Textbook of
FORENSIC MEDICINE
AND TOXICOLOGY

BY

R. J. M. BUCHANAN, M.D., F.R.C.P.LOND., &c.

PROFESSOR IN FORENSIC MEDICINE AND TOXICOLOGY,
UNIVERSITY OF LIVERPOOL;

HONORARY PHYSICIAN, ROYAL INFIRMARY,
LIVERPOOL;

FORMERLY HONORARY PHYSICIAN,
STANLEY HOSPITAL;

ASSISTANT HONORARY PHYSICIAN,
LIVERPOOL CHEST HOSPITAL, ETC.

EIGHTH EDITION,
REVISED AND ENLARGED

NEW YORK

WILLIAM WOOD AND COMPANY

MDCCCCXV

PRINTED IN GREAT BRITAIN

The present edition of Forensic Medicine, Toxicology, and Public Health has been issued in two volumes; the first, on Public Health, written by Professor Hope, has been already published separately. Hitherto the subjects have been dealt with in a single volume under the title of Husband‘s Forensic Medicine, but as they are now being taught by different lecturers and in separate classes in most of the medical schools, it has been thought advisable to issue the work in two parts. This volume on Forensic Medicine and Toxicology has been revised throughout, and certain alterations and additions have been made, whilst at the same time the view that the work is intended for students and junior practitioners has not been lost sight of.

The author expresses his indebtedness to Dr. M‘Fall, Demonstrator of Toxicology in the University of Liverpool, for his assistance in revising the section on “Toxicology,” and also to the publishers for the compilation of the index.

Apart from the general bibliography mentioned in the text, the works of Taylor and Stevenson, Dickson, Mann, Glaister, Petersen and Haynes, have been consulted.

A plate, showing the centre of ossification in the lower epiphysis of the femur in a full time fœtus, has been introduced at the last moment, and will be found opposite page 64. References to the subject may also be found on pages 33 and 174.

Medical Jurisprudence, Forensic Medicine, or Legal Medicine are terms for that science which teaches the application of the knowledge of all branches of medical and surgical science and art to the solution of every question connected with the conservation of the species and the administration of Justice. We find traces of this science in the Jewish law; among the Egyptians, according to Plutarch; and even among the Romans as early as the times of Numa Pompilius. Among German writers the term State Medicine includes both Medical Jurisprudence and Medical Police, Public Health, or Sanitary Science.

The special knowledge requisite to the Medical Jurist differs in many ways from that requisite for the art of healing the sick. The majority of medical students and practitioners may consider a simple exercise of common sense in the application of their general professional knowledge to the elucidation of problems of medico-legal import all that is requisite, and that no special training is necessary for the purpose. They may hope that it may never fall to their lot to be called upon to act in the capacity of medical jurists. It may occur, however, to any medical practitioner at any time of his professional career that his services be requisitioned by law for the purpose of elucidating problems of such a nature as will demand from him thought and judgment quite apart from those he exercises in the ordinary course of his medical and surgical practice. From such a requisition he has no escape; he cannot shift his responsibility to another, and it behoves him, therefore, to acquire a knowledge of Forensic Medicine, in order to guide him, when so called upon, to give such evidence as will enable a judge and jury to arrive at a just conclusion. The relations of all medical practitioners to the State are twofold—first, as healers of disease, and secondly, both as guardians of the innocent against unfounded criminal charges and aids towards the detection and punishment of crime.

The Coroner‘s Court.—The office of coroner is mentioned in a charter in 925. Coroners were formerly chosen for life by the freeholders of the district, but their election is now in the hands of the County Councils. Their duties were first clearly pointed out by the Act 4 Edw. I. c. 2, 1275 (De officio coronatoris).

At the present time the duties of the coroner are chiefly to hold inquiry into the cause of death when there is any reason to doubt that death resulted from natural causes.

When death results from natural causes, and under ordinary conditions, the medical attendant is bound, under a penalty of forty shillings, to certify as to the cause. The registrar of deaths accepts such a certificate when accompanied by oral testimony given by a person who was present at the time of death, and issues a certificate accordingly, authorising the interment of the deceased.

Should conditions obtain to prevent the medical attendant from forming an opinion as to the cause of death, or which would lead him to infer that death did not take place from natural causes, he should notify the matter to the coroner. Such would be necessary if death were directly or indirectly due to accident, or if death occurred within a reasonable time after an accident, although due to some other cause, or if an accident happened to deceased during the course of a chronic illness, the accident, however, not being in itself necessarily fatal.

It would be necessary also to notify the coroner if the death took place under circumstances which, to the medical attendant, appeared suspicious, such as might arise from culpable neglect or cruelty on the part of persons in charge of the deceased. The same would apply to cases in which the cause of death was unknown. A great responsibility rests on the medical practitioner, in that he is compelled under a penalty to certify as to the cause of death; while if he do so without due consideration, or carelessly, he renders himself liable to censure or legal proceedings.

It may happen that in certain cases—for example, where an accident befell the deceased during the course of a lingering illness, and which in itself had no causal relations to the death—the doctor may be prone to certify the death as from the illness alone, taking no note of the accident; and pressure may be brought to bear upon him by the relations of the deceased to so certify and save them the trouble and publicity [Pg 3] of an inquest. It should be remembered, however, that although the certificate be accepted by the registrar, and interment take place, the coroner, if informed of the matter, may order the body to be exhumed for the purposes of inquest.

There are coroners who, on receipt of information of death from uncertain causes, may elect, on evidence obtained apart from the medical practitioner, to notify the registrar authorising the interment without holding an inquest. The law, however, states that, “except upon holding an inquest, no order, warrant, or other document for the burial of the body shall be given by the coroner” (50 and 51 Vict.).

The Coroners Act (50 and 51 Vict.) provides that, when a coroner is informed that the dead body is lying within his jurisdiction, and there is reasonable cause to suspect that such person has died a violent or unnatural death, or a sudden death, of which the cause is unknown, or died in prison, he shall summon a jury of not less than twelve, or more than twenty-three, men to inquire touching the death of such person aforesaid.

If the deceased were attended at his death, or during his last illness, by a legally qualified medical practitioner, the coroner may summon such practitioner as a witness. If the deceased were not so attended in his last illness, the coroner may summon any legally qualified medical practitioner in actual practice, in or near the place where the death happened, to give evidence as to the cause of death. In either case the coroner may require the medical witness to make a post-mortem examination of the body, with or without analysis of the contents of the stomach or intestines.

Should a statement on oath be made by any one before the coroner, that in his belief the death of the deceased was caused partly or entirely by the improper or negligent treatment of a medical practitioner, such medical practitioner shall not make or assist at the post-mortem examination.

If a majority of the jury are not satisfied with the medical evidence, they may require the coroner, in writing, to summon another legally qualified practitioner, named by them, to make a post-mortem examination, with or without analysis of the contents of the stomach and intestines, and give evidence as to the cause of death. A medical practitioner who fails to obey the summons of a coroner, issued in pursuance of the Coroners Act, is liable to a penalty not exceeding five pounds, unless he shows good and sufficient cause for not having so done. When evidence has been given before a coroner or magistrate, and the case is afterwards sent for trial, copies of the medical report and depositions are given to the judge and counsel, so that evidence given at the trial is compared in detail with that given before the coroner or magistrate. In view of this, it is imperative on the part of medical witnesses to carefully consider their evidence before giving it.

The object of a coroner‘s inquest is to ascertain whether the death of the person, over whose body the inquest is held, was due to natural causes or not. [Pg 4]

The proceedings are not directed against any one, they do not constitute a trial, and hearsay evidence is admissible. The coroner and jury alone have the right to interrogate the witnesses. Counsel may be present in the interest of persons concerned with the inquest who may desire such assistance, but counsel may not cross-examine any witnesses, and may only question them by permission of and subject to the decision of the coroner.

Witnesses are examined on oath, their evidence is taken down, and should the case be transferred to a superior court, they are bound under a penalty to appear and give evidence. The coroner may adjourn an inquest for the purpose of obtaining further evidence, if he should deem it necessary.

Should the verdict of the jury charge a person with murder, the coroner issues a warrant for the arrest of the person, unless the person be already in custody. In the case of manslaughter the coroner may accept bail. According to the Act 4 Edw. I. c. 2, the coroner and jurors must view the body, this being absolutely necessary to give jurisdiction to him, and he has the power, within a convenient time after the death, to order a dead body to be disinterred for this purpose.

Order of Summons from the Coroner to a
Legally Qualified Medical Practitioner

Prosecution.—There was no Public Prosecutor in England until some years ago, when an Act was passed authorising the appointment of such an official, who should undertake the duty of prosecuting in certain and specific cases of public importance, and in districts where the appointment might be agreed upon. In ordinary circumstances it has usually been left to the person against whom a crime has been committed to prosecute the offender.

Magistrates‘ Court.—In the Magistrates‘ Court of Petty Sessions, the proceedings are for the purpose of investigating as to the culpability or non-culpability of a person accused of some criminal act, or criminal negligence. [Pg 5]

In this Court the accused person must be present, as the inquiry is relative to his guilt or innocence. Witnesses in this Court may be examined and cross-examined by counsel. A magisterial investigation cannot take place if no arrest have been made. The magistrate may deal summarily with cases of simple assault and such-like of minor import, but when the case is of a more serious nature, and in suspected manslaughter or murder, the accused person is committed to a superior Court for trial, such as the Court of Quarter Sessions, the Assize Court or, in London, the Central Criminal Court, all witnesses, medical or lay, being bound over to appear and give evidence. The summons to the Assizes is called a subpœna, and all witnesses receiving the same, when accompanied with reasonable travelling expenses, are bound to obey it.

Assizes.—The Assizes comprise two Courts, the Crown Court and the Civil Court. A separate judge presides over each. In the former only cases of a criminal nature are tried; in the latter suits are tried between two parties. Medical practitioners may be called upon to give evidence in either Court, according to the nature of the case in which they are directly concerned.

Prior to a case being investigated by a judge and petty jury, it has to come before the grand jury. This jury decides whether the case is a proper one to proceed to trial.

The grand jury hear the evidence of such witnesses as they think fit, apart from counsel. Should the grand jury consider the case one for trial, they return a “true bill,” and it goes before the judge and petty jury; if not, they “cut the bill,” and the accused is discharged.

Medical witnesses may be called upon, when under subpœna, to give evidence before the grand jury.

The Crown Court of Assize consists of a judge and a sworn jury of twelve men, called the petty jury. The latter hear the evidence of witnesses, and are guided by the summing up of the judge. They deliver a verdict after consideration of the evidence by which the accused person is found guilty or not guilty. The judge, after receiving the verdict, allots such punishment as he considers just. In certain cases the prisoner when convicted may appeal to the Court of Criminal Appeal.

In the Assize Courts only barristers can plead; in the Magistrates‘ Courts of Petty Sessions, solicitors or barristers may plead.

In the Courts of Assize the witnesses are subject to the following routine of examination. First, Examination-in-chief: this the witness undergoes at the hands of the barrister who is pleading on behalf of the party by whom the witness is called. In this examination such questions are put to the witness as may elicit answers conveying to the judge and jury a clear account of all the witness knows with regard to the case. After the examination-in-chief, the counsel of the opposite side subjects the witness to cross-examination, in such a way as to shake the evidence given by the witness during his examination in chief in points which would weigh against the prospects of his client. It is during cross-examination that a medical witness [Pg 6] may be subjected to questions which suggest answers capable of a different interpretation from those he had previously given. After cross-examination, the counsel for the party upon whose side the witness appears subjects the latter to re-examination, if he consider it necessary, during which he endeavours to clear up any doubtful points in the evidence given by the witness during cross-examination, with the purpose of eliciting an explanation of their meaning.

The judge and members of the jury may put such questions to the witness as they may consider necessary.

The same method of procedure applies to the higher Courts.

In Scotland public prosecutors are appointed by the Crown. The chief public prosecutor is the Lord-Advocate; next in rank come the Deputy-Advocates and Procurator-Fiscal. The Lord-Advocate and Deputies take charge of cases in the High Courts of Justiciary, the Procurator-Fiscal in the lower Courts.

The duties of the public prosecutor are to bring all accused persons to a bar of justice; and in addition he acts as the coroner does in England. Any person who is supposed to know anything about the case is interrogated by the Procurator-Fiscal, or is precognosced. The examination is made on oath; the written evidence constitutes the precognitions. Counsel for the accused or for the Crown may precognosce witnesses.

The preliminary examination of the accused takes place before the Sheriff or Justice, and he may commit the person for trial or liberate him, according to the evidence.

The precognitions, in cases of committal, are forwarded to the Crown Counsel in Edinburgh, who may stop the proceedings, or send the accused before the High Court, Circuit Court of Justiciary, or Sheriff, with or without a jury. The Justiciary Courts correspond to the Courts of Assize in England. Should the case be so transferred for trial, the witnesses are summoned by writ. A penalty of £5 may be imposed for disobedience to such writ, or imprisonment pending expression of regret before the Court, and tendering bail for appearance.

Common witnesses and medical witnesses to fact are not allowed in Court except when giving evidence. Expert witnesses may be allowed to remain in Court by mutual consent of counsel. When one expert witness is giving evidence, other experts are required to leave the Court, and no expert witness who may have been present during the examination of common witnesses is allowed to give evidence as to facts.

The verdicts of “Guilty” or “Not guilty” are similar to those given in England, but in addition a verdict of “Not proven” may be given, and all are final. In the case of the last two the accused cannot be tried again.

In Scotland the verdict of a bare majority of the jury holds good, whereas in England the decision must be unanimous. In the case of a suspicious death, or a dead body being discovered, [Pg 7] the Procurator-Fiscal, acting as a coroner does in England, but without a jury, may direct a medical man to examine the body and send in a report; but all reports must be certified on soul and conscience, without which they are of no value. Should the medical examiner be satisfied without making an internal examination, he may certify to the Procurator-Fiscal on the result of his external examination.

Should the Procurator-Fiscal consider it requisite to have a complete examination, he issues a warrant to that effect to the medical practitioner who has seen the case, and usually associates with him the most skilled practitioner available in the neighbourhood. The warrant consists of a petition by the Procurator-Fiscal, addressed to the local judge, setting forth the grounds of his application, and craving warrant to the inspectors named to make the necessary examination. This is signed by the Procurator-Fiscal, and countersigned by the Sheriff or local judge, if granted. The receivers of this warrant are empowered to take full custody of the body, and they should be careful to carry the warrant with them, or they may be refused admission pending its production, which may result in great waste of time, and end in a miscarriage of justice. The Procurator-Fiscal may supply to the medical inspectors portions of the precognitions likely to bear on the medical part of the inquiry. Medical men ought to be on their guard against performing dissections in cases evidently judicial without previously warning the proper law authorities, or without a warrant; for instances have occurred where, owing to the want of proper support, obstructions were thrown in the way which might have proved fatal to the value of the investigation; and, besides, the premature disclosure of the results of the inspection might frustrate other important steps of the precognition.

The medical men so engaged will, as a rule, find it to their interest to exclude all visitors, whether lay or professional, from the room during the dissection. The regulations issued by the Crown Office, Edinburgh, direct that no one should be allowed to be present at the examination out of mere curiosity, and recommend that any one not engaged in the inspection, but who is in attendance to give information, or for any other purpose, and who may afterwards become a witness, should remain in an adjoining room. The medical inspection often furnishes good tests of the value of other evidence in the case; therefore, it is desirable that the general witnesses should not have an opportunity of knowing what is observed in the dissection of the body. The notes of a case should be made at the time of inspection or immediately afterwards. In the case of post-mortem examinations it is better that while one inspector conducts the practical details of the examination, the other should take notes of its successive steps, indicating all the points inquired into, with the observations made, the appearances presented, negative as well as positive, stating simple facts alone, without either generalisations or opinions. These notes should be looked over by both inspectors before the body is sewn up, so that omissions in the notes, or in the inspection itself, may be then supplied. [Pg 8]

In England, except upon a subpœna, a medical man is not bound to attend as a witness at a trial, and then it should be served a reasonable time before the trial, in order that he may make proper arrangements for the carrying on of his business during his absence. In civil cases his reasonable expenses should be tendered to him at the time the subpœna is served, or within a reasonable time of the trial; and he may refuse to give evidence unless his charges are paid, provided his objection be stated before he has been sworn. A witness may be summoned from any part of the United Kingdom.

The question has been raised, whether a scientific witness was bound to attend when subpœnaed. The law on the point is enveloped in some obscurity; the better course is therefore to attend.

No tender of fees is necessary in criminal cases, “except in the case of witnesses living in one distinct part of the United Kingdom being required to attend subpœnas directing their attendance in another, who are not liable to punishment for disobedience of the process, unless at the time of service a reasonable and sufficient sum of money, to defray their expenses in coming, attending, and returning, have been tendered to them.” When summoned to two cases, the one civil, the other criminal, the witness must attend the criminal; or when both cases are the same, the one to which he first received the subpœna—notifying, however, to the counsel engaged on the other case his unavoidable absence, and giving the reasons which prevent his attendance.

In Scotland, witnesses are summoned by a writ or citation, which must be delivered at the residence of the witness a reasonable time before the trial. Delivery to a member of the family, or a servant not within the house, will not do. If access cannot be gained, the copy is fastened to the most patent door of the house. If the witness do not appear, and it be clearly shown that he was duly cited, a warrant for his apprehension may be issued, and he becomes liable to be incarcerated till he finds “caution” for his due attendance at the trial. His non-attendance may also, unless good excuse be forthcoming, render him liable to a fine, or unlaw, of a hundred merks Scots—about £5.

Form of Subpœna in England.—Where a medical witness has given evidence in a case in which the accused person has been committed for trial to a superior Court, he is summoned to give evidence at such Court in the following terms:

[Pg 9]

In Scotland the following is the form of summons to appear before the High Court of Justiciary, and at an inquiry into a fatal accident:

Coroner‘s Court.—The Coroners Act states that fees for medical witnesses attending an inquest shall be, for attending to give evidence at an inquest whereat no post-mortem examination has been made by the witness, one guinea. For making a post-mortem examination and attending to give evidence, two guineas. No fee can be obtained for making a post-mortem examination by a medical practitioner, unless it be made by order of the coroner. Extra fees are not provided for when the inquest is adjourned. For an inquest held over the body of a person who has died in a lunatic asylum, public hospital, infirmary, workhouse infirmary, or other medical institution, whether endowed or supported by voluntary contributions, the medical officer of such institution shall not be entitled to a fee. Should the dead body of a person be taken to such an institution, the medical officer, if summoned to give evidence, is entitled to the usual fee. Such fees are paid at the termination of the inquest. [Pg 10]

Magistrates‘ Court.—If the witness reside within two miles of the Court, the fee is ten shillings and sixpence; beyond two miles, one guinea.

Courts of Quarter Sessions, and Central Criminal Court of London.—One guinea per day, and two shillings a night away from home, with threepence per mile each way travelling expenses.

Assize Court.—One guinea per day, with two shillings a night away from home, and a reasonable and sufficient amount for travelling expenses. If there be no railway, threepence a mile each way. Sundays are not included.

Court of Probate and Divorce.—One guinea per day within five miles of the General Post Office. If beyond, two or three guineas a day, with expenses out of pocket for coming and returning.

Court of Appeal.—One guinea a day if resident in London; two or three guineas, with travelling expenses, if from a distance.

County Court.—From fifteen shillings as an ordinary witness, with one guinea per day expenses if from home, to one to three guineas for qualifying as an expert witness. With attendance at Court one to two guineas and expenses one to three guineas per day.

In Civil Cases.—An arrangement is usually made with the solicitor for a fee; this should be made before accepting the subpœna. A written undertaking for payment, and properly stamped, should be obtained from the solicitor before giving evidence; in default of this, the witness should appeal to the judge from the witness-box before being sworn. After taking the oath a witness is bound to give evidence, and the solicitor may refer him to his client for the fee, which may lead to disappointment.

IN SCOTLAND

The fee for attendance at High Courts of Justiciary or the Sheriff Criminal Court is one guinea per day, if the Court be held in the town in which the medical witness lives. For a post-mortem examination and report, two guineas. For an analysis of blood or other stains on clothing, two to four guineas, depending upon the amount of work done.

If the witness come from a distance, he is allowed two guineas per day, both for the actual attendance at Court and also for each day occupied in travelling to and fro, with a guinea a day for travelling expenses.

On the subject of evidence it is necessary to say a few words, for it must be remembered that that which may be held to be evidence in logic may not be so in law. Nothing in law is intuitive—nothing is self-evident; everything must go through the process of proof by testimony.

Legal evidence is therefore composed of testimony, but all testimony is not necessarily evidence in law. Thus, if a witness declare that he saw a certain act committed, his testimony may be accepted as evidence; but if he state that his knowledge of a fact is obtained from another person, such information, although it contain an absolutely true description of what actually occurred, will not be received. In this case his testimony is simply hearsay, and as such is not admissible, except in the case of dying declarations, and in one or two other instances which do not, however, concern us.

Medical evidence may be divided under the following heads: (1) Documentary; (2) Oral or Parol; (3) Experimental.

Under this head are included Medical Certificates, Written Opinions, Medical Reports, and Dying Declarations.

Medical Certificates.—Certificates generally refer to death, to vaccination, to notification of infectious and industrial diseases, and in districts which have adopted it, the notification of births; to the state of health of an individual, &c. For those which have respect to the health or to the illness of an individual there is no particular legal form, as a certificate is merely a simple statement of a fact. The only essential condition is that it contains the exact truth, and any departure from this will entail heavy penalties. A statement signed by a registered medical practitioner, distinctly describing the condition of A or B, is all that is necessary as far as the law in England is concerned. In Scotland the law is somewhat different, for “A certificate of bad health by a physician or surgeon must bear to be on soul and conscience.” ... “In cases of homicide, and other crimes against the person, medical certificates produced respecting the nature of the injuries must be verified on oath by the medical persons who granted them” (Dictionary Scot. Law). In Scotland, the omission of the words “on soul and conscience” invalidates a certificate.

Certificates of death, of vaccination, of notification of infectious diseases, tuberculosis, industrial diseases, and births, and of insanity can be procured already printed in the forms prescribed by the law.

Certificates of the Cause of Death.—A medical practitioner who has been in attendance during the last illness of a person is legally [Pg 12] bound to give a certificate stating, “to the best of his knowledge and belief, the cause of death.” If he be unaware of the cause of death, or have reason to believe that death was not due to natural causes, or the result of violence, he may refuse the certificate. In such a case it is customary and desirable for the medical man to notify the Coroner of the circumstance as soon as possible. If he have no reasonable cause to prevent him supplying the certificate, he is liable to a penalty not exceeding forty shillings. In England and Ireland it is given to a relative of the deceased or legally authorised person, who must deliver it to the Registrar. In Scotland the doctor sends it to the Registrar direct. Not more than one certificate should be given. No fee is chargeable. The information on the certificate should be as clear, complete, and accurate as possible.

Notification of Births.—When the authorities of any district have adopted the Notification of Births Act of 1907, it is the duty of any person who has been in attendance on the mother at the time, or within six hours after the birth, to give notice of the birth in writing to the Medical Officer of Health of the district in which the child is born. The necessary certificate must be filled in and posted to the Medical Officer of Health within thirty-six hours of the time of birth. The certificate applies to any child dead or alive born after the twenty-eighth week of pregnancy. Should the relatives of, or other attendant upon the mother, fail to notify the birth, it is the duty of the medical attendant to do so, failing which he may be fined not exceeding twenty shillings.

Notification of Infectious Diseases.—By the Act of Parliament 1889, every medical practitioner attending on or called in to visit the patient, shall forthwith, on becoming aware that the patient is suffering from an infectious disease to which the Act applies, send to the Medical Officer of Health of the district a certificate stating the name of the patient, the situation of the building, and the infectious disease from which in the opinion of such medical practitioner the patient is suffering.

The notifiable diseases are: smallpox, cholera, diphtheria, membranous croup, erysipelas, scarlatina or scarlet fever, typhus, typhoid, enteric, relapsing, continued and puerperal fever.

By consent of the Local Government Board the Health Authorities may add other diseases as occasion may require for a time or permanently. Of these due notice is given to medical men. Tuberculosis and ophthalmia neonatorum are now notifiable. The fee for the certificate in private practice is 2s. 6d., if in a public institution, 1s. Failure to certify renders the medical man liable to a penalty of 40s.

Notification of Tuberculosis.—As mentioned previously, tuberculosis is now a disease notification of which is compulsory. Special forms are provided for the purpose.

Notification of Industrial Diseases.—Under the Factory and Workshop Act, 1901, every case of lead, phosphorus, arsenical, or mercurial poisoning, or anthrax, if contracted in a factory or workshop must be notified by the practitioner in attendance on the case. The certificate must be sent to the Chief Inspector of Factories at the Home [Pg 13] Office, London. The fee for notification is 2s. 6d. Other diseases may be added to the list by special order of the Home Office.

Written Opinions.—These generally refer to civil questions.

The Medical Report.—A Report is a document given in obedience to a demand by the public authorities in Scotland, and has reference chiefly to criminal cases. Medical Reports are sworn to as true by those who draw them up. According to Alison, it is not a sufficient objection that a Medical Report was made up at an interval after the occurrence of the circumstances to which it refers. The same high authority also states that should the writer of a Medical Report die before the trial, his Report may be used in evidence,—this may be doubted.

The necessity for simplicity in the arrangement and in the wording of their Reports cannot be too strongly urged on medical men. “A medical witness will do well to remember, also, that copies of his Report and depositions, either before a coroner or a magistrate, are usually placed in the hands of counsel as well as of the Court; and that his evidence, as it is given at the trial, is compared word for word with that which has already been put on record.” All hearsay statements and irrelevant matter should not be inserted in a Report; and the reporter should be particularly careful not to add any comments to his simple narration of facts. The use of superlatives is also very objectionable, as it partakes somewhat of exaggeration. All technical words or phrases should be as much as possible avoided; and where they are absolutely necessary, they should be briefly explained.

As a case in point, showing the necessity for care in the use of words, is the following from a published Paper by the late Sir R. Christison: “Some years ago, on an important trial in the High Court of Justiciary for assault, the public prosecutor attempted to prove that the person assailed had been wounded to the effusion of blood; which is held in law to be an aggravation of guilt in such cases. When the principal medical witness was examined as to the injuries inflicted, he was asked whether any blood had been effused; and he replied that a good deal must have been effused. But he meant that there was effusion of blood under the skin, constituting the contusion he had described; while the counsel and the Court at first received his answer as implying that there had been considerable loss of blood from a wound. The latter view was on the point of passing to the jury as a fact, when one of the judges detected the equivoque, and set the matter to rights.”[1]

In Scotland a medical practitioner may be called upon by the authorities to grant reports as to dead bodies, without performing a post-mortem examination.

