. It is thus freed from any adhering organic matter. The sul-
phuret may now be converted into sulphate by treating it with a few
drops of nitric acid. The solution will strike the usual deep blue'
colour with an excess of ammonia.

If copi^^)er is not by this means detected in the liquid which has
passed the filter, the insoluble substances which remain on the filter,
or ate contained in the stomach, must be dried and heated to redness
in a crucible, till they ai'e completely charred. The residue contains
metallic copper, and must be gently heated in equal parts of nitric
acid and water. Nitrate of copper is thus formed, which may be
identified by the usual tests.

Copper has been detected in the solid organs of the body, but more
rarely in the secretions, in cases of poisoning by its salts.

430 COPPER AND ITS PREPARATIONS.

Copper has also been found in several vegetable substances used as
food, and is asserted to exist as a natural constituent of the fluids and
solids of the human body. The existence of copper in vegetable sub-
stances has been confiiTned and explained by M. Boutigny, who has
traced it to the manure used in laising those substances. Its presence
as a natural constituent of the human body, has, however, been
rendered doubtful by the negative results of experiments pei'formed
by Chiistison and Chevreul. The quantity of copper existing naturally
in animal and vegetable substances is so minute, not exceeding in any
case one part in 120,000, and in some instances being so little as one
in 1,500,000 parts, that it can give rise to no fallacy even where large
portions of the solid contents of the stomach or of the body itself are
submitted to analysis.

Quantitative Analysis. — Use for this purpose the precipitated sul-
phuret, digest it in nitric acid, and preci}>itate the oxide from the
solution by potash. One hundred parts ot the black oxide correspond
to 312 of the crystallized sulphate.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — The symptoms set in from a quarter to half an hour
after swallowing the poison, with pains in the abdomen resembling colic,
with nausea, eructations, vomiting of matters of a bluish oi- gieen
colour, purging and cramps in. the extremities. Kervous symptoms
also supervene. Convulsions, palsy of the limbs, tetanus, and insensi-
bility have been present in dilierent cases. As in the case of arsenic
and mercury, the group of symptoms varies in each instance. One
symptom of more frequent occurience in poisoning with the salts of
copper than in poisoning with other irritants is jaundice.

Post-mortem Appearances. — The mucous membrane of the stomach
and intestines has been found inflamed, ulcerated, thickened, and of
a green colour, and in parts apparently gangrenous. The salt of
copper sometimes adheres to the surface of the membrane. The in-
flammation and discolouration of the mucous membrane occasionally
extend to the oesophagus. The skin is yellow. The other post-mortem
appearances are not characteristic.

in some instances the intestines have been found perforated.

Treatment. — The antidotes to the salts of copper are albumen, and
iron filings. The first is to be prefened. The treatment will consist
in the free administration of the white of egg, followed by mucilaginous
drinks. If vomiting is not present the sltomach-pump may be used.
The remainder of the treatment will vary with the symptoms.

Severe efl'ects have been produced by comparatively small doses of
the salts of copper. In a case mentioned by Dr. Percival, convulsions
were occasioned by two drachms of blue vitriol.

Shortest Fatal Period. — The salts of copper have proved speedilv
fatal. A girl aged sixteen months died mfour hours after swallowing

ACCIDENTAL POISONINGS BY COPPER. 431

several fragments of blue stone (Taylor). In other instances death has
taken place after longer intervals, such as 12, 13, 60, 72, and 78 hours.

Accidental Poisoning by Copper. — Serious and even fatal accidents
have occurred from the use of copper vessels in cooking.

The inmates of a monastery suffered severely from obstinate and
severe colic, retching, and bilious vomiting, costiveness, flatus, burning
pain in the pit of the stomach, in the kidneys and extremities, and para-
lytic weakness in the arms. These symptoms were traced by Gmelin
to the fact, " that every vessel in the kitchen, the pots and pans, and
even the milk pails and butter dishes for storing the butter, were made
of copper."

The principal facts established in reference to the impregnation of
various fluids and articles of food with copper, in consequence of being
prepared or kept in copper vessels, are the following. Distilled water
kept in contact with clean copper is not impregnated with it. Solu-
tions of several saline matters, as common salt, alum, nitre, and Epsom
salts, when heated in copper vessels, are found to contain the poison.
Acids, and fatty and oily matters, especially when rancid, act still
more strongly on copper vessels. One general principle applies to all
these substances, which is, that provided the vessels be clean, they may
be boiled in them with comparative safety, but cannot be allowed to
stand in them without danger. The contact of air with the moistened
copper leads to the formation of the hydrated carbonate, which is dis-
solved by any acid that the substance may happen to contain. As
saline, acid, or oily matters act strongly on copper vessels, it would be
well to avoid using such vessels in preparing articles of food containing
any of these matters.

6. ZINC, TIN, SILVER, IRON, BISMUTH, CHROME, AND THEIR
PREPARATIONS.

There are two preparations of zinc which require notice — the
sulphate and the chloride.

Zing (sulphate of zinc, white vitriol, white copperas). — This sub-
stance is in common use as an emetic, but as a poison it is unimportant.

Sulphate of zinc is found in the form of colourless, or nearly colour-
less, prismatic crystals, of a styptic taste, and very soluble in water.
It resembles oxalic acid and sulj)hate of magnesia. From the former, it
is distinguished by the tests described at p. 345, and from the latter by
adding to their respe(;tive solutions sulphuretted hydrogen or sulphide
of ammonium. The sulphate of zinc yields a white precipitate, but
there is no precipitate with the sulphate of magnesia.

Sulphate of zinc in solution possesses the following properties: 1. It
is precipitated as a white sulphuret, by sulphuretted hydrogen and
sulphide of ammonium, provided the solution does not contain an
excess of acid. 2. Liquor ammonise and the sesquicarbonate of am-
monia throw down a white precipitate soluble in an excess of the
precipitant, 3. Ferrocyanide of potassium causes a white precipitate.

432 ZINC, TIN, ETC., AND THEIR PREPARATIONS.

As sulphate of zinc often contains iron, the precipitates are apt to be
tinged with the colours which ifon gives witli these reagents.

In Organic Liquids. — Sulphate of zinc is decomposed by albumen
and milk, which form with the oxide an insoluble compound, and also
by substances containing tannin. The first step of the piocess for
organic liquids consists in acidulating with acetic acid, by which any
oxide thrown down in union with animal matters is dissolved. The
mixture must then be filtered, and sulphide of ammonium added. A
white sulphuret of zinc is thrown down, which must be washed,
collected, dried, and heated to redness in a glass tube. The residue is
then to be acted on by strong nitric acid, which dissolves the zinc ; and
the acid solution, being neutralized by caibonate of ammonia, is ready
for the application of the tests. The carbonate of zinc which results
from this decomposition becomes yellow when heated, and resumes its
white colour on cooling. It is also redissolved by an excess of the car-
bonate of ammonia.

Symptoms. — Sulphate of zinc is one of the simplest of the irritant
poisons. It has a disagreeable bitter taste, and causes, in large doses,
dryness of the throat, thirst, vomiting, purging, and pain of the abdo-
men. In consequence of its strong emetic propei-ties, it is, in most
cases, soon rejected from the stomach ; but in a case reported by Dr.
Gibb, in which 67 grains, contained in a lotion, was swallowed by an
adult female, there was no vomiting from the poison, and some diflB-
culty in relieving the stomach by emetics. It has been administered
medicinally in doses of two scruples three times a day for several
weeks, without injurious consequences. (Dr. Babington.)

The Post-mortem Appearances are those of simple inflammation of
the mucous membrane of the stoma(;h and intestines.

Treatment. — This consists in the use of a dilute solution of carbonate
of potash as an antidote, followed by the free administration of milk, of
the white of egg in large quantity, and of liquids containing tannin,
such as tea, and decoctions of oak or Peruvian bark. The remainder of
the treatment is that common to all the irritant poisons.

Chloride of Zinc. — An aqueous solution of this substance is the dis-
infectant known as *' Burnett's Fluid." It is a corrosive poison, and
produces the symptoms and post-mortem appearances common to the
class of coirosive poisons ; and it requires the same treatment. (See
Irritant Poisons, p. 317.)

Tin.— Chlorides of Tin. There are two chlorides of tin, the proto-
chloride and the perchloride. A mixture of these two salts in solution
is known by the name oi dyers' spirit. They also exist in the form of
yellowish-white acicular crystals. These are the only preparations of
tin which require notice.

Tests. — The protochloride has the following properties: 1. Sul-
phuretted hydrogen or sulphide of ammonium throws down a
precipitate of a dark chocolate colour, soluble in an excess of
sulphide of ammonium. 2. The bichloride of meicury gives a grey

SILVER.

433

Fig 50.

precipitate of finely divided mercury. 3. Chloride of gold gives a
deep purple precipitate (the purple of Cassius). 4. A fragment of zinc
placed in a drop of the solution throws
down the metal in an arborescent form,
characterized, though not distinguished,
by the rectangular arrangements of the
branches (fig. 50). One grain of the
protochloride in two ounces of distilled
water gives characteristic results. These
are the tests for the base. The acid is
detected by the white precipitate inso-
luble in nitric acid, thrown down by
nitrate of silver.

The perchloride is precipitated yel-
low by sulphuretted hydrogen, and sulphide of ammonium, the pre-
cipitate being soluble in an excess of the sulphide. In colour, therefore,
the precipitated sulphide resembles the sulphide of arsenic and the sul-
phide of cadmium. It differs from the foi-mer in being insoluble in
ammonia, and irom the latter in being insoluble in hydrochloric acid.
Neither corrosive sublimate nor the chloride of gold gives any pre-
cipitate with the perchloride. The acid of* the salt may be detected
by the nitrate of silver.

The salts of tin produce the common symptoms of irritant poison-
ing, which muit be met by the free use of albumen or milk, and of
diluents. Emetics, or the stomach-pump may be employed if necessary.

Silver. — Nitrate of Silver — (Lunar Caustic). This substance is
met with in the form of tabular crystals, or fused into small cylinders.
It has the following properties : — It is veiy soluble in distilled water,
its solution has an acid reaction, and a stiong styptic, metallic taste;
is a very powerful corrosive ;. and, when mixed with organic matter,
is blackened by light. The base is detected by the following tests : —
1. Sulphuretted hydrogen or sulphide of ammonium yields a black pre-
cipitate. 2. Liquor ammoniac throws down the brown oxide, which is
dissolved by the precipitant in excess. 3. Hydrochloric acid yields a
white clotted precipitate, the chloride of silver, which is insoluble in
nitric acid, and when heated on platinum foil fuses into a horny mass.
4. On adding to the solution liquor p,j^ ^^

ammonia;, until the brown oxide is re-
dissolved, and then arsenious acid, the
yellow arsenite of silver is thrown
down. 5. A strip of copper introduced
into the solution is speedily coated with
silver. 6. If a minute fragment of
zinc is placed in a drop of the solution
the metallic silver is deposited in an
arborescent form (fig. 51). This test is
very delicate, a distinct tree (generally
in the shape of the shaded figure) being

434 ZINC, TIN, ETC., AND THEIR PREPARATIONS.

obtained from a grain of nitrate of silver in eight ounces of water. The
acid is detected by adding to the filtered liquid, remaining after the
application of the tests, carbonate of potash, when nitrate of potash is
formed.

No detailed cases of poisoning by nitrate of silver have been placed
on record, but from experiments on animals, it appears that it acts as
a simple corrosive and local iiTJtant.

The treatment consists in changing the soluble nitrate of silver to
the insoluble chloride, by the free use of a solution of common salt.

Iron. — The sulphate of iron (green vitriol, copperas) and the
chloilde, or muriate, of iron possess sufficiently active properties
to entitle them to the name of poisons, but they are among the least
active of the irritants. The base may be detected by the following
tests : — 1. Sulphuretted hydrogen gives no precipitate, but the sul-
phide of ammonium throws dov^n a black sulphide. 2. Infusion of
galls also gives a black precipitate. 3. Ferrocyanide of potassium
throws down a blue precipitate, which deepens by exposure to the air.
4. Sulphocyanide of potassium gives a deep blood-red precipitate.
The acid in combination in the sulphate and muriate, respectively,
may be detected by the nitrate of baryta and nitrate of silver.

The sulphate of iron, arid the chloride in the form of tincture, have
both proved fatal, and have in one or two other instances produced
severe effects. The symptoms and post-mortem appearances in one
case of poisoning by the tincture, recorded by Dr. Christison, were
those of a strong irritant. The treatment would consist in the free
use of emetics and diluents.

Bismuth.^ Trisnitrate, subnitrate, or nitrate of Bismuth. — This
substance has proved fatal in a large dose, with the symptoms and
post-mortem appearances proper to irritant poisoning. It is found in
the form of a white, insoluble powder, which is blackened by sul-
phuretted hydrogen, and sulphide of ammonium. It is soluble in
nitric acid, but it is again thrown down when the solution is largely
diluted with water. The solution resembles that of the salts of lead in
being precipitated white by liquor ammonite and liquor potassse, but
differs from it inasmuch as it gives no precipitate with dilute sulphuric
acid. It gives a deep-brown precipitate with iodide of potassium.

Chrome. — The bichromate of potash is much used as a dye. It is
found in the form of deep orange-red crystals, which yield a yellow
solution. The solution has an acid reaction. With the salts of lead it
gives a yellow, and with those of silver a deep-red precipitate. Little
is known of the action of this substance on man, but experiments on
animals have shown that it possesses the properties of an irritant
poison. The treatment would not differ from that proper to the class
of irritants.

435

CHAPTER XII.
NARCOTIC POISONS.

This class of poisons owes its importance less to the number of in
dividual poisonous substances which it comprises (for they are few)
than to the habitual use made of them by large classes of persons,
their constant employment in the treatment of medical and surgical
maladies, the many accidents to which they give rise, and the many
occasions on which they are employed by the suicide or murderer.
For all these reasons combined poisons belonging to this class are used
twice as often as the whole class of irritants, and more than fifty times
as often as the whole class of narcotico-acrids.

The narcotic poisons are characterized by the disorder which they
produce in the functions of the brain and spinal cord. In one leading
division of the class, comprising opium and its preparations, symptoms
of narcotism are the most prominent. In the other, which comprises
prussic acid and the substances that contain it, narcotic symptoms are
less conspicuous, and are subordinate to the effect produced on the
functions of the heart and lungs.

In examining this class of poisons we encounter difficulties which do
not occur in the case of the class of irritants. The symptoms they
produce are moie apt to simulate those of disease, and the post-mortem
appearances are often very slight and indistinct. The chemical analysis,
moreover, is, on the whole, less sure and satisfactory.

The symptoms of narcotic poisoning are giddiness, headache, dimness
of sight, noises in the ears, drowsiness and confusion of mind, passing
into insensibility more or less complete. Delirium is i-are, and palsy,
convnlsions, and tetanic spasms are only of occasional occurrence.

The morbid appearances are often slightly marked. They consist
in fulness of the veins and sinuses of the brain, with effusion of serum
beneath the membranes, at the base, and into the ventricles ; and in
some instances extravasation of blood.

The treatment of cases of poisoning by the narcotics as a class does
not admit of being laid down with precision. The use of the stomach-
pump, or of emetics, to discharge the poison ; the cold affusion to
rouse the patient ; forced exercise to prevent sleep ; stimulants to re-
store the patient from collapse ; warmth and frictions in case of
apncea ; and in extreme cases, artificial respiration, and the galvanic
shock, are the items of treatment common to the whole class.

The narcotic poisons as a class are distinguished from the narcotico-
aorids as a class by the absence of irritation of the stomach and bowels.
When irritation of any part of the alimentary canal exists, it assumes
the form of nausea and vomiting, which occur, not at the commence-

436 KARCOTIC POISONS.

mcnt, as in the case of the jrritants and narcotico-aerids, but when
the patient begins to recover from tlie effects of the poison. Dianiioea
is a raie incident in narcotic poisoning ; but the expulsion of the
contents of the bowels often occurs in poisoning by prussic acid as in
other violent and sudden deaths.

Among the narcotic poisons it is possible to distinguish three classes:
— n class, to which opium and its pre)).-! rations, and the narcotic gases
belong, characterized by the production of narcotism either without a
previous stage of excitement, or with that stage faintly maiked ; a
class to which alcohol and the a-thers belong, characterized, though not
always, yet often, by a preliminary stage of excitement ; and a class, of
which prussic acid and the substances containing it are the only members,
which, in fatal doses, kill by syncope or shock, and in smaller doses
occasion narcotism and a state resembling apncea.

There are several diseases affecting the brain and nervous system,
which, in the symptoms they present during life, and the morbid ap-
peai-ances they leave after death, resemble moie or less closely the
operation of one or other of these three classes of narcotic poisons.
Diseases of the heart and large vessels may destroy life suddenly or
speedily with symptoms not unlike those of poisoning by a full dose of
prussic acid ; and a person may die in an epileptic fit with some symptoms
common to it and to poisoning by the same substance. On the other
hand, all the poisons of this class which do not prove rapidly fatal,
and prussic acid itself in smaller doses, develop symptoms of narcotism
which are also present in attacks of apoplexy and of uraemia. Again,
many chronic diseases of the brain and spinal cord, and many affections
of the nervous system, terminate fatally after decided symptoms of
narcotism. It must also be borne in mind that, in infancy and child-
hood, convulsions from teething or fjom gastiic or intestinal irritation,
as well as narcotism from the state of bi'ain preceding and accom-
panying the effusion of serum, ai'e of very common occurrence. It
may, therefore, sometimes happen that we are called upon to dis-
tinguish certain diseases and their symptoms from the effects of narcotic
poisons.

This distinction between disease and narcotic poisoning must often
present diflficulties in infants and yoiuig children, and occasionally in
adults. But we are sometimes greatly assisted by detecting the peculiar
odour of the poison, and, in the case of prussic acid and oil of bitter
almonds, by finding the vessel from which the poison has been taken on
the person or near the body. In other instances, the death is fully ex-
plained on the examination of the dead body, by the discovery of organic
disease of the heart and large vessels, or of the biain, or of some disease
of the kidney capable of giving rise to the poisoned state of the blood
known as uramiia. Among the diseases of the heart which may
occasion sudden or speedy death it is important to include fatty dege-
neration of the substance of the organ which is now admitted among
the recognized causes of such deaths. Effusion of serum or of blood

DIAGNOSIS. — EPILEPSY. 437

upon the brain or into any part of the cavity of the cranium would
not be conclusive evidence of death by disease, as such appearances
have been present in one or two cases of narcotic poisoning in healthy
subjects.

In some cases the interval which has elapsed between the presumed
administration of poison. and the first appearance of the symptoms, is
such as of itself to rebut the supposition of poisoning. But this means
of distinction will be best considered when ti eating of the narcotic
poisons individually.

Among the fatal diseases to which reference has just been made,
there are two of such common occurrence that it may be well to specify
some of the best-ascertained facts respecting them for use in cases of
difficult diagnosis.

Apoplexy, — Apoplexy is sometimes preceded by marked premonitory
symptoms of long continuance. It is rare under thirty years of age,
while many cases of poisoning by narcotics occur in infants and young
persons. Apoplexy sometimes "follows directly upon a full meal ; in
other instances on sudden exertion or violent passion. The symptoms
of apoplexy manifest themselves suddenly. In many cases of apoplexy
there is rather a loss of power to move and to articulate than a loss of
the intellectual faculties. In cases of narcotic poisoning, the mind is
evidently more strongly affected; the stupor is more complete, but the
loss of power much less marked. In the former case, the muscles are
paralysed, in the latter, the will. When, however, the apoplectic
patient is insensible, he is more difficult to rouse than one who has
taken nai'cotic poison. Narcotic poisoris, when they prove fatal, destroy
life much more rapidly than most apoplectic attacks. On the other
hand, when apoplexy destroys life very rapidly, it does so sooner than
any other poison of the narcotic class, except hydrocyanic acid or the
nai'cotic gases.

The post-mortem appearances in cases of apoplexy generally differ
from those due to poison. Eflusion of blood on the surface, in the
ventricles, in the substance, or at flie base, of the brain, is rare in
poisoning, so that its presence affords a strong presumption in favour
of sanguineous apoplexy. A copious effusion of serum in the same
situation affords a less forcible presiunption in fiwour of serous
apoplexy ; while a mere turgescence of the veins and sinuses of the
brain furnishes in itself an equal presumption in favour of poisoning or
of simple apoplexy.

Epilepsy. — Epilepsy is one of the occasional symptoms of irritant
poisoning, and of poisoning by the narcotico-acrids. It also resembles
acute poisoning by prussic acid. When it is merely one of a group of
symptoms due to poisoning, the concomitants will serve to distinguish
it at once from a case of simple epilepsy. The points of distinction
most insisted upon are the following: The epileptic fit almost always
begins abruptly, and in most cases without any previous warning ;
and the premonitory symptom , if present, is rarely such as to be con-

438 NARCOTIC POISONS.

founded with the effects of a narcotic poison. The symptoms of
narcotic poisoning, also, gradually increa.se in severity. In epilepsy
the patient cannot be roused by external stimuli. The reverse obtains
in most cases of narcotic poisoning. In fatal cases of epilepsy, death
does not take place so rapidly as in poisoning by prussic acid, and gene-
rally after a longer interval than in poisoning with opium. Epilepsy
very rarely, if ever, proves fatal in the first paroxysm.

Prussic acid, the poison which produces the symptoms most resem-
bling epilepsy, would be at once detected by its odour. In fatal cases,
the morbid appearances render little assistance to the diagnosis. There
are no morbid appearances proper to epilepsy, but the brain is otten
found extensively diseased. If that disease is of a very marked cha-
racter, it renders the supposition of poisoning improbable ; but if it
consist simply in congestion, or in a moderate effusion of serum, it is
consistent with the supposition of poisoning, apoplexy, or epilepsy.

If death take place with symptoms similar to those of narcotic
poisoning within the time at which such poisons may prove fatal,
lecourse must be had to the post-mortem appearances. These will
often be of so marked a character as to explain the death without
having recourse to the supposition of poisoning. But if the post-mortem
appearances should happen to be such as are found in cases of poison-
ing, recourse must be had to an analysis of the contents of the stomach,
which may issue in rendering the previous exhibition of poison impro-
bable, or in proving that this was the cause of death.

The most important of the narcotic poisons are opium and hydro-
cyanic acid. Alcohol, ether, and chloroform follow next in order,
and a feeble narcotic poison, lactuca, completes the list of simple
narcotics.

The principal narcotic gases are, carbonic acid, carbonic oxide, and
sulphuretted and carburetted hydrogen.

Some poisons usually classed with the narcotics will be considered
as narcotico-acrids.

The relative importance of the two principal poisons of the narcotic
class — opium and prussic acid — is shown by the fact that, on the
average of the five years 1852 to 1856, opium and its preparations
were administered in 141, and prussic acid and its preparations in 34,
cases of poisoning, in which the nature of the poison was distinctly
specified.

439

CHAPTER XIII.
OPIUM AND ITS PREPAKATIONS.

The importance of opium and its preparations as poisons will be
understood from the statement, that of the 543 cases of poisoning
brought under the notice of the Coroner's court in England and Wales,
during 1837-38, no less than 200 were cases of poisoning by opium
or its preparations, either alone or in union with other poisons. This
number exceeds the total of cases (184) of poisoning by arsenic.

Of these 200 cases, 42 were by solid opium, 133 by laudanum, 21
by other preparations containing opium, 2 by acetate of morphia, and 2
were cases of mixed poisoning (laudanum and prussic acid, and lau-
danum and aquafortis). Of the 200 cases, 64 occurred in children,
and the remainder in adults, and of these 64, 41, or a fifth of all the
cases, were from over doses of cordials or medicines, administered to
infants and young children by their mothers or nurses.

Since the years 1837-38 great changes have taken place in the com-
parative frequency with which the different poisons are employed. In
consequence partly of the legal enactment restricting the sale of arsenic,
and partly of the increased knowledge of the properties of other poisons,
opium and its preparations, which in 1837-38 formed four in eleven of
all the recorded poisons, constitute on the average of the five years
1852-56 more than one-half of the deaths by ascertained poisons. The
total annual average of deaths by ascertained poisons being 268, no less
than 141 were attributed to opium and its several preparations, while
prussic acid and its compounds accounted for 34 deaths, and arsenic
and its preparations for only 27 deaths.

Opium itself caused, on the average of these five years, 34 deaths,
laudanum 89, Godfrey's cordial 16, and morphia 2.

The cases of poisoning by opium and its preparations, in the five
years, 1852-56, in which the ages of the victims were ascertained,
amounted to 377 ; of which number 170, or nearly half, occurred in
infants under one year of age, and 203 in children under five years old.

In adults the great majority of cases were suicidal. Only one
murder and one manslaughter (by laudanum) are reported in the whole
five years.

Opium and its preparations, especially laudanum, are sometimes
given to facilitate the commission of other ciimes, such as theft and
rape. In such cases the taste and colour are generally concealed in
brandy or coffee, and the poison is given after the sense of taste has
been deadened by intoxicating liquoi's.

The capsules of the Papaver somniferum (white, or garden poppy)

440 Ol'lUM AND ITS PltErAUATlONS.

lumish several piopirations to the London Phannacopcoifi — a decoction
for external use, a syrup given chiefly to infants, and an aqueous
extract (otractum i)apavei'is), in addition to the inspissated juice known
FJg. 52 ^s opium. A decoction of the capsules, or poppy

heads, not authorized by the Pharniacopoeia, is
sometimes given to infants with fatal effect. As
the seeds from the capsule have been found in the
stomach, and as the seeds taken by themselves
have proved fatal in some instances abroad, the
annexed wood-cut is given to show their size and
microscopic character. They weigh about 230 ^to
the grain. Some of the seeds are white, others grey.

Opium, the inspissated juice of the unripe capsules, has the follow-
ing familiar properties: It is of a reddish-brown colour, of a strong
and peculiar odour, and a bitter and lather acrid taste. Different
specimens of the drug vary in physical properties, and in activity,
with the place of growth, the maturity of the capsule, the greater or
less care bestowed on the manufacture, and the presence or absence of
aduiteiation. The quantity of morphia may vary from 2 to 28 per
cent, and the quantity of meconic acid bears no fixed proportion to
the moii)hia which it holds dissolved. The average quantity of morphia
in good Turkey opium is about 10 per cent., and the nipconic acid is
usually stated at 6 per cent. The drug consists of a number of distinct
principles combined with a peculiar acid, and mixed with resin, and
extractive matter. These principles are dissolved by water at ordinary
temperatures, by alcohol, and by mineral and vegetable acids.

The preparations of opium in the London Pharmacopoeia are: —
The tincture, or Laudanum, which contains one grain in thirteen drops ;
the compound tincture of camphor, or Paregoric, which contains one
grain in the half ounce ; the extract of opium, a preparation of some-
what variable strength; the confection, which contains one grain in
thirty-six; the compound ipecacuanha, or Dover's powder, which con-
tains one grain in ten ; the compound opium and chalk powder, which
contains one grain in forty ; and the compound kino powder, which
contains one grain in twenty ; the compound soap pill and compound
styrax pill, which contain one grain in five. The vinum opii, fre-
quently dropped into the eye, the enema opii, consisting of thirty diops
of the tincture in ^iv of starch, the emplastrum opii, the unguentum
opii, and the unguentum Gallae compositum, complete the long list of
phai-macopoeial preparations containing opium.

The black drop said to contain two, three, or four times as much
opium as the tincture, and Battley's liquor opii sedativus, of which
twenty drops are said to be equal to thirty of laudanum, are also in
common use. The first is made with verjuice and aromatics, the second
is believed to be an aqueous solution. Godfiey's cordial, Dalby's car-
minative, children's quietness, and several mixtures improperly given
to children to procure sleep, contain laudanum as their chief ingredient

TESTS FOR MORPHIA. 441

in combination with syrups, stomachics, and magnesia. The quantity
of laudanum in these preparations is very variable.

Opium contains several active principles. Morphia, narcotine, nar-
ceine, meconine, thebain or paramorphia, codeia, papaverine, and me-
conic acid, have been separated ; but the most important, indeed the
only ones of any medico-legal importance, are morphia and meconic
acid, wliich exist in combination in opium as a meconate of morphia.
Opium may be recognized by the reactions of these two substances, as
well as by its odour and other physical properties.

The morphia and meconic acid are extracted and separated by the
following process:

The opium is infused in successive portions of cold water. This
aqueous solution, which holds the active principles of the drug dis-
solved, is boiled with magnesia, in combination with which the active
principles are thrown down. The precipitate thus formed, after being
washed and dried, is boiled with proof spirit, which dissolves the nar-
cotine and the resin, leaving the morphia and a meconate of magnesia
behind.

To separate the morphia from the meconate of magnesia the preci-
pitate is boiled in strong alcohol, which dissolves the morphia mixed
with some resin. From this impure spirituous solution, the morphia
may be obtained pui-e by crystallization or by digesting it with animal
charcoal.

To obtain the meconic acid, the impure meconate of magnesia is
boiled in dilute sulphuric acid, and the mixture partially evaporated.
The sediment which falls on cooling is dissolved in water, and acetate
of lead is added to the solution. A meconate of lead is thus formed.
This is washed and suspended in water, and a stream of sulphuretted
hydrogen gas is transmitted through it. Sulphuret of lead is thrown
down, and meconic acid left in solution ; and on evaporation, impure
scaly crystals of meconic acid are obtained.

TESTS FOR MORPHIA AND MECONIC ACID.

Morphia. — Properties : — 1. It is sold as a white powder, or as
crystals, which when quite pure are colourless; but they are generally
more or less discoloured by resin. Their form Fig. 53.

is the six-sided prism (tig. 53). Crystals, or ^^ ,

the fragments of crystals of this shape may he / '■; /-A

recognized in good specimens of the alkaloid, i j ' '

2. They have a bitter taste, but no odour. I /' ""

3. When heated, they first melt into a yellow ^^

oily liquid, then burn like a resin, leaving a
carbonaceous deposit of a semi-crystalline appearance, and giving out
ammonia. 4. They are very sparingly soluble in cold water, sparingly
soluble in hot water, more soluble inaather, and still more so in alcohol.
They are soluble in the caustic alkalis, and very soluble in the mineral
and vegetable acids, in combination with which they are used in

442 OPIUM AND ITS PllEPARATIOKS.

medicine. 5. In solution they have a slight alkaline reaction.
6. In common with other alkaloids, morphia is precipitated from its
solutions by tann'c acid, biniodide of potassium, and corrosive sub-
limate.

Tests.~l. Nitric Acid, 2. The Permuriate of Iron, 3. Iodic Acid
and Starch, 4. SulpJturic Acid, and Bichromate of Potash.

When these tests are applied to moi-phia, or to its salts, in substance,
a white surface of porcelain should be used, and the reagents applied in
quantities proportioned to the substance tested.

1. Nitric Acid. — When morphia is treated with nitric acid, it
becomes instantly orange-red, and is dissolved with efiervescence,
nitrous acid fumes being given off. On standing, or on the addition of
a larger quantity of acid, the colour of the solution changes to a bright
yellow; and on heating it, it becomes of a straw colour. Nitric acid
causes the same change of colour in moderately strong solutions of
morphia.

2. Permuriate of Iron. — This test added to the ciystals, or to a
solution of morphia, or to morphia suspended in water, strikes a rich
indigo-blue colour, turning to green when added in excess. The test
should be neutral. It should not be applied to a hot or acid solution.
If the test, or the solution, has an acid reaction, it should be neutralized
by caustic potash.

