<SPAN name="startofbook"></SPAN>
<h1>AIDS</h1>
<h5>TO</h5>
<h1>FORENSIC MEDICINE AND TOXICOLOGY</h1>
<h5>BY</h5>
<h2>W.G. AITCHISON ROBERTSON</h2>
<h3>M.D., D.Sc., F.R.C.P.E.</h3>
<h5>LECTURER ON FORENSIC MEDICINE, SCHOOL OF MEDICINE, EDINBURGH;
LATE EXAMINER IN THE UNIVERSITIES OF EDINBURGH AND
ST. ANDREWS; FOR THE TRIPLE BOARD; DIPLOMA
IN PUBLIC HEALTH, ETC.</h5>
<h4>NINTH EDITION</h4>
<table summary="image">
<tr><td>TWENTIETH</td><td><ANTIMG src="images/seal.jpg" alt="STUDENTS' AIDS SERIES
MENS SANA CORPORE SANO"
title="STUDENTS' AIDS SERIES
MENS SANA CORPORE SANO" /></td>
<td>THOUSAND</td></tr>
</table>
<h4>LONDON</h4>
<h5>BAILLIÈRE, TINDALL AND COX</h5>
<p class="centre">8, <span class="smcap">Henrietta Street, Covent Garden</span></p>
<p class="centre">1922</p>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="pagev" id="pagev">[v]</SPAN></span></p>
<h2>PREFACE TO NINTH EDITION</h2>
<p>I trust that, having thoroughly revised the "Aids to
Forensic Medicine," it may prove as useful to students
preparing for examination in the future as it has been
in the past.</p>
<p class="right">W.G. AITCHISON ROBERTSON.</p>
<p><span class="smcap">Surgeons' Hall</span>,<br/>
<span class="smcap" style="margin-left: 2em;">Edinburgh,</span><br/>
<span style="margin-left: 3em;"><i>November</i>, 1921.</span></p>
<p><span class="pagenum"><SPAN name="pagevi" id="pagevi">[vi]</SPAN></span></p>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="pagevii" id="pagevii">[vii]</SPAN></span></p>
<h2>PREFACE TO EIGHTH EDITION</h2>
<p>This work of the late Dr. William Murrell having met
with such a large measure of success, the publishers
thought it would be well to bring out a new edition, and
invited me to revise the last impression.</p>
<p>This I have done, and while retaining Dr. Murrell's
text closely, I have made large additions, in order to
bring the "Aids" up to present requirements. I have
also rearranged the matter with the object of making
the various sections more consecutive than they were
previously.</p>
<p class="right">W.G. AITCHISON ROBERTSON.</p>
<p><span class="smcap">Surgeons' Hall</span>,<br/>
<span class="smcap" style="margin-left: 2em;">Edinburgh.</span><br/>
<span style="margin-left: 3em;"><i>June</i>, 1914.</span></p>
<p><span class="pagenum"><SPAN name="pageviii" id="pageviii">[viii]</SPAN></span></p>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="pageix" id="pageix">[ix]</SPAN></span></p>
<h2>CONTENTS</h2>
<table summary="table of contents">
<tr><td colspan="3"><h3><SPAN href="#part1">PART I</SPAN></h3></td></tr>
<tr><td colspan="3"><h4>FORENSIC MEDICINE</h4></td></tr>
<tr><td></td><td></td><td align="right"><span class="smaller">PAGE</span></td></tr>
<tr><td align="right">I.</td><td><SPAN href="#chapteri_1">Crimes</SPAN></td>
<td align="right"><SPAN href="#page1">1</SPAN></td></tr>
<tr><td align="right">II.</td><td><SPAN href="#chapterii_1">Medical Evidence</SPAN></td>
<td align="right"><SPAN href="#page2">2</SPAN></td></tr>
<tr><td align="right">III.</td><td><SPAN href="#chapteriii_1">Personal Identity</SPAN></td>
<td align="right"><SPAN href="#page10">10</SPAN></td></tr>
<tr><td align="right">IV.</td><td><SPAN href="#chapteriv_1">Examination of Persons found Dead</SPAN></td>
<td align="right"><SPAN href="#page12">12</SPAN></td></tr>
<tr><td align="right">V.</td><td><SPAN href="#chapterv_1">Modes of Sudden Death</SPAN></td>
<td align="right"><SPAN href="#page13">13</SPAN></td></tr>
<tr><td align="right">VI.</td><td><SPAN href="#chaptervi_1">Signs of Death</SPAN></td>
<td align="right"><SPAN href="#page16">16</SPAN></td></tr>
<tr><td align="right">VII.</td><td><SPAN href="#chaptervii_1">Death from Anæsthetics, etc.</SPAN></td>
<td align="right"><SPAN href="#page19">19</SPAN></td></tr>
<tr><td align="right">VIII.</td><td><SPAN href="#chapterviii_1">Presumption of Death; Survivorship</SPAN></td>
<td align="right"><SPAN href="#page20">20</SPAN></td></tr>
<tr><td align="right">IX.</td><td><SPAN href="#chapterix_1">Assaults, Murder, Manslaughter, etc.</SPAN></td>
<td align="right"><SPAN href="#page21">21</SPAN></td></tr>
<tr><td align="right">X.</td><td><SPAN href="#chapterx_1">Wounds and Mechanical Injuries</SPAN></td>
<td align="right"><SPAN href="#page21">21</SPAN></td></tr>
<tr><td align="right">XI.</td><td><SPAN href="#chapterxi_1">Contused Wounds, etc.</SPAN></td>
<td align="right"><SPAN href="#page22">22</SPAN></td></tr>
<tr><td align="right">XII.</td><td><SPAN href="#chapterxii_1">Incised Wounds</SPAN></td>
<td align="right"><SPAN href="#page23">23</SPAN></td></tr>
<tr><td align="right">XIII.</td><td><SPAN href="#chapterxiii_1">Gunshot Wounds</SPAN></td>
<td align="right"><SPAN href="#page24">24</SPAN></td></tr>
<tr><td align="right">XIV.</td><td><SPAN href="#chapterxiv_1">Wounds of Various Parts of the Body</SPAN></td>
<td align="right"><SPAN href="#page26">26</SPAN></td></tr>
<tr><td align="right">XV.</td><td><SPAN href="#chapterxv_1">Detection of Blood-Stains, etc.</SPAN></td>
<td align="right"><SPAN href="#page30">30</SPAN></td></tr>
<tr><td align="right">XVI.</td><td><SPAN href="#chapterxvi_1">Death by Suffocation</SPAN></td>
<td align="right"><SPAN href="#page34">34</SPAN></td></tr>
<tr><td align="right">XVII.</td><td><SPAN href="#chapterxvii_1">Death by Hanging</SPAN></td>
<td align="right"><SPAN href="#page35">35</SPAN></td></tr>
<tr><td align="right">XVIII.</td><td><SPAN href="#chapterxviii_1">Death by Strangulation</SPAN></td>
<td align="right"><SPAN href="#page35">35</SPAN></td></tr>
<tr><td align="right">XIX.</td><td><SPAN href="#chapterxix_1">Death by Drowning</SPAN></td>
<td align="right"><SPAN href="#page36">36</SPAN></td></tr>
<tr><td align="right">XX.</td><td><SPAN href="#chapterxx_1">Death from Starvation</SPAN></td>
<td align="right"><SPAN href="#page38">38</SPAN></td></tr>
<tr><td align="right">XXI.</td><td><SPAN href="#chapterxxi_1">Death from Lightning and Electricity</SPAN></td>
<td align="right"><SPAN href="#page38">38</SPAN></td></tr>
<tr><td align="right">XXII.</td><td><SPAN href="#chapterxxii_1">Death from Cold or Heat</SPAN></td>
<td align="right"><SPAN href="#page39">39</SPAN></td></tr>
<tr><td align="right">XXIII.</td><td><SPAN href="#chapterxxiii_1">Pregnancy</SPAN></td>
<td align="right"><SPAN href="#page40">40</SPAN><span class="pagenum"><SPAN name="pagex" id="pagex">[x]</SPAN></span></td></tr>
<tr><td align="right">XXIV.</td><td><SPAN href="#chapterxxiv_1">Delivery</SPAN></td>
<td align="right"><SPAN href="#page41">41</SPAN></td></tr>
<tr><td align="right">XXV.</td><td><SPAN href="#chapterxxv_1">Fœticide or Criminal Abortion</SPAN></td>
<td align="right"><SPAN href="#page42">42</SPAN></td></tr>
<tr><td align="right">XXVI.</td><td><SPAN href="#chapterxxvi_1">Infanticide</SPAN></td>
<td align="right"><SPAN href="#page44">44</SPAN></td></tr>
<tr><td align="right">XXVII.</td><td><SPAN href="#chapterxxvii_1">Evidences of Live-Birth</SPAN></td>
<td align="right"><SPAN href="#page46">46</SPAN></td></tr>
<tr><td align="right">XXVIII.</td><td><SPAN href="#chapterxxviii_1">Cause of Death in the Fœtus</SPAN></td>
<td align="right"><SPAN href="#page50">50</SPAN></td></tr>
<tr><td align="right">XXIX.</td><td><SPAN href="#chapterxxix_1">Duration of Pregnancy</SPAN></td>
<td align="right"><SPAN href="#page50">50</SPAN></td></tr>
<tr><td align="right">XXX.</td><td><SPAN href="#chapterxxx_1">Viability of Children</SPAN></td>
<td align="right"><SPAN href="#page51">51</SPAN></td></tr>
<tr><td align="right">XXXI.</td><td><SPAN href="#chapterxxxi_1">Legitimacy</SPAN></td>
<td align="right"><SPAN href="#page52">52</SPAN></td></tr>
<tr><td align="right">XXXII.</td><td><SPAN href="#chapterxxxii_1">Superfœtation</SPAN></td>
<td align="right"><SPAN href="#page53">53</SPAN></td></tr>
<tr><td align="right">XXXIII.</td><td><SPAN href="#chapterxxxiii_1">Inheritance</SPAN></td>
<td align="right"><SPAN href="#page54">54</SPAN></td></tr>
<tr><td align="right">XXXIV.</td><td><SPAN href="#chapterxxxiv_1">Impotence and Sterility</SPAN></td>
<td align="right"><SPAN href="#page54">54</SPAN></td></tr>
<tr><td align="right">XXXV.</td><td><SPAN href="#chapterxxxv_1">Rape</SPAN></td>
<td align="right"><SPAN href="#page55">55</SPAN></td></tr>
<tr><td align="right">XXXVI.</td><td><SPAN href="#chapterxxxvi_1">Unnatural Offences</SPAN></td>
<td align="right"><SPAN href="#page59">59</SPAN></td></tr>
<tr><td align="right">XXXVII.</td><td><SPAN href="#chapterxxxvii_1">Blackmailing</SPAN></td>
<td align="right"><SPAN href="#page60">60</SPAN></td></tr>
<tr><td align="right">XXXVIII.</td><td><SPAN href="#chapterxxxviii_1">Marriage and Divorce</SPAN></td>
<td align="right"><SPAN href="#page60">60</SPAN></td></tr>
<tr><td align="right">XXXIX.</td><td><SPAN href="#chapterxxxix_1">Feigned Diseases</SPAN></td>
<td align="right"><SPAN href="#page63">63</SPAN></td></tr>
<tr><td align="right">XL.</td><td><SPAN href="#chapterxl_1">Mental Unsoundness</SPAN></td>
<td align="right"><SPAN href="#page67">67</SPAN></td></tr>
<tr><td align="right">XLI.</td><td><SPAN href="#chapterxli_1">Idiocy, Imbecility, Cretinism</SPAN></td>
<td align="right"><SPAN href="#page68">68</SPAN></td></tr>
<tr><td align="right">XLII.</td><td><SPAN href="#chapterxlii_1">Dementia</SPAN></td>
<td align="right"><SPAN href="#page70">70</SPAN></td></tr>
<tr><td align="right">XLIII.</td><td><SPAN href="#chapterxliii_1">Mania, Lucid Intervals,
Undue Influence, Responsibility, etc.</SPAN></td>
<td align="right"><SPAN href="#page71">71</SPAN></td></tr>
<tr><td align="right">XLIV.</td><td><SPAN href="#chapterxliv_1">Examination of Persons of Unsound Mind</SPAN></td>
<td align="right"><SPAN href="#page76">76</SPAN></td></tr>
<tr><td align="right">XLV.</td><td><SPAN href="#chapterxlv_1">Inebriates Acts</SPAN></td>
<td align="right"><SPAN href="#page78">78</SPAN></td></tr>
<tr><td colspan="3"><h3><SPAN href="#part2">PART II</SPAN></h3></td></tr>
<tr><td colspan="3"><h4>TOXICOLOGY</h4></td></tr>
<tr><td align="right">I.</td><td><SPAN href="#chapteri_2">Definition of a Poison</SPAN></td>
<td align="right"><SPAN href="#page80">80</SPAN></td></tr>
<tr><td align="right">II.</td><td><SPAN href="#chapterii_2">Scheduled Poisons</SPAN></td>
<td align="right"><SPAN href="#page80">80</SPAN></td></tr>
<tr><td align="right">III.</td><td><SPAN href="#chapteriii_2">Classification of Poisons</SPAN></td>
<td align="right"><SPAN href="#page83">83</SPAN></td></tr>
<tr><td align="right">IV.</td><td><SPAN href="#chapteriv_2">Evidence of Poisoning</SPAN></td>
<td align="right"><SPAN href="#page85">85</SPAN></td></tr>
<tr><td align="right">V.</td><td><SPAN href="#chapterv_2">Symptoms and Post-Mortem
Appearances of Different Classes of Poisons</SPAN></td>
<td align="right"><SPAN href="#page86">86</SPAN></td></tr>
<tr><td align="right">VI.</td><td><SPAN href="#chaptervi_2">Duty of Practitioner in Supposed Case of Poisoning</SPAN></td>
<td align="right"><SPAN href="#page89">89</SPAN></td></tr>
<tr><td align="right">VII.</td><td><SPAN href="#chaptervii_2">Treatment of Poisoning</SPAN></td>
<td align="right"><SPAN href="#page90">90</SPAN><span class="pagenum"><SPAN name="pagexi" id="pagexi">[xi]</SPAN></span></td></tr>
<tr><td align="right">VIII.</td><td><SPAN href="#chapterviii_2">Detection of Poison</SPAN></td>
<td align="right"><SPAN href="#page91">91</SPAN></td></tr>
<tr><td align="right">IX.</td><td><SPAN href="#chapterix_2">The Mineral Acids</SPAN></td>
<td align="right"><SPAN href="#page94">94</SPAN></td></tr>
<tr><td align="right">X.</td><td><SPAN href="#chapterx_2">Sulphuric Acid</SPAN></td>
<td align="right"><SPAN href="#page95">95</SPAN></td></tr>
<tr><td align="right">XI.</td><td><SPAN href="#chapterxi_2">Nitric Acid</SPAN></td>
<td align="right"><SPAN href="#page97">97</SPAN></td></tr>
<tr><td align="right">XII.</td><td><SPAN href="#chapterxii_2">Hydrochloric Acid</SPAN></td>
<td align="right"><SPAN href="#page98">98</SPAN></td></tr>
<tr><td align="right">XIII.</td><td><SPAN href="#chapterxiii_2">Oxalic Acid</SPAN></td>
<td align="right"><SPAN href="#page98">98</SPAN></td></tr>
<tr><td align="right">XIV.</td><td><SPAN href="#chapterxiv_2">Carbolic Acid</SPAN></td>
<td align="right"><SPAN href="#page100">100</SPAN></td></tr>
<tr><td align="right">XV.</td><td><SPAN href="#chapterxv_2">Potash, Soda, and Ammonia</SPAN></td>
<td align="right"><SPAN href="#page101">101</SPAN></td></tr>
<tr><td align="right">XVI.</td><td><SPAN href="#chapterxvi_2">Nitrate of Potassium, etc.</SPAN></td>
<td align="right"><SPAN href="#page103">103</SPAN></td></tr>
<tr><td align="right">XVII.</td><td><SPAN href="#chapterxvii_2">Potassium Salts, etc.</SPAN></td>
<td align="right"><SPAN href="#page103">103</SPAN></td></tr>
<tr><td align="right">XVIII.</td><td><SPAN href="#chapterxviii_2">Barium Salts</SPAN></td>
<td align="right"><SPAN href="#page104">104</SPAN></td></tr>
<tr><td align="right">XIX.</td><td><SPAN href="#chapterxix_2">Iodine—Iodide of Potassium</SPAN></td>
<td align="right"><SPAN href="#page104">104</SPAN></td></tr>
<tr><td align="right">XX.</td><td><SPAN href="#chapterxx_2">Phosphorus</SPAN></td>
<td align="right"><SPAN href="#page105">105</SPAN></td></tr>
<tr><td align="right">XXI.</td><td><SPAN href="#chapterxxi_2">Arsenic and its Preparations</SPAN></td>
<td align="right"><SPAN href="#page107">107</SPAN></td></tr>
<tr><td align="right">XXII.</td><td><SPAN href="#chapterxxii_2">Antimony and its Preparations</SPAN></td>
<td align="right"><SPAN href="#page112">112</SPAN></td></tr>
<tr><td align="right">XXIII.</td><td><SPAN href="#chapterxxiii_2">Mercury and its Preparations</SPAN></td>
<td align="right"><SPAN href="#page113">113</SPAN></td></tr>
<tr><td align="right">XXIV.</td><td><SPAN href="#chapterxxiv_2">Lead and its Preparations</SPAN></td>
<td align="right"><SPAN href="#page116">116</SPAN></td></tr>
<tr><td align="right">XXV.</td><td><SPAN href="#chapterxxv_2">Copper and its Preparations</SPAN></td>
<td align="right"><SPAN href="#page117">117</SPAN></td></tr>
<tr><td align="right">XXVI.</td><td><SPAN href="#chapterxxvi_2">Zinc, Silver, Bismuth, and Chromium</SPAN></td>
<td align="right"><SPAN href="#page118">118</SPAN></td></tr>
<tr><td align="right">XXVII.</td><td><SPAN href="#chapterxxvii_2">Gaseous Poisons</SPAN></td>
<td align="right"><SPAN href="#page120">120</SPAN></td></tr>
<tr><td align="right">XXVIII.</td><td><SPAN href="#chapterxxviii_2">Vegetable Irritants</SPAN></td>
<td align="right"><SPAN href="#page123">123</SPAN></td></tr>
<tr><td align="right">XXIX.</td><td><SPAN href="#chapterxxix_2">Opium and Morphine</SPAN></td>
<td align="right"><SPAN href="#page124">124</SPAN></td></tr>
<tr><td align="right">XXX.</td><td><SPAN href="#chapterxxx_2">Belladonna, Hyoscyamus, and Stramonium</SPAN></td>
<td align="right"><SPAN href="#page127">127</SPAN></td></tr>
<tr><td align="right">XXXI.</td><td><SPAN href="#chapterxxxi_2">Cocaine</SPAN></td>
<td align="right"><SPAN href="#page128">128</SPAN></td></tr>
<tr><td align="right">XXXII.</td><td><SPAN href="#chapterxxxii_2">Camphor</SPAN></td>
<td align="right"><SPAN href="#page129">129</SPAN></td></tr>
<tr><td align="right">XXXIII.</td><td><SPAN href="#chapterxxxiii_2">Tetrachlorethane</SPAN></td>
<td align="right"><SPAN href="#page129">129</SPAN></td></tr>
<tr><td align="right">XXXIV.</td><td><SPAN href="#chapterxxxiv_2">Alcohol, Ether, and Chloroform</SPAN></td>
<td align="right"><SPAN href="#page130">130</SPAN></td></tr>
<tr><td align="right">XXXV.</td><td><SPAN href="#chapterxxxv_2">Chloral Hydrate</SPAN></td>
<td align="right"><SPAN href="#page134">134</SPAN></td></tr>
<tr><td align="right">XXXVI.</td><td><SPAN href="#chapterxxxvi_2">Petroleum and Paraffin Oil</SPAN></td>
<td align="right"><SPAN href="#page134">134</SPAN></td></tr>
<tr><td align="right">XXXVII.</td>
<td><SPAN href="#chapterxxxvii_2">Antipyrine, Antefebrin, Phenacetin, and Aniline</SPAN></td>
<td align="right"><SPAN href="#page135">135</SPAN></td></tr>
<tr><td align="right">XXXVIII.</td>
<td><SPAN href="#chapterxxxviii_2">Sulphonal, Trional, Tetronal, Veronal, Paraldehyde</SPAN></td>
<td align="right"><SPAN href="#page137">137</SPAN></td></tr>
<tr><td align="right">XXXIX.</td><td><SPAN href="#chapterxxxix_2">Conium and Calabar Bean</SPAN></td>
<td align="right"><SPAN href="#page138">138</SPAN></td></tr>
<tr><td align="right">XL.</td><td><SPAN href="#chapterxl_2">Tobacco and Lobelia</SPAN></td>
<td align="right"><SPAN href="#page139">139</SPAN></td></tr>
<tr><td align="right">XLI.</td><td><SPAN href="#chapterxli_2">Hydrocyanic Acid</SPAN></td>
<td align="right"><SPAN href="#page140">140</SPAN></td></tr>
<tr><td align="right">XLII.</td><td><SPAN href="#chapterxlii_2">Aconite</SPAN></td>
<td align="right"><SPAN href="#page143">143</SPAN></td></tr>
<tr><td align="right">XLIII.</td><td><SPAN href="#chapterxliii_2">Digitalis</SPAN></td>
<td align="right"><SPAN href="#page144">144</SPAN>
<span class="pagenum"><SPAN name="pagexii" id="pagexii">[xii]</SPAN></span></td></tr>
<tr><td align="right">XLIV.</td><td><SPAN href="#chapterxliv_2">Nux Vomica, Strychnine, and Brucine</SPAN></td>
<td align="right"><SPAN href="#page145">145</SPAN></td></tr>
<tr><td align="right">XLV.</td><td><SPAN href="#chapterxlv_2">Cantharides</SPAN></td>
<td align="right"><SPAN href="#page146">146</SPAN></td></tr>
<tr><td align="right">XLVI.</td><td><SPAN href="#chapterxlvi_2">Abortifacients</SPAN></td>
<td align="right"><SPAN href="#page147">147</SPAN></td></tr>
<tr><td align="right">XLVII.</td><td><SPAN href="#chapterxlvii_2">Poisonous Fungi and Toxic Foods</SPAN></td>
<td align="right"><SPAN href="#page148">148</SPAN></td></tr>
<tr><td align="right">XLVIII.</td><td><SPAN href="#chapterxlviii_2">Ptomaines or Cadaveric Alkaloids</SPAN></td>
<td align="right"><SPAN href="#page150">150</SPAN></td></tr>
<tr><td></td><td><SPAN href="#index">Index</SPAN></td><td align="right"><SPAN href="#page152">152</SPAN></td></tr>
</table>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="page1" id="page1">[1]</SPAN></span></p>
<h2>AIDS TO FORENSIC MEDICINE AND TOXICOLOGY</h2>
<hr />
<h2><SPAN name="part1" id="part1"></SPAN>PART I</h2>
<h3>FORENSIC MEDICINE</h3>
<hr class="shorter" />
<h2><SPAN name="chapteri_1" id="chapteri_1"></SPAN>I.—CRIMES</h2>
<p>Forensic medicine is also called Medical Jurisprudence
or Legal Medicine, and includes all questions which
bring medical matters into relation with the law. It
deals, therefore, with (1) crimes and (2) civil injuries.</p>
<p>1. A <i>crime</i> is the voluntary act of a person of sound
mind harmful to others and also unjust. No act is a
crime unless it is plainly forbidden by law. To constitute
a crime, two circumstances are necessary to be
proved—(<i>a</i>) that the act has been committed, (<i>b</i>) that
a guilty mind or malice was present. The act may be
one of omission or of commission. Every person who
commits a crime may be punished, unless he is under
the age of seven years, is insane, or has been made
to commit it under compulsion.</p>
<p>Crimes are divided into <i>misdemeanours</i> and <i>felonies</i>.
The distinction is not very definite, but, as a rule, the
former are less serious forms of crime, and are punishable
with a term of imprisonment, generally under two
years; while felonies comprise the more serious charges,
as murder, manslaughter, rape, which involve the
capital sentence or long terms of imprisonment.</p>
<p>An <i>offence</i> is a trivial breach of the criminal law, and
<span class="pagenum"><SPAN name="page2" id="page2">[2]</SPAN></span>
is punishable on summary conviction before a magistrate
or justices only, while the more serious crimes (<i>indictable
offences</i>) must be tried before a jury.</p>
<p>2. <i>Civil injuries</i> differ from crimes in that the former
are compensated by damages awarded, while the latter
are punished; any person, whether injured or not, may
prosecute for a crime, while only the sufferer can sue
for a civil injury. The Crown may remit punishment for
a crime, but not for a civil injury.</p>
<hr class="shorter" />
<h2><SPAN name="chapterii_1" id="chapterii_1"></SPAN>II.—MEDICAL EVIDENCE</h2>
<p>On being called, the medical witness enters the
witness-box and takes the oath. This is very generally
done by uplifting the right hand and repeating the oath
(Scottish form), or by kissing the Bible, or by making a
solemn affirmation.</p>
<p>1. He may be called to give <i>ordinary evidence</i> as a
<i>common witness</i>. Thus he may be asked to detail the
facts of an accident which he has observed, and of the
inferences he has deduced. This evidence is what any
lay observer might be asked.</p>
<p>2. <i>Expert Witness.</i>—On the other hand, he may be
examined on matters of a technical or professional
character. The medical man then gives evidence of a
skilled or expert nature. He may be asked his opinion
on certain facts narrated—<i>e.g.</i>, if a certain wound would
be immediately fatal. Again, he may be asked whether
he concurs with opinions held by other medical
authorities.</p>
<p>In important cases specialists are often called to give
evidence of a skilled nature. Thus the hospital surgeon,
the nerve specialist, or the mental consultant may be
served with a subpœna to appear at court on a certain
date to give evidence. The evidence of such skilled<span class="pagenum"><SPAN name="page3" id="page3">[3]</SPAN></span>
observers will, it is supposed, carry greater weight
with the jury than would the evidence of an ordinary
practitioner.</p>
<p>Skilled witnesses may hear the evidence of ordinary
witnesses in regard to the case in which they are to give
evidence, and it is, indeed, better that they should
understand the case thoroughly, but they are not
usually allowed to hear the evidence of other expert
witnesses.</p>
<p>In civil cases the medical witness should, previous to
the trial, make an agreement with the solicitor who has
called him with reference to the fee he is to receive.
Before consenting to appear as a witness the practitioner
should insist on having all the facts of the case put
before him in writing. In this way only can he decide
as to whether in his opinion the plaintiff or defendant is
right as regards the medical evidence. If summoned by
the side on which he thinks the medical testimony is
correct, then it is his duty to consent to appear. If,
however, he is of opinion that the medical evidence is
clearly and correctly on the opposite side, then he ought
to refuse to appear and give evidence; and, indeed, the
lawyer would not desire his presence in the witness-box
unless he could uphold the case.</p>
<p>Whether an expert witness who has no personal knowledge
of the facts is bound to attend on a subpœna is a
moot point. It would be safer for him to do so, and to
explain to the judge before taking the oath that his
memory has not been sufficiently 'refreshed.' The
solicitor, if he desires his evidence, will probably see
that the fee is forthcoming.</p>
<p>A witness may be subjected to <i>three</i> examinations:
first, by the party on whose side he is engaged, which is
called the 'examination in chief,' and in which he affords
the basis for the next examination or 'cross-examination'
by the opposite side. The third is the 're-examination'<span class="pagenum"><SPAN name="page4" id="page4">[4]</SPAN></span>
by his own side. In the first he merely gives a clear
statement of facts or of his opinions. In the next his
testimony is subjected to rigid examination in order to
weaken his previous statements. In the third he is
allowed to clear up any discrepancies in the cross-examination,
but he must not introduce any new matter
which would render him liable to another cross-examination.</p>
<p>The medical witness should answer questions put to
him as clearly and as concisely as possible. He should
make his statements in plain and simple language, avoiding
as much as possible technical terms and figurative
expressions, and should not quote authorities in support
of his opinions.</p>
<p>An expert witness when giving evidence may refer to
notes for the purpose of refreshing his memory, but only
if the notes were taken by him at the time when the
observations were made, or as soon after as practicable.</p>
<p>There are various <i>courts</i> in which a medical witness
may be called on to give evidence:</p>
<p>1. <b>The Coroner's Court.</b>—When a coroner is informed
that the dead body of a person is lying within his jurisdiction,
and that there is reasonable cause to suspect
that such person died either a violent or unnatural death,
or died a sudden death of which the cause is unknown,
he must summon a jury of not less than twelve men to
investigate the matter—in other words, hold an inquest—and
if the deceased had received medical treatment,
the coroner may summon the medical attendant to give
evidence. By the Coroners (Emergency Provisions)
Act of 1917, the number of the jury has been cut down
to a minimum of seven and a maximum of eleven men.
By the Juries Act of 1918, the coroner has the power of
holding a court without a jury if, in his discretion, it
appears to be unnecessary. In charges of murder,
manslaughter, deaths of prisoners in prison, inmates<span class="pagenum"><SPAN name="page5" id="page5">[5]</SPAN></span>
of asylums or inebriates' homes, or of infants in nursing
homes, he must summon a jury. The coroner may
be satisfied with the evidence as to the cause of a
person's death, and may dispense with an inquest and
grant a burial certificate.</p>
<p>Cases are notified to the coroner by the police, parish
officer, any medical practitioner, registrar of deaths, or
by any private individual.</p>
<p>Witnesses, having been cited to appear, are examined
on oath by the coroner, who must, in criminal cases at
least, take down the evidence in writing. This is then
read over to each witness, who signs it, and this forms
his <i>deposition</i>. At the end of each case the coroner
sums up, and the jury return their verdict or <i>inquisition</i>,
either unanimously or by a majority.</p>
<p>If this charges any person with murder or manslaughter,
he is committed by the coroner to prison to
await trial, or, if not present, the coroner may issue
a warrant for his arrest.</p>
<p>A chemical analysis of the contents of the stomach,
etc., in suspected cases of poisoning is usually done
by a special analyst named by the coroner. If any
witness disobeys the summons to attend the inquest,
he renders himself liable to a fine not exceeding £2 2s.,
but in addition the coroner may commit him to prison
for contempt of court. In criminal cases the witnesses
are bound over to appear at the assizes to give evidence
there. The coroner may give an order for the exhumation
of a body if he thinks the evidence warrants a post-mortem
examination.</p>
<p>Coroners' inquests are held in all cases of sudden or
violent death, where the cause of death is not clear;
in cases of assault, where death has taken place
immediately or some time afterwards; in cases of
homicide or suicide; where the medical attendant
refuses to give a certificate of death; where the attendants
<span class="pagenum"><SPAN name="page6" id="page6">[6]</SPAN></span>
on the deceased have been culpably negligent; or
in certain cases of uncertified deaths.</p>
<p>The medical witness should be very careful in giving
evidence before a coroner. Even though the inquest be
held in a coach-house or barn, yet it has to be remembered
it is a court of law. If the case goes on for
trial before a superior court, your deposition made to
the coroner forms the basis of your examination. Any
misstatements or discrepancies in your evidence will be
carefully inquired into, and you will make a bad impression
on judge and jury if you modify, retract, or
explain away your evidence as given to the coroner.
You had your opportunity of making any amendments on
your evidence when the coroner read over to you your
deposition before you signed it as true.</p>
<p>By the Licensing Act of 1902, an inquest may not
be held in any premises licensed for the sale of intoxicating
liquor if other suitable premises have been
provided.</p>
<p>The duties of the coroner are based partly on Common
Law, and are also defined by statute, principally by the
Coroners Act of 1887 (50 and 51 Vict. c. 71). They
have been modified, however, by subsequent Acts—<i>e.g.</i>,
the Act of 1892, the Coroners (Emergency Provisions)
Act, 1917, and the Juries Act of 1918.</p>
<p>The fee payable to a medical witness for giving
evidence at an inquest is one guinea, with an extra
guinea for making a post-mortem examination and
report (in the metropolitan area these fees are doubled).
The coroner must sign the order authorizing the payment,
and should an inquest be adjourned to a later
day, no further fee is payable. If the deceased died in
a hospital, infirmary, or lunatic asylum, the medical
witness is not paid any fee. Should a medical witness
neglect to make the post-mortem examination after
receiving the order to do so, he is liable to a fine
of £5.<span class="pagenum"><SPAN name="page7" id="page7">[7]</SPAN></span></p>
<p>In Scotland the Procurator Fiscal fulfils many of the
duties of the coroner, but he cannot hold a public
inquiry. He interrogates the witnesses privately, and
these questions with the answers form the <i>precognition</i>.
More serious cases are dealt with by the Sheriff of each
county, and capital charges must be dealt with by the
High Court of Justiciary. In Scotland the verdicts of
the jury may be 'guilty,' 'not guilty,' or 'not proven.'</p>
<p>2. <b>The Magistrate's Court or Petty Sessions</b> is also
a court of preliminary inquiry. The prisoner may be
dealt with summarily, as, for example, in minor assault
cases, or, if the case is of sufficient gravity, and the
evidence justifies such a course, may be committed for
trial. The fee for a medical witness who resides within
three miles of the court is ten shillings and sixpence; if
at a greater distance, one guinea.</p>
<p>In the Metropolis the prisoner in the first instance is
brought before a magistrate, technically known as the
'beak,' who, in addition to being a person of great
acumen, is a stipendiary, and thus occupies a superior
position to the ordinary 'J.P.,' who is one of the great
unpaid. In the City of London is the Mansion House
Justice-Room, presided over by the Lord Mayor or one
of the Aldermen. The prisoner may ultimately be sent
for trial to the Central Criminal Court, known as the Old
Bailey, or elsewhere.</p>
<p>3. <b>Quarter Sessions.</b>—These are held every quarter
by Justices of the Peace. All cases can be tried before
the sessions except felonies or cases which involve difficult
legal questions. In London this court is known as
the Central Criminal Court, and it also acts as the Assize
Court. In Borough Sessions a barrister known as the
<i>Recorder</i> is appointed as sole judge.</p>
<p>4. <b>The Assizes</b> deal with both criminal and civil
cases. There is the <i>Crown Court</i>, where criminal cases
are tried, and there is the <i>Civil Court</i>, where civil cases
are heard. Before a case sent up by a lower court can<span class="pagenum"><SPAN name="page8" id="page8">[8]</SPAN></span>
be tried by the judge and petty jury, it is investigated by
the <i>grand jury</i>, which is composed of superior individuals.
If they find a 'true bill,' the case goes on; but if they
'throw it out,' the accused is at liberty to take his
departure. At the Court of Assize the prisoner is tried
by a jury of twelve. In bringing in the verdict the jury
must be unanimous. If they cannot agree, the case
must be retried before a new jury. At the Assize Court
the medical witness gets a guinea a day, with two
shillings extra to pay for his bed and board for every night
he is away from home, with his second-class railway
fare, if there is a second class on the railway by which he
travels. If there is no railway, and he has to walk, he is
entitled to threepence a mile for refreshments both ways.</p>
<p>5. <b>Court of Criminal Appeal.</b>—This was established
in 1908, and consists of three judges. A right of appeal
may be based (1) solely on a question of law; (2) on
certificate from the judge who tried the prisoner;
(3) on mitigation of sentence.</p>
<p>Speaking generally, in the Superior Courts the fees
which may be claimed by medical men called on to give
evidence are a guinea a day if resident in the town in
which the case is tried, and from two to three guineas a
day if resident at a distance from the place of trial, this
to include everything except travelling expenses. The
medical witness also receives a reasonable allowance for
hotel and travelling expenses.</p>
<p>If a witness is summoned to appear before two courts
at the same time, he must obey the summons of the
higher court. Criminal cases take precedence of civil.</p>
<p>A medical man has no right to claim privilege as an
excuse for not divulging professional secrets in a court
of law, and the less he talks about professional etiquette
the better. Still, in a civil case, if he were to make an
emphatic protest, the matter in all probability would
not be pressed. In a criminal case he would promptly
be reminded of the nature of his oath.<span class="pagenum"><SPAN name="page9" id="page9">[9]</SPAN></span></p>
<p>A medical man may be required to furnish a <i>formal
written report</i>. It may be the history of a fatal illness
or the result of a post-mortem examination. These
reports must be drawn up very carefully, and no
technical terms should be employed.</p>
<p>No witness on being sworn can be compelled to
'kiss the book.' The Oaths Act (51 and 52 Vict.,
c. 46, § 5) declares, without any qualification, that 'if
any person to whom an oath is administered desires
to swear with uplifted hand, in the form and manner
in which an oath is usually administered in Scotland,
he shall be permitted to do so, and the oath shall
be administered to him in such form and manner
without further question.' The witness takes the oath
standing, with the bare right hand uplifted above the
head, the formula being: 'I swear by Almighty God that
I will speak the truth, the whole truth, and nothing but
the truth.' The presiding judge should say the words,
and the witness should repeat them after him. There is
no kissing of the book, and the words 'So help me, God,'
which occur in the English form, are not employed. It
will be noted that the Scotch form constitutes an oath,
and is not an affirmation. The judge has no right to
ask if you object on religious grounds, or to put any
question. He is bound by the provisions of the Act,
and the enactment applies not only to all forms of the
witness oath, whether in civil or criminal courts, or
before coroners, but to every oath which may be lawfully
administered either in Great Britain or Ireland.</p>
<p>A witness engaged to give expert evidence should
demand his fee before going into court, or, at all events,
before being sworn.</p>
<p>With regard to notes, these should be made at the
time, on the spot, and may be used by the witness in
court as a refresher to the memory, though not altogether
to supply its place. All evidence is made up of
testimony, but all testimony is not evidence. The witness
<span class="pagenum"><SPAN name="page10" id="page10">[10]</SPAN></span>
must not introduce hearsay testimony. In one case
only is hearsay evidence admissible, and that is in the
case of a <i>dying declaration</i>. This is a statement made
by a dying person as to how his injuries were inflicted.
These declarations are accepted because the law presumes
that a dying man is anxious to speak the truth.
But the person must believe that he is <i>actually</i> on the
point of death, with <i>absolutely</i> no hope of recovery. A
statement was rejected because the dying person, in
using the expression 'I have no hope of recovery,' requested
that the words 'at present' should be added.
If after making the statement the patient were to say,
'I hope now I shall get better,' it would invalidate the
declaration. To make the declaration admissible as
evidence, death must ensue. If possible, a magistrate
should take the dying declaration; but if he is not
available, the medical man, without any suggestions or
comments of his own, should write down the statements
made by the dying person, and see them signed and
witnessed. It must be made clear to the court that at
the time of making his statement the witness was under
the full conviction of approaching or impending death.</p>
<hr class="shorter" />
<h2><SPAN name="chapteriii_1" id="chapteriii_1"></SPAN>III.—PERSONAL IDENTITY</h2>
<p>It is but seldom that medical evidence is required with
regard to the identification of the living, though it may
sometimes be so, as in the celebrated Tichborne case.
The medical man may in such cases be consulted as to
family resemblance, marks on the body, nævi materni,
scars and tattoo marks, or with regard to the organs of
generation in cases of doubtful sex. Tattoo marks may
disappear during life; the brighter colours, as vermilion,
as a rule, more readily than those made with carbon, as
Indian ink; after death the colouring-matter may be
found in the proximal glands. If the tattooing is superficial
(merely underneath the cuticle) the marks may<span class="pagenum"><SPAN name="page11" id="page11">[11]</SPAN></span>
possibly be removed by acetic acid or cantharides, or
even by picking out the colouring-matter with a fine
needle. With regard to scars and their permanence, it
will be remembered that scars occasioned by actual loss
of substance, or by wounds healed by granulation, never
disappear. The scars of leech-bites, lancet-wounds, or
cupping instruments, may disappear after a lapse of
time. It is difficult, if not impossible, to give any certain
or positive opinion as to the age of a scar; recent
scars are pink in colour; old scars are white and glistening.
The cicatrix resulting from a wound depends upon
its situation. Of incised wounds an elliptical cicatrix is
typical, linear being chiefly found between the fingers
and toes. By way of disguise the hair may be dyed black
with lead acetate or nitrate of silver; detected by allowing
the hair to grow, or by steeping some of it in dilute
nitric acid, and testing with iodide of potassium for lead,
and hydrochloric acid for silver. The hair may be
bleached with chlorine or peroxide of hydrogen, detected
by letting the hair grow and by its unnatural
feeling and the irregularity of the bleaching.</p>
<p>Finger-print impressions are the most trustworthy of
all means of identification. Such a print is obtained by
rubbing the pulp of the finger in lampblack, and then
impressing it on a glazed card. The impression reveals
the fine lines which exist at the tips of the fingers. The
arrangement of these lines is special to each person, and
cannot be changed. Hence this method is employed by
the police in the identification of prisoners.</p>
<p>In the determination of cases of doubtful sex in the
living, the following points should be noticed: the size
of the penis or clitoris, and whether perforate or not, the
form of the prepuce, the presence or absence of nymphæ
and of testicles or ovaries. Openings must be carefully
sounded as to their communication with bladder or
uterus. After puberty, inquiry should be made as to
menstrual or vicarious discharges, the general development
<span class="pagenum"><SPAN name="page12" id="page12">[12]</SPAN></span>
of the body, the growth of hair, the tone of voice,
and the behaviour of the individual towards either sex.</p>
<p>With regard to the identification of the dead in cases
of death by accident or violence, the medical man's
assistance may be called. The sex of the skeleton, if
that only be found, may be judged from the bones of
the female generally being smaller and more slender
than those of the male, by the female thorax being
deeper, the costal cartilages longer, the ilia more expanded,
the sacrum flatter and broader, the coccyx
movable and turned back, the tuberosities of the ischia
wider apart, the pubes shallow, and the whole pelvis
shallower and with larger outlets. But of all these signs
the only one of any real value is the roundness of the
pubic arch in the female, as compared with the pointed
arch in the male. Before puberty the sex cannot be
determined from an examination of the bones.</p>
<p>Age may be calculated from the presence, nature and
number of the erupted teeth; from the cartilages of the
ribs, which gradually ossify as age advances; from the
angle formed by the ramus of the lower jaw with its
body (obtuse in infancy, a right angle in the adult, and
again obtuse in the aged from loss of the teeth); and in
the young from the condition of the epiphyses with
regard to their attachment to their respective shafts.</p>
<p>To determine stature, the whole skeleton should be
laid out and measured, 1-1/2 to 2 inches being allowed for
the soft parts.</p>
<hr class="shorter" />
<h2><SPAN name="chapteriv_1" id="chapteriv_1"></SPAN>IV.—EXAMINATION OF PERSONS FOUND DEAD</h2>
<p>When a medical man is called to a case of sudden
death, he should carefully note anything likely to throw
any light on the cause of death. He should notice the
place where the body was found, the position and attitude
of the body, the soil or surface on which the body lies,
<span class="pagenum"><SPAN name="page13" id="page13">[13]</SPAN></span>
the position of surrounding objects, and the condition of
the clothes. He should also notice if there are any signs
of a struggle having taken place, if the hands are clenched,
if the face is distorted, if there has been foaming at the
mouth, and if urine or fæces have been passed involuntarily.