In the first case, where a death has occurred unaccompanied by any suspicious circumstances, or where the evidence of suicide or death from accidental injury is apparent from a simple examination of the [Pg 14] body, a certificate “on soul and conscience,” stating the probable cause of death, is considered sufficient by the authorities, and a post-mortem is dispensed with. It is not necessary that the deceased be seen by the medical practitioner before death, “yet, from the suddenness of the death, the age of the deceased, and the symptoms spoken to by the friends, he may still be enabled, satisfactorily to himself, to certify the cause of death.” In England, such a case would be the subject of a coroner‘s inquest.

In the second case, he may be summoned by a constable to inspect a body found on the public road, or in any other unusual situation. In this case he is called not only to certify the fact, but also the probable cause of death. He may, under these circumstances, give a report of the external examination of the body, at the same time suggesting the necessity for further and more careful examination by dissection, &c., and this is considered the proper course for him to take. In England, in this case also, an inquest would be necessary. In all cases medical men will consult their own interests in giving these Reports.

A Medical Report consists of two parts—the Minute of the Examination, and the Reasoned Opinion on the first portion of the Report. In the case where the Report is made by two or more persons appointed for the purpose, the latter portion is written in the plural, and signed by each of the parties certifying.

The following is an outline of a Medical Report, which may be more or less modified to suit the requirements of the case:

Dying Declarations.—The principle on which these are accepted is founded, partly on the awful situation of the dying person, and partly on the absence of interested motives in one on the brink of eternity, and which is supposed to obviate the necessity of a cross-examination. The law presumes that any one cognisant of impending death will tell the truth, and such declarations are equal to evidence on oath. The greatest care must be taken by the medical man who is called in to see a person supposed to be dying, with regard to any declaration he or she may wish to make. He must be satisfied as to the mental condition of the person. The medical attendant should simply take the statement as it is made, writing it down on the spot, or as soon after as possible. The identical words used should be committed to paper, and no suggestions or interpretations of his own should be made. Leading questions should never be put, nor any attempt made to induce the patient to make any statement. When we consider the condition of the patient, the possibility of delirium induced by the severity of the injury, together with the dread of death, it is, to say the least, injudicious to introduce the suspected party into the room for the purpose of identification, though this procedure has been suggested by some writers. In every case, however, it is advisable for the medical attendant, as soon as he sees that the case must end fatally, to acquaint the patient in the presence of others of the fact, when any statements made may then be taken. It is preferable that such statements be made before a magistrate if time will allow. It should also be borne in mind by those receiving dying declarations, that in England “it must be shown that the deceased, at the time he made the statement, was under the impression that death was impending; not merely that he had received an injury from which death must ensue, but that, as the popular phrase goes, ‘he then believed he was on the point [Pg 17] of death’” (R. v. Forester). In one case (R. v. Fagent, 7 C. & P. 238) it was held that a declaration was inadmissible, because the person making it asked some one near her whether he thought she would “rise again”; and it was held that this showed such a hope of recovery as rendered the previous declaration inadmissible. The declaration should be signed by the person making it, and witnessed by some one present at the time.

In the case of Reg. v. Whitmarsh (Central Criminal Court, Sept. 19, 20, 21, 1896), 62 J.P. 680. Upon an indictment for the murder of a woman, who died as the result of the prisoner having used certain instruments or other means upon her with the intent to procure her miscarriage, it was shown that an inspector of police had seen her at Charing Cross Hospital. He asked her questions, and from her answers he wrote down a statement. The woman signed it. On July 7 the woman appeared to be in a dying condition, and was aware of it. She said she feared she must die, and asked to see her mother and a clergyman. The doctor told her that he had given up all hope, and that she might not live to see her mother. A magistrate saw her shortly afterwards, and read over to her the statement she made on June 29, and he affixed to it the following note, “This statement was read over to Alice Bayley by me, and is referred to in her dying declaration,” and signed. Held (Darling, J.), that though this statement might be admissible, it had better not be admitted in evidence. On the same day the woman had also made a statement to the magistrate, of which he had taken note, but before it was finished she became exhausted. The magistrate then took the statement of June 29, repeated portions of it to her in his own words, wrote these down, and asked her if it was correct. He then read the whole statement to her and she signed it. The statement commenced, “Having the fear of death before me, and being without hope of recovery”—concluding with the words, “And the statement I made on the 29th of June, and have now heard read over, is true.”

Justice Darling held this statement was admissible as a dying declaration.

In the case of Rex v. Smith, 65 J.P. 426 (Bruce, J., Central Criminal Court). A magistrate and a doctor visited a dying woman for the purpose of taking her statement. In reply to a question put to her by one of them, she said, “I am aware that I am seriously ill.” The magistrate asked her questions and the doctor wrote down the answers. At the trial the statement was objected to as inadmissible as a dying declaration on two grounds: Firstly, that the statement consists only of answers to questions put to her by the magistrate, and so comes within the ruling of Cave, J., in Reg. v. Mitchell, 17 Cox C.C. 503, that “a declaration should be taken down in the exact words which the person who makes it uses, in order that it may be possible from those words to arrive precisely at what the person meant. When a statement is not the ipsissima verba of the person making it, but is composed of a mixture of questions and answers, there are several objections open to its reception in evidence.... In the first [Pg 18] place, the questions may be leading questions, and in the condition of a person making a dying declaration there is always very great danger of leading questions being answered without their force and effect being fully comprehended.”

Secondly, the prosecution had not shown that at the time the woman made the statement she was in expectation of immediate death.

The judge held (1) That the prosecution had not proved that in her own opinion the woman was beyond all hope of recovery, and that therefore the statement was inadmissible; (2) That such a statement—the magistrate asking her questions and the doctor taking down only her answers in writing—was not admissible as a dying declaration.

In the case of Rex v. Holloway, 65 J.P. 712 (Wills, J., Central Criminal Court). The prisoner threw a burning lamp at his stepson and set fire to his stepdaughter, who succumbed to the burns she received. A deposition of the deceased girl was taken down by a magistrate. At the time it was taken it was intended that it should be in accordance with the provisions of the 1867 Act. The accused was present and had full opportunity of cross-examining the witness. The deposition was read over to the girl, and she assented to it, but could not sign it because of the injuries to her hands. The magistrate who took the deposition signed it. It was held that the deposition had been taken in accordance with the provisions of the Indictable Offences Act, 1848, sec. 17, and was admissible though it had not been signed by the girl.

The validity of a dying declaration has been called in question when made by a person who has suffered a severe concussion of the brain, and then recovered his sensibility. It is well known that under such circumstances the recollection of what took place before or after the injury is in many cases very imperfect, and the injured party may thus draw unintentionally upon his imagination for his facts. In Scotland, “the written deposition of a person who is dead is admissible, whether the person were the party injured or not, if he would have been a competent witness. It is not necessary that the deceased believe himself to be dying when he emits the deposition, for his consciousness of approaching death may be inferred from the nature of the wound, or the state of illness or other circumstances of the case. Such depositions are generally taken by a magistrate, but a declaration deliberately made, though without an oath, and taken down ‘by a creditable person,’ is admissible” (Macdonald, Scottish Criminal Law, p. 512).

A medical man may be called as a common witness, or as an expert witness. In the first case, he has only to state, as any other witness might do, the facts that have fallen under his observation; in the second, he has to interpret the facts he has himself observed, or to give his opinion on facts noticed by others. In stating his opinion, a medical witness must be prepared to back up his [Pg 19] opinion by such reasons as may be satisfactory to the understanding of his hearers, “and this is the principal qualification of a medical witness, that he make himself intelligible to ordinary comprehensions.” No man is bound to give any testimony by which he may render himself liable to any criminal prosecution. (See the ruling of Bailie, J., in the case of Mr. George Patmore, tried for the murder of John Scott in a duel.)

At the trial, the witness is first examined by the party who calls him: this is the examination-in-chief. He is then cross-examined by the opposite party; and, lastly, re-examined by the former party, when he is offered the privilege of explaining any discrepancies between his examination-in-chief and cross-examination, but he must not introduce any new matter, for by so doing he renders himself liable to be cross-examined on it.

The Use of Notes.—All notes should contain a plain statement of the facts, and, to render them admissible as evidence, they must be taken at the time, and duly attested. From the notes prepared as before mentioned a witness may refresh his memory, but they are not accepted in its place. A witness may not read his notes as evidence, nor may he refresh his memory by documents not his own and not produced, but he may refresh his memory by looking at a document received from the accused at the time of the offence, and kept by him (Geo. Wilson, jun., Aberdeen, May 1, 1861; 4 Irv. 42).

The Use of Books.—No witness is allowed to quote from books, or to quote the opinion of other medical men on the subject, but he may refer to facts. Sir Henry Littlejohn, in his papers on Medical Jurisprudence,[2] gives some useful hints on this subject. It appears that a medical witness, in an unguarded moment, stated that his opinion was corroborated by a distinguished member of the medical profession not engaged on the trial. The judge informed the witness that it was most irregular to have other medical men present at the dissection than those mentioned in the warrant, and that, if the witness did not feel qualified for conducting such dissections, he had better resign the post of medical inspector.

In England, at the request of both parties, the medical and scientific witnesses may be excluded from the Court, but as a general rule they are allowed to be in Court, and hear the whole of the evidence of the case. In Scotland they are always excluded, although, by mutual consent, “experts” may remain to hear the general evidence on which they are to express their opinions, but when an expert is giving his opinion the others must leave the Court. In the latter country also, a medical witness who has been in Court cannot be examined on the facts of the case, but only on matters of opinion. A medical man is, however, sometimes allowed, on a special motion, to remain, although he is to be examined as to facts, and withdrawn when other witnesses are to be examined as to facts to which he is to speak. (See case of E. W. Pritchard, H.C. 1865; 5 Irv. 88.) [Pg 20]

In giving evidence the witness should—(1) Speak loudly and distinctly. (2) Answer questions categorically—Yes or no. (3) Never use superlatives. (4) Give answers irrespective of results of trial. (5) Express no opinion as to guilt of prisoner; state facts only. (6) Avoid using technical terms. (7) Avoid long discussions, especially theoretical arguments.

When a quotation is made from a book by the examining counsel, the medical witness, before replying to a question based on it, should see that the quotation has been fairly and fully given, due regard being paid to the context. Neglect of this precaution may lead him into considerable difficulty.

A medical witness should remember that he is not retained for a party, but in the cause of justice. He must, therefore, be candid in his manner and simple in his language. Mr. Haslam remarks that, however dexterous a witness may show himself in fencing with the advocate, he should be aware that his evidence ought to impress the judge, and be convincing to the jury. Their belief must be the test by which his scientific opinion is to be established. That which may be deemed by the medical evidence clear and unequivocal, may not impress the judge, nor carry conviction to the jury.

The advice given by Sir W. Blizard may not be out of place here: “Be the plainest man in the world in a Court of Justice; never harbour a thought that if you do not appear positive, you must appear little and mean for ever after; many old practitioners have erred in this respect. Give your evidence in as concise, plain, and yet clear manner as possible; be intelligent, candid, open, and just, never aiming at appearing unnecessarily scientific. State all the sources by which you have gained your information. If you can, make your evidence a self-evident truth: thus, though the Court may at the time have too good or too mean an opinion of your judgment, yet they must deem you an honest man. Never, then, be dogmatic, or set yourself up for judge and jury; take no side whatever, be impartial, and you will be honest. In Courts of Judicature you will frequently hear the counsellors complain when a surgeon gives his opinion with any of the least kind of doubt, that he does not speak clearly; but if he is loud and positive, if he is technical and dogmatic, then he is allowed to be clear and right. I am sorry to have to observe that this is too frequently the case.”

Liability of Medical Men to reveal Professional Secrets.—The question has arisen how far a medical man is bound to reveal the secrets confided to him in his professional capacity as medical attendant. This question was raised by Mr. Cæsar Hawkins in the trial of the Duchess of Kingston (11 Harg. St. Tri. 243), before the House of Peers, and decided by Lord Mansfield thus: “Mr. Hawkins will understand that it is your (the other Peers) judgment and opinion that a surgeon has no privilege, where it is a material question in a civil or criminal course to know whether parties were married or whether a child was born, to say that his introduction to the parties was in the course [Pg 21] of his profession, and in that way he came to the knowledge of it. I take it for granted, that if Mr. Hawkins understands that, it is a satisfaction to him and a clear justification to all the world. If a surgeon was voluntarily to reveal these secrets, to be sure he would be guilty of a breach of honour, and of great indiscretion; but, to give that information in a Court of Justice, which, by the law of the land, he is bound to do, will never be imputed to him as any indiscretion whatever.” However objectionable it may be to the medical witness, and be considered by him a breach of professional confidence, to reveal in a Court of Law secrets known but to himself and patient, and regarded as sacred, he has no privilege but to reveal them if demanded as evidence, unless the evidence be such as might incriminate himself. This is not the ruling in most Continental countries, where the medical man claims the same privileges of secrecy as the priest in confessional.

Under this head will be treated Identity and the examination of the Living and the Dead, Real and Apparent Death, Cause of Death, Exhumations, and Autopsies.

Examination of the Living.—With regard to the identification of the living, the presence of a medical man is seldom required, but there are many occasions when his opinion may be sought. Thus, under the Factory Acts, he may have to examine children about whose age doubts may have arisen. The Table on p. 33, giving the periods at which the teeth appear, will assist him. A medical man may also be requested to give an opinion as to the mental soundness or unsoundness of an individual. He may also be consulted in cases where questions have arisen as to the existence and character of certain marks on the body—of deformities, either congenital or produced subsequent to birth, or of doubtful sex. The marks which most frequently give rise to differences of opinion are nævi materni, scars, and tattoo marks. In cases of doubtful sex, the male organs may resemble the female, the female the male, or they may be blended together in about equal proportions.

In all cases where an examination of a living person is required, the consent of the person must be obtained, the nature of the examination explained, and that any facts recorded will be used as evidence if required. If the person refuse to be examined then it must not be carried out.

Cicatrices.—The following questions may be put to the medical expert—(1) Do scars ever disappear? (2) Can the age of a scar be definitely stated?

In reply to the first and second questions, I shall quote the words of the late Professor Casper: “Consequently the scars occasioned by actual loss of substance, or by a wound healed by granulation, never disappear, and are always to be seen upon the body; but the scars of [Pg 22] leech bites, or lancet wounds, or of cupping instruments, may disappear after a lapse of time that cannot be more distinctly specified, and may therefore cease to be visible upon the body. It is extremely difficult, or impossible, to give any certain or positive opinion as to the age of a scar.”

All cicatrices should be examined with oblique light and the aid of a lens. In the early stages a cicatrix is of a red colour, changes to brown, and later to white, and the surface glistens. In the intermediate stages one could not give any positive evidence of the age of a cicatrix. The probability is that a red cicatrix is a recent one, a white cicatrix is not recent.

I have seen well-defined cicatrices upon the back of a Russian, after incisions made by the blades of a cupping instrument fourteen years previously, and in an Englishman after twenty-five years (R. J. M. Buchanan).

Devergie states that where the brand of a galley-slave has vanished, it may be recalled by slapping its usual position with the palm of the hand. The scar remains white, while the skin round it is reddened. A change of temperature to the part will sometimes cause the reappearance of a vanished scar. Washing may also help to reproduce scars. Cicatrices produced in childhood may grow with the ordinary growth of the individual. The shape of a cicatrix will depend upon the character of the wound which produced it; on the nature of the healing process; on the elasticity or tension of the skin; on the convexity of the part; and on the looseness of the subcutaneous cellular tissue. An incised wound healing by the “first intention” will most probably leave a white linear cicatrix; on the other hand, a wound healing by granulation will leave a more or less irregular scar. The position of a wound on the body also modifies the subsequent cicatrix; thus a linear cicatrix is produced when the wound is in the long diameter of the limb, a more or less oval one when across the limb. The retraction of the skin in the latter case tends to draw the skin at right angles to the line of incision, thus approximating the extremities of the cut, increasing it in breadth and lessening it in length. Owing to one or more of the above-mentioned conditions the typical cicatrix of an incised wound is elliptical, tending, however, in some cases to assume a circular form. Linear cicatrices are found chiefly between the fingers and toes, and where the cutaneous surfaces are concave. In gunshot wounds the resulting cicatrix is depressed and disc-shaped, and more or less adherent in the centre to the subcutaneous tissues, and if the weapon be fired close to the surface of the body, grains of unburnt powder may be seen in the surrounding skin. Cicatrices from burns are, as a rule, large, irregular, and superficial, and frequently give rise to deformity. A scar left by caustics is circumscribed, deep and depressed in the centre. Cicatrices in the groins are probably venereal; those in the neck and under the jaw, strumous. Scars from operation incisions are much less evident now than when wounds were more likely to suppurate and heal by granulation. It is remarkable, after an incision made with aseptic precautions and healing by first intent, as time [Pg 23] progresses the cicatrix becomes less and less noticeable, but they can be detected by methods described above. Fine punctures and stitch cicatrices may eventually leave little or no trace.

Dupuytren and Delpech state that the tissue formed in a cicatrix is never converted into true skin—the rete mucosum when once destroyed never being re-formed. It contains no sebaceous glands, sweat glands, or hair follicles, and is but slightly vascular. This may account for the white colour of ordinary cicatrices, but even to this rule exceptions may be taken, and dark brown patches of pigment have been known to mark the situation of old lacerated wounds. It must be remembered also that in irregular wounds and in incised wounds which may heal with an uneven joint, that portions of skin may become embedded or grow into the scar tissue and give rise to difficulty in forming an opinion. I have seen a well-defined dark coloration of the skin continue for three months after the application of a mustard plaster, followed at the time by desquamation.

Tattoo Marks.—With regard to tattoo marks, the question of their disappearance gave rise to considerable discussion in the celebrated Tichborne case. On this subject the experiments of Hutin, Tardieu, and Casper appear to point to the fact “that tattoo marks may become perfectly effaced during life,” but that after death the colouring matter with which the marks were made may be found in the lymphatic glands. This is especially the case when vermilion is used. The most permanent marks are made with Indian ink, powdered charcoal, gunpowder, washing blue or ink, and vermilion. These are given in the order of their permanency. Hutin found that in 506 men who had been formerly tattooed, the marks had disappeared from 47 of the number. Not only does permanency depend upon the colouring matter used, but also upon the depth to which it has penetrated. If superficial, it may gradually become effaced. If the material be carried down to the papillæ, it will remain permanent, and can only be removed in such a way as to leave a scar. But besides the spontaneous disappearance of tattoo marks from the lapse of time, these marks may be artificially removed, and in such a manner as to prevent the possibility of a definite opinion being given as to their primary character. The presence of a scar in the situation of a well-known tattoo mark is suspicious. Thus, the Claimant had a scar on a part where it was sworn that Arthur Orton had been tattooed. The application of strong acetic acid, potash, hydrochloric acid and glycerole of papain appears to be the means adopted for the removal of tattoo marks. Efforts are made to remove superficial tattoo marks by removing the particles with needles. Tattoo marks according to their position and design are useful evidence of identification.

Birth Marks.—The presence and characters of birth marks should be noted for purposes of identification. Their removal may be possible, but, except in such as are small and superficial, the process used for removal leaves traces behind in the [Pg 24] form of cicatrices or irregularities of surface, which may generally be detected in oblique light and with the aid of a good lens. Large moles or nævi may he excised, but a cicatrix will remain, which will differ in shape from the original mark.

Congenital Deformities.—These offer no difficulty and are in many cases permanent, such as intra-uterine amputations, constrictions, abnormality of limbs, &c. Such conditions as hare-lip, cleft-palate, herniæ;, &c., may be altered by surgical procedure, but leave permanent records of this. Peculiarities in twins are interesting as to their being of the “mirror image” or “identical” type.

Anthropometry.—This is principally used for the identity of habitual criminals. The Bertillon method is based upon certain measurements of the body, the principal of which are (1) the length of the head, (2) width of head, (3) length of body, (4) length of trunk while sitting, (5) distance between tips of mid-fingers with arms outstretched, (6) length of left forearm, left middle finger, and left foot, (7) length and width of right ear, (8) colour of irides. These measurements place the person in one or other class, according to the special system of classification.

Finger Prints.—These are largely used as a means of identification in criminal cases, either by prints left upon articles, or by prints definitely made by the police authorities as a record for identification purposes.

On articles, the finger prints may be rendered more visible by dusting with some finely powdered material of dark colour which will adhere to the impression, which may then be photographed and enlarged. [Pg 25]

For purposes of record, the impressions are taken directly upon a suitable surface of the bulbs of the fingers and thumbs after having coated them with printer‘s ink. The impressions thus made show individual peculiarities in the distribution and arrangement of the ridges of the skin; and the chances of the markings of two individuals being alike is about one in sixty-four millions. By means of the pattern of these ridges, prints may be classified under the headings of arches, whorls, and loops, with certain recognised modifications of these. (See Figs. 1 and 2.)

Eyes and Veins.—The angle of the eyes to the middle line of the face is an aid to identity; this will show whether the equator of the eye is on a plane at a right angle to the middle line, or above or below it. Tamassia lays much stress upon the arrangement of the veins on the back of the hands, which is an individual characteristic and one which is not easily altered or likely to be. By compressing the arms with a ligature the veins are made to stand out in relief and the backs of the hands are photographed.

Other Peculiarities.—The identity of the accused may be further proved by the absence or malformation of the teeth corresponding with a bite on the party assaulted, or the impression of the teeth on soft articles like cheese. Peculiarities of dentistry may be useful in identification. Or it may be proved that the wound inflicted could only have been made by a left-handed person, or in a manner peculiar to those engaged in the slaughtering of animals—e.g. is the cut from within outwards, as employed by butchers? The correspondence in the size and peculiarities of the foot of the prisoner and the footprints found in the vicinity of the [Pg 26] crime is important as evidence. There is considerable difference of opinion as to the size of a footprint on the ground, Mascar of Belgium asserting that it is smaller than the foot that made it, Caussè, on the contrary, that it is usually larger. It should be borne in mind that the size of the footprint varies in running, walking, and standing, being smallest in running and largest when the individual is standing, which may account for the difference of opinion of the two observers just mentioned. This fact should always be borne in mind when an examination is required to be made of the footprints in the neighbourhood of the crime. A mark in the footprint showing that the sole of the boot had been patched, or in the case of the naked foot that there was some deformity of the toes, would of necessity be important. The mark of the naked foot smeared with blood has, in several cases, led to the identification of the culprit. Photographs may be used as a means of identification. Casts of footprints may be taken by smearing the print carefully with oil, and pouring in liquid plaster of Paris, or by dusting it over with powdered paraffin wax, and then melting it by holding a hot iron over the print; this may be repeated until a sufficiently thick cast is obtained. Hot solution of gelatine in water, mixed with oxide of zinc and glycerine to the requisite consistence, may be used for the purpose.

Dyeing of Hair.—As a means of disguise the hair may be dyed, or the colour may be changed from dark to light. For darkening the hair, preparations containing permanganate of potash, or the acetate of lead, bismuth, or nitrate of silver, are most frequently employed. Sticks of nitrate of silver or lunar caustic are used for darkening eyebrows and moustachios. A wash containing sulphide of potassium is used before the application of the lead solution. This removes the grease, and helps the rapid formation of the black sulphide of lead. Preparations of henna are fashionable for the production of shades of copper to rich brown. To detect fraud, some of the suspected hair should be steeped in dilute nitric acid, the acid driven off by gentle heat, and the nitrate dissolved in distilled water, and then sulphuretted hydrogen passed through the solution, the result being the formation of the black sulphide of lead. If silver be present, the addition of hydrochloric acid will throw down the insoluble chloride of silver. If careful examination be made of dyed hair, it will be found that the dye is irregularly taken by the hair; the hair loses lustre, and I have not unfrequently seen the hair close to the scalp white, or at least several shades lighter than the rest. The scalp may also be seen more or less discoloured, especially when nitrate of silver is used and applied by the individual himself.

For lightening the natural colour, solutions of chlorine, of peroxide of hydrogen, nitric and nitro-hydrochloric acids, of varying strengths, are used. It must be remembered that the action of chlorine is by no means uniform. The hair retains the odour of chlorine for some time, even after repeated washing, and is hard, stiff, and brittle. Devergie states that he has not succeeded in producing a perfect [Pg 27] whitening of the hair in less than from twelve to twenty hours. It must be borne in mind that, under certain circumstances, dark hair may become suddenly white. I have seen large patches of grey hair over the head, the result of repeated attacks of neuralgia.

In the examination of persons whose hair is alleged to have been dyed, it is necessary to compare the dyed hair with that from other parts of the body, e.g. the pubes, or axilla, to wait and watch for irregularities of colour as the hair grows, new growth being free from dye, and if necessary to shave the part and compare the new growth with other hair, also to examine carefully the skin in the position where the dye has been applied. In one case which I noted, a man had been in the habit of touching the moustachios and eyebrows with lunar caustic, having previously damped it with his tongue; in time it produced argyria which coloured the whole of his face, the body generally, but most noticeable on the face.

Carefully examine the bruises, wounds, &c., to see if they could have been inflicted as described. Ask no questions that may suggest an answer. Examine all weapons said to have been used, and hand them over to the police. In all cases where danger to life is imminent, send for the Authorities, and take dying declarations, as these may become evidence of vast importance, and, if properly taken, are as valid as if given on oath. [Pg 28]

Much of what has been said under the heading of identity of the living is applicable in examinations to establish identity of the dead. The latter requires certain special details of examination owing to the peculiar circumstances which may be present demanding them. The material subject to examination may be incomplete, and difficulties arise, so that it is essential to record every minute detail which may be of value as evidence.

The purposes of examination under this heading are mainly related to the questions of stature, age, sex, and special peculiarities of the body.

It will be useful here to emphasize the importance of making a detailed examination of the body. The examination, particularly the external inspection, should be made in daylight.

If the body be seen where first discovered, note should be taken of the exact position and attitude, of any signs of a struggle, of footprints to or from the body; of bottles, medicines, vomit, or excreta near the body, and which should be collected and retained. The expression and colour of the face, the condition of the hands, the condition of the dress as to tears and stains, the heat, amount of rigidity or putrefaction, the presence of wounds and vital reaction in them.

If the body has been removed from the place where found, make similar notes, remove the clothes, and compare any cuts if present in the clothes with those on the body. Record for identification—nævi, moles, tattoos, scars, hare-lip, cleft-palate, the mammæ, abnormalities of fingers, teeth, bones, limbs, joints, &c.