3. Iodic Acid and Starch. — Morphia, when added to iodic acid,
combines with its oxygen, and sets the iodine free, which may be
detected by its brown colour, and the deep blue which it strikes with
starch.

The iodic acid must not contain free iodine ; nor must it be applied
to an acid or hot solution. This is a very characteristic and delicate
test, but liable to be interfered with by slight causes, and requiring
time for the complete development of its effect.

4. Sulphuric Acid and Bichromate of Potash. — Strong sulphuric
acid added to morphia in substance either produces no effect, or gives it
a straw-tiut ; but on adding a solution of bichromate of potash, the
mixture assumes first a rich brown tint and then rapidly changes to a
green colour, due to the formation of the oxide of chrome.

When these four tests for morphia act characteristically on a white
powder or colourless crystal, or on a colourless solution of a white
powder or crystalline substance, there can be no doubt of the existence
of morphia.

Meconic Acid. — This acid assumes the form of scaly crystals, which
when impure are dusky red, when pure of a pale yellow colour, when
quite pure almost colourless. They are soluble in cold water, and
more soluble in hot water, the resulting solution having a strong acid
reaction. When heated in a glass tube the crystals are partly decom-
posed and paHly sublimed, and the sublimate condenses on the sides of
the tube in the form of filamentous ladiated crystals. Meconic acid is
precipitated from its solutions by acetate of lead, as a meconate of lead,

TESTS FOE MECONIC ACID. 443

which is insoluble in acetic acid. The only test of any value for meconic
acid, whether in crystals or in solution, is one which has been just
mentioned as a test for morphia, viz. :

Permuriate of Iron. — This reagent strikes with meconic acid an in-
tense cherry-red colour, which is discharged by a solution of the
protochloride of tin, but not by the dilute mineral acids, or by the
solutions of bichloride of mercury and chloride of gold.

The test gives a similar reaction with the sulpho-cyanide of potas-
sium, with the saliva which contains that salt, with common mustard
in solution, and with the alkaline acetates ; but this fact does not con-
stitute an objection to the test for meconic acid obtained from a
solution of opium, or from an organic fluid by the process now to be
described.

If the tests for morphia and meconic acid act characteristically, the
evidence of the existence of opium in the liquid from which they were
obtained is conclusive.

Opium in Organic Mixtures. — In consequence of the important
corroboration which the detection of meconic acid affords to that of
morphia the process for organic mixtures should be one which separates
both the alkaloid and the acid. A solution of opium itself may be
regarded as a suspension of its active principles in an organic mixture,
for opium, in addition to those principles, contains 5 large amount of
resin and extractive matters. The process for the detection of the
morphia and meconic acid in the contents of the stomach is as follows :
The solid mattei's, if any, must be cut into small fragments, and well
mixed with the more liquid contents, distilled water being added if
necessary. The mixture must then be slightly acidulated with acetic
acid, and after being allowed to stand for several hours must be
filtered, evaporated to the consistence of a syrup, and treated with a
solution of acetate of lead, so long as any precipitate falls. The liquid
must then be boiled and filtered. An impure meconate of lead remains
on the filter, while the fluid part contains the morphia. This impure
meconate of lead must now be suspended in distilled water, and sul-
phuretted hydrogen must be transmitted through it. A sulphuret of
lead is formed, and meconic acid remains in solution. This solution
may be concentrated by evaporation, and the acid may be obtained in a
state of greater purity by repeating the process. The fluid part which
contains the morphia is next to be treated with sulphuretted hydrogen
gas, by which any lead it may contain is thrown down as a sulphuret.
The liquid must again be filtered, and on being reduced by evaporation
to the consistence of a syrup, and treated with alcohol, the acetate of
morphia is dissolved, and may be obtained in the form of crystal. The
meconic acid and the morphia may be identified by their proper
tests.

Though other processes have been recommended, this process,
which has the advantage of separating both the meconic acid and the
morphia, is in skilful hands a satisfactory one. Christison states

444 OPIUM AND ITS PREPARATIONS.

(p. 641), that by a process similar to the one just described, he has
succeeded in obtaining distinct evidence of morphia and meconic acid
by all the tests, in an infusion of ten grains of opium in four ounces
of water. But on proceeding to apply the process to organic mixtures
he found that when the soluble part of ten grains of opium was mixed
with four ounces of porter or milk, he could detect no property of
morphia, except its bitterness, and but faint indications of meconic acid
by the permuriate of iron.

The fact now stated would lead us to expect few or no traces of
opium in the stomach in the majority of cases of poisoning by it and
its preparations. Very laige quantities of the drug in its fluid pie-
parations may be taken, and yet be detected neither by the odour, nor
by the taste, nor by the several tests, even where death takes place
most rapidly ; and it may be stated as a general rule that, in poisoning
with opium, the medical jurist, by the best methods of analysis yet
known, will often fail in procuring satisfactory evidence, and sometimes
fail to obtain any evidence at all, of the existence of the poison in the
contents of the stomach. Even the odour may be absent in the liquid
removed within half an hour after an ounce and a half of laudanum
has been taken on an empty stomach, and when present is so mixed
up with other odours, that it cannot be detected with any certainty.
(Bright's ' Reports of Medical Cases,' ii. 203).

Fiom what has now been stated it will be inferred that we have no
reason to expect the discovery of opium in the secretions or solids of
the body by any process of analysis, though there is no reason to doubt
that the poison is absorbed, circulated in the blood, and deposited in
the tissues. For information on this point, and for a description of
other modes of dealing with organic liquids see * Taylor on Poisons,'
2nd edit., p. 631.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — There is so much difference between the symptoms
present in different cases of poisoning by opium, and at different stages
of the action of the drug, that it is quite impossible to give the his-
tory of an average case of poisoning within the ordinary compass of a
description.

The symptoms due to a poisonous dose of opium, or its prepara-
tions, are giddiness, drowsiness,' and listlessness, followed by stupor,
passing by degrees into a state of complete insensibility. The patient
lies as if in profound sleep, breathing slowly and almost impercep-
tibly, with the eyes shut, the pupils contracted, the pulse either very
iVeq'uent, or full and slow, the skin warm and moist, and the face
flushed. At first the patient can be easily roused by loud noises,
sudden movements, or slight blows ; but, in a more advanced stage,
lie is kept awake with great difficulty, by violent shaking, loud speak-
ing, tickling the nostrils, injecting water into the ear, or flecking the

FIRST APPEARANCE OF THE SYMPTOMS. 445

hands and feet with a towel ; and at length falls into a state of com-
plete coma, with stertor, slow and noisy respiration, a slow and full
pulse, a pale countenance, and livid hands and lips. Nausea and
vomiting are sometimes present from the first, but in other cases they
are among the early signs of recovery. When the patient is kept
roused, by being briskly moved about, he is subject to constant retch-
ing, even though no emetic has been used. The bowels are generally
confined. In fatal cases death takes place sometimes as in apoplexy,
sometimes in a state of collapse, sometimes from apnoea, sometimes in
convulsions, sometimes in a palsied state. In patients who recover, a
long deep sleep with a remarkably slow breathing (I have counted it
in a female as low as 6 in the minute, while the pulse was upwards
of 80), is followed by a stage of painful nervous excitement, with head-
ache, and distressing nausea. The recovery is ultimately complete.

Occasional Symptoms. — Spontaneous Vomiting, Diarrhoea, Diuresis :
Delirium, convulsions (most common in children), sometimes alter-
nating with stupor, locked-jaw and tetanic spasms, paralysis, anae-
sthesia, dilated pupils, or one pupil dilated the other contracted
(Taylor), and the reflex function active, and easily excited, though the
patient is otherwise quite insensible. The pulse sometimes nearly
natural in frequency and force ; in other cases full and accelerated,
but this happens chiefly in the first stage. In the stage of insensi-
bility, while the patient can still be roused, the pulse is generally full
and slow, but towards the fatal termination it becomes small, frequent,
and iriegular. The respiiation is much more uniformly affected than
the pulse. Itching and dryness of the skin are also among the occasional
symptoms.

Anomalous Cases. — An absence of the usual narcotic symptoms,
with sudden death. A long postponement of the symptoms. Recovery
for a time, with fatal relapse.

Post-mortem Appearances. — These are neither constant nor well
marked. The most usual are turgescence of the vessels of the
brain, with or without serous effusion under the arachnoid, into the
ventricles, at the base, and around the spinal cord, very rarely accom-
panied by extravasation of blood. The stomach and intestines are
generally healthy, Lividity of the skin, congestion of the lungs, a
fluid state of the blood, and early putrefaction of the body are among
the less constant appearances.

First Appearance of the Symptoms. — The poison, when taken in
large quantity, and in a fluid state, may begin to act within a few
minutes, and coma may be fully formed within half an hour. Even
when taken in the solid form, complete stupor has been present in as
little as fifteen minutes. Sometimes, however, the action of the
poison, even though a large dose has been taken, is postponed for half
an hour, an hour, or an hour and a half; and cases are even on record
in which large quantities of the poison have not produced any serious
effect till the lapse of 3, 5, 9, 10, and even 18 hours. One of the

446 OPIUM AND ITS PREPAEATIONS.

most recent of this curious cla«s of cases was published in the ' Lancet,'
July 15, 1857, by Dr. Gibbs. Twelve drachms of laudanum were
spontaneously lejected from the stomach at the end of 9 houre,
without having given rise to any marked symptoms. The patient
was a little exhausted, and the pupils were contracted.

The action of the poison is more prompt when taken on an empty
than on a full stomach ; when in a liquid state than when swallowed in
the solid form ; when the patient remains still than when he takes exer-
cise immediately after swallowing the poison ; and it is probable that
the action is postponed and diminished by spirituous liquors.

The shortest period within which opium or its preparations have
proved fatal to adult persons is three quarters of an hour. Cases of
death in two hours are reported by Beck and Taylor ; few cases are
prolonged beyond twenty-four hours, and the average may be stated at
from seven to twelve hours. When a patient survives twelve hoars
there is good hope of his recovery.

The smallest quantity of opiunj which has proved fatal in the adult
is four and a half grains.* A quantity of the extract equivalent to
four gi-ains of solid opium has also destroyed life. Enormous quanti-
ties liave been taken with impunity. In one instance recovery took
place after no less than eight ounces of solid opium.

In very young children extremely small doses produce very marked
effects, and have proved fatal. Cases are on record in which an eighth
of a grain of opium, or its equivalent, has killed an infant two days
old, a sixth of a grain an infant of four, and another of five days, a
fifth of a grain an infant of three days old, a third of a grain an infant
of nine months, and another a few weeks old, a fourth of a grain a
child of fourteen months, less than half a grain a child of four years
and a half. Two drops of laudanum killed an infant. Severe symptoms
have been produced by a single grain of Dover's powder, containing a
tenth of a grain of opium. A child of four months, and several infants,
have suffered severely from quanities of laudanum equivalent to the
sixth of a grain of opium. t

Death has happened, in the instances referred to, in intervals of time
varying from 7 to 18 hours. As in the adult, so in infants and young
children, recovery has taken place after considerable doses of opium.
In a case under my own observation a child of six months recovered
from ten grains of Dover's powder.

There are some persons on whom comparatively small dosets of
opium and its preparations, in consequence of peculiarity of constitu-
tion, produce unusually severe effects. On the other hand, the power
of habit in lessening the effect of the poison must not be overlooked.

Opium, like tobacco, may be taken in constantly increasing doses

• This was mixed with nine grains of camphor. Case reported to Dr. Chrlsti-
son by Mr. W. Brown. ' On Poisons,' p. 657

t Vov details of these cases, with the particular preparations given, see the
works on Toxicology of Christison and Taylor.

TREATMENT. 447

with impunity. Thirty grains of sohd opium, and even one hundred
grains, are often taken in tlie day by opium eaters, and De Quincey, the
English opium eater, brouglit himself to take nine ounces of laudanum,
equivalent to 333 grains of solid opium in the day. There is scarcely
a druggist in London who has not seen laudanum swallowed by the
wine-glassfull ; and I am informed that the Lascar beggars purchase
half an ounce of opium a day, from which they procure a watery
extract which they smoke with tobacco.

Opium, when thus taken habitually in large quantities, and for long
periods, causes emaciation and loss of vigour, loss of appetite and con-
stipation, loss of mental vigour, severe neuralgic pains, premature old
age, and early death. Hobhouse describes the opium eaters of Con-
stantinople as ' pale, emaciated, and rickety, sunk into a profound
stupor, or agitaied by the grimaces of delirium.'

Mr. Madden and Dr. Oppenheim confirm this account. The former
adds, that a regular opium eater seldom lives beyond thirty years, if
he commence the practice early ; and the latter tells us that those who
begin the practice early seldom attain the age of 40.

In the face of these explicit statements, and of the extreme impro-
bability that a habit so unnatural should not affect the duration of life,
it has been denied that the practice of opium-eating tends to shorten
life. There is no doubt that many persons who indulge in it (but in
a less degree than in the cases referred to by Hobhouse, Madden, and
Oppenheim), live to a good age; but it is probably with opium as
with spirits and tobacco, those who indulge in them and live long
would attain a much greater age if their habits of life were other than
tjiey are. At any rate, the facts hitherto collected are not sufficient
to decide this question.*

Opium applied to the skin, and especially to an abraded surface, or
used in the form of injection, or introduced into the nostril or ear,
may produce dangerous or fatal results. M. Tournon, of Bourdeaux,
relates a case in which death was attributed to four grains of opium
introduced into the external meatus of the ear.

Treatment. — The treatment must begin with the use of the stomach-
pump, and warm water should be freely injected and withdrawn till
it is discharged without odour and colour. If the stomach-pump
cannot be immediately applied, an emetic of sulphate of zinc should
be given ; or, if this is not at hand, a table-spoonful of mustard, mixed
with water. At the same time, vomiting should be encouraged by the
free use of warm water, and by tickling the throat with a feather.
If the pitient is comatose, cold water should be freely dashed over the
face, head, and neck, till he is somewhat roused from the stupor,
and he must then be kept awake by causing him to walk rapidly
between two assistants, shaking him arid shouting to him. In small
apartments, where it is inconvenient to move the patient about, the
object of keeping the patient roused may be accomplished by flecking
* For cases, see Christison on the case of the Earl of Mar, p. 661.

448 MOIIPHIA AND ITS SALTS.

the hands and feet with a towel. When the patient is beginning to
recover, strong coiVee should be freely administeied. If emetics ad-
ministered by the mouth do not act, they may be injected into the
bowels, and, in hopeless cases, a solution of tartar-emetic might be
introduced into a vein. Galvanism and artificial respiration have been
used in extieme cases. When the symptoms present are those of
collapse, ammonia may be freely given internally and applied to the
nostrils ; when those of apncea, warmth and friction to the surface
are indicateil ; when those of cerebral congestion, the moderate ab-
straction of blood by bleeding or leeches. In the stage of excitement
which follows lecovery, as well as in the early stage of the poisoning,
cold affusion has been practised with excellent effect.

MORPHIA AND ITS SALTS.

Of this alkaloid, which is found in opium in proportions varying
from 2 to more than 10 per cent., there are three salts in use in medi-
cine— the acetate, hydrochlorate, and sulphate, of which the first two
supply officinal preparations, namely, the liquor morphia' acetatis and
the liquor morphias hydrochloratis, which contain one grain of the salt
in a drachm. The hydiochlorate of morphia is the preparation in
most common use, and its ordinary dose for the adult is an eighth of a
grain. The acetate of morphia is sold as a snow-white powder, or as
imperfectly formed crystals, and the hydrochlorate either as a white
powder, or in the form of silky acicular crystals. Both salt have the
chemical reactions of moi-phia itself.

Symptoms. — Those of opium and its preparations. The symptoms
set in somewhat earlier, and contraction of the pupils, with great dim-
ness of vision or actual blindness, is a very constant symptom. In-
tense itching of the skin is also very common, and dysuria, tetanic
spasmi, and strong convulsions are among the occasional symptoms.

Anomalous Cases. — In one case reported by Dr. Shearman (' Med.
Times and Gazette,' Maich 7, 1857), a grain and a half of the acetate
of morphia in divided doses caused twitching of the limbs and face,
with difficulty in swallowing, spasms of the muscles of the arms and
legs, and of the muscles of the abdomen, partial o{>isthotonos, and great
activity of the reflex function. Morphia was found in the urine. The
patient recovered. A similar case of poisoning by twenty-two giains
of the muriate of morphia, in which locked jaw, tension of the abdo-
men, and occasional convulsions, were present, is related byOrfila, and
cited by Christison (p. 725). In one case, also, delirium seems to have
followed its application to a blistered surface.

It is worthy of observation that Augustus Ballet, the ]>resumed
victim of Castaing, had, in addition to vomiting and purging, con-
vulsions, locked jaw, rigid spasms of the neck and abdomen, inability to
swallow, loss of sensibility in the legs, contracted pupils and stertorous
breathing : and that Castaing, who prescribed for Ballet, and gave him

FATAL DOSE. TREATMENT, 449

food and medicine, was pioved to have recently purchased twelve
grains of tartar emetic, and twenty-six grains of acetate of morphia.

John Parsons Cook, the victim of William Palmer, took two pills
containing half a grain of acetate of morphia on each of the two
nights preceding his first attack ; and on the night of the attack itself
two pills were given by Palmer, and again two pills on the occurrence
of the tetanic symptoms. On the succeeding night, which was the
night of his death, Cook also took two pills given him by Palmer, who
had previously obtained the acetate of morphia pills from the medical
attendant; and during the fatal attack two other pills, said to contain
ammonia, were given. If all these pills contained acetate of morphia
in the dose first prescribed, an aggregate of three grains would have
been given within three days, of which quantity tvw grains were
administered in little more than twenty-four hours. As the lady
attended by Dr. Shearman was severely attacked with symptoms of
tetanus from taking three doses of half a grain of acetate of morphia
within seven hours, it is quite possible that the same drug in the same
dose, and the aggregate of three grains in the space of seventy-two
hours, may have proved fatal to a patient previously reduced by tartar
emetic. Jt is not intended by these observations to raise any doubt of
the guilt of Palmer, but merely to suggest the possibility of the death
of Cook having been occasioned by acetate of morphia and not by
strychnia.

Fatal Dose. — In the case of this, as of most other active poisons,
very large doses have been taken with impunity, and very small ones,
in certain states of the system, have been followed by dangerous symp-
toms. One case has been reported in which half a grain of the acetate
of morphia given as a medicine to a female in ill health was supposed
to have proved fatal (* Lancet,' Nov. 1838), and it is probable that
less than a grain of morphia given in one dose would prove fatal to
an adult.

Treatment. — That proper to poisoning by opium and its prepara-
tions. Finely-divided animal charcoal suspended in water might be
administefed with advantage after the use of the stomach-pump.

2g

450

CHAPTER XIV.

HYDROCYANIC ACID.

Hydrocyanic, or prussic acid, with essential oil of bitter almonds,
of which it is the active principle, and cyanide of potassium, one of its
salts, form a gi-oup of poisons ranking next to opium and its prepara-
tions in the frequency with which they are taken as poisons.

In the two years 1837-8, twenty-seven cases of poisoning by prussic
acid were brought under the notice of the coroner's court, of which
eight (all cases of suicide) occurred in medical men and druggists.
Four cases of poisoning by essential oil of almonds also occurred in those
years, and one of poisoning by prussic acid mixed with arsenic. Prussic
acid, with its preparations and compounds, caused, on the average of
those years, sixteen deaths. But on the average of the five years
1852-56, they were credited with 34 out of the 268 deaths from ascer-
tained poisons. The use of this poison is, therefore, on the increase.

In the five years, 93 deaths were attributed to prussic acid, of which
83 in males and 10 in females ; 75 to the essential oil of almonds, of
which 45 in males and 30 in females; and 2 to cyanide of potassium,
of which one in a male the other in a female. The great majority were
adults. One murder only was committed by any of these substances ;
and that one was by the essential oil of almonds. The remainder of the
deaths were suicidal or accidental ; and 75 by prussic acid, 51 by
essential oil of almonds, and 1 by cyanide of potassium were ascertained
suicidal acts.

This poison is remai'kable for its quick and fatal effect, and this,
coupled with the frequent use of the essential oil of almonds in cookery,
and of the cyanide of potassium in the arts, renders it a favourite
instrument of suicide. It has been only occjuiionally used as an instru-
ment of murder. For medicinal purposes, the acid is formed by a
complex chemical process, or by the decomposition of salts which con-
tain it ; but it also exists in the leaves, Howers, and fruit-kernels of
many plants belonging to the natural order Kosaceaj. The bitter
almond, the cherry -laurel, the peach, the cluster cheny, and the
mountain ash ; the kernels of peaches, plums, and cherries, and the
pips of apples, contain it. The prussic acid obtained from these sources
is mixed with an essential oil, and distils along with it. The cherry-
laurel water was administered as a poison in the well-known case of Sir
Theodosius Boughton; and a bitter almond water improperly kept in
the shops of very variable strength, and incautiously prescribed, has also
proved fatal.

DILUTE HYDROCYANIC ACID. 451

The acid is met with under two forms ; as a pure anhydrous acid,
and diluted with water.

The pure anhydrous acid is limpid and colourless, has an acrid pun-
gent taste, and a peculiar odour. It boils at 80°, freezes at 5°, and
at ordinary temperatures readily freezes by its own evaporation. If
left exposed to the light, it soon decomposes and turns brown. It is
highly inflammable. The pure acid is not likely to come under notice
in medico-legal cases : it is the dilute acid, as kept in the shops, that is
commonly used as a poison.

Dilute Hydrocyanic Acid.

Properties. — The dilute acid has the same appearance, odour, and
taste as the stx'ong acid, but provided it be kept from the light, is not
so apt to decompose. Like the strong acid it is volatile, though in a
less degree, and loses its activity by exposure. But the acid obtained
by decomposing a solution of ferrocyanide of potassium by sulphuric
acid is much more stable, and has been kept for years, even exposed to
diffused light, without undergoing decomposition. The quantity of the
sti'ong acid contained in the dilute acid employed in medicine differs
with the mode of preparation, and the time that it has been kept. As
found in the shops, the strength has been found to vary from 1'3 to 6*5
per cent. (Taylor.) This variation of strength in the same medicinal
preparation is well illustrated by the case of a French physician re-
ferred to by Christison, who swallowed a whole ounce of one sample of
Scheele's acid, and a drachm of a stronger sample without injury ; but
on trving some recently prepared by Vauquelin, he had a narrow escape
of his life.

The prussic acid of the London Pharmacopoeia should contain about
2 per cent., that of Vauquelin, 3-3 per cent., and that of Scheele about
5 per cent. The strength of the dilute acid employed in other coun-
tries varies from 1 to 25, or even 50, per cent.

Among the properties of prussic acid just described, there is one
which is so characteristic and so delicate as to be justly regarded in the
light of a test, namely —

The odour. — This is peculiar, and generally perceptible even where
the acid is present in very small quantity. As a test, it has the
advantage of not being dependent on any chemical knowledge or skill
on the part of the observer, and when perceived by more than one
person, and especially when recognized by several persons at the same
time, it is conclusive of the presence of the acid. It has, indeed, been
alleged that the odour of prussic acid is not decisive ; because nitro-
benzole, one of the products of coal-tar, and some other artificial
products used as scents or flavours, have a like odour, and because the
brain itself has an odour similar in kind though faint in degree. Of
nitro-benzole it will suffice to observe that it is itself an active poison ;
of the objection founded on the faint similar odour of the brain, that it

452 HYDROCYANIC ACID.

has a very limited application in post-mortem inspections, and of both
that they are very unlikely ever to constitute real objections.

The odour of the acid, considered as a highly characteristic property
and test, finds its application both during life and after death — during
life, as indicating at once what poison has been taken, by the odour dif-
fused through the air, or perceptible in the breath; in the dead body, as
equally indicating the presence of the poison in the contents of the
stomach or in the tissues.

In patients under treatment, the odour of the acid may be disguised
by that of other remedies, as in a case which fell under my observation,
in which assafffitida had been administered in an injection.

The odour, as perceived in the dead body, is generally recognizable
soon after death, but it often disappears in less than twenty-four hours.
In the case of Sarah Hart, the victim of Tawell, the odour was recog-
nized by two only out of five witnesses, eighteen hours after death. In
a case i-eported by Mr. Newham, of Bury St. Edmunds, it was perceived
eleven hours after death in the stomach, heart, and brain ; and in an
interesting case of double suicide (that of C. W. Duckett and Elizabeth
Williams, reported by Dr. Letheby), it was perceived about the mouth
twelve hours, and according to Mr. G. Davies, seventeen or eighteen
hours after death.

The odour of prussic acid is therefore to be regarded as a highly
characteristic property, and even a valuable test of the presence of the
poison.

Tests. — There are four recognized tests for prussic acid, which may
be briefly designated as the copper, silver, iron, and sulphur tests.
These tests are equally applicable to the acid in solution and in vapour.

1. Copper Test. — A solution of sulphate of copper added to a liquid
containing hydrocyanic acid gives characteristic results. The liquid is
first rendered slightly alkaline by liquor potassaj; and on adding the
solution of sulphate of copper, a greenish-white precipitate is thrown
down, which, on the addition of a little hydrochloric acid, becomes
nearly white, the blue oxide of copper which is mixed with the white
cyanide being re-dissolved.

Though this test was recommended by Lassaigne as a very delicate
one, it is less characteristic than the three remaining tests.

2. Silver Test. — A solution of nitrate of silver gives with liquids
containing hydrocyanic acid a white clotted precipitate, distinguished
from the other white precipitates thrown down by nitrate of silver, by
its insolubility in nitric acid at common temperatures, and its solubility
at a boiling heat. If the precipitated cyanide of silver, after being well
washed and dried, is introduced into a small tube closed at one end, and
drawn out at the other into a fine point, and the precipitate is heated
by the flame of a spirit-lamp, cyanogen gas is given off, which, on
being lighted, burns with, a highly characteristic crimson flame, sur-
rounded by a blue halo.

3. Iron Test. — Add to the suspected liquid a slight excess of liquor

IRON AND SULPHUR TESTS. 453

potassse, then a few drops of a mixture of the proto-sulphate and per-
sulphate of iron iu solution. A brownish-green precipitate is thrown
down, which, on the addition of a little dilute hydrochloric acid, becomes
Prussian blue.

4. Sulphur Test. (Liebig's Test.) — To the liquid containing the acid
add a few drops of the sulphide of ammonium ; then heat the liquid
gently till it becomes a pure white or colourless ; then evaporate
slowly. A white amorphous sulpho-cyanide of ammonia remains, which
assumes an intense cherry-red colour when touched with a solution of
the perchloride of iron. This colour is^^discharged by a solution of
corrosive sublimate.

When these tests are applied to detect the acid by its vapour, the
following method of procedure is to be observed : —

Place the fluid or substance yielding the vapour iu a watch-glass;
moisten a large flat disc of glass with the test; invert it over the watch-
glass, with the moistened surface downwards, and allow it to remain
for ten minutes or more, or till a distinct reaction is perceptible through
the glass. Or, place the liquid or substance in a small wine-glass with
a conical stem, moisten with the test two flat glass discs — a smaller
and larger one — and insert them over the contents of the glass, so that
the vapour which passes the first disc may act upon the second.

In the case of the copper-test use a solution of sulphate of copper, of
the strength of 1 gr. to the ounce. Moisten the disc of glass with a
drop of this solution rendered slightly alkaline by dilute liquor potassa^ ;
and after exposure add a drop of dilute hydiochloric acid. Compare
the dried stain with the stain from a drop of the test-solution of sul-
phate of copper.

In the case of the silver-test, moisten the glass disc with a solution
of nitrate of silver (gr. 1 to f^i). The colourless solution soon becomes
opalescent, and when dry, leaves a white stain. Examine the stain
under the microscope. Some parts of it will be found to consist of dis-
tinct needles more or less thiclily interlaced. Compare the stain with
that left by a drop of the test solution. It is faintly white, and shows
under the microscope no distinct crystalline form.

In the case of the iron-test, moisten the glass disc with a drop of
liquor potassae, and after due exposure, add a drop 5f^ie fresh solution
of the mixed sulphates of iron. Develop the PrussiaiTijkie by a drop
of dilute hydrochloric acid. Compare with the Prussian blue the brown
oxide of iron thrown down by the addition of liquor potassse to the test
liquid.

In the case of the sulphur-test, moisten the glass disc with the sul-
phide of ammonium, allow the white stain of cyanide of ammonia to
dry, and test with a drop of the perchloride of iron solution. Compare
the cherry-red of the sulpho-cyanide with the yellow of the dry spot of
perchloride of iron. To increase the contrast use a solution of the per-
chloride diluted with distilled water so as to be nearly colourless. As
the liquid in the watch-glass will have absorbed a portion of the vapour

454 HYDROCYANIC ACID.

of the sulphide of ammonium, and changed to white, it should be eva-
porated to dryness, and tested with the perchloride of iron. This test,
as two vapours are in presence of each other, is always applicable both
to the stain and to the liquid under examination.

Of these four tests of prussic acid in vapour, I have found the nitrate
of silver the most satisfactory. A single apple-pip bruised and moist-
ened with distilled water, and placed in a watch-glass, yielded as many
as twenty-two distinct reactions. The solution of nitrate of silver was
rendered opalescent in every instance, and the dried stain was found to
contain microscopic crystals of the cyanide of silver. The results ob-
tained with the other tests in a comparative experiment, under exactly
similar circumstances, were less satisfactory. Three apple-pips were
bruised, moistened, and placed in three watch-glasses ; and the three
tests were used in the manner already described for ten successive
exposures of five minutes each. The nitrate of silver tests acted cha-
racteristically in the ten experiments; the Prussian blue test succeeded
in three ; and Liebig's test in one. But the liquid in the watch-glass
used for this test was found to have been whitened by the sulphide of
ammonium, and on being evaporated yielded a white stain, which gave
a distinct and characteristic reaction with the per-salt of iron.

Hydrocyanic Acid in Organic Mixtures.

The acid being highly volatile, the examination of organic liquids
supposed to contain it, should on no account be delayed ; and though
the acid has been detected in the body after seA'eral days, the same pre-
caution should be observed in reference to the post-mortem examination,
and the analyses which may arise out of it.

For the detection of hydrocyanic acid in compound mixtures, nitrate
of silver cannot be immediately employed, as it throws down a white
precipitate with hydrochloric acid, of which there is always some in
the contents of the stomach, as well as with salts containing that acid,
such as common salt. We must therefore resort to a process of dis-
tillation. But previous to doing so, we may advantageously apply
the four tests already described to the vapour given off by the
organic substance. The process of distillation is to be conducted as
follows : —

The filtered liquid, if alkaline, is to be neutralized by sulphuric acid,
which will fix any ammonia disengaged in the process of putrefaction.
The mixture is then to be distilled from a water bath, at a tempera-
ture of about 150°, till about an eighth part has passed over into the
receiver. This distilled fluid is then to be tested by the reagents just
described.

It has been objected to this, and every other process in which
heat is employed, that hydrocyanic acid may be formed during the
distillation by the decomposition of animal matter. This is a mere
conjecture, altogether unsupported by experiment. It has also been

EXPERIMENTS ON ANIMALS. 455

objected that hydrocyanic acid may be formed by the processes of
putrefaction and decay in various animal and vegetable matters, such
as cheese and the ergot of rye.