Urine may be drawn off with a catheter and
tested for albumin and sugar.</p>
<p>If required to make a post-mortem examination, every
cavity and important organ of the body must be carefully
and minutely examined, the seat of injury being
inspected first.</p>
<hr class="shorter" />
<h2><SPAN name="chapterv_1" id="chapterv_1"></SPAN>V.—MODES OF SUDDEN DEATH</h2>
<p>There are three modes in which death may occur:
(1) Syncope; (2) asphyxia; (3) coma.</p>
<p>1. <b>Syncope</b> is death beginning at the heart—in other
words, failure of circulation. It may arise from—(1)
<i>Anæmia</i>, or deficiency of blood due to hæmorrhage,
such as occurs in injuries, or from bleeding from the
lungs, stomach, uterus, or other internal organs.
(2) <i>Asthenia</i>, or failure of the heart's action, met with in
starvation, in exhausting diseases, such as phthisis, cancer,
pernicious anæmia, and Bright's disease, and in
some cases of poisoning—for example, aconite.</p>
<p>The symptoms of syncope are faintness, giddiness,
pallor, slow, weak, and irregular pulse, sighing respiration,
insensibility, dilated pupils, and convulsions.</p>
<p>Post mortem the heart is found empty and contracted.
When, however, there is sudden stoppage of the heart,
the right and left cavities contain blood in the normal
quantities, and blood is found in the venæ cavæ and in
the arterial trunks. There is no engorgement of either
lungs or brain.</p>
<p>2. <b>Asphyxia</b>, or death beginning at the lungs, may be
due to obstruction of the air-passages from foreign bodies
in the larynx, drowning, suffocation, strangling, and
<span class="pagenum"><SPAN name="page14" id="page14">[14]</SPAN></span>
hanging; from injury to the cervical cord; effusion into
the pleuræ, with consequent pressure on the lungs;
embolism of the pulmonary artery; and from spasmodic
contraction of the thoracic and abdominal muscles in
strychnine-poisoning.</p>
<p>The symptoms of this condition are fighting for breath,
giddiness, relaxation of the sphincters, and convulsions.</p>
<p>Post mortem, cadaveric lividity is well marked, especially
in nose, lips, ears, etc.; the right cavities of the
heart and the venæ cavæ are found gorged with dark
fluid blood. The pulmonary veins, the left cavities of the
heart, and the aorta, are either empty or contain but little
blood. The lungs are dark and engorged with blood,
and the lining of the air-tubes is bright red in colour.
Much bloody froth escapes on cutting into the lungs.
Numerous small hæmorrhages (Tardieu's spots) are found
on the surface and in the substance of the internal organs,
as well as in the skin of the neck and face.</p>
<p>3. <b>Coma</b>, or death beginning at the brain, may arise
from concussion; compression; cerebral pressure from
hæmorrhage and other forms of apoplexy; blocking of
a cerebral artery from embolism; dietetic and uræmic
conditions; and from opium and other narcotic poisons.</p>
<p>The symptoms of this condition are stupor, loss of consciousness,
and stertorous breathing.</p>
<p>The post-mortem signs are congestion of the substance
of the brain and its membranes, with accumulation of the
blood in the cavities of the heart, more on the right side
than on the left.</p>
<p>It must be remembered that, owing to the interdependence
of all the vital functions, there is no line of demarcation
between the various modes of death. In all cases
of sudden death think of angina pectoris and the rupture
of an aneurism.</p>
<p>The following is a list of some of the commoner causes
of sudden death:<span class="pagenum"><SPAN name="page15" id="page15">[15]</SPAN></span></p>
<p>(<i>a</i>) <b>Instantaneously Sudden Death</b>—</p>
<ol>
<li>Syncope (by far the commonest cause).</li>
<li>Aortic incompetence.</li>
<li>Rupture of heart.</li>
<li>Rupture of a valve.</li>
<li>Rupture of aortic aneurism.</li>
<li>Embolism of coronary artery.</li>
<li>Angina pectoris.</li>
</ol>
<p>(<i>b</i>) <b>Less Sudden but Unexpected Death</b>—</p>
<ol>
<li>Cerebral hæmorrhage or embolism.</li>
<li>Mitral and tricuspid valvular lesions if the patient exerts himself.</li>
<li>Rupture of a gastric or duodenal ulcer; rupture of
liver, spleen, or extra-uterine gestation, or abdominal
aneurism.</li>
<li>Suffocation during an epileptic fit; vomited matter
or other material drawn into the trachea or air-passages;
croup.</li>
<li>Arterio-sclerosis may lead to thrombosis, embolism,
or aneurism.</li>
<li>Poisoning, as by hydrocyanic acid, cyanide of
potassium, inhalation of carbonic acid or coal gas, œdema
of glottis following inhalation of ammonia.</li>
<li>Rapid onset of some acute specific disease, such as
pneumonia or diphtheria; collapse from cholera.</li>
<li>Heat-stroke, lightning, shocks of electricity of high
tension.</li>
<li>Mental or physical shock.</li>
<li>Exertion while the stomach is overloaded.</li>
<li>Diabetic coma; uræmia.</li>
<li><i>Status lymphaticus.</i> This is a general hyperplastic
condition of the lymphatic structures in the body, and is
seen in enlargement of tonsils, thymus, spleen, as well as
of Peyer's patches and mesenteric glands. It is a frequent
cause of death during chloroform anæsthesia for slight
operations in young people.</li>
</ol>
<p>In addition, it may be as well to remember that death
<span class="pagenum"><SPAN name="page16" id="page16">[16]</SPAN></span>
sometimes occurs suddenly in exophthalmic goitre, hypertrophy
of the thymus, and in Addison's disease.</p>
<p>In some cases of sudden death nothing has been found
post mortem, even when the autopsy has been made by
skilled observers, and the brain and cord have been submitted
to microscopical examination.</p>
<hr class="shorter" />
<h2><SPAN name="chaptervi_1" id="chaptervi_1"></SPAN>VI.—SIGNS OF DEATH</h2>
<p>(1) Cadaveric appearance; ashy white colour. (2) Cessation
of the circulation and respiration, no sound being
heard by the stethoscope. Cessation of the circulation
may be determined by (<i>a</i>) placing a ligature round the base
of a finger (Magnus' test); (<i>b</i>) injecting a solution of fluorescin
(Icard's test); (<i>c</i>) looking through the web of the
fingers at a bright light (diaphanous test); (<i>d</i>) the dulling
of a steel needle when thrust into the living body; (<i>e</i>) the
clear outline of the dead heart when viewed in the fluorescent
screen. (3) The state of the eye; the tension is at
once lost; iris insensible to light, fundus yellow in colour;
cornea dull and sunken. (4) The state of the skin; pale,
livid, with loss of elasticity. (5) Extinction of muscular
irritability. The above signs afford no means of determining
how long life has been extinct. The following,
however, do:</p>
<p><b>Cooling of the Body.</b>—The average internal temperature
of the body is from 98° to 100° F. The time taken
in cooling is from fifteen to twenty hours, but it may be
modified by the kind of death, the age of the person, the
presence or absence of clothing on the body, the surrounding
temperature, and the stillness or otherwise
of the air about the body. Still, the body, other things
being equal, may be said to be <i>quite cold</i> in about <i>twelve
hours</i>.</p>
<p><b>Hypostasis</b> or <b>post-mortem staining</b> is due to the
settling down of the blood in the most dependent parts
of the body while the body is cooling. It is a sure sign
<span class="pagenum"><SPAN name="page17" id="page17">[17]</SPAN></span>
of death, and occurs in all forms of death, even in that
due to hæmorrhage, although not so marked in degree.
Post-mortem staining (<i>cadaveric lividity</i>) begins to appear
in from eight to twelve hours after death, and its position
on the body will help to determine the length of time
the body has lain in the position in which it was found.
The staining is of a dull red or slaty blue colour. It
must be distinguished from ecchymosis the result of a
bruise, by making an incision into the part; in the case
of hypostasis a few small bloody points of divided
arteries will be seen, in the case of ecchymosis the
subcutaneous tissues are infiltrated with blood-clot. Internally,
hypostasis must not be mistaken for congestion
of the brain or lungs, or the results of inflammation of
the intestines. If the intestine is pulled straight, inflammatory
redness is continuous, hypostasis is disconnected.
About the neck hypostasis must not be mistaken for the
mark of a cord or other ligature. When the blood is of
a bright red colour after death (as happens in poisoning
by CO or HCN, or in death from cold), the hypostasis is
bright red also.</p>
<p><b>Cadaveric Rigidity—Rigor Mortis.</b>—For some time
after death the muscles continue to contract under
stimuli. When this irritability ceases—and it seldom
exceeds two hours—rigidity and hardening sets in, and
in <i>all</i> cases precedes putrefaction. It is caused by the
coagulation of the muscle plasma. It commences in the
muscles of the back of the neck and lower jaw, and
then passes into the muscles of the face, front of the
neck, chest, upper extremities, and lastly to the lower
extremities.</p>
<p>It has been noticed in the new-born infant, as well as
in the fœtus. It lasts from sixteen to twenty hours or
more. In lingering diseases, after violent exertion, and
in warm climates, it sets in quickly, and disappears in
two or three hours; in those who are in perfect health
and die from accident or asphyxia, it may not come on
<span class="pagenum"><SPAN name="page18" id="page18">[18]</SPAN></span>
until from ten to twenty-four hours, and may last three
or four days. After death from convulsions or strychnine-poisoning,
the body may pass at once into rigor
mortis. Rigor mortis must be distinguished from <i>cadaveric
spasm</i> or the <i>death clutch</i>; in the former, articles in
the hands are readily removable, in the latter this is not
the case. In tetanic spasm the limbs when bent return
to their former position; not so in rigor mortis.</p>
<p><b>Putrefaction</b> appears in from one to three days after
death, as a greenish-blue discoloration of the abdomen;
in the drowned, over the head and face. This increases,
becomes darker and more general, a strong putrefactive
odour is developed, the thorax and abdomen become
distended with gas, and the epidermis peels off. The
muscles then become pulpy, and assume a dark greenish
colour, the whole body at length becoming changed into
a soft, semi-fluid mass. The organ first showing the
putrefactive change is the trachea; that which resists
putrefaction longest is the uterus. These putrefactive
changes are modified by the fat or lean condition of the
body, the temperature (putrefaction taking place more
rapidly in summer than in winter), access of air, the
period, place, mode of interment, age, etc. Bodies
which remain in water putrefy more slowly than those
in air.</p>
<p><b>Saponification.</b>—In bodies which are very fat and
have lain in water or moist soil for from one to three
years this process takes place, the fat uniting with the
ammonia given off by the decomposition to form <i>adipocere</i>.
This consists of a margarate or stearate of ammonium
with lime, oxide of iron, potash, certain fatty acids,
and a yellowish odorous matter. It has a fatty, unctuous
feel, is either pure white or pale yellow, with an odour
of decayed cheese. Small portions of the body may
show signs of this change in six weeks.</p>
<p><b>Post-Mortem Examination.</b>—Never make an autopsy
in criminal cases without a written order from the
coroner or Procurator Fiscal. If authorized, however,
<span class="pagenum"><SPAN name="page19" id="page19">[19]</SPAN></span>
first have the body identified, then photographed if it
has not been identified. A medical man representing
the accused may be present, but only by consent of the
Crown authorities or of the Sheriff. Clothing should
be examined for blood-stains, cuts, etc.</p>
<p>Examine external surface of body and take accurate
measurements of wounds, marks, deformities, tattooings;
note degree and distribution of post-mortem staining,
rigidity, etc.</p>
<p>Examine brain by making incision from ear to ear
across vertex, reflect scalp forwards and backwards, and
saw off calvarium. Examine brain carefully externally
and on section.</p>
<p>Examine organs of chest and abdomen through an
incision made from symphysis menti to pubis, reflecting
tissues from chest wall and cutting through costal
cartilages.</p>
<p>In cases of suspected poisoning have several clean
jars into which you place the stomach with contents,
intestines with contents, piece of liver, kidney, spleen,
etc., and seal each up carefully, attaching label with
name of deceased, date, and contained organs, and
transmit these personally to the analyst.</p>
<p><b>Exhumation.</b>—A body which has been buried cannot
be exhumed without an order from a coroner, fiscal, or
from the Home Secretary. There is no legal limit in
England as to when a body may be exhumed; in
Scotland, however, if an interval of twenty years has
elapsed, an accused person cannot be prosecuted (<i>prescription
of crime</i>).</p>
<hr class="shorter" />
<h2><SPAN name="chaptervii_1" id="chaptervii_1"></SPAN>VII.—DEATH FROM ANÆSTHETICS, ETC.</h2>
<p>The coroner in England and Wales and Ireland must
inquire into every case of death during the administration
of an anæsthetic. The anæsthetist has to appear
at the inquest, and must answer a long series of questions
relative to the administration of the drug.<span class="pagenum"><SPAN name="page20" id="page20">[20]</SPAN></span></p>
<p>Before, therefore, giving an anæsthetic, and so as to
furnish yourself with a proper defence in the event of
death occurring, you ought to examine the heart, lungs,
and kidneys of the patient to see if they are healthy.
Should a fatal result follow, the anæsthetist will require
to prove that it was necessary to give the anæsthetic,
that the one employed was the most suitable, that the
patient was in a fit state of health to have it administered,
that it was given skilfully and in moderate amount, that
he had the usual remedies at hand in case of failure of
the heart or lungs, and that he employed every means
in his power to resuscitate the patient.</p>
<p>The condition of the lungs is of more importance than
the state of the heart.</p>
<p>The chloroformist ought always to use the best
chloroform.</p>
<p>An anæsthetic should never be administered except in
the presence of a <i>third person</i>. This applies especially
to dentists who give gas to females.</p>
<p><b>Malpractice.</b>—In every case where a medical man
attends a patient, he must give him that amount of care,
skill, knowledge, or judgment, that the law expects of
him. If he does not, then the charge of malpractice
may be brought against him. It is most frequently
alleged in connection with surgical affections—<i>e.g.</i>,
overlooking a fracture or dislocation. Before a major
operation is performed, it is well to get a written agreement.</p>
<hr class="shorter" />
<h2><SPAN name="chapterviii_1" id="chapterviii_1"></SPAN>VIII.—PRESUMPTION OF DEATH; SURVIVORSHIP</h2>
<p><b>Presumption of Death.</b>—If a person be unheard of
for seven years, the court may, on application by the
nearest relative, presume death to have taken place. If,
however, it can be shown that in all probability death
had occurred in a certain accident or shipwreck, the
decree may be made much earlier.<span class="pagenum"><SPAN name="page21" id="page21">[21]</SPAN></span></p>
<p><b>Presumption of Survivorship.</b>—When two or more
related persons perish in a common accident, it may be
necessary, in order to decide questions of succession,
to determine which of them died first. It is generally
accepted that the stronger and more vigorous will survive
longest.</p>
<hr class="shorter" />
<h2><SPAN name="chapterix_1" id="chapterix_1"></SPAN>IX.—ASSAULT, MURDER, MANSLAUGHTER, ETC.</h2>
<p><b>Assault.</b>—This is an attempt or offer to do violence
to another person; it is not necessary that actual injury
has been done, but evil intention must be proved. When
a corporal hurt has been sustained, then <i>assault and
battery</i> has been committed. The assault may be
aggravated by the use of weapons, etc.</p>
<p><b>Homicide</b> may be <i>justifiable</i>, as in the case of judicial
execution, or <i>excusable</i>, as in defence of one's family or
property.</p>
<p><i>Felonious homicide</i> is murder. This means that a
human being has been killed by another maliciously and
deliberately or with reckless disregard of consequences.</p>
<p><b>Manslaughter</b> or <b>Culpable Homicide</b> (Scotland) is
the unlawful killing of a human being without malice—as
homicide after great provocation; signalman who
allows a train to pass, and so collide with another in
front.</p>
<hr class="shorter" />
<h2><SPAN name="chapterx_1" id="chapterx_1"></SPAN>X.—WOUNDS AND MECHANICAL INJURIES</h2>
<p>A wound may be defined as a 'breach of continuity
in the structures of the body, whether external or
internal, suddenly occasioned by mechanical violence.'
The law does not define 'a wound,' but the <i>true skin
must be broken</i>. Wounds are dangerous from shock,
hæmorrhage, from the supervention of crysipelas or
pyæmia, and from <i>malum regimen</i> on the part of the
patient or surgeon. <i>Is the wound dangerous to life?</i>
<span class="pagenum"><SPAN name="page22" id="page22">[22]</SPAN></span>
This question can only be answered by a full consideration
of all the circumstances of the case; a guarded
prognosis is wise in all cases.</p>
<p><b>Burns</b> are caused by flames, highly heated solids, or
very cold solids, as solid carbonic acid; scalds, by steam
or hot fluids. Burns may cause death from shock,
suffocation, œdema glottidis, inflammation of serous
surfaces, bronchitis, pneumonia, duodenal ulcer, coma,
or exhaustion. A burn of the skin inflicted during life
is followed by a bleb containing serum; the edges of this
blister are bright red, and the base, seen after removing
the cuticle, is red and inflamed; if sustained after death,
a bleb, if present, contains but little fluid, and there are
no signs of vital reaction. There are six degrees of burns:
(1) Superficial inflammation; (2) formation of vesicles;
(3) destruction of superficial layer of skin; (4) destruction
of cellular tissue; (5) deep parts charred; (6) carbonization
of bones.</p>
<p>The larger the area of skin burnt, the more grave is
the prognosis. Burns of the abdomen and genital
organs are especially dangerous. Young children are
specially liable to die after burns.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxi_1" id="chapterxi_1"></SPAN>XI.—CONTUSED WOUNDS AND INJURIES UNACCOMPANIED BY SOLUTION OF CONTINUITY</h2>
<p>If a blow be inflicted with a blunt instrument, there is
produced a bruise, or <i>ecchymosis</i>, of which it is unnecessary
here to describe the appearance and progress.
A bruise may be distinguished from a post-mortem
stain by the cuticle in the former often being abraded
and raised. When an incision is made into the bruise,
the whole of the subcutaneous tissues are found to be
infiltrated with blood-clot, and there is no clear margin.
In the case of a post-mortem stain the edges are<span class="pagenum"><SPAN name="page23" id="page23">[23]</SPAN></span>
sharply defined, not raised, and, on section, mere bloody
points are seen which are the cut ends of the divided
blood vessels.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxii_1" id="chapterxii_1"></SPAN>XII.—INCISED WOUNDS AND THOSE ACCOMPANIED BY SOLUTION OF CONTINUITY</h2>
<p>These comprise incised, punctured, and lacerated
wounds. In a recent incised wound inflicted during life
there is copious hæmorrhage, the cellular tissue is filled
with blood, the edges of the wound gape and are everted,
and the cavity of the wound is filled with coagula.</p>
<p>Lacerated wounds combine the characters of incised
and contused wounds. They are caused by falls, being
ridden over, machinery crushes, bites, blows from blunt
weapons, etc. The wounds heal by suppuration.</p>
<p><i>Punctured wounds</i> come intermediate between incised
and lacerated. They are greater in depth than in length,
being caused by sword or rapier thrusts. They cause
little hæmorrhage externally, but death may be due to
internal hæmorrhage. They may be complicated by
(1) the introduction of septic material adhering to the
instrument; (2) the entrance of foreign bodies which
lodge in the wound, not only carrying in septic matter,
but acting as mechanical irritants; (3) injury to deeper
parts, which may at the time be difficult to detect.</p>
<p>An apparently <i>incised wound</i> may be produced by a
hard, blunt weapon over a bone—<i>e.g.</i>, shin or cranium.
It is often difficult to distinguish between a wound of the
scalp inflicted with a knife and one made by a blow with
a stick. A puncture with a sharp-edged, pointed knife
leaves a fusiform or spindle-shaped wound. A wound
from a blow with a stick might be of this character,
or it might present a jagged, swollen appearance at
the margin, with much contusion of the surrounding
tissues. If the wound is seen soon after it is inflicted,
examination with a lens may disclose irregularities
of the margins, or little bridges of connective tissue
<span class="pagenum"><SPAN name="page24" id="page24">[24]</SPAN></span>
or vessels running across the wound, and so be inconsistent
with its production by a cutting instrument.
<i>Lacerated wounds</i> as a rule bleed less freely than those
which are incised. Symptoms of concussion would favour
the theory of the injury having been inflicted by a heavy
instrument. Again, it is often difficult to decide whether
the injury which caused death was the result of a blow
or a fall. A heavy blow with a stick may at once cause
fatal effusion of blood, but this might equally result from
fracture of the skull resulting from a fall. The wound
should be carefully examined for foreign bodies, such as
grit, dirt, or sand. The distinction between incised
wounds inflicted during life and after death is found in
the fact that a wound inflicted during life presents
the appearances already described, whereas in a post-mortem
incised wound only a small quantity of liquid
venous blood is effused; the edges are close, yielding,
inelastic; the blood is not effused into the cellular
tissue, and there are no signs of vital reaction. The
presence of inflammatory reaction or pus shows that the
wound must have been inflicted some time before death,
probably two or three days.</p>
<p><i>Self-inflicted wounds</i> are made by the person himself in
order to divert suspicion, or in order to bring accusation
against another. Such wounds are always in front, not
over vital organs, and superficial in character. Note the
condition of the clothes in such cases.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxiii_1" id="chapterxiii_1"></SPAN>XIII.—GUNSHOT WOUNDS</h2>
<p>These may be punctured, contused, or lacerated.
Round balls make a larger opening than those which are
conical. Small shot fired at a short distance make one
large ragged opening; while at distances greater than
3 feet the shot scatter and there is no central
opening. The Lee-Metford bullet is more destructive
than the Mauser. The former is the larger, but the
difference in size is not great. The Martini-Henry<span class="pagenum"><SPAN name="page25" id="page25">[25]</SPAN></span>
bullet weighs 480 grains, the Lee-Metford 215, and the
Mauser 173. Speaking generally, a gunshot wound, unlike
a punctured wound, becomes larger as it increases in
depth; the aperture of entrance is round, clean, with
inverted edges, and that of exit larger, less regular than
that of entrance, and with everted edges.</p>
<p>In the case of high-velocity bullets from smooth-bore
rifles, including the Mauser and Lee-Metford, the
aperture of entry is small; the aperture of exit is
slightly larger, and tends to be more slit-like. There
is but little tendency to carry in portions of clothing
or septic material, and the wound heals by first
intention, if reasonable precautions be taken. The
external cicatrices finally look very similar to those produced
by bad acne pustules.</p>
<p>The contents of all gunshot wounds should be preserved,
as they may be useful in evidence. A pocket
revolver, as a rule, leaves the bullet in the body.</p>
<p>Wounds inflicted by firearms may be due to accident,
homicide, or suicide. Blackening of the wound, singeing
of the hair, scorching of the skin and clothing, show that
the weapon was fired at close quarters, whilst blackening
of the hand points to suicide. Even when the weapon is
fired quite close there may be no blackening of the skin,
and the hand is not always blackened in cases of suicide.
Smokeless powder does not blacken the skin. Wounds
on the back of the body are not usually self-inflicted, but
a suicide may elect to blow off the back of his head. A
wound in the back may be met with in a sportsman who
indulges in the careless habit of dragging a loaded gun
after him. If a revolver is found tightly grasped in the
hand it is probably a case of suicide, whilst if it lies
lightly in the hand it may be suicide or homicide. If
no weapon is found near the body, it is not conclusive
proof that it is not suicide, for it may have been thrown
into a river or pond, or to some distance and picked up
by a passer-by.<span class="pagenum"><SPAN name="page26" id="page26">[26]</SPAN></span></p>
<p>A bullet penetrating the skull even from a distance of
3,000 yards may act as an explosive, scattering the contents
in all directions; but the bullet from a revolver will
usually be found in the cranium.</p>
<p>The prognosis depends partly on the extent of the
injury and the parts involved, but there is also risk from
secondary hæmorrhage, and from such complications
as pleurisy, pericarditis, and peritonitis. Death may
result from shock, hæmorrhage, injury to brain or
important nervous structures.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxiv_1" id="chapterxiv_1"></SPAN>XIV.—WOUNDS OF VARIOUS PARTS OF THE BODY</h2>
<p>1. <b>Of the Head.</b>—Wounds of the scalp are likely to be
followed by (1) erysipelatous inflammation; (2) inflammation
of the tendinous structures, with or without
suppuration. A severe blow on the vertex may cause
fracture of the base of the skull. Injuries of the brain
include concussion, compression, wounds, contusion,
and inflammation. Concussion is a common effect of
blows or violent shocks, and the symptoms follow
immediately on the accident, death sometimes taking
place without reaction. Compression may be caused by
depressed bone or effused blood (rupture of middle
meningeal artery) and serum. The symptoms may come
on suddenly or gradually. Wounds of the brain present
very great difficulties, and vary greatly in their effect,
very slight wounds producing severe symptoms, and
<i>vice versâ</i>. A person may receive an injury to the
head, recover from the first effects, and then die with all
the symptoms of compression from internal hæmorrhage.
This is due to the fact that the primary syncope arrests
the hæmorrhage, which returns during the subsequent
reaction, or on the occurrence of any excitement.
Inflammation of the meninges or brain may follow
injuries, not only to the brain itself, but to the scalp and
<span class="pagenum"><SPAN name="page27" id="page27">[27]</SPAN></span>
adjacent parts, as the orbit and ear. Inflammation does
not usually come on at once, but after variable periods.</p>
<p>2. <b>Injuries to the Spinal Cord</b> may be due to concussion,
compression (fracture-dislocation), or wounds. That
the wound has penetrated the meninges is shown by the
escape of cerebro-spinal fluid. The cord and nerves
may be injured (1) by the puncture; (2) by extravasation
of blood and the formation of a clot; and (3) by subsequent
septic inflammation. Division or complete
compression of the cord at or above the level of the
fourth cervical vertebra is immediately fatal (as happens
in judicial hanging). When the injury is below the
fourth, the diaphragm continues forcibly in action, but
the lungs are imperfectly expanded, and life will not be
maintained for more than a day or two. When the
injury is in the dorsal region, there is paralysis of the
legs and of the sphincters of the bladder and rectum, but
power is retained in the arms and the upper intercostal
muscles act, the extent of paralysis depending on the
level of the lesion. In injuries to the lumbar region the
legs may be partly paralysed, and the rectal and bladder
sphincters may be involved.</p>
<p><i>Railway spine</i>, or traumatic neurasthenia, may be set
up by concussion of the cord as a result of blows or
falls. Passengers after railway accidents, or miners,
often suffer from this affection.</p>
<p>3. <b>Of the Face.</b>—These produce great disfigurement
and inconvenience, and there is a risk of injury to the
brain. The seventh nerve may be involved, giving rise
to facial paralysis. Punctured wounds of the orbit are
especially dangerous. Wounds apparently confined to
the external parts often conceal deep-seated mischief.</p>
<p>4. <b>Of the Eye.</b>—The iris may be injured by sharp
blows, as from the cork of a soda-water bottle. It is
usually followed by hæmorrhage into the anterior
chamber, and there may be separation of the iris from
its ciliary border. Wounds at the edge of the cornea
<span class="pagenum"><SPAN name="page28" id="page28">[28]</SPAN></span>
are often followed by prolapse of the iris. Acute
traumatic iritis or irido-cyclitis may supervene four or
five days after the injury. The lens is frequently
wounded in addition to the cornea and iris. In dislocation
of the lens into the anterior chamber as the
result of a blow, the lens appears like a large drop of oil
lying at the back of the cornea, the margin exhibiting a
brilliant yellow reflex. Partial dislocations of the lens
as the result of severe blows generally terminate in
cataract.</p>
<p>5. <b>Of the Throat.</b>—Very frequently inflicted by
suicides. Division of the carotid artery is fatal, and of
the internal jugular vein very dangerous on account of
entrance of air. Wounds of the larynx and trachea are
not necessarily or immediately dangerous, but septic
pneumonia is very apt to follow. Wounds of the throat
inflicted by suicides are commonly situated at the upper
part, involving the hyoid bone and the thyroid and
cricoid cartilages. The larynx is opened, but the large
vessels often escape. In most suicidal wounds of the
throat the direction is from left to right, the incision
being slightly inclined from above downwards. At the
termination of a suicidal cut-throat the skin is the last
structure divided, the wound being shallower as it
reaches its termination; the wounds often show
parallelism. The weapon is often firmly grasped in the
hand. Inquiry should be made as to whether the patient
is right or left handed, or ambidextrous.</p>
<p>Homicidal cut throat is usually very severe and situated
low down in the neck or far to the side.</p>
<p>6. <b>Of the Chest.</b>—Incised wounds of the walls are not
of necessity dangerous; but severe blows, by causing
fracture of the bones and internal injuries, are often
fatal. The symptoms of penetrating wounds of the
chest are—(1) The passage of blood and air through the
wound; (2) hæmoptysis; (3) pneumothorax; and (4)
protrusion of the lung forming a tumour covered with
<span class="pagenum"><SPAN name="page29" id="page29">[29]</SPAN></span>
pleura. Fracture of the ribs may be due to direct
violence, as from a blow, when the ends are driven
inwards, or to indirect violence, as from a squeeze in a
crowd, when the ends are driven outwards.</p>
<p>7. <b>Of the Lungs.</b>—These usually cause hæmorrhage,
and are frequently followed by pleurisy, either dry or
with effusion, and by pneumonia.</p>
<p>8. <b>Of the Heart.</b>—Penetrating wounds are fatal from
hæmorrhage, of the base more speedily than of the apex;
but life may be prolonged for some time even after a
severe wound to the heart. Injury to the right ventricle
is the most fatal injury and the most frequent. Rupture
from disease usually occurs in the left ventricle; rupture
from a crush is usually towards the base and on the right
side.</p>
<p>9. <b>Of the Aorta and Pulmonary Artery.</b>—Fatal.</p>
<p>10. <b>Of the Diaphragm.</b>—Generally fatal, owing to the
severe injury of the other abdominal organs. If the
diaphragm be ruptured, hernia of the organs may result.</p>
<p>11. <b>Of the Abdomen.</b>—Of the walls, may be dangerous
from division of the epigastric artery; ventral hernia
may follow, internal hæmorrhage, etc. Blows on the
abdomen are prone to cause death from cardiac inhibition.</p>
<p>12. <b>Of the Liver.</b>—May divide the large vessels.
Venous blood flows profusely from a punctured wound
of the liver. Wounds of the gall-bladder cause effusion
of bile and peritoneal inflammation. Laceration of the
liver may result from external violence without leaving
any outward sign of the injury; it is commonly fatal.
There is rapid and acute anæmia from the pouring out
of blood into the abdominal cavity. This may also occur
with injuries of other organs in the abdomen.</p>
<p>13. <b>Of the Spleen.</b>—Fatal hæmorrhage may result
from penetrating wounds or from rupture due to kicks,
blows, crushes, especially if the spleen be enlarged.</p>
<p>14. <b>Of the Stomach.</b>—May be fatal from shock, from
<span class="pagenum"><SPAN name="page30" id="page30">[30]</SPAN></span>
hæmorrhage, from extravasation of contents, or from
inflammation. The danger is materially lessened by
prompt surgical intervention.</p>
<p>15. <b>Of the Intestines.</b>—May be fatal in the same way
as those of the stomach. More dangerous in the small
than in the large intestines.</p>
<p>16. <b>Of the Kidneys.</b>—May prove fatal from hæmorrhage,
extravasation of urine, or inflammation.</p>
<p>17. <b>Of the Bladder.</b>—Dangerous from extravasation
of urine. In fracture of the pelvis the bladder is often
injured, and extraperitoneal infiltration of urine occurs,
with frequently a fatal issue.</p>
<p>18. <b>Of Genital Organs.</b>—Incised wounds of penis may
produce fatal hæmorrhage. Removal of testicles may
prove fatal from shock to nervous system. Wounds of
the spermatic cord may be dangerous from hæmorrhage.
Wounds to the vulva are dangerous, owing to hæmorrhage
from the large plexus of veins without valves.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxv_1" id="chapterxv_1"></SPAN>XV.—DETECTION OF BLOOD-STAINS, ETC.</h2>
<p>Stains may require detection on clothing, on cutting
instruments, on floors and furniture, etc. The following
are the distinctive characters of blood-stains:</p>
<p>(<i>a</i>) <b>Ocular Inspection.</b>—Blood-stains on dark-coloured
materials, which in daylight might be easily overlooked,
may be readily detected by the use of artificial light, as
that of a candle, brought near the cloth. Blood-spots
when recent are of a bright red colour if arterial, of a
purple hue if venous, the latter becoming brighter on exposure
to the air. After a few hours blood-stains assume
a reddish-brown or chocolate tint, which they maintain
for years. This change is due to the conversion of
hæmoglobin into methæmoglobin, and finally into
hæmatin. The change of colour in warm weather
usually occurs in less than twenty-four hours. The
colour is determined, not entirely by the age of the stain,
<span class="pagenum"><SPAN name="page31" id="page31">[31]</SPAN></span>
but is influenced by the presence or absence of impurities
in the air, such as the vapours of sulphurous, sulphuric,
and hydrochloric acids. If recent, a jelly-like material
may be seen by the aid of a magnifying-glass lying
between the fibres. If old, a cinnabar-red streak is seen
on drawing a needle across the stain.</p>
<p>(<i>b</i>) <b>Microscopic Demonstration.</b>—With the aid of the
microscope, blood may be detected by the presence of
the characteristic blood-corpuscles. The human blood-corpuscle
is a non-nucleated, biconcave disc, having a
diameter of about 1/3500 of an inch. All mammalian red
corpuscles have the same shape, except those of the
camel, which are oval. The corpuscles of birds, fishes,
reptiles, and amphibians, are oval and nucleated. The
corpuscles of most mammals are smaller than those of
man, but the size of a corpuscle is affected by various
circumstances, such as drying or moisture, so that the
medical witness is rarely justified in going farther than
stating whether the stain is that of the blood of a mammal
or not. Unfortunately, the corpuscles are usually so
dried that little information regarding their size can be
given.</p>
<p>(<i>c</i>) <b>Action of Water.</b>—Water has a solvent action on
blood, fresh stains rapidly dissolving when the material
on which they occur is placed in cold distilled water,
forming a bright red solution. The hæmatin of old
stains dissolves very slowly, so employ a weak solution
of ammonia, and this will give a solution of alkaline
hæmatin. Rust is not soluble in water.</p>
<p>(<i>d</i>) <b>Action of Heat.</b>—Blood-stains on knives may be
removed by heating the metal, when the blood will peel
off, at once distinguishing it from rust. Should the
blood-stain on the metal be long exposed to the air, rust
may be mixed with the blood, when the test will fail.
The solution obtained in water is coagulated by heat, the
colour entirely destroyed, and a flocculent muddy-brown
precipitate formed.<span class="pagenum"><SPAN name="page32" id="page32">[32]</SPAN></span></p>
<p>(<i>e</i>) <b>Action of Caustic Potash.</b>—The solution of blood
obtained in water is boiled, when a coagulum is formed
soluble in hot caustic potash, the solution formed being
greenish by transmitted and red by reflected light.</p>
<p>(<i>f</i>) <b>Action of Nitric Acid.</b>—Nitric acid added to a
watery solution produces a whitish-grey precipitate.</p>
<p>(<i>g</i>) <b>Action of Guaiacum.</b>—Tincture of guaiacum produces
in the watery solution a reddish-white precipitate
of the resin, but on addition of an aqueous solution of
peroxide of hydrogen, or of an ethereal solution of the
same substance (known as <i>ozonic ether</i>), a blue or bluish-green
colour is developed. This test is delicate, and
succeeds best in dilute solutions. It is not absolutely
indicative of the presence of blood, for tincture of
guaiacum is coloured blue by milk, saliva, and pus.</p>
<p>(<i>h</i>) <b>Hæmin Crystals (Teichman's Crystals).</b>—These
are produced by heating a drop of blood, or a watery
solution of it, with a minute crystal of sodium chloride on
a glass slide and evaporating to dryness. A cover-glass
is placed over this, and a drop of glacial acetic acid
allowed to run in. It is again heated until bubbles
appear. Crystals of hæmin may now be detected by the
microscope. They are dark brown or yellow rhombic
prisms.</p>
<p>An improvement on this test is the use of formic acid
alone; on slowly evaporating it, numerous very small
dark crystals are visible if hæmoglobin has been present
(Whitney's test).</p>
<p>(<i>i</i>) <b>Spectroscopic Appearances.</b>—If a solution of a
recent stain be examined by the spectroscope, we get two
absorption bands situated between the lines D and E,
the one nearer E being doubly as broad as the other.
These bands indicate <i>oxyhæmoglobin</i>.</p>
<p>If we now add a little ammonium sulphide to this
solution, we get the spectrum of <i>reduced hæmoglobin</i>,
which is a single broad absorption band situated in the
interval between the preceding oxyhæmoglobin bands.
<span class="pagenum"><SPAN name="page33" id="page33">[33]</SPAN></span>
By shaking the solution, oxyhæmoglobin is again reproduced,
and gives its special absorption bands.</p>
<p>If ammonia be added to the original solution, <i>alkaline
hæmatin</i> is produced, or if acetic acid be chosen, <i>acid
hæmatin</i> is produced, and each gives its appropriate
absorption bands.</p>
<p><i>Methæmoglobin</i> is formed in stains which have been
exposed to the air for a few days, and <i>hæmatin</i> is
found in old stains. <i>Hæmochromogen</i> gives a very
characteristic spectrum, and is obtained by reducing
alkaline hæmatin by ammonium sulphide. <i>Carbon monoxide
hæmoglobin</i> gives a spectrum which resembles that
of oxyhæmoglobin, but it is not reduced by ammonium
sulphide.</p>
<p>(<i>j</i>) <b>Precipitin Test.</b>—This allows us to tell whether
the blood is from a human being or not. A specific
serum must be obtained from a rabbit which is sensitized
as follows: 10 c.c. of human blood is injected into its
peritoneal cavity at intervals, until from three to five injections
have been given. The serum of this animal's
blood will then give a white precipitate only when
brought into contact with dilute solutions of human
blood, but with the blood of no other animal. This is
known also as the 'biologic,' or Uhlenhuth's test.</p>
<p><b>Rust Stains.</b>—These are yellowish-red in colour, and
do not stiffen the cloth. The iron may be dissolved by
placing the stain in a dilute solution of hydrochloric acid,
when, on adding ferrocyanide of potassium, Prussian blue
is produced.</p>
<p><b>Fruit Stains</b> are seldom so dark as blood-stains.
Solutions of these do not change colour or coagulate on
boiling; ammonia changes the colour to blue or green;
acid brightens the original colour, while chlorine
bleaches it.</p>
<p><b>Hairs.</b>—Human hairs must be identified and distinguished
from those of the lower mammals. If the hair
has been pulled out from the root, the microscope will
<span class="pagenum"><SPAN name="page34" id="page34">[34]</SPAN></span>
show that the bulbous root has a concave surface which
fitted over the hair papilla, or that the root is encased in
a fatty sheath.</p>
<p><b>Fibres of Clothing.</b>—Microscopically, wool fibres are
coarse, curly, and striated transversely; cotton fibres
appear as flattened bands twisted into spirals; linen
fibres are round, jointed at frequent intervals, with small
root-like filaments; silk fibres are solid, continuous, and
highly glistening.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxvi_1" id="chapterxvi_1"></SPAN>XVI.—DEATH BY SUFFOCATION</h2>
<p><i>Signs and Symptoms.</i>—There are usually three stages:</p>
<ol>
<li>Exaggerated respiratory activity; air hunger;
anxiety; congested appearance of face; ringing in ears.</li>
<li>Loss of consciousness; convulsions; relaxation of
sphincters.</li>
<li>Respirations feeble and gasping, and soon cease;
convulsions of stretching character; heart continues to
beat for three to four minutes after breathing ceases.</li>
</ol>
<p><i>Post-Mortem Appearances—External.</i>—Cadaveric
lividity well marked; nose, lips, ears, finger-tips almost
black in colour; appearance may be placid or, if asphyxia
has been sudden, the tongue may be protruded
and eyeballs prominent, with much bloody mucus
escaping from mouth and nose.</p>
<p><i>Internal.</i>—The blood is dark and remains fluid; great
engorgement of venous system, right side of heart, great
veins of thorax and abdomen, liver, spleen, etc. Lungs
dark purple in colour; much bloody froth escapes on
squeezing them; mucous lining of trachea and bronchi
congested and bright red in colour; air-cells distended
or ruptured; many small hæmorrhages on surface of
lungs and other organs, as well as in their substance
(<i>Tardieu's spots</i>), due to rupture of venous capillaries
from increased vascular pressure.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page35" id="page35">[35]</SPAN></span></p>
<h2><SPAN name="chapterxvii_1" id="chapterxvii_1"></SPAN>XVII.—DEATH BY HANGING</h2>
<p>In hanging, death occurs by asphyxia, as in drowning.
Sensibility is soon lost, and death takes place in four or
five minutes. The eyes in some cases are brilliant and
staring, tongue swollen and livid, blood or bloody froth
is found about the mouth and nostrils, and the hands are
clenched. In other cases the countenance is placid, with
an almost entire absence of the signs just given. The
mark on the neck, which may be more or less interrupted
by the beard, shows the course of the cord,
which in hanging is obliquely round the neck following
the line of the jaw, but straight round in strangulation.
In judicial hanging, death is not due to asphyxiation,
but, owing to the long drop, the cervical vertebræ are
dislocated, and the spinal cord injured so high up that
almost instant death takes place. On dissection the
muscles and ligaments of the windpipe may be found
stretched, bruised, or torn, and the inner coats of the
carotid arteries are sometimes found divided. In
ordinary suicidal hanging there may be entire absence
of injury to the soft parts about the neck, the length of
the drop modifying these appearances. The mark of
the cord is not a sign of hanging, is a purely cadaveric
phenomenon, and may be produced some hours after
death.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxviii_1" id="chapterxviii_1"></SPAN>XVIII.—DEATH BY STRANGULATION</h2>
<p>This differs from hanging in that the body is not suspended.