An examination of the mouth, for the presence or absence of false teeth, or of any peculiar formation of the jaw, may lead to the identification of the body. In the case of Dr. Parkman, the recognition by a dentist of the false teeth worn by the deceased led to identification of the remains, and also to the discovery of his murderer. The presence of an ununited fracture, as in the case of Livingstone, may lead to the identification of the body. In one case where a man was said to have died from a fracture of the ribs recently caused by a blow, it was found on examination that the bones were united by a firm callus, clearly showing that the skeleton produced could not be that of the man alleged to have been murdered.

Record the height and if possible the weight. Note the sex, the probable age, nutrition, and cleanliness or otherwise. Examine all wounds, bruises, and describe them carefully, and marks, e.g. strangulation or throttling. Examine the hands carefully and describe their peculiarities, also the colour of hair and eyes. Examine all the apertures of the body for foreign bodies, or abnormal conditions, and, in females, record carefully the condition of the external genitalia and the presence or absence of the hymen.

Although a more detailed account of the method of carrying out post-mortem examinations is given later on, it will not be out of place here to point out briefly the steps of examination. I would again [Pg 29] emphasize the importance of making a thorough and complete internal examination, leaving no organ unexamined. If there be no call for special examination of the thorax or abdomen first, commence with the examination of the surface of the brain, then proceed downwards. Note the direction of any wounds and their depth. Examine all organs for morbid changes, and in females, the vagina and uterus. Examine the larynx and œsophagus. Remove injured bones and examine joints. Remove the spinal cord. Always remember to note the contents of the stomach and bladder in reference to the period at which death may have occurred. Weigh all organs. Always remember the probability of poisoning, and make your examination accordingly.

All fragments or injured parts of a body or its organs should be preserved, and photographs taken of them.

It is better for two medical men to conduct the examination together. Do not make the examination without an order from the coroner. A medical man who is alleged as implicated in the cause of death should not be present.

Identification of the dead may present special difficulties where mutilation of the body has taken place, or where the body has been severely burnt, or is disfigured as in cases of explosions or advanced putrefaction. In such cases, fragments of clothes, ornaments, and dental work may afford valuable evidence.

Occupation Marks.—As an aid to identification, it is important to remember that certain trades leave marks by which those engaged in them may be identified.

Thus, in shoemakers there may be more or less depression of the lower portion of the sternum, due to constant pressure of the last against the bone.

Tailors work sitting, with the legs crossed and the body bent forward. The body is thus cramped, and the abdomen drawn in, and the thorax projects over it, due to the manner of sitting. They frequently have a soft red tumour on the external malleolus. A like tumour, but not so large, may also be found on the external edge of the foot, and a corn on the little toe.

Photographers have their fingers blackened by nitrate of silver, pyrogallic acid and other developers, or stained yellow with bichromate of potash.

Seamstresses have the index finger of the left hand roughened by the constant pricking of the needle.

Copyists have on the little finger of the right hand, near its extremity, a corn, and at the end of the middle finger a hard groove made by the pen.

Violinists have corns on the tips of the fingers of the left hand, harpists on both hands.

In smokers of pipes the incisors and canines are more or less worn by the mouthpiece, but sometimes the groove is between the canines and bicuspids. In cigarette smokers, the forefinger and thumb are stained with tobacco juice, also between the index and middle fingers, on the dorsum. [Pg 30]

In coachmen, corns may be formed between the thumb and index finger, and between the index and the second finger of the left hand, from the pressure of the reins, and between the thumb and index finger of the right hand, from the pressure of the whip.

In bricklayers, from the constant action of picking up bricks, the flattening of the tip of the thumb and index finger of the left hand is not uncommon.

Plasterers have corns on the external surfaces of the thumb and index finger, due to grasping the “hawk” on which the plaster is placed during their work.

Joiners and carpenters have callosities on the palm of the right hand from grasping their tools, and between the thumb and index finger of the right hand, also over the first interphalangeal joint of the right index finger. The right shoulder is lower than the left.

The finger-ends of turners and coppersmiths are also more or less flattened; in the latter, a deposit of the metal may take place.

To ascertain the time which may have elapsed since death.—This can scarcely be determined with precision, as so much depends upon the conditions under which the body may have been placed. The subject under consideration is, therefore, beset with difficulties, and its elucidation will require the greatest care on the part of the medical expert. A careful attention, however, to the subjects treated in the following pages will help to clear up many a doubtful point.

COOLING OF THE BODY

The following circumstances must also be taken into consideration: (1) Age. (2) Air—(a) moving; and (b) at rest. (3) Moisture. (4) Warmth. (5) Nature of the supposed cause of death, as affecting cooling of the body, and promoting the rapid advance of putrefaction. (6) Presence or absence of the rigor mortis. Bodies may be preserved for months if exposed to intense cold.

The following Table, compiled from the experiments of Devergie, may be of use in aiding the expert to form his opinion, but it must be borne in mind that, from the great difficulties which surround the subject, the statements made are only approximately correct. The table is divided into four stages or periods, the last being that in which putrefaction commences:—

First.—From a few minutes to twenty hours after death—Animal heat more or less present, but seldom continuing longer than ten or twelve hours. Muscles contract on the application of galvanic stimuli, and in the earlier stage to blows. [Pg 31]

Second.—From ten hours to three days—Body quite cold and rigor mortis well marked; muscles do not contract on the application of stimuli. The age, mode of death, and other collateral circumstances must, more or less, be taken into consideration before an opinion can be given.

Third.—From three to eight days—The body is quite cold, and cadaveric rigidity has passed off. The muscles no longer respond to any galvanic or mechanical stimulus. The stage is modified and somewhat shortened in summer.

Fourth.—From six to twelve days—Commencement of putrefaction. Putrefaction may, however, take place on the first or second day after death; so that, as before stated, care must be taken before any positive decision can be given.

Stature.—As a general rule the length of the body is equal to the distance between the tips of the middle fingers with the arms outstretched. If an arm be missing, the length of the remaining one multiplied by two, with the addition of 6 inches for each clavicle and 1½ inches for the width of the sternum, will give the approximate height. The femur is said to be equal to .275 of the body height. If the skeleton be entire, the addition of 1½ inches for the soft parts should be made.

Where only a limb or long bone or part of one be available, it is not possible to give anything more than an approximate opinion of the height.

Sex.—When mutilation, putrefaction, or charring has taken place, by which the genitalia have been demolished, it may be difficult to determine the sex. Evidence will be afforded by the distribution of the pubic hair, which in the male reaches as high as the umbilicus, but is horizontal with few exceptions in the female. Males have more hair on the body generally.

The presence of moustachios and beard and the length of the hair on the head will assist in sex determination.

The breasts if present will denote the sex, also the uterus, which withstands putrefaction and burning to a marked degree.

Remains of clothing and ornaments will indicate the sex of the wearer.

Lineæ albicantes on the abdomen, buttocks, and breasts indicate the female sex, and the probable occurrence of previous pregnancies. It must, however, be remembered that lineæ albicantes occur in males who have been stout or had the abdomen distended by disease.

The Skeleton in Relation to Identification.—When a complete skeleton is submitted for examination, the chief points to elucidate are the age and sex. These will be noted further on. It may happen that a single bone, separate bones, or only a part of one is obtainable, when there may be considerable difficulty in expressing a definite opinion. The questions to be answered are: Are they human or belonging to the lower animals? When the bones are entire the answer is not very difficult to settle; but when parts of bones have to be dealt with, one has to be very careful in forming conclusions, and the fragments may [Pg 32] have to be submitted, to a skilled anatomist. One may not be able to express an opinion about bones of the lower animals, other than to state they are not human. The services of a skilled Comparative Osteologist may be necessary to decide the nature of the animal.

When fragments resembling bone have to be examined, the microscope will be necessary to determine their osseous structure. When several bones have to be examined it may be possible to build up part or the whole of a skeleton. Duplicate bones will indicate remains of more than one creature. All fragments and bones should be carefully described, measured, and photographed.

By the character of the bones one may be able to determine the sex to which they belong and the approximate age. As a general rule the bones of the female are smaller, lighter, and less marked by muscular and other attachments.

The thorax in the female is deeper than in the male, the sternum shorter and more convex, the ensiform cartilage thinner and ossified later in life. The cartilages of the ribs are larger and the ribs smaller than in the male. The ribs are more oblique and may show the results of long corset pressure. The body of the sternum is over twice the length of the manubrium in the male, less than this in the female.

The length of the twelfth rib in the male averages 103 mm., in the female 83.8 mm. The pelvis exhibits marked differences. The sacrum of the male is more curved than that of the female, which is straighter in the upper half and more curved in the lower. The male pelvis is more compact, deeper, rougher, and narrower. The pubic angle is smaller, the obturator foramen is oval, and the ischia incurved. The female pelvis is more open, shallower, wider, not so rough, a wider pubic angle, and shallower and broader symphysis, the ischia are everted, wider apart and flatter, and the obturator foramen triangular. The inlet of the female pelvis is greater in all its diameters.

The skull in the male is heavier and larger, the markings and ridges being more pronounced, the mastoid processes, occipital protuberance, zygomatic and superciliary ridges are more prominent, and the capacity greater than in the female.

In the female the jaw is less prominent and has a wider angle.

The lumbar curve is longer in the female, and the lumbo-sacral angle greater than in the male.

The angle made by the neck of the femur with the shaft is about a right angle in the female, more obtuse in the male. It must be remembered that these differences between the sexes are not present to the same degree before puberty, so that prior to it the examination offers little evidence as to sex.

When examining bones any injuries to their structure or other abnormalities should be noted. The skull must be carefully examined for fractures, especially the base, which may be easily overlooked. [Pg 33] Injuries to vertebræ should be looked for. The presence of callus will indicate that fracture has occurred at a period before death long enough for its formation.

Age.—There are several data which enable one to form a fairly accurate opinion as to the age of a body, these are especially useful in earlier years and intra-uterine life.

The more general are the size, height, development, the presence or absence of signs of puberty, the state of dentition, the greyness of the hair; in the female the atrophic condition of the uterus after the menopause, and the character of the lower jaw.

In addition are the time of life at which centres of ossification appear and the union of epiphyses to the shafts of bones and bones with each other.

In intra-uterine life centres of ossification appear by the end of the sixth month in the os calcis, manubrium, and the bodies and laminas of the sacral vertebræ; by the seventh, in the first piece of the body of the sternum and the astragalus; by the eighth, in the second piece of the body of the sternum; at full term in the cuboid, third piece of the sternal body, first coccygeal vertebra, and the lower epiphysis of the femur.

All traces of the fontanelles have disappeared by the end of the fourth year. The angle of the jaw in infants and young children is obtuse; as dentition proceeds, the body becomes deeper and the angle alters so that towards adult life it approaches a right angle, the ramus is longer and the body has become well developed with a mental foramen midway between upper and lower borders. In the new-born, the mental foramen is low down as the body of the jaw is practically all alveolar. In old people the angle again becomes obtuse and the alveolus disappears as the teeth are shed, and the mental foramen is at the upper border.

Table of the Eruption
of the Teeth

[Pg 34]

Table showing the Periods at which Points
of Ossification appear after Birth

Periods of Union of Epiphyses with the Shafts of Bones,
and of Bones with each other

Table showing the Development of the Embryo
according to the Lunar Months

[Pg 37]

Table giving the Measurements, according to the Months,
of the Extremities of the Fœtus in
the Order of their Development

Table showing the Maximum and Minimum Dimensions of the Osseous
Nucleus of the Inferior Femoral Epiphysis from the Seventh
Month of Intra-Uterine Life to Two Years after Birth

Syncope—death beginning at the heart.
Asphyxia—death beginning at the lungs.
  Coma—death beginning at the brain.

Syncope.—From δνγκοπτω, I strike down. Sudden arrest of the action of the heart.

This condition may be brought about by

Causes—Heart Disease.—Aortic regurgitation, fatty degeneration, &c.

Hæmorrhages from wounds of blood-vessels or the heart, profuse hæmoptysis or hæmatemesis, uterine hæmorrhage, bursting of varicose veins, bursting of aneurysms.

Shock.—Emotion; blows on the head or epigastrium; sudden evacuation of fluids from the body, as in emptying an over-distended bladder, tapping a hydrocele, ascites, or a pleural effusion. Extensive injuries to the body (railway and machinery accidents). Drinking large quantities of cold water when heated.

Exhaustive diseases, chronic or infective.

Symptoms.—Pallor of the face and mucous membranes, dimness of vision, cold perspirations, sense of impending death, restlessness, air hunger and gasping for breath, nausea, and, maybe, vomiting, noises in the ears, passing delirium, quick, feeble, and fluttering pulse, or the latter may be imperceptible at the wrist, insensibility, convulsions.

In ordinary fainting attacks many of the above symptoms are absent; such as are present are temporary. In collapse, consciousness is retained.

Post-mortem Signs.—The cavities of the heart contain a normal quantity of blood in death by asthenia, but may be almost empty when death is due to anæmia. The blood in asthenic death is simply arrested in its course; blood is, therefore, found in the large veins and in the arteries. The brain and the lungs are not engorged with blood.

Asphyxia.—From ἀ priv. et δφνξιϛ, pulse. Apnœa is the better term—ἀ priv. et πνεω, I respire; but this word is now used by physiologists to denote a cessation of the respiratory movements due to [Pg 39] artificially oxygenated blood. Blood in this condition fails to excite the respiratory centre in the medulla, and respiration ceases. To avoid confusion the term asphyxia had better be retained, especially as it is most commonly used and generally understood. Asphyxia, or death from defect in the quality of the blood, is brought about when any impediment is placed on the healthy action of the lungs. Experiment has shown that for a short time after respiration has ceased, the heart still continues to act, and that if the impediment to the proper aeration of the air by the lungs be removed, life may be prolonged. Taking therefore the primary meaning of the terms asphyxia and apnœa into consideration, it may be remarked that the latter precedes the former in point of time—asphyxia marking the period at which the action of the heart ceases, apnœa the cessation of the respiratory functions.

Causes of Asphyxia.—1. Mechanical obstruction to the air passages: foreign bodies, exudations, tumours, suffocation, strangulation, drowning, hanging, spasm of glottis from mechanical irritation, or irritant gases.

2. Interference with the action of the respiratory muscles: exhaustion of the muscles from cold; paralysis of muscles from injury to or disease of respiratory centre; poisons acting on the centre; continued pressure on walls of the chest; fixation of muscles from tetanus or strychnine poisoning.

3. Diseases of and injuries to the lungs: pleurisy with effusion, acute pneumonia, empyema, pneumothorax, pyopneumothorax, pulmonary apoplexy, embolism of pulmonary artery.

4. Inhalation of air deficient in oxygen.

Symptoms of Asphyxia.—Divided into three stages. First stage: deep, frequent, and laboured respiration; the extraordinary muscles of respiration are called into play. Second stage: the inspiratory muscles are less active than expiratory, convulsions of nearly all the muscles of the body occur. Third stage: paralysis of respiratory centres, dilated pupils, loss of consciousness, absence of reflexes. Gasping inspirations with prolonged intervals precede dissolution.

Post-mortem Signs.—Engorgement of the pulmonary artery, the right cavities of the heart, and vent cavæ; but on the left side of the heart the cavities, together with the aorta and pulmonary veins, are either empty or contain but little blood. It must be remembered, however, that cases of asphyxia do sometimes occur where the cavities on each side of the heart are empty, or nearly so. This is the case in the syncopal asphyxia of some writers. If also the obstruction to respiration be imperfect, the circulation may be continued for some time, congestion of one or more of the internal organs being the result. The blood is dark-coloured, contains much CO₂, and the hæmoglobin is almost completely reduced. The blood coagulates slowly.

Coma.—Insensibility ending in death. Causes.—Concussion of the brain, cerebral hæmorrhage, embolism, thrombosis, tumour, depressed fracture of skull, meningitis, and serous effusions; effects of poisons such as opium, alcohol, ptomaines, arsenic, barium, oxalic [Pg 40] and carbolic acids; in certain diseases of kidneys and liver, uræmia, cholæmia, acetonæmia, profound anæmia, e.g. pernicious, and as a terminal stage to acute or chronic diseases.

Symptoms of Coma.—Coma is generally preceded by stupor, from which the patient may be roused to a certain extent, but only temporarily. The reflexes in this stage may be exaggerated, and the power of swallowing fluids may be retained. When coma is present there is complete abolition of consciousness, sweating, the patient is powerless, the breathing stertorous. The temperature may vary according to the cause; normal or subnormal generally, it may rise in lesions of the pons Varolii. The pulse is generally full and bounding, the pupils dilated or contracted and insensitive to light, the conjunctival reflex absent. Mucus collects in the air-passages and causes “the death rattle,” and the breathing becomes more and more embarrassed and irregular. The reflexes are lost, and the sphincters relaxed.

Post-mortem Appearances.—Causal lesions are found in the brain or other organs; there is usually hyperæmia of the brain and spinal cord and their membranes, unless there be profound anæmia preceding death. The condition of the heart and lungs is not constant; the general appearances resemble those in death from asphyxia.

Table giving the Diagnosis of Several
Forms of Insensibility

Injury to the Head—Concussion of the Brain.—The symptoms are very similar to those of shock, with unconsciousness, but it may be possible to rouse the person. The pupils are equal and dilated or contracted, and react sluggishly to light. The breathing is shallow and slow with sighing, the pulse feeble. The muscles are relaxed but not paralysed. Vomiting and involuntary micturition and defæcation may occur. The temperature is usually subnormal.

Cerebral Compression.—This, when due to injury, is usually associated with fracture of the skull and hæmorrhage. Insensibility is complete, the person cannot be roused. The pupils may be unequal, contracted or dilated, and may not react to light. The breathing is slow, stertorous, and may be irregular, or Cheyne-Stokes in type. The pulse is full and bounding, the cheeks are blown out during expiration. Paralysis, rigidity, or convulsions may be present on one side of the body. There may be retention of urine, with overflow incontinence.

In cases associated with severe fracture or hæmorrhage within the skull, the conjunctivæ may be chemosed, or there may be hæmorrhage from the nose or ear; and a flow of cerebro-spinal fluid may take place from the nose.

Alcohol.—In coma due to alcohol, there will be an alcoholic odour of the breath, alcohol in the stomach contents, and it can be detected in the urine. The odour of alcohol in the breath may be due to the administration of alcohol by an outsider [Pg 41] at the onset of the symptoms which have ended in the coma. The pupils are equal, contracted, the conjunctival reflex present, and the pupil dilates on pinching the skin of the neck. The pulse is rapid, at first strong it becomes feeble, the respirations snoring. If the coma be not complete, muscular inco-ordination may be noticed. The person can usually be aroused by stimulation.

In pure alcoholic coma the presence of the special features of coma from other causes will be absent. It must be remembered, however, that alcoholic coma may be combined with other kinds, and the more serious form should be kept in mind. Where there is the slightest doubt in the diagnosis, one‘s procedure should be ruled by the possibility of the graver cause.

Opium or Narcotic Poisoning.—The skin is usually perspiring freely, moist and cold; the countenance placid, pale and ghastly, the lips livid. The eyes are heavy, and the pupils contracted to a pin-head and equal, the conjunctival reflex usually present. There is the odour of opium in the breath. The pulse is slow, and the respiration stertorous and slow. There is no paralysis, and the person can be momentarily roused by a sharp question or blow.

Apoplexy.—The person is with difficulty, if ever, temporarily aroused. The face is red and bloated. Respiration suspirious and stertorous, and there is often Cheyne-Stokes breathing. The pupils are dilated or irregular; in pontine hæmorrhage, contracted. The temperature may at first be subnormal but gradually rises.

There may be rigidity of the limbs, or hemiplegia. The pulse is full and bounding, often of high tension with hardened arteries.

Albuminuria may be present.

Uræmia.—This is less profound than in cerebral hæmorrhage; the patient may be temporarily aroused; the onset is usually gradual. There is albuminuria with casts; albuminuric retinitis may be present. The pupils may be contracted or dilated. The breath has a peculiar so-called “uræmic odour.” The pulse is generally slow, the tension high, and the heart enlarged. The respirations are slow and sighing, and may be Cheyne-Stokes in type. There is no paralysis. There may have been preceding convulsions, and the coma may alternate with these attacks.

Anasarca may be present.

Diabetic Coma.—This may come on suddenly, and may occur unexpectedly in a person in whom diabetes has not been discovered up to the time of coma. There is sighing respiration, “air hunger.” The odour of acetone in the breath is present, and sugar in the urine.

Epilepsy.—Unconsciousness is profound, and comes on immediately with rigidity, followed by convulsions, unilateral, limited to the side of the face, jaws, head and neck or arm, or generalised. Bloody froth exudes from the mouth, the tongue being bitten. The eyes are wide open, the pupils dilated and insensible to light. Micturition may occur. After the convulsive attack has passed off, post-epileptic coma may remain, though usually for a short time only.

Syncope.—This has been described under modes of dying (p. 38). [Pg 42]

In all cases of coma when first seen examine the head for signs of injury, note the odour of the breath, observe the state of the pupils and their reactions, examine the limbs for paralysis, count the pulse and note its character, and the state of the arteries, note the size of the heart and auscultate it at each area. Count and note the character of the respirations, take the temperature, examine the urine, take note of the person‘s age, and inquire into the previous history.

Sudden death may proceed from natural or violent causes. From the former, death may occur unexpectedly and very rapidly, but as a rule the period of time occupied by the phenomena of “dying” is measurable, though inconstant. Should such period of time be immeasurable, death may be considered as instantaneous.

Apart from sudden death resulting from violence or poisoning, the common causes are as follows:—

1. Diseases of the heart: angina pectoris, valvular diseases with failure of compensation, especially aortic regurgitation, degeneration of the heart muscle, rupture of the heart, heart failure from diphtheria or toxic diseases.

2. Diseases of the blood-vessels: rupture of aneurysms or varicose veins, thrombosis, embolism.

3. Cerebral hæmorrhage, especially when in the region of the pons Varolii or cerebellum.

4. Lesions of the respiratory system: œdema or spasm of the glottis, membranous deposit or foreign bodies in the larynx or trachea, foreign bodies in the pharynx, tumours, whooping-cough, asthma, embolism of the pulmonary artery, air embolism, fat embolism, rupture of a vessel or aneurysm into the air-passages, as in phthisical cavities, pneumothorax, hæmothorax, pleuritic effusion, and in acute pneumonia.

5. Rupture of a gastric ulcer or ulcer of some other part of the alimentary tract.

6. Sudden hæmorrhage into the peritoneal cavity from ruptured uterus, ectopic gestation, &c.

7. Rupture of internal organs: distended bladder, spleen, pregnant uterus, or other abdominal viscus.

8. Hæmorrhage into the pancreas.

9. Conditions associated with the nervous system: mental emotions, epilepsy, uræmia, laryngismus stridulus in children.

10. Sudden death has occurred in Addison‘s disease, in diabetes, in cases of lymphatism or status lymphaticus in young people, during the early stage of chloroform anæsthesia, during simple vaginal examination in women, during the injection of fluids into the vagina or uterus. Bouvalat (Annales d‘Hygiène, 1892) relates a case in which, as the cannula of a syringe was being introduced into the os uteri of a woman with the object of criminal abortion, she fell back before any fluid was injected, and died in a few minutes. [Pg 43]

A similar case came under my notice, in which death took place while the husband of the woman was attempting to introduce a solution of 20 minims of tincture of iodine, mixed with water to measure two drachms, into her uterus through a No. 3 catheter.

Real or Apparent Death

It will be unnecessary here to discuss any of the theories put forward with regard to cases of apparent death or prolonged trance, but simply to note in the order of their occurrence the phenomena which attend real death.

Under this heading it is important to draw a distinction between “Somatic death” and “Molecular death.” “Somatic death” is defined as “the cessation of the vital functions and of the general renewal of tissue consequent on that cessation”; “Molecular death” is the death of the tissues themselves.

The signs of death occur as follows:—

1. Entire and continuous cessation of the respiration and circulation; no sounds heard on auscultation. The absence of the heart sounds is the most important sign of death, for even in the severest forms of syncope the cardiac pulsations, as shown by M. Bouchet, can with care be heard.

Tests for cessation of respiration:—

(a) Auscultation. (b) Placing a cold hand-mirror or empty drinking-glass over the mouth or nostrils, or a light feather, and noting the presence or absence of bedewing or movement. (c) Placing a shallow vessel, such as a saucer, full of water on the chest or abdomen, and observing the presence or absence of rippling of the fluid (Winslow‘s test).

Tests for cessation of the circulation:—

(a) Auscultation.

(b) Manual exploration of the principal arteries for pulsation or thrill.

(c) Magnus‘s test, applying a ligature tightly round a finger, sufficient to stop the venous but not the arterial circulation, and noticing whether or not a bloodless ring forms at the seat of ligature, and a zone of livid redness on the distal side of the ligature, the part becoming first red, then purple.

(d) Applying pressure to the finger-nail, and noticing whether the colour disappears on pressure, and a pink tinge appears after relaxing the pressure.

(e) Applying heat, such as dropping melted sealing-wax on the skin, and noting whether or not redness or vesication ensues. [Pg 44]

(f) Holding the hand, with the fingers abducted, against a strong fight, and observing whether or not the web of the fingers is translucent.

(g) Inserting a brightly polished needle into a fleshy part of the body, allowing it to remain for ten seconds or so in situ, and noticing whether it is tarnished or not on withdrawing it.

(h) Injecting hypodermically a solution of fluorescin (resorcin-phthalein and sodium bicarbonate, a gramme of each dissolved in 8 c.c. of water). No local discoloration of the skin takes place if the circulation has ceased, but if not, a yellowish-green coloration of the skin occurs round the seat of injection, and the substance may be detected in the blood at a part some distance from the seat of injection. By immersing some white silk threads in the blood drawn at a distance from the prick, then boiling them in distilled water, the latter will have a greenish colour if the fluorescin has been circulated (Icard‘s test).

These tests will detect whether the circulation has ceased or not, and so differentiate suspended animation from real death.

2. The lustre of the eye is lost immediately after death. It has, however, been stated that the iris will respond to the action of atropine and eserine for some hours after death, and that the action of the latter is always more marked than that of the former. The fundus as seen by ophthalmoscopic examination is altered, the normal redness changes to a yellowish-white, the vessels in the disc and just around it become empty, and the veins appear to contain bubbles of gas and the column of blood is broken up (Bouchet). A blackish round or oval stain has been described by M. Larcher on the sclerotic coat on the outer side, which he calls l‘imbibition cadavérique du fond de l‘œil. It is probably due to thinning of the sclerotic from evaporation, enabling the choroid to be seen through it. The spot precedes rigidity and is a forerunner of putrefaction.