These objections are futile in all those cases in which persons are
found dying or dead with the odour of prussic acid strong upon them ;
and in many cases they are effectually removed by analyzing the fluid
contents of other parts of the body, such as the serum contained in
the brain. In a case which the author saw during his pupilage,
hydrocyanic acid could be readily detected by the odour in all parts of
the body, and was found in the brain by a delicate process of analysis
performed by Mr. Everett.

Quantitative Analysis. — Use for this purpose the precipitated cyanide
of silver, every 100 grains of which correspond to 20*33 grains of the
pure anhydrous acid, of which the prussic acid of the London Phar-
macopoeia contains two per cent.

EXPERIMENTS ON ANIMALS.

Hydrocyanic acid is, in all its forms, a most active and energetic
poison. Animals made to breathe air saturated with the vapour of
the anhydrous acid, die instantaneously (Pereira), or in from one to
ten seconds (M. Robert). In the fluid form the anhydrous acid is
scarcely less rapid in its action. A single drop put into the throat of
a dog killed the animal after two or three deep hurried respirations ;
it caused death almost as quickly when dropped under the eyelid ;
and when injected into the jugular vein, the animal fell dead at the
very instant, as if struck with a cannon ball, or with lightning.
(Majendie.)

A single drop in the mouth of a rabbit began to act in sixty-three
seconds, and killed it in eighty-three seconds ; three drops began to act on
one cat in ten seconds, and on another in five seconds, killing the first
in thirty seconds, and the second in forty seconds ; four drops began
to act on a rabbit in twenty seconds, and killed it in thirty seconds ;
and twenty-five grains, corresponding with an ounce and a half of
medicinal acid, began to act on a rabbit as soon as it was poured into
its mouth, and killed it outright in ten seconds at furthest. Three
drops projected into the eye, acted on a cat in twenty seconds, and
killed it in twenty more, and the same quantity dropped on a fresh
wound in the loins, acted in forty -five seconds, and proved fatal in a
hundred and five seconds. In the slower cases, there were fits of
violent tetanus ; but in the very vapid cases the animals perished just
as the fit began to show itself with retraction of the head. In rabbits
the spine was bent back, in cats it was curved forwards. (Christison.)

The concentrated acid, then, according to its quantity, and mode of
administration, may begin to act on the animals usually submitted to
experiment instantaneously, or in from five to sixty-three seconds, and
may prove fatal in from ten to one hundred and five seconds ; when

•456 HYDROCYANIC ACID.

dropped into the mouth it may begin to act in from five to ten
seconds, and prove fatal in from thirty to forty seconds.

The effects of the dilute acid on animals have been reported by
several observers ; among others by Mr. Nunneley of Leeds, to whom
we are indebted for a very large an I carefully conducted series of
experiments, mostly on dogs. It results from these experiments that
a large dose of the dilute acid causes death as promptly as the con-
centrated acid ; and that moderate dilution not only does not impair,
but even somewhat enhances its effects. (Nunneley.) Large doses of
the dilute acid destroy life in from two to fifteen minutes ; but life
may be prolonged, after a fatal dose, for hours or even days. A dog
poisoned by the dilute acid died after nineteen days of suffering.
(Coullon.)

When the dose is short of a fatal one, the animal is seized in one
or two minutes with giddiness, weakness, salivation, and protrusion of
the tongue, hurried and panting respiration, lividity of the face, and
protrusion of the eyes ; with convulsions or tetanic spasms, passing
into paralysis, and insensibility ; after lying in this state some time,
the sensibility and power of motion are gradually restored, with slight
convulsions and gasping respiration, and sometimes with powerful
convulsions and loud bowlings. The animal then falls asleep, and
wakes up recovered but feeble. This sleep is sometimes so profound
as to resemble the effects of opium. The breath of the animal is said
to smell of the poison.

Several questions of obvious medico-legal importance relating to
the symptoms of poisoning by prussic acid have been illustrated by
experiments on animals. These will now be briefly indicated.

Convulsions. — Some importance naturally attaches to the question
whether convulsions are to be classed among the common symptoms
of poisoning by prussic acid. This question has been answered in the
affirmative. Convulsions are generally present. But there is no
doubt that exceptions to the rule are not infrequent. They are re-
corded by almost all who have experimented largely on animals, and
large numbers of instances might easily be cited.

The shriek or cry, — This too is a common, but not constant, symp-
tom. It is described by Mr. Nunneley as " a peculiar cry, indicative
of severe distress, different from anything heard in any other state,"
and as he believes " characteristic of the poison." This cry of distress
has been frequently reported as absent, and in Mr. Nunneley 's nume-
rous experiments on dogs was present in one half the cases.

Expulsion of Fceces and Urine. — In Mr. Nunneley 's experiments,
the faeces alone were passed in about a tenth of the cases ; in another
tenth both faeces and urine ; in a far larger number of instances the
urine alone ; and in about two fifths of the whole number neither faeces
nor urine.

Acts of Volition. — The dogs experimented on by Mr. Nunneley
sometimes performed acts of volition before the poisonous effects showed

SYMPTOMS. 457

themselves. One dog, after taking the poison, " went down three or
four steps of some stairs, saw the door at the bottom was closed, and
came back again ;" and another " went down, came up, and then went
down again the whole flight of a steep winding staircase ;" and a third
*' retained sufficient vigour to jump over one of the dogs, and then
actually leaped completely across the open top of the staircase."

The Post-mortem Appearances in the animals submitted to experi-
ment were not well marked. The brain is generally natural in ap-
pearance, though its vessels have been found turgid, and in one in-
stance, in the horse, there was extravasation of blood between its
external membranes. The heart and great A^essels differ in their
condition and in their contents according as the death occurs quickly
or slowly. In cases of sudden death, the left side of the heart is, in
almost every case, perfectly empty and rigidly contracted, while the
right side contains blood sometimes in large quantity. In chronic
cases, both sides of the heart are distended with black blood. (Nun-
ueley.) Sometimes the blood is found florid, and though usually fluid,
it is sometimes found coagulated. According to Magendie the pure
acid so completely destroys the irritability of the heart and voluntary
muscles, that they are insensible even to the stimulus of galvanism.
It appears, however, that this result was not met vvith by other ob-
servers, and in Christison's experiments was not constant, occurring
in some instances, but not in others. *' 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 grains, 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." The
lungs are sometimes empty, but more generally gorged with blood.
The membrane to which the acid is applied is usually found congested.
The corpse is generally very rigid.

SYMPTOMS, MORBID APPEARANCES, AND TREATMENT.

Symptoms. — The symptoms of poisoning by prussic acid in the
human subject vary, as experiments on animals would lead us to expect,
with the dose, and with the age, strength, and state of the patient.
When a large dose is taken, the symptoms begin in a few seconds or
minutes after the swallowing of the poison. There is probably, in all
cases, a short interval of consciousness, and then a sudden access of gid-
diness, rapidly followed by insensibility, deep catching respiration, and
death in a short space of time. When the case is prolonged beyond a
few seconds, or minutes, other symptoms are superadded.

If the fatal cases and those of greater severity are thrown into one
group, the symptoms may be thus briefly described : — There is insen-

458 HYDROCYANIC ACID.

sibility, deep catching respiration, loud mucous rattle, cold and blue
skin, dilated pupil, very rapid pulse and breathing, rigid contraction
of the jaw, tetanic spasms or strong convulsions of the extremities,
and, in some cases, discharges of urine and fazces. In protracted fatal
cases, and in rare cases of recovery, the leading symptoms are dyspnoea,
loud mucous rattle, slight convulsions, and salivation. In acute cases,
the cause of death is shock, in chronic cases, suffocation. In rare
instances narcotic symptoms are present as in poisoning by opium.

The short interval of consciousness which, as has just been stated,
probably occurs in all cases of poisoning by prussic acid, is sometimes
tilled in by voluntary acts. A few persons, after swallowing large
doses, have merely staggered a few steps, and sunk down without a
groan, apparently lifeless, and died after a few convulsive expirations,
in less than four minutes after swallowing the poison ; others have
uttered expressions of fear, and then fallen as if struck by lightning.
In many cases the patients were heard to fall without having uttered
any sound previously.

In smaller doses, the action of the poison occasions nausea, saliva-
tion, followed sometimes by ulceration of the mouth, a rapid pulse,
and weight and pain in the head, succeeded by a feeling of anxiety
which does not pass off for several hours.

Post-mortem Appearances. — The countenance is pale and composed,
the eyes glistening, the venous system gorged with blood of a gUm-
mering blue tint, the vessels of the brain charged with blood, with
some effusion of serum into the ventricles. Traces of inflammation, or
congestion, of the mucous membrane of the stomach, congestion of the
lungs, and a deep blue colour of the bile, have been mentioned among
the occasional post-mortem appearances. Putrefaction makes rapid
progress as in most other forms of sudden death.

The stomach and every part of the body exhale the odour of prussic
acid. But this is not a constant phenomenon. It may be expected to
be absent in cases of poisoning, where the patient survives long enough
• to exhale it freely from the lungs, or where the body has been for some
time exposed to the air under circumstances favourable to evaporation.
It has been recognized in the stomach, and not in other parts of the
body, and, on the other hand, it has been perceived in other parts of
the body wheu there was no trace of it in the stomach. The odour
is most conclusive when perceived in the blood or limbs ; for it has
been asserted occasionally to exist in the stomach and intestines, and
in the brain, where no substance containing prussic acid has been
taken.

Treatment : — Antidotes. Chlorine and the mixed oxides of iron are
antidotes to prussic acid. The one acts by withdrawing the hydrogen
of the poison, the other by forming with it the insoluble Prussian blue.
But there are few cases in the human subject in which an antidote can
be applied, and none in which the preparation of an antidote would not
prove a loss of valuable time. In the great majority of cases the

VOLUNTARY ACTS. 459

medical man is called to a suicide ali'eady dead, or m articulo mortis ;
and when the patient is still alive, the jaw is so firmly closed as to
render the introduction of an antidote very difficult, if not impossible.
The treatment must therefore be independent of the use of antidotes.

The first step to be taken is to administer the cold affusion as a
shock. Water must be dashed into the face, or freely poured on the
head and back. As soon as the patient is roused, though still insensible,
and perhaps in convulsions, the face and trunk must be wiped dry, the
clothes must be removed, and the patient be placed in bed. A sponge
or rag sprinkled with ammonia, or with disinfecting fluid, may now be
held to the nostrils, and the surface of the body must be kept warm by
hot cloths or flannels, and by frictions with the hand or flesh-brush.
As soon as the jaws can be opened, and the patient be made to swallow,
an emetic of sulphate of zinc, of mustard, or of common salt should be
given ; or the stomach-pump may be employed.

Smallest fatal dose. — This may be stated for the adult at somewhat
less than a grain of the pure acid or about 45 minims of the acid of
the Pharmacopoeia. Very severe symptoms have been occasioned by
about half a drachm of this acid, but recovery has taken place from
doses of seventy or eighty drops.

Commencement of the Symptoms. — The pei'iod at which the symptoms
first show themselves is a point of considerable importance, and closely
connected with the question' — What amount of voluntary motion is
possible after swallowing a large dose of the poison ?

There are no cases on record of that instantaneous action in the
human subject which has been noted in experiments on animals. But
when a large dose of the acid is taken the symptoms set in very soon,
and death is very sudden. In a case reported by Hufeland a quantity
of the poison equivalent to forty grains of the pure acid was taken.
The man was seen to swallow the poison, was observed to stagger a
few steps, and then to sink down without a groan apparently lifeless.
It may be fairly assumed, then, that when the dose is very large, the
symptoms manifest themselves almost instantaneously. But in the
case of smaller fatal doses, or of doses productive of severe effects, a
short interval elapses between the taking of the poison and the loss of
sense and power.

The voluntary acts which can be performed in this interval will be
presently ascertained by an appeal to recorded cases.

Fatal Period. — After a large dose of the poison, death appears to
take place in from two to five minutes. But the poison may not prove
fatal till the lapse of twenty minutes, half an hour, three quarters of
an hour, or an hour. A patient of mine, to whose case allusion will
presently be made, was in a very dangerous state for six hours ; and
then began to recover.

Voluntary Acts. — The question whether, after taking a large dose
of prussic acid, the patient retains his consciousness for a time, and
whether, during that interval, he is in a condition to perform certain

460 HYDROCYANIC ACID.

Voluntary acts ? may become important in a medico-legal point of
view. In favour ot the retention of consciousness I have the distinct
statement of the patient whose case will be presently cited. That
many voluntary acts may be performed in this conscious interval is
proved by several recorded cases. The medico- legal import of the
question will be understood from the following case.

An apothecary's maid-servant at Leicester, who was pregnant by
Freeman, her master's apprentice, was found dead in bed, poisoned with
prussic acid. The apprentice was suspected of having been accessory
to her death ; but, as it was proved that the deceased had made pre-
parations for effecting a miscarriage, it was probable that she had taken
the poison of her own accord. The question, whether the poisoning
was suicidal or homicidal, could be answered only by a reference to
the condition in which the body was found. It appealed, from the
evidence, that the body lay at full length on the bed, with the head
turned a little on one side, the arms crossed over the trunk, and the
bed-clothes pulled smoothly up to the chin ; under the clothes, on her
right side, lay a corked phial, wrapped in paper, and containing three
drachms and a half of the poison. The leather and string which, had
fastened the cork were found in the chamber- vessel* It was probable,
therefore, that four and a half drachms of the poison had been swal-
lowed ; and the question arose, Could the girl,' after swallowing this
quantity of the poison, have corked the bottle, wrapped it up, and
adjusted the bed-clothes?

This question can be answered only by an appeal to fatal suicidal
cases in which acts of volition have been performed ; or by comparing
the time which such acts require for their performance, with ascertained
intervals of consciousness in the human subject. The experiments on
animals performed by some of the medical witnesses examined in this
case, though useful as illustrations, are quite inconclusive.

The following facts are recorded in illustration of the question
raised in this case: — An apothecary's assistant in Germany took four
ounces of the hydrocyanic acid of the Bavarian Pharmacopoeia, and was
found dead in bed, with an empty two-ounce phial on each side of the
bed, and the bed-covering pulled up as high as the breast, the right
arm extended beneath it, and the left arm bent at the elbow. In a
suicidal case reported by Mr. Newham of Bury St. Edmunds, the bed-
clothes were smoothly drawn up to the shoulders ; and on a chair close
to the back of the bed there was a phial with the cork in it. A third
case of the same kind was communicated to Dr. A. Taylor by one of
his pupils. A man found dead on the seat of a water-closet, had the
bottle from which the poison was taken corked in his pocket. In a
curious case of double suicide reported by Dr. Letheby, the bodies
were found in positions which implied a succession of slight voluntary
movements.

These facts are sufficient to prove the possibility of some slight

* See this case very fully reported, • Medical Gazette,' vol. viii. p. 759.

VOLUNTARY ACTS. 461

voluntary efforts being made after swallowing a large dose of prussic
acid ; and they must be held to justify, as far as this particular ques-
tion is concerned, the verdict of acquittal pronounced in favour of
Freeman.

But the voluntary acts which may be performed after fatal or highly
dangerous doses of this poison go much beyond those inferred from the
position of the bodies in these instances. The voluntary acts may be
more numerous and more considerable. In the suicidal case presently
to be more minutely described a large dose of the poison was taken in
bed ; but the lad was able to get out of bed, to walk round the foot of
the bed to a chest of drawers at a distance of two or three yards, to
place the stopper firmly in the phial, and to return to the side of the
bed whence he fell senseless.

In another class of cases the suicide, in addition to other movements
implying volition, has been able to cry for help and even to converse.

An apothecary's apprentice who had been sent from the shop to the
cellar had only been a few minutes away when his companions heard
him cry, in a voice of great alarm, " Hartshorn! hartshorn!" On
instantly rushing down stairs, they found him lying on the lower step,
grasping the lail ; and he had scarcely time to mutter, " Prussic acid !"
when he expired not more than five minutes after leaving the shop.
He had taken a drachm of the Bavarian acid, had tried to get at the
ammonia, but had not strength to uncover the bottle.

In two cases reported by Mr. Nunneley of Leeds, the patients not
only moved about, but spoke and answered questions, after taking, the
one a fatal, the other a large dose of the poison. The subject of the
first case answered a question addressed to him some minutes after he
had swallowed the poison, and the man who recovered retained the use
of his speech till the jaws gradually closed. One of the most remark-
able cases illustrating the power of locomotion and of speech after a
fatal dose of the poison is recorded by Dr. S. C. Sewell of Montreal.

A hypochondriac gentleman took seven drachms of prussic acid
of the estimated strength of 3 per cent. Previous to swallowing
the poison he locked himself in his room, but after about a minute
unlocked the door, and cnVd out, " Come to me quick, I am dying,"
A servant immediately entered the room, and found him lying on
his back on the sofa, with his legs crossed, insensible, and snoring.
Dr. Sewell arrived in twenty minutes. He was then dead, and pre-
sented the appearance of profound slumber; the legs crossed, his arms
by his sides, and his eyelids firmly closed.*

The effects of prussic acid when taken in a large, but not fatal, dose
will be seen by the two cases which follow. The first case will be
found described in the 'Revue Me'dicale ' for February 1845, the
second came under my own observation in the previous year,

* For more full details of some of the cases just cited, and for other cases of
poisoning by hydrocyanic acid, refer to Ranking's half-yearly abstract of the
Medical Science, vol. ii., p. 399.

462 HYDROCYANIC ACID.

Dr. B , a physician at Rennes, having taken a teaspoonful of

prussic acid, prepared by himself, in the morning, without inconve-
nience, took another teaspoonful, prepared after Scheele's method, after
dinner. These two doses produced no marked effect. He then took
a third teaspoonful of a preparation purchased of M. Vauquelin, and
after an interval of a few seconds, another teaspoonful. This new
preparation tasted a little stronger than the former doses, but Dr.

B remarked that " it had not hurt him." But on walking out

of the shop in which he had made this last experiment, he felt an
alarming kind of disturbance in his head, and on returning he uttered
a few expressions of fear, and fell down as if he had been struck by
lightning. The teeth were, at this time, firmly closed, there was con-
tinually-increasing dyspnoea, with noisy and rattling respiration, cold-
ness of the extremities, distortion of the mouth, redness and swelling
of the face and neck, fixed and dilated pupil, and a pulse impercep-
tible in the left, and very small in the right arm. The trismus con-
tinued to inci'ease in intensity, a short and violent convulsion followed,
and the abdomen, especially about the epigastrium, became rapidly
distended. Attempts were now made to rouse the patient by stimu-
lant frictions with ammonia and cantharides, and by stimulant appli-
cations. Vomiting was also excited by tickling the throat with a
feather, and some dark-coloured mucus was thrown off. After re-
maining in this state for two hours and a half, he began to show signs
of returning reason, and recognized those around him. The intellec-
tual faculties were gradually restored, but considerable difficulty of
breathing and very distinct rattle remained, with occasional expectora-
tion of yellowish black mucus. During the whole of this time the

breath smelt strongly of prussic acid. Dr. B was thirteen days

before he could go out to see his patients, during which time the
dyspnoea was frequently distressing, particularly when he turned in
bed, and when he awoke in the morning. At last he quite recovered.
During the first four days very little urine was passed.

In the mouth of November 1844, I was called up at night to see
a young gentleman who had swallowed prussic acid. The particulars
of the case, as detailed by himself and his relatives, are as follows : —

He is the son of a medical man, is about nineteen years of age, and
studying the law. His disposition is naturally cheerful ; he has met
with no disappointment, and never, until the present attempt, had
contemplated suicide. His habits are temperate and industrious. On
the afternoon of the day on which he swallowed the poison he dined
in the Hall of one of the Inns of Court, and drank, according to his
own account, half a bottle of wine— a quantity much exceeding that
which he was in the habit of taking. On reaching home he was ob-
served to be somewhat affected by liquor, and before going to bed
went, under some pretence, into the surgery, from which he took a
stoppered bottle containing, according to the estimate of his father and
the apprentice, from one to two drachms of prussic acid of the Phar-

CASE OF RECOVERY. 463

macoposial strength, but according to his own statement, about a
mouthlul. Soon after he had gone to bed the family was startled by
a noise in his room as of a heavy body falling, and a relative, who was
passing at the time, was alarmed by a loud gurgling noise. His
father was almost immediately on the spot, and seeing the bottle on
the drawers, dashed several buckets of water over the face and chest of
his son. This roused him. He was then taken into an adjoining
room, and put to bed, the treatment consisting in holding ammonia to
the nostrils, and applying heat to the spine and feet. An injection
was also given, containing tincture of assafoetida.

When I reached the house I found him in the following state, in
which he had continued without alteration for three hours : — He lay
on his back, drawing in his breath with great effort, each inspiration
being accompanied by a loud gasping sound, and a distinct mucous
rale. The pulse was upwards of 140 in a minute, and the respiration
36. The surface of the body was very cold ; the countenance was of a
dull leaden hue ; the lips blue ; the pupil extremely dilated, and the
jaws rigid, in which state they had remained for the whole period, so
that it had been impossible to administer any antidote.

The treatment fiom this time forward consisted in holding ammonia
under the nostrils, assiduous frictions with the flesh-brush, and the
application of heat to the surface by means, of flannels warmed at the
fire, and constantly renewed. At the expiration of about five hours
there was some effort to vomit, encouraged by tickling the throat, and
some bloody mucus was wiped from the mouth. Soon afterwards
he could be made to swallow, when some warm brandy and water and
some strong coffee were given him. At this time, too, he could be
made to answer in monosyllables, and could raise himself on his
elbows. He was also perfectly sensible, but looked bewildered. At
the end of about six hours he was sufficiently recovered to answer
questions, move himself about, and call for lemonade, which he drank
freely. The mucous rale had disappeared, the respiration and pulse
were still frequent, the pupil was restored to nearly its usual size, and
the skin was warm. Being disposed to be quiet, and seeming out of
danger, he was left to himself. After a time he complained of fulness
at the pit of the stomach, and asked for an emetic, which was given
him, with the effect of bringing off" his stomach a large quantity of
undigested food.

I saw him about fourteen hours after taking the poison, and found
him quite well, though weak. He gave the following distinct account
of the attempt of the night before: — He was suddenly tempted, as
he said, by the devil, to take prussic acid, under a confused idea that it
would not hurt him. He swallowed, according to his own account, a
mouthful of the acid from the bottle in bed. He then got out of bed,
walked round the foot of it to a chest of drawers standing within a few
yards of his bed-side, placed the stopper so firmly in the bottle that it
could not be removed, and then walked back to bed, intending to get

464 HYDEOCYANIC ACID.

in again. He reached the side of his bed, sat down upon it, and then
lost all consciousness. During all this time he said that he had no
giddiness, and no unpleasant sensation of any kind, no more than if he
had talcen so much water. He also assured me, and his manner made
me quite confident that he spoke the truth, that the idea of suicide had
never before entered his head. The father of the lad has since informed
me that the faeces, and, as he believes, the urine too, were expelled as
the first effect of the poison.

On examining the bottle which had contained the prussic acid, it
was found quite empty, so that it was not possible to ascertain the
strength of the preparation which the lad had taken. From the
statement of the father and apprentice that the bottle contained one or
two drachms, and that of the lad himself, who affirmed that he had
swallowed a mouthful, it is highly probable that the dose taken was
such as to prove fatal had it not been for the prompt application of
the cold affusion, the continued use of ammonia, and the assiduous
application of warmth to the surface. At the time that I first saw the
patient the remedies most strongly indicated, in addition to those
already employed, were warmth and friction to the surface, of which
the first had been already applied, but to an insufficient extent. The
extreme coldness of the suriace rendered such treatment imperative,
and the blueness of the skin of the hands and face, the labouring re-
spiration, and the abundant collection of mucus in the air-passages,
furnished an additional reason for its assiduous application. Friction
and warmth to the surface are as strongly indicated, after the patient
has been in some degree roused from the' first effect of the poison, as
the cold affusion at the onset.

This case is especially interesting as showing the interval of perfect
consciousness and complete command of the voluntary muscles which
may intervene between the swallowing of a large dose of prussic acid
and the development of the characteristic effects of the poison ; and it
is a very striking example of a large class of cases of suicide in which
the impulse to the commission of the act precedes the act itself by a
very short interval, and springs up during a temporary excitement of
the'mind. I have every reason to believe that the account which the
lad gave me of the act itself, and of the sudden impulse which led to
it was perfectly correct. His narration had all the appearance of open-
ness and truth.

Three medico-legal questions which have been raised in cases of
poisoning by prussic acid have still to be considered. To two of these
questions some importance was attached in the case of Sarah Hart, the
victim of Tawell. 1. Is there, in cases of poisoning by prussic acid, any
death-cry or scream which would serve to announce the ojieration of
the poison ? 2. Are convulsions of common or of universal occur-
rence ?3js prussic acid a cumulative poison? 1. In answer to the
first question it may be stated that a patient who is conscious of having
swallowed the poison may call out for assistance ; but the plaintive cry

CYANIDE OF POTASSIUM. 465

ov louder scieam, sometimes heard in animals has not yet been recorded
in any case of poisoning in man. 2. It is probable that convulsions
are not of more frequent occurrence in poisoning by prussic acid than
in other cases of sudden death. The expulsion of the urine and fasces,
which has been observed in certain cases, was probably accompanied in
those cases by shoit convulsions, and in some instances (as in a case
reported by Mr. Hicks) there have been muscular efforts expressive of
intense anxiety and urgent want of breath ; but the delibe)-ation which
has characterized the few movements of the patient, and the calm and
easy attitude of the dead body in almost every instance show that con-
vulsions aie either absent altogether or short and transient. 3. The
question of the cumulative property of prussic acid is sometimes
raised when a patient dies while taking a series of medicinal doses ol
the acid at such short intervals of time as a few hours. It is
deemed piobable that the previous doses have not been eliminated from
the system, or spent their effect upon it, and that the addition of the
last dose determines the Altai result. In the case of so volatile a
poison, and one so readily eliminated by the lungs as well as by other
organs of the body, it seems highly improbable that a medicinal dose,
which is geneially but a small fraction of the smallest fatal dose, or
even a series of medicinal doses, would leave such a residual effect as
to prove fatal to life on the addition of another medicinal dose. But
doses that exceed the proper medicinal limit may happen to prove fatal,
though similar previous doses have appeared to be hai mless, in conse-
quence of a change in the state of the body itself ; for there is no doubt
that the line which divides a harmless from a fatal dose is not verv
wide. Fortunately this question, so difficult of solution, is not one of
great practical importance.

POISONING BY THE CYANIDES.

The cyanides of potassium and of mercury have proved poisonous,
the latter with symptoms allied to those of poisoning by corrosive sub-
limate (see p. 419). the former with symptoms of poisoning by the
acid itself.

Cyanide of Potassium. — This substance is now largely used in tf.e
arts, both in the process of electrotyping and in that of photography.
It is employed to remove the stains of nitrate of silver from the hands,
and to clean tarnished metal and gold and silver lace.

Properties. — This salt is sold as a white crystal or crystalline mass,
which readily absorbs moisture, gives out a strong odour of prussic
acid, and has a characteristic cold, bitter, pungent taste. It is very
soluble in water ; and its solution has a strong alkaline reaction.

Tests: — a. On the addition of an acid, the vapour of prussic acid is
given off, which may be -identified by its odour, and by the tests
described at p. 453. 6. It yields with a solution of nitrate of silver
the white cyanide of silver, c. A solution of chloride of platinum throws

2h

4:66 HYDROCYANIC ACID.

down the base. d. The liquid tests produce with tlie solution the
reactions described at p. 452 ; but as the solution already contains
potash, ihe addition of liquor potassae is not required.

In organic liquids the poison may be detected by neutralizing the
base with sulphuric acid, and immediately distilling over the prussic acid.

Si/mptoms. — This substance acts neaily with the rapidity and
violence of prussic acid itself, and produces symptoms differing so little
from those proper to the acid as to require no separate description.

Fatal Dose. — Less than five grains. From the composition of the
cyanide, which contains nearly forty per cent, of the anhydrous acid,
it is probable that about 2^ grains of this salt would destroy life.

Post-mortem Appearances. — Those proper to poisoning by prussic acid.

Treatment. — That of poisoning by prussic acid itself. As the
cyanide of potassium is a strong local irritant, it should be applied to
the hands to remove stains with caution, and used with similar care
for manufacturing purposes.

3. VEGETABLE SUBSTANCES AND PRODUCTS CONTAINING, OR
. YIELDING, HYDROCYANIC ACID.

The leaves, seeds, or roots of several plants either contain prussic
acid, or they yield it when bruised and moistened. The bitter almond,
the kernels of the chei ry, plum, and peach, and the pips of the appie,
are examples of poisonous seeds; the leaves of the cheriy- laurel yield
the poison on distillation, and the plant which yields tapioca (the
latropha manihot, or cassava) contains prussic acid in the juice of the
root. The bitter almond, and the oil and water obtained from it, and
the distilled water from the cherry laurel, are particularly deserving of
notice.

The bitter almond is distinguished, as its name implies, by its bitter
taste. It forms with water a white emulsion, in which the essential
oil blended with prussic acid is rapidly developed by the nuitual action
of two of its constituents, emulsine and amygdaline. The A^apour from
the emulsion acts characteristically with the tests for prussic acid. As
the same change takes place in the stomach, bitter almonds cannot be
eaten in large numbers without inducing symptoms of poisoning. The
same result follows from eating the hitter almond cake, which remains
after the expression of the fixed oil. But the essential oil, its alcoholic
solution (almond flavouring), and bitter almond water, are active
poisons, and have proved fatal. , Of these three preparations the essential
oil is by far the most important, as it is a very active, and has now
become a very favourite, poison.

Essence or Oil of Bitter Almonds. — This is the product of the distil-
lation of the pulp or emulsion of the bitter almond. It contains, in addi-
tion to hydrocyanic acid, hydride of benzole, benzoin, and benzoic acid.
The hydrocyanic acid, to which it chiefly owes its poisonous properties,
may be separated from it, and the essence thus purified, and rendered

OIL OF BITTER ALMONDS. 467

comparatively liarailess, is sold for culinary purposes. The essence, or
oil, pveAnous to this separation, contains from 8^ to l4j per cent, of
the anhydrous acid. It has, therefore, fiom four to seven times the
strength of the acid of the Pharmacopoiia. A liquid variously known
as almond flavour, spirit of almonds, or essence of peach kernels,
consists of the oil dissolved in seven or eight times its quantity of spirit.

Properties. — Ordinary specimens of the oil have the colour of amber,
a peculiar, pungent odour, due in part to the prussic acid which it
contains, and a bitter, aromatic taste. It is heavier than water, which
dissolves only a small fraction of it; but it is soluble in alcohol and
aether. It produces a greasy stain on paper, and it has a slight acid
reaction. Strong sulphuric acid reddens it.

Tests. — Those of hydrocyanic acid. Pour a drop of the oil into
a series of watch glasses, add a few drops of distilled water, and invert
over them discs of glass moistened with the several tests (p. 453), The
vapour acts more promptly when the glasses are warmed. Or, place a
few drops of the oil in a test-tube, add a drachm of distilled water,
mix them well by shaking ; pour the mixture on a wet filter, and test
the liquid that passes through as for dilute hydrocyanic acid. The
odour of the oil is not a decisive proof, since a chemical compound
known as nitro-benzole or nitro-benzine has a very smiilar odour.