It may be effected by a ligature round the
neck, or by direct pressure on the windpipe with the
hand, in which case death is said to be caused by
<i>throttling</i>. Strangulation is frequently suicidal, but may
be accidental. When homicidal, much injury is done
to the neck, owing to the force with which the ligature
is drawn. In throttling, the marks of the finger-nails
are found on the neck.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page36" id="page36">[36]</SPAN></span></p>
<h2><SPAN name="chapterxix_1" id="chapterxix_1"></SPAN>XIX.—DEATH BY DROWNING</h2>
<p>Death by drowning occurs when breathing is arrested
by watery or semi-fluid substances—blood, urine, etc.
The fluid acts mechanically by entering the air-cells of
the lung and preventing the due oxidation of the blood.
The post-mortem appearances include those usually
present in death by asphyxia, together with the following,
peculiar to death by drowning: Excoriations of the
fingers, with sand or mud under the nails; fragments
of plants grasped in the hand; water in the stomach
(this is a vital act, and shows that the person fell into
the water alive); fine froth at the mouth and nostrils;
cutis anserina; retraction of penis and scrotum. On
post-mortem examination, the lungs are found to be
increased in size ('ballooned'); on section, froth, water
mud, sand, in air-tubes. The presence of this fine (often
blood-stained) froth is the most characteristic sign of
drowning. Froth like that of soap-suds in the trachea
is an indication of a vital act, and must not be mistaken
for the tenacious mucus of bronchitis. The presence of
vomited matters in the trachea and bronchi is a valuable
sign of drowning. The blood collects in the venous
system, and is dark and fluid. Tardieu's spots are not
so frequently met with in cases of drowning as in
other forms of asphyxia. The other signs of death by
asphyxia are present. Wounds may be present on the
body, due to falling on stakes, injuries from passing
vessels, etc.</p>
<p>The methods of performing artificial respiration in
the case of the apparently drowned are the following
(the best and most easily performed is Schäfer's prone
pressure method):</p>
<p>1. <i>Schäfer's.</i>—Place the patient on his face, with a
folded coat under the lower part of the chest. Unfasten
the collar and neckband. Go to work at once.
Kneel over him athwart or on one side facing his head.
Place your hands flat over the lower part of his back,
<span class="pagenum"><SPAN name="page37" id="page37">[37]</SPAN></span>
and make pressure on his ribs on both sides, and throw
the weight of your body on to them so as to squeeze
out the air from his chest. Get back into position at
once, but leave your hands as they were. Do this every
five seconds, and get someone to time you with a watch.
Keep this going for half an hour, and when you are tired
get someone to relieve you.</p>
<p>Other people may apply hot flannels to the limbs and
hot water to the feet. Hypodermic injections of 1/50 grain
of atropine, suprarenal or pituitary extracts, may be
found useful.</p>
<p>2. <i>Silvester's.</i>.—In this method the capacity of the
chest is increased by raising the arms above the head,
holding them by the elbows, and thus dragging upon and
elevating the ribs, the chest being emptied by lowering
the arms against the sides of the chest and exerting
lateral pressure on the thorax. The patient is in the supine
position—but first the water must have been drained
from the mouth and nose by keeping the body in the
prone position. The tongue must be kept forward by
transfixing with a pin.</p>
<p>3. <i>Marshall Hall's.</i>—This consists in placing the
patient in the prone position, with a folded coat under
the chest, and rolling the body alternately into the
lateral and prone positions.</p>
<p>4. <i>Howard's.</i>—This consists in emptying the thorax
by forcibly compressing the lower part of the chest;
on relaxing the pressure the chest again fills with air.
Here the patient is placed in the supine position.</p>
<p>The objections to the supine position are that the
tongue falls back, and not only blocks the entrance of
air, but prevents the escape of water, mucus, and froth
from the air-passages.</p>
<p>5. <i>Laborde's Method.</i>—This consists in holding the
tongue by means of a handkerchief, and rhythmically
drawing it out fully at the rate of fifteen times per minute.
This excites the respiratory centre, and this method may
be employed along with any of the other methods.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page38" id="page38">[38]</SPAN></span></p>
<h2><SPAN name="chapterxx_1" id="chapterxx_1"></SPAN>XX.—DEATH FROM STARVATION</h2>
<p>The post-mortem appearances in death from starvation
are as follows: There is marked general emaciation;
the skin is dry, shrivelled, and covered with a brown,
bad-smelling excretion; the muscles soft, atrophied, and
free from fat; the liver is small, but the gall-bladder is
distended with bile. The heart, lungs, and internal
organs are shrivelled and bloodless. The stomach is
sometimes quite healthy; in other cases it may be
collapsed, empty, and ulcerated. The intestines are
also contracted, empty, and translucent.</p>
<p>In the absence of any disease productive of extreme
emaciation (<i>e.g.</i>, tuberculosis, stricture of œsophagus,
diabetes, Addison's disease), such a state of body will
furnish a strong presumption of death by starvation.</p>
<p>In the case of children there is not always absolute
deprivation of food, but what is supplied is insufficient
in quantity or of improper quality. The defence commonly
set up is that the child died either of marasmus
or of tuberculosis.</p>
<p>In cases where it is alleged that a child has been
starved and ill-used, one must examine the body for
signs of neglect—<i>e.g.</i>, dirtiness of skin and hair, presence
of vermin, bruises or skin eruptions. Compare its
weight with a normal child of the same age and sex.
If the disproportion be great and signs of neglect
present, then the probability is great (provided there
be no actual disease present) that the child has been
starved.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxi_1" id="chapterxxi_1"></SPAN>XXI.—DEATH FROM LIGHTNING AND ELECTRICITY</h2>
<p>The signs of death from lightning vary greatly. In
some cases there are no signs; in others the body may
be most curiously marked. Wounds of various characters—contused,
<span class="pagenum"><SPAN name="page39" id="page39">[39]</SPAN></span>
lacerated, and punctured—may be
produced. There may be burns, vesications, and
ecchymoses; arborescent markings are not uncommon.
The hair may be singed or burnt and the
clothing damaged. Rigor mortis is very rapid in its
onset and transient. Post mortem there are no characteristic
signs, but the blood may be dark in colour and
fluid. The presence or absence of a storm may assist
the diagnosis.</p>
<p>Injuries by electrical currents of high pressure are not
uncommon; speaking generally, 1,000 to 2,000 volts will
kill. In America, where electricity is adopted as the
official means of destroying criminals, 1,500 volts is regarded
as the lethal dose, but there are many instances
of persons having been exposed to higher voltages without
bad effects. The alternating current is supposed to
be more fatal than the continuous. Much depends on
whether the contact is good (perspiring hands or damp
clothes). Death has been attributed in these cases to
respiratory arrest or sudden cessation of the heart's
action. The best treatment is artificial respiration, but
the inhalation of nitrite of amyl may prove useful.
Rescuers must be careful that they, also, do not receive
a shock. The patient should be handled with india-rubber
gloves or through a blanket thrown over him.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxii_1" id="chapterxxii_1"></SPAN>XXII.—DEATH FROM COLD OR HEAT</h2>
<p><b>Cold.</b>—The weak, aged, or infants, readily succumb to
low temperatures. The symptoms are increasing lassitude,
drowsiness, coma, with sometimes illusions of
sight. Post mortem, bright red patches are found on
the skin surface, and the blood remains fluid for long.</p>
<p><b>Heat.</b>—Death may result from syncope, the result of
exposure to great heat.</p>
<p><b>Sunstroke.</b>—The person loses consciousness and falls
down insensible; the body temperature may be 112° F.,
<span class="pagenum"><SPAN name="page40" id="page40">[40]</SPAN></span>
the pulse is full, and a peculiar pungent odour is given
off from the skin. Coma, convulsions with (rarely)
delirium, may precede death. <i>Treatment</i> consists in
lowering the body temperature by application of cold
cloths, stimulants, strychnine or digitalin hypodermically.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxiii_1" id="chapterxxiii_1"></SPAN>XXIII.—PREGNANCY</h2>
<p>The signs of the existence of pregnancy are of two
kinds, uncertain and certain, or maternal and fœtal.
Amongst the former class are included—Cessation of
menstruation (which may occur without pregnancy);
morning vomiting; salivation; enlargement of the
breasts and of the abdomen; quickening. It must be
borne in mind that every woman with a big abdomen
is not necessarily pregnant. The tests which afford
conclusive evidence of the existence of a fœtus in the
uterus are—Ballottement, the uterine souffle, intermittent
uterine contractions, fœtal movements, and, above
all, the pulsation of the fœtal heart. The uterine souffle
is synchronous with the maternal pulse; the fœtal heart
is not, being about 120 beats per minute.</p>
<p>Evidence of pregnancy may also be afforded by the
discharge from the uterus of an early ovum, of moles,
hydatids, etc. Disease of the uterus and ovarian dropsy
may be mistaken for pregnancy. Careful examination
is necessary to determine the nature of the condition
present. Pregnancy may be pleaded in bar of immediate
capital punishment, in which case the woman
must be shown to be 'quick with child.' A woman
may also plead pregnancy to delay her trial in Scotland,
and both in England and Scotland, in civil cases, to
produce a successor to estates, to increase damages for
seduction, in compensation cases where a husband has
been killed, to obtain increased damages, etc. A woman
may become pregnant within a month of her last
delivery.<span class="pagenum"><SPAN name="page41" id="page41">[41]</SPAN></span></p>
<p>In cases of rape and suspected pregnancy, it must be
borne in mind that a medical man who examines a
woman under any circumstances against her will renders
himself liable to heavy damages, and that the law will
not support him in so doing. If, on being requested to
permit an examination, the woman refuse, such refusal
may go against her, but of this she is the best judge.
The duty of the medical man ends on making the
suggestion.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxiv_1" id="chapterxxiv_1"></SPAN>XXIV.—DELIVERY</h2>
<p>The signs of recent delivery are as follows: The face
is pale, with dark circles round the eyes; the pulse
quickened; the skin soft, warm, and covered with a
peculiar sweat; the breasts full, tense, and knotty;
the abdomen distended, its integuments relaxed, with
irregular light pink streaks on the lower part. The labia
and vagina show signs of distension and injury. For
the first three or four days there is a discharge from
the uterus more or less sanguineous in character, consisting
of blood, mucus, epithelium, and shreds of membrane.
During the next four or five days it becomes
of a dirty green colour, and in a few days more of a
yellowish, milky, mucous character, continuing for two
to three weeks. The change in character of the lochial
discharge is due to the quantity of blood decreasing and
its place being taken by fatty granules and leucocytes.
The os uteri is soft, patulous, and its edges are torn.
The uterus may be felt for two or three hours above the
pubis as a hard round ball, regaining its normal size in
about eight weeks after delivery. Most of these signs
disappear about the tenth day, after which it becomes
impossible to fix the date of delivery.</p>
<p>In the dead the external parts have the same appearance
as given above. The uterus will vary in appearance
according to the time elapsed since delivery. If death
<span class="pagenum"><SPAN name="page42" id="page42">[42]</SPAN></span>
occurred immediately after delivery, the uterus will be
wide open, about 9 or 10 inches long, with clots of blood
inside, and the inner surface lined by decidua.</p>
<p>The signs of a previous delivery consist in silvery
streaks in the skin of the abdomen, which, however,
may be due to distension from other causes; similar
marks on the breast; circular and jagged condition of
the os uteri (the virgin os being oval and smooth);
marks of rupture of the perineum or fourchette; absence
of the vaginal rugæ; dark-coloured areola round the
nipples, etc. The difference between the virgin <i>corpus
luteum</i> and that of recent pregnancy is not so marked
as to justify a confident use of it for medico-legal
purposes.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxv_1" id="chapterxxv_1"></SPAN>XXV.—FŒTICIDE, OR CRIMINAL ABORTION</h2>
<p>This consists in giving to any woman, or causing to be
taken by her, with intent to procure her miscarriage, any
poison or other noxious thing, or using for the same
purpose any instruments or other means whatsoever. It
is a felony to procure or attempt to procure the miscarriage
of a woman, whether she be pregnant or not,
and it is a felony for the woman, if pregnant, to attempt
to procure her own miscarriage. It is a misdemeanour
for any person or persons to procure drugs or instruments
for a like purpose. It is not necessary that the
woman be <i>quick</i> with child. The offence is the intent to
procure the miscarriage of any woman, <i>whether she be or
be not with child</i>. When from any causes it is necessary
to procure abortion, a medical man should do so only
after consultation with a brother practitioner. Even in
these cases there is no exemption legally. Any medical
man who gives even the most harmless medicine where
he suspects the possibility of pregnancy may render
himself liable to grave suspicion should the woman
abort.<span class="pagenum"><SPAN name="page43" id="page43">[43]</SPAN></span></p>
<p>In medicine, an <i>abortion</i> is said to occur when the
fœtus is expelled before the sixth month; after that it
is <i>premature birth</i>. In law, however, any expulsion of
the contents of the uterus before the full time is an
<i>abortion</i> or <i>miscarriage</i>.</p>
<p>In deciding whether any substance expelled from the
uterus is really a fœtus or a mole, and therefore the
result of conception, or the coat of the uterus, and
unconnected with pregnancy, the examination of the
substances expelled must be carefully made. Moles are
blighted fœtuses. An examination of the woman will
be necessary, though it is not easy during the early
months of pregnancy, and especially in those who have
borne children, to say whether abortion has taken place
or not. The history must be inquired into; the regular
or exceptional use of drugs to promote menstruation is
important, for in the former case no criminal intent may
exist, although pregnancy be present. The state of the
breasts, the hymen, and the os uteri, should all be carefully
examined. Putting a few apparently unimportant
questions as to the frequent use of purgatives, the
presence or absence of constipation, will often assist the
diagnosis as showing that the woman has acted in an
unusual manner. Abortion may be procured by the
introduction of instruments, by falls, violent exercise,
blows on the abdomen, etc. In the hands of ignorant
persons the use of instruments (sounds, bougies, skewers,
etc.) is attended with great danger. Perforation of the
vaginal walls, bladder, cervix, or uterus, may follow their
use. Septic pelvic peritonitis may ensue, and the woman
may lose her life. The person who has employed such
means for inducing abortion is liable to be charged with
the crime of murder. There is no evidence to show
that ergot, savin, bitter-apple, pennyroyal, or any other
drug administered internally, will cause a woman to
abort, except when taken in such large doses that actual
poisoning results, with inflammation of the contents of
<span class="pagenum"><SPAN name="page44" id="page44">[44]</SPAN></span>
the true pelvis. In such cases reflex uterine contractions
may be set up, and abortion may follow. Diachylon
pills are largely employed to induce abortion, and very
often the woman taking them suffers severely from lead-poisoning.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxvi_1" id="chapterxxvi_1"></SPAN>XXVI.—INFANTICIDE</h2>
<p>Infanticide, or the murder of a new-born child, is not
treated as a specific crime, but is tried by the same rules
as in cases of felonious homicide. The term is applied
technically to those cases in which the mother kills her
child at, or soon after, its birth. She is often in such a
condition of mental anxiety as not to be responsible for
her actions. It is usually committed with the object of
concealing delivery, and to hide the fact that the girl has,
in popular language, 'strayed from the paths of virtue.'
The child must have had a separate existence. To constitute
'live birth,' the child must have been alive after its
body was entirely born—that is, entirely outside the
maternal passages—and it must have had an independent
circulation, though this does not imply the severance of
the umbilical cord. Every child is held in law to be
born dead until it has been shown to have been born
alive. Killing a child in the act of birth and before it is
fully born is not infanticide, but if before birth injuries
are inflicted which result in death after birth, it is
murder. Medical evidence will be called to show that
the child was born alive.</p>
<p>The methods of death usually employed are—(1) Suffocation
by the hand or a cloth. (2) Strangulation with
the hands, by a tape or ribbon, or by the umbilical cord
itself. (3) Blows on the head, or dashing the child
against the wall. (4) Drowning by putting it in the privy
or in a bucket of water. (5) Omission: by neglecting
to do what is absolutely necessary for the newly-born
child—<i>e.g.</i>, not separating the cord; allowing it to lie
under the bed-clothes and be suffocated.<span class="pagenum"><SPAN name="page45" id="page45">[45]</SPAN></span></p>
<p>With regard to the question of the maturity of a
child, the differences between a child of six or seven
months and one at full term may be stated as follows:</p>
<p>Between the sixth and seventh month, length of child
10 to 14 inches—that is, the length of the child after the
fifth month is about double the lunar months—weight
1 to 3 pounds; skin, dusky red, covered with downy hair
(lanugo) and sebaceous matter; membrana pupillaris
disappearing; nails not reaching to ends of fingers;
meconium at upper part of large intestine; testes near
kidneys; no appearance of convolutions in brain; points
of ossification in four divisions of sternum.</p>
<p>At nine months, length of child 18 to 22 inches;
weight, 7 to 8 pounds; skin rosy; lanugo only about
shoulders; sebaceous matter on the body; hair on head
about an inch long; testes past inguinal ring; clitoris
covered by the labia; membrana pupillaris disappeared;
nails reach to ends of fingers; meconium at termination
of large intestine; points of ossification in centre of
cartilage at lower end of femur, about 1-1/2 to 2-1/2 lines in
diameter; umbilicus midway between the ensiform
cartilage and pubis.</p>
<p>Owing to the difficulty of proving that the crime of
infanticide has been committed, the woman may in
England be tried for <i>concealment of birth</i>, and in Scotland
for <i>concealment of pregnancy</i>, if she conceal her
pregnancy during the whole time and fail to call for
assistance in the birth. Either of these charges would
only be brought against a woman who had obviously been
pregnant, and now the child is missing or its dead body
has been found. It is expected that every pregnant
woman should make provision for the child about to be
born, and so should have talked about it or have made
clothes, etc., for it. The punishment for concealment is
imprisonment for any term not exceeding two years.
The charge of concealment is very often alternative to
infanticide. To substantiate the charge, however, it
<span class="pagenum"><SPAN name="page46" id="page46">[46]</SPAN></span>
must be proved that there had been a <i>secret disposition of
the dead body</i> of the infant, as well as an endeavour to
conceal its birth.</p>
<p>A woman may be delivered of a child unconsciously,
for the contractile power of the womb is independent of
volition. Under an anæsthetic the uterus acts as
energetically as if the patient were in the full possession
of her senses.</p>
<p>Nowadays a woman is rarely hanged for infanticide,
and it is a mere travesty of justice to pass on her the
death sentence, well knowing that it will never be
executed.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxvii_1" id="chapterxxvii_1"></SPAN>XXVII.—EVIDENCES OF LIVE BIRTH</h2>
<p>The signs of live birth prior to respiration are negative
and positive. A negative opinion may be formed when
evidence is found of the child having undergone intra-uterine
maceration. In this case the body will be flaccid
and flattened; the ilia prominent; the head soft and
yielding; the cuticle more or less detached, and raised
into large bullæ; the skin of a red or brownish-red
colour; the cavities filled with abundant bloody serum;
the umbilical cord straight and flaccid.</p>
<p>A positive opinion is justified when such injuries are
found on the body as could not have been inflicted
during birth, and are attended with such hæmorrhage
as could only have occurred while the blood was circulating.
Fractures of the cranium from accidental
falls (precipitate labour) are as a rule stellate, and are
situated on the vertex or in the parietal protuberance.
The fractures from violence are more extensive,
usually depressed, and accompanied by laceration of the
scalp.</p>
<p>The evidences of live birth after respiration has taken
place are usually deduced from the condition of the
lungs, though indications are also found in other organs.
<span class="pagenum"><SPAN name="page47" id="page47">[47]</SPAN></span>
The diaphragm is more arched before than after respiration,
and rises higher in the thorax in the former case
than in the latter. The lungs before respiration are
situated in the back of the thorax, and do not fill that
cavity; they are of a dark, red-brown colour and of the
consistence of liver, without mottling. After respiration
they expand and occupy the whole thorax, and
closely surround the heart and thymus gland. The
portions containing air are of a light brick-red colour,
and crepitate under the finger. The lungs are mottled
from the presence of islands of aerated tissue, surrounded
by arteries and veins. The weight of the lungs before
respiration is about 550 grains, after an hour's respiration
900 grains; but this test is of little value. The
ratio of the weight of the lungs to that of the body
(Ploucquet's test), which is also unreliable, is, before
respiration, about 1 to 70; after, 1 to 35. Lungs in
which respiration has taken place float in water; those
in which it has not, sink. There are exceptions to this
rule, on which, however, is founded the <i>hydrostatic test</i>.
As originally performed, this test consisted merely in
placing the lungs, with or without the heart, in water,
and noticing whether they sank or floated. The test is
now modified by squeezing, and by cutting the lungs up
into pieces.</p>
<p>The objections to the test as originally performed
are—(1) That the lungs may sink as the result of disease—<i>e.g.</i>,
double pneumonia. (2) That respiration may
have been so limited in extent that the lungs may sink,
owing to large portions of lung tissue remaining unexpanded
(<i>atelectasis</i>). (3) Putrefaction may cause the
lungs to float when respiration has not taken place.
(4) The lungs may have been inflated artificially. Few
of these objections apply, however, when the hydrostatic
test, modified by pressure, is employed. To take these
objections in detail, it may be stated: (1) If the lungs
sink from disease, the question of live birth is answered.
<span class="pagenum"><SPAN name="page48" id="page48">[48]</SPAN></span>
(2) This objection is too refined for practical use. The
lungs sink, there is an absence of any of the signs of
suffocation, and the matter ends. The examiner has only
to describe the conditions which he finds, and is not
required to indulge in conjectures as to the amount of
respiration which may or may not have taken place.
(3) Gas due to putrefaction collects under the pleural
membrane, and can be expelled by pressure, and is not
found in the air cells. The lungs decompose late, hence
in a fresh body putrefaction of the lungs is absent; in a
putrefied child, if the lungs sink, it must have been stillborn.
The so-called <i>emphysema pulmonum neonatorum</i>
is simply incipient putrefaction.</p>
<p>The lung test simply shows that the child has
breathed, but affords no proof that the child has been
born alive. The child may have breathed as soon as its
head protruded, the rest of the body being in the
maternal passages. The child is not born alive until it
has been completely expelled, although it is not necessary
that the umbilical cord should have been cut.</p>
<p>In addition to these tests, live birth may be suspected
from the following conditions: The <i>stomach</i> may contain
milk or food, recognized by the microscope and by
Trommer's test for sugar; the <i>large intestines</i> in stillborn
children are filled with meconium, in those born alive
they are usually empty; the <i>bladder</i> is generally emptied
soon after birth; the <i>skin</i> is in a condition of exfoliation
soon after birth. The <i>organs of circulation</i> undergo the
following changes after birth, and the extent to which
these changes have advanced will give an idea of how
long the child has lived: The <i>ductus arteriosus</i> begins to
contract within a few seconds of birth; at the end of a
week it is about the size of a crow quill, and about the
tenth day is obliterated. The <i>umbilical arteries and
vein</i>: the arteries are remarkably diminished in calibre
at the end of twenty-four hours, and obliterated almost
up to the iliacs in three days; the umbilical vein and the
<span class="pagenum"><SPAN name="page49" id="page49">[49]</SPAN></span>
ductus venosus are generally completely contracted by
the fifth day. The <i>foramen ovale</i> becomes obliterated at
extremely variable periods, and may continue open even
in the adult.</p>
<p>Importance of late has been attached to the <i>stomach-bowel
test</i>. If the stomach and duodenum contain air,
and consequently float in water, the chances are that the
child did not die immediately after birth; this is known
as Breslau's second life test, and the lower the air in the
intestinal canal, the greater is the probability that the
child survived birth.</p>
<p>The umbilical cord in a new-born child is fresh, firm,
round, and bluish in colour; blood is contained in its
vessels. The cord may be ruptured by the child falling
from the maternal parts in a precipitate labour, and the
ruptured parts present ragged ends. It is seldom that a
child bleeds to death from an untied or cut umbilical
cord, and the chances in a torn cord are still more
remote. The changes in the cord are as follows: First
it shrinks from the ligature towards the navel; this
change may begin early, and is rarely delayed beyond
thirty hours; the cord becomes flabby, and there is a
distinct inflammatory circle round its insertion. The
next change is that of desiccation or mummification;
the cord becomes reddish-brown, then flattened and
shrivelled, then translucent and of the colour of parchment,
and falls off about the fifth day. The third stage,
that of cicatrization, then ensues about the tenth to the
twelfth day. The bright red rim round the insertion of
the cord, with inflammatory thickening and slight purulent
secretion, may be considered as evidence of live
birth, and the stage at which the separation of the cord
by ulcerative process has arrived will point to the
probable duration of time the child has existed after
birth.</p>
<p>There are many fallacies in the application of any of
these tests, and the whole subject bristles with difficulties.
<span class="pagenum"><SPAN name="page50" id="page50">[50]</SPAN></span>
The medical witness would do well to exhibit a cautious
reserve, for if the child dies immediately after birth it is
almost impossible to prove that it was born alive.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxviii_1" id="chapterxxviii_1"></SPAN>XXVIII.—CAUSE OF DEATH IN THE FŒTUS</h2>
<p>The death of the fœtus may be due to—(1) Immaturity
or intra-uterine malnutrition, or simply from deficient
vitality; (2) complications occurring during or immediately
after birth, which may either be unavoidable or
inherent in the process of parturition, or may be induced
with criminal intent.</p>
<p>In the latter category come such accidents as the
pressure of tumours in the pelvic passages, or disease of
the bones in the mother, or pressure on the cord from
malposition of the child during labour, asphyxiation
from the funis being twisted tightly round the neck or
limbs, or from injuries due to falls on the floor in sudden
labours. Where the death of the fœtus has been induced
with criminal intent, it may be due to punctured wounds
of the fontanelles, orbits, heart, or spinal marrow; dislocation
of the neck; separation of the head from the
body; fracture of the bones of the head and face;
strangulation; suffocation; drowning in the closet pan
or privy, or from being thrown into water.</p>
<p>Under the head of infanticide by <i>commission</i>, we have
injuries of all kinds; under infanticide by <i>omission</i>,
neglecting to tie the cord, allowing it to be suffocated
by discharges in the bed, neglect to provide food,
clothes, and warmth, for the new-born child.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxix_1" id="chapterxxix_1"></SPAN>XXIX.—DURATION OF PREGNANCY</h2>
<p>The natural period of gestation is considered as forty
weeks, ten lunar months, or 280 days. A medical witness
would have to admit the possibility of gestation being
prolonged to 300 days, and if this time were not very
<span class="pagenum"><SPAN name="page51" id="page51">[51]</SPAN></span>
materially exceeded it would be well to give the woman
the benefit of the doubt. It may be mentioned that
300 days is the extreme limit fixed by the French and
Scottish law. No fixed period is assigned in English or
American law to the duration of pregnancy, though it is
allowed that utero-gestation may be greatly prolonged.
In a recent case decided, the Lord Chancellor accepted
a case where it was alleged pregnancy had extended to
331 days. A child only five months old may live, for
a short time at all events. There is considerable difficulty
in many cases in fixing the date of conception.
The data from which it is calculated are the following:
(1) <i>Peculiar sensations attending conception</i>, which are
not sufficiently defined to be recognized by those conceiving
for the first time. (2) <i>Cessation of the catamenia.</i>
Other causes may, however, cause this; and, on the
other hand, a woman may menstruate during the whole
period of her pregnancy. This datum also gives a
variable period, and may involve an error of several
days or a month, for the menses may be arrested by
cold, etc., at one monthly period, and the woman become
pregnant before the next. (3) <i>The period of quickening.</i>
This, when perceived (which is not always the case),
also occurs at variable periods from the tenth to the
twenty-sixth week. (4) <i>A single coitus.</i> This does not,
however, correspond to the time of fertilization. Several
days may elapse before the spermatozoa meet with an
ovum and fertilize it.</p>
<p>In Scotland a child born six months after marriage
is legitimate, which is allowing an ample margin.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxx_1" id="chapterxxx_1"></SPAN>XXX.—VIABILITY OF CHILDREN</h2>
<p>A child may be born alive, but may not be viable, by
which is meant that it is not endowed with a capacity of
maintaining its life. Speaking generally, 180 days represents
<span class="pagenum"><SPAN name="page52" id="page52">[52]</SPAN></span>
the lowest limit at which a child is viable, but prolonged
survival under these circumstances is the exception.
Many cases, however, have been recorded in which
children born at six months have been reared. The
signs of immaturity and maturity may be thus tabulated:</p>
<table summary="signs of immaturity and maturity">
<tr><td align="center"><span class="smcap">Immaturity.</span></td><td></td>
<td align="center"><span class="smcap">Maturity.</span></td></tr>
<tr><td style="width: 50%;" >
Centre of body high; head
disproportionate in size; membrana
pupillaris present; testicles
undescended; deep red colour of
parts of generation; intense red
colour, mottled appearance, and
downy covering, of skin; nails not
formed; feeble movements;
inability to suck; necessity for
artificial heat; almost unbroken
sleep; rare and imperfect
discharges of urine and meconium;
closed state of mouth, eyelids,
and nostrils.</td>
<td></td>
<td>
Strong movements and cries as soon
as born; body clear, red colour,
coated with sebaceous matter; mouth,
nostrils, eyelids, and ears, open;
skull somewhat firm, and fontanelles
not far apart; hair, eyebrows, and
nails, perfectly developed;
testicles descended; free discharge
of urine and meconium; power of
suction, indicated by seizure on the
nipple or a finger placed in the
mouth.</td>
</tr>
</table>
<hr class="shorter" />
<h2><SPAN name="chapterxxxi_1" id="chapterxxxi_1"></SPAN>XXXI.—LEGITIMACY</h2>
<p>A child born in wedlock is presumed to have the
mother's husband for its father. This may, however, be
open to question upon the following grounds: Absence
or death of the reputed father; impotence or disease in
the husband preventing matrimonial intercourse; premature
delivery in a newly-married woman; want of
access; and the marriage of the woman again immediately
on the death of her husband. In the last case,
where either husband might have been the father, the
child at the age of twenty-one is at liberty to select its
father from the possible pair.</p>
<p>A child born of parents before marriage is in Scotland
rendered legitimate by their subsequent marriage, but
in England the offspring remains illegitimate whether
the parents marry or not after its birth. The offspring
<span class="pagenum"><SPAN name="page53" id="page53">[53]</SPAN></span>
of voidable or invalid marriages may be made legitimate
by application to the courts.</p>
<p>There is a difference between being legitimate and
lawfully begotten. A child born in wedlock is legitimate,
but if the parents were married only a week
previously it could not have been lawfully begotten.</p>
<p>The Acts and rulings relating to Marriage and Legitimacy
are extremely complicated. It is not putting it too
strongly to say that a very large number of people in
this country who believe themselves to be legally married
are not married at all, and that thousands of children
who have not the slightest doubt as to their legitimacy
are in the eyes of the law bastards.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxii_1" id="chapterxxxii_1"></SPAN>XXXII.—SUPERFŒTATION</h2>
<p>By superfœtation is meant the conception, by a woman
already pregnant, of a second embryo, resulting in the
birth of two children at the same time, differing much
in their degree of maturity, or in two separate births,
with a considerable interval between. The possibility
of the occurrence of superfœtation has been doubted,
but there are well-authenticated cases which countenance
the theory of a double conception. It has been
shown that the os uteri is not closed, as was once supposed,
immediately <i>on conception</i>. Should an ovum
escape into the uterus, it may become impregnated a
month or so after a previous conception. The most
probable explanation is that the case has been one of
twins, one being born prematurely; or, on the other
hand, the uterus may have been double, and conception
may have taken place in one cornu at a later period
than in the other cornu.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page54" id="page54">[54]</SPAN></span></p>
<h2><SPAN name="chapterxxxiii_1" id="chapterxxxiii_1"></SPAN>XXXIII.—INHERITANCE</h2>
<p>In order to inherit, the child must be born alive, must
be born during the lifetime of the mother, and must be
born capable of inheriting—that is to say, monsters are
incapable of inheriting. There is a mode of inheritance
called 'tenancy by courtesy.' When a man marries a
woman possessed of an estate or inheritance, and has,
by her, issue born alive in her lifetime capable of inheriting
her estate, in this case he shall, on the death of
his wife, hold the lands for his life as tenant by the
courtesy of England. The meaning of the words 'born
alive' in this instance is not the same as in cases of
infanticide. In Civil law any motion of the child's body,
however slight, or the fact of it having been heard to
cry by witnesses, is held to be sufficient proof of the
child having been born alive. It may die immediately
afterwards, and it is not necessary that the child be
viable.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxiv_1" id="chapterxxxiv_1"></SPAN>XXXIV.—IMPOTENCE AND STERILITY</h2>
<p>In the male, impotence may arise from physical or
mental causes. The physical causes may be—too great or
too tender an age; malformation of the genital organs;
<i>crypsorchides</i>, defect or disease in the testicles; constitutional
disease (diabetes, neurasthenia, etc.); or debility
from acute disease, as mumps. Masturbation, and early
and excessive sexual indulgence, are also causes. The
mental causes include—passion, timidity, apprehension,
aversion, and disgust. The case will be remembered of
the man who was impotent unless the lady were attired
in a black silk dress and high-heeled French kid boots.</p>
<p>If a man is impotent when he marries, the marriage
may be set aside on the ground that it had never been
consummated. The law requires that the impotency
should have existed <i>ab initio</i>—that is, before marriage—and
<span class="pagenum"><SPAN name="page55" id="page55">[55]</SPAN></span>
should be of a permanent or incurable nature; marriage,
as far as the law goes, being regarded as a contract
in which it is presupposed that both the contracting
parties are capable of fulfilling all the objects of marriage.
In the case of the Earl of Essex the defendant
admitted the charge as regards the Countess, but pleaded
that he was not impotent with others, as many of her
waiting-maids could testify. When a man becomes
impotent <i>after</i> marriage, his wife must accept the situation,
and has no redress. A man may be <i>sterile</i> without
being impotent, but the law will not take cognizance of
that. The wife may be practically impotent, but the
law will not assist the husband. He must continue to
do his best under difficult circumstances. In former
times in case of doubt a husband was permitted to
demonstrate his competency in open court, but this
custom is no longer regarded with favour by the judges.</p>
<p>The removal of the testicles does not of necessity
render a man impotent, although it deprives him of his
procreative power. Eunuchs are capable of affording
illicit pleasure, whilst the male sopranos, or <i>castrati</i>, are
often utilized for that purpose.</p>
<p>In the female, impotence may be caused by the narrowness
of the vagina, adhesion of the vulva, absence of
vagina, imperforate hymen, and tumours of the vagina.</p>
<p>Sterility in women may occur from the above-named
causes of impotence, together with absence of the uterus
and ovaries, or from great debility, syphilis, constant
amenorrhœa, dysmenorrhœa, or menorrhagia.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxv_1" id="chapterxxxv_1"></SPAN>XXXV.—RAPE</h2>
<p>Rape is the carnal knowledge of a woman by force
and against her will. The resistance of the woman
<i>must be</i> to the utmost of her power, but if she yield
through fear or duress it is still rape. The woman is a
competent witness, but her statements may be impugned
<span class="pagenum"><SPAN name="page56" id="page56">[56]</SPAN></span>
on the ground of her previous bad character, and evidence
may be called to substantiate the charge. The
perpetrator must be above the age of fourteen years.</p>
<p>The definition of rape which we have given is not
altogether satisfactory. Take, for example, the case of
a woman who goes to bed expecting her husband to
return at a certain hour. The lodger, let us say, takes
advantage of this fact, and, getting into bed, has connection
with her, she not resisting, assuming all the
while that it is her husband. This is rape, but it is not
'by force,' and it is not 'against her will,' but it is
'without her consent,' as she has not been fully informed
as to all the circumstances of the case.</p>
<p>In all cases of rape in which there is no actual resistance
or objection, consent may be assumed. It is not
essential that the woman should state in so many words
that she does not object. The force used may be moral
and not physical—<i>e.g.</i>, threats, fear, horror, syncope.</p>
<p>By 48 and 49 Vict., c. 49, the carnal knowledge of
a girl under thirteen is technically rape. The consent
of the girl makes no difference, since she is not of an
age to become a consenting party.</p>
<p>An attempt at carnal knowledge of a girl under
thirteen is a misdemeanour. Her consent makes no
difference, and even the solicitation of the act on the
part of the child will not exonerate the accused.</p>
<p>Intercourse with a girl between thirteen and sixteen,
even with her consent, is a misdemeanour.</p>
<p>This Act is a favourite with the blackmailer. The
child is sent out to solicit, dressed like a woman, but
appears in the witness-box in a much more juvenile
costume.</p>
<p>To constitute rape there must be <i>penetration</i>, but this
may be of the slightest. There may be a sufficient
degree of penetration to constitute rape without rupturing
the hymen. Proof of actual emission is now
unnecessary.<span class="pagenum"><SPAN name="page57" id="page57">[57]</SPAN></span></p>
<p>The subject of carnal knowledge (C.K.) or its attempt
may be summed up as follows:</p>
<table cellpadding="3" summary="carnal knowledge or its attempt">
<tr><td>Under thirteen</td><td>C.K.</td><td>Felony.</td></tr>
<tr><td>Under thirteen</td><td>Attempt</td><td>Misdemeanour.</td></tr>
<tr><td align="center" colspan="3">Consent no defence.</td></tr>
<tr><td>From thirteen to sixteen</td><td>C.K.</td><td>Misdemeanour.</td></tr>
<tr><td>From thirteen to sixteen</td><td>Attempt</td><td>Misdemeanour.</td></tr>
<tr><td align="center" colspan="3">Consent and even solicitation no defence.</td></tr>
<tr><td align="center" colspan="3">Reasonable cause to believe the girl over sixteen is a good defence.</td></tr>
<tr><td align="center" colspan="3">Charge must be brought within three months.</td></tr>
<tr><td>Over sixteen</td><td>C.K. with consent</td><td>Nil.</td></tr>
<tr><td align="center" colspan="3">Subject to civil action for loss of girl's services by father.</td></tr>
<tr><td>Idiot or imbecile</td><td>C.K. with violence</td><td>Rape.</td></tr>
<tr><td>Idiot or imbecile</td><td>C.K. without violence</td><td>Misdemeanour.</td></tr>
<tr><td>Personation of husband</td><td></td><td>Rape.</td></tr>
<tr><td align="center" colspan="3">Tacit consent no defence, for obtained by fraud.</td></tr>
<tr><td>Married woman</td><td>C.K. with consent</td><td> Adultery.</td></tr>
<tr><td>Mother, sister, daughter, grand-daughter</td>
<td>C.K. consent immaterial; born in wedlock or not</td><td>Incest.</td></tr>
<tr><td>Females</td><td>Indecent assaults</td><td>Misdemeanour.</td></tr>
</table>
<p>It is a misdemeanour to give to a woman any drug so
as to stupefy her, and so enable any person to have
unlawful connection with her.</p>
<p>False charges of rape are very often made. The
motive may be to extort blackmail, revenge, or mere
delusion. On examining such cases bruises are seldom
found, but scratches which the woman has made on the
front of her body may be discovered, and the local
injuries to the generative organs are slight, if present
at all.</p>
<p><i>Physical Signs.</i>—In the adult the hymen may be
ruptured, the fourchette lacerated, and blood found on
the parts, together with scratches and other marks and
signs of a struggle. In the child there may be no
hæmorrhage, but there will be indications of bruising
on the external organs, with probably considerable
laceration of the hymen, the laceration in some cases
extending into the rectum. Severe hæmorrhage, and
even death, may follow the rape of a young child. The
patient will have difficulty in walking, and in passing
<span class="pagenum"><SPAN name="page58" id="page58">[58]</SPAN></span>
water and fæces. After some hours the parts are very
tender and swollen, and a sticky greenish-yellow discharge
is present. These signs last longer in children
than in adults; but as a rule—in the adult, at least—all
signs of rape disappear in three or four days. Young
and delicate children may suffer from a vaginal discharge,
with swelling of the external genitals, simulating
an attempt at rape. Infantile leucorrhœa is common,
and many innocent people have been exposed to danger
from false charges of rape on children, instituted as a
means of levying blackmail. A knowledge of these facts
suggests the necessity of giving a guarded opinion when
children are brought for examination in suspected cases.
Pregnancy may follow rape.</p>
<p><i>Seminal stains</i> render the clothing stiff and greyish-yellow
in colour, with translucent edges. On being
moistened they give the characteristic seminal odour.</p>
<p>Semen may be found on the linen of the woman and
man, and will be recognized under the microscope by
the presence in it of spermatozoa, minute filamentary
bodies with a pear-shaped head; but it must not be forgotten
that the non-detection of spermatozoa is no proof
of absence of sexual intercourse, for these bodies are
not always present in the semen of even healthy adult
young men. Spermatozoa must not be mistaken for
the <i>Trichomonas vaginæ</i> found in the vaginæ of some
women. The latter have cilia surrounding the head,
which is globular.</p>
<p><i>Florence's Micro-Chemical Test for Spermatic Fluid.</i>—If
a drop of the fluid obtained by wetting a supposed
spermatic stain be mixed with a drop of the following
solution (KI, parts 1.65; pure iodine, 2.54; distilled
water, 30) in a watch-glass, brownish-red pointed
crystals resembling hæmin crystals are obtained.</p>
<p><i>Barberio's Test.</i>—Mix a drop of the spermatic stain
with a drop of a saturated solution of picric acid, when
needle-shaped yellow rhombic crystals are formed.
<span class="pagenum"><SPAN name="page59" id="page59">[59]</SPAN></span></p>
<p><i>Gonorrhœal Stains.</i>—A cover-glass preparation stained
with methylene blue reveals the gonococci lying in pairs
within the leucocytes.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxvi_1" id="chapterxxxvi_1"></SPAN>XXXVI.—UNNATURAL OFFENCES</h2>
<p>Trials for <b>sodomy</b> and <b>bestiality</b> are common at the
assizes, but, as they are rarely reported, they fail to attract
attention. Sodomy is a crime both in the active and
passive agent, unless the latter is a non-consenting party.
The evidence of either associated may be received as
against his colleague. If the crime is committed on a
boy under fourteen, it is a felony in the active agent only.
As in cases of rape, emission is not essential, and penetration,
however slight, answers all practical purposes.</p>
<p>There can be no doubt that in the majority of these
cases there exists a congenitally abnormal condition of
the sexual instinct, these individuals from their childhood
manifesting a perverted sexual instinct. The man is
physically a man, but psychically a woman, and <i>vice versâ</i>.