3. The most powerful stimulus applied to the body does not cause any reaction. The muscles may, however, be made to contract shortly after death by the stimulus of a slight blow, or by galvanism.

4. The surface of the body becomes of an ashy-white colour.

[Pg 45] 5. The temperature of the body at the time of death is retained for some time. As a sign of death the fall of temperature must be progressively continuous. Cooling will depend on the medium in which the body is placed, and mere coldness of the body is not a sign of death.

6. Relaxation, primary flaccidity, more or less general, of the muscular system takes place.

“If the above signs are alone present, death must have taken place in from ten to twelve hours at the longest” (Casper). Exception: cadaveric spasm.

7. Want of elasticity in the eyeball: flaccidity of the iris. This condition invariably occurs in from twelve to eighteen hours after death.

8. Flattening of the muscles of those parts on which the body rests, due probably to loss of vital turgidity.

9. Hypostasis.—Suggillation, or post-mortem staining, is due to the gravitation of the blood to the most dependent parts of the body not subject to direct pressure. The hypostatic marks begin to form in from eight to twelve hours after death, and increase in size till putrefaction sets in. They alter their position with changes in the position of the body so long as the blood remains fluid, but when it has coagulated they remain permanent. Hypostasis may be mistaken for an ecchymosis or a bruise, and in the lungs for congestion, inflammation, &c. Errors may also occur with regard to the brain, stomach, kidneys, and intestines: in the last, the redness of inflammation is seen all over the parts, whereas the coloration of hypostasis is interrupted, [Pg 46] and this is best shown by drawing out the convolutions. The heart is an exception to the rule, but it may contain clots varying in size and colour. These are post-mortem formations. The use of the word suggillation is objectionable, as it has been used in opposite senses by Continental and British authors—some writers restricting the term to ecchymosis proper, others using it as synonymous with cadaveric lividity or external hypostasis.

10. Cadaveric rigidity.—From the moment of death till the time when putrefaction sets in, the muscular structures of the body may be said to pass through three stages:—

Cadaveric rigidity, or rigor mortis, is a purely muscular phenomenon, and is not dependent on the nervous system, as it is not [Pg 47] prevented, though it may be delayed, by division of the nerves, and is as well marked in paralysed as in non-paralysed limbs. Cadaveric rigidity, which occurs early in the heart, must not be mistaken for hypertrophy, or its absence for dilatation. In every case the rigor mortis precedes putrefaction, and consists in a shortening and thickening of certain muscles, chiefly the flexor and adductor muscles of the extremities, and also the elevators of the lower jaw.

This condition commences in the involuntary muscles, and in the heart may simulate hypertrophy of that organ, then passes into the voluntary muscles of the back of the neck and lower jaw, and then into the muscles of the face, front of the neck, chest, and upper extremities, and then into the trunk muscles, and last of all, into those of the lower extremities. In most cases it passes off in the same order, the body becoming quite flaccid, the rigor mortis never returning. These phenomena occur whilst the body is cooling. The muscle becoming rigid is dying, the rigid muscle is dead. The cause of the rigor mortis is held to be due to the coagulation of the myosin. The reaction is acid from the presence of sarcolactic acid, but becomes alkaline during putrefaction.

If fresh difibrinated blood be passed through the rigid muscle, it will become flaccid, and respond by contraction to electric stimulation.

Cadaveric rigidity generally supervenes from eight to twenty hours after death, and may continue from a few hours to four or nine days.

The sooner rigidity comes on after death the sooner will it pass away, and the later the onset the longer it will last. It is a general rule that whatever exhausts the muscular irritability before death causes the early appearance and the more rapid disappearance of rigor mortis.

Conditions which modify the onset and duration of rigor mortis:—

[Pg 48] Death during alcoholic intoxication favours the duration of rigor mortis. After violent muscular exercise death is quickly followed by rigidity. Animals that have been hunted for some time before death stiffen very rapidly. When convulsions precede death, rigor mortis sets in early as a rule, but in certain cases, where death has been preceded by strong convulsions, rigidity may appear quickly, but last for some days, as in some cases of poisoning by strychnine.

Conditions which simulate rigor mortis:—

Cadaveric Spasm or Instantaneous Rigor.—“When this phenomenon occurs the last act of life is crystallised in death.” It is a prolongation of the last vital contraction of the muscles into the rigidity of death. Cadaveric rigidity of the muscles must be distinguished from muscular spasm occurring at the moment of death.

They may thus he distinguished: In cadaveric rigidity any object placed in the hand prior to the onset of rigor mortis can be readily removed, even if the precaution be taken of binding it in the hand prior to the accession of rigor mortis.

In the case of muscular spasm the object is found grasped in the hand, and can only be with difficulty removed.

The difficulty experienced in removing a pistol or other weapon from the hand may point to suicide; its easy removal to homicide, the weapon having been placed there after death.

No adequate explanation of this phenomenon has yet been made. It is not an unusually early onset of rigor mortis in the muscles affected, because they do not share in the initial relaxation that precedes it, or the weapon would fall from the hand, and the bodies would not retain the peculiar attitudes which have been described in different instances. Nothing can simulate cadaveric spasm and it cannot be produced in any way after death. Instantaneous rigor only occurs in cases in which there has been great mental tension and nerve excitation before death. It is a continuation of probably the very last voluntary act of life.

A body showing the signs of death before mentioned (Nos. 1 to 10) [Pg 49] may be held to be that of a person who has been dead from two to three days at the longest (Casper).

Muscular states of the body between the period of somatic and molecular death:—

11. Putrefaction.—the last of the phenomena which follow death—is the resolution of the organised tissues of the body to the inorganic state. It is a gradual process, and is the result of the action of micro-organisms, aided by moisture, air, and warmth.

Putrefaction is the only absolute sign of death having taken place.

The conditions which modify putrefaction are as follows:—

External Conditions.—1. Micro-organisms; 2. Air; 3. Moisture; 4. Warmth.

[Pg 50] Internal Conditions.—1. Age; 2. Sex; 3. Condition of the body—(a) Constitutional peculiarity; (b) State of the body. 4. Kind of death—(a) The result of disease; (b) The result of poisons.

1. Micro-organisms.—A fauna and flora of decomposition has been described in a paper by Hough on “The Fauna of Dead Bodies,” B. M. J., vol. ii. 1897, p. 1853, to which the reader is referred.

Many different forms of micro-organisms combine in the production of putrefaction, and the result of their action is inevitable, unless the body be guarded against their invasion by special means, or the tissues be rendered unfit for their use.

2. Air.—Exposure in the open air has a marked effect in promoting putrefaction; but garments fitting close to the body, and thus excluding air, have a contrary effect. Dry air, or air in motion, by assisting evaporation from the corpse, acts as a preservative. The composition of the soil in which the body is placed has also a more or less modifying effect. In light, porous soil, allowing of the free ingress of air, decomposition is more rapid than in close, compact soil, as clay; but in this we have to contend with another agent—moisture—which more or less counteracts the protective virtue of the closer earth.

3. Moisture.—Putrefaction cannot proceed without moisture. The body, however, contains sufficient water to enable this process to commence spontaneously. Organic substances artificially deprived of water do not putrefy. Cold and heat possess marked antiseptic properties—the former by freezing the fluids in the body, the latter by drying them up.

4. Warmth.—A temperature between 70° and 100° F. is found most favourable to decomposition. The effect of cold is shown by the fact that a body immersed in water during winter, at a temperature between 36° and 45° F., may be so well preserved as to present, ten or twelve days after death, well-marked signs of violence, which would in summer have been utterly obliterated in five or seven days. The preservative influence of cold water will, however, depend greatly on the depth at which the body has been submerged. Bodies so submerged, and then exposed to the air, putrefy with such rapidity that exposure for one day is said to work a greater change than three or four days longer retention of the body in the water. As an instance of the preservative power of cold, may be mentioned the mammoth found in Siberia embedded in a block of ice.

1. Age.—The bodies of young children, other things being equal, are said to putrefy rapidly. It should be remembered, however, that clothing possesses considerable power in retarding putrefaction, and that, in the hurry and anxiety to get rid of the infants, they are oftener exposed naked than clothed, which may, in some measure, account for their more rapid decomposition. [Pg 51]

2. Sex.—Sex, it would appear, has little or no influence either to retard or hasten putrefaction; but it has been remarked that females dying during or soon after child-birth, irrespectively of the cause of death, putrefy rapidly.

3. Condition of the Body.

(a) Constitutional Peculiarity.—It is generally admitted that persons of the same age and sex, dying similar deaths, and subjected to like conditions as to exposure to the air and interment in the same soil, exhibit marked differences as regards the accession and rapidity of putrefaction. The explanation may be difficult, but the fact still remains.

(b) State of the Body.—Fat and flabby corpses putrefy more rapidly than the lean and emaciated. Hence old people, who are generally thin, keep fresh for a comparatively long time. Bodies, also, which are much mutilated rapidly decompose—decomposition setting in first at the parts injured. In examining wounds and bruises said to have been inflicted during life, it is well to remember that the tendency of putrefaction is to make them appear more severe.

4. Kind of Death.

(a) Effect of Disease.—Healthy persons dying suddenly, other things being equal, are said to decompose more slowly than those who have died from exhausting diseases, as in the case of typhoid, phthisis, and dropsy, following organic disease, or of those diseases attended with more or less putridity of the fluids.

(b) Effects of Poisons.—Putrefaction rapidly supervenes in those who have died suffocated by smoke, by carbonic oxide, and by sulphuretted hydrogen. Narcotic poisoning is stated to accelerate this condition; but in poisoning by phosphorus or alcohol, and in cases of death from sulphuric acid, the putrefactive changes are greatly retarded. Arsenic, chloride of zinc, and antimony are reputed to possess antiseptic properties. The manner in which death takes place from the action of the poison greatly hastens or retards putrefaction. Thus, in the case of poisoning by strychnine, it is found that when death has occurred rapidly, without much muscular exhaustion, putrefaction sets in slowly; but that, when the muscular irritability has been greatly exhausted by successive fits, the contrary is the result.

One to Three Days.—Greenish coloration of the abdominal walls. Odour of putrescence is gradually developed, and, concurrently with this, the eyeball becomes soft and yielding to pressure.

Three to Five Days.—The green colour, of a deeper shade, has now passed over the abdomen, extending also to the genital organs. Patches of this green coloration also make their appearance somewhat irregularly on other parts of the body, such as the neck, back, chest, and lower extremities. A dark reddish frothy fluid about this time wells up from the mouth. [Pg 52]

Eight to Ten Days.—The patches of green colour have now coalesced, so that the whole body is discoloured. On some parts of the body the colour is of a reddish-green, due to the presence of decomposed blood in the cellular tissue. The abdomen is now distended with gases, the products of decomposition. In India this distension has been known to occur in less than six hours, the average period being a little over eighteen hours. Much depends upon the season of the year. The colour of the eyes has not disappeared, but the cornea have fallen in. Relaxation of the sphincter ani takes place, and the superficial veins appear like reddish-brown cords. The nails still remain firm.

Fourteen to Twenty Days.—The colour of the surface is now bright green, with here and there patches of a blood and brown colour. The epidermal layer of the skin is raised in bullæ of varying size, in some places the skin being more or less stripped off. The nails are detached, and can be easily removed. The hair can be pulled from the scalp with ease. The body is now greatly distended with gases, and the features cannot be recognised, owing to the swollen condition of the face. The body is generally covered with vermin. In determining the time at which death occurred, it will be necessary to take into consideration the season of the year, as it is found that an advanced stage of decomposition may be present in from eight to ten days, with the thermometer ranging between 68° and 77° F., which in winter, with a temperature of from 32° to 50° F., would require twenty to thirty days. “Bodies green from putridity, blown up and excoriated, at the expiry of one month, or from three to five months after death (cæt. par.), cannot with any certainty be distinguished from one another” (Casper).

Three to Six Months.—During the above period the stage of colliquative putrefaction has set in. The thoracic and abdominal cavities, due to the increased formation of gas, have burst. The bones of the cranium have more or less separated, allowing the brain to escape. The soft parts are more or less absorbed, and no recognition of the features is possible. The sex can only be positively made out by the presence of a uterus, or by the peculiar growth of hair on the pubes, which in woman only covers the pubes, but in man extends upwards to the navel.

Saponification.—Bodies exposed to the action of water, or buried in damp, moist soil, are apt to undergo certain changes, in the course of which they become saponified, and the formation of a substance known as adipocere is the result. Adipocere—adeps, lard, and cera, wax—is chiefly composed of margarate of ammonia, together with lime, oxide of iron, potash, certain fatty acids, and a yellow-coloured odorous matter. The melting-point is 126.5° F. Adipocere has a fatty, unctuous feel, is either pure white or of a pale yellowish colour, and with the odour of decayed cheese. It is highly resistant to putrefactive organisms, and is generally free from them. The formation of this substance “to any considerable extent is not likely to occur in less than three to four months in water, or six months in moist earth, though its commencement [Pg 53] may take place at a much earlier period” (Casper). The above-quoted authority mentions a case in “which the remains of a fœtus were found imbedded in adipocere, and which fœtus was proved to have been buried in a garden exactly six months and three-quarters.” Taylor also records the case of a bankrupt who committed suicide by drowning, in which the muscles of the buttocks were found converted into adipocere in five weeks and four days at the longest.

Although the above statements may be accepted with regard to the formation of adipocere as far as European countries are concerned, they do not seem to be applicable to India, where the change appears to be more rapid. Dr. S. Coull Mackenzie, in his valuable book on Medico-Legal Experiences in Calcutta, records a case of a young man whose body, recovered after seven days‘ immersion in the river Hooghly, “was found to be in an advanced state of saponification,” and the fleshy portions of undigested food in the stomach were converted entirely into adipocere. “Lastly,” he writes, “in the hot, steamy, rainy months of September and October, in three of the cases above mentioned, saponification was found in bodies immersed in water, both externally and internally, in from two days to eight days ten hours. In the soft and porous soil of Lower Bengal during the rainy seasons, even in a wooden coffin, the change is very rapid—three or four days.”

To explain the formation of adipocere, it has been supposed to be due to the decomposition of the muscular structures of the body, by which hydrogen and nitrogen are evolved, these combining to form ammonia, and this, coming in contact with the fatty acids of the fat, forms a soap. The process of saponification takes place most rapidly in young fat persons; next, in those adults who abound in fat, and in those whose bodies have been exposed to the soil of water-closets; more rapidly in running than in stagnant water; and lastly, in those who have been buried in moist, damp soil, especially if the bodies have been piled one on the top of the other, the lowest being first saponified. The muscular tissue appears to be the first to undergo this change. In water the process is said to be completed in about five months, but in soil a period of two or three years appears necessary.

Mummification is of no medico-legal interest, as the causes which produce it are unknown, and no reliable data can be obtained as to the period of its accession, or the time required for its production.

[Pg 54]

1. The Trachea, including the Larynx.—The rapid change in the trachea must be borne in mind, in order to avoid the error of attributing death to suffocation or drowning. An examination of the trachea should never be omitted.

2. The Brain of Infants up to the First Year.

3. The Stomach.—The first traces of putrefaction are seen in from four to six days after death. All the coats of the stomach are softened, but there is no excoriation, as is the case when corrosive poisons are taken. Emphysematous separation of the mucous coat may be present, but must not be confounded with the excoriation just mentioned.

4. The Intestines.—Casper declares that he does not remember any case in the course of his experience where the intestines were “found earlier putrefied than the stomach.” In the course of putrefaction they become of a dark brown colour, bursting, and allowing an escape of their contents; and they ultimately become changed into a dark pultaceous mass.

5. The Spleen.—This organ in some cases putrefies before the stomach and intestines; but, as a rule, it resists decomposition longer.

6. The Omentum and Mesentery.

7. The Liver.—This organ is not unfrequently found firm and dense some weeks after death. It putrefies earlier in new-born children than in adults. The convex surface first shows signs of putrefaction. The gall-bladder also remains for some time recognisable.

8. The Adult Brain.—The brain of newly-born children, as mentioned before, soon putrefies. This is not the case in the adult brain. Putrefaction sets in not on the surface, but at the base of the brain. A wound of the brain causes it to putrefy more rapidly than if no injury be present.

9. The Heart.

10. The Lungs.—Contemporaneously with the appearance of decomposition in the heart, the lungs also begin to show signs of putrefaction, though this condition may take place earlier.

11. The Kidneys.—These organs are long in yielding to the putrefactive process.

12. The Bladder.—Nearly all the other organs of the body are in a state of decomposition before this viscus becomes materially affected.

13. The Gullet.—This long remains firm, even after the stomach and intestines fail to be recognised.

14. The Pancreas.—The body must be far advanced in putrefaction before this gland becomes affected.

15. The Diaphragm.—This may be distinguished after the lapse of four to six months. [Pg 55]

16. The Blood-vessels.—The aorta may be recognised after the body has been interred for fourteen months.

17. The Uterus.—Of all the organs of the body, the uterus resists the putrefactive changes longer than any other organ.

Table showing some important Facts to be
noticed with regard To Putrefaction:

Does Lime hasten Putrefaction?—It is a very general opinion that it does. Careful experiment has, however, proved that lime neither retards nor hastens putrefaction, but that it prevents the escape of the gases produced during the process by absorbing them; it is, therefore, a good and safe deodoriser, and in this property its true value lies.

The following are some of the Instructions issued to Medical Inspectors by the Crown Office in Scotland, slightly modified:

13. When any portions of the body, or any substances found in or near it, are to be preserved for further examination, they ought never to be put out of the custody of the inspectors, or of a special law officer. They must be locked up in the absence of the person who keeps them. When they are to be transmitted to a distance, they should be labelled, and the labels signed by the inspectors; and after being properly secured and sealed, they should be delivered by the inspectors themselves, or the special law officer whose duty it is to see them delivered into the hands of the parties for whom they are intended.

14. Besides the ordinary instruments used in common dissections, the inspector should be provided with a foot-rule for measuring distances, and a glass measure graduated to drachms, for measuring the quantities of fluids, two or three stoneware jars of medium size, or when these cannot be had, a few clean bladders, for carrying away any parts of the body which it may be necessary to preserve for future examination, and in cases of possible poisoning, three or four bottles of eight, twelve, and sixteen ounces, with glass stoppers or clean corks, for preserving fluids to be analysed. The common square green glass pickle bottles are very suitable, and can generally be obtained. No bottle or jar should be used until it has been thoroughly washed under the supervision of one of the inspectors. In cases of infanticide a balance, having a flat scale-pan with a foot-rule painted on it, is of great use; on it the infant may be stretched, weighed, and measured at one operation. Paper, pens, ink, and sealing-wax should also be provided.

15. All distances, lengths, surfaces, and the like, whose extent may require to be described, ought to be accurately measured; and the same rule ought to be followed in ascertaining the volume of fluids. When large quantities of fluids are to be measured, any convenient vessel may be used, whose capacity is previously ascertained by the inspectors. Conjectural estimates and comparisons, however common, even in medico-legal inspections, are quite inadmissible.

16. The importance of the external examination, and the particulars to be chiefly attended to in performing it, will vary in different cases with the probable cause of death. It comprehends an examination—(1) Of the position of the body when found, as well as of all external injuries or marks presented by it. (2) Of the vicinity of the body, with a view to discover the objects on which it rested, or from or upon [Pg 57] which it may have fallen, marks of a struggle, signs of the presence of a second party about the time of death or after it, weapons or other objects the property or not the property of the deceased, the remains of poisons, marks of vomiting; and where marks of blood are of importance, and doubts may arise as to their really being blood, the articles presenting them must be preserved for further examination. (3) Of the dress, its nature and condition, stains on it of mud, sand, and the like, of blood, of vomit, of acids, or other corrosive substances, marks of injuries, such as rents or incisions; where injuries have been inflicted on the body, care should be taken to compare the relative position of those on the body and those on the clothes; and where stains, apparently from poison, are seen, the stained parts are to be preserved for analysis. (4) Ligatures, their material and kind, as throwing light on the trade of the person who applied them; the possibility, or impossibility, of the deceased having applied them himself; their sufficiency for accomplishing their apparent purpose, &c.

17. The inspectors will commence the examination of the body itself by surveying the external surface and openings. Before cleaning it they will examine it on all sides, not neglecting the back, as is often done, and look for marks of mud, blood, ligatures, injuries, stains from acids, and the like; foreign bodies, or injuries within the natural openings of the body, viz. the mouth, nostrils, ears, anus, vagina, and urethra. If there are impressions of finger marks, they will consider which hand produced them. If there be any doubt about stains being blood, the skin presenting them must be preserved for analysis. If there be acid stains, or other probable remains of poison, or any foreign matter, the nature of which may require to be determined by analysis, these must also be preserved. The ordinary places for the impressions of ligatures are the neck, the wrists, the ankles, and the waist. The degree of warmth of the trunk and extremities, the presence or absence of cadaveric rigidity, and whether it exists equally in the upper or the lower extremities, should be noted in this stage of the proceedings; in other cases the progress of putrefaction, as indicated by the odour of the body, the looseness of the cuticle, the colour of the skin, and formation of dark vesicles on it, the evolution of air in the cellular tissue, the alteration of the features, the softness of the muscles, the shrivelling of the eyes, the looseness of the hair and nails.

18. In this part of the examination it will sometimes be necessary to observe the particulars by which the body may be identified. These are numerous. But the most important are the stature, the age and sex, the degree of plumpness, the size and form of the nose and mouth, the colour of the eyes and hair, the state of the teeth, warts, nævi, deformities, scars of old abscesses, ulcers, and wounds, and, if a woman, marks of her having had one or more children.

19. The body is next to be washed, if necessary, and the hair of the head shaved, or at least closely cut; and a thorough examination of the whole integuments is to be made. At this stage the inspectors will look particularly for the appearance of lividity, noting its chief seat and its relation to the posture in which the body was found—for impressions on the skin of objects on which it had rested—for marks of injuries, more especially contusions, taking care to ascertain their real nature by making incisions through the skin—for marks of disease, such as eruptions, ulcers, and the like—for marks of burning—for marks of concealed punctures in the nostrils, mouth, external openings of the ears, the eyes, the nape of the neck, the arm-pits, the anus, the vagina, and beneath the mammæ or scrotum; in infants, also in the fontanelles and the whole course of the spine. At this stage, wounds and other injuries should be carefully examined according to the directions given in Division V. (infra). Where the injury may have caused loss of blood, the presence or absence of pallor of the skin, lining membrane of the mouth, and the gums ought to be noted. [Pg 58]

20. In commencing the dissection of the body, it must be laid down as an invariable rule that all the great cavities should be examined, and also every important organ in each, however distinctly the cause of death may seem to be indicated in one of them. It is right to examine the cavity of the spine, and at all events its upper portion, in any case where an unequivocal cause of death has not been discovered elsewhere.

21. In examining the organs situated in the several cavities of the body the inspectors must be guided in a great measure by their ordinary anatomical and pathological knowledge.

22. The inspectors should begin with that cavity over which there is a wound or other mark of injury. Or, if there be an injury on the extremities, the dissection ought to commence there. In the absence of any such guide, that cavity should be taken first where the circumstances of death, so far as they are ascertained, may lead the inspectors to expect unusual appearances. In other cases, the abdomen should be first opened but not dissected, and a general survey made of the parts exposed, without disturbing them materially, the position of the diaphragm being determined by examining it with the hand; then the thorax is immediately to be examined, unless there is good reason for doing otherwise. The reasons for this method of procedure are as follow: If the abdominal organs are removed, and the veins cut, the blood in the heart may drain away through the venæ cavæ, and error result. If, on the other hand, the thorax be first opened, the relation of the abdominal organs to each other cannot be clearly made, owing to the relaxation of the diaphragm, due to the severing of its thoracic connections. Again, if the thorax be first opened, the position of the diaphragm cannot be determined. The inspectors may begin with the head, which may be examined thoroughly in the first instance, afterwards the chest and belly, as above described; the spine being reserved till the conclusion. Wherever unusual appearances are discovered in the first cursory survey, the anatomical examination ought in general to be begun there.

23. In examining the several regions of the body it is to be observed that wherever a wound, or other obvious injury of the external parts, lies in the way of the ordinary incisions, that part must be avoided, so as to leave the external injury unaltered.

24. The most approved mode of opening the head in medico-legal cases is, after dividing the integuments from ear to ear, and reflecting the scalp over the forehead and occiput, to make the usual circular incision through the skull, about an inch above the orbits in front, and over the occipital protuberance behind, using the saw lightly and carefully after the outer table of the skull has been divided, so as to avoid injuring the membranes of the brain; and to raise the skull-cap from before backwards, taking care to detach the dura mater from the skull with the handle of the scalpel or a spatula where it adheres firmly. The chisel and mallet should never be used where there is any chance of finding a fracture of the skull; for how could it be distinguished from a fracture made with the mallet? Should the dura mater be firmly adherent to the skull-cap, the better practice is to divide it carefully, so as to remove both at the same time. Tearing the membrane and crushing the brain substance are thus avoided. In infants and young children this mode of procedure is most necessary, as in them the dura mater is, as a rule, adherent.

25. The ordinary mode of examining the membranes of the brain, and the brain itself, answers well in medico-legal dissections. Effusions of fluid within the skull should always be measured. After the brain is removed, the dura mater ought to be stripped from the base of the skull to facilitate the search for fractures there, which will, of course, [Pg 59] indicate external violence. After the removal of the brain, the upper part of the spinal canal should be examined through the foramen magnum before any part of its course be laid open; and search should be particularly made for dislocation or other injury in the region of the atlas and dentata. In cases of fatal fractures of the head, the strength of the bones should be attended to. In cases of extravasation within the head, the state of the coats of the cerebral arteries should be examined.

26. The best mode of opening the spine is, after having finished the examination of the brain, to cut through the integuments from the occiput to the coccyx—to lay the vertebræ thoroughly bare on each side by cutting away the muscles—to make an incision with the saw on each side of the skull, from the postero-inferior angle of the parietal bones into the lateral edge of the occipital hole—to remove the triangular portion of the occipital bone thus detached, and then to cut the rings of the vertebræ on each side with the bone-nippers or spine-knife, beginning with the atlas. In these cases preference should be given to the saw, by which the operation is not only more easily accomplished, but there is no risk of confounding previous fracture with that made in dissecting. Where there is reason to think that the bones are injured, the laying open of the canal should stop at the distance of two or three vertebræ from the injury, and the injured bones, with two or three adjacent vertebræ on each side, should be removed entire before the examination is extended farther down the spine.