Symptoms. — Those of poisoning by hydrocyanic acid (p. 457) ; but
the symptoms do not appear to commence so soon, and the duration of
the poisoning seems to be longer. The recorded cases pi-esent similar
variety in the symptoms, and similar acts of volition occupy the inter-
val between the swallowing of the poison and the commencement of
the symptoms.

Post-mortem Appearances.-^-Those of poisoning by hydrocyanic
acid (p. 458), the odour of the oil taking the place of the odour of
the acid.

Treatment. — That of poisoning by hydrocyanic acid (p. 458).

Fata! Dose. — About twenty drops. As strong specimens of the oil
have from four to seven times the strength of the hydrocyanic acid of the
Pharmacopeia, and a less quantity of the acid than fifty minims has
proved fatal, it is probable that as small a quantity as ten or twelve
drops might destroy the life of an adult.

Duration. — From a few minutes to half an hour. It may destroy
life as speedily as prussic acid itself.

Bitter-almond Water. — This water is distilled from the cake left
after expressing the fixed oil from the bitter almond. It is found in the
shops of very variable strength, and is quite unfit for medicinal uses.
Some specimens are found to contain one per cent., others a quarter per
cent.

It owes its poisonous property to the prussic acid which it contains ;
and responds to the tests for that poison (p. 452). The symptoms,
post-mortem appearances, and treatment aie those of poisoning by
hydrocyanic acid (p. 457),

468 HYDROCYANIC ACID.

Laurel Water. — The leaves of the cherry laurel (Prunus lauro-
cerasus) yield both a distilled water and an essential oil which have
the same properties as the water and oil of bitter almonds, and wei-o
formerly employed for the same purposes. The quantity of the prussic
acid in the distilled water is about a quarter per cent., and in the
essential oil three and a quarter per cent. Other portions of the plant
also yield the poison ; but it is not contained in the pulp of the fruit.
The cherry laurel water has proved fatal in more than one case ; but the
one which possesses the greatest interest is that of Sir Theodosius
Boughton, poisoned by Captain Donellan in 1781.

Sir Theodosius Boughton, a healthy young man of twenty years
of age, was in the habit of taking a laxative draught from the hands
of his mother. On the morning of his death she observed, while
giving him his draught, 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 dose, and in
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." The body was
carelessly inspected ten days after death, but the post-mortem appear-
ances threw no light on the cause of death. The odour of the draught,
the rapid occurrence of symptoms so closely resembling those present in
recorded cases of poisoning by prussic acid, and the speedy death of tlic
sufferer at an age when apoplexy is so rare, combine to leave no reason-
able doubt of the i eal cause of death.

469

CHAPTER XV.

POISONING BY ALCOHOL, iETHER, AND CHLOROFORM.

These poisons have the common property of inducing a state of nar-
cotism, often preceded by delirious excitement, and followed by indis-
position, of which nausea and vomiting are generally the leading symp-
toms. In large doses, and in a concentrated form, tliey may destroy
life suddenly by shock ; but they generally prove fatal by inducing a
state allied to apoplexy, or by paralyzing the heai t. They act as irri-
tants to the parts with whiclv they come in contact, producing intense
inflammation in the lining membrane of the stomach when swallowed,
and in the lining membranes of the air-passages when inhaled. But
they do not affect the whole tract of the intestinal canal, as do the
poisons grouped under the class of narcotico-irritants,

1. ALCOHOL.

Alcohol, or spirit of wine, is the active ingredient of a great variety
of intoxicating agents obtained from saccharine juices in a state of fer-
mentation. By the distillation of such fluids, followed by rectification
with charcoal, and a final distillation from quick-lime, anhydrous or
absolute alcohol is obtained. This absolute alcohol, diluted with little
more than its weight of water, constitutes proof spirit, which differs
little in strength from the various ardent spirits distilled from wine,
malt, molasses, or rice, flavoured and coloured with burnt sugar,
juniper berries, and peat, and known respectively as brandy, whiskey,
hollands or gin, rum, and arrack. The absolute alcohol in these
ardent spirits varies from 51 to 54 per cent. Of the stronger wines it
constitutes from 12 to 17 per cent. ; of the lighter wines from 7 to 9
per cent., and of the stronger English malt liquors from 5 to 6 per
cent.

Properties. — Pure alcohol is a colourless, volatile liquid of low
specific gravity (0-&15 at 32^), boiling at 173^, and not freezing at
the lowest attainable temperature. It has an agreeable odour, and a
burning, pungent taste. It is very inflammable, burns \yith a light-
blue flame, and yields, as the products of its combustion, carbonic acid
and water.

Tests. — a. When burned, it leaves no stain of charcoal. 6. The
products of combustion render lime-water or the solution of nitrate
of baryta white and turbid, c. It dissolves camphor, d. When boiled
with a saturated solution of bichromate of potash, mixed with sulphuric

470 ALCOHOL.

acid, i he green oxide of chrome is set free. This last test is recom-
mended by Dr. Taylor (* On Poisons,' p. 728) as one of great delicacy ;
but it doesjiot distinguish pure alcohol from aether or pyroxylic spirit.

In Organic Liquids.— The contents of the stomach in prsons dying
from the effects of large doses of spirituous liquors generally have the
odour of the spirit ; but there are exceptions to this rule. If they
contain any spirit it may be separated by submitting them to the same
procesvS of distillation as is adopted in order to obtain anhydrous or
absolute alcohol from fermenting sacchai-ine substances. If the con-
tents of the stomach have an acid reaction, they must first be neu-
tralized by potash. The liquid resulting from the distillation may be
identified by the tests just enumerated.

Alcohol is absorbed, and may be detected by its odour, and by tests
apphed to the products of distillation, in the blood and secretions, in
the brain, and in other solid viscera.

Experiments on Animals. — From Sir Benjamin Brodie's experi-
ments on rabbits with large quantities of proof spirits, it appears that
symptoms of poisoning set in immediately or in a few minutes, and
that death ensues in from about half an hour to an hour and a quarter.
In one experiment in which two ounces of proof spirit were injected
into the stomach of a rabbit, the injection was scarcely completed
when the animal became perfectly insensible. It was apparently
dead in twenty-seven minutes, but the heart had not ceased to beat.
The symptoms produced in these experiments were complete insen-
sibility, dilatation of the pupils, rapid pulse, laborious and stertorous
breathing, and slight convulsions. The lining membrane of the stomach
bore marks of great inflammation. M

SYMPTOMS, MORBID APPEARANCES, AND TREATMENT.

Symptoms. — After a period varying from a few minutes to an hour
or more, according to the quantity and strength of the alcoholic liquid,
the symptoms set in with confusion of thought, giddiness, imperfect
or double vision, indistinct and stammering speech, uncertain and abrupt
movements of the limbs, and a tottering and stumbling gait. At
length the patient becomes speechless, motionless, and insensible, with
a bloated and suffused countenance, injected eye, dilated and fixed
pupil, livid lip, and slow and stertorous breathing. Recovery may take
place after a prolonged sleep, or more abruptly by vomiting ; or death
may occur after an interval of several hours with symptoms of collapse,
indicated by pallor of the face, cold sweats, quick and feeble pulse, and
complete relaxation of the limb>. When very large quantities of ardent
spirits are taken death may ensue almost immediately by shock.
Sometimes insensibility sets in suddenly ; sometimes as a sudden
relapse after apparent recovery. Convulsions are among the occasional
symptoms, and delirium tremens and raging incoherence are some-
times the result of a single debauch. The symptoms of poisoning by

tEther. 471

alcohol nearly resemble, as has been shown by Sir Benjamin Brodie,
tliose of concussion of the brain ; they are also difficult to distinguish
troni the effects of severe cold and from those of poisoning by opium.
In many cases the odour ot spirits will assist the diagnosis. As a
-t'lieral rule, the pupils are dilated in poisoning by alcohol, and con-
tracted in poisoning by opium, and the countenance which is flushed in
the one case is pallid in the other.

Morbid Appearances. — The most constant appearance is a deep
crimson or dusky red colour of the lining membrane of the stomach,
sometimes extending upwards to the gullet and downwards to the com-
mencement of the small intestines. In some cases there is dark extra-
vasation under the lining membrane. In rare instances the stomach is
inflamed only in patches : still less frequently there are no marks of
inflammation in any part of the organ. Congestion cf the brain, and
of the air-passages, are among the less constant appearances.

Treatment.— The stomach-pump s?iould be used without delay, and
the cold affusion as a shock. The after treatment will depend on the
state of the patient. If there is much congestion of the brain,
blood may be drawn from the arm. If great difficulty of breathing,
with a cold surfiace and feeble pulse, the treatment proper to apticea
may be required. In the last resort, galvanism may be employed.

Chronic Poisoning by Alcohol. — Drunkards suffer from functional
and organic diseases of all the important organs of the economy : from
indigestion, with vomiting and purging through irritation of the
stomach and bowels ; from jaundice through irritation of the liver ;
ftom albuminous urine, diabetes, and other urinary disorders through
irritation of the kidney ; from congestion of the brain, delirium
tremens (see p. 159), and insanity; from paralysis, convulsions, and
shaking palsy ; as the effect of the poison on the nervous centres. The
organic diseases induced by the prolonged abuse of spirituous liquors
are fatty degeneration of the liver, kidneys, heart, brain, and spinal
cord, scirrhus of the stomach, and pulmonary consumption. Dropsy
is a common result of the organic diseases of the drunkard.

2. .ETHER.

Several volatile and inflammable liquids are known to the chemist
under the general name of CBther, and they are divided into three groups
undei' the titles of simple, double, and compound aethers. The liquid
known as aether, ordinary aether, vinic ather, or sulphuric asther, belongs
to the class of simple aethei-s, and is the poison here spoken of. It is
the product of the distillation of a mixture of alcohol and sulphuric
acid.

Properties. — Pure aether is a colourless liquid, highly volatile and
inflammable, with a low specific gravity (0'724 at 55^), boiling at 95'-'
and freezing at about — 24<^. It burns with a yellow flame, and deposits
charcoal on cooled surfaces, but when burned with a proper proportion

472 .ETHER.

of oxygen is resolved (like alcohol) into carbonic acid and water. It
yields a <lense, inflammable A'apour, which ibrms with oxygen or air,
in certain proportions, an explosive mixture. Its odour is penetrating
and characteristic, and its taste hot and pungent, but on evaporation it
gives a sensation of cold. It is sparingly soluble in water, but fieely
dissolves in alcohol. It is also a powerful solvent of a considerable
number of bodies, among others the alkaloid strychnia.

Tests. — a. Its characteri.^tic odour, b. Its imperfect combustion,
leaving a stain of carbon on cool surfaces, c. Its being only partially
dissolved in water, the bulk of the liquid floating on the surface*
d. It has the same reaction as alcohol with bichromate of potash and
sulphuric acid.

In Orijanic Liquids. — The process for separating a;ther from the
contents of the stomach is the same process of distillation as for
alcohol.

Experiments on Animals. — The experiments of Orfila show that
ffither produces nearly the same effect on animals as alcohol.

SYMPTOMS, MORBID APPEARANCES, AND TREATMENT.

Symptoms. — Large doses of liquid sether, such as several drachms,
give rise to nearly the same effects as alcohol. A stage of delirious ex-
citement is followed by narcotic symptoms.

The symptoms which follow the inhalation of the vapour show
themselves more quickly, and are more severe than those which follow
the swallowing of an equal quantity of the poison. The first effects
of the vapour are seen in quickened pulse and respiration, flushed face,
suffused eye, and excitement of the mind ; but if the inhalation be
continued, the patient falls into a state of stupor, with slow labo-
rious stertorous breathing, and quick pulse. The face and lips are
livid, the sui-face pale and cold, the pupil dilated and fixed, the eye
turned upwards, and the whole voluntary muscular system relaxed.
If the inhalation is carried on for a few minutes only, these symptoms
soon disappear ; but if it is continued for ten minutes, a quarter of
an hour, or more, all the effects are increased, and the patient is
roused with difficulty. When the effect of the poison is complete,
sensation is suspended, so that long and difficult operations may be
performed either without any evidence of pain, or with indications
of suffering which leave no recollection behind them. The symp-
toms are not, however, uniformly such as are described above. The
poison sometimes causes violent excitement; in other cases it pro-
duces a state of incoherence ; in others, again, it irritates the lungs
and gives rise to a troublesome cough ; and nausea and vomiting either
occur during the inhalation, or they are among the symptoms of reco-
very. The prolonged inhalation of the vapour may end fatally.

Morbid Apjpearances. — Those due to poisoning by alcohol. The

CHLOROFORM — SYMPTOMS.

473

odour of aether perceptible in the contents of the stomach, and through-
out the body.

Treatment. — Tliat of poisoning by alcohol.

3. Chloroform.

Chloroform, or chloroformyl, is one of the large class of chemical
compounds formed by substituting chlorine, bromine-, or iodine for the
hydrogen of the simple or compound aethers. It is procured by a
process of distillation from a mixture of chloride of lime, alcohol, and
water.

Properties. — Chloroform is a colourless liquid, of high refracting
.power, and high specific gravity (1-497). It is very volatile, giving
out a dense vapour (sp. gr. 4-2). It boils at 142° F, It has a swe6t
pungent taste, and a strong pleasant aethereal odour compared to that of
apples. It is perfectly soluble in alcohol and aether, but veiy sparingly
soluble in water, in which it sinks in large globules. If pure it has a
neutral reaction ; it does not discolour oil of vitriol, has no odour of
chlorine, and leaves no unpleasant odour on evaporation. It dissolves
camphor, volatile oils, wax, resin, caoutchouc, gutta percha, and some
of the alkaloids, among which strychnia is the most important in a
medico-legal point of view. It also dissolves iodine, bromine, sulphur,
and phosphorus. At a red heat its vapour is resolved into chlorine
and hydrochloric acid.

Tests. — a. Its taste and odour, 6. Its high specific gravity and
sparing solubility in water, c. It is inflamed with difficulty, and burns
with a green flame, d. It completely dissolves camphor, gutta percha,
and caoutchouc, e. It produces its characteristic effects on small
animals.

In Organic if /x^wres.— Liquid chloroform may be separated from the
contents of the stomach by a process of distillation at a temperature
of 120° F. The A^apour may be separated from the blood and tissues
by the same process, or by one based on the fact that the vapour of
chloroform is decomposed when transmitted through a tube heated to
redness. (For details of this process, see Taylor, ' On Poisons,' p. 742.)

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — Those due to poisoning by aether, but they set in more
rapidly. The loss of sensibility is more complete, and the relaxation
of the muscular system may extend to the sphincters. Death may
take place suddenly from shock or syncope, in convulsions, or in an
epileptic fit ; and the fetal event may happen either during the inha-
lation, immediately after it, or at an interval of several hours, or of
one or two days. Among the fatal cases (now amounting to more
than fifty) there are many in which it is impossible to attribute the
event to the impurity of the chlorofoi-m, or to the want of skill and

474 CHLOROFORM.

care in administering the vapour. The fatal event has been due in
some cases to disease of the heart or brain ; in others, probably, to the
action of the poison combined with the shock of the operation.

The successive effects of chloroform have been distinguished by five
distinct stages, namely : — 1. A stage of exhilaration. 2. A stage of
drunken drowsiness. 3. A stage of profound sleep, with contracted
pupil. 4. A stage of perfect insensibility; and 5. A stage of coma,
with slow breathing and dilated pupil. (Druitt).

Shof'test Fatal Period. — Death may take place in less than two
minutes from the commencement o ' the inhalation.

Smallest Fatal Dose. — The vapour from as small a quantity as fifteen
drops of chloroform has proved speedily fatal. A drachm of liquid
chloroform swallowed by a boy aged four proved fatal in three hours.
(Taylor, ' On Poisons,' p. 740.) For a minute detail of the symptoms
and post-mortem appearances in a case of poisoning by repeated doses
of liquid chloroform, amounting in the aggregate to moi-e than five
ounces, consult the case of Dr. Glover, as described by Mr. F. J. (iant,
' Lancet/ April 23, 1859, p. 425. Death took place, in this instance,
afler 25 hours, in spite of judicious and persevering treatment. Con-
sult also the able chapter on chloroform in the sixth edition of
Druitt's ' Surgeon's Vade Mecuni.'

Treatment. — Cold affusion as a shock, followed by the treatment
proper to apnoea. In poisoning by liquid chloroform, the treatment
should commence with the use of the stomach-pump.

CHAPTER XVI.
POISONING BY NARCOTIC GASES.

1. Carbonic acid, and other products of combustion.

2. Sulphuretted hydrogen, and the gaseous contents of

sewers and drains.

3. Carburetted hydrogen and coal gas.

The most important of the narcotic gases are carbonic acid and
carbonic oxide, sulphuretted hydrogen, and carburetted hydrogen.
Cyanogen gas is also an active narcotic poison, and nitrous oxide,
oxygen, and hydrogen appear to belong to the same class of poisons.
But these gases have little medico-legal importance.

The narcotic gases, in a pure and undiluted state, may, like the
in-itant gases, act as asphyxiating agents, by causing spasm of the
glottis, and thus excluding air from the lungs. When diluted with
atmospheric air, they destroy life by affecting the brain and nervous
centres. It is in this state of dilution with atmospheric air, as well as
of admixture with other gaseous poisons emanating from the same
sources, that these gases will have to be examined.

!^*

1. carbonic acid gas.

Carbonic acid gas is generated in many different ways. It is the
principal product of the combustion of fuel ; it is given out largely in
the process of fermentation, and in the burning of lime ; animals expire
it as a product of respiration, and plants exhale it freely at night ; and
it collects in mines, caves, coal-pits, graves, and wells. From the
inhalation of the gas produced in any of these ways fatal accidents have
occurred.

The question of accident, suicide, or homicide, is rarely raised in
cases of poisoning by this gas. The place in which a body is found,
and the surrounding circumstances, are generally decisive as to the
cause, which, in the majority of cases in this country, is accidental.
It is very rarely employed here as a means of committing suicide, though
the practice is very common in France ; and it is not likely to be made
use of by a murderer, though Devergie has related some cases which
seem to justify the suspicion that it has been so employed.

But though the cause of death in poisoning by carbonic acid will
generally be inferred from the place and circumstances in which a body,
is found', suspicions of foul, play have been ignorantly entertained; and

476 POISONING BY NARCOTIC GASES.

the dangerous or fatal results have been attributed to mechanical suffo-
cation, as in a case related in the Reports of Ambrose Pare, or to
some poison administered by the mouth, as in a case cited by Chris-
tison.

Occasionally the true state of things is not suspected, until several
persons have suffered or perished. This haj)pens when the wood-work
of houses is carbonized by heated flues, or when the products of com-
bustion make their way from one apailment into another.

Properties. — Carbonic acid is a colourless, inodorous gas, much
heavier than atmospheric air, with which it mixes slowly. It is soluble
in water, and has the reaction and other properties of an acid. It
combines with lime to form chalk.

Tests. — a. It produces a milkiness, followed by a white precipitate,
in lime water. 6. It does not support combustion ; and when mixed
with air, in the proportion of from ten or twelve to fifteen or twenty
per cent., it extinguishes flame. A small feeble flame is extinguished
by as little as ten or twelve per cent. c. Litmus paper moistened
with bleaching liquid is lirst leddened, and then bleached by the gas
as it exists in the air.

The property which carbonic acid has of combining with lime is
turned to practical account in purifying the air of wells or pits. A
vessel of Jime, mixed up with water into a thin paste, is lowei-ed into
the stratum of gas. But the same result may be obtained by a current
of ail' or jet of steam.

Quarditative Analysis. — The quantity of carbonic acid in the air
may be determined by the amount of absorption which takes place in
a graduated jar containing liquor potassae. The gas may be collected
for analysis by emptying a full jar of water into the space containing
it. The quantity of charcoal which has been burned in any case may
be estimated at twenty or twenty-five times the quantity of ash
remaining.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — Carbonic acid gas, pure and unmixed, acts as an irri*
tant, and causes a spasm of the glottis, and death by apna?a. In a
state of dilution, and either pure or mixed with other products of com-
bustion, it may be breathed for a considerable period ; and it produces
symptoms varying in intensity with the quantity of the gas. The
character of the symptoms will also be modified by the gases with
which it may happen to be mixed. When mixed with the more active
carbonic oxide, the narcotic symptoms are more urgent ; the sulphurous
acid gas, which is given off during the combustion of coal, acts as an
irritant to the organs of respiration ; and other modifications may
arise from the admixture of carburetted hydrogen, or of other hydro-
carbons.

The ordinary symptoms of poisoning by carbonic acid are : a sensa-

CARBONIC ACID GAS. 477

tiou of weight in the forehead and back of the head, and of tightness in
the temples, violent headache, giddiness, ringing in the ears, dimness-
f)f sight, drowsiness, hurried respiration, and violent palpitation, nausea,
and, in many cases, vomiting ; followed by complete insensibility,
stt'}torous breathing, slow pulse, and pallor and lividity of the surface.
Death may be due to apoplexy, or to apncea. Sometimes a deep sleep
terminates in death. Occasionally the sensations seem, as in drowning
ami hanging, to be pleasurable. In a few cases the symptoms have set
in with delirium. Convulsions and tetanic spasms are of occasional
occurrence.

J'ost-mortem Appearances. — The body is generally swollen, and
marked more or less extensively with livid spots, and the limbs are fre-
quently rigid, and the abdomen distended with air. The countenance
is, in some cases, pale and composed, in others livid and bloated ;
ami the eyes are bright and prominent. Froth, or froth tinged with
l)luod, is sometimes found about the mouth and nostrils; and the
tongue is sometimes protruded between the teeth. The animal heat is
retained longer than usual, cadaverous rigidity is slow to show itself,
.nil putrefaction is retarded. Internally the body presents the fol-
lt>\viug appearances : the large veins and the right cavities of the heart
are gorged with black blood, and the lungs and lining membrane of the
air-passages are congested. The brain and its membranes are injected,
ami the veins and sinuses distended. Serum is found in the ventricles,
ainl at the base ; and effusions of blood on the surface of the brain or
into the ventricles are of occasional occurrence. The base of the tongue
IS injected, and ecchymosed patches are sometimes found in the alimen-
tary canal.

Some of these appearances bear a close resemblance to those present
in cases of death by apnoea, but the turgescence of the brain is much
more remarkable in cases of poisoning by carbonic acid than in fatal cases
of apnoea from other causes ; and it has been proved experimentally that
oar i ionic acid gas does not act as a mere asphyxiating agent, but as a .
sj)<»oific narcotic poison.*

* As the value of some of the post-moriem appearances was a subject of
lively controversy in the case of James Trickey, given in tlie text, the follow-
iiiu particulars are subjoined from a valuable paper by the late Dr. Gelding
l>inl —Q Guy's tlospital Reports,' vol. viil. p. 75.)

i'lie expression of countenance in twelve cases in whicli it is described, was
pall' and calm in 5 cases; bloated in 7. Vomiting had occurred in 3 cases, and
was absent in 5 in which that symptom was noticed. There was froth at the
mouth in 6 cases ; it was absent in 4. There was froth and serum at the nos-
trils in 4, and they were lined with black mucus in 2. The eyes were injected
in 2 ; dilated, prominent, and shining in 3 ; closed and dull in 3. The limbs
were rigid in 5 ; flexible in 2. The tongue was protruded and grasped by the
teeth in 6 ; drawn in and concealed in 2. There were livid patches on the
skin in 10 cases ; they were absent in 2. The abdomen was distended with air
in 9 ; not distended in 4. The membranes of the brain were injected with blood
in 8, and described as congested in 4 ; there was serous effusion beneath the
arachnoid in 3. The vessels and sinuses were turgid in all the cases in which
those parts are mentioned. The blood was not always of the same colour. There

478 POISONING BY NARCOTIC GASES.

Treatment. — This consists in the prompt removal of the patient
pure air, the use of cold affusion as a shock, and, where the count©
nance is bloated and livid, of general or local blood-letting. Artifici
respiration, galvanism, and the inhalation of oxygen gas may beresorte
to in extreme cases. Frictions and warmth to the sui-face are indicated
as in cases of apnoea.
• Preventive Measures. — The prevention of accidental poisoning b;
carbonic acid must rest in a great degree on the possession on the jiar
of the public of correct information respecting the nature of combustioi
and of its products, and of the situations in which accumulations
carboni(! acid gas are most likely to take place. The fact that stove
heated by charcoal in the open air of rooms, and giving out carbon!
acid into the atmosphere, are still used by persons of education, show
how little scientific knowledge such persons may possess. It may b
well, when speaking of preventive measures, to correct an error in
which even intelligent and educated persons are liable to fell, that it i
safe to breathe an atmosphere in which a candle continues to burn
It should, on the contrary, be understood that a candle may burn in
atmosphere which will speedily prove fatal to life; while, on the othe
hand, a man may for a short time breathe with impunity an atmospher
in which candles are extinguished. Thus, Mr. Coathupe cites a cas(
that occurred in his own neighbourhood, of a man who descended int<
an abandoned coal-pit, in which ignited candles were repeatedly extin-
guished, and remained in it for several minutes, until he succeeded il
bringing to light the body of a child, who had fallen from a part o!
the old machinery.

In a case mentioned by M. Marye, and quoted by Devergie, a candl<
was extinguished in an atmosphere that produced only a slight sensa
tion of uneasiness in a gentleman who made an abortive attempt
suicide. In another and successful attempt, a candle was found burn
ing on the table, whilst he was lying dead on the floor. In the forme
instance, the candle was probably below the level of the body, in th<
latter it was above it. (' Annales d'Hygiene,' vol. xxiii. p. 190.)

Several interesting and practically important questions connecte<
with poisoning by carbonic acid require examination. Some of th
are set forth in the following case, which, at the time of its occurrence
excited a lively interest, and gave rise to much discussion.

James Trickey, aged QQ, watchman and steeple-keeper of St

was no effusion of serum on the brain in 6 cases. Serous effusions in 3 cases
The substance of the brain was injected in 8, Blood was effused on the surfao
in 1 ; the brain was in its natural condition in 2. Serum in the ventricles oj
the brain in 6 ; absent in 3. Blood was effused into them In one case.

Among the post-mortem appearances on whicli the greatest stress has beei
laid is the rosy or livid discoloration of the skin. Devergie places great relian«
upon this sign. The long continuance of animal heat, and rigidity, and th(
slow progress of putrefaction, are also points which have been much Insistec
on. (' Annales d'Hygiene,' vol. xvii. p. 225.)

CARBONIC ACID GAS. 479

Michael's Church, Comihill, was placed in the church, on the night of
Nov. 17, 1838, in charge of a stove heated by charcoal (one of Har-
]ior and Joyce's patent apparatus). He entered the church at eleven
■I'dock' at night, and the next morning he was found dead, lying on
his face, with his feet about three feet from the stove, and his head
lower than the rest of his body, the trunk resting on a step. A con-
r>i(lerable quantity of vomited food was found on the floor near his
mouth. The church was so full of some vapour that the respiration
ot' the persons who first entered in the morning was considerably af-
fected. The principal post-mortem appearances were as follows : The
countenance calm and composed, and the eyes lustrous. The vessels
of the brain gorged with fluid blood ; considerable serous effusion
between the arachnoid and pia mater, and at the base of the brain ;
numerous bloody points in the substance of the brain. The lungs
ahnost black, the vessels turgid with blood, the trachea containing a
frotliy mucus, and the lining membrane injected ; the blood in the
large veins dark, but fluid; the stomach nearly full of undigested
food. Every other part of the body healthy.

At the inquest, considerable difference of opinion existed among the
medical witnesses as to the cause of death. They all agreed that he
li id died of apoplexy, but some thought this mode of death was suffi-
ciently explained by his advanced age, by his apoplectic make, and by
the full meal which he had taken before he commenced his watch in
the church. Others, on the contrary, though they likewise attributed
tlie death to apoplexy, attributed the apoplexy itself to the inhalation
of carbonic acid.

The question to be decided, therefore, ultimately took this shape :
Was there a sufficient quantity of carbonic acid in the church to ac-
count for the man's death; and supposing the quantity diffused
through the church not to be sufficient to account for the fatal event,
might not the part in which he lay (for he was on the floor close to
tlie stove) contain a sufficient quantity of the gas to prove fatal?
As similar cases, involving similar questions, may again arise, it may
be well to say a few words on each of these two points.

1. What is the smallest quantity of carbonic acid diffused through
the air that may prove fatal ?

2. Is the carbonic acid produced in the burning of fuel in rooms or
buildings equally diffused, or does it accumulate in one part of the
apartment more than in another ?

1. In estimating the quantity of carbonic acid required to destroy
life, it ought to be borne in mind that when the gas is the product of
respiration or combustion it is formed at the expense of the oxygen of
Uie air ; so that the air is rendered less fit for the support of life by
the withdrawal of a vital element, as well as by the addition of a
poison. The different susceptibility of persons of the two sexes and
different ages should also be considered (see p. 227). Some light is
thrown on this question by the experiments of Allen and Pepys, which

480 POISONING BY NARCOTIC GASES.

have shown that air once inspired becomes charged with from 8 to 8
per cent, of carbonic acid, and that, however often it may be respired
it never acquires more than 10 per cent. As fatal consequences hav
more than once ensued from simple overcrowding, when the pollutio
of the air, in all probability, fell far short of this limit, we may safely
assume that a quantity of carbonic acid much less considerable would
destroy life. Devergie thinks that five per cent, is sutficient, but Mr
Coathupe (' Lancet,' vol. xxxi. p. 201) states that he suffered most
severely from inhaling an atmosphere containing, at the outside,!
according to his own calculation, 2 per cent.

In the case of St. Michael's Church, it appears that the contents o:
the building were 110,000 cubic feet, and the quantity of carbon!
acid which might have arisen from the charcoal employed was 150'
cubic feet; so that little more than 1^ per cent, of the gas could hav
been diffused through the building, a quantity probably much smaller
than that contained in crowded and ill-ventilated looms, especially
when lighted by gas, and probably too small to destroy life, though
breathed by a sleeping man for several hours in succession. The death
of James Trickey could not therefore be attributed to the inhalation
of carbonic acid, on the supposition that the gas is uniformly diffused
through the air of the building. But if. as some believe, and as the ex-
peiiments of Devergie seem to prove,* the carbonic acid is unequally
distributed, and, when the temperature of the apaitment has become
the same in every part of it, subsides to the floor, the death of James
Trickey, who lay on the floor of the church witiiin three feet of the
stove, was probably due to the poisonous gas which he inhaled. But
in order to explain the death of James Trickey by carbonic acid, it is
not necessary to assume this subsidence of the gas to the lower part
of the building; for except in those cases in which this heated gas
given off from the burning fuel rises in a column of air to escape by
a vent in the ceiling directly above it, the gas will doubtless bs, diffused
in larger quantity through the air immediately surrounding the stove,
whether above it, around it, or beneath it ; and if the air of the apartr
ment, instead of being assumed to be still, is subject to drafts, the gas
would be carried in the direction of the draft, so as to increase the
danger of a person exposed to it. If the draft, however, be strong, it
will clear the air of the carbonic acid which it contains, and free those
who may happen to be in the cuiTeut from all danger. This circum-
stance is illustrated by a case reported by Dr. Golding Bird, which
also seems to place, beyond all i-easonable doubt, the greater imme-
diate accumulation of air in the proximity of the stove, than in the
remoter parts of an apartment. This subject requires, and would well
rejiay a careful investigation.!