The tendency nowadays is not to charge these people
with the more serious offence, but to deal with them under
Section 11 of the Criminal Law Amendment Act, 1885
(48 and 49 Vict., c. 69). This section, which is sufficiently
comprehensive, runs as follows: 'Any male person
who in public or private commits or is a party to the
commission, or attempts to procure the commission by
any male person, of any act of gross indecency with
another male person, shall be guilty of a misdemeanour.'
The penalty is imprisonment for two years, with or
without hard labour. It is provided by Section 4 of the
same Act that a boy under sixteen may be whipped.</p>
<p><b>Incest.</b>—This crime is dealt with under the Punishment
of Incest Act, 1908 (8 Edward VII., c. 45). Carnal
knowledge with mother, sister, daughter, or grand-daughter,
is a misdemeanour, provided the relationship
is known. It also applies to the half-brother and half-sister.
<span class="pagenum"><SPAN name="page60" id="page60">[60]</SPAN></span>
It is equally an offence whether the relationship
can or cannot be traced through lawful wedlock. Consent
is no defence. A woman may be charged under the
Act if she, being above the age of sixteen, with consent
permits her grandfather, father, brother, or son, to have
carnal knowledge of her.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxvii_1" id="chapterxxxvii_1"></SPAN>XXXVII.—BLACKMAILING</h2>
<p>There are in London and every large city scores of
men and women who live by blackmailing or chantage.
There are many different forms of this industry. There
is the man who knows something about your past life,
which he threatens to reveal to your friends or colleagues
unless you buy him off. There is the breach-of-promise
blackmailer, and there is the female patient, who
threatens to charge you with improper conduct or
indecent assault. Medical men from their position are
often selected as victims. The introduction of corridor
carriages on many of our railways has done much to
stamp out one particular form of blackmailing, but
public urinals are still a source of danger.</p>
<p>It is the worst possible policy to temporize with a
blackmailer. If you give him a single penny, you are
his for life. It is as well to remember that it is just as
criminal to attempt to extract money from a guilty as
from an innocent person. It is of no use attempting to
deal with these cases single-handed. You must not only
deny the allegation, but 'spurn the allegator.' Put the
matter into the hands of a good sharp criminal solicitor,
and instruct him to rid you of the nuisance by taking
criminal proceedings.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxviii_1" id="chapterxxxviii_1"></SPAN>XXXVIII.—MARRIAGE AND DIVORCE</h2>
<p>Marriage may be accomplished in many ways: (1) By
the publication of banns; (2) by an ordinary licence;
(3) by a special licence; (4) by the Superintendent-Registrar's
<span class="pagenum"><SPAN name="page61" id="page61">[61]</SPAN></span>
licence; (5) by a special licence granted by
the Archbishop of Canterbury in consideration of the
payment of the sum of £25. Then, for persons having
a domicile in Scotland, there is the marriage by repute.
The consent of the parties, which is the essence of the
contract, may be expressed before witnesses, and it is
not requisite that a clergyman should assist, but it is
essential that the expressions of consent must be for a
matrimonial intent. 'Habit and repute' constitute good
evidence, but the repute must be the general, constant,
and unvarying belief of friends and neighbours. The
cohabitation must be in Scotland.</p>
<p>Any irregularity in the marriage ceremony or the non-observance
of any formality will not invalidate the
marriage, unless it were known to both the contracting
parties. If a man were married in a wrong name the
contract would still be valid if the wife were unacquainted
with the deception at the time. If the person who
officiated were a bogus clergyman, the marriage would
hold good if the contracting parties supposed him to
be a properly ordained priest. In a case in which a
marriage was solemnized in a building near the church
at a time when the church was undergoing repairs, and
where during such alterations Divine service had been
performed, it was held that the ceremony was good.
To all intents and purposes marriage comes under the
'Law of Contract' (see Anson, W.R., Bart.), and the
law looks to the <i>intention</i> rather than to the actual
details. All marriages between persons within the
prohibited degrees of consanguinity or affinity are null
and void. This prohibition extends both to the illegitimate
as well as the legitimate children of the late wife's
or husband's parents. A marriage with a deceased
wife's sister is now legal in Great Britain and the
Colonies, and is recognized in most foreign countries.
A common device with people within the prohibited
degrees is to get married abroad, but such marriage is
<span class="pagenum"><SPAN name="page62" id="page62">[62]</SPAN></span>
strictly speaking inoperative, and the children of such
union are illegitimate. Practically, however, it is a
matter of no importance, for when people live together
and say they are married, they are accepted at their
own estimate.</p>
<p>A man can obtain a divorce from his wife if he can
prove that she has been guilty of adultery since her
marriage. This may be established by inference.
Obviously, it is difficult in the majority of cases to
establish by ocular demonstration that adultery has been
committed. But given evidence of familiarity and affection
with opportunity and suspicious conduct, a jury will
commonly infer it.</p>
<p>A woman cannot obtain a divorce from her husband
for adultery alone. She must prove adultery plus
cruelty, or adultery plus desertion without reasonable
cause. Failing this, she may be able to prove either
bigamy or incestuous adultery. Legal cruelty is a very
comprehensive term, and does not of necessity mean
physical violence. If the husband as the result of his
infidelity were to give his wife a contagious disease,
that would constitute cruelty. Taking a more extreme
case, if a husband were to have connection in her house
with his wife's maid, that would probably be held to constitute
cruelty, as it would tend to lower her in the eyes
of her servants.</p>
<p>A wife can obtain a judicial separation if she can prove
(1) adultery, (2) cruelty, or (3) desertion without reasonable
cause for two years. If a husband is away on his
business, as, for example, the case of an officer ordered
abroad, that is not desertion. For a woman to get a
judicial separation, it is sufficient if she can prove one
variety of matrimonial offence, but for a divorce she
requires more than one.</p>
<p>The jury may find that Mrs. A. has committed
adultery with Mr. B., but that Mr. B. has not committed
adultery with Mrs. A. The explanation is, that a wife's
<span class="pagenum"><SPAN name="page63" id="page63">[63]</SPAN></span>
confession is evidence against herself, but not against
another person. You can confess your own sins, but not
another's.</p>
<p>The Divorce Law of Scotland differs materially from
that of England. In Scotland there is no decree nisi,
no decree absolute, and no intervention by the King's
Proctor. Instead there is a single and final judgment,
and when a decree of divorce is pronounced the successful
litigant at once succeeds to all rights, legal and conventional,
that would have come to him or her on the
death of the losing party. If the husband is the offender,
the wife in such circumstances may claim her right to
one-third of his real estate; and if there are children, to
one-third of his personal property, and to one-half if there
are none.</p>
<p><b>Voidable Marriages.</b>—If a man and woman go through
the marriage ceremony, such a contract is null and void
under the following circumstances: (1) Where bigamy
has been committed; (2) if one of the parties were
insane at the time of marriage; (3) where the plaintiff is
under sixteen years of age; (4) when the marriage has
not been consummated or followed by cohabitation;
(5) when one of the parties was incapable of performing
the marital act (impotent, and such not known by the
other at the time); (6) when drunkenness had been
induced so as to obtain consent; (7) concealment of
pregnancy at the time of marriage.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxix_1" id="chapterxxxix_1"></SPAN>XXXIX.—FEIGNED DISEASES</h2>
<p>Malingering in its various forms is by no means
uncommon, and by many is regarded as a disease in
itself. It is necessary, however, to distinguish between
those cases in which it is feigned for some definite
purpose—for example, to escape punishment or avoid
public service—and those in which there is adequate
motive, and the patient shams simply with the view of
<span class="pagenum"><SPAN name="page64" id="page64">[64]</SPAN></span>
exciting sympathy, or from the mere delight of giving
trouble. It is not uncommon for individuals summoned
on a jury, or to give evidence in the law courts, to apply
to their doctor for a certificate, assigning as a cause of
exemption neuralgia, or some similar complaint unattended
with objective symptoms. In such cases it is
well to remind the patient that in most courts such
certificates are received with suspicion, and are often
rejected, and that the personal attendance of the medical
man is required to endorse his certificate on oath.</p>
<p>Malingering has become much more common since
the National Health Insurance Act has been passed. The
possibility of obtaining a fair sum each week without the
necessity of working for it induces many persons either
to feign disease or to make recovery from actual disease
or accident much more tedious than it ought really
to be.</p>
<p>The feasibility of successfully malingering is greatly
enhanced by the possession of some chronic organic
disease. An old mitral regurgitant murmur is useful for
this purpose.</p>
<p>It is not flattering to one's vanity to overlook a case
of malingering, but should this occur little harm is
done. It is a much more serious matter to accuse a
person of malingering when in reality he may be suffering
from an organic disease.</p>
<p>Here are some of the diseases which are most
frequently feigned:</p>
<p><b>Nervous Diseases</b>, as headache, vertigo, paralysis of
limbs, vomiting, sciatica, or incontinence or suppression
of urine, spitting of blood; others, again, simulate
hysteria, epilepsy, or insanity.</p>
<p>On the other hand, the malingerer may actually
produce injuries on his person either to excite commiseration
or to escape from work. Thus, the beggar
produces ulcers on his legs by binding a penny-piece
tightly on for some days; the hospital patient, in order
<span class="pagenum"><SPAN name="page65" id="page65">[65]</SPAN></span>
to escape discharge, produces factitious skin diseases by
the application of irritants or caustics.</p>
<p>It is much more difficult to decide whether certain
symptoms are due to a real disease which is present, or
whether they are merely exaggerations of slight symptoms
or simulations of past ones. The miner, after an
injury to his back, recovers very slowly, if at all. He is
suffering from 'traumatic neurasthenia'—a condition
only too often simulated, and a disease very difficult to
diagnose accurately. The miner takes advantage of our
ignorance, and continues to draw his compensation. A
workman during his work receives a fracture; instead
of being able to resume work in six weeks, he asserts
that the pain and stiffness prevent him, and this disability
may persist for months. Such cases as these
frequently come before the courts when the employer
has discontinued to pay the weekly compensation for
the injury. Medical men are called to give evidence for
or against the injured workman.</p>
<p><b>Epilepsy</b> is often simulated. The foaming at the
mouth is produced by a piece of soap between the
gums and the cheek. The true epileptic, especially if
he suspects that a fit is imminent, takes his walks abroad
in some secluded spot, whilst the impostor selects a
crowded locality for his exertions. The epileptic often
injures himself in falling, his imitator never; one bites
his tongue, but the other carefully refrains from doing
so. The skin of an epileptic during an attack is cold
and pallid, but that of the exhibitor is covered with
sweat as the result of his exertions. In epilepsy the
urine and fæces are passed involuntarily, but his colleague
rarely considers it necessary to carry his deception
to this extent. In true epilepsy the eyes are partly
open, with the eyeballs rolling and distorted, whilst the
pupils are dilated and do not contract to light; the
impostor keeps his eyes closed, and he cannot prevent
the iris from contracting when a bicycle-lamp is flashed
<span class="pagenum"><SPAN name="page66" id="page66">[66]</SPAN></span>
across his face. A useful test is to give the impostor a
pinch of snuff, which promptly brings the entertainment
to an end.</p>
<p><b>Lumbago</b> is often feigned, and the imposture should
be suspected when there is a motive, and when physical
signs, such as nodes and tender spots, are absent. A
simple test is to inadvertently drop a shilling in front of
him, when he will promptly stoop and pick it up. The
same principles apply to spurious sciatica.</p>
<p><b>Hæmorrhages</b> purporting to come from the lungs,
stomach, or bowels, rarely present much difficulty. The
microscope is of use in all cases of bleeding. Possibly
the gums or the inside of the cheeks may have been
scratched or abraded with a pin.</p>
<p><b>Skin Diseases</b> are excited artificially, especially those
which may be produced by mechanical and chemical
irritants. The most commonly employed are vinegar,
acetic acid, carbolic acid, nitric acid, and carbonate of
sodium; but tramps frequently use sorrel and various
species of ranunculus. The lesions simulated are usually
inflammatory in character, such as erythema, vesicular
and bullous eruptions, and ulceration of the skin. They
may be complicated by the presence of pediculi and
other animal and vegetable parasites. Chromidrosis of
the lower eyelids in young women often owes its origin
to a box of paints. Factitious skin diseases are seen
most commonly on the face and extremities, especially
on the left side—in other words, on the most accessible
parts of the body.</p>
<p>Feigned menstruation, pregnancy, abortion, and recent
delivery are common, and should give rise to no difficulty.
The same may be said of feigned insanity,
aphonia, deaf-mutism, and loss of memory.</p>
<p>The following hints may be useful to a medical man
when called to a supposed case of malingering: Do not
be satisfied with one visit, but go again and unexpectedly;
see that the patient is watched between the<span class="pagenum"><SPAN name="page67" id="page67">[67]</SPAN></span>
visits; make an objective examination, compare the
indications with the statements of the patient, noting
especially any discrepancies between his account of his
symptoms and the real symptoms of disease; ask questions
the reverse of the patient's statements, or take
them for granted, and he will often be found to contradict
himself; have all dressings and bandages removed;
suggest, in the hearing of the patient, some heroic
methods of treatment—the actual cautery, or severe
surgical operation, for example; finally, chloroform will
be found of great use in the detection of many sham
diseases.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxl_1" id="chapterxl_1"></SPAN>XL.—MENTAL UNSOUNDNESS</h2>
<p>The presumption in law is in favour of a person's
sanity, even though he may be deaf, dumb, or blind.</p>
<p>The terms 'insanity,' 'lunacy,' 'unsoundness of mind,'
'mental derangement,' 'madness,' and 'mental alienation
or aberration,' are indifferently applied to those states of
disordered mind in which the person loses the power
of regulating his actions and conduct according to the
ordinary rules of society. The reasoning power is lost
or perverted, and he is no longer fitted to discharge
those duties which his social position demands. In some
cases of insanity, as in confirmed idiocy, there is no
evidence of the exercise of the intellectual faculties. It
is probable that no standard of sanity as fixed by nature
can be said to exist. The medical witness should decline
to commit himself to any definition of insanity. There
is no practical advantage in attempting to classify the
different forms of insanity.</p>
<p>According to English law, madness absolves from all
guilt, but in order to excuse from punishment on this
ground it must be proved that the individual was not
capable of distinguishing right from wrong in relation
to the particular act of which he is accused, and that he
<span class="pagenum"><SPAN name="page68" id="page68">[68]</SPAN></span>
did not know at the time of committing the crime that
the offence was against the laws of <i>God</i> and <i>nature</i>.</p>
<p>Lunatics are competent witnesses in relation to testimony,
as in relation to crime, if they understand the
nature of an oath and the character of the proceedings
in which they are engaged. The judge, as in the case
of children, examines the lunatic tendered as a witness
as to his knowledge of the nature and obligation of an
oath, and, if satisfied, he allows him to be sworn.</p>
<p>A person, if suffering from such a state of mental unsoundness
as to be unable to take care of his property,
may be placed under the care of the Court of Chancery.
The Court then administers his property, and otherwise
allows him entire freedom of action.</p>
<p>With regard to the care of lunatics, no person is
allowed to receive more than one lunatic into his house
unless such house is licensed and the proper certificates
have been signed. One patient may be taken without
the house being licensed, but the usual certificates must
in all cases be signed, and the Lunacy Commissioners
communicated with. If a person receives another not
of unsound mind into his house, and such person
becomes subsequently insane, the person so keeping him
renders himself liable to heavy penalties, unless the legal
certificates are at once procured and the Commissioners
of Lunacy communicated with.</p>
<p>At common law it appears that a lunatic cannot be
placed in an asylum unless dangerous to himself or to
others, but under the Lunacy Acts the placing of a madman
in an asylum is considered as a part of the treatment
with a view to the cure of the patient.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxli_1" id="chapterxli_1"></SPAN>XLI.—IDIOCY, IMBECILITY, CRETINISM</h2>
<p><b>Idiocy</b> is not a disease, but a congenital condition in
which the intellectual faculties are either never manifested
or have not been sufficiently developed to enable
<span class="pagenum"><SPAN name="page69" id="page69">[69]</SPAN></span>
the idiot to acquire an amount of knowledge equal to
that acquired by other persons of his own age and in
similar circumstances with himself. Idiots, as a rule, are
deformed in body as well as deficient in mind. Their
heads are generally small and badly-shaped, and their
features ill-formed and distorted. The teeth are few in
number and very irregular. The hard palate has a very
deep arch, or may even be cleft. The complexion is
sallow and unhealthy, the limbs imperfectly developed,
and the gait is awkward, shambling, and unsteady. In
his legal relations an absolute idiot is civilly disabled and
irresponsible, but in regard to crime, or as a witness, see
remarks made above.</p>
<p><b>Imbecility</b> is a form of mental defect not usually congenital,
but commencing in infancy or in early life. The
line of demarcation between the imbecile and the idiot
may be found in the possession by the former of the
faculty of speech, in distinction from the mere parrot-like
utterance of a few words which can be taught the
idiot. Imbecility may be intellectual, moral, or general.
Questions frequently arise as to their responsibility for
actions done by them, or as to their ability to manage
their own affairs.</p>
<p><b>Cretinism</b> is a form of amentia, which is endemic in
certain districts, especially in some of the valleys of
Switzerland, Savoy, and France. The malady is not
congenital, but its symptoms usually appear within a few
months of birth. The characteristics of this form of
idiocy are an enlarged thyroid gland constituting a goitre
or bronchocele, a high-arched palate, dwarfed stature,
squinting eyes, sallow complexion, small legs, conical
head, large mouth, and indistinct speech.</p>
<p><b>Feeble-Minded.</b>—These are persons who are capable
of earning a living under favourable circumstances, but
are incapable, from mental defect which has existed from
birth or from an early age, of (<i>a</i>) competing on equal
terms with their normal fellows, or (<i>b</i>) of managing themselves
<span class="pagenum"><SPAN name="page70" id="page70">[70]</SPAN></span>
and their affairs with ordinary prudence. Feeble-mindedness
may affect the moral nature only, rendering
the person selfish, untruthful, obscene, or unemployable.
The Act of 1899 controls feeble-minded children; many
such become paupers, criminals, prostitutes, etc.</p>
<p><b>Mental Deficiency and Lunacy Act, 1913.</b>—Those
included under this Act are idiots, imbeciles, feeble-minded
persons, and moral imbeciles. The parents or
guardians of such children between the ages of five and
sixteen years must provide for them education and
proper care. If they are unable to do so, the School
Boards or Parish Councils must do so.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlii_1" id="chapterxlii_1"></SPAN>XLII.—DEMENTIA: ACUTE, CHRONIC, SENILE, AND PARALYTIC</h2>
<p>In dementia the mental aberration does not occur
until the mind has become fully developed, thus differing
from amentia, which is congenital or comes on very early
in life.</p>
<p><b>Acute Dementia.</b>—This is a condition of profound
melancholy or stupor, which arises from sudden mental
shock, the mind being, as it were, arrested and fixed in
abstraction on the event.</p>
<p><b>Chronic Dementia</b> is generally caused by the gradual
action on the mind of grief or anxiety, by severe pain,
mania, apoplexy, paralysis, or repeated attacks of
epilepsy.</p>
<p><b>Senile Dementia</b> is a form which is incidental to aged
persons, and commences gradually with such symptoms
as loss of memory for recent events, dulness of perception,
and inability to fix the attention. Later on the
reasoning powers begin to fail, and finally, memory,
reason, and power of attention, are quite lost, the muscular
power and force remaining intact. In the last stage
there is simply bare physical existence.<span class="pagenum"><SPAN name="page71" id="page71">[71]</SPAN></span></p>
<p><b>General Paralysis of the Insane, Paralytic Dementia.</b>—This
is a most interesting form of dementia. It is
closely allied to, if not identical with, locomotor ataxy.
Its most prominent and characteristic symptom consists
in delusions of great power, exalted position, and unlimited
wealth—megalomania. The exaltation is universal,
and the patient may maintain at one and the
same time that he is running a theatrical company, that
he is the Prince of Wales, and that he is the Almighty.
Moral perversion is a common symptom, and the patient
is often guilty of criminal assaults, indecent exposures,
bigamous marriages, and the like. It is accompanied
with progressive bodily and mental decay. Women
are comparatively rarely affected by it, and it generally
commences in men about middle age, and its duration
is from a few months to three years. It is commonly
parasyphilitic in origin. Paralytic symptoms first appear
in the tongue, lips, and face; the speech becomes thick
and hesitating. The paralytic symptoms gradually go
on increasing, the sphincters refuse to act, and death
may occur from suffocation and choking. Sometimes,
during the earlier stages especially, there may be
maniacal paroxysms or epileptic fits. The delusions
remain the same throughout, the patient always expresses
himself as being happy, and his last words will probably
have reference to money and other absurd delusions.</p>
<p>When a person of hitherto blameless life is charged
with an act of indecency, he should be examined for
G.P.I. The condition of his prostate should also be
investigated. He may be suffering from either mental
or physical disease, or both (see p. 59).</p>
<hr class="shorter" />
<h2><SPAN name="chapterxliii_1" id="chapterxliii_1"></SPAN>XLIII.—MANIA</h2>
<p>Under the term 'mania' are included all those forms
of mental unsoundness in which there is undue excitement.
It is divided into general, intellectual, and moral,
<span class="pagenum"><SPAN name="page72" id="page72">[72]</SPAN></span>
and each of the two latter classes again into general and
partial.</p>
<p><b>General Mania</b> affects the intellect as well as the
passions and emotions. Mania is usually preceded by
an incubative period in which the patient's general health
is affected. The duration of this period may vary from
a few days to fifteen or twenty years. When the disease
is established, the patient has paroxysms of violence
directed against himself as well as others. He tears his
clothes to pieces, either abstains from food and drink
or eats voraciously, and sustains immense muscular
exertion without apparent fatigue. The face becomes
flushed, the eye wild and sparkling; there is pain,
weight, and giddiness in the head, with restlessness.</p>
<p><b>General Intellectual Mania</b>, attacking the intellect
alone, is rare; but some one emotion or passion, as
pride, vanity, or love of gain, may obtain ascendancy,
and fill the mind with intellectual delusions.</p>
<p>A <i>delusion</i> may be defined as a perversion of the judgment,
a chimerical thought; an <i>illusion</i>, an incorrect
impression of the senses, counterfeit appearances; hence
we speak of a delusion of the mind, an illusion of the
senses. Lawyers lay great stress on the presence of
delusions as indicative of insanity. An <i>hallucination</i> is
a sensation which is supposed by the patient to be
produced by external impressions, although no material
object acts upon his senses at the time.</p>
<p><b>Partial Intellectual Mania</b>, or <b>Monomania</b>, also
called <b>Melancholia</b>, is a form of the disease in which
the patient becomes possessed of some single notion,
contradictory alike to common-sense and his own experience.</p>
<p><b>General Moral Mania.</b>—This is a morbid perversion
of the natural feelings, affections, inclinations, temper,
habits, moral dispositions, and natural impulses, without
any remarkable disorder or defect of the intellect, or
knowing and reasoning faculties, and particularly without
<span class="pagenum"><SPAN name="page73" id="page73">[73]</SPAN></span>
any insane illusion or hallucination. It is often
difficult to distinguish this form of mania from the moral
depravity which we associate with the criminal classes.</p>
<p><b>Partial Moral Mania—Paranoia—Delusional
Insanity.</b>—In this form one or two only of the moral
powers are perverted. Delusions are always present,
and very frequently are those of persecution. The
patient's conduct is dominated by his delusion; thus
murder and suicide may be committed. There are
several forms:</p>
<p><i>Kleptomania</i>, a propensity to theft; common in women
in easy circumstances. <i>Dipsomania</i>, or <i>Oinomania</i>, an
insatiable desire for drink. <i>Morphinomania</i>, a craving
for morphine or its preparations. <i>Erotomania</i>, or
amorous madness. When occurring in women this is
also called <i>Nymphomania</i>, and in men <i>Satyriasis</i>. It
consists in an uncontrollable desire for sexual intercourse.
<i>Pyromania</i>, an insane impulse to set fire to everything.
<i>Homicidal mania</i>, a propensity to murder. <i>Suicidal
mania</i>, a propensity to self-destruction. Some consider
suicide as always a manifestation of insanity.</p>
<p><b>Insanity of Pregnancy.</b>—This may show itself after
the third month of pregnancy in the form of melancholia.
It is not recovered from until after delivery.</p>
<p><b>Puerperal Mania.</b>—This form of mania attacks women
soon after childbirth. There is in many cases a strong
homicidal tendency against the child.</p>
<p><b>Insanity of Lactation</b> comes on four to eight months
after parturition, either as mania or melancholia. The
mother may repeatedly attempt suicide.</p>
<p><b>Mania with Lucid Intervals.</b>—In many cases mania
is intermittent or recurrent in its nature, the patient in
the interval being in his right mind. The question of
the presence or absence of a lucid interval frequently
occurs where attempts are made to set aside wills made
by persons having property. In these cases the law,
from the reasonableness of the provisions of the will,
<span class="pagenum"><SPAN name="page74" id="page74">[74]</SPAN></span>
may assume the existence of the lucid interval. A will
made during a lucid interval is valid. When an attempt
is made to set aside the provisions of a will on the
ground of insanity in a person not previously judged
insane, the plaintiff must show that the testator was mad;
when the provisions of the will of a lunatic are attempted
to be upheld, the plaintiff must show that the will was
made during a lucid interval.</p>
<p>A testator is capable of making a valid will when he
has (1) a knowledge of his property and of his kindred;
(2) memory sufficient to recognize his proper relations
to those about him; (3) freedom from delusions affecting
his property and his friends; and (4) sufficient physical
and mental power to resist undue influence. The fact
of a man being subject to delusions may not affect his
testamentary capacity. He may believe himself to be a
tea-kettle, and yet be sufficiently sound mentally to make
a valid will.</p>
<p><b>Undue Influence.</b>—Persons of weak mind or those
suffering from senile dementia are often said to have
been unduly influenced in making their wills, and subsequently
their dispositions are disputed in court. Before
witnessing the will made by such a person, the medical
man should satisfy himself that the testator is of a
'sound disposing mind.' This he will do by questioning,
and his knowledge of the home-life of the patient
will either confirm or set aside the idea of influence.</p>
<p>A person who is aphasic may be competent to make a
will. He may not be able to speak, but may understand
what is said to him, and may be able to indicate his
wishes by nods and shakes of the head. Ask him if he
wishes to make a will, then inquire if he has £10,000 to
leave, then if he has £100, and in this way arrive approximately
at the sum. Then ask him if he wishes to
leave it all to one person. If he nods assent, ask if it be
to his wife or some other likely person. If he wishes
to divide it, ascertain his intention by definite questions,
<span class="pagenum"><SPAN name="page75" id="page75">[75]</SPAN></span>
and, having ascertained his views, commit them to
writing, read the document over to him, and ask if it
expresses his intentions. That being settled, a mark
which he acknowledges in the presence of two witnesses,
preferably men of standing, will constitute a valid document.</p>
<p>In certain forms of neurasthenia, the 'phobias' are
common, but must not be regarded as evidence of
insanity. 'Agoraphobia' is the fear of crossing an open
space, 'batophobia' is the fear that high things will
fall, 'siderophobia' is the fear of thunder and lightning,
'pathophobia' is the fear of disease, whilst 'pantophobia'
is the fear of everything and everybody.</p>
<p><b>Epilepsy in Relation to Insanity.</b>—The subjects of
this disease are often subject to sudden fits of uncontrollable
passion; their conduct is sometimes brutal,
ferocious, and often very immoral. As the fits increase
in number, the intellect deteriorates and chronic dementia
or delusional insanity may supervene. (1) Before
a fit the patient may develop paroxysms of rage with
brutal impulses (<i>preparoxysmal insanity</i>), and may commit
crimes such as rape or murder. (2) Instead of the
usual epileptic fit, the patient may have a violent
maniacal attack (<i>masked epilepsy</i>, <i>epileptic equivalent</i>,
<i>psychic form of epilepsy</i>). (3) After the fit the patient
may perform various automatic actions (<i>post-epileptic
automatism</i>) of which he has no subsequent recollection.
Thus the patient may urinate or undress in a public
place, and may be arrested for indecent exposure.
Epileptics who suffer from both petit and grand mal
attacks are specially liable to maniacal attacks. Such
insanity differs from ordinary insanity in its sudden
onset, intensity of symptoms, short duration and abrupt
ending. To establish a plea of epilepsy in cases of
crime, one must show that the individual really did
suffer from true epilepsy, and that the crime was committed
at a period having a definite relation to the
epileptic seizure.<span class="pagenum"><SPAN name="page76" id="page76">[76]</SPAN></span></p>
<p><b>Alcoholic Insanity.</b>—This may occur in three forms:</p>
<ol>
<li><i>Acute Alcoholic Delirium</i> (<i>mania a potu</i>), due to
excessive amount of alcohol consumed.</li>
<li><i>Delirium Tremens</i>, due to long-continued over-drinking.
The patient suffers from horrible dreams,
illusions, and suspicions, which may lead him to attack
people or commit suicide.</li>
<li><i>Chronic Alcoholic Insanity.</i> Loss of memory is the
chief symptom, with paralysis of motion, hallucinations
and delusions of persecution.</li>
</ol>
<p><b>Responsibility for Criminal Acts.</b>—To establish a
defence on the ground of insanity, it must be proved
that the prisoner at the time when the crime was committed
did not know the nature and quality of the act
he was committing, and did not know that it was wrong.
At the present time, however, the <i>power of controlling
his actions</i> is usually made the test.</p>
<p>The plea of insanity is brought forward, as a rule,
only in capital charges, so that the prisoner, if found
guilty, will escape hanging. If proved 'guilty, but
insane,' the person is sentenced to be kept in a criminal
lunatic asylum 'during His Majesty's pleasure.'</p>
<hr class="shorter" />
<h2><SPAN name="chapterxliv_1" id="chapterxliv_1"></SPAN>XLIV.—EXAMINATION OF PERSONS OF UNSOUND MIND</h2>
<p>The following hints with regard to the examination
of patients supposed to be insane will be useful: The
general appearance and shape of head, complexion, and
expression of countenance, gait, movements, and speech,
should be noted; the state of the general health,
appetite, bowels, tongue, skin, and pulse, should be
inquired into; and in women the state of the menstrual
function should be ascertained. The family history
must be traced out, and the personal history taken with
care, especially as to whether the unsoundness came on
late in life or followed any physical cause. Ascertain
<span class="pagenum"><SPAN name="page77" id="page77">[77]</SPAN></span>
whether it is a first attack, whether the patient has
suffered from epilepsy, has squandered his money,
grown restless, has absurd delusions, etc. In order to
ascertain the capacity of the mind, questions should be
asked with regard to age, birthplace, profession, number
of family, and common events, such as the day of week,
month, and year. The power of performing simple
arithmetical operations may be tested. It may be
necessary to pay more than one visit. The examiner
should be careful to ask questions adapted to the station
of life of the supposed lunatic; a man is not necessarily
mad because he cannot perform simple arithmetical
operations, or does not know about things with which
his questioner is well acquainted. The opinion of a
supposed lunatic that his examiner's feet <i>were large</i> was
not considered by the Commissioners among the facts
indicating insanity, yet statements quite as absurd are
made by medical men as 'facts of insanity' observed by
themselves. 'Reads his Bible and is anxious about the
salvation of his soul' is another example of a bad
certificate. Some well-marked delusion should be
recorded.</p>
<p>For a lunacy certificate (<i>Reception Order on Petition</i> or
<i>Judicial Reception Order</i>), except in the case of a pauper
patient, there are required the signatures of two independent
medical men and of a relation or friend. The
medical men must not be in partnership or in any way
interested in the patient; they must make separate visits
at different times, and write on the proper forms the facts
observed by themselves and those observed by others,
giving the name of the informer. A certificate is valid
only for seven days. In very urgent non-pauper cases
the signature of one medical man is sufficient, but such
certificate (<i>Emergency Certificate</i> or <i>Urgency Order</i>) is
only valid for two days, and, as the patient can only be
detained in the asylum under this order for seven days
in England or three in Scotland, it must be supplemented
<span class="pagenum"><SPAN name="page78" id="page78">[78]</SPAN></span>
by another signed as above directed. The
medical certificate must contain a statement that it is
expedient for the alleged lunatic to be placed forthwith
under care, with reasons for making such statement.
The certifying medical practitioner must have personally
examined the patient not more than two clear days
before his reception. In London and other large towns,
where an expert opinion is readily obtainable, it is not
expedient to resort to such urgency orders. Medical
men should be careful how they sign certificates of
insanity. No medical man is bound to certify, but if he
does so he must be prepared to take the responsibility of
his acts. There must be no reasonable ground for
alleging want of 'good faith' or 'reasonable care.'
The practitioner must exercise that amount of care
and skill which he may reasonably be expected to
possess.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlv_1" id="chapterxlv_1"></SPAN>XLV.—THE INEBRIATES ACTS</h2>
<p>It is somewhat difficult to define an inebriate, but for
the moment the following will suffice, and will ultimately,
in all probability, be officially adopted:</p>
<p>An inebriate is a person who habitually takes or uses
any intoxicating thing or things, and while under the
influence of such thing or things, or in consequence of
the effects thereof, is—(<i>a</i>) dangerous to himself or
others; or (<i>b</i>) a cause of harm or serious annoyance to
his family or others; or (<i>c</i>) incapable of managing himself
or his affairs, or of ordinary proper conduct.</p>
<p>Under the provisions of the Habitual Drunkards Acts
(42 and 43 Vict., c. 19, and 51 and 52 Vict., c. 19), any
habitual drunkard may voluntarily place himself under
restraint. He must make an application to the owner
of a licensed retreat, stating the time during which he
undertakes to remain. His application must be accompanied
by a statutory declaration of two persons stating<span class="pagenum"><SPAN name="page79" id="page79">[79]</SPAN></span>
that they knew the applicant to be a confirmed drunkard.
Without this testimony as to moral character his application
cannot be entertained. His signature must also
be attested by two justices, who must state that he
understands the effect of his application, and that it has
been explained to him. The limit to the term of restraint
is twelve months, after which he must resume his
former habits if he wishes to qualify for another period.
The Act works automatically, and, when it has been set
for a certain time, the patient cannot release himself
until the period has expired. The Inebriates' Retreat
must be duly licensed, and the licensee incurs distinct
obligation in return for the powers entrusted to him.
It is an offence against the Act to assist any habitual
drunkard to escape from his retreat, and should he
succeed in effecting his escape he may be arrested on a
warrant. A drunkard who does not obey orders and
conform to the rules of the establishment may be sent to
prison for seven days. It may be as well to mention
that it is an offence to supply any drunkard under the
Act with any intoxicating drink or sedative or stimulant
drug without authority, and that the penalty is a fine of
£20 or three months' imprisonment. The Act is a good
one, but might be carried farther with advantage. It
has been ruled that a crime committed during drunkenness
is as much a crime as if committed during sobriety.
A person is supposed to know the effect of drink, and
if he takes away his senses by drink it is no excuse.
He is held answerable both for being under the influence
of alcohol or of any other drug, and for the acts such
influence induces.</p>
<p><b>Inebriates Act</b> (1898-1900).—If an habitual drunkard
be sentenced to imprisonment or penal servitude for an
offence committed during drunkenness, or if he has been
convicted four times in one year, the court may order
him to be detained for a term not exceeding three years
in an inebriate reformatory.</p>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="page80" id="page80">[80]</SPAN></span></p>
<h2><SPAN name="part2" id="part2"></SPAN>PART II</h2>
<h3>TOXICOLOGY</h3>
<hr class="shorter" />
<h2><SPAN name="chapteri_2" id="chapteri_2"></SPAN>I.—DEFINITION OF A POISON</h2>
<p>Though the law does not define in definite terms
what a poison really is, it lays stress on the <i>malicious
intention</i> in giving a drug or other substance to an
individual. It is a <i>felony</i> to administer, or cause to be
administered, any poison or other destructive thing with
intent to murder, or with the intention of stupefying or
overpowering an individual so that any indictable offence
may be committed. It is a <i>misdemeanour</i> to administer
any poison, or destructive or noxious thing, merely to
aggrieve, injure, or annoy an individual. For a working
<i>definition</i> we may state that a poison is a substance
which, when introduced into or applied to the body, is
capable of injuring health or destroying life. A poison
may therefore be swallowed, applied to the skin, injected
into the tissues, or introduced into any orifice of the
body.</p>
<hr class="shorter" />
<h2><SPAN name="chapterii_2" id="chapterii_2"></SPAN>II.—SALE OF POISONS; SCHEDULED POISONS</h2>
<p>The sale of poisons is regulated by various Acts, but
chiefly by the Pharmacy Act, 1868, and by the Poisons
and Pharmacy Act, 1908. Only registered medical
practitioners and legally qualified druggists are permitted
to dispense and sell scheduled poisons. They<span class="pagenum"><SPAN name="page81" id="page81">[81]</SPAN></span>
are responsible for any errors which may be committed
in the sale of poisons. If a druggist knows that a drug
in a prescription is to be used for an improper purpose,
he may refuse to dispense it. The practitioner who
carelessly prescribes a drug in a poisonous dose is not
held responsible, but the dispenser would be if he
dispensed it and harmful or fatal consequences followed
on its being swallowed. When a dispenser finds an
error in a prescription, it is his duty to communicate
with the prescriber privately pointing out the mistake.</p>
<p>A great responsibility rests on the medical man who
does his own dispensing, as there is no one to check
his work.</p>
<p>If a doctor prescribes a drug with the intention of
curing or preventing a disease, but that, contrary to
expectation and general experience, it causes illness
or even death, no responsibility can rest with the prescriber.
It has to be proved that actual injury has been
sustained by the complainant before an action for
damages can be commenced, and that the plaintiff was
free from all contributory negligence.</p>
<p><b>Scheduled Poisons.</b>—By the Pharmacy Act of 1868
two groups of poisons are scheduled. Part I. contains
a list of those which are considered very active poisons—<i>e.g.</i>,
arsenic, alkaloids, belladonna, cantharides, coca
(if containing more than 1 per cent. alkaloids), corrosive
sublimate, diachylon, cyanides, tartar emetic, ergot,
nux vomica, laudanum, opium, savin, picrotoxin, veronal
and all poisonous urethanes, prussic acid, vermin killers,
etc. Such poisons must not be sold to strangers, but
only to persons known to or introduced by someone
known to the druggist. If sold, the latter must enter
into the 'Poison Register' the name of the poison, the
name of the person to whom it is sold, the quantity and
purpose for which it is to be used, and date of sale.
The entry must be signed by the purchaser and by the
introducer. The word 'Poison' must be affixed to the
<span class="pagenum"><SPAN name="page82" id="page82">[82]</SPAN></span>
bottle or package, and also the name and address of the
seller.</p>
<p>Part II. contains a list of poisons supposed to be less
active. These may only be sold if on the bottle, box, or
package there is affixed a label with the name of the
article, the word 'Poison,' and the name and address of
the seller. It is not necessary to enter the transaction in
a register.</p>
<p>Chemists are required to keep poisons in specially
distinguishable bottles, and these in a special room or
locked cupboard.</p>
<p><b>Dangerous Drugs Act, 1920.</b>—The regulations restrict
the manufacture and sale of opium, morphine, cocaine,
and heroin so as to prevent their abuse. Preparations
containing less than 1/5 per cent. of the first two or less
than 1/10 per cent. of the last two are excluded. Prescriptions
containing the above drugs must be dated and
signed with the full name and address of the prescriber,
and must have also those of the patient. The total
amount of the drug to be supplied must be stated, and
it must not be dispensed more than once; the dispenser
retains the prescription. Special books must be kept
recording the purchase and sale of these drugs.</p>
<p><b>Proprietary Medicines Bill</b> (introduced in 1920, and
likely soon to become law).—The sale of any unregistered
proprietary medicine purporting to cure certain diseases
or produce abortion is made an offence. A register of
proprietary medicines, etc., is established. The object
is to protect the public against quack remedies.</p>
<p><b>Notification of Poisoning.</b>—Every case of poisoning
which occurs in any industry (lead, arsenic, anthrax,
etc.) must be notified by the medical attendant to the
Chief Inspector of Factories (Factory and Workshops
Act, 1895).</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page83" id="page83">[83]</SPAN></span></p>
<h2><SPAN name="chapteriii_2" id="chapteriii_2"></SPAN>III.—ACTION OF POISONS; CLASSIFICATION OF POISONS</h2>
<p><b>Action of Poisons.</b>—They may act either locally or
only after absorption into the system.</p>
<ol>
<li><i>Local Action</i>, as seen in (<i>a</i>) corrosive poisons;
(<i>b</i>) irritant poisons, causing congestion and inflammation
of the mucous membranes—<i>e.g.</i>, metallic and
vegetable irritants; (<i>c</i>) stimulants or sedatives to the
nerve endings, as aconite, conium, cocaine.</li>
<li><i>Remote Action.</i>—This may be of reflex character,
as seen in the shock produced by the pain caused by
corrosive poisons, or the poison may exert a special
action on certain structures, as belladonna on the cells
of the brain, strychnine on the motor nerve cells of the
spinal cord.</li>
<li><i>In Both Ways.</i>—Certain poisons, as carbolic or
oxalic acids, act in this way.</li>
</ol>
<p>Age, idiosyncrasy, tolerance, and disease, all exert
modifying influences on the action of a poison. The
form in which the poison is swallowed and the quantity
also determine its action. In the gaseous form, poisons
act most rapidly and fatally. When in solution and injected
hypodermically, they also act very rapidly. In the
solid form they act as a rule slowly, and may even set up
vomiting, and so may be entirely ejected by vomiting.
Poisons act most energetically when the stomach is
empty. If taken when the stomach already contains
food, solution and absorption may be greatly delayed.</p>
<p>Some poisons are cumulative in their action, and thus,
even if infinitesimal doses be swallowed each day, there
is a certain amount of storage in the tissues (though a
certain percentage of the poison is being constantly
eliminated), and at last symptoms of poisoning show
themselves.<span class="pagenum"><SPAN name="page84" id="page84">[84]</SPAN></span></p>
<p><b>Classification of Poisons.</b>—As an aid to memory, the
following classification is perhaps the best:</p>
<ol style="list-style-type: upper-roman;" >
<li><i>Inorganic.</i>
<ol>
<li>Corrosive acids and alkalies, and caustic salts
(carbolic and oxalic acids also).</li>
<li>Irritant—practically all the metals and the metalloids
(I. Cl. Br. P.).</li>
</ol></li>
<li><i>Organic.</i>
<ol><li style="list-style-type: none;"><table style="margin-left: -2.25em;" summary="">
<tr><td>1. Irritant</td>
<td style="font-size: 200%;">{</td>
<td>Animal—venomous bites, food poisoning, cantharides.<br/>
Vegetable—all strong purgatives, hellebores, savin, yew, ergot,
hemlock, laburnum, bryony, etc.</td></tr></table></li>
<li>Neuronic.