27. The organs of the throat may be examined, either by dividing the lower jaw-bone at the chin, cutting the soft parts close to the inner surface of each half of the bone backwards, and then turning the two segments outwards; or by freely reflecting the skin of the throat, separating the soft parts from the inside of the lower jaw, the knife being carried parallel with and close to the bone, drawing the tongue out below the chin, and then continuing the dissection backwards.

28. The best mode of examining the organs situated in the throat is, after detaching the soft parts from the lower jaw, as advised in Sect. 27, to dissect the soft palate from the bone, and proceeding backwards, to detach the whole soft parts from the base of the skull and vertebræ down to the sternum, leaving them connected with the organs in the chest. Besides the ordinary points to be attended to in this part of the examination, the presence of venereal or other ulcerations is a matter requiring attention in some cases.

29. It is necessary to examine the pharynx and gullet, the larynx, trachea, and its greater ramifications, the lungs, the heart, and the great vessels with particular care, because here are most frequently found the causes of sudden natural death. In examining the heart each auricle and each ventricle ought to be laid open by an independent incision of its parietes; and this should not intersect any of the valvular openings or the septum cordis.

30. For laying open the chest and abdomen, the most convenient method is to make an incision down the fore part of the neck, chest, and abdomen to the pubes; then cutting from the peritoneum upwards, to dissect back the integuments and muscles of the chest, and examine the abdomen, as in Sect. 22; next, divide the cartilages of the ribs, and, cutting upwards, close under them, to raise the cartilages along with the sternum. In separating the sternum from the clavicles, care must be taken not to wound the subjacent vessels; and this may be avoided by the dissector moving each shoulder so as to show the exact position of the sterno-clavicular joints, and then dividing both joints cautiously. In dividing the cartilages of the ribs, the saw is sometimes necessary. The cartilages should be cut as far from the sternum as possible, to give free space for the subsequent examination. [Pg 60]

31. In inspecting the organs in the chest, a cursory examination should be first made by turning them over, ascertaining the nature and measuring the quantity of effused fluids, feeling for fractures of the ribs, tumours, or other diseases, and opening the pericardium to obtain a view of the heart. The most convenient course to pursue next is, without moving the heart from its place, to lay open its several cavities, in order to judge of the quantity and state of the blood in both sides of that organ. For this purpose the following incisions should be made: The first, beginning close to the base, is carried along the right border of the heart directly into the right ventricle towards the apex, care being taken not to cut the septum. This lays open the right ventricle. The second incision, opening up the right auricle, begins midway between the entrances of the venæ cavæ, ending just in front of the base. The third, for exposing the left auricle, commences at the left superior pulmonary vein, and ends just in front of the base, close to the coronary vein, care being taken not to wound it. The fourth, displaying the left ventricle, commences behind the base, and ends close to the apex. If the blood is in a fluid state, the quantity contained in the right auricle may be materially affected by the head being examined previously, as the blood may have escaped from the heart by the jugular veins. The whole of the organs in the chest—the lungs, heart, and gullet—together with the parts dissected downwards from the throat, should now be removed in one mass, in order to examine them in detail on a table. But previously two ligatures should be applied on the gullet, just above the cardiac orifice of the stomach, and the division made between them.

32. The organs in the abdomen ought to be turned over, like those of the chest, before any one of them is minutely examined, but before the thorax is opened, for the reasons given in Sect. 22. In the subsequent examination, that organ is to be first proceeded with in which there may appear to be disease.

33. In a post-mortem examination, the most approved mode of examining these injuries is, if they be situated over great cavities, to expose the successive structures in the manner of an ordinary dissection, observing carefully what injuries have been sustained by the parts successively exposed before they are divided. Wounds ought not to be probed, especially if situated over any of the great cavities. The depth of a wound is best ascertained by careful dissection and exposure of the parts involved; but after this is done, the thickness of the tissues penetrated may be measured by the probe.

34. The seat of the wounds must be described by actual measurement from known points, their figure and nature also carefully noted, and their direction ascertained with exactness.

35. Before altering by incisions the external appearances of injuries, which should never, if possible, be done, care must be taken to consider what weapon might have produced them, and if a particular weapon be suspected, it should be compared with them. The wounded parts should be cut out entire, and carefully preserved.

36. Apparent contusions must be examined by making incisions through them; and the inspectors will note whether there is a swelling or puckering of the skin; whether the substance of the true skin be black through a part or the whole of its thickness; whether there be extravasation below the skin or in the deeper textures, and whether the blood be fluid or coagulated, generally or partially; whether the soft parts below be lacerated, or subjacent bones injured; and whether there be blood in contact with the lacerated surfaces. By these means the question may be settled whether the contusions were inflicted before or after death. [Pg 61]

37. In the cases of wounds, too, the signs of vital action must be attended to, especially the retraction of the edges, adhesion of blood to their surfaces, or the injection of blood into the cellular tissue around, or the presence of the signs or sequelæ of inflammation. Hypostasis must not be mistaken for vascular injection.

38. When large arteries or veins are found divided, care must be taken to corroborate the presumption thus arising by ascertaining, in the subsequent dissection, whether the great vessels, lungs, liver, and membranous viscera of the abdomen be unusually free of blood.

39. In the course of the dissection of wounds, a careful search must be made for foreign bodies in them. When firearms have occasioned them, the examination should not be ended before discovering the bullet, wadding, or other article, if any, lodged in the body; and whatever is found must be preserved. When the article discharged from firearms, or when any other weapon had passed through and through a part of the body, the two wounds must be carefully distinguished by their respective characters, especially as regards their comparative size, inversion or eversion, smoothness or laceration, of their edges, their roundness or angularity, and the comparative amount of bleeding from each. In gunshot injuries, the presence or absence of marks of gunpowder should be noted.

40. When wounds are situated over any of the great cavities, they ought not to be particularly examined until the cavity is laid open; and in laying open the cavity, the external incisions should be kept clear of the wounds.

41. When the discoloured state of a portion of the skin is such as to render it doubtful whether it is due to injury or to changes after death, an incision should be made to ascertain whether there is blood effused into the textures, constituting true ecchymosis, or merely gorging of the vessels of the skin, or discoloration from infiltration of the colouring matter of the blood, which takes place in depending parts of a dead body. The term suggillation should be avoided, as it has been used in opposite senses by Continental and British authors. The respective expressions, “discoloration from extravasated blood,” and “lividity after death,” are preferable.

42. In examining a body in a case of suspected poisoning, the inspectors should begin with the alimentary canal, first tying two ligatures round the gullet, above the cardiac orifice of the stomach, two round its pyloric end, and a third at the sigmoid flexure of the colon, then removing the stomach and entire intestines; next dissecting out the parts in the mouth, throat, neck, and chest in one mass; and, finally, dissecting the gullet, with the parts about the throat, from the other organs of the chest. The several portions of the alimentary canal may then be examined in succession.

43. Previous to commencing the dissection in cases of supposed poisoning, the inspectors should make such inquiries as may enable them to form an opinion as to the class of poison to which the death may be traceable, and thus to guide them as to the conclusions to be come to from the presence, or it may be the complete absence, of any marked appearance explaining the cause of death.

44. The medical inspectors may afford most important aid to the law officers in investigating the history of cases of supposed poisoning. For this purpose minute inquiry should be made into the symptoms during life their nature, their precise date, especially in relation to meals or the taking of any suspicious article, their progressive development, and the treatment pursued. It is impossible to be too cautious in [Pg 62] collecting such information, and, in particular, great care must be taken to fix the precise date of the first invasion of the symptoms, and the hours of the previous meals. The same care is required in tracing the early history of the case, where the inspector happens to visit the individual before death; and if suspicions should not arise till his attendance has been going on for some time, he ought, subsequently to such suspicions, to review and correct the information gathered at first, especially as to dates. All facts thus obtained should be immediately committed to writing.

45. Besides inspecting the body and ascertaining the history of the case, the inspectors may afford valuable assistance to the law officers in searching for suspicious articles in the house of the deceased. These are—suspected articles of food, drink, or medicine; the vessels in which they have been prepared or afterwards contained; the family stores of the articles with which suspected food, &c., appears to have been made. All such articles must be secured, according to the rules in Sect. 13, for preserving their identity. In this examination the body-clothes, bed-clothes, floor, and hearth should not be neglected, as they may present traces of vomited matter, acids spurted out or spilled, and the like.

46. When a medical man is called to a case during life, where poisoning is suspected, he ought as soon as possible to follow the instructions laid down for securing articles in which poison may have been administered.

47. In the same circumstances, it is his duty to observe the conduct of any suspected individual, were it for no other reason than to prevent the remains of poisoned articles from being put out of the way, and to protect his patient against further attempts.

48. The whole organs of the abdomen must be surveyed, and particularly the stomach and whole tract of the intestines, the liver, spleen, and kidneys, the bladder; and in the female, the uterus and its appendages. The intestines should in general be split up throughout their whole length; and it should be remembered that the most frequent seat of natural disease of their mucous membrane is in the neighbourhood of the ileo-cæcal valve, and that, next to the stomach, the parts most generally presenting appearances in cases of poisoning are the duodenum, upper part of jejunum, lower part of ileum, and rectum.

49. In cases where the possibility of poisoning must be kept in view, and where matters may require to be procured for chemical analysis, it is essential to be sure that all instruments, vessels, and bladders used are scrupulously clean.

50. When any unusual odour is perceived, either in the blood in the course of making the dissection, or in the stomach when opened, it ought to be carefully observed, and if possible identified by all the medical men present. In this way alcohol, opium, prussic acid, oil of bitter almonds, and other odorous poisons may be recognised. The smell of the contents of the stomach ought always to be noted whenever it is opened, as the smell often alters rapidly.

51. The stomach and intestines should be taken out entire, and their contents emptied into separate bottles. If the stomach or part of the intestines present any remarkable appearance, examination may be reserved, if convenient, till a future opportunity; but in every circumstance it must be preserved and carried away, as it may itself be an important article for analysis. The throat and gullet may be examined at once, and preserved with their contents, which, if abundant, may be kept apart in a bottle. In addition to the alimentary canal and its various contents, portions of the solid organs of the body ought to be secured for analysis. The most important are the liver, spleen, and kidneys. A part of the liver, at least a fourth part, should be secured in every case of supposed poisoning; and in cases where the fatal illness has been of long duration, and therefore [Pg 63] only traces of the poison may remain in the body, the whole of the liver, the spleen, and both kidneys should be secured. A portion of the blood, especially when the odour of any volatile poison is perceived, should be at once put into a bottle, closed by a good cork or stopper.

52. No person ought to undertake an analysis in a case of suspected poisoning unless he be either familiar with chemical researches, or have previously analysed with success a mixture of organic substances, containing a small proportion of the poison suspected.

53. All persons undertaking an analysis should bear in mind that the opinion of some other person practised in toxicological researches may be required; and they should therefore take care, when practicable, to use only a portion of the several articles preserved for analysis. The identity of the subjects for analysis must be secured by the rules in Sect. 13.

54. In cases of suspected drowning, the inspectors will observe particularly whether grass, mud, or other objects be clutched by the hands, or contained under the nails; whether the tongue be protruded or not between the teeth; state of the penis; whether any fluid, froth, or foreign substances be contained in the mouth, nostrils, trachea, or bronchial ramifications; whether the stomach contains much water; whether the blood in the great vessels be fluid. Careful pressure should be made upon the lungs; any fluid contained in them in thus forced into the bronchial tubes and trachea, and its nature observed. When water with particles of vegetable matter or mud is found within the body, these must be compared with what may exist in the water in which the body was discovered, and should be preserved for further scientific investigation, if requisite. Marks of injuries must be compared diligently with objects both in the water and on the banks near it, and especial attention given to the question—whether any observed injuries had been sustained by the body before or after death.

55. In cases of suspected death by hanging, strangling, or smothering, it is important to attend particularly to the state of the face as to lividity, compared with the rest of the body; the state of the conjunctiva of the eyes as to vascularity; of the tongue as to position; of the throat, chin, and lips as to marks of the nails, scratches, ruffling of the scarf-skin, or small contusions; the state of the blood as to colour and fluidity; the state of the heart as regards the amount of blood in its several cavities; the state of the trunk and branches of the vena cava in the abdomen as regards distension with blood; and the state of the lungs as regards congestion, rupture of any of the air cells, and small ecchymoses under the pleura, or the pericardium. The mark of a cord or other ligature round the neck must be attentively examined; and here it requires to be mentioned that the mark is often not distinct till seven or eight hours after death, and that it is seldom a dark livid mark, as is very commonly supposed, but a pale greenish-brown streak, presenting no ecchymosis, but the thinnest possible line of bright redness at each edge, where it is conterminous with the sound skin. Nevertheless, effusions of blood and lacerations should be also looked for under and around the mark, in the skin, cellular tissue, muscles, cartilages, and lining membrane of the larynx and trachea. Accessory injuries on other parts of the body, more especially on the chest, back, and arms, must also be looked for, as likewise the appearance of blood having flowed from the nostrils or ears, and the discharge of fæces, urine or semen. In cases where death may be due to the emanations from burning fuel or other poisonous vapours, a small phial should be filled with the fresh blood, and securely corked for further investigation, if requisite. [Pg 64]

56. In supposed death by burning, the skin at the edge of the burns should be carefully examined for redness, or the appearance of vesicles containing fluids.

57. In suspected criminal abortion, when the woman survives, the chief points for inquiry are: The proofs of recent delivery, the ascertaining of facts tending to show that she has been subjected to manœuvres with instruments, and the occurrence of symptoms traceable to the action of any of the drugs reputed as capable of causing abortion.

When the woman has died, the points requiring special attention at the dissection are: The state of the womb, as regards its size and the condition of its lining membrane, in reference to the probable period of delivery; the condition of the intestinal canal, in reference to the action of irritant drugs; of the mucous membrane of the bladder, in reference to the action of cantharides; close inspection of the womb and vagina, in reference to mechanical injuries, especially punctured wounds; and any appearances that the death may have been caused by inflammation in the organs of the pelvis, or by bleeding from the wound.

58. In cases of suspected infanticide, certain specialities must be borne in mind. The cavity of the head should be laid open with a pair of scissors. In opening the abdomen, the navel should be avoided, so that the state of the vessels of the navel-string may be examined correctly. This is done by carrying two incisions from the ensiform cartilage to each of the anterior superior spines of the ilia, and by deflecting downwards the triangular flap thus formed.

59. The inquiry in cases of infanticide should be conducted with reference to the five following distinct questions: (1) The probable degree of maturity of the child? (2) How long it has been dead? (3) Whether it died before, during, or after delivery, and how long after? (4) Whether death arose from natural causes, neglect, or violence? and (5) Whether a suspected female be the mother of the child?

60. The points to be attended to for ascertaining the probable degree of maturity of the child are: The general appearance and development, the state of the skin, its secretions, and its appendages; the hair and nails; the presence or absence of the pupillary membrane; the length and weight of the whole body; whether the navel corresponds or not with the middle of the length of the body; the situation of the meconium in the intestines; the size of the testicles in the case of males, and in either sex the size of the point of ossification in the lower epiphysis of the thigh-bone. This is easily observed by making an incision across the front of the knee into the joint, pushing the end of the thigh-bone through the cut, slicing off the cartilaginous texture carefully until a coloured point is observed in the section, and then, by successive very fine slices, ascertaining the greatest diameter of the bony nucleus. This does not exist previous to the thirty-sixth week of gestation, and in a mature child is about one-fourth of an inch in diameter. Has the infant been washed? Absence or presence of vernix caseosa. Nature and character of the wrappings, if any, found on the child.

61. The points of chief importance in reference to the period which has elapsed after death are those specified in the last clause of Sect. 17—it being borne in mind that the bodies of infants are often concealed in ash-pits and dunghills, and that in these circumstances putrefaction is very rapid.

[Pg 65] 62. The circumstances which indicate whether the child died before, during, or after parturition, and how long after it, are the signs of its having undergone putrefaction within the womb; the marks on the crown, feet, buttocks, shoulders, &c., indicating presumptively the kind of labour, and whether it was likely to have proved fatal to the child; the state of the lungs, heart, and great vessels, showing whether or not it had breathed; the nature of the contents of the stomach and of the intestines; the presence of foreign matters in the windpipe; the state of the umbilical cord, or of the navel itself, if the cord be detached.

63. In order to examine properly the state of the lungs, heart, and great vessels, with a view to determine whether or not the child had breathed, the inspection should be made in the following order: Attend, first, to the situation of the lungs; how far they rise along the sides of the heart; to their colour and texture; whether they crepitate or not. Then secure a ligature round the great vessels at the root of the neck, and another round the vena cava above the diaphragm. Cut both sets of vessels beyond the ligatures, and remove the heart and lungs in one mass, which must be weighed and put into water, to ascertain whether the lungs, with the heart attached, sink or swim. In the next place, put a ligature round the pulmonary vessels, close to the lungs, and cut away the heart by an incision between it and the ligature. Lastly, ascertain the weight of the lungs; whether they sink or swim in water; whether blood issues freely or sparingly when they are cut into; whether any fragments swim in the instances where the entire lungs sink; and in every instance of buoyancy whether fragments of them continue to swim after being well squeezed in a cloth.

64. The general question to be considered in relation to the cause of death is, whether the appearances are such as to be traceable to the act of parturition, or whether they indicate some form of violent death. The directions given in Divisions V., VI., and VII. apply to infants as well as adults; but the following points are specially to be noticed in cases of supposed infanticide:

65. The circumstances noticed in Sects. 60, 61, 62, 63, 64, compared with the signs of recent delivery in the female, will lead to the [Pg 66] decision of the question whether the suspected female be the mother of the child. These circumstances may be shortly recapitulated as being the signs of the degree of maturity of the child—the signs on the body of the kind of labour, the signs which indicate the date of its death, and the interval which elapsed both between its birth and death, and between its death and the inspection.

It becomes necessary sometimes to exhume the bodies of persons who have been buried. The cases which generally call for this always unpleasant proceeding are those where a suspicion of poisoning or violence has arisen some little time after the burial of the supposed victim. Or the necessity may arise to show that the body buried is that of a person whose death it is absolutely necessary to prove. In the case of Livingstone, though this can scarcely be called a case of exhumation, yet an examination some months after death of the arm of the corpse alleged to be that of Livingstone, proved the existence of a badly united fracture which the deceased was known to have had.

In conducting the exhumation, it is necessary that the medical experts should be present to see the body removed from the coffin, and also any person or persons who may be in a position to speak as to the identity of the corpse—as, for instance, those who dressed it and prepared it for burial. The person who made the coffin may also be of assistance to speak as to its identity. As soon as the medical men are armed with the proper authority, no time should be lost in order to get the body as fresh as possible, and at once prove or disprove the accusation of the crime, which, in the case of innocent persons, cannot be too quickly removed. The best time to take up the body, if in the summer, is early in the morning; and, in all cases, the examination, if possible, should be made during daylight. Everything necessary for making a medical inspection should be taken, and also a table on which to place the body. Rubber gloves should be worn. A pail containing a solution of some disinfectant, for the inspectors to wash their hands after the exhumation is finished, should be close at hand. And it is as well to expose the body for a short time to the air before beginning the inspection. There is seldom any risk to health in removing a single body, yet certain precautions are necessary; thus it is as well to stand on the windward side of the corpse. Vaults should not be entered as soon as they are opened, but time allowed for their ventilation. Carefully note the amount of preservation of the coffin, and, if broken, if any of the surrounding earth is in contact with the body. This precaution is necessary in cases of suspected mineral poisoning (as in arsenic, &c.), and it is as well also to save one or two pounds of the earth immediately above the coffin for analysis. The body may then be examined externally, any hair left on head or face preserved for identification; and then an inspection of all the cavities made, the contents of the stomach and bowels being placed in dry earthenware jars or glass bottles, corked and capped with thin indiarubber skin, [Pg 67] and so tied and sealed that the string must be cut or the seals broken in order to open them. The ends of the string should be sealed in the presence of the authorities. In the examination, the instructions previously given should be carefully followed. All injured or diseased parts should be removed and preserved whenever this is practicable. Soft parts not intended for analysis may be preserved in a concentrated solution of salt.

Beyond what Period is it useless to Exhume a Corpse?—There is no scientific limit, for even the bones may show that violence has been used, or may point to the identity of a corpse, as in the case of Livingstone just mentioned. Pregnancy may be detected. The medical inspectors must proceed with the inspection unless they can positively say that the progress of decay is such as to render the examination nugatory in relation to its special objects. Casper mentions the case of a man whose body was three times exhumed for different purposes. In Scotland the law imposes a limit of twenty years, but in England the law is silent on the point; in France a limit of ten years from the date of the supposed crime; and in Germany, the limit is thirty years, if the offence is that punishable with death, the time varying from three to thirty years with the nature of the crime.

Assault.—Every act of attack upon the person of another is an assault in law, whether it injure or not; nor is it necessary that the act done take effect. Spitting on anyone is an assault. No provocation by word, whether written or spoken, can justify an assault, though it may mitigate the offence. If a medical man unnecessarily strip a female patient naked, under pretence that he cannot otherwise judge of her illness, it is an assault if he himself take off her clothes (R. v. Rosinski, 1 Mood C.C. 12). So, where a medical man had connection with a girl fourteen years of age, under the pretence that he was thereby treating her medically for the complaint for which he was attending her, she making no resistance solely from the bona fide belief that such was the case, this was held to be certainly an assault, and probably a rape (R. v. Case, 1 Den. 580; 19 L.J. [M.C.] 174). Such an act is now held to constitute a rape.

Battery.—This includes beating or wounding. A touch of the finger, however slight, is included under this term.

Homicide.—In Scotch law homicide is held to be committed only where a distinctly self-existent human life has been destroyed. Destruction of an unborn child, however short a time before delivery, may be criminal, but is not homicidal. In the same country criminal homicide is divided into two classes:

1. Murder is constituted in law by any wilful act causing the destruction of human life, whether plainly intended to kill, or displaying such utter and wicked recklessness as to imply a disposition depraved enough to be wholly regardless of the consequences. Murder may be the result of personal violence, poison, or by the committal of some other serious crime, as where anyone causes the death of a woman in the attempt to procure criminal abortion, rape, or by the exposure of an infant which results in its death. The use of weapons is not essential.

2. Culpable Homicide.—The name applied in law to cases where the death of a person is caused or materially accelerated by improper conduct of another, and where the guilt does not come up to the crime of murder:

[Pg 69] Justifiable Homicide.—Self-defence; hanging a prisoner properly sentenced to death; killing another to prevent murder, if prevention can avail in no other way. In self-defence, the person killing must be in reasonable dread of death at the hand of his adversary.

In England there is—1. Murder; 2. Manslaughter; 3. Justifiable Homicide.

Murder, according to Lord Coke (3 Inst. 47), is constituted “where a person of sound memory and discretion unlawfully killeth any reasonable creature in being, and under the King‘s peace, with malice aforethought, either expressed or implied.”

In England the killing must be committed with malice aforethought. Malice may be expressed or implied.

In Scotland malice aforethought is not necessary (5 Irv. 525, and 40 S.J. 92, and 5 S.L.R. 20).

The law in both countries appears to differ more in terms than in practice. In England, if an injured party live for one year and a day, and then die, death is not attributed to the injury; but in Scotland, although no definite time is fixed, yet no case would I believe be entertained at any lengthened period after the commission of a homicidal act. The longest interval, according to Taylor, at which conviction has taken place from indirectly fatal consequences was nine months.

In the United States, as a rule, the crime of murder admits of two degrees: in the first, where the act is intentional or is the result of an attempt at burglary, rape, arson, or by poison; otherwise the crime falls under the second degree.

Legal Definition.—According to the statute (24 and 25 Vict. c. 100, sec. 18), the word “wound” includes incised, punctured, lacerated, contused, and gunshot wounds. But to constitute a wound within the meaning of the statute, the whole skin, not the mere cuticle, or upper skin, must be divided (R. v. M‘Laughlin, 8 C. & P. 635). But a division of the internal skin, e.g. within the cheek or lip, is sufficient to constitute a wound within the statute (R. v. Warman, 1 Den. C.C. 183). If the skin be broken, the nature of the instrument with which the injury is inflicted is immaterial, for the present statute extends to wounding, &c., “by any means whatsoever.” A wound from a kick with a boot is within the statute (R. v. Briggs, 1 Mood C.C. 318). Injuries, burns, and scalds—which, in accordance with the above definition of a [Pg 70] wound, are not wounds—are provided for under the clause, “or cause any grievous bodily harm to any person.”

Casper defines “an injury” to be “every alteration of the structure or function of any part of the body produced by any external cause.” Taylor proposed the following as the best definition which can be given to the word “wound,” whether in a medical or legal sense, viz. that it is “a breach of continuity in the structures of the body, whether external or internal, suddenly occasioned by mechanical violence.” This would include dislocations, fractures, either simple or compound, injury to the skin or mucous membrane, and to internal organs. Burns and injuries due to the action of corrosives are excluded from the category of wounds.

Concerning Wounds in general.—Great care must be taken to ascertain the exact site and course of the injury on the body, as this precaution will greatly assist in answering the questions: Is the wound dangerous to life? Does it cause grievous bodily harm? Is it suicidal, that is, inflicted by the person on himself; or homicidal, inflicted by another? The solution of the question of the dangerous character of the wound is left to the professional knowledge of the witness, who may be required to state his reasons for considering the wound dangerous to life. His mere assertion will not be accepted. “The safest course,” says Elwell, “for the witness, in regard to all these questions, is to give a true and plain account of the wound, describing it minutely, and the probable consequences that may attend it.” In relation to their danger to life (apart from so-called “simple” wounds which are not usually extensive, heal easily, and cause little trouble in their course), wounds may be considered dangerous to life when they are so extensive, or on account of their position and relation to important structures when they would prove fatal without the intervention of surgical skill; and when the danger is imminent. A mortal wound is one which is rapidly followed by death. Wounds, however, which in themselves could not be regarded as dangerous to life, may become so by intercurrent complications, such as erysipelas or other infective process. As a general rule, only those wounds in which the danger to life is imminent should be stated as dangerous to life. Compound fracture of the bones of the cranium, injury to any large arterial trunk, or to any of the internal organs, may be considered as “dangerous to life”; but where the danger is more remote, as in the probable supervention of tetanus, erysipelas, &c., the medical opinion must be more guarded. But the medical witness should always bear in mind that death may follow the slightest injury. A case is recorded of death in forty-eight hours after extraction of a tooth. The contrary also holds good, for the most fearful injuries have been followed with recovery.