* These experiments deriye some confimiation from a case quoted by
Devergie from a work \<y M.Marye, for which the reader is referred to the;
first edition of this work.

t ' Guy's Hospital Reports,' vol. viii. p. 84.

CARBONIC ACID GAS. 481

That such a diffusion of the gas does happen may be ascertained by
placing lime water in watch-glasses, in different positions, about the
source of supply. It becomes rapidly coated with a film, of about
('<Hial thickness, in whatever position it is placed. This equal diffu-
sion of the gas is the more probable explanation of the death of
Jnmes Trickey, assuming that his death was due to the inhalation of
carbonic acid.

Meanwhile it may be useful to subjoin a short summary of the
innie obvious causes of an unequal distribution of carbonic gas, or of
other products of combustion.

1. Carbonic acid may be generated (as in beer-vats) in an enclosed
s|)aGe, and form a stratum of gas above the source of supply, at the
same time that it mixes very slowly with the atmospheric air above
and around it. 2. Carbonic acid may enter an enclosed space (such
as a well, cavern, or grotto,) from openings in the floor. In this case
too, if the air of the upper part of the space be renewed by strong
currents of air, or by the occasional opening of a door, the lower
stratum of air maybe poisonous, while the upper strata are compara-
tively pure. 3. Carbonic acid may be generated in an apartment by
combustion, and rise as a compact column of heated air to a vent in
the ceiling ; or it may be drawn towards an open chimney ; or, again, it
may be forced into a particular direction by drafts or currents of air.
4. In an apartment without chimney, or other vent, and with no
currents or drafts of air, or only very feeble ones, the gas will
Ijo diffused abundantly, though unequally, around the source of
supply.

Other products of combustion. — Carbonic acid gas, though it is the
chief, is not the only, product of the combustion of charcoal or coal.
In the case of burning charcoal, the gases given off vary according to
the rapidity with which the fuel is consumed. According to Orfila,
the gas from dimly burning charcoal consists of 14 parts of carbonic
acid and 14 parts of carburetted hydrogen, mixed with .52 parts of
nitrogen and 20 of atmospheric air ; while the products of vivid com-
l)iistion are 12 pai-ts of carbonic acid, mixed with 39 of nitrogen and
49 of atmospheric air.

Well-burned charcoal, therefore, yields little or no carburetted
hydrogen ; but it gives off, in variable quantity, a gas, not mentioned
in this statement of M. Orfila, viz. carbonic oxide. This gas is a most
active narcotic poison.

Where, then, combustion goes on slowly, a much larger quantity of
air is deprived of its oxygen than when combustion is vivid.

The gases given off in the smothered combustion of coal are of a
much more compound nature than those produced from charcoal. In
addition to carbonic acid, we may expect to find sulphurous acid gas,
and the sulphuretted and carburetted hydrogen gases. These gases
are also highly injurious to life.

2 I

482 POISONING BY NARCOTIC GASES.

2. SULPHURETTED HYDROGEN {IlijdrO-SUlphuric Ackl).

This gas ranks next in importance to carbonic acid. It is scarcely
less generally ditfiised, but being of a most offensive odour it gives
warning of its presence. It is an extremely active poison, for according
to The'nard atmospheric air, which contains i^^th of its volume will
destroy a bird ; when it contains glgth of its volume it will kill a dog ;
and jjgth proves fatal to a horse. Injected into the blood, it speedily
destroys life ; and it also proves fatal when introduced into any of the
cavities of the body, or even when applied to the unbroken skin.

Properties. — This gas is characterized by a peculiarly offensivi
odour — that of rotten eggs. It is also remarkable for the variety o
its reactions with the metallic bases. It combines with ammonia t<
form the sulphide of ammonium, which has a similar offensive odoui
added to the pungency of hartshorn, and similar chemical reactionf
The presence of ammonia is indicated by the fumes given out whe
a rod dipped in hydrochlonc acid is held in the gas.

Tests. — The usual test for this gas is acetate of lead, with which i|
gives a black precipitate. Filtering paper moistened with a solutioi
of the salt of lead is a very delicate test for the gas. It is tumec
brown or black according to the quantity of the gas.

Symptoms. — When the gas is breathed in a moderately dilute(i
state, it produces giddiness, a sensation of tightness across the tem
pies, and of oppression in the pit of the stomach, nausea, suddei
weakness, and loss of sense and motion. Tetanus, delirium, and coD'
vulsions, a cold skin, an irregular and very frequent pulse, an(i
laborious respiration, are occasionally present.

Post-mortem Appearances. — The body has a highly offensive odour
and undergoes very rapid decomposition. The muscles are dark, an<
insensible to the stimulus of galvanism. The large vessels and all th<
internal viscera are distended with black liquid blood.

Treatment. — The means to be adopted for resuscitation are remova
to a pure air, the use of stimulants, and the respiration of chlorim
gas as given off from bleaching powder moistened with a dilute acid
or from any of the bleaching liquids. As chlorine is a powerfu
irritant it should be administered in a state of dilution with atmo
spheric air.

The sulphuretted hydrogen gas rarely exists in a separate state as a
poison ; it is most commonly met with combined with other gases in
the soil of privies, cesspools, and common sewers.

Feculent matter in a state of putrefaction gives rise to three prin
cipal gases — sulphuretted hydrogen, sulphide of ammonium, ant
nitrogen. The first two are exceedingly deleterious, the latter possesses
negative properties. These three gases may exist separately or com«
bined in the soil of privies.

Sometimes it happens that no disagreeable odour is given out ; neitheif
the nauseous odour of the sulphuretted hydrogen, nor the irritating^

CARBURETTED HYDROGEN. 483

ami pungent odour of the sulphide of ammonium, but still the air is
cdiitaininated. In these cases the gases consist of carbonic acid and
nitrogen, with a very small proportion of oxygen.

The symptoms and post-mortem appearances produced by the
u;ises taken collectively will not differ much from those which are
due to the inhalation of sulphuretted hydrogen alone. The rapidity
witli which the symptoms take place will depend on the degree of
dilution or concentration of the gas. The most remarkable symptoms
isi'oduced in those who have been suddenly and strongly affected and
siiljsequently recovered, are, a feeling of violent pressure at the epigas-
ti ium, and round the head. Those who are employed in emptying the
con:!mon sewers in Paris are frequently affected in this way.

Chlorine is the best substance to employ for the purification of the
air from these gases, as well as for the recovery of persons asphyxiated
by them.

The gases arising from the stagnant water of sewers are similar to
those given off by privies and cesspools ; but the gases as they form
are partly held in solution by the water. In sewers with a good fall
and liberal supply of water no gases are given off; but there is a
peculiar animal odour due to their feculent contents. This odour does
not appear to exercise any injui'ious effect on the health of men who
work in sewers.

3. CARBURETTED HYDROGEN.

The chief constituent of coal gas is the combination of carbon and
hydrogen known as light carburetted hydrogen, sub-carburetted
hydrogen, marsh gas, or fire damp. In coal gas the light carburetted
hydrogen, is mixed with olefiant gas, and unless of unusual purity
contains several other gases, such as ammonia, sulphuretted hydrogen,
carbonic acid, and carbonic oxide, with free hydrogen and nitrogen.

Properties. — These mixed gases have a peculiar and offensive
odour. They burn with a yellowish-white flame, yielding, as the
products of combustion, chiefly water and carbonic acid, and forming,
witli certain proportions of atmospheric air, a dangerous explosive '
mixture.

Coal gas does not constitute so active a poison as carbonic acid
and sulphuretted hydrogen ; but when mixed with an equal bulk of
atmospheric air it cannot be breathed without producing very serious
effects upon the system. If greatly diluted with air no bad effects
follow, as is proved by the fact that men who work in coal mines are
rarely incommoded by it. *

■ Symptoms. — Very few cases of poisoning by coal gas, or its prin-
cipal constituents, are recorded. From a case des(;ribed by Devergie,
it appears that foaming at the mouth, vomiting, violent convulsions,
tetanic spasms,, stertorous respiration, and injection of the countenance,
with dilated pupil, are amongst the most prominent symptoms.

Post-mortem Appearances. — From two cases reported by Mr. Teale

484 POISONING BY NARCOTIC GASES.

in the * Guy's Hospital Reports,' * it seems that the principal morbid
appearances are the following : — Pallor of the integuments, and of the
internal tissues generally, with the exception of some portions of the
mucous membrane ; florid discolouration of the neck and back ; light
florid colour of the muscles ; absence of all indications of venous con-
gestion ; fluidity of the blood, which is of a florid colour ; infiltration of
the lungs ; injection and ecchymosis of the small intestines, and of the
air-passages. Higidity rapidly supervenes.

Treatment. — This consists in prompt removal into the fresh air,
and the cold affusion, followed by the use of diffusible and othei
stimulants.

• No. viii., p. 106.

485

CHAPTER XVII.
NARCOTICO-ACRID POISONS.

This third division of narcotico-acrid or narcotico-irritant poisons con-
sists, with few and insignificant exceptions, of substances derived from
the vegetable kingdom — of the leaves, berries, seeds, and roots of
plants, with their juices and the alkaloids, or other proximate prin-
ciples, obtainable from*them.

This group or division comprises many distinct poisons ; in which
respect it resembles the irritant and differs from the narcotic group.
But these poisons are so rarely taken or given, that whereas on the
average of the five years 1852 to 1856, out of 268 ascertained poisons,
175 were narcotics and 90 irritants, only 3 belonged to the class of
narcotico-acrids. Bat though thus rarely administered in comparison
with the members of the other two classes, most of the narcotico-
acrids have been taken often enough to enable us to generalize their
effects, and to describe the symptoms and morbid results which they
produce.

The symptoms occasioned by the narcotico-acrids are partly due to
certain vegetable alkaloids or principles which admit of separation, and
partly to the vegetable matters that form the bulk of the plants, or
parts of plants, from which those alkaloids or principles are procured.
It is probably chiefly, if not wholly, to these active principles that the
members of this class owe their peculiar and characteristic remote
effects on the nervous centres, while their local irritant action is mainly
due to the vegetable structures which constitute the bulk of the plants
themselves. It should also be understood that this local action is not
so severe as of itself to prove fatal to life ; that it is not of constant
occurrence ; and that when the poison is taken in large quantities, it
is often masked by the narcotic effects. The two classes of symptoms
sometimes coincide, but sometimes the one precedes or follows the
other.

The appearance of the plants belonging to this class is, for the most
part, highly characteristic. The majority belong to the two natural
orders, solanaceae and umhelliferas. The several portions of the plants
themselves, as the leaves, roots, berries, and seeds, are often found in
the alimentary canal, or in the matters rejected from the stomach or
passed by the bowels, so as to be readily identified ; and the odour
and taste, or the impression produced upon the sentient nerves of the
tongue and lips, are, in the case of more than one of them, in the

486 NARCOTICO-ACRID POISONS.

highest degree characteristic. The alkaloids themselves have the
odour and taste of the plants from which they are extracted.
Strychnia has the intense bitterness of nux vomica, conia the peculiar
odour of hemlock, and aconitina produces the singular tingling of
the lips and tongue which results from chewing the leaves, seeds, oi
root of aconite. The most important of the alkaloids (strychnia) ha
many characteristic chemical reactions, and is so permanent that i
may be detected in the fluids and solids of the body. But the greatei
number of the alkaloids are less stable and less easily distinguished bj
chemical reagents, and we are consequently indebted to experiments
small animals for our best means of identifying them.

The symptoms common to the entire class of the narcotico-acrids
are heat and dryness of the throat with thirst; pain in the stomacl:
with vomiting and pui'ging; and delirium and spectral illusions, witl
dilated pupil. Convulsions ; tetanic spasms and*heightened sensibility
paralysis of the motor and sensitive nerves ; coma and syncope ; an
among the less general symptoms.

Great difference in degree, and strange varieties in the combinatioi
of these elements, are observed in different cases of poisoning by thi
same substance, or by different substances.

Post-mortem Appearances. — Inflammation or congestion of the
stomach and bowels, and congestion of the brain and its membranes,
are the most common appearances after death ; but they are not con
stant ; nor are they sufficiently well marked to be deci.-ive as to the
cause of death.

Treatment. — If the poison has been swallowed in the form ol
leaves, roots, berries, or seeds, the first part of the treatment will consist
in the use of emetics of sulphate of zinc, mustard, or salt, so a-s to
empty the stomach. If the stomach-pum]) is at hand it is to be pre-
ferred. A full dose of castor oil mixed with hot milk should then be
given with a view to discharge such portions of the poison as may
have passed into the alimentary canal. At a later period clysters may
be used with advantage. If the poison has been taken in the form of
alkaloid, animal charcoal suspended in water should be first given, and
should be followed, after a short interval, by emetics or the stomach-
pump. As the alkaloids are precipitated both by tannic acid and by a \
solution of iodine in iodide of potassium, either of these may be sub-
stituted for animal charcoal, the tannic acid in the form of a decoction
of oak bark, or of gall nuts, of the tincture of galls, catechu, or
kino; or of a strong infusion of black tea; the iodine in a weak solu-
tion containing six grains of iodide of potassium and three grains of '
iodine in sixteen ounces of water (Bouchardat, as cited by Dr. Taylor,
' On Poisons,' p. 804). The after treatment will be determined by the
prevailing symptoms of each case. If symptoms of collapse are pre-
sent, the cold affusion should be administoi-ed as a shock, followed by ;
diffusible stimulants ; if symptoms of narcotism, the patient must be \
treated as if opium had been taken (see p. 447) ; if great irritation of ■

I

CLASSIFICATION. 487

the alimentaiy canal should happen to be present, demulcents should
i)e largely given, as in poisoning by the irritants; and in case of
tenesmus and dysuria, emollient clysters. If the symptoms are such as
\n indicate the propriety of bleeding, the use of the lancet is to be
( onimended as a means of removing part of the poison which has been
' -orbed. But, as a general rule, vena?section and the use of de-

-sing emetics, such as tartar emetic and ipecacuanha, are objection-

j, as tending to promote absorption. Bleeding should in no case
l>-' j-esorted to until the stomach has been emptied by emetics or the
Ntumach-pump.

Hitherto the group of narcotico-acrids has been treated as consisting
oi individual poisons having certain characters in common. It is now
uGcessaiy to deal with this group, as has been done already with the
irritants and narcotics, as consisting of certain subordinate groups
characterized by certain symptoms in common. One well-defined
class consists of the plants which yield strychnia as their active prin-
ciple— a class characterized by the powerful effect produced on the
reflex function of the nerves of voluntary motion and sensation, in
the shape of tetanic spasm, and heightened sensibility of the surface.
The mind is generally unaffected. A second class is characterized by
the very geneial occurrence of delirium, and illusions of the senses, asso-
ciated with great dilatation of the pupil. This class comprises
belladonna, hyoscyamus, stramonium, and camphor. A third class is
equally characterized by the general occurrence of syncope or collapse,
without delirium. This class comprises aconite, digitalis, tobacco,
lobelia inflata, and hemlock ; and in this class, too, the mind is usually
unaffected. The remaining members of the class are chiefly remark-
able for occasioning violent irritation of the alimentary canal with
nervous symptoms not sufficiently defined or ascertained to justify
their admission into the three classes just described.

The following classification of the narcotico-irritants will be
adopted : —

1. Strychnia and the plants which yield it.

2. Belladonna, hyoscyamus, stramonium, and camphor, with the

oenanthe crocata, cocculus indicus, lolium temulentum, and
poisonous mushrooms.

3. Aconite, digitalis, tobacco, lobelia inflata, and hemlock.

4. The ergot of rye, cicuta virosa, phellandrium aquaticum^thusa ^ .

cynapium, cytisus laburnum, and solanum nigrum. /*-A^x»^ ^a^^S^**^

5. Oil of turpentine, kreasote, oil of tar, and oil of dippel.

488

CHAPTKR XVIII.

NUX VOMICA AXD STRYCHNIA.

The alkaloid strychnia is the chief active ingredient in several plan'
which have the common property of giving rise to symptoms similar
to those of tetanus. It is generally found with another alkaloid, brucia
possessed of similar, but less active, poisonous properties.

Strychnia is ascertained to be the active poisonous principle of five
plants — the Strychnos nnx vomica, S. Ignatia, S. tieute', S. toxifera,
and S. colubrina. All these plants are natives of hot climates. The
Strychnos nux vomica grows as a tree in Coromandel, in other parts
of India, and in Ceylon ; the S, Ignatia in the Philippine islands, also
as a tree ; the S. tieute in Java, as a large climbing shrub ; the
S. toxifera is a native of Guiana ; and the S. colubrina grows as a tree
in many parts of Asia.

The S. nux vomica yields the poisonous seed and baik in use in this
country ; the S. Ignatia produces the seed known as the bean of St.'
Ignatius; the S. tieute supplies the bark of which an aqueous extract
constitutes theiipas poison ; the S. toxifera was until lately the reputed
source of the poison variously designated as woorara, woorali, oorara,
cui-ara, and ticunas, and used by the natives of South America in
preparing their poisoned arrows. Theie is now reason to believe that
this poison is a compound derived from several sources (animal and
vegetable). The curara as thus prepared, as well as the upas antiar
(from the Japanese tree the Antiaris toxicaria), and the poison nut of
Madagascar (the produce of the Tanghinia venenifera) act on the
heart and brain, and not on the spinal cord. For more minute details
respecting these poisons, the reader is referred to works on Toxicology.

There are three vegetable productions more or less common in
England which contain strychnia — the bean of St. Ignatius, and the
bark and seed of the Strychnos nux vomica.

The beans of St. Ignatius are not often met with out of museums.
They are the seeds of the pear-shaped fruit of the S. Ignatia, in which
they exist to the number of about twenty. They vary in size from
that of a nut to that of a large filbert. They have a thin brown
outer coat, which is easily detached, and leaves a smooth, black sur-
face. They are very hard, and have the appearance of small pebbles
with irregular shaped and rounded outline, and two or three unequal flat-
tened surfaces. They contain strychnia in the proportion of 12 parts
in 1000, and some brucia, and produce the same effects as nux
vomica or strychnia.

NUX VOMICA.

489

The hark of the Strychnos nux vomica, formerly mistaken for cusparia
or angostura bark, and named, accordingly, ' false Angostura bark,' has
a very characteristic appearance. It is quilled, or twisted like dried
horn, and is thickly covered with white prominent spots bearing some
resemblance to a lichen. It yields a light yellow powder, which has
an intensely bitter taste, and is reddened by nitric acid, it contains both
Ntiychnia and brucia, and acts upon the system in the same manner as
the seed or the alkaloid.

The nux vomica, or seed of the S. nux vomica, is much more im-
portant than the foregoing, and requires to be more minutely
tloscribed.

NUX VOMICA.

This poisonous seed is imported into this country in large quanti-
ties ; and the seed itself, a powder prepared from it, and a spirituous
extract (the extractum nucis vomicae of the London and Edinburgh
Pharmacopoeias), as well as the alkaloid strychnia and its salts, are in
common use as a poison for wild animals, rats, and vermin ; and it is
prescribed as a medicine in paralytic affections, and in some other
diseases to which it would seem less applicable. In the two years
1837-8, nux vomica was the cause of death in three instances.

These seeds are enclosed in a rich orange-coloured fruit of the size
and shape of a large apple, each fruit containing ft-om three to five
seeds. The seeds are circular in outline, vary in size and thickness
from that of a shilling to that of a florin, and weigh from less than one
scruple to more than two scruples. Their edges are rounded ; one
surface is concave, and the other convex, or convex in the centre and
deeply grooved near the margin as in fig. 54. A horizontal section has
the appearance shown in fig, 55, and a vertical section displays a circular

Fig. 54.

Fig. 55.

Fig. 56.

central cavity and heart-shaped embryo, as in fig. 56. By introducing a
sharp knife at the projecting point shown in rig. 54, the seed may be
easily cleft in two so as to display the embryo. The seeds have an
external coating of liglit brown silky hai)'s, radiating from the centre,
but the bulk of the seed is white, or of a light slate colour, and has
a waxy appearance. The texture of the seeds is so hard that it can
only be reduced to powder by rasping or filing. When turned in the

490 NUX VOMICA AND STRYCHNIA.

lathe they yield a white shaving like hartshorn. The interior poili
of the seeds assumes a rich orange colour when touched with nitrie
acid, and is tinged green by the perchloride of iron.

The powder of the seeds has the colour of jalap powder, a faint
odour, and an intense and persistent bitter taste. The brown silky
fibres which tbinm the coating of the nut are seen in large numbers
under the microscope, and are very distinctly defined when treated
Fig. 57. ^vith a drop of strong nitric acid. They have the
appearance shown in fig. 57. Its watery solution is
^ rendered pink by nitric acid, and green by the per-

d^f/^DS chloride of iron. The powdt-r contains the alkaloids
^<*^li strychnia and brucia in union with strychnic or igasuric

acid. The quantity of the alkaloid strychnia has been
variously estimated at 4 and at 10 parts in the 1000.
The extract of nux vomica is readily recognized by the rich orange
colour imparted by nitric acid, the lake colour developed by sulphuric
acid, and the transient blue tint given by sulphuric acid and bichromate
of potash.

Symptoms. — Those of poisoning by strychnia.
Post-mortem Appearances. — Those of poisoning by strychnia. The
brown powder often adhei'es to the lining membrane of the stomach.

Treatment. — The poison to be removed by emetics or the stomach-
pump. The rest of the treatment that of poisoning by strychnia.

Fatal Dose. — Thirty grains of the powder, or the weight of a nut of
medium size, and three grains of the alcoholic extract, have pioved fatal.
Commencement of Symptoms. — From ten to foity minutes, or an
hour.

Fatal Period. — From fifteen minutes to three hours or more. One
hour is a common period.

STRYCHNIA.

This alkaloid is now in very general use in every part of the world
for the destruction of wild animals and veimin. in poisoning wild
animals it is usual to insert the strychnia into the stomach of a small
animal or bird recently killed ; and in poisoning birds, to steep grains
of wheat in a strong solution of the alkaloid, or of one of its salts. A
powder known as " Battle's Vermin Killer " contains, according to an
analysis by Dr. Letheby, 23 per cent, of the poison mixed with flour,
sugar, and Prussian blue. The flesh of animals that have eaten or
poisoned meat or grain sometimes proves poisonous to other animals. \

Strychnia and its salts are also used as medicines, and in consequen«?
of this twofold use, cases of accidental poisoning occasionally occur.
Of late yeai-s, too, the alkaloid has become a formidable instrum.ent of
death in the hands of the murderer ; and is believed to have been the
immediate cause of death in more than one recent instance, as in the
cases of Palmer and Dove.

POISONING BY STRYCHNIA.

491

Fi'om the Report of the Registrar-General it appears that on an
r.-erage of the five years 1852-56 strychnia and nuxvomicaare credite<^l
with 2 out of the 268 deaths by ascertained poisons.

Strychnia may have to be examined, 1. in substance, 2. in solution,
'!. in organic substances.

1. In Substance.

Properties. — Strychnia is found in commerce either as a white
powder, or as a colourless crystal. In
commercial specimens the form of the
crystal is a rectangular prism, either of the
exact shape shown in fig. 58, or with
the ends replaced by one or two oblique
jilanes. The crystals of strychnia, when
obtained from solutions of its salts by the addition of liquor am-
monia3, or, still better, by exposure to its vapour, present under the
lens or microscope three leading forms — the long rectangular prism,
the short hexagonal prism, or the regular octahedron. From a group
of crystals obtained by exposing a drop of a solution of the acetate of
strychnia to tlie vapour of ammonia, the forms shown in figs. 59 and
60 have been selected.* The crystals in fig. 69 are long four-sided

Fig. 58.

\

\

^,

\;

Fig. 59.

Fig. 60.

prisms, isolated or in stellate groups, with a single octahedron shown
in contact with one of the prisms. The crystals in fig. 60 are either
regular octahedra or modifications of the same, or short six-sided
prisms. One or two of the crystals appear to be dodecahedra. The
octahedra will be recognized in the several points of view in which
they present themselves, on referring to the account given of the
crystals of arscnious acid at p. 372.

Strychnia has an intensely bitter and very persistent taste, which is
slated to be distinctly perceptible in solutions containing one grain of

Acetate of morphia similarly treate yields prismatic forms only.

492 NUX VOMICA AND STRYCHNIA.

the alkaloid in a gallon (70,000) grains of water. Strychnia is very
insoluble in water. It requires for its solution nearly 7000 times
its weight of water at 50° (which is in the proportion of one grain in
about fourteen measured ounces) and 2500 times its weight at 212°,
But it is very soluble in alcohol, aether, benzole, and chloroform, and
in some liquids in less common use. It is stated to be soluble in 350
parts of aether, 250 of benzole, 100 of alcohol, and 10 of chloroform.
If pure it undergoes no change of colour when treated with the strong
mineral acids ; but as it usually contains some brucia, it is reddened
by nitric acid.

Tests. — a.. The form of the crystals as above described. 6. The
intensely bitter taste, c. The sparing solubility, d. The chemical
colour tests, being the succession of rich hues imparted to a mixture of
strychnia and strong sulphuric acid by contact with bichromate of
potash and ferridcyanide of potassium and their solutions, or with the
peroxide of lead and peroxide of manganese, e. The galvanic colour
test, being the same coloui's developed by the electric current. The
chemical and galvanic colour tests will now be separately described.

The Colour Tests. — 1. Chemical colour tests, a. Place the smallest
visible crystal or granule of strychnia on a surface of white porcelain,
or on the glazed side of a piece of white enamelled glass. Add a
drop of strong sulphuric acid, and mix the acid and alkaloid thoroughly
with a small glass rod or spatula.* Kear this acid mixture, which
is colourless, place a drop of a strong solution of bichromate of potash.
Bring the two liquids together with the point of the rod or spatula,
having previously placed the porcelain or glass in a favourable light.
At the point of contact of the two liquids a deep rich blue colour will
make its appearance, and extend wherever the two liquids mix. This
colour soon changes to purple, from purple to crimson, and from
crimson to a rich red brown. It then gradually fades into a bright
red, which colour it retains for several hours, b. Proceed in the same
manner with a weak solution of the ferridcyanide of potassium, which
yields similar and highly characteristic results, c. Place a drop of
strong sulphuric acid on a surface of porcelain or enamelled glass. Add
a minute fragment of the peroxide of manganese (not more than will
impart to the acid when mixed with it a neutral tint). Draw out a
thin line of this acid liquid with the point of the rod or spatula, and
bring it into contact with a minute fragment or crystal of strychnia.
Similar colours will develop themselves wherever the alkaloid is
brought into contact with the mixture, d. Proceed in the same way
with the peroxide of lead, substituting for strong sulphuric acid a mix-
ture of one part of nitric to thjree of sulphuric acid. The same colours
will be developed.

Of these tests, the first and last are to be preferred, though they all

* The glass spatula consists of a long triangle or spear-head of thin glass,
fixed by its short side in a wooden handle. It will le found very conveuient
lor this and all similar purposes.

POISONING BY STRYCHNIA. 493

give highly satisfactory results. It should be understood that they
are equally applicable to spots of strychnia obtained by evaporating
solutions of the alkaloid ; as also to its salts.

2. Galvanic Colour Test. — This, like the foregoing tests, is appli-
cable either to a crystal or granule of strychnia, or to a deposit
of the alkaloid from any of its solutions. It is thus described by
Dr. Letheby: " Place a drop of a solution of strychnia (say of one
part of the alkaloid in 10,000, or even 20,000 of water) into a cup-
shaped depression made in a piece of platinum foil. Allow the liquid to
evaporate, and, when dry, moisten the spot with a drop of concen-
trated sulphuric acid. Connect the foil with the positive pole of a
siugle cell of Grove's or Smee's battery, and then touch the acid with
the platinum terminal of the negative pole. In an instant the violet
colour will flash out, and on removing the pole from the acid the tint
will remain."

2. Tn Solution.

Strychnia differs from other poisons in the circumstance that the
process now employed for extracting it from organic mixtures presents
the poison not as an aqueous solution, but dissolved in one of the four
liquids already specified, namely, alcohol, ajther, benzole, and chloro-
form. The solution of strychnia in these reagents is allowed to
evaporate in a watch-glass or on a disc of glass ; and if the liquid hold
sufficient of the poison in solution, a number of deposits are obtained,
which should first be examined by the microscope, and then submitted
to the action of the various tests. One or more of the stains should be
treated with dilute acetic acid, so as to convert the strychnia into the
acetate. To this acetate of strychnia, more or less diluted, the several
tests to be presently described are to be applied. Assuming this
method of procedure to be adopted, the form of the deposits from the
solutions of strychnia in the four liquids, alcohol, aither, benzole, and
chloroform will be described, and then the effect of certain chemical
tests on the solution indicated.

Strychnia in alcohol, cether, benzole, and chloroform, a. In alcohol.
The deposit from this solution is usually dendritic, but it may assume
the shape of octahedra, long four-sided prisms and short six-sided
prisms, with two long and four short sides. These forms are all
depicted by Dr. Letheby (' Lancet,' June 28, 1856). 6. Tn cether.
This crystalline deposit usually assumes similar forms, c. In benzole.
The solution of stiychnia in benzole sometimes leaves on evaporation
crystals of great brilliancy, distinctness, and permanence, in the form
of octahedra, and of short six-sided prisms, the latter crystal consti-
tuting the prevailing form. Cubes and dodecahedra are occasionally
met with. Generally, however, the deposit, though crystalline, does
not put on the form of distinct crystals, even when the stiychnia and
benzole are apparently of great purity, d. In chloroform. The
alkaloid is deposited from this solution in the forms of rosettes, veineil

494

NUX VOMICA AND STBTCHNIA.

leaves, stellate dotted needles, circles with broken radii, and branched

and leticulated forms of great delicacy aud beauty. Some of these

Fig. 61. forms are shown in the annexed

figure. My obsei-vation of these forms

coincides with Dr. Letheby's as given

in the paper just referred to.

Other Chemical Tests. — A con-
siderable number of chemical reagents
have been recommended as tests for
strychnia, among which the most im-
portant are: — the solutions of iodine
and iodide of potassium ; of the tannic
and carbazotic acids ; of the chlorides
of mercury (corrosive sublimate), pla-
tinum, gold, and iron ; of the bichro-
mate and perchlorate of potash ; and
of the sulpho-cyanide of potassium. Some of these tests give amorphous
precipitates, but the greater number throw down crystals, some of
which are highly characteristic, aud sufficiently constant to be con-
sidered as subsidiary tests.

It may be well to premise that the acetate of strychnia itself, to a
weak solution of which the tests are supposed to be applied, crystal-
lizes in tufts of needles, as shown in 1, fig. 62, and that when exposed
to the vapours of ammonia, it yields the crystals shown in figs. 59
and 60.