<ul class="plain">
<li>(<i>a</i>) Somniferous—opium and its alkaloids.</li>
<li>(<i>b</i>) Deliriant—belladonna, hyoscyamus, stramonium,
cannabis, cocaine, cocculus, camphor,
fungi.</li>
<li>(<i>c</i>) Inebriants—alcohol, ether, chloral, carbolic
acid (weak), benzol, aniline, nitro-glycerine.</li>
</ul></li>
<li>Sedative or depressant.
<ul class="plain">
<li>(<i>a</i>) Neural—conium, lobelia, tobacco, physostigma.</li>
<li>(<i>b</i>) Cerebral—hydrocyanic acid.</li>
<li>(<i>c</i>) Cardiac—aconite, digitalis, colchicum, veratrum.</li>
</ul></li>
<li>Excito-motory or convulsives—nux vomica, strychnine.</li>
<li>Vulnerants—powdered glass.</li>
</ol></li>
<li><i>Asphyxiants.</i>
<ul class="plain">
<li>Poisonous and irrespirable gases.</li></ul>
</li></ol>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page85" id="page85">[85]</SPAN></span></p>
<h2><SPAN name="chapteriv_2" id="chapteriv_2"></SPAN>IV.—EVIDENCE OF POISONING</h2>
<p>It may be inferred that poison has been taken from
consideration of the following factors: Symptoms and
post-mortem appearances, experiments on animals,
chemical analysis, and the conduct of suspected persons.</p>
<ol>
<li><i>Symptoms</i> in poisoning usually come on suddenly,
when the patient is in good health, and soon after
taking a meal, drink, or medicine. Many diseases, however,
come on suddenly, and in cases of slow poisoning
the invasion of the symptoms may be gradual.</li>
<li><i>Post-Mortem Appearances.</i>—These in many poisons
and classes of poisons are characteristic and unmistakable.
The post-mortem appearances peculiar to the
various poisons will be described in due course.</li>
<li><i>Experiments on Animals.</i>—These may be of value,
but are not always conclusive.</li>
<li><i>Chemical Analysis.</i>—This is one of the most important
forms of evidence, as a demonstration of the
actual presence of a poison in the body carries immense
weight. The poison may be discovered in the living
person by testing the urine, the blood abstracted by
bleeding, or the serum of a blister. In the dead body
it may be found in the blood, muscles, viscera—especially
the liver—and secretions. Its discovery in these cases
must be taken as conclusive evidence of administration.
If, however, it be found only in substances rejected or
voided from the body, the evidence is not so conclusive,
as it may be contended that the poison was introduced
into or formed in the material examined after its rejection
from the body, or if the quantity be very minute it
will be argued that it is not sufficient to cause death. A
poison may not be detected in the body, owing to defective
methods, smallness of the dose required to cause
death, or to its ejection by vomiting or its elimination
by the excretions.<span class="pagenum"><SPAN name="page86" id="page86">[86]</SPAN></span></li>
<li><i>Conduct of Suspected Persons.</i>—A prisoner may be
proved to have purchased poison, to have made a study
of the properties and effects of poison, to have concocted
medicines or prepared food for the deceased, to have
made himself the sole attendant of the deceased, to have
placed obstacles in the way of obtaining proper medical
assistance, or to have removed substances which might
have been examined.</li>
</ol>
<hr class="shorter" />
<h2><SPAN name="chapterv_2" id="chapterv_2"></SPAN>V.—SYMPTOMS AND POST-MORTEM APPEARANCES OF DIFFERENT CLASSES OF POISONS</h2>
<p>Whilst recognizing the fact that toxic agents cannot
be accurately classified, the following grouping may for
descriptive purposes be admitted with the view of saving
needless repetition:</p>
<p>1. <b>Corrosives.</b>—Characterized by their destructive
action on tissues with which they come in contact. The
principal inorganic corrosives are the mineral acids, the
caustic alkalies, and their carbonates; the organic are
carbolic acid, strong solutions of oxalic acid, and acetic
acid.</p>
<p><i>Symptoms.</i>—Burning pain in mouth, throat, and gullet,
strong acid, metallic or alkaline taste; retching and
vomiting, the discharged matters containing shreds of
mucus, blood, and the lining membrane of the passages.
Inside of mouth corroded. There are also dysphagia,
thirst, dyspnœa, small and frequent pulse, anxious expression,
shock. Death may result from shock, destruction
of the parts—<i>e.g.</i>, perforation of stomach or duodenum,
suffocation; or some weeks subsequently death
may be due to cicatricial contraction of the gullet,
stomach, or pylorus.</p>
<p><i>Post-Mortem Appearances.</i>—Those of corrosion, with
corrugation from strong contraction of muscular fibres,
and followed by inflammation and its consequences.<span class="pagenum"><SPAN name="page87" id="page87">[87]</SPAN></span>
The mouth, gullet, and stomach, and in some cases the
intestines, may be white, yellow, or brown, shrivelled
and corroded. The corrosions may be small, or may
extend over a very large surface. Sometimes considerable
portions of the lining membrane of the gullet or
stomach may be discharged by vomiting or by stool.
Beyond the corroded parts the textures are acutely
inflamed. The stomach is filled with a yellow, brown,
or black gelatinous liquid or black blood, and may in
rare cases be perforated.</p>
<p>2. <b>Irritants.</b>—These are substances which inflame
parts to which they are applied. The class includes
mineral, animal, and vegetable substances, and contains
a larger number of poisons than all the other classes
together. Irritants may be divided into two groups:
(1) Those which destroy life by the irritation they set
up in the parts to which they are applied; (2) those
which add to local irritation peculiar or specific remote
effects. The first group includes the principal vegetable
irritants, some alkaline salts, some metallic poisons, etc.;
and the second comprises the metallic irritants, the
metalloids (phosphorus and iodine), and one animal
substance, cantharides.</p>
<p><i>Symptoms.</i>—Burning pain and constriction in throat
and gullet, pain and tenderness of stomach and bowels,
intense thirst, nausea, vomiting, purging and tenesmus,
with bloody stools, dysuria, cold skin, and feeble and
irregular pulse. The vomit consists at first of the food,
then it becomes bile-stained, and later dark coffee-grounds
in appearance, due to extravasation of blood
from the over-distended vessels in the gastric mucous
membrane. Death may occur from shock, convulsions,
collapse, exhaustion, or from starvation on account of
chronic inflammation of the gastro-intestinal mucous
membrane.</p>
<p><i>Post-Mortem Appearances.</i>—Those of inflammation
and its consequences. Coats of stomach, fauces, gullet,
<span class="pagenum"><SPAN name="page88" id="page88">[88]</SPAN></span>
and duodenum, may be thickened, black, ulcerated, gangrenous,
or sloughing. Vessels filled with dark blood
ramify over the surface. Acute inflammation is often
found in the small intestines, with ulceration and softening
of mucous membrane. The rectum is frequently
the seat of marked ulceration.</p>
<p>3. <b>Poisons Acting on the Brain.</b>—Three classes: The
opium group, producing sleep; the belladonna group,
producing delirium and illusions; and the alcohol group,
causing exhilaration, followed by delirium or sleep.</p>
<p><i>Symptoms.</i>—Of the opium group, giddiness, headache,
dimness of sight, contraction of the pupils, noises in the
ears, drowsiness and confusion, passing into insensibility.
Of the belladonna group, delirium, illusions of sight,
dilated pupils, dry mouth, thirst, redness of skin, coma.
Of the alcohol group, excitement of circulation and of
cerebral functions, want of power of co-ordination and
of muscular movement, double vision, mania, followed
by profound sleep and coma. In the chronic form,
delirium tremens.</p>
<p><i>Post-Mortem Appearances.</i>—In the opium group,
fulness of the sinuses and veins of the brain, with effusion
of serum into the ventricles and beneath the membranes.
In the belladonna group, nil. In the alcohol group,
signs of inflammation, congestion of brain and membranes,
fluidity of blood, long-continued rigor mortis.</p>
<p>4. <b>Poisons Acting on the Spinal Cord.</b>—Strychnine,
brucine, thebaïne. The leading symptom is tetanic
spasm.</p>
<p>5. <b>Poisons Affecting the Heart.</b>—These kill by
sudden shock, syncope, or collapse. They comprise
prussic acid, dilute solution of oxalic acid and oxalates,
aconite, digitalis, strophanthus, convallaria, and tobacco.</p>
<p>6. <b>Poisons Acting on the Lungs.</b>—These have for
their type carbonic acid gas and coal gas. The fumes
of ammonia are intensely irritating, and may give rise
to laryngitis, bronchitis, and even pneumonia. Nitric
<span class="pagenum"><SPAN name="page89" id="page89">[89]</SPAN></span>
acid fumes sometimes produce no serious symptoms for
an hour or more, but there may then be coughing, difficulty
of breathing, and tightness in the lower part of the
throat, followed by capillary bronchitis (see p. 120).</p>
<hr class="shorter" />
<h2><SPAN name="chaptervi_2" id="chaptervi_2"></SPAN>VI.—DUTY OF PRACTITIONER IN SUPPOSED CASE OF POISONING</h2>
<p>If called to a case supposed or suspected to be one of
poisoning, the medical man has two duties to perform:
To save the patient's life, and to place himself in a position
to give evidence if called on to do so. If life is
extinct, his duty is a simple one. He should make inquiries
as to symptoms, and time at which food or
medicine was last taken. He should take possession of
any food, medicine, vomited matter, urine, or fæces, in
the room, and should seal them up in clean vessels for
examination. He should notice the position and temperature
of the body, the condition of rigor mortis,
marks of violence, appearance of lips and mouth. He
should not make a post-mortem examination without an
order in writing from the coroner. In making a post-mortem
examination, the alimentary canal should be
removed and preserved for further investigation. A
double ligature should be passed round the œsophagus,
and also round the duodenum a few inches below the
pylorus. The gut and the gullet being cut across
between these ligatures, the stomach may be removed
entire without spilling its contents. The intestines may
be removed in a similar way, and the whole or a portion
of the liver should be preserved. These should all be
put in separate jars without any preservative fluid, tied
up, sealed, labelled, and initialled. All observations
should be at once committed to writing, or they will not
be admitted by the court for the purpose of refreshing
the memory whilst giving evidence. If the medical
practitioner is in doubt on any point, he should obtain
<span class="pagenum"><SPAN name="page90" id="page90">[90]</SPAN></span>
technical assistance from someone who has paid attention
to the subject.</p>
<p>In a case of attempted suicide by poisoning, is it the
duty of the doctor to inform the police? He would be
unwise to do so. He had much better stick to his own
business, and not act as an amateur detective.</p>
<hr class="shorter" />
<h2><SPAN name="chaptervii_2" id="chaptervii_2"></SPAN>VII.—TREATMENT OF POISONING</h2>
<p>The modes of treatment may be ranged under three
heads: (1) To eliminate the poison; (2) to antagonize its
action; (3) to avert the tendency to death.</p>
<p>1. The first indication is met by the administration of
emetics, to produce vomiting, or by the application of
the stomach-tube. The best emetic is that which is at
hand. If there is a choice, give apomorphine hypodermically.
The dose for an adult is 10 minims. It may
be given in the form of the injection of the Pharmacopœia,
or preferably as a tablet dissolved in water.
Apomorphine is not allied in physiological action to
morphine, and may be given in cases of narcotic poisoning.
Sulphate of zinc, salt-and-water, ipecacuanha, and
mustard, are all useful as emetics. Tickling the fauces
with a feather may excite vomiting.</p>
<p>In using the elastic stomach-tube, some fluid should be
introduced into the stomach before attempting to empty
it, or a portion of the mucous membrane may be sucked
into the aperture. The tube should be examined to see
that it is not broken or cracked, as accidents have happened
from neglecting this precaution. The bowels and kidneys
must also be stimulated to activity, to help in the
elimination of the poison.</p>
<p>2. The second indication is met by the administration
of the appropriate antidote. Antidotes are usually given
hypodermically, or, if by mouth, in the form of tablets.
In the absence of a hypodermic syringe, the remedy may
be given by the rectum. In the selection of the appropriate
<span class="pagenum"><SPAN name="page91" id="page91">[91]</SPAN></span>
antidote, a knowledge of pharmacology is required,
especially of the physiological antagonism of drugs.
Antidotes may act (1) chemically, by forming harmless
compounds, as lime in oxalic acid poisoning; (2) physiologically,
the drug which is administered neutralizing
more or less completely the poison which has been
absorbed; (3) physically, as charcoal. Every doctor
should provide himself with an antidote case. The
various antidotes will be mentioned under their respective
poisons.</p>
<p>3. To avert the tendency to death, we must endeavour
to palliate the symptoms and neutralize the effects of the
poison. Pain must be relieved by the use of morphine;
inflamed mucous membrane soothed by such <i>demulcents</i>
as oils, milk, starch; stimulants to overcome collapse;
saline infusions in shock, etc. In the case of narcotics
and depressing agents, stimulants, electricity, and cold
affusions, may be found useful. We should endeavour to
promote the elimination of the poison from the body by
stimulating the secretions.</p>
<hr class="shorter" />
<h2><SPAN name="chapterviii_2" id="chapterviii_2"></SPAN>VIII.—DETECTION OF POISONS</h2>
<p>Notice the smell, colour, and general appearance, of the
matter submitted for examination. The odour may show
the presence of prussic acid, alcohol, opium, or phosphorus.
The colour may indicate salts of copper, cantharides,
etc. Seeds of plants may be found.</p>
<p>This examination having been made, the contents of
the alimentary canal, and any other substances to be
examined, must be submitted to chemical processes.</p>
<p>Simple filtration will sometimes suffice to separate the
required substance; in other cases dialysis will be necessary,
in order that crystalloid substances may be separated
from colloid bodies.</p>
<p>In the case of volatile substances distillation will be
required. The poisons thus sought for are alcohol,
<span class="pagenum"><SPAN name="page92" id="page92">[92]</SPAN></span>
phosphorus, iodine, chloral, ether, hydrocyanic acid,
carbolic acid, nitro-benzol, chloroform, and anilin. The
organic matters are placed in a flask, diluted with distilled
water if necessary, and acidulated with tartaric acid.
The flask is heated in a water-bath, and the vapours condensed
by a Liebig's condenser. In the case of phosphorus
the condenser should be of glass, and the process
of distillation conducted in the dark, so that the luminosity
of the phosphorus may be noted.</p>
<p>For the separation of an alkaloid, the following is the
process of Stas-Otto. This process is based upon the
principle that the salts of the alkaloids are <i>soluble in
alcohol and water</i>, and <i>insoluble in ether</i>. The pure
alkaloids, with the exception of morphine in its crystalline
form, are <i>soluble</i> in ether. Make a solution of the
contents of the stomach or solid organs minced very
fine by digesting them with acidulated alcohol or water
and filtering. The filtrate is shaken with ether to
remove fat, etc., the ether separated, the watery solution
neutralized with soda, and then shaken with ether,
which removes the alkaloid in a more or less impure
condition. The knowledge of these facts will help to
explain the following details, which may be modified to
suit individual cases: (1) Treat the organic matter, after
distillation for the volatile substances just mentioned,
with twice its weight of absolute alcohol, free from fusel
oil, to which from 10 to 30 grains of tartaric or oxalic
acid have been added, and subject to a gentle heat.
(2) Cool the mixture and filter; wash the residue with
strong alcohol, and mix the filtrates. <i>The residue may be
set aside for the detection of the metallic poisons, if suspected.</i>
Expel the alcohol by careful evaporation. On the
evaporation of the alcohol the resinous and fatty matters
separate. Filter through a filter moistened with water.
Evaporate the filtrate to a syrup, and extract with
successive portions of absolute alcohol. Filter through a
filter moistened with alcohol. Evaporate filtrate to dryness,
<span class="pagenum"><SPAN name="page93" id="page93">[93]</SPAN></span>
and dissolve residue in water, the solution being
made distinctly acid. Now shake watery solution with
ether. (3) Ether from the acid solution dissolves out
<i>colchicin</i>, <i>digitalin</i>, <i>cantharidin</i>, and <i>picrotoxin</i>, and traces
of <i>veratrine</i> and <i>atropine</i>. Separate the ethereal solution
and evaporate. Hot water will now dissolve out <i>picrotoxin</i>,
<i>colchicin</i>, and <i>digitalin</i>, but not cantharidin.
(4) The remaining acid watery liquid, holding the other
alkaloids in solution or suspension, is made strongly alkaline
with soda, mixed with four or five times its bulk of
ether, chloroform, or benzole, briskly shaken, and left to
rest. The ether floats on the surface, holding the alkaloids,
except morphine, in solution. (5) A part of this
ethereal solution is poured into a watch-glass and allowed
to evaporate. If the alkaloid is volatile, oily streaks
appear on the glass; if not volatile, crystalline traces will
be visible. If a volatile alkaloid, add a few pieces of
calcium chloride to ethereal solution to absorb the water;
draw off the ethereal solution with a pipette, allow it to
evaporate, and test the residue for the alkaloids, conine
and nicotine.</p>
<p>If a fixed alkaloid, treat the acid solution with soda or
potash and ether, evaporate ethereal solution after separation,
when the solid alkaloid will be left in an impure
state. To purify it, add a small quantity of dilute sulphuric
acid, and, after evaporating to three-quarters of
its bulk, add a saturated solution of carbonate of
potash or soda. Absolute alcohol will then dissolve out
the alkaloid, and leave it on evaporation in a crystalline
form.</p>
<p><i>General Reactions for Alkaloids.</i>—(1) Wagner's reagent
(iodine dissolved in a solution of potassium iodide) yields
a reddish-brown precipitate; (2) Mayer's reagent
(potassio-mercuric iodide) gives a yellowish-white precipitate;
(3) phospho-molybdic acid gives a yellow
precipitate; (4) platinic chloride, a brown precipitate;
(5) tannic acid, etc.<span class="pagenum"><SPAN name="page94" id="page94">[94]</SPAN></span></p>
<p>In order to isolate an inorganic substance from organic
matter, Fresenius's method is adopted. Boil the finely
divided substance with about one-eighth its bulk of pure
hydrochloric acid; add from time to time potassic
chlorate until the solids are reduced to a straw-yellow
fluid. Treat this with excess of bisulphate of sodium,
then saturate with sulphuretted hydrogen until metals
are thrown down as sulphides. These may be collected
and tested. From the acid solution, hydrogen sulphide
precipitates copper, lead, and mercury, <i>dark</i>; arsenic,
antimony, and tin, <i>yellowish</i>. If no precipitate, add
ammonia and ammonium sulphide, iron, <i>black</i>, zinc,
<i>white</i>, chromium, <i>green</i>, manganese, <i>pink</i>. The residue of
the material after digestion with hydrochloric acid and
potassium chlorate may have to be examined for silver,
lead, and barium.</p>
<p>For the detection of minute quantities, the microscope
must be used, and Guy's and Helwig's method of sublimation
will be found advantageous. Crystalline poisons
may be recognized by their characteristic forms.</p>
<hr class="shorter" />
<h2><SPAN name="chapterix_2" id="chapterix_2"></SPAN>IX.—THE MINERAL ACIDS</h2>
<p>These are sulphuric, nitric, and hydrochloric acids.</p>
<p><i>Symptoms of Poisoning by the Mineral Acids.</i>—Acid
taste in the mouth, with violent burning pain extending
into the œsophagus and stomach, and commencing immediately
on the poison being swallowed; eructations,
constant retching, and vomiting of brown, black, or
yellow matter containing blood, coagulated mucus,
epithelium, or portions of the lining membrane of the
gullet and stomach. The vomited matters are strongly
acid in reaction, and stain articles of clothing on which
they may fall. There is intense thirst and constipation,
with scanty or suppressed urine, tenesmus, and small
and frequent pulse; the lips, tongue, and inside of the
mouth, are shrivelled and corroded. Exhaustion succeeds,
<span class="pagenum"><SPAN name="page95" id="page95">[95]</SPAN></span>
and the patient dies either collapsed, convulsed, or suffocated,
the intellect remaining clear to the last. After
recovering from the acute form of poisoning, the patient
may ultimately die from starvation, due to stricture of
the œsophagus, stomach, etc.</p>
<p><i>Post-Mortem Appearances Common to the Mineral
Acids.</i>—Stains and corrosions about the mouth, chin,
and fingers, or wherever the acid has come in contact.
The inside of the mouth, fauces, and œsophagus, is
white and corroded, yellow or dark brown, and shrivelled.
Epiglottis contracted or swollen. Stomach filled with
brown, yellow, or black glutinous liquid; its lining
membrane is charred or inflamed, and the vessels are
injected. Pylorus contracted. Perforation, when it
takes place, is on the posterior aspect; the apertures
are circular, and surrounded by inflammation and black
extravasation. The blood in the large vessels may be
coagulated.</p>
<p>Avoid mistaking gastric or duodenal ulcer, with or
without perforation, for the effects of a corrosive
poison.</p>
<p><i>Treatment.</i>—Calcined magnesia or the carbonate or
bicarbonate of sodium, mixed with milk or some mucilaginous
liquid, are the best antidotes. In the absence
of these, chalk, whiting, milk, oil, soap-suds, etc., will
be found of service. The stomach-pump should not
be used. If the breathing is impeded, tracheotomy
may be necessary. Injuries of external parts by the
acid must be treated as burns.</p>
<hr class="shorter" />
<h2><SPAN name="chapterx_2" id="chapterx_2"></SPAN>X.—SULPHURIC ACID</h2>
<p><b>Sulphuric Acid</b>, or oil of vitriol, may be concentrated
or diluted. It is frequently thrown over the person to
disfigure the features or destroy the clothes. Parts of
the body touched by it are stained, first white, and then
<span class="pagenum"><SPAN name="page96" id="page96">[96]</SPAN></span>
dark brown or black. The presence of corrosion of the
mouth is as important as the chemical tests. Black
woollen cloths are turned to a dirty brown, the edges of
the spots becoming red in a few days, due to the dilution
of the acid from the absorption of moisture; the stains
remain damp for long, owing to the hygroscopic property
of the acid.</p>
<p><i>Method of Extraction from the Stomach.</i>—The contents
of the stomach or vomited matter should, if necessary,
be diluted with pure distilled water and filtered. The
stomach should be cut up into small pieces and boiled
for some time in water. The solution, filtered and concentrated,
is now ready for testing. Blood, milk, etc.,
may be separated by dialysis, and the fluid so obtained
tested. A sulphate may be present. Take a portion of
the liquid, evaporate to dryness, and incinerate; a sulphate,
if present, will be obtained, and may be tested.</p>
<p><i>Caution.</i>—Sulphuric acid may not be found even after
large doses, due to treatment, vomiting, or survival for
several days. In all cases every organ should be
examined. Vomited matters and contents of stomach
should not be mixed, but each <i>separately</i> examined.
This rule holds good for all poisons. On <i>cloth</i> the stain
may be cut out, boiled in water, the solution filtered,
and tested with blue litmus and other tests.</p>
<p><i>Post-Mortem Appearances.</i>—Where the acid has come
in contact with the mucous membranes there are dark
brown or black patches. The stomach is greatly contracted,
the summits of the mucous membrane ridges
being charred and the furrows greatly inflamed; the
contents are black or brown.</p>
<p><i>Tests.</i>—Concentrated acid chars organic matter;
evolves heat when added to water, and sulphurous
fumes when boiled with chips of wood, copper cuttings,
or mercury. Dilute acid chars paper when the paper
is heated; gives a white precipitate with nitrate or
chloride of barium, and is entirely volatilized by heat.
<span class="pagenum"><SPAN name="page97" id="page97">[97]</SPAN></span>
Dilute solutions give a white precipitate with barium
nitrate, insoluble in hydrochloric acid even on boiling.</p>
<p><i>Fatal Dose.</i>—In an adult, 1 drachm.</p>
<p><i>Fatal Period.</i>—Shortest, three-quarters of an hour;
average period from onset of primary effects, eighteen
to twenty-four hours.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxi_2" id="chapterxi_2"></SPAN>XI.—NITRIC ACID</h2>
<p><b>Nitric Acid</b>, or aqua fortis, is less frequently used as
a poison than sulphuric acid. The fumes from nitric
acid have caused death from pneumonia in ten or twelve
hours.</p>
<p><i>Method of Extraction from the Stomach.</i>—The same as
for sulphuric acid. In beer, etc., the mixture may be
neutralized with carbonate of potassium, dialyzed, the
fluid concentrated and allowed to crystallize, when
crystals of nitrate of potassium may be recognized.</p>
<p><i>Post-Mortem Appearance.</i>—The mucous membranes
are rendered yellow or greenish if bile be present; they
are also thickened and hardened.</p>
<p><i>Tests.</i>—Concentrated acid gives off irritating orange-coloured
fumes of nitric acid gas. When poured on
copper, it gives off red fumes and leaves a green solution
of nitrate of copper. It gives a red colour with brucine,
turns the green sulphate of iron black, and with hydrochloric
acid dissolves gold. A delicate test for the acid,
free or in combination, is to dissolve in the suspected
fluid some crystals of ferrous sulphate, and then to
gently pour down the test-tube some strong sulphuric
acid. Where the two liquids meet, if nitric acid be
present, a reddish-brown ring will be formed. It turns
the skin bright yellow, and does the same with woollen
clothes, from the formation of <i>picric</i> acid.</p>
<p><i>Fatal Dose.</i>—Two drachms.</p>
<p><i>Fatal Period.</i>—Shortest, one hour and three-quarters
in an adult; in infants in a few minutes, from suffocation.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page98" id="page98">[98]</SPAN></span></p>
<h2><SPAN name="chapterxii_2" id="chapterxii_2"></SPAN>XII.—HYDROCHLORIC ACID</h2>
<p><b>Hydrochloric Acid</b>, muriatic acid, or spirit of salt, is
not uncommonly used for suicidal purposes, being fifth
in the list.</p>
<p><i>Method of Extraction from the Stomach.</i>—The same
as for sulphuric acid. As hydrochloric acid is a constituent
of the gastric juice, the signs of the acid must
be looked for.</p>
<p><i>Post-Mortem Appearances.</i>—The mucous membranes
are dry, white, and shrivelled, and often eroded.</p>
<p><i>Tests.</i>—The concentrated acid yields dense white
fumes with ammonia. When warmed with black oxide
of manganese and strong sulphuric acid it gives off
chlorine, recognized by its smell and bleaching properties.
Diluted it gives with nitrate of silver, a white
precipitate, which is insoluble in nitric acid and in
caustic potash, but is soluble in ammonia, and when
dried and heated melts, and forms a horny mass. Stains
on clothing are reddish-brown in colour.</p>
<p><i>Fatal Dose.</i>—Half an ounce.</p>
<p><i>Fatal Period.</i>—Shortest, two hours; average, twenty-four
hours. Death may occur after an interval of some
weeks from destruction of the gastric glands and inability
to digest food.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxiii_2" id="chapterxiii_2"></SPAN>XIII.—OXALIC ACID</h2>
<p><b>Oxalic Acid</b> is used by suicides, though not often
by murderers. The crystals closely resemble those of
Epsom salts or sulphate of zinc; oxalic acid has been
taken in mistake for the former. It is in common use
for cleansing brass, in laundry work, for dyeing purposes,
and especially for bleaching straw hats.</p>
<p><i>Symptoms.</i>—If a concentrated solution be taken, it acts
as a corrosive, causing a burning acid, intensely sour
taste, which comes on immediately, great pain and<span class="pagenum"><SPAN name="page99" id="page99">[99]</SPAN></span>
tenderness and burning at pit of stomach, pain and
tightness in throat. Vomiting of mucus, bloody or dark
coffee-ground matters, purging and tenesmus, followed
by collapse, feeble pulse, cyanosis and pallor of the
skin; also swelling of tongue, with dysphagia. In some
cases cramps and numbness in limbs, pain in head and
back, delirium and convulsions. May be tetanus or
coma. If taken freely diluted, the nervous symptoms
predominate, and may resemble narcotic poisoning.
Sometimes almost instant death.</p>
<p><i>Post-Mortem Appearances.</i>—Mucous membrane of
mouth, throat, and gullet, white and softened, as if they
had been boiled; there are often black or brown streaks
in it. Stomach contains dark, grumous matter, and is
soft, pale, and brittle. Intestines slightly inflamed,
stomach sometimes quite healthy.</p>
<p><i>Treatment.</i>—Warm water, then chalk, carbonate of
magnesium, or lime-water, freely. Not alkalies, as the
oxalates of the alkalies are soluble and poisonous. Castor-oil.
Emetics, but not stomach-pump.</p>
<p><i>Fatal Dose.</i>—One drachm is the smallest, but half an
ounce is usually fatal.</p>
<p><i>Method of Extraction from the Stomach.</i>—Mince up the
coats of the stomach and boil them in water, or boil the
contents of the stomach and subject them to dialysis.
Concentrate the distilled water outside the tube containing
the vomited matters, etc., and apply tests.</p>
<p><i>Tests.</i>—White precipitate with nitrate of silver, soluble
in nitric acid and ammonia. When the precipitate is
dried and heated on platinum-foil, it disperses as white
vapour with slight detonation. Sulphate of lime in excess
gives a white precipitate, soluble in nitric or hydrochloric
acid, but insoluble in oxalic, tartaric, acetic, or any
vegetable acid.</p>
<p><b>Oxalate or Binoxalate of Potash</b> (salts of sorrel or
salts of lemon) is almost as poisonous as the acid itself.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page100" id="page100">[100]</SPAN></span></p>
<h2><SPAN name="chapterxiv_2" id="chapterxiv_2"></SPAN>XIV.—CARBOLIC ACID</h2>
<p><b>Carbolic Acid, Phenic Acid, or Phenol</b>, is largely
employed as a disinfectant, and is often supplied in
ordinary beer-bottles without labels.</p>
<p><i>Symptoms.</i>—An intense burning pain extending from
the mouth to the stomach and intestines. Indications
of collapse soon supervene. The skin is cold and clammy,
and the lips, eyelids, and ears, are livid. This is followed
by insensibility, coma, stertorous breathing, abolition of
reflex movements, hurried and shallowed respiration,
and death. The pupils are usually contracted, and the
urine, if not suppressed, is dark in colour, or even black.
Patients often improve for a time, and then die suddenly
from collapse. When the poison has been absorbed
through the skin or mucous membranes, a mild form of
delirium, with great weakness and lividity, are the first
signs.</p>
<p><i>Post-Mortem.</i>—If strong acid has been swallowed, the
lips and mucous membranes are hardened, whitened,
and corrugated. In the stomach the tops of the folds
are whitened and eroded, while the furrows are intensely
inflamed.</p>
<p><i>Treatment.</i>—Soluble sulphates which form harmless
sulpho-carbolates in the blood should be administered
at once. An ounce of Epsom salts or of Glauber's salts
dissolved in a pint of water will answer the purpose
admirably. After this an emetic of sulphate of zinc may
be given. White of egg and water or olive-oil may prove
useful. Warmth should be applied to the body.</p>
<p><i>Fatal Dose.</i>—One drachm, but recovery has taken
place after much larger quantities, if well diluted or
taken after a meal.</p>
<p><i>Tests</i> are not necessary, as the smell of carbolic acid
is characteristic.</p>
<p><i>Local action</i> of carbolic acid produces anæsthesia and
<span class="pagenum"><SPAN name="page101" id="page101">[101]</SPAN></span>
necrosis. Accidents sometimes happen from too strong
lotions applied as surgical dressings.</p>
<p><b>Lysol</b> is a compound of cresol and linseed-oil soap,
and is much less toxic than carbolic acid.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxv_2" id="chapterxv_2"></SPAN>XV.—POTASH, SODA, AND AMMONIA</h2>
<p><b>Caustic Potash</b> occurs in cylindrical sticks, is soapy
to the touch, has an acrid taste, is deliquescent, fusible
by heat, soluble in water. <b>Liquor Potassæ</b> is a strong
solution of caustic potash, and has a similar reaction.
<b>Carbonate of Potassium</b>, also known as potash, pearlash,
salt of tartar, is a white crystalline powder, alkaline and
caustic in taste, and very deliquescent. The bicarbonate
is in colourless prisms, which have a saline, feebly
alkaline taste, and are not deliquescent.</p>
<p><i>Symptoms.</i>—Acrid soapy taste in mouth, burning in
throat and gullet, acute pain at pit of stomach, vomiting
of bloody or brown mucus, colicky pains, bloody stools,
surface cold, pulse weak. These preparations are not
volatile, so that there is not much fear of lung trouble.
In chronic cases death occurs from stricture of the
œsophagus causing starvation.</p>
<p><i>Post-Mortem Appearances.</i>—Soapy feeling, softening,
inflammation, and corrosion of mucous membrane of
mouth, pharynx, œsophagus, stomach, and intestines.
Inflammation may have extended to larynx.</p>
<p><i>Method of Extraction from the Stomach.</i>—If the contents
of the stomach have a strong alkaline action,
dilute with water, filter, and apply tests.</p>
<p><i>Tests.</i>—The carbonates effervesce with an acid. The
salts give a yellow precipitate with platinum chloride,
and a white precipitate with tartaric acid. They are
not dissipated by heat, and give a violet colour to the
deoxidizing flame of the blowpipe. Stains on dark
clothing are red or brown.</p>
<p><i>Treatment.</i>—Vinegar and water, lemon-juice and
<span class="pagenum"><SPAN name="page102" id="page102">[102]</SPAN></span>
water, acidulated stimulant drinks, oil, linseed-tea,
opium to relieve pain, stimulants in collapse. Do not
use the stomach-tube. The glottis may be inflamed,
and if there is danger of asphyxia, tracheotomy may
have to be performed.</p>
<p><b>Carbonate of Sodium</b> occurs as <i>soda</i> and <i>best soda</i>,
the former in dirty crystalline masses, the latter of a
purer white colour. It is also found as 'washing soda.'</p>
<p><i>Symptoms, Post-Mortem Appearances, Treatment, and
Extraction from the Stomach.</i>—As for potash.</p>
<p><i>Tests.</i>—Alkaline reaction, effervesces and evolves carbonic
acid when treated with an acid; crystallizes, gives
yellow tinge to blowpipe flame. No precipitate with
tartaric acid, nor with bichloride of platinum.</p>
<p><b>Ammonia</b> may be taken as <i>liquor ammoniæ</i> (harts-horn),
as carbonate of ammonium, as 'Cleansel,' or as
'Scrubb's Cloudy Ammonia.'</p>
<p><i>Symptoms.</i>—Being volatile, it attacks the air-passages,
nose, eyes and lungs, being immediately affected; profuse
salivation; lips and tongue swollen, red, and glazed.
The urgent symptoms are those of suffocation.</p>
<p>Inhalation of the fumes of strong ammonia may lead
to death from capillary bronchitis or broncho-pneumonia.
Death may result from inflammation of the larynx and
lungs. When swallowed in solution, the symptoms are
similar to those of soda and potash.</p>
<p><i>Post-Mortem Appearances.</i>—Similar to other corrosives.</p>
<p><i>Method of Extraction from the Stomach.</i>—The contents
of the stomach, etc., must be first distilled, the gas being
conveyed into water free from ammonia.</p>
<p><i>Tests.</i>—Nessler's reagent is the most delicate, a
reddish-brown colour or precipitate being produced,
but ammonia may be recognized by its pungent odour,
dense fumes given off with hydrochloric acid, and strong
alkaline reaction.</p>
<p><i>Treatment.</i>—Vinegar and water. Other treatment
according to symptoms.<span class="pagenum"><SPAN name="page103" id="page103">[103]</SPAN></span></p>
<p><i>Fatal Dose.</i>—One drachm of strong solution.</p>
<p><i>Fatal Period (Shortest).</i>—Four minutes.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxvi_2" id="chapterxvi_2"></SPAN>XVI.—INORGANIC IRRITANTS</h2>
<p><b>Nitrate of Potassium (Nitre, Saltpetre)—Bitartrate
of Potassium (Cream of Tartar)—Alum (Double Sulphate
of Alumina and Potassium)—Chlorides of
Lime, Sodium, and Potassium.</b>—All these are irritant
drugs, and give the usual symptoms.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxvii_2" id="chapterxvii_2"></SPAN>XVII.—CHLORATE OF POTASSIUM, ETC.</h2>
<p><b>Chlorate of Potassium</b> produces irritation of stomach
and bowels; hæmaturia; melæna; cyanosis, weakness,
delirium, and coma.</p>
<p><i>Post-Mortem.</i>—Blood is chocolate-brown in colour,
and so are all the internal organs; gastro-enteritis;
nephritis.</p>
<p><i>Tests.</i>—Spectroscope shows blood contains methæmoglobin;
the drug discharges the colour of indigo in acid
solution with SO<sub>2</sub>.</p>
<p><i>Treatment.</i>—Transfusion of blood or saline fluid;
stimulants.</p>
<p><b>Sulphuret of Potassium</b> (liver of sulphur) occurs in
mass or powder of a dirty green colour; has a strong
smell of sulphuretted hydrogen.</p>
<p><i>Symptoms.</i>—Of acute irritant poisoning, with stupor or
convulsions. Excreta smell of sulphuretted hydrogen.</p>
<p><i>Post-Mortem Appearances.</i>—Stomach and duodenum
reddened, with deposits of sulphur. Lungs congested.</p>
<p><i>Treatment.</i>—Chloride of sodium or lime in dilute solution,
and ordinary treatment for irritant poisoning.</p>
<p><i>Fatal Period (Shortest).</i>—Fifteen minutes.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page104" id="page104">[104]</SPAN></span></p>
<h2><SPAN name="chapterxviii_2" id="chapterxviii_2"></SPAN>XVIII.—BARIUM SALTS</h2>
<p><b>Chloride of Barium</b> occurs crystallized in irregular
plates, like magnesium sulphate, soluble in water and
bitter in taste. <b>Carbonate of Barium</b> is found in shops
as a fine powder, tasteless and colourless, insoluble in
water, but effervescing with dilute acids, and readily
decomposed by the free acids of the stomach. <b>Nitrate
of Barium</b> occurs in octahedral crystals, soluble in
water.</p>
<p><i>Method of Extraction from the Stomach.</i>—Dialysis as
for other soluble poisons.</p>
<p><i>Tests.</i>—Precipitated from its solutions by potassium
carbonate or sulphuric acid. Burnt on platinum-foil, it
gives a green colour to the flame.</p>
<p><i>Symptoms.</i>—Besides those of irritants generally, violent
cramps and convulsions, headache, debility, dimness of
sight, double vision, noises in the ears, and beating at
the heart. The salts of barium are also cardiac poisons.</p>
<p><i>Post-Mortem Appearances.</i>—As of irritants generally.
Stomach may be perforated.</p>
<p><i>Treatment.</i>—Wash out stomach with a solution of
sodium or magnesium sulphate, or of alum, and give
stimulants by the mouth and hypodermically.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxix_2" id="chapterxix_2"></SPAN>XIX.—IODINE—IODIDE OF POTASSIUM</h2>
<p><b>Iodine</b> occurs in scales of a dark bluish-black colour.
It strikes blue with solution of starch, and stains the skin
and intestines yellowish-brown. Liquid preparations,
as the liniment or tincture, may be taken accidentally or
suicidally.</p>
<p><i>Symptoms.</i>—Acrid taste, tightness of throat, epigastric
pain, and then symptoms of irritant poisons generally.
Chronic poisoning (iodism) is characterized by coryza,
salivation, and lachrymation, frontal headache, loss of
<span class="pagenum"><SPAN name="page105" id="page105">[105]</SPAN></span>
appetite, marked mental depression, acne of the face
and chest, and a petechial eruption on the limbs.</p>
<p><i>Post-Mortem Appearances.</i>—Those of irritant poisoning
with corrosion, and staining of a dark brown or yellow
colour.</p>
<p><i>Treatment.</i>—Stomach-pump and emetics, carbonate of
sodium, amylaceous fluids, gruel, arrowroot, starch, etc.</p>
<p><i>Analysis of Organic Mixture containing Iodine.</i>—Add
bisulphide of carbon, and shake. The iodine may be
obtained on evaporation as a sublimate. It will be recognized
by the blue colour which it gives with starch.</p>
<p><b>Iodide of Potassium.</b>—Colourless, generally opaque,
cubic crystals, soluble in less than their weight of cold
water.</p>
<p><i>Symptoms.</i>—Not an active poison, but even small
doses sometimes produce the effects of a common cold,
including those symptoms already mentioned as occurring
with iodine.</p>
<p><i>Analysis.</i>—Iodide of potassium in solution gives a
bright yellow precipitate with lead salts; a bright
scarlet with corrosive sublimate; and a blue colour with
sulphuric or nitric acid and starch.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxx_2" id="chapterxx_2"></SPAN>XX.—PHOSPHORUS</h2>
<p><b>Phosphorus</b> is usually found in small, waxy-looking
cylinders, which are kept in water to prevent oxidation.
It may also occur as the amorphous non-poisonous
variety, a red opaque infusible substance, insoluble in
carbon disulphide. Ordinary phosphorus is soluble in
oil, alcohol, ether, chloroform, and carbon disulphide;
insoluble in water. It is much used in rat poisons, made
into a paste with flour, sugar, fat, and Prussian blue.
Yellow phosphorus is not allowed to be used in the
manufacture of lucifer matches, and the importation of
such is prohibited. In 'safety' matches the amorphous
phosphorus is on the box.<span class="pagenum"><SPAN name="page106" id="page106">[106]</SPAN></span></p>
<p><i>Symptoms.</i>—At first those of an irritant poison, but
days may elapse before any characteristic symptoms
appear, and these may be mistaken for those of acute
yellow atrophy of the liver. The earliest signs are a
garlicky taste in the mouth and pain in the throat and
stomach. Vomited matter luminous in the dark, bile-stained
or bloody, with garlic-like odour. Great prostration,
diarrhœa, with bloody stools. Harsh, dry, yellow
skin, purpuric spots with ecchymoses under the skin
and mucous membranes, retention or suppression of
urine, delirium, convulsions, coma, and death. Usually
there are remissions for two to three days, then jaundice
comes on, with enlargement of the liver; hæmorrhages
from the mucous surfaces and under the skin; later,
coma and convulsions. In chronic cases there is fatty
degeneration of most of the organs and tissues of the
body. The inhalation of the fumes of phosphorus, as in
making vermin-killers, etc., gives rise to 'phossy-jaw.'</p>
<p><i>Post-Mortem Appearances.</i>—Softening of the stomach,
hæmorrhagic spots on all organs and under the skin,
fatty degeneration of liver, kidneys, and heart, blood-stained
urine, phosphorescent contents of alimentary
canal.</p>
<p><i>Treatment.</i>—Early use of stomach-pump and emetics,
followed by the administration of permanganate of
potassium or peroxide of hydrogen to oxidize the phosphorus.