The following suggestions may help the practitioner in the formation of his opinion as to the probable danger of a wound: [Pg 71]

1. The extent of the injury. 2. The character of the instrument used in the infliction of the wound. 3. The violence suffered by the parts. 4. The size and importance of the blood-vessels and nerves injured. 5. Is the wound healing or likely to heal well, and is the constitutional disturbance severe or slight? 6. Age of the sufferer. 7. Is there any constitutional taint likely to render even a slight wound more severe, or even dangerous to life? 8. Has the previous medical treatment been skilful or otherwise?

Should the injured party be found dead, a careful post-mortem examination will alone determine the probable part the injury bore in the production of the fatal result.

Points of Importance to be Noticed
in Examination of a Dead Body
found Wounded.

These may be either external, affecting the integuments; or internal, affecting the brain substance, &c. In the latter, as a rule, there are signs of external violence. An ecchymosed tumour of the scalp may impart a sensation of crepitation to the finger, and may thus be mistaken for a fracture of the skull. The tumour may also [Pg 72] pulsate if any large vessel be near it, giving one the idea that the pulsations are due to the movements of the brain. A large wound without fracture points to a more or less oblique blow, a small wound to direct violence. A blow with a heavy blunt weapon may make a clean incised wound, and often in these cases the seat of the bruise does not correspond with the centre of the cut. Dr. Ogston mentions the case of a young lady on whom a cricket ball inflicted a wound across the forehead, immediately above, and of the length of, one of the eyebrows, which he could not distinguish from a wound by a cutting instrument. All injuries to the head are more or less severe and dangerous, and great care is required in forming a prognosis with regard to the ultimate effect of an injury to the head. Inflammation of the brain does not, as a rule, supervene for about a week after the accident, and patients should not be considered safe from danger till two or three weeks after. Be it remembered also that in some cases the inflammatory action may proceed insidiously for some months without giving any distinct evidence of its presence till close upon a fatal termination. Scalp wounds are dangerous, from erysipelas, &c. They should be examined as to their extent, form, depth, and position.

Concussion of the brain may arise from falls on the nates, or from blows on the head. The face becomes pale, the pupils contracted, the pulse weak and small, the extremities cold, the respiration scarcely perceptible, and the sphincters relaxed. The tendency to death is from syncope. Reaction may then occur: the pulse quickens; the skin is hot and dry; there is great confusion of thought, from which the patient ultimately recovers; vomiting is present in most cases. Concussion often passes into compression, due to hæmorrhage from the lacerated cerebral vessels. Concussion and compression differ in this: in the former, the effects are instantaneous; in the latter, a short time elapses before the symptoms make their appearance; and these become more and more marked, whereas in concussion they gradually pass off. It is often a difficult matter to distinguish the effects of compression from those common to drunkenness or narcotic poisoning. The odour of the breath and the history of the case will assist in forming an opinion. Concussion of the brain may prove fatal without either fracture of the skull, effusion of blood within the cranium, or any other change being observed on dissection, death being caused by the shock given to the whole nervous organ, which, being unrelieved, speedily lapses into annihilation of function.

The symptoms of compression—a full, strong, and often irregular or slow pulse; normal heat of surface; muscular relaxation; dilatation, contraction, or inequality of the pupils; stertorous breathing, and paralysis—are not unfrequently retarded, and this consideration should render the opinion very guarded. Bryant records a case (Surgery, vol. i. p. 216) in which a man was thrown out of a gig on to his head. After a short period of insensibility he walked for half an hour, and then gradually again became insensible, and ultimately died. A large clot was found over the left cerebral hemisphere, the blood evidently [Pg 73] having flowed from the middle meningeal artery. The short period of insensibility probably arrested the flow of blood from the artery, which recurred on the sufferer walking. The structural form of the cranium may have much to do with the danger to be expected from blows—some skulls being thinner than others—and in a few rare instances the fontanelles may not have become ossified during life.

The possibility of an unhealthy condition—atheroma—of the arteries of the brain, or of disease of the heart, must be taken into consideration before venturing an opinion as to the tendency or ultimate cause of death.

It may be stated that the patient died of apoplexy. Apoplexy is a disease of old age, and seldom occurs in the young, although it is just possible it might occur. The arteries should, in every case, be examined for the presence or absence of disease. When violence is used, the effusion of blood is, as a general rule, on the surface of the brain; but two cases are given by Dr. Abercrombie of spontaneous bursting of a blood-vessel within the head, followed by effusion of blood upon the surface of the brain. “An external injury, coexisting with an extravasation of blood into the cerebral substance, does not necessarily imply cause and effect. The previous condition of the brain, or the outpouring of blood from diseased vessels, may, in fact, have been the cause of the accident” (Hewett). When, however, blood is found effused on the surface of the brain, especially between the dura mater and the skull, either beneath or opposite to an external wound, we may reasonably infer that the hæmorrhage is due to a direct blow. Hæmorrhage so severe as to produce dangerous pressure on the brain, as a rule, comes from a rupture of the middle meningeal artery.

Husband relates a case in the Edinburgh Infirmary in which there was a large clot over the left frontal lobes, accompanied with aphasia and right hemiplegia, with no rupture of the middle meningeal artery, or any signs of external injury. The man had just left the cells on a charge of drunkenness. The source of the hæmorrhage was not clearly made out, but it seemed to be due to the rupture of an artery in a pachy-meningitic patch. Blood may be found in the cavity of the arachnoid in the great majority of severe injuries to the head, and even in trifling cases where least expected. Rupture of the venous sinuses may take place without fracture of the skull. I have met with this in a fatality during a boxing match; a large effusion over the brain, and especially in the temperosphenoidal fossa, taking place from rupture of the left lateral sinus at the junction with the superior petrosal; there was also a vertical hæmorrhage into the pons. The effused blood may, after a time, become changed, and form a false membrane on the parietal arachnoid, seldom on the visceral surface. Blood cysts may even be formed, in the course of time, having all the appearances of a serous membrane. The blood may spread to parts remote from the seat of injury, and the extravasation does not always occur at the exact spot of the application of the blow, but often at a spot directly opposite. Two extravasations may be the result of one blow. [Pg 74]

Fits of passion have been advanced as a cause of apoplexy, but this cause is rare. Fracture of the cranial bones may be due to counter-stroke—contre-coup—or to falls on the nates, &c. Fractures of the skull are divided into two groups (Körber): (1) those produced by bilateral compression of the skull; and (2) those resulting from violence applied to one side only. In both groups the line of fracture runs parallel with the axis of compression. Fissures of the base from bilateral compression of the skull are always transverse. Punctured wounds of the cranium are always dangerous, but the patient may survive many days. Dr. Bigelow, Professor of Surgery in Harvard University, U.S.A., relates a case in which an iron bar, weighing thirteen and a quarter pounds, three feet seven inches in length, and one inch thick, was driven through the head, followed by recovery, the patient only losing the use of the injured eye.

Contusion and laceration of the brain may occur from injuries to the head, either at the seat of injury or by contre-coup at some other part. The contused area may exhibit local extravasation of blood, or in the diffuse form, extravasations may be multiple and also on the surface. The symptoms are those of cerebral irritation, coma, or restlessness, paralysis, tonic or clonic spasms. In slight cases recovery may follow, in others some degree of loss of mentality and paralysis may remain.

There is great danger of inflammatory complications. I have met with a case of severe comminuted fracture of the skull with laceration of the brain, the latter substance appearing on the surface of the scalp, with loss of brain substance, in a boy who made a complete recovery without any loss of intelligence or power following the injury.

For the detection of brain substance on weapons the microscope is alone reliable, and then only the cellular portion of the brain is of any use.

Injuries to the spinal cord may cause immediate death; cases, however, occur of life being prolonged for some days, or even longer, after injury to the cord. The symptoms are progressive paraplegia and paralysis of the bladder and rectum, ending in death. Bedsores and septic infection of the bladder and kidneys are complications which add to the gravity of the condition. Spicula of bone in the cord, dislocation of the vertebræ, or extravasation of blood in the membranes of the cord, may be found after death. The presence of blood upon the spinal cord is not necessarily the result of violence, as hæmorrhage may take place spontaneously. The spine should be examined in all fatal cases of supposed injury. Concussion of the spinal cord is a fertile source of differences of opinion in railway cases. In no case should a hasty decision be given as to the probable future result to the patient from the injury.

Wounds of the face are not generally dangerous, unless they penetrate the brain. There is always the possibility of injury to the eye causing detachment of the retina, or inflammation leading to blindness. Punctured wounds in the neighbourhood of the orbit may become septic and lead to secondary meningitis. [Pg 75]

Wounds of the throat are more or less dangerous, due to the possibility of severe hæmorrhage, emphysema, and bronchitis.

Wounds of the chest are dangerous, on account of the amount of the hæmorrhage which may take place, and the importance of the organs which may be injured. Death may result more from the mechanical action of the blood effused than from the depressing effect of the quantity evacuated. Penetrating wounds of the thorax injuring the lungs cause emphysema, pneumo-, pyo-, or hæmothorax, any of which may prove fatal; pleurisy and pneumonia may occur. A fracture of the ribs may give rise to injury of the lung substance or to inflammation of its coverings. Laceration of the lungs may take place without fracture of the ribs. The ventricles of the heart may be pierced, and yet life may be prolonged for one or two months, permitting of considerable locomotion during that period (Briand et Chaudé, Med. Leg., vol. i. p. 511). Wounds of the heart, however, are, as a rule, rapidly fatal. Rupture of valves may follow blows on the chest, and rupture of the heart may occur from crushes or violent blows. Rupture of the heart has taken place during violent exertion, and this is more likely to occur when the muscle is diseased. It is often difficult to make out the direction of the wound, as the lungs change their position during respiration.

Wounds of the abdomen, penetrating the intestines, although not necessarily fatal, may cause death from peritonitis, due to the escape of the intestinal fluids. Rupture of the intestine may follow blows or crushing; it is generally fatal from peritonitis unless early surgical treatment is carried out. Hernia may also follow wounds of the abdomen. Rupture of the liver is not of infrequent occurrence, and may occur without any external signs of the injury. The rupture is, as a rule, longitudinal, transverse lacerations being rare. It is often followed by pneumonia if not rapidly fatal. The cœliac plexus may be much damaged by a blow or kick on the stomach, especially if this organ be distended with food, and death may result without leaving any trace of the injury externally or internally. The bladder may be ruptured and death result from extravasated urine. Rupture of the bladder may occur from fracture of the pelvis without sign of external injury. Rupture of the kidney may be recovered from if slight, but when severe is fatal. Rupture of the spleen is usually fatal, and is more likely to occur when enlarged from any cause. Coagulable lymph, the effect of a wound of a serous membrane, may be thrown out in twelve hours or less.

Injuries to the abdomen may cause death by— [Pg 76]

Wounds of the genital organs of the female may cause fatal hæmorrhage, which takes place from the plexus of veins which, in these parts, are devoid of valves. A kick from behind whilst the woman is stooping or kneeling may rupture the labial vessels and death supervene.

Blows and kicks upon the abdomen do not often injure the non-gravid uterus, but during gestation may produce abortion and hæmorrhage. If the pregnancy be advanced the uterus may be ruptured or the placenta separated. Penetrating wounds either through the abdominal wall, or per vaginam in the attempt to procure abortion, cause hæmorrhage and peritonitis with septic infection.

Unless they implicate some special structure, such as the brain and medulla, simple fractures are not considered dangerous to life. When compound, they may be complicated with hæmorrhage and infective processes.

Certain pathological conditions favour the spontaneous fracture of bones, or this occurrence with such slight violence as would not cause fracture in the normal may take place.

In old people bones are more liable to fracture from their brittle condition. Liability to easy fracture occurs in the insane, in nervous lesions as locomotor ataxia and general paralysis of the insane, when the bones are the seat of new growths, in fragillitas ossium, osteopsathyrosis; in the latter disease I have seen the femur fracture by the weight of the leg while resting the foot on a cushion. The liability to fracture depends upon the proportion of organic and inorganic constituents. In disease, the latter may be reduced and predispose to fracture; in the young, the bones are more liable to greenstick or incomplete fracture; and in the old, from excess of inorganic constituents causing brittleness.

A medical man may be required to express an opinion as to whether or not fractures are the result of direct violence, and especially when allegations have been made against attendants on the senile or insane.

The previous predisposing pathological conditions must always be taken into account, and also the amount, if any, of repair that has followed in relation to the time the alleged violence took place.

As the condition of a fracture of the bone of a limb may become a question of considerable importance in medico-legal investigations, the [Pg 77] following brief account of the process of repair in fractures is given:

Although the blood clot completely disappears from the immediate neighbourhood of the fracture at an early period, yet layers of dark coagulum may often be found beneath the superficial fascia for four weeks or more after the accident (Erichsen).

It may be of importance to remember this in medico-legal inquiries. The presence or absence of the signs of vital reaction will help to distinguish fractures caused before or after death.

A fracture taking place immediately after death cannot be distinguished from one immediately before death, but if a few hours after death, the differences are easily recognised, blood is not effused round the ends of the bones unless a large vessel be torn.

In the examination of bones for fracture in the living it is the duty of the examiner to have an X-ray plate taken of the injured bone, especially if the seat of injury is in close vicinity to a joint.

Previous fractures are easily recognisable after death even when the bone does not show manifestations externally; on longitudinal section the seat of fracture is rendered evident.

An attempt is made to answer this question by a consideration of the wounds in reference to their position, nature, extent, and direction.

In reference to their position it has to be borne in mind that one person may wound any part of the body of another, but that to the suicide certain parts only are accessible, and they have a predilection for wounding themselves in favoured regions; the front of the body and vital parts are chosen by the suicide, while wounds on the back point to homicide. Suicidal wounds on the head are generally in front or lateral, and on the neck in front or to one side, in cutting the throat. Accidental head injuries are more often on the vertex, and when [Pg 78] there may be no history of a fall on the occiput, wounds in this situation indicate homicide.

Suicides may choose unusual regions, such as cutting of a large vessel as the femoral artery in Scarpa‘s triangle, or by a limited incision, the carotid in the neck, the injury may be about the genitals, and the penis and scrotum have been amputated.

Accidental injuries may occur on any part of the body, but most commonly on exposed parts.

The nature and extent of the wounds does not afford much assistance; with the exception of contused wounds which are usually homicidal or accidental, any other form of wound, particularly incised or punctured wounds, may be suicidal or homicidal, and with regard to gunshot wounds, much depends upon their position and extent. As a rule, the suicide does not make several wounds, and the homicide may not only inflict several but of a greater severity than are necessary to carry out his purpose.

Suicides, especially when insane, may wound themselves severely and cause great injuries by leaping from buildings or similar high positions. In some cases suicides have inflicted several and varied wounds on their bodies.

The direction of suicidal wounds, when the person is right-handed, is generally from above downwards and inwards on the chest, and on the left side. An upward direction points rather to homicide.

Cut throat wounds, when suicidal and inflicted by the right hand, are generally oblique from left to right, beginning higher up than they end. They generally cross the thyroid cartilage, and the larger vessels may escape; if made below the thyroid cartilage they are generally smaller and horizontal. The skin is the last structure divided, and there may be several so-called “tentative cuts.” It has been held that when the large vessels are cut the suicide stops, but this is incorrect, as in some cases the wound has reached the spine and the vessels been quite severed. Suicides may try to decapitate themselves from behind, and failing this stab themselves. A homicidal cut throat wound, when made from the front with the right hand, commences on the right side and is carried to the left; they are often deep incisions to the vertebræ and the tissues “undercut” at the ends. A homicidal cut throat wound when made from behind the victim resembles a suicidal one. When wounds are present on the forearms, hands, and fingers, and if there are injuries on other parts of the body also, the inference would be that the hand wounds were received in guarding the throat or other efforts at defence from a homicidal attack.

Wounds produced by Firearms.—To distinguish between suicidal, homicidal, and accidental wounds is far from easy. If the weapon be held hard up or close to the body, as in suicide, the skin and hair would be scorched and blackened, as would probably the hand that held the weapon, but this has not occurred in every case. The grasping of the firearm by the hand in cadaveric spasm is certain evidence of suicide, as this cannot be simulated by an assailant placing the weapon [Pg 79] in the hand after death. Full investigation should be made by noting the bullet track and surrounding objects which may have been grazed in its course, in order to form a probable estimate of the direction from whence it came. Bullet wounds in the back are usually homicidal.

The surgeon should at once visit the wounded party, and proceed to examine the injury, for if this be done before swelling occurs, he will be better able to form an opinion of its nature, extent, and severity. If the wound has been dressed, he should, if possible, obtain the attendance of the person who applied the dressings, and who would be able to describe their nature, and the dangers to be avoided in their removal, should that be deemed necessary. In no case should a surgeon remove the dressings applied by a professional brother without his presence and assistance. The condition of the injured party should be carefully noted, and a minute description of the wound written down at the time. The statements of the bystanders are also useful and should be noted. The procedure in the examination of the dead body has been previously described (p. 60).

An important question here arises. Have the wounds found on the body been produced during life or after death? The answer is beset with difficulties, and considerable caution will be necessary, but tables will be given under the different kinds of wounds to assist the diagnosis. Signs of vital reaction are important, as showing the ante-mortem infliction of the wound; but these may, to some extent, be removed by the action of water, as in cases where the body is found in a pond. Under these circumstances the evident signs of drowning—water in the stomach, &c.—will assist the diagnosis. The presence of putrefaction also greatly obscures the diagnosis. The presence of coagulated blood between the edges of the wound is not a trustworthy indication of the ante-mortem infliction of the wound, as experiment has shown that as long as the body remains warm coagulation may take place. Coagulation even in contused wounds, effected before death, may be retarded from various unknown causes—disease, e.g. scurvy; mode of death, e.g. asphyxia. The amount of hæmorrhage on or around the body is, other things being equal, a safe criterion as to the time when the wound was inflicted; if in considerable amount, arterial blood points to ante-mortem injury; the presence of venous points blood to post-mortem injury.

Care should be taken to record and photograph the body in position where found, and its relation to surrounding objects. Careful note should be made of the surroundings and the character and presence of any blood-stains, footprints, &c. The question may have to be considered as to whether the body is in the place it was when the wounds were inflicted. Blood in any quantity in one place, and the body [Pg 80] found in another so seriously injured that locomotion would be impossible, point to the body having been removed.

Signs of a struggle, if any, should be recorded. If a weapon be found near to the body, its position should be noted, and if in the hand, the firmness of the grasp—cadaveric spasm—should be recorded. All clothing should be carefully examined, and the relation of cuts and body wounds noted. All blood-stains on the clothing should be examined and described.

Multiple bullet wounds denote homicide, but suicides have been known to inflict more than one wound. It is strong evidence of suicide if the gun or pistol has burst by the explosion, as suicides have a predilection for overloading the weapon employed.

How may wounds, alleged to have been the result of an assault, be shown to have been self-inflicted? This has to be done by considering:

(1) The character of the wounds: in these cases they are generally slight, and may consist in a series of small, superficial wounds.

(2) The parts of the body where they are, and those from which they are absent. They are never found on vital parts, but always where there is little danger of doing harm. They are present on parts accessible to the individual. The hands are seldom wounded, and if they be, not severely.

(3) The clothing may not be cut, and if it be, the cuts may not go right through, and if they do, they may not coincide with the position of the wounds. The person should be clothed in order to determine this. Blood-stains on the cuts in the clothing may be erratic in distribution, some being on the inner layer only, some on the outer, and rarely soaking through all, pointing to the probability of its having been artificially applied.

Such self-inflicted wounds are usually produced for the purpose of bringing a fictitious charge of assault, feigning self-defence or provocation on the part of the assailant when accused; and in order to divert suspicion, as in the case of a person who alleges he has received the injuries by an assailant who was committing robbery while he himself is guilty of it.

Wounds may prove fatal from results which are (1) directly due to injury—hæmorrhage, shock, or mechanical injury to some vital organ, e.g. the heart or lung; or (2) indirectly from complications which may supervene such as infective processes—erysipelas, tetanus, septic infections, gangrene,—exhaustion, or the effects of surgical operations; or (3) malum regimen (a) on the part of the patient, (b) on the part of the medical attendant. [Pg 81]

Hæmorrhage.—Hæmorrhage may be profuse and cause rapid death if a large blood-vessel, more especially an artery, has been injured. The hæmorrhage may take place internally, in which case it need not necessarily be profuse; it will depend upon the position; a small hæmorrhage into the pericardium or in the brain may prove rapidly fatal.

Shock.—Death from shock is generally associated with severe injury, either a single one, or from several smaller injuries, any of which alone would not be expected to prove fatal. Death may occur from shock when the visible injury may be slight, as in blows over the heart and abdomen, the latter causing fatal syncope from dilatation of the splanchnic vessels. Repeated lesser injuries as in flogging may cause death through shock; and fatal psychical shock may be caused by mental excitement, as, for instance, in an encounter when no physical injuries have been received.

Mechanical Injury to Viscera.—This causes rapid death, more especially when the viscus injured, as the heart or medulla, is necessary for the immediate functions of life; injuries to other organs may not be followed by immediate death unless very severe and with great shock. A wound of the lung may not be followed by death for some time.

In a healthy person the violence necessary to prove fatal ought to be greater than in one diseased, and pathological conditions may be found post-mortem, which were pre-existent to the injury, e.g. degeneration of blood-vessels, aneurysm, valvular disease of the heart, phthisical cavities which may have bled, gastric ulcer which may have ruptured. Such conditions might influence the findings of a jury, as, for example, it is not always possible to form the opinion that death has been directly due to violence when signs of injury are slight; a man may receive a blow on the head while in the act of falling in a fight, and post-mortem a cerebral hæmorrhage be found with diseased vessels, when it would be difficult to say with certainty that the hæmorrhage was directly caused by the blow or preceded it.

Fatal Complications.—In English law if death follow injury inflicted by a person within a year and a day, the assailant may be tried and punished; beyond that time the person is not held responsible for the death. The infective processes mentioned above may supervene at any time during the course of wounds with fatal result. Further, as a result of altered conditions left by injuries which in themselves have not proved fatal, and from the immediate effects of which the person has recovered, fatal complications may follow, e.g. a person may have received an abdominal wound which after healing may become the seat of hernia which may strangulate; or an injury to the spinal cord, which may cause death at a late date from bedsores and exhaustion.

Septic Processes.—These may cause death at an early date according to their nature and virulence and the power [Pg 82] of resistance of the person. In such cases the original injury need not have been dangerous to life. In other cases the infection may persist after the wound has healed, as infective endocarditis might conceivably do.

Surgical Operations.—Should a surgical operation be considered necessary for the treatment of the injury or in order to save life, and the person dies after it, the prisoner will be held responsible for the death. This holds good if the operation has been done in good faith and performed with reasonable skill and care. If, however, it can be shown that the operation was unnecessary, or performed unskilfully and death resulted, the prisoner would not be held responsible unless it can be proved that the injury apart from the operation could have caused death, when the jury might convict.

Where from improper treatment of an injury an operation is called for because of the improper treatment and the person dies, the prisoner would not be held responsible. The main points to be considered in reference to surgical operations for criminal injuries are:

(a) On the part of the Person Injured.—If the wound is not in itself sufficient to cause death, but by negligence in the care of it by the injured person, complications arise which cause death, then the punishment would probably be mitigated; but in law a person accused of criminally injuring another is held responsible for the immediate and remote results. “No man is authorised to place another in such a predicament as to make the preservation of his life depend merely on his own prudence.” If, however, it can be proved that death was largely due to the imprudence or recklessness of the deceased, it is probable that this would lessen the punishment.

(b) On the part of the Doctor.—A person accused of criminally injuring another being held responsible for the results immediate and remote, may plead that the latter, i.e. complications, or the death itself are not due to the injury directly, and endeavour to throw the responsibility on someone else, either the injured person through negligence, or on the doctor for unskilful treatment. In reference to the complications, the medical witness may be asked for his opinion as to the cause and effect of the complication, and how it might have been avoided. Having considered all the facts laid before him and made his deductions, he must give his opinion fairly, and leave it to the Court to decide in what way his opinion may influence its judgment and the amount of punishment for the offence.

When there is an allegation that the treatment has been unskilful or negligent, and contributory to complications and death, and a defence [Pg 83] raised accordingly, the prisoner has to prove this to the satisfaction of the Court in order to mitigate the offence and punishment. The medical man is expected to have exercised reasonable skill. If the person treating the injury is a registered medical practitioner, and has applied his treatment in good faith and for cure, even if the treatment were improper, the assailant would be held responsible.

The care which the medical man ought to exercise is that which everyone ought to exercise who has received the statutory education and passed the statutory examinations.

(1) Incised; (2) Punctured; (3) Lacerated and Contused; and (4) Gunshot.

Made by sharp instruments.

General Characters.—Incised wounds are somewhat spindle-shaped, their superficial extent being greater than their depth; the edges are smooth and slightly everted, and the wounds are always larger than the weapon which inflicted them—due to retraction of the divided tissues. If a wound be in a line with the fibres of a muscle, there will be less “gaping” than when the wound is directly or obliquely across the muscle. From muscular contraction, or the elasticity of the skin, an incised wound may assume a crescentic form. The cellular tissue is infiltrated with blood, and coagula are found at the bottom and between the edges of the cut. It must be borne in mind that a wound with smooth edges may be made by a blunt weapon over bones near the surface, as on the scalp and over the tibia or shin, but a certain amount of contusion may, in most cases, be detected by careful inspection a short time after the receipt of the injury.

It is often of importance to distinguish where the weapon entered, and where it was drawn out. The end where the weapon entered is usually more abrupt than the other, which is naturally more drawn out. But in some cases I have seen, when the weapon was simply drawn across the part, both ends of the wound alike.

The orifice is generally a little smaller than the weapon.

A stab may sometimes present the appearance of an incised wound; the depth will, however, help to distinguish the one from the other. The wound may not at all correspond with the shape of the weapon, and the same pointed instrument may produce very different-shaped wounds in different parts of the body. Much depends upon the movement of the instrument in the action of puncturing; in the case of a double-edged instrument the wound will most probably be fusiform or diamond-shaped. When made with a knife the wound may be wedge-shaped if the knife have a thick back. A circular weapon splits the skin and leaves a slit; broken glass and pottery act in a similar way, but the wounds may have [Pg 84] jagged edges and show signs of contusion in them. On dissection, two or more punctures may be found in the soft parts, with only one external orifice; these are due to the weapon being only partially withdrawn at each stab. Punctured wounds are always more dangerous than incised. They cause little, if any, hæmorrhage externally, unless a large vessel, such as the femoral artery, be injured, but they may cause internal hæmorrhage or penetrate a viscus, e.g. the lung or heart. These wounds generally heal by suppuration, and not infrequently an abscess is formed in and around the track of the wound. Perforating wounds generally have a large entrance wound with inverted edges, and a small exit with everted edges; if the weapon be rough, the reverse may be the case.