Fig. 62.
1. 2. 3.

a. Iodine and Iodide of Potassium (a solution of these reagents in
the proportion of one grain of iodine and three grains of iodide of
potassium in a drachm of distilled water) constitutes a valuable test for
the alkaloids as a class, and for strychnia in particular. It produces
in solutions containing strychnia an abundant yellowish or reddish-
Itrown precipitate, partly amorphous, partly crystalline, b. Tannic
acid. A solution of this acid yields an abundant white curdy pre-
cipitate with the salts of strychnia, but it reacts similarly with other
alkaloids, c. Carbazotic acid in solution yields with strychnia a
white precipitate, aud stellate and radiating crystals, with notched and

PHYSIOLOGICAL TEST. 495

hooked edges, as in 2. fig. 62. d. A solution of corrosive sublimate
causes an abundant white precipitate, which assumes the highly cha-
racteristic crystalline form depicted in 3, fig. 62. This is one of the
best tests for strychnia, e. The bichloride of platinum yields a bright
yellow precipitate. /. The terchloride of gold gives an abundant
bright yellow precipitate which is dissolved by a few drops of liquor
potassae. On boiling this solution, it assumes a deep purple tint, and
rapidly deposits a precipitate of the same colour, g. The jjerchloride
or permuriate of iron (causes an abundant yellow precipitate, and
yellow octahedral crystals of great size and beauty, h. The bichromate
of potash yields a bulky canary-yellow precipitate, consisting of
abundant dendritic yellow crystals, with isolated colourless octahedra.
i. The perchlorate of potash rapidly precipitates strychnia in long
four-sided prisms, blended with other crystalline forms, k. The sul-
phocyanide of potassium yields an abundant white precipitate.

In making use of the foregoing tests it is necessary to bear in mind
that some of them (as tests a and 6) give similar reactions with other
alkaloids ; and that the crystalline foi-ms described or depicted are not
uniform in their occurrence. Differences in temperature, in the strength
of the solution of strychnia, and in the strength and purity of the
reagents, give rise to modifications in the foi'ms of the crystals. Some
of the reagents also (such as the bichloride of platinum) yield similar
crystals of great distinctness and beauty. Hence, in all cases in which
crystalline forms are examined under the microscope, a comparison
should be made between the crystals resulting from the two liquids
and those afforded by the reagent itself* The crystals depicted in
fig. 62 are not obtained from any other alkaloid in the group of alka-
loids to which strychnia belongs ; namely, that which is marked by the
common property of not being changed in colour by strong sulphuric
acid.

The Physiological Test. — This title has been given to a test first pro-
posed by the late Dr. Marshall Hall, who alleged that the common
frog, properly prepared for experiment, was not less susceptible of the
peculiar effects of strychnia than of the convulsive effects of galvanism.
He directed that frogs recently taken from the pond should be selected ;
that the skin should be well dried with blotting paper, and that the
liquid to be tested, being a strong solution of a salt of strychnia, should

* Refer to papers by Dr. Letheby in • Lancet,' June 28 and July 12, 1856.
Also to two papers by Dr. Wormley in the ' Chemical Gazette,' April, I860.
Dr. Letheby's papers present the microscopic forms of strychnia as obtained by
means of several reagents, while those by Dr. Wormley give the results of
carefully conducted experiments on the chemical reactions of strychnia ; from
which it appears that the more important tests described above take rank in
point of delicacy as follows:— The iodine test reacts with ^^^ grains of
strychnia in a minim of water ; tannic acid with gjjWj ? bichloride of gold
_i_ ; carbazotic acid ^ L^ ; bichromate of potash -r-^ ; bichloride of

496 NUX VOMICA AND STRYCHNIA.

be dropped on the back of the animal. In a short time the frog thus
treated became affected with tetanoid, or epileptoid spasm, or convul-
sion, on the appliciition of the slightest cause of excitation. This test,
according to Dr. Marshall Hall, detects so small a quantity as the
jj^th gi-aiu of the poison ; and he thought that if inserted under the
skin, or injected into the stomach, a still less quantity might be detected.
The delicacy and certainty of this test have been fully confirmed by
Dr. John Traill ('Lancet,' July 12th, 1856), by Di-. Harley, by Dr.
Wormley, and others. Dr. Wormley (* Chemical News,' April 28th,
1860) gives an account of some experiments on a small species of frog
(the Rana halecina), from which it appears that when a solution of
strychnia was introduced into the stomach, quantities of strychnia much
less than ^^th grain produced characteristic effects.

The experiment is best performed as follows : Introduce the frog into
a Powell's flat specimen glass, with the belly of the frog towards the
flat surface ; close the opening with a cork perforated to allow the
passage of a pipette and glass rod. The skin of the frog should be
dried before it is introduced into the vessel. Apply a drop or two of a
solution of one of the salts of strychnia, or a sQlution in alcohol of the
alkaloid itself, by the point of the pipette to the skin of the back. In
a period of time varying from one or two minutes to a quarter of an
hour or more, the characteristic tetanic convulsions will show them-
selves, and will recur every time the glass is shaken, or the frog
touched with the glass rod. In many cases the frog utters a shriek or
cry expressive of pain. When the dose is large, the symptoms show
themselves almost immediately, and death takes place in a few minutes.
When the dose is smaller, the symptoms come on after an interval of
a quarter of an hour or half an hour, and the animal may recover. The
characteristic symptom is generally ushered in by a state of evident
distress, with panting respiration and protruding eye.

3. In Organic Substances.

The process which seems best adapted to the detection of strychnia
in the contents of the stomach, or in the animal fluids and tissues, is
the one originally recommended by Stas, but since modified by the
substitution of chloroform or benzole for aether.* The organic matters
are first digested with from ten grains to half a drachm of tartaric
acid, over a water-bath, till they are reduced to a fluid state. This
liquid is then filtered, and the substance remaining on the filter washed
with distilled water so long as it has an acid reaction, the washings
being added to the filtrate. The liquid is then to be somewhat con-
centrated by evaporation, and carbonate of soda is to be added in slight

* Messrs. Rodgers and Glrdwood (' Medical Times and Gazette,' June 20th,
1857) treat the organic mixture with dilute hydrochloric acid (cue part acid
and ten water), and ultimately resort to chloroform as a solvent of the alkaloid.

EXPERIMENTS ON ANIMALS. 497

excess. The liquid is now to be strongly shaken for several minutes
in a bottle or long tube with about half an ounce of chloroform (Messrs.
Rodgers and Girdwood), or with benzole (Professor Bloxam). The chlo-
roform, having been allowed to subside, or the benzole to collect on the
surface, is drawn off by a pipette, transferred to an evaporating basin,
and expelled over a water-bath. If the residue left in the basin is
free from colour, it may be at once tested for strychnia ; but if not, it
must be moistened with concentrated sulphuric acid, and exposed for
some hours to the temperature of a water-bath, by which procedure
all the organic matters except the strychnia is destroyed. The charred
mass is then treated with water, and the solution filtered to separate
the carbon. Ammonia is added to excess, and the solution again
shaken with about a drachm of chloroform. If, on evaporating a
small portion of this chloroform solution, and acting on the residue
with strong sulphuric acid, any charring takes place, the same pro-
cess must be repeated. The chloroform solution ultimately obtained
affords strychnia sufficiently pure for the application of the several
tests. The colour tests may be applied to the deposit left on a poi-ce-
lain slab after repeated evaporations ; the deposit on a slip of glass
may be examined under the microscope; and a solution of the de-
posited matters in dilute acertic acid may be examined by the several
tests just described.

By this process very satisfactory results are obtained.* Strychnia
has now been detected in the contents of the alimentary canal, in the
muscles and viscera, and in the blood and urine. Messrs. Rodgers and
Girdwood also state that they detected it in the bones. There is no
longer any I'oom for doubt that strychnia, like arsenic, antimony, and
mercury, undergoes no change in the alimentary canal, in the vessels
of the body, or in the secreting organs ; but that it can be detected in
organic fluids and tissues by a proper method of analysis carefully
and skilfully conducted.

In a medico-legal case lately examined by Professor Bloxam, he
substituted benzole for chloroform, and obtained beautiful crystalline
forais similar to those just mentioned as characterizing the deposit
from a solution of strychnia in benzole. Benzole, though a less perfect
solvent than chloroform, has the twofold advantage of being lighter than
water, and leaving a crystalline deposit of a more marked character.

Experiments on Animals.

The effect of strychnia on animals varies with the dose of the
poison, and the state in which it is administered. A large dose of
a salt of strychnia given in solution may begin to act almost
immediately, and prove fatal in a minute and a half. A smaller

* See the particulars of a recent analysis by Dr. Letheby, in a case of poison-
ing by strychnia, in the ' Chemical News,' September 29, 1860, and ' Br. Med.
Journal,' August 4, 1860, in which a similar process was adopted.

2 K

498 NUX VOMICA AND STRYCHNIA.

dose may not produce any effect for several minutes, and death
may not ensue for twenty minutes or half an hour ; or severe symp-
toms may be developed, and yet the animal recover. The symptoms
produced by the poison in animals are well shown in the following
instance. Dr. Taylor gave to a full-grown healthy rabbit, which had
been recently fed, a quarter of a grain of sulphate of strychnia dissolved
in a few drops of distilled water. The animal remained active for
fifteen minutes, but at that time appeared easily startled, tremulous in
its movements, and unsteady on its legs. Soon afterwards it trembled
violently, or started when touched ; and slight twitchings occurred in
the limbs at intervals on its attempting to move, or on making a noise.
After the lapse of eighteen minutes no well-marked convulsion of the
trunk had occurred ; but when gently lifted by the ears from the table
to the- floor, it was seized with a violent convulsive paroxysm. The
hind and fore legs were rigidly stretched out, and there was complete
opisthotonos. Its eyes protruded ; its breathing was difficult ; the pulsa-
tions of the heart could not be counted ; the head and tall were drawn
backwards, as if by a tightened bow-string, with occasional slight
intervals of relaxation ; and in this state it died, two minutes after the
commencement of the convulsions, and twenty minutes after taking the
poison. Immediately after death the whole body was flaccid ; but it
speedily stiffened, and the fore limbs altered their position, and became
rigidly stretched out. In eight minutes from the death, while the
body was still warm, the muscles were rigid over the greater part of
the trunk. On inspecting the body, the lungs were found collapsed,
and of a bright red colour; the heart contained blood, chiefly coagu-
lated, on both sides ; the blood in all other parts of the body was
liquid, and dark coloured.*

The mode and immediate cause of death in animals poisoned by
strychnia are not uniform. From the experimental inquiries Instituted
by Dr. Harley, of University College, London, and Mr. Bayldon, of
Edinburgh, it may be inferred that death may take place by shock, by
apncea, by syncope, or by exhaustion ; and that the poison affects no
the nervous centres only, but the muscular tissue of the heart, and o:
the voluntary muscles.

SYMPTOMS, POST-MORTEM APPEARANCES, AND TREATMENT.

Symptoms. — At an interval of from a few minutes to an hour oi
more after swallowing a substance which, if in solution, would have i
hot and intensely bitter taste, the symptoms of poisoning set in with i
feeling of suffocation and difficulty of breathing, the patient complain'
ing of want of air. These feelings of distress are soon followed by^
twitchings of the muscles, and jerking movements of the head and

* For a minute account of several experiments on animals, and a collection
of several cases in the human subject, with an examination of the case of
Palmer, see Dr. Taylor's Essay, reprinted from the • Guy's Hospital Reports/

POISONING BY STRYCHNIA. TREATMENT. 499

limbs, which shortly become heightened into tetanic convulsions. The
limbs are forcibly extended, the legs widely separated, and the feet
often turned either inwards or outwards, the head bent back, and the
whole body arched so as to rest on the head and heels. This position
is technically designated ' opisthotonos.'' The muscles of the abdomen
are rigidly contracted, respiration suspended, the face livid and con-
gested, the pupil (in the fit) usually dilated, the eyes prominent and
staring, and the features drawn into a grin (the risus sardonicus).
The patient complains of a choking sensation, and of thirst and dryness
of the throat ; but the effort to drink often occasions rigid and violent
spasms of the muscles of the jaw. There is sometimes foaming at the
mouth, and the froth is occasionally tinged with blood. The violent
contractions of the muscles are accompanied by pain at the pit of the
stomach and cramps in the limbs, and by intense suffering and distress.
The pulse is very rapid. After the spasms have lasted for one or two
minutes there is a remission of short duration, and the patient remains
exhausted, and bathed in sweat. The fits sometimes i-eturn without
apparent cause, but they may be brought on by the slightest touch, or
the least effort of the patient. In the intervals of the fits the patient
can converse, and swallow, and the jaw is not always fixed even in the
fit. The mind is generally unaffected till towards the fatal termina-
tion, and may even continue clear to the last. The patient is generally
quite conscious of his danger, and aware of the approach of his
paroxysms, which he announces by screams or shrieks, or by calling
out that " they are coming ;" and he often asks to be held, moved, or
turned over. Towards the fatal termination, the fits become more
frequent and severe, and the patient dies exhausted, or suffocated, in
most cases within two hours of the commencement of his symptoms.
If a patient survive that period there would be fair hope, but not a
certainty, of recovery.

The post-mortem appearances in death by stiychnia are not highly
characteristic, nor are they uniform. As a general rule, the body
would seem to be relaxed at the time of death ; but it stiffens soon
afterwards, and remains rigid for a long time. The hands are usually
clenched, and the feet arched, or turned inwards. In some cases the
body retains the posture given to it by the last fatal spasm. There is
usually some lividity about the face, trunk, and limbs. The expression
of the countenance is sometimes quite natural. The internal appear-
ances consist in congestion of the brain and spinal cord, of the lungs
and air-passages, and sometimes of the mucous membrane of the
stomach. The heart is sometimes contracted, and all its cavities empty;
in other cases the right side is full of blood. The blood throughout
the body is black and fluid. The urinary bladder is empty.

The treatment consists in the prompt evacuation of the stomach by
emetics or the stomach-pump, and then in the administration of
chloroform, for the relief of the pain attending the spasms. There is
no antidote to the poison unless finely-divided charcoal is to be con-

500 NUX VOMICA AND STRYXilHNIA.

sidered in that light. Opium, tobacco, and the active principles of
tobacco and conium, have been recommended as tending to relieve the
patient's sufferings, or relax the muscular contractions.

Commencement of Symptoms. — The symptoms may show themselves
in fi'om five minutes to an hour or more.

Fatal Period. — Death may take place in fifteen minutes, or not till
the lapse of two hours and three quarters. These were the limits in
eleven cases which I have minutely analyzed.

Fatal Dose. — A quarter of a grain of strychnia may destroy life ;
but recovery may take place after much more considerable doses.

From the account just given of the symptoms of poisoning by
strychnia, it will be seen that they are closely allied to those of the dis-
ease known as tetanus or locked jaw. In poisoning by strychnia, as
in tetanus, there are violent paroxysms of rigid convulsion, with
intense suffering ; and in both the mind is little if at all affected ; and
when it does suffier, it is apparently as the result of the exquisite tor-
tures which the patient has undergone.

The differences between the disease, tetanus, and the effect of poison-
ing by strychnia are well marked. In this country, and in temperate
climates, tetanus is rare, except as the consequence of a wound or
severe mechanical injury. In tetanus the symptoms are at first obscure,
and develop themselves gradually: in poisoning by strychnia they are
strongly marked at the onset, and attain their full development in a
few minutes. Tetanus begins with difficulty of swallowing and stiff-
ness of the jaws and neck, the trunk, legs, and arms being attacked in
succession. In poisoning by strychnia, all, or nearly all, the voluntary
muscles are attacked at the same time; and the muscles of the jaw are
not only not affected first, but*sometimes wholly escape, or are violently
contracted only during efforts to swallow. In tetanus, opisthotonos
does not occur till after some hours or days : in poisoning by strychnia,
it is among the early symptoms. In tetanus, the symptoms undergo
abatement, but there is no perfect intermission: in poisoning by
strychnia there are intervals of complete intermission. In tetanus the
patient either dies after the lapse of several hours or days, or recovers
slowly after several days or weeks : in poisoning by strychnia death
happens in from less than a quarter of an hour to less than three hours
after the first appearance of the symptoms, or the patient recovers
in a f^vf hours.

The tetanus occasioned by strychnia is distinguished from that which
occurs in the coui'se of poisoning by several of the more active irritants
and narcotico-irritants, inasmuch as the tetanus of strychnia-poisoning
constitutes the one symptom, whereas the tetanus of irritant and nar-
cotico-irritant poisoning occurs after other symptoms of poisoning have
shown themselves, or is mixed up with them. To this rule, however,
it is possible that the salts of morphia, in certain cases, may form an
exception. (See p. 448 )

The tetanic convulsions of hysteric and epileptic seizures ar<

BRUCIA. 501

similarly distinguished from the tetanus of strychnia-poisoning, by
forming only a part of the fit. These seizures, moreover, are not in
themselves fatal. Death from hysteria is unknown, and it very rarely
follows immediately or speedily on an epileptic seizure. There is a
marked difference, also, in the character of the convulsive movements in
the diseases just specified, and in poisoning by strychnia. Strychnia
produces a violent rigid tremor, uniformly continuous throughout the
paroxysm ; whereas epileptic, epileptiform, or hysteric convulsions are
marked by a more or less regular alternation of relaxation and contrac-
tion of the muscles. In a word, the tetanic paroxysm is distinguished
by uniform iHgid tremor, the epileptic or hysteric fit \>y jactitation.

Brucia.

This alkaloid derives its importance from its being associated with
strychnia in the seed and bark of nux vomica, and in St. Ignatius'
bean. It possesses the same poisonous properties as strychnia, but in a
less degree of intensity, variously estimated at a sixth or a twelfth.

Properties. — Brucia is usually found in the form of a white powder,
consisting, in part, of crystals. It is more soluble in water than
strychnia, insoluble in aether, but very soluble in alcohol. Its aqueous
solution has an intensely bitter taste. With acids it forms salts.
Strong and pure sulphuric acid does not discolour it ; but it is de-
scribed as giving it at first contact a pale rose tint.

Tests. — a. In common with many other alkaloids, brucia is precipi-
tated of a red-brown colour by the solution of iodine in iodide of potas-
sium, h. It is also precipitated white by tannic acid. c. Nitric
acid imparts to brucia and its salts a deep rich red colour. This red
solution, if wai-med and then allowed to cool, is changed to a purple hue
by protochloride of tin, and bleached by an excess of the solution.
d. Strong sulphuric acid, followed by bichromate of potash, ferrid-
cyanide of potassium, and peroxide of lead, or peroxide of manganese,
develops immediately a red or reddish-brown colour, passing to green
and yellow, e. The ferridcyanide and sulphocyanide of potassium, the
bichromate of potash, carbazotic acid, the bichloride of platinum, and
the terchloi'ide of gold, also yield precipitates. (Consult a paper by Dr.
Wormley in the * Chemical News,' July 21, 1860.)

It will be seen from what has just been stated that brucia belongs to
the same group of alkaloids as strychnia, namely, to the group which
is characterized by the absence of colour when treated with strong sul-
phuric acid. But it differs from strychnia in giving a more intense
red with nitric acid, and in the absence of the rich deep blue tint
developed by the contact of bichromate of potash in substance or solu-
tion, with the solution of the alkaloid in sulphuric acid. The crystal-
line forms yielded by strychnia with the several reagents ai'e also more
distinct and characteristic than those afforded by brucia.

502

CHAPTER XIX.

1. Belladonna.

2. Hyoscyamus.

3. Stramonium.

4. Camphor.

5. (Enanthe crocata.

6. cocculus indicus.

7. Lolium temulentum.

8. Poisonous mushrooms.

The poisons belonging to this group are characterized by the common
leading property of causing delirium, with illusions of the senses.
Other poisons of the narcotico-acrid class either do not give rise to
delirium, or they produce it only exceptionally. They also share, with
other poisons of the narcotico-acrid class, the property of causing dilata-
tion of the pupil, but more constantly and in a more remarkable degree.
Irritation of the stomach and bowels is present in a sufficient number
of cases to justify their being classed with the narcotico-acrid poisons.
Dysuria, or suppression of urine, is also not uncommon. The poisons
at the head of the group are the most conspicuous of their class ; the
others, as being less important, are more briefly noticed. For more
ample details respecting them, reference must be made to treatises on
toxicology.

1. Belladonna (Atropa Belladonna. Deadly Nightshade).

This is a plant of the Linnsean class and order, Pentandi^ia Mono-
gynia, and natural order, Solanacece.

It is indigenous, and grows in waste shady spots. All parts of the
plant are poisonous, and cases of poisoning by the root, leaves, and
berries, and by the medicinal extract, are on record, several of which
proved fatal. A decoction of the root, given as a clyster, has also
caused death, and serious symptoms have followed the external appli-
cation of the extract to a blistered surface.

The plant owes its poisonous properties mainly to the alkaloid
atropia, which has been admitted into the Pharmacopoeia, with one of
its salts, the sulphate.

The officinal preparations of the plant itself are, the extract, chiefly
used externally, but occasionally internally, in doses of gr. ^ to gr. i,
cautiously increased ; the tincture (dose from five to ten drops) ; and
for external application, the emplastrum and unguentum belladonnas.

BELLADONNA.

305

Fig. 63.

ejected by the

The parts of the plant which have been taken as poisons are readily
recognized. The root is thick and fleshy, branched and creeping; its
section, white when fresh, and greyish when dried. It has a slightly
bitter taste. The leaves, often in pairs of unequal size, ovate and un-
divided, smooth and soft, are attached to the stem by short foot-stalks.
The berries of the size of a small cherry, furrowed on each side, of a
shining violet black colour, and of a sweetish taste, are enclosed in the
enlarged calices. They have two cells, which contain several seeds.
The seeds are of the small size shown in fig. 63, with circular or
oval outline, and rounded surfaces ; sometimes they
are kidney-shaped. Their colour is nut-brown. They
weigh about ninety to the grain. When viewed by
a pocket lens, they look like sultana raisins in miniature,
and are stndded closely with equal small round pro-
jections. Viewed by leflected light, under a two-inch
power of the microscope, they have the appearance
shown in fig. 63.

As all parts of the berries, and the seeds which
they contain, are very indigestible, portions of them
will be found, in cases of poisoning, in the matters
stomach, or passed from the bowels.

The entile plant has a lurid hue, and when bruised, a fetid odour.

The extract of belladonna has the property which, however, it shares
with that of hyoscyamus and stramonium, of causing dilatation of the
pupil when locally applied, or when taken internally.

The effects of belladonna on animals are not very characteristic. In
them, as in man, it dilates the pupils, and it produces a state allied to
intoxication.

In the human subject, the symptoms of poisoning by belladonna are
the following : dryness of the throat, great difficulty of swallowing, or
even total inability to swallow, and intense thirst, followed by delirium,
ending in coma, or alternating with it. Convulsions are rare, and
when present, generally slight. The pupil is largely dilated, the coun-
tenance flashed and swollen, the eyes prominent and sparkling, the
vision indistinct, the gait unsteady. Symptoms of irritation in the
alimentary canal, beyond dryness and constriction of the throat, are of
very rare occurrence ; but nausea and unsuccessful efforts to vomit are
recorded in some cases, and aphthous inflammation of the throat, swell-
ing of the abdomen, and discharge of blood by stool, in at least one
instance. Violent strangury, suppression of urine, and hajmaturia,
have also been reported, as also an eruption on the skin, said to
resemble that of scarlatina. The symptoms rarely show themselves till
two or three hours, or even more, after the swallowing of the poison ;
but in some instances they have set in within half an hour. The fatal
cases bear but a small proportion to the cases of recovery. Death,
when it occurs, takes place within twenty-four hours ; in one case in
fifteen hours : in another in twelve hours. Favourable cases often last

504 ATROPIA.

for two or three days or more ; and some of the leading symptoms, such
as impaired vision, and greatly dilated pupil, survive the recovery of
the patient.

The delirium is generally a very prominent symptom. It is some-
times pleasing, sometimes accompanied by uncontrollable laughter,
sometimes by incessant talking, sometimes only by motions of the lips,
the voice being lost. Sometimes the state of the patient closely re-
sembles somnambulism, at others intoxication. The patient is generally
unconscious, and, on recovery, does not recollect what has happened to
him. Generally, the delirium precedes the sopor or coma; but some-
times the order is reversed, and sometimes the two states alternate.
Trismus and subsultus tendinum are i-ecorded among the nervous
symptoms of occasional occurience.

The vision is affected synchronously with the extreme dilatation of
the pupil. Sometimes there is merely indistinctness of vision, some-
times double vision, sometimes utter insensibility of the retina.

The post-mortem appearances are sometimes quite unimportant; in
other instances they have been described as those of narcotico-irritant
poisoning. The vessels of the brain are congested, and there are patches
of redness in the pharynx and oesophagus, and at the cardiac end of the
stomach. The mucous membrane of the stomach has been found dyed
of a dark purple colour throughout, or in patches, and portions of the
berries and some of the seeds have been detected in the intestinal canal.

The treatment consists in the prompt administration of emetics, fol-
lowed by animal charcoal diffused through water, and this, after an
interval, by a full dose of castor oil. In other respects it will be deter-
mined by the symptoms actually present. Bleeding may be practised
with advantage.

The diagnosis of the poisoning is not free from difficulty. The
symptoms are very similar to those present in poisoning by hyoscyamus
and stramonium. It is only the discovery of some portion of the plant
itself in the substances rejected from the stomach, or passed from the
bowels; or, in a fatal event, in the contents of the ahmentary canal,
which will enable us to state with confidence what poison has been
taken. In many instances the description given of the part of the plant
swallowed is quite decisive. The berry is easy to recognize.

Atropia (^Atropine). — This alkaloid, with one of its salts (the sul-
phate), is admitted into the London Pharmacopoeia, and used medicinally.

Properties. — When pure, it is in the form of white silky crystals,
which when viewed under the microscope are four-sided prisms. It is
sparingly soluble in water, but soluble in alcohol and a;ther. It is
also soluble in the dilute acids, with which it forms crystallizable salts.
The solution of iodine in iodide of potassium, and tannic acid, throw
down respectively a greenish-brown and dirty white precipitate.

Tests. — It is dissolved by sulphuric acid, and the solution is changed
to a rich brown when heated. This solution also bleaches a solution
of the permanganate of potash ; and with a solution of the bichromate

HYOSCYAMUS. 505

of potash yields a rich red colour, changing to red-brown and yellow.
Nitric acid dissolves it without change of colour. The bichloride of pla-
tinum and the terchloride of gold yield yellow precipitates. The solu-
tion of the alltaloid, and of its salts, has the property, which, however, it
shares with hyoscyamia and daturia, of causing dilatation of the pupil.

The alkaloid may be detected in organic mixtures, when it is in
sufficient quantity, by the method of Stas — a method which, as it is
applicable to the isolation and identification of the alkaloids as a class,
may be here conveniently described. This method is founded on the
ascertained fact that the salts of the alkaloids are soluble in water and
in alcohol ; and that their aqueous and alcoholic solutions, when neu-
tralized by an alkali, so as to set free the base, and then shaken with
aether, yield the base to the aether. The folio v/ing are the several leading
steps of this process.

The organic matters cut into small fragments are first mixed with
double their weight of strong pure alcohol ; from 8 to 30 grains of
tartaric or oxalic acid are added, and the mixture heated over a water-
bath. When cold the liquid is filtered, and the matters on the filter
are washed with strong alcohol, and the washings added to the filtrate,
which is then evaporated in vacuo over sulphuric acid. The residue
is now treated with cold anhydrous alcohol, the alcoholic extract
evaporated to dryness, and this residue in its turn dissolved in a very
small quantity of distilled water. This aqueous solution is mixed
with powdered bicarbonate of soda or potash till effervescence ceases,
and then shaken up with from four to six times its volume of pure
rectified aether. When the aether has collected on the surface, it is with-
drawn by the pipette, and evaporated in a watch-glass. The deposit
contains the alkaloid. Some parts of this process are repeated in
order to insure greater purity in the ultimate result. (For a more
detailed account of this process, and the modifications required in the
case of the volatile alkaloids, see Otto's * Manual of the Detection of
Poisons,' p. 156.)

2. Hyoscvamus (Byoscyamus Niger. Henbane).

This, too, is a plant of the Linnaean class and order Pentandria
Monogynia,and of the natural order Solanacese. It is indigenous, and
grows on waste and poor lands, and on the sea -shore. All parts of the
plant are poisonous, and the seeds, root, leaves, and young shoots have
severally been taken as poisons.

The plant owes its poisonous property to an alkaloid known as
hyoscyamia, and a peculiar volatile pi'inciple.

The London Pharmacopoeia contains two preparations of henbane
— the extract, procured from the fiesh leaves, and the tincture, from
the dried leaves. The dose of the extract is from 5 grains to a scruple,
and of the tincture from 20 drops to a drachm, a drachm and a half,
01' two drachms. These preparations are of very variable strength.

506 HY08CYAMUS.

The several parts of the plant which have been taken as poisons are
easily recognized.

The seeds are of about the same size and shape as those of bella-
donna, but less rounded. They are about an eighteenth of an inch in
Fig. 64. diameter, and weigh 120 to the grain. Under the

pocket lens they appear dotted over their entire
surface by slight projections ; and under the lower
powers of the microscope they look very much like
pine-apples in miniature, being thickly covered with
ridges formed of nipple-like projections separated by
distinct furrows, the projections being marked with
black lines, as shown in fig. 64, which represents
the seeds of their usual size, and as seen by reflected
light under a two-inch power of the microscope.
The root is spindle-shaped, and bears some resemblance to a small
parsnep, for which it has been eaten by mistake. It also somewhat
resembles the wild chicory.

The leaves are of a pale dull green colour, slightly pubescent, with
long hairs upon the midrib, unequally cut at the sides and pointed at
the end. They are sessile, and half embrace the stem of the plant.
They have, in common with the rest of the plant, a strong and un-
pleasant odour, a mucilaginous and slightly acrid taste, and a clammv
feel.

The different parts of the plant, and its officinal preparations, vary
greatly in activity and strength, according to the season of the year
and the mode of preparation.

Effects of the Poison on Animals. — Purely narcotic ; no local symp-
toms. Dilatation of the pupils a very marked symptom.

Symptoms in Man. — The symptoms make their appearance in from
a few minutes to half an hour. When fully developed, they consist
of flushing of the face, giddiness, rapid pulse, weakness, and trembling
of the limbs, convulsive or tetanic movements, delirium (commonly
of the active or violent kind), incoherence, the delirium tentiinating in
coma, or alternating with it, loss of speech, great dilatation of the
pupil, and indistinctness of vision, or total loss of sight.

Heat and dryness of the throat, vomiting and diarrhoea, are present
in a sufficient number of cases to justify us in placing henbane among
the narcoti co-acrid poisons ; but those symptoms certainly occur in a
minority of cases. A cutaneous rash has been observed.

Poisonous effects have been produced by a poultice of the leaves
applied to the abdomen, and by a decoction of" the plant used as a
clyster.

The most characteristic symptoms are delirium, and dilated pupil.
This dilatation of the pupil is caused by the application to the eye of
the preparations of henbane.

The post-mortem appearances are congestion of the brain and lungs.
The treatment is that of poisoning by belladonna.

STRAMONIUM. 507

In consequence of this poison being generally taken by mistake for
some wholesome vegetable (either leaves or root), and cooked as an
article of diet, the symptoms have commonly been described as affecting
several persons simultaneously.

HvoscvAMiA {Hyoscyamine). — This rare alkaloid is sometimes seen
in the form of white silky crystals, but generally as an amorphous mass.
It is without odour when quite pure ; but, as generally procured, has
a very disagreeable odour, like that of tobacco, and an acrid taste. It is
not very soluble in water, but more readily dissolved in alcohol and
aether. It forms salts with acids. Strong nitric acid dissolves it with-
out change of colour, and strong sulphuric acid colours it brown. It
is one of the alkaloids which M. Stas succeeded in obtaining by his
process, for a description of which see p. 505.