Oil should not be given. Sulphate and carbonate
of magnesium, mucilaginous drinks. Sulphate
of copper is a valuable antidote, both as an emetic and
as forming an insoluble compound with phosphorus.</p>
<p><i>Fatal Dose.</i>—One grain and a half.</p>
<p><i>Fatal Period.</i>—Four hours; more commonly two to
four days.</p>
<p><i>Detection of Phosphorus in Organic Mixtures.</i>—Mitscherlich's
method is the best. Introduce the suspected
material into a retort. Acidulate with sulphuric acid to
fix any ammonia present. Distil in the dark, through a
<span class="pagenum"><SPAN name="page107" id="page107">[107]</SPAN></span>
glass tube kept cool by a stream of water. As the vapour
passes over and condenses, a flash of light is perceived,
which is the test.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxi_2" id="chapterxxi_2"></SPAN>XXI.—ARSENIC AND ITS PREPARATIONS</h2>
<p><b>Arsenic</b> is the most important of all the metallic
poisons. It is much used in medicine and the arts. It
occurs as metallic arsenic, which is of a steel-grey
colour, brittle, and gives off a garlic-like odour when
heated; as arsenious acid; in the form of two sulphides—the
red sulphide, or realgar, and the yellow sulphide,
or orpiment; and as arsenite of copper, or Scheele's
green. It also exists as an impurity in the ores of
several metals—iron, copper, silver, tin, zinc, nickel, and
cobalt. Sulphuric acid is frequently impregnated with
arsenic from the iron pyrites used in preparing the acid.
It is a constituent of many rat pastes, vermin or weed
killers, complexion powders, sheep dips, etc.</p>
<p><b>Arsenious Acid</b> (White Arsenic, Trioxide of Arsenic).—Colourless,
odourless, and almost tasteless. It occurs
in commerce as a white powder or in a solid cake, which
is at first translucent, but afterwards becomes opaque.
Slightly soluble in cold water; 1 ounce of water dissolves
about 1/2 grain of arsenic. Fowler's solution is the
best-known medicinal preparation of arsenic, and contains
1 grain of arsenious anhydride in 110 minims.</p>
<p><i>Symptoms.</i>—Commence in from half to one hour.
Faintness, nausea, incessant vomiting, epigastric pain,
headache, diarrhœa, tightness and heat of throat and
fauces, thirst, catching in the breath, restlessness,
debility, cramp in the legs, and convulsive twitchings.
The skin becomes cold and clammy. In some cases the
symptoms are those of collapse, with but little pain,
vomiting, or diarrhœa. In others the patient falls into a
deep sleep, while in the fourth class the symptoms resemble
closely those of English cholera. The vomited<span class="pagenum"><SPAN name="page108" id="page108">[108]</SPAN></span>
matters are often blue from indigo, or black from soot, or
greenish from bile, mixed with the poison. Should the
patient survive some days, no trace of arsenic may be
found in the body, as the poison is rapidly eliminated by
the kidneys. In all suspected cases the urine should be
examined.</p>
<p>The symptoms of <i>chronic</i> poisoning by arsenic are loss
of appetite, silvery tongue, thirst, nausea, colicky pains,
diarrhœa, headache, languor, sleeplessness, cutaneous
eruptions, soreness of the edges of the eyelids, emaciation,
falling out of the hair, cough, hæmoptysis, anæmia,
great tenderness on pressure over muscles of legs and
arms, due to peripheral neuritis, and convulsions.</p>
<p>Pigmentation is common; the face becomes dusky red,
the rest of the body a dark brown shade. This darkening
is most marked in situations normally pigmented and
in parts exposed to pressure of the clothes, such as the
neck, axilla, and inner aspect of the arms, the extensor
aspects being less marked than the flexor. The pigmentation
resembles the bronzing of Addison's disease, but
there are no patches on the mucous membranes, and the
normal rosy tint of the lips is not altered. The skin
over the feet may show marked hyperkeratosis.</p>
<p>The nervous system is notably affected. The sensory
symptoms appear first: numbness and tingling of the
hands and feet, pain in the soles of the feet on walking,
pain on moving the joints, and erythromelalgia. Then
come the motor symptoms, with drop-wrist and drop-foot.
The patient suffers severely from neuritis, and
there may be early loss of patellar reflex. The nervous
symptoms come on later than the cutaneous manifestations.</p>
<p><i>Post-Mortem Appearances.</i>—Signs of acute inflammation
of stomach, duodenum, small intestines, colon, and
rectum. Stomach may contain dark grumous fluid, and
its mucous coat presents the appearance of crimson
velvet. Ulceration is rare, and cases of perforation still
<span class="pagenum"><SPAN name="page109" id="page109">[109]</SPAN></span>
less common, the patient dying before it occurs. If life
has been preserved for some days, there is extensive
fatty degeneration of the organs. There may be entire
absence of <i>post-mortem</i> signs. Putrefaction of the body
is retarded by arsenic.</p>
<p><i>Treatment.</i>—The stomach-pump, emetics, then milk,
milk and eggs, oil and lime-water. Inflammatory
symptoms, collapse, coma, etc., must be treated on
ordinary principles. As an antidote, the best when the
poison is in solution is the hydrated sesquioxide of iron,
formed by precipitating tinctura ferri perchloridi with
excess of ammonia, or carbonate of soda. This is
filtered off through muslin and given in tablespoonful
doses. It forms ferric arsenate, which is sparingly
soluble. Colloidal iron hydroxide may be used instead.
Dialyzed iron in large quantities is efficacious.</p>
<p><i>Fatal Dose (Smallest).</i>—Two grains. Exceptionally,
recovery from very large doses if rejected by
vomiting.</p>
<p><i>Fatal Period (Shortest).</i>—Twenty minutes. Exceptionally,
death as late as the sixteenth day. The effects
of arsenic are modified by tolerance, some persons
being able to take considerable quantities. The peasants
of Styria are in the habit of eating it.</p>
<p><i>Method of Extraction from the Stomach.</i>—The coats
of the stomach should be examined with a lens for any
white particles. These, if present, may be collected,
mixed with a little charcoal in a test-tube, and heated.
If arsenic is present, a metallic ring will be formed in
the cooler parts of the tube. If this ring be also heated,
octahedral crystals of arsenic will be deposited farther
up the tube, and are easily recognized by the microscope.
The contents of the stomach, or the solid organs minced
up, should be boiled with pure hydrochloric acid and
water, then filtered. The filtrate can then be subjected
to Marsh's or Reinsch's process.</p>
<p><i>Tests.</i>—In <i>solution</i>, arsenic may be detected by the liquid
<span class="pagenum"><SPAN name="page110" id="page110">[110]</SPAN></span>
tests. (1) Ammonio-nitrate of silver gives a yellow precipitate
(arsenite of silver). (2) Ammonio-sulphate of
copper gives a green precipitate (Scheele's green).
(3) Sulphuretted hydrogen water gives a yellow precipitate.</p>
<p><i>Marsh's Process.</i>—Put pure distilled water into a
Marsh's apparatus with metallic zinc and sulphuric acid.
Hydrogen is set free, and should be tested by lighting
the issuing gas and depressing over it a piece of white
porcelain. If no mark appears, the reagents are pure,
and the suspected liquid may now be added. The
hydrogen decomposes arsenious acid, and forms arseniuretted
hydrogen. The gas carried off by a fine tube is
again ignited. A piece of glass or porcelain held to the
flame will have, if arsenic be present, a deposit on it
having the following characters: In the centre a deposit
of metallic arsenic, round this a mixture of metallic
arsenic and arsenious acid, and outside this another ring
of arsenious acid in octahedral crystals. The deposit
is dissolved by a solution of chloride of lime, turned
yellow by sulphide of ammonium after evaporation;
on the addition of strong nitric acid, evaporated and
neutralized with ammonia and nitrate of silver added,
a brick-red colour is produced—arseniate of silver.</p>
<p><i>Reinsch's Process.</i>—Boil distilled water with one-sixth
or one-eighth of hydrochloric acid, and introduce a slip
of bright copper. If, after a quarter of an hour's boiling,
there is no stain on the copper, add the suspected liquid.
If arsenic be present, it will form an iron-grey deposit.
If this foil be dried, cut up, put in a reduction-tube, and
heated, crystals of arsenious trioxide will be deposited
on the cold part of the tube.</p>
<p>These tests are difficult to apply, but as arsenic is
a ubiquitous poison, and as there are many sources of
fallacy, it would be well, when possible, to obtain the
services of an expert.</p>
<p><i>Biological Test.</i>—Put the substance to be tested into a
<span class="pagenum"><SPAN name="page111" id="page111">[111]</SPAN></span>
flask with some small pieces of bread, sterilize for half
an hour at 120° C. When cold, inoculate with a culture
of <i>Penicillium brevicaule</i>, and keep at a temperature of
37° C. If arsenic is present, a garlic-like odour is noticed
in twenty four hours, due to arseniuretted hydrogen or
an organic combination of arsenic. This test is delicate,
and will detect 1/1000 of a milligramme, but it is not
quantitative.</p>
<p><b>Other Preparations of Arsenic.</b>—These are arsenite
of potash (Fowler's solution), cacodylate of sodium, and
arsenite of copper (Scheele's green), the last frequently
used for colouring dresses and wall-papers. Persons
using these preparations may suffer from catarrhal
symptoms, rashes on the neck, ears, and face, thirst,
nausea, pain in stomach, vomiting, headache, perhaps
peripheral neuritis and loss of patellar reflex. The cacodylates,
although formerly employed in the treatment of
phthisis, should be used with the utmost caution. The
arsenites give the reactions of arsenious acid.</p>
<p>Arsenic is eliminated not only by the kidneys and
bowels, but by the skin, and in women by the menses.
It may be detected in the sweat, the saliva, the bronchial
secretion, and, during lactation, in the milk.</p>
<p>The sale of arsenic and its preparations to the public
is properly hedged round with restrictions of all kinds.
It is included in Part I. of the Poisons and Pharmacy
Act (8 Edward VII., c. 55). No arsenic may be sold to
a person under age, nor may it be sold unless mixed
with soot or indigo in the proportion of 1 ounce of soot or
1/2 ounce of indigo at the least to every pound of arsenic.</p>
<p><b>Arseniuretted Hydrogen</b> (arsine, AsH<sub>3</sub>) is an extremely
poisonous gas, and is evolved in various chemical
and manufacturing processes. When damp, <i>Ferro-silicon</i>
evolves AsH<sub>3</sub> and PH<sub>3</sub>, both very lethal gases.
<i>Ferrochrome</i> is used in making steel, and it also evolves
PH<sub>3</sub>, and in such extreme dilution as 0.02 per cent.
may cause death.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page112" id="page112">[112]</SPAN></span></p>
<h2><SPAN name="chapterxxii_2" id="chapterxxii_2"></SPAN>XXII.—ANTIMONY AND ITS PREPARATIONS</h2>
<p><b>Tartar Emetic</b> (tartarized antimony, potassio-tartrate
of antimony) occurs as a white powder, or in yellowish-white
efflorescent crystals. Vinum antimoniale contains
2 grains to a fluid ounce of the wine.</p>
<p><i>Symptoms.</i>—Metallic taste, rapidly followed by nausea,
incessant vomiting, burning heat and pain in stomach,
purging. Dysphagia, sense of constriction in throat,
intense thirst, cramps, faintness, profound depression;
in fatal cases, giddiness and tetanic spasms. In <i>chronic
poisoning</i>, nausea, vomiting and purging, weak pulse,
loss of appetite, debility, cold sweats, great prostration,
progressive emaciation. The symptoms in chronic
poisoning may simulate gastritis or enteritis. Externally
applied, it produces an eruption not unlike that of
smallpox.</p>
<p><i>Post-Mortem Appearances.</i>—Inflammation, softening,
and an aphthous condition of the throat, gullet, and
stomach, the last reddened in patches. In chronic
poisoning, inflammation also of cæcum and colon.
Brain and lungs may be congested. Decomposition is
hindered for long.</p>
<p><i>Treatment.</i>—Promote vomiting by warm greasy water,
or the stomach-tube may be used. Cinchona bark or
any preparation containing tannin, as tea, decoction of
oak bark, etc. Morphine to allay pain.</p>
<p><i>Fatal Dose.</i>—In an adult 2 grains (same as arsenic).</p>
<p><i>Fatal Period.</i>—Death follows in eight to twelve hours,
from exhaustion.</p>
<p><i>Method of Extraction from the Stomach.</i>—The contents
of the stomach or its coats should be finely cut up and
boiled in water, acidulated with tartaric acid and subjected
to dialysis, or strained and filtered. Pass hydrogen
sulphide through the filtered or dialyzed fluid until a
precipitate ceases to fall; collect the sulphide thus
formed, wash and dry it. Boil the orange-coloured
<span class="pagenum"><SPAN name="page113" id="page113">[113]</SPAN></span>
sulphide in a little hydrochloric acid. If the solution be
now added to a large bulk of water, the white oxychloride
is precipitated, which is soluble in tartaric acid and
precipitated orange yellow with hydrogen sulphide.
The chloride of bismuth is also precipitated white, but
the precipitate is not soluble in tartaric acid, and the
precipitate with hydrogen sulphide is black.</p>
<p><i>Tests.</i>—Soluble in water, but not in alcohol.</p>
<p>Heated in substance, it crepitates and chars; and if
heat be increased, the metal is deposited. Treated with
sulphuretted hydrogen, a characteristic orange-red sulphide
is formed.</p>
<p>A drop of the solution evaporated leaves crystals,
either tetrahedric, or cubes with edges bevelled off.
Sulphuretted hydrogen passed through gives the orange-red
precipitate above named. Dilute nitric acid gives
a white precipitate, soluble in excess, and also in tartaric
acid. Marsh's and Reinsch's processes are applicable
for the detection of antimony, but Reinsch's is the
better. Reinsch's process gives a violet deposit instead
of the black, lustrous one of arsenic.</p>
<p><b>Chloride of Antimony</b> (Butter of Antimony).—A light
yellow or dark red corrosive liquid.</p>
<p><i>Symptoms.</i>—Violet corrosion and irritation of the
alimentary canal, with the addition of narcotic symptoms.
After death the mucous membrane of the entire canal is
charred, softened, and abraded.</p>
<p><i>Treatment.</i>—As for tartar emetic; magnesia in milk.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxiii_2" id="chapterxxiii_2"></SPAN>XXIII.—MERCURY AND ITS PREPARATIONS</h2>
<p>The most important salt of mercury, toxicologically,
is corrosive sublimate. Other poisonous preparations
are red precipitate, white precipitate, mercuric nitrate,
the cyanide and potassio-mercuric iodide. Calomel
has very little toxic action. Metallic mercury is not
poisonous, but its vapour is.<span class="pagenum"><SPAN name="page114" id="page114">[114]</SPAN></span></p>
<p><b>Corrosive Sublimate</b> (perchloride of mercury) is in
heavy colourless masses of prismatic crystals, possessing
an acrid, metallic taste. It is soluble in sixteen parts of
cold and two of boiling water. Soluble in alcohol and
ether, the latter also separating it from its solution in
water.</p>
<p><i>Symptoms</i> come on rapidly. Acrid, metallic taste,
constriction and burning in throat and stomach, nausea,
vomiting of stringy mucus tinged with blood, tenesmus,
purging. Feeble, quick, and irregular pulse, dysuria
with scanty, albuminous or bloody urine or total suppression.
Cramp, twitches and convulsions of limbs,
occasionally paralysis. In poisoning from the medicinal
use of mercury, there may be salivation, a coppery taste
in the mouth, peculiar fœtor of breath, tenderness and
swelling of mouth, inflammation, swelling and ulceration
of gums (cancrum oris), a blue line on the gums, and
the loosening of teeth. Mercury is less quickly eliminated
from the body than arsenic. In chronic cases 'mercurialism,'
'hydrargyrism,' 'ptyalism,' or 'salivation,'
including most of the symptoms enumerated above.
May get <i>eczema mercuriale</i> and periostitis. Profound
anæmia often a prominent symptom; neuritis not uncommon.
If fumes of mercury inhaled, mercurial
tremors develop.</p>
<p><i>Post-Mortem Appearances.</i>—Corrosion, softening, and
sloughing ulceration of stomach and intestines. The
mucous membrane of the œsophagus and stomach is
often of a bluish-grey colour. The large intestine and
rectum are often ulcerated and gangrenous. Inflamed
condition of urinary organs, with contraction of the
bladder.</p>
<p><i>Treatment.</i>—Encourage or produce vomiting. Albumin,
as white of egg, gluten, or wheat flour, is the best
antidote. Demulcent drinks, milk, and ice. Stomach-tube
to be used with care, owing to softened state of
gullet and stomach.<span class="pagenum"><SPAN name="page115" id="page115">[115]</SPAN></span></p>
<p><i>Fatal Dose.</i>—Three grains in a child.</p>
<p><i>Fatal Period.</i>—Half an hour the shortest.</p>
<p><i>Method of Extraction from the Stomach.</i>—A trial test
may be made of the contents of the stomach with
copper-foil. If mercury is found, the contents of the
stomach may be dialyzed, the resulting clear fluid concentrated
and shaken with ether, which has the power
of taking corrosive sublimate up, and thus separating it
from arsenic and other metallic poisons. The ether
allowed to evaporate will leave the corrosive sublimate
in white silky-looking prisms. Suppose no mercury is
found in the dialyzed fluid, owing to the fact that corrosive
sublimate enters into insoluble compounds with
albumin, fibrin, mucous membrane, gluten, tannic acid,
etc., we must dry the insoluble matter, and heat it with
nitro-hydrochloric acid until all organic matter is destroyed
and excess of nitric acid expelled. The residue
dissolved in water, filtered, and tested with copper-foil,
etc.</p>
<p><i>Tests.</i>—The following table gives the action of corrosive
sublimate with reagents:</p>
<table style="margin-left: 5%; margin-right: 5%;" summary="action of corrosive sublimate with reagents">
<tr><td>1. With iodide of potassium</td><td>Bright scarlet colour.</td></tr>
<tr><td>2. With potash solution</td><td>Bright yellow colour.</td></tr>
<tr><td>3. With hydrochloric acid and sulphuretted hydrogen</td>
<td>First a yellowish and then a black colour.</td></tr>
<tr><td>4. Heated in a reduction-tube</td>
<td>Melts, boils, is volatilized, and forms
a white crystalline sublimate.</td></tr>
<tr><td>5. With ether</td>
<td>Freely soluble; the ethereal solution,
when allowed to evaporate
spontaneously, deposits the salt in
white prismatic crystals.</td></tr>
<tr><td>6. Heated with carbonate of sodium in a reduction-tube</td>
<td>Globules of metallic mercury are produced.</td></tr>
</table>
<p>A very simple process for detecting corrosive sublimate
is to put a drop of the suspected solution on a sovereign
<span class="pagenum"><SPAN name="page116" id="page116">[116]</SPAN></span>
and touch the gold through the solution with a key, when
metallic mercury will be deposited on the gold.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxiv_2" id="chapterxxiv_2"></SPAN>XXIV.—LEAD AND ITS PREPARATIONS</h2>
<p><b>Acetate of Lead</b> (Sugar of Lead).—A glistening white
powder or crystalline mass. Soluble in water, with a
sweetish taste. It is practically the only lead salt which
gives rise to acute symptoms, and only when taken in
large doses.</p>
<p><i>Symptoms.</i>—Metallic taste, dryness in throat, intense
thirst, vomiting, colicky pains, cramps, cold sweat, <i>constipation</i>
and scanty urine, severe headache, convulsions.</p>
<p><i>Chronic lead-poisoning</i> is liable to occur in those who
handle lead in any form—white-lead workers, paint
manufacturers, plumbers, pottery workers, etc.</p>
<p>In chronic lead-poisoning the most prominent symptoms
are a blue line on the gums, anæmia, emaciation,
pallor, quick pulse, persistent constipation, colic, cramps
in limbs, and paralysis of the extensor muscles, causing
'dropped hand.' May get <i>saturnine encephalopathies</i>,
of which intense headache, optic neuritis, and epileptiform
convulsions, are the most common. Albumin in
urine, tendency to gout, and in women to abortion.</p>
<p><i>Post-Mortem Appearances.</i>—Inflamed mucous membrane
of stomach and intestines, with layers of white or
whitish-yellow mucus, impregnated with the salt of lead.</p>
<p><i>Treatment.</i>—Sulphate of sodium or magnesium, or a
mixture of dilute sulphuric acid, spirits of chloroform,
and peppermint-water. Milk, or milk and eggs. As a
prophylactic among workers in lead, a drink containing
sulphuric acid flavoured with treacle should be given.
Lavatory accommodation should be provided, and
scrupulous cleanliness should also be enjoined in the
workshops. The dry grinding of lead salts should be
prohibited. The ionization method of Sir Thomas Oliver
<span class="pagenum"><SPAN name="page117" id="page117">[117]</SPAN></span>
is most useful both as regards cure and also prevention
of chronic poisoning by lead.</p>
<p><i>Fatal Dose and Fatal Period.</i>—Uncertain.</p>
<p><i>Method of Extraction from the Stomach.</i>—Dry the
contents of the stomach or portions of the liver, etc.,
and incinerate in a porcelain crucible. Treat the ash
with nitric acid, dry, and dissolve in water. The solution
of nitrate of lead may now have the proper tests applied.</p>
<p><i>Tests.</i>—Sulphuretted hydrogen gives a black precipitate;
liquor potassæ, white precipitate; sulphuric acid,
white precipitate, insoluble in nitric acid; iodide of
potassium, a bright yellow precipitate. A delicate test
for lead in water is to stir the water, concentrated or
not, with a glass rod dipped in ammonium sulphide: a
brown coloration is produced. One-tenth of a grain of
lead in a gallon of water may be detected.</p>
<p>Chronic lead-poisoning is an 'industrial disease,' and,
being an occupation risk, its victims are entitled to compensation
at the hands of their employers. In case of
death, compensation has been awarded even when at
the autopsy the patient has been found to have suffered
from acute tuberculosis of the lungs. The responsibility
of apportioning the monetary value of disablement
resulting from the action of the lead rests with a judge
or jury, who are guided by the expert medical evidence
available.</p>
<p>Diachylon, or lead-plaster, is largely used as an abortifacient.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxv_2" id="chapterxxv_2"></SPAN>XXV.—COPPER AND ITS PREPARATIONS</h2>
<p>Poisoning with copper salts is rare. The most important
are the sulphate, subacetate, and arsenite.</p>
<p><b>Sulphate of Copper</b> (bluestone, blue vitriol) in half-ounce
doses is a powerful irritant. Has been given to
procure abortion.</p>
<p><b>Subacetate of Copper</b> (verdegris) occurs in masses,
<span class="pagenum"><SPAN name="page118" id="page118">[118]</SPAN></span>
or as a greenish powder. Powerful, astringent, metallic
taste. Half-ounce doses have proved fatal.</p>
<p><i>Symptoms.</i>—Epigastric pain, vomiting of bluish or
greenish matter, diarrhœa. Dyspnœa, depression, cold
extremities, headache, purple line round the gums.
Jaundice is common. A <i>chronic</i> form of poisoning may
occur, with symptoms closely resembling those of lead.</p>
<p><i>Post-Mortem Appearances.</i>—Inflammation of stomach
and intestines, which are bluish or green in colour.</p>
<p><i>Treatment.</i>—Encourage vomiting. Give albumin or
very dilute solution of ferrocyanide of potassium.</p>
<p><i>Method of Extraction from the Stomach.</i>—Boil the
contents of the stomach in water, filter, pass hydrogen
sulphide, filter, collect precipitate and boil in nitric acid,
filter, dilute filtrate with water and apply tests. In the
case of the solid organs, dry, incinerate, digest ash in
hydrochloric acid, evaporate nearly to dryness, dilute
with water, and test.</p>
<p><i>Tests.</i>—Polished steel put into a solution containing a
copper salt receives a coating of metallic copper. Ammonia
gives a whitish-blue precipitate, soluble in excess.
Ferrocyanide of potassium gives a rich red-brown precipitate.
Sulphuretted hydrogen gives a deep brown
precipitate.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxvi_2" id="chapterxxvi_2"></SPAN>XXVI.—ZINC, SILVER, BISMUTH, AND CHROMIUM</h2>
<p>The salts of zinc requiring notice are the sulphate
and chloride.</p>
<p><b>Sulphate of Zinc</b> has been taken in mistake for
Epsom salts. In large doses it causes dryness of throat,
thirst, vomiting, purging, and abdominal pain.</p>
<p><i>Post-Mortem Appearances.</i>—Those of inflammation of
digestive tract.</p>
<p><i>Treatment.</i>—Tea, decoction of oak-bark, carbonate of
potassium or sodium as antidote.<span class="pagenum"><SPAN name="page119" id="page119">[119]</SPAN></span></p>
<p><b>Chloride of Zinc.</b>—A solution containing this substance
(230 grains to the ounce) constitutes 'Burnett's
disinfecting fluid.' It is a corrosive poison.</p>
<p>The symptoms are burning sensation in the mouth,
throat, stomach, and abdomen, followed by vomiting,
diarrhœa, with tenesmus and distension of the abdomen.
The vomited matter contains shreds of mucous membrane
with blood. There is profound collapse, cold
surface, clammy sweats, weak pulse, with great prostration.
The <i>treatment</i> is to wash out the stomach with
large and weak solutions of carbonate of sodium.
Mucilaginous drinks may be given, and hypodermic
injections of morphine are useful to allay the pain.</p>
<p><i>Method of Extraction from the Stomach.</i>—Dry and
incinerate the tissues in a porcelain crucible, digest ash
in water, apply tests.</p>
<p><i>Tests.</i>—Ammonia, a white precipitate soluble in excess,
reprecipitated by sulphuretted hydrogen; ferrocyanide
of potassium, a white precipitate; sulphuretted hydrogen,
a white precipitate in pure and neutral solutions. Nitrate
of baryta will show the presence of sulphuric acid, and
nitrate of silver of hydrochloric acid.</p>
<p><b>Silver.</b>—Nitrate of silver is a powerful irritant.</p>
<p><i>Tests.</i>—Black precipitate with sulphuretted hydrogen;
white with hydrochloric acid.</p>
<p><i>Treatment.</i>—Common salt.</p>
<p>Chronic nitrate of silver poisoning is characterized by
<i>argyria</i>. The gums show a blue line, which is darker
than that produced by lead, and the skin presents a
greyish hue, which is permanent.</p>
<p><b>Bismuth.</b>—The bismuth salts are not poisonous, but
may contain arsenic as an impurity, although this is far
less common than it was some years ago.</p>
<p><b>Chromic Acid, Chromate, Bichromate of Potassium.</b>—These
act as corrosives when solid or in concentrated
liquid forms. In dilute solutions they act as irritants.
Used as dyes; have proved fatal more than once. Those
<span class="pagenum"><SPAN name="page120" id="page120">[120]</SPAN></span>
engaged in their manufacture suffer from unhealthy
ulcers on the nasal septum and hands. The former may
to some extent be prevented by taking snuff. Lead
chromate (chrome yellow) is a powerful irritant poison.
Two drachms of the bichromate caused death in four
hours.</p>
<p><i>Tests.</i>—Yellow precipitate with salts of lead, deep red
with those of silver.</p>
<p><i>Treatment.</i>—Emetics, magnesia, and diluents. Washing
out of the stomach with weak solution of nitrate of
silver.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxvii_2" id="chapterxxvii_2"></SPAN>XXVII.—GASEOUS POISONS</h2>
<p><b>Carbon Dioxide.</b>—Carbon dioxide is a product of
combustion and respiration, and is generated in many
ways during fermentation. It is a constituent of <i>choke
damp</i> due to explosions in coal-mines, and is given
off from lime-kilns, brick-kilns, and cement-works. It
is often met with in dangerous quantities in wells and in
brewers' vats. From 10 to 15 per cent. in the atmosphere
would prove fatal, but even 2 per cent. inhaled for long
would produce serious symptoms. The proportion
usually present in air is 0.04 per cent.</p>
<p><i>Symptoms.</i>—Inhalation of the <i>pure</i> gas causes spasm
of the glottis, insensibility, and death from asphyxia, at
once; <i>diluted</i>, causes sense of weight in forehead and
back of head, giddiness, vomiting, somnolence, loss of
muscular power. Insensibility, stertorous breathing,
lividity of face and body, and death from asphyxia.
Convulsions occasionally.</p>
<p><i>Post-Mortem Appearances.</i>—Face swollen and livid, or
calm and pale; lividity is most marked in eyelids, lips,
ears, etc.; limbs usually flaccid, abdomen distended;
right side of heart, lungs, and large veins, gorged with
dark-coloured blood. Brain and membranes congested.</p>
<p><i>Treatment.</i>—Pure air, cold affusion, stimulants, artificial
respiration, galvanism, inhalation of oxygen,
venesection, transfusion.<span class="pagenum"><SPAN name="page121" id="page121">[121]</SPAN></span></p>
<p><b>Carbonic Oxide.</b>—This is one of the most poisonous
of gases. It is evolved in the process of burning charcoal
and coke in stoves or furnaces. Water-gas, obtained by
passing steam over heated coke, contains 40 per cent. of
the substance, the remainder being chiefly hydrogen.
It forms the chief part of the deadly 'choke damp' after
an explosion in a mine. Two per cent. in the atmosphere
is immediately fatal.</p>
<p><i>Symptoms.</i>—When in <i>large amount</i>, insensibility comes
on at once; when in <i>very small amounts</i>, headache,
giddiness, noises in the ears, nausea, and vomiting, with
prostration, insensibility, and coma. There may be convulsions.
Even in cases which recover, permanent
impairment of the brain may result.</p>
<p><i>Post-Mortem Appearances.</i>—The blood is bright red in
colour, due to the interaction of carbonic oxide with
hæmoglobin. A rosy hue of the skin-surface and viscera
is often noticed. Bright red patches of colour are
found over the surface of the body. The spectrum of
the blood is characteristic.</p>
<p><i>Treatment.</i>—Ammonia to the nostrils, inhalation of
oxygen, cold douche in moderation, artificial respiration,
transfusion of blood.</p>
<p><b>Coal Gas.</b>—Coal gas contains light carburetted
hydrogen or marsh gas, olefiant gas, ammonia, sulphuretted
hydrogen, carbonic acid, carbonic oxide, free
hydrogen, and nitrogen. Coal gas has an offensive
odour, burns with a yellowish-white flame, yielding
water and carbonic acid. Cases of poisoning often due
to escape of gas into the room.</p>
<p><i>Symptoms.</i>—Headache and giddiness, foaming at
mouth, vomiting, convulsions, tetanic spasms, stertorous
breathing, dilated pupil. The breath smells of gas; there
is profound stupor; the patient, if alive, exhales gas from
the lungs when removed into a fresh room or into the
air. Smell of gas in the room and in patient's breath.</p>
<p><i>Post-Mortem Appearances.</i>—Pallor of skin and internal
<span class="pagenum"><SPAN name="page122" id="page122">[122]</SPAN></span>
tissues; florid colour of neck, back, and muscles, if much
CO present in the coal gas; fluid florid blood; infiltration
of lungs.</p>
<p><i>Treatment.</i>—Fresh air, artificial respiration, cold affusion,
diffusible stimulants; inhalation of oxygen freely.</p>
<p><b>Sulphuretted Hydrogen</b> is characterized by its odour,
like that of rotten eggs. It is extremely poisonous.</p>
<p><i>Symptoms.</i>—Giddiness, pain and oppression in
stomach, nausea, loss of power; delirium, tetanus, and
convulsions.</p>
<p><i>Post-Mortem Appearances.</i>—Fluid and black blood
(sulph-hæmoglobin), smell of H<sub>2</sub>S on opening the body;
loss of contractility of muscles, rapid putrefaction.</p>
<p><i>Treatment.</i>—Fresh air, stimulants, inhalation of
chlorine.</p>
<p><i>Tests.</i>—Acetate of lead throws down a brown or black
precipitate according to the quantity of the gas.</p>
<p><b>Sewer Gas.</b>—Cesspool emanations usually consist of
a mixture of sulphuretted hydrogen, sulphide of ammonium,
and nitrogen; but sometimes it is only
deoxidized air with an excess of carbonic acid gas.</p>
<p><i>Symptoms.</i>—If poison concentrated, death may ensue
at once; if gas diluted, or exposure only short, insensibility,
lividity, hurried respiration, weak pulse, dilated
pupils, elevation of temperature to 104°, tonic convulsions
not unlike those of tetanus.</p>
<p><i>Treatment.</i>—Fresh air, oxygen, with artificial respiration.
Stimulants, hypodermic of strychnine, and alternate
hot and cold douche.</p>
<p><b>Irritant Gases</b> are—(1) Nitrous acid gas; (2) sulphurous
acid gas; (3) hydrochloric acid gas; (4)
chlorine; (5) bromine; (6) ammonia. They have the
common property of causing irritation and inflammation
of the eyes, throat, and air-passages, and may cause
spasm of the glottis, bronchitis, and pneumonia.</p>
<p><b>Sulphurous Acid Gas.</b>—One of the products of combustion
of common coal.<span class="pagenum"><SPAN name="page123" id="page123">[123]</SPAN></span></p>
<p><b>Hydrochloric Acid Gas.</b>—Irrespirable when concentrated,
and very irritating when diluted. Very destructive
to vegetable life.</p>
<p><b>Chlorine.</b>—Used in bleaching, and as a disinfectant.
Greenish-yellow colour, suffocating odour. In poisoning,
inhalation of sulphuretted hydrogen gives relief.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxviii_2" id="chapterxxviii_2"></SPAN>XXVIII.—VEGETABLE IRRITANTS</h2>
<p>The chief vegetable purgatives are aloes, colocynth,
gamboge, jalap, scammony, seeds of castor-oil plant,
croton-oil, elaterium, the hellebores, and colchicum. All
these have, either alone or combined, proved fatal. The
active principle in aloes is aloin; of jalap, jalapin; of
white hellebore, veratria; and of colchicum, colchicin.
Morrison's pills contain aloes and colocynth; aloes is
also the chief ingredient in Holloway's pills.</p>
<p><i>Symptoms.</i>—Vomiting, purging, tenesmus, etc., followed
by cold sweats, collapse, or convulsions.</p>
<p><i>Post-Mortem Appearances.</i>—Inflammation of alimentary
canal; ulceration, softening, and submucous effusion
of dark blood.</p>
<p><i>Treatment.</i>—Diluents, opium, stimulants, abdominal
fomentations, etc.</p>
<p>Certain of these irritant poisons exert a marked influence
on the central nervous system, as the following:</p>
<p><b>Laburnum</b> (<i>Cytisis Laburnum</i>).—All parts of the plant
are poisonous; the seeds, which are contained in pods,
are often eaten by children. Contains the alkaloid
<i>cytisine</i>, which is also contained in arnica. It has a
bitter taste, and is powerfully toxic. Symptoms are
purging, vomiting, restlessness, followed by drowsiness,
insensibility, and convulsive twitchings. Death due to
respiratory paralysis. Most of the cases are in children.
Treatment consists of stomach-pump or emetics, stimulants
freely, artificial respiration, warmth and friction to
the surface of the body.<span class="pagenum"><SPAN name="page124" id="page124">[124]</SPAN></span></p>
<p><b>Yew</b> (<i>Taxus baccata</i>) contains the alkaloid <i>taxine</i>.
The symptoms are convulsions, insensibility, coma,
dilated pupils, pallor, laboured breathing, collapse.
Death may occur suddenly. Treatment as above.
Post-mortem appearances not characteristic, but fragments
of leaves or berries may be found in the stomach
and intestines.</p>
<p><b>Arum</b> (<i>Arum Maculatum</i>).—This plant, commonly
known as 'lords and ladies,' is common in the woods,
and the berries may be eaten by children. It gives
rise to symptoms of irritant poisoning, vomiting, purging,
dilated pupils, convulsions, followed by insensibility,
coma, and death.</p>
<p>Many plants have an intensely irritating action on the
skin, and when absorbed act as active poisons.</p>
<p><b>Rhus toxicodendron</b> is the poison oak or poison ivy.
Poisoning by this plant is rare in England, though not
uncommon in the United States. Mere contact with the
leaves or branches will in many people set up an acute
dermatitis, with much œdema and hyperæmia of the
skin. The inflammation spreads rapidly, and there is
formation of blebs with much itching. There is often
great constitutional disturbance, nausea, vomiting, diarrhœa,
and pains in the abdomen. The effects may last
a week, and the skin may desquamate.</p>
<p><b>Primula obconica</b> is another plant which, when
handled, gives rise to an acute dermatitis of an erysipelatous
character. The face swells, and large blisters form
on the cheeks and chin.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxix_2" id="chapterxxix_2"></SPAN>XXIX.—OPIUM AND MORPHINE</h2>
<p><b>Opium.</b>—The inspissated juice of the unripe capsules
of the <i>Papaver somniferum</i>. As a poison it is generally
taken in the form of the tincture (laudanum), which
contains 1 grain opium in 15 minims. Opium is found
in almost all so-called 'soothing syrups' for children,
<span class="pagenum"><SPAN name="page125" id="page125">[125]</SPAN></span>
and in Godfrey's cordial, Dalby's carminative, and Collis
Browne's chlorodyne. Laudanum contains 1 per cent.
morphine, and it, along with all other preparations
(<i>e.g.</i>, paregoric) which contain 1 or more per cent.
morphine, are included in Part I. of the Schedule of
Poisons, and come under the Dangerous Drugs Regulations.</p>
<p>The most important active principles of opium are the
alkaloids morphine and codeine.</p>
<p><i>Symptoms</i> usually commence in from twenty to thirty
minutes: Giddiness, drowsiness and stupor, followed by
insensibility. Patient seems asleep; may be roused by
loud noise, but quickly relapses. Breathing slow and
stertorous, pulse weak, countenance livid. As coma increases,
pulse becomes slower and fuller. The pupils
are contracted, even to a pin's point; they are insensible
to the action of light. In deep, natural sleep the eyes
are turned upwards and the pupils contracted. Bowels
confined, skin cold and livid or bathed in sweat. Temperature
subnormal. Nausea and vomiting are sometimes
present. Remissions are not infrequent, the
patient appearing about to recover and then relapsing.
Hæmorrhage into the pons may give rise to contracted
pupils. Young children and infants are specially
susceptible to the poison.</p>
<p><i>Diagnosis</i> is not always easy, and one has to differentiate
poisoning from <i>cerebral apoplexy</i>. In the
latter one can seldom rouse the patient, the pupils are
often unequal, and hemiplegia is present. In <i>compression
of the brain</i>, fracture of the skull may be
present, subconjunctival hæmorrhages may be seen,
the pupils are unequal and dilated, and the paralysis
increases. In <i>uræmic or diabetic coma</i> the urine must
be examined.</p>
<p>The habitual use of opium is not uncommon, and
opium-eaters are able to take enormous quantities of the
drug. The opium-eater may be known by his attenuated
<span class="pagenum"><SPAN name="page126" id="page126">[126]</SPAN></span>
body, withered yellow countenance, stooping posture,
and glassy, sunken eyes.</p>
<p><i>Post-Mortem Appearances.</i>—Not characteristic. Turgescence
of cerebral vessels. There may be effusion
under arachnoid, into ventricles, at base of the brain,
and around the cord. Rarely extravasation of blood.
Stomach and intestines usually healthy. Lungs gorged,
skin livid.</p>
<p><i>Fatal Period.</i>—Usually nine to twelve hours; but in
many cases, if life is prolonged for eight hours, recovery
takes place.</p>
<p><i>Fatal Dose.</i>—Four grains of opium is the smallest fatal
dose in an adult, or one drachm of laudanum; children
are proportionately much more susceptible to the action
of opium than adults.</p>
<p><i>Treatment.</i>—Stomach-tube, emetics, strong coffee or
tea, ammonia to nostrils. Give 10 grains of permanganate
of potassium in a pint of water acidulated with
sulphuric acid, and repeat the dose every half hour.
Belladonna by mouth, or atropine hypodermically.
Patient must be kept roused by dashing cold water
over him, flagellating with a wet towel, walking about,
etc. In conditions of collapse, however, this treatment
must not be continued, but everything should be done
to preserve the strength. Treatment must be continued
as long as life remains.</p>
<p><i>Method of Extraction from the Stomach.</i>—Opium itself
cannot be directly detected, but we test for morphine
and meconic acid. These may be separated from
organic mixtures thus: Boil the organic matter with
distilled water, spirit, and acetic acid; filter, and to the
fluid passed through add acetate of lead till precipitate
ceases. Filter. Acetate of morphine passes through,
and meconate of lead remains. The solution of acetate
of morphine may be freed from excess of lead by
hydrogen sulphide and filtered, excess of hydrogen sulphide
driven off by heat, and tests applied. Put the
<span class="pagenum"><SPAN name="page127" id="page127">[127]</SPAN></span>
meconate of lead with water into a beaker and pass
hydrogen sulphide; sulphide of lead is formed, and
meconic acid set free. Filter. Concentrate the solution
of meconic acid, allow a portion to crystallize, and
apply tests.</p>
<p><i>Tests.</i>—Morphine and its acetate give an orange-red
colour with nitric acid, becoming brighter on standing;
decompose iodic acid, setting free iodine; with perchloride
of iron, gives a rich indigo-blue; with bichromate
of potassium, a green turning to brown.
When the alkaloid is heated in a watchglass with a drop
of strong sulphuric acid until the acid begins to fume,
and is then allowed to get quite cold, a drop of nitric
acid produces a brilliant red colour. The iodic acid test
is very delicate, but requires great care, and may be used
in the presence of organic matter.</p>
<p>Meconic acid gives a blood-red colour with perchloride
of iron, not discharged by corrosive sublimate or chloride
of gold. The similar colour produced by sulpho-cyanide
of potassium and perchloride of iron is discharged by
chloride of gold and corrosive sublimate.</p>
<p><b>Morphine Habit.</b>—Individuals who have acquired
this habit take the drug usually by hypodermic injection.