The edges of these wounds are never smooth, and generally do not correspond at all with the weapon. A considerable amount of contusion or bruising surrounds the solution of continuity of the part. Hæmorrhage from these wounds is usually slight. A point of considerable interest may arise in connection with this class of wounds; the defence may declare that the injury was the result of a fall, and not due to a blow. The history of the case, and the presence of a bruise where no theory of a fall can explain its existence, will often afford the only solution of the difficulty. Lacerated wounds heal by suppuration, generally with more or less sloughing, and leave a permanent scar. Scratches with the finger-nails may be considered as lacerated wounds, but the skin is merely abraded, not divided. They are never important as wounds, but often as a proof of a struggle in cases of rape, &e. Bites are also lacerated wounds. The diagnosis of lacerated and punctured wounds, whether inflicted before or after death, will depend on much the same grounds as those of incised wounds, hæmorrhage, vital reaction, &c.

Table of Differentiation Between
Ante-mortem and Post-mortem Wounds:

The appearance which gunshot wounds present will to a great extent depend upon the form of the projectile, and the distance at which the firearm was discharged. Round halls make a larger opening than conical. Small-shot, fired within a short distance of the body, make one large ragged opening. The scattering of the shot depends on the calibre of the gun, on the charge of powder, and essentially on the distance. A charge of ordinary (No. 5) shot, to make a single hole, must have been fired at less than one foot; but experiments should always be made with the alleged weapon. A patent cartridge would make a single hole at a considerable distance—five or six yards. Round bullets may split, but the conical ones seldom do. The edges of wounds produced by the discharge of firearms are always more or less ecchymosed; this condition appears in about an hour after the infliction of the injury. If the ball strikes obliquely, the edges of the wound may be much lacerated, or the opening may be valvular and of small size, if the skin over the part be in any way tightened, or if a conical ball has been used. The injury to bones is greater from conical than from round balls. The old round balls were easily deflected; the conical are not [Pg 86] so easily turned aside. The track of the ball widens as it deepens. This is the reverse of an ordinary punctured wound. The ball may either lodge in a part, or perforate it. Should it have lodged, it must be preserved and compared with the alleged firearm. Bits of clothing or wadding may be carried into the wound. The latter should be carefully kept, as they may prove important as a means of identification.

The aperture of entrance and exit must, if possible, be determined. On this point there is much difference of opinion. The wound of exit is always smaller than the wound of entrance (Casper). In this opinion Casper agrees with M. Malle, Olliver d‘Angers, and M. Huguier, but is opposed by Taylor, M. Matthysens, and others. “The characters of a gunshot wound,” says Assistant-Surgeon Neill, “are those of a contusion and laceration of all the tissues. Sometimes they are so simple as to bear resemblance to a punctured wound, particularly if a rifle-ball (conoidal), revolving on its long axis, has passed through the soft parts at a great speed, but within a few hours it resembles a contusion. The wound of entrance, as it has been termed, bears no comparison in size or shape to that of the exit when a rifle-ball has caused the injury. In the former you see the edges of the wound curving inwards, and the circumference small, with little or no hæmorrhage. In the latter, the wound is large, with torn and irregular edges projecting outwards, and perhaps only slight oozing of blood. In a short time, averaging an hour, round the entrance wound slight redness begins, gradually extending to about two inches round its orifice. Again, this colour changes to a blue- or greenish-black, and you see all the appearances of a severe bruise, with a small wound of the skin, its edges still curved inwards. In the exit wound the discoloration of the skin is not apparent.” The probable reason for the discrepancies in the statements of observers, as to the characters of entrance and exit wounds, may be found in the fact that experiments have been conducted with different-sized balls, different kinds of weapons, with varying quantities and qualities of the powder used, the character of the wads, and with varying velocities and distances. As pointed out by M. Roux, the two openings may be equal if the ball preserves the same velocity through the tissues as it possessed before entrance; the entrance hole is smaller than the exit, when the ball has lost much of its trajectile force, and enters the softer parts of the body first; the entrance is larger than the exit, when the ball first enters through the denser tissues of the body, and leaves through the softer.

The opening of entrance made by the ball has generally, but by no means always, inverted edges. The edges of the exit opening are everted, bloody, and raw; but both the entrance and exit wounds may be everted in fat persons, due to the protrusion of the fat; and this eversion may also result from the expansive power of the gases generated during putrefaction, should this condition be present. Wounds made by double shots, as from double-barrelled guns, or pistols, or from slugs fired from one barrel, diverge after their entrance into the body. [Pg 87]

Observations during the war in South Africa threw fresh light upon the results of gunshot wounds produced by modern projectiles. Of wounds produced by the Mauser bullet, one correspondent (The Physician and Surgeon, 1900, p. 49) states that “the aperture of entrance seldom shows any bruising of surrounding tissue; frequently it has been difficult to locate it, for where the skin is dense and elastic, there is seldom any bleeding. There is never any inversion of the edges, which are sometimes circular in form, and sometimes triangular like a leech-bite. The aperture of exit, where the bullet has not been distorted, is seldom any larger than that of entrance; there is no bruising of surrounding tissue, and no eversion of the edges; bleeding varies, of course, in accordance with the proximity of large, medium, or small blood-vessels in the track, but in the vast majority of cases it is slight.”

The late Sir William MacCormac, quoted by Sir William Stokes (B. M. J., vol. i., 1900, p. 1453), says: “I saw a large number of injuries inflicted by the Mauser bullet, which is remarkable for the small wound it produces. In three-fourths, if not a larger proportion, it was impossible to tell the exit from the entrance wound, they were so similar in appearance.”

In the examination of gunshot wounds we have to consider—

1. Direction in which the Gun was fired.—The track and position of the ball in the body, coupled with the relative position of the body to a window or door through which the gun may have been discharged, and the place where the ball is found, should it have passed through the body, may assist us in forming an opinion. It is often impossible to trace the course of the ball through the cavities of the body, but through the muscles and denser structures this is more easily accomplished. The effects of the ball on surrounding objects may assist very much in finding the direction of its course. Sir Astley Cooper, by a careful consideration of the above suggestions, once correctly determined that a left-handed man had fired the fatal shot.

2. Distance at which the Charge was fired.—In the case of wounds inflicted by a small shot, the scattering of the shot must be our guide. Dupuytren has related a case in which a fowling-piece charged with powder alone and fired at a distance of two or three feet from the abdomen made a round hole in it and killed the man. If the weapon be fired a short distance, e.g. a few inches from the body, the skin will be scorched, smoke-blackened, and tatooed with powder, the flame may singe the hair or clothing. If discharged quite hard up to the body, the edges of the wound are freely lacerated, ecchymosed, and burnt. Smokeless powder will not cause blackening of the skin. The absence of scorching, or marks made round the wound by the half-burnt powder, allows of the assumption that the shot must have come from some distance—rather more than four feet. The absence of any of the above, however, is not an absolute proof that the shot has come from a distance.

There is no means of deciding, from an examination of a pistol or gun, when the weapon was last used. In all cases, medical men, unless sportsmen and familiar with firearms, should hand over the weapon to a [Pg 88] gamekeeper or gunsmith, and not attempt to give an opinion on matters about which they know nothing. The following may be of use to students for examination purposes, but for nothing else: Among the products formed when gunpowder is exploded is the sulphide of potassium, but if exposed to the air some portion of this substance is converted into the sulphate of potash. If, then, the gun-barrel be washed out with distilled water, and the washings filtered, and, on the addition of a solution of acetate of lead, a black precipitate of sulphide of lead be formed, this is supposed to point to recent use; if, on the other hand, a white precipitate of sulphate of lead forms, to the use of the weapon at some more distant date than the period alleged.

It is important in medico-legal investigations to determine the nature of stains found on clothes, weapons, articles of furniture, &c. In the case of blood-stains note should be made of their incidence upon the body or in its vicinity. Blood-stains may vary in their character, incidence, and magnitude, as sprays, spirts, or jets, smears of various forms, or pools of blood.

Notes should be made of the relation of the direction of a spray of blood to the position of a wounded body when found. A plan with the position of the stains should be sketched upon the spot, and measurements taken carefully.

In the examination of blood-stains the purpose of the medico-jurist is not to demonstrate all the properties of blood, but to identify it. There is not much difficulty in ascertaining whether stains are due to blood or not; but when the question arises as to whether the blood be human or that of some other animal, the identification is more difficult and less certain.

Blood-stains vary in colour, according to the age of the stain, the quantity of blood in it—the thicker the stain the darker—and the nature and colour of the material upon which it is. Recent stains are reddish in colour, old stains brownish. This change of colour depends upon the free access of air and the presence or absence of chemical substances in the air, so that it is almost impossible to infer the age of a blood-stain by its colour. On dark-coloured materials the stains are rendered more visible by the aid of artificial light, such as candle-light; on light-coloured materials, on leather, wood, iron, and stone, they are more visible in good daylight. By reason of the coagulation and the albuminous composition of blood, dry stains stiffen the fabric when thin, and on thicker woollen materials the fine fibres become matted. On metals, such as iron or steel, they appear as dark shiny spots or smears, and when dried are often fissured or cracked. Rust may so alter blood as to produce a difference between the stains on the blade and handle of a knife. In quite recent blood-stains the general appearances are sufficient to give rise to a conclusion as to their nature, especially if the stains are large. The general features as seen by the naked eye are such that one may often recognise blood-stains as arterial by the comet shape they retain when falling slantwise on an object. Venous blood is not spurted in small jets like arterial, but blood from veins may become splashed upon objects and assume shapes similar to those produced from an arterial jet. [Pg 90]

The examination of blood-stains should be carried out in the following way:

1. Examine the stains carefully with a good pocket lens or a low power microscope lens. A fabric will show matting of its fibres, red filaments, and minute coagula in its meshes. In old blood-stains coagula may be absent and the fabric appear as if dyed. The characters of any fibres or hairs adhering to the stain and the nature of the substance upon which the stain is should be noted.

2. Make accurate notes of the position and shape of the stains on the material examined.

3. Take one stain, if there are several, or part if single, and note the solubility of it in water, or in a mixture of water and some other substance. The solubility of the colouring matter is greater if the stain be recent than if it be old. The older the stain the less soluble it becomes, as the hæmoglobin is gradually changed in course of time to insoluble hæmatin.

An endeavour should be made to obtain a solution for microscopical, chemical, and spectroscopical examination. The solvent, in order to obtain the blood corpuscles in as natural a form as possible, should approach in its specific gravity the liquor sanguinis.

The following solvents fulfil this purpose:

[Pg 91] If distilled water alone be used, the red corpuscles lose their hæmoglobin and become “laked” or “phantom” corpuscles; if the solution be of higher sp. gr. than liquor sanguinis, then the corpuscles become crenated and irregular in shape.

The technique of examination has to be varied in certain details, according to the material upon which the stain is. Stains may have to be examined upon cloth-fabrics, wood, plaster, metal, or leather. These will be taken separately, and the methods of examination described which will prove most reliable in each case.

1. Cloth-fabrics.—Cut out a stain, or part of one, and macerate it in a quantity of one of the solvents mentioned above, sufficient for the purpose. If the stain be very small, squeeze with fine forceps one or more drops upon microscope slides for microscopic, and keep the remainder of the solution for spectroscopic, examination. In dyed fabrics, which have been mordanted, the mordant may fix the blood-stain so as to prevent solution, and especially so when the attempts have been made to wash out the stain with soap and water.

To make a solution of the stain in such cases it is best to use distilled water to which a small quantity of ammonia or citric acid has been added; in one or other of these the colouring matter will dissolve.

2. Wood.—Note the kind of wood, cut off a thin shaving and treat with one of the solvents mentioned above. If on wood containing [Pg 92] tannic acid, such as oak or elm, the best solvent is a two per cent. solution of hydrochloric acid.

3. Plaster.—Scrape off some of the stained plaster, and treat as for cloth or wood.

4. Metal.—If the stain be upon a clean and unrusted metal, e.g. the clean blade of a knife, then gently heat the metal on the side opposite to the stain, when the latter, if recent, will peel off or can be easily detached. This requires some care and dexterity. It is easy, however, to scrape the stain off into a watch-glass, and this procedure is necessary when the metal is rusted and the stain mixed with the rust, or when the stain is thin.

If on iron and mixed with rust the borax solution may be used, with a drop or two of solution of ammonia; use a fine camel-hair pencil dipped in the solution, and brush the stain off into a watch-glass. Becker advises that stains mixed with rust should be digested with a weak solution of ammonia and common salt for a few hours; decant the solution and evaporate it upon a microscope slide to dryness, then test the residue by the “hæmin test.”

Ganttner‘s test should be used to a portion of a stain upon metal when thin or mixed with rust. It may be carried out upon the metal itself or upon a scraping of the stain in a watch-glass resting upon a black surface. Moisten the scraping in a watch-glass with a drop or two of distilled water rendered feebly alkaline, then add a minute drop of hydrogen peroxide. Wherever blood is present bubbles of gas develop, which give the material a white beaded appearance. The froth develops from the outside of the drop towards the centre when the stain is mainly composed of blood. In a scraping consisting of mixed particles [Pg 93] of rust and blood, the reaction only appears upon the particles of blood, and rust to which blood adheres; it does not take place on those particles of rust free from blood. Before adding the peroxide of hydrogen it may be necessary to dissipate any air-bubbles which may cling to the scraping in the alkaline water by gentle agitation with the point of a fine glass rod. Should the above reaction with peroxide of hydrogen not take place, then one can rest assured that no blood is present. The test, however, is a negative one; it is not a positive test for blood only; other fluids and exudations from the body, such as saliva and pus, give the reaction. The reaction will take place with blood-stains of any age.

In examining a clasp-knife or any hinged weapon for blood-stains, the instrument should be taken to pieces and all the hinges and recesses carefully examined, for in these places blood may be found, although the weapon had previously been wiped clean, and appear free from stains.

5. On Leather.—The tannic acid in leather forms a compound with blood which is insoluble in the solvents generally used. A thin shaving of the stained portion should be taken and folded, with the stained surface outwards, in the form of a loop. If the outer surface of the loop with the stain be made to touch the surface of the glycerine and water solution, at the same time taking care that the leather itself be not moistened, a recent stain may yield a sufficient quantity of colouring matter for the purposes of examination. Failing this, the shaving should be digested in a small quantity of a two per cent. solution of hydrochloric acid in distilled water (Sorby). [Pg 94]

The microscopical examination of blood-stains, for the purpose of identifying the presence of the red blood corpuscles, is especially applicable to recent stains. In these the corpuscles may retain, to a great extent, their normal characters; but their condition varies with the age of the stain; they become altered in appearance and irregular in shape with increasing age, until a stage is reached when they become completely disintegrated and unrecognisable. Having obtained a solution of a stain by one of the methods recommended, a few drops should be placed upon a clean microscope slide and covered with a No. 1 cover-glass. In a recent stain, where minute coagula are present, one may be placed on a microscope slide and moistened by breathing upon it several times, and then covering it with a No. 1 slip, or a drop of the glycerine solution may be allowed to act upon it on the slide until it be sufficiently moistened, when it should be covered in the same way. The preparation should be examined through the microscope with a good lens (preferably a ¹/₁₂th oil immersion), magnifying 300 to 400 diameters, and if any corpuscles be found, their characters should be carefully observed and noted.

All such specimens should be carefully preserved and labelled with a description of the method of preparation, the case to which they belong, the date of preparation, and the signature of the individual who has made and examined them. It is essential that the preparation and examination of the specimen should be made by the same individual. In certain cases the conditions may be sufficiently favourable to allow of the production of stained specimens, which can be mounted so as to retain their original characters permanently. In every case it is advisable to pursue the investigation with this object in view.

This process is especially applicable to recent blood-stains, in which, from preliminary examination, the presence of blood corpuscles has been determined; where complete disintegration of the blood corpuscles has taken place it would not be of any value.

It may so happen that by means of stained specimens the identity of blood corpuscles may be more easily established, when the result of examination is uncertain in a specimen not so prepared.

By the action of certain dyes upon the corpuscles their special features are rendered easier of recognition. Any of the approved methods of preparing blood films for general clinical purposes, which will suit the circumstances, may be employed. An easy and reliable method is as follows. A drop of the solution of the blood-stain properly prepared as previously recommended, or if obtainable a small coagulum moistened with normal saline solution, is placed on a clean coverslip and spread evenly over its surface with the aid of a fine glass rod. The film is allowed to dry in the air, covered with a watch-glass for protection against dust. When dry it is passed three times through the flame of a Bunsen burner, or placed in a mixture of [Pg 95] equal parts of absolute alcohol and ether, to fix it. After fixation it should be placed for a minute or more in an aqueous solution of eosin.

Any excess of stain should be removed by washing in distilled water, and the specimen allowed to drain by standing it on edge upon a piece of filter paper; it should then be allowed to dry, and then counterstained with a freshly prepared aqueous solution of methylene blue, hæmatoxylin solution, or other nuclear dye. Wash again in distilled water, allow to dry, and mount in Canada balsam. By this method the corpuscle will be stained pink, and if nucleated, the nucleus will be stained by the methylene blue, hæmatoxylin, or other nuclear stain which may have been used.

Leishman‘s stain may be used. This stain being a methyl-alcohol solution is used for fixing and staining at the same time. A few drops of the stain is placed on the dried film; after standing until evaporation is almost complete, distilled water is dropped on to the slide, and left to stand for two or three minutes, it is then drained off, and a few more drops of distilled water added until the film is pink in colour, then dried with filter paper. Red corpuscles are tinted red with the eosin, and nuclei of leucocytes or nucleated red cells violet or deep blue. The specimen may be examined direct with the oil immersion or mounted in Canada balsam.

When examining specimens prepared from blood-stains, it is necessary to search carefully for other cellular structures such as epithelial cells, spermatozoa, or fragments of hair.

It may be advisable, in certain cases where the amount of material submitted for examination is small, to centrifugalise some of the solution in a fine glass tube, in order to determine any cellular elements present to one spot. By making use of this concentrated portion containing the cellular elements for the preparation of a microscopic specimen, one not only facilitates the microscopical examination, but is able to place more reliance upon the results obtained.

The Results of Microscopical Examination of
Blood-Stains in Their Medico-Legal Relations.

As previously stated, the examination of alleged blood-stains from a medico-legal standpoint is pursued essentially for the purpose of testifying as to whether they have been produced by blood or not. Where the examination yields a negative result, further procedure is necessary with a view of identifying the true nature of the stain. Should, however, the result be positive, the question arises as to the possibility of distinguishing between human blood and the blood of other animals, and determining the exact animal from which the blood has been derived. Such an examination should be pursued in full recognition of its importance as a factor towards the establishment of truth essential to the administration of justice.

To fulfil this obligation the methods employed should be so selected as to produce results bearing testimony free from any possibility of doubt.

Certain differences exist, and may be detected by microscopical [Pg 96] examination, between the red corpuscles of human blood and those of some other animals sufficiently well marked to render differentiation possible. The differences are those of form and structure.

(1) In man the red corpuscles appear as circular biconcave discs, averaging ¹/₃₅₀₀ of an inch in diameter, and are non-nucleated.

The red corpuscles of mammals present the same features, with the exception of the

(2) Camel tribe, in which the corpuscles are oval in form, but non-nucleated.

(3) In birds, fishes, reptiles, and amphibians the red corpuscles are oval in shape, and possess a nucleus.

Guided by the above facts, one is able to testify whether or not the corpuscles exhibit the characters of mammalian blood.

Many attempts have been made with a view to establishing a reliable means of differentiation between the red blood corpuscles of man and other mammals (the camel excepted), and with a certain degree of success, such as might be expected, under select conditions favourable to histological research, but which do not obtain in medico-legal practice. Differences in size of the red corpuscles, as revealed by micrometric measurement, have been suggested as a possible means of distinguishing between the blood of different mammals. Of the common animals, the red blood corpuscles of the sheep present the most marked difference in size compared with those of man. The following table of the dimensions of red blood corpuscles is derived from measurements made by Treadwell, and quoted by White (The Medico-Legal Journal, New York, 1895):

Menstrual blood contains no fibrin, has an acid reaction due to the vaginal mucus which keeps it fluid, and contains squamous epithelial cells. None of these characters can be differentiated on fabrics, especially when contaminated with urinary stains in addition. Hence, in cases of alleged rape, no distinction can be drawn between blood-stains on the underclothing of the female, which may have arisen from hæmorrhage the result of violence to the sexual parts, and those which might have arisen from the ordinary menstrual flow or metrorrhagia. The detection of spermatozoa, however, would add considerable value to the observation. [Pg 97]

[Pg 98] Blood Crystals.—Professor Preyer of Jena pointed out many years ago that the hæmoglobin crystals from the blood of some animals differed in shape from those of man, and this fact has given rise to many attempts to trace the identity of the blood to the animal from which it has been derived. The results have not been of sufficient value to establish it as trustworthy for medico-legal purposes. Dr. Monckton Copeman (B. M. J., vol. ii. p. 190, 1889) has carefully investigated the subject, and his researches, partly confirmed by Professor Glaister of Glasgow, show that from the guinea-pig, rat, and squirrel, crystals of hæmoglobin may be easily obtained, but the solubility of human hæmoglobin renders it much more difficult to crystallise. Crystals may, however, be obtained in the following ways:

Crystals of human hæmoglobin appear in the form of rectangular plates, with a greenish or pale claret colour. On spectroscopic examination they exhibit the characters of reduced hæmoglobin, in contradistinction to the crystals derived from the lower animals, which produce the spectrum of oxyhæmoglobin.

The blood of the bullock, sheep, and pig is very difficult to crystallise. By the method adopted by Gamgee of adding to defibrinated blood one-sixteenth its volume of ether, shaking until the mixture becomes transparent, and allowing to stand in an ordinary temperature for 48 hours, crystals may be obtained from the blood of the following animals:

Crystals from human blood are not easily obtainable by this process, but when they are, they always give the spectrum of reduced hæmoglobin, whereas those from the animals mentioned above give the spectrum of oxyhæmoglobin.

Having obtained a coloured solution from a supposed blood-stain, if sufficient in quantity, apply the following chemical tests to separate portions:

1. Add a few drops of a weak solution of ammonia in distilled water. The colour may remain unchanged, or, at the most, a slight heightening may take place, if it be due to blood. If the solution of ammonia be too strong, a brown colour may be produced if blood be present.

2. Heat to boiling, when the following changes take place if blood be present:

[Pg 99]

3. Add tincture of guaiacum, freshly prepared: an opaque, cream-coloured precipitate of the guaiac resin will form in the aqueous solution. On the addition of ozonic ether, turpentine, or peroxide of hydrogen, a blue colour will be produced at the junction of the fluids: proportionate to the amount of blood-colouring matter present, the blue colour will vary in intensity.

This test, known as Day‘s or Schönbein‘s, is extremely delicate, and reacts to no coloured substance except blood.

In cases where the blood-stain is small, the test may be applied as follows. Moisten a pure white filter paper with a drop of distilled water, or one of the solutions recommended in the section on physical examination, and touch the stain with the moistened portion. On adding a drop of tincture of guaiacum followed by a drop of ozonic ether to the wet filter paper the blue colour will be produced and easily recognised on the white surface.

The guaiacum test, although extremely delicate, can only be accepted as providing negative evidence. The absence of reaction proves the absence of blood, except in very old blood-stains, which may not respond [Pg 101] to the test. The blue colour produced indicates that the substance may be blood, but it cannot be accepted without corroboration. Gluten, raw potato, milk, bile, sweat (Ogston), and other oxidising substances give a blue colour with guaiacum and ozonic ether; some substances give the blue colour with guaiacum alone.

With blood, however, the test is sufficiently delicate to detect one drop in six ounces of water.

4. Nitric acid added to a portion of the solution of blood in distilled water produces a whitish-grey precipitate.

5. Hæmin Crystals.—Concentrate a portion of the solution upon a microscope slide, add to it a minute crystal of chloride of sodium and a few drops of glacial acetic acid. Heat gently to dryness or to a lesser degree under a coverslip; examine with the microscope; if blood be present, crystals of hæmin, or the hydrochloride of hæmatin, will be found. They are of a yellowish-red to brownish-black colour with a metallic lustre. They occur in rhomboidal prisms, or six-sided in shape, or in the form of “whetstones,” often in clusters; many of the crystals exhibit a lipped projection on one side. They are known as Teichmann‘s crystals. It is well to verify their origin from blood by placing upon them a drop of hydrogen peroxide, when they will give off bubbles of oxygen gas.

They are insoluble in water, alcohol, and dilute acetic and hydrochloric acids. They dissolve in boiling acetic or hydrochloric acids, and the caustic alkalies. They respond to the guaiacum test, and the ash produced by incineration shows the presence of iron by the red [Pg 102] colour produced on the addition of a drop of hydrochloric acid and a solution of potassium sulphocyanide.

The production, by the methods described, of such crystals affords conclusive proof of the presence of blood.

To a portion of the coloured solution, filtered if necessary, the spectroscopic tests should be applied. The following points must be remembered in carrying out a spectroscopic examination:

(a) The colouring matter of fresh blood is hæmoglobin, and it may exist in two states, according to the degree of its combination with oxygen.

In arterial blood it is present as oxidised hæmoglobin, and the same obtains in blood which has been exposed to the air under certain conditions and for a varying period of time.

In venous blood, especially when obtained under conditions preventing oxidation, as from the heart cavity of an animal newly asphyxiated, it is present as deoxidised hæmoglobin.

(b) In dry stains, especially if they have been subjected to the action of impure air containing the products of coal-combustion, the colouring matter becomes changed into methæmoglobin, or hæmoglobin in which its combination with oxygen has been altered in such a way that a current of a neutral gas, such as hydrogen or nitrogen, will not dissociate it, as it does with oxyhæmoglobin. Such stains have a brownish colour, and may give an acid reaction.

(c) In stains which have retained moisture, from having lain in damp places, the hæmoglobin becomes converted into hæmatin. The same change takes place in dry stains after a longer period of time. [Pg 103]

On examining the solution of the colouring matter from a blood-stain with the spectroscope, the spectrum will vary according to its condition and the nature of the solvent used.