3. Stramonium (Datura Stramonium, Thorn-Apple).

This also is a plant of the Linnaan class and order Pentandria Mono-
gynia, and natural order Solanaceee ; growing in waste places and on
dung-heaps in all parts of Europe. Every part of the plant is poisonous ;
but the fruit and seeds are believed to be the most active. The
vapour of the flowers is asserted to have produced poisonous effects.
In France and Germany, as also in India, and the Eastern Archipelago,
the seeds are administered intentionally to facilitate the commission of
crime. Cases of poisoning by the leaves, fruit, seeds, and extract are
on record. Dangerous symptoms have been occasioned by the external
application of the several parts of the plant.

The extract of stramonium is in the London Pharmacopoeia, and
is given in doses of J gr. to 2 or 3 grains, or it may be applied ex-
ternally. It is smoked with tobacco as a remedy for asthma.

Stramonium owes its poisonous properties to an alkaloid, known as
daturia.

The appearance of the plant and of its parts is highly characteristic.
The entire plant has a rank odour. The flowers, however, are sweet-
scented.

The leaves are of a dull green colour : they are large, sharply and
irregularly cut at the edges, smooth, ribbed, and veined.

ThQ fruity or apple, is as large as a walnut, and has a strong prickly
outer coat.

The seeds are light brown or black, circular or nearly so, sometimes
kiduey-shaped, flattened, with a corrugated surface. They are much
larger than the seeds of henbane or belladonna, which they resemble in
shape ; for while the seeds of henbane measure about the eighteenth 6f
an inch, and the seeds of belladonna about the sixteenth, the stramo-
nium seed measures about the eighth of an inch, or from that to the
tenth of an inch; and while the seeds of henbane weigh 120 to the
grain, and those of belladonna 90 to the grain, there are only about 8

508 CAMPHOR.

stramonium seeds in one grain. The size and the microscopic appeal
ance of the cuticle of the seeds are shown in the annexed figui*e.

Fig. 65.

fit*

• •

The effects of this poison on animals are not very characteristic. In
common with henbane and deadly nightshade it causes extreme dilata-
tion of the pupil.

The symptoms of poisoning by stramonium, in the huma,n subject,
nearly resemble those of poisoning by henbane and the deadly night-
shade. There are dryness of the throat, flushing of the face, dilatation
of the pupils, delirium, accompanied by convulsions and followed by
coma, and, in some instances, symptoms of irritation in the alimen-
tary canal.

The symptoms set in very soon after taking the poison, and seem to
be more severe than those of poisoning either by henbane or deadly
nightshade. Delirium may be present in as short a space of time as
15 minutes, and death may take place in 7 hours.

Post-mx)rtem Appearances. — In some cases congestion of the vessels
of the brain has existed, and in one instance redness of the cardiac end
of the stomach.

The treatment of cases of poisoning by stramonium will consist in
the prompt use of emetics, followed by full doses of castor oil ; and
where there is much flushing of the face, the abstraction of blood
from the arm, or by leeches to the temple. In one case reported in
* Rust's Magazine,* bleeding appears to have afforded great relief, and
would seem to be applicable in poisoning by henbane and deadly night-
shade, as well as the thorn apple, and in cases of poisoning generally
where the face is flushed and the eyes prominent and brilliant.

Daturia. — This alkaloid is believed to differ very little in its com-
position and properties from atropia : like it, it is found in silky
crystals, which are four-sided prisms. It produces the same effect on
the pupil of the eye as the alkaloids atropia and hyoscyamia.

The diagnosis of poisoning by stramonium is only possible by the
history of the case, or by the discovery of portions of the plant in the
alimentary canal, or in the matters vomited or purged.

4. Camphor.

This substance has decidedly poisonous properties, but has only
proved fatal in one instance.

Properties. — It is a colourless, translucent, and semi-crystalline

(ENANTHE CROC ATA. 509

substance of a tough texture, strong and peculiar odour, and pungent
and yet cool taste. It floats on water, in which it is sparingly soluble.
It evaporates at common temperatures, and is deposited on cool sur-
faces (as on the inside of bottles) in crystals. It is readily dissolved
by alcohol, aether, and chloroform, and by the volatile and fixed oils.
When swallowed it impacts its peculiar odour to the breath.

When taken as a poison it is usually in fragments, and being
sparingly soluble in the contents of the stomach, would be easily
identified in a fatal case. If dissolved in spirits, it may be separated
by distillation, and then thrown down by the addition of water.

The symptoms of poisoning by camphor begin with languor, giddi-
ness, dimness of vision, and confusion of intellect, which are followed
by feelings of depression, intoxication, or violent delirium. Convul-
sions also occur, especially in children ; and there js much excitement
of the circulation, with heat of skin, flushed face, and hurried pulse ;
and the pupils are dilated.

The post-mortem appearances, as observed in animals, are distinct
marks of inflammation in the stomach and bowels, injection of the
membranes of the brain, and an inflammatory condition of the urinary
passages. Every part of the bodies of the animals had the odour of
the poison.

The smallest fatal dose has not been ascertained. Two scruples
have produced serious symptoms in an adult male.

The treatment consists in the prompt use of emetics, followed by
castor oil as a purgative. The discharge of the contents of the
stomach is generally followed by speedy relief.

5. ffiNANTHE CROCATA [Hemlock Water Dropwort).

This is an indigenous umbelliferous plant, which grows on the banks
of streams and ditches, and bears some resemblance to celery. All
parts of the plant are poisonous ; but the root, from a rough resem-
blance to the parsnep, is generally the part eaten by mistake. The
plant is so virulent a poison that a very small piece of the root has
proved rapidly fatal.

The symptoms may set in as soon as twenty minutes after swallow-
ing the poison, with convulsions and insensibility. The face livid
and bloated, the mouth and nostrils covered with bloody foam, and
the respiration stertorous, and death may follow in as little as five
minutes from the first seizure. In more protracted cases nervous
symptoms of great severity show themselves, consisting of locked
jaw, tetanic spasms, and violent mania, or delirium allied to delirium
tremens. The pupil is usually dilated. There are also symptoms
of violent irritation in the alimentary canal.

The post-mortem appearances consist of great congestion of the
brain ; an accumulation of dark blood in the lungs, heart, and larp-^
vessels; and signs of irritation in the stomach and bowels.

510 POISONOUS MUSHROOMS.

The treatment consists in the prompt discharge of the contents of
the stomach by emetics, followed by a full dose of castor oil.
Bleeding is indicated by the congested state of the cerebral vessels.
The remainder of the treatment will be determined by the symptoms
actually present.

6. COCCULUS INDICUS {Levant Nut).

This is the berry of a plant known as the Menispermum, or Ana-
mirta Cocculus. It is of the size and shape, and exhibits the section
Pj gg^ shown in fig. 66. The shell acts as an

emetic, while the seed itself contains an
active poison (Picrotoxia), in the propor-
tion of from 1 to 2 per cent. An extract
of the berries is sold for poisoning fish, to
which, when used in large quantity, it im-
parts a poisonous property, and a decoction
or extract is employed to give an intoxi-
cating quality to ale, porter, and spirits. It is used, too, with this
intent by thieves. In two instances, at least, the poison has proved
fatal in the human subject.

The symptoms are those of severe irritation in the alimentary canal,
and cerebral effects, including delirium, and •* a lethargic stupor, with
a consciousness of passing events, but a complete loss of voluntary
power." (Taylor.)

Picrotoxia {Picrotoxine). — This poison is obtained in the form of
colourless crystals, which are long four-sided prisms. Its taste is
intensely bitter. The crystals are sparingly soluble in water, but are
readily "dissolved by alcohol and fether. It is also sparingly soluble in
acids, but soluble in solutions of potash and soda. For this reason, and
because it does not contain nitrogen, it is not properly grouped with
the alkaloids. (Otto.) Sulphuric acid dissolves it without change of
colour, but the acid solution becomes yellowish when it is warmed,
and brown when it is heated. On the addition of a solution of bichro-
mate of potash to the acid liquid, it assumes a rich yellow tint.
Nitric acid dissolves it without change of colour. An alkaline solution,
with addition of sulphate of copper, when heated deposits the oxide of
copper.

7. LOLIUM TEMULENTUM {Darnel).

The seeds of this plant are sometimes mixed with other grains,
used for distillation, or ground into flour for making bread. When
so used they may produce marked symptoms of narcotico-acrid poi-
soning, including headache, giddiness, staggering as if from intoxica-
tion, strong tremulous movements of the limbs, impaired vision,
symptoms of collapse, and vomiting.

8. Poisonous Mushrooms or Fungi,
The fungi constitute a large class of plants, of which some are habi-

POISONOUS MUSHROOMS. 511

tually eaten with impunity, except by a few persons of peculiar consti-
tution ; while the majority, especially those belonging to the three
genera Amanita, Agaricus, and Hypophyllum are poisonous. The
poisonous property is sometimes destroyed by heat ; but in other cases,
when it is due to an alkaloidal principle known as fungia or fungine,
it is permanent.

The symptoms of poisoning by this class of substances are very
variable in the time at which they appear, sometimes coming on soon
after eating them, in other cases not till the lapse of perhaps twenty-
four or even thirty-six hours. Cases also ditler fi-om each other in
the order in which the symptoms are developed. Sometimes symptoms
of irritation of the alimentary canal precede the nervous symptoms,
but sometimes they follow them ; and in the same group of cases,
some patients will sufler from symptoms of irritation, others from
nervous symptoms. The symptoms of irritation consist of vomiting,
with or without purging; and the nervous symptoms of headache,
giddiness, dimness or confusion of sight, intoxication, delirium, or
coma.

The post-mortem appearances consist in marks of inflammation in
the stomach and bowels, and of congestion in the brain.

The treatment consists in the prompt use of emetics, followed by a
full dose of castor oil.

Precautions. — As a general rule, highly-coloured mushrooms and
fungi, and those which grow in damp and shady spots, as well as those
which have a disagreeable odour, and astringent taste, are to be re-
jected as articles of food. The orange-coloured amanita muscaria,
which appears in the autumn, is one of the most poisonous species, and
should especially be avoided.

;i2

CHAPTER XX.

1. Aconite.

2. Digitalis.

3. Tobacco.

4. Lobelia inflata.

5. CONIUM.

The poisons contained in this chapter are characterized by the effect
they produce on the organs of circulation and respiration ; their lead-
ing symptom being syncope or asphyxia, while the mental faculties are
generally, but not universally, unaffected. The irritation of the ali-
mentary canal which characterizes the whole class of narcotico-acrids
is, as a general rule, more strongly marked in the case of these poisons
than of those contained in the preceding chapter.

1, Aconite (^Aconitum Napellus, Monkshood, Wolfsbane,
Blue-rocket).

With the exception of the Aconitum ferox, which grows on the
Himalayan mountains in India, the Aconitum napellus is the most
active poisonous plant of the many which go by the name of aconite.
Some of them have no poisonous property whatever. But not only is
the Aconitum napellus, with this single exception, the most active poi-
sonous plant bearing the name of aconite ; it is also, when compared
with other poisonous plants, a very fatal one ; and there is reason to
believe that aconitina, the active principle of the plant, is the most
deadly poison in existence.

Monkshood is a beautiful plant, growing from two to six feet in
height, with dark-green leaves, of very characteristic form, and a ter-
minal spike of rich blue flowers. It grows on hilly ground in many
parts of Europe, is supposed to be indigenous, and is often cultivated
as a garden flower. It belongs to the Linnajan class and order, Foly-
andria trigynia, and the natural order Ranunculacece, or crowfoots.

All parts of the plant are poisonous, but the root is the most active.
Both the root and the haves have been several times taken as poisons ;
and liie extract and tincture have also proved fatal.

The London Pharmacopoeia contains two preparations of monkshood ;
an extract from the bruised leaves, and a tincture from the coarsely
powdered root. The dose of the extract is from one to two gi'ains,
and that of the tincture from three to five drops.

ACONITE.

513

The leaves, seeds, and root of the Aconitum uapellus are
identified.

The leaves are completely divided to the base into five wedge-shaped
lobes, which are again divided into three, the segments being linear.
They are not liable to be mistaken for the leaves of any other plant.

The seeds are numerous, three-sided, iiregularly twisted, and
wrinkled, of a black or dark -brown colour, about a sixth of an inch
long, and weighing 25 to the grain. Fig. 67 shows their size and
shape, and fig. 68 the markings on their surface, as seen under the

Fig. -67.

Fig. 68.

microscope. A single seed contains enough of the active principle of
the plant to produce numbness and tingling of the lips, tongue, and
throat.

The root requires to be more minutely described, since it has, on more
than one occasion, been scraped and eaten instead of the horse-radish.
This accident occurred in 1836 to a Mr. and Mrs. Prescott and their
child, whose cases are minutely described by Dj-. Pereira ; in 1842 to
a lady residing at Lambeth (Taylor); so lately as the winter of 1853
to two brothers, of whom one died and the other recovered. Still
more recently, in the winter ot 1856, the poison proved fatal to two
priests at Dingwall, and to a third person out of five who were affected
at a dinner there. In the next year, 1857, a case occurred in London.
Besides these accidental cases, the root has been given intentionally in
one instance at least.

It is not easy to understand how the root of monkshood should
have been mistaken for that of the horse-radish, even though the
respective plants were not attached to the roots to render the mis-
take impossible ; and though the section of both roots is white when
fresh, the scrapings of the two roots are distinguishable, the monkshood
being friable and succulent, the horse-radish tough ahd stringy, and the
first soon acquire a pink colour while the second retain their whiteness.
The monkshood-root differs from that of the horse-radish in shape, in
colour, and in taste. The root of monkshood is conical, and throws
off a large number of curling fibres, and it is not tmusual to find
one or more pear-shaped tubers, attached by naiTOW necks to the upper
part of the root-stock, as in the specimens shown in the three figures
annexed, which, with the single root in fig. 70, were selected out of
a large number of freshly-dug roots of Aconitum uapellus, as pre-

2l

EXPERIMENTS ON ANIMALS. 515

sentiDg the most characteristic varieties of form. The figures are of
the size of the roots themselves. On the other hand, the root, or,
as it is commonly called, the stick of the horse-radish (fig. 71) is
cylindrical in all its larger branches, and throws off straight rootlets.
The colour of the monkshood-root is a dark nut-brown externally,
that of the horse-radish is buff-coloured. The root of the monkshood
when chewed causes a peculiar tingling and numbing sensation in the
lips, with a feeling of enlargement, and a similar sensation in the
throat, when swallowed ; and this sensation in the lips and throat con-
tinues for several hours : the taste of the horse-radish is pungent and
sweet ; causing profuse lacrymation, but not being very persistent.

This peculiar property which the root of the monkshood possesses, of
causing numbness and tingling of the lips, is shared by the other parts
of the plant, such as the leaves and seeds.

Experiments on Animals. — Experiments on animals have been made
with monkshood, and its active principle aconitina, by Sir B. Brodie,
Orfila, Christison, and Pereira, and more recently by Drs. Fleming and
Headland. According to Dr. Fleming, aconite, when introduced into
the system of one of the lower animals, causes, successively, weakness of
the limbs and staggering; accelerated, or slow and labouring respiration ;
paralysis ; diminution or total loss of sensibility of the surface ; dim-
ness of vision, or actual blindness ; increasing difficulty of breathing ;
and, after a few spasmodic twitches, death by asphyxia. On examining
the body immediately after death, the heart is found beating with con-
siderable strength, which it continues to do for some time ; the peristaltic
action of the intestines also continues ; the irritability of the voluntary
muscles is impaired but not extinguished; there is general venous con-
gestion, with distension of the right side of the heart and large veins,
and venous blood is usually found in. the left cavities of the heart, and
in the aorta. The venous system of the brain is often gorged with
blood. Dr. Fleming adds that in some of his experiments there were
decided convulsive movements, and, in two instances, distinct opistho-
tonos ; that in general the pupil was more or less contracted ;* that
the pulse became weaker and less frequent ; and that the poison did
not appear to give rise to any local imtation. From other experiments
of Dr. Fleming's it would appear that aconite* proves poisonous to
vegetables.

From Dr. Fleming's experiments, then, it would seem that aconite
occasions muscular debility or actual paralysis, extending from the
muscles of the extremities to those of the chest ; that it acts as a sedative
to the heart; that it impairs or destroys common sensibility ; and that
it proves fatal by inducing asphyxia. Asphyxia, however, is not the
only mode of death in poisoning by inonkshood ; for Dr. Fleming dis-
tinctly recognizes three possible modes of death. 1. It may prove

* This statement is opposed to Dr. Headland's experience. He found that it
caused in animals dilatation of the pupil, but in a less degree than belladonna.
('Lancet,' March 29, 1856.)

51G ACONITE.

fatiil by a powerfully sedative impression on the nervous system, death
tiiking place in a few seconds ; 2. It may prove fatal by suspension of
the respiratory function ; and 3. It may prove fatal by syncope.
Shock, asphyxia, and syncope, then, are the three modes of death in
animals poisoned by aconite. In the human subject, accoi'ding to Dr.
Fleming, syncope is the common cause of death.

The symptoms of poisoning by monkshood in the human subject
are : — numbness, tingling, and burning heat in the mouth, throat, and
stomach, followed by nausea and vomiting, with pain and tenderness
of the epigastrium. The numbness and tingling speedily become
general, with diminished sensibility of the surface, vertigo, dimness of
vision, or complete blindness, tinnitus aurium, and occasionally deaf-
ness ; frothing at the mouth ; sense of constriction in the throat, with
sensations of weight and enlargement of various parts of the body,
but especially of the face and ears ; great muscular feebleness, with
genei'al trembling ; more or less difficulty of breathing, and speechless-
ness ; a distressing sense of sinking at the pit of the stomach, and
dread of approaching death. The pulse becomes small, feeble, irregular,
and finally imperceptible both at the wrist and heart ; the extremities,
and afterwards the whole body, become cold, and a clammy sweat
bedews the surface ; finally, the countenance grows blanched, the lips
bloodless, and with a few hurried gasps the individual expires. He
usually retains perfect possession of his mental faculties till the last,
and exhibits no tendency to sleep ; or there may be slight wandering
delirium. The fatal result is often sudden.

Fost-mortem Appearances. — These are general venous congestion,
and, in some cases, engorgement of the brain and its membranes, with
considerable sub-arachnoid effusion ; also occasionally signs of gastro-
intestinal irritation.

Commencement of Symptoms. — The symptoms of poisoning may
commence in a few minutes, or not for one or two hours.

Fatal Feriod. — The preparations of aconite may destroy life in as
little as an hour and a quarter. The extreme limit of survivorship
appears to be twenty hours. The average is less than four hours, and
the majority of deaths occur within three hours.

Fatal Dose. — Of ihe root, it is believed that less than a drachm has
proved fatal ; of the alcoholic extract, four grains ; of the tincture, a
drachm. But very severe symptoms have been produced by much
smaller quantities. Dr. Headland thinks that so little as a tenth of a
grain of the alkaloid aconitina would destroy an adult male ; and Dr.
Herapath performed an analysis in a case at Bristol, from which he
inferred that ^'^th of a grain had proved fatal.

Treatment. — There is no antidote to this poison, unless animal char-
coal, recom.raended by Dr. Headland, is to be considered in that light.
The treatment will therefore consist in the prompt administration of an
emetic, followed, after an interval of time, by a full dose of castor-oil.
The remote effects of the poison must be met by stimulants, such as

DIGITALIS. 517

hot brandy and water, and ammonia. Strong coffee may also be given
with advantage. Dr. Fleming also recommends friction along the
course of the spine, and on the extremities, with warm cloths and spi-
rituous liniments, and sinapisms, or bottles of hot water to the prsecordia
and extremities. Convulsions, should they come on, are to be treated
by opening the jugular vein ; and great dyspnoea, and extreme feeble-
ness of the heart's action, by artificial respiration, and slight galvanic
shocks passed through the heart.

Diagnosis. — In some instances we are able to identify some portions
of the plant itself in the contents of the alimentary canal. An alcoholic
extract of the contents of the stomach may be tested by the taste.
The numbness and tingling of the lips would serve to prove the pre-
sence of aconite. Dr. Headland suggests that we should administer to
some of the smaller animals an alcoholic extract of the contents of the
stomach previously reduced by evaporation.

ACONITINA (aconitine).— This alkaloid is so active a poison that,
according to Dr. Headland's experiments, 3^ grain will kill a mouse;
•j^, a small bird in a few minutes, and 3L almost instantaneously;
g'o of a grain a cat, and j'g of a grain the same animal in twenty minutes
or half^ an hour. Dr. Headland is of opinion that jL of a grain would
prove fatal to an adult man. This estimate appears to be borne out by
Dr. Herapath's case, y;^ grain causes tingling and numbness of the
tip of the tongue, and -^ of a grain dissolved in spirit, and rubbed
into the skin, causes loss of feeling, lasting for some time. Aconitina
may be separated from organic liquids by the method of Stas (p. 505),
or by a similar method suggested by Dr. Headland. In the fresh root,
the alkaloid is contained in the proportion of a quarter to three quarters
of a grain in the ounce, and in the dried root, of twelve to thirty-six
grains to the pound.

Properties. — Aconitina may be obtained in a crystalline form, but
generally it is seen as a white powder. It is sparingly soluble in water,
but soluble in alcohol and ather, and in acids. Its salts are not crys-
talline. It has an acrid taste, and strong alkaline reaction. It resembles
the other alkaloids in melting and depositing carbon when heated by the
spirit-lamp, and in being precipitated by the solution of iodine in iodide
of potassium, and by tannin.

Tests. — a. Strong sulphuric acid dissolves it without change of
colour, but when heated, it assumes a deep brown tint. b. A solution
of bichromate of potash added to the acid solution colours it yellow,
c. A solution of the peimanganate of potash added to the same solu-
tion is bleached, d. Nitric acid dissolves it, without change of colour.
e. The terchloride of gold gives a yellowish-white precipitate. /. The
bichloride of platinum yields no precipitate.

2. Digitalis {Digitalis purpurea — 'Foxglove, purple foxglove).
This is an indigenous plant, commonly met with about banks and
hedge-rows, and in pastures, on a gravelly or sandy soil. It is also

518 DIGITALIS.

cultivated in gardens, and is easily recognized by its purple dotted
Howers.

It beloncrs to the Linnaean class and order Didynamia angiospermta,
and natural order Scrophiilariaccx, or figwoits.

All the parts of the plant are believed to be poisonous, and the leaves
have more than once destroyed life.

The plant owes its poisonous property to the alkaloid digifalia, which
exists in the fresh leaves in the proportion of less than one per cent.
The leaves of the foxglove are officinal in the London PharmacopoBia.
The dried leaves powdered are given in doses of from one to three
grains ; an infusion made from the dried leaves is-given in doses of from
|ss. to ^i. ; and a tincture, also prepared from the dried leaves, in doses .
of from ten drops to half a drachm, cautiously increased.

The root of the foxglove consists of numerous long and slender
fibres, and is not, therefore, likely to be confounded with any of the
common edible roots.

The leaves are ovate, narrowed at the base, crenate, rugous, and
veined, downy, especially on the under surface. The dried leaves have
a dull green colour, a faint odour, and a bitter, nauseous taste.

The seeds are of the small size shown in fig. 72, and weigh about

1,126 to a grain. They are of a light browii

^' colour, cylindrical, ovoid or conical in shape, and

when viewed by the lens or microscope, present

the pitted appearance shown in the figure. They

may be mistaken for the seeds of the Lobelia iniflata,

^^f§^^^^ which they resemble in colour and size. They are,

^Mp^B^^y however, larger.

BBr -* «^pF Experiine7its on Animals. — In moderate doses

^ZL—1JL1^^ digitalis causes vomiting, giddiness, languor, and

death in twenty-four hours. In larger doses, in
addition to these symptoms, tremors, convulsions, stupor, and coma.
Injected into the veins, it destroys life in a few seconds, by acting
on the heart and on the pulmonary circulation. In one of Mr.
Blake's experiments, an infusion of three di-achms of the leaves injected
into the jugular vein arrested the action of the heart in five seconds,
that organ after death being motionless, turgid, inirritable, and its left
cavities full of fiorid blood.

Symptoms. — In the human subject, a single fatal dose of the poison
produces the following symptoms: — Vomiting, purging, and severe
colicky pains in the abdomen ; pain in the head, giddiness, and dim-
ness of vision, or actual blindness; a dilated and insensible pupil; a
slow, weak, and irregular, or intermittent pnlse ; nausea and faintness,
with occasional syncope ; the skin is covered with a cold perspiration ;
the patient is much worse when he assumes the upright posture. Sali-
vation is a common occurrence. The urine is suppressed ; convulsions
occasionally occur ; and the patient sometimes continues for a consider-
able space of time in a state of stupor. In two fatal cases death took

EXPERIMENTS ON ANIMALS. 519

place in twenty-two hours. When the poison does not prove fatal, the
recovery occupies several days, and the circulation is slowly restored to
its usual state.

The post-mortem appearances in cases of poisoning by foxglove are
turgescence of the vessels of the brain, and redness of the inner mem-
brane of the stomach.

In consequence of the frequent use of digitalis in the form of infu-
sion or tincture in the practice of medicine, and in consequence, also, of
its tendency to accumulate in the system, cases are of frequent occur-
rence in which serious symptoms show themselves, without terminating
fatally. These symptoms are dryness in the throat, and thirst ; nausea ;
headache ; salivation ; giddiness, and dimness of sight, an appearance
of sparks before the eyes, and a feeling of pressure on the eyeballs ;
with weakness of the limbs, and a weak and rapid pulse.

The symptoms arising from the gradual accumulation of the poison
in the system are nausea, dryness of the mouth, loss of appetite, and
vomiting, and intense thirst ; giddiness, and throbbing of the temples ;
restlessness and sleeplessness ; a hot and moist skin ; great languor and
depression, with, in most cases, a slow pulse. Sometimes there is
diaiThoea, sometimes salivation ; and an increased flow of urine,
delirium, spectral illusions, convulsions, and coma, are among the occa-
sional symptoms.

Fatal Dose. — This has not been accurately ascertained. No poison
in common use is more uncertain in its operation ; and in the treat-
ment of inflanimatory diseases, as well as in delirium tremens, it is
often administered in doses which would have been very unsafe in a
state of health.

Dr. Pereira cites several cases of disease, both in children and adults,
in which the tincture of digitalis was administered in such doses as
twenty drops three times a day to an infant, and from ^^ss. to ^i to an
adult; but in the cases referred to by him, the natural operation of the
poison on the healthy subject was counteracted by disease accompanied
by decided febrile action, or by a state ot intoxication attended by great
excitement of the circulation. It is also possible that the tincture may
not have been, in all these cases, of the best quality.

The treatment of poisoning by digitalis will consist in the use of
emetics, followed by aperients, and by the free use of vegetable infu-
sions containing tannin, such as infusion of nutgalls, or of oak-bark.
Substances containing tannin are given with a view of rendering the
alkaloid digitalia inert. Green tea or strong coffee may also be given
with advantage. Stimulants, such as ammonia, wine, and brandy,
should also be administered, and the recumbent posture should be
strictly preserved. Friction to the spine, though less indicated than
in poisoning by aconite, or when asphyxia is imminent, might be used
with advantage ; and, in desperate cases, artificial respiration, and gal-
vanic shocks through the heart.

Digitalia {digitaline). — Properties. — When pure, this alkaloid is

520 TOBACCO.

a white amorphous substance ; when less pure, of a light yellow or
brown colour. It is sparingly soluble in cold or hot water, and
has an intensely bitter taste. With acids it does not form crystallizable
salts.

Tests. — a. Sulphuric acid dissolves it, and gives it a deep brown
tint, passing to a rich puce colour when heated. After further exposure,
it assumes a crimson hue. b. On the addition of a solution of bichro-
mate of potash to the recent solution in sulphuric acid, the liquid
becomes first yellow, then green, c. A solution of the permanganate
of potash added to the solution in sulphuric acid is bleached, d. Nitric
and hydrochloric acids dissolve it without change of colour. These
reactions were obtained with a specimen of the alkaloid supplied by
Mr. Morson. They differ from those given by Dr. Taylor, on the
authority of M. Homolle (' On Poisons,' p. 835).

The quantity of the alkaloid in the leaves of the plant is less than
one per cent. ; and it is believed that a dose of more than one-sixteenth
of a grain would produce symptoms of poisoning in the adult.

3. Tobacco (Nicotiana tabacum).

The Nicotiana tabacum, or "Virginian tobacco, is a plant which be-
longs, as do so many of our chief poisons — hyoscyamus, belladonna,
stramonium, and dulcamara— to the artificial class and order Pentan-
dria monogynia, and natural order, Solaneae or Solanacea?.

Tobacco contains, as the source of its activity, an alkaloid, which,
like that contained in conium, is a liquid; and a concrete volatile oil,
known as tobacco-camphor. These active ingredients are obtainable
from all parts of the plant, and are contained in the infusion and
decoction, and in the smoke, blended with carbonate and acetate of
ammonia, and several gases.

Experiments on Animals. — The effects produced by tobacco on car-
nivorous animals (for the herbivora are less affected, and differently)
are : nausea, vomiting, sometimes purging, universal tremors, stagger-
ing, convulsions, and stupor. In the experiments of Orfila, 3vss. of
rappee introduced into a dog's stomach, the gullet being afterwards tied,
killed the animal in nine hours; and 3ii applied to a wound killed
another animal in an hour.

Infusion of tobacco, as appears from the experiments of Sir Benjamin
Brodie, paralyses the heart, acting, as other experiments prove, through
the nervous system ; but the empyreumatic oil of tobacco does not
cause paralysis of the heart, as Sir Benjamin Brodie proved by placing
a single drop of it on the tongue of a cat. It caused convulsions and
death in two minutes. On opening the body, the heart was found
beating with regularity and force.

Symptoms. — The effects of tobacco on the human subject are similar
to those which it produces in animals. The first symptoms are

SYMPTOMS. 521

acceleration and strengthening of the pulse, with very transient excite-
ment, sudden giddiness, fainting, and great sickness, accompanied with
a weak, quivering pulse. These effects are, for the most part, transient,
but occasionally they are more serious, and may even prove fatal. Dr.
Marshall Hall relates the case of a young man who smoked two pipes
for his first debauch, and was seized, in consequence, with nausea,
vomiting, and syncope, then with stupor and stertorous breathing,
general spasms, and insensible pupil. Next day the tendency to faint
continued, and in the evening the stupor, stertor, and spasms returned,
but from that time he recovered steadily. Other authors have reported
cases of death from excessive smoking. Fatal results also sometimes
follow the use of tobacco infusion or tobacco smoke introduced into the
bowels. Severe effects have also followed from the abuse of snuff,
from external application of tobacco, and from sleeping surrounded by
bales of the weed.

Commencement of Symptoms. — The symptoms may show themselves
in a few minutes.

Fatal Period. — Eighteen minutes is the shortest fatal period.

Fatal Dose. — Half a drachm (Copland).

Post-mortem Appearances. — These are not very characteristic. Tur-
gescence of the vessels of the brain, and marks of inflammation in the
stomach have been found.

Treatment. — If the tobacco has been taken in substance, and it has
not been discharged by spontaneous vomiting, emetics must be first
administered. The after treatment must consist of the free use of sti-
mulants.

NlCOTlNA {Nicotia). — This alkaloid has acted fatally as a poison
in two instances: one in Belgium in 1851, when it was administered
by Count Bocarme to his brother-in-law, the other in London in 1858,
the act being suicidal. The alkaloid acts with the rapidity, and some-
what after tlie manner of prussic acid. Dr. Taylor found that a single
drop killed a rabbit in three minutes and a half, with tetanic con-
vulsions. The victim of Count Bocarme does not seem to have sur-
vived five minutes ; and in the suicidal case death was quite as rapid.
The patient was observed to stare wildly, and to die without convul-
sions, while heaving a deep sigh.