The victim suffers from nausea and vomiting, and
becomes so mentally debilitated that asylum treatment
is required.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxx_2" id="chapterxxx_2"></SPAN>XXX.—BELLADONNA, HYOSCYAMUS, AND STRAMONIUM</h2>
<p><b>Belladonna.</b>—The root, leaves, and berries, of the
<i>Atropa belladonna</i> are poisonous from the presence of
alkaloid atropine.</p>
<p><i>Symptoms.</i>—Dryness of mouth and throat, intense
thirst, dysphagia and dysphonia, quick pulse, noisy
delirium and stupor. Strangury and hæmaturia, and
redness of the skin, especially of the face, like that of
<span class="pagenum"><SPAN name="page128" id="page128">[128]</SPAN></span>
scarlatina, have been noticed. Dilatation of the pupil
occurs, whether the poison be taken internally or applied
locally to the eye.</p>
<p><i>Post-Mortem Appearances.</i>—Congestion of cerebral
vessels, dilated pupils, red patches in alimentary canal.</p>
<p><i>Treatment.</i>—Wash out the stomach freely; a hypodermic
injection of apomorphine as an emetic, followed
by hypodermic injections of pilocarpine or morphine.
Tea, coffee, or tannin, to precipitate the alkaloid.</p>
<p><i>Tests.</i>—Atropine may be recognized by its action on
the pupil. The chloro-iodide of potassium and mercury
precipitates it from very dilute solutions.</p>
<p><b>Hyoscyamus</b> (Henbane).—<i>Hyoscyamus niger.</i></p>
<p><b>Stramonium</b> (Thorn-Apple).—<i>Datura stramonium.</i></p>
<p><i>Symptoms.</i>—Identical with those of belladonna and
hyoscyamus, the <i>post-mortem appearances</i> and <i>treatment</i>
being also the same.</p>
<p><b>Cannabis Indica</b> (Indian Hemp).—When smoked,
produces intoxication and mania. <i>Hashish</i>, used in the
East as a narcotic, may cause persons to run 'amok'
and commit murder.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxi_2" id="chapterxxxi_2"></SPAN>XXXI.—COCAINE</h2>
<p><b>Cocaine.</b>—Any dose above 1/2 grain applied to a
mucous membrane or injected hypodermically may give
rise to alarming symptoms. These are intense pallor,
faintness, giddiness, dilatation of pupils, paroxysmal
dyspnœa, rapid, intermittent, and weak pulse, nausea
and vomiting, intense prostration verging on collapse,
and convulsions. The patient may recover
if allowed to remain in a recumbent position, but
stimulants by mouth—<i>e.g.</i>, ammonia—and the hypodermic
injection of brandy or ether may be necessary,
with the inhalation of nitrite of amyl.</p>
<p>For care in the prescribing of cocaine see under the
'Dangerous Drugs Act, 1920' (p. 82).</p>
<p>The <b>Cocaine Habit</b> consists in the self-administration
<span class="pagenum"><SPAN name="page129" id="page129">[129]</SPAN></span>
of the drug hypodermically. It induces excitement,
which is followed by prostration. In time melancholia
or mania develops, with great irritation of the skin
('cocaine bugs').</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxii_2" id="chapterxxxii_2"></SPAN>XXXII.—CAMPHOR</h2>
<p>The liniment, oil, and spirit have been poisonous in
large dose.</p>
<p><i>Symptoms.</i>—Odour of breath, languor, giddiness, faintness,
dimness of vision, difficulty of breathing, delirium,
convulsions, with hot skin, flushed face, and dilated
pupils.</p>
<p><i>Fatal Dose.</i>—Thirty grains.</p>
<p><b>Cocculus Indicus.</b>—The fruit of <i>Anamirta cocculus</i>.
Contains a poisonous active principle, picrotoxin; used
to adulterate beer, and by poachers to stupefy fish.</p>
<p><i>Symptoms.</i>—Convulsions, followed by stupor and
complete loss of voluntary power.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxiii_2" id="chapterxxxiii_2"></SPAN>XXXIII.—TETRACHLORETHANE, ETC.</h2>
<p><b>Tetrachlorethane</b> ('Cellon').—Acetylene tetrachloride;
vapour has caused poisoning in aeroplane
('dope') and cinema film works.</p>
<p><i>Symptoms.</i>—Gastric symptoms and marked jaundice.
This may be followed in days or weeks by stupor, coma,
death.</p>
<p><i>Post-Mortem.</i>—Fatty degeneration of internal organs,
chiefly liver.</p>
<p><b>Trinitrotoluene (T.N.T.).</b>—An explosive solid which
stains the skin an orange colour; may be absorbed
through skin or be inhaled.</p>
<p><i>Symptoms.</i>—Shortness of breath, headache, drowsiness.
Later, skin irritation, gastritis, jaundice, blood degeneration.</p>
<p><i>Treatment.</i>—Remove from work, rest in bed, diuretics,
purgatives, alkalies.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page130" id="page130">[130]</SPAN></span></p>
<h2><SPAN name="chapterxxxiv_2" id="chapterxxxiv_2"></SPAN>XXXIV.—ALCOHOL, ETHER, AND CHLOROFORM</h2>
<p>Alcohol, ether, and chloroform, induce general anæsthesia,
often preceded by delirious excitement, and
followed by nausea and vomiting. When they cause
death, it is by inducing a state like apoplexy or by
paralyzing the heart.</p>
<p><b>Alcohol.</b>—Absolute alcohol is ethyl hydroxide
(C<sub>2</sub>H<sub>5</sub>OH) with not more than 1 per cent. by weight
of water. Rectified spirit (spiritus rectificatus) contains
90 per cent. of alcohol. Methylated spirit consists of
rectified spirit with 10 per cent. of wood spirit. Proof
spirit contains a little over 49 per cent. of absolute
alcohol; brandy or whisky, 53 per cent.; port wine,
20 to 25 per cent.; ales and stout, 4 to 6 per cent.</p>
<p><i>Symptoms.</i>—Acute poisoning; confusion, giddiness,
staggering gait, headache, passing into stupor, with
subnormal temperature, and coma. Vomiting may
occur and recovery ensue, otherwise collapse sets in.
Pupils usually dilated.</p>
<p>Dipsomaniacs suffer from indigestion, vomiting and
purging, jaundice, albuminuria, diabetes, cirrhosis of
liver, degeneration of kidneys, congestion of brain,
peripheral neuritis, alcoholic insanity, and various forms
of paralysis. In the acute form delirium tremens is the
most common manifestation.</p>
<p><i>Post-Mortem Appearances.</i>—Deep red colour of lining
membranes of stomach. Sometimes congestion of cerebral
vessels and meninges. Lungs congested, blood
fluid. Rigor mortis persistent.</p>
<p><i>Fatal Dose.</i>—Death from 1/2 pint of gin and from two
bottles of port, but recovery from larger quantities.</p>
<p><i>Fatal Period.</i>—Average about twenty-four hours.</p>
<p><i>Treatment.</i>—Stomach-tube, cold affusion, electricity,
injection of a pint of hot coffee into the rectum. Give
chloride of ammonium in 30 grain doses to prevent
delirium; strychnine or digitalin hypodermically.
<span class="pagenum"><SPAN name="page131" id="page131">[131]</SPAN></span></p>
<p><i>Method of Extraction from the Stomach.</i>—Neutralize the
contents of the stomach, if acid, with sodium carbonate;
place them in a retort and carefully distil. Collect the
distillate, mix with chloride of calcium or anhydrous sulphate
of copper, and again distil. Agitate distillate with
dry potassium carbonate, and draw off some of the
supernatant fluid for testing.</p>
<p><i>Tests.</i>—Odour. Dissolves camphor. With dilute sulphuric
acid and bichromate of potassium turns green,
and evolves aldehyde. Product of combustion makes
lime-water white and turbid.</p>
<p><b>Methyl Alcohol: Wood Naphtha.</b>—Used to produce
intoxication by painters, furniture-polishers, etc.</p>
<p><i>Symptoms</i> are those of alcoholic poisoning, but vomiting
and delirium are more persistent. Total or partial
blindness may follow as a sequel of optic atrophy. A
fatal result not infrequently follows.</p>
<p>The following table gives the points of distinction
between concussion of brain, alcoholic poisoning, and
opium poisoning:</p>
<table style="margin-left: 5%; margin-right: 5%;" summary="distinction between concussion of brain,
alcoholic poisoning and opium poisoning">
<tr><td align="center"><span class="smcap">Concussion of Brain.</span></td>
<td align="center"><span class="smcap">Alcohol.</span></td>
<td align="center"><span class="smcap">Opium.</span></td></tr>
<tr><td>1. Marks of violence on head</td>
<td>1. No marks of violence, unless person has fallen. History will be of use.</td>
<td>1. As alcohol.</td></tr>
<tr><td>2. Stupor, sudden.</td>
<td>2. Excitement precedes sudden stupor.</td>
<td>2. Symptoms slow. Drowsiness, stupor, lethargy.</td></tr>
<tr><td>3. Face pale, cold; pupils sluggish, sometimes dilated.</td>
<td>3. Face flushed; pupils generally dilated.</td>
<td>3. Face pale; pupils contracted.</td></tr>
<tr><td>4. Remission rare. Patient recovers slowly.</td>
<td>4. Partial recovery may occur, followed by death.</td>
<td>4. Remission rare.</td></tr>
<tr><td>5. No odour of alcohol in breath.</td>
<td>5. Odour of alcohol in breath.</td>
<td>5. Odour of opium in breath.</td></tr>
</table>
<p><span class="pagenum"><SPAN name="page132" id="page132">[132]</SPAN></span></p>
<p><b>Ether</b> is a volatile liquid prepared from ethylic alcohol
by interaction with sulphuric acid. It contains 92 per
cent. of ethyl oxide (C<sub>2</sub>H<sub>5</sub>)O. It was formerly called
'sulphuric ether.' It is a colourless, inflammable liquid,
having a strong and characteristic odour, specific gravity
0.735. <b>Purified ether</b> from which the ethylic alcohol
has been removed by washing with distilled water, and
most of the water by subsequent distillation in the
presence of calcium chloride and lime. It is this preparation
which is used for the production of general
anæsthesia. It has a specific gravity of 0.722 to 0.720,
and its vapour is very inflammable.</p>
<p><i>Symptoms.</i>—When taken as a liquid, same as alcohol.
When inhaled as vapour, causes slow, prolonged, and
stertorous breathing; face becomes pale, lips bluish,
surface of body cold. Pulse first quickens, then slows.
Pupils dilated, eyes glassy and fixed, muscles become
flabby and relaxed, profound anæsthesia. Then pulse
sinks and coma ensues, sensation being entirely suspended.
Nausea and vomiting not uncommon.</p>
<p><i>Post-Mortem Appearances.</i>—Brain and lungs congested.
Cavities of heart full of dark, liquid blood. Vessels at
upper part of spinal cord congested.</p>
<p><i>Treatment.</i>—Exposure to pure air, cold affusion, artificial
respiration, galvanism.</p>
<p><i>Method of Extraction from the Contents of the Stomach.</i>—Same
as for alcohol. During distillation pass some of
the vapour into concentrated solution of bichromate of
potash, nitric and sulphuric acids, and note reaction as
for alcohol.</p>
<p><i>Tests.</i>—Vapour burns with smoky flame, depositing
carbon. Sparingly soluble in water. With bichromate
of potash and sulphuric acid same as alcohol.</p>
<p><b>Chloroform.</b>—A colourless liquid, specific gravity 1.490
to 1.495, very volatile, giving off dense vapour. Sweet
taste and pleasant odour.</p>
<p><i>Symptoms.</i>—When swallowed, characteristic smell in
<span class="pagenum"><SPAN name="page133" id="page133">[133]</SPAN></span>
breath, anxious countenance, burning pain in the throat,
stomach, and region of the abdomen, staggering gait,
coldness of the extremities, vomiting, insensibility,
deepening into coma, with stertorous breathing, dilated
pupils, and imperceptible pulse. When inhaled, much
the same as ether, but produces insensibility and muscular
relaxation more rapidly. It would be impossible
to instantly render a person insensible by holding a
pocket-handkerchief saturated with chloroform over the
face. Statements such as this, which are often made in
cases of robbery from the person and in cases of rape,
are incredible.</p>
<p><i>Delayed Chloroform-Poisoning.</i>—Death may take place
in from four to seven days after chloroform has been
administered, especially in the case of children. The
internal organs are found to be fattily degenerated, and
death is thought to be due to acetonuria.</p>
<p><i>Post-Mortem Appearances.</i>—Cerebral and pulmonary
congestion. Heart empty, or right side distended with
dark blood.</p>
<p><i>Treatment.</i>—Stomach-tube and free lavage; cold
affusion; drawing forward tongue; artificial respiration;
galvanism and suspension with head downward. Inhalation
of nitrite of amyl; strychnine hypodermically.</p>
<p><i>Fatal Dose.</i>—When swallowed, from 1 to 2 ounces.</p>
<p><i>Method of Extraction from the Stomach.</i>—By distillation
at 120° F. The vapour, as it passes along a glass tube,
may be decomposed by heat into chlorine, hydrochloric
acid, and carbon—the first shown by setting free iodine
in iodide of starch, the second by reddening blue litmus-paper,
and the last by its deposit.</p>
<p><i>Tests.</i>—Taste, colour, weight; burns with a green
flame; dissolves camphor, guttapercha, and caoutchouc.</p>
<p><b>Iodoform.</b>—Poisoning may result from its use in
surgery. It produces delirium, sleepiness, and coma.
It may lead to mental weakness or optic neuritis.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page134" id="page134">[134]</SPAN></span></p>
<h2><SPAN name="chapterxxxv_2" id="chapterxxxv_2"></SPAN>XXXV.—CHLORAL HYDRATE</h2>
<p>It was formerly largely used as a hypnotic, and many
fatal consequences ensued. It is prepared from alcohol
and chlorine.</p>
<p><i>Symptoms.</i>—Deep sleep, loss of muscular power,
diminished or abolished reflex action and sensibility,
followed by loss of consciousness and marked fall of
temperature. Pulse may become quick, and face flushed
or livid and bloated. Prolonged use of this drug may
produce a peculiar eruption on the skin. Supposed to
act in the blood by being decomposed into chloroform
and sodium formate. Its effects are due chiefly to depression
of the central nervous system, the medulla being
the last part of the nervous system to be attacked.</p>
<p><i>Method of Extraction from the Stomach.</i>—By distillation
in strongly alkaline solutions, when it may be obtained
as chloroform and tested as such.</p>
<p><i>Treatment.</i>—Stomach-tube or emetic. Hypodermic
injections of strychnine. Keep patient warm, and inject
a pint of hot strong coffee into the rectum. Nitrite of
amyl and artificial respiration.</p>
<p><i>Tests.</i>—Heated with caustic potash, it yields chloroform
and potassium formate. The chloroform is readily recognized
by its odour, and, if the solution be concentrated,
by separating as a heavy layer at the bottom of
the test-tube.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxvi_2" id="chapterxxxvi_2"></SPAN>XXXVI.—PETROLEUM AND PARAFFIN-OIL</h2>
<p>Cases of poisoning by petroleum and paraffin are
common, and occur chiefly in children.</p>
<p><b>Petroleum</b> is a natural product, and is a mixture of
the higher saturated hydrocarbons. The crude petroleum
is purified by distillation, and is then free from
colour, but retains its peculiar penetrating odour.
Different varieties are sold under the names of cymogene,
<span class="pagenum"><SPAN name="page135" id="page135">[135]</SPAN></span>
gasolene, naphtha, petrol, and benzoline. Benzoline
is highly inflammable, and is often called mineral
naphtha, petroleum naphtha, and petroleum spirit.
Benzoline is not the same as benzene or benzol, which
is one of the products of the dry distillation of
coal.</p>
<p>From its very general use as a fuel in motor-cars
many accidents have happened from inhaling the vapour
of petrol. It gives rise to coldness, shallow respiration,
syncope, and insensibility, but seldom death.</p>
<p><b>Paraffin</b>, also known as kerosene and mineral oil, is a
mixture of saturated hydrocarbons obtained by the distillation
of shale.</p>
<p>By the retailer the terms 'petroleum' and 'paraffin'
oil are used indifferently, and each is sold for the other
without prejudice.</p>
<p><i>Symptoms.</i>—These substances are not very active
poisons, and, as a rule, even children recover. The
breath has the odour of paraffin, the face is pale and
cyanotic, hot and dry, and there may be vomiting.
Death may result from gastro-enteritis or from coma.</p>
<p><i>Fatal Dose.</i>—In the case of an adult, 1/2 pint should not
prove lethal, and patients have recovered after drinking
a pint.</p>
<p><i>Treatment.</i>—Emetics, purgatives, and stimulants.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxvii_2" id="chapterxxxvii_2"></SPAN>XXXVII.—ANTIPYRINE, ANTIFEBRIN, PHENACETIN, AND ANILINE</h2>
<p>Many of the synthetical coal-tar products now so largely
employed as analgesics are powerful toxic agents.</p>
<p><b>Phenazone, Antipyrine, or Analgesin</b>, is a complex
benzene derivative prepared from aniline, aceto-acetic
ether, and methyl iodide. It is in colourless, inodorous,
scaly crystals, which have a bitter taste. It is soluble in
its own weight of water.<span class="pagenum"><SPAN name="page136" id="page136">[136]</SPAN></span></p>
<p><i>Tests.</i>—Can be extracted from an alkaline solution
of chloroform. The residue left on the evaporation of
chloroform should be employed for testing. If heated
with strong nitric acid and allowed to cool, a purple
colour is produced. Ferric chloride gives a blood-red
coloration, destroyed by the addition of mineral acids.</p>
<p><i>Treatment.</i>—Stimulants freely, inhalation of oxygen,
patient to be kept in the recumbent position.</p>
<p><b>Acetanilide, Antifebrin, Phenylacetamide</b> (a constituent
of 'Daisy' or 'headache' powders), is obtained
by the interaction of acetic acid and aniline. It is in
colourless, inodorous, lamellar crystals, which have a
slight pungent taste. It is insoluble in water.</p>
<p><i>Tests.</i>—May be extracted from acid solutions by ether
or chloroform. If heated with solution of potassium
hydroxide, odour of aniline is given off; if liquid, when it
is warmed with a few drops of chloroform, a penetrating
and unpleasant odour of isocyanide.</p>
<p><i>Treatment.</i>—Emetics, stimulants, inhalation of ether,
recumbent position.</p>
<p><b>Phenacetin, Phenacetinum</b>, is produced by the interaction
of glacial acetic acid and para-phenetidin. It is
in white, tasteless, inodorous, glistening, scaly crystals,
insoluble in water. Of all the members of the group, it
most rarely produces toxic symptoms.</p>
<p><i>Treatment.</i>—As for the other members of this group.</p>
<p><b>Exalgin, Aspirin, etc.</b>, as well as the above, may all
act as poisons to certain persons, and even small
medicinal doses may cause serious and even fatal
consequences.</p>
<p><i>Symptoms</i> (more or less common to all).—Nausea,
vomiting, hurried respiration, marked cyanosis, syncope.
Persistent sneezing and widespread urticaria may be
present; collapse.</p>
<p><b>Aniline</b> is an oily liquid, heavier than, and not soluble
in, water. It is colourless or reddish-brown; it has a
peculiar tar-like odour; it is soluble in alcohol, and
forms a soluble sulphate with sulphuric acid. A solution
<span class="pagenum"><SPAN name="page137" id="page137">[137]</SPAN></span>
of bleaching-powder gives with solution of the sulphate
a purple colour changing to red-brown.</p>
<p><i>Symptoms.</i>—Nausea, vomiting, giddiness, intoxication,
drowsiness, gasping for breath, feeble pulse, and marked
cyanosis. In its <i>industrial use</i> it may act as a poison
either by inhalation of the fumes or by absorption
through the skin. The symptoms then are mainly
those of peripheral neuritis with blindness.</p>
<p><i>Fatal Dose.</i>—About 6 drachms.</p>
<p><i>Treatment.</i>—Wash out stomach; stimulants, artificial
respiration, inhalation of oxygen, transfusion.</p>
<p><b>Nitro-benzol</b> (Artificial Oil of Bitter Almonds).—It
is used in perfumery, but is very poisonous when
swallowed, or inhaled, or absorbed through skin. It is
used in the manufacture of aniline dyes, and may act as
an industrial poison. The symptoms closely resemble
those of aniline poisoning, but there is perhaps greater
mental confusion.</p>
<p><i>Fatal Dose.</i>—Eight to ten drops have caused death.</p>
<p><i>Treatment.</i>—Emetics, stimulants, transfusion of saline
or blood, pituitrin, strychnine, or digitalin hypodermically.</p>
<p><b>Nitroglycerine</b> gives rise to intense and persistent
headache ('powder headache'). Throbbing and pulsation
of all the arteries in the body; flushing of the face
and collapse may follow.</p>
<p><b>Dinitrobenzene</b> causes symptoms resembling nitro-benzol
poisoning, and when acting as a chronic poison
gives rise to weakness, jaundice, peripheral neuritis.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxviii_2" id="chapterxxxviii_2"></SPAN>XXXVIII.—SULPHONAL, TRIONAL, TETRONAL, VERONAL, PARALDEHYDE</h2>
<p>These are dangerous drugs. The ordinary <i>symptoms</i>
of the group are noises in the ears, headache, vertigo,
inability to stand or to walk properly, insensibility, and
cyanosis.</p>
<p>The most interesting point is the condition of the
<span class="pagenum"><SPAN name="page138" id="page138">[138]</SPAN></span>
urine. In cases of poisoning it is dark or reddish-brown
in colour, due to the presence of <i>hæmatoporphyrin</i>. It
contains albumin and casts, but no red corpuscles. In
cases of hæmatoporphyrinuria the prognosis is bad, and
it is said that these cases invariably end fatally.</p>
<p><i>Treatment.</i>—In an ordinary case emetics, strong coffee,
hypodermic injections of strychnine, saline injections,
and transfusion.</p>
<p>Cases of chronic poisoning from the 'als' are not uncommon,
and are increasing in frequency. Hypnogen
is apparently identical with veronal.</p>
<p>All the above-named aniline derivatives are included
in Part I. of the scheduled poisons.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxxxix_2" id="chapterxxxix_2"></SPAN>XXXIX.—CONIUM AND CALABAR BEAN</h2>
<p><b>Conium Maculatum</b> (Spotted Hemlock).—All parts of
the plant are poisonous, often mistaken for parsley.
Contains the poisonous principle <i>coniine</i>, a volatile liquid
alkaloid with a mousy smell; insoluble in water; soluble
in alcohol, ether, and chloroform. It also contains
methyl coniine.</p>
<p><i>Symptoms.</i>—Dryness of throat, headache, dilated
pupil, dysphagia, loss of muscular power, passing into
complete paralysis. Delirium, coma, and convulsions,
occasionally.</p>
<p><i>Post-Mortem Appearances.</i>—Congested brain and
lungs; redness of the mucous membrane of the
stomach. The stomach and intestines should be examined
for fragments of the leaves and fruit, recognized
by their microscopical appearances.</p>
<p><i>Treatment.</i>—Emetics, tannic acid or gallic acid. Diffusible
stimulants.</p>
<p><i>Method of Extraction from the Stomach.</i>—Use Stas-Otto
process.</p>
<p><i>Tests.</i>—The mousy odour. Deepened colour and
<span class="pagenum"><SPAN name="page139" id="page139">[139]</SPAN></span>
dense white fumes with nitric acid. Pale red, deepening,
with hydrochloric acid.</p>
<p>There are several other umbelliferous plants which
are poisonous. The water hemlock (<i>Cicuta virosa</i>)
produces symptoms not unlike those of hemlock; it has
been mistaken for parsnip and celery. It contains an
active principle, <i>cicutoxin</i>, which in some respects is
allied to strychnine and picrotoxin. The fool's parsley,
or lesser hemlock (<i>Æthusa cynapium</i>), is another member
of this group, although doubt has been expressed as to
whether it is really poisonous. The water dropwort
(<i>Œnanthe crocata</i>) is undoubtedly poisonous, especially
to cattle. In man it produces abdominal pain with
diarrhœa and vomiting; dilated pupils, slow pulse, and
cyanosis; delirium, insensibility, and convulsions. The
post-mortem appearances are not characteristic, but the
stomach and intestines should be examined for portions
of the plant.</p>
<p><b>Calabar Bean or Physostigma.</b>—The bean of <i>Physostigma
venenosum</i> contains the alkaloid physostigmine
or eserine, with the antagonistic alkaloid calabarine.</p>
<p><i>Symptoms.</i>—Vomiting, giddiness, irregular cardiac
action, contraction of the pupils, paralysis of lower
extremities, and death from asphyxia.</p>
<p><i>Treatment.</i>—Emetics; hypodermic injection of 1/50 grain
sulphate of atropine, repeated if necessary.</p>
<p><i>Method of Extraction from the Stomach.</i>—Use Stas-Otto
process.</p>
<p><i>Test.</i>—The contraction of the pupil which it causes.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxl_2" id="chapterxl_2"></SPAN>XL.—TOBACCO AND LOBELIA</h2>
<p><b>Tobacco.</b>—<i>Nicotiana tabacum</i> owes its poisonous
properties to its alkaloid nicotine, a volatile, oily, amber-coloured
liquid, with an acrid taste and ethereal odour;
soluble in water, alcohol, ether, and chloroform. The
drug has an intense depressant action on the heart and
respiratory centre.<span class="pagenum"><SPAN name="page140" id="page140">[140]</SPAN></span></p>
<p><i>Symptoms.</i>—Giddiness, fainting, nausea, and vomiting,
with syncope, muscular tremors, stupor, stertorous
breathing, and insensible pupil. Death has occurred
after seventeen or eighteen pipes at a sitting.</p>
<p><i>Post-Mortem Appearances.</i>—Not uniform or characteristic.
General relaxed condition of muscles; engorgement
of cerebral and pulmonary vessels. Congestion of
gastric mucous membrane.</p>
<p><i>Treatment.</i>—Emetics, stimulants, hypodermic injection
of 1/25 grain of strychnine. Warmth to the surface
by hot bottles, hot blankets.</p>
<p><i>Method of Extraction from the Stomach.</i>—Digest the
contents of the stomach in cold distilled water and <i>very
dilute</i> sulphuric acid; strain, filter, and press residue.
Evaporate the filtrate to half its bulk, digest with
alcohol, and evaporate alcohol off in a water-bath.
Dissolve residue (sulphate of nicotine) in water, and
make solution alkaline with potash; then shake with
ether in a test-tube. Remove ether and allow it slowly
to evaporate. Test resulting alkaloid.</p>
<p><i>Tests.</i>—No change of colour with the mineral acids.
White deposit with corrosive sublimate. Sulphuric acid
and bichromate of potassium give a green colour, oxide of
chromium. Precipitate with bichloride of platinum and
with carbazotic acid.</p>
<p><b>Lobelia Inflata</b> (Indian Tobacco).—Much used in
America by the Coffenite practitioners, and a valuable
remedy for asthma.</p>
<p><i>Symptoms.</i>—Nausea, vomiting, giddiness, cold sweats,
prostration. Headache, giddiness, tremors, insensibility,
and convulsions.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxli_2" id="chapterxli_2"></SPAN>XLI.—HYDROCYANIC ACID</h2>
<p><b>Prussic Acid</b> is the most active of poisons. The
diluted hydrocyanic acid of the Pharmacopœia contains
2 per cent. of hydrocyanic acid, Scheele's 4 per cent.
<span class="pagenum"><SPAN name="page141" id="page141">[141]</SPAN></span>
It is a colourless liquid, feebly acid, with odour of bitter
almonds.</p>
<p><b>Cyanide of Potassium</b> is largely used in photography
and in electro-plating, and is also poisonous. It often
contains undecomposed carbonate of potassium, which
may act as a corrosive poison and cause erosion of the
mucous membranes of the lips, mouth, and stomach.</p>
<p><b>Oil of Bitter Almonds</b>, used as a flavouring agent,
may contain (when improperly prepared) from 5 to
15 per cent. of the anhydrous acid.</p>
<p><i>Symptoms.</i>—The symptoms usually come on in a few
seconds, and are of the shortest possible duration.
There is a sudden gasp for breath, possibly a loud cry,
and the patient drops down dead. If the fatal termination
is prolonged for a few minutes, the symptoms are
intense giddiness, pallor of the skin, dilatation of the
pupils, laboured and irregular breathing, small and
frequent pulse, followed by insensibility. There may be
convulsions or tetanic spasms, with evacuation of urine
and fæces. Death results from paralysis of the central
nervous system, but artificial respiration is useless, as
the drug promptly arrests the heart's action. It also
kills the protoplasm of the red blood-corpuscles, rendering
them useless as oxygen-carriers.</p>
<p><i>Post-Mortem Appearances.</i>—Skin livid, pale, or violet,
with bright red patches on the dependent parts. The
gastro-intestinal mucous membrane is bright red in
colour, owing to the presence of cyanmethæmoglobin.
Hands clenched, nails blue, jaws fixed, froth about
mouth. Eyes prominent and glistening, odour of acid
from body, venous system gorged.</p>
<p><i>Treatment.</i>—Empty the stomach by the tube at once,
and wash it out with a solution of sodium thiosulphate.
Strong ammonia to the nostrils. Stimulants freely—brandy,
chloric ether, ammonia, sal volatile <i>ad libitum</i>.
If patient cannot swallow, inject hypodermically either
brandy or ether. Hypodermic injection of 1/50 grain
<span class="pagenum"><SPAN name="page142" id="page142">[142]</SPAN></span>
atropine. Douche to the face, alternately hot and cold.
Death commonly occurs so rapidly that there is no time
for treatment.</p>
<p><i>Fatal Dose (Smallest).</i>—Half a drachm of the B.P.
acid, equal to 0.6 grain of the anhydrous. <i>Recovery</i>
from 1/2 ounce of the B.P. acid. These records are
fallacious, for in specimens the percentage of anhydrous
acid varies enormously. Practically, 1 grain of the
anhydrous acid is fatal.</p>
<p><i>Fatal Period.</i>—From two to five minutes after a large
dose, but may be less.</p>
<p><i>Method of Extraction from the Stomach.</i>—Having
previously carefully fitted a watchglass to a wide-mouthed
bottle, nearly fill the bottle with the contents
of the stomach, blood, secretions, etc. Place a few
drops of a solution of nitrate of silver on the concave
surface of the watchglass, and cover the mouth of the
bottle with it. The vapour of hydrocyanic acid, if
present, will form a white precipitate which may be
tested. Other watchglasses, treated with sulphide of
ammonium or sulphate of iron and liquor potassæ, will
give the reactions of the acid with appropriate tests.
This method removes all objections as to foreign
admixture. If the acid is not at first detected, gentle
warming of the bottle in a water-bath will assist the
evolution of the vapour. The vapour may be obtained
by distillation, but this process is open to objections to
which the other is not. In some cases it becomes
changed in the body into formic acid, which should
therefore be sought for.</p>
<p><i>Tests.</i>—With nitrate of silver a white precipitate,
insoluble in cold, but soluble in boiling, nitric acid.
The precipitate heated, evolves cyanogen, having an
odour of peach-blossoms, and burning, when lighted,
with a pink flame. Liquor potassæ and sulphate of iron
give a brownish-green precipitate, which turns to
Prussian blue with hydrochloric acid. Liquor potassæ
<span class="pagenum"><SPAN name="page143" id="page143">[143]</SPAN></span>
and sulphate of copper give a greenish-white precipitate,
becoming white with hydrochloric acid. Sulphide
of ammonium gives sulpho-cyanide of ammonium. This
develops a blood-red colour with perchloride of iron,
bleached by corrosive sublimate.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlii_2" id="chapterxlii_2"></SPAN>XLII.—ACONITE</h2>
<p><b>Aconite</b> (<i>Aconitum Napellus</i>, monkshood).—Root and
leaves. Poisonous property depends upon an alkaloid,
aconitine. Aconite is one of the constituents of St.
Jacob's Oil.</p>
<p><i>Symptoms.</i>—Numbness and tingling in mouth, throat,
and stomach, giddiness, loss of sensation, deafness, dimness
of sight, paralysis, first of the lower and then of
the upper extremities, vomiting, and shallow respiration.
Pupils dilated. Pulse small, irregular, finally imperceptible.
The mind remains unaffected. Death often
sudden.</p>
<p><i>Post-Mortem Appearances.</i>—Venous congestion, engorgement
of brain and membranes.</p>
<p><i>Treatment.</i>—Emetics, stimulants freely. Best antidote
is sulphate of atropine, 1/50 grain hypodermically,
and also strychnine. Digitalis also useful. Warmth to
whole body. Patient to make no exertion.</p>
<p><i>Fatal Dose.</i>—Of root or tincture, 1 drachm.</p>
<p><i>Fatal Period.</i>—Average, less than four hours.</p>
<p><i>Method of Extraction from the Stomach, etc.</i>—Extraction
from contents of stomach by Stas-Otto process. It may
be found in the urine; gives usual alkaloidal reactions,
but no distinctive chemical test known.</p>
<p><i>Tests.</i>—Chiefly physiological; tingling and numbness
when applied to tongue or inner surface of cheek.
Effects on mice, etc. A cadaveric alkaloid or ptomaine
has been found in the body, possessing many of the
actions of aconitine. The presence of this substance
was suggested in the Lamson trial.<span class="pagenum"><SPAN name="page144" id="page144">[144]</SPAN></span></p>
<p>The Indian aconite, <i>Aconitum ferox</i>, the Bish poison,
is much more active than the European variety. It
contains a large proportion of pseudaconitine, and is
frequently employed in India, not only for the destruction
of wild beasts, but for criminal purposes.</p>
<p><b>Aconitine</b> varies much in activity according to its
mode of preparation and the source from which it is
derived. The most active kind is probably made from
<i>A. ferox</i>.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxliii_2" id="chapterxliii_2"></SPAN>XLIII.—DIGITALIS</h2>
<p>All parts of the plant <i>Digitalis purpurea</i> (purple foxglove)
are poisonous. Contains the glucoside digitalin
and other active principles.</p>
<p><i>Symptoms.</i>—Nausea, vomiting, purging, and abdominal
pains. Vomited matter grass-green in colour. Headache,
giddiness, and loss of sight; pupils dilated, insensitive;
pulse weak, remarkably slow and irregular; cold
sweat. Salivation occasionally, or syncope and stupor.
Death sometimes quite suddenly.</p>
<p><i>Post-Mortem Appearances.</i>—Congested condition of
brain and membranes; inflammation of gastric mucous
membrane.</p>
<p><i>Treatment.</i>—Emetics freely; infusions containing
tannin, as coffee, tea, oak-bark, galls, etc. Stimulants.
Hypodermic injection of 1/120 grain of aconitine.</p>
<p><i>Method of Extraction from the Stomach, etc.</i>—Use Stas-Otto
process.</p>
<p><i>Tests for Digitalin.</i>—A white substance, sparingly
soluble in water, not changed by nitric acid; turns
yellow, changing to green, with hydrochloric acid. The
minutest trace of digitalin moistened with sulphuric
and treated with bromine vapour gives a rose colour,
turning to mauve. This is very delicate, but in experienced
hands the physiological test is more reliable.
The chemist who has had no practical experience in
<span class="pagenum"><SPAN name="page145" id="page145">[145]</SPAN></span>
pharmacological methods would be wiser to keep to his
chemical tests.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxliv_2" id="chapterxliv_2"></SPAN>XLIV.—NUX VOMICA, STRYCHNINE, AND BRUCINE</h2>
<p><b>Nux Vomica</b> consists of the seeds of the <i>Strychnos
nux vomica</i>. From these strychnine and brucine are
obtained. The symptoms, post-mortem appearances,
and treatment, of poisoning by nux vomica are the same
as for strychnine.</p>
<p><b>Strychnine</b> is a powerful poison, and forms the active
ingredient of many 'vermin-killers.' It occurs as a
white powder or as colourless crystals, with a persistent
bitter taste; very slightly soluble in water; more or
less soluble in benzol, ether, and alcohol.</p>
<p><i>Symptoms.</i>—Sense of suffocation, twitchings of
muscles, followed by tetanic convulsions and opisthotonos,
each lasting half to two minutes. Mental faculties
unaffected, face congested and anxious; eyes staring,
lips livid; much thirst. The period of accession of the
symptoms varies with the mode of administration of
the poison. Symptoms, as a rule, come on soon after
food has been taken. Patient may die within a few
hours from asphyxia or from exhaustion.</p>
<p>In <i>Tetanus</i> there is usually history of a wound; the
symptoms come on slowly; lockjaw is an early
symptom, and only later complete convulsions; the
intervals between the fits are never entirely free from
rigidity. Death is delayed for some days.</p>
<p><i>Post-Mortem Appearances.</i>—Heart empty, blood fluid,
rigor mortis persistent. Hands usually clenched; feet
arched and inverted. Congestion of brain, spinal cord,
and lungs.</p>
<p><i>Treatment.</i>—Emetics or stomach-pump if the patient
is deeply anæsthetized. Tannic acid and permanganate
of potassium. Bromide of potassium 1/2 ounce with
chloral 30 grains, repeated if necessary.<span class="pagenum"><SPAN name="page146" id="page146">[146]</SPAN></span></p>
<p><i>Fatal Dose (Smallest).</i>—Quarter of a grain.</p>
<p><i>Fatal Period (Shortest).</i>—Ten minutes; usually two to
four hours.</p>
<p><i>Method of Extraction from the Stomach.</i>—The alkaloid
may be separated by the process of Stas-Otto.</p>
<p><i>Tests.</i>—Strychnine has a characteristic, very bitter
taste; it imparts this taste to even very dilute solutions;
it is unaffected by sulphuric acid, but gives a purple-blue
colour, changing to crimson and light red, when
the edge of this solution is touched with dioxide of
manganese, potassium bichromate, ferricyanide of potassium,
or permanganate of potassium. This test is so
delicate as to show the 1/25000 of a grain of the alkaloid.
A very minute quantity (1/5000 grain) in solution placed
on the skin of a frog after drying causes tetanic convulsions.</p>
<p><b>Brucine.</b>—This alkaloid, found associated with strychnine,
possesses the same properties, though in a less
powerful degree. Nitric acid gives a blood-red colour,
changed to purple with protochloride of tin.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlv_2" id="chapterxlv_2"></SPAN>XLV.—CANTHARIDES</h2>
<p><b>Cantharides.</b>—Spanish fly, or blistering beetle, is the
basis of most of the blistering preparations. It is sometimes
taken as an abortifacient or given as an aphrodisiac,
but whether it has any such action is open to
question. It acts as an irritant to the kidneys and
bladder, and sometimes produces haæmaturia and a good
deal of temporary discomfort.</p>
<p><i>Symptoms.</i>—Burning sensation in the throat and
stomach, with salivation, pain and difficulty in swallowing.
Vomiting of mucus mixed with blood. Tenesmus,
diarrhœa, the motions containing blood and mucus.
Dysuria, with passage of small amounts of albuminous
and bloody urine. Peritonitis, high temperature, quick
pulse, headache, loss of sensibility, and convulsions.
<span class="pagenum"><SPAN name="page147" id="page147">[147]</SPAN></span></p>
<p><i>Post-Mortem.</i>—Gastro-intestinal mucous membrane inflamed,
with gangrenous patches. Genito-urinary tract
inflamed. Acute nephritis.</p>
<p><i>Treatment.</i>—An emetic of apomorphine; demulcent
drinks, such as barley-water, white of egg and water,
linseed-tea and gruel (but not oils), with a hypodermic
injection of morphine to allay pain.</p>
<p><i>Tests.</i>—The vomited matter often contains shining
particles of the powder. The urine will probably be
albuminous.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlvi_2" id="chapterxlvi_2"></SPAN>XLVI.—ABORTIFACIENTS</h2>
<p>Emmenagogues are remedies which have the property
of exciting the catamenial flow; ecbolics, or abortives,
are drugs which excite contraction of the uterus, and are
supposed to have the power of expelling its contents.
The vegetable substances commonly reputed to be
abortives are ergot, savin, aloes (Hierapicra), digitalis,
colocynth, pennyroyal, and nutmeg; but <i>there is no
evidence to show that any drug possesses this property</i>.
Lead in some parts of the country is a popular abortifacient.
A medicine may be an emmenagogue without
being an ecbolic. Permanganate of potassium and binoxide
of manganese are valuable remedies for amenorrhœa,
but will not produce abortion. The vegetable
substances frequently used as abortives are savin and
ergot.</p>
<p><b>Savin</b> (<i>Juniperus Sabina</i>).—Leaves and tops of the
plant yield an acrid oil having poisonous properties, and
which has even produced death.</p>
<p><i>Symptoms.</i>—Those of irritant poisons. Purging not
always present, but tenesmus and strangury.</p>
<p><i>Post-Mortem Appearances.</i>—Acute inflammation of
alimentary canal. Green powder found. This, washed
and dried and then rubbed, gives odour of savin.</p>
<p><i>Test.</i>—A watery solution of savin strikes deep green
<span class="pagenum"><SPAN name="page148" id="page148">[148]</SPAN></span>
with perchloride of iron, and if an infusion of the twigs
has been taken the twigs may be detected with the
microscope. The twigs obtained from the stomach,
dried and rubbed between the finger and thumb, will
give the odour of savin.</p>
<p><b>Ergot</b> (<i>Secale Cornutum</i>).—A parasitic fungus attacking
wheat, barley, oats, and rye, which is reputed to have the
power of causing contraction of unstriped muscular fibre,
especially that of the uterus.</p>
<p><i>Symptoms.</i>—Lassitude, headache, nausea, diarrhœa,
anuria, convulsions, coma. Small quantities frequently
repeated have in the past produced gangrene of the
extremities, or anæsthesia of fingers and toes.</p>
<p><i>Tests.</i>—Lake-red colour with liquor potassæ; this
liquid filtered gives a precipitate of same colour with
nitric acid.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlvii_2" id="chapterxlvii_2"></SPAN>XLVII.—POISONOUS FUNGI AND TOXIC FOODS</h2>
<p><b>Fungi.</b>—Of the poisonous mushrooms, the <i>Amanita
phalloides</i> and the fly agaric, or <i>Agaricus muscarius</i>, are
the most potent. The active principle of the former is
<i>phallin</i>, and of the latter <i>muscarine</i>. The <i>Amanita
phalloides</i> is distinguished from the common mushroom
(<i>Agaricus campestris</i>) by having permanent white gills
and a hollow stem. The <i>Agaricus muscarius</i> is bright
red with yellow spots. Phallin is a toxalbumin which
destroys the red blood-corpuscles, causing the serum
to become red in colour and the urine blood-stained.