The spectra of hæmoglobin and its derivatives are characteristic, and afford conclusive evidence of the presence of blood. The spectra must be recognised, however, in more than one condition. Other substances may yield spectra very similar to that of oxyhæmoglobin, but when subjected to certain tests they do not alter in the same way. They cannot be made to give the spectra of reduced hæmoglobin and reduced hæmatin, and any colouring matter which may be made to yield the spectra of reduced hæmoglobin and reduced hæmatin is derived from blood.

1. Oxidised hæmoglobin (O₂Hb) is characterised by the presence in its solar spectrum of two absorption bands between the D and E lines. The first band commences at the D line and extends a short distance towards the E. The second commences at a little distance from it, and terminates at the E line; it is about twice the breadth of the first. The band at D is more defined than the other (Fig. 15, 1).

2. Deoxidised or reduced hæmoglobin presents one broad band occupying almost the whole of the space between D and E slightly to the left of these lines (Fig. 15, 2).

3. Methæmoglobin presents two bands between D and E, in the same position as those of O₂Hb, but in addition a third band between C and D and near to the former (Fig. 15, 3).

A solution of oxyhæmoglobin or methæmoglobin may be reduced by the addition of a reducing agent, such as Stokes‘ reagent, consisting of ferrous sulphate with a small quantity of tartaric acid dissolved in water and rendered alkaline at the time of using with ammonia, or, better still, by the addition of ammonium sulphide. The spectrum will change to that of reduced hæmoglobin.

4. Acid hæmatin presents a spectrum with a band between D and E, commencing at a little distance from D and ending at E, also a narrower band between C and D and commencing at C. It is a difficult spectrum to obtain.

5. Alkaline hæmatin presents a spectrum with a single band between C and D near to the D line. It is more difficult to obtain than the spectrum of acid hæmatin.

It is not necessary, however, to obtain these spectra, viz. 5 and 6, but it is necessary to reduce solutions of either acid or alkaline hæmatin in order to obtain the spectrum of reduced hæmatin. To do so proceed as follows. To some of the solution of colouring matter obtained from the stain add a small quantity of a 20 per cent. solution of sodium hydrate; the solution will alter in colour, and the spectrum of O₂Hb or MetHb will disappear. On adding to this solution of alkaline hæmatin a few drops of ammonium sulphide, or Stokes‘ fluid, it becomes claret-coloured, and on examination with the spectroscope the spectrum [Pg 104] of reduced hæmatin will be seen. This is the most pronounced of all blood spectra. Its production can be hastened by gently warming the solution.

If the stain be old and already changed into hæmatin, its solution will yield the spectrum of acid hæmatin, and will give the spectrum of reduced hæmatin on the addition of ammonium sulphide or Stokes‘ fluid without previous alkalisation.

6. Reduced hæmatin presents a spectrum with a dark band about midway between D and E, and a broad but paler band commences near the E line and extends to the b line (Fig. 15, 4).

In cases of death by asphyxia, in which the hæmoglobin is in combination with CO₂, the blood, if removed and examined immediately after death, gives a spectrum of reduced hæmoglobin, but on exposure to the air it rapidly changes to oxyhæmoglobin. The period after death at which blood is usually submitted for medico-legal examination is sufficiently late to allow of this change, and so prevents the possibility of determining death by asphyxia by spectroscopic examination of the blood. Where death has been caused by the action of carbon monoxide, the blood is of a cherry-red colour, and it will retain this colour unchanged for a long time, in fact for years, due to a stable combination of the CO and hæmoglobin, called carboxyhæmoglobin. Such blood yields a very characteristic spectrum, with two bands similar to those of O₂Hb, but nearer to the violet end (Fig. 15, 6). Their position should be assured by accurate measurement and comparison with a spectrum of O₂Hb. The CO hæmoglobin, however, cannot be reduced; on the addition of ammonium sulphide or Stokes‘ fluid the bands remain unaltered. [Pg 105]

In cases where the amount of fluid obtainable for examination is very small, recourse must be had to the micro-spectroscope, using a Sorby‘s cell to hold the fluid, and substituting for the eye-piece of the microscope a specially constructed spectroscope arranged so as to throw the spectrum of a known solution of blood-colouring matter alongside of that yielded by the solution under examination. Artificial light should be used, and the D line located by placing in the flame a platinum wire carrying a salt of sodium.

The results of the experimental investigations of Friedenthal,[3] Deutsch,[4] Uhlenhuth,[5] Wasserman and Schutze,[6] Nuttall,[7] Tarchetti,[8] Grünbaum,[9] Metchnikoff,[10] and M‘Weeney[11] into “blood relationships” have led to the suggestion of a new method—the “biological test,” by which different kinds of mammalian blood may be distinguished one from the other. Their experiments show in a general way that the “serum from an animal which has been injected intraperitoneally with any given organic fluid will, if mixed in small quantity with a dilute solution of the fluid used for the injection, produce a more or less definite precipitate.” If human defibrinated blood be injected into the peritoneal cavity of a rabbit, the serum obtained from the rabbit‘s blood, when mixed with a clear solution of the blood of man or ape, will produce a precipitate, and agglutinate the red blood corpuscles if present: the same reaction will not follow if such serum be added to a solution of the blood of any other animal.

The introduction of substances of albuminous or proteid nature into the body of an animal, and which can be taken up by its cells as a food, produces in the body of the animal a series of substances called antibodies, of which one is designated precipitin from its power of producing a precipitate with the substance introduced. The organic substance introduced capable of producing antibodies is called the antigen. The precipitin is formed and present in the blood serum of the inoculated animal.

Metallic poisons, alkaloids and carbohydrates, do not produce antibodies; some vegetable proteids do.

The serum containing the precipitin is called the antiserum.

The precipitin in the antiserum is specific, and produces the effect only with its own antigen, not with that derived from another species of animal, but will act with one derived from a closely allied species, e.g. man and the higher apes, sheep, and goat. [Pg 106]

In order to eliminate this the antigen should be diluted to 1:1000.

The blood used as antigen may be dried and sterilised, thus it may be kept for a long time, and when required for use dissolved in normal saline.

The most convenient human antigen for general use is ascitic or pleuritic fluid, and may be kept in good condition when mixed with a small quantity of chloroform.

To produce the antiserum 3 to 10 c.c. of the antigen serum is injected into a vein or the peritoneal cavity of a rabbit, and repeated at an interval of four or five days until 25 c.c. have been injected. The serum of the rabbit is then tested with the antigen diluted 1:100. The injections are then continued until 70 to 80 c.c. have been administered. The animal is then killed, the blood collected, and stood in a refrigerator for the serum to separate. This is then drawn into sterile pipettes, sealed, and kept in the cold. For purposes of preservation one-tenth its volume of 5 per cent. phenol may be added before pipetting. The antiserum may be dried on slips of black paper for future use.

For medico-legal purposes, the antiserum should always be tested with its antigen to be sure of its efficacy.

The antigen to be tested should be diluted 1:1000 at least, as potent antisera may give reactions with strong solutions of antigens derived from other species of animals. Various antisera may be made by inoculating rabbits with the serum of different animals.

Metchnikoff has shown that intraperitoneal injection is not absolutely necessary in order to produce an antiserum, feeding a rabbit on the blood will act in the same way.

The procedure for testing a stain is as follows. First of all the stain must be proved to be blood by the usual methods; this because the antiserum will give reactions with other albuminous substances, e.g. mucus, pus, semen, milk, or albuminous urine derived from the animal providing the antigen.

Having proved the stain to be blood, a solution of it should be made in normal saline, sufficiently strong to give the HNO₃ reaction for albumin, or to foam when shaken up. If the amount of solution be small, the tests can be carried out in capillary tubes or pipettes. The solution of the stain must be cleared by filtration or the centrifuge.

The tests must be controlled by comparison with known human blood, and blood from several domestic animals. For this purpose the various antisera should be kept in stock.

Two sets, A and B, of six small tubes are used, into each of A is placed 0.05 c.c. of human antiserum from a sensitised rabbit. Into each tube of Set A is then added double the amount of diluted antigen, as follows:

Set B is now charged as follows: [Pg 107]

To each tube in Set B is now added about 0.1 c.c. of the extract of the suspected stain.

It will thus be seen that in Set A known antigen is added to known precipitin, with the exception of tube 6, which receives suspected antigen, while in Set B the suspected antigen is added to known antisera, with the exception of No. 1, which contains normal rabbit serum.

The tubes are observed in an hour and the results noted. Should the stain be human blood, positive reactions will be present in tubes 1 and 6 of stand A, and tube 2 of B.

The negative reactions in the other tubes in stand A prove that the antiserum used is specific, and will only react with its own antigen; in stand B that the stain is composed of specific human antigen, reacting only with its own antiserum.

Should the stain suspected be other than human, and derived from one of the other animals used for antiserum in stand B, then the positive reaction will occur in the particular tube.[12] The test is now recognised as very sensitive and reliable, and is also applicable to the detection of the flesh or fluids of animals, and has thus been used for the detection of meat stuffs.

Tarchetti advises the following procedure in the examination of blood-stains: Dissolve the stain in a few drops of a 0.9 per cent. aqueous solution of sodium chloride, filter, and divide the filtrate into two portions; to one (a) add 0.5 c.c. of the prepared rabbit serum (the so-called antiserum); to the other (b) serum from a rabbit which has not been injected with human blood. Both are to be placed in an incubator at 37° C. for an hour. By this time, if the solution of the stain be of human or anthropoid origin, the contents of the tube (a) will have become turbid, the contents of tube (b) will remain clear. From a series of experiments with blood-stains of man and other animals on a variety of materials, Tarchetti states that this method is reliable. Prepared rabbit “human antiserum” has been shown to have no such reaction with the blood of the pig, ox, calf, mouse, or rat.

From the result of his investigations Grünbaum points out that these reactions must be looked upon rather as “special” than “specific,” in view of the fact that his “chimpanzee antiserum” gave a slight but distinct turbidity after a few hours with horse blood. He also suggests a method for the microscopical application of the “biological test,” by using a 1 per cent. blood solution with a drop of [Pg 108] “antiserum.” This method has enabled him to distinguish between human and anthropoid blood, the reaction occurring earlier and being more complete when the “antiserum” is used on its own blood.

Certain vegetable colouring matters give spectra which may be mistaken for blood, from their close similarity. Of these cochineal dissolved in a solution of alum gives two bands similar to O₂Hb. On the addition of boric acid the bands move to the violet end of the spectrum, but they are unaffected if the colouring matter be blood. Lac-dye, alkanet root, madder, and others also give spectra resembling O₂Hb, but they are changed or disappear on adding ammonia or sulphite of potassium, while the spectrum of blood remains unaltered.

As stated previously, spectra of colouring matters other than blood are not capable of being altered by reducing agents, so that, however similar they may be to O₂Hb, they cannot be accepted as derived from blood unless the spectra of reduced Hb and reduced hæmatin can be obtained in the way described.

Cochineal, colours of certain roots and wood, turn crimson on the addition of ammonia, logwood bluish-black.

The colour of the rose and certain flowers turn green on adding ammonia.

Fruit-stains from mulberry, currants, gooseberries, &c., turn bluish-green with ammonia.

Vegetable stains have their colour heightened by the action of dilute acids.

Chlorine bleaches fruit-stains, but turns the colour of blood-stains to an olive-green.

Red dyes fixed by a mordant are not influenced by ammonia.

Iron stains are usually blackened by ammonium sulphide.

Red paint may contain red oxide of iron; digest with hydrochloric acid and test for iron, by adding ferrocyanide of potassium to obtain the Prussian blue. Iron stains may be of a reddish-brown or orange colour, and insoluble in water, so that HCl is used to dissolve them.

Citrate and malate of iron stains are soluble in water; the addition of ammonia to an aqueous solution produces no change; guaiacum will give a blue reaction if a persalt of iron be present. The addition of hydrochloric acid and ferrocyanide of potassium will give the Prussian blue reaction. A drop of nitric acid added to the solution will oxidise the iron to the ferric state, and on the addition of a few drops of fresh-made aqueous solution of sulphocyanide of potassium the port-wine colour of sulphocyanide of iron will be produced.

A control test must be made with distilled water to prove the purity of the reagents, and the two results compared with each other.

Aniline stains resembling blood are changed to greenish-yellow or yellow on the addition of dilute nitric acid. Eosin stains produce a [Pg 109] fluorescent solution when dissolved in water. Grease, tar, pitch, snuff, and paint may be mistaken for blood, especially on dark fabrics. They may be detected by two methods:

(a) The Wet Method.—Having failed to obtain a solution by the aid of the ordinary solvents for blood, other solvents must be used; ether or benzene for grease, paint, or tar. The solution obtained must be examined with the spectroscope.

(b) The Dry Method.—Place the cloth or other fabric stain down upon a clean white filter paper; then on pressing the cloth with a hot laundry iron, grease, tar, or pitch will stain the paper, paint or snuff will not.

Burns and Scalds are lesions characterised by a more or less marked destruction of the tissues of the body, caused by the action upon its internal or external surfaces of a temperature higher than that of the body itself, or by the action of corrosive chemical substances.

Scalds are produced by the application of heated liquids, at or near their boiling-points, or in a gaseous form—as steam.

The injuries produced will depend upon the degree of temperature, the period of exposure to its action, and the extent of surface involved.

The danger to life depends more on the extent of surface injured than the intensity of the burn or scald upon a limited area, unless the position of the burn render it peculiarly dangerous. Even though the injuries be comparatively superficial, if they involve one-third or one half of the surface of the body they must be regarded as fatal. They may prove fatal by shock, by asphyxia, by constant and profuse discharge from the injured surface, from absorption of septic matter, from secondary inflammations of internal organs and serous membranes—pleurisy, peritonitis, meningitis, perforating ulcer of the duodenum. Children succumb more quickly than adults to burns and scalds—the simplest, in their case, often proving fatal.

The cause of early death from burns and scalds is looked upon as a disorder of the blood following injury to the red corpuscles by the heat, and that this is more easily brought about in children, because of the thinness of the skin, and the red corpuscles being less capable of resistance.

The following table gives the different degrees of burns:

These will vary according to the extent of the injuries, the length of time the individual lived after receiving them, and the causative agent.

External Appearances.—1. Burns.—Radiant heat whitens the skin, flames blacken it, from deposit of carbonaceous material. The hair and clothing of the body are singed. Blisters may be present on various parts, and roasted patches of the skin or deeper parts may be present. The flame of an explosive, such as a mixture of coal gas and air, scorches and mummifies the skin. The skin is blackened by the explosion of gunpowder, and particles of the powder may be driven into it; similar results follow explosions in coal mines, but to a greater degree. Burns caused by red-hot solids or molten metals vary in appearance according to the length of time they have remained in contact with the surface: if short, there may be injury to the skin only, with blistering; if for a longer period, there will be roasting or charring of the part, and blisters may not be present.

All stages of burns may be present.

The uncovered parts of the body, as a rule, are more affected than the clothed, unless the clothes become ignited, when the converse would hold good. In cases where the clothes have been saturated with an inflammable oil like petroleum the burns are much more severe.

2. Scalds.—The appearances produced and the severity of the result will vary directly with the boiling-point of the liquid. Boiling water and steam produce vesication; the hairs are not affected. If the steam be superheated, blistering may be absent, and the skin appear sodden and devoid of elasticity. If the person survive the injuries for some days, the skin will present appearances of reaction. After exposure to great heat the bodies of the victims are usually contorted, with the limbs flexed and the arms fixed in a defensive attitude—the “pugilistic attitude.” This condition is due to heat rigidity.

Internal Appearances.—The brain is shrunk, usually without any alteration in form, the lungs also shrunk, and the larynx, trachea, and bronchi may contain carbonaceous material; their membranes may be injected and covered with frothy mucus. The kidneys may present reddish-brown markings from altered blood, and degeneration of the epithelium of the tubules and Malpighian bodies.

There may be a reddened appearance of the mucous membrane of the stomach and intestines, and in a certain number of cases, where death [Pg 112] has occurred some time after the injuries, ulcers may be present in the duodenum.

The uterus and testicles resist the action of fire in a marked degree, and may be changed but slightly, although the rest of the body has been almost consumed.

The blood of persons who have been exposed to the action of CO during a fire will present the usual cherry-red colour and the spectrum of COHb. A similar cherry-red colour of the blood is found in bodies of persons burnt to death which is not due to the action of CO. The cause is a physical one, the alteration in colour being due to the coagulation of the albumin in microscopical particles by the heat. In this condition the spectrum is that of O₂Hb, and can be reduced in the usual way. The same peculiar condition of the blood may be produced in corpses by exposure to a sufficiently high temperature.

If on the examination of the blood COHb is detected, it indicates that the person in whose body it is found was alive during the progress of the fire.

Corrosives.—The appearances produced by the application of corrosive chemical substances are peculiar to them, and depend upon their special actions upon the tissues. Sulphuric acid acts by rapidly extracting water from the tissues and producing local rise of temperature; nitric acid combines with the tissues to form picric acid; nitrate of silver acts upon the tissue by hyperoxidation, and combines to form albuminate of silver, nitric acid being liberated. A solution of phosphorus in carbon disulphide, known as Greek fire, by the rapid oxidation and burning of the phosphorus produces combustion of the tissues.

The diagnosis of lesions produced by corrosives from those by fire or heated fluid or steam rests upon the absence of vesication, the presence of the stains on the skin or clothing which they produce, and the chemical analysis of the stains. Sulphuric acid produces a grey or brownish-black eschar on the body; hydrochloric acid may leave a whitish-grey stain; nitric acid produces a yellow stain on the skin, and may produce sloughing.

Was the burn inflicted before or after death?—The answer to this question depends upon careful consideration of all the evidences afforded by the external and internal appearances, and upon the presence or absence of vital reaction in the lesions found.

Two characteristic appearances—redness and vesication—are present in burns inflicted during life when the surface of the body is not charred and the tissues destroyed. The redness affects the surface and entire substance of the true skin, which is dotted by the deep red openings of the sudoriferous and sebaceous ducts. This appearance cannot be produced after death. Blisters are formed by a temperature somewhat less than that of boiling water. Vesication, according to Orfila, is characteristic of a burn inflicted during life, and the late Sir Robert Christison found that in burns caused before and after death the vesicles in the former contained serum, the latter air. In anasarcous subjects, however, serous blisters may be formed, especially if the [Pg 113] heat employed be not too severe. A case is recorded by Taylor in which vesicles containing bloody serum were formed on the body of a man who had just been drowned and who had been put into a hot bath.

Ante-mortem vesicles in which vital reaction has taken place present the following characteristics:

In burns produced after death, the surface and substance of the skin is of a dull white colour, dotted with grey openings of the sudoriferous and sebaceous ducts, and the subcutaneous tissues are uninjected. Vesicles produced by burns may have to be distinguished from the phlyctænæ, the result of advanced putrefaction. The latter possesses none of the characteristics of the former.

If a vesicle present the following characteristics it may be accepted as a post-mortem origin without doubt: if it be small and its contents scanty, if the fluid it contain be free from albumin and chlorides, if it contain air, and if there be no signs of inflammatory reaction.

Was the burning homicidal, suicidal, or accidental?—No general rules for guidance can be here laid down. In most cases the conditions under which the body is found will point less to suicide than to homicide or accident. In cases of murder, the body is often burnt in the attempt to destroy all traces of the crime. It must, however, be borne in mind that intense heat applied to the body may give rise to a wound on the surface like that caused by a cutting instrument. Casper mentions such a case, in which a wound was found over the liver, due to the application of intense heat to the body. The conjunction of robbery will greatly assist in helping to solve the difficulty. It may be very confidently stated that to dispose of a body by burning is no easy matter.

The possibility of “spontaneous combustion” occurring in bodies during life has been mentioned in the earlier writings on medical jurisprudence, and cases have been recorded in which it has been alleged to have taken place. Up to the present time no undoubted case of “spontaneous combustion” during life has been seen. On the other hand, the possibility of its occurrence is contra-indicated by the following facts: that the human body must consist of 75 per cent. of its weight of water, to be compatible with life, and that a dead body steeped in methylated spirit for many months or even years will never [Pg 114] be consumed, if set on fire, in the rapid and complete manner alleged as occurring in cases of so-called “spontaneous combustion.”

A case is recorded by Beatson (B. M. J., vol. i., 1886, p. 295) of a man, subject to foul eructations from the stomach, who got out of bed during the night and struck a match to see the time; while blowing out the light his breath took fire, producing an explosive noise sufficiently loud to awaken his wife. Such cases are very rare.

It is a fact that by the action of certain micro-organisms upon organic matter inflammable gases are produced. That such an occurrence is possible, in the dead human body, is supported by cases recorded by Gull (Med. Times and Gazette, 1885) and Reynolds (Med. Chron., 1891). In Gull‘s case inflammable gases escaped through punctures made into the abdomen, and they burned spontaneously on contact with the air. In Reynold‘s case no flames were seen, but extensive and deep marks of burning were present, especially on the trunk and thighs. It has been suggested that the habitual use of alcohol in excess during life renders the tissues of the body more inflammable, but the matter is not yet decided. Tissues steeped in alcohol are not rendered more inflammable.

Dr. Ogston, who cautiously avoids committing himself to the belief in “spontaneous combustion,” yet thinks that the subject of preternatural combustibility in certain conditions of the body may perhaps, to say the least of it, be set down as one still sub judice. “There is no evidence to justify the use of the word ‘spontaneous,’ but there can be no doubt that an extraordinarily high degree of combustibility occurs in rare instances, to which the term preternatural combustibility would more correctly apply” (J. Dixon Mann).

Over-exposure to the action of X-rays produces burns of a peculiar character, and in cases of unprotected skin exposed to the action of the rays in those who are constantly working with them, forms of dermatitis have arisen which are intractable and tend to become epitheliomatous in character.

The results of slight over-exposure, or repeated short exposures vary from a simple redness of the skin to severe dermatitis, the hair of the part being shed. When the over-exposure or dosage has been severe, the skin may vesicate and ulcerate. I have seen this in cases where the rays have been used for reduction of the spleen in leukæmia and Banti‘s disease. The burns heal with cicatrisation of radiate shape, the skin around the scar being permeated with numerous capillary vessels which produce the appearance of capillary nævi, and in other instances large stellate superficial vessels are formed. In addition, marked pigmentation of the skin may follow the burn. X-ray burns which have produced vesication and ulceration or sloughing take a long time to heal in comparison with ordinary burns.

In repeated exposure to the rays, even when little redness has been noticed at the time, the formation of capillary vessels may become evident some time after the exposures have been stopped. This may cause [Pg 115] disfigurement, by the formation of telangiectasis, especially if they appear on the face or neck. The falling out of the hair is produced by X-rays as a therapeutic measure in cases of ringworm, and due precaution must be taken to limit the effect and area of exposure by proper screening. The same precaution should be used to protect parts of the body other than the part which requires treatment or examination in other conditions.

With increasing knowledge of the effects of X-ray exposures, special precautions have been devised to prevent untoward effects, so that burns from over-exposure, and dermatitis amongst X-ray workers are prevented.

In the living these injuries are accompanied with swelling, pain, and more or less discoloration of the part affected. Among malingerers it is not an uncommon practice to bruise the body to imitate the spots of purpura and scurvy. In scurvy, the condition of the gums common to that disease, and the state of the general health, will point to the true nature of the spots. The diagnosis of purpura will be assisted by noting the diffusion of the spots over the body. In old people purpuric spots frequently extend round the limbs, chiefly on one of the lower extremities. Many blood diseases are associated with ecchymoses and purpuric eruptions. Some persons are very easily bruised, and a pinch, by no means severe, will cause on their arms a severe bruise. Discoloration—ecchymosis—may take place in the skin, cellular tissue, muscles, or internal organs as a result of external injury, or it may be due to sudden and powerful contraction of a muscle or group of muscles. Not infrequently the discoloration does not appear over the seat of injury, but at some distance from it; and when the effusion is deep-seated, days may elapse before any discoloration of the skin takes place, and then it is not blue, as in superficial parts, but of a violet, greenish, or yellowish hue. A deep-seated ecchymosis may give no external sign of its presence; hence in all cases deep incisions should be made before an opinion is ventured as to the entire absence of this occurrence. This is very noticeable among the deep-seated muscles of a limb. In these cases, forty or fifty days may elapse before the deep-seated bruise shows its existence on the surface, and then only as irregular, yellowish, green, or bluish spots over the part. A very slight contusion, as a sprain of the ankle, may give rise to extended discoloration of the leg. An ecchymosis is not necessarily situated directly under the seat of injury. A blow given during life may not appear as an ecchymosis till after death. The change of colour in bruises begins at the circumference, and travels inwards. During the first three days the colour of the bruise is blue, bluish-black, or black; greenish on the fifth or sixth day; and yellow from the seventh to the twelfth. The extent of an ecchymosis depends greatly on the looseness of the cellular tissue. A slight contusion [Pg 116] causes a slight redness and swelling, and may leave no mark on the dead body, unless death has taken place within thirty-six hours. Injuries of this kind sometimes leave a parchment-like hardness and discoloration of the skin. The part looks slightly depressed, due probably to the epidermis having been partly rubbed off, and the skin then drying. Similar marks are sometimes made by blisters. These marks may be produced on the dead body by friction and exposure to the air.

The diagnosis of ecchymosis from hypostasis has been given (see p. 46). A tolerably severe blow after death would be necessary to produce appearances similar to those produced by a slight one during life. In scourging, there are parallel ecchymosed lines, of small spots resembling petechiæ. An internal organ may be ruptured, and yet there may be no appearance of injury externally. The liver is the organ most commonly ruptured. The rupture is almost always longitudinal, and in some cases a portion of the gland is more or less detached. The spleen is also not infrequently ruptured; and this occurs most frequently in countries where ague prevails. Rupture of the lungs and brain is rare. When the pelvis is fractured, the bladder is frequently found ruptured.

Death in most cases is due to internal hæmorrhage or shock, when any of the internal organs are ruptured.

Can the appearance of a bruise be produced after death?—It is possible that the appearance of a bruise inflicted during life may be produced within two hours after death, and in some rare cases even after the lapse of three hours and a quarter (Christison); but these ecchymoses are limited in extent, and when large are due to a rupture in a vein which can be readily ascertained. The experiments of the late Sir Robert Christison, relating to this question, are detailed in the Edinburgh Medical and Surgical Journal, vol. xxxi. The amount of violence required after death to produce appearances like those made before death is such as would seldom, if ever, be inflicted on a corpse, and, therefore, where we find a well-marked bruise we ought to infer that it was made before death.

The following table, compiled from the experiments of Christison, may assist the diagnosis:

N.B.—Extensive effusion may occur without affecting the skin, but when the skin is so affected Christison thought it decisive of ante-mortem injury. [Pg 117]