The post-mortem appearances in this case were general relaxation of
the muscular system, staring eyes, bloated and livid features, the ves-
sels of the scalp and membranes of the brain, and those of the lungs,
gorged with black blood, and the cjivities of the heart, with the excep-
tion of the left auricle, empty. There was intense congestion of the
mucous membrane of the stomach, and of the liver. The blood
was black and liquid, and, in some parts, had the consistence of
treacle. Dr. Taylor detected nicotina in the stomach, liver, and lungs,
by a process similar to that of Stas. (See Taylor, * On Poisons,'
p. 750.)

Properties. — Nicotina resembles conia in being a liquid and volatile

522 LOBEIJA.

alkaloid. When quite pure, it is a colourless oily liquid, but becomes
of an amber colour on exposure to the air, and deepens in tint by
keeping. A drop placed on a white surface of enamelled glass has a
green colour, while conia is pink : and the same difference of colour
obtains if the liquids are dropped on filtering paper, when they
produce a greasy sLain. It has an acrid taste, but a pleasant athereal
odour; while conia has a disagreeable odour, which might be mistaken
for that of stale tobacco. Otto thus describes the odour of nicotina,
and his description is true of two specimens in my possession ; but
Dr. Taylor states that a specimen which he examined evolved the odour
here described as belonging to conia. Nicotina is soluble in water, in
alcohol, and in aether ; and the aqueous solution has a decided alkaline
reaction. With acids, the alkaloid forms fixed salts, and with several
reagents characteristic crystallizable compounds.

Tests. — a. Nicotina resembles conia and the fixed alkaloids in the
effect of heat, and in the precipitates which it yields with the solution
of iodine in iodine of potassium, and with tannic acid. h. Sulphuric
acid combines with it without change of colour, and the mixtuie gives
a yellow tinge to a solution of the bichromate of potash, and a pale
gi'een to that of the ferridcyanide of potassium, c. Nitric acid also
does not change the colour of the alkaloid, d. Terchloride of gold
yields an abundant amorphous yellow precipitate, e. Bichloride of
platinum yields a yellow crystalline precipitate. /. Bichromate of
potash gives a yellow crystalline precipitate, g. Ferridcyanide of po-
tassium yields a yellow crystalline precipitate. A. Corrosive sublimate
throws down a white deposit, which is found to consist of well-defined
groups of transparent plates attached to a darker centre in the form of
flowers, winged insects, and bows of ribbon, i. Oxalic acid gives with
the alkaloid crystals of oxalate of nicotina.

In some of these reactions nicotina resembles ammonia. It is suffi-
ciently distinguished from it by the fact, that ammonia reddens tannic
acid, and gives with the solution of iodine in iodide of potassium a dark-
green precipitate.

4. Lobelia {Lobelia Infiata. Indian Tobacco. Bladder-podded

Lobelia).

Lobelia infiata belongs to the artificial class and order, Pentandria
Monogynia, and natural order Loheliacem. It is a native of North
America, and has long been used by the aborigines: it at length
became a quack medicine among the American irregular practitioners,
was the subject of favourable notice by a clergyman (I))-. Cutler) and
of a work by an English physician. Dr. Reece, in the year 1829, in
which work it was highly commended as an anti-asthmatic.

The herb is usually imported into England by the Shaking Quakers
of New Lebanon, North America, compressed into oblong cakes weigh-
ing half a pound or a pound each, wrapped in blue paper (Pereira),

TREATMENT.

523

Fig. 73.

The seeds, and the powder of the seeds, are sold by all the herbalists.
Both have proved fatal in several instances in America and in
England.

The dried herb is of a pale green colour ; it has a nauseous odour,
and a burning and acrid taste, closely resembling the taste of tobacco.
The taste and odour are believed to be due to a volatile oil, to a
resinous alkaloid (lobelin), and to a peculiar acid.

The seeds of lobelia are brown grains of the small size shown in
fig. 73, and weigh 3176 to a grain. They have
the shape and microscopic characters depicted in
fig. 73.

Lobelia is an active medicine, and a potent
poison. In ten grain or scruple doses of the
powdered leaves or seeds it is a strong nauseating
emetic ; and has, indeed, been termed the emetic
weed. A tea-spoonful or a drachm is sufficient
to destroy life.

The symptoms occasioned by the lobelia are speedy vomiting fol-
lowed by distressing nausea, with headache, giddiness, and tremors,
copious sweats, and extreme depression. Diarrhoea is sometimes
present, and some degree of dysuria is occasionally experienced. Some-
times the pulse intermits, as a consequence of its depressant effect on
the circulation. The fatal event is ushered in by convulsions. Em-
ployed as an enema it acts as tobacco does, causing the same sick-
ness and tendency to faint.

Fatal Dose. — A case of poisoning by gi of the powdered leaves
occurred in England in 1847.

Fatal Period. — In this case death happened in about thirty-six hours.

Post-mortem Appearances. — The mucous membrane of the stomach
is found intensely inflamed, and the vessels of the brain strongly con-
gested.

The treatment of poisoning by lobelia will consist in promoting
vomiting by draughts of warm water, and tickling the throat, follow-
ing this up by the free use of stimulants to counteract the depressing
effect of the poison. As its effects so closely resemble those of tobacco,
it will require the same treatment.

^. CONIUM ( Conium maculatum — HemlocTi. Common or spotted
Hemlock).

This plant grows abundantly in our hedge-rows all over England,
It belongs to the natural order Umbelliferae or parsley tribe, to which
tribe also belong the iEthusa cynapium, or fool's parsley, the Cicuta
virosa, or water hemlock, the (Enanthe crocata, or water dropwort,
and the CEnanthe phellandrium, or fine-leaved water dropwort — all
poisonous plants.

The plant is readily recognized by its tall, smooth, glossy green

524

LOBELIA.

stems, dotted with brownish-purple spots. Its root is tapering, like
that of the parsnep, and its leaves have been often mist<vken for those

Fig. 15.

FlK. 74.

of parsley. The seeds are of the size and shape shown in fig. 74.
They weigh about 20 to a grain, and under the lens have the ribbed
appearance shown in tig. 75. They are distinguished from other
seeds of the umbelliferse by the presence of five prominent wavy
ridges (lig. 75), and the absence of the linear receptacles for volatile
oil teraied vittce. Every part of the plant has a strong unpleasant
odour by which it is readily recognized. This odour is strongly de-
veloped when the plant is rubbed with liq. potassae. The odour has
been compared to that of mice. The active volatile liquid alkaloid
conia on which its poisonous properties depend, has the same mousy
odour.

The part of the plant usually taken as a poison is the leaves. The
effects which they produce are not always the same ; for in some in-
stances they seem to have produced narcotic symptoms, preceded by
intoxication ; in others paralysis of the muscles e.xtending to those of
respiration, and causing death by apncea.

Symptoms. — Dryness and constriction of the throat, headache,
drowsiness, dilated pupil, loss of power in the extremities, passing into
perfect paralysis ; inability to swallow ; pulse small and quick, or slow
and intermitting, and the lespiration embarrassed. Death takes place
from gradual loss of power in the respiratory muscles. Delirium, coma,
and convulsions are occasional symptoms. The pupil is described as
dilated and fixed.

The post-mortem appearances are those proper to apncea, with
redness of the mucous membrane of the stomach, and congestion of the
vessels of the brain.

Treatment. — After emptying the stomach by emetics, a full dose of
castor oil to remove the poison ftom tlie bowels ; followed by the treat-
ment proper to apncea, including the free u^;e of diffusible stimulants.

Commencement of Symptoms. — From a few minutes to a quarter
of an hour.

Fatal Period. — One hour in a child; three hours in an adult.

Fatal Dose. — The smallest quantity that may prove fatal is not
ascertained.

Conia (Conein, conicin, conicina). — This alkaloid destroys life in
the same way — by producing apnoea. It does not seem to paralyze

coNiUM. 525

the heart; but affects the whole system of voluntary muscles, in
common with the muscles of i-espiration. In some experiments on
animals conia has been found to give rise to tetanic spasms. The pupils
were stated to be dilated and insensible.

From experiments on animals it appears that this alkaloid, in doses
of one or two drops, may kill a rabbit, cat, or dog in the short space
of five minutes.

Properties. — Conia, like nicotina, is, when pure, an oily, volatile,
colourless liquid ; but it turns yellow and grows darker by exposure.
Placed on a white surface of enamelled glass it has a pink colour, and
it gives the same colour to filtering paper, on which it leaves a greasy
stain. It has an acrid taste, and disagreeable pungent odour of the
plant itself. The odour may be compared to that of mice, or of stale
tebacco. It is less soluble in water than nicotina, but readily dissolves
in alcohol and aether. The aqueous solution has a strong alkaline
reaction. With acids it forms salts. It forms thick white fumes with
the vapours of nitric, hydrochloric, and acetic acids. In common with
the alkaloids, it deposits carbon when heated, and yields a yellowish-
brown precipitate with the solution of iodine in iodide of potassium,
and a white precipitate with tannic acid.

Tests. — a. Sulphuric acid does not change its colour, and the acid
mixture is tinged pale yellow by a solution of the bichromate of potash,
and by the solution of ferridcyanide of potassium, 6. Nitric acid deepens
its colour, and gives out with it dense white fumes, c. Chloride of
gold gives a yellowish-white precipitate, d. Bichloride of platinum
does not pi-ecipitate it. e. Corrosive sublimate gives a white amorphous
precipitate. /. Oxalic acid forms with it an oxalate of conia, which
is deposited as crystals.

626

CHAPTER XXI.

1. Ergot of Rye.

2. CiCUTA VIROSA.

3. Phellandrium aquaticum.

4. -^thusa cynapium.

5. Cytisus Laburnum.

6. solanum nigrum.

1. Ergot of Rye {Spurred Rye, Secale cormutum).

This substance is the result of a disease attacking the grain of several
plants, such as wheat, barley, oats, and rye, in wet seasons, and in
ill-drained soils. The ear of the plant is occupied wholly, or in part,
by the diseased grains, each of which is of a deep purple colour, elon-
gated, slightly curved, and projecting, so as to bear some resemblance
to a cock's spur. These diseased grains, collected, dried, and powdered,
form the ergot of the shops, used by the accoucheur to promote con-
traction of the uterus, and sometimes criminally administered to pro-
cure abortion.

Properties. — The ergot, in its entire state, varies in length from a
quaiier of an inch to two inches, and in thickness from a sixth to
a third of an inch. Its surface is black, with lighter dotted streaks,
and its substance reddish-grey. It is lighter than water, has a disagree-
able odour, and somewhat acrid taste.

Tests. — a. Liq. potassa? gives it a lake-red tint, and develops the
characteristic odour, h. The filtered alkaline liquid has the same
colour, and lets fall the same coloured precipitate, on the addition of
nitric acid, or a solution of alum in excess.

Experiments on Animals. — The symptoms produced in animals by
large single doses of the ergot, or by smaller doses frequently repeated,
are partly those of intestinal irritation, partly those indicative of
affection of the nervous centres. To the first belong diaiThcea, to the
last, giddiness, dilated pupil, drowsiness, and paralysis. Suppurat-
ing tumours, and gangrene of the extremities, are also among the
symptoms.

In the human subject a single full dose gives rise to irritation of the
stomach and bowels, giddiness, headache, and flushing of the face, with
great lassitude and weariness.

When the spurred rye, or other grain similarly diseased, is mixed
with flour and made into bread it gives rise to an epidemic malady

LABURNUM. 527

which assumes the form either of convulsive or of gangrenous ergotism.
In the first form nervous symptoms, such as giddiness, weakness of the
limbs, mental incapacity, coma, and convulsions predominate ; in the
latter, dry gangrene of the extremities.

The symptoms produced by spurred rye, or by other grain similarly
diseased, present such a combination of intestinal irritation and nervous
affections as to justify the assigning it a place among the nai'cotico-
acrid poisons.

2. CiCfiTA viROSA [Water Hemlock. Cowbane).

This is a perennial, indigenous, umbelliferous plant, growing in wet
ditches and on the banks of streams. It attains three or four feet in
height, has a stunted stem, and large dark-green tripartite leaves.
The leaflets are grouped in twos or threes, narrowly spear-shaped and
serrated ; and the leaf-stalks are of a reddish colour where attached
to the stem. The root stalk, which has been repeatedly mistaken for
parsneps, is hollow and filled with large cells.

In animals the root gives rise to tetanus. In man well-marked
tetanic spasms are also among the prominent symptoms, together with
dilated pupil, insensibility, and coma, nausea, vomiting, and diarrhoea.
Death may take place within an hour of the swallowing of the
poison.

3. PHiiLLANDRiUM AQUATICUM {Fine-leavecl Water Hemlock).

This, too, is an indigenous, umbelliferous plant, growing in similar
situations with the foregoing, and of which the tapering root eaten by
mistake for parsneps has produced poisonous effects. The plant grows
to about three fee't in height, and is furnished with small finely-divided
dark -green leaves.

4. vEthdsa cynapium {Fool's Parsley).

The leaves of this plant, as its name implies, have been eaten by
mistake for parsley. 'J'he roots also have been eaten by mistake for
young turnips. It is an annual umbelliferous plant, growing in
gardens and fields, and may be recognized by the secondary involucres
appended to the flower-stalks, which are composed of three long and
narrow drooping leaflets (bracts). When rubbed, the leaves have a
nauseous odour. When given to animals it occasions convulsions and
stupor. The symptoms in man are heat in the mouth and throat,
nausea and vomiting ; with headache, giddiness, stupor, dilated pupil,
convulsions, and locked jaw.

5 Cytisus Laburnum {Laburnum'),

Every part of this common plant appears to be poisonous, and
cases are recorded of poisoning by the seeds, flowers, and bark. All

528 NIGHTSHADE.

parts of the plant have an extremely nauseous and disagreeable odour
and taste. It owes its poisonous properties to an alkaloid known as
Cytisin. From Christison's experiments with the dried bark, it follows
that the laburnum is an extremely active narcotico-acrid poison,
producing, in the space of a few minutes, violent tetanic convulsions,
and speedy death. In man, the symptoms are those of violent irrita-
tion of the alimentary canal, with great exhaustion, drowsiness, and
rigidity of the limbs, convulsions, dilated pupil, and frequent pulse.

6. SOLANUM NIGRUM {Common Nightshade).

The black berries of this plant have been eaten by mistake, and
have given rise to mixed symptoms of intestinal iiTitation — nausea,
vomiting, colic, and intense thirst ; and cerebral affection, dilated pupil,
stertor, and tetanic convulsions.

The red berries of the Solanum dulcamara, woody-nightshade, or
bitter-sweet, pi'oduce similar symptoms ; but they do not appear to
be a very active poison.

SOLANIA {Solanine). — This is the active principle of the S. nigrum
and dulcamara.

Properties. — Solania is obtained as a white powder, soluble in water,
in acids, and in alcohol.

Tests. — a. Concentrated sulphuric acid gives it a deep yellow tint,
which deepens to a red-brown when warmed, and becomes almost
black when heated. 6. Bichromate of potash, when added to the
solution in sulphuric acid, imparts a faint yellow colour, c. Nitric
acid produces no change of colour, d. It is not precipitated by the
solution of iodine in iodide of potassium, e. It gives no precipitate
with bichloride of platinum.

529

CHAPTER XXII.

1. Oil of Turpentine.

2. Oil of Tar.

3. Kreasote.

4. Oil of Dippel.

1. Oil of Turpentine. — Though this liquid has not yet proved
fatal, it is evidently possessed of poisonous properties, partly irritant,
partly narcotic. Two drachms of the oil have killed a dog in three
minutes, the effects showing themselves immediately in staggering,
cries, tetanus, and failure of pulse and respiration (Professor Schu-
barth, as cited by Christison). In the human subject it is often given
as an aperient, or used as an injection, for the destruction of worms, or
to promote the expulsion of flatus from the bowels. For these purposes
it has been administered in doses of one, two, or three ounces, and has
acted only as an aperient ; but in some instances it has caused violent
irritation of the urinary organs, and in others intoxication, followed
by coma, collapse, and convulsions.

2. Oil of Tar. — This liquid gives rise to similar symptoms, and has
proved fatal, in one instance, in about twenty-four hours.

3. Kreasote. — This is one of the products obtained from wood-tar.
It is named from its property of preserving flesh, and possesses very
powerful antiseptic properties : it is used in medicine, chiefly for the
purpose of checking obstinate vomiting; but it is also employed as
a local application to carious teeth, and externally, inastate of dilution,
in foetid ulcers, and in some skin diseases. If applied to the skin it
destroys its vitality.

Kreasote is an active poison. Thirty drops suffice to kill a rabbit
in one minute. In the human subject, a large medicinal dose produces
irritation of the stomach and bowels, with giddiness, headache, and
drowsiness. Two drachms in a single dose have proved fatal to an
adult in thirty-six hours.

4. Oil of Dippel. — This animal oil is the product of the destructive
distillation of hartshorn, bones, and other animal matters. It has
twice proved fatal in the human subject, but under circumstances
which have prevented a full description being given of the symptoms
occasioned by it. Vomiting was present, and, on examination of the
body, there were marks of irritation of the stomach and bowels, and of
strong corrosive action in the mouth and gullet.

2 M

530 OIL OF DIPPEL.

All the liquids contained in this chapter possess highly characteristic
physical properties, and among others an odour which enables them to
be easily recognized in the contents of the alimentary canal and
throughout the body.

The treatment of cases of poisoning by them will commence with
the use of the stomach-pump, or of emetics ; and as kreasote possesses
the property of promptly coagulating albumen, white of eggs diffused
through water would form an appropriate antidote, a-j well as a suitable
emollient application to the inflamed intestinal canal, in poisoning by
kreasote as well as by the other liquids mentioned in this chaptei-.

531

INDEX.

Abdomen, wounds of, 282.
Abortion, crinnnal, 69.
Acid, arsenious, 369.

„ arsenic, 397.

„ hydrocyanic, 450.

„ muriatic, 336.

„ nitric, 333.

„ oxalic, 344.

„ sulphuric, 32S.

„ tartaric, 349.
Acids, mineral, poisoning by, 325.

„ vegetable, poisoning by, 344.
Aconite, poisoning by, 512.
Aconitina, tests for, 517.
Adipocere, formation of, 218.
^ther, poisoning by, 471.
jEthusa cynapium, poisoning, by, 527.
Age, of the dead, 16.

„ of the foetus, 63.

„ of the living, 13.

„ the teeth as a tpst of, 14.
Air-cells, developed, characters of, 79.
Alcohol, poisoning by, 469.
Alkalis, poisoning by, 340.
Alum, poisoning by, 352.
Amentia, 161.

Ammonia, poisoning by, 343.
Androgyni and androgynae, 17.
Animal heat, extinction of, 210.
„ irritants, poisoning by, 360.
„ matter, diseased, 362.
Antimony, poisoning by, 400.
Apnoea, 221.
Arcus senilis, 15.
Arsenious acid, poisoning by, 369.
Arsenic, acid, 397.

sulphides of, 399.
Arscnite of potash, 397.
„ of copper, 397.
Arseniuretted hydrogen, 399.
Arum, poisoning by, 357.
Asphyxia, 221.
Atelectasis pulmonura, 104.
Atropia, tests for, 504.
Authorities, medical, citation of, xxi.

Banbury peerage case, 25.

Baryta, poisoning by, 354.
Belladonna, poisoning by, 502.
Bichromate of potash, 434,
Bicyanide of mercury, 419.
Binoxalate of potash, 349.
Bismuth, poisoning by, 434.
Bitter almond, poisoning by, 466
Bladder, wounds of, 283.
Bleaching liquids, poisoning by, 353.
Blindness, feigned, 143.
Blood, spots of, on clothes, 26 1.

„ on steel, 266.
Bones, fcetal ossification of, 63.
Born alive, meaning of term, 76, 128.
Boughton, Sir Theodosius, case of, 468.
Brain, inflammation of, 278.

,, injuries of, 275.
Breasts, appearance of, in pregnancy,

48.
Brucia, tests for, 501.
Bruises, 256.
Burns, 285.

Calomel, poisoning by, 418
Camphor, poisoning by, 508.
Cantharides, poisoning by, 360.
Carbonic acid gas, poisoning by, 475.
Carburetted hydrogen, poisoning by,

483.
Cdtamenia, suppression of, 48.
Chest, wounds of, 281.
Chlorides of lime, &c., as poisons, 353.
Chlorine, poisoning by, 363.
Chloroform, poisoning by, 473.
Chrome, salts of, poisoning by, 434.
Circulation, fcetal, 98.
Cicuta virosa, poisoning by, 527.
Coccnlus indicus, poisoning by, 510.
Colchicum, poisoning by, 357.
Cold, death by, 290.
Compression of the brain, 276.
Conception, unconscious, 53.
Concussion of the brain, 275.
Confessions, law relating to, xxi.
Conia, 524.

Conium, poisoning by, 523.
Contusions, 256.
Convulsions, feigned, 141.

532

INDEX.

Copper, poisoning by, 427,

Copperas, poisoning by, 434.

Corrosive sublimate, poisoning by, 407.

Corpus luteum, 51.

Cretinism, 166.

Cyanide of potassium, 465.

D.
Darnel, poisoning by, 510.
Daturia, tests for, 508.
Dead, the, identity of, 8.
„ age of, 16.
„ sex of, 20.
Deafness and dumbness, feigned, 144.
Death-bed declarations, xxii.
Death, real and apparent, 206.
„ causes of in infants, 103.
„ signs of, 208.
„ sudden, 219.
Declarations, death-bed, xxii.
Deformities, feigned, 137.
Delirium, 158.

„ tremens, 159.
Delivery, signs of, in the living, 59.

„ in the dead, 60.

„ sudden, 106,

„ imconscious, 53, 62.
Delusions and illusions, 154.
Dementia, 167.

„ senile, 168,

„ feigned, 197,

Diaphragm, wounds of, 282,
DigiUlla, tests for, 519,
Digitalis, poisoning by, 517,
Dippel, oil of, 529.
Discharges, feigned, 139.
Diseases, feigned, 135.

„ rules for detection of, 147,
Douglas peerage case, 2.
Dreaming, 154.
Drowning, death by, 230.
Drunkenness, 160.
Ductus arteriosus, obliteration of, 99.

Ecchymosis, 256.
Embryo, growth of, 63.
Emphysema, of fostal lungs, what? 88,
Epispadians, 19.
Ergot of ryp, poisoning by, 526.
Essence of bitter almonds, 466,
Evidence, medical, xix.
Exaltation, 176.

Examination, rules for, in abortion,
74.

„ feigned diseases, 147,

« impotence, 33.

„ infanticide. 111.

„ poisoning, 312.

„ rape, 45.

Face, wounds of, 279.
Feigned diseases, 135, 145.

„ insanity, 196.
Fire, death by, 285.
Fish, poisonous, 361.
Foetal circulation, 98.

„ lungs, diseases of, 104.

„ skull, fractures of, 107.
Foeticide, 68.
Foetus, growth of, 63,
Foramen ovale, obliteration of, 100.
Foxglove, poisoning by, 517.
Fungi, poisonous, 510,

G.

Gardner peerage case, 119.
Gases, irritant, 363.

H.
Hair, fraudulent discolouration of, 4.
Hanging, death by, 239.
Head, injuries of, 275.
Heart, wounds of, 281.
Hellebore, poisoning by, 358.
Hemlock, poisoning by, 523.
Henbane, poisoning by, 505.
Hermaphrodites, 17.
Homicidal mania, 176.
Hydatids in womb, 50.
Hydrocyanic acid, poisoning by, 450.

„ „ tests for, 451.

Hydrochloric acid, poisoning by, 336.
Hydrostatic test, 85v
Hyoscyamia, tests for, 507.
Hyoscyamus, poisoning by, 505.
Hypospadians, 18.
Hymen, the, 35.

I.

Identity, personal, 1.
Idiocy, 161.

„ feigned, 196,
Illusions, spectral, 153.

„ and delusions, 154.
Imbecility, 162.

„ feigned, 197.

Immaturity of the foetus, signs of, 124.
Impotence, 24.
Infanticide, law relating to, 75, 113.

„ by omission, 110.

Inflati' n of foetal lungs, 89.
Insanity, 149.

„ feigned, 196.

,, plea of, in criminal cases, 186.
Intestines, wounds of, 283.
Iodide of potassium, poisoning by, 306.
Iodine, poisoning by, 365.
Iron, salts of, poisoning by, 434.
Irritant gases, poisoning by, 363.

„ poisons, 316.

533

Irritants, animal, 360.
„ mineral, 364.
„ vegetable, 355.

J.
Jardine, case of, 121.

K.

Kreasote, 529.

Laburnum, poisoning by, 527.
Laurel water, poisoning by, 468.
Ijcad, poisoning by, 42(».

,, action of water on, 425.

„ colic, 424.

„ palsy, 424.
Legitimacy, 114.
Legge V. Edmonds, case of, 30.
Tyeraon Juice, spots of, on steel, 266.
Life-assurance, 129.

Light, what, needed for identification, 7.
Lightning, death by, 288.
Tiive birth, proofs after respiration, 73.

before respiration, 77.
Liver, wounds of, 283.
Living, the, age of, 13.

„ identity of, 2.

„ sex of, 17.
Lobelia inflata, poisoning by, 522.
Lolium temulentum, poisoning by, 510.
Lungs, diseases of, in infants, 104.

„ foetal appearance of, 78.

„ effect of respiration on, 79, 93.

„ weight of (absolute), 82.

,, weight of (relative), 83.

„ wounds of, 281.

M.

Maceration, intra uterine. 77.
Mania, 169, 179.

„ general, 169.

„ intellectual, 171.

„ moral, 172.

„ with lucid intervals, 176.

„ feigned, 197.
Marsh's test for arsenic, 381.
Maturity of foetus, signs of, 124.
Meconic acid, tests for, 442.
Medical evidence, xix.
Melancholia, 176.
Membranes, false, 50.
Menses, suppressed, 48.

„ first and last appearance of, 52.
Menstrual fluid, characters of, 40,
Mercury, polsomng by, 407.
Mercurial salivation, 413.

„ tremors, 416.
Mezereon, poisoning by, 356.
Mind, unsoundness of, 149.

Mineral acids, poisoning by, 325.
Moles, 50.

Monkshood, poisoning by, 512.
Monomania, 174.

,, feigned, 199.

Monsters, inheritance of, 128.
Morphia, tests for, 441.

„ poisoning by, 448.
Muriatic acid, poisoning by, 336.
Mushrooms, poisonous, 511.

N.
Narcotic gases, poisoning by, 475.

„ poisons, 435.
Narcotico-acrid poisons, 485.
Nicotia, tests for, 521.
Nitre, poisoning by, 351.
Nitric acid, poisoning by, 333.
Nitrous acid gas, poisoning bj-, 335.
JVoti compos nuntis, fonns of, 152.
Notes, use of, in courts of law, xxi.
Nux vomica, poisoning by, 489.

G^nanthe crocata, poisoning by, 509.
Oil of bitter almonds, poisoning by, 466.
Opium, poisoning by, 439.
Ovum, characters of, 63
Oxalic acid, poisoning by, 344.

Pain, feigned, 143.
Paralysis, feigned, 142.
Pelvis, male and female, 21.
Penis, malformation of, 26.
Persons found dead, 202.
Phellandrium aquaticum, 527.
I'hosphorus, poisoning by, 364.
Picrotoxla, tests for, 510.
Ploucquet's test, 83.
Potash, poisoning by, 340.
„ nitrate of, 351.
„ sulphate of, 352.
„ bitartrate of, 350
Poisoning, evidence of, 304.
Poisons, 293.

„ definition of, 293.
„ mode of action of, 295.
„ causes which modify their ac-
tion, 300.
„ classification of, 313.
„ irritant, 316.
„ narcotic, 435.
„ narcotico-acrid, 485.
Post-mortem inspection, 206.
I'otash, poisoning by, 340.
Pregnancy, following rape, 45.
„ signs of, 47.

„ duration of, 114.

„ in animals, 117.

634

INDEX,

Pressure, as distinguishing respiration

(\nd inflation, 90.
Putrefaction in air, 212.

„ in water, 217.

Q.

Quickening, 48, 116.

R.
Ilape, 33.

„ physical signs of, 34.

„ simulated by disease, 38.

Red precipitate, poisoning by, 419.

Reinsch's test for arsenic, 385.

Resjiiration in the womb, 96.

„ vagina, 96.

„ bafore complete delivery, 96.
„ signs of, 78.
Rigidity, cadaveric, 211.
Rust, spots of, 267.

Salivation, mercurial, 413.

Salt, common, poisoning by, 353.

Savin, poisoning by, 356.

Scars as means of identification, 3.

Secale comutum, poisoning by, 526.

Seminal spots, characters of, 41.

Senile dementia, 168.

Sex, 17.
„ doubtful, 17.

Silver, Siilts of, poisonitig by, 433.

Skeleton, measurements of, 10.
„ male and ffmale, 20.

Skull, fractures of, 275.
„ foetal, fractures of, 107.

Soda, poisoning by, 342.

Solanum nigrum, poisoning by, 528.

Somnambulism, 156.

Spectral illusions, 153.

Spencer, Earl, on gestation in the cow,
117.

Spermatozoa, 41.

Spine, injuries of, 279.

Spontaneous combustion, 2?7.

Spots of blood, 263.
„ semen, 41.

Starvation, death by, 291,

Stomach, foetal, contents of, 97.
wounds of, 283.

Stramonium, poisoning by, 507.

Strangulation, 247.

„ of new-born child, 106.

Strychnia, poisoning by, 488,

Sue, M., his measurements of the skele-
ton, 10.

Suffocation, death by, 251.

Suffocation of infants, lf)5
Suicidal monomania, 175;
Sulphuretted hydrogen, poisoning by,

482.
Sulphuric acid, poisoning by, 328.
Sulphuret of potassium, poisoning by,

353.
Superfcetatlon, 51.
Survivorship, 226.

T.

Tar, oil of, 529,

Teeth, as a test of age, 14.

Testicles, disease and defect of, 28.

Throat, wounds of, 279.

Tin, poisoning by, 432.

Tobacco, poisoning by, 520.

Townshend, Col., case of, 208.

Toxicology, 293.

Trickey, James, case of, 478,

Tumours, feigned, 136.

Turpantine, poisoning by, 529.

U,

Ulcers, feigned, 137.
Umbilical vessels, obliteration of, 99.
Umbilical cord, changes after birth, 101.
Unsoundness of mind, 149.
„ feigned, 196.

Uterus, changes in, in pregnancy, 48,
„ appearance of, after death, 50,
Uterine maceration, 77.
„ respiration, 96.

Vaginal respiration, 96.
Vegetable acids, poisoning by, 344.

„ irritants, poisoning by, 355.

„ decayed, poisoning by, 358,
Veratria, poisoning by, 358,
Viability of children, 121,
Violation during sleep, 44.
Virginity, signs of, 35.

W.

White precipitate, poisoning by, 419,
Witnesses, medical, duties of, xix.
Wounds, 255.

„ as means of identification, 4,

„ contused, 256,

„ incised, 259.

„ gun-shot, 261.

Y. Z.

Yew, poisoning by, 356.
Zinc, poisoning by, 431.

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