Fibrin is liberated, and thromboses occur, especially in
the liver. The symptoms may be mistaken for phosphorus-poisoning
or acute yellow atrophy of the liver.
Muscarine affects the nervous system chiefly.</p>
<p><i>Edible fungi</i> have an agreeable taste and smell, and
are firm in substance. <i>Poisonous fungi</i> have an offensive
smell and bitter taste, are often of a bright colour, and
soon become pulpy.<span class="pagenum"><SPAN name="page149" id="page149">[149]</SPAN></span></p>
<p><i>Symptoms.</i>—These may be of the narcotic or irritant
types. Usually, however, there is violent colic, with
thirst, vomiting, and diarrhœa, mental excitement, followed
by delirium, convulsions, coma, slow pulse,
stertorous breathing, cyanosis, cold extremities, and
dilated pupils.</p>
<p><i>Post-Mortem.</i>—In phallin-poisoning the blood remains
fluid; numerous hæmorrhages are present, with fatty
degeneration of the internal organs.</p>
<p><i>Treatment.</i>—Use the stomach-tube to give a solution
of permanganate of potash, emetics, followed by a hypodermic
injection of 1/50 grain of atropine. Transfusion
of saline fluid. A dose of castor-oil would be useful.</p>
<p><b>Foods.</b>—The kinds of food which most frequently
produce symptoms of poisoning are pork, veal, beef,
meat-pies, potted and tinned meats, sausages, and
brawn. Sausage-poisoning is common in Germany. It
is not necessary that the food should be 'high' to give
rise to poisoning. It may arise from the use of the
flesh of an animal suffering from some disease, from
inoculation with micro-organisms, or from the presence
of toxalbumoses or ptomaines. Many diseases, such
as diarrhœa, enteric fever, and cholera, and perhaps
tuberculosis, may be caused by eating infected food.
Trichiniasis may also be mentioned. Tinned fish often
gives rise to symptoms of poisoning, and shell-fish are
not uncommonly contaminated with pathogenic micro-organisms.
Mussel-poisoning was formerly supposed
to be due to the copper in them derived from ships'
bottoms, but it is more probably the result of the
formation of a toxine during life, and not after decomposition
has set in. Milk, too, may give rise to gastro-intestinal
irritation from the occurrence in it of chemical
changes. There have been epidemics of poisoning from
eating cheese containing <i>tyrotoxicon</i>. Ergotism from
eating bread made with ergotized wheat is now rare,
but <i>pellagra</i> from the consumption of mouldy maize,
<span class="pagenum"><SPAN name="page150" id="page150">[150]</SPAN></span>
and <i>lathyrism</i>, due to the admixture with flour of the
seeds of certain kinds of vetch, are still common in
Southern Europe.</p>
<p><i>Symptoms.</i>—The symptoms which result from the
ingestion of poisonous meat are often very severe. In
some cases their appearance is delayed from twenty-four
to forty-eight hours. They may resemble those of
an infectious disease or those of acute enteritis. Usually
there are headache, anorexia, rigors, intestinal disturbance,
pains in the back and limbs, and delirium.
Sometimes the symptoms resemble atropine-poisoning,
a condition due to ptomatropine.</p>
<p><i>Treatment.</i>—Emetics, purgatives, stimulants, with
hypodermic injections of strychnine and atropine along
with stimulants.</p>
<hr class="shorter" />
<h2><SPAN name="chapterxlviii_2" id="chapterxlviii_2"></SPAN>XLVIII.—PTOMAINES OR CADAVERIC ALKALOIDS</h2>
<p>Every medical man, before presenting himself to give
evidence in a case of suspected poisoning, should make
himself thoroughly acquainted with recent researches
on the subject. Ptomaines are, for the most part,
alkaloids generated during the process of putrefaction,
and they closely resemble many of the vegetable
alkaloids—veratrine, morphine, and codeine, for example—not
only in chemical characters, but in physiological
properties. They are probably allied to neurine, an
alkaloid obtained from the brain and also from the bile.
Some of them are analogous in action to muscarine, the
active principle of the fly fungus. Some are proteids,
albumins, and globulins. Ptomaines may be produced
abundantly in animal substances which, after exposure
under insanitary conditions, have been excluded from
the air. Ptomaines or toxalbumins are sometimes
found in potted meats and sausages, and are due to
organisms—the <i>Bacillus botulinus</i>, the <i>B. enteritidis</i> of
<span class="pagenum"><SPAN name="page151" id="page151">[151]</SPAN></span>
Gärtner, the <i>B. proteus vulgaris</i>, or the <i>B. ærtrycke</i>
(which is perhaps the most common of all). The
symptoms produced by the latter are usually vomiting,
abdominal pain, pains in the limbs and cramps,
diarrhœa, vertigo, coldness, faintness, and collapse.
The symptoms of <i>botulism</i> are dryness of skin and
mucous membranes, dilatation of pupils, paralysis of
muscles, diplopia, etc. Articles of food most often
associated with poisoning are pork, ham, bacon, veal,
baked meat-pie, milk, cheese, mussels, tinned meats.</p>
<p>In a case of suspected poisoning, counsel for the
defence, if he knows his work, will probably cross-examine
the medical expert on this subject, and endeavour
to elicit an admission that the reactions which
have been attributed to a poison may possibly be
accounted for on the theory of the formation of a
ptomaine. There is practically no counter-move to this
form of attack.</p>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="page152" id="page152">[152]</SPAN></span></p>
<h2><SPAN name="index" id="index"></SPAN>INDEX</h2>
<ul>
<li>Abdomen, injuries of, <SPAN href="#page29">29</SPAN></li>
<li>Abortifacients, <SPAN href="#page147">147</SPAN></li>
<li>Abortion, criminal, <SPAN href="#page42">42</SPAN></li>
<li>Acetanilide, <SPAN href="#page136">136</SPAN></li>
<li>Acetate of lead, <SPAN href="#page116">116</SPAN></li>
<li>Aconite, <SPAN href="#page143">143</SPAN></li>
<li>Adipocere, <SPAN href="#page18">18</SPAN></li>
<li>Adultery, <SPAN href="#page62">62</SPAN></li>
<li>Age, determination of, <SPAN href="#page12">12</SPAN></li>
<li>Alcohol, <SPAN href="#page130">130</SPAN></li>
<li>Alcoholic insanity, <SPAN href="#page76">76</SPAN></li>
<li>Alkaloids, <SPAN href="#page93">93</SPAN></li>
<li>Alum, <SPAN href="#page103">103</SPAN></li>
<li>Ammonia, <SPAN href="#page102">102</SPAN></li>
<li>Anæsthetics, death from, <SPAN href="#page19">19</SPAN></li>
<li>Aniline, <SPAN href="#page136">136</SPAN></li>
<li>Antifebrin, <SPAN href="#page136">136</SPAN></li>
<li>Antimony, <SPAN href="#page112">112</SPAN></li>
<li>Antipyrine, <SPAN href="#page135">135</SPAN></li>
<li>Aqua fortis, <SPAN href="#page97">97</SPAN></li>
<li>Arsenic, <SPAN href="#page107">107</SPAN></li>
<li>Arsenious acid, <SPAN href="#page107">107</SPAN></li>
<li>Artificial oil of bitter almonds, <SPAN href="#page137">137</SPAN></li>
<li>Arum, <SPAN href="#page124">124</SPAN></li>
<li>Asphyxia, <SPAN href="#page13">13</SPAN></li>
<li>Assaults, <SPAN href="#page21">21</SPAN></li>
<li>Assizes, <SPAN href="#page7">7</SPAN></li>
<li>Atropine, <SPAN href="#page127">127</SPAN></li>
</ul>
<ul>
<li>Barberio's test, <SPAN href="#page58">58</SPAN></li>
<li>Barium salts, <SPAN href="#page104">104</SPAN></li>
<li>Belladonna, <SPAN href="#page127">127</SPAN></li>
<li>Bestiality, <SPAN href="#page59">59</SPAN></li>
<li>Bichromate of potassium, <SPAN href="#page119">119</SPAN></li>
<li>Bismuth, <SPAN href="#page119">119</SPAN></li>
<li>Blackmailing, <SPAN href="#page60">60</SPAN></li>
<li>Bladder, injuries of, <SPAN href="#page30">30</SPAN></li>
<li>Blood-stains, <SPAN href="#page30">30</SPAN></li>
<li>Born in wedlock, <SPAN href="#page52">52</SPAN></li>
<li>Botulism, <SPAN href="#page151">151</SPAN></li>
<li>Brain, injuries to, <SPAN href="#page26">26</SPAN></li>
<li>Breslau's life test, <SPAN href="#page49">49</SPAN></li>
<li>Brucine, <SPAN href="#page146">146</SPAN></li>
<li>Bruises, <SPAN href="#page22">22</SPAN></li>
<li>Bullet wounds, <SPAN href="#page24">24</SPAN></li>
<li>Burnett's fluid, <SPAN href="#page119">119</SPAN></li>
<li>Burns, <SPAN href="#page22">22</SPAN></li>
</ul>
<ul>
<li>Cadaveric alkaloids, <SPAN href="#page150">150</SPAN>
<ul>
<li>rigidity, <SPAN href="#page17">17</SPAN></li>
</ul></li>
<li>Calabar bean, <SPAN href="#page139">139</SPAN></li>
<li>Camphor, <SPAN href="#page129">129</SPAN></li>
<li>Cantharides, <SPAN href="#page146">146</SPAN></li>
<li>Carbolic acid, <SPAN href="#page100">100</SPAN></li>
<li>Carbonic acid gas, <SPAN href="#page120">120</SPAN>
<ul class="plain">
<li>oxide, <SPAN href="#page121">121</SPAN></li>
</ul></li>
<li>Carnal knowledge, <SPAN href="#page55">55</SPAN></li>
<li>Cellon, <SPAN href="#page129">129</SPAN></li>
<li>Chemical analysis, <SPAN href="#page91">91</SPAN></li>
<li>Chest injuries, <SPAN href="#page28">28</SPAN></li>
<li>Chloral, <SPAN href="#page134">134</SPAN></li>
<li>Chlorate of potassium, <SPAN href="#page103">103</SPAN></li>
<li>Chloride of zinc, <SPAN href="#page119">119</SPAN></li>
<li>Chlorine, <SPAN href="#page122">122</SPAN></li>
<li>Chloroform, <SPAN href="#page19">19</SPAN>, <SPAN href="#page132">132</SPAN></li>
<li>Choke-damp, <SPAN href="#page121">121</SPAN></li>
<li>Chromium, <SPAN href="#page119">119</SPAN></li>
<li>Chronic lead-poisoning, <SPAN href="#page117">117</SPAN></li>
<li>Clothing, fibres of, <SPAN href="#page34">34</SPAN></li>
<li>Coal-gas, <SPAN href="#page121">121</SPAN></li>
<li>Cocaine, <SPAN href="#page128">128</SPAN></li>
<li>Cocculus indicus, <SPAN href="#page129">129</SPAN></li>
<li>Cold, death from, <SPAN href="#page39">39</SPAN></li>
<li>Coma, <SPAN href="#page14">14</SPAN></li>
<li>Common witness, <SPAN href="#page2">2</SPAN></li>
<li>Concealment of birth, <SPAN href="#page45">45</SPAN>
<ul>
<li>of pregnancy, <SPAN href="#page45">45</SPAN></li>
</ul></li>
<li>Conium, <SPAN href="#page138">138</SPAN></li>
<li>Contused wounds, <SPAN href="#page24">24</SPAN></li>
<li>Cooling, rate of, <SPAN href="#page16">16</SPAN>
<span class="pagenum"><SPAN name="page153" id="page153">[153]</SPAN></span></li>
<li>Copper, <SPAN href="#page117">117</SPAN></li>
<li>Coroners, <SPAN href="#page4">4</SPAN></li>
<li>Coroner's court, <SPAN href="#page4">4</SPAN></li>
<li>Corrosive sublimate, <SPAN href="#page113">113</SPAN></li>
<li>Corrosives, <SPAN href="#page86">86</SPAN></li>
<li>Cretinism, <SPAN href="#page69">69</SPAN></li>
<li>Crimes, <SPAN href="#page1">1</SPAN></li>
<li>Criminal abortion, <SPAN href="#page42">42</SPAN></li>
<li>Criminal Appeal Court, <SPAN href="#page8">8</SPAN>
<ul>
<li>courts, <SPAN href="#page7">7</SPAN></li>
</ul></li>
<li>Cross-examination, <SPAN href="#page3">3</SPAN></li>
<li>Crown Court of Assize, <SPAN href="#page7">7</SPAN></li>
<li>Culpable homicide, <SPAN href="#page21">21</SPAN></li>
<li>Cut throat, <SPAN href="#page28">28</SPAN></li>
</ul>
<ul>
<li>Dangerous Drugs Bill, <SPAN href="#page82">82</SPAN></li>
<li>Death in the fœtus, <SPAN href="#page50">50</SPAN>
<ul>
<li>signs of, <SPAN href="#page16">16</SPAN></li>
</ul></li>
<li>Delivery, <SPAN href="#page41">41</SPAN></li>
<li>Dementia, <SPAN href="#page70">70</SPAN></li>
<li>Depositions, <SPAN href="#page6">6</SPAN></li>
<li>Determination of sex, <SPAN href="#page11">11</SPAN></li>
<li>Diachylon pills, <SPAN href="#page117">117</SPAN></li>
<li>Diaphragm, wounds of, <SPAN href="#page29">29</SPAN></li>
<li>Digitalis, <SPAN href="#page144">144</SPAN></li>
<li>Dinitrobenzene, <SPAN href="#page137">137</SPAN></li>
<li>Divorce, <SPAN href="#page60">60</SPAN></li>
<li>"Dope," <SPAN href="#page129">129</SPAN></li>
<li>Drowning, <SPAN href="#page36">36</SPAN></li>
<li>Duration of pregnancy, <SPAN href="#page50">50</SPAN></li>
<li>Dyeing of hair, <SPAN href="#page11">11</SPAN></li>
<li>Dying declarations, <SPAN href="#page10">10</SPAN></li>
</ul>
<ul>
<li>Ecchymosis, <SPAN href="#page22">22</SPAN></li>
<li>Electricity, <SPAN href="#page38">38</SPAN></li>
<li>Epilepsy, <SPAN href="#page65">65</SPAN>, <SPAN href="#page75">75</SPAN></li>
<li>Ergot, <SPAN href="#page148">148</SPAN></li>
<li>Ether, <SPAN href="#page132">132</SPAN></li>
<li>Evidence, giving of, <SPAN href="#page2">2</SPAN></li>
<li>Examination-in-chief, <SPAN href="#page3">3</SPAN></li>
<li>Experiments on animals, <SPAN href="#page85">85</SPAN></li>
<li>Experts, <SPAN href="#page2">2</SPAN></li>
<li>Eye injuries, <SPAN href="#page27">27</SPAN></li>
</ul>
<ul>
<li>Face injuries, <SPAN href="#page27">27</SPAN></li>
<li>Feeble-minded, <SPAN href="#page69">69</SPAN></li>
<li>Fees for medical witness, <SPAN href="#page5">5</SPAN>, <SPAN href="#page7">7</SPAN></li>
<li>Feigned diseases, <SPAN href="#page63">63</SPAN></li>
<li>Felony, <SPAN href="#page1">1</SPAN></li>
<li>Ferro-silicon, <SPAN href="#page111">111</SPAN></li>
<li>Finger prints, <SPAN href="#page11">11</SPAN></li>
<li>Florence's test, <SPAN href="#page58">58</SPAN></li>
<li>Fœticide, <SPAN href="#page42">42</SPAN></li>
<li>Foods, poisonous, <SPAN href="#page150">150</SPAN></li>
<li>Found dead, <SPAN href="#page5">5</SPAN></li>
<li>Fruit stains, <SPAN href="#page33">33</SPAN></li>
<li>Fungi, <SPAN href="#page148">148</SPAN></li>
</ul>
<ul>
<li>Gaseous poisons, <SPAN href="#page120">120</SPAN></li>
<li>General paralysis, <SPAN href="#page71">71</SPAN></li>
<li>Genital organs, wounds of, <SPAN href="#page30">30</SPAN></li>
<li>Grand jury, <SPAN href="#page8">8</SPAN></li>
<li>Gunshot wounds, <SPAN href="#page24">24</SPAN></li>
</ul>
<ul>
<li>Hæmin crystals, <SPAN href="#page32">32</SPAN></li>
<li>Hair, detection of, <SPAN href="#page33">33</SPAN>
<ul>
<li>dyeing of, <SPAN href="#page11">11</SPAN></li>
</ul></li>
<li>Hanging, <SPAN href="#page35">35</SPAN></li>
<li>Head injuries, <SPAN href="#page26">26</SPAN></li>
<li>Heart, injuries of, <SPAN href="#page29">29</SPAN></li>
<li>Heat, death from, <SPAN href="#page39">39</SPAN></li>
<li>Hemlock, <SPAN href="#page138">138</SPAN></li>
<li>Henbane, <SPAN href="#page128">128</SPAN></li>
<li>Homicide, <SPAN href="#page21">21</SPAN></li>
<li>Hydrochloric acid, <SPAN href="#page98">98</SPAN>
<ul>
<li>gas, <SPAN href="#page122">122</SPAN></li>
</ul></li>
<li>Hydrocyanic acid, <SPAN href="#page140">140</SPAN></li>
<li>Hyoscyamus, <SPAN href="#page128">128</SPAN></li>
<li>Hypostasis, <SPAN href="#page16">16</SPAN></li>
</ul>
<ul>
<li>Identification of dead, <SPAN href="#page12">12</SPAN></li>
<li>Identity, personal, <SPAN href="#page10">10</SPAN></li>
<li>Idiocy, <SPAN href="#page68">68</SPAN></li>
<li>Imbecility, <SPAN href="#page69">69</SPAN></li>
<li>Impotence, <SPAN href="#page54">54</SPAN></li>
<li>Incest, <SPAN href="#page59">59</SPAN></li>
<li>Incised wounds, <SPAN href="#page23">23</SPAN></li>
<li>Indecent assault, <SPAN href="#page57">57</SPAN></li>
<li>Indictable offences, <SPAN href="#page2">2</SPAN></li>
<li>Inebriates Act, <SPAN href="#page78">78</SPAN></li>
<li>Infanticide, <SPAN href="#page44">44</SPAN></li>
<li>Inheritance, <SPAN href="#page54">54</SPAN></li>
<li>Injuries, <SPAN href="#page21">21</SPAN></li>
<li>Insanity, <SPAN href="#page67">67</SPAN>-<SPAN href="#page76">76</SPAN></li>
<li>Intestines, wounds of, <SPAN href="#page30">30</SPAN></li>
<li>Iodide of potassium, <SPAN href="#page104">104</SPAN></li>
<li>Iodine, <SPAN href="#page104">104</SPAN></li>
<li>Irritants, <SPAN href="#page87">87</SPAN>
<ul>
<li>gases, <SPAN href="#page122">122</SPAN></li>
<li>vegetable, <SPAN href="#page123">123</SPAN></li>
</ul></li>
</ul>
<ul>
<li>Judicial separation, <SPAN href="#page62">62</SPAN></li>
<li>Jury, coroner's, <SPAN href="#page4">4</SPAN></li>
</ul>
<ul>
<li>Kidney, injuries of, <SPAN href="#page30">30</SPAN>
<span class="pagenum"><SPAN name="page154" id="page154">[154]</SPAN></span></li>
<li>Kleptomania, <SPAN href="#page73">73</SPAN></li>
</ul>
<ul>
<li>Laborde's method, <SPAN href="#page37">37</SPAN></li>
<li>Laburnum, <SPAN href="#page123">123</SPAN></li>
<li>Lacerated wounds, <SPAN href="#page24">24</SPAN></li>
<li>Lead, <SPAN href="#page116">116</SPAN></li>
<li>Lee-Metford bullet, <SPAN href="#page24">24</SPAN></li>
<li>Legitimacy, <SPAN href="#page52">52</SPAN></li>
<li>Lightning, <SPAN href="#page38">38</SPAN></li>
<li>Live-birth, <SPAN href="#page44">44</SPAN>-<SPAN href="#page46">46</SPAN></li>
<li>Liver, injuries of, <SPAN href="#page29">29</SPAN></li>
<li>Lobelia, <SPAN href="#page140">140</SPAN></li>
<li>Lucid intervals, <SPAN href="#page73">73</SPAN></li>
<li>Lumbago, <SPAN href="#page66">66</SPAN></li>
<li>Lunacy, <SPAN href="#page67">67</SPAN>
<ul>
<li>certification, <SPAN href="#page77">77</SPAN></li>
</ul></li>
<li>Lungs, injuries of, <SPAN href="#page29">29</SPAN>
<ul>
<li>evidences of live-birth from, <SPAN href="#page47">47</SPAN></li>
</ul></li>
</ul>
<ul>
<li>Magistrate's court, <SPAN href="#page7">7</SPAN></li>
<li>Malingering, <SPAN href="#page63">63</SPAN></li>
<li>Malpractice, <SPAN href="#page20">20</SPAN></li>
<li>Malum regimen, <SPAN href="#page21">21</SPAN></li>
<li>Mania, <SPAN href="#page71">71</SPAN></li>
<li>Manslaughter, <SPAN href="#page21">21</SPAN></li>
<li>Marriage, <SPAN href="#page60">60</SPAN></li>
<li>Marsh's process, <SPAN href="#page110">110</SPAN></li>
<li>Martini-Henry bullet, <SPAN href="#page25">25</SPAN></li>
<li>Maturity of infant, <SPAN href="#page45">45</SPAN></li>
<li>Mauser bullet, <SPAN href="#page25">25</SPAN></li>
<li>Medical evidence, <SPAN href="#page2">2</SPAN></li>
<li>Mentally deficients, <SPAN href="#page70">70</SPAN></li>
<li>Mercury salts, <SPAN href="#page113">113</SPAN></li>
<li>Methyl alcohol, <SPAN href="#page131">131</SPAN></li>
<li>Mineral acids, <SPAN href="#page94">94</SPAN></li>
<li>Misdemeanour, <SPAN href="#page1">1</SPAN></li>
<li>Monkshood, <SPAN href="#page143">143</SPAN></li>
<li>Monomania, <SPAN href="#page72">72</SPAN></li>
<li>Morphine, <SPAN href="#page127">127</SPAN></li>
<li>Murder, <SPAN href="#page21">21</SPAN></li>
<li>Muriatic acid, <SPAN href="#page98">98</SPAN></li>
</ul>
<ul>
<li>Naphtha, <SPAN href="#page135">135</SPAN></li>
<li>Nitrate of silver, <SPAN href="#page119">119</SPAN></li>
<li>Nitric acid, <SPAN href="#page95">95</SPAN></li>
<li>Nitro-benzol, <SPAN href="#page137">137</SPAN></li>
<li>Notes, <SPAN href="#page9">9</SPAN></li>
<li>Nux vomica, <SPAN href="#page145">145</SPAN></li>
</ul>
<ul>
<li>Oaths Act, <SPAN href="#page9">9</SPAN></li>
<li>Oil of bitter almonds, <SPAN href="#page141">141</SPAN></li>
<li>Opium, <SPAN href="#page124">124</SPAN></li>
<li>Oxalate of potash, <SPAN href="#page99">99</SPAN></li>
<li>Oxalic acid, <SPAN href="#page98">98</SPAN></li>
</ul>
<ul>
<li>Paraffin oil, <SPAN href="#page135">135</SPAN></li>
<li>Paranoia, <SPAN href="#page73">73</SPAN></li>
<li>Personal identity, <SPAN href="#page10">10</SPAN></li>
<li>Petroleum, <SPAN href="#page134">134</SPAN></li>
<li>Petty Sessions, <SPAN href="#page7">7</SPAN></li>
<li>Phenacetin, <SPAN href="#page136">136</SPAN></li>
<li>Phenol, <SPAN href="#page100">100</SPAN></li>
<li>Phosphorus, <SPAN href="#page105">105</SPAN></li>
<li>Phossy-jaw, <SPAN href="#page106">106</SPAN></li>
<li>Physostigma, <SPAN href="#page139">139</SPAN></li>
<li>Picrotoxin, <SPAN href="#page129">129</SPAN></li>
<li>Poison, definition of, <SPAN href="#page80">80</SPAN></li>
<li>Poisonous foods, <SPAN href="#page149">149</SPAN></li>
<li>Poisons acting on the brain, <SPAN href="#page88">88</SPAN>
<ul>
<li>classification of, <SPAN href="#page84">84</SPAN></li>
<li>detection of, <SPAN href="#page91">91</SPAN></li>
<li>evidence, <SPAN href="#page85">85</SPAN></li>
<li>scheduled, <SPAN href="#page81">81</SPAN></li>
<li>symptoms and post-mortem appearances, <SPAN href="#page86">86</SPAN></li>
<li>treatment of, <SPAN href="#page90">90</SPAN></li>
</ul></li>
<li>Potash, <SPAN href="#page101">101</SPAN></li>
<li>Precipitin test for blood, <SPAN href="#page33">33</SPAN></li>
<li>Pregnancy, <SPAN href="#page40">40</SPAN>, <SPAN href="#page50">50</SPAN>
<ul>
<li>insanity of, <SPAN href="#page73">73</SPAN></li>
</ul></li>
<li>Presumption of death, <SPAN href="#page20">20</SPAN>
<ul>
<li>survivorship, <SPAN href="#page21">21</SPAN></li>
</ul></li>
<li>Primula, <SPAN href="#page124">124</SPAN></li>
<li>Privilege, <SPAN href="#page8">8</SPAN></li>
<li>Procurator Fiscal, <SPAN href="#page7">7</SPAN></li>
<li>Prussic acid, <SPAN href="#page140">140</SPAN></li>
<li>Ptomaines, <SPAN href="#page150">150</SPAN></li>
<li>Puerperal mania, <SPAN href="#page73">73</SPAN></li>
<li>Punctured wounds, <SPAN href="#page23">23</SPAN></li>
<li>Purgatives, <SPAN href="#page123">123</SPAN></li>
<li>Putrefaction, <SPAN href="#page18">18</SPAN></li>
</ul>
<ul>
<li>Quarter Sessions, <SPAN href="#page7">7</SPAN></li>
</ul>
<ul>
<li>Railway spine, <SPAN href="#page27">27</SPAN></li>
<li>Rape, <SPAN href="#page55">55</SPAN></li>
<li>Reception orders, <SPAN href="#page77">77</SPAN></li>
<li>Rectified spirit, <SPAN href="#page130">130</SPAN></li>
<li>Re-examination, <SPAN href="#page3">3</SPAN></li>
<li>Reinsch's process, <SPAN href="#page110">110</SPAN></li>
<li>Reports, medical, <SPAN href="#page9">9</SPAN></li>
<li>Responsibility, <SPAN href="#page76">76</SPAN></li>
<li>Resuscitation, 36<span class="pagenum"><SPAN name="page155" id="page155">[155]</SPAN></span></li>
<li>Rhus, <SPAN href="#page124">124</SPAN></li>
<li>Rigor mortis, <SPAN href="#page17">17</SPAN></li>
<li>Rust stains, <SPAN href="#page33">33</SPAN></li>
</ul>
<ul>
<li>Sale of arsenic, <SPAN href="#page111">111</SPAN></li>
<li>Saponification, <SPAN href="#page18">18</SPAN></li>
<li>Satyriasis, <SPAN href="#page73">73</SPAN></li>
<li>Savin, <SPAN href="#page147">147</SPAN></li>
<li>Scars, <SPAN href="#page11">11</SPAN></li>
<li>Schiller's method of resuscitation, <SPAN href="#page36">36</SPAN></li>
<li>Scheduled poisons, <SPAN href="#page81">81</SPAN></li>
<li>Scotch oath, <SPAN href="#page9">9</SPAN></li>
<li>Secrets, professional, <SPAN href="#page8">8</SPAN></li>
<li>Self-inflicted wounds, <SPAN href="#page24">24</SPAN></li>
<li>Seminal stains, <SPAN href="#page58">58</SPAN></li>
<li>Sewer-gas, <SPAN href="#page122">122</SPAN></li>
<li>Sex, determination of, <SPAN href="#page11">11</SPAN></li>
<li>Signs of death, <SPAN href="#page16">16</SPAN></li>
<li>Silver, <SPAN href="#page118">118</SPAN></li>
<li>Skin diseases, <SPAN href="#page66">66</SPAN></li>
<li>Soda, <SPAN href="#page101">101</SPAN></li>
<li>Sodomy, <SPAN href="#page59">59</SPAN></li>
<li>Spanish-fly, <SPAN href="#page146">146</SPAN></li>
<li>Spectroscopic examination of blood, <SPAN href="#page32">32</SPAN></li>
<li>Spinal cord injuries, <SPAN href="#page27">27</SPAN></li>
<li>Spleen, injuries of, <SPAN href="#page29">29</SPAN></li>
<li>Staining, post-mortem, <SPAN href="#page16">16</SPAN></li>
<li>Starvation, <SPAN href="#page38">38</SPAN></li>
<li>Stas-Otto process, <SPAN href="#page92">92</SPAN></li>
<li>Status lymphaticus, <SPAN href="#page15">15</SPAN></li>
<li>Sterility, <SPAN href="#page54">54</SPAN></li>
<li>Stomach, injuries of, <SPAN href="#page29">29</SPAN></li>
<li>Stramonium, <SPAN href="#page128">128</SPAN></li>
<li>Strangulation, <SPAN href="#page35">35</SPAN></li>
<li>Strychnine, <SPAN href="#page145">145</SPAN></li>
<li>Sudden death, <SPAN href="#page13">13</SPAN>, <SPAN href="#page15">15</SPAN></li>
<li>Suffocation, <SPAN href="#page34">34</SPAN></li>
<li>Sugar of lead, <SPAN href="#page116">116</SPAN></li>
<li>Sulphonal, <SPAN href="#page137">137</SPAN></li>
<li>Sulphuretted hydrogen, <SPAN href="#page122">122</SPAN></li>
<li>Sulphuric acid, <SPAN href="#page95">95</SPAN></li>
<li>Sulphurous acid gas, <SPAN href="#page122">122</SPAN></li>
<li>Summary offences, <SPAN href="#page2">2</SPAN></li>
<li>Sunstroke, <SPAN href="#page39">39</SPAN></li>
<li>Superfœtation, <SPAN href="#page53">53</SPAN></li>
<li>Syncope, <SPAN href="#page13">13</SPAN></li>
</ul>
<ul>
<li>Tartar emetic, <SPAN href="#page112">112</SPAN></li>
<li>Tattoo marks, <SPAN href="#page10">10</SPAN></li>
<li>Teichman's crystals, <SPAN href="#page32">32</SPAN></li>
<li>Tetanus, <SPAN href="#page145">145</SPAN></li>
<li>Tetrachlorethane, <SPAN href="#page129">129</SPAN></li>
<li>Tetronal, <SPAN href="#page137">137</SPAN></li>
<li>Throat injuries, <SPAN href="#page28">28</SPAN></li>
<li>Tobacco, <SPAN href="#page139">139</SPAN></li>
<li>Treason, <SPAN href="#page1">1</SPAN></li>
<li>Trinitrotoluene, <SPAN href="#page129">129</SPAN></li>
<li>Trional, <SPAN href="#page137">137</SPAN></li>
<li>True bill, <SPAN href="#page8">8</SPAN></li>
</ul>
<ul>
<li>Undue influence, <SPAN href="#page74">74</SPAN></li>
<li>Unnatural offences, <SPAN href="#page59">59</SPAN></li>
<li>Unsound mind, <SPAN href="#page67">67</SPAN></li>
</ul>
<ul>
<li>Veronal, <SPAN href="#page137">137</SPAN></li>
<li>Viability, <SPAN href="#page51">51</SPAN></li>
<li>Vitriol, <SPAN href="#page95">95</SPAN></li>
<li>Voidable marriage, <SPAN href="#page63">63</SPAN></li>
</ul>
<ul>
<li>Witnesses, <SPAN href="#page2">2</SPAN></li>
<li>Wounds, <SPAN href="#page21">21</SPAN></li>
</ul>
<ul>
<li>Yew, <SPAN href="#page124">124</SPAN></li>
</ul>
<ul>
<li>Zinc, <SPAN href="#page118">118</SPAN></li>
</ul>
<p class="centre smaller">
PRINTED IN GREAT BRITAIN BY<br/>
BILLING AND SONS, LTD., GUILDFORD AND ESHER
<span class="pagenum"><SPAN name="page156" id="page156">[156]</SPAN></span></p>
<hr class="longer" />
<p><span class="pagenum"><SPAN name="page157" id="page157">[157]</SPAN></span></p>
<h3>BAILLIÈRE, TINDALL & COX'S</h3>
<h2>MANUALS FOR STUDENTS</h2>
<p><b>Blair Bell's The Principles of Gynæcology.</b> Third
Edition. Pp. xxviii+660, with 7 coloured plates and 392 other
illustrations. Royal 8vo. Price 38s. net.</p>
<p><b>Buchanan's Manual of Anatomy, Systematic and
Practical, including Embryology.</b> Fourth Edition. Complete
in 1 volume. Demy 8vo. Pp. xii+1743, with 677 illustrations, mostly
original, and in several colours. Price 30s. net. (<i>University Series.</i>)</p>
<p><b>Castellani and Chalmers' Manual of Tropical
Medicine.</b> Third Edition. Pp. xii+2436, with 16 coloured plates
and 909 other illustrations. Price 45s. net. (<i>University Series.</i>)</p>
<p><b>Green's Pathology.</b> Twelfth Edition. Demy 8vo. Pp.
x+603, with 4 coloured plates and 243 illustrations. Price 22s. 6d. net.
(<i>University Series.</i>)</p>
<p><b>Jellett and Madill's Manual of Midwifery.</b> Third
Edition. Demy 8vo. Pp. xii+1256, with 20 plates and 540 other
illustrations. Price 42s. net.</p>
<p><b>Mathews' Physiological Chemistry.</b> Third Edition.
Royal 8vo. Pp. xv+1154, with 109 illustrations. Price 42s. net.</p>
<p><b>May & Worth's Manual of the Diseases of the Eye.</b>
Fourth Edition. Pp. viii+444, with 337 illustrations, including
22 coloured plates. Price 18s. net.</p>
<p><b>Monro's Manual of Medicine.</b> Fourth Edition. Demy 8vo.
Pp. xxiv+1045, with 47 illustrations, plain and coloured. Price 21s.
net. (<i>University Series.</i>)</p>
<p><b>Rose and Carless' Manual of Surgery.</b> Tenth Edition.
Demy 8vo. Pp. xii+1560, with 18 coloured plates and 600 illustrations.
Price 30s. net. (<i>University Series.</i>)</p>
<p><b>Schmieden and Turnbull's Operative Surgery.</b>
Second Edition, Royal 8vo. Pp. xx+350, with 436 illustrations;
many in colour. Price 25s. net.</p>
<p><b>Stewart's Manual of Physiology.</b> Eighth Edition.
Demy 8vo. Pp. xxiv+1245, with coloured plate and 492 illustrations.
Price 21s. net. (<i>University Series.</i>)</p>
<p><b>Whitla's Dictionary of Treatment.</b> Sixth Edition.
Demy 8vo. Pp. x+1083. Price 30s. net.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page158" id="page158">[158]</SPAN></span></p>
<h2>BOOKS FOR STUDENTS.</h2>
<p><b>Blomfield's Anæsthetics.</b> Fourth Edition. Pp. iv+147,
with 22 illustrations. Price 6s. net.</p>
<p><b>Brown's Physiological Principles in Treatment.</b>
Fourth Edition. Crown 8vo. Pp. viii+427. Price 8s. 6d. net.</p>
<p><b>Clarke's Refraction of the Eye.</b> Fourth Edition. Pp.
viii+243, with 92 illustrations. Price 7s. 6d. net.</p>
<p><b>Gray's Diseases of the Ear.</b> Pp. xii+388, with 53 plates,
of which 37 are stereoscopic, and 70 other illustrations. Price, with
Stereoscope, 15s. net.</p>
<p><b>Ince's Latin Grammar of Pharmacy</b>, including the
reading of Latin Prescriptions. Eighth Edition. Price 7s. 6d. net.</p>
<p><b>Lamb's Practical Guide to the Diseases of the Throat,
Nose and Ear.</b> Fourth Edition. Pp. xii+372, with 61 illustrations.
Price 10s. 6d. net.</p>
<p><b>Laroquette's Atlas for Electro-Diagnosis and Therapeutics.</b>
Translated by <span class="smcap">M.G. Cheetham</span>. With Foreword by
<span class="smcap">R. Knox</span>, M.D. Demy 8vo. Pp. xvi+180, with 52 plates. Price
15s. net.</p>
<p><b>Macewen's Surgical Anatomy.</b> Second Edition. Pp.
xvi+535, with 77 illustrations, plain and coloured. Price 12s. net.</p>
<p><b>McCaw's Diseases of Children.</b> Pp. xii+524, with 14
plates and other illustrations. Price 12s. net.</p>
<p><b>Marshall and Ffrench's Syphilis and Venereal
Disease.</b> For Students and Practitioners. Fourth Edition. Demy
8vo. Pp. x+433, with 7 coloured plates and 90 illustrations. Price
25s. net.</p>
<p><b>Minett's Diagnosis of Bacteria and Blood-Parasites.</b>
Third Edition. Pp. viii+94. Price 4s. 6d. net.</p>
<p><b>Orrin's Systemic Arteries: an X-Ray Atlas</b> showing
the Systemic Arteries in continuity, and precisely as they exist <i>in
situ</i> in the undissected body. 4to. Pp. viii+92, with 21 original
plates and illustrations. Price 12s. 6d. net.</p>
<p><b>Richards' Practical Chemistry</b>, including Simple Volumetric
Analysis and Toxicology. Third Edition. Pp. x+150.
Price 5s. net.</p>
<p><b>Solomons' Handbook of Gynæcology.</b> Pp. xii+236
with 196 Illustrations. Price 12s. 6d. net.</p>
<p><b>Stedman's Illustrated Medical Dictionary.</b> Sixth
Edition. Royal 8vo. Containing over 70,000 words. Bound in limp
leather with rounded corners and thumbcut index. Price 42s. net.</p>
<p><b>Wheeler's Student's Handbook of Operative Surgery.</b>
Third Edition. Pp. x+364, with 226 figures. Price 12s. net.</p>
<p><b>Whitla's Pharmacy, Materia Medica, and Therapeutics.</b>
Tenth Edition. Pp. xii+674, with 23 figures. Price
10s. 6d. net.</p>
<p><b>Williams' Minor Maladies and their Treatment.</b>
Fourth Edition. Pp. viii+404. Price 8s. 6d. net.</p>
<p><b>Younger's Insanity in Everyday Practice.</b> Fourth
Edition. Pp. x+134. Price 6s. net.</p>
<hr class="shorter" />
<p><span class="pagenum"><SPAN name="page159" id="page159">[159]</SPAN></span></p>
<h2>STUDENTS' AIDS SERIES.</h2>
<p class="centre smaller"><i>Specially designed to assist Students in grouping and committing to memory
the subjects upon which they are to be examined.</i></p>
<div class="blockquot">
<p>¶ "<i>The Students' Aids Series have always been noted for their
reliability, and we speak from real personal experience when we
say that the student will find the series exceedingly valuable.</i>"</p>
</div>
<p class="right"><span class="smcap">Charing Cross Hospital Gazette.</span></p>
<div class="blockquot">
<p>¶ "<i>Their popularity is sufficient testimony of their usefulness.</i>"</p>
</div>
<p class="right"><span class="smcap">St. Thomas's Hospital Gazette.</span></p>
<p><b>Aids to the Analysis and Assay of Ores, Metals,
Fuels, etc.</b> By <span class="smcap">J.J. Morgan</span>, F.I.C., F.C.S. Second Edition.
With 8 Illustrations. Price 3s. net.</p>
<p><b>Aids to the Analysis of Food and Drugs.</b> By
<span class="smcap">C.G. Moor</span>, M.A., F.I.C., and <span class="smcap">W. Partridge</span>, F.I.C. Fourth Edition.
Price 4s. 6d. net.</p>
<p><b>Aids to Anatomy (Pocket Anatomy).</b> By <span class="smcap">C.H.
Fagge</span>, M.B., M.S., F.R.C.S. Eighth Edition. Price 5s. net.</p>
<p><b>Aids to Bacteriology.</b> By <span class="smcap">C.G. Moor</span>, M.A., F.I.C., and
<span class="smcap">W. Partridge</span>, F.I.C. Third Edition. Price 4s. net.</p>
<p><b>Aids to Chemistry.</b> By <span class="smcap">William Partridge</span>, F.I.C.
Pp. viii+280. Price 6s. net.</p>
<p><b>Aids to the Diagnosis and Treatment of the
Diseases of Children.</b> By <span class="smcap">J. McCaw</span>, M.D., L.R.C.P. Edin.
Fifth Edition. Price 6s. net.</p>
<p><b>Aids to the Feeding and Hygiene of Infants and
Children.</b> By the same Author. Price 3s. net.</p>
<p><b>Aids to Dental Anatomy and Physiology.</b> By
<span class="smcap">Arthur S. Underwood</span>, M.R.C.S., L.D.S. Eng. Third Edition.
Price 3s. net.</p>
<p><b>Aids to Dental Surgery.</b> By <span class="smcap">Douglas Gabell</span>,
M.R.C.S., L.R.C.P. Lond., L.D.S. Eng. Third Edition. Price
3s. 6d. net.</p>
<p><b>Aids to Medical Diagnosis.</b> By <span class="smcap">A.J. Whiting</span>, M.D.,
C.M. Edin., M.R.C.P. Lond. Second Edition. Price 3s. net.</p>
<p><b>Aids to Surgical Diagnosis.</b> By <span class="smcap">H.W. Carson</span>,
F.R.C.S. Eng. Price 3s. 6d. net.</p>
<p><b>Aids to Practical Dispensing.</b> By <span class="smcap">C.J.S. Thompson</span>.
Price 3s. net.</p>
<p><b>Aids to Electro-Therapeutics.</b> By <span class="smcap">J. Magnus
Reading</span>, F.R.C.S. Pp. viii+196, with 16 diagrams. Price 5s. net.</p>
<p><b>Aids to Forensic Medicine and Toxicology.</b> By
<span class="smcap">W. Murrell</span>, M.D., F.R.C.P. Eighth Edition. Revised by <span class="smcap">W.G.
Aitchison Robertson</span>, M.D., D.Sc., F.R.C.P.E. Price 3s. net.</p>
<SPAN name="endofbook"></SPAN>
<div style="break-after:column;"></div><